|
0266T
|
OTHER
|
Insertion Or Replacement Of Carotid Sinus Baroreflex Activation Device
|
13
|
13
|
$33,149.00
|
$33,149.00
|
$1,233.00
|
$30,497.08
|
$30,497.08
|
2026-03-04
|
|
0268T
|
OTHER
|
Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device Pulse …
|
13
|
13
|
$53,716.00
|
$53,716.00
|
$1,233.00
|
$49,418.72
|
$49,418.72
|
2026-03-04
|
|
0308T
|
OTHER
|
Insertion Of Prosthetic Telescope In Eye For The Treatment Of Central Vision
|
11
|
11
|
$35,403.00
|
$35,403.00
|
$26,552.25
|
$32,570.76
|
$26,552.25
|
2026-03-04
|
|
0515T
|
OTHER
|
Insertion Of Complete Wireless Heart Stimulator System For Pacing Of Lower Left …
|
12
|
12
|
$44,656.00
|
$44,656.00
|
$1,405.50
|
$41,083.52
|
$33,492.00
|
2026-03-04
|
|
0520T
|
OTHER
|
Removal And Replacement Of Pulse Generator Battery Of Wireless Heart Stimulator …
|
12
|
12
|
$44,656.00
|
$44,656.00
|
$1,405.50
|
$41,083.52
|
$33,492.00
|
2026-03-04
|
|
0532T
|
OTHER
|
Removal Of Implantable Monitor Of Monitoring System For Deficient Blood Flow In …
|
12
|
12
|
$33,724.00
|
$33,724.00
|
$1,561.09
|
$31,026.08
|
$25,293.00
|
2026-03-04
|
|
100
|
MS_DRG
|
Seizures With Mcc
|
1
|
1
|
$110,649.54
|
$110,649.54
|
$26,898.20
|
$26,898.20
|
$26,898.20
|
2026-03-04
|
|
11
|
MS_DRG
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc
|
1
|
1
|
$282,108.55
|
$282,108.55
|
$75,746.32
|
$75,746.32
|
$75,746.32
|
2026-03-04
|
|
113
|
MS_DRG
|
Orbital Procedures With Cc/mcc
|
1
|
1
|
$75,495.72
|
$75,495.72
|
$32,651.98
|
$32,651.98
|
$32,651.98
|
2026-03-04
|
|
116
|
MS_DRG
|
Intraocular Procedures With Cc/mcc
|
1
|
1
|
$39,384.03
|
$39,384.03
|
$25,110.82
|
$25,110.82
|
$25,110.82
|
2026-03-04
|
|
11980495_1
|
CDM
|
Charging System Sjm Eon Mini Le 3722
|
12
|
12
|
$27,118.00
|
$27,118.00
|
$5,500.00
|
$24,948.56
|
$24,948.56
|
2026-03-04
|
|
12
|
MS_DRG
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc
|
1
|
1
|
$95,928.40
|
$95,928.40
|
$58,551.64
|
$58,551.64
|
$58,551.64
|
2026-03-04
|
|
121
|
MS_DRG
|
Acute Major Eye Infections With Cc/mcc
|
2
|
2
|
$40,603.60
|
$40,603.60
|
$16,155.86
|
$85,603.60
|
$50,879.73
|
2026-03-04
|
|
122
|
MS_DRG
|
Acute Major Eye Infections Without Cc/mcc
|
2
|
2
|
$18,965.25
|
$18,965.25
|
$10,913.16
|
$43,911.25
|
$27,412.20
|
2026-03-04
|
|
135
|
MS_DRG
|
Sinus And Mastoid Procedures With Cc/mcc
|
1
|
1
|
$33,325.55
|
$33,325.55
|
$29,375.81
|
$29,375.81
|
$29,375.81
|
2026-03-04
|
|
140
|
MS_DRG
|
Major Head And Neck Procedures With Mcc
|
1
|
1
|
$102,342.20
|
$102,342.20
|
$59,236.32
|
$59,236.32
|
$59,236.32
|
2026-03-04
|
|
141
|
MS_DRG
|
Major Head And Neck Procedures With Cc
|
1
|
1
|
$104,751.92
|
$104,751.92
|
$30,291.03
|
$30,291.03
|
$30,291.03
|
2026-03-04
|
|
143
|
MS_DRG
|
Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc
|
1
|
1
|
$142,257.70
|
$142,257.70
|
$52,032.63
|
$52,032.63
|
$52,032.63
|
2026-03-04
|
|
144
|
MS_DRG
|
Other Ear, Nose, Mouth And Throat O.r. Procedures With Cc
|
1
|
1
|
$69,919.85
|
$69,919.85
|
$24,066.45
|
$24,066.45
|
$24,066.45
|
2026-03-04
|
|
14544304_1
|
CDM
|
Processor Sound Cochlear Nucleus 6
|
12
|
12
|
$31,132.00
|
$31,132.00
|
$5,500.00
|
$28,641.44
|
$28,641.44
|
2026-03-04
|
|
1468051_1
|
CDM
|
Operating Room Services - General Classification
|
12
|
12
|
$188,094.00
|
$188,094.00
|
$5,500.00
|
$173,046.48
|
$173,046.48
|
2026-03-04
|
|
15072281_1
|
CDM
|
Implant Cranial Sy Patient Specific Peek
|
12
|
12
|
$37,604.00
|
$37,604.00
|
$5,500.00
|
$34,595.68
|
$34,595.68
|
2026-03-04
|
|
163
|
MS_DRG
|
Major Chest Procedures With Mcc
|
1
|
1
|
$236,337.96
|
$236,337.96
|
$62,243.06
|
$62,243.06
|
$62,243.06
|
2026-03-04
|
|
164
|
MS_DRG
|
Major Chest Procedures With Cc
|
1
|
1
|
$157,809.29
|
$157,809.29
|
$35,053.21
|
$35,053.21
|
$35,053.21
|
2026-03-04
|
|
165
|
MS_DRG
|
Major Chest Procedures Without Cc/mcc
|
1
|
1
|
$55,702.97
|
$55,702.97
|
$26,584.33
|
$26,584.33
|
$26,584.33
|
2026-03-04
|
|
166
|
MS_DRG
|
Other Respiratory System O.r. Procedures With Mcc
|
1
|
1
|
$76,264.03
|
$76,264.03
|
$51,909.03
|
$51,909.03
|
$51,909.03
|
2026-03-04
|
|
167
|
MS_DRG
|
Other Respiratory System O.r. Procedures With Cc
|
1
|
1
|
$54,354.73
|
$54,354.73
|
$25,045.55
|
$25,045.55
|
$25,045.55
|
2026-03-04
|
|
180
|
MS_DRG
|
Respiratory Neoplasms With Mcc
|
1
|
1
|
$67,772.06
|
$67,772.06
|
$24,526.14
|
$24,526.14
|
$24,526.14
|
2026-03-04
|
|
18095217_1
|
CDM
|
Implant Cochlear Nucleus C1422 w/Slim Str Electrode Z1905074
|
12
|
12
|
$74,624.00
|
$74,624.00
|
$5,500.00
|
$68,654.08
|
$68,654.08
|
2026-03-04
|
|
196
|
MS_DRG
|
Interstitial Lung Disease With Mcc
|
1
|
1
|
$62,532.53
|
$62,532.53
|
$26,209.36
|
$26,209.36
|
$26,209.36
|
2026-03-04
|
|
199
|
MS_DRG
|
Pneumothorax With Mcc
|
1
|
1
|
$54,014.17
|
$54,014.17
|
$24,499.75
|
$24,499.75
|
$24,499.75
|
2026-03-04
|
|
205
|
MS_DRG
|
Other Respiratory System Diagnoses With Mcc
|
1
|
1
|
$149,898.73
|
$149,898.73
|
$25,428.85
|
$25,428.85
|
$25,428.85
|
2026-03-04
|
|
207
|
MS_DRG
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
1
|
1
|
$477,832.51
|
$477,832.51
|
$89,364.86
|
$89,364.86
|
$89,364.86
|
2026-03-04
|
|
208
|
MS_DRG
|
Respiratory System Diagnosis With Ventilator Support <=96 Hours
|
1
|
1
|
$113,061.38
|
$113,061.38
|
$38,173.84
|
$38,173.84
|
$38,173.84
|
2026-03-04
|
|
21599729_2
|
CDM
|
Insertion/replacement Of Permanent Cardiac Contractility Modulation System; Puls…
|
11
|
11
|
$44,656.00
|
$44,656.00
|
$33,492.00
|
$41,083.52
|
$33,492.00
|
2026-03-04
|
|
21613656_1
|
CDM
|
Cage Stry Tl 8-12 X11 X34mm 0Deg 305008
|
12
|
12
|
$27,688.00
|
$27,688.00
|
$5,500.00
|
$25,472.96
|
$25,472.96
|
2026-03-04
|
|
21639662_1
|
CDM
|
Pacemaker Viva Biventricular 3 Lead Crt-p C6tr01
|
12
|
12
|
$28,645.00
|
$28,645.00
|
$5,500.00
|
$26,353.40
|
$26,353.40
|
2026-03-04
|
|
21639663_1
|
CDM
|
Cage Lateral H12mm 22 X 55mm 0 Deg Ir7112p
|
12
|
12
|
$26,547.00
|
$26,547.00
|
$5,500.00
|
$24,423.24
|
$24,423.24
|
2026-03-04
|
|
21643651_1
|
CDM
|
Cage Lateral H10mm 22 X 55mm 0 Deg Ir7110p
|
12
|
12
|
$26,547.00
|
$26,547.00
|
$5,500.00
|
$24,423.24
|
$24,423.24
|
2026-03-04
|
|
2167075_1
|
CDM
|
Spacer Tl 9 X 25 X 0 48375090
|
12
|
12
|
$43,775.00
|
$43,775.00
|
$5,500.00
|
$40,273.00
|
$40,273.00
|
2026-03-04
|
|
2178603_1
|
CDM
|
Spacer Obelisc Center 20mm/20-28mm Cs2920-20
|
12
|
12
|
$26,247.00
|
$26,247.00
|
$5,500.00
|
$24,147.24
|
$24,147.24
|
2026-03-04
|
|
2188729_1
|
CDM
|
Fixator External Hinged Elbow
|
12
|
12
|
$43,775.00
|
$43,775.00
|
$5,500.00
|
$40,273.00
|
$40,273.00
|
2026-03-04
|
|
221
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
1
|
1
|
$184,445.50
|
$184,445.50
|
$69,998.10
|
$69,998.10
|
$69,998.10
|
2026-03-04
|
|
22105952_1
|
CDM
|
Prosthesis Cervical Disc Mobi-c Mb3555
|
12
|
12
|
$26,111.00
|
$26,111.00
|
$5,500.00
|
$24,022.12
|
$24,022.12
|
2026-03-04
|
|
22123984_1
|
CDM
|
Excluder Implant Endoprosthesis 23x14.5mm 12cm
|
12
|
12
|
$34,840.00
|
$34,840.00
|
$5,500.00
|
$32,052.80
|
$32,052.80
|
2026-03-04
|
|
224
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh…
|
1
|
1
|
$398,481.55
|
$398,481.55
|
$98,454.53
|
$98,454.53
|
$98,454.53
|
2026-03-04
|
|
227
|
MS_DRG
|
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc
|
1
|
1
|
$147,380.66
|
$147,380.66
|
$69,727.28
|
$69,727.28
|
$69,727.28
|
2026-03-04
|
|
23395890_1
|
CDM
|
Catheter 7fr X 130cm Lightening Ber Litngbt7tq130
|
12
|
12
|
$29,057.00
|
$29,057.00
|
$5,500.00
|
$26,732.44
|
$26,732.44
|
2026-03-04
|
|
23408240_1
|
CDM
|
Catheter 80cm 6fr X 105cm Lightening Ber Litngfht80ber
|
12
|
12
|
$34,510.00
|
$34,510.00
|
$5,500.00
|
$31,749.20
|
$31,749.20
|
2026-03-04
|
|
23408241_1
|
CDM
|
Catheter 100cm 6fr X 135cm H1 Lightening Litngfxt100h1
|
12
|
12
|
$34,510.00
|
$34,510.00
|
$5,500.00
|
$31,749.20
|
$31,749.20
|
2026-03-04
|
|
23413441_1
|
CDM
|
61755-0050-01 - Aflibercept Ophthalmic 114.3 mg/mL Sol
|
12
|
12
|
$213,833.00
|
$213,833.00
|
$5,500.00
|
$196,726.36
|
$196,726.36
|
2026-03-04
|
|
23434841_1
|
CDM
|
Cap Endo Mivu Esophageal Mi-eso-cap-3l
|
12
|
12
|
$49,000.00
|
$49,000.00
|
$5,500.00
|
$45,080.00
|
$45,080.00
|
2026-03-04
|
|
23470525_1
|
CDM
|
Graft 20mmx14mmx120mm Main Body Cxt201412
|
12
|
12
|
$39,750.00
|
$39,750.00
|
$5,500.00
|
$36,570.00
|
$36,570.00
|
2026-03-04
|
|
23470526_1
|
CDM
|
Graft 23mmx14mmx120mm Main Body Cxt231412
|
12
|
12
|
$39,750.00
|
$39,750.00
|
$5,500.00
|
$36,570.00
|
$36,570.00
|
2026-03-04
|
|
23470527_1
|
CDM
|
Graft 36mmx14mmx120mm Main Body Cxt361414
|
12
|
12
|
$39,750.00
|
$39,750.00
|
$5,500.00
|
$36,570.00
|
$36,570.00
|
2026-03-04
|
|
23470528_1
|
CDM
|
Graft 28mmx14mmx120mm Main Body Cxt281412
|
12
|
12
|
$39,750.00
|
$39,750.00
|
$5,500.00
|
$36,570.00
|
$36,570.00
|
2026-03-04
|
|
23470529_1
|
CDM
|
Graft 26mmx14mmx120mm Main Body Cxt261412
|
12
|
12
|
$39,450.00
|
$39,450.00
|
$5,500.00
|
$36,294.00
|
$36,294.00
|
2026-03-04
|
|
23470530_1
|
CDM
|
Graft 32mmx14mmx120mm Main Body Cxt321414
|
12
|
12
|
$39,750.00
|
$39,750.00
|
$5,500.00
|
$36,570.00
|
$36,570.00
|
2026-03-04
|
|
239
|
MS_DRG
|
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc
|
1
|
1
|
$293,726.30
|
$293,726.30
|
$68,352.37
|
$68,352.37
|
$68,352.37
|
2026-03-04
|
|
240
|
MS_DRG
|
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc
|
1
|
1
|
$79,199.65
|
$79,199.65
|
$39,587.63
|
$39,587.63
|
$39,587.63
|
2026-03-04
|
|
242
|
MS_DRG
|
Permanent Cardiac Pacemaker Implant With Mcc
|
1
|
1
|
$105,097.57
|
$105,097.57
|
$44,341.48
|
$44,341.48
|
$44,341.48
|
2026-03-04
|
|
243
|
MS_DRG
|
Permanent Cardiac Pacemaker Implant With Cc
|
1
|
1
|
$57,250.03
|
$57,250.03
|
$29,593.85
|
$29,593.85
|
$29,593.85
|
2026-03-04
|
|
244
|
MS_DRG
|
Permanent Cardiac Pacemaker Implant Without Cc/mcc
|
1
|
1
|
$35,300.43
|
$35,300.43
|
$25,102.49
|
$25,102.49
|
$25,102.49
|
2026-03-04
|
|
25
|
MS_DRG
|
Craniotomy And Endovascular Intracranial Procedures With Mcc
|
1
|
1
|
$146,029.48
|
$146,029.48
|
$63,144.39
|
$63,144.39
|
$63,144.39
|
2026-03-04
|
|
253
|
MS_DRG
|
Other Vascular Procedures With Cc
|
1
|
1
|
$99,062.64
|
$99,062.64
|
$36,047.59
|
$36,047.59
|
$36,047.59
|
2026-03-04
|
|
254
|
MS_DRG
|
Other Vascular Procedures Without Cc/mcc
|
1
|
1
|
$67,859.83
|
$67,859.83
|
$24,744.18
|
$24,744.18
|
$24,744.18
|
2026-03-04
|
|
255
|
MS_DRG
|
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc
|
1
|
1
|
$46,988.00
|
$46,988.00
|
$37,461.38
|
$37,461.38
|
$37,461.38
|
2026-03-04
|
|
26
|
MS_DRG
|
Craniotomy And Endovascular Intracranial Procedures With Cc
|
1
|
1
|
$188,118.92
|
$188,118.92
|
$43,180.45
|
$43,180.45
|
$43,180.45
|
2026-03-04
|
|
261
|
MS_DRG
|
Cardiac Pacemaker Revision Except Device Replacement With Cc
|
1
|
1
|
$119,565.50
|
$119,565.50
|
$26,255.19
|
$26,255.19
|
$26,255.19
|
2026-03-04
|
|
263
|
MS_DRG
|
Vein Ligation And Stripping
|
1
|
1
|
$200,613.35
|
$200,613.35
|
$42,461.05
|
$42,461.05
|
$42,461.05
|
2026-03-04
|
|
264
|
MS_DRG
|
Other Circulatory System O.r. Procedures
|
1
|
1
|
$112,814.68
|
$112,814.68
|
$46,394.12
|
$46,394.12
|
$46,394.12
|
2026-03-04
|
|
268
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
1
|
1
|
$256,816.31
|
$256,816.31
|
$95,520.00
|
$95,520.00
|
$95,520.00
|
2026-03-04
|
|
269
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc
|
1
|
1
|
$142,555.85
|
$142,555.85
|
$58,651.63
|
$58,651.63
|
$58,651.63
|
2026-03-04
|
|
27
|
MS_DRG
|
Craniotomy And Endovascular Intracranial Procedures Without Cc/mcc
|
1
|
1
|
$90,214.12
|
$90,214.12
|
$35,037.93
|
$35,037.93
|
$35,037.93
|
2026-03-04
|
|
270
|
MS_DRG
|
Other Major Cardiovascular Procedures With Mcc
|
1
|
1
|
$190,582.51
|
$190,582.51
|
$73,277.04
|
$73,277.04
|
$73,277.04
|
2026-03-04
|
|
271
|
MS_DRG
|
Other Major Cardiovascular Procedures With Cc
|
1
|
1
|
$177,432.45
|
$177,432.45
|
$49,389.75
|
$49,389.75
|
$49,389.75
|
2026-03-04
|
|
272
|
MS_DRG
|
Other Major Cardiovascular Procedures Without Cc/mcc
|
1
|
1
|
$121,733.42
|
$121,733.42
|
$35,455.96
|
$35,455.96
|
$35,455.96
|
2026-03-04
|
|
283
|
MS_DRG
|
Acute Myocardial Infarction, Expired With Mcc
|
1
|
1
|
$130,038.10
|
$130,038.10
|
$27,509.27
|
$27,509.27
|
$27,509.27
|
2026-03-04
|
|
286
|
MS_DRG
|
Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc
|
1
|
1
|
$211,349.00
|
$211,349.00
|
$30,731.28
|
$30,731.28
|
$30,731.28
|
2026-03-04
|
|
288
|
MS_DRG
|
Acute And Subacute Endocarditis With Mcc
|
1
|
1
|
$70,776.03
|
$70,776.03
|
$37,583.60
|
$37,583.60
|
$37,583.60
|
2026-03-04
|
|
29
|
MS_DRG
|
Spinal Procedures With Cc Or Spinal Neurostimulators
|
1
|
1
|
$144,740.34
|
$144,740.34
|
$47,380.16
|
$47,380.16
|
$47,380.16
|
2026-03-04
|
|
3
|
MS_DRG
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
1
|
1
|
$1,059,511.66
|
$1,059,511.66
|
$294,774.73
|
$294,774.73
|
$294,774.73
|
2026-03-04
|
|
30
|
MS_DRG
|
Spinal Procedures Without Cc/mcc
|
1
|
1
|
$232,514.28
|
$232,514.28
|
$30,486.85
|
$30,486.85
|
$30,486.85
|
2026-03-04
|
|
314
|
MS_DRG
|
Other Circulatory System Diagnoses With Mcc
|
1
|
1
|
$97,085.11
|
$97,085.11
|
$28,959.17
|
$28,959.17
|
$28,959.17
|
2026-03-04
|
|
3141228_1
|
CDM
|
Bone Tamp Inflatable Fracture Management Inflate Fx El153b
|
12
|
12
|
$28,454.00
|
$28,454.00
|
$5,500.00
|
$26,177.68
|
$26,177.68
|
2026-03-04
|
|
32
|
MS_DRG
|
Ventricular Shunt Procedures With Cc
|
1
|
1
|
$136,232.52
|
$136,232.52
|
$29,595.24
|
$29,595.24
|
$29,595.24
|
2026-03-04
|
|
326
|
MS_DRG
|
Stomach, Esophageal And Duodenal Procedures With Mcc
|
1
|
1
|
$232,003.62
|
$232,003.62
|
$69,264.81
|
$69,264.81
|
$69,264.81
|
2026-03-04
|
|
327
|
MS_DRG
|
Stomach, Esophageal And Duodenal Procedures With Cc
|
1
|
1
|
$45,677.32
|
$45,677.32
|
$33,944.95
|
$33,944.95
|
$33,944.95
|
2026-03-04
|
|
329
|
MS_DRG
|
Major Small And Large Bowel Procedures With Mcc
|
1
|
1
|
$252,683.37
|
$252,683.37
|
$63,836.01
|
$63,836.01
|
$63,836.01
|
2026-03-04
|
|
330
|
MS_DRG
|
Major Small And Large Bowel Procedures With Cc
|
1
|
1
|
$123,538.23
|
$123,538.23
|
$33,292.22
|
$33,292.22
|
$33,292.22
|
2026-03-04
|
|
335
|
MS_DRG
|
Peritoneal Adhesiolysis With Mcc
|
1
|
1
|
$127,425.80
|
$127,425.80
|
$49,592.52
|
$49,592.52
|
$49,592.52
|
2026-03-04
|
|
336
|
MS_DRG
|
Peritoneal Adhesiolysis With Cc
|
1
|
1
|
$97,657.27
|
$97,657.27
|
$29,285.54
|
$29,285.54
|
$29,285.54
|
2026-03-04
|
|
34
|
MS_DRG
|
Carotid Artery Stent Procedures With Mcc
|
1
|
1
|
$95,657.20
|
$95,657.20
|
$53,756.13
|
$53,756.13
|
$53,756.13
|
2026-03-04
|
|
347
|
MS_DRG
|
Anal And Stomal Procedures With Mcc
|
1
|
1
|
$26,493.98
|
$26,493.98
|
$31,881.20
|
$31,881.20
|
$31,881.20
|
2026-03-04
|
|
34847
|
HCPCS
|
Repair Of Aorta In Abdomen Between And Below Kidneys With Graft, Including 3 Gra…
|
12
|
12
|
$43,530.00
|
$43,530.00
|
$4,411.39
|
$40,047.60
|
$32,647.50
|
2026-03-04
|
|
34848
|
HCPCS
|
Repair Of Aorta In Abdomen Between And Below Kidneys With Graft, Including 4 Or …
|
12
|
12
|
$46,668.00
|
$46,668.00
|
$4,581.07
|
$42,934.56
|
$35,001.00
|
2026-03-04
|
|
353
|
MS_DRG
|
Hernia Procedures Except Inguinal And Femoral With Mcc
|
1
|
1
|
$169,033.93
|
$169,033.93
|
$40,302.86
|
$40,302.86
|
$40,302.86
|
2026-03-04
|
|
356
|
MS_DRG
|
Other Digestive System O.r. Procedures With Mcc
|
1
|
1
|
$156,802.59
|
$156,802.59
|
$61,007.03
|
$61,007.03
|
$61,007.03
|
2026-03-04
|
|
357
|
MS_DRG
|
Other Digestive System O.r. Procedures With Cc
|
1
|
1
|
$47,424.92
|
$47,424.92
|
$32,296.45
|
$32,296.45
|
$32,296.45
|
2026-03-04
|
|
36
|
MS_DRG
|
Carotid Artery Stent Procedures Without Cc/mcc
|
1
|
1
|
$48,315.06
|
$48,315.06
|
$26,981.53
|
$26,981.53
|
$26,981.53
|
2026-03-04
|
|
37
|
MS_DRG
|
Extracranial Procedures With Mcc
|
1
|
1
|
$109,849.00
|
$109,849.00
|
$45,720.55
|
$45,720.55
|
$45,720.55
|
2026-03-04
|
|
371
|
MS_DRG
|
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc
|
1
|
1
|
$145,785.85
|
$145,785.85
|
$24,624.74
|
$24,624.74
|
$24,624.74
|
2026-03-04
|
|
37221
|
HCPCS
|
Insertion Of Stent In Groin Artery, Initial Vessel
|
13
|
13
|
$55,167.00
|
$55,167.00
|
$1,730.81
|
$50,753.64
|
$41,375.25
|
2026-03-04
|
|
37227
|
HCPCS
|
Removal Of Plaque And Insertion Of Stents In Arteries Of Leg
|
26
|
13
|
$51,075.50
|
$51,075.50
|
$1,233.00
|
$48,911.80
|
$39,873.75
|
2026-03-04
|
|
37228
|
HCPCS
|
Balloon Dilation Of Artery Of Leg, Initial Vessel
|
13
|
13
|
$60,092.00
|
$60,092.00
|
$1,900.84
|
$55,284.64
|
$45,069.00
|
2026-03-04
|
|
374
|
MS_DRG
|
Digestive Malignancy With Mcc
|
1
|
1
|
$80,415.27
|
$80,415.27
|
$29,702.18
|
$29,702.18
|
$29,702.18
|
2026-03-04
|
|
377
|
MS_DRG
|
Gastrointestinal Hemorrhage With Mcc
|
1
|
1
|
$83,783.06
|
$83,783.06
|
$25,387.19
|
$25,387.19
|
$25,387.19
|
2026-03-04
|
|
380
|
MS_DRG
|
Complicated Peptic Ulcer With Mcc
|
1
|
1
|
$453,818.88
|
$453,818.88
|
$27,250.96
|
$27,250.96
|
$27,250.96
|
2026-03-04
|
|
4
|
MS_DRG
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
1
|
1
|
$1,150,760.80
|
$1,150,760.80
|
$192,367.69
|
$192,367.69
|
$192,367.69
|
2026-03-04
|
|
40
|
MS_DRG
|
Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc
|
1
|
1
|
$56,247.70
|
$56,247.70
|
$53,624.19
|
$53,624.19
|
$53,624.19
|
2026-03-04
|
|
4010593_1
|
CDM
|
Screw Stryker Driver Quik Drive Mini 62-50101
|
12
|
12
|
$43,775.00
|
$43,775.00
|
$5,500.00
|
$40,273.00
|
$40,273.00
|
2026-03-04
|
|
405
|
MS_DRG
|
Pancreas, Liver And Shunt Procedures With Mcc
|
1
|
1
|
$578,725.82
|
$578,725.82
|
$75,974.09
|
$75,974.09
|
$75,974.09
|
2026-03-04
|
|
406
|
MS_DRG
|
Pancreas, Liver And Shunt Procedures With Cc
|
1
|
1
|
$143,982.17
|
$143,982.17
|
$40,277.86
|
$40,277.86
|
$40,277.86
|
2026-03-04
|
|
407
|
MS_DRG
|
Pancreas, Liver And Shunt Procedures Without Cc/mcc
|
1
|
1
|
$108,886.15
|
$108,886.15
|
$30,825.72
|
$30,825.72
|
$30,825.72
|
2026-03-04
|
|
408
|
MS_DRG
|
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With…
|
1
|
1
|
$22,742.55
|
$22,742.55
|
$49,518.91
|
$49,518.91
|
$49,518.91
|
2026-03-04
|
|
409
|
MS_DRG
|
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With…
|
1
|
1
|
$154,359.00
|
$154,359.00
|
$30,238.26
|
$30,238.26
|
$30,238.26
|
2026-03-04
|
|
41
|
MS_DRG
|
Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Periphe…
|
1
|
1
|
$65,267.61
|
$65,267.61
|
$30,535.46
|
$30,535.46
|
$30,535.46
|
2026-03-04
|
|
412
|
MS_DRG
|
Cholecystectomy With C.d.e. With Cc
|
1
|
1
|
$34,877.86
|
$34,877.86
|
$29,199.44
|
$29,199.44
|
$29,199.44
|
2026-03-04
|
|
414
|
MS_DRG
|
Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc
|
1
|
1
|
$90,812.35
|
$90,812.35
|
$49,477.25
|
$49,477.25
|
$49,477.25
|
2026-03-04
|
|
42
|
MS_DRG
|
Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/mcc
|
1
|
1
|
$104,977.50
|
$104,977.50
|
$23,994.23
|
$23,994.23
|
$23,994.23
|
2026-03-04
|
|
420
|
MS_DRG
|
Hepatobiliary Diagnostic Procedures With Mcc
|
1
|
1
|
$303,353.98
|
$303,353.98
|
$47,317.67
|
$47,317.67
|
$47,317.67
|
2026-03-04
|
|
421
|
MS_DRG
|
Hepatobiliary Diagnostic Procedures With Cc
|
1
|
1
|
$89,461.60
|
$89,461.60
|
$24,130.33
|
$24,130.33
|
$24,130.33
|
2026-03-04
|
|
423
|
MS_DRG
|
Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc
|
1
|
1
|
$202,381.60
|
$202,381.60
|
$57,676.70
|
$57,676.70
|
$57,676.70
|
2026-03-04
|
|
424
|
MS_DRG
|
Other Hepatobiliary Or Pancreas O.r. Procedures With Cc
|
1
|
1
|
$52,917.25
|
$52,917.25
|
$30,385.47
|
$30,385.47
|
$30,385.47
|
2026-03-04
|
|
432
|
MS_DRG
|
Cirrhosis And Alcoholic Hepatitis With Mcc
|
1
|
1
|
$146,174.24
|
$146,174.24
|
$27,334.28
|
$27,334.28
|
$27,334.28
|
2026-03-04
|
|
435
|
MS_DRG
|
Malignancy Of Hepatobiliary System Or Pancreas With Mcc
|
1
|
1
|
$93,370.66
|
$93,370.66
|
$25,508.02
|
$25,508.02
|
$25,508.02
|
2026-03-04
|
|
441
|
MS_DRG
|
Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc
|
1
|
1
|
$75,491.69
|
$75,491.69
|
$24,924.72
|
$24,924.72
|
$24,924.72
|
2026-03-04
|
|
454
|
MS_DRG
|
Combined Anterior And Posterior Spinal Fusion With Cc
|
1
|
1
|
$118,373.85
|
$118,373.85
|
$84,942.93
|
$84,942.93
|
$84,942.93
|
2026-03-04
|
|
455
|
MS_DRG
|
Combined Anterior And Posterior Spinal Fusion Without Cc/mcc
|
1
|
1
|
$131,913.27
|
$131,913.27
|
$63,962.39
|
$63,962.39
|
$63,962.39
|
2026-03-04
|
|
456
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
1
|
1
|
$437,061.50
|
$437,061.50
|
$116,706.08
|
$116,706.08
|
$116,706.08
|
2026-03-04
|
|
460
|
MS_DRG
|
Spinal Fusion Except Cervical Without Mcc
|
1
|
1
|
$128,720.14
|
$128,720.14
|
$50,800.77
|
$50,800.77
|
$50,800.77
|
2026-03-04
|
|
462
|
MS_DRG
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc
|
1
|
1
|
$99,672.75
|
$99,672.75
|
$36,941.97
|
$36,941.97
|
$36,941.97
|
2026-03-04
|
|
463
|
MS_DRG
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …
|
1
|
1
|
$312,142.80
|
$312,142.80
|
$79,154.43
|
$79,154.43
|
$79,154.43
|
2026-03-04
|
|
464
|
MS_DRG
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …
|
1
|
1
|
$106,219.24
|
$106,219.24
|
$43,256.83
|
$43,256.83
|
$43,256.83
|
2026-03-04
|
|
465
|
MS_DRG
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …
|
1
|
1
|
$109,661.86
|
$109,661.86
|
$25,327.47
|
$25,327.47
|
$25,327.47
|
2026-03-04
|
|
467
|
MS_DRG
|
Revision Of Hip Or Knee Replacement With Cc
|
1
|
1
|
$157,447.40
|
$157,447.40
|
$48,977.28
|
$48,977.28
|
$48,977.28
|
2026-03-04
|
|
468
|
MS_DRG
|
Revision Of Hip Or Knee Replacement Without Cc/mcc
|
1
|
1
|
$97,821.91
|
$97,821.91
|
$38,164.11
|
$38,164.11
|
$38,164.11
|
2026-03-04
|
|
469
|
MS_DRG
|
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc…
|
1
|
1
|
$91,918.23
|
$91,918.23
|
$42,124.96
|
$42,124.96
|
$42,124.96
|
2026-03-04
|
|
470
|
MS_DRG
|
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without …
|
1
|
1
|
$62,781.70
|
$62,781.70
|
$26,788.49
|
$26,788.49
|
$26,788.49
|
2026-03-04
|
|
471
|
MS_DRG
|
Cervical Spinal Fusion With Mcc
|
1
|
1
|
$266,800.62
|
$266,800.62
|
$67,060.79
|
$67,060.79
|
$67,060.79
|
2026-03-04
|
|
472
|
MS_DRG
|
Cervical Spinal Fusion With Cc
|
1
|
1
|
$112,125.28
|
$112,125.28
|
$40,915.32
|
$40,915.32
|
$40,915.32
|
2026-03-04
|
|
473
|
MS_DRG
|
Cervical Spinal Fusion Without Cc/mcc
|
1
|
1
|
$93,958.17
|
$93,958.17
|
$33,904.68
|
$33,904.68
|
$33,904.68
|
2026-03-04
|
|
474
|
MS_DRG
|
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc
|
1
|
1
|
$104,875.60
|
$104,875.60
|
$59,619.62
|
$59,619.62
|
$59,619.62
|
2026-03-04
|
|
475
|
MS_DRG
|
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc
|
1
|
1
|
$69,725.97
|
$69,725.97
|
$31,604.83
|
$31,604.83
|
$31,604.83
|
2026-03-04
|
|
478
|
MS_DRG
|
Biopsies Of Musculoskeletal System And Connective Tissue With Cc
|
1
|
1
|
$95,659.53
|
$95,659.53
|
$34,153.27
|
$34,153.27
|
$34,153.27
|
2026-03-04
|
|
479
|
MS_DRG
|
Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/mcc
|
1
|
1
|
$89,583.50
|
$89,583.50
|
$25,816.33
|
$25,816.33
|
$25,816.33
|
2026-03-04
|
|
480
|
MS_DRG
|
Hip And Femur Procedures Except Major Joint With Mcc
|
1
|
1
|
$150,668.94
|
$150,668.94
|
$40,445.91
|
$40,445.91
|
$40,445.91
|
2026-03-04
|
|
481
|
MS_DRG
|
Hip And Femur Procedures Except Major Joint With Cc
|
1
|
1
|
$114,413.13
|
$114,413.13
|
$29,088.33
|
$29,088.33
|
$29,088.33
|
2026-03-04
|
|
483
|
MS_DRG
|
Major Joint Or Limb Reattachment Procedures Of Upper Extremities
|
1
|
1
|
$81,042.14
|
$81,042.14
|
$38,496.04
|
$38,496.04
|
$38,496.04
|
2026-03-04
|
|
485
|
MS_DRG
|
Knee Procedures With Principal Diagnosis Of Infection With Mcc
|
1
|
1
|
$53,256.28
|
$53,256.28
|
$44,817.84
|
$44,817.84
|
$44,817.84
|
2026-03-04
|
|
486
|
MS_DRG
|
Knee Procedures With Principal Diagnosis Of Infection With Cc
|
1
|
1
|
$93,110.72
|
$93,110.72
|
$29,041.11
|
$29,041.11
|
$29,041.11
|
2026-03-04
|
|
492
|
MS_DRG
|
Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc
|
1
|
1
|
$131,468.12
|
$131,468.12
|
$50,991.03
|
$50,991.03
|
$50,991.03
|
2026-03-04
|
|
493
|
MS_DRG
|
Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc
|
1
|
1
|
$84,893.80
|
$84,893.80
|
$35,221.26
|
$35,221.26
|
$35,221.26
|
2026-03-04
|
|
494
|
MS_DRG
|
Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/mcc
|
1
|
1
|
$74,017.83
|
$74,017.83
|
$27,866.19
|
$27,866.19
|
$27,866.19
|
2026-03-04
|
|
495
|
MS_DRG
|
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit…
|
1
|
1
|
$81,740.85
|
$81,740.85
|
$50,353.58
|
$50,353.58
|
$50,353.58
|
2026-03-04
|
|
496
|
MS_DRG
|
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit…
|
1
|
1
|
$68,569.97
|
$68,569.97
|
$25,052.49
|
$25,052.49
|
$25,052.49
|
2026-03-04
|
|
498
|
MS_DRG
|
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc…
|
1
|
1
|
$56,000.70
|
$56,000.70
|
$41,897.20
|
$41,897.20
|
$41,897.20
|
2026-03-04
|
|
499
|
MS_DRG
|
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without…
|
1
|
1
|
$145,573.60
|
$145,573.60
|
$27,981.46
|
$27,981.46
|
$27,981.46
|
2026-03-04
|
|
500
|
MS_DRG
|
Soft Tissue Procedures With Mcc
|
1
|
1
|
$42,489.00
|
$42,489.00
|
$43,952.62
|
$43,952.62
|
$43,952.62
|
2026-03-04
|
|
501
|
MS_DRG
|
Soft Tissue Procedures With Cc
|
1
|
1
|
$77,235.85
|
$77,235.85
|
$24,277.54
|
$24,277.54
|
$24,277.54
|
2026-03-04
|
|
503
|
MS_DRG
|
Foot Procedures With Mcc
|
1
|
1
|
$39,428.25
|
$39,428.25
|
$38,762.69
|
$38,762.69
|
$38,762.69
|
2026-03-04
|
|
504
|
MS_DRG
|
Foot Procedures With Cc
|
1
|
1
|
$77,541.85
|
$77,541.85
|
$25,959.37
|
$25,959.37
|
$25,959.37
|
2026-03-04
|
|
505
|
MS_DRG
|
Foot Procedures Without Cc/mcc
|
1
|
1
|
$71,584.35
|
$71,584.35
|
$24,898.33
|
$24,898.33
|
$24,898.33
|
2026-03-04
|
|
510
|
MS_DRG
|
Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc
|
1
|
1
|
$207,442.25
|
$207,442.25
|
$41,948.58
|
$41,948.58
|
$41,948.58
|
2026-03-04
|
|
511
|
MS_DRG
|
Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc
|
1
|
1
|
$75,926.28
|
$75,926.28
|
$28,878.62
|
$28,878.62
|
$28,878.62
|
2026-03-04
|
|
515
|
MS_DRG
|
Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc
|
1
|
1
|
$142,335.51
|
$142,335.51
|
$44,259.54
|
$44,259.54
|
$44,259.54
|
2026-03-04
|
|
516
|
MS_DRG
|
Other Musculoskeletal System And Connective Tissue O.r. Procedures With Cc
|
1
|
1
|
$125,574.70
|
$125,574.70
|
$28,860.57
|
$28,860.57
|
$28,860.57
|
2026-03-04
|
|
518
|
MS_DRG
|
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost…
|
1
|
1
|
$89,104.88
|
$89,104.88
|
$51,903.47
|
$51,903.47
|
$51,903.47
|
2026-03-04
|
|
519
|
MS_DRG
|
Back And Neck Procedures Except Spinal Fusion With Cc
|
1
|
1
|
$81,356.29
|
$81,356.29
|
$27,778.70
|
$27,778.70
|
$27,778.70
|
2026-03-04
|
|
52
|
MS_DRG
|
Spinal Disorders And Injuries With Cc/mcc
|
1
|
1
|
$50,303.70
|
$50,303.70
|
$24,731.68
|
$24,731.68
|
$24,731.68
|
2026-03-04
|
|
521
|
MS_DRG
|
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc
|
1
|
1
|
$135,228.95
|
$135,228.95
|
$39,861.22
|
$39,861.22
|
$39,861.22
|
2026-03-04
|
|
522
|
MS_DRG
|
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc
|
1
|
1
|
$53,467.33
|
$53,467.33
|
$29,410.53
|
$29,410.53
|
$29,410.53
|
2026-03-04
|
|
539
|
MS_DRG
|
Osteomyelitis With Mcc
|
1
|
1
|
$36,060.63
|
$36,060.63
|
$27,355.11
|
$27,355.11
|
$27,355.11
|
2026-03-04
|
|
542
|
MS_DRG
|
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With…
|
1
|
1
|
$150,730.88
|
$150,730.88
|
$24,533.08
|
$24,533.08
|
$24,533.08
|
2026-03-04
|
|
545
|
MS_DRG
|
Connective Tissue Disorders With Mcc
|
1
|
1
|
$40,362.38
|
$40,362.38
|
$34,465.75
|
$34,465.75
|
$34,465.75
|
2026-03-04
|
|
548
|
MS_DRG
|
Septic Arthritis With Mcc
|
1
|
1
|
$29,996.30
|
$29,996.30
|
$26,816.26
|
$26,816.26
|
$26,816.26
|
2026-03-04
|
|
559
|
MS_DRG
|
Aftercare, Musculoskeletal System And Connective Tissue With Mcc
|
1
|
1
|
$45,729.73
|
$45,729.73
|
$25,899.66
|
$25,899.66
|
$25,899.66
|
2026-03-04
|
|
56
|
MS_DRG
|
Degenerative Nervous System Disorders With Mcc
|
1
|
1
|
$122,740.94
|
$122,740.94
|
$32,263.12
|
$32,263.12
|
$32,263.12
|
2026-03-04
|
|
570
|
MS_DRG
|
Skin Debridement With Mcc
|
1
|
1
|
$54,707.10
|
$54,707.10
|
$40,845.88
|
$40,845.88
|
$40,845.88
|
2026-03-04
|
|
576
|
MS_DRG
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc
|
1
|
1
|
$173,395.65
|
$173,395.65
|
$68,067.67
|
$68,067.67
|
$68,067.67
|
2026-03-04
|
|
577
|
MS_DRG
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc
|
1
|
1
|
$72,639.53
|
$72,639.53
|
$36,812.82
|
$36,812.82
|
$36,812.82
|
2026-03-04
|
|
579
|
MS_DRG
|
Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc
|
1
|
1
|
$57,700.99
|
$57,700.99
|
$44,976.16
|
$44,976.16
|
$44,976.16
|
2026-03-04
|
|
580
|
MS_DRG
|
Other Skin, Subcutaneous Tissue And Breast Procedures With Cc
|
1
|
1
|
$83,057.28
|
$83,057.28
|
$23,998.39
|
$23,998.39
|
$23,998.39
|
2026-03-04
|
|
582
|
MS_DRG
|
Mastectomy For Malignancy With Cc/mcc
|
1
|
1
|
$35,100.84
|
$35,100.84
|
$26,756.54
|
$26,756.54
|
$26,756.54
|
2026-03-04
|
|
584
|
MS_DRG
|
Breast Biopsy, Local Excision And Other Breast Procedures With Cc/mcc
|
1
|
1
|
$234,436.99
|
$234,436.99
|
$29,729.96
|
$29,729.96
|
$29,729.96
|
2026-03-04
|
|
585
|
MS_DRG
|
Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/mcc
|
1
|
1
|
$123,744.53
|
$123,744.53
|
$26,791.26
|
$26,791.26
|
$26,791.26
|
2026-03-04
|
|
592
|
MS_DRG
|
Skin Ulcers With Mcc
|
1
|
1
|
—
|
—
|
$26,877.37
|
$26,877.37
|
$26,877.37
|
2026-03-04
|
|
616
|
MS_DRG
|
Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…
|
1
|
1
|
$340,855.45
|
$340,855.45
|
$48,432.87
|
$48,432.87
|
$48,432.87
|
2026-03-04
|
|
617
|
MS_DRG
|
Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…
|
1
|
1
|
$47,963.19
|
$47,963.19
|
$25,974.65
|
$25,974.65
|
$25,974.65
|
2026-03-04
|
|
62
|
MS_DRG
|
Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A…
|
1
|
1
|
$135,928.25
|
$135,928.25
|
$24,403.92
|
$24,403.92
|
$24,403.92
|
2026-03-04
|
|
622
|
MS_DRG
|
Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor…
|
1
|
1
|
$161,471.50
|
$161,471.50
|
$49,430.03
|
$49,430.03
|
$49,430.03
|
2026-03-04
|
|
623
|
MS_DRG
|
Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor…
|
1
|
1
|
$47,888.00
|
$47,888.00
|
$24,913.61
|
$24,913.61
|
$24,913.61
|
2026-03-04
|
|
628
|
MS_DRG
|
Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc
|
1
|
1
|
$198,655.65
|
$198,655.65
|
$51,757.65
|
$51,757.65
|
$51,757.65
|
2026-03-04
|
|
64
|
MS_DRG
|
Intracranial Hemorrhage Or Cerebral Infarction With Mcc
|
1
|
1
|
$100,533.67
|
$100,533.67
|
$27,928.69
|
$27,928.69
|
$27,928.69
|
2026-03-04
|
|
654
|
MS_DRG
|
Major Bladder Procedures With Cc
|
1
|
1
|
$150,332.03
|
$150,332.03
|
$38,876.57
|
$38,876.57
|
$38,876.57
|
2026-03-04
|
|
655
|
MS_DRG
|
Major Bladder Procedures Without Cc/mcc
|
1
|
1
|
$166,604.61
|
$166,604.61
|
$29,395.26
|
$29,395.26
|
$29,395.26
|
2026-03-04
|
|
656
|
MS_DRG
|
Kidney And Ureter Procedures For Neoplasm With Mcc
|
1
|
1
|
$159,204.05
|
$159,204.05
|
$44,216.49
|
$44,216.49
|
$44,216.49
|
2026-03-04
|
|
6563804_1
|
CDM
|
Device Sy Mini Lenthening 110mm 394.071
|
12
|
12
|
$30,375.00
|
$30,375.00
|
$5,500.00
|
$27,945.00
|
$27,945.00
|
2026-03-04
|
|
657
|
MS_DRG
|
Kidney And Ureter Procedures For Neoplasm With Cc
|
1
|
1
|
$108,371.38
|
$108,371.38
|
$25,414.97
|
$25,414.97
|
$25,414.97
|
2026-03-04
|
|
659
|
MS_DRG
|
Kidney And Ureter Procedures For Non-neoplasm With Mcc
|
1
|
1
|
$74,983.25
|
$74,983.25
|
$35,287.92
|
$35,287.92
|
$35,287.92
|
2026-03-04
|
|
673
|
MS_DRG
|
Other Kidney And Urinary Tract Procedures With Mcc
|
1
|
1
|
$163,401.02
|
$163,401.02
|
$58,351.65
|
$58,351.65
|
$58,351.65
|
2026-03-04
|
|
674
|
MS_DRG
|
Other Kidney And Urinary Tract Procedures With Cc
|
1
|
1
|
$22,348.53
|
$22,348.53
|
$32,478.38
|
$32,478.38
|
$32,478.38
|
2026-03-04
|
|
686
|
MS_DRG
|
Kidney And Urinary Tract Neoplasms With Mcc
|
1
|
1
|
$24,767.40
|
$24,767.40
|
$25,049.71
|
$25,049.71
|
$25,049.71
|
2026-03-04
|
|
6963148_1
|
CDM
|
Baha 3 Unilateral System Stage One
|
12
|
12
|
$40,814.00
|
$40,814.00
|
$5,500.00
|
$37,548.88
|
$37,548.88
|
2026-03-04
|
|
707
|
MS_DRG
|
Major Male Pelvic Procedures With Cc/mcc
|
1
|
1
|
$107,789.72
|
$107,789.72
|
$27,780.09
|
$27,780.09
|
$27,780.09
|
2026-03-04
|
|
711
|
MS_DRG
|
Testes Procedures With Cc/mcc
|
1
|
1
|
$58,156.90
|
$58,156.90
|
$28,939.73
|
$28,939.73
|
$28,939.73
|
2026-03-04
|
|
734
|
MS_DRG
|
Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/mcc
|
1
|
1
|
$67,694.48
|
$67,694.48
|
$29,581.35
|
$29,581.35
|
$29,581.35
|
2026-03-04
|
|
736
|
MS_DRG
|
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc
|
1
|
1
|
$152,001.95
|
$152,001.95
|
$49,642.51
|
$49,642.51
|
$49,642.51
|
2026-03-04
|
|
737
|
MS_DRG
|
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc
|
1
|
1
|
$134,178.09
|
$134,178.09
|
$28,617.53
|
$28,617.53
|
$28,617.53
|
2026-03-04
|
|
742
|
MS_DRG
|
Uterine And Adnexa Procedures For Non-malignancy With Cc/mcc
|
1
|
1
|
$94,808.28
|
$94,808.28
|
$25,481.63
|
$25,481.63
|
$25,481.63
|
2026-03-04
|
|
749
|
MS_DRG
|
Other Female Reproductive System O.r. Procedures With Cc/mcc
|
1
|
1
|
$165,976.11
|
$165,976.11
|
$35,658.73
|
$35,658.73
|
$35,658.73
|
2026-03-04
|
|
75
|
MS_DRG
|
Viral Meningitis With Cc/mcc
|
1
|
1
|
$15,528.45
|
$15,528.45
|
$26,630.16
|
$26,630.16
|
$26,630.16
|
2026-03-04
|
|
789
|
MS_DRG
|
Neonates, Died Or Transferred To Another Acute Care Facility
|
1
|
1
|
$25,470.14
|
$25,470.14
|
$25,028.88
|
$25,028.88
|
$25,028.88
|
2026-03-04
|
|
790
|
MS_DRG
|
Extreme Immaturity Or Respiratory Distress Syndrome, Neonate
|
1
|
1
|
$141,692.62
|
$141,692.62
|
$82,543.09
|
$82,543.09
|
$82,543.09
|
2026-03-04
|
|
791
|
MS_DRG
|
Prematurity With Major Problems
|
1
|
1
|
$81,158.86
|
$81,158.86
|
$56,371.23
|
$56,371.23
|
$56,371.23
|
2026-03-04
|
|
792
|
MS_DRG
|
Prematurity Without Major Problems
|
1
|
1
|
$67,923.30
|
$67,923.30
|
$34,014.39
|
$34,014.39
|
$34,014.39
|
2026-03-04
|
|
793
|
MS_DRG
|
Full Term Neonate With Major Problems
|
1
|
1
|
$37,338.49
|
$37,338.49
|
$57,907.24
|
$57,907.24
|
$57,907.24
|
2026-03-04
|
|
794
|
MS_DRG
|
Neonate With Other Significant Problems
|
2
|
2
|
$14,510.79
|
$14,510.79
|
$20,497.24
|
$29,510.79
|
$25,004.01
|
2026-03-04
|
|
801
|
MS_DRG
|
Splenic Procedures Without Cc/mcc
|
1
|
1
|
$55,763.65
|
$55,763.65
|
$26,510.73
|
$26,510.73
|
$26,510.73
|
2026-03-04
|
|
808
|
MS_DRG
|
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co…
|
1
|
1
|
$430,821.72
|
$430,821.72
|
$30,663.23
|
$30,663.23
|
$30,663.23
|
2026-03-04
|
|
814
|
MS_DRG
|
Reticuloendothelial And Immunity Disorders With Mcc
|
1
|
1
|
$76,494.80
|
$76,494.80
|
$29,535.52
|
$29,535.52
|
$29,535.52
|
2026-03-04
|
|
82
|
MS_DRG
|
Traumatic Stupor And Coma >1 Hour With Mcc
|
1
|
1
|
$61,765.09
|
$61,765.09
|
$31,742.32
|
$31,742.32
|
$31,742.32
|
2026-03-04
|
|
820
|
MS_DRG
|
Lymphoma And Leukemia With Major O.r. Procedures With Mcc
|
1
|
1
|
$261,804.86
|
$261,804.86
|
$81,450.11
|
$81,450.11
|
$81,450.11
|
2026-03-04
|
|
821
|
MS_DRG
|
Lymphoma And Leukemia With Major O.r. Procedures With Cc
|
1
|
1
|
$271,705.55
|
$271,705.55
|
$31,089.59
|
$31,089.59
|
$31,089.59
|
2026-03-04
|
|
823
|
MS_DRG
|
Lymphoma And Non-acute Leukemia With Other Procedures With Mcc
|
1
|
1
|
$285,549.45
|
$285,549.45
|
$63,673.52
|
$63,673.52
|
$63,673.52
|
2026-03-04
|
|
824
|
MS_DRG
|
Lymphoma And Non-acute Leukemia With Other Procedures With Cc
|
1
|
1
|
$29,978.05
|
$29,978.05
|
$31,464.56
|
$31,464.56
|
$31,464.56
|
2026-03-04
|
|
826
|
MS_DRG
|
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …
|
1
|
1
|
$72,123.50
|
$72,123.50
|
$64,965.10
|
$64,965.10
|
$64,965.10
|
2026-03-04
|
|
829
|
MS_DRG
|
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce…
|
1
|
1
|
$158,425.67
|
$158,425.67
|
$43,885.95
|
$43,885.95
|
$43,885.95
|
2026-03-04
|
|
835
|
MS_DRG
|
Acute Leukemia With Cc
|
1
|
1
|
$24,250.75
|
$24,250.75
|
$28,967.51
|
$28,967.51
|
$28,967.51
|
2026-03-04
|
|
840
|
MS_DRG
|
Lymphoma And Non-acute Leukemia With Mcc
|
1
|
1
|
$158,128.43
|
$158,128.43
|
$44,926.16
|
$44,926.16
|
$44,926.16
|
2026-03-04
|
|
846
|
MS_DRG
|
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc
|
1
|
1
|
$478,702.61
|
$478,702.61
|
$36,004.54
|
$36,004.54
|
$36,004.54
|
2026-03-04
|
|
85
|
MS_DRG
|
Traumatic Stupor And Coma <1 Hour With Mcc
|
1
|
1
|
$51,280.33
|
$51,280.33
|
$31,552.06
|
$31,552.06
|
$31,552.06
|
2026-03-04
|
|
853
|
MS_DRG
|
Infectious And Parasitic Diseases With O.r. Procedures With Mcc
|
1
|
1
|
$330,527.61
|
$330,527.61
|
$68,587.08
|
$68,587.08
|
$68,587.08
|
2026-03-04
|
|
854
|
MS_DRG
|
Infectious And Parasitic Diseases With O.r. Procedures With Cc
|
1
|
1
|
$93,401.33
|
$93,401.33
|
$27,749.53
|
$27,749.53
|
$27,749.53
|
2026-03-04
|
|
856
|
MS_DRG
|
Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc
|
1
|
1
|
$218,978.61
|
$218,978.61
|
$63,172.16
|
$63,172.16
|
$63,172.16
|
2026-03-04
|
|
857
|
MS_DRG
|
Postoperative Or Post-traumatic Infections With O.r. Procedures With Cc
|
1
|
1
|
$80,291.15
|
$80,291.15
|
$29,741.07
|
$29,741.07
|
$29,741.07
|
2026-03-04
|
|
862
|
MS_DRG
|
Postoperative And Post-traumatic Infections With Mcc
|
1
|
1
|
$112,170.74
|
$112,170.74
|
$25,327.47
|
$25,327.47
|
$25,327.47
|
2026-03-04
|
|
867
|
MS_DRG
|
Other Infectious And Parasitic Diseases Diagnoses With Mcc
|
1
|
1
|
$264,931.90
|
$264,931.90
|
$29,070.28
|
$29,070.28
|
$29,070.28
|
2026-03-04
|
|
870
|
MS_DRG
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
1
|
1
|
$335,118.47
|
$335,118.47
|
$95,990.80
|
$95,990.80
|
$95,990.80
|
2026-03-04
|
|
871
|
MS_DRG
|
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc
|
1
|
1
|
$81,057.58
|
$81,057.58
|
$26,977.36
|
$26,977.36
|
$26,977.36
|
2026-03-04
|
|
881
|
MS_DRG
|
Depressive Neuroses
|
2
|
2
|
$26,211.90
|
$26,211.90
|
$13,067.18
|
$56,211.90
|
$34,639.54
|
2026-03-04
|
|
883
|
MS_DRG
|
Disorders Of Personality And Impulse Control
|
1
|
1
|
$17,105.98
|
$17,105.98
|
$27,307.90
|
$27,307.90
|
$27,307.90
|
2026-03-04
|
|
886
|
MS_DRG
|
Behavioral And Developmental Disorders
|
1
|
1
|
$27,172.60
|
$27,172.60
|
$28,821.68
|
$28,821.68
|
$28,821.68
|
2026-03-04
|
|
896
|
MS_DRG
|
Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc
|
1
|
1
|
$74,326.20
|
$74,326.20
|
$24,235.88
|
$24,235.88
|
$24,235.88
|
2026-03-04
|
|
901
|
MS_DRG
|
Wound Debridements For Injuries With Mcc
|
1
|
1
|
$76,810.10
|
$76,810.10
|
$58,282.21
|
$58,282.21
|
$58,282.21
|
2026-03-04
|
|
902
|
MS_DRG
|
Wound Debridements For Injuries With Cc
|
1
|
1
|
$103,586.91
|
$103,586.91
|
$26,588.50
|
$26,588.50
|
$26,588.50
|
2026-03-04
|
|
904
|
MS_DRG
|
Skin Grafts For Injuries With Cc/mcc
|
1
|
1
|
$151,036.63
|
$151,036.63
|
$51,011.87
|
$51,011.87
|
$51,011.87
|
2026-03-04
|
|
906
|
MS_DRG
|
Hand Procedures For Injuries
|
1
|
1
|
$43,924.45
|
$43,924.45
|
$24,476.14
|
$24,476.14
|
$24,476.14
|
2026-03-04
|
|
907
|
MS_DRG
|
Other O.r. Procedures For Injuries With Mcc
|
1
|
1
|
$195,013.09
|
$195,013.09
|
$53,320.04
|
$53,320.04
|
$53,320.04
|
2026-03-04
|
|
908
|
MS_DRG
|
Other O.r. Procedures For Injuries With Cc
|
1
|
1
|
$63,067.23
|
$63,067.23
|
$27,709.26
|
$27,709.26
|
$27,709.26
|
2026-03-04
|
|
91
|
MS_DRG
|
Other Disorders Of Nervous System With Mcc
|
1
|
1
|
$147,335.72
|
$147,335.72
|
$24,390.04
|
$24,390.04
|
$24,390.04
|
2026-03-04
|
|
919
|
MS_DRG
|
Complications Of Treatment With Mcc
|
1
|
1
|
$59,319.87
|
$59,319.87
|
$25,426.08
|
$25,426.08
|
$25,426.08
|
2026-03-04
|
|
922
|
MS_DRG
|
Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc
|
1
|
1
|
$198,000.79
|
$198,000.79
|
$24,295.60
|
$24,295.60
|
$24,295.60
|
2026-03-04
|
|
927
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
1
|
1
|
$736,762.14
|
$736,762.14
|
$255,957.88
|
$255,957.88
|
$255,957.88
|
2026-03-04
|
|
928
|
MS_DRG
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
1
|
1
|
$355,417.13
|
$355,417.13
|
$99,614.17
|
$99,614.17
|
$99,614.17
|
2026-03-04
|
|
929
|
MS_DRG
|
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/mcc
|
1
|
1
|
$118,538.99
|
$118,538.99
|
$44,730.34
|
$44,730.34
|
$44,730.34
|
2026-03-04
|
|
9296039_1
|
CDM
|
Spacer Obelisc Center 20m/23-31mm Cs 2920-23
|
12
|
12
|
$26,247.00
|
$26,247.00
|
$5,500.00
|
$24,147.24
|
$24,147.24
|
2026-03-04
|
|
933
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft
|
1
|
1
|
$196,517.75
|
$196,517.75
|
$53,006.18
|
$53,006.18
|
$53,006.18
|
2026-03-04
|
|
934
|
MS_DRG
|
Full Thickness Burn Without Skin Graft Or Inhalation Injury
|
1
|
1
|
$56,310.83
|
$56,310.83
|
$30,700.72
|
$30,700.72
|
$30,700.72
|
2026-03-04
|
|
935
|
MS_DRG
|
Non-extensive Burns
|
1
|
1
|
$56,764.11
|
$56,764.11
|
$28,609.20
|
$28,609.20
|
$28,609.20
|
2026-03-04
|
|
94
|
MS_DRG
|
Bacterial And Tuberculous Infections Of Nervous System With Mcc
|
1
|
1
|
$205,020.72
|
$205,020.72
|
$48,877.29
|
$48,877.29
|
$48,877.29
|
2026-03-04
|
|
941
|
MS_DRG
|
O.r. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/…
|
1
|
1
|
$59,000.23
|
$59,000.23
|
$28,160.62
|
$28,160.62
|
$28,160.62
|
2026-03-04
|
|
95
|
MS_DRG
|
Bacterial And Tuberculous Infections Of Nervous System With Cc
|
1
|
1
|
$148,852.50
|
$148,852.50
|
$35,819.83
|
$35,819.83
|
$35,819.83
|
2026-03-04
|
|
955
|
MS_DRG
|
Craniotomy For Multiple Significant Trauma
|
1
|
1
|
$420,996.97
|
$420,996.97
|
$93,481.25
|
$93,481.25
|
$93,481.25
|
2026-03-04
|
|
956
|
MS_DRG
|
Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma
|
1
|
1
|
$276,978.77
|
$276,978.77
|
$52,260.39
|
$52,260.39
|
$52,260.39
|
2026-03-04
|
|
957
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
1
|
1
|
$295,033.56
|
$295,033.56
|
$105,824.87
|
$105,824.87
|
$105,824.87
|
2026-03-04
|
|
958
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Cc
|
1
|
1
|
$138,427.32
|
$138,427.32
|
$58,522.47
|
$58,522.47
|
$58,522.47
|
2026-03-04
|
|
96
|
MS_DRG
|
Bacterial And Tuberculous Infections Of Nervous System Without Cc/mcc
|
1
|
1
|
$47,286.13
|
$47,286.13
|
$35,819.83
|
$35,819.83
|
$35,819.83
|
2026-03-04
|
|
963
|
MS_DRG
|
Other Multiple Significant Trauma With Mcc
|
1
|
1
|
$223,985.23
|
$223,985.23
|
$37,966.91
|
$37,966.91
|
$37,966.91
|
2026-03-04
|
|
969
|
MS_DRG
|
HIV With Extensive O.r. Procedures With Mcc
|
1
|
1
|
$179,696.13
|
$179,696.13
|
$85,012.37
|
$85,012.37
|
$85,012.37
|
2026-03-04
|
|
97
|
MS_DRG
|
Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc
|
1
|
1
|
$74,067.85
|
$74,067.85
|
$50,160.53
|
$50,160.53
|
$50,160.53
|
2026-03-04
|
|
970
|
MS_DRG
|
HIV With Extensive O.r. Procedures Without Mcc
|
1
|
1
|
$57,855.53
|
$57,855.53
|
$36,628.11
|
$36,628.11
|
$36,628.11
|
2026-03-04
|
|
974
|
MS_DRG
|
HIV With Major Related Condition With Mcc
|
1
|
1
|
$201,786.91
|
$201,786.91
|
$40,080.65
|
$40,080.65
|
$40,080.65
|
2026-03-04
|
|
98
|
MS_DRG
|
Non-bacterial Infection Of Nervous System Except Viral Meningitis With Cc
|
1
|
1
|
$42,504.00
|
$42,504.00
|
$31,871.48
|
$31,871.48
|
$31,871.48
|
2026-03-04
|
|
981
|
MS_DRG
|
Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc
|
1
|
1
|
$408,379.24
|
$408,379.24
|
$65,159.53
|
$65,159.53
|
$65,159.53
|
2026-03-04
|
|
982
|
MS_DRG
|
Extensive O.r. Procedures Unrelated To Principal Diagnosis With Cc
|
1
|
1
|
$75,386.53
|
$75,386.53
|
$34,143.55
|
$34,143.55
|
$34,143.55
|
2026-03-04
|
|
987
|
MS_DRG
|
Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc
|
1
|
1
|
$219,057.36
|
$219,057.36
|
$47,613.48
|
$47,613.48
|
$47,613.48
|
2026-03-04
|
|
C1722
|
HCPCS
|
Cardioverter-defibrillator, Single Chamber (implantable)
|
46
|
13
|
$57,545.00
|
$57,545.00
|
$1,233.00
|
$74,529.20
|
$49,464.72
|
2026-03-04
|
|
C1767
|
HCPCS
|
Generator, Neurostimulator (implantable), Non-rechargeable
|
24
|
13
|
$40,560.00
|
$40,560.00
|
$1,233.00
|
$56,262.60
|
$37,315.20
|
2026-03-04
|
|
C1820
|
HCPCS
|
Generator, Neurostimulator (implantable), With Rechargeable Battery And Charging…
|
13
|
13
|
$57,165.00
|
$57,165.00
|
$1,233.00
|
$52,591.80
|
$52,591.80
|
2026-03-04
|
|
C9047
|
HCPCS
|
Injection, Caplacizumab-yhdp, 1 Mg
|
13
|
13
|
$29,671.20
|
$29,671.20
|
$1,233.00
|
$27,297.50
|
$27,297.50
|
2026-03-04
|
|
J0517
|
HCPCS
|
Injection, Benralizumab, 1 Mg
|
13
|
13
|
$30,583.00
|
$30,583.00
|
$1,233.00
|
$28,136.36
|
$28,136.36
|
2026-03-04
|
|
J1300
|
HCPCS
|
Injection, Eculizumab, 10 Mg
|
13
|
13
|
$31,315.25
|
$31,315.25
|
$1,233.00
|
$28,810.03
|
$28,810.03
|
2026-03-04
|
|
J1303
|
HCPCS
|
Injection, Ravulizumab-cwvz, 10 Mg
|
24
|
13
|
$112,717.00
|
$112,717.00
|
$1,233.00
|
$103,699.64
|
$28,282.12
|
2026-03-04
|
|
J2323
|
HCPCS
|
Injection, Natalizumab, 1 Mg
|
13
|
13
|
$37,727.90
|
$37,727.90
|
$1,233.00
|
$34,709.67
|
$34,709.67
|
2026-03-04
|
|
J2350
|
HCPCS
|
Injection, Ocrelizumab, 1 Mg
|
13
|
13
|
$89,566.23
|
$89,566.23
|
$1,233.00
|
$82,400.93
|
$82,400.93
|
2026-03-04
|
|
J2427
|
HCPCS
|
Injection, Paliperidone Palmitate Extended Release (invega Hafyera, Or Invega Tr…
|
24
|
13
|
$35,409.80
|
$35,409.80
|
$1,233.00
|
$54,699.24
|
$32,577.02
|
2026-03-04
|
|
J3380
|
HCPCS
|
Injection, Vedolizumab, Intravenous, 1 Mg
|
13
|
13
|
$39,297.49
|
$39,297.49
|
$1,233.00
|
$36,153.69
|
$36,153.69
|
2026-03-04
|
|
J9022
|
HCPCS
|
Injection, Atezolizumab, 10 Mg
|
24
|
13
|
$47,293.30
|
$47,293.30
|
$1,233.00
|
$43,509.84
|
$30,453.20
|
2026-03-04
|
|
J9063
|
HCPCS
|
Injection, Mirvetuximab Soravtansine-gynx, 1 Mg
|
13
|
13
|
$29,713.50
|
$29,713.50
|
$1,233.00
|
$27,336.42
|
$27,336.42
|
2026-03-04
|
|
J9144
|
HCPCS
|
Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj
|
13
|
13
|
$45,797.19
|
$45,797.19
|
$1,233.00
|
$42,133.41
|
$42,133.41
|
2026-03-04
|
|
J9228
|
HCPCS
|
Injection, Ipilimumab, 1 Mg
|
24
|
13
|
$151,357.25
|
$151,357.25
|
$1,233.00
|
$139,248.67
|
$34,210.11
|
2026-03-04
|
|
J9273
|
HCPCS
|
Injection, Tisotumab Vedotin-tftv, 1 Mg
|
13
|
13
|
$27,885.06
|
$27,885.06
|
$1,233.00
|
$25,654.26
|
$25,654.26
|
2026-03-04
|
|
J9316
|
HCPCS
|
Injection, Pertuzumab, Trastuzumab, And Hyaluronidase-zzxf, Per 10 Mg
|
24
|
13
|
$40,680.60
|
$40,680.60
|
$1,233.00
|
$56,132.24
|
$37,426.15
|
2026-03-04
|
|
J9347
|
HCPCS
|
Injection, Tremelimumab-actl, 1 Mg
|
13
|
13
|
$187,220.00
|
$187,220.00
|
$1,233.00
|
$172,242.40
|
$172,242.40
|
2026-03-04
|
|
J9359
|
HCPCS
|
Injection, Loncastuximab Tesirine-lpyl, 0.075 Mg
|
13
|
13
|
$114,117.00
|
$114,117.00
|
$1,233.00
|
$104,987.64
|
$104,987.64
|
2026-03-04
|
|
L8614
|
HCPCS
|
Cochlear Device, Includes All Internal And External Components
|
123
|
13
|
$78,023.00
|
$78,023.00
|
$1,233.00
|
$80,593.84
|
$69,940.80
|
2026-03-04
|
|
L8686
|
HCPCS
|
Implantable Neurostimulator Pulse Generator, Single Array, Non-rechargeable, Inc…
|
13
|
13
|
$29,541.00
|
$29,541.00
|
$1,233.00
|
$27,177.72
|
$27,177.72
|
2026-03-04
|
|
Q4104
|
HCPCS
|
Integra Bilayer Matrix Wound Dressing (bmwd), Per Square Centimeter
|
13
|
13
|
$29,111.00
|
$29,111.00
|
$1,233.00
|
$26,782.12
|
$26,782.12
|
2026-03-04
|
|
Q4142
|
HCPCS
|
Xcm Biologic Tissue Matrix, Per Square Centimeter
|
13
|
13
|
$27,918.00
|
$27,918.00
|
$1,233.00
|
$25,684.56
|
$25,684.56
|
2026-03-04
|