|
J1411
|
HCPCS
|
Inj Hemgenix Per Tx Dose
|
7
|
4
|
—
|
—
|
$3,710,000.00
|
$3,932,600.00
|
$3,710,000.00
|
2026-09-21
|
|
J1413
|
HCPCS
|
Inj Delandistrogene Mox Rokl
|
7
|
4
|
—
|
—
|
$3,327,159.88
|
$3,526,789.47
|
$3,327,159.88
|
2026-09-21
|
|
J3394
|
HCPCS
|
Inj Lovotibeglogene Autotem
|
7
|
4
|
—
|
—
|
$3,286,000.00
|
$3,483,160.00
|
$3,286,000.00
|
2026-09-21
|
|
J3393
|
HCPCS
|
Inj Betibeglogene Autotemce
|
7
|
4
|
—
|
—
|
$2,968,000.00
|
$3,146,080.00
|
$2,968,000.00
|
2026-09-21
|
|
J3399
|
HCPCS
|
Inj Onase Abepar-xioi Treat
|
11
|
6
|
—
|
—
|
$2,178,938.07
|
$2,422,500.00
|
$2,354,513.02
|
2026-09-21
|
|
Q2042
|
HCPCS
|
Tisagenlecleucel Car-pos T
|
15
|
6
|
—
|
—
|
$421,728.84
|
$559,680.00
|
$523,452.56
|
2026-09-21
|
|
Q2056
|
HCPCS
|
Ciltacabtagene Car-pos T
|
7
|
4
|
—
|
—
|
$507,687.00
|
$538,148.22
|
$507,687.00
|
2026-09-21
|
|
Q2055
|
HCPCS
|
Idecabtagene Vicleucel Car
|
7
|
4
|
—
|
—
|
$503,454.53
|
$533,661.80
|
$503,454.53
|
2026-09-21
|
|
Q2054
|
HCPCS
|
Lisocabtagene Mara Car Pos T
|
7
|
4
|
—
|
—
|
$496,390.21
|
$526,173.62
|
$496,390.21
|
2026-09-21
|
|
Q2053
|
HCPCS
|
Brexucabtagene Car Pos T
|
9
|
5
|
—
|
—
|
$395,380.00
|
$476,406.40
|
$449,440.00
|
2026-09-21
|
|
Q2041
|
HCPCS
|
Axicabtagene Ciloleucel Car+
|
15
|
6
|
—
|
—
|
$255,132.00
|
$518,485.12
|
$425,220.00
|
2026-09-21
|
|
Q2040
|
HCPCS
|
Incobotulinumtoxin A
|
4
|
1
|
—
|
—
|
$324,900.00
|
$324,900.00
|
$324,900.00
|
2026-09-21
|
|
3
|
MS_DRG
|
Ecmo Or Trach W Mv >96 Hrs Or Pdx Exc Face Mouth & Neck W Maj O.r.
|
4
|
4
|
—
|
—
|
$152,818.30
|
$188,572.98
|
$188,572.98
|
2026-09-21
|
|
003
|
OTHER
|
Ecmo Or Trach W Mv >96 Hrs Or Pdx Exc Face Mouth & Neck W Maj O.r.
|
3
|
3
|
—
|
—
|
$152,818.30
|
$188,572.98
|
$188,572.98
|
2026-05-06
|
|
4
|
MS_DRG
|
Trach W Mv >96 Hrs Or Pdx Exc Face Mouth & Neck Without Maj O.r.
|
4
|
4
|
—
|
—
|
$117,190.94
|
$139,642.88
|
$139,642.88
|
2026-09-21
|
|
004
|
OTHER
|
Trach W Mv >96 Hrs Or Pdx Exc Face Mouth & Neck Without Maj O.r.
|
3
|
3
|
—
|
—
|
$117,190.94
|
$139,642.88
|
$139,642.88
|
2026-05-06
|
|
165
|
MS_DRG
|
Major Chest Procedures Without Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$128,001.14
|
$128,001.14
|
2026-09-21
|
|
163
|
OTHER
|
Major Chest Procedures W Mcc
|
3
|
3
|
—
|
—
|
$121,014.03
|
$128,001.14
|
$128,001.14
|
2026-05-06
|
|
164
|
MS_DRG
|
Major Chest Procedures W Cc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$128,001.14
|
$128,001.14
|
2026-09-21
|
|
165
|
OTHER
|
Major Chest Procedures Without Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$128,001.14
|
$128,001.14
|
2026-05-06
|
|
163
|
MS_DRG
|
Major Chest Procedures W Mcc
|
4
|
4
|
—
|
—
|
$121,014.03
|
$128,001.14
|
$128,001.14
|
2026-09-21
|
|
164
|
OTHER
|
Major Chest Procedures W Cc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$128,001.14
|
$128,001.14
|
2026-05-06
|
|
981
|
OTHER
|
Extensive O.r. Procedure Unrelated To Principal Diagnosis W Mcc
|
3
|
3
|
—
|
—
|
$95,678.64
|
$119,776.05
|
$119,776.05
|
2026-05-06
|
|
981
|
MS_DRG
|
Extensive O.r. Procedure Unrelated To Principal Diagnosis W Mcc
|
4
|
4
|
—
|
—
|
$95,678.64
|
$119,776.05
|
$119,776.05
|
2026-09-21
|
|
987
|
MS_DRG
|
Non-extensive O.r. Proc Unrelated To Principal Diagnosis W Mcc
|
4
|
4
|
—
|
—
|
$83,386.51
|
$115,156.08
|
$115,156.08
|
2026-09-21
|
|
987
|
OTHER
|
Non-extensive O.r. Proc Unrelated To Principal Diagnosis W Mcc
|
3
|
3
|
—
|
—
|
$83,386.51
|
$115,156.08
|
$115,156.08
|
2026-05-06
|
|
166
|
OTHER
|
Other Resp System O.r. Procedures W Mcc
|
3
|
3
|
—
|
—
|
$99,202.14
|
$112,111.54
|
$112,111.54
|
2026-05-06
|
|
166
|
MS_DRG
|
Other Resp System O.r. Procedures W Mcc
|
4
|
4
|
—
|
—
|
$99,202.14
|
$112,111.54
|
$112,111.54
|
2026-09-21
|
|
870
|
MS_DRG
|
Septicemia Or Severe Sepsis W Mv >96 Hours
|
4
|
4
|
—
|
—
|
$82,082.60
|
$98,633.41
|
$98,633.41
|
2026-09-21
|
|
870
|
OTHER
|
Septicemia Or Severe Sepsis W Mv >96 Hours
|
3
|
3
|
—
|
—
|
$82,082.60
|
$98,633.41
|
$98,633.41
|
2026-05-06
|
|
207
|
OTHER
|
Respiratory System Diagnosis W Ventilator Support >96 Hours
|
3
|
3
|
—
|
—
|
$79,217.39
|
$93,298.22
|
$93,298.22
|
2026-05-06
|
|
207
|
MS_DRG
|
Respiratory System Diagnosis W Ventilator Support >96 Hours
|
4
|
4
|
—
|
—
|
$79,217.39
|
$93,298.22
|
$93,298.22
|
2026-09-21
|
|
853
|
OTHER
|
Infectious & Parasitic Diseases W O.r. Procedure W Mcc
|
3
|
3
|
—
|
—
|
$72,693.66
|
$81,859.45
|
$81,859.45
|
2026-05-06
|
|
853
|
MS_DRG
|
Infectious & Parasitic Diseases W O.r. Procedure W Mcc
|
4
|
4
|
—
|
—
|
$72,693.66
|
$81,859.45
|
$81,859.45
|
2026-09-21
|
|
J2351
|
HCPCS
|
Ocrelizumab 920 Mg-hyaluronidase-ocsq 23,000 Unit/23 Ml Subcut Soln
|
24
|
21
|
$111,662.00
|
$55,831.00
50% off
|
$33,498.60
|
$100,495.80
|
$78,163.40
|
2026-09-21
|
|
574
|
OTHER
|
Skin Graft For Skin Ulcer Or Cellulitis W Cc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,069.64
|
$75,069.64
|
2026-05-06
|
|
573
|
OTHER
|
Skin Graft For Skin Ulcer Or Cellulitis W Mcc
|
3
|
3
|
—
|
—
|
$75,069.64
|
$77,052.66
|
$75,069.64
|
2026-05-06
|
|
573
|
MS_DRG
|
Skin Graft For Skin Ulcer Or Cellulitis W Mcc
|
4
|
4
|
—
|
—
|
$75,069.64
|
$77,052.66
|
$75,069.64
|
2026-09-21
|
|
574
|
MS_DRG
|
Skin Graft For Skin Ulcer Or Cellulitis W Cc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,069.64
|
$75,069.64
|
2026-09-21
|
|
843
|
MS_DRG
|
Other Myeloprolif Dis Or Poorly Diff Neopl Diag W Mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
480
|
OTHER
|
Hip & Femur Procedures Except Major Joint W Mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
496
|
OTHER
|
Local Excision & Removal Int Fix Devices Exc Hip & Femur W Cc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
736
|
OTHER
|
Uterine & Adnexa Proc For Ovarian Or Adnexal Malignancy W Mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
020
|
OTHER
|
Intracranial Vascular Procedures W Pdx Hemorrhage W Mcc
|
3
|
3
|
—
|
—
|
$39,036.92
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
492
|
MS_DRG
|
Lower Extrem & Humer Proc Except Hipfootfemur W Mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
265
|
MS_DRG
|
Aicd Lead Procedures
|
4
|
4
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
027
|
OTHER
|
Craniotomy & Endovascular Intracranial Procedures Without Cc/mcc
|
3
|
3
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
577
|
OTHER
|
Skin Graft Exc For Skin Ulcer Or Cellulitis W Cc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
505
|
MS_DRG
|
Foot Procedures Without Cc/mcc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
268
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon W Mcc
|
4
|
4
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
307
|
OTHER
|
Cardiac Congenital & Valvular Disorders Without Mcc
|
3
|
3
|
—
|
—
|
$21,904.73
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
739
|
OTHER
|
Uterineadnexa Proc For Non-ovarian/adnexal Malig W Mcc
|
3
|
3
|
—
|
—
|
$57,481.45
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
504
|
OTHER
|
Foot Procedures W Cc
|
3
|
3
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
405
|
OTHER
|
Pancreas Liver & Shunt Procedures W Mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
662
|
OTHER
|
Minor Bladder Procedures W Mcc
|
3
|
3
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
20
|
MS_DRG
|
Intracranial Vascular Procedures W Pdx Hemorrhage W Mcc
|
4
|
4
|
—
|
—
|
$39,036.92
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
628
|
OTHER
|
Other Endocrine Nutrit & Metab O.r. Proc W Mcc
|
3
|
3
|
—
|
—
|
$57,481.45
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
616
|
OTHER
|
Amputat Of Lower Limb For Endocrinenutrit& Metabol Dis W Mcc
|
3
|
3
|
—
|
—
|
$70,761.01
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
011
|
OTHER
|
Tracheostomy For Facemouth & Neck Diagnoses W Mcc
|
3
|
3
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
492
|
OTHER
|
Lower Extrem & Humer Proc Except Hipfootfemur W Mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
665
|
OTHER
|
Prostatectomy W Mcc
|
3
|
3
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
659
|
OTHER
|
Kidney & Ureter Procedures For Non-neoplasm W Mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
553
|
OTHER
|
Bone Diseases & Arthropathies W Mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
737
|
OTHER
|
Uterine & Adnexa Proc For Ovarian Or Adnexal Malignancy W Cc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
748
|
OTHER
|
Female Reproductive System Reconstructive Procedures
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
749
|
OTHER
|
Other Female Reproductive System O.r. Procedures W Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
22
|
MS_DRG
|
Intracranial Vascular Procedures W Pdx Hemorrhage Without Cc/mcc
|
4
|
4
|
—
|
—
|
$39,036.92
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
616
|
MS_DRG
|
Amputat Of Lower Limb For Endocrinenutrit& Metabol Dis W Mcc
|
4
|
4
|
—
|
—
|
$70,761.01
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
470
|
OTHER
|
Major Joint Replacement Or Reattachment Of Lower Extremity Without Mcc
|
3
|
3
|
—
|
—
|
$70,161.81
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
29
|
MS_DRG
|
Spinal Procedures W Cc Or Spinal Neurostimulators
|
4
|
4
|
—
|
—
|
$38,969.40
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
619
|
OTHER
|
O.r. Procedures For Obesity W Mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
496
|
MS_DRG
|
Local Excision & Removal Int Fix Devices Exc Hip & Femur W Cc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
032
|
OTHER
|
Ventricular Shunt Procedures W Cc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
23
|
MS_DRG
|
Cranio W Major Dev Impl/acute Complex Cns Pdx W Mcc Or Chemo Implant
|
4
|
4
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
012
|
OTHER
|
Tracheostomy For Facemouth & Neck Diagnoses W Cc
|
3
|
3
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
272
|
MS_DRG
|
Other Major Cardiovascular Procedures Without Cc/mcc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
489
|
MS_DRG
|
Knee Procedures Without Pdx Of Infection Without Cc/mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
504
|
MS_DRG
|
Foot Procedures W Cc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
252
|
OTHER
|
Other Vascular Procedures W Mcc
|
3
|
3
|
—
|
—
|
$75,050.31
|
$81,837.86
|
$75,050.31
|
2026-05-06
|
|
578
|
OTHER
|
Skin Graft Exc For Skin Ulcer Or Cellulitis Without Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
653
|
MS_DRG
|
Major Bladder Procedures W Mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
244
|
OTHER
|
Permanent Cardiac Pacemaker Implant Without Cc/mcc
|
3
|
3
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
243
|
OTHER
|
Permanent Cardiac Pacemaker Implant W Cc
|
3
|
3
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
435
|
MS_DRG
|
Malignancy Of Hepatobiliary System Or Pancreas W Mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
742
|
OTHER
|
Uterine & Adnexa Proc For Non-malignancy W Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
488
|
MS_DRG
|
Knee Procedures Without Pdx Of Infection W Cc/mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
241
|
MS_DRG
|
Amputation For Circ Sys Disorders Exc Upper Limb & Toe Without Cc/mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
259
|
OTHER
|
Cardiac Pacemaker Device Replacement Without Mcc
|
3
|
3
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
258
|
OTHER
|
Cardiac Pacemaker Device Replacement W Mcc
|
3
|
3
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
81
|
MS_DRG
|
Nontraumatic Stupor & Coma Without Mcc
|
4
|
4
|
—
|
—
|
$21,904.73
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
244
|
MS_DRG
|
Permanent Cardiac Pacemaker Implant Without Cc/mcc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
241
|
OTHER
|
Amputation For Circ Sys Disorders Exc Upper Limb & Toe Without Cc/mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
617
|
OTHER
|
Amputat Of Lower Limb For Endocrinenutrit& Metabol Dis W Cc
|
3
|
3
|
—
|
—
|
$55,531.93
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
480
|
MS_DRG
|
Hip & Femur Procedures Except Major Joint W Mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
329
|
OTHER
|
Major Small & Large Bowel Procedures W Mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
023
|
OTHER
|
Cranio W Major Dev Impl/acute Complex Cns Pdx W Mcc Or Chemo Implant
|
3
|
3
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
271
|
OTHER
|
Other Major Cardiovascular Procedures W Cc
|
3
|
3
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
272
|
OTHER
|
Other Major Cardiovascular Procedures Without Cc/mcc
|
3
|
3
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
518
|
MS_DRG
|
Back & Neck Proc Exc Spinal Fusion W Mcc Or Disc Device/neurostim
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
286
|
OTHER
|
Circulatory Disorders Except Ami W Card Cath W Mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
306
|
OTHER
|
Cardiac Congenital & Valvular Disorders W Mcc
|
3
|
3
|
—
|
—
|
$35,319.32
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
287
|
OTHER
|
Circulatory Disorders Except Ami W Card Cath Without Mcc
|
3
|
3
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
456
|
OTHER
|
Spinal Fus Exc Cerv W Spinal Curv/malig/infec Or Ext Fus W Mcc
|
3
|
3
|
—
|
—
|
$42,754.52
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
576
|
OTHER
|
Skin Graft Exc For Skin Ulcer Or Cellulitis W Mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
734
|
MS_DRG
|
Pelvic Evisceration Rad Hysterectomy & Rad Vulvectomy W Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
344
|
OTHER
|
Minor Small & Large Bowel Procedures W Mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
739
|
MS_DRG
|
Uterineadnexa Proc For Non-ovarian/adnexal Malig W Mcc
|
4
|
4
|
—
|
—
|
$57,481.45
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
435
|
OTHER
|
Malignancy Of Hepatobiliary System Or Pancreas W Mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
307
|
MS_DRG
|
Cardiac Congenital & Valvular Disorders Without Mcc
|
4
|
4
|
—
|
—
|
$21,904.73
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
737
|
MS_DRG
|
Uterine & Adnexa Proc For Ovarian Or Adnexal Malignancy W Cc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
013
|
OTHER
|
Tracheostomy For Facemouth & Neck Diagnoses Without Cc/mcc
|
3
|
3
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
653
|
OTHER
|
Major Bladder Procedures W Mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
748
|
MS_DRG
|
Female Reproductive System Reconstructive Procedures
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
750
|
OTHER
|
Other Female Reproductive System O.r. Procedures Without Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
747
|
MS_DRG
|
Vagina Cervix & Vulva Procedures Without Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
742
|
MS_DRG
|
Uterine & Adnexa Proc For Non-malignancy W Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
746
|
MS_DRG
|
Vagina Cervix & Vulva Procedures W Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
518
|
OTHER
|
Back & Neck Proc Exc Spinal Fusion W Mcc Or Disc Device/neurostim
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
576
|
MS_DRG
|
Skin Graft Exc For Skin Ulcer Or Cellulitis W Mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
344
|
MS_DRG
|
Minor Small & Large Bowel Procedures W Mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
475
|
OTHER
|
Amputation For Musculoskeletal Sys & Conn Tissue Dis W Cc
|
3
|
3
|
—
|
—
|
$70,161.81
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
474
|
OTHER
|
Amputation For Musculoskeletal Sys & Conn Tissue Dis W Mcc
|
3
|
3
|
—
|
—
|
$70,161.81
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
481
|
OTHER
|
Hip & Femur Procedures Except Major Joint W Cc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
489
|
OTHER
|
Knee Procedures Without Pdx Of Infection Without Cc/mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
488
|
OTHER
|
Knee Procedures Without Pdx Of Infection W Cc/mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
483
|
OTHER
|
Major Joint/limb Reattachment Procedure Of Upper Extremities
|
3
|
3
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
253
|
OTHER
|
Other Vascular Procedures W Cc
|
3
|
3
|
—
|
—
|
$75,050.31
|
$81,837.86
|
$75,050.31
|
2026-05-06
|
|
497
|
MS_DRG
|
Local Excision & Removal Int Fix Devices Exc Hip & Femur Without Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
21
|
MS_DRG
|
Intracranial Vascular Procedures W Pdx Hemorrhage W Cc
|
4
|
4
|
—
|
—
|
$39,036.92
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
735
|
OTHER
|
Pelvic Evisceration Rad Hysterectomy & Rad Vulvectomy Without Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
625
|
MS_DRG
|
Thyroid Parathyroid & Thyroglossal Procedures W Mcc
|
4
|
4
|
—
|
—
|
$57,481.45
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
030
|
OTHER
|
Spinal Procedures Without Cc/mcc
|
3
|
3
|
—
|
—
|
$38,969.40
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
240
|
OTHER
|
Amputation For Circ Sys Disorders Exc Upper Limb & Toe W Cc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
231
|
OTHER
|
Coronary Bypass W Ptca W Mcc
|
3
|
3
|
—
|
—
|
$75,050.31
|
$81,837.86
|
$75,050.31
|
2026-05-06
|
|
239
|
OTHER
|
Amputation For Circ Sys Disorders Exc Upper Limb & Toe W Mcc
|
3
|
3
|
—
|
—
|
$75,050.31
|
$79,601.39
|
$75,050.31
|
2026-05-06
|
|
553
|
MS_DRG
|
Bone Diseases & Arthropathies W Mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
734
|
OTHER
|
Pelvic Evisceration Rad Hysterectomy & Rad Vulvectomy W Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
855
|
MS_DRG
|
Infectious & Parasitic Diseases W O.r. Procedure Without Cc/mcc
|
4
|
4
|
—
|
—
|
$21,904.73
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
855
|
OTHER
|
Infectious & Parasitic Diseases W O.r. Procedure Without Cc/mcc
|
3
|
3
|
—
|
—
|
$21,904.73
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
854
|
OTHER
|
Infectious & Parasitic Diseases W O.r. Procedure W Cc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
495
|
OTHER
|
Local Excision & Removal Int Fix Devices Exc Hip & Femur W Mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
747
|
OTHER
|
Vagina Cervix & Vulva Procedures Without Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
665
|
MS_DRG
|
Prostatectomy W Mcc
|
4
|
4
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
469
|
MS_DRG
|
Major Joint Replacement Or Reattachment Of Lower Extremity W Mcc
|
4
|
4
|
—
|
—
|
$70,161.81
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
738
|
OTHER
|
Uterine & Adnexa Proc For Ovarian Or Adnexal Malignancy Without Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
33
|
MS_DRG
|
Ventricular Shunt Procedures Without Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
743
|
OTHER
|
Uterine & Adnexa Proc For Non-malignancy Without Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
746
|
OTHER
|
Vagina Cervix & Vulva Procedures W Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
843
|
OTHER
|
Other Myeloprolif Dis Or Poorly Diff Neopl Diag W Mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
033
|
OTHER
|
Ventricular Shunt Procedures Without Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
749
|
MS_DRG
|
Other Female Reproductive System O.r. Procedures W Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
25
|
MS_DRG
|
Craniotomy & Endovascular Intracranial Procedures W Mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
659
|
MS_DRG
|
Kidney & Ureter Procedures For Non-neoplasm W Mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
628
|
MS_DRG
|
Other Endocrine Nutrit & Metab O.r. Proc W Mcc
|
4
|
4
|
—
|
—
|
$57,481.45
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
493
|
MS_DRG
|
Lower Extrem & Humer Proc Except Hipfootfemur W Cc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
503
|
MS_DRG
|
Foot Procedures W Mcc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
233
|
OTHER
|
Coronary Bypass W Cardiac Cath W Mcc
|
3
|
3
|
—
|
—
|
$75,050.31
|
$81,837.86
|
$75,050.31
|
2026-05-06
|
|
235
|
OTHER
|
Coronary Bypass Without Cardiac Cath W Mcc
|
3
|
3
|
—
|
—
|
$75,050.31
|
$81,837.86
|
$75,050.31
|
2026-05-06
|
|
494
|
MS_DRG
|
Lower Extrem & Humer Proc Except Hipfootfemur Without Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
028
|
OTHER
|
Spinal Procedures W Mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
483
|
MS_DRG
|
Major Joint/limb Reattachment Procedure Of Upper Extremities
|
4
|
4
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
330
|
MS_DRG
|
Major Small & Large Bowel Procedures W Cc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
231
|
MS_DRG
|
Coronary Bypass W Ptca W Mcc
|
4
|
4
|
—
|
—
|
$75,050.31
|
$81,837.86
|
$75,050.31
|
2026-09-21
|
|
021
|
OTHER
|
Intracranial Vascular Procedures W Pdx Hemorrhage W Cc
|
3
|
3
|
—
|
—
|
$39,036.92
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
662
|
MS_DRG
|
Minor Bladder Procedures W Mcc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
233
|
MS_DRG
|
Coronary Bypass W Cardiac Cath W Mcc
|
4
|
4
|
—
|
—
|
$75,050.31
|
$81,837.86
|
$75,050.31
|
2026-09-21
|
|
505
|
OTHER
|
Foot Procedures Without Cc/mcc
|
3
|
3
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
235
|
MS_DRG
|
Coronary Bypass Without Cardiac Cath W Mcc
|
4
|
4
|
—
|
—
|
$75,050.31
|
$81,837.86
|
$75,050.31
|
2026-09-21
|
|
24
|
MS_DRG
|
Cranio W Major Dev Impl/acute Complex Cns Pdx Without Mcc
|
4
|
4
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
240
|
MS_DRG
|
Amputation For Circ Sys Disorders Exc Upper Limb & Toe W Cc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
617
|
MS_DRG
|
Amputat Of Lower Limb For Endocrinenutrit& Metabol Dis W Cc
|
4
|
4
|
—
|
—
|
$55,531.93
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
481
|
MS_DRG
|
Hip & Femur Procedures Except Major Joint W Cc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
495
|
MS_DRG
|
Local Excision & Removal Int Fix Devices Exc Hip & Femur W Mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
239
|
MS_DRG
|
Amputation For Circ Sys Disorders Exc Upper Limb & Toe W Mcc
|
4
|
4
|
—
|
—
|
$75,050.31
|
$79,601.39
|
$75,050.31
|
2026-09-21
|
|
081
|
OTHER
|
Nontraumatic Stupor & Coma Without Mcc
|
3
|
3
|
—
|
—
|
$21,904.73
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
32
|
MS_DRG
|
Ventricular Shunt Procedures W Cc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
254
|
OTHER
|
Other Vascular Procedures Without Cc/mcc
|
3
|
3
|
—
|
—
|
$75,050.31
|
$81,837.86
|
$75,050.31
|
2026-05-06
|
|
482
|
MS_DRG
|
Hip & Femur Procedures Except Major Joint Without Cc/mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
255
|
OTHER
|
Upper Limb & Toe Amputation For Circ System Disorders W Mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
854
|
MS_DRG
|
Infectious & Parasitic Diseases W O.r. Procedure W Cc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
287
|
MS_DRG
|
Circulatory Disorders Except Ami W Card Cath Without Mcc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
711
|
MS_DRG
|
Testes Procedures W Cc/mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
711
|
OTHER
|
Testes Procedures W Cc/mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
750
|
MS_DRG
|
Other Female Reproductive System O.r. Procedures Without Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
243
|
MS_DRG
|
Permanent Cardiac Pacemaker Implant W Cc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
242
|
MS_DRG
|
Permanent Cardiac Pacemaker Implant W Mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
625
|
OTHER
|
Thyroid Parathyroid & Thyroglossal Procedures W Mcc
|
3
|
3
|
—
|
—
|
$57,481.45
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
080
|
OTHER
|
Nontraumatic Stupor & Coma W Mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
286
|
MS_DRG
|
Circulatory Disorders Except Ami W Card Cath W Mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
618
|
OTHER
|
Amputat Of Lower Limb For Endocrinenutrit& Metabol Dis Without Cc/mcc
|
3
|
3
|
—
|
—
|
$55,531.93
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
268
|
OTHER
|
Aortic And Heart Assist Procedures Except Pulsation Balloon W Mcc
|
3
|
3
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
265
|
OTHER
|
Aicd Lead Procedures
|
3
|
3
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
80
|
MS_DRG
|
Nontraumatic Stupor & Coma W Mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
031
|
OTHER
|
Ventricular Shunt Procedures W Mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
475
|
MS_DRG
|
Amputation For Musculoskeletal Sys & Conn Tissue Dis W Cc
|
4
|
4
|
—
|
—
|
$70,161.81
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
242
|
OTHER
|
Permanent Cardiac Pacemaker Implant W Mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
618
|
MS_DRG
|
Amputat Of Lower Limb For Endocrinenutrit& Metabol Dis Without Cc/mcc
|
4
|
4
|
—
|
—
|
$55,531.93
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
270
|
OTHER
|
Other Major Cardiovascular Procedures W Mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
470
|
MS_DRG
|
Major Joint Replacement Or Reattachment Of Lower Extremity Without Mcc
|
4
|
4
|
—
|
—
|
$70,161.81
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
30
|
MS_DRG
|
Spinal Procedures Without Cc/mcc
|
4
|
4
|
—
|
—
|
$38,969.40
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
258
|
MS_DRG
|
Cardiac Pacemaker Device Replacement W Mcc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
31
|
MS_DRG
|
Ventricular Shunt Procedures W Mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
270
|
MS_DRG
|
Other Major Cardiovascular Procedures W Mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
555
|
OTHER
|
Signs & Symptoms Of Musculoskeletal System & Conn Tissue W Mcc
|
3
|
3
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
329
|
MS_DRG
|
Major Small & Large Bowel Procedures W Mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
271
|
MS_DRG
|
Other Major Cardiovascular Procedures W Cc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
28
|
MS_DRG
|
Spinal Procedures W Mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
330
|
OTHER
|
Major Small & Large Bowel Procedures W Cc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
494
|
OTHER
|
Lower Extrem & Humer Proc Except Hipfootfemur Without Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
735
|
MS_DRG
|
Pelvic Evisceration Rad Hysterectomy & Rad Vulvectomy Without Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
029
|
OTHER
|
Spinal Procedures W Cc Or Spinal Neurostimulators
|
3
|
3
|
—
|
—
|
$38,969.40
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
026
|
OTHER
|
Craniotomy & Endovascular Intracranial Procedures W Cc
|
3
|
3
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
497
|
OTHER
|
Local Excision & Removal Int Fix Devices Exc Hip & Femur Without Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
405
|
MS_DRG
|
Pancreas Liver & Shunt Procedures W Mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
306
|
MS_DRG
|
Cardiac Congenital & Valvular Disorders W Mcc
|
4
|
4
|
—
|
—
|
$35,319.32
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
738
|
MS_DRG
|
Uterine & Adnexa Proc For Ovarian Or Adnexal Malignancy Without Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
253
|
MS_DRG
|
Other Vascular Procedures W Cc
|
4
|
4
|
—
|
—
|
$75,050.31
|
$81,837.86
|
$75,050.31
|
2026-09-21
|
|
252
|
MS_DRG
|
Other Vascular Procedures W Mcc
|
4
|
4
|
—
|
—
|
$75,050.31
|
$81,837.86
|
$75,050.31
|
2026-09-21
|
|
11
|
MS_DRG
|
Tracheostomy For Facemouth & Neck Diagnoses W Mcc
|
4
|
4
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
254
|
MS_DRG
|
Other Vascular Procedures Without Cc/mcc
|
4
|
4
|
—
|
—
|
$75,050.31
|
$81,837.86
|
$75,050.31
|
2026-09-21
|
|
736
|
MS_DRG
|
Uterine & Adnexa Proc For Ovarian Or Adnexal Malignancy W Mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
255
|
MS_DRG
|
Upper Limb & Toe Amputation For Circ System Disorders W Mcc
|
4
|
4
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
259
|
MS_DRG
|
Cardiac Pacemaker Device Replacement Without Mcc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
619
|
MS_DRG
|
O.r. Procedures For Obesity W Mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
024
|
OTHER
|
Cranio W Major Dev Impl/acute Complex Cns Pdx Without Mcc
|
3
|
3
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
493
|
OTHER
|
Lower Extrem & Humer Proc Except Hipfootfemur W Cc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
025
|
OTHER
|
Craniotomy & Endovascular Intracranial Procedures W Mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
578
|
MS_DRG
|
Skin Graft Exc For Skin Ulcer Or Cellulitis Without Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
456
|
MS_DRG
|
Spinal Fus Exc Cerv W Spinal Curv/malig/infec Or Ext Fus W Mcc
|
4
|
4
|
—
|
—
|
$42,754.52
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
022
|
OTHER
|
Intracranial Vascular Procedures W Pdx Hemorrhage Without Cc/mcc
|
3
|
3
|
—
|
—
|
$39,036.92
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
474
|
MS_DRG
|
Amputation For Musculoskeletal Sys & Conn Tissue Dis W Mcc
|
4
|
4
|
—
|
—
|
$70,161.81
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
743
|
MS_DRG
|
Uterine & Adnexa Proc For Non-malignancy Without Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
26
|
MS_DRG
|
Craniotomy & Endovascular Intracranial Procedures W Cc
|
4
|
4
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
503
|
OTHER
|
Foot Procedures W Mcc
|
3
|
3
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
555
|
MS_DRG
|
Signs & Symptoms Of Musculoskeletal System & Conn Tissue W Mcc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
482
|
OTHER
|
Hip & Femur Procedures Except Major Joint Without Cc/mcc
|
3
|
3
|
—
|
—
|
$74,292.94
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
469
|
OTHER
|
Major Joint Replacement Or Reattachment Of Lower Extremity W Mcc
|
3
|
3
|
—
|
—
|
$70,161.81
|
$75,050.31
|
$75,050.31
|
2026-05-06
|
|
13
|
MS_DRG
|
Tracheostomy For Facemouth & Neck Diagnoses Without Cc/mcc
|
4
|
4
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
27
|
MS_DRG
|
Craniotomy & Endovascular Intracranial Procedures Without Cc/mcc
|
4
|
4
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
577
|
MS_DRG
|
Skin Graft Exc For Skin Ulcer Or Cellulitis W Cc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
12
|
MS_DRG
|
Tracheostomy For Facemouth & Neck Diagnoses W Cc
|
4
|
4
|
—
|
—
|
$27,137.22
|
$75,050.31
|
$75,050.31
|
2026-09-21
|
|
579
|
OTHER
|
Other Skin Subcut Tiss & Breast Proc W Mcc
|
3
|
3
|
—
|
—
|
$58,625.01
|
$73,233.26
|
$73,233.26
|
2026-05-06
|
|
579
|
MS_DRG
|
Other Skin Subcut Tiss & Breast Proc W Mcc
|
4
|
4
|
—
|
—
|
$58,625.01
|
$73,233.26
|
$73,233.26
|
2026-09-21
|
|
116
|
MS_DRG
|
Intraocular Procedures W Cc/mcc
|
4
|
4
|
—
|
—
|
$27,137.22
|
$73,117.27
|
$73,117.27
|
2026-09-21
|
|
135
|
MS_DRG
|
Sinus & Mastoid Procedures W Cc/mcc
|
4
|
4
|
—
|
—
|
$27,137.22
|
$73,117.27
|
$73,117.27
|
2026-09-21
|
|
113
|
MS_DRG
|
Orbital Procedures W Cc/mcc
|
4
|
4
|
—
|
—
|
$27,137.22
|
$73,117.27
|
$73,117.27
|
2026-09-21
|
|
137
|
MS_DRG
|
Mouth Procedures W Cc/mcc
|
4
|
4
|
—
|
—
|
$27,137.22
|
$73,117.27
|
$73,117.27
|
2026-09-21
|
|
167
|
MS_DRG
|
Other Resp System O.r. Procedures W Cc
|
4
|
4
|
—
|
—
|
$60,203.19
|
$73,117.27
|
$73,117.27
|
2026-09-21
|
|
167
|
OTHER
|
Other Resp System O.r. Procedures W Cc
|
3
|
3
|
—
|
—
|
$60,203.19
|
$73,117.27
|
$73,117.27
|
2026-05-06
|
|
137
|
OTHER
|
Mouth Procedures W Cc/mcc
|
3
|
3
|
—
|
—
|
$27,137.22
|
$73,117.27
|
$73,117.27
|
2026-05-06
|
|
135
|
OTHER
|
Sinus & Mastoid Procedures W Cc/mcc
|
3
|
3
|
—
|
—
|
$27,137.22
|
$73,117.27
|
$73,117.27
|
2026-05-06
|
|
113
|
OTHER
|
Orbital Procedures W Cc/mcc
|
3
|
3
|
—
|
—
|
$27,137.22
|
$73,117.27
|
$73,117.27
|
2026-05-06
|
|
116
|
OTHER
|
Intraocular Procedures W Cc/mcc
|
3
|
3
|
—
|
—
|
$27,137.22
|
$73,117.27
|
$73,117.27
|
2026-05-06
|
|
801
|
MS_DRG
|
Splenectomy Without Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$71,991.28
|
$71,991.28
|
2026-09-21
|
|
799
|
MS_DRG
|
Splenectomy W Mcc
|
4
|
4
|
—
|
—
|
$67,963.32
|
$71,991.28
|
$71,991.28
|
2026-09-21
|
|
799
|
OTHER
|
Splenectomy W Mcc
|
3
|
3
|
—
|
—
|
$67,963.32
|
$71,991.28
|
$71,991.28
|
2026-05-06
|
|
800
|
OTHER
|
Splenectomy W Cc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$71,991.28
|
$71,991.28
|
2026-05-06
|
|
358
|
OTHER
|
Other Digestive System O.r. Procedures Without Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$71,991.28
|
$71,991.28
|
2026-05-06
|
|
356
|
OTHER
|
Other Digestive System O.r. Procedures W Mcc
|
3
|
3
|
—
|
—
|
$67,963.32
|
$71,991.28
|
$71,991.28
|
2026-05-06
|
|
357
|
OTHER
|
Other Digestive System O.r. Procedures W Cc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$71,991.28
|
$71,991.28
|
2026-05-06
|
|
620
|
MS_DRG
|
O.r. Procedures For Obesity W Cc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$71,991.28
|
$71,991.28
|
2026-09-21
|
|
620
|
OTHER
|
O.r. Procedures For Obesity W Cc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$71,991.28
|
$71,991.28
|
2026-05-06
|
|
621
|
OTHER
|
O.r. Procedures For Obesity Without Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$71,991.28
|
$71,991.28
|
2026-05-06
|
|
356
|
MS_DRG
|
Other Digestive System O.r. Procedures W Mcc
|
4
|
4
|
—
|
—
|
$67,963.32
|
$71,991.28
|
$71,991.28
|
2026-09-21
|
|
621
|
MS_DRG
|
O.r. Procedures For Obesity Without Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$71,991.28
|
$71,991.28
|
2026-09-21
|
|
801
|
OTHER
|
Splenectomy Without Cc/mcc
|
3
|
3
|
—
|
—
|
$35,606.26
|
$71,991.28
|
$71,991.28
|
2026-05-06
|
|
357
|
MS_DRG
|
Other Digestive System O.r. Procedures W Cc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$71,991.28
|
$71,991.28
|
2026-09-21
|
|
358
|
MS_DRG
|
Other Digestive System O.r. Procedures Without Cc/mcc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$71,991.28
|
$71,991.28
|
2026-09-21
|
|
800
|
MS_DRG
|
Splenectomy W Cc
|
4
|
4
|
—
|
—
|
$35,606.26
|
$71,991.28
|
$71,991.28
|
2026-09-21
|
|
205
|
MS_DRG
|
Other Respiratory System Diagnoses W Mcc
|
4
|
4
|
—
|
—
|
$38,391.30
|
$70,802.46
|
$70,802.46
|
2026-09-21
|
|
205
|
OTHER
|
Other Respiratory System Diagnoses W Mcc
|
3
|
3
|
—
|
—
|
$38,391.30
|
$70,802.46
|
$70,802.46
|
2026-05-06
|
|
64
|
MS_DRG
|
Intracranial Hemorrhage Or Cerebral Infarction W Mcc
|
4
|
4
|
—
|
—
|
$39,036.92
|
$70,227.38
|
$70,227.38
|
2026-09-21
|
|
061
|
OTHER
|
Acute Ischemic Stroke W Use Of Thrombolytic Agent W Mcc
|
3
|
3
|
—
|
—
|
$36,838.43
|
$70,227.38
|
$70,227.38
|
2026-05-06
|
|
064
|
OTHER
|
Intracranial Hemorrhage Or Cerebral Infarction W Mcc
|
3
|
3
|
—
|
—
|
$39,036.92
|
$70,227.38
|
$70,227.38
|
2026-05-06
|
|
61
|
MS_DRG
|
Acute Ischemic Stroke W Use Of Thrombolytic Agent W Mcc
|
4
|
4
|
—
|
—
|
$36,838.43
|
$70,227.38
|
$70,227.38
|
2026-09-21
|
|
622
|
OTHER
|
Skin Grafts & Wound Debrid For Endoc Nutrit & Metab Dis W Mcc
|
3
|
3
|
—
|
—
|
$57,637.58
|
$68,468.31
|
$68,468.31
|
2026-05-06
|
|
622
|
MS_DRG
|
Skin Grafts & Wound Debrid For Endoc Nutrit & Metab Dis W Mcc
|
4
|
4
|
—
|
—
|
$57,637.58
|
$68,468.31
|
$68,468.31
|
2026-09-21
|
|
500
|
OTHER
|
Soft Tissue Procedures W Mcc
|
3
|
3
|
—
|
—
|
$53,607.72
|
$66,496.61
|
$66,496.61
|
2026-05-06
|
|
500
|
MS_DRG
|
Soft Tissue Procedures W Mcc
|
4
|
4
|
—
|
—
|
$53,607.72
|
$66,496.61
|
$66,496.61
|
2026-09-21
|
|
463
|
OTHER
|
Wnd Debrid & Skn Grft Exc Hand For Musculo-conn Tiss Dis W Mcc
|
3
|
3
|
—
|
—
|
$65,735.29
|
$66,424.12
|
$66,424.12
|
2026-05-06
|
|
463
|
MS_DRG
|
Wnd Debrid & Skn Grft Exc Hand For Musculo-conn Tiss Dis W Mcc
|
4
|
4
|
—
|
—
|
$65,735.29
|
$66,424.12
|
$66,424.12
|
2026-09-21
|
|
E0766
|
HCPCS
|
Elec Stim Cancer Treatment
|
14
|
2
|
—
|
—
|
$8,815.27
|
$88,152.70
|
$66,114.53
|
2026-09-21
|
|
L8702
|
HCPCS
|
Ewhf S/d Uprt Micro Sensor
|
5
|
3
|
—
|
—
|
$65,871.74
|
$65,871.74
|
$65,871.74
|
2026-09-21
|
|
820
|
MS_DRG
|
Lymphoma & Leukemia W Major O.r. Procedure W Mcc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$65,491.43
|
$65,491.43
|
2026-09-21
|
|
907
|
MS_DRG
|
Other O.r. Procedures For Injuries W Mcc
|
4
|
4
|
—
|
—
|
$63,752.00
|
$65,491.43
|
$65,491.43
|
2026-09-21
|
|
907
|
OTHER
|
Other O.r. Procedures For Injuries W Mcc
|
3
|
3
|
—
|
—
|
$63,752.00
|
$65,491.43
|
$65,491.43
|
2026-05-06
|
|
826
|
OTHER
|
Myeloprolif Disord Or Poorly Diff Neopl W Maj O.r. Proc W Mcc
|
3
|
3
|
—
|
—
|
$45,113.36
|
$65,491.43
|
$65,491.43
|
2026-05-06
|
|
820
|
OTHER
|
Lymphoma & Leukemia W Major O.r. Procedure W Mcc
|
3
|
3
|
—
|
—
|
$45,113.36
|
$65,491.43
|
$65,491.43
|
2026-05-06
|
|
826
|
MS_DRG
|
Myeloprolif Disord Or Poorly Diff Neopl W Maj O.r. Proc W Mcc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$65,491.43
|
$65,491.43
|
2026-09-21
|
|
246
|
MS_DRG
|
Perc Cardiovasc Proc W Drug-eluting Stent W Mcc Or 4+ Vessels/stents
|
4
|
4
|
—
|
—
|
$65,153.14
|
$74,292.94
|
$65,153.14
|
2026-09-21
|
|
247
|
MS_DRG
|
Perc Cardiovasc Proc W Drug-eluting Stent Without Mcc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$65,153.14
|
$65,153.14
|
2026-09-21
|
|
248
|
MS_DRG
|
Perc Cardiovasc Proc W Non-drug-eluting Stent W Mcc Or 4+ Ves/stents
|
4
|
4
|
—
|
—
|
$65,153.14
|
$74,292.94
|
$65,153.14
|
2026-09-21
|
|
248
|
OTHER
|
Perc Cardiovasc Proc W Non-drug-eluting Stent W Mcc Or 4+ Ves/stents
|
3
|
3
|
—
|
—
|
$65,153.14
|
$74,292.94
|
$65,153.14
|
2026-05-06
|
|
249
|
MS_DRG
|
Perc Cardiovasc Proc W Non-drug-eluting Stent Without Mcc
|
4
|
4
|
—
|
—
|
$65,153.14
|
$74,292.94
|
$65,153.14
|
2026-09-21
|
|
249
|
OTHER
|
Perc Cardiovasc Proc W Non-drug-eluting Stent Without Mcc
|
3
|
3
|
—
|
—
|
$65,153.14
|
$74,292.94
|
$65,153.14
|
2026-05-06
|
|
247
|
OTHER
|
Perc Cardiovasc Proc W Drug-eluting Stent Without Mcc
|
3
|
3
|
—
|
—
|
$45,113.36
|
$65,153.14
|
$65,153.14
|
2026-05-06
|
|
246
|
OTHER
|
Perc Cardiovasc Proc W Drug-eluting Stent W Mcc Or 4+ Vessels/stents
|
3
|
3
|
—
|
—
|
$65,153.14
|
$74,292.94
|
$65,153.14
|
2026-05-06
|
|
226
|
MS_DRG
|
Cardiac Defibrillator Implant Without Cardiac Cath W Mcc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$65,153.14
|
$65,153.14
|
2026-09-21
|
|
227
|
MS_DRG
|
Cardiac Defibrillator Implant Without Cardiac Cath Without Mcc
|
4
|
4
|
—
|
—
|
$45,113.36
|
$65,153.14
|
$65,153.14
|
2026-09-21
|
|
226
|
OTHER
|
Cardiac Defibrillator Implant Without Cardiac Cath W Mcc
|
3
|
3
|
—
|
—
|
$45,113.36
|
$65,153.14
|
$65,153.14
|
2026-05-06
|