|
927
|
OTHER
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
32
|
14
|
—
|
—
|
$67.38
|
$322,222.04
|
$201,621.82
|
2026-02-28
|
|
957
|
OTHER
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
32
|
14
|
—
|
—
|
$67.38
|
$117,611.75
|
$73,358.90
|
2026-02-28
|
|
870
|
OTHER
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
32
|
14
|
—
|
—
|
$67.38
|
$108,237.90
|
$72,158.60
|
2026-02-28
|
|
928
|
OTHER
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
32
|
14
|
—
|
—
|
$67.38
|
$111,691.70
|
$72,156.98
|
2026-02-28
|
|
955
|
OTHER
|
Craniotomy For Multiple Significant Trauma
|
32
|
14
|
—
|
—
|
$67.38
|
$107,572.14
|
$70,890.76
|
2026-02-28
|
|
969
|
OTHER
|
HIV With Extensive O.r. Procedures With Mcc
|
32
|
14
|
—
|
—
|
$67.38
|
$97,773.23
|
$65,182.15
|
2026-02-28
|
|
820
|
OTHER
|
Lymphoma And Leukemia With Major O.r. Procedures With Mcc
|
32
|
14
|
—
|
—
|
$67.38
|
$94,377.68
|
$62,472.95
|
2026-02-28
|
|
18
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
31
|
14
|
—
|
—
|
$67.38
|
$588,394.52
|
$336,532.84
|
2026-02-28
|
|
1
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
31
|
14
|
—
|
—
|
$67.38
|
$387,720.53
|
$253,492.18
|
2026-02-28
|
|
3
|
OTHER
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
31
|
14
|
—
|
—
|
$67.38
|
$297,719.13
|
$194,880.41
|
2026-02-28
|
|
63600973
|
OTHER
|
Sipuleucel-t Susp 250 Ml
|
31
|
15
|
$174,982.50
|
$61,243.88
65% off
|
$43,300.08
|
$210,723.57
|
$127,011.82
|
2024-12-31
|
|
14
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
31
|
14
|
—
|
—
|
$67.38
|
$183,612.13
|
$122,408.09
|
2026-02-28
|
|
7
|
OTHER
|
Lung Transplant
|
31
|
14
|
—
|
—
|
$67.38
|
$188,174.42
|
$122,120.98
|
2026-02-28
|
|
2
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
31
|
14
|
—
|
—
|
$67.38
|
$166,749.99
|
$104,293.05
|
2026-02-28
|
|
212
|
OTHER
|
Concomitant Aortic And Mitral Valve Procedures
|
31
|
14
|
—
|
—
|
$67.38
|
$160,690.95
|
$103,198.55
|
2026-02-28
|
|
5
|
OTHER
|
Liver Transplant With Mcc Or Intestinal Transplant
|
31
|
14
|
—
|
—
|
$67.38
|
$153,229.99
|
$101,071.31
|
2026-02-28
|
|
215
|
OTHER
|
Other Heart Assist System Implant
|
31
|
14
|
—
|
—
|
$67.38
|
$150,894.40
|
$99,033.57
|
2026-02-28
|
|
216
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
31
|
14
|
—
|
—
|
$67.38
|
$146,244.28
|
$92,385.73
|
2026-02-28
|
|
231
|
OTHER
|
Coronary Bypass With Ptca With Mcc
|
31
|
14
|
—
|
—
|
$67.38
|
$128,334.55
|
$82,143.66
|
2026-02-28
|
|
456
|
OTHER
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
31
|
14
|
—
|
—
|
$67.38
|
$127,983.74
|
$82,102.77
|
2026-02-28
|
|
20
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
31
|
14
|
—
|
—
|
$67.38
|
$120,906.69
|
$78,552.15
|
2026-02-28
|
|
233
|
OTHER
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
31
|
14
|
—
|
—
|
$67.38
|
$117,946.67
|
$76,423.17
|
2026-02-28
|
|
219
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
31
|
14
|
—
|
—
|
$67.38
|
$118,384.85
|
$75,736.71
|
2026-02-28
|
|
10
|
OTHER
|
Pancreas Transplant
|
31
|
14
|
—
|
—
|
$67.38
|
$116,678.47
|
$74,487.61
|
2026-02-28
|
|
19
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
31
|
14
|
—
|
—
|
$67.38
|
$116,082.06
|
$74,124.89
|
2026-02-28
|
|
275
|
OTHER
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
31
|
14
|
—
|
—
|
$67.38
|
$111,131.73
|
$69,903.11
|
2026-02-28
|
|
573
|
OTHER
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
31
|
14
|
—
|
—
|
$67.38
|
$103,466.91
|
$68,977.94
|
2026-02-28
|
|
207
|
OTHER
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
31
|
14
|
—
|
—
|
$67.38
|
$101,922.03
|
$67,948.02
|
2026-02-28
|
|
268
|
OTHER
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
31
|
14
|
—
|
—
|
$67.38
|
$107,789.13
|
$66,428.18
|
2026-02-28
|
|
217
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
31
|
14
|
—
|
—
|
$67.38
|
$103,783.30
|
$64,603.72
|
2026-02-28
|
|
16
|
OTHER
|
Autologous Bone Marrow Transplant With Cc/mcc
|
31
|
14
|
—
|
—
|
$67.38
|
$95,236.82
|
$63,491.22
|
2026-02-28
|
|
276
|
OTHER
|
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator
|
31
|
14
|
—
|
—
|
$67.38
|
$96,254.83
|
$62,311.17
|
2026-02-28
|
|
232
|
OTHER
|
Coronary Bypass With Ptca Without Mcc
|
31
|
14
|
—
|
—
|
$67.38
|
$96,996.16
|
$61,565.55
|
2026-02-28
|
|
463
|
OTHER
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …
|
31
|
14
|
—
|
—
|
$67.38
|
$92,189.43
|
$61,459.62
|
2026-02-28
|
|
28
|
OTHER
|
Spinal Procedures With Mcc
|
31
|
14
|
—
|
—
|
$67.38
|
$96,277.33
|
$61,311.50
|
2026-02-28
|
|
17
|
OTHER
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
31
|
14
|
—
|
—
|
$67.38
|
$91,398.24
|
$60,932.16
|
2026-02-28
|
|
790
|
OTHER
|
Extreme Immaturity Or Respiratory Distress Syndrome, Neonate
|
27
|
13
|
—
|
—
|
$67.38
|
$172,594.61
|
$63,613.01
|
2026-02-28
|
|
4
|
OTHER
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
26
|
13
|
—
|
—
|
$67.38
|
$200,104.54
|
$132,378.41
|
2026-02-28
|
|
426
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
26
|
13
|
—
|
—
|
$67.38
|
$162,638.26
|
$99,557.44
|
2026-02-28
|
|
850
|
OTHER
|
Acute Leukemia With Other Procedures
|
26
|
13
|
—
|
—
|
$67.38
|
$132,846.79
|
$88,564.53
|
2026-02-28
|
|
427
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
26
|
13
|
—
|
—
|
$67.38
|
$112,299.32
|
$70,213.71
|
2026-02-28
|
|
317
|
OTHER
|
Concomitant Left Atrial Appendage Closure And Cardiac Ablation
|
26
|
13
|
—
|
—
|
$67.38
|
$105,255.37
|
$62,241.57
|
2026-02-28
|
|
429
|
OTHER
|
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc
|
25
|
13
|
—
|
—
|
$67.38
|
$136,008.64
|
$80,983.90
|
2026-02-28
|
|
447
|
OTHER
|
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…
|
25
|
13
|
—
|
—
|
$67.38
|
$105,190.50
|
$66,750.97
|
2026-02-28
|
|
002-4
|
OTHER
|
Heart &/or Lung Transplant
|
8
|
3
|
—
|
—
|
$346,148.00
|
$1,099,608.41
|
$369,804.87
|
2026-02-28
|
|
161-4
|
OTHER
|
Cardiac Defibrillator & Heart Assist Implant
|
8
|
3
|
—
|
—
|
$307,088.02
|
$990,901.77
|
$336,710.52
|
2026-02-28
|
|
841-4
|
OTHER
|
Extensive 3rd Degree Burns W Skin Graft
|
8
|
3
|
—
|
—
|
$262,265.00
|
$856,935.31
|
$318,170.67
|
2026-02-28
|
|
001-4
|
OTHER
|
Liver Transplant &/or Intestinal Transplant
|
8
|
3
|
—
|
—
|
$238,932.00
|
$794,156.32
|
$274,821.95
|
2026-02-28
|
|
004-4
|
OTHER
|
Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo
|
8
|
3
|
—
|
—
|
$175,860.18
|
$750,329.84
|
$234,545.09
|
2026-02-28
|
|
002-3
|
OTHER
|
Heart &/or Lung Transplant
|
8
|
3
|
—
|
—
|
$210,158.00
|
$698,530.39
|
$233,340.82
|
2026-02-28
|
|
006-4
|
OTHER
|
Pancreas Transplant
|
8
|
3
|
—
|
—
|
$187,423.30
|
$358,237.17
|
$220,287.11
|
2026-02-28
|
|
160-4
|
OTHER
|
Major Cardiothoracic Repair Of Heart Anomaly
|
8
|
3
|
—
|
—
|
$146,740.10
|
$372,635.88
|
$194,896.12
|
2026-02-28
|
|
161-3
|
OTHER
|
Cardiac Defibrillator & Heart Assist Implant
|
8
|
3
|
—
|
—
|
$81,123.34
|
$417,619.91
|
$181,924.02
|
2026-02-28
|
|
842-4
|
OTHER
|
Full Thickness Burns W Skin Graft
|
8
|
3
|
—
|
—
|
$144,322.00
|
$416,710.68
|
$177,474.35
|
2026-02-28
|
|
002-2
|
OTHER
|
Heart &/or Lung Transplant
|
8
|
3
|
—
|
—
|
$159,365.92
|
$439,964.85
|
$170,676.92
|
2026-02-28
|
|
005-4
|
OTHER
|
Tracheostomy W Mv 96+ Hours Without Extensive Procedure
|
8
|
3
|
—
|
—
|
$113,678.78
|
$537,714.87
|
$163,242.24
|
2026-02-28
|
|
002-1
|
OTHER
|
Heart &/or Lung Transplant
|
8
|
3
|
—
|
—
|
$130,769.00
|
$408,894.35
|
$161,045.64
|
2026-02-28
|
|
863-4
|
OTHER
|
Neonatal Aftercare
|
8
|
3
|
—
|
—
|
$132,070.33
|
$202,888.49
|
$159,444.42
|
2026-02-28
|
|
303-4
|
OTHER
|
Dorsal & Lumbar Fusion Proc For Curvature Of Back
|
8
|
3
|
—
|
—
|
$107,177.51
|
$451,505.98
|
$157,122.44
|
2026-02-28
|
|
004-3
|
OTHER
|
Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo
|
8
|
3
|
—
|
—
|
$135,150.21
|
$428,679.68
|
$154,479.13
|
2026-02-28
|
|
006-3
|
OTHER
|
Pancreas Transplant
|
8
|
3
|
—
|
—
|
$122,891.32
|
$261,163.35
|
$152,989.28
|
2026-02-28
|
|
440-4
|
OTHER
|
Kidney Transplant
|
8
|
3
|
—
|
—
|
$130,841.00
|
$433,558.21
|
$151,631.59
|
2026-02-28
|
|
162-4
|
OTHER
|
Cardiac Valve Procedures W Cardiac Catheterization
|
8
|
3
|
—
|
—
|
$112,121.61
|
$434,200.02
|
$141,049.82
|
2026-02-28
|
|
001-3
|
OTHER
|
Liver Transplant &/or Intestinal Transplant
|
8
|
3
|
—
|
—
|
$119,777.97
|
$404,210.66
|
$140,613.20
|
2026-02-28
|
|
910-4
|
OTHER
|
Craniotomy For Multiple Significant Trauma
|
8
|
3
|
—
|
—
|
$81,326.99
|
$303,522.84
|
$138,138.66
|
2026-02-28
|
|
006-2
|
OTHER
|
Pancreas Transplant
|
8
|
3
|
—
|
—
|
$106,477.76
|
$209,959.87
|
$129,058.34
|
2026-02-28
|
|
850-4
|
OTHER
|
Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service
|
8
|
3
|
—
|
—
|
$66,202.27
|
$393,529.10
|
$128,800.55
|
2026-02-28
|
|
004-2
|
OTHER
|
Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo
|
8
|
3
|
—
|
—
|
$105,020.86
|
$331,999.35
|
$127,235.02
|
2026-02-28
|
|
304-4
|
OTHER
|
Dorsal & Lumbar Fusion Proc Except For Curvature Of Back
|
8
|
3
|
—
|
—
|
$82,265.89
|
$396,230.06
|
$124,815.58
|
2026-02-28
|
|
312-4
|
OTHER
|
Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses
|
8
|
3
|
—
|
—
|
$104,044.00
|
$508,810.48
|
$124,530.92
|
2026-02-28
|
|
161-2
|
OTHER
|
Cardiac Defibrillator & Heart Assist Implant
|
8
|
3
|
—
|
—
|
$46,196.10
|
$254,623.00
|
$124,420.19
|
2026-02-28
|
|
163-4
|
OTHER
|
Cardiac Valve Procedures Without Cardiac Catheterization
|
8
|
3
|
—
|
—
|
$98,940.48
|
$364,101.33
|
$120,389.29
|
2026-02-28
|
|
680-4
|
OTHER
|
Major O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms
|
8
|
3
|
—
|
—
|
$78,023.62
|
$454,928.96
|
$120,118.96
|
2026-02-28
|
|
167-4
|
OTHER
|
Other Cardiothoracic Procedures
|
8
|
3
|
—
|
—
|
$107,038.90
|
$263,203.39
|
$119,137.76
|
2026-02-28
|
|
021-4
|
OTHER
|
Craniotomy Except For Trauma
|
8
|
3
|
—
|
—
|
$80,336.92
|
$330,562.92
|
$117,130.23
|
2026-02-28
|
|
260-4
|
OTHER
|
Major Pancreas, Liver & Shunt Procedures
|
8
|
3
|
—
|
—
|
$84,017.32
|
$319,491.69
|
$114,283.80
|
2026-02-28
|
|
911-4
|
OTHER
|
Extensive Abdominal/thoracic Procedures For Mult Significant Trauma
|
8
|
3
|
—
|
—
|
$73,271.68
|
$274,232.59
|
$113,002.92
|
2026-02-28
|
|
022-4
|
OTHER
|
Ventricular Shunt Procedures
|
8
|
3
|
—
|
—
|
$43,343.90
|
$298,548.80
|
$112,076.76
|
2026-02-28
|
|
844-4
|
OTHER
|
Partial Thickness Burns W Or Without Skin Graft
|
8
|
3
|
—
|
—
|
$40,235.00
|
$236,564.44
|
$111,359.33
|
2026-02-28
|
|
690-4
|
OTHER
|
Acute Leukemia
|
8
|
3
|
—
|
—
|
$81,407.41
|
$370,194.71
|
$111,152.74
|
2026-02-28
|
|
303-3
|
OTHER
|
Dorsal & Lumbar Fusion Proc For Curvature Of Back
|
8
|
3
|
—
|
—
|
$71,458.64
|
$264,273.07
|
$110,944.82
|
2026-02-28
|
|
005-3
|
OTHER
|
Tracheostomy W Mv 96+ Hours Without Extensive Procedure
|
8
|
3
|
—
|
—
|
$78,671.13
|
$369,774.48
|
$110,441.14
|
2026-02-28
|
|
001-2
|
OTHER
|
Liver Transplant &/or Intestinal Transplant
|
8
|
3
|
—
|
—
|
$103,541.00
|
$404,210.66
|
$110,014.17
|
2026-02-28
|
|
912-4
|
OTHER
|
Musculoskeletal & Other Procedures For Multiple Significant Trauma
|
8
|
3
|
—
|
—
|
$56,126.08
|
$299,897.37
|
$108,733.28
|
2026-02-28
|
|
220-4
|
OTHER
|
Major Stomach, Esophageal & Duodenal Procedures
|
8
|
3
|
—
|
—
|
$86,076.00
|
$304,283.07
|
$108,445.39
|
2026-02-28
|
|
006-1
|
OTHER
|
Pancreas Transplant
|
8
|
3
|
—
|
—
|
$87,819.60
|
$209,959.87
|
$108,147.79
|
2026-02-28
|
|
023-4
|
OTHER
|
Spinal Procedures
|
8
|
3
|
—
|
—
|
$63,252.94
|
$319,300.67
|
$108,021.68
|
2026-02-28
|
|
841-3
|
OTHER
|
Extensive 3rd Degree Burns W Skin Graft
|
8
|
3
|
—
|
—
|
$95,956.24
|
$291,263.49
|
$107,899.27
|
2026-02-28
|
|
089-4
|
OTHER
|
Major Cranial/facial Bone Procedures
|
8
|
3
|
—
|
—
|
$71,329.13
|
$289,502.33
|
$106,883.11
|
2026-02-28
|
|
165-4
|
OTHER
|
Coronary Bypass W Cardiac Cath Or Percutaneous Cardiac Procedure
|
8
|
3
|
—
|
—
|
$70,281.62
|
$324,595.61
|
$106,062.37
|
2026-02-28
|
|
651-4
|
OTHER
|
Other Procedures Of Blood & Blood-forming Organs
|
8
|
3
|
—
|
—
|
$79,402.39
|
$271,829.63
|
$102,622.55
|
2026-02-28
|
|
004-1
|
OTHER
|
Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo
|
8
|
3
|
—
|
—
|
$92,078.00
|
$331,999.35
|
$102,044.20
|
2026-02-28
|
|
001-1
|
OTHER
|
Liver Transplant &/or Intestinal Transplant
|
8
|
3
|
—
|
—
|
$98,621.94
|
$404,210.66
|
$100,928.24
|
2026-02-28
|
|
169-4
|
OTHER
|
Major Thoracic & Abdominal Vascular Procedures
|
8
|
3
|
—
|
—
|
$76,266.97
|
$294,128.72
|
$100,194.02
|
2026-02-28
|
|
020-4
|
OTHER
|
Craniotomy For Trauma
|
8
|
3
|
—
|
—
|
$69,307.21
|
$278,664.14
|
$99,909.38
|
2026-02-28
|
|
401-4
|
OTHER
|
Pituitary & Adrenal Procedures
|
8
|
3
|
—
|
—
|
$60,853.00
|
$389,395.54
|
$98,245.24
|
2026-02-28
|
|
950-4
|
OTHER
|
Extensive Procedure Unrelated To Principal Diagnosis
|
8
|
3
|
—
|
—
|
$60,862.35
|
$351,750.30
|
$97,489.92
|
2026-02-28
|
|
681-4
|
OTHER
|
Other O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms
|
8
|
3
|
—
|
—
|
$61,208.04
|
$347,383.70
|
$97,423.43
|
2026-02-28
|
|
403-4
|
OTHER
|
Procedures For Obesity
|
8
|
3
|
—
|
—
|
$74,457.00
|
$309,356.43
|
$96,461.41
|
2026-02-28
|
|
161-1
|
OTHER
|
Cardiac Defibrillator & Heart Assist Implant
|
8
|
3
|
—
|
—
|
$32,887.56
|
$214,479.00
|
$95,833.49
|
2026-02-28
|
|
841-2
|
OTHER
|
Extensive 3rd Degree Burns W Skin Graft
|
8
|
3
|
—
|
—
|
$73,659.00
|
$291,263.49
|
$95,202.98
|
2026-02-28
|
|
440-3
|
OTHER
|
Kidney Transplant
|
8
|
3
|
—
|
—
|
$84,675.00
|
$218,337.79
|
$94,802.64
|
2026-02-28
|
|
166-4
|
OTHER
|
Coronary Bypass Without Cardiac Cath Or Percutaneous Cardiac Procedure
|
8
|
3
|
—
|
—
|
$69,686.32
|
$349,087.55
|
$92,450.76
|
2026-02-28
|
|
091-4
|
OTHER
|
Other Major Head & Neck Procedures
|
8
|
3
|
—
|
—
|
$79,542.67
|
$174,366.13
|
$90,666.43
|
2026-02-28
|
|
073-4
|
OTHER
|
Eye Procedures Except Orbit
|
8
|
3
|
—
|
—
|
$64,945.00
|
$109,864.19
|
$90,231.54
|
2026-02-28
|
|
162-3
|
OTHER
|
Cardiac Valve Procedures W Cardiac Catheterization
|
8
|
3
|
—
|
—
|
$63,563.12
|
$221,298.52
|
$89,972.99
|
2026-02-28
|
|
321-4
|
OTHER
|
Cervical Spinal Fusion & Other Back/neck Proc Exc Disc Excis/decomp
|
8
|
3
|
—
|
—
|
$51,925.58
|
$371,719.01
|
$89,946.90
|
2026-02-28
|
|
441-4
|
OTHER
|
Major Bladder Procedures
|
8
|
3
|
—
|
—
|
$75,458.62
|
$323,655.82
|
$89,341.46
|
2026-02-28
|
|
361-4
|
OTHER
|
Skin Graft For Skin & Subcutaneous Tissue Diagnoses
|
8
|
3
|
—
|
—
|
$86,416.73
|
$390,167.24
|
$88,862.40
|
2026-02-28
|
|
510-4
|
OTHER
|
Pelvic Evisceration, Radical Hysterectomy & Other Radical GYN Procs
|
8
|
3
|
—
|
—
|
$68,374.00
|
$264,597.80
|
$88,483.59
|
2026-02-28
|
|
120-4
|
OTHER
|
Major Respiratory & Chest Procedures
|
8
|
3
|
—
|
—
|
$70,881.09
|
$264,567.24
|
$88,381.37
|
2026-02-28
|
|
710-4
|
OTHER
|
Infectious & Parasitic Diseases Including HIV W O.r. Procedure
|
8
|
3
|
—
|
—
|
$52,989.80
|
$275,279.36
|
$86,673.52
|
2026-02-28
|
|
841-1
|
OTHER
|
Extensive 3rd Degree Burns W Skin Graft
|
8
|
3
|
—
|
—
|
$73,087.00
|
$291,263.49
|
$86,155.17
|
2026-02-28
|
|
005-2
|
OTHER
|
Tracheostomy W Mv 96+ Hours Without Extensive Procedure
|
8
|
3
|
—
|
—
|
$73,359.41
|
$247,360.60
|
$85,649.74
|
2026-02-28
|
|
423-4
|
OTHER
|
Inborn Errors Of Metabolism
|
8
|
3
|
—
|
—
|
$48,539.27
|
$200,871.37
|
$85,635.06
|
2026-02-28
|
|
264-4
|
OTHER
|
Other Hepatobiliary, Pancreas & Abdominal Procedures
|
8
|
3
|
—
|
—
|
$54,860.29
|
$307,369.88
|
$84,323.39
|
2026-02-28
|
|
711-4
|
OTHER
|
Post-op, Post-trauma, Other Device Infections W O.r. Procedure
|
8
|
3
|
—
|
—
|
$55,960.02
|
$265,281.63
|
$84,111.74
|
2026-02-28
|
|
440-2
|
OTHER
|
Kidney Transplant
|
8
|
3
|
—
|
—
|
$70,003.16
|
$181,979.99
|
$83,924.37
|
2026-02-28
|
|
121-4
|
OTHER
|
Other Respiratory & Chest Procedures
|
8
|
3
|
—
|
—
|
$68,781.00
|
$276,203.87
|
$82,403.89
|
2026-02-28
|
|
405-4
|
OTHER
|
Other Procedures For Endocrine, Nutritional & Metabolic Disorders
|
8
|
3
|
—
|
—
|
$75,566.19
|
$328,954.57
|
$81,834.61
|
2026-02-28
|
|
650-4
|
OTHER
|
Splenectomy
|
8
|
3
|
—
|
—
|
$63,755.00
|
$248,827.60
|
$81,587.06
|
2026-02-28
|
|
026-4
|
OTHER
|
Other Nervous System & Related Procedures
|
8
|
3
|
—
|
—
|
$45,875.48
|
$293,490.73
|
$80,838.36
|
2026-02-28
|
|
514-4
|
OTHER
|
Female Reproductive System Reconstructive Procedures
|
8
|
3
|
—
|
—
|
$46,434.96
|
$186,514.69
|
$80,338.29
|
2026-02-28
|
|
440-1
|
OTHER
|
Kidney Transplant
|
8
|
3
|
—
|
—
|
$63,970.83
|
$156,540.61
|
$79,430.40
|
2026-02-28
|
|
024-4
|
OTHER
|
Extracranial Vascular Procedures
|
8
|
3
|
—
|
—
|
$51,360.57
|
$269,228.00
|
$79,400.78
|
2026-02-28
|
|
160-3
|
OTHER
|
Major Cardiothoracic Repair Of Heart Anomaly
|
8
|
3
|
—
|
—
|
$63,868.08
|
$159,168.98
|
$78,453.06
|
2026-02-28
|
|
130-4
|
OTHER
|
Respiratory System Diagnosis W Ventilator Support 96+ Hours
|
8
|
3
|
—
|
—
|
$55,956.89
|
$239,509.89
|
$78,445.23
|
2026-02-28
|
|
480-4
|
OTHER
|
Major Male Pelvic Procedures
|
8
|
3
|
—
|
—
|
$59,341.36
|
$99,518.82
|
$77,017.50
|
2026-02-28
|
|
447-4
|
OTHER
|
Other Kidney, Urinary Tract & Related Procedures
|
8
|
3
|
—
|
—
|
$50,285.90
|
$318,135.48
|
$76,853.37
|
2026-02-28
|
|
005-1
|
OTHER
|
Tracheostomy W Mv 96+ Hours Without Extensive Procedure
|
8
|
3
|
—
|
—
|
$69,060.00
|
$242,783.89
|
$76,853.37
|
2026-02-28
|
|
303-2
|
OTHER
|
Dorsal & Lumbar Fusion Proc For Curvature Of Back
|
8
|
3
|
—
|
—
|
$51,395.03
|
$189,968.24
|
$76,241.60
|
2026-02-28
|
|
404-4
|
OTHER
|
Thyroid, Parathyroid & Thyroglossal Procedures
|
8
|
3
|
—
|
—
|
$61,024.80
|
$93,127.45
|
$76,131.97
|
2026-02-28
|
|
092-4
|
OTHER
|
Facial Bone Procedures Except Major Cranial/facial Bone Procedures
|
8
|
3
|
—
|
—
|
$65,326.00
|
$103,309.00
|
$75,003.20
|
2026-02-28
|
|
261-4
|
OTHER
|
Major Biliary Tract Procedures
|
8
|
3
|
—
|
—
|
$58,022.68
|
$272,895.49
|
$74,770.29
|
2026-02-28
|
|
692-4
|
OTHER
|
Radiotherapy
|
8
|
3
|
—
|
—
|
$52,888.16
|
$118,612.67
|
$74,380.81
|
2026-02-28
|
|
222-4
|
OTHER
|
Other Stomach, Esophageal & Duodenal Procedures
|
8
|
3
|
—
|
—
|
$59,325.00
|
$219,930.85
|
$74,291.58
|
2026-02-28
|
|
740-4
|
OTHER
|
Mental Illness Diagnosis W O.r. Procedure
|
8
|
3
|
—
|
—
|
$54,342.16
|
$91,088.13
|
$74,219.98
|
2026-02-28
|
|
483-4
|
OTHER
|
Testes & Scrotal Procedures
|
8
|
3
|
—
|
—
|
$53,603.00
|
$134,990.30
|
$74,170.96
|
2026-02-28
|
|
223-4
|
OTHER
|
Other Small & Large Bowel Procedures
|
8
|
3
|
—
|
—
|
$55,045.14
|
$231,834.91
|
$74,006.95
|
2026-02-28
|
|
163-3
|
OTHER
|
Cardiac Valve Procedures Without Cardiac Catheterization
|
8
|
3
|
—
|
—
|
$48,951.18
|
$179,603.76
|
$72,072.51
|
2026-02-28
|
|
843-4
|
OTHER
|
Extensive 3rd Degree Or Full Thickness Burns Without Skin Graft
|
8
|
3
|
—
|
—
|
$61,868.00
|
$129,492.89
|
$71,485.79
|
2026-02-28
|
|
951-4
|
OTHER
|
Moderately Extensive Procedure Unrelated To Principal Diagnosis
|
8
|
3
|
—
|
—
|
$55,620.60
|
$263,906.32
|
$71,302.85
|
2026-02-28
|
|
910-3
|
OTHER
|
Craniotomy For Multiple Significant Trauma
|
8
|
3
|
—
|
—
|
$58,603.00
|
$164,253.80
|
$70,875.89
|
2026-02-28
|
|
165-3
|
OTHER
|
Coronary Bypass W Cardiac Cath Or Percutaneous Cardiac Procedure
|
8
|
3
|
—
|
—
|
$45,764.78
|
$186,002.77
|
$70,422.05
|
2026-02-28
|
|
304-3
|
OTHER
|
Dorsal & Lumbar Fusion Proc Except For Curvature Of Back
|
8
|
3
|
—
|
—
|
$42,317.27
|
$209,822.34
|
$70,271.28
|
2026-02-28
|
|
176-4
|
OTHER
|
Cardiac Pacemaker & Defibrillator Device Replacement
|
8
|
3
|
—
|
—
|
$59,055.57
|
$130,199.64
|
$69,990.37
|
2026-02-28
|
|
317-4
|
OTHER
|
Tendon, Muscle & Other Soft Tissue Procedures
|
8
|
3
|
—
|
—
|
$57,297.87
|
$259,207.36
|
$69,737.32
|
2026-02-28
|
|
229-4
|
OTHER
|
Other Digestive System & Abdominal Procedures
|
8
|
3
|
—
|
—
|
$47,512.02
|
$228,438.66
|
$69,594.99
|
2026-02-28
|
|
511-4
|
OTHER
|
Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy
|
8
|
3
|
—
|
—
|
$54,491.62
|
$237,702.89
|
$69,594.99
|
2026-02-28
|
|
863-3
|
OTHER
|
Neonatal Aftercare
|
8
|
3
|
—
|
—
|
$34,517.84
|
$140,197.37
|
$68,883.39
|
2026-02-28
|
|
162-2
|
OTHER
|
Cardiac Valve Procedures W Cardiac Catheterization
|
8
|
3
|
—
|
—
|
$45,112.04
|
$163,069.51
|
$68,659.90
|
2026-02-28
|
|
224-4
|
OTHER
|
Peritoneal Adhesiolysis
|
8
|
3
|
—
|
—
|
$41,398.22
|
$193,425.61
|
$67,887.14
|
2026-02-28
|
|
444-4
|
OTHER
|
Renal Dialysis Access Device Procedure Only
|
8
|
3
|
—
|
—
|
$35,168.49
|
$261,533.92
|
$66,525.61
|
2026-02-28
|
|
320-4
|
OTHER
|
Other Musculoskeletal System & Connective Tissue Procedures
|
8
|
3
|
—
|
—
|
$48,769.46
|
$241,553.75
|
$65,752.33
|
2026-02-28
|
|
484-4
|
OTHER
|
Other Male Reproductive System & Related Procedures
|
8
|
3
|
—
|
—
|
$38,438.61
|
$79,995.00
|
$65,603.46
|
2026-02-28
|
|
303-1
|
OTHER
|
Dorsal & Lumbar Fusion Proc For Curvature Of Back
|
8
|
3
|
—
|
—
|
$45,120.39
|
$164,498.30
|
$65,183.04
|
2026-02-28
|
|
362-4
|
OTHER
|
Mastectomy Procedures
|
8
|
3
|
—
|
—
|
$45,148.00
|
$112,137.27
|
$65,071.71
|
2026-02-28
|
|
309-4
|
OTHER
|
Hip & Femur Procedures For Non-trauma Except Joint Replacement
|
8
|
3
|
—
|
—
|
$56,576.21
|
$251,631.70
|
$64,898.40
|
2026-02-28
|
|
170-4
|
OTHER
|
Permanent Cardiac Pacemaker Implant W Ami, Heart Failure Or Shock
|
8
|
3
|
—
|
—
|
$45,325.09
|
$164,964.37
|
$64,329.12
|
2026-02-28
|
|
021-3
|
OTHER
|
Craniotomy Except For Trauma
|
8
|
3
|
—
|
—
|
$41,106.84
|
$182,625.62
|
$64,044.47
|
2026-02-28
|
|
952-4
|
OTHER
|
Nonextensive Procedure Unrelated To Principal Diagnosis
|
8
|
3
|
—
|
—
|
$45,495.33
|
$258,114.75
|
$63,048.22
|
2026-02-28
|
|
313-4
|
OTHER
|
Knee & Lower Leg Procedures Except Foot
|
8
|
3
|
—
|
—
|
$46,874.95
|
$277,552.44
|
$62,621.26
|
2026-02-28
|
|
842-3
|
OTHER
|
Full Thickness Burns W Skin Graft
|
8
|
3
|
—
|
—
|
$60,744.23
|
$180,600.86
|
$62,563.40
|
2026-02-28
|
|
442-4
|
OTHER
|
Kidney & Urinary Tract Procedures For Malignancy
|
8
|
3
|
—
|
—
|
$57,439.91
|
$271,608.05
|
$62,336.62
|
2026-02-28
|
|
305-4
|
OTHER
|
Amputation Of Lower Limb Except Toes
|
8
|
3
|
—
|
—
|
$43,986.19
|
$255,127.27
|
$62,078.56
|
2026-02-28
|
|
167-3
|
OTHER
|
Other Cardiothoracic Procedures
|
8
|
3
|
—
|
—
|
$47,996.62
|
$137,129.67
|
$62,070.99
|
2026-02-28
|
|
177-4
|
OTHER
|
Cardiac Pacemaker & Defibrillator Revision Except Device Replacement
|
8
|
3
|
—
|
—
|
$47,268.68
|
$279,569.55
|
$62,051.98
|
2026-02-28
|
|
050-4
|
OTHER
|
Non-bacterial Infections Of Nervous System Exc Viral Meningitis
|
8
|
3
|
—
|
—
|
$38,882.30
|
$194,216.41
|
$61,633.35
|
2026-02-28
|
|
049-4
|
OTHER
|
Bacterial & Tuberculous Infections Of Nervous System
|
8
|
3
|
—
|
—
|
$44,700.55
|
$198,036.71
|
$61,482.69
|
2026-02-28
|
|
180-4
|
OTHER
|
Other Circulatory System Procedures
|
8
|
3
|
—
|
—
|
$43,702.12
|
$223,304.18
|
$61,482.69
|
2026-02-28
|
|
162-1
|
OTHER
|
Cardiac Valve Procedures W Cardiac Catheterization
|
8
|
3
|
—
|
—
|
$40,056.19
|
$140,778.06
|
$61,376.24
|
2026-02-28
|
|
443-4
|
OTHER
|
Kidney & Urinary Tract Procedures For Nonmalignancy
|
8
|
3
|
—
|
—
|
$40,234.78
|
$218,758.02
|
$61,189.98
|
2026-02-28
|
|
519-4
|
OTHER
|
Uterine & Adnexa Procedures For Leiomyoma
|
8
|
3
|
—
|
—
|
$48,118.41
|
$167,948.03
|
$60,609.61
|
2026-02-28
|
|
588-4
|
OTHER
|
Neonate Bwt <1500g W Major Procedure
|
7
|
4
|
—
|
—
|
$287,612.08
|
$984,575.36
|
$511,065.00
|
2026-02-28
|
|
583-4
|
OTHER
|
Neonate W Ecmo
|
7
|
4
|
—
|
—
|
$378,197.00
|
$697,728.13
|
$474,617.00
|
2026-02-28
|
|
591-4
|
OTHER
|
Neonate Birthwt 500-749g Without Major Procedure
|
7
|
4
|
—
|
—
|
$193,095.60
|
$628,527.22
|
$369,055.00
|
2026-02-28
|
|
609-4
|
OTHER
|
Neonate Bwt 1500-2499g W Major Procedure
|
7
|
4
|
—
|
—
|
$137,844.71
|
$627,388.77
|
$346,348.00
|
2026-02-28
|
|
593-4
|
OTHER
|
Neonate Birthwt 750-999g Without Major Procedure
|
7
|
4
|
—
|
—
|
$165,591.83
|
$597,433.80
|
$331,483.00
|
2026-02-28
|
|
588-3
|
OTHER
|
Neonate Bwt <1500g W Major Procedure
|
7
|
4
|
—
|
—
|
$200,743.61
|
$808,245.59
|
$328,811.00
|
2026-02-28
|
|
630-4
|
OTHER
|
Neonate Birthwt >2499g W Major Cardiovascular Procedure
|
7
|
4
|
—
|
—
|
$132,941.35
|
$492,180.71
|
$268,782.00
|
2026-02-28
|
|
602-4
|
OTHER
|
Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
7
|
4
|
—
|
—
|
$154,290.58
|
$485,090.23
|
$268,467.00
|
2026-02-28
|
|
603-4
|
OTHER
|
Neonate Birthwt 1000-1249g W Or Without Other Significant Condition
|
7
|
4
|
—
|
—
|
$187,608.43
|
$517,050.86
|
$263,557.00
|
2026-02-28
|
|
591-3
|
OTHER
|
Neonate Birthwt 500-749g Without Major Procedure
|
7
|
4
|
—
|
—
|
$160,353.21
|
$436,900.97
|
$254,978.00
|
2026-02-28
|
|
593-3
|
OTHER
|
Neonate Birthwt 750-999g Without Major Procedure
|
7
|
4
|
—
|
—
|
$146,389.84
|
$497,571.15
|
$241,976.00
|
2026-02-28
|
|
631-4
|
OTHER
|
Neonate Birthwt >2499g W Other Major Procedure
|
7
|
4
|
—
|
—
|
$137,271.35
|
$408,405.35
|
$238,367.00
|
2026-02-28
|
|
589-2
|
OTHER
|
Neonate Bwt <500g Or Ga <24 Weeks
|
7
|
4
|
—
|
—
|
$183,604.00
|
$376,566.97
|
$221,490.50
|
2026-02-28
|
|
589-1
|
OTHER
|
Neonate Bwt <500g Or Ga <24 Weeks
|
7
|
4
|
—
|
—
|
$189,438.00
|
$376,566.97
|
$220,937.00
|
2026-02-28
|
|
607-4
|
OTHER
|
Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
7
|
4
|
—
|
—
|
$126,614.49
|
$406,995.66
|
$220,131.00
|
2026-02-28
|
|
593-2
|
OTHER
|
Neonate Birthwt 750-999g Without Major Procedure
|
7
|
4
|
—
|
—
|
$112,921.61
|
$430,746.47
|
$208,502.00
|
2026-02-28
|
|
588-2
|
OTHER
|
Neonate Bwt <1500g W Major Procedure
|
7
|
4
|
—
|
—
|
$138,951.76
|
$788,093.51
|
$196,721.00
|
2026-02-28
|
|
602-3
|
OTHER
|
Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
7
|
4
|
—
|
—
|
$123,738.26
|
$420,595.93
|
$186,311.00
|
2026-02-28
|
|
588-1
|
OTHER
|
Neonate Bwt <1500g W Major Procedure
|
7
|
4
|
—
|
—
|
$130,875.56
|
$788,093.51
|
$185,430.00
|
2026-02-28
|
|
611-4
|
OTHER
|
Neonate Birthwt 1500-1999g W Major Anomaly
|
7
|
4
|
—
|
—
|
$132,892.26
|
$310,326.79
|
$178,408.50
|
2026-02-28
|
|
608-4
|
OTHER
|
Neonate Bwt 1250-1499g W Or Without Other Significant Condition
|
7
|
4
|
—
|
—
|
$141,637.91
|
$299,534.44
|
$175,225.50
|
2026-02-28
|
|
609-3
|
OTHER
|
Neonate Bwt 1500-2499g W Major Procedure
|
7
|
4
|
—
|
—
|
$104,476.74
|
$287,607.47
|
$162,621.00
|
2026-02-28
|
|
603-3
|
OTHER
|
Neonate Birthwt 1000-1249g W Or Without Other Significant Condition
|
7
|
4
|
—
|
—
|
$100,477.81
|
$369,136.49
|
$160,147.00
|
2026-02-28
|
|
602-2
|
OTHER
|
Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
7
|
4
|
—
|
—
|
$82,105.06
|
$341,557.74
|
$157,031.00
|
2026-02-28
|
|
591-2
|
OTHER
|
Neonate Birthwt 500-749g Without Major Procedure
|
7
|
4
|
—
|
—
|
$59,529.99
|
$255,189.00
|
$148,339.70
|
2026-02-28
|
|
589-3
|
OTHER
|
Neonate Bwt <500g Or Ga <24 Weeks
|
7
|
4
|
—
|
—
|
$95,315.88
|
$214,543.00
|
$144,601.86
|
2026-02-28
|
|
621-4
|
OTHER
|
Neonate Bwt 2000-2499g W Major Anomaly
|
7
|
4
|
—
|
—
|
$83,214.19
|
$260,326.70
|
$144,553.00
|
2026-02-28
|
|
612-4
|
OTHER
|
Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond
|
7
|
4
|
—
|
—
|
$111,511.00
|
$275,848.58
|
$143,331.00
|
2026-02-28
|
|
607-3
|
OTHER
|
Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
7
|
4
|
—
|
—
|
$91,034.51
|
$314,785.12
|
$140,826.00
|
2026-02-28
|
|
613-4
|
OTHER
|
Neonate Birthwt 1500-1999g W Congenital/perinatal Infection
|
7
|
4
|
—
|
—
|
$119,330.97
|
$224,503.75
|
$134,390.00
|
2026-02-28
|
|
630-3
|
OTHER
|
Neonate Birthwt >2499g W Major Cardiovascular Procedure
|
7
|
4
|
—
|
—
|
$92,871.58
|
$236,121.28
|
$128,483.00
|
2026-02-28
|
|
614-4
|
OTHER
|
Neonate Bwt 1500-1999g W Or Without Other Significant Condition
|
7
|
4
|
—
|
—
|
$104,497.00
|
$210,788.87
|
$121,444.50
|
2026-02-28
|
|
631-3
|
OTHER
|
Neonate Birthwt >2499g W Other Major Procedure
|
7
|
4
|
—
|
—
|
$76,327.54
|
$220,488.61
|
$119,277.00
|
2026-02-28
|
|
608-3
|
OTHER
|
Neonate Bwt 1250-1499g W Or Without Other Significant Condition
|
7
|
4
|
—
|
—
|
$71,546.36
|
$292,978.81
|
$117,490.00
|
2026-02-28
|
|
633-4
|
OTHER
|
Neonate Birthwt >2499g W Major Anomaly
|
7
|
4
|
—
|
—
|
$67,300.96
|
$196,703.43
|
$110,527.50
|
2026-02-28
|
|
607-2
|
OTHER
|
Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
7
|
4
|
—
|
—
|
$58,334.95
|
$271,371.19
|
$110,405.00
|
2026-02-28
|
|
611-3
|
OTHER
|
Neonate Birthwt 1500-1999g W Major Anomaly
|
7
|
4
|
—
|
—
|
$64,355.80
|
$222,647.08
|
$106,242.00
|
2026-02-28
|
|
622-4
|
OTHER
|
Neonate Bwt 2000-2499g W Resp Dist Synd/oth Maj Resp Cond
|
7
|
4
|
—
|
—
|
$67,849.26
|
$185,456.46
|
$104,904.00
|
2026-02-28
|
|
603-2
|
OTHER
|
Neonate Birthwt 1000-1249g W Or Without Other Significant Condition
|
7
|
4
|
—
|
—
|
$74,797.52
|
$281,674.54
|
$104,260.00
|
2026-02-28
|
|
623-4
|
OTHER
|
Neonate Bwt 2000-2499g W Congenital/perinatal Infection
|
7
|
4
|
—
|
—
|
$76,105.09
|
$169,063.56
|
$97,261.50
|
2026-02-28
|
|
612-3
|
OTHER
|
Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond
|
7
|
4
|
—
|
—
|
$62,067.56
|
$222,016.73
|
$96,915.00
|
2026-02-28
|
|
609-2
|
OTHER
|
Neonate Bwt 1500-2499g W Major Procedure
|
7
|
4
|
—
|
—
|
$68,269.10
|
$169,732.11
|
$95,935.00
|
2026-02-28
|
|
613-3
|
OTHER
|
Neonate Birthwt 1500-1999g W Congenital/perinatal Infection
|
7
|
4
|
—
|
—
|
$65,133.87
|
$211,426.86
|
$93,794.00
|
2026-02-28
|
|
609-1
|
OTHER
|
Neonate Bwt 1500-2499g W Major Procedure
|
7
|
4
|
—
|
—
|
$62,164.69
|
$169,732.11
|
$92,614.50
|
2026-02-28
|
|
634-4
|
OTHER
|
Neonate, Birthwt >2499g W Resp Dist Synd/oth Maj Resp Cond
|
7
|
4
|
—
|
—
|
$43,838.94
|
$156,964.67
|
$90,105.00
|
2026-02-28
|
|
625-4
|
OTHER
|
Neonate Bwt 2000-2499g W Other Significant Condition
|
7
|
4
|
—
|
—
|
$65,716.63
|
$120,538.11
|
$89,251.14
|
2026-02-28
|
|
614-3
|
OTHER
|
Neonate Bwt 1500-1999g W Or Without Other Significant Condition
|
7
|
4
|
—
|
—
|
$51,478.58
|
$205,558.88
|
$84,081.00
|
2026-02-28
|
|
608-2
|
OTHER
|
Neonate Bwt 1250-1499g W Or Without Other Significant Condition
|
7
|
4
|
—
|
—
|
$48,329.78
|
$233,821.46
|
$81,376.00
|
2026-02-28
|
|
602-1
|
OTHER
|
Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
7
|
4
|
—
|
—
|
$61,850.00
|
$282,140.62
|
$79,499.00
|
2026-02-28
|
|
630-2
|
OTHER
|
Neonate Birthwt >2499g W Major Cardiovascular Procedure
|
7
|
4
|
—
|
—
|
$48,299.49
|
$146,649.86
|
$77,752.50
|
2026-02-28
|
|
621-3
|
OTHER
|
Neonate Bwt 2000-2499g W Major Anomaly
|
7
|
4
|
—
|
—
|
$50,034.20
|
$128,618.04
|
$75,378.00
|
2026-02-28
|
|
607-1
|
OTHER
|
Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
7
|
4
|
—
|
—
|
$51,381.46
|
$225,221.97
|
$74,233.00
|
2026-02-28
|
|
636-4
|
OTHER
|
Neonate Birthwt >2499g W Congenital/perinatal Infection
|
7
|
4
|
—
|
—
|
$53,576.50
|
$82,801.18
|
$72,006.94
|
2026-02-28
|
|
612-2
|
OTHER
|
Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond
|
7
|
4
|
—
|
—
|
$44,382.01
|
$151,719.39
|
$71,602.00
|
2026-02-28
|
|
623-3
|
OTHER
|
Neonate Bwt 2000-2499g W Congenital/perinatal Infection
|
7
|
4
|
—
|
—
|
$48,936.56
|
$154,733.61
|
$70,234.00
|
2026-02-28
|
|
613-2
|
OTHER
|
Neonate Birthwt 1500-1999g W Congenital/perinatal Infection
|
7
|
4
|
—
|
—
|
$43,190.38
|
$132,541.49
|
$67,462.00
|
2026-02-28
|
|
631-2
|
OTHER
|
Neonate Birthwt >2499g W Other Major Procedure
|
7
|
4
|
—
|
—
|
$38,021.73
|
$139,356.90
|
$66,056.00
|
2026-02-28
|
|
611-2
|
OTHER
|
Neonate Birthwt 1500-1999g W Major Anomaly
|
7
|
4
|
—
|
—
|
$36,248.38
|
$164,666.39
|
$63,104.00
|
2026-02-28
|
|
625-3
|
OTHER
|
Neonate Bwt 2000-2499g W Other Significant Condition
|
7
|
4
|
—
|
—
|
$42,542.86
|
$120,538.11
|
$62,498.00
|
2026-02-28
|
|
583-3
|
OTHER
|
Neonate W Ecmo
|
6
|
3
|
—
|
—
|
$262,129.19
|
$579,100.18
|
$415,338.24
|
2026-02-28
|
|
003-4
|
OTHER
|
Bone Marrow Transplant
|
6
|
2
|
—
|
—
|
$242,956.44
|
$1,107,844.98
|
$352,529.24
|
2026-02-28
|
|
583-2
|
OTHER
|
Neonate W Ecmo
|
6
|
3
|
—
|
—
|
$246,561.64
|
$570,622.93
|
$308,489.00
|
2026-02-28
|
|
583-1
|
OTHER
|
Neonate W Ecmo
|
6
|
3
|
—
|
—
|
$221,905.90
|
$570,622.93
|
$271,630.50
|
2026-02-28
|
|
003-3
|
OTHER
|
Bone Marrow Transplant
|
6
|
2
|
—
|
—
|
$149,332.91
|
$541,588.65
|
$200,530.36
|
2026-02-28
|
|
090-4
|
OTHER
|
Major Larynx & Trachea Procedures
|
6
|
2
|
—
|
—
|
$108,582.06
|
$200,577.21
|
$127,045.82
|
2026-02-28
|
|
003-2
|
OTHER
|
Bone Marrow Transplant
|
6
|
2
|
—
|
—
|
$89,290.40
|
$381,793.14
|
$122,111.46
|
2026-02-28
|
|
591-1
|
OTHER
|
Neonate Birthwt 500-749g Without Major Procedure
|
6
|
3
|
—
|
—
|
$45,270.51
|
$183,992.00
|
$103,299.72
|
2026-02-28
|
|
003-1
|
OTHER
|
Bone Marrow Transplant
|
6
|
2
|
—
|
—
|
$72,442.44
|
$332,992.63
|
$87,242.80
|
2026-02-28
|
|
221-4
|
OTHER
|
Major Small & Large Bowel Procedures
|
6
|
2
|
—
|
—
|
$53,120.35
|
$270,901.29
|
$85,250.30
|
2026-02-28
|
|
791-4
|
OTHER
|
O.r. Procedure For Other Complications Of Treatment
|
6
|
2
|
—
|
—
|
$64,929.17
|
$275,378.68
|
$82,119.24
|
2026-02-28
|
|
546-4
|
OTHER
|
Other O.r. Proc For Obstetric Diagnoses Except Delivery Diagnoses
|
6
|
2
|
—
|
—
|
$54,899.41
|
$78,529.23
|
$77,249.21
|
2026-02-28
|
|
481-4
|
OTHER
|
Penis Procedures
|
6
|
2
|
—
|
—
|
$61,024.80
|
$146,626.93
|
$74,918.67
|
2026-02-28
|
|
593-1
|
OTHER
|
Neonate Birthwt 750-999g Without Major Procedure
|
6
|
3
|
—
|
—
|
$42,356.00
|
$428,729.35
|
$69,408.52
|
2026-02-28
|
|
093-4
|
OTHER
|
Sinus & Mastoid Procedures
|
6
|
2
|
—
|
—
|
$48,555.36
|
$95,366.15
|
$67,744.82
|
2026-02-28
|
|
070-4
|
OTHER
|
Orbital Procedures
|
6
|
2
|
—
|
—
|
$56,816.19
|
$86,185.97
|
$65,668.40
|
2026-02-28
|
|
262-4
|
OTHER
|
Cholecystectomy Except Laparoscopic
|
6
|
2
|
—
|
—
|
$30,152.32
|
$191,828.72
|
$64,471.44
|
2026-02-28
|
|
173-4
|
OTHER
|
Other Vascular Procedures
|
4
|
2
|
—
|
—
|
$57,189.26
|
$284,283.80
|
$133,842.07
|
2026-02-28
|
|
693-4
|
OTHER
|
Chemotherapy
|
4
|
2
|
—
|
—
|
$60,599.16
|
$265,018.03
|
$128,414.46
|
2026-02-28
|
|
695-4
|
OTHER
|
Chemotherapy For Acute Leukemia
|
4
|
2
|
—
|
—
|
$72,009.27
|
$124,564.00
|
$85,503.76
|
2026-02-28
|
|
181-4
|
OTHER
|
Lower Extremity Arterial Procedures
|
4
|
2
|
—
|
—
|
$77,198.00
|
$99,228.00
|
$79,343.99
|
2026-02-28
|
|
182-4
|
OTHER
|
Other Peripheral Vascular Procedures
|
4
|
2
|
—
|
—
|
$68,304.00
|
$87,796.00
|
$69,594.99
|
2026-02-28
|
|
173-3
|
OTHER
|
Other Vascular Procedures
|
4
|
2
|
—
|
—
|
$27,076.62
|
$128,033.53
|
$60,938.84
|
2026-02-28
|
|
007-4
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
2
|
1
|
—
|
—
|
$291,670.00
|
$374,901.00
|
$333,285.50
|
2024-12-31
|
|
009-4
|
OTHER
|
Extracorporeal Membrane Oxygenation (ecmo)
|
2
|
1
|
—
|
—
|
$243,001.00
|
$312,343.00
|
$277,672.00
|
2024-12-31
|
|
612
|
OTHER
|
Neonate, Birth Weight <750 Grams, Discharged Alive
|
2
|
1
|
—
|
—
|
$237,150.80
|
$285,105.09
|
$261,127.95
|
2026-02-28
|
|
633
|
OTHER
|
Neonate, Birth Weight 1000-1499 Grams, With Significant O.r. Procedures, Dischar…
|
2
|
1
|
—
|
—
|
$195,515.27
|
$311,127.21
|
$253,321.24
|
2026-02-28
|
|
636
|
OTHER
|
Neonate, Birth Weight 1500-1999 Grams, With Significant O.r. Procedures, With Mu…
|
2
|
1
|
—
|
—
|
$182,813.14
|
$217,616.72
|
$200,214.93
|
2026-02-28
|
|
631
|
OTHER
|
Neonate, Birth Weight 750-999 Grams, Discharged Alive
|
2
|
1
|
—
|
—
|
$190,465.19
|
$206,732.43
|
$198,598.81
|
2026-02-28
|
|
007-3
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
2
|
1
|
—
|
—
|
$168,942.00
|
$217,151.00
|
$193,046.50
|
2024-12-31
|
|
008-4
|
OTHER
|
Autologous Bone Marrow Transplant
|
2
|
1
|
—
|
—
|
$143,770.00
|
$184,796.00
|
$164,283.00
|
2024-12-31
|
|
007-2
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
2
|
1
|
—
|
—
|
$130,597.00
|
$167,864.00
|
$149,230.50
|
2024-12-31
|
|
178-4
|
OTHER
|
External Heart Assist Systems
|
2
|
1
|
—
|
—
|
$121,838.00
|
$156,606.00
|
$139,222.00
|
2024-12-31
|
|
009-3
|
OTHER
|
Extracorporeal Membrane Oxygenation (ecmo)
|
2
|
1
|
—
|
—
|
$119,386.00
|
$153,454.00
|
$136,420.00
|
2024-12-31
|
|
183-4
|
OTHER
|
Percutaneous Structural Cardiac Procedures
|
2
|
1
|
—
|
—
|
$110,200.00
|
$141,647.00
|
$125,923.50
|
2024-12-31
|
|
007-1
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
2
|
1
|
—
|
—
|
$105,320.00
|
$135,374.00
|
$120,347.00
|
2024-12-31
|
|
681
|
OTHER
|
Neonate, Birth Weight >2499 Grams, With Significant O.r. Procedures, With Multip…
|
2
|
1
|
—
|
—
|
$112,219.40
|
$124,518.91
|
$118,369.15
|
2026-02-28
|
|
179-4
|
OTHER
|
Defibrillator Implants
|
2
|
1
|
—
|
—
|
$96,882.00
|
$124,528.00
|
$110,705.00
|
2024-12-31
|
|
232-4
|
OTHER
|
Gastric Fundoplication
|
2
|
1
|
—
|
—
|
$92,166.00
|
$118,466.00
|
$105,316.00
|
2024-12-31
|
|
008-3
|
OTHER
|
Autologous Bone Marrow Transplant
|
2
|
1
|
—
|
—
|
$90,295.00
|
$116,061.00
|
$103,178.00
|
2024-12-31
|
|
634
|
OTHER
|
Neonate, Birth Weight 1000-1499 Grams, Without Significant O.r. Procedures, Disc…
|
2
|
1
|
—
|
—
|
$88,028.65
|
$111,517.90
|
$99,773.27
|
2026-02-28
|
|
027-4
|
OTHER
|
Other Open Craniotomy
|
2
|
1
|
—
|
—
|
$86,076.00
|
$110,638.00
|
$98,357.00
|
2024-12-31
|
|
178-3
|
OTHER
|
External Heart Assist Systems
|
2
|
1
|
—
|
—
|
$84,958.00
|
$109,201.00
|
$97,079.50
|
2024-12-31
|
|
792-4
|
OTHER
|
Extensive Or Procedures For Other Complications Of Treatment
|
2
|
1
|
—
|
—
|
$78,813.00
|
$101,302.00
|
$90,057.50
|
2024-12-31
|
|
009-2
|
OTHER
|
Extracorporeal Membrane Oxygenation (ecmo)
|
2
|
1
|
—
|
—
|
$78,519.00
|
$100,926.00
|
$89,722.50
|
2024-12-31
|
|
030-4
|
OTHER
|
Percutaneous Intracranial And Extracranial Vascular Procedures
|
2
|
1
|
—
|
—
|
$77,059.00
|
$99,048.00
|
$88,053.50
|
2024-12-31
|
|
230-4
|
OTHER
|
Major Small Bowel Procedures
|
2
|
1
|
—
|
—
|
$76,169.00
|
$97,904.00
|
$87,036.50
|
2024-12-31
|
|
009-1
|
OTHER
|
Extracorporeal Membrane Oxygenation (ecmo)
|
2
|
1
|
—
|
—
|
$76,148.00
|
$97,877.00
|
$87,012.50
|
2024-12-31
|
|
632
|
OTHER
|
Neonate, Birth Weight 750-999 Grams, Died
|
2
|
1
|
—
|
—
|
$70,694.20
|
$101,459.95
|
$86,077.07
|
2026-02-28
|
|
183-3
|
OTHER
|
Percutaneous Structural Cardiac Procedures
|
2
|
1
|
—
|
—
|
$75,234.00
|
$96,703.00
|
$85,968.50
|
2024-12-31
|
|
178-2
|
OTHER
|
External Heart Assist Systems
|
2
|
1
|
—
|
—
|
$72,917.00
|
$93,724.00
|
$83,320.50
|
2024-12-31
|
|
008-2
|
OTHER
|
Autologous Bone Marrow Transplant
|
2
|
1
|
—
|
—
|
$72,663.00
|
$93,398.00
|
$83,030.50
|
2024-12-31
|
|
179-3
|
OTHER
|
Defibrillator Implants
|
2
|
1
|
—
|
—
|
$70,369.00
|
$90,450.00
|
$80,409.50
|
2024-12-31
|
|
029-4
|
OTHER
|
Other Percutaneous Intracranial Procedures
|
2
|
1
|
—
|
—
|
$68,013.00
|
$87,421.00
|
$77,717.00
|
2024-12-31
|
|
635
|
OTHER
|
Neonate, Birth Weight 1000-1499 Grams, Died
|
2
|
1
|
—
|
—
|
$62,067.45
|
$92,742.62
|
$77,405.04
|
2026-02-28
|
|
178-1
|
OTHER
|
External Heart Assist Systems
|
2
|
1
|
—
|
—
|
$66,842.00
|
$85,916.00
|
$76,379.00
|
2024-12-31
|
|
231-4
|
OTHER
|
Major Large Bowel Procedures
|
2
|
1
|
—
|
—
|
$66,131.00
|
$85,002.00
|
$75,566.50
|
2024-12-31
|
|
325-4
|
OTHER
|
Non-elective Or Complex Knee Joint Replacement
|
2
|
1
|
—
|
—
|
$63,651.00
|
$81,815.00
|
$72,733.00
|
2024-12-31
|
|
183-2
|
OTHER
|
Percutaneous Structural Cardiac Procedures
|
2
|
1
|
—
|
—
|
$63,270.00
|
$81,324.00
|
$72,297.00
|
2024-12-31
|
|
008-1
|
OTHER
|
Autologous Bone Marrow Transplant
|
2
|
1
|
—
|
—
|
$60,859.00
|
$78,226.00
|
$69,542.50
|
2024-12-31
|
|
793-4
|
OTHER
|
Moderately Extensive Or Procedures For Other Complications Of Treatment
|
2
|
1
|
—
|
—
|
$60,306.00
|
$77,515.00
|
$68,910.50
|
2024-12-31
|
|
183-1
|
OTHER
|
Percutaneous Structural Cardiac Procedures
|
2
|
1
|
—
|
—
|
$60,187.00
|
$77,362.00
|
$68,774.50
|
2024-12-31
|
|
179-2
|
OTHER
|
Defibrillator Implants
|
2
|
1
|
—
|
—
|
$58,409.00
|
$75,077.00
|
$66,743.00
|
2024-12-31
|
|
030-3
|
OTHER
|
Percutaneous Intracranial And Extracranial Vascular Procedures
|
2
|
1
|
—
|
—
|
$55,611.00
|
$71,480.00
|
$63,545.50
|
2024-12-31
|
|
548-4
|
OTHER
|
Other O.r. Proc For Obstetric Diagnoses Except Delivery Diagnoses
|
2
|
1
|
—
|
—
|
$55,159.00
|
$70,899.00
|
$63,029.00
|
2024-12-31
|
|
613
|
OTHER
|
Neonate, Birth Weight <750 Grams, Died
|
2
|
1
|
—
|
—
|
$39,972.15
|
$84,112.60
|
$62,042.38
|
2026-02-28
|
|
365
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
1
|
1
|
—
|
—
|
$88,388.55
|
$88,388.55
|
$88,388.55
|
2026-02-28
|
|
366
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
1
|
1
|
—
|
—
|
$67,270.60
|
$67,270.60
|
$67,270.60
|
2026-02-28
|