|
45006121000
|
OTHER
|
Pierce Skull Implant Device
|
107
|
71
|
$52,500.00
|
$52,500.00
|
$280.34
|
$200,025.00
|
$49,875.00
|
2026-05-11
|
|
215
|
OTHER
|
Other Heart Assist System Implant
|
71
|
55
|
—
|
—
|
$15,100.00
|
$265,490.85
|
$106,665.67
|
2026-05-11
|
|
216
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
71
|
55
|
—
|
—
|
$10,600.00
|
$260,982.42
|
$104,854.33
|
2026-05-11
|
|
231
|
OTHER
|
Coronary Bypass With Ptca With Mcc
|
71
|
55
|
—
|
—
|
$12,400.00
|
$225,967.98
|
$90,786.65
|
2026-05-11
|
|
219
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
71
|
55
|
—
|
—
|
$9,500.00
|
$206,515.87
|
$82,971.42
|
2026-05-11
|
|
233
|
OTHER
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
71
|
55
|
—
|
—
|
$10,600.00
|
$205,659.20
|
$82,627.24
|
2026-05-11
|
|
218
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
71
|
55
|
—
|
—
|
$9,500.00
|
$177,969.13
|
$71,502.26
|
2026-05-11
|
|
217
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
71
|
55
|
—
|
—
|
$9,500.00
|
$177,969.13
|
$71,502.26
|
2026-05-11
|
|
232
|
OTHER
|
Coronary Bypass With Ptca Without Mcc
|
71
|
55
|
—
|
—
|
$11,300.00
|
$164,699.95
|
$66,171.13
|
2026-05-11
|
|
235
|
OTHER
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
71
|
55
|
—
|
—
|
$9,500.00
|
$159,679.01
|
$64,153.88
|
2026-05-11
|
|
234
|
OTHER
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc
|
71
|
55
|
—
|
—
|
$10,600.00
|
$149,173.94
|
$59,933.28
|
2026-05-11
|
|
220
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
71
|
55
|
—
|
—
|
$9,500.00
|
$145,812.01
|
$58,582.57
|
2026-05-11
|
|
221
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
71
|
55
|
—
|
—
|
$9,500.00
|
$138,239.23
|
$55,540.07
|
2026-05-11
|
|
228
|
OTHER
|
Other Cardiothoracic Procedures With Mcc
|
71
|
55
|
—
|
—
|
$9,500.00
|
$135,837.47
|
$54,575.12
|
2026-05-11
|
|
245
|
OTHER
|
Aicd Generator Procedures
|
72
|
55
|
—
|
—
|
$3,600.00
|
$125,873.27
|
$50,571.82
|
2026-05-11
|
|
236
|
OTHER
|
Coronary Bypass Without Cardiac Catheterization Without Mcc
|
71
|
55
|
—
|
—
|
$9,500.00
|
$116,204.15
|
$46,687.08
|
2026-05-11
|
|
275
|
OTHER
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
67
|
54
|
—
|
—
|
$5,800.00
|
$192,335.64
|
$77,274.26
|
2026-05-11
|
|
471
|
OTHER
|
Cervical Spinal Fusion With Mcc
|
66
|
54
|
—
|
—
|
$3,700.00
|
$137,086.02
|
$60,235.50
|
2026-05-11
|
|
267
|
OTHER
|
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc
|
68
|
54
|
—
|
—
|
$5,800.00
|
$131,008.08
|
$52,634.83
|
2026-05-11
|
|
981
|
OTHER
|
Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc
|
66
|
54
|
—
|
—
|
$1,900.00
|
$129,222.31
|
$51,917.36
|
2026-05-11
|
|
876
|
OTHER
|
O.r. Procedures With Principal Diagnosis Of Mental Illness
|
66
|
54
|
—
|
—
|
$1,726.98
|
$107,821.29
|
$42,669.34
|
2026-05-11
|
|
001
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
65
|
53
|
—
|
—
|
$4,700.00
|
$733,080.14
|
$294,527.98
|
2026-05-11
|
|
002
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
65
|
53
|
—
|
—
|
$4,700.00
|
$319,991.07
|
$158,411.42
|
2026-05-11
|
|
268
|
OTHER
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
67
|
53
|
—
|
—
|
$9,500.00
|
$201,503.63
|
$99,754.27
|
2026-05-11
|
|
266
|
OTHER
|
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc
|
67
|
53
|
—
|
—
|
$9,500.00
|
$166,402.95
|
$66,855.34
|
2026-05-11
|
|
270
|
OTHER
|
Other Major Cardiovascular Procedures With Mcc
|
67
|
53
|
—
|
—
|
$9,500.00
|
$144,349.73
|
$57,995.07
|
2026-05-11
|
|
319
|
OTHER
|
Other Endovascular Cardiac Valve Procedures With Mcc
|
67
|
53
|
—
|
—
|
$2,600.00
|
$123,298.10
|
$49,537.20
|
2026-05-11
|
|
269
|
OTHER
|
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc
|
67
|
53
|
—
|
—
|
$9,500.00
|
$117,094.46
|
$47,044.78
|
2026-05-11
|
|
040
|
OTHER
|
Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc
|
65
|
53
|
—
|
—
|
$3,600.00
|
$111,231.25
|
$43,280.64
|
2026-05-11
|
|
018
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
64
|
52
|
—
|
—
|
$572,240.79
|
$1,444,908.00
|
$715,300.99
|
2026-05-11
|
|
927
|
OTHER
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
64
|
52
|
—
|
—
|
$180,109.58
|
$560,365.94
|
$225,136.98
|
2026-05-11
|
|
003
|
OTHER
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
64
|
52
|
—
|
—
|
$179,067.26
|
$575,253.59
|
$223,834.08
|
2026-05-11
|
|
004
|
OTHER
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
65
|
52
|
—
|
—
|
$167,492.00
|
$422,917.30
|
$209,365.00
|
2026-05-11
|
|
969
|
OTHER
|
HIV With Extensive O.r. Procedures With Mcc
|
64
|
52
|
—
|
—
|
$115,824.83
|
$292,457.70
|
$144,781.04
|
2026-05-11
|
|
014
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
64
|
52
|
—
|
—
|
$33,049.73
|
$318,828.98
|
$128,095.21
|
2026-05-11
|
|
212
|
OTHER
|
Hip & Femur Procedures Except Major Joint Age 0-17
|
64
|
52
|
—
|
—
|
$92,961.45
|
$289,226.31
|
$116,201.81
|
2026-05-11
|
|
207
|
OTHER
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
64
|
52
|
—
|
—
|
$82,274.91
|
$207,744.15
|
$102,843.64
|
2026-05-11
|
|
570
|
OTHER
|
Skin Debridement With Mcc
|
64
|
52
|
—
|
—
|
$70,258.56
|
$194,850.07
|
$96,460.43
|
2026-05-11
|
|
453
|
OTHER
|
Combined Anterior And Posterior Spinal Fusion With Mcc
|
64
|
52
|
—
|
—
|
$76,218.77
|
$244,852.80
|
$95,273.46
|
2026-05-11
|
|
456
|
OTHER
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
64
|
52
|
—
|
—
|
$72,408.90
|
$232,613.57
|
$90,511.12
|
2026-05-11
|
|
020
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
64
|
52
|
—
|
—
|
$67,961.82
|
$218,327.33
|
$84,952.27
|
2026-05-11
|
|
957
|
OTHER
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
64
|
52
|
—
|
—
|
$65,891.34
|
$211,675.91
|
$82,364.17
|
2026-05-11
|
|
837
|
OTHER
|
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…
|
64
|
52
|
—
|
—
|
$62,859.22
|
$158,719.52
|
$78,574.02
|
2026-05-11
|
|
928
|
OTHER
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
64
|
52
|
—
|
—
|
$49,560.14
|
$193,430.44
|
$77,714.12
|
2026-05-11
|
|
019
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
64
|
52
|
—
|
—
|
$13,913.56
|
$192,444.38
|
$77,317.95
|
2026-05-11
|
|
163
|
OTHER
|
Major Chest Procedures With Mcc
|
64
|
52
|
—
|
—
|
$60,775.07
|
$153,457.05
|
$75,968.84
|
2026-05-11
|
|
870
|
OTHER
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
64
|
52
|
—
|
—
|
$60,001.00
|
$186,678.11
|
$75,001.25
|
2026-05-11
|
|
955
|
OTHER
|
Craniotomy For Multiple Significant Trauma
|
64
|
52
|
—
|
—
|
$58,497.82
|
$187,924.26
|
$73,122.28
|
2026-05-11
|
|
459
|
OTHER
|
Spinal Fusion Except Cervical With Mcc
|
64
|
52
|
—
|
—
|
$57,675.97
|
$185,284.04
|
$72,094.96
|
2026-05-11
|
|
573
|
OTHER
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
64
|
52
|
—
|
—
|
$50,719.95
|
$177,350.55
|
$71,253.74
|
2026-05-11
|
|
653
|
OTHER
|
Major Bladder Procedures With Mcc
|
64
|
52
|
—
|
—
|
$56,864.30
|
$143,582.34
|
$71,080.37
|
2026-05-11
|
|
454
|
OTHER
|
Combined Anterior And Posterior Spinal Fusion With Cc
|
64
|
52
|
—
|
—
|
$53,383.60
|
$171,494.82
|
$66,729.50
|
2026-05-11
|
|
028
|
OTHER
|
Spinal Procedures With Mcc
|
64
|
52
|
—
|
—
|
$52,485.22
|
$168,608.75
|
$65,606.52
|
2026-05-11
|
|
276
|
OTHER
|
Non-maligant Breast Disorders
|
64
|
52
|
—
|
—
|
$52,471.08
|
$163,250.64
|
$65,588.85
|
2026-05-11
|
|
457
|
OTHER
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
64
|
52
|
—
|
—
|
$52,109.22
|
$167,400.87
|
$65,136.53
|
2026-05-11
|
|
790
|
OTHER
|
Extreme Immaturity Or Respiratory Distress Syndrome, Neonate
|
64
|
52
|
—
|
—
|
$4,356.29
|
$161,617.50
|
$64,932.70
|
2026-05-11
|
|
016
|
OTHER
|
Autologous Bone Marrow Transplant With Cc/mcc
|
64
|
52
|
—
|
—
|
$51,831.37
|
$161,260.35
|
$64,789.21
|
2026-05-11
|
|
820
|
OTHER
|
Lymphoma And Leukemia With Major O.r. Procedures With Mcc
|
64
|
52
|
—
|
—
|
$51,291.50
|
$159,580.69
|
$64,114.38
|
2026-05-11
|
|
023
|
OTHER
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
64
|
52
|
—
|
—
|
$50,172.66
|
$161,179.68
|
$62,715.83
|
2026-05-11
|
|
463
|
OTHER
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …
|
64
|
52
|
—
|
—
|
$49,916.45
|
$155,302.55
|
$62,395.56
|
2026-05-11
|
|
278
|
OTHER
|
Cellulitis Age >17 Without Cc
|
64
|
52
|
—
|
—
|
$12,266.30
|
$151,852.62
|
$61,009.49
|
2026-05-11
|
|
461
|
OTHER
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
64
|
52
|
—
|
—
|
$48,448.23
|
$150,734.56
|
$60,560.29
|
2026-05-11
|
|
834
|
OTHER
|
Acute Leukemia Without Major O.r. Procedures With Mcc
|
64
|
52
|
—
|
—
|
$33,843.26
|
$149,877.89
|
$60,216.11
|
2026-05-11
|
|
405
|
OTHER
|
Pancreas, Liver And Shunt Procedures With Mcc
|
64
|
52
|
—
|
—
|
$48,011.50
|
$149,375.80
|
$60,014.38
|
2026-05-11
|
|
011
|
OTHER
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc
|
64
|
52
|
—
|
—
|
$47,875.09
|
$148,951.36
|
$59,843.86
|
2026-05-11
|
|
017
|
OTHER
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
64
|
52
|
—
|
—
|
$16,063.41
|
$148,387.16
|
$59,617.18
|
2026-05-11
|
|
326
|
OTHER
|
Stomach, Esophageal And Duodenal Procedures With Mcc
|
65
|
52
|
—
|
—
|
$46,264.72
|
$136,872.71
|
$58,643.47
|
2026-05-11
|
|
021
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
64
|
52
|
—
|
—
|
$46,541.63
|
$149,515.00
|
$58,177.04
|
2026-05-11
|
|
466
|
OTHER
|
Revision Of Hip Or Knee Replacement With Mcc
|
64
|
52
|
—
|
—
|
$45,806.27
|
$142,514.76
|
$57,257.84
|
2026-05-11
|
|
853
|
OTHER
|
Infectious And Parasitic Diseases With O.r. Procedures With Mcc
|
65
|
52
|
—
|
—
|
$32,045.00
|
$135,609.73
|
$54,483.62
|
2026-05-11
|
|
239
|
OTHER
|
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc
|
64
|
52
|
—
|
—
|
$43,446.31
|
$135,172.33
|
$54,307.89
|
2026-05-11
|
|
576
|
OTHER
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc
|
64
|
52
|
—
|
—
|
$10,820.87
|
$134,641.78
|
$54,094.73
|
2026-05-11
|
|
650
|
OTHER
|
Kidney Transplant With Hemodialysis With Mcc
|
64
|
52
|
—
|
—
|
$41,613.74
|
$129,470.74
|
$52,017.17
|
2026-05-11
|
|
826
|
OTHER
|
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …
|
64
|
52
|
—
|
—
|
$41,417.42
|
$128,859.94
|
$51,771.77
|
2026-05-11
|
|
277
|
OTHER
|
Cellulitis Age >17 W Cc
|
64
|
52
|
—
|
—
|
$40,924.14
|
$127,325.22
|
$51,155.17
|
2026-05-11
|
|
455
|
OTHER
|
Combined Anterior And Posterior Spinal Fusion Without Cc/mcc
|
64
|
52
|
—
|
—
|
$40,816.82
|
$131,124.04
|
$51,021.03
|
2026-05-11
|
|
329
|
OTHER
|
Major Small And Large Bowel Procedures With Mcc
|
64
|
52
|
—
|
—
|
$40,741.11
|
$126,755.79
|
$50,926.39
|
2026-05-11
|
|
823
|
OTHER
|
Lymphoma And Non-acute Leukemia With Other Procedures With Mcc
|
64
|
52
|
—
|
—
|
$40,643.79
|
$126,453.00
|
$50,804.74
|
2026-05-11
|
|
856
|
OTHER
|
Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc
|
64
|
52
|
—
|
—
|
$40,343.50
|
$125,518.71
|
$50,429.37
|
2026-05-11
|
|
025
|
OTHER
|
Craniotomy And Endovascular Intracranial Procedures With Mcc
|
64
|
52
|
—
|
—
|
$40,326.86
|
$129,550.05
|
$50,408.58
|
2026-05-11
|
|
799
|
OTHER
|
Splenectomy With Mcc
|
64
|
52
|
—
|
—
|
$40,178.79
|
$125,006.27
|
$50,223.49
|
2026-05-11
|
|
031
|
OTHER
|
Ventricular Shunt Procedures With Mcc
|
64
|
52
|
—
|
—
|
$39,776.18
|
$127,780.98
|
$49,720.23
|
2026-05-11
|
|
022
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…
|
64
|
52
|
—
|
—
|
$39,529.90
|
$99,812.98
|
$49,412.37
|
2026-05-11
|
|
356
|
OTHER
|
Other Digestive System O.r. Procedures With Mcc
|
64
|
52
|
—
|
—
|
$39,046.65
|
$121,483.88
|
$48,808.31
|
2026-05-11
|
|
323
|
OTHER
|
Urinary Stones W Cc, &/or Esw Lithotripsy
|
64
|
52
|
—
|
—
|
$38,502.62
|
$119,791.26
|
$48,128.27
|
2026-05-11
|
|
474
|
OTHER
|
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc
|
64
|
52
|
—
|
—
|
$38,215.62
|
$118,898.36
|
$47,769.53
|
2026-05-11
|
|
140
|
OTHER
|
Major Head And Neck Procedures With Mcc
|
64
|
52
|
—
|
—
|
$37,986.03
|
$118,184.04
|
$47,482.54
|
2026-05-11
|
|
012
|
OTHER
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc
|
64
|
52
|
—
|
—
|
$37,575.94
|
$116,908.13
|
$46,969.92
|
2026-05-11
|
|
958
|
OTHER
|
Other O.r. Procedures For Multiple Significant Trauma With Cc
|
64
|
52
|
—
|
—
|
$37,558.46
|
$120,656.56
|
$46,948.08
|
2026-05-11
|
|
673
|
OTHER
|
Other Kidney And Urinary Tract Procedures With Mcc
|
64
|
52
|
—
|
—
|
$37,456.14
|
$116,535.43
|
$46,820.18
|
2026-05-11
|
|
901
|
OTHER
|
Wound Debridements For Injuries With Mcc
|
64
|
52
|
—
|
—
|
$37,414.55
|
$116,406.03
|
$46,768.19
|
2026-05-11
|
|
458
|
OTHER
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
64
|
52
|
—
|
—
|
$37,214.90
|
$119,552.89
|
$46,518.63
|
2026-05-11
|
|
793
|
OTHER
|
Full Term Neonate With Major Problems
|
64
|
52
|
—
|
—
|
$7,257.47
|
$115,707.21
|
$46,487.43
|
2026-05-11
|
|
423
|
OTHER
|
Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc
|
64
|
52
|
—
|
—
|
$37,051.86
|
$115,277.59
|
$46,314.82
|
2026-05-11
|
|
273
|
OTHER
|
Percutaneous And Other Intracardiac Procedures With Mcc
|
66
|
52
|
—
|
—
|
$36,823.10
|
$114,565.86
|
$46,028.87
|
2026-05-11
|
|
791
|
OTHER
|
Prematurity With Major Problems
|
64
|
52
|
—
|
—
|
$7,138.94
|
$112,844.78
|
$45,337.40
|
2026-05-11
|
|
802
|
OTHER
|
Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc
|
64
|
52
|
—
|
—
|
$35,646.87
|
$110,906.34
|
$44,558.59
|
2026-05-11
|
|
024
|
OTHER
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
64
|
52
|
—
|
—
|
$35,046.27
|
$112,586.14
|
$43,807.84
|
2026-05-11
|
|
933
|
OTHER
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft
|
64
|
52
|
—
|
—
|
$34,899.02
|
$108,579.58
|
$43,623.78
|
2026-05-11
|
|
034
|
OTHER
|
Carotid Artery Stent Procedures With Mcc
|
64
|
52
|
—
|
—
|
$34,703.54
|
$107,971.41
|
$43,379.43
|
2026-05-11
|
|
907
|
OTHER
|
Other O.r. Procedures For Injuries With Mcc
|
64
|
52
|
—
|
—
|
$34,442.34
|
$107,158.75
|
$43,052.93
|
2026-05-11
|
|
956
|
OTHER
|
Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma
|
64
|
52
|
—
|
—
|
$33,807.64
|
$105,184.01
|
$42,259.55
|
2026-05-11
|
|
143
|
OTHER
|
Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc
|
64
|
52
|
—
|
—
|
$33,671.22
|
$104,759.57
|
$42,089.02
|
2026-05-11
|
|
166
|
OTHER
|
Other Respiratory System O.r. Procedures With Mcc
|
64
|
52
|
—
|
—
|
$33,597.18
|
$104,529.24
|
$41,996.48
|
2026-05-11
|
|
518
|
OTHER
|
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost…
|
64
|
52
|
—
|
—
|
$33,593.86
|
$104,518.90
|
$41,992.33
|
2026-05-11
|
|
628
|
OTHER
|
Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc
|
64
|
52
|
—
|
—
|
$33,506.51
|
$104,247.13
|
$41,883.14
|
2026-05-11
|
|
651
|
OTHER
|
Kidney Transplant With Hemodialysis Without Mcc
|
64
|
52
|
—
|
—
|
$33,331.82
|
$103,703.62
|
$41,664.77
|
2026-05-11
|
|
007
|
OTHER
|
Lung Transplant
|
62
|
50
|
—
|
—
|
$287,153.13
|
$989,968.71
|
$490,083.52
|
2026-05-11
|
|
006
|
OTHER
|
Liver Transplant Without Mcc
|
62
|
50
|
—
|
—
|
$89,534.27
|
$226,074.03
|
$111,917.84
|
2026-05-11
|
|
005
|
OTHER
|
Liver Transplant With Mcc Or Intestinal Transplant
|
62
|
50
|
—
|
—
|
$88,273.14
|
$274,639.79
|
$110,341.42
|
2026-05-11
|
|
008
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant
|
62
|
50
|
—
|
—
|
$87,219.91
|
$220,230.28
|
$109,024.89
|
2026-05-11
|
|
010
|
OTHER
|
Pancreas Transplant
|
62
|
50
|
—
|
—
|
$62,196.24
|
$193,508.06
|
$77,745.30
|
2026-05-11
|
|
8275942
|
OTHER
|
Imp Icd ProMRI Hf-t Qp Df4 Is4
|
75
|
48
|
$114,570.00
|
$114,570.00
|
$950.00
|
$114,570.00
|
$51,556.50
|
2026-05-11
|
|
44700278009
|
OTHER
|
IM Stryker Surpass Evolve Fds-long 40mm
|
73
|
48
|
$98,117.00
|
$98,117.00
|
$950.00
|
$98,117.00
|
$44,152.65
|
2026-05-11
|
|
44700278011
|
OTHER
|
IM Stryker Surpass Streamline M00-long 40-50mm
|
73
|
48
|
$98,117.00
|
$98,117.00
|
$950.00
|
$98,117.00
|
$44,152.65
|
2026-05-11
|
|
8240012
|
OTHER
|
Cardioverterdfib Other
|
74
|
48
|
$94,044.00
|
$94,044.00
|
$950.00
|
$94,044.00
|
$42,319.80
|
2026-05-11
|
|
8275938
|
OTHER
|
Imp Ice ProMRI Hf-t Qp Df-1 Is4
|
74
|
48
|
$91,996.00
|
$91,996.00
|
$950.00
|
$91,996.00
|
$41,398.20
|
2026-05-11
|
|
8285410
|
OTHER
|
Imp Maci Wprotective Spacer 10mm X 10mm
|
66
|
42
|
$157,026.00
|
$157,026.00
|
$950.00
|
$157,026.00
|
$84,244.45
|
2026-05-11
|
|
48003323101
|
OTHER
|
Insrtn Imp Defib Pls Gnrtr W-existng Mltpl Leads
|
53
|
37
|
$121,563.00
|
$121,563.00
|
$950.00
|
$121,563.00
|
$72,937.80
|
2026-05-11
|
|
48003326401
|
OTHER
|
Rmvl Implntbl Difib Pls Gnrtr Mltpl Lead Sys
|
53
|
37
|
$121,563.00
|
$121,563.00
|
$950.00
|
$121,563.00
|
$72,937.80
|
2026-05-11
|
|
48003327001
|
OTHER
|
Insrtn Perm Impl Defib Sys W-elctrd
|
53
|
37
|
$121,563.00
|
$121,563.00
|
$950.00
|
$121,563.00
|
$72,937.80
|
2026-05-11
|
|
48003324901
|
OTHER
|
Insrtn Rplcmnt Perm Defib Sngle Or Dual
|
53
|
37
|
$121,563.00
|
$121,563.00
|
$950.00
|
$121,563.00
|
$72,937.80
|
2026-05-11
|
|
36000408T01
|
OTHER
|
Insertionreplacement Ccm System
|
56
|
37
|
$85,340.00
|
$85,340.00
|
$950.00
|
$85,340.00
|
$54,011.68
|
2026-05-11
|
|
48003324001
|
OTHER
|
Insrt Imp Defib Pls Gnrtr W-exstng Sngl Lead
|
53
|
37
|
$85,340.00
|
$85,340.00
|
$950.00
|
$85,340.00
|
$51,204.00
|
2026-05-11
|
|
48003326201
|
OTHER
|
Rmvl Implntbl Difib Pls Gnrtr Sngl Lead Sys
|
53
|
37
|
$85,340.00
|
$85,340.00
|
$950.00
|
$85,340.00
|
$51,204.00
|
2026-05-11
|
|
48003323001
|
OTHER
|
Insrtn Implntbl Defibpls Gnrtr W-exstng Dual Lds
|
53
|
37
|
$85,340.00
|
$85,340.00
|
$950.00
|
$85,340.00
|
$51,204.00
|
2026-05-11
|
|
48003326301
|
OTHER
|
Rmvl Implntbl Difib Pls Gnrtr Dual Lead Sys
|
53
|
37
|
$85,340.00
|
$85,340.00
|
$950.00
|
$85,340.00
|
$51,204.00
|
2026-05-11
|
|
48003322901
|
OTHER
|
Remvrplc Perm Pcmkrpls Gnrtr W-mltpl Lead Sys
|
53
|
37
|
$68,925.00
|
$68,925.00
|
$950.00
|
$68,925.00
|
$41,355.00
|
2026-05-11
|
|
754-2
|
OTHER
|
Depression Except Major Depressive Disorder
|
15
|
14
|
—
|
—
|
$30,711.72
|
$58,323.45
|
$58,323.45
|
2026-05-11
|
|
480-2
|
OTHER
|
Major Male Pelvic Procedures
|
15
|
14
|
—
|
—
|
$28,133.19
|
$53,166.39
|
$53,166.39
|
2026-05-11
|
|
480-1
|
OTHER
|
Major Male Pelvic Procedures
|
15
|
14
|
—
|
—
|
$27,102.83
|
$51,105.65
|
$51,105.65
|
2026-05-11
|
|
162-2
|
OTHER
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
15
|
14
|
—
|
—
|
$32,543.30
|
$61,986.60
|
$49,589.28
|
2026-05-11
|
|
440-2
|
OTHER
|
Kidney Transplant
|
15
|
14
|
—
|
—
|
$32,477.99
|
$61,855.99
|
$49,484.79
|
2026-05-11
|
|
020-4
|
OTHER
|
Open Craniotomy For Trauma
|
15
|
14
|
—
|
—
|
$32,338.49
|
$61,576.97
|
$49,261.58
|
2026-05-11
|
|
004-1
|
OTHER
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
15
|
14
|
—
|
—
|
$32,034.98
|
$60,969.96
|
$48,775.97
|
2026-05-11
|
|
312-4
|
OTHER
|
Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses
|
15
|
14
|
—
|
—
|
$31,982.29
|
$60,864.58
|
$48,691.66
|
2026-05-11
|
|
441-4
|
OTHER
|
Major Bladder Procedures
|
15
|
14
|
—
|
—
|
$31,968.19
|
$60,836.38
|
$48,669.11
|
2026-05-11
|
|
178-2
|
OTHER
|
External Heart Assist Systems
|
15
|
14
|
—
|
—
|
$31,855.40
|
$60,610.79
|
$48,488.63
|
2026-05-11
|
|
681-4
|
OTHER
|
Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms
|
15
|
14
|
—
|
—
|
$31,534.82
|
$59,969.64
|
$47,975.72
|
2026-05-11
|
|
008-3
|
OTHER
|
Autologous Bone Marrow Transplant Or T-cell Immunotherapy
|
15
|
14
|
—
|
—
|
$31,443.55
|
$59,787.10
|
$47,829.68
|
2026-05-11
|
|
603-2
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
15
|
14
|
—
|
—
|
$31,096.26
|
$59,092.52
|
$47,274.01
|
2026-05-11
|
|
614-3
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition
|
15
|
14
|
—
|
—
|
$30,692.58
|
$58,285.15
|
$46,628.12
|
2026-05-11
|
|
261-4
|
OTHER
|
Major Biliary Tract Procedures
|
15
|
14
|
—
|
—
|
$30,668.08
|
$58,236.16
|
$46,588.93
|
2026-05-11
|
|
609-1
|
OTHER
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
15
|
14
|
—
|
—
|
$30,659.18
|
$58,218.36
|
$46,574.68
|
2026-05-11
|
|
183-3
|
OTHER
|
Percutaneous Structural Cardiac Procedures
|
15
|
14
|
—
|
—
|
$30,536.00
|
$57,972.00
|
$46,377.60
|
2026-05-11
|
|
361-4
|
OTHER
|
Skin Graft For Skin And Subcutaneous Tissue Diagnoses
|
15
|
14
|
—
|
—
|
$30,205.78
|
$57,311.55
|
$45,849.24
|
2026-05-11
|
|
630-2
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
15
|
14
|
—
|
—
|
$30,083.33
|
$57,066.67
|
$45,653.34
|
2026-05-11
|
|
179-3
|
OTHER
|
Defibrillator Implants
|
15
|
14
|
—
|
—
|
$29,968.31
|
$56,836.63
|
$45,469.30
|
2026-05-11
|
|
440-1
|
OTHER
|
Kidney Transplant
|
15
|
14
|
—
|
—
|
$29,805.80
|
$56,511.60
|
$45,209.28
|
2026-05-11
|
|
321-4
|
OTHER
|
Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures
|
15
|
14
|
—
|
—
|
$29,599.51
|
$56,099.01
|
$44,879.21
|
2026-05-11
|
|
166-3
|
OTHER
|
Coronary Bypass Without Ami Or Complex Principal Diagnosis
|
15
|
14
|
—
|
—
|
$29,523.07
|
$55,946.14
|
$44,756.91
|
2026-05-11
|
|
178-1
|
OTHER
|
External Heart Assist Systems
|
15
|
14
|
—
|
—
|
$29,354.62
|
$55,609.25
|
$44,487.40
|
2026-05-11
|
|
092-4
|
OTHER
|
Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures
|
15
|
14
|
—
|
—
|
$28,977.65
|
$54,855.30
|
$43,884.24
|
2026-05-11
|
|
230-4
|
OTHER
|
Major Small Bowel Procedures
|
15
|
14
|
—
|
—
|
$28,878.95
|
$54,657.90
|
$43,726.32
|
2026-05-11
|
|
695-4
|
OTHER
|
Chemotherapy For Acute Leukemia
|
15
|
14
|
—
|
—
|
$28,867.82
|
$54,635.64
|
$43,708.52
|
2026-05-11
|
|
027-4
|
OTHER
|
Other Open Craniotomy
|
15
|
14
|
—
|
—
|
$28,847.79
|
$54,595.58
|
$43,676.46
|
2026-05-11
|
|
181-4
|
OTHER
|
Lower Extremity Arterial Procedures
|
15
|
14
|
—
|
—
|
$28,824.04
|
$54,548.09
|
$43,638.47
|
2026-05-11
|
|
510-2
|
OTHER
|
Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced…
|
15
|
14
|
—
|
—
|
$23,367.12
|
$43,634.24
|
$43,634.24
|
2026-05-11
|
|
304-3
|
OTHER
|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
15
|
14
|
—
|
—
|
$28,763.94
|
$54,427.87
|
$43,542.30
|
2026-05-11
|
|
792-4
|
OTHER
|
Extensive O.r. Procedures For Other Complications Of Treatment
|
15
|
14
|
—
|
—
|
$28,673.40
|
$54,246.81
|
$43,397.45
|
2026-05-11
|
|
165-2
|
OTHER
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
15
|
14
|
—
|
—
|
$28,546.51
|
$53,993.02
|
$43,194.41
|
2026-05-11
|
|
651-4
|
OTHER
|
Other Procedures Of Blood And Blood-forming Organs
|
15
|
14
|
—
|
—
|
$28,516.82
|
$53,933.64
|
$43,146.91
|
2026-05-11
|
|
511-4
|
OTHER
|
Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy
|
15
|
14
|
—
|
—
|
$28,385.48
|
$53,670.96
|
$42,936.77
|
2026-05-11
|
|
754-4
|
OTHER
|
Depression Except Major Depressive Disorder
|
15
|
14
|
—
|
—
|
$28,268.56
|
$53,437.13
|
$42,749.71
|
2026-05-11
|
|
512-4
|
OTHER
|
Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy
|
15
|
14
|
—
|
—
|
$28,254.13
|
$53,408.26
|
$42,726.61
|
2026-05-11
|
|
162-1
|
OTHER
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
15
|
14
|
—
|
—
|
$28,179.92
|
$53,259.85
|
$42,607.88
|
2026-05-11
|
|
121-4
|
OTHER
|
Other Respiratory And Chest Procedures
|
15
|
14
|
—
|
—
|
$28,177.70
|
$53,255.40
|
$42,604.32
|
2026-05-11
|
|
234-4
|
OTHER
|
Appendectomy Without Complex Principal Diagnosis
|
15
|
14
|
—
|
—
|
$28,021.12
|
$52,942.25
|
$42,353.80
|
2026-05-11
|
|
030-4
|
OTHER
|
Percutaneous Intracranial And Extracranial Vascular Procedures
|
15
|
14
|
—
|
—
|
$27,776.97
|
$52,453.95
|
$41,963.16
|
2026-05-11
|
|
303-2
|
OTHER
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
15
|
14
|
—
|
—
|
$27,413.37
|
$51,726.74
|
$41,381.39
|
2026-05-11
|
|
710-4
|
OTHER
|
Infectious And Parasitic Diseases Including HIV With O.r. Procedure
|
15
|
14
|
—
|
—
|
$27,380.72
|
$51,661.43
|
$41,329.14
|
2026-05-11
|
|
631-4
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
14
|
13
|
—
|
—
|
$248,757.18
|
$348,260.05
|
$288,558.33
|
2026-05-11
|
|
630-4
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
14
|
13
|
—
|
—
|
$221,182.19
|
$309,655.07
|
$256,571.34
|
2026-05-11
|
|
583-4
|
OTHER
|
Neonate With Ecmo
|
14
|
13
|
—
|
—
|
$221,000.00
|
$309,400.00
|
$256,360.00
|
2026-05-11
|
|
588-4
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
14
|
13
|
—
|
—
|
$221,000.00
|
$309,400.00
|
$256,360.00
|
2026-05-11
|
|
583-3
|
OTHER
|
Neonate With Ecmo
|
14
|
13
|
—
|
—
|
$221,000.00
|
$309,400.00
|
$256,360.00
|
2026-05-11
|
|
011-3
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
14
|
13
|
—
|
—
|
$213,464.00
|
$298,849.60
|
$247,618.24
|
2026-05-11
|
|
161-4
|
OTHER
|
Implantable Heart Assist Systems
|
14
|
13
|
—
|
—
|
$202,241.64
|
$283,138.30
|
$234,600.30
|
2026-05-11
|
|
002-4
|
OTHER
|
Heart And/or Lung Transplant
|
14
|
13
|
—
|
—
|
$200,167.87
|
$280,235.02
|
$232,194.73
|
2026-05-11
|
|
583-2
|
OTHER
|
Neonate With Ecmo
|
14
|
13
|
—
|
—
|
$190,963.00
|
$267,348.20
|
$221,517.08
|
2026-05-11
|
|
589-1
|
OTHER
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
14
|
13
|
—
|
—
|
$177,222.13
|
$248,110.98
|
$205,577.67
|
2026-05-11
|
|
583-1
|
OTHER
|
Neonate With Ecmo
|
14
|
13
|
—
|
—
|
$174,515.37
|
$244,321.52
|
$202,437.83
|
2026-05-11
|
|
609-4
|
OTHER
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
14
|
13
|
—
|
—
|
$165,000.00
|
$231,000.00
|
$191,400.00
|
2026-05-11
|
|
841-4
|
OTHER
|
Extensive Third Degree Burns With Skin Graft
|
14
|
13
|
—
|
—
|
$162,615.78
|
$227,662.09
|
$188,634.30
|
2026-05-11
|
|
161-3
|
OTHER
|
Implantable Heart Assist Systems
|
14
|
13
|
—
|
—
|
$159,302.01
|
$223,022.81
|
$184,790.33
|
2026-05-11
|
|
007-4
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
14
|
13
|
—
|
—
|
$149,835.59
|
$209,769.83
|
$173,809.28
|
2026-05-11
|
|
009-4
|
OTHER
|
Extracorporeal Membrane Oxygenation (ecmo)
|
14
|
13
|
—
|
—
|
$139,000.00
|
$194,600.00
|
$161,240.00
|
2026-05-11
|
|
588-3
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
14
|
13
|
—
|
—
|
$132,000.00
|
$184,800.00
|
$153,120.00
|
2026-05-11
|
|
002-3
|
OTHER
|
Heart And/or Lung Transplant
|
14
|
13
|
—
|
—
|
$131,530.85
|
$184,143.19
|
$152,575.78
|
2026-05-11
|
|
588-2
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
14
|
13
|
—
|
—
|
$130,000.00
|
$182,000.00
|
$150,800.00
|
2026-05-11
|
|
863-4
|
OTHER
|
Neonatal Aftercare
|
14
|
13
|
—
|
—
|
$126,963.94
|
$177,749.52
|
$147,278.17
|
2026-05-11
|
|
593-4
|
OTHER
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
14
|
13
|
—
|
—
|
$121,000.00
|
$169,400.00
|
$140,360.00
|
2026-05-11
|
|
303-4
|
OTHER
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
14
|
13
|
—
|
—
|
$120,000.00
|
$168,000.00
|
$139,200.00
|
2026-05-11
|
|
591-4
|
OTHER
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
14
|
13
|
—
|
—
|
$120,000.00
|
$168,000.00
|
$139,200.00
|
2026-05-11
|
|
001-4
|
OTHER
|
Liver Transplant And/or Intestinal Transplant
|
14
|
13
|
—
|
—
|
$120,000.00
|
$168,000.00
|
$139,200.00
|
2026-05-11
|
|
510-4
|
OTHER
|
Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced…
|
14
|
13
|
—
|
—
|
$137,644.70
|
$137,644.70
|
$137,644.70
|
2026-05-11
|
|
009-3
|
OTHER
|
Extracorporeal Membrane Oxygenation (ecmo)
|
14
|
13
|
—
|
—
|
$110,110.47
|
$154,154.66
|
$127,728.14
|
2026-05-11
|
|
004-4
|
OTHER
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
14
|
13
|
—
|
—
|
$110,000.00
|
$154,000.00
|
$127,600.00
|
2026-05-11
|
|
161-2
|
OTHER
|
Implantable Heart Assist Systems
|
14
|
13
|
—
|
—
|
$109,991.74
|
$153,988.44
|
$127,590.42
|
2026-05-11
|
|
161-1
|
OTHER
|
Implantable Heart Assist Systems
|
14
|
13
|
—
|
—
|
$109,991.74
|
$153,988.44
|
$127,590.42
|
2026-05-11
|
|
160-4
|
OTHER
|
Major Cardiothoracic Repair Of Heart Anomaly
|
14
|
13
|
—
|
—
|
$106,925.93
|
$149,696.30
|
$124,034.08
|
2026-05-11
|
|
754-3
|
OTHER
|
Depression Except Major Depressive Disorder
|
14
|
13
|
—
|
—
|
$118,394.95
|
$118,394.95
|
$118,394.95
|
2026-05-11
|
|
002-2
|
OTHER
|
Heart And/or Lung Transplant
|
14
|
13
|
—
|
—
|
$101,523.66
|
$142,133.12
|
$117,767.45
|
2026-05-11
|
|
602-4
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
14
|
13
|
—
|
—
|
$100,000.00
|
$140,000.00
|
$116,000.00
|
2026-05-11
|
|
607-4
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
14
|
13
|
—
|
—
|
$100,000.00
|
$140,000.00
|
$116,000.00
|
2026-05-11
|
|
593-3
|
OTHER
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
14
|
13
|
—
|
—
|
$99,000.00
|
$138,600.00
|
$114,840.00
|
2026-05-11
|
|
633-4
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Anomaly
|
14
|
13
|
—
|
—
|
$95,464.13
|
$133,649.78
|
$110,738.40
|
2026-05-11
|
|
630-3
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
14
|
13
|
—
|
—
|
$95,000.00
|
$133,000.00
|
$110,200.00
|
2026-05-11
|
|
611-4
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Major Anomaly
|
14
|
13
|
—
|
—
|
$93,000.00
|
$130,200.00
|
$107,880.00
|
2026-05-11
|
|
842-4
|
OTHER
|
Burns With Skin Graft Except Extensive Third Degree Burns
|
14
|
13
|
—
|
—
|
$92,524.47
|
$129,534.26
|
$107,328.39
|
2026-05-11
|
|
602-3
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
14
|
13
|
—
|
—
|
$92,000.00
|
$128,800.00
|
$106,720.00
|
2026-05-11
|
|
591-3
|
OTHER
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
14
|
13
|
—
|
—
|
$91,000.00
|
$127,400.00
|
$105,560.00
|
2026-05-11
|
|
004-3
|
OTHER
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
14
|
13
|
—
|
—
|
$91,000.00
|
$127,400.00
|
$105,560.00
|
2026-05-11
|
|
621-4
|
OTHER
|
Neonate Birth Weight 2000-2499 Grams With Major Anomaly
|
14
|
13
|
—
|
—
|
$90,000.00
|
$126,000.00
|
$104,400.00
|
2026-05-11
|
|
860-2
|
OTHER
|
Rehabilitation
|
14
|
13
|
—
|
—
|
$103,566.20
|
$103,566.20
|
$103,566.20
|
2026-05-11
|
|
007-3
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
14
|
13
|
—
|
—
|
$89,273.14
|
$124,982.40
|
$103,556.85
|
2026-05-11
|
|
612-4
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…
|
14
|
13
|
—
|
—
|
$89,000.00
|
$124,600.00
|
$103,240.00
|
2026-05-11
|
|
005-4
|
OTHER
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
14
|
13
|
—
|
—
|
$88,000.00
|
$123,200.00
|
$102,080.00
|
2026-05-11
|
|
589-3
|
OTHER
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
14
|
13
|
—
|
—
|
$87,000.00
|
$121,800.00
|
$100,920.00
|
2026-05-11
|
|
607-3
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
14
|
13
|
—
|
—
|
$86,000.00
|
$120,400.00
|
$99,760.00
|
2026-05-11
|
|
006-4
|
OTHER
|
Pancreas Transplant
|
14
|
13
|
—
|
—
|
$85,000.00
|
$119,000.00
|
$98,600.00
|
2026-05-11
|
|
860-4
|
OTHER
|
Rehabilitation
|
14
|
13
|
—
|
—
|
$96,303.14
|
$96,303.14
|
$96,303.14
|
2026-05-11
|
|
162-4
|
OTHER
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
14
|
13
|
—
|
—
|
$80,771.14
|
$113,079.60
|
$93,694.52
|
2026-05-11
|
|
609-3
|
OTHER
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
14
|
13
|
—
|
—
|
$80,681.03
|
$112,953.44
|
$93,589.99
|
2026-05-11
|
|
603-4
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
14
|
13
|
—
|
—
|
$80,000.00
|
$112,000.00
|
$92,800.00
|
2026-05-11
|
|
591-2
|
OTHER
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
14
|
13
|
—
|
—
|
$80,000.00
|
$112,000.00
|
$92,800.00
|
2026-05-11
|
|
602-2
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
14
|
13
|
—
|
—
|
$80,000.00
|
$112,000.00
|
$92,800.00
|
2026-05-11
|
|
006-3
|
OTHER
|
Pancreas Transplant
|
14
|
13
|
—
|
—
|
$79,144.95
|
$110,802.93
|
$91,808.14
|
2026-05-11
|
|
593-2
|
OTHER
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
14
|
13
|
—
|
—
|
$79,000.00
|
$110,600.00
|
$91,640.00
|
2026-05-11
|
|
440-4
|
OTHER
|
Kidney Transplant
|
14
|
13
|
—
|
—
|
$76,896.47
|
$107,655.06
|
$89,199.90
|
2026-05-11
|
|
001-3
|
OTHER
|
Liver Transplant And/or Intestinal Transplant
|
14
|
13
|
—
|
—
|
$76,155.46
|
$106,617.64
|
$88,340.33
|
2026-05-11
|
|
007-1
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
14
|
13
|
—
|
—
|
$74,667.08
|
$104,533.91
|
$86,613.82
|
2026-05-11
|
|
005-3
|
OTHER
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
14
|
13
|
—
|
—
|
$74,623.62
|
$104,473.07
|
$86,563.39
|
2026-05-11
|
|
163-4
|
OTHER
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
14
|
13
|
—
|
—
|
$71,005.50
|
$99,407.70
|
$82,366.38
|
2026-05-11
|
|
608-4
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition
|
14
|
13
|
—
|
—
|
$70,000.00
|
$98,000.00
|
$81,200.00
|
2026-05-11
|
|
006-2
|
OTHER
|
Pancreas Transplant
|
14
|
13
|
—
|
—
|
$66,925.17
|
$93,695.24
|
$77,633.20
|
2026-05-11
|
|
007-2
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
14
|
13
|
—
|
—
|
$66,446.01
|
$93,024.41
|
$77,077.37
|
2026-05-11
|
|
178-4
|
OTHER
|
External Heart Assist Systems
|
14
|
13
|
—
|
—
|
$66,228.69
|
$92,720.17
|
$76,825.28
|
2026-05-11
|
|
008-4
|
OTHER
|
Autologous Bone Marrow Transplant Or T-cell Immunotherapy
|
14
|
13
|
—
|
—
|
$65,108.16
|
$91,151.42
|
$75,525.46
|
2026-05-11
|
|
860-1
|
OTHER
|
Rehabilitation
|
14
|
13
|
—
|
—
|
$74,940.00
|
$74,940.00
|
$74,940.00
|
2026-05-11
|
|
165-4
|
OTHER
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
14
|
13
|
—
|
—
|
$63,659.01
|
$89,122.61
|
$73,844.45
|
2026-05-11
|
|
631-3
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
14
|
13
|
—
|
—
|
$62,013.73
|
$86,819.22
|
$71,935.93
|
2026-05-11
|
|
613-4
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection
|
14
|
13
|
—
|
—
|
$62,000.00
|
$86,800.00
|
$71,920.00
|
2026-05-11
|
|
004-2
|
OTHER
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
14
|
13
|
—
|
—
|
$61,468.84
|
$86,056.38
|
$71,303.86
|
2026-05-11
|
|
001-2
|
OTHER
|
Liver Transplant And/or Intestinal Transplant
|
14
|
13
|
—
|
—
|
$61,446.58
|
$86,025.21
|
$71,278.04
|
2026-05-11
|
|
608-3
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition
|
14
|
13
|
—
|
—
|
$60,412.98
|
$84,578.17
|
$70,079.06
|
2026-05-11
|
|
009-2
|
OTHER
|
Extracorporeal Membrane Oxygenation (ecmo)
|
14
|
13
|
—
|
—
|
$59,643.74
|
$83,501.24
|
$69,186.74
|
2026-05-11
|
|
841-3
|
OTHER
|
Extensive Third Degree Burns With Skin Graft
|
14
|
13
|
—
|
—
|
$59,376.24
|
$83,126.74
|
$68,876.44
|
2026-05-11
|
|
607-2
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
14
|
13
|
—
|
—
|
$59,012.59
|
$82,617.63
|
$68,454.61
|
2026-05-11
|
|
183-4
|
OTHER
|
Percutaneous Structural Cardiac Procedures
|
14
|
13
|
—
|
—
|
$58,768.76
|
$82,276.26
|
$68,171.76
|
2026-05-11
|
|
162-3
|
OTHER
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
14
|
13
|
—
|
—
|
$57,853.90
|
$80,995.46
|
$67,110.52
|
2026-05-11
|
|
910-4
|
OTHER
|
Craniotomy For Multiple Significant Trauma
|
14
|
13
|
—
|
—
|
$56,988.86
|
$79,784.40
|
$66,107.07
|
2026-05-11
|
|
622-4
|
OTHER
|
Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…
|
14
|
13
|
—
|
—
|
$56,954.93
|
$79,736.90
|
$66,067.72
|
2026-05-11
|
|
510-1
|
OTHER
|
Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced…
|
14
|
13
|
—
|
—
|
$64,646.12
|
$64,646.12
|
$64,646.12
|
2026-05-11
|
|
166-4
|
OTHER
|
Coronary Bypass Without Ami Or Complex Principal Diagnosis
|
14
|
13
|
—
|
—
|
$55,046.75
|
$77,065.45
|
$63,854.23
|
2026-05-11
|
|
179-4
|
OTHER
|
Defibrillator Implants
|
14
|
13
|
—
|
—
|
$54,992.69
|
$76,989.77
|
$63,791.52
|
2026-05-11
|
|
623-4
|
OTHER
|
Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection
|
14
|
13
|
—
|
—
|
$54,746.74
|
$76,645.44
|
$63,506.22
|
2026-05-11
|
|
911-4
|
OTHER
|
Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma
|
14
|
13
|
—
|
—
|
$54,718.12
|
$76,605.37
|
$63,473.01
|
2026-05-11
|
|
304-4
|
OTHER
|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
14
|
13
|
—
|
—
|
$54,426.59
|
$76,197.23
|
$63,134.85
|
2026-05-11
|
|
634-4
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…
|
14
|
13
|
—
|
—
|
$54,074.64
|
$75,704.50
|
$62,726.58
|
2026-05-11
|
|
167-4
|
OTHER
|
Other Cardiothoracic And Thoracic Vascular Procedures
|
14
|
13
|
—
|
—
|
$54,029.06
|
$75,640.68
|
$62,673.71
|
2026-05-11
|
|
091-4
|
OTHER
|
Other Major Head And Neck Procedures
|
14
|
13
|
—
|
—
|
$53,845.66
|
$75,383.92
|
$62,460.96
|
2026-05-11
|
|
178-3
|
OTHER
|
External Heart Assist Systems
|
14
|
13
|
—
|
—
|
$53,704.67
|
$75,186.54
|
$62,297.42
|
2026-05-11
|
|
680-4
|
OTHER
|
Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms
|
14
|
13
|
—
|
—
|
$52,992.28
|
$74,189.19
|
$61,471.04
|
2026-05-11
|
|
612-3
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…
|
14
|
13
|
—
|
—
|
$52,715.59
|
$73,801.83
|
$61,150.08
|
2026-05-11
|
|
912-4
|
OTHER
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
14
|
13
|
—
|
—
|
$52,238.55
|
$73,133.97
|
$60,596.72
|
2026-05-11
|
|
625-4
|
OTHER
|
Neonate Birth Weight 2000-2499 Grams With Other Significant Condition
|
14
|
13
|
—
|
—
|
$52,004.27
|
$72,805.98
|
$60,324.95
|
2026-05-11
|
|
609-2
|
OTHER
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
14
|
13
|
—
|
—
|
$51,663.97
|
$72,329.56
|
$59,930.21
|
2026-05-11
|
|
440-3
|
OTHER
|
Kidney Transplant
|
14
|
13
|
—
|
—
|
$51,187.99
|
$71,663.19
|
$59,378.07
|
2026-05-11
|
|
011-4
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
14
|
13
|
—
|
—
|
$50,021.00
|
$70,029.40
|
$58,024.36
|
2026-05-11
|
|
001-1
|
OTHER
|
Liver Transplant And/or Intestinal Transplant
|
14
|
13
|
—
|
—
|
$50,000.00
|
$70,000.00
|
$58,000.00
|
2026-05-11
|
|
002-1
|
OTHER
|
Heart And/or Lung Transplant
|
14
|
13
|
—
|
—
|
$50,000.00
|
$70,000.00
|
$58,000.00
|
2026-05-11
|
|
011-2
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
14
|
13
|
—
|
—
|
$50,000.00
|
$70,000.00
|
$58,000.00
|
2026-05-11
|
|
006-1
|
OTHER
|
Pancreas Transplant
|
14
|
13
|
—
|
—
|
$50,000.00
|
$70,000.00
|
$58,000.00
|
2026-05-11
|
|
588-1
|
OTHER
|
Female Reproductive System Reconstructive Procedures
|
14
|
13
|
—
|
—
|
$50,000.00
|
$70,000.00
|
$58,000.00
|
2026-05-11
|
|
011-1
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
14
|
13
|
—
|
—
|
$50,000.00
|
$70,000.00
|
$58,000.00
|
2026-05-11
|
|
005-2
|
OTHER
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
14
|
13
|
—
|
—
|
$49,972.05
|
$69,960.87
|
$57,967.58
|
2026-05-11
|
|
169-4
|
OTHER
|
Major Abdominal Vascular Procedures
|
14
|
13
|
—
|
—
|
$49,701.73
|
$69,582.42
|
$57,654.01
|
2026-05-11
|
|
021-4
|
OTHER
|
Open Craniotomy Except Trauma
|
14
|
13
|
—
|
—
|
$49,641.30
|
$69,497.82
|
$57,583.91
|
2026-05-11
|
|
602-1
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
14
|
13
|
—
|
—
|
$49,524.69
|
$69,334.57
|
$57,448.64
|
2026-05-11
|
|
303-3
|
OTHER
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
14
|
13
|
—
|
—
|
$49,432.46
|
$69,205.44
|
$57,341.65
|
2026-05-11
|
|
603-3
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
14
|
13
|
—
|
—
|
$49,059.31
|
$68,683.03
|
$56,908.80
|
2026-05-11
|
|
613-3
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection
|
14
|
13
|
—
|
—
|
$48,931.04
|
$68,503.46
|
$56,760.01
|
2026-05-11
|
|
009-1
|
OTHER
|
Extracorporeal Membrane Oxygenation (ecmo)
|
14
|
13
|
—
|
—
|
$48,887.57
|
$68,442.60
|
$56,709.58
|
2026-05-11
|
|
232-4
|
OTHER
|
Gastric Fundoplication
|
14
|
13
|
—
|
—
|
$48,638.45
|
$68,093.83
|
$56,420.60
|
2026-05-11
|
|
163-3
|
OTHER
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
14
|
13
|
—
|
—
|
$48,537.74
|
$67,952.84
|
$56,303.78
|
2026-05-11
|
|
483-4
|
OTHER
|
Penis, Testes And Scrotal Procedures
|
14
|
13
|
—
|
—
|
$47,990.73
|
$67,187.02
|
$55,669.25
|
2026-05-11
|
|
130-4
|
OTHER
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
14
|
13
|
—
|
—
|
$47,938.78
|
$67,114.29
|
$55,608.99
|
2026-05-11
|
|
023-4
|
OTHER
|
Spinal Procedures
|
14
|
13
|
—
|
—
|
$47,896.38
|
$67,054.93
|
$55,559.81
|
2026-05-11
|
|
850-4
|
OTHER
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…
|
14
|
13
|
—
|
—
|
$47,159.61
|
$66,023.45
|
$54,705.15
|
2026-05-11
|
|
160-3
|
OTHER
|
Major Cardiothoracic Repair Of Heart Anomaly
|
14
|
13
|
—
|
—
|
$46,998.47
|
$65,797.86
|
$54,518.23
|
2026-05-11
|
|
260-4
|
OTHER
|
Major Pancreas, Liver And Shunt Procedures
|
14
|
13
|
—
|
—
|
$46,961.37
|
$65,745.92
|
$54,475.18
|
2026-05-11
|
|
165-3
|
OTHER
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
14
|
13
|
—
|
—
|
$46,931.69
|
$65,704.37
|
$54,440.76
|
2026-05-11
|
|
089-4
|
OTHER
|
Major Cranial Or Facial Bone Procedures
|
14
|
13
|
—
|
—
|
$45,836.60
|
$64,171.24
|
$53,170.46
|
2026-05-11
|
|
220-4
|
OTHER
|
Major Stomach, Esophageal And Duodenal Procedures
|
14
|
13
|
—
|
—
|
$45,647.91
|
$63,907.07
|
$52,951.57
|
2026-05-11
|
|
740-4
|
OTHER
|
Mental Illness Diagnosis With O.r. Procedure
|
14
|
13
|
—
|
—
|
$45,534.48
|
$63,748.27
|
$52,820.00
|
2026-05-11
|
|
401-4
|
OTHER
|
Adrenal Procedures
|
14
|
13
|
—
|
—
|
$45,294.89
|
$63,412.85
|
$52,542.07
|
2026-05-11
|
|
690-4
|
OTHER
|
Acute Leukemia
|
14
|
13
|
—
|
—
|
$45,078.63
|
$63,110.08
|
$52,291.21
|
2026-05-11
|
|
120-4
|
OTHER
|
Major Respiratory And Chest Procedures
|
14
|
13
|
—
|
—
|
$44,991.70
|
$62,988.38
|
$52,190.37
|
2026-05-11
|
|
950-4
|
OTHER
|
Extensive O.r. Procedure Unrelated To Principal Diagnosis
|
14
|
13
|
—
|
—
|
$44,744.70
|
$62,642.58
|
$51,903.85
|
2026-05-11
|