Hospital

BUFFALO HOSPITAL

Buffalo, MN · CCN 240076 · Rates published

18,831 distinct procedures filed

24 distinct payers

1,228,286 rate rows

2026-05-24 last MRF observed

Data quality

1,164,660 of 1,228,286 rate rows are consumer-grade (94.8%)

63,626 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reason	Rows
template filing: same amount across many unrelated codes — excluded	28,518
placeholder amount (≤ $0.02) — excluded from medians	25,550
per-diem day rate — not a per-procedure price	7,926
exceeds 10× this hospital's gross charge — excluded from medians	1,392
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	240

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

Source MRF file	https://www.allinahealth.org/-/media/allina-health/files/customer-service/billing-and-insurance/price-transparency/363261413_buffalo-hospital_standardcharges.csv
Found on page	https://www.allinahealth.org/customer-service/billing-and-insurance
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-05-17
Content fingerprint	be1da398f031106c… · 164,951,973 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	12	$9,290.00	$1,188,652.19	$670,309.72	nat. median $386,529 1.7× median
583-4 OTHER	Neonate With Ecmo	3	$225,675.80	$856,642.96	$644,452.65	nat. median $309,400 outlier · 2.1×
588-4 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	3	$206,314.11	$783,147.88	$589,162.29	nat. median $267,493 outlier · 2.2×
589-1 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	3	$203,009.98	$770,605.74	$579,726.84	nat. median $86,371 outlier · 6.7×
583-3 OTHER	Neonate With Ecmo	3	$191,909.66	$728,470.02	$548,028.13	nat. median $259,487 outlier · 2.1×
591-4 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	3	$186,131.83	$706,537.97	$531,528.64	nat. median $156,696 outlier · 3.4×
841-4 OTHER	Extensive Third Degree Burns With Skin Graft	3	$151,691.49	$575,805.85	$433,178.84	nat. median $151,691 outlier · 2.9×
002-4 OTHER	Heart And/or Lung Transplant	3	$150,473.99	$571,184.36	$429,702.09	nat. median $216,800 2.0× median
589-2 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	3	$147,849.69	$561,222.77	$422,207.99	nat. median $49,980 outlier · 8.4×
161-4 OTHER	Implantable Heart Assist Systems	3	$144,856.62	$549,861.38	$413,660.81	nat. median $202,242 outlier · 2.0×
602-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	3	$130,332.54	$494,729.38	$372,185.00	nat. median $125,000 outlier · 3.0×
583-2 OTHER	Neonate With Ecmo	3	$127,664.60	$484,602.17	$364,566.30	nat. median $191,347 1.9× median
593-4 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	3	$127,019.26	$482,152.51	$362,723.42	nat. median $151,250 outlier · 2.4×
161-3 OTHER	Implantable Heart Assist Systems	3	$126,943.96	$481,866.68	$362,508.38	nat. median $152,491 outlier · 2.4×
589-3 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	3	$124,158.50	$471,293.34	$354,554.07	nat. median $87,000 outlier · 4.1×
609-4 OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	3	$119,624.91	$454,084.30	$341,607.70	nat. median $169,856 outlier · 2.0×
1 OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	11	$16,996.00	$474,834.09	$337,167.37	nat. median $239,422 1.4× median
007-4 OTHER	Allogeneic Bone Marrow Transplant	3	$115,154.66	$437,115.67	$328,842.20	nat. median $172,311 1.9× median
583-1 OTHER	Neonate With Ecmo	3	$104,453.37	$396,494.63	$298,282.98	nat. median $171,226 1.7× median
588-3 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	3	$103,867.14	$394,269.37	$296,608.91	nat. median $165,000 1.8× median
607-4 OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	3	$103,250.65	$391,929.24	$294,848.43	nat. median $100,015 outlier · 2.9×
161-2 OTHER	Implantable Heart Assist Systems	3	$101,924.78	$386,896.35	$291,062.19	nat. median $109,992 outlier · 2.6×
588-2 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	3	$101,104.90	$383,784.19	$288,720.91	nat. median $153,523 1.9× median
004-4 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	3	$99,516.53	$377,754.88	$284,185.06	nat. median $110,000 outlier · 2.6×
602-3 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	3	$98,457.38	$373,734.45	$281,160.49	nat. median $99,067 outlier · 2.8×
002-3 OTHER	Heart And/or Lung Transplant	3	$98,144.21	$372,545.68	$280,266.18	nat. median $133,471 outlier · 2.1×
593-3 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	3	$98,073.83	$372,278.55	$280,065.21	nat. median $112,711 outlier · 2.5×
3 OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	13	$16,996.00	$537,640.29	$280,027.88	nat. median $181,005 1.5× median
161-1 OTHER	Implantable Heart Assist Systems	3	$96,828.89	$367,552.87	$276,510.09	nat. median $101,352 outlier · 2.7×
593-2 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	3	$94,025.13	$356,910.08	$268,503.52	nat. median $89,334 outlier · 3.0×
603-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	3	$89,966.58	$341,504.22	$256,913.68	nat. median $107,050 outlier · 2.4×
001-4 OTHER	Liver Transplant And/or Intestinal Transplant	3	$88,376.09	$335,466.89	$252,371.80	nat. median $124,561 outlier · 2.0×
006-4 OTHER	Pancreas Transplant	3	$87,664.60	$332,766.12	$250,340.01	nat. median $92,449 outlier · 2.7×
630-4 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	3	$85,571.63	$324,821.43	$244,363.22	nat. median $210,669 1.2× median
593-1 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	3	$85,477.33	$324,463.47	$244,093.92	nat. median $2,705 outlier · 90.2×
591-3 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	3	$84,428.74	$320,483.11	$241,099.50	nat. median $99,157 outlier · 2.4×
011-4 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	3	$84,218.31	$319,684.36	$240,498.60	nat. median $105,647 outlier · 2.3×
927 OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	12	$16,996.00	$489,438.86	$236,305.27	nat. median $146,562 1.6× median
009-4 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	3	$79,752.99	$302,734.44	$227,747.17	nat. median $150,954 1.5× median
631-4 OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	3	$79,524.27	$301,866.24	$227,094.03	nat. median $203,379 1.1× median
005-4 OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	3	$78,620.65	$298,436.19	$224,513.59	nat. median $88,000 outlier · 2.6×
607-3 OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	3	$77,123.76	$292,754.15	$220,239.00	nat. median $77,124 outlier · 2.9×
7 OTHER	Lung Transplant	11	$16,996.00	$856,085.48	$219,426.86	nat. median $169,933 1.3× median
4 OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	13	$16,996.00	$369,912.57	$215,318.07	nat. median $134,983 1.6× median
160-4 OTHER	Major Cardiothoracic Repair Of Heart Anomaly	3	$74,336.89	$282,175.48	$212,280.66	nat. median $106,926 2.0× median
178-4 OTHER	External Heart Assist Systems	3	$73,137.70	$277,623.44	$208,856.17	nat. median $67,533 outlier · 3.1×
611-4 OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	3	$72,765.41	$276,210.28	$207,793.04	nat. median $93,000 outlier · 2.2×
007-3 OTHER	Allogeneic Bone Marrow Transplant	3	$72,707.70	$275,991.23	$207,628.25	nat. median $104,111 2.0× median
001-3 OTHER	Liver Transplant And/or Intestinal Transplant	3	$71,158.74	$270,111.52	$203,204.94	nat. median $81,541 outlier · 2.5×
002-2 OTHER	Heart And/or Lung Transplant	3	$70,637.26	$268,132.02	$201,715.77	nat. median $106,681 1.9× median

Other procedures at this hospital

Browse this hospital's 18,831 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

001-1	OTHER	Liver Transplant And/or Intestinal Transplant	14	3	—	—	$43,318.21	$164,431.62	$123,701.93	2026-05-24
001-2	OTHER	Liver Transplant And/or Intestinal Transplant	14	3	—	—	$48,601.29	$184,485.69	$138,788.61	2026-05-24
001-3	OTHER	Liver Transplant And/or Intestinal Transplant	14	3	—	—	$71,158.74	$270,111.52	$203,204.94	2026-05-24
001-4	OTHER	Liver Transplant And/or Intestinal Transplant	14	3	—	—	$88,376.09	$335,466.89	$252,371.80	2026-05-24
002-1	OTHER	Heart And/or Lung Transplant	14	3	—	—	$58,071.01	$220,431.81	$165,830.89	2026-05-24
002-2	OTHER	Heart And/or Lung Transplant	14	3	—	—	$70,637.26	$268,132.02	$201,715.77	2026-05-24
002-3	OTHER	Heart And/or Lung Transplant	14	3	—	—	$98,144.21	$372,545.68	$280,266.18	2026-05-24
002-4	OTHER	Heart And/or Lung Transplant	14	3	—	—	$150,473.99	$571,184.36	$429,702.09	2026-05-24
004-1	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	14	3	—	—	$23,956.51	$90,936.54	$68,411.57	2026-05-24
004-2	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	14	3	—	—	$35,876.00	$136,181.75	$102,449.55	2026-05-24
004-3	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	14	3	—	—	$51,860.38	$196,856.86	$148,095.45	2026-05-24
004-4	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	14	3	—	—	$99,516.53	$377,754.88	$284,185.06	2026-05-24
005-1	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	14	3	—	—	$30,818.12	$116,982.52	$88,005.97	2026-05-24
005-2	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	14	3	—	—	$36,513.60	$138,602.02	$104,270.32	2026-05-24
005-3	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	14	3	—	—	$64,036.74	$243,077.12	$182,866.96	2026-05-24
005-4	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	14	3	—	—	$78,620.65	$298,436.19	$224,513.59	2026-05-24
006-1	OTHER	Pancreas Transplant	14	3	—	—	$47,293.01	$179,519.59	$135,052.62	2026-05-24
006-2	OTHER	Pancreas Transplant	14	3	—	—	$56,930.93	$216,104.17	$162,575.21	2026-05-24
006-3	OTHER	Pancreas Transplant	14	3	—	—	$69,307.16	$263,083.11	$197,917.47	2026-05-24
006-4	OTHER	Pancreas Transplant	14	3	—	—	$87,664.60	$332,766.12	$250,340.01	2026-05-24
007-1	OTHER	Allogeneic Bone Marrow Transplant	14	3	—	—	$45,169.08	$171,457.35	$128,987.40	2026-05-24
007-2	OTHER	Allogeneic Bone Marrow Transplant	14	3	—	—	$57,270.85	$217,394.45	$163,545.88	2026-05-24
007-3	OTHER	Allogeneic Bone Marrow Transplant	14	3	—	—	$72,707.70	$275,991.23	$207,628.25	2026-05-24
007-4	OTHER	Allogeneic Bone Marrow Transplant	14	3	—	—	$115,154.66	$437,115.67	$328,842.20	2026-05-24
008-3	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	14	3	—	—	$24,601.85	$93,386.20	$70,254.45	2026-05-24
008-4	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	14	3	—	—	$43,488.52	$165,078.09	$124,188.28	2026-05-24
009-1	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	14	3	—	—	$25,108.56	$95,309.59	$71,701.42	2026-05-24
009-2	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	14	3	—	—	$26,430.21	$100,326.45	$75,475.60	2026-05-24
009-3	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	14	3	—	—	$45,269.72	$171,839.36	$129,274.78	2026-05-24
009-4	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	14	3	—	—	$79,752.99	$302,734.44	$227,747.17	2026-05-24
011-2	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	14	3	—	—	$32,324.15	$122,699.28	$92,306.69	2026-05-24
011-3	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	14	3	—	—	$45,252.83	$171,775.25	$129,226.55	2026-05-24
011-4	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	14	3	—	—	$84,218.31	$319,684.36	$240,498.60	2026-05-24
020-4	OTHER	Open Craniotomy For Trauma	14	3	—	—	$30,150.96	$114,450.05	$86,100.79	2026-05-24
021-4	OTHER	Open Craniotomy Except Trauma	14	3	—	—	$40,997.93	$155,624.07	$117,076.01	2026-05-24
022-4	OTHER	Ventricular Shunt Procedures	14	3	—	—	$34,738.03	$131,862.12	$99,199.90	2026-05-24
023-4	OTHER	Spinal Procedures	14	3	—	—	$44,123.30	$167,487.68	$126,001.01	2026-05-24
024-4	OTHER	Open Extracranial Vascular Procedures	14	3	—	—	$28,397.20	$107,792.96	$81,092.66	2026-05-24
026-4	OTHER	Other Nervous System And Related Procedures	14	3	—	—	$26,556.88	$100,807.30	$75,837.35	2026-05-24
027-4	OTHER	Other Open Craniotomy	14	3	—	—	$33,440.31	$126,936.09	$95,494.04	2026-05-24
029-4	OTHER	Other Percutaneous Intracranial Procedures	14	3	—	—	$28,688.56	$108,898.91	$81,924.67	2026-05-24
030-4	OTHER	Percutaneous Intracranial And Extracranial Vascular Procedures	14	3	—	—	$25,333.76	$96,164.43	$72,344.52	2026-05-24
042-4	OTHER	Degenerative Nervous System Disorders Except Multiple Sclerosis	14	3	—	—	$28,250.12	$107,234.64	$80,672.64	2026-05-24
043-4	OTHER	Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies	14	3	—	—	$27,668.11	$105,025.41	$79,010.63	2026-05-24
089-4	OTHER	Major Cranial Or Facial Bone Procedures	14	3	—	—	$36,985.12	$140,391.84	$105,616.81	2026-05-24
091-3	OTHER	Other Major Head And Neck Procedures	14	3	—	—	$23,261.90	$88,299.88	$66,428.02	2026-05-24
091-4	OTHER	Other Major Head And Neck Procedures	14	3	—	—	$32,883.64	$124,823.03	$93,904.38	2026-05-24
092-4	OTHER	Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures	14	3	—	—	$30,210.78	$114,677.12	$86,271.61	2026-05-24
1	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	30	11	—	—	$16,996.00	$474,834.09	$337,167.37	2026-05-24
10	OTHER	Pancreas Transplant	44	17	—	—	$16,996.00	$139,141.19	$86,369.45	2026-05-24
11	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	46	18	—	—	$16,996.00	$125,029.79	$71,012.90	2026-05-24
120-4	OTHER	Major Respiratory And Chest Procedures	14	3	—	—	$43,412.51	$164,789.58	$123,971.23	2026-05-24
121-4	OTHER	Other Respiratory And Chest Procedures	14	3	—	—	$27,090.33	$102,832.20	$77,360.69	2026-05-24
130-3	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	14	3	—	—	$27,561.14	$104,619.36	$78,705.16	2026-05-24
130-4	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	14	3	—	—	$35,604.35	$135,150.59	$101,673.81	2026-05-24
14	OTHER	Allogeneic Bone Marrow Transplant	30	11	—	—	$9,290.00	$203,630.06	$100,271.14	2026-05-24
160-4	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	14	3	—	—	$74,336.89	$282,175.48	$212,280.66	2026-05-24
161-1	OTHER	Implantable Heart Assist Systems	14	3	—	—	$96,828.89	$367,552.87	$276,510.09	2026-05-24
161-2	OTHER	Implantable Heart Assist Systems	14	3	—	—	$101,924.78	$386,896.35	$291,062.19	2026-05-24
161-3	OTHER	Implantable Heart Assist Systems	14	3	—	—	$126,943.96	$481,866.68	$362,508.38	2026-05-24
161-4	OTHER	Implantable Heart Assist Systems	14	3	—	—	$144,856.62	$549,861.38	$413,660.81	2026-05-24
162-3	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	14	3	—	—	$29,940.54	$113,651.30	$85,499.90	2026-05-24
162-4	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	14	3	—	—	$50,713.96	$192,505.18	$144,821.68	2026-05-24
163	OTHER	Major Chest Procedures With Mcc	30	12	—	—	$2,948.26	$157,080.04	$72,192.23	2026-05-24
163-3	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	14	3	—	—	$24,103.59	$91,494.86	$68,831.60	2026-05-24
163-4	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	14	3	—	—	$41,132.34	$156,134.30	$117,459.86	2026-05-24
165-3	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	14	3	—	—	$26,788.42	$101,686.18	$76,498.53	2026-05-24
165-4	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	14	3	—	—	$41,149.94	$156,201.09	$117,510.11	2026-05-24
166-4	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	14	3	—	—	$40,143.57	$152,381.01	$114,636.26	2026-05-24
167-4	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	14	3	—	—	$42,410.36	$160,985.53	$121,109.45	2026-05-24
169-4	OTHER	Major Abdominal Vascular Procedures	14	3	—	—	$40,074.60	$152,119.21	$114,439.31	2026-05-24
170-4	OTHER	Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock	14	3	—	—	$35,408.71	$134,407.95	$101,115.12	2026-05-24
175-4	OTHER	Percutaneous Cardiac Intervention Without Ami	14	3	—	—	$23,317.50	$88,510.92	$66,586.78	2026-05-24
176-4	OTHER	Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices	14	3	—	—	$34,020.20	$129,137.31	$97,150.02	2026-05-24
178-1	OTHER	External Heart Assist Systems	14	3	—	—	$35,137.76	$133,379.47	$100,341.39	2026-05-24
178-2	OTHER	External Heart Assist Systems	14	3	—	—	$37,666.35	$142,977.74	$107,562.18	2026-05-24
178-3	OTHER	External Heart Assist Systems	14	3	—	—	$42,103.53	$159,820.81	$120,233.22	2026-05-24
178-4	OTHER	External Heart Assist Systems	14	3	—	—	$73,137.70	$277,623.44	$208,856.17	2026-05-24
179-3	OTHER	Defibrillator Implants	14	3	—	—	$27,563.96	$104,630.04	$78,713.20	2026-05-24
179-4	OTHER	Defibrillator Implants	14	3	—	—	$37,345.44	$141,759.59	$106,645.77	2026-05-24
18	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	32	12	—	—	$9,290.00	$1,188,652.19	$670,309.72	2026-05-24
180-4	OTHER	Other Circulatory System Procedures	14	3	—	—	$28,593.55	$108,538.28	$81,653.37	2026-05-24
181-4	OTHER	Lower Extremity Arterial Procedures	14	3	—	—	$39,749.47	$150,885.04	$113,510.84	2026-05-24
182-4	OTHER	Other Peripheral Vascular And Related Procedures	14	3	—	—	$40,513.74	$153,786.16	$115,693.35	2026-05-24
183-3	OTHER	Percutaneous Structural Cardiac Procedures	14	3	—	—	$23,612.37	$89,630.23	$67,428.84	2026-05-24
183-4	OTHER	Percutaneous Structural Cardiac Procedures	14	3	—	—	$36,353.85	$137,995.61	$103,814.12	2026-05-24
19	OTHER	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	46	18	—	—	$16,996.00	$163,553.57	$90,274.79	2026-05-24
2	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	44	17	—	—	$16,996.00	$286,649.38	$152,051.06	2026-05-24
20	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	46	18	—	—	$16,996.00	$293,902.61	$108,391.30	2026-05-24
207	OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	32	12	—	—	$9,290.00	$199,837.42	$100,772.49	2026-05-24
21	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	46	18	—	—	$16,996.00	$122,092.73	$69,842.05	2026-05-24
212	OTHER	Hip & Femur Procedures Except Major Joint Age 0-17	46	18	—	—	$16,996.00	$410,917.21	$133,136.93	2026-05-24
215	OTHER	Other Heart Assist System Implant	46	18	—	—	$16,996.00	$240,019.66	$122,625.13	2026-05-24
216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	46	18	—	—	$16,996.00	$281,696.47	$120,628.45	2026-05-24
217	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	46	18	—	—	$16,996.00	$196,496.28	$83,864.09	2026-05-24
218	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	46	18	—	—	$16,996.00	$150,732.18	$83,864.09	2026-05-24
219	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	46	18	—	—	$16,996.00	$403,645.46	$96,506.68	2026-05-24
220	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	46	18	—	—	$16,996.00	$126,408.69	$69,622.55	2026-05-24
220-4	OTHER	Major Stomach, Esophageal And Duodenal Procedures	14	3	—	—	$45,939.69	$174,382.52	$131,188.00	2026-05-24
221	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	46	18	—	—	$16,996.00	$115,541.54	$66,268.77	2026-05-24
222-4	OTHER	Other Stomach, Esophageal And Duodenal Procedures	14	3	—	—	$31,434.61	$119,322.65	$89,766.45	2026-05-24
227-4	OTHER	Hernia Procedures Except Inguinal, Femoral And Umbilical	14	3	—	—	$24,637.74	$93,522.44	$70,356.94	2026-05-24
23	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	46	18	—	—	$16,996.00	$188,871.27	$78,933.86	2026-05-24
230-4	OTHER	Major Small Bowel Procedures	14	3	—	—	$27,230.38	$103,363.81	$77,760.61	2026-05-24
231	OTHER	Coronary Bypass With Ptca With Mcc	46	18	—	—	$16,996.00	$444,348.15	$105,121.51	2026-05-24
231-4	OTHER	Major Large Bowel Procedures	14	3	—	—	$26,732.82	$101,475.14	$76,339.77	2026-05-24
232	OTHER	Coronary Bypass With Ptca Without Mcc	46	18	—	—	$16,996.00	$138,979.04	$77,987.52	2026-05-24
232-4	OTHER	Gastric Fundoplication	14	3	—	—	$29,901.13	$113,501.71	$85,387.35	2026-05-24
233	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	46	18	—	—	$16,996.00	$175,258.57	$96,127.29	2026-05-24
234	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	46	18	—	—	$16,996.00	$125,226.93	$71,111.46	2026-05-24
235	OTHER	Coronary Bypass Without Cardiac Catheterization With Mcc	46	18	—	—	$16,996.00	$134,531.79	$75,763.90	2026-05-24
260-4	OTHER	Major Pancreas, Liver And Shunt Procedures	14	3	—	—	$37,070.27	$140,715.08	$105,859.98	2026-05-24
261-4	OTHER	Major Biliary Tract Procedures	14	3	—	—	$29,060.14	$110,309.40	$82,985.78	2026-05-24
266	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	46	18	—	—	$16,996.00	$140,487.44	$78,741.72	2026-05-24
268	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	46	18	—	—	$16,996.00	$193,682.36	$105,339.18	2026-05-24
270	OTHER	Other Major Cardiovascular Procedures With Mcc	46	18	—	—	$16,996.00	$192,002.95	$68,974.95	2026-05-24
275	OTHER	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	46	18	—	—	$16,996.00	$163,457.29	$90,226.65	2026-05-24
276	OTHER	Non-maligant Breast Disorders	46	18	—	—	$16,996.00	$180,980.39	$77,345.65	2026-05-24
278	OTHER	Cellulitis Age >17 Without Cc	46	18	—	—	$16,996.00	$127,599.57	$72,297.79	2026-05-24
28	OTHER	Spinal Procedures With Mcc	46	18	—	—	$16,996.00	$137,734.27	$77,365.13	2026-05-24
3	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	34	13	—	—	$16,996.00	$537,640.29	$280,027.88	2026-05-24
303-2	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	14	3	—	—	$23,811.54	$90,386.23	$67,997.58	2026-05-24
303-3	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	14	3	—	—	$32,398.75	$122,982.44	$92,519.71	2026-05-24
303-4	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	14	3	—	—	$57,180.06	$217,049.84	$163,286.63	2026-05-24
304-3	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	14	3	—	—	$24,535.70	$93,135.09	$70,065.54	2026-05-24
304-4	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	14	3	—	—	$38,351.81	$145,579.67	$109,519.61	2026-05-24
305-4	OTHER	Amputation Of Lower Limb Except Toes	14	3	—	—	$27,335.24	$103,761.85	$78,060.05	2026-05-24
309-4	OTHER	Other Significant Hip And Femur Surgery	14	3	—	—	$25,005.10	$94,916.90	$71,406.00	2026-05-24
310-4	OTHER	Vertebral And Intervertebral Spinal Procedures Including Disc Procedures	14	3	—	—	$25,822.87	$98,021.04	$73,741.25	2026-05-24
312-4	OTHER	Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses	14	3	—	—	$34,754.92	$131,926.23	$99,248.13	2026-05-24
313-4	OTHER	Knee And Lower Leg Procedures Except Foot	14	3	—	—	$32,697.85	$124,117.78	$93,373.83	2026-05-24
317-4	OTHER	Tendon, Muscle And Other Soft Tissue Procedures	14	3	—	—	$33,391.75	$126,751.76	$95,355.37	2026-05-24
321-4	OTHER	Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures	14	3	—	—	$31,735.81	$120,466.00	$90,626.59	2026-05-24
322-4	OTHER	Shoulder And Elbow Joint Replacement	14	3	—	—	$24,620.15	$93,455.65	$70,306.70	2026-05-24
324-4	OTHER	Elective Hip Joint Replacement	14	3	—	—	$23,956.51	$90,936.54	$68,411.57	2026-05-24
325-4	OTHER	Non-elective Or Complex Knee Joint Replacement	14	3	—	—	$25,263.38	$95,897.29	$72,143.55	2026-05-24
326	OTHER	Stomach, Esophageal And Duodenal Procedures With Mcc	46	18	—	—	$16,996.00	$126,238.83	$71,617.41	2026-05-24
326-4	OTHER	Elective Knee Joint Replacement	14	3	—	—	$25,962.91	$98,552.65	$74,141.18	2026-05-24
361-4	OTHER	Skin Graft For Skin And Subcutaneous Tissue Diagnoses	14	3	—	—	$31,729.48	$120,441.96	$90,608.51	2026-05-24
362-4	OTHER	Mastectomy Procedures	14	3	—	—	$23,095.11	$87,666.76	$65,951.72	2026-05-24
363-4	OTHER	Breast Procedures Except Mastectomy	14	3	—	—	$24,397.06	$92,608.82	$69,669.63	2026-05-24
4	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	34	13	—	—	$16,996.00	$369,912.57	$215,318.07	2026-05-24
401-4	OTHER	Adrenal Procedures	14	3	—	—	$33,504.35	$127,179.19	$95,676.92	2026-05-24
403-4	OTHER	Procedures For Obesity	14	3	—	—	$31,690.77	$120,295.03	$90,497.97	2026-05-24
404-4	OTHER	Thyroid, Parathyroid And Thyroglossal Procedures	14	3	—	—	$29,180.48	$110,766.21	$83,329.44	2026-05-24
405	OTHER	Pancreas, Liver And Shunt Procedures With Mcc	46	18	—	—	$16,996.00	$125,405.74	$71,200.87	2026-05-24
405-4	OTHER	Other Procedures For Endocrine, Nutritional And Metabolic Disorders	14	3	—	—	$30,053.14	$114,078.73	$85,821.45	2026-05-24
440-1	OTHER	Kidney Transplant	14	3	—	—	$35,576.91	$135,046.41	$101,595.44	2026-05-24
440-2	OTHER	Kidney Transplant	14	3	—	—	$39,677.68	$150,612.55	$113,305.85	2026-05-24
440-3	OTHER	Kidney Transplant	14	3	—	—	$45,128.97	$171,305.08	$128,872.85	2026-05-24
440-4	OTHER	Kidney Transplant	14	3	—	—	$56,439.01	$214,236.88	$161,170.44	2026-05-24
441-4	OTHER	Major Bladder Procedures	14	3	—	—	$26,829.24	$101,841.12	$76,615.09	2026-05-24
442-4	OTHER	Kidney And Urinary Tract Procedures For Malignancy	14	3	—	—	$27,262.05	$103,484.02	$77,851.05	2026-05-24
444-4	OTHER	Renal Dialysis Access Device Procedures	14	3	—	—	$29,101.66	$110,467.02	$83,104.36	2026-05-24
445-4	OTHER	Other Bladder Procedures	14	3	—	—	$25,632.85	$97,299.77	$73,198.63	2026-05-24
447-4	OTHER	Other Kidney, Urinary Tract And Related Procedures	14	3	—	—	$36,384.11	$138,110.48	$103,900.54	2026-05-24
453	OTHER	Combined Anterior And Posterior Spinal Fusion With Mcc	20	9	—	—	$9,290.00	$226,829.35	$85,288.36	2026-05-24
456	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	46	18	—	—	$16,996.00	$192,639.54	$104,817.77	2026-05-24
457	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	46	18	—	—	$16,996.00	$136,698.10	$76,847.05	2026-05-24
459	OTHER	Spinal Fusion Except Cervical With Mcc	34	15	—	—	$9,290.00	$146,691.20	$77,990.60	2026-05-24
461	OTHER	Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc	46	18	—	—	$16,996.00	$126,609.25	$72,865.94	2026-05-24
463	OTHER	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …	46	18	—	—	$16,996.00	$130,655.34	$73,825.67	2026-05-24
466	OTHER	Revision Of Hip Or Knee Replacement With Mcc	46	18	—	—	$16,996.00	$119,328.59	$68,162.29	2026-05-24
471	OTHER	Cervical Spinal Fusion With Mcc	46	18	—	—	$16,996.00	$129,281.25	$73,138.62	2026-05-24
480-4	OTHER	Major Male Pelvic Procedures	14	3	—	—	$25,473.10	$96,693.37	$72,742.44	2026-05-24
482-4	OTHER	Transurethral Prostatectomy	14	3	—	—	$27,051.62	$102,685.28	$77,250.15	2026-05-24
484-4	OTHER	Other Male Reproductive System And Related Procedures	14	3	—	—	$25,791.20	$97,900.83	$73,650.81	2026-05-24
5	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	44	17	—	—	$16,996.00	$199,926.88	$122,244.86	2026-05-24
510-4	OTHER	Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced…	14	3	—	—	$31,200.26	$118,433.08	$89,097.23	2026-05-24
511-4	OTHER	Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy	14	3	—	—	$24,121.89	$91,564.31	$68,883.85	2026-05-24
512-4	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy	14	3	—	—	$26,162.78	$99,311.32	$74,711.92	2026-05-24
514-4	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	14	3	—	—	$26,592.77	$100,943.54	$75,939.84	2026-05-24
518-4	OTHER	Other Female Reproductive System And Related Procedures	14	3	—	—	$28,345.83	$107,597.95	$80,945.96	2026-05-24
519929	OTHER	Hchg Pump Pr54570	50	15	$173,594.00	$97,212.64 44% off	$34,927.11	$173,594.00	$88,532.94	2026-05-24
519930	OTHER	Hchg Kit Strl Implant Pr72570	50	15	$230,882.80	$129,294.37 44% off	$46,453.62	$230,882.80	$117,750.23	2026-05-24
519931	OTHER	Hchg Hospital Implant Set Pr65970	50	15	$209,967.70	$117,581.91 44% off	$42,245.50	$209,967.70	$107,083.53	2026-05-24
519932	OTHER	Hchg Kit Pump Implant Pr65970	50	15	$209,967.70	$117,581.91 44% off	$42,245.50	$209,967.70	$107,083.53	2026-05-24
522889	OTHER	Hchg Ide Vad Heartassist5 G100297 Pr59970	46	14	$187,889.20	$105,217.95 44% off	$37,803.31	$187,889.20	$88,401.87	2026-05-24
523374	OTHER	Hchg Heartmate 3 Implant Pr96570	50	15	$302,721.10	$169,523.82 44% off	$60,907.49	$302,721.10	$154,387.76	2026-05-24
523381	OTHER	Hchg Heartmate 3 Implant Pr79770	50	15	$251,797.70	$141,006.71 44% off	$50,661.70	$251,797.70	$128,416.83	2026-05-24
523722	OTHER	Hchg Heartmate 3 Implant Pr87670	50	15	$279,229.70	$156,368.63 44% off	$56,181.02	$279,229.70	$142,407.15	2026-05-24
524521	OTHER	Hchg Transcatheter Heart Valve Pr41170	50	15	$138,144.00	$77,360.64 44% off	$27,794.57	$138,144.00	$70,453.44	2026-05-24
524756	OTHER	Hchg Ide Altavalve Pivotal G190128 Pr49670	46	14	$166,784.00	$93,399.04 44% off	$33,556.94	$166,784.00	$78,471.87	2026-05-24
524900	OTHER	Hchg Ide Innovate G240020 Pr87670	46	14	$294,784.00	$165,079.04 44% off	$59,310.54	$294,784.00	$138,695.87	2026-05-24
524991	OTHER	Hchg Ide Team-hf Heartmate 3 G240119 Pr96570	46	14	$324,864.00	$181,923.84 44% off	$65,362.64	$324,864.00	$152,848.51	2026-05-24
570	OTHER	Skin Debridement With Mcc	46	18	—	—	$14,973.14	$195,308.07	$91,383.03	2026-05-24
573	OTHER	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	46	18	—	—	$16,996.00	$150,184.29	$83,590.15	2026-05-24
583-1	OTHER	Neonate With Ecmo	14	3	—	—	$104,453.37	$396,494.63	$298,282.98	2026-05-24
583-2	OTHER	Neonate With Ecmo	14	3	—	—	$127,664.60	$484,602.17	$364,566.30	2026-05-24
583-3	OTHER	Neonate With Ecmo	14	3	—	—	$191,909.66	$728,470.02	$548,028.13	2026-05-24
583-4	OTHER	Neonate With Ecmo	14	3	—	—	$225,675.80	$856,642.96	$644,452.65	2026-05-24
588-1	OTHER	Female Reproductive System Reconstructive Procedures	14	3	—	—	$67,245.86	$255,258.63	$192,031.11	2026-05-24
588-2	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	14	3	—	—	$101,104.90	$383,784.19	$288,720.91	2026-05-24
588-3	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	14	3	—	—	$103,867.14	$394,269.37	$296,608.91	2026-05-24
588-4	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	14	3	—	—	$206,314.11	$783,147.88	$589,162.29	2026-05-24
589-1	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	14	3	—	—	$203,009.98	$770,605.74	$579,726.84	2026-05-24
589-2	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	14	3	—	—	$147,849.69	$561,222.77	$422,207.99	2026-05-24
589-3	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	14	3	—	—	$124,158.50	$471,293.34	$354,554.07	2026-05-24
589-4	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	14	3	—	—	$37,247.62	$141,388.27	$106,366.42	2026-05-24
590029	OTHER	Hchg New Tech Evoque Ttvr	50	15	$180,600.00	$101,136.00 44% off	$36,336.72	$180,600.00	$92,106.00	2026-05-24
591-1	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	14	3	—	—	$58,334.92	$221,433.58	$166,584.52	2026-05-24
591-2	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	14	3	—	—	$64,168.34	$243,576.67	$183,242.77	2026-05-24
591-3	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	14	3	—	—	$84,428.74	$320,483.11	$241,099.50	2026-05-24
591-4	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	14	3	—	—	$186,131.83	$706,537.97	$531,528.64	2026-05-24
593-1	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	14	3	—	—	$85,477.33	$324,463.47	$244,093.92	2026-05-24
593-2	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	14	3	—	—	$94,025.13	$356,910.08	$268,503.52	2026-05-24
593-3	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	14	3	—	—	$98,073.83	$372,278.55	$280,065.21	2026-05-24
593-4	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	14	3	—	—	$127,019.26	$482,152.51	$362,723.42	2026-05-24
6	OTHER	Liver Transplant Without Mcc	44	17	—	—	$16,996.00	$218,837.11	$114,491.87	2026-05-24
602-1	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	14	3	—	—	$46,007.96	$174,641.64	$131,382.94	2026-05-24
602-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	14	3	—	—	$69,725.89	$264,672.58	$199,113.23	2026-05-24
602-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	14	3	—	—	$98,457.38	$373,734.45	$281,160.49	2026-05-24
602-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	14	3	—	—	$130,332.54	$494,729.38	$372,185.00	2026-05-24
603-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	14	3	—	—	$43,442.07	$164,901.78	$124,055.64	2026-05-24
603-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	14	3	—	—	$89,966.58	$341,504.22	$256,913.68	2026-05-24
607-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	14	3	—	—	$47,893.32	$181,798.28	$136,766.87	2026-05-24
607-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	14	3	—	—	$77,123.76	$292,754.15	$220,239.00	2026-05-24
607-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	14	3	—	—	$103,250.65	$391,929.24	$294,848.43	2026-05-24
608-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	14	3	—	—	$30,421.20	$115,475.86	$86,872.51	2026-05-24
608-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	14	3	—	—	$42,304.10	$160,582.15	$120,805.98	2026-05-24
608-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	14	3	—	—	$43,268.94	$164,244.62	$123,561.26	2026-05-24
609-2	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	14	3	—	—	$29,675.92	$112,646.86	$84,744.26	2026-05-24
609-3	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	14	3	—	—	$52,228.44	$198,253.99	$149,146.51	2026-05-24
609-4	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	14	3	—	—	$119,624.91	$454,084.30	$341,607.70	2026-05-24
611-2	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	14	3	—	—	$30,084.81	$114,198.94	$85,911.88	2026-05-24
611-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	20	6	—	—	$207.06	$204,080.28	$136,677.43	2026-05-24
611-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	14	3	—	—	$72,765.41	$276,210.28	$207,793.04	2026-05-24
612-2	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	14	3	—	—	$33,619.76	$127,617.29	$96,006.51	2026-05-24
612-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	14	3	—	—	$50,959.57	$193,437.49	$145,523.06	2026-05-24
612-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	14	3	—	—	$62,358.99	$236,708.55	$178,075.88	2026-05-24
613-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	14	3	—	—	$35,803.52	$135,906.59	$102,242.55	2026-05-24
613-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	14	3	—	—	$41,569.38	$157,793.23	$118,707.88	2026-05-24
614-2	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	14	3	—	—	$23,998.74	$91,096.82	$68,532.15	2026-05-24
614-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	14	3	—	—	$34,628.95	$131,448.06	$98,888.40	2026-05-24
614-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	14	3	—	—	$44,656.75	$169,512.59	$127,524.35	2026-05-24
621-3	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	20	6	—	—	$280.40	$134,568.23	$90,123.55	2026-05-24
621-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	14	3	—	—	$70,490.17	$267,573.70	$201,295.74	2026-05-24
622-2	OTHER	Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…	14	3	—	—	$23,550.44	$89,395.15	$67,251.99	2026-05-24
622-3	OTHER	Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…	14	3	—	—	$27,965.80	$106,155.40	$79,860.73	2026-05-24
622-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…	14	3	—	—	$30,041.88	$114,035.98	$85,789.29	2026-05-24
623-3	OTHER	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	14	3	—	—	$31,293.86	$118,788.37	$89,364.51	2026-05-24
623-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	14	3	—	—	$37,948.56	$144,048.97	$108,368.06	2026-05-24
625-3	OTHER	Neonate Birth Weight 2000-2499 Grams With Other Significant Condition	14	3	—	—	$29,552.06	$112,176.70	$84,390.55	2026-05-24
625-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Other Significant Condition	14	3	—	—	$31,735.11	$120,463.33	$90,624.58	2026-05-24
626-4	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	14	3	—	—	$27,777.19	$105,439.47	$79,322.13	2026-05-24
630-2	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	14	3	—	—	$30,364.90	$115,262.15	$86,711.73	2026-05-24
630-3	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	14	3	—	—	$48,641.41	$184,637.96	$138,903.17	2026-05-24
630-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	14	3	—	—	$85,571.63	$324,821.43	$244,363.22	2026-05-24
631-3	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	14	3	—	—	$31,802.67	$120,719.78	$90,817.51	2026-05-24
631-4	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	14	3	—	—	$79,524.27	$301,866.24	$227,094.03	2026-05-24
633-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Anomaly	14	3	—	—	$62,443.44	$237,029.11	$178,317.04	2026-05-24
634-4	OTHER	Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…	14	3	—	—	$25,502.66	$96,805.56	$72,826.84	2026-05-24
636-4	OTHER	Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection	14	3	—	—	$24,364.69	$92,485.94	$69,577.19	2026-05-24
639-4	OTHER	Neonate Birth Weight > 2499 Grams With Other Significant Condition	14	3	—	—	$25,753.20	$97,756.58	$73,542.29	2026-05-24
650-4	OTHER	Splenectomy	14	3	—	—	$27,770.16	$105,412.76	$79,302.04	2026-05-24
651-4	OTHER	Other Procedures Of Blood And Blood-forming Organs	14	3	—	—	$34,608.54	$131,370.59	$98,830.11	2026-05-24
653	OTHER	Major Bladder Procedures With Mcc	46	18	—	—	$16,996.00	$147,315.89	$82,155.95	2026-05-24
660-4	OTHER	Major Hematologic Or Immunologic Diagnoses Except Sickle Cell Crisis And Coagula…	14	3	—	—	$25,640.60	$97,329.16	$73,220.74	2026-05-24
661-4	OTHER	Coagulation And Platelet Disorders	14	3	—	—	$24,716.57	$93,821.63	$70,582.03	2026-05-24
680-4	OTHER	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	14	3	—	—	$44,987.51	$170,768.14	$128,468.90	2026-05-24
681-4	OTHER	Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	14	3	—	—	$46,093.81	$174,967.55	$131,628.12	2026-05-24
690-3	OTHER	Acute Leukemia	14	3	—	—	$28,582.29	$108,495.54	$81,621.21	2026-05-24
690-4	OTHER	Acute Leukemia	14	3	—	—	$47,389.43	$179,885.57	$135,327.94	2026-05-24
691-4	OTHER	Lymphoma, Myeloma And Non-acute Leukemia	14	3	—	—	$32,526.13	$123,465.96	$92,883.47	2026-05-24
692-4	OTHER	Radiotherapy	14	3	—	—	$23,437.84	$88,967.73	$66,930.44	2026-05-24
695-4	OTHER	Chemotherapy For Acute Leukemia	14	3	—	—	$34,836.56	$132,236.11	$99,481.25	2026-05-24
7	OTHER	Lung Transplant	30	11	—	—	$16,996.00	$856,085.48	$219,426.86	2026-05-24
710-4	OTHER	Infectious And Parasitic Diseases Including HIV With O.r. Procedure	14	3	—	—	$31,108.06	$118,083.13	$88,833.96	2026-05-24
711-4	OTHER	Post-operative, Post-trauma, Other Device Infections With O.r. Procedure	14	3	—	—	$27,232.49	$103,371.82	$77,766.64	2026-05-24
740-4	OTHER	Mental Illness Diagnosis With O.r. Procedure	14	3	—	—	$34,906.93	$132,503.25	$99,682.22	2026-05-24
750-4	OTHER	Schizophrenia	14	3	—	—	$23,804.50	$90,359.52	$67,977.48	2026-05-24
752-4	OTHER	Disorders Of Personality And Impulse Control	14	3	—	—	$32,636.62	$123,885.37	$93,198.99	2026-05-24
757-4	OTHER	Organic Mental Health Disturbances	14	3	—	—	$23,262.61	$88,302.55	$66,430.03	2026-05-24
759-4	OTHER	Eating Disorders	14	3	—	—	$31,049.65	$117,861.40	$88,667.15	2026-05-24
792-4	OTHER	Extensive O.r. Procedures For Other Complications Of Treatment	14	3	—	—	$28,663.92	$108,805.42	$81,854.33	2026-05-24
793-4	OTHER	Moderately Extensive O.r. Procedures For Other Complications Of Treatment	14	3	—	—	$25,863.69	$98,175.98	$73,857.81	2026-05-24
8	OTHER	Simultaneous Pancreas And Kidney Transplant	44	17	—	—	$16,996.00	$212,047.29	$111,599.13	2026-05-24
820	OTHER	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	46	18	—	—	$16,996.00	$134,444.68	$75,720.34	2026-05-24
834	OTHER	Acute Leukemia Without Major O.r. Procedures With Mcc	46	18	—	—	$9,290.00	$125,850.47	$67,570.24	2026-05-24
837	OTHER	Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…	46	18	—	—	$9,290.00	$160,977.51	$85,133.76	2026-05-24
841-3	OTHER	Extensive Third Degree Burns With Skin Graft	14	3	—	—	$69,261.42	$262,909.47	$197,786.84	2026-05-24
841-4	OTHER	Extensive Third Degree Burns With Skin Graft	14	3	—	—	$151,691.49	$575,805.85	$433,178.84	2026-05-24
842-3	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	14	3	—	—	$29,663.26	$112,598.78	$84,708.08	2026-05-24
842-4	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	14	3	—	—	$51,191.81	$194,319.05	$146,186.25	2026-05-24
844-4	OTHER	Partial Thickness Burns Without Skin Graft	14	3	—	—	$26,494.95	$100,572.21	$75,660.49	2026-05-24
850-4	OTHER	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	14	3	—	—	$39,868.40	$151,336.50	$113,850.47	2026-05-24
863-3	OTHER	Neonatal Aftercare	14	3	—	—	$36,529.09	$138,660.79	$104,314.54	2026-05-24
863-4	OTHER	Neonatal Aftercare	14	3	—	—	$57,659.32	$218,869.05	$164,655.23	2026-05-24
870	OTHER	Septicemia Or Severe Sepsis With Mv >96 Hours	46	18	—	—	$9,290.00	$158,446.10	$83,868.05	2026-05-24
910-4	OTHER	Craniotomy For Multiple Significant Trauma	14	3	—	—	$33,877.34	$128,595.02	$96,742.06	2026-05-24
911-4	OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	14	3	—	—	$35,460.08	$134,602.96	$101,261.83	2026-05-24
912-4	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	14	3	—	—	$38,073.83	$144,524.47	$108,725.79	2026-05-24
927	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	32	12	—	—	$16,996.00	$489,438.86	$236,305.27	2026-05-24
928	OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	46	18	—	—	$16,996.00	$164,426.97	$90,711.49	2026-05-24
950-4	OTHER	Extensive O.r. Procedure Unrelated To Principal Diagnosis	14	3	—	—	$43,028.26	$163,331.01	$122,873.95	2026-05-24
951-4	OTHER	Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis	14	3	—	—	$27,798.31	$105,519.62	$79,382.43	2026-05-24
952-4	OTHER	Non-extensive O.r. Procedure Unrelated To Principal Diagnosis	14	3	—	—	$30,932.83	$117,417.95	$88,333.55	2026-05-24
955	OTHER	Craniotomy For Multiple Significant Trauma	46	18	—	—	$16,996.00	$154,303.74	$85,649.87	2026-05-24
957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	46	18	—	—	$16,996.00	$174,678.59	$95,837.29	2026-05-24
969	OTHER	HIV With Extensive O.r. Procedures With Mcc	46	18	—	—	$16,996.00	$272,800.24	$141,772.21	2026-05-24

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