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

COMMUNITY HOSPITAL OF BREMEN INC

Bremen, IN · CCN 151300 · Rates published

21,967 distinct procedures filed
21 distinct payers
720,735 rate rows
2026-05-23 last MRF observed
Data quality

694,268 of 720,735 rate rows are consumer-grade (96.3%)

26,467 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 25,346
percent-of-charges filed in the dollar field — excluded from medians 693
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 325
placeholder amount (≤ $0.02) — excluded from medians 103
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.beaconhealthsystem.org/wp-content/uploads/2026/03/350835006_Community-Hospital-of-Bremen_standardcharges-8.csv
Found on page https://www.beaconhealthsystem.org/hospital-chargemaster/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-05-18
Content fingerprint 72dfa2118951f456… · 51,800,623 bytes · first seen 2026-05-13

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
J3394
OTHER 		Inj- Lovotibeglogene Autotem 1 $4,929,000.00 $4,929,000.00 $4,929,000.00 nat. median
$3,286,000
1.5× median
J3393
OTHER 		Inj- Betibeglogene Autotemce 1 $4,452,000.00 $4,452,000.00 $4,452,000.00 nat. median
$2,968,000
1.5× median
J1414
OTHER 		Inj- Beqvez- Per Tx Dose 6 $3,675,000.00 $3,675,000.00 $3,675,000.00 nat. median
$3,710,000
1.0× median
J1411
OTHER 		Inj- Hemgenix- Per Tx Dose 6 $3,675,000.00 $3,675,000.00 $3,675,000.00 nat. median
$3,685,267
1.0× median
C9172
OTHER 		Inj- Beqvez- Per Tx Dose 6 $3,675,000.00 $3,675,000.00 $3,675,000.00 nat. median
$3,675,000
1.0× median
J1413
OTHER 		Inj Delandistrogene Mox Rokl 7 $3,360,000.00 $4,988,182.14 $3,360,000.00 nat. median
$3,327,860
1.0× median
J3399
OTHER 		Inj Onase Abepar-xioi Treat 7 $2,231,250.00 $3,582,921.35 $2,231,250.00 nat. median
$2,472,216
0.9× median
Q2042
OTHER 		Tisagenlecleucel Car-pos T 1 $793,789.29 $793,789.29 $793,789.29 nat. median
$591,726
1.3× median
Q2057
OTHER 		Afamitresgene Autoleucel 6 $763,350.00 $763,350.00 $763,350.00 nat. median
$770,620
1.0× median
114
OTHER 		Extracorporeal Membrane Oxygenation (ecmo) 6 $647,979.12 $647,979.12 $647,979.12 nat. median
$10,012
outlier · 64.7×
5833
OTHER 		Neonate With Ecmo 6 $191,228.48 $588,944.20 $588,944.20 nat. median
$252,069
outlier · 2.3×
5834
OTHER 		Neonate With Ecmo 6 $191,228.48 $588,944.20 $588,944.20 nat. median
$372,748
1.6× median
Q2056
OTHER 		Ciltacabtagene Car-pos T 7 $548,128.28 $790,685.15 $583,075.96 nat. median
$583,076
1.0× median
5832
OTHER 		Neonate With Ecmo 6 $191,228.48 $558,502.30 $558,502.30 nat. median
$152,272
outlier · 3.7×
5831
OTHER 		Neonate With Ecmo 6 $189,686.93 $558,502.30 $558,502.30 nat. median
$139,037
outlier · 4.0×
Q2054
OTHER 		Lisocabtagene Mara Car Pos T 7 $511,851.30 $775,089.12 $557,917.92 nat. median
$562,538
1.0× median
Q2055
OTHER 		Idecabtagene Vicleucel Car 7 $523,328.35 $789,881.39 $554,728.05 nat. median
$558,082
1.0× median
Q2058
OTHER 		Obecbtge Autol Up To 400 Mil 6 $551,250.00 $551,250.00 $551,250.00 nat. median
$281,111
2.0× median
24
OTHER 		Heart And/or Lung Transplant 6 $537,458.68 $537,458.68 $537,458.68 nat. median
$27,988
outlier · 19.2×
Q2041
OTHER 		Axicabtagene Ciloleucel Car+ 7 $485,100.00 $734,183.94 $528,759.00 nat. median
$533,230
1.0× median
5884
OTHER 		Neonate Bwt <1500g W Major Procedure 6 $389,138.03 $503,124.62 $503,124.62 nat. median
$243,175
outlier · 2.1×
Q2053
OTHER 		Brexucabtagene Car Pos T 7 $485,100.00 $690,795.60 $485,100.00 nat. median
$489,720
1.0× median
1614
OTHER 		Implantable Heart Assist Systems 6 $335,581.17 $469,930.95 $469,930.95 nat. median
$194,298
outlier · 2.4×
6314
OTHER 		Neonate Birthwt >2499g W Other Major Procedure 6 $182,838.72 $469,136.53 $469,136.53 nat. median
$163,675
outlier · 2.9×
MS-018
OTHER 		Chimeric Antigen Receptor (car) T-cell Immunotherapy 2 $373,825.00 $565,692.00 $424,615.95 nat. median
$309,559
1.4× median
5883
OTHER 		Neonate Bwt <1500g W Major Procedure 6 $171,934.87 $396,403.43 $396,403.43 nat. median
$163,694
outlier · 2.4×
44
OTHER 		Tracheostomy With Mv >96 Hours With Extensive Procedure 6 $393,435.20 $393,435.20 $393,435.20 nat. median
$33,835
outlier · 11.6×
113
OTHER 		Extracorporeal Membrane Oxygenation (ecmo) 6 $378,177.99 $378,177.99 $378,177.99 nat. median
$18,223
outlier · 20.8×
0024
OTHER 		Heart And/or Lung Transplant 6 $347,823.74 $347,823.74 $347,823.74 nat. median
$235,636
1.5× median
74
OTHER 		Allogeneic Bone Marrow Transplant 6 $333,375.47 $333,375.47 $333,375.47 nat. median
$10,670
outlier · 31.2×
5914
OTHER 		Neonate Birthwt 500-749g Without Major Procedure 6 $225,770.30 $332,614.53 $332,614.53 nat. median
$149,152
outlier · 2.2×
14
OTHER 		Liver Transplant And/or Intestinal Transplant 6 $328,688.97 $328,688.97 $328,688.97 nat. median
$100,915
outlier · 3.3×
5934
OTHER 		Neonate Birthwt 750-999g Without Major Procedure 6 $202,944.11 $317,330.38 $317,330.38 nat. median
$129,842
outlier · 2.4×
112
OTHER 		Extracorporeal Membrane Oxygenation (ecmo) 7 $50.00 $304,837.81 $304,837.81 nat. median
$3,671
outlier · 83.0×
1613
OTHER 		Implantable Heart Assist Systems 6 $79,670.23 $303,870.59 $303,870.59 nat. median
$79
outlier · 3860.1×
1612
OTHER 		Implantable Heart Assist Systems 6 $67,714.74 $303,851.24 $303,851.24 nat. median
$84,765
outlier · 3.6×
1611
OTHER 		Implantable Heart Assist Systems 6 $55,181.08 $302,838.59 $302,838.59 nat. median
$80,527
outlier · 3.8×
23
OTHER 		Heart And/or Lung Transplant 6 $295,712.02 $295,712.02 $295,712.02 nat. median
$56,822
outlier · 5.2×
5881
OTHER 		Neonate Bwt <1500g W Major Procedure 6 $171,212.47 $294,207.35 $294,207.35 nat. median
$14,014
outlier · 21.0×
5882
OTHER 		Neonate Bwt <1500g W Major Procedure 6 $171,212.47 $294,207.35 $294,207.35 nat. median
$119,369
outlier · 2.5×
MS-001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 2 $275,868.79 $422,524.50 $277,642.68 nat. median
$224,278
1.2× median
MS-003
OTHER 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth… 3 $209,156.35 $489,311.20 $267,127.61 nat. median
$169,886
1.6× median
0014
OTHER 		Liver Transplant And/or Intestinal Transplant 6 $253,450.84 $253,450.84 $253,450.84 nat. median
$147,828
1.7× median
6094
OTHER 		Neonate Bwt 1500-2499g W Major Procedure 6 $214,457.63 $250,369.68 $250,369.68 nat. median
$170,784
1.5× median
6024
OTHER 		Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom 6 $145,995.49 $245,243.37 $245,243.37 nat. median
$99,381
outlier · 2.5×
22
OTHER 		Heart And/or Lung Transplant 6 $243,586.70 $243,586.70 $243,586.70 nat. median
$36,392
outlier · 6.7×
1604
OTHER 		Major Cardiothoracic Repair Of Heart Anomaly 6 $122,895.96 $242,358.25 $242,358.25 nat. median
$44,507
outlier · 5.4×
0074
OTHER 		Allogeneic Bone Marrow Transplant 6 $235,802.82 $235,802.82 $235,802.82 nat. median
$147,645
1.6× median
6304
OTHER 		Neonate Birthwt >2499g W Major Cardiovascular Procedure 6 $180,341.17 $235,523.02 $235,523.02 nat. median
$164,743
1.4× median
0044
OTHER 		Tracheostomy With Mv >96 Hours With Extensive Procedure 6 $231,442.66 $231,442.66 $231,442.66 nat. median
$138,863
1.7× median

Other procedures at this hospital

Browse this hospital's 21,967 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
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
             
2614 OTHER Major Biliary Tract Procedures 31 6 — — $48,169.27 $62,708.61 $62,708.61 2026-05-23
913 OTHER Other Major Head And Neck Procedures 20 6 — — $63,111.68 $63,111.68 $63,111.68 2026-05-23
4854 OTHER Prostatectomy Procedures 20 6 — — $63,155.40 $63,155.40 $63,155.40 2026-05-23
1781 OTHER External Heart Assist Systems 20 6 — — $63,427.05 $63,427.05 $63,427.05 2026-05-23
9113 OTHER Extensive Abdominal/thoracic Procedures For Mult Significant Trauma 31 6 — — $36,555.28 $63,495.98 $63,495.98 2026-05-23
8632 OTHER Neonatal Aftercare 31 6 — — $45,854.61 $63,739.24 $63,739.24 2026-05-23
494 OTHER Bacterial And Tuberculous Infections Of Nervous System 20 6 — — $63,777.03 $63,777.03 $63,777.03 2026-05-23
9103 OTHER Craniotomy For Multiple Significant Trauma 31 6 — — $52,557.30 $63,841.42 $63,841.42 2026-05-23
2234 OTHER Other Small And Large Bowel Procedures 31 6 — — $38,730.24 $64,136.78 $64,136.78 2026-05-23
6333 OTHER Neonate Birthwt >2499g W Major Anomaly 31 6 — — $48,057.93 $64,851.31 $64,851.31 2026-05-23
0266T OTHER Implt/rpl Crtd Sns Dev Total 1 1 — — $64,973.52 $64,973.52 $64,973.52 2026-05-09
2804 OTHER Alcoholic Liver Disease 31 6 — — $35,667.29 $65,080.29 $65,080.29 2026-05-23
9123 OTHER Musculoskeletal And Other Procedures For Multiple Significant Trauma 31 6 — — $52,909.19 $65,116.56 $65,116.56 2026-05-23
3054 OTHER Amputation Of Lower Limb Except Toes 31 6 — — $40,547.96 $65,173.95 $65,173.95 2026-05-23
2294 OTHER Other Digestive System And Abdominal Procedures 31 6 — — $46,896.11 $65,179.74 $65,179.74 2026-05-23
1603 OTHER Major Cardiothoracic Repair Of Heart Anomaly 31 6 — — $54,308.99 $65,226.10 $65,226.10 2026-05-23
264 OTHER Other Nervous System And Related Procedures 20 6 — — $65,432.59 $65,432.59 $65,432.59 2026-05-23
0234 OTHER Spinal Procedures 11 6 — — $65,807.38 $65,807.38 $65,807.38 2026-05-09
1804 OTHER Other Circulatory System Procedures 31 6 — — $39,282.01 $65,886.11 $65,886.11 2026-05-23
1924 OTHER Cardiac Catheterization For Other Non-coronary Conditions 31 6 — — $36,304.08 $66,086.72 $66,086.72 2026-05-23
293 OTHER Other Percutaneous Intracranial Procedures 20 6 — — $66,238.49 $66,238.49 $66,238.49 2026-05-23
734 OTHER Orbit And Eye Procedures 20 6 — — $66,312.82 $66,312.82 $66,312.82 2026-05-23
2244 OTHER Peritoneal Adhesiolysis 31 6 — — $50,659.24 $66,397.62 $66,397.62 2026-05-23
233 OTHER Spinal Procedures 20 6 — — $66,407.89 $66,407.89 $66,407.89 2026-05-23
1673 OTHER Other Cardiothoracic And Thoracic Vascular Procedures 31 6 — — $46,428.61 $66,541.14 $66,541.14 2026-05-23
A9604 OTHER Sm 153 Lexidronam 21 7 — — $25,889.78 $66,678.38 $66,678.38 2026-05-23
6071 OTHER Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom 31 6 — — $49,875.22 $66,705.33 $66,705.33 2026-05-23
1793 OTHER Defibrillator Implants 20 6 — — $67,549.46 $67,549.46 $67,549.46 2026-05-23
2064 OTHER Malfunction,reaction,complication Of Cardiac/vasc Device Or Procedure 31 6 — — $24,242.29 $68,672.66 $68,672.66 2026-05-23
6953 OTHER Chemotherapy For Acute Leukemia 31 6 — — $36,255.95 $69,037.41 $69,037.41 2026-05-23
6122 OTHER Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond 31 6 — — $61,042.01 $69,137.09 $69,137.09 2026-05-23
0081 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 11 6 — — $69,628.93 $69,628.93 $69,628.93 2026-05-09
4424 OTHER Kidney And Urinary Tract Procedures For Malignancy 31 6 — — $48,819.78 $69,722.43 $69,722.43 2026-05-23
0082 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 11 6 — — $69,745.03 $69,745.03 $69,745.03 2026-05-09
0083 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 11 6 — — $69,848.23 $69,848.23 $69,848.23 2026-05-09
6213 OTHER Neonate Bwt 2000-2499g W Major Anomaly 31 6 — — $53,327.08 $70,070.79 $70,070.79 2026-05-23
1824 OTHER Other Peripheral Vascular Procedures 31 6 — — $51,334.14 $70,195.10 $70,195.10 2026-05-23
6082 OTHER Neonate Bwt 1250-1499g W Or Without Other Significant Condition 31 6 — — $63,219.90 $71,420.76 $71,420.76 2026-05-23
1652 OTHER Coronary Bypass With Ami Or Complex Principal Diagnosis 31 6 — — $50,819.00 $71,827.10 $71,827.10 2026-05-23
6112 OTHER Neonate Birthwt 1500-1999g W Major Anomaly 31 6 — — $64,275.23 $72,122.13 $64,275.23 2026-05-23
1622 OTHER Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 31 6 — — $53,660.95 $72,944.62 $72,944.62 2026-05-23
5204 OTHER Other GYN Procedures For Malignancy 20 6 — — $73,420.43 $73,420.43 $73,420.43 2026-05-23
1782 OTHER External Heart Assist Systems 20 6 — — $73,715.50 $73,715.50 $73,715.50 2026-05-23
4484 OTHER Other Kidney, Urinary Tract And Related Percutaneous Procedures 20 6 — — $74,022.53 $74,022.53 $74,022.53 2026-05-23
1833 OTHER Percutaneous Structural Cardiac Procedures 20 6 — — $74,455.37 $74,455.37 $74,455.37 2026-05-23
3084 OTHER Hip And Femur Fracture Repair 31 6 — — $35,199.12 $74,569.02 $74,569.02 2026-05-23
0214 OTHER Open Craniotomy Except Trauma 11 6 — — $74,838.00 $74,838.00 $74,838.00 2026-05-09
3134 OTHER Knee And Lower Leg Procedures Except Foot 31 6 — — $47,298.43 $75,266.96 $75,266.96 2026-05-23
6223 OTHER Neonate Bwt 2000-2499g W Resp Dist Synd/oth Maj Resp Cond 31 6 — — $47,537.71 $75,527.18 $75,527.18 2026-05-23
2644 OTHER Other Hepatobiliary, Pancreas And Abdominal Procedures 31 6 — — $65,374.51 $76,544.35 $76,544.35 2026-05-23
1633 OTHER Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 31 6 — — $57,640.93 $76,935.52 $76,935.52 2026-05-23
6143 OTHER Neonate Bwt 1500-1999g W Or Without Other Significant Condition 31 6 — — $61,633.80 $76,940.27 $76,940.27 2026-05-23
554 OTHER Head Trauma With Coma > 1 Hour Or Hemorrhage 20 6 — — $77,121.40 $77,121.40 $77,121.40 2026-05-23
4474 OTHER Other Kidney, Urinary Tract And Related Procedures 31 6 — — $31,429.50 $77,900.70 $77,900.70 2026-05-23
41 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 20 6 — — $78,058.12 $78,058.12 $78,058.12 2026-05-23
256400405 OTHER Graft Bone Allograft Whole Femoral Condyle Left 13 8 $88,816.00 $57,730.40 35% off $35,526.40 $78,158.08 $66,612.00 2026-05-09
4284 OTHER Genetic Disorders 20 6 — — $78,294.40 $78,294.40 $78,294.40 2026-05-23
213 OTHER Open Craniotomy Except Trauma 20 6 — — $78,298.23 $78,298.23 $78,298.23 2026-05-23
1214 OTHER Other Respiratory And Chest Procedures 31 6 — — $70,983.12 $78,448.14 $78,448.14 2026-05-23
6144 OTHER Neonate Bwt 1500-1999g W Or Without Other Significant Condition 31 6 — — $62,156.25 $78,591.47 $78,591.47 2026-05-23
0894 OTHER Major Cranial/facial Bone Procedures 11 6 — — $79,013.05 $79,013.05 $79,013.05 2026-05-09
4414 OTHER Major Bladder Procedures 31 6 — — $78,766.42 $79,252.26 $79,252.26 2026-05-23
6902 OTHER Acute Leukemia 31 6 — — $35,861.22 $79,314.45 $79,314.45 2026-05-23
6313 OTHER Neonate Birthwt >2499g W Other Major Procedure 31 6 — — $46,834.04 $79,950.34 $79,950.34 2026-05-23
81 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 20 6 — — $80,551.63 $80,551.63 $80,551.63 2026-05-23
82 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 20 6 — — $80,603.23 $80,603.23 $80,603.23 2026-05-23
4054 OTHER Other Procedures For Endocrine, Nutritional And Metabolic Disorders 31 6 — — $59,454.27 $80,814.58 $80,814.58 2026-05-23
0011 OTHER Liver Transplant And/or Intestinal Transplant 11 6 — — $81,312.37 $81,312.37 $81,312.37 2026-05-09
0012 OTHER Liver Transplant And/or Intestinal Transplant 11 6 — — $81,331.72 $81,331.72 $81,331.72 2026-05-09
0013 OTHER Liver Transplant And/or Intestinal Transplant 11 6 — — $81,615.52 $81,615.52 $81,615.52 2026-05-09
Q2043 OTHER Sipuleucel-t Auto Cd54+ 32 7 — — $65,732.65 $82,522.85 $65,732.65 2026-05-23
7924 OTHER Extensive Or Procedures For Other Complications Of Treatment 31 6 — — $61,518.90 $83,239.52 $83,239.52 2026-05-23
274 OTHER Other Open Craniotomy 20 6 — — $84,403.30 $84,403.30 $84,403.30 2026-05-23
6032 OTHER Neonate Birthwt 1000-1249g W Or Without Other Significant Condition 31 6 — — $68,755.81 $84,467.93 $68,755.81 2026-05-23
894 OTHER Major Cranial/facial Bone Procedures 20 6 — — $85,568.88 $85,568.88 $85,568.88 2026-05-23
1794 OTHER Defibrillator Implants 20 6 — — $85,673.79 $85,673.79 $85,673.79 2026-05-23
9304 OTHER Multiple Significant Trauma Without O.r. Procedure 31 6 — — $30,773.54 $85,912.30 $85,912.30 2026-05-23
304 OTHER Percutaneous Intracranial And Extracranial Vascular Procedures 20 6 — — $87,568.42 $87,568.42 $87,568.42 2026-05-23
1653 OTHER Coronary Bypass With Ami Or Complex Principal Diagnosis 31 6 — — $60,067.02 $87,793.50 $87,793.50 2026-05-23
3124 OTHER Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses 31 6 — — $76,239.22 $87,926.72 $76,239.22 2026-05-23
91 OTHER Extracorporeal Membrane Oxygenation (ecmo) 20 6 — — $88,491.13 $88,491.13 $88,491.13 2026-05-23
92 OTHER Extracorporeal Membrane Oxygenation (ecmo) 20 6 — — $88,620.13 $88,620.13 $88,620.13 2026-05-23
1623 OTHER Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 31 6 — — $81,860.95 $89,298.56 $89,298.56 2026-05-23
234 OTHER Spinal Procedures 20 6 — — $90,204.57 $90,204.57 $90,204.57 2026-05-23
2992 OTHER Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical 20 6 — — $90,231.60 $90,231.60 $90,231.60 2026-05-23
1783 OTHER External Heart Assist Systems 20 6 — — $90,339.64 $90,339.64 $90,339.64 2026-05-23
256449679 OTHER Kit Ipg Nevro Senza Ii 2500 13 8 $104,000.00 $67,600.00 35% off $41,600.00 $91,520.00 $78,000.00 2026-05-09
1204 OTHER Major Respiratory And Chest Procedures 31 6 — — $84,377.79 $92,232.30 $92,232.30 2026-05-23
52 OTHER Tracheostomy With Mv >96 Hours Without Extensive Procedure 20 6 — — $92,323.37 $92,323.37 $92,323.37 2026-05-23
MS-317 OTHER Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 4 2 — — $61,980.95 $92,796.00 $66,494.92 2026-05-23
9514 OTHER Moderately Extensive Procedure Unrelated To Principal Diagnosis 31 6 — — $53,265.01 $93,047.62 $93,047.62 2026-05-23
7114 OTHER Post-operative, Post-trauma, Other Device Infections With O.r. Procedure 31 6 — — $60,183.11 $93,332.37 $93,332.37 2026-05-23
0053 OTHER Tracheostomy With Mv >96 Hours Without Extensive Procedure 11 6 — — $93,875.45 $93,875.45 $93,875.45 2026-05-09
3043 OTHER Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 31 6 — — $71,945.19 $94,520.97 $94,520.97 2026-05-23
6113 OTHER Neonate Birthwt 1500-1999g W Major Anomaly 31 6 — — $84,159.71 $94,985.80 $94,985.80 2026-05-23
J9029 OTHER Instill Adstiladrin- Tx Dose 32 7 — — $63,000.00 $95,032.16 $63,945.00 2026-05-23
6021 OTHER Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom 31 6 — — $93,687.08 $95,180.70 $93,687.08 2026-05-23
6903 OTHER Acute Leukemia 31 6 — — $74,232.00 $95,802.54 $95,802.54 2026-05-23
6904 OTHER Acute Leukemia 31 6 — — $76,802.22 $95,802.54 $95,802.54 2026-05-23
0103 OTHER Head Trauma With Deep Coma 11 6 — — $96,681.47 $96,681.47 $96,681.47 2026-05-09
0102 OTHER Head Trauma With Deep Coma 11 6 — — $96,681.47 $96,681.47 $96,681.47 2026-05-09
0101 OTHER Head Trauma With Deep Coma 11 6 — — $96,681.47 $96,681.47 $96,681.47 2026-05-09
6303 OTHER Neonate Birthwt >2499g W Major Cardiovascular Procedure 31 6 — — $48,672.85 $96,758.04 $96,758.04 2026-05-23
6302 OTHER Neonate Birthwt >2499g W Major Cardiovascular Procedure 31 6 — — $48,524.50 $96,758.04 $96,758.04 2026-05-23
6301 OTHER Neonate Birthwt >2499g W Major Cardiovascular Procedure 31 6 — — $48,408.40 $96,758.04 $96,758.04 2026-05-23
3213 OTHER Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures 31 6 — — $43,216.81 $96,872.40 $96,872.40 2026-05-23
6083 OTHER Neonate Bwt 1250-1499g W Or Without Other Significant Condition 31 6 — — $87,849.58 $96,948.30 $96,948.30 2026-05-23
3214 OTHER Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures 31 6 — — $55,747.86 $97,040.10 $97,040.10 2026-05-23
2204 OTHER Major Stomach, Esophageal And Duodenal Procedures 31 6 — — $70,247.00 $97,069.40 $97,069.40 2026-05-23
6084 OTHER Neonate Bwt 1250-1499g W Or Without Other Significant Condition 31 6 — — $88,346.23 $97,374.00 $97,374.00 2026-05-23
1664 OTHER Coronary Bypass Without Ami Or Complex Principal Diagnosis 31 6 — — $80,850.20 $97,549.52 $97,549.52 2026-05-23
6224 OTHER Neonate Bwt 2000-2499g W Resp Dist Synd/oth Maj Resp Cond 31 6 — — $72,526.92 $98,064.99 $98,064.99 2026-05-23
3031 OTHER Dorsal And Lumbar Fusion Procedure For Curvature Of Back 31 6 — — $90,448.37 $98,772.21 $90,448.37 2026-05-23
L8702 OTHER Ewhf S/d Uprt Micro Sensor 1 1 — — $98,807.61 $98,807.61 $98,807.61 2026-05-09
MS-268 OTHER Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 4 2 — — $66,744.65 $100,014.00 $68,373.04 2026-05-23
MS-928 OTHER Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 4 2 — — $66,856.43 $100,183.50 $71,265.78 2026-05-23
MS-447 OTHER Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 4 2 — — $66,446.85 $100,570.50 $66,776.76 2026-05-23
2304 OTHER Major Small Bowel Procedures 31 6 — — $75,262.60 $100,576.91 $100,576.91 2026-05-23
3032 OTHER Dorsal And Lumbar Fusion Procedure For Curvature Of Back 31 6 — — $98,836.71 $101,038.94 $101,038.94 2026-05-23
7104 OTHER Infectious And Parasitic Diseases Including HIV With O.r. Procedure 31 6 — — $69,102.30 $101,277.72 $101,277.72 2026-05-23
1304 OTHER Respiratory System Diagnosis With Ventilator Support > 96 Hours 31 6 — — $67,161.19 $102,054.57 $102,054.57 2026-05-23
MS-955 OTHER Craniotomy For Multiple Significant Trauma 4 2 — — $66,932.56 $102,424.50 $67,633.39 2026-05-23
1814 OTHER Lower Extremity Vascular Procedures 31 6 — — $75,492.62 $103,777.96 $103,777.96 2026-05-23
0104 OTHER Head Trauma With Deep Coma 11 6 — — $104,064.07 $104,064.07 $104,064.07 2026-05-09
MS-870 OTHER Septicemia Or Severe Sepsis With Mv >96 Hours 4 2 — — $68,705.68 $104,347.50 $69,153.98 2026-05-23
0084 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 11 6 — — $104,413.45 $104,413.45 $104,413.45 2026-05-09
1694 OTHER Major Abdominal Vascular Procedures 31 6 — — $79,530.68 $104,651.81 $104,651.81 2026-05-23
6072 OTHER Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom 31 6 — — $95,258.73 $104,674.53 $104,674.53 2026-05-23
256449292 OTHER Valve Evolut Fx 29mm 13 8 $120,000.00 $78,000.00 35% off $48,000.00 $105,600.00 $90,000.00 2026-05-09
256449290 OTHER Valve Evolut Fx 23mm 13 8 $120,000.00 $78,000.00 35% off $48,000.00 $105,600.00 $90,000.00 2026-05-09
256449291 OTHER Valve Evolut Fx 26mm 13 8 $120,000.00 $78,000.00 35% off $48,000.00 $105,600.00 $90,000.00 2026-05-09
256449293 OTHER Valve Evolut Fx 34mm 13 8 $120,000.00 $78,000.00 35% off $48,000.00 $105,600.00 $90,000.00 2026-05-09
MS-275 OTHER Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 4 2 — — $70,695.27 $106,005.00 $70,850.70 2026-05-23
MS-427 OTHER Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 4 2 — — $71,008.85 $106,540.50 $71,716.18 2026-05-23
2004 OTHER Cardiac Structural And Valvular Disorders 31 6 — — $20,389.62 $107,954.58 $107,954.58 2026-05-23
5911 OTHER Neonate Birthwt 500-749g Without Major Procedure 31 6 — — $103,735.90 $109,627.95 $109,627.95 2026-05-23
6123 OTHER Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond 31 6 — — $80,273.63 $109,899.76 $109,899.76 2026-05-23
2604 OTHER Major Pancreas, Liver And Shunt Procedures 31 6 — — $81,657.49 $110,819.19 $110,819.19 2026-05-23
3044 OTHER Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 31 6 — — $82,254.29 $111,053.89 $111,053.89 2026-05-23
6804 OTHER Major O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms 31 6 — — $66,105.27 $111,276.39 $111,276.39 2026-05-23
6954 OTHER Chemotherapy For Acute Leukemia 31 6 — — $79,163.70 $111,363.86 $111,363.86 2026-05-23
0061 OTHER Pancreas Transplant 11 6 — — $111,406.23 $111,406.23 $111,406.23 2026-05-09
0062 OTHER Pancreas Transplant 11 6 — — $111,438.48 $111,438.48 $111,438.48 2026-05-09
0063 OTHER Pancreas Transplant 11 6 — — $111,535.23 $111,535.23 $111,535.23 2026-05-09
204 OTHER Open Craniotomy For Trauma 20 6 — — $111,739.26 $111,739.26 $111,739.26 2026-05-23
6344 OTHER Neonate, Birthwt >2499g W Resp Dist Synd/oth Maj Resp Cond 31 6 — — $67,447.87 $111,911.47 $111,911.47 2026-05-23
MS-209 OTHER Kidney And Urinary Tract Signs And Symptoms Age 0-17 2 1 — — $111,949.49 $111,949.49 $111,949.49 2026-05-23
MS-957 OTHER Other O.r. Procedures For Multiple Significant Trauma With Mcc 4 2 — — $74,624.15 $111,963.00 $75,653.95 2026-05-23
5912 OTHER Neonate Birthwt 500-749g Without Major Procedure 31 6 — — $104,929.15 $112,195.05 $112,195.05 2026-05-23
5931 OTHER Neonate Birthwt 750-999g Without Major Procedure 31 6 — — $99,884.45 $112,777.42 $112,777.42 2026-05-23
0041 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 11 6 — — $113,049.42 $113,049.42 $113,049.42 2026-05-09
0042 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 11 6 — — $113,262.27 $113,262.27 $113,262.27 2026-05-09
0043 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 11 6 — — $113,713.77 $113,713.77 $113,713.77 2026-05-09
1834 OTHER Percutaneous Structural Cardiac Procedures 20 6 — — $113,743.82 $113,743.82 $113,743.82 2026-05-23
8633 OTHER Neonatal Aftercare 31 6 — — $91,197.12 $113,807.97 $113,807.97 2026-05-23
42 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 20 6 — — $114,623.02 $114,623.02 $114,623.02 2026-05-23
2993 OTHER Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical 20 6 — — $114,901.02 $114,901.02 $114,901.02 2026-05-23
2994 OTHER Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical 20 6 — — $115,017.12 $115,017.12 $115,017.12 2026-05-23
6033 OTHER Neonate Birthwt 1000-1249g W Or Without Other Significant Condition 31 6 — — $85,805.76 $115,169.99 $115,169.99 2026-05-23
6034 OTHER Neonate Birthwt 1000-1249g W Or Without Other Significant Condition 31 6 — — $87,585.96 $115,963.34 $115,963.34 2026-05-23
MS-219 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 6 3 — — $76,227.00 $116,062.50 $88,593.17 2026-05-23
6814 OTHER Other O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms 31 6 — — $69,646.48 $116,133.18 $116,133.18 2026-05-23
1784 OTHER External Heart Assist Systems 20 6 — — $118,390.37 $118,390.37 $118,390.37 2026-05-23
MS-019 OTHER Simultaneous Pancreas And Kidney Transplant With Hemodialysis 4 2 — — $70,891.91 $118,909.50 $75,048.38 2026-05-23
MS-010 OTHER Pancreas Transplant 4 2 — — $71,295.21 $119,595.00 $75,476.04 2026-05-23
93 OTHER Extracorporeal Membrane Oxygenation (ecmo) 20 6 — — $119,929.30 $119,929.30 $119,929.30 2026-05-23
12 OTHER Liver Transplant And/or Intestinal Transplant 20 6 — — $120,077.11 $120,077.11 $120,077.11 2026-05-23
MS-020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 4 2 — — $78,096.26 $120,916.50 $79,312.29 2026-05-23
111 OTHER Extracorporeal Membrane Oxygenation (ecmo) 20 6 — — $122,184.42 $122,184.42 $122,184.42 2026-05-23
71 OTHER Allogeneic Bone Marrow Transplant 20 6 — — $122,893.92 $122,893.92 $122,893.92 2026-05-23
224 OTHER Ventricular Shunt Procedures 20 6 — — $124,923.91 $124,923.91 $124,923.91 2026-05-23
MS-429 OTHER Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 4 2 — — $83,287.03 $125,109.00 $89,290.41 2026-05-23
1654 OTHER Coronary Bypass With Ami Or Complex Principal Diagnosis 31 6 — — $102,012.19 $125,385.71 $125,385.71 2026-05-23
MS-456 OTHER Spinal Fusion Except Cervical With Spinal Curvature- Malignancy- Infection Or Ex… 4 2 — — $83,342.05 $127,038.00 $83,953.52 2026-05-23
MS-231 OTHER Coronary Bypass With Ptca With Mcc 4 2 — — $83,602.08 $127,108.50 $84,106.79 2026-05-23
9104 OTHER Craniotomy For Multiple Significant Trauma 31 6 — — $81,088.74 $127,441.76 $127,441.76 2026-05-23
5892 OTHER Neonate Bwt <500g Or Ga <24 Weeks 31 6 — — $66,187.58 $127,924.41 $127,924.41 2026-05-23
5891 OTHER Neonate Bwt <500g Or Ga <24 Weeks 31 6 — — $66,187.58 $127,924.41 $127,924.41 2026-05-23
3004 OTHER Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 20 6 — — $129,752.55 $129,752.55 $129,752.55 2026-05-23
9114 OTHER Extensive Abdominal/thoracic Procedures For Mult Significant Trauma 31 6 — — $72,900.47 $131,271.86 $131,271.86 2026-05-23
1674 OTHER Other Cardiothoracic And Thoracic Vascular Procedures 31 6 — — $73,979.33 $131,273.94 $131,273.94 2026-05-23
0092 OTHER Extracorporeal Membrane Oxygenation (ecmo) 11 6 — — $132,078.56 $132,078.56 $132,078.56 2026-05-09
0093 OTHER Extracorporeal Membrane Oxygenation (ecmo) 11 6 — — $132,078.56 $132,078.56 $132,078.56 2026-05-09
0091 OTHER Extracorporeal Membrane Oxygenation (ecmo) 11 6 — — $132,078.56 $132,078.56 $132,078.56 2026-05-09
9124 OTHER Musculoskeletal And Other Procedures For Multiple Significant Trauma 31 6 — — $83,664.73 $132,125.87 $132,125.87 2026-05-23
1634 OTHER Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 31 6 — — $99,693.76 $133,236.70 $133,236.70 2026-05-23
5894 OTHER Neonate Bwt <500g Or Ga <24 Weeks 31 6 — — $66,187.58 $134,367.74 $134,367.74 2026-05-23
5893 OTHER Neonate Bwt <500g Or Ga <24 Weeks 31 6 — — $66,187.58 $134,367.74 $134,367.74 2026-05-23
6073 OTHER Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom 31 6 — — $103,060.66 $134,562.75 $134,562.75 2026-05-23
6022 OTHER Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom 31 6 — — $96,251.40 $135,568.66 $135,568.66 2026-05-23
214 OTHER Open Craniotomy Except Trauma 20 6 — — $138,009.22 $138,009.22 $138,009.22 2026-05-23
MS-850 OTHER Acute Leukemia With Other Procedures 4 2 — — $85,855.05 $138,178.50 $88,880.23 2026-05-23
4401 OTHER Kidney Transplant 31 6 — — $63,958.85 $138,825.89 $138,825.89 2026-05-23
4402 OTHER Kidney Transplant 31 6 — — $65,530.27 $138,883.94 $138,883.94 2026-05-23
4403 OTHER Kidney Transplant 31 6 — — $75,658.78 $138,967.79 $138,967.79 2026-05-23
4404 OTHER Kidney Transplant 31 6 — — $128,478.07 $140,057.84 $140,057.84 2026-05-23
9504 OTHER Extensive Procedure Unrelated To Principal Diagnosis 31 6 — — $65,889.66 $141,031.91 $141,031.91 2026-05-23
3033 OTHER Dorsal And Lumbar Fusion Procedure For Curvature Of Back 31 6 — — $98,946.36 $142,378.87 $142,378.87 2026-05-23
0072 OTHER Allogeneic Bone Marrow Transplant 11 6 — — $142,486.60 $142,486.60 $142,486.60 2026-05-09
0073 OTHER Allogeneic Bone Marrow Transplant 11 6 — — $142,486.60 $142,486.60 $142,486.60 2026-05-09
0071 OTHER Allogeneic Bone Marrow Transplant 11 6 — — $142,486.60 $142,486.60 $142,486.60 2026-05-09
914 OTHER Behavioral Health Treatment/Services - Extension Of 090x - Individual Therapy 40 6 — — $159.12 $143,859.47 $72,009.29 2026-05-23
MS-216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 4 2 — — $96,255.64 $144,766.50 $96,877.46 2026-05-23
5913 OTHER Neonate Birthwt 500-749g Without Major Procedure 31 6 — — $104,929.15 $147,993.49 $147,993.49 2026-05-23
6214 OTHER Neonate Bwt 2000-2499g W Major Anomaly 31 6 — — $134,235.08 $149,016.91 $149,016.91 2026-05-23
Q0480 OTHER Driver Pneumatic Vad- Rep 32 7 — — $72,648.53 $149,999.93 $72,648.53 2026-05-23
8634 OTHER Neonatal Aftercare 31 6 — — $120,447.58 $150,117.29 $150,117.29 2026-05-23
0054 OTHER Tracheostomy With Mv >96 Hours Without Extensive Procedure 11 6 — — $150,698.11 $150,698.11 $150,698.11 2026-05-09
6091 OTHER Neonate Bwt 1500-2499g W Major Procedure 31 6 — — $112,943.33 $150,780.11 $150,780.11 2026-05-23
6092 OTHER Neonate Bwt 1500-2499g W Major Procedure 31 6 — — $112,943.33 $151,921.76 $151,921.76 2026-05-23
6124 OTHER Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond 31 6 — — $90,007.56 $153,859.46 $153,859.46 2026-05-23
MS-426 OTHER Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 4 2 — — $104,470.44 $157,131.00 $109,029.30 2026-05-23
6093 OTHER Neonate Bwt 1500-2499g W Major Procedure 31 6 — — $112,943.33 $157,422.04 $157,422.04 2026-05-23
MS-215 OTHER Other Heart Assist System Implant 4 2 — — $98,586.80 $158,922.00 $102,088.48 2026-05-23
MS-005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 4 2 — — $102,055.53 $159,741.00 $104,092.87 2026-05-23
0064 OTHER Pancreas Transplant 11 6 — — $162,404.42 $162,404.42 $162,404.42 2026-05-09
MS-212 OTHER Testes Procedures Age 0-17 4 2 — — $107,585.88 $163,408.50 $108,067.27 2026-05-23
MS-233 OTHER Coronary Bypass With Cardiac Catheterization With Mcc 6 3 — — $75,902.19 $163,728.66 $97,676.93 2026-05-23
6114 OTHER Neonate Birthwt 1500-1999g W Major Anomaly 31 6 — — $152,229.56 $163,952.35 $152,229.56 2026-05-23
MS-002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 4 2 — — $109,793.00 $165,295.50 $112,077.05 2026-05-23
83 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 20 6 — — $166,061.36 $166,061.36 $166,061.36 2026-05-23
84 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 20 6 — — $166,222.61 $166,222.61 $166,222.61 2026-05-23
53 OTHER Tracheostomy With Mv >96 Hours Without Extensive Procedure 20 6 — — $166,227.07 $166,227.07 $166,227.07 2026-05-23
5932 OTHER Neonate Birthwt 750-999g Without Major Procedure 31 6 — — $101,883.95 $167,555.65 $167,555.65 2026-05-23
6334 OTHER Neonate Birthwt >2499g W Major Anomaly 31 6 — — $92,371.31 $169,641.18 $169,641.18 2026-05-23
62 OTHER Pancreas Transplant 20 6 — — $171,455.28 $171,455.28 $171,455.28 2026-05-23
63 OTHER Pancreas Transplant 20 6 — — $171,455.28 $171,455.28 $171,455.28 2026-05-23
64 OTHER Pancreas Transplant 20 6 — — $171,455.28 $171,455.28 $171,455.28 2026-05-23
6023 OTHER Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom 31 6 — — $135,186.74 $172,990.93 $172,990.93 2026-05-23
3034 OTHER Dorsal And Lumbar Fusion Procedure For Curvature Of Back 31 6 — — $122,155.07 $180,120.92 $180,120.92 2026-05-23
8514 OTHER Gender Related Procedures 20 6 — — $180,152.55 $180,152.55 $180,152.55 2026-05-23
13 OTHER Liver Transplant And/or Intestinal Transplant 20 6 — — $180,772.13 $180,772.13 $180,772.13 2026-05-23
1624 OTHER Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 31 6 — — $113,894.85 $181,159.91 $181,159.91 2026-05-23
8504 OTHER Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 31 6 — — $42,394.61 $186,758.52 $186,758.52 2026-05-23
5933 OTHER Neonate Birthwt 750-999g Without Major Procedure 31 6 — — $161,361.55 $191,842.30 $191,842.30 2026-05-23
MS-007 OTHER Lung Transplant 4 2 — — $127,957.66 $196,032.00 $129,009.55 2026-05-23
MS-014 OTHER Allogeneic Bone Marrow Transplant 4 2 — — $118,809.44 $196,527.00 $124,598.66 2026-05-23
72 OTHER Allogeneic Bone Marrow Transplant 20 6 — — $198,437.33 $198,437.33 $198,437.33 2026-05-23
43 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 20 6 — — $199,957.70 $199,957.70 $199,957.70 2026-05-23
0021 OTHER Heart And/or Lung Transplant 11 6 — — $200,197.22 $200,197.22 $200,197.22 2026-05-09
0022 OTHER Heart And/or Lung Transplant 11 6 — — $200,364.92 $200,364.92 $200,364.92 2026-05-09
0023 OTHER Heart And/or Lung Transplant 11 6 — — $200,848.67 $200,848.67 $200,848.67 2026-05-09
MS-004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth And Nec… 6 3 — — $136,800.72 $211,950.00 $144,004.00 2026-05-23
21 OTHER Heart And/or Lung Transplant 20 6 — — $217,018.03 $217,018.03 $217,018.03 2026-05-23
6074 OTHER Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom 31 6 — — $142,086.95 $219,132.78 $219,132.78 2026-05-23
73 OTHER Allogeneic Bone Marrow Transplant 20 6 — — $220,943.88 $220,943.88 $220,943.88 2026-05-23
94 OTHER Extracorporeal Membrane Oxygenation (ecmo) 20 6 — — $227,390.60 $227,390.60 $227,390.60 2026-05-23
0094 OTHER Extracorporeal Membrane Oxygenation (ecmo) 11 6 — — $228,301.56 $228,301.56 $228,301.56 2026-05-09
54 OTHER Tracheostomy With Mv >96 Hours Without Extensive Procedure 20 6 — — $228,748.68 $228,748.68 $228,748.68 2026-05-23
0044 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 11 6 — — $231,442.66 $231,442.66 $231,442.66 2026-05-09
6304 OTHER Neonate Birthwt >2499g W Major Cardiovascular Procedure 31 6 — — $180,341.17 $235,523.02 $235,523.02 2026-05-23
0074 OTHER Allogeneic Bone Marrow Transplant 11 6 — — $235,802.82 $235,802.82 $235,802.82 2026-05-09
1604 OTHER Major Cardiothoracic Repair Of Heart Anomaly 31 6 — — $122,895.96 $242,358.25 $242,358.25 2026-05-23
22 OTHER Heart And/or Lung Transplant 20 6 — — $243,586.70 $243,586.70 $243,586.70 2026-05-23
6024 OTHER Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom 31 6 — — $145,995.49 $245,243.37 $245,243.37 2026-05-23
6094 OTHER Neonate Bwt 1500-2499g W Major Procedure 31 6 — — $214,457.63 $250,369.68 $250,369.68 2026-05-23
0014 OTHER Liver Transplant And/or Intestinal Transplant 11 6 — — $253,450.84 $253,450.84 $253,450.84 2026-05-09
5881 OTHER Neonate Bwt <1500g W Major Procedure 31 6 — — $171,212.47 $294,207.35 $294,207.35 2026-05-23
5882 OTHER Neonate Bwt <1500g W Major Procedure 31 6 — — $171,212.47 $294,207.35 $294,207.35 2026-05-23
23 OTHER Heart And/or Lung Transplant 20 6 — — $295,712.02 $295,712.02 $295,712.02 2026-05-23
1611 OTHER Implantable Heart Assist Systems 31 6 — — $55,181.08 $302,838.59 $302,838.59 2026-05-23
1612 OTHER Implantable Heart Assist Systems 31 6 — — $67,714.74 $303,851.24 $303,851.24 2026-05-23
1613 OTHER Implantable Heart Assist Systems 31 6 — — $79,670.23 $303,870.59 $303,870.59 2026-05-23
112 OTHER Extracorporeal Membrane Oxygenation (ecmo) 22 7 — — $50.00 $304,837.81 $304,837.81 2026-05-23
5934 OTHER Neonate Birthwt 750-999g Without Major Procedure 31 6 — — $202,944.11 $317,330.38 $317,330.38 2026-05-23
14 OTHER Liver Transplant And/or Intestinal Transplant 20 6 — — $328,688.97 $328,688.97 $328,688.97 2026-05-23
5914 OTHER Neonate Birthwt 500-749g Without Major Procedure 31 6 — — $225,770.30 $332,614.53 $332,614.53 2026-05-23
74 OTHER Allogeneic Bone Marrow Transplant 20 6 — — $333,375.47 $333,375.47 $333,375.47 2026-05-23
0024 OTHER Heart And/or Lung Transplant 11 6 — — $347,823.74 $347,823.74 $347,823.74 2026-05-09
MS-927 OTHER Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 4 2 — — $210,385.85 $355,842.00 $222,915.12 2026-05-23
113 OTHER Extracorporeal Membrane Oxygenation (ecmo) 20 6 — — $378,177.99 $378,177.99 $378,177.99 2026-05-23
44 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 20 6 — — $393,435.20 $393,435.20 $393,435.20 2026-05-23
5883 OTHER Neonate Bwt <1500g W Major Procedure 31 6 — — $171,934.87 $396,403.43 $396,403.43 2026-05-23
MS-001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 4 2 — — $275,868.79 $422,524.50 $277,642.68 2026-05-23
6314 OTHER Neonate Birthwt >2499g W Other Major Procedure 31 6 — — $182,838.72 $469,136.53 $469,136.53 2026-05-23
1614 OTHER Implantable Heart Assist Systems 31 6 — — $335,581.17 $469,930.95 $469,930.95 2026-05-23
MS-003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth… 6 3 — — $209,156.35 $489,311.20 $267,127.61 2026-05-23
5884 OTHER Neonate Bwt <1500g W Major Procedure 31 6 — — $389,138.03 $503,124.62 $503,124.62 2026-05-23
24 OTHER Heart And/or Lung Transplant 20 6 — — $537,458.68 $537,458.68 $537,458.68 2026-05-23
Q2058 OTHER Obecbtge Autol Up To 400 Mil 20 6 — — $551,250.00 $551,250.00 $551,250.00 2026-05-23
5831 OTHER Neonate With Ecmo 31 6 — — $189,686.93 $558,502.30 $558,502.30 2026-05-23
5832 OTHER Neonate With Ecmo 31 6 — — $191,228.48 $558,502.30 $558,502.30 2026-05-23
MS-018 OTHER Chimeric Antigen Receptor (car) T-cell Immunotherapy 4 2 — — $373,825.00 $565,692.00 $424,615.95 2026-05-23
5833 OTHER Neonate With Ecmo 31 6 — — $191,228.48 $588,944.20 $588,944.20 2026-05-23
5834 OTHER Neonate With Ecmo 31 6 — — $191,228.48 $588,944.20 $588,944.20 2026-05-23
114 OTHER Extracorporeal Membrane Oxygenation (ecmo) 20 6 — — $647,979.12 $647,979.12 $647,979.12 2026-05-23
Q2053 OTHER Brexucabtagene Car Pos T 32 7 — — $485,100.00 $690,795.60 $485,100.00 2026-05-23
Q2041 OTHER Axicabtagene Ciloleucel Car+ 32 7 — — $485,100.00 $734,183.94 $528,759.00 2026-05-23
Q2057 OTHER Afamitresgene Autoleucel 20 6 — — $763,350.00 $763,350.00 $763,350.00 2026-05-23
Q2054 OTHER Lisocabtagene Mara Car Pos T 32 7 — — $511,851.30 $775,089.12 $557,917.92 2026-05-23
Q2055 OTHER Idecabtagene Vicleucel Car 32 7 — — $523,328.35 $789,881.39 $554,728.05 2026-05-23
Q2056 OTHER Ciltacabtagene Car-pos T 32 7 — — $548,128.28 $790,685.15 $583,075.96 2026-05-23
Q2042 OTHER Tisagenlecleucel Car-pos T 1 1 — — $793,789.29 $793,789.29 $793,789.29 2026-05-09
J3399 OTHER Inj Onase Abepar-xioi Treat 32 7 — — $2,231,250.00 $3,582,921.35 $2,231,250.00 2026-05-23
J1411 OTHER Inj- Hemgenix- Per Tx Dose 31 6 — — $3,675,000.00 $3,675,000.00 $3,675,000.00 2026-05-23
C9172 OTHER Inj- Beqvez- Per Tx Dose 20 6 — — $3,675,000.00 $3,675,000.00 $3,675,000.00 2026-05-23
J1414 OTHER Inj- Beqvez- Per Tx Dose 20 6 — — $3,675,000.00 $3,675,000.00 $3,675,000.00 2026-05-23
J3393 OTHER Inj- Betibeglogene Autotemce 1 1 — — $4,452,000.00 $4,452,000.00 $4,452,000.00 2026-05-09
J3394 OTHER Inj- Lovotibeglogene Autotem 1 1 — — $4,929,000.00 $4,929,000.00 $4,929,000.00 2026-05-09
J1413 OTHER Inj Delandistrogene Mox Rokl 32 7 — — $3,360,000.00 $4,988,182.14 $3,360,000.00 2026-05-23
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