Hospital

COMMUNITY HOSPITAL OF STAUNTON

Staunton, IL · CCN 141306 · Rates published

15,269 distinct procedures filed

16 distinct payers

359,900 rate rows

2025-01-21 last MRF observed · ⚠ 21 mo old

Data quality

325,969 of 359,900 rate rows are consumer-grade (90.6%)

33,931 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 — reason	Rows
per-diem day rate — not a per-procedure price	13,926
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	12,333
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	4,590
template filing: same amount across many unrelated codes — excluded	2,904
exceeds 10× this hospital's gross charge — excluded from medians	166
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings	12

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 21 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://stauntonhospital.org/wp-content/uploads/2026/04/370624255_anderson_healthcare_standardcharges.csv
Found on page	https://stauntonhospital.org/visitor-patient-information/price-transparency/
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-10-12
Content fingerprint	65bb0e644ce58a50… · 35,936,850 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
'583-4 OTHER	Neonate With Ecmo	4	$190,753.52	$190,753.52	$190,753.52	—
'588-4 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	4	$156,469.62	$156,469.62	$156,469.62	—
'583-3 OTHER	Neonate With Ecmo	4	$151,080.42	$151,080.42	$151,080.42	—
'161-4 OTHER	Implantable Heart Assist Systems	4	$149,603.53	$149,603.53	$149,603.53	—
'002-4 OTHER	Heart And/or Lung Transplant	4	$144,371.88	$144,371.88	$144,371.88	—
'161-3 OTHER	Implantable Heart Assist Systems	4	$114,611.68	$114,611.68	$114,611.68	—
'630-4 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	4	$113,571.45	$113,571.45	$113,571.45	—
'583-2 OTHER	Neonate With Ecmo	4	$111,407.32	$111,407.32	$111,407.32	—
'841-4 OTHER	Extensive Third Degree Burns With Skin Graft	4	$105,500.94	$105,500.94	$105,500.94	—
'593-4 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	4	$102,047.97	$102,047.97	$102,047.97	—
'588-3 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	4	$100,803.67	$100,803.67	$100,803.67	—
'588-2 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	4	$98,706.40	$98,706.40	$98,706.40	—
'591-4 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	4	$98,544.17	$98,544.17	$98,544.17	—
'011-4 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	4	$98,417.51	$98,417.51	$98,417.51	—
'609-4 OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	4	$97,915.57	$97,915.57	$97,915.57	—
'583-1 OTHER	Neonate With Ecmo	4	$96,276.06	$96,276.06	$96,276.06	—
'007-4 OTHER	Allogeneic Bone Marrow Transplant	4	$94,647.89	$94,647.89	$94,647.89	—
'631-4 OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	4	$94,003.26	$94,003.26	$94,003.26	—
'004-4 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	4	$93,749.17	$93,749.17	$93,749.17	—
C9073 HCPCS	Brexucabtagene Autoleucel Ca	4	$92,877.03	$92,877.03	$92,877.03	nat. median $1,000,529 outlier · 0.1×
C9076 HCPCS	Lisocabtagene Car Pos T	4	$92,877.03	$92,877.03	$92,877.03	nat. median $1,000,529 outlier · 0.1×
J3393 HCPCS	Inj, Betibeglogene Autotemce	4	$92,877.03	$92,877.03	$92,877.03	nat. median $2,968,000 outlier · 0.0×
C9081 HCPCS	Idecabtagene Car Pos T	4	$92,877.03	$92,877.03	$92,877.03	nat. median $422,856 outlier · 0.2×
J3394 HCPCS	Inj, Lovotibeglogene Autotem	4	$92,877.03	$92,877.03	$92,877.03	nat. median $3,248,446 outlier · 0.0×
Q2056 HCPCS	Ciltacabtagene Car-pos T	4	$92,877.03	$92,877.03	$92,877.03	nat. median $599,737 outlier · 0.2×
Q2040 HCPCS	Tisagenlecleucel Car-pos T	4	$92,877.03	$92,877.03	$92,877.03	nat. median $6 outlier · 16180.7×
Q2054 HCPCS	Lisocabtagene Mara Car Pos T	4	$92,877.03	$92,877.03	$92,877.03	nat. median $579,571 outlier · 0.2×
Q2053 HCPCS	Brexucabtagene Car Pos T	4	$92,877.03	$92,877.03	$92,877.03	nat. median $513,770 outlier · 0.2×
Q2041 HCPCS	Axicabtagene Ciloleucel Car+	4	$92,877.03	$92,877.03	$92,877.03	nat. median $562,501 outlier · 0.2×
C9098 HCPCS	Ciltacabtagene Car Pos T	4	$92,877.03	$92,877.03	$92,877.03	nat. median $2,313,353 outlier · 0.0×
Q2042 HCPCS	Tisagenlecleucel Car-pos T	4	$92,877.03	$92,877.03	$92,877.03	nat. median $621,313 outlier · 0.1×
Q2055 HCPCS	Idecabtagene Vicleucel Car	4	$92,877.03	$92,877.03	$92,877.03	nat. median $574,037 outlier · 0.2×
'001-4 OTHER	Liver Transplant And/or Intestinal Transplant	4	$92,291.43	$92,291.43	$92,291.43	—
'161-2 OTHER	Implantable Heart Assist Systems	4	$92,023.26	$92,023.26	$92,023.26	—
'009-4 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	4	$91,782.85	$91,782.85	$91,782.85	—
'002-3 OTHER	Heart And/or Lung Transplant	4	$89,277.46	$89,277.46	$89,277.46	—
'161-1 OTHER	Implantable Heart Assist Systems	4	$87,421.77	$87,421.77	$87,421.77	—
'603-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	4	$82,029.45	$82,029.45	$82,029.45	—
'006-4 OTHER	Pancreas Transplant	4	$81,504.05	$81,504.05	$81,504.05	—
C9031 HCPCS	Lutetium Lu 177 Dotatate, Tx	4	$74,517.38	$74,517.38	$74,517.38	—
A9543 HCPCS	Y90 Ibritumomab, Rx	4	$74,517.38	$74,517.38	$74,517.38	nat. median $65,477 1.1× median
A9513 HCPCS	Lutetium Lu 177 Dotatat Ther	4	$74,517.38	$74,517.38	$74,517.38	nat. median $550 outlier · 135.4×
A9607 HCPCS	Lutetium Lu 177 Vipivotide	4	$74,517.38	$74,517.38	$74,517.38	nat. median $396 outlier · 188.2×
'602-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	4	$73,148.18	$73,148.18	$73,148.18	—
J0202 HCPCS	Alemtuzumab 12 Mg/1.2 Ml Vial	14	$35,820.80	$90,547.02	$66,666.49	nat. median $3,427 outlier · 19.5×
'002-2 OTHER	Heart And/or Lung Transplant	4	$66,253.56	$66,253.56	$66,253.56	—
'593-3 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	4	$65,623.40	$65,623.40	$65,623.40	—
'588-1 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	4	$64,972.13	$64,972.13	$64,972.13	—
'004-3 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	4	$64,155.11	$64,155.11	$64,155.11	—
'160-4 OTHER	Major Cardiothoracic Repair Of Heart Anomaly	4	$63,303.69	$63,303.69	$63,303.69	—

Other procedures at this hospital

Browse this hospital's 15,269 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

'583-4	OTHER	Neonate With Ecmo	8	4	—	—	$190,753.52	$190,753.52	$190,753.52	2025-01-21
'588-4	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	8	4	—	—	$156,469.62	$156,469.62	$156,469.62	2025-01-21
'583-3	OTHER	Neonate With Ecmo	8	4	—	—	$151,080.42	$151,080.42	$151,080.42	2025-01-21
'161-4	OTHER	Implantable Heart Assist Systems	8	4	—	—	$149,603.53	$149,603.53	$149,603.53	2025-01-21
'002-4	OTHER	Heart And/or Lung Transplant	8	4	—	—	$144,371.88	$144,371.88	$144,371.88	2025-01-21
'161-3	OTHER	Implantable Heart Assist Systems	8	4	—	—	$114,611.68	$114,611.68	$114,611.68	2025-01-21
'630-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	8	4	—	—	$113,571.45	$113,571.45	$113,571.45	2025-01-21
'583-2	OTHER	Neonate With Ecmo	8	4	—	—	$111,407.32	$111,407.32	$111,407.32	2025-01-21
'841-4	OTHER	Extensive Third Degree Burns With Skin Graft	8	4	—	—	$105,500.94	$105,500.94	$105,500.94	2025-01-21
'593-4	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	8	4	—	—	$102,047.97	$102,047.97	$102,047.97	2025-01-21
'588-3	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	8	4	—	—	$100,803.67	$100,803.67	$100,803.67	2025-01-21
'588-2	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	8	4	—	—	$98,706.40	$98,706.40	$98,706.40	2025-01-21
'591-4	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	8	4	—	—	$98,544.17	$98,544.17	$98,544.17	2025-01-21
'011-4	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	8	4	—	—	$98,417.51	$98,417.51	$98,417.51	2025-01-21
'609-4	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	8	4	—	—	$97,915.57	$97,915.57	$97,915.57	2025-01-21
'583-1	OTHER	Neonate With Ecmo	8	4	—	—	$96,276.06	$96,276.06	$96,276.06	2025-01-21
'007-4	OTHER	Allogeneic Bone Marrow Transplant	8	4	—	—	$94,647.89	$94,647.89	$94,647.89	2025-01-21
'631-4	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	8	4	—	—	$94,003.26	$94,003.26	$94,003.26	2025-01-21
'004-4	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	8	4	—	—	$93,749.17	$93,749.17	$93,749.17	2025-01-21
Q2041	HCPCS	Axicabtagene Ciloleucel Car+	8	4	—	—	$92,877.03	$92,877.03	$92,877.03	2025-01-21
Q2054	HCPCS	Lisocabtagene Mara Car Pos T	8	4	—	—	$92,877.03	$92,877.03	$92,877.03	2025-01-21
C9098	HCPCS	Ciltacabtagene Car Pos T	8	4	—	—	$92,877.03	$92,877.03	$92,877.03	2025-01-21
J3393	HCPCS	Inj, Betibeglogene Autotemce	8	4	—	—	$92,877.03	$92,877.03	$92,877.03	2025-01-21
Q2042	HCPCS	Tisagenlecleucel Car-pos T	8	4	—	—	$92,877.03	$92,877.03	$92,877.03	2025-01-21
Q2055	HCPCS	Idecabtagene Vicleucel Car	8	4	—	—	$92,877.03	$92,877.03	$92,877.03	2025-01-21
Q2053	HCPCS	Brexucabtagene Car Pos T	8	4	—	—	$92,877.03	$92,877.03	$92,877.03	2025-01-21
C9073	HCPCS	Brexucabtagene Autoleucel Ca	8	4	—	—	$92,877.03	$92,877.03	$92,877.03	2025-01-21
C9081	HCPCS	Idecabtagene Car Pos T	8	4	—	—	$92,877.03	$92,877.03	$92,877.03	2025-01-21
C9076	HCPCS	Lisocabtagene Car Pos T	8	4	—	—	$92,877.03	$92,877.03	$92,877.03	2025-01-21
Q2040	HCPCS	Tisagenlecleucel Car-pos T	8	4	—	—	$92,877.03	$92,877.03	$92,877.03	2025-01-21
Q2056	HCPCS	Ciltacabtagene Car-pos T	8	4	—	—	$92,877.03	$92,877.03	$92,877.03	2025-01-21
J3394	HCPCS	Inj, Lovotibeglogene Autotem	8	4	—	—	$92,877.03	$92,877.03	$92,877.03	2025-01-21
'001-4	OTHER	Liver Transplant And/or Intestinal Transplant	8	4	—	—	$92,291.43	$92,291.43	$92,291.43	2025-01-21
'161-2	OTHER	Implantable Heart Assist Systems	8	4	—	—	$92,023.26	$92,023.26	$92,023.26	2025-01-21
'009-4	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	8	4	—	—	$91,782.85	$91,782.85	$91,782.85	2025-01-21
'002-3	OTHER	Heart And/or Lung Transplant	8	4	—	—	$89,277.46	$89,277.46	$89,277.46	2025-01-21
'161-1	OTHER	Implantable Heart Assist Systems	8	4	—	—	$87,421.77	$87,421.77	$87,421.77	2025-01-21
'603-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	8	4	—	—	$82,029.45	$82,029.45	$82,029.45	2025-01-21
'006-4	OTHER	Pancreas Transplant	8	4	—	—	$81,504.05	$81,504.05	$81,504.05	2025-01-21
A9543	HCPCS	Y90 Ibritumomab, Rx	8	4	—	—	$74,517.38	$74,517.38	$74,517.38	2025-01-21
C9031	HCPCS	Lutetium Lu 177 Dotatate, Tx	8	4	—	—	$74,517.38	$74,517.38	$74,517.38	2025-01-21
A9513	HCPCS	Lutetium Lu 177 Dotatat Ther	8	4	—	—	$74,517.38	$74,517.38	$74,517.38	2025-01-21
A9607	HCPCS	Lutetium Lu 177 Vipivotide	8	4	—	—	$74,517.38	$74,517.38	$74,517.38	2025-01-21
'602-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	8	4	—	—	$73,148.18	$73,148.18	$73,148.18	2025-01-21
J0202	HCPCS	Alemtuzumab 12 Mg/1.2 Ml Vial	58	14	$99,502.22	$49,751.11 50% off	$35,820.80	$90,547.02	$66,666.49	2025-01-21
'002-2	OTHER	Heart And/or Lung Transplant	8	4	—	—	$66,253.56	$66,253.56	$66,253.56	2025-01-21
'593-3	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	8	4	—	—	$65,623.40	$65,623.40	$65,623.40	2025-01-21
'588-1	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	8	4	—	—	$64,972.13	$64,972.13	$64,972.13	2025-01-21
'004-3	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	8	4	—	—	$64,155.11	$64,155.11	$64,155.11	2025-01-21
'160-4	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	8	4	—	—	$63,303.69	$63,303.69	$63,303.69	2025-01-21
'005-4	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	8	4	—	—	$61,782.63	$61,782.63	$61,782.63	2025-01-21
33981	HCPCS	Replace Vad Pump Ext	8	4	—	—	$61,110.38	$61,110.38	$61,110.38	2025-01-21
33976	HCPCS	Implant Ventricular Device	8	4	—	—	$61,110.38	$61,110.38	$61,110.38	2025-01-21
33975	HCPCS	Implant Ventricular Device	8	4	—	—	$61,110.38	$61,110.38	$61,110.38	2025-01-21
33983	HCPCS	Replace Vad Intra W/bp	8	4	—	—	$61,110.38	$61,110.38	$61,110.38	2025-01-21
33991	HCPCS	Insj Perq Vad L Hrt Artl&ven	8	4	—	—	$61,110.38	$61,110.38	$61,110.38	2025-01-21
33995	HCPCS	Insj Perq Vad R Hrt Venous	8	4	—	—	$61,110.38	$61,110.38	$61,110.38	2025-01-21
0452T	OTHER	Insj/rplcmt Dev Vasc Seal	8	4	—	—	$61,110.38	$61,110.38	$61,110.38	2025-01-21
0451T	OTHER	Insj/rplcmt Aortic Ventr Sys	8	4	—	—	$61,110.38	$61,110.38	$61,110.38	2025-01-21
33979	HCPCS	Insert Intracorporeal Device	8	4	—	—	$61,110.38	$61,110.38	$61,110.38	2025-01-21
0459T	OTHER	Relocaj Rplcmt Aortic Ventr	8	4	—	—	$61,110.38	$61,110.38	$61,110.38	2025-01-21
0454T	OTHER	Insj/rplcmt Subq Electrode	8	4	—	—	$61,110.38	$61,110.38	$61,110.38	2025-01-21
33982	HCPCS	Replace Vad Intra Without Bp	8	4	—	—	$61,110.38	$61,110.38	$61,110.38	2025-01-21
0453T	OTHER	Insj/rplcmt Mech-elec Ntrfce	8	4	—	—	$61,110.38	$61,110.38	$61,110.38	2025-01-21
33990	HCPCS	Insj Perq Vad L Hrt Arterial	8	4	—	—	$61,110.38	$61,110.38	$61,110.38	2025-01-21
'162-4	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	8	4	—	—	$59,662.68	$59,662.68	$59,662.68	2025-01-21
'591-3	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	8	4	—	—	$57,731.94	$57,731.94	$57,731.94	2025-01-21
'602-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	8	4	—	—	$57,679.16	$57,679.16	$57,679.16	2025-01-21
'006-3	OTHER	Pancreas Transplant	8	4	—	—	$57,309.36	$57,309.36	$57,309.36	2025-01-21
'303-4	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	8	4	—	—	$57,039.23	$57,039.23	$57,039.23	2025-01-21
'002-1	OTHER	Heart And/or Lung Transplant	8	4	—	—	$56,796.86	$56,796.86	$56,796.86	2025-01-21
'607-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	8	4	—	—	$56,184.29	$56,184.29	$56,184.29	2025-01-21
'007-3	OTHER	Allogeneic Bone Marrow Transplant	8	4	—	—	$55,778.52	$55,778.52	$55,778.52	2025-01-21
'630-3	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	8	4	—	—	$54,875.11	$54,875.11	$54,875.11	2025-01-21
'440-4	OTHER	Kidney Transplant	8	4	—	—	$54,225.79	$54,225.79	$54,225.79	2025-01-21
'001-3	OTHER	Liver Transplant And/or Intestinal Transplant	8	4	—	—	$53,356.39	$53,356.39	$53,356.39	2025-01-21
'842-4	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	8	4	—	—	$53,317.30	$53,317.30	$53,317.30	2025-01-21
'593-2	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	8	4	—	—	$52,012.81	$52,012.81	$52,012.81	2025-01-21
J3357	HCPCS	Ustekinumab 90 Mg/ml Syringe	66	16	$95,013.73	$47,506.87 50% off	$14,636.76	$86,462.49	$51,307.41	2025-01-21
'163-4	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	8	4	—	—	$50,769.30	$50,769.30	$50,769.30	2025-01-21
'178-4	OTHER	External Heart Assist Systems	8	4	—	—	$50,430.37	$50,430.37	$50,430.37	2025-01-21
'006-2	OTHER	Pancreas Transplant	8	4	—	—	$49,750.17	$49,750.17	$49,750.17	2025-01-21
69930	HCPCS	Implant Cochlear Device	8	4	—	—	$49,271.80	$49,271.80	$49,271.80	2025-01-21
S2235	HCPCS	Implant Auditory Brain Imp	8	4	—	—	$49,271.80	$49,271.80	$49,271.80	2025-01-21
'609-3	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	8	4	—	—	$48,781.87	$48,781.87	$48,781.87	2025-01-21
'011-3	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	8	4	—	—	$48,443.73	$48,443.73	$48,443.73	2025-01-21
'008-4	OTHER	Autologous Bone Marrow Transplant	8	4	—	—	$47,878.46	$47,878.46	$47,878.46	2025-01-21
'165-4	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	8	4	—	—	$46,427.37	$46,427.37	$46,427.37	2025-01-21
0409T	OTHER	Insj/rplc Car Modulj Pls Gn	8	4	—	—	$45,905.74	$45,905.74	$45,905.74	2025-01-21
0414T	OTHER	Rmvl & Rpl Car Modulj Pls Gn	8	4	—	—	$45,905.74	$45,905.74	$45,905.74	2025-01-21
33230	HCPCS	Insrt Pulse Gen W/dual Leads	8	4	—	—	$45,905.74	$45,905.74	$45,905.74	2025-01-21
0614T	OTHER	Rmvl&rplcmt Ss Impl Dfb Pg	8	4	—	—	$45,905.74	$45,905.74	$45,905.74	2025-01-21
33289	HCPCS	Tcat Impl Wrls P-art Prs Snr	8	4	—	—	$45,905.74	$45,905.74	$45,905.74	2025-01-21
33270	HCPCS	Ins/rep Subq Defibrillator	8	4	—	—	$45,905.74	$45,905.74	$45,905.74	2025-01-21
33263	HCPCS	Rmvl & Rplcmt Dfb Gen 2 Lead	8	4	—	—	$45,905.74	$45,905.74	$45,905.74	2025-01-21
0571T	OTHER	Insj/rplcmt Icds Ss Eltrd	8	4	—	—	$45,905.74	$45,905.74	$45,905.74	2025-01-21
0520T	OTHER	Rmv&rplcmt Pg Wcs Lv Battery	8	4	—	—	$45,905.74	$45,905.74	$45,905.74	2025-01-21
33264	HCPCS	Rmvl & Rplcmt Dfb Gen Mlt Ld	8	4	—	—	$45,905.74	$45,905.74	$45,905.74	2025-01-21
33262	HCPCS	Rmvl& Replc Pulse Gen 1 Lead	8	4	—	—	$45,905.74	$45,905.74	$45,905.74	2025-01-21
33249	HCPCS	Insj/rplcmt Defib W/lead(s)	8	4	—	—	$45,905.74	$45,905.74	$45,905.74	2025-01-21
33231	HCPCS	Insrt Pulse Gen W/mult Leads	8	4	—	—	$45,905.74	$45,905.74	$45,905.74	2025-01-21
C9741	HCPCS	Impl Pressure Sensor W/angio	8	4	—	—	$45,905.74	$45,905.74	$45,905.74	2025-01-21
G0448	HCPCS	Place Perm Pacing Cardiovert	8	4	—	—	$45,905.74	$45,905.74	$45,905.74	2025-01-21
33240	HCPCS	Insrt Pulse Gen W/singl Lead	8	4	—	—	$45,905.74	$45,905.74	$45,905.74	2025-01-21
'167-4	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	8	4	—	—	$45,667.43	$45,667.43	$45,667.43	2025-01-21
'005-3	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	8	4	—	—	$45,495.81	$45,495.81	$45,495.81	2025-01-21
'001-2	OTHER	Liver Transplant And/or Intestinal Transplant	8	4	—	—	$44,719.06	$44,719.06	$44,719.06	2025-01-21
J9269	HCPCS	Inj. Tagraxofusp-erzs 10 Mcg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J9381	HCPCS	Inj Teplizumab Mzwv 5 Mcg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J9298	HCPCS	Inj Nivol Relatlimab 3mg/1mg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J9029	HCPCS	Instill Adstiladrin, Tx Dose	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J7180	HCPCS	Factor Xiii Anti-hem Factor	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J9210	HCPCS	Inj., Emapalumab-lzsg, 1 Mg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J7175	HCPCS	Inj, Factor X, (human), 1iu	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J2840	HCPCS	Inj Sebelipase Alfa 1 Mg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J2350	HCPCS	Injection, Ocrelizumab, 1 Mg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J2326	HCPCS	Inj, Nusinersen, 0.1mg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J1413	HCPCS	Inj Delandistrogene Mox Rokl	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J1747	HCPCS	Inj, Spesolimab-sbzo, 1 Mg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J9226	HCPCS	Supprelin La Implant	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J0221	HCPCS	Lumizyme Injection	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J0223	HCPCS	Inj Givosiran 0.5 Mg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J0217	HCPCS	Inj Velmanase Alfa-tycv 1 Mg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J1300	HCPCS	Eculizumab Injection	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
C9146	HCPCS	Inj, Elahere, 1 Mg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
C9149	HCPCS	Inj, Teplizumab-mzwv, 5 Mcg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J1411	HCPCS	Inj, Hemgenix, Per Tx Dose	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
C9052	HCPCS	Injection, Ravulizumab-cwv	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J1412	HCPCS	Inj Roctavian Ml 2x10^13vc G	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
C9085	HCPCS	Inj Avalglucosid Alfa-ngpt	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J9350	HCPCS	Inj Mosunetuzumab-axgb, 1 Mg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J7170	HCPCS	Inj., Emicizumab-kxwh 0.5 Mg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J9376	HCPCS	Inj Pozelimab-bbfg, 1 Mg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
Q2043	HCPCS	Sipuleucel-t Auto Cd54+	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J9600	HCPCS	Porfimer Sodium Injection	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
Q9995	HCPCS	Inj. Emicizumab-kxwh, 0.5 Mg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
J0219	HCPCS	Inj Aval Alfa-nqpt 4mg	8	4	—	—	$44,475.48	$44,475.48	$44,475.48	2025-01-21
'004-2	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	8	4	—	—	$44,106.88	$44,106.88	$44,106.88	2025-01-21
'602-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	8	4	—	—	$44,011.11	$44,011.11	$44,011.11	2025-01-21
'304-4	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	8	4	—	—	$43,780.47	$43,780.47	$43,780.47	2025-01-21
'607-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	8	4	—	—	$43,708.15	$43,708.15	$43,708.15	2025-01-21
'007-2	OTHER	Allogeneic Bone Marrow Transplant	8	4	—	—	$43,630.35	$43,630.35	$43,630.35	2025-01-21
'303-3	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	8	4	—	—	$43,188.22	$43,188.22	$43,188.22	2025-01-21
'183-4	OTHER	Percutaneous Structural Cardiac Procedures	8	4	—	—	$43,034.59	$43,034.59	$43,034.59	2025-01-21
'611-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	8	4	—	—	$42,695.67	$42,695.67	$42,695.67	2025-01-21
'009-3	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	8	4	—	—	$42,302.01	$42,302.01	$42,302.01	2025-01-21
'863-4	OTHER	Neonatal Aftercare	8	4	—	—	$41,857.15	$41,857.15	$41,857.15	2025-01-21
'166-4	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	8	4	—	—	$41,850.11	$41,850.11	$41,850.11	2025-01-21
'910-4	OTHER	Craniotomy For Multiple Significant Trauma	8	4	—	—	$41,343.48	$41,343.48	$41,343.48	2025-01-21
'179-4	OTHER	Defibrillator Implants	8	4	—	—	$41,087.04	$41,087.04	$41,087.04	2025-01-21
'680-4	OTHER	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	8	4	—	—	$40,916.60	$40,916.60	$40,916.60	2025-01-21
'162-3	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	8	4	—	—	$40,863.83	$40,863.83	$40,863.83	2025-01-21
'612-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	8	4	—	—	$40,827.86	$40,827.86	$40,827.86	2025-01-21
'613-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	8	4	—	—	$40,056.97	$40,056.97	$40,056.97	2025-01-21
'603-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	8	4	—	—	$39,918.20	$39,918.20	$39,918.20	2025-01-21
'001-1	OTHER	Liver Transplant And/or Intestinal Transplant	8	4	—	—	$39,704.75	$39,704.75	$39,704.75	2025-01-21
'169-4	OTHER	Major Abdominal Vascular Procedures	8	4	—	—	$39,170.37	$39,170.37	$39,170.37	2025-01-21
'006-1	OTHER	Pancreas Transplant	8	4	—	—	$39,105.87	$39,105.87	$39,105.87	2025-01-21
0424T	OTHER	Insj/rplc Nstim Apnea Compl	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
0312T	OTHER	Laps Impltj Nstim Vagus	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
0431T	OTHER	Rmvl/rplc Nstim Apnea Pls Gn	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
0268T	OTHER	Implt/rpl Crtd Sns Dev Gen	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
64582	HCPCS	Opn Mpltj Hpglsl Nstm Ary Pg	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
0266T	OTHER	Implt/rpl Crtd Sns Dev Total	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
0427T	OTHER	Insj/rplc Nstim Apnea Pls Gn	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
61860	HCPCS	Implant Neuroelectrodes	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
0816T	OTHER	Opn Insj/rplcmt Ins Ptn Subq	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
61850	HCPCS	Implant Neuroelectrodes	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
61863	HCPCS	Implant Neuroelectrode	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
0466T	OTHER	Insj Ch Wal Respir Eltrd/ra	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
61870	HCPCS	Implant Neuroelectrodes	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
61885	HCPCS	Insrt/redo Neurostim 1 Array	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
33276	HCPCS	Insj Phrnc Nrv Stim Sys	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
33287	HCPCS	Rmv&rplcmt Phrnc Nrv Stim Pg	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
0817T	OTHER	Opn Insj/rplcmt Ins Ptn Subf	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
64590	HCPCS	Ins/rpl Prph Sac/gstr Npg/r	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
64575	HCPCS	Opn Impltj Nea Perph Nerve	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
63655	HCPCS	Implant Neuroelectrodes	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
63685	HCPCS	Ins/rplc Spi Npg/rcvr Pocket	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
63664	HCPCS	Revise Spine Eltrd Plate	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
64553	HCPCS	Implant Neuroelectrodes	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
61889	HCPCS	Ins Sk-mnt Crnl Nstm Pg/rcvr	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
61886	HCPCS	Implant Neurostim Arrays	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
61867	HCPCS	Implant Neuroelectrode	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
61864	HCPCS	Implant Neuroelectrde Addl	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
61868	HCPCS	Implant Neuroelectrde Addl	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
64568	HCPCS	Opn Impltj Crnl Nrv Nea&pg	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
64580	HCPCS	Opn Impltj Nea Neuromuscular	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
64569	HCPCS	Revise/repl Vagus N Eltrd	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
0316T	OTHER	Replc Vagus Nerve Pls Gen	8	4	—	—	$39,082.13	$39,082.13	$39,082.13	2025-01-21
'911-4	OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	8	4	—	—	$39,058.96	$39,058.96	$39,058.96	2025-01-21
'312-4	OTHER	Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses	8	4	—	—	$38,888.52	$38,888.52	$38,888.52	2025-01-21
'007-1	OTHER	Allogeneic Bone Marrow Transplant	8	4	—	—	$38,849.43	$38,849.43	$38,849.43	2025-01-21
'841-3	OTHER	Extensive Third Degree Burns With Skin Graft	8	4	—	—	$38,717.69	$38,717.69	$38,717.69	2025-01-21
'091-4	OTHER	Other Major Head And Neck Procedures	8	4	—	—	$38,684.85	$38,684.85	$38,684.85	2025-01-21
'912-4	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	8	4	—	—	$37,949.14	$37,949.14	$37,949.14	2025-01-21
'178-3	OTHER	External Heart Assist Systems	8	4	—	—	$37,308.43	$37,308.43	$37,308.43	2025-01-21
'850-4	OTHER	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	8	4	—	—	$37,156.75	$37,156.75	$37,156.75	2025-01-21
'023-4	OTHER	Spinal Procedures	8	4	—	—	$37,061.37	$37,061.37	$37,061.37	2025-01-21
'021-4	OTHER	Open Craniotomy Except Trauma	8	4	—	—	$36,553.56	$36,553.56	$36,553.56	2025-01-21
'441-4	OTHER	Major Bladder Procedures	8	4	—	—	$36,546.92	$36,546.92	$36,546.92	2025-01-21
0747T	OTHER	Car Ablt Rad Arrhyt Dlvr Rad	8	4	—	—	$36,198.71	$36,198.71	$36,198.71	2025-01-21
0745T	OTHER	Car Ablt Rad Arr N-invas Loc	8	4	—	—	$36,198.71	$36,198.71	$36,198.71	2025-01-21
93656	HCPCS	Compre Ep Eval Abltj Atr Fib	8	4	—	—	$36,198.71	$36,198.71	$36,198.71	2025-01-21
93655	HCPCS	Icar Cath Abltj Dscrt Arrhyt	8	4	—	—	$36,198.71	$36,198.71	$36,198.71	2025-01-21
93657	HCPCS	Tx L/r Atrial Fib Addl	8	4	—	—	$36,198.71	$36,198.71	$36,198.71	2025-01-21
93650	HCPCS	Ablate Heart Dysrhythm Focus	8	4	—	—	$36,198.71	$36,198.71	$36,198.71	2025-01-21
93609	HCPCS	Map Tachycardia Add-on	8	4	—	—	$36,198.71	$36,198.71	$36,198.71	2025-01-21
93653	HCPCS	Compre Ep Eval Tx Svt	8	4	—	—	$36,198.71	$36,198.71	$36,198.71	2025-01-21
93654	HCPCS	Compre Ep Eval Tx Vt	8	4	—	—	$36,198.71	$36,198.71	$36,198.71	2025-01-21
0746T	OTHER	Car Ablt Rad Arr Cnv Loc Map	8	4	—	—	$36,198.71	$36,198.71	$36,198.71	2025-01-21
33534	HCPCS	Cabg Arterial Two	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33533	HCPCS	Cabg Arterial Single	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33510	HCPCS	Cabg Vein Single	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33511	HCPCS	Cabg Vein Two	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33535	HCPCS	Cabg Arterial Three	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33530	HCPCS	Coronary Artery Bypass/reop	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33506	HCPCS	Repair Artery Translocation	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33507	HCPCS	Repair Art Intramural	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33504	HCPCS	Coronary Artery Graft	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33508	HCPCS	Endoscopic Vein Harvest	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33512	HCPCS	Cabg Vein Three	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33503	HCPCS	Coronary Artery Graft	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33523	HCPCS	Cabg Art-vein Six Or More	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33536	HCPCS	Cabg Arterial Four Or More	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33509	HCPCS	Ndsc Hrv Uxtr Art 1 Sgm Cab	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33502	HCPCS	Coronary Artery Correction	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33513	HCPCS	Cabg Vein Four	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33519	HCPCS	Cabg Artery-vein Three	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
35600	HCPCS	Open Hrv Uxtr Art 1 Sgm Cab	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33521	HCPCS	Cabg Artery-vein Four	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33572	HCPCS	Open Coronary Endarterectomy	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33518	HCPCS	Cabg Artery-vein Two	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33516	HCPCS	Cabg Vein Six Or More	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33522	HCPCS	Cabg Artery-vein Five	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33517	HCPCS	Cabg Artery-vein Single	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33514	HCPCS	Cabg Vein Five	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
33505	HCPCS	Repair Artery W/tunnel	8	4	—	—	$36,131.04	$36,131.04	$36,131.04	2025-01-21
'631-3	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	8	4	—	—	$36,099.71	$36,099.71	$36,099.71	2025-01-21
'260-4	OTHER	Major Pancreas, Liver And Shunt Procedures	8	4	—	—	$36,088.76	$36,088.76	$36,088.76	2025-01-21
'440-3	OTHER	Kidney Transplant	8	4	—	—	$35,743.19	$35,743.19	$35,743.19	2025-01-21
'740-4	OTHER	Mental Illness Diagnosis With O.r. Procedure	8	4	—	—	$35,626.31	$35,626.31	$35,626.31	2025-01-21
'608-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	8	4	—	—	$35,573.53	$35,573.53	$35,573.53	2025-01-21
'681-4	OTHER	Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	8	4	—	—	$34,890.21	$34,890.21	$34,890.21	2025-01-21
'630-2	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	8	4	—	—	$34,816.32	$34,816.32	$34,816.32	2025-01-21
'178-2	OTHER	External Heart Assist Systems	8	4	—	—	$34,759.64	$34,759.64	$34,759.64	2025-01-21
'220-4	OTHER	Major Stomach, Esophageal And Duodenal Procedures	8	4	—	—	$34,623.21	$34,623.21	$34,623.21	2025-01-21
'089-4	OTHER	Major Cranial Or Facial Bone Procedures	8	4	—	—	$34,389.44	$34,389.44	$34,389.44	2025-01-21
'165-3	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	8	4	—	—	$34,289.76	$34,289.76	$34,289.76	2025-01-21
'950-4	OTHER	Extensive O.r. Procedure Unrelated To Principal Diagnosis	8	4	—	—	$34,050.52	$34,050.52	$34,050.52	2025-01-21
0338T	OTHER	Trnscth Renal Symp Denrv Unl	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
0339T	OTHER	Trnscth Renal Symp Denrv Bil	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
0254T	OTHER	Evasc Rpr Iliac Art Bifur	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
0234T	OTHER	Trluml Perip Athrc Renal Art	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34847	HCPCS	Visc & Infraren Abd 3 Prosth	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34846	HCPCS	Visc & Infraren Abd 2 Prosth	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34848	HCPCS	Visc & Infraren Abd 4+ Prost	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34843	HCPCS	Endovasc Visc Aorta 3 Graft	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34844	HCPCS	Endovasc Visc Aorta 4 Graft	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34845	HCPCS	Visc & Infraren Abd 1 Prosth	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34813	HCPCS	Femoral Endovas Graft Add-on	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34820	HCPCS	Opn Iliac Art Expos	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34841	HCPCS	Endovasc Visc Aorta 1 Graft	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34808	HCPCS	Endovas Iliac A Device Addon	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34842	HCPCS	Endovasc Visc Aorta 2 Graft	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
35840	HCPCS	Explore Abdominal Vessels	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34718	HCPCS	Evasc Rpr N/a A-iliac Ndgft	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34711	HCPCS	Dlyd Plmt Xtn Prosth Ea Addl	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34709	HCPCS	Plmt Xtn Prosth Evasc Rpr	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34713	HCPCS	Perq Access & Clsr Fem Art	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34710	HCPCS	Dlyd Plmt Xtn Prosth 1st Vsl	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34712	HCPCS	Tcat Dlvr Enhncd Fixj Dev	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34706	HCPCS	Evasc Rpr A-biiliac Rpt	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
33894	HCPCS	Evasc St Rpr Thrc/aa Acrs Br	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
33883	HCPCS	Insert Endovasc Prosth Taa	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
33881	HCPCS	Endovasc Taa Repr Without Subcl	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
33884	HCPCS	Endovasc Prosth Taa Add-on	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
33880	HCPCS	Endovasc Taa Repr Incl Subcl	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
33886	HCPCS	Endovasc Prosth Delayed	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34704	HCPCS	Evasc Rpr A-unilac Ndgft Rpt	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34707	HCPCS	Evasc Rpr Ilio-iliac Ndgft	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
33895	HCPCS	Evasc St Rpr Thrc/aa X Crsg	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34705	HCPCS	Evac Rpr A-biiliac Ndgft	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34703	HCPCS	Evasc Rpr A-unilac Ndgft	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34051	HCPCS	Removal Of Artery Clot	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34708	HCPCS	Evasc Rpr Ilio-iliac Rpt	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34717	HCPCS	Evasc Rpr A-iliac Ndgft	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34701	HCPCS	Evasc Rpr A-ao Ndgft	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
34702	HCPCS	Evasc Rpr A-ao Ndgft Rpt	8	4	—	—	$33,999.49	$33,999.49	$33,999.49	2025-01-21
'160-3	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	8	4	—	—	$33,981.71	$33,981.71	$33,981.71	2025-01-21
'608-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	8	4	—	—	$33,879.29	$33,879.29	$33,879.29	2025-01-21
'607-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	8	4	—	—	$33,844.50	$33,844.50	$33,844.50	2025-01-21
'163-3	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	8	4	—	—	$33,798.37	$33,798.37	$33,798.37	2025-01-21
'020-4	OTHER	Open Craniotomy For Trauma	8	4	—	—	$33,723.32	$33,723.32	$33,723.32	2025-01-21
'120-4	OTHER	Major Respiratory And Chest Procedures	8	4	—	—	$33,567.73	$33,567.73	$33,567.73	2025-01-21
'621-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	8	4	—	—	$33,495.41	$33,495.41	$33,495.41	2025-01-21
'690-4	OTHER	Acute Leukemia	8	4	—	—	$33,397.29	$33,397.29	$33,397.29	2025-01-21
'759-4	OTHER	Eating Disorders	8	4	—	—	$33,337.48	$33,337.48	$33,337.48	2025-01-21
'005-2	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	8	4	—	—	$33,301.91	$33,301.91	$33,301.91	2025-01-21
'361-4	OTHER	Skin Graft For Skin And Subcutaneous Tissue Diagnoses	8	4	—	—	$32,933.66	$32,933.66	$32,933.66	2025-01-21

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