Hospital

LAKE GRANBURY MEDICAL CENTER

Granbury, TX · CCN 450596 · Rates published

5,991 distinct procedures filed

54 distinct payers

311,652 rate rows

2026-05-06 last MRF observed

Data quality

297,430 of 311,652 rate rows are consumer-grade (95.4%)

14,222 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reason	Rows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	10,739
per-diem day rate — not a per-procedure price	3,062
placeholder amount (≤ $0.02) — excluded from medians	419
exceeds 10× this hospital's gross charge — excluded from medians	2

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

Source MRF file	https://www.lakegranburymedicalcenter.com/Uploads/Public/Documents/charge-masters/charge-masters-2024/752682017_lake-granbury-medical-center_standardcharges.csv
Found on page	https://www.lakegranburymedicalcenter.com/pricing-information
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-05-15
Content fingerprint	c68d41a120ed2f02… · 118,597,077 bytes · first seen 2026-05-05

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	22	$880,717.56	$3,634,281.01	$924,753.44	nat. median $309,400 outlier · 3.0×
583-3 OTHER	Neonate With Ecmo	22	$745,759.26	$3,077,375.59	$783,047.22	nat. median $259,487 outlier · 3.0×
588-4 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	22	$557,479.77	$2,300,440.27	$585,353.76	nat. median $267,493 outlier · 2.2×
630-4 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	22	$414,802.11	$1,711,680.91	$435,542.22	nat. median $210,669 outlier · 2.1×
609-4 OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	22	$411,126.22	$1,696,512.35	$431,682.53	nat. median $169,856 outlier · 2.5×
583-2 OTHER	Neonate With Ecmo	22	$371,594.81	$1,533,385.98	$390,174.55	nat. median $191,347 outlier · 2.0×
011-4 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	22	$352,853.60	$1,456,050.38	$370,496.28	nat. median $105,647 outlier · 3.5×
583-1 OTHER	Neonate With Ecmo	22	$327,196.62	$1,350,176.85	$343,556.45	nat. median $171,226 outlier · 2.0×
18 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	21	$280,140.78	$880,684.72	$330,773.62	nat. median $386,529 0.9× median
588-3 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	22	$299,125.39	$1,234,340.92	$314,081.66	nat. median $165,000 1.9× median
588-2 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	22	$297,758.24	$1,228,699.38	$312,646.15	nat. median $153,523 outlier · 2.0×
681 OTHER	Neonate, Birth Weight >2499 Grams, With Significant O.r. Procedures, With Multip…	2	$289,300.26	$331,509.99	$310,405.12	nat. median $0
631-4 OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	22	$292,758.11	$1,208,066.34	$307,396.02	nat. median $203,379 1.5× median
591-4 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	22	$282,492.30	$1,165,704.48	$296,616.91	nat. median $156,696 1.9× median
603-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	22	$242,401.97	$1,000,271.73	$254,522.07	nat. median $107,050 outlier · 2.4×
589-1 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	22	$235,225.30	$970,657.20	$246,986.57	nat. median $86,371 outlier · 2.9×
593-4 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	22	$234,521.43	$967,752.68	$246,247.50	nat. median $151,250 1.6× median
589-2 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	22	$227,981.37	$940,765.12	$239,380.44	nat. median $49,980 outlier · 4.8×
602-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	22	$215,591.20	$889,637.09	$226,370.76	nat. median $125,000 1.8× median
589-3 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	22	$213,841.39	$882,416.50	$224,533.46	nat. median $87,000 outlier · 2.6×
1 OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	22	$8,496.10	$573,276.99	$215,327.43	nat. median $239,422 0.9× median
621-4 OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	22	$204,728.21	$844,810.96	$214,964.62	nat. median $80,035 outlier · 2.7×
011-3 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	22	$200,509.64	$827,403.03	$210,535.12	nat. median $171,094 1.2× median
246-4 OTHER	Gastrointestinal Vascular Insufficiency	22	$200,000.00	$825,300.00	$210,000.00	nat. median $14,775 outlier · 14.2×
008-4 OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	22	$200,000.00	$825,300.00	$210,000.00	nat. median $81,385 outlier · 2.6×
681-4 OTHER	Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	22	$200,000.00	$825,300.00	$210,000.00	nat. median $52,952 outlier · 4.0×
004-4 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	22	$200,000.00	$825,300.00	$210,000.00	nat. median $110,000 1.9× median
007-4 OTHER	Allogeneic Bone Marrow Transplant	22	$200,000.00	$825,300.00	$210,000.00	nat. median $172,311 1.2× median
162-4 OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	22	$200,000.00	$825,300.00	$210,000.00	nat. median $80,850 outlier · 2.6×
009-3 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	22	$200,000.00	$825,300.00	$210,000.00	nat. median $87,912 outlier · 2.4×
850-4 OTHER	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	22	$200,000.00	$825,300.00	$210,000.00	nat. median $54,797 outlier · 3.8×
007-3 OTHER	Allogeneic Bone Marrow Transplant	22	$200,000.00	$825,300.00	$210,000.00	nat. median $104,111 outlier · 2.0×
007-2 OTHER	Allogeneic Bone Marrow Transplant	22	$200,000.00	$825,300.00	$210,000.00	nat. median $74,284 outlier · 2.8×
160-4 OTHER	Major Cardiothoracic Repair Of Heart Anomaly	22	$200,000.00	$825,300.00	$210,000.00	nat. median $106,926 2.0× median
006-4 OTHER	Pancreas Transplant	18	$200,000.00	$825,300.00	$210,000.00	nat. median $92,449 outlier · 2.3×
841-4 OTHER	Extensive Third Degree Burns With Skin Graft	22	$200,000.00	$825,300.00	$210,000.00	nat. median $151,691 1.4× median
161-3 OTHER	Implantable Heart Assist Systems	22	$200,000.00	$825,300.00	$210,000.00	nat. median $152,491 1.4× median
161-4 OTHER	Implantable Heart Assist Systems	22	$200,000.00	$825,300.00	$210,000.00	nat. median $202,242 1.0× median
588-1 OTHER	Female Reproductive System Reconstructive Procedures	22	$200,000.00	$825,300.00	$210,000.00	nat. median $75,325 outlier · 2.8×
001-4 OTHER	Liver Transplant And/or Intestinal Transplant	18	$200,000.00	$825,300.00	$210,000.00	nat. median $124,561 1.7× median
200-4 OTHER	Cardiac Structural And Valvular Disorders	22	$200,000.00	$825,300.00	$210,000.00	nat. median $19,067 outlier · 11.0×
002-4 OTHER	Heart And/or Lung Transplant	18	$200,000.00	$825,300.00	$210,000.00	nat. median $216,800 1.0× median
009-4 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	22	$200,000.00	$825,300.00	$210,000.00	nat. median $150,954 1.4× median
161-2 OTHER	Implantable Heart Assist Systems	22	$200,000.00	$825,300.00	$210,000.00	nat. median $109,992 1.9× median
863-4 OTHER	Neonatal Aftercare	22	$197,399.63	$814,569.57	$207,269.61	nat. median $108,047 1.9× median
630-3 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	22	$195,503.71	$806,746.06	$205,278.90	nat. median $95,000 outlier · 2.2×
161-1 OTHER	Implantable Heart Assist Systems	22	$192,364.72	$793,793.02	$201,982.96	nat. median $101,352 2.0× median
440-4 OTHER	Kidney Transplant	18	$191,889.29	$791,831.16	$201,483.75	nat. median $87,123 outlier · 2.3×
005-4 OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	22	$191,012.64	$788,213.66	$200,563.27	nat. median $88,000 outlier · 2.3×
004-3 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	22	$190,947.70	$787,945.68	$200,495.09	nat. median $91,000 outlier · 2.2×

Other procedures at this hospital

Browse this hospital's 5,991 published procedures. Use the slice to choose what to show, then sort or filter any column.

Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code	Type	Description	Rate rows	Payers	Gross	Cash	Min $	Max $	Avg median	Last observed

001-1	OTHER	Liver Transplant And/or Intestinal Transplant	20	18	—	—	$97,880.57	$403,904.17	$102,774.60	2026-05-06
001-2	OTHER	Liver Transplant And/or Intestinal Transplant	20	18	—	—	$101,699.08	$419,661.25	$106,784.03	2026-05-06
001-3	OTHER	Liver Transplant And/or Intestinal Transplant	20	18	—	—	$132,404.89	$546,368.78	$139,025.13	2026-05-06
001-4	OTHER	Liver Transplant And/or Intestinal Transplant	20	18	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
002-1	OTHER	Heart And/or Lung Transplant	20	18	—	—	$109,946.05	$453,692.38	$115,443.35	2026-05-06
002-2	OTHER	Heart And/or Lung Transplant	20	18	—	—	$141,944.80	$585,735.22	$149,042.04	2026-05-06
002-3	OTHER	Heart And/or Lung Transplant	20	18	—	—	$176,695.24	$729,132.91	$185,530.00	2026-05-06
002-4	OTHER	Heart And/or Lung Transplant	20	18	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
004-1	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	24	22	—	—	$102,450.49	$422,761.95	$107,573.01	2026-05-06
004-2	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	24	22	—	—	$124,846.72	$515,179.99	$131,089.06	2026-05-06
004-3	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	24	22	—	—	$190,947.70	$787,945.68	$200,495.09	2026-05-06
004-4	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
005-1	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	24	22	—	—	$102,647.62	$423,575.40	$107,780.00	2026-05-06
005-2	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	24	22	—	—	$125,658.43	$518,529.51	$131,941.35	2026-05-06
005-3	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	24	22	—	—	$137,598.68	$567,800.95	$144,478.61	2026-05-06
005-4	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	24	22	—	—	$191,012.64	$788,213.66	$200,563.27	2026-05-06
006-1	OTHER	Pancreas Transplant	20	18	—	—	$135,728.26	$560,082.66	$142,514.67	2026-05-06
006-2	OTHER	Pancreas Transplant	20	18	—	—	$137,503.59	$567,408.56	$144,378.77	2026-05-06
006-3	OTHER	Pancreas Transplant	20	18	—	—	$152,023.91	$627,326.66	$159,625.11	2026-05-06
006-4	OTHER	Pancreas Transplant	20	18	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
007-1	OTHER	Allogeneic Bone Marrow Transplant	24	22	—	—	$133,378.95	$550,388.24	$140,047.90	2026-05-06
007-2	OTHER	Allogeneic Bone Marrow Transplant	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
007-3	OTHER	Allogeneic Bone Marrow Transplant	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
007-4	OTHER	Allogeneic Bone Marrow Transplant	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
008-1	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	24	22	—	—	$75,429.84	$311,261.23	$79,201.33	2026-05-06
008-2	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	24	22	—	—	$90,059.17	$371,629.17	$94,562.13	2026-05-06
008-3	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	24	22	—	—	$173,006.60	$713,911.73	$181,656.93	2026-05-06
008-4	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
009-1	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	24	22	—	—	$158,926.92	$655,811.94	$166,873.27	2026-05-06
009-2	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	24	22	—	—	$163,876.03	$676,234.44	$172,069.83	2026-05-06
009-3	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
009-4	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
011-1	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	24	22	—	—	$79,242.56	$326,994.42	$83,204.69	2026-05-06
011-2	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	24	22	—	—	$139,341.53	$574,992.82	$146,308.61	2026-05-06
011-3	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	24	22	—	—	$200,509.64	$827,403.03	$210,535.12	2026-05-06
011-4	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	24	22	—	—	$352,853.60	$1,456,050.38	$370,496.28	2026-05-06
020-3	OTHER	Open Craniotomy For Trauma	24	22	—	—	$64,976.19	$268,124.25	$68,225.00	2026-05-06
020-4	OTHER	Open Craniotomy For Trauma	24	22	—	—	$103,350.33	$426,475.14	$108,517.85	2026-05-06
021-3	OTHER	Open Craniotomy Except Trauma	24	22	—	—	$70,414.64	$290,566.01	$73,935.37	2026-05-06
021-4	OTHER	Open Craniotomy Except Trauma	24	22	—	—	$123,033.13	$507,696.21	$129,184.79	2026-05-06
022-4	OTHER	Ventricular Shunt Procedures	24	22	—	—	$122,105.46	$503,868.18	$128,210.73	2026-05-06
023-3	OTHER	Spinal Procedures	24	22	—	—	$68,968.64	$284,599.09	$72,417.07	2026-05-06
023-4	OTHER	Spinal Procedures	24	22	—	—	$141,667.66	$584,591.60	$148,751.04	2026-05-06
024-4	OTHER	Open Extracranial Vascular Procedures	24	22	—	—	$69,801.22	$288,034.73	$73,291.28	2026-05-06
026-4	OTHER	Other Nervous System And Related Procedures	24	22	—	—	$132,168.34	$545,392.66	$138,776.76	2026-05-06
027-3	OTHER	Other Open Craniotomy	24	22	—	—	$64,253.76	$265,143.14	$67,466.45	2026-05-06
027-4	OTHER	Other Open Craniotomy	24	22	—	—	$70,855.28	$292,384.31	$74,398.04	2026-05-06
029-3	OTHER	Other Percutaneous Intracranial Procedures	24	22	—	—	$67,797.46	$279,766.22	$71,187.33	2026-05-06
029-4	OTHER	Other Percutaneous Intracranial Procedures	24	22	—	—	$76,931.51	$317,457.88	$80,778.09	2026-05-06
030-4	OTHER	Percutaneous Intracranial And Extracranial Vascular Procedures	24	22	—	—	$78,115.44	$322,343.36	$82,021.21	2026-05-06
040-4	OTHER	Spinal Disorders And Injuries	24	22	—	—	$68,047.93	$280,799.78	$71,450.33	2026-05-06
042-4	OTHER	Degenerative Nervous System Disorders Except Multiple Sclerosis	24	22	—	—	$58,494.11	$241,375.94	$61,418.82	2026-05-06
043-3	OTHER	Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies	24	22	—	—	$68,277.52	$281,747.19	$71,691.40	2026-05-06
043-4	OTHER	Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies	24	22	—	—	$164,060.40	$676,995.24	$172,263.42	2026-05-06
049-4	OTHER	Bacterial And Tuberculous Infections Of Nervous System	24	22	—	—	$73,376.22	$302,786.97	$77,045.03	2026-05-06
050-4	OTHER	Non-bacterial Infections Of Nervous System Except Viral Meningitis	24	22	—	—	$93,955.37	$387,706.83	$98,653.14	2026-05-06
059-4	OTHER	Anoxic And Other Severe Brain Damage	24	22	—	—	$64,186.51	$264,865.63	$67,395.84	2026-05-06
073-4	OTHER	Orbit And Eye Procedures	24	22	—	—	$76,777.28	$316,821.45	$80,616.14	2026-05-06
089-3	OTHER	Major Cranial Or Facial Bone Procedures	24	22	—	—	$61,134.48	$252,271.43	$64,191.20	2026-05-06
089-4	OTHER	Major Cranial Or Facial Bone Procedures	24	22	—	—	$114,874.29	$474,028.76	$120,618.00	2026-05-06
091-3	OTHER	Other Major Head And Neck Procedures	24	22	—	—	$74,917.31	$309,146.28	$78,663.18	2026-05-06
091-4	OTHER	Other Major Head And Neck Procedures	24	22	—	—	$104,415.99	$430,872.58	$109,636.79	2026-05-06
092-3	OTHER	Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures	24	22	—	—	$85,329.22	$352,111.03	$89,595.68	2026-05-06
092-4	OTHER	Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures	24	22	—	—	$88,467.06	$365,059.32	$92,890.41	2026-05-06
098-4	OTHER	Other Ear, Nose, Mouth And Throat Procedures	24	22	—	—	$74,648.28	$308,036.13	$78,380.69	2026-05-06
1	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	23	22	—	—	$8,496.10	$573,276.99	$215,327.43	2026-05-06
120-4	OTHER	Major Respiratory And Chest Procedures	24	22	—	—	$116,562.64	$480,995.73	$122,390.77	2026-05-06
121-3	OTHER	Other Respiratory And Chest Procedures	24	22	—	—	$58,832.70	$242,773.14	$61,774.33	2026-05-06
121-4	OTHER	Other Respiratory And Chest Procedures	24	22	—	—	$108,782.99	$448,893.01	$114,222.14	2026-05-06
130-1	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	24	22	—	—	$58,291.18	$240,538.55	$61,205.74	2026-05-06
130-2	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	24	22	—	—	$68,085.03	$280,952.88	$71,489.28	2026-05-06
130-3	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	24	22	—	—	$77,877.73	$321,362.45	$81,771.62	2026-05-06
130-4	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	24	22	—	—	$114,693.39	$473,282.27	$120,428.06	2026-05-06
131-4	OTHER	Cystic Fibrosis - Pulmonary Disease	24	22	—	—	$60,654.41	$250,290.42	$63,687.13	2026-05-06
14	OTHER	Allogeneic Bone Marrow Transplant	22	21	—	—	$6,195.18	$248,690.89	$93,429.95	2026-05-06
160-2	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	24	22	—	—	$73,778.60	$304,447.39	$77,467.53	2026-05-06
160-3	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	24	22	—	—	$106,183.20	$438,164.97	$111,492.36	2026-05-06
160-4	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
161-1	OTHER	Implantable Heart Assist Systems	24	22	—	—	$192,364.72	$793,793.02	$201,982.96	2026-05-06
161-2	OTHER	Implantable Heart Assist Systems	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
161-3	OTHER	Implantable Heart Assist Systems	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
161-4	OTHER	Implantable Heart Assist Systems	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
162-1	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	24	22	—	—	$81,709.00	$337,172.19	$85,794.45	2026-05-06
162-2	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	24	22	—	—	$92,088.44	$380,002.95	$96,692.86	2026-05-06
162-3	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	24	22	—	—	$123,325.34	$508,902.02	$129,491.61	2026-05-06
162-4	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
163-2	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	24	22	—	—	$64,769.78	$267,272.50	$68,008.27	2026-05-06
163-3	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	24	22	—	—	$87,489.53	$361,025.55	$91,864.01	2026-05-06
163-4	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	24	22	—	—	$130,634.21	$539,062.07	$137,165.92	2026-05-06
165-2	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	24	22	—	—	$61,266.67	$252,816.91	$64,330.00	2026-05-06
165-3	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	24	22	—	—	$74,285.33	$306,538.41	$77,999.60	2026-05-06
165-4	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	24	22	—	—	$112,985.32	$466,233.92	$118,634.59	2026-05-06
166-3	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	24	22	—	—	$62,087.66	$256,204.73	$65,192.04	2026-05-06
166-4	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	24	22	—	—	$87,316.75	$360,312.57	$91,682.59	2026-05-06
167-3	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	24	22	—	—	$72,353.47	$298,566.59	$75,971.14	2026-05-06
167-4	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	24	22	—	—	$166,567.43	$687,340.50	$174,895.80	2026-05-06
169-3	OTHER	Major Abdominal Vascular Procedures	24	22	—	—	$60,292.62	$248,797.50	$63,307.25	2026-05-06
169-4	OTHER	Major Abdominal Vascular Procedures	24	22	—	—	$117,038.07	$482,957.60	$122,889.97	2026-05-06
170-4	OTHER	Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock	24	22	—	—	$72,940.22	$300,987.82	$76,587.23	2026-05-06
171-4	OTHER	Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock	24	22	—	—	$82,613.47	$340,904.48	$86,744.14	2026-05-06
175-4	OTHER	Percutaneous Cardiac Intervention Without Ami	24	22	—	—	$74,797.87	$308,653.41	$78,537.76	2026-05-06
176-4	OTHER	Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices	24	22	—	—	$84,825.96	$350,034.32	$89,067.26	2026-05-06
177-4	OTHER	Cardiac Pacemaker And Defibrillator Revision Except Device Replacement	24	22	—	—	$58,066.22	$239,610.26	$60,969.53	2026-05-06
178-1	OTHER	External Heart Assist Systems	24	22	—	—	$85,635.35	$353,374.27	$89,917.12	2026-05-06
178-2	OTHER	External Heart Assist Systems	24	22	—	—	$93,418.49	$385,491.40	$98,089.41	2026-05-06
178-3	OTHER	External Heart Assist Systems	24	22	—	—	$108,845.61	$449,151.41	$114,287.89	2026-05-06
178-4	OTHER	External Heart Assist Systems	24	22	—	—	$170,085.61	$701,858.27	$178,589.89	2026-05-06
179-3	OTHER	Defibrillator Implants	24	22	—	—	$64,082.15	$264,434.99	$67,286.26	2026-05-06
179-4	OTHER	Defibrillator Implants	24	22	—	—	$83,572.45	$344,861.71	$87,751.07	2026-05-06
18	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	22	21	—	—	$280,140.78	$880,684.72	$330,773.62	2026-05-06
180-1	OTHER	Other Circulatory System Procedures	24	22	—	—	$69,750.20	$287,824.20	$73,237.71	2026-05-06
180-2	OTHER	Other Circulatory System Procedures	24	22	—	—	$59,789.36	$246,720.79	$62,778.83	2026-05-06
180-4	OTHER	Other Circulatory System Procedures	24	22	—	—	$76,989.49	$317,697.13	$80,838.96	2026-05-06
181-4	OTHER	Lower Extremity Arterial Procedures	24	22	—	—	$101,657.34	$419,489.01	$106,740.21	2026-05-06
182-4	OTHER	Other Peripheral Vascular And Related Procedures	24	22	—	—	$130,711.90	$539,382.66	$137,247.49	2026-05-06
183-1	OTHER	Percutaneous Structural Cardiac Procedures	24	22	—	—	$59,221.17	$244,376.16	$62,182.23	2026-05-06
183-2	OTHER	Percutaneous Structural Cardiac Procedures	24	22	—	—	$62,254.64	$256,893.77	$65,367.37	2026-05-06
183-3	OTHER	Percutaneous Structural Cardiac Procedures	24	22	—	—	$95,893.04	$395,702.63	$100,687.69	2026-05-06
183-4	OTHER	Percutaneous Structural Cardiac Procedures	24	22	—	—	$98,307.30	$405,665.07	$103,222.67	2026-05-06
193-4	OTHER	Acute And Subacute Endocarditis	24	22	—	—	$62,763.70	$258,994.41	$65,901.88	2026-05-06
2	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	23	22	—	—	$15,304.71	$234,777.45	$88,204.79	2026-05-06
20	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	27	24	—	—	$9,362.25	$213,923.11	$61,856.83	2026-05-06
200-4	OTHER	Cardiac Structural And Valvular Disorders	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
205-4	OTHER	Cardiomyopathy	24	22	—	—	$128,101.67	$528,611.54	$134,506.75	2026-05-06
207-4	OTHER	Other Circulatory System Diagnoses	24	22	—	—	$63,309.86	$261,248.14	$66,475.35	2026-05-06
212	OTHER	Hip & Femur Procedures Except Major Joint Age 0-17	24	23	—	—	$6,595.51	$225,495.78	$84,719.08	2026-05-06
215	OTHER	Other Heart Assist System Implant	27	24	—	—	$73,991.64	$383,137.99	$82,851.10	2026-05-06
216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	27	24	—	—	$11,334.38	$206,420.65	$76,447.53	2026-05-06
220-4	OTHER	Major Stomach, Esophageal And Duodenal Procedures	24	22	—	—	$144,924.93	$598,032.72	$152,171.18	2026-05-06
222-4	OTHER	Other Stomach, Esophageal And Duodenal Procedures	24	22	—	—	$68,924.57	$284,417.24	$72,370.80	2026-05-06
223-4	OTHER	Other Small And Large Bowel Procedures	24	22	—	—	$91,026.26	$375,619.86	$95,577.57	2026-05-06
224-4	OTHER	Peritoneal Adhesiolysis	24	22	—	—	$106,013.90	$437,466.36	$111,314.60	2026-05-06
226-4	OTHER	Anal And Perineal Procedures	24	22	—	—	$63,862.98	$263,530.59	$67,056.13	2026-05-06
227-4	OTHER	Hernia Procedures Except Inguinal, Femoral And Umbilical	24	22	—	—	$101,346.57	$418,206.62	$106,413.90	2026-05-06
229-4	OTHER	Other Digestive System And Abdominal Procedures	24	22	—	—	$60,987.21	$251,663.72	$64,036.57	2026-05-06
230-4	OTHER	Major Small Bowel Procedures	24	22	—	—	$122,589.01	$505,863.55	$128,718.46	2026-05-06
231	OTHER	Coronary Bypass With Ptca With Mcc	27	24	—	—	$13,355.53	$184,710.58	$66,134.19	2026-05-06
231-4	OTHER	Major Large Bowel Procedures	24	22	—	—	$74,364.19	$306,863.83	$78,082.40	2026-05-06
233-4	OTHER	Appendectomy With Complex Principal Diagnosis	24	22	—	—	$79,532.46	$328,190.70	$83,509.08	2026-05-06
245-4	OTHER	Inflammatory Bowel Disease	24	22	—	—	$66,189.11	$273,129.36	$69,498.57	2026-05-06
246-4	OTHER	Gastrointestinal Vascular Insufficiency	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
260-4	OTHER	Major Pancreas, Liver And Shunt Procedures	24	22	—	—	$110,135.06	$454,472.33	$115,641.81	2026-05-06
261-3	OTHER	Major Biliary Tract Procedures	24	22	—	—	$63,949.95	$263,889.47	$67,147.45	2026-05-06
261-4	OTHER	Major Biliary Tract Procedures	24	22	—	—	$96,747.66	$399,229.22	$101,585.04	2026-05-06
263-4	OTHER	Cholecystectomy	24	22	—	—	$64,049.68	$264,301.00	$67,252.16	2026-05-06
264-4	OTHER	Other Hepatobiliary, Pancreas And Abdominal Procedures	24	22	—	—	$81,973.38	$338,263.15	$86,072.05	2026-05-06
282-4	OTHER	Disorders Of Pancreas Except Malignancy	24	22	—	—	$64,435.82	$265,894.41	$67,657.61	2026-05-06
3	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	27	24	—	—	$9,876.40	$435,405.98	$163,674.51	2026-05-06
303-1	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	24	22	—	—	$69,920.66	$288,527.60	$73,416.69	2026-05-06
303-2	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	24	22	—	—	$94,914.35	$391,664.07	$99,660.07	2026-05-06
303-3	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	24	22	—	—	$130,817.42	$539,818.08	$137,358.29	2026-05-06
303-4	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	24	22	—	—	$154,637.62	$638,112.14	$162,369.50	2026-05-06
304-3	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	24	22	—	—	$80,439.25	$331,932.57	$84,461.21	2026-05-06
304-4	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	24	22	—	—	$128,464.62	$530,109.25	$134,887.85	2026-05-06
305-4	OTHER	Amputation Of Lower Limb Except Toes	24	22	—	—	$63,266.96	$261,071.11	$66,430.31	2026-05-06
308-4	OTHER	Hip And Femur Fracture Repair	24	22	—	—	$69,515.96	$286,857.61	$72,991.76	2026-05-06
309-4	OTHER	Other Significant Hip And Femur Surgery	24	22	—	—	$58,680.80	$242,146.32	$61,614.84	2026-05-06
310-4	OTHER	Vertebral And Intervertebral Spinal Procedures Including Disc Procedures	24	22	—	—	$79,586.96	$328,415.59	$83,566.31	2026-05-06
312-4	OTHER	Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses	24	22	—	—	$83,458.81	$344,392.78	$87,631.75	2026-05-06
313-4	OTHER	Knee And Lower Leg Procedures Except Foot	24	22	—	—	$76,175.46	$314,338.04	$79,984.23	2026-05-06
315-4	OTHER	Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement	24	22	—	—	$117,436.97	$484,603.66	$123,308.82	2026-05-06
316-4	OTHER	Hand And Wrist Procedures	24	22	—	—	$61,822.11	$255,108.94	$64,913.22	2026-05-06
320-4	OTHER	Other Musculoskeletal System And Connective Tissue Procedures	24	22	—	—	$60,039.83	$247,754.36	$63,041.82	2026-05-06
321-4	OTHER	Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures	24	22	—	—	$69,943.85	$288,623.30	$73,441.04	2026-05-06
322-4	OTHER	Shoulder And Elbow Joint Replacement	24	22	—	—	$64,815.00	$267,459.10	$68,055.75	2026-05-06
324-4	OTHER	Elective Hip Joint Replacement	24	22	—	—	$58,361.91	$240,830.42	$61,280.01	2026-05-06
325-4	OTHER	Non-elective Or Complex Knee Joint Replacement	24	22	—	—	$71,788.75	$296,236.28	$75,378.19	2026-05-06
343-4	OTHER	Musculoskeletal Malignancy And Pathological Fracture Due To Musculoskeletal Mali…	24	22	—	—	$60,086.22	$247,945.79	$63,090.53	2026-05-06
346-4	OTHER	Connective Tissue Disorders	24	22	—	—	$77,858.02	$321,281.12	$81,750.92	2026-05-06
361-4	OTHER	Skin Graft For Skin And Subcutaneous Tissue Diagnoses	24	22	—	—	$104,980.71	$433,202.90	$110,229.75	2026-05-06
381-4	OTHER	Major Skin Disorders	24	22	—	—	$61,913.72	$255,486.97	$65,009.41	2026-05-06
4	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	27	24	—	—	$6,529.74	$285,872.51	$107,463.02	2026-05-06
401-2	OTHER	Adrenal Procedures	24	22	—	—	$68,553.51	$282,886.06	$71,981.19	2026-05-06
401-3	OTHER	Adrenal Procedures	24	22	—	—	$80,447.37	$331,966.07	$84,469.74	2026-05-06
401-4	OTHER	Adrenal Procedures	24	22	—	—	$71,939.49	$296,858.31	$75,536.46	2026-05-06
404-3	OTHER	Thyroid, Parathyroid And Thyroglossal Procedures	24	22	—	—	$58,997.37	$243,452.65	$61,947.24	2026-05-06
404-4	OTHER	Thyroid, Parathyroid And Thyroglossal Procedures	24	22	—	—	$77,614.50	$320,276.23	$81,495.23	2026-05-06
405-4	OTHER	Other Procedures For Endocrine, Nutritional And Metabolic Disorders	24	22	—	—	$72,199.24	$297,930.16	$75,809.20	2026-05-06
421-4	OTHER	Malnutrition, Failure To Thrive And Other Nutritional Disorders	24	22	—	—	$58,644.85	$241,997.97	$61,577.09	2026-05-06
440-1	OTHER	Kidney Transplant	20	18	—	—	$70,808.90	$292,192.93	$74,349.35	2026-05-06
440-2	OTHER	Kidney Transplant	20	18	—	—	$75,538.85	$311,711.06	$79,315.79	2026-05-06
440-3	OTHER	Kidney Transplant	20	18	—	—	$117,445.09	$484,637.16	$123,317.34	2026-05-06
440-4	OTHER	Kidney Transplant	20	18	—	—	$191,889.29	$791,831.16	$201,483.75	2026-05-06
441-4	OTHER	Major Bladder Procedures	24	22	—	—	$181,596.81	$749,359.24	$190,676.65	2026-05-06
442-4	OTHER	Kidney And Urinary Tract Procedures For Malignancy	24	22	—	—	$121,436.38	$501,107.22	$127,508.20	2026-05-06
443-4	OTHER	Kidney And Urinary Tract Procedures For Non-malignancy	24	22	—	—	$77,027.75	$317,855.01	$80,879.14	2026-05-06
444-4	OTHER	Renal Dialysis Access Device Procedures	24	22	—	—	$66,284.20	$273,521.75	$69,598.41	2026-05-06
445-4	OTHER	Other Bladder Procedures	24	22	—	—	$62,608.31	$258,353.19	$65,738.73	2026-05-06
447-4	OTHER	Other Kidney, Urinary Tract And Related Procedures	24	22	—	—	$143,797.82	$593,381.70	$150,987.71	2026-05-06
453	OTHER	Combined Anterior And Posterior Spinal Fusion With Mcc	27	24	—	—	$24,434.80	$191,734.94	$69,423.57	2026-05-06
456	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	27	24	—	—	$14,223.11	$193,719.61	$65,932.17	2026-05-06
461-4	OTHER	Kidney And Urinary Tract Malignancy	24	22	—	—	$60,202.17	$248,424.25	$63,212.28	2026-05-06
462-4	OTHER	Nephritis And Nephrosis	24	22	—	—	$64,289.71	$265,291.49	$67,504.20	2026-05-06
468-4	OTHER	Other Kidney And Urinary Tract Diagnoses, Signs And Symptoms	24	22	—	—	$76,389.98	$315,223.25	$80,209.48	2026-05-06
480-4	OTHER	Major Male Pelvic Procedures	24	22	—	—	$78,790.32	$325,128.26	$82,729.84	2026-05-06
483-4	OTHER	Penis, Testes And Scrotal Procedures	24	22	—	—	$116,119.68	$479,167.86	$121,925.66	2026-05-06
484-4	OTHER	Other Male Reproductive System And Related Procedures	24	22	—	—	$73,574.51	$303,605.22	$77,253.24	2026-05-06
5	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	21	20	—	—	$8,166.43	$214,066.50	$80,426.85	2026-05-06
510-4	OTHER	Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced…	24	22	—	—	$80,830.03	$333,545.12	$84,871.53	2026-05-06
511-4	OTHER	Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy	24	22	—	—	$79,417.66	$327,716.97	$83,388.54	2026-05-06
512-4	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy	24	22	—	—	$68,843.40	$284,082.29	$72,285.57	2026-05-06
513-4	OTHER	Uterine And Adnexa Procedures For Non-malignancy Except Leiomyoma	24	22	—	—	$83,623.47	$345,072.25	$87,804.64	2026-05-06
514-4	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	24	22	—	—	$68,984.87	$284,666.07	$72,434.11	2026-05-06
517-4	OTHER	Dilation And Curettage For Non-obstetric Diagnoses	24	22	—	—	$58,909.24	$243,088.98	$61,854.70	2026-05-06
518-4	OTHER	Other Female Reproductive System And Related Procedures	24	22	—	—	$61,031.28	$251,845.58	$64,082.84	2026-05-06
583-1	OTHER	Neonate With Ecmo	24	22	—	—	$327,196.62	$1,350,176.85	$343,556.45	2026-05-06
583-2	OTHER	Neonate With Ecmo	24	22	—	—	$371,594.81	$1,533,385.98	$390,174.55	2026-05-06
583-3	OTHER	Neonate With Ecmo	24	22	—	—	$745,759.26	$3,077,375.59	$783,047.22	2026-05-06
583-4	OTHER	Neonate With Ecmo	24	22	—	—	$880,717.56	$3,634,281.01	$924,753.44	2026-05-06
588-1	OTHER	Female Reproductive System Reconstructive Procedures	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
588-2	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	24	22	—	—	$297,758.24	$1,228,699.38	$312,646.15	2026-05-06
588-3	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	24	22	—	—	$299,125.39	$1,234,340.92	$314,081.66	2026-05-06
588-4	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	24	22	—	—	$557,479.77	$2,300,440.27	$585,353.76	2026-05-06
589-1	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	24	22	—	—	$235,225.30	$970,657.20	$246,986.57	2026-05-06
589-2	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	24	22	—	—	$227,981.37	$940,765.12	$239,380.44	2026-05-06
589-3	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	24	22	—	—	$213,841.39	$882,416.50	$224,533.46	2026-05-06
591-1	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	24	22	—	—	$110,739.21	$456,965.35	$116,276.17	2026-05-06
591-2	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	24	22	—	—	$153,589.35	$633,786.45	$161,268.82	2026-05-06
591-3	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	24	22	—	—	$186,020.63	$767,614.13	$195,321.66	2026-05-06
591-4	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	24	22	—	—	$282,492.30	$1,165,704.48	$296,616.91	2026-05-06
593-2	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	24	22	—	—	$131,597.82	$543,038.40	$138,177.71	2026-05-06
593-3	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	24	22	—	—	$167,499.73	$691,187.64	$175,874.72	2026-05-06
593-4	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	24	22	—	—	$234,521.43	$967,752.68	$246,247.50	2026-05-06
602-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	24	22	—	—	$105,275.24	$434,418.28	$110,539.00	2026-05-06
602-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	24	22	—	—	$139,335.73	$574,968.89	$146,302.52	2026-05-06
602-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	24	22	—	—	$215,591.20	$889,637.09	$226,370.76	2026-05-06
603-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	24	22	—	—	$74,046.46	$305,552.72	$77,748.78	2026-05-06
603-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	24	22	—	—	$92,440.96	$381,457.62	$97,063.01	2026-05-06
603-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	24	22	—	—	$242,401.97	$1,000,271.73	$254,522.07	2026-05-06
607-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	24	22	—	—	$69,357.10	$286,202.07	$72,824.96	2026-05-06
607-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	24	22	—	—	$96,402.10	$397,803.27	$101,222.21	2026-05-06
607-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	24	22	—	—	$152,086.53	$627,585.07	$159,690.86	2026-05-06
608-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	24	22	—	—	$73,515.37	$303,361.17	$77,191.14	2026-05-06
608-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	24	22	—	—	$185,493.01	$765,436.91	$194,767.66	2026-05-06
609-3	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	24	22	—	—	$132,248.35	$545,722.82	$138,860.77	2026-05-06
609-4	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	24	22	—	—	$411,126.22	$1,696,512.35	$431,682.53	2026-05-06
611-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	24	22	—	—	$65,526.99	$270,397.12	$68,803.34	2026-05-06
611-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	24	22	—	—	$167,307.24	$690,393.33	$175,672.60	2026-05-06
612-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	24	22	—	—	$62,653.54	$258,539.83	$65,786.22	2026-05-06
612-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	24	22	—	—	$107,200.15	$442,361.42	$112,560.16	2026-05-06
613-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	24	22	—	—	$60,508.30	$249,687.50	$63,533.72	2026-05-06
613-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	24	22	—	—	$144,135.26	$594,774.15	$151,342.02	2026-05-06
614-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	24	22	—	—	$123,535.23	$509,768.13	$129,711.99	2026-05-06
621-3	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	24	22	—	—	$61,211.01	$252,587.23	$64,271.56	2026-05-06
621-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	24	22	—	—	$204,728.21	$844,810.96	$214,964.62	2026-05-06
623-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	24	22	—	—	$100,992.90	$416,747.20	$106,042.54	2026-05-06
625-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Other Significant Condition	24	22	—	—	$107,509.76	$443,639.02	$112,885.25	2026-05-06
630-2	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	24	22	—	—	$70,570.02	$291,207.19	$74,098.52	2026-05-06
630-3	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	24	22	—	—	$195,503.71	$806,746.06	$205,278.90	2026-05-06
630-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	24	22	—	—	$414,802.11	$1,711,680.91	$435,542.22	2026-05-06
631-2	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	24	22	—	—	$58,412.93	$241,040.96	$61,333.58	2026-05-06
631-3	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	24	22	—	—	$108,385.25	$447,251.73	$113,804.51	2026-05-06
631-4	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	24	22	—	—	$292,758.11	$1,208,066.34	$307,396.02	2026-05-06
633-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Anomaly	24	22	—	—	$155,586.16	$642,026.29	$163,365.47	2026-05-06
634-4	OTHER	Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…	24	22	—	—	$79,125.44	$326,511.13	$83,081.71	2026-05-06
650-4	OTHER	Splenectomy	24	22	—	—	$64,084.47	$264,444.57	$67,288.69	2026-05-06
651-4	OTHER	Other Procedures Of Blood And Blood-forming Organs	24	22	—	—	$125,237.50	$516,792.54	$131,499.38	2026-05-06
660-4	OTHER	Major Hematologic Or Immunologic Diagnoses Except Sickle Cell Crisis And Coagula…	24	22	—	—	$101,013.77	$416,833.32	$106,064.46	2026-05-06
661-3	OTHER	Coagulation And Platelet Disorders	24	22	—	—	$70,939.93	$292,733.62	$74,486.93	2026-05-06
661-4	OTHER	Coagulation And Platelet Disorders	24	22	—	—	$86,523.59	$357,039.59	$90,849.77	2026-05-06
680-3	OTHER	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	24	22	—	—	$68,049.09	$280,804.57	$71,451.54	2026-05-06
680-4	OTHER	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	24	22	—	—	$186,020.63	$767,614.13	$195,321.66	2026-05-06
681	OTHER	Neonate, Birth Weight >2499 Grams, With Significant O.r. Procedures, With Multip…	2	2	—	—	$289,300.26	$331,509.99	$310,405.12	2026-05-06
681-3	OTHER	Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	24	22	—	—	$66,745.71	$275,426.17	$70,083.00	2026-05-06
681-4	OTHER	Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
690-2	OTHER	Acute Leukemia	24	22	—	—	$62,081.86	$256,180.80	$65,185.95	2026-05-06
690-3	OTHER	Acute Leukemia	24	22	—	—	$72,654.96	$299,810.69	$76,287.71	2026-05-06
690-4	OTHER	Acute Leukemia	24	22	—	—	$165,071.56	$681,167.79	$173,325.14	2026-05-06
691-4	OTHER	Lymphoma, Myeloma And Non-acute Leukemia	24	22	—	—	$90,466.18	$373,308.69	$94,989.49	2026-05-06
692-4	OTHER	Radiotherapy	24	22	—	—	$74,745.69	$308,438.09	$78,482.97	2026-05-06
694-4	OTHER	Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior	24	22	—	—	$89,550.11	$369,528.53	$94,027.62	2026-05-06
695-4	OTHER	Chemotherapy For Acute Leukemia	24	22	—	—	$127,937.01	$527,932.07	$134,333.86	2026-05-06
7	OTHER	Lung Transplant	21	20	—	—	$21,626.97	$516,186.81	$193,887.36	2026-05-06
710-4	OTHER	Infectious And Parasitic Diseases Including HIV With O.r. Procedure	24	22	—	—	$93,259.62	$384,835.82	$97,922.60	2026-05-06
711-4	OTHER	Post-operative, Post-trauma, Other Device Infections With O.r. Procedure	24	22	—	—	$78,319.53	$323,185.54	$82,235.51	2026-05-06
723-4	OTHER	Viral Illness	24	22	—	—	$89,428.35	$369,026.09	$93,899.77	2026-05-06
740-4	OTHER	Mental Illness Diagnosis With O.r. Procedure	24	22	—	—	$80,750.02	$333,214.96	$84,787.52	2026-05-06
759-4	OTHER	Eating Disorders	24	22	—	—	$64,234.05	$265,061.81	$67,445.75	2026-05-06
792-3	OTHER	Extensive O.r. Procedures For Other Complications Of Treatment	24	22	—	—	$67,001.98	$276,483.67	$70,352.08	2026-05-06
792-4	OTHER	Extensive O.r. Procedures For Other Complications Of Treatment	24	22	—	—	$128,495.93	$530,238.46	$134,920.73	2026-05-06
793-4	OTHER	Moderately Extensive O.r. Procedures For Other Complications Of Treatment	24	22	—	—	$69,967.04	$288,718.99	$73,465.39	2026-05-06
810-4	OTHER	Hemorrhage Or Hematoma Due To Complication	24	22	—	—	$74,256.34	$306,418.79	$77,969.16	2026-05-06
815-4	OTHER	Other Injury, Poisoning And Toxic Effect Diagnoses	24	22	—	—	$75,497.10	$311,538.78	$79,271.96	2026-05-06
841-1	OTHER	Chemotherapy For Acute Leukemia	24	22	—	—	$82,407.07	$340,052.77	$86,527.42	2026-05-06
841-2	OTHER	Extensive Third Degree Burns With Skin Graft	24	22	—	—	$83,052.96	$342,718.04	$87,205.61	2026-05-06
841-3	OTHER	Extensive Third Degree Burns With Skin Graft	24	22	—	—	$127,805.98	$527,391.38	$134,196.28	2026-05-06
841-4	OTHER	Extensive Third Degree Burns With Skin Graft	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
842-4	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	24	22	—	—	$100,879.26	$416,278.27	$105,923.22	2026-05-06
850-3	OTHER	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	24	22	—	—	$60,101.29	$248,007.97	$63,106.35	2026-05-06
850-4	OTHER	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	24	22	—	—	$200,000.00	$825,300.00	$210,000.00	2026-05-06
863-4	OTHER	Neonatal Aftercare	24	22	—	—	$197,399.63	$814,569.57	$207,269.61	2026-05-06
910-4	OTHER	Craniotomy For Multiple Significant Trauma	24	22	—	—	$141,155.12	$582,476.60	$148,212.88	2026-05-06
911-4	OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	24	22	—	—	$119,588.00	$493,479.88	$125,567.40	2026-05-06
912-4	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	24	22	—	—	$114,722.38	$473,401.90	$120,458.50	2026-05-06
927	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	24	23	—	—	$11,954.91	$437,946.94	$164,504.57	2026-05-06
930-4	OTHER	Multiple Significant Trauma Without O.r. Procedure	24	22	—	—	$58,576.44	$241,715.68	$61,505.26	2026-05-06
950-4	OTHER	Extensive O.r. Procedure Unrelated To Principal Diagnosis	24	22	—	—	$136,964.38	$565,183.51	$143,812.60	2026-05-06
951-4	OTHER	Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis	24	22	—	—	$95,517.34	$394,152.30	$100,293.21	2026-05-06
952-3	OTHER	Non-extensive O.r. Procedure Unrelated To Principal Diagnosis	24	22	—	—	$58,191.45	$240,127.02	$61,101.02	2026-05-06
952-4	OTHER	Non-extensive O.r. Procedure Unrelated To Principal Diagnosis	24	22	—	—	$120,690.77	$498,030.46	$126,725.31	2026-05-06

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