Price Transparency Hospital negotiated rates

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

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Hospital

KAISER FOUNDATION HOSPITAL WESTSIDE

Hillsboro, OR · CCN 380103 · Rates published

15,405 distinct procedures filed
1 distinct payers
60,186 rate rows
2026-05-08 last MRF observed
Data quality

52,568 of 60,186 rate rows are consumer-grade (87.3%)

7,618 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
per-diem day rate — not a per-procedure price 4,608
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 2,900
exceeds 10× this hospital's gross charge — excluded from medians 81
placeholder amount (≤ $0.02) — excluded from medians 29
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/health-plan-documents/coverage-information/machine-readable/941105628-westside-medical-center-standard-charges-nw-en.csv
Found on page https://healthy.kaiserpermanente.org/oregon-washington/doctors-locations/price-transparency
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint 8d474b9afca58ff6… · 112,724,973 bytes · first seen 2026-05-08

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
J3391
OTHER 		"Inj, Atidarsagene Autotemcel" 1 $4,632,500.00 $4,632,500.00 $4,632,500.00 nat. median
$4,505,000
1.0× median
J1411
OTHER 		"Inj, Hemgenix, Per Tx Dose" 1 $3,815,000.00 $3,815,000.00 $3,815,000.00 nat. median
$3,685,267
1.0× median
J1414
OTHER 		Beqvez (fidanacogene Elaparvovec-dz 1 $3,815,000.00 $3,815,000.00 $3,815,000.00 nat. median
$3,710,000
1.0× median
J1413
OTHER 		Inj Delandistrogene Mox Rokl 1 $3,383,360.00 $3,383,360.00 $3,383,360.00 nat. median
$3,327,860
1.0× median
J3394
OTHER 		"Inj, Lovotibeglogene Autotem" 1 $3,379,000.00 $3,379,000.00 $3,379,000.00 nat. median
$3,286,000
1.0× median
J3393
OTHER 		"Inj, Betibeglogene Autotemce" 1 $3,052,000.00 $3,052,000.00 $3,052,000.00 nat. median
$2,968,000
1.0× median
J3399
OTHER 		Inj Onase Abepar-xioi Treat 1 $2,737,307.00 $2,737,307.00 $2,737,307.00 nat. median
$2,472,216
1.1× median
J3392
OTHER 		Casgevy (exagamglogene Autotemcel) 1 $2,398,000.00 $2,398,000.00 $2,398,000.00 nat. median
$2,332,000
1.0× median
Q2057
OTHER 		Tecelra (afamitresgene Autoleucel) 1 $792,430.00 $792,430.00 $792,430.00 nat. median
$770,620
1.0× median
Q2056
OTHER 		Ciltacabtagene Car-pos T 1 $605,288.00 $605,288.00 $605,288.00 nat. median
$583,076
1.0× median
Q2055
OTHER 		Idecabtagene Vicleucel Car 1 $575,861.00 $575,861.00 $575,861.00 nat. median
$558,082
1.0× median
Q2054
OTHER 		Lisocabtagene Mara Car Pos T 1 $567,588.00 $567,588.00 $567,588.00 nat. median
$562,538
1.0× median
Q2042
OTHER 		Tisagenlecleucel Car-pos T 1 $557,936.00 $557,936.00 $557,936.00 nat. median
$591,726
0.9× median
Q2041
OTHER 		Axicabtagene Ciloleucel Car+ 1 $548,902.00 $548,902.00 $548,902.00 nat. median
$533,230
1.0× median
Q2053
OTHER 		Brexucabtagene Car Pos T 1 $503,580.00 $503,580.00 $503,580.00 nat. median
$489,720
1.0× median
Q2058
OTHER 		Obecbtge Autol Up To 400 Mil 1 $294,709.00 $294,709.00 $294,709.00 nat. median
$281,111
1.0× median
A9543
OTHER 		Y-90 Ibritumomb Tiuxtn Tx To 40 Mci 1 $79,095.69 $132,881.00 $79,197.00 nat. median
$66,156
1.2× median
J9029
OTHER 		"Instill Adstiladrin, Tx Dose" 1 $63,431.05 $106,564.00 $63,512.00 nat. median
$66,509
1.0× median
Q2043
OTHER 		Sipuleucel-t Auto Cd54+ 1 $55,945.97 $93,989.00 $56,017.00 nat. median
$55,946
1.0× median
38240
OTHER 		Transplt Allo Hct/donor 1 $46,913.00 $151,449.00 $51,038.00 nat. median
$18,374
outlier · 2.8×
A9699
OTHER 		Radiopharmaceutical Therapeutic Noc 1 $49,878.82 $83,796.00 $49,942.00 nat. median
$258
outlier · 193.8×
J9226
OTHER 		Supprelin La Implant 1 $45,560.39 $76,541.00 $45,618.00 nat. median
$45,345
1.0× median
A9513
OTHER 		Lutetium Lu 177 Dotatate 10 mCi/mL (370 MBq/mL) Soln 1 Each Vial 1 $38,368.11 $123,824.37 $41,856.12 nat. median
$341
outlier · 122.9×
33276
OTHER 		Insj Phrnc Nrv Stim Sys 1 $35,695.00 $115,235.00 $38,834.00 nat. median
$43,556
0.9× median
0266T
OTHER 		Implt/rpl Crtd Sns Dev Total 1 $35,695.00 $115,235.00 $38,834.00 nat. median
$43,194
0.9× median
187001050
OTHER 		Sodium Benzoate-sod Phenylacet 10-10 % Soln 50 Ml Vial 1 $31,342.61 $101,151.15 $34,191.94 nat. median
$57,533
0.6× median
68875010201
OTHER 		Teduglutide 5 Mg Kit 1 Each Kit 1 $31,250.75 $100,854.70 $34,091.73 nat. median
$100,000
outlier · 0.3×
A9607
OTHER 		Lutetium Lu-177 Vipivotide Tetraxetan 27 mCi/mL (1,000 MBq/mL) Soln 1 Each Vial 1 $31,244.31 $100,833.92 $34,084.70 nat. median
$269
outlier · 126.9×
0620T
OTHER 		Evasc Ven Artlz Tibl/prnl Vn 1 $27,763.00 $89,628.00 $30,205.00 nat. median
$34,721
0.9× median
J9266
OTHER 		Pegaspargase Injection 1 $28,424.06 $47,752.00 $28,460.00 nat. median
$28,424
1.0× median
34847
OTHER 		Viscer And Infrarenal Abdom Aorta 3 Prosthesis 1 $25,867.18 $84,349.50 $28,116.50 nat. median
$8,284
outlier · 3.4×
33231
OTHER 		Insj Implntbl Defib Pulse Gen W/exist Multileads 1 $25,432.00 $82,102.00 $27,668.00 nat. median
$30,055
0.9× median
0571T
OTHER 		Insj/rplcmt Icds Ss Eltrd 1 $25,432.00 $82,102.00 $27,668.00 nat. median
$31,782
0.9× median
0408T
OTHER 		Insj/rplc Cardiac Modulj Sys 1 $25,432.00 $82,102.00 $27,668.00 nat. median
$31,782
0.9× median
33264
OTHER 		Rmvl Impltbl Dfb Pls Gen W/rplcmt Pls Gen Mlt Ld 1 $25,432.00 $82,102.00 $27,668.00 nat. median
$29,348
0.9× median
33270
OTHER 		Ins/rplcmnt Perm Subq Impltbl Dfb W/subq Eltrd 1 $25,432.00 $82,102.00 $27,668.00 nat. median
$29,560
0.9× median
33249
OTHER 		Insj/rplcmt Perm Dfb W/trnsvns Lds 1/dual Chmbr 1 $25,432.00 $82,102.00 $27,668.00 nat. median
$30,055
0.9× median
69930
OTHER 		Implant Cochlear Device 1 $25,231.00 $81,452.00 $27,449.00 nat. median
$27,893
1.0× median
35001
OTHER 		Dir Rpr Aneurysm Carotid-subclavian Artery 1 $24,283.40 $79,185.00 $26,395.00 nat. median
$2,093
outlier · 12.6×
34846
OTHER 		Viscer And Infrarenal Abdom Aorta 2 Prosthesis 1 $24,283.40 $79,185.00 $26,395.00 nat. median
$9,462
outlier · 2.8×
64568
OTHER 		Opn Impltj Crnl Nrv Nea&pg 1 $24,172.00 $78,035.00 $26,298.00 nat. median
$25,829
1.0× median
0268T
OTHER 		Implt/rpl Crtd Sns Dev Gen 1 $24,172.00 $78,035.00 $26,298.00 nat. median
$29,995
0.9× median
0674T
OTHER 		Laps Insj Nw/rpcmt Prm Isdss 1 $24,172.00 $78,035.00 $26,298.00 nat. median
$31,043
0.8× median
63685
OTHER 		Ins/rplc Spi Npg/rcvr Pocket 1 $24,172.00 $78,035.00 $26,298.00 nat. median
$25,009
1.1× median
64582
OTHER 		Opn Mpltj Hpglsl Nstm Ary Pg 1 $24,172.00 $78,035.00 $26,298.00 nat. median
$28,637
0.9× median
61886
OTHER 		Implant Neurostim Arrays 1 $24,172.00 $78,035.00 $26,298.00 nat. median
$27,282
1.0× median
33287
OTHER 		Rmv&rplcmt Phrnc Nrv Stim Pg 1 $24,172.00 $78,035.00 $26,298.00 nat. median
$29,995
0.9× median
34844
OTHER 		Endovasc Viscer Aorta Repr Fenest 4+ Endograft 1 $23,562.35 $76,833.75 $25,611.25 nat. median
$9,315
outlier · 2.7×
33289
OTHER 		Tcat Impl Wrls P-art Prs Snr 1 $22,550.00 $72,798.00 $24,533.00 nat. median
$26,244
0.9× median
J9600
OTHER 		Porfimer Sodium Injection 1 $24,228.42 $40,704.00 $24,260.00 nat. median
$24,471
1.0× median

Other procedures at this hospital

Browse this hospital's 15,405 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
J3391 OTHER "Inj, Atidarsagene Autotemcel" 3 1 — — $4,632,500.00 $4,632,500.00 $4,632,500.00 2026-05-08
J1414 OTHER Beqvez (fidanacogene Elaparvovec-dz 3 1 — — $3,815,000.00 $3,815,000.00 $3,815,000.00 2026-05-08
J1411 OTHER "Inj, Hemgenix, Per Tx Dose" 3 1 — — $3,815,000.00 $3,815,000.00 $3,815,000.00 2026-05-08
J1413 OTHER Inj Delandistrogene Mox Rokl 3 1 — — $3,383,360.00 $3,383,360.00 $3,383,360.00 2026-05-08
J3394 OTHER "Inj, Lovotibeglogene Autotem" 3 1 — — $3,379,000.00 $3,379,000.00 $3,379,000.00 2026-05-08
J3393 OTHER "Inj, Betibeglogene Autotemce" 3 1 — — $3,052,000.00 $3,052,000.00 $3,052,000.00 2026-05-08
J3399 OTHER Inj Onase Abepar-xioi Treat 3 1 — — $2,737,307.00 $2,737,307.00 $2,737,307.00 2026-05-08
J3392 OTHER Casgevy (exagamglogene Autotemcel) 3 1 — — $2,398,000.00 $2,398,000.00 $2,398,000.00 2026-05-08
Q2057 OTHER Tecelra (afamitresgene Autoleucel) 3 1 — — $792,430.00 $792,430.00 $792,430.00 2026-05-08
Q2056 OTHER Ciltacabtagene Car-pos T 3 1 — — $605,288.00 $605,288.00 $605,288.00 2026-05-08
Q2055 OTHER Idecabtagene Vicleucel Car 3 1 — — $575,861.00 $575,861.00 $575,861.00 2026-05-08
Q2054 OTHER Lisocabtagene Mara Car Pos T 3 1 — — $567,588.00 $567,588.00 $567,588.00 2026-05-08
Q2042 OTHER Tisagenlecleucel Car-pos T 3 1 — — $557,936.00 $557,936.00 $557,936.00 2026-05-08
Q2041 OTHER Axicabtagene Ciloleucel Car+ 3 1 — — $548,902.00 $548,902.00 $548,902.00 2026-05-08
Q2053 OTHER Brexucabtagene Car Pos T 3 1 — — $503,580.00 $503,580.00 $503,580.00 2026-05-08
Q2058 OTHER Obecbtge Autol Up To 400 Mil 3 1 — — $294,709.00 $294,709.00 $294,709.00 2026-05-08
A9543 OTHER Y-90 Ibritumomb Tiuxtn Tx To 40 Mci 3 1 — — $79,095.69 $132,881.00 $79,197.00 2026-05-08
J9029 OTHER "Instill Adstiladrin, Tx Dose" 3 1 — — $63,431.05 $106,564.00 $63,512.00 2026-05-08
Q2043 OTHER Sipuleucel-t Auto Cd54+ 3 1 — — $55,945.97 $93,989.00 $56,017.00 2026-05-08
38240 OTHER Transplt Allo Hct/donor 3 1 — — $46,913.00 $151,449.00 $51,038.00 2026-05-08
A9699 OTHER Radiopharmaceutical Therapeutic Noc 3 1 — — $49,878.82 $83,796.00 $49,942.00 2026-05-08
J9226 OTHER Supprelin La Implant 3 1 — — $45,560.39 $76,541.00 $45,618.00 2026-05-08
A9513 OTHER Lutetium Lu 177 Dotatate 10 mCi/mL (370 MBq/mL) Soln 1 Each Vial 3 1 $209,183.43 $177,805.92 $38,368.11 $123,824.37 $41,856.12 2026-05-08
33276 OTHER Insj Phrnc Nrv Stim Sys 3 1 — — $35,695.00 $115,235.00 $38,834.00 2026-05-08
0266T OTHER Implt/rpl Crtd Sns Dev Total 3 1 — — $35,695.00 $115,235.00 $38,834.00 2026-05-08
187001050 OTHER Sodium Benzoate-sod Phenylacet 10-10 % Soln 50 Ml Vial 3 1 $142,466.41 $121,096.45 $31,342.61 $101,151.15 $34,191.94 2026-05-08
68875010201 OTHER Teduglutide 5 Mg Kit 1 Each Kit 3 1 $146,310.19 $124,363.67 $31,250.75 $100,854.70 $34,091.73 2026-05-08
A9607 OTHER Lutetium Lu-177 Vipivotide Tetraxetan 27 mCi/mL (1,000 MBq/mL) Soln 1 Each Vial 3 1 $159,649.57 $135,702.14 $31,244.31 $100,833.92 $34,084.70 2026-05-08
0620T OTHER Evasc Ven Artlz Tibl/prnl Vn 3 1 — — $27,763.00 $89,628.00 $30,205.00 2026-05-08
J9266 OTHER Pegaspargase Injection 3 1 — — $28,424.06 $47,752.00 $28,460.00 2026-05-08
34847 OTHER Viscer And Infrarenal Abdom Aorta 3 Prosthesis 3 1 $115,840.00 $98,464.00 $25,867.18 $84,349.50 $28,116.50 2026-05-08
33270 OTHER Ins/rplcmnt Perm Subq Impltbl Dfb W/subq Eltrd 3 1 $94,927.00 $80,687.95 $25,432.00 $82,102.00 $27,668.00 2026-05-08
33264 OTHER Rmvl Impltbl Dfb Pls Gen W/rplcmt Pls Gen Mlt Ld 3 1 $94,927.00 $80,687.95 $25,432.00 $82,102.00 $27,668.00 2026-05-08
33231 OTHER Insj Implntbl Defib Pulse Gen W/exist Multileads 3 1 $94,927.00 $80,687.95 $25,432.00 $82,102.00 $27,668.00 2026-05-08
33249 OTHER Insj/rplcmt Perm Dfb W/trnsvns Lds 1/dual Chmbr 3 1 $94,927.00 $80,687.95 $25,432.00 $82,102.00 $27,668.00 2026-05-08
0571T OTHER Insj/rplcmt Icds Ss Eltrd 3 1 — — $25,432.00 $82,102.00 $27,668.00 2026-05-08
0408T OTHER Insj/rplc Cardiac Modulj Sys 3 1 — — $25,432.00 $82,102.00 $27,668.00 2026-05-08
69930 OTHER Implant Cochlear Device 3 1 — — $25,231.00 $81,452.00 $27,449.00 2026-05-08
35001 OTHER Dir Rpr Aneurysm Carotid-subclavian Artery 3 1 $14,216.00 $12,083.60 $24,283.40 $79,185.00 $26,395.00 2026-05-08
34846 OTHER Viscer And Infrarenal Abdom Aorta 2 Prosthesis 3 1 $108,747.00 $92,434.95 $24,283.40 $79,185.00 $26,395.00 2026-05-08
33287 OTHER Rmv&rplcmt Phrnc Nrv Stim Pg 3 1 — — $24,172.00 $78,035.00 $26,298.00 2026-05-08
0674T OTHER Laps Insj Nw/rpcmt Prm Isdss 3 1 — — $24,172.00 $78,035.00 $26,298.00 2026-05-08
64568 OTHER Opn Impltj Crnl Nrv Nea&pg 3 1 — — $24,172.00 $78,035.00 $26,298.00 2026-05-08
61886 OTHER Implant Neurostim Arrays 3 1 — — $24,172.00 $78,035.00 $26,298.00 2026-05-08
63685 OTHER Ins/rplc Spi Npg/rcvr Pocket 3 1 — — $24,172.00 $78,035.00 $26,298.00 2026-05-08
64582 OTHER Opn Mpltj Hpglsl Nstm Ary Pg 3 1 — — $24,172.00 $78,035.00 $26,298.00 2026-05-08
0268T OTHER Implt/rpl Crtd Sns Dev Gen 3 1 — — $24,172.00 $78,035.00 $26,298.00 2026-05-08
34844 OTHER Endovasc Viscer Aorta Repr Fenest 4+ Endograft 3 1 $105,518.00 $89,690.30 $23,562.35 $76,833.75 $25,611.25 2026-05-08
33289 OTHER Tcat Impl Wrls P-art Prs Snr 3 1 — — $22,550.00 $72,798.00 $24,533.00 2026-05-08
J9600 OTHER Porfimer Sodium Injection 3 1 — — $24,228.42 $40,704.00 $24,260.00 2026-05-08
33305 OTHER Repair Cardiac Wound W/cardiopulmonary Bypass 3 1 $98,426.00 $83,662.10 $21,978.57 $71,669.25 $23,889.75 2026-05-08
C9760 OTHER Nrnd Nbld Pd Nyha Cls Ii Iii IV Hf; 3 1 — — $21,814.00 $70,422.00 $23,732.00 2026-05-08
34845 OTHER Viscer And Infrarenal Abdom Aorta 1 Prosthesis 3 1 $96,673.00 $82,172.05 $21,587.11 $70,392.75 $23,464.25 2026-05-08
34843 OTHER Endovasc Viscer Aorta Repair Fenest 3 Endograft 3 1 $95,357.00 $81,053.45 $21,293.40 $69,435.00 $23,145.00 2026-05-08
Q9982 OTHER flutemetamoL F-18 5 mCi (185 MBq) Soln 1 Each Vial 2 1 $3,850.00 $3,272.50 $20,911.00 $22,812.00 $21,861.50 2026-05-08
G0448 OTHER Ins/rpl Prm Cv-dfib Tv Leads Insrt Pace Elctrode 3 1 $91,063.00 $77,403.55 $20,033.86 $64,654.73 $21,855.12 2026-05-08
34842 OTHER Endovasc Viscer Aorta Repair Fenest 2 Endograft 3 1 $86,909.00 $73,872.65 $19,406.94 $63,283.50 $21,094.50 2026-05-08
33858 OTHER As-aort Grf W/card Byp F/aortic Dissection 3 1 $83,045.00 $70,588.25 $18,543.98 $60,469.50 $20,156.50 2026-05-08
0515T OTHER Insj Wcs Lv Compl Sys 3 1 — — $17,805.00 $57,480.00 $19,371.00 2026-05-08
0614T OTHER Rmvl&rplcmt Ss Impl Dfb Pg 3 1 — — $17,805.00 $57,480.00 $19,371.00 2026-05-08
33240 OTHER Insj Implntbl Defib Pulse Gen W/1 Existing Ld 3 1 $68,013.00 $57,811.05 $17,805.00 $57,480.00 $19,371.00 2026-05-08
33230 OTHER Insj Implntbl Defib Pulse Gen W/exist Dual Leads 3 1 $68,013.00 $57,811.05 $17,805.00 $57,480.00 $19,371.00 2026-05-08
0414T OTHER Rmvl & Rpl Car Modulj Pls Gn 3 1 — — $17,805.00 $57,480.00 $19,371.00 2026-05-08
33262 OTHER Rmvl Impltbl Dfb Plse Gen W/repl Plse Gen 1 Lead 3 1 $68,013.00 $57,811.05 $17,805.00 $57,480.00 $19,371.00 2026-05-08
33263 OTHER Rmvl Impltbl Dfb Plse Gen W/rplcmt Plse Gen 2 Ld 3 1 $68,013.00 $57,811.05 $17,805.00 $57,480.00 $19,371.00 2026-05-08
0409T OTHER Insj/rplc Car Modulj Pls Gn 3 1 — — $17,805.00 $57,480.00 $19,371.00 2026-05-08
34841 OTHER Endovasc Viscer Aorta Repair Fenest 1 Endograft 3 1 $79,379.00 $67,472.15 $17,725.41 $57,800.25 $19,266.75 2026-05-08
33871 OTHER Transvrs A-arch Grf W/card Byp Prfd Hypothermia 3 1 $79,379.00 $67,472.15 $17,725.41 $57,800.25 $19,266.75 2026-05-08
187000714 OTHER Ribavirin 6 Gram Recon Soln 4 Each Vial 3 1 $77,884.08 $66,201.47 $17,134.50 $55,297.70 $18,692.18 2026-05-08
33430 OTHER Replacement Mitral Valve W/cardiopulmonary Byp 3 1 $76,669.00 $65,168.65 $17,120.28 $55,827.00 $18,609.00 2026-05-08
0817T OTHER Opn Insj/rplcmt Ins Ptn Subf 3 1 — — $17,010.00 $54,914.00 $18,506.00 2026-05-08
61885 OTHER Insrt/redo Neurostim 1 Array 3 1 — — $17,010.00 $54,914.00 $18,506.00 2026-05-08
63655 OTHER Implant Neuroelectrodes 3 1 — — $17,010.00 $54,914.00 $18,506.00 2026-05-08
61891 OTHER Rev/rplcmt Sk-mnt Crnl Nstm 3 1 — — $17,010.00 $54,914.00 $18,506.00 2026-05-08
64590 OTHER Ins/rpl Prph Sac/gstr Npg/r 3 1 — — $17,010.00 $54,914.00 $18,506.00 2026-05-08
0816T OTHER Opn Insj/rplcmt Ins Ptn Subq 3 1 — — $17,010.00 $54,914.00 $18,506.00 2026-05-08
64580 OTHER Opn Impltj Nea Neuromuscular 3 1 — — $17,010.00 $54,914.00 $18,506.00 2026-05-08
0680T OTHER Insj/rplcmt Pg Only Isdss 3 1 — — $17,010.00 $54,914.00 $18,506.00 2026-05-08
33406 OTHER Rplcmt Aortic Valve Opn Allograft Valve Freehand 3 1 $76,030.00 $64,625.50 $16,977.68 $55,362.00 $18,454.00 2026-05-08
A9590 OTHER Iobenguane I-131 30 mCi/2 Ml Soln 1 Each Vial 6 1 $70,656.00 $60,057.61 $2,539.69 $92,135.25 $18,372.61 2026-05-08
33425 OTHER Valvuloplasty Mitral Valve W/cardiac Bypass 3 1 $72,843.00 $61,916.55 $16,265.83 $53,040.75 $17,680.25 2026-05-08
0483T OTHER Tmvi W/prosthetic Valve Percutaneous Approach 3 1 $75,593.00 $64,254.05 $16,146.02 $52,107.61 $17,613.84 2026-05-08
53447 OTHER Remove/replace Ur Sphincter 3 1 — — $15,966.00 $51,544.00 $17,370.00 2026-05-08
54416 OTHER Remv/repl Penis Contain Pros 3 1 — — $15,966.00 $51,544.00 $17,370.00 2026-05-08
54405 OTHER Insert Multi-comp Penis Pros 3 1 — — $15,966.00 $51,544.00 $17,370.00 2026-05-08
54411 OTHER Remov/replc Penis Pros Comp 3 1 — — $15,966.00 $51,544.00 $17,370.00 2026-05-08
54401 OTHER Insert Self-contd Prosthesis 3 1 — — $15,966.00 $51,544.00 $17,370.00 2026-05-08
54410 OTHER Remove/replace Penis Prosth 3 1 — — $15,966.00 $51,544.00 $17,370.00 2026-05-08
53444 OTHER Insert Tandem Cuff 3 1 — — $15,966.00 $51,544.00 $17,370.00 2026-05-08
53445 OTHER Insert Uro/ves Nck Sphincter 3 1 — — $15,966.00 $51,544.00 $17,370.00 2026-05-08
0795T OTHER Tcat Ins 2chmbr Ldls Pm Cmpl 3 1 — — $15,128.00 $48,837.00 $16,458.00 2026-05-08
0802T OTHER Tcat Rmv&rpl2chmb Ldls Pm Ra 3 1 — — $15,128.00 $48,837.00 $16,458.00 2026-05-08
0525T OTHER Insj/rplcmt Compl Iims 3 1 — — $15,128.00 $48,837.00 $16,458.00 2026-05-08
0797T OTHER Tcat Ins 2chmbr Ldls Pm Rv 3 1 — — $15,128.00 $48,837.00 $16,458.00 2026-05-08
0825T OTHER Tcat Rmv&rpl1chmb Ldls Pm Ra 3 1 — — $15,128.00 $48,837.00 $16,458.00 2026-05-08
0823T OTHER Tcat Ins 1chmbr Ldls Pm Ra 3 1 — — $15,128.00 $48,837.00 $16,458.00 2026-05-08
33274 OTHER Tcat Insj/rpl Perm Leadless Pacemaker Rv W/img 3 1 $53,934.00 $45,843.90 $15,128.00 $48,837.00 $16,458.00 2026-05-08
0803T OTHER Tcat Rmv&rpl2chmb Ldls Pm Rv 3 1 — — $15,128.00 $48,837.00 $16,458.00 2026-05-08
0796T OTHER Tcat Ins 2chmbr Ldls Pm Ra 3 1 — — $15,128.00 $48,837.00 $16,458.00 2026-05-08
33229 OTHER Remvl Perm Pm Pls Gen W/repl Plse Gen Mult Lead 3 1 $56,223.00 $47,789.55 $15,128.00 $48,837.00 $16,458.00 2026-05-08
33221 OTHER Ins Pacemaker Pulse Gen Only W/exist Mult Leads 3 1 $56,223.00 $47,789.55 $15,128.00 $48,837.00 $16,458.00 2026-05-08
0801T OTHER Tcat Rmv&rpl 2chmbr Ldls Pm 3 1 — — $15,128.00 $48,837.00 $16,458.00 2026-05-08
35216 OTHER Rpr Blood Vessel Direct Intrathoracic Without Bypass 3 1 $67,304.00 $57,208.40 $15,029.12 $49,008.00 $16,336.00 2026-05-08
0569T OTHER Ttvr Percutaneous Approach Initial Prosthesis 3 1 $68,899.00 $58,564.15 $14,716.24 $47,493.32 $16,054.08 2026-05-08
93653 OTHER Compre Ep Eval Abltj 3d Mapg Tx Svt 3 1 $66,534.00 $56,553.90 $14,637.37 $47,238.79 $15,968.04 2026-05-08
22630 OTHER Arthrd Pst Tq 1ntrspc Lum 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
24371 OTHER Revise Reconst Elbow Joint 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
22633 OTHER Arthrd Cmbn 1ntrspc Lumbar 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
25446 OTHER Arthrp W/prostc Dst Rds&crps 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
25442 OTHER Arthrp W/prostc Dstl Ulna 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
28705 OTHER Arthrodesis Pantalar 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
23472 OTHER Reconstruct Shoulder Joint 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
27702 OTHER Reconstruct Ankle Joint 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
22612 OTHER Arthrd Pst Tq 1ntrspc Lumbar 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
22867 OTHER Insj Stablj Dev W/dcmprn 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
20696 OTHER App Mltpln Uni Xtrnl Fix 1st 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
23616 OTHER Optx Prx Hmrl Fx Fix Rpr Rpl 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
22856 OTHER Tot Disc Arthrp 1ntrspc Crv 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
24361 OTHER Reconstruct Elbow Joint 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
24363 OTHER Replace Elbow Joint 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
27279 OTHER Arthrd Si Jt Perq/min Nvas 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
27278 OTHER Arthrd Si Jt Prq Wo Tfxj Dev 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
21243 OTHER Reconstruction Of Jaw Joint 3 1 — — $14,588.00 $47,093.00 $15,870.00 2026-05-08
33426 OTHER Vlvp Mitral Valve W/card Byp W/prostc Ring 3 1 $65,312.00 $55,515.20 $14,584.30 $47,557.50 $15,852.50 2026-05-08
93654 OTHER Compre Ep Eval Abltj 3d Mapg Tx Vt 3 1 $65,740.00 $55,879.00 $14,462.80 $46,675.40 $15,777.60 2026-05-08
37242 OTHER Vascular Embolization Or Occlusion Arterial Rs&i 3 1 $50,596.00 $43,006.60 $14,244.00 $45,983.00 $15,496.00 2026-05-08
0645T OTHER Tcat Impltj C Sins Rdctj Dev 3 1 — — $14,244.00 $45,983.00 $15,496.00 2026-05-08
37231 OTHER Tib/per Revasc Stent & Ather 3 1 — — $14,244.00 $45,983.00 $15,496.00 2026-05-08
37227 OTHER Fem/popl Revasc Stnt & Ather 3 1 — — $14,244.00 $45,983.00 $15,496.00 2026-05-08
37229 OTHER Tib/per Revasc W/ather 3 1 — — $14,244.00 $45,983.00 $15,496.00 2026-05-08
C9775 OTHER Rvsc Evar O/p Tb/pa; Ivl & Tsp & At 3 1 — — $14,244.00 $45,983.00 $15,496.00 2026-05-08
37184 OTHER Prim Prq Trluml Mchnl Thrmbc N-cor N-icra 1st 3 1 $50,596.00 $43,006.60 $14,244.00 $45,983.00 $15,496.00 2026-05-08
36837 OTHER Prq Av Fstl Crt Uxtr Sep Acs 3 1 — — $14,244.00 $45,983.00 $15,496.00 2026-05-08
36836 OTHER Prq Av Fstl Crtj Uxtr 1 Acs 3 1 — — $14,244.00 $45,983.00 $15,496.00 2026-05-08
0238T OTHER Trluml Peripheral Atherectomy Iliac Artery Ea 3 1 $47,175.00 $40,098.75 $14,244.00 $45,983.00 $15,496.00 2026-05-08
0793T OTHER Prq Tcat Thrm Ablt Nrv P-art 3 1 — — $14,244.00 $45,983.00 $15,496.00 2026-05-08
C9774 OTHER Rvsc Evar O/pc Tib/pa;ivasc Lith&at 3 1 — — $14,244.00 $45,983.00 $15,496.00 2026-05-08
33902 OTHER Perq P-art Revsc 1 Abnor Uni 3 1 — — $14,244.00 $45,983.00 $15,496.00 2026-05-08
C9773 OTHER Revasc Lithotr-stent Tib/per 3 1 $49,122.70 $41,754.30 $14,244.00 $45,983.00 $15,496.00 2026-05-08
C9766 OTHER Rev Evar Le Aa; IV Litho & Atherect 3 1 — — $14,244.00 $45,983.00 $15,496.00 2026-05-08
C9765 OTHER Rev Evar Any Ves;iv Lithotripsy & Tl Stent Plcmt 3 1 $48,536.00 $41,255.60 $14,244.00 $45,983.00 $15,496.00 2026-05-08
36906 OTHER Perq Thrmbc/nfs Dial Circuit Tcat Plmt IV Stent 3 1 $50,596.00 $43,006.60 $14,244.00 $45,983.00 $15,496.00 2026-05-08
C9767 OTHER Rev Evr Le Aa; IV Litho & Tl St&ath 3 1 — — $14,244.00 $45,983.00 $15,496.00 2026-05-08
C9797 OTHER Vasc Emb/occ W/prs-gen Cath 3 1 — — $14,244.00 $45,983.00 $15,496.00 2026-05-08
37225 OTHER Fem/popl Revas W/ather 3 1 — — $14,244.00 $45,983.00 $15,496.00 2026-05-08
37230 OTHER Tib/per Revasc W/stent 3 1 — — $14,244.00 $45,983.00 $15,496.00 2026-05-08
C9602 OTHER Pc Tl Cor Atherect W/rx Elut Ic Stent; 1 Mca/br 3 1 $50,596.00 $43,006.60 $14,244.00 $45,983.00 $15,496.00 2026-05-08
C9607 OTHER Pc Tl Rev Chrn Tot Occl Ca Ca Br/cabg; 1 Ves 3 1 $50,596.00 $43,006.60 $14,244.00 $45,983.00 $15,496.00 2026-05-08
0632T OTHER Perq Tcat US Abltj Nrv P-art 3 1 — — $14,244.00 $45,983.00 $15,496.00 2026-05-08
62361 OTHER Implant Spine Infusion Pump 3 1 — — $14,020.00 $45,259.00 $15,252.00 2026-05-08
62360 OTHER Insert Spine Infusion Device 3 1 — — $14,020.00 $45,259.00 $15,252.00 2026-05-08
62362 OTHER Implant Spine Infusion Pump 3 1 — — $14,020.00 $45,259.00 $15,252.00 2026-05-08
C9782 OTHER Bl P Nyha Ii/iii Hf/ccs Iii/iv Cra 3 1 — — $13,882.00 $44,814.00 $15,102.00 2026-05-08
C9758 OTHER Bi Prc Nyha 3/4 Hf;trnscth I Ias/pc 3 1 — — $13,882.00 $44,814.00 $15,102.00 2026-05-08
0686T OTHER Histotripsy Mal Hepatcel Tis 3 1 — — $13,882.00 $44,814.00 $15,102.00 2026-05-08
0888T OTHER Histotripsy Mal Renal Tissue 3 1 — — $13,882.00 $44,814.00 $15,102.00 2026-05-08
33859 OTHER As-aort Grf W/card Byp F/aortic Ds Oth/thn Dsj 3 1 $62,005.00 $52,704.25 $13,845.77 $45,149.25 $15,049.75 2026-05-08
19357 OTHER Tiss Xpndr Plmt Brst Rcnstj 3 1 — — $13,801.00 $44,553.00 $15,014.00 2026-05-08
81416 OTHER Exome Sequence Analysis 6 1 — — $13,494.00 $43,561.09 $14,680.00 2026-05-08
66683 OTHER Implantation Iris Prosthesis 3 1 — — $13,022.00 $42,039.00 $14,167.00 2026-05-08
0308T OTHER Insj Ocular Telescope Prosth 3 1 — — $13,022.00 $42,039.00 $14,167.00 2026-05-08
61711 OTHER Anast Artl Extracranial-intracranial Arteries 3 1 $56,982.00 $48,434.70 $12,724.06 $41,491.50 $13,830.50 2026-05-08
77371 OTHER Srs Multisource 6 1 — — $12,666.00 $40,890.00 $13,780.00 2026-05-08
77372 OTHER Radiation Delivery Stereotactic Cranial Linear 6 1 $42,916.00 $36,478.60 $12,666.00 $40,890.00 $13,780.00 2026-05-08
90288 OTHER Botulism Immune Globulin (human) 100 Mg Recon Soln 1 Each Vial 3 1 $57,310.00 $48,713.50 $12,608.20 $40,690.10 $13,754.40 2026-05-08
67027 OTHER Implant Eye Drug System 3 1 — — $12,188.00 $39,346.00 $13,260.00 2026-05-08
33533 OTHER Cabg W/arterial Graft Single Arterial Graft 3 1 $52,760.00 $44,846.00 $11,781.29 $38,417.25 $12,805.75 2026-05-08
33418 OTHER Tcat Mitral Valve Repair Initial Prosthesis 3 1 $52,481.00 $44,608.85 $11,718.96 $38,214.00 $12,738.00 2026-05-08
61680 OTHER Intracranial Arven Malfrmj Supratentrl Smpl 3 1 $52,125.00 $44,306.25 $11,639.61 $37,955.25 $12,651.75 2026-05-08
J1412 OTHER Inj Roctavian Ml 2x10^13vc G 3 1 — — $12,368.21 $20,779.00 $12,384.00 2026-05-08
65770 OTHER Keratoprosthesis 3 1 — — $11,334.00 $36,591.00 $12,331.00 2026-05-08
32110 OTHER Thorcom Ctrl Traumtc Hemrrg&/rpr Lng Tear 3 1 $49,772.00 $42,306.20 $11,114.06 $36,241.50 $12,080.50 2026-05-08
C9293 OTHER Glucarpidase 1,000 Unit Recon Soln 1 Each Vial 3 1 $51,889.60 $44,106.16 $10,872.14 $35,087.35 $11,860.51 2026-05-08
93591 OTHER Perq Transcath Cls Paravalvr Leak 1 Aortic Valve 3 1 $48,536.00 $41,255.60 $10,677.92 $34,460.56 $11,648.64 2026-05-08
93590 OTHER Perq Transcath Cls Paravalvr Leak 1 Mitral Valve 3 1 $48,536.00 $41,255.60 $10,677.92 $34,460.56 $11,648.64 2026-05-08
92933 OTHER Perq Trluml C Athrc St Angiop 1 Maj C Art&/brnch 3 1 $48,536.00 $41,255.60 $10,677.92 $34,460.56 $11,648.64 2026-05-08
93582 OTHER Percutan Transcath Closure Pat Duct Arteriosus 3 1 $48,536.00 $41,255.60 $10,677.92 $34,460.56 $11,648.64 2026-05-08
93580 OTHER Prq Tcat Clsr Cgen Intratrl Comunicaj W/implt 3 1 $48,536.00 $41,255.60 $10,677.92 $34,460.56 $11,648.64 2026-05-08
0315U OTHER Onc Cutan Sq Cll Ca Mrna 40 6 1 — — $10,400.00 $33,575.38 $11,315.00 2026-05-08
62192 OTHER Crtj Shunt Sarach/sdrl-prtl-pleural Oth 3 1 $46,503.00 $39,527.55 $10,384.27 $33,861.75 $11,287.25 2026-05-08
0211U OTHER Onc Pan-tum Dna&rna Gnrj Seq 6 1 — — $10,346.00 $33,398.42 $11,255.00 2026-05-08
54417 OTHER Remv/replc Penis Pros Compl 3 1 — — $10,306.00 $33,270.00 $11,212.00 2026-05-08
53451 OTHER Tprnl Balo Cntnc Dev Bi 3 1 — — $10,306.00 $33,270.00 $11,212.00 2026-05-08
53440 OTHER Male Sling Procedure 3 1 — — $10,306.00 $33,270.00 $11,212.00 2026-05-08
55882 OTHER Ablt Trurl Prst8 Tis Trnsdcr 3 1 — — $10,306.00 $33,270.00 $11,212.00 2026-05-08
54400 OTHER Insert Semi-rigid Prosthesis 3 1 — — $10,306.00 $33,270.00 $11,212.00 2026-05-08
22869 OTHER Insj Stablj Dev Without Dcmprn 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
28735 OTHER Fusion Of Foot Bones 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24586 OTHER Treat Elbow Fracture 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
23615 OTHER Optx Prox Humrl Fx W/int Fix 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24346 OTHER Reconstruct Elbow Med Ligmnt 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
25810 OTHER Arthrd Wrst Iliac/oth Agrft 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24366 OTHER Reconstruct Head Of Radius 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
C9734 OTHER Focused U/s Abl/tx Int Oth Than Ul 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
0737T OTHER Xenograft Impltj Artclr Surf 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
23485 OTHER Revision Of Collar Bone 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
C9757 OTHER Laminotomy Decomp Nerve Root; 1 Interspace Lumb 3 1 $37,976.00 $32,279.60 $10,206.00 $32,949.00 $11,104.00 2026-05-08
C9781 OTHER Arthrosc Shldr Sx; W/imp Sa Spacer 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24370 OTHER Revise Reconst Elbow Joint 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24587 OTHER Treat Elbow Fracture 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24579 OTHER Treat Humerus Fracture 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
25491 OTHER Prophylactic Tx Ulna 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27441 OTHER Revision Of Knee Joint 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
25444 OTHER Arthrp W/prostc Lunate 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
0627T OTHER Perq Njx Algc Fluor Lmbr 1st 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
28715 OTHER Arthrodesis Triple 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
25441 OTHER Arthrp W/prostc Dstl Rds 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
23491 OTHER Reinforce Shoulder Bones 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24365 OTHER Reconstruct Head Of Radius 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
28420 OTHER Treat/graft Heel Fracture 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24430 OTHER Repair Of Humerus 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
25391 OTHER Lengthen Radius Or Ulna 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
23802 OTHER Arthrd Glenohumeral Jt W/grf 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
20982 OTHER Ablation Bone Tumor Rf Perq W/img Gdn When Done 3 1 $37,976.00 $32,279.60 $10,206.00 $32,949.00 $11,104.00 2026-05-08
22554 OTHER Arthrd Ant Ntrbd Min Dsc Crv 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
25365 OTHER Revise Radius & Ulna 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
69719 OTHER Rplcm Oi Implt Sk Tc Esp<100 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
69729 OTHER Impl Oi Implt Sk Tc Esp>=100 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24362 OTHER Reconstruct Elbow Joint 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
69730 OTHER Rplc Oi Implt Sk Tc Esp>=100 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24575 OTHER Treat Humerus Fracture 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
0629T OTHER Perq Njx Algc CT Lmbr 1st 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
23680 OTHER Optx Sho Dislc Neck Fx Fixj 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
69716 OTHER Impl Oi Implt Sk Tc Esp<100 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
23470 OTHER Reconstruct Shoulder Joint 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24666 OTHER Treat Radius Fracture 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
29889 OTHER Knee Arthroscopy/surgery 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
29907 OTHER Subtalar Arthro W/fusion 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
69714 OTHER Impl Oi Implt Skull Perq Esp 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
28737 OTHER Revision Of Foot Bones 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
29856 OTHER Tibial Arthroscopy/surgery 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
29867 OTHER Allgrft Implnt Knee W/scope 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
28725 OTHER Arthrodesis Subtalar 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24802 OTHER Fusion/graft Of Elbow Joint 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
28730 OTHER Fusion Of Foot Bones 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
64628 OTHER Trml Dstrj Ios Bvn 1st 2 L/s 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27759 OTHER Treatment Of Tibia Fracture 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24545 OTHER Treat Humerus Fracture 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27870 OTHER Fusion Of Ankle Joint Open 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27828 OTHER Treat Lower Leg Fracture 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24546 OTHER Treat Humerus Fracture 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27827 OTHER Treat Lower Leg Fracture 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27871 OTHER Fusion Of Tibiofibular Joint 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27709 OTHER Osteotomy Tibia & Fibula 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
28297 OTHER Cor Hlx Vlgs Jt Arthrd 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24498 OTHER Reinforce Humerus 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
20692 OTHER Appl Mltpln Uni Ext Fixj Sys 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24515 OTHER Treat Humerus Fracture 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27758 OTHER Treatment Of Tibia Fracture 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24516 OTHER Treat Humerus Fracture 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27442 OTHER Revision Of Knee Joint 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27440 OTHER Revision Of Knee Joint 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27443 OTHER Revision Of Knee Joint 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27429 OTHER Reconstruction Knee 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24435 OTHER Repair Humerus With Graft 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27438 OTHER Revise Kneecap With Implant 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27446 OTHER Arthrp Knee Condyle&plateau Medial/lat Cmprt 3 1 $37,976.00 $32,279.60 $10,206.00 $32,949.00 $11,104.00 2026-05-08
27356 OTHER Remove Femur Lesion/graft 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27415 OTHER Osteochondral Knee Allograft 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27130 OTHER Total Hip Arthroplasty 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
23473 OTHER Revis Reconst Shoulder Joint 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27447 OTHER Total Knee Arthroplasty 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
28320 OTHER Repair Of Foot Bones 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
24410 OTHER Revision Of Humerus 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
22551 OTHER Arthrd Ant Ntrbdy Cervical 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
27428 OTHER Reconstruction Knee 3 1 — — $10,206.00 $32,949.00 $11,104.00 2026-05-08
33243 OTHER Rmvl 1/dual Chamber Defib Electrode By Thoracom 3 1 $45,467.00 $38,646.95 $10,152.89 $33,107.25 $11,035.75 2026-05-08
61635 OTHER Tcat Plmt IV Stent Icra W/balo Angiop If Pfrmd 3 1 $44,853.00 $38,125.05 $10,015.81 $32,660.25 $10,886.75 2026-05-08
61624 OTHER Tcat Perm Occls/embolization Perq Cns 3 1 $44,853.00 $38,125.05 $10,015.81 $32,660.25 $10,886.75 2026-05-08
43647 OTHER Lap Impl Electrode Antrum 3 1 — — $9,892.00 $31,933.00 $10,761.00 2026-05-08
0784T OTHER Ins/rplmt Eltrd Ra Spi Nstim 3 1 — — $9,892.00 $31,933.00 $10,761.00 2026-05-08
61715 OTHER Mrgfus Strtctc Ablt Trgt Icr 3 1 — — $9,892.00 $31,933.00 $10,761.00 2026-05-08
64553 OTHER Implant Neuroelectrodes 3 1 — — $9,892.00 $31,933.00 $10,761.00 2026-05-08
33288 OTHER Rmv&rplcmt Phrnc Nrv Stim Ld 3 1 — — $9,892.00 $31,933.00 $10,761.00 2026-05-08
63664 OTHER Revise Spine Eltrd Plate 3 1 — — $9,892.00 $31,933.00 $10,761.00 2026-05-08
0675T OTHER Laps Insj Nw/rpcmt Isdss 1ld 3 1 — — $9,892.00 $31,933.00 $10,761.00 2026-05-08
64596 OTHER Ins/rplcmt Prq Eltrd Ra Pn 1 3 1 — — $9,892.00 $31,933.00 $10,761.00 2026-05-08
64583 OTHER Rev/rplct Hpglsl Nstm Ary Pg 3 1 — — $9,892.00 $31,933.00 $10,761.00 2026-05-08
64569 OTHER Revise/repl Vagus N Eltrd 3 1 — — $9,892.00 $31,933.00 $10,761.00 2026-05-08
61888 OTHER Revise/remove Neuroreceiver 3 1 — — $9,892.00 $31,933.00 $10,761.00 2026-05-08
64575 OTHER Opn Impltj Nea Perph Nerve 3 1 — — $9,892.00 $31,933.00 $10,761.00 2026-05-08
33620 OTHER Application Right & Left Pulmonary Artery Band 3 1 $44,271.00 $37,630.35 $9,885.86 $32,236.50 $10,745.50 2026-05-08
33322 OTHER Suture Repair Aorta/great Vessel W/bypass 3 1 $43,275.00 $36,783.75 $9,663.45 $31,511.25 $10,503.75 2026-05-08
C9606 OTHER Perq Tl Rev Ac Total/subtotal Occlusion 1 Ves 3 1 $44,853.00 $38,125.05 $9,580.34 $30,918.37 $10,451.28 2026-05-08
93656 OTHER Compre Ep Eval Abltj Atr Fib Pulm Vein Isolation 3 1 $43,007.00 $36,555.95 $9,461.54 $30,534.97 $10,321.68 2026-05-08
34706 OTHER Evasc Rpr Dplmnt Aorto-bi-iliac Ndgft Rpt 3 1 $41,881.00 $35,598.85 $9,352.03 $30,495.75 $10,165.25 2026-05-08
0094U OTHER Genome Rapid Sequence Alys 6 1 — — $9,278.00 $29,950.82 $10,093.00 2026-05-08
35840 OTHER Expl Po Hemrrg Thrombosis/infctj Abd 3 1 $41,482.00 $35,259.70 $9,263.02 $30,205.50 $10,068.50 2026-05-08
33979 OTHER Insj Ventr Assist Dev Impltable Icorp 1 Vntrc 3 1 $41,283.00 $35,090.55 $9,218.63 $30,060.75 $10,020.25 2026-05-08
C9604 OTHER Pc Tl Rev Of/thru Cabg Comb De Ic Stnt; 1 Ves 3 1 $31,742.00 $26,980.70 $8,995.00 $29,040.00 $9,786.00 2026-05-08
C9600 OTHER Pc Trnscth Plcmt Rx Elut Ic Stents; 1 Maj Ca/br 3 1 $31,742.00 $26,980.70 $8,995.00 $29,040.00 $9,786.00 2026-05-08
37244 OTHER Vascular Embolization Or Occlusion Hemorrhage 3 1 $31,742.00 $26,980.70 $8,995.00 $29,040.00 $9,786.00 2026-05-08
37243 OTHER Vascular Embolize/occlude Organ Tumor Infarct 3 1 $31,742.00 $26,980.70 $8,995.00 $29,040.00 $9,786.00 2026-05-08
37238 OTHER Open/perq Placement Intravascular Stent Same 1st 3 1 $31,742.00 $26,980.70 $8,995.00 $29,040.00 $9,786.00 2026-05-08
37236 OTHER Open/perq Placement Intravascular Stent Initial 3 1 $31,742.00 $26,980.70 $8,995.00 $29,040.00 $9,786.00 2026-05-08
37241 OTHER Vascular Embolization Or Occlusion Venous Rs&i 3 1 $31,742.00 $26,980.70 $8,995.00 $29,040.00 $9,786.00 2026-05-08
37226 OTHER Fem/popl Revasc W/stent 3 1 — — $8,995.00 $29,040.00 $9,786.00 2026-05-08
37228 OTHER Tib/per Revasc W/tla 3 1 — — $8,995.00 $29,040.00 $9,786.00 2026-05-08
37187 OTHER Prq Transluminal Mechanical Thrombectomy Vein 3 1 $31,742.00 $26,980.70 $8,995.00 $29,040.00 $9,786.00 2026-05-08
37221 OTHER Iliac Revasc W/stent 3 1 — — $8,995.00 $29,040.00 $9,786.00 2026-05-08
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