|
J0485
|
OTHER
|
Injection; Belatacept; 1 Mg
|
1
|
1
|
$6,595.20
|
$3,957.12
40% off
|
$5,368.49
|
$5,368.49
|
$5,368.49
|
2026-05-13
|
|
73223
|
OTHER
|
MRI Joint Upr Extr W/O&with Contrast
|
2
|
2
|
$4,757.00
|
$2,854.20
40% off
|
$2,521.21
|
$4,757.00
|
$3,639.11
|
2026-05-13
|
|
73720
|
OTHER
|
MRI Lwr Extremity W/O&with Contrast
|
2
|
2
|
$4,757.00
|
$2,854.20
40% off
|
$1,558.14
|
$4,757.00
|
$3,157.57
|
2026-05-13
|
|
47562
|
OTHER
|
Laparoscopic Cholecystectomy
|
30
|
29
|
$4,525.00
|
$2,715.00
40% off
|
$4,696.65
|
$4,696.65
|
$4,696.65
|
2026-05-13
|
|
27130
|
OTHER
|
Total Hip Arthroplasty
|
30
|
29
|
$3,734.00
|
$2,240.40
40% off
|
$10,712.91
|
$10,712.91
|
$10,712.91
|
2026-05-13
|
|
27447
|
OTHER
|
Total Knee Arthroplasty
|
30
|
29
|
$3,730.00
|
$2,238.00
40% off
|
$10,712.91
|
$10,712.91
|
$10,712.91
|
2026-05-13
|
|
44180
|
OTHER
|
Lap Enterolysis
|
30
|
29
|
$3,666.00
|
$2,199.60
40% off
|
$4,696.65
|
$4,696.65
|
$4,696.65
|
2026-05-13
|
|
73206
|
OTHER
|
CT Scan Of Blood Vessels Of Arm With Contrast
|
1
|
1
|
$3,410.00
|
$2,046.00
40% off
|
$3,410.00
|
$3,410.00
|
$3,410.00
|
2026-05-13
|
|
25607
|
OTHER
|
Optx Dst Rd Xartc Fx/epi Sep
|
30
|
29
|
$3,404.85
|
$2,042.91
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
27428
|
OTHER
|
Reconstruction Knee
|
30
|
29
|
$3,237.00
|
$1,942.20
40% off
|
$10,712.91
|
$10,712.91
|
$10,712.91
|
2026-05-13
|
|
23460
|
OTHER
|
Repair Shoulder Capsule
|
30
|
29
|
$3,167.00
|
$1,900.20
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
29827
|
OTHER
|
Sho Arthrs Srg Rt8tr Cuf Rpr
|
30
|
29
|
$3,104.00
|
$1,862.40
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
29806
|
OTHER
|
Sho Arthrs Srg Capsulorraphy
|
30
|
29
|
$3,068.00
|
$1,840.80
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
29807
|
OTHER
|
Sho Arthrs Srg Rpr Slap Les
|
30
|
29
|
$2,999.00
|
$1,799.40
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
25609
|
OTHER
|
Optx Dst Rd Xart Fx/ep Sep3+
|
30
|
29
|
$2,977.00
|
$1,786.20
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
27870
|
OTHER
|
Fusion Of Ankle Joint Open
|
30
|
29
|
$2,938.00
|
$1,762.80
40% off
|
$10,712.91
|
$10,712.91
|
$10,712.91
|
2026-05-13
|
|
29856
|
OTHER
|
Tibial Arthroscopy/surgery
|
30
|
29
|
$2,881.00
|
$1,728.60
40% off
|
$10,712.91
|
$10,712.91
|
$10,712.91
|
2026-05-13
|
|
23455
|
OTHER
|
Repair Shoulder Capsule
|
30
|
29
|
$2,876.00
|
$1,725.60
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
25320
|
OTHER
|
Repair/revise Wrist Joint
|
30
|
29
|
$2,856.00
|
$1,713.60
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
23420
|
OTHER
|
Repair Of Shoulder
|
30
|
29
|
$2,826.00
|
$1,695.60
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
23515
|
OTHER
|
Optx Clavicular Fx W/int Fix
|
30
|
29
|
$2,790.00
|
$1,674.00
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
25526
|
OTHER
|
Optx Rdl Shft Fx&dstl Rad/ul
|
30
|
29
|
$2,776.00
|
$1,665.60
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
27386
|
OTHER
|
Repair/graft Of Thigh Muscle
|
30
|
29
|
$2,748.00
|
$1,648.80
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
27654
|
OTHER
|
Repair Of Achilles Tendon
|
30
|
29
|
$2,739.00
|
$1,643.40
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
29888
|
OTHER
|
Knee Arthroscopy/surgery
|
30
|
29
|
$2,698.00
|
$1,618.80
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
29828
|
OTHER
|
Sho Arthrs Srg Bicp Tenodsis
|
30
|
29
|
$2,659.00
|
$1,595.40
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
29905
|
OTHER
|
Subtalar Arthro W/exc
|
30
|
29
|
$2,637.00
|
$1,582.20
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
27235
|
OTHER
|
Treat Thigh Fracture
|
30
|
29
|
$2,631.00
|
$1,578.60
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
28309
|
OTHER
|
Incision Of Metatarsals
|
30
|
29
|
$2,621.00
|
$1,572.60
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
47563
|
OTHER
|
Laparo Cholecystectomy/graph
|
30
|
29
|
$2,593.00
|
$1,555.80
40% off
|
$4,696.65
|
$4,696.65
|
$4,696.65
|
2026-05-13
|
|
65820
|
OTHER
|
Goniotomy
|
30
|
29
|
$2,552.00
|
$1,531.20
40% off
|
$3,309.51
|
$3,309.51
|
$3,309.51
|
2026-05-13
|
|
25810
|
OTHER
|
Arthrd Wrst Iliac/oth Agrft
|
30
|
29
|
$2,517.00
|
$1,510.20
40% off
|
$10,712.91
|
$10,712.91
|
$10,712.91
|
2026-05-13
|
|
23412
|
OTHER
|
Repair Rotator Cuff Chronic
|
30
|
29
|
$2,475.00
|
$1,485.00
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
27826
|
OTHER
|
Treat Lower Leg Fracture
|
30
|
29
|
$2,470.00
|
$1,482.00
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
25805
|
OTHER
|
Arthrd Wrist W/sliding Graft
|
30
|
29
|
$2,464.00
|
$1,478.40
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
25608
|
OTHER
|
Optx Dst Rd Xart Fx/epi Sep2
|
30
|
29
|
$2,461.00
|
$1,476.60
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
28750
|
OTHER
|
Fusion Of Big Toe Joint
|
30
|
29
|
$2,413.00
|
$1,447.80
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
24400
|
OTHER
|
Revision Of Humerus
|
30
|
29
|
$2,404.00
|
$1,442.40
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
28615
|
OTHER
|
Repair Foot Dislocation
|
30
|
29
|
$2,384.00
|
$1,430.40
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
23410
|
OTHER
|
Repair Rotator Cuff Acute
|
30
|
29
|
$2,382.00
|
$1,429.20
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
25525
|
OTHER
|
Optx Rdl Shft Fx&cltx Rad/ul
|
30
|
29
|
$2,296.00
|
$1,377.60
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
28202
|
OTHER
|
Repair/graft Of Foot Tendon
|
30
|
29
|
$2,268.00
|
$1,360.80
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
1800
|
OTHER
|
Airborne Isolation Rm Bariatri
|
14
|
14
|
$2,255.00
|
$1,353.00
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
24342
|
OTHER
|
Repair Of Ruptured Tendon
|
30
|
29
|
$2,253.00
|
$1,351.80
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
25390
|
OTHER
|
Shorten Radius Or Ulna
|
30
|
29
|
$2,236.00
|
$1,341.60
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
27814
|
OTHER
|
Treatment Of Ankle Fracture
|
30
|
29
|
$2,221.00
|
$1,332.60
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
27524
|
OTHER
|
Treat Kneecap Fracture
|
30
|
29
|
$2,189.00
|
$1,313.40
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
29887
|
OTHER
|
Knee Arthroscopy/surgery
|
30
|
29
|
$2,183.00
|
$1,309.80
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
29892
|
OTHER
|
Ankle Arthroscopy/surgery
|
30
|
29
|
$2,183.00
|
$1,309.80
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
27420
|
OTHER
|
Revision Of Unstable Kneecap
|
30
|
29
|
$2,169.00
|
$1,301.40
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
24341
|
OTHER
|
Rpr Tdn/musc Upr A/e Each
|
30
|
29
|
$2,162.00
|
$1,297.20
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
27422
|
OTHER
|
Revision Of Unstable Kneecap
|
30
|
29
|
$2,156.00
|
$1,293.60
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
28730
|
OTHER
|
Fusion Of Foot Bones
|
30
|
29
|
$2,112.00
|
$1,267.20
40% off
|
$10,712.91
|
$10,712.91
|
$10,712.91
|
2026-05-13
|
|
28130
|
OTHER
|
Removal Of Ankle Bone
|
30
|
29
|
$2,102.00
|
$1,261.20
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
27427
|
OTHER
|
Reconstruction Knee
|
30
|
29
|
$2,064.00
|
$1,238.40
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
1700
|
OTHER
|
Airborne Isolation Rm Level 2
|
14
|
14
|
$1,973.00
|
$1,183.80
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
49650
|
OTHER
|
Lap Ing Hernia Repair Init
|
30
|
29
|
$1,967.00
|
$1,180.20
40% off
|
$4,696.65
|
$4,696.65
|
$4,696.65
|
2026-05-13
|
|
27405
|
OTHER
|
Repair Of Knee Ligament
|
30
|
29
|
$1,963.00
|
$1,177.80
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
25515
|
OTHER
|
Optx Radial Shaft Fracture
|
30
|
29
|
$1,945.00
|
$1,167.00
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
38525
|
OTHER
|
Biopsy/removal Lymph Nodes
|
30
|
29
|
$1,941.00
|
$1,164.60
40% off
|
$3,102.68
|
$3,102.68
|
$3,102.68
|
2026-05-13
|
|
27652
|
OTHER
|
Repair/graft Achilles Tendon
|
30
|
29
|
$1,937.00
|
$1,162.20
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
27650
|
OTHER
|
Repair Achilles Tendon
|
30
|
29
|
$1,907.00
|
$1,144.20
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
25360
|
OTHER
|
Revision Of Ulna
|
30
|
29
|
$1,906.00
|
$1,143.60
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
1600
|
OTHER
|
Airborne Isolation Rm Level 1
|
14
|
14
|
$1,879.00
|
$1,127.40
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
27792
|
OTHER
|
Treatment Of Ankle Fracture
|
30
|
29
|
$1,873.00
|
$1,123.80
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
26531
|
OTHER
|
Revise Knuckle With Implant
|
30
|
29
|
$1,833.00
|
$1,099.80
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
19120
|
OTHER
|
Removal Of Breast Lesion
|
30
|
29
|
$1,826.00
|
$1,095.60
40% off
|
$3,102.68
|
$3,102.68
|
$3,102.68
|
2026-05-13
|
|
27698
|
OTHER
|
Repair Of Ankle Ligament
|
30
|
29
|
$1,818.25
|
$1,090.95
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
27385
|
OTHER
|
Repair Of Thigh Muscle
|
30
|
29
|
$1,749.00
|
$1,049.40
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
24340
|
OTHER
|
Tenodesis Biceps Tdn At Elbw
|
30
|
29
|
$1,746.00
|
$1,047.60
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
28291
|
OTHER
|
Corrj Halux Rigdus W/implt
|
30
|
29
|
$1,730.00
|
$1,038.00
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
28103
|
OTHER
|
Remove/graft Foot Lesion
|
30
|
29
|
$1,689.00
|
$1,013.40
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
28485
|
OTHER
|
Treat Metatarsal Fracture
|
30
|
29
|
$1,650.00
|
$990.00
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
1500
|
OTHER
|
Pediatric Room-level 2
|
14
|
14
|
$1,580.00
|
$948.00
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
29820
|
OTHER
|
Sho Arthrs Srg Prtl Synvct
|
30
|
29
|
$1,549.00
|
$929.40
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
1400
|
OTHER
|
Pediatric Room-level 1
|
14
|
14
|
$1,418.00
|
$850.80
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
27695
|
OTHER
|
Repair Of Ankle Ligament
|
30
|
29
|
$1,404.00
|
$842.40
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
49592
|
OTHER
|
Rpr Aa Hrn 1st < 3 Ncr/strn
|
30
|
29
|
$1,298.75
|
$779.25
40% off
|
$4,696.65
|
$4,696.65
|
$4,696.65
|
2026-05-13
|
|
1100
|
OTHER
|
Swingbed Baria Level 2
|
14
|
14
|
$1,277.00
|
$766.20
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
28070
|
OTHER
|
Removal Of Foot Joint Lining
|
30
|
29
|
$1,257.00
|
$754.20
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
49320
|
OTHER
|
Diag Laparo Separate Proc
|
30
|
29
|
$1,125.00
|
$675.00
40% off
|
$4,696.65
|
$4,696.65
|
$4,696.65
|
2026-05-13
|
|
1000
|
OTHER
|
Swingbed Baria-level 1
|
14
|
14
|
$1,117.00
|
$670.20
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
28456
|
OTHER
|
Treat Midfoot Fracture
|
30
|
29
|
$1,079.00
|
$647.40
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
1300
|
OTHER
|
Swingbed Private Level 2
|
14
|
14
|
$897.00
|
$538.20
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
1200
|
OTHER
|
Swingbed Private Level 1
|
14
|
14
|
$736.00
|
$441.60
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
28531
|
OTHER
|
Treat Sesamoid Bone Fracture
|
30
|
29
|
$735.00
|
$441.00
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
26841
|
OTHER
|
Fusion Of Thumb
|
30
|
29
|
$719.15
|
$431.49
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
24685
|
OTHER
|
Treat Ulnar Fracture
|
30
|
29
|
$632.00
|
$379.20
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
08065183905
|
OTHER
|
Viscoat
|
14
|
14
|
$594.85
|
$356.91
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
27766
|
OTHER
|
Optx Medial Ankle Fx
|
27
|
26
|
$558.20
|
$334.92
40% off
|
$5,823.26
|
$5,823.26
|
$5,823.26
|
2026-05-13
|
|
06466
|
OTHER
|
Phenyl-cyclo-trop-keto Ophth 1
|
14
|
14
|
$537.00
|
$322.20
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
10019064164
|
OTHER
|
Suprane
|
14
|
14
|
$480.70
|
$288.42
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00006542312
|
OTHER
|
Bridion
|
14
|
14
|
$408.45
|
$245.07
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
10122031401A
|
OTHER
|
Cardene IV
|
14
|
14
|
$365.95
|
$219.57
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00998020615
|
OTHER
|
Isopto Carpine
|
14
|
14
|
$299.20
|
$179.52
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00131181067
|
OTHER
|
Vimpat
|
14
|
14
|
$297.25
|
$178.35
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00019-1323-90
|
OTHER
|
Optiray 320
|
14
|
14
|
$225.00
|
$135.00
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00002-8215-01
|
OTHER
|
HumuLIN R
|
14
|
14
|
$152.00
|
$91.20
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
17478020605A
|
OTHER
|
Phenylephrine HCl
|
14
|
14
|
$120.00
|
$72.00
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
04071-4131-00
|
OTHER
|
Low Osmolar Contrast Material; 300-399 Mg/ml Iodine Concentration; Per Ml
|
14
|
14
|
$120.00
|
$72.00
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
05017
|
OTHER
|
Gelatin Sponge,absorb/porcine
|
14
|
14
|
$82.30
|
$49.38
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
06611
|
OTHER
|
Ketamine 50 Mg/5 Ml-0.9% Nacl
|
14
|
14
|
$56.80
|
$34.08
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
06609
|
OTHER
|
Mko (midaz-keta-ond) 3-25-2 Mg
|
14
|
14
|
$55.45
|
$33.27
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
10019012001
|
OTHER
|
Esmolol HCl
|
14
|
14
|
$36.50
|
$21.90
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
10119002003B
|
OTHER
|
Advanced Eye Relief Dry Eye
|
14
|
14
|
$33.90
|
$20.34
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00641601501A
|
OTHER
|
dilTIAZem HCl
|
14
|
14
|
$32.80
|
$19.68
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-7470-66
|
OTHER
|
Sucralfate
|
14
|
14
|
$32.60
|
$19.56
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-7269-66
|
OTHER
|
Sucralfate
|
14
|
14
|
$32.58
|
$19.55
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
02687
|
OTHER
|
Sodium Bicarb 8.4% Syringe 50m
|
14
|
14
|
$32.50
|
$19.50
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
17478071710B
|
OTHER
|
Ketotifen Fumarate
|
14
|
14
|
$27.45
|
$16.47
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00003-0894-21
|
OTHER
|
Eliquis
|
14
|
14
|
$22.75
|
$13.65
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-6987-61
|
OTHER
|
Dicyclomine HCl
|
14
|
14
|
$22.00
|
$13.20
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00781-2020-01
|
OTHER
|
Amoxicillin
|
14
|
14
|
$22.00
|
$13.20
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
10223020103
|
OTHER
|
Cetacaine
|
14
|
14
|
$21.10
|
$12.66
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
17478040401
|
OTHER
|
Ful-glo
|
14
|
14
|
$20.00
|
$12.00
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
12870000101
|
OTHER
|
Silver Nitrate
|
14
|
14
|
$20.00
|
$12.00
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
17238090099
|
OTHER
|
Bio Glo
|
14
|
14
|
$20.00
|
$12.00
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00990793003A
|
OTHER
|
Dextrose
|
14
|
14
|
$20.00
|
$12.00
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00990792609A
|
OTHER
|
Dextrose-sodium Chloride
|
14
|
14
|
$20.00
|
$12.00
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00990798436D
|
OTHER
|
Sodium Chloride
|
14
|
14
|
$20.00
|
$12.00
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00990792409A
|
OTHER
|
Dextrose-sodium Chloride
|
14
|
14
|
$20.00
|
$12.00
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00536108691
|
OTHER
|
Artificial Tears
|
14
|
14
|
$20.00
|
$12.00
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
05719
|
OTHER
|
H20 For Inhalation
|
14
|
14
|
$16.00
|
$9.60
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00990-7922-02
|
OTHER
|
Dextrose
|
1
|
1
|
$15.75
|
$9.45
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00990-7983-02
|
OTHER
|
Sodium Chloride
|
14
|
14
|
$15.75
|
$9.45
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00990-7983-03
|
OTHER
|
Sodium Chloride
|
1
|
1
|
$15.75
|
$9.45
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
001390
|
OTHER
|
7250 Redicat Banana
|
14
|
14
|
$15.35
|
$9.21
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00093-3160-06
|
OTHER
|
Cefdinir
|
14
|
14
|
$13.45
|
$8.07
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00121-0759-08
|
OTHER
|
prednisoLONE Sodium Phosphate
|
14
|
14
|
$11.25
|
$6.75
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-6666-61
|
OTHER
|
Gabapentin
|
14
|
14
|
$11.00
|
$6.60
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00121-1761-30
|
OTHER
|
Mag-al Plus
|
14
|
14
|
$9.48
|
$5.69
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-7350-06
|
OTHER
|
Azithromycin
|
14
|
14
|
$8.70
|
$5.22
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-7337-35
|
OTHER
|
Cephalexin
|
14
|
14
|
$8.25
|
$4.95
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-7304-61
|
OTHER
|
Promethazine HCl
|
14
|
14
|
$8.25
|
$4.95
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-6925-61
|
OTHER
|
Sertraline HCl
|
14
|
14
|
$8.25
|
$4.95
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00121-1154-00
|
OTHER
|
Lactulose
|
14
|
14
|
$8.20
|
$4.92
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-6938-06
|
OTHER
|
Butalbital-acetaminophen-caffeine
|
14
|
14
|
$8.20
|
$4.92
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00603-1880-10
|
OTHER
|
Lidocaine
|
1
|
1
|
$7.05
|
$4.23
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-7044-61
|
OTHER
|
DULoxetine HCl
|
14
|
14
|
$6.50
|
$3.90
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-5677-61
|
OTHER
|
PARoxetine HCl
|
14
|
14
|
$5.50
|
$3.30
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-7122-61
|
OTHER
|
busPIRone HCl
|
14
|
14
|
$5.50
|
$3.30
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00121-4950-15
|
OTHER
|
Lidocaine HCl Viscous
|
14
|
14
|
$4.95
|
$2.97
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00536-1107-88
|
OTHER
|
Nicotine Transdermal System
|
14
|
14
|
$4.80
|
$2.88
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
16571-0676-21
|
OTHER
|
Hydrocortisone Acetate
|
14
|
14
|
$4.70
|
$2.82
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-7276-41
|
OTHER
|
Nystatin
|
14
|
14
|
$3.15
|
$1.89
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-6557-61
|
OTHER
|
Morphine Sulfate
|
14
|
14
|
$3.00
|
$1.80
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
17238-0900-99
|
OTHER
|
Bio Glo
|
14
|
14
|
$2.75
|
$1.65
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00121-0914-05
|
OTHER
|
Children's Ibuprofen
|
14
|
14
|
$2.75
|
$1.65
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-7401-61
|
OTHER
|
Cyclobenzaprine HCl
|
14
|
14
|
$2.75
|
$1.65
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-7383-61
|
OTHER
|
Tamsulosin HCl
|
1
|
1
|
$2.75
|
$1.65
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-7442-61
|
OTHER
|
cloNIDine HCl
|
14
|
14
|
$2.75
|
$1.65
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-7346-61
|
OTHER
|
FLUoxetine HCl
|
14
|
14
|
$2.75
|
$1.65
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00093-4148-56
|
OTHER
|
Levalbuterol
|
14
|
14
|
$2.75
|
$1.65
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00093-4148-45
|
OTHER
|
Levalbuterol
|
14
|
14
|
$2.75
|
$1.65
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-6427-61
|
OTHER
|
Escitalopram
|
14
|
14
|
$2.75
|
$1.65
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-6351-61
|
OTHER
|
levoFLOXacin
|
1
|
1
|
$2.75
|
$1.65
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-5854-61
|
OTHER
|
Ibuprofen
|
14
|
14
|
$2.75
|
$1.65
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00904-6322-06
|
OTHER
|
Metoprolol Succinate
|
14
|
14
|
$2.75
|
$1.65
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
00574-0275-00
|
OTHER
|
Potassium Chloride
|
14
|
14
|
$2.75
|
$1.65
40% off
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
784
|
OTHER
|
Cesarean Section With Sterilization With Cc
|
14
|
14
|
—
|
—
|
$3,786.00
|
$3,786.00
|
$3,786.00
|
2026-05-13
|
|
787
|
OTHER
|
Cesarean Section Without Sterilization With Cc
|
14
|
14
|
—
|
—
|
$3,786.00
|
$3,786.00
|
$3,786.00
|
2026-05-13
|
|
785
|
OTHER
|
Cesarean Section With Sterilization Without Cc/mcc
|
14
|
14
|
—
|
—
|
$3,786.00
|
$3,786.00
|
$3,786.00
|
2026-05-13
|
|
788
|
OTHER
|
Cesarean Section Without Sterilization Without Cc/mcc
|
14
|
14
|
—
|
—
|
$3,786.00
|
$3,786.00
|
$3,786.00
|
2026-05-13
|
|
783
|
OTHER
|
Cesarean Section With Sterilization With Mcc
|
14
|
14
|
—
|
—
|
$3,786.00
|
$3,786.00
|
$3,786.00
|
2026-05-13
|
|
786
|
OTHER
|
Cesarean Section Without Sterilization With Mcc
|
14
|
14
|
—
|
—
|
$3,786.00
|
$3,786.00
|
$3,786.00
|
2026-05-13
|
|
178
|
OTHER
|
Respiratory Infections & Inflammations With Complication
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
167
|
OTHER
|
Other Respiratory System O.r. Procedures With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
168
|
OTHER
|
Other Respiratory System O.r. Procedures Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
176
|
OTHER
|
Pulmonary Embolism Without Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
179
|
OTHER
|
Respiratory Infections And Inflammations Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
181
|
OTHER
|
Respiratory Neoplasms With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
173
|
OTHER
|
Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary…
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
175
|
OTHER
|
Pulmonary Embolism With Comorbity Or Acute Cor Pulmonale
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
163
|
OTHER
|
Major Chest Procedures With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
165
|
OTHER
|
Major Chest Procedures Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
180
|
OTHER
|
Respiratory Neoplasms With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
182
|
OTHER
|
Respiratory Neoplasms Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
143
|
OTHER
|
Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
099
|
OTHER
|
Non-bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
153
|
OTHER
|
Otitis Media And Uri Without Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
094
|
OTHER
|
Bacterial And Tuberculous Infections Of Nervous System With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
091
|
OTHER
|
Other Disorders Of Nervous System With Comorbity
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
139
|
OTHER
|
Salivary Gland Procedures
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
159
|
OTHER
|
Dental And Oral Diseases Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
154
|
OTHER
|
Other Ear, Nose, Mouth And Throat Diagnoses With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
164
|
OTHER
|
Major Chest Procedures With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
137
|
OTHER
|
Mouth Procedures With Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
155
|
OTHER
|
Other Ear, Nose, Mouth And Throat Diagnoses With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
156
|
OTHER
|
Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
149
|
OTHER
|
Dysequilibrium
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
146
|
OTHER
|
Ear, Nose, Mouth And Throat Malignancy With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
158
|
OTHER
|
Dental And Oral Diseases With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
152
|
OTHER
|
Otitis Media And Uri With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
166
|
OTHER
|
Other Respiratory System O.r. Procedures With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
177
|
OTHER
|
Respiratory Infections & Inflammations With Comorbity
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
095
|
OTHER
|
Bacterial And Tuberculous Infections Of Nervous System With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
087
|
OTHER
|
Traumatic Stupor And Coma <1 Hour Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
084
|
OTHER
|
Traumatic Stupor And Coma >1 Hour Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
088
|
OTHER
|
Concussion With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
096
|
OTHER
|
Bacterial And Tuberculous Infections Of Nervous System Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
076
|
OTHER
|
Viral Meningitis Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
080
|
OTHER
|
Nontraumatic Stupor And Coma With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
074
|
OTHER
|
Cranial And Peripheral Nerve Disorders Without Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
072
|
OTHER
|
Other Cerebrovascular Disorders Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
075
|
OTHER
|
Viral Meningitis With Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
081
|
OTHER
|
Nontraumatic Stupor & Coma Without Comorbity
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
067
|
OTHER
|
Precerebral Occlusion Without Infarction With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
066
|
OTHER
|
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
068
|
OTHER
|
Precerebral Occlusion Without Infarction Without Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
063
|
OTHER
|
Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A…
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
060
|
OTHER
|
Multiple Sclerosis And Cerebellar Ataxia Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
064
|
OTHER
|
Intracranial Hemorrhage Or Cerebral Infarction With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
069
|
OTHER
|
Transient Ischemia Without Thrombolytic
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
183
|
OTHER
|
Major Chest Trauma With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
054
|
OTHER
|
Nervous System Neoplasms With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
055
|
OTHER
|
Nervous System Neoplasms Without Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
040
|
OTHER
|
Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
037
|
OTHER
|
Extracranial Procedures With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
056
|
OTHER
|
Degenerative Nervous System Disorders With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
033
|
OTHER
|
Ventricular Shunt Procedures Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
031
|
OTHER
|
Ventricular Shunt Procedures With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
034
|
OTHER
|
Carotid Artery Stent Procedures With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
027
|
OTHER
|
Craniotomy And Endovascular Intracranial Procedures Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
025
|
OTHER
|
Craniotomy And Endovascular Intracranial Procedures With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
028
|
OTHER
|
Spinal Procedures With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
035
|
OTHER
|
Carotid Artery Stent Procedures With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
057
|
OTHER
|
Degenerative Nervous System Disorders Without Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
019
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
013
|
OTHER
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
016
|
OTHER
|
Autologous Bone Marrow Transplant With Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
020
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
010
|
OTHER
|
Pancreas Transplant
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
011
|
OTHER
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
014
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
017
|
OTHER
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
018
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
023
|
OTHER
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
024
|
OTHER
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
026
|
OTHER
|
Craniotomy And Endovascular Intracranial Procedures With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
029
|
OTHER
|
Spinal Procedures With Cc Or Spinal Neurostimulators
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
030
|
OTHER
|
Spinal Procedures Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
032
|
OTHER
|
Ventricular Shunt Procedures With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
001
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
036
|
OTHER
|
Carotid Artery Stent Procedures Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
038
|
OTHER
|
Extracranial Procedures With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
039
|
OTHER
|
Extracranial Procedures Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
041
|
OTHER
|
Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Periphe…
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
042
|
OTHER
|
Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
052
|
OTHER
|
Spinal Disorders And Injuries With Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
053
|
OTHER
|
Spinal Disorders And Injuries Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
059
|
OTHER
|
Multiple Sclerosis And Cerebellar Ataxia With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
061
|
OTHER
|
Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A…
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
062
|
OTHER
|
Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A…
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
065
|
OTHER
|
Intracranial Hemorrhage Or Cerebral Infarction With Complication Or Tpa In 24 Hr…
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
070
|
OTHER
|
Other Cerebrovascular Disorders With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
071
|
OTHER
|
Other Cerebrovascular Disorders With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
073
|
OTHER
|
Cranial And Peripheral Nerve Disorders With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
082
|
OTHER
|
Traumatic Stupor And Coma >1 Hour With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
083
|
OTHER
|
Traumatic Stupor And Coma >1 Hour With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
085
|
OTHER
|
Traumatic Stupor And Coma <1 Hour With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
086
|
OTHER
|
Traumatic Stupor And Coma <1 Hour With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
089
|
OTHER
|
Concussion With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
090
|
OTHER
|
Concussion Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
092
|
OTHER
|
Other Disorders Of Nervous System With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
093
|
OTHER
|
Other Disorders Of Nervous System Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
097
|
OTHER
|
Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
098
|
OTHER
|
Non-bacterial Infection Of Nervous System Except Viral Meningitis With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
100
|
OTHER
|
Seizures With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
101
|
OTHER
|
Seizures Without Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
102
|
OTHER
|
Headaches With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
103
|
OTHER
|
Headaches Without Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
113
|
OTHER
|
Orbital Procedures With Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
123
|
OTHER
|
Neurological Eye Disorders
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
125
|
OTHER
|
Other Disorders Of The Eye Without Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
150
|
OTHER
|
Epistaxis With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
138
|
OTHER
|
Mouth Procedures Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
122
|
OTHER
|
Acute Major Eye Infections Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
114
|
OTHER
|
Orbital Procedures Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
121
|
OTHER
|
Acute Major Eye Infections With Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
145
|
OTHER
|
Other Ear, Nose, Mouth And Throat O.r. Procedures Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
142
|
OTHER
|
Major Head And Neck Procedures Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
144
|
OTHER
|
Other Ear, Nose, Mouth And Throat O.r. Procedures With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
151
|
OTHER
|
Epistaxis Without Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
124
|
OTHER
|
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
115
|
OTHER
|
Extraocular Procedures Except Orbit
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
140
|
OTHER
|
Major Head And Neck Procedures With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
116
|
OTHER
|
Intraocular Procedures With Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
136
|
OTHER
|
Sinus And Mastoid Procedures Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
148
|
OTHER
|
Ear, Nose, Mouth And Throat Malignancy Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
147
|
OTHER
|
Ear, Nose, Mouth And Throat Malignancy With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
135
|
OTHER
|
Sinus And Mastoid Procedures With Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
141
|
OTHER
|
Major Head And Neck Procedures With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
157
|
OTHER
|
Dental And Oral Diseases With Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
117
|
OTHER
|
Intraocular Procedures Without Cc/mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
012
|
OTHER
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
021
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
022
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
007
|
OTHER
|
Lung Transplant
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
008
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|
|
006
|
OTHER
|
Liver Transplant Without Mcc
|
14
|
14
|
—
|
—
|
$2,839.00
|
$2,839.00
|
$2,839.00
|
2026-05-13
|