Hospital

JEFFERSON EINSTEIN MONTGOMERY HOSPITAL

East Norriton, PA · CCN 390329 · Rates published

8,320 distinct procedures filed

20 distinct payers

277,440 rate rows

2026-05-08 last MRF observed

Data quality

277,335 of 277,440 rate rows are consumer-grade (100.0%)

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

Excluded — reason	Rows
per-diem day rate — not a per-procedure price	68
placeholder amount (≤ $0.02) — excluded from medians	37

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

Source MRF file	https://use2webtechstgpricelist.blob.core.windows.net/pricelist/Complete%20File/204193243_jefferson-einstein-montgomery-hospital_standardcharges.csv
Found on page	https://www.jeffersonhealth.org/pay-my-bill/charge-description
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-05-15
Content fingerprint	fcc6aee7d790c367… · 16,670,691 bytes · first seen 2026-05-08

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
583-4 OTHER	Neonate With Ecmo	6	$443,051.00	$833,499.00	$669,985.00	nat. median $309,400 outlier · 2.2×
588-4 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	6	$271,360.00	$510,503.00	$410,353.50	nat. median $267,493 1.5× median
011-4 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	6	$253,677.00	$477,235.00	$383,612.00	nat. median $105,647 outlier · 3.6×
'2-4 OTHER	Heart And/or Lung Transplant	6	$253,509.00	$476,919.00	$383,358.00	nat. median $412,192 0.9× median
583-3 OTHER	Neonate With Ecmo	6	$252,332.00	$474,705.00	$381,578.00	nat. median $259,487 1.5× median
18 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	19	$275,283.00	$1,173,910.00	$341,443.00	nat. median $386,529 0.9× median
583-2 OTHER	Neonate With Ecmo	6	$193,744.00	$364,486.00	$292,982.00	nat. median $191,347 1.5× median
161-4 OTHER	Implantable Heart Assist Systems	6	$189,180.00	$355,900.00	$286,080.00	nat. median $202,242 1.4× median
609-4 OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	6	$189,064.00	$355,681.00	$285,904.00	nat. median $169,856 1.7× median
011-3 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	6	$188,789.00	$355,165.00	$285,489.50	nat. median $171,094 1.7× median
'9-4 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	6	$185,457.00	$348,896.00	$280,450.50	nat. median $301,544 0.9× median
631-4 OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	6	$181,845.00	$342,101.00	$274,988.00	nat. median $203,379 1.4× median
588-3 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	6	$180,726.00	$339,995.00	$273,295.00	nat. median $165,000 1.7× median
591-4 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	6	$177,945.00	$334,762.00	$269,089.50	nat. median $156,696 1.7× median
583-1 OTHER	Neonate With Ecmo	6	$173,909.00	$327,171.00	$262,987.50	nat. median $171,226 1.5× median
841-4 OTHER	Extensive Third Degree Burns With Skin Graft	6	$168,280.00	$316,581.00	$254,475.00	nat. median $151,691 1.7× median
630-4 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	6	$164,915.00	$310,250.00	$249,386.00	nat. median $210,669 1.2× median
593-4 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	6	$156,448.00	$294,321.00	$236,582.00	nat. median $151,250 1.6× median
588-2 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	6	$154,862.00	$291,338.00	$234,184.00	nat. median $153,523 1.5× median
011-2 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	6	$150,085.00	$282,352.00	$226,960.50	nat. median $52,878 outlier · 4.3×
'7-4 OTHER	Allogeneic Bone Marrow Transplant	6	$149,256.00	$280,791.00	$225,706.00	nat. median $242,682 0.9× median
161-3 OTHER	Implantable Heart Assist Systems	6	$148,132.00	$278,677.00	$224,006.50	nat. median $152,491 1.5× median
1 OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	19	$205,658.00	$715,730.00	$223,744.50	nat. median $239,422 0.9× median
'4-4 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	6	$142,526.00	$268,130.00	$215,528.50	nat. median $231,740 0.9× median
'1-4 OTHER	Liver Transplant And/or Intestinal Transplant	6	$141,108.00	$265,463.00	$213,385.50	nat. median $229,434 0.9× median
'2-3 OTHER	Heart And/or Lung Transplant	6	$138,091.00	$259,787.00	$208,822.50	nat. median $224,528 0.9× median
591-3 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	6	$134,201.00	$252,470.00	$202,941.00	nat. median $99,157 outlier · 2.0×
588-1 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	6	$132,739.00	$249,719.00	$200,729.50	nat. median $75,325 outlier · 2.7×
589-2 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	6	$126,491.00	$237,964.00	$191,280.50	nat. median $49,980 outlier · 3.8×
589-3 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	6	$126,491.00	$237,964.00	$191,280.50	nat. median $87,000 outlier · 2.2×
589-1 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	6	$126,491.00	$237,964.00	$191,280.50	nat. median $86,371 outlier · 2.2×
'9-3 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	6	$124,639.00	$234,480.00	$188,480.50	nat. median $202,656 0.9× median
602-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	6	$117,857.00	$221,722.00	$178,225.00	nat. median $125,000 1.4× median
591-2 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	6	$115,106.00	$216,546.00	$174,064.50	nat. median $80,000 outlier · 2.2×
927 OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	19	$159,357.00	$545,292.00	$173,228.00	nat. median $146,562 1.2× median
593-3 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	6	$114,446.00	$215,305.00	$173,066.50	nat. median $112,711 1.5× median
3 OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	19	$156,514.00	$552,846.00	$171,097.00	nat. median $181,005 0.9× median
161-2 OTHER	Implantable Heart Assist Systems	6	$108,996.00	$205,052.00	$164,825.50	nat. median $109,992 1.5× median
161-1 OTHER	Implantable Heart Assist Systems	6	$108,996.00	$205,052.00	$164,825.50	nat. median $101,352 1.6× median
160-4 OTHER	Major Cardiothoracic Repair Of Heart Anomaly	6	$108,599.00	$204,305.00	$164,225.00	nat. median $106,926 1.5× median
'2-2 OTHER	Heart And/or Lung Transplant	6	$104,567.00	$196,719.00	$158,127.00	nat. median $170,020 0.9× median
'5-4 OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	6	$99,289.00	$186,790.00	$150,145.50	nat. median $161,438 0.9× median
'4-3 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	6	$98,282.00	$184,896.00	$148,623.50	nat. median $159,802 0.9× median
'7-3 OTHER	Allogeneic Bone Marrow Transplant	6	$94,929.00	$178,587.00	$143,552.00	nat. median $154,349 0.9× median
842-4 OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	6	$94,213.00	$177,240.00	$142,469.00	nat. median $83,517 1.7× median
'2-1 OTHER	Heart And/or Lung Transplant	6	$92,421.00	$173,869.00	$139,759.50	nat. median $150,272 0.9× median
'6-4 OTHER	Pancreas Transplant	6	$92,172.00	$173,400.00	$139,383.00	nat. median $149,866 0.9× median
593-2 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	6	$92,053.00	$173,176.00	$139,203.00	nat. median $89,334 1.6× median
607-4 OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	6	$91,104.00	$171,392.00	$137,768.00	nat. median $100,015 1.4× median
630-3 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	6	$90,905.00	$171,017.00	$137,467.50	nat. median $95,000 1.4× median

Other procedures at this hospital

Browse this hospital's 8,320 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

'1-1	OTHER	Liver Transplant And/or Intestinal Transplant	6	6	—	—	$49,739.00	$93,572.00	$75,215.00	2026-05-08
'1-2	OTHER	Liver Transplant And/or Intestinal Transplant	6	6	—	—	$56,616.00	$106,510.00	$85,615.50	2026-05-08
'1-3	OTHER	Liver Transplant And/or Intestinal Transplant	6	6	—	—	$73,260.00	$137,823.00	$110,785.00	2026-05-08
'1-4	OTHER	Liver Transplant And/or Intestinal Transplant	6	6	—	—	$141,108.00	$265,463.00	$213,385.50	2026-05-08
'2-1	OTHER	Heart And/or Lung Transplant	6	6	—	—	$92,421.00	$173,869.00	$139,759.50	2026-05-08
'2-2	OTHER	Heart And/or Lung Transplant	6	6	—	—	$104,567.00	$196,719.00	$158,127.00	2026-05-08
'2-3	OTHER	Heart And/or Lung Transplant	6	6	—	—	$138,091.00	$259,787.00	$208,822.50	2026-05-08
'2-4	OTHER	Heart And/or Lung Transplant	6	6	—	—	$253,509.00	$476,919.00	$383,358.00	2026-05-08
'4-1	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	6	6	—	—	$43,453.00	$81,747.00	$65,710.00	2026-05-08
'4-2	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	6	6	—	—	$62,806.00	$118,155.00	$94,976.00	2026-05-08
'4-3	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	6	6	—	—	$98,282.00	$184,896.00	$148,623.50	2026-05-08
'4-4	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	6	6	—	—	$142,526.00	$268,130.00	$215,528.50	2026-05-08
'5-2	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	6	6	—	—	$48,047.00	$90,389.00	$72,656.50	2026-05-08
'5-3	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	6	6	—	—	$72,057.00	$135,559.00	$108,965.00	2026-05-08
'5-4	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	6	6	—	—	$99,289.00	$186,790.00	$150,145.50	2026-05-08
'6-1	OTHER	Pancreas Transplant	6	6	—	—	$42,535.00	$80,020.00	$64,322.00	2026-05-08
'6-2	OTHER	Pancreas Transplant	6	6	—	—	$61,238.00	$115,206.00	$92,605.00	2026-05-08
'6-3	OTHER	Pancreas Transplant	6	6	—	—	$71,033.00	$133,632.00	$107,416.00	2026-05-08
'6-4	OTHER	Pancreas Transplant	6	6	—	—	$92,172.00	$173,400.00	$139,383.00	2026-05-08
'7-1	OTHER	Allogeneic Bone Marrow Transplant	6	6	—	—	$59,011.00	$111,016.00	$89,236.50	2026-05-08
'7-2	OTHER	Allogeneic Bone Marrow Transplant	6	6	—	—	$66,849.00	$125,761.00	$101,090.00	2026-05-08
'7-3	OTHER	Allogeneic Bone Marrow Transplant	6	6	—	—	$94,929.00	$178,587.00	$143,552.00	2026-05-08
'7-4	OTHER	Allogeneic Bone Marrow Transplant	6	6	—	—	$149,256.00	$280,791.00	$225,706.00	2026-05-08
'8-1	OTHER	Autologous Bone Marrow Transplant	6	6	—	—	$30,976.00	$58,274.00	$46,841.50	2026-05-08
'8-2	OTHER	Autologous Bone Marrow Transplant	6	6	—	—	$36,673.00	$68,992.00	$55,457.50	2026-05-08
'8-3	OTHER	Autologous Bone Marrow Transplant	6	6	—	—	$46,725.00	$87,902.00	$70,657.00	2026-05-08
'8-4	OTHER	Autologous Bone Marrow Transplant	6	6	—	—	$66,384.00	$124,887.00	$100,387.00	2026-05-08
'9-1	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	6	6	—	—	$45,808.00	$86,178.00	$69,271.50	2026-05-08
'9-2	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	6	6	—	—	$62,556.00	$117,685.00	$94,598.00	2026-05-08
'9-3	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	6	6	—	—	$124,639.00	$234,480.00	$188,480.50	2026-05-08
'9-4	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	6	6	—	—	$185,457.00	$348,896.00	$280,450.50	2026-05-08
011-1	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	6	6	—	—	$73,917.00	$139,059.00	$111,778.50	2026-05-08
011-2	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	6	6	—	—	$150,085.00	$282,352.00	$226,960.50	2026-05-08
011-3	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	6	6	—	—	$188,789.00	$355,165.00	$285,489.50	2026-05-08
011-4	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	6	6	—	—	$253,677.00	$477,235.00	$383,612.00	2026-05-08
1	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	34	19	—	$368,752.00	$205,658.00	$715,730.00	$223,744.50	2026-05-08
10	OTHER	Pancreas Transplant	35	19	—	$94,990.00	$51,352.00	$260,000.00	$57,979.00	2026-05-08
120-4	OTHER	Major Respiratory And Chest Procedures	6	6	—	—	$44,388.00	$83,506.00	$67,124.00	2026-05-08
121-4	OTHER	Other Respiratory And Chest Procedures	6	6	—	—	$37,207.00	$69,996.00	$56,264.00	2026-05-08
130-3	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	6	6	—	—	$33,093.00	$62,257.00	$50,043.00	2026-05-08
130-4	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	6	6	—	—	$43,866.00	$82,524.00	$66,334.50	2026-05-08
14	OTHER	Allogeneic Bone Marrow Transplant	35	19	—	$158,574.00	$89,783.00	$384,800.00	$96,965.00	2026-05-08
16	OTHER	Autologous Bone Marrow Transplant With Cc/mcc	35	19	—	$78,628.00	$44,205.00	$384,800.00	$47,947.00	2026-05-08
160-2	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	6	6	—	—	$37,712.00	$70,946.00	$57,027.50	2026-05-08
160-3	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	6	6	—	—	$50,336.00	$94,696.00	$76,119.00	2026-05-08
160-4	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	6	6	—	—	$108,599.00	$204,305.00	$164,225.00	2026-05-08
161-1	OTHER	Implantable Heart Assist Systems	6	6	—	—	$108,996.00	$205,052.00	$164,825.50	2026-05-08
161-2	OTHER	Implantable Heart Assist Systems	6	6	—	—	$108,996.00	$205,052.00	$164,825.50	2026-05-08
161-3	OTHER	Implantable Heart Assist Systems	6	6	—	—	$148,132.00	$278,677.00	$224,006.50	2026-05-08
161-4	OTHER	Implantable Heart Assist Systems	6	6	—	—	$189,180.00	$355,900.00	$286,080.00	2026-05-08
162-1	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	6	6	—	—	$33,631.00	$63,270.00	$50,857.50	2026-05-08
162-2	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	6	6	—	—	$40,361.00	$75,930.00	$61,034.00	2026-05-08
162-3	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	6	6	—	—	$53,387.00	$100,436.00	$80,733.00	2026-05-08
162-4	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	6	6	—	—	$72,983.00	$137,301.00	$110,366.00	2026-05-08
163-2	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	6	6	—	—	$33,884.00	$63,745.00	$51,240.00	2026-05-08
163-3	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	6	6	—	—	$45,911.00	$86,371.00	$69,427.50	2026-05-08
163-4	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	6	6	—	—	$63,863.00	$120,144.00	$96,574.50	2026-05-08
165-1	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	6	6	—	—	$30,806.00	$57,954.00	$46,584.50	2026-05-08
165-2	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	6	6	—	—	$34,378.00	$64,675.00	$51,987.00	2026-05-08
165-3	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	6	6	—	—	$42,636.00	$80,209.00	$64,474.00	2026-05-08
165-4	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	6	6	—	—	$57,374.00	$107,937.00	$86,761.50	2026-05-08
166-3	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	6	6	—	—	$37,526.00	$70,596.00	$56,746.50	2026-05-08
166-4	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	6	6	—	—	$51,149.00	$96,225.00	$77,348.00	2026-05-08
167-3	OTHER	Other Cardiothoracic And Thoracic Circulatory Procedures	6	6	—	—	$35,683.00	$67,129.00	$53,960.00	2026-05-08
167-4	OTHER	Other Cardiothoracic And Thoracic Circulatory Procedures	6	6	—	—	$56,216.00	$105,758.00	$85,010.50	2026-05-08
169-3	OTHER	Major Abdominal Vascular Procedures	6	6	—	—	$31,877.00	$59,969.00	$48,205.00	2026-05-08
169-4	OTHER	Major Abdominal Vascular Procedures	6	6	—	—	$45,603.00	$85,792.00	$68,961.00	2026-05-08
170-4	OTHER	Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock	6	6	—	—	$37,614.00	$70,762.00	$56,880.00	2026-05-08
171-4	OTHER	Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock	6	6	—	—	$30,588.00	$57,544.00	$46,255.50	2026-05-08
174-4	OTHER	Percutaneous Cardiac Intervention With Ami	6	6	—	—	$30,772.00	$57,890.00	$46,533.00	2026-05-08
175-4	OTHER	Percutaneous Cardiac Intervention Without Ami	6	6	—	—	$34,622.00	$65,133.00	$52,355.00	2026-05-08
176-4	OTHER	Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices	6	6	—	—	$36,218.00	$68,136.00	$54,769.00	2026-05-08
178-1	OTHER	External Heart Assist Devices	6	6	—	—	$35,908.00	$67,552.00	$54,300.00	2026-05-08
178-2	OTHER	External Heart Assist Devices	6	6	—	—	$39,898.00	$75,058.00	$60,333.50	2026-05-08
178-3	OTHER	External Heart Assist Devices	6	6	—	—	$49,001.00	$92,184.00	$74,100.00	2026-05-08
178-4	OTHER	External Heart Assist Devices	6	6	—	—	$60,729.00	$114,247.00	$91,834.00	2026-05-08
179-2	OTHER	Defibrillator Implants	6	6	—	—	$31,785.00	$59,796.00	$48,065.50	2026-05-08
179-3	OTHER	Defibrillator Implants	6	6	—	—	$38,444.00	$72,324.00	$58,135.50	2026-05-08
179-4	OTHER	Defibrillator Implants	6	6	—	—	$50,482.00	$94,970.00	$76,339.00	2026-05-08
18	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	31	19	—	$567,806.00	$275,283.00	$1,173,910.00	$341,443.00	2026-05-08
180-4	OTHER	Other Circulatory System Procedures	6	6	—	—	$30,854.00	$58,046.00	$46,658.00	2026-05-08
181-4	OTHER	Lower Extremity Vascular Procedures	6	6	—	—	$37,531.00	$70,605.00	$56,754.50	2026-05-08
182-4	OTHER	Other Peripheral Vascular And Related Procedures	6	6	—	—	$32,470.00	$61,085.00	$49,102.00	2026-05-08
183-2	OTHER	Percutaneous Structural Cardiac Procedures	6	6	—	—	$31,836.00	$59,892.00	$48,143.00	2026-05-08
183-3	OTHER	Percutaneous Structural Cardiac Procedures	6	6	—	—	$39,717.00	$74,718.00	$60,060.00	2026-05-08
183-4	OTHER	Percutaneous Structural Cardiac Procedures	6	6	—	—	$54,656.00	$102,823.00	$82,652.00	2026-05-08
19	OTHER	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	31	19	—	$94,450.00	$53,378.00	$179,122.00	$57,648.00	2026-05-08
2	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	34	19	—	$149,564.00	$80,561.00	$369,200.00	$90,594.50	2026-05-08
20	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	35	19	—	$104,091.00	$58,851.00	$294,329.00	$63,560.00	2026-05-08
20-4	OTHER	Open Craniotomy For Trauma	6	6	—	—	$43,110.00	$81,102.00	$65,192.00	2026-05-08
207	OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	35	19	—	$85,260.00	$47,351.00	$164,742.00	$52,013.00	2026-05-08
209	OTHER	Complex Aortic Arch Procedures	28	18	—	$149,394.00	$84,571.00	$289,082.00	$89,645.00	2026-05-08
21-3	OTHER	Open Craniotomy Except Trauma	6	6	—	—	$34,727.00	$65,331.00	$52,514.50	2026-05-08
21-4	OTHER	Open Craniotomy Except Trauma	6	6	—	—	$49,347.00	$92,834.00	$74,622.00	2026-05-08
212	OTHER	Concomitant Aortic And Mitral Valve Procedures	30	19	—	$143,554.00	$79,643.00	$277,725.00	$85,725.00	2026-05-08
215	OTHER	Other Heart Assist System Implant	35	19	—	$131,512.00	$74,419.00	$463,262.00	$80,372.00	2026-05-08
216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	35	19	—	$129,224.00	$70,577.00	$297,163.00	$78,970.00	2026-05-08
217	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	35	19	—	$87,106.00	$47,283.00	$196,963.00	$53,145.00	2026-05-08
218	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	35	19	—	$87,106.00	$43,573.00	$170,090.00	$53,145.00	2026-05-08
219	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	35	19	—	$101,590.00	$56,618.00	$248,232.00	$62,026.00	2026-05-08
22-4	OTHER	Ventricular Shunt Procedures	6	6	—	—	$38,560.00	$72,543.00	$58,311.50	2026-05-08
220-4	OTHER	Major Stomach, Esophageal And Duodenal Procedures	6	6	—	—	$43,722.00	$82,252.00	$66,116.00	2026-05-08
222	OTHER	Cardiac Defib Implant W Cardiac Cath W Ami/hf/shock W Mcc	4	1	—	—	$92,573.00	$112,832.00	$103,879.50	2026-05-08
222-4	OTHER	Other Stomach, Esophageal And Duodenal Procedures	6	6	—	—	$32,427.00	$61,004.00	$49,036.50	2026-05-08
223	OTHER	Cardiac Defib Implant W Cardiac Cath W Ami/hf/shock Without Mcc	4	1	—	—	$72,311.00	$88,136.00	$81,143.00	2026-05-08
223-4	OTHER	Other Small And Large Bowel Procedures	6	6	—	—	$30,982.00	$58,286.00	$46,852.00	2026-05-08
224	OTHER	Cardiac Defib Implant W Cardiac Cath Without Ami/hf/shock W Mcc	4	1	—	—	$84,467.00	$102,952.00	$94,783.50	2026-05-08
225	OTHER	Cardiac Defib Implant W Cardiac Cath Without Ami/hf/shock Without Mcc	4	1	—	—	$65,067.00	$79,306.00	$73,014.00	2026-05-08
226	OTHER	Cardiac Defibrillator Implant Without Cardiac Cath W Mcc	4	1	—	—	$77,567.00	$94,542.00	$87,041.00	2026-05-08
227	OTHER	Cardiac Defibrillator Implant Without Cardiac Cath Without Mcc	4	1	—	—	$60,485.00	$73,722.00	$67,873.00	2026-05-08
227-4	OTHER	Hernia Procedures Except Inguinal, Femoral And Umbilical	6	6	—	—	$31,078.00	$58,466.00	$46,996.00	2026-05-08
229-4	OTHER	Other Digestive System And Abdominal Procedures	6	6	—	—	$32,194.00	$60,565.00	$48,683.50	2026-05-08
23	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	35	19	—	$76,010.00	$41,792.00	$161,705.00	$46,342.00	2026-05-08
23-3	OTHER	Spinal Procedures	6	6	—	—	$30,991.00	$58,302.00	$46,865.00	2026-05-08
23-4	OTHER	Spinal Procedures	6	6	—	—	$44,994.00	$84,646.00	$68,040.00	2026-05-08
230-4	OTHER	Major Small Bowel Procedures	6	6	—	—	$36,983.00	$69,576.00	$55,927.00	2026-05-08
231	OTHER	Coronary Bypass With Ptca With Mcc	35	19	—	$111,459.00	$61,990.00	$244,994.00	$68,077.00	2026-05-08
231-4	OTHER	Major Large Bowel Procedures	6	6	—	—	$32,648.00	$61,419.00	$49,370.00	2026-05-08
232	OTHER	Coronary Bypass With Ptca Without Mcc	35	19	—	$80,374.00	$44,736.00	$175,992.00	$49,017.00	2026-05-08
232-4	OTHER	Gastric Fundoplication	6	6	—	—	$31,096.00	$58,501.00	$47,024.50	2026-05-08
233	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	35	19	—	$101,155.00	$57,184.00	$231,606.00	$61,759.00	2026-05-08
235	OTHER	Coronary Bypass Without Cardiac Catheterization With Mcc	35	19	—	$77,826.00	$43,098.00	$183,305.00	$47,455.00	2026-05-08
26-4	OTHER	Other Nervous System And Related Procedures	6	6	—	—	$34,999.00	$65,842.00	$52,925.50	2026-05-08
260-4	OTHER	Major Pancreas, Liver And Shunt Procedures	6	6	—	—	$46,042.00	$86,617.00	$69,624.50	2026-05-08
261-4	OTHER	Major Biliary Tract Procedures	6	6	—	—	$42,811.00	$80,539.00	$64,739.50	2026-05-08
264-4	OTHER	Other Hepatobiliary, Pancreas And Abdominal Procedures	6	6	—	—	$36,497.00	$68,661.00	$55,191.50	2026-05-08
266	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	35	19	—	$81,238.00	$43,876.00	$281,863.00	$49,547.00	2026-05-08
268	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	35	19	—	$91,079.00	$48,813.00	$196,875.00	$55,581.00	2026-05-08
27-4	OTHER	Other Open Craniotomy	6	6	—	—	$41,531.00	$78,132.00	$62,804.00	2026-05-08
275	OTHER	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	30	19	—	$94,395.00	$51,727.00	$182,110.00	$56,280.50	2026-05-08
276	OTHER	Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator	30	19	—	$79,638.00	$44,969.00	$153,409.00	$47,442.00	2026-05-08
28	OTHER	Spinal Procedures With Mcc	35	19	—	$79,660.00	$44,523.00	$170,331.00	$48,580.00	2026-05-08
29-4	OTHER	Other Percutaneous Intracranial Procedures	6	6	—	—	$35,217.00	$66,253.00	$53,255.50	2026-05-08
299-2	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical	6	6	—	—	$35,987.00	$67,702.00	$54,420.50	2026-05-08
299-3	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical	6	6	—	—	$48,931.00	$92,052.00	$73,993.50	2026-05-08
299-4	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical	6	6	—	—	$62,575.00	$117,720.00	$94,626.00	2026-05-08
3	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	35	19	—	$279,477.00	$156,514.00	$552,846.00	$171,097.00	2026-05-08
30-4	OTHER	Percutaneous Intracranial And Extracranial Vascular Procedures	6	6	—	—	$37,643.00	$70,816.00	$56,923.50	2026-05-08
300-3	OTHER	Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical	6	6	—	—	$33,378.00	$62,793.00	$50,474.00	2026-05-08
300-4	OTHER	Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical	6	6	—	—	$47,737.00	$89,807.00	$72,188.50	2026-05-08
303-1	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	6	6	—	—	$31,778.00	$59,783.00	$48,055.00	2026-05-08
303-2	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	6	6	—	—	$36,660.00	$68,967.00	$55,437.00	2026-05-08
303-3	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	6	6	—	—	$50,405.00	$94,826.00	$76,223.00	2026-05-08
303-4	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	6	6	—	—	$72,631.00	$136,638.00	$109,832.50	2026-05-08
304-3	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	6	6	—	—	$37,760.00	$71,038.00	$57,101.50	2026-05-08
304-4	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	6	6	—	—	$51,222.00	$96,363.00	$77,459.00	2026-05-08
305-4	OTHER	Amputation Of Lower Limb Except Toes	6	6	—	—	$30,598.00	$57,563.00	$46,270.50	2026-05-08
309-4	OTHER	Other Significant Hip And Femur Surgery	6	6	—	—	$31,708.00	$59,651.00	$47,948.00	2026-05-08
312-4	OTHER	Skin Graft For Musculoskeletal And Connective Tissue Diagnoses	6	6	—	—	$44,233.00	$83,214.00	$66,889.50	2026-05-08
313-4	OTHER	Knee And Lower Leg Procedures Except Foot	6	6	—	—	$31,789.00	$59,803.00	$48,071.00	2026-05-08
315-4	OTHER	Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement	6	6	—	—	$31,224.00	$58,741.00	$47,217.50	2026-05-08
317	OTHER	Concomitant Left Atrial Appendage Closure And Cardiac Ablation	30	19	—	$88,566.00	$45,303.00	$170,773.00	$52,789.50	2026-05-08
321-4	OTHER	Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures	6	6	—	—	$38,586.00	$72,590.00	$58,349.50	2026-05-08
325-4	OTHER	Non-elective Or Complex Knee Joint Replacement	6	6	—	—	$31,180.00	$58,659.00	$47,151.00	2026-05-08
361-4	OTHER	Skin Graft For Skin And Subcutaneous Tissue Diagnoses	6	6	—	—	$43,036.00	$80,963.00	$65,080.00	2026-05-08
38240	OTHER	Bone Marrow Or Blood-derived Peripheral Stem Cell Tra0lantation; Allogenic	41	20	—	$26,318.03	$1,008.80	$238,604.58	$58,553.27	2026-05-08
4	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	35	19	—	$182,650.00	$103,250.00	$353,765.00	$111,728.00	2026-05-08
401-4	OTHER	Adrenal Procedures	6	6	—	—	$40,735.00	$76,633.00	$61,600.00	2026-05-08
403-4	OTHER	Procedures For Obesity	6	6	—	—	$36,031.00	$67,783.00	$54,485.50	2026-05-08
404-4	OTHER	Thyroid, Parathyroid And Thyroglossal Procedures	6	6	—	—	$36,132.00	$67,974.00	$54,639.00	2026-05-08
405-4	OTHER	Other Procedures For Endocrine, Nutritional And Metabolic Disorders	6	6	—	—	$36,569.00	$68,797.00	$55,300.00	2026-05-08
426	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	30	19	—	$145,486.00	$76,590.00	$281,481.00	$86,882.00	2026-05-08
427	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	30	19	—	$95,553.00	$51,987.00	$184,363.00	$56,974.00	2026-05-08
428-4	OTHER	Genetic Disorders	6	6	—	—	$42,984.00	$80,865.00	$65,000.50	2026-05-08
429	OTHER	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	30	19	—	$119,071.00	$61,017.00	$230,105.00	$71,060.50	2026-05-08
43-4	OTHER	Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies	6	6	—	—	$33,048.00	$62,171.00	$49,975.00	2026-05-08
440-1	OTHER	Kidney Transplant	6	6	—	—	$38,749.00	$72,898.00	$58,597.00	2026-05-08
440-2	OTHER	Kidney Transplant	6	6	—	—	$41,406.00	$77,897.00	$62,615.00	2026-05-08
440-3	OTHER	Kidney Transplant	6	6	—	—	$48,587.00	$91,406.00	$73,474.50	2026-05-08
440-4	OTHER	Kidney Transplant	6	6	—	—	$71,464.00	$134,444.00	$108,069.00	2026-05-08
441-4	OTHER	Major Bladder Procedures	6	6	—	—	$40,175.00	$75,580.00	$60,753.00	2026-05-08
442-4	OTHER	Kidney And Urinary Tract Procedures For Malignancy	6	6	—	—	$34,184.00	$64,310.00	$51,694.00	2026-05-08
444-4	OTHER	Renal Dialysis Access Device Procedures	6	6	—	—	$32,113.00	$60,414.00	$48,562.00	2026-05-08
447	OTHER	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	30	19	—	$88,502.00	$49,084.00	$170,648.00	$52,751.00	2026-05-08
447-4	OTHER	Other Kidney, Urinary Tract And Related Non-percutaneous Procedures	6	6	—	—	$34,292.00	$64,513.00	$51,857.00	2026-05-08
448-4	OTHER	Other Kidney, Urinary Tract And Related Percutaneous Procedures	6	6	—	—	$34,004.00	$63,971.00	$51,421.00	2026-05-08
453	OTHER	Combined Anterior/posterior Spinal Fusion W Mcc	4	1	—	—	$108,041.00	$131,685.00	$121,237.00	2026-05-08
454	OTHER	Combined Anterior/posterior Spinal Fusion W Cc	4	1	—	—	$72,090.00	$87,867.00	$80,895.50	2026-05-08
455	OTHER	Combined Anterior/posterior Spinal Fusion Without Cc/mcc	4	1	—	—	$56,882.00	$69,331.00	$63,830.00	2026-05-08
456	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	35	19	—	$111,111.00	$61,955.00	$300,517.00	$67,864.00	2026-05-08
457	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	35	19	—	$79,067.00	$42,042.00	$213,742.00	$48,216.00	2026-05-08
459	OTHER	Spinal Fusion Except Cervical W Mcc	4	1	—	—	$72,636.00	$88,533.00	$81,508.50	2026-05-08
460	OTHER	Spinal Fusion Except Cervical Without Mcc	4	1	—	—	$45,932.00	$55,985.00	$51,543.00	2026-05-08
483-4	OTHER	Penis, Testes And Scrotal Procedures	6	6	—	—	$31,967.00	$60,138.00	$48,340.50	2026-05-08
484-4	OTHER	Other Male Reproductive System And Related Procedures	6	6	—	—	$35,214.00	$66,247.00	$53,251.00	2026-05-08
485-4	OTHER	Prostatectomy Procedures	6	6	—	—	$35,131.00	$66,092.00	$53,126.50	2026-05-08
5	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	35	19	—	$136,154.00	$77,054.00	$447,200.00	$83,219.00	2026-05-08
50-4	OTHER	Non-bacterial Infections Of Nervous System Except Viral Meningitis	6	6	—	—	$30,515.00	$57,407.00	$46,144.50	2026-05-08
511-4	OTHER	Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy	6	6	—	—	$38,876.00	$73,137.00	$58,789.00	2026-05-08
512-4	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy	6	6	—	—	$37,192.00	$69,968.00	$56,241.50	2026-05-08
513-4	OTHER	Uterine And Adnexa Procedures For Non-malignancy Except Leiomyoma	6	6	—	—	$31,365.00	$59,006.00	$47,430.50	2026-05-08
514-4	OTHER	Female Reproductive System Reconstructive Procedures	6	6	—	—	$32,879.00	$61,855.00	$49,720.50	2026-05-08
518-4	OTHER	Other Female Reproductive System And Related Procedures	6	6	—	—	$32,142.00	$60,468.00	$48,605.50	2026-05-08
519-4	OTHER	Uterine And Adnexa Procedures For Leiomyoma	6	6	—	—	$31,478.00	$59,220.00	$47,602.00	2026-05-08
520-4	OTHER	Other GYN Procedures For Malignancy	6	6	—	—	$40,585.00	$76,351.00	$61,372.50	2026-05-08
573	OTHER	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	35	19	—	$86,792.00	$45,097.00	$167,323.00	$52,953.00	2026-05-08
583-1	OTHER	Neonate With Ecmo	6	6	—	—	$173,909.00	$327,171.00	$262,987.50	2026-05-08
583-2	OTHER	Neonate With Ecmo	6	6	—	—	$193,744.00	$364,486.00	$292,982.00	2026-05-08
583-3	OTHER	Neonate With Ecmo	6	6	—	—	$252,332.00	$474,705.00	$381,578.00	2026-05-08
583-4	OTHER	Neonate With Ecmo	6	6	—	—	$443,051.00	$833,499.00	$669,985.00	2026-05-08
588-1	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	6	6	—	—	$132,739.00	$249,719.00	$200,729.50	2026-05-08
588-2	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	6	6	—	—	$154,862.00	$291,338.00	$234,184.00	2026-05-08
588-3	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	6	6	—	—	$180,726.00	$339,995.00	$273,295.00	2026-05-08
588-4	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	6	6	—	—	$271,360.00	$510,503.00	$410,353.50	2026-05-08
589-1	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	6	6	—	—	$126,491.00	$237,964.00	$191,280.50	2026-05-08
589-2	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	6	6	—	—	$126,491.00	$237,964.00	$191,280.50	2026-05-08
589-3	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	6	6	—	—	$126,491.00	$237,964.00	$191,280.50	2026-05-08
591-2	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	6	6	—	—	$115,106.00	$216,546.00	$174,064.50	2026-05-08
591-3	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	6	6	—	—	$134,201.00	$252,470.00	$202,941.00	2026-05-08
591-4	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	6	6	—	—	$177,945.00	$334,762.00	$269,089.50	2026-05-08
593-1	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	6	6	—	—	$70,055.00	$131,793.00	$105,938.50	2026-05-08
593-2	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	6	6	—	—	$92,053.00	$173,176.00	$139,203.00	2026-05-08
593-3	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	6	6	—	—	$114,446.00	$215,305.00	$173,066.50	2026-05-08
593-4	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	6	6	—	—	$156,448.00	$294,321.00	$236,582.00	2026-05-08
602-1	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$48,709.00	$91,635.00	$73,658.00	2026-05-08
602-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$65,387.00	$123,011.00	$98,878.50	2026-05-08
602-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$81,830.00	$153,945.00	$123,744.50	2026-05-08
602-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$117,857.00	$221,722.00	$178,225.00	2026-05-08
603-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	6	6	—	—	$39,827.00	$74,926.00	$60,227.00	2026-05-08
603-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	6	6	—	—	$48,812.00	$91,829.00	$73,814.50	2026-05-08
603-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	6	6	—	—	$86,202.00	$162,170.00	$130,355.50	2026-05-08
607-1	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$33,351.00	$62,743.00	$50,434.00	2026-05-08
607-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$46,653.00	$87,767.00	$70,548.50	2026-05-08
607-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$62,463.00	$117,510.00	$94,457.00	2026-05-08
607-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$91,104.00	$171,392.00	$137,768.00	2026-05-08
608-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	6	6	—	—	$30,988.00	$58,297.00	$46,860.50	2026-05-08
608-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	6	6	—	—	$44,855.00	$84,384.00	$67,829.50	2026-05-08
608-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	6	6	—	—	$51,963.00	$97,756.00	$78,578.50	2026-05-08
609-1	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	6	6	—	—	$34,375.00	$64,669.00	$51,983.00	2026-05-08
609-2	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	6	6	—	—	$42,794.00	$80,508.00	$64,714.50	2026-05-08
609-3	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	6	6	—	—	$65,584.00	$123,382.00	$99,177.50	2026-05-08
609-4	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	6	6	—	—	$189,064.00	$355,681.00	$285,904.00	2026-05-08
611-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	6	6	—	—	$40,410.00	$76,022.00	$61,108.00	2026-05-08
611-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	6	6	—	—	$75,772.00	$142,548.00	$114,583.50	2026-05-08
612-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$41,334.00	$77,760.00	$62,505.50	2026-05-08
612-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$59,689.00	$112,291.00	$90,262.00	2026-05-08
613-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	6	6	—	—	$40,569.00	$76,321.00	$61,348.50	2026-05-08
613-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	6	6	—	—	$75,076.00	$141,238.00	$113,530.50	2026-05-08
614-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	6	6	—	—	$33,832.00	$63,648.00	$51,161.50	2026-05-08
614-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	6	6	—	—	$50,093.00	$94,239.00	$75,751.50	2026-05-08
621-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	6	6	—	—	$58,535.00	$110,121.00	$88,518.00	2026-05-08
622-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$38,707.00	$72,818.00	$58,533.00	2026-05-08
623-3	OTHER	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	6	6	—	—	$31,449.00	$59,164.00	$47,557.50	2026-05-08
623-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	6	6	—	—	$41,815.00	$78,665.00	$63,233.00	2026-05-08
625-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Other Significant Condition	6	6	—	—	$51,887.00	$97,614.00	$78,464.50	2026-05-08
630-2	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	6	6	—	—	$41,429.00	$77,940.00	$62,649.50	2026-05-08
630-3	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	6	6	—	—	$90,905.00	$171,017.00	$137,467.50	2026-05-08
630-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	6	6	—	—	$164,915.00	$310,250.00	$249,386.00	2026-05-08
631-2	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	6	6	—	—	$30,787.00	$57,919.00	$46,556.50	2026-05-08
631-3	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	6	6	—	—	$53,447.00	$100,548.00	$80,823.00	2026-05-08
631-4	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	6	6	—	—	$181,845.00	$342,101.00	$274,988.00	2026-05-08
633-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Anomaly	6	6	—	—	$59,532.00	$111,996.00	$90,025.00	2026-05-08
634-4	OTHER	Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…	6	6	—	—	$36,110.00	$67,933.00	$54,606.00	2026-05-08
650-4	OTHER	Splenic Procedures	6	6	—	—	$33,868.00	$63,716.00	$51,216.00	2026-05-08
651-4	OTHER	Other Procedures Of Blood And Blood-forming Organs	6	6	—	—	$38,048.00	$71,580.00	$57,537.00	2026-05-08
680-4	OTHER	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	6	6	—	—	$52,970.00	$99,651.00	$80,102.00	2026-05-08
681-4	OTHER	Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	6	6	—	—	$44,316.00	$83,371.00	$67,015.50	2026-05-08
690-3	OTHER	Acute Leukemia	6	6	—	—	$31,984.00	$60,171.00	$48,366.00	2026-05-08
690-4	OTHER	Acute Leukemia	6	6	—	—	$47,349.00	$89,076.00	$71,601.00	2026-05-08
695-4	OTHER	Chemotherapy For Acute Leukemia	6	6	—	—	$43,579.00	$81,983.00	$65,900.00	2026-05-08
7	OTHER	Lung Transplant	35	19	—	$170,816.00	$95,509.00	$572,000.00	$104,472.00	2026-05-08
710-4	OTHER	Infectious And Parasitic Diseases Including HIV With O.r. Procedure	6	6	—	—	$36,366.00	$68,414.00	$54,993.00	2026-05-08
711-4	OTHER	Post-operative, Post-trauma, Other Device Infections With O.r. Procedure	6	6	—	—	$35,455.00	$66,700.00	$53,615.00	2026-05-08
740-4	OTHER	Mental Illness Diagnosis With O.r. Procedure	6	6	—	—	$44,871.00	$84,415.00	$67,854.50	2026-05-08
790	OTHER	Extreme Immaturity Or Respiratory Distress Syndrome, Neonate	29	19	—	$78,810.00	$43,540.00	$151,797.00	$46,723.00	2026-05-08
792-4	OTHER	Extensive O.r. Procedures For Other Complications Of Treatment	6	6	—	—	$38,446.00	$72,327.00	$58,137.50	2026-05-08
820	OTHER	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	32	17	—	$77,776.00	$42,647.00	$149,787.00	$46,985.50	2026-05-08
841-1	OTHER	Extensive Third Degree Burns With Skin Graft	6	6	—	—	$35,859.00	$67,460.00	$54,226.00	2026-05-08
841-2	OTHER	Extensive Third Degree Burns With Skin Graft	6	6	—	—	$35,859.00	$67,460.00	$54,226.00	2026-05-08
841-3	OTHER	Extensive Third Degree Burns With Skin Graft	6	6	—	—	$54,727.00	$102,956.00	$82,758.00	2026-05-08
841-4	OTHER	Extensive Third Degree Burns With Skin Graft	6	6	—	—	$168,280.00	$316,581.00	$254,475.00	2026-05-08
842-3	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	6	6	—	—	$38,055.00	$71,592.00	$57,547.00	2026-05-08
842-4	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	6	6	—	—	$94,213.00	$177,240.00	$142,469.00	2026-05-08
850	OTHER	Acute Leukemia With Other Procedures	30	19	—	$114,474.00	$64,746.00	$221,164.00	$68,307.00	2026-05-08
850-4	OTHER	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	6	6	—	—	$49,416.00	$92,965.00	$74,727.50	2026-05-08
851-3	OTHER	Gender Related Procedures	6	6	—	—	$86,935.00	$163,549.00	$131,464.50	2026-05-08
851-4	OTHER	Gender Related Procedures	6	6	—	—	$86,935.00	$163,549.00	$131,464.50	2026-05-08
863-3	OTHER	Neonatal Aftercare	6	6	—	—	$37,911.00	$71,320.00	$57,328.50	2026-05-08
863-4	OTHER	Neonatal Aftercare	6	6	—	—	$74,108.00	$139,418.00	$112,067.00	2026-05-08
870	OTHER	Septicemia Or Severe Sepsis With Mv >96 Hours	35	19	—	$91,525.00	$50,920.00	$185,528.00	$55,854.00	2026-05-08
89-3	OTHER	Major Cranial Or Facial Bone Procedures	6	6	—	—	$32,127.00	$60,439.00	$48,582.50	2026-05-08
89-4	OTHER	Major Cranial Or Facial Bone Procedures	6	6	—	—	$43,085.00	$81,054.00	$65,153.00	2026-05-08
91-3	OTHER	Other Major Head And Neck Procedures	6	6	—	—	$33,534.00	$63,087.00	$50,711.00	2026-05-08
91-4	OTHER	Other Major Head And Neck Procedures	6	6	—	—	$50,187.00	$94,416.00	$75,894.00	2026-05-08
910-3	OTHER	Craniotomy For Multiple Significant Trauma	6	6	—	—	$35,178.00	$66,180.00	$53,197.00	2026-05-08
910-4	OTHER	Craniotomy For Multiple Significant Trauma	6	6	—	—	$54,495.00	$102,521.00	$82,408.00	2026-05-08
911-4	OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	6	6	—	—	$51,833.00	$97,513.00	$78,383.00	2026-05-08
912-3	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	6	6	—	—	$30,569.00	$57,509.00	$46,227.00	2026-05-08
912-4	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	6	6	—	—	$48,194.00	$90,666.00	$72,879.50	2026-05-08
92-4	OTHER	Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures	6	6	—	—	$41,070.00	$77,264.00	$62,107.00	2026-05-08
927	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	35	19	—	$281,122.00	$159,357.00	$545,292.00	$173,228.00	2026-05-08
928	OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	35	19	—	$94,950.00	$48,895.00	$183,191.00	$57,955.00	2026-05-08
950-4	OTHER	Extensive O.r. Procedure Unrelated To Principal Diagnosis	6	6	—	—	$42,805.00	$80,527.00	$64,729.00	2026-05-08
951-4	OTHER	Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis	6	6	—	—	$33,563.00	$63,141.00	$50,754.50	2026-05-08
952-4	OTHER	Non-extensive O.r. Procedure Unrelated To Principal Diagnosis	6	6	—	—	$30,570.00	$57,511.00	$46,228.00	2026-05-08
955	OTHER	Craniotomy For Multiple Significant Trauma	35	19	—	$89,152.00	$49,985.00	$171,912.00	$54,400.00	2026-05-08
957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	35	19	—	$100,823.00	$54,624.00	$210,977.00	$61,556.00	2026-05-08
969	OTHER	HIV With Extensive O.r. Procedures With Mcc	35	19	—	$81,144.00	$45,824.00	$172,077.00	$49,490.00	2026-05-08
98-4	OTHER	Other Ear, Nose, Mouth, Throat, Craniofacial, And Neck Procedures	6	6	—	—	$31,107.00	$58,521.00	$47,040.50	2026-05-08
Q2043	OTHER	Sipuleucel-t; Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm…	41	20	—	$63,866.98	$51,648.94	$226,311.24	$58,868.69	2026-05-08

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