Hospital

PENN HIGHLANDS CONNELLSVILLE

Connellsville, PA · CCN 390184 · Rates published

27,760 distinct procedures filed

8 distinct payers

373,860 rate rows

2026-05-09 last MRF observed

Data quality

373,018 of 373,860 rate rows are consumer-grade (99.8%)

842 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	420
template filing: same amount across many unrelated codes — excluded	171
placeholder amount (≤ $0.02) — excluded from medians	118
per-diem day rate — not a per-procedure price	97
percent-of-charges filed in the dollar field — excluded from medians	36

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

Source MRF file	https://www.phhealthcare.org/download/?id=14597
Found on page	https://www.phhealthcare.org/patients-visitors/patient-billing-services
Discovered via	Discovered by HANK (automated)
Last fetch	not_modified · 2026-05-17
Content fingerprint	06babe5fd5853990… · 54,134,098 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	5	$3,524,500.00	$4,043,900.00	$3,728,550.00	nat. median $3,710,000 1.0× median
J1411 OTHER	Inj- Hemgenix- Per Tx Dose	5	$3,501,003.34	$4,016,940.67	$3,716,059.67	nat. median $3,685,267 1.0× median
J1413 OTHER	Inj Delandistrogene Mox Rokl	5	$3,158,343.31	$3,623,783.37	$3,341,194.76	nat. median $3,327,860 1.0× median
J3394 OTHER	Inj- Lovotibeglogene Autotem	5	$3,098,287.25	$3,554,876.95	$3,277,661.77	nat. median $3,286,000 1.0× median
J3393 OTHER	Inj- Betibeglogene Autotemce	5	$2,803,152.34	$3,216,248.47	$2,974,096.77	nat. median $2,968,000 1.0× median
J3399 OTHER	Inj Onase Abepar-xioi Treat	5	$2,329,509.82	$2,672,806.00	$2,464,376.18	nat. median $2,472,216 1.0× median
J3392 OTHER	Inj Exagamglogene Autotem	5	$2,215,400.00	$2,541,880.00	$2,343,660.00	nat. median $2,332,000 1.0× median
Q2057 OTHER	Afamitresgene Autoleucel	4	$732,089.00	$839,975.80	$770,620.00	nat. median $770,620 1.0× median
Q2042 OTHER	Tisagenlecleucel Car-pos T	4	$549,408.35	$630,373.79	$578,324.58	nat. median $591,726 1.0× median
Q2056 OTHER	Ciltacabtagene Car-pos T	4	$525,709.89	$603,182.92	$553,378.83	nat. median $583,076 0.9× median
Q2054 OTHER	Lisocabtagene Mara Car Pos T	4	$514,553.87	$590,382.87	$541,635.66	nat. median $562,538 1.0× median
Q2055 OTHER	Idecabtagene Vicleucel Car	4	$514,197.42	$589,973.89	$541,260.45	nat. median $558,082 1.0× median
Q2041 OTHER	Axicabtagene Ciloleucel Car+	4	$489,517.15	$581,053.36	$533,076.48	nat. median $533,230 1.0× median
Q2053 OTHER	Brexucabtagene Car Pos T	4	$465,234.00	$533,794.80	$489,720.00	nat. median $489,720 1.0× median
5834 OTHER	Neonate With Ecmo	3	$410,022.31	$410,022.31	$410,022.31	nat. median $372,748 1.1× median
5884 OTHER	Neonate Bwt <1500g W Major Procedure	3	$267,492.84	$267,492.84	$267,492.84	nat. median $243,175 1.1× median
5833 OTHER	Neonate With Ecmo	3	$265,625.54	$265,625.54	$265,625.54	nat. median $252,069 1.1× median
MS-018 OTHER	Chimeric Antigen Receptor (car) T-cell Immunotherapy	6	$3,396.00	$549,366.93	$247,220.29	nat. median $309,559 0.8× median
0024 OTHER	Heart And/or Lung Transplant	3	$846.00	$236,889.37	$236,889.37	nat. median $235,636 1.0× median
5832 OTHER	Neonate With Ecmo	3	$203,951.61	$203,951.61	$203,951.61	nat. median $152,272 1.3× median
1614 OTHER	Implantable Heart Assist Systems	3	$203,013.29	$203,013.29	$203,013.29	nat. median $194,298 1.0× median
6304 OTHER	Neonate Birthwt >2499g W Major Cardiovascular Procedure	3	$195,126.59	$195,126.59	$195,126.59	nat. median $164,743 1.2× median
8414 OTHER	Extensive Third Degree Burns With Skin Graft	3	$192,453.70	$192,453.70	$192,453.70	nat. median $161,322 1.2× median
MS-001 OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	6	$170,310.86	$405,623.52	$190,031.07	nat. median $224,278 0.8× median
6094 OTHER	Neonate Bwt 1500-2499g W Major Procedure	3	$175,877.57	$175,877.57	$175,877.57	nat. median $170,784 1.0× median
5883 OTHER	Neonate Bwt <1500g W Major Procedure	3	$173,970.10	$173,970.10	$173,970.10	nat. median $163,694 1.1× median
6314 OTHER	Neonate Birthwt >2499g W Other Major Procedure	3	$172,668.08	$172,668.08	$172,668.08	nat. median $163,675 1.1× median
5914 OTHER	Neonate Birthwt 500-749g Without Major Procedure	3	$169,928.47	$169,928.47	$169,928.47	nat. median $149,152 1.1× median
0114 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	3	$161,603.46	$161,603.46	$161,603.46	nat. median $125,206 1.3× median
0074 OTHER	Allogeneic Bone Marrow Transplant	3	$161,296.43	$161,296.43	$161,296.43	nat. median $147,645 1.1× median
0094 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	3	$160,487.96	$160,487.96	$160,487.96	nat. median $165,362 1.0× median
5934 OTHER	Neonate Birthwt 750-999g Without Major Procedure	3	$157,566.85	$157,566.85	$157,566.85	nat. median $129,842 1.2× median
MS-927 OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	6	$3,396.00	$341,608.32	$155,511.06	nat. median $175,322 0.9× median
5882 OTHER	Neonate Bwt <1500g W Major Procedure	3	$152,655.06	$152,655.06	$152,655.06	nat. median $119,369 1.3× median
5831 OTHER	Neonate With Ecmo	3	$148,245.42	$148,245.42	$148,245.42	nat. median $139,037 1.1× median
6034 OTHER	Neonate Birthwt 1000-1249g W Or Without Other Significant Condition	3	$145,744.69	$145,744.69	$145,744.69	nat. median $92,525 1.6× median
0014 OTHER	Liver Transplant And/or Intestinal Transplant	3	$143,444.11	$143,444.11	$143,444.11	nat. median $147,828 1.0× median
0044 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	3	$142,461.32	$142,461.32	$142,461.32	nat. median $138,863 1.0× median
MS-003 OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth…	6	$3,396.00	$308,615.04	$140,491.46	nat. median $169,886 0.8× median
1613 OTHER	Implantable Heart Assist Systems	3	$137,363.73	$137,363.73	$137,363.73	nat. median $79 outlier · 1745.0×
0023 OTHER	Heart And/or Lung Transplant	3	$133,012.20	$133,012.20	$133,012.20	nat. median $133,752 1.0× median
5881 OTHER	Neonate Bwt <1500g W Major Procedure	3	$130,847.91	$130,847.91	$130,847.91	nat. median $14,014 outlier · 9.3×
5913 OTHER	Neonate Birthwt 500-749g Without Major Procedure	3	$126,127.66	$126,127.66	$126,127.66	nat. median $115,252 1.1× median
1604 OTHER	Major Cardiothoracic Repair Of Heart Anomaly	3	$118,444.69	$118,444.69	$118,444.69	nat. median $44,507 outlier · 2.7×
6024 OTHER	Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom	3	$117,005.66	$117,005.66	$117,005.66	nat. median $99,381 1.2× median
1612 OTHER	Implantable Heart Assist Systems	3	$110,264.59	$110,264.59	$110,264.59	nat. median $84,765 1.3× median
5933 OTHER	Neonate Birthwt 750-999g Without Major Procedure	3	$109,278.93	$109,278.93	$109,278.93	nat. median $87,090 1.3× median
Q0480 OTHER	Driver Pneumatic Vad- Rep	5	$83,459.27	$207,107.96	$106,120.90	nat. median $109,316 1.0× median
1611 OTHER	Implantable Heart Assist Systems	3	$105,055.81	$105,055.81	$105,055.81	nat. median $80,527 1.3× median
5891 OTHER	Neonate Bwt <500g Or Ga <24 Weeks	3	$104,493.39	$104,493.39	$104,493.39	nat. median $77,714 1.3× median

Other procedures at this hospital

Browse this hospital's 27,760 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

0011	OTHER	Liver Transplant And/or Intestinal Transplant	3	3	—	—	$46,871.13	$46,871.13	$46,871.13	2026-05-09
0012	OTHER	Liver Transplant And/or Intestinal Transplant	3	3	—	—	$53,906.32	$53,906.32	$53,906.32	2026-05-09
0013	OTHER	Liver Transplant And/or Intestinal Transplant	3	3	—	—	$67,103.66	$67,103.66	$67,103.66	2026-05-09
0014	OTHER	Liver Transplant And/or Intestinal Transplant	3	3	—	—	$143,444.11	$143,444.11	$143,444.11	2026-05-09
0021	OTHER	Heart And/or Lung Transplant	3	3	—	—	$89,021.29	$89,021.29	$89,021.29	2026-05-09
0022	OTHER	Heart And/or Lung Transplant	4	3	—	—	$700.00	$96,799.66	$96,799.66	2026-05-09
0023	OTHER	Heart And/or Lung Transplant	3	3	—	—	$133,012.20	$133,012.20	$133,012.20	2026-05-09
0024	OTHER	Heart And/or Lung Transplant	4	3	—	—	$846.00	$236,889.37	$236,889.37	2026-05-09
0041	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	3	3	—	—	$48,917.77	$48,917.77	$48,917.77	2026-05-09
0042	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	3	3	—	—	$55,124.40	$55,124.40	$55,124.40	2026-05-09
0043	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	3	3	—	—	$89,332.62	$89,332.62	$89,332.62	2026-05-09
0044	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	3	3	—	—	$142,461.32	$142,461.32	$142,461.32	2026-05-09
0052	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	3	3	—	—	$42,382.58	$42,382.58	$42,382.58	2026-05-09
0053	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	3	3	—	—	$64,188.30	$64,188.30	$64,188.30	2026-05-09
0054	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	3	3	—	—	$92,923.75	$92,923.75	$92,923.75	2026-05-09
0061	OTHER	Pancreas Transplant	3	3	—	—	$43,897.66	$43,897.66	$43,897.66	2026-05-09
0062	OTHER	Pancreas Transplant	3	3	—	—	$58,696.87	$58,696.87	$58,696.87	2026-05-09
0063	OTHER	Pancreas Transplant	3	3	—	—	$73,307.43	$73,307.43	$73,307.43	2026-05-09
0064	OTHER	Pancreas Transplant	3	3	—	—	$103,189.94	$103,189.94	$103,189.94	2026-05-09
0071	OTHER	Allogeneic Bone Marrow Transplant	3	3	—	—	$60,053.41	$60,053.41	$60,053.41	2026-05-09
0072	OTHER	Allogeneic Bone Marrow Transplant	3	3	—	—	$63,214.12	$63,214.12	$63,214.12	2026-05-09
0073	OTHER	Allogeneic Bone Marrow Transplant	3	3	—	—	$78,831.13	$78,831.13	$78,831.13	2026-05-09
0074	OTHER	Allogeneic Bone Marrow Transplant	3	3	—	—	$161,296.43	$161,296.43	$161,296.43	2026-05-09
0083	OTHER	Autologous Bone Marrow Transplant	3	3	—	—	$40,790.75	$40,790.75	$40,790.75	2026-05-09
0084	OTHER	Autologous Bone Marrow Transplant	3	3	—	—	$79,945.20	$79,945.20	$79,945.20	2026-05-09
0091	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	3	3	—	—	$39,641.53	$39,641.53	$39,641.53	2026-05-09
0092	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	3	3	—	—	$41,726.91	$41,726.91	$41,726.91	2026-05-09
0093	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	3	3	—	—	$69,164.65	$69,164.65	$69,164.65	2026-05-09
0094	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	3	3	—	—	$160,487.96	$160,487.96	$160,487.96	2026-05-09
0111	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	3	3	—	—	$36,901.20	$36,901.20	$36,901.20	2026-05-09
0112	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	3	3	—	—	$80,923.68	$80,923.68	$80,923.68	2026-05-09
0113	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	3	3	—	—	$94,247.28	$94,247.28	$94,247.28	2026-05-09
0114	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	3	3	—	—	$161,603.46	$161,603.46	$161,603.46	2026-05-09
0204	OTHER	Open Craniotomy For Trauma	3	3	—	—	$47,551.19	$47,551.19	$47,551.19	2026-05-09
0214	OTHER	Open Craniotomy Except Trauma	3	3	—	—	$53,076.33	$53,076.33	$53,076.33	2026-05-09
0224	OTHER	Ventricular Shunt Procedures	3	3	—	—	$41,130.06	$41,130.06	$41,130.06	2026-05-09
0234	OTHER	Spinal Procedures	3	3	—	—	$48,729.82	$48,729.82	$48,729.82	2026-05-09
0244	OTHER	Open Extracranial Vascular Procedures	3	3	—	—	$34,605.64	$34,605.64	$34,605.64	2026-05-09
0264	OTHER	Other Nervous System And Related Procedures	3	3	—	—	$40,372.53	$40,372.53	$40,372.53	2026-05-09
0266T	OTHER	Implt/rpl Crtd Sns Dev Total	12	5	—	—	$867.45	$82,765.11	$43,507.83	2026-05-09
0274	OTHER	Other Open Craniotomy	3	3	—	—	$49,751.35	$49,751.35	$49,751.35	2026-05-09
0294	OTHER	Other Percutaneous Intracranial Procedures	3	3	—	—	$34,916.98	$34,916.98	$34,916.98	2026-05-09
0304	OTHER	Percutaneous Intracranial And Extracranial Vascular Procedures	3	3	—	—	$39,139.38	$39,139.38	$39,139.38	2026-05-09
0504	OTHER	Non-bacterial Infections Of Nervous System Except Viral Meningitis	3	3	—	—	$34,903.35	$34,903.35	$34,903.35	2026-05-09
0894	OTHER	Major Cranial/facial Bone Procedures	3	3	—	—	$44,193.93	$44,193.93	$44,193.93	2026-05-09
0914	OTHER	Other Major Head And Neck Procedures	3	3	—	—	$53,957.25	$53,957.25	$53,957.25	2026-05-09
0924	OTHER	Facial Bone Procedures Except Major Cranial/facial Bone Procedures	3	3	—	—	$45,767.11	$45,767.11	$45,767.11	2026-05-09
1204	OTHER	Major Respiratory And Chest Procedures	3	3	—	—	$50,917.06	$50,917.06	$50,917.06	2026-05-09
1214	OTHER	Other Respiratory And Chest Procedures	3	3	—	—	$40,356.75	$40,356.75	$40,356.75	2026-05-09
1304	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	3	3	—	—	$42,898.37	$42,898.37	$42,898.37	2026-05-09
1603	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	3	3	—	—	$47,971.57	$47,971.57	$47,971.57	2026-05-09
1604	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	3	3	—	—	$118,444.69	$118,444.69	$118,444.69	2026-05-09
1611	OTHER	Implantable Heart Assist Systems	3	3	—	—	$105,055.81	$105,055.81	$105,055.81	2026-05-09
1612	OTHER	Implantable Heart Assist Systems	3	3	—	—	$110,264.59	$110,264.59	$110,264.59	2026-05-09
1613	OTHER	Implantable Heart Assist Systems	3	3	—	—	$137,363.73	$137,363.73	$137,363.73	2026-05-09
1614	OTHER	Implantable Heart Assist Systems	3	3	—	—	$203,013.29	$203,013.29	$203,013.29	2026-05-09
1622	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	3	3	—	—	$38,422.73	$38,422.73	$38,422.73	2026-05-09
1623	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	3	3	—	—	$51,656.66	$51,656.66	$51,656.66	2026-05-09
1624	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	3	3	—	—	$80,859.84	$80,859.84	$80,859.84	2026-05-09
1633	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	3	3	—	—	$42,983.73	$42,983.73	$42,983.73	2026-05-09
1634	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	3	3	—	—	$67,355.46	$67,355.46	$67,355.46	2026-05-09
1653	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	3	3	—	—	$42,097.07	$42,097.07	$42,097.07	2026-05-09
1654	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	3	3	—	—	$62,903.50	$62,903.50	$62,903.50	2026-05-09
1663	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	3	3	—	—	$35,386.13	$35,386.13	$35,386.13	2026-05-09
1664	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	3	3	—	—	$55,085.66	$55,085.66	$55,085.66	2026-05-09
1673	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	3	3	—	—	$38,967.21	$38,967.21	$38,967.21	2026-05-09
1674	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	3	3	—	—	$67,813.14	$67,813.14	$67,813.14	2026-05-09
1694	OTHER	Major Abdominal Vascular Procedures	3	3	—	—	$48,545.46	$48,545.46	$48,545.46	2026-05-09
1704	OTHER	Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock	3	3	—	—	$35,604.21	$35,604.21	$35,604.21	2026-05-09
1754	OTHER	Percutaneous Coronary Intervention Without Ami	3	3	—	—	$35,095.60	$35,095.60	$35,095.60	2026-05-09
1764	OTHER	Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices	3	3	—	—	$43,457.19	$43,457.19	$43,457.19	2026-05-09
1781	OTHER	External Heart Assist Systems	3	3	—	—	$38,774.96	$38,774.96	$38,774.96	2026-05-09
1782	OTHER	External Heart Assist Systems	3	3	—	—	$45,704.70	$45,704.70	$45,704.70	2026-05-09
1783	OTHER	External Heart Assist Systems	3	3	—	—	$47,544.73	$47,544.73	$47,544.73	2026-05-09
1784	OTHER	External Heart Assist Systems	3	3	—	—	$64,546.98	$64,546.98	$64,546.98	2026-05-09
1793	OTHER	Defibrillator Implants	3	3	—	—	$37,860.32	$37,860.32	$37,860.32	2026-05-09
1794	OTHER	Defibrillator Implants	3	3	—	—	$52,310.90	$52,310.90	$52,310.90	2026-05-09
1814	OTHER	Lower Extremity Arterial Procedures	3	3	—	—	$42,259.20	$42,259.20	$42,259.20	2026-05-09
1824	OTHER	Other Peripheral Vascular Procedures	3	3	—	—	$38,577.68	$38,577.68	$38,577.68	2026-05-09
1833	OTHER	Percutaneous Structural Cardiac Procedures	3	3	—	—	$37,672.37	$37,672.37	$37,672.37	2026-05-09
1834	OTHER	Percutaneous Structural Cardiac Procedures	3	3	—	—	$56,251.38	$56,251.38	$56,251.38	2026-05-09
2204	OTHER	Major Stomach, Esophageal And Duodenal Procedures	3	3	—	—	$48,864.68	$48,864.68	$48,864.68	2026-05-09
2304	OTHER	Major Small Bowel Procedures	3	3	—	—	$40,283.58	$40,283.58	$40,283.58	2026-05-09
2314	OTHER	Major Large Bowel Procedures	3	3	—	—	$34,744.09	$34,744.09	$34,744.09	2026-05-09
2324	OTHER	Gastric Fundoplication	3	3	—	—	$49,413.47	$49,413.47	$49,413.47	2026-05-09
2604	OTHER	Major Pancreas, Liver And Shunt Procedures	3	3	—	—	$50,508.16	$50,508.16	$50,508.16	2026-05-09
2614	OTHER	Major Biliary Tract Procedures	3	3	—	—	$43,780.72	$43,780.72	$43,780.72	2026-05-09
2644	OTHER	Other Hepatobiliary, Pancreas And Abdominal Procedures	3	3	—	—	$40,637.95	$40,637.95	$40,637.95	2026-05-09
3032	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	3	3	—	—	$40,679.56	$40,679.56	$40,679.56	2026-05-09
3033	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	3	3	—	—	$57,972.34	$57,972.34	$57,972.34	2026-05-09
3034	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	3	3	—	—	$85,070.04	$85,070.04	$85,070.04	2026-05-09
3043	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	3	3	—	—	$38,363.19	$38,363.19	$38,363.19	2026-05-09
3044	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	3	3	—	—	$59,644.51	$59,644.51	$59,644.51	2026-05-09
3104	OTHER	Vertebral And Intervertebral Spinal Procedures Including Disc Procedures	3	3	—	—	$34,545.38	$34,545.38	$34,545.38	2026-05-09
3124	OTHER	Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses	3	3	—	—	$55,856.83	$55,856.83	$55,856.83	2026-05-09
3154	OTHER	Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement	3	3	—	—	$34,938.50	$34,938.50	$34,938.50	2026-05-09
3214	OTHER	Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures	3	3	—	—	$40,292.18	$40,292.18	$40,292.18	2026-05-09
3254	OTHER	Non-elective Or Complex Knee Joint Replacement	3	3	—	—	$36,451.42	$36,451.42	$36,451.42	2026-05-09
33276	OTHER	Insj Phrnc Nrv Stim Sys	19	5	—	—	$428.40	$82,765.11	$41,776.18	2026-05-09
3614	OTHER	Skin Graft For Skin And Subcutaneous Tissue Diagnoses	3	3	—	—	$54,119.37	$54,119.37	$54,119.37	2026-05-09
3634	OTHER	Breast Procedures Except Mastectomy	3	3	—	—	$40,485.15	$40,485.15	$40,485.15	2026-05-09
38240	OTHER	Transplt Allo Hct/donor	20	5	—	—	$214.34	$108,774.82	$54,478.02	2026-05-09
4014	OTHER	Adrenal Procedures	3	3	—	—	$38,231.20	$38,231.20	$38,231.20	2026-05-09
4034	OTHER	Procedures For Obesity	3	3	—	—	$38,145.83	$38,145.83	$38,145.83	2026-05-09
4044	OTHER	Thyroid, Parathyroid And Thyroglossal Procedures	3	3	—	—	$40,324.47	$40,324.47	$40,324.47	2026-05-09
4054	OTHER	Other Procedures For Endocrine, Nutritional And Metabolic Disorders	3	3	—	—	$38,777.83	$38,777.83	$38,777.83	2026-05-09
4401	OTHER	Kidney Transplant	3	3	—	—	$36,926.31	$36,926.31	$36,926.31	2026-05-09
4402	OTHER	Kidney Transplant	3	3	—	—	$40,027.48	$40,027.48	$40,027.48	2026-05-09
4403	OTHER	Kidney Transplant	3	3	—	—	$45,794.37	$45,794.37	$45,794.37	2026-05-09
4404	OTHER	Kidney Transplant	3	3	—	—	$75,564.97	$75,564.97	$75,564.97	2026-05-09
4414	OTHER	Major Bladder Procedures	3	3	—	—	$44,624.35	$44,624.35	$44,624.35	2026-05-09
4424	OTHER	Kidney And Urinary Tract Procedures For Malignancy	3	3	—	—	$35,719.71	$35,719.71	$35,719.71	2026-05-09
4474	OTHER	Other Kidney, Urinary Tract And Related Procedures	3	3	—	—	$36,132.19	$36,132.19	$36,132.19	2026-05-09
4804	OTHER	Major Male Pelvic Procedures	3	3	—	—	$34,602.77	$34,602.77	$34,602.77	2026-05-09
5104	OTHER	Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced…	3	3	—	—	$42,409.84	$42,409.84	$42,409.84	2026-05-09
5114	OTHER	Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy	3	3	—	—	$40,409.83	$40,409.83	$40,409.83	2026-05-09
5124	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy	3	3	—	—	$35,744.81	$35,744.81	$35,744.81	2026-05-09
5144	OTHER	Female Reproductive System Reconstructive Procedures	3	3	—	—	$42,578.42	$42,578.42	$42,578.42	2026-05-09
5184	OTHER	Other Female Reproductive System And Related Procedures	3	3	—	—	$39,508.10	$39,508.10	$39,508.10	2026-05-09
5831	OTHER	Neonate With Ecmo	3	3	—	—	$148,245.42	$148,245.42	$148,245.42	2026-05-09
5832	OTHER	Neonate With Ecmo	3	3	—	—	$203,951.61	$203,951.61	$203,951.61	2026-05-09
5833	OTHER	Neonate With Ecmo	3	3	—	—	$265,625.54	$265,625.54	$265,625.54	2026-05-09
5834	OTHER	Neonate With Ecmo	3	3	—	—	$410,022.31	$410,022.31	$410,022.31	2026-05-09
5881	OTHER	Neonate Bwt <1500g W Major Procedure	3	3	—	—	$130,847.91	$130,847.91	$130,847.91	2026-05-09
5882	OTHER	Neonate Bwt <1500g W Major Procedure	3	3	—	—	$152,655.06	$152,655.06	$152,655.06	2026-05-09
5883	OTHER	Neonate Bwt <1500g W Major Procedure	3	3	—	—	$173,970.10	$173,970.10	$173,970.10	2026-05-09
5884	OTHER	Neonate Bwt <1500g W Major Procedure	3	3	—	—	$267,492.84	$267,492.84	$267,492.84	2026-05-09
5891	OTHER	Neonate Bwt <500g Or Ga <24 Weeks	3	3	—	—	$104,493.39	$104,493.39	$104,493.39	2026-05-09
5892	OTHER	Neonate Bwt <500g Or Ga <24 Weeks	3	3	—	—	$101,410.88	$101,410.88	$101,410.88	2026-05-09
5893	OTHER	Neonate Bwt <500g Or Ga <24 Weeks	3	3	—	—	$99,250.18	$99,250.18	$99,250.18	2026-05-09
5911	OTHER	Neonate Birthwt 500-749g Without Major Procedure	3	3	—	—	$57,493.86	$57,493.86	$57,493.86	2026-05-09
5912	OTHER	Neonate Birthwt 500-749g Without Major Procedure	3	3	—	—	$95,644.71	$95,644.71	$95,644.71	2026-05-09
5913	OTHER	Neonate Birthwt 500-749g Without Major Procedure	3	3	—	—	$126,127.66	$126,127.66	$126,127.66	2026-05-09
5914	OTHER	Neonate Birthwt 500-749g Without Major Procedure	3	3	—	—	$169,928.47	$169,928.47	$169,928.47	2026-05-09
5932	OTHER	Neonate Birthwt 750-999g Without Major Procedure	3	3	—	—	$89,504.07	$89,504.07	$89,504.07	2026-05-09
5933	OTHER	Neonate Birthwt 750-999g Without Major Procedure	3	3	—	—	$109,278.93	$109,278.93	$109,278.93	2026-05-09
5934	OTHER	Neonate Birthwt 750-999g Without Major Procedure	3	3	—	—	$157,566.85	$157,566.85	$157,566.85	2026-05-09
6022	OTHER	Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom	3	3	—	—	$66,372.67	$66,372.67	$66,372.67	2026-05-09
6023	OTHER	Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom	3	3	—	—	$82,996.86	$82,996.86	$82,996.86	2026-05-09
6024	OTHER	Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom	3	3	—	—	$117,005.66	$117,005.66	$117,005.66	2026-05-09
6032	OTHER	Neonate Birthwt 1000-1249g W Or Without Other Significant Condition	3	3	—	—	$35,895.46	$35,895.46	$35,895.46	2026-05-09
6033	OTHER	Neonate Birthwt 1000-1249g W Or Without Other Significant Condition	3	3	—	—	$64,376.96	$64,376.96	$64,376.96	2026-05-09
6034	OTHER	Neonate Birthwt 1000-1249g W Or Without Other Significant Condition	3	3	—	—	$145,744.69	$145,744.69	$145,744.69	2026-05-09
6072	OTHER	Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom	3	3	—	—	$45,845.30	$45,845.30	$45,845.30	2026-05-09
6073	OTHER	Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom	3	3	—	—	$62,074.22	$62,074.22	$62,074.22	2026-05-09
6074	OTHER	Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom	3	3	—	—	$89,670.50	$89,670.50	$89,670.50	2026-05-09
6083	OTHER	Neonate Bwt 1250-1499g W Or Without Other Significant Condition	3	3	—	—	$45,111.44	$45,111.44	$45,111.44	2026-05-09
6084	OTHER	Neonate Bwt 1250-1499g W Or Without Other Significant Condition	3	3	—	—	$56,654.54	$56,654.54	$56,654.54	2026-05-09
6091	OTHER	Neonate Bwt 1500-2499g W Major Procedure	3	3	—	—	$34,419.84	$34,419.84	$34,419.84	2026-05-09
6092	OTHER	Neonate Bwt 1500-2499g W Major Procedure	3	3	—	—	$36,231.19	$36,231.19	$36,231.19	2026-05-09
6093	OTHER	Neonate Bwt 1500-2499g W Major Procedure	3	3	—	—	$65,668.94	$65,668.94	$65,668.94	2026-05-09
6094	OTHER	Neonate Bwt 1500-2499g W Major Procedure	3	3	—	—	$175,877.57	$175,877.57	$175,877.57	2026-05-09
6113	OTHER	Neonate Birthwt 1500-1999g W Major Anomaly	3	3	—	—	$44,900.53	$44,900.53	$44,900.53	2026-05-09
6114	OTHER	Neonate Birthwt 1500-1999g W Major Anomaly	3	3	—	—	$72,676.86	$72,676.86	$72,676.86	2026-05-09
6123	OTHER	Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond	3	3	—	—	$39,904.09	$39,904.09	$39,904.09	2026-05-09
6124	OTHER	Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond	3	3	—	—	$64,052.00	$64,052.00	$64,052.00	2026-05-09
6133	OTHER	Neonate Birthwt 1500-1999g W Congenital/perinatal Infection	3	3	—	—	$44,315.88	$44,315.88	$44,315.88	2026-05-09
6134	OTHER	Neonate Birthwt 1500-1999g W Congenital/perinatal Infection	3	3	—	—	$73,017.61	$73,017.61	$73,017.61	2026-05-09
6143	OTHER	Neonate Bwt 1500-1999g W Or Without Other Significant Condition	3	3	—	—	$35,899.05	$35,899.05	$35,899.05	2026-05-09
6144	OTHER	Neonate Bwt 1500-1999g W Or Without Other Significant Condition	3	3	—	—	$52,293.68	$52,293.68	$52,293.68	2026-05-09
6214	OTHER	Neonate Bwt 2000-2499g W Major Anomaly	3	3	—	—	$61,522.57	$61,522.57	$61,522.57	2026-05-09
6224	OTHER	Neonate Bwt 2000-2499g W Resp Dist Synd/oth Maj Resp Cond	3	3	—	—	$38,272.80	$38,272.80	$38,272.80	2026-05-09
6233	OTHER	Neonate Bwt 2000-2499g W Congenital/perinatal Infection	3	3	—	—	$34,451.41	$34,451.41	$34,451.41	2026-05-09
6234	OTHER	Neonate Bwt 2000-2499g W Congenital/perinatal Infection	3	3	—	—	$43,104.25	$43,104.25	$43,104.25	2026-05-09
6254	OTHER	Neonate Bwt 2000-2499g W Other Significant Condition	3	3	—	—	$51,160.25	$51,160.25	$51,160.25	2026-05-09
6302	OTHER	Neonate Birthwt >2499g W Major Cardiovascular Procedure	3	3	—	—	$53,318.80	$53,318.80	$53,318.80	2026-05-09
6303	OTHER	Neonate Birthwt >2499g W Major Cardiovascular Procedure	3	3	—	—	$93,173.39	$93,173.39	$93,173.39	2026-05-09
6304	OTHER	Neonate Birthwt >2499g W Major Cardiovascular Procedure	3	3	—	—	$195,126.59	$195,126.59	$195,126.59	2026-05-09
6313	OTHER	Neonate Birthwt >2499g W Other Major Procedure	3	3	—	—	$51,848.20	$51,848.20	$51,848.20	2026-05-09
6314	OTHER	Neonate Birthwt >2499g W Other Major Procedure	3	3	—	—	$172,668.08	$172,668.08	$172,668.08	2026-05-09
6334	OTHER	Neonate Birthwt >2499g W Major Anomaly	3	3	—	—	$60,903.49	$60,903.49	$60,903.49	2026-05-09
6344	OTHER	Neonate, Birthwt >2499g W Resp Dist Synd/oth Maj Resp Cond	3	3	—	—	$36,218.27	$36,218.27	$36,218.27	2026-05-09
6504	OTHER	Splenic Procedures	3	3	—	—	$36,633.63	$36,633.63	$36,633.63	2026-05-09
6514	OTHER	Other Procedures Of Blood And Blood-forming Organs	3	3	—	—	$42,051.88	$42,051.88	$42,051.88	2026-05-09
6804	OTHER	Major O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms	3	3	—	—	$61,470.20	$61,470.20	$61,470.20	2026-05-09
6814	OTHER	Other O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms	3	3	—	—	$56,011.78	$56,011.78	$56,011.78	2026-05-09
6904	OTHER	Acute Leukemia	3	3	—	—	$55,485.95	$55,485.95	$55,485.95	2026-05-09
6954	OTHER	Chemotherapy For Acute Leukemia	3	3	—	—	$49,170.28	$49,170.28	$49,170.28	2026-05-09
7000935	OTHER	Ev Stent Placement Iliac	6	4	$137,292.00	$82,375.20 40% off	$46,267.40	$107,087.76	$47,159.80	2026-05-09
7000937	OTHER	Ev Stent Placement Fem /pop	6	4	$137,292.00	$82,375.20 40% off	$46,267.40	$107,087.76	$47,159.80	2026-05-09
7000943	OTHER	Ev Pta Tibial / Peroneal	6	4	$137,292.00	$82,375.20 40% off	$46,267.40	$107,087.76	$47,159.80	2026-05-09
7000955	OTHER	Ev Thrombectomy Art Primary	6	4	$217,389.00	$130,433.40 40% off	$73,260.09	$169,563.42	$74,673.12	2026-05-09
7000957	OTHER	Ev Thrombectomy Vein	6	4	$137,292.00	$82,375.20 40% off	$46,267.40	$107,087.76	$47,159.80	2026-05-09
7001005	OTHER	Vvi Pacemaker Insertion/replacement	6	4	$126,696.00	$76,017.60 40% off	$42,696.55	$98,822.88	$43,520.07	2026-05-09
7001008	OTHER	Insert Pm Sngl Chamb Atrial	6	4	$126,696.00	$76,017.60 40% off	$42,696.55	$98,822.88	$43,520.07	2026-05-09
7001010	OTHER	Remove/repla Pulse Gen Duel Chamber	6	4	$126,696.00	$76,017.60 40% off	$42,696.55	$98,822.88	$43,520.07	2026-05-09
7001014	OTHER	Upgrade Pacemaker Sc To Dc	6	4	$126,696.00	$76,017.60 40% off	$42,696.55	$98,822.88	$43,520.07	2026-05-09
7001017	OTHER	Removal Perm Pacemaker Generator	6	4	$100,192.00	$60,115.20 40% off	$33,764.70	$78,149.76	$34,415.95	2026-05-09
7001025	OTHER	Ev Transcath Placement Intrvascular Sten	6	4	$137,292.00	$82,375.20 40% off	$46,267.40	$107,087.76	$47,159.80	2026-05-09
7104	OTHER	Infectious And Parasitic Diseases Including HIV With O.r. Procedure	3	3	—	—	$37,866.06	$37,866.06	$37,866.06	2026-05-09
7114	OTHER	Post-operative, Post-trauma, Other Device Infections With O.r. Procedure	3	3	—	—	$36,399.05	$36,399.05	$36,399.05	2026-05-09
73201107	OTHER	Ipilimumab (yervoy) 200 Mg/40 Ml Vial	6	4	$160,611.16	$96,366.70 40% off	$54,125.96	$125,276.70	$55,169.93	2026-05-09
73201255	OTHER	Imjudo (tremelimumab) 300mg/15ml Sdv	6	4	$159,120.00	$95,472.00 40% off	$53,623.44	$124,113.60	$54,657.72	2026-05-09
7404	OTHER	Mental Illness Diagnosis With O.r. Procedure	3	3	—	—	$55,782.94	$55,782.94	$55,782.94	2026-05-09
7584	OTHER	Behavioral Disorders	3	3	—	—	$40,798.64	$40,798.64	$40,798.64	2026-05-09
7594	OTHER	Eating Disorders	3	3	—	—	$52,381.20	$52,381.20	$52,381.20	2026-05-09
7924	OTHER	Extensive Or Procedures For Other Complications Of Treatment	3	3	—	—	$42,490.90	$42,490.90	$42,490.90	2026-05-09
7934	OTHER	Moderately Extensive Or Procedures For Other Complications Of Treatment	3	3	—	—	$35,096.32	$35,096.32	$35,096.32	2026-05-09
8411	OTHER	Extensive Third Degree Burns With Skin Graft	3	3	—	—	$41,787.89	$41,787.89	$41,787.89	2026-05-09
8412	OTHER	Extensive Third Degree Burns With Skin Graft	3	3	—	—	$41,787.89	$41,787.89	$41,787.89	2026-05-09
8413	OTHER	Extensive Third Degree Burns With Skin Graft	3	3	—	—	$61,589.29	$61,589.29	$61,589.29	2026-05-09
8414	OTHER	Extensive Third Degree Burns With Skin Graft	3	3	—	—	$192,453.70	$192,453.70	$192,453.70	2026-05-09
8423	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	3	3	—	—	$36,394.03	$36,394.03	$36,394.03	2026-05-09
8424	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	3	3	—	—	$98,562.23	$98,562.23	$98,562.23	2026-05-09
8504	OTHER	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	3	3	—	—	$63,466.63	$63,466.63	$63,466.63	2026-05-09
8514	OTHER	Gender Related Procedures	3	3	—	—	$77,625.24	$77,625.24	$77,625.24	2026-05-09
8633	OTHER	Neonatal Aftercare	3	3	—	—	$38,686.01	$38,686.01	$38,686.01	2026-05-09
8634	OTHER	Neonatal Aftercare	3	3	—	—	$74,682.61	$74,682.61	$74,682.61	2026-05-09
9103	OTHER	Craniotomy For Multiple Significant Trauma	3	3	—	—	$38,183.85	$38,183.85	$38,183.85	2026-05-09
9104	OTHER	Craniotomy For Multiple Significant Trauma	3	3	—	—	$56,941.48	$56,941.48	$56,941.48	2026-05-09
9114	OTHER	Extensive Abdominal/thoracic Procedures For Mult Significant Trauma	3	3	—	—	$53,402.01	$53,402.01	$53,402.01	2026-05-09
9124	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	3	3	—	—	$49,938.58	$49,938.58	$49,938.58	2026-05-09
9504	OTHER	Extensive Procedure Unrelated To Principal Diagnosis	3	3	—	—	$46,934.97	$46,934.97	$46,934.97	2026-05-09
9514	OTHER	Moderately Extensive Procedure Unrelated To Principal Diagnosis	3	3	—	—	$35,226.16	$35,226.16	$35,226.16	2026-05-09
A9543	OTHER	Y90 Ibritumomab- Rx	13	5	—	—	$53,983.32	$70,418.21	$56,824.55	2026-05-09
C1721	OTHER	Aicd- Dual Chamber	1	1	—	—	$41,600.46	$41,600.46	$41,600.46	2026-05-09
C1882	OTHER	Aicd- Other Than Sing/dual	1	1	—	—	$43,675.42	$43,675.42	$43,675.42	2026-05-09
J1411	OTHER	Inj- Hemgenix- Per Tx Dose	12	5	—	—	$3,501,003.34	$4,016,940.67	$3,716,059.67	2026-05-09
J1413	OTHER	Inj Delandistrogene Mox Rokl	12	5	—	—	$3,158,343.31	$3,623,783.37	$3,341,194.76	2026-05-09
J1414	OTHER	Inj Beqvez Per Tx Dose	12	5	—	—	$3,524,500.00	$4,043,900.00	$3,728,550.00	2026-05-09
J3392	OTHER	Inj Exagamglogene Autotem	12	5	—	—	$2,215,400.00	$2,541,880.00	$2,343,660.00	2026-05-09
J3393	OTHER	Inj- Betibeglogene Autotemce	12	5	—	—	$2,803,152.34	$3,216,248.47	$2,974,096.77	2026-05-09
J3394	OTHER	Inj- Lovotibeglogene Autotem	12	5	—	—	$3,098,287.25	$3,554,876.95	$3,277,661.77	2026-05-09
J3399	OTHER	Inj Onase Abepar-xioi Treat	12	5	—	—	$2,329,509.82	$2,672,806.00	$2,464,376.18	2026-05-09
J9029	OTHER	Instill Adstiladrin- Tx Dose	18	6	—	—	$60,259.50	$73,690.23	$63,748.21	2026-05-09
J9226	OTHER	Supprelin La Implant	15	5	—	—	$43,282.37	$55,576.39	$45,560.39	2026-05-09
K1007	OTHER	Bil Hkaf Pc S/d Micro Sensor	1	1	—	—	$92,852.57	$92,852.57	$92,852.57	2026-05-09
L2006	OTHER	Kaf Sng/dbl Swg/stn Mcpr Cus	13	5	—	—	$35,936.80	$41,232.75	$37,828.21	2026-05-09
L7180	OTHER	Electronic Elbow Sequential	14	5	—	—	$17,622.37	$54,663.39	$41,907.21	2026-05-09
L7181	OTHER	Electronic Elbo Simultaneous	14	5	—	—	$37,129.52	$92,138.59	$47,211.27	2026-05-09
L8702	OTHER	Ewhf S/d Uprt Micro Sensor	12	5	—	—	$64,080.03	$73,523.40	$67,452.66	2026-05-09
MS-001	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	12	6	—	—	$170,310.86	$405,623.52	$190,031.07	2026-05-09
MS-002	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	12	6	—	—	$66,627.19	$190,063.56	$74,341.91	2026-05-09
MS-003	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth…	13	6	—	—	$3,396.00	$308,615.04	$140,491.46	2026-05-09
MS-004	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth And Nec…	13	6	—	—	$3,396.00	$203,472.00	$92,626.98	2026-05-09
MS-005	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	12	6	—	—	$64,388.28	$158,940.21	$71,843.76	2026-05-09
MS-007	OTHER	Lung Transplant	12	6	—	—	$79,016.43	$188,190.72	$88,165.71	2026-05-09
MS-008	OTHER	Simultaneous Pancreas/kidney Transplant	12	6	—	—	$32,897.92	$80,869.83	$36,707.15	2026-05-09
MS-010	OTHER	Pancreas Transplant	12	6	—	—	$48,206.26	$114,811.20	$53,788.04	2026-05-09
MS-011	OTHER	Tracheostomy For Facemouth & Neck Diagnoses W Mcc	13	6	—	—	$3,396.00	$77,700.96	$35,371.97	2026-05-09
MS-014	OTHER	Allogeneic Bone Marrow Transplant	13	6	—	—	$3,396.00	$188,665.92	$85,886.77	2026-05-09
MS-016	OTHER	Autologous Bone Marrow Transplant With Cc/mcc	13	6	—	—	$3,396.00	$86,916.96	$39,567.39	2026-05-09
MS-017	OTHER	Autologous Bone Marrow Transplant Without Cc/mcc	13	6	—	—	$3,396.00	$86,916.96	$37,740.25	2026-05-09
MS-018	OTHER	Chimeric Antigen Receptor (car) T-cell Immunotherapy	13	6	—	—	$3,396.00	$549,366.93	$247,220.29	2026-05-09
MS-019	OTHER	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	13	6	—	—	$3,396.00	$114,153.12	$51,966.16	2026-05-09
MS-020	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	13	6	—	—	$3,396.00	$116,079.84	$52,843.26	2026-05-09
MS-021	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	13	6	—	—	$3,396.00	$86,962.76	$36,233.34	2026-05-09
MS-023	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	13	6	—	—	$3,396.00	$82,153.44	$37,398.88	2026-05-09
MS-028	OTHER	Spinal Procedures With Mcc	13	6	—	—	$3,396.00	$87,544.80	$39,853.20	2026-05-09
MS-207	OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	13	6	—	—	$3,396.00	$93,127.68	$42,394.71	2026-05-09
MS-212	OTHER	Concomitant Aortic And Mitral Valve?procedures	13	6	—	—	$3,396.00	$161,709.72	$71,413.24	2026-05-09
MS-215	OTHER	Other Heart Assist System Implant	13	6	—	—	$3,396.00	$152,565.12	$69,452.53	2026-05-09
MS-216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	13	6	—	—	$3,396.00	$138,975.84	$63,266.26	2026-05-09
MS-217	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	13	6	—	—	$3,396.00	$92,993.76	$42,333.74	2026-05-09
MS-218	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	13	6	—	—	$3,396.00	$85,669.92	$38,999.69	2026-05-09
MS-219	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	13	6	—	—	$3,396.00	$111,420.00	$50,721.96	2026-05-09
MS-220	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	13	6	—	—	$3,396.00	$76,272.48	$34,721.68	2026-05-09
MS-231	OTHER	Coronary Bypass With Ptca With Mcc	13	6	—	—	$3,396.00	$122,024.16	$55,549.31	2026-05-09
MS-232	OTHER	Coronary Bypass With Ptca Without Mcc	13	6	—	—	$3,396.00	$87,965.28	$40,044.62	2026-05-09
MS-233	OTHER	Coronary Bypass With Cardiac Catheterization With Mcc	13	6	—	—	$3,396.00	$112,556.16	$51,239.17	2026-05-09
MS-234	OTHER	Coronary Bypass With Cardiac Catheterization Without Mcc	13	6	—	—	$3,396.00	$76,610.88	$34,875.73	2026-05-09
MS-235	OTHER	Coronary Bypass Without Cardiac Catheterization With Mcc	13	6	—	—	$3,396.00	$84,732.48	$38,572.94	2026-05-09
MS-266	OTHER	Endovascular Cardiac Valve Replacement W Mcc	13	6	—	—	$3,396.00	$86,267.52	$39,271.74	2026-05-09
MS-268	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	13	6	—	—	$3,396.00	$96,013.44	$43,708.40	2026-05-09
MS-275	OTHER	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	13	6	—	—	$3,396.00	$101,764.80	$46,326.60	2026-05-09
MS-276	OTHER	Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator	13	6	—	—	$3,396.00	$89,199.36	$40,606.41	2026-05-09
MS-317	OTHER	Concomitant Left Atrial Appendage Closure And Cardiac Ablation	13	6	—	—	$3,396.00	$92,606.59	$40,553.97	2026-05-09
MS-405	OTHER	Pancreas- Liver And Shunt Procedures With Mcc	13	6	—	—	$3,396.00	$78,173.28	$35,586.98	2026-05-09
MS-426	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	13	6	—	—	$3,396.00	$150,845.76	$68,669.83	2026-05-09
MS-427	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	13	6	—	—	$3,396.00	$102,278.88	$46,560.62	2026-05-09
MS-428	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	13	6	—	—	$3,396.00	$79,259.04	$36,081.26	2026-05-09
MS-429	OTHER	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	13	6	—	—	$3,396.00	$124,852.72	$54,675.48	2026-05-09
MS-430	OTHER	Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc	13	6	—	—	$3,396.00	$78,775.20	$35,861.00	2026-05-09
MS-447	OTHER	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	13	6	—	—	$3,396.00	$96,547.68	$43,951.60	2026-05-09
MS-456	OTHER	Spinal Fusion Except Cervical With Spinal Curvature- Malignancy- Infection Or Ex…	13	6	—	—	$3,396.00	$121,956.48	$55,518.50	2026-05-09
MS-457	OTHER	Spinal Fusion Except Cervical With Spinal Curvature- Malignancy- Infection Or Ex…	13	6	—	—	$3,396.00	$82,647.36	$37,623.73	2026-05-09
MS-461	OTHER	Bilateral Or Multiple Major Joint Procs Of Lower Extremity W Mcc	13	6	—	—	$3,396.00	$95,630.60	$40,228.16	2026-05-09
MS-463	OTHER	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …	13	6	—	—	$3,396.00	$77,774.40	$35,405.40	2026-05-09
MS-573	OTHER	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	13	6	—	—	$3,396.00	$88,678.08	$40,369.10	2026-05-09
MS-576	OTHER	Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc	13	6	—	—	$3,396.00	$81,932.73	$35,368.03	2026-05-09
MS-653	OTHER	Major Bladder Procedures With Mcc	13	6	—	—	$3,396.00	$82,007.58	$36,543.41	2026-05-09
MS-790	OTHER	Extreme Immaturity Or Respiratory Distress Syndrome- Neonate	12	6	—	—	$35,943.38	$97,681.53	$40,105.25	2026-05-09
MS-820	OTHER	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	13	6	—	—	$3,396.00	$83,841.12	$38,167.17	2026-05-09
MS-834	OTHER	Acute Leukemia Without Major O.r. Procedures With Mcc	13	6	—	—	$3,396.00	$101,933.11	$36,233.34	2026-05-09
MS-850	OTHER	Acute Leukemia With Other Procedures	13	6	—	—	$3,396.00	$137,891.89	$60,387.15	2026-05-09
MS-870	OTHER	Septicemia Or Severe Sepsis With Mv >96 Hours	13	6	—	—	$3,396.00	$100,173.60	$45,602.23	2026-05-09
MS-927	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	13	6	—	—	$3,396.00	$341,608.32	$155,511.06	2026-05-09
MS-928	OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	13	6	—	—	$3,396.00	$96,176.16	$41,019.50	2026-05-09
MS-955	OTHER	Craniotomy For Multiple Significant Trauma	13	6	—	—	$3,396.00	$98,327.52	$44,761.84	2026-05-09
MS-957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	13	6	—	—	$3,396.00	$107,484.48	$48,930.38	2026-05-09
MS-969	OTHER	HIV With Extensive O.r. Procedures With Mcc	13	6	—	—	$3,396.00	$98,909.10	$41,457.95	2026-05-09
Q0480	OTHER	Driver Pneumatic Vad- Rep	14	5	—	—	$83,459.27	$207,107.96	$106,120.90	2026-05-09
Q2041	OTHER	Axicabtagene Ciloleucel Car+	13	4	—	—	$489,517.15	$581,053.36	$533,076.48	2026-05-09
Q2042	OTHER	Tisagenlecleucel Car-pos T	12	4	—	—	$549,408.35	$630,373.79	$578,324.58	2026-05-09
Q2043	OTHER	Sipuleucel-t Auto Cd54+	15	5	—	—	$53,148.67	$68,902.76	$56,505.43	2026-05-09
Q2053	OTHER	Brexucabtagene Car Pos T	12	4	—	—	$465,234.00	$533,794.80	$489,720.00	2026-05-09
Q2054	OTHER	Lisocabtagene Mara Car Pos T	13	4	—	—	$514,553.87	$590,382.87	$541,635.66	2026-05-09
Q2055	OTHER	Idecabtagene Vicleucel Car	13	4	—	—	$514,197.42	$589,973.89	$541,260.45	2026-05-09
Q2056	OTHER	Ciltacabtagene Car-pos T	12	4	—	—	$525,709.89	$603,182.92	$553,378.83	2026-05-09
Q2057	OTHER	Afamitresgene Autoleucel	11	4	—	—	$732,089.00	$839,975.80	$770,620.00	2026-05-09

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