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

CHESTER COUNTY HOSPITAL

West Chester, PA · CCN 390179 · Rates published

9,141 distinct procedures filed
63 distinct payers
609,413 rate rows
2026-05-08 last MRF observed
Data quality

592,174 of 609,413 rate rows are consumer-grade (97.2%)

17,239 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
template filing: same amount across many unrelated codes — excluded 13,643
placeholder amount (≤ $0.02) — excluded from medians 3,054
per-diem day rate — not a per-procedure price 515
exceeds 10× this hospital's gross charge — excluded from medians 27
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www1.pennmedicine.org/images/pricing/230469150_The-Chester-County-Hospital_standardcharges.csv
Found on page https://www.pennmedicine.org/patient-resources/policies/pricing-transparency
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-16
Content fingerprint e2f2c479cfd291ba… · 492,834,959 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
0053037037J1411
OTHER 		Etranacogene Dezaparvovecdrlb 37 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053038038J1411
OTHER 		Etranacogene Dezaparvovecdrlb 38 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053014014J1411
OTHER 		Etranacogene Dezaparvovecdrlb 14 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053024024J1411
OTHER 		Etranacogene Dezaparvovecdrlb 24 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053013013J1411
OTHER 		Etranacogene Dezaparvovecdrlb 13 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053023023J1411
OTHER 		Etranacogene Dezaparvovecdrlb 23 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053048048J1411
OTHER 		Etranacogene Dezaparvovecdrlb 48 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053017017J1411
OTHER 		Etranacogene Dezaparvovecdrlb 17 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053046046J1411
OTHER 		Etranacogene Dezaparvovecdrlb 46 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053047047J1411
OTHER 		Etranacogene Dezaparvovecdrlb 47 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053012012J1411
OTHER 		Etranacogene Dezaparvovecdrlb 12 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053034034J1411
OTHER 		Etranacogene Dezaparvovecdrlb 34 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053022022J1411
OTHER 		Etranacogene Dezaparvovecdrlb 22 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053044044J1411
OTHER 		Etranacogene Dezaparvovecdrlb 44 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053042042J1411
OTHER 		Etranacogene Dezaparvovecdrlb 42 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053033033J1411
OTHER 		Etranacogene Dezaparvovecdrlb 33 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053040040J1411
OTHER 		Etranacogene Dezaparvovecdrlb 40 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053036036J1411
OTHER 		Etranacogene Dezaparvovecdrlb 36 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053043043J1411
OTHER 		Etranacogene Dezaparvovecdrlb 43 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053031031J1411
OTHER 		Etranacogene Dezaparvovecdrlb 31 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053026026J1411
OTHER 		Etranacogene Dezaparvovecdrlb 26 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053039039J1411
OTHER 		Etranacogene Dezaparvovecdrlb 39 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053030030J1411
OTHER 		Etranacogene Dezaparvovecdrlb 30 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053045045J1411
OTHER 		Etranacogene Dezaparvovecdrlb 45 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053020020J1411
OTHER 		Etranacogene Dezaparvovecdrlb 20 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053032032J1411
OTHER 		Etranacogene Dezaparvovecdrlb 32 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053015015J1411
OTHER 		Etranacogene Dezaparvovecdrlb 15 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053016016J1411
OTHER 		Etranacogene Dezaparvovecdrlb 16 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053028028J1411
OTHER 		Etranacogene Dezaparvovecdrlb 28 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053029029J1411
OTHER 		Etranacogene Dezaparvovecdrlb 29 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053018018J1411
OTHER 		Etranacogene Dezaparvovecdrlb 18 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053021021J1411
OTHER 		Etranacogene Dezaparvovecdrlb 21 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053025025J1411
OTHER 		Etranacogene Dezaparvovecdrlb 25 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053010010J1411
OTHER 		Etranacogene Dezaparvovecdrlb 10 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053041041J1411
OTHER 		Etranacogene Dezaparvovecdrlb 41 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053011011J1411
OTHER 		Etranacogene Dezaparvovecdrlb 11 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053027027J1411
OTHER 		Etranacogene Dezaparvovecdrlb 27 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053035035J1411
OTHER 		Etranacogene Dezaparvovecdrlb 35 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
0053019019J1411
OTHER 		Etranacogene Dezaparvovecdrlb 19 X 10 Ml IV Supk 51 $1,300.00 $4,569,730.67 $2,800,000.00 nat. median
$2,800,000
1.0× median
30230G2
OTHER 		Bmt Allogeneic Related 1 $413,418.76 $413,418.76 $413,418.76 nat. median
$212,688
1.9× median
30230G3
OTHER 		Bmt Allogeneic Unrelated 1 $413,418.76 $413,418.76 $413,418.76 nat. median
$259,794
1.6× median
30230AZ
OTHER 		Bmt Allogeneic Related 1 $413,418.76 $413,418.76 $413,418.76 nat. median
$265,174
1.6× median
30230G4
OTHER 		Bmt Allogeneic Related 1 $413,418.76 $413,418.76 $413,418.76 nat. median
$265,174
1.6× median
30230X4
OTHER 		Bmt Allogeneic Related 1 $413,418.76 $413,418.76 $413,418.76 nat. median
$301,078
1.4× median
30230Y3
OTHER 		Bmt Allogeneic Unrelated 1 $413,418.76 $413,418.76 $413,418.76 nat. median
$255,150
1.6× median
30230X2
OTHER 		Bmt Allogeneic Related 1 $413,418.76 $413,418.76 $413,418.76 nat. median
$222,600
1.9× median
30230X3
OTHER 		Bmt Allogeneic Unrelated 1 $413,418.76 $413,418.76 $413,418.76 nat. median
$270,000
1.5× median
30230Y2
OTHER 		Bmt Allogeneic Related 1 $413,418.76 $413,418.76 $413,418.76 nat. median
$212,688
1.9× median
30230Y4
OTHER 		Bmt Allogeneic Related 1 $413,418.76 $413,418.76 $413,418.76 nat. median
$265,174
1.6× median
30233G2
OTHER 		Bmt Allogeneic Related 1 $413,418.76 $413,418.76 $413,418.76 nat. median
$212,688
1.9× median

Other procedures at this hospital

Browse this hospital's 9,141 published procedures. Use the slice to choose what to show, then sort or filter any column.

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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
             
0002840001J3110 OTHER Teriparatide 600 Mcg/2.4ml Sc Sopn 63 52 $15,444.00 $15,444.00 $47.34 $15,444.00 $10,162.15 2026-05-08
0009722401J7504 OTHER Lymphocyteantithymo Imm Glob 50 Mg/ml IV Soln 73 59 $17,354.00 $17,354.00 $1,300.00 $17,354.00 $6,594.52 2026-05-08
0009722402J7504 OTHER Lymphocyteantithymo Imm Glob 50 Mg/ml IV Soln 73 59 $15,090.00 $15,090.00 $1,300.00 $16,834.10 $6,546.02 2026-05-08
0053010010J1411 OTHER Etranacogene Dezaparvovecdrlb 10 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053011011J1411 OTHER Etranacogene Dezaparvovecdrlb 11 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053012012J1411 OTHER Etranacogene Dezaparvovecdrlb 12 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053013013J1411 OTHER Etranacogene Dezaparvovecdrlb 13 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053014014J1411 OTHER Etranacogene Dezaparvovecdrlb 14 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053015015J1411 OTHER Etranacogene Dezaparvovecdrlb 15 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053016016J1411 OTHER Etranacogene Dezaparvovecdrlb 16 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053017017J1411 OTHER Etranacogene Dezaparvovecdrlb 17 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053018018J1411 OTHER Etranacogene Dezaparvovecdrlb 18 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053019019J1411 OTHER Etranacogene Dezaparvovecdrlb 19 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053020020J1411 OTHER Etranacogene Dezaparvovecdrlb 20 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053021021J1411 OTHER Etranacogene Dezaparvovecdrlb 21 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053022022J1411 OTHER Etranacogene Dezaparvovecdrlb 22 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053023023J1411 OTHER Etranacogene Dezaparvovecdrlb 23 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053024024J1411 OTHER Etranacogene Dezaparvovecdrlb 24 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053025025J1411 OTHER Etranacogene Dezaparvovecdrlb 25 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053026026J1411 OTHER Etranacogene Dezaparvovecdrlb 26 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053027027J1411 OTHER Etranacogene Dezaparvovecdrlb 27 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053028028J1411 OTHER Etranacogene Dezaparvovecdrlb 28 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053029029J1411 OTHER Etranacogene Dezaparvovecdrlb 29 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053030030J1411 OTHER Etranacogene Dezaparvovecdrlb 30 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053031031J1411 OTHER Etranacogene Dezaparvovecdrlb 31 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053032032J1411 OTHER Etranacogene Dezaparvovecdrlb 32 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053033033J1411 OTHER Etranacogene Dezaparvovecdrlb 33 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053034034J1411 OTHER Etranacogene Dezaparvovecdrlb 34 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053035035J1411 OTHER Etranacogene Dezaparvovecdrlb 35 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053036036J1411 OTHER Etranacogene Dezaparvovecdrlb 36 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053037037J1411 OTHER Etranacogene Dezaparvovecdrlb 37 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053038038J1411 OTHER Etranacogene Dezaparvovecdrlb 38 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053039039J1411 OTHER Etranacogene Dezaparvovecdrlb 39 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053040040J1411 OTHER Etranacogene Dezaparvovecdrlb 40 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053041041J1411 OTHER Etranacogene Dezaparvovecdrlb 41 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053042042J1411 OTHER Etranacogene Dezaparvovecdrlb 42 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053043043J1411 OTHER Etranacogene Dezaparvovecdrlb 43 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053044044J1411 OTHER Etranacogene Dezaparvovecdrlb 44 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053045045J1411 OTHER Etranacogene Dezaparvovecdrlb 45 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053046046J1411 OTHER Etranacogene Dezaparvovecdrlb 46 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053047047J1411 OTHER Etranacogene Dezaparvovecdrlb 47 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0053048048J1411 OTHER Etranacogene Dezaparvovecdrlb 48 X 10 Ml IV Supk 63 51 $3,500,000.00 $3,500,000.00 $1,300.00 $4,569,730.67 $2,800,000.00 2026-05-08
0074210001C9399 OTHER Risankizumabrzaa 150 Mg/ml Sc Soaj 65 53 $75,663.00 $75,663.00 $1,300.00 $75,663.00 $49,180.95 2026-05-08
0074379902J0135 OTHER Adalimumab 40 Mg/0.8ml Sc Pskt 63 52 $12,461.00 $12,461.00 $1,300.00 $12,461.00 $8,099.65 2026-05-08
0074433902J0135 OTHER Adalimumab 40 Mg/0.8ml Sc Ajkt 63 52 $12,461.00 $12,461.00 $1,300.00 $12,461.00 $8,099.65 2026-05-08
0078063941C9399 OTHER Secukinumab (300 Mg Dose) 150 Mg/ml Sc Soaj 65 53 $13,337.00 $13,337.00 $1,300.00 $13,337.00 $8,775.75 2026-05-08
0078063968C9399 OTHER Secukinumab 150 Mg/ml Sc Soaj 65 53 $26,673.00 $26,673.00 $1,300.00 $26,673.00 $17,550.83 2026-05-08
0078063997C9399 OTHER Secukinumab 150 Mg/ml Sc Sosy 65 53 $26,673.00 $26,673.00 $1,300.00 $26,673.00 $17,550.83 2026-05-08
0078063998C9399 OTHER Secukinumab (300 Mg Dose) 150 Mg/ml Sc Sosy 65 53 $13,337.00 $13,337.00 $1,300.00 $13,337.00 $8,775.75 2026-05-08
02YA0Z0 OTHER Heart Transplant 2 2 — — $67,836.00 $555,165.86 $311,500.93 2026-05-08
02YA0Z1 OTHER Heart Transplant 2 2 — — $67,836.00 $555,165.86 $311,500.93 2026-05-08
02YA0Z2 OTHER Heart Transplant 2 2 — — $67,836.00 $555,165.86 $311,500.93 2026-05-08
0BYC0Z0 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYC0Z1 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYC0Z2 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYD0Z0 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYD0Z1 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYD0Z2 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYF0Z0 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYF0Z1 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYF0Z2 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYG0Z0 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYG0Z1 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYG0Z2 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYH0Z0 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYH0Z1 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYH0Z2 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYJ0Z0 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYJ0Z1 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYJ0Z2 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYK0Z0 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYK0Z1 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYK0Z2 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYL0Z0 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYL0Z1 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYL0Z2 OTHER Lung Trans (Single) 2 2 — — $43,762.00 $579,111.87 $311,436.93 2026-05-08
0BYM0Z0 OTHER Lung Trans (Double) 2 2 — — $43,762.00 $626,359.50 $335,060.75 2026-05-08
0BYM0Z1 OTHER Lung Trans (Double) 2 2 — — $43,762.00 $626,359.50 $335,060.75 2026-05-08
0BYM0Z2 OTHER Lung Trans (Double) 2 2 — — $43,762.00 $626,359.50 $335,060.75 2026-05-08
0FY00Z0 OTHER Liver Transplant 1 1 — — $60,256.00 $60,256.00 $60,256.00 2026-05-08
0FY00Z1 OTHER Liver Transplant 1 1 — — $60,256.00 $60,256.00 $60,256.00 2026-05-08
0FY00Z2 OTHER Liver Transplant 1 1 — — $60,256.00 $60,256.00 $60,256.00 2026-05-08
0FYG0Z0 OTHER Pancreas Transplant 1 1 — — $41,043.00 $41,043.00 $41,043.00 2026-05-08
0FYG0Z1 OTHER Pancreas Transplant 1 1 — — $41,043.00 $41,043.00 $41,043.00 2026-05-08
0FYG0Z2 OTHER Pancreas Transplant 1 1 — — $41,043.00 $41,043.00 $41,043.00 2026-05-08
17300003 OTHER Hc Newborn Level Iii Transitional Cch 1 42 40 $10,514.00 $10,514.00 $1,008.39 $10,514.00 $10,514.00 2026-05-08
17400003 OTHER Hc Newborn Level IV ICU Cch 1 42 40 $12,607.00 $12,607.00 $1,008.39 $12,607.00 $12,607.00 2026-05-08
20000005 OTHER Hc Intensive Care General Cch1 48 43 $7,115.00 $7,115.00 $1,008.39 $7,115.00 $7,115.00 2026-05-08
20300000 OTHER Hc Intensive Care Pediatric Cch 1 48 43 $7,115.00 $7,115.00 $1,008.39 $7,115.00 $7,115.00 2026-05-08
21000002 OTHER Hc Coronary Care General Cch 1 48 43 $7,115.00 $7,115.00 $1,008.39 $7,115.00 $7,115.00 2026-05-08
2420140002J0630 OTHER Calcitonin (salmon) 200 Unit/ml Injection Soln 63 52 $11,272.00 $11,272.00 $816.00 $11,272.00 $7,416.98 2026-05-08
2420841601J7311 OTHER Fluocinolone Acetonide 0.59 Mg Intravitreal Impl 73 59 $68,490.00 $68,490.00 $338.94 $68,490.00 $18,492.30 2026-05-08
2535702501J2787 OTHER Riboflav5 Riboflav5dextran 0.146 0.14620 Opht 63 52 $16,416.00 $16,416.00 $1,300.00 $16,416.00 $10,670.40 2026-05-08
2535702503J2787 OTHER Riboflav5 Riboflav5dextran 0.146 0.14620 Opht 63 52 $16,416.00 $16,416.00 $1,300.00 $16,416.00 $10,670.40 2026-05-08
2568200101J1300 OTHER Eculizumab 300 Mg/30ml IV Soln 63 52 $23,483.00 $23,483.00 $1,300.00 $23,483.00 $15,263.95 2026-05-08
2568200701J2840 OTHER Sebelipase Alfa 20 Mg/10ml IV Soln 73 59 $36,756.00 $36,756.00 $520.71 $36,756.00 $7,351.20 2026-05-08
27800015 OTHER Hc Y-90 Spheres 71 58 $38,588.00 $38,588.00 $1,300.00 $56,360.76 $18,837.27 2026-05-08
27800213 OTHER Hc Covered Stent Lev 12 61 51 $10,087.00 $10,087.00 $1,300.00 $10,087.00 $6,556.55 2026-05-08
27800214 OTHER Hc Covered Stent Lev 13 61 51 $10,941.00 $10,941.00 $1,300.00 $10,941.00 $7,111.65 2026-05-08
27800215 OTHER Hc Covered Stent Lev 14 61 51 $11,792.00 $11,792.00 $1,300.00 $11,792.00 $7,664.80 2026-05-08
27800216 OTHER Hc Covered Stent Lev 15 61 51 $12,642.00 $12,642.00 $1,300.00 $12,642.00 $8,217.30 2026-05-08
27800236 OTHER Hc Icd Single Chamber Lev5 Bs 61 51 $39,772.00 $39,772.00 $1,300.00 $39,772.00 $25,851.80 2026-05-08
27800237 OTHER Hc Icd Single Chamber Lev7 Bs 61 51 $43,654.00 $43,654.00 $1,300.00 $43,654.00 $28,375.10 2026-05-08
27800238 OTHER Hc Icd Single Chamber Lev10 Bs 61 51 $49,474.00 $49,474.00 $1,300.00 $49,474.00 $32,158.10 2026-05-08
27800239 OTHER Hc Icd Single Chamber Lev 4 Sj 61 51 $43,654.00 $43,654.00 $1,300.00 $43,654.00 $28,375.10 2026-05-08
27800240 OTHER Hc Icd Single Chamber Lev9 Sj 61 51 $47,533.00 $47,533.00 $1,300.00 $47,533.00 $30,896.45 2026-05-08
27800241 OTHER Hc Icd Single Chamber Lev10 Sj 61 51 $49,474.00 $49,474.00 $1,300.00 $49,474.00 $32,158.10 2026-05-08
27800242 OTHER Hc Icd Single Chamber Lev11 Sj 61 51 $51,413.00 $51,413.00 $1,300.00 $51,413.00 $33,418.45 2026-05-08
27800243 OTHER Hc Icd Single Chamber Lev12 Sj 61 51 $53,817.00 $53,817.00 $1,300.00 $53,817.00 $34,981.05 2026-05-08
27800244 OTHER Hc Icd Dual Chamber Lev4 Bs 61 51 $45,594.00 $45,594.00 $1,300.00 $45,594.00 $29,636.10 2026-05-08
27800245 OTHER Hc Icd Dual Chamber Lev5 Bs 61 51 $47,533.00 $47,533.00 $1,300.00 $47,533.00 $30,896.45 2026-05-08
27800246 OTHER Hc Icd Dual Chamber Lev9 Bs 61 51 $55,293.00 $55,293.00 $1,300.00 $55,293.00 $35,940.45 2026-05-08
27800248 OTHER Hc Icd Dual Chamber Lev7 Sj 61 51 $51,413.00 $51,413.00 $1,300.00 $51,413.00 $33,418.45 2026-05-08
27800249 OTHER Hc Icd Dual Chamber Lev10 Sj 61 51 $57,234.00 $57,234.00 $1,300.00 $57,234.00 $37,202.10 2026-05-08
27800250 OTHER Hc Icd Dual Chamber Lev11 Sj 61 51 $59,175.00 $59,175.00 $1,300.00 $59,175.00 $38,463.75 2026-05-08
27800251 OTHER Hc Icd Dual Chamber Lev13 Sj 61 51 $63,056.00 $63,056.00 $1,300.00 $63,056.00 $40,986.40 2026-05-08
27800252 OTHER Hc Crt Defibrillator Lev4 Bs 61 51 $64,997.00 $64,997.00 $1,300.00 $64,997.00 $42,248.05 2026-05-08
27800253 OTHER Hc Crt Defibrillator Lev7 Bs 61 51 $70,811.00 $70,811.00 $1,300.00 $70,811.00 $46,027.15 2026-05-08
27800254 OTHER Hc Crt Defibrillator Lev8 Bs 61 51 $72,752.00 $72,752.00 $1,300.00 $72,752.00 $47,288.80 2026-05-08
27800255 OTHER Hc Crt Defibrillator Lev1 Sj 61 51 $59,175.00 $59,175.00 $1,300.00 $59,175.00 $38,463.75 2026-05-08
27800256 OTHER Hc Crt Defibrillator Lev4 Sj 61 51 $64,997.00 $64,997.00 $1,300.00 $64,997.00 $42,248.05 2026-05-08
27800257 OTHER Hc Crt Defibrillator Lev7 Sj 61 51 $70,811.00 $70,811.00 $1,300.00 $70,811.00 $46,027.15 2026-05-08
27800258 OTHER Hc Crt Defibrillator Lev 8 Sj 61 51 $72,752.00 $72,752.00 $1,300.00 $72,752.00 $47,288.80 2026-05-08
27800260 OTHER Hc Crt Defibrillator Lev11 Sj 61 51 $78,569.00 $78,569.00 $1,300.00 $78,569.00 $51,069.85 2026-05-08
27800261 OTHER Hc Crt Pacemaker Lev14 Bs 61 51 $26,680.00 $26,680.00 $1,300.00 $26,680.00 $17,342.00 2026-05-08
27800262 OTHER Hc Crt Pacemaker Lev9 Sj 61 51 $21,834.00 $21,834.00 $1,300.00 $21,834.00 $14,192.10 2026-05-08
27800263 OTHER Hc Crt Pacemaker Lev13 Sj 61 51 $25,713.00 $25,713.00 $1,300.00 $25,713.00 $16,713.45 2026-05-08
27800264 OTHER Hc Lead Rt Icd Dual Coil Lev11 Bs 61 51 $12,999.00 $12,999.00 $1,300.00 $12,999.00 $8,449.35 2026-05-08
27800265 OTHER Hc Lead Rt Icd Dual Coil Lev13bs 61 51 $13,775.00 $13,775.00 $1,300.00 $13,775.00 $8,953.75 2026-05-08
27800266 OTHER Hc Lead Rt Icd Dual Coil Lev17bs 61 51 $15,334.00 $15,334.00 $1,300.00 $15,334.00 $9,967.10 2026-05-08
27800267 OTHER Hc Lead Rt Icd Dual Coil Lev13 Sj 61 51 $13,775.00 $13,775.00 $1,300.00 $13,775.00 $8,953.75 2026-05-08
27800268 OTHER Hc Lead Rt Icd Dual Coil Lev16 Sj 61 51 $14,940.00 $14,940.00 $1,300.00 $14,940.00 $9,711.00 2026-05-08
27800274 OTHER Hc Lead Rt Icd Sngl Coil Lev11 Bs 61 51 $12,999.00 $12,999.00 $1,300.00 $12,999.00 $8,449.35 2026-05-08
27800275 OTHER Hc Lead Rt Icd Sngl Coil Lev17 Bs 61 51 $15,334.00 $15,334.00 $1,300.00 $15,334.00 $9,967.10 2026-05-08
27800276 OTHER Hc Lead Rt Icd Sngl Coil Lev13 Sj 61 51 $13,775.00 $13,775.00 $1,300.00 $13,775.00 $8,953.75 2026-05-08
27800277 OTHER Hc Lead Rt Icd Sngl Coil Lev16 Sj 61 51 $14,940.00 $14,940.00 $1,300.00 $14,940.00 $9,711.00 2026-05-08
27800278 OTHER Hc Icd Single Chamber Lev4 Mt 61 51 $37,831.00 $37,831.00 $1,300.00 $37,831.00 $24,590.15 2026-05-08
27800279 OTHER Hc Icd Single Chamber Lev6 Mt 61 51 $41,713.00 $41,713.00 $1,300.00 $41,713.00 $27,113.45 2026-05-08
27800280 OTHER Hc Icd Single Chamber Lev7 Mt 61 51 $43,654.00 $43,654.00 $1,300.00 $43,654.00 $28,375.10 2026-05-08
27800281 OTHER Hc Icd Single Chamber Lev8 Mt 61 51 $45,594.00 $45,594.00 $1,300.00 $45,594.00 $29,636.10 2026-05-08
27800282 OTHER Hc Icd Single Chamber Lev 10 Mt 61 51 $49,474.00 $49,474.00 $1,300.00 $49,474.00 $32,158.10 2026-05-08
27800283 OTHER Hc Icd Dual Chamber Lev8 Mt 61 51 $53,817.00 $53,817.00 $1,300.00 $53,817.00 $34,981.05 2026-05-08
27800284 OTHER Hc Icd Dual Chamber Lev10 Mt 61 51 $57,234.00 $57,234.00 $1,300.00 $57,234.00 $37,202.10 2026-05-08
27800285 OTHER Hc Icd Dual Chamber Lev11 Mt 61 51 $59,175.00 $59,175.00 $1,300.00 $59,175.00 $38,463.75 2026-05-08
27800286 OTHER Hc Crt Defibrillator Lev3 Mt 61 51 $63,056.00 $63,056.00 $1,300.00 $63,056.00 $40,986.40 2026-05-08
27800287 OTHER Hc Crt Defibrillator Lev5 Mt 61 51 $66,933.00 $66,933.00 $1,300.00 $66,933.00 $43,506.45 2026-05-08
27800288 OTHER Hc Crt Defibrillator Lev6 Mt 61 51 $68,874.00 $68,874.00 $1,300.00 $68,874.00 $44,768.10 2026-05-08
27800289 OTHER Hc Crt Defibrillator Lev7 Mt 61 51 $70,811.00 $70,811.00 $1,300.00 $70,811.00 $46,027.15 2026-05-08
27800290 OTHER Hc Crt Defibrillator Lev 1c Sj 61 51 $53,355.00 $53,355.00 $1,300.00 $53,355.00 $34,680.75 2026-05-08
27800291 OTHER Hc Crt Pacemaker Lev14 Mt 61 51 $26,680.00 $26,680.00 $1,300.00 $26,680.00 $17,342.00 2026-05-08
27800292 OTHER Hc Crt Pacemaker Lev15 Mt 61 51 $27,656.00 $27,656.00 $1,300.00 $27,656.00 $17,976.40 2026-05-08
27800293 OTHER Hc Lead Rt Icd Dual Coil Lev18 Mt 61 51 $15,715.00 $15,715.00 $1,300.00 $15,715.00 $10,214.75 2026-05-08
27800294 OTHER Hc Lead Rt Icd Dual Coil Lev19mt 61 51 $16,105.00 $16,105.00 $1,300.00 $16,105.00 $10,468.25 2026-05-08
27800298 OTHER Hc Lead Left Ventr Lev35 Sj 61 51 $12,514.00 $12,514.00 $1,300.00 $12,514.00 $8,134.10 2026-05-08
27800299 OTHER Hc Lead Right Icd Lev23 Mt 61 51 $17,656.00 $17,656.00 $1,300.00 $17,656.00 $11,476.40 2026-05-08
27800300 OTHER Hc Lead Right Icd Lev25 Mt 61 51 $18,433.00 $18,433.00 $1,300.00 $18,433.00 $11,981.45 2026-05-08
27800301 OTHER Hc Lead Right Icd Lev26 Mt 61 51 $18,822.00 $18,822.00 $1,300.00 $18,822.00 $12,234.30 2026-05-08
27800302 OTHER Hc Lead Left Ventr Lev25 Mt 61 51 $10,579.00 $10,579.00 $1,300.00 $10,579.00 $6,876.35 2026-05-08
27800303 OTHER Hc Icd Single Chamber Lev5 Bk 61 51 $39,772.00 $39,772.00 $1,300.00 $39,772.00 $25,851.80 2026-05-08
27800304 OTHER Hc Icd Dual Chamber Lev3 Bk 61 51 $43,654.00 $43,654.00 $1,300.00 $43,654.00 $28,375.10 2026-05-08
27800305 OTHER Hc Crt Defibrillator Lev1 Bk 61 51 $59,175.00 $59,175.00 $1,300.00 $59,175.00 $38,463.75 2026-05-08
27800306 OTHER Hc Crt Pacemaker Lev11 Bk 61 51 $23,781.00 $23,781.00 $1,300.00 $23,781.00 $15,457.65 2026-05-08
27800307 OTHER Hc Crt Pacemaker Lev12 Bk 61 51 $24,749.00 $24,749.00 $1,300.00 $24,749.00 $16,086.85 2026-05-08
27800308 OTHER Hc Lead Rt Icd Dual Coil Lev5 Bk 61 51 $10,673.00 $10,673.00 $1,300.00 $10,673.00 $6,937.45 2026-05-08
27800334 OTHER Hc Crt Defibrillator Lev 8 Mt 61 51 $72,754.00 $72,754.00 $1,300.00 $72,754.00 $47,290.10 2026-05-08
27800335 OTHER Hc Crt Defibrillator Lev1d Bk 61 51 $51,413.00 $51,413.00 $1,300.00 $51,413.00 $33,418.45 2026-05-08
27800336 OTHER Hc Crt Pacemaker Lev 11 Sj 61 51 $23,781.00 $23,781.00 $1,300.00 $23,781.00 $15,457.65 2026-05-08
27800338 OTHER Hc Lead Left Ventr Lev 22 Bs 61 51 $9,999.00 $9,999.00 $1,300.00 $9,999.00 $6,499.35 2026-05-08
27800339 OTHER Hc Lead Rt Icd Sngl Coil Lev3 Bk 61 51 $9,901.00 $9,901.00 $1,300.00 $9,901.00 $6,435.65 2026-05-08
27800374 OTHER Hc Aaa Bifurcated Main Body Lvl 47 61 51 $27,236.00 $27,236.00 $1,300.00 $27,236.00 $17,703.40 2026-05-08
27800375 OTHER Hc Aaa Bifurcated Main Body Lvl 48 61 51 $28,888.00 $28,888.00 $1,300.00 $28,888.00 $18,777.20 2026-05-08
27800376 OTHER Hc Aaa Bifurcated Main Body Lvl 49 61 51 $30,533.00 $30,533.00 $1,300.00 $30,533.00 $19,846.45 2026-05-08
27800377 OTHER Hc Aaa Bifurcated Main Body Lvl 50 61 51 $32,186.00 $32,186.00 $1,300.00 $32,186.00 $20,920.90 2026-05-08
27800378 OTHER Hc Aaa Bifurcated Main Body Lvl 51 61 51 $33,840.00 $33,840.00 $1,300.00 $33,840.00 $21,996.00 2026-05-08
27800379 OTHER Hc Aaa Bifurcated Main Body Lvl 52 61 51 $35,487.00 $35,487.00 $1,300.00 $35,487.00 $23,066.55 2026-05-08
27800380 OTHER Hc Aaa Bifurcated Main Body Lvl 53 61 51 $37,140.00 $37,140.00 $1,300.00 $37,140.00 $24,141.00 2026-05-08
27800381 OTHER Hc Aaa Illiac Leg Lev 38 61 51 $12,382.00 $12,382.00 $1,300.00 $12,382.00 $8,048.30 2026-05-08
27800382 OTHER Hc Aaa Illiac Leg Lev 39 61 51 $14,035.00 $14,035.00 $1,300.00 $14,035.00 $9,122.75 2026-05-08
27800387 OTHER Hc Aaa Extension Lev 37 61 51 $10,729.00 $10,729.00 $1,300.00 $10,729.00 $6,973.85 2026-05-08
27800388 OTHER Hc Aaa Extension Lev 38 61 51 $12,382.00 $12,382.00 $1,300.00 $12,382.00 $8,048.30 2026-05-08
27800390 OTHER Hc Aaa Bifurcated Main Body Lvl 54 61 51 $38,790.00 $38,790.00 $1,300.00 $38,790.00 $25,213.50 2026-05-08
27800399 OTHER Hc Crt Defibrillator Lev 1 Bs 61 51 $60,307.00 $60,307.00 $1,300.00 $60,307.00 $39,199.55 2026-05-08
27800400 OTHER Hc Icd Dual Chamber Lev 2 Bs 61 51 $42,512.00 $42,512.00 $1,300.00 $42,512.00 $27,632.80 2026-05-08
27800401 OTHER Hc Micra Pacemaker Single Chamber 61 51 $19,601.00 $19,601.00 $1,300.00 $19,601.00 $12,740.65 2026-05-08
30002675 OTHER Hc Prolaris 62 51 $9,626.00 $9,626.00 $177.17 $9,626.00 $7,700.80 2026-05-08
30002676 OTHER Hc Genome Dx Decipher 62 51 $14,497.00 $14,497.00 $177.17 $14,497.00 $11,597.60 2026-05-08
30002677 OTHER Hc Confirm Mdx For Prostate Cancer 62 51 $9,291.00 $9,291.00 $177.17 $9,291.00 $7,432.80 2026-05-08
30230AZ OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30230G2 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30230G3 OTHER Bmt Allogeneic Unrelated 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30230G4 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30230X2 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30230X3 OTHER Bmt Allogeneic Unrelated 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30230X4 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30230Y2 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30230Y3 OTHER Bmt Allogeneic Unrelated 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30230Y4 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30233G2 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30233G3 OTHER Bmt Allogeneic Unrelated 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30233G4 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30233X2 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30233X3 OTHER Bmt Allogeneic Unrelated 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30233X4 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30233Y2 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30233Y3 OTHER Bmt Allogeneic Unrelated 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30233Y4 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30240G2 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30240G3 OTHER Bmt Allogeneic Unrelated 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30240G4 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30240X2 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30240X3 OTHER Bmt Allogeneic Unrelated 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30240X4 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30240Y2 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30240Y3 OTHER Bmt Allogeneic Unrelated 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30240Y4 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30243G2 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30243G3 OTHER Bmt Allogeneic Unrelated 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30243G4 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30243X2 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30243X3 OTHER Bmt Allogeneic Unrelated 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30243X4 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30243Y2 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30243Y3 OTHER Bmt Allogeneic Unrelated 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30243Y4 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30250G1 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30250X1 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30250Y1 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30253G1 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30253X1 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30253Y1 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30260G1 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30260X1 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30260Y1 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30263G1 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30263X1 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
30263Y1 OTHER Bmt Allogeneic Related 1 1 — — $413,418.76 $413,418.76 $413,418.76 2026-05-08
32000213 OTHER Hc Perq Plmt Bile Duct Stent Exst 76 61 $7,321.00 $7,321.00 $343.69 $19,697.96 $6,262.62 2026-05-08
32000215 OTHER Hc Perq Plmt Bile Duct Stent New Acs With Drnge 76 61 $7,321.00 $7,321.00 $554.85 $19,697.96 $6,262.62 2026-05-08
32000216 OTHER Hc Plmt Access Bil Tree Sm Bwl 76 61 $7,905.00 $7,905.00 $295.09 $21,093.49 $6,650.95 2026-05-08
32000302 OTHER Hc Thrmbc/nfs Dialysis Circuit W/angioplasty 76 61 $36,353.00 $36,353.00 $449.96 $37,614.12 $12,512.34 2026-05-08
32000307 OTHER Hc Trluml Balo Angiop Addl Vein 65 55 $13,507.00 $13,507.00 $123.10 $13,507.00 $7,552.50 2026-05-08
33300060 OTHER Hc Respirator Motion Mgmt Simul 62 53 $10,910.00 $10,910.00 $242.07 $10,910.00 $7,091.50 2026-05-08
36000014 OTHER Hc Vasc Embolize/occlude Artery 76 61 $25,273.00 $25,273.00 $523.44 $59,729.49 $18,927.36 2026-05-08
36000031 OTHER Hc Mechan. Thrombectomy Venous 76 61 $7,532.00 $7,532.00 $776.00 $37,614.12 $7,532.00 2026-05-08
36000048 OTHER Hc Vasc Embolize/occlude Venous 76 61 $21,880.00 $21,880.00 $468.76 $37,614.12 $12,215.84 2026-05-08
36000049 OTHER Hc Vasc Embolize/occlude Organ 76 61 $21,775.00 $21,775.00 $624.13 $37,614.12 $12,215.84 2026-05-08
36000050 OTHER Hc Vasc Embolize/occlude Bleed 76 61 $21,775.00 $21,775.00 $728.04 $37,614.12 $12,215.84 2026-05-08
36000051 OTHER Hc Open/perq Place Stent Same 75 61 $22,456.00 $22,456.00 $342.37 $37,614.12 $12,215.84 2026-05-08
36000090 OTHER Hc (tace/re/ufe/bland) 76 61 $21,775.00 $21,775.00 $624.13 $37,614.12 $12,215.84 2026-05-08
36000803 OTHER Hc Perc Ver Augment Thoracic 76 61 $21,480.00 $21,480.00 $776.00 $23,642.74 $7,864.76 2026-05-08
36000804 OTHER Hc Perq Vert Agmntj Cavity Crtj Uni/bi Cannulj Lmb 76 61 $21,480.00 $21,480.00 $776.00 $23,642.74 $7,864.76 2026-05-08
36000843 OTHER Hc Peripheral Lab Init Up To 1 Hr 59 49 $12,463.00 $12,463.00 $1,300.00 $12,463.00 $8,100.95 2026-05-08
36000847 OTHER Hc C-section 60 50 $14,694.00 $14,694.00 $2,060.00 $14,694.00 $9,551.10 2026-05-08
36100030 OTHER Hc Bone Rf Ablation 76 61 $25,100.00 $25,100.00 $776.00 $57,129.97 $18,103.62 2026-05-08
36100233 OTHER Hc Ablation-kidney 73 59 $18,522.00 $18,522.00 $3,000.00 $34,634.90 $11,248.29 2026-05-08
36100679 OTHER Hc Ablation 1 Or More Liver Tumors 76 61 $12,735.00 $12,735.00 $776.00 $34,634.90 $10,920.67 2026-05-08
36101068 OTHER Hc Ablation Therapy Of 1 Or More Pulmonary Tumor(s 73 59 $12,031.00 $12,031.00 $2,406.20 $34,634.90 $10,920.67 2026-05-08
4202320501J0630 OTHER Calcitonin (salmon) 200 Unit/ml Injection Soln 63 52 $11,272.00 $11,272.00 $816.00 $11,272.00 $7,416.98 2026-05-08
4359805111J0630 OTHER Calcitonin (salmon) 200 Unit/ml Injection Soln 63 52 $9,581.00 $9,581.00 $816.00 $9,581.00 $6,304.30 2026-05-08
4408711171S0126 OTHER Follitropin Alfa 900 Unit/1.5ml Sc Sopn 63 52 $10,434.00 $10,434.00 $246.34 $10,434.00 $6,782.10 2026-05-08
48000044 OTHER Hc Implant Pat-active Ht Record 75 60 $20,007.00 $20,007.00 $776.00 $26,963.49 $9,351.99 2026-05-08
48100052 OTHER Hc Cardiac Cath Initial Up To 1hr 59 49 $12,463.00 $12,463.00 $1,300.00 $12,463.00 $8,100.95 2026-05-08
48100055 OTHER Hc Ep Initial Up To 1 Hr 59 49 $12,463.00 $12,463.00 $1,300.00 $12,463.00 $8,100.95 2026-05-08
5024255401C9399 OTHER Ocrelizumabhyaluronidaseocsq 92023000 Mgut/23ml Sc 65 53 $141,945.00 $141,945.00 $1,300.00 $141,945.00 $93,399.81 2026-05-08
5024293301C9399 OTHER Atezolizumabhyaluronidastqjs 187530000 Mgut/15ml S 65 53 $39,327.00 $39,327.00 $1,300.00 $39,327.00 $25,877.17 2026-05-08
5041938501J9057 OTHER Copanlisib Hcl 60 Mg IV Solr 63 52 $18,913.00 $18,913.00 $89.31 $18,913.00 $12,293.45 2026-05-08
5063312011J1162 OTHER Digoxin Immune Fab 40 Mg IV Solr 73 59 $17,219.00 $17,219.00 $1,300.00 $17,219.00 $6,588.27 2026-05-08
5063312111J1162 OTHER Digoxin Immune Fab 40 Mg IV Solr 73 59 $15,920.00 $15,920.00 $1,300.00 $16,387.11 $6,588.27 2026-05-08
5063321011C9293 OTHER Glucarpidase 1000 Units IV Solr 73 59 $148,227.00 $148,227.00 $336.52 $148,227.00 $29,645.40 2026-05-08
5789406002J3357 OTHER Ustekinumab 45 Mg/0.5ml Sc Soln 63 52 $50,118.00 $50,118.00 $97.04 $50,118.00 $32,977.64 2026-05-08
5789406003J3357 OTHER Ustekinumab 45 Mg/0.5ml Sc Sosy 63 52 $50,118.00 $50,118.00 $97.04 $50,118.00 $32,977.64 2026-05-08
5789406103J3357 OTHER Ustekinumab 90 Mg/ml Sc Sosy 63 52 $100,235.00 $100,235.00 $97.04 $100,235.00 $65,954.63 2026-05-08
5789407001C9399 OTHER Golimumab 50 Mg/0.5ml Sc Sosy 65 53 $21,968.00 $21,968.00 $1,300.00 $21,968.00 $14,454.94 2026-05-08
5789407002C9399 OTHER Golimumab 50 Mg/0.5ml Sc Soaj 65 53 $21,968.00 $21,968.00 $1,300.00 $21,968.00 $14,454.94 2026-05-08
5846802001J0202 OTHER Alemtuzumab 12 Mg/1.2ml IV Soln 73 59 $104,970.00 $104,970.00 $1,300.00 $104,970.00 $7,760.98 2026-05-08
5913723101J8499 OTHER Aminolevulinic Acid Hcl 1.5 G Po Solr 58 50 $11,506.00 $11,506.00 $21.45 $11,506.00 $8,054.20 2026-05-08
5992360402J9185 OTHER Fludarabine Phosphate 50 Mg IV Solr (wrapper) 64 52 $9,850.00 $9,850.00 $71.65 $9,850.00 $6,402.50 2026-05-08
6050562280J9058 OTHER Bendamustine Hcl 100 Mg/4ml IV Soln 63 52 $11,555.00 $11,555.00 $1,300.00 $11,555.00 $7,510.75 2026-05-08
6080980101J2507 OTHER Pegloticase 8 Mg/ml IV Soln 73 59 $66,900.00 $66,900.00 $1,300.00 $66,900.00 $10,904.70 2026-05-08
6233267816J9171 OTHER Docetaxel 160 Mg/16ml IV Soln 63 51 $9,717.00 $9,717.00 $0.38 $9,717.00 $6,316.05 2026-05-08
6440605801J2326 OTHER Nusinersen 12 Mg/5ml Intrathecal Soln 73 59 $450,000.00 $450,000.00 $1,243.54 $450,000.00 $90,000.00 2026-05-08
6675805003J9171 OTHER Docetaxel 160 Mg/16ml IV Soln 63 51 $9,717.00 $9,717.00 $0.38 $9,717.00 $6,316.05 2026-05-08
6745767502J0630 OTHER Calcitonin (salmon) 200 Unit/ml Injection Soln 63 52 $11,276.00 $11,276.00 $816.00 $11,276.00 $7,419.61 2026-05-08
7133610031J0225 OTHER Vutrisiran Sodium 25 Mg/0.5ml Sc Sosy 73 59 $417,150.00 $417,150.00 $1,300.00 $417,150.00 $15,887.81 2026-05-08
7139406501J3398 OTHER Voretigene Neparvovecrzyl 5000000000000 Vg/ml Intr 69 57 $467,500.00 $467,500.00 $1,300.00 $467,500.00 $116,875.00 2026-05-08
7139441501J3398 OTHER Voretigene Neparvovecrzyl 5000000000000 Vg/ml Intr 69 57 $467,500.00 $467,500.00 $1,300.00 $467,500.00 $116,875.00 2026-05-08
7146923101J8499 OTHER Aminolevulinic Acid Hcl 1.5 G Po Solr 58 50 $10,041.00 $10,041.00 $21.45 $10,041.00 $7,028.70 2026-05-08
7207803802J0630 OTHER Calcitonin (salmon) 200 Unit/ml Injection Soln 63 52 $11,276.00 $11,276.00 $816.00 $11,276.00 $7,419.61 2026-05-08
7269495401J9266 OTHER Pegaspargase 750 Unit/ml IM Soln 73 59 $96,535.00 $96,535.00 $1,300.00 $96,535.00 $36,683.30 2026-05-08
75000013 OTHER Hc Diag Laparo Brush/wash Sep Proc 75 60 $12,186.00 $12,186.00 $281.84 $19,697.96 $6,397.26 2026-05-08
7598705006J8499 OTHER Glycerol Phenylbutyrate 1.1 Gm/ml Po Liqd 58 50 $20,492.00 $20,492.00 $21.45 $20,492.00 $14,344.40 2026-05-08
7598708010J2507 OTHER Pegloticase 8 Mg/ml IV Soln 73 59 $66,900.00 $66,900.00 $1,300.00 $66,900.00 $10,904.70 2026-05-08
7598711110J9216 OTHER Interferon Gamma1b 100 Mcg/0.5ml Sc Soln 63 52 $19,542.00 $19,542.00 $1,300.00 $19,542.00 $13,679.40 2026-05-08
7598711111J9216 OTHER Interferon Gamma1b 100 Mcg/0.5ml Sc Soln 63 52 $19,542.00 $19,542.00 $1,300.00 $19,542.00 $13,679.40 2026-05-08
76100040 OTHER Hc Treatment Of Ankle Fracture Bimalleolar 76 61 $15,219.00 $15,219.00 $450.00 $23,642.74 $7,902.04 2026-05-08
76100041 OTHER Hc Treatment Of Ankle Fracture W/out Fix 75 60 $15,219.00 $15,219.00 $497.50 $23,642.74 $7,902.04 2026-05-08
7612815575J9600 OTHER Porfimer Sodium 75 Mg IV Solr 73 59 $83,963.00 $83,963.00 $1,300.00 $83,963.00 $33,585.20 2026-05-08
8105213810A9603 OTHER Pafolacianine Sodium 3.2 Mg/1.6ml IV Soln 63 52 $15,300.00 $15,300.00 $135.47 $15,300.00 $9,945.00 2026-05-08
8295911101C9399 OTHER Imetelstat Sodium 188 Mg IV Solr 65 53 $35,583.00 $35,583.00 $1,300.00 $35,583.00 $23,413.61 2026-05-08
HC1001 OTHER Hc 70320 Aicd Dual Chamber 61 51 $25,507.00 $25,507.00 $1,300.00 $25,507.00 $16,579.55 2026-05-08
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