Price Transparency Hospital negotiated rates

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

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Hospital

ST JAMES HOSPITAL

Butte, MT · CCN 270017 · Rates published

23,996 distinct procedures filed
16 distinct payers
1,409,262 rate rows
2026-05-22 last MRF observed
Data quality

1,403,600 of 1,409,262 rate rows are consumer-grade (99.6%)

5,662 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
placeholder amount (≤ $0.02) — excluded from medians 5,236
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 396
per-diem day rate — not a per-procedure price 30
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://intermountainhealthcare.org/sc10media/files/intermountain-health/locations/hospital-prices/810231785_st-james-healthcare_standardcharges.ashx
Found on page https://intermountainhealthcare.org/locations/intermountain-health-st-james-hospital/about/hospital-pricing
Discovered viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-05-19
Content fingerprint c670d7b2f8ba8eb8… · 4,587,485 bytes · first seen 2026-05-15

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
J3391
OTHER 		Inj Atidarsagene Autotemcel 2 $4,595,100.00 $4,640,150.00 $4,595,100.00 nat. median
$4,505,000
1.0× median
J1411
OTHER 		Inj Hemgenix Per Tx Dose 2 $3,758,972.00 $3,795,824.67 $3,758,972.00 nat. median
$3,685,267
1.0× median
J3399
OTHER 		Inj Onase Abepar-xioi Treat 3 $2,504,212.82 $4,721,750.00 $3,625,256.96 nat. median
$2,472,216
1.5× median
J1413
OTHER 		Inj Delandistrogene Mox Rokl 2 $3,382,791.84 $3,415,956.47 $3,382,791.84 nat. median
$3,327,860
1.0× median
J3394
OTHER 		Inj Lovotibeglogene Autotem 2 $3,313,414.63 $3,345,899.09 $3,313,414.63 nat. median
$3,286,000
1.0× median
J3393
OTHER 		Inj Betibeglogene Autotemce 2 $3,004,654.80 $3,034,112.20 $3,004,654.80 nat. median
$2,968,000
1.0× median
J3392
OTHER 		Inj Exagamglogene Autotem 3 $2,378,640.00 $4,897,200.00 $2,390,300.00 nat. median
$2,332,000
1.0× median
Q2056
OTHER 		Ciltacabtagene Car-pos T 7 $577,186.33 $1,612,726.51 $1,125,532.50 nat. median
$583,076
1.9× median
Q2040
OTHER 		Tisagenlecleucel Car-pos T 1 $992,750.00 $1,060,437.50 $1,026,593.75 nat. median
$567,625
1.8× median
Q2055
OTHER 		Idecabtagene Vicleucel Car 7 $568,464.29 $1,588,356.10 $985,825.00 nat. median
$558,082
1.8× median
Q2042
OTHER 		Tisagenlecleucel Car-pos T 7 $603,560.72 $1,686,419.67 $981,642.00 nat. median
$591,726
1.7× median
Q2054
OTHER 		Lisocabtagene Mara Car Pos T 7 $573,788.95 $1,603,233.84 $964,205.00 nat. median
$562,538
1.7× median
Q2053
OTHER 		Brexucabtagene Car Pos T 7 $499,090.70 $1,394,518.14 $947,026.50 nat. median
$489,720
1.9× median
Q2041
OTHER 		Axicabtagene Ciloleucel Car+ 7 $543,894.77 $1,519,705.98 $832,722.50 nat. median
$533,230
1.6× median
Q2057
OTHER 		Afamitresgene Autoleucel 4 $786,032.40 $2,196,267.00 $793,738.60 nat. median
$770,620
1.0× median
143901
OTHER 		Sipuleucel-t In Lactated Ringers 50 Million Cell/250 Ml IV Suspension 13 $175,106.21 $334,172.15 $310,780.10 nat. median
$255,642
1.2× median
Q2058
OTHER 		Obecbtge Autol Up To 400 Mil 4 $283,815.00 $793,012.50 $286,597.50 nat. median
$281,111
1.0× median
J3403
OTHER 		Revakinagene Per Implant 4 $262,650.00 $733,875.00 $265,225.00 nat. median
$265,000
1.0× median
MS-018
OTHER 		Chimeric Antigen Receptor (car) T-cell Immunotherapy 6 $245,049.10 $816,470.50 $245,049.10 nat. median
$309,559
0.8× median
J3402
OTHER 		Inj. Remestemcel-l-rknd/ Td 4 $209,752.80 $586,074.00 $211,809.20 nat. median
$205,640
1.0× median
210658
OTHER 		Inebilizumab-cdon 10 Mg/ml Intravenous Solution 13 $117,083.80 $223,442.36 $207,801.39 nat. median
$198,864
1.0× median
216356
OTHER 		Lutetium Lu-177 Vipivotide Tetraxetan 27 Mci/ml (1,000 Mbq/ml) IV Soln 13 $112,195.90 $214,114.32 $199,126.32 nat. median
$121,941
1.6× median
Q0480
OTHER 		Driver Pneumatic Vad Rep 6 $112,341.97 $313,896.69 $190,972.51 nat. median
$109,316
1.7× median
MS-001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 6 $183,031.13 $529,856.51 $183,031.13 nat. median
$224,278
0.8× median
170072
OTHER 		Ipilimumab 200 Mg/40 Ml (5 Mg/ml) Intravenous Solution 13 $99,321.87 $189,545.55 $176,277.36 nat. median
$161,114
1.1× median
192637
OTHER 		Flutemetamol F-18 5 Mci (185 Mbq) Intravenous Solution 13 $65,073.25 $372,556.80 $159,702.68 nat. median
$117,976
1.4× median
J9029
OTHER 		Instill Adstiladrin Tx Dose 7 $64,609.13 $180,525.50 $158,552.02 nat. median
$66,509
outlier · 2.4×
MS-927
OTHER 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 6 $147,055.03 $403,680.48 $154,145.30 nat. median
$175,322
0.9× median
2722109771
OTHER 		Hc Percutaneous Ventricular Assist Device Lvl 71 13 $85,512.92 $163,192.60 $151,769.12 nat. median
$113,676
1.3× median
2782649771
OTHER 		Hc Valve Implant Lvl 71 13 $85,512.92 $163,192.60 $151,769.12 nat. median
$113,676
1.3× median
2721649601
OTHER 		Hc Kit Pump Device Cardiac Ventricular Smartassist 5.5 S2 13 $82,079.36 $156,640.00 $145,675.20 nat. median
$109,112
1.3× median
278TRIG470
OTHER 		Hc Ntap Triclip G4 Vlv Rpr Systm 13 $81,440.87 $155,421.50 $144,542.00 nat. median
$108,263
1.3× median
2782649770
OTHER 		Hc Valve Implant Lvl 70 13 $81,440.87 $155,421.50 $144,542.00 nat. median
$108,263
1.3× median
2721649701
OTHER 		Hc Pump Blood Vad With Valves 13 $81,418.99 $155,379.75 $144,503.17 nat. median
$108,234
1.3× median
MS-003
OTHER 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth… 6 $139,257.61 $401,311.39 $139,257.61 nat. median
$169,886
0.8× median
A9543
OTHER 		Y90 Ibritumomab Rx 7 $57,961.04 $163,691.45 $139,026.28 nat. median
$66,156
outlier · 2.1×
183256
OTHER 		Radium Ra 223 Dichlor 1,100 Kbq/ml (30 Microcurie/ml) Intravenous Soln 13 $74,157.78 $141,522.48 $131,615.91 nat. median
$80,599
1.6× median
275C188267
OTHER 		Hc Icd Biv/crt-d Lvl 67 13 $70,351.61 $134,258.80 $124,860.68 nat. median
$93,521
1.3× median
Q2043
OTHER 		Sipuleucel-t Auto Cd54+ 7 $56,377.77 $157,526.11 $120,479.47 nat. median
$55,946
outlier · 2.2×
278C188966
OTHER 		Hc Implantable-insertable Device Noc Lvl 66 13 $67,001.52 $127,865.50 $118,914.92 nat. median
$89,068
1.3× median
278C182366
OTHER 		Hc Neurostim Generator/lead Lvl 66 13 $67,001.52 $127,865.50 $118,914.92 nat. median
$89,068
1.3× median
2782649766
OTHER 		Hc Valve Implant Lvl 66 13 $67,001.52 $127,865.50 $118,914.92 nat. median
$89,068
1.3× median
2782649765
OTHER 		Hc Valve Implant Lvl 65 13 $63,810.96 $121,776.65 $113,252.28 nat. median
$84,827
1.3× median
189298
OTHER 		Alemtuzumab 12 Mg/1.2 Ml Intravenous Solution 13 $61,217.41 $116,827.12 $108,649.22 nat. median
$103,042
1.1× median
168829
OTHER 		Pegloticase 8 Mg/ml Intravenous Solution 13 $60,945.22 $116,307.68 $108,166.14 nat. median
$91,022
1.2× median
2782669764
OTHER 		Hc Vascular Stent Graft Implant Lvl 64 13 $60,772.31 $115,977.70 $107,859.26 nat. median
$80,787
1.3× median
2782649764
OTHER 		Hc Valve Implant Lvl 64 13 $60,772.31 $115,977.70 $107,859.26 nat. median
$80,787
1.3× median
2782649763
OTHER 		Hc Valve Implant Lvl 63 13 $57,878.37 $110,454.90 $102,723.06 nat. median
$76,940
1.3× median
278C188963
OTHER 		Hc Implantable-insertable Device Noc Lvl 63 13 $57,878.37 $110,454.90 $102,723.06 nat. median
$76,940
1.3× median
199175
OTHER 		Ocrelizumab 30 Mg/ml Intravenous Solution 13 $55,344.78 $105,619.80 $98,226.41 nat. median
$45,427
outlier · 2.2×

Other procedures at this hospital

Browse this hospital's 23,996 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
J3391 OTHER Inj Atidarsagene Autotemcel 10 2 — — $4,595,100.00 $4,640,150.00 $4,595,100.00 2026-05-22
J1411 OTHER Inj Hemgenix Per Tx Dose 10 2 — — $3,758,972.00 $3,795,824.67 $3,758,972.00 2026-05-22
J3399 OTHER Inj Onase Abepar-xioi Treat 20 3 — — $2,504,212.82 $4,721,750.00 $3,625,256.96 2026-05-22
J1413 OTHER Inj Delandistrogene Mox Rokl 10 2 — — $3,382,791.84 $3,415,956.47 $3,382,791.84 2026-05-22
J3394 OTHER Inj Lovotibeglogene Autotem 10 2 — — $3,313,414.63 $3,345,899.09 $3,313,414.63 2026-05-22
J3393 OTHER Inj Betibeglogene Autotemce 10 2 — — $3,004,654.80 $3,034,112.20 $3,004,654.80 2026-05-22
J3392 OTHER Inj Exagamglogene Autotem 12 3 — — $2,378,640.00 $4,897,200.00 $2,390,300.00 2026-05-22
Q2056 OTHER Ciltacabtagene Car-pos T 52 7 — — $577,186.33 $1,612,726.51 $1,125,532.50 2026-05-22
Q2040 OTHER Tisagenlecleucel Car-pos T 20 1 — — $992,750.00 $1,060,437.50 $1,026,593.75 2026-05-22
Q2055 OTHER Idecabtagene Vicleucel Car 52 7 — — $568,464.29 $1,588,356.10 $985,825.00 2026-05-22
Q2042 OTHER Tisagenlecleucel Car-pos T 52 7 — — $603,560.72 $1,686,419.67 $981,642.00 2026-05-22
Q2054 OTHER Lisocabtagene Mara Car Pos T 52 7 — — $573,788.95 $1,603,233.84 $964,205.00 2026-05-22
Q2053 OTHER Brexucabtagene Car Pos T 52 7 — — $499,090.70 $1,394,518.14 $947,026.50 2026-05-22
Q2041 OTHER Axicabtagene Ciloleucel Car+ 52 7 — — $543,894.77 $1,519,705.98 $832,722.50 2026-05-22
Q2057 OTHER Afamitresgene Autoleucel 16 4 — — $786,032.40 $2,196,267.00 $793,738.60 2026-05-22
143901 OTHER Sipuleucel-t In Lactated Ringers 50 Million Cell/250 Ml IV Suspension 108 13 $334,172.15 — $175,106.21 $334,172.15 $310,780.10 2026-05-22
Q2058 OTHER Obecbtge Autol Up To 400 Mil 16 4 — — $283,815.00 $793,012.50 $286,597.50 2026-05-22
J3403 OTHER Revakinagene Per Implant 16 4 — — $262,650.00 $733,875.00 $265,225.00 2026-05-22
MS-018 OTHER Chimeric Antigen Receptor (car) T-cell Immunotherapy 36 6 — — $245,049.10 $816,470.50 $245,049.10 2026-05-22
J3402 OTHER Inj. Remestemcel-l-rknd/ Td 16 4 — — $209,752.80 $586,074.00 $211,809.20 2026-05-22
210658 OTHER Inebilizumab-cdon 10 Mg/ml Intravenous Solution 108 13 $223,442.36 — $117,083.80 $223,442.36 $207,801.39 2026-05-22
216356 OTHER Lutetium Lu-177 Vipivotide Tetraxetan 27 Mci/ml (1,000 Mbq/ml) IV Soln 108 13 $214,114.32 — $112,195.90 $214,114.32 $199,126.32 2026-05-22
Q0480 OTHER Driver Pneumatic Vad Rep 30 6 — — $112,341.97 $313,896.69 $190,972.51 2026-05-22
MS-001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 36 6 — — $183,031.13 $529,856.51 $183,031.13 2026-05-22
170072 OTHER Ipilimumab 200 Mg/40 Ml (5 Mg/ml) Intravenous Solution 108 13 $189,545.55 — $99,321.87 $189,545.55 $176,277.36 2026-05-22
192637 OTHER Flutemetamol F-18 5 Mci (185 Mbq) Intravenous Solution 216 13 $248,371.20 — $65,073.25 $372,556.80 $159,702.68 2026-05-22
J9029 OTHER Instill Adstiladrin Tx Dose 36 7 — — $64,609.13 $180,525.50 $158,552.02 2026-05-22
MS-927 OTHER Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 36 6 — — $147,055.03 $403,680.48 $154,145.30 2026-05-22
2722109771 OTHER Hc Percutaneous Ventricular Assist Device Lvl 71 108 13 $163,192.60 — $85,512.92 $163,192.60 $151,769.12 2026-05-22
2782649771 OTHER Hc Valve Implant Lvl 71 108 13 $163,192.60 — $85,512.92 $163,192.60 $151,769.12 2026-05-22
2721649601 OTHER Hc Kit Pump Device Cardiac Ventricular Smartassist 5.5 S2 108 13 $156,640.00 — $82,079.36 $156,640.00 $145,675.20 2026-05-22
2782649770 OTHER Hc Valve Implant Lvl 70 108 13 $155,421.50 — $81,440.87 $155,421.50 $144,542.00 2026-05-22
278TRIG470 OTHER Hc Ntap Triclip G4 Vlv Rpr Systm 108 13 $155,421.50 — $81,440.87 $155,421.50 $144,542.00 2026-05-22
2721649701 OTHER Hc Pump Blood Vad With Valves 108 13 $155,379.75 — $81,418.99 $155,379.75 $144,503.17 2026-05-22
MS-003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth… 36 6 — — $139,257.61 $401,311.39 $139,257.61 2026-05-22
A9543 OTHER Y90 Ibritumomab Rx 52 7 — — $57,961.04 $163,691.45 $139,026.28 2026-05-22
183256 OTHER Radium Ra 223 Dichlor 1,100 Kbq/ml (30 Microcurie/ml) Intravenous Soln 108 13 $141,522.48 — $74,157.78 $141,522.48 $131,615.91 2026-05-22
275C188267 OTHER Hc Icd Biv/crt-d Lvl 67 108 13 $134,258.80 — $70,351.61 $134,258.80 $124,860.68 2026-05-22
Q2043 OTHER Sipuleucel-t Auto Cd54+ 52 7 — — $56,377.77 $157,526.11 $120,479.47 2026-05-22
278C182366 OTHER Hc Neurostim Generator/lead Lvl 66 108 13 $127,865.50 — $67,001.52 $127,865.50 $118,914.92 2026-05-22
278C188966 OTHER Hc Implantable-insertable Device Noc Lvl 66 108 13 $127,865.50 — $67,001.52 $127,865.50 $118,914.92 2026-05-22
2782649766 OTHER Hc Valve Implant Lvl 66 108 13 $127,865.50 — $67,001.52 $127,865.50 $118,914.92 2026-05-22
2782649765 OTHER Hc Valve Implant Lvl 65 108 13 $121,776.65 — $63,810.96 $121,776.65 $113,252.28 2026-05-22
189298 OTHER Alemtuzumab 12 Mg/1.2 Ml Intravenous Solution 108 13 $116,827.12 — $61,217.41 $116,827.12 $108,649.22 2026-05-22
168829 OTHER Pegloticase 8 Mg/ml Intravenous Solution 108 13 $116,307.68 — $60,945.22 $116,307.68 $108,166.14 2026-05-22
2782649764 OTHER Hc Valve Implant Lvl 64 108 13 $115,977.70 — $60,772.31 $115,977.70 $107,859.26 2026-05-22
2782669764 OTHER Hc Vascular Stent Graft Implant Lvl 64 108 13 $115,977.70 — $60,772.31 $115,977.70 $107,859.26 2026-05-22
278C188963 OTHER Hc Implantable-insertable Device Noc Lvl 63 108 13 $110,454.90 — $57,878.37 $110,454.90 $102,723.06 2026-05-22
2782649763 OTHER Hc Valve Implant Lvl 63 108 13 $110,454.90 — $57,878.37 $110,454.90 $102,723.06 2026-05-22
199175 OTHER Ocrelizumab 30 Mg/ml Intravenous Solution 108 13 $105,619.80 — $55,344.78 $105,619.80 $98,226.41 2026-05-22
278C187462 OTHER Hc Stent Coated/covered Implant Lvl 62 108 13 $105,195.10 — $55,122.23 $105,195.10 $97,831.44 2026-05-22
2782669762 OTHER Hc Vascular Stent Graft Implant Lvl 62 108 13 $105,195.10 — $55,122.23 $105,195.10 $97,831.44 2026-05-22
278C188962 OTHER Hc Implantable-insertable Device Noc Lvl 62 108 13 $105,195.10 — $55,122.23 $105,195.10 $97,831.44 2026-05-22
E0194 OTHER Air Fluidized Bed 10 1 — — $94,608.32 $94,608.32 $94,608.32 2026-05-22
278C182361 OTHER Hc Neurostim Generator/lead Lvl 61 108 13 $100,185.80 — $52,497.36 $100,185.80 $93,172.79 2026-05-22
2782649761 OTHER Hc Valve Implant Lvl 61 108 13 $100,185.80 — $52,497.36 $100,185.80 $93,172.79 2026-05-22
2722109761 OTHER Hc Percutaneous Ventricular Assist Device Lvl 61 108 13 $100,185.80 — $52,497.36 $100,185.80 $93,172.79 2026-05-22
MS-004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth And Nec… 36 6 — — $91,813.49 $261,892.69 $91,813.49 2026-05-22
2721649501 OTHER Hc Set Pump Impella Cp W/smart Assist 108 13 $96,120.00 — $50,366.88 $96,120.00 $89,391.60 2026-05-22
J7330 OTHER Cultured Chondrocytes Implnt 24 2 — — $80.00 $95,369.77 $89,282.34 2026-05-22
2722109760 OTHER Hc Percutaneous Ventricular Assist Device Lvl 60 108 13 $95,415.00 — $49,997.46 $95,415.00 $88,735.95 2026-05-22
3601276297 OTHER Hc Trcath Replace Aortic Valve 108 13 $92,179.55 — $48,302.08 $92,179.55 $85,726.98 2026-05-22
MS-014 OTHER Allogeneic Bone Marrow Transplant 36 6 — — $82,775.24 $227,226.14 $85,132.48 2026-05-22
MS-007 OTHER Lung Transplant 36 6 — — $84,918.06 $244,853.42 $84,918.06 2026-05-22
L7181 OTHER Electronic Elbo Simultaneous 30 6 — — $49,879.14 $139,368.19 $84,790.60 2026-05-22
278C188959 OTHER Hc Implantable-insertable Device Noc Lvl 59 108 13 $90,871.40 — $47,616.61 $90,871.40 $84,510.40 2026-05-22
278C262459 OTHER Hc Wireless Pressure Sensor Lvl 59 108 13 $90,871.40 — $47,616.61 $90,871.40 $84,510.40 2026-05-22
278C182359 OTHER Hc Neurostim Generator/lead Lvl 59 108 13 $90,871.40 — $47,616.61 $90,871.40 $84,510.40 2026-05-22
275C188259 OTHER Hc Icd Biv/crt-d Lvl 59 108 13 $90,871.40 — $47,616.61 $90,871.40 $84,510.40 2026-05-22
278LIMFW59 OTHER Hc Ntap Limflow System 108 13 $90,871.40 — $47,616.61 $90,871.40 $84,510.40 2026-05-22
272C176959 OTHER Hc Guidewire Lvl 59 108 13 $90,871.40 — $47,616.61 $90,871.40 $84,510.40 2026-05-22
2782649759 OTHER Hc Valve Implant Lvl 59 108 13 $90,871.40 — $47,616.61 $90,871.40 $84,510.40 2026-05-22
275C172159 OTHER Hc Icd Dual Chamber Lvl 59 108 13 $90,871.40 — $47,616.61 $90,871.40 $84,510.40 2026-05-22
2722109759 OTHER Hc Percutaneous Ventricular Assist Device Lvl 59 108 13 $90,871.40 — $47,616.61 $90,871.40 $84,510.40 2026-05-22
2722109758 OTHER Hc Percutaneous Ventricular Assist Device Lvl 58 108 13 $86,544.15 — $45,349.13 $86,544.15 $80,486.06 2026-05-22
2782649758 OTHER Hc Valve Implant Lvl 58 108 13 $86,544.15 — $45,349.13 $86,544.15 $80,486.06 2026-05-22
MS-209 OTHER Complex Aortic Arch Procedures 16 4 — — $77,960.07 $214,008.04 $78,724.39 2026-05-22
2722109757 OTHER Hc Percutaneous Ventricular Assist Device Lvl 57 108 13 $82,422.95 — $43,189.63 $82,422.95 $76,653.34 2026-05-22
L8702 OTHER Ewhf S/d Uprt Micro Sensor 20 5 — — $68,801.71 $192,240.08 $75,907.96 2026-05-22
4813324901 OTHER Hc Implant/repos Defib Pulse Gen W/leads Sng/dual 108 13 $80,576.30 — $42,221.98 $80,576.30 $74,935.96 2026-05-22
L7180 OTHER Electronic Elbow Sequential 30 6 — — $43,710.99 $122,133.64 $74,305.26 2026-05-22
K0606 OTHER Aed Garment W Elec Analysis 10 1 — — $73,210.24 $73,210.24 $73,210.24 2026-05-22
278C182656 OTHER Hc Gen Neuro Rchg W Bat & Lds & Cmpnts Implant Lvl 56 108 13 $78,498.05 — $41,132.98 $78,498.05 $73,003.19 2026-05-22
275C172256 OTHER Hc Icd Single Chamber Lvl 56 108 13 $78,498.05 — $41,132.98 $78,498.05 $73,003.19 2026-05-22
275C188256 OTHER Hc Icd Biv/crt-d Lvl 56 108 13 $78,498.05 — $41,132.98 $78,498.05 $73,003.19 2026-05-22
2721489756 OTHER Hc Cardiovascular Non Implant Supply Lvl 56 108 13 $78,498.05 — $41,132.98 $78,498.05 $73,003.19 2026-05-22
MS-002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 36 6 — — $71,603.48 $214,253.83 $71,603.48 2026-05-22
J9226 OTHER Supprelin La Implant 56 8 — — $45,921.06 $128,308.85 $71,479.10 2026-05-22
MS-212 OTHER Concomitant Aortic And Mitral Valve?procedures 36 6 — — $70,786.06 $205,599.96 $70,786.06 2026-05-22
MS-247 OTHER Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc 10 1 — — $70,560.00 $70,560.00 $70,560.00 2026-05-22
2782669755 OTHER Hc Vascular Stent Graft Implant Lvl 55 108 13 $74,760.00 — $39,174.24 $74,760.00 $69,526.80 2026-05-22
2782649755 OTHER Hc Valve Implant Lvl 55 108 13 $74,760.00 — $39,174.24 $74,760.00 $69,526.80 2026-05-22
275C188255 OTHER Hc Icd Biv/crt-d Lvl 55 108 13 $74,760.00 — $39,174.24 $74,760.00 $69,526.80 2026-05-22
MS-005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 36 6 — — $69,197.35 $194,943.80 $69,197.35 2026-05-22
4813324001 OTHER Hc Insert Pulse Gen With Single Lead 108 13 $74,169.95 — $38,865.05 $74,169.95 $68,978.05 2026-05-22
228839 OTHER Guselkumab 200 Mg/20 Ml (10 Mg/ml) Intravenous Solution 108 13 $74,053.01 — $38,803.78 $74,053.01 $68,869.30 2026-05-22
MS-215 OTHER Other Heart Assist System Implant 36 6 — — $68,580.45 $188,260.07 $68,842.57 2026-05-22
206941 OTHER Polatuzumab Vedotin-piiq 140 Mg Intravenous Solution 108 13 $73,831.47 — $38,687.69 $73,831.47 $68,663.27 2026-05-22
MS-426 OTHER Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 36 6 — — $68,066.74 $208,381.22 $68,066.74 2026-05-22
275C188254 OTHER Hc Icd Biv/crt-d Lvl 54 108 13 $71,199.95 — $37,308.77 $71,199.95 $66,215.95 2026-05-22
2782669754 OTHER Hc Vascular Stent Graft Implant Lvl 54 108 13 $71,199.95 — $37,308.77 $71,199.95 $66,215.95 2026-05-22
MS-249 OTHER Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent Without Mcc 10 1 — — $65,268.00 $65,268.00 $65,268.00 2026-05-22
MS-338 OTHER Appendectomy With Complicated Principal Diagnosis With Mcc 10 1 — — $64,204.00 $64,204.00 $64,204.00 2026-05-22
2721489753 OTHER Hc Cardiovascular Non Implant Supply Lvl 53 108 13 $67,596.45 — $35,420.54 $67,596.45 $62,864.70 2026-05-22
278C261601 OTHER Hc Brachytx Non-str Yttrium-90 108 13 $67,596.45 — $35,420.54 $67,596.45 $62,864.70 2026-05-22
2781909753 OTHER Hc Embolization Device Implant Lvl 53 108 13 $67,596.45 — $35,420.54 $67,596.45 $62,864.70 2026-05-22
2782669753 OTHER Hc Vascular Stent Graft Implant Lvl 53 108 13 $67,596.45 — $35,420.54 $67,596.45 $62,864.70 2026-05-22
275C172153 OTHER Hc Icd Dual Chamber Lvl 53 108 13 $67,596.45 — $35,420.54 $67,596.45 $62,864.70 2026-05-22
278C171701 OTHER Hc Brachytherapy Source Hdr Ir192 108 13 $67,596.45 — $35,420.54 $67,596.45 $62,864.70 2026-05-22
278C182053 OTHER Hc Generator Neuro Rechg Battery System Implant Lvl 53 108 13 $67,596.45 — $35,420.54 $67,596.45 $62,864.70 2026-05-22
2782019753 OTHER Hc General Supply Implant Lvl 53 108 13 $67,596.45 — $35,420.54 $67,596.45 $62,864.70 2026-05-22
278C188953 OTHER Hc Implantable-insertable Device Noc Lvl 53 108 13 $67,596.45 — $35,420.54 $67,596.45 $62,864.70 2026-05-22
278C187453 OTHER Hc Stent Coated/covered Implant Lvl 53 108 13 $67,596.45 — $35,420.54 $67,596.45 $62,864.70 2026-05-22
275C188253 OTHER Hc Icd Biv/crt-d Lvl 53 108 13 $67,596.45 — $35,420.54 $67,596.45 $62,864.70 2026-05-22
144240 OTHER Cabazitaxel 10 Mg/ml (first Dilution) Intravenous Solution 108 13 $67,543.47 — $35,392.78 $67,543.47 $62,815.43 2026-05-22
MS-216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 36 6 — — $62,710.63 $184,966.41 $62,710.63 2026-05-22
38240 OTHER Transplt Allo Hct/donor 16 4 — — $60,325.18 $168,555.64 $60,916.60 2026-05-22
MS-850 OTHER Acute Leukemia With Other Procedures 36 6 — — $59,643.71 $163,727.83 $59,856.81 2026-05-22
142123 OTHER Pralatrexate 40 Mg/2 Ml (20 Mg/ml) Intravenous Solution 108 13 $63,856.99 — $33,461.06 $63,856.99 $59,387.00 2026-05-22
MS-341 OTHER Appendectomy Without Complicated Principal Diagnosis With Mcc 10 1 — — $57,792.00 $57,792.00 $57,792.00 2026-05-22
7613722703 OTHER Hc Revas Fem-pop W/ather W Stnt/pta Bilateral 108 13 $61,661.35 — $32,310.55 $61,661.35 $57,345.06 2026-05-22
7613723103 OTHER Hc Revasc Tib/pero Stnt Ather Bilateral 108 13 $61,661.35 — $32,310.55 $61,661.35 $57,345.06 2026-05-22
2782019752 OTHER Hc General Supply Implant Lvl 52 108 13 $61,451.25 — $32,200.46 $61,451.25 $57,149.66 2026-05-22
2782649752 OTHER Hc Valve Implant Lvl 52 108 13 $61,451.25 — $32,200.46 $61,451.25 $57,149.66 2026-05-22
275C172252 OTHER Hc Icd Single Chamber Lvl 52 108 13 $61,451.25 — $32,200.46 $61,451.25 $57,149.66 2026-05-22
275C188252 OTHER Hc Icd Biv/crt-d Lvl 52 108 13 $61,451.25 — $32,200.46 $61,451.25 $57,149.66 2026-05-22
2781909752 OTHER Hc Embolization Device Implant Lvl 52 108 13 $61,451.25 — $32,200.46 $61,451.25 $57,149.66 2026-05-22
278C182052 OTHER Hc Generator Neuro Rechg Battery System Implant Lvl 52 108 13 $61,451.25 — $32,200.46 $61,451.25 $57,149.66 2026-05-22
278C188952 OTHER Hc Implantable-insertable Device Noc Lvl 52 108 13 $61,451.25 — $32,200.46 $61,451.25 $57,149.66 2026-05-22
2782679752 OTHER Hc Left Atrial Appendage Implant Lvl 52 108 13 $61,451.25 — $32,200.46 $61,451.25 $57,149.66 2026-05-22
278C187452 OTHER Hc Stent Coated/covered Implant Lvl 52 108 13 $61,451.25 — $32,200.46 $61,451.25 $57,149.66 2026-05-22
7613722903 OTHER Hc Revasc Tib Pero Arther Pta/initial Bilateral 108 13 $60,633.65 — $31,772.03 $60,633.65 $56,389.29 2026-05-22
213879 OTHER Dostarlimab-gxly 50 Mg/ml Intravenous Solution 108 13 $60,351.85 — $31,624.37 $60,351.85 $56,127.22 2026-05-22
196494 OTHER Atezolizumab 1,200 Mg/20 Ml (60 Mg/ml) Intravenous Solution 108 13 $60,062.22 — $31,472.60 $60,062.22 $55,857.86 2026-05-22
MS-231 OTHER Coronary Bypass With Ptca With Mcc 36 6 — — $55,061.45 $159,386.72 $55,061.45 2026-05-22
MS-456 OTHER Spinal Fusion Except Cervical With Spinal Curvature- Malignancy- Infection Or Ex… 36 6 — — $55,030.91 $158,885.67 $55,030.91 2026-05-22
MS-429 OTHER Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 36 6 — — $54,195.30 $170,347.28 $54,195.30 2026-05-22
7613723003 OTHER Hc Revasc Tib Pero W/stent Pta Initial Bilateral 108 13 $57,807.50 — $30,291.13 $57,807.50 $53,760.98 2026-05-22
81416 OTHER Exome Sequence Analysis 54 9 — — $12,240.00 $77,430.00 $53,640.00 2026-05-22
MS-020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 36 6 — — $52,379.17 $148,777.83 $52,379.17 2026-05-22
2781949751 OTHER Hc Endoprosthesis Implant Lvl 51 108 13 $55,864.75 — $29,273.13 $55,864.75 $51,954.22 2026-05-22
2782649751 OTHER Hc Valve Implant Lvl 51 108 13 $55,864.75 — $29,273.13 $55,864.75 $51,954.22 2026-05-22
2782669751 OTHER Hc Vascular Stent Graft Implant Lvl 51 108 13 $55,864.75 — $29,273.13 $55,864.75 $51,954.22 2026-05-22
275C262151 OTHER Hc Pacemaker Biv Crt-p Lvl 51 108 13 $55,864.75 — $29,273.13 $55,864.75 $51,954.22 2026-05-22
275C188251 OTHER Hc Icd Biv/crt-d Lvl 51 108 13 $55,864.75 — $29,273.13 $55,864.75 $51,954.22 2026-05-22
275C172251 OTHER Hc Icd Single Chamber Lvl 51 108 13 $55,864.75 — $29,273.13 $55,864.75 $51,954.22 2026-05-22
275C172151 OTHER Hc Icd Dual Chamber Lvl 51 108 13 $55,864.75 — $29,273.13 $55,864.75 $51,954.22 2026-05-22
2781909751 OTHER Hc Embolization Device Implant Lvl 51 108 13 $55,864.75 — $29,273.13 $55,864.75 $51,954.22 2026-05-22
278C187651 OTHER Hc Stent Non Coated/non Covered Implant Lvl 51 108 13 $55,864.75 — $29,273.13 $55,864.75 $51,954.22 2026-05-22
272C188951 OTHER Hc Implantable-insertable Device Noc Non Implant Lvl 51 108 13 $55,864.75 — $29,273.13 $55,864.75 $51,954.22 2026-05-22
278C187451 OTHER Hc Stent Coated/covered Implant Lvl 51 108 13 $55,864.75 — $29,273.13 $55,864.75 $51,954.22 2026-05-22
278C188951 OTHER Hc Implantable-insertable Device Noc Lvl 51 108 13 $55,864.75 — $29,273.13 $55,864.75 $51,954.22 2026-05-22
MS-010 OTHER Pancreas Transplant 36 6 — — $49,423.80 $135,673.17 $51,806.72 2026-05-22
MS-019 OTHER Simultaneous Pancreas And Kidney Transplant With Hemodialysis 36 6 — — $49,140.71 $134,896.08 $51,509.77 2026-05-22
MS-131 OTHER Cranial/facial Procedures W Cc/mcc 10 1 — — $51,324.00 $51,324.00 $51,324.00 2026-05-22
MS-233 OTHER Coronary Bypass With Cardiac Catheterization With Mcc 36 6 — — $50,789.17 $144,550.15 $50,789.17 2026-05-22
L5856 OTHER Elec Knee-shin Swing/stance 30 6 — — $29,862.87 $83,440.36 $50,764.54 2026-05-22
L6880 OTHER Elec Hand Ind Art Digits 30 6 — — $29,802.29 $83,271.10 $50,661.55 2026-05-22
217022 OTHER Risankizumab-rzaa 60 Mg/ml Intravenous Solution 108 13 $54,404.05 — $28,507.72 $54,404.05 $50,595.77 2026-05-22
204992 OTHER Cemiplimab-rwlc 50 Mg/ml Intravenous Solution 108 13 $54,274.78 — $28,439.98 $54,274.78 $50,475.55 2026-05-22
MS-219 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 36 6 — — $50,276.50 $145,175.98 $50,276.50 2026-05-22
210135 OTHER Daratumumab 1,800 Mg-hyaluronidase-fihj 30,000 Unit/15 Ml Subcut Soln 108 13 $53,500.78 — $28,034.41 $53,500.78 $49,755.73 2026-05-22
2721649401 OTHER Hc Oxygenator Perfusion Set Cardiohelp Hls Adv 7 108 13 $53,289.65 — $27,923.78 $53,289.65 $49,559.37 2026-05-22
J9600 OTHER Porfimer Sodium Injection 56 8 — — $24,712.99 $69,051.00 $49,443.55 2026-05-22
MS-957 OTHER Other O.r. Procedures For Multiple Significant Trauma With Mcc 36 6 — — $48,500.65 $144,071.80 $48,500.65 2026-05-22
86371 OTHER Alteplase 100 Mg Intravenous Solution 108 13 $51,218.33 — $26,838.40 $51,218.33 $47,633.05 2026-05-22
7613724201 OTHER Hc Vasc Embolize/occlude Artery 108 13 $50,876.55 — $26,659.31 $50,876.55 $47,315.19 2026-05-22
4819359101 OTHER Hc Perivalvular Leak Initial Device, Aortic Valve 108 13 $50,876.55 — $26,659.31 $50,876.55 $47,315.19 2026-05-22
7613718403 OTHER Hc Thrombectomy Artery Non Intracranial Initial W Fluoro Bilateral 108 13 $50,876.55 — $26,659.31 $50,876.55 $47,315.19 2026-05-22
2782669750 OTHER Hc Vascular Stent Graft Implant Lvl 50 108 13 $50,786.10 — $26,611.92 $50,786.10 $47,231.07 2026-05-22
2781909750 OTHER Hc Embolization Device Implant Lvl 50 108 13 $50,786.10 — $26,611.92 $50,786.10 $47,231.07 2026-05-22
278C188950 OTHER Hc Implantable-insertable Device Noc Lvl 50 108 13 $50,786.10 — $26,611.92 $50,786.10 $47,231.07 2026-05-22
275C188250 OTHER Hc Icd Biv/crt-d Lvl 50 108 13 $50,786.10 — $26,611.92 $50,786.10 $47,231.07 2026-05-22
275C172150 OTHER Hc Icd Dual Chamber Lvl 50 108 13 $50,786.10 — $26,611.92 $50,786.10 $47,231.07 2026-05-22
272C188750 OTHER Hc Catheter Guiding Lvl 50 108 13 $50,786.10 — $26,611.92 $50,786.10 $47,231.07 2026-05-22
272C175750 OTHER Hc Catheter Thromb/embolectomy Lvl 50 108 13 $50,786.10 — $26,611.92 $50,786.10 $47,231.07 2026-05-22
278C187650 OTHER Hc Stent Non Coated/non Covered Implant Lvl 50 108 13 $50,786.10 — $26,611.92 $50,786.10 $47,231.07 2026-05-22
2721489750 OTHER Hc Cardiovascular Non Implant Supply Lvl 50 108 13 $50,786.10 — $26,611.92 $50,786.10 $47,231.07 2026-05-22
33276 OTHER Insj Phrnc Nrv Stim Sys 16 4 — — $45,900.51 $128,251.43 $46,350.52 2026-05-22
0266T OTHER Implt/rpl Crtd Sns Dev Total 16 4 — — $45,900.51 $128,251.43 $46,350.52 2026-05-22
4813326401 OTHER Hc Remove & Replac Defib Pulse Gen Mult Leads 108 13 $49,825.38 — $26,108.50 $49,825.38 $46,337.60 2026-05-22
MS-427 OTHER Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 36 6 — — $46,151.71 $136,484.29 $46,151.71 2026-05-22
MS-275 OTHER Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 36 6 — — $45,919.74 $134,816.67 $45,919.74 2026-05-22
7613722803 OTHER Hcd Revasc Tib-pero Initial Pta Bilateral 108 13 $49,318.50 — $25,842.89 $49,318.50 $45,866.20 2026-05-22
MS-129 OTHER Major Head & Neck Procedures W Cc/mcc Or Major Device 10 1 — — $45,752.00 $45,752.00 $45,752.00 2026-05-22
MS-870 OTHER Septicemia Or Severe Sepsis With Mv >96 Hours 36 6 — — $45,201.74 $130,683.53 $45,201.74 2026-05-22
172923 OTHER Brentuximab Vedotin 50 Mg Intravenous Solution 108 13 $48,397.40 — $25,360.24 $48,397.40 $45,009.58 2026-05-22
K0864 OTHER Pwc Gp3 Xhd Mult Pow Opt S/b 10 1 — — $44,968.47 $44,968.47 $44,968.47 2026-05-22
MS-955 OTHER Craniotomy For Multiple Significant Trauma 36 6 — — $44,368.72 $127,266.98 $44,368.72 2026-05-22
170071 OTHER Ipilimumab 50 Mg/10 Ml (5 Mg/ml) Intravenous Solution 108 13 $47,386.50 — $24,830.53 $47,386.50 $44,069.44 2026-05-22
4819293301 OTHER Hc Perq Trluml C Athrc St Angiop 1 Maj C Art&/brnch 108 13 $47,116.06 — $24,688.82 $47,116.06 $43,817.94 2026-05-22
4819293306 OTHER Hc Revasc Des & Ather With Ptca Initial Art/brnch 108 13 $47,116.06 — $24,688.82 $47,116.06 $43,817.94 2026-05-22
48192933LD OTHER Hc Ptca W Stent/ather Major Art Or Branch-ld 108 13 $47,116.06 — $24,688.82 $47,116.06 $43,817.94 2026-05-22
48192933LM OTHER Hc Ptca W Stent/ather Major Art Or Branch-lm 108 13 $47,116.06 — $24,688.82 $47,116.06 $43,817.94 2026-05-22
48192933RC OTHER Hc Ptca W Stent/ather Major Art Or Branch-rc 108 13 $47,116.06 — $24,688.82 $47,116.06 $43,817.94 2026-05-22
48192933RI OTHER Hc Ptca W Stent/ather Major Art Or Branch-ri 108 13 $47,116.06 — $24,688.82 $47,116.06 $43,817.94 2026-05-22
48192933LC OTHER Hc Ptca W Stent/ather Major Art Or Branch-lc 108 13 $47,116.06 — $24,688.82 $47,116.06 $43,817.94 2026-05-22
200669 OTHER Hemin 350 Mg Intravenous Powder For Solution 108 13 $47,040.00 — $24,648.96 $47,040.00 $43,747.20 2026-05-22
MS-447 OTHER Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 36 6 — — $43,565.60 $126,331.07 $43,565.60 2026-05-22
MS-928 OTHER Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 36 6 — — $43,397.96 $135,616.45 $43,397.96 2026-05-22
MS-268 OTHER Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 36 6 — — $43,324.53 $130,042.57 $43,324.53 2026-05-22
185261 OTHER Obinutuzumab 1,000 Mg/40 Ml Intravenous Solution 108 13 $46,560.00 — $24,397.44 $46,560.00 $43,300.80 2026-05-22
222673 OTHER Toripalimab-tpzi 240 Mg/6 Ml (40 Mg/ml) Intravenous Solution 108 13 $46,410.53 — $24,319.12 $46,410.53 $43,161.79 2026-05-22
278C188949 OTHER Hc Implantable-insertable Device Noc Lvl 49 108 13 $46,169.15 — $24,192.63 $46,169.15 $42,937.31 2026-05-22
2781909749 OTHER Hc Embolization Device Implant Lvl 49 108 13 $46,169.15 — $24,192.63 $46,169.15 $42,937.31 2026-05-22
275C262149 OTHER Hc Pacemaker Biv Crt-p Lvl 49 108 13 $46,169.15 — $24,192.63 $46,169.15 $42,937.31 2026-05-22
2782669749 OTHER Hc Vascular Stent Graft Implant Lvl 49 108 13 $46,169.15 — $24,192.63 $46,169.15 $42,937.31 2026-05-22
275C188249 OTHER Hc Icd Biv/crt-d Lvl 49 108 13 $46,169.15 — $24,192.63 $46,169.15 $42,937.31 2026-05-22
275C178649 OTHER Hc Pacemaker Single Chamber Lvl 49 108 13 $46,169.15 — $24,192.63 $46,169.15 $42,937.31 2026-05-22
275C172249 OTHER Hc Icd Single Chamber Lvl 49 108 13 $46,169.15 — $24,192.63 $46,169.15 $42,937.31 2026-05-22
275C172149 OTHER Hc Icd Dual Chamber Lvl 49 108 13 $46,169.15 — $24,192.63 $46,169.15 $42,937.31 2026-05-22
272C175749 OTHER Hc Catheter Thromb/embolectomy Lvl 49 108 13 $46,169.15 — $24,192.63 $46,169.15 $42,937.31 2026-05-22
2721489749 OTHER Hc Cardiovascular Non Implant Supply Lvl 49 108 13 $46,169.15 — $24,192.63 $46,169.15 $42,937.31 2026-05-22
278C187649 OTHER Hc Stent Non Coated/non Covered Implant Lvl 49 108 13 $46,169.15 — $24,192.63 $46,169.15 $42,937.31 2026-05-22
4810238T01 OTHER Hc Trluml Perip Athrc Iliac Art 108 13 $45,794.00 — $23,996.06 $45,794.00 $42,588.42 2026-05-22
4810237T01 OTHER Hc Trluml Perip Athrec Brchiocph 108 13 $45,794.00 — $23,996.06 $45,794.00 $42,588.42 2026-05-22
4819358201 OTHER Hc Perc Transcath Closure Pda 108 13 $45,284.95 — $23,729.31 $45,284.95 $42,115.00 2026-05-22
7619358301 OTHER Hc Perc Transcath Septal Redux Incl Pmkr 108 13 $45,284.95 — $23,729.31 $45,284.95 $42,115.00 2026-05-22
MS-207 OTHER Respiratory System Diagnosis With Ventilator Support >96 Hours 36 6 — — $42,022.38 $121,662.85 $42,022.38 2026-05-22
MS-460 OTHER Spinal Fusion Except Cervical Without Mcc 10 1 — — $42,020.00 $42,020.00 $42,020.00 2026-05-22
MS-217 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 36 6 — — $41,961.95 $124,321.22 $41,961.95 2026-05-22
4813323001 OTHER Hc Insrt Pulse Gen W/dual Leads 108 13 $44,906.86 — $23,531.19 $44,906.86 $41,763.38 2026-05-22
2721649301 OTHER Hc Pump Blood Centrimag 108 13 $44,856.00 — $23,504.54 $44,856.00 $41,716.08 2026-05-22
99357 OTHER Natalizumab 300 Mg/15 Ml Intravenous Solution 118 13 $45,574.33 — $268.77 $45,574.33 $41,472.64 2026-05-22
MS-969 OTHER HIV With Extensive O.r. Procedures With Mcc 36 6 — — $41,093.85 $115,737.30 $41,093.85 2026-05-22
187069 OTHER Vedolizumab 300 Mg Intravenous Solution 108 13 $44,029.02 — $23,071.21 $44,029.02 $40,946.99 2026-05-22
C9610 OTHER Cath Coronary Drug-delivery 16 4 — — $42.19 $52,937.59 $40,603.04 2026-05-22
L8614 OTHER Cochlear Device 10 1 — — $40,404.39 $40,404.39 $40,404.39 2026-05-22
L2006 OTHER Kaf Sng/dbl Swg/stn Mcpr Cus 30 6 — — $8,671.93 $112,524.84 $40,272.05 2026-05-22
MS-276 OTHER Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 36 6 — — $40,249.79 $113,568.64 $40,249.79 2026-05-22
MS-317 OTHER Concomitant Left Atrial Appendage Closure And Cardiac Ablation 36 6 — — $40,197.80 $126,423.71 $40,197.80 2026-05-22
MS-573 OTHER Skin Graft For Skin Ulcer Or Cellulitis With Mcc 36 6 — — $40,014.57 $123,869.34 $40,014.57 2026-05-22
MS-461 OTHER Bilateral Or Multiple Major Joint Procs Of Lower Extremity W Mcc 36 6 — — $38,040.56 $104,425.06 $39,874.87 2026-05-22
Q0483 OTHER Monitor Elec Vad Rep 30 6 — — $23,387.17 $65,346.51 $39,756.35 2026-05-22
MS-232 OTHER Coronary Bypass With Ptca Without Mcc 36 6 — — $39,692.93 $114,627.45 $39,692.93 2026-05-22
MS-213 OTHER Endovascular Abdominal Aorta With Iliac Branch Procedures 16 4 — — $39,307.20 $107,902.12 $39,692.56 2026-05-22
MS-133 OTHER Other Ear- Nose- Mouth & Throat O.r. Procedures W Cc/mcc 10 1 — — $39,620.00 $39,620.00 $39,620.00 2026-05-22
MS-339 OTHER Appendectomy With Complicated Principal Diagnosis With Cc 10 1 — — $39,592.00 $39,592.00 $39,592.00 2026-05-22
MS-028 OTHER Spinal Procedures With Mcc 36 6 — — $39,503.19 $113,600.78 $39,503.19 2026-05-22
L5858 OTHER Stance Phase Only 30 6 — — $23,135.94 $64,644.53 $39,329.27 2026-05-22
L6975 OTHER Interscap-thor Myoelectronic 30 6 — — $23,106.59 $64,562.53 $39,279.39 2026-05-22
MS-017 OTHER Autolous Bone Marrow Transplant Without Cc/mcc 36 6 — — $37,415.85 $102,710.17 $39,219.89 2026-05-22
MS-016 OTHER Autolous Bone Marrow Transplant With Cc/mcc 36 6 — — $39,219.89 $112,114.66 $39,219.89 2026-05-22
2782669748 OTHER Hc Vascular Stent Graft Implant Lvl 48 108 13 $41,971.90 — $21,993.28 $41,971.90 $39,033.87 2026-05-22
275C188248 OTHER Hc Icd Biv/crt-d Lvl 48 108 13 $41,971.90 — $21,993.28 $41,971.90 $39,033.87 2026-05-22
275C178648 OTHER Hc Pacemaker Single Chamber Lvl 48 108 13 $41,971.90 — $21,993.28 $41,971.90 $39,033.87 2026-05-22
275C172248 OTHER Hc Icd Single Chamber Lvl 48 108 13 $41,971.90 — $21,993.28 $41,971.90 $39,033.87 2026-05-22
278C187448 OTHER Hc Stent Coated/covered Implant Lvl 48 108 13 $41,971.90 — $21,993.28 $41,971.90 $39,033.87 2026-05-22
272C175748 OTHER Hc Catheter Thromb/embolectomy Lvl 48 108 13 $41,971.90 — $21,993.28 $41,971.90 $39,033.87 2026-05-22
275C172148 OTHER Hc Icd Dual Chamber Lvl 48 108 13 $41,971.90 — $21,993.28 $41,971.90 $39,033.87 2026-05-22
MS-266 OTHER Endovascular Cardiac Valve Replacement W Mcc 36 6 — — $38,926.84 $115,871.55 $38,926.84 2026-05-22
202322 OTHER Nivolumab 240 Mg/24 Ml Intravenous Solution 108 13 $41,568.76 — $21,782.03 $41,568.76 $38,658.95 2026-05-22
MS-218 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 36 6 — — $38,657.18 $124,321.22 $38,657.18 2026-05-22
MS-790 OTHER Extreme Immaturity Or Respiratory Distress Syndrome- Neonate 36 6 — — $38,627.94 $112,375.59 $38,627.94 2026-05-22
L8701 OTHER Ewh S/d Uprt Micro Sensor 20 5 — — $34,970.13 $97,710.65 $38,582.05 2026-05-22
J7310 OTHER Ganciclovir Long Act Implant 24 2 — — $80.00 $40,984.00 $38,368.00 2026-05-22
MS-235 OTHER Coronary Bypass Without Cardiac Catheterization With Mcc 36 6 — — $38,234.18 $110,959.43 $38,234.18 2026-05-22
7613723102 OTHER Hc Revasc Tib/pero Stnt Ather Unilateral 108 13 $41,107.55 — $21,540.36 $41,107.55 $38,230.02 2026-05-22
7613690601 OTHER Hc Av Fist W/mech/lytic Thromb W Periph Stenting 108 13 $41,107.55 — $21,540.36 $41,107.55 $38,230.02 2026-05-22
7613722702 OTHER Hc Revas Fem-pop W/ather W Stnt/pta Unilateral 108 13 $41,107.55 — $21,540.36 $41,107.55 $38,230.02 2026-05-22
MS-820 OTHER Lymphoma And Leukemia With Major O.r. Procedures With Mcc 36 6 — — $37,831.97 $110,887.58 $37,831.97 2026-05-22
K0860 OTHER Pwc Gp3 Vhd Sing Pow Opt S/b 10 1 — — $37,788.51 $37,788.51 $37,788.51 2026-05-22
K0863 OTHER Pwc Gp3 Vhd Mult Pow Opt S/b 10 1 — — $37,788.51 $37,788.51 $37,788.51 2026-05-22
7613722902 OTHER Hc Revasc Tib Pero Arther Pta/initial Unilateral 108 13 $40,422.45 — $21,181.36 $40,422.45 $37,592.88 2026-05-22
206181 OTHER Caplacizumab-yhdp 11 Mg Injection Kit 108 13 $40,321.19 — $21,128.30 $40,321.19 $37,498.71 2026-05-22
MS-457 OTHER Spinal Fusion Except Cervical With Spinal Curvature- Malignancy- Infection Or Ex… 36 6 — — $37,293.30 $112,746.17 $37,293.30 2026-05-22
481C976503 OTHER Hc Open Or Perc Intravasc Lithotripsy W/stent Bilat 108 13 $39,916.70 — $20,916.35 $39,916.70 $37,122.53 2026-05-22
MS-023 OTHER Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 36 6 — — $37,070.43 $108,344.55 $37,070.43 2026-05-22
L5973 OTHER Ank-foot Sys Dors-plant Flex 30 6 — — $21,711.59 $60,664.73 $36,908.00 2026-05-22
L6970 OTHER Interscapular-thor Switch CT 30 6 — — $21,566.72 $60,259.94 $36,661.73 2026-05-22
203091 OTHER Tenecteplase 50 Mg Intravenous Solution 108 13 $39,030.32 — $20,451.89 $39,030.32 $36,298.20 2026-05-22
K0854 OTHER Pwc Gp 3 Xhd Seat/back 10 1 — — $36,226.31 $36,226.31 $36,226.31 2026-05-22
MS-653 OTHER Major Bladder Procedures With Mcc 36 6 — — $35,791.05 $98,249.94 $36,222.47 2026-05-22
L6965 OTHER Shldr Disartic Myoelectronic 30 6 — — $21,303.71 $59,525.07 $36,214.64 2026-05-22
0620T OTHER Evasc Ven Artlz Tibl/prnl Vn 16 4 — — $35,700.51 $99,751.43 $36,050.52 2026-05-22
MS-834 OTHER Acute Leukemia Without Major O.r. Procedures With Mcc 36 6 — — $35,915.12 $103,799.23 $35,915.12 2026-05-22
MS-021 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 36 6 — — $35,915.12 $100,091.51 $35,915.12 2026-05-22
A9604 OTHER Sm 153 Lexidronam 52 7 — — $4,401.21 $43,149.63 $35,856.93 2026-05-22
7613723002 OTHER Hc Revasc Tib Pero W/stent Pta Initial Unilateral 108 13 $38,538.35 — $20,194.10 $38,538.35 $35,840.67 2026-05-22
4813326301 OTHER Hc Remove & Replac Defib Pulse Gen Dual Leads 108 13 $38,470.75 — $20,158.67 $38,470.75 $35,777.80 2026-05-22
MS-428 OTHER Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 36 6 — — $35,764.38 $106,296.89 $35,764.38 2026-05-22
MS-430 OTHER Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 36 6 — — $35,546.05 $109,040.34 $35,546.05 2026-05-22
2781949747 OTHER Hc Endoprosthesis Implant Lvl 47 108 13 $38,156.25 — $19,993.88 $38,156.25 $35,485.31 2026-05-22
275C178647 OTHER Hc Pacemaker Single Chamber Lvl 47 108 13 $38,156.25 — $19,993.88 $38,156.25 $35,485.31 2026-05-22
2782669747 OTHER Hc Vascular Stent Graft Implant Lvl 47 108 13 $38,156.25 — $19,993.88 $38,156.25 $35,485.31 2026-05-22
275C188247 OTHER Hc Icd Biv/crt-d Lvl 47 108 13 $38,156.25 — $19,993.88 $38,156.25 $35,485.31 2026-05-22
275C172247 OTHER Hc Icd Single Chamber Lvl 47 108 13 $38,156.25 — $19,993.88 $38,156.25 $35,485.31 2026-05-22
272C175747 OTHER Hc Catheter Thromb/embolectomy Lvl 47 108 13 $38,156.25 — $19,993.88 $38,156.25 $35,485.31 2026-05-22
278C181747 OTHER Hc Septal Defect Implant Lvl 47 108 13 $38,156.25 — $19,993.88 $38,156.25 $35,485.31 2026-05-22
272C173347 OTHER Hc Catheter Ep Diag/abl Non-3d/map/cool-tip Lvl 47 108 13 $38,156.25 — $19,993.88 $38,156.25 $35,485.31 2026-05-22
272A464947 OTHER Hc Surgical Supply Non Implant Lvl 47 108 13 $38,156.25 — $19,993.88 $38,156.25 $35,485.31 2026-05-22
278C187447 OTHER Hc Stent Coated/covered Implant Lvl 47 108 13 $38,156.25 — $19,993.88 $38,156.25 $35,485.31 2026-05-22
MS-008 OTHER Simultaneous Pancreas/kidney Transplant 36 6 — — $35,355.02 $105,967.90 $35,355.02 2026-05-22
MS-405 OTHER Pancreas- Liver And Shunt Procedures With Mcc 36 6 — — $35,274.44 $103,432.43 $35,274.44 2026-05-22
210663 OTHER Lurbinectedin 4 Mg Intravenous Solution 108 13 $37,773.12 — $19,793.11 $37,773.12 $35,129.00 2026-05-22
MS-463 OTHER Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 36 6 — — $35,094.46 $107,762.20 $35,094.46 2026-05-22
MS-011 OTHER Tracheostomy For Facemouth & Neck Diagnoses W Mcc 36 6 — — $35,061.32 $103,122.35 $35,061.32 2026-05-22
MS-576 OTHER Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 36 6 — — $33,757.81 $92,668.50 $35,057.42 2026-05-22
MS-234 OTHER Coronary Bypass With Cardiac Catheterization Without Mcc 36 6 — — $34,569.44 $103,284.95 $34,569.44 2026-05-22
MS-342 OTHER Appendectomy Without Complicated Principal Diagnosis With Cc 10 1 — — $34,552.00 $34,552.00 $34,552.00 2026-05-22
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