|
J1411
|
HCPCS
|
Inj, Hemgenix, Per Tx Dose
|
17
|
15
|
—
|
—
|
$3,654,350.00
|
$4,040,190.00
|
$3,672,900.00
|
2025-06-28
|
|
J1414
|
HCPCS
|
Inj, Beqvez, Per Tx Dose
|
16
|
14
|
—
|
—
|
$3,605,000.00
|
$3,965,500.00
|
$3,605,000.00
|
2025-06-28
|
|
J1413
|
HCPCS
|
Inj Delandistrogene Mox Rokl
|
17
|
15
|
—
|
—
|
$3,325,454.76
|
$3,658,000.24
|
$3,325,454.76
|
2025-06-28
|
|
J3394
|
HCPCS
|
Lyfgenia 1.7 X To 20 X 10exp6 Cell/ml Intravenous Suspension
|
18
|
16
|
—
|
—
|
$500,000.00
|
$4,483,344.00
|
$3,286,000.00
|
2025-06-28
|
|
J3393
|
HCPCS
|
Zynteglo 2 X 10exp6 To 20 X 10exp6 Cell/ml Intravenous Suspension
|
19
|
16
|
—
|
—
|
$500,000.00
|
$4,744,320.00
|
$2,968,000.00
|
2025-06-28
|
|
J3399
|
HCPCS
|
Zolgensma 2 X 10exp13 Vg/ml Intravenous Suspension Kit
|
41
|
24
|
—
|
$4,972,500.00
|
$500,000.00
|
$4,948,785.00
|
$2,700,450.00
|
2025-06-28
|
|
J3392
|
HCPCS
|
Casgevy 4x10exp6 To 13x10exp6 Cell/ml Intravenous Suspension
|
26
|
18
|
—
|
—
|
$500,000.00
|
$4,540,800.00
|
$2,401,960.00
|
2025-06-28
|
|
Q2042
|
HCPCS
|
Kymriah 0.2 X 10exp6 To 2.5 X 10exp8 Cell Intravenous Suspension
|
96
|
34
|
$2,848,960.04
|
$1,851,824.03
35% off
|
$500,000.00
|
$2,848,960.04
|
$1,416,294.76
|
2025-06-28
|
|
Q2056
|
HCPCS
|
Carvykti 0.5x 10exp6 To 1x 10exp8 Cell Intravenous Suspension
|
58
|
34
|
$2,505,866.40
|
$1,628,813.16
35% off
|
$500,000.00
|
$2,505,866.40
|
$1,252,933.20
|
2025-06-28
|
|
Q2041
|
HCPCS
|
Yescarta Intravenous Suspension
|
58
|
34
|
$2,417,184.00
|
$1,571,169.60
35% off
|
$459,381.45
|
$2,417,184.00
|
$1,208,592.00
|
2025-06-28
|
|
Q2054
|
HCPCS
|
Breyanzi 1.5x To 70x10exp6 Cell/ml Intravenous Suspension
|
58
|
34
|
$2,339,891.68
|
$1,520,929.59
35% off
|
$474,060.62
|
$2,339,891.68
|
$1,169,945.84
|
2025-06-28
|
|
Q2053
|
HCPCS
|
Tecartus 2x10exp6 To 2x10exp8 Cell Intravenous Suspension
|
58
|
34
|
$2,217,600.00
|
$1,441,440.00
35% off
|
$449,440.00
|
$2,217,600.00
|
$1,108,800.00
|
2025-06-28
|
|
005-I
|
MS_DRG
|
Intestinal - Adult
|
2
|
2
|
—
|
—
|
$563,700.00
|
$563,700.00
|
$563,700.00
|
2025-06-28
|
|
005-LA
|
MS_DRG
|
Liver (Live Donor) - Adult
|
2
|
2
|
—
|
—
|
$561,500.00
|
$561,500.00
|
$561,500.00
|
2025-06-28
|
|
006-LA
|
MS_DRG
|
Liver (Live Donor) - Adult
|
2
|
2
|
—
|
—
|
$561,500.00
|
$561,500.00
|
$561,500.00
|
2025-06-28
|
|
005-LP
|
MS_DRG
|
Liver (Live Donor) - Pediatric
|
2
|
2
|
—
|
—
|
$560,500.00
|
$560,500.00
|
$560,500.00
|
2025-06-28
|
|
006-LP
|
MS_DRG
|
Liver (Live Donor) - Pediatric
|
2
|
2
|
—
|
—
|
$560,500.00
|
$560,500.00
|
$560,500.00
|
2025-06-28
|
|
005-DA
|
MS_DRG
|
Liver (Deceased Donor) - Adult
|
2
|
2
|
—
|
—
|
$486,600.00
|
$486,600.00
|
$486,600.00
|
2025-06-28
|
|
006-DA
|
MS_DRG
|
Liver (Deceased Donor) - Adult
|
2
|
2
|
—
|
—
|
$486,600.00
|
$486,600.00
|
$486,600.00
|
2025-06-28
|
|
014-U
|
MS_DRG
|
Allogeneic Unrelated Bmt ? Adult & Pediatric
|
2
|
2
|
—
|
—
|
$481,200.00
|
$481,200.00
|
$481,200.00
|
2025-06-28
|
|
006-DP
|
MS_DRG
|
Liver (Deceased Donor) -pediatric
|
2
|
2
|
—
|
—
|
$471,700.00
|
$471,700.00
|
$471,700.00
|
2025-06-28
|
|
005-DP
|
MS_DRG
|
Liver (Deceased Donor) -pediatric
|
2
|
2
|
—
|
—
|
$471,700.00
|
$471,700.00
|
$471,700.00
|
2025-06-28
|
|
002-P
|
MS_DRG
|
Heart - Pediatric
|
2
|
2
|
—
|
—
|
$444,900.00
|
$444,900.00
|
$444,900.00
|
2025-06-28
|
|
003-P
|
MS_DRG
|
Heart - Pediatric
|
2
|
2
|
—
|
—
|
$444,900.00
|
$444,900.00
|
$444,900.00
|
2025-06-28
|
|
007-D
|
MS_DRG
|
Lung (Double) - Adult
|
2
|
2
|
—
|
—
|
$433,900.00
|
$433,900.00
|
$433,900.00
|
2025-06-28
|
|
007-S
|
MS_DRG
|
Lung (Single) - Adult
|
2
|
2
|
—
|
—
|
$428,300.00
|
$428,300.00
|
$428,300.00
|
2025-06-28
|
|
014-R
|
MS_DRG
|
Allogeneic Related Bmt ? Adult & Pediatric
|
2
|
2
|
—
|
—
|
$428,000.00
|
$428,000.00
|
$428,000.00
|
2025-06-28
|
|
002-A
|
MS_DRG
|
Heart - Adult
|
2
|
2
|
—
|
—
|
$361,500.00
|
$361,500.00
|
$361,500.00
|
2025-06-28
|
|
001-A
|
MS_DRG
|
Heart - Adult
|
3
|
3
|
—
|
—
|
$36,400.00
|
$361,500.00
|
$361,500.00
|
2025-06-28
|
|
18
|
MS_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
28
|
17
|
—
|
—
|
$250,726.35
|
$584,548.40
|
$254,487.24
|
2025-06-28
|
|
J0225
|
HCPCS
|
Amvuttra 25 Mg/0.5 Ml Subcutaneous Syringe
|
68
|
40
|
$859,327.20
|
$558,562.68
35% off
|
$4,926.00
|
$859,327.20
|
$224,842.97
|
2025-06-28
|
|
5884
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$184,812.76
|
$197,372.85
|
$191,989.95
|
2025-06-28
|
|
1
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
28
|
17
|
—
|
—
|
$187,526.29
|
$436,608.65
|
$190,339.18
|
2025-06-28
|
|
5834
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$178,779.19
|
$190,929.23
|
$185,722.07
|
2025-06-28
|
|
5833
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$178,779.19
|
$190,929.23
|
$185,722.07
|
2025-06-28
|
|
652-C
|
MS_DRG
|
Kidney Transplant - Cadaveric
|
1
|
1
|
—
|
—
|
$185,100.00
|
$185,100.00
|
$185,100.00
|
2025-06-28
|
|
651-C
|
MS_DRG
|
Kidney Transplant With Hemodialysis Without Mcc - Cadaveric
|
1
|
1
|
—
|
—
|
$185,100.00
|
$185,100.00
|
$185,100.00
|
2025-06-28
|
|
650-C
|
MS_DRG
|
Kidney Transplant With Hemodialysis With Mcc - Cadaveric
|
1
|
1
|
—
|
—
|
$185,100.00
|
$185,100.00
|
$185,100.00
|
2025-06-28
|
|
5831
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$170,055.35
|
$181,612.51
|
$176,659.44
|
2025-06-28
|
|
5832
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$170,055.35
|
$181,612.51
|
$176,659.44
|
2025-06-28
|
|
1614
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$169,396.52
|
$180,908.90
|
$175,975.02
|
2025-06-28
|
|
652-D
|
MS_DRG
|
Kidney (Deceased) - Adult & Pediatric
|
2
|
2
|
—
|
—
|
$175,300.00
|
$175,300.00
|
$175,300.00
|
2025-06-28
|
|
651-D
|
MS_DRG
|
Kidney (Deceased) - Adult & Pediatric
|
2
|
2
|
—
|
—
|
$175,300.00
|
$175,300.00
|
$175,300.00
|
2025-06-28
|
|
650-D
|
MS_DRG
|
Kidney (Deceased) - Adult & Pediatric
|
2
|
2
|
—
|
—
|
$175,300.00
|
$175,300.00
|
$175,300.00
|
2025-06-28
|
|
652-LD
|
MS_DRG
|
Kidney Transplant - Live Donor
|
1
|
1
|
—
|
—
|
$170,100.00
|
$170,100.00
|
$170,100.00
|
2025-06-28
|
|
650-LD
|
MS_DRG
|
Kidney Transplant With Hemodialysis With Mcc - Live Donor
|
1
|
1
|
—
|
—
|
$170,100.00
|
$170,100.00
|
$170,100.00
|
2025-06-28
|
|
651-LD
|
MS_DRG
|
Kidney Transplant With Hemodialysis Without Mcc - Live Donor
|
1
|
1
|
—
|
—
|
$170,100.00
|
$170,100.00
|
$170,100.00
|
2025-06-28
|
|
652-L
|
MS_DRG
|
Kidney (Live Donor) - Adult & Pediatric
|
2
|
2
|
—
|
—
|
$161,100.00
|
$161,100.00
|
$161,100.00
|
2025-06-28
|
|
650-L
|
MS_DRG
|
Kidney ( Live Donor) - Adult & Pediatric
|
2
|
2
|
—
|
—
|
$161,100.00
|
$161,100.00
|
$161,100.00
|
2025-06-28
|
|
651-L
|
MS_DRG
|
Kidney ( Live Donor) - Adult & Pediatric
|
2
|
2
|
—
|
—
|
$161,100.00
|
$161,100.00
|
$161,100.00
|
2025-06-28
|
|
927
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
28
|
17
|
—
|
—
|
$158,089.88
|
$367,703.40
|
$160,461.23
|
2025-06-28
|
|
0024
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$148,982.24
|
$159,107.25
|
$154,767.96
|
2025-06-28
|
|
3
|
MS_DRG
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
29
|
18
|
—
|
—
|
$41,100.00
|
$332,189.80
|
$142,918.42
|
2025-06-28
|
|
1611
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$131,100.69
|
$140,010.44
|
$136,191.98
|
2025-06-28
|
|
1613
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$131,100.69
|
$140,010.44
|
$136,191.98
|
2025-06-28
|
|
1612
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$131,100.69
|
$140,010.44
|
$136,191.98
|
2025-06-28
|
|
0074
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$127,351.93
|
$136,006.92
|
$132,297.64
|
2025-06-28
|
|
8412
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$118,543.31
|
$126,599.65
|
$123,146.93
|
2025-06-28
|
|
8413
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$118,543.31
|
$126,599.65
|
$123,146.93
|
2025-06-28
|
|
8414
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$118,543.31
|
$126,599.65
|
$123,146.93
|
2025-06-28
|
|
8411
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$118,543.31
|
$126,599.65
|
$123,146.93
|
2025-06-28
|
|
6094
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$118,534.48
|
$126,590.22
|
$123,137.76
|
2025-06-28
|
|
6304
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$115,036.80
|
$122,854.83
|
$119,504.24
|
2025-06-28
|
|
J2779
|
HCPCS
|
Susvimo 10 Mg/0.1 Ml Intravitreal Solution
|
59
|
34
|
$288,000.00
|
$187,200.00
35% off
|
$79.08
|
$288,000.00
|
$114,912.00
|
2025-06-28
|
|
6314
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$101,540.76
|
$108,441.59
|
$105,484.09
|
2025-06-28
|
|
A9699
|
HCPCS
|
Radiopharm Rx Agent Noc
|
1
|
1
|
—
|
—
|
$97,225.26
|
$97,225.26
|
$97,225.26
|
2025-06-28
|
|
5883
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$93,358.75
|
$99,703.52
|
$96,984.33
|
2025-06-28
|
|
4
|
MS_DRG
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
29
|
18
|
—
|
—
|
$28,700.00
|
$219,015.00
|
$94,569.99
|
2025-06-28
|
|
5881
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$88,803.15
|
$94,838.32
|
$92,251.82
|
2025-06-28
|
|
5882
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$88,803.15
|
$94,838.32
|
$92,251.82
|
2025-06-28
|
|
14
|
MS_DRG
|
Allogeneic Bone Marrow Transplant
|
31
|
19
|
—
|
—
|
$12,900.00
|
$4,334,979.46
|
$90,394.49
|
2025-06-28
|
|
5934
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$86,060.52
|
$91,909.29
|
$89,402.67
|
2025-06-28
|
|
7
|
MS_DRG
|
Lung Transplant
|
30
|
18
|
—
|
—
|
$26,000.00
|
$4,868,232.55
|
$88,856.27
|
2025-06-28
|
|
5914
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$79,893.82
|
$85,323.50
|
$82,996.50
|
2025-06-28
|
|
C9293
|
HCPCS
|
Voraxaze 1000 Unit Intravenous Solution
|
50
|
34
|
$148,226.40
|
$96,347.16
35% off
|
$902.96
|
$148,226.40
|
$79,152.90
|
2025-06-28
|
|
J9226
|
HCPCS
|
Supprelin La 50 Mg (65 Mcg/day) Implant Kit
|
68
|
40
|
$175,562.52
|
$114,115.64
35% off
|
$15,639.22
|
$175,562.52
|
$76,972.76
|
2025-06-28
|
|
1604
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$73,492.38
|
$78,487.01
|
$76,346.46
|
2025-06-28
|
|
2
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
29
|
17
|
—
|
—
|
$73,974.77
|
$4,055,315.72
|
$76,194.01
|
2025-06-28
|
|
212
|
MS_DRG
|
Concomitant Aortic And Mitral Valve?procedures
|
28
|
17
|
—
|
—
|
$13,964.00
|
$168,855.45
|
$73,141.77
|
2025-06-28
|
|
215
|
MS_DRG
|
Other Heart Assist System Implant
|
28
|
17
|
—
|
—
|
$71,161.24
|
$164,219.40
|
$72,228.66
|
2025-06-28
|
|
5
|
MS_DRG
|
Liver Transplant With Mcc Or Intestinal Transplant
|
29
|
18
|
—
|
—
|
$27,200.00
|
$165,065.70
|
$71,522.78
|
2025-06-28
|
|
426
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
28
|
17
|
—
|
—
|
$17,771.00
|
$162,368.70
|
$70,370.62
|
2025-06-28
|
|
27879075_IP
|
CDM
|
Tavr Device Kit
|
1
|
1
|
$105,000.00
|
$68,250.00
35% off
|
$70,245.00
|
$70,245.00
|
$70,245.00
|
2025-06-28
|
|
001-C
|
MS_DRG
|
Deep Brain Stimulation Bilateral
|
1
|
1
|
—
|
—
|
$69,100.00
|
$69,100.00
|
$69,100.00
|
2025-06-28
|
|
0021
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$66,036.89
|
$70,524.84
|
$68,601.43
|
2025-06-28
|
|
0023
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$66,036.89
|
$70,524.84
|
$68,601.43
|
2025-06-28
|
|
0022
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$66,036.89
|
$70,524.84
|
$68,601.43
|
2025-06-28
|
|
0094
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$65,930.56
|
$70,411.28
|
$68,490.97
|
2025-06-28
|
|
27879075_OP
|
CDM
|
Tavr Device Kit
|
1
|
1
|
$105,000.00
|
$68,250.00
35% off
|
$66,675.00
|
$66,675.00
|
$66,675.00
|
2025-06-28
|
|
J2777
|
HCPCS
|
Vabysmo 6 Mg/0.05 Ml Intravitreal Solution
|
59
|
34
|
$164,854.80
|
$107,155.62
35% off
|
$34.25
|
$164,854.80
|
$65,777.07
|
2025-06-28
|
|
27882225_IP
|
CDM
|
Sapien 3 Transcatheter Heart Valve
|
1
|
1
|
$97,500.00
|
$63,375.00
35% off
|
$65,227.50
|
$65,227.50
|
$65,227.50
|
2025-06-28
|
|
0453T
|
HCPCS
|
Insj/rplcmt Mech-elec Ntrfce
|
9
|
9
|
—
|
—
|
$58,990.54
|
$68,304.83
|
$65,200.07
|
2025-06-28
|
|
0454T
|
HCPCS
|
Insj/rplcmt Subq Electrode
|
9
|
9
|
—
|
—
|
$58,990.54
|
$68,304.83
|
$65,200.07
|
2025-06-28
|
|
216
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
29
|
18
|
—
|
—
|
$13,964.00
|
$283,600.00
|
$64,912.42
|
2025-06-28
|
|
0073
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$62,154.78
|
$66,378.90
|
$64,568.56
|
2025-06-28
|
|
A9543
|
HCPCS
|
Zevalin (y-90) 3.2 Mg/2 Ml Intravenous Kit
|
67
|
40
|
$148,248.86
|
$96,361.76
35% off
|
$14,774.74
|
$148,248.86
|
$63,747.01
|
2025-06-28
|
|
27879075
|
CDM
|
Tavr Device Kit
|
40
|
27
|
$105,000.00
|
$68,250.00
35% off
|
$22,890.00
|
$105,000.00
|
$63,000.00
|
2025-06-28
|
|
0044
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$59,873.51
|
$63,942.58
|
$62,198.69
|
2025-06-28
|
|
850
|
MS_DRG
|
Acute Leukemia With Other Procedures
|
28
|
17
|
—
|
—
|
$46,072.00
|
$142,784.45
|
$62,004.20
|
2025-06-28
|
|
27882225_OP
|
CDM
|
Sapien 3 Transcatheter Heart Valve
|
1
|
1
|
$97,500.00
|
$63,375.00
35% off
|
$61,912.50
|
$61,912.50
|
$61,912.50
|
2025-06-28
|
|
J0223
|
HCPCS
|
Givlaari 189 Mg/ml Subcutaneous Solution
|
59
|
34
|
$153,417.60
|
$99,721.44
35% off
|
$112.02
|
$153,417.60
|
$61,213.62
|
2025-06-28
|
|
6024
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$58,903.52
|
$62,906.67
|
$61,191.03
|
2025-06-28
|
|
6074
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$58,255.09
|
$62,214.17
|
$60,517.42
|
2025-06-28
|
|
27881015_IP
|
CDM
|
Mitraclip System
|
1
|
1
|
$90,000.00
|
$58,500.00
35% off
|
$60,210.00
|
$60,210.00
|
$60,210.00
|
2025-06-28
|
|
J9248
|
HCPCS
|
Hepzato (62 Mm Catheter) 50 Mg Intra-arterial Solution
|
68
|
40
|
$180,000.00
|
$117,000.00
35% off
|
$693.50
|
$180,000.00
|
$58,887.00
|
2025-06-28
|
|
8504
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$56,408.78
|
$60,242.39
|
$58,599.42
|
2025-06-28
|
|
27882225
|
CDM
|
Sapien 3 Transcatheter Heart Valve
|
40
|
27
|
$97,500.00
|
$63,375.00
35% off
|
$21,255.00
|
$97,500.00
|
$58,500.00
|
2025-06-28
|
|
27881015_OP
|
CDM
|
Mitraclip System
|
1
|
1
|
$90,000.00
|
$58,500.00
35% off
|
$57,150.00
|
$57,150.00
|
$57,150.00
|
2025-06-28
|
|
231
|
MS_DRG
|
Coronary Bypass With Ptca With Mcc
|
28
|
17
|
—
|
—
|
$13,964.00
|
$131,345.45
|
$57,117.45
|
2025-06-28
|
|
456
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
29
|
18
|
—
|
—
|
$13,964.00
|
$212,600.00
|
$57,086.32
|
2025-06-28
|
|
3034
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$54,698.21
|
$58,415.57
|
$56,822.41
|
2025-06-28
|
|
8514
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$54,589.90
|
$58,299.89
|
$56,709.89
|
2025-06-28
|
|
38240
|
HCPCS
|
Trnsplj Allogeneic Hematopoietic Cells Per Donor
|
67
|
40
|
$131,220.00
|
$85,293.00
35% off
|
$1,495.91
|
$131,220.00
|
$56,472.12
|
2025-06-28
|
|
429
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc
|
28
|
17
|
—
|
—
|
$17,771.00
|
$129,279.30
|
$56,234.78
|
2025-06-28
|
|
5933
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$53,849.93
|
$57,509.64
|
$55,941.19
|
2025-06-28
|
|
J0177
|
HCPCS
|
Eylea Hd 8 Mg/0.07 Ml Intravitreal Solution For Injection
|
59
|
34
|
$137,700.00
|
$89,505.00
35% off
|
$333.70
|
$137,700.00
|
$55,768.50
|
2025-06-28
|
|
10
|
MS_DRG
|
Pancreas Transplant
|
33
|
21
|
—
|
—
|
$10,700.00
|
$1,615,106.56
|
$55,414.70
|
2025-06-28
|
|
19
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
31
|
19
|
—
|
—
|
$53,498.07
|
$1,784,276.68
|
$55,103.01
|
2025-06-28
|
|
0014
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$52,549.48
|
$56,120.80
|
$54,590.23
|
2025-06-28
|
|
J0178
|
HCPCS
|
Eylea 2 Mg/0.05 Ml Intravitreal Syringe
|
59
|
34
|
$136,530.00
|
$88,744.50
35% off
|
$821.98
|
$136,530.00
|
$54,475.47
|
2025-06-28
|
|
20
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
29
|
18
|
—
|
—
|
$13,964.00
|
$289,300.00
|
$54,384.04
|
2025-06-28
|
|
27881015
|
CDM
|
Mitraclip System
|
40
|
27
|
$90,000.00
|
$58,500.00
35% off
|
$19,620.00
|
$90,000.00
|
$54,000.00
|
2025-06-28
|
|
J9029
|
HCPCS
|
Adstiladrin 3x10exp11 Vp/ml Intravesical Suspension
|
68
|
40
|
$72,000.00
|
$46,800.00
35% off
|
$15,639.22
|
$144,556.65
|
$52,891.20
|
2025-06-28
|
|
6303
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$50,812.99
|
$54,266.30
|
$52,786.31
|
2025-06-28
|
|
233
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
29
|
18
|
—
|
—
|
$13,964.00
|
$217,200.00
|
$52,763.73
|
2025-06-28
|
|
219
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
29
|
18
|
—
|
—
|
$13,964.00
|
$193,600.00
|
$52,241.28
|
2025-06-28
|
|
0084
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$49,879.27
|
$53,269.13
|
$51,816.33
|
2025-06-28
|
|
0072
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$49,755.54
|
$53,136.99
|
$51,687.79
|
2025-06-28
|
|
0071
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$49,755.54
|
$53,136.99
|
$51,687.79
|
2025-06-28
|
|
6334
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$49,542.67
|
$52,909.65
|
$51,466.66
|
2025-06-28
|
|
J9274
|
HCPCS
|
Kimmtrak 100 Mcg/0.5 Ml Intravenous Solution
|
68
|
40
|
$196,608.00
|
$127,795.20
35% off
|
$208.93
|
$196,608.00
|
$51,442.49
|
2025-06-28
|
|
8424
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$49,495.89
|
$52,859.69
|
$51,418.06
|
2025-06-28
|
|
957
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
28
|
17
|
—
|
—
|
$50,431.60
|
$115,695.10
|
$51,188.07
|
2025-06-28
|
|
J3357
|
HCPCS
|
Stelara 45 Mg/0.5 Ml Subcutaneous Solution
|
103
|
40
|
$104,945.34
|
$68,214.47
35% off
|
$152.57
|
$104,945.34
|
$51,003.39
|
2025-06-28
|
|
J2778
|
HCPCS
|
Darvocet-n 50 50 Mg-325 Mg Tab
|
103
|
40
|
$140,400.00
|
$91,260.00
35% off
|
$137.14
|
$140,400.00
|
$50,544.00
|
2025-06-28
|
|
6093
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$48,175.18
|
$51,449.22
|
$50,046.06
|
2025-06-28
|
|
6023
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$47,621.17
|
$50,857.57
|
$49,470.54
|
2025-06-28
|
|
J1930
|
HCPCS
|
Somatuline Depot 60 Mg/0.2 Ml Subcutaneous Syringe
|
129
|
34
|
$109,584.00
|
$71,229.60
35% off
|
$48.00
|
$109,584.00
|
$48,192.48
|
2025-06-28
|
|
427
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
29
|
18
|
—
|
—
|
$17,771.00
|
$269,394.00
|
$48,037.88
|
2025-06-28
|
|
275
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
28
|
17
|
—
|
—
|
$13,964.00
|
$109,538.50
|
$47,801.49
|
2025-06-28
|
|
6091
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$45,824.39
|
$48,938.67
|
$47,603.98
|
2025-06-28
|
|
6092
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$45,824.39
|
$48,938.67
|
$47,603.98
|
2025-06-28
|
|
6114
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$45,667.95
|
$48,771.60
|
$47,441.47
|
2025-06-28
|
|
1834
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$45,456.29
|
$48,545.55
|
$47,221.58
|
2025-06-28
|
|
0043
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$45,368.54
|
$48,451.84
|
$47,130.43
|
2025-06-28
|
|
870
|
MS_DRG
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
29
|
18
|
—
|
—
|
$11,984.00
|
$194,500.00
|
$47,069.80
|
2025-06-28
|
|
8634
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$45,302.38
|
$48,381.18
|
$47,061.69
|
2025-06-28
|
|
1784
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$45,287.27
|
$48,365.04
|
$47,046.00
|
2025-06-28
|
|
955
|
MS_DRG
|
Craniotomy For Multiple Significant Trauma
|
28
|
17
|
—
|
—
|
$46,220.91
|
$105,838.65
|
$46,914.23
|
2025-06-28
|
|
6904
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$45,110.18
|
$48,175.92
|
$46,862.03
|
2025-06-28
|
|
6214
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$44,842.98
|
$47,890.56
|
$46,584.45
|
2025-06-28
|
|
5913
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$44,256.60
|
$47,264.33
|
$45,975.30
|
2025-06-28
|
|
928
|
MS_DRG
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
28
|
17
|
—
|
—
|
$45,231.64
|
$103,522.95
|
$45,910.11
|
2025-06-28
|
|
447
|
MS_DRG
|
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…
|
28
|
17
|
—
|
—
|
$15,763.00
|
$103,922.85
|
$45,402.48
|
2025-06-28
|
|
J9600
|
HCPCS
|
Photofrin 75 Mg Intravenous Solution
|
67
|
40
|
$111,950.40
|
$72,767.76
35% off
|
$15,639.22
|
$111,950.40
|
$45,339.91
|
2025-06-28
|
|
001-B
|
MS_DRG
|
Deep Brain Stimulation Unilateral
|
1
|
1
|
—
|
—
|
$45,300.00
|
$45,300.00
|
$45,300.00
|
2025-06-28
|
|
268
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
28
|
17
|
—
|
—
|
$13,964.00
|
$159,178.00
|
$45,156.81
|
2025-06-28
|
|
207
|
MS_DRG
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
29
|
18
|
—
|
—
|
$43,829.84
|
$148,400.00
|
$45,144.74
|
2025-06-28
|
|
6124
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$42,690.18
|
$45,591.46
|
$44,348.05
|
2025-06-28
|
|
0054
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$42,268.39
|
$45,141.00
|
$43,909.88
|
2025-06-28
|
|
471A
|
MS_DRG
|
Bilateral Total Hip Replacement Proc. Of Lower Extremitv
|
1
|
1
|
—
|
—
|
$43,800.00
|
$43,800.00
|
$43,800.00
|
2025-06-28
|
|
217
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
29
|
18
|
—
|
—
|
$13,964.00
|
$223,200.00
|
$43,768.26
|
2025-06-28
|
|
969
|
MS_DRG
|
HIV With Extensive O.r. Procedures With Mcc
|
28
|
17
|
—
|
—
|
$42,883.61
|
$98,026.65
|
$43,526.87
|
2025-06-28
|
|
J7352
|
HCPCS
|
Scenesse 16 Mg Subcutaneous Implant
|
67
|
40
|
$120,982.00
|
$78,638.30
35% off
|
$2,873.33
|
$120,982.00
|
$42,706.65
|
2025-06-28
|
|
3033
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$41,025.80
|
$43,813.96
|
$42,619.03
|
2025-06-28
|
|
6073
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$40,937.44
|
$43,719.60
|
$42,527.25
|
2025-06-28
|
|
573
|
MS_DRG
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
28
|
17
|
—
|
—
|
$41,783.76
|
$95,452.10
|
$42,410.51
|
2025-06-28
|
|
J9269
|
HCPCS
|
Elzonris 1000 Mcg/ml Intravenous Solution
|
68
|
40
|
$162,031.92
|
$105,320.75
35% off
|
$326.65
|
$162,031.92
|
$42,395.65
|
2025-06-28
|
|
16
|
MS_DRG
|
Autologous Bone Marrow Transplant With Cc/mcc
|
31
|
19
|
—
|
—
|
$40,973.94
|
$1,120,812.31
|
$42,203.16
|
2025-06-28
|
|
17
|
MS_DRG
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
31
|
19
|
—
|
—
|
$40,973.94
|
$1,120,812.31
|
$42,203.16
|
2025-06-28
|
|
276
|
MS_DRG
|
Cardiac Defibrillator Implant With Mcc
|
28
|
17
|
—
|
—
|
$13,964.00
|
$96,013.20
|
$42,023.46
|
2025-06-28
|
|
317
|
MS_DRG
|
Concomitant Left Atrial Appendage Closure And Cardiac Ablation
|
28
|
17
|
—
|
—
|
$17,771.00
|
$95,889.20
|
$41,970.49
|
2025-06-28
|
|
5894
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$40,376.49
|
$43,120.53
|
$41,944.51
|
2025-06-28
|
|
5893
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$40,376.49
|
$43,120.53
|
$41,944.51
|
2025-06-28
|
|
33276
|
HCPCS
|
Insj Phrnc Nrv Stim Sys
|
26
|
21
|
—
|
—
|
$16,585.98
|
$45,888.99
|
$41,717.26
|
2025-06-28
|
|
0266T
|
HCPCS
|
Implt/rpl Crtd Sns Dev Total
|
26
|
21
|
—
|
—
|
$16,585.98
|
$45,888.99
|
$41,717.26
|
2025-06-28
|
|
461
|
MS_DRG
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
29
|
18
|
—
|
—
|
$13,964.00
|
$116,800.00
|
$41,641.39
|
2025-06-28
|
|
232
|
MS_DRG
|
Coronary Bypass With Ptca Without Mcc
|
28
|
17
|
—
|
—
|
$13,964.00
|
$94,684.85
|
$41,455.99
|
2025-06-28
|
|
28
|
MS_DRG
|
Spinal Procedures With Mcc
|
29
|
18
|
—
|
—
|
$13,964.00
|
$108,100.00
|
$41,262.64
|
2025-06-28
|
|
6814
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$39,714.53
|
$42,413.58
|
$41,256.85
|
2025-06-28
|
|
6954
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$39,488.35
|
$42,172.02
|
$41,021.87
|
2025-06-28
|
|
3004
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$39,337.61
|
$42,011.04
|
$40,865.28
|
2025-06-28
|
|
820
|
MS_DRG
|
Lymphoma And Leukemia With Major O.r. Procedures With Mcc
|
29
|
18
|
—
|
—
|
$39,559.56
|
$207,900.00
|
$40,746.35
|
2025-06-28
|
|
1634
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$39,164.73
|
$41,826.41
|
$40,685.69
|
2025-06-28
|
|
266
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc
|
30
|
19
|
—
|
—
|
$13,964.00
|
$173,600.00
|
$40,675.30
|
2025-06-28
|
|
218
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
28
|
17
|
—
|
—
|
$13,964.00
|
$92,214.15
|
$40,400.50
|
2025-06-28
|
|
790
|
MS_DRG
|
Extreme Immaturity Or Respiratory Distress Syndrome, Neonate
|
23
|
17
|
—
|
—
|
$5,351.00
|
$92,144.40
|
$40,370.71
|
2025-06-28
|
|
1624
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$38,722.91
|
$41,354.57
|
$40,226.71
|
2025-06-28
|
|
6313
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$38,536.81
|
$41,155.82
|
$40,033.39
|
2025-06-28
|
|
235
|
MS_DRG
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
29
|
18
|
—
|
—
|
$13,964.00
|
$168,400.00
|
$39,969.44
|
2025-06-28
|
|
5892
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$38,406.26
|
$41,016.39
|
$39,897.76
|
2025-06-28
|
|
5891
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$38,406.26
|
$41,016.39
|
$39,897.76
|
2025-06-28
|
|
0224
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$37,658.29
|
$40,217.60
|
$39,120.75
|
2025-06-28
|
|
653
|
MS_DRG
|
Major Bladder Procedures With Mcc
|
29
|
18
|
—
|
—
|
$37,919.38
|
$144,700.00
|
$39,056.96
|
2025-06-28
|
|
457
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
29
|
18
|
—
|
—
|
$13,964.00
|
$158,200.00
|
$39,010.62
|
2025-06-28
|
|
0083
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$37,466.48
|
$40,012.74
|
$38,921.49
|
2025-06-28
|
|
23
|
MS_DRG
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
29
|
18
|
—
|
—
|
$13,964.00
|
$139,200.00
|
$38,783.50
|
2025-06-28
|
|
834
|
MS_DRG
|
Acute Leukemia Without Major O.r. Procedures With Mcc
|
29
|
18
|
—
|
—
|
$37,606.18
|
$152,300.00
|
$38,734.37
|
2025-06-28
|
|
0113
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$37,110.93
|
$39,633.03
|
$38,552.13
|
2025-06-28
|
|
0114
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$37,110.93
|
$39,633.03
|
$38,552.13
|
2025-06-28
|
|
0112
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$37,110.93
|
$39,633.03
|
$38,552.13
|
2025-06-28
|
|
0111
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$37,110.93
|
$39,633.03
|
$38,552.13
|
2025-06-28
|
|
J0179
|
HCPCS
|
Beovu 6 Mg/0.05 Ml Intravitreal Syringe
|
68
|
40
|
$147,062.88
|
$95,590.87
35% off
|
$325.68
|
$147,062.88
|
$38,479.01
|
2025-06-28
|
|
8
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant
|
33
|
21
|
—
|
—
|
$26,000.00
|
$1,224,682.79
|
$38,146.46
|
2025-06-28
|
|
405
|
MS_DRG
|
Pancreas, Liver And Shunt Procedures With Mcc
|
29
|
18
|
—
|
—
|
$36,953.29
|
$128,400.00
|
$38,061.89
|
2025-06-28
|
|
463
|
MS_DRG
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …
|
29
|
18
|
—
|
—
|
$36,769.87
|
$188,200.00
|
$37,872.97
|
2025-06-28
|
|
7924
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$36,448.16
|
$38,925.22
|
$37,863.62
|
2025-06-28
|
|
Q5128
|
HCPCS
|
Cimerli 0.5 Mg/0.05 Ml Intravitreal Solution
|
68
|
40
|
$97,920.00
|
$63,648.00
35% off
|
$201.01
|
$97,920.00
|
$37,723.68
|
2025-06-28
|
|
C9766
|
HCPCS
|
Revasc Endov W/ivl W/atherectomy Incl Angioplasty
|
58
|
34
|
$90,220.00
|
$58,643.00
35% off
|
$5,688.00
|
$90,220.00
|
$37,666.85
|
2025-06-28
|
|
21
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
29
|
18
|
—
|
—
|
$13,964.00
|
$160,500.00
|
$37,606.18
|
2025-06-28
|
|
428
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
29
|
18
|
—
|
—
|
$17,771.00
|
$203,786.00
|
$37,452.56
|
2025-06-28
|
|
11
|
MS_DRG
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc
|
28
|
17
|
—
|
—
|
$36,736.10
|
$83,636.45
|
$37,287.14
|
2025-06-28
|
|
576
|
MS_DRG
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc
|
28
|
17
|
—
|
—
|
$36,732.12
|
$83,627.15
|
$37,283.10
|
2025-06-28
|
|
430
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc
|
29
|
18
|
—
|
—
|
$17,771.00
|
$228,300.00
|
$37,230.07
|
2025-06-28
|
|
9504
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$35,420.37
|
$37,827.58
|
$36,795.92
|
2025-06-28
|
|
471B
|
MS_DRG
|
Bilateral Total Knee Replacement Proc. Of Low Extr
|
1
|
1
|
—
|
—
|
$36,700.00
|
$36,700.00
|
$36,700.00
|
2025-06-28
|
|
234
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc
|
29
|
18
|
—
|
—
|
$13,964.00
|
$158,100.00
|
$36,234.84
|
2025-06-28
|
|
6022
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$34,841.94
|
$37,209.84
|
$36,195.03
|
2025-06-28
|
|
220
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
29
|
18
|
—
|
—
|
$13,964.00
|
$146,600.00
|
$36,079.23
|
2025-06-28
|
|
326
|
MS_DRG
|
Stomach, Esophageal And Duodenal Procedures With Mcc
|
29
|
18
|
—
|
—
|
$34,637.71
|
$144,100.00
|
$35,676.84
|
2025-06-28
|
|
6034
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$34,285.67
|
$36,615.77
|
$35,617.15
|
2025-06-28
|
|
6033
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$34,285.67
|
$36,615.77
|
$35,617.15
|
2025-06-28
|
|
8633
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$34,226.16
|
$36,552.21
|
$35,555.33
|
2025-06-28
|
|
2994
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$34,090.62
|
$36,407.46
|
$35,414.53
|
2025-06-28
|
|
5932
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$34,066.93
|
$36,382.16
|
$35,389.92
|
2025-06-28
|
|
5931
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$34,066.93
|
$36,382.16
|
$35,389.92
|
2025-06-28
|
|
239
|
MS_DRG
|
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc
|
29
|
18
|
—
|
—
|
$34,358.94
|
$159,900.00
|
$35,389.71
|
2025-06-28
|
|
837
|
MS_DRG
|
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…
|
29
|
18
|
—
|
—
|
$34,162.27
|
$171,600.00
|
$35,187.14
|
2025-06-28
|
|
450
|
MS_DRG
|
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically …
|
28
|
17
|
—
|
—
|
$15,763.00
|
$95,704.00
|
$35,108.50
|
2025-06-28
|
|
J2326
|
HCPCS
|
Spinraza (pf) 12 Mg/5 Ml Intrathecal Solution
|
67
|
40
|
$99,288.57
|
$64,537.57
35% off
|
$1,210.10
|
$99,288.57
|
$35,048.87
|
2025-06-28
|
|
270
|
MS_DRG
|
Other Major Cardiovascular Procedures With Mcc
|
28
|
17
|
—
|
—
|
$14,362.00
|
$120,149.00
|
$34,995.27
|
2025-06-28
|
|
33902
|
HCPCS
|
Perq P-art Revsc St 1st Abnor Connj Unilateral
|
70
|
40
|
$90,220.00
|
$58,643.00
35% off
|
$5,077.98
|
$90,220.00
|
$34,870.03
|
2025-06-28
|
|
0914
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$33,451.62
|
$35,725.03
|
$34,750.71
|
2025-06-28
|
|
466
|
MS_DRG
|
Revision Of Hip Or Knee Replacement With Mcc
|
29
|
18
|
—
|
—
|
$13,964.00
|
$120,500.00
|
$34,741.00
|
2025-06-28
|
|
36837
|
HCPCS
|
Perq Av Fistula Creation Uxtr Sep Access Sites
|
67
|
40
|
$90,220.00
|
$58,643.00
35% off
|
$2,727.64
|
$90,220.00
|
$34,689.59
|
2025-06-28
|
|
36836
|
HCPCS
|
Perq Av Fistula Creation Uxtr Single Access
|
67
|
40
|
$90,220.00
|
$58,643.00
35% off
|
$2,727.64
|
$90,220.00
|
$34,689.59
|
2025-06-28
|
|
5911
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$33,387.92
|
$35,657.01
|
$34,684.54
|
2025-06-28
|
|
5912
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$33,387.92
|
$35,657.01
|
$34,684.54
|
2025-06-28
|
|
6301
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$33,294.71
|
$35,557.46
|
$34,587.71
|
2025-06-28
|
|
6302
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$33,294.71
|
$35,557.46
|
$34,587.71
|
2025-06-28
|
|
0620T
|
HCPCS
|
Endovascular Venous Arterialization Tibl/prnl Vn
|
70
|
40
|
$82,502.00
|
$53,626.30
35% off
|
$5,834.00
|
$82,502.00
|
$34,555.91
|
2025-06-28
|
|
278
|
MS_DRG
|
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures …
|
28
|
17
|
—
|
—
|
$13,964.00
|
$77,551.15
|
$34,136.45
|
2025-06-28
|
|
853
|
MS_DRG
|
Infectious And Parasitic Diseases With O.r. Procedures With Mcc
|
29
|
18
|
—
|
—
|
$11,984.00
|
$124,000.00
|
$34,123.21
|
2025-06-28
|
|
6
|
MS_DRG
|
Liver Transplant Without Mcc
|
29
|
17
|
—
|
—
|
$33,116.06
|
$1,609,905.30
|
$34,109.54
|
2025-06-28
|
|
228
|
MS_DRG
|
Other Cardiothoracic Procedures With Mcc
|
29
|
18
|
—
|
—
|
$13,964.00
|
$185,200.00
|
$34,004.02
|
2025-06-28
|
|
2004
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$32,635.70
|
$34,853.67
|
$33,903.11
|
2025-06-28
|
|
3044
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$32,404.47
|
$34,606.72
|
$33,662.90
|
2025-06-28
|
|
9104
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$32,206.19
|
$34,394.97
|
$33,456.92
|
2025-06-28
|
|
245
|
MS_DRG
|
Aicd Generator Procedures
|
29
|
18
|
—
|
—
|
$13,964.00
|
$120,547.00
|
$33,365.03
|
2025-06-28
|
|
1833
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$31,969.22
|
$34,141.89
|
$33,210.75
|
2025-06-28
|
|
471
|
MS_DRG
|
Cervical Spinal Fusion With Mcc
|
29
|
18
|
—
|
—
|
$13,964.00
|
$125,500.00
|
$33,169.69
|
2025-06-28
|
|
826
|
MS_DRG
|
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …
|
28
|
17
|
—
|
—
|
$32,628.04
|
$74,020.25
|
$33,117.46
|
2025-06-28
|
|
27818685_IP
|
CDM
|
Watchman Device Cap Ea Add
|
1
|
1
|
$49,500.00
|
$32,175.00
35% off
|
$33,115.50
|
$33,115.50
|
$33,115.50
|
2025-06-28
|
|
27818680_IP
|
CDM
|
Watchman Device Cap 1-3 Units
|
1
|
1
|
$49,500.00
|
$32,175.00
35% off
|
$33,115.50
|
$33,115.50
|
$33,115.50
|
2025-06-28
|
|
799
|
MS_DRG
|
Splenic Procedures With Mcc
|
28
|
17
|
—
|
—
|
$32,490.98
|
$73,699.40
|
$32,978.35
|
2025-06-28
|
|
981
|
MS_DRG
|
Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc
|
28
|
17
|
—
|
—
|
$32,485.02
|
$73,685.45
|
$32,972.29
|
2025-06-28
|
|
823
|
MS_DRG
|
Lymphoma And Non-acute Leukemia With Other Procedures With Mcc
|
29
|
18
|
—
|
—
|
$31,992.37
|
$112,000.00
|
$32,952.14
|
2025-06-28
|
|
163
|
MS_DRG
|
Major Chest Procedures With Mcc
|
29
|
18
|
—
|
—
|
$31,526.87
|
$119,500.00
|
$32,472.68
|
2025-06-28
|
|
650
|
MS_DRG
|
Kidney Transplant With Hemodialysis With Mcc
|
29
|
17
|
—
|
—
|
$31,514.29
|
$622,206.65
|
$32,459.72
|
2025-06-28
|
|
1794
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$31,103.69
|
$33,217.54
|
$32,311.60
|
2025-06-28
|
|
Q5124
|
HCPCS
|
Byooviz 0.5 Mg/0.05 Ml Intravitreal Solution
|
68
|
40
|
$83,800.80
|
$54,470.52
35% off
|
$149.75
|
$83,800.80
|
$32,284.26
|
2025-06-28
|
|
C1824
|
HCPCS
|
Generator, Cardiac Contractility Modulation (implantable)
|
127
|
29
|
$46,000.00
|
$29,900.00
35% off
|
$201.26
|
$63,250.00
|
$32,200.00
|
2025-06-28
|
|
267
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc
|
29
|
18
|
—
|
—
|
$13,964.00
|
$159,600.00
|
$32,159.23
|
2025-06-28
|
|
1674
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$30,899.68
|
$32,999.66
|
$32,099.67
|
2025-06-28
|
|
0214
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$30,844.03
|
$32,940.23
|
$32,041.86
|
2025-06-28
|
|
1204
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$30,669.24
|
$32,753.56
|
$31,860.28
|
2025-06-28
|
|
277
|
MS_DRG
|
Cardiac Defibrillator Implant Without Mcc
|
28
|
17
|
—
|
—
|
$13,964.00
|
$117,356.00
|
$31,809.61
|
2025-06-28
|
|
856
|
MS_DRG
|
Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc
|
29
|
18
|
—
|
—
|
$30,880.60
|
$103,500.00
|
$31,807.02
|
2025-06-28
|
|
0053
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$30,590.45
|
$32,669.42
|
$31,778.43
|
2025-06-28
|
|
J2781
|
HCPCS
|
Syfovre (pf) 15 Mg/0.1 Ml Intravitreal Solution
|
59
|
34
|
$79,628.40
|
$51,758.46
35% off
|
$147.36
|
$79,628.40
|
$31,771.73
|
2025-06-28
|
|
6604
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$30,579.93
|
$32,658.18
|
$31,767.50
|
2025-06-28
|
|
27818680_OP
|
CDM
|
Watchman Device Cap 1-3 Units
|
1
|
1
|
$49,500.00
|
$32,175.00
35% off
|
$31,432.50
|
$31,432.50
|
$31,432.50
|
2025-06-28
|
|
27818685_OP
|
CDM
|
Watchman Device Cap Ea Add
|
1
|
1
|
$49,500.00
|
$32,175.00
35% off
|
$31,432.50
|
$31,432.50
|
$31,432.50
|
2025-06-28
|
|
221
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
29
|
18
|
—
|
—
|
$13,964.00
|
$127,500.00
|
$31,416.95
|
2025-06-28
|
|
329
|
MS_DRG
|
Major Small And Large Bowel Procedures With Mcc
|
30
|
18
|
—
|
—
|
$11,984.00
|
$152,669.00
|
$31,412.31
|
2025-06-28
|
|
1603
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$30,128.73
|
$32,176.31
|
$31,298.77
|
2025-06-28
|
|
27881005_IP
|
CDM
|
Watchman Device Nct 02699957
|
1
|
1
|
$46,750.00
|
$30,387.50
35% off
|
$31,275.75
|
$31,275.75
|
$31,275.75
|
2025-06-28
|
|
61715
|
HCPCS
|
Mrgfus Stereotactic Ablation Target Intracranial
|
66
|
40
|
$80,808.00
|
$52,525.20
35% off
|
$3,655.51
|
$80,808.00
|
$31,232.29
|
2025-06-28
|
|
474
|
MS_DRG
|
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc
|
28
|
17
|
—
|
—
|
$30,702.48
|
$69,512.85
|
$31,163.01
|
2025-06-28
|
|
6840311006
|
NDC
|
Babybig 100 Mg Intravenous Solution
|
42
|
28
|
$51,570.00
|
$33,520.50
35% off
|
$11,242.26
|
$51,570.00
|
$30,942.00
|
2025-06-28
|
|
J0202
|
HCPCS
|
Lemtrada 12 Mg/1.2 Ml Intravenous Solution
|
68
|
40
|
$117,798.96
|
$76,569.32
35% off
|
$2,337.69
|
$117,798.96
|
$30,822.10
|
2025-06-28
|
|
901
|
MS_DRG
|
Wound Debridements For Injuries With Mcc
|
28
|
17
|
—
|
—
|
$30,343.59
|
$68,672.75
|
$30,798.75
|
2025-06-28
|
|
J9281
|
HCPCS
|
Jelmyto 40 Mg X 2 Intra-pyelocalyceal Kit
|
68
|
40
|
$117,504.00
|
$76,377.60
35% off
|
$300.59
|
$117,504.00
|
$30,744.92
|
2025-06-28
|
|
3124
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$29,537.09
|
$31,544.47
|
$30,684.17
|
2025-06-28
|
|
0745T
|
HCPCS
|
Car Fcl Abltj Radj Arrhyt N-invas Loclzj & Mapg
|
42
|
28
|
$51,097.00
|
$33,213.05
35% off
|
$11,139.15
|
$51,097.00
|
$30,658.20
|
2025-06-28
|
|
0747T
|
HCPCS
|
Car Fcl Abltj Radj Arrhyt Dlvr Radj Ther
|
42
|
28
|
$51,097.00
|
$33,213.05
35% off
|
$11,139.15
|
$51,097.00
|
$30,658.20
|
2025-06-28
|
|
0746T
|
HCPCS
|
Car Fcl Abltj Radj Arrhyt Conv Loclzj & Mapg
|
42
|
28
|
$51,097.00
|
$33,213.05
35% off
|
$11,139.15
|
$51,097.00
|
$30,658.20
|
2025-06-28
|
|
25
|
MS_DRG
|
Craniotomy And Endovascular Intracranial Procedures With Mcc
|
29
|
18
|
—
|
—
|
$13,964.00
|
$135,700.00
|
$30,620.37
|
2025-06-28
|
|
J2782
|
HCPCS
|
Izervay (pf) 2 Mg/0.1 Ml Intravitreal Solution
|
59
|
34
|
$75,600.00
|
$49,140.00
35% off
|
$109.53
|
$75,600.00
|
$30,618.00
|
2025-06-28
|
|
933
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft
|
28
|
17
|
—
|
—
|
$29,657.59
|
$67,066.95
|
$30,102.46
|
2025-06-28
|
|
319
|
MS_DRG
|
Other Endovascular Cardiac Valve Procedures With Mcc
|
28
|
17
|
—
|
—
|
$17,771.00
|
$68,088.40
|
$30,093.95
|
2025-06-28
|
|
27276975
|
CDM
|
Impella Cardiac Assist Dev 22
|
41
|
27
|
$50,000.00
|
$32,500.00
35% off
|
$10,900.00
|
$50,000.00
|
$30,000.00
|
2025-06-28
|
|
6084
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$28,848.53
|
$30,809.11
|
$29,968.86
|
2025-06-28
|
|
6083
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$28,848.53
|
$30,809.11
|
$29,968.86
|
2025-06-28
|
|
6344
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$28,762.71
|
$30,717.46
|
$29,879.71
|
2025-06-28
|
|
2204
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$28,760.43
|
$30,715.03
|
$29,877.34
|
2025-06-28
|
|
1832
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$28,704.93
|
$30,655.75
|
$29,819.68
|
2025-06-28
|
|
33231
|
HCPCS
|
Insrt Pulse Gen W/mult Leads
|
26
|
21
|
—
|
—
|
$18,884.95
|
$32,694.60
|
$29,722.37
|
2025-06-28
|
|
0571T
|
HCPCS
|
Insj/rplcmt Icds Ss Eltrd
|
26
|
21
|
—
|
—
|
$18,884.95
|
$32,694.60
|
$29,722.37
|
2025-06-28
|
|
6072
|
APR_DRG
|
—
|
9
|
9
|
—
|
—
|
$28,607.85
|
$30,552.07
|
$29,718.83
|
2025-06-28
|