Hospital

CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS INC

Norfolk, VA · CCN 493301 · Rates published

33,771 distinct procedures filed

27 distinct payers

685,496 rate rows

2026-05-13 last MRF observed

Data quality

678,299 of 685,496 rate rows are consumer-grade (99.0%)

7,197 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
exceeds 10× this hospital's gross charge — excluded from medians	3,358
placeholder amount (≤ $0.02) — excluded from medians	1,910
template filing: same amount across many unrelated codes — excluded	1,283
per-diem day rate — not a per-procedure price	610
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	36

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

Source MRF file	https://www.chkd.org/media/5yhlxvtl/540506321_childrens-hospital-of-the-kings-daughters_standardcharges.csv
Found on page	https://www.chkd.org/Billing/Price-Transparency/
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-05-15
Content fingerprint	a06789f7b02964a7… · 93,452,683 bytes · first seen 2026-05-13

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
1980005 OTHER	Elevidys 1.33e13 VG/mL Inj (Home Supply)	1	$2,700,000.00	$2,700,000.00	$2,700,000.00	nat. median $2,700,000 1.0× median
1980009 OTHER	Tisagenlecleucel (all) Soln	20	$57,245.42	$1,691,570.00	$1,347,914.20	nat. median $1,347,914 1.0× median
1980010 OTHER	Tisagenlecleucel (dlbcl/fl) Soln	20	$57,245.42	$1,393,441.76	$1,110,353.07	nat. median $249 outlier · 4461.9×
583-4 OTHER	Neonate With Ecmo	6	$568,011.94	$1,013,083.72	$647,307.06	nat. median $309,400 outlier · 2.1×
589-1 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	6	$520,199.00	$927,806.44	$592,819.38	nat. median $86,371 outlier · 6.9×
589-2 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	6	$501,794.23	$894,980.42	$571,845.28	nat. median $49,980 outlier · 11.4×
583-3 OTHER	Neonate With Ecmo	6	$498,915.66	$889,846.32	$568,564.85	nat. median $259,487 outlier · 2.2×
588-4 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	6	$401,286.10	$715,718.08	$457,306.10	nat. median $267,493 1.7× median
161-4 OTHER	Implantable Heart Assist Systems	6	$388,650.70	$693,182.07	$442,906.78	nat. median $202,242 outlier · 2.2×
5060001 OTHER	Kidney Acqui-lvng Dnr-sng	8	$313,024.87	$433,709.16	$424,280.70	nat. median $8 outlier · 54255.8×
630-4 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	6	$351,746.33	$627,360.89	$400,850.51	nat. median $210,669 1.9× median
583-2 OTHER	Neonate With Ecmo	6	$343,286.52	$612,272.32	$391,209.71	nat. median $191,347 outlier · 2.0×
609-4 OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	6	$335,779.62	$598,883.30	$382,654.83	nat. median $169,856 outlier · 2.3×
841-4 OTHER	Extensive Third Degree Burns With Skin Graft	6	$329,354.08	$587,422.97	$375,332.29	nat. median $151,691 outlier · 2.5×
011-4 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	6	$312,887.22	$558,053.32	$356,566.64	nat. median $105,647 outlier · 3.4×
160-4 OTHER	Major Cardiothoracic Repair Of Heart Anomaly	6	$312,169.87	$556,773.89	$355,749.15	nat. median $106,926 outlier · 3.3×
591-4 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	6	$296,727.79	$529,232.00	$338,151.33	nat. median $156,696 outlier · 2.2×
631-4 OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	6	$280,563.78	$500,402.49	$319,730.80	nat. median $203,379 1.6× median
593-4 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	6	$259,031.13	$461,997.71	$295,192.17	nat. median $151,250 2.0× median
681 OTHER	Neonate, Birth Weight >2499 Grams, With Significant O.r. Procedures, With Multip…	1	$279,457.22	$279,457.22	$279,457.22	nat. median $0
453 OTHER	Combined Anterior And Posterior Spinal Fusion With Mcc	6	$5,793.00	$279,128.73	$273,655.62	nat. median $65,342 outlier · 4.2×
009-4 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	6	$235,080.30	$419,279.96	$267,897.78	nat. median $150,954 1.8× median
589-3 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	6	$233,209.69	$415,943.62	$265,766.03	nat. median $87,000 outlier · 3.1×
603-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	6	$231,727.58	$413,300.18	$264,077.02	nat. median $107,050 outlier · 2.5×
004-4 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	6	$225,601.83	$402,374.54	$257,096.11	nat. median $110,000 outlier · 2.3×
18 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	6	$5,793.00	$254,932.91	$249,934.22	nat. median $386,529 0.6× median
583-1 OTHER	Neonate With Ecmo	6	$214,873.75	$383,240.35	$244,870.36	nat. median $171,226 1.4× median
792-4 OTHER	Extensive O.r. Procedures For Other Complications Of Treatment	6	$193,177.44	$344,543.67	$220,145.23	nat. median $43,650 outlier · 5.0×
161-3 OTHER	Implantable Heart Assist Systems	6	$188,471.09	$336,149.62	$214,781.87	nat. median $152,491 1.4× median
161-2 OTHER	Implantable Heart Assist Systems	6	$184,003.35	$328,181.13	$209,690.43	nat. median $109,992 1.9× median
593-3 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	6	$178,599.54	$318,543.10	$203,532.24	nat. median $112,711 1.8× median
680-4 OTHER	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	6	$177,828.66	$317,168.19	$202,653.74	nat. median $61,090 outlier · 3.3×
011-3 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	6	$177,798.07	$317,113.63	$202,618.89	nat. median $171,094 1.2× median
681-4 OTHER	Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	6	$175,540.49	$313,087.10	$200,046.15	nat. median $52,952 outlier · 3.8×
161-1 OTHER	Implantable Heart Assist Systems	6	$174,761.96	$311,698.55	$199,158.93	nat. median $101,352 2.0× median
602-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	6	$174,757.37	$311,690.37	$199,153.71	nat. median $125,000 1.6× median
591-3 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	6	$174,235.81	$310,760.12	$198,559.32	nat. median $99,157 outlier · 2.0×
005-4 OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	6	$164,437.67	$293,284.55	$187,393.35	nat. median $88,000 outlier · 2.1×
842-4 OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	6	$162,320.81	$289,509.00	$184,980.98	nat. median $83,517 outlier · 2.2×
609-3 OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	6	$162,218.33	$289,326.22	$184,864.20	nat. median $83,785 outlier · 2.2×
602-3 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	6	$158,076.38	$281,938.80	$180,144.02	nat. median $99,067 1.8× median
459 OTHER	Spinal Fusion Except Cervical With Mcc	6	$5,793.00	$180,513.35	$176,973.88	nat. median $50,246 outlier · 3.5×
15065851 OTHER	Set Univ Frag Elbow Impl	14	$49,375.90	$203,943.92	$176,465.16	nat. median $176,465 1.0× median
588-3 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	6	$147,961.63	$263,898.54	$168,617.24	nat. median $165,000 1.0× median
630-3 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	6	$145,092.24	$258,780.81	$165,347.29	nat. median $95,000 1.7× median
591-2 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	6	$143,871.68	$256,603.86	$163,956.33	nat. median $80,000 outlier · 2.0×
588-1 OTHER	Female Reproductive System Reconstructive Procedures	6	$141,780.82	$252,874.69	$161,573.58	nat. median $75,325 outlier · 2.1×
588-2 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	6	$141,780.82	$252,874.69	$161,573.58	nat. median $153,523 1.1× median
3925176 OTHER	Nusinersen 12 Mg/5 Ml Inj	21	$882.79	$562,406.84	$160,285.14	nat. median $160,285 1.0× median
5060002 OTHER	Kidney Acqui-cdvr Dnr-lnt	8	$117,528.00	$162,840.00	$159,300.00	nat. median $12 outlier · 13241.9×

Other procedures at this hospital

Browse this hospital's 33,771 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

004-1	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	6	6	—	—	$80,367.35	$143,340.03	$91,586.72	2026-05-13
004-2	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	6	6	—	—	$103,866.96	$185,253.02	$118,366.91	2026-05-13
004-3	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	6	6	—	—	$120,502.07	$214,922.75	$137,324.30	2026-05-13
004-4	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	6	6	—	—	$225,601.83	$402,374.54	$257,096.11	2026-05-13
005-1	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	6	6	—	—	$54,030.46	$96,366.60	$61,573.18	2026-05-13
005-2	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	6	6	—	—	$79,472.57	$141,744.15	$90,567.04	2026-05-13
005-3	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	6	6	—	—	$94,299.79	$168,189.38	$107,464.15	2026-05-13
005-4	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	6	6	—	—	$164,437.67	$293,284.55	$187,393.35	2026-05-13
009-1	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	6	6	—	—	$70,538.62	$125,809.90	$80,385.90	2026-05-13
009-2	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	6	6	—	—	$70,538.62	$125,809.90	$80,385.90	2026-05-13
009-3	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	6	6	—	—	$113,840.99	$203,042.31	$129,733.33	2026-05-13
009-4	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	6	6	—	—	$235,080.30	$419,279.96	$267,897.78	2026-05-13
011-1	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	6	6	—	—	$70,266.36	$125,324.32	$80,075.63	2026-05-13
011-2	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	6	6	—	—	$123,559.59	$220,376.02	$140,808.65	2026-05-13
011-3	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	6	6	—	—	$177,798.07	$317,113.63	$202,618.89	2026-05-13
011-4	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	6	6	—	—	$312,887.22	$558,053.32	$356,566.64	2026-05-13
020-4	OTHER	Open Craniotomy For Trauma	6	6	—	—	$103,550.35	$184,688.33	$118,006.10	2026-05-13
021-3	OTHER	Open Craniotomy Except Trauma	6	6	—	—	$55,608.93	$99,181.90	$63,372.00	2026-05-13
021-4	OTHER	Open Craniotomy Except Trauma	6	6	—	—	$81,563.43	$145,473.33	$92,949.79	2026-05-13
022-4	OTHER	Ventricular Shunt Procedures	6	6	—	—	$76,546.59	$136,525.49	$87,232.58	2026-05-13
023-4	OTHER	Spinal Procedures	6	6	—	—	$84,273.75	$150,307.34	$96,038.46	2026-05-13
024-4	OTHER	Open Extracranial Vascular Procedures	6	6	—	—	$55,849.07	$99,610.19	$63,645.65	2026-05-13
026-4	OTHER	Other Nervous System And Related Procedures	6	6	—	—	$74,012.17	$132,005.19	$84,344.36	2026-05-13
027-3	OTHER	Other Open Craniotomy	6	6	—	—	$49,464.83	$88,223.52	$56,370.18	2026-05-13
027-4	OTHER	Other Open Craniotomy	6	6	—	—	$82,468.91	$147,088.30	$93,981.67	2026-05-13
029-4	OTHER	Other Percutaneous Intracranial Procedures	6	6	—	—	$65,691.56	$117,164.87	$74,862.18	2026-05-13
030-4	OTHER	Percutaneous Intracranial And Extracranial Vascular Procedures	6	6	—	—	$60,474.35	$107,859.66	$68,916.64	2026-05-13
042-4	OTHER	Degenerative Nervous System Disorders Except Multiple Sclerosis	6	6	—	—	$58,401.84	$104,163.22	$66,554.80	2026-05-13
043-4	OTHER	Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies	6	6	—	—	$51,462.39	$91,786.29	$58,646.60	2026-05-13
049-4	OTHER	Bacterial And Tuberculous Infections Of Nervous System	6	6	—	—	$62,779.34	$111,970.76	$71,543.41	2026-05-13
050-4	OTHER	Non-bacterial Infections Of Nervous System Except Viral Meningitis	6	6	—	—	$50,231.12	$89,590.25	$57,243.45	2026-05-13
073-4	OTHER	Orbit And Eye Procedures	6	6	—	—	$59,223.20	$105,628.16	$67,490.82	2026-05-13
089-4	OTHER	Major Cranial Or Facial Bone Procedures	6	6	—	—	$77,858.93	$138,866.11	$88,728.12	2026-05-13
091-4	OTHER	Other Major Head And Neck Procedures	6	6	—	—	$83,209.20	$148,408.66	$94,825.30	2026-05-13
092-4	OTHER	Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures	6	6	—	—	$79,672.94	$142,101.52	$90,795.38	2026-05-13
1	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	7	6	—	—	$5,793.00	$156,811.03	$153,736.31	2026-05-13
120-4	OTHER	Major Respiratory And Chest Procedures	6	6	—	—	$83,840.90	$149,535.32	$95,545.18	2026-05-13
121-4	OTHER	Other Respiratory And Chest Procedures	6	6	—	—	$75,642.64	$134,913.24	$86,202.45	2026-05-13
130-3	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	6	6	—	—	$59,481.69	$106,089.19	$67,785.39	2026-05-13
130-4	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	6	6	—	—	$85,203.70	$151,965.97	$97,098.24	2026-05-13
14	OTHER	Allogeneic Bone Marrow Transplant	7	6	—	—	$5,793.00	$130,963.00	$128,395.10	2026-05-13
15015593	OTHER	Gen Vns Demipls Mdl 103	19	14	$78,393.30	$70,553.97	$18,030.46	$74,473.63	$64,439.29	2026-05-13
15018373	OTHER	Gen Vns Demipls Mdl 104	19	14	$76,995.00	$69,295.50	$17,708.85	$73,145.25	$63,289.89	2026-05-13
15021720	OTHER	Cochlear Impt-all Synchrn	19	14	$96,900.00	$87,210.00	$22,287.00	$92,055.00	$79,651.80	2026-05-13
15021852	OTHER	Cochlear Synchrony Flex24	19	14	$96,900.00	$87,210.00	$22,287.00	$92,055.00	$79,651.80	2026-05-13
15022638	OTHER	Imp Cochlear Synch Flx 28	19	14	$73,500.00	$66,150.00	$16,905.00	$69,825.00	$60,417.00	2026-05-13
15023076	OTHER	Generator Aspire Model 16	19	14	$106,989.00	$96,290.10	$24,607.47	$101,639.55	$87,944.96	2026-05-13
15023262	OTHER	Implt Cochlr Synchrny Pi8	19	14	$105,000.00	$94,500.00	$24,150.00	$99,750.00	$86,310.00	2026-05-13
15023376	OTHER	Cochlr Synchrony Pin Fle4	19	14	$105,000.00	$94,500.00	$24,150.00	$99,750.00	$86,310.00	2026-05-13
15024084	OTHER	Implnt Cochlear Ci532	19	14	$70,591.50	$63,532.35	$16,236.05	$67,061.93	$58,026.21	2026-05-13
15025123	OTHER	Generator Model 1000	19	14	$104,721.00	$94,248.90	$24,085.83	$99,484.95	$86,080.66	2026-05-13
15026653	OTHER	Cochlr Model Ci632 Slim R	19	14	$70,591.50	$63,532.35	$16,236.05	$67,061.93	$58,026.21	2026-05-13
15026925	OTHER	Cochlr Synchrny2 Flx26	19	14	$67,800.00	$61,020.00	$15,594.00	$64,410.00	$55,731.60	2026-05-13
15026926	OTHER	Cochlr Synchrny2 Flx28	19	14	$113,775.00	$102,397.50	$26,168.25	$108,086.25	$93,523.05	2026-05-13
15029633	OTHER	Trnscth Sapn 3.20hrt Vlv	19	14	$97,500.00	$87,750.00	$22,425.00	$92,625.00	$80,145.00	2026-05-13
15029634	OTHER	Trnscth Sapn 3.23hrt Vlv	19	14	$97,500.00	$87,750.00	$22,425.00	$92,625.00	$80,145.00	2026-05-13
15029635	OTHER	Trnscth Sapn 3.26hrt Vlv	19	14	$97,500.00	$87,750.00	$22,425.00	$92,625.00	$80,145.00	2026-05-13
15029636	OTHER	Trnscth Sapn 3.29hrt Vlv	19	14	$97,500.00	$87,750.00	$22,425.00	$92,625.00	$80,145.00	2026-05-13
15030023	OTHER	Imp Cochlr Synchrny 2pin	19	14	$113,775.00	$102,397.50	$26,168.25	$108,086.25	$93,523.05	2026-05-13
15030459	OTHER	Trncath Pulm Valve 25mm	19	14	$99,000.00	$89,100.00	$22,770.00	$94,050.00	$81,378.00	2026-05-13
15030500	OTHER	Imp Cochlr Synchr	19	14	$113,775.00	$102,397.50	$26,168.25	$108,086.25	$93,523.05	2026-05-13
15050514	OTHER	Cochlear Impl/20elt Ci624	19	14	$72,708.00	$65,437.20	$16,722.84	$69,072.60	$59,765.98	2026-05-13
15060587	OTHER	Cochlear Snd Prcssr	21	15	$71,250.00	$64,125.00	$8,755.40	$67,687.50	$58,567.50	2026-05-13
15061061	OTHER	Synchrny 2pinflex26s-vctr	19	14	$71,250.00	$64,125.00	$16,387.50	$67,687.50	$58,567.50	2026-05-13
15064270	OTHER	Cochlr Synch2pin Fs Svpkg	19	14	$73,500.00	$66,150.00	$16,905.00	$69,825.00	$60,417.00	2026-05-13
15064846	OTHER	El Icd Is Df1 Drd121mmntm	19	14	$85,836.00	$77,252.40	$19,742.28	$81,544.20	$70,557.19	2026-05-13
15064857	OTHER	Coch Imp Sych2pn Cmps-vec	19	14	$73,500.00	$66,150.00	$16,905.00	$69,825.00	$60,417.00	2026-05-13
15064863	OTHER	Nl Antfemr Trch12.5x245mm	19	14	$69,492.00	$62,542.80	$15,983.16	$66,017.40	$57,122.42	2026-05-13
15064956	OTHER	Gen Vns Duo Model 1000d	19	14	$120,369.00	$108,332.10	$27,684.87	$114,350.55	$98,943.32	2026-05-13
15065851	OTHER	Set Univ Frag Elbow Impl	19	14	$214,677.81	$193,210.03	$49,375.90	$203,943.92	$176,465.16	2026-05-13
15069892	OTHER	Cochlear Synch 2 Flex 28	19	14	$113,775.00	$102,397.50	$26,168.25	$108,086.25	$93,523.05	2026-05-13
160-3	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	6	6	—	—	$77,689.15	$138,563.30	$88,534.64	2026-05-13
160-4	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	6	6	—	—	$312,169.87	$556,773.89	$355,749.15	2026-05-13
161-1	OTHER	Implantable Heart Assist Systems	6	6	—	—	$174,761.96	$311,698.55	$199,158.93	2026-05-13
161-2	OTHER	Implantable Heart Assist Systems	6	6	—	—	$184,003.35	$328,181.13	$209,690.43	2026-05-13
161-3	OTHER	Implantable Heart Assist Systems	6	6	—	—	$188,471.09	$336,149.62	$214,781.87	2026-05-13
161-4	OTHER	Implantable Heart Assist Systems	6	6	—	—	$388,650.70	$693,182.07	$442,906.78	2026-05-13
162-1	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	6	6	—	—	$54,396.02	$97,018.59	$61,989.76	2026-05-13
162-2	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	6	6	—	—	$57,494.83	$102,545.52	$65,521.18	2026-05-13
162-3	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	6	6	—	—	$89,103.99	$158,922.37	$101,543.01	2026-05-13
162-4	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	6	6	—	—	$112,331.35	$200,349.78	$128,012.93	2026-05-13
163-3	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	6	6	—	—	$66,849.41	$119,229.97	$76,181.66	2026-05-13
163-4	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	6	6	—	—	$98,868.48	$176,337.92	$112,670.63	2026-05-13
165-3	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	6	6	—	—	$51,482.27	$91,821.75	$58,669.26	2026-05-13
165-4	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	6	6	—	—	$77,178.29	$137,652.15	$87,952.46	2026-05-13
166-4	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	6	6	—	—	$57,009.97	$101,680.74	$64,968.63	2026-05-13
167-3	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	6	6	—	—	$66,439.49	$118,498.86	$75,714.52	2026-05-13
167-4	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	6	6	—	—	$86,364.61	$154,036.52	$98,421.21	2026-05-13
169-4	OTHER	Major Abdominal Vascular Procedures	6	6	—	—	$87,961.44	$156,884.55	$100,240.95	2026-05-13
170-4	OTHER	Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock	6	6	—	—	$61,312.53	$109,354.61	$69,871.82	2026-05-13
176-4	OTHER	Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices	6	6	—	—	$68,460.00	$122,102.55	$78,017.09	2026-05-13
177-3	OTHER	Cardiac Pacemaker And Defibrillator Revision Except Device Replacement	6	6	—	—	$66,439.49	$118,498.86	$75,714.52	2026-05-13
177-4	OTHER	Cardiac Pacemaker And Defibrillator Revision Except Device Replacement	6	6	—	—	$92,904.86	$165,701.45	$105,874.49	2026-05-13
178-1	OTHER	External Heart Assist Systems	6	6	—	—	$61,866.22	$110,342.14	$70,502.81	2026-05-13
178-2	OTHER	External Heart Assist Systems	6	6	—	—	$77,084.99	$137,485.74	$87,846.14	2026-05-13
178-3	OTHER	External Heart Assist Systems	6	6	—	—	$79,255.38	$141,356.78	$90,319.52	2026-05-13
178-4	OTHER	External Heart Assist Systems	6	6	—	—	$83,553.35	$149,022.46	$95,217.49	2026-05-13
179-2	OTHER	Defibrillator Implants	6	6	—	—	$52,653.89	$93,911.40	$60,004.43	2026-05-13
179-3	OTHER	Defibrillator Implants	6	6	—	—	$58,547.15	$104,422.38	$66,720.39	2026-05-13
179-4	OTHER	Defibrillator Implants	6	6	—	—	$74,818.23	$133,442.85	$85,262.95	2026-05-13
18	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	7	6	—	—	$5,793.00	$254,932.91	$249,934.22	2026-05-13
180-4	OTHER	Other Circulatory System Procedures	6	6	—	—	$60,544.71	$107,985.15	$68,996.82	2026-05-13
181-4	OTHER	Lower Extremity Arterial Procedures	6	6	—	—	$70,384.14	$125,534.38	$80,209.85	2026-05-13
182-4	OTHER	Other Peripheral Vascular And Related Procedures	6	6	—	—	$51,919.72	$92,601.96	$59,167.76	2026-05-13
183-3	OTHER	Percutaneous Structural Cardiac Procedures	6	6	—	—	$57,530.01	$102,608.26	$65,561.27	2026-05-13
183-4	OTHER	Percutaneous Structural Cardiac Procedures	6	6	—	—	$89,442.02	$159,525.26	$101,928.22	2026-05-13
19	OTHER	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	8	7	—	—	$5,793.00	$77,149.58	$58,554.07	2026-05-13
1980005	OTHER	Elevidys 1.33e13 VG/mL Inj (Home Supply)	1	1	$0.01	—	$2,700,000.00	$2,700,000.00	$2,700,000.00	2026-05-13
1980009	OTHER	Tisagenlecleucel (all) Soln	25	20	$1,780,600.00	$1,602,540.00	$57,245.42	$1,691,570.00	$1,347,914.20	2026-05-13
1980010	OTHER	Tisagenlecleucel (dlbcl/fl) Soln	25	20	$1,466,780.80	$1,320,102.72	$57,245.42	$1,393,441.76	$1,110,353.07	2026-05-13
1980024	OTHER	Emapalumab 100 Mg/20 Ml Vial	27	21	$144,774.00	$130,296.60	$768.26	$137,535.30	$101,341.80	2026-05-13
2	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	7	6	—	—	$5,793.00	$137,937.80	$135,233.14	2026-05-13
200-4	OTHER	Cardiac Structural And Valvular Disorders	6	6	—	—	$60,319.87	$107,584.14	$68,740.59	2026-05-13
212	OTHER	Hip & Femur Procedures Except Major Joint Age 0-17	8	7	—	—	$5,793.00	$78,705.57	$59,705.81	2026-05-13
213	OTHER	Splenic Procedures Age 0-17	1	1	—	—	$63,329.06	$63,329.06	$63,329.06	2026-05-13
220-4	OTHER	Major Stomach, Esophageal And Duodenal Procedures	6	6	—	—	$66,945.77	$119,401.83	$76,291.47	2026-05-13
222-4	OTHER	Other Stomach, Esophageal And Duodenal Procedures	6	6	—	—	$55,849.07	$99,610.19	$63,645.65	2026-05-13
223-4	OTHER	Other Small And Large Bowel Procedures	6	6	—	—	$58,444.67	$104,239.61	$66,603.61	2026-05-13
224-4	OTHER	Peritoneal Adhesiolysis	6	6	—	—	$62,412.26	$111,316.04	$71,125.08	2026-05-13
229-4	OTHER	Other Digestive System And Abdominal Procedures	6	6	—	—	$71,994.73	$128,406.96	$82,045.27	2026-05-13
230-4	OTHER	Major Small Bowel Procedures	6	6	—	—	$83,337.68	$148,637.81	$94,971.72	2026-05-13
231-4	OTHER	Major Large Bowel Procedures	6	6	—	—	$63,481.39	$113,222.91	$72,343.47	2026-05-13
232-4	OTHER	Gastric Fundoplication	6	6	—	—	$73,010.33	$130,218.35	$83,202.65	2026-05-13
252-4	OTHER	Malfunction, Reaction And Complication Of Gastrointestinal Device Or Procedure	6	6	—	—	$49,068.68	$87,516.97	$55,918.73	2026-05-13
260-4	OTHER	Major Pancreas, Liver And Shunt Procedures	6	6	—	—	$67,644.76	$120,648.53	$77,088.04	2026-05-13
261-4	OTHER	Major Biliary Tract Procedures	6	6	—	—	$73,580.84	$131,235.90	$83,852.82	2026-05-13
263-4	OTHER	Cholecystectomy	6	6	—	—	$67,817.60	$120,956.79	$77,285.01	2026-05-13
3	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	8	7	—	—	$5,793.00	$2,392,192.85	$118,685.50	2026-05-13
303-1	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	6	6	—	—	$57,332.70	$102,256.35	$65,336.41	2026-05-13
303-2	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	6	6	—	—	$60,868.97	$108,563.49	$69,366.34	2026-05-13
303-3	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	6	6	—	—	$63,484.45	$113,228.37	$72,346.95	2026-05-13
303-4	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	6	6	—	—	$118,775.24	$211,842.84	$135,356.40	2026-05-13
304-3	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	6	6	—	—	$53,680.20	$95,741.89	$61,174.01	2026-05-13
304-4	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	6	6	—	—	$104,353.35	$186,120.53	$118,921.20	2026-05-13
305-4	OTHER	Amputation Of Lower Limb Except Toes	6	6	—	—	$54,876.29	$97,875.18	$62,537.08	2026-05-13
308-4	OTHER	Hip And Femur Fracture Repair	6	6	—	—	$52,828.25	$94,222.39	$60,203.14	2026-05-13
309-4	OTHER	Other Significant Hip And Femur Surgery	6	6	—	—	$54,801.34	$97,741.51	$62,451.67	2026-05-13
312-4	OTHER	Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses	6	6	—	—	$106,643.05	$190,204.34	$121,530.54	2026-05-13
313-4	OTHER	Knee And Lower Leg Procedures Except Foot	6	6	—	—	$58,562.44	$104,449.66	$66,737.82	2026-05-13
318	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc	1	1	—	—	$74,359.59	$74,359.59	$74,359.59	2026-05-13
320-4	OTHER	Other Musculoskeletal System And Connective Tissue Procedures	6	6	—	—	$58,034.76	$103,508.50	$66,136.48	2026-05-13
325-4	OTHER	Non-elective Or Complex Knee Joint Replacement	6	6	—	—	$62,560.62	$111,580.66	$71,294.15	2026-05-13
361-4	OTHER	Skin Graft For Skin And Subcutaneous Tissue Diagnoses	6	6	—	—	$95,705.42	$170,696.42	$109,066.01	2026-05-13
363-4	OTHER	Breast Procedures Except Mastectomy	6	6	—	—	$54,906.88	$97,929.74	$62,571.94	2026-05-13
364-4	OTHER	Other Skin, Subcutaneous Tissue And Related Procedures	6	6	—	—	$51,754.53	$92,307.34	$58,979.52	2026-05-13
3922983	OTHER	Pegasparginase 3750 Units	47	21	$80,152.90	$72,137.61	$18,435.17	$94,699.99	$66,190.31	2026-05-13
3923554	OTHER	Ribavirin Inhalation 6 Gm	42	16	$89,890.50	$80,901.45	$20,674.82	$85,395.97	$73,889.99	2026-05-13
3925044	OTHER	Dinutuximab 3.5 mg/mL Inj	40	15	$72,098.45	$64,888.61	$14,368.86	$77,637.42	$57,340.98	2026-05-13
3925055	OTHER	Glucarpidase 10 Units Inj	47	21	$143,225.60	$128,903.04	$897.38	$160,221.02	$117,731.44	2026-05-13
3925127	OTHER	Nusinersen 12 Mg/5 Ml Inj (No Charge)	5	4	$0.01	—	$2,572.30	$160,285.14	$152,999.00	2026-05-13
3925176	OTHER	Nusinersen 12 Mg/5 Ml Inj	35	21	$592,007.20	$532,806.48	$882.79	$562,406.84	$160,285.14	2026-05-13
3925213	OTHER	Inotuzmb Ozogamicn0.1mg	47	21	$74,762.20	$67,285.98	$5,633.54	$88,689.43	$61,989.25	2026-05-13
3925230	OTHER	Ustekinumab 1 Mg	47	21	$90,069.90	$81,062.91	$11,375.58	$89,669.74	$72,055.92	2026-05-13
3925337	OTHER	Cerliponase Alfa1 1mg	47	21	$115,801.80	$104,221.62	$242.40	$115,297.89	$92,641.44	2026-05-13
3925598	OTHER	Pegasprginse-nc-3750 Unt	2	1	$0.01	—	$56,848.12	$56,848.12	$56,848.12	2026-05-13
3925608	OTHER	Calasprgse Pgl-mknl/10u	47	21	$92,902.80	$83,612.52	$164.16	$107,659.60	$76,366.10	2026-05-13
4	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	8	7	—	—	$5,793.00	$111,758.76	$84,171.65	2026-05-13
401-4	OTHER	Adrenal Procedures	6	6	—	—	$83,498.28	$148,924.25	$95,154.74	2026-05-13
403-4	OTHER	Procedures For Obesity	6	6	—	—	$58,193.83	$103,792.22	$66,317.75	2026-05-13
404-4	OTHER	Thyroid, Parathyroid And Thyroglossal Procedures	6	6	—	—	$76,471.65	$136,391.82	$87,147.18	2026-05-13
405-4	OTHER	Other Procedures For Endocrine, Nutritional And Metabolic Disorders	6	6	—	—	$76,275.87	$136,042.63	$86,924.07	2026-05-13
421-4	OTHER	Malnutrition, Failure To Thrive And Other Nutritional Disorders	6	6	—	—	$51,866.18	$92,506.48	$59,106.76	2026-05-13
423-4	OTHER	Inborn Errors Of Metabolism	6	6	—	—	$49,756.97	$88,744.57	$56,703.10	2026-05-13
440-1	OTHER	Kidney Transplant	6	6	—	—	$59,565.81	$106,239.23	$67,881.26	2026-05-13
440-2	OTHER	Kidney Transplant	6	6	—	—	$98,328.55	$175,374.94	$112,055.33	2026-05-13
440-3	OTHER	Kidney Transplant	6	6	—	—	$121,467.20	$216,644.12	$138,424.17	2026-05-13
440-4	OTHER	Kidney Transplant	6	6	—	—	$124,338.12	$221,764.58	$141,695.86	2026-05-13
441-4	OTHER	Major Bladder Procedures	6	6	—	—	$90,598.34	$161,587.62	$103,245.97	2026-05-13
442-4	OTHER	Kidney And Urinary Tract Procedures For Malignancy	6	6	—	—	$64,420.52	$114,897.90	$73,413.70	2026-05-13
443-4	OTHER	Kidney And Urinary Tract Procedures For Non-malignancy	6	6	—	—	$51,127.42	$91,188.86	$58,264.86	2026-05-13
446-4	OTHER	Urethral And Transurethral Procedures	6	6	—	—	$49,366.94	$88,048.93	$56,258.62	2026-05-13
447-4	OTHER	Other Kidney, Urinary Tract And Related Procedures	6	6	—	—	$72,799.26	$129,841.89	$82,962.12	2026-05-13
453	OTHER	Combined Anterior And Posterior Spinal Fusion With Mcc	7	6	—	—	$5,793.00	$279,128.73	$273,655.62	2026-05-13
454	OTHER	Combined Anterior And Posterior Spinal Fusion With Cc	8	7	—	—	$5,793.00	$91,388.54	$69,093.68	2026-05-13
455	OTHER	Combined Anterior And Posterior Spinal Fusion Without Cc/mcc	7	6	—	—	$5,793.00	$149,081.52	$146,158.35	2026-05-13
459	OTHER	Spinal Fusion Except Cervical With Mcc	7	6	—	—	$5,793.00	$180,513.35	$176,973.88	2026-05-13
45916414	OTHER	Melody Trnscath Pul Valve	19	14	$76,500.00	$68,850.00	$17,595.00	$72,675.00	$62,883.00	2026-05-13
45920593	OTHER	Melody Trnscath Pul Vlv M	19	14	$76,500.00	$68,850.00	$17,595.00	$72,675.00	$62,883.00	2026-05-13
4592249	OTHER	Sapn3 Ultr Trnscth Hrtvlv	19	14	$97,500.00	$87,750.00	$22,425.00	$92,625.00	$80,145.00	2026-05-13
45929633	OTHER	Trnscth Sapn 3.20hrt Vlv	19	14	$97,500.00	$87,750.00	$22,425.00	$92,625.00	$80,145.00	2026-05-13
45929634	OTHER	Trnscth Sapn 3.23hrt Vlv	19	14	$97,500.00	$87,750.00	$22,425.00	$92,625.00	$80,145.00	2026-05-13
45929635	OTHER	Trnscth Sapn 3.26hrt Vlv	19	14	$97,500.00	$87,750.00	$22,425.00	$92,625.00	$80,145.00	2026-05-13
45929636	OTHER	Trnscth Sapn 3.29hrt Vlv	19	14	$97,500.00	$87,750.00	$22,425.00	$92,625.00	$80,145.00	2026-05-13
45930458	OTHER	Transcath Pulm Vlv 22mm	19	14	$99,000.00	$89,100.00	$22,770.00	$94,050.00	$81,378.00	2026-05-13
45930459	OTHER	Trncath Pulm Valve 25mm	19	14	$99,000.00	$89,100.00	$22,770.00	$94,050.00	$81,378.00	2026-05-13
4593900	OTHER	Ins/rplcmt Def W/lead	27	21	$87,772.13	$78,994.92	$20,187.59	$107,847.67	$70,217.70	2026-05-13
45964846	OTHER	Icd Dr Df-1 Mmtm D121	19	14	$85,836.00	$77,252.40	$19,742.28	$81,544.20	$70,557.19	2026-05-13
460	OTHER	Spinal Fusion Except Cervical Without Mcc	8	7	—	—	$5,793.00	$81,323.46	$61,643.56	2026-05-13
480-4	OTHER	Major Male Pelvic Procedures	6	6	—	—	$49,232.34	$87,808.87	$56,105.23	2026-05-13
483-4	OTHER	Penis, Testes And Scrotal Procedures	6	6	—	—	$53,897.39	$96,129.26	$61,421.53	2026-05-13
484-4	OTHER	Other Male Reproductive System And Related Procedures	6	6	—	—	$52,370.93	$93,406.72	$59,681.96	2026-05-13
5	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	8	7	—	—	$5,793.00	$108,379.82	$81,670.57	2026-05-13
5060001	OTHER	Kidney Acqui-lvng Dnr-sng	9	8	$471,423.00	$424,280.70	$313,024.87	$433,709.16	$424,280.70	2026-05-13
5060002	OTHER	Kidney Acqui-cdvr Dnr-lnt	9	8	$177,000.00	$159,300.00	$117,528.00	$162,840.00	$159,300.00	2026-05-13
509	OTHER	Arthroscopy	7	6	—	—	$5,793.00	$138,977.74	$136,252.68	2026-05-13
510-4	OTHER	Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced…	6	6	—	—	$66,413.49	$118,452.49	$75,684.90	2026-05-13
511-4	OTHER	Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy	6	6	—	—	$66,428.79	$118,479.77	$75,702.33	2026-05-13
512-4	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy	6	6	—	—	$56,814.20	$101,331.56	$64,745.52	2026-05-13
514-4	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	6	6	—	—	$58,926.47	$105,098.93	$67,152.68	2026-05-13
518-4	OTHER	Other Female Reproductive System And Related Procedures	6	6	—	—	$61,584.78	$109,840.19	$70,182.09	2026-05-13
519-4	OTHER	Uterine And Adnexa Procedures For Leiomyoma	6	6	—	—	$52,594.24	$93,805.01	$59,936.46	2026-05-13
583-1	OTHER	Neonate With Ecmo	6	6	—	—	$214,873.75	$383,240.35	$244,870.36	2026-05-13
583-2	OTHER	Neonate With Ecmo	6	6	—	—	$343,286.52	$612,272.32	$391,209.71	2026-05-13
583-3	OTHER	Neonate With Ecmo	6	6	—	—	$498,915.66	$889,846.32	$568,564.85	2026-05-13
583-4	OTHER	Neonate With Ecmo	6	6	—	—	$568,011.94	$1,013,083.72	$647,307.06	2026-05-13
588-1	OTHER	Female Reproductive System Reconstructive Procedures	6	6	—	—	$141,780.82	$252,874.69	$161,573.58	2026-05-13
588-2	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	6	6	—	—	$141,780.82	$252,874.69	$161,573.58	2026-05-13
588-3	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	6	6	—	—	$147,961.63	$263,898.54	$168,617.24	2026-05-13
588-4	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	6	6	—	—	$401,286.10	$715,718.08	$457,306.10	2026-05-13
589-1	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	6	6	—	—	$520,199.00	$927,806.44	$592,819.38	2026-05-13
589-2	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	6	6	—	—	$501,794.23	$894,980.42	$571,845.28	2026-05-13
589-3	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	6	6	—	—	$233,209.69	$415,943.62	$265,766.03	2026-05-13
589-4	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	6	6	—	—	$64,975.74	$115,888.17	$74,046.43	2026-05-13
591-1	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	6	6	—	—	$103,730.84	$185,010.23	$118,211.78	2026-05-13
591-2	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	6	6	—	—	$143,871.68	$256,603.86	$163,956.33	2026-05-13
591-3	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	6	6	—	—	$174,235.81	$310,760.12	$198,559.32	2026-05-13
591-4	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	6	6	—	—	$296,727.79	$529,232.00	$338,151.33	2026-05-13
593-2	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	6	6	—	—	$121,034.35	$215,872.10	$137,930.88	2026-05-13
593-3	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	6	6	—	—	$178,599.54	$318,543.10	$203,532.24	2026-05-13
593-4	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	6	6	—	—	$259,031.13	$461,997.71	$295,192.17	2026-05-13
6	OTHER	Liver Transplant Without Mcc	8	7	—	—	$5,793.00	$76,929.44	$58,391.12	2026-05-13
602-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$119,302.93	$212,784.00	$135,957.75	2026-05-13
602-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$158,076.38	$281,938.80	$180,144.02	2026-05-13
602-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$174,757.37	$311,690.37	$199,153.71	2026-05-13
603-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	6	6	—	—	$67,318.97	$120,067.46	$76,716.77	2026-05-13
603-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	6	6	—	—	$115,734.55	$206,419.58	$131,891.23	2026-05-13
603-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	6	6	—	—	$231,727.58	$413,300.18	$264,077.02	2026-05-13
607-1	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$53,204.52	$94,893.48	$60,631.93	2026-05-13
607-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$75,069.07	$133,890.24	$85,548.80	2026-05-13
607-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$102,078.95	$182,063.99	$116,329.29	2026-05-13
607-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$137,069.89	$244,472.45	$156,204.99	2026-05-13
608-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	6	6	—	—	$52,849.67	$94,260.58	$60,227.54	2026-05-13
608-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	6	6	—	—	$75,043.07	$133,843.86	$85,519.17	2026-05-13
608-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	6	6	—	—	$98,252.08	$175,238.54	$111,968.18	2026-05-13
609-1	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	6	6	—	—	$65,105.75	$116,120.05	$74,194.58	2026-05-13
609-2	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	6	6	—	—	$65,105.75	$116,120.05	$74,194.58	2026-05-13
609-3	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	6	6	—	—	$162,218.33	$289,326.22	$184,864.20	2026-05-13
609-4	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	6	6	—	—	$335,779.62	$598,883.30	$382,654.83	2026-05-13
611-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	6	6	—	—	$75,619.70	$134,872.32	$86,176.30	2026-05-13
611-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	6	6	—	—	$110,024.83	$196,235.95	$125,384.42	2026-05-13
612-2	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$50,983.65	$90,932.42	$58,101.02	2026-05-13
612-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$83,912.78	$149,663.54	$95,627.10	2026-05-13
612-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$128,204.76	$228,660.96	$146,102.29	2026-05-13
613-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	6	6	—	—	$69,798.33	$124,489.55	$79,542.26	2026-05-13
613-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	6	6	—	—	$129,868.88	$231,629.02	$147,998.73	2026-05-13
614-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	6	6	—	—	$55,368.79	$98,753.60	$63,098.35	2026-05-13
614-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	6	6	—	—	$86,006.70	$153,398.17	$98,013.34	2026-05-13
621-3	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	6	6	—	—	$57,881.80	$103,235.70	$65,962.17	2026-05-13
621-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	6	6	—	—	$94,604.16	$168,732.26	$107,811.01	2026-05-13
622-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…	6	6	—	—	$49,015.15	$87,421.49	$55,857.72	2026-05-13
623-3	OTHER	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	6	6	—	—	$59,385.33	$105,917.33	$67,675.58	2026-05-13
623-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	6	6	—	—	$72,415.35	$129,157.16	$82,524.61	2026-05-13
625-3	OTHER	Neonate Birth Weight 2000-2499 Grams With Other Significant Condition	6	6	—	—	$51,861.59	$92,498.30	$59,101.53	2026-05-13
625-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Other Significant Condition	6	6	—	—	$103,839.43	$185,203.92	$118,335.54	2026-05-13
630-2	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	6	6	—	—	$108,221.52	$193,019.64	$123,329.37	2026-05-13
630-3	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	6	6	—	—	$145,092.24	$258,780.81	$165,347.29	2026-05-13
630-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	6	6	—	—	$351,746.33	$627,360.89	$400,850.51	2026-05-13
631-2	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	6	6	—	—	$59,181.90	$105,554.50	$67,443.76	2026-05-13
631-3	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	6	6	—	—	$120,220.64	$214,420.80	$137,003.58	2026-05-13
631-4	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	6	6	—	—	$280,563.78	$500,402.49	$319,730.80	2026-05-13
633-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Anomaly	6	6	—	—	$99,763.25	$177,933.80	$113,690.31	2026-05-13
634-4	OTHER	Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…	6	6	—	—	$60,307.63	$107,562.31	$68,726.64	2026-05-13
651-4	OTHER	Other Procedures Of Blood And Blood-forming Organs	6	6	—	—	$92,286.93	$164,599.34	$105,170.29	2026-05-13
652	OTHER	Kidney Transplant	8	7	—	—	$5,793.00	$414,557.01	$65,802.19	2026-05-13
660-4	OTHER	Major Hematologic Or Immunologic Diagnoses Except Sickle Cell Crisis And Coagula…	6	6	—	—	$61,694.91	$110,036.61	$70,307.59	2026-05-13
680-4	OTHER	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	6	6	—	—	$177,828.66	$317,168.19	$202,653.74	2026-05-13
681	OTHER	Neonate, Birth Weight >2499 Grams, With Significant O.r. Procedures, With Multip…	1	1	—	—	$279,457.22	$279,457.22	$279,457.22	2026-05-13
681-4	OTHER	Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	6	6	—	—	$175,540.49	$313,087.10	$200,046.15	2026-05-13
690-3	OTHER	Acute Leukemia	6	6	—	—	$58,467.61	$104,280.53	$66,629.76	2026-05-13
690-4	OTHER	Acute Leukemia	6	6	—	—	$112,472.07	$200,600.75	$128,173.30	2026-05-13
691-4	OTHER	Lymphoma, Myeloma And Non-acute Leukemia	6	6	—	—	$53,761.26	$95,886.47	$61,266.39	2026-05-13
692-4	OTHER	Radiotherapy	6	6	—	—	$49,630.02	$88,518.14	$56,558.43	2026-05-13
695-4	OTHER	Chemotherapy For Acute Leukemia	6	6	—	—	$67,872.66	$121,055.00	$77,347.76	2026-05-13
7	OTHER	Lung Transplant	7	6	—	—	$5,793.00	$130,819.29	$128,254.21	2026-05-13
710-4	OTHER	Infectious And Parasitic Diseases Including HIV With O.r. Procedure	6	6	—	—	$68,386.58	$121,971.61	$77,933.43	2026-05-13
711-4	OTHER	Post-operative, Post-trauma, Other Device Infections With O.r. Procedure	6	6	—	—	$59,067.19	$105,349.90	$67,313.03	2026-05-13
792-4	OTHER	Extensive O.r. Procedures For Other Complications Of Treatment	6	6	—	—	$193,177.44	$344,543.67	$220,145.23	2026-05-13
793-4	OTHER	Moderately Extensive O.r. Procedures For Other Complications Of Treatment	6	6	—	—	$50,263.24	$89,647.54	$57,280.04	2026-05-13
841-1	OTHER	Chemotherapy For Acute Leukemia	6	6	—	—	$71,514.46	$127,550.37	$81,497.96	2026-05-13
841-2	OTHER	Extensive Third Degree Burns With Skin Graft	6	6	—	—	$71,514.46	$127,550.37	$81,497.96	2026-05-13
841-3	OTHER	Extensive Third Degree Burns With Skin Graft	6	6	—	—	$110,050.83	$196,282.33	$125,414.05	2026-05-13
841-4	OTHER	Extensive Third Degree Burns With Skin Graft	6	6	—	—	$329,354.08	$587,422.97	$375,332.29	2026-05-13
842-3	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	6	6	—	—	$53,879.04	$96,096.53	$61,400.61	2026-05-13
842-4	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	6	6	—	—	$162,320.81	$289,509.00	$184,980.98	2026-05-13
850-3	OTHER	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	6	6	—	—	$55,908.72	$99,716.58	$63,713.64	2026-05-13
850-4	OTHER	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	6	6	—	—	$120,468.42	$214,862.74	$137,285.96	2026-05-13
861-4	OTHER	Signs, Symptoms And Other Factors Influencing Health Status	6	6	—	—	$56,558.76	$100,875.98	$64,454.43	2026-05-13
863-3	OTHER	Neonatal Aftercare	6	6	—	—	$65,697.67	$117,175.78	$74,869.15	2026-05-13
863-4	OTHER	Neonatal Aftercare	6	6	—	—	$111,145.97	$198,235.58	$126,662.07	2026-05-13
890-3	OTHER	HIV With Multiple Major HIV Related Conditions	6	6	—	—	$50,460.55	$89,999.45	$57,504.90	2026-05-13
890-4	OTHER	HIV With Multiple Major HIV Related Conditions	6	6	—	—	$103,450.93	$184,511.01	$117,892.80	2026-05-13
910-3	OTHER	Craniotomy For Multiple Significant Trauma	6	6	—	—	$57,906.28	$103,279.35	$65,990.06	2026-05-13
910-4	OTHER	Craniotomy For Multiple Significant Trauma	6	6	—	—	$109,663.86	$195,592.14	$124,973.06	2026-05-13
911-4	OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	6	6	—	—	$87,063.61	$155,283.22	$99,217.79	2026-05-13
912-4	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	6	6	—	—	$81,996.29	$146,245.35	$93,443.07	2026-05-13
927	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	8	7	—	—	$5,793.00	$106,858.27	$80,544.32	2026-05-13
930-4	OTHER	Multiple Significant Trauma Without O.r. Procedure	6	6	—	—	$54,036.58	$96,377.51	$61,580.15	2026-05-13
950-4	OTHER	Extensive O.r. Procedure Unrelated To Principal Diagnosis	6	6	—	—	$94,388.50	$168,347.61	$107,565.24	2026-05-13
951-4	OTHER	Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis	6	6	—	—	$69,501.60	$123,960.32	$79,204.10	2026-05-13
952-4	OTHER	Non-extensive O.r. Procedure Unrelated To Principal Diagnosis	6	6	—	—	$61,987.05	$110,557.66	$70,640.51	2026-05-13

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