Price Transparency Hospital negotiated rates

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

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Hospital

KAISER FOUNDATION HOSPITAL

Honolulu, HI · CCN 120011 · Rates published

18,703 distinct procedures filed
1 distinct payers
59,727 rate rows
2026-05-09 last MRF observed
Data quality

54,745 of 59,727 rate rows are consumer-grade (91.7%)

4,982 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
per-diem day rate — not a per-procedure price 3,070
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 1,680
placeholder amount (≤ $0.02) — excluded from medians 162
exceeds 10× this hospital's gross charge — excluded from medians 70
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/health-plan-documents/coverage-information/machine-readable/941105628-moanalua-medical-center-standard-charges-hi-en.csv
Found on page https://healthy.kaiserpermanente.org/hawaii/doctors-locations/price-transparency
Discovered viaCMS hospital list
Last fetch not_modified · 2026-05-17
Content fingerprint 2a620ca98c430db3… · 194,766,073 bytes · first seen 2026-05-09

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
J3391
OTHER 		"Inj, Atidarsagene Autotemcel" 1 $4,632,500.00 $4,632,500.00 $4,632,500.00 nat. median
$4,505,000
1.0× median
J1411
OTHER 		"Inj, Hemgenix, Per Tx Dose" 1 $3,815,000.00 $3,815,000.00 $3,815,000.00 nat. median
$3,685,267
1.0× median
J1414
OTHER 		Beqvez (fidanacogene Elaparvovec-dz 1 $3,815,000.00 $3,815,000.00 $3,815,000.00 nat. median
$3,710,000
1.0× median
53010010
OTHER 		Etranacogene Dezaparvovec-drlb 1x10exp13 gc/mL Susp 1 Each Kit 1 $3,815,000.00 $3,815,000.00 $3,815,000.00 nat. median
$3,815,000
1.0× median
J1413
OTHER 		Inj Delandistrogene Mox Rokl 1 $3,383,360.00 $3,383,360.00 $3,383,360.00 nat. median
$3,327,860
1.0× median
J3394
OTHER 		"Inj, Lovotibeglogene Autotem" 1 $3,379,000.00 $3,379,000.00 $3,379,000.00 nat. median
$3,286,000
1.0× median
J3393
OTHER 		"Inj, Betibeglogene Autotemce" 1 $3,052,000.00 $3,052,000.00 $3,052,000.00 nat. median
$2,968,000
1.0× median
J3399
OTHER 		Inj Onase Abepar-xioi Treat 1 $2,737,307.00 $2,737,307.00 $2,737,307.00 nat. median
$2,472,216
1.1× median
J3392
OTHER 		Casgevy (exagamglogene Autotemcel) 1 $2,398,000.00 $2,398,000.00 $2,398,000.00 nat. median
$2,332,000
1.0× median
Q2057
OTHER 		Tecelra (afamitresgene Autoleucel) 1 $792,430.00 $792,430.00 $792,430.00 nat. median
$770,620
1.0× median
Q2056
OTHER 		Ciltacabtagene Car-pos T 1 $605,288.00 $605,288.00 $605,288.00 nat. median
$583,076
1.0× median
Q2055
OTHER 		Idecabtagene Vicleucel Car 1 $575,861.00 $575,861.00 $575,861.00 nat. median
$558,082
1.0× median
73153090001
OTHER 		Lisocabtagene maraleuceL 1.5 X To 70 X 10exp6 cell/mL Susp 1 Each Vial 1 $567,588.00 $567,588.00 $567,588.00 nat. median
$567,588
1.0× median
Q2054
OTHER 		Lisocabtagene Mara Car Pos T 1 $567,588.00 $567,588.00 $567,588.00 nat. median
$562,538
1.0× median
Q2042
OTHER 		Tisagenlecleucel Car-pos T 1 $557,936.00 $557,936.00 $557,936.00 nat. median
$591,726
0.9× median
Q2041
OTHER 		Axicabtagene Ciloleucel Car+ 1 $548,902.00 $548,902.00 $548,902.00 nat. median
$533,230
1.0× median
Q2053
OTHER 		Brexucabtagene Car Pos T 1 $503,580.00 $503,580.00 $503,580.00 nat. median
$489,720
1.0× median
Q2058
OTHER 		Obecbtge Autol Up To 400 Mil 1 $294,709.00 $294,709.00 $294,709.00 nat. median
$281,111
1.0× median
591
OTHER 		Neonate Birthwt 500-749g Without Major Procedure 1 $2,220.80 $229,577.80 $169,939.45 nat. median
$5,729
outlier · 29.7×
583
OTHER 		Mastectomy For Malignancy Without Cc/mcc 1 $99,816.50 $272,371.80 $161,779.25 nat. median
$16,109
outlier · 10.0×
161
OTHER 		Implantable Heart Assist Systems 1 $95,664.10 $210,550.80 $144,100.25 nat. median
$12,684
outlier · 11.4×
589
OTHER 		Neonate Bwt < 500g, Or Bwt 500-999g & Gestational Age <24 Wks, Or Bwt 500-749g W… 1 $2,656.30 $149,980.00 $139,436.90 nat. median
$536
outlier · 260.1×
593
OTHER 		Neonate Birthwt 750-999g Without Major Procedure 1 $6,400.10 $197,893.40 $135,104.80 nat. median
$11,631
outlier · 11.6×
588
OTHER 		Neonate Bwt <1500g W Major Procedure 1 $66,541.20 $228,647.10 $121,465.25 nat. median
$613
outlier · 198.1×
2
OTHER 		Heart &/or Lung Transplant 1 $78,719.80 $191,299.00 $115,260.65 nat. median
$111,558
1.0× median
7
OTHER 		Allogeneic Bone Marrow Transplant 1 $75,865.70 $187,109.10 $103,268.30 nat. median
$169,933
0.6× median
602
OTHER 		Cellulitis With Mcc 1 $40,466.80 $160,178.90 $102,396.70 nat. median
$14,934
outlier · 6.9×
6
OTHER 		Liver Transplant Without Mcc 1 $54,135.60 $133,853.90 $86,268.85 nat. median
$52,924
1.6× median
603
OTHER 		Cellulitis Without Mcc 1 $21,151.80 $132,913.90 $84,832.45 nat. median
$9,288
outlier · 9.1×
A9543
OTHER 		Yttrium Y-90 Ibritumomab Tiuxetan Tx To 40 Mci 1 $82,357.00 $138,832.00 $82,357.00 nat. median
$66,156
1.2× median
72893000704
OTHER 		Yttrium-90-ibritumomab 3.2 Mg/2 Ml Kit 1 Each Vial 1 $82,357.00 $138,832.00 $82,357.00 nat. median
$93,567
0.9× median
1
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $73,427.10 $148,315.30 $81,761.15 nat. median
$239,422
outlier · 0.3×
4
OTHER 		"tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Ne… 1 $61,911.20 $129,524.80 $79,770.45 nat. median
$134,983
0.6× median
607
OTHER 		Minor Skin Disorders Without Mcc 1 $47,398.30 $124,698.10 $74,178.10 nat. median
$8,745
outlier · 8.5×
630
OTHER 		"other Endocrine, Nutritional And Metabolic O.r. Procedures Without Cc/mcc" 1 $28,125.50 $148,350.40 $67,960.05 nat. median
$14,720
outlier · 4.6×
609
OTHER 		Neonate Bwt 1500-2499g W Major Procedure 1 $15,932.90 $181,083.70 $67,515.85 nat. median
$19,261
outlier · 3.5×
38240
OTHER 		Transplt Allo Hct/donor 1 $48,037.00 $154,332.00 $63,625.00 nat. median
$18,374
outlier · 3.5×
55566105000
OTHER 		Nadofaragene Firadenovec-vncg 3x10exp11 vp/mL Susp 1 Each Vial 1 $63,402.00 $106,880.00 $63,402.00 nat. median
$63,431
1.0× median
J9029
OTHER 		"Instill Adstiladrin, Tx Dose" 1 $63,402.00 $106,880.00 $63,402.00 nat. median
$66,509
1.0× median
71258001522
OTHER 		Iobenguane I-131 337.5 mCi/22.5 Ml Soln 1 Each Vial 1 $57,094.50 $188,411.85 $62,803.95 nat. median
$50,243
1.2× median
303
OTHER 		Atherosclerosis Without Mcc 1 $43,641.60 $90,188.90 $60,087.90 nat. median
$5,626
outlier · 10.7×
9
OTHER 		Extracorporeal Membrane Oxygenation (ecmo) 1 $36,854.10 $131,770.10 $58,129.35 nat. median
$1,920
outlier · 30.3×
608
OTHER 		Neonate Bwt 1250-1499g W Or Without Other Significant Condition 1 $26,430.40 $116,421.40 $57,761.15 nat. median
$12,228
outlier · 4.7×
5
OTHER 		Liver Transplant With Mcc Or Intestinal Transplant 1 $46,336.50 $82,828.80 $56,620.30 nat. median
$94,894
0.6× median
30237890006
OTHER 		Sipuleucel-t In Lr 50 Million Cell/250 Ml Susp 250 Ml Bag 1 $55,920.00 $94,267.00 $55,920.00 nat. median
$62,565
0.9× median
Q2043
OTHER 		Sipuleucel-t Auto Cd54+ 1 $55,920.00 $94,267.00 $55,920.00 nat. median
$55,946
1.0× median
162
OTHER 		Cardiac Valve Procedures W Ami Or Complex Pdx 1 $43,404.00 $88,823.90 $55,736.50 nat. median
$14,971
outlier · 3.7×
440
OTHER 		Disorders Of Pancreas Except Malignancy Without Cc/mcc 1 $43,943.70 $85,994.30 $53,620.45 nat. median
$494
outlier · 108.4×
841
OTHER 		Extensive 3rd Degree Burns W Skin Graft 1 $30,751.30 $147,941.80 $53,328.40 nat. median
$13,937
outlier · 3.8×
8
OTHER 		Autologous Bone Marrow Transplant Or T-cell Immunotherapy 1 $36,395.10 $90,349.30 $52,753.60 nat. median
$57,589
0.9× median

Other procedures at this hospital

Browse this hospital's 18,703 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
442 OTHER "disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc" 4 1 — — $13,468.60 $39,449.40 $19,525.10 2026-05-09
441 OTHER "disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc… 4 1 — — $13,977.90 $56,325.90 $25,403.65 2026-05-09
443 OTHER "disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without … 4 1 — — $10,903.70 $34,873.30 $16,050.00 2026-05-09
50633021011 OTHER "glucarpidase 1,000 Unit Recon Soln 1 Each Vial" 3 1 $124,516.04 $93,387.03 25% off $23,717.20 $78,266.84 $26,088.95 2026-05-09
J3391 OTHER "Inj, Atidarsagene Autotemcel" 3 1 — — $4,632,500.00 $4,632,500.00 $4,632,500.00 2026-05-09
J3393 OTHER "Inj, Betibeglogene Autotemce" 3 1 — — $3,052,000.00 $3,052,000.00 $3,052,000.00 2026-05-09
J1411 OTHER "Inj, Hemgenix, Per Tx Dose" 3 1 — — $3,815,000.00 $3,815,000.00 $3,815,000.00 2026-05-09
J3394 OTHER "Inj, Lovotibeglogene Autotem" 3 1 — — $3,379,000.00 $3,379,000.00 $3,379,000.00 2026-05-09
J9029 OTHER "Instill Adstiladrin, Tx Dose" 3 1 — — $63,402.00 $106,880.00 $63,402.00 2026-05-09
69488001061 OTHER "lutetium Lu-177 Vipivotide Tetraxetan 27 mCi/mL (1,000 MBq/mL) Soln 1 Each Vial… 3 1 $147,409.21 $110,556.91 25% off $26,227.10 $86,549.36 $28,849.79 2026-05-09
630 OTHER "other Endocrine, Nutritional And Metabolic O.r. Procedures Without Cc/mcc" 4 1 — — $28,125.50 $148,350.40 $67,960.05 2026-05-09
405 OTHER "pancreas, Liver And Shunt Procedures With Mcc" 4 1 — — $12,497.00 $42,727.30 $18,218.05 2026-05-09
511 OTHER "shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc" 4 1 — — $12,916.10 $45,088.60 $19,465.45 2026-05-09
510 OTHER "shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc" 4 1 — — $11,976.00 $39,313.60 $19,499.95 2026-05-09
512 OTHER "shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc… 4 1 — — $11,293.50 $36,666.70 $17,101.85 2026-05-09
622 OTHER "skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Diso… 4 1 — — $19,366.50 $56,698.20 $29,624.55 2026-05-09
623 OTHER "skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Diso… 4 1 — — $13,322.30 $39,825.20 $26,145.30 2026-05-09
625 OTHER "thyroid, Parathyroid And Thyroglossal Procedures With Mcc" 4 1 — — $14,007.10 $34,542.00 $26,347.25 2026-05-09
4 OTHER "tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Ne… 4 1 — — $61,911.20 $129,524.80 $79,770.45 2026-05-09
690 OTHER Acute Leukemia 4 1 — — $9,987.00 $46,800.10 $21,421.60 2026-05-09
850 OTHER Acute Leukemia With Other Procedures 4 1 — — $15,989.10 $52,321.00 $22,123.40 2026-05-09
121 OTHER Acute Major Eye Infections With Cc/mcc 4 1 — — $12,897.30 $40,570.90 $19,878.10 2026-05-09
614 OTHER Adrenal And Pituitary Procedures With Cc/mcc 4 1 — — $14,559.70 $78,827.50 $38,440.30 2026-05-09
401 OTHER Adrenal Procedures 4 1 — — $13,264.90 $40,074.60 $25,044.25 2026-05-09
950 OTHER Aftercare Without Cc/mcc 4 1 — — $13,617.30 $45,374.20 $19,742.90 2026-05-09
7 OTHER Allogeneic Bone Marrow Transplant 4 1 — — $75,865.70 $187,109.10 $103,268.30 2026-05-09
305 OTHER Amputation Of Lower Limb Except Toes 4 1 — — $9,461.40 $38,792.70 $16,387.10 2026-05-09
20696 OTHER App Mltpln Uni Xtrnl Fix 1st 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
233 OTHER Appendectomy With Complex Principal Diagnosis 4 1 — — $10,407.30 $31,028.80 $16,795.10 2026-05-09
22633 OTHER Arthrd Cmbn 1ntrspc Lumbar 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
22630 OTHER Arthrd Pst Tq 1ntrspc Lum 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
22612 OTHER Arthrd Pst Tq 1ntrspc Lumbar 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
27279 OTHER Arthrd Si Jt Plmt Transarticular&/i-artic Device 3 1 $24,557.00 $18,417.75 25% off $14,937.00 $47,989.00 $19,784.00 2026-05-09
27278 OTHER Arthrd Si Jt Prq Wo Tfxj Dev 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
22808 OTHER Arthrodesis Anterior Spinal Dfrm 2-3 Vrt Seg 3 1 $11,313.00 $8,484.75 25% off $14,550.00 $46,746.00 $19,272.00 2026-05-09
28705 OTHER Arthrodesis Pantalar 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
25446 OTHER Arthrp W/prostc Dst Rds&crps 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
25442 OTHER Arthrp W/prostc Dstl Ulna 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
302 OTHER Atherosclerosis With Mcc 4 1 — — $15,324.10 $32,406.70 $19,198.50 2026-05-09
303 OTHER Atherosclerosis Without Mcc 4 1 — — $43,641.60 $90,188.90 $60,087.90 2026-05-09
8 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 4 1 — — $36,395.10 $90,349.30 $52,753.60 2026-05-09
Q2041 OTHER Axicabtagene Ciloleucel Car+ 3 1 — — $548,902.00 $548,902.00 $548,902.00 2026-05-09
49 OTHER Bacterial & Tuberculous Infections Of Nervous System 4 1 — — $10,225.90 $35,733.70 $17,859.25 2026-05-09
J1414 OTHER Beqvez (fidanacogene Elaparvovec-dz 3 1 — — $3,815,000.00 $3,815,000.00 $3,815,000.00 2026-05-09
187552560 OTHER Bexarotene 1 % Gel 60 G Tube 3 1 $83,983.06 $62,987.30 25% off $16,796.60 $55,428.82 $18,476.27 2026-05-09
C9758 OTHER Bi Prc Nyha 3/4 Hf;trnscth I Ias/pc 3 1 — — $14,214.00 $45,668.00 $18,827.00 2026-05-09
C9782 OTHER Bl P Nyha Ii/iii Hf/ccs Iii/iv Cra 3 1 — — $14,214.00 $45,668.00 $18,827.00 2026-05-09
99999015868 OTHER Botulism Immune Globulin (human) 100 Mg Recon Soln 1 Each Vial 3 1 $137,525.00 $103,143.75 25% off $27,505.00 $90,766.50 $30,255.50 2026-05-09
68403110006 OTHER Botulism Immune Globulin (human) 100 Mg Recon Soln 1 Each Vial 3 1 $137,525.00 $103,143.75 25% off $27,505.00 $90,766.50 $30,255.50 2026-05-09
363 OTHER Breast Procedures Except Mastectomy 4 1 — — $10,361.70 $24,195.50 $18,951.50 2026-05-09
Q2053 OTHER Brexucabtagene Car Pos T 3 1 — — $503,580.00 $503,580.00 $503,580.00 2026-05-09
842 OTHER Burns W Skin Graft Except Extensive 3rd Degree Burns 4 1 — — $12,278.00 $76,346.80 $25,736.70 2026-05-09
309 OTHER Cardiac Arrhythmia And Conduction Disorders With Cc 4 1 — — $13,234.50 $38,388.80 $20,153.80 2026-05-09
308 OTHER Cardiac Arrhythmia And Conduction Disorders With Mcc 4 1 — — $12,751.00 $28,402.90 $17,358.80 2026-05-09
177 OTHER Cardiac Pacemaker & Defibrillator Revision Except Device Replacement 4 1 — — $11,174.10 $26,841.30 $17,941.80 2026-05-09
261 OTHER Cardiac Pacemaker Revision Except Device Replacement With Cc 4 1 — — $13,612.60 $45,952.50 $22,900.75 2026-05-09
260 OTHER Cardiac Pacemaker Revision Except Device Replacement With Mcc 4 1 — — $17,148.10 $57,418.10 $26,757.55 2026-05-09
220 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 4 1 — — $13,250.90 $52,165.30 $24,522.70 2026-05-09
162 OTHER Cardiac Valve Procedures W Ami Or Complex Pdx 4 1 — — $43,404.00 $88,823.90 $55,736.50 2026-05-09
163 OTHER Cardiac Valve Procedures Without Ami Or Complex Pdx 4 1 — — $36,737.00 $75,299.10 $45,664.60 2026-05-09
J3392 OTHER Casgevy (exagamglogene Autotemcel) 3 1 — — $2,398,000.00 $2,398,000.00 $2,398,000.00 2026-05-09
602 OTHER Cellulitis With Mcc 4 1 — — $40,466.80 $160,178.90 $102,396.70 2026-05-09
603 OTHER Cellulitis Without Mcc 4 1 — — $21,151.80 $132,913.90 $84,832.45 2026-05-09
321 OTHER Cervical Spinal Fusion & Other Back/neck Proc Exc Disc Excis/decomp 4 1 — — $16,066.40 $44,774.80 $23,376.05 2026-05-09
313 OTHER Chest Pain 4 1 — — $11,827.30 $34,632.10 $18,291.25 2026-05-09
263 OTHER Cholecystectomy 4 1 — — $10,608.70 $30,788.80 $15,412.55 2026-05-09
Q2056 OTHER Ciltacabtagene Car-pos T 3 1 — — $605,288.00 $605,288.00 $605,288.00 2026-05-09
89 OTHER Concussion With Cc 4 1 — — $15,913.00 $56,133.90 $27,102.90 2026-05-09
165 OTHER Coronary Bypass W Ami Or Complex Pdx 4 1 — — $35,706.80 $68,870.90 $46,278.55 2026-05-09
166 OTHER Coronary Bypass Without Ami Or Complex Pdx 4 1 — — $31,779.20 $61,639.60 $38,251.25 2026-05-09
231 OTHER Coronary Bypass With Ptca With Mcc 4 1 — — $14,116.00 $42,696.90 $21,940.20 2026-05-09
232 OTHER Coronary Bypass With Ptca Without Mcc 4 1 — — $10,963.40 $42,571.60 $16,222.65 2026-05-09
26 OTHER Craniotomy And Endovascular Intracranial Procedures With Cc 4 1 — — $13,112.70 $39,073.70 $18,757.75 2026-05-09
27 OTHER Craniotomy And Endovascular Intracranial Procedures Without Cc/mcc 4 1 — — $15,318.30 $48,914.40 $20,851.50 2026-05-09
910 OTHER Craniotomy For Multiple Significant Trauma 4 1 — — $19,585.40 $64,242.00 $30,508.95 2026-05-09
23 OTHER Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 4 1 — — $13,818.70 $53,936.60 $24,331.90 2026-05-09
24 OTHER Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 4 1 — — $9,435.60 $36,275.70 $16,167.60 2026-05-09
131 OTHER Cystic Fibrosis - Pulmonary Disease 4 1 — — $11,813.30 $31,416.30 $20,063.60 2026-05-09
179 OTHER Defibrillator Implants 4 1 — — $35,679.90 $64,139.00 $42,499.60 2026-05-09
440 OTHER Disorders Of Pancreas Except Malignancy Without Cc/mcc 4 1 — — $43,943.70 $85,994.30 $53,620.45 2026-05-09
444 OTHER Disorders Of The Biliary Tract With Mcc 4 1 — — $9,353.70 $38,429.80 $16,657.00 2026-05-09
304 OTHER Dorsal & Lumbar Fusion Proc Except For Curvature Of Back 4 1 — — $26,598.90 $64,657.60 $37,963.85 2026-05-09
0620T OTHER Endovascular Venous Arterialization Tibl/prnl Vn 3 1 $136,916.00 $102,687.00 25% off $28,428.00 $91,334.00 $37,654.00 2026-05-09
53010010 OTHER Etranacogene Dezaparvovec-drlb 1x10exp13 gc/mL Susp 1 Each Kit 3 1 — — $3,815,000.00 $3,815,000.00 $3,815,000.00 2026-05-09
81416 OTHER Exome Sequence Analysis 3 1 — — $11,973.00 $58,410.00 $35,400.00 2026-05-09
841 OTHER Extensive 3rd Degree Burns W Skin Graft 4 1 — — $30,751.30 $147,941.80 $53,328.40 2026-05-09
911 OTHER Extensive Abdominal/thoracic Procedures For Mult Significant Trauma 4 1 — — $15,228.20 $55,657.40 $23,388.35 2026-05-09
792 OTHER Extensive Or Procedures For Other Complications Of Treatment 4 1 — — $13,942.80 $46,774.40 $20,222.25 2026-05-09
178 OTHER External Heart Assist Systems 4 1 — — $40,988.90 $73,914.10 $52,407.10 2026-05-09
9 OTHER Extracorporeal Membrane Oxygenation (ecmo) 4 1 — — $36,854.10 $131,770.10 $58,129.35 2026-05-09
92 OTHER Facial Bone Procedures Except Major Cranial/facial Bone Procedures 4 1 — — $11,706.80 $53,674.30 $20,202.35 2026-05-09
17156006730 OTHER flutemetamoL F-18 5 mCi (185 MBq) Soln 1 Each Vial 2 1 $10,029.00 $7,521.75 25% off $45,628.20 $50,191.02 $47,909.61 2026-05-09
0094U OTHER Genome Rapid Sequence Alys 3 1 — — $7,565.00 $36,906.00 $22,367.00 2026-05-09
2 OTHER Heart &/or Lung Transplant 4 1 — — $78,719.80 $191,299.00 $115,260.65 2026-05-09
1 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 4 1 — — $73,427.10 $148,315.30 $81,761.15 2026-05-09
227 OTHER Hernia Procedures Except Inguinal, Femoral & Umbilical 4 1 — — $11,243.20 $36,644.50 $17,285.05 2026-05-09
480 OTHER Hip And Femur Procedures Except Major Joint With Mcc 4 1 — — $11,791.00 $37,468.70 $17,372.25 2026-05-09
301 OTHER Hip Joint Replacement 4 1 — — $15,778.40 $31,322.60 $19,504.00 2026-05-09
0686T OTHER Histotripsy Mal Hepatcel Tis 3 1 — — $14,214.00 $45,668.00 $18,827.00 2026-05-09
0888T OTHER Histotripsy Mal Renal Tissue 3 1 — — $14,214.00 $45,668.00 $18,827.00 2026-05-09
67979000201 OTHER Histrelin 50 Mg (65 Mcg/day) Kit 1 Each Kit 3 1 $144,528.07 $108,396.06 25% off $45,540.00 $76,768.00 $45,540.00 2026-05-09
Q2055 OTHER Idecabtagene Vicleucel Car 3 1 — — $575,861.00 $575,861.00 $575,861.00 2026-05-09
69930 OTHER Implant Cochlear Device 3 1 — — $25,835.00 $83,002.00 $34,219.00 2026-05-09
67027 OTHER Implant Eye Drug System 3 1 — — $12,479.00 $40,094.00 $16,529.00 2026-05-09
63655 OTHER Implant Neuroelectrodes 3 1 — — $17,418.00 $55,959.00 $23,070.00 2026-05-09
61886 OTHER Implant Neurostim Arrays 3 1 — — $24,751.00 $79,521.00 $32,784.00 2026-05-09
62362 OTHER Implant Spine Infusion Pump 3 1 — — $14,355.00 $46,121.00 $19,014.00 2026-05-09
62361 OTHER Implant Spine Infusion Pump 3 1 — — $14,355.00 $46,121.00 $19,014.00 2026-05-09
161 OTHER Implantable Heart Assist Systems 4 1 — — $95,664.10 $210,550.80 $144,100.25 2026-05-09
66683 OTHER Implantation Iris Prosthesis 3 1 — — $13,334.00 $42,839.00 $17,661.00 2026-05-09
710 OTHER Infectious & Parasitic Diseases Including HIV W O.r. Procedure 4 1 — — $10,309.00 $41,782.60 $19,327.30 2026-05-09
J1413 OTHER Inj Delandistrogene Mox Rokl 3 1 — — $3,383,360.00 $3,383,360.00 $3,383,360.00 2026-05-09
J3399 OTHER Inj Onase Abepar-xioi Treat 3 1 — — $2,737,307.00 $2,737,307.00 $2,737,307.00 2026-05-09
64590 OTHER Ins/rpl Prph Sac/gstr Npg/r 3 1 — — $17,418.00 $55,959.00 $23,070.00 2026-05-09
33270 OTHER Ins/rplcmnt Perm Subq Impltbl Dfb W/subq Eltrd 3 1 $49,467.00 $37,100.25 25% off $26,041.00 $83,665.00 $34,492.00 2026-05-09
54405 OTHER Insert Multi-comp Penis Pros 3 1 — — $16,349.00 $52,525.00 $21,654.00 2026-05-09
33221 OTHER Insert Pulse Gen Mult Leads 3 1 — — $15,490.00 $49,766.00 $20,517.00 2026-05-09
54401 OTHER Insert Self-contd Prosthesis 3 1 — — $16,349.00 $52,525.00 $21,654.00 2026-05-09
62360 OTHER Insert Spine Infusion Device 3 1 — — $14,355.00 $46,121.00 $19,014.00 2026-05-09
53444 OTHER Insert Tandem Cuff 3 1 — — $16,349.00 $52,525.00 $21,654.00 2026-05-09
53445 OTHER Insert Uro/ves Nck Sphincter 3 1 — — $16,349.00 $52,525.00 $21,654.00 2026-05-09
0515T OTHER Insertion Wrls Car Stimulator Lv Pacg Compl Sys 3 1 $50,714.00 $38,035.50 25% off $18,231.00 $58,573.00 $24,147.00 2026-05-09
176 OTHER Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices 4 1 — — $15,132.20 $46,969.90 $22,970.40 2026-05-09
33240 OTHER Insj Implntbl Defib Pulse Gen W/1 Existing Ld 3 1 $35,326.00 $26,494.50 25% off $18,231.00 $58,573.00 $24,147.00 2026-05-09
0308T OTHER Insj Ocular Telescope Prosth 3 1 — — $13,334.00 $42,839.00 $17,661.00 2026-05-09
33276 OTHER Insj Phrnc Nrv Stim Sys 3 1 — — $36,551.00 $117,430.00 $48,412.00 2026-05-09
22867 OTHER Insj Stablj Dev W/dcmprn 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
37182 OTHER Insj Transvns Intrahepatc Portosysic Shunt 2 1 $3,913.00 $2,934.75 25% off $15,212.00 $20,149.00 $17,680.50 2026-05-09
0409T OTHER Insj/rplc Car Modulj Pls Gn 3 1 — — $18,231.00 $58,573.00 $24,147.00 2026-05-09
0408T OTHER Insj/rplc Cardiac Modulj Sys 3 1 — — $26,041.00 $83,665.00 $34,492.00 2026-05-09
0525T OTHER Insj/rplcmt Compl Iims 3 1 — — $15,490.00 $49,766.00 $20,517.00 2026-05-09
0571T OTHER Insj/rplcmt Icds W/substernal Electrode 3 1 $46,476.00 $34,857.00 25% off $26,041.00 $83,665.00 $34,492.00 2026-05-09
33249 OTHER Insj/rplcmt Perm Dfb W/trnsvns Lds 1/dual Chmbr 3 1 $33,963.00 $25,472.25 25% off $26,041.00 $83,665.00 $34,492.00 2026-05-09
0680T OTHER Insj/rplcmt Pg Only Isdss 3 1 — — $17,418.00 $55,959.00 $23,070.00 2026-05-09
63685 OTHER Insj/rplcmt Spinal Npg/rcvr Pocket Crtj&connj 3 1 $37,919.00 $28,439.25 25% off $24,751.00 $79,521.00 $32,784.00 2026-05-09
33230 OTHER Insrt Pulse Gen W/dual Leads 3 1 — — $18,231.00 $58,573.00 $24,147.00 2026-05-09
33231 OTHER Insrt Pulse Gen W/mult Leads 3 1 — — $26,041.00 $83,665.00 $34,492.00 2026-05-09
61885 OTHER Insrt/redo Neurostim 1 Array 3 1 — — $17,418.00 $55,959.00 $23,070.00 2026-05-09
21 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 4 1 — — $18,513.10 $53,037.50 $30,033.70 2026-05-09
20 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 4 1 — — $19,195.60 $48,920.20 $26,320.30 2026-05-09
22 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 4 1 — — $12,117.70 $42,974.30 $16,846.60 2026-05-09
71258001522 OTHER Iobenguane I-131 337.5 mCi/22.5 Ml Soln 1 Each Vial 3 1 $285,472.50 $214,104.38 25% off $57,094.50 $188,411.85 $62,803.95 2026-05-09
65770 OTHER Keratoprosthesis 3 1 — — $11,606.00 $37,288.00 $15,372.00 2026-05-09
650 OTHER Kidney Transplant With Hemodialysis With Mcc 4 1 — — $12,582.40 $39,064.30 $21,922.05 2026-05-09
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 4 1 — — $10,012.80 $49,560.60 $17,598.80 2026-05-09
0674T OTHER Laps Insj Nw/rpcmt Prm Isdss 3 1 — — $24,751.00 $79,521.00 $32,784.00 2026-05-09
Q2054 OTHER Lisocabtagene Mara Car Pos T 3 1 — — $567,588.00 $567,588.00 $567,588.00 2026-05-09
73153090001 OTHER Lisocabtagene maraleuceL 1.5 X To 70 X 10exp6 cell/mL Susp 1 Each Vial 3 1 $1,472,908.31 $1,104,681.24 25% off $567,588.00 $567,588.00 $567,588.00 2026-05-09
5 OTHER Liver Transplant With Mcc Or Intestinal Transplant 4 1 — — $46,336.50 $82,828.80 $56,620.30 2026-05-09
6 OTHER Liver Transplant Without Mcc 4 1 — — $54,135.60 $133,853.90 $86,268.85 2026-05-09
181 OTHER Lower Extremity Arterial Procedures 4 1 — — $14,470.70 $47,248.50 $24,804.30 2026-05-09
69488000301 OTHER Lutetium Lu 177 Dotatate 10 mCi/mL (370 MBq/mL) Soln 1 Each Vial 3 1 $193,132.79 $144,849.60 25% off $32,205.10 $106,276.82 $35,425.61 2026-05-09
169 OTHER Major Abdominal Vascular Procedures 4 1 — — $18,655.90 $58,852.20 $29,693.65 2026-05-09
160 OTHER Major Cardiothoracic Repair Of Heart Anomaly 4 1 — — $36,733.50 $96,132.40 $48,718.85 2026-05-09
183 OTHER Major Chest Trauma With Mcc 4 1 — — $40,091.00 $69,867.10 $46,399.75 2026-05-09
680 OTHER Major O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms 4 1 — — $14,713.10 $58,676.60 $25,897.70 2026-05-09
120 OTHER Major Respiratory & Chest Procedures 4 1 — — $17,788.40 $55,333.20 $26,468.40 2026-05-09
230 OTHER Major Small Bowel Procedures 4 1 — — $13,397.20 $47,792.80 $22,703.50 2026-05-09
583 OTHER Mastectomy For Malignancy Without Cc/mcc 4 1 — — $99,816.50 $272,371.80 $161,779.25 2026-05-09
362 OTHER Mastectomy Procedures 4 1 — — $10,735.10 $32,556.50 $15,615.65 2026-05-09
740 OTHER Mental Illness Diagnosis W O.r. Procedure 4 1 — — $11,312.20 $52,301.10 $18,117.40 2026-05-09
607 OTHER Minor Skin Disorders Without Mcc 4 1 — — $47,398.30 $124,698.10 $74,178.10 2026-05-09
951 OTHER Moderately Extensive Procedure Unrelated To Principal Diagnosis 4 1 — — $10,053.80 $38,264.70 $17,215.95 2026-05-09
447 OTHER Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 4 1 — — $12,015.80 $41,011.10 $16,689.70 2026-05-09
912 OTHER Musculoskeletal & Other Procedures For Multiple Significant Trauma 4 1 — — $17,791.90 $53,894.40 $23,109.10 2026-05-09
55566105000 OTHER Nadofaragene Firadenovec-vncg 3x10exp11 vp/mL Susp 1 Each Vial 3 1 $43,853.00 $32,889.75 25% off $63,402.00 $106,880.00 $63,402.00 2026-05-09
863 OTHER Neonatal Aftercare 4 1 — — $7,906.70 $78,807.60 $28,339.70 2026-05-09
613 OTHER Neonate Birthwt 1500-1999g W Congenital/perinatal Infection 4 1 — — $22,457.10 $65,686.60 $46,566.55 2026-05-09
611 OTHER Neonate Birthwt 1500-1999g W Major Anomaly 4 1 — — $17,158.60 $98,794.50 $47,302.90 2026-05-09
591 OTHER Neonate Birthwt 500-749g Without Major Procedure 4 1 — — $2,220.80 $229,577.80 $169,939.45 2026-05-09
593 OTHER Neonate Birthwt 750-999g Without Major Procedure 4 1 — — $6,400.10 $197,893.40 $135,104.80 2026-05-09
636 OTHER Neonate Birthwt >2499g W Congenital/perinatal Infection 4 1 — — $7,324.90 $33,553.90 $16,754.10 2026-05-09
633 OTHER Neonate Birthwt >2499g W Major Anomaly 4 1 — — $3,515.50 $61,582.20 $19,717.10 2026-05-09
631 OTHER Neonate Birthwt >2499g W Other Major Procedure 4 1 — — $16,282.90 $128,893.80 $47,962.00 2026-05-09
608 OTHER Neonate Bwt 1250-1499g W Or Without Other Significant Condition 4 1 — — $26,430.40 $116,421.40 $57,761.15 2026-05-09
612 OTHER Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond 4 1 — — $30,307.60 $83,882.40 $50,417.50 2026-05-09
609 OTHER Neonate Bwt 1500-2499g W Major Procedure 4 1 — — $15,932.90 $181,083.70 $67,515.85 2026-05-09
621 OTHER Neonate Bwt 2000-2499g W Major Anomaly 4 1 — — $7,966.50 $81,898.20 $32,778.90 2026-05-09
589 OTHER Neonate Bwt < 500g, Or Bwt 500-999g & Gestational Age <24 Wks, Or Bwt 500-749g W… 4 1 — — $2,656.30 $149,980.00 $139,436.90 2026-05-09
588 OTHER Neonate Bwt <1500g W Major Procedure 4 1 — — $66,541.20 $228,647.10 $121,465.25 2026-05-09
634 OTHER Neonate, Birthwt >2499g W Resp Dist Synd/oth Maj Resp Cond 4 1 — — $7,769.80 $49,859.10 $17,167.35 2026-05-09
952 OTHER Nonextensive Procedure Unrelated To Principal Diagnosis 4 1 — — $8,643.10 $35,503.10 $15,334.10 2026-05-09
C9760 OTHER Nrnd Nbld Pd Nyha Cls Ii Iii IV Hf; 3 1 — — $22,337.00 $71,763.00 $29,585.00 2026-05-09
Q2058 OTHER Obecbtge Autol Up To 400 Mil 3 1 — — $294,709.00 $294,709.00 $294,709.00 2026-05-09
0295U OTHER Onc Brst Dux Carc 7 Proteins 3 1 — — $5,423.00 $26,454.00 $16,033.00 2026-05-09
81529 OTHER Onc Cutan Mlnma Mrna 31 Gene 3 1 — — $7,177.00 $35,011.00 $21,219.00 2026-05-09
0315U OTHER Onc Cutan Sq Cll Ca Mrna 40 3 1 — — $8,481.00 $41,374.00 $25,075.00 2026-05-09
0211U OTHER Onc Pan-tum Dna&rna Gnrj Seq 3 1 — — $8,436.00 $41,154.00 $24,942.00 2026-05-09
81552 OTHER Onc Uveal Mlnma Mrna 15 Gene 3 1 — — $7,759.00 $37,849.00 $22,939.00 2026-05-09
64568 OTHER Opn Impltj Crnl Nrv Nea&pg 3 1 — — $24,751.00 $79,521.00 $32,784.00 2026-05-09
64580 OTHER Opn Impltj Nea Neuromuscular 3 1 — — $17,418.00 $55,959.00 $23,070.00 2026-05-09
0817T OTHER Opn Insj/rplcmt Ins Ptn Subf 3 1 — — $17,418.00 $55,959.00 $23,070.00 2026-05-09
0816T OTHER Opn Insj/rplcmt Ins Ptn Subq 3 1 — — $17,418.00 $55,959.00 $23,070.00 2026-05-09
64582 OTHER Opn Mpltj Hpglsl Nstm Ary Pg 3 1 — — $24,751.00 $79,521.00 $32,784.00 2026-05-09
23616 OTHER Optx Prx Hmrl Fx Fix Rpr Rpl 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
167 OTHER Other Cardiothoracic & Thoracic Vascular Procedures 4 1 — — $26,453.80 $67,611.20 $32,337.55 2026-05-09
229 OTHER Other Cardiothoracic Procedures Without Mcc 4 1 — — $10,835.80 $33,311.60 $16,137.15 2026-05-09
315 OTHER Other Circulatory System Diagnoses With Cc 4 1 — — $8,042.50 $31,312.10 $16,226.75 2026-05-09
264 OTHER Other Circulatory System O.r. Procedures 4 1 — — $12,938.30 $45,160.00 $17,321.30 2026-05-09
180 OTHER Other Circulatory System Procedures 4 1 — — $11,484.30 $33,804.40 $16,337.40 2026-05-09
91 OTHER Other Disorders Of Nervous System With Mcc 4 1 — — $11,453.90 $61,020.30 $25,251.50 2026-05-09
320 OTHER Other Endovascular Cardiac Valve Procedures Without Mcc 4 1 — — $9,923.80 $33,250.70 $16,534.05 2026-05-09
681 OTHER Other O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms 4 1 — — $11,023.10 $50,970.10 $19,972.30 2026-05-09
29 OTHER Other Percutaneous Intracranial Procedures 4 1 — — $14,896.90 $39,243.40 $19,778.00 2026-05-09
182 OTHER Other Peripheral Vascular Procedures 4 1 — — $17,891.40 $42,032.00 $22,071.35 2026-05-09
223 OTHER Other Small & Large Bowel Procedures 4 1 — — $10,220.00 $36,866.90 $18,253.15 2026-05-09
C9602 OTHER Pc Tl Cor Atherect W/rx Elut Ic Stent; 1 Mca/br 3 1 $34,774.00 $26,080.50 25% off $14,585.00 $46,858.00 $19,318.00 2026-05-09
C9607 OTHER Pc Tl Rev Chrn Tot Occl Ca Ca Br/cabg; 1 Ves 3 1 $31,961.00 $23,970.75 25% off $14,585.00 $46,858.00 $19,318.00 2026-05-09
72694095401 OTHER Pegaspargase In Sterile Diluent 750 Unit/ml Inj 5 Ml Vial 3 1 $79,203.32 $59,402.49 25% off $28,411.00 $47,894.00 $28,411.00 2026-05-09
J9266 OTHER Pegaspargase Injection 3 1 — — $28,411.00 $47,894.00 $28,411.00 2026-05-09
174 OTHER Percutaneous Cardiac Intervention W Ami 4 1 — — $19,340.70 $34,897.90 $23,067.00 2026-05-09
175 OTHER Percutaneous Cardiac Intervention Without Ami 4 1 — — $19,470.70 $39,037.40 $23,695.05 2026-05-09
322 OTHER Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc 4 1 — — $17,471.20 $33,692.10 $21,484.25 2026-05-09
30 OTHER Percutaneous Intra & Extracranial Vascular Procedures 4 1 — — $17,055.60 $44,728.00 $27,969.20 2026-05-09
224 OTHER Peritoneal Adhesiolysis 4 1 — — $12,685.40 $37,840.90 $19,365.30 2026-05-09
171 OTHER Perm Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock 4 1 — — $15,490.40 $32,754.30 $19,639.85 2026-05-09
170 OTHER Permanent Cardiac Pacemaker Implant W Ami, Heart Failure Or Shock 4 1 — — $19,408.60 $36,749.90 $23,970.20 2026-05-09
33902 OTHER Perq P-art Revsc 1 Abnor Uni 3 1 — — $14,585.00 $46,858.00 $19,318.00 2026-05-09
0632T OTHER Perq Tcat US Abltj Nrv P-art 3 1 — — $14,585.00 $46,858.00 $19,318.00 2026-05-09
36906 OTHER Perq Thrmbc/nfs Dial Circuit Tcat Plmt IV Stent 3 1 $18,188.00 $13,641.00 25% off $14,585.00 $46,858.00 $19,318.00 2026-05-09
76128015575 OTHER Porfimer 75 Mg Recon Soln 1 Each Vial 3 1 $67,175.24 $50,381.43 25% off $24,217.00 $40,824.00 $24,217.00 2026-05-09
J9600 OTHER Porfimer Sodium Injection 3 1 — — $24,217.00 $40,824.00 $24,217.00 2026-05-09
711 OTHER Post-op, Post-trauma, Other Device Infections W O.r. Procedure 4 1 — — $9,862.90 $40,085.10 $17,076.05 2026-05-09
37184 OTHER Prim Prq Trluml Mchnl Thrmbc N-cor N-icra 1st 3 1 $15,526.00 $11,644.50 25% off $14,585.00 $46,858.00 $19,318.00 2026-05-09
403 OTHER Procedures For Obesity 4 1 — — $11,922.20 $46,144.50 $16,055.85 2026-05-09
36837 OTHER Prq Av Fstl Crt Uxtr Sep Acs 3 1 — — $14,585.00 $46,858.00 $19,318.00 2026-05-09
36836 OTHER Prq Av Fstl Crtj Uxtr 1 Acs 3 1 — — $14,585.00 $46,858.00 $19,318.00 2026-05-09
0793T OTHER Prq Tcat Thrm Ablt Nrv P-art 3 1 — — $14,585.00 $46,858.00 $19,318.00 2026-05-09
81554 OTHER Pulm Ds Ipf Mrna 190 Gen Alg 3 1 — — $5,433.00 $26,504.00 $16,063.00 2026-05-09
A9699 OTHER Radiopharmaceutical Therapeutic Noc 3 1 — — $51,935.00 $87,549.00 $51,935.00 2026-05-09
0265U OTHER Rar Do Whl Gn&mtcdrl DNA Als 3 1 — — $5,464.00 $26,654.00 $16,154.00 2026-05-09
0267U OTHER Rare Do Id Opt Gen Mapg&seq 3 1 — — $6,724.00 $32,804.00 $19,881.00 2026-05-09
0212U OTHER Rare Ds Gen DNA Alys Proband 3 1 — — $5,463.00 $26,651.00 $16,152.00 2026-05-09
0335U OTHER Rare Ds Whl Gen Seq Feta 3 1 — — $5,213.00 $25,431.00 $15,413.00 2026-05-09
0214U OTHER Rare Ds Xom DNA Alys Proband 3 1 — — $5,213.00 $25,431.00 $15,413.00 2026-05-09
27702 OTHER Reconstruct Ankle Joint 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
24361 OTHER Reconstruct Elbow Joint 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
23472 OTHER Reconstruct Shoulder Joint 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
21243 OTHER Reconstruction Of Jaw Joint 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
54411 OTHER Remov/replc Penis Pros Comp 3 1 — — $16,349.00 $52,525.00 $21,654.00 2026-05-09
54410 OTHER Remove/replace Penis Prosth 3 1 — — $16,349.00 $52,525.00 $21,654.00 2026-05-09
53447 OTHER Remove/replace Ur Sphincter 3 1 — — $16,349.00 $52,525.00 $21,654.00 2026-05-09
54416 OTHER Remv/repl Penis Contain Pros 3 1 — — $16,349.00 $52,525.00 $21,654.00 2026-05-09
33229 OTHER Remvl Perm Pm Pls Gen W/repl Plse Gen Mult Lead 3 1 $17,252.00 $12,939.00 25% off $15,490.00 $49,766.00 $20,517.00 2026-05-09
24363 OTHER Replace Elbow Joint 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
130 OTHER Respiratory System Diagnosis W Ventilator Support 96+ Hours 4 1 — — $31,326.10 $48,276.30 $34,853.95 2026-05-09
C9766 OTHER Rev Evar Le Aa; IV Litho & Atherect 3 1 — — $14,585.00 $46,858.00 $19,318.00 2026-05-09
C9767 OTHER Rev Evr Le Aa; IV Litho & Tl St&ath 3 1 — — $14,585.00 $46,858.00 $19,318.00 2026-05-09
C9765 OTHER Rev Evr Le Aa;iv Lith&tl Stnt Plcmt 3 1 — — $14,585.00 $46,858.00 $19,318.00 2026-05-09
61891 OTHER Rev/rplcmt Sk-mnt Crnl Nstm 3 1 — — $17,418.00 $55,959.00 $23,070.00 2026-05-09
C9775 OTHER Revasc Lith-sten-ath Tib/per 3 1 $60,556.00 $45,417.00 25% off $14,585.00 $46,858.00 $19,318.00 2026-05-09
C9774 OTHER Revasc Lithotr-ather Tib/per 3 1 $60,556.00 $45,417.00 25% off $14,585.00 $46,858.00 $19,318.00 2026-05-09
C9773 OTHER Revasc Lithotr-stent Tib/per 3 1 $60,556.00 $45,417.00 25% off $14,585.00 $46,858.00 $19,318.00 2026-05-09
24371 OTHER Revise Reconst Elbow Joint 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
37273 OTHER Revsc Evasc Fpvt Athrc Uni Cplx Les 1st Vsl 3 1 $37,457.00 $28,092.75 25% off $15,212.00 $48,873.00 $20,149.00 2026-05-09
37271 OTHER Revsc Evasc Fpvt Athrc Uni Sf Les 1st Vsl 3 1 $37,457.00 $28,092.75 25% off $15,212.00 $48,873.00 $20,149.00 2026-05-09
37277 OTHER Revsc Evasc Fpvt St Athrc Uni Cplx Les 1st Vsl 3 1 $37,457.00 $28,092.75 25% off $15,212.00 $48,873.00 $20,149.00 2026-05-09
37275 OTHER Revsc Evasc Fpvt St Athrc Uni Sf Les 1st Vsl 3 1 $37,457.00 $28,092.75 25% off $15,212.00 $48,873.00 $20,149.00 2026-05-09
37290 OTHER Revsc Evasc Tpvt Athrc Uni Cplx Les 1st Vsl 3 1 $37,457.00 $28,092.75 25% off $15,212.00 $48,873.00 $20,149.00 2026-05-09
37288 OTHER Revsc Evasc Tpvt Athrc Uni Sf Les 1st Vsl 3 1 $37,457.00 $28,092.75 25% off $15,212.00 $48,873.00 $20,149.00 2026-05-09
37294 OTHER Revsc Evasc Tpvt St Athrc Uni Cplx Les 1st Vsl 3 1 $37,457.00 $28,092.75 25% off $15,212.00 $48,873.00 $20,149.00 2026-05-09
37292 OTHER Revsc Evasc Tpvt St Athrc Uni Sf Les 1st Vsl 3 1 $37,457.00 $28,092.75 25% off $15,212.00 $48,873.00 $20,149.00 2026-05-09
37286 OTHER Revsc Evasc Tpvt St Plmt Uni Cplx Les 1st Vsl 3 1 $37,457.00 $28,092.75 25% off $15,212.00 $48,873.00 $20,149.00 2026-05-09
37284 OTHER Revsc Evasc Tpvt St Plmt Uni Sf Les 1st Vsl 3 1 $37,457.00 $28,092.75 25% off $15,212.00 $48,873.00 $20,149.00 2026-05-09
187000714 OTHER Ribavirin 6 Gram Recon Soln 4 Each Vial 3 1 $71,893.39 $53,920.05 25% off $14,378.70 $47,449.64 $15,816.55 2026-05-09
33287 OTHER Rmv&rplcmt Phrnc Nrv Stim Pg 3 1 — — $24,751.00 $79,521.00 $32,784.00 2026-05-09
0414T OTHER Rmvl & Rpl Car Modulj Pls Gn 3 1 — — $18,231.00 $58,573.00 $24,147.00 2026-05-09
33264 OTHER Rmvl Impltbl Dfb Pls Gen W/rplcmt Pls Gen Mlt Ld 3 1 $29,128.00 $21,846.00 25% off $26,041.00 $83,665.00 $34,492.00 2026-05-09
33262 OTHER Rmvl Impltbl Dfb Plse Gen W/repl Plse Gen 1 Lead 3 1 $20,870.00 $15,652.50 25% off $18,231.00 $58,573.00 $24,147.00 2026-05-09
33263 OTHER Rmvl Impltbl Dfb Plse Gen W/rplcmt Plse Gen 2 Ld 3 1 $20,870.00 $15,652.50 25% off $18,231.00 $58,573.00 $24,147.00 2026-05-09
0614T OTHER Rmvl&rplcmt Ss Impl Dfb Pg 3 1 — — $18,231.00 $58,573.00 $24,147.00 2026-05-09
Q2043 OTHER Sipuleucel-t Auto Cd54+ 3 1 — — $55,920.00 $94,267.00 $55,920.00 2026-05-09
30237890006 OTHER Sipuleucel-t In Lr 50 Million Cell/250 Ml Susp 250 Ml Bag 3 1 $180,340.20 $135,255.15 25% off $55,920.00 $94,267.00 $55,920.00 2026-05-09
312 OTHER Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses 4 1 — — $10,812.40 $48,139.40 $18,347.45 2026-05-09
187001050 OTHER Sodium Benzoate-sod Phenylacet 10-10 % Soln 50 Ml Vial 3 1 $131,507.84 $98,630.88 25% off $26,301.60 $86,795.17 $28,931.72 2026-05-09
J9226 OTHER Supprelin La Implant 3 1 — — $45,540.00 $76,768.00 $45,540.00 2026-05-09
33289 OTHER Tcat Impl Wrls P-art Prs Snr 3 1 — — $23,090.00 $74,184.00 $30,583.00 2026-05-09
0645T OTHER Tcat Impltj C Sins Rdctj Dev 3 1 — — $14,585.00 $46,858.00 $19,318.00 2026-05-09
0823T OTHER Tcat Ins 1chmbr Ldls Pm Ra 3 1 — — $15,490.00 $49,766.00 $20,517.00 2026-05-09
0795T OTHER Tcat Ins 2chmbr Ldls Pm Cmpl 3 1 — — $15,490.00 $49,766.00 $20,517.00 2026-05-09
0796T OTHER Tcat Ins 2chmbr Ldls Pm Ra 3 1 — — $15,490.00 $49,766.00 $20,517.00 2026-05-09
0797T OTHER Tcat Ins 2chmbr Ldls Pm Rv 3 1 — — $15,490.00 $49,766.00 $20,517.00 2026-05-09
33274 OTHER Tcat Insj/rpl Perm Leadless Pacemaker Rv W/img 3 1 $41,922.00 $31,441.50 25% off $15,490.00 $49,766.00 $20,517.00 2026-05-09
61624 OTHER Tcat Perm Occls/embolization Perq Cns 3 1 $5,067.00 $3,800.25 25% off $15,212.00 $48,873.00 $20,149.00 2026-05-09
0801T OTHER Tcat Rmv&rpl 2chmbr Ldls Pm 3 1 — — $15,490.00 $49,766.00 $20,517.00 2026-05-09
0825T OTHER Tcat Rmv&rpl1chmb Ldls Pm Ra 3 1 — — $15,490.00 $49,766.00 $20,517.00 2026-05-09
0802T OTHER Tcat Rmv&rpl2chmb Ldls Pm Ra 3 1 — — $15,490.00 $49,766.00 $20,517.00 2026-05-09
0803T OTHER Tcat Rmv&rpl2chmb Ldls Pm Rv 3 1 — — $15,490.00 $49,766.00 $20,517.00 2026-05-09
Q2057 OTHER Tecelra (afamitresgene Autoleucel) 3 1 — — $792,430.00 $792,430.00 $792,430.00 2026-05-09
68875010201 OTHER Teduglutide 5 Mg Kit 1 Each Kit 3 1 $135,055.95 $101,291.97 25% off $26,224.50 $86,540.79 $28,846.93 2026-05-09
404 OTHER Thyroid, Parathyroid & Thyroglossal Procedures 4 1 — — $8,729.70 $41,075.50 $16,559.20 2026-05-09
Q2042 OTHER Tisagenlecleucel Car-pos T 3 1 — — $557,936.00 $557,936.00 $557,936.00 2026-05-09
19357 OTHER Tiss Xpndr Plmt Brst Rcnstj 3 1 — — $14,131.00 $45,401.00 $18,717.00 2026-05-09
22856 OTHER Tot Disc Arthrp 1ntrspc Crv 3 1 — — $14,937.00 $47,989.00 $19,784.00 2026-05-09
38240 OTHER Transplt Allo Hct/donor 3 1 — — $48,037.00 $154,332.00 $63,625.00 2026-05-09
0238T OTHER Trluml Perip Athrc Iliac Art 3 1 — — $14,585.00 $46,858.00 $19,318.00 2026-05-09
C9797 OTHER Vasc Emb/occ W/prs-gen Cath 3 1 — — $14,585.00 $46,858.00 $19,318.00 2026-05-09
37242 OTHER Vascular Embolization Or Occlusion Arterial Rs&i 3 1 $18,748.00 $14,061.00 25% off $14,585.00 $46,858.00 $19,318.00 2026-05-09
A9543 OTHER Yttrium Y-90 Ibritumomab Tiuxetan Tx To 40 Mci 3 1 $180,482.00 $135,361.50 25% off $82,357.00 $138,832.00 $82,357.00 2026-05-09
72893000704 OTHER Yttrium-90-ibritumomab 3.2 Mg/2 Ml Kit 1 Each Vial 3 1 $195,328.32 $146,496.24 25% off $82,357.00 $138,832.00 $82,357.00 2026-05-09
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