|
J1414
|
HCPCS
|
Inj, Beqvez, Per Tx Dose
|
1
|
1
|
—
|
—
|
$3,710,000.00
|
$3,710,000.00
|
$3,710,000.00
|
2026-04-01
|
|
J1411
|
HCPCS
|
Inj, Hemgenix, Per Tx Dose
|
2
|
2
|
—
|
—
|
$3,685,266.67
|
$3,710,000.00
|
$3,697,633.33
|
2026-04-01
|
|
J1413
|
HCPCS
|
Inj Delandistrogene Mox Rokl
|
2
|
2
|
—
|
—
|
$3,316,462.59
|
$3,321,781.51
|
$3,319,122.05
|
2026-04-01
|
|
J3394
|
HCPCS
|
Inj, Lovotibeglogene Autotem
|
3
|
3
|
—
|
—
|
$3,193,000.00
|
$4,970,121.94
|
$3,248,445.72
|
2026-04-01
|
|
J3399
|
HCPCS
|
Inj Onase Abepar-xioi Treat
|
4
|
4
|
—
|
—
|
$2,403,458.75
|
$4,173,688.03
|
$3,105,714.92
|
2026-04-01
|
|
J3393
|
HCPCS
|
Inj, Betibeglogene Autotemce
|
3
|
3
|
—
|
—
|
$2,945,740.00
|
$4,506,982.20
|
$2,968,000.00
|
2026-04-01
|
|
J3392
|
HCPCS
|
Inj, Exagamglogene Autotem
|
4
|
4
|
—
|
—
|
$2,332,000.00
|
$3,964,400.00
|
$2,949,980.00
|
2026-04-01
|
|
Q2042
|
HCPCS
|
Tisagenlecleucel IV Infusion (wrapped)
|
29
|
17
|
$4,253,411.58
|
$2,126,705.79
50% off
|
$466,070.00
|
$3,828,070.00
|
$2,147,070.00
|
2026-04-01
|
|
Q2055
|
HCPCS
|
Idecabtagene Vicleucel 460000000 Cells IV Susp
|
30
|
18
|
$4,964,120.33
|
$2,482,060.16
50% off
|
$460,227.00
|
$4,467,708.00
|
$2,123,043.25
|
2026-04-01
|
|
Q2054
|
HCPCS
|
Lisocabtagene Maraleucel 70000000 Cells/ml IV Susp
|
30
|
18
|
$4,855,287.41
|
$2,427,643.70
50% off
|
$454,489.00
|
$4,369,759.00
|
$2,077,586.00
|
2026-04-01
|
|
Q2041
|
HCPCS
|
Axicabtagene Ciloleucel Car+
|
4
|
4
|
—
|
—
|
$489,517.15
|
$906,491.29
|
$674,536.17
|
2026-04-01
|
|
Q2053
|
HCPCS
|
Brexucabtagene Car Pos T
|
4
|
4
|
—
|
—
|
$488,051.51
|
$831,817.83
|
$618,970.33
|
2026-04-01
|
|
Q2056
|
HCPCS
|
Ciltacabtagene Car-pos T
|
5
|
5
|
—
|
—
|
$494,704.54
|
$961,977.21
|
$565,868.94
|
2026-04-01
|
|
A9520
|
HCPCS
|
Technetium-99 (tc-99) Tilmanocept (lymphoseek) Radio-isotope Injection
|
22
|
13
|
$770,386.00
|
$385,193.00
50% off
|
$10.00
|
$693,347.00
|
$564,693.00
|
2024-12-15
|
|
18
|
MS_DRG
|
Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies
|
20
|
12
|
$0.01
|
—
|
$129,318.00
|
$745,896.50
|
$359,327.99
|
2026-04-01
|
|
1
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
20
|
12
|
$0.01
|
—
|
$106,702.00
|
$484,056.82
|
$261,399.59
|
2026-04-01
|
|
13925-522-01
|
NDC
|
Pentamidine Isethionate 300 Mg In Solr
|
25
|
14
|
$396,641.51
|
$198,320.76
50% off
|
$103,127.00
|
$356,977.00
|
$230,052.00
|
2024-12-15
|
|
58914-501-56
|
NDC
|
Mesalamine 1000 Mg Re Supp
|
25
|
14
|
$372,735.21
|
$186,367.60
50% off
|
$96,911.00
|
$335,462.00
|
$216,186.50
|
2024-12-15
|
|
C1831
|
HCPCS
|
Kit Imp Aprevo Spine Lvl 1
|
99
|
14
|
$332,120.00
|
$166,060.00
50% off
|
$9,900.00
|
$437,000.00
|
$213,116.00
|
2024-12-15
|
|
A9588
|
HCPCS
|
Fluciclovine F 18 9-221 Mci/ml IV Soln
|
26
|
16
|
$460,111.00
|
$230,055.50
50% off
|
$80.00
|
$414,100.00
|
$204,519.50
|
2026-04-01
|
|
927
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
20
|
12
|
$0.01
|
—
|
$114,065.15
|
$392,802.00
|
$197,356.00
|
2026-04-01
|
|
52427-273-75
|
NDC
|
Naproxen Sodium ER 500 Mg Po Tb24
|
25
|
14
|
$339,243.38
|
$169,621.69
50% off
|
$88,203.00
|
$305,319.00
|
$196,761.00
|
2024-12-15
|
|
C9089
|
HCPCS
|
Bupivacaine Hcl (300 Mg Dose) 3 X 100 Mg Il Impl
|
42
|
14
|
$246,873.71
|
$123,436.86
50% off
|
$64,187.00
|
$228,405.00
|
$186,636.50
|
2024-12-15
|
|
63323-877-15
|
NDC
|
Pentamidine Isethionate 300 Mg In Solr
|
25
|
14
|
$311,091.56
|
$155,545.78
50% off
|
$80,884.00
|
$279,982.00
|
$180,433.00
|
2024-12-15
|
|
3
|
MS_DRG
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
20
|
12
|
$0.01
|
—
|
$83,931.00
|
$366,622.88
|
$178,364.00
|
2026-04-01
|
|
A9572
|
HCPCS
|
Indium In-111 Pentetreotide IV Kit
|
26
|
16
|
$386,681.14
|
$193,340.57
50% off
|
$57.00
|
$348,013.00
|
$171,880.00
|
2026-04-01
|
|
58468-0132-2
|
NDC
|
Sevelamer Carbonate 0.8 G Po Pack
|
25
|
14
|
$294,215.74
|
$147,107.87
50% off
|
$76,496.00
|
$264,794.00
|
$170,645.00
|
2024-12-15
|
|
58468-0132-1
|
NDC
|
Sevelamer Carbonate 0.8 G Po Pack
|
25
|
14
|
$294,215.74
|
$147,107.87
50% off
|
$76,496.00
|
$264,794.00
|
$170,645.00
|
2024-12-15
|
|
68382-395-04
|
NDC
|
Ribavirin 6 G In Solr
|
25
|
14
|
$274,709.53
|
$137,354.77
50% off
|
$71,424.00
|
$247,239.00
|
$159,331.50
|
2024-12-15
|
|
68382-395-01
|
NDC
|
Ribavirin 6 G In Solr
|
25
|
14
|
$274,709.53
|
$137,354.77
50% off
|
$71,424.00
|
$247,239.00
|
$159,331.50
|
2024-12-15
|
|
59385-027-01
|
NDC
|
Buprenorphine Hcl 900 Mcg Bu Film
|
25
|
14
|
$264,236.27
|
$132,118.13
50% off
|
$68,701.00
|
$237,813.00
|
$153,257.00
|
2024-12-15
|
|
59385-027-60
|
NDC
|
Buprenorphine Hcl 900 Mcg Bu Film
|
25
|
14
|
$264,236.27
|
$132,118.13
50% off
|
$68,701.00
|
$237,813.00
|
$153,257.00
|
2024-12-15
|
|
A9595
|
HCPCS
|
Piflufolastat F 18 9 Mci IV Sosy
|
27
|
17
|
$475,098.80
|
$237,549.40
50% off
|
$332.44
|
$427,589.00
|
$152,982.00
|
2026-04-01
|
|
C1825
|
HCPCS
|
System Neo Barostim Includes 2102 Ipg 1036 Csl Kit
|
45
|
14
|
$198,240.00
|
$99,120.00
50% off
|
$9,900.00
|
$244,720.00
|
$151,059.00
|
2024-12-15
|
|
209
|
MS_DRG
|
Complex Aortic Arch Procedures
|
9
|
5
|
—
|
—
|
$76,874.09
|
$195,509.63
|
$148,072.54
|
2026-04-01
|
|
24338-050-08
|
NDC
|
Carmustine In Polifeprosan 7.7 Mg Il Wafr
|
25
|
14
|
$243,921.81
|
$121,960.90
50% off
|
$63,420.00
|
$219,530.00
|
$141,475.00
|
2024-12-15
|
|
A9569
|
HCPCS
|
Technetium-99 (tc-99) Exametazime White Blood Cells Radio-isotope Injection
|
26
|
16
|
$317,369.80
|
$158,684.90
50% off
|
$55.00
|
$285,633.00
|
$141,071.00
|
2026-04-01
|
|
C1824
|
HCPCS
|
Generator Pul Implantable Optimizer Smt F/hrt Fail
|
45
|
14
|
$227,240.00
|
$113,620.00
50% off
|
$9,900.00
|
$227,240.00
|
$140,269.00
|
2024-12-15
|
|
C1822
|
HCPCS
|
Construct Neuromod Nevro Pain Mgmt Omnia With Ipg Rm
|
63
|
14
|
$194,246.50
|
$97,123.25
50% off
|
$9,900.00
|
$227,240.00
|
$139,080.00
|
2024-12-15
|
|
426
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
19
|
11
|
$0.01
|
—
|
$74,852.88
|
$190,369.19
|
$128,431.50
|
2026-04-01
|
|
0187-0007-14
|
NDC
|
Ribavirin 6 G In Solr
|
25
|
14
|
$210,690.03
|
$105,345.02
50% off
|
$54,779.00
|
$189,621.00
|
$122,200.00
|
2024-12-15
|
|
0781-5893-31
|
NDC
|
Nevirapine ER 400 Mg Po Tb24
|
25
|
14
|
$206,564.77
|
$103,282.38
50% off
|
$53,707.00
|
$185,908.00
|
$119,807.50
|
2024-12-15
|
|
4
|
MS_DRG
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
20
|
12
|
$0.01
|
—
|
$57,874.00
|
$239,255.23
|
$117,840.00
|
2026-04-01
|
|
14
|
MS_DRG
|
Allogeneic Bone Marrow Transplant
|
20
|
12
|
$0.01
|
—
|
$40,206.00
|
$216,940.00
|
$116,638.24
|
2026-04-01
|
|
850
|
MS_DRG
|
Acute Leukemia With Other Procedures
|
19
|
11
|
$0.01
|
—
|
$58,812.88
|
$152,531.00
|
$111,572.00
|
2026-04-01
|
|
C1882
|
HCPCS
|
Defibrillator Consulta 2chb Is1 Df1 Av 35jl 38ml 6
|
1,089
|
14
|
$148,486.80
|
$74,243.40
50% off
|
$13.00
|
$301,141.00
|
$109,621.00
|
2024-12-15
|
|
7
|
MS_DRG
|
Lung Transplant
|
20
|
12
|
$0.01
|
—
|
$48,286.00
|
$223,688.80
|
$109,043.00
|
2026-04-01
|
|
2
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
20
|
12
|
$0.01
|
—
|
$48,209.00
|
$195,734.18
|
$106,829.28
|
2026-04-01
|
|
C1767
|
HCPCS
|
Stimulator Proclaim Elite 5 W/pat Cntrlr
|
477
|
14
|
$144,210.00
|
$72,105.00
50% off
|
$9,900.00
|
$342,127.00
|
$103,735.00
|
2024-12-15
|
|
429
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc
|
19
|
11
|
$0.01
|
—
|
$61,190.66
|
$155,622.82
|
$102,331.00
|
2026-04-01
|
|
C1816
|
HCPCS
|
System Stim Nerv Stimq-4 8 Elect Dl Transm Kt
|
64
|
14
|
$157,320.00
|
$78,660.00
50% off
|
$3,758.00
|
$179,170.00
|
$99,887.50
|
2024-12-15
|
|
47781-153-01
|
NDC
|
Naproxen Sodium ER 375 Mg Po Tb24
|
25
|
14
|
$171,325.06
|
$85,662.53
50% off
|
$44,545.00
|
$154,193.00
|
$99,369.00
|
2024-12-15
|
|
5
|
MS_DRG
|
Liver Transplant With Mcc Or Intestinal Transplant
|
20
|
12
|
$0.01
|
—
|
$40,748.00
|
$178,093.27
|
$99,186.77
|
2026-04-01
|
|
212
|
MS_DRG
|
Concomitant Aortic And Mitral Valve Procedures
|
20
|
12
|
$0.01
|
—
|
$52,114.00
|
$187,828.33
|
$98,644.39
|
2026-04-01
|
|
C2616
|
HCPCS
|
Sphere Embol Sir Msphre 90
|
45
|
14
|
$129,882.60
|
$64,941.30
50% off
|
$9,900.00
|
$129,883.00
|
$97,082.00
|
2024-12-15
|
|
215
|
MS_DRG
|
Other Heart Assist System Implant
|
20
|
12
|
$0.01
|
—
|
$49,446.00
|
$175,429.00
|
$92,858.93
|
2026-04-01
|
|
C1721
|
HCPCS
|
Defibrillator Lumax 540 Dr-t 2chb Home Mon
|
907
|
14
|
$123,723.60
|
$61,861.80
50% off
|
$24.00
|
$190,501.00
|
$88,011.00
|
2024-12-15
|
|
J2326
|
HCPCS
|
Nusinersen 12 Mg/5ml It Soln
|
26
|
16
|
$255,909.86
|
$127,954.93
50% off
|
$1,170.00
|
$230,319.00
|
$87,137.50
|
2026-04-01
|
|
427
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
19
|
11
|
$0.01
|
—
|
$49,026.69
|
$124,686.88
|
$86,818.10
|
2026-04-01
|
|
Q3001
|
HCPCS
|
Hc I-125 Iotrex - 2 Ml
|
24
|
13
|
$118,208.95
|
$59,104.48
50% off
|
$735.00
|
$118,209.00
|
$86,647.50
|
2024-12-15
|
|
38240
|
CPT
|
Hc Trnsplj Allogeneic Hematopoietic Cells Per Donor
|
25
|
14
|
$178,757.65
|
$89,378.82
50% off
|
$11,694.00
|
$160,882.00
|
$86,288.00
|
2024-12-15
|
|
C1827
|
HCPCS
|
Generator Imp Vivistim Vns Ipg 1001
|
45
|
14
|
$257,830.00
|
$128,915.00
50% off
|
$9,900.00
|
$257,830.00
|
$85,084.00
|
2024-12-15
|
|
A9591
|
HCPCS
|
Fluoroestradiol F 18 4-100 Mci/ml IV Soln
|
26
|
16
|
$243,748.00
|
$121,874.00
50% off
|
$66.00
|
$219,373.00
|
$82,996.50
|
2026-04-01
|
|
0187-3013-30
|
NDC
|
Pyridostigmine Bromide ER 180 Mg Po Tbcr
|
25
|
14
|
$141,474.57
|
$70,737.28
50% off
|
$36,783.00
|
$127,327.00
|
$82,055.00
|
2024-12-15
|
|
51167-331-01
|
NDC
|
Elexacaf-tezacaf-ivacaf&ivacaf 100-50-75 (trikafta Kit Morning Dose)
|
25
|
14
|
$140,799.12
|
$70,399.56
50% off
|
$36,608.00
|
$126,719.00
|
$81,663.50
|
2024-12-15
|
|
216
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
20
|
12
|
$0.01
|
—
|
$46,972.00
|
$168,978.30
|
$81,568.14
|
2026-04-01
|
|
447
|
MS_DRG
|
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…
|
19
|
11
|
$0.01
|
—
|
$45,379.54
|
$115,411.28
|
$81,400.00
|
2026-04-01
|
|
C1722
|
HCPCS
|
Defibrillator Maximo Ii Vr 1chb Is1 Df1 Av 35jl 37
|
873
|
14
|
$117,348.00
|
$58,674.00
50% off
|
$9,900.00
|
$206,052.00
|
$80,266.00
|
2024-12-15
|
|
J9029
|
HCPCS
|
Inj, Adstiladrin, Per Tx Dos
|
4
|
4
|
—
|
—
|
$63,342.28
|
$107,681.88
|
$80,157.87
|
2026-04-01
|
|
C2624
|
HCPCS
|
System Cardiomems Hrt Failure Ptnt
|
27
|
14
|
$141,246.00
|
$70,623.00
50% off
|
$9,900.00
|
$141,246.00
|
$78,744.50
|
2024-12-15
|
|
C1820
|
HCPCS
|
System Chrgr Prc Fam Neurostim Ptnt Kt
|
333
|
14
|
$114,319.20
|
$57,159.60
50% off
|
$1,776.00
|
$223,351.00
|
$77,983.00
|
2024-12-15
|
|
C1823
|
HCPCS
|
Generator Implantable Remede Pul Cent Sleep Apnea
|
45
|
14
|
$235,620.00
|
$117,810.00
50% off
|
$9,900.00
|
$235,620.00
|
$77,755.00
|
2024-12-15
|
|
317
|
MS_DRG
|
Concomitant Left Atrial Appendage Closure And Cardiac Ablation
|
19
|
11
|
$0.01
|
—
|
$45,412.82
|
$115,495.91
|
$75,993.00
|
2026-04-01
|
|
453
|
MS_DRG
|
Combined Anterior And Posterior Spinal Fusion With Mcc
|
1
|
1
|
—
|
—
|
$75,434.06
|
$75,434.06
|
$75,434.06
|
2026-04-01
|
|
213
|
MS_DRG
|
Endovascular Abdominal Aorta With Iliac Branch Procedures
|
9
|
5
|
—
|
—
|
$38,759.65
|
$98,575.28
|
$74,657.67
|
2026-04-01
|
|
C9047
|
HCPCS
|
Caplacizumab-yhdp 11 Mg Ij Kit
|
22
|
13
|
$98,637.57
|
$49,318.78
50% off
|
$745.00
|
$88,774.00
|
$72,301.50
|
2024-12-15
|
|
0078-0697-19
|
NDC
|
Eltrombopag Olamine 25 Mg Po Pack
|
25
|
14
|
$124,394.78
|
$62,197.39
50% off
|
$32,343.00
|
$111,955.00
|
$72,149.00
|
2024-12-15
|
|
0078-0697-61
|
NDC
|
Eltrombopag Olamine 25 Mg Po Pack
|
25
|
14
|
$124,394.78
|
$62,197.39
50% off
|
$32,343.00
|
$111,955.00
|
$72,149.00
|
2024-12-15
|
|
A9543
|
HCPCS
|
Y90 Ibritumomab, Rx
|
4
|
4
|
—
|
—
|
$56,824.55
|
$96,601.73
|
$71,883.05
|
2026-04-01
|
|
790
|
MS_DRG
|
Extreme Immaturity Or Respiratory Distress Syndrome, Neonate
|
20
|
12
|
$0.01
|
—
|
$40,366.57
|
$102,662.08
|
$71,868.74
|
2026-04-01
|
|
19
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
20
|
12
|
$0.01
|
—
|
$31,469.00
|
$131,260.00
|
$71,492.89
|
2026-04-01
|
|
231
|
MS_DRG
|
Coronary Bypass With Ptca With Mcc
|
20
|
12
|
$0.01
|
—
|
$39,279.00
|
$145,609.66
|
$70,955.00
|
2026-04-01
|
|
456
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
20
|
12
|
$0.01
|
—
|
$38,815.00
|
$145,151.93
|
$70,916.00
|
2026-04-01
|
|
Q2043
|
HCPCS
|
Sipuleucel-t Auto Cd54+
|
4
|
4
|
—
|
—
|
$55,272.32
|
$93,962.95
|
$70,051.58
|
2026-04-01
|
|
20
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
20
|
12
|
$0.01
|
—
|
$39,047.00
|
$135,917.78
|
$67,738.99
|
2026-04-01
|
|
428
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
19
|
11
|
$0.01
|
—
|
$38,183.04
|
$97,108.81
|
$67,615.79
|
2026-04-01
|
|
430
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc
|
19
|
11
|
$0.01
|
—
|
$39,168.51
|
$99,615.12
|
$67,240.50
|
2026-04-01
|
|
10
|
MS_DRG
|
Pancreas Transplant
|
20
|
12
|
$0.01
|
—
|
$18,943.00
|
$132,017.00
|
$66,803.00
|
2026-04-01
|
|
233
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
20
|
12
|
$0.01
|
—
|
$37,732.00
|
$132,055.54
|
$66,022.42
|
2026-04-01
|
|
C1772
|
HCPCS
|
Pump Inf Synchromed Ii Ti 3.4x0.78x0.78in 20ml
|
45
|
14
|
$100,510.00
|
$50,255.00
50% off
|
$9,900.00
|
$100,510.00
|
$65,933.00
|
2024-12-15
|
|
219
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
20
|
12
|
$0.01
|
—
|
$37,307.00
|
$132,627.28
|
$65,502.20
|
2026-04-01
|
|
0955-1052-01
|
NDC
|
Sevelamer Carbonate 0.8 G Po Pack
|
25
|
14
|
$112,748.02
|
$56,374.01
50% off
|
$29,314.00
|
$101,473.00
|
$65,393.50
|
2024-12-15
|
|
0955-1052-90
|
NDC
|
Sevelamer Carbonate 0.8 G Po Pack
|
25
|
14
|
$112,748.02
|
$56,374.01
50% off
|
$29,314.00
|
$101,473.00
|
$65,393.50
|
2024-12-15
|
|
L8614
|
HCPCS
|
Electrode Hires Ultra 3d Ci Hifocus Slimj Cochlear
|
222
|
14
|
$94,916.25
|
$47,458.12
50% off
|
$552.00
|
$148,680.00
|
$64,491.00
|
2024-12-15
|
|
450
|
MS_DRG
|
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically …
|
19
|
11
|
$0.01
|
—
|
$36,197.14
|
$92,058.18
|
$63,323.00
|
2026-04-01
|
|
957
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
20
|
12
|
$0.01
|
—
|
$28,802.00
|
$131,618.53
|
$62,586.00
|
2026-04-01
|
|
A9555
|
HCPCS
|
Rubidium-82 (rb-82) Radio-isotope Injection
|
22
|
13
|
$84,001.00
|
$42,000.50
50% off
|
$78.00
|
$75,601.00
|
$61,573.00
|
2024-12-15
|
|
33365
|
CPT
|
Hc Cath Replace Aortic Valve Open Transaortic Approach
|
17
|
10
|
$80,395.84
|
$40,197.92
50% off
|
$1,623.00
|
$72,356.00
|
$61,262.00
|
2024-12-15
|
|
275
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
20
|
12
|
$0.01
|
—
|
$34,059.00
|
$123,163.40
|
$60,963.76
|
2026-04-01
|
|
J7674
|
HCPCS
|
Methacholine Chloride 100 Mg In Solr
|
22
|
13
|
$81,687.09
|
$40,843.54
50% off
|
$125.00
|
$73,518.00
|
$59,876.50
|
2024-12-15
|
|
61958-1004-1
|
NDC
|
Ranolazine ER 1000 Mg Po Tb12
|
25
|
14
|
$102,106.23
|
$51,053.12
50% off
|
$26,548.00
|
$91,896.00
|
$59,222.00
|
2024-12-15
|
|
870
|
MS_DRG
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
20
|
12
|
$0.01
|
—
|
$31,895.00
|
$119,387.52
|
$58,377.00
|
2026-04-01
|
|
A9592
|
HCPCS
|
Copper Cu 64 Dotatate 1 Mci/ml IV Soln
|
26
|
16
|
$170,101.00
|
$85,050.50
50% off
|
$258.00
|
$153,091.00
|
$57,919.50
|
2026-04-01
|
|
955
|
MS_DRG
|
Craniotomy For Multiple Significant Trauma
|
20
|
12
|
$0.01
|
—
|
$24,278.00
|
$116,266.29
|
$57,315.00
|
2026-04-01
|
|
16
|
MS_DRG
|
Autologous Bone Marrow Transplant With Cc/Mcc
|
20
|
12
|
$0.01
|
—
|
$21,688.00
|
$102,423.71
|
$57,188.55
|
2026-04-01
|
|
J9226
|
HCPCS
|
Supprelin La Implant
|
4
|
4
|
—
|
—
|
$45,020.65
|
$76,535.10
|
$57,071.69
|
2026-04-01
|
|
268
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
20
|
12
|
$0.01
|
—
|
$33,170.00
|
$118,801.97
|
$56,576.07
|
2026-04-01
|
|
928
|
MS_DRG
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc
|
20
|
12
|
$0.01
|
—
|
$30,387.00
|
$123,894.05
|
$56,076.00
|
2026-04-01
|
|
33240
|
CPT
|
Hc Insj Implntbl Defib Pulse Gen W/1 Existing Ld
|
40
|
14
|
$79,329.69
|
$39,664.84
50% off
|
$1,623.00
|
$71,397.00
|
$55,954.00
|
2024-12-15
|
|
207
|
MS_DRG
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
20
|
12
|
$0.01
|
—
|
$33,480.00
|
$111,146.57
|
$55,862.54
|
2026-04-01
|
|
459
|
MS_DRG
|
Spinal Fusion Except Cervical With Mcc
|
1
|
1
|
—
|
—
|
$55,282.47
|
$55,282.47
|
$55,282.47
|
2026-04-01
|
|
55566-9800-0
|
NDC
|
Fecal Microbiota, Live-jslm 150 Ml Re Susp
|
25
|
14
|
$94,953.71
|
$47,476.86
50% off
|
$24,688.00
|
$85,458.00
|
$55,073.00
|
2024-12-15
|
|
55566-9800-2
|
NDC
|
Fecal Microbiota, Live-jslm 150 Ml Re Susp
|
25
|
14
|
$94,953.71
|
$47,476.86
50% off
|
$24,688.00
|
$85,458.00
|
$55,073.00
|
2024-12-15
|
|
69468-151-04
|
NDC
|
Uridine Triacetate 10 G Po Pack
|
25
|
14
|
$94,691.13
|
$47,345.56
50% off
|
$24,620.00
|
$85,222.00
|
$54,921.00
|
2024-12-15
|
|
266
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$35,722.00
|
$105,855.85
|
$54,317.20
|
2026-04-01
|
|
217
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
20
|
12
|
$0.01
|
—
|
$30,812.00
|
$113,575.16
|
$54,244.00
|
2026-04-01
|
|
454
|
MS_DRG
|
Combined Anterior And Posterior Spinal Fusion With Cc
|
1
|
1
|
—
|
—
|
$54,026.33
|
$54,026.33
|
$54,026.33
|
2026-04-01
|
|
276
|
MS_DRG
|
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator
|
20
|
12
|
$0.01
|
—
|
$30,039.00
|
$103,752.00
|
$53,602.60
|
2026-04-01
|
|
969
|
MS_DRG
|
HIV With Extensive O.r. Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$30,155.00
|
$105,733.21
|
$53,137.00
|
2026-04-01
|
|
820
|
MS_DRG
|
Lymphoma And Leukemia With Major O.r. Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$26,521.00
|
$101,302.69
|
$52,974.43
|
2026-04-01
|
|
0398T
|
CPT
|
Hc MRI Guided Focused US Stereo Lesion Ablate
|
22
|
13
|
$71,584.70
|
$35,792.35
50% off
|
$1,623.00
|
$64,426.00
|
$52,472.00
|
2024-12-15
|
|
33363
|
CPT
|
Hc Replace Aortic Valve Open Axillry Artry Approach
|
31
|
10
|
$69,725.12
|
$34,862.56
50% off
|
$1,623.00
|
$62,753.00
|
$52,294.00
|
2024-12-15
|
|
8
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant
|
20
|
12
|
$0.01
|
—
|
$20,722.00
|
$96,808.26
|
$52,119.79
|
2026-04-01
|
|
235
|
MS_DRG
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
20
|
12
|
$0.01
|
—
|
$28,454.00
|
$101,368.33
|
$51,959.71
|
2026-04-01
|
|
34708
|
CPT
|
Hc Evasc Rpr Dplmnt Ilio-iliac Ndgft Rpt
|
31
|
10
|
$124,978.98
|
$62,489.49
50% off
|
$1,058.00
|
$112,481.00
|
$51,866.00
|
2024-12-15
|
|
67546-212-21
|
NDC
|
Nitazoxanide 100 Mg/5ml Po Susr Bulk
|
25
|
14
|
$89,264.62
|
$44,632.31
50% off
|
$23,209.00
|
$80,338.00
|
$51,773.50
|
2024-12-15
|
|
573
|
MS_DRG
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
20
|
12
|
$0.01
|
—
|
$27,195.36
|
$113,162.33
|
$51,760.00
|
2026-04-01
|
|
461
|
MS_DRG
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
20
|
12
|
$0.01
|
—
|
$31,392.00
|
$101,611.00
|
$51,582.00
|
2026-04-01
|
|
232
|
MS_DRG
|
Coronary Bypass With Ptca Without Mcc
|
20
|
12
|
$0.01
|
—
|
$28,802.00
|
$104,719.29
|
$51,350.00
|
2026-04-01
|
|
33362
|
CPT
|
Hc Replace Aortic Valve Openfemoral Artery Approach
|
17
|
10
|
$67,313.25
|
$33,656.62
50% off
|
$1,623.00
|
$60,582.00
|
$51,293.00
|
2024-12-15
|
|
L8619
|
HCPCS
|
Hc Supply Cochlear Implnt, Ext Speech Processor_cont Rplcmt - L8619
|
283
|
17
|
$81,420.00
|
$40,710.00
50% off
|
$903.00
|
$148,680.00
|
$51,172.00
|
2026-04-01
|
|
28
|
MS_DRG
|
Spinal Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$27,835.00
|
$103,781.37
|
$51,108.00
|
2026-04-01
|
|
17
|
MS_DRG
|
Autologous Bone Marrow Transplant Without Cc/Mcc
|
20
|
12
|
$0.01
|
—
|
$20,644.00
|
$99,942.00
|
$50,746.00
|
2026-04-01
|
|
77371
|
CPT
|
Hc Tr Srs 1 Session Multi Cobalt 60
|
24
|
14
|
$93,660.20
|
$46,830.10
50% off
|
$6,537.00
|
$84,294.00
|
$50,670.50
|
2024-12-15
|
|
0310-0283-60
|
NDC
|
Quetiapine Fumarate ER 300 Mg Po Tb24
|
25
|
14
|
$87,338.95
|
$43,669.47
50% off
|
$22,708.00
|
$78,605.00
|
$50,656.50
|
2024-12-15
|
|
448
|
MS_DRG
|
Multiple Level Spinal Fusion Except Cervical Without Mcc
|
19
|
11
|
$0.01
|
—
|
$28,802.32
|
$73,251.34
|
$50,283.00
|
2026-04-01
|
|
218
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
20
|
12
|
$0.01
|
—
|
$27,565.00
|
$113,575.16
|
$50,029.00
|
2026-04-01
|
|
791
|
MS_DRG
|
Prematurity With Major Problems
|
20
|
12
|
$0.01
|
—
|
$27,567.58
|
$70,111.11
|
$49,194.79
|
2026-04-01
|
|
0008-0423-03
|
NDC
|
Antivenin Micrurus Fulvius IV Solr
|
25
|
14
|
$84,789.87
|
$42,394.94
50% off
|
$22,045.00
|
$76,311.00
|
$49,178.00
|
2024-12-15
|
|
0008-0423-01
|
NDC
|
Antivenin Micrurus Fulvius IV Solr
|
25
|
14
|
$84,789.87
|
$42,394.94
50% off
|
$22,045.00
|
$76,311.00
|
$49,178.00
|
2024-12-15
|
|
21
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
20
|
12
|
$0.01
|
—
|
$28,376.00
|
$91,521.00
|
$49,009.93
|
2026-04-01
|
|
457
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
20
|
12
|
$0.01
|
—
|
$27,951.00
|
$103,000.63
|
$48,996.30
|
2026-04-01
|
|
234
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc
|
20
|
12
|
$0.01
|
—
|
$25,168.00
|
$94,357.22
|
$48,977.41
|
2026-04-01
|
|
834
|
MS_DRG
|
Acute Leukemia With Mcc
|
20
|
12
|
$0.01
|
—
|
$19,021.00
|
$94,827.04
|
$48,657.24
|
2026-04-01
|
|
35371
|
CPT
|
Hc Thromboendartectmy Femoral Common
|
31
|
10
|
$116,847.32
|
$58,423.66
50% off
|
$68.00
|
$105,163.00
|
$48,492.00
|
2024-12-15
|
|
35355
|
CPT
|
Hc Thromboendarterectomy With Without Patch Graft Iliofemoral
|
31
|
10
|
$116,847.32
|
$58,423.66
50% off
|
$1,058.00
|
$105,163.00
|
$48,492.00
|
2024-12-15
|
|
402
|
MS_DRG
|
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical
|
19
|
11
|
$0.01
|
—
|
$27,306.10
|
$69,446.10
|
$48,188.50
|
2026-04-01
|
|
23
|
MS_DRG
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
20
|
12
|
$0.01
|
—
|
$25,168.00
|
$98,979.47
|
$48,004.00
|
2026-04-01
|
|
47335-625-60
|
NDC
|
Ranolazine ER 1000 Mg Po Pack
|
25
|
14
|
$82,310.16
|
$41,155.08
50% off
|
$21,401.00
|
$74,079.00
|
$47,740.00
|
2024-12-15
|
|
33264
|
CPT
|
Hc Rmvl Impltbl Dfb Pls Gen W/rplcmt Pls Gen Mlt Ld
|
41
|
14
|
$62,630.09
|
$31,315.04
50% off
|
$1,623.00
|
$70,932.00
|
$47,724.00
|
2024-12-15
|
|
81416
|
CPT
|
Hc Exome Sequence Analysis Each Comparator Exome
|
25
|
14
|
$92,610.00
|
$46,305.00
50% off
|
$12,000.00
|
$83,349.00
|
$47,674.50
|
2024-12-15
|
|
34705
|
CPT
|
Hc Evasc Rpr Dplmnt Aorto-bi-iliac Ndgft
|
17
|
10
|
$62,489.49
|
$31,244.74
50% off
|
$1,623.00
|
$56,241.00
|
$47,617.00
|
2024-12-15
|
|
228
|
MS_DRG
|
Other Cardiothoracic Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$24,394.00
|
$85,456.44
|
$47,348.08
|
2026-04-01
|
|
653
|
MS_DRG
|
Major Bladder Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$25,361.00
|
$92,304.00
|
$46,923.00
|
2026-04-01
|
|
405
|
MS_DRG
|
Pancreas, Liver And Shunt Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$21,186.00
|
$94,491.95
|
$46,409.53
|
2026-04-01
|
|
34707
|
CPT
|
Hc Evasc Rpr Dplmnt Ilio-iliac Ndgft
|
31
|
10
|
$55,641.55
|
$27,820.78
50% off
|
$1,623.00
|
$100,155.00
|
$46,182.00
|
2024-12-15
|
|
73702-140-71
|
NDC
|
Indomethacin 100 Mg Re Supp
|
25
|
14
|
$79,128.71
|
$39,564.36
50% off
|
$20,573.00
|
$71,216.00
|
$45,894.50
|
2024-12-15
|
|
33229
|
CPT
|
Hc Remvl Perm Pm Pls Gen W/repl Plse Gen Mult Lead
|
40
|
14
|
$68,033.29
|
$34,016.64
50% off
|
$1,623.00
|
$61,230.00
|
$45,580.00
|
2024-12-15
|
|
463
|
MS_DRG
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …
|
20
|
12
|
$0.01
|
—
|
$26,057.00
|
$98,447.46
|
$45,484.00
|
2026-04-01
|
|
11
|
MS_DRG
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc
|
20
|
12
|
$0.01
|
—
|
$20,297.00
|
$94,208.67
|
$45,441.00
|
2026-04-01
|
|
576
|
MS_DRG
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc
|
20
|
12
|
$0.01
|
—
|
$24,936.00
|
$89,335.00
|
$45,436.00
|
2026-04-01
|
|
6
|
MS_DRG
|
Liver Transplant Without Mcc
|
20
|
12
|
$0.01
|
—
|
$19,059.00
|
$80,293.00
|
$45,334.62
|
2026-04-01
|
|
359
|
MS_DRG
|
Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc
|
9
|
5
|
—
|
—
|
$23,354.00
|
$59,394.94
|
$44,983.77
|
2026-04-01
|
|
220
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
20
|
12
|
$0.01
|
—
|
$25,361.00
|
$92,113.45
|
$44,816.01
|
2026-04-01
|
|
267
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc
|
20
|
12
|
$0.01
|
—
|
$23,621.00
|
$82,233.30
|
$44,792.60
|
2026-04-01
|
|
31253
|
CPT
|
Hc Nasal/sinus Endo Total With Tiss Rem
|
38
|
14
|
$58,344.44
|
$29,172.22
50% off
|
$3,288.00
|
$105,020.00
|
$44,458.00
|
2024-12-15
|
|
837
|
MS_DRG
|
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…
|
20
|
12
|
$0.01
|
—
|
$16,469.00
|
$82,984.67
|
$44,278.15
|
2026-04-01
|
|
245
|
MS_DRG
|
Aicd Generator Procedures
|
20
|
12
|
$0.01
|
—
|
$21,920.00
|
$80,916.00
|
$44,162.60
|
2026-04-01
|
|
0078-0494-71
|
NDC
|
Tobramycin 300 Mg/5ml In Nebu
|
25
|
14
|
$75,495.29
|
$37,747.64
50% off
|
$19,629.00
|
$67,946.00
|
$43,787.50
|
2024-12-15
|
|
466
|
MS_DRG
|
Revision Of Hip Or Knee Replacement With Mcc
|
20
|
12
|
$0.01
|
—
|
$23,853.00
|
$89,912.87
|
$43,416.26
|
2026-04-01
|
|
270
|
MS_DRG
|
Other Major Cardiovascular Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$24,472.00
|
$91,137.53
|
$43,262.00
|
2026-04-01
|
|
326
|
MS_DRG
|
Stomach, Esophageal And Duodenal Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$22,964.00
|
$86,147.36
|
$43,231.07
|
2026-04-01
|
|
278
|
MS_DRG
|
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures …
|
20
|
12
|
$0.01
|
—
|
$21,572.00
|
$96,144.97
|
$43,098.74
|
2026-04-01
|
|
650
|
MS_DRG
|
Kidney Transplant With Hemodialysis With Mcc
|
20
|
12
|
$0.01
|
—
|
$21,070.00
|
$81,207.28
|
$42,927.10
|
2026-04-01
|
|
J2353
|
HCPCS
|
Octreotide Acetate 10 Mg IM Kit
|
73
|
16
|
$243,787.15
|
$121,893.58
50% off
|
$67.00
|
$618,699.00
|
$42,541.00
|
2026-04-01
|
|
239
|
MS_DRG
|
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc
|
20
|
12
|
$0.01
|
—
|
$23,273.00
|
$85,012.52
|
$42,466.00
|
2026-04-01
|
|
34710
|
CPT
|
Hc Dlyd Placement Xtn Prosth For Evasc Rpr 1st Vsl
|
17
|
10
|
$55,641.55
|
$27,820.78
50% off
|
$1,623.00
|
$50,077.00
|
$42,399.00
|
2024-12-15
|
|
34701
|
CPT
|
Hc Ccl Evasc Rpr A-ao Non-ruptre
|
17
|
10
|
$55,641.55
|
$27,820.78
50% off
|
$1,623.00
|
$50,077.00
|
$42,399.00
|
2024-12-15
|
|
277
|
MS_DRG
|
Cardiac Defibrillator Implant Without Mcc
|
20
|
12
|
$0.01
|
—
|
$23,157.00
|
$79,775.35
|
$42,361.78
|
2026-04-01
|
|
0591-2720-60
|
NDC
|
Metformin Hcl ER (osm) 1000 Mg Po Tb24
|
25
|
14
|
$72,962.64
|
$36,481.32
50% off
|
$18,970.00
|
$65,666.00
|
$42,318.00
|
2024-12-15
|
|
853
|
MS_DRG
|
Infectious And Parasitic Diseases With O.r. Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$21,998.00
|
$85,304.44
|
$42,171.00
|
2026-04-01
|
|
33881
|
CPT
|
Hc Endovasc Taa Rew/o Subcl
|
20
|
11
|
$55,641.55
|
$27,820.78
50% off
|
$1,316.00
|
$50,077.00
|
$42,065.00
|
2024-12-15
|
|
826
|
MS_DRG
|
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …
|
20
|
12
|
$0.01
|
—
|
$20,297.00
|
$80,799.64
|
$41,887.90
|
2026-04-01
|
|
69344-102-33
|
NDC
|
Indomethacin 50 Mg Re Supp
|
25
|
14
|
$72,208.70
|
$36,104.35
50% off
|
$18,774.00
|
$64,988.00
|
$41,881.00
|
2024-12-15
|
|
24341
|
CPT
|
Hc Repair Tend/musc Upr Arm/elb Each
|
38
|
14
|
$54,655.25
|
$27,327.62
50% off
|
$1,058.00
|
$98,379.00
|
$41,647.00
|
2024-12-15
|
|
37231
|
CPT
|
Hc Revascularize Tibial/peron Artery,angioplasty/stent/atherectomy Init
|
38
|
14
|
$54,603.61
|
$27,301.80
50% off
|
$1,623.00
|
$98,286.00
|
$41,608.00
|
2024-12-15
|
|
33270
|
CPT
|
Hc Ins/rplcmnt Perm Subq Impltbl Dfb W/subq Eltrd
|
25
|
14
|
$57,753.41
|
$28,876.70
50% off
|
$15,016.00
|
$51,978.00
|
$41,351.00
|
2024-12-15
|
|
799
|
MS_DRG
|
Splenic Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$21,727.00
|
$78,730.00
|
$41,193.74
|
2026-04-01
|
|
471
|
MS_DRG
|
Cervical Spinal Fusion With Mcc
|
20
|
12
|
$0.01
|
—
|
$22,655.00
|
$83,406.14
|
$41,094.53
|
2026-04-01
|
|
33289
|
CPT
|
Hc Rhc W/plc Pressure Sensor
|
25
|
14
|
$86,635.40
|
$43,317.70
50% off
|
$1,623.00
|
$77,972.00
|
$40,788.00
|
2024-12-15
|
|
61958-1003-1
|
NDC
|
Ranolazine ER 500 Mg Po Tb12
|
25
|
14
|
$70,311.18
|
$35,155.59
50% off
|
$18,281.00
|
$63,280.00
|
$40,780.50
|
2024-12-15
|
|
C1833
|
HCPCS
|
Monitor Crdc The Guardian Amsg3-e
|
27
|
14
|
$72,570.00
|
$36,285.00
50% off
|
$9,900.00
|
$72,570.00
|
$40,458.00
|
2024-12-15
|
|
455
|
MS_DRG
|
Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc
|
1
|
1
|
—
|
—
|
$40,302.54
|
$40,302.54
|
$40,302.54
|
2026-04-01
|
|
27446
|
CPT
|
Hc Knee Arthroplasty Condyle/plateau Medial Or Lateral Comptmnt
|
38
|
14
|
$52,870.37
|
$26,435.18
50% off
|
$1,058.00
|
$95,167.00
|
$40,287.00
|
2024-12-15
|
|
981
|
MS_DRG
|
Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc
|
20
|
12
|
$0.01
|
—
|
$22,461.00
|
$81,041.46
|
$40,120.00
|
2026-04-01
|
|
329
|
MS_DRG
|
Major Small And Large Bowel Procedures With Mcc
|
21
|
12
|
$0.01
|
—
|
$22,655.00
|
$79,395.34
|
$40,116.00
|
2026-04-01
|
|
163
|
MS_DRG
|
Major Chest Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$17,281.00
|
$77,414.13
|
$40,013.07
|
2026-04-01
|
|
221
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
20
|
12
|
$0.01
|
—
|
$22,500.00
|
$87,059.37
|
$39,906.68
|
2026-04-01
|
|
C2621
|
HCPCS
|
Pacemaker Consulta Bip Is1 Av 15ml 26gm
|
406
|
14
|
$54,516.00
|
$27,258.00
50% off
|
$7,733.00
|
$102,090.00
|
$39,851.00
|
2024-12-15
|
|
823
|
MS_DRG
|
Lymphoma And Non-acute Leukemia With Other Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$19,755.00
|
$79,193.25
|
$39,630.78
|
2026-04-01
|
|
C1817
|
HCPCS
|
Occluder Sept Amplatzer Cvd Dbl Disc 45deg 4mm 6fr
|
153
|
14
|
$58,070.16
|
$29,035.08
50% off
|
$8,116.00
|
$73,597.00
|
$39,443.00
|
2024-12-15
|
|
323
|
MS_DRG
|
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc
|
20
|
12
|
$0.01
|
—
|
$20,026.00
|
$74,747.18
|
$38,435.06
|
2026-04-01
|
|
C1875
|
HCPCS
|
Stent G-armor Cov 5.2cm Lgth 10 Zig
|
226
|
15
|
$51,302.03
|
$25,651.02
50% off
|
$9,665.00
|
$63,616.00
|
$38,403.50
|
2026-04-01
|
|
59676-565-01
|
NDC
|
Darunavir 100 Mg/ml Po Susp Bulk
|
25
|
14
|
$66,064.35
|
$33,032.18
50% off
|
$17,177.00
|
$59,458.00
|
$38,317.50
|
2024-12-15
|
|
856
|
MS_DRG
|
Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$20,451.00
|
$78,569.70
|
$38,200.96
|
2026-04-01
|
|
451
|
MS_DRG
|
Single Level Spinal Fusion Except Cervical Without Mcc
|
19
|
11
|
$0.01
|
—
|
$21,939.96
|
$55,798.70
|
$38,087.00
|
2026-04-01
|
|
474
|
MS_DRG
|
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc
|
20
|
12
|
$0.01
|
—
|
$19,794.00
|
$74,258.00
|
$37,888.00
|
2026-04-01
|
|
25
|
MS_DRG
|
Craniotomy And Endovascular Intracranial Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$21,263.00
|
$78,535.15
|
$37,786.00
|
2026-04-01
|
|
33263
|
CPT
|
Hc Rmvl Impltbl Dfb Plse Gen W/rplcmt Plse Gen 2 Ld
|
41
|
14
|
$76,768.82
|
$38,384.41
50% off
|
$1,623.00
|
$69,092.00
|
$37,536.00
|
2024-12-15
|
|
901
|
MS_DRG
|
Wound Debridements For Injuries With Mcc
|
20
|
12
|
$0.01
|
—
|
$18,982.00
|
$73,360.00
|
$37,439.00
|
2026-04-01
|
|
0915T
|
OTHER
|
Insj Perm Ccm-d Sys Pg&eltrd
|
4
|
4
|
—
|
—
|
$21,140.00
|
$50,179.48
|
$37,339.43
|
2026-04-01
|
|
L5856
|
HCPCS
|
Elec Knee-shin Swing/stance
|
4
|
4
|
—
|
—
|
$25,277.30
|
$49,993.29
|
$37,200.89
|
2026-04-01
|
|
458
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
20
|
12
|
$0.01
|
—
|
$20,838.00
|
$72,073.32
|
$37,191.51
|
2026-04-01
|
|
236
|
MS_DRG
|
Coronary Bypass Without Cardiac Catheterization Without Mcc
|
20
|
12
|
$0.01
|
—
|
$19,562.00
|
$72,353.14
|
$37,158.85
|
2026-04-01
|
|
319
|
MS_DRG
|
Other Endovascular Cardiac Valve Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$21,108.00
|
$77,087.67
|
$37,127.00
|
2026-04-01
|
|
27428
|
CPT
|
Hc Ligament Reconst Knee, Intra-artic (open)
|
38
|
14
|
$48,659.87
|
$24,329.94
50% off
|
$1,058.00
|
$87,588.00
|
$37,079.00
|
2024-12-15
|
|
0908T
|
OTHER
|
Opn Imp Int Nstm Sys Vgs Nrv
|
4
|
4
|
—
|
—
|
$5,562.00
|
$49,330.34
|
$36,707.58
|
2026-04-01
|
|
0909T
|
OTHER
|
Rplcmt Int Nstim Sys Vgs Nrv
|
4
|
4
|
—
|
—
|
$5,562.00
|
$49,330.34
|
$36,707.58
|
2026-04-01
|
|
J1324
|
HCPCS
|
Enfuvirtide 90 Mg Sc Solr
|
25
|
14
|
$63,146.42
|
$31,573.21
50% off
|
$16,418.00
|
$56,832.00
|
$36,625.00
|
2024-12-15
|
|
933
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft
|
20
|
12
|
$0.01
|
—
|
$11,791.00
|
$71,645.00
|
$36,580.00
|
2026-04-01
|
|
54092-252-90
|
NDC
|
Lanthanum Carbonate 500 Mg Po Chew
|
25
|
14
|
$62,957.87
|
$31,478.94
50% off
|
$16,369.00
|
$56,662.00
|
$36,515.50
|
2024-12-15
|
|
54092-252-45
|
NDC
|
Lanthanum Carbonate 500 Mg Po Chew
|
25
|
14
|
$62,957.87
|
$31,478.94
50% off
|
$16,369.00
|
$56,662.00
|
$36,515.50
|
2024-12-15
|
|
Q0479
|
HCPCS
|
Module Pwr Heartmate Ii Cntrlr Tethered Operation
|
27
|
14
|
$65,318.40
|
$32,659.20
50% off
|
$9,900.00
|
$65,318.00
|
$36,429.00
|
2024-12-15
|
|
33880
|
CPT
|
Hc Endovasc Taa Repr Incl Subcl
|
20
|
11
|
$48,174.49
|
$24,087.24
50% off
|
$1,533.00
|
$43,357.00
|
$36,420.00
|
2024-12-15
|
|
54092-191-12
|
NDC
|
Mesalamine ER 500 Mg Po Cpcr
|
25
|
14
|
$62,289.39
|
$31,144.70
50% off
|
$16,195.00
|
$56,060.00
|
$36,127.50
|
2024-12-15
|
|
356
|
MS_DRG
|
Other Digestive System O.r. Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$19,330.00
|
$75,876.83
|
$36,073.00
|
2026-04-01
|
|
33477
|
CPT
|
Hc Cath Tcat Pulmonary Valve Implantation Prq Approach
|
17
|
10
|
$47,291.51
|
$23,645.76
50% off
|
$1,623.00
|
$42,562.00
|
$36,036.00
|
2024-12-15
|
|
0483T
|
CPT
|
Hc Cath Tmvi W/prosthetic Valve Percutaneous Approach
|
22
|
13
|
$49,127.40
|
$24,563.70
50% off
|
$140.00
|
$44,215.00
|
$36,010.50
|
2024-12-15
|
|
956
|
MS_DRG
|
Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma
|
20
|
12
|
$0.01
|
—
|
$15,464.00
|
$64,998.30
|
$35,885.79
|
2026-04-01
|
|
140
|
MS_DRG
|
Major Head And Neck Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$16,585.00
|
$73,674.53
|
$35,770.00
|
2026-04-01
|
|
31
|
MS_DRG
|
Ventricular Shunt Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$19,021.00
|
$77,391.68
|
$35,450.00
|
2026-04-01
|
|
50474-598-66
|
NDC
|
Levetiracetam ER 500 Mg Po Tb24
|
25
|
14
|
$61,109.72
|
$30,554.86
50% off
|
$15,889.00
|
$54,999.00
|
$35,444.00
|
2024-12-15
|
|
673
|
MS_DRG
|
Other Kidney And Urinary Tract Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$17,320.00
|
$72,574.24
|
$35,442.00
|
2026-04-01
|
|
269
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc
|
20
|
12
|
$0.01
|
—
|
$20,142.00
|
$72,947.33
|
$35,315.12
|
2026-04-01
|
|
793
|
MS_DRG
|
Full Term Neonate With Major Problems
|
20
|
12
|
$0.01
|
—
|
$4,021.00
|
$72,021.50
|
$35,284.00
|
2026-04-01
|
|
460
|
MS_DRG
|
Spinal Fusion Except Cervical Without Mcc
|
1
|
1
|
—
|
—
|
$35,265.52
|
$35,265.52
|
$35,265.52
|
2026-04-01
|
|
0408T
|
CPT
|
Hc Ins/repl Ccm System, Pulse Gen With Tv Electrodes
|
22
|
13
|
$46,579.28
|
$23,289.64
50% off
|
$1,758.00
|
$46,169.00
|
$35,213.50
|
2024-12-15
|
|
25609
|
CPT
|
Hc Open Rx Distal Radius Fx, Intra-articular, 3+ Frag
|
39
|
14
|
$46,177.30
|
$23,088.65
50% off
|
$2,378.00
|
$83,119.00
|
$35,187.00
|
2024-12-15
|
|
Q0495
|
HCPCS
|
Charger Batt Heartmate Univ
|
45
|
14
|
$58,786.56
|
$29,393.28
50% off
|
$4,900.00
|
$58,787.00
|
$35,140.00
|
2024-12-15
|
|
27870
|
CPT
|
Hc Asc Ankle Arthrodesis Open 27870
|
38
|
14
|
$46,090.31
|
$23,045.16
50% off
|
$1,368.00
|
$82,963.00
|
$35,121.00
|
2024-12-15
|
|
Q5111
|
HCPCS
|
Pegfilgrastim-cbqv 6 Mg/0.6ml Sc Soaj
|
42
|
16
|
$66,398.25
|
$33,199.12
50% off
|
$106.33
|
$59,758.00
|
$35,022.00
|
2026-04-01
|
|
958
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Cc
|
20
|
12
|
$0.01
|
—
|
$16,121.00
|
$72,786.69
|
$34,781.00
|
2026-04-01
|
|
12
|
MS_DRG
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc
|
20
|
12
|
$0.01
|
—
|
$15,773.00
|
$72,822.97
|
$34,730.00
|
2026-04-01
|
|
37230
|
CPT
|
Hc Revascularize Tibial/peron Artery,angioplasty/stent Initial
|
38
|
14
|
$45,503.02
|
$22,751.51
50% off
|
$1,623.00
|
$81,905.00
|
$34,673.00
|
2024-12-15
|
|
33995
|
CPT
|
Hc Insert Perq Vad R Hrt Venous
|
17
|
10
|
$45,405.18
|
$22,702.59
50% off
|
$1,623.00
|
$40,865.00
|
$34,599.00
|
2024-12-15
|
|
423
|
MS_DRG
|
Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$15,039.00
|
$71,734.77
|
$34,429.00
|
2026-04-01
|
|
54092-254-90
|
NDC
|
Lanthanum Carbonate 1000 Mg Po Chew
|
25
|
14
|
$59,222.24
|
$29,611.12
50% off
|
$15,398.00
|
$53,300.00
|
$34,349.00
|
2024-12-15
|
|
54092-253-90
|
NDC
|
Lanthanum Carbonate 750 Mg Po Chew
|
25
|
14
|
$59,222.24
|
$29,611.12
50% off
|
$15,398.00
|
$53,300.00
|
$34,349.00
|
2024-12-15
|
|
29888
|
CPT
|
Hc Knee Scope,aid Ant Cruciate Repair
|
39
|
14
|
$44,941.54
|
$22,470.77
50% off
|
$68.00
|
$80,895.00
|
$34,245.00
|
2024-12-15
|
|
0009-7667-01
|
NDC
|
Clindamycin Phosphate 100 Mg Va Supp
|
25
|
14
|
$58,996.14
|
$29,498.07
50% off
|
$15,339.00
|
$53,097.00
|
$34,218.00
|
2024-12-15
|
|
736
|
MS_DRG
|
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc
|
20
|
12
|
$0.01
|
—
|
$17,049.00
|
$65,199.00
|
$34,166.81
|
2026-04-01
|
|
651
|
MS_DRG
|
Kidney Transplant With Hemodialysis Without Mcc
|
20
|
12
|
$0.01
|
—
|
$16,199.00
|
$64,010.28
|
$33,962.58
|
2026-04-01
|
|
25607
|
CPT
|
Hc Open Rx Distal Radius Fx, Extra-articular
|
38
|
14
|
$44,392.55
|
$22,196.28
50% off
|
$68.00
|
$79,907.00
|
$33,827.00
|
2024-12-15
|
|
907
|
MS_DRG
|
Other O.r. Procedures For Injuries With Mcc
|
20
|
12
|
$0.01
|
—
|
$16,315.00
|
$66,316.23
|
$33,735.00
|
2026-04-01
|
|
739
|
MS_DRG
|
Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc…
|
20
|
12
|
$0.01
|
—
|
$15,889.00
|
$65,916.00
|
$33,712.00
|
2026-04-01
|
|
37215
|
CPT
|
Hc Tcat IV Stent Crv Crtd Art Embolic Protecj
|
33
|
11
|
$40,299.75
|
$20,149.88
50% off
|
$208.00
|
$72,540.00
|
$33,449.00
|
2024-12-15
|
|
628
|
MS_DRG
|
Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$13,028.00
|
$65,333.00
|
$33,420.00
|
2026-04-01
|
|
876
|
MS_DRG
|
O.r. Procedures With Principal Diagnosis Of Mental Illness
|
20
|
12
|
$0.01
|
—
|
$16,392.00
|
$66,758.42
|
$33,287.00
|
2026-04-01
|
|
273
|
MS_DRG
|
Percutaneous And Other Intracardiac Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$18,866.00
|
$71,259.76
|
$33,127.00
|
2026-04-01
|
|
33230
|
CPT
|
Hc Ep Insj Implntbl Defib Pulse Gen W/exist Dual Leads
|
25
|
14
|
$73,431.05
|
$36,715.52
50% off
|
$1,623.00
|
$66,088.00
|
$33,079.00
|
2024-12-15
|
|
34
|
MS_DRG
|
Carotid Artery Stent Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$18,016.00
|
$66,858.60
|
$32,948.00
|
2026-04-01
|
|
A9560
|
HCPCS
|
Technetium-99 (tc-99) Labeled Red Blood Cells (ultratag) Radio-isotope Injection
|
22
|
13
|
$44,934.70
|
$22,467.35
50% off
|
$186.00
|
$40,441.00
|
$32,937.00
|
2024-12-15
|
|
37227
|
CPT
|
Hc Revascularize Fem/pop Artery,angioplasty/stent/atherectomy
|
38
|
14
|
$43,206.82
|
$21,603.41
50% off
|
$1,623.00
|
$77,772.00
|
$32,924.00
|
2024-12-15
|
|
616
|
MS_DRG
|
Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…
|
20
|
12
|
$0.01
|
—
|
$12,835.00
|
$63,997.00
|
$32,752.00
|
2026-04-01
|
|
904
|
MS_DRG
|
Skin Grafts For Injuries With Cc/Mcc
|
20
|
12
|
$0.01
|
—
|
$14,304.00
|
$63,932.00
|
$32,719.00
|
2026-04-01
|
|
166
|
MS_DRG
|
Other Respiratory System O.r. Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$14,884.00
|
$64,561.29
|
$32,630.00
|
2026-04-01
|
|
0085-1328-01
|
NDC
|
Posaconazole 40 Mg/ml Po Susp Bulk
|
25
|
14
|
$56,226.98
|
$28,113.49
50% off
|
$14,619.00
|
$50,604.00
|
$32,611.50
|
2024-12-15
|
|
J0571
|
HCPCS
|
Buprenorphine Hcl 300 Mcg Bu Film
|
25
|
14
|
$56,121.38
|
$28,060.69
50% off
|
$14,592.00
|
$50,509.00
|
$32,550.50
|
2024-12-15
|
|
63304-089-13
|
NDC
|
Mesalamine ER 500 Mg Po Cpcr
|
25
|
14
|
$56,076.44
|
$28,038.22
50% off
|
$14,580.00
|
$50,469.00
|
$32,524.50
|
2024-12-15
|
|
C2622
|
HCPCS
|
Prosthesis Penile Genisis Kt Semi Rgd Malle 9.5x23
|
64
|
14
|
$58,155.12
|
$29,077.56
50% off
|
$2,548.00
|
$68,792.00
|
$32,421.50
|
2024-12-15
|
|
24
|
MS_DRG
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
20
|
12
|
$0.01
|
—
|
$17,513.00
|
$67,570.25
|
$32,283.22
|
2026-04-01
|
|
0960T
|
OTHER
|
Rpl S-sclp Eltr Ra Rcvr&tlmt
|
4
|
4
|
—
|
—
|
$21,140.00
|
$43,377.52
|
$32,277.98
|
2026-04-01
|
|
0956T
|
OTHER
|
Prt Crn Ch Cr&tun Elt S-sclp
|
4
|
4
|
—
|
—
|
$21,140.00
|
$43,377.52
|
$32,277.98
|
2026-04-01
|
|
33262
|
CPT
|
Hc Rmvl Impltbl Dfb Plse Gen W/repl Plse Gen 1 Lead
|
40
|
14
|
$84,270.87
|
$42,135.44
50% off
|
$1,623.00
|
$75,844.00
|
$32,174.00
|
2024-12-15
|
|
335
|
MS_DRG
|
Peritoneal Adhesiolysis With Mcc
|
21
|
12
|
$0.01
|
—
|
$16,160.00
|
$61,680.16
|
$32,130.07
|
2026-04-01
|
|
22
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…
|
20
|
12
|
$0.01
|
—
|
$18,132.00
|
$58,456.00
|
$32,037.20
|
2026-04-01
|
|
28725
|
CPT
|
Hc Fusion Foot Bones,subtalar
|
38
|
14
|
$42,009.16
|
$21,004.58
50% off
|
$68.00
|
$75,616.00
|
$32,011.00
|
2024-12-15
|
|
27827
|
CPT
|
Hc Open Treatment Fracture Distal Tibia Only
|
39
|
14
|
$42,009.16
|
$21,004.58
50% off
|
$1,435.00
|
$75,616.00
|
$32,011.00
|
2024-12-15
|
|
40
|
MS_DRG
|
Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc
|
20
|
12
|
$0.01
|
—
|
$17,784.00
|
$66,694.51
|
$31,981.00
|
2026-04-01
|
|
13811-715-30
|
NDC
|
Venlafaxine Hcl ER 225 Mg Po Tb24
|
25
|
14
|
$55,014.17
|
$27,507.08
50% off
|
$14,304.00
|
$49,513.00
|
$31,908.50
|
2024-12-15
|
|
622
|
MS_DRG
|
Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor…
|
20
|
12
|
$0.01
|
—
|
$12,410.00
|
$61,960.00
|
$31,732.00
|
2026-04-01
|
|
318
|
MS_DRG
|
Percutaneous Coronary Atherectomy Without Intraluminal Device
|
9
|
5
|
—
|
—
|
$16,450.90
|
$41,838.66
|
$31,687.22
|
2026-04-01
|
|
332
|
MS_DRG
|
Rectal Resection With Mcc
|
20
|
12
|
$0.01
|
—
|
$16,508.00
|
$62,540.35
|
$31,660.67
|
2026-04-01
|
|
360
|
MS_DRG
|
Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc
|
9
|
5
|
—
|
—
|
$16,397.24
|
$41,702.20
|
$31,583.87
|
2026-04-01
|
|
242
|
MS_DRG
|
Permanent Cardiac Pacemaker Implant With Mcc
|
20
|
12
|
$0.01
|
—
|
$16,701.00
|
$56,165.00
|
$31,546.33
|
2026-04-01
|
|
64980-282-03
|
NDC
|
Mesalamine 1000 Mg Re Supp
|
25
|
14
|
$54,125.21
|
$27,062.60
50% off
|
$14,073.00
|
$48,713.00
|
$31,393.00
|
2024-12-15
|
|
59762-0118-3
|
NDC
|
Mesalamine 1000 Mg Re Supp
|
25
|
14
|
$54,125.21
|
$27,062.60
50% off
|
$14,073.00
|
$48,713.00
|
$31,393.00
|
2024-12-15
|
|
33361
|
CPT
|
Hc Replace Aortic Valve Perq Femoral Artry Approach
|
31
|
10
|
$62,489.49
|
$31,244.74
50% off
|
$1,623.00
|
$56,241.00
|
$31,151.00
|
2024-12-15
|
|
94
|
MS_DRG
|
Bacterial And Tuberculous Infections Of Nervous System With Mcc
|
20
|
12
|
$0.01
|
—
|
$22,848.00
|
$60,790.60
|
$30,959.00
|
2026-04-01
|
|
97
|
MS_DRG
|
Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc
|
20
|
12
|
$0.01
|
—
|
$22,964.00
|
$62,386.62
|
$30,650.06
|
2026-04-01
|
|
J9600
|
HCPCS
|
Porfimer Sodium Injection
|
4
|
4
|
—
|
—
|
$24,228.42
|
$41,188.31
|
$30,648.95
|
2026-04-01
|
|
68180-354-07
|
NDC
|
Ranolazine ER 500 Mg Po Tb12
|
25
|
14
|
$52,829.52
|
$26,414.76
50% off
|
$13,736.00
|
$47,547.00
|
$30,641.50
|
2024-12-15
|
|
28415
|
CPT
|
Hc Open Treatment Calcaneal Fracture
|
38
|
14
|
$40,164.60
|
$20,082.30
50% off
|
$68.00
|
$72,296.00
|
$30,605.00
|
2024-12-15
|
|
63664
|
CPT
|
Hc Revision Spinal Neurostim Electrode Plate/paddle Inc Fluoro
|
22
|
13
|
$41,673.08
|
$20,836.54
50% off
|
$1,058.00
|
$37,506.00
|
$30,546.50
|
2024-12-15
|
|
Q0138
|
HCPCS
|
Ferumoxytol 510 Mg/17ml IV Soln
|
25
|
16
|
$84,832.31
|
$42,416.15
50% off
|
$0.32
|
$76,349.00
|
$30,455.00
|
2026-04-01
|
|
802
|
MS_DRG
|
Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc
|
20
|
12
|
$0.01
|
—
|
$15,039.00
|
$68,817.36
|
$30,429.00
|
2026-04-01
|
|
518
|
MS_DRG
|
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost…
|
20
|
12
|
$0.01
|
—
|
$16,817.00
|
$64,554.38
|
$30,422.00
|
2026-04-01
|
|
652
|
MS_DRG
|
Kidney Transplant
|
20
|
12
|
$0.01
|
—
|
$14,072.00
|
$55,783.15
|
$30,414.24
|
2026-04-01
|
|
55111-284-48
|
NDC
|
Fluoxetine Hcl 90 Mg Po Cpdr
|
25
|
14
|
$52,355.85
|
$26,177.93
50% off
|
$13,613.00
|
$47,120.00
|
$30,366.50
|
2024-12-15
|
|
265
|
MS_DRG
|
Aicd Lead Procedures
|
20
|
12
|
$0.01
|
—
|
$17,088.00
|
$62,497.17
|
$30,283.00
|
2026-04-01
|