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Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

TIDALHEALTH NANTICOKE, INC.

Seaford, DE · CCN 080006 · Rates published

34,598 distinct procedures filed
8 distinct payers
425,147 rate rows
2026-05-22 last MRF observed
Data quality

424,412 of 425,147 rate rows are consumer-grade (99.8%)

735 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 — reasonRows
placeholder amount (≤ $0.02) — excluded from medians 633
percent-of-charges filed in the dollar field — excluded from medians 79
exceeds 10× this hospital's gross charge — excluded from medians 14
per-diem day rate — not a per-procedure price 8
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.tidalhealth.org/sites/default/files/2026-04/510069243_tidalhealth-nanticoke-inc_standardcharges.csv
Found on page https://www.tidalhealth.org/patients-visitors/billing-insurance-medical-records/billing?tab=4
Discovered viaCMS hospital list
Last fetch not_modified · 2026-05-17
Content fingerprint 157c7601ab910d6e… · 13,720,817 bytes · first seen 2026-05-09

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
SUP-83234
OTHER 		Generator Neurostimulator Remede Pulse 7 $119,701.33 $511,500.00 $407,000.00 nat. median
$2,375
outlier · 171.4×
003
OTHER 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 $141,371.00 $152,767.00 $152,767.00 nat. median
$218,232
0.7× median
RX-104852
OTHER 		Sipuleucel-t In Lactated Ringers 50 Million Cell/250 Ml IV Suspension 8 $46,689.07 $174,661.44 $147,787.00 nat. median
$57,568
outlier · 2.6×
277
OTHER 		Cardiac Defibrillator Implant Without McC 6 $33,163.60 $138,440.00 $138,440.00 nat. median
$44,716
outlier · 3.1×
RX-184131
OTHER 		Givosiran 189 Mg/ml Subcutaneous Solution 8 $110.56 $127,848.00 $122,464.26 nat. median
$122,464
1.0× median
SUP-CS-1000
OTHER 		Chondrocytes Autologous 4 $119,118.00 $119,118.00 $119,118.00 nat. median
$119,118
1.0× median
RX-194930
OTHER 		Tremelimumab-actl 20 Mg/ml Intravenous Solution 8 $133.17 $119,340.00 $115,469.73 nat. median
$115,470
1.0× median
233
OTHER 		Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC 2 $77,839.80 $106,773.00 $106,773.00 nat. median
$68,249
1.6× median
PX-481332740
OTHER 		Hc Tcat Insj/Rpl Perm Ldls Pm 7 $52,345.85 $129,493.20 $103,037.60 nat. median
$103,038
1.0× median
004
OTHER 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 2 $100,721.00 $139,294.00 $100,721.00 nat. median
$150,232
0.7× median
870
OTHER 		Septicemia Or Severe Sepsis With Mv >96 Hours 8 $3,506.66 $124,750.00 $96,056.70 nat. median
$54,564
1.8× median
SUP-4960-3-000
OTHER 		Assembly Lengthening 4 $95,754.90 $95,754.90 $95,754.90 nat. median
$95,755
1.0× median
207
OTHER 		Respiratory System Diagnosis With Ventilator Support >96 Hours 8 $3,506.66 $123,374.00 $91,854.30 nat. median
$66,849
1.4× median
RX-201599
OTHER 		Ocrelizumab 920 Mg-hyaluronidase-ocsq 23,000 Unit/23 Ml Subcut Soln 7 $125.14 $115,176.78 $91,646.04 nat. median
$91,646
1.0× median
276
OTHER 		Cardiac Defibrillator Implant With McC Or Carotid Sinus Neurostimulator 8 $3,506.66 $157,047.00 $87,967.20 nat. median
$3,947
outlier · 22.3×
SUP-EVFXPLUS-26
OTHER 		Evolut Fx+ 26mm Valve 4 $83,200.00 $83,200.00 $83,200.00 nat. median
$83,200
1.0× median
SUP-EVFXPLUS-29
OTHER 		Evolut Fx+ 29mm Valve 4 $83,200.00 $83,200.00 $83,200.00 nat. median
$83,200
1.0× median
SUP-EVFXPLUS-23
OTHER 		Evolut Fx+ 23mm Valve 4 $83,200.00 $83,200.00 $83,200.00 nat. median
$83,200
1.0× median
SUP-EVFXPLUS-34
OTHER 		Evolut Fx+ 34mm Valve 4 $83,200.00 $83,200.00 $83,200.00 nat. median
$83,200
1.0× median
PX-361332640
OTHER 		Hc Cc Aicd Battery Change Multi Lead 8 $7,587.55 $85,302.82 $78,364.90 nat. median
$78,365
1.0× median
PX-361332490
OTHER 		Hc Cc Acid Insertion Single Or Dual 8 $11,789.80 $85,302.82 $78,364.90 nat. median
$78,365
1.0× median
SUP-EVOLUTFX-29
OTHER 		Valve Aortic Evolut Fx 29 Mm 4 $78,000.00 $78,000.00 $78,000.00 nat. median
$41,745
1.9× median
SUP-EVOLUTPRO-29-US
OTHER 		Valve Transcatheter Aortic 29 4 $78,000.00 $78,000.00 $78,000.00 nat. median
$41,745
1.9× median
SUP-MCS-P3-26-AOA-US
OTHER 		Valve Aortic 20-23mm 0-40mm Corevalve 26mm Heart Porcine Pericardium Nitinol Fra… 4 $78,000.00 $78,000.00 $78,000.00 nat. median
$78,000
1.0× median
SUP-EVOLUTPRO-23-US
OTHER 		Valve Transcatheter Aortic 23 4 $78,000.00 $78,000.00 $78,000.00 nat. median
$41,745
1.9× median
SUP-MCS-P3-29-AOA-US
OTHER 		Valve Aortic Corevalve Porcine Pericardium 29 Mm Od23-26 Mm Odsec0-43 Mm Heart N… 4 $78,000.00 $78,000.00 $78,000.00 nat. median
$78,000
1.0× median
SUP-EVOLUTFX-26
OTHER 		Valve Aortic Evolut Fx 26 Mm 4 $78,000.00 $78,000.00 $78,000.00 nat. median
$41,745
1.9× median
SUP-EVOLUTFX-23
OTHER 		Valve Aortic Evolut Fx 23 Mm 4 $78,000.00 $78,000.00 $78,000.00 nat. median
$42,900
1.8× median
SUP-MCS-P3-31-AOA-US
OTHER 		Valve Aortic Corevalve Porcine Pericardium 31 Mm Od26-29 Mm Odsec0-43 Mm Heart N… 4 $78,000.00 $78,000.00 $78,000.00 nat. median
$41,745
1.9× median
SUP-EVOLUTFX-34
OTHER 		Valve Aortic Evolut Fx 34 Mm 4 $78,000.00 $78,000.00 $78,000.00 nat. median
$41,745
1.9× median
SUP-EVPROPLUS-23US
OTHER 		Valve Aortic Transcatheter Evolutr 23mm 4 $78,000.00 $78,000.00 $78,000.00 nat. median
$41,745
1.9× median
SUP-MCS-PC-26-AOA-US
OTHER 		Valve Aortic Corevalve Porcine Pericardium 26 Mm Od20-23 Mm Odsec0-40 Mm Heart N… 4 $78,000.00 $78,000.00 $78,000.00 nat. median
$78,000
1.0× median
212
OTHER 		Concomitant Aortic And Mitral Valve Procedures 2 $77,652.40 $92,667.80 $77,652.40 nat. median
$90,581
0.9× median
215
OTHER 		Other Heart Assist System Implant 2 $3,506.66 $75,521.70 $75,521.70 nat. median
$92,359
0.8× median
SUP-ATAA43120160A
OTHER 		Gore Excluder Thoracoabdominal Branch Endoprosthesis, 31 Mm 4 $75,400.00 $75,400.00 $75,400.00 nat. median
$51,040
1.5× median
SUP-ATAA43720160A
OTHER 		Gore Excluder Thoracoabdominal Branch Endoprosthesis, 37 Mm 4 $75,400.00 $75,400.00 $75,400.00 nat. median
$51,040
1.5× median
SUP-04.402.007S
OTHER 		Stem Radial Titanium Straight H26 Mm Od7 Mm Sterile 4 $74,144.20 $74,144.20 $74,144.20 nat. median
$74,144
1.0× median
SUP-CD3249-40/40QS
OTHER 		Icd Quadra Hf Crt-d System 4 $69,355.00 $69,355.00 $69,355.00 nat. median
$69,355
1.0× median
321
OTHER 		Percutaneous Cardiovascular Procedures With Intraluminal Device With McC Or 4+ A… 8 $3,506.66 $153,117.00 $68,843.70 nat. median
$26,529
outlier · 2.6×
RX-189782
OTHER 		Loncastuximab Tesirine-lpyl 10 Mg Intravenous Solution 8 $204.47 $81,069.80 $68,800.55 nat. median
$68,801
1.0× median
216
OTHER 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 $68,793.70 $170,737.00 $68,793.70 nat. median
$90,130
0.8× median
820
OTHER 		Lymphoma And Leukemia With Major O.r. Procedures With McC 4 $41,501.90 $75,520.60 $66,591.10 nat. median
$45,878
1.5× median
326
OTHER 		Stomach, Esophageal And Duodenal Procedures With McC 8 $3,506.66 $77,472.60 $64,808.00 nat. median
$45,545
1.4× median
SUP-106
OTHER 		Aspire Generator 4 $57,433.70 $68,548.50 $62,991.10 nat. median
$4
outlier · 16933.1×
SUP-CLARIAMRIQDCRTMMQM
OTHER 		Crtd Claria MRI Quad System 4 $61,360.00 $61,360.00 $61,360.00 nat. median
$32,787
1.9× median
329
OTHER 		Major Small And Large Bowel Procedures With McC 8 $3,506.66 $65,660.10 $60,637.60 nat. median
$42,757
1.4× median
323
OTHER 		Coronary Intravascular Lithotripsy With Intraluminal Device With McC 8 $3,506.66 $72,347.00 $60,489.20 nat. median
$31,081
1.9× median
231
OTHER 		Coronary Bypass With Ptca With McC 2 $60,403.40 $147,983.00 $60,403.40 nat. median
$74,989
0.8× median
SUP-MAXIICRTDMMMM
OTHER 		Defibrillator Cardiac Maximo Ii Crt 4 $58,931.60 $58,931.60 $58,931.60 nat. median
$58,932
1.0× median
PX-481936560
OTHER 		Hc Ep Compre Ep Eval Abltj Atr Fib Pulm Vein Isolation 8 $22,985.20 $71,032.61 $58,703.20 nat. median
$58,703
1.0× median

Other procedures at this hospital

Browse this hospital's 34,598 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
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
             
SUP-83234 OTHER Generator Neurostimulator Remede Pulse 7 7 $550,000.00 $550,000.00 $119,701.33 $511,500.00 $407,000.00 2026-05-09
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 6 2 $141,371.00 $141,371.00 $141,371.00 $152,767.00 $152,767.00 2026-05-22
RX-104852 OTHER Sipuleucel-t In Lactated Ringers 50 Million Cell/250 Ml IV Suspension 17 8 $147,787.00 $147,787.00 $46,689.07 $174,661.44 $147,787.00 2026-05-22
277 OTHER Cardiac Defibrillator Implant Without McC 14 6 $64,333.50 $64,333.50 $33,163.60 $138,440.00 $138,440.00 2026-05-22
RX-184131 OTHER Givosiran 189 Mg/ml Subcutaneous Solution 17 8 $127,848.00 $127,848.00 $110.56 $127,848.00 $122,464.26 2026-05-22
SUP-CS-1000 OTHER Chondrocytes Autologous 10 4 $119,118.00 $119,118.00 $119,118.00 $119,118.00 $119,118.00 2026-05-22
RX-194930 OTHER Tremelimumab-actl 20 Mg/ml Intravenous Solution 17 8 $119,340.00 $119,340.00 $133.17 $119,340.00 $115,469.73 2026-05-22
233 OTHER Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC 6 2 $77,839.80 $77,839.80 $77,839.80 $106,773.00 $106,773.00 2026-05-22
PX-481332740 OTHER Hc Tcat Insj/Rpl Perm Ldls Pm 7 7 $139,240.00 $139,240.00 $52,345.85 $129,493.20 $103,037.60 2026-05-09
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 6 2 $139,294.00 $139,294.00 $100,721.00 $139,294.00 $100,721.00 2026-05-22
870 OTHER Septicemia Or Severe Sepsis With Mv >96 Hours 17 8 $96,056.70 $96,056.70 $3,506.66 $124,750.00 $96,056.70 2026-05-22
SUP-4960-3-000 OTHER Assembly Lengthening 10 4 $95,754.90 $95,754.90 $95,754.90 $95,754.90 $95,754.90 2026-05-22
207 OTHER Respiratory System Diagnosis With Ventilator Support >96 Hours 21 8 $72,789.70 $72,789.70 $3,506.66 $123,374.00 $91,854.30 2026-05-22
RX-201599 OTHER Ocrelizumab 920 Mg-hyaluronidase-ocsq 23,000 Unit/23 Ml Subcut Soln 7 7 $123,846.00 $123,846.00 $125.14 $115,176.78 $91,646.04 2026-05-09
276 OTHER Cardiac Defibrillator Implant With McC Or Carotid Sinus Neurostimulator 21 8 $70,940.30 $70,940.30 $3,506.66 $157,047.00 $87,967.20 2026-05-22
SUP-EVFXPLUS-26 OTHER Evolut Fx+ 26mm Valve 10 4 $83,200.00 $83,200.00 $83,200.00 $83,200.00 $83,200.00 2026-05-22
SUP-EVFXPLUS-23 OTHER Evolut Fx+ 23mm Valve 10 4 $83,200.00 $83,200.00 $83,200.00 $83,200.00 $83,200.00 2026-05-22
SUP-EVFXPLUS-29 OTHER Evolut Fx+ 29mm Valve 10 4 $83,200.00 $83,200.00 $83,200.00 $83,200.00 $83,200.00 2026-05-22
SUP-EVFXPLUS-34 OTHER Evolut Fx+ 34mm Valve 10 4 $83,200.00 $83,200.00 $83,200.00 $83,200.00 $83,200.00 2026-05-22
PX-361332490 OTHER Hc Cc Acid Insertion Single Or Dual 17 8 $78,364.90 $78,364.90 $11,789.80 $85,302.82 $78,364.90 2026-05-22
PX-361332640 OTHER Hc Cc Aicd Battery Change Multi Lead 17 8 $78,364.90 $78,364.90 $7,587.55 $85,302.82 $78,364.90 2026-05-22
SUP-MCS-P3-26-AOA-US OTHER Valve Aortic 20-23mm 0-40mm Corevalve 26mm Heart Porcine Pericardium Nitinol Fra… 10 4 $78,000.00 $78,000.00 $78,000.00 $78,000.00 $78,000.00 2026-05-22
SUP-EVOLUTFX-23 OTHER Valve Aortic Evolut Fx 23 Mm 10 4 $78,000.00 $78,000.00 $78,000.00 $78,000.00 $78,000.00 2026-05-22
SUP-EVPROPLUS-23US OTHER Valve Aortic Transcatheter Evolutr 23mm 10 4 $78,000.00 $78,000.00 $78,000.00 $78,000.00 $78,000.00 2026-05-22
SUP-MCS-PC-26-AOA-US OTHER Valve Aortic Corevalve Porcine Pericardium 26 Mm Od20-23 Mm Odsec0-40 Mm Heart N… 10 4 $78,000.00 $78,000.00 $78,000.00 $78,000.00 $78,000.00 2026-05-22
SUP-EVOLUTFX-26 OTHER Valve Aortic Evolut Fx 26 Mm 10 4 $78,000.00 $78,000.00 $78,000.00 $78,000.00 $78,000.00 2026-05-22
SUP-MCS-P3-31-AOA-US OTHER Valve Aortic Corevalve Porcine Pericardium 31 Mm Od26-29 Mm Odsec0-43 Mm Heart N… 10 4 $78,000.00 $78,000.00 $78,000.00 $78,000.00 $78,000.00 2026-05-22
SUP-EVOLUTPRO-29-US OTHER Valve Transcatheter Aortic 29 10 4 $78,000.00 $78,000.00 $78,000.00 $78,000.00 $78,000.00 2026-05-22
SUP-EVOLUTPRO-23-US OTHER Valve Transcatheter Aortic 23 10 4 $78,000.00 $78,000.00 $78,000.00 $78,000.00 $78,000.00 2026-05-22
SUP-EVOLUTFX-34 OTHER Valve Aortic Evolut Fx 34 Mm 10 4 $78,000.00 $78,000.00 $78,000.00 $78,000.00 $78,000.00 2026-05-22
SUP-MCS-P3-29-AOA-US OTHER Valve Aortic Corevalve Porcine Pericardium 29 Mm Od23-26 Mm Odsec0-43 Mm Heart N… 10 4 $78,000.00 $78,000.00 $78,000.00 $78,000.00 $78,000.00 2026-05-22
SUP-EVOLUTFX-29 OTHER Valve Aortic Evolut Fx 29 Mm 10 4 $78,000.00 $78,000.00 $78,000.00 $78,000.00 $78,000.00 2026-05-22
212 OTHER Concomitant Aortic And Mitral Valve Procedures 6 2 $92,667.80 $92,667.80 $77,652.40 $92,667.80 $77,652.40 2026-05-22
215 OTHER Other Heart Assist System Implant 6 2 $85,257.70 $85,257.70 $3,506.66 $75,521.70 $75,521.70 2026-05-22
SUP-ATAA43720160A OTHER Gore Excluder Thoracoabdominal Branch Endoprosthesis, 37 Mm 10 4 $75,400.00 $75,400.00 $75,400.00 $75,400.00 $75,400.00 2026-05-22
SUP-ATAA43120160A OTHER Gore Excluder Thoracoabdominal Branch Endoprosthesis, 31 Mm 10 4 $75,400.00 $75,400.00 $75,400.00 $75,400.00 $75,400.00 2026-05-22
SUP-04.402.007S OTHER Stem Radial Titanium Straight H26 Mm Od7 Mm Sterile 10 4 $74,144.20 $74,144.20 $74,144.20 $74,144.20 $74,144.20 2026-05-22
SUP-CD3249-40/40QS OTHER Icd Quadra Hf Crt-d System 10 4 $69,355.00 $69,355.00 $69,355.00 $69,355.00 $69,355.00 2026-05-22
321 OTHER Percutaneous Cardiovascular Procedures With Intraluminal Device With McC Or 4+ A… 21 8 $69,955.40 $69,955.40 $3,506.66 $153,117.00 $68,843.70 2026-05-22
RX-189782 OTHER Loncastuximab Tesirine-lpyl 10 Mg Intravenous Solution 19 8 $81,069.80 $81,069.80 $204.47 $81,069.80 $68,800.55 2026-05-22
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 6 2 $170,737.00 $170,737.00 $68,793.70 $170,737.00 $68,793.70 2026-05-22
820 OTHER Lymphoma And Leukemia With Major O.r. Procedures With McC 10 4 $66,591.10 $66,591.10 $41,501.90 $75,520.60 $66,591.10 2026-05-22
326 OTHER Stomach, Esophageal And Duodenal Procedures With McC 17 8 $77,472.60 $77,472.60 $3,506.66 $77,472.60 $64,808.00 2026-05-22
SUP-106 OTHER Aspire Generator 20 4 $62,991.10 $62,991.10 $57,433.70 $68,548.50 $62,991.10 2026-05-22
SUP-CLARIAMRIQDCRTMMQM OTHER Crtd Claria MRI Quad System 10 4 $61,360.00 $61,360.00 $61,360.00 $61,360.00 $61,360.00 2026-05-22
329 OTHER Major Small And Large Bowel Procedures With McC 21 8 $63,622.90 $63,622.90 $3,506.66 $65,660.10 $60,637.60 2026-05-22
323 OTHER Coronary Intravascular Lithotripsy With Intraluminal Device With McC 17 8 $70,015.00 $70,015.00 $3,506.66 $72,347.00 $60,489.20 2026-05-22
231 OTHER Coronary Bypass With Ptca With McC 6 2 $147,983.00 $147,983.00 $60,403.40 $147,983.00 $60,403.40 2026-05-22
SUP-MAXIICRTDMMMM OTHER Defibrillator Cardiac Maximo Ii Crt 10 4 $58,931.60 $58,931.60 $58,931.60 $58,931.60 $58,931.60 2026-05-22
PX-481936540 OTHER Hc Ep Compre Ep Eval Abltj 3d Mapg Tx Vt 17 8 $58,703.20 $58,703.20 $22,985.20 $71,032.61 $58,703.20 2026-05-22
PX-481936560 OTHER Hc Ep Compre Ep Eval Abltj Atr Fib Pulm Vein Isolation 17 8 $58,703.20 $58,703.20 $22,985.20 $71,032.61 $58,703.20 2026-05-22
PX-481936530 OTHER Hc Ep Compre Ep Eval Abltj 3d Mapg Tx Svt 17 8 $58,703.20 $58,703.20 $22,985.20 $71,032.61 $58,703.20 2026-05-22
RX-175187 OTHER Ocrelizumab 30 Mg/ml Intravenous Solution 17 8 $59,143.20 $59,143.20 $56.32 $59,143.20 $57,588.30 2026-05-22
SUP-104 OTHER Generator Neurostimulator Vns Therapy .2in 1.8x1.6x.27in Tecothane Ss Titanium S… 10 4 $57,525.00 $57,525.00 $57,525.00 $57,525.00 $57,525.00 2026-05-22
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC 6 2 $114,306.00 $114,306.00 $57,460.00 $114,306.00 $57,460.00 2026-05-22
SUP-10-0011-2101 OTHER Generator Aspiresr Single Pin 10 4 $57,433.70 $57,433.70 $57,433.70 $57,433.70 $57,433.70 2026-05-22
456 OTHER Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 6 2 $170,253.00 $170,253.00 $57,100.00 $170,253.00 $57,100.00 2026-05-22
574 OTHER Skin Graft For Skin Ulcer Or Cellulitis With Cc 14 6 $59,078.20 $59,078.20 $24,698.40 $59,078.20 $57,097.50 2026-05-22
273 OTHER Percutaneous And Other Intracardiac Procedures With McC 21 8 $52,375.30 $52,375.30 $3,506.66 $122,538.00 $56,992.60 2026-05-22
PX-361332630 OTHER Hc Cc Aicd Battery Change Dual Lead 17 8 $56,146.60 $56,146.60 $7,587.55 $60,449.46 $56,146.60 2026-05-22
PX-361332620 OTHER Hc Cc Aicd Battery Change Single Lead 17 8 $56,146.60 $56,146.60 $7,587.55 $60,449.46 $56,146.60 2026-05-22
SUP-222ETPENSY33 OTHER Eterna 16-channel Ipg Penta System 10 4 $55,900.00 $55,900.00 $55,900.00 $55,900.00 $55,900.00 2026-05-22
219 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 6 2 $78,363.10 $78,363.10 $55,153.90 $78,363.10 $55,153.90 2026-05-22
SUP-103 OTHER Generator Neurostimulator Vns Therapy .126in 1.8x1.3x.27in Tecothane Ss Titanium… 10 4 $55,142.80 $55,142.80 $55,142.80 $55,142.80 $55,142.80 2026-05-22
RX-195188 OTHER Mosunetuzumab-axgb 1 Mg/ml Intravenous Solution 17 8 $55,081.30 $55,081.30 $615.80 $55,081.30 $55,081.30 2026-05-22
SUP-SPINALSTIMCAP OTHER Spinal Stimulator Cap Pricing 10 4 $54,600.00 $54,600.00 $54,600.00 $54,600.00 $54,600.00 2026-05-22
275 OTHER Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 13 8 $132,692.00 $132,692.00 $3,506.66 $123,403.56 $54,145.30 2026-05-22
616 OTHER Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 17 8 $68,091.40 $68,091.40 $3,506.66 $68,091.40 $53,463.40 2026-05-22
957 OTHER Other O.r. Procedures For Multiple Significant Trauma With Mcc 13 8 $67,510.40 $67,510.40 $3,506.66 $105,999.00 $53,205.60 2026-05-22
495 OTHER Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 10 4 $80,903.30 $80,903.30 $25,094.80 $80,903.30 $52,751.90 2026-05-22
SUP-A701128 OTHER Catheter Ablation Flexability 1-4-1 Mm Space F-j Curve L115 Cm L4 Mm Od8 Fr 4 Ho… 10 4 $52,036.40 $52,036.40 $52,036.40 $52,036.40 $52,036.40 2026-05-22
SUP-DVEA3E4 OTHER Icd-vr Dvea3e4 Ev Icd Ev4 10 4 $52,000.00 $52,000.00 $52,000.00 $52,000.00 $52,000.00 2026-05-22
RX-182753 OTHER Polatuzumab Vedotin-piiq 140 Mg Intravenous Solution 17 8 $54,208.00 $54,208.00 $128.52 $54,208.00 $51,925.81 2026-05-22
SUP-TGM262610 OTHER Graft Stent Tag L10 Cm Od26 Mm Thoracic Active Control Conformable 10 4 $51,329.20 $51,329.20 $51,329.20 $51,329.20 $51,329.20 2026-05-22
SUP-TGM212110 OTHER Graft Stent Tag L10 Cm Od21 Mm Thoracic Active Control Conformable 10 4 $51,329.20 $51,329.20 $51,329.20 $51,329.20 $51,329.20 2026-05-22
SUP-TGMR313110 OTHER Graft Stent Tag L10 Cm Od31 Mm Thoracic Active Control Conformable 10 4 $51,329.20 $51,329.20 $51,329.20 $51,329.20 $51,329.20 2026-05-22
SUP-TGM282810 OTHER Graft Stent Tag L10 Cm Od28 Mm Thoracic Active Control Conformable 10 4 $51,329.20 $51,329.20 $51,329.20 $51,329.20 $51,329.20 2026-05-22
SUP-TGM262110 OTHER Graft Stent Tag L10 Cm Od21-26 Mm Thoracic Active Control Conformable 10 4 $51,329.20 $51,329.20 $51,329.20 $51,329.20 $51,329.20 2026-05-22
SUP-TGMR312610 OTHER Graft Stent Tag L10 Cm Od26-31 Mm Thoracic Active Control Conformable 10 4 $51,329.20 $51,329.20 $51,329.20 $51,329.20 $51,329.20 2026-05-22
SUP-BOM25EDGE15ISLEEVE OTHER Valve Aortic Lotus Edge Od 25mm Transcatheter 15 French Isleeve Expandable Intro… 10 4 $51,300.00 $51,300.00 $51,300.00 $51,300.00 $51,300.00 2026-05-22
SUP-BOM23EDGE15ISLEEVE OTHER Valve Aortic Lotus Edge Od 23mm Transcatheter 15 French Isleeve Expandable Intro… 10 4 $51,300.00 $51,300.00 $51,300.00 $51,300.00 $51,300.00 2026-05-22
SUP-S3UCM220A OTHER Valve Aortic Sapien 3 Commander Edwards Od 20 Mm Transcatheter Ultra Low Profile 10 4 $51,300.00 $51,300.00 $51,300.00 $51,300.00 $51,300.00 2026-05-22
SUP-H749LVSUS270 OTHER Valve Aortic Lotus Edge Od 27mm Transcatheter Premount Sterile Latex Free 10 4 $51,300.00 $51,300.00 $51,300.00 $51,300.00 $51,300.00 2026-05-22
SUP-BOM27EDGE15ISLEEVE OTHER Valve Aortic Lotus Edge Od 27mm Transcatheter 15 French Isleeve Expandable Intro… 10 4 $51,300.00 $51,300.00 $51,300.00 $51,300.00 $51,300.00 2026-05-22
SUP-S3UCM226A OTHER Valve Aortic Sapien 3 Commander Edwards Od 26 Mm Transcatheter Ultra Low Profile 10 4 $51,300.00 $51,300.00 $51,300.00 $51,300.00 $51,300.00 2026-05-22
SUP-9750CM23A OTHER System Delivery Sapien 3 Od23 Mm Commander Delivery System Sterile Latex Free 10 4 $51,300.00 $51,300.00 $51,300.00 $51,300.00 $51,300.00 2026-05-22
SUP-S3UCM223A OTHER Valve Aortic Sapien 3 Commander Edwards Od 23 Mm Transcatheter Ultra Low Profile 10 4 $51,300.00 $51,300.00 $51,300.00 $51,300.00 $51,300.00 2026-05-22
SUP-9750CM26A OTHER System Delivery Sapien 3 Od26 Mm Commander Delivery System Sterile Latex Free 10 4 $51,300.00 $51,300.00 $51,300.00 $51,300.00 $51,300.00 2026-05-22
SUP-H749LVSUS250 OTHER Valve Aortic Lotus Edge Od 25mm Transcatheter Premount Sterile Latex Free 10 4 $51,300.00 $51,300.00 $51,300.00 $51,300.00 $51,300.00 2026-05-22
SUP-H749LVSUS230 OTHER Valve Aortic Lotus Edge Od 23mm Transcatheter Premount Sterile Latex Free 10 4 $51,300.00 $51,300.00 $51,300.00 $51,300.00 $51,300.00 2026-05-22
SUP-9600CM29A OTHER Valve Aortic Edwards Sapien 3 Commander Od 29mm Delivery System 10 4 $51,300.00 $51,300.00 $51,300.00 $51,300.00 $51,300.00 2026-05-22
SUP-9750CM20A OTHER System Delivery Sapien 3 Od20 Mm Commander Delivery System Sterile Latex Free 10 4 $51,300.00 $51,300.00 $51,300.00 $51,300.00 $51,300.00 2026-05-22
SUP-VAMF3838C200TU OTHER Graft Stent Valiant Captivia Nitinol Platinum Iridium Hydrophilic Sinusoidal Str… 10 4 $50,687.00 $50,687.00 $50,687.00 $50,687.00 $50,687.00 2026-05-22
260 OTHER Cardiac Pacemaker Revision Except Device Replacement With McC 17 8 $62,416.30 $62,416.30 $3,506.66 $71,516.07 $49,687.10 2026-05-22
SUP-PROTECTADRMMEM OTHER Icd Protecta Dr System 10 4 $49,641.80 $49,641.80 $49,641.80 $49,641.80 $49,641.80 2026-05-22
SUP-EVPROPLUS-26US OTHER 26mm Evolut Pro+ Tavr Valve 10 4 $48,800.00 $48,800.00 $48,800.00 $48,800.00 $48,800.00 2026-05-22
SUP-EVOLUTPRO-26-US OTHER Valve Transcather Aortic 26 10 4 $48,800.00 $48,800.00 $48,800.00 $48,800.00 $48,800.00 2026-05-22
SUP-EVPROPLUS-34US OTHER Evolut Pro+ Tavr Valve 34mm 10 4 $48,800.00 $48,800.00 $48,800.00 $48,800.00 $48,800.00 2026-05-22
SUP-EVOLUTR-29-US OTHER Valve Aortic Corevalve Evolut R Porcine Pericardium 29 Mm Od23-26 Mm 1 Layer Sel… 10 4 $48,800.00 $48,800.00 $48,800.00 $48,800.00 $48,800.00 2026-05-22
SUP-EVOLUTR-26-US OTHER Valve Aortic Transcatheter Evolutr 26mm 10 4 $48,800.00 $48,800.00 $48,800.00 $48,800.00 $48,800.00 2026-05-22
SUP-EVPROPLUS-29US OTHER Evolut Pro+ Tavr Valve 29mm 10 4 $48,800.00 $48,800.00 $48,800.00 $48,800.00 $48,800.00 2026-05-22
SUP-EVOLUTR-23-US OTHER Valve Aortic Transcatheter Evolutr 23mm 10 4 $48,800.00 $48,800.00 $48,800.00 $48,800.00 $48,800.00 2026-05-22
SUP-EVOLUTR-34-US OTHER Valve Aortic Transcatheter Evolutr 34mm 10 4 $48,800.00 $48,800.00 $48,800.00 $48,800.00 $48,800.00 2026-05-22
SUP-CD3265-40QS OTHER Icd Biv Quadra Assura Crt-d Df4 Connector System 10 4 $48,774.00 $48,774.00 $48,774.00 $48,774.00 $48,774.00 2026-05-22
SUP-CD3265-40S OTHER Defibrillator Cardiac Quadra Assura Crt-d Titanium Thk14 Mm 40 J W41 Mm X H83 Mm… 10 4 $48,774.00 $48,774.00 $48,774.00 $48,774.00 $48,774.00 2026-05-22
955 OTHER Craniotomy For Multiple Significant Trauma 6 2 $75,465.60 $75,465.60 $48,673.30 $75,465.60 $48,673.30 2026-05-22
SUP-MAXIIDRMMEM OTHER Defibrillator Cardiac Maximo Ii Vr System Icd 10 4 $48,404.20 $48,404.20 $48,404.20 $48,404.20 $48,404.20 2026-05-22
SUP-VAMF4040C150TU OTHER Graft Stent Valiant Straight Sinusoidal 150mm 40mm 40mm Endovascular System Free… 10 4 $48,087.00 $48,087.00 $48,087.00 $48,087.00 $48,087.00 2026-05-22
SUP-VAMF3838C150TU OTHER Graft Thoracic Medtronic Valiant 10 4 $48,087.00 $48,087.00 $48,087.00 $48,087.00 $48,087.00 2026-05-22
274 OTHER Percutaneous And Other Intracardiac Procedures Without McC 21 8 $49,208.50 $49,208.50 $3,506.66 $123,657.00 $47,711.60 2026-05-22
474 OTHER Amputation For Musculoskeletal System And Connective Tissue Disorders With McC 17 8 $47,632.90 $47,632.90 $3,506.66 $63,687.40 $47,632.90 2026-05-22
268 OTHER Aortic And Heart Assist Procedures Except Pulsation Balloon With McC 6 2 $52,588.80 $52,588.80 $3,506.66 $47,527.70 $47,527.70 2026-05-22
SUP-VAMF2626C150TU OTHER Graft Endovascular Valiant Stent 26mm P/d 150mm Straight Proximal Freeflo C Dist… 6 2 $47,510.00 $47,510.00 $47,510.00 $47,510.00 $47,510.00 2026-05-22
SUP-VAMF2424C150TU OTHER Graft Endovascular Valiant Stent 24mm P/d 150mm Straight Proximal Freeflo C Dist… 6 2 $47,510.00 $47,510.00 $47,510.00 $47,510.00 $47,510.00 2026-05-22
SUP-VAMF2828C150TU OTHER Graft Endovascular Valiant Stent 28mm P/d 150mm Straight Proximal Freeflo C Dist… 6 2 $47,510.00 $47,510.00 $47,510.00 $47,510.00 $47,510.00 2026-05-22
SUP-VAMF3030C150TU OTHER Graft Endovascular Valiant Stent 30mm P/d 150mm Straight Proximal Freeflo C Dist… 6 2 $47,510.00 $47,510.00 $47,510.00 $47,510.00 $47,510.00 2026-05-22
SUP-VAMF2222C150TU OTHER Graft Endovascular Valiant Stent 22mm P/d 150mm Straight Proximal Freeflo C Dist… 6 2 $47,510.00 $47,510.00 $47,510.00 $47,510.00 $47,510.00 2026-05-22
SUP-VAMF3232C150TU OTHER Graft Endovascular Valiant Stent 32mm P/d 150mm Straight Proximal Freeflo C Dist… 6 2 $47,510.00 $47,510.00 $47,510.00 $47,510.00 $47,510.00 2026-05-22
SUP-VAMF3636C150TU OTHER Graft Endovascular Valiant Stent 36mm P/d 150mm Straight Proximal Freeflo C Dist… 6 2 $47,510.00 $47,510.00 $47,510.00 $47,510.00 $47,510.00 2026-05-22
SUP-24208-416-01 OTHER Implant Ophthalmic Retisert Fluocinolone Acetonide 3 Mm X 2 Mm X 5 Mm .59 Mg Pos… 10 4 $47,450.00 $47,450.00 $47,450.00 $47,450.00 $47,450.00 2026-05-22
SUP-AB41601 OTHER Implant Orbital Retisert .59 Mg Intravitreal Eye 10 4 $47,450.00 $47,450.00 $47,450.00 $47,450.00 $47,450.00 2026-05-22
242 OTHER Permanent Cardiac Pacemaker Implant With McC 17 8 $57,216.70 $57,216.70 $3,506.66 $57,216.70 $47,043.02 2026-05-22
SUP-SC-1200 OTHER Generator Neurostimulator Precision Montage 16 Contact MRI 10 4 $46,800.00 $46,800.00 $46,800.00 $46,800.00 $46,800.00 2026-05-22
420 OTHER Hepatobiliary Diagnostic Procedures With McC 10 4 $46,959.50 $46,959.50 $25,158.20 $46,959.50 $46,315.60 2026-05-22
SUP-PROTECTAVREMEM OTHER Icd Protecta Vr System 10 4 $46,225.40 $46,225.40 $46,225.40 $46,225.40 $46,225.40 2026-05-22
SUP-D224VRC S OTHER Defibrillator Cardiac Secura Vr 10 4 $46,225.40 $46,225.40 $46,225.40 $46,225.40 $46,225.40 2026-05-22
SUP-VAMFC4036C150TU OTHER Graft Stent Valiant Captivia Nitinol Platinum Iridium Hydrophilic Sinusoidal Tap… 10 4 $46,137.00 $46,137.00 $46,137.00 $46,137.00 $46,137.00 2026-05-22
217 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 6 2 $72,855.40 $72,855.40 $46,032.10 $72,855.40 $46,032.10 2026-05-22
SUP-TGU282810 OTHER Graft Thoracic Endoprosthesis 28x28x10 10 4 $45,497.40 $45,497.40 $45,497.40 $45,497.40 $45,497.40 2026-05-22
SUP-TGU313110 OTHER Graft Thoracic Endoprosthesis 31x31x10 10 4 $45,497.40 $45,497.40 $45,497.40 $45,497.40 $45,497.40 2026-05-22
SUP-TGU343415 OTHER Graft Thoracic Endoprosthesis 34x34x15 10 4 $45,497.40 $45,497.40 $45,497.40 $45,497.40 $45,497.40 2026-05-22
SUP-TGU312610 OTHER Graft Thoracic Endoprosthesis 31x26x10 10 4 $45,497.40 $45,497.40 $45,497.40 $45,497.40 $45,497.40 2026-05-22
SUP-TGU262110 OTHER Graft Thoracic Endoprosthesis 26x21x10 10 4 $45,497.40 $45,497.40 $45,497.40 $45,497.40 $45,497.40 2026-05-22
SUP-TGU212110 OTHER Graft Thoracic Endoprosthesis 21x10 10 4 $45,497.40 $45,497.40 $45,497.40 $45,497.40 $45,497.40 2026-05-22
SUP-TGU262610 OTHER Graft Thoracic Endoprosthesis 26x26x10 10 4 $45,497.40 $45,497.40 $45,497.40 $45,497.40 $45,497.40 2026-05-22
324 OTHER Coronary Intravascular Lithotripsy With Intraluminal Device Without McC 17 8 $113,092.00 $113,092.00 $3,506.66 $113,092.00 $45,375.40 2026-05-22
969 OTHER HIV With Extensive O.r. Procedures With McC 6 2 $142,602.00 $142,602.00 $45,080.50 $142,602.00 $45,080.50 2026-05-22
RX-200547 OTHER Tarlatamab-dlle 10 Mg Intravenous Solution 17 8 $45,000.00 $45,000.00 $4,167.12 $45,000.00 $45,000.00 2026-05-22
SUP-SC-1232 OTHER Neurostimulator Implantable Wavewriter Alpha Implantable Pulse 32 Contact Imager… 10 4 $44,980.00 $44,980.00 $44,980.00 $44,980.00 $44,980.00 2026-05-22
SUP-D224TRKD OTHER Defibrillator Maximo Ii Crtd 10 4 $44,631.60 $44,631.60 $44,631.60 $44,631.60 $44,631.60 2026-05-22
040 OTHER Peripheral, Cranial Nerve And Other Nervous System Procedures With McC 21 8 $50,438.90 $50,438.90 $3,506.66 $56,501.87 $44,564.30 2026-05-22
SUP-3789-SCCAP OTHER Generator Spinal Cord Stim Protege 10 4 $44,200.00 $44,200.00 $44,200.00 $44,200.00 $44,200.00 2026-05-22
SUP-M635WU60270 OTHER Device Closure Watchman Flx Pro L 27mm Left Atrial Appendage Sterile Latex Free … 10 4 $44,200.00 $44,200.00 $44,200.00 $44,200.00 $44,200.00 2026-05-22
SUP-M635WU60240 OTHER Device Closure Watchman Flx Pro L 24 Mm Left Atrial Appendage Sterile Latex Free… 10 4 $44,200.00 $44,200.00 $44,200.00 $44,200.00 $44,200.00 2026-05-22
SUP-M635WU60200 OTHER Device Closure Watchman Flx Pro L 20 Mm Left Atrial Appendage Sterile Latex Free… 10 4 $44,200.00 $44,200.00 $44,200.00 $44,200.00 $44,200.00 2026-05-22
SUP-3788-SCSCAP OTHER Generator Spinal Cord Stimulator Eon Mini 10 4 $44,200.00 $44,200.00 $44,200.00 $44,200.00 $44,200.00 2026-05-22
SUP-M635WU60350 OTHER Device Closure Watchman Flx Pro L 35mm Left Atrial Appendage Sterile Latex Free … 10 4 $44,200.00 $44,200.00 $44,200.00 $44,200.00 $44,200.00 2026-05-22
SUP-M635WU60310 OTHER Device Closure Watchman Flx Pro L 31 Mm Left Atrial Appendage Sterile Latex Free… 10 4 $44,200.00 $44,200.00 $44,200.00 $44,200.00 $44,200.00 2026-05-22
SUP-M635WU60400 OTHER Device Closure Watchman Flx Pro L 40 Mm Left Atrial Appendage Sterile Latex Free… 10 4 $44,200.00 $44,200.00 $44,200.00 $44,200.00 $44,200.00 2026-05-22
673 OTHER Other Kidney And Urinary Tract Procedures With McC 19 8 $52,965.20 $52,965.20 $3,506.66 $52,965.20 $43,870.70 2026-05-22
SUP-00813502011876 OTHER Impella Cp With Smartassist 10 4 $43,800.00 $43,800.00 $43,800.00 $43,800.00 $43,800.00 2026-05-22
SUP-9B11 OTHER Defibrillator Sq Emblem A219 S-icd Pulse Generator System Includes Electrode 10 4 $43,740.00 $43,740.00 $43,740.00 $43,740.00 $43,740.00 2026-05-22
SUP-8XV1/2 OTHER System Crtd Vigilant MRI X4 Df1 10 4 $43,598.00 $43,598.00 $43,598.00 $43,598.00 $43,598.00 2026-05-22
232 OTHER Coronary Bypass With Ptca Without McC 6 2 $73,736.10 $73,736.10 $43,543.50 $73,736.10 $43,543.50 2026-05-22
028 OTHER Spinal Procedures With McC 6 2 $28,081.10 $28,081.10 $28,081.10 $43,335.40 $43,335.40 2026-05-22
RX-192534 OTHER Nivolumab 240 Mg-relatlimab-rmbw 80 Mg/20 Ml Intravenous Solution 17 8 $44,469.30 $44,469.30 $186.46 $44,469.30 $43,027.29 2026-05-22
PX-361C97741 OTHER Hc Ivl+Atherectomy With Angioplasty 17 8 $42,944.00 $42,944.00 $13,832.26 $49,818.32 $42,944.00 2026-05-22
PX-361C97671 OTHER Hc Ivl+Stent+Atherectomy With Angioplasty 17 8 $42,944.00 $42,944.00 $13,832.26 $49,818.32 $42,944.00 2026-05-22
PX-361C97731 OTHER Hc Ivl+Stent With Angioplasty 17 8 $42,944.00 $42,944.00 $13,832.26 $49,818.32 $42,944.00 2026-05-22
PX-361C97751 OTHER Hc Ivl+Stent+Atherectomy With Angioplasty 17 8 $42,944.00 $42,944.00 $13,832.26 $49,818.32 $42,944.00 2026-05-22
PX-361C97661 OTHER Hc Ivl+Atherectomy With Angioplasty 17 8 $42,944.00 $42,944.00 $13,832.26 $49,818.32 $42,944.00 2026-05-22
PX-361C97651 OTHER Hc Ivl+Stent With Angioplasty 17 8 $42,944.00 $42,944.00 $7,587.55 $49,818.32 $42,944.00 2026-05-22
SUP-W5-5-3 OTHER Device Embolization Web Sl H3 Mm Od5 Mm 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
SUP-W5-4-3 OTHER Device Embolization Web Sl H3 Mm Od4 Mm 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
SUP-W5-6-2 OTHER Device Embolization Web Sl H3 Mm Od6 Mm Sterile Latex Free Disposable 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
SUP-W5-6-S OTHER Device Embolization Web Sphere H4.6 Mm Od6 Mm 1 Layer Via 17 Catheter 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
SUP-W5-4-2 OTHER Device Embolization Web Sl H2 Mm Od4 Mm 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
SUP-W5-4.5-3 OTHER Device Embolization Web Sl H3 Mm Od4.5 Mm Via 17 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
SUP-W5-6-3 OTHER Device Embolization Web Sl H3 Mm Od6 Mm 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
SUP-W5-6-4 OTHER Device Embolization Web Sl H4 Mm Od6 Mm 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
SUP-W5-5-S OTHER Device Embolization Web Sphere H3.6 Mm Od5 Mm 1 Layer Via 17 Catheter 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
SUP-W5-4-S OTHER Device Embolization Web Sphere H2.6 Mm Od4 Mm 1 Layer Via 17 Catheter 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
SUP-W5-4.5-2 OTHER Device Embolization Web Sl H2 Mm Od5 Mm Via 17 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
SUP-W5-7-4 OTHER Device Embolization Web Sl H4 Mm Od7 Mm 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
SUP-W5-7-S OTHER Device Embolization Web Sphere H5.6 Mm Od7 Mm 1 Layer Via 17 Catheter 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
SUP-W5-7-2 OTHER System Embolization Web 17 Sl 7x2 H2 Mm Od 7 Mm Recommended Via 17 Sterile 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
SUP-W5-7-5 OTHER Device Embolization Web Sl H5 Mm Od7 Mm 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
SUP-W5-7-3 OTHER Device Embolization Web Sl H3 Mm Od7 Mm 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
SUP-W5-5-2 OTHER Device Embolization Web Sl H2 Mm Od5 Mm 10 4 $42,887.00 $42,887.00 $42,887.00 $42,887.00 $42,887.00 2026-05-22
570 OTHER Skin Debridement With McC 21 8 $33,521.20 $33,521.20 $3,506.66 $105,074.00 $42,753.70 2026-05-22
266 OTHER Endovascular Cardiac Valve Replacement And Supplement Procedures With McC 6 2 $77,160.40 $77,160.40 $42,703.10 $77,160.40 $42,703.10 2026-05-22
SUP-SC-1132 OTHER Generator Neurostimulator Precision Spectra Titanium Epoxy Silicone D10.8 Mm W46… 10 4 $42,627.00 $42,627.00 $42,627.00 $42,627.00 $42,627.00 2026-05-22
SUP-8DBC/D OTHER Crt-d Dynagen X4 Df4 System 10 4 $42,598.00 $42,598.00 $42,598.00 $42,598.00 $42,598.00 2026-05-22
SUP-PROECTACRTDMMM OTHER Crt Protecta Crt-d System 10 4 $42,466.00 $42,466.00 $42,466.00 $42,466.00 $42,466.00 2026-05-22
790 OTHER Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 6 2 $17,599.10 $17,599.10 $1,048.16 $42,379.40 $42,379.40 2026-05-22
SUP-VAMC3232C100TU OTHER Graft Stent Valiant Straight L100 Mm Od32 Mm Proximal Main Section Free Flow Cap… 10 4 $42,237.00 $42,237.00 $42,237.00 $42,237.00 $42,237.00 2026-05-22
SUP-COMPIAMRICRTDMMAM OTHER Pacemaker Compia Dtmc1d1 MRI System 10 4 $42,120.00 $42,120.00 $42,120.00 $42,120.00 $42,120.00 2026-05-22
SUP-8XM1/2 OTHER System Crtd Momentum X4 Df1 10 4 $42,050.00 $42,050.00 $42,050.00 $42,050.00 $42,050.00 2026-05-22
SUP-114USPH OTHER Device Embolization Surpass Streamline L50mm Od 4mm 10 4 $41,990.00 $41,990.00 $41,990.00 $41,990.00 $41,990.00 2026-05-22
SUP-122USPH OTHER Device Embolization Surpass Streamline L40mm Od 5mm 10 4 $41,990.00 $41,990.00 $41,990.00 $41,990.00 $41,990.00 2026-05-22
SUP-113USPH OTHER Device Embolization Surpass Streamline L40mm Od 4mm 10 4 $41,990.00 $41,990.00 $41,990.00 $41,990.00 $41,990.00 2026-05-22
SUP-123USPH OTHER Device Embolization Surpass Streamline L50mm Od 5mm 10 4 $41,990.00 $41,990.00 $41,990.00 $41,990.00 $41,990.00 2026-05-22
SUP-CD3265-40 OTHER Quadra Assura Crt-d 10 4 $41,974.50 $41,974.50 $41,974.50 $41,974.50 $41,974.50 2026-05-22
SUP-CD3265-40Q OTHER Defibrillator Cardiac Quadra Assura Tailoredtherapy Shockguard Decisiontx Thk14m… 10 4 $41,974.50 $41,974.50 $41,974.50 $41,974.50 $41,974.50 2026-05-22
235 OTHER Coronary Bypass Without Cardiac Catheterization With McC 6 2 $58,878.40 $58,878.40 $41,943.20 $58,878.40 $41,943.20 2026-05-22
PX-361371841 OTHER Hc Ir Thrombectomy Arterial Initial 17 8 $41,768.30 $41,768.30 $4,285.74 $49,818.32 $41,768.30 2026-05-22
PX-481C96021 OTHER Hc Cc Coronary Ather/ Stent Major Brnch-des 17 8 $41,768.30 $41,768.30 $1,812.98 $49,818.32 $41,768.30 2026-05-22
PX-481C96071 OTHER Hc Cc Coronary Pci In Cto Major - Des 17 8 $41,768.30 $41,768.30 $1,814.93 $49,818.32 $41,768.30 2026-05-22
RX-126167 OTHER Ustekinumab 45 Mg/0.5 Ml Subcutaneous Syringe 16 7 $41,764.30 $43,727.20 $10,870.58 $41,764.30 $41,764.30 2026-05-22
SUP-D334DRGD334DRM OTHER Icd Protecta Dr Device 10 4 $41,607.80 $41,607.80 $41,607.80 $41,607.80 $41,607.80 2026-05-22
SUP-11060A29 OTHER Conduit Valve Konect Resilia Od29 Mm Aortic 10 4 $41,600.00 $41,600.00 $41,600.00 $41,600.00 $41,600.00 2026-05-22
SUP-11060A25 OTHER Conduit Valve Konect Resilia Od25 Mm Aortic 10 4 $41,600.00 $41,600.00 $41,600.00 $41,600.00 $41,600.00 2026-05-22
SUP-11060A23 OTHER Valve Aortic Konect Resilia 23 Mm Aortic Valved Conduit Sterile Preassembled Ben… 10 4 $41,600.00 $41,600.00 $41,600.00 $41,600.00 $41,600.00 2026-05-22
SUP-11060A27 OTHER Valve Aortic Konect Resilia 27 Mm Aortic Valved Conduit Sterile Preassembled Ben… 10 4 $41,600.00 $41,600.00 $41,600.00 $41,600.00 $41,600.00 2026-05-22
SUP-11060A21 OTHER Conduit Valve Konect Resilia Od21 Mm Aortic 10 4 $41,600.00 $41,600.00 $41,600.00 $41,600.00 $41,600.00 2026-05-22
SUP-ZTA-P-28-109-W OTHER Graft Endovascular Zenith Alpha Flexor Captor Nitinol Polypropylene Polyester Fa… 10 4 $41,509.00 $41,509.00 $41,509.00 $41,509.00 $41,509.00 2026-05-22
SUP-MAXIIVREMEM OTHER Defibrillator Cardiac Maximo Ii Vr System Icd 10 4 $41,342.60 $41,342.60 $41,342.60 $41,342.60 $41,342.60 2026-05-22
SUP-3688 SCS EON OTHER Generator Neurostimulator Eonc 16 Channel Implantable Pulse Ipg 10 4 $41,160.60 $41,160.60 $41,160.60 $41,160.60 $41,160.60 2026-05-22
322 OTHER Percutaneous Cardiovascular Procedures With Intraluminal Device Without McC 21 8 $56,591.50 $56,591.50 $3,506.66 $56,591.50 $41,158.90 2026-05-22
228 OTHER Other Cardiothoracic Procedures With Mcc 13 8 $52,061.90 $52,061.90 $3,506.66 $90,249.40 $41,128.90 2026-05-22
RX-410132 OTHER Cabazitaxel 60 Mg/6 Ml First Dilution IV Soln 17 8 $42,439.60 $42,439.60 $214.25 $42,439.60 $41,068.43 2026-05-22
RX-105644 OTHER Cabazitaxel 10 Mg/ml (first Dilution) Intravenous Solution 17 8 $42,439.60 $42,439.60 $214.25 $42,439.60 $41,068.43 2026-05-22
SUP-8DAC/D OTHER Crt-d Dynagen X4 System 10 4 $41,050.00 $41,050.00 $41,050.00 $41,050.00 $41,050.00 2026-05-22
457 OTHER Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 6 2 $85,874.40 $85,874.40 $40,910.90 $85,874.40 $40,910.90 2026-05-22
023 OTHER Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 6 2 $56,498.50 $56,498.50 $40,666.40 $56,498.50 $40,666.40 2026-05-22
SUP-D284DRG OTHER Defibrillator Cardiac Maximo Ii Dr Icd Thk15 Mm W51 Mm X H68 Mm 37 Ml 68 Gm Atri… 10 4 $40,370.20 $40,370.20 $40,370.20 $40,370.20 $40,370.20 2026-05-22
907 OTHER Other O.r. Procedures For Injuries With McC 17 8 $47,677.90 $47,677.90 $3,506.66 $56,573.70 $40,335.58 2026-05-22
SUP-8CMA/B OTHER System Crtd Momentum Is1 Df1 10 4 $40,330.00 $40,330.00 $40,330.00 $40,330.00 $40,330.00 2026-05-22
SUP-8CM1/2 OTHER System Crtd Momentum Is1 Df4 10 4 $40,330.00 $40,330.00 $40,330.00 $40,330.00 $40,330.00 2026-05-22
PX-361372291 OTHER Hc Ir Tib/per, Initial, Pta, Ather 16 7 $41,768.30 $41,768.30 $8,788.20 $41,768.30 $40,306.41 2026-05-22
PX-361372271 OTHER Hc Ir Fem/Pop Art, Init'l, Pta Stent Arther 16 7 $41,768.30 $41,768.30 $8,788.20 $41,768.30 $40,306.41 2026-05-22
PX-361372251 OTHER Hc Ir Fem/Pop Art, Initial, Pta Ather 16 7 $41,768.30 $41,768.30 $4,285.74 $41,768.30 $40,306.41 2026-05-22
PX-361372301 OTHER Hc Tib/per Revasc W/Stent 16 7 $41,768.30 $41,768.30 $8,788.20 $41,768.30 $40,306.41 2026-05-22
SUP-PED-475-16 OTHER Device Embolization Pipeline Flex L16 Mm Od 4.75 Mm Neurovascular 48 Strand Brai… 10 4 $40,118.00 $40,118.00 $40,118.00 $40,118.00 $40,118.00 2026-05-22
SUP-PED-450-14 OTHER Device Embolization Pipeline Flex L14mm Od 4.5mm Neurovascular 48 Strand Braid M… 10 4 $40,118.00 $40,118.00 $40,118.00 $40,118.00 $40,118.00 2026-05-22
467 OTHER Revision Of Hip Or Knee Replacement With Cc 21 8 $59,134.50 $59,134.50 $3,506.66 $59,134.50 $39,736.70 2026-05-22
653 OTHER Major Bladder Procedures With McC 6 2 $45,819.40 $45,819.40 $39,736.20 $45,819.40 $39,736.20 2026-05-22
SUP-99702 OTHER Battery 10 4 $39,624.00 $39,624.00 $39,624.00 $39,624.00 $39,624.00 2026-05-22
252 OTHER Other Vascular Procedures With McC 17 8 $88,717.90 $88,717.90 $3,506.66 $88,717.90 $39,621.42 2026-05-22
468 OTHER Revision Of Hip Or Knee Replacement Without Cc/McC 21 8 $70,531.20 $50,505.30 28% off $3,506.66 $70,531.20 $39,613.60 2026-05-22
981 OTHER Extensive O.r. Procedures Unrelated To Principal Diagnosis With McC 21 8 $53,600.70 $53,600.70 $3,506.66 $68,956.82 $39,521.60 2026-05-22
853 OTHER Infectious And Parasitic Diseases With O.r. Procedures With McC 21 8 $43,567.30 $43,567.30 $3,506.66 $71,031.30 $39,508.53 2026-05-22
SUP-A219 OTHER Sq Icd A219 Emblem Device _41836_ 10 4 $39,440.00 $39,440.00 $39,440.00 $39,440.00 $39,440.00 2026-05-22
SUP-CD3249-40/40Q OTHER Quadra Hf Crt-d 10 4 $39,425.00 $39,425.00 $39,425.00 $39,425.00 $39,425.00 2026-05-22
021 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 6 2 $46,285.20 $46,285.20 $39,401.80 $46,285.20 $39,401.80 2026-05-22
834 OTHER Acute Leukemia With McC 6 2 $53,531.10 $53,531.10 $39,399.00 $53,531.10 $39,399.00 2026-05-22
SUP-8DCC/D OTHER Crt-d Dynagen Lv-1 System 10 4 $39,330.00 $39,330.00 $39,330.00 $39,330.00 $39,330.00 2026-05-22
SUP-8D8C/D OTHER Crt-d Dynagen Df4 System 10 4 $39,330.00 $39,330.00 $39,330.00 $39,330.00 $39,330.00 2026-05-22
SUP-8D9C/D OTHER Crt-d Dynagen System 10 4 $39,330.00 $39,330.00 $39,330.00 $39,330.00 $39,330.00 2026-05-22
428 OTHER Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 6 2 $152,210.00 $152,210.00 $39,244.30 $152,210.00 $39,244.30 2026-05-22
SUP-CD2257-40QS OTHER Icd Fortify Assura Dr40 Df4 Dual Chamber System 10 4 $39,000.00 $39,000.00 $39,000.00 $39,000.00 $39,000.00 2026-05-22
SUP-CD2257-40S OTHER Icd Fortify Dr 40 Dual Chamber System 10 4 $39,000.00 $39,000.00 $39,000.00 $39,000.00 $39,000.00 2026-05-22
SUP-CD2231-40Q-S OTHER System Icd Dr Fortify 10 4 $39,000.00 $39,000.00 $39,000.00 $39,000.00 $39,000.00 2026-05-22
SUP-W2-10-S OTHER System Embolization Web Sls H8.6 Mm Od10 Mm Intrasaccular Microbraid Accepts .03… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-8-4 OTHER Device Embolization Web Sl H4 Mm Od8 Mm Id.027 In Low Profile Sterile Latex Free… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-8-6 OTHER Device Embolization Web Sl H6 Mm Od8 Mm Id.027 In Low Profile Sterile Latex Free… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-10-8 OTHER Device Embolization Web Sl H8 Mm Od10 Mm Id.033 In Low Profile Sterile Latex Fre… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-10-7 OTHER Device Embolization Web Sl H7 Mm Od10 Mm Id.033 In Low Profile Sterile Latex Fre… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-11-6 OTHER Device Embolization Web Sl H6 Mm Od11 Mm Id.033 In Low Profile Sterile Latex Fre… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-8-S OTHER System Embolization Web Sls H6.6 Mm Od8 Mm Intrasaccular Microbraid Accepts .027… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-11-9 OTHER Device Embolization Web Sl H9 Mm Od11 Mm Id.033 In Low Profile Sterile Latex Fre… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-8-5 OTHER Device Embolization Web Sl H5 Mm Od8 Mm Id.027 In Low Profile Sterile Latex Free… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-11-7 OTHER Device Embolization Web Sl H7 Mm Od11 Mm Id.033 In Low Profile Sterile Latex Fre… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-10-6 OTHER Device Embolization Web Sl H6 Mm Od10 Mm Id.033 In Low Profile Sterile Latex Fre… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-11-S OTHER System Embolization Web Sls H9.6 Mm Od11 Mm Intrasaccular Microbraid Accepts .03… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-9-6 OTHER Device Embolization Web Sl H6 Mm Od9 Mm Id.027 In Low Profile Sterile Latex Free… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-9-7 OTHER Device Embolization Web Sl H7 Mm Od9 Mm Id.027 In Low Profile Sterile Latex Free… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-9-4 OTHER Device Embolization Web Sl H4 Mm Od9 Mm Id.027 In Low Profile Sterile Latex Free… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-10-5 OTHER Device Embolization Web Sl H5 Mm Od10 Mm Id.033 In Low Profile Sterile Latex Fre… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-9-S OTHER System Embolization Web Sls H7.6 Mm Od9 Mm Intrasaccular Microbraid Accepts .027… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-9-5 OTHER Device Embolization Web Sl H5 Mm Od9 Mm Id.027 In Intrasaccular Low Profile Via … 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-11-8 OTHER Device Embolization Web Sl H8 Mm Od11 Mm Id.033 In Low Profile Sterile Latex Fre… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
SUP-W2-8-3 OTHER Device Embolization Web Sl H3 Mm Od8 Mm Id.027 In Low Profile Sterile Latex Free… 10 4 $38,870.00 $38,870.00 $38,870.00 $38,870.00 $38,870.00 2026-05-22
RX-186382 OTHER Pertuzumab 1,200 Mg-trastuzumab 600 Mg-hyaluron-zzxf/15 Ml Subcut Soln 17 8 $39,951.80 $39,951.80 $59.80 $39,951.80 $38,827.13 2026-05-22
405 OTHER Pancreas, Liver And Shunt Procedures With McC 6 2 $72,835.60 $72,835.60 $38,696.80 $72,835.60 $38,696.80 2026-05-22
SUP-112USPH OTHER Device Embolization Surpass Streamline L30mm Od 4mm 10 4 $38,610.00 $38,610.00 $38,610.00 $38,610.00 $38,610.00 2026-05-22
SUP-115USPH OTHER Device Embolization Surpass Streamline L15mm Od 4mm 10 4 $38,610.00 $38,610.00 $38,610.00 $38,610.00 $38,610.00 2026-05-22
SUP-100USPH OTHER Device Embolization Surpass Streamline L15mm Od 3mm 10 4 $38,610.00 $38,610.00 $38,610.00 $38,610.00 $38,610.00 2026-05-22
SUP-110USPH OTHER Device Embolization Surpass Streamline L20mm Od 4mm 10 4 $38,610.00 $38,610.00 $38,610.00 $38,610.00 $38,610.00 2026-05-22
SUP-120USPH OTHER Device Embolization Surpass Streamline L25mm Od 5mm 10 4 $38,610.00 $38,610.00 $38,610.00 $38,610.00 $38,610.00 2026-05-22
SUP-121USPH OTHER Device Embolization Surpass Streamline L30mm Od 5mm 10 4 $38,610.00 $38,610.00 $38,610.00 $38,610.00 $38,610.00 2026-05-22
SUP-111USPH OTHER Device Embolization Surpass Streamline L25mm Od 4mm 10 4 $38,610.00 $38,610.00 $38,610.00 $38,610.00 $38,610.00 2026-05-22
SUP-102USPH OTHER Device Embolization Surpass Streamline L25mm Od 3mm 10 4 $38,610.00 $38,610.00 $38,610.00 $38,610.00 $38,610.00 2026-05-22
SUP-124USPH OTHER Device Embolization Surpass Streamline L20mm Od 5mm 10 4 $38,610.00 $38,610.00 $38,610.00 $38,610.00 $38,610.00 2026-05-22
SUP-101USPH OTHER Device Embolization Surpass Streamline L20mm Od 3mm 10 4 $38,610.00 $38,610.00 $38,610.00 $38,610.00 $38,610.00 2026-05-22
239 OTHER Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC 21 8 $41,678.00 $41,678.00 $3,506.66 $71,528.40 $38,507.30 2026-05-22
463 OTHER Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 13 8 $52,492.10 $52,492.10 $3,506.66 $76,700.70 $38,499.30 2026-05-22
011 OTHER Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC 10 4 $33,802.00 $33,802.00 $33,802.00 $73,356.20 $38,463.00 2026-05-22
SUP-G247 OTHER Crtd G247 Vigilant MRI X4 Df4 _51712_ 10 4 $38,312.00 $38,312.00 $38,312.00 $38,312.00 $38,312.00 2026-05-22
412 OTHER Cholecystectomy With C.d.e. With Cc 7 7 $55,726.80 $55,726.80 $3,506.66 $51,825.92 $38,148.19 2026-05-09
234 OTHER Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC 6 2 $67,576.20 $67,576.20 $37,923.40 $67,576.20 $37,923.40 2026-05-22
SUP-CD1311-36QS OTHER Icd Ellipse MRI Vr 36 Df4 Connector System 10 4 $37,800.00 $37,800.00 $37,800.00 $37,800.00 $37,800.00 2026-05-22
220 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 6 2 $85,288.20 $85,288.20 $37,755.10 $85,288.20 $37,755.10 2026-05-22
SUP-BEA25-90/116-30 OTHER Graft Endolobix Aaa Afx2 Main Body 10 4 $37,697.40 $37,697.40 $37,697.40 $37,697.40 $37,697.40 2026-05-22
SUP-BEA22-80/I16-40 OTHER Graft Stent Afx2 2 Branch L80 Mm L40 Mm Od22 Mm Odsec16 Mm Main Body Iliac Limb … 10 4 $37,697.40 $37,697.40 $37,697.40 $37,697.40 $37,697.40 2026-05-22
SUP-BEA25-60/116-40 OTHER Graft Endologix Afx Main Body 10 4 $37,697.40 $37,697.40 $37,697.40 $37,697.40 $37,697.40 2026-05-22
SUP-BEA22-70/I16-30 OTHER Graft Stent Afx2 2 Branch L70 Mm L30 Mm Od22 Mm Odsec16 Mm Main Body Iliac Limb … 10 4 $37,697.40 $37,697.40 $37,697.40 $37,697.40 $37,697.40 2026-05-22
503 OTHER Foot Procedures With McC 21 8 $91,941.10 $91,941.10 $3,506.66 $91,941.10 $37,585.60 2026-05-22
SUP-CD3231-40Q-D OTHER Unify Hf Crt-d 10 4 $37,555.00 $37,555.00 $37,555.00 $37,555.00 $37,555.00 2026-05-22
SUP-CD3257-40Q OTHER Crtd Cd3257-40q Assura _35390_ 10 4 $37,555.00 $37,555.00 $37,555.00 $37,555.00 $37,555.00 2026-05-22
SUP-CD3369-40Q SYSTEM OTHER Icd Quadra Assura Mp Crt-d Df4 Connector System 10 4 $37,515.00 $37,515.00 $37,515.00 $37,515.00 $37,515.00 2026-05-22
SUP-CD3369-40C SYSTEM OTHER Icd Quadra Assura Mp Crt-d System 10 4 $37,515.00 $37,515.00 $37,515.00 $37,515.00 $37,515.00 2026-05-22
SUP-G158 OTHER Defibrillator Cardiac Dynagen X4 D.99 In Mini W5.37 Cm X H8.18 Cm 32.5 Cc 73.8 G… 10 4 $37,312.00 $37,312.00 $37,312.00 $37,312.00 $37,312.00 2026-05-22
SUP-99-04154 OTHER Pacemaker - Aicd - Cobalt - Dtpa2q1 16 7 $37,197.00 $37,197.00 $15,910.50 $37,197.00 $37,197.00 2026-05-22
SUP-99-04151 OTHER Pacemaker - Aicd - Cobalt - Dtpa2d1 16 7 $37,197.00 $37,197.00 $15,910.50 $37,197.00 $37,197.00 2026-05-22
SUP-99-04152 OTHER Pacemaker - Aicd - Cobalt - Dtpa2d4 16 7 $37,197.00 $37,197.00 $15,910.50 $37,197.00 $37,197.00 2026-05-22
492 OTHER Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 13 8 $94,148.20 $94,148.20 $3,506.66 $87,557.83 $37,179.60 2026-05-22
SUP-D334TRG OTHER Defibrillator Cardiac Protecta Xt Crt-d Thk15 Mm W51 Mm X H69 Mm 38 Ml 68 Gm Ven… 10 4 $36,966.00 $36,966.00 $36,966.00 $36,966.00 $36,966.00 2026-05-22
SUP-1193030 OTHER Mesh Surgical Phasix Poly 4-hydroxybutyrate Square L 12in X W 12in Monofilament … 10 4 $36,956.40 $36,956.40 $36,956.40 $36,956.40 $36,956.40 2026-05-22
SUP-G138 OTHER Device Crtd Momentum X4 Df1 10 4 $36,764.00 $36,764.00 $36,764.00 $36,764.00 $36,764.00 2026-05-22
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