Hospital

VIRTUA MOUNT HOLLY HOSPITAL

Mount Holly, NJ · CCN 310057 · Rates published

5,558 distinct procedures filed

40 distinct payers

213,476 rate rows

2026-05-09 last MRF observed

Data quality

174,858 of 213,476 rate rows are consumer-grade (81.9%)

38,618 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	33,706
exceeds 10× this hospital's gross charge — excluded from medians	1,947
per-diem day rate — not a per-procedure price	1,554
template filing: same amount across many unrelated codes — excluded	1,001
placeholder amount (≤ $0.02) — excluded from medians	410

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

Source MRF file	https://www.virtua.org/-/media/Project/Virtua-Tenant/Virtua/PDFs/Hospital-Charges-June-2026/210634562_virtua-memorial-hospital-burlington-county-inc_standardcharges.csv
Found on page	https://www.virtua.org/Patients-and-Visitors/Hospital-Charges-and-Estimates
Discovered via	CMS hospital list
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-06-08

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
9138 OTHER	Inj, Hemgenix, Per Tx Dose	17	$3,853,477.39	$4,415,442.85	$4,054,179.34	nat. median $3,746,358 1.1× median
773 OTHER	Inj, Beqvez, Per Tx Dose	17	$3,782,239.10	$4,333,815.64	$3,979,230.72	nat. median $3,605,000 1.1× median
9141 OTHER	Inj Onase Abepar-xioi Treat	18	$2,506,049.97	$4,568,320.26	$2,649,625.75	nat. median $2,588,981 1.0× median
9194 OTHER	Tisagenlecleucel Car-pos T	21	$555,210.52	$1,735,032.86	$595,694.62	nat. median $566,531 1.1× median
9498 OTHER	Ciltacabtagene Car-pos T	21	$553,039.35	$1,728,247.97	$593,365.14	nat. median $587,650 1.0× median
9422 OTHER	Idecabtagene Vicleucel Car	21	$552,477.17	$1,726,491.15	$592,761.96	nat. median $558,082 1.1× median
9413 OTHER	Lisocabtagene Mara Car Pos T	21	$542,130.81	$1,694,158.78	$581,661.18	nat. median $562,201 1.0× median
9035 OTHER	Axicabtagene Ciloleucel Car+	21	$513,519.96	$1,604,749.88	$550,964.13	nat. median $532,192 1.0× median
9391 OTHER	Brexucabtagene Car Pos T	21	$483,172.29	$1,509,913.40	$518,403.60	nat. median $489,450 1.1× median
5834 OTHER	Neonate W Ecmo	5	$251,290.00	$555,194.02	$462,650.04	nat. median $372,748 1.2× median
5833 OTHER	Neonate W Ecmo	5	$168,049.52	$483,502.52	$402,908.63	nat. median $252,069 1.6× median
18 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	23	$304,062.04	$1,264,132.50	$382,851.56	nat. median $386,529 1.0× median
5884 OTHER	Neonate Bwt <1500g W Major Procedure	5	$240,423.35	$414,103.15	$345,077.27	nat. median $243,175 1.4× median
1 OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	23	$234,473.03	$820,655.62	$334,124.08	nat. median $239,422 1.4× median
1614 OTHER	Cardiac Defibrillator & Heart Assist Implant	5	$197,038.03	$381,951.30	$318,284.74	nat. median $194,298 1.6× median
3 OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	23	$154,691.32	$621,758.22	$253,144.42	nat. median $181,005 1.4× median
5832 OTHER	Neonate W Ecmo	5	$89,636.13	$303,409.48	$252,834.87	nat. median $152,272 1.7× median
6304 OTHER	Neonate Birthwt >2499g W Major Cardiovascular Procedure	5	$107,026.21	$281,465.27	$234,548.49	nat. median $164,743 1.4× median
8414 OTHER	Extensive 3rd Degree Burns W Skin Graft	5	$191,186.49	$274,323.77	$228,597.39	nat. median $161,322 1.4× median
5934 OTHER	Neonate Birthwt 750-999g Without Major Procedure	5	$165,872.48	$272,226.90	$226,850.04	nat. median $129,842 1.7× median
5914 OTHER	Neonate Birthwt 500-749g Without Major Procedure	5	$201,909.31	$269,511.04	$224,586.89	nat. median $149,152 1.5× median
5883 OTHER	Neonate Bwt <1500g W Major Procedure	5	$179,624.33	$265,594.04	$221,322.80	nat. median $163,694 1.4× median
6314 OTHER	Neonate Birthwt >2499g W Other Major Procedure	5	$95,014.66	$264,767.13	$220,633.72	nat. median $163,675 1.3× median
6094 OTHER	Neonate Bwt 1500-2499g W Major Procedure	5	$139,424.50	$261,739.38	$218,110.66	nat. median $170,784 1.3× median
5882 OTHER	Neonate Bwt <1500g W Major Procedure	5	$87,968.96	$258,530.98	$215,437.06	nat. median $119,369 1.8× median
5831 OTHER	Neonate W Ecmo	5	$80,672.48	$245,705.08	$204,749.08	nat. median $139,037 1.5× median
44 OTHER	Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo	5	$141,247.15	$241,984.81	$201,648.93	nat. median $33,835 outlier · 6.0×
1612 OTHER	Cardiac Defibrillator & Heart Assist Implant	5	$51,058.90	$232,106.65	$193,417.34	nat. median $84,765 outlier · 2.3×
1611 OTHER	Cardiac Defibrillator & Heart Assist Implant	5	$39,549.97	$220,766.69	$183,967.61	nat. median $80,527 outlier · 2.3×
927 OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	23	$1.62	$625,423.84	$183,212.65	nat. median $146,562 1.3× median
14 OTHER	Allogeneic Bone Marrow Transplant	25	$100,684.76	$352,396.67	$176,067.05	nat. median $100,915 1.7× median
6034 OTHER	Neonate Birthwt 1000-1249g W Or Without Other Significant Condition	5	$131,378.77	$204,209.33	$170,170.16	nat. median $92,525 1.8× median
4 OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	23	$96,621.50	$406,036.08	$165,314.69	nat. median $134,983 1.2× median
6024 OTHER	Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom	5	$127,743.10	$196,434.51	$163,691.31	nat. median $99,381 1.6× median
215 OTHER	Other Heart Assist System Implant	24	$83,458.45	$339,832.23	$160,657.51	nat. median $92,359 1.7× median
7 OTHER	Lung Transplant	23	$94,278.05	$379,671.26	$154,580.44	nat. median $169,933 0.9× median
5933 OTHER	Neonate Birthwt 750-999g Without Major Procedure	5	$116,144.43	$183,362.29	$152,798.07	nat. median $87,090 1.8× median
2 OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	23	$94,949.89	$353,983.44	$147,963.85	nat. median $111,558 1.3× median
5913 OTHER	Neonate Birthwt 500-749g Without Major Procedure	5	$133,670.53	$176,449.54	$147,037.58	nat. median $115,252 1.3× median
1604 OTHER	Major Cardiothoracic Repair Of Heart Anomaly	5	$114,923.77	$174,159.16	$145,128.99	nat. median $44,507 outlier · 3.3×
216 OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	24	$82,002.37	$287,008.30	$143,989.99	nat. median $90,130 1.6× median
5881 OTHER	Neonate Bwt <1500g W Major Procedure	5	$79,172.04	$171,951.94	$143,289.68	nat. median $14,014 outlier · 10.2×
A9543 OTHER	Hc Yttrium Y-90 Zevalin Per Tx Dose Up To 40mci	37	$95.27	$214,674.14	$141,684.93	nat. median $66,156 outlier · 2.1×
43 OTHER	Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo	5	$98,173.18	$159,937.04	$133,277.51	nat. median $48,509 outlier · 2.7×
6074 OTHER	Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom	5	$102,011.28	$152,699.62	$127,246.48	nat. median $85,400 1.5× median
6303 OTHER	Neonate Birthwt >2499g W Major Cardiovascular Procedure	5	$46,670.15	$152,469.22	$127,054.49	nat. median $84,422 1.5× median
3034 OTHER	Dorsal & Lumbar Fusion Proc For Curvature Of Back	5	$105,949.31	$151,282.50	$126,065.58	nat. median $71,896 1.8× median
8424 OTHER	Burns With Skin Graft Except Extensive 3rd Degree Burns	5	$100,192.65	$149,735.79	$124,776.69	nat. median $91,349 1.4× median
1624 OTHER	Cardiac Valve Procedures W Ami Or Complex Pdx	5	$97,897.97	$148,937.73	$124,111.66	nat. median $5 outlier · 25590.0×
6023 OTHER	Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom	5	$92,273.72	$148,392.29	$123,657.13	nat. median $75,452 1.6× median

Other procedures at this hospital

Browse this hospital's 5,558 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

9138	OTHER	Inj, Hemgenix, Per Tx Dose	17	17	—	—	$3,853,477.39	$4,415,442.85	$4,054,179.34	2026-05-09
773	OTHER	Inj, Beqvez, Per Tx Dose	17	17	—	—	$3,782,239.10	$4,333,815.64	$3,979,230.72	2026-05-09
9141	OTHER	Inj Onase Abepar-xioi Treat	18	18	—	—	$2,506,049.97	$4,568,320.26	$2,649,625.75	2026-05-09
9194	OTHER	Tisagenlecleucel Car-pos T	24	21	—	—	$555,210.52	$1,735,032.86	$595,694.62	2026-05-09
9498	OTHER	Ciltacabtagene Car-pos T	24	21	—	—	$553,039.35	$1,728,247.97	$593,365.14	2026-05-09
9422	OTHER	Idecabtagene Vicleucel Car	24	21	—	—	$552,477.17	$1,726,491.15	$592,761.96	2026-05-09
9413	OTHER	Lisocabtagene Mara Car Pos T	24	21	—	—	$542,130.81	$1,694,158.78	$581,661.18	2026-05-09
9035	OTHER	Axicabtagene Ciloleucel Car+	24	21	—	—	$513,519.96	$1,604,749.88	$550,964.13	2026-05-09
9391	OTHER	Brexucabtagene Car Pos T	24	21	—	—	$483,172.29	$1,509,913.40	$518,403.60	2026-05-09
5834	OTHER	Neonate W Ecmo	6	5	—	—	$251,290.00	$555,194.02	$462,650.04	2026-05-09
5833	OTHER	Neonate W Ecmo	6	5	—	—	$168,049.52	$483,502.52	$402,908.63	2026-05-09
18	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	31	23	—	—	$304,062.04	$1,264,132.50	$382,851.56	2026-05-09
5884	OTHER	Neonate Bwt <1500g W Major Procedure	6	5	—	—	$240,423.35	$414,103.15	$345,077.27	2026-05-09
1	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	36	23	—	—	$234,473.03	$820,655.62	$334,124.08	2026-05-09
1614	OTHER	Cardiac Defibrillator & Heart Assist Implant	6	5	—	—	$197,038.03	$381,951.30	$318,284.74	2026-05-09
3	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	36	23	—	—	$154,691.32	$621,758.22	$253,144.42	2026-05-09
5832	OTHER	Neonate W Ecmo	6	5	—	—	$89,636.13	$303,409.48	$252,834.87	2026-05-09
6304	OTHER	Neonate Birthwt >2499g W Major Cardiovascular Procedure	6	5	—	—	$107,026.21	$281,465.27	$234,548.49	2026-05-09
8414	OTHER	Extensive 3rd Degree Burns W Skin Graft	6	5	—	—	$191,186.49	$274,323.77	$228,597.39	2026-05-09
5934	OTHER	Neonate Birthwt 750-999g Without Major Procedure	6	5	—	—	$165,872.48	$272,226.90	$226,850.04	2026-05-09
5914	OTHER	Neonate Birthwt 500-749g Without Major Procedure	6	5	—	—	$201,909.31	$269,511.04	$224,586.89	2026-05-09
5883	OTHER	Neonate Bwt <1500g W Major Procedure	6	5	—	—	$179,624.33	$265,594.04	$221,322.80	2026-05-09
6314	OTHER	Neonate Birthwt >2499g W Other Major Procedure	6	5	—	—	$95,014.66	$264,767.13	$220,633.72	2026-05-09
6094	OTHER	Neonate Bwt 1500-2499g W Major Procedure	6	5	—	—	$139,424.50	$261,739.38	$218,110.66	2026-05-09
5882	OTHER	Neonate Bwt <1500g W Major Procedure	6	5	—	—	$87,968.96	$258,530.98	$215,437.06	2026-05-09
5831	OTHER	Neonate W Ecmo	6	5	—	—	$80,672.48	$245,705.08	$204,749.08	2026-05-09
44	OTHER	Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo	6	5	—	—	$141,247.15	$241,984.81	$201,648.93	2026-05-09
1612	OTHER	Cardiac Defibrillator & Heart Assist Implant	6	5	—	—	$51,058.90	$232,106.65	$193,417.34	2026-05-09
1611	OTHER	Cardiac Defibrillator & Heart Assist Implant	6	5	—	—	$39,549.97	$220,766.69	$183,967.61	2026-05-09
927	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	58	23	—	—	$1.62	$625,423.84	$183,212.65	2026-05-09
14	OTHER	Allogeneic Bone Marrow Transplant	40	25	—	—	$100,684.76	$352,396.67	$176,067.05	2026-05-09
6034	OTHER	Neonate Birthwt 1000-1249g W Or Without Other Significant Condition	6	5	—	—	$131,378.77	$204,209.33	$170,170.16	2026-05-09
4	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	36	23	—	—	$96,621.50	$406,036.08	$165,314.69	2026-05-09
6024	OTHER	Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom	6	5	—	—	$127,743.10	$196,434.51	$163,691.31	2026-05-09
215	OTHER	Other Heart Assist System Implant	38	24	—	—	$83,458.45	$339,832.23	$160,657.51	2026-05-09
7	OTHER	Lung Transplant	36	23	—	—	$94,278.05	$379,671.26	$154,580.44	2026-05-09
5933	OTHER	Neonate Birthwt 750-999g Without Major Procedure	6	5	—	—	$116,144.43	$183,362.29	$152,798.07	2026-05-09
2	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	36	23	—	—	$94,949.89	$353,983.44	$147,963.85	2026-05-09
5913	OTHER	Neonate Birthwt 500-749g Without Major Procedure	6	5	—	—	$133,670.53	$176,449.54	$147,037.58	2026-05-09
1604	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	6	5	—	—	$114,923.77	$174,159.16	$145,128.99	2026-05-09
216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	38	24	—	—	$82,002.37	$287,008.30	$143,989.99	2026-05-09
5881	OTHER	Neonate Bwt <1500g W Major Procedure	6	5	—	—	$79,172.04	$171,951.94	$143,289.68	2026-05-09
A9543	OTHER	Hc Yttrium Y-90 Zevalin Per Tx Dose Up To 40mci	54	37	$94,628.00	$9,462.80 90% off	$95.27	$214,674.14	$141,684.93	2026-05-09
43	OTHER	Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo	6	5	—	—	$98,173.18	$159,937.04	$133,277.51	2026-05-09
6074	OTHER	Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom	6	5	—	—	$102,011.28	$152,699.62	$127,246.48	2026-05-09
6303	OTHER	Neonate Birthwt >2499g W Major Cardiovascular Procedure	6	5	—	—	$46,670.15	$152,469.22	$127,054.49	2026-05-09
3034	OTHER	Dorsal & Lumbar Fusion Proc For Curvature Of Back	6	5	—	—	$105,949.31	$151,282.50	$126,065.58	2026-05-09
8424	OTHER	Burns With Skin Graft Except Extensive 3rd Degree Burns	6	5	—	—	$100,192.65	$149,735.79	$124,776.69	2026-05-09
1624	OTHER	Cardiac Valve Procedures W Ami Or Complex Pdx	6	5	—	—	$97,897.97	$148,937.73	$124,111.66	2026-05-09
6023	OTHER	Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom	6	5	—	—	$92,273.72	$148,392.29	$123,657.13	2026-05-09
5	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	36	23	—	—	$83,273.53	$397,994.00	$123,138.84	2026-05-09
5932	OTHER	Neonate Birthwt 750-999g Without Major Procedure	6	5	—	—	$87,206.47	$142,568.76	$118,804.31	2026-05-09
219	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	38	24	—	—	$64,411.63	$225,440.69	$117,662.84	2026-05-09
4404	OTHER	Kidney Transplant	6	5	—	—	$89,050.62	$140,388.74	$116,987.67	2026-05-09
8514	OTHER	Gender Related Procedures	6	5	—	—	$75,672.04	$131,822.16	$109,849.04	2026-05-09
1634	OTHER	Cardiac Valve Procedures Without Ami Or Complex Pdx	6	5	—	—	$83,015.69	$126,013.06	$105,008.25	2026-05-09
870	OTHER	Septicemia Or Severe Sepsis With Mv >96 Hours	37	23	—	—	$52,332.98	$256,562.54	$101,508.29	2026-05-09
8634	OTHER	Neonatal Aftercare	6	5	—	—	$91,004.28	$121,633.77	$101,358.92	2026-05-09
1784	OTHER	External Heart Assist Systems	6	5	—	—	$75,672.04	$121,078.79	$100,896.46	2026-05-09
456	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	36	23	—	—	$70,035.51	$246,653.66	$100,423.27	2026-05-09
20	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	36	23	—	—	$66,003.95	$274,936.01	$99,784.46	2026-05-09
426	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	30	23	—	—	$92,353.71	$323,237.97	$98,818.46	2026-05-09
209	OTHER	Complex Aortic Arch Procedures	43	32	$14,422.00	$1,442.20 90% off	$10,907.50	$331,944.33	$97,686.47	2026-05-09
268	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	38	24	—	—	$56,648.45	$202,024.85	$97,577.96	2026-05-09
1654	OTHER	Coronary Bypass W Ami Or Complex Pdx	6	5	—	—	$74,521.14	$116,720.31	$97,264.48	2026-05-09
1674	OTHER	Other Cardiothoracic & Thoracic Vascular Procedures	6	5	—	—	$75,693.45	$116,504.42	$97,084.58	2026-05-09
6114	OTHER	Neonate Birthwt 1500-1999g W Major Anomaly	6	5	—	—	$82,245.02	$115,813.39	$96,508.73	2026-05-09
266	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	38	24	—	—	$51,456.59	$189,654.24	$96,024.51	2026-05-09
6022	OTHER	Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom	6	5	—	—	$69,508.53	$115,120.88	$95,931.65	2026-05-09
6073	OTHER	Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom	6	5	—	—	$72,967.77	$114,908.14	$95,754.37	2026-05-09
217	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	38	24	—	—	$52,886.87	$193,172.25	$95,694.37	2026-05-09
5912	OTHER	Neonate Birthwt 500-749g Without Major Procedure	6	5	—	—	$79,013.72	$115,179.01	$95,607.92	2026-05-09
6093	OTHER	Neonate Bwt 1500-2499g W Major Procedure	6	5	—	—	$75,189.86	$114,162.81	$95,133.28	2026-05-09
212	OTHER	Concomitant Aortic And Mitral Valve Procedures	34	25	—	—	$26,656.71	$318,934.52	$95,094.70	2026-05-09
23	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	40	25	—	—	$46,122.06	$195,155.37	$94,625.78	2026-05-09
6124	OTHER	Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond	6	5	—	—	$79,026.74	$111,319.03	$92,763.52	2026-05-09
112	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	6	5	—	—	$39,375.01	$110,321.00	$91,931.85	2026-05-09
3044	OTHER	Dorsal & Lumbar Fusion Proc Except For Curvature Of Back	6	5	—	—	$80,785.30	$109,882.76	$91,566.66	2026-05-09
957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	36	23	—	—	$60,445.86	$223,732.21	$91,090.98	2026-05-09
5891	OTHER	Neonate Bwt <500g Or Ga <24 Weeks	6	5	—	—	$74,640.82	$139,012.91	$90,316.63	2026-05-09
1834	OTHER	Percutaneous Structural Cardiac Procedures	6	5	—	—	$39,375.01	$108,244.94	$90,201.84	2026-05-09
21	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	40	25	—	—	$44,480.47	$208,486.48	$89,133.52	2026-05-09
1794	OTHER	Defibrillator Implants	6	5	—	—	$39,375.01	$103,728.10	$86,437.91	2026-05-09
3033	OTHER	Dorsal & Lumbar Fusion Proc For Curvature Of Back	6	5	—	—	$77,994.36	$103,430.63	$86,190.02	2026-05-09
235	OTHER	Coronary Bypass Without Cardiac Catheterization With Mcc	38	24	—	—	$49,118.78	$172,497.52	$85,832.31	2026-05-09
6804	OTHER	Major O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms	6	5	—	—	$69,634.72	$101,368.91	$84,471.96	2026-05-09
1623	OTHER	Cardiac Valve Procedures W Ami Or Complex Pdx	6	5	—	—	$62,242.45	$100,876.28	$84,061.45	2026-05-09
6033	OTHER	Neonate Birthwt 1000-1249g W Or Without Other Significant Condition	6	5	—	—	$74,700.17	$98,606.71	$82,170.19	2026-05-09
429	OTHER	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	30	23	—	—	$75,539.48	$264,388.18	$80,827.24	2026-05-09
8504	OTHER	Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service	6	5	—	—	$46,945.23	$96,741.81	$80,616.15	2026-05-09
955	OTHER	Craniotomy For Multiple Significant Trauma	36	23	—	—	$51,218.68	$197,730.17	$80,504.43	2026-05-09
228	OTHER	Other Cardiothoracic Procedures With Mcc	38	24	—	—	$41,585.03	$173,427.55	$80,051.19	2026-05-09
220	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	38	24	—	—	$43,984.69	$156,822.57	$80,022.60	2026-05-09
218	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	36	23	—	—	$41,893.75	$193,172.25	$78,648.70	2026-05-09
6134	OTHER	Neonate Birthwt 1500-1999g W Congenital/perinatal Infection	6	5	—	—	$70,243.00	$94,355.42	$78,627.54	2026-05-09
850	OTHER	Acute Leukemia With Other Procedures	30	23	—	—	$72,613.12	$254,145.93	$77,696.04	2026-05-09
11	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	40	25	—	—	$40,860.91	$160,371.25	$77,313.87	2026-05-09
1783	OTHER	External Heart Assist Systems	6	5	—	—	$39,375.01	$92,776.80	$77,312.06	2026-05-09
231	OTHER	Coronary Bypass With Ptca With Mcc	42	26	—	—	$13,822.84	$247,428.90	$77,056.43	2026-05-09
9124	OTHER	Musculoskeletal & Other Procedures For Multiple Significant Trauma	6	5	—	—	$69,921.77	$92,410.52	$77,006.83	2026-05-09
207	OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	36	23	—	—	$46,644.18	$189,058.95	$76,974.01	2026-05-09
6084	OTHER	Neonate Bwt 1250-1499g W Or Without Other Significant Condition	6	5	—	—	$63,176.07	$95,172.11	$76,444.10	2026-05-09
267	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc	38	24	—	—	$40,025.32	$154,226.09	$75,848.23	2026-05-09
3124	OTHER	Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses	6	5	—	—	$64,204.78	$84,752.44	$75,495.02	2026-05-09
6214	OTHER	Neonate Bwt 2000-2499g W Major Anomaly	6	5	—	—	$67,755.41	$90,457.57	$75,379.41	2026-05-09
8413	OTHER	Extensive 3rd Degree Burns W Skin Graft	6	5	—	—	$68,313.51	$90,176.10	$75,144.86	2026-05-09
214	OTHER	Craniotomy Except For Trauma	6	5	—	—	$68,297.75	$90,155.29	$75,127.52	2026-05-09
234	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	42	26	—	—	$43,312.69	$160,622.85	$74,721.01	2026-05-09
270	OTHER	Other Major Cardiovascular Procedures With Mcc	38	24	—	—	$42,206.54	$155,169.67	$74,539.32	2026-05-09
1643	OTHER	Y90 Ibritumomab, Rx	24	21	—	—	$68,695.73	$214,674.14	$73,704.79	2026-05-09
1204	OTHER	Major Respiratory & Chest Procedures	6	5	—	—	$53,088.33	$88,431.08	$73,690.71	2026-05-09
6904	OTHER	Acute Leukemia	6	5	—	—	$65,304.96	$86,204.71	$73,474.38	2026-05-09
969	OTHER	HIV With Extensive O.r. Procedures With Mcc	36	23	—	—	$47,141.06	$179,890.33	$73,241.06	2026-05-09
4403	OTHER	Kidney Transplant	6	5	—	—	$56,249.35	$87,725.80	$73,102.99	2026-05-09
853	OTHER	Infectious And Parasitic Diseases With O.r. Procedures With Mcc	37	23	—	—	$40,276.06	$145,290.19	$72,645.10	2026-05-09
6814	OTHER	Other O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms	6	5	—	—	$65,806.59	$86,866.89	$72,387.25	2026-05-09
2204	OTHER	Major Stomach, Esophageal & Duodenal Procedures	6	5	—	—	$61,448.52	$86,839.69	$72,364.59	2026-05-09
6313	OTHER	Neonate Birthwt >2499g W Other Major Procedure	6	5	—	—	$34,102.09	$86,830.07	$72,356.58	2026-05-09
28	OTHER	Spinal Procedures With Mcc	36	23	—	—	$47,406.60	$176,584.54	$71,895.14	2026-05-09
2604	OTHER	Major Pancreas, Liver & Shunt Procedures	6	5	—	—	$64,422.73	$86,188.71	$71,822.12	2026-05-09
16	OTHER	Autologous Bone Marrow Transplant With Cc/mcc	36	23	—	—	$49,795.73	$174,285.05	$70,965.27	2026-05-09
6334	OTHER	Neonate Birthwt >2499g W Major Anomaly	6	5	—	—	$48,565.75	$85,123.53	$70,934.49	2026-05-09
233	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	42	26	—	—	$38,265.03	$224,472.38	$69,907.11	2026-05-09
1653	OTHER	Coronary Bypass W Ami Or Complex Pdx	6	5	—	—	$50,059.85	$83,771.98	$69,808.23	2026-05-09
3614	OTHER	Skin Graft For Skin & Subcutaneous Tissue Diagnoses	6	5	—	—	$55,077.95	$83,639.25	$69,697.62	2026-05-09
6072	OTHER	Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom	6	5	—	—	$53,878.23	$83,599.20	$69,664.25	2026-05-09
4414	OTHER	Major Bladder Procedures	6	5	—	—	$59,484.35	$83,396.08	$69,494.99	2026-05-09
1633	OTHER	Cardiac Valve Procedures Without Ami Or Complex Pdx	6	5	—	—	$51,522.26	$83,010.65	$69,173.80	2026-05-09
1304	OTHER	Respiratory System Diagnosis W Ventilator Support 96+ Hours	6	5	—	—	$50,242.26	$82,479.63	$68,731.30	2026-05-09
1782	OTHER	External Heart Assist Systems	6	5	—	—	$39,375.01	$82,345.24	$68,619.31	2026-05-09
1603	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	6	5	—	—	$51,604.00	$82,262.09	$68,550.01	2026-05-09
6083	OTHER	Neonate Bwt 1250-1499g W Or Without Other Significant Condition	6	5	—	—	$61,766.88	$81,534.33	$67,943.57	2026-05-09
329	OTHER	Major Small And Large Bowel Procedures With Mcc	37	23	—	—	$38,651.99	$135,281.97	$67,640.98	2026-05-09
24	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	40	25	—	—	$32,032.03	$308,348.50	$67,148.90	2026-05-09
8	OTHER	Simultaneous Pancreas And Kidney Transplant	36	23	—	—	$44,203.81	$164,816.00	$67,086.62	2026-05-09
4014	OTHER	Pituitary & Adrenal Procedures	6	5	—	—	$58,061.61	$76,643.26	$66,629.08	2026-05-09
5244	OTHER	Transplt Allo Hct/donor	24	21	—	—	$62,050.05	$193,906.41	$66,574.53	2026-05-09
12	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc	40	25	—	—	$31,212.60	$124,150.38	$65,893.75	2026-05-09
6144	OTHER	Neonate Bwt 1500-1999g W Or Without Other Significant Condition	6	5	—	—	$47,054.02	$79,020.02	$65,848.36	2026-05-09
5892	OTHER	Neonate Bwt <500g Or Ga <24 Weeks	6	5	—	—	$54,359.99	$97,510.68	$65,776.49	2026-05-09
1622	OTHER	Cardiac Valve Procedures W Ami Or Complex Pdx	6	5	—	—	$47,031.12	$78,815.33	$65,677.79	2026-05-09
10	OTHER	Pancreas Transplant	36	23	—	—	$29,467.84	$210,737.03	$65,629.54	2026-05-09
405	OTHER	Pancreas, Liver And Shunt Procedures With Mcc	36	23	—	—	$45,957.43	$160,851.02	$65,489.35	2026-05-09
2614	OTHER	Major Biliary Tract Procedures	6	5	—	—	$49,299.80	$78,413.90	$65,343.27	2026-05-09
427	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	30	23	—	—	$60,569.16	$211,992.04	$64,809.00	2026-05-09
1814	OTHER	Lower Extremity Arterial Procedures	6	5	—	—	$57,369.46	$77,708.53	$64,755.48	2026-05-09
7404	OTHER	Mental Illness Diagnosis W O.r. Procedure	6	5	—	—	$51,815.53	$77,553.32	$64,626.14	2026-05-09
4402	OTHER	Kidney Transplant	6	5	—	—	$49,744.23	$77,129.50	$64,272.97	2026-05-09
1764	OTHER	Cardiac Pacemaker & Defibrillator Device Replacement	6	5	—	—	$45,769.75	$76,899.19	$64,081.05	2026-05-09
275	OTHER	Selox 53cm Actv Ster	30	23	$5,322.50	$532.25 90% off	$59,831.93	$209,411.77	$64,020.17	2026-05-09
17	OTHER	Autologous Bone Marrow Transplant Without Cc/mcc	36	23	—	—	$39,344.22	$159,733.52	$63,821.63	2026-05-09
19	OTHER	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	31	23	—	—	$54,264.27	$209,534.62	$63,459.06	2026-05-09
3214	OTHER	Cervical Spinal Fusion & Other Back/neck Proc Exc Disc Excis/decomp	6	5	—	—	$55,000.99	$72,603.14	$62,864.64	2026-05-09
5104	OTHER	Pelvic Evisceration, Radical Hysterectomy & Other Radical GYN Procs	6	5	—	—	$57,144.39	$75,432.49	$62,858.83	2026-05-09
1781	OTHER	External Heart Assist Systems	6	5	—	—	$39,375.01	$75,280.61	$62,732.26	2026-05-09
3032	OTHER	Dorsal & Lumbar Fusion Proc For Curvature Of Back	6	5	—	—	$53,234.78	$75,055.01	$62,544.27	2026-05-09
466	OTHER	Revision Of Hip Or Knee Replacement With Mcc	36	23	—	—	$43,537.51	$153,095.47	$62,331.73	2026-05-09
94	OTHER	Bacterial And Tuberculous Infections Of Nervous System With Mcc	40	25	—	—	$29,593.29	$205,448.79	$62,262.72	2026-05-09
653	OTHER	Major Bladder Procedures With Mcc	36	23	—	—	$43,666.33	$152,832.16	$62,224.52	2026-05-09
236	OTHER	Coronary Bypass Without Cardiac Catheterization Without Mcc	38	24	—	—	$33,240.01	$123,354.66	$62,129.31	2026-05-09
6954	OTHER	Chemotherapy For Acute Leukemia	6	5	—	—	$56,170.26	$74,146.61	$62,073.11	2026-05-09
6302	OTHER	Neonate Birthwt >2499g W Major Cardiovascular Procedure	6	5	—	—	$29,659.42	$74,388.12	$61,988.54	2026-05-09
9273	OTHER	Sipuleucel-t Auto Cd54+	24	21	—	—	$57,720.04	$180,375.12	$61,928.79	2026-05-09
928	OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	58	23	—	—	$1.73	$210,649.28	$61,838.64	2026-05-09
7924	OTHER	Extensive O.r. Procedures For Other Complications Of Treatment	6	5	—	—	$39,375.01	$73,770.71	$61,474.05	2026-05-09
269	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	38	24	—	—	$35,144.42	$124,360.99	$61,378.82	2026-05-09
2304	OTHER	Major Small Bowel Procedures	6	5	—	—	$39,375.01	$73,068.58	$60,888.95	2026-05-09
1793	OTHER	Defibrillator Implants	6	5	—	—	$39,375.01	$72,396.78	$60,329.13	2026-05-09
1833	OTHER	Percutaneous Structural Cardiac Procedures	6	5	—	—	$39,375.01	$72,302.43	$60,250.51	2026-05-09
924	OTHER	Facial Bone Procedures Except Major Cranial/facial Bone Procedures	6	5	—	—	$49,355.54	$72,097.65	$60,079.87	2026-05-09
317	OTHER	Concomitant Left Atrial Appendage Closure And Cardiac Ablation	30	23	—	—	$56,121.54	$196,425.39	$60,050.04	2026-05-09
447	OTHER	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	30	23	—	—	$56,080.59	$196,282.06	$60,006.22	2026-05-09
326	OTHER	Stomach, Esophageal And Duodenal Procedures With Mcc	36	23	—	—	$41,919.39	$146,717.86	$59,735.13	2026-05-09
3043	OTHER	Dorsal & Lumbar Fusion Proc Except For Curvature Of Back	6	5	—	—	$48,505.07	$71,493.10	$59,576.08	2026-05-09
239	OTHER	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	36	23	—	—	$39,169.10	$144,795.80	$58,952.57	2026-05-09
573	OTHER	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	40	25	—	—	$11,451.18	$192,473.00	$58,841.74	2026-05-09
2324	OTHER	Gastric Fundoplication	6	5	—	—	$39,375.01	$70,501.45	$58,749.73	2026-05-09
1673	OTHER	Other Cardiothoracic & Thoracic Vascular Procedures	6	5	—	—	$43,186.06	$70,480.64	$58,732.39	2026-05-09
576	OTHER	Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc	36	23	—	—	$41,198.88	$144,196.08	$58,708.40	2026-05-09
837	OTHER	Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…	36	23	—	—	$40,388.91	$141,725.77	$58,551.21	2026-05-09
6123	OTHER	Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond	6	5	—	—	$51,518.60	$70,010.40	$58,340.53	2026-05-09
1663	OTHER	Coronary Bypass Without Ami Or Complex Pdx	6	5	—	—	$42,848.04	$69,868.05	$58,221.91	2026-05-09
1652	OTHER	Coronary Bypass W Ami Or Complex Pdx	6	5	—	—	$39,375.01	$69,680.93	$58,065.98	2026-05-09
6113	OTHER	Neonate Birthwt 1500-1999g W Major Anomaly	6	5	—	—	$52,350.26	$69,484.19	$57,902.03	2026-05-09
224	OTHER	Ventricular Shunt Procedures	6	5	—	—	$48,063.02	$63,444.78	$57,709.97	2026-05-09
4401	OTHER	Kidney Transplant	6	5	—	—	$47,540.33	$69,157.95	$57,630.18	2026-05-09
3254	OTHER	Non-elective Or Complex Knee Joint Replacement	6	5	—	—	$39,375.01	$68,484.59	$57,069.05	2026-05-09
1621	OTHER	Cardiac Valve Procedures W Ami Or Complex Pdx	6	5	—	—	$42,374.98	$68,439.82	$57,031.75	2026-05-09
4034	OTHER	Procedures For Obesity	6	5	—	—	$49,676.95	$65,575.23	$56,709.48	2026-05-09
2644	OTHER	Other Hepatobiliary, Pancreas & Abdominal Procedures	6	5	—	—	$51,542.87	$68,038.30	$56,697.15	2026-05-09
6133	OTHER	Neonate Birthwt 1500-1999g W Congenital/perinatal Infection	6	5	—	—	$51,284.80	$67,697.63	$56,413.28	2026-05-09
22	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…	40	25	—	—	$26,790.26	$140,458.77	$56,259.55	2026-05-09
4054	OTHER	Other Procedures For Endocrine, Nutritional & Metabolic Disorders	6	5	—	—	$50,995.20	$67,315.35	$56,094.71	2026-05-09
4044	OTHER	Thyroid, Parathyroid & Thyroglossal Procedures	6	5	—	—	$48,248.18	$67,067.46	$55,888.15	2026-05-09
7104	OTHER	Infectious & Parasitic Diseases Including HIV W O.r. Procedure	6	5	—	—	$50,734.74	$66,971.54	$55,808.21	2026-05-09
5124	OTHER	Uterine & Adnexa Procedures For Non-ovarian & Non-adnexal Malig	6	5	—	—	$41,066.29	$66,941.11	$55,782.86	2026-05-09
6514	OTHER	Other Procedures Of Blood & Blood-forming Organs	6	5	—	—	$50,572.32	$66,757.14	$55,629.55	2026-05-09
245	OTHER	Aicd Generator Procedures	36	23	—	—	$38,366.96	$134,284.37	$55,620.87	2026-05-09
6	OTHER	Liver Transplant Without Mcc	36	23	—	—	$38,216.08	$397,994.00	$55,561.50	2026-05-09
232	OTHER	Coronary Bypass With Ptca Without Mcc	42	26	—	—	$19,805.26	$178,173.04	$55,488.18	2026-05-09
5893	OTHER	Neonate Bwt <500g Or Ga <24 Weeks	6	5	—	—	$45,649.36	$69,752.72	$55,236.49	2026-05-09
1754	OTHER	Percutaneous Coronary Intervention Without Ami	6	5	—	—	$48,131.46	$66,197.36	$55,163.08	2026-05-09
1632	OTHER	Cardiac Valve Procedures Without Ami Or Complex Pdx	6	5	—	—	$40,175.78	$66,195.78	$55,161.76	2026-05-09
457	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	37	23	—	—	$28,026.09	$175,262.19	$55,082.40	2026-05-09
628	OTHER	Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc	37	23	—	—	$30,122.74	$212,779.27	$54,919.37	2026-05-09
51	OTHER	Tracheostomy W Mv 96+ Hours Without Extensive Procedure	6	5	—	—	$47,779.03	$65,872.70	$54,892.53	2026-05-09
25	OTHER	Craniotomy And Endovascular Intracranial Procedures With Mcc	36	23	—	—	$36,586.98	$133,825.09	$54,485.92	2026-05-09
2314	OTHER	Major Large Bowel Procedures	6	5	—	—	$47,783.12	$65,017.02	$54,179.48	2026-05-09
6092	OTHER	Neonate Bwt 1500-2499g W Major Procedure	6	5	—	—	$47,130.76	$64,866.62	$54,054.16	2026-05-09
8633	OTHER	Neonatal Aftercare	6	5	—	—	$38,091.41	$64,778.66	$53,980.86	2026-05-09
276	OTHER	Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator	30	23	$10.54	$1.05 90% off	$50,438.51	$176,534.78	$53,969.21	2026-05-09
163	OTHER	Major Chest Procedures With Mcc	36	23	—	—	$37,693.25	$131,926.38	$53,712.89	2026-05-09
31	OTHER	Ventricular Shunt Procedures With Mcc	36	23	—	—	$35,563.91	$131,888.40	$53,697.42	2026-05-09
6504	OTHER	Splenectomy	6	5	—	—	$48,138.30	$64,388.42	$53,655.67	2026-05-09
4474	OTHER	Other Kidney, Urinary Tract & Related Procedures	6	5	—	—	$47,983.84	$64,161.34	$53,466.44	2026-05-09
5144	OTHER	Female Reproductive System Reconstructive Procedures	6	5	—	—	$47,718.71	$64,127.68	$53,438.38	2026-05-09
4424	OTHER	Kidney & Urinary Tract Procedures For Malignancy	6	5	—	—	$45,984.33	$63,895.79	$53,245.15	2026-05-09
356	OTHER	Other Digestive System O.r. Procedures With Mcc	36	23	—	—	$34,955.45	$129,322.72	$52,652.82	2026-05-09
1303	OTHER	Respiratory System Diagnosis W Ventilator Support 96+ Hours	6	5	—	—	$36,582.48	$63,092.92	$52,576.11	2026-05-09
3031	OTHER	Dorsal & Lumbar Fusion Proc For Curvature Of Back	6	5	—	—	$44,239.39	$63,060.92	$52,549.44	2026-05-09
3094	OTHER	Other Significant Hip & Femur Surgery	6	5	—	—	$47,498.39	$62,699.45	$52,248.22	2026-05-09
6224	OTHER	Neonate Bwt 2000-2499g W Resp Dist Synd/oth Maj Resp Cond	6	5	—	—	$47,229.38	$62,344.36	$52,246.56	2026-05-09
294	OTHER	Other Percutaneous Intracranial Procedures	6	5	—	—	$47,157.91	$62,250.01	$51,873.70	2026-05-09
3134	OTHER	Knee & Lower Leg Procedures Except Foot	6	5	—	—	$46,007.35	$62,205.15	$51,836.32	2026-05-09
430	OTHER	Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc	30	23	—	—	$48,436.61	$169,528.13	$51,827.18	2026-05-09
2294	OTHER	Other Digestive System & Abdominal Procedures	6	5	—	—	$46,955.55	$61,982.88	$51,651.10	2026-05-09
4804	OTHER	Major Male Pelvic Procedures	6	5	—	—	$46,672.04	$61,608.65	$51,339.25	2026-05-09
7114	OTHER	Post-op, Post-trauma, Other Device Infections W O.r. Procedure	6	5	—	—	$46,266.12	$61,072.82	$51,264.52	2026-05-09
463	OTHER	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …	40	25	—	—	$11,212.73	$167,550.45	$51,222.57	2026-05-09
458	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	36	23	—	—	$35,108.76	$135,056.29	$51,154.69	2026-05-09
229	OTHER	Other Cardiothoracic Procedures Without Mcc	38	24	—	—	$26,557.05	$122,587.60	$51,122.32	2026-05-09
6143	OTHER	Neonate Bwt 1500-1999g W Or Without Other Significant Condition	6	5	—	—	$43,989.82	$61,275.94	$51,062.00	2026-05-09
790	OTHER	Extreme Immaturity Or Respiratory Distress Syndrome, Neonate	60	24	—	—	$0.12	$174,688.78	$50,862.92	2026-05-09
1831	OTHER	Percutaneous Structural Cardiac Procedures	6	5	—	—	$46,194.65	$60,978.47	$50,814.11	2026-05-09
1142	OTHER	Supprelin La Implant	28	23	—	—	$6,267.76	$148,687.03	$50,801.40	2026-05-09
6234	OTHER	Neonate Bwt 2000-2499g W Congenital/perinatal Infection	6	5	—	—	$45,201.05	$59,666.89	$50,778.57	2026-05-09
1580	OTHER	Implt/rpl Crtd Sns Dev Total	24	21	—	—	$47,212.94	$147,540.44	$50,655.55	2026-05-09
820	OTHER	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	58	23	—	—	$25.64	$172,386.41	$50,641.92	2026-05-09
260	OTHER	Cardiac Pacemaker Revision Except Device Replacement With Mcc	38	24	—	—	$27,420.50	$95,971.74	$50,640.56	2026-05-09
2244	OTHER	Peritoneal Adhesiolysis	6	5	—	—	$42,365.64	$60,740.11	$50,615.49	2026-05-09
428	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	30	23	—	—	$47,223.77	$165,283.18	$50,529.43	2026-05-09
958	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Cc	36	23	—	—	$34,254.93	$124,088.94	$50,521.93	2026-05-09
264	OTHER	Other Circulatory System O.r. Procedures	41	25	—	—	$26,454.84	$166,392.21	$50,518.57	2026-05-09
673	OTHER	Other Kidney And Urinary Tract Procedures With Mcc	36	23	—	—	$28,208.56	$123,729.08	$50,375.41	2026-05-09
213	OTHER	Endovascular Abdominal Aorta With Iliac Branch Procedures	34	25	—	—	$40,851.52	$167,767.01	$50,070.15	2026-05-09
278	OTHER	Bone Substitute 5cc (pick This To Document Serial And Lot # From Kit 402.202 Mm …	30	23	$0.11	$9.58	$46,757.36	$163,650.77	$50,030.38	2026-05-09
3104	OTHER	Intervertebral Disc Excision & Decompression	6	5	—	—	$37,957.95	$60,012.36	$50,009.04	2026-05-09
1651	OTHER	Coronary Bypass W Ami Or Complex Pdx	6	5	—	—	$36,612.09	$60,009.21	$50,006.42	2026-05-09
6254	OTHER	Neonate Bwt 2000-2499g W Other Significant Condition	6	5	—	—	$41,327.33	$59,929.20	$49,939.75	2026-05-09
893	OTHER	Major Cranial/facial Bone Procedures	6	5	—	—	$35,034.35	$59,902.01	$49,917.09	2026-05-09
461	OTHER	Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc	40	25	—	—	$7,057.11	$162,386.95	$49,800.72	2026-05-09
1792	OTHER	Defibrillator Implants	6	5	—	—	$45,144.08	$59,591.69	$49,658.49	2026-05-09
1744	OTHER	Percutaneous Coronary Intervention W Ami	6	5	—	—	$40,838.33	$59,486.15	$49,570.55	2026-05-09
1631	OTHER	Cardiac Valve Procedures Without Ami Or Complex Pdx	6	5	—	—	$34,965.74	$59,251.03	$49,374.61	2026-05-09
6091	OTHER	Neonate Bwt 1500-2499g W Major Procedure	6	5	—	—	$36,289.02	$58,841.55	$49,033.39	2026-05-09
4844	OTHER	Other Male Reproductive System & Related Procedures	6	5	—	—	$41,030.02	$58,726.39	$48,937.43	2026-05-09
1693	OTHER	Major Abdominal Vascular Procedures	6	5	—	—	$34,879.60	$58,660.81	$48,882.78	2026-05-09
6082	OTHER	Neonate Bwt 1250-1499g W Or Without Other Significant Condition	6	5	—	—	$43,943.79	$58,632.05	$48,858.81	2026-05-09
2224	OTHER	Other Stomach, Esophageal & Duodenal Procedures	6	5	—	—	$43,842.80	$57,873.95	$48,805.17	2026-05-09
3154	OTHER	Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement	6	5	—	—	$43,827.86	$58,457.69	$48,713.52	2026-05-09
6344	OTHER	Neonate, Birthwt >2499g W Resp Dist Synd/oth Maj Resp Cond	6	5	—	—	$41,827.78	$55,214.06	$48,670.44	2026-05-09
3054	OTHER	Amputation Of Lower Limb Except Toes	6	5	—	—	$44,074.24	$58,179.46	$48,481.67	2026-05-09
7934	OTHER	Moderately Extensive O.r. Procedures For Other Complications Of Treatment	6	5	—	—	$44,071.79	$58,176.23	$48,478.97	2026-05-09
61	OTHER	Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A…	40	25	—	—	$23,277.13	$83,300.46	$48,469.64	2026-05-09
3204	OTHER	Other Musculoskeletal System & Connective Tissue Procedures	6	5	—	—	$40,355.99	$57,793.94	$48,160.41	2026-05-09
984	OTHER	Other Ear, Nose, Mouth & Throat Procedures	6	5	—	—	$35,595.45	$57,739.56	$48,115.09	2026-05-09
1714	OTHER	Perm Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock	6	5	—	—	$37,293.63	$57,622.83	$48,017.81	2026-05-09
450	OTHER	Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically …	30	23	—	—	$44,779.71	$156,729.00	$47,914.29	2026-05-09
3224	OTHER	Shoulder & Elbow Joint Replacement	6	5	—	—	$37,845.44	$57,467.71	$47,888.55	2026-05-09
252	OTHER	Other Vascular Procedures With Mcc	38	24	—	—	$27,048.64	$102,861.32	$47,849.33	2026-05-09
2234	OTHER	Other Small & Large Bowel Procedures	6	5	—	—	$43,289.03	$57,142.96	$47,836.06	2026-05-09
802	OTHER	Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc	36	23	—	—	$30,209.09	$117,366.09	$47,784.76	2026-05-09
2274	OTHER	Hernia Procedures Except Inguinal, Femoral & Umbilical	6	5	—	—	$43,029.66	$57,342.93	$47,784.58	2026-05-09
834	OTHER	Acute Leukemia With Mcc	58	23	—	—	$104.53	$161,418.61	$47,432.45	2026-05-09
274	OTHER	Splint Orthopedic Large 20in 19-22in Knee Contact Closure Alternate Strap Foam P…	42	26	$106.45	$10.65 90% off	$26,761.11	$97,109.75	$47,323.60	2026-05-09
7524	OTHER	Disorders Of Personality & Impulse Control	6	5	—	—	$8,232.96	$56,586.41	$47,154.16	2026-05-09
7594	OTHER	Eating Disorders	6	5	—	—	$26,499.32	$56,268.13	$46,888.93	2026-05-09
111	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	6	5	—	—	$41,768.43	$55,135.71	$46,864.19	2026-05-09
34	OTHER	Carotid Artery Stent Procedures With Mcc	36	23	—	—	$32,374.97	$114,048.55	$46,434.06	2026-05-09
876	OTHER	O.r. Procedures With Principal Diagnosis Of Mental Illness	36	23	—	—	$26,564.80	$113,878.85	$46,364.96	2026-05-09
3634	OTHER	Breast Procedures Except Mastectomy	6	5	—	—	$40,704.45	$55,633.15	$46,359.79	2026-05-09
3174	OTHER	Tendon, Muscle & Other Soft Tissue Procedures	6	5	—	—	$40,047.84	$52,864.48	$46,329.52	2026-05-09
40	OTHER	Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc	36	23	—	—	$32,238.12	$113,770.69	$46,320.92	2026-05-09
3624	OTHER	Mastectomy Procedures	6	5	—	—	$39,821.27	$55,562.76	$46,301.14	2026-05-09
907	OTHER	Other O.r. Procedures For Injuries With Mcc	36	23	—	—	$32,232.41	$113,129.94	$46,060.04	2026-05-09
1804	OTHER	Other Circulatory System Procedures	6	5	—	—	$39,143.75	$55,090.94	$45,907.96	2026-05-09
3234	OTHER	Non-elective Or Complex Hip Joint Replacement	6	5	—	—	$24,043.60	$55,052.56	$45,875.98	2026-05-09
6122	OTHER	Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond	6	5	—	—	$24,043.60	$54,860.63	$45,716.04	2026-05-09
3244	OTHER	Elective Hip Joint Replacement	6	5	—	—	$24,043.60	$54,619.12	$45,514.79	2026-05-09
6032	OTHER	Neonate Birthwt 1000-1249g W Or Without Other Significant Condition	6	5	—	—	$37,464.62	$50,779.24	$45,332.81	2026-05-09
221	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	40	25	—	—	$12,239.50	$148,262.52	$45,325.97	2026-05-09
4834	OTHER	Testes & Scrotal Procedures	6	5	—	—	$37,434.28	$58,191.84	$45,296.10	2026-05-09
956	OTHER	Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma	36	23	—	—	$31,350.26	$110,897.78	$45,151.24	2026-05-09
166	OTHER	Other Respiratory System O.r. Procedures With Mcc	36	23	—	—	$30,881.90	$110,157.61	$44,849.88	2026-05-09
518	OTHER	Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost…	36	23	—	—	$29,195.78	$110,145.86	$44,845.10	2026-05-09
933	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft	36	23	—	—	$18,389.20	$114,736.02	$44,547.89	2026-05-09
8423	OTHER	Burns With Skin Graft Except Extensive 3rd Degree Burns	6	5	—	—	$40,482.84	$53,438.69	$44,531.13	2026-05-09
1602	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	6	5	—	—	$34,081.33	$53,257.96	$44,380.52	2026-05-09
1302	OTHER	Respiratory System Diagnosis W Ventilator Support 96+ Hours	6	5	—	—	$29,534.76	$53,153.99	$44,293.88	2026-05-09
4444	OTHER	Renal Dialysis Access Device Procedure Only	6	5	—	—	$40,225.96	$53,099.61	$44,248.56	2026-05-09

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