|
C9172
|
OTHER
|
Inj- Beqvez- Per Tx Dose
|
4
|
2
|
—
|
—
|
$4,326,000.00
|
$4,326,000.00
|
$4,326,000.00
|
2026-05-22
|
|
J3391
|
OTHER
|
Inj Atidarsagene Autotemcel
|
2
|
1
|
—
|
—
|
$4,246,175.00
|
$4,246,175.00
|
$4,246,175.00
|
2026-05-22
|
|
J1414
|
OTHER
|
Inj Beqvez Per Tx Dose
|
20
|
9
|
—
|
—
|
$3,598,700.00
|
$4,637,500.00
|
$4,025,350.00
|
2026-05-22
|
|
J1413
|
OTHER
|
Inj Delandistrogene Mox Rokl
|
26
|
12
|
—
|
—
|
$3,224,834.74
|
$4,650,494.11
|
$3,820,048.74
|
2026-05-22
|
|
J1411
|
OTHER
|
Inj Hemgenix Per Tx Dose
|
42
|
17
|
—
|
—
|
$15,363.65
|
$4,637,500.00
|
$3,710,000.00
|
2026-05-22
|
|
J3394
|
OTHER
|
Inj Lovotibeglogene Autotem
|
26
|
12
|
—
|
—
|
$3,163,514.35
|
$4,470,200.00
|
$3,671,950.00
|
2026-05-22
|
|
J3393
|
OTHER
|
Inj Betibeglogene Autotemce
|
26
|
12
|
—
|
—
|
$2,862,166.07
|
$4,155,200.00
|
$3,413,200.00
|
2026-05-22
|
|
J3392
|
OTHER
|
Inj Exagamglogene Autotem
|
22
|
10
|
—
|
—
|
$2,262,040.00
|
$3,264,800.00
|
$2,565,200.00
|
2026-05-22
|
|
J3399
|
OTHER
|
Inj Onase Abepar-xioi Treat
|
50
|
18
|
—
|
—
|
$10,687.19
|
$3,364,842.25
|
$2,391,610.02
|
2026-05-22
|
|
Q2042
|
OTHER
|
Tisagenlecleucel Car-pos T
|
30
|
13
|
—
|
—
|
$560,974.84
|
$1,272,653.64
|
$635,031.43
|
2026-05-22
|
|
Q2056
|
OTHER
|
Ciltacabtagene Car-pos T
|
30
|
13
|
—
|
—
|
$536,777.47
|
$1,240,466.27
|
$632,548.12
|
2026-05-22
|
|
Q2055
|
OTHER
|
Idecabtagene Vicleucel Car
|
30
|
13
|
—
|
—
|
$525,022.64
|
$1,188,702.97
|
$607,559.29
|
2026-05-22
|
|
Q2054
|
OTHER
|
Lisocabtagene Mara Car Pos T
|
30
|
13
|
—
|
—
|
$516,485.97
|
$1,162,093.43
|
$593,958.87
|
2026-05-22
|
|
Q2041
|
OTHER
|
Axicabtagene Ciloleucel Car+
|
30
|
13
|
—
|
—
|
$489,517.15
|
$1,101,413.59
|
$562,944.72
|
2026-05-22
|
|
Q2053
|
OTHER
|
Brexucabtagene Car Pos T
|
30
|
13
|
—
|
—
|
$475,028.40
|
$1,098,115.90
|
$552,636.48
|
2026-05-22
|
|
MS-018
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell Immunotherapy
|
64
|
18
|
—
|
—
|
$267,446.87
|
$1,277,596.53
|
$373,331.55
|
2026-05-22
|
|
5834
|
OTHER
|
Neonate With Ecmo
|
36
|
9
|
—
|
—
|
$210,343.71
|
$529,191.44
|
$357,490.58
|
2026-05-22
|
|
MS-633
|
OTHER
|
Neonate- Birthwt 1000-1499g- W Signif O.r. Pro- Discharged Alive
|
2
|
1
|
—
|
—
|
$312,452.24
|
$312,452.24
|
$312,452.24
|
2026-05-22
|
|
MS-001
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
66
|
19
|
—
|
—
|
$190,021.30
|
$954,257.50
|
$292,919.34
|
2026-05-22
|
|
MS-612
|
OTHER
|
Neonate- Birthwt <750g-- Discharged Alive
|
2
|
1
|
—
|
—
|
$286,319.29
|
$286,319.29
|
$286,319.29
|
2026-05-22
|
|
Q2058
|
OTHER
|
Obecbtge Autol Up To 400 Mil
|
2
|
1
|
—
|
—
|
$262,263.75
|
$262,263.75
|
$262,263.75
|
2026-05-22
|
|
5884
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
36
|
9
|
—
|
—
|
$128,831.50
|
$324,119.63
|
$218,956.14
|
2026-05-22
|
|
MS-927
|
OTHER
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
66
|
19
|
—
|
—
|
$144,771.06
|
$803,657.30
|
$211,401.10
|
2026-05-22
|
|
MS-631
|
OTHER
|
Neonate- Birthwt 750-999g- Discharged Alive
|
2
|
1
|
—
|
—
|
$207,612.86
|
$207,612.86
|
$207,612.86
|
2026-05-22
|
|
0114
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
36
|
9
|
—
|
—
|
$120,435.79
|
$302,997.38
|
$204,687.19
|
2026-05-22
|
|
0024
|
OTHER
|
Heart And/or Lung Transplant
|
36
|
9
|
—
|
—
|
$120,356.31
|
$302,797.40
|
$204,552.10
|
2026-05-22
|
|
5833
|
OTHER
|
Neonate With Ecmo
|
36
|
9
|
—
|
—
|
$119,797.74
|
$301,392.11
|
$203,602.77
|
2026-05-22
|
|
MS-003
|
OTHER
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth…
|
66
|
19
|
—
|
—
|
$143,921.44
|
$726,038.31
|
$201,490.02
|
2026-05-22
|
|
MS-636
|
OTHER
|
Neonate- Birthwt 1500-1999g- W Signif O.r. Proc W Mult Major Prob
|
2
|
1
|
—
|
—
|
$183,591.71
|
$183,591.71
|
$183,591.71
|
2026-05-22
|
|
MS-453
|
OTHER
|
Combined Anterior/posterior Spinal Fusion W Mcc
|
16
|
3
|
—
|
—
|
$99,714.20
|
$264,016.55
|
$183,479.71
|
2026-05-22
|
|
2424195
|
OTHER
|
Impl Maci Double Membrane
|
60
|
13
|
$313,500.00
|
$188,100.00
40% off
|
$56,430.00
|
$313,500.00
|
$165,559.35
|
2026-05-22
|
|
2423837
|
OTHER
|
Impl-cardio Vasc 99001-100000
|
60
|
13
|
$298,500.00
|
$179,100.00
40% off
|
$53,730.00
|
$298,500.00
|
$157,637.85
|
2026-05-22
|
|
1614
|
OTHER
|
Implantable Heart Assist Systems
|
36
|
9
|
—
|
—
|
$89,815.36
|
$225,961.22
|
$152,646.10
|
2026-05-22
|
|
6094
|
OTHER
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
36
|
9
|
—
|
—
|
$89,760.19
|
$225,822.43
|
$152,552.34
|
2026-05-22
|
|
0113
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
36
|
9
|
—
|
—
|
$89,629.89
|
$225,494.62
|
$152,330.89
|
2026-05-22
|
|
0094
|
OTHER
|
Extracorporeal Membrane Oxygenation (ecmo)
|
36
|
9
|
—
|
—
|
$88,048.17
|
$221,515.25
|
$149,642.67
|
2026-05-22
|
|
6314
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
36
|
9
|
—
|
—
|
$86,333.24
|
$217,200.76
|
$146,728.05
|
2026-05-22
|
|
5883
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
36
|
9
|
—
|
—
|
$85,801.52
|
$215,863.04
|
$145,824.36
|
2026-05-22
|
|
5914
|
OTHER
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
36
|
9
|
—
|
—
|
$84,481.48
|
$212,542.03
|
$143,580.89
|
2026-05-22
|
|
2423695
|
OTHER
|
Impl-heart 89001-90000
|
60
|
13
|
$268,500.00
|
$161,100.00
40% off
|
$48,330.00
|
$268,500.00
|
$141,794.85
|
2026-05-22
|
|
2423618
|
OTHER
|
Impl-cardio Vasc 87001-88000
|
60
|
13
|
$262,500.00
|
$157,500.00
40% off
|
$47,250.00
|
$262,500.00
|
$138,626.25
|
2026-05-22
|
|
MS-459
|
OTHER
|
Spinal Fusion Except Cervical With Mcc
|
16
|
3
|
—
|
—
|
$44,989.74
|
$197,602.75
|
$137,227.66
|
2026-05-22
|
|
8414
|
OTHER
|
Extensive Third Degree Burns With Skin Graft
|
36
|
9
|
—
|
—
|
$79,893.10
|
$200,998.39
|
$135,782.68
|
2026-05-22
|
|
6304
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
36
|
9
|
—
|
—
|
$78,295.40
|
$196,978.84
|
$133,067.30
|
2026-05-22
|
|
MS-224
|
OTHER
|
Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami- Hf Or Sh…
|
18
|
5
|
—
|
—
|
$83.30
|
$241,784.27
|
$132,922.50
|
2026-05-22
|
|
MS-004
|
OTHER
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth And Nec…
|
66
|
19
|
—
|
—
|
$93,922.01
|
$478,682.01
|
$131,490.82
|
2026-05-22
|
|
MS-454
|
OTHER
|
Combined Anterior/posterior Spinal Fusion W Cc
|
16
|
3
|
—
|
—
|
$64,925.00
|
$182,229.04
|
$126,641.05
|
2026-05-22
|
|
5934
|
OTHER
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
36
|
9
|
—
|
—
|
$74,275.40
|
$186,865.14
|
$126,235.09
|
2026-05-22
|
|
2423694
|
OTHER
|
Impl-heart 79001-80000
|
60
|
13
|
$238,500.00
|
$143,100.00
40% off
|
$42,930.00
|
$238,500.00
|
$125,951.85
|
2026-05-22
|
|
MS-681
|
OTHER
|
Neonate- Birthwt >2499g- W Signif O.r. Proc- W Mult Major Prob
|
2
|
1
|
—
|
—
|
$125,049.21
|
$125,049.21
|
$125,049.21
|
2026-05-22
|
|
0074
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
36
|
9
|
—
|
—
|
$70,861.16
|
$178,275.43
|
$120,432.39
|
2026-05-22
|
|
Q0480
|
OTHER
|
Driver Pneumatic Vad Rep
|
30
|
13
|
—
|
—
|
$106,036.81
|
$245,961.68
|
$120,247.93
|
2026-05-22
|
|
MS-226
|
OTHER
|
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc
|
18
|
5
|
—
|
—
|
$83.30
|
$232,381.28
|
$120,016.88
|
2026-05-22
|
|
5832
|
OTHER
|
Neonate With Ecmo
|
36
|
9
|
—
|
—
|
$91,982.52
|
$152,272.05
|
$119,996.20
|
2026-05-22
|
|
1613
|
OTHER
|
Implantable Heart Assist Systems
|
36
|
9
|
—
|
—
|
$70,327.62
|
$176,933.15
|
$119,525.62
|
2026-05-22
|
|
0044
|
OTHER
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
36
|
9
|
—
|
—
|
$67,666.12
|
$170,237.25
|
$115,002.26
|
2026-05-22
|
|
MS-020
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
66
|
19
|
—
|
—
|
$53,355.87
|
$273,085.88
|
$114,702.60
|
2026-05-22
|
|
MS-007
|
OTHER
|
Lung Transplant
|
66
|
19
|
—
|
—
|
$87,811.26
|
$442,731.74
|
$114,334.78
|
2026-05-22
|
|
MS-014
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
66
|
19
|
—
|
—
|
$81,489.62
|
$443,849.68
|
$114,085.47
|
2026-05-22
|
|
0014
|
OTHER
|
Liver Transplant And/or Intestinal Transplant
|
36
|
9
|
—
|
—
|
$66,992.86
|
$168,543.42
|
$113,858.01
|
2026-05-22
|
|
MS-002
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
66
|
19
|
—
|
—
|
$76,837.39
|
$373,314.38
|
$112,309.60
|
2026-05-22
|
|
MS-634
|
OTHER
|
Neonate- Birthwt 1000-1499g- Without Signif O.r. Proc- Discharged Alive
|
2
|
1
|
—
|
—
|
$111,992.83
|
$111,992.83
|
$111,992.83
|
2026-05-22
|
|
0023
|
OTHER
|
Heart And/or Lung Transplant
|
36
|
9
|
—
|
—
|
$65,560.30
|
$164,939.34
|
$111,423.30
|
2026-05-22
|
|
MS-005
|
OTHER
|
Liver Transplant With Mcc Or Intestinal Transplant
|
66
|
19
|
—
|
—
|
$69,912.28
|
$360,769.72
|
$109,314.62
|
2026-05-22
|
|
5913
|
OTHER
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
36
|
9
|
—
|
—
|
$63,713.63
|
$160,293.39
|
$108,284.77
|
2026-05-22
|
|
MS-212
|
OTHER
|
Testes Procedures Age 0-17
|
64
|
18
|
—
|
—
|
$73,733.87
|
$369,052.65
|
$107,127.17
|
2026-05-22
|
|
MS-222
|
OTHER
|
Cardiac Defibrillator Implant With Cardiac Catheterization With Ami- Hf Or Shock…
|
18
|
5
|
—
|
—
|
$83.30
|
$259,382.64
|
$104,715.59
|
2026-05-22
|
|
5893
|
OTHER
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
36
|
9
|
—
|
—
|
$60,053.30
|
$151,084.59
|
$102,063.86
|
2026-05-22
|
|
MS-632
|
OTHER
|
Neonate- Birthwt 750-999g- Died
|
2
|
1
|
—
|
—
|
$101,892.05
|
$101,892.05
|
$101,892.05
|
2026-05-22
|
|
0093
|
OTHER
|
Extracorporeal Membrane Oxygenation (ecmo)
|
36
|
9
|
—
|
—
|
$59,173.88
|
$148,872.10
|
$100,569.23
|
2026-05-22
|
|
5882
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
36
|
9
|
—
|
—
|
$73,522.65
|
$121,712.74
|
$95,914.29
|
2026-05-22
|
|
MS-455
|
OTHER
|
Combined Anterior/posterior Spinal Fusion Without Cc/mcc
|
16
|
3
|
—
|
—
|
$51,020.98
|
$137,219.25
|
$95,361.26
|
2026-05-22
|
|
6024
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
36
|
9
|
—
|
—
|
$55,954.17
|
$140,771.83
|
$95,097.16
|
2026-05-22
|
|
MS-225
|
OTHER
|
Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami- Hf Or Sh…
|
18
|
5
|
—
|
—
|
$83.30
|
$177,232.59
|
$94,831.88
|
2026-05-22
|
|
MS-227
|
OTHER
|
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc
|
18
|
5
|
—
|
—
|
$83.30
|
$170,086.25
|
$94,138.13
|
2026-05-22
|
|
0112
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
36
|
9
|
—
|
—
|
$71,254.59
|
$117,958.09
|
$92,955.49
|
2026-05-22
|
|
5933
|
OTHER
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
36
|
9
|
—
|
—
|
$54,334.70
|
$136,697.49
|
$92,344.77
|
2026-05-22
|
|
MS-365
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
2
|
1
|
—
|
—
|
$88,764.98
|
$88,764.98
|
$88,764.98
|
2026-05-22
|
|
1604
|
OTHER
|
Major Cardiothoracic Repair Of Heart Anomaly
|
36
|
9
|
—
|
—
|
$51,558.87
|
$129,713.96
|
$87,627.12
|
2026-05-22
|
|
MS-215
|
OTHER
|
Other Heart Assist System Implant
|
76
|
19
|
—
|
—
|
$65.55
|
$358,920.04
|
$86,082.01
|
2026-05-22
|
|
MS-426
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
58
|
17
|
—
|
—
|
$18,645.27
|
$354,875.13
|
$85,941.01
|
2026-05-22
|
|
5831
|
OTHER
|
Neonate With Ecmo
|
18
|
9
|
—
|
—
|
$82,565.48
|
$89,922.80
|
$85,835.40
|
2026-05-22
|
|
MS-216
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
76
|
19
|
—
|
—
|
$65.55
|
$335,720.20
|
$84,575.99
|
2026-05-22
|
|
2424194
|
OTHER
|
Impl Maci Single Membrane
|
60
|
13
|
$157,500.00
|
$94,500.00
40% off
|
$28,350.00
|
$157,500.00
|
$83,175.75
|
2026-05-22
|
|
0054
|
OTHER
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
36
|
9
|
—
|
—
|
$47,138.54
|
$118,593.09
|
$80,114.51
|
2026-05-22
|
|
MS-456
|
OTHER
|
Spinal Fusion Except Cervical With Spinal Curvature- Malignancy- Infection Or Ex…
|
66
|
19
|
—
|
—
|
$56,980.83
|
$286,911.09
|
$79,773.16
|
2026-05-22
|
|
MS-209
|
OTHER
|
Kidney And Urinary Tract Signs And Symptoms Age 0-17
|
36
|
16
|
—
|
—
|
$4,884.66
|
$195,710.57
|
$79,665.71
|
2026-05-22
|
|
0043
|
OTHER
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
36
|
9
|
—
|
—
|
$46,660.90
|
$117,391.43
|
$79,302.74
|
2026-05-22
|
|
2424856
|
OTHER
|
Impl-heart 49001-50000
|
60
|
13
|
$148,501.00
|
$89,100.60
40% off
|
$26,730.18
|
$148,501.00
|
$78,423.38
|
2026-05-22
|
|
2422945
|
OTHER
|
Impl-spine 49001-50000
|
60
|
13
|
$148,501.00
|
$89,100.60
40% off
|
$26,730.18
|
$148,501.00
|
$78,423.38
|
2026-05-22
|
|
2424631
|
OTHER
|
C1767 Neurostm Gen 49001-50000
|
60
|
13
|
$148,501.00
|
$89,100.60
40% off
|
$26,730.18
|
$148,501.00
|
$78,423.38
|
2026-05-22
|
|
5892
|
OTHER
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
36
|
9
|
—
|
—
|
$60,053.30
|
$99,414.97
|
$78,342.79
|
2026-05-22
|
|
MS-429
|
OTHER
|
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc
|
60
|
18
|
—
|
—
|
$59,148.81
|
$282,554.51
|
$77,630.02
|
2026-05-22
|
|
L8702
|
OTHER
|
Ewhf S/d Uprt Micro Sensor
|
30
|
13
|
—
|
—
|
$65,429.08
|
$151,768.49
|
$77,570.56
|
2026-05-22
|
|
2424855
|
OTHER
|
Impl-heart 48001-49000
|
60
|
13
|
$145,501.00
|
$87,300.60
40% off
|
$26,190.18
|
$145,501.00
|
$76,839.08
|
2026-05-22
|
|
2422944
|
OTHER
|
Impl-spine 48001-49000
|
60
|
13
|
$145,501.00
|
$87,300.60
40% off
|
$26,190.18
|
$145,501.00
|
$76,839.08
|
2026-05-22
|
|
2422800
|
OTHER
|
Impl-totl Knee 48001-49000
|
60
|
13
|
$145,501.00
|
$87,300.60
40% off
|
$26,190.18
|
$145,501.00
|
$76,839.08
|
2026-05-22
|
|
2424630
|
OTHER
|
C1767 Neurostm Gen 48001-49000
|
60
|
13
|
$145,501.00
|
$87,300.60
40% off
|
$26,190.18
|
$145,501.00
|
$76,839.08
|
2026-05-22
|
|
0073
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
36
|
9
|
—
|
—
|
$45,068.28
|
$113,384.67
|
$76,596.01
|
2026-05-22
|
|
8424
|
OTHER
|
Burns With Skin Graft Except Extensive Third Degree Burns
|
36
|
9
|
—
|
—
|
$44,728.57
|
$112,529.99
|
$76,018.64
|
2026-05-22
|
|
MS-460
|
OTHER
|
Spinal Fusion Except Cervical Without Mcc
|
16
|
3
|
—
|
—
|
$26,489.41
|
$108,983.47
|
$75,738.65
|
2026-05-22
|
|
2424629
|
OTHER
|
C1767 Neurostm Gen 47001-48000
|
60
|
13
|
$142,501.00
|
$85,500.60
40% off
|
$25,650.18
|
$142,501.00
|
$75,254.78
|
2026-05-22
|
|
2422943
|
OTHER
|
Impl-spine 47001-48000
|
60
|
13
|
$142,501.00
|
$85,500.60
40% off
|
$25,650.18
|
$142,501.00
|
$75,254.78
|
2026-05-22
|
|
2424077
|
OTHER
|
L8614 Cochlear Imp 47001-48000
|
60
|
13
|
$142,501.00
|
$85,500.60
40% off
|
$25,650.18
|
$142,501.00
|
$75,254.78
|
2026-05-22
|
|
2424854
|
OTHER
|
Impl-heart 47001-48000
|
60
|
13
|
$142,501.00
|
$85,500.60
40% off
|
$25,650.18
|
$142,501.00
|
$75,254.78
|
2026-05-22
|
|
MS-850
|
OTHER
|
Acute Leukemia With Other Procedures
|
60
|
18
|
—
|
—
|
$58,717.36
|
$312,071.54
|
$74,864.64
|
2026-05-22
|
|
0064
|
OTHER
|
Pancreas Transplant
|
36
|
9
|
—
|
—
|
$43,759.49
|
$110,091.96
|
$74,371.65
|
2026-05-22
|
|
MS-019
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
64
|
18
|
—
|
—
|
$48,377.49
|
$268,553.14
|
$74,260.50
|
2026-05-22
|
|
2424628
|
OTHER
|
C1767 Neurostm Gen 46001-47000
|
60
|
13
|
$139,501.00
|
$83,700.60
40% off
|
$25,110.18
|
$139,501.00
|
$73,670.48
|
2026-05-22
|
|
2424853
|
OTHER
|
Impl-heart 46001-47000
|
60
|
13
|
$139,501.00
|
$83,700.60
40% off
|
$25,110.18
|
$139,501.00
|
$73,670.48
|
2026-05-22
|
|
2424076
|
OTHER
|
L8614 Cochlear Imp 46001-47000
|
60
|
13
|
$139,501.00
|
$83,700.60
40% off
|
$25,110.18
|
$139,501.00
|
$73,670.48
|
2026-05-22
|
|
2422942
|
OTHER
|
Impl-spine 46001-47000
|
60
|
13
|
$139,501.00
|
$83,700.60
40% off
|
$25,110.18
|
$139,501.00
|
$73,670.48
|
2026-05-22
|
|
6074
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
36
|
9
|
—
|
—
|
$43,252.83
|
$108,817.25
|
$73,510.52
|
2026-05-22
|
|
6303
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
36
|
9
|
—
|
—
|
$43,158.09
|
$108,578.92
|
$73,349.52
|
2026-05-22
|
|
J9029
|
OTHER
|
Instill Adstiladrin Tx Dose
|
30
|
13
|
—
|
—
|
$61,528.12
|
$142,654.59
|
$72,912.35
|
2026-05-22
|
|
MS-957
|
OTHER
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
66
|
19
|
—
|
—
|
$51,668.16
|
$252,864.70
|
$72,335.42
|
2026-05-22
|
|
MS-233
|
OTHER
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
76
|
19
|
—
|
—
|
$65.55
|
$264,796.18
|
$72,314.49
|
2026-05-22
|
|
2422941
|
OTHER
|
Impl-spine 45001-46000
|
60
|
13
|
$136,501.00
|
$81,900.60
40% off
|
$24,570.18
|
$136,501.00
|
$72,086.18
|
2026-05-22
|
|
2424627
|
OTHER
|
C1767 Neurostm Gen 45001-46000
|
60
|
13
|
$136,501.00
|
$81,900.60
40% off
|
$24,570.18
|
$136,501.00
|
$72,086.18
|
2026-05-22
|
|
2424075
|
OTHER
|
L8614 Cochlear Imp 45001-46000
|
60
|
13
|
$136,501.00
|
$81,900.60
40% off
|
$24,570.18
|
$136,501.00
|
$72,086.18
|
2026-05-22
|
|
MS-219
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
76
|
19
|
—
|
—
|
$65.55
|
$276,498.26
|
$71,367.03
|
2026-05-22
|
|
5912
|
OTHER
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
36
|
9
|
—
|
—
|
$54,647.92
|
$90,466.66
|
$71,291.19
|
2026-05-22
|
|
2424626
|
OTHER
|
C1767 Neurostm Gen 44001-45000
|
60
|
13
|
$133,501.00
|
$80,100.60
40% off
|
$24,030.18
|
$133,501.00
|
$70,501.88
|
2026-05-22
|
|
2424120
|
OTHER
|
Cardiovasc Supply 44001-45000
|
60
|
13
|
$133,501.00
|
$80,100.60
40% off
|
$24,030.18
|
$133,501.00
|
$70,501.88
|
2026-05-22
|
|
2424074
|
OTHER
|
L8614 Cochlear Imp 44001-45000
|
60
|
13
|
$133,501.00
|
$80,100.60
40% off
|
$24,030.18
|
$133,501.00
|
$70,501.88
|
2026-05-22
|
|
2422940
|
OTHER
|
Impl-spine 44001-45000
|
60
|
13
|
$133,501.00
|
$80,100.60
40% off
|
$24,030.18
|
$133,501.00
|
$70,501.88
|
2026-05-22
|
|
2423699
|
OTHER
|
Impl-heart 44001-45000
|
60
|
13
|
$133,501.00
|
$80,100.60
40% off
|
$24,030.18
|
$133,501.00
|
$70,501.88
|
2026-05-22
|
|
8513
|
OTHER
|
Gender Related Procedures
|
36
|
9
|
—
|
—
|
$41,273.67
|
$103,838.01
|
$70,146.85
|
2026-05-22
|
|
8514
|
OTHER
|
Gender Related Procedures
|
36
|
9
|
—
|
—
|
$41,273.67
|
$103,838.01
|
$70,146.85
|
2026-05-22
|
|
6034
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
36
|
9
|
—
|
—
|
$40,925.24
|
$102,961.42
|
$69,554.67
|
2026-05-22
|
|
2422939
|
OTHER
|
Impl-spine 43001-44000
|
60
|
13
|
$130,501.00
|
$78,300.60
40% off
|
$23,490.18
|
$130,501.00
|
$68,917.58
|
2026-05-22
|
|
2424625
|
OTHER
|
C1767 Neurostm Gen 43001-44000
|
60
|
13
|
$130,501.00
|
$78,300.60
40% off
|
$23,490.18
|
$130,501.00
|
$68,917.58
|
2026-05-22
|
|
2424376
|
OTHER
|
Impl-totl Knee 43001-44000
|
60
|
13
|
$130,501.00
|
$78,300.60
40% off
|
$23,490.18
|
$130,501.00
|
$68,917.58
|
2026-05-22
|
|
2424213
|
OTHER
|
Cardiovasc Supply 43001-44000
|
60
|
13
|
$130,501.00
|
$78,300.60
40% off
|
$23,490.18
|
$130,501.00
|
$68,917.58
|
2026-05-22
|
|
2424852
|
OTHER
|
Impl-heart 43001-44000
|
60
|
13
|
$130,501.00
|
$78,300.60
40% off
|
$23,490.18
|
$130,501.00
|
$68,917.58
|
2026-05-22
|
|
2424073
|
OTHER
|
L8614 Cochlear Imp 43001-44000
|
60
|
13
|
$130,501.00
|
$78,300.60
40% off
|
$23,490.18
|
$130,501.00
|
$68,917.58
|
2026-05-22
|
|
38240
|
OTHER
|
Transplt Allo Hct/donor
|
44
|
13
|
—
|
—
|
$14,280.00
|
$133,573.25
|
$68,270.77
|
2026-05-22
|
|
MS-010
|
OTHER
|
Pancreas Transplant
|
66
|
19
|
—
|
—
|
$42,146.66
|
$270,101.32
|
$68,118.65
|
2026-05-22
|
|
S2068
|
OTHER
|
Breast Diep Or Siea Flap
|
2
|
1
|
—
|
—
|
$68,089.13
|
$68,089.13
|
$68,089.13
|
2026-05-22
|
|
MS-366
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
2
|
1
|
—
|
—
|
$67,557.09
|
$67,557.09
|
$67,557.09
|
2026-05-22
|
|
1612
|
OTHER
|
Implantable Heart Assist Systems
|
36
|
9
|
—
|
—
|
$51,747.25
|
$85,664.75
|
$67,507.10
|
2026-05-22
|
|
2424212
|
OTHER
|
Cardiovasc Supply 42001-43000
|
60
|
13
|
$127,501.00
|
$76,500.60
40% off
|
$22,950.18
|
$127,501.00
|
$67,333.28
|
2026-05-22
|
|
2424375
|
OTHER
|
Impl-totl Knee 42001-43000
|
60
|
13
|
$127,501.00
|
$76,500.60
40% off
|
$22,950.18
|
$127,501.00
|
$67,333.28
|
2026-05-22
|
|
2424624
|
OTHER
|
C1767 Neurostm Gen 42001-43000
|
60
|
13
|
$127,501.00
|
$76,500.60
40% off
|
$22,950.18
|
$127,501.00
|
$67,333.28
|
2026-05-22
|
|
2424072
|
OTHER
|
L8614 Cochlear Imp 42001-43000
|
60
|
13
|
$127,501.00
|
$76,500.60
40% off
|
$22,950.18
|
$127,501.00
|
$67,333.28
|
2026-05-22
|
|
2422938
|
OTHER
|
Impl-spine 42001-43000
|
60
|
13
|
$127,501.00
|
$76,500.60
40% off
|
$22,950.18
|
$127,501.00
|
$67,333.28
|
2026-05-22
|
|
2424851
|
OTHER
|
Impl-heart 42001-43000
|
60
|
13
|
$127,501.00
|
$76,500.60
40% off
|
$22,950.18
|
$127,501.00
|
$67,333.28
|
2026-05-22
|
|
MS-870
|
OTHER
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
66
|
19
|
—
|
—
|
$46,866.75
|
$235,665.35
|
$67,037.58
|
2026-05-22
|
|
MS-338
|
OTHER
|
Appendectomy With Complicated Principal Diagnosis With Mcc
|
8
|
2
|
—
|
—
|
$30,847.06
|
$79,147.76
|
$66,096.38
|
2026-05-22
|
|
6023
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
36
|
9
|
—
|
—
|
$38,849.90
|
$97,740.21
|
$66,027.53
|
2026-05-22
|
|
2424623
|
OTHER
|
C1767 Neurostm Gen 41001-42000
|
60
|
13
|
$124,501.00
|
$74,700.60
40% off
|
$22,410.18
|
$124,501.00
|
$65,748.98
|
2026-05-22
|
|
2424071
|
OTHER
|
L8614 Cochlear Imp 41001-42000
|
60
|
13
|
$124,501.00
|
$74,700.60
40% off
|
$22,410.18
|
$124,501.00
|
$65,748.98
|
2026-05-22
|
|
2424374
|
OTHER
|
Impl-totl Knee 41001-42000
|
60
|
13
|
$124,501.00
|
$74,700.60
40% off
|
$22,410.18
|
$124,501.00
|
$65,748.98
|
2026-05-22
|
|
2422937
|
OTHER
|
Impl-spine 41001-42000
|
60
|
13
|
$124,501.00
|
$74,700.60
40% off
|
$22,410.18
|
$124,501.00
|
$65,748.98
|
2026-05-22
|
|
2424211
|
OTHER
|
Cardiovasc Supply 41001-42000
|
60
|
13
|
$124,501.00
|
$74,700.60
40% off
|
$22,410.18
|
$124,501.00
|
$65,748.98
|
2026-05-22
|
|
2424152
|
OTHER
|
Impl-heart 41001-42000
|
60
|
13
|
$124,501.00
|
$74,700.60
40% off
|
$22,410.18
|
$124,501.00
|
$65,748.98
|
2026-05-22
|
|
MS-928
|
OTHER
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
66
|
19
|
—
|
—
|
$31,588.71
|
$226,261.10
|
$65,665.94
|
2026-05-22
|
|
5881
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
18
|
9
|
—
|
—
|
$63,019.67
|
$68,635.28
|
$65,515.50
|
2026-05-22
|
|
A9543
|
OTHER
|
Y90 Ibritumomab Rx
|
30
|
13
|
—
|
—
|
$55,119.81
|
$127,855.24
|
$65,348.23
|
2026-05-22
|
|
MS-223
|
OTHER
|
Cardiac Defibrillator Implant With Cardiac Catheterization With Ami- Hf Or Shock…
|
18
|
5
|
—
|
—
|
$83.30
|
$176,793.90
|
$65,054.62
|
2026-05-22
|
|
3560723
|
OTHER
|
Cl Endovascular Venous Arterialization Tibl/prnl Vn
|
60
|
13
|
$122,965.00
|
$73,779.00
40% off
|
$22,133.70
|
$122,965.00
|
$64,937.82
|
2026-05-22
|
|
0022
|
OTHER
|
Heart And/or Lung Transplant
|
36
|
9
|
—
|
—
|
$49,644.69
|
$82,184.08
|
$64,764.20
|
2026-05-22
|
|
MS-317
|
OTHER
|
Endovascular Cardiac Valve Replacement & Supplement Procedures W Mcc
|
64
|
18
|
—
|
—
|
$43,871.93
|
$209,576.67
|
$64,592.67
|
2026-05-22
|
|
MS-231
|
OTHER
|
Coronary Bypass With Ptca With Mcc
|
76
|
19
|
—
|
—
|
$65.55
|
$287,070.31
|
$64,305.58
|
2026-05-22
|
|
0100T
|
OTHER
|
Prosth Retina Receive&gen
|
2
|
1
|
—
|
—
|
$64,230.00
|
$64,230.00
|
$64,230.00
|
2026-05-22
|
|
0424T
|
OTHER
|
Insj/rplc Nstim Apnea Compl
|
2
|
1
|
—
|
—
|
$64,230.00
|
$64,230.00
|
$64,230.00
|
2026-05-22
|
|
2424622
|
OTHER
|
C1767 Neurostm Gen 40001-41000
|
60
|
13
|
$121,501.00
|
$72,900.60
40% off
|
$21,870.18
|
$121,501.00
|
$64,164.68
|
2026-05-22
|
|
2424070
|
OTHER
|
L8614 Cochlear Imp 40001-41000
|
60
|
13
|
$121,501.00
|
$72,900.60
40% off
|
$21,870.18
|
$121,501.00
|
$64,164.68
|
2026-05-22
|
|
2424373
|
OTHER
|
Impl-totl Knee 40001-41000
|
60
|
13
|
$121,501.00
|
$72,900.60
40% off
|
$21,870.18
|
$121,501.00
|
$64,164.68
|
2026-05-22
|
|
2422936
|
OTHER
|
Impl-spine 40001-41000
|
60
|
13
|
$121,501.00
|
$72,900.60
40% off
|
$21,870.18
|
$121,501.00
|
$64,164.68
|
2026-05-22
|
|
2424850
|
OTHER
|
Impl-heart 40001-41000
|
60
|
13
|
$121,501.00
|
$72,900.60
40% off
|
$21,870.18
|
$121,501.00
|
$64,164.68
|
2026-05-22
|
|
2424210
|
OTHER
|
Cardiovasc Supply 40001-41000
|
60
|
13
|
$121,501.00
|
$72,900.60
40% off
|
$21,870.18
|
$121,501.00
|
$64,164.68
|
2026-05-22
|
|
MS-275
|
OTHER
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
68
|
18
|
—
|
—
|
$52.30
|
$239,408.76
|
$63,739.91
|
2026-05-22
|
|
2424012
|
OTHER
|
C1767 Neurostm Gen 39001-40000
|
60
|
13
|
$118,501.00
|
$71,100.60
40% off
|
$21,330.18
|
$118,501.00
|
$62,580.38
|
2026-05-22
|
|
2424209
|
OTHER
|
Cardiovasc Supply 39001-40000
|
60
|
13
|
$118,501.00
|
$71,100.60
40% off
|
$21,330.18
|
$118,501.00
|
$62,580.38
|
2026-05-22
|
|
2424849
|
OTHER
|
Impl-heart 39001-40000
|
60
|
13
|
$118,501.00
|
$71,100.60
40% off
|
$21,330.18
|
$118,501.00
|
$62,580.38
|
2026-05-22
|
|
2423367
|
OTHER
|
L8614 Cochlear Imp 39001-40000
|
60
|
13
|
$118,501.00
|
$71,100.60
40% off
|
$21,330.18
|
$118,501.00
|
$62,580.38
|
2026-05-22
|
|
2424372
|
OTHER
|
Impl-totl Knee 39001-40000
|
60
|
13
|
$118,501.00
|
$71,100.60
40% off
|
$21,330.18
|
$118,501.00
|
$62,580.38
|
2026-05-22
|
|
2424580
|
OTHER
|
C1822 Gen Neu Rchg Hf 39001-40000
|
60
|
13
|
$118,501.00
|
$71,100.60
40% off
|
$21,330.18
|
$118,501.00
|
$62,580.38
|
2026-05-22
|
|
2422935
|
OTHER
|
Impl-spine 39001-40000
|
60
|
13
|
$118,501.00
|
$71,100.60
40% off
|
$21,330.18
|
$118,501.00
|
$62,580.38
|
2026-05-22
|
|
MS-647
|
OTHER
|
Neonate- Birthwt 1500-1999g- Without Signif O.r. Proc- W Mult Major Prob
|
2
|
1
|
—
|
—
|
$62,462.17
|
$62,462.17
|
$62,462.17
|
2026-05-22
|
|
5891
|
OTHER
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
18
|
9
|
—
|
—
|
$60,053.30
|
$65,404.58
|
$62,431.65
|
2026-05-22
|
|
MS-635
|
OTHER
|
Neonate- Birthwt 1000-1499g- Died
|
2
|
1
|
—
|
—
|
$62,331.79
|
$62,331.79
|
$62,331.79
|
2026-05-22
|
|
MS-573
|
OTHER
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
66
|
19
|
—
|
—
|
$43,671.94
|
$208,621.34
|
$62,192.19
|
2026-05-22
|
|
MS-834
|
OTHER
|
Acute Leukemia Without Major O.r. Procedures With Mcc
|
66
|
19
|
—
|
—
|
$37,225.30
|
$187,248.34
|
$61,930.50
|
2026-05-22
|
|
MS-969
|
OTHER
|
HIV With Extensive O.r. Procedures With Mcc
|
66
|
19
|
—
|
—
|
$41,506.62
|
$214,248.31
|
$61,508.62
|
2026-05-22
|
|
6114
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Major Anomaly
|
36
|
9
|
—
|
—
|
$35,973.91
|
$90,504.65
|
$61,139.61
|
2026-05-22
|
|
MS-207
|
OTHER
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
66
|
19
|
—
|
—
|
$43,631.69
|
$219,089.33
|
$61,084.36
|
2026-05-22
|
|
2424011
|
OTHER
|
C1767 Neurostm Gen 38001-39000
|
60
|
13
|
$115,501.00
|
$69,300.60
40% off
|
$20,790.18
|
$115,501.00
|
$60,996.08
|
2026-05-22
|
|
2424208
|
OTHER
|
Cardiovasc Supply 38001-39000
|
60
|
13
|
$115,501.00
|
$69,300.60
40% off
|
$20,790.18
|
$115,501.00
|
$60,996.08
|
2026-05-22
|
|
2423366
|
OTHER
|
L8614 Cochlear Imp 38001-39000
|
60
|
13
|
$115,501.00
|
$69,300.60
40% off
|
$20,790.18
|
$115,501.00
|
$60,996.08
|
2026-05-22
|
|
2424579
|
OTHER
|
C1822 Gen Neu Rchg Hf 38001-39000
|
60
|
13
|
$115,501.00
|
$69,300.60
40% off
|
$20,790.18
|
$115,501.00
|
$60,996.08
|
2026-05-22
|
|
2424848
|
OTHER
|
Impl-heart 38001-39000
|
60
|
13
|
$115,501.00
|
$69,300.60
40% off
|
$20,790.18
|
$115,501.00
|
$60,996.08
|
2026-05-22
|
|
2424371
|
OTHER
|
Impl-totl Knee 38001-39000
|
60
|
13
|
$115,501.00
|
$69,300.60
40% off
|
$20,790.18
|
$115,501.00
|
$60,996.08
|
2026-05-22
|
|
2424830
|
OTHER
|
C1889 Implantable Device Nos 38001-39000
|
60
|
13
|
$115,501.00
|
$69,300.60
40% off
|
$20,790.18
|
$115,501.00
|
$60,996.08
|
2026-05-22
|
|
2422934
|
OTHER
|
Impl-spine 38001-39000
|
60
|
13
|
$115,501.00
|
$69,300.60
40% off
|
$20,790.18
|
$115,501.00
|
$60,996.08
|
2026-05-22
|
|
6134
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection
|
36
|
9
|
—
|
—
|
$35,643.26
|
$89,672.80
|
$60,577.67
|
2026-05-22
|
|
8634
|
OTHER
|
Neonatal Aftercare
|
36
|
9
|
—
|
—
|
$35,183.77
|
$88,516.80
|
$59,796.74
|
2026-05-22
|
|
MS-268
|
OTHER
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
68
|
19
|
—
|
—
|
$70.90
|
$225,878.29
|
$59,462.04
|
2026-05-22
|
|
2424207
|
OTHER
|
Cardiovasc Supply 37001-38000
|
60
|
13
|
$112,501.00
|
$67,500.60
40% off
|
$20,250.18
|
$112,501.00
|
$59,411.78
|
2026-05-22
|
|
2424010
|
OTHER
|
C1767 Neurostm Gen 37001-38000
|
60
|
13
|
$112,501.00
|
$67,500.60
40% off
|
$20,250.18
|
$112,501.00
|
$59,411.78
|
2026-05-22
|
|
2423380
|
OTHER
|
Impl-heart 37001-38000
|
60
|
13
|
$112,501.00
|
$67,500.60
40% off
|
$20,250.18
|
$112,501.00
|
$59,411.78
|
2026-05-22
|
|
2422933
|
OTHER
|
Impl-spine 37001-38000
|
60
|
13
|
$112,501.00
|
$67,500.60
40% off
|
$20,250.18
|
$112,501.00
|
$59,411.78
|
2026-05-22
|
|
2424829
|
OTHER
|
C1889 Implantable Device Nos 37001-38000
|
60
|
13
|
$112,501.00
|
$67,500.60
40% off
|
$20,250.18
|
$112,501.00
|
$59,411.78
|
2026-05-22
|
|
2424370
|
OTHER
|
Impl-totl Knee 37001-38000
|
60
|
13
|
$112,501.00
|
$67,500.60
40% off
|
$20,250.18
|
$112,501.00
|
$59,411.78
|
2026-05-22
|
|
2424578
|
OTHER
|
C1822 Gen Neu Rchg Hf 37001-38000
|
60
|
13
|
$112,501.00
|
$67,500.60
40% off
|
$20,250.18
|
$112,501.00
|
$59,411.78
|
2026-05-22
|
|
2423365
|
OTHER
|
L8614 Cochlear Imp 37001-38000
|
60
|
13
|
$112,501.00
|
$67,500.60
40% off
|
$20,250.18
|
$112,501.00
|
$59,411.78
|
2026-05-22
|
|
0013
|
OTHER
|
Liver Transplant And/or Intestinal Transplant
|
36
|
9
|
—
|
—
|
$34,780.90
|
$87,503.23
|
$59,112.03
|
2026-05-22
|
|
1624
|
OTHER
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
36
|
9
|
—
|
—
|
$34,649.51
|
$87,172.69
|
$58,888.74
|
2026-05-22
|
|
MS-023
|
OTHER
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
68
|
19
|
—
|
—
|
$38,855.37
|
$293,885.73
|
$58,828.40
|
2026-05-22
|
|
3034
|
OTHER
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
36
|
9
|
—
|
—
|
$34,482.20
|
$86,751.74
|
$58,604.36
|
2026-05-22
|
|
MS-457
|
OTHER
|
Spinal Fusion Except Cervical With Spinal Curvature- Malignancy- Infection Or Ex…
|
66
|
19
|
—
|
—
|
$40,433.92
|
$194,433.65
|
$58,298.27
|
2026-05-22
|
|
MS-266
|
OTHER
|
Endovascular Cardiac Valve Replacement W Mcc
|
66
|
19
|
—
|
—
|
$38,567.72
|
$202,950.33
|
$58,176.67
|
2026-05-22
|
|
MS-646
|
OTHER
|
Neonate- Birthwt 1500-1999g- W Signif O.r. Proc- Without Mult Major Prob
|
2
|
1
|
—
|
—
|
$58,161.46
|
$58,161.46
|
$58,161.46
|
2026-05-22
|
|
0053
|
OTHER
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
36
|
9
|
—
|
—
|
$34,209.98
|
$86,066.90
|
$58,141.74
|
2026-05-22
|
|
2424206
|
OTHER
|
Cardiovasc Supply 36001-37000
|
60
|
13
|
$109,501.00
|
$65,700.60
40% off
|
$19,710.18
|
$109,501.00
|
$57,827.48
|
2026-05-22
|
|
2422932
|
OTHER
|
Impl-spine 36001-37000
|
60
|
13
|
$109,501.00
|
$65,700.60
40% off
|
$19,710.18
|
$109,501.00
|
$57,827.48
|
2026-05-22
|
|
2424009
|
OTHER
|
C1767 Neurostm Gen 36001-37000
|
60
|
13
|
$109,501.00
|
$65,700.60
40% off
|
$19,710.18
|
$109,501.00
|
$57,827.48
|
2026-05-22
|
|
2423379
|
OTHER
|
Impl-heart 36001-37000
|
60
|
13
|
$109,501.00
|
$65,700.60
40% off
|
$19,710.18
|
$109,501.00
|
$57,827.48
|
2026-05-22
|
|
2424828
|
OTHER
|
C1889 Implantable Device Nos 36001-37000
|
60
|
13
|
$109,501.00
|
$65,700.60
40% off
|
$19,710.18
|
$109,501.00
|
$57,827.48
|
2026-05-22
|
|
2423364
|
OTHER
|
L8614 Cochlear Imp 36001-37000
|
60
|
13
|
$109,501.00
|
$65,700.60
40% off
|
$19,710.18
|
$109,501.00
|
$57,827.48
|
2026-05-22
|
|
2424369
|
OTHER
|
Impl-totl Knee 36001-37000
|
60
|
13
|
$109,501.00
|
$65,700.60
40% off
|
$19,710.18
|
$109,501.00
|
$57,827.48
|
2026-05-22
|
|
2424577
|
OTHER
|
C1822 Gen Neu Rchg Hf 36001-37000
|
60
|
13
|
$109,501.00
|
$65,700.60
40% off
|
$19,710.18
|
$109,501.00
|
$57,827.48
|
2026-05-22
|
|
MS-447
|
OTHER
|
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…
|
60
|
18
|
—
|
—
|
$45,305.84
|
$227,135.12
|
$57,764.95
|
2026-05-22
|
|
4404
|
OTHER
|
Kidney Transplant
|
36
|
9
|
—
|
—
|
$33,928.70
|
$85,359.23
|
$57,663.67
|
2026-05-22
|
|
0063
|
OTHER
|
Pancreas Transplant
|
36
|
9
|
—
|
—
|
$33,723.64
|
$84,843.32
|
$57,315.15
|
2026-05-22
|
|
MS-028
|
OTHER
|
Spinal Procedures With Mcc
|
66
|
19
|
—
|
—
|
$40,740.40
|
$205,955.22
|
$57,036.57
|
2026-05-22
|
|
MS-461
|
OTHER
|
Bilateral Or Multiple Major Joint Procs Of Lower Extremity W Mcc
|
66
|
19
|
—
|
—
|
$37,449.74
|
$207,892.99
|
$57,015.28
|
2026-05-22
|
|
5932
|
OTHER
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
36
|
9
|
—
|
—
|
$43,702.87
|
$72,347.73
|
$57,012.79
|
2026-05-22
|
|
MS-248
|
OTHER
|
Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent With Mcc Or 4…
|
18
|
5
|
—
|
—
|
$83.30
|
$101,962.99
|
$56,433.75
|
2026-05-22
|
|
MS-016
|
OTHER
|
Autolous Bone Marrow Transplant With Cc/mcc
|
66
|
19
|
—
|
—
|
$40,207.44
|
$204,478.18
|
$56,290.42
|
2026-05-22
|
|
MS-427
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
60
|
18
|
—
|
—
|
$13,977.30
|
$240,618.17
|
$56,289.13
|
2026-05-22
|
|
2422931
|
OTHER
|
Impl-spine 35001-36000
|
60
|
13
|
$106,501.00
|
$63,900.60
40% off
|
$19,170.18
|
$106,501.00
|
$56,243.18
|
2026-05-22
|
|
2424008
|
OTHER
|
C1767 Neurostm Gen 35001-36000
|
60
|
13
|
$106,501.00
|
$63,900.60
40% off
|
$19,170.18
|
$106,501.00
|
$56,243.18
|
2026-05-22
|
|
2423079
|
OTHER
|
Cardiovasc Supply 35001-36000
|
60
|
13
|
$106,501.00
|
$63,900.60
40% off
|
$19,170.18
|
$106,501.00
|
$56,243.18
|
2026-05-22
|
|
2424827
|
OTHER
|
C1889 Implantable Device Nos 35001-36000
|
60
|
13
|
$106,501.00
|
$63,900.60
40% off
|
$19,170.18
|
$106,501.00
|
$56,243.18
|
2026-05-22
|
|
2423378
|
OTHER
|
Impl-heart 35001-36000
|
60
|
13
|
$106,501.00
|
$63,900.60
40% off
|
$19,170.18
|
$106,501.00
|
$56,243.18
|
2026-05-22
|
|
2423363
|
OTHER
|
L8614 Cochlear Imp 35001-36000
|
60
|
13
|
$106,501.00
|
$63,900.60
40% off
|
$19,170.18
|
$106,501.00
|
$56,243.18
|
2026-05-22
|
|
2423817
|
OTHER
|
C1822 Gen Neu Rchg Hf 35001-36000
|
60
|
13
|
$106,501.00
|
$63,900.60
40% off
|
$19,170.18
|
$106,501.00
|
$56,243.18
|
2026-05-22
|
|
2424368
|
OTHER
|
Impl-totl Knee 35001-36000
|
60
|
13
|
$106,501.00
|
$63,900.60
40% off
|
$19,170.18
|
$106,501.00
|
$56,243.18
|
2026-05-22
|
|
MS-341
|
OTHER
|
Appendectomy Without Complicated Principal Diagnosis With Mcc
|
8
|
2
|
—
|
—
|
$27,115.86
|
$67,304.65
|
$56,206.18
|
2026-05-22
|
|
MS-246
|
OTHER
|
Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar…
|
18
|
5
|
—
|
—
|
$83.30
|
$101,475.17
|
$56,163.75
|
2026-05-22
|
|
L7181
|
OTHER
|
Electronic Elbo Simultaneous
|
30
|
13
|
—
|
—
|
$47,173.81
|
$109,423.78
|
$55,927.71
|
2026-05-22
|
|
MS-820
|
OTHER
|
Lymphoma And Leukemia With Major O.r. Procedures With Mcc
|
66
|
19
|
—
|
—
|
$39,767.38
|
$197,242.06
|
$55,674.33
|
2026-05-22
|
|
MS-235
|
OTHER
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
76
|
19
|
—
|
—
|
$65.55
|
$199,339.04
|
$55,617.90
|
2026-05-22
|
|
Q2043
|
OTHER
|
Sipuleucel-t Auto Cd54+
|
48
|
19
|
—
|
—
|
$15,363.65
|
$124,957.13
|
$55,536.50
|
2026-05-22
|
|
MS-008
|
OTHER
|
Simultaneous Pancreas/kidney Transplant
|
66
|
19
|
—
|
—
|
$38,003.04
|
$184,328.14
|
$55,453.78
|
2026-05-22
|
|
3560705
|
OTHER
|
Cl Insert/repl Ss Icd & Lead (s)
|
60
|
13
|
$103,975.00
|
$62,385.00
40% off
|
$18,715.50
|
$103,975.00
|
$54,909.19
|
2026-05-22
|
|
2422860
|
OTHER
|
Impl-totl Knee 34001-35000
|
60
|
13
|
$103,501.00
|
$62,100.60
40% off
|
$18,630.18
|
$103,501.00
|
$54,658.88
|
2026-05-22
|
|
2424618
|
OTHER
|
C1781 Surg Mesh 34001-35000
|
60
|
13
|
$103,501.00
|
$62,100.60
40% off
|
$18,630.18
|
$103,501.00
|
$54,658.88
|
2026-05-22
|
|
2422739
|
OTHER
|
Impl-spine 34001-35000
|
60
|
13
|
$103,501.00
|
$62,100.60
40% off
|
$18,630.18
|
$103,501.00
|
$54,658.88
|
2026-05-22
|
|
2423377
|
OTHER
|
Impl-heart 34001-35000
|
60
|
13
|
$103,501.00
|
$62,100.60
40% off
|
$18,630.18
|
$103,501.00
|
$54,658.88
|
2026-05-22
|
|
2423078
|
OTHER
|
Cardiovasc Supply 34001-35000
|
60
|
13
|
$103,501.00
|
$62,100.60
40% off
|
$18,630.18
|
$103,501.00
|
$54,658.88
|
2026-05-22
|
|
2423362
|
OTHER
|
L8614 Cochlear Imp 34001-35000
|
60
|
13
|
$103,501.00
|
$62,100.60
40% off
|
$18,630.18
|
$103,501.00
|
$54,658.88
|
2026-05-22
|
|
2424576
|
OTHER
|
C1822 Gen Neu Rchg Hf 34001-35000
|
60
|
13
|
$103,501.00
|
$62,100.60
40% off
|
$18,630.18
|
$103,501.00
|
$54,658.88
|
2026-05-22
|
|
2424826
|
OTHER
|
C1889 Implantable Device Nos 34001-35000
|
60
|
13
|
$103,501.00
|
$62,100.60
40% off
|
$18,630.18
|
$103,501.00
|
$54,658.88
|
2026-05-22
|
|
2423670
|
OTHER
|
C1767 Neurostm Gen 34001-35000
|
60
|
13
|
$103,501.00
|
$62,100.60
40% off
|
$18,630.18
|
$103,501.00
|
$54,658.88
|
2026-05-22
|
|
MS-463
|
OTHER
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …
|
66
|
19
|
—
|
—
|
$38,302.13
|
$182,969.68
|
$54,105.14
|
2026-05-22
|
|
1611
|
OTHER
|
Implantable Heart Assist Systems
|
18
|
9
|
—
|
—
|
$51,747.25
|
$56,358.39
|
$53,796.64
|
2026-05-22
|
|
0084
|
OTHER
|
Autologous Bone Marrow Transplant
|
36
|
9
|
—
|
—
|
$31,516.91
|
$79,291.56
|
$53,564.71
|
2026-05-22
|
|
MS-234
|
OTHER
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc
|
76
|
19
|
—
|
—
|
$65.55
|
$328,997.91
|
$53,521.99
|
2026-05-22
|
|
3560355
|
OTHER
|
Cl Insert Defib Pulse Gen Only W/mult Leads
|
60
|
13
|
$100,849.00
|
$60,509.40
40% off
|
$18,152.82
|
$100,849.00
|
$53,258.35
|
2026-05-22
|
|
MS-228
|
OTHER
|
Other Cardiothoracic Procedures With Mcc
|
76
|
19
|
—
|
—
|
$65.55
|
$293,041.63
|
$53,146.96
|
2026-05-22
|
|
2422859
|
OTHER
|
Impl-totl Knee 33001-34000
|
60
|
13
|
$100,501.00
|
$60,300.60
40% off
|
$18,090.18
|
$100,501.00
|
$53,074.58
|
2026-05-22
|
|
2423077
|
OTHER
|
Cardiovasc Supply 33001-34000
|
60
|
13
|
$100,501.00
|
$60,300.60
40% off
|
$18,090.18
|
$100,501.00
|
$53,074.58
|
2026-05-22
|
|
2424617
|
OTHER
|
C1781 Surg Mesh 33001-34000
|
60
|
13
|
$100,501.00
|
$60,300.60
40% off
|
$18,090.18
|
$100,501.00
|
$53,074.58
|
2026-05-22
|
|
2423263
|
OTHER
|
L8614 Cochlear Imp 33001-34000
|
60
|
13
|
$100,501.00
|
$60,300.60
40% off
|
$18,090.18
|
$100,501.00
|
$53,074.58
|
2026-05-22
|
|
2423669
|
OTHER
|
C1767 Neurostm Gen 33001-34000
|
60
|
13
|
$100,501.00
|
$60,300.60
40% off
|
$18,090.18
|
$100,501.00
|
$53,074.58
|
2026-05-22
|
|
2423376
|
OTHER
|
Impl-heart 33001-34000
|
60
|
13
|
$100,501.00
|
$60,300.60
40% off
|
$18,090.18
|
$100,501.00
|
$53,074.58
|
2026-05-22
|
|
2424825
|
OTHER
|
C1889 Implantable Device Nos 33001-34000
|
60
|
13
|
$100,501.00
|
$60,300.60
40% off
|
$18,090.18
|
$100,501.00
|
$53,074.58
|
2026-05-22
|
|
2422738
|
OTHER
|
Impl-spine 33001-34000
|
60
|
13
|
$100,501.00
|
$60,300.60
40% off
|
$18,090.18
|
$100,501.00
|
$53,074.58
|
2026-05-22
|
|
2424575
|
OTHER
|
C1822 Gen Neu Rchg Hf 33001-34000
|
60
|
13
|
$100,501.00
|
$60,300.60
40% off
|
$18,090.18
|
$100,501.00
|
$53,074.58
|
2026-05-22
|
|
2424413
|
OTHER
|
C1825 Gen Neuro Carot Sinus Baro 33001-34000
|
60
|
13
|
$100,501.00
|
$60,300.60
40% off
|
$18,090.18
|
$100,501.00
|
$53,074.58
|
2026-05-22
|
|
2424736
|
OTHER
|
C1827 Gen Neuro Imp Led Ex Cntr 33001-34000
|
60
|
13
|
$100,501.00
|
$60,300.60
40% off
|
$18,090.18
|
$100,501.00
|
$53,074.58
|
2026-05-22
|
|
3560480
|
OTHER
|
Cl Ins/replac Sq Impltbl Defib
|
60
|
13
|
$100,354.00
|
$60,212.40
40% off
|
$18,063.72
|
$100,354.00
|
$52,996.95
|
2026-05-22
|
|
6093
|
OTHER
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
36
|
9
|
—
|
—
|
$31,136.91
|
$78,335.52
|
$52,918.87
|
2026-05-22
|
|
MS-955
|
OTHER
|
Craniotomy For Multiple Significant Trauma
|
76
|
19
|
—
|
—
|
$65.55
|
$231,322.32
|
$52,487.71
|
2026-05-22
|
|
MS-011
|
OTHER
|
Tracheostomy For Facemouth & Neck Diagnoses W Mcc
|
66
|
19
|
—
|
—
|
$36,982.55
|
$182,796.90
|
$52,404.28
|
2026-05-22
|
|
MS-270
|
OTHER
|
Other Major Cardiovascular Procedures With Mcc
|
68
|
19
|
—
|
—
|
$3,353.16
|
$173,890.64
|
$52,127.92
|
2026-05-22
|
|
0266T
|
OTHER
|
Implt/rpl Crtd Sns Dev Total
|
30
|
12
|
—
|
—
|
$43,478.00
|
$101,633.85
|
$51,946.19
|
2026-05-22
|
|
MS-405
|
OTHER
|
Pancreas- Liver And Shunt Procedures With Mcc
|
66
|
19
|
—
|
—
|
$37,093.75
|
$183,908.07
|
$51,931.25
|
2026-05-22
|
|
MS-367
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
2
|
1
|
—
|
—
|
$51,767.33
|
$51,767.33
|
$51,767.33
|
2026-05-22
|
|
MS-006
|
OTHER
|
Liver Transplant Without Mcc
|
66
|
19
|
—
|
—
|
$31,442.05
|
$164,276.35
|
$51,642.14
|
2026-05-22
|
|
MS-017
|
OTHER
|
Autolous Bone Marrow Transplant Without Cc/mcc
|
66
|
19
|
—
|
—
|
$36,834.73
|
$204,478.18
|
$51,568.62
|
2026-05-22
|
|
1634
|
OTHER
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
36
|
9
|
—
|
—
|
$30,319.55
|
$76,279.18
|
$51,529.73
|
2026-05-22
|
|
2422858
|
OTHER
|
Impl-totl Knee 32001-33000
|
60
|
13
|
$97,501.00
|
$58,500.60
40% off
|
$17,550.18
|
$97,501.00
|
$51,490.28
|
2026-05-22
|
|
2424412
|
OTHER
|
C1825 Gen Neuro Carot Sinus Baro 32001-33000
|
60
|
13
|
$97,501.00
|
$58,500.60
40% off
|
$17,550.18
|
$97,501.00
|
$51,490.28
|
2026-05-22
|
|
2423668
|
OTHER
|
C1767 Neurostm Gen 32001-33000
|
60
|
13
|
$97,501.00
|
$58,500.60
40% off
|
$17,550.18
|
$97,501.00
|
$51,490.28
|
2026-05-22
|
|
2423361
|
OTHER
|
L8614 Cochlear Imp 32001-33000
|
60
|
13
|
$97,501.00
|
$58,500.60
40% off
|
$17,550.18
|
$97,501.00
|
$51,490.28
|
2026-05-22
|
|
2424616
|
OTHER
|
C1781 Surg Mesh 32001-33000
|
60
|
13
|
$97,501.00
|
$58,500.60
40% off
|
$17,550.18
|
$97,501.00
|
$51,490.28
|
2026-05-22
|
|
2423187
|
OTHER
|
Impl-heart 32001-33000
|
60
|
13
|
$97,501.00
|
$58,500.60
40% off
|
$17,550.18
|
$97,501.00
|
$51,490.28
|
2026-05-22
|
|
2424735
|
OTHER
|
C1827 Gen Neuro Imp Led Ex Cntr 32001-33000
|
60
|
13
|
$97,501.00
|
$58,500.60
40% off
|
$17,550.18
|
$97,501.00
|
$51,490.28
|
2026-05-22
|
|
2424824
|
OTHER
|
C1889 Implantable Device Nos 32001-33000
|
60
|
13
|
$97,501.00
|
$58,500.60
40% off
|
$17,550.18
|
$97,501.00
|
$51,490.28
|
2026-05-22
|
|
2422737
|
OTHER
|
Impl-spine 32001-33000
|
60
|
13
|
$97,501.00
|
$58,500.60
40% off
|
$17,550.18
|
$97,501.00
|
$51,490.28
|
2026-05-22
|
|
2423076
|
OTHER
|
Cardiovasc Supply 32001-33000
|
60
|
13
|
$97,501.00
|
$58,500.60
40% off
|
$17,550.18
|
$97,501.00
|
$51,490.28
|
2026-05-22
|
|
2424574
|
OTHER
|
C1822 Gen Neu Rchg Hf 32001-33000
|
60
|
13
|
$97,501.00
|
$58,500.60
40% off
|
$17,550.18
|
$97,501.00
|
$51,490.28
|
2026-05-22
|
|
MS-576
|
OTHER
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc
|
66
|
19
|
—
|
—
|
$33,233.50
|
$182,776.58
|
$51,401.52
|
2026-05-22
|
|
MS-217
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
74
|
19
|
—
|
—
|
$65.55
|
$218,774.28
|
$51,272.81
|
2026-05-22
|
|
MS-218
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
76
|
19
|
—
|
—
|
$65.55
|
$201,544.44
|
$51,272.81
|
2026-05-22
|
|
3560606
|
OTHER
|
Cl Transcath Impl Wrls P-art Prs Snr
|
60
|
13
|
$95,890.00
|
$57,534.00
40% off
|
$17,260.20
|
$95,890.00
|
$50,639.51
|
2026-05-22
|