Hospital

SAN GABRIEL VALLEY MEDICAL CENTER

San Gabriel, CA · CCN 050132 · Rates published

15,140 distinct procedures filed

70 distinct payers

1,533,198 rate rows

2026-05-09 last MRF observed

Data quality

1,478,366 of 1,533,198 rate rows are consumer-grade (96.4%)

54,832 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reason	Rows
per-diem day rate — not a per-procedure price	35,536
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	12,782
template filing: same amount across many unrelated codes — excluded	2,440
exceeds 10× this hospital's gross charge — excluded from medians	2,283
placeholder amount (≤ $0.02) — excluded from medians	1,791

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://www.ahmchealth.com/docs/PricingTransparency-San_Gabriel_Valley_Medical_Center-3324-20260326210352.csv
Found on page	https://www.ahmchealth.com/sgvmc/getpage.php?name=Price_Transparency
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-05-17
Content fingerprint	bf5b440f95f3e73d… · 277,268,780 bytes · first seen 2026-05-09

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code	Description	Payers	Min $	Max $	Avg median	vs national
018 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	36	$2,000.00	$1,110,484.04	$391,567.01	nat. median $424,868 0.9× median
001 OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	36	$4,500.00	$829,654.95	$286,726.70	nat. median $263,894 1.1× median
007 OTHER	Lung Transplant	34	$2,300.00	$690,054.64	$243,319.69	nat. median $141,082 1.7× median
927 OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	36	$2,300.00	$698,854.41	$241,527.64	nat. median $146,562 1.6× median
630-4 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	15	$205,488.86	$273,985.14	$228,320.95	nat. median $210,669 1.1× median
631-4 OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	15	$203,628.70	$271,504.93	$226,254.11	nat. median $203,379 1.1× median
583-4 OTHER	Neonate With Ecmo	15	$198,900.00	$265,200.00	$221,000.00	nat. median $309,400 0.7× median
583-3 OTHER	Neonate With Ecmo	15	$198,900.00	$265,200.00	$221,000.00	nat. median $259,487 0.9× median
588-4 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	15	$198,900.00	$265,200.00	$221,000.00	nat. median $267,493 0.8× median
003 OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	37	$1,196.00	$631,440.11	$218,232.15	nat. median $218,232 1.0× median
161-4 OTHER	Implantable Heart Assist Systems	15	$191,733.80	$255,645.07	$213,037.56	nat. median $202,242 1.1× median
583-2 OTHER	Neonate With Ecmo	15	$160,500.96	$214,001.28	$178,334.40	nat. median $191,347 0.9× median
002-4 OTHER	Heart And/or Lung Transplant	15	$158,430.91	$211,241.21	$176,034.34	nat. median $216,800 0.8× median
609-4 OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	15	$148,500.00	$198,000.00	$165,000.00	nat. median $169,856 1.0× median
583-1 OTHER	Neonate With Ecmo	15	$143,483.18	$191,310.90	$159,425.75	nat. median $171,226 0.9× median
161-3 OTHER	Implantable Heart Assist Systems	15	$137,242.31	$182,989.74	$152,491.45	nat. median $152,491 1.0× median
841-4 OTHER	Extensive Third Degree Burns With Skin Graft	15	$132,591.63	$176,788.84	$147,324.03	nat. median $151,691 1.0× median
004 OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	36	$2,300.00	$416,604.15	$146,898.50	nat. median $150,232 1.0× median
014 OTHER	Allogeneic Bone Marrow Transplant	35	$2,000.00	$386,351.29	$136,231.06	nat. median $105,808 1.3× median
009-4 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	15	$120,495.34	$160,660.45	$133,883.71	nat. median $150,954 0.9× median
007-4 OTHER	Allogeneic Bone Marrow Transplant	15	$120,253.63	$160,338.18	$133,615.15	nat. median $172,311 0.8× median
588-3 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	15	$118,800.00	$158,400.00	$132,000.00	nat. median $165,000 0.8× median
002-3 OTHER	Heart And/or Lung Transplant	15	$117,561.11	$156,748.15	$130,623.46	nat. median $133,471 1.0× median
588-2 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	15	$117,000.00	$156,000.00	$130,000.00	nat. median $153,523 0.8× median
161-2 OTHER	Implantable Heart Assist Systems	15	$116,514.37	$155,352.49	$129,460.41	nat. median $109,992 1.2× median
863-4 OTHER	Neonatal Aftercare	15	$109,905.13	$146,540.17	$122,116.81	nat. median $108,047 1.1× median
593-4 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	15	$108,900.00	$145,200.00	$121,000.00	nat. median $151,250 0.8× median
001-4 OTHER	Liver Transplant And/or Intestinal Transplant	15	$108,000.00	$144,000.00	$120,000.00	nat. median $124,561 1.0× median
591-4 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	15	$108,000.00	$144,000.00	$120,000.00	nat. median $156,696 0.8× median
303-4 OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	15	$108,000.00	$144,000.00	$120,000.00	nat. median $108,000 1.1× median
161-1 OTHER	Implantable Heart Assist Systems	15	$106,189.21	$141,585.61	$117,988.01	nat. median $101,352 1.2× median
212 OTHER	Hip & Femur Procedures Except Major Joint Age 0-17	36	$2,300.00	$321,387.97	$113,324.39	nat. median $90,581 1.3× median
002 OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	36	$4,500.00	$325,089.38	$112,370.47	nat. median $117,167 1.0× median
005 OTHER	Liver Transplant With Mcc Or Intestinal Transplant	34	$2,300.00	$314,194.03	$110,787.74	nat. median $104,489 1.1× median
004-4 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	15	$99,000.00	$132,000.00	$110,000.00	nat. median $110,000 1.0× median
215 OTHER	Other Heart Assist System Implant	40	$4,100.00	$312,587.49	$108,050.35	nat. median $92,359 1.2× median
011-3 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	15	$96,911.84	$129,215.78	$107,679.82	nat. median $171,094 0.6× median
602-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	15	$90,000.00	$120,000.00	$100,000.00	nat. median $125,000 0.8× median
607-4 OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	15	$90,000.00	$120,000.00	$100,000.00	nat. median $100,015 1.0× median
593-3 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	15	$89,100.00	$118,800.00	$99,000.00	nat. median $112,711 0.9× median
216 OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	41	$4,100.00	$284,820.90	$98,455.41	nat. median $90,130 1.1× median
160-4 OTHER	Major Cardiothoracic Repair Of Heart Anomaly	15	$87,425.42	$116,567.22	$97,139.35	nat. median $106,926 0.9× median
630-3 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	15	$85,500.00	$114,000.00	$95,000.00	nat. median $95,000 1.0× median
002-2 OTHER	Heart And/or Lung Transplant	15	$84,612.19	$112,816.25	$94,013.54	nat. median $106,681 0.9× median
611-4 OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	15	$83,700.00	$111,600.00	$93,000.00	nat. median $93,000 1.0× median
453 OTHER	Combined Anterior And Posterior Spinal Fusion With Mcc	36	$3,250.00	$261,585.44	$92,237.46	nat. median $65,342 1.4× median
602-3 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	15	$82,800.00	$110,400.00	$92,000.00	nat. median $99,067 0.9× median
591-3 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	15	$81,900.00	$109,200.00	$91,000.00	nat. median $99,157 0.9× median
621-4 OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	15	$81,000.00	$108,000.00	$90,000.00	nat. median $80,035 1.1× median
004-3 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	15	$80,285.59	$107,047.45	$89,206.21	nat. median $91,000 1.0× median

Other procedures at this hospital

Browse this hospital's 15,140 published procedures. Use the slice to choose what to show, then sort or filter any column.

Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code	Type	Description	Rate rows	Payers	Gross	Cash	Min $	Max $	Avg median	Last observed

690-4	OTHER	Acute Leukemia	16	15	—	—	$43,273.11	$57,697.48	$48,081.23	2026-05-08
834	OTHER	Acute Leukemia Without Major O.r. Procedures With Mcc	53	36	—	—	$2,000.00	$163,485.76	$57,646.60	2026-05-08
401-4	OTHER	Adrenal Procedures	16	15	—	—	$38,473.60	$51,298.13	$42,748.44	2026-05-08
245	OTHER	Aicd Generator Procedures	56	38	—	—	$3,250.00	$144,640.25	$50,014.99	2026-05-08
265	OTHER	Aicd Lead Procedures	53	36	—	—	$2,300.00	$105,813.46	$37,310.81	2026-05-08
014	OTHER	Allogeneic Bone Marrow Transplant	52	35	—	—	$2,000.00	$386,351.29	$136,231.06	2026-05-08
007-4	OTHER	Allogeneic Bone Marrow Transplant	16	15	—	—	$120,253.63	$160,338.18	$133,615.15	2026-05-08
007-3	OTHER	Allogeneic Bone Marrow Transplant	16	15	—	—	$68,932.68	$91,910.24	$76,591.87	2026-05-08
007-2	OTHER	Allogeneic Bone Marrow Transplant	16	15	—	—	$54,298.13	$72,397.50	$60,331.25	2026-05-08
007-1	OTHER	Allogeneic Bone Marrow Transplant	16	15	—	—	$53,528.83	$71,371.78	$59,476.48	2026-05-08
239	OTHER	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	53	36	—	—	$2,300.00	$149,056.67	$52,558.77	2026-05-08
474	OTHER	Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc	53	36	—	—	$2,300.00	$132,809.20	$46,829.76	2026-05-08
616	OTHER	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	53	36	—	—	$2,300.00	$114,575.65	$40,400.44	2026-05-08
268	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	58	38	—	—	$2,300.00	$197,036.97	$68,121.05	2026-05-08
269	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	58	38	—	—	$2,300.00	$123,276.13	$43,050.38	2026-05-08
234-4	OTHER	Appendectomy Without Complex Principal Diagnosis	16	15	—	—	$36,676.48	$48,901.97	$40,751.64	2026-05-08
008-4	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	16	15	—	—	$58,371.59	$77,828.78	$64,857.32	2026-05-08
008-3	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	16	15	—	—	$34,981.15	$46,641.54	$38,867.95	2026-05-08
016	OTHER	Autologous Bone Marrow Transplant With Cc/mcc	53	36	—	—	$2,000.00	$178,450.37	$62,923.26	2026-05-08
017	OTHER	Autologous Bone Marrow Transplant Without Cc/mcc	53	36	—	—	$2,000.00	$178,450.37	$62,923.26	2026-05-08
518	OTHER	Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost…	53	36	—	—	$2,300.00	$106,307.77	$37,485.11	2026-05-08
094	OTHER	Bacterial And Tuberculous Infections Of Nervous System With Mcc	53	36	—	—	$2,000.00	$108,211.44	$38,156.36	2026-05-08
461	OTHER	Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc	53	36	—	—	$2,300.00	$181,416.23	$63,969.05	2026-05-08
842-4	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	16	15	—	—	$75,165.39	$100,220.52	$83,517.10	2026-05-08
275	OTHER	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	61	38	—	—	$4,100.00	$208,788.56	$72,181.89	2026-05-08
216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	67	41	—	—	$4,100.00	$284,820.90	$98,455.41	2026-05-08
217	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	66	40	—	—	$2,300.00	$190,866.91	$65,988.94	2026-05-08
218	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	64	40	—	—	$2,300.00	$175,902.33	$60,817.82	2026-05-08
219	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	66	40	—	—	$2,300.00	$228,516.80	$78,999.13	2026-05-08
220	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	66	40	—	—	$2,300.00	$156,700.80	$54,182.60	2026-05-08
221	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	66	40	—	—	$2,300.00	$135,983.96	$47,023.75	2026-05-08
162-4	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	16	15	—	—	$74,764.53	$99,686.04	$83,071.70	2026-05-08
162-3	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	16	15	—	—	$50,638.13	$67,517.51	$56,264.59	2026-05-08
162-2	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	16	15	—	—	$39,564.48	$52,752.64	$43,960.53	2026-05-08
162-1	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	16	15	—	—	$34,356.00	$45,808.00	$38,173.33	2026-05-08
163-4	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	16	15	—	—	$63,256.68	$84,342.24	$70,285.20	2026-05-08
163-3	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	16	15	—	—	$41,669.67	$55,559.56	$46,299.63	2026-05-08
034	OTHER	Carotid Artery Stent Procedures With Mcc	52	35	—	—	$2,300.00	$115,273.05	$40,646.35	2026-05-08
277	OTHER	Cellulitis Age >17 W Cc	53	36	—	—	$2,300.00	$137,728.72	$48,564.43	2026-05-08
278	OTHER	Cellulitis Age >17 Without Cc	53	36	—	—	$2,300.00	$148,068.04	$52,210.17	2026-05-08
471	OTHER	Cervical Spinal Fusion With Mcc	61	39	—	—	$2,957.00	$143,772.27	$49,715.05	2026-05-08
695-4	OTHER	Chemotherapy For Acute Leukemia	16	15	—	—	$37,220.57	$49,627.43	$41,356.19	2026-05-08
837	OTHER	Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…	53	36	—	—	$2,000.00	$148,182.79	$52,250.63	2026-05-08
018	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	53	36	—	—	$2,000.00	$1,110,484.04	$391,567.01	2026-05-08
011-3	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	16	15	—	—	$96,911.84	$129,215.78	$107,679.82	2026-05-08
011-4	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	16	15	—	—	$45,018.90	$60,025.20	$50,021.00	2026-05-08
011-2	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	16	15	—	—	$45,000.00	$60,000.00	$50,000.00	2026-05-08
454	OTHER	Combined Anterior And Posterior Spinal Fusion With Cc	52	36	—	—	$3,250.00	$180,815.99	$63,757.40	2026-05-08
453	OTHER	Combined Anterior And Posterior Spinal Fusion With Mcc	52	36	—	—	$3,250.00	$261,585.44	$92,237.46	2026-05-08
455	OTHER	Combined Anterior And Posterior Spinal Fusion Without Cc/mcc	52	36	—	—	$3,250.00	$136,366.45	$48,084.08	2026-05-08
165-4	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	16	15	—	—	$58,592.29	$78,123.05	$65,102.54	2026-05-08
165-3	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	16	15	—	—	$42,052.51	$56,070.01	$46,725.01	2026-05-08
165-2	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	16	15	—	—	$34,978.46	$46,637.94	$38,864.95	2026-05-08
233	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	67	41	—	—	$4,100.00	$230,838.29	$79,801.34	2026-05-08
234	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	67	41	—	—	$4,100.00	$157,392.24	$54,421.53	2026-05-08
231	OTHER	Coronary Bypass With Ptca With Mcc	67	41	—	—	$4,578.00	$250,183.98	$86,486.38	2026-05-08
232	OTHER	Coronary Bypass With Ptca Without Mcc	66	40	—	—	$5,475.00	$180,592.40	$62,438.51	2026-05-08
166-4	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	16	15	—	—	$51,576.78	$68,769.04	$57,307.53	2026-05-08
166-3	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	16	15	—	—	$35,073.04	$46,764.05	$38,970.04	2026-05-08
235	OTHER	Coronary Bypass Without Cardiac Catheterization With Mcc	66	40	—	—	$2,300.00	$173,986.90	$60,155.93	2026-05-08
236	OTHER	Coronary Bypass Without Cardiac Catheterization Without Mcc	66	40	—	—	$2,300.00	$121,846.13	$42,138.32	2026-05-08
025	OTHER	Craniotomy And Endovascular Intracranial Procedures With Mcc	52	35	—	—	$2,300.00	$132,444.35	$46,701.11	2026-05-08
955	OTHER	Craniotomy For Multiple Significant Trauma	53	36	—	—	$2,300.00	$201,765.26	$71,144.31	2026-05-08
910-4	OTHER	Craniotomy For Multiple Significant Trauma	16	15	—	—	$51,992.06	$69,322.74	$57,768.95	2026-05-08
023	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	52	35	—	—	$2,300.00	$168,717.18	$58,913.10	2026-05-08
024	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	52	35	—	—	$2,300.00	$112,713.22	$39,743.73	2026-05-08
179-4	OTHER	Defibrillator Implants	16	15	—	—	$52,069.52	$69,426.02	$57,855.02	2026-05-08
179-3	OTHER	Defibrillator Implants	16	15	—	—	$36,342.28	$48,456.37	$40,380.31	2026-05-08
304-4	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	16	15	—	—	$55,159.30	$73,545.73	$61,288.11	2026-05-08
304-3	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	16	15	—	—	$35,888.27	$47,851.03	$39,875.86	2026-05-08
303-4	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	16	15	—	—	$108,000.00	$144,000.00	$120,000.00	2026-05-08
303-3	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	16	15	—	—	$51,920.88	$69,227.84	$57,689.87	2026-05-08
303-1	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	16	15	—	—	$39,568.98	$52,758.64	$43,965.53	2026-05-08
303-2	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	16	15	—	—	$37,676.38	$50,235.17	$41,862.64	2026-05-08
759-4	OTHER	Eating Disorders	16	15	—	—	$27,723.19	$44,462.40	$36,964.26	2026-05-08
003	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	55	37	—	—	$1,196.00	$631,440.11	$218,232.15	2026-05-08
266	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	58	38	—	—	$2,300.00	$177,123.37	$61,239.76	2026-05-08
267	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc	62	39	—	—	$4,100.00	$139,282.31	$48,163.52	2026-05-08
911-4	OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	16	15	—	—	$46,333.16	$61,777.55	$51,481.29	2026-05-08
927	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	56	36	—	—	$2,300.00	$698,854.41	$241,527.64	2026-05-08
933	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft	53	36	—	—	$2,000.00	$128,166.24	$45,192.61	2026-05-08
950-4	OTHER	Extensive O.r. Procedure Unrelated To Principal Diagnosis	16	15	—	—	$42,516.43	$56,688.58	$47,240.48	2026-05-08
792-4	OTHER	Extensive O.r. Procedures For Other Complications Of Treatment	16	15	—	—	$37,031.40	$49,375.20	$41,146.00	2026-05-08
981	OTHER	Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc	61	39	—	—	$2,957.00	$140,729.89	$48,663.74	2026-05-08
841-4	OTHER	Extensive Third Degree Burns With Skin Graft	16	15	—	—	$132,591.63	$176,788.84	$147,324.03	2026-05-08
841-3	OTHER	Extensive Third Degree Burns With Skin Graft	16	15	—	—	$45,266.61	$60,355.48	$50,296.23	2026-05-08
178-4	OTHER	External Heart Assist Systems	16	15	—	—	$60,779.45	$81,039.26	$67,532.72	2026-05-08
178-3	OTHER	External Heart Assist Systems	16	15	—	—	$46,572.78	$62,097.04	$51,747.53	2026-05-08
178-2	OTHER	External Heart Assist Systems	16	15	—	—	$41,336.37	$55,115.16	$45,929.30	2026-05-08
178-1	OTHER	External Heart Assist Systems	16	15	—	—	$37,789.88	$50,386.51	$41,988.76	2026-05-08
009-4	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	16	15	—	—	$120,495.34	$160,660.45	$133,883.71	2026-05-08
009-3	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	16	15	—	—	$56,044.79	$74,726.39	$62,271.99	2026-05-08
790	OTHER	Extreme Immaturity Or Respiratory Distress Syndrome, Neonate	53	36	—	—	$2,000.00	$175,769.92	$61,978.11	2026-05-08
092-4	OTHER	Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures	16	15	—	—	$36,191.84	$48,255.79	$40,213.16	2026-05-08
588-1	OTHER	Female Reproductive System Reconstructive Procedures	16	15	—	—	$45,000.00	$60,000.00	$50,000.00	2026-05-08
793	OTHER	Full Term Neonate With Major Problems	53	36	—	—	$2,000.00	$123,564.46	$43,569.98	2026-05-08
928	OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	53	36	—	—	$2,300.00	$197,369.41	$69,594.29	2026-05-08
232-4	OTHER	Gastric Fundoplication	16	15	—	—	$61,934.29	$82,579.06	$68,815.88	2026-05-08
002-4	OTHER	Heart And/or Lung Transplant	16	15	—	—	$158,430.91	$211,241.21	$176,034.34	2026-05-08
002-3	OTHER	Heart And/or Lung Transplant	16	15	—	—	$117,561.11	$156,748.15	$130,623.46	2026-05-08
002-2	OTHER	Heart And/or Lung Transplant	16	15	—	—	$84,612.19	$112,816.25	$94,013.54	2026-05-08
002-1	OTHER	Heart And/or Lung Transplant	16	15	—	—	$45,000.00	$60,000.00	$50,000.00	2026-05-08
001	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	57	36	—	—	$4,500.00	$829,654.95	$286,726.70	2026-05-08
002	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	57	36	—	—	$4,500.00	$325,089.38	$112,370.47	2026-05-08
212	OTHER	Hip & Femur Procedures Except Major Joint Age 0-17	53	36	—	—	$2,300.00	$321,387.97	$113,324.39	2026-05-08
969	OTHER	HIV With Extensive O.r. Procedures With Mcc	53	36	—	—	$2,300.00	$186,935.99	$65,915.37	2026-05-08
1656977	OTHER	Imp, Hemi Arthroplasty	137	38	$173,938.00	$52,181.40 70% off	$1,000.00	$173,938.00	$45,223.88	2026-05-09
1661140	OTHER	Implant Knee System	68	36	$162,840.00	$48,852.00 70% off	$1,000.00	$162,840.00	$43,030.47	2026-05-09
1669888	OTHER	Implant Knee System	69	37	$156,070.00	$46,821.00 70% off	$1,000.00	$156,070.00	$39,017.50	2026-05-09
1655086	OTHER	Implant, Hip System	137	38	$173,938.00	$52,181.40 70% off	$1,000.00	$173,938.00	$45,223.88	2026-05-09
1655997	OTHER	Implant, Knee System	68	36	$177,925.00	$53,377.50 70% off	$1,000.00	$177,925.00	$47,016.68	2026-05-09
1656811	OTHER	Implant, Knee System	137	38	$173,938.00	$52,181.40 70% off	$1,000.00	$173,938.00	$45,223.88	2026-05-09
1646143	OTHER	Implant, Shoulder System	68	36	$173,938.00	$52,181.40 70% off	$1,000.00	$173,938.00	$45,963.12	2026-05-09
1686103	OTHER	Implant, Shoulder System	137	38	$173,938.00	$52,181.40 70% off	$1,000.00	$173,938.00	$45,223.88	2026-05-09
161-4	OTHER	Implantable Heart Assist Systems	16	15	—	—	$191,733.80	$255,645.07	$213,037.56	2026-05-08
161-3	OTHER	Implantable Heart Assist Systems	16	15	—	—	$137,242.31	$182,989.74	$152,491.45	2026-05-08
161-2	OTHER	Implantable Heart Assist Systems	16	15	—	—	$116,514.37	$155,352.49	$129,460.41	2026-05-08
161-1	OTHER	Implantable Heart Assist Systems	16	15	—	—	$106,189.21	$141,585.61	$117,988.01	2026-05-08
710-4	OTHER	Infectious And Parasitic Diseases Including HIV With O.r. Procedure	16	15	—	—	$33,619.13	$44,825.51	$37,354.59	2026-05-08
853	OTHER	Infectious And Parasitic Diseases With O.r. Procedures With Mcc	53	36	—	—	$2,300.00	$148,009.20	$52,189.42	2026-05-08
176-4	OTHER	Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices	16	15	—	—	$38,602.41	$51,469.88	$42,891.57	2026-05-08
021	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	52	35	—	—	$2,300.00	$163,485.76	$57,646.60	2026-05-08
020	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	52	35	—	—	$2,300.00	$238,038.10	$83,934.45	2026-05-08
022	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…	52	35	—	—	$2,300.00	$104,730.73	$36,929.03	2026-05-08
440-4	OTHER	Kidney Transplant	16	15	—	—	$70,473.07	$93,964.09	$78,303.41	2026-05-08
440-3	OTHER	Kidney Transplant	16	15	—	—	$44,037.00	$58,716.00	$48,930.00	2026-05-08
440-2	OTHER	Kidney Transplant	16	15	—	—	$38,717.71	$51,623.62	$43,019.68	2026-05-08
440-1	OTHER	Kidney Transplant	16	15	—	—	$34,716.32	$46,288.43	$38,573.69	2026-05-08
650	OTHER	Kidney Transplant With Hemodialysis With Mcc	58	37	—	—	$2,300.00	$136,416.48	$47,173.21	2026-05-08
956	OTHER	Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma	53	36	—	—	$2,300.00	$113,322.28	$39,958.49	2026-05-08
001-4	OTHER	Liver Transplant And/or Intestinal Transplant	16	15	—	—	$108,000.00	$144,000.00	$120,000.00	2026-05-08
001-3	OTHER	Liver Transplant And/or Intestinal Transplant	16	15	—	—	$66,333.84	$88,445.12	$73,704.27	2026-05-08
001-2	OTHER	Liver Transplant And/or Intestinal Transplant	16	15	—	—	$55,343.96	$73,791.95	$61,493.29	2026-05-08
001-1	OTHER	Liver Transplant And/or Intestinal Transplant	16	15	—	—	$45,000.00	$60,000.00	$50,000.00	2026-05-08
005	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	51	34	—	—	$2,300.00	$314,194.03	$110,787.74	2026-05-08
006	OTHER	Liver Transplant Without Mcc	51	34	—	—	$2,300.00	$143,533.96	$50,611.41	2026-05-08
492	OTHER	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc	53	36	—	—	$2,300.00	$105,342.71	$37,144.82	2026-05-08
181-4	OTHER	Lower Extremity Arterial Procedures	16	15	—	—	$39,008.67	$52,011.56	$43,342.97	2026-05-08
007	OTHER	Lung Transplant	51	34	—	—	$2,300.00	$690,054.64	$243,319.69	2026-05-08
820	OTHER	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	53	36	—	—	$2,300.00	$172,165.59	$60,707.19	2026-05-08
823	OTHER	Lymphoma And Non-acute Leukemia With Other Procedures With Mcc	53	36	—	—	$2,300.00	$138,540.84	$48,850.79	2026-05-08
169-4	OTHER	Major Abdominal Vascular Procedures	16	15	—	—	$46,230.47	$61,640.63	$51,367.19	2026-05-08
261-4	OTHER	Major Biliary Tract Procedures	16	15	—	—	$39,362.70	$52,483.60	$43,736.33	2026-05-08
441-4	OTHER	Major Bladder Procedures	16	15	—	—	$41,863.35	$55,817.80	$46,514.83	2026-05-08
653	OTHER	Major Bladder Procedures With Mcc	55	37	—	—	$2,300.00	$164,877.50	$57,008.11	2026-05-08
160-4	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	16	15	—	—	$87,425.42	$116,567.22	$97,139.35	2026-05-08
160-3	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	16	15	—	—	$41,294.03	$55,058.71	$45,882.26	2026-05-08
163	OTHER	Major Chest Procedures With Mcc	53	36	—	—	$2,300.00	$136,472.35	$48,121.42	2026-05-08
089-4	OTHER	Major Cranial Or Facial Bone Procedures	16	15	—	—	$42,675.88	$56,901.17	$47,417.64	2026-05-08
140	OTHER	Major Head And Neck Procedures With Mcc	53	36	—	—	$2,300.01	$125,291.59	$44,178.98	2026-05-08
680-4	OTHER	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	16	15	—	—	$50,885.86	$67,847.81	$56,539.84	2026-05-08
260-4	OTHER	Major Pancreas, Liver And Shunt Procedures	16	15	—	—	$43,265.01	$57,686.68	$48,072.23	2026-05-08
120-4	OTHER	Major Respiratory And Chest Procedures	16	15	—	—	$44,391.01	$59,188.02	$49,323.35	2026-05-08
329	OTHER	Major Small And Large Bowel Procedures With Mcc	53	36	—	—	$2,300.00	$135,963.37	$47,941.95	2026-05-08
230-4	OTHER	Major Small Bowel Procedures	16	15	—	—	$36,679.19	$48,905.58	$40,754.65	2026-05-08
220-4	OTHER	Major Stomach, Esophageal And Duodenal Procedures	16	15	—	—	$43,592.00	$58,122.66	$48,435.55	2026-05-08
740-4	OTHER	Mental Illness Diagnosis With O.r. Procedure	16	15	—	—	$38,930.31	$51,907.08	$47,516.24	2026-05-08
912-4	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	16	15	—	—	$46,389.01	$61,852.02	$51,543.35	2026-05-08
826	OTHER	Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …	53	36	—	—	$2,300.00	$141,365.44	$49,846.77	2026-05-08
1690159	OTHER	Nail Lapidus	137	38	$260,300.00	$78,090.00 70% off	$1,000.00	$260,300.00	$57,266.00	2026-05-09
863-4	OTHER	Neonatal Aftercare	16	15	—	—	$109,905.13	$146,540.17	$122,116.81	2026-05-08
603-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	16	15	—	—	$72,000.00	$96,000.00	$80,000.00	2026-05-08
603-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	16	15	—	—	$61,873.94	$82,498.58	$68,748.82	2026-05-08
602-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$90,000.00	$120,000.00	$100,000.00	2026-05-08
602-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$82,800.00	$110,400.00	$92,000.00	2026-05-08
602-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$72,000.00	$96,000.00	$80,000.00	2026-05-08
608-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	16	15	—	—	$63,000.00	$84,000.00	$70,000.00	2026-05-08
608-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	16	15	—	—	$51,161.51	$68,215.34	$56,846.12	2026-05-08
608-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	16	15	—	—	$36,789.98	$49,053.31	$40,877.76	2026-05-08
607-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$90,000.00	$120,000.00	$100,000.00	2026-05-08
607-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$72,102.64	$96,136.85	$80,114.04	2026-05-08
607-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$52,455.97	$69,941.29	$58,284.41	2026-05-08
613-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	16	15	—	—	$55,800.00	$74,400.00	$62,000.00	2026-05-08
613-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	16	15	—	—	$42,478.60	$56,638.13	$47,198.44	2026-05-08
611-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	16	15	—	—	$83,700.00	$111,600.00	$93,000.00	2026-05-08
614-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	16	15	—	—	$38,449.27	$51,265.69	$42,721.41	2026-05-08
612-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$80,100.00	$106,800.00	$89,000.00	2026-05-08
612-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$43,929.80	$58,573.07	$48,810.89	2026-05-08
612-2	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$34,424.45	$45,899.27	$38,249.39	2026-05-08
609-4	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	16	15	—	—	$148,500.00	$198,000.00	$165,000.00	2026-05-08
609-3	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	16	15	—	—	$71,634.21	$95,512.28	$79,593.57	2026-05-08
609-2	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	16	15	—	—	$40,703.10	$54,270.80	$45,225.67	2026-05-08
609-1	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	16	15	—	—	$36,921.50	$49,228.67	$41,023.89	2026-05-08
623-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	16	15	—	—	$53,913.48	$71,884.64	$59,903.87	2026-05-08
621-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	16	15	—	—	$81,000.00	$108,000.00	$90,000.00	2026-05-08
625-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Other Significant Condition	16	15	—	—	$54,149.49	$72,199.32	$60,166.10	2026-05-08
622-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$56,332.15	$75,109.54	$62,591.28	2026-05-08
591-4	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	16	15	—	—	$108,000.00	$144,000.00	$120,000.00	2026-05-08
591-3	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	16	15	—	—	$81,900.00	$109,200.00	$91,000.00	2026-05-08
591-2	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	16	15	—	—	$65,446.55	$87,262.07	$72,718.39	2026-05-08
593-4	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	16	15	—	—	$108,900.00	$145,200.00	$121,000.00	2026-05-08
593-3	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	16	15	—	—	$89,100.00	$118,800.00	$99,000.00	2026-05-08
593-2	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	16	15	—	—	$71,100.00	$94,800.00	$79,000.00	2026-05-08
588-4	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	16	15	—	—	$198,900.00	$265,200.00	$221,000.00	2026-05-08
588-3	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	16	15	—	—	$118,800.00	$158,400.00	$132,000.00	2026-05-08
588-2	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	16	15	—	—	$117,000.00	$156,000.00	$130,000.00	2026-05-08
589-1	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	16	15	—	—	$61,824.39	$82,432.52	$68,693.77	2026-05-08
589-3	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	16	15	—	—	$37,811.50	$50,415.34	$42,012.78	2026-05-08
636-4	OTHER	Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection	16	15	—	—	$41,301.23	$55,068.31	$45,890.26	2026-05-08
633-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Anomaly	16	15	—	—	$76,914.77	$102,553.02	$85,460.85	2026-05-08
630-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	16	15	—	—	$205,488.86	$273,985.14	$228,320.95	2026-05-08
630-3	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	16	15	—	—	$85,500.00	$114,000.00	$95,000.00	2026-05-08
630-2	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	16	15	—	—	$46,676.37	$62,235.16	$51,862.63	2026-05-08
631-4	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	16	15	—	—	$203,628.70	$271,504.93	$226,254.11	2026-05-08
631-3	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	16	15	—	—	$54,483.69	$72,644.92	$60,537.43	2026-05-08
639-4	OTHER	Neonate Birth Weight > 2499 Grams With Other Significant Condition	16	15	—	—	$35,992.76	$47,990.35	$39,991.96	2026-05-08
634-4	OTHER	Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…	16	15	—	—	$49,890.46	$66,520.62	$55,433.85	2026-05-08
583-3	OTHER	Neonate With Ecmo	16	15	—	—	$198,900.00	$265,200.00	$221,000.00	2026-05-08
583-4	OTHER	Neonate With Ecmo	16	15	—	—	$198,900.00	$265,200.00	$221,000.00	2026-05-08
583-2	OTHER	Neonate With Ecmo	16	15	—	—	$160,500.96	$214,001.28	$178,334.40	2026-05-08
583-1	OTHER	Neonate With Ecmo	16	15	—	—	$143,483.18	$191,310.90	$159,425.75	2026-05-08
097	OTHER	Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc	53	36	—	—	$2,000.00	$106,325.41	$37,491.33	2026-05-08
325-4	OTHER	Non-elective Or Complex Knee Joint Replacement	16	15	—	—	$34,378.51	$45,838.02	$38,198.35	2026-05-08
276	OTHER	Non-maligant Breast Disorders	53	36	—	—	$2,300.00	$183,113.91	$64,567.67	2026-05-08
021-4	OTHER	Open Craniotomy Except Trauma	16	15	—	—	$45,256.70	$60,342.26	$50,285.22	2026-05-08
020-4	OTHER	Open Craniotomy For Trauma	16	15	—	—	$42,510.12	$56,680.16	$47,233.47	2026-05-08
681-4	OTHER	Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	16	15	—	—	$43,605.51	$58,140.68	$48,450.57	2026-05-08
167-4	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	16	15	—	—	$58,483.29	$77,977.72	$64,981.43	2026-05-08
167-3	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	16	15	—	—	$35,380.21	$47,173.62	$39,311.35	2026-05-08
228	OTHER	Other Cardiothoracic Procedures With Mcc	62	39	—	—	$2,299.99	$147,479.60	$50,996.15	2026-05-08
356	OTHER	Other Digestive System O.r. Procedures With Mcc	53	36	—	—	$2,300.00	$126,365.52	$44,557.66	2026-05-08
628	OTHER	Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc	54	37	—	—	$2,300.00	$116,950.15	$40,842.10	2026-05-08
319	OTHER	Other Endovascular Cardiac Valve Procedures With Mcc	58	37	—	—	$4,000.00	$130,105.22	$44,992.30	2026-05-08
215	OTHER	Other Heart Assist System Implant	63	40	—	—	$4,100.00	$312,587.49	$108,050.35	2026-05-08
423	OTHER	Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc	55	37	—	—	$2,300.00	$120,530.91	$41,683.83	2026-05-08
264-4	OTHER	Other Hepatobiliary, Pancreas And Abdominal Procedures	16	15	—	—	$34,154.21	$45,538.94	$37,949.12	2026-05-08
673	OTHER	Other Kidney And Urinary Tract Procedures With Mcc	53	36	—	—	$2,300.00	$124,126.45	$43,768.14	2026-05-08
270	OTHER	Other Major Cardiovascular Procedures With Mcc	64	39	—	—	$2,500.00	$151,884.22	$52,518.19	2026-05-08
091-4	OTHER	Other Major Head And Neck Procedures	16	15	—	—	$50,301.23	$67,068.31	$55,890.26	2026-05-08
907	OTHER	Other O.r. Procedures For Injuries With Mcc	55	37	—	—	$2,300.00	$118,068.21	$40,832.83	2026-05-08
958	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Cc	53	36	—	—	$2,300.00	$121,778.46	$42,940.22	2026-05-08
957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	53	36	—	—	$2,300.00	$220,475.40	$77,741.68	2026-05-08
802	OTHER	Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc	53	36	—	—	$2,300.00	$106,331.31	$37,493.41	2026-05-08
027-4	OTHER	Other Open Craniotomy	16	15	—	—	$40,122.98	$53,497.31	$44,581.09	2026-05-08
182-4	OTHER	Other Peripheral Vascular And Related Procedures	16	15	—	—	$33,367.81	$44,490.41	$37,075.34	2026-05-08
405-4	OTHER	Other Procedures For Endocrine, Nutritional And Metabolic Disorders	16	15	—	—	$33,791.18	$45,054.91	$37,545.76	2026-05-08
651-4	OTHER	Other Procedures Of Blood And Blood-forming Organs	16	15	—	—	$33,511.03	$44,681.38	$37,234.48	2026-05-08
121-4	OTHER	Other Respiratory And Chest Procedures	16	15	—	—	$35,580.20	$47,440.26	$39,533.55	2026-05-08
166	OTHER	Other Respiratory System O.r. Procedures With Mcc	53	36	—	—	$2,300.00	$114,143.19	$40,247.95	2026-05-08
006-4	OTHER	Pancreas Transplant	16	15	—	—	$76,500.00	$102,000.00	$85,000.00	2026-05-08
010	OTHER	Pancreas Transplant	51	34	—	—	$2,300.00	$235,445.91	$83,020.42	2026-05-08
006-3	OTHER	Pancreas Transplant	16	15	—	—	$73,538.52	$98,051.36	$81,709.47	2026-05-08
006-2	OTHER	Pancreas Transplant	16	15	—	—	$60,406.52	$80,542.02	$67,118.35	2026-05-08
006-1	OTHER	Pancreas Transplant	16	15	—	—	$45,000.00	$60,000.00	$50,000.00	2026-05-08
405	OTHER	Pancreas, Liver And Shunt Procedures With Mcc	56	36	—	—	$2,300.00	$160,584.64	$55,524.69	2026-05-08
510-4	OTHER	Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced…	16	15	—	—	$37,865.55	$50,487.40	$42,072.83	2026-05-08
483-4	OTHER	Penis, Testes And Scrotal Procedures	16	15	—	—	$43,409.13	$57,878.84	$48,232.37	2026-05-08
273	OTHER	Percutaneous And Other Intracardiac Procedures With Mcc	58	37	—	—	$2,300.00	$115,908.57	$40,086.55	2026-05-08
175-4	OTHER	Percutaneous Cardiac Intervention Without Ami	16	15	—	—	$33,229.98	$44,306.64	$36,922.20	2026-05-08
030-4	OTHER	Percutaneous Intracranial And Extracranial Vascular Procedures	16	15	—	—	$34,682.08	$46,242.78	$38,535.65	2026-05-08
183-4	OTHER	Percutaneous Structural Cardiac Procedures	16	15	—	—	$54,337.76	$72,450.35	$60,375.29	2026-05-08
183-3	OTHER	Percutaneous Structural Cardiac Procedures	16	15	—	—	$36,294.53	$48,392.71	$40,327.26	2026-05-08
040	OTHER	Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc	55	35	—	—	$2,500.00	$111,842.25	$38,681.41	2026-05-08
335	OTHER	Peritoneal Adhesiolysis With Mcc	53	36	—	—	$2,300.00	$107,467.04	$37,893.88	2026-05-08
170-4	OTHER	Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock	16	15	—	—	$34,474.00	$45,965.33	$38,304.44	2026-05-08
856	OTHER	Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc	53	36	—	—	$2,300.00	$133,600.70	$47,108.85	2026-05-08
791	OTHER	Prematurity With Major Problems	53	36	—	—	$2,000.00	$120,310.30	$42,422.53	2026-05-08
850-4	OTHER	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	16	15	—	—	$48,562.67	$64,750.22	$53,958.52	2026-05-08
130-4	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	16	15	—	—	$41,403.93	$55,205.24	$46,004.37	2026-05-08
207	OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	53	36	—	—	$2,000.00	$191,140.56	$67,397.94	2026-05-08
466	OTHER	Revision Of Hip Or Knee Replacement With Mcc	53	36	—	—	$2,300.00	$150,754.41	$53,157.41	2026-05-08
870	OTHER	Septicemia Or Severe Sepsis With Mv >96 Hours	53	36	—	—	$2,000.00	$205,537.31	$72,474.37	2026-05-08
008	OTHER	Simultaneous Pancreas And Kidney Transplant	54	34	—	—	$2,300.00	$160,949.52	$56,752.30	2026-05-08
019	OTHER	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	53	36	—	—	$2,300.00	$234,101.31	$82,546.30	2026-05-08
576	OTHER	Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc	53	36	—	—	$2,300.00	$159,601.91	$56,277.12	2026-05-08
361-4	OTHER	Skin Graft For Skin And Subcutaneous Tissue Diagnoses	16	15	—	—	$41,985.85	$55,981.14	$46,650.95	2026-05-08
573	OTHER	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	53	36	—	—	$2,300.00	$182,048.80	$64,192.10	2026-05-08
312-4	OTHER	Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses	16	15	—	—	$42,544.36	$56,725.81	$47,271.51	2026-05-08
622	OTHER	Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor…	53	36	—	—	$2,300.00	$110,956.66	$39,124.35	2026-05-08
904	OTHER	Skin Grafts For Injuries With Cc/mcc	53	36	—	—	$2,300.00	$114,460.93	$40,359.99	2026-05-08
321-4	OTHER	Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures	16	15	—	—	$36,445.87	$48,594.49	$40,495.41	2026-05-08
459	OTHER	Spinal Fusion Except Cervical With Mcc	52	36	—	—	$3,250.00	$195,998.37	$69,110.85	2026-05-08
456	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	53	36	—	—	$2,300.00	$250,045.70	$88,168.44	2026-05-08
457	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	53	36	—	—	$2,300.00	$169,726.40	$59,847.11	2026-05-08
458	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	53	36	—	—	$2,300.00	$127,904.39	$45,100.28	2026-05-08
460	OTHER	Spinal Fusion Except Cervical Without Mcc	52	36	—	—	$3,250.00	$108,482.16	$38,251.82	2026-05-08
023-4	OTHER	Spinal Procedures	16	15	—	—	$45,011.67	$60,015.56	$50,012.97	2026-05-08
028	OTHER	Spinal Procedures With Mcc	52	35	—	—	$2,300.00	$179,733.20	$63,375.60	2026-05-08
799	OTHER	Splenectomy With Mcc	53	36	—	—	$2,300.00	$140,756.38	$49,632.01	2026-05-08
326	OTHER	Stomach, Esophageal And Duodenal Procedures With Mcc	56	36	—	—	$2,300.00	$150,295.41	$51,969.17	2026-05-08
404-4	OTHER	Thyroid, Parathyroid And Thyroglossal Procedures	16	15	—	—	$33,666.88	$44,889.17	$37,407.64	2026-05-08
012	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc	53	36	—	—	$2,300.00	$121,599.00	$42,052.92	2026-05-08
011	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	53	36	—	—	$2,300.00	$159,619.55	$56,283.34	2026-05-08
004	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	53	36	—	—	$2,300.00	$416,604.15	$146,898.50	2026-05-08
004-4	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	16	15	—	—	$99,000.00	$132,000.00	$110,000.00	2026-05-08
004-3	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	16	15	—	—	$80,285.59	$107,047.45	$89,206.21	2026-05-08
004-2	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	16	15	—	—	$52,270.40	$69,693.86	$58,078.22	2026-05-08
004-1	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	16	15	—	—	$37,833.12	$50,444.16	$42,036.80	2026-05-08
005-4	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	16	15	—	—	$79,200.00	$105,600.00	$88,000.00	2026-05-08
005-3	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	16	15	—	—	$59,060.71	$78,747.61	$65,623.01	2026-05-08
005-1	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	16	15	—	—	$41,333.67	$55,111.56	$45,926.30	2026-05-08
005-2	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	16	15	—	—	$39,178.03	$52,237.37	$43,531.14	2026-05-08
323	OTHER	Urinary Stones W Cc, &/or Esw Lithotripsy	53	36	—	—	$2,300.00	$126,180.16	$44,492.30	2026-05-08
512-4	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy	16	15	—	—	$33,603.81	$44,805.08	$37,337.57	2026-05-08
739	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc…	53	36	—	—	$2,300.00	$117,985.80	$41,602.89	2026-05-08
511-4	OTHER	Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy	16	15	—	—	$36,305.34	$48,407.12	$40,339.27	2026-05-08
736	OTHER	Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc	53	36	—	—	$2,300.00	$116,711.84	$41,153.68	2026-05-08
031	OTHER	Ventricular Shunt Procedures With Mcc	52	35	—	—	$2,300.00	$124,155.85	$43,778.51	2026-05-08
463	OTHER	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …	53	36	—	—	$2,300.00	$159,769.61	$56,336.25	2026-05-08
901	OTHER	Wound Debridements For Injuries With Mcc	53	36	—	—	$2,300.00	$131,214.46	$46,267.44	2026-05-08

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