Price Transparency Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

NORTHWEST HEALTH - STARKE

Knox, IN · CCN 150102 · Rates published

47,788 distinct procedures filed
48 distinct payers
1,370,007 rate rows
2026-05-27 last MRF observed
Data quality

1,320,590 of 1,370,007 rate rows are consumer-grade (96.4%)

49,417 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 — reasonRows
per-diem day rate — not a per-procedure price 30,987
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 11,194
placeholder amount (≤ $0.02) — excluded from medians 5,854
exceeds 10× this hospital's gross charge — excluded from medians 1,041
template filing: same amount across many unrelated codes — excluded 341
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.nwhealthstarke.com/Uploads/Public/Documents/charge-masters/charge-masters-2024/272691760_northwest-health-starke_standardcharges.csv
Found on page https://www.nwhealthstarke.com/pricing-information
Discovered viaCMS hospital list
Last fetch not_modified · 2026-05-17
Content fingerprint 85941fdb85643e2c… · 450,549,030 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 26 $2,506.00 $3,424,048.38 $1,141,349.46 nat. median
$386,529
outlier · 3.0×
7
OTHER 		Lung Transplant 23 $2,506.00 $2,478,898.38 $826,299.46 nat. median
$169,933
outlier · 4.9×
011-4
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 9 $434,216.72 $647,979.12 $647,979.12 nat. median
$105,647
outlier · 6.1×
583-4
OTHER 		Neonate With Ecmo 9 $395,514.93 $588,944.20 $588,944.20 nat. median
$309,400
1.9× median
583-3
OTHER 		Neonate With Ecmo 9 $395,514.93 $588,944.20 $588,944.20 nat. median
$259,487
outlier · 2.3×
583-1
OTHER 		Neonate With Ecmo 9 $374,511.63 $558,502.30 $558,502.30 nat. median
$171,226
outlier · 3.3×
583-2
OTHER 		Neonate With Ecmo 9 $374,511.63 $558,502.30 $558,502.30 nat. median
$191,347
outlier · 2.9×
002-4
OTHER 		Heart And/or Lung Transplant 9 $360,685.28 $537,458.68 $537,458.68 nat. median
$216,800
outlier · 2.5×
588-4
OTHER 		Neonate Birth Weight < 1500 Grams With Major Procedure 9 $339,285.68 $503,124.62 $503,124.62 nat. median
$267,493
1.9× median
161-4
OTHER 		Implantable Heart Assist Systems 9 $315,431.69 $469,930.95 $469,930.95 nat. median
$202,242
outlier · 2.3×
631-4
OTHER 		Neonate Birth Weight > 2499 Grams With Other Major Procedure 9 $316,233.60 $469,136.53 $469,136.53 nat. median
$203,379
outlier · 2.3×
103958919-2215111
OTHER 		69866-1030-08 - Autologous Cultured Chondrocytes 1 18 $148,868.43 $538,216.63 $431,718.44 nat. median
$427,424
1.0× median
103958918-2215111
OTHER 		69866-1030-05 - Autologous Cultured Chondrocytes 1 18 $148,868.43 $538,216.63 $431,718.44 nat. median
$427,424
1.0× median
588-3
OTHER 		Neonate Birth Weight < 1500 Grams With Major Procedure 9 $267,470.97 $396,403.43 $396,403.43 nat. median
$165,000
outlier · 2.4×
102534551-2215105
OTHER 		71336-1001-01 - Givosiran 189 mg/mL Soln 18 $136,484.40 $493,443.60 $395,804.76 nat. median
$391,868
1.0× median
004-4
OTHER 		Tracheostomy With Mv >96 Hours With Extensive Procedure 9 $264,547.95 $393,435.20 $393,435.20 nat. median
$110,000
outlier · 3.6×
011-3
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 9 $253,343.54 $378,177.99 $378,177.99 nat. median
$171,094
outlier · 2.2×
51905029-2215107
OTHER 		30237-8900-06 - Sipuleucel-t - Susp 18 $129,805.73 $469,297.63 $376,436.61 nat. median
$372,692
1.0× median
4
OTHER 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 26 $2,506.00 $1,067,245.80 $355,748.60 nat. median
$134,983
outlier · 2.6×
1279402-2215105
OTHER 		Ipilimumab 200 Mg / 40 Ml Soln-IV 40 Ml 18 $119,273.68 $431,220.23 $345,893.67 nat. median
$342,453
1.0× median
1
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 24 $2,506.00 $1,009,392.36 $341,169.32 nat. median
$239,422
1.4× median
007-4
OTHER 		Allogeneic Bone Marrow Transplant 7 $224,142.59 $333,375.47 $333,375.47 nat. median
$172,311
1.9× median
591-4
OTHER 		Neonate Birth Weight 500-749 Grams Without Major Procedure 9 $224,358.82 $332,614.53 $332,614.53 nat. median
$156,696
outlier · 2.1×
001-4
OTHER 		Liver Transplant And/or Intestinal Transplant 7 $220,536.98 $328,688.97 $328,688.97 nat. median
$124,561
outlier · 2.6×
593-4
OTHER 		Neonate Birth Weight 750-999 Grams Without Major Procedure 9 $214,523.26 $317,330.38 $317,330.38 nat. median
$151,250
outlier · 2.1×
106410809-2124721
OTHER 		00310-3040-00 - Anifrolumab Fnia 300 Mg/2 Ml Soln 18 $108,895.43 $393,698.86 $315,796.74 nat. median
$312,656
1.0× median
681
OTHER 		Neonate, Birth Weight >2499 Grams, With Significant O.r. Procedures, With Multip… 2 $283,093.37 $333,752.18 $308,422.78 nat. median
$0
011-2
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 9 $204,264.27 $304,837.81 $304,837.81 nat. median
$52,878
outlier · 5.8×
161-3
OTHER 		Implantable Heart Assist Systems 9 $203,905.05 $303,870.59 $303,870.59 nat. median
$152,491
2.0× median
161-2
OTHER 		Implantable Heart Assist Systems 9 $203,885.70 $303,851.24 $303,851.24 nat. median
$109,992
outlier · 2.8×
161-1
OTHER 		Implantable Heart Assist Systems 9 $202,873.05 $302,838.59 $302,838.59 nat. median
$101,352
outlier · 3.0×
002-3
OTHER 		Heart And/or Lung Transplant 7 $198,507.20 $295,712.02 $295,712.02 nat. median
$133,471
outlier · 2.2×
588-1
OTHER 		Female Reproductive System Reconstructive Procedures 9 $198,127.58 $294,207.35 $294,207.35 nat. median
$75,325
outlier · 3.9×
588-2
OTHER 		Neonate Birth Weight < 1500 Grams With Major Procedure 9 $198,127.58 $294,207.35 $294,207.35 nat. median
$153,523
1.9× median
1286149-2215105
OTHER 		Pegloticase 8 Mg/1 Ml Soln-IV 18 $97,713.80 $353,272.97 $283,370.03 nat. median
$280,551
1.0× median
95367892-2215105
OTHER 		60809-0801-01 - Pegloticase 8 mg/mL Soln 18 $97,713.80 $353,272.97 $283,370.03 nat. median
$280,551
1.0× median
2
OTHER 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 23 $2,506.00 $827,258.85 $275,752.95 nat. median
$111,558
outlier · 2.5×
969
OTHER 		HIV With Extensive O.r. Procedures With Mcc 26 $2,506.00 $790,524.57 $263,508.19 nat. median
$64,729
outlier · 4.1×
1282362-2215105
OTHER 		54482-0301-01 - Pegaspargase 3750. Soln 18 $89,373.62 $323,120.03 $259,183.51 nat. median
$256,605
1.0× median
1282361-2215105
OTHER 		57665-0002-02 - Pegaspargase 3750. Soln 18 $89,373.62 $323,120.03 $259,183.51 nat. median
$256,605
1.0× median
99090561-2215105
OTHER 		72694-0954-01 - Pegaspargase 3,750 IntlUnit(s) / 5 18 $89,373.62 $323,120.03 $259,183.51 nat. median
$256,605
1.0× median
3
OTHER 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 26 $2,506.00 $744,705.30 $251,902.87 nat. median
$181,005
1.4× median
94990000-2215105
OTHER 		57894-0061-03 - Ustekinumab 90 mg/mL Soln 18 $86,442.18 $312,521.74 $250,682.34 nat. median
$248,189
1.0× median
609-4
OTHER 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 9 $169,002.62 $250,369.68 $250,369.68 nat. median
$169,856
1.5× median
602-4
OTHER 		Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 9 $165,770.53 $245,243.37 $245,243.37 nat. median
$125,000
2.0× median
002-2
OTHER 		Heart And/or Lung Transplant 7 $163,464.90 $243,586.70 $243,586.70 nat. median
$106,681
outlier · 2.3×
160-4
OTHER 		Major Cardiothoracic Repair Of Heart Anomaly 9 $162,843.39 $242,358.25 $242,358.25 nat. median
$106,926
outlier · 2.3×
630-4
OTHER 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 9 $158,132.69 $235,523.02 $235,523.02 nat. median
$210,669
1.1× median
005-4
OTHER 		Tracheostomy With Mv >96 Hours Without Extensive Procedure 7 $154,011.10 $228,748.68 $228,748.68 nat. median
$88,000
outlier · 2.6×
009-4
OTHER 		Extracorporeal Membrane Oxygenation (ecmo) 9 $152,611.53 $227,390.60 $227,390.60 nat. median
$150,954
1.5× median

Other procedures at this hospital

Browse this hospital's 47,788 published procedures. Use the slice to choose what to show, then sort or filter any column.

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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
             
103461918-2215107 OTHER 00003-7125-11 - Nivolumab-relatlimab Rmbw 240 Mg-8 24 18 $102,310.45 $56,270.75 45% off $26,600.72 $96,171.82 $77,142.08 2026-05-27
103469064-2215107 OTHER 00008-0100-01 - Inotuzumab Ozogamicin 0.9 Mg Powde 24 18 $156,540.74 $86,097.41 45% off $40,700.59 $147,148.30 $118,031.71 2026-05-27
103152117-2215105 OTHER 00008-0423-03 - Antivenin (Micrurus Fulvius) - Kit 24 18 $97,715.29 $53,743.41 45% off $25,405.98 $91,852.37 $73,677.33 2026-05-27
1288090-2215107 OTHER 00024-5824-11 - Cabazitaxel Soln 24 18 $97,640.60 $53,702.33 45% off $25,386.56 $91,782.16 $73,621.01 2026-05-27
99211218-2215105 OTHER 00074-3779-03 - Leuprolide 11.25 Mg/3 Months Kit 24 18 $140,915.97 $77,503.78 45% off $36,638.15 $132,461.01 $106,250.64 2026-05-27
104059220-2215105 OTHER 00074-5015-01 - Risankizumab Rzaa 60 mg/mL Soln 24 18 $131,802.88 $72,491.58 45% off $34,268.75 $123,894.71 $99,379.37 2026-05-27
96754854-2215105 OTHER 00074-9694-03 - Leuprolide 30 Mg/3 Months Kit 24 18 $155,204.84 $85,362.66 45% off $40,353.26 $145,892.55 $117,024.45 2026-05-27
105646369-2215105 OTHER 00078-0734-61 - Canakinumab 150 mg/mL Soln 24 18 $244,250.41 $134,337.73 45% off $63,505.11 $229,595.39 $184,164.81 2026-05-27
1288223-2168371 OTHER 00169-7050-01 - Coagulation Factor VIIa Rec Inject 24 18 $144,146.51 $79,280.58 45% off $37,478.09 $135,497.72 $108,686.47 2026-05-27
39888518-2168371 OTHER 00169-7205-01 - Coagulation Factor VIIa 5000 Mcg ( 24 18 $144,146.51 $79,280.58 45% off $37,478.09 $135,497.72 $108,686.47 2026-05-27
95380079-2168371 OTHER 00169-7208-01 - Coagulation Factor VIIa 8000 Mcg ( 24 18 $230,634.27 $126,848.85 45% off $59,964.91 $216,796.21 $173,898.24 2026-05-27
1285618-2215104 OTHER 00187-0007-14 - Ribavirin 6. Gm Rec Powder 24 18 $103,921.19 $57,156.65 45% off $27,019.51 $97,685.92 $78,356.57 2026-05-27
106410809-2124721 OTHER 00310-3040-00 - Anifrolumab Fnia 300 Mg/2 Ml Soln 24 18 $418,828.57 $230,355.71 45% off $108,895.43 $393,698.86 $315,796.74 2026-05-27
96750733-2215106 OTHER 15054-1090-03 - Lanreotide 90 Mg/0.3 Ml Soln 24 18 $108,980.91 $59,939.50 45% off $28,335.04 $102,442.06 $82,171.60 2026-05-27
95304976-2215106 OTHER 15054-1120-03 - Lanreotide 120 Mg/0.5 Ml Soln 24 18 $128,524.29 $70,688.36 45% off $33,416.32 $120,812.83 $96,907.32 2026-05-27
101961112-2215106 OTHER 15054-1120-04 - Lanreotide 120 Mg/0.5 Ml Soln 24 18 $128,524.29 $70,688.36 45% off $33,416.32 $120,812.83 $96,907.32 2026-05-27
102525786-2215105 OTHER 25682-0025-01 - Ravulizumab 100 mg/mL Soln 24 18 $86,197.84 $47,408.81 45% off $22,411.44 $81,025.97 $64,993.17 2026-05-27
51905029-2215107 OTHER 30237-8900-06 - Sipuleucel-t - Susp 24 18 $499,252.80 $274,589.04 45% off $129,805.73 $469,297.63 $376,436.61 2026-05-27
40256775-2215105 OTHER 44087-8822-01 - Interferon Beta-1a - Kit 24 18 $130,196.16 $71,607.89 45% off $33,851.00 $122,384.39 $98,167.90 2026-05-27
95048080-2215105 OTHER 47783-0101-01 - Ecallantide 10 mg/mL Soln 24 18 $198,772.30 $109,324.77 45% off $51,680.80 $186,845.96 $149,874.32 2026-05-27
1284898-2215107 OTHER 48818-0001-02 - PRALAtrexate Soln 24 18 $99,297.21 $54,613.47 45% off $25,817.27 $93,339.38 $74,870.10 2026-05-27
103420537-2215106 OTHER 49702-0240-15 - Cabotegravir-rilpivirine 200 Mg-30 24 18 $87,713.97 $48,242.68 45% off $22,805.63 $82,451.13 $66,136.33 2026-05-27
1604324-2215105 OTHER 50242-0037-06 - Tenecteplase 50 Mg Powder-inj 24 18 $95,283.88 $52,406.13 45% off $24,773.81 $89,566.85 $71,844.05 2026-05-27
51716934-2215105 OTHER 50242-0070-01 - Obinutuzumab 25 mg/mL Soln 24 18 $110,779.84 $60,928.91 45% off $28,802.76 $104,133.05 $83,528.00 2026-05-27
1604376-2215105 OTHER 50242-0085-25 - Alteplase 100 Mg Powder-inj 24 18 $110,338.89 $60,686.39 45% off $28,688.11 $103,718.56 $83,195.52 2026-05-27
98898725-2215107 OTHER 50242-0105-01 - Polatuzumab Vedotin 140 Mg Powder 24 18 $123,505.28 $67,927.90 45% off $32,111.37 $116,094.96 $93,122.98 2026-05-27
106849961-2215107 OTHER 50242-0245-01 - Hyaluronidase/pertuzumab/trastuzum 24 18 $92,142.72 $50,678.50 45% off $23,957.11 $86,614.16 $69,475.61 2026-05-27
102888870-2215106 OTHER 50242-0922-01 - Emicizumab 150 mg/mL Soln 24 18 $138,564.78 $76,210.63 45% off $36,026.84 $130,250.89 $104,477.84 2026-05-27
1282362-2215105 OTHER 54482-0301-01 - Pegaspargase 3750. Soln 24 18 $343,744.71 $189,059.59 45% off $89,373.62 $323,120.03 $259,183.51 2026-05-27
105981461-2215111 OTHER 55566-9800-02 - Fecal Microbiota, Live Jslm Susp 24 18 $112,770.00 $62,023.50 45% off $29,320.20 $106,003.80 $85,028.58 2026-05-27
1282361-2215105 OTHER 57665-0002-02 - Pegaspargase 3750. Soln 24 18 $343,744.71 $189,059.59 45% off $89,373.62 $323,120.03 $259,183.51 2026-05-27
1287179-2215105 OTHER 57894-0060-03 - Ustekinumab Soln 24 18 $166,234.90 $91,429.20 45% off $43,221.07 $156,260.81 $125,341.12 2026-05-27
94990000-2215105 OTHER 57894-0061-03 - Ustekinumab 90 mg/mL Soln 24 18 $332,469.94 $182,858.47 45% off $86,442.18 $312,521.74 $250,682.34 2026-05-27
106693419-2215105 OTHER 57894-0640-11 - Guselkumab 100 mg/mL Soln 24 18 $165,654.24 $91,109.83 45% off $43,070.10 $155,714.99 $124,903.30 2026-05-27
1285912-2215105 OTHER 58468-0040-01 - Agalsidase Beta 35. Mg Rec Injecti 24 18 $100,340.67 $55,187.37 45% off $26,088.57 $94,320.23 $75,656.86 2026-05-27
100573945-2215105 OTHER 58468-0225-01 - Caplacizumab 11 Mg Kit 24 18 $110,781.99 $60,930.09 45% off $28,803.32 $104,135.07 $83,529.62 2026-05-27
99090581-2215105 OTHER 59572-0775-01 - Luspatercept 75 Mg Powder 24 18 $156,289.31 $85,959.12 45% off $40,635.22 $146,911.95 $117,842.14 2026-05-27
1284897-2215105 OTHER 59627-0002-05 - Interferon Beta-1a 60. Kit 24 18 $108,476.70 $59,662.19 45% off $28,203.94 $101,968.10 $81,791.43 2026-05-27
96925710-2215105 OTHER 59627-0222-05 - Interferon Beta-1a 30 Mcg/0.5 Ml K 24 18 $108,476.70 $59,662.19 45% off $28,203.94 $101,968.10 $81,791.43 2026-05-27
95367892-2215105 OTHER 60809-0801-01 - Pegloticase 8 mg/mL Soln 24 18 $375,822.31 $206,702.27 45% off $97,713.80 $353,272.97 $283,370.03 2026-05-27
1279159-2215106 OTHER 63004-7731-01 - Corticotropin 400. Soln 24 18 $209,299.84 $115,114.91 45% off $54,417.96 $196,741.85 $157,812.08 2026-05-27
20410991-2215105 OTHER 64406-0008-01 - Natalizumab 300 Mg/15 Ml Conc 24 18 $110,497.85 $60,773.82 45% off $28,729.44 $103,867.98 $83,315.38 2026-05-27
51721446-2215105 OTHER 64764-0300-20 - Vedolizumab 300 Mg Powder 24 18 $116,488.90 $64,068.90 45% off $30,287.11 $109,499.57 $87,832.63 2026-05-27
1284615-2215105 OTHER 66887-0003-01 - Collagenase Clostridium Histolytic 24 18 $85,299.65 $46,914.81 45% off $22,177.91 $80,181.67 $64,315.93 2026-05-27
103958918-2215111 OTHER 69866-1030-05 - Autologous Cultured Chondrocytes 1 24 18 $572,570.88 $314,913.98 45% off $148,868.43 $538,216.63 $431,718.44 2026-05-27
103958919-2215111 OTHER 69866-1030-08 - Autologous Cultured Chondrocytes 1 24 18 $572,570.88 $314,913.98 45% off $148,868.43 $538,216.63 $431,718.44 2026-05-27
102534551-2215105 OTHER 71336-1001-01 - Givosiran 189 mg/mL Soln 24 18 $524,940.00 $288,717.00 45% off $136,484.40 $493,443.60 $395,804.76 2026-05-27
101891901-2215107 OTHER 72187-0401-01 - Tagraxofusp 1000 mcg/mL Soln 24 18 $217,934.39 $119,863.91 45% off $56,662.94 $204,858.33 $164,322.53 2026-05-27
102917747-2215107 OTHER 72493-0103-03 - mitoMYcin 40 Mg Kit 24 18 $166,873.50 $91,780.43 45% off $43,387.11 $156,861.09 $125,822.62 2026-05-27
99090561-2215105 OTHER 72694-0954-01 - Pegaspargase 3,750 IntlUnit(s) / 5 24 18 $343,744.71 $189,059.59 45% off $89,373.62 $323,120.03 $259,183.51 2026-05-27
106757341-2215106 OTHER 72903-0853-01 - Mirvetuximab Soravtansine Gynx 100 24 18 $85,395.62 $46,967.59 45% off $22,202.86 $80,271.88 $64,388.30 2026-05-27
99247005-2215105 OTHER 75987-0130-15 - Teprotumumab Trbw 500 Mg Powder 24 18 $213,987.21 $117,692.97 45% off $55,636.67 $201,147.98 $161,346.35 2026-05-27
101883920-2215107 OTHER 79952-0110-01 - Loncastuximab Tesirine 10 Mg Injec 24 18 $185,415.07 $101,978.29 45% off $48,207.92 $174,290.17 $139,802.96 2026-05-27
97331864-2215105 OTHER 99999-0201-35 - Alteplase 10 Mg / 10 Ml Soln-inj 24 18 $110,338.89 $60,686.39 45% off $28,688.11 $103,718.56 $83,195.52 2026-05-27
690-3 OTHER Acute Leukemia 12 9 — — $64,484.48 $95,802.54 $95,802.54 2026-05-27
690-4 OTHER Acute Leukemia 12 9 — — $64,484.48 $95,802.54 $95,802.54 2026-05-27
690-2 OTHER Acute Leukemia 12 9 — — $53,324.76 $79,314.45 $79,314.45 2026-05-27
895 OTHER Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy 30 26 — — $1,539.63 $192,555.03 $64,185.01 2026-05-27
280-4 OTHER Alcoholic Liver Disease 12 9 — — $43,803.52 $65,080.29 $65,080.29 2026-05-27
007-4 OTHER Allogeneic Bone Marrow Transplant 10 7 — — $224,142.59 $333,375.47 $333,375.47 2026-05-27
007-3 OTHER Allogeneic Bone Marrow Transplant 10 7 — — $148,660.10 $220,943.88 $220,943.88 2026-05-27
007-2 OTHER Allogeneic Bone Marrow Transplant 10 7 — — $133,323.47 $198,437.33 $198,437.33 2026-05-27
007-1 OTHER Allogeneic Bone Marrow Transplant 10 7 — — $82,742.06 $122,893.92 $122,893.92 2026-05-27
14 OTHER Allogeneic Bone Marrow Transplant 28 24 — — $2,506.00 $274,103.64 $91,366.96 2026-05-27
1287692-2215105 OTHER Alteplase 100 Mg Powder-inj 24 18 $110,338.89 $60,686.39 45% off $28,688.11 $103,718.56 $83,195.52 2026-05-27
305-4 OTHER Amputation Of Lower Limb Except Toes 12 9 — — $43,913.14 $65,173.95 $65,173.95 2026-05-27
347 OTHER Anal And Stomal Procedures With Mcc 30 26 — — $2,506.00 $253,742.22 $84,580.74 2026-05-27
268 OTHER Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 30 26 — — $2,506.00 $560,392.62 $186,797.54 2026-05-27
008-4 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 10 7 — — $111,808.05 $166,222.61 $166,222.61 2026-05-27
008-3 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 10 7 — — $111,646.80 $166,061.36 $166,061.36 2026-05-27
008-2 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 10 7 — — $54,276.82 $80,603.23 $80,603.23 2026-05-27
008-1 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 10 7 — — $54,225.22 $80,551.63 $80,551.63 2026-05-27
461 OTHER Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 30 26 — — $2,506.00 $359,956.77 $119,985.59 2026-05-27
192-4 OTHER Cardiac Catheterization For Other Non-coronary Conditions 12 9 — — $44,453.55 $66,086.72 $66,086.72 2026-05-27
200-4 OTHER Cardiac Structural And Valvular Disorders 12 9 — — $72,644.36 $107,954.58 $107,954.58 2026-05-27
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 30 26 — — $2,506.00 $298,020.12 $102,320.24 2026-05-27
219 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 30 26 — — $2,506.00 $285,906.27 $95,302.09 2026-05-27
162-4 OTHER Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 12 9 — — $121,851.03 $181,159.91 $181,159.91 2026-05-27
162-3 OTHER Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 12 9 — — $59,995.46 $89,298.56 $89,298.56 2026-05-27
162-2 OTHER Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 12 9 — — $49,006.59 $72,944.62 $72,944.62 2026-05-27
163-4 OTHER Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 12 9 — — $89,471.43 $133,236.70 $133,236.70 2026-05-27
163-3 OTHER Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 12 9 — — $51,653.84 $76,935.52 $76,935.52 2026-05-27
1280169-2215105 OTHER Certolizumab 400 Mg Kit 24 18 $112,309.63 $61,770.30 45% off $29,200.50 $105,571.05 $84,681.46 2026-05-27
471 OTHER Cervical Spinal Fusion With Mcc 30 26 — — $2,506.00 $374,837.88 $124,945.96 2026-05-27
695-4 OTHER Chemotherapy For Acute Leukemia 12 9 — — $74,960.00 $111,363.86 $111,363.86 2026-05-27
695-3 OTHER Chemotherapy For Acute Leukemia 12 9 — — $46,426.03 $69,037.41 $69,037.41 2026-05-27
837 OTHER Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 30 26 — — $2,506.00 $466,848.36 $155,616.12 2026-05-27
18 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 30 26 — — $2,506.00 $3,424,048.38 $1,141,349.46 2026-05-27
011-4 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 9 — — $434,216.72 $647,979.12 $647,979.12 2026-05-27
011-3 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 9 — — $253,343.54 $378,177.99 $378,177.99 2026-05-27
011-2 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 9 — — $204,264.27 $304,837.81 $304,837.81 2026-05-27
011-1 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 9 — — $82,032.56 $122,184.42 $122,184.42 2026-05-27
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 30 26 — — $2,506.00 $273,655.62 $88,997.33 2026-05-27
165-4 OTHER Coronary Bypass With Ami Or Complex Principal Diagnosis 12 9 — — $84,332.75 $125,385.71 $125,385.71 2026-05-27
165-3 OTHER Coronary Bypass With Ami Or Complex Principal Diagnosis 12 9 — — $58,994.68 $87,793.50 $87,793.50 2026-05-27
165-2 OTHER Coronary Bypass With Ami Or Complex Principal Diagnosis 12 9 — — $48,265.15 $71,827.10 $71,827.10 2026-05-27
233 OTHER Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 30 26 — — $2,506.00 $187,464.99 $64,362.98 2026-05-27
231 OTHER Coronary Bypass With Ptca With Mcc 30 26 — — $2,506.00 $300,999.45 $101,175.90 2026-05-27
166-4 OTHER Coronary Bypass Without Ami Or Complex Principal Diagnosis 12 9 — — $65,542.61 $97,549.52 $97,549.52 2026-05-27
910-4 OTHER Craniotomy For Multiple Significant Trauma 12 9 — — $85,636.12 $127,441.76 $127,441.76 2026-05-27
955 OTHER Craniotomy For Multiple Significant Trauma 30 26 — — $2,506.00 $168,870.30 $65,662.04 2026-05-27
910-3 OTHER Craniotomy For Multiple Significant Trauma 12 9 — — $42,891.26 $63,841.42 $63,841.42 2026-05-27
23 OTHER Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 30 26 — — $2,506.00 $259,305.36 $86,435.12 2026-05-27
179-4 OTHER Defibrillator Implants 12 9 — — $57,535.63 $85,673.79 $85,673.79 2026-05-27
179-3 OTHER Defibrillator Implants 12 9 — — $45,366.28 $67,549.46 $67,549.46 2026-05-27
304-4 OTHER Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 12 9 — — $74,605.34 $111,053.89 $111,053.89 2026-05-27
304-3 OTHER Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 12 9 — — $63,439.09 $94,520.97 $94,520.97 2026-05-27
303-4 OTHER Dorsal And Lumbar Fusion Procedure For Curvature Of Back 12 9 — — $120,940.24 $180,120.92 $180,120.92 2026-05-27
303-3 OTHER Dorsal And Lumbar Fusion Procedure For Curvature Of Back 12 9 — — $95,465.61 $142,378.87 $142,378.87 2026-05-27
303-2 OTHER Dorsal And Lumbar Fusion Procedure For Curvature Of Back 12 9 — — $67,687.83 $101,038.94 $101,038.94 2026-05-27
303-1 OTHER Dorsal And Lumbar Fusion Procedure For Curvature Of Back 12 9 — — $60,583.56 $90,448.37 $90,448.37 2026-05-27
3 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 30 26 — — $2,506.00 $744,705.30 $251,902.87 2026-05-27
911-4 OTHER Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 12 9 — — $88,175.76 $131,271.86 $131,271.86 2026-05-27
927 OTHER Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 30 26 — — $2,506.00 $551,185.89 $189,240.49 2026-05-27
950-4 OTHER Extensive O.r. Procedure Unrelated To Principal Diagnosis 12 9 — — $94,822.40 $141,031.91 $141,031.91 2026-05-27
792-4 OTHER Extensive O.r. Procedures For Other Complications Of Treatment 12 9 — — $55,938.61 $83,239.52 $83,239.52 2026-05-27
178-4 OTHER External Heart Assist Systems 12 9 — — $79,406.10 $118,390.37 $118,390.37 2026-05-27
178-3 OTHER External Heart Assist Systems 12 9 — — $60,583.33 $90,339.64 $90,339.64 2026-05-27
178-2 OTHER External Heart Assist Systems 12 9 — — $49,407.25 $73,715.50 $73,715.50 2026-05-27
009-4 OTHER Extracorporeal Membrane Oxygenation (ecmo) 12 9 — — $152,611.53 $227,390.60 $227,390.60 2026-05-27
009-3 OTHER Extracorporeal Membrane Oxygenation (ecmo) 12 9 — — $80,442.35 $119,929.30 $119,929.30 2026-05-27
009-2 OTHER Extracorporeal Membrane Oxygenation (ecmo) 12 9 — — $59,368.63 $88,620.13 $88,620.13 2026-05-27
009-1 OTHER Extracorporeal Membrane Oxygenation (ecmo) 12 9 — — $59,239.63 $88,491.13 $88,491.13 2026-05-27
588-1 OTHER Female Reproductive System Reconstructive Procedures 12 9 — — $198,127.58 $294,207.35 $294,207.35 2026-05-27
055-4 OTHER Head Trauma With Coma > 1 Hour Or Hemorrhage 12 9 — — $51,891.30 $77,121.40 $77,121.40 2026-05-27
002-4 OTHER Heart And/or Lung Transplant 12 9 — — $360,685.28 $537,458.68 $537,458.68 2026-05-27
002-3 OTHER Heart And/or Lung Transplant 10 7 — — $198,507.20 $295,712.02 $295,712.02 2026-05-27
002-2 OTHER Heart And/or Lung Transplant 10 7 — — $163,464.90 $243,586.70 $243,586.70 2026-05-27
002-1 OTHER Heart And/or Lung Transplant 10 7 — — $145,569.92 $217,018.03 $217,018.03 2026-05-27
1 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 28 24 — — $2,506.00 $1,009,392.36 $341,169.32 2026-05-27
2 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 27 23 — — $2,506.00 $827,258.85 $275,752.95 2026-05-27
97083307-2215105 OTHER Hemin 350 Mg Powder-inj 24 18 $140,163.83 $77,090.11 45% off $36,442.60 $131,754.00 $105,683.52 2026-05-27
212 OTHER Hip & Femur Procedures Except Major Joint Age 0-17 30 26 — — $2,506.00 $248,205.00 $85,217.05 2026-05-27
308-4 OTHER Hip And Femur Fracture Repair 12 9 — — $50,129.91 $74,569.02 $74,569.02 2026-05-27
969 OTHER HIV With Extensive O.r. Procedures With Mcc 30 26 — — $2,506.00 $790,524.57 $263,508.19 2026-05-27
970 OTHER HIV With Extensive O.r. Procedures Without Mcc 30 26 — — $2,506.00 $249,784.08 $83,261.36 2026-05-27
161-4 OTHER Implantable Heart Assist Systems 12 9 — — $315,431.69 $469,930.95 $469,930.95 2026-05-27
161-3 OTHER Implantable Heart Assist Systems 12 9 — — $203,905.05 $303,870.59 $303,870.59 2026-05-27
161-2 OTHER Implantable Heart Assist Systems 12 9 — — $203,885.70 $303,851.24 $303,851.24 2026-05-27
161-1 OTHER Implantable Heart Assist Systems 12 9 — — $202,873.05 $302,838.59 $302,838.59 2026-05-27
710-4 OTHER Infectious And Parasitic Diseases Including HIV With O.r. Procedure 12 9 — — $68,133.54 $101,277.72 $101,277.72 2026-05-27
197 OTHER Interstitial Lung Disease With Cc 30 26 — — $2,506.00 $249,235.77 $83,078.59 2026-05-27
21 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 30 26 — — $2,506.00 $353,665.17 $117,888.39 2026-05-27
20 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 30 26 — — $2,506.00 $385,591.83 $128,530.61 2026-05-27
22 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 30 26 — — $2,506.00 $330,618.72 $110,206.24 2026-05-27
1279402-2215105 OTHER Ipilimumab 200 Mg / 40 Ml Soln-IV 40 Ml 24 18 $458,744.93 $252,309.71 45% off $119,273.68 $431,220.23 $345,893.67 2026-05-27
1284328-2215105 OTHER Ipilimumab 50 Mg / 10 Ml Soln-IV 10 Ml 24 18 $114,686.47 $63,077.56 45% off $29,818.48 $107,805.28 $86,473.60 2026-05-27
442-4 OTHER Kidney And Urinary Tract Procedures For Malignancy 12 9 — — $46,884.44 $69,722.43 $69,722.43 2026-05-27
440-4 OTHER Kidney Transplant 12 9 — — $94,217.49 $140,057.84 $140,057.84 2026-05-27
440-3 OTHER Kidney Transplant 12 9 — — $93,127.44 $138,967.79 $138,967.79 2026-05-27
440-2 OTHER Kidney Transplant 12 9 — — $93,043.59 $138,883.94 $138,883.94 2026-05-27
440-1 OTHER Kidney Transplant 12 9 — — $92,985.54 $138,825.89 $138,825.89 2026-05-27
650 OTHER Kidney Transplant With Hemodialysis With Mcc 30 26 — — $2,506.00 $196,185.45 $65,399.43 2026-05-27
313-4 OTHER Knee And Lower Leg Procedures Except Foot 12 9 — — $50,603.37 $75,266.96 $75,266.96 2026-05-27
001-4 OTHER Liver Transplant And/or Intestinal Transplant 10 7 — — $220,536.98 $328,688.97 $328,688.97 2026-05-27
001-3 OTHER Liver Transplant And/or Intestinal Transplant 10 7 — — $121,179.73 $180,772.13 $180,772.13 2026-05-27
001-2 OTHER Liver Transplant And/or Intestinal Transplant 10 7 — — $80,526.33 $120,077.11 $120,077.11 2026-05-27
5 OTHER Liver Transplant With Mcc Or Intestinal Transplant 27 23 — — $2,506.00 $496,998.33 $165,666.11 2026-05-27
6 OTHER Liver Transplant Without Mcc 27 23 — — $2,506.00 $634,889.52 $211,629.84 2026-05-27
181-4 OTHER Lower Extremity Arterial Procedures 12 9 — — $69,778.96 $103,777.96 $103,777.96 2026-05-27
7 OTHER Lung Transplant 27 23 — — $2,506.00 $2,478,898.38 $826,299.46 2026-05-27
169-4 OTHER Major Abdominal Vascular Procedures 12 9 — — $70,254.92 $104,651.81 $104,651.81 2026-05-27
441-4 OTHER Major Bladder Procedures 12 9 — — $53,345.02 $79,252.26 $79,252.26 2026-05-27
653 OTHER Major Bladder Procedures With Mcc 30 26 — — $2,506.00 $426,936.78 $142,312.26 2026-05-27
160-4 OTHER Major Cardiothoracic Repair Of Heart Anomaly 12 9 — — $162,843.39 $242,358.25 $242,358.25 2026-05-27
160-3 OTHER Major Cardiothoracic Repair Of Heart Anomaly 12 9 — — $43,839.22 $65,226.10 $65,226.10 2026-05-27
163 OTHER Major Chest Procedures With Mcc 30 26 — — $2,506.00 $455,750.67 $151,916.89 2026-05-27
089-4 OTHER Major Cranial Or Facial Bone Procedures 12 9 — — $57,610.51 $85,568.88 $85,568.88 2026-05-27
680-4 OTHER Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 12 9 — — $74,824.65 $111,276.39 $111,276.39 2026-05-27
260-4 OTHER Major Pancreas, Liver And Shunt Procedures 12 9 — — $74,456.82 $110,819.19 $110,819.19 2026-05-27
120-4 OTHER Major Respiratory And Chest Procedures 12 9 — — $62,044.07 $92,232.30 $92,232.30 2026-05-27
230-4 OTHER Major Small Bowel Procedures 12 9 — — $67,698.69 $100,576.91 $100,576.91 2026-05-27
220-4 OTHER Major Stomach, Esophageal And Duodenal Procedures 12 9 — — $65,302.40 $97,069.40 $97,069.40 2026-05-27
206-4 OTHER Malfunction, Reaction, Complication Of Cardiac Or Vascular Device Or Procedure 12 9 — — $46,213.94 $68,672.66 $68,672.66 2026-05-27
951-4 OTHER Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis 12 9 — — $62,596.08 $93,047.62 $93,047.62 2026-05-27
043-4 OTHER Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies 12 9 — — $47,656.83 $70,758.66 $70,758.66 2026-05-27
930-4 OTHER Multiple Significant Trauma Without O.r. Procedure 12 9 — — $57,757.11 $85,912.30 $85,912.30 2026-05-27
912-4 OTHER Musculoskeletal And Other Procedures For Multiple Significant Trauma 12 9 — — $88,764.32 $132,125.87 $132,125.87 2026-05-27
912-3 OTHER Musculoskeletal And Other Procedures For Multiple Significant Trauma 12 9 — — $43,742.45 $65,116.56 $65,116.56 2026-05-27
1279800-2215105 OTHER Natalizumab 300 Mg/15 Ml Soln-IV 24 18 $110,497.85 $60,773.82 45% off $28,729.44 $103,867.98 $83,315.38 2026-05-27
863-4 OTHER Neonatal Aftercare 12 9 — — $101,102.91 $150,117.29 $150,117.29 2026-05-27
863-3 OTHER Neonatal Aftercare 12 9 — — $76,776.96 $113,807.97 $113,807.97 2026-05-27
603-4 OTHER Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 12 9 — — $78,867.96 $115,963.34 $115,963.34 2026-05-27
603-3 OTHER Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 12 9 — — $78,074.61 $115,169.99 $115,169.99 2026-05-27
603-2 OTHER Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 12 9 — — $46,788.06 $68,755.81 $68,755.81 2026-05-27
602-4 OTHER Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $165,770.53 $245,243.37 $245,243.37 2026-05-27
602-3 OTHER Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $117,122.59 $172,990.93 $172,990.93 2026-05-27
602-2 OTHER Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $91,836.36 $135,568.66 $135,568.66 2026-05-27
602-1 OTHER Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $63,344.06 $93,687.08 $93,687.08 2026-05-27
608-4 OTHER Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 12 9 — — $66,161.26 $97,374.00 $97,374.00 2026-05-27
608-3 OTHER Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 12 9 — — $65,735.56 $96,948.30 $96,948.30 2026-05-27
608-2 OTHER Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 12 9 — — $48,434.89 $71,420.76 $71,420.76 2026-05-27
607-4 OTHER Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $148,158.63 $219,132.78 $219,132.78 2026-05-27
607-3 OTHER Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $91,056.52 $134,562.75 $134,562.75 2026-05-27
607-2 OTHER Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $70,869.69 $104,674.53 $104,674.53 2026-05-27
607-1 OTHER Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $45,193.98 $66,705.33 $66,705.33 2026-05-27
611-4 OTHER Neonate Birth Weight 1500-1999 Grams With Major Anomaly 12 9 — — $102,819.42 $152,229.56 $152,229.56 2026-05-27
611-3 OTHER Neonate Birth Weight 1500-1999 Grams With Major Anomaly 12 9 — — $64,336.91 $94,985.80 $94,985.80 2026-05-27
611-2 OTHER Neonate Birth Weight 1500-1999 Grams With Major Anomaly 12 9 — — $43,522.95 $64,275.23 $64,275.23 2026-05-27
614-4 OTHER Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 12 9 — — $53,873.63 $78,591.47 $78,591.47 2026-05-27
614-3 OTHER Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 12 9 — — $52,222.43 $76,940.27 $76,940.27 2026-05-27
612-4 OTHER Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $104,217.39 $153,859.46 $153,859.46 2026-05-27
612-3 OTHER Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $74,458.16 $109,899.76 $109,899.76 2026-05-27
612-2 OTHER Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $46,872.52 $69,137.09 $69,137.09 2026-05-27
609-4 OTHER Neonate Birth Weight 1500-2499 Grams With Major Procedure 12 9 — — $169,002.62 $250,369.68 $250,369.68 2026-05-27
609-3 OTHER Neonate Birth Weight 1500-2499 Grams With Major Procedure 12 9 — — $106,507.59 $157,422.04 $157,422.04 2026-05-27
609-2 OTHER Neonate Birth Weight 1500-2499 Grams With Major Procedure 12 9 — — $102,342.46 $151,921.76 $151,921.76 2026-05-27
609-1 OTHER Neonate Birth Weight 1500-2499 Grams With Major Procedure 12 9 — — $101,200.81 $150,780.11 $150,780.11 2026-05-27
621-4 OTHER Neonate Birth Weight 2000-2499 Grams With Major Anomaly 12 9 — — $100,498.82 $149,016.91 $149,016.91 2026-05-27
621-3 OTHER Neonate Birth Weight 2000-2499 Grams With Major Anomaly 12 9 — — $47,431.21 $70,070.79 $70,070.79 2026-05-27
622-4 OTHER Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $66,378.31 $98,064.99 $98,064.99 2026-05-27
622-3 OTHER Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $51,127.43 $75,527.18 $75,527.18 2026-05-27
591-4 OTHER Neonate Birth Weight 500-749 Grams Without Major Procedure 12 9 — — $224,358.82 $332,614.53 $332,614.53 2026-05-27
591-3 OTHER Neonate Birth Weight 500-749 Grams Without Major Procedure 12 9 — — $100,110.52 $147,993.49 $147,993.49 2026-05-27
591-2 OTHER Neonate Birth Weight 500-749 Grams Without Major Procedure 12 9 — — $76,070.98 $112,195.05 $112,195.05 2026-05-27
591-1 OTHER Neonate Birth Weight 500-749 Grams Without Major Procedure 12 9 — — $73,503.88 $109,627.95 $109,627.95 2026-05-27
593-4 OTHER Neonate Birth Weight 750-999 Grams Without Major Procedure 12 9 — — $214,523.26 $317,330.38 $317,330.38 2026-05-27
593-3 OTHER Neonate Birth Weight 750-999 Grams Without Major Procedure 12 9 — — $129,612.05 $191,842.30 $191,842.30 2026-05-27
593-2 OTHER Neonate Birth Weight 750-999 Grams Without Major Procedure 12 9 — — $113,082.04 $167,555.65 $167,555.65 2026-05-27
593-1 OTHER Neonate Birth Weight 750-999 Grams Without Major Procedure 12 9 — — $75,918.76 $112,777.42 $112,777.42 2026-05-27
588-4 OTHER Neonate Birth Weight < 1500 Grams With Major Procedure 12 9 — — $339,285.68 $503,124.62 $503,124.62 2026-05-27
588-3 OTHER Neonate Birth Weight < 1500 Grams With Major Procedure 12 9 — — $267,470.97 $396,403.43 $396,403.43 2026-05-27
588-2 OTHER Neonate Birth Weight < 1500 Grams With Major Procedure 12 9 — — $198,127.58 $294,207.35 $294,207.35 2026-05-27
589-3 OTHER Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 12 9 — — $90,682.79 $134,367.74 $134,367.74 2026-05-27
589-4 OTHER Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 12 9 — — $90,682.79 $134,367.74 $134,367.74 2026-05-27
589-1 OTHER Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 12 9 — — $86,370.90 $127,924.41 $127,924.41 2026-05-27
589-2 OTHER Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 12 9 — — $86,370.90 $127,924.41 $127,924.41 2026-05-27
633-4 OTHER Neonate Birth Weight > 2499 Grams With Major Anomaly 12 9 — — $114,277.11 $169,641.18 $169,641.18 2026-05-27
633-3 OTHER Neonate Birth Weight > 2499 Grams With Major Anomaly 12 9 — — $43,765.51 $64,851.31 $64,851.31 2026-05-27
630-4 OTHER Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 9 — — $158,132.69 $235,523.02 $235,523.02 2026-05-27
630-1 OTHER Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 9 — — $64,972.41 $96,758.04 $96,758.04 2026-05-27
630-2 OTHER Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 9 — — $64,972.41 $96,758.04 $96,758.04 2026-05-27
630-3 OTHER Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 9 — — $64,972.41 $96,758.04 $96,758.04 2026-05-27
631-4 OTHER Neonate Birth Weight > 2499 Grams With Other Major Procedure 12 9 — — $316,233.60 $469,136.53 $469,136.53 2026-05-27
631-3 OTHER Neonate Birth Weight > 2499 Grams With Other Major Procedure 12 9 — — $54,027.67 $79,950.34 $79,950.34 2026-05-27
634-4 OTHER Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma… 12 9 — — $75,431.01 $111,911.47 $111,911.47 2026-05-27
583-3 OTHER Neonate With Ecmo 12 9 — — $395,514.93 $588,944.20 $588,944.20 2026-05-27
583-4 OTHER Neonate With Ecmo 12 9 — — $395,514.93 $588,944.20 $588,944.20 2026-05-27
583-2 OTHER Neonate With Ecmo 12 9 — — $374,511.63 $558,502.30 $558,502.30 2026-05-27
583-1 OTHER Neonate With Ecmo 12 9 — — $374,511.63 $558,502.30 $558,502.30 2026-05-27
681 OTHER Neonate, Birth Weight >2499 Grams, With Significant O.r. Procedures, With Multip… 2 2 — — $283,093.37 $333,752.18 $308,422.78 2026-05-27
021-4 OTHER Open Craniotomy Except Trauma 12 9 — — $92,846.56 $138,009.22 $138,009.22 2026-05-27
021-3 OTHER Open Craniotomy Except Trauma 12 9 — — $52,651.11 $78,298.23 $78,298.23 2026-05-27
020-4 OTHER Open Craniotomy For Trauma 12 9 — — $75,106.67 $111,739.26 $111,739.26 2026-05-27
073-4 OTHER Orbit And Eye Procedures 12 9 — — $44,722.22 $66,312.82 $66,312.82 2026-05-27
681-4 OTHER Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 12 9 — — $78,143.09 $116,133.18 $116,133.18 2026-05-27
167-4 OTHER Other Cardiothoracic And Thoracic Vascular Procedures 12 9 — — $88,232.62 $131,273.94 $131,273.94 2026-05-27
167-3 OTHER Other Cardiothoracic And Thoracic Vascular Procedures 12 9 — — $44,680.84 $66,541.14 $66,541.14 2026-05-27
180-4 OTHER Other Circulatory System Procedures 12 9 — — $44,366.25 $65,886.11 $65,886.11 2026-05-27
229-4 OTHER Other Digestive System And Abdominal Procedures 12 9 — — $43,840.20 $65,179.74 $65,179.74 2026-05-27
356 OTHER Other Digestive System O.r. Procedures With Mcc 30 26 — — $2,506.00 $304,121.28 $101,373.76 2026-05-27
215 OTHER Other Heart Assist System Implant 30 26 — — $2,506.00 $333,986.58 $114,668.73 2026-05-27
264-4 OTHER Other Hepatobiliary, Pancreas And Abdominal Procedures 12 9 — — $51,532.88 $76,544.35 $76,544.35 2026-05-27
447-4 OTHER Other Kidney, Urinary Tract And Related Procedures 12 9 — — $52,534.43 $77,900.70 $77,900.70 2026-05-27
091-4 OTHER Other Major Head And Neck Procedures 12 9 — — $96,793.55 $143,859.47 $143,859.47 2026-05-27
026-4 OTHER Other Nervous System And Related Procedures 12 9 — — $44,056.35 $65,432.59 $65,432.59 2026-05-27
027-4 OTHER Other Open Craniotomy 12 9 — — $56,858.24 $84,403.30 $84,403.30 2026-05-27
029-4 OTHER Other Percutaneous Intracranial Procedures 12 9 — — $55,159.30 $81,963.38 $81,963.38 2026-05-27
029-3 OTHER Other Percutaneous Intracranial Procedures 12 9 — — $44,437.77 $66,238.49 $66,238.49 2026-05-27
182-4 OTHER Other Peripheral Vascular And Related Procedures 12 9 — — $47,190.08 $70,195.10 $70,195.10 2026-05-27
405-4 OTHER Other Procedures For Endocrine, Nutritional And Metabolic Disorders 12 9 — — $54,501.47 $80,814.58 $80,814.58 2026-05-27
121-4 OTHER Other Respiratory And Chest Procedures 12 9 — — $52,794.10 $78,448.14 $78,448.14 2026-05-27
223-4 OTHER Other Small And Large Bowel Procedures 12 9 — — $43,219.06 $64,136.78 $64,136.78 2026-05-27
006-2 OTHER Pancreas Transplant 10 7 — — $114,947.03 $171,455.28 $171,455.28 2026-05-27
006-3 OTHER Pancreas Transplant 10 7 — — $114,947.03 $171,455.28 $171,455.28 2026-05-27
006-4 OTHER Pancreas Transplant 10 7 — — $114,947.03 $171,455.28 $171,455.28 2026-05-27
10 OTHER Pancreas Transplant 27 23 — — $2,506.00 $355,419.12 $118,473.04 2026-05-27
1286149-2215105 OTHER Pegloticase 8 Mg/1 Ml Soln-IV 24 18 $375,822.31 $206,702.27 45% off $97,713.80 $353,272.97 $283,370.03 2026-05-27
030-4 OTHER Percutaneous Intracranial And Extracranial Vascular Procedures 12 9 — — $58,848.32 $87,568.42 $87,568.42 2026-05-27
183-4 OTHER Percutaneous Structural Cardiac Procedures 12 9 — — $76,371.31 $113,743.82 $113,743.82 2026-05-27
183-3 OTHER Percutaneous Structural Cardiac Procedures 12 9 — — $49,923.71 $74,455.37 $74,455.37 2026-05-27
224-4 OTHER Peritoneal Adhesiolysis 12 9 — — $44,727.75 $66,397.62 $66,397.62 2026-05-27
711-4 OTHER Post-operative, Post-trauma, Other Device Infections With O.r. Procedure 12 9 — — $62,801.57 $93,332.37 $93,332.37 2026-05-27
850-4 OTHER Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 12 9 — — $125,727.77 $186,758.52 $186,758.52 2026-05-27
849 OTHER Radiotherapy 30 26 — — $2,506.00 $221,856.54 $73,952.18 2026-05-27
130-4 OTHER Respiratory System Diagnosis With Ventilator Support > 96 Hours 12 9 — — $68,674.74 $102,054.57 $102,054.57 2026-05-27
207 OTHER Respiratory System Diagnosis With Ventilator Support >96 Hours 30 26 — — $2,506.00 $578,551.23 $192,850.41 2026-05-27
8 OTHER Simultaneous Pancreas And Kidney Transplant 27 23 — — $2,506.00 $614,540.19 $204,846.73 2026-05-27
570 OTHER Skin Debridement With Mcc 30 26 — — $2,506.00 $567,725.97 $189,241.99 2026-05-27
312-4 OTHER Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses 12 9 — — $51,375.63 $76,239.22 $76,239.22 2026-05-27
321-4 OTHER Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures 12 9 — — $65,240.11 $97,040.10 $97,040.10 2026-05-27
321-3 OTHER Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures 12 9 — — $65,072.41 $96,872.40 $96,872.40 2026-05-27
456 OTHER Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 30 26 — — $2,506.00 $315,979.80 $105,326.60 2026-05-27
023-4 OTHER Spinal Procedures 12 9 — — $60,684.97 $90,204.57 $90,204.57 2026-05-27
023-3 OTHER Spinal Procedures 12 9 — — $44,617.27 $66,407.89 $66,407.89 2026-05-27
326 OTHER Stomach, Esophageal And Duodenal Procedures With Mcc 30 26 — — $2,506.00 $365,902.23 $121,967.41 2026-05-27
1281038-2215105 OTHER Tenecteplase 50 Mg Powder-inj 24 18 $95,283.88 $52,406.13 45% off $24,773.81 $89,566.85 $71,844.05 2026-05-27
1281039-2215105 OTHER Tenecteplase 50 Mg Powder-inj 24 18 $95,283.88 $52,406.13 45% off $24,773.81 $89,566.85 $71,844.05 2026-05-27
106856913-2215105 OTHER Tenecteplase 50 Mg Powder-inj 24 18 $95,283.88 $52,406.13 45% off $24,773.81 $89,566.85 $71,844.05 2026-05-27
100575164-2215105 OTHER Tildrakizumab-asmn 100 mg/mL Soln-inj 1 Ml 24 18 $220,658.66 $121,362.26 45% off $57,371.25 $207,419.14 $166,376.63 2026-05-27
11 OTHER Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 30 26 — — $2,506.00 $186,053.16 $63,827.32 2026-05-27
4 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 30 26 — — $2,506.00 $1,067,245.80 $355,748.60 2026-05-27
004-4 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 12 9 — — $264,547.95 $393,435.20 $393,435.20 2026-05-27
004-3 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 12 9 — — $134,626.81 $199,957.70 $199,957.70 2026-05-27
004-2 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 12 9 — — $77,104.75 $114,623.02 $114,623.02 2026-05-27
004-1 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 12 9 — — $52,428.55 $78,058.12 $78,058.12 2026-05-27
005-4 OTHER Tracheostomy With Mv >96 Hours Without Extensive Procedure 10 7 — — $154,011.10 $228,748.68 $228,748.68 2026-05-27
005-3 OTHER Tracheostomy With Mv >96 Hours Without Extensive Procedure 10 7 — — $111,958.25 $166,227.07 $166,227.07 2026-05-27
005-2 OTHER Tracheostomy With Mv >96 Hours Without Extensive Procedure 10 7 — — $62,226.63 $92,323.37 $92,323.37 2026-05-27
022-4 OTHER Ventricular Shunt Procedures 12 9 — — $84,179.47 $124,923.91 $124,923.91 2026-05-27
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