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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

NEBRASKA ORTHOPAEDIC HOSPITAL

Omaha, NE · CCN 280129 · Rates published

37,815 distinct procedures filed
23 distinct payers
1,566,180 rate rows
2025-12-27 last MRF observed
Data quality

1,091,350 of 1,566,180 rate rows are consumer-grade (69.7%)

474,830 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 471,990
template filing: same amount across many unrelated codes — excluded 1,686
placeholder amount (≤ $0.02) — excluded from medians 668
percent-of-charges filed in the dollar field — excluded from medians 324
exceeds 10× this hospital's gross charge — excluded from medians 158
per-diem day rate — not a per-procedure price 4
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://orthonebraska.pt.panaceainc.com/MRFDownload/orthonebraska/orthonebraska
Found on page https://orthonebraska.com/patients-visitors/billing-insurance/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-18
Content fingerprint d6e2e93fafb5bdad… · 8,663,141 bytes · first seen 2026-05-09

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
J3391
HCPCS 		Inj, Atidarsagene Autotemcel 6 $4,266,136.40 $4,465,050.00 $4,266,136.40 nat. median
$4,505,000
0.9× median
J1414
HCPCS 		Inj, Beqvez, Per Tx Dose 7 $3,615,617.60 $4,700,302.88 $3,615,617.60 nat. median
$3,710,000
1.0× median
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 7 $3,591,513.49 $4,668,967.53 $3,591,513.49 nat. median
$3,710,000
1.0× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 10 $3,239,994.79 $4,986,857.85 $3,391,063.34 nat. median
$3,325,455
1.0× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 10 $3,178,386.13 $4,892,032.50 $3,326,582.10 nat. median
$3,286,000
1.0× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 10 $2,875,621.20 $4,426,030.01 $3,009,700.40 nat. median
$3,006,423
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 11 $25,235.55 $3,678,173.40 $2,401,682.45 nat. median
$2,469,189
1.0× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 10 $2,272,673.92 $3,498,000.00 $2,378,640.00 nat. median
$2,448,600
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel 12 $751,015.43 $2,311,860.00 $973,650.63 nat. median
$824,563
1.2× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 13 $65,239.56 $1,775,178.60 $658,413.16 nat. median
$754,974
0.9× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 13 $65,239.56 $1,697,606.84 $632,768.77 nat. median
$675,122
0.9× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 13 $65,239.56 $1,687,614.56 $619,340.88 nat. median
$674,188
0.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 13 $65,239.56 $1,671,953.80 $618,911.84 nat. median
$625,184
1.0× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 14 $65,239.56 $1,599,690.51 $602,217.83 nat. median
$634,511
0.9× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 13 $65,239.56 $1,467,913.82 $558,019.10 nat. median
$620,080
0.9× median
5834
APR_DRG 		5 $194,159.70 $570,783.64 $472,816.54 nat. median
$309,665
1.5× median
J3402
HCPCS 		Inj. Remestemcel-l-rknd/ Td 2 $259,106.40 $616,920.00 $438,013.20 nat. median
$209,753
outlier · 2.1×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell Immunotherapy 12 $216,342.87 $601,330.60 $378,315.39 nat. median
$370,174
1.0× median
Q2058
HCPCS 		Obecbtge Autol Up To 400 Mil 11 $263,496.66 $587,597.55 $309,164.08 nat. median
$324,450
1.0× median
5884
APR_DRG 		5 $154,850.47 $540,890.14 $289,591.51 nat. median
$246,434
1.2× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 12 $161,589.99 $449,143.54 $282,569.88 nat. median
$265,286
1.1× median
0114
APR_DRG 		4 $270,719.54 $3,559,708.49 $270,719.54 nat. median
$197,700
1.4× median
0024
APR_DRG 		5 $133,214.63 $584,291.71 $270,540.72 nat. median
$372,987
0.7× median
5833
APR_DRG 		5 $176,508.67 $484,090.59 $269,284.70 nat. median
$244,017
1.1× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 12 $136,087.98 $378,260.05 $237,974.91 nat. median
$206,368
1.2× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 12 $122,944.30 $341,726.86 $214,990.77 nat. median
$202,986
1.1× median
5832
APR_DRG 		5 $104,290.20 $307,646.82 $206,760.87 nat. median
$156,126
1.3× median
1614
APR_DRG 		5 $137,756.73 $463,292.31 $201,889.94 nat. median
$207,730
1.0× median
6094
APR_DRG 		5 $122,500.10 $308,952.64 $201,765.88 nat. median
$162,982
1.2× median
0113
APR_DRG 		4 $201,473.27 $1,752,174.76 $201,473.27 nat. median
$128,705
1.6× median
0094
APR_DRG 		5 $95,944.52 $271,710.09 $197,917.39 nat. median
$166,008
1.2× median
6314
APR_DRG 		5 $93,506.21 $209,765.06 $194,062.06 nat. median
$122,924
1.6× median
5883
APR_DRG 		5 $106,235.90 $322,994.05 $192,867.64 nat. median
$182,736
1.1× median
5914
APR_DRG 		5 $132,972.72 $271,835.36 $189,899.56 nat. median
$164,279
1.2× median
5831
APR_DRG 		5 $104,065.85 $265,862.35 $185,593.33 nat. median
$145,122
1.3× median
8414
APR_DRG 		5 $94,640.73 $314,519.48 $179,586.16 nat. median
$160,267
1.1× median
6304
APR_DRG 		5 $100,219.16 $182,033.38 $175,994.35 nat. median
$150,721
1.2× median
5934
APR_DRG 		5 $116,388.35 $340,799.19 $166,958.36 nat. median
$151,838
1.1× median
5882
APR_DRG 		5 $95,763.28 $316,273.23 $165,266.84 nat. median
$145,336
1.1× median
E0766
HCPCS 		Elec Stim Cancer Treatment 1 $161,763.99 $161,763.99 $161,763.99 nat. median
$16,785
outlier · 9.6×
E0766NU
HCPCS 		Elec Stim Cancer Treatment 1 $161,763.99 $161,763.99 $161,763.99 —
0112
APR_DRG 		4 $160,168.32 $928,129.59 $160,168.32 nat. median
$93,442
1.7× median
0074
APR_DRG 		5 $126,864.16 $330,696.13 $159,283.63 nat. median
$178,275
0.9× median
1613
APR_DRG 		5 $110,050.65 $333,140.76 $158,084.08 nat. median
$119,796
1.3× median
0044
APR_DRG 		5 $89,004.83 $255,738.42 $152,101.72 nat. median
$195,681
0.8× median
0014
APR_DRG 		5 $99,225.95 $419,904.03 $150,589.02 nat. median
$190,591
0.8× median
0023
APR_DRG 		5 $94,934.55 $365,011.97 $147,367.69 nat. median
$167,082
0.9× median
5913
APR_DRG 		5 $106,437.89 $191,479.73 $143,217.17 nat. median
$102,636
1.4× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 12 $81,058.02 $225,302.85 $141,744.89 nat. median
$133,176
1.1× median
5881
APR_DRG 		5 $86,187.28 $208,184.03 $141,657.41 nat. median
$124,573
1.1× median

Other procedures at this hospital

Browse this hospital's 37,815 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 HCPCS Inj, Atidarsagene Autotemcel 14 6 — — $4,266,136.40 $4,465,050.00 $4,266,136.40 2025-12-27
J1414 HCPCS Inj, Beqvez, Per Tx Dose 18 7 — — $3,615,617.60 $4,700,302.88 $3,615,617.60 2025-12-27
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 18 7 — — $3,591,513.49 $4,668,967.53 $3,591,513.49 2025-12-27
J1413 HCPCS Inj Delandistrogene Mox Rokl 26 10 — — $3,239,994.79 $4,986,857.85 $3,391,063.34 2025-12-27
J3394 HCPCS Inj, Lovotibeglogene Autotem 26 10 — — $3,178,386.13 $4,892,032.50 $3,326,582.10 2025-12-27
J3393 HCPCS Inj, Betibeglogene Autotemce 26 10 — — $2,875,621.20 $4,426,030.01 $3,009,700.40 2025-12-27
J3392 HCPCS Inj, Exagamglogene Autotem 26 10 — — $2,272,673.92 $3,498,000.00 $2,378,640.00 2025-12-27
Q2057 HCPCS Afamitresgene Autoleucel 32 12 — — $751,015.43 $2,311,860.00 $973,650.63 2025-12-27
0114 APR_DRG — 10 4 — — $270,719.54 $3,559,708.49 $270,719.54 2025-12-27
Q2058 HCPCS Obecbtge Autol Up To 400 Mil 28 11 — — $263,496.66 $587,597.55 $309,164.08 2025-12-27
J3402 HCPCS Inj. Remestemcel-l-rknd/ Td 4 2 — — $259,106.40 $616,920.00 $438,013.20 2025-12-27
18 MS_DRG Chimeric Antigen Receptor (car) T-cell Immunotherapy 36 12 — — $216,342.87 $601,330.60 $378,315.39 2025-12-27
0113 APR_DRG — 10 4 — — $201,473.27 $1,752,174.76 $201,473.27 2025-12-27
5834 APR_DRG — 12 5 — — $194,159.70 $570,783.64 $472,816.54 2025-12-27
5833 APR_DRG — 12 5 — — $176,508.67 $484,090.59 $269,284.70 2025-12-27
E0766NU HCPCS Elec Stim Cancer Treatment 2 1 — — $161,763.99 $161,763.99 $161,763.99 2025-12-27
E0766 HCPCS Elec Stim Cancer Treatment 2 1 — — $161,763.99 $161,763.99 $161,763.99 2025-12-27
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 36 12 — — $161,589.99 $449,143.54 $282,569.88 2025-12-27
0112 APR_DRG — 10 4 — — $160,168.32 $928,129.59 $160,168.32 2025-12-27
5884 APR_DRG — 12 5 — — $154,850.47 $540,890.14 $289,591.51 2025-12-27
1614 APR_DRG — 12 5 — — $137,756.73 $463,292.31 $201,889.94 2025-12-27
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 36 12 — — $136,087.98 $378,260.05 $237,974.91 2025-12-27
0024 APR_DRG — 12 5 — — $133,214.63 $584,291.71 $270,540.72 2025-12-27
5914 APR_DRG — 12 5 — — $132,972.72 $271,835.36 $189,899.56 2025-12-27
0074 APR_DRG — 12 5 — — $126,864.16 $330,696.13 $159,283.63 2025-12-27
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 36 12 — — $122,944.30 $341,726.86 $214,990.77 2025-12-27
6094 APR_DRG — 12 5 — — $122,500.10 $308,952.64 $201,765.88 2025-12-27
5891 APR_DRG — 12 5 — — $117,249.83 $229,811.74 $134,989.72 2025-12-27
5934 APR_DRG — 12 5 — — $116,388.35 $340,799.19 $166,958.36 2025-12-27
1613 APR_DRG — 12 5 — — $110,050.65 $333,140.76 $158,084.08 2025-12-27
5913 APR_DRG — 12 5 — — $106,437.89 $191,479.73 $143,217.17 2025-12-27
5883 APR_DRG — 12 5 — — $106,235.90 $322,994.05 $192,867.64 2025-12-27
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 12 3 — — $104,607.34 $109,449.00 $105,560.29 2025-12-27
5832 APR_DRG — 12 5 — — $104,290.20 $307,646.82 $206,760.87 2025-12-27
5831 APR_DRG — 12 5 — — $104,065.85 $265,862.35 $185,593.33 2025-12-27
6304 APR_DRG — 12 5 — — $100,219.16 $182,033.38 $175,994.35 2025-12-27
0014 APR_DRG — 12 5 — — $99,225.95 $419,904.03 $150,589.02 2025-12-27
6024 APR_DRG — 12 5 — — $98,259.08 $210,905.76 $125,775.77 2025-12-27
5912 APR_DRG — 12 5 — — $96,219.11 $122,839.35 $122,839.35 2025-12-27
0094 APR_DRG — 12 5 — — $95,944.52 $271,710.09 $197,917.39 2025-12-27
5882 APR_DRG — 12 5 — — $95,763.28 $316,273.23 $165,266.84 2025-12-27
0023 APR_DRG — 12 5 — — $94,934.55 $365,011.97 $147,367.69 2025-12-27
8414 APR_DRG — 12 5 — — $94,640.73 $314,519.48 $179,586.16 2025-12-27
6314 APR_DRG — 12 5 — — $93,506.21 $209,765.06 $194,062.06 2025-12-27
8513 APR_DRG — 8 3 — — $92,776.13 $92,776.13 $92,776.13 2025-12-27
8514 APR_DRG — 8 3 — — $92,776.13 $92,776.13 $92,776.13 2025-12-27
850 MS_DRG Acute Leukemia With Other Procedures 10 2 — — $91,990.03 $92,828.04 $92,828.04 2025-12-27
5933 APR_DRG — 12 5 — — $89,146.94 $264,152.25 $122,135.19 2025-12-27
0044 APR_DRG — 12 5 — — $89,004.83 $255,738.42 $152,101.72 2025-12-27
5881 APR_DRG — 12 5 — — $86,187.28 $208,184.03 $141,657.41 2025-12-27
0064 APR_DRG — 12 5 — — $83,354.55 $261,153.41 $98,364.05 2025-12-27
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 12 3 — — $83,289.23 $109,449.00 $84,047.98 2025-12-27
5892 APR_DRG — 12 5 — — $82,244.78 $190,779.37 $134,989.72 2025-12-27
0073 APR_DRG — 12 5 — — $81,620.43 $243,870.22 $101,306.46 2025-12-27
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 36 12 — — $81,058.02 $225,302.85 $141,744.89 2025-12-27
1612 APR_DRG — 12 5 — — $79,436.00 $294,861.89 $116,318.82 2025-12-27
6074 APR_DRG — 12 5 — — $79,396.08 $248,004.07 $97,225.25 2025-12-27
6034 APR_DRG — 12 5 — — $76,886.71 $262,836.94 $91,993.26 2025-12-27
1611 APR_DRG — 12 5 — — $76,488.31 $280,118.23 $116,318.82 2025-12-27
5932 APR_DRG — 12 5 — — $76,434.02 $163,127.41 $98,236.57 2025-12-27
14 MS_DRG Allogeneic Bone Marrow Transplant 36 12 — — $75,159.65 $208,908.20 $131,430.51 2025-12-27
7 MS_DRG Lung Transplant 36 12 — — $74,970.35 $208,382.02 $131,099.48 2025-12-27
1604 APR_DRG — 12 5 — — $73,933.43 $160,337.35 $115,895.30 2025-12-27
Q0480 HCPCS Driver Pneumatic Vad, Rep 4 2 — — $73,762.20 $141,013.16 $107,387.68 2025-12-27
0022 APR_DRG — 12 5 — — $73,073.56 $212,287.50 $111,592.49 2025-12-27
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 12 3 — — $70,927.56 $72,819.00 $71,573.69 2025-12-27
455S MS_DRG Combined A/p Spinal Fusion (360) (22633, 22612) 2 1 — — $70,241.00 $70,241.00 $70,241.00 2025-12-27
6114 APR_DRG — 12 5 — — $69,428.06 $145,470.31 $80,862.76 2025-12-27
6023 APR_DRG — 12 5 — — $69,234.05 $195,252.95 $87,327.67 2025-12-27
0084 APR_DRG — 12 5 — — $67,831.26 $202,453.97 $70,844.54 2025-12-27
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 12 3 — — $66,953.13 $72,819.00 $67,563.06 2025-12-27
2994 APR_DRG — 8 3 — — $66,778.72 $66,778.72 $66,778.72 2025-12-27
Q2042 HCPCS Tisagenlecleucel Car-pos T 40 13 — — $65,239.56 $1,775,178.60 $658,413.16 2025-12-27
Q2056 HCPCS Ciltacabtagene Car-pos T 40 13 — — $65,239.56 $1,697,606.84 $632,768.77 2025-12-27
Q2054 HCPCS Lisocabtagene Mara Car Pos T 40 13 — — $65,239.56 $1,687,614.56 $619,340.88 2025-12-27
Q2055 HCPCS Idecabtagene Vicleucel Car 40 13 — — $65,239.56 $1,671,953.80 $618,911.84 2025-12-27
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 42 14 — — $65,239.56 $1,599,690.51 $602,217.83 2025-12-27
Q2053 HCPCS Brexucabtagene Car Pos T 40 13 — — $65,239.56 $1,467,913.82 $558,019.10 2025-12-27
C9076 HCPCS Lisocabtagene Car Pos T 8 3 — — $65,239.56 $65,239.56 $65,239.56 2025-12-27
C9073 HCPCS Brexucabtagene Autoleucel Ca 8 3 — — $65,239.56 $65,239.56 $65,239.56 2025-12-27
C9081 HCPCS Idecabtagene Car Pos T 8 3 — — $65,239.56 $65,239.56 $65,239.56 2025-12-27
C9098 HCPCS Ciltacabtagene Car Pos T 8 3 — — $65,239.56 $65,239.56 $65,239.56 2025-12-27
0043 APR_DRG — 12 5 — — $64,278.38 $154,677.51 $104,885.44 2025-12-27
8634 APR_DRG — 12 5 — — $64,248.84 $150,811.28 $79,087.39 2025-12-27
1624 APR_DRG — 12 5 — — $64,091.56 $173,826.43 $77,886.12 2025-12-27
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 36 12 — — $63,215.50 $175,709.12 $110,543.96 2025-12-27
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 36 12 — — $62,493.84 $173,703.24 $109,281.99 2025-12-27
6214 APR_DRG — 12 5 — — $62,323.90 $245,734.06 $62,468.21 2025-12-27
J9029 HCPCS Instill Adstiladrin, Tx Dose 32 12 — — $61,817.36 $190,026.85 $80,086.93 2025-12-27
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 10 2 — — $61,777.39 $62,340.17 $62,340.17 2025-12-27
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 36 12 — — $61,091.24 $169,804.68 $106,829.29 2025-12-27
215 MS_DRG Other Heart Assist System Implant 36 12 — — $60,778.02 $168,934.09 $106,281.57 2025-12-27
6093 APR_DRG — 12 5 — — $60,440.47 $141,199.81 $69,990.65 2025-12-27
3034 APR_DRG — 12 5 — — $60,230.49 $119,365.22 $77,509.66 2025-12-27
4404 APR_DRG — 12 5 — — $59,952.65 $288,420.08 $76,265.62 2025-12-27
6134 APR_DRG — 12 5 — — $59,876.80 $128,350.35 $80,120.10 2025-12-27
0054 APR_DRG — 12 5 — — $59,809.74 $242,566.30 $105,960.07 2025-12-27
0072 APR_DRG — 12 5 — — $59,206.15 $224,011.45 $71,340.78 2025-12-27
8424 APR_DRG — 12 5 — — $58,912.33 $156,829.84 $100,542.41 2025-12-27
0063 APR_DRG — 12 5 — — $58,062.84 $193,577.02 $75,805.30 2025-12-27
6303 APR_DRG — 12 5 — — $57,138.29 $114,652.49 $97,012.21 2025-12-27
0021 APR_DRG — 12 5 — — $56,715.14 $181,987.83 $98,630.15 2025-12-27
L7180NU HCPCS Electronic Elbow Sequential 2 1 — — $56,530.07 $56,530.07 $56,530.07 2025-12-27
6084 APR_DRG — 12 5 — — $55,454.00 $113,984.39 $55,454.00 2025-12-27
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 36 12 — — $55,364.40 $153,886.79 $96,814.87 2025-12-27
6022 APR_DRG — 12 5 — — $55,238.90 $153,335.62 $69,780.17 2025-12-27
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 12 3 — — $54,963.94 $57,242.00 $55,464.65 2025-12-27
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 12 3 — — $54,628.41 $57,242.00 $55,126.06 2025-12-27
1784 APR_DRG — 12 5 — — $54,454.07 $248,017.35 $64,808.28 2025-12-27
0093 APR_DRG — 12 5 — — $54,375.03 $146,461.07 $133,013.29 2025-12-27
0071 APR_DRG — 12 5 — — $54,347.08 $134,556.81 $62,975.58 2025-12-27
0013 APR_DRG — 12 5 — — $54,119.54 $306,889.52 $78,182.16 2025-12-27
1634 APR_DRG — 12 5 — — $53,931.12 $102,638.15 $68,153.67 2025-12-27
6144 APR_DRG — 12 5 — — $53,458.74 $155,708.12 $53,458.74 2025-12-27
6334 APR_DRG — 12 5 — — $53,324.33 $345,343.00 $63,531.72 2025-12-27
0111 APR_DRG — 10 4 — — $53,054.79 $78,883.75 $78,883.75 2025-12-27
0062 APR_DRG — 12 5 — — $52,634.52 $159,409.22 $65,352.44 2025-12-27
A9543 HCPCS Y90 Ibritumomab, Rx 42 15 — — $52,343.27 $123,495.02 $57,961.04 2025-12-27
1674 APR_DRG — 12 5 — — $52,237.71 $120,204.14 $59,992.96 2025-12-27
2993 APR_DRG — 8 3 — — $52,218.12 $52,218.12 $52,218.12 2025-12-27
6033 APR_DRG — 12 5 — — $52,092.35 $133,391.44 $52,092.35 2025-12-27
0012 APR_DRG — 12 5 — — $51,840.11 $184,176.23 $60,419.91 2025-12-27
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 10 2 — — $51,428.90 $51,897.40 $51,897.40 2025-12-27
6124 APR_DRG — 12 5 — — $50,949.89 $173,405.08 $63,698.56 2025-12-27
3004 APR_DRG — 8 3 — — $50,944.99 $50,944.99 $50,944.99 2025-12-27
1834 APR_DRG — 12 5 — — $50,941.11 $138,280.69 $58,328.82 2025-12-27
6073 APR_DRG — 12 5 — — $50,677.64 $185,797.12 $66,658.94 2025-12-27
0042 APR_DRG — 12 5 — — $49,298.00 $131,225.82 $67,025.99 2025-12-27
231 MS_DRG Coronary Bypass With Ptca With Mcc 36 12 — — $48,611.29 $135,116.34 $85,005.80 2025-12-27
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 36 12 — — $48,584.33 $135,041.39 $84,958.65 2025-12-27
3033 APR_DRG — 12 5 — — $48,529.14 $68,844.26 $53,791.57 2025-12-27
0011 APR_DRG — 12 5 — — $48,062.88 $127,221.04 $53,080.57 2025-12-27
3044 APR_DRG — 12 5 — — $47,563.88 $99,707.63 $54,663.43 2025-12-27
1654 APR_DRG — 12 5 — — $47,255.69 $101,698.64 $61,229.30 2025-12-27
6804 APR_DRG — 12 5 — — $46,819.77 $127,374.78 $56,528.64 2025-12-27
8504 APR_DRG — 12 5 — — $46,782.24 $123,400.37 $52,736.62 2025-12-27
0053 APR_DRG — 12 5 — — $46,629.75 $136,849.60 $76,897.91 2025-12-27
460A MS_DRG Plif Posterior Lumbar Interbody Fusion - Single Level (22630) 2 1 — — $46,291.00 $46,291.00 $46,291.00 2025-12-27
460B MS_DRG Alif Anterior Lumbar Interbody Fusion - Single Level (22558, 22845) 2 1 — — $46,291.00 $46,291.00 $46,291.00 2025-12-27
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 36 12 — — $46,243.23 $128,534.24 $80,864.80 2025-12-27
4284 APR_DRG — 8 3 — — $45,872.14 $45,872.14 $45,872.14 2025-12-27
10 MS_DRG Pancreas Transplant 36 12 — — $45,737.83 $127,129.49 $79,981.03 2025-12-27
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 36 12 — — $45,475.67 $126,400.80 $79,522.59 2025-12-27
0061 APR_DRG — 12 5 — — $45,393.00 $125,304.06 $45,393.00 2025-12-27
9104 APR_DRG — 12 5 — — $45,318.78 $120,574.25 $58,156.84 2025-12-27
233 MS_DRG Coronary Bypass With Cardiac Catheterization With Mcc 36 12 — — $44,839.48 $124,632.50 $78,410.10 2025-12-27
8413 APR_DRG — 12 5 — — $44,759.90 $109,603.81 $58,404.11 2025-12-27
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 36 12 — — $44,386.87 $123,374.44 $77,618.62 2025-12-27
6814 APR_DRG — 12 5 — — $44,252.91 $131,487.75 $47,293.29 2025-12-27
0914 APR_DRG — 12 5 — — $44,045.33 $120,999.40 $53,559.70 2025-12-27
6904 APR_DRG — 12 5 — — $43,936.75 $117,036.37 $50,529.17 2025-12-27
33276 HCPCS Insj Phrnc Nrv Stim Sys 28 11 — — $43,855.69 $97,798.18 $50,872.60 2025-12-27
2604 APR_DRG — 12 5 — — $43,789.84 $152,572.63 $49,135.40 2025-12-27
1794 APR_DRG — 12 5 — — $43,591.84 $105,350.39 $53,873.71 2025-12-27
5204 APR_DRG — 8 3 — — $43,311.33 $43,311.33 $43,311.33 2025-12-27
6954 APR_DRG — 12 5 — — $43,096.03 $80,243.64 $46,506.14 2025-12-27
1664 APR_DRG — 12 5 — — $42,960.30 $88,824.50 $54,585.57 2025-12-27
0454T HCPCS Insj/rplcmt Subq Electrode 10 4 — — $42,925.84 $91,360.37 $42,925.84 2025-12-27
0453T HCPCS Insj/rplcmt Mech-elec Ntrfce 10 4 — — $42,925.84 $91,360.37 $42,925.84 2025-12-27
0452T HCPCS Insj/rplcmt Dev Vasc Seal 10 4 — — $42,925.84 $91,360.37 $42,925.84 2025-12-27
0451T HCPCS Insj/rplcmt Aortic Ventr Sys 10 4 — — $42,925.84 $91,360.37 $42,925.84 2025-12-27
0459T HCPCS Relocaj Rplcmt Aortic Ventr 10 4 — — $42,925.84 $91,360.37 $42,925.84 2025-12-27
33995 HCPCS Insj Perq Vad R Hrt Venous 10 4 — — $42,925.84 $91,360.37 $42,925.84 2025-12-27
6313 APR_DRG — 12 5 — — $42,917.99 $80,554.92 $57,037.72 2025-12-27
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 36 12 — — $42,819.06 $119,016.67 $74,877.01 2025-12-27
0083 APR_DRG — 12 5 — — $42,707.21 $123,009.38 $49,863.51 2025-12-27
1623 APR_DRG — 12 5 — — $42,420.58 $113,208.11 $56,973.55 2025-12-27
1694 APR_DRG — 12 5 — — $42,255.32 $116,104.46 $48,666.53 2025-12-27
0214 APR_DRG — 12 5 — — $42,223.38 $112,488.77 $52,662.18 2025-12-27
6083 APR_DRG — 12 5 — — $41,533.56 $112,874.06 $47,868.25 2025-12-27
4414 APR_DRG — 12 5 — — $41,123.18 $118,797.72 $42,874.12 2025-12-27
0894 APR_DRG — 12 5 — — $40,985.86 $113,593.40 $45,979.09 2025-12-27
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 36 12 — — $40,540.48 $112,683.32 $70,892.51 2025-12-27
0924 APR_DRG — 12 5 — — $40,306.42 $88,718.21 $43,829.82 2025-12-27
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 36 12 — — $39,906.59 $110,921.39 $69,784.02 2025-12-27
6113 APR_DRG — 12 5 — — $39,648.54 $136,097.99 $43,124.81 2025-12-27
3124 APR_DRG — 12 5 — — $39,645.35 $124,607.50 $47,204.31 2025-12-27
0041 APR_DRG — 12 5 — — $39,441.75 $94,374.25 $46,371.81 2025-12-27
955 MS_DRG Craniotomy For Multiple Significant Trauma 36 12 — — $39,171.16 $108,877.24 $68,497.99 2025-12-27
1204 APR_DRG — 12 5 — — $38,989.86 $87,431.37 $47,370.29 2025-12-27
6072 APR_DRG — 12 5 — — $38,877.28 $135,019.92 $49,787.36 2025-12-27
9114 APR_DRG — 12 5 — — $38,836.57 $162,992.65 $55,315.40 2025-12-27
6032 APR_DRG — 12 5 — — $38,820.60 $83,126.71 $42,503.64 2025-12-27
4403 APR_DRG — 12 5 — — $38,754.33 $190,115.07 $51,851.93 2025-12-27
7404 APR_DRG — 12 5 — — $38,533.97 $114,155.21 $47,886.22 2025-12-27
0092 APR_DRG — 12 5 — — $38,494.05 $89,646.34 $66,759.05 2025-12-27
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 36 12 — — $38,314.11 $106,495.06 $66,999.29 2025-12-27
0234 APR_DRG — 12 5 — — $38,312.02 $104,443.14 $48,016.27 2025-12-27
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 36 12 — — $38,249.29 $106,314.88 $66,885.93 2025-12-27
2204 APR_DRG — 12 5 — — $37,986.27 $127,714.52 $46,658.43 2025-12-27
1783 APR_DRG — 12 5 — — $37,943.96 $124,702.40 $52,293.42 2025-12-27
9124 APR_DRG — 12 5 — — $37,778.69 $110,833.71 $51,431.83 2025-12-27
1603 APR_DRG — 12 5 — — $37,612.62 $57,830.16 $53,717.13 2025-12-27
2614 APR_DRG — 12 5 — — $37,109.63 $98,464.44 $45,687.33 2025-12-27
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 36 12 — — $37,099.67 $103,119.50 $64,875.62 2025-12-27
0052 APR_DRG — 12 5 — — $37,066.51 $91,073.63 $51,274.40 2025-12-27
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 36 12 — — $37,046.32 $102,971.22 $64,782.32 2025-12-27
0274 APR_DRG — 12 5 — — $37,001.84 $105,464.27 $44,321.79 2025-12-27
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 36 12 — — $36,279.92 $100,840.96 $63,442.12 2025-12-27
0204 APR_DRG — 12 5 — — $35,872.91 $90,276.47 $46,006.47 2025-12-27
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 36 12 — — $35,534.73 $98,769.71 $62,139.03 2025-12-27
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 36 12 — — $35,327.07 $98,192.50 $61,775.90 2025-12-27
1304 APR_DRG — 12 5 — — $35,216.62 $117,583.00 $46,813.30 2025-12-27
461 MS_DRG Bilateral Or Multiple Major Joint Procs Of Lower Extremity W Mcc 36 12 — — $35,203.73 $97,849.68 $61,560.21 2025-12-27
6123 APR_DRG — 12 5 — — $35,165.52 $121,950.30 $44,111.31 2025-12-27
6234 APR_DRG — 12 5 — — $35,062.53 $77,743.98 $44,623.82 2025-12-27
6092 APR_DRG — 12 5 — — $35,061.73 $74,244.07 $45,669.36 2025-12-27
232 MS_DRG Coronary Bypass With Ptca Without Mcc 36 12 — — $35,043.11 $97,403.22 $61,279.34 2025-12-27
9504 APR_DRG — 12 5 — — $35,028.20 $154,172.64 $45,680.48 2025-12-27
6302 APR_DRG — 12 5 — — $34,991.47 $89,429.96 $44,213.13 2025-12-27
28 MS_DRG Spinal Procedures With Mcc 36 12 — — $34,875.60 $96,937.63 $60,986.42 2025-12-27
0091 APR_DRG — 12 5 — — $34,644.97 $81,135.70 $48,886.42 2025-12-27
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 36 12 — — $34,625.48 $96,242.43 $60,549.04 2025-12-27
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 36 12 — — $34,625.48 $96,242.43 $60,549.04 2025-12-27
6133 APR_DRG — 12 5 — — $34,579.50 $83,694.21 $43,295.07 2025-12-27
1833 APR_DRG — 12 5 — — $34,474.11 $94,584.93 $42,384.71 2025-12-27
266 MS_DRG Endovascular Cardiac Valve Replacement W Mcc 36 12 — — $34,366.76 $95,523.31 $60,096.62 2025-12-27
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 46 16 — — $34,364.93 $165,816.97 $59,212.09 2025-12-27
J9226 HCPCS Supprelin La Implant 44 16 — — $34,364.93 $135,061.95 $51,598.81 2025-12-27
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 36 12 — — $34,128.69 $94,861.59 $59,680.32 2025-12-27
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 36 12 — — $34,102.88 $94,789.84 $59,635.17 2025-12-27
4402 APR_DRG — 12 5 — — $34,078.10 $172,702.82 $44,188.32 2025-12-27
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 36 12 — — $33,755.24 $93,823.57 $59,027.26 2025-12-27
1633 APR_DRG — 12 5 — — $33,752.36 $79,199.74 $48,995.93 2025-12-27
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 36 12 — — $33,400.15 $92,836.57 $58,406.32 2025-12-27
1782 APR_DRG — 12 5 — — $32,992.28 $111,376.54 $42,578.08 2025-12-27
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 36 12 — — $32,924.58 $91,514.73 $57,574.71 2025-12-27
L7181 HCPCS Electronic Elbo Simultaneous 4 2 — — $32,815.43 $62,734.14 $47,774.79 2025-12-27
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 36 12 — — $32,727.82 $90,967.82 $57,230.62 2025-12-27
3614 APR_DRG — 12 5 — — $32,671.32 $90,593.44 $45,927.75 2025-12-27
1653 APR_DRG — 12 5 — — $32,543.58 $83,866.93 $45,500.81 2025-12-27
653 MS_DRG Major Bladder Procedures With Mcc 36 12 — — $31,979.19 $88,887.00 $55,921.52 2025-12-27
834 MS_DRG Acute Leukemia Without Major O.r. Procedures With Mcc 36 12 — — $31,707.85 $88,132.80 $55,447.03 2025-12-27
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 36 12 — — $31,707.85 $88,132.80 $55,447.03 2025-12-27
1622 APR_DRG — 12 5 — — $31,632.60 $101,998.52 $43,072.62 2025-12-27
6254 APR_DRG — 12 5 — — $31,346.78 $110,941.90 $55,372.72 2025-12-27
8 MS_DRG Simultaneous Pancreas/kidney Transplant 36 12 — — $31,213.36 $86,758.34 $54,582.31 2025-12-27
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 36 12 — — $31,142.23 $86,560.62 $54,457.93 2025-12-27
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 36 12 — — $30,983.32 $86,118.95 $54,180.05 2025-12-27
11 MS_DRG Tracheostomy For Face,mouth & Neck Diagnoses W Mcc 36 12 — — $30,954.07 $86,037.63 $54,128.89 2025-12-27
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 36 12 — — $30,950.62 $86,028.06 $54,122.88 2025-12-27
234 MS_DRG Coronary Bypass With Cardiac Catheterization Without Mcc 36 12 — — $30,519.81 $84,830.59 $53,369.51 2025-12-27
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 36 12 — — $30,385.00 $84,455.88 $53,133.77 2025-12-27
L7180 HCPCS Electronic Elbow Sequential 4 2 — — $29,570.15 $56,530.07 $43,050.11 2025-12-27
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 36 12 — — $29,445.92 $81,845.69 $51,491.61 2025-12-27
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 36 12 — — $29,225.63 $81,233.40 $51,106.40 2025-12-27
5893 APR_DRG — 12 5 — — $29,204.53 $134,989.72 $134,989.72 2025-12-27
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 36 12 — — $29,136.14 $80,984.66 $50,949.91 2025-12-27
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 36 12 — — $28,894.63 $80,313.37 $50,527.59 2025-12-27
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 36 12 — — $28,724.25 $79,839.80 $50,229.65 2025-12-27
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 36 12 — — $28,701.88 $79,777.62 $50,190.52 2025-12-27
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 36 12 — — $28,690.41 $79,745.73 $50,170.46 2025-12-27
228 MS_DRG Other Cardiothoracic Procedures With Mcc 36 12 — — $28,587.15 $79,458.72 $49,989.90 2025-12-27
4804 APR_DRG — 4 2 — — $28,534.81 $73,949.88 $51,242.35 2025-12-27
245 MS_DRG Aicd Generator Procedures 36 12 — — $28,033.57 $77,920.03 $49,021.86 2025-12-27
5104 APR_DRG — 4 2 — — $27,986.31 $99,396.36 $63,691.34 2025-12-27
471 MS_DRG Cervical Spinal Fusion With Mcc 38 13 — — $27,864.34 $77,449.65 $48,946.87 2025-12-27
6 MS_DRG Liver Transplant Without Mcc 36 12 — — $27,817.87 $77,320.49 $48,644.68 2025-12-27
6021 APR_DRG — 12 5 — — $27,729.78 $51,981.12 $51,981.12 2025-12-27
4014 APR_DRG — 12 5 — — $27,589.51 $97,380.69 $43,471.32 2025-12-27
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 36 12 — — $27,395.09 $76,145.35 $47,905.35 2025-12-27
799 MS_DRG Splenic Procedures With Mcc 36 12 — — $27,276.34 $75,815.29 $47,697.71 2025-12-27
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 36 12 — — $27,271.18 $75,800.94 $47,688.68 2025-12-27
267 MS_DRG Endovascular Cardiac Valve Replacement Without Mcc 36 12 — — $26,988.93 $75,016.44 $47,195.12 2025-12-27
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 36 12 — — $26,844.37 $74,614.63 $46,942.33 2025-12-27
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 36 12 — — $26,686.04 $74,174.55 $46,665.46 2025-12-27
163 MS_DRG Major Chest Procedures With Mcc 36 12 — — $26,441.09 $73,493.69 $46,237.12 2025-12-27
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 36 12 — — $26,430.19 $73,463.40 $46,218.06 2025-12-27
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 36 12 — — $26,345.86 $73,229.01 $46,070.60 2025-12-27
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 36 12 — — $26,341.85 $73,217.85 $46,063.57 2025-12-27
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 36 12 — — $25,881.20 $71,937.46 $45,258.05 2025-12-27
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 36 12 — — $25,726.89 $71,508.54 $44,988.20 2025-12-27
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 36 12 — — $25,655.75 $71,310.82 $44,863.81 2025-12-27
901 MS_DRG Wound Debridements For Injuries With Mcc 36 12 — — $25,415.96 $70,644.32 $44,444.49 2025-12-27
J3399 HCPCS Inj Onase Abepar-xioi Treat 36 11 — — $25,235.55 $3,678,173.40 $2,401,682.45 2025-12-27
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 36 12 — — $25,199.69 $70,043.20 $44,066.31 2025-12-27
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 36 12 — — $24,821.65 $68,992.42 $43,405.23 2025-12-27
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 36 12 — — $24,770.60 $68,850.51 $43,315.96 2025-12-27
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 36 12 — — $24,470.57 $68,016.59 $42,791.31 2025-12-27
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 36 12 — — $24,434.43 $67,916.13 $42,728.11 2025-12-27
140 MS_DRG Major Head And Neck Procedures With Mcc 36 12 — — $24,261.19 $67,434.59 $42,425.15 2025-12-27
31 MS_DRG Ventricular Shunt Procedures With Mcc 36 12 — — $24,039.75 $66,819.12 $42,037.94 2025-12-27
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 36 12 — — $24,034.02 $66,803.17 $42,027.91 2025-12-27
793 MS_DRG Full Term Neonate With Major Problems 36 12 — — $23,924.45 $66,498.62 $41,836.31 2025-12-27
313001617 CDM 426-multiple Level Combined Anterior And Posterior Spinal Fu 40 14 $79,769.00 — $23,133.01 $75,780.55 $47,861.40 2025-12-27
5931 APR_DRG — 12 5 — — $19,957.60 $148,298.33 $74,761.47 2025-12-27
38240 HCPCS Transplt Allo Hct/donor 40 13 — — $6,455.25 $128,532.18 $57,925.94 2025-12-27
Q2040 HCPCS Tisagenlecleucel Car-pos T 10 4 — — $5,741.71 $65,239.56 $65,239.56 2025-12-27
A9545 HCPCS I131 Tositumomab, Rx 4 2 — — $3,868.20 $99,164.60 $51,516.40 2025-12-27
33983 HCPCS Replace Vad Intra W/bp 12 5 — — $2,627.96 $91,360.37 $42,925.84 2025-12-27
33982 HCPCS Replace Vad Intra Without Bp 12 5 — — $2,222.33 $91,360.37 $42,925.84 2025-12-27
33979 HCPCS Insert Intracorporeal Device 12 5 — — $2,213.65 $91,360.37 $42,925.84 2025-12-27
33976 HCPCS Implant Ventricular Device 12 5 — — $1,805.43 $91,360.37 $42,925.84 2025-12-27
33975 HCPCS Implant Ventricular Device 12 5 — — $1,485.96 $91,360.37 $42,925.84 2025-12-27
J7330 HCPCS Membrane Maci Assembled - 81073 44 15 $90,982.50 — $1,058.66 $90,982.50 $54,589.51 2025-12-27
33981 HCPCS Replace Vad Pump Ext 12 5 — — $945.43 $91,360.37 $42,925.84 2025-12-27
33991 HCPCS Insj Perq Vad L Hrt Artl&ven 14 6 — — $718.51 $91,360.37 $42,925.84 2025-12-27
33990 HCPCS Insj Perq Vad L Hrt Arterial 14 6 — — $497.42 $91,360.37 $42,925.84 2025-12-27
C9031 HCPCS Lutetium Lu 177 Dotatate, Tx 14 6 — — $279.53 $99,164.60 $52,343.27 2025-12-27
0266T HCPCS Implt/rpl Crtd Sns Dev Total 42 14 — — $124.67 $97,798.18 $43,855.69 2025-12-27
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