|
9138
|
OTHER
|
Inj, Hemgenix, Per Tx Dose
|
17
|
17
|
—
|
—
|
$3,853,477.39
|
$4,415,442.85
|
$4,054,179.34
|
2026-05-09
|
|
773
|
OTHER
|
Inj, Beqvez, Per Tx Dose
|
17
|
17
|
—
|
—
|
$3,782,239.10
|
$4,333,815.64
|
$3,979,230.72
|
2026-05-09
|
|
9141
|
OTHER
|
Inj Onase Abepar-xioi Treat
|
18
|
18
|
—
|
—
|
$2,506,049.97
|
$4,568,320.26
|
$2,649,625.75
|
2026-05-09
|
|
9194
|
OTHER
|
Tisagenlecleucel Car-pos T
|
24
|
21
|
—
|
—
|
$555,210.52
|
$1,735,032.86
|
$595,694.62
|
2026-05-09
|
|
9498
|
OTHER
|
Ciltacabtagene Car-pos T
|
24
|
21
|
—
|
—
|
$553,039.35
|
$1,728,247.97
|
$593,365.14
|
2026-05-09
|
|
9422
|
OTHER
|
Idecabtagene Vicleucel Car
|
24
|
21
|
—
|
—
|
$552,477.17
|
$1,726,491.15
|
$592,761.96
|
2026-05-09
|
|
9413
|
OTHER
|
Lisocabtagene Mara Car Pos T
|
24
|
21
|
—
|
—
|
$542,130.81
|
$1,694,158.78
|
$581,661.18
|
2026-05-09
|
|
5834
|
OTHER
|
Neonate W Ecmo
|
6
|
5
|
—
|
—
|
$251,290.00
|
$555,194.02
|
$555,194.02
|
2026-05-09
|
|
9035
|
OTHER
|
Axicabtagene Ciloleucel Car+
|
24
|
21
|
—
|
—
|
$513,519.96
|
$1,604,749.88
|
$550,964.13
|
2026-05-09
|
|
9391
|
OTHER
|
Brexucabtagene Car Pos T
|
24
|
21
|
—
|
—
|
$483,172.29
|
$1,509,913.40
|
$518,403.60
|
2026-05-09
|
|
5833
|
OTHER
|
Neonate W Ecmo
|
6
|
5
|
—
|
—
|
$168,049.52
|
$483,502.52
|
$483,502.52
|
2026-05-09
|
|
5884
|
OTHER
|
Neonate Bwt <1500g W Major Procedure
|
6
|
5
|
—
|
—
|
$240,423.35
|
$414,103.15
|
$414,103.15
|
2026-05-09
|
|
18
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
31
|
23
|
—
|
—
|
$304,062.04
|
$992,055.74
|
$392,322.63
|
2026-05-09
|
|
1614
|
OTHER
|
Cardiac Defibrillator & Heart Assist Implant
|
6
|
5
|
—
|
—
|
$197,038.03
|
$381,951.30
|
$381,951.30
|
2026-05-09
|
|
1
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
36
|
23
|
—
|
—
|
$235,934.19
|
$696,500.34
|
$342,488.26
|
2026-05-09
|
|
5832
|
OTHER
|
Neonate W Ecmo
|
6
|
5
|
—
|
—
|
$89,636.13
|
$303,409.48
|
$303,409.48
|
2026-05-09
|
|
6304
|
OTHER
|
Neonate Birthwt >2499g W Major Cardiovascular Procedure
|
6
|
5
|
—
|
—
|
$107,026.21
|
$281,465.27
|
$281,465.27
|
2026-05-09
|
|
8414
|
OTHER
|
Extensive 3rd Degree Burns W Skin Graft
|
6
|
5
|
—
|
—
|
$191,186.49
|
$274,323.77
|
$274,323.77
|
2026-05-09
|
|
5934
|
OTHER
|
Neonate Birthwt 750-999g Without Major Procedure
|
6
|
5
|
—
|
—
|
$165,872.48
|
$272,226.90
|
$272,226.90
|
2026-05-09
|
|
5914
|
OTHER
|
Neonate Birthwt 500-749g Without Major Procedure
|
6
|
5
|
—
|
—
|
$201,909.31
|
$269,511.04
|
$269,511.04
|
2026-05-09
|
|
5883
|
OTHER
|
Neonate Bwt <1500g W Major Procedure
|
6
|
5
|
—
|
—
|
$179,624.33
|
$265,594.04
|
$265,594.04
|
2026-05-09
|
|
6314
|
OTHER
|
Neonate Birthwt >2499g W Other Major Procedure
|
6
|
5
|
—
|
—
|
$95,014.66
|
$264,767.13
|
$264,767.13
|
2026-05-09
|
|
6094
|
OTHER
|
Neonate Bwt 1500-2499g W Major Procedure
|
6
|
5
|
—
|
—
|
$139,424.50
|
$261,739.38
|
$261,739.38
|
2026-05-09
|
|
3
|
OTHER
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
36
|
23
|
—
|
—
|
$154,691.32
|
$487,615.01
|
$259,549.48
|
2026-05-09
|
|
5882
|
OTHER
|
Neonate Bwt <1500g W Major Procedure
|
6
|
5
|
—
|
—
|
$87,968.96
|
$258,530.98
|
$258,530.98
|
2026-05-09
|
|
5831
|
OTHER
|
Neonate W Ecmo
|
6
|
5
|
—
|
—
|
$80,672.48
|
$245,705.08
|
$245,705.08
|
2026-05-09
|
|
44
|
OTHER
|
Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo
|
6
|
5
|
—
|
—
|
$141,247.15
|
$241,984.81
|
$241,984.81
|
2026-05-09
|
|
1612
|
OTHER
|
Cardiac Defibrillator & Heart Assist Implant
|
6
|
5
|
—
|
—
|
$51,058.90
|
$232,106.65
|
$232,106.65
|
2026-05-09
|
|
1611
|
OTHER
|
Cardiac Defibrillator & Heart Assist Implant
|
6
|
5
|
—
|
—
|
$39,549.97
|
$220,766.69
|
$220,766.69
|
2026-05-09
|
|
6034
|
OTHER
|
Neonate Birthwt 1000-1249g W Or Without Other Significant Condition
|
6
|
5
|
—
|
—
|
$131,378.77
|
$204,209.33
|
$204,209.33
|
2026-05-09
|
|
6024
|
OTHER
|
Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
6
|
5
|
—
|
—
|
$127,743.10
|
$196,434.51
|
$196,434.51
|
2026-05-09
|
|
14
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
40
|
25
|
—
|
—
|
$103,317.67
|
$315,153.31
|
$192,886.62
|
2026-05-09
|
|
927
|
OTHER
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
58
|
23
|
—
|
—
|
$1.62
|
$484,836.03
|
$184,128.71
|
2026-05-09
|
|
5933
|
OTHER
|
Neonate Birthwt 750-999g Without Major Procedure
|
6
|
5
|
—
|
—
|
$116,144.43
|
$183,362.29
|
$183,362.29
|
2026-05-09
|
|
5913
|
OTHER
|
Neonate Birthwt 500-749g Without Major Procedure
|
6
|
5
|
—
|
—
|
$143,025.55
|
$176,449.54
|
$176,449.54
|
2026-05-09
|
|
1604
|
OTHER
|
Major Cardiothoracic Repair Of Heart Anomaly
|
6
|
5
|
—
|
—
|
$114,923.77
|
$174,159.16
|
$174,159.16
|
2026-05-09
|
|
5881
|
OTHER
|
Neonate Bwt <1500g W Major Procedure
|
6
|
5
|
—
|
—
|
$79,172.04
|
$171,951.94
|
$171,951.94
|
2026-05-09
|
|
4
|
OTHER
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
36
|
23
|
—
|
—
|
$96,621.50
|
$318,213.75
|
$169,166.50
|
2026-05-09
|
|
215
|
OTHER
|
Other Heart Assist System Implant
|
38
|
24
|
—
|
—
|
$85,674.61
|
$339,832.23
|
$160,639.90
|
2026-05-09
|
|
43
|
OTHER
|
Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo
|
6
|
5
|
—
|
—
|
$98,173.18
|
$159,937.04
|
$159,937.04
|
2026-05-09
|
|
7
|
OTHER
|
Lung Transplant
|
36
|
23
|
—
|
—
|
$94,278.05
|
$297,510.12
|
$158,601.01
|
2026-05-09
|
|
6074
|
OTHER
|
Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
6
|
5
|
—
|
—
|
$102,011.28
|
$152,699.62
|
$152,699.62
|
2026-05-09
|
|
6303
|
OTHER
|
Neonate Birthwt >2499g W Major Cardiovascular Procedure
|
6
|
5
|
—
|
—
|
$46,670.15
|
$152,469.22
|
$152,469.22
|
2026-05-09
|
|
3034
|
OTHER
|
Dorsal & Lumbar Fusion Proc For Curvature Of Back
|
6
|
5
|
—
|
—
|
$105,949.31
|
$151,282.50
|
$151,282.50
|
2026-05-09
|
|
2
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
36
|
23
|
—
|
—
|
$97,444.07
|
$353,983.44
|
$150,146.27
|
2026-05-09
|
|
8424
|
OTHER
|
Burns With Skin Graft Except Extensive 3rd Degree Burns
|
6
|
5
|
—
|
—
|
$100,192.65
|
$149,735.79
|
$149,735.79
|
2026-05-09
|
|
1624
|
OTHER
|
Cardiac Valve Procedures W Ami Or Complex Pdx
|
6
|
5
|
—
|
—
|
$97,897.97
|
$148,937.73
|
$148,937.73
|
2026-05-09
|
|
6023
|
OTHER
|
Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
6
|
5
|
—
|
—
|
$92,273.72
|
$148,392.29
|
$148,392.29
|
2026-05-09
|
|
216
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
38
|
24
|
—
|
—
|
$84,183.31
|
$258,996.77
|
$144,475.84
|
2026-05-09
|
|
5932
|
OTHER
|
Neonate Birthwt 750-999g Without Major Procedure
|
6
|
5
|
—
|
—
|
$87,206.47
|
$142,568.76
|
$142,568.76
|
2026-05-09
|
|
A9543
|
OTHER
|
Hc Yttrium Y-90 Zevalin Per Tx Dose Up To 40mci
|
54
|
37
|
$94,628.00
|
$9,462.80
90% off
|
$95.27
|
$214,674.14
|
$141,684.93
|
2026-05-09
|
|
4404
|
OTHER
|
Kidney Transplant
|
6
|
5
|
—
|
—
|
$89,050.62
|
$140,388.74
|
$140,388.74
|
2026-05-09
|
|
8514
|
OTHER
|
Gender Related Procedures
|
6
|
5
|
—
|
—
|
$75,672.04
|
$131,822.16
|
$131,822.16
|
2026-05-09
|
|
5
|
OTHER
|
Liver Transplant With Mcc Or Intestinal Transplant
|
36
|
23
|
—
|
—
|
$83,273.53
|
$397,994.00
|
$126,398.76
|
2026-05-09
|
|
1634
|
OTHER
|
Cardiac Valve Procedures Without Ami Or Complex Pdx
|
6
|
5
|
—
|
—
|
$83,015.69
|
$126,013.06
|
$126,013.06
|
2026-05-09
|
|
8634
|
OTHER
|
Neonatal Aftercare
|
6
|
5
|
—
|
—
|
$91,004.28
|
$121,633.77
|
$121,633.77
|
2026-05-09
|
|
1784
|
OTHER
|
External Heart Assist Systems
|
6
|
5
|
—
|
—
|
$75,672.04
|
$121,078.79
|
$121,078.79
|
2026-05-09
|
|
219
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
38
|
24
|
—
|
—
|
$65,612.53
|
$202,842.88
|
$119,198.79
|
2026-05-09
|
|
1654
|
OTHER
|
Coronary Bypass W Ami Or Complex Pdx
|
6
|
5
|
—
|
—
|
$74,521.14
|
$116,720.31
|
$116,720.31
|
2026-05-09
|
|
1674
|
OTHER
|
Other Cardiothoracic & Thoracic Vascular Procedures
|
6
|
5
|
—
|
—
|
$75,693.45
|
$116,504.42
|
$116,504.42
|
2026-05-09
|
|
6114
|
OTHER
|
Neonate Birthwt 1500-1999g W Major Anomaly
|
6
|
5
|
—
|
—
|
$82,245.02
|
$115,813.39
|
$115,813.39
|
2026-05-09
|
|
6022
|
OTHER
|
Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
6
|
5
|
—
|
—
|
$69,508.53
|
$115,120.88
|
$115,120.88
|
2026-05-09
|
|
6073
|
OTHER
|
Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
6
|
5
|
—
|
—
|
$72,967.77
|
$114,908.14
|
$114,908.14
|
2026-05-09
|
|
6093
|
OTHER
|
Neonate Bwt 1500-2499g W Major Procedure
|
6
|
5
|
—
|
—
|
$75,189.86
|
$114,162.81
|
$114,162.81
|
2026-05-09
|
|
6124
|
OTHER
|
Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond
|
6
|
5
|
—
|
—
|
$79,026.74
|
$111,319.03
|
$111,319.03
|
2026-05-09
|
|
112
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
6
|
5
|
—
|
—
|
$39,375.01
|
$110,321.00
|
$110,321.00
|
2026-05-09
|
|
3044
|
OTHER
|
Dorsal & Lumbar Fusion Proc Except For Curvature Of Back
|
6
|
5
|
—
|
—
|
$80,785.30
|
$109,882.76
|
$109,882.76
|
2026-05-09
|
|
1834
|
OTHER
|
Percutaneous Structural Cardiac Procedures
|
6
|
5
|
—
|
—
|
$39,375.01
|
$108,244.94
|
$108,244.94
|
2026-05-09
|
|
5912
|
OTHER
|
Neonate Birthwt 500-749g Without Major Procedure
|
6
|
5
|
—
|
—
|
$94,818.85
|
$115,179.01
|
$104,300.74
|
2026-05-09
|
|
1794
|
OTHER
|
Defibrillator Implants
|
6
|
5
|
—
|
—
|
$39,375.01
|
$103,728.10
|
$103,728.10
|
2026-05-09
|
|
3033
|
OTHER
|
Dorsal & Lumbar Fusion Proc For Curvature Of Back
|
6
|
5
|
—
|
—
|
$77,994.36
|
$103,430.63
|
$103,430.63
|
2026-05-09
|
|
456
|
OTHER
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
36
|
23
|
—
|
—
|
$70,035.51
|
$240,649.77
|
$103,133.65
|
2026-05-09
|
|
426
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
30
|
23
|
—
|
—
|
$94,785.07
|
$253,194.44
|
$101,420.02
|
2026-05-09
|
|
6804
|
OTHER
|
Major O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms
|
6
|
5
|
—
|
—
|
$69,634.72
|
$101,368.91
|
$101,368.91
|
2026-05-09
|
|
20
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
36
|
23
|
—
|
—
|
$67,797.84
|
$274,936.01
|
$101,354.11
|
2026-05-09
|
|
1623
|
OTHER
|
Cardiac Valve Procedures W Ami Or Complex Pdx
|
6
|
5
|
—
|
—
|
$62,242.45
|
$100,876.28
|
$100,876.28
|
2026-05-09
|
|
209
|
OTHER
|
Complex Aortic Arch Procedures
|
43
|
32
|
$14,422.00
|
$1,442.20
90% off
|
$10,907.50
|
$260,031.32
|
$100,252.77
|
2026-05-09
|
|
6033
|
OTHER
|
Neonate Birthwt 1000-1249g W Or Without Other Significant Condition
|
6
|
5
|
—
|
—
|
$75,455.79
|
$98,606.71
|
$98,606.71
|
2026-05-09
|
|
5891
|
OTHER
|
Neonate Bwt <500g Or Ga <24 Weeks
|
6
|
5
|
—
|
—
|
$89,571.24
|
$139,012.91
|
$98,528.36
|
2026-05-09
|
|
268
|
OTHER
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
38
|
24
|
—
|
—
|
$56,648.45
|
$176,789.98
|
$97,577.96
|
2026-05-09
|
|
266
|
OTHER
|
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc
|
38
|
24
|
—
|
—
|
$52,898.55
|
$189,654.24
|
$97,286.23
|
2026-05-09
|
|
8504
|
OTHER
|
Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service
|
6
|
5
|
—
|
—
|
$46,945.23
|
$96,741.81
|
$96,741.81
|
2026-05-09
|
|
212
|
OTHER
|
Concomitant Aortic And Mitral Valve Procedures
|
34
|
25
|
—
|
—
|
$26,656.71
|
$249,815.05
|
$96,331.54
|
2026-05-09
|
|
217
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
38
|
24
|
—
|
—
|
$52,886.87
|
$167,799.76
|
$95,694.37
|
2026-05-09
|
|
23
|
OTHER
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
40
|
25
|
—
|
—
|
$46,122.06
|
$234,192.33
|
$94,625.78
|
2026-05-09
|
|
6134
|
OTHER
|
Neonate Birthwt 1500-1999g W Congenital/perinatal Infection
|
6
|
5
|
—
|
—
|
$70,243.00
|
$94,355.42
|
$94,355.42
|
2026-05-09
|
|
957
|
OTHER
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
36
|
23
|
—
|
—
|
$60,445.86
|
$200,387.64
|
$93,575.55
|
2026-05-09
|
|
1783
|
OTHER
|
External Heart Assist Systems
|
6
|
5
|
—
|
—
|
$39,375.01
|
$92,776.80
|
$92,776.80
|
2026-05-09
|
|
9124
|
OTHER
|
Musculoskeletal & Other Procedures For Multiple Significant Trauma
|
6
|
5
|
—
|
—
|
$69,921.77
|
$92,410.52
|
$92,410.52
|
2026-05-09
|
|
6214
|
OTHER
|
Neonate Bwt 2000-2499g W Major Anomaly
|
6
|
5
|
—
|
—
|
$67,755.41
|
$90,457.57
|
$90,457.57
|
2026-05-09
|
|
8413
|
OTHER
|
Extensive 3rd Degree Burns W Skin Graft
|
6
|
5
|
—
|
—
|
$73,896.92
|
$90,176.10
|
$90,176.10
|
2026-05-09
|
|
214
|
OTHER
|
Craniotomy Except For Trauma
|
6
|
5
|
—
|
—
|
$71,422.33
|
$90,155.29
|
$90,155.29
|
2026-05-09
|
|
1204
|
OTHER
|
Major Respiratory & Chest Procedures
|
6
|
5
|
—
|
—
|
$53,088.33
|
$88,431.08
|
$88,431.08
|
2026-05-09
|
|
21
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
40
|
25
|
—
|
—
|
$45,753.67
|
$208,486.48
|
$88,182.71
|
2026-05-09
|
|
4403
|
OTHER
|
Kidney Transplant
|
6
|
5
|
—
|
—
|
$56,249.35
|
$87,725.80
|
$87,725.80
|
2026-05-09
|
|
6814
|
OTHER
|
Other O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms
|
6
|
5
|
—
|
—
|
$65,821.22
|
$86,866.89
|
$86,866.89
|
2026-05-09
|
|
2204
|
OTHER
|
Major Stomach, Esophageal & Duodenal Procedures
|
6
|
5
|
—
|
—
|
$61,448.52
|
$86,839.69
|
$86,839.69
|
2026-05-09
|
|
6313
|
OTHER
|
Neonate Birthwt >2499g W Other Major Procedure
|
6
|
5
|
—
|
—
|
$34,102.09
|
$86,830.07
|
$86,830.07
|
2026-05-09
|
|
6904
|
OTHER
|
Acute Leukemia
|
6
|
5
|
—
|
—
|
$75,113.31
|
$86,204.71
|
$86,204.71
|
2026-05-09
|
|
2604
|
OTHER
|
Major Pancreas, Liver & Shunt Procedures
|
6
|
5
|
—
|
—
|
$64,422.73
|
$86,188.71
|
$86,188.71
|
2026-05-09
|
|
235
|
OTHER
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
38
|
24
|
—
|
—
|
$49,118.78
|
$153,218.68
|
$85,832.31
|
2026-05-09
|
|
6334
|
OTHER
|
Neonate Birthwt >2499g W Major Anomaly
|
6
|
5
|
—
|
—
|
$48,565.75
|
$85,123.53
|
$85,123.53
|
2026-05-09
|
|
870
|
OTHER
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
36
|
23
|
—
|
—
|
$52,332.98
|
$166,019.65
|
$84,937.30
|
2026-05-09
|
|
3124
|
OTHER
|
Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses
|
6
|
5
|
—
|
—
|
$77,047.67
|
$84,752.44
|
$84,752.44
|
2026-05-09
|
|
11
|
OTHER
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc
|
40
|
25
|
—
|
—
|
$40,860.91
|
$129,549.81
|
$83,837.90
|
2026-05-09
|
|
1653
|
OTHER
|
Coronary Bypass W Ami Or Complex Pdx
|
6
|
5
|
—
|
—
|
$50,059.85
|
$83,771.98
|
$83,771.98
|
2026-05-09
|
|
3614
|
OTHER
|
Skin Graft For Skin & Subcutaneous Tissue Diagnoses
|
6
|
5
|
—
|
—
|
$55,077.95
|
$83,639.25
|
$83,639.25
|
2026-05-09
|
|
6072
|
OTHER
|
Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
6
|
5
|
—
|
—
|
$53,878.23
|
$83,599.20
|
$83,599.20
|
2026-05-09
|
|
4414
|
OTHER
|
Major Bladder Procedures
|
6
|
5
|
—
|
—
|
$59,484.35
|
$83,396.08
|
$83,396.08
|
2026-05-09
|
|
6084
|
OTHER
|
Neonate Bwt 1250-1499g W Or Without Other Significant Condition
|
6
|
5
|
—
|
—
|
$75,813.19
|
$95,172.11
|
$83,394.51
|
2026-05-09
|
|
1633
|
OTHER
|
Cardiac Valve Procedures Without Ami Or Complex Pdx
|
6
|
5
|
—
|
—
|
$51,522.26
|
$83,010.65
|
$83,010.65
|
2026-05-09
|
|
429
|
OTHER
|
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc
|
30
|
23
|
—
|
—
|
$77,564.07
|
$206,981.14
|
$82,993.55
|
2026-05-09
|
|
955
|
OTHER
|
Craniotomy For Multiple Significant Trauma
|
36
|
23
|
—
|
—
|
$51,218.68
|
$160,787.45
|
$82,732.90
|
2026-05-09
|
|
1304
|
OTHER
|
Respiratory System Diagnosis W Ventilator Support 96+ Hours
|
6
|
5
|
—
|
—
|
$50,242.26
|
$82,479.63
|
$82,479.63
|
2026-05-09
|
|
1782
|
OTHER
|
External Heart Assist Systems
|
6
|
5
|
—
|
—
|
$39,375.01
|
$82,345.24
|
$82,345.24
|
2026-05-09
|
|
1603
|
OTHER
|
Major Cardiothoracic Repair Of Heart Anomaly
|
6
|
5
|
—
|
—
|
$51,604.00
|
$82,262.09
|
$82,262.09
|
2026-05-09
|
|
6083
|
OTHER
|
Neonate Bwt 1250-1499g W Or Without Other Significant Condition
|
6
|
5
|
—
|
—
|
$64,919.84
|
$81,534.33
|
$81,534.33
|
2026-05-09
|
|
220
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
38
|
24
|
—
|
—
|
$43,984.69
|
$137,274.17
|
$81,143.54
|
2026-05-09
|
|
234
|
OTHER
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc
|
42
|
26
|
—
|
—
|
$43,312.69
|
$135,741.96
|
$81,099.17
|
2026-05-09
|
|
218
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
36
|
23
|
—
|
—
|
$41,893.75
|
$155,734.57
|
$80,605.50
|
2026-05-09
|
|
228
|
OTHER
|
Other Cardiothoracic Procedures With Mcc
|
38
|
24
|
—
|
—
|
$42,788.18
|
$173,427.55
|
$80,227.85
|
2026-05-09
|
|
850
|
OTHER
|
Acute Leukemia With Other Procedures
|
30
|
23
|
—
|
—
|
$74,566.92
|
$198,938.16
|
$79,786.61
|
2026-05-09
|
|
231
|
OTHER
|
Coronary Bypass With Ptca With Mcc
|
42
|
26
|
—
|
—
|
$13,822.84
|
$221,495.79
|
$79,135.48
|
2026-05-09
|
|
207
|
OTHER
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
36
|
23
|
—
|
—
|
$46,644.18
|
$147,826.94
|
$79,117.05
|
2026-05-09
|
|
6144
|
OTHER
|
Neonate Bwt 1500-1999g W Or Without Other Significant Condition
|
6
|
5
|
—
|
—
|
$47,054.02
|
$79,020.02
|
$79,020.02
|
2026-05-09
|
|
1622
|
OTHER
|
Cardiac Valve Procedures W Ami Or Complex Pdx
|
6
|
5
|
—
|
—
|
$47,031.12
|
$78,815.33
|
$78,815.33
|
2026-05-09
|
|
2614
|
OTHER
|
Major Biliary Tract Procedures
|
6
|
5
|
—
|
—
|
$49,299.80
|
$78,413.90
|
$78,413.90
|
2026-05-09
|
|
1814
|
OTHER
|
Lower Extremity Arterial Procedures
|
6
|
5
|
—
|
—
|
$57,369.46
|
$77,708.53
|
$77,708.53
|
2026-05-09
|
|
7404
|
OTHER
|
Mental Illness Diagnosis W O.r. Procedure
|
6
|
5
|
—
|
—
|
$51,815.53
|
$77,553.32
|
$77,553.32
|
2026-05-09
|
|
4402
|
OTHER
|
Kidney Transplant
|
6
|
5
|
—
|
—
|
$49,744.23
|
$77,129.50
|
$77,129.50
|
2026-05-09
|
|
1764
|
OTHER
|
Cardiac Pacemaker & Defibrillator Device Replacement
|
6
|
5
|
—
|
—
|
$45,769.75
|
$76,899.19
|
$76,899.19
|
2026-05-09
|
|
267
|
OTHER
|
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc
|
38
|
24
|
—
|
—
|
$41,190.72
|
$154,226.09
|
$76,867.95
|
2026-05-09
|
|
4014
|
OTHER
|
Pituitary & Adrenal Procedures
|
6
|
5
|
—
|
—
|
$69,390.40
|
$76,643.26
|
$76,643.26
|
2026-05-09
|
|
5104
|
OTHER
|
Pelvic Evisceration, Radical Hysterectomy & Other Radical GYN Procs
|
6
|
5
|
—
|
—
|
$62,312.17
|
$75,432.49
|
$75,432.49
|
2026-05-09
|
|
969
|
OTHER
|
HIV With Extensive O.r. Procedures With Mcc
|
36
|
23
|
—
|
—
|
$47,141.06
|
$147,648.92
|
$75,293.81
|
2026-05-09
|
|
1781
|
OTHER
|
External Heart Assist Systems
|
6
|
5
|
—
|
—
|
$39,375.01
|
$75,280.61
|
$75,280.61
|
2026-05-09
|
|
3032
|
OTHER
|
Dorsal & Lumbar Fusion Proc For Curvature Of Back
|
6
|
5
|
—
|
—
|
$53,234.78
|
$75,055.01
|
$75,055.01
|
2026-05-09
|
|
270
|
OTHER
|
Other Major Cardiovascular Procedures With Mcc
|
38
|
24
|
—
|
—
|
$42,206.54
|
$133,487.15
|
$74,539.32
|
2026-05-09
|
|
6302
|
OTHER
|
Neonate Birthwt >2499g W Major Cardiovascular Procedure
|
6
|
5
|
—
|
—
|
$29,659.42
|
$74,388.12
|
$74,388.12
|
2026-05-09
|
|
6954
|
OTHER
|
Chemotherapy For Acute Leukemia
|
6
|
5
|
—
|
—
|
$62,358.93
|
$74,146.61
|
$74,146.61
|
2026-05-09
|
|
28
|
OTHER
|
Spinal Procedures With Mcc
|
36
|
23
|
—
|
—
|
$47,406.60
|
$141,744.23
|
$73,915.32
|
2026-05-09
|
|
7924
|
OTHER
|
Extensive O.r. Procedures For Other Complications Of Treatment
|
6
|
5
|
—
|
—
|
$39,375.01
|
$73,770.71
|
$73,770.71
|
2026-05-09
|
|
1643
|
OTHER
|
Y90 Ibritumomab, Rx
|
24
|
21
|
—
|
—
|
$68,695.73
|
$214,674.14
|
$73,704.79
|
2026-05-09
|
|
457
|
OTHER
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
36
|
23
|
—
|
—
|
$51,483.45
|
$172,594.19
|
$73,363.91
|
2026-05-09
|
|
2304
|
OTHER
|
Major Small Bowel Procedures
|
6
|
5
|
—
|
—
|
$39,375.01
|
$73,068.58
|
$73,068.58
|
2026-05-09
|
|
16
|
OTHER
|
Autologous Bone Marrow Transplant With Cc/mcc
|
36
|
23
|
—
|
—
|
$51,197.50
|
$172,457.06
|
$72,956.44
|
2026-05-09
|
|
3214
|
OTHER
|
Cervical Spinal Fusion & Other Back/neck Proc Exc Disc Excis/decomp
|
6
|
5
|
—
|
—
|
$65,228.20
|
$72,603.14
|
$72,603.14
|
2026-05-09
|
|
1793
|
OTHER
|
Defibrillator Implants
|
6
|
5
|
—
|
—
|
$39,375.01
|
$72,396.78
|
$72,396.78
|
2026-05-09
|
|
1833
|
OTHER
|
Percutaneous Structural Cardiac Procedures
|
6
|
5
|
—
|
—
|
$39,375.01
|
$72,302.43
|
$72,302.43
|
2026-05-09
|
|
924
|
OTHER
|
Facial Bone Procedures Except Major Cranial/facial Bone Procedures
|
6
|
5
|
—
|
—
|
$49,355.54
|
$72,097.65
|
$72,097.65
|
2026-05-09
|
|
233
|
OTHER
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
42
|
26
|
—
|
—
|
$38,265.03
|
$201,421.42
|
$71,813.17
|
2026-05-09
|
|
5892
|
OTHER
|
Neonate Bwt <500g Or Ga <24 Weeks
|
6
|
5
|
—
|
—
|
$65,233.63
|
$97,510.68
|
$71,756.99
|
2026-05-09
|
|
3043
|
OTHER
|
Dorsal & Lumbar Fusion Proc Except For Curvature Of Back
|
6
|
5
|
—
|
—
|
$48,505.07
|
$71,493.10
|
$71,493.10
|
2026-05-09
|
|
2324
|
OTHER
|
Gastric Fundoplication
|
6
|
5
|
—
|
—
|
$39,375.01
|
$70,501.45
|
$70,501.45
|
2026-05-09
|
|
1673
|
OTHER
|
Other Cardiothoracic & Thoracic Vascular Procedures
|
6
|
5
|
—
|
—
|
$43,186.06
|
$70,480.64
|
$70,480.64
|
2026-05-09
|
|
6123
|
OTHER
|
Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond
|
6
|
5
|
—
|
—
|
$51,518.60
|
$70,010.40
|
$70,010.40
|
2026-05-09
|
|
1663
|
OTHER
|
Coronary Bypass Without Ami Or Complex Pdx
|
6
|
5
|
—
|
—
|
$42,848.04
|
$69,868.05
|
$69,868.05
|
2026-05-09
|
|
1652
|
OTHER
|
Coronary Bypass W Ami Or Complex Pdx
|
6
|
5
|
—
|
—
|
$39,375.01
|
$69,680.93
|
$69,680.93
|
2026-05-09
|
|
6113
|
OTHER
|
Neonate Birthwt 1500-1999g W Major Anomaly
|
6
|
5
|
—
|
—
|
$52,350.26
|
$69,484.19
|
$69,484.19
|
2026-05-09
|
|
4401
|
OTHER
|
Kidney Transplant
|
6
|
5
|
—
|
—
|
$47,540.33
|
$69,157.95
|
$69,157.95
|
2026-05-09
|
|
8
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant
|
36
|
23
|
—
|
—
|
$44,203.81
|
$164,816.00
|
$68,990.49
|
2026-05-09
|
|
3254
|
OTHER
|
Non-elective Or Complex Knee Joint Replacement
|
6
|
5
|
—
|
—
|
$39,375.01
|
$68,484.59
|
$68,484.59
|
2026-05-09
|
|
1621
|
OTHER
|
Cardiac Valve Procedures W Ami Or Complex Pdx
|
6
|
5
|
—
|
—
|
$42,374.98
|
$68,439.82
|
$68,439.82
|
2026-05-09
|
|
2644
|
OTHER
|
Other Hepatobiliary, Pancreas & Abdominal Procedures
|
6
|
5
|
—
|
—
|
$52,049.65
|
$68,038.30
|
$68,038.30
|
2026-05-09
|
|
6133
|
OTHER
|
Neonate Birthwt 1500-1999g W Congenital/perinatal Infection
|
6
|
5
|
—
|
—
|
$52,685.17
|
$67,697.63
|
$67,697.63
|
2026-05-09
|
|
405
|
OTHER
|
Pancreas, Liver And Shunt Procedures With Mcc
|
36
|
23
|
—
|
—
|
$46,677.59
|
$141,857.63
|
$67,354.57
|
2026-05-09
|
|
4054
|
OTHER
|
Other Procedures For Endocrine, Nutritional & Metabolic Disorders
|
6
|
5
|
—
|
—
|
$51,573.84
|
$67,315.35
|
$67,315.35
|
2026-05-09
|
|
24
|
OTHER
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
40
|
25
|
—
|
—
|
$32,032.03
|
$370,027.51
|
$67,148.90
|
2026-05-09
|
|
4044
|
OTHER
|
Thyroid, Parathyroid & Thyroglossal Procedures
|
6
|
5
|
—
|
—
|
$48,248.18
|
$67,067.46
|
$67,067.46
|
2026-05-09
|
|
10
|
OTHER
|
Pancreas Transplant
|
36
|
23
|
—
|
—
|
$29,467.84
|
$206,724.00
|
$66,990.57
|
2026-05-09
|
|
7104
|
OTHER
|
Infectious & Parasitic Diseases Including HIV W O.r. Procedure
|
6
|
5
|
—
|
—
|
$51,553.27
|
$66,971.54
|
$66,971.54
|
2026-05-09
|
|
5124
|
OTHER
|
Uterine & Adnexa Procedures For Non-ovarian & Non-adnexal Malig
|
6
|
5
|
—
|
—
|
$41,066.29
|
$66,941.11
|
$66,941.11
|
2026-05-09
|
|
6514
|
OTHER
|
Other Procedures Of Blood & Blood-forming Organs
|
6
|
5
|
—
|
—
|
$52,109.36
|
$66,757.14
|
$66,757.14
|
2026-05-09
|
|
427
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
30
|
23
|
—
|
—
|
$62,231.58
|
$165,835.79
|
$66,587.79
|
2026-05-09
|
|
5244
|
OTHER
|
Transplt Allo Hct/donor
|
24
|
21
|
—
|
—
|
$62,050.05
|
$193,906.41
|
$66,574.53
|
2026-05-09
|
|
1754
|
OTHER
|
Percutaneous Coronary Intervention Without Ami
|
6
|
5
|
—
|
—
|
$48,131.46
|
$66,197.36
|
$66,197.36
|
2026-05-09
|
|
1632
|
OTHER
|
Cardiac Valve Procedures Without Ami Or Complex Pdx
|
6
|
5
|
—
|
—
|
$40,175.78
|
$66,195.78
|
$66,195.78
|
2026-05-09
|
|
12
|
OTHER
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc
|
40
|
25
|
—
|
—
|
$31,212.60
|
$110,250.61
|
$65,893.75
|
2026-05-09
|
|
51
|
OTHER
|
Tracheostomy W Mv 96+ Hours Without Extensive Procedure
|
6
|
5
|
—
|
—
|
$47,779.03
|
$65,872.70
|
$65,872.70
|
2026-05-09
|
|
275
|
OTHER
|
Selox 53cm Actv Ster
|
30
|
23
|
$5,322.50
|
$532.25
90% off
|
$61,476.52
|
$163,809.53
|
$65,779.88
|
2026-05-09
|
|
4034
|
OTHER
|
Procedures For Obesity
|
6
|
5
|
—
|
—
|
$58,774.30
|
$65,575.23
|
$65,575.23
|
2026-05-09
|
|
19
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
31
|
23
|
—
|
—
|
$54,264.27
|
$153,781.17
|
$65,203.22
|
2026-05-09
|
|
2314
|
OTHER
|
Major Large Bowel Procedures
|
6
|
5
|
—
|
—
|
$47,783.12
|
$65,017.02
|
$65,017.02
|
2026-05-09
|
|
6092
|
OTHER
|
Neonate Bwt 1500-2499g W Major Procedure
|
6
|
5
|
—
|
—
|
$47,130.76
|
$64,866.62
|
$64,866.62
|
2026-05-09
|
|
8633
|
OTHER
|
Neonatal Aftercare
|
6
|
5
|
—
|
—
|
$38,091.41
|
$64,778.66
|
$64,778.66
|
2026-05-09
|
|
17
|
OTHER
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
36
|
23
|
—
|
—
|
$39,344.22
|
$117,348.38
|
$64,537.29
|
2026-05-09
|
|
6504
|
OTHER
|
Splenectomy
|
6
|
5
|
—
|
—
|
$48,138.30
|
$64,388.42
|
$64,388.42
|
2026-05-09
|
|
4474
|
OTHER
|
Other Kidney, Urinary Tract & Related Procedures
|
6
|
5
|
—
|
—
|
$47,983.84
|
$64,161.34
|
$64,161.34
|
2026-05-09
|
|
5144
|
OTHER
|
Female Reproductive System Reconstructive Procedures
|
6
|
5
|
—
|
—
|
$47,718.71
|
$64,127.68
|
$64,127.68
|
2026-05-09
|
|
466
|
OTHER
|
Revision Of Hip Or Knee Replacement With Mcc
|
36
|
23
|
—
|
—
|
$43,537.51
|
$134,845.31
|
$64,120.54
|
2026-05-09
|
|
653
|
OTHER
|
Major Bladder Procedures With Mcc
|
36
|
23
|
—
|
—
|
$44,386.26
|
$144,755.91
|
$64,010.75
|
2026-05-09
|
|
4424
|
OTHER
|
Kidney & Urinary Tract Procedures For Malignancy
|
6
|
5
|
—
|
—
|
$45,984.33
|
$63,895.79
|
$63,895.79
|
2026-05-09
|
|
224
|
OTHER
|
Ventricular Shunt Procedures
|
6
|
5
|
—
|
—
|
$57,677.07
|
$63,444.78
|
$63,444.78
|
2026-05-09
|
|
1303
|
OTHER
|
Respiratory System Diagnosis W Ventilator Support 96+ Hours
|
6
|
5
|
—
|
—
|
$36,582.48
|
$63,092.92
|
$63,092.92
|
2026-05-09
|
|
3031
|
OTHER
|
Dorsal & Lumbar Fusion Proc For Curvature Of Back
|
6
|
5
|
—
|
—
|
$44,239.39
|
$63,060.92
|
$63,060.92
|
2026-05-09
|
|
3094
|
OTHER
|
Other Significant Hip & Femur Surgery
|
6
|
5
|
—
|
—
|
$50,053.13
|
$62,699.45
|
$62,699.45
|
2026-05-09
|
|
236
|
OTHER
|
Coronary Bypass Without Cardiac Catheterization Without Mcc
|
38
|
24
|
—
|
—
|
$33,240.01
|
$103,544.38
|
$62,581.28
|
2026-05-09
|
|
673
|
OTHER
|
Other Kidney And Urinary Tract Procedures With Mcc
|
37
|
23
|
—
|
—
|
$28,208.56
|
$96,525.04
|
$62,366.80
|
2026-05-09
|
|
6224
|
OTHER
|
Neonate Bwt 2000-2499g W Resp Dist Synd/oth Maj Resp Cond
|
6
|
5
|
—
|
—
|
$52,540.79
|
$62,344.36
|
$62,344.36
|
2026-05-09
|
|
294
|
OTHER
|
Other Percutaneous Intracranial Procedures
|
6
|
5
|
—
|
—
|
$47,783.12
|
$62,250.01
|
$62,250.01
|
2026-05-09
|
|
3134
|
OTHER
|
Knee & Lower Leg Procedures Except Foot
|
6
|
5
|
—
|
—
|
$46,007.35
|
$62,205.15
|
$62,205.15
|
2026-05-09
|
|
928
|
OTHER
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
58
|
23
|
—
|
—
|
$1.73
|
$164,781.31
|
$62,147.83
|
2026-05-09
|
|
2294
|
OTHER
|
Other Digestive System & Abdominal Procedures
|
6
|
5
|
—
|
—
|
$49,182.16
|
$61,982.88
|
$61,982.88
|
2026-05-09
|
|
9273
|
OTHER
|
Sipuleucel-t Auto Cd54+
|
24
|
21
|
—
|
—
|
$57,720.04
|
$180,375.12
|
$61,928.79
|
2026-05-09
|
|
317
|
OTHER
|
Concomitant Left Atrial Appendage Closure And Cardiac Ablation
|
30
|
23
|
—
|
—
|
$57,676.35
|
$153,611.64
|
$61,713.69
|
2026-05-09
|
|
447
|
OTHER
|
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…
|
30
|
23
|
—
|
—
|
$57,634.41
|
$153,499.07
|
$61,668.82
|
2026-05-09
|
|
4804
|
OTHER
|
Major Male Pelvic Procedures
|
6
|
5
|
—
|
—
|
$48,094.71
|
$61,608.65
|
$61,608.65
|
2026-05-09
|
|
326
|
OTHER
|
Stomach, Esophageal And Duodenal Procedures With Mcc
|
36
|
23
|
—
|
—
|
$43,130.61
|
$138,608.59
|
$61,461.13
|
2026-05-09
|
|
269
|
OTHER
|
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc
|
38
|
24
|
—
|
—
|
$35,144.42
|
$109,467.53
|
$61,378.82
|
2026-05-09
|
|
6143
|
OTHER
|
Neonate Bwt 1500-1999g W Or Without Other Significant Condition
|
6
|
5
|
—
|
—
|
$43,989.82
|
$61,275.94
|
$61,275.94
|
2026-05-09
|
|
94
|
OTHER
|
Bacterial And Tuberculous Infections Of Nervous System With Mcc
|
40
|
25
|
—
|
—
|
$29,593.29
|
$246,544.75
|
$61,126.58
|
2026-05-09
|
|
7114
|
OTHER
|
Post-op, Post-trauma, Other Device Infections W O.r. Procedure
|
6
|
5
|
—
|
—
|
$51,636.30
|
$61,072.82
|
$61,072.82
|
2026-05-09
|
|
1831
|
OTHER
|
Percutaneous Structural Cardiac Procedures
|
6
|
5
|
—
|
—
|
$47,783.12
|
$60,978.47
|
$60,978.47
|
2026-05-09
|
|
853
|
OTHER
|
Infectious And Parasitic Diseases With O.r. Procedures With Mcc
|
36
|
23
|
—
|
—
|
$40,276.06
|
$133,365.84
|
$60,865.83
|
2026-05-09
|
|
2244
|
OTHER
|
Peritoneal Adhesiolysis
|
6
|
5
|
—
|
—
|
$42,365.64
|
$60,740.11
|
$60,740.11
|
2026-05-09
|
|
239
|
OTHER
|
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc
|
36
|
23
|
—
|
—
|
$39,169.10
|
$124,193.66
|
$60,659.65
|
2026-05-09
|
|
573
|
OTHER
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
40
|
25
|
—
|
—
|
$11,451.18
|
$150,507.93
|
$60,476.18
|
2026-05-09
|
|
576
|
OTHER
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc
|
36
|
23
|
—
|
—
|
$41,216.87
|
$128,713.82
|
$60,409.59
|
2026-05-09
|
|
5893
|
OTHER
|
Neonate Bwt <500g Or Ga <24 Weeks
|
6
|
5
|
—
|
—
|
$54,780.61
|
$69,752.72
|
$60,258.67
|
2026-05-09
|
|
3104
|
OTHER
|
Intervertebral Disc Excision & Decompression
|
6
|
5
|
—
|
—
|
$37,957.95
|
$60,012.36
|
$60,012.36
|
2026-05-09
|
|
1651
|
OTHER
|
Coronary Bypass W Ami Or Complex Pdx
|
6
|
5
|
—
|
—
|
$36,612.09
|
$60,009.21
|
$60,009.21
|
2026-05-09
|
|
6254
|
OTHER
|
Neonate Bwt 2000-2499g W Other Significant Condition
|
6
|
5
|
—
|
—
|
$41,327.33
|
$59,929.20
|
$59,929.20
|
2026-05-09
|
|
893
|
OTHER
|
Major Cranial/facial Bone Procedures
|
6
|
5
|
—
|
—
|
$35,034.35
|
$59,902.01
|
$59,902.01
|
2026-05-09
|
|
6234
|
OTHER
|
Neonate Bwt 2000-2499g W Congenital/perinatal Infection
|
6
|
5
|
—
|
—
|
$51,835.99
|
$59,666.89
|
$59,666.89
|
2026-05-09
|
|
1792
|
OTHER
|
Defibrillator Implants
|
6
|
5
|
—
|
—
|
$47,783.12
|
$59,591.69
|
$59,591.69
|
2026-05-09
|
|
837
|
OTHER
|
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…
|
36
|
23
|
—
|
—
|
$41,563.13
|
$141,725.77
|
$59,578.64
|
2026-05-09
|
|
1744
|
OTHER
|
Percutaneous Coronary Intervention W Ami
|
6
|
5
|
—
|
—
|
$40,838.33
|
$59,486.15
|
$59,486.15
|
2026-05-09
|
|
1631
|
OTHER
|
Cardiac Valve Procedures Without Ami Or Complex Pdx
|
6
|
5
|
—
|
—
|
$34,965.74
|
$59,251.03
|
$59,251.03
|
2026-05-09
|
|
6091
|
OTHER
|
Neonate Bwt 1500-2499g W Major Procedure
|
6
|
5
|
—
|
—
|
$36,289.02
|
$58,841.55
|
$58,841.55
|
2026-05-09
|
|
4844
|
OTHER
|
Other Male Reproductive System & Related Procedures
|
6
|
5
|
—
|
—
|
$41,030.02
|
$58,726.39
|
$58,726.39
|
2026-05-09
|
|
1693
|
OTHER
|
Major Abdominal Vascular Procedures
|
6
|
5
|
—
|
—
|
$34,879.60
|
$58,660.81
|
$58,660.81
|
2026-05-09
|
|
6082
|
OTHER
|
Neonate Bwt 1250-1499g W Or Without Other Significant Condition
|
6
|
5
|
—
|
—
|
$43,943.79
|
$58,632.05
|
$58,632.05
|
2026-05-09
|
|
3154
|
OTHER
|
Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement
|
6
|
5
|
—
|
—
|
$43,827.86
|
$58,457.69
|
$58,457.69
|
2026-05-09
|
|
3054
|
OTHER
|
Amputation Of Lower Limb Except Toes
|
6
|
5
|
—
|
—
|
$47,783.12
|
$58,179.46
|
$58,179.46
|
2026-05-09
|
|
7934
|
OTHER
|
Moderately Extensive O.r. Procedures For Other Complications Of Treatment
|
6
|
5
|
—
|
—
|
$47,783.12
|
$58,176.23
|
$58,176.23
|
2026-05-09
|
|
2224
|
OTHER
|
Other Stomach, Esophageal & Duodenal Procedures
|
6
|
5
|
—
|
—
|
$49,383.25
|
$57,873.95
|
$57,873.95
|
2026-05-09
|
|
3204
|
OTHER
|
Other Musculoskeletal System & Connective Tissue Procedures
|
6
|
5
|
—
|
—
|
$40,355.99
|
$57,793.94
|
$57,793.94
|
2026-05-09
|
|
984
|
OTHER
|
Other Ear, Nose, Mouth & Throat Procedures
|
6
|
5
|
—
|
—
|
$35,595.45
|
$57,739.56
|
$57,739.56
|
2026-05-09
|
|
1714
|
OTHER
|
Perm Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock
|
6
|
5
|
—
|
—
|
$37,293.63
|
$57,622.83
|
$57,622.83
|
2026-05-09
|
|
3224
|
OTHER
|
Shoulder & Elbow Joint Replacement
|
6
|
5
|
—
|
—
|
$37,845.44
|
$57,467.71
|
$57,467.71
|
2026-05-09
|
|
2274
|
OTHER
|
Hernia Procedures Except Inguinal, Femoral & Umbilical
|
6
|
5
|
—
|
—
|
$43,029.66
|
$57,342.93
|
$57,342.93
|
2026-05-09
|
|
6
|
OTHER
|
Liver Transplant Without Mcc
|
36
|
23
|
—
|
—
|
$38,216.08
|
$397,994.00
|
$57,186.54
|
2026-05-09
|
|
2234
|
OTHER
|
Other Small & Large Bowel Procedures
|
6
|
5
|
—
|
—
|
$48,054.17
|
$57,142.96
|
$57,142.96
|
2026-05-09
|
|
232
|
OTHER
|
Coronary Bypass With Ptca Without Mcc
|
42
|
26
|
—
|
—
|
$19,805.26
|
$162,462.07
|
$57,045.41
|
2026-05-09
|
|
245
|
OTHER
|
Aicd Generator Procedures
|
36
|
23
|
—
|
—
|
$39,492.26
|
$132,179.10
|
$56,605.50
|
2026-05-09
|
|
7524
|
OTHER
|
Disorders Of Personality & Impulse Control
|
6
|
5
|
—
|
—
|
$8,232.96
|
$56,586.41
|
$56,586.41
|
2026-05-09
|
|
7594
|
OTHER
|
Eating Disorders
|
6
|
5
|
—
|
—
|
$26,499.32
|
$56,268.13
|
$56,268.13
|
2026-05-09
|
|
25
|
OTHER
|
Craniotomy And Endovascular Intracranial Procedures With Mcc
|
36
|
23
|
—
|
—
|
$36,586.98
|
$112,806.23
|
$56,084.93
|
2026-05-09
|
|
3634
|
OTHER
|
Breast Procedures Except Mastectomy
|
6
|
5
|
—
|
—
|
$40,704.45
|
$55,633.15
|
$55,633.15
|
2026-05-09
|
|
3624
|
OTHER
|
Mastectomy Procedures
|
6
|
5
|
—
|
—
|
$39,821.27
|
$55,562.76
|
$55,562.76
|
2026-05-09
|
|
276
|
OTHER
|
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator
|
30
|
23
|
$10.54
|
$1.05
90% off
|
$51,855.83
|
$137,992.02
|
$55,485.74
|
2026-05-09
|
|
163
|
OTHER
|
Major Chest Procedures With Mcc
|
36
|
23
|
—
|
—
|
$38,802.25
|
$129,731.78
|
$55,293.21
|
2026-05-09
|
|
31
|
OTHER
|
Ventricular Shunt Procedures With Mcc
|
36
|
23
|
—
|
—
|
$35,563.91
|
$110,311.44
|
$55,277.35
|
2026-05-09
|
|
22
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…
|
40
|
25
|
—
|
—
|
$27,635.48
|
$168,554.76
|
$55,270.95
|
2026-05-09
|
|
6344
|
OTHER
|
Neonate, Birthwt >2499g W Resp Dist Synd/oth Maj Resp Cond
|
6
|
5
|
—
|
—
|
$50,194.60
|
$55,214.06
|
$55,214.06
|
2026-05-09
|
|
111
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
6
|
5
|
—
|
—
|
$47,783.12
|
$55,135.71
|
$55,135.71
|
2026-05-09
|
|
1804
|
OTHER
|
Other Circulatory System Procedures
|
6
|
5
|
—
|
—
|
$39,143.75
|
$55,090.94
|
$55,090.94
|
2026-05-09
|
|
3234
|
OTHER
|
Non-elective Or Complex Hip Joint Replacement
|
6
|
5
|
—
|
—
|
$24,043.60
|
$55,052.56
|
$55,052.56
|
2026-05-09
|
|
6122
|
OTHER
|
Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond
|
6
|
5
|
—
|
—
|
$24,043.60
|
$54,860.63
|
$54,860.63
|
2026-05-09
|
|
3244
|
OTHER
|
Elective Hip Joint Replacement
|
6
|
5
|
—
|
—
|
$24,043.60
|
$54,619.12
|
$54,619.12
|
2026-05-09
|
|
356
|
OTHER
|
Other Digestive System O.r. Procedures With Mcc
|
36
|
23
|
—
|
—
|
$34,955.45
|
$104,847.16
|
$54,207.49
|
2026-05-09
|
|
8423
|
OTHER
|
Burns With Skin Graft Except Extensive 3rd Degree Burns
|
6
|
5
|
—
|
—
|
$42,123.82
|
$53,438.69
|
$53,438.69
|
2026-05-09
|
|
430
|
OTHER
|
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc
|
30
|
23
|
—
|
—
|
$49,805.51
|
$132,489.90
|
$53,291.89
|
2026-05-09
|
|
1602
|
OTHER
|
Major Cardiothoracic Repair Of Heart Anomaly
|
6
|
5
|
—
|
—
|
$34,081.33
|
$53,257.96
|
$53,257.96
|
2026-05-09
|
|
1302
|
OTHER
|
Respiratory System Diagnosis W Ventilator Support 96+ Hours
|
6
|
5
|
—
|
—
|
$29,534.76
|
$53,153.99
|
$53,153.99
|
2026-05-09
|
|
4444
|
OTHER
|
Renal Dialysis Access Device Procedure Only
|
6
|
5
|
—
|
—
|
$42,264.85
|
$53,099.61
|
$53,099.61
|
2026-05-09
|
|
1661
|
OTHER
|
Coronary Bypass Without Ami Or Complex Pdx
|
6
|
5
|
—
|
—
|
$30,269.72
|
$53,005.26
|
$53,005.26
|
2026-05-09
|
|
3174
|
OTHER
|
Tendon, Muscle & Other Soft Tissue Procedures
|
6
|
5
|
—
|
—
|
$48,058.62
|
$52,864.48
|
$52,864.48
|
2026-05-09
|
|
264
|
OTHER
|
Other Circulatory System O.r. Procedures
|
40
|
25
|
—
|
—
|
$26,454.84
|
$83,298.60
|
$52,837.09
|
2026-05-09
|
|
213
|
OTHER
|
Endovascular Abdominal Aorta With Iliac Branch Procedures
|
34
|
25
|
—
|
—
|
$40,851.52
|
$131,106.90
|
$52,740.47
|
2026-05-09
|
|
1791
|
OTHER
|
Defibrillator Implants
|
6
|
5
|
—
|
—
|
$24,043.60
|
$52,728.52
|
$52,728.52
|
2026-05-09
|
|
463
|
OTHER
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …
|
40
|
25
|
—
|
—
|
$11,212.73
|
$135,338.47
|
$52,672.67
|
2026-05-09
|
|
458
|
OTHER
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
36
|
23
|
—
|
—
|
$36,155.25
|
$135,056.29
|
$52,070.37
|
2026-05-09
|
|
958
|
OTHER
|
Other O.r. Procedures For Multiple Significant Trauma With Cc
|
36
|
23
|
—
|
—
|
$34,254.93
|
$110,229.69
|
$52,025.07
|
2026-05-09
|
|
428
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
30
|
23
|
—
|
—
|
$48,563.33
|
$129,156.45
|
$51,962.76
|
2026-05-09
|
|
790
|
OTHER
|
Extreme Immaturity Or Respiratory Distress Syndrome, Neonate
|
58
|
23
|
—
|
—
|
$0.12
|
$144,684.70
|
$51,572.23
|
2026-05-09
|
|
4434
|
OTHER
|
Kidney & Urinary Tract Procedures For Nonmalignancy
|
6
|
5
|
—
|
—
|
$40,374.79
|
$51,524.13
|
$51,524.13
|
2026-05-09
|
|
278
|
OTHER
|
Bone Substitute 5cc (pick This To Document Serial And Lot # From Kit 402.202 Mm …
|
30
|
23
|
$0.11
|
$9.58
|
$48,085.64
|
$127,874.54
|
$51,451.63
|
2026-05-09
|
|
3042
|
OTHER
|
Dorsal & Lumbar Fusion Proc Except For Curvature Of Back
|
6
|
5
|
—
|
—
|
$32,206.78
|
$51,412.21
|
$51,412.21
|
2026-05-09
|
|
260
|
OTHER
|
Cardiac Pacemaker Revision Except Device Replacement With Mcc
|
38
|
24
|
—
|
—
|
$28,280.97
|
$95,453.45
|
$51,393.46
|
2026-05-09
|
|
229
|
OTHER
|
Other Cardiothoracic Procedures Without Mcc
|
38
|
24
|
—
|
—
|
$27,396.63
|
$122,587.60
|
$51,368.69
|
2026-05-09
|
|
461
|
OTHER
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
40
|
25
|
—
|
—
|
$7,057.11
|
$123,151.21
|
$51,055.92
|
2026-05-09
|
|
820
|
OTHER
|
Lymphoma And Leukemia With Major O.r. Procedures With Mcc
|
58
|
23
|
—
|
—
|
$25.64
|
$143,561.26
|
$50,895.12
|
2026-05-09
|
|
1142
|
OTHER
|
Supprelin La Implant
|
28
|
23
|
—
|
—
|
$6,267.76
|
$148,687.03
|
$50,801.40
|
2026-05-09
|
|
1774
|
OTHER
|
Cardiac Pacemaker & Defibrillator Revision Except Device Replacement
|
6
|
5
|
—
|
—
|
$44,234.51
|
$50,801.27
|
$50,801.27
|
2026-05-09
|
|
6803
|
OTHER
|
Major O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms
|
6
|
5
|
—
|
—
|
$34,813.97
|
$50,682.88
|
$50,682.88
|
2026-05-09
|
|
6312
|
OTHER
|
Neonate Birthwt >2499g W Other Major Procedure
|
6
|
5
|
—
|
—
|
$15,172.86
|
$50,662.07
|
$50,662.07
|
2026-05-09
|
|
1580
|
OTHER
|
Implt/rpl Crtd Sns Dev Total
|
24
|
21
|
—
|
—
|
$47,212.94
|
$147,540.44
|
$50,655.55
|
2026-05-09
|
|
1813
|
OTHER
|
Lower Extremity Arterial Procedures
|
6
|
5
|
—
|
—
|
$32,195.37
|
$50,457.37
|
$50,457.37
|
2026-05-09
|
|
6233
|
OTHER
|
Neonate Bwt 2000-2499g W Congenital/perinatal Infection
|
6
|
5
|
—
|
—
|
$34,083.04
|
$50,420.56
|
$50,420.56
|
2026-05-09
|
|
4454
|
OTHER
|
Other Bladder Procedures
|
6
|
5
|
—
|
—
|
$32,979.17
|
$50,179.06
|
$50,179.06
|
2026-05-09
|
|
6914
|
OTHER
|
Lymphoma, Myeloma & Non-acute Leukemia
|
6
|
5
|
—
|
—
|
$39,530.25
|
$49,804.82
|
$49,804.82
|
2026-05-09
|
|
5134
|
OTHER
|
Uterine & Adnexa Procedures For Non-malignancy Except Leiomyoma
|
6
|
5
|
—
|
—
|
$38,700.61
|
$49,468.88
|
$49,468.88
|
2026-05-09
|
|
6032
|
OTHER
|
Neonate Birthwt 1000-1249g W Or Without Other Significant Condition
|
6
|
5
|
—
|
—
|
$44,958.67
|
$50,779.24
|
$49,454.54
|
2026-05-09
|
|
3084
|
OTHER
|
Hip & Femur Fracture Repair
|
6
|
5
|
—
|
—
|
$33,605.22
|
$49,440.11
|
$49,440.11
|
2026-05-09
|
|
4834
|
OTHER
|
Testes & Scrotal Procedures
|
6
|
5
|
—
|
—
|
$44,922.26
|
$58,191.84
|
$49,414.49
|
2026-05-09
|
|
450
|
OTHER
|
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically …
|
30
|
23
|
—
|
—
|
$46,060.15
|
$122,439.03
|
$49,284.36
|
2026-05-09
|
|
6924
|
OTHER
|
Radiotherapy
|
6
|
5
|
—
|
—
|
$40,233.34
|
$49,185.84
|
$49,185.84
|
2026-05-09
|
|
5484
|
OTHER
|
Postpartum And Post Abortion Diagnosis With O.r. Procedure
|
6
|
5
|
—
|
—
|
$24,043.60
|
$49,037.02
|
$49,037.02
|
2026-05-09
|
|
802
|
OTHER
|
Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc
|
36
|
23
|
—
|
—
|
$30,209.09
|
$91,528.32
|
$48,992.51
|
2026-05-09
|