|
6664211
|
OTHER
|
Powered Ue Orthosis Elbow Wrist Hand Finger Cust
|
96
|
40
|
$106,169.00
|
$63,701.40
40% off
|
$21,198.22
|
$100,860.55
|
$67,700.88
|
2026-05-22
|
|
728494
|
OTHER
|
Electronic Elbow Microproc Sequential Control Of
|
96
|
40
|
$115,320.00
|
$69,192.00
40% off
|
$23,094.30
|
$109,554.00
|
$63,426.00
|
2026-05-22
|
|
6060818
|
OTHER
|
L6880 Elec Hand Ind Art Digits
|
96
|
40
|
$86,957.00
|
$52,174.20
40% off
|
$17,217.49
|
$82,609.15
|
$47,826.35
|
2026-05-22
|
|
728726
|
OTHER
|
Addition To Le Pros Endo Knee-shin Sys Microproc
|
96
|
40
|
$86,237.00
|
$51,742.20
40% off
|
$17,068.31
|
$81,925.15
|
$47,430.35
|
2026-05-22
|
|
6664210
|
OTHER
|
Powered Ue Orthosis Elbow Wrist Hand Custom
|
96
|
40
|
$55,720.00
|
$33,432.00
40% off
|
$10,745.18
|
$52,934.00
|
$34,410.61
|
2026-05-22
|
|
7852522
|
OTHER
|
Addition Ue Pattern Recognition System
|
96
|
40
|
$56,084.00
|
$33,650.40
40% off
|
$10,820.60
|
$53,279.80
|
$31,126.62
|
2026-05-22
|
|
5272317
|
OTHER
|
Ank-foot Sys Dors-plant Flex
|
96
|
40
|
$52,801.00
|
$31,680.60
40% off
|
$10,140.37
|
$50,160.95
|
$29,040.55
|
2026-05-22
|
|
728581
|
OTHER
|
Interscapular-thoracic Ext Power Molded Inner So
|
96
|
40
|
$52,029.00
|
$31,217.40
40% off
|
$9,980.41
|
$49,427.55
|
$28,615.95
|
2026-05-22
|
|
728728
|
OTHER
|
L5858 Add To Le Pros Endo Knee-shin Sys Micropro
|
96
|
40
|
$51,834.00
|
$31,100.40
40% off
|
$9,940.00
|
$49,242.30
|
$28,508.70
|
2026-05-22
|
|
728580
|
OTHER
|
Intrerscapular-thoracic Ext Power Molded Inner S
|
96
|
40
|
$47,199.00
|
$28,319.40
40% off
|
$8,979.63
|
$44,839.05
|
$25,959.45
|
2026-05-22
|
|
6577830
|
OTHER
|
Addition To Le Pros Endo Knee-shin Sys Powered
|
96
|
40
|
$43,371.00
|
$26,022.60
40% off
|
$8,186.47
|
$41,202.45
|
$23,854.05
|
2026-05-22
|
|
728497
|
OTHER
|
Electronic Elbow Child Variety Village Or Equal
|
96
|
40
|
$38,960.00
|
$23,376.00
40% off
|
$7,272.51
|
$37,012.00
|
$21,428.00
|
2026-05-22
|
|
728577
|
OTHER
|
Above Elbow External Power Switch Control
|
96
|
40
|
$37,736.00
|
$22,641.60
40% off
|
$7,018.90
|
$35,849.20
|
$20,754.80
|
2026-05-22
|
|
7781366
|
OTHER
|
Addition Le Ext Osseointegrated Connector
|
96
|
40
|
$34,748.00
|
$20,848.80
40% off
|
$6,399.79
|
$33,010.60
|
$19,285.14
|
2026-05-22
|
|
728574
|
OTHER
|
Elbow Disartic External Power Myo Control
|
96
|
40
|
$34,106.00
|
$20,463.60
40% off
|
$6,266.76
|
$32,400.70
|
$18,758.30
|
2026-05-22
|
|
728499
|
OTHER
|
Electronic Elbow Child Variety Village Or Equal
|
96
|
40
|
$33,138.00
|
$19,882.80
40% off
|
$6,066.19
|
$31,481.10
|
$18,225.90
|
2026-05-22
|
|
728575
|
OTHER
|
Elbow Disartic External Power Switch Control
|
96
|
40
|
$30,570.00
|
$18,342.00
40% off
|
$5,534.10
|
$29,041.50
|
$16,813.50
|
2026-05-22
|
|
728571
|
OTHER
|
Wrist Disartic Ext Power Self-susp Inner Socket
|
96
|
40
|
$26,256.00
|
$15,753.60
40% off
|
$4,640.24
|
$24,943.20
|
$14,440.80
|
2026-05-22
|
|
728498
|
OTHER
|
Electronic Elbow Adolescent Variety Village Or E
|
96
|
40
|
$24,864.00
|
$14,918.40
40% off
|
$4,351.82
|
$23,620.80
|
$13,675.20
|
2026-05-22
|
|
728727
|
OTHER
|
Addition To Le Pros Endo Knee-shin Sys Microproc
|
96
|
40
|
$24,746.00
|
$14,847.60
40% off
|
$4,327.37
|
$23,508.70
|
$13,610.30
|
2026-05-22
|
|
728569
|
OTHER
|
Wrist Disartic Ext Power Self-susp Inner Socket
|
96
|
40
|
$24,580.00
|
$14,748.00
40% off
|
$4,292.98
|
$23,351.00
|
$13,519.00
|
2026-05-22
|
|
5272315
|
OTHER
|
Endo Poly Hip Pneu/hyd/rot
|
96
|
40
|
$24,548.00
|
$14,728.80
40% off
|
$4,286.35
|
$23,320.60
|
$13,501.40
|
2026-05-22
|
|
728572
|
OTHER
|
Be Ext Power Self-susp Inner Socket Remov Shell
|
96
|
40
|
$23,676.00
|
$14,205.60
40% off
|
$4,105.67
|
$22,492.20
|
$13,021.80
|
2026-05-22
|
|
728241
|
OTHER
|
Knee-ankle-foot Orthosis Single Or Double Upright
|
96
|
40
|
$22,699.00
|
$13,619.40
40% off
|
$3,796.00
|
$21,564.05
|
$12,484.45
|
2026-05-22
|
|
7852514
|
OTHER
|
Addition Endo Knee-shin System Electromechanical S
|
96
|
40
|
$20,889.00
|
$12,533.40
40% off
|
$3,528.20
|
$19,844.55
|
$11,593.40
|
2026-05-22
|
|
728894
|
OTHER
|
Electric Hand Switch Or Myo Pediatric
|
96
|
40
|
$20,347.00
|
$12,208.20
40% off
|
$3,415.90
|
$19,329.65
|
$11,190.85
|
2026-05-22
|
|
728520
|
OTHER
|
Hip Disart Canadian Type Molded Socket Endo Sys
|
96
|
40
|
$18,799.00
|
$11,279.40
40% off
|
$3,095.15
|
$17,859.05
|
$10,339.45
|
2026-05-22
|
|
728496
|
OTHER
|
Electronic Elbow Adolescent Variety Village Or E
|
96
|
40
|
$18,743.00
|
$11,245.80
40% off
|
$3,083.55
|
$17,805.85
|
$10,308.65
|
2026-05-22
|
|
728535
|
OTHER
|
Prep Hip Disartic Or Hemipel Pylon No Cover Sa
|
96
|
40
|
$18,734.00
|
$11,240.40
40% off
|
$3,081.68
|
$17,797.30
|
$10,303.70
|
2026-05-22
|
|
728493
|
OTHER
|
Electronic Elbow Hosmer Or Equal Switch Controll
|
96
|
40
|
$17,824.00
|
$10,694.40
40% off
|
$2,893.13
|
$16,932.80
|
$9,803.20
|
2026-05-22
|
|
728518
|
OTHER
|
Hip Disartic Tilt Table Type Molded Socket Lock
|
96
|
40
|
$17,258.00
|
$10,354.80
40% off
|
$2,775.86
|
$16,395.10
|
$9,491.90
|
2026-05-22
|
|
728515
|
OTHER
|
Above Knee For Proximal Femoral Focal Deficiency
|
96
|
40
|
$17,127.00
|
$10,276.20
40% off
|
$2,748.71
|
$16,270.65
|
$9,419.85
|
2026-05-22
|
|
728519
|
OTHER
|
Hemipelvectomy Canadian Type Molded Socket Hip
|
96
|
40
|
$16,781.00
|
$10,068.60
40% off
|
$2,677.02
|
$15,941.95
|
$9,229.55
|
2026-05-22
|
|
728534
|
OTHER
|
Prep Hip Disartic - Hemipel Pylon No Cover Sac
|
96
|
40
|
$16,464.00
|
$9,878.40
40% off
|
$2,611.34
|
$15,640.80
|
$9,055.20
|
2026-05-22
|
|
728521
|
OTHER
|
Hemipel Canadian Type Molded Socket Endo System
|
96
|
40
|
$15,514.00
|
$9,308.40
40% off
|
$2,414.50
|
$14,738.30
|
$8,532.70
|
2026-05-22
|
|
728517
|
OTHER
|
Hip Disartic Canadian Type Molded Socket Hip Jt
|
96
|
40
|
$15,490.00
|
$9,294.00
40% off
|
$2,409.53
|
$14,715.50
|
$8,519.50
|
2026-05-22
|
|
728841
|
OTHER
|
Addition Vacuum Pump Residual Limb Volume Manage
|
96
|
40
|
$15,151.00
|
$9,090.60
40% off
|
$2,339.29
|
$14,393.45
|
$8,333.05
|
2026-05-22
|
|
728840
|
OTHER
|
Addition Vacuum Pump Residual Limb Volume Manage
|
96
|
40
|
$15,111.00
|
$9,066.60
40% off
|
$2,331.00
|
$14,355.45
|
$8,311.05
|
2026-05-22
|
|
728713
|
OTHER
|
Addition Endo Knee-shin Sys Polycentric Hydraul
|
96
|
40
|
$14,452.00
|
$8,671.20
40% off
|
$2,194.45
|
$13,729.40
|
$7,948.60
|
2026-05-22
|
|
728654
|
OTHER
|
All Le Prostheses Flex-foot System
|
96
|
40
|
$14,346.00
|
$8,607.60
40% off
|
$2,172.49
|
$13,628.70
|
$7,890.30
|
2026-05-22
|
|
728558
|
OTHER
|
L6570 Shoulder Disartic Molded Socket Endo Sys
|
96
|
40
|
$14,223.00
|
$8,533.80
40% off
|
$2,147.01
|
$13,511.85
|
$7,822.65
|
2026-05-22
|
|
6391586
|
OTHER
|
Knee Disart Sach Ft Endo (l5312)
|
96
|
40
|
$14,040.00
|
$8,424.00
40% off
|
$2,109.09
|
$13,338.00
|
$7,722.00
|
2026-05-22
|
|
728721
|
OTHER
|
Addition Endo Knee-shin Sys 4-bar Linkage Or Mul
|
96
|
40
|
$14,010.00
|
$8,406.00
40% off
|
$2,102.87
|
$13,309.50
|
$7,705.50
|
2026-05-22
|
|
728509
|
OTHER
|
Knee Disartic (or Through Knee) Molded Socket Ex
|
96
|
40
|
$14,006.00
|
$8,403.60
40% off
|
$2,102.04
|
$13,305.70
|
$7,703.30
|
2026-05-22
|
|
728617
|
OTHER
|
Replacement Socket Hip Disartic Incl Hip Joint
|
96
|
40
|
$13,933.00
|
$8,359.80
40% off
|
$2,086.92
|
$13,236.35
|
$7,663.15
|
2026-05-22
|
|
728507
|
OTHER
|
Below Knee Plastic Socket Joints And Thigh Lacer
|
96
|
40
|
$13,831.00
|
$8,298.60
40% off
|
$2,065.78
|
$13,139.45
|
$7,607.05
|
2026-05-22
|
|
728551
|
OTHER
|
Interscapular Thoracic Molded Socket Shoulder Bu
|
96
|
40
|
$13,810.00
|
$8,286.00
40% off
|
$2,061.43
|
$13,119.50
|
$7,595.50
|
2026-05-22
|
|
728616
|
OTHER
|
Replacement Socket AK/knee Disartic Incl Attach
|
96
|
40
|
$13,670.00
|
$8,202.00
40% off
|
$2,032.42
|
$12,986.50
|
$7,518.50
|
2026-05-22
|
|
728895
|
OTHER
|
Electric Hook Switch Or Myo Adult
|
96
|
40
|
$13,558.00
|
$8,134.80
40% off
|
$2,009.22
|
$12,880.10
|
$7,456.90
|
2026-05-22
|
|
728512
|
OTHER
|
Above Knee Molded Socket Single Axis Constant Fr
|
96
|
40
|
$13,058.00
|
$7,834.80
40% off
|
$1,905.62
|
$12,405.10
|
$7,181.90
|
2026-05-22
|
|
728510
|
OTHER
|
Knee Disarticulation Molded Socket Bent Knee Con
|
96
|
40
|
$13,017.00
|
$7,810.20
40% off
|
$1,897.12
|
$12,366.15
|
$7,159.35
|
2026-05-22
|
|
728557
|
OTHER
|
Shoulder Disartic Molded Socket Endo Sys Incl S
|
96
|
40
|
$12,979.00
|
$7,787.40
40% off
|
$1,889.25
|
$12,330.05
|
$7,138.45
|
2026-05-22
|
|
728655
|
OTHER
|
All Le Prostheses Flex-walk System Or Equal
|
96
|
40
|
$12,888.00
|
$7,732.80
40% off
|
$1,870.39
|
$12,243.60
|
$7,088.40
|
2026-05-22
|
|
728516
|
OTHER
|
Above Knee Molded Socket Open End Sach Foot En
|
96
|
40
|
$12,838.00
|
$7,702.80
40% off
|
$1,860.03
|
$12,196.10
|
$7,060.90
|
2026-05-22
|
|
728556
|
OTHER
|
Ae Molded Socket Endo Sys Incl Soft Prosthetic
|
96
|
40
|
$12,671.00
|
$7,602.60
40% off
|
$1,825.43
|
$12,037.45
|
$6,969.05
|
2026-05-22
|
|
728546
|
OTHER
|
Elbow Disartic Molded Socket With Expandable Inte
|
96
|
40
|
$12,630.00
|
$7,578.00
40% off
|
$1,816.94
|
$11,998.50
|
$6,946.50
|
2026-05-22
|
|
728730
|
OTHER
|
Addition Endo Sys High Activity Knee Control Fra
|
96
|
40
|
$12,094.00
|
$7,256.40
40% off
|
$1,705.88
|
$11,489.30
|
$6,651.70
|
2026-05-22
|
|
728552
|
OTHER
|
Interscapular Thoracic Passive Restoration (compl
|
96
|
40
|
$11,817.00
|
$7,090.20
40% off
|
$1,648.48
|
$11,226.15
|
$6,499.35
|
2026-05-22
|
|
728615
|
OTHER
|
Replacement Socket Bk Molded To Patient Model
|
96
|
40
|
$11,586.00
|
$6,951.60
40% off
|
$1,600.62
|
$11,006.70
|
$6,372.30
|
2026-05-22
|
|
728540
|
OTHER
|
Wrist Disarticulation Molded Socket Flexible Elb
|
96
|
40
|
$11,505.00
|
$6,903.00
40% off
|
$1,583.84
|
$10,929.75
|
$6,327.75
|
2026-05-22
|
|
728014
|
OTHER
|
Lower Extremity Addition Pelvic Control Reciproc
|
96
|
40
|
$11,494.00
|
$6,896.40
40% off
|
$1,581.56
|
$10,919.30
|
$6,321.70
|
2026-05-22
|
|
728334
|
OTHER
|
Thoracic-lumbar-sacral Orthosis 2-piece Rigid She
|
96
|
40
|
$11,339.00
|
$6,803.40
40% off
|
$1,549.44
|
$10,772.05
|
$6,236.45
|
2026-05-22
|
|
728549
|
OTHER
|
Shoulder Disartic Passive Restoration (complete P
|
96
|
40
|
$11,256.00
|
$6,753.60
40% off
|
$1,532.24
|
$10,693.20
|
$6,190.80
|
2026-05-22
|
|
1083375
|
OTHER
|
L6885 Replacement Socketshoulder Disarticulation/
|
96
|
40
|
$11,217.00
|
$6,730.20
40% off
|
$1,524.16
|
$10,656.15
|
$6,169.35
|
2026-05-22
|
|
728245
|
OTHER
|
L2034 Knee-ankle-foot Orthosis Full Plastic Sing
|
96
|
40
|
$10,925.00
|
$6,555.00
40% off
|
$1,463.66
|
$10,378.75
|
$6,008.75
|
2026-05-22
|
|
728394
|
OTHER
|
Wrist-hand-finger Orthosis Electric External Pow
|
96
|
40
|
$10,811.00
|
$6,486.60
40% off
|
$1,440.04
|
$10,270.45
|
$5,946.05
|
2026-05-22
|
|
728719
|
OTHER
|
Addition Endo Knee-shin Sys Single Axis Fluid S
|
96
|
40
|
$10,587.00
|
$6,352.20
40% off
|
$1,393.63
|
$10,057.65
|
$5,822.85
|
2026-05-22
|
|
728484
|
OTHER
|
All Le Prosthesis Ankle Multiaxial Shock Absorbi
|
96
|
40
|
$10,559.00
|
$6,335.40
40% off
|
$1,387.82
|
$10,031.05
|
$5,807.45
|
2026-05-22
|
|
728533
|
OTHER
|
Prep Ak Or Knee Disartic Ischial Level Socket N
|
96
|
40
|
$10,533.00
|
$6,319.80
40% off
|
$1,382.44
|
$10,006.35
|
$5,793.15
|
2026-05-22
|
|
7781365
|
OTHER
|
Hip Orthosis Bilat Hip Abduction Adjust Flexion Ex
|
96
|
40
|
$10,382.00
|
$6,229.20
40% off
|
$1,351.15
|
$9,862.90
|
$5,762.01
|
2026-05-22
|
|
728372
|
OTHER
|
Hip Orthosis Adduction Control
|
96
|
40
|
$10,402.00
|
$6,241.20
40% off
|
$1,355.29
|
$9,881.90
|
$5,721.10
|
2026-05-22
|
|
728513
|
OTHER
|
Above Knee Short Prosthesis No Knee Joint (""stub
|
96
|
40
|
$10,367.00
|
$6,220.20
40% off
|
$1,348.04
|
$9,848.65
|
$5,701.85
|
2026-05-22
|
|
728247
|
OTHER
|
Knee-ankle-foot Orthosis Double Upright Free Kne
|
96
|
40
|
$10,270.00
|
$6,162.00
40% off
|
$1,327.94
|
$9,756.50
|
$5,648.50
|
2026-05-22
|
|
728503
|
OTHER
|
Ankle Symes Molded Socket Sach Foot
|
96
|
40
|
$10,236.00
|
$6,141.60
40% off
|
$1,320.90
|
$9,724.20
|
$5,629.80
|
2026-05-22
|
|
728531
|
OTHER
|
L5580 Prep Ak Or Knee Disartic Ischial Level Soc
|
96
|
40
|
$10,195.00
|
$6,117.00
40% off
|
$1,312.40
|
$9,685.25
|
$5,607.25
|
2026-05-22
|
|
728333
|
OTHER
|
Thoracic-lumbar-sacral Orthosis 2-piece Rigid She
|
96
|
40
|
$10,095.00
|
$6,057.00
40% off
|
$1,291.68
|
$9,590.25
|
$5,552.25
|
2026-05-22
|
|
728563
|
OTHER
|
Prep Shoulder Disartic Or Interscapular Thoracic
|
96
|
40
|
$10,039.00
|
$6,023.40
40% off
|
$1,280.08
|
$9,537.05
|
$5,521.45
|
2026-05-22
|
|
728555
|
OTHER
|
Elbow Disartic Molded Socket Endo Sys Incl Soft
|
96
|
40
|
$10,021.00
|
$6,012.60
40% off
|
$1,276.35
|
$9,519.95
|
$5,511.55
|
2026-05-22
|
|
728554
|
OTHER
|
Be Molded Socket Endo Sys Incl Soft Prosthetic
|
96
|
40
|
$9,968.00
|
$5,980.80
40% off
|
$1,265.37
|
$9,469.60
|
$5,482.40
|
2026-05-22
|
|
728506
|
OTHER
|
Below Knee Molded Socket Shin Sach Foot (exo)
|
96
|
40
|
$9,891.00
|
$5,934.60
40% off
|
$1,249.42
|
$9,396.45
|
$5,440.05
|
2026-05-22
|
|
728508
|
OTHER
|
Below Knee Molded Socket Shin Sach Foot Endosk
|
96
|
40
|
$9,624.00
|
$5,774.40
40% off
|
$1,194.09
|
$9,142.80
|
$5,293.20
|
2026-05-22
|
|
728653
|
OTHER
|
All Le Prostheses Multi-axial Ankle/foot Dynamic
|
96
|
40
|
$9,419.00
|
$5,651.40
40% off
|
$1,151.62
|
$8,948.05
|
$5,180.45
|
2026-05-22
|
|
728504
|
OTHER
|
Ankle Symes Metal Frame Molded Leather Socket
|
96
|
40
|
$9,357.00
|
$5,614.20
40% off
|
$1,138.77
|
$8,889.15
|
$5,146.35
|
2026-05-22
|
|
728332
|
OTHER
|
Thoracic-lumbar-sacral Orthosis Triplaner Control
|
96
|
40
|
$9,346.00
|
$5,607.60
40% off
|
$1,136.49
|
$8,878.70
|
$5,140.30
|
2026-05-22
|
|
728605
|
OTHER
|
Addition To Le Ischial Containment/narrow M-l Soc
|
96
|
40
|
$9,258.00
|
$5,554.80
40% off
|
$1,118.26
|
$8,795.10
|
$5,091.90
|
2026-05-22
|
|
728695
|
OTHER
|
Addition To Le Endo Sys Ak Or Knee Disartic 4-b
|
96
|
40
|
$9,200.00
|
$5,520.00
40% off
|
$1,106.24
|
$8,740.00
|
$5,060.00
|
2026-05-22
|
|
728532
|
OTHER
|
Prep Ak Or Knee Disartic Ischial Level Socket N
|
96
|
40
|
$9,125.00
|
$5,475.00
40% off
|
$1,090.70
|
$8,668.75
|
$5,018.75
|
2026-05-22
|
|
728539
|
OTHER
|
Wrist Disartic Molded Socket Flexible Elbow Hing
|
96
|
40
|
$9,099.00
|
$5,459.40
40% off
|
$1,085.31
|
$8,644.05
|
$5,004.45
|
2026-05-22
|
|
728502
|
OTHER
|
Partial Foot Molded Socket Tibial Tubercle Heigh
|
96
|
40
|
$9,098.00
|
$5,458.80
40% off
|
$1,085.11
|
$8,643.10
|
$5,003.90
|
2026-05-22
|
|
728718
|
OTHER
|
Addition Endo Knee-shin Sys Single Axis Hydraul
|
96
|
40
|
$9,074.00
|
$5,444.40
40% off
|
$1,080.13
|
$8,620.30
|
$4,990.70
|
2026-05-22
|
|
728544
|
OTHER
|
L6130 Be Molded Socket (Muenster Or Northwestern
|
96
|
40
|
$8,940.00
|
$5,364.00
40% off
|
$1,052.37
|
$8,493.00
|
$4,917.00
|
2026-05-22
|
|
728896
|
OTHER
|
Prehensile Actuator Hosmer Or Equal Switch Contr
|
96
|
40
|
$8,927.00
|
$5,356.20
40% off
|
$1,049.67
|
$8,480.65
|
$4,909.85
|
2026-05-22
|
|
728248
|
OTHER
|
Knee-ankle-foot Orthosis Single Upright Full Pla
|
96
|
40
|
$8,920.00
|
$5,352.00
40% off
|
$1,048.22
|
$8,474.00
|
$4,906.00
|
2026-05-22
|
|
728514
|
OTHER
|
Above Knee Short Prosthesis No Knee Joint (""stub
|
96
|
40
|
$8,872.00
|
$5,323.20
40% off
|
$1,038.28
|
$8,428.40
|
$4,879.60
|
2026-05-22
|
|
728564
|
OTHER
|
Prep Shoulder Disartic Or Interscapular Thoracic
|
96
|
40
|
$8,691.00
|
$5,214.60
40% off
|
$1,000.78
|
$8,256.45
|
$4,780.05
|
2026-05-22
|
|
728195
|
OTHER
|
Cervical Halo Procedure Incorporated Into Milwauk
|
96
|
40
|
$8,488.00
|
$5,092.80
40% off
|
$958.71
|
$8,063.60
|
$4,668.40
|
2026-05-22
|
|
728543
|
OTHER
|
Be Molded Socket (Muenster Or Northwestern Suspen
|
96
|
40
|
$8,481.00
|
$5,088.60
40% off
|
$957.26
|
$8,056.95
|
$4,664.55
|
2026-05-22
|
|
728231
|
OTHER
|
Knee Orthosis Single Upright Thigh/Calf Adjustab
|
96
|
40
|
$8,439.00
|
$5,063.40
40% off
|
$948.56
|
$8,017.05
|
$4,641.45
|
2026-05-22
|
|
728015
|
OTHER
|
Lower Extremity Addition Pelvic Control Reciproc
|
96
|
40
|
$8,425.00
|
$5,055.00
40% off
|
$945.66
|
$8,003.75
|
$4,633.75
|
2026-05-22
|
|
728331
|
OTHER
|
Thoracic-lumbar-sacral Orthosis Triplaner Control
|
96
|
40
|
$8,369.00
|
$5,021.40
40% off
|
$934.06
|
$7,950.55
|
$4,602.95
|
2026-05-22
|
|
6311583
|
OTHER
|
Skin Splt Grft Trnk/arm/leg 100 Sq Cm/1 Ba (15100
|
96
|
38
|
$7,333.00
|
$4,399.80
40% off
|
$2,175.67
|
$6,966.35
|
$4,586.79
|
2026-05-22
|
|
728179
|
OTHER
|
Cranial Cervical Orthosis Congenital Torticolous
|
96
|
40
|
$7,752.00
|
$4,651.20
40% off
|
$806.21
|
$7,364.40
|
$4,263.60
|
2026-05-22
|
|
728550
|
OTHER
|
Shoulder Disartic Passive Restoration (shoulder C
|
96
|
40
|
$7,608.00
|
$4,564.80
40% off
|
$776.38
|
$7,227.60
|
$4,184.40
|
2026-05-22
|
|
5760304
|
OTHER
|
Hook/hand Hvy Dty Vol Clos
|
96
|
40
|
$7,509.00
|
$4,505.40
40% off
|
$755.86
|
$7,133.55
|
$4,129.95
|
2026-05-22
|
|
728525
|
OTHER
|
Prep Bk ""ptb"" Type Socket Non-align Sys Pylon
|
96
|
40
|
$7,454.00
|
$4,472.40
40% off
|
$744.47
|
$7,081.30
|
$4,099.70
|
2026-05-22
|
|
728527
|
OTHER
|
Prep Bk ""ptb"" Type Socket Non-alignable Sys Pyl
|
96
|
40
|
$7,431.00
|
$4,458.60
40% off
|
$739.70
|
$7,059.45
|
$4,087.05
|
2026-05-22
|
|
6581204
|
OTHER
|
MRI Face/Neck W Without Contrast
|
94
|
37
|
$8,384.00
|
$5,030.40
40% off
|
$367.88
|
$7,964.80
|
$4,460.29
|
2026-05-22
|
|
6581112
|
OTHER
|
CT Lower Extremity With Without Contrast Bil
|
94
|
37
|
$7,911.00
|
$4,746.60
40% off
|
$452.99
|
$7,515.45
|
$4,208.65
|
2026-05-22
|
|
6578758
|
OTHER
|
MRI Spine Cervical W Without Contrast
|
94
|
37
|
$7,724.00
|
$4,634.40
40% off
|
$367.88
|
$7,337.80
|
$4,109.17
|
2026-05-22
|
|
6581255
|
OTHER
|
MRI Spine Thoracic W Without Contrast
|
94
|
37
|
$7,712.00
|
$4,627.20
40% off
|
$367.88
|
$7,326.40
|
$4,102.78
|
2026-05-22
|
|
6581258
|
OTHER
|
MRI Spine Lumbar W Without Contrast
|
94
|
37
|
$7,642.00
|
$4,585.20
40% off
|
$367.88
|
$7,259.90
|
$4,065.54
|
2026-05-22
|
|
6050320
|
OTHER
|
Comprehensive Computer Based Motion Analysis-5 Cha
|
92
|
38
|
$8,779.00
|
$5,267.40
40% off
|
$278.20
|
$8,340.05
|
$4,753.83
|
2026-05-22
|
|
6050319
|
OTHER
|
Comprehensive Computer Based Motion Analysis-4 Cha
|
92
|
38
|
$8,493.00
|
$5,095.80
40% off
|
$278.20
|
$8,068.35
|
$4,598.96
|
2026-05-22
|
|
6056317
|
OTHER
|
Comprehensive Computer Based Motion Analysis-3 Cha
|
92
|
38
|
$7,929.00
|
$4,757.40
40% off
|
$278.20
|
$7,532.55
|
$4,293.56
|
2026-05-22
|
|
6050321
|
OTHER
|
Dynamic Plantar Pressure Meas During Walk-5 Charge
|
92
|
38
|
$7,593.00
|
$4,555.80
40% off
|
$278.20
|
$7,213.35
|
$4,111.61
|
2026-05-22
|
|
728495
|
OTHER
|
Electronic Elbow Microproc Simultaneous Control O
|
88
|
40
|
$127,351.00
|
$76,410.60
40% off
|
$25,587.13
|
$120,983.45
|
$68,896.89
|
2026-05-22
|
|
728578
|
OTHER
|
Shoulder Disarticulation External Power Myo Cont
|
88
|
40
|
$54,529.00
|
$32,717.40
40% off
|
$10,498.41
|
$51,802.55
|
$29,500.19
|
2026-05-22
|
|
728579
|
OTHER
|
Shoulder Disarticulation External Power Switch C
|
88
|
40
|
$45,574.00
|
$27,344.40
40% off
|
$8,642.93
|
$43,295.30
|
$24,655.53
|
2026-05-22
|
|
728576
|
OTHER
|
Above Elbow External Power Myo Control
|
88
|
40
|
$35,386.00
|
$21,231.60
40% off
|
$6,531.98
|
$33,616.70
|
$19,143.82
|
2026-05-22
|
|
728573
|
OTHER
|
Be Ext Power Self-susp Inner Socket Remov Shell
|
88
|
40
|
$32,960.00
|
$19,776.00
40% off
|
$6,029.31
|
$31,312.00
|
$17,831.36
|
2026-05-22
|
|
728489
|
OTHER
|
All Le Prosthesis Shank Foot System With Vertical
|
88
|
40
|
$27,982.00
|
$16,789.20
40% off
|
$4,997.87
|
$26,582.90
|
$14,410.73
|
2026-05-22
|
|
7795336
|
OTHER
|
Ak 4 Bar Fluid Swing/stance
|
88
|
40
|
$18,377.00
|
$11,026.20
40% off
|
$3,007.71
|
$17,458.15
|
$10,107.35
|
2026-05-22
|
|
728548
|
OTHER
|
Shoulder Disartic Molded Socket Shoulder Bulkhea
|
88
|
40
|
$16,107.00
|
$9,664.20
40% off
|
$2,537.37
|
$15,301.65
|
$8,713.89
|
2026-05-22
|
|
728886
|
OTHER
|
Automatic Grasp Feature Addition To Upper-limb Pr
|
88
|
40
|
$15,904.00
|
$9,542.40
40% off
|
$2,495.31
|
$15,108.80
|
$8,604.07
|
2026-05-22
|
|
6538052
|
OTHER
|
Part Hand Myo Exclu Term Dev (l6026)
|
88
|
40
|
$14,710.00
|
$8,826.00
40% off
|
$2,247.91
|
$13,974.50
|
$8,090.50
|
2026-05-22
|
|
6521605
|
OTHER
|
Electronic Wrist Rotator Any
|
88
|
40
|
$13,701.00
|
$8,220.60
40% off
|
$2,038.85
|
$13,015.95
|
$7,535.55
|
2026-05-22
|
|
728890
|
OTHER
|
Electric Hand Switch Or Myo Adult
|
88
|
40
|
$13,857.00
|
$8,314.20
40% off
|
$2,071.17
|
$13,164.15
|
$7,496.64
|
2026-05-22
|
|
7824301
|
OTHER
|
Graft MirraSurg 10 Cm X 10 Cm
|
88
|
34
|
$9,660.00
|
$5,796.00
40% off
|
$4,491.90
|
$39,344.76
|
$7,003.50
|
2026-05-22
|
|
728785
|
OTHER
|
Ue Addition Shoulder Lock Mechanism External Pow
|
88
|
40
|
$11,918.00
|
$7,150.80
40% off
|
$1,669.41
|
$11,322.10
|
$6,447.64
|
2026-05-22
|
|
728783
|
OTHER
|
Ue Addition Shoulder Jt Multipositional Lock Fl
|
88
|
40
|
$11,672.00
|
$7,003.20
40% off
|
$1,618.44
|
$11,088.40
|
$6,314.55
|
2026-05-22
|
|
728547
|
OTHER
|
Ae Molded Double Wall Socket Internal Locking El
|
88
|
40
|
$11,669.00
|
$7,001.40
40% off
|
$1,617.82
|
$11,085.55
|
$6,312.93
|
2026-05-22
|
|
2995297
|
OTHER
|
Upper Extremity Addition Flexion/extension And Ro
|
88
|
40
|
$11,160.00
|
$6,696.00
40% off
|
$1,512.35
|
$10,602.00
|
$6,037.56
|
2026-05-22
|
|
728887
|
OTHER
|
Microproc Control Feature Addtion To Upper-limb P
|
88
|
40
|
$11,140.00
|
$6,684.00
40% off
|
$1,508.21
|
$10,583.00
|
$6,026.74
|
2026-05-22
|
|
728492
|
OTHER
|
Ue Addition External Locking Elbow Forearm Count
|
88
|
40
|
$10,934.00
|
$6,560.40
40% off
|
$1,465.52
|
$10,387.30
|
$5,915.30
|
2026-05-22
|
|
1083265
|
OTHER
|
L6883 Replacement Socketbelow Elbow/wrist Disarti
|
88
|
40
|
$10,705.00
|
$6,423.00
40% off
|
$1,418.08
|
$10,169.75
|
$5,791.41
|
2026-05-22
|
|
6521606
|
OTHER
|
Term Device Multi Art Digit
|
88
|
40
|
$10,249.00
|
$6,149.40
40% off
|
$1,323.59
|
$9,736.55
|
$5,544.71
|
2026-05-22
|
|
728542
|
OTHER
|
Be Molded Socket (Muenster Or Northwestern Suspen
|
88
|
40
|
$9,651.00
|
$5,790.60
40% off
|
$1,199.69
|
$9,168.45
|
$5,221.19
|
2026-05-22
|
|
728778
|
OTHER
|
Ue Addition Electric Lock Feature With Manually Po
|
88
|
40
|
$9,163.00
|
$5,497.80
40% off
|
$1,098.57
|
$8,704.85
|
$4,957.18
|
2026-05-22
|
|
728545
|
OTHER
|
Elbow Disartic Molded Socket Outside Locking Hin
|
88
|
40
|
$9,125.00
|
$5,475.00
40% off
|
$1,090.70
|
$8,668.75
|
$4,936.62
|
2026-05-22
|
|
728541
|
OTHER
|
Be Molded Socket Flexible Elbow Hinges Triceps
|
88
|
40
|
$9,121.00
|
$5,472.60
40% off
|
$1,089.87
|
$8,664.95
|
$4,934.46
|
2026-05-22
|
|
1083260
|
OTHER
|
L6621 Upper Extremity Additionsflexion/extension
|
88
|
40
|
$8,462.00
|
$5,077.20
40% off
|
$953.33
|
$8,038.90
|
$4,577.94
|
2026-05-22
|
|
6445587
|
OTHER
|
Revise/Remove Imp Spinal Neurostim Gen W/detach El
|
84
|
38
|
$28,068.00
|
$16,840.80
40% off
|
$13,051.62
|
$57,677.86
|
$25,120.86
|
2026-05-22
|
|
6781389
|
OTHER
|
Insert/rplcmt Periphl/sacral/gast Neurostim Gen With
|
84
|
38
|
$20,526.00
|
$12,315.60
40% off
|
$9,544.59
|
$57,677.86
|
$18,370.77
|
2026-05-22
|
|
4277297
|
OTHER
|
Implant Neuroelectrodes Epidural (63650)
|
84
|
38
|
$21,222.00
|
$12,733.20
40% off
|
$6,720.15
|
$20,160.90
|
$13,313.19
|
2026-05-22
|
|
6724732
|
OTHER
|
Implant Neuroelectrodes Peripheral Nrv (64555)
|
84
|
38
|
$18,494.00
|
$11,096.40
40% off
|
$6,720.15
|
$17,964.86
|
$12,832.08
|
2026-05-22
|
|
6805246
|
OTHER
|
59676-0820-01 - Hyaluronan 88 Mg/4 Ml Soln
|
84
|
38
|
$15,939.80
|
$9,563.88
40% off
|
$564.77
|
$15,142.81
|
$8,631.40
|
2026-05-22
|
|
6307582
|
OTHER
|
Skn Splt A-grft Fac/nck/hf/g 100 Sq Cm/1 Ba (1512
|
84
|
38
|
$9,116.00
|
$5,469.60
40% off
|
$3,736.76
|
$8,660.20
|
$5,702.06
|
2026-05-22
|
|
6311580
|
OTHER
|
Skin Full Grft Face/genit/hf < 20 Sq Cm (15240)
|
84
|
38
|
$6,568.00
|
$3,940.80
40% off
|
$2,175.67
|
$6,239.60
|
$4,154.41
|
2026-05-22
|
|
6309580
|
OTHER
|
Skin Full Graft Sclp/arm/leg < 20 Sq Cm (15220)
|
84
|
38
|
$6,205.00
|
$3,723.00
40% off
|
$2,175.67
|
$5,894.75
|
$4,074.76
|
2026-05-22
|
|
7793332
|
OTHER
|
Insert/replace Perq Electrode Array Pn W/intgd Neu
|
82
|
37
|
$23,553.00
|
$14,131.80
40% off
|
$10,952.15
|
$22,375.35
|
$12,832.08
|
2026-05-22
|
|
4277299
|
OTHER
|
Revj/rmvl Implnt Spinal Neurostim Gen W/detach Cnn
|
82
|
37
|
$14,324.00
|
$8,594.40
40% off
|
$3,686.55
|
$13,607.80
|
$7,620.37
|
2026-05-22
|
|
6680454
|
OTHER
|
Destruction Neurolytic Agt Genicular Nerve W/img B
|
82
|
37
|
$10,282.00
|
$6,169.20
40% off
|
$2,059.10
|
$9,767.90
|
$5,470.02
|
2026-05-22
|
|
6680456
|
OTHER
|
Radiofrequency Abltj Nrv Nrvtg Si Jt W/img Gdn Bil
|
82
|
37
|
$8,242.00
|
$4,945.20
40% off
|
$2,059.10
|
$7,829.90
|
$4,384.74
|
2026-05-22
|
|
7793330
|
OTHER
|
Revise/remove Neurostim Electrode Array Pn W/intgr
|
82
|
37
|
$7,353.00
|
$4,411.80
40% off
|
$3,419.14
|
$7,003.11
|
$4,117.68
|
2026-05-22
|
|
6680449
|
OTHER
|
L2006 Kafo Microprocessor Swing And/or Stance
|
80
|
34
|
$107,464.00
|
$64,478.40
40% off
|
$21,466.54
|
$102,090.80
|
$65,284.38
|
2026-05-22
|
|
6369615
|
OTHER
|
Ak/ft Power Asst Incl Motors (l5969)
|
80
|
34
|
$48,742.00
|
$29,245.20
40% off
|
$9,299.34
|
$46,304.90
|
$29,610.76
|
2026-05-22
|
|
7928510
|
OTHER
|
Prosthetic Thumb Mechanical Initial Or Replaceme
|
80
|
34
|
$15,013.00
|
$9,007.80
40% off
|
$2,310.69
|
$14,262.35
|
$9,120.40
|
2026-05-22
|
|
7928509
|
OTHER
|
Single Prosthetic Digit Mechanical Initial Or Re
|
80
|
34
|
$13,022.00
|
$7,813.20
40% off
|
$1,898.16
|
$12,370.90
|
$7,910.86
|
2026-05-22
|
|
7928508
|
OTHER
|
Partial Hand Transmetacarpal Incl Flex Or Non-fl
|
80
|
34
|
$9,064.00
|
$5,438.40
40% off
|
$1,078.06
|
$8,610.80
|
$5,506.38
|
2026-05-22
|
|
960473
|
OTHER
|
L5999 - Lower Extremity Prosthesis Not Otherwise
|
80
|
34
|
$8,953.48
|
$5,372.09
40% off
|
$1,055.16
|
$8,505.81
|
$5,439.24
|
2026-05-22
|
|
7928511
|
OTHER
|
Addition To Single Prosthetic Digit Or Thumb Mult
|
80
|
34
|
$7,507.00
|
$4,504.20
40% off
|
$755.45
|
$7,131.65
|
$4,560.51
|
2026-05-22
|
|
7809930
|
OTHER
|
MRA Lower Ext W Without Contrast Lt-73725
|
80
|
32
|
$7,542.00
|
$4,525.20
40% off
|
$1,002.74
|
$7,164.90
|
$4,283.85
|
2026-05-22
|
|
7809933
|
OTHER
|
MRA Lower Ext W Without Contrast Rt-73725
|
80
|
32
|
$7,542.00
|
$4,525.20
40% off
|
$1,002.74
|
$7,164.90
|
$4,283.85
|
2026-05-22
|
|
7928512
|
OTHER
|
Passive Prosthetic Digit Or Thumb Custom Made Pe
|
80
|
34
|
$6,946.00
|
$4,167.60
40% off
|
$639.21
|
$6,598.70
|
$4,219.69
|
2026-05-22
|
|
7824292
|
OTHER
|
Graft EpiEffect 7cm X 7cm
|
76
|
34
|
$29,327.00
|
$17,596.20
40% off
|
$6,429.95
|
$37,553.70
|
$16,657.74
|
2026-05-22
|
|
7824286
|
OTHER
|
Graft EpiFix 7cm X 7cm
|
76
|
34
|
$19,989.00
|
$11,993.40
40% off
|
$6,429.95
|
$26,962.68
|
$11,353.75
|
2026-05-22
|
|
7824285
|
OTHER
|
Graft EpiFix 5cm X 6cm
|
76
|
34
|
$11,946.00
|
$7,167.60
40% off
|
$3,936.70
|
$16,507.76
|
$6,785.33
|
2026-05-22
|
|
7824253
|
OTHER
|
Theraskin 7.6cm X 15.24cm
|
76
|
34
|
$7,550.00
|
$4,530.00
40% off
|
$3,016.00
|
$22,273.16
|
$5,775.75
|
2026-05-22
|
|
7824261
|
OTHER
|
Graft EpiEffect 3cm X 5cm
|
76
|
34
|
$8,978.00
|
$5,386.80
40% off
|
$1,968.35
|
$11,496.03
|
$5,099.51
|
2026-05-22
|
|
962469
|
OTHER
|
L7499 - Ue Prosthesis Not Otherwise Specified
|
72
|
34
|
$15,616.52
|
$9,369.91
40% off
|
$2,435.74
|
$14,835.69
|
$9,190.33
|
2026-05-22
|
|
7852518
|
OTHER
|
Replacement Socket Partial Hand
|
72
|
34
|
$10,300.00
|
$6,180.00
40% off
|
$1,334.16
|
$9,785.00
|
$6,061.55
|
2026-05-22
|
|
7852515
|
OTHER
|
Partial Hand Molded Socket Flexible Or Non-flexibl
|
72
|
34
|
$9,064.00
|
$5,438.40
40% off
|
$1,078.06
|
$8,610.80
|
$5,334.16
|
2026-05-22
|
|
6781392
|
OTHER
|
Sprint Pns Dual Lead C1778
|
70
|
33
|
$17,899.00
|
$10,739.40
40% off
|
$2,908.67
|
$17,004.05
|
$10,309.82
|
2026-05-22
|
|
6781393
|
OTHER
|
Sprint Pns Single Lead C1778
|
70
|
33
|
$11,359.00
|
$6,815.40
40% off
|
$1,553.58
|
$10,791.05
|
$6,542.78
|
2026-05-22
|
|
4650303
|
OTHER
|
E0770 Fes Complete System Nos
|
70
|
27
|
$8,161.00
|
$4,896.60
40% off
|
$3,794.87
|
$7,752.95
|
$5,304.65
|
2026-05-22
|
|
7793331
|
OTHER
|
Insert/replace Perq Electrode Array Pn W/intgd Neu
|
66
|
31
|
$11,776.00
|
$7,065.60
40% off
|
$5,475.84
|
$12,832.08
|
$7,654.40
|
2026-05-22
|
|
7801410
|
OTHER
|
50242-0137-01 - Tocilizumab 20 mg/mL Soln
|
44
|
20
|
$28,348.70
|
$17,009.22
40% off
|
$1,500.00
|
$25,513.83
|
$18,866.06
|
2026-05-22
|
|
6297612
|
OTHER
|
00944-2700-07 - Immune Globulin Intravenous And Su
|
44
|
20
|
$22,833.50
|
$13,700.10
40% off
|
$2,586.00
|
$20,550.15
|
$15,195.69
|
2026-05-22
|
|
6759209
|
OTHER
|
68982-0850-05 - Immune Globulin Intravenous 10 So
|
44
|
20
|
$15,788.00
|
$9,472.80
40% off
|
$2,376.00
|
$14,209.20
|
$10,550.81
|
2026-05-22
|
|
6297613
|
OTHER
|
00944-2700-06 - Immune Globulin Intravenous And Su
|
44
|
20
|
$14,358.00
|
$8,614.80
40% off
|
$1,724.00
|
$12,922.20
|
$9,555.25
|
2026-05-22
|
|
6759211
|
OTHER
|
68982-0850-04 - Immune Globulin Intravenous 10 So
|
44
|
20
|
$10,552.00
|
$6,331.20
40% off
|
$1,584.00
|
$9,496.80
|
$7,042.94
|
2026-05-22
|
|
4980303
|
OTHER
|
00944-2700-05 - Immune Globulin Intravenous 10 So
|
44
|
20
|
$7,219.00
|
$4,331.40
40% off
|
$862.00
|
$6,497.10
|
$4,804.25
|
2026-05-22
|
|
728315
|
OTHER
|
L0640 Lumbar-sacral Orthosis Sac - T9 Custom Fab
|
34
|
17
|
$5,626.00
|
$3,375.60
40% off
|
$969.00
|
$5,063.40
|
$4,388.28
|
2026-05-22
|
|
809881
|
OTHER
|
00173-0696-00 - Fluticasone-salmeterol 250 Mcg-50
|
32
|
15
|
$120,654.25
|
$72,392.55
40% off
|
$60,327.12
|
$108,588.82
|
$95,316.86
|
2026-05-22
|
|
6112049
|
OTHER
|
Gk Delivery Complex Nmh
|
32
|
15
|
$53,098.00
|
$31,858.80
40% off
|
$26,549.00
|
$47,788.20
|
$41,947.42
|
2026-05-22
|
|
1309227
|
OTHER
|
59627-0002-05 - Interferon Beta-1a 30 Mcg/0.5 Ml K
|
32
|
15
|
$50,688.45
|
$30,413.07
40% off
|
$25,344.22
|
$45,619.60
|
$40,043.88
|
2026-05-22
|
|
4526304
|
OTHER
|
Imrt Planning Nmh
|
32
|
15
|
$27,170.00
|
$16,302.00
40% off
|
$13,585.00
|
$24,453.00
|
$21,464.30
|
2026-05-22
|
|
1517297
|
OTHER
|
00186-0372-20 - Budesonide 80 Mcg/fomoterol Fumara
|
32
|
15
|
$16,353.45
|
$9,812.07
40% off
|
$8,176.72
|
$14,718.11
|
$12,919.23
|
2026-05-22
|
|
5706340
|
OTHER
|
Ir Cva Port Place Nmh
|
32
|
15
|
$13,133.00
|
$7,879.80
40% off
|
$6,566.50
|
$11,819.70
|
$10,375.07
|
2026-05-22
|
|
6385588
|
OTHER
|
Ins Endvas Venacavafiltr Nmh
|
32
|
15
|
$12,827.00
|
$7,696.20
40% off
|
$6,413.50
|
$11,544.30
|
$10,133.33
|
2026-05-22
|
|
6591730
|
OTHER
|
55513-0221-01 - romiPLOStim 250 Mcg Rec I
|
32
|
15
|
$12,383.20
|
$7,429.92
40% off
|
$6,191.60
|
$11,144.88
|
$9,782.73
|
2026-05-22
|
|
6821242
|
OTHER
|
Exchange Nephrostomy Cath Nmh
|
32
|
15
|
$11,383.00
|
$6,829.80
40% off
|
$5,691.50
|
$10,244.70
|
$8,992.57
|
2026-05-22
|
|
6601755
|
OTHER
|
67457-0675-02 - Calcitonin INJection 200 Unit(s) /
|
32
|
15
|
$10,940.45
|
$6,564.27
40% off
|
$5,470.22
|
$9,846.41
|
$8,642.95
|
2026-05-22
|
|
6012897
|
OTHER
|
Rem Endvas Venacava Filter Nmh
|
32
|
15
|
$10,164.00
|
$6,098.40
40% off
|
$5,082.00
|
$9,147.60
|
$8,029.56
|
2026-05-22
|
|
5836305
|
OTHER
|
CT Ab/pelvis Wwo Contrast Nmh
|
32
|
15
|
$10,151.00
|
$6,090.60
40% off
|
$5,075.50
|
$9,135.90
|
$8,019.29
|
2026-05-22
|
|
6581094
|
OTHER
|
CT Abdomen/Pelvis With Without Contrast
|
32
|
15
|
$9,665.00
|
$5,799.00
40% off
|
$4,832.50
|
$8,698.50
|
$7,635.35
|
2026-05-22
|
|
6623718
|
OTHER
|
00003-0371-13 - Belatacept 250 Mg Rec I
|
32
|
15
|
$9,218.20
|
$5,530.92
40% off
|
$4,609.10
|
$8,296.38
|
$7,282.38
|
2026-05-22
|
|
6797241
|
OTHER
|
Cath Exchange Central Tunneled Nmh
|
32
|
15
|
$8,903.00
|
$5,341.80
40% off
|
$4,451.50
|
$8,012.70
|
$7,033.37
|
2026-05-22
|
|
5218303
|
OTHER
|
CT Abdomen Pelvis W/Contrast Nmh
|
32
|
15
|
$8,642.00
|
$5,185.20
40% off
|
$4,321.00
|
$7,777.80
|
$6,827.18
|
2026-05-22
|
|
6581093
|
OTHER
|
CT Abdomen/Pelvis With Contrast
|
32
|
15
|
$8,553.00
|
$5,131.80
40% off
|
$4,276.50
|
$7,697.70
|
$6,756.87
|
2026-05-22
|
|
6581280
|
OTHER
|
MRI Orbits W Without Contrast
|
32
|
15
|
$8,384.00
|
$5,030.40
40% off
|
$4,192.00
|
$7,545.60
|
$6,623.36
|
2026-05-22
|
|
983249
|
OTHER
|
MRA Head W Without Contrast Nmh
|
32
|
15
|
$8,158.00
|
$4,894.80
40% off
|
$4,079.00
|
$7,342.20
|
$6,444.82
|
2026-05-22
|
|
6581095
|
OTHER
|
CT Abdomen/Pelvis Without Contrast
|
32
|
15
|
$8,018.00
|
$4,810.80
40% off
|
$4,009.00
|
$7,216.20
|
$6,334.22
|
2026-05-22
|
|
6581097
|
OTHER
|
CT Angiography Abd/Pel With Without Contrast
|
32
|
15
|
$7,995.00
|
$4,797.00
40% off
|
$3,997.50
|
$7,195.50
|
$6,316.05
|
2026-05-22
|
|
7395320
|
OTHER
|
23155-0216-31 - Cidofovir 75 mg/mL Soln
|
32
|
15
|
$7,938.80
|
$4,763.28
40% off
|
$3,969.40
|
$7,144.92
|
$6,271.65
|
2026-05-22
|
|
6513744
|
OTHER
|
CT Angiography Abdomen/pelvis Nmh (74174
|
32
|
15
|
$7,743.00
|
$4,645.80
40% off
|
$3,871.50
|
$6,968.70
|
$6,116.97
|
2026-05-22
|
|
983254
|
OTHER
|
Mr Brain W Without Contrast Nmh
|
32
|
15
|
$7,693.00
|
$4,615.80
40% off
|
$3,846.50
|
$6,923.70
|
$6,077.47
|
2026-05-22
|
|
983105
|
OTHER
|
Therapeutic Radiology 3d Nmh
|
32
|
15
|
$7,417.00
|
$4,450.20
40% off
|
$3,708.50
|
$6,675.30
|
$5,859.43
|
2026-05-22
|
|
983178
|
OTHER
|
Mr Cervical Spine W Without Contrast Nmh
|
32
|
15
|
$7,347.00
|
$4,408.20
40% off
|
$3,673.50
|
$6,612.30
|
$5,804.13
|
2026-05-22
|
|
983247
|
OTHER
|
MRI Face/Neck W Without Contrast Nmh
|
32
|
15
|
$7,265.00
|
$4,359.00
40% off
|
$3,632.50
|
$6,538.50
|
$5,739.35
|
2026-05-22
|
|
981143
|
OTHER
|
Polysomnogram With Cpap Nmh
|
32
|
15
|
$7,113.00
|
$4,267.80
40% off
|
$3,556.50
|
$6,401.70
|
$5,619.27
|
2026-05-22
|
|
6512985
|
OTHER
|
Pln Iso Complex W/calc Nmh (77307)
|
32
|
15
|
$6,949.00
|
$4,169.40
40% off
|
$3,474.50
|
$6,254.10
|
$5,489.71
|
2026-05-22
|
|
5176304
|
OTHER
|
CT Ab/pelvis Wo Contras Nmh
|
32
|
15
|
$6,860.00
|
$4,116.00
40% off
|
$3,430.00
|
$6,174.00
|
$5,419.40
|
2026-05-22
|
|
983189
|
OTHER
|
MRI Pelvis W Without Contrast Nmh
|
32
|
15
|
$6,808.00
|
$4,084.80
40% off
|
$3,404.00
|
$6,127.20
|
$5,378.32
|
2026-05-22
|
|
6821263
|
OTHER
|
Stress Tte Complete W Contrast Nmh
|
32
|
15
|
$6,800.00
|
$4,080.00
40% off
|
$3,400.00
|
$6,120.00
|
$5,372.00
|
2026-05-22
|
|
983180
|
OTHER
|
MRI Tl Spine W Without Contrast Nmh
|
32
|
15
|
$6,724.00
|
$4,034.40
40% off
|
$3,362.00
|
$6,051.60
|
$5,311.96
|
2026-05-22
|
|
983179
|
OTHER
|
MRI Thoracic Spine W Without Contrast Nmh
|
32
|
15
|
$6,709.00
|
$4,025.40
40% off
|
$3,354.50
|
$6,038.10
|
$5,300.11
|
2026-05-22
|
|
7785370
|
OTHER
|
MRI Neurography Lumb W Without Cont-72197
|
32
|
15
|
$6,676.00
|
$4,005.60
40% off
|
$3,338.00
|
$6,008.40
|
$5,274.04
|
2026-05-22
|
|
6797262
|
OTHER
|
Insert Tunnel Cv Cath Nmh
|
32
|
15
|
$6,610.00
|
$3,966.00
40% off
|
$3,305.00
|
$5,949.00
|
$5,221.90
|
2026-05-22
|
|
2347298
|
OTHER
|
49884-0868-02 - Dronabinol 5 Mg Cap
|
32
|
15
|
$6,532.80
|
$3,919.68
40% off
|
$3,266.40
|
$5,879.52
|
$5,160.91
|
2026-05-22
|
|
6787243
|
OTHER
|
00378-8117-45 - Doxepin Topical 5 Cream
|
32
|
15
|
$6,416.20
|
$3,849.72
40% off
|
$3,208.10
|
$5,774.58
|
$5,068.80
|
2026-05-22
|
|
6395663
|
OTHER
|
Stress Echo-pharm Agent Nmh
|
32
|
15
|
$6,415.00
|
$3,849.00
40% off
|
$3,207.50
|
$5,773.50
|
$5,067.85
|
2026-05-22
|
|
6581227
|
OTHER
|
MRI Hip W Without Contrast Lt
|
32
|
15
|
$6,382.00
|
$3,829.20
40% off
|
$3,191.00
|
$5,743.80
|
$5,041.78
|
2026-05-22
|
|
6581247
|
OTHER
|
MRI Sacrum Coccyx With Contrast
|
32
|
15
|
$6,360.00
|
$3,816.00
40% off
|
$3,180.00
|
$5,724.00
|
$5,024.40
|
2026-05-22
|
|
2353297
|
OTHER
|
MRI Lower Extemity Jt W Without Contrast Nmh
|
32
|
15
|
$6,327.00
|
$3,796.20
40% off
|
$3,163.50
|
$5,694.30
|
$4,998.33
|
2026-05-22
|
|
6581195
|
OTHER
|
MRI Chest W Without Contrast
|
32
|
15
|
$6,308.00
|
$3,784.80
40% off
|
$3,154.00
|
$5,677.20
|
$4,983.32
|
2026-05-22
|
|
6578725
|
OTHER
|
MRI Pelvis With Contrast
|
32
|
15
|
$6,300.00
|
$3,780.00
40% off
|
$3,150.00
|
$5,670.00
|
$4,977.00
|
2026-05-22
|
|
6581107
|
OTHER
|
CT L-spine With Without Contrast
|
32
|
15
|
$6,279.00
|
$3,767.40
40% off
|
$3,139.50
|
$5,651.10
|
$4,960.41
|
2026-05-22
|
|
983156
|
OTHER
|
MRI Abdomen W Without Contrast Nmh
|
32
|
15
|
$6,265.00
|
$3,759.00
40% off
|
$3,132.50
|
$5,638.50
|
$4,949.35
|
2026-05-22
|
|
983272
|
OTHER
|
MRI Chest W Without Contrast Nmh
|
32
|
15
|
$6,246.00
|
$3,747.60
40% off
|
$3,123.00
|
$5,621.40
|
$4,934.34
|
2026-05-22
|
|
983252
|
OTHER
|
MRA Neck W Without Contrast Nmh
|
32
|
15
|
$6,243.00
|
$3,745.80
40% off
|
$3,121.50
|
$5,618.70
|
$4,931.97
|
2026-05-22
|
|
983104
|
OTHER
|
Stimulator Assist Complex Nmh
|
32
|
15
|
$6,211.00
|
$3,726.60
40% off
|
$3,105.50
|
$5,589.90
|
$4,906.69
|
2026-05-22
|
|
1977300
|
OTHER
|
CT Angiograph Abdomen Nmh
|
32
|
15
|
$6,161.00
|
$3,696.60
40% off
|
$3,080.50
|
$5,544.90
|
$4,867.19
|
2026-05-22
|
|
7235323
|
OTHER
|
Thrmbc/nfs Dialysis Circuit S I Nmh
|
32
|
15
|
$6,134.00
|
$3,680.40
40% off
|
$3,067.00
|
$5,520.60
|
$4,845.86
|
2026-05-22
|
|
2009297
|
OTHER
|
MRI Brain With Contrast Nmh
|
32
|
15
|
$6,130.00
|
$3,678.00
40% off
|
$3,065.00
|
$5,517.00
|
$4,842.70
|
2026-05-22
|
|
7785379
|
OTHER
|
MRI Neurography Tib W Without Cont Rt-73720
|
32
|
15
|
$6,080.00
|
$3,648.00
40% off
|
$3,040.00
|
$5,472.00
|
$4,803.20
|
2026-05-22
|
|
7785334
|
OTHER
|
MRI Neurography Femoral W Without Cont Lt-73720
|
32
|
15
|
$6,080.00
|
$3,648.00
40% off
|
$3,040.00
|
$5,472.00
|
$4,803.20
|
2026-05-22
|
|
983176
|
OTHER
|
Mr Cervical Spine Without Contrast Nmh
|
32
|
15
|
$5,959.00
|
$3,575.40
40% off
|
$2,979.50
|
$5,363.10
|
$4,707.61
|
2026-05-22
|
|
983049
|
OTHER
|
Percutaneous Placement Gastic Tube Under Fluoro Gu
|
32
|
15
|
$5,946.00
|
$3,567.60
40% off
|
$2,973.00
|
$5,351.40
|
$4,697.34
|
2026-05-22
|
|
4672314
|
OTHER
|
MRI Brain Functional Md/phd Nmh
|
32
|
15
|
$5,946.00
|
$3,567.60
40% off
|
$2,973.00
|
$5,351.40
|
$4,697.34
|
2026-05-22
|
|
1281227
|
OTHER
|
Colonoscopy W/bx Nmh
|
32
|
15
|
$5,849.00
|
$3,509.40
40% off
|
$2,924.50
|
$5,264.10
|
$4,620.71
|
2026-05-22
|
|
983145
|
OTHER
|
MRI Lower Extremity W Without Contrast Nmh
|
32
|
15
|
$5,790.00
|
$3,474.00
40% off
|
$2,895.00
|
$5,211.00
|
$4,574.10
|
2026-05-22
|
|
6821238
|
OTHER
|
Insj Picc W/imaging 5 Yr Nmh
|
32
|
15
|
$5,756.00
|
$3,453.60
40% off
|
$2,878.00
|
$5,180.40
|
$4,547.24
|
2026-05-22
|
|
7826337
|
OTHER
|
68462-0904-01 - Posaconazole 18 mg/mL Soln
|
32
|
15
|
$5,708.90
|
$3,425.34
40% off
|
$2,854.45
|
$5,138.01
|
$4,510.03
|
2026-05-22
|
|
981142
|
OTHER
|
Sleep Disorder Study
|
32
|
15
|
$5,700.00
|
$3,420.00
40% off
|
$2,850.00
|
$5,130.00
|
$4,503.00
|
2026-05-22
|
|
1659300
|
OTHER
|
58177-0363-22 - Ondansetron 4 Mg Dis Tablet
|
32
|
15
|
$5,657.75
|
$3,394.65
40% off
|
$2,828.88
|
$5,091.98
|
$4,469.62
|
2026-05-22
|
|
1723297
|
OTHER
|
58177-3633-75 - Ondansetron 4 Mg Tab
|
32
|
15
|
$5,657.75
|
$3,394.65
40% off
|
$2,828.88
|
$5,091.98
|
$4,469.62
|
2026-05-22
|
|
2593299
|
OTHER
|
62576-0240-64 - Ondansetron 4 Mg Tab
|
32
|
15
|
$5,657.75
|
$3,394.65
40% off
|
$2,828.88
|
$5,091.98
|
$4,469.62
|
2026-05-22
|
|
983248
|
OTHER
|
MRA Head Without Contrast Nmh
|
32
|
15
|
$5,638.00
|
$3,382.80
40% off
|
$2,819.00
|
$5,074.20
|
$4,454.02
|
2026-05-22
|
|
6791276
|
OTHER
|
61958-2901-02 - Remdesivir 100 Mg Rec I
|
32
|
15
|
$5,614.90
|
$3,368.94
40% off
|
$2,807.45
|
$5,053.41
|
$4,435.77
|
2026-05-22
|
|
6581102
|
OTHER
|
CT C-spine With Without Contrast
|
32
|
15
|
$5,608.00
|
$3,364.80
40% off
|
$2,804.00
|
$5,047.20
|
$4,430.32
|
2026-05-22
|
|
983058
|
OTHER
|
Ivc-gram Nmh
|
32
|
15
|
$5,605.00
|
$3,363.00
40% off
|
$2,802.50
|
$5,044.50
|
$4,427.95
|
2026-05-22
|
|
6581134
|
OTHER
|
CT Thorax With Without Contrast
|
32
|
15
|
$5,600.00
|
$3,360.00
40% off
|
$2,800.00
|
$5,040.00
|
$4,424.00
|
2026-05-22
|
|
6637975
|
OTHER
|
CT Angiography Chest Pe-71275
|
32
|
15
|
$5,554.00
|
$3,332.40
40% off
|
$2,777.00
|
$4,998.60
|
$4,387.66
|
2026-05-22
|
|
6581098
|
OTHER
|
CT Angiography Chest
|
32
|
15
|
$5,554.00
|
$3,332.40
40% off
|
$2,777.00
|
$4,998.60
|
$4,387.66
|
2026-05-22
|
|
983253
|
OTHER
|
Mr Brain Without Contrast Nmh
|
32
|
15
|
$5,553.00
|
$3,331.80
40% off
|
$2,776.50
|
$4,997.70
|
$4,386.87
|
2026-05-22
|
|
810671
|
OTHER
|
55513-0823-10 - Epoetin Alfa 40000 units/mL Soln
|
32
|
15
|
$5,502.40
|
$3,301.44
40% off
|
$2,751.20
|
$4,952.16
|
$4,346.90
|
2026-05-22
|
|
983251
|
OTHER
|
MRA Neck With Contrast Nmh
|
32
|
15
|
$5,490.00
|
$3,294.00
40% off
|
$2,745.00
|
$4,941.00
|
$4,337.10
|
2026-05-22
|
|
983177
|
OTHER
|
Mr Ls Spine Without Contrast Nmh
|
32
|
15
|
$5,482.00
|
$3,289.20
40% off
|
$2,741.00
|
$4,933.80
|
$4,330.78
|
2026-05-22
|
|
983146
|
OTHER
|
MRI Lower Extremity Jt Without Contrast Nmh
|
32
|
15
|
$5,479.00
|
$3,287.40
40% off
|
$2,739.50
|
$4,931.10
|
$4,328.41
|
2026-05-22
|
|
6581131
|
OTHER
|
CT T-spine With Without Contrast
|
32
|
15
|
$5,457.00
|
$3,274.20
40% off
|
$2,728.50
|
$4,911.30
|
$4,311.03
|
2026-05-22
|
|
983103
|
OTHER
|
Stimulator Assist Intermed Nmh
|
32
|
15
|
$5,447.00
|
$3,268.20
40% off
|
$2,723.50
|
$4,902.30
|
$4,303.13
|
2026-05-22
|
|
3847297
|
OTHER
|
MRI T Spine Without Contrast Nmh
|
32
|
15
|
$5,442.00
|
$3,265.20
40% off
|
$2,721.00
|
$4,897.80
|
$4,299.18
|
2026-05-22
|
|
2341297
|
OTHER
|
CT Angiography Nec Nmh
|
32
|
15
|
$5,440.00
|
$3,264.00
40% off
|
$2,720.00
|
$4,896.00
|
$4,297.60
|
2026-05-22
|
|
6575740
|
OTHER
|
68462-0501-65 - Calcipotriene Topical 0.005 Cream
|
32
|
15
|
$5,417.00
|
$3,250.20
40% off
|
$2,708.50
|
$4,875.30
|
$4,279.43
|
2026-05-22
|
|
983241
|
OTHER
|
CT Brain W Without Contrast Nmh
|
32
|
15
|
$5,367.00
|
$3,220.20
40% off
|
$2,683.50
|
$4,830.30
|
$4,239.93
|
2026-05-22
|
|
6581114
|
OTHER
|
CT Lower Extremity With Without Contrast Rt
|
32
|
15
|
$5,300.00
|
$3,180.00
40% off
|
$2,650.00
|
$4,770.00
|
$4,187.00
|
2026-05-22
|
|
6297603
|
OTHER
|
MRA Abd Without Contrast Nmh
|
32
|
15
|
$5,286.00
|
$3,171.60
40% off
|
$2,643.00
|
$4,757.40
|
$4,175.94
|
2026-05-22
|
|
6581091
|
OTHER
|
CT Abdomen With Without Contrast
|
32
|
15
|
$5,281.00
|
$3,168.60
40% off
|
$2,640.50
|
$4,752.90
|
$4,171.99
|
2026-05-22
|
|
983155
|
OTHER
|
CT Abdomen W Without Contrast Nmh
|
32
|
15
|
$5,227.00
|
$3,136.20
40% off
|
$2,613.50
|
$4,704.30
|
$4,129.33
|
2026-05-22
|
|
809349
|
OTHER
|
99207-0010-10 - Ciclopirox Topical 1 Shamp
|
32
|
15
|
$5,225.40
|
$3,135.24
40% off
|
$2,612.70
|
$4,702.86
|
$4,128.06
|
2026-05-22
|
|
983246
|
OTHER
|
CT Angiograph Head With And/or Without Contrast Nm
|
32
|
15
|
$5,223.00
|
$3,133.80
40% off
|
$2,611.50
|
$4,700.70
|
$4,126.17
|
2026-05-22
|
|
6821244
|
OTHER
|
CT Angio Hrt W/3d Image Nmh
|
32
|
15
|
$5,202.00
|
$3,121.20
40% off
|
$2,601.00
|
$4,681.80
|
$4,109.58
|
2026-05-22
|
|
983188
|
OTHER
|
MRI Pelvis Without Contrast Nmh
|
32
|
15
|
$5,165.00
|
$3,099.00
40% off
|
$2,582.50
|
$4,648.50
|
$4,080.35
|
2026-05-22
|
|
1421304
|
OTHER
|
58406-0435-04 - Etanercept 50 mg/mL Soln
|
32
|
15
|
$5,146.30
|
$3,087.78
40% off
|
$2,573.15
|
$4,631.67
|
$4,065.57
|
2026-05-22
|
|
983111
|
OTHER
|
MRI Upper Extremity Joint Without Contrast Nmh
|
32
|
15
|
$5,131.00
|
$3,078.60
40% off
|
$2,565.50
|
$4,617.90
|
$4,053.49
|
2026-05-22
|
|
6581104
|
OTHER
|
CT Head/Brain With Without Contrast
|
32
|
15
|
$5,118.00
|
$3,070.80
40% off
|
$2,559.00
|
$4,606.20
|
$4,043.22
|
2026-05-22
|
|
160
|
OTHER
|
Non-traumatic Spinal Cord A0503
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
23
|
OTHER
|
Replacement Of Lower Extremity A0803
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
67
|
OTHER
|
Traumatic Spinal Cord D0403
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
16
|
OTHER
|
Fracture Of Lower Extremity B0704
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
171
|
OTHER
|
Stroke D0103
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
230
|
OTHER
|
Non-traumatic Spinal Cord D0504
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
170
|
OTHER
|
Miscellaneous C2001
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
224
|
OTHER
|
Non-traumatic Brain Injury A0304
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
20
|
OTHER
|
Fracture Of Lower Extremity A0702
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
246
|
OTHER
|
Other Orthopedic B0904
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
237
|
OTHER
|
Non-traumatic Brain Injury A0305
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
128
|
OTHER
|
Cardiac A1402
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
21
|
OTHER
|
Traumatic Spinal Cord A0401
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
25
|
OTHER
|
Miscellaneous A2001
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
108
|
OTHER
|
Traumatic Spinal Cord B0403
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
107
|
OTHER
|
Major Multi-trauma With Tbi Or Sci A1805
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
17
|
OTHER
|
Amputation Of Non-lower Extremity A1101
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
71
|
OTHER
|
Major Multi-trauma With Tbi Or Sci C1802
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
106
|
OTHER
|
Major Multi-trauma With Tbi Or Sci D1805
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
210
|
OTHER
|
Cardiac C1404
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
161
|
OTHER
|
Fracture Of Lower Extremity A0703
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
105
|
OTHER
|
Amputation Of Non-lower Extremity D1102
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|
|
172
|
OTHER
|
Non-traumatic Spinal Cord B0501
|
16
|
8
|
—
|
—
|
$4,040.85
|
$4,087.89
|
$4,040.85
|
2026-05-22
|