|
18
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
102
|
51
|
—
|
—
|
$169,050.99
|
$2,002,042.70
|
$309,648.84
|
2026-05-24
|
|
588-4
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
20
|
10
|
—
|
—
|
$221,000.00
|
$232,050.00
|
$221,000.00
|
2026-05-24
|
|
583-3
|
OTHER
|
Neonate With Ecmo
|
20
|
10
|
—
|
—
|
$221,000.00
|
$232,050.00
|
$221,000.00
|
2026-05-24
|
|
583-4
|
OTHER
|
Neonate With Ecmo
|
20
|
10
|
—
|
—
|
$221,000.00
|
$232,050.00
|
$221,000.00
|
2026-05-24
|
|
1
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
90
|
45
|
—
|
—
|
$148,745.00
|
$592,614.42
|
$220,489.90
|
2026-05-24
|
|
630-4
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
20
|
10
|
—
|
—
|
$211,296.47
|
$221,861.29
|
$211,296.47
|
2026-05-24
|
|
7
|
OTHER
|
Lung Transplant
|
92
|
46
|
—
|
—
|
$102,297.21
|
$1,513,993.04
|
$201,363.45
|
2026-05-24
|
|
927
|
OTHER
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
108
|
54
|
—
|
—
|
$125,501.41
|
$540,951.01
|
$201,323.58
|
2026-05-24
|
|
631-4
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
20
|
10
|
—
|
—
|
$186,976.63
|
$196,325.46
|
$186,976.63
|
2026-05-24
|
|
3
|
OTHER
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
108
|
54
|
—
|
—
|
$113,521.72
|
$548,272.58
|
$185,716.90
|
2026-05-24
|
|
609-4
|
OTHER
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
20
|
10
|
—
|
—
|
$165,000.00
|
$173,250.00
|
$165,000.00
|
2026-05-24
|
|
02HA3QZ
|
OTHER
|
Lvad
|
6
|
3
|
—
|
—
|
$101,501.00
|
$149,266.00
|
$149,266.00
|
2026-05-24
|
|
02HA4QZ
|
OTHER
|
Lvad
|
6
|
3
|
—
|
—
|
$101,501.00
|
$149,266.00
|
$149,266.00
|
2026-05-24
|
|
02HA0QZ
|
OTHER
|
Lvad
|
6
|
3
|
—
|
—
|
$101,501.00
|
$149,266.00
|
$149,266.00
|
2026-05-24
|
|
583-2
|
OTHER
|
Neonate With Ecmo
|
20
|
10
|
—
|
—
|
$145,322.76
|
$152,588.90
|
$145,322.76
|
2026-05-24
|
|
588-3
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
20
|
10
|
—
|
—
|
$132,000.00
|
$138,600.00
|
$132,000.00
|
2026-05-24
|
|
011-3
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
20
|
10
|
—
|
—
|
$131,545.36
|
$138,122.63
|
$131,545.36
|
2026-05-24
|
|
4
|
OTHER
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
108
|
54
|
—
|
—
|
$75,355.54
|
$664,447.89
|
$123,265.68
|
2026-05-24
|
|
593-4
|
OTHER
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
20
|
10
|
—
|
—
|
$121,000.00
|
$127,050.00
|
$121,000.00
|
2026-05-24
|
|
591-4
|
OTHER
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
20
|
10
|
—
|
—
|
$120,000.00
|
$126,000.00
|
$120,000.00
|
2026-05-24
|
|
002-4
|
OTHER
|
Heart And/or Lung Transplant
|
20
|
10
|
—
|
—
|
$111,047.26
|
$116,599.62
|
$111,047.26
|
2026-05-24
|
|
588-2
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
20
|
10
|
—
|
—
|
$108,772.56
|
$114,211.19
|
$108,772.56
|
2026-05-24
|
|
14
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
102
|
51
|
—
|
—
|
$27,217.43
|
$308,644.41
|
$104,953.25
|
2026-05-24
|
|
602-4
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
20
|
10
|
—
|
—
|
$100,000.00
|
$105,000.00
|
$100,000.00
|
2026-05-24
|
|
593-3
|
OTHER
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
20
|
10
|
—
|
—
|
$99,000.00
|
$103,950.00
|
$99,000.00
|
2026-05-24
|
|
607-4
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
20
|
10
|
—
|
—
|
$97,101.66
|
$101,956.74
|
$97,101.66
|
2026-05-24
|
|
161-4
|
OTHER
|
Implantable Heart Assist Systems
|
20
|
10
|
—
|
—
|
$95,167.09
|
$99,925.44
|
$95,167.09
|
2026-05-24
|
|
630-3
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
20
|
10
|
—
|
—
|
$95,000.00
|
$99,750.00
|
$95,000.00
|
2026-05-24
|
|
215
|
OTHER
|
Other Heart Assist System Implant
|
108
|
54
|
—
|
—
|
$56,860.81
|
$318,651.60
|
$93,002.81
|
2026-05-24
|
|
303-4
|
OTHER
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
20
|
10
|
—
|
—
|
$92,119.45
|
$96,725.42
|
$92,119.45
|
2026-05-24
|
|
591-3
|
OTHER
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
20
|
10
|
—
|
—
|
$91,000.00
|
$95,550.00
|
$91,000.00
|
2026-05-24
|
|
841-4
|
OTHER
|
Extensive Third Degree Burns With Skin Graft
|
20
|
10
|
—
|
—
|
$90,217.23
|
$94,728.09
|
$90,217.23
|
2026-05-24
|
|
602-3
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
20
|
10
|
—
|
—
|
$89,874.13
|
$94,367.84
|
$89,874.13
|
2026-05-24
|
|
2
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
90
|
45
|
—
|
—
|
$59,082.43
|
$527,020.84
|
$88,623.65
|
2026-05-24
|
|
212
|
OTHER
|
Hip & Femur Procedures Except Major Joint Age 0-17
|
108
|
54
|
—
|
—
|
$43,022.87
|
$294,654.04
|
$88,300.46
|
2026-05-24
|
|
589-3
|
OTHER
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
20
|
10
|
—
|
—
|
$87,000.00
|
$91,350.00
|
$87,000.00
|
2026-05-24
|
|
5
|
OTHER
|
Liver Transplant With Mcc Or Intestinal Transplant
|
92
|
46
|
—
|
—
|
$57,146.29
|
$331,493.71
|
$86,367.99
|
2026-05-24
|
|
863-4
|
OTHER
|
Neonatal Aftercare
|
20
|
10
|
—
|
—
|
$80,871.28
|
$84,914.84
|
$80,871.28
|
2026-05-24
|
|
603-4
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
20
|
10
|
—
|
—
|
$80,000.00
|
$84,000.00
|
$80,000.00
|
2026-05-24
|
|
231
|
OTHER
|
Coronary Bypass With Ptca With Mcc
|
118
|
59
|
—
|
—
|
$45,771.55
|
$218,792.21
|
$79,450.00
|
2026-05-24
|
|
216
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
118
|
59
|
—
|
—
|
$51,926.61
|
$220,074.03
|
$79,065.30
|
2026-05-24
|
|
611-4
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Major Anomaly
|
20
|
10
|
—
|
—
|
$78,699.03
|
$82,633.98
|
$78,699.03
|
2026-05-24
|
|
007-4
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
20
|
10
|
—
|
—
|
$75,611.37
|
$79,391.94
|
$75,611.37
|
2026-05-24
|
|
009-4
|
OTHER
|
Extracorporeal Membrane Oxygenation (ecmo)
|
20
|
10
|
—
|
—
|
$75,232.49
|
$78,994.11
|
$75,232.49
|
2026-05-24
|
|
233
|
OTHER
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
118
|
59
|
—
|
—
|
$42,333.76
|
$178,237.37
|
$73,935.00
|
2026-05-24
|
|
453
|
OTHER
|
Combined Anterior And Posterior Spinal Fusion With Mcc
|
110
|
55
|
—
|
—
|
$13,475.00
|
$273,655.62
|
$71,696.43
|
2026-05-24
|
|
20
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
108
|
54
|
—
|
—
|
$26,400.00
|
$271,028.61
|
$71,325.77
|
2026-05-24
|
|
609-3
|
OTHER
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
20
|
10
|
—
|
—
|
$71,110.29
|
$74,665.80
|
$71,110.29
|
2026-05-24
|
|
603-3
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
20
|
10
|
—
|
—
|
$69,711.95
|
$73,197.55
|
$69,711.95
|
2026-05-24
|
|
583-1
|
OTHER
|
Neonate With Ecmo
|
20
|
10
|
—
|
—
|
$69,493.60
|
$72,968.28
|
$69,493.60
|
2026-05-24
|
|
612-4
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…
|
20
|
10
|
—
|
—
|
$69,359.04
|
$72,826.99
|
$69,359.04
|
2026-05-24
|
|
456
|
OTHER
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
114
|
57
|
—
|
—
|
$26,947.00
|
$227,851.88
|
$68,620.46
|
2026-05-24
|
|
219
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
118
|
59
|
—
|
—
|
$41,921.24
|
$211,702.44
|
$68,312.00
|
2026-05-24
|
|
591-2
|
OTHER
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
20
|
10
|
—
|
—
|
$68,150.11
|
$71,557.62
|
$68,150.11
|
2026-05-24
|
|
001-4
|
OTHER
|
Liver Transplant And/or Intestinal Transplant
|
20
|
10
|
—
|
—
|
$67,242.62
|
$70,604.75
|
$67,242.62
|
2026-05-24
|
|
607-3
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
20
|
10
|
—
|
—
|
$67,217.52
|
$70,578.40
|
$67,217.52
|
2026-05-24
|
|
004-4
|
OTHER
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
20
|
10
|
—
|
—
|
$66,782.14
|
$70,121.25
|
$66,782.14
|
2026-05-24
|
|
621-4
|
OTHER
|
Neonate Birth Weight 2000-2499 Grams With Major Anomaly
|
18
|
9
|
—
|
—
|
$1,200.00
|
$69,952.39
|
$66,621.32
|
2026-05-24
|
|
957
|
OTHER
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
108
|
54
|
—
|
—
|
$40,492.27
|
$170,206.15
|
$66,147.87
|
2026-05-24
|
|
633-4
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Anomaly
|
18
|
9
|
—
|
—
|
$1,200.00
|
$69,247.90
|
$65,950.38
|
2026-05-24
|
|
10
|
OTHER
|
Pancreas Transplant
|
92
|
46
|
—
|
—
|
$43,152.56
|
$254,735.84
|
$64,728.84
|
2026-05-24
|
|
161-3
|
OTHER
|
Implantable Heart Assist Systems
|
20
|
10
|
—
|
—
|
$64,392.40
|
$67,612.02
|
$64,392.40
|
2026-05-24
|
|
19
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
102
|
51
|
—
|
—
|
$11,458.23
|
$180,766.22
|
$64,370.42
|
2026-05-24
|
|
593-2
|
OTHER
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
20
|
10
|
—
|
—
|
$63,775.17
|
$66,963.93
|
$63,775.17
|
2026-05-24
|
|
002-3
|
OTHER
|
Heart And/or Lung Transplant
|
20
|
10
|
—
|
—
|
$62,352.43
|
$65,470.05
|
$62,352.43
|
2026-05-24
|
|
613-4
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection
|
20
|
10
|
—
|
—
|
$62,000.00
|
$65,100.00
|
$62,000.00
|
2026-05-24
|
|
217
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
118
|
59
|
—
|
—
|
$35,230.76
|
$200,119.19
|
$61,350.05
|
2026-05-24
|
|
608-4
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition
|
20
|
10
|
—
|
—
|
$61,349.31
|
$64,416.78
|
$61,349.31
|
2026-05-24
|
|
955
|
OTHER
|
Craniotomy For Multiple Significant Trauma
|
108
|
54
|
—
|
—
|
$37,167.41
|
$191,422.40
|
$60,606.06
|
2026-05-24
|
|
232
|
OTHER
|
Coronary Bypass With Ptca Without Mcc
|
118
|
59
|
—
|
—
|
$33,404.95
|
$201,593.73
|
$58,386.00
|
2026-05-24
|
|
275
|
OTHER
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
108
|
54
|
—
|
—
|
$38,415.49
|
$192,478.38
|
$58,053.36
|
2026-05-24
|
|
969
|
OTHER
|
HIV With Extensive O.r. Procedures With Mcc
|
108
|
54
|
—
|
—
|
$35,405.22
|
$518,619.95
|
$56,878.68
|
2026-05-24
|
|
218
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
118
|
59
|
—
|
—
|
$32,571.52
|
$200,119.19
|
$56,518.35
|
2026-05-24
|
|
631-3
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
20
|
10
|
—
|
—
|
$56,144.55
|
$58,951.78
|
$56,144.55
|
2026-05-24
|
|
235
|
OTHER
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
118
|
59
|
—
|
—
|
$32,231.14
|
$139,465.99
|
$55,899.90
|
2026-05-24
|
|
160-4
|
OTHER
|
Major Cardiothoracic Repair Of Heart Anomaly
|
20
|
10
|
—
|
—
|
$55,523.63
|
$58,299.81
|
$55,523.63
|
2026-05-24
|
|
625-4
|
OTHER
|
Neonate Birth Weight 2000-2499 Grams With Other Significant Condition
|
20
|
10
|
—
|
—
|
$55,399.71
|
$58,169.70
|
$55,399.71
|
2026-05-24
|
|
268
|
OTHER
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
118
|
59
|
—
|
—
|
$36,327.20
|
$378,527.91
|
$55,302.34
|
2026-05-24
|
|
928
|
OTHER
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
108
|
54
|
—
|
—
|
$36,386.28
|
$152,298.96
|
$54,985.88
|
2026-05-24
|
|
870
|
OTHER
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
108
|
54
|
—
|
—
|
$24,247.11
|
$158,629.07
|
$54,865.88
|
2026-05-24
|
|
3400001856
|
OTHER
|
Y90 Ibritumomab Rx =< 40 Mci
|
162
|
76
|
$73,949.96
|
$73,949.96
|
$2,218.50
|
$122,172.78
|
$54,551.57
|
2026-05-24
|
|
459
|
OTHER
|
Spinal Fusion Except Cervical With Mcc
|
110
|
55
|
—
|
—
|
$13,475.00
|
$176,973.88
|
$54,213.94
|
2026-05-24
|
|
232-4
|
OTHER
|
Gastric Fundoplication
|
20
|
10
|
—
|
—
|
$53,508.13
|
$56,183.54
|
$53,508.13
|
2026-05-24
|
|
266
|
OTHER
|
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc
|
108
|
54
|
—
|
—
|
$32,788.50
|
$245,994.14
|
$53,307.34
|
2026-05-24
|
|
207
|
OTHER
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
108
|
54
|
—
|
—
|
$35,279.39
|
$390,586.18
|
$52,919.09
|
2026-05-24
|
|
461
|
OTHER
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
108
|
54
|
—
|
—
|
$33,551.35
|
$261,786.99
|
$52,779.26
|
2026-05-24
|
|
161-2
|
OTHER
|
Implantable Heart Assist Systems
|
20
|
10
|
—
|
—
|
$51,688.84
|
$54,273.28
|
$51,688.84
|
2026-05-24
|
|
234
|
OTHER
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc
|
118
|
59
|
—
|
—
|
$29,282.23
|
$129,119.57
|
$51,181.51
|
2026-05-24
|
|
23
|
OTHER
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
108
|
54
|
—
|
—
|
$31,294.71
|
$200,839.49
|
$50,817.49
|
2026-05-24
|
|
276
|
OTHER
|
Non-maligant Breast Disorders
|
114
|
57
|
—
|
—
|
$20,321.70
|
$141,250.90
|
$50,779.56
|
2026-05-24
|
|
220
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
118
|
59
|
—
|
—
|
$29,159.36
|
$173,410.55
|
$50,318.65
|
2026-05-24
|
|
011-4
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
20
|
10
|
—
|
—
|
$50,021.00
|
$52,522.05
|
$50,021.00
|
2026-05-24
|
|
588-1
|
OTHER
|
Female Reproductive System Reconstructive Procedures
|
20
|
10
|
—
|
—
|
$50,000.00
|
$52,500.00
|
$50,000.00
|
2026-05-24
|
|
28
|
OTHER
|
Spinal Procedures With Mcc
|
108
|
54
|
—
|
—
|
$33,252.28
|
$138,630.84
|
$49,878.42
|
2026-05-24
|
|
820
|
OTHER
|
Lymphoma And Leukemia With Major O.r. Procedures With Mcc
|
108
|
54
|
—
|
—
|
$31,907.49
|
$132,765.91
|
$49,642.27
|
2026-05-24
|
|
17
|
OTHER
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
102
|
51
|
—
|
—
|
$13,228.69
|
$308,644.41
|
$49,536.47
|
2026-05-24
|
|
16
|
OTHER
|
Autologous Bone Marrow Transplant With Cc/mcc
|
96
|
48
|
—
|
—
|
$33,024.31
|
$308,644.41
|
$49,536.47
|
2026-05-24
|
|
270
|
OTHER
|
Other Major Cardiovascular Procedures With Mcc
|
118
|
59
|
—
|
—
|
$28,303.44
|
$117,047.80
|
$49,469.35
|
2026-05-24
|
|
573
|
OTHER
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
108
|
54
|
—
|
—
|
$33,663.76
|
$140,425.43
|
$49,370.19
|
2026-05-24
|
|
21
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
108
|
54
|
—
|
—
|
$30,365.06
|
$258,611.36
|
$49,267.98
|
2026-05-24
|
|
161-1
|
OTHER
|
Implantable Heart Assist Systems
|
20
|
10
|
—
|
—
|
$49,247.34
|
$51,709.71
|
$49,247.34
|
2026-05-24
|
|
454
|
OTHER
|
Combined Anterior And Posterior Spinal Fusion With Cc
|
110
|
55
|
—
|
—
|
$13,475.00
|
$102,722.96
|
$49,211.46
|
2026-05-24
|
|
589-1
|
OTHER
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
20
|
10
|
—
|
—
|
$48,983.85
|
$51,433.04
|
$48,983.85
|
2026-05-24
|
|
011-2
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
20
|
10
|
—
|
—
|
$48,895.78
|
$51,340.57
|
$48,895.78
|
2026-05-24
|
|
608-3
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition
|
20
|
10
|
—
|
—
|
$48,849.76
|
$51,292.25
|
$48,849.76
|
2026-05-24
|
|
790
|
OTHER
|
Extreme Immaturity Or Respiratory Distress Syndrome, Neonate
|
102
|
51
|
—
|
—
|
$3,587.53
|
$151,938.04
|
$48,821.97
|
2026-05-24
|
|
405
|
OTHER
|
Pancreas, Liver And Shunt Procedures With Mcc
|
108
|
54
|
—
|
—
|
$29,849.54
|
$123,790.65
|
$48,408.71
|
2026-05-24
|
|
006-4
|
OTHER
|
Pancreas Transplant
|
20
|
10
|
—
|
—
|
$48,372.76
|
$50,791.40
|
$48,372.76
|
2026-05-24
|
|
653
|
OTHER
|
Major Bladder Procedures With Mcc
|
108
|
54
|
—
|
—
|
$30,612.37
|
$302,839.44
|
$48,364.38
|
2026-05-24
|
|
228
|
OTHER
|
Other Cardiothoracic Procedures With Mcc
|
118
|
59
|
—
|
—
|
$27,520.73
|
$130,774.67
|
$48,100.16
|
2026-05-24
|
|
613-3
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection
|
20
|
10
|
—
|
—
|
$47,988.67
|
$50,388.10
|
$47,988.67
|
2026-05-24
|
|
602-2
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
20
|
10
|
—
|
—
|
$47,292.77
|
$49,657.41
|
$47,292.77
|
2026-05-24
|
|
457
|
OTHER
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
114
|
57
|
—
|
—
|
$26,947.00
|
$138,806.68
|
$47,211.08
|
2026-05-24
|
|
11
|
OTHER
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc
|
108
|
54
|
—
|
—
|
$29,678.03
|
$157,601.39
|
$47,055.62
|
2026-05-24
|
|
623-4
|
OTHER
|
Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection
|
20
|
10
|
—
|
—
|
$46,675.86
|
$49,009.65
|
$46,675.86
|
2026-05-24
|
|
842-4
|
OTHER
|
Burns With Skin Graft Except Extensive Third Degree Burns
|
20
|
10
|
—
|
—
|
$46,203.37
|
$48,513.54
|
$46,203.37
|
2026-05-24
|
|
002-2
|
OTHER
|
Heart And/or Lung Transplant
|
20
|
10
|
—
|
—
|
$45,376.96
|
$47,645.81
|
$45,376.96
|
2026-05-24
|
|
8
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant
|
92
|
46
|
—
|
—
|
$29,931.27
|
$414,358.28
|
$45,228.09
|
2026-05-24
|
|
834
|
OTHER
|
Acute Leukemia Without Major O.r. Procedures With Mcc
|
108
|
54
|
—
|
—
|
$27,870.92
|
$126,039.02
|
$45,113.80
|
2026-05-24
|
|
853
|
OTHER
|
Infectious And Parasitic Diseases With O.r. Procedures With Mcc
|
108
|
54
|
—
|
—
|
$27,614.84
|
$114,044.64
|
$44,683.94
|
2026-05-24
|
|
463
|
OTHER
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …
|
108
|
54
|
—
|
—
|
$29,704.69
|
$123,159.00
|
$44,557.03
|
2026-05-24
|
|
221
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
118
|
59
|
—
|
—
|
$25,477.93
|
$173,410.55
|
$43,629.70
|
2026-05-24
|
|
005-4
|
OTHER
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
20
|
10
|
—
|
—
|
$43,560.21
|
$45,738.22
|
$43,560.21
|
2026-05-24
|
|
4810000266
|
OTHER
|
Implt/rpl Crtd Sns Dev Total
|
172
|
86
|
$98,248.15
|
$98,248.15
|
$2,947.44
|
$98,248.15
|
$43,415.37
|
2026-05-24
|
|
612-3
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…
|
20
|
10
|
—
|
—
|
$43,210.73
|
$45,371.27
|
$43,210.73
|
2026-05-24
|
|
576
|
OTHER
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc
|
108
|
54
|
—
|
—
|
$8,911.31
|
$123,029.03
|
$42,846.67
|
2026-05-24
|
|
799
|
OTHER
|
Splenectomy With Mcc
|
108
|
54
|
—
|
—
|
$26,326.00
|
$108,423.70
|
$42,535.72
|
2026-05-24
|
|
981
|
OTHER
|
Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc
|
108
|
54
|
—
|
—
|
$26,321.29
|
$108,403.18
|
$42,527.88
|
2026-05-24
|
|
466
|
OTHER
|
Revision Of Hip Or Knee Replacement With Mcc
|
108
|
54
|
—
|
—
|
$28,102.67
|
$116,172.16
|
$42,154.01
|
2026-05-24
|
|
267
|
OTHER
|
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc
|
108
|
54
|
—
|
—
|
$26,064.05
|
$184,706.26
|
$42,099.11
|
2026-05-24
|
|
326
|
OTHER
|
Stomach, Esophageal And Duodenal Procedures With Mcc
|
108
|
54
|
—
|
—
|
$28,021.09
|
$266,757.65
|
$42,031.64
|
2026-05-24
|
|
004-3
|
OTHER
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
20
|
10
|
—
|
—
|
$41,876.47
|
$43,970.29
|
$41,876.47
|
2026-05-24
|
|
002-1
|
OTHER
|
Heart And/or Lung Transplant
|
20
|
10
|
—
|
—
|
$41,730.88
|
$43,817.42
|
$41,730.88
|
2026-05-24
|
|
239
|
OTHER
|
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc
|
108
|
54
|
—
|
—
|
$27,800.98
|
$137,146.10
|
$41,701.47
|
2026-05-24
|
|
277
|
OTHER
|
Cellulitis Age >17 W Cc
|
108
|
54
|
—
|
—
|
$25,787.98
|
$163,038.40
|
$41,638.96
|
2026-05-24
|
|
837
|
OTHER
|
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…
|
108
|
54
|
—
|
—
|
$27,645.69
|
$327,818.67
|
$41,468.54
|
2026-05-24
|
|
622-4
|
OTHER
|
Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…
|
20
|
10
|
—
|
—
|
$41,444.54
|
$43,516.77
|
$41,444.54
|
2026-05-24
|
|
278
|
OTHER
|
Cellulitis Age >17 Without Cc
|
108
|
54
|
—
|
—
|
$4,170.54
|
$122,023.16
|
$41,437.95
|
2026-05-24
|
|
4818350703
|
OTHER
|
Mitraclip G4 System
|
106
|
49
|
$120,000.00
|
$120,000.00
|
$8,400.00
|
$120,000.00
|
$41,388.00
|
2026-05-24
|
|
163
|
OTHER
|
Major Chest Procedures With Mcc
|
108
|
54
|
—
|
—
|
$25,564.72
|
$322,003.03
|
$41,266.84
|
2026-05-24
|
|
329
|
OTHER
|
Major Small And Large Bowel Procedures With Mcc
|
108
|
54
|
—
|
—
|
$25,474.26
|
$113,447.59
|
$41,116.07
|
2026-05-24
|
|
6
|
OTHER
|
Liver Transplant Without Mcc
|
92
|
46
|
—
|
—
|
$27,182.27
|
$429,104.52
|
$41,072.53
|
2026-05-24
|
|
245
|
OTHER
|
Aicd Generator Procedures
|
112
|
56
|
—
|
—
|
$13,664.00
|
$111,433.70
|
$40,821.43
|
2026-05-24
|
|
856
|
OTHER
|
Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc
|
108
|
54
|
—
|
—
|
$25,054.41
|
$102,878.01
|
$40,416.26
|
2026-05-24
|
|
236
|
OTHER
|
Coronary Bypass Without Cardiac Catheterization Without Mcc
|
118
|
59
|
—
|
—
|
$22,965.60
|
$98,898.29
|
$40,132.02
|
2026-05-24
|
|
25
|
OTHER
|
Craniotomy And Endovascular Intracranial Procedures With Mcc
|
108
|
54
|
—
|
—
|
$24,848.93
|
$104,260.26
|
$40,073.76
|
2026-05-24
|
|
826
|
OTHER
|
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …
|
108
|
54
|
—
|
—
|
$26,434.22
|
$108,895.73
|
$39,651.34
|
2026-05-24
|
|
458
|
OTHER
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
114
|
57
|
—
|
—
|
$24,042.17
|
$138,806.68
|
$39,629.00
|
2026-05-24
|
|
471
|
OTHER
|
Cervical Spinal Fusion With Mcc
|
114
|
57
|
—
|
—
|
$13,475.00
|
$272,535.86
|
$39,525.39
|
2026-05-24
|
|
634-4
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…
|
18
|
9
|
—
|
—
|
$1,200.00
|
$41,180.11
|
$39,219.15
|
2026-05-24
|
|
823
|
OTHER
|
Lymphoma And Non-acute Leukemia With Other Procedures With Mcc
|
108
|
54
|
—
|
—
|
$25,932.29
|
$119,301.21
|
$38,898.43
|
2026-05-24
|
|
614-3
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition
|
20
|
10
|
—
|
—
|
$38,873.71
|
$40,817.40
|
$38,873.71
|
2026-05-24
|
|
650
|
OTHER
|
Kidney Transplant With Hemodialysis With Mcc
|
96
|
48
|
—
|
—
|
$25,554.78
|
$165,653.25
|
$38,332.17
|
2026-05-24
|
|
455
|
OTHER
|
Combined Anterior And Posterior Spinal Fusion Without Cc/mcc
|
110
|
55
|
—
|
—
|
$13,475.00
|
$146,158.35
|
$38,318.82
|
2026-05-24
|
|
356
|
OTHER
|
Other Digestive System O.r. Procedures With Mcc
|
108
|
54
|
—
|
—
|
$23,768.71
|
$231,237.69
|
$38,273.27
|
2026-05-24
|
|
D020JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D723JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D725HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D725DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB20DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB21JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD22JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D92CHZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D928JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB20HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D92BJZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD23HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD27HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D92BHZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D721HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD20JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D723HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DG20DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DG21HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D724HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB20JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB21DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD23JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD25HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DF20DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DG20HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DG24JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DG25DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D92DHZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D027DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DF21HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D722DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D728HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DF23HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D928DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D726DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD20DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D920DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DF23JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DG24DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D921JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD24DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D728DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD25JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D727HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D920JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D926HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D929DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D928HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB26HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB28HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB28JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DG20JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DG25HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DM20DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D722HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D927HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD27JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DG21DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D026HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D820JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D021JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D92CDZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB22JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD24JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DG22JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D726HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D720DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD21JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D026JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D020HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB21HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB28DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D92DDZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB25DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D021HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB26JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DF22DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D921DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D021DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D925JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D927DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB22DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D026DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD21HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DF20HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D925HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D727JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D724DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D727DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DF21JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D721DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DF22JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DM20HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DM20JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D725JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D726JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD25DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DF21DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D721JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD23DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD24HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DF22HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D820DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D723DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D927JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D929JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D722JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D724JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D924HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D020DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D820HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D924JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D92CJZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DG22HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB27HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D720HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD21DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D027HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB26DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD20HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD27DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D924DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D925DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D926JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D92BDZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB27DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DF23DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D92DJZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D926DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB25JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD22HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D929HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DB22HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DG21JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D720JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D921HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DD22DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DF20JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DG22DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DG24HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
D027JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DG25JZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DM21DZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|
|
DM21HZZ
|
OTHER
|
Stereotactic Radiosurgery
|
4
|
2
|
—
|
—
|
$37,100.00
|
$38,953.00
|
$38,026.50
|
2026-05-24
|