Hospital

MAT-SU REGIONAL MEDICAL CENTER

Palmer, AK · CCN 020006 · Rates published

93,410 distinct procedures filed

31 distinct payers

2,120,645 rate rows

2026-05-06 last MRF observed

Data quality

2,115,039 of 2,120,645 rate rows are consumer-grade (99.7%)

5,606 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	3,503
template filing: same amount across many unrelated codes — excluded	1,234
per-diem day rate — not a per-procedure price	869

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

Source MRF file	https://www.matsuregional.com/Uploads/Public/Documents/charge-masters/charge-masters-2024/721563402_mat-su-regional-medical-center_standardcharges.csv
Found on page	https://www.matsuregional.com/pricing-information
Discovered via	Public MRF directory
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-05-18
Content fingerprint	9d6ecf831e550792… · 269,452,876 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
18 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	19	$432,228.49	$2,745,658.56	$1,830,439.04	nat. median $386,529 outlier · 4.7×
7 OTHER	Lung Transplant	19	$116,443.83	$2,076,333.31	$1,384,222.21	nat. median $169,933 outlier · 8.1×
583-4 OTHER	Neonate With Ecmo	1	$777,971.23	$777,971.23	$777,971.23	nat. median $309,400 outlier · 2.5×
583-3 OTHER	Neonate With Ecmo	1	$652,264.90	$652,264.90	$652,264.90	nat. median $259,487 outlier · 2.5×
4 OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	19	$112,039.64	$911,242.82	$607,495.21	nat. median $134,983 outlier · 4.5×
588-4 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	1	$574,878.91	$574,878.91	$574,878.91	nat. median $267,493 outlier · 2.1×
1 OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	19	$200,766.65	$812,728.35	$541,818.90	nat. median $239,422 outlier · 2.3×
2 OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	19	$6,950.00	$722,771.44	$481,847.63	nat. median $111,558 outlier · 4.3×
969 OTHER	HIV With Extensive O.r. Procedures With Mcc	19	$67,778.35	$711,250.21	$474,166.81	nat. median $64,729 outlier · 7.3×
3 OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	19	$72,638.87	$619,295.43	$412,863.62	nat. median $181,005 outlier · 2.3×
591-4 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	1	$397,773.62	$397,773.62	$397,773.62	nat. median $156,696 outlier · 2.5×
6 OTHER	Liver Transplant Without Mcc	19	$35,632.69	$588,486.19	$392,324.13	nat. median $52,924 outlier · 7.4×
609-4 OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	1	$380,063.90	$380,063.90	$380,063.90	nat. median $169,856 outlier · 2.2×
8 OTHER	Simultaneous Pancreas And Kidney Transplant	19	$6,950.00	$568,262.78	$378,841.86	nat. median $57,589 outlier · 6.6×
002-4 OTHER	Heart And/or Lung Transplant	1	$375,063.35	$375,063.35	$375,063.35	nat. median $216,800 1.7× median
570 OTHER	Skin Debridement With Mcc	19	$10,260.28	$539,298.13	$359,532.09	nat. median $33,751 outlier · 10.7×
207 OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	19	$57,185.30	$535,661.04	$357,107.36	nat. median $66,849 outlier · 5.3×
681 OTHER	Neonate, Birth Weight >2499 Grams, With Significant O.r. Procedures, With Multip…	2	$353,950.76	$353,950.76	$353,950.76	nat. median $0
927 OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	19	$94,815.49	$447,040.80	$353,907.30	nat. median $146,562 outlier · 2.4×
588-3 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	1	$352,852.50	$352,852.50	$352,852.50	nat. median $165,000 outlier · 2.1×
593-4 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	1	$347,070.62	$347,070.62	$347,070.62	nat. median $151,250 outlier · 2.3×
268 OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	19	$3,015.29	$519,123.99	$346,082.66	nat. median $67,670 outlier · 5.1×
630-4 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	1	$337,515.78	$337,515.78	$337,515.78	nat. median $210,669 1.6× median
583-2 OTHER	Neonate With Ecmo	1	$331,329.54	$331,329.54	$331,329.54	nat. median $191,347 1.7× median
631-4 OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	1	$324,518.23	$324,518.23	$324,518.23	nat. median $203,379 1.6× median
583-1 OTHER	Neonate With Ecmo	1	$315,825.27	$315,825.27	$315,825.27	nat. median $171,226 1.8× median
603-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	1	$313,729.36	$313,729.36	$313,729.36	nat. median $107,050 outlier · 2.9×
5 OTHER	Liver Transplant With Mcc Or Intestinal Transplant	19	$72,488.47	$454,619.95	$303,079.97	nat. median $94,894 outlier · 3.2×
837 OTHER	Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…	19	$37,067.58	$449,579.88	$299,719.92	nat. median $38,617 outlier · 7.8×
163 OTHER	Major Chest Procedures With Mcc	20	$27,441.92	$441,604.16	$285,202.68	nat. median $47,944 outlier · 5.9×
653 OTHER	Major Bladder Procedures With Mcc	19	$12,750.55	$415,322.66	$276,881.77	nat. median $54,646 outlier · 5.1×
602-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	1	$272,563.48	$272,563.48	$272,563.48	nat. median $125,000 outlier · 2.2×
161-4 OTHER	Implantable Heart Assist Systems	1	$266,821.88	$266,821.88	$266,821.88	nat. median $202,242 1.3× median
001-4 OTHER	Liver Transplant And/or Intestinal Transplant	1	$261,702.12	$261,702.12	$261,702.12	nat. median $124,561 outlier · 2.1×
471 OTHER	Cervical Spinal Fusion With Mcc	19	$17,240.32	$373,763.46	$249,175.64	nat. median $399 outlier · 624.1×
20 OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	19	$30,958.67	$371,696.38	$247,797.59	nat. median $74,209 outlier · 3.3×
326 OTHER	Stomach, Esophageal And Duodenal Procedures With Mcc	19	$14,387.47	$365,839.07	$243,892.71	nat. median $45,545 outlier · 5.4×
841-4 OTHER	Extensive Third Degree Burns With Skin Graft	1	$240,164.66	$240,164.66	$240,164.66	nat. median $151,691 1.6× median
461 OTHER	Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc	19	$6,950.00	$359,022.15	$239,348.10	nat. median $53,999 outlier · 4.4×
21 OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	19	$32,456.00	$354,667.01	$236,444.67	nat. median $55,888 outlier · 4.2×
593-3 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	1	$233,928.48	$233,928.48	$233,928.48	nat. median $112,711 outlier · 2.1×
10 OTHER	Pancreas Transplant	19	$6,950.00	$349,352.02	$232,901.34	nat. median $62,879 outlier · 3.7×
007-4 OTHER	Allogeneic Bone Marrow Transplant	1	$230,872.41	$230,872.41	$230,872.41	nat. median $172,311 1.3× median
22 OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…	19	$18,284.75	$343,299.50	$228,866.34	nat. median $36,392 outlier · 6.3×
006-4 OTHER	Pancreas Transplant	1	$224,950.37	$224,950.37	$224,950.37	nat. median $92,449 outlier · 2.4×
607-4 OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	1	$224,117.49	$224,117.49	$224,117.49	nat. median $100,015 outlier · 2.2×
002-3 OTHER	Heart And/or Lung Transplant	1	$221,269.24	$221,269.24	$221,269.24	nat. median $133,471 1.7× median
863-4 OTHER	Neonatal Aftercare	1	$216,972.70	$216,972.70	$216,972.70	nat. median $108,047 outlier · 2.0×
215 OTHER	Other Heart Assist System Implant	19	$100,178.73	$321,723.46	$214,482.30	nat. median $92,359 outlier · 2.3×
356 OTHER	Other Digestive System O.r. Procedures With Mcc	19	$16,704.63	$317,125.97	$211,417.31	nat. median $43,743 outlier · 4.8×

Other procedures at this hospital

Browse this hospital's 93,410 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

18	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	19	19	—	—	$432,228.49	$2,745,658.56	$1,830,439.04	2026-05-06
7	OTHER	Lung Transplant	19	19	—	—	$116,443.83	$2,076,333.31	$1,384,222.21	2026-05-06
583-4	OTHER	Neonate With Ecmo	2	1	—	—	$777,971.23	$777,971.23	$777,971.23	2026-05-06
583-3	OTHER	Neonate With Ecmo	2	1	—	—	$652,264.90	$652,264.90	$652,264.90	2026-05-06
4	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	19	19	—	—	$112,039.64	$911,242.82	$607,495.21	2026-05-06
588-4	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	2	1	—	—	$574,878.91	$574,878.91	$574,878.91	2026-05-06
1	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	19	19	—	—	$200,766.65	$812,728.35	$541,818.90	2026-05-06
2	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	19	19	—	—	$6,950.00	$722,771.44	$481,847.63	2026-05-06
969	OTHER	HIV With Extensive O.r. Procedures With Mcc	19	19	—	—	$67,778.35	$711,250.21	$474,166.81	2026-05-06
3	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	19	19	—	—	$72,638.87	$619,295.43	$412,863.62	2026-05-06
591-4	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	2	1	—	—	$397,773.62	$397,773.62	$397,773.62	2026-05-06
6	OTHER	Liver Transplant Without Mcc	19	19	—	—	$35,632.69	$588,486.19	$392,324.13	2026-05-06
609-4	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	2	1	—	—	$380,063.90	$380,063.90	$380,063.90	2026-05-06
8	OTHER	Simultaneous Pancreas And Kidney Transplant	19	19	—	—	$6,950.00	$568,262.78	$378,841.86	2026-05-06
002-4	OTHER	Heart And/or Lung Transplant	2	1	—	—	$375,063.35	$375,063.35	$375,063.35	2026-05-06
570	OTHER	Skin Debridement With Mcc	19	19	—	—	$10,260.28	$539,298.13	$359,532.09	2026-05-06
207	OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	19	19	—	—	$57,185.30	$535,661.04	$357,107.36	2026-05-06
681	OTHER	Neonate, Birth Weight >2499 Grams, With Significant O.r. Procedures, With Multip…	2	2	—	—	$353,950.76	$353,950.76	$353,950.76	2026-05-06
927	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	19	19	—	—	$94,815.49	$447,040.80	$353,907.30	2026-05-06
588-3	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	2	1	—	—	$352,852.50	$352,852.50	$352,852.50	2026-05-06
593-4	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	2	1	—	—	$347,070.62	$347,070.62	$347,070.62	2026-05-06
268	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	19	19	—	—	$3,015.29	$519,123.99	$346,082.66	2026-05-06
630-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	2	1	—	—	$337,515.78	$337,515.78	$337,515.78	2026-05-06
583-2	OTHER	Neonate With Ecmo	2	1	—	—	$331,329.54	$331,329.54	$331,329.54	2026-05-06
631-4	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	2	1	—	—	$324,518.23	$324,518.23	$324,518.23	2026-05-06
583-1	OTHER	Neonate With Ecmo	2	1	—	—	$315,825.27	$315,825.27	$315,825.27	2026-05-06
603-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	2	1	—	—	$313,729.36	$313,729.36	$313,729.36	2026-05-06
5	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	19	19	—	—	$72,488.47	$454,619.95	$303,079.97	2026-05-06
837	OTHER	Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…	19	19	—	—	$37,067.58	$449,579.88	$299,719.92	2026-05-06
163	OTHER	Major Chest Procedures With Mcc	20	20	—	—	$27,441.92	$441,604.16	$285,202.68	2026-05-06
653	OTHER	Major Bladder Procedures With Mcc	19	19	—	—	$12,750.55	$415,322.66	$276,881.77	2026-05-06
602-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	2	1	—	—	$272,563.48	$272,563.48	$272,563.48	2026-05-06
161-4	OTHER	Implantable Heart Assist Systems	2	1	—	—	$266,821.88	$266,821.88	$266,821.88	2026-05-06
001-4	OTHER	Liver Transplant And/or Intestinal Transplant	2	1	—	—	$261,702.12	$261,702.12	$261,702.12	2026-05-06
471	OTHER	Cervical Spinal Fusion With Mcc	19	19	—	—	$17,240.32	$373,763.46	$249,175.64	2026-05-06
20	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	19	19	—	—	$30,958.67	$371,696.38	$247,797.59	2026-05-06
326	OTHER	Stomach, Esophageal And Duodenal Procedures With Mcc	19	19	—	—	$14,387.47	$365,839.07	$243,892.71	2026-05-06
841-4	OTHER	Extensive Third Degree Burns With Skin Graft	2	1	—	—	$240,164.66	$240,164.66	$240,164.66	2026-05-06
461	OTHER	Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc	19	19	—	—	$6,950.00	$359,022.15	$239,348.10	2026-05-06
21	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	19	19	—	—	$32,456.00	$354,667.01	$236,444.67	2026-05-06
593-3	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	2	1	—	—	$233,928.48	$233,928.48	$233,928.48	2026-05-06
10	OTHER	Pancreas Transplant	19	19	—	—	$6,950.00	$349,352.02	$232,901.34	2026-05-06
007-4	OTHER	Allogeneic Bone Marrow Transplant	2	1	—	—	$230,872.41	$230,872.41	$230,872.41	2026-05-06
22	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…	19	19	—	—	$18,284.75	$343,299.50	$228,866.34	2026-05-06
006-4	OTHER	Pancreas Transplant	2	1	—	—	$224,950.37	$224,950.37	$224,950.37	2026-05-06
607-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	2	1	—	—	$224,117.49	$224,117.49	$224,117.49	2026-05-06
002-3	OTHER	Heart And/or Lung Transplant	2	1	—	—	$221,269.24	$221,269.24	$221,269.24	2026-05-06
863-4	OTHER	Neonatal Aftercare	2	1	—	—	$216,972.70	$216,972.70	$216,972.70	2026-05-06
215	OTHER	Other Heart Assist System Implant	19	19	—	—	$100,178.73	$321,723.46	$214,482.30	2026-05-06
356	OTHER	Other Digestive System O.r. Procedures With Mcc	19	19	—	—	$16,704.63	$317,125.97	$211,417.31	2026-05-06
004-4	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	2	1	—	—	$208,431.18	$208,431.18	$208,431.18	2026-05-06
456	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	19	19	—	—	$17,098.86	$312,482.58	$208,321.72	2026-05-06
231	OTHER	Coronary Bypass With Ptca With Mcc	19	19	—	—	$29,831.05	$300,057.89	$200,038.59	2026-05-06
161-3	OTHER	Implantable Heart Assist Systems	2	1	—	—	$198,792.57	$198,792.57	$198,792.57	2026-05-06
602-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	2	1	—	—	$197,059.13	$197,059.13	$197,059.13	2026-05-06
216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	19	19	—	—	$43,035.53	$291,656.30	$194,437.54	2026-05-06
219	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	19	19	—	—	$37,622.12	$290,334.78	$193,556.52	2026-05-06
453	OTHER	Combined Anterior And Posterior Spinal Fusion With Mcc	18	18	—	—	$31,242.76	$262,709.40	$191,558.93	2026-05-06
197	OTHER	Interstitial Lung Disease With Cc	19	19	—	—	$12,435.74	$284,320.23	$189,546.82	2026-05-06
347	OTHER	Anal And Stomal Procedures With Mcc	19	19	—	—	$2,836.28	$283,193.50	$188,795.67	2026-05-06
593-2	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	2	1	—	—	$186,455.53	$186,455.53	$186,455.53	2026-05-06
970	OTHER	HIV With Extensive O.r. Procedures Without Mcc	19	19	—	—	$12,898.37	$278,708.26	$185,805.50	2026-05-06
757-4	OTHER	Organic Mental Health Disturbances	2	1	—	—	$185,213.45	$185,213.45	$185,213.45	2026-05-06
23	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	19	19	—	—	$40,260.96	$275,437.01	$183,624.67	2026-05-06
740-4	OTHER	Mental Illness Diagnosis With O.r. Procedure	2	1	—	—	$183,262.53	$183,262.53	$183,262.53	2026-05-06
588-2	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	2	1	—	—	$182,403.86	$182,403.86	$182,403.86	2026-05-06
51905029-4639971	OTHER	30237-8900-06 - Sipuleucel-t - Susp	29	26	$298,843.52	$89,653.06 70% off	$15,721.03	$286,889.78	$182,294.55	2026-05-06
002-2	OTHER	Heart And/or Lung Transplant	2	1	—	—	$182,199.27	$182,199.27	$182,199.27	2026-05-06
609-3	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	2	1	—	—	$182,022.06	$182,022.06	$182,022.06	2026-05-06
103958919-4660260	OTHER	69866-1030-08 - Autologous Cultured Chondrocytes 1	22	20	$228,480.00	$114,240.00 50% off	$24,493.06	$219,340.80	$177,072.00	2026-05-06
103958918-4660260	OTHER	69866-1030-05 - Autologous Cultured Chondrocytes 1	22	20	$228,480.00	$114,240.00 50% off	$24,493.06	$219,340.80	$177,072.00	2026-05-06
630-3	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	2	1	—	—	$176,870.08	$176,870.08	$176,870.08	2026-05-06
608-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	2	1	—	—	$171,004.43	$171,004.43	$171,004.43	2026-05-06
009-4	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	2	1	—	—	$170,405.14	$170,405.14	$170,405.14	2026-05-06
849	OTHER	Radiotherapy	19	19	—	—	$18,449.12	$255,463.68	$170,309.12	2026-05-06
591-3	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	2	1	—	—	$169,301.60	$169,301.60	$169,301.60	2026-05-06
752-4	OTHER	Disorders Of Personality And Impulse Control	2	1	—	—	$167,083.25	$167,083.25	$167,083.25	2026-05-06
602-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	2	1	—	—	$166,231.04	$166,231.04	$166,231.04	2026-05-06
625-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Other Significant Condition	2	1	—	—	$158,575.56	$158,575.56	$158,575.56	2026-05-06
895	OTHER	Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy	19	19	—	—	$4,819.09	$235,994.06	$157,329.38	2026-05-06
607-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	2	1	—	—	$156,197.73	$156,197.73	$156,197.73	2026-05-06
745	OTHER	D&c, Conization, Laparoscopy And Tubal Interruption Without Cc/mcc	19	19	—	—	$6,238.00	$233,504.93	$155,669.95	2026-05-06
613-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	2	1	—	—	$155,095.80	$155,095.80	$155,095.80	2026-05-06
759-4	OTHER	Eating Disorders	2	1	—	—	$153,720.01	$153,720.01	$153,720.01	2026-05-06
006-3	OTHER	Pancreas Transplant	2	1	—	—	$153,644.29	$153,644.29	$153,644.29	2026-05-06
611-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	2	1	—	—	$152,178.28	$152,178.28	$152,178.28	2026-05-06
650	OTHER	Kidney Transplant With Hemodialysis With Mcc	19	19	—	—	$27,926.34	$227,181.60	$151,454.40	2026-05-06
633	OTHER	Neonate, Birth Weight 1000-1499 Grams, With Significant O.r. Procedures, Dischar…	2	2	—	—	$150,252.53	$150,252.53	$150,252.53	2026-05-06
485	OTHER	Knee Procedures With Principal Diagnosis Of Infection With Mcc	19	19	—	—	$42,200.27	$224,534.09	$149,689.40	2026-05-06
612-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	2	1	—	—	$149,515.30	$149,515.30	$149,515.30	2026-05-06
277	OTHER	Cellulitis Age >17 W Cc	19	19	—	—	$22,295.80	$223,595.52	$149,063.68	2026-05-06
440-4	OTHER	Kidney Transplant	2	1	—	—	$148,846.73	$148,846.73	$148,846.73	2026-05-06
432	OTHER	Cirrhosis And Alcoholic Hepatitis With Mcc	18	18	—	—	$8,317.25	$230,150.90	$148,639.12	2026-05-06
802	OTHER	Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc	19	19	—	—	$19,640.52	$220,943.12	$147,295.41	2026-05-06
603-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	2	1	—	—	$146,120.92	$146,120.92	$146,120.92	2026-05-06
004-3	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	2	1	—	—	$144,418.10	$144,418.10	$144,418.10	2026-05-06
001-3	OTHER	Liver Transplant And/or Intestinal Transplant	2	1	—	—	$144,207.05	$144,207.05	$144,207.05	2026-05-06
11	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	19	19	—	—	$50,284.92	$216,139.06	$144,092.70	2026-05-06
006-2	OTHER	Pancreas Transplant	2	1	—	—	$142,125.64	$142,125.64	$142,125.64	2026-05-06
651	OTHER	Kidney Transplant With Hemodialysis Without Mcc	19	19	—	—	$48,454.99	$210,381.36	$140,254.24	2026-05-06
005-4	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	2	1	—	—	$138,758.65	$138,758.65	$138,758.65	2026-05-06
95380079-4660257	OTHER	00169-7208-01 - Coagulation Factor VIIa 8000 Mcg (	22	20	$178,902.50	$89,451.25 50% off	$19,178.35	$171,746.40	$138,649.44	2026-05-06
333	OTHER	Rectal Resection With Cc	19	19	—	—	$22,431.67	$207,970.66	$138,647.10	2026-05-06
212	OTHER	Hip & Femur Procedures Except Major Joint Age 0-17	19	19	—	—	$2,370.31	$194,984.13	$138,447.29	2026-05-06
636	OTHER	Neonate, Birth Weight 1500-1999 Grams, With Significant O.r. Procedures, With Mu…	2	2	—	—	$137,974.17	$137,974.17	$137,974.17	2026-05-06
233	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	19	19	—	—	$40,955.48	$206,802.36	$137,868.24	2026-05-06
327	OTHER	Stomach, Esophageal And Duodenal Procedures With Cc	19	19	—	—	$16,162.32	$206,789.10	$137,859.40	2026-05-06
002-1	OTHER	Heart And/or Lung Transplant	2	1	—	—	$135,952.29	$135,952.29	$135,952.29	2026-05-06
007-3	OTHER	Allogeneic Bone Marrow Transplant	2	1	—	—	$135,053.35	$135,053.35	$135,053.35	2026-05-06
303-4	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	2	1	—	—	$135,027.58	$135,027.58	$135,027.58	2026-05-06
591-2	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	2	1	—	—	$134,951.86	$134,951.86	$134,951.86	2026-05-06
269	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	19	19	—	—	$243.88	$200,657.54	$133,771.69	2026-05-06
40	OTHER	Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc	19	19	—	—	$15,010.40	$200,578.32	$133,718.88	2026-05-06
870	OTHER	Septicemia Or Severe Sepsis With Mv >96 Hours	19	19	—	—	$33,313.59	$197,135.05	$131,423.37	2026-05-06
608-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	2	1	—	—	$131,243.34	$131,243.34	$131,243.34	2026-05-06
503	OTHER	Foot Procedures With Mcc	19	19	—	—	$25,468.26	$196,019.94	$130,679.96	2026-05-06
957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	20	20	—	—	$44,128.80	$172,287.11	$130,299.43	2026-05-06
955	OTHER	Craniotomy For Multiple Significant Trauma	19	19	—	—	$87,983.78	$195,242.08	$130,161.39	2026-05-06
161-2	OTHER	Implantable Heart Assist Systems	2	1	—	—	$127,816.74	$127,816.74	$127,816.74	2026-05-06
102534551-4660256	OTHER	71336-1001-01 - Givosiran 189 mg/mL Soln	22	20	$164,580.00	$82,290.00 50% off	$17,642.98	$157,996.80	$127,549.50	2026-05-06
908	OTHER	Other O.r. Procedures For Injuries With Cc	19	19	—	—	$5,259.07	$191,059.49	$127,372.99	2026-05-06
127538326-4639971	OTHER	00310-4535-30 - Tremelimumab Actl 20 mg/mL Soln	22	20	$164,349.59	$82,174.80 50% off	$17,618.28	$157,775.61	$127,370.93	2026-05-06
841	OTHER	Lymphoma And Non-acute Leukemia With Cc	19	19	—	—	$334.85	$190,572.53	$127,048.35	2026-05-06
459	OTHER	Spinal Fusion Except Cervical With Mcc	18	18	—	—	$29,150.67	$169,894.92	$127,039.04	2026-05-06
959	OTHER	Other O.r. Procedures For Multiple Significant Trauma Without Cc/mcc	19	19	—	—	$8,168.82	$189,200.36	$126,133.57	2026-05-06
239	OTHER	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	19	19	—	—	$61,029.06	$188,086.08	$125,390.72	2026-05-06
314	OTHER	Other Circulatory System Diagnoses With Mcc	19	19	—	—	$27,280.10	$187,693.97	$125,129.31	2026-05-06
634	OTHER	Neonate, Birth Weight 1000-1499 Grams, Without Significant O.r. Procedures, Disc…	2	2	—	—	$124,759.83	$124,759.83	$124,759.83	2026-05-06
232	OTHER	Coronary Bypass With Ptca Without Mcc	19	19	—	—	$6,950.00	$186,477.71	$124,318.47	2026-05-06
607-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	2	1	—	—	$123,373.60	$123,373.60	$123,373.60	2026-05-06
288	OTHER	Acute And Subacute Endocarditis With Mcc	19	19	—	—	$35,394.13	$180,214.65	$120,143.10	2026-05-06
631-3	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	2	1	—	—	$119,959.89	$119,959.89	$119,959.89	2026-05-06
266	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	19	19	—	—	$80,108.86	$179,888.27	$119,925.51	2026-05-06
589-1	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	2	1	—	—	$119,884.18	$119,884.18	$119,884.18	2026-05-06
783	OTHER	Cesarean Section With Sterilization With Mcc	19	19	—	—	$5,878.17	$178,843.44	$119,228.96	2026-05-06
001-2	OTHER	Liver Transplant And/or Intestinal Transplant	2	1	—	—	$119,102.84	$119,102.84	$119,102.84	2026-05-06
217	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	19	19	—	—	$38,691.62	$155,546.93	$118,564.67	2026-05-06
140	OTHER	Major Head And Neck Procedures With Mcc	19	19	—	—	$460.99	$177,235.60	$118,157.07	2026-05-06
001-1	OTHER	Liver Transplant And/or Intestinal Transplant	2	1	—	—	$117,612.67	$117,612.67	$117,612.67	2026-05-06
598	OTHER	Malignant Breast Disorders With Cc	19	19	—	—	$5,835.64	$173,853.12	$115,902.08	2026-05-06
399	OTHER	Reticuloendothelial & Immunity Disorders Without Cc	19	19	—	—	$4,175.61	$173,167.33	$115,444.89	2026-05-06
842-4	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	2	1	—	—	$114,981.90	$114,981.90	$114,981.90	2026-05-06
1279402-4660256	OTHER	00003-2328-22 - Ipilimumab Soln	22	20	$148,050.81	$74,025.41 50% off	$15,871.05	$142,128.78	$114,739.38	2026-05-06
621-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	2	1	—	—	$114,571.10	$114,571.10	$114,571.10	2026-05-06
652	OTHER	Kidney Transplant	19	19	—	—	$23,641.88	$170,053.46	$113,368.97	2026-05-06
275	OTHER	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	19	19	—	—	$29,469.53	$143,060.73	$113,256.41	2026-05-06
16	OTHER	Autologous Bone Marrow Transplant With Cc/mcc	19	19	—	—	$17,644.31	$169,869.12	$113,246.08	2026-05-06
500	OTHER	Soft Tissue Procedures With Mcc	19	19	—	—	$23,561.18	$169,861.90	$113,241.27	2026-05-06
622-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…	2	1	—	—	$112,573.46	$112,573.46	$112,573.46	2026-05-06
896	OTHER	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc	19	19	—	—	$6,079.55	$168,814.66	$112,543.10	2026-05-06
633-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Anomaly	2	1	—	—	$112,157.82	$112,157.82	$112,157.82	2026-05-06
673	OTHER	Other Kidney And Urinary Tract Procedures With Mcc	19	19	—	—	$38,491.67	$167,708.28	$111,805.52	2026-05-06
162-4	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	2	1	—	—	$111,622.97	$111,622.97	$111,622.97	2026-05-06
750-4	OTHER	Schizophrenia	2	1	—	—	$111,329.77	$111,329.77	$111,329.77	2026-05-06
70	OTHER	Nonspecific Cerebrovascular Disorders With Mcc	19	19	—	—	$6,282.37	$166,384.96	$110,923.31	2026-05-06
007-2	OTHER	Allogeneic Bone Marrow Transplant	2	1	—	—	$109,678.49	$109,678.49	$109,678.49	2026-05-06
160-4	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	2	1	—	—	$109,454.56	$109,454.56	$109,454.56	2026-05-06
823	OTHER	Lymphoma And Non-acute Leukemia With Other Procedures With Mcc	19	19	—	—	$10,796.66	$163,613.09	$109,075.39	2026-05-06
12	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc	19	19	—	—	$28,966.48	$163,309.99	$108,873.32	2026-05-06
740-3	OTHER	Mental Illness Diagnosis With O.r. Procedure	2	1	—	—	$108,826.27	$108,826.27	$108,826.27	2026-05-06
609-2	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	2	1	—	—	$108,051.38	$108,051.38	$108,051.38	2026-05-06
008-4	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	2	1	—	—	$106,878.57	$106,878.57	$106,878.57	2026-05-06
267	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc	19	19	—	—	$2,101.94	$160,045.25	$106,696.83	2026-05-06
820	OTHER	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	19	19	—	—	$45,611.59	$153,257.60	$105,934.15	2026-05-06
242	OTHER	Permanent Cardiac Pacemaker Implant With Mcc	19	19	—	—	$16,163.27	$158,775.05	$105,850.04	2026-05-06
612-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	2	1	—	—	$105,209.58	$105,209.58	$105,209.58	2026-05-06
867	OTHER	Other Infectious And Parasitic Diseases Diagnoses With Mcc	19	19	—	—	$5,386.43	$157,755.48	$105,170.32	2026-05-06
101891901-4639971	OTHER	72187-0401-01 - Tagraxofusp 1000 mcg/mL Soln	22	20	$135,669.58	$67,834.79 50% off	$14,543.78	$130,242.80	$105,143.93	2026-05-06
613-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	2	1	—	—	$104,118.93	$104,118.93	$104,118.93	2026-05-06
329	OTHER	Major Small And Large Bowel Procedures With Mcc	19	19	—	—	$26,421.16	$155,585.27	$103,723.51	2026-05-06
929	OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/mcc	19	19	—	—	$6,374.26	$155,529.96	$103,686.64	2026-05-06
455	OTHER	Combined Anterior And Posterior Spinal Fusion Without Cc/mcc	18	18	—	—	$45,350.35	$140,312.02	$102,310.85	2026-05-06
161-1	OTHER	Implantable Heart Assist Systems	2	1	—	—	$101,890.92	$101,890.92	$101,890.92	2026-05-06
611-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	2	1	—	—	$101,544.55	$101,544.55	$101,544.55	2026-05-06
004-2	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	2	1	—	—	$100,945.26	$100,945.26	$100,945.26	2026-05-06
405	OTHER	Pancreas, Liver And Shunt Procedures With Mcc	19	19	—	—	$42,261.38	$151,109.37	$100,739.58	2026-05-06
423	OTHER	Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc	19	19	—	—	$54,298.14	$124,242.72	$100,339.10	2026-05-06
303-3	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	2	1	—	—	$100,154.26	$100,154.26	$100,154.26	2026-05-06
005-3	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	2	1	—	—	$99,577.52	$99,577.52	$99,577.52	2026-05-06
234	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	19	19	—	—	$26,282.94	$145,292.58	$98,786.04	2026-05-06
613	OTHER	Neonate, Birth Weight <750 Grams, Died	2	2	—	—	$98,512.89	$98,512.89	$98,512.89	2026-05-06
006-1	OTHER	Pancreas Transplant	2	1	—	—	$97,425.23	$97,425.23	$97,425.23	2026-05-06
440-3	OTHER	Kidney Transplant	2	1	—	—	$96,387.74	$96,387.74	$96,387.74	2026-05-06
304-4	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	2	1	—	—	$96,289.47	$96,289.47	$96,289.47	2026-05-06
463	OTHER	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …	19	19	—	—	$19,329.41	$121,588.88	$96,257.86	2026-05-06
826	OTHER	Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …	19	19	—	—	$25,284.92	$143,956.40	$95,970.93	2026-05-06
630-2	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	2	1	—	—	$95,841.61	$95,841.61	$95,841.61	2026-05-06
178-4	OTHER	External Heart Assist Systems	2	1	—	—	$95,831.95	$95,831.95	$95,831.95	2026-05-06
509	OTHER	Arthroscopy	18	18	—	—	$6,950.00	$130,802.57	$95,376.88	2026-05-06
198	OTHER	Interstitial Lung Disease Without Cc/mcc	19	19	—	—	$6,950.00	$142,917.12	$95,278.08	2026-05-06
163-4	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	2	1	—	—	$94,800.91	$94,800.91	$94,800.91	2026-05-06
630	OTHER	Other Endocrine, Nutritional And Metabolic O.r. Procedures Without Cc/mcc	19	19	—	—	$8,887.53	$142,177.63	$94,785.09	2026-05-06
741	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy Without…	19	19	—	—	$7,427.02	$140,330.11	$93,553.41	2026-05-06
1286149-4660256	OTHER	54396-0801-01 - Pegloticase Soln	22	20	$120,656.21	$60,328.11 50% off	$12,934.35	$115,829.96	$93,508.57	2026-05-06
95367892-4660256	OTHER	60809-0801-01 - Pegloticase 8 mg/mL Soln	22	20	$120,656.21	$60,328.11 50% off	$12,934.35	$115,829.96	$93,508.57	2026-05-06
910-4	OTHER	Craniotomy For Multiple Significant Trauma	2	1	—	—	$93,275.29	$93,275.29	$93,275.29	2026-05-06
786	OTHER	Cesarean Section Without Sterilization With Mcc	17	17	—	—	$21,587.21	$117,729.39	$93,202.43	2026-05-06
614-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	2	1	—	—	$92,695.33	$92,695.33	$92,695.33	2026-05-06
800	OTHER	Splenectomy With Cc	19	19	—	—	$9,186.74	$137,513.18	$91,675.46	2026-05-06
235	OTHER	Coronary Bypass Without Cardiac Catheterization With Mcc	19	19	—	—	$21,460.12	$115,596.42	$91,513.83	2026-05-06
809	OTHER	Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co…	19	19	—	—	$2,789.61	$137,158.18	$91,438.78	2026-05-06
221	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	19	19	—	—	$18,458.53	$124,665.00	$91,275.27	2026-05-06
911-4	OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	2	1	—	—	$89,764.92	$89,764.92	$89,764.92	2026-05-06
912-4	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	2	1	—	—	$89,624.76	$89,624.76	$89,624.76	2026-05-06
39888518-4660257	OTHER	00169-7205-01 - Coagulation Factor VIIa 5000 Mcg (	22	20	$115,423.00	$57,711.50 50% off	$12,373.35	$110,806.08	$89,452.82	2026-05-06
1288223-4660257	OTHER	00169-7050-01 - Coagulation Factor VIIa Rec Inject	22	20	$115,423.00	$57,711.50 50% off	$12,373.35	$110,806.08	$89,452.82	2026-05-06
939	OTHER	O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc	19	19	—	—	$10,184.63	$133,244.04	$88,829.36	2026-05-06
312-4	OTHER	Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses	2	1	—	—	$88,782.21	$88,782.21	$88,782.21	2026-05-06
680-4	OTHER	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	2	1	—	—	$88,725.83	$88,725.83	$88,725.83	2026-05-06
933	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft	19	19	—	—	$6,950.00	$132,583.34	$88,388.90	2026-05-06
736	OTHER	Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc	19	19	—	—	$8,138.98	$131,741.79	$87,827.86	2026-05-06
165-4	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	2	1	—	—	$87,801.11	$87,801.11	$87,801.11	2026-05-06
260-4	OTHER	Major Pancreas, Liver And Shunt Procedures	2	1	—	—	$87,536.91	$87,536.91	$87,536.91	2026-05-06
675	OTHER	Other Kidney And Urinary Tract Procedures Without Cc/mcc	19	19	—	—	$6,950.00	$130,824.19	$87,216.13	2026-05-06
183-4	OTHER	Percutaneous Structural Cardiac Procedures	2	1	—	—	$87,068.11	$87,068.11	$87,068.11	2026-05-06
114	OTHER	Orbital Procedures Without Cc/mcc	19	19	—	—	$13,997.32	$130,499.39	$86,999.59	2026-05-06
634-4	OTHER	Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…	2	1	—	—	$86,926.34	$86,926.34	$86,926.34	2026-05-06
101883920-4639971	OTHER	79952-0110-01 - Loncastuximab Tesirine 10 Mg Injec	22	20	$110,986.04	$55,493.02 50% off	$11,897.70	$106,546.60	$86,014.18	2026-05-06
603-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	2	1	—	—	$85,855.02	$85,855.02	$85,855.02	2026-05-06
751-4	OTHER	Major Depressive Disorders And Other Or Unspecified Psychoses	2	1	—	—	$85,096.24	$85,096.24	$85,096.24	2026-05-06
94990000-4660256	OTHER	57894-0061-03 - Ustekinumab 90 mg/mL Soln	22	20	$109,389.53	$54,694.77 50% off	$11,726.56	$105,013.95	$84,776.88	2026-05-06
753-4	OTHER	Bipolar Disorders	2	1	—	—	$84,530.78	$84,530.78	$84,530.78	2026-05-06
220	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	19	19	—	—	$31,547.05	$106,642.19	$84,425.06	2026-05-06
656	OTHER	Kidney And Ureter Procedures For Neoplasm With Mcc	19	19	—	—	$15,063.95	$126,385.29	$84,256.86	2026-05-06
623-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	2	1	—	—	$83,937.93	$83,937.93	$83,937.93	2026-05-06
499	OTHER	Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without…	19	19	—	—	$9,650.28	$125,684.76	$83,789.84	2026-05-06
385	OTHER	Inflammatory Bowel Disease With Mcc	19	19	—	—	$6,067.77	$125,479.20	$83,652.80	2026-05-06
1282361-4660256	OTHER	57665-0002-02 - Pegaspargase 3750. Soln	22	20	$107,771.37	$53,885.69 50% off	$11,553.09	$103,460.52	$83,522.81	2026-05-06
99090561-4660256	OTHER	72694-0954-01 - Pegaspargase 3,750 IntlUnit(s) / 5	22	20	$107,771.37	$53,885.69 50% off	$11,553.09	$103,460.52	$83,522.81	2026-05-06
1282362-4660256	OTHER	54482-0301-01 - Pegaspargase 3750. Soln	22	20	$107,771.37	$53,885.69 50% off	$11,553.09	$103,460.52	$83,522.81	2026-05-06
614-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	2	1	—	—	$83,279.03	$83,279.03	$83,279.03	2026-05-06
406	OTHER	Pancreas, Liver And Shunt Procedures With Cc	19	19	—	—	$9,405.31	$124,883.97	$83,255.98	2026-05-06
608-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	2	1	—	—	$83,076.05	$83,076.05	$83,076.05	2026-05-06
167-4	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	2	1	—	—	$83,034.16	$83,034.16	$83,034.16	2026-05-06
271	OTHER	Other Major Cardiovascular Procedures With Cc	19	19	—	—	$16,762.25	$124,424.30	$82,949.54	2026-05-06
023-4	OTHER	Spinal Procedures	2	1	—	—	$82,692.63	$82,692.63	$82,692.63	2026-05-06
13	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/mcc	19	19	—	—	$37,688.54	$123,985.33	$82,656.89	2026-05-06
089-4	OTHER	Major Cranial Or Facial Bone Procedures	2	1	—	—	$82,552.47	$82,552.47	$82,552.47	2026-05-06
616	OTHER	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	19	19	—	—	$10,382.39	$123,589.06	$82,392.70	2026-05-06
130257256-4639870	OTHER	Abbo-kit Prclm Eterna Nrstm Abbt[akms]	18	18	$99,999.54	$49,999.77 50% off	$1,676.00	$95,999.56	$82,099.62	2026-05-06
441-4	OTHER	Major Bladder Procedures	2	1	—	—	$82,045.01	$82,045.01	$82,045.01	2026-05-06
904	OTHER	Skin Grafts For Injuries With Cc/mcc	19	19	—	—	$48,027.72	$123,065.47	$82,043.65	2026-05-06
668	OTHER	Transurethral Procedures With Mcc	19	19	—	—	$7,749.93	$122,300.56	$81,533.71	2026-05-06
424	OTHER	Other Hepatobiliary Or Pancreas O.r. Procedures With Cc	18	18	—	—	$17,614.47	$126,034.55	$81,397.31	2026-05-06
495	OTHER	Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit…	19	19	—	—	$5,521.36	$122,050.95	$81,367.30	2026-05-06
31	OTHER	Ventricular Shunt Procedures With Mcc	19	19	—	—	$13,619.09	$118,319.84	$81,325.53	2026-05-06
440-2	OTHER	Kidney Transplant	2	1	—	—	$81,202.46	$81,202.46	$81,202.46	2026-05-06
319	OTHER	Other Endovascular Cardiac Valve Procedures With Mcc	19	19	—	—	$15,751.22	$119,129.57	$81,012.65	2026-05-06
963	OTHER	Other Multiple Significant Trauma With Mcc	19	19	—	—	$5,154.92	$120,831.88	$80,554.59	2026-05-06
021-4	OTHER	Open Craniotomy Except Trauma	2	1	—	—	$80,467.84	$80,467.84	$80,467.84	2026-05-06
1287035-4639971	OTHER	76128-0155-75 - Porfimer 75. Mg Rec Injection	22	20	$103,442.33	$51,721.17 50% off	$11,089.02	$99,304.64	$80,167.80	2026-05-06
841-3	OTHER	Extensive Third Degree Burns With Skin Graft	2	1	—	—	$80,082.81	$80,082.81	$80,082.81	2026-05-06
454	OTHER	Combined Anterior And Posterior Spinal Fusion With Cc	18	18	—	—	$36,768.40	$110,405.05	$79,950.77	2026-05-06
091-4	OTHER	Other Major Head And Neck Procedures	2	1	—	—	$79,873.38	$79,873.38	$79,873.38	2026-05-06
250	OTHER	Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With Mcc	19	19	—	—	$28,551.43	$119,313.46	$79,542.30	2026-05-06
009-3	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	2	1	—	—	$79,520.57	$79,520.57	$79,520.57	2026-05-06
179-4	OTHER	Defibrillator Implants	2	1	—	—	$79,201.59	$79,201.59	$79,201.59	2026-05-06
612-2	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	2	1	—	—	$79,085.60	$79,085.60	$79,085.60	2026-05-06
863-3	OTHER	Neonatal Aftercare	2	1	—	—	$78,913.22	$78,913.22	$78,913.22	2026-05-06
252	OTHER	Other Vascular Procedures With Mcc	19	19	—	—	$5,899.98	$118,304.45	$78,869.63	2026-05-06
220-4	OTHER	Major Stomach, Esophageal And Duodenal Procedures	2	1	—	—	$78,566.86	$78,566.86	$78,566.86	2026-05-06
760-3	OTHER	Other Mental Health Disorders	2	1	—	—	$78,431.54	$78,431.54	$78,431.54	2026-05-06
618	OTHER	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	19	19	—	—	$6,950.00	$117,003.12	$78,002.08	2026-05-06
027-4	OTHER	Other Open Craniotomy	2	1	—	—	$77,974.01	$77,974.01	$77,974.01	2026-05-06
005-2	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	2	1	—	—	$77,800.02	$77,800.02	$77,800.02	2026-05-06
690-4	OTHER	Acute Leukemia	2	1	—	—	$77,796.80	$77,796.80	$77,796.80	2026-05-06
143	OTHER	Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc	19	19	—	—	$3,789.96	$116,290.49	$77,527.00	2026-05-06
115221888-4639870	OTHER	S-tib Per Rev Stn At[akms]	22	20	$99,999.85	$49,999.93 50% off	$10,719.98	$95,999.86	$77,499.89	2026-05-06
115221886-4639870	OTHER	S-tib Per Revas Athr[akms]	22	20	$99,999.85	$49,999.93 50% off	$10,719.98	$95,999.86	$77,499.89	2026-05-06
96549823-4639870	OTHER	Ic-trl Peri Ath Ilia - Gl 106	22	20	$99,999.85	$49,999.93 50% off	$10,719.98	$95,999.86	$77,499.89	2026-05-06
96549821-4639870	OTHER	S-tib Per Rev Stn At - Gl 106	22	20	$99,999.85	$49,999.93 50% off	$10,719.98	$95,999.86	$77,499.89	2026-05-06
96549817-4639870	OTHER	S-tib Per Revas Athr - Gl 106	22	20	$99,999.85	$49,999.93 50% off	$10,719.98	$95,999.86	$77,499.89	2026-05-06
115221924-4639870	OTHER	S-fem Pop Stnt Athr[akms]	22	20	$99,999.85	$49,999.93 50% off	$10,719.98	$95,999.86	$77,499.89	2026-05-06
96549813-4639870	OTHER	S-fem Pop Stnt Athr - Gl 106	22	20	$99,999.85	$49,999.93 50% off	$10,719.98	$95,999.86	$77,499.89	2026-05-06
115221894-4639870	OTHER	Ic-trl Peri Ath Ilia[akms]	22	20	$99,999.85	$49,999.93 50% off	$10,719.98	$95,999.86	$77,499.89	2026-05-06
96549819-4639870	OTHER	S-tib Per Revas Stnt - Gl 106	22	20	$99,999.40	$49,999.70 50% off	$10,719.94	$95,999.42	$77,499.54	2026-05-06
115221887-4639870	OTHER	S-tib Per Revas Stnt[akms]	22	20	$99,999.40	$49,999.70 50% off	$10,719.94	$95,999.42	$77,499.54	2026-05-06
950-4	OTHER	Extensive O.r. Procedure Unrelated To Principal Diagnosis	2	1	—	—	$77,469.77	$77,469.77	$77,469.77	2026-05-06
166-4	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	2	1	—	—	$77,469.77	$77,469.77	$77,469.77	2026-05-06
270	OTHER	Other Major Cardiovascular Procedures With Mcc	19	19	—	—	$491.99	$95,472.42	$77,249.29	2026-05-06
636-4	OTHER	Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection	2	1	—	—	$77,232.95	$77,232.95	$77,232.95	2026-05-06
799	OTHER	Splenectomy With Mcc	19	19	—	—	$37,784.86	$97,468.39	$77,162.47	2026-05-06
228	OTHER	Other Cardiothoracic Procedures With Mcc	19	19	—	—	$44,900.23	$95,960.20	$76,932.07	2026-05-06
905	OTHER	Skin Grafts For Injuries Without Cc/mcc	19	19	—	—	$19,416.93	$115,293.95	$76,862.63	2026-05-06
102525788-4660256	OTHER	25682-0028-01 - Ravulizumab 100 mg/mL Soln	22	20	$99,091.21	$49,545.61 50% off	$10,622.58	$95,127.56	$76,795.69	2026-05-06
162-3	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	2	1	—	—	$76,777.04	$76,777.04	$76,777.04	2026-05-06
020-4	OTHER	Open Craniotomy For Trauma	2	1	—	—	$76,382.34	$76,382.34	$76,382.34	2026-05-06
102917747-4639971	OTHER	72493-0103-03 - mitoMYcin 40 Mg Kit	22	20	$98,199.40	$49,099.70 50% off	$10,526.98	$94,271.42	$76,104.54	2026-05-06
133632825-4639870	OTHER	Abio-dsc-use #2358147 Pmp Set Impella Rp US 11f-US	23	21	$99,999.99	$50,000.00 50% off	$10,000.00	$95,999.99	$75,999.99	2026-05-06
127827790-4639870	OTHER	Abbo-gntr/nrstmltr Prdg MRI 5.3x4.8[akms]	23	21	$99,999.54	$49,999.77 50% off	$9,999.95	$95,999.56	$75,999.65	2026-05-06
127825672-4639870	OTHER	Medt-nrstm Impl Restoreultra Suresc[akms]	23	21	$99,999.54	$49,999.77 50% off	$9,999.95	$95,999.56	$75,999.65	2026-05-06
128058447-4639870	OTHER	Abbo-gntr Neuro Prclm Hdr M 5[akms]	23	21	$99,999.54	$49,999.77 50% off	$9,999.95	$95,999.56	$75,999.65	2026-05-06
128061023-4639870	OTHER	Axon-nrstm Impl Scrl Nrv Model 1101[akms]	23	21	$99,999.54	$49,999.77 50% off	$9,999.95	$95,999.56	$75,999.65	2026-05-06
128058432-4639870	OTHER	Stm Neuro Xtrn Mic Rchrg 14x41 - 97810[akms]	23	21	$99,999.54	$49,999.77 50% off	$9,999.95	$95,999.56	$75,999.65	2026-05-06
128061025-4639870	OTHER	Axon-impl Urn Ctrl Axnc Snm Bsc Trl[akms]	23	21	$99,999.54	$49,999.77 50% off	$9,999.95	$95,999.56	$75,999.65	2026-05-06
128058048-4639870	OTHER	Kit Acces Chrgr Nrstm Axonics No Charge X - 1401[a	23	21	$99,999.54	$49,999.77 50% off	$9,999.95	$95,999.56	$75,999.65	2026-05-06
127812648-4639870	OTHER	Kit Ipg Prcsn Spctr - M365sc11320[akms]	23	21	$99,999.54	$49,999.77 50% off	$9,999.95	$95,999.56	$75,999.65	2026-05-06
128057641-4639870	OTHER	Medt-kit Intellis MRI Repl[akms]	23	21	$99,999.54	$49,999.77 50% off	$9,999.95	$95,999.56	$75,999.65	2026-05-06
128057809-4639870	OTHER	Bost-kit Ipg Wvwrtr Alph 16 Su Strl[akms]	23	21	$99,999.54	$49,999.77 50% off	$9,999.95	$95,999.56	$75,999.65	2026-05-06
128057595-4639870	OTHER	Abbo-kit Prdg MRI Pt Ctrlr & Chrgr[akms]	23	21	$99,999.54	$49,999.77 50% off	$9,999.95	$95,999.56	$75,999.65	2026-05-06

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