|
001-1
|
OTHER
|
Liver Transplant And/or Intestinal Transplant
|
12
|
12
|
—
|
—
|
$14,358.93
|
$45,476.22
|
$41,342.02
|
2026-05-18
|
|
001-2
|
OTHER
|
Liver Transplant And/or Intestinal Transplant
|
12
|
12
|
—
|
—
|
$58,232.92
|
$86,061.89
|
$78,238.08
|
2026-05-18
|
|
001-3
|
OTHER
|
Liver Transplant And/or Intestinal Transplant
|
12
|
12
|
—
|
—
|
$90,441.06
|
$116,549.16
|
$105,953.78
|
2026-05-18
|
|
001-4
|
OTHER
|
Liver Transplant And/or Intestinal Transplant
|
12
|
12
|
—
|
—
|
$131,882.31
|
$153,933.77
|
$139,939.79
|
2026-05-18
|
|
002-1
|
OTHER
|
Heart And/or Lung Transplant
|
12
|
12
|
—
|
—
|
$49,005.69
|
$60,109.76
|
$51,455.97
|
2026-05-18
|
|
002-2
|
OTHER
|
Heart And/or Lung Transplant
|
12
|
12
|
—
|
—
|
$130,705.05
|
$151,688.30
|
$137,898.45
|
2026-05-18
|
|
002-3
|
OTHER
|
Heart And/or Lung Transplant
|
12
|
12
|
—
|
—
|
$79,789.22
|
$133,012.18
|
$120,920.16
|
2026-05-18
|
|
002-4
|
OTHER
|
Heart And/or Lung Transplant
|
12
|
12
|
—
|
—
|
$238,975.78
|
$265,995.80
|
$250,924.57
|
2026-05-18
|
|
004-1
|
OTHER
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
12
|
12
|
—
|
—
|
$20,960.68
|
$48,917.76
|
$44,470.69
|
2026-05-18
|
|
004-2
|
OTHER
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
12
|
12
|
—
|
—
|
$1,012,399.96
|
$1,495,143.06
|
$1,063,019.96
|
2026-05-18
|
|
004-3
|
OTHER
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
12
|
12
|
—
|
—
|
$428,453.67
|
$611,844.69
|
$449,876.35
|
2026-05-18
|
|
004-4
|
OTHER
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
12
|
12
|
—
|
—
|
$142,212.94
|
$169,298.98
|
$149,323.59
|
2026-05-18
|
|
005-1
|
OTHER
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
12
|
12
|
—
|
—
|
$38,031.44
|
$42,391.08
|
$39,813.24
|
2026-05-18
|
|
005-2
|
OTHER
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
12
|
12
|
—
|
—
|
$16,432.56
|
$42,382.58
|
$38,529.62
|
2026-05-18
|
|
005-3
|
OTHER
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
12
|
12
|
—
|
—
|
$33,789.41
|
$64,188.29
|
$58,352.99
|
2026-05-18
|
|
005-4
|
OTHER
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
12
|
12
|
—
|
—
|
$178,651.14
|
$235,882.56
|
$187,583.70
|
2026-05-18
|
|
006-1
|
OTHER
|
Pancreas Transplant
|
12
|
12
|
—
|
—
|
$14,106.04
|
$43,897.64
|
$39,906.95
|
2026-05-18
|
|
006-2
|
OTHER
|
Pancreas Transplant
|
12
|
12
|
—
|
—
|
$36,599.57
|
$65,264.13
|
$59,331.03
|
2026-05-18
|
|
006-3
|
OTHER
|
Pancreas Transplant
|
12
|
12
|
—
|
—
|
$86,823.55
|
$113,604.71
|
$103,277.01
|
2026-05-18
|
|
006-4
|
OTHER
|
Pancreas Transplant
|
12
|
12
|
—
|
—
|
$80,225.72
|
$107,254.30
|
$97,503.91
|
2026-05-18
|
|
007-1
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
12
|
12
|
—
|
—
|
$43,296.48
|
$60,053.40
|
$54,594.00
|
2026-05-18
|
|
007-2
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
12
|
12
|
—
|
—
|
$98,515.88
|
$122,049.00
|
$110,953.64
|
2026-05-18
|
|
007-3
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
12
|
12
|
—
|
—
|
$169,776.84
|
$189,615.05
|
$177,907.16
|
2026-05-18
|
|
007-4
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
12
|
12
|
—
|
—
|
$129,808.59
|
$161,296.40
|
$146,633.09
|
2026-05-18
|
|
008-2
|
OTHER
|
Autologous Bone Marrow Transplant Or T-cell Immunotherapy
|
12
|
12
|
—
|
—
|
$79,932.90
|
$106,389.88
|
$96,718.07
|
2026-05-18
|
|
008-3
|
OTHER
|
Autologous Bone Marrow Transplant Or T-cell Immunotherapy
|
12
|
12
|
—
|
—
|
$32,766.62
|
$40,790.75
|
$37,082.50
|
2026-05-18
|
|
008-4
|
OTHER
|
Autologous Bone Marrow Transplant Or T-cell Immunotherapy
|
12
|
12
|
—
|
—
|
$603,160.68
|
$694,101.29
|
$633,318.71
|
2026-05-18
|
|
009-2
|
OTHER
|
Extracorporeal Membrane Oxygenation (ecmo)
|
12
|
12
|
—
|
—
|
$23,828.84
|
$41,726.91
|
$37,933.55
|
2026-05-18
|
|
009-3
|
OTHER
|
Extracorporeal Membrane Oxygenation (ecmo)
|
12
|
12
|
—
|
—
|
$23,828.84
|
$69,164.65
|
$62,876.95
|
2026-05-18
|
|
009-4
|
OTHER
|
Extracorporeal Membrane Oxygenation (ecmo)
|
12
|
12
|
—
|
—
|
$240,528.67
|
$288,776.20
|
$252,555.10
|
2026-05-18
|
|
011-2
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
12
|
12
|
—
|
—
|
$32,461.86
|
$52,286.73
|
$47,533.39
|
2026-05-18
|
|
011-3
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
12
|
12
|
—
|
—
|
$32,461.86
|
$86,670.01
|
$78,790.92
|
2026-05-18
|
|
011-4
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
12
|
12
|
—
|
—
|
$32,461.86
|
$68,426.75
|
$62,206.14
|
2026-05-18
|
|
020-4
|
OTHER
|
Open Craniotomy For Trauma
|
12
|
12
|
—
|
—
|
$22,961.69
|
$47,551.19
|
$43,228.35
|
2026-05-18
|
|
021-4
|
OTHER
|
Open Craniotomy Except Trauma
|
12
|
12
|
—
|
—
|
$27,092.11
|
$53,076.32
|
$48,251.20
|
2026-05-18
|
|
022-4
|
OTHER
|
Ventricular Shunt Procedures
|
12
|
12
|
—
|
—
|
$32,930.89
|
$41,130.06
|
$37,390.96
|
2026-05-18
|
|
023-4
|
OTHER
|
Spinal Procedures
|
12
|
12
|
—
|
—
|
$23,728.98
|
$48,729.81
|
$44,299.83
|
2026-05-18
|
|
026-4
|
OTHER
|
Other Nervous System And Related Procedures
|
12
|
12
|
—
|
—
|
$24,212.70
|
$40,372.52
|
$36,702.29
|
2026-05-18
|
|
027-4
|
OTHER
|
Other Open Craniotomy
|
12
|
12
|
—
|
—
|
$22,477.54
|
$49,751.34
|
$45,228.49
|
2026-05-18
|
|
029-3
|
OTHER
|
Other Percutaneous Intracranial Procedures
|
12
|
12
|
—
|
—
|
$52,531.01
|
$69,125.65
|
$62,841.50
|
2026-05-18
|
|
029-4
|
OTHER
|
Other Percutaneous Intracranial Procedures
|
12
|
12
|
—
|
—
|
$246,317.85
|
$328,003.65
|
$258,633.74
|
2026-05-18
|
|
042-4
|
OTHER
|
Degenerative Nervous System Disorders Except Multiple Sclerosis
|
12
|
12
|
—
|
—
|
$26,182.99
|
$48,276.70
|
$43,887.91
|
2026-05-18
|
|
046-4
|
OTHER
|
Nonspecific Cva And Precerebral Occlusion Without Infarction
|
12
|
12
|
—
|
—
|
$113,700.07
|
$131,594.17
|
$119,385.07
|
2026-05-18
|
|
049-4
|
OTHER
|
Bacterial And Tuberculous Infections Of Nervous System
|
12
|
12
|
—
|
—
|
$17,092.22
|
$40,298.08
|
$36,634.62
|
2026-05-18
|
|
054-4
|
OTHER
|
Migraine And Other Headaches
|
12
|
12
|
—
|
—
|
$115,472.35
|
$135,773.31
|
$121,245.97
|
2026-05-18
|
|
073-4
|
OTHER
|
Orbit And Eye Procedures
|
12
|
12
|
—
|
—
|
$62,666.75
|
$78,045.90
|
$70,950.82
|
2026-05-18
|
|
089-4
|
OTHER
|
Major Cranial Or Facial Bone Procedures
|
12
|
12
|
—
|
—
|
$98,030.09
|
$107,833.10
|
$101,951.29
|
2026-05-18
|
|
091-3
|
OTHER
|
Other Major Head And Neck Procedures
|
12
|
12
|
—
|
—
|
$106,183.28
|
$117,481.95
|
$111,492.44
|
2026-05-18
|
|
091-4
|
OTHER
|
Other Major Head And Neck Procedures
|
12
|
12
|
—
|
—
|
$29,326.12
|
$53,957.24
|
$49,052.04
|
2026-05-18
|
|
092-4
|
OTHER
|
Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures
|
12
|
12
|
—
|
—
|
$15,153.45
|
$45,767.10
|
$41,606.45
|
2026-05-18
|
|
1
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
30
|
22
|
—
|
—
|
$175,781.46
|
$355,807.87
|
$187,470.91
|
2026-05-18
|
|
10
|
OTHER
|
Pancreas Transplant
|
29
|
21
|
—
|
—
|
$42,046.19
|
$74,746.69
|
$44,415.56
|
2026-05-18
|
|
110-4
|
OTHER
|
Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies
|
12
|
12
|
—
|
—
|
$59,359.92
|
$74,166.88
|
$67,424.44
|
2026-05-18
|
|
120-4
|
OTHER
|
Major Respiratory And Chest Procedures
|
12
|
12
|
—
|
—
|
$26,942.11
|
$50,917.05
|
$46,288.23
|
2026-05-18
|
|
121-4
|
OTHER
|
Other Respiratory And Chest Procedures
|
12
|
12
|
—
|
—
|
$19,806.06
|
$40,356.75
|
$36,687.95
|
2026-05-18
|
|
130-2
|
OTHER
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
12
|
12
|
—
|
—
|
$26,929.78
|
$50,155.31
|
$45,595.74
|
2026-05-18
|
|
130-4
|
OTHER
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
12
|
12
|
—
|
—
|
$97,754.08
|
$107,529.49
|
$101,664.24
|
2026-05-18
|
|
131-4
|
OTHER
|
Cystic Fibrosis - Pulmonary Disease
|
12
|
12
|
—
|
—
|
$82,266.41
|
$92,162.80
|
$86,338.81
|
2026-05-18
|
|
14
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
33
|
23
|
—
|
—
|
$5,196.00
|
$150,482.99
|
$79,463.62
|
2026-05-18
|
|
16
|
OTHER
|
Autologous Bone Marrow Transplant With Cc/mcc
|
32
|
22
|
—
|
—
|
$5,196.00
|
$81,104.75
|
$42,975.56
|
2026-05-18
|
|
160-3
|
OTHER
|
Major Cardiothoracic Repair Of Heart Anomaly
|
12
|
12
|
—
|
—
|
$96,830.26
|
$107,230.52
|
$101,039.26
|
2026-05-18
|
|
160-4
|
OTHER
|
Major Cardiothoracic Repair Of Heart Anomaly
|
12
|
12
|
—
|
—
|
$63,636.02
|
$118,444.67
|
$107,676.97
|
2026-05-18
|
|
161-1
|
OTHER
|
Implantable Heart Assist Systems
|
12
|
12
|
—
|
—
|
$63,914.13
|
$118,648.65
|
$67,109.84
|
2026-05-18
|
|
161-2
|
OTHER
|
Implantable Heart Assist Systems
|
12
|
12
|
—
|
—
|
$75,245.28
|
$118,648.65
|
$79,007.54
|
2026-05-18
|
|
161-3
|
OTHER
|
Implantable Heart Assist Systems
|
12
|
12
|
—
|
—
|
$178,987.92
|
$208,635.09
|
$187,937.32
|
2026-05-18
|
|
161-4
|
OTHER
|
Implantable Heart Assist Systems
|
12
|
12
|
—
|
—
|
$145,813.37
|
$179,715.55
|
$163,377.77
|
2026-05-18
|
|
162-3
|
OTHER
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
12
|
12
|
—
|
—
|
$57,271.92
|
$77,643.49
|
$70,584.99
|
2026-05-18
|
|
162-4
|
OTHER
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
12
|
12
|
—
|
—
|
$59,590.42
|
$84,566.47
|
$76,878.61
|
2026-05-18
|
|
163
|
OTHER
|
Major Chest Procedures With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$105,880.90
|
$61,069.86
|
2026-05-18
|
|
163-3
|
OTHER
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
12
|
12
|
—
|
—
|
$20,553.47
|
$42,983.73
|
$39,076.12
|
2026-05-18
|
|
163-4
|
OTHER
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
12
|
12
|
—
|
—
|
$34,221.67
|
$67,355.45
|
$61,232.23
|
2026-05-18
|
|
165-3
|
OTHER
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
12
|
12
|
—
|
—
|
$17,865.57
|
$42,097.07
|
$38,270.06
|
2026-05-18
|
|
165-4
|
OTHER
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
12
|
12
|
—
|
—
|
$24,672.65
|
$62,903.49
|
$57,184.99
|
2026-05-18
|
|
166-4
|
OTHER
|
Coronary Bypass Without Ami Or Complex Principal Diagnosis
|
12
|
12
|
—
|
—
|
$22,789.21
|
$55,085.66
|
$50,077.87
|
2026-05-18
|
|
167-4
|
OTHER
|
Other Cardiothoracic And Thoracic Vascular Procedures
|
12
|
12
|
—
|
—
|
$27,139.66
|
$67,813.13
|
$61,648.30
|
2026-05-18
|
|
169-4
|
OTHER
|
Major Abdominal Vascular Procedures
|
12
|
12
|
—
|
—
|
$22,440.80
|
$48,545.45
|
$44,132.23
|
2026-05-18
|
|
17
|
OTHER
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
33
|
23
|
—
|
—
|
$5,196.00
|
$81,104.75
|
$42,975.56
|
2026-05-18
|
|
171-4
|
OTHER
|
Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock
|
12
|
12
|
—
|
—
|
$17,724.64
|
$41,681.31
|
$37,892.10
|
2026-05-18
|
|
176-4
|
OTHER
|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
12
|
12
|
—
|
—
|
$20,293.67
|
$43,457.18
|
$39,506.53
|
2026-05-18
|
|
177-4
|
OTHER
|
Cardiac Pacemaker And Defibrillator Revision Except Device Replacement
|
12
|
12
|
—
|
—
|
$71,960.60
|
$85,022.15
|
$77,292.86
|
2026-05-18
|
|
178-1
|
OTHER
|
External Heart Assist Systems
|
12
|
12
|
—
|
—
|
$39,609.89
|
$61,546.87
|
$55,951.70
|
2026-05-18
|
|
178-2
|
OTHER
|
External Heart Assist Systems
|
12
|
12
|
—
|
—
|
$23,682.30
|
$45,704.69
|
$41,549.72
|
2026-05-18
|
|
178-3
|
OTHER
|
External Heart Assist Systems
|
12
|
12
|
—
|
—
|
$23,682.30
|
$47,544.73
|
$43,222.48
|
2026-05-18
|
|
178-4
|
OTHER
|
External Heart Assist Systems
|
12
|
12
|
—
|
—
|
$39,467.79
|
$64,546.97
|
$58,679.06
|
2026-05-18
|
|
179-3
|
OTHER
|
Defibrillator Implants
|
12
|
12
|
—
|
—
|
$20,255.20
|
$44,193.20
|
$40,175.64
|
2026-05-18
|
|
179-4
|
OTHER
|
Defibrillator Implants
|
12
|
12
|
—
|
—
|
$27,314.30
|
$52,310.90
|
$47,555.36
|
2026-05-18
|
|
18
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
34
|
24
|
—
|
—
|
$5,196.00
|
$963,634.46
|
$555,539.56
|
2026-05-18
|
|
181-4
|
OTHER
|
Lower Extremity Arterial Procedures
|
12
|
12
|
—
|
—
|
$21,790.65
|
$42,259.19
|
$38,417.45
|
2026-05-18
|
|
182-4
|
OTHER
|
Other Peripheral Vascular And Related Procedures
|
12
|
12
|
—
|
—
|
$40,226.74
|
$62,157.50
|
$56,506.82
|
2026-05-18
|
|
183-4
|
OTHER
|
Percutaneous Structural Cardiac Procedures
|
12
|
12
|
—
|
—
|
$78,759.45
|
$93,960.67
|
$85,418.79
|
2026-05-18
|
|
19
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
34
|
24
|
—
|
—
|
$5,196.00
|
$104,955.61
|
$55,519.43
|
2026-05-18
|
|
2
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
30
|
22
|
—
|
—
|
$122,192.60
|
$218,909.99
|
$128,752.36
|
2026-05-18
|
|
20
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$110,981.03
|
$58,688.38
|
2026-05-18
|
|
207
|
OTHER
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
35
|
25
|
—
|
—
|
$5,196.00
|
$142,940.03
|
$82,433.36
|
2026-05-18
|
|
21
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$82,043.27
|
$46,854.26
|
2026-05-18
|
|
212
|
OTHER
|
Hip & Femur Procedures Except Major Joint Age 0-17
|
34
|
24
|
—
|
—
|
$5,196.00
|
$148,868.05
|
$74,697.44
|
2026-05-18
|
|
215
|
OTHER
|
Other Heart Assist System Implant
|
34
|
24
|
—
|
—
|
$5,196.00
|
$134,121.55
|
$70,858.65
|
2026-05-18
|
|
216
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
35
|
25
|
—
|
—
|
$5,196.00
|
$127,431.75
|
$67,340.28
|
2026-05-18
|
|
217
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
35
|
25
|
—
|
—
|
$5,196.00
|
$86,778.00
|
$44,275.85
|
2026-05-18
|
|
218
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
35
|
25
|
—
|
—
|
$5,196.00
|
$78,517.00
|
$39,658.83
|
2026-05-18
|
|
219
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
35
|
25
|
—
|
—
|
$5,196.00
|
$101,248.98
|
$53,570.00
|
2026-05-18
|
|
22
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…
|
34
|
24
|
—
|
—
|
$5,196.00
|
$70,626.50
|
$41,145.87
|
2026-05-18
|
|
220
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
35
|
25
|
—
|
—
|
$5,196.00
|
$68,862.23
|
$36,536.85
|
2026-05-18
|
|
220-4
|
OTHER
|
Major Stomach, Esophageal And Duodenal Procedures
|
12
|
12
|
—
|
—
|
$25,306.37
|
$48,864.67
|
$44,422.43
|
2026-05-18
|
|
229-4
|
OTHER
|
Other Digestive System And Abdominal Procedures
|
12
|
12
|
—
|
—
|
$54,596.60
|
$72,367.09
|
$65,788.26
|
2026-05-18
|
|
23
|
OTHER
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
34
|
24
|
—
|
—
|
$5,196.00
|
$74,432.02
|
$39,466.16
|
2026-05-18
|
|
230-4
|
OTHER
|
Major Small Bowel Procedures
|
12
|
12
|
—
|
—
|
$23,023.51
|
$40,283.57
|
$36,621.43
|
2026-05-18
|
|
231
|
OTHER
|
Coronary Bypass With Ptca With Mcc
|
35
|
25
|
—
|
—
|
$5,196.00
|
$106,553.55
|
$56,359.82
|
2026-05-18
|
|
232
|
OTHER
|
Coronary Bypass With Ptca Without Mcc
|
35
|
25
|
—
|
—
|
$5,196.00
|
$78,105.83
|
$41,398.32
|
2026-05-18
|
|
232-4
|
OTHER
|
Gastric Fundoplication
|
12
|
12
|
—
|
—
|
$12,614.25
|
$49,413.46
|
$44,921.33
|
2026-05-18
|
|
233
|
OTHER
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
35
|
25
|
—
|
—
|
$5,196.00
|
$102,409.68
|
$54,180.45
|
2026-05-18
|
|
234
|
OTHER
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc
|
35
|
25
|
—
|
—
|
$5,196.00
|
$68,249.05
|
$36,214.35
|
2026-05-18
|
|
234-4
|
OTHER
|
Appendectomy Without Complex Principal Diagnosis
|
12
|
12
|
—
|
—
|
$21,391.86
|
$45,905.50
|
$41,732.27
|
2026-05-18
|
|
235
|
OTHER
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
35
|
25
|
—
|
—
|
$5,196.00
|
$77,212.98
|
$40,928.76
|
2026-05-18
|
|
260-4
|
OTHER
|
Major Pancreas, Liver And Shunt Procedures
|
12
|
12
|
—
|
—
|
$22,702.32
|
$50,508.16
|
$45,916.51
|
2026-05-18
|
|
261-4
|
OTHER
|
Major Biliary Tract Procedures
|
12
|
12
|
—
|
—
|
$16,878.24
|
$43,780.72
|
$39,800.65
|
2026-05-18
|
|
264-4
|
OTHER
|
Other Hepatobiliary, Pancreas And Abdominal Procedures
|
12
|
12
|
—
|
—
|
$157,005.87
|
$192,376.74
|
$164,856.16
|
2026-05-18
|
|
266
|
OTHER
|
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$82,012.04
|
$43,452.72
|
2026-05-18
|
|
268
|
OTHER
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$137,194.05
|
$79,120.97
|
2026-05-18
|
|
275
|
OTHER
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$149,021.59
|
$48,906.01
|
2026-05-18
|
|
276
|
OTHER
|
Non-maligant Breast Disorders
|
34
|
24
|
—
|
—
|
$5,196.00
|
$81,540.67
|
$43,204.82
|
2026-05-18
|
|
28
|
OTHER
|
Spinal Procedures With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$79,123.42
|
$41,933.51
|
2026-05-18
|
|
3
|
OTHER
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
36
|
26
|
—
|
—
|
$5,196.00
|
$279,938.10
|
$147,560.76
|
2026-05-18
|
|
303-2
|
OTHER
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
12
|
12
|
—
|
—
|
$24,854.20
|
$40,679.55
|
$36,981.41
|
2026-05-18
|
|
303-3
|
OTHER
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
12
|
12
|
—
|
—
|
$35,816.34
|
$57,972.33
|
$52,702.12
|
2026-05-18
|
|
303-4
|
OTHER
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
12
|
12
|
—
|
—
|
$114,418.86
|
$126,572.36
|
$119,328.77
|
2026-05-18
|
|
304-4
|
OTHER
|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
12
|
12
|
—
|
—
|
$114,467.37
|
$125,914.11
|
$119,224.24
|
2026-05-18
|
|
310-4
|
OTHER
|
Vertebral And Intervertebral Spinal Procedures Including Disc Procedures
|
12
|
12
|
—
|
—
|
$17,409.61
|
$44,249.02
|
$40,226.38
|
2026-05-18
|
|
312-4
|
OTHER
|
Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses
|
12
|
12
|
—
|
—
|
$25,972.07
|
$55,856.82
|
$50,778.93
|
2026-05-18
|
|
320-4
|
OTHER
|
Other Musculoskeletal System And Connective Tissue Procedures
|
12
|
12
|
—
|
—
|
$148,688.42
|
$181,018.21
|
$156,122.84
|
2026-05-18
|
|
321-4
|
OTHER
|
Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures
|
12
|
12
|
—
|
—
|
$21,644.97
|
$40,292.18
|
$36,629.25
|
2026-05-18
|
|
323-3
|
OTHER
|
Non-elective Or Complex Hip Joint Replacement
|
12
|
12
|
—
|
—
|
$27,718.01
|
$49,476.91
|
$44,979.01
|
2026-05-18
|
|
325-3
|
OTHER
|
Non-elective Or Complex Knee Joint Replacement
|
12
|
12
|
—
|
—
|
$17,526.20
|
$42,467.54
|
$38,606.85
|
2026-05-18
|
|
325-4
|
OTHER
|
Non-elective Or Complex Knee Joint Replacement
|
12
|
12
|
—
|
—
|
$270,860.39
|
$364,132.14
|
$284,403.41
|
2026-05-18
|
|
326
|
OTHER
|
Stomach, Esophageal And Duodenal Procedures With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$80,966.63
|
$47,641.67
|
2026-05-18
|
|
3400001856
|
OTHER
|
Y90 Ibritumomab Rx =< 40 Mci
|
28
|
22
|
$113,358.87
|
$113,358.87
|
$11,606.32
|
$113,358.87
|
$64,161.12
|
2026-05-18
|
|
356
|
OTHER
|
Other Digestive System O.r. Procedures With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$62,551.59
|
$36,813.62
|
2026-05-18
|
|
361-4
|
OTHER
|
Skin Graft For Skin And Subcutaneous Tissue Diagnoses
|
12
|
12
|
—
|
—
|
$162,271.22
|
$196,117.26
|
$170,384.78
|
2026-05-18
|
|
363-4
|
OTHER
|
Breast Procedures Except Mastectomy
|
12
|
12
|
—
|
—
|
$11,492.92
|
$40,485.15
|
$36,804.68
|
2026-05-18
|
|
4
|
OTHER
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
35
|
25
|
—
|
—
|
$5,196.00
|
$288,675.40
|
$166,445.52
|
2026-05-18
|
|
404-4
|
OTHER
|
Thyroid, Parathyroid And Thyroglossal Procedures
|
12
|
12
|
—
|
—
|
$29,906.21
|
$55,426.87
|
$50,388.06
|
2026-05-18
|
|
405
|
OTHER
|
Pancreas, Liver And Shunt Procedures With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$72,283.94
|
$38,336.43
|
2026-05-18
|
|
405-4
|
OTHER
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
12
|
12
|
—
|
—
|
$327,854.30
|
$449,214.57
|
$344,247.02
|
2026-05-18
|
|
440-2
|
OTHER
|
Kidney Transplant
|
12
|
12
|
—
|
—
|
$9,728.36
|
$40,027.47
|
$36,388.61
|
2026-05-18
|
|
440-3
|
OTHER
|
Kidney Transplant
|
12
|
12
|
—
|
—
|
$17,184.30
|
$45,794.36
|
$41,631.24
|
2026-05-18
|
|
440-4
|
OTHER
|
Kidney Transplant
|
12
|
12
|
—
|
—
|
$97,655.97
|
$123,734.63
|
$112,486.03
|
2026-05-18
|
|
441-4
|
OTHER
|
Major Bladder Procedures
|
12
|
12
|
—
|
—
|
$108,333.76
|
$119,167.14
|
$113,105.67
|
2026-05-18
|
|
442-4
|
OTHER
|
Kidney And Urinary Tract Procedures For Malignancy
|
12
|
12
|
—
|
—
|
$27,372.49
|
$52,161.19
|
$47,419.26
|
2026-05-18
|
|
445-4
|
OTHER
|
Other Bladder Procedures
|
12
|
12
|
—
|
—
|
$62,515.13
|
$78,221.30
|
$71,110.27
|
2026-05-18
|
|
453
|
OTHER
|
Combined Anterior And Posterior Spinal Fusion With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$116,351.25
|
$61,512.71
|
2026-05-18
|
|
454
|
OTHER
|
Combined Anterior And Posterior Spinal Fusion With Cc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$80,307.75
|
$42,556.39
|
2026-05-18
|
|
456
|
OTHER
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
34
|
24
|
—
|
—
|
$5,196.00
|
$110,679.03
|
$58,529.53
|
2026-05-18
|
|
457
|
OTHER
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
34
|
24
|
—
|
—
|
$5,196.00
|
$79,769.42
|
$42,273.26
|
2026-05-18
|
|
459
|
OTHER
|
Spinal Fusion Except Cervical With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$87,082.89
|
$46,119.64
|
2026-05-18
|
|
461
|
OTHER
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$89,527.72
|
$48,788.29
|
2026-05-18
|
|
463
|
OTHER
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …
|
34
|
24
|
—
|
—
|
$5,196.00
|
$74,365.06
|
$39,430.95
|
2026-05-18
|
|
466
|
OTHER
|
Revision Of Hip Or Knee Replacement With Mcc
|
35
|
25
|
—
|
—
|
$5,196.00
|
$68,100.68
|
$36,136.33
|
2026-05-18
|
|
471
|
OTHER
|
Cervical Spinal Fusion With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$83,290.55
|
$49,008.14
|
2026-05-18
|
|
480-4
|
OTHER
|
Major Male Pelvic Procedures
|
12
|
12
|
—
|
—
|
$36,136.39
|
$59,330.91
|
$53,937.19
|
2026-05-18
|
|
4810001154
|
OTHER
|
Defib Dynagen El Vr D151
|
25
|
19
|
$70,578.74
|
$70,578.74
|
$13,621.70
|
$70,578.74
|
$39,947.57
|
2026-05-18
|
|
4810001155
|
OTHER
|
Defib Dynagen Mini Vr D021
|
25
|
19
|
$70,578.74
|
$70,578.74
|
$13,621.70
|
$70,578.74
|
$39,947.57
|
2026-05-18
|
|
4810001156
|
OTHER
|
Defib Dynagen Mini Vr Df-4 020
|
25
|
19
|
$70,578.74
|
$70,578.74
|
$13,621.70
|
$70,578.74
|
$39,947.57
|
2026-05-18
|
|
4810001158
|
OTHER
|
Defib Fortify Assura Vr40
|
25
|
19
|
$70,578.74
|
$70,578.74
|
$13,621.70
|
$70,578.74
|
$39,947.57
|
2026-05-18
|
|
4810001159
|
OTHER
|
Defib Imp Frif Vr Icd 40j Is-1
|
25
|
19
|
$70,578.74
|
$70,578.74
|
$13,621.70
|
$70,578.74
|
$39,947.57
|
2026-05-18
|
|
4810001161
|
OTHER
|
Defib MRI Emblem S Pulse Gen
|
25
|
19
|
$70,578.74
|
$70,578.74
|
$13,621.70
|
$70,578.74
|
$39,947.57
|
2026-05-18
|
|
4810001170
|
OTHER
|
Icd Ellp Ngen Vr36/df4 Cell
|
25
|
19
|
$70,578.74
|
$70,578.74
|
$13,621.70
|
$70,578.74
|
$39,947.57
|
2026-05-18
|
|
4810001171
|
OTHER
|
Icd Fort Ngen Vr36/df4
|
25
|
19
|
$70,578.74
|
$70,578.74
|
$13,621.70
|
$70,578.74
|
$39,947.57
|
2026-05-18
|
|
4810001173
|
OTHER
|
Icd Generator Med 7231cx
|
25
|
19
|
$70,578.74
|
$70,578.74
|
$13,621.70
|
$70,578.74
|
$39,947.57
|
2026-05-18
|
|
4810001181
|
OTHER
|
Icd Medtronic Maximo 7232cx
|
25
|
19
|
$70,578.74
|
$70,578.74
|
$13,621.70
|
$70,578.74
|
$39,947.57
|
2026-05-18
|
|
4810003692
|
OTHER
|
Consulta Crt-d D224trk
|
25
|
19
|
$68,715.44
|
$68,715.44
|
$13,262.08
|
$68,715.44
|
$38,892.94
|
2026-05-18
|
|
4810003694
|
OTHER
|
Defib Crt-d Dynagen Df-4 G150
|
25
|
19
|
$68,715.44
|
$68,715.44
|
$13,262.08
|
$68,715.44
|
$38,892.94
|
2026-05-18
|
|
4810003695
|
OTHER
|
Defib Crt-d Dynagen X4 G156
|
25
|
19
|
$68,715.44
|
$68,715.44
|
$13,262.08
|
$68,715.44
|
$38,892.94
|
2026-05-18
|
|
4810003701
|
OTHER
|
Icd Crtd Energen Rf He N141
|
25
|
19
|
$68,715.44
|
$68,715.44
|
$13,262.08
|
$68,715.44
|
$38,892.94
|
2026-05-18
|
|
4810003703
|
OTHER
|
Icd Quadr Ngen Crtd40/df4
|
25
|
19
|
$68,715.44
|
$68,715.44
|
$13,262.08
|
$68,715.44
|
$38,892.94
|
2026-05-18
|
|
4810003704
|
OTHER
|
Icd Quadr Ngen Crtd40/df4 Cell
|
25
|
19
|
$68,715.44
|
$68,715.44
|
$13,262.08
|
$68,715.44
|
$38,892.94
|
2026-05-18
|
|
4810003705
|
OTHER
|
Icd Unify Ngen Crtd40/df4
|
25
|
19
|
$68,715.44
|
$68,715.44
|
$13,262.08
|
$68,715.44
|
$38,892.94
|
2026-05-18
|
|
4810003706
|
OTHER
|
Icd Unify Ngen Crtd40/df4 Cell
|
25
|
19
|
$68,715.44
|
$68,715.44
|
$13,262.08
|
$68,715.44
|
$38,892.94
|
2026-05-18
|
|
4810003709
|
OTHER
|
Inogen X4 Df G148
|
25
|
19
|
$68,715.44
|
$68,715.44
|
$13,262.08
|
$68,715.44
|
$38,892.94
|
2026-05-18
|
|
4810004272
|
OTHER
|
Cardiomems Pa Sens And Dev Sys
|
25
|
19
|
$94,816.51
|
$94,816.51
|
$18,299.59
|
$94,816.51
|
$53,666.14
|
2026-05-18
|
|
4810004970
|
OTHER
|
Evera MRI Xt Vr Dvmb1d4
|
25
|
19
|
$70,578.74
|
$70,578.74
|
$13,621.70
|
$70,578.74
|
$39,947.57
|
2026-05-18
|
|
4810004971
|
OTHER
|
Evera MRI S Dr Ddmc3d4
|
25
|
19
|
$70,578.74
|
$70,578.74
|
$13,621.70
|
$70,578.74
|
$39,947.57
|
2026-05-18
|
|
4810005148
|
OTHER
|
Amplia MRI Crtd Dev
|
25
|
19
|
$68,576.00
|
$68,576.00
|
$13,235.17
|
$68,576.00
|
$38,814.02
|
2026-05-18
|
|
4810005171
|
OTHER
|
Claria MRI Crtd Dev
|
25
|
19
|
$69,776.00
|
$69,776.00
|
$13,466.77
|
$69,776.00
|
$39,493.22
|
2026-05-18
|
|
4810033362
|
OTHER
|
Replac Aortic Valve Open 33362
|
25
|
18
|
$65,633.38
|
$65,633.38
|
$1,220.96
|
$65,633.38
|
$37,936.09
|
2026-05-18
|
|
4818035661
|
OTHER
|
Byp Graft Not Vein; Fem-fem
|
24
|
18
|
$85,020.00
|
$85,020.00
|
$2,001.01
|
$85,020.00
|
$49,736.70
|
2026-05-18
|
|
4818128978
|
OTHER
|
Valve Aor 29mm Edwrd Sapien 3
|
22
|
17
|
$130,000.00
|
$130,000.00
|
$25,090.00
|
$130,000.00
|
$73,580.00
|
2026-05-18
|
|
4818345561
|
OTHER
|
Df1 X4 Momentum Is4
|
25
|
19
|
$65,064.00
|
$65,064.00
|
$12,557.35
|
$65,064.00
|
$36,826.22
|
2026-05-18
|
|
4818346469
|
OTHER
|
20mm 3 Ultra Heart Valve Sapie
|
25
|
19
|
$130,000.00
|
$130,000.00
|
$25,090.00
|
$130,000.00
|
$73,580.00
|
2026-05-18
|
|
4818346470
|
OTHER
|
23mm 3 Ultra Heart Valve Sapie
|
25
|
19
|
$130,000.00
|
$130,000.00
|
$25,090.00
|
$130,000.00
|
$73,580.00
|
2026-05-18
|
|
4818346471
|
OTHER
|
26mm 3 Ultra Heart Valve Sapie
|
25
|
19
|
$130,000.00
|
$130,000.00
|
$25,090.00
|
$130,000.00
|
$73,580.00
|
2026-05-18
|
|
4818349223
|
OTHER
|
20mm Watchman Flx Laa Closure
|
25
|
19
|
$68,000.00
|
$68,000.00
|
$13,124.00
|
$68,000.00
|
$38,488.00
|
2026-05-18
|
|
4818349224
|
OTHER
|
24mm Watchman Flx Laa Closure
|
25
|
19
|
$68,000.00
|
$68,000.00
|
$13,124.00
|
$68,000.00
|
$38,488.00
|
2026-05-18
|
|
4818349225
|
OTHER
|
27mm Watchman Flx Laa Closure
|
25
|
19
|
$68,000.00
|
$68,000.00
|
$13,124.00
|
$68,000.00
|
$38,488.00
|
2026-05-18
|
|
4818349226
|
OTHER
|
31mm Watchman Flx Laa Closure
|
25
|
19
|
$68,000.00
|
$68,000.00
|
$13,124.00
|
$68,000.00
|
$38,488.00
|
2026-05-18
|
|
4818349227
|
OTHER
|
35mm Watchman Flx Laa Closure
|
25
|
19
|
$68,000.00
|
$68,000.00
|
$13,124.00
|
$68,000.00
|
$38,488.00
|
2026-05-18
|
|
4818509329
|
OTHER
|
X4 Vigilant Is4 Df4
|
25
|
19
|
$90,936.00
|
$90,936.00
|
$15,733.99
|
$90,936.00
|
$51,469.78
|
2026-05-18
|
|
4818509330
|
OTHER
|
Is1 Momentum Df1
|
25
|
19
|
$65,064.00
|
$65,064.00
|
$12,557.35
|
$65,064.00
|
$36,826.22
|
2026-05-18
|
|
5
|
OTHER
|
Liver Transplant With Mcc Or Intestinal Transplant
|
29
|
21
|
—
|
—
|
$69,542.83
|
$145,068.20
|
$73,583.26
|
2026-05-18
|
|
500-4
|
OTHER
|
Malignancy, Male Reproductive System
|
12
|
12
|
—
|
—
|
$188,502.22
|
$243,702.49
|
$197,927.33
|
2026-05-18
|
|
510-4
|
OTHER
|
Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced…
|
12
|
12
|
—
|
—
|
$6,671.29
|
$42,409.84
|
$38,554.40
|
2026-05-18
|
|
511-4
|
OTHER
|
Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy
|
12
|
12
|
—
|
—
|
$10,049.55
|
$40,409.83
|
$36,736.21
|
2026-05-18
|
|
512-4
|
OTHER
|
Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy
|
12
|
12
|
—
|
—
|
$85,365.91
|
$97,421.87
|
$89,634.21
|
2026-05-18
|
|
514-4
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
12
|
12
|
—
|
—
|
$4,901.55
|
$42,578.42
|
$38,707.65
|
2026-05-18
|
|
519-4
|
OTHER
|
Uterine And Adnexa Procedures For Leiomyoma
|
12
|
12
|
—
|
—
|
$84,355.35
|
$95,981.40
|
$88,573.12
|
2026-05-18
|
|
548-4
|
OTHER
|
Postpartum And Post Abortion Diagnosis With O.r. Procedure
|
12
|
12
|
—
|
—
|
$119,316.60
|
$138,186.09
|
$125,282.43
|
2026-05-18
|
|
570
|
OTHER
|
Skin Debridement With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$134,949.99
|
$77,827.34
|
2026-05-18
|
|
573
|
OTHER
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$81,644.40
|
$43,259.37
|
2026-05-18
|
|
576
|
OTHER
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$74,619.78
|
$39,564.91
|
2026-05-18
|
|
583-1
|
OTHER
|
Neonate With Ecmo
|
12
|
12
|
—
|
—
|
$294,079.14
|
$357,640.83
|
$308,783.10
|
2026-05-18
|
|
583-2
|
OTHER
|
Neonate With Ecmo
|
12
|
12
|
—
|
—
|
$160,227.19
|
$203,951.58
|
$185,410.53
|
2026-05-18
|
|
583-3
|
OTHER
|
Neonate With Ecmo
|
12
|
12
|
—
|
—
|
$611,241.38
|
$739,020.40
|
$641,803.45
|
2026-05-18
|
|
588-1
|
OTHER
|
Female Reproductive System Reconstructive Procedures
|
12
|
12
|
—
|
—
|
$56,610.53
|
$80,592.99
|
$59,441.06
|
2026-05-18
|
|
588-2
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
12
|
12
|
—
|
—
|
$174,263.02
|
$206,551.11
|
$182,976.17
|
2026-05-18
|
|
588-3
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
12
|
12
|
—
|
—
|
$227,016.09
|
$270,264.66
|
$238,366.89
|
2026-05-18
|
|
588-4
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
12
|
12
|
—
|
—
|
$243,175.28
|
$288,390.20
|
$255,334.04
|
2026-05-18
|
|
589-1
|
OTHER
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
12
|
12
|
—
|
—
|
$33,571.95
|
$87,569.93
|
$79,609.03
|
2026-05-18
|
|
589-2
|
OTHER
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
12
|
12
|
—
|
—
|
$33,571.95
|
$53,154.19
|
$48,321.99
|
2026-05-18
|
|
589-3
|
OTHER
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
12
|
12
|
—
|
—
|
$540,714.12
|
$641,935.43
|
$567,749.83
|
2026-05-18
|
|
591-2
|
OTHER
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
12
|
12
|
—
|
—
|
$99,871.63
|
$112,295.67
|
$104,865.21
|
2026-05-18
|
|
591-3
|
OTHER
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
12
|
12
|
—
|
—
|
$339,340.73
|
$400,636.45
|
$356,307.77
|
2026-05-18
|
|
591-4
|
OTHER
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
12
|
12
|
—
|
—
|
$300,773.15
|
$357,561.70
|
$315,811.81
|
2026-05-18
|
|
593-2
|
OTHER
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
12
|
12
|
—
|
—
|
$60,213.57
|
$89,504.06
|
$81,367.33
|
2026-05-18
|
|
593-3
|
OTHER
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
12
|
12
|
—
|
—
|
$135,994.17
|
$157,483.69
|
$142,793.88
|
2026-05-18
|
|
593-4
|
OTHER
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
12
|
12
|
—
|
—
|
$188,489.92
|
$223,376.65
|
$197,914.42
|
2026-05-18
|
|
6
|
OTHER
|
Liver Transplant Without Mcc
|
29
|
21
|
—
|
—
|
$48,489.92
|
$156,106.24
|
$90,023.30
|
2026-05-18
|
|
602-1
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
12
|
12
|
—
|
—
|
$54,432.45
|
$60,383.21
|
$56,847.35
|
2026-05-18
|
|
602-2
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
12
|
12
|
—
|
—
|
$127,345.05
|
$145,394.58
|
$133,712.30
|
2026-05-18
|
|
602-3
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
12
|
12
|
—
|
—
|
$157,504.60
|
$182,735.79
|
$165,379.83
|
2026-05-18
|
|
602-4
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
12
|
12
|
—
|
—
|
$159,954.57
|
$186,690.89
|
$167,952.30
|
2026-05-18
|
|
603-2
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
12
|
12
|
—
|
—
|
$100,375.52
|
$111,723.17
|
$105,394.30
|
2026-05-18
|
|
603-3
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
12
|
12
|
—
|
—
|
$72,294.06
|
$79,523.47
|
$75,708.37
|
2026-05-18
|
|
603-4
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
12
|
12
|
—
|
—
|
$132,495.16
|
$145,744.68
|
$137,794.97
|
2026-05-18
|
|
607-2
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
12
|
12
|
—
|
—
|
$75,862.93
|
$83,449.22
|
$79,378.12
|
2026-05-18
|
|
607-3
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
12
|
12
|
—
|
—
|
$127,719.91
|
$146,392.84
|
$134,105.91
|
2026-05-18
|
|
607-4
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
12
|
12
|
—
|
—
|
$271,182.70
|
$320,106.27
|
$284,741.84
|
2026-05-18
|
|
608-1
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition
|
12
|
12
|
—
|
—
|
$79,208.36
|
$87,129.20
|
$82,397.85
|
2026-05-18
|
|
608-2
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition
|
12
|
12
|
—
|
—
|
$33,729.08
|
$40,597.68
|
$36,906.98
|
2026-05-18
|
|
608-3
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition
|
12
|
12
|
—
|
—
|
$136,461.37
|
$155,794.95
|
$143,284.44
|
2026-05-18
|
|
608-4
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition
|
12
|
12
|
—
|
—
|
$48,045.90
|
$56,654.53
|
$51,504.12
|
2026-05-18
|
|
609-3
|
OTHER
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
12
|
12
|
—
|
—
|
$41,942.59
|
$65,668.92
|
$59,699.02
|
2026-05-18
|
|
609-4
|
OTHER
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
12
|
12
|
—
|
—
|
$241,708.04
|
$290,160.11
|
$253,793.44
|
2026-05-18
|
|
611-1
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Major Anomaly
|
12
|
12
|
—
|
—
|
$33,866.68
|
$41,627.78
|
$37,843.44
|
2026-05-18
|
|
611-4
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Major Anomaly
|
12
|
12
|
—
|
—
|
$293,476.30
|
$345,726.13
|
$308,150.11
|
2026-05-18
|
|
612-1
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…
|
12
|
12
|
—
|
—
|
$41,400.17
|
$48,292.57
|
$43,902.34
|
2026-05-18
|
|
612-2
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…
|
12
|
12
|
—
|
—
|
$46,182.18
|
$52,326.90
|
$48,491.29
|
2026-05-18
|
|
612-3
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…
|
12
|
12
|
—
|
—
|
$137,017.06
|
$156,258.84
|
$143,867.91
|
2026-05-18
|
|
612-4
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…
|
12
|
12
|
—
|
—
|
$107,977.64
|
$122,859.81
|
$113,376.52
|
2026-05-18
|
|
613-1
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection
|
12
|
12
|
—
|
—
|
$70,788.47
|
$77,867.32
|
$73,620.01
|
2026-05-18
|
|
613-3
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection
|
12
|
12
|
—
|
—
|
$20,358.32
|
$44,315.88
|
$40,287.16
|
2026-05-18
|
|
613-4
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection
|
12
|
12
|
—
|
—
|
$67,975.43
|
$74,772.97
|
$70,694.45
|
2026-05-18
|
|
614-3
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition
|
12
|
12
|
—
|
—
|
$84,916.00
|
$93,407.60
|
$88,999.01
|
2026-05-18
|
|
621-4
|
OTHER
|
Neonate Birth Weight 2000-2499 Grams With Major Anomaly
|
12
|
12
|
—
|
—
|
$263,641.34
|
$309,849.97
|
$276,823.41
|
2026-05-18
|
|
622-4
|
OTHER
|
Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…
|
12
|
12
|
—
|
—
|
$139,573.37
|
$159,490.95
|
$146,552.04
|
2026-05-18
|
|
623-3
|
OTHER
|
Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection
|
12
|
12
|
—
|
—
|
$38,893.95
|
$46,266.08
|
$42,060.07
|
2026-05-18
|
|
623-4
|
OTHER
|
Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection
|
12
|
12
|
—
|
—
|
$9,432.25
|
$43,104.25
|
$39,185.68
|
2026-05-18
|
|
625-4
|
OTHER
|
Neonate Birth Weight 2000-2499 Grams With Other Significant Condition
|
12
|
12
|
—
|
—
|
$8,559.92
|
$51,160.24
|
$46,509.31
|
2026-05-18
|
|
630-1
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
12
|
12
|
—
|
—
|
$106,511.17
|
$120,254.73
|
$111,836.73
|
2026-05-18
|
|
630-2
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
12
|
12
|
—
|
—
|
$29,191.68
|
$53,318.79
|
$48,471.63
|
2026-05-18
|
|
630-3
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
12
|
12
|
—
|
—
|
$44,876.18
|
$93,173.38
|
$84,703.07
|
2026-05-18
|
|
630-4
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
12
|
12
|
—
|
—
|
$99,234.12
|
$134,590.61
|
$122,355.10
|
2026-05-18
|
|
631-3
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
12
|
12
|
—
|
—
|
$33,683.48
|
$51,848.19
|
$47,134.72
|
2026-05-18
|
|
631-4
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
12
|
12
|
—
|
—
|
$87,669.82
|
$139,439.82
|
$126,763.47
|
2026-05-18
|
|
633-4
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Anomaly
|
12
|
12
|
—
|
—
|
$43,114.06
|
$60,903.48
|
$55,366.80
|
2026-05-18
|
|
636-3
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection
|
12
|
12
|
—
|
—
|
$74,327.29
|
$81,760.02
|
$77,300.38
|
2026-05-18
|
|
651-4
|
OTHER
|
Other Procedures Of Blood And Blood-forming Organs
|
12
|
12
|
—
|
—
|
$8,192.91
|
$42,051.87
|
$38,228.97
|
2026-05-18
|
|
653
|
OTHER
|
Major Bladder Procedures With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$98,565.64
|
$57,416.31
|
2026-05-18
|
|
680-4
|
OTHER
|
Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms
|
12
|
12
|
—
|
—
|
$176,483.94
|
$216,166.63
|
$185,308.14
|
2026-05-18
|
|
681-4
|
OTHER
|
Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms
|
12
|
12
|
—
|
—
|
$77,781.84
|
$93,538.81
|
$85,035.28
|
2026-05-18
|
|
690-3
|
OTHER
|
Acute Leukemia
|
12
|
12
|
—
|
—
|
$25,153.77
|
$46,530.77
|
$42,300.70
|
2026-05-18
|
|
690-4
|
OTHER
|
Acute Leukemia
|
12
|
12
|
—
|
—
|
$39,316.06
|
$58,530.85
|
$53,209.86
|
2026-05-18
|
|
695-4
|
OTHER
|
Chemotherapy For Acute Leukemia
|
12
|
12
|
—
|
—
|
$34,498.76
|
$49,170.28
|
$44,700.25
|
2026-05-18
|
|
7
|
OTHER
|
Lung Transplant
|
29
|
21
|
—
|
—
|
$122,970.66
|
$679,172.64
|
$391,555.69
|
2026-05-18
|
|
740-4
|
OTHER
|
Mental Illness Diagnosis With O.r. Procedure
|
12
|
12
|
—
|
—
|
$121,182.22
|
$133,483.93
|
$127,184.44
|
2026-05-18
|
|
790
|
OTHER
|
Extreme Immaturity Or Respiratory Distress Syndrome, Neonate
|
32
|
24
|
—
|
—
|
$39,128.99
|
$82,190.18
|
$41,753.97
|
2026-05-18
|
|
792-4
|
OTHER
|
Extensive O.r. Procedures For Other Complications Of Treatment
|
12
|
12
|
—
|
—
|
$31,893.85
|
$42,490.90
|
$38,628.09
|
2026-05-18
|
|
794-4
|
OTHER
|
Non-extensive O.r. Procedures For Other Complications Of Treatment
|
12
|
12
|
—
|
—
|
$126,344.74
|
$149,627.31
|
$132,661.98
|
2026-05-18
|
|
8
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant
|
29
|
21
|
—
|
—
|
$52,748.54
|
$150,213.61
|
$86,626.37
|
2026-05-18
|
|
820
|
OTHER
|
Lymphoma And Leukemia With Major O.r. Procedures With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$79,393.90
|
$42,075.75
|
2026-05-18
|
|
834
|
OTHER
|
Acute Leukemia Without Major O.r. Procedures With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$99,218.53
|
$38,984.17
|
2026-05-18
|
|
837
|
OTHER
|
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…
|
34
|
24
|
—
|
—
|
$5,196.00
|
$108,894.52
|
$62,807.13
|
2026-05-18
|
|
841-1
|
OTHER
|
Chemotherapy For Acute Leukemia
|
12
|
12
|
—
|
—
|
$37,988.98
|
$107,350.82
|
$39,888.43
|
2026-05-18
|
|
841-2
|
OTHER
|
Extensive Third Degree Burns With Skin Graft
|
12
|
12
|
—
|
—
|
$37,988.98
|
$107,350.82
|
$39,888.43
|
2026-05-18
|
|
841-3
|
OTHER
|
Extensive Third Degree Burns With Skin Graft
|
12
|
12
|
—
|
—
|
$96,809.27
|
$107,350.82
|
$101,649.73
|
2026-05-18
|
|
841-4
|
OTHER
|
Extensive Third Degree Burns With Skin Graft
|
12
|
12
|
—
|
—
|
$114,853.94
|
$192,453.67
|
$174,957.88
|
2026-05-18
|
|
842-4
|
OTHER
|
Burns With Skin Graft Except Extensive Third Degree Burns
|
12
|
12
|
—
|
—
|
$49,086.81
|
$98,562.21
|
$89,602.01
|
2026-05-18
|
|
843-4
|
OTHER
|
Extensive Third Degree Burns Without Skin Graft
|
12
|
12
|
—
|
—
|
$1,486,229.07
|
$1,750,106.11
|
$1,560,540.52
|
2026-05-18
|
|
850-4
|
OTHER
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…
|
12
|
12
|
—
|
—
|
$48,997.36
|
$62,447.89
|
$56,770.81
|
2026-05-18
|
|
863-4
|
OTHER
|
Neonatal Aftercare
|
12
|
12
|
—
|
—
|
$39,480.76
|
$70,850.40
|
$64,409.45
|
2026-05-18
|
|
870
|
OTHER
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
34
|
24
|
—
|
—
|
$5,196.00
|
$91,449.97
|
$48,416.42
|
2026-05-18
|
|
894-3
|
OTHER
|
HIV With One Significant HIV Condition Or Without Significant Related Conditions
|
12
|
12
|
—
|
—
|
$38,188.41
|
$56,039.91
|
$50,945.37
|
2026-05-18
|
|
910-4
|
OTHER
|
Craniotomy For Multiple Significant Trauma
|
12
|
12
|
—
|
—
|
$28,259.26
|
$56,941.48
|
$51,764.98
|
2026-05-18
|
|
911-1
|
OTHER
|
Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma
|
12
|
12
|
—
|
—
|
$33,941.76
|
$53,632.96
|
$48,757.24
|
2026-05-18
|
|
911-4
|
OTHER
|
Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma
|
12
|
12
|
—
|
—
|
$24,374.38
|
$53,402.01
|
$48,547.28
|
2026-05-18
|
|
912-4
|
OTHER
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
12
|
12
|
—
|
—
|
$22,053.47
|
$49,938.57
|
$45,398.70
|
2026-05-18
|
|
927
|
OTHER
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
34
|
24
|
—
|
—
|
$5,196.00
|
$346,092.89
|
$182,340.66
|
2026-05-18
|
|
928
|
OTHER
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$90,856.49
|
$48,097.25
|
2026-05-18
|
|
950-4
|
OTHER
|
Extensive O.r. Procedure Unrelated To Principal Diagnosis
|
12
|
12
|
—
|
—
|
$31,013.30
|
$46,934.97
|
$42,668.15
|
2026-05-18
|
|
955
|
OTHER
|
Craniotomy For Multiple Significant Trauma
|
34
|
24
|
—
|
—
|
$5,196.00
|
$79,965.06
|
$42,376.15
|
2026-05-18
|
|
957
|
OTHER
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$94,963.59
|
$50,264.33
|
2026-05-18
|
|
969
|
OTHER
|
HIV With Extensive O.r. Procedures With Mcc
|
34
|
24
|
—
|
—
|
$5,196.00
|
$202,558.42
|
$116,801.61
|
2026-05-18
|