Hospital

DECATUR MEMORIAL HOSPITAL

Decatur, IL · CCN 140135 · Rates published

51,735 distinct procedures filed

32 distinct payers

1,752,901 rate rows

2026-05-09 last MRF observed

Data quality

1,742,363 of 1,752,901 rate rows are consumer-grade (99.4%)

10,538 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
template filing: same amount across many unrelated codes — excluded	5,577
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	4,589
placeholder amount (≤ $0.02) — excluded from medians	215
per-diem day rate — not a per-procedure price	100
exceeds 10× this hospital's gross charge — excluded from medians	57

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

Source MRF file	https://memorial.health/Resources/463a1f34-823e-44f8-9278-9e022e939496/370661199_Decatur_Memorial_Hospital_standardcharges.csv?v=2
Found on page	https://memorial.health/financial/price-transparency/
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-05-17
Content fingerprint	28cb069d2e09ca23… · 669,080,772 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	18	$1,433.00	$628,901.64	$522,645.95	nat. median $424,868 1.2× median
002-4 OTHER	Heart And/or Lung Transplant	2	$224,400.00	$325,818.06	$275,109.03	nat. median $216,800 1.3× median
583-4 OTHER	Neonate With Ecmo	2	$225,420.00	$314,197.96	$269,808.98	nat. median $309,400 0.9× median
841-4 OTHER	Extensive Third Degree Burns With Skin Graft	2	$193,800.00	$311,440.82	$252,620.41	nat. median $151,691 1.7× median
588-4 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	2	$225,420.00	$257,727.54	$241,573.77	nat. median $267,493 0.9× median
583-3 OTHER	Neonate With Ecmo	2	$209,712.35	$227,843.89	$218,778.12	nat. median $259,487 0.8× median
001 OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	18	$1,433.00	$386,729.82	$217,913.85	nat. median $263,894 0.8× median
007-4 OTHER	Allogeneic Bone Marrow Transplant	2	$196,602.99	$213,601.10	$205,102.04	nat. median $172,311 1.2× median
630-4 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	2	$172,181.55	$187,068.20	$179,624.88	nat. median $210,669 0.9× median
004 OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	22	$1,433.00	$299,605.78	$176,948.42	nat. median $150,232 1.2× median
002-3 OTHER	Heart And/or Lung Transplant	2	$142,800.00	$201,481.13	$172,140.57	nat. median $133,471 1.3× median
927 OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	20	$1,433.00	$461,811.32	$166,021.49	nat. median $146,562 1.1× median
003 OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	22	$1,433.00	$459,101.08	$165,993.02	nat. median $218,232 0.8× median
001-4 OTHER	Liver Transplant And/or Intestinal Transplant	2	$122,400.00	$208,283.06	$165,341.53	nat. median $124,561 1.3× median
583-2 OTHER	Neonate With Ecmo	2	$156,836.27	$170,396.19	$163,616.23	nat. median $191,347 0.9× median
609-4 OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	2	$148,446.24	$161,280.77	$154,863.51	nat. median $169,856 0.9× median
161-4 OTHER	Implantable Heart Assist Systems	2	$147,278.23	$160,011.77	$153,645.00	nat. median $202,242 0.8× median
631-4 OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	2	$142,514.94	$154,836.65	$148,675.79	nat. median $203,379 0.7× median
593-4 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	2	$123,420.00	$168,087.41	$145,753.71	nat. median $151,250 1.0× median
002-2 OTHER	Heart And/or Lung Transplant	2	$137,622.17	$149,520.86	$143,571.52	nat. median $106,681 1.3× median
588-3 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	2	$134,640.00	$152,021.70	$143,330.85	nat. median $165,000 0.9× median
591-4 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	2	$122,400.00	$162,316.16	$142,358.08	nat. median $156,696 0.9× median
588-2 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	2	$132,600.00	$150,970.28	$141,785.14	nat. median $153,523 0.9× median
842-4 OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	2	$122,400.00	$157,393.71	$139,896.85	nat. median $83,517 1.7× median
007 OTHER	Lung Transplant	18	$1,433.00	$436,302.09	$136,831.82	nat. median $141,082 1.0× median
011-4 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	2	$51,021.42	$222,108.37	$136,564.90	nat. median $105,647 1.3× median
006-4 OTHER	Pancreas Transplant	2	$86,700.00	$183,938.13	$135,319.07	nat. median $92,449 1.5× median
583-1 OTHER	Neonate With Ecmo	2	$127,952.51	$139,015.17	$133,483.84	nat. median $171,226 0.8× median
007-3 OTHER	Allogeneic Bone Marrow Transplant	2	$115,863.38	$125,880.82	$120,872.10	nat. median $104,111 1.2× median
002 OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	18	$1,433.00	$156,378.84	$119,731.80	nat. median $117,167 1.0× median
161-3 OTHER	Implantable Heart Assist Systems	2	$112,830.26	$122,585.46	$117,707.86	nat. median $152,491 0.8× median
910-4 OTHER	Craniotomy For Multiple Significant Trauma	2	$112,334.43	$122,046.77	$117,190.60	nat. median $56,989 outlier · 2.1×
602-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	2	$102,000.00	$120,485.38	$111,242.69	nat. median $125,000 0.9× median
911-4 OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	2	$106,127.15	$115,302.80	$110,714.98	nat. median $51,806 outlier · 2.1×
841-3 OTHER	Extensive Third Degree Burns With Skin Graft	2	$105,199.88	$114,295.37	$109,747.62	nat. median $61,016 1.8× median
603-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	2	$81,600.00	$135,114.08	$108,357.04	nat. median $107,050 1.0× median
006-3 OTHER	Pancreas Transplant	2	$86,700.00	$129,335.60	$108,017.80	nat. median $85,000 1.3× median
912-4 OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	2	$103,111.66	$112,026.61	$107,569.14	nat. median $52,239 outlier · 2.1×
001-3 OTHER	Liver Transplant And/or Intestinal Transplant	2	$93,840.00	$120,414.57	$107,127.29	nat. median $81,541 1.3× median
440-4 OTHER	Kidney Transplant	2	$91,800.00	$122,376.63	$107,088.32	nat. median $87,123 1.2× median
011-3 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	2	$100,627.52	$109,327.68	$104,977.60	nat. median $171,094 0.6× median
008-4 OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	2	$99,453.34	$108,051.98	$103,752.66	nat. median $81,385 1.3× median
006-2 OTHER	Pancreas Transplant	2	$86,700.00	$112,276.07	$99,488.04	nat. median $67,906 1.5× median
004-4 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	2	$92,292.02	$100,271.50	$96,281.76	nat. median $110,000 0.9× median
020-4 OTHER	Open Craniotomy For Trauma	2	$91,629.67	$99,551.89	$95,590.78	nat. median $47,233 outlier · 2.0×
593-3 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	2	$91,090.81	$98,966.44	$95,028.62	nat. median $112,711 0.8× median
001-2 OTHER	Liver Transplant And/or Intestinal Transplant	2	$88,740.00	$100,921.86	$94,830.93	nat. median $63,438 1.5× median
007-2 OTHER	Allogeneic Bone Marrow Transplant	2	$90,629.16	$98,464.87	$94,547.01	nat. median $74,284 1.3× median
161-2 OTHER	Implantable Heart Assist Systems	2	$90,592.94	$98,425.53	$94,509.24	nat. median $109,992 0.9× median
009-4 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	2	$90,356.26	$98,168.38	$94,262.32	nat. median $150,954 0.6× median

Other procedures at this hospital

Browse this hospital's 51,735 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

1013136	OTHER	00944-3810-01 - Pegaspargase 750 Iu/ml Inj	57	32	$187,706.05	$187,706.05	$998.60	$187,706.05	$66,516.17	2026-05-09
618650	OTHER	57665-0002-02 - Pegaspargase 750 Unit/ml Inj 5ml (	57	32	$187,706.05	$187,706.05	$998.60	$187,706.05	$66,516.17	2026-05-09
1337261	OTHER	72694-0954-01 - Pegaspargase 750 Iu/ml Inj	57	32	$187,706.05	$187,706.05	$998.60	$187,706.05	$66,516.17	2026-05-09
1274660	OTHER	Nail Tib Ant 10d 11.5x320x7/8	32	24	$139,245.00	$139,245.00	$3,121.00	$139,245.00	$87,028.12	2026-05-09
1330763	OTHER	Nail Tib Ant 10d 11.5x380x7/8	32	24	$139,245.00	$139,245.00	$3,121.00	$139,245.00	$87,028.12	2026-05-09
1561290	OTHER	00310-4535-30 - Tremelimumab Actl 20 mg/mL Sol	56	32	$122,671.40	$122,671.40	$652.61	$122,671.40	$47,827.05	2026-05-09
1491080	OTHER	System Proclaim 1 DRG Lead	32	24	$115,000.00	$115,000.00	$3,121.00	$115,000.00	$71,875.00	2026-05-09
1524278	OTHER	Generator Sentiva Duo 1000-d	32	24	$111,563.00	$111,563.00	$3,121.00	$111,563.00	$69,726.88	2026-05-09
1039504	OTHER	Generator Sentiva 1000	32	24	$108,842.00	$108,842.00	$3,121.00	$108,842.00	$68,026.25	2026-05-09
1044195	OTHER	Ccls-crm-icd Not S Or D Lvliii	32	24	$104,400.00	$104,400.00	$3,121.00	$104,400.00	$65,250.00	2026-05-09
1044194	OTHER	Ccls-crm-icd Not S Or D Lvl Ii	32	24	$104,094.00	$104,094.00	$3,121.00	$104,094.00	$65,058.75	2026-05-09
995253	OTHER	Generator Aspire Sr 106	32	24	$101,835.00	$101,835.00	$3,121.00	$101,835.00	$63,646.88	2026-05-09
1371435	OTHER	Kit Neurostimulator Rns	32	24	$101,700.00	$101,700.00	$3,121.00	$101,700.00	$63,562.50	2026-05-09
1356570	OTHER	Neurostimulator Rns	32	24	$101,700.00	$101,700.00	$3,121.00	$101,700.00	$63,562.50	2026-05-09
1493410	OTHER	Icd Cobalt Xt Hf Crt-d MRI	32	24	$98,123.00	$98,123.00	$3,121.00	$98,123.00	$61,326.88	2026-05-09
1044157	OTHER	Ccls-system Cardiomems Sensor	32	24	$97,500.00	$97,500.00	$3,121.00	$97,500.00	$60,937.50	2026-05-09
1489278	OTHER	Ir-stnt Coa/cov W/del Lvl 10	32	24	$96,445.00	$96,445.00	$3,121.00	$96,445.00	$60,278.12	2026-05-09
1516180	OTHER	Grf Thoracic Branch 37x15	32	24	$96,000.00	$96,000.00	$3,121.00	$96,000.00	$60,000.00	2026-05-09
1561419	OTHER	Grft Evar Taa Cvr 8mm 45x15	32	24	$96,000.00	$96,000.00	$3,121.00	$96,000.00	$60,000.00	2026-05-09
1494797	OTHER	Grf Thor Artc 40mmx15cm 8mm	32	24	$96,000.00	$96,000.00	$3,121.00	$96,000.00	$60,000.00	2026-05-09
1529079	OTHER	Grf Thoracic Branch 31x15	32	24	$96,000.00	$96,000.00	$3,121.00	$96,000.00	$60,000.00	2026-05-09
1559142	OTHER	Grf Evar Taa Tag 8mmx34mmx20cm	32	24	$96,000.00	$96,000.00	$3,121.00	$96,000.00	$60,000.00	2026-05-09
1504485	OTHER	Graft Thoracic Aortic 28x15x8	32	24	$96,000.00	$96,000.00	$3,121.00	$96,000.00	$60,000.00	2026-05-09
1527293	OTHER	Grf Evar Taa Tag 34mmx15cmx8mm	32	24	$96,000.00	$96,000.00	$3,121.00	$96,000.00	$60,000.00	2026-05-09
1044129	OTHER	Ccls-vascular Graft Level V	32	24	$95,875.00	$95,875.00	$3,121.00	$95,875.00	$59,921.88	2026-05-09
1044189	OTHER	Ccls-crm-icd Single Level IV	32	24	$95,750.00	$95,750.00	$3,121.00	$95,750.00	$59,843.75	2026-05-09
1364253	OTHER	Nm Therasphere	44	30	$89,975.00	$89,975.00	$3,121.00	$89,975.00	$48,676.47	2026-05-09
1044193	OTHER	Ccls-crm-icd Not S Or D Lvl I	32	24	$89,581.00	$89,581.00	$3,121.00	$89,581.00	$55,988.12	2026-05-09
1352360	OTHER	Generator Symmetry Vns	32	24	$89,235.00	$89,235.00	$3,121.00	$89,235.00	$55,771.88	2026-05-09
655882	OTHER	Generator Vns Demipulse 104 (rev)	32	24	$89,196.00	$89,196.00	$3,121.00	$89,196.00	$55,747.50	2026-05-09
1326661	OTHER	Ccls-stent Coat/covrd Lvl Ix	32	24	$88,836.00	$88,836.00	$3,121.00	$88,836.00	$55,522.50	2026-05-09
1020276	OTHER	Nm Y-90 Microspheres- Nonstranded	44	30	$87,672.00	$87,672.00	$3,121.00	$87,672.00	$47,430.55	2026-05-09
1302704	OTHER	Nail Fem Precice 8.5x50x305mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302707	OTHER	Nail Fem Precice 10.7x50x230mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302728	OTHER	Nail Tib Prec 10d 10.7x50x240	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302690	OTHER	Nail Tib Precice 10.7x50x335mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302691	OTHER	Nail Tib Precice 10.7x50x365mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302724	OTHER	Nail Tib Prec 10d 8.5x80x315	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302689	OTHER	Nail Tib Precice 10.7x50x305mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302725	OTHER	Nail Tib Prec 10d 8.5x80x345	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302687	OTHER	Nail Tib Precice 10.7x50x245mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302702	OTHER	Nail Fem Precice 8.5x50x245mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302686	OTHER	Nail Tib Precice 10.7x50x230mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302688	OTHER	Nail Tib Precice 10.7x50x275mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302727	OTHER	Nail Tib Prec 10d 10.7x50x225	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302721	OTHER	Nail Tib Prec 10d 8.5x50x240	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302723	OTHER	Nail Tib Prec 10d 8.5x80x285	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302701	OTHER	Nail Fem Precice 8.5x50x230mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302756	OTHER	Nail Fem Prec 10d 12.5x80x375	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302722	OTHER	Nail Tib Prec 10d 8.5x80x255	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302713	OTHER	Nail Fem Precice 12.5x50x230mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302734	OTHER	Nail Tib Prec 10d 12.5x50x205	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302736	OTHER	Nail Tib Prec 10d 12.5x50x240	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302694	OTHER	Nail Tib Precice 12.5x50x230mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302755	OTHER	Nail Fem Prec 10d 12.5x80x345	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1026538	OTHER	Nail Femur Precice 10.7x240mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302754	OTHER	Nail Fem Prec 10d 12.5x80x315	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302705	OTHER	Nail Fem Precice 8.5x50x335mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302726	OTHER	Nail Tib Prec 10d 10.7x50x205	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302752	OTHER	Nail Fem Prec 10d 12.5x80x255	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302720	OTHER	Nail Tib Prec 10d 8.5x50x225	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1026542	OTHER	Nail Femur Precice 10.7x345mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302740	OTHER	Nail Tib Prec 10d 12.5x80x345	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302696	OTHER	Nail Tib Precice 12.5x50x275mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302698	OTHER	Nail Tib Precice 12.5x50x335mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1026540	OTHER	Nail Femur Precice 10.7x285mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302697	OTHER	Nail Tib Precice 12.5x50x305mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302741	OTHER	Nail Tib Prec 10d 12.5x80x375	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302742	OTHER	Nail Fem Prec 10d 8.5x50x225	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302739	OTHER	Nail Tib Prec 10d 12.5x80x315	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302719	OTHER	Nail Tib Prec 10d 8.5x50x205	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1026541	OTHER	Nail Femur Precice 10.7x315mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302699	OTHER	Nail Tib Precice 12.5x50x365mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302748	OTHER	Nail Fem Prec 10d 10.7x50x225	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302731	OTHER	Nail Tib Prec 10d 10.7x80x315	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302730	OTHER	Nail Tib Prec 10d 10.7x80x285	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302749	OTHER	Nail Fem Prec 10d 10.7x80x375	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302751	OTHER	Nail Fem Prec 10d 12.5x50x240	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302732	OTHER	Nail Tib Prec 10d 10.7x80x345	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302695	OTHER	Nail Tib Precice 12.5x50x245mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302747	OTHER	Nail Fem Prec 10d 8.5x80x345	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302750	OTHER	Nail Fem Prec 10d 12.5x50x225	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302743	OTHER	Nail Fem Prec 10d 8.5x50x240	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302744	OTHER	Nail Fem Prec 10d 8.5x80x255	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302735	OTHER	Nail Tib Prec 10d 12.5x50x225	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302745	OTHER	Nail Fem Prec 10d 8.5x80x285	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302737	OTHER	Nail Tib Prec 10d 12.5x80x255	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302753	OTHER	Nail Fem Prec 10d 12.5x80x285	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302733	OTHER	Nail Tib Prec 10d 10.7x80x375	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302746	OTHER	Nail Fem Prec 10d 8.5x80x315	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302703	OTHER	Nail Fem Precice 8.5x50x275mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302729	OTHER	Nail Tib Prec 10d 10.7x80x255	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1026534	OTHER	Nail Tibia Precice 8.5x230mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1026539	OTHER	Nail Femur Precice 10.7x255mm	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1302738	OTHER	Nail Tib Prec 10d 12.5x80x285	32	24	$85,455.00	$85,455.00	$3,121.00	$85,455.00	$53,409.38	2026-05-09
1025499	OTHER	Mesh Strattice	41	27	$85,425.00	$85,425.00	$114.33	$85,425.00	$51,255.00	2026-05-09
1044130	OTHER	Ccls-vascular Graft Level Vi	32	24	$83,699.00	$83,699.00	$3,121.00	$83,699.00	$52,311.88	2026-05-09
1533164	OTHER	Kit Dual Chamber Aveir Pacer	44	30	$83,250.00	$83,250.00	$3,121.00	$83,250.00	$45,038.25	2026-05-09
1326662	OTHER	Ccls-stent With Del Sys Lvl Xi	32	24	$79,414.00	$79,414.00	$3,121.00	$79,414.00	$49,633.75	2026-05-09
1492634	OTHER	Ir-stent Fred	30	22	$78,500.00	$78,500.00	$3,121.00	$78,500.00	$51,613.75	2026-05-09
1330340	OTHER	Kit Ipg Senza Omnia	32	24	$78,000.00	$78,000.00	$3,121.00	$78,000.00	$48,750.00	2026-05-09
1185862	OTHER	Kit Ipg 2000	32	24	$78,000.00	$78,000.00	$3,121.00	$78,000.00	$48,750.00	2026-05-09
1533217	OTHER	Generator Optimizer Smart Mini	33	25	$78,000.00	$78,000.00	$3,121.00	$78,000.00	$46,800.00	2026-05-09
1337380	OTHER	Nail Tib Ant 10d 11.5x360x7/10	32	24	$77,250.00	$77,250.00	$3,121.00	$77,250.00	$48,281.25	2026-05-09
1539209	OTHER	Generator Liberta Rc Ipg	32	24	$76,500.00	$76,500.00	$3,121.00	$76,500.00	$47,812.50	2026-05-09
1313370	OTHER	Ccls-stent With Del Sys Lvl Xiii	30	22	$75,633.00	$75,633.00	$3,121.00	$75,633.00	$49,728.69	2026-05-09
1313950	OTHER	Ccls- Endovasclr Dissection Stent	30	22	$75,633.00	$75,633.00	$3,121.00	$75,633.00	$49,728.69	2026-05-09
1044192	OTHER	Ccls-crm-icd Dual Level Iii	32	24	$75,000.00	$75,000.00	$3,121.00	$75,000.00	$46,875.00	2026-05-09
1493706	OTHER	Mesh Phasix 12x14in Mfil Resrb	32	24	$74,949.00	$74,949.00	$3,121.00	$74,949.00	$46,843.12	2026-05-09
1044191	OTHER	Ccls-crm-icd Dual Level Ii	32	24	$73,581.00	$73,581.00	$3,121.00	$73,581.00	$45,988.12	2026-05-09
1376967	OTHER	Component Acetab Triflng Sz 27	32	24	$72,905.00	$72,905.00	$3,121.00	$72,905.00	$45,565.62	2026-05-09
1505291	OTHER	Icd Cobalt Xt Hf Quad MRI Is4	32	24	$72,000.00	$72,000.00	$3,121.00	$72,000.00	$45,000.00	2026-05-09
1508791	OTHER	Icd Cobalt Xt Hf Crt-d MRI D1	32	24	$72,000.00	$72,000.00	$3,121.00	$72,000.00	$45,000.00	2026-05-09
1540808	OTHER	Icd Cobalt Xt Hf Quad MRI Is4	32	24	$72,000.00	$72,000.00	$3,121.00	$72,000.00	$45,000.00	2026-05-09
1559701	OTHER	System Eterna Octrode Scs	32	24	$72,000.00	$72,000.00	$3,121.00	$72,000.00	$45,000.00	2026-05-09
1405324	OTHER	Stimulator Spine Omnia	32	24	$70,725.00	$70,725.00	$3,121.00	$70,725.00	$44,203.12	2026-05-09
1482180	OTHER	Kit Nipg2000 Chgr2500 Ptrc2300	32	24	$70,725.00	$70,725.00	$3,121.00	$70,725.00	$44,203.12	2026-05-09
1493071	OTHER	Systm Cardiomems Sensor	32	24	$67,500.00	$67,500.00	$3,121.00	$67,500.00	$42,187.50	2026-05-09
1176639	OTHER	Neurostimulator Percept Rc	32	24	$67,500.00	$67,500.00	$3,121.00	$67,500.00	$42,187.50	2026-05-09
1561420	OTHER	Gore Tag Cnfrm Thor 45x37x15	32	24	$66,897.00	$66,897.00	$3,121.00	$66,897.00	$41,810.62	2026-05-09
1561421	OTHER	Gore Tag Cnfrm Thor 37x31x15	32	24	$66,897.00	$66,897.00	$3,121.00	$66,897.00	$41,810.62	2026-05-09
1374196	OTHER	Ccls-crm-ppm Single Rr Lvl Vi	32	24	$66,250.00	$66,250.00	$3,121.00	$66,250.00	$41,406.25	2026-05-09
1519174	OTHER	Icd Cobalt Quad	32	24	$66,000.00	$66,000.00	$3,121.00	$66,000.00	$41,250.00	2026-05-09
1485798	OTHER	Generator Vercise R16 Recharge	32	24	$66,000.00	$66,000.00	$3,121.00	$66,000.00	$41,250.00	2026-05-09
1044188	OTHER	Ccls-crm-icd Single Level Ii	32	24	$65,405.00	$65,405.00	$3,121.00	$65,405.00	$40,878.12	2026-05-09
1518412	OTHER	Allograft Whole Fem Condyle Rt	29	22	$64,050.00	$64,050.00	$3,121.00	$64,050.00	$42,593.25	2026-05-09
018	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	24	18	—	—	$1,433.00	$628,901.64	$522,645.95	2026-05-09
002-4	OTHER	Heart And/or Lung Transplant	2	2	—	—	$224,400.00	$325,818.06	$275,109.03	2026-05-09
583-4	OTHER	Neonate With Ecmo	2	2	—	—	$225,420.00	$314,197.96	$269,808.98	2026-05-09
841-4	OTHER	Extensive Third Degree Burns With Skin Graft	2	2	—	—	$193,800.00	$311,440.82	$252,620.41	2026-05-09
588-4	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	2	2	—	—	$225,420.00	$257,727.54	$241,573.77	2026-05-09
583-3	OTHER	Neonate With Ecmo	2	2	—	—	$209,712.35	$227,843.89	$218,778.12	2026-05-09
001	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	23	18	—	—	$1,433.00	$386,729.82	$217,913.85	2026-05-09
007-4	OTHER	Allogeneic Bone Marrow Transplant	2	2	—	—	$196,602.99	$213,601.10	$205,102.04	2026-05-09
630-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	2	2	—	—	$172,181.55	$187,068.20	$179,624.88	2026-05-09
004	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	30	22	—	—	$1,433.00	$299,605.78	$176,948.42	2026-05-09
002-3	OTHER	Heart And/or Lung Transplant	2	2	—	—	$142,800.00	$201,481.13	$172,140.57	2026-05-09
927	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	27	20	—	—	$1,433.00	$461,811.32	$166,021.49	2026-05-09
003	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	30	22	—	—	$1,433.00	$459,101.08	$165,993.02	2026-05-09
001-4	OTHER	Liver Transplant And/or Intestinal Transplant	2	2	—	—	$122,400.00	$208,283.06	$165,341.53	2026-05-09
583-2	OTHER	Neonate With Ecmo	2	2	—	—	$156,836.27	$170,396.19	$163,616.23	2026-05-09
609-4	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	2	2	—	—	$148,446.24	$161,280.77	$154,863.51	2026-05-09
161-4	OTHER	Implantable Heart Assist Systems	2	2	—	—	$147,278.23	$160,011.77	$153,645.00	2026-05-09
631-4	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	2	2	—	—	$142,514.94	$154,836.65	$148,675.79	2026-05-09
593-4	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	2	2	—	—	$123,420.00	$168,087.41	$145,753.71	2026-05-09
002-2	OTHER	Heart And/or Lung Transplant	2	2	—	—	$137,622.17	$149,520.86	$143,571.52	2026-05-09
588-3	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	2	2	—	—	$134,640.00	$152,021.70	$143,330.85	2026-05-09
591-4	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	2	2	—	—	$122,400.00	$162,316.16	$142,358.08	2026-05-09
588-2	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	2	2	—	—	$132,600.00	$150,970.28	$141,785.14	2026-05-09
842-4	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	2	2	—	—	$122,400.00	$157,393.71	$139,896.85	2026-05-09
007	OTHER	Lung Transplant	23	18	—	—	$1,433.00	$436,302.09	$136,831.82	2026-05-09
011-4	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	2	2	—	—	$51,021.42	$222,108.37	$136,564.90	2026-05-09
006-4	OTHER	Pancreas Transplant	2	2	—	—	$86,700.00	$183,938.13	$135,319.07	2026-05-09
583-1	OTHER	Neonate With Ecmo	2	2	—	—	$127,952.51	$139,015.17	$133,483.84	2026-05-09
007-3	OTHER	Allogeneic Bone Marrow Transplant	2	2	—	—	$115,863.38	$125,880.82	$120,872.10	2026-05-09
002	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	23	18	—	—	$1,433.00	$156,378.84	$119,731.80	2026-05-09
161-3	OTHER	Implantable Heart Assist Systems	2	2	—	—	$112,830.26	$122,585.46	$117,707.86	2026-05-09
910-4	OTHER	Craniotomy For Multiple Significant Trauma	2	2	—	—	$112,334.43	$122,046.77	$117,190.60	2026-05-09
602-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	2	2	—	—	$102,000.00	$120,485.38	$111,242.69	2026-05-09
911-4	OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	2	2	—	—	$106,127.15	$115,302.80	$110,714.98	2026-05-09
841-3	OTHER	Extensive Third Degree Burns With Skin Graft	2	2	—	—	$105,199.88	$114,295.37	$109,747.62	2026-05-09
603-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	2	2	—	—	$81,600.00	$135,114.08	$108,357.04	2026-05-09
006-3	OTHER	Pancreas Transplant	2	2	—	—	$86,700.00	$129,335.60	$108,017.80	2026-05-09
912-4	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	2	2	—	—	$103,111.66	$112,026.61	$107,569.14	2026-05-09
001-3	OTHER	Liver Transplant And/or Intestinal Transplant	2	2	—	—	$93,840.00	$120,414.57	$107,127.29	2026-05-09
440-4	OTHER	Kidney Transplant	2	2	—	—	$91,800.00	$122,376.63	$107,088.32	2026-05-09
011-3	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	2	2	—	—	$100,627.52	$109,327.68	$104,977.60	2026-05-09
008-4	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	2	2	—	—	$99,453.34	$108,051.98	$103,752.66	2026-05-09
006-2	OTHER	Pancreas Transplant	2	2	—	—	$86,700.00	$112,276.07	$99,488.04	2026-05-09
004-4	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	2	2	—	—	$92,292.02	$100,271.50	$96,281.76	2026-05-09
020-4	OTHER	Open Craniotomy For Trauma	2	2	—	—	$91,629.67	$99,551.89	$95,590.78	2026-05-09
593-3	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	2	2	—	—	$91,090.81	$98,966.44	$95,028.62	2026-05-09
001-2	OTHER	Liver Transplant And/or Intestinal Transplant	2	2	—	—	$88,740.00	$100,921.86	$94,830.93	2026-05-09
007-2	OTHER	Allogeneic Bone Marrow Transplant	2	2	—	—	$90,629.16	$98,464.87	$94,547.01	2026-05-09
161-2	OTHER	Implantable Heart Assist Systems	2	2	—	—	$90,592.94	$98,425.53	$94,509.24	2026-05-09
009-4	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	2	2	—	—	$90,356.26	$98,168.38	$94,262.32	2026-05-09
014	OTHER	Allogeneic Bone Marrow Transplant	25	19	—	—	$1,433.00	$165,847.02	$92,894.38	2026-05-09
161-1	OTHER	Implantable Heart Assist Systems	2	2	—	—	$86,062.97	$93,503.89	$89,783.43	2026-05-09
002-1	OTHER	Heart And/or Lung Transplant	2	2	—	—	$51,000.00	$128,179.01	$89,589.51	2026-05-09
607-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	2	2	—	—	$85,178.97	$92,543.47	$88,861.22	2026-05-09
207	OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	32	23	—	—	$1,433.00	$139,182.56	$84,736.50	2026-05-09
969	OTHER	HIV With Extensive O.r. Procedures With Mcc	27	20	—	—	$1,433.00	$132,403.72	$84,473.94	2026-05-09
007-1	OTHER	Allogeneic Bone Marrow Transplant	2	2	—	—	$80,698.19	$87,675.29	$84,186.74	2026-05-09
212	OTHER	Hip & Femur Procedures Except Major Joint Age 0-17	29	21	—	—	$1,433.00	$235,206.78	$84,106.48	2026-05-09
215	OTHER	Other Heart Assist System Implant	38	29	—	—	$59,742.00	$215,369.91	$83,813.02	2026-05-09
591-3	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	2	2	—	—	$80,136.80	$87,065.35	$83,601.08	2026-05-09
268	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	27	20	—	—	$1,433.00	$148,768.98	$83,561.31	2026-05-09
602-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	2	2	—	—	$80,063.54	$86,985.77	$83,524.65	2026-05-09
216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	38	29	—	—	$58,696.80	$211,601.96	$80,958.20	2026-05-09
005	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	23	18	—	—	$1,433.00	$142,284.90	$80,174.45	2026-05-09
630-3	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	2	2	—	—	$76,171.28	$82,756.98	$79,464.13	2026-05-09
440-3	OTHER	Kidney Transplant	2	2	—	—	$74,245.91	$80,665.15	$77,455.53	2026-05-09
593-2	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	2	2	—	—	$73,222.25	$79,552.98	$76,387.61	2026-05-09
588-1	OTHER	Female Reproductive System Reconstructive Procedures	2	2	—	—	$51,000.00	$93,814.72	$72,407.36	2026-05-09
609-3	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	2	2	—	—	$67,713.35	$73,567.78	$70,640.57	2026-05-09
001-1	OTHER	Liver Transplant And/or Intestinal Transplant	2	2	—	—	$51,000.00	$89,605.59	$70,302.79	2026-05-09
910-3	OTHER	Craniotomy For Multiple Significant Trauma	2	2	—	—	$66,934.37	$72,721.45	$69,827.91	2026-05-09
231	OTHER	Coronary Bypass With Ptca With Mcc	38	29	—	—	$50,579.40	$182,338.74	$69,799.24	2026-05-09
006-1	OTHER	Pancreas Transplant	2	2	—	—	$51,000.00	$88,254.03	$69,627.01	2026-05-09
453	OTHER	Combined Anterior And Posterior Spinal Fusion With Mcc	19	16	—	—	$1,665.00	$273,655.62	$68,642.75	2026-05-09
611-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	2	2	—	—	$64,729.36	$70,325.80	$67,527.58	2026-05-09
440-2	OTHER	Kidney Transplant	2	2	—	—	$63,678.33	$69,183.90	$66,431.11	2026-05-09
837	OTHER	Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…	27	20	—	—	$1,433.00	$103,917.01	$66,299.34	2026-05-09
004-3	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	2	2	—	—	$63,157.95	$68,618.53	$65,888.24	2026-05-09
163	OTHER	Major Chest Procedures With Mcc	32	23	—	—	$1,433.00	$114,866.98	$65,755.57	2026-05-09
008-3	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	2	2	—	—	$62,624.33	$68,038.77	$65,331.55	2026-05-09
456	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	27	20	—	—	$1,433.00	$181,765.54	$65,123.88	2026-05-09
160-4	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	2	2	—	—	$62,319.76	$67,707.87	$65,013.82	2026-05-09
602-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	2	2	—	—	$61,957.67	$67,314.47	$64,636.07	2026-05-09
612-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	2	2	—	—	$61,897.64	$67,249.26	$64,573.45	2026-05-09
219	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	38	29	—	—	$46,069.80	$166,081.63	$63,599.91	2026-05-09
005-4	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	2	2	—	—	$60,822.34	$66,080.99	$63,451.67	2026-05-09
613-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	2	2	—	—	$60,728.92	$65,979.49	$63,354.21	2026-05-09
233	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	38	29	—	—	$45,871.20	$165,365.68	$63,326.90	2026-05-09
607-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	2	2	—	—	$60,670.59	$65,916.12	$63,293.35	2026-05-09
842-3	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	2	2	—	—	$59,743.52	$64,908.89	$62,326.21	2026-05-09
910-2	OTHER	Craniotomy For Multiple Significant Trauma	2	2	—	—	$59,453.56	$64,593.85	$62,023.71	2026-05-09
162-4	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	2	2	—	—	$58,735.34	$63,813.55	$61,274.44	2026-05-09
020	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	27	20	—	—	$1,433.00	$170,202.14	$61,187.79	2026-05-09
020-3	OTHER	Open Craniotomy For Trauma	2	2	—	—	$58,611.26	$63,678.73	$61,145.00	2026-05-09
957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	31	22	—	—	$1,433.00	$172,807.15	$60,274.97	2026-05-09
653	OTHER	Major Bladder Procedures With Mcc	27	20	—	—	$1,433.00	$112,398.13	$60,010.90	2026-05-09
440-1	OTHER	Kidney Transplant	2	2	—	—	$56,859.83	$61,775.88	$59,317.85	2026-05-09
008	OTHER	Simultaneous Pancreas And Kidney Transplant	23	18	—	—	$1,433.00	$97,993.21	$59,218.20	2026-05-09
303-4	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	2	2	—	—	$56,152.67	$61,007.58	$58,580.12	2026-05-09
603-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	2	2	—	—	$55,409.82	$60,200.51	$57,805.17	2026-05-09
275	OTHER	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	29	21	—	—	$1,433.00	$154,230.55	$56,437.34	2026-05-09
608-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	2	2	—	—	$53,931.75	$58,594.64	$56,263.19	2026-05-09
010	OTHER	Pancreas Transplant	23	18	—	—	$1,433.00	$99,024.66	$55,798.25	2026-05-09
928	OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	27	20	—	—	$1,433.00	$155,145.50	$55,668.31	2026-05-09
019	OTHER	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	24	18	—	—	$1,433.00	$98,457.48	$55,427.12	2026-05-09
308-4	OTHER	Hip And Femur Fracture Repair	2	2	—	—	$52,511.25	$57,051.32	$54,781.29	2026-05-09
008-2	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	2	2	—	—	$52,396.17	$56,926.30	$54,661.24	2026-05-09
011-2	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	2	2	—	—	$51,000.00	$57,910.86	$54,455.43	2026-05-09
910-1	OTHER	Craniotomy For Multiple Significant Trauma	2	2	—	—	$51,000.00	$56,466.25	$53,733.12	2026-05-09
870	OTHER	Septicemia Or Severe Sepsis With Mv >96 Hours	27	20	—	—	$1,433.00	$149,502.23	$53,663.79	2026-05-09
621-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	2	2	—	—	$50,781.18	$55,171.68	$52,976.43	2026-05-09
955	OTHER	Craniotomy For Multiple Significant Trauma	30	22	—	—	$1,433.00	$145,593.69	$52,823.96	2026-05-09
459	OTHER	Spinal Fusion Except Cervical With Mcc	22	18	—	—	$1,665.00	$176,973.88	$52,724.61	2026-05-09
631-3	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	2	2	—	—	$50,109.44	$54,441.86	$52,275.65	2026-05-09
163-4	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	2	2	—	—	$49,980.19	$54,301.43	$52,140.81	2026-05-09
911-3	OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	2	2	—	—	$49,944.00	$54,262.11	$52,103.06	2026-05-09
570	OTHER	Skin Debridement With Mcc	28	20	—	—	$1,433.00	$87,525.79	$52,101.58	2026-05-09
178-4	OTHER	External Heart Assist Systems	2	2	—	—	$49,646.53	$53,938.93	$51,792.73	2026-05-09
217	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	30	22	—	—	$1,433.00	$142,223.74	$51,607.47	2026-05-09
326	OTHER	Stomach, Esophageal And Duodenal Procedures With Mcc	31	22	—	—	$1,433.00	$107,877.46	$51,393.47	2026-05-09
630-2	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	2	2	—	—	$49,013.50	$53,251.16	$51,132.33	2026-05-09
471	OTHER	Cervical Spinal Fusion With Mcc	27	20	—	—	$1,433.00	$104,444.78	$51,130.86	2026-05-09
218	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	30	22	—	—	$1,433.00	$142,223.74	$51,078.42	2026-05-09
461	OTHER	Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc	27	20	—	—	$1,433.00	$119,462.49	$50,978.63	2026-05-09
573	OTHER	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	30	22	—	—	$1,433.00	$141,706.78	$50,894.83	2026-05-09
028	OTHER	Spinal Procedures With Mcc	38	29	—	—	$34,861.00	$129,959.53	$49,825.46	2026-05-09
930-4	OTHER	Multiple Significant Trauma Without O.r. Procedure	2	2	—	—	$47,664.60	$51,785.63	$49,725.11	2026-05-09
607-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	2	2	—	—	$47,645.40	$51,764.77	$49,705.08	2026-05-09
021	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	27	20	—	—	$1,433.00	$114,504.89	$49,683.26	2026-05-09
608-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	2	2	—	—	$47,027.32	$51,093.26	$49,060.29	2026-05-09
006	OTHER	Liver Transplant Without Mcc	23	18	—	—	$1,433.01	$100,852.14	$48,994.54	2026-05-09
235	OTHER	Coronary Bypass Without Cardiac Catheterization With Mcc	38	29	—	—	$35,211.60	$126,937.82	$48,673.19	2026-05-09
454	OTHER	Combined Anterior And Posterior Spinal Fusion With Cc	23	19	—	—	$1,433.00	$89,596.60	$48,486.93	2026-05-09
633-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Anomaly	2	2	—	—	$46,154.91	$50,145.42	$48,150.17	2026-05-09
165-4	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	2	2	—	—	$45,705.75	$49,657.43	$47,681.59	2026-05-09
266	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	27	20	—	—	$1,433.00	$132,557.29	$47,644.87	2026-05-09
232	OTHER	Coronary Bypass With Ptca Without Mcc	27	20	—	—	$1,433.00	$131,134.04	$47,139.33	2026-05-09
167-4	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	2	2	—	—	$44,957.62	$48,844.61	$46,901.12	2026-05-09
005-3	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	2	2	—	—	$44,788.67	$48,661.06	$46,724.86	2026-05-09
276	OTHER	Non-maligant Breast Disorders	29	21	—	—	$1,433.00	$129,922.76	$46,709.06	2026-05-09
457	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	27	20	—	—	$1,433.00	$128,981.85	$46,374.87	2026-05-09
790	OTHER	Extreme Immaturity Or Respiratory Distress Syndrome, Neonate	32	23	—	—	$1,433.00	$128,557.91	$46,224.26	2026-05-09
016	OTHER	Autologous Bone Marrow Transplant With Cc/mcc	25	19	—	—	$1,433.00	$81,829.86	$46,118.24	2026-05-09
820	OTHER	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	30	22	—	—	$1,433.00	$139,766.93	$46,067.40	2026-05-09
234	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	38	29	—	—	$32,776.20	$118,158.20	$45,325.25	2026-05-09
004-2	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	2	2	—	—	$43,421.33	$47,175.50	$45,298.42	2026-05-09
591-2	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	2	2	—	—	$43,247.76	$46,986.92	$45,117.34	2026-05-09
023	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	30	22	—	—	$1,433.00	$123,946.39	$45,023.48	2026-05-09
304-4	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	2	2	—	—	$43,099.99	$46,826.37	$44,963.18	2026-05-09
912-3	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	2	2	—	—	$26,603.37	$63,093.65	$44,848.51	2026-05-09
463	OTHER	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …	30	22	—	—	$1,433.00	$123,280.18	$44,784.43	2026-05-09
020-2	OTHER	Open Craniotomy For Trauma	2	2	—	—	$42,836.00	$46,539.56	$44,687.78	2026-05-09
303-3	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	2	2	—	—	$42,516.95	$46,192.93	$44,354.94	2026-05-09
183-4	OTHER	Percutaneous Structural Cardiac Procedures	2	2	—	—	$42,365.71	$46,028.61	$44,197.16	2026-05-09
009-3	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	2	2	—	—	$41,644.51	$45,245.06	$43,444.79	2026-05-09
278	OTHER	Cellulitis Age >17 Without Cc	29	21	—	—	$1,433.00	$120,396.91	$43,325.44	2026-05-09
834	OTHER	Acute Leukemia Without Major O.r. Procedures With Mcc	30	22	—	—	$1,433.00	$173,874.09	$43,157.62	2026-05-09
405	OTHER	Pancreas, Liver And Shunt Procedures With Mcc	30	22	—	—	$1,433.00	$118,326.92	$43,007.04	2026-05-09
863-4	OTHER	Neonatal Aftercare	2	2	—	—	$41,206.56	$44,769.25	$42,987.90	2026-05-09
166-4	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	2	2	—	—	$41,199.64	$44,761.72	$42,980.68	2026-05-09
022	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…	27	20	—	—	$1,433.00	$68,727.16	$42,569.85	2026-05-09
011	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	27	20	—	—	$1,433.00	$117,972.18	$42,464.16	2026-05-09
589-1	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	2	2	—	—	$40,628.80	$44,141.53	$42,385.17	2026-05-09
017	OTHER	Autologous Bone Marrow Transplant Without Cc/mcc	25	19	—	—	$1,433.00	$74,965.74	$42,296.69	2026-05-09
179-4	OTHER	Defibrillator Implants	2	2	—	—	$40,448.43	$43,945.56	$42,196.99	2026-05-09
680-4	OTHER	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	2	2	—	—	$40,280.63	$43,763.26	$42,021.94	2026-05-09
162-3	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	2	2	—	—	$40,228.68	$43,706.82	$41,967.75	2026-05-09
220	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	30	22	—	—	$1,433.00	$115,348.46	$41,938.29	2026-05-09
622-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…	2	2	—	—	$40,081.36	$43,546.76	$41,814.06	2026-05-09
612-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	2	2	—	—	$39,856.50	$43,302.46	$41,579.48	2026-05-09
055-4	OTHER	Head Trauma With Coma > 1 Hour Or Hemorrhage	2	2	—	—	$39,771.66	$43,210.28	$41,490.97	2026-05-09
270	OTHER	Other Major Cardiovascular Procedures With Mcc	28	20	—	—	$1,433.00	$317,992.25	$41,098.12	2026-05-09
008-1	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	2	2	—	—	$39,373.86	$42,778.09	$41,075.97	2026-05-09
844-4	OTHER	Partial Thickness Burns Without Skin Graft	2	2	—	—	$38,576.32	$43,225.28	$40,900.80	2026-05-09

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