Hospital

Seton Medical Center Coastside

Moss Beach, CA · CCN 050613 · Rates published

7,084 distinct procedures filed

52 distinct payers

294,972 rate rows

2026-05-09 last MRF observed

Data quality

267,725 of 294,972 rate rows are consumer-grade (90.8%)

27,247 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	18,205
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	7,730
exceeds 10× this hospital's gross charge — excluded from medians	666
placeholder amount (≤ $0.02) — excluded from medians	646

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

Source MRF file	https://www.ahmchealth.com/docs/PricingTransparency-Seton_Medical_Center_-_Coastside-3333-20260331195524.csv
Found on page	https://www.ahmchealth.com/smc/getpage.php?name=Price_Transparency
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-05-18
Content fingerprint	6aebb65f2c41bd68… · 173,306,865 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
18 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	25	$333,850.38	$2,431,051.85	$507,414.03	nat. median $386,529 1.3× median
7 OTHER	Lung Transplant	24	$215,107.66	$1,838,420.12	$322,599.93	nat. median $169,933 1.9× median
1 OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	24	$216,823.16	$719,603.23	$309,747.37	nat. median $239,422 1.3× median
631-4 OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	9	$254,329.29	$276,201.61	$254,329.29	nat. median $203,379 1.3× median
927 OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	25	$165,304.29	$531,335.23	$236,148.99	nat. median $146,562 1.6× median
3 OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	25	$164,336.96	$548,334.50	$234,767.08	nat. median $181,005 1.3× median
161-4 OTHER	Implantable Heart Assist Systems	9	$227,262.67	$246,807.26	$227,262.67	nat. median $202,242 1.1× median
630-4 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	9	$225,389.88	$244,773.41	$225,389.88	nat. median $210,669 1.1× median
583-4 OTHER	Neonate With Ecmo	9	$221,000.00	$240,006.00	$221,000.00	nat. median $309,400 0.7× median
583-3 OTHER	Neonate With Ecmo	9	$221,000.00	$240,006.00	$221,000.00	nat. median $259,487 0.9× median
588-4 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	9	$221,000.00	$240,006.00	$221,000.00	nat. median $267,493 0.8× median
011-3 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	9	$213,464.00	$231,821.90	$213,464.00	nat. median $171,094 1.2× median
002-4 OTHER	Heart And/or Lung Transplant	9	$210,006.45	$228,067.00	$210,006.45	nat. median $216,800 1.0× median
480-4 OTHER	Major Male Pelvic Procedures	1	$203,077.60	$203,077.60	$203,077.60	nat. median $27,837 outlier · 7.3×
583-2 OTHER	Neonate With Ecmo	9	$199,338.50	$216,481.61	$199,338.50	nat. median $191,347 1.0× median
589-1 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	9	$184,079.96	$199,910.84	$184,079.96	nat. median $86,371 outlier · 2.1×
583-1 OTHER	Neonate With Ecmo	9	$180,157.09	$195,650.60	$180,157.09	nat. median $171,226 1.1× median
841-4 OTHER	Extensive Third Degree Burns With Skin Graft	9	$168,218.77	$182,685.58	$168,218.77	nat. median $151,691 1.1× median
609-4 OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	9	$165,000.00	$179,190.00	$165,000.00	nat. median $169,856 1.0× median
161-3 OTHER	Implantable Heart Assist Systems	9	$163,685.56	$177,762.52	$163,685.56	nat. median $152,491 1.1× median
007-4 OTHER	Allogeneic Bone Marrow Transplant	9	$156,612.88	$170,081.59	$156,612.88	nat. median $172,311 0.9× median
4 OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	25	$107,410.97	$806,829.58	$153,444.25	nat. median $134,983 1.1× median
002-3 OTHER	Heart And/or Lung Transplant	9	$139,975.16	$152,013.02	$139,975.16	nat. median $133,471 1.0× median
009-4 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	9	$139,000.00	$150,954.00	$139,000.00	nat. median $150,954 0.9× median
863-4 OTHER	Neonatal Aftercare	9	$138,804.09	$150,741.24	$138,804.09	nat. median $108,047 1.3× median
14 OTHER	Allogeneic Bone Marrow Transplant	25	$33,049.73	$299,752.40	$133,223.29	nat. median $100,915 1.3× median
588-3 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	9	$132,000.00	$143,352.00	$132,000.00	nat. median $165,000 0.8× median
588-2 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	9	$130,000.00	$141,180.00	$130,000.00	nat. median $153,523 0.8× median
009-3 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	9	$128,412.01	$139,455.44	$128,412.01	nat. median $87,912 1.5× median
161-2 OTHER	Implantable Heart Assist Systems	9	$128,273.54	$139,305.06	$128,273.54	nat. median $109,992 1.2× median
2 OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	24	$87,959.58	$639,953.88	$125,656.55	nat. median $111,558 1.1× median
160-4 OTHER	Major Cardiothoracic Repair Of Heart Anomaly	9	$124,698.16	$135,422.20	$124,698.16	nat. median $106,926 1.2× median
593-4 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	9	$121,000.00	$131,406.00	$121,000.00	nat. median $151,250 0.8× median
212 OTHER	Hip & Femur Procedures Except Major Joint Age 0-17	25	$84,426.13	$271,369.69	$120,608.75	nat. median $90,581 1.3× median
303-4 OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	9	$120,000.00	$130,320.00	$120,000.00	nat. median $108,000 1.1× median
001-4 OTHER	Liver Transplant And/or Intestinal Transplant	9	$120,000.00	$130,320.00	$120,000.00	nat. median $124,561 1.0× median
591-4 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	9	$120,000.00	$130,320.00	$120,000.00	nat. median $156,696 0.8× median
002-2 OTHER	Heart And/or Lung Transplant	9	$118,397.98	$128,580.21	$118,397.98	nat. median $106,681 1.1× median
161-1 OTHER	Implantable Heart Assist Systems	9	$117,988.01	$128,134.98	$117,988.01	nat. median $101,352 1.2× median
5 OTHER	Liver Transplant With Mcc Or Intestinal Transplant	24	$80,075.11	$402,528.08	$114,393.02	nat. median $94,894 1.2× median
633-4 OTHER	Neonate Birth Weight > 2499 Grams With Major Anomaly	9	$111,331.29	$120,905.78	$111,331.29	nat. median $74,597 1.5× median
215 OTHER	Other Heart Assist System Implant	30	$14,676.00	$284,859.31	$110,494.42	nat. median $92,359 1.2× median
004-4 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	9	$110,000.00	$119,460.00	$110,000.00	nat. median $110,000 1.0× median
216 OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	31	$14,676.00	$258,237.35	$108,573.22	nat. median $90,130 1.2× median
842-4 OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	9	$107,903.03	$117,182.69	$107,903.03	nat. median $83,517 1.3× median
007-3 OTHER	Allogeneic Bone Marrow Transplant	9	$104,111.30	$113,064.87	$104,111.30	nat. median $104,111 1.0× median
602-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	9	$100,000.00	$108,600.00	$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…	9	$100,000.00	$108,600.00	$100,000.00	nat. median $100,015 1.0× median
593-3 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	9	$99,000.00	$107,514.00	$99,000.00	nat. median $112,711 0.9× median
453 OTHER	Combined Anterior And Posterior Spinal Fusion With Mcc	32	$17,250.00	$232,607.28	$98,411.45	nat. median $65,342 1.5× median

Other procedures at this hospital

Browse this hospital's 7,084 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

939	OTHER	O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc	27	25	—	—	$28,489.85	$117,976.49	$40,699.79	2026-05-09
650-4	OTHER	Splenectomy	9	9	—	—	$40,874.55	$44,389.76	$40,874.55	2026-05-09
636-4	OTHER	Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection	9	9	—	—	$40,917.82	$44,436.75	$40,917.82	2026-05-09
460	OTHER	Spinal Fusion Except Cervical Without Mcc	37	32	—	—	$17,250.00	$92,304.09	$41,024.04	2026-05-09
404-4	OTHER	Thyroid, Parathyroid And Thyroglossal Procedures	9	9	—	—	$41,029.09	$44,557.59	$41,029.09	2026-05-09
165-1	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	9	9	—	—	$41,061.23	$44,592.50	$41,061.23	2026-05-09
492	OTHER	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc	29	27	—	—	$17,106.00	$92,644.04	$41,175.13	2026-05-09
904	OTHER	Skin Grafts For Injuries With Cc/mcc	27	25	—	—	$28,834.17	$108,964.22	$41,191.67	2026-05-09
651	OTHER	Kidney Transplant With Hemodialysis Without Mcc	26	24	—	—	$29,086.62	$186,275.16	$41,552.31	2026-05-09
711-4	OTHER	Post-operative, Post-trauma, Other Device Infections With O.r. Procedure	9	9	—	—	$41,605.20	$45,183.25	$41,605.20	2026-05-09
160-1	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	9	9	—	—	$41,685.56	$45,270.52	$41,685.56	2026-05-09
022-4	OTHER	Ventricular Shunt Procedures	9	9	—	—	$41,744.91	$45,334.97	$41,744.91	2026-05-09
029-4	OTHER	Other Percutaneous Intracranial Procedures	9	9	—	—	$41,775.81	$45,368.53	$41,775.81	2026-05-09
628	OTHER	Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc	27	25	—	—	$29,248.74	$94,013.80	$41,783.91	2026-05-09
130-3	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	9	9	—	—	$41,807.96	$45,403.44	$41,807.96	2026-05-09
518	OTHER	Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost…	32	27	—	—	$25,846.00	$94,274.32	$41,899.70	2026-05-09
166	OTHER	Other Respiratory System O.r. Procedures With Mcc	27	25	—	—	$29,332.88	$94,284.25	$41,904.11	2026-05-09
264-4	OTHER	Other Hepatobiliary, Pancreas And Abdominal Procedures	9	9	—	—	$41,905.62	$45,509.50	$41,905.62	2026-05-09
143	OTHER	Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc	27	25	—	—	$29,401.59	$102,965.54	$42,002.27	2026-05-09
175-4	OTHER	Percutaneous Cardiac Intervention Without Ami	9	9	—	—	$42,050.27	$45,666.59	$42,050.27	2026-05-09
956	OTHER	Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma	27	25	—	—	$29,528.20	$94,912.06	$42,183.14	2026-05-09
608-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	9	9	—	—	$42,499.05	$46,153.97	$42,499.05	2026-05-09
403-4	OTHER	Procedures For Obesity	9	9	—	—	$42,506.47	$46,162.03	$42,506.47	2026-05-09
170-4	OTHER	Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock	9	9	—	—	$42,536.14	$46,194.25	$42,536.14	2026-05-09
160-2	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	9	9	—	—	$42,788.34	$46,468.14	$42,788.34	2026-05-09
405-4	OTHER	Other Procedures For Endocrine, Nutritional And Metabolic Disorders	9	9	—	—	$42,836.56	$46,520.50	$42,836.56	2026-05-09
607-1	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	9	9	—	—	$43,017.06	$46,716.53	$43,017.06	2026-05-09
163-2	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	9	9	—	—	$43,023.24	$46,723.24	$43,023.24	2026-05-09
907	OTHER	Other O.r. Procedures For Injuries With Mcc	29	26	—	—	$14,613.00	$96,805.42	$43,024.63	2026-05-09
710-4	OTHER	Infectious And Parasitic Diseases Including HIV With O.r. Procedure	9	9	—	—	$43,034.37	$46,735.33	$43,034.37	2026-05-09
303-2	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	9	9	—	—	$43,088.76	$46,794.39	$43,088.76	2026-05-09
40	OTHER	Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc	30	26	—	—	$30,286.31	$177,595.39	$43,266.16	2026-05-09
876	OTHER	O.r. Procedures With Principal Diagnosis Of Mental Illness	27	25	—	—	$2,397.40	$97,440.66	$43,306.96	2026-05-09
34	OTHER	Carotid Artery Stent Procedures With Mcc	34	29	—	—	$14,271.00	$97,584.59	$43,370.93	2026-05-09
933	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft	27	25	—	—	$30,541.08	$117,391.50	$43,630.11	2026-05-09
030-4	OTHER	Percutaneous Intracranial And Extracranial Vascular Procedures	9	9	—	—	$43,694.55	$47,452.28	$43,694.55	2026-05-09
229	OTHER	Other Cardiothoracic Procedures Without Mcc	51	41	—	—	$14,676.00	$81,540.00	$43,755.50	2026-05-09
24	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	30	26	—	—	$30,677.71	$98,606.93	$43,825.30	2026-05-09
234-4	OTHER	Appendectomy Without Complex Principal Diagnosis	9	9	—	—	$44,101.29	$47,894.00	$44,101.29	2026-05-09
121-4	OTHER	Other Respiratory And Chest Procedures	9	9	—	—	$44,362.15	$48,177.29	$44,362.15	2026-05-09
162-1	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	9	9	—	—	$44,365.86	$48,181.32	$44,365.86	2026-05-09
512-4	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy	9	9	—	—	$44,489.49	$48,315.59	$44,489.49	2026-05-09
802	OTHER	Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc	27	25	—	—	$31,235.09	$195,626.72	$44,621.56	2026-05-09
511-4	OTHER	Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy	9	9	—	—	$44,708.32	$48,553.24	$44,708.32	2026-05-09
651-4	OTHER	Other Procedures Of Blood And Blood-forming Organs	9	9	—	—	$44,927.14	$48,790.87	$44,927.14	2026-05-09
165-2	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	9	9	—	—	$44,976.59	$48,844.58	$44,976.59	2026-05-09
792-4	OTHER	Extensive O.r. Procedures For Other Complications Of Treatment	9	9	—	—	$45,188.00	$49,074.17	$45,188.00	2026-05-09
304-3	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	9	9	—	—	$45,338.83	$49,237.97	$45,338.83	2026-05-09
181-4	OTHER	Lower Extremity Arterial Procedures	9	9	—	—	$45,438.97	$49,346.72	$45,438.97	2026-05-09
791	OTHER	Prematurity With Major Problems	26	25	—	—	$7,138.94	$102,257.12	$45,447.61	2026-05-09
027-4	OTHER	Other Open Craniotomy	9	9	—	—	$45,478.53	$49,389.68	$45,478.53	2026-05-09
695-4	OTHER	Chemotherapy For Acute Leukemia	9	9	—	—	$45,511.91	$49,425.93	$45,511.91	2026-05-09
230-4	OTHER	Major Small Bowel Procedures	9	9	—	—	$45,530.46	$49,446.08	$45,530.46	2026-05-09
092-4	OTHER	Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures	9	9	—	—	$45,694.88	$49,624.64	$45,694.88	2026-05-09
273	OTHER	Percutaneous And Other Intracardiac Procedures With Mcc	36	30	—	—	$14,271.00	$103,907.27	$46,181.01	2026-05-09
178-1	OTHER	External Heart Assist Systems	9	9	—	—	$46,322.92	$50,306.69	$46,322.92	2026-05-09
423	OTHER	Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc	29	26	—	—	$14,613.00	$110,006.58	$46,484.30	2026-05-09
166-3	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	9	9	—	—	$46,603.56	$50,611.47	$46,603.56	2026-05-09
793	OTHER	Full Term Neonate With Major Problems	26	25	—	—	$7,257.47	$105,001.60	$46,667.38	2026-05-09
458	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	37	32	—	—	$17,250.00	$105,076.04	$46,700.46	2026-05-09
321-4	OTHER	Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures	9	9	—	—	$46,730.90	$50,749.76	$46,730.90	2026-05-09
901	OTHER	Wound Debridements For Injuries With Mcc	27	25	—	—	$32,875.61	$105,671.61	$46,965.16	2026-05-09
673	OTHER	Other Kidney And Urinary Tract Procedures With Mcc	27	25	—	—	$32,914.21	$148,491.70	$47,020.30	2026-05-09
440-1	OTHER	Kidney Transplant	9	9	—	—	$47,074.60	$51,123.02	$47,074.60	2026-05-09
958	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Cc	27	25	—	—	$33,009.16	$106,100.87	$47,155.94	2026-05-09
12	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc	27	25	—	—	$33,025.38	$144,597.38	$47,179.12	2026-05-09
269	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	36	30	—	—	$14,676.00	$177,665.53	$47,258.52	2026-05-09
179-3	OTHER	Defibrillator Implants	9	9	—	—	$47,345.34	$51,417.04	$47,345.34	2026-05-09
630-2	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	9	9	—	—	$47,536.97	$51,625.15	$47,536.97	2026-05-09
140	OTHER	Major Head And Neck Procedures With Mcc	27	25	—	—	$33,405.97	$156,927.36	$47,722.81	2026-05-09
361-4	OTHER	Skin Graft For Skin And Subcutaneous Tissue Diagnoses	9	9	—	—	$47,740.96	$51,846.68	$47,740.96	2026-05-09
570	OTHER	Skin Debridement With Mcc	27	25	—	—	$31,105.88	$477,503.56	$47,991.93	2026-05-09
474	OTHER	Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc	27	25	—	—	$33,619.05	$108,061.22	$48,027.21	2026-05-09
860-4	OTHER	Rehabilitation	1	1	—	—	$48,151.57	$48,151.57	$48,151.57	2026-05-09
183-3	OTHER	Percutaneous Structural Cardiac Procedures	9	9	—	—	$48,291.11	$52,444.15	$48,291.11	2026-05-09
323	OTHER	Urinary Stones W Cc, &/or Esw Lithotripsy	27	25	—	—	$33,885.38	$108,917.30	$48,407.69	2026-05-09
609-1	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	9	9	—	—	$48,496.34	$52,667.03	$48,496.34	2026-05-09
261-4	OTHER	Major Biliary Tract Procedures	9	9	—	—	$48,511.18	$52,683.14	$48,511.18	2026-05-09
614-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	9	9	—	—	$48,551.97	$52,727.44	$48,551.97	2026-05-09
356	OTHER	Other Digestive System O.r. Procedures With Mcc	29	26	—	—	$14,613.00	$280,788.62	$49,128.96	2026-05-09
603-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	9	9	—	—	$49,224.52	$53,457.83	$49,224.52	2026-05-09
008-3	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	9	9	—	—	$49,803.11	$54,086.18	$49,803.11	2026-05-09
319	OTHER	Other Endovascular Cardiac Valve Procedures With Mcc	31	28	—	—	$14,613.00	$112,279.68	$49,902.08	2026-05-09
681-4	OTHER	Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	9	9	—	—	$49,955.17	$54,251.31	$49,955.17	2026-05-09
009-1	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	9	9	—	—	$50,000.00	$54,300.00	$50,000.00	2026-05-09
001-1	OTHER	Liver Transplant And/or Intestinal Transplant	9	9	—	—	$50,000.00	$54,300.00	$50,000.00	2026-05-09
006-1	OTHER	Pancreas Transplant	9	9	—	—	$50,000.00	$54,300.00	$50,000.00	2026-05-09
002-1	OTHER	Heart And/or Lung Transplant	9	9	—	—	$50,000.00	$54,300.00	$50,000.00	2026-05-09
588-1	OTHER	Female Reproductive System Reconstructive Procedures	9	9	—	—	$50,000.00	$54,300.00	$50,000.00	2026-05-09
011-2	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	9	9	—	—	$50,000.00	$54,300.00	$50,000.00	2026-05-09
011-1	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	9	9	—	—	$50,000.00	$54,300.00	$50,000.00	2026-05-09
011-4	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	9	9	—	—	$50,021.00	$54,322.81	$50,021.00	2026-05-09
31	OTHER	Ventricular Shunt Procedures With Mcc	32	28	—	—	$27,144.00	$112,716.40	$50,096.18	2026-05-09
163	OTHER	Major Chest Procedures With Mcc	27	25	—	—	$35,077.36	$391,003.68	$50,110.52	2026-05-09
178-2	OTHER	External Heart Assist Systems	9	9	—	—	$50,489.26	$54,831.34	$50,489.26	2026-05-09
799	OTHER	Splenectomy With Mcc	27	25	—	—	$35,440.97	$113,917.41	$50,629.96	2026-05-09
441-4	OTHER	Major Bladder Procedures	9	9	—	—	$50,677.17	$55,035.41	$50,677.17	2026-05-09
312-4	OTHER	Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses	9	9	—	—	$50,700.66	$55,060.92	$50,700.66	2026-05-09
004-1	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	9	9	—	—	$50,788.44	$55,156.25	$50,788.44	2026-05-09
25	OTHER	Craniotomy And Endovascular Intracranial Procedures With Mcc	32	28	—	—	$31,011.00	$114,359.11	$50,826.27	2026-05-09
856	OTHER	Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc	27	25	—	—	$35,593.84	$114,408.76	$50,848.34	2026-05-09
245	OTHER	Aicd Generator Procedures	34	29	—	—	$14,676.00	$114,748.72	$50,999.43	2026-05-09
823	OTHER	Lymphoma And Non-acute Leukemia With Other Procedures With Mcc	27	25	—	—	$35,872.53	$144,865.75	$51,246.47	2026-05-09
020-4	OTHER	Open Craniotomy For Trauma	9	9	—	—	$51,294.09	$55,705.38	$51,294.09	2026-05-09
329	OTHER	Major Small And Large Bowel Procedures With Mcc	27	25	—	—	$35,962.85	$137,757.79	$51,375.50	2026-05-09
455	OTHER	Combined Anterior And Posterior Spinal Fusion Without Cc/mcc	37	32	—	—	$17,250.00	$124,234.60	$51,475.86	2026-05-09
440-2	OTHER	Kidney Transplant	9	9	—	—	$51,526.51	$55,957.79	$51,526.51	2026-05-09
277	OTHER	Cellulitis Age >17 W Cc	29	27	—	—	$31,434.00	$232,912.00	$51,618.13	2026-05-09
162-2	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	9	9	—	—	$51,635.31	$56,075.95	$51,635.31	2026-05-09
860-2	OTHER	Rehabilitation	1	1	—	—	$51,783.10	$51,783.10	$51,783.10	2026-05-09
950-4	OTHER	Extensive O.r. Procedure Unrelated To Principal Diagnosis	9	9	—	—	$52,181.75	$56,669.38	$52,181.75	2026-05-09
826	OTHER	Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …	27	25	—	—	$36,590.49	$127,461.39	$52,272.13	2026-05-09
981	OTHER	Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc	29	26	—	—	$14,613.00	$117,959.71	$52,426.54	2026-05-09
120-4	OTHER	Major Respiratory And Chest Procedures	9	9	—	—	$52,469.81	$56,982.21	$52,469.81	2026-05-09
650	OTHER	Kidney Transplant With Hemodialysis With Mcc	28	25	—	—	$14,613.00	$201,150.37	$52,532.39	2026-05-09
690-4	OTHER	Acute Leukemia	9	9	—	—	$52,571.18	$57,092.30	$52,571.18	2026-05-09
401-4	OTHER	Adrenal Procedures	9	9	—	—	$52,823.39	$57,366.20	$52,823.39	2026-05-09
740-4	OTHER	Mental Illness Diagnosis With O.r. Procedure	9	9	—	—	$53,102.79	$57,669.63	$53,102.79	2026-05-09
267	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc	36	30	—	—	$14,676.00	$141,706.73	$53,187.49	2026-05-09
220-4	OTHER	Major Stomach, Esophageal And Duodenal Procedures	9	9	—	—	$53,235.08	$57,813.30	$53,235.08	2026-05-09
089-4	OTHER	Major Cranial Or Facial Bone Procedures	9	9	—	—	$53,455.14	$58,052.28	$53,455.14	2026-05-09
837	OTHER	Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…	27	25	—	—	$37,567.07	$398,065.52	$53,667.24	2026-05-09
471	OTHER	Cervical Spinal Fusion With Mcc	37	32	—	—	$17,250.00	$330,936.40	$53,936.35	2026-05-09
165-3	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	9	9	—	—	$54,732.24	$59,439.21	$54,732.24	2026-05-09
576	OTHER	Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc	27	25	—	—	$10,820.87	$123,155.80	$54,735.91	2026-05-09
260-4	OTHER	Major Pancreas, Liver And Shunt Procedures	9	9	—	—	$54,766.85	$59,476.80	$54,766.85	2026-05-09
160-3	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	9	9	—	—	$54,810.12	$59,523.79	$54,810.12	2026-05-09
239	OTHER	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	27	25	—	—	$38,473.41	$166,534.55	$54,962.01	2026-05-09
850-4	OTHER	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	9	9	—	—	$54,998.04	$59,727.87	$54,998.04	2026-05-09
853	OTHER	Infectious And Parasitic Diseases With O.r. Procedures With Mcc	27	25	—	—	$38,603.87	$124,083.85	$55,148.38	2026-05-09
228	OTHER	Other Cardiothoracic Procedures With Mcc	37	31	—	—	$14,676.00	$124,302.24	$55,245.44	2026-05-09
2856831	OTHER	Sipuleucel-t 50m/250 Ml Inj	70	51	$105,172.23	$105,172.23	$3,124.00	$105,172.23	$55,272.32	2026-05-09
326	OTHER	Stomach, Esophageal And Duodenal Procedures With Mcc	27	25	—	—	$38,980.61	$323,920.01	$55,686.58	2026-05-09
236	OTHER	Coronary Bypass Without Cardiac Catheterization Without Mcc	51	41	—	—	$14,676.00	$105,478.04	$55,724.52	2026-05-09
023-4	OTHER	Spinal Procedures	9	9	—	—	$55,857.27	$60,661.00	$55,857.27	2026-05-09
130-4	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	9	9	—	—	$55,906.72	$60,714.70	$55,906.72	2026-05-09
483-4	OTHER	Penis, Testes And Scrotal Procedures	9	9	—	—	$55,967.30	$60,780.49	$55,967.30	2026-05-09
221	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	37	31	—	—	$14,676.00	$126,605.02	$56,268.90	2026-05-09
163-3	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	9	9	—	—	$56,605.23	$61,473.28	$56,605.23	2026-05-09
232-4	OTHER	Gastric Fundoplication	9	9	—	—	$56,722.68	$61,600.83	$56,722.68	2026-05-09
613-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	9	9	—	—	$57,063.90	$61,971.40	$57,063.90	2026-05-09
603-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	9	9	—	—	$57,213.49	$62,133.85	$57,213.49	2026-05-09
303-3	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	9	9	—	—	$57,648.67	$62,606.46	$57,648.67	2026-05-09
602-1	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	9	9	—	—	$57,756.23	$62,723.27	$57,756.23	2026-05-09
021-4	OTHER	Open Craniotomy Except Trauma	9	9	—	—	$57,892.22	$62,870.95	$57,892.22	2026-05-09
169-4	OTHER	Major Abdominal Vascular Procedures	9	9	—	—	$57,962.69	$62,947.48	$57,962.69	2026-05-09
653	OTHER	Major Bladder Procedures With Mcc	31	28	—	—	$11,200.00	$367,733.60	$57,991.57	2026-05-09
466	OTHER	Revision Of Hip Or Knee Replacement With Mcc	29	27	—	—	$28,116.00	$130,704.37	$58,090.83	2026-05-09
005-2	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	9	9	—	—	$58,277.95	$63,289.85	$58,277.95	2026-05-09
270	OTHER	Other Major Cardiovascular Procedures With Mcc	36	30	—	—	$14,676.00	$132,463.69	$58,872.75	2026-05-09
21	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	32	28	—	—	$39,137.00	$314,028.08	$59,065.75	2026-05-09
754-3	OTHER	Depression Except Major Depressive Disorder	1	1	—	—	$59,197.47	$59,197.47	$59,197.47	2026-05-09
220	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	37	31	—	—	$14,676.00	$133,865.68	$59,495.86	2026-05-09
009-2	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	9	9	—	—	$59,643.74	$64,773.10	$59,643.74	2026-05-09
440-3	OTHER	Kidney Transplant	9	9	—	—	$59,695.98	$64,829.83	$59,695.98	2026-05-09
609-2	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	9	9	—	—	$60,251.08	$65,432.67	$60,251.08	2026-05-09
17	OTHER	Autologous Bone Marrow Transplant Without Cc/mcc	27	25	—	—	$16,063.41	$136,334.72	$60,593.21	2026-05-09
625-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Other Significant Condition	9	9	—	—	$60,647.93	$65,863.65	$60,647.93	2026-05-09
11	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	27	25	—	—	$42,583.55	$191,373.12	$60,833.64	2026-05-09
912-4	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	9	9	—	—	$60,921.16	$66,160.38	$60,921.16	2026-05-09
234	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	37	31	—	—	$14,676.00	$137,089.08	$60,928.48	2026-05-09
405	OTHER	Pancreas, Liver And Shunt Procedures With Mcc	27	25	—	—	$42,710.15	$137,282.63	$61,014.50	2026-05-09
841-3	OTHER	Extensive Third Degree Burns With Skin Graft	9	9	—	—	$61,016.35	$66,263.76	$61,016.35	2026-05-09
6	OTHER	Liver Transplant Without Mcc	26	24	—	—	$39,732.42	$521,055.48	$61,017.34	2026-05-09
834	OTHER	Acute Leukemia Without Major O.r. Procedures With Mcc	27	25	—	—	$33,843.26	$137,764.06	$61,228.47	2026-05-09
612-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	9	9	—	—	$61,477.49	$66,764.55	$61,477.49	2026-05-09
461	OTHER	Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc	32	28	—	—	$28,110.00	$317,884.20	$61,593.52	2026-05-09
680-4	OTHER	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	9	9	—	—	$61,800.16	$67,114.97	$61,800.16	2026-05-09
613-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	9	9	—	—	$62,000.00	$67,332.00	$62,000.00	2026-05-09
278	OTHER	Cellulitis Age >17 Without Cc	29	27	—	—	$12,266.30	$139,657.39	$62,069.95	2026-05-09
8	OTHER	Simultaneous Pancreas And Kidney Transplant	26	24	—	—	$43,745.41	$503,149.34	$62,493.45	2026-05-09
178-3	OTHER	External Heart Assist Systems	9	9	—	—	$62,630.96	$68,017.22	$62,630.96	2026-05-09
091-4	OTHER	Other Major Head And Neck Procedures	9	9	—	—	$62,795.39	$68,195.79	$62,795.39	2026-05-09
167-4	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	9	9	—	—	$63,009.27	$68,428.07	$63,009.27	2026-05-09
634-4	OTHER	Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…	9	9	—	—	$63,062.43	$68,485.80	$63,062.43	2026-05-09
304-4	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	9	9	—	—	$63,472.88	$68,931.55	$63,472.88	2026-05-09
463	OTHER	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …	27	25	—	—	$44,478.04	$142,965.14	$63,540.06	2026-05-09
911-4	OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	9	9	—	—	$63,812.86	$69,300.77	$63,812.86	2026-05-09
623-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	9	9	—	—	$63,846.24	$69,337.02	$63,846.24	2026-05-09
23	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	30	26	—	—	$39,137.00	$243,876.52	$63,879.75	2026-05-09
179-4	OTHER	Defibrillator Implants	9	9	—	—	$64,133.06	$69,648.50	$64,133.06	2026-05-09
166-4	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	9	9	—	—	$64,196.11	$69,716.98	$64,196.11	2026-05-09
820	OTHER	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	27	25	—	—	$45,754.16	$147,066.95	$65,363.09	2026-05-09
235	OTHER	Coronary Bypass Without Cardiac Catheterization With Mcc	37	31	—	—	$14,676.00	$147,161.25	$65,405.00	2026-05-09
457	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	37	32	—	—	$17,250.00	$149,506.20	$65,608.54	2026-05-09
16	OTHER	Autologous Bone Marrow Transplant With Cc/mcc	26	24	—	—	$46,255.20	$150,404.95	$66,078.86	2026-05-09
28	OTHER	Spinal Procedures With Mcc	37	32	—	—	$17,250.00	$150,627.85	$66,097.51	2026-05-09
790	OTHER	Extreme Immaturity Or Respiratory Distress Syndrome, Neonate	26	25	—	—	$4,356.29	$149,019.86	$66,231.05	2026-05-09
622-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…	9	9	—	—	$66,421.45	$72,133.69	$66,421.45	2026-05-09
910-4	OTHER	Craniotomy For Multiple Significant Trauma	9	9	—	—	$66,461.02	$72,176.67	$66,461.02	2026-05-09
276	OTHER	Non-maligant Breast Disorders	29	27	—	—	$42,227.00	$150,585.66	$66,926.96	2026-05-09
162-3	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	9	9	—	—	$67,469.84	$73,272.25	$67,469.84	2026-05-09
232	OTHER	Coronary Bypass With Ptca Without Mcc	36	30	—	—	$14,676.00	$165,110.47	$67,544.55	2026-05-09
454	OTHER	Combined Anterior And Posterior Spinal Fusion With Cc	37	32	—	—	$17,250.00	$153,307.78	$68,136.79	2026-05-09
266	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	36	30	—	—	$14,676.00	$159,276.07	$68,270.24	2026-05-09
183-4	OTHER	Percutaneous Structural Cardiac Procedures	9	9	—	—	$68,536.76	$74,430.92	$68,536.76	2026-05-09
607-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	9	9	—	—	$68,821.11	$74,739.73	$68,821.11	2026-05-09
510-4	OTHER	Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced…	1	1	—	—	$68,822.35	$68,822.35	$68,822.35	2026-05-09
608-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	9	9	—	—	$70,000.00	$76,020.00	$70,000.00	2026-05-09
004-2	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	9	9	—	—	$70,000.00	$76,020.00	$70,000.00	2026-05-09
608-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	9	9	—	—	$70,000.00	$76,020.00	$70,000.00	2026-05-09
207	OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	27	25	—	—	$50,153.81	$474,283.21	$71,648.30	2026-05-09
001-2	OTHER	Liver Transplant And/or Intestinal Transplant	9	9	—	—	$71,659.66	$77,822.39	$71,659.66	2026-05-09
631-3	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	9	9	—	—	$72,321.08	$78,540.69	$72,321.08	2026-05-09
573	OTHER	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	27	25	—	—	$50,719.95	$164,104.54	$72,935.35	2026-05-09
218	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	36	30	—	—	$14,676.00	$164,697.59	$73,198.93	2026-05-09
217	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	37	31	—	—	$14,676.00	$164,697.59	$73,198.93	2026-05-09
459	OTHER	Spinal Fusion Except Cervical With Mcc	37	32	—	—	$17,250.00	$166,112.03	$73,827.57	2026-05-09
165-4	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	9	9	—	—	$74,239.82	$80,624.44	$74,239.82	2026-05-09
955	OTHER	Craniotomy For Multiple Significant Trauma	32	28	—	—	$31,554.00	$172,870.59	$74,917.18	2026-05-09
008-4	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	9	9	—	—	$75,929.84	$82,459.81	$75,929.84	2026-05-09
268	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	36	30	—	—	$14,676.00	$459,641.04	$76,536.19	2026-05-09
870	OTHER	Septicemia Or Severe Sepsis With Mv >96 Hours	27	25	—	—	$53,837.05	$174,546.66	$76,910.07	2026-05-09
005-3	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	9	9	—	—	$77,000.00	$83,622.00	$77,000.00	2026-05-09
178-4	OTHER	External Heart Assist Systems	9	9	—	—	$77,236.61	$83,878.96	$77,236.61	2026-05-09
007-2	OTHER	Allogeneic Bone Marrow Transplant	9	9	—	—	$77,490.05	$84,154.19	$77,490.05	2026-05-09
006-2	OTHER	Pancreas Transplant	9	9	—	—	$78,048.86	$84,761.06	$78,048.86	2026-05-09
593-2	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	9	9	—	—	$79,000.00	$85,794.00	$79,000.00	2026-05-09
275	OTHER	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	29	27	—	—	$49,823.00	$178,472.07	$79,320.92	2026-05-09
19	OTHER	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	27	25	—	—	$13,913.56	$178,576.31	$79,367.25	2026-05-09
928	OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	27	25	—	—	$49,560.14	$179,521.69	$79,787.42	2026-05-09
10	OTHER	Pancreas Transplant	26	24	—	—	$55,874.36	$309,322.10	$79,820.51	2026-05-09
591-2	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	9	9	—	—	$80,000.00	$86,880.00	$80,000.00	2026-05-09
603-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	9	9	—	—	$80,000.00	$86,880.00	$80,000.00	2026-05-09
602-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	9	9	—	—	$80,000.00	$86,880.00	$80,000.00	2026-05-09
163-4	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	9	9	—	—	$82,807.37	$89,928.80	$82,807.37	2026-05-09
969	OTHER	HIV With Extensive O.r. Procedures With Mcc	27	25	—	—	$55,792.00	$629,752.79	$84,395.00	2026-05-09
957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	27	25	—	—	$59,303.59	$190,618.70	$84,719.42	2026-05-09
233	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	37	31	—	—	$14,676.00	$191,246.49	$84,998.44	2026-05-09
006-4	OTHER	Pancreas Transplant	9	9	—	—	$85,000.00	$92,310.00	$85,000.00	2026-05-09
006-3	OTHER	Pancreas Transplant	9	9	—	—	$85,000.00	$92,310.00	$85,000.00	2026-05-09
219	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	37	31	—	—	$14,676.00	$257,067.25	$85,363.50	2026-05-09
607-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	9	9	—	—	$86,000.00	$93,396.00	$86,000.00	2026-05-09
589-3	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	9	9	—	—	$87,000.00	$94,482.00	$87,000.00	2026-05-09
007-1	OTHER	Allogeneic Bone Marrow Transplant	9	9	—	—	$87,077.55	$94,566.22	$87,077.55	2026-05-09
20	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	32	28	—	—	$39,137.00	$329,106.17	$87,464.45	2026-05-09
005-4	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	9	9	—	—	$88,000.00	$95,568.00	$88,000.00	2026-05-09
001-3	OTHER	Liver Transplant And/or Intestinal Transplant	9	9	—	—	$88,813.32	$96,451.27	$88,813.32	2026-05-09
612-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	9	9	—	—	$89,000.00	$96,654.00	$89,000.00	2026-05-09
440-4	OTHER	Kidney Transplant	9	9	—	—	$89,677.49	$97,389.75	$89,677.49	2026-05-09
621-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	9	9	—	—	$90,000.00	$97,740.00	$90,000.00	2026-05-09
004-3	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	9	9	—	—	$91,000.00	$98,826.00	$91,000.00	2026-05-09
591-3	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	9	9	—	—	$91,000.00	$98,826.00	$91,000.00	2026-05-09
602-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	9	9	—	—	$92,000.00	$99,912.00	$92,000.00	2026-05-09
611-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	9	9	—	—	$93,000.00	$100,998.00	$93,000.00	2026-05-09
456	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	37	32	—	—	$17,250.00	$276,677.29	$93,360.34	2026-05-09
231	OTHER	Coronary Bypass With Ptca With Mcc	37	31	—	—	$14,676.00	$265,676.26	$93,652.60	2026-05-09
609-3	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	9	9	—	—	$94,091.08	$102,182.91	$94,091.08	2026-05-09
162-4	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	9	9	—	—	$94,196.17	$102,297.04	$94,196.17	2026-05-09
630-3	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	9	9	—	—	$95,000.00	$103,170.00	$95,000.00	2026-05-09
453	OTHER	Combined Anterior And Posterior Spinal Fusion With Mcc	37	32	—	—	$17,250.00	$232,607.28	$98,411.45	2026-05-09
593-3	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	9	9	—	—	$99,000.00	$107,514.00	$99,000.00	2026-05-09
607-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	9	9	—	—	$100,000.00	$108,600.00	$100,000.00	2026-05-09
602-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	9	9	—	—	$100,000.00	$108,600.00	$100,000.00	2026-05-09
007-3	OTHER	Allogeneic Bone Marrow Transplant	9	9	—	—	$104,111.30	$113,064.87	$104,111.30	2026-05-09
842-4	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	9	9	—	—	$107,903.03	$117,182.69	$107,903.03	2026-05-09
216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	37	31	—	—	$14,676.00	$258,237.35	$108,573.22	2026-05-09
004-4	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	9	9	—	—	$110,000.00	$119,460.00	$110,000.00	2026-05-09
215	OTHER	Other Heart Assist System Implant	36	30	—	—	$14,676.00	$284,859.31	$110,494.42	2026-05-09
633-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Anomaly	9	9	—	—	$111,331.29	$120,905.78	$111,331.29	2026-05-09
5	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	26	24	—	—	$80,075.11	$402,528.08	$114,393.02	2026-05-09
161-1	OTHER	Implantable Heart Assist Systems	9	9	—	—	$117,988.01	$128,134.98	$117,988.01	2026-05-09
002-2	OTHER	Heart And/or Lung Transplant	9	9	—	—	$118,397.98	$128,580.21	$118,397.98	2026-05-09
303-4	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	9	9	—	—	$120,000.00	$130,320.00	$120,000.00	2026-05-09
001-4	OTHER	Liver Transplant And/or Intestinal Transplant	9	9	—	—	$120,000.00	$130,320.00	$120,000.00	2026-05-09
591-4	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	9	9	—	—	$120,000.00	$130,320.00	$120,000.00	2026-05-09
212	OTHER	Hip & Femur Procedures Except Major Joint Age 0-17	27	25	—	—	$84,426.13	$271,369.69	$120,608.75	2026-05-09
593-4	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	9	9	—	—	$121,000.00	$131,406.00	$121,000.00	2026-05-09
160-4	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	9	9	—	—	$124,698.16	$135,422.20	$124,698.16	2026-05-09
2	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	26	24	—	—	$87,959.58	$639,953.88	$125,656.55	2026-05-09
161-2	OTHER	Implantable Heart Assist Systems	9	9	—	—	$128,273.54	$139,305.06	$128,273.54	2026-05-09
009-3	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	9	9	—	—	$128,412.01	$139,455.44	$128,412.01	2026-05-09
588-2	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	9	9	—	—	$130,000.00	$141,180.00	$130,000.00	2026-05-09
588-3	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	9	9	—	—	$132,000.00	$143,352.00	$132,000.00	2026-05-09
14	OTHER	Allogeneic Bone Marrow Transplant	27	25	—	—	$33,049.73	$299,752.40	$133,223.29	2026-05-09
863-4	OTHER	Neonatal Aftercare	9	9	—	—	$138,804.09	$150,741.24	$138,804.09	2026-05-09
009-4	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	9	9	—	—	$139,000.00	$150,954.00	$139,000.00	2026-05-09
002-3	OTHER	Heart And/or Lung Transplant	9	9	—	—	$139,975.16	$152,013.02	$139,975.16	2026-05-09
4	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	27	25	—	—	$107,410.97	$806,829.58	$153,444.25	2026-05-09
007-4	OTHER	Allogeneic Bone Marrow Transplant	9	9	—	—	$156,612.88	$170,081.59	$156,612.88	2026-05-09
161-3	OTHER	Implantable Heart Assist Systems	9	9	—	—	$163,685.56	$177,762.52	$163,685.56	2026-05-09
609-4	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	9	9	—	—	$165,000.00	$179,190.00	$165,000.00	2026-05-09
841-4	OTHER	Extensive Third Degree Burns With Skin Graft	9	9	—	—	$168,218.77	$182,685.58	$168,218.77	2026-05-09
583-1	OTHER	Neonate With Ecmo	9	9	—	—	$180,157.09	$195,650.60	$180,157.09	2026-05-09
589-1	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	9	9	—	—	$184,079.96	$199,910.84	$184,079.96	2026-05-09
583-2	OTHER	Neonate With Ecmo	9	9	—	—	$199,338.50	$216,481.61	$199,338.50	2026-05-09
480-4	OTHER	Major Male Pelvic Procedures	1	1	—	—	$203,077.60	$203,077.60	$203,077.60	2026-05-09
002-4	OTHER	Heart And/or Lung Transplant	9	9	—	—	$210,006.45	$228,067.00	$210,006.45	2026-05-09
011-3	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	9	9	—	—	$213,464.00	$231,821.90	$213,464.00	2026-05-09
588-4	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	9	9	—	—	$221,000.00	$240,006.00	$221,000.00	2026-05-09
583-3	OTHER	Neonate With Ecmo	9	9	—	—	$221,000.00	$240,006.00	$221,000.00	2026-05-09
583-4	OTHER	Neonate With Ecmo	9	9	—	—	$221,000.00	$240,006.00	$221,000.00	2026-05-09
630-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	9	9	—	—	$225,389.88	$244,773.41	$225,389.88	2026-05-09
161-4	OTHER	Implantable Heart Assist Systems	9	9	—	—	$227,262.67	$246,807.26	$227,262.67	2026-05-09
3	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	27	25	—	—	$164,336.96	$548,334.50	$234,767.08	2026-05-09
927	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	27	25	—	—	$165,304.29	$531,335.23	$236,148.99	2026-05-09
631-4	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	9	9	—	—	$254,329.29	$276,201.61	$254,329.29	2026-05-09
1	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	26	24	—	—	$216,823.16	$719,603.23	$309,747.37	2026-05-09
7	OTHER	Lung Transplant	26	24	—	—	$215,107.66	$1,838,420.12	$322,599.93	2026-05-09
18	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	27	25	—	—	$333,850.38	$2,431,051.85	$507,414.03	2026-05-09

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