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 — reason	Rows
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 via	CMS 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.

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

J1413	OTHER	Inj Delandistrogene Mox Rokl	32	7	—	—	$3,360,000.00	$4,988,182.14	$3,360,000.00	2026-05-23
J3394	OTHER	Inj- Lovotibeglogene Autotem	1	1	—	—	$4,929,000.00	$4,929,000.00	$4,929,000.00	2026-05-09
J3393	OTHER	Inj- Betibeglogene Autotemce	1	1	—	—	$4,452,000.00	$4,452,000.00	$4,452,000.00	2026-05-09
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
J3399	OTHER	Inj Onase Abepar-xioi Treat	32	7	—	—	$2,231,250.00	$3,582,921.35	$2,231,250.00	2026-05-23
Q2042	OTHER	Tisagenlecleucel Car-pos T	1	1	—	—	$793,789.29	$793,789.29	$793,789.29	2026-05-09
Q2056	OTHER	Ciltacabtagene Car-pos T	32	7	—	—	$548,128.28	$790,685.15	$583,075.96	2026-05-23
Q2055	OTHER	Idecabtagene Vicleucel Car	32	7	—	—	$523,328.35	$789,881.39	$554,728.05	2026-05-23
Q2054	OTHER	Lisocabtagene Mara Car Pos T	32	7	—	—	$511,851.30	$775,089.12	$557,917.92	2026-05-23
Q2057	OTHER	Afamitresgene Autoleucel	20	6	—	—	$763,350.00	$763,350.00	$763,350.00	2026-05-23
Q2041	OTHER	Axicabtagene Ciloleucel Car+	32	7	—	—	$485,100.00	$734,183.94	$528,759.00	2026-05-23
Q2053	OTHER	Brexucabtagene Car Pos T	32	7	—	—	$485,100.00	$690,795.60	$485,100.00	2026-05-23
114	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	20	6	—	—	$647,979.12	$647,979.12	$647,979.12	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
MS-018	OTHER	Chimeric Antigen Receptor (car) T-cell Immunotherapy	4	2	—	—	$373,825.00	$565,692.00	$424,615.95	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
Q2058	OTHER	Obecbtge Autol Up To 400 Mil	20	6	—	—	$551,250.00	$551,250.00	$551,250.00	2026-05-23
24	OTHER	Heart And/or Lung Transplant	20	6	—	—	$537,458.68	$537,458.68	$537,458.68	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
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
1614	OTHER	Implantable Heart Assist Systems	31	6	—	—	$335,581.17	$469,930.95	$469,930.95	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
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
5883	OTHER	Neonate Bwt <1500g W Major Procedure	31	6	—	—	$171,934.87	$396,403.43	$396,403.43	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
113	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	20	6	—	—	$378,177.99	$378,177.99	$378,177.99	2026-05-23
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
0024	OTHER	Heart And/or Lung Transplant	11	6	—	—	$347,823.74	$347,823.74	$347,823.74	2026-05-09
74	OTHER	Allogeneic Bone Marrow Transplant	20	6	—	—	$333,375.47	$333,375.47	$333,375.47	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
14	OTHER	Liver Transplant And/or Intestinal Transplant	20	6	—	—	$328,688.97	$328,688.97	$328,688.97	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
112	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	22	7	—	—	$50.00	$304,837.81	$304,837.81	2026-05-23
1613	OTHER	Implantable Heart Assist Systems	31	6	—	—	$79,670.23	$303,870.59	$303,870.59	2026-05-23
1612	OTHER	Implantable Heart Assist Systems	31	6	—	—	$67,714.74	$303,851.24	$303,851.24	2026-05-23
1611	OTHER	Implantable Heart Assist Systems	31	6	—	—	$55,181.08	$302,838.59	$302,838.59	2026-05-23
23	OTHER	Heart And/or Lung Transplant	20	6	—	—	$295,712.02	$295,712.02	$295,712.02	2026-05-23
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
0014	OTHER	Liver Transplant And/or Intestinal Transplant	11	6	—	—	$253,450.84	$253,450.84	$253,450.84	2026-05-09
6094	OTHER	Neonate Bwt 1500-2499g W Major Procedure	31	6	—	—	$214,457.63	$250,369.68	$250,369.68	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
22	OTHER	Heart And/or Lung Transplant	20	6	—	—	$243,586.70	$243,586.70	$243,586.70	2026-05-23
1604	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	31	6	—	—	$122,895.96	$242,358.25	$242,358.25	2026-05-23
0074	OTHER	Allogeneic Bone Marrow Transplant	11	6	—	—	$235,802.82	$235,802.82	$235,802.82	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
0044	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	11	6	—	—	$231,442.66	$231,442.66	$231,442.66	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
0094	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	11	6	—	—	$228,301.56	$228,301.56	$228,301.56	2026-05-09
94	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	20	6	—	—	$227,390.60	$227,390.60	$227,390.60	2026-05-23
73	OTHER	Allogeneic Bone Marrow Transplant	20	6	—	—	$220,943.88	$220,943.88	$220,943.88	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
21	OTHER	Heart And/or Lung Transplant	20	6	—	—	$217,018.03	$217,018.03	$217,018.03	2026-05-23
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
0023	OTHER	Heart And/or Lung Transplant	11	6	—	—	$200,848.67	$200,848.67	$200,848.67	2026-05-09
0022	OTHER	Heart And/or Lung Transplant	11	6	—	—	$200,364.92	$200,364.92	$200,364.92	2026-05-09
0021	OTHER	Heart And/or Lung Transplant	11	6	—	—	$200,197.22	$200,197.22	$200,197.22	2026-05-09
43	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	20	6	—	—	$199,957.70	$199,957.70	$199,957.70	2026-05-23
72	OTHER	Allogeneic Bone Marrow Transplant	20	6	—	—	$198,437.33	$198,437.33	$198,437.33	2026-05-23
MS-014	OTHER	Allogeneic Bone Marrow Transplant	4	2	—	—	$118,809.44	$196,527.00	$124,598.66	2026-05-23
MS-007	OTHER	Lung Transplant	4	2	—	—	$127,957.66	$196,032.00	$129,009.55	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
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
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
13	OTHER	Liver Transplant And/or Intestinal Transplant	20	6	—	—	$180,772.13	$180,772.13	$180,772.13	2026-05-23
8514	OTHER	Gender Related Procedures	20	6	—	—	$180,152.55	$180,152.55	$180,152.55	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
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
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
6334	OTHER	Neonate Birthwt >2499g W Major Anomaly	31	6	—	—	$92,371.31	$169,641.18	$169,641.18	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
53	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	20	6	—	—	$166,227.07	$166,227.07	$166,227.07	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
83	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	20	6	—	—	$166,061.36	$166,061.36	$166,061.36	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
6114	OTHER	Neonate Birthwt 1500-1999g W Major Anomaly	31	6	—	—	$152,229.56	$163,952.35	$152,229.56	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
MS-212	OTHER	Testes Procedures Age 0-17	4	2	—	—	$107,585.88	$163,408.50	$108,067.27	2026-05-23
0064	OTHER	Pancreas Transplant	11	6	—	—	$162,404.42	$162,404.42	$162,404.42	2026-05-09
MS-005	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	4	2	—	—	$102,055.53	$159,741.00	$104,092.87	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
6093	OTHER	Neonate Bwt 1500-2499g W Major Procedure	31	6	—	—	$112,943.33	$157,422.04	$157,422.04	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
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
6092	OTHER	Neonate Bwt 1500-2499g W Major Procedure	31	6	—	—	$112,943.33	$151,921.76	$151,921.76	2026-05-23
6091	OTHER	Neonate Bwt 1500-2499g W Major Procedure	31	6	—	—	$112,943.33	$150,780.11	$150,780.11	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
8634	OTHER	Neonatal Aftercare	31	6	—	—	$120,447.58	$150,117.29	$150,117.29	2026-05-23
Q0480	OTHER	Driver Pneumatic Vad- Rep	32	7	—	—	$72,648.53	$149,999.93	$72,648.53	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
5913	OTHER	Neonate Birthwt 500-749g Without Major Procedure	31	6	—	—	$104,929.15	$147,993.49	$147,993.49	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
914	OTHER	Behavioral Health Treatment/Services - Extension Of 090x - Individual Therapy	40	6	—	—	$159.12	$143,859.47	$72,009.29	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
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
9504	OTHER	Extensive Procedure Unrelated To Principal Diagnosis	31	6	—	—	$65,889.66	$141,031.91	$141,031.91	2026-05-23
4404	OTHER	Kidney Transplant	31	6	—	—	$128,478.07	$140,057.84	$140,057.84	2026-05-23
4403	OTHER	Kidney Transplant	31	6	—	—	$75,658.78	$138,967.79	$138,967.79	2026-05-23
4402	OTHER	Kidney Transplant	31	6	—	—	$65,530.27	$138,883.94	$138,883.94	2026-05-23
4401	OTHER	Kidney Transplant	31	6	—	—	$63,958.85	$138,825.89	$138,825.89	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
214	OTHER	Open Craniotomy Except Trauma	20	6	—	—	$138,009.22	$138,009.22	$138,009.22	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
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
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
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
9124	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	31	6	—	—	$83,664.73	$132,125.87	$132,125.87	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
1674	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	31	6	—	—	$73,979.33	$131,273.94	$131,273.94	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
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
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
9104	OTHER	Craniotomy For Multiple Significant Trauma	31	6	—	—	$81,088.74	$127,441.76	$127,441.76	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
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
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-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
224	OTHER	Ventricular Shunt Procedures	20	6	—	—	$124,923.91	$124,923.91	$124,923.91	2026-05-23
71	OTHER	Allogeneic Bone Marrow Transplant	20	6	—	—	$122,893.92	$122,893.92	$122,893.92	2026-05-23
111	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	20	6	—	—	$122,184.42	$122,184.42	$122,184.42	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
12	OTHER	Liver Transplant And/or Intestinal Transplant	20	6	—	—	$120,077.11	$120,077.11	$120,077.11	2026-05-23
93	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	20	6	—	—	$119,929.30	$119,929.30	$119,929.30	2026-05-23
MS-010	OTHER	Pancreas Transplant	4	2	—	—	$71,295.21	$119,595.00	$75,476.04	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
1784	OTHER	External Heart Assist Systems	20	6	—	—	$118,390.37	$118,390.37	$118,390.37	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
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
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
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
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
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
42	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	20	6	—	—	$114,623.02	$114,623.02	$114,623.02	2026-05-23
8633	OTHER	Neonatal Aftercare	31	6	—	—	$91,197.12	$113,807.97	$113,807.97	2026-05-23
1834	OTHER	Percutaneous Structural Cardiac Procedures	20	6	—	—	$113,743.82	$113,743.82	$113,743.82	2026-05-23
0043	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	11	6	—	—	$113,713.77	$113,713.77	$113,713.77	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
0041	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	11	6	—	—	$113,049.42	$113,049.42	$113,049.42	2026-05-09
5931	OTHER	Neonate Birthwt 750-999g Without Major Procedure	31	6	—	—	$99,884.45	$112,777.42	$112,777.42	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
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
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
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
204	OTHER	Open Craniotomy For Trauma	20	6	—	—	$111,739.26	$111,739.26	$111,739.26	2026-05-23
0063	OTHER	Pancreas Transplant	11	6	—	—	$111,535.23	$111,535.23	$111,535.23	2026-05-09
0062	OTHER	Pancreas Transplant	11	6	—	—	$111,438.48	$111,438.48	$111,438.48	2026-05-09
0061	OTHER	Pancreas Transplant	11	6	—	—	$111,406.23	$111,406.23	$111,406.23	2026-05-09
6954	OTHER	Chemotherapy For Acute Leukemia	31	6	—	—	$79,163.70	$111,363.86	$111,363.86	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
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
2604	OTHER	Major Pancreas, Liver And Shunt Procedures	31	6	—	—	$81,657.49	$110,819.19	$110,819.19	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
5911	OTHER	Neonate Birthwt 500-749g Without Major Procedure	31	6	—	—	$103,735.90	$109,627.95	$109,627.95	2026-05-23
2004	OTHER	Cardiac Structural And Valvular Disorders	31	6	—	—	$20,389.62	$107,954.58	$107,954.58	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
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
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
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
1694	OTHER	Major Abdominal Vascular Procedures	31	6	—	—	$79,530.68	$104,651.81	$104,651.81	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
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
0104	OTHER	Head Trauma With Deep Coma	11	6	—	—	$104,064.07	$104,064.07	$104,064.07	2026-05-09
1814	OTHER	Lower Extremity Vascular Procedures	31	6	—	—	$75,492.62	$103,777.96	$103,777.96	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
1304	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	31	6	—	—	$67,161.19	$102,054.57	$102,054.57	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
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
2304	OTHER	Major Small Bowel Procedures	31	6	—	—	$75,262.60	$100,576.91	$100,576.91	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
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-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
L8702	OTHER	Ewhf S/d Uprt Micro Sensor	1	1	—	—	$98,807.61	$98,807.61	$98,807.61	2026-05-09
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
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
1664	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	31	6	—	—	$80,850.20	$97,549.52	$97,549.52	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
2204	OTHER	Major Stomach, Esophageal And Duodenal Procedures	31	6	—	—	$70,247.00	$97,069.40	$97,069.40	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
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
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
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
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
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
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
J9029	OTHER	Instill Adstiladrin- Tx Dose	32	7	—	—	$63,000.00	$95,032.16	$63,945.00	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
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
0053	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	11	6	—	—	$93,875.45	$93,875.45	$93,875.45	2026-05-09
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
9514	OTHER	Moderately Extensive Procedure Unrelated To Principal Diagnosis	31	6	—	—	$53,265.01	$93,047.62	$93,047.62	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
52	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	20	6	—	—	$92,323.37	$92,323.37	$92,323.37	2026-05-23
1204	OTHER	Major Respiratory And Chest Procedures	31	6	—	—	$84,377.79	$92,232.30	$92,232.30	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
1783	OTHER	External Heart Assist Systems	20	6	—	—	$90,339.64	$90,339.64	$90,339.64	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
234	OTHER	Spinal Procedures	20	6	—	—	$90,204.57	$90,204.57	$90,204.57	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
92	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	20	6	—	—	$88,620.13	$88,620.13	$88,620.13	2026-05-23
91	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	20	6	—	—	$88,491.13	$88,491.13	$88,491.13	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
1653	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	31	6	—	—	$60,067.02	$87,793.50	$87,793.50	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
9304	OTHER	Multiple Significant Trauma Without O.r. Procedure	31	6	—	—	$30,773.54	$85,912.30	$85,912.30	2026-05-23
1794	OTHER	Defibrillator Implants	20	6	—	—	$85,673.79	$85,673.79	$85,673.79	2026-05-23
894	OTHER	Major Cranial/facial Bone Procedures	20	6	—	—	$85,568.88	$85,568.88	$85,568.88	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
274	OTHER	Other Open Craniotomy	20	6	—	—	$84,403.30	$84,403.30	$84,403.30	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
Q2043	OTHER	Sipuleucel-t Auto Cd54+	32	7	—	—	$65,732.65	$82,522.85	$65,732.65	2026-05-23
0013	OTHER	Liver Transplant And/or Intestinal Transplant	11	6	—	—	$81,615.52	$81,615.52	$81,615.52	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
0011	OTHER	Liver Transplant And/or Intestinal Transplant	11	6	—	—	$81,312.37	$81,312.37	$81,312.37	2026-05-09
4054	OTHER	Other Procedures For Endocrine, Nutritional And Metabolic Disorders	31	6	—	—	$59,454.27	$80,814.58	$80,814.58	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
81	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	20	6	—	—	$80,551.63	$80,551.63	$80,551.63	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
6902	OTHER	Acute Leukemia	31	6	—	—	$35,861.22	$79,314.45	$79,314.45	2026-05-23
4414	OTHER	Major Bladder Procedures	31	6	—	—	$78,766.42	$79,252.26	$79,252.26	2026-05-23
0894	OTHER	Major Cranial/facial Bone Procedures	11	6	—	—	$79,013.05	$79,013.05	$79,013.05	2026-05-09
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
1214	OTHER	Other Respiratory And Chest Procedures	31	6	—	—	$70,983.12	$78,448.14	$78,448.14	2026-05-23
213	OTHER	Open Craniotomy Except Trauma	20	6	—	—	$78,298.23	$78,298.23	$78,298.23	2026-05-23
4284	OTHER	Genetic Disorders	20	6	—	—	$78,294.40	$78,294.40	$78,294.40	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
41	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	20	6	—	—	$78,058.12	$78,058.12	$78,058.12	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
554	OTHER	Head Trauma With Coma > 1 Hour Or Hemorrhage	20	6	—	—	$77,121.40	$77,121.40	$77,121.40	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
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
2644	OTHER	Other Hepatobiliary, Pancreas And Abdominal Procedures	31	6	—	—	$65,374.51	$76,544.35	$76,544.35	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
3134	OTHER	Knee And Lower Leg Procedures Except Foot	31	6	—	—	$47,298.43	$75,266.96	$75,266.96	2026-05-23
0214	OTHER	Open Craniotomy Except Trauma	11	6	—	—	$74,838.00	$74,838.00	$74,838.00	2026-05-09
3084	OTHER	Hip And Femur Fracture Repair	31	6	—	—	$35,199.12	$74,569.02	$74,569.02	2026-05-23
1833	OTHER	Percutaneous Structural Cardiac Procedures	20	6	—	—	$74,455.37	$74,455.37	$74,455.37	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
1782	OTHER	External Heart Assist Systems	20	6	—	—	$73,715.50	$73,715.50	$73,715.50	2026-05-23
5204	OTHER	Other GYN Procedures For Malignancy	20	6	—	—	$73,420.43	$73,420.43	$73,420.43	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
6112	OTHER	Neonate Birthwt 1500-1999g W Major Anomaly	31	6	—	—	$64,275.23	$72,122.13	$64,275.23	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
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
1824	OTHER	Other Peripheral Vascular Procedures	31	6	—	—	$51,334.14	$70,195.10	$70,195.10	2026-05-23
6213	OTHER	Neonate Bwt 2000-2499g W Major Anomaly	31	6	—	—	$53,327.08	$70,070.79	$70,070.79	2026-05-23
0083	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	11	6	—	—	$69,848.23	$69,848.23	$69,848.23	2026-05-09
0082	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	11	6	—	—	$69,745.03	$69,745.03	$69,745.03	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
0081	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	11	6	—	—	$69,628.93	$69,628.93	$69,628.93	2026-05-09
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
6953	OTHER	Chemotherapy For Acute Leukemia	31	6	—	—	$36,255.95	$69,037.41	$69,037.41	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
1793	OTHER	Defibrillator Implants	20	6	—	—	$67,549.46	$67,549.46	$67,549.46	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
A9604	OTHER	Sm 153 Lexidronam	21	7	—	—	$25,889.78	$66,678.38	$66,678.38	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
233	OTHER	Spinal Procedures	20	6	—	—	$66,407.89	$66,407.89	$66,407.89	2026-05-23
2244	OTHER	Peritoneal Adhesiolysis	31	6	—	—	$50,659.24	$66,397.62	$66,397.62	2026-05-23
734	OTHER	Orbit And Eye Procedures	20	6	—	—	$66,312.82	$66,312.82	$66,312.82	2026-05-23
293	OTHER	Other Percutaneous Intracranial Procedures	20	6	—	—	$66,238.49	$66,238.49	$66,238.49	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
1804	OTHER	Other Circulatory System Procedures	31	6	—	—	$39,282.01	$65,886.11	$65,886.11	2026-05-23
0234	OTHER	Spinal Procedures	11	6	—	—	$65,807.38	$65,807.38	$65,807.38	2026-05-09
264	OTHER	Other Nervous System And Related Procedures	20	6	—	—	$65,432.59	$65,432.59	$65,432.59	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
2294	OTHER	Other Digestive System And Abdominal Procedures	31	6	—	—	$46,896.11	$65,179.74	$65,179.74	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
9123	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	31	6	—	—	$52,909.19	$65,116.56	$65,116.56	2026-05-23
2804	OTHER	Alcoholic Liver Disease	31	6	—	—	$35,667.29	$65,080.29	$65,080.29	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
6333	OTHER	Neonate Birthwt >2499g W Major Anomaly	31	6	—	—	$48,057.93	$64,851.31	$64,851.31	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
9103	OTHER	Craniotomy For Multiple Significant Trauma	31	6	—	—	$52,557.30	$63,841.42	$63,841.42	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
8632	OTHER	Neonatal Aftercare	31	6	—	—	$45,854.61	$63,739.24	$63,739.24	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
1781	OTHER	External Heart Assist Systems	20	6	—	—	$63,427.05	$63,427.05	$63,427.05	2026-05-23
4854	OTHER	Prostatectomy Procedures	20	6	—	—	$63,155.40	$63,155.40	$63,155.40	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
2614	OTHER	Major Biliary Tract Procedures	31	6	—	—	$48,169.27	$62,708.61	$62,708.61	2026-05-23

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