Hospital

PENN HIGHLANDS MON VALLEY

Monongahela, PA · CCN 390147 · Rates published

28,723 distinct procedures filed

9 distinct payers

1,470,110 rate rows

2026-05-23 last MRF observed

Data quality

1,463,248 of 1,470,110 rate rows are consumer-grade (99.5%)

6,862 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 — reason	Rows
placeholder amount (≤ $0.02) — excluded from medians	3,648
per-diem day rate — not a per-procedure price	1,660
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	624
percent-of-charges filed in the dollar field — excluded from medians	494
template filing: same amount across many unrelated codes — excluded	436

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://www.phhealthcare.org/download/?id=14847
Found on page	https://www.phhealthcare.org/patients-visitors/patient-billing-services
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-05-18
Content fingerprint	b3201e3bff6300a1… · 106,239,854 bytes · first seen 2026-05-09

Top 50 most expensive offerings

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

Code	Description	Payers	Min $	Max $	Avg median	vs national
J1414 OTHER	Inj Beqvez Per Tx Dose	7	$3,487,400.00	$4,085,452.00	$3,802,750.00	nat. median $3,710,000 1.0× median
J1411 OTHER	Inj- Hemgenix- Per Tx Dose	7	$3,464,150.67	$4,058,215.66	$3,777,398.33	nat. median $3,685,267 1.0× median
J1413 OTHER	Inj Delandistrogene Mox Rokl	7	$3,125,097.59	$3,661,018.58	$3,407,686.20	nat. median $3,327,860 1.0× median
J3394 OTHER	Inj- Lovotibeglogene Autotem	7	$3,065,673.70	$3,591,404.13	$3,342,888.88	nat. median $3,286,000 1.0× median
J3393 OTHER	Inj- Betibeglogene Autotemce	7	$2,773,645.47	$3,249,296.16	$3,024,453.83	nat. median $2,968,000 1.0× median
J3399 OTHER	Inj Onase Abepar-xioi Treat	7	$2,304,988.66	$2,700,269.70	$2,513,418.49	nat. median $2,472,216 1.0× median
J3392 OTHER	Inj Exagamglogene Autotem	7	$2,192,080.00	$2,567,998.40	$2,390,300.00	nat. median $2,332,000 1.0× median
Q2057 OTHER	Afamitresgene Autoleucel	8	$724,382.80	$1,745,762.55	$793,738.60	nat. median $770,620 1.0× median
Q2042 OTHER	Tisagenlecleucel Car-pos T	8	$543,625.10	$1,310,136.50	$595,674.32	nat. median $591,726 1.0× median
Q2056 OTHER	Ciltacabtagene Car-pos T	8	$520,176.10	$1,253,624.40	$569,980.19	nat. median $583,076 1.0× median
Q2054 OTHER	Lisocabtagene Mara Car Pos T	8	$509,137.52	$1,227,021.42	$557,884.73	nat. median $562,538 1.0× median
Q2055 OTHER	Idecabtagene Vicleucel Car	8	$508,784.82	$1,226,171.42	$557,498.26	nat. median $558,082 1.0× median
Q2041 OTHER	Axicabtagene Ciloleucel Car+	8	$501,091.89	$1,207,631.46	$549,068.77	nat. median $533,230 1.0× median
Q2053 OTHER	Brexucabtagene Car Pos T	8	$460,336.80	$1,109,411.69	$504,411.60	nat. median $489,720 1.0× median
5834 OTHER	Neonate With Ecmo	5	$372,747.50	$395,124.96	$372,747.50	nat. median $372,748 1.0× median
MS-018 OTHER	Chimeric Antigen Receptor (car) T-cell Immunotherapy	7	$225,618.51	$651,738.35	$259,221.27	nat. median $309,559 0.8× median
5884 OTHER	Neonate Bwt <1500g W Major Procedure	5	$243,175.28	$257,774.02	$243,175.28	nat. median $243,175 1.0× median
5833 OTHER	Neonate With Ecmo	5	$241,477.73	$255,974.56	$241,477.73	nat. median $252,069 1.0× median
0024 OTHER	Heart And/or Lung Transplant	5	$846.00	$228,282.47	$215,353.95	nat. median $235,636 0.9× median
MS-001 OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	6	$168,518.12	$405,623.52	$194,512.93	nat. median $224,278 0.9× median
5832 OTHER	Neonate With Ecmo	5	$185,410.53	$196,541.43	$185,410.53	nat. median $152,272 1.2× median
1614 OTHER	Implantable Heart Assist Systems	5	$184,557.51	$195,637.21	$184,557.51	nat. median $194,298 0.9× median
6304 OTHER	Neonate Birthwt >2499g W Major Cardiovascular Procedure	5	$177,387.79	$188,037.06	$177,387.79	nat. median $164,743 1.1× median
8414 OTHER	Extensive Third Degree Burns With Skin Graft	5	$174,957.88	$185,461.27	$174,957.88	nat. median $161,322 1.1× median
MS-927 OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	7	$141,922.71	$385,320.74	$163,060.14	nat. median $175,322 0.9× median
6094 OTHER	Neonate Bwt 1500-2499g W Major Procedure	5	$159,888.67	$169,487.40	$159,888.67	nat. median $170,784 0.9× median
5883 OTHER	Neonate Bwt <1500g W Major Procedure	5	$158,154.61	$167,649.24	$158,154.61	nat. median $163,694 1.0× median
6314 OTHER	Neonate Birthwt >2499g W Other Major Procedure	5	$156,970.96	$166,394.53	$156,970.96	nat. median $163,675 1.0× median
5914 OTHER	Neonate Birthwt 500-749g Without Major Procedure	5	$154,480.40	$163,754.45	$154,480.40	nat. median $149,152 1.0× median
MS-003 OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth…	7	$128,215.51	$308,615.04	$147,311.43	nat. median $169,886 0.9× median
0114 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	5	$146,912.21	$155,731.92	$146,912.21	nat. median $125,206 1.2× median
0074 OTHER	Allogeneic Bone Marrow Transplant	5	$146,633.09	$155,436.04	$146,633.09	nat. median $147,645 1.0× median
0094 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	5	$145,898.12	$154,656.94	$145,898.12	nat. median $165,362 0.9× median
5934 OTHER	Neonate Birthwt 750-999g Without Major Procedure	5	$143,242.57	$151,841.97	$143,242.57	nat. median $129,842 1.1× median
5882 OTHER	Neonate Bwt <1500g W Major Procedure	5	$138,777.31	$147,108.64	$138,777.31	nat. median $119,369 1.2× median
5831 OTHER	Neonate With Ecmo	5	$134,768.55	$142,859.22	$134,768.55	nat. median $139,037 1.0× median
6034 OTHER	Neonate Birthwt 1000-1249g W Or Without Other Significant Condition	5	$132,495.16	$140,449.35	$132,495.16	nat. median $92,525 1.4× median
0014 OTHER	Liver Transplant And/or Intestinal Transplant	5	$130,403.71	$138,232.35	$130,403.71	nat. median $147,828 0.9× median
C9150 OTHER	Xe129 Xenon- Diagnostic	1	$53,040.00	$206,856.00	$129,948.00	nat. median $53,040 outlier · 2.5×
0044 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	5	$129,510.27	$137,285.27	$129,510.27	nat. median $138,863 0.9× median
1613 OTHER	Implantable Heart Assist Systems	5	$124,876.10	$132,372.89	$124,876.10	nat. median $79 outlier · 1586.3×
0023 OTHER	Heart And/or Lung Transplant	5	$120,920.16	$128,179.46	$120,920.16	nat. median $133,752 0.9× median
5881 OTHER	Neonate Bwt <1500g W Major Procedure	5	$118,952.63	$126,093.81	$118,952.63	nat. median $14,014 outlier · 8.5×
5913 OTHER	Neonate Birthwt 500-749g Without Major Procedure	5	$114,661.49	$121,545.06	$114,661.49	nat. median $115,252 1.0× median
Q0480 OTHER	Driver Pneumatic Vad- Rep	7	$65,046.24	$296,280.39	$109,304.53	nat. median $109,316 1.0× median
1604 OTHER	Major Cardiothoracic Repair Of Heart Anomaly	5	$107,676.97	$114,141.23	$107,676.97	nat. median $44,507 outlier · 2.4×
6024 OTHER	Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom	5	$106,368.76	$112,754.49	$106,368.76	nat. median $99,381 1.1× median
1612 OTHER	Implantable Heart Assist Systems	5	$100,240.52	$106,258.34	$100,240.52	nat. median $84,765 1.2× median
K1007 OTHER	Bil Hkaf Pc S/d Micro Sensor	1	$100,135.12	$100,135.12	$100,135.12	nat. median $96,013 1.0× median
5933 OTHER	Neonate Birthwt 750-999g Without Major Procedure	5	$99,344.47	$105,308.49	$99,344.47	nat. median $87,090 1.1× median

Other procedures at this hospital

Browse this hospital's 28,723 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

J1414	OTHER	Inj Beqvez Per Tx Dose	24	7	—	—	$3,487,400.00	$4,085,452.00	$3,802,750.00	2026-05-23
J1411	OTHER	Inj- Hemgenix- Per Tx Dose	24	7	—	—	$3,464,150.67	$4,058,215.66	$3,777,398.33	2026-05-23
J1413	OTHER	Inj Delandistrogene Mox Rokl	24	7	—	—	$3,125,097.59	$3,661,018.58	$3,407,686.20	2026-05-23
J3394	OTHER	Inj- Lovotibeglogene Autotem	24	7	—	—	$3,065,673.70	$3,591,404.13	$3,342,888.88	2026-05-23
J3393	OTHER	Inj- Betibeglogene Autotemce	24	7	—	—	$2,773,645.47	$3,249,296.16	$3,024,453.83	2026-05-23
J3399	OTHER	Inj Onase Abepar-xioi Treat	24	7	—	—	$2,304,988.66	$2,700,269.70	$2,513,418.49	2026-05-23
J3392	OTHER	Inj Exagamglogene Autotem	24	7	—	—	$2,192,080.00	$2,567,998.40	$2,390,300.00	2026-05-23
Q2057	OTHER	Afamitresgene Autoleucel	50	8	—	—	$724,382.80	$1,745,762.55	$793,738.60	2026-05-23
Q2042	OTHER	Tisagenlecleucel Car-pos T	58	8	—	—	$543,625.10	$1,310,136.50	$595,674.32	2026-05-23
Q2056	OTHER	Ciltacabtagene Car-pos T	52	8	—	—	$520,176.10	$1,253,624.40	$569,980.19	2026-05-23
Q2054	OTHER	Lisocabtagene Mara Car Pos T	54	8	—	—	$509,137.52	$1,227,021.42	$557,884.73	2026-05-23
Q2055	OTHER	Idecabtagene Vicleucel Car	56	8	—	—	$508,784.82	$1,226,171.42	$557,498.26	2026-05-23
Q2041	OTHER	Axicabtagene Ciloleucel Car+	58	8	—	—	$501,091.89	$1,207,631.46	$549,068.77	2026-05-23
Q2053	OTHER	Brexucabtagene Car Pos T	52	8	—	—	$460,336.80	$1,109,411.69	$504,411.60	2026-05-23
5834	OTHER	Neonate With Ecmo	12	5	—	—	$372,747.50	$395,124.96	$372,747.50	2026-05-23
MS-018	OTHER	Chimeric Antigen Receptor (car) T-cell Immunotherapy	38	7	—	—	$225,618.51	$651,738.35	$259,221.27	2026-05-23
5884	OTHER	Neonate Bwt <1500g W Major Procedure	12	5	—	—	$243,175.28	$257,774.02	$243,175.28	2026-05-23
5833	OTHER	Neonate With Ecmo	12	5	—	—	$241,477.73	$255,974.56	$241,477.73	2026-05-23
0024	OTHER	Heart And/or Lung Transplant	18	5	—	—	$846.00	$228,282.47	$215,353.95	2026-05-23
MS-001	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	36	6	—	—	$168,518.12	$405,623.52	$194,512.93	2026-05-23
5832	OTHER	Neonate With Ecmo	12	5	—	—	$185,410.53	$196,541.43	$185,410.53	2026-05-23
1614	OTHER	Implantable Heart Assist Systems	12	5	—	—	$184,557.51	$195,637.21	$184,557.51	2026-05-23
6304	OTHER	Neonate Birthwt >2499g W Major Cardiovascular Procedure	12	5	—	—	$177,387.79	$188,037.06	$177,387.79	2026-05-23
8414	OTHER	Extensive Third Degree Burns With Skin Graft	12	5	—	—	$174,957.88	$185,461.27	$174,957.88	2026-05-23
MS-927	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	38	7	—	—	$141,922.71	$385,320.74	$163,060.14	2026-05-23
6094	OTHER	Neonate Bwt 1500-2499g W Major Procedure	12	5	—	—	$159,888.67	$169,487.40	$159,888.67	2026-05-23
5883	OTHER	Neonate Bwt <1500g W Major Procedure	12	5	—	—	$158,154.61	$167,649.24	$158,154.61	2026-05-23
6314	OTHER	Neonate Birthwt >2499g W Other Major Procedure	12	5	—	—	$156,970.96	$166,394.53	$156,970.96	2026-05-23
5914	OTHER	Neonate Birthwt 500-749g Without Major Procedure	12	5	—	—	$154,480.40	$163,754.45	$154,480.40	2026-05-23
MS-003	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth…	38	7	—	—	$128,215.51	$308,615.04	$147,311.43	2026-05-23
0114	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	12	5	—	—	$146,912.21	$155,731.92	$146,912.21	2026-05-23
0074	OTHER	Allogeneic Bone Marrow Transplant	12	5	—	—	$146,633.09	$155,436.04	$146,633.09	2026-05-23
0094	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	12	5	—	—	$145,898.12	$154,656.94	$145,898.12	2026-05-23
5934	OTHER	Neonate Birthwt 750-999g Without Major Procedure	12	5	—	—	$143,242.57	$151,841.97	$143,242.57	2026-05-23
5882	OTHER	Neonate Bwt <1500g W Major Procedure	12	5	—	—	$138,777.31	$147,108.64	$138,777.31	2026-05-23
5831	OTHER	Neonate With Ecmo	12	5	—	—	$134,768.55	$142,859.22	$134,768.55	2026-05-23
6034	OTHER	Neonate Birthwt 1000-1249g W Or Without Other Significant Condition	12	5	—	—	$132,495.16	$140,449.35	$132,495.16	2026-05-23
0014	OTHER	Liver Transplant And/or Intestinal Transplant	12	5	—	—	$130,403.71	$138,232.35	$130,403.71	2026-05-23
C9150	OTHER	Xe129 Xenon- Diagnostic	4	1	—	—	$53,040.00	$206,856.00	$129,948.00	2026-05-23
0044	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	12	5	—	—	$129,510.27	$137,285.27	$129,510.27	2026-05-23
1613	OTHER	Implantable Heart Assist Systems	12	5	—	—	$124,876.10	$132,372.89	$124,876.10	2026-05-23
0023	OTHER	Heart And/or Lung Transplant	12	5	—	—	$120,920.16	$128,179.46	$120,920.16	2026-05-23
5881	OTHER	Neonate Bwt <1500g W Major Procedure	12	5	—	—	$118,952.63	$126,093.81	$118,952.63	2026-05-23
5913	OTHER	Neonate Birthwt 500-749g Without Major Procedure	12	5	—	—	$114,661.49	$121,545.06	$114,661.49	2026-05-23
Q0480	OTHER	Driver Pneumatic Vad- Rep	40	7	—	—	$65,046.24	$296,280.39	$109,304.53	2026-05-23
1604	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	12	5	—	—	$107,676.97	$114,141.23	$107,676.97	2026-05-23
6024	OTHER	Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom	12	5	—	—	$106,368.76	$112,754.49	$106,368.76	2026-05-23
1612	OTHER	Implantable Heart Assist Systems	12	5	—	—	$100,240.52	$106,258.34	$100,240.52	2026-05-23
K1007	OTHER	Bil Hkaf Pc S/d Micro Sensor	2	1	—	—	$100,135.12	$100,135.12	$100,135.12	2026-05-23
5933	OTHER	Neonate Birthwt 750-999g Without Major Procedure	12	5	—	—	$99,344.47	$105,308.49	$99,344.47	2026-05-23
MS-004	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth And Nec…	38	7	—	—	$84,533.36	$203,472.00	$97,123.43	2026-05-23
1611	OTHER	Implantable Heart Assist Systems	12	5	—	—	$95,505.26	$101,238.81	$95,505.26	2026-05-23
5891	OTHER	Neonate Bwt <500g Or Ga <24 Weeks	12	5	—	—	$94,993.98	$100,696.83	$94,993.98	2026-05-23
0064	OTHER	Pancreas Transplant	12	5	—	—	$93,809.03	$99,440.74	$93,809.03	2026-05-23
5892	OTHER	Neonate Bwt <500g Or Ga <24 Weeks	12	5	—	—	$92,191.70	$97,726.32	$92,191.70	2026-05-23
MS-007	OTHER	Lung Transplant	36	6	—	—	$78,184.68	$218,003.88	$90,245.09	2026-05-23
5893	OTHER	Neonate Bwt <500g Or Ga <24 Weeks	12	5	—	—	$90,227.42	$95,644.12	$90,227.42	2026-05-23
MS-014	OTHER	Allogeneic Bone Marrow Transplant	38	7	—	—	$78,382.10	$188,665.92	$90,056.04	2026-05-23
8424	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	12	5	—	—	$89,602.01	$94,981.16	$89,602.01	2026-05-23
0022	OTHER	Heart And/or Lung Transplant	18	5	—	—	$700.00	$93,282.64	$87,999.68	2026-05-23
5912	OTHER	Neonate Birthwt 500-749g Without Major Procedure	12	5	—	—	$86,949.72	$92,169.65	$86,949.72	2026-05-23
0113	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	12	5	—	—	$85,679.34	$90,822.99	$85,679.34	2026-05-23
6303	OTHER	Neonate Birthwt >2499g W Major Cardiovascular Procedure	12	5	—	—	$84,703.07	$89,788.12	$84,703.07	2026-05-23
0054	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	12	5	—	—	$84,476.12	$89,547.55	$84,476.12	2026-05-23
6074	OTHER	Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom	12	5	—	—	$81,518.63	$86,412.50	$81,518.63	2026-05-23
5932	OTHER	Neonate Birthwt 750-999g Without Major Procedure	12	5	—	—	$81,367.33	$86,252.12	$81,367.33	2026-05-23
0043	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	12	5	—	—	$81,211.46	$86,086.90	$81,211.46	2026-05-23
0021	OTHER	Heart And/or Lung Transplant	12	5	—	—	$80,928.43	$85,786.87	$80,928.43	2026-05-23
3034	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	12	5	—	—	$77,336.39	$81,979.19	$77,336.39	2026-05-23
MS-002	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	36	6	—	—	$65,925.85	$225,480.83	$76,095.26	2026-05-23
6023	OTHER	Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom	12	5	—	—	$75,451.68	$79,981.34	$75,451.68	2026-05-23
MS-212	OTHER	Concomitant Aortic And Mitral Valve?procedures	38	7	—	—	$65,173.24	$191,843.41	$74,879.90	2026-05-23
0112	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	12	5	—	—	$73,566.97	$77,983.48	$73,566.97	2026-05-23
MS-005	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	36	6	—	—	$63,710.51	$188,557.81	$73,538.20	2026-05-23
1624	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	12	5	—	—	$73,508.93	$77,921.95	$73,508.93	2026-05-23
MS-215	OTHER	Other Heart Assist System Implant	38	7	—	—	$63,383.87	$152,565.12	$72,824.02	2026-05-23
0084	OTHER	Autologous Bone Marrow Transplant	12	5	—	—	$72,677.44	$77,040.55	$72,677.44	2026-05-23
MS-426	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	38	7	—	—	$62,669.55	$150,845.76	$72,003.31	2026-05-23
0073	OTHER	Allogeneic Bone Marrow Transplant	12	5	—	—	$71,664.65	$75,966.96	$71,664.65	2026-05-23
8514	OTHER	Gender Related Procedures	12	5	—	—	$70,568.39	$74,804.88	$70,568.39	2026-05-23
L8702	OTHER	Ewhf S/d Uprt Micro Sensor	34	7	—	—	$63,405.50	$152,807.26	$69,476.24	2026-05-23
4404	OTHER	Kidney Transplant	12	5	—	—	$68,695.42	$72,819.47	$68,695.42	2026-05-23
8634	OTHER	Neonatal Aftercare	12	5	—	—	$67,893.28	$71,969.17	$67,893.28	2026-05-23
J9029	OTHER	Instill Adstiladrin- Tx Dose	64	8	—	—	$59,625.19	$143,696.70	$66,919.76	2026-05-23
0063	OTHER	Pancreas Transplant	12	5	—	—	$66,643.11	$70,643.95	$66,643.11	2026-05-23
6134	OTHER	Neonate Birthwt 1500-1999g W Congenital/perinatal Infection	12	5	—	—	$66,379.64	$70,364.66	$66,379.64	2026-05-23
MS-216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	38	7	—	—	$57,738.14	$138,975.84	$66,337.43	2026-05-23
6114	OTHER	Neonate Birthwt 1500-1999g W Major Anomaly	12	5	—	—	$66,069.87	$70,036.29	$66,069.87	2026-05-23
MS-850	OTHER	Acute Leukemia With Other Procedures	38	7	—	—	$55,110.60	$163,587.27	$63,318.57	2026-05-23
0093	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	12	5	—	—	$62,876.95	$66,651.69	$62,876.95	2026-05-23
A9543	OTHER	Y90 Ibritumomab- Rx	40	7	—	—	$53,415.08	$128,730.34	$61,654.64	2026-05-23
1674	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	12	5	—	—	$61,648.30	$65,349.28	$61,648.30	2026-05-23
1634	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	12	5	—	—	$61,232.23	$64,908.23	$61,232.23	2026-05-23
0013	OTHER	Liver Transplant And/or Intestinal Transplant	12	5	—	—	$61,003.32	$64,665.58	$61,003.32	2026-05-23
6022	OTHER	Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom	12	5	—	—	$60,338.78	$63,961.15	$60,338.78	2026-05-23
20136388	OTHER	Revasc Intra Lithotrip-ather	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
20136396	OTHER	Revasc Lithotrip-stent-ather	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
20136371	OTHER	Revasc Intra Lithotrip-stent	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
20135992	OTHER	Tib/per Revas W/ather	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
20135638	OTHER	Fem/popl Revasc Stnt & Ather	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
20150618	OTHER	Perc Des Revasc Ami 1 Vsl	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
20136412	OTHER	Revasc Lithotr-stent Tib/per	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
20135489	OTHER	Vasc Emboliz/occlude Artery Rt	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
20135497	OTHER	Vasc Emboliz/occlude Artery Lt	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
20135422	OTHER	Tib/per Revasc W/stent Rt	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
20135075	OTHER	Tib/per Revasc W/stent Lt	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
20150619	OTHER	Perc Des Revasc Tot Occl 1 Vsl	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
20135661	OTHER	Prim Art Mech Thrombectomy	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
20150673	OTHER	Trluml Perip Athr Iliac Artery	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
20136421	OTHER	Revasc Lithotr-ather Tib/per	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
20136438	OTHER	Revasc Lith-sten-ath Tib/per	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
20150614	OTHER	Perc Trl Cor Des Ath/angio Sgl	26	4	$217,389.00	$130,433.40 40% off	$58,477.64	$266,410.22	$59,781.98	2026-05-23
6093	OTHER	Neonate Bwt 1500-2499g W Major Procedure	12	5	—	—	$59,699.02	$63,282.98	$59,699.02	2026-05-23
1784	OTHER	External Heart Assist Systems	12	5	—	—	$58,679.06	$62,201.79	$58,679.06	2026-05-23
6033	OTHER	Neonate Birthwt 1000-1249g W Or Without Other Significant Condition	12	5	—	—	$58,524.50	$62,037.95	$58,524.50	2026-05-23
0053	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	12	5	—	—	$58,352.99	$61,856.14	$58,352.99	2026-05-23
MS-231	OTHER	Coronary Bypass With Ptca With Mcc	38	7	—	—	$50,695.49	$125,776.25	$58,245.88	2026-05-23
6124	OTHER	Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond	12	5	—	—	$58,229.08	$61,724.79	$58,229.08	2026-05-23
MS-456	OTHER	Spinal Fusion Except Cervical With Spinal Curvature- Malignancy- Infection Or Ex…	38	7	—	—	$50,667.37	$121,956.48	$58,213.57	2026-05-23
8504	OTHER	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	12	5	—	—	$57,696.93	$61,160.69	$57,696.93	2026-05-23
Q2043	OTHER	Sipuleucel-t Auto Cd54+	58	8	—	—	$52,589.21	$126,740.00	$57,624.35	2026-05-23
0072	OTHER	Allogeneic Bone Marrow Transplant	12	5	—	—	$57,467.37	$60,917.36	$57,467.37	2026-05-23
MS-429	OTHER	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	38	7	—	—	$49,898.01	$148,118.32	$57,329.63	2026-05-23
1654	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	12	5	—	—	$57,184.99	$60,618.02	$57,184.99	2026-05-23
6073	OTHER	Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom	12	5	—	—	$56,431.11	$59,818.88	$56,431.11	2026-05-23
L8687	OTHER	Implt Nrostm Pls Gen Dua Rec	18	3	—	—	$4,671.62	$56,216.42	$56,216.42	2026-05-23
8413	OTHER	Extensive Third Degree Burns With Skin Graft	12	5	—	—	$55,990.25	$59,351.56	$55,990.25	2026-05-23
6214	OTHER	Neonate Bwt 2000-2499g W Major Anomaly	12	5	—	—	$55,929.60	$59,287.27	$55,929.60	2026-05-23
6804	OTHER	Major O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms	12	5	—	—	$55,882.00	$59,236.81	$55,882.00	2026-05-23
MS-020	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	38	7	—	—	$48,225.89	$136,432.24	$55,408.47	2026-05-23
6334	OTHER	Neonate Birthwt >2499g W Major Anomaly	12	5	—	—	$55,366.80	$58,690.68	$55,366.80	2026-05-23
MS-010	OTHER	Pancreas Transplant	36	6	—	—	$47,698.83	$114,811.20	$55,056.62	2026-05-23
0071	OTHER	Allogeneic Bone Marrow Transplant	12	5	—	—	$54,594.00	$57,871.49	$54,594.00	2026-05-23
MS-019	OTHER	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	38	7	—	—	$47,425.43	$134,425.36	$54,488.79	2026-05-23
3044	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	12	5	—	—	$54,222.28	$57,477.45	$54,222.28	2026-05-23
MS-233	OTHER	Coronary Bypass With Cardiac Catheterization With Mcc	38	7	—	—	$46,761.96	$112,556.16	$53,726.51	2026-05-23
0062	OTHER	Pancreas Transplant	12	5	—	—	$53,360.79	$56,564.24	$53,360.79	2026-05-23
MS-219	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	38	7	—	—	$46,289.94	$111,420.00	$53,184.19	2026-05-23
3033	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	12	5	—	—	$52,702.12	$55,866.03	$52,702.12	2026-05-23
5911	OTHER	Neonate Birthwt 500-749g Without Major Procedure	12	5	—	—	$52,267.13	$55,404.93	$52,267.13	2026-05-23
9104	OTHER	Craniotomy For Multiple Significant Trauma	12	5	—	—	$51,764.98	$54,872.63	$51,764.98	2026-05-23
6084	OTHER	Neonate Bwt 1250-1499g W Or Without Other Significant Condition	12	5	—	—	$51,504.12	$54,596.11	$51,504.12	2026-05-23
MS-957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	38	7	—	—	$44,654.91	$107,484.48	$51,305.64	2026-05-23
1834	OTHER	Percutaneous Structural Cardiac Procedures	12	5	—	—	$51,137.61	$54,207.60	$51,137.61	2026-05-23
6814	OTHER	Other O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms	12	5	—	—	$50,919.79	$53,976.70	$50,919.79	2026-05-23
3124	OTHER	Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses	12	5	—	—	$50,778.93	$53,827.38	$50,778.93	2026-05-23
7404	OTHER	Mental Illness Diagnosis With O.r. Procedure	12	5	—	—	$50,711.76	$53,756.18	$50,711.76	2026-05-23
6904	OTHER	Acute Leukemia	12	5	—	—	$50,441.77	$53,469.98	$50,441.77	2026-05-23
0042	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	12	5	—	—	$50,113.09	$53,121.57	$50,113.09	2026-05-23
1664	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	12	5	—	—	$50,077.87	$53,084.24	$50,077.87	2026-05-23
3614	OTHER	Skin Graft For Skin And Subcutaneous Tissue Diagnoses	12	5	—	—	$49,199.42	$52,153.05	$49,199.42	2026-05-23
0914	OTHER	Other Major Head And Neck Procedures	12	5	—	—	$49,052.04	$51,996.82	$49,052.04	2026-05-23
0012	OTHER	Liver Transplant And/or Intestinal Transplant	12	5	—	—	$49,005.74	$51,947.74	$49,005.74	2026-05-23
MS-427	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	38	7	—	—	$42,492.22	$102,278.88	$48,820.85	2026-05-23
L7181	OTHER	Electronic Elbo Simultaneous	40	7	—	—	$23,150.31	$131,809.80	$48,627.61	2026-05-23
MS-275	OTHER	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	38	7	—	—	$42,278.64	$109,969.86	$48,575.46	2026-05-23
9114	OTHER	Extensive Abdominal/thoracic Procedures For Mult Significant Trauma	12	5	—	—	$48,547.28	$51,461.75	$48,547.28	2026-05-23
6302	OTHER	Neonate Birthwt >2499g W Major Cardiovascular Procedure	12	5	—	—	$48,471.63	$51,381.56	$48,471.63	2026-05-23
0214	OTHER	Open Craniotomy Except Trauma	12	5	—	—	$48,251.20	$51,147.90	$48,251.20	2026-05-23
MS-870	OTHER	Septicemia Or Severe Sepsis With Mv >96 Hours	38	7	—	—	$41,617.57	$100,173.60	$47,815.93	2026-05-23
7594	OTHER	Eating Disorders	12	5	—	—	$47,619.27	$50,478.03	$47,619.27	2026-05-23
1794	OTHER	Defibrillator Implants	12	5	—	—	$47,555.36	$50,410.29	$47,555.36	2026-05-23
6144	OTHER	Neonate Bwt 1500-1999g W Or Without Other Significant Condition	12	5	—	—	$47,539.71	$50,393.70	$47,539.71	2026-05-23
6313	OTHER	Neonate Birthwt >2499g W Other Major Procedure	12	5	—	—	$47,134.72	$49,964.40	$47,134.72	2026-05-23
1623	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	12	5	—	—	$46,960.60	$49,779.82	$46,960.60	2026-05-23
MS-955	OTHER	Craniotomy For Multiple Significant Trauma	38	7	—	—	$40,850.61	$106,240.26	$46,934.74	2026-05-23
J9226	OTHER	Supprelin La Implant	58	8	—	—	$42,826.77	$103,212.51	$46,927.20	2026-05-23
6254	OTHER	Neonate Bwt 2000-2499g W Other Significant Condition	12	5	—	—	$46,509.31	$49,301.44	$46,509.31	2026-05-23
1204	OTHER	Major Respiratory And Chest Procedures	12	5	—	—	$46,288.23	$49,067.09	$46,288.23	2026-05-23
MS-447	OTHER	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	38	7	—	—	$40,111.17	$96,547.68	$46,085.17	2026-05-23
2604	OTHER	Major Pancreas, Liver And Shunt Procedures	12	5	—	—	$45,916.51	$48,673.05	$45,916.51	2026-05-23
MS-268	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	38	7	—	—	$39,889.22	$97,804.26	$45,830.16	2026-05-23
K0864	OTHER	Pwc Gp3 Xhd Mult Pow Opt S/b	24	3	—	—	$1,135.46	$45,640.78	$45,640.78	2026-05-23
9124	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	12	5	—	—	$45,398.70	$48,124.16	$45,398.70	2026-05-23
0274	OTHER	Other Open Craniotomy	18	5	—	—	$41.20	$47,943.73	$45,228.49	2026-05-23
2324	OTHER	Gastric Fundoplication	12	5	—	—	$44,921.33	$47,618.13	$44,921.33	2026-05-23
6954	OTHER	Chemotherapy For Acute Leukemia	12	5	—	—	$44,700.25	$47,383.78	$44,700.25	2026-05-23
0266T	OTHER	Implt/rpl Crtd Sns Dev Total	38	7	—	—	$388.11	$98,072.29	$44,590.12	2026-05-23
0041	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	12	5	—	—	$44,470.69	$47,140.44	$44,470.69	2026-05-23
MS-207	OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	38	7	—	—	$38,690.31	$100,450.50	$44,452.70	2026-05-23
2204	OTHER	Major Stomach, Esophageal And Duodenal Procedures	12	5	—	—	$44,422.43	$47,089.28	$44,422.43	2026-05-23
MS-217	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	38	7	—	—	$38,634.68	$92,993.76	$44,388.78	2026-05-23
0234	OTHER	Spinal Procedures	12	5	—	—	$44,299.83	$46,959.32	$44,299.83	2026-05-23
1694	OTHER	Major Abdominal Vascular Procedures	12	5	—	—	$44,132.23	$46,781.65	$44,132.23	2026-05-23
1603	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	12	5	—	—	$43,610.51	$46,228.61	$43,610.51	2026-05-23
MS-969	OTHER	HIV With Extensive O.r. Procedures With Mcc	38	7	—	—	$37,835.41	$117,340.25	$43,470.47	2026-05-23
0204	OTHER	Open Craniotomy For Trauma	12	5	—	—	$43,228.35	$45,823.51	$43,228.35	2026-05-23
1783	OTHER	External Heart Assist Systems	12	5	—	—	$43,222.48	$45,817.29	$43,222.48	2026-05-23
L8685	OTHER	Implt Nrostm Pls Gen Sng Rec	18	3	—	—	$3,589.60	$43,196.87	$43,196.87	2026-05-23
L7180	OTHER	Electronic Elbow Sequential	40	7	—	—	$20,025.42	$94,936.59	$43,164.43	2026-05-23
9504	OTHER	Extensive Procedure Unrelated To Principal Diagnosis	12	5	—	—	$42,668.15	$45,229.69	$42,668.15	2026-05-23
0011	OTHER	Liver Transplant And/or Intestinal Transplant	12	5	—	—	$42,610.11	$45,168.16	$42,610.11	2026-05-23
MS-276	OTHER	Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator	38	7	—	—	$37,058.28	$94,767.31	$42,577.59	2026-05-23
MS-317	OTHER	Concomitant Left Atrial Appendage Closure And Cardiac Ablation	38	7	—	—	$37,010.41	$109,863.30	$42,522.60	2026-05-23
MS-928	OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	38	7	—	—	$33,375.18	$96,176.16	$42,507.25	2026-05-23
MS-573	OTHER	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	38	7	—	—	$36,841.71	$104,002.50	$42,328.77	2026-05-23
MS-461	OTHER	Bilateral Or Multiple Major Joint Procs Of Lower Extremity W Mcc	38	7	—	—	$36,713.08	$113,450.82	$42,180.99	2026-05-23
MS-232	OTHER	Coronary Bypass With Ptca Without Mcc	38	7	—	—	$36,545.57	$87,965.28	$41,988.53	2026-05-23
MS-028	OTHER	Spinal Procedures With Mcc	38	7	—	—	$36,370.88	$87,544.80	$41,787.82	2026-05-23
6072	OTHER	Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom	12	5	—	—	$41,677.54	$44,179.60	$41,677.54	2026-05-23
4403	OTHER	Kidney Transplant	12	5	—	—	$41,631.24	$44,130.52	$41,631.24	2026-05-23
0924	OTHER	Facial Bone Procedures Except Major Cranial/facial Bone Procedures	12	5	—	—	$41,606.45	$44,104.25	$41,606.45	2026-05-23
1782	OTHER	External Heart Assist Systems	12	5	—	—	$41,549.72	$44,044.11	$41,549.72	2026-05-23
MS-016	OTHER	Autologous Bone Marrow Transplant With Cc/mcc	38	7	—	—	$36,110.04	$86,916.96	$41,488.13	2026-05-23
MS-266	OTHER	Endovascular Cardiac Valve Replacement W Mcc	38	7	—	—	$35,840.23	$86,267.52	$41,178.14	2026-05-23
6083	OTHER	Neonate Bwt 1250-1499g W Or Without Other Significant Condition	12	5	—	—	$41,010.39	$43,472.40	$41,010.39	2026-05-23
MS-218	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	38	7	—	—	$35,591.95	$85,669.92	$40,892.88	2026-05-23
MS-790	OTHER	Extreme Immaturity Or Respiratory Distress Syndrome- Neonate	38	7	—	—	$35,565.03	$115,883.93	$40,861.95	2026-05-23
6113	OTHER	Neonate Birthwt 1500-1999g W Major Anomaly	12	5	—	—	$40,818.66	$43,269.16	$40,818.66	2026-05-23
4414	OTHER	Major Bladder Procedures	12	5	—	—	$40,567.58	$43,003.01	$40,567.58	2026-05-23
MS-235	OTHER	Coronary Bypass Without Cardiac Catheterization With Mcc	38	7	—	—	$35,202.49	$84,732.48	$40,445.41	2026-05-23
6133	OTHER	Neonate Birthwt 1500-1999g W Congenital/perinatal Infection	12	5	—	—	$40,287.16	$42,705.75	$40,287.16	2026-05-23
MS-017	OTHER	Autologous Bone Marrow Transplant Without Cc/mcc	38	7	—	—	$35,727.74	$86,916.96	$40,220.44	2026-05-23
0894	OTHER	Major Cranial/facial Bone Procedures	12	5	—	—	$40,176.29	$42,588.23	$40,176.29	2026-05-23
MS-820	OTHER	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	38	7	—	—	$34,832.17	$84,537.55	$40,019.94	2026-05-23
0061	OTHER	Pancreas Transplant	12	5	—	—	$39,906.95	$42,302.72	$39,906.95	2026-05-23
2614	OTHER	Major Biliary Tract Procedures	12	5	—	—	$39,800.65	$42,190.04	$39,800.65	2026-05-23
1764	OTHER	Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices	12	5	—	—	$39,506.53	$41,878.26	$39,506.53	2026-05-23
MS-457	OTHER	Spinal Fusion Except Cervical With Spinal Curvature- Malignancy- Infection Or Ex…	38	7	—	—	$34,336.22	$88,036.27	$39,450.12	2026-05-23
MS-023	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	38	7	—	—	$34,131.02	$82,153.44	$39,214.36	2026-05-23
6234	OTHER	Neonate Bwt 2000-2499g W Congenital/perinatal Infection	12	5	—	—	$39,185.68	$41,538.14	$39,185.68	2026-05-23
E0764	OTHER	Functional Neuromuscularstim	22	3	—	—	$812.36	$39,134.19	$39,134.19	2026-05-23
1633	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	12	5	—	—	$39,076.12	$41,422.00	$39,076.12	2026-05-23
1304	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	12	5	—	—	$38,998.51	$41,339.74	$38,998.51	2026-05-23
L2006	OTHER	Kaf Sng/dbl Swg/stn Mcpr Cus	38	7	—	—	$18,218.03	$85,696.03	$38,963.06	2026-05-23
5144	OTHER	Female Reproductive System Reconstructive Procedures	12	5	—	—	$38,707.65	$41,031.42	$38,707.65	2026-05-23
7924	OTHER	Extensive Or Procedures For Other Complications Of Treatment	12	5	—	—	$38,628.09	$40,947.08	$38,628.09	2026-05-23
5104	OTHER	Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced…	12	5	—	—	$38,554.40	$40,868.96	$38,554.40	2026-05-23
0052	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	12	5	—	—	$38,529.62	$40,842.70	$38,529.62	2026-05-23
1814	OTHER	Lower Extremity Arterial Procedures	12	5	—	—	$38,417.45	$40,723.79	$38,417.45	2026-05-23
MS-653	OTHER	Major Bladder Procedures With Mcc	38	7	—	—	$33,350.29	$97,289.23	$38,317.36	2026-05-23
1653	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	12	5	—	—	$38,270.06	$40,567.56	$38,270.06	2026-05-23
6514	OTHER	Other Procedures Of Blood And Blood-forming Organs	12	5	—	—	$38,228.97	$40,524.01	$38,228.97	2026-05-23
MS-834	OTHER	Acute Leukemia Without Major O.r. Procedures With Mcc	38	7	—	—	$33,067.32	$120,927.77	$37,992.24	2026-05-23
MS-021	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	38	7	—	—	$33,067.32	$103,167.78	$37,992.24	2026-05-23
8412	OTHER	Extensive Third Degree Burns With Skin Graft	12	5	—	—	$37,988.98	$40,269.61	$37,988.98	2026-05-23
8411	OTHER	Extensive Third Degree Burns With Skin Graft	12	5	—	—	$37,988.98	$40,269.61	$37,988.98	2026-05-23
0092	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	12	5	—	—	$37,933.55	$40,210.85	$37,933.55	2026-05-23
MS-428	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	38	7	—	—	$32,928.52	$79,259.04	$37,832.77	2026-05-23
20136362	OTHER	Revasc Intravasc Lithotripsy	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20136041	OTHER	Thrombectomy & Pta Dialys Circ	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20136404	OTHER	Revasc Lithotrip Tibi/perone	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20150665	OTHER	Perc Bms Revasc Byp Grft 1 Vsl	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20136024	OTHER	Stent Dialysis Circuit	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20150662	OTHER	Perc Coronary Bms Single	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20135588	OTHER	Vascular Stent Initial Vein Rt	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20135596	OTHER	Vascular Stent Initial Vein Lt	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20136446	OTHER	Venous Mech Thrombectomy	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20135547	OTHER	Vasc Stent Initial Artery Rt	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20135521	OTHER	Vasc Embol/occlu Hemorrhage Rt	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20135539	OTHER	Vasc Embol/occlu Hemorrhage Lt	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20135554	OTHER	Vasc Stent Initial Artery Lt	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20135513	OTHER	Vasc Embol/occ Tumor/infarc Lt	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20135505	OTHER	Vasc Embol/occ Tumor/infarc Rt	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20150587	OTHER	Prq Card Stent W/angio 1 Vsl	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20150616	OTHER	Perc Des Revasc Cabg 1 Vsl	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20135406	OTHER	Fem/popl Revasc W/stent Rt	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20135414	OTHER	Tib/per Revasc W/tla Rt	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20135463	OTHER	Vasc Emboliz/occlusion Vein Rt	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20135364	OTHER	Iliac Revasc W/stent Rt	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20135067	OTHER	Tib/per Revasc W/tla Lt	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20150668	OTHER	Perc Bms Revasc Tot Occl 1 Vsl	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20135018	OTHER	Iliac Revasc W/stent Lt	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20135471	OTHER	Vasc Emboliz/occlusion Vein Lt	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20150612	OTHER	Perc Coronary Des Single	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
20135059	OTHER	Fem/popl Revasc W/stent Lt	26	4	$137,292.00	$82,375.20 40% off	$36,931.55	$168,251.35	$37,755.30	2026-05-23
MS-430	OTHER	Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc	38	7	—	—	$32,727.51	$78,775.20	$37,601.82	2026-05-23
MS-008	OTHER	Simultaneous Pancreas/kidney Transplant	36	6	—	—	$32,551.62	$95,939.47	$37,572.88	2026-05-23
0224	OTHER	Ventricular Shunt Procedures	12	5	—	—	$37,390.96	$39,635.69	$37,390.96	2026-05-23
MS-405	OTHER	Pancreas- Liver And Shunt Procedures With Mcc	38	7	—	—	$32,477.44	$78,173.28	$37,314.51	2026-05-23
C1882	OTHER	Aicd- Other Than Sing/dual	4	2	—	—	$12,087.27	$62,480.31	$37,283.79	2026-05-23
MS-463	OTHER	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …	38	7	—	—	$32,311.72	$77,774.40	$37,124.11	2026-05-23
7584	OTHER	Behavioral Disorders	12	5	—	—	$37,089.67	$39,316.30	$37,089.67	2026-05-23
MS-011	OTHER	Tracheostomy For Facemouth & Neck Diagnoses W Mcc	38	7	—	—	$32,281.21	$77,700.96	$37,089.05	2026-05-23
MS-576	OTHER	Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc	38	7	—	—	$32,277.62	$97,200.43	$37,084.93	2026-05-23
0083	OTHER	Autologous Bone Marrow Transplant	12	5	—	—	$37,082.50	$39,308.70	$37,082.50	2026-05-23
3032	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	12	5	—	—	$36,981.41	$39,201.55	$36,981.41	2026-05-23
2644	OTHER	Other Hepatobiliary, Pancreas And Abdominal Procedures	12	5	—	—	$36,943.59	$39,161.45	$36,943.59	2026-05-23
3634	OTHER	Breast Procedures Except Mastectomy	12	5	—	—	$36,804.68	$39,014.21	$36,804.68	2026-05-23
5114	OTHER	Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy	12	5	—	—	$36,736.21	$38,941.62	$36,736.21	2026-05-23
0264	OTHER	Other Nervous System And Related Procedures	12	5	—	—	$36,702.29	$38,905.67	$36,702.29	2026-05-23
1214	OTHER	Other Respiratory And Chest Procedures	12	5	—	—	$36,687.95	$38,890.46	$36,687.95	2026-05-23
4044	OTHER	Thyroid, Parathyroid And Thyroglossal Procedures	12	5	—	—	$36,658.60	$38,859.36	$36,658.60	2026-05-23
3214	OTHER	Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures	12	5	—	—	$36,629.25	$38,828.25	$36,629.25	2026-05-23
2304	OTHER	Major Small Bowel Procedures	12	5	—	—	$36,621.43	$38,819.95	$36,621.43	2026-05-23
MS-234	OTHER	Coronary Bypass With Cardiac Catheterization Without Mcc	38	7	—	—	$31,828.33	$76,610.88	$36,568.72	2026-05-23
K0863	OTHER	Pwc Gp3 Vhd Mult Pow Opt S/b	24	3	—	—	$954.17	$36,512.96	$36,512.96	2026-05-23
K0860	OTHER	Pwc Gp3 Vhd Sing Pow Opt S/b	24	3	—	—	$954.17	$36,512.96	$36,512.96	2026-05-23
MS-220	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	38	7	—	—	$31,687.74	$76,272.48	$36,407.20	2026-05-23
4402	OTHER	Kidney Transplant	12	5	—	—	$36,388.61	$38,573.16	$36,388.61	2026-05-23
6123	OTHER	Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond	12	5	—	—	$36,276.44	$38,454.25	$36,276.44	2026-05-23
0091	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	12	5	—	—	$36,037.75	$38,201.24	$36,037.75	2026-05-23
5184	OTHER	Other Female Reproductive System And Related Procedures	12	5	—	—	$35,916.45	$38,072.66	$35,916.45	2026-05-23
L8688	OTHER	Implt Nrostm Pls Gen Dua Non	18	3	—	—	$2,980.90	$35,870.59	$35,870.59	2026-05-23
E0766	OTHER	Elec Stim Cancer Treatment	8	2	—	—	$383.86	$84,394.32	$35,867.58	2026-05-23
0304	OTHER	Percutaneous Intracranial And Extracranial Vascular Procedures	12	5	—	—	$35,581.25	$37,717.33	$35,581.25	2026-05-23
1673	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	12	5	—	—	$35,424.73	$37,551.42	$35,424.73	2026-05-23
MS-450	OTHER	Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically …	38	7	—	—	$30,810.70	$74,161.44	$35,399.53	2026-05-23
L8701	OTHER	Ewh S/d Uprt Micro Sensor	34	7	—	—	$32,227.37	$77,667.97	$35,312.97	2026-05-23
MS-270	OTHER	Other Major Cardiovascular Procedures With Mcc	38	7	—	—	$30,708.40	$73,915.20	$35,281.99	2026-05-23

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