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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

GRAND ISLAND REGIONAL MEDICAL CENTER

Grand Island, NE · CCN 280139 · Rates published

45,817 distinct procedures filed
10 distinct payers
200,963 rate rows
2026-05-23 last MRF observed
Data quality

200,919 of 200,963 rate rows are consumer-grade (100.0%)

44 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
exceeds 10× this hospital's gross charge — excluded from medians 32
placeholder amount (≤ $0.02) — excluded from medians 12
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.bryanhealth.com/app/files/public/e01c3132-8364-4d8d-b232-e46446138095/352621082_grand-island-regional-medical-center_standardcharges.csv
Found on page https://www.bryanhealth.com/cms-hpt.txt
Discovered viaDiscovered by HANK (automated)
Last fetch success · 2026-05-18
Content fingerprint 647ecc819f4f7325… · 17,996,536 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
9138
OTHER 		Inj, Hemgenix, Per Tx Dose 2 $3,557,519.00 $3,557,519.00 $3,557,519.00 nat. median
$3,746,358
0.9× median
0773
OTHER 		Inj, Beqvez, Per Tx Dose 2 $3,557,519.00 $3,557,519.00 $3,557,519.00 nat. median
$3,635,800
1.0× median
0714
OTHER 		Inj Delandistrogene Mox Rokl 2 $3,185,256.29 $3,185,256.29 $3,185,256.29 nat. median
$3,316,463
1.0× median
0748
OTHER 		Inj, Lovotibeglogene Autotem 2 $3,061,767.70 $3,061,767.70 $3,061,767.70 nat. median
$3,248,446
0.9× median
0746
OTHER 		Inj, Betibeglogene Autotemce 2 $2,846,015.20 $2,846,015.20 $2,846,015.20 nat. median
$2,945,740
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Treat 2 $2,304,676.60 $2,304,676.60 $2,304,676.60 nat. median
$2,588,981
0.9× median
0824
OTHER 		Inj, Exagamglogene Autotem 2 $2,236,154.80 $2,236,154.80 $2,236,154.80 nat. median
$17,829
outlier · 125.4×
9194
OTHER 		Tisagenlecleucel Car-pos T 2 $542,376.70 $542,376.70 $542,376.70 nat. median
$566,531
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 2 $528,659.16 $528,659.16 $528,659.16 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Car 2 $506,598.79 $506,598.79 $506,598.79 nat. median
$558,082
0.9× median
9413
OTHER 		Lisocabtagene Mara Car Pos T 2 $495,258.40 $495,258.40 $495,258.40 nat. median
$562,201
0.9× median
583 - 4
OTHER 		Neonate With Ecmo 4 $472,816.54 $774,455.49 $472,816.54 nat. median
$472,817
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel Car+ 2 $469,398.00 $469,398.00 $469,398.00 nat. median
$532,192
0.9× median
9391
OTHER 		Brexucabtagene Car Pos T 2 $467,992.59 $467,992.59 $467,992.59 nat. median
$489,450
1.0× median
588 - 4
OTHER 		Neonate Birth Weight < 1500 Grams With Major Procedure 4 $289,591.51 $688,447.48 $289,591.51 nat. median
$289,592
1.0× median
11 - 4
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 $270,719.54 $1,355,897.38 $270,719.54 nat. median
$270,720
1.0× median
2 - 4
OTHER 		Heart And/or Lung Transplant 4 $270,540.72 $854,611.48 $270,540.72 nat. median
$270,541
1.0× median
583 - 3
OTHER 		Neonate With Ecmo 4 $269,284.70 $767,167.94 $269,284.70 nat. median
$269,285
1.0× median
583 - 2
OTHER 		Neonate With Ecmo 4 $206,760.87 $481,415.24 $206,760.87 nat. median
$206,761
1.0× median
161 - 4
OTHER 		Implantable Heart Assist Systems 4 $201,889.94 $612,198.29 $201,889.94 nat. median
$201,890
1.0× median
609 - 4
OTHER 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 4 $201,765.88 $496,146.98 $201,765.88 nat. median
$201,766
1.0× median
11 - 3
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 $201,473.27 $1,250,109.90 $201,473.27 nat. median
$201,473
1.0× median
9 - 4
OTHER 		Extracorporeal Membrane Oxygenation (ecmo) 4 $197,917.39 $318,344.42 $197,917.39 nat. median
$197,917
1.0× median
631 - 4
OTHER 		Neonate Birth Weight > 2499 Grams With Other Major Procedure 4 $194,062.06 $340,625.56 $194,062.06 nat. median
$194,062
1.0× median
588 - 3
OTHER 		Neonate Birth Weight < 1500 Grams With Major Procedure 4 $192,867.64 $421,415.15 $192,867.64 nat. median
$192,868
1.0× median
591 - 4
OTHER 		Neonate Birth Weight 500-749 Grams Without Major Procedure 4 $189,899.56 $412,862.74 $189,899.56 nat. median
$189,900
1.0× median
583 - 1
OTHER 		Neonate With Ecmo 4 $185,593.33 $361,417.39 $185,593.33 nat. median
$185,593
1.0× median
841 - 4
OTHER 		Extensive Third Degree Burns With Skin Graft 4 $179,586.16 $435,265.46 $179,586.16 nat. median
$179,586
1.0× median
630 - 4
OTHER 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 4 $175,994.35 $291,377.93 $175,994.35 nat. median
$175,994
1.0× median
593 - 4
OTHER 		Neonate Birth Weight 750-999 Grams Without Major Procedure 4 $166,958.36 $430,573.09 $166,958.36 nat. median
$166,958
1.0× median
588 - 2
OTHER 		Neonate Birth Weight < 1500 Grams With Major Procedure 4 $165,266.84 $410,206.78 $165,266.84 nat. median
$165,267
1.0× median
11 - 2
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 $160,168.32 $892,954.68 $160,168.32 nat. median
$160,168
1.0× median
7 - 4
OTHER 		Allogeneic Bone Marrow Transplant 4 $159,283.63 $400,144.02 $159,283.63 nat. median
$159,284
1.0× median
161 - 3
OTHER 		Implantable Heart Assist Systems 4 $158,084.08 $416,858.39 $158,084.08 nat. median
$158,084
1.0× median
4 - 4
OTHER 		Tracheostomy With Mv >96 Hours With Extensive Procedure 4 $152,101.72 $320,168.06 $152,101.72 nat. median
$152,102
1.0× median
1 - 4
OTHER 		Liver Transplant And/or Intestinal Transplant 4 $150,589.02 $584,528.06 $150,589.02 nat. median
$150,589
1.0× median
2 - 3
OTHER 		Heart And/or Lung Transplant 4 $147,367.69 $430,325.27 $147,367.69 nat. median
$147,368
1.0× median
591 - 3
OTHER 		Neonate Birth Weight 500-749 Grams Without Major Procedure 4 $143,217.17 $245,309.97 $143,217.17 nat. median
$143,217
1.0× median
588 - 1
OTHER 		Neonate Birth Weight < 1500 Grams With Major Procedure 4 $141,657.41 $272,832.91 $141,657.41 nat. median
$141,657
1.0× median
589 - 1
OTHER 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 4 $134,989.72 $324,350.74 $134,989.72 nat. median
$134,990
1.0× median
589 - 2
OTHER 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 4 $134,989.72 $236,219.83 $134,989.72 nat. median
$134,990
1.0× median
589 - 3
OTHER 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 4 $134,989.72 $218,079.29 $134,989.72 nat. median
$134,990
1.0× median
9 - 3
OTHER 		Extracorporeal Membrane Oxygenation (ecmo) 4 $133,013.29 $227,153.07 $133,013.29 nat. median
$133,013
1.0× median
602 - 4
OTHER 		Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 4 $125,775.77 $285,455.77 $125,775.77 nat. median
$125,776
1.0× median
591 - 2
OTHER 		Neonate Birth Weight 500-749 Grams Without Major Procedure 4 $122,839.35 $179,911.44 $122,839.35 nat. median
$122,839
1.0× median
593 - 3
OTHER 		Neonate Birth Weight 750-999 Grams Without Major Procedure 4 $122,135.19 $333,471.28 $122,135.19 nat. median
$122,135
1.0× median
510 - 4
OTHER 		Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced… 1 $119,686.90 $119,686.90 $119,686.90 nat. median
$119,687
1.0× median
SUP-421192
OTHER 		Heartmate 3 Lvas Implant Kit 6 $34,174.35 $143,892.00 $119,610.23 nat. median
$98,926
1.2× median
161 - 2
OTHER 		Implantable Heart Assist Systems 4 $116,318.82 $368,279.42 $116,318.82 nat. median
$116,319
1.0× median
161 - 1
OTHER 		Implantable Heart Assist Systems 4 $116,318.82 $350,288.51 $116,318.82 nat. median
$116,319
1.0× median

Other procedures at this hospital

Browse this hospital's 45,817 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
             
0714 OTHER Inj Delandistrogene Mox Rokl 2 2 — — $3,185,256.29 $3,185,256.29 $3,185,256.29 2026-05-23
0717 OTHER Instill Adstiladrin, Tx Dose 2 2 — — $60,796.22 $60,796.22 $60,796.22 2026-05-23
0746 OTHER Inj, Betibeglogene Autotemce 2 2 — — $2,846,015.20 $2,846,015.20 $2,846,015.20 2026-05-23
0748 OTHER Inj, Lovotibeglogene Autotem 2 2 — — $3,061,767.70 $3,061,767.70 $3,061,767.70 2026-05-23
0773 OTHER Inj, Beqvez, Per Tx Dose 2 2 — — $3,557,519.00 $3,557,519.00 $3,557,519.00 2026-05-23
0824 OTHER Inj, Exagamglogene Autotem 2 2 — — $2,236,154.80 $2,236,154.80 $2,236,154.80 2026-05-23
1 - 1 OTHER Liver Transplant And/or Intestinal Transplant 4 4 — — $53,080.57 $155,916.54 $53,080.57 2026-05-23
1 - 2 OTHER Liver Transplant And/or Intestinal Transplant 4 4 — — $60,419.91 $174,933.84 $60,419.91 2026-05-23
1 - 3 OTHER Liver Transplant And/or Intestinal Transplant 4 4 — — $78,182.16 $430,867.68 $78,182.16 2026-05-23
1 - 4 OTHER Liver Transplant And/or Intestinal Transplant 4 4 — — $150,589.02 $584,528.06 $150,589.02 2026-05-23
11 - 1 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 4 — — $78,883.75 $83,216.43 $78,883.75 2026-05-23
11 - 2 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 4 — — $160,168.32 $892,954.68 $160,168.32 2026-05-23
11 - 3 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 4 — — $201,473.27 $1,250,109.90 $201,473.27 2026-05-23
11 - 4 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 4 — — $270,719.54 $1,355,897.38 $270,719.54 2026-05-23
1142 OTHER Supprelin La Implant 2 2 — — $43,401.54 $43,401.54 $43,401.54 2026-05-23
120 OTHER Car T-cell Immunotherapy 4 4 — — $65,239.56 $68,759.98 $65,239.56 2026-05-23
120 - 4 OTHER Major Respiratory And Chest Procedures 4 4 — — $47,370.29 $123,228.97 $47,370.29 2026-05-23
121 - 4 OTHER Other Respiratory And Chest Procedures 4 4 — — $39,706.68 $136,211.88 $39,706.68 2026-05-23
130 - 3 OTHER Respiratory System Diagnosis With Ventilator Support > 96 Hours 4 4 — — $35,315.75 $82,150.31 $35,315.75 2026-05-23
130 - 4 OTHER Respiratory System Diagnosis With Ventilator Support > 96 Hours 4 4 — — $46,813.30 $112,997.88 $46,813.30 2026-05-23
1580 OTHER Implt/rpl Crtd Sns Dev Total 2 2 — — $43,150.98 $43,150.98 $43,150.98 2026-05-23
160 - 2 OTHER Major Cardiothoracic Repair Of Heart Anomaly 4 4 — — $40,244.86 $48,095.00 $40,244.86 2026-05-23
160 - 3 OTHER Major Cardiothoracic Repair Of Heart Anomaly 4 4 — — $53,717.13 $74,079.53 $53,717.13 2026-05-23
160 - 4 OTHER Major Cardiothoracic Repair Of Heart Anomaly 4 4 — — $115,895.30 $241,973.65 $115,895.30 2026-05-23
161 - 1 OTHER Implantable Heart Assist Systems 4 4 — — $116,318.82 $350,288.51 $116,318.82 2026-05-23
161 - 2 OTHER Implantable Heart Assist Systems 4 4 — — $116,318.82 $368,279.42 $116,318.82 2026-05-23
161 - 3 OTHER Implantable Heart Assist Systems 4 4 — — $158,084.08 $416,858.39 $158,084.08 2026-05-23
161 - 4 OTHER Implantable Heart Assist Systems 4 4 — — $201,889.94 $612,198.29 $201,889.94 2026-05-23
162 - 1 OTHER Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 4 4 — — $35,890.71 $100,454.51 $35,890.71 2026-05-23
162 - 2 OTHER Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 4 4 — — $43,072.62 $118,115.76 $43,072.62 2026-05-23
162 - 3 OTHER Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 4 4 — — $56,973.55 $134,937.67 $56,973.55 2026-05-23
162 - 4 OTHER Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 4 4 — — $77,886.12 $201,750.70 $77,886.12 2026-05-23
163 - 2 OTHER Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 4 4 — — $36,161.08 $76,050.46 $36,161.08 2026-05-23
163 - 3 OTHER Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 4 4 — — $48,995.93 $94,237.77 $48,995.93 2026-05-23
163 - 4 OTHER Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 4 4 — — $68,153.67 $125,153.14 $68,153.67 2026-05-23
1643 OTHER Y90 Ibritumomab, Rx 2 2 — — $54,489.06 $54,489.06 $54,489.06 2026-05-23
165 - 2 OTHER Coronary Bypass With Ami Or Complex Principal Diagnosis 4 4 — — $36,687.27 $80,347.71 $36,687.27 2026-05-23
165 - 3 OTHER Coronary Bypass With Ami Or Complex Principal Diagnosis 4 4 — — $45,500.81 $96,624.86 $45,500.81 2026-05-23
165 - 4 OTHER Coronary Bypass With Ami Or Complex Principal Diagnosis 4 4 — — $61,229.30 $127,883.92 $61,229.30 2026-05-23
166 - 3 OTHER Coronary Bypass Without Ami Or Complex Principal Diagnosis 4 4 — — $40,046.36 $85,795.25 $40,046.36 2026-05-23
166 - 4 OTHER Coronary Bypass Without Ami Or Complex Principal Diagnosis 4 4 — — $54,585.57 $124,468.11 $54,585.57 2026-05-23
167 - 3 OTHER Other Cardiothoracic And Thoracic Vascular Procedures 4 4 — — $38,080.19 $78,313.65 $38,080.19 2026-05-23
167 - 4 OTHER Other Cardiothoracic And Thoracic Vascular Procedures 4 4 — — $59,992.96 $192,866.30 $59,992.96 2026-05-23
169 - 4 OTHER Major Abdominal Vascular Procedures 4 4 — — $48,666.53 $103,133.86 $48,666.53 2026-05-23
170 - 4 OTHER Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock 4 4 — — $40,141.33 $108,964.83 $40,141.33 2026-05-23
175 - 4 OTHER Percutaneous Cardiac Intervention Without Ami 4 4 — — $36,947.37 $108,431.76 $36,947.37 2026-05-23
176 - 4 OTHER Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices 4 4 — — $38,650.87 $122,015.54 $38,650.87 2026-05-23
178 - 1 OTHER External Heart Assist Systems 4 4 — — $38,319.76 $119,446.08 $38,319.76 2026-05-23
178 - 2 OTHER External Heart Assist Systems 4 4 — — $42,578.08 $130,656.79 $42,578.08 2026-05-23
178 - 3 OTHER External Heart Assist Systems 4 4 — — $52,293.42 $136,983.42 $52,293.42 2026-05-23
178 - 4 OTHER External Heart Assist Systems 4 4 — — $64,808.28 $250,348.36 $64,808.28 2026-05-23
179 - 3 OTHER Defibrillator Implants 4 4 — — $41,026.88 $89,793.23 $41,026.88 2026-05-23
179 - 4 OTHER Defibrillator Implants 4 4 — — $53,873.71 $144,892.87 $53,873.71 2026-05-23
181 - 4 OTHER Lower Extremity Arterial Procedures 4 4 — — $40,052.35 $112,371.29 $40,052.35 2026-05-23
182 - 4 OTHER Other Peripheral Vascular And Related Procedures 4 4 — — $34,651.80 $143,688.80 $34,651.80 2026-05-23
183 - 3 OTHER Percutaneous Structural Cardiac Procedures 4 4 — — $42,384.71 $97,010.63 $42,384.71 2026-05-23
183 - 4 OTHER Percutaneous Structural Cardiac Procedures 4 4 — — $58,328.82 $173,704.05 $58,328.82 2026-05-23
2 - 1 OTHER Heart And/or Lung Transplant 4 4 — — $98,630.15 $219,865.52 $98,630.15 2026-05-23
2 - 2 OTHER Heart And/or Lung Transplant 4 4 — — $111,592.49 $267,443.82 $111,592.49 2026-05-23
2 - 3 OTHER Heart And/or Lung Transplant 4 4 — — $147,367.69 $430,325.27 $147,367.69 2026-05-23
2 - 4 OTHER Heart And/or Lung Transplant 4 4 — — $270,540.72 $854,611.48 $270,540.72 2026-05-23
20 - 4 OTHER Open Craniotomy For Trauma 4 4 — — $46,006.47 $130,404.29 $46,006.47 2026-05-23
21 - 3 OTHER Open Craniotomy Except Trauma 4 4 — — $37,060.31 $83,527.39 $37,060.31 2026-05-23
21 - 4 OTHER Open Craniotomy Except Trauma 4 4 — — $52,662.18 $166,977.62 $52,662.18 2026-05-23
22 - 4 OTHER Ventricular Shunt Procedures 4 4 — — $41,151.79 $108,836.24 $41,151.79 2026-05-23
220 - 4 OTHER Major Stomach, Esophageal And Duodenal Procedures 4 4 — — $46,658.43 $145,930.95 $46,658.43 2026-05-23
222 - 4 OTHER Other Stomach, Esophageal And Duodenal Procedures 4 4 — — $34,605.60 $113,465.48 $34,605.60 2026-05-23
229 - 4 OTHER Other Digestive System And Abdominal Procedures 4 4 — — $34,356.62 $116,907.01 $34,356.62 2026-05-23
23 - 4 OTHER Spinal Procedures 4 4 — — $48,016.27 $149,444.96 $48,016.27 2026-05-23
230 - 4 OTHER Major Small Bowel Procedures 4 4 — — $39,468.83 $99,956.51 $39,468.83 2026-05-23
231 - 4 OTHER Major Large Bowel Procedures 4 4 — — $34,840.89 $87,387.43 $34,840.89 2026-05-23
246 OTHER Class IV Therapeutic Radiopharmaceuticals 4 4 — — $52,343.27 $58,451.73 $52,343.27 2026-05-23
250 OTHER Cochlear Device Implantation 4 4 — — $34,610.01 $41,197.91 $34,610.01 2026-05-23
26 - 4 OTHER Other Nervous System And Related Procedures 4 4 — — $37,349.51 $100,938.47 $37,349.51 2026-05-23
260 - 4 OTHER Major Pancreas, Liver And Shunt Procedures 4 4 — — $49,135.40 $157,436.24 $49,135.40 2026-05-23
261 - 4 OTHER Major Biliary Tract Procedures 4 4 — — $45,687.33 $128,632.08 $45,687.33 2026-05-23
264 - 4 OTHER Other Hepatobiliary, Pancreas And Abdominal Procedures 4 4 — — $38,949.48 $122,279.74 $38,949.48 2026-05-23
27 - 4 OTHER Other Open Craniotomy 4 4 — — $44,321.79 $113,187.26 $44,321.79 2026-05-23
29 - 4 OTHER Other Percutaneous Intracranial Procedures 4 4 — — $37,583.09 $83,978.62 $37,583.09 2026-05-23
299 - 2 OTHER Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical 3 3 — — $38,405.32 $38,405.32 $38,405.32 2026-05-23
299 - 3 OTHER Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical 3 3 — — $52,218.12 $52,218.12 $52,218.12 2026-05-23
299 - 4 OTHER Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical 3 3 — — $66,778.72 $66,778.72 $66,778.72 2026-05-23
30 - 4 OTHER Percutaneous Intracranial And Extracranial Vascular Procedures 4 4 — — $40,172.13 $113,949.44 $40,172.13 2026-05-23
300 - 3 OTHER Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 3 3 — — $35,620.34 $35,620.34 $35,620.34 2026-05-23
300 - 4 OTHER Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 3 3 — — $50,944.99 $50,944.99 $50,944.99 2026-05-23
303 - 2 OTHER Dorsal And Lumbar Fusion Procedure For Curvature Of Back 4 4 — — $39,122.31 $88,451.22 $39,122.31 2026-05-23
303 - 3 OTHER Dorsal And Lumbar Fusion Procedure For Curvature Of Back 4 4 — — $53,791.57 $121,891.63 $53,791.57 2026-05-23
303 - 4 OTHER Dorsal And Lumbar Fusion Procedure For Curvature Of Back 4 4 — — $77,509.66 $185,646.55 $77,509.66 2026-05-23
304 - 3 OTHER Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 4 4 — — $40,297.90 $92,182.66 $40,297.90 2026-05-23
304 - 4 OTHER Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 4 4 — — $54,663.43 $129,590.66 $54,663.43 2026-05-23
3060 OTHER Ventricular Assist Device Procedures 4 4 — — $42,925.84 $52,563.06 $42,925.84 2026-05-23
312 - 4 OTHER Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses 4 4 — — $47,204.31 $134,474.75 $47,204.31 2026-05-23
321 - 4 OTHER Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures 4 4 — — $41,178.32 $112,696.28 $41,178.32 2026-05-23
326 OTHER Stomach, Esophageal And Duodenal Procedures With Mcc 2 2 $32,222.28 — $34,284.78 $34,284.78 $34,284.78 2026-05-23
361 - 4 OTHER Skin Graft For Skin And Subcutaneous Tissue Diagnoses 4 4 — — $45,927.75 $123,086.35 $45,927.75 2026-05-23
4 - 1 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 4 4 — — $46,371.81 $119,584.02 $46,371.81 2026-05-23
4 - 2 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 4 4 — — $67,025.99 $153,538.80 $67,025.99 2026-05-23
4 - 3 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 4 4 — — $104,885.44 $212,124.40 $104,885.44 2026-05-23
4 - 4 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 4 4 — — $152,101.72 $320,168.06 $152,101.72 2026-05-23
401 - 4 OTHER Adrenal Procedures 4 4 — — $43,471.32 $121,608.73 $43,471.32 2026-05-23
403 - 4 OTHER Procedures For Obesity 4 4 — — $38,451.52 $94,207.37 $38,451.52 2026-05-23
404 - 4 OTHER Thyroid, Parathyroid And Thyroglossal Procedures 4 4 — — $38,559.33 $106,414.07 $38,559.33 2026-05-23
405 - 4 OTHER Other Procedures For Endocrine, Nutritional And Metabolic Disorders 4 4 — — $39,025.63 $142,323.41 $39,025.63 2026-05-23
426 OTHER Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 2 2 $221,893.07 — $75,762.80 $75,762.80 $75,762.80 2026-05-23
428 - 4 OTHER Genetic Disorders 3 3 — — $45,872.14 $45,872.14 $45,872.14 2026-05-23
43 - 4 OTHER Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies 4 4 — — $35,267.83 $83,557.78 $35,267.83 2026-05-23
430 OTHER Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 2 2 $75,816.67 — $39,644.65 $39,644.65 $39,644.65 2026-05-23
440 - 1 OTHER Kidney Transplant 4 4 — — $41,352.86 $116,098.07 $41,352.86 2026-05-23
440 - 2 OTHER Kidney Transplant 4 4 — — $44,188.32 $217,670.14 $44,188.32 2026-05-23
440 - 3 OTHER Kidney Transplant 4 4 — — $51,851.93 $245,284.26 $51,851.93 2026-05-23
440 - 4 OTHER Kidney Transplant 4 4 — — $76,265.62 $392,531.50 $76,265.62 2026-05-23
441 - 4 OTHER Major Bladder Procedures 4 4 — — $42,874.12 $125,118.07 $42,874.12 2026-05-23
442 - 4 OTHER Kidney And Urinary Tract Procedures For Malignancy 4 4 — — $36,481.07 $119,041.61 $36,481.07 2026-05-23
447 - 4 OTHER Other Kidney, Urinary Tract And Related Procedures 4 4 — — $36,595.72 $101,803.53 $36,595.72 2026-05-23
448 - 4 OTHER Other Kidney, Urinary Tract And Related Percutaneous Procedures 3 3 — — $36,288.56 $36,288.56 $36,288.56 2026-05-23
466 OTHER Class Xiv Combined Chemotherapy And Pharmacotherapy 6 6 $134,955.16 — $34,364.93 $41,185.84 $35,074.15 2026-05-23
480 - 3 OTHER Major Male Pelvic Procedures 1 1 — — $49,376.22 $49,376.22 $49,376.22 2026-05-23
480 - 4 OTHER Major Male Pelvic Procedures 1 1 — — $94,158.27 $94,158.27 $94,158.27 2026-05-23
484 - 4 OTHER Other Male Reproductive System And Related Procedures 4 4 — — $37,579.66 $88,289.89 $37,579.66 2026-05-23
485 - 4 OTHER Prostatectomy Procedures 3 3 — — $37,492.39 $37,492.39 $37,492.39 2026-05-23
5 - 2 OTHER Tracheostomy With Mv >96 Hours Without Extensive Procedure 4 4 — — $51,274.40 $123,834.51 $51,274.40 2026-05-23
5 - 3 OTHER Tracheostomy With Mv >96 Hours Without Extensive Procedure 4 4 — — $76,897.91 $214,090.66 $76,897.91 2026-05-23
5 - 4 OTHER Tracheostomy With Mv >96 Hours Without Extensive Procedure 4 4 — — $105,960.07 $302,336.13 $105,960.07 2026-05-23
510 - 3 OTHER Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced… 1 1 — — $72,821.69 $72,821.69 $72,821.69 2026-05-23
510 - 4 OTHER Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced… 1 1 — — $119,686.90 $119,686.90 $119,686.90 2026-05-23
511 - 4 OTHER Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy 4 4 — — $41,488.04 $114,753.72 $41,488.04 2026-05-23
512 - 4 OTHER Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy 4 4 — — $39,690.43 $98,046.37 $39,690.43 2026-05-23
514 - 4 OTHER Female Reproductive System Reconstructive Procedures 4 4 — — $35,089.01 $101,749.76 $35,089.01 2026-05-23
518 - 4 OTHER Other Female Reproductive System And Related Procedures 4 4 — — $34,301.00 $90,623.22 $34,301.00 2026-05-23
520 - 4 OTHER Other GYN Procedures For Malignancy 3 3 — — $43,311.33 $43,311.33 $43,311.33 2026-05-23
5244 OTHER Transplt Allo Hct/donor 2 2 — — $56,711.58 $56,711.58 $56,711.58 2026-05-23
583 - 1 OTHER Neonate With Ecmo 4 4 — — $185,593.33 $361,417.39 $185,593.33 2026-05-23
583 - 2 OTHER Neonate With Ecmo 4 4 — — $206,760.87 $481,415.24 $206,760.87 2026-05-23
583 - 3 OTHER Neonate With Ecmo 4 4 — — $269,284.70 $767,167.94 $269,284.70 2026-05-23
583 - 4 OTHER Neonate With Ecmo 4 4 — — $472,816.54 $774,455.49 $472,816.54 2026-05-23
588 - 1 OTHER Neonate Birth Weight < 1500 Grams With Major Procedure 4 4 — — $141,657.41 $272,832.91 $141,657.41 2026-05-23
588 - 2 OTHER Neonate Birth Weight < 1500 Grams With Major Procedure 4 4 — — $165,266.84 $410,206.78 $165,266.84 2026-05-23
588 - 3 OTHER Neonate Birth Weight < 1500 Grams With Major Procedure 4 4 — — $192,867.64 $421,415.15 $192,867.64 2026-05-23
588 - 4 OTHER Neonate Birth Weight < 1500 Grams With Major Procedure 4 4 — — $289,591.51 $688,447.48 $289,591.51 2026-05-23
589 - 1 OTHER Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 4 4 — — $134,989.72 $324,350.74 $134,989.72 2026-05-23
589 - 2 OTHER Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 4 4 — — $134,989.72 $236,219.83 $134,989.72 2026-05-23
589 - 3 OTHER Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 4 4 — — $134,989.72 $218,079.29 $134,989.72 2026-05-23
591 - 2 OTHER Neonate Birth Weight 500-749 Grams Without Major Procedure 4 4 — — $122,839.35 $179,911.44 $122,839.35 2026-05-23
591 - 3 OTHER Neonate Birth Weight 500-749 Grams Without Major Procedure 4 4 — — $143,217.17 $245,309.97 $143,217.17 2026-05-23
591 - 4 OTHER Neonate Birth Weight 500-749 Grams Without Major Procedure 4 4 — — $189,899.56 $412,862.74 $189,899.56 2026-05-23
593 - 1 OTHER Neonate Birth Weight 750-999 Grams Without Major Procedure 4 4 — — $74,761.47 $205,608.40 $74,761.47 2026-05-23
593 - 2 OTHER Neonate Birth Weight 750-999 Grams Without Major Procedure 4 4 — — $98,236.57 $226,168.77 $98,236.57 2026-05-23
593 - 3 OTHER Neonate Birth Weight 750-999 Grams Without Major Procedure 4 4 — — $122,135.19 $333,471.28 $122,135.19 2026-05-23
593 - 4 OTHER Neonate Birth Weight 750-999 Grams Without Major Procedure 4 4 — — $166,958.36 $430,573.09 $166,958.36 2026-05-23
6 - 1 OTHER Pancreas Transplant 4 4 — — $45,393.00 $158,609.92 $45,393.00 2026-05-23
6 - 2 OTHER Pancreas Transplant 4 4 — — $65,352.44 $190,935.11 $65,352.44 2026-05-23
6 - 3 OTHER Pancreas Transplant 4 4 — — $75,805.30 $232,441.62 $75,805.30 2026-05-23
6 - 4 OTHER Pancreas Transplant 4 4 — — $98,364.05 $293,603.70 $98,364.05 2026-05-23
602 - 1 OTHER Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $29,047.31 $51,981.12 $51,981.12 2026-05-23
602 - 2 OTHER Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $69,780.17 $176,324.95 $69,780.17 2026-05-23
602 - 3 OTHER Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $87,327.67 $241,033.77 $87,327.67 2026-05-23
602 - 4 OTHER Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $125,775.77 $285,455.77 $125,775.77 2026-05-23
603 - 2 OTHER Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 4 4 — — $42,503.64 $123,359.89 $42,503.64 2026-05-23
603 - 3 OTHER Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 4 4 — — $52,092.35 $163,049.78 $52,092.35 2026-05-23
603 - 4 OTHER Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 4 4 — — $91,993.26 $324,016.41 $91,993.26 2026-05-23
607 - 1 OTHER Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $35,591.25 $51,742.28 $35,591.25 2026-05-23
607 - 2 OTHER Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $49,787.36 $110,145.52 $49,787.36 2026-05-23
607 - 3 OTHER Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $66,658.94 $233,575.55 $66,658.94 2026-05-23
607 - 4 OTHER Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $97,225.25 $310,392.88 $97,225.25 2026-05-23
608 - 3 OTHER Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 4 4 — — $47,868.25 $149,910.22 $47,868.25 2026-05-23
608 - 4 OTHER Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 4 4 — — $55,454.00 $153,330.72 $55,454.00 2026-05-23
609 - 1 OTHER Neonate Birth Weight 1500-2499 Grams With Major Procedure 4 4 — — $36,684.71 $93,363.35 $36,684.71 2026-05-23
609 - 2 OTHER Neonate Birth Weight 1500-2499 Grams With Major Procedure 4 4 — — $45,669.36 $102,923.44 $45,669.36 2026-05-23
609 - 3 OTHER Neonate Birth Weight 1500-2499 Grams With Major Procedure 4 4 — — $69,990.65 $154,036.79 $69,990.65 2026-05-23
609 - 4 OTHER Neonate Birth Weight 1500-2499 Grams With Major Procedure 4 4 — — $201,765.88 $496,146.98 $201,765.88 2026-05-23
611 - 3 OTHER Neonate Birth Weight 1500-1999 Grams With Major Anomaly 4 4 — — $43,124.81 $143,576.58 $43,124.81 2026-05-23
611 - 4 OTHER Neonate Birth Weight 1500-1999 Grams With Major Anomaly 4 4 — — $80,862.76 $179,754.79 $80,862.76 2026-05-23
612 - 3 OTHER Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $44,111.31 $158,392.49 $44,111.31 2026-05-23
612 - 4 OTHER Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $63,698.56 $162,612.58 $63,698.56 2026-05-23
613 - 3 OTHER Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 4 4 — — $43,295.07 $107,414.73 $43,295.07 2026-05-23
613 - 4 OTHER Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 4 4 — — $80,120.10 $149,711.49 $80,120.10 2026-05-23
614 - 3 OTHER Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 4 4 — — $36,105.46 $160,162.35 $36,105.46 2026-05-23
614 - 4 OTHER Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 4 4 — — $53,458.74 $206,541.26 $53,458.74 2026-05-23
621 - 4 OTHER Neonate Birth Weight 2000-2499 Grams With Major Anomaly 4 4 — — $62,468.21 $142,877.52 $62,468.21 2026-05-23
622 - 4 OTHER Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $41,307.51 $225,214.86 $41,307.51 2026-05-23
623 - 4 OTHER Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection 4 4 — — $44,623.82 $94,672.63 $44,623.82 2026-05-23
625 - 4 OTHER Neonate Birth Weight 2000-2499 Grams With Other Significant Condition 4 4 — — $55,372.72 $143,487.74 $55,372.72 2026-05-23
630 - 2 OTHER Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 4 4 — — $44,213.13 $93,421.80 $44,213.13 2026-05-23
630 - 3 OTHER Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 4 4 — — $97,012.21 $175,943.85 $97,012.21 2026-05-23
630 - 4 OTHER Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 4 4 — — $175,994.35 $291,377.93 $175,994.35 2026-05-23
631 - 3 OTHER Neonate Birth Weight > 2499 Grams With Other Major Procedure 4 4 — — $57,037.72 $111,707.30 $57,037.72 2026-05-23
631 - 4 OTHER Neonate Birth Weight > 2499 Grams With Other Major Procedure 4 4 — — $194,062.06 $340,625.56 $194,062.06 2026-05-23
633 - 4 OTHER Neonate Birth Weight > 2499 Grams With Major Anomaly 4 4 — — $63,531.72 $158,062.83 $63,531.72 2026-05-23
634 - 4 OTHER Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma… 4 4 — — $38,536.22 $85,776.54 $38,536.22 2026-05-23
650 - 4 OTHER Splenic Procedures 4 4 — — $36,143.97 $96,907.76 $36,143.97 2026-05-23
651 - 4 OTHER Other Procedures Of Blood And Blood-forming Organs 4 4 — — $40,605.06 $105,923.09 $40,605.06 2026-05-23
680 - 4 OTHER Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 4 4 — — $56,528.64 $141,785.67 $56,528.64 2026-05-23
681 - 4 OTHER Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 4 4 — — $47,293.29 $131,288.05 $47,293.29 2026-05-23
690 - 4 OTHER Acute Leukemia 4 4 — — $50,529.17 $161,378.11 $50,529.17 2026-05-23
695 - 4 OTHER Chemotherapy For Acute Leukemia 4 4 — — $46,506.14 $118,697.92 $46,506.14 2026-05-23
7 - 1 OTHER Allogeneic Bone Marrow Transplant 4 4 — — $62,975.58 $135,358.51 $62,975.58 2026-05-23
7 - 2 OTHER Allogeneic Bone Marrow Transplant 4 4 — — $71,340.78 $290,959.42 $71,340.78 2026-05-23
7 - 3 OTHER Allogeneic Bone Marrow Transplant 4 4 — — $101,306.46 $334,528.05 $101,306.46 2026-05-23
7 - 4 OTHER Allogeneic Bone Marrow Transplant 4 4 — — $159,283.63 $400,144.02 $159,283.63 2026-05-23
710 - 4 OTHER Infectious And Parasitic Diseases Including HIV With O.r. Procedure 4 4 — — $38,809.16 $110,475.18 $38,809.16 2026-05-23
711 - 4 OTHER Post-operative, Post-trauma, Other Device Infections With O.r. Procedure 4 4 — — $37,837.20 $95,925.80 $37,837.20 2026-05-23
740 - 4 OTHER Mental Illness Diagnosis With O.r. Procedure 4 4 — — $47,886.22 $123,053.62 $47,886.22 2026-05-23
754 - 4 OTHER Depression Except Major Depressive Disorder 1 1 — — $36,818.82 $36,818.82 $36,818.82 2026-05-23
790 OTHER Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 2 2 $32,274.24 — $40,857.27 $40,857.27 $40,857.27 2026-05-23
792 - 4 OTHER Extensive O.r. Procedures For Other Complications Of Treatment 4 4 — — $41,028.59 $116,472.15 $41,028.59 2026-05-23
8 - 2 OTHER Autologous Bone Marrow Transplant 4 4 — — $39,137.71 $121,087.36 $39,137.71 2026-05-23
8 - 3 OTHER Autologous Bone Marrow Transplant 4 4 — — $49,863.51 $195,604.09 $49,863.51 2026-05-23
8 - 4 OTHER Autologous Bone Marrow Transplant 4 4 — — $70,844.54 $247,624.59 $70,844.54 2026-05-23
841 - 1 OTHER Extensive Third Degree Burns With Skin Graft 4 4 — — $38,267.57 $41,081.00 $38,267.57 2026-05-23
841 - 2 OTHER Extensive Third Degree Burns With Skin Graft 4 4 — — $38,267.57 $46,764.68 $38,267.57 2026-05-23
841 - 3 OTHER Extensive Third Degree Burns With Skin Graft 4 4 — — $58,404.11 $143,080.92 $58,404.11 2026-05-23
841 - 4 OTHER Extensive Third Degree Burns With Skin Graft 4 4 — — $179,586.16 $435,265.46 $179,586.16 2026-05-23
842 - 3 OTHER Burns With Skin Graft Except Extensive Third Degree Burns 4 4 — — $40,611.91 $93,555.07 $40,611.91 2026-05-23
842 - 4 OTHER Burns With Skin Graft Except Extensive Third Degree Burns 4 4 — — $100,542.41 $210,043.58 $100,542.41 2026-05-23
850 - 4 OTHER Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 4 4 — — $52,736.62 $155,900.18 $52,736.62 2026-05-23
851 - 3 OTHER Gender Related Procedures 4 4 — — $67,937.60 $92,776.13 $92,776.13 2026-05-23
851 - 4 OTHER Gender Related Procedures 4 4 — — $92,776.13 $209,159.82 $92,776.13 2026-05-23
863 - 3 OTHER Neonatal Aftercare 4 4 — — $40,457.90 $109,259.42 $40,457.90 2026-05-23
863 - 4 OTHER Neonatal Aftercare 4 4 — — $79,087.39 $160,251.20 $79,087.39 2026-05-23
89 - 3 OTHER Major Cranial Or Facial Bone Procedures 4 4 — — $34,285.60 $69,078.55 $34,285.60 2026-05-23
89 - 4 OTHER Major Cranial Or Facial Bone Procedures 4 4 — — $45,979.09 $134,890.91 $45,979.09 2026-05-23
9 - 1 OTHER Extracorporeal Membrane Oxygenation (ecmo) 4 4 — — $48,886.42 $91,951.20 $48,886.42 2026-05-23
9 - 2 OTHER Extracorporeal Membrane Oxygenation (ecmo) 4 4 — — $66,759.05 $96,790.86 $66,759.05 2026-05-23
9 - 3 OTHER Extracorporeal Membrane Oxygenation (ecmo) 4 4 — — $133,013.29 $227,153.07 $133,013.29 2026-05-23
9 - 4 OTHER Extracorporeal Membrane Oxygenation (ecmo) 4 4 — — $197,917.39 $318,344.42 $197,917.39 2026-05-23
9035 OTHER Axicabtagene Ciloleucel Car+ 2 2 — — $469,398.00 $469,398.00 $469,398.00 2026-05-23
91 - 3 OTHER Other Major Head And Neck Procedures 4 4 — — $35,787.18 $72,248.88 $35,787.18 2026-05-23
91 - 4 OTHER Other Major Head And Neck Procedures 4 4 — — $53,559.70 $165,644.96 $53,559.70 2026-05-23
910 - 3 OTHER Craniotomy For Multiple Significant Trauma 4 4 — — $37,541.16 $80,027.40 $37,541.16 2026-05-23
910 - 4 OTHER Craniotomy For Multiple Significant Trauma 4 4 — — $58,156.84 $117,652.84 $58,156.84 2026-05-23
911 - 4 OTHER Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 4 4 — — $55,315.40 $187,311.21 $55,315.40 2026-05-23
912 - 4 OTHER Musculoskeletal And Other Procedures For Multiple Significant Trauma 4 4 — — $51,431.83 $130,841.49 $51,431.83 2026-05-23
9138 OTHER Inj, Hemgenix, Per Tx Dose 2 2 — — $3,557,519.00 $3,557,519.00 $3,557,519.00 2026-05-23
9141 OTHER Inj Onase Abepar-xioi Treat 2 2 — — $2,304,676.60 $2,304,676.60 $2,304,676.60 2026-05-23
9194 OTHER Tisagenlecleucel Car-pos T 2 2 — — $542,376.70 $542,376.70 $542,376.70 2026-05-23
92 - 4 OTHER Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 4 4 — — $43,829.82 $99,224.72 $43,829.82 2026-05-23
9273 OTHER Sipuleucel-t Auto Cd54+ 2 2 — — $53,253.95 $53,253.95 $53,253.95 2026-05-23
9391 OTHER Brexucabtagene Car Pos T 2 2 — — $467,992.59 $467,992.59 $467,992.59 2026-05-23
9413 OTHER Lisocabtagene Mara Car Pos T 2 2 — — $495,258.40 $495,258.40 $495,258.40 2026-05-23
9422 OTHER Idecabtagene Vicleucel Car 2 2 — — $506,598.79 $506,598.79 $506,598.79 2026-05-23
9498 OTHER Ciltacabtagene Car-pos T 2 2 — — $528,659.16 $528,659.16 $528,659.16 2026-05-23
950 - 4 OTHER Extensive O.r. Procedure Unrelated To Principal Diagnosis 4 4 — — $45,680.48 $240,750.87 $45,680.48 2026-05-23
951 - 4 OTHER Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis 4 4 — — $35,817.98 $214,415.64 $35,817.98 2026-05-23
PX-48000075 OTHER Hc Implant Pressure Sensor W Angio 6 6 $55,323.00 $33,193.80 40% off $27,259.93 $47,024.55 $40,939.02 2026-05-23
PX-48100022 OTHER Insrt Repl Icd Single Dual Chamber 6 6 $54,259.00 $32,555.40 40% off $30,743.85 $46,120.15 $40,151.66 2026-05-23
PX-48100024 OTHER Replace Icd Gen Only To Dual 6 6 $55,686.00 $33,411.60 40% off $21,523.65 $47,333.10 $41,207.64 2026-05-23
PX-48100025 OTHER Replace Icd Gen Only To Mult 6 6 $56,642.00 $33,985.20 40% off $30,743.85 $48,145.70 $41,915.08 2026-05-23
PX-48100129 OTHER Hc Rmvl&Rplcmt Substernal Impltbl Defibrillator Pg 6 6 $46,977.00 $28,186.20 40% off $21,523.65 $39,930.45 $34,762.98 2026-05-23
PX-48100154 OTHER Insj/Rplc Cardiac Modulj Sys 6 6 $62,664.00 $37,598.40 40% off $30,743.85 $53,264.40 $46,371.36 2026-05-23
RX-122149 OTHER Immun Glob G(igg)-pro-iga 0-50 10 % IV Soln 10 5 $6,498.52 $3,899.11 40% off $10,147.40 $51,738.18 $38,803.63 2026-05-23
RX-173341 OTHER Tenecteplase 50 Mg IV Solr 14 7 $27,901.35 $16,740.81 40% off $539.20 $89,284.12 $34,444.20 2026-05-23
RX-9002 OTHER Alteplase 100 Mg IV Solr 10 5 $29,592.12 $17,755.28 40% off $18,889.40 $47,347.40 $35,510.55 2026-05-23
SUP-400823 OTHER Kit Mitraclip 1 Clip Ntr 4 4 $54,000.00 $32,400.00 40% off $32,400.00 $43,200.00 $39,960.00 2026-05-23
SUP-400824 OTHER Kit Mitraclip 2 Clip Ntr 6 6 $54,000.00 $32,400.00 40% off $10,260.00 $43,200.00 $35,910.00 2026-05-23
SUP-400825 OTHER Kit Mitraclip 1 Clip Xtr 6 6 $54,000.00 $32,400.00 40% off $10,260.00 $43,200.00 $35,910.00 2026-05-23
SUP-400888 OTHER Kit Mitraclip 2 Clip Xtr 6 6 $54,000.00 $32,400.00 40% off $10,260.00 $43,200.00 $35,910.00 2026-05-23
SUP-403015 OTHER Icd Gallant Crt-d Cdhfa500t 4 4 $48,375.00 $29,025.00 40% off $29,025.00 $38,700.00 $35,797.50 2026-05-23
SUP-405098 OTHER Kit Pain Stimulator (3 Items) 4 4 $50,000.00 $30,000.00 40% off $30,000.00 $40,000.00 $37,000.00 2026-05-23
SUP-405478 OTHER Guide Mitraclip G4 Steerable System 6 6 $54,000.00 $32,400.00 40% off $10,260.00 $43,200.00 $35,910.00 2026-05-23
SUP-407110 OTHER Valve Sapien 3 Ultra 20mm 6 6 $58,500.00 $35,100.00 40% off $11,115.00 $46,800.00 $38,902.50 2026-05-23
SUP-407111 OTHER Valve Sapien 3 Ultra 23mm 6 6 $58,500.00 $35,100.00 40% off $11,115.00 $46,800.00 $38,902.50 2026-05-23
SUP-407112 OTHER Valve Sapien 3 Ultra 26mm 6 6 $58,500.00 $35,100.00 40% off $11,115.00 $46,800.00 $38,902.50 2026-05-23
SUP-407113 OTHER Kit Mitraclip 3 Clip Ntr 4 4 $54,000.00 $32,400.00 40% off $32,400.00 $43,200.00 $39,960.00 2026-05-23
SUP-407114 OTHER Kit Mitraclip 3 Clip Xtr 4 4 $54,000.00 $32,400.00 40% off $32,400.00 $43,200.00 $39,960.00 2026-05-23
SUP-407115 OTHER Kit Mitraclip 1 Ntr And 1 Xtr 4 4 $54,000.00 $32,400.00 40% off $32,400.00 $43,200.00 $39,960.00 2026-05-23
SUP-407116 OTHER Kit Mitraclip 2 Ntr And 1 Xtr 4 4 $54,000.00 $32,400.00 40% off $32,400.00 $43,200.00 $39,960.00 2026-05-23
SUP-407117 OTHER Kit Mitraclip 1 Ntr And 2 Xtr 4 4 $54,000.00 $32,400.00 40% off $32,400.00 $43,200.00 $39,960.00 2026-05-23
SUP-408965 OTHER Stent Graft Navion Thoracic 31mmx31mmx229mm 4 4 $50,000.00 $30,000.00 40% off $30,000.00 $40,000.00 $37,000.00 2026-05-23
SUP-408969 OTHER Stent Graft Navion Thoracic 34mmx34mmx229mm 4 4 $48,363.75 $29,018.25 40% off $29,018.25 $38,691.00 $35,789.18 2026-05-23
SUP-408972 OTHER Stent Graft Navion Thoracic 37mmx37mmx175mm 4 4 $49,987.50 $29,992.50 40% off $29,992.50 $39,990.00 $36,990.75 2026-05-23
SUP-408973 OTHER Stent Graft Navion Thoracic 37mmx37mmx229mm 4 4 $48,363.75 $29,018.25 40% off $29,018.25 $38,691.00 $35,789.18 2026-05-23
SUP-408977 OTHER Stent Graft Navion Thoracic 40mmx40mmx223mm 4 4 $48,363.75 $29,018.25 40% off $29,018.25 $38,691.00 $35,789.18 2026-05-23
SUP-408981 OTHER Stent Graft Navion Thoracic 43mmx43mmx223mm 4 4 $48,363.75 $29,018.25 40% off $29,018.25 $38,691.00 $35,789.18 2026-05-23
SUP-408985 OTHER Stent Graft Navion Thoracic 46mmx46mmx223mm 4 4 $48,363.75 $29,018.25 40% off $29,018.25 $38,691.00 $35,789.18 2026-05-23
SUP-412730 OTHER Catheter Impella 4.0cp 4 4 $50,000.00 $30,000.00 40% off $30,000.00 $40,000.00 $37,000.00 2026-05-23
SUP-412753 OTHER Monitor Cardiomems Hf System 4 4 $50,000.00 $30,000.00 40% off $30,000.00 $40,000.00 $37,000.00 2026-05-23
SUP-418967 OTHER Catheter Impella 2.5 4 4 $50,000.00 $30,000.00 40% off $30,000.00 $40,000.00 $37,000.00 2026-05-23
SUP-421192 OTHER Heartmate 3 Lvas Implant Kit 6 6 $179,865.00 $107,919.00 40% off $34,174.35 $143,892.00 $119,610.23 2026-05-23
SUP-426036 OTHER Icd Gallant Hf Crt-d Cdhfa500q 4 4 $48,375.00 $29,025.00 40% off $29,025.00 $38,700.00 $35,797.50 2026-05-23
SUP-431937 OTHER Cath Impella 5.5 S2 W Smart Assist 6 6 $79,200.00 $47,520.00 40% off $15,048.00 $63,360.00 $52,668.00 2026-05-23
SUP-452531 OTHER Valve Evolut Fx 23mm 6 6 $54,000.00 $32,400.00 40% off $10,260.00 $43,200.00 $35,910.00 2026-05-23
SUP-452532 OTHER Valve Evolut Fx 26mm 6 6 $54,000.00 $32,400.00 40% off $10,260.00 $43,200.00 $35,910.00 2026-05-23
SUP-452533 OTHER Valve Evolut Fx 29mm 6 6 $54,000.00 $32,400.00 40% off $10,260.00 $43,200.00 $35,910.00 2026-05-23
SUP-452534 OTHER Valve Evolut Fx 34mm 6 6 $54,000.00 $32,400.00 40% off $10,260.00 $43,200.00 $35,910.00 2026-05-23
SUP-454170 OTHER Valve Sapien 3 Resilia 20mm 6 6 $61,200.00 $36,720.00 40% off $11,628.00 $48,960.00 $40,698.00 2026-05-23
SUP-454171 OTHER Valve Sapien 3 Resilia 23mm 6 6 $61,200.00 $36,720.00 40% off $11,628.00 $48,960.00 $40,698.00 2026-05-23
SUP-454172 OTHER Valve Sapien 3 Resilia 26mm 6 6 $61,200.00 $36,720.00 40% off $11,628.00 $48,960.00 $40,698.00 2026-05-23
SUP-454173 OTHER Valve Sapien 3 Resilia 29mm 6 6 $61,200.00 $36,720.00 40% off $11,628.00 $48,960.00 $40,698.00 2026-05-23
SUP-454269 OTHER Valve Sapien 3 Femoral Kit 29m 4 4 $58,500.00 $35,100.00 40% off $35,100.00 $46,800.00 $43,290.00 2026-05-23
SUP-477182 OTHER Valve Evolut Fx+ 23mm 6 6 $56,700.00 $34,020.00 40% off $10,773.00 $45,360.00 $37,705.50 2026-05-23
SUP-477183 OTHER Valve Evolut Fx+ 26mm 6 6 $56,700.00 $34,020.00 40% off $10,773.00 $45,360.00 $37,705.50 2026-05-23
SUP-477184 OTHER Valve Evolut Fx+ 29mm 6 6 $56,700.00 $34,020.00 40% off $10,773.00 $45,360.00 $37,705.50 2026-05-23
SUP-477185 OTHER Valve Evolut Fx+ 34mm 6 6 $56,700.00 $34,020.00 40% off $10,773.00 $45,360.00 $37,705.50 2026-05-23
SUP-477459 OTHER Guide Triclip G4 Steerable System 6 6 $64,800.00 $38,880.00 40% off $12,312.00 $51,840.00 $43,092.00 2026-05-23
SUP-477464 OTHER Guide Triclip 24fr Steerable 6 6 $64,800.00 $38,880.00 40% off $12,312.00 $51,840.00 $43,092.00 2026-05-23
SUP-477512 OTHER Guide Triclip G5 Steerable System 6 6 $64,800.00 $38,880.00 40% off $12,312.00 $51,840.00 $43,092.00 2026-05-23
SUP-477517 OTHER Guide Triclip G5 Steerable 6 6 $64,800.00 $38,880.00 40% off $12,312.00 $51,840.00 $43,092.00 2026-05-23
SUP-477518 OTHER Guide Mitraclip G5 Steerable System 6 6 $59,400.00 $35,640.00 40% off $11,286.00 $47,520.00 $39,501.00 2026-05-23
SUP-477523 OTHER Guide Mitraclip G5 Steerable 6 6 $59,400.00 $35,640.00 40% off $11,286.00 $47,520.00 $39,501.00 2026-05-23
SUP-480467 OTHER Icd Aurora Ev Dvea3e4 4 4 $50,000.00 $30,000.00 40% off $30,000.00 $40,000.00 $37,000.00 2026-05-23
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