|
2067
|
OTHER
|
Afamitresgene Autoleucel
|
8
|
7
|
—
|
—
|
$757,719.82
|
$1,022,921.76
|
$757,719.82
|
2026-05-06
|
|
Both-35825249
|
OTHER
|
Gen Neurostimulator Spinal
|
14
|
13
|
$437,000.00
|
$87,400.00
80% off
|
$83,030.00
|
$314,640.00
|
$224,836.50
|
2026-05-06
|
|
UMC Main-35825249
|
OTHER
|
Gen Neurostimulator Spinal
|
14
|
13
|
$437,000.00
|
$87,400.00
80% off
|
$83,030.00
|
$314,640.00
|
$224,836.50
|
2026-05-06
|
|
Both-46035390
|
OTHER
|
Botulism Immune Globulin 100 Mg Inj
|
14
|
13
|
$225,000.00
|
$45,000.00
80% off
|
$42,750.00
|
$162,000.00
|
$112,500.00
|
2026-05-06
|
|
Both-46040325
|
OTHER
|
Sodium Benzoate-sodium Phenylacetate 10%-10% Inj 50 Ml
|
13
|
13
|
$219,000.00
|
$43,800.00
80% off
|
$41,610.00
|
$157,680.00
|
$109,500.00
|
2026-05-06
|
|
365
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
1
|
1
|
—
|
—
|
$81,987.14
|
$81,987.14
|
$81,987.14
|
2026-05-06
|
|
UMC Main-72133218
|
OTHER
|
Cci Cassette Prge Impella Pmp
|
14
|
13
|
$159,274.40
|
$31,854.88
80% off
|
$30,262.14
|
$114,677.57
|
$81,946.68
|
2026-05-06
|
|
Both-35811405
|
OTHER
|
Ors Matristem Matrix
|
14
|
13
|
$130,183.20
|
$26,036.64
80% off
|
$24,734.81
|
$93,731.90
|
$66,979.26
|
2026-05-06
|
|
UMC Main-35811405
|
OTHER
|
Ors Matristem Matrix
|
14
|
13
|
$130,183.20
|
$26,036.64
80% off
|
$24,734.81
|
$93,731.90
|
$66,979.26
|
2026-05-06
|
|
UMC Main-78419504
|
OTHER
|
Eps Icd Biventricular
|
14
|
13
|
$128,716.14
|
$25,743.23
80% off
|
$24,456.07
|
$92,675.62
|
$66,224.46
|
2026-05-06
|
|
UMC Main-72127756
|
OTHER
|
Icd Biventricular
|
14
|
13
|
$128,716.14
|
$25,743.23
80% off
|
$24,456.07
|
$92,675.62
|
$66,224.46
|
2026-05-06
|
|
UMC Main-35860816
|
OTHER
|
Gen Neurostim Demipulse
|
14
|
13
|
$126,267.12
|
$25,253.42
80% off
|
$23,990.75
|
$90,912.33
|
$64,964.43
|
2026-05-06
|
|
Both-35860816
|
OTHER
|
Gen Neurostim Demipulse
|
14
|
13
|
$126,267.12
|
$25,253.42
80% off
|
$23,990.75
|
$90,912.33
|
$64,964.43
|
2026-05-06
|
|
366
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
1
|
1
|
—
|
—
|
$62,398.63
|
$62,398.63
|
$62,398.63
|
2026-05-06
|
|
UMC Main-35842509
|
OTHER
|
Ors Nail Antegrade Tibial
|
14
|
13
|
$108,675.00
|
$21,735.00
80% off
|
$20,648.25
|
$78,246.00
|
$55,913.29
|
2026-05-06
|
|
Both-35842509
|
OTHER
|
Ors Nail Antegrade Tibial
|
14
|
13
|
$108,675.00
|
$21,735.00
80% off
|
$20,648.25
|
$78,246.00
|
$55,913.29
|
2026-05-06
|
|
UMC Main-35862648
|
OTHER
|
Ors Mesh Hernia Phasix St 30x35cm
|
14
|
13
|
$103,400.00
|
$20,680.00
80% off
|
$19,646.00
|
$74,448.00
|
$53,199.30
|
2026-05-06
|
|
Both-35862648
|
OTHER
|
Ors Mesh Hernia Phasix St 30x35cm
|
14
|
13
|
$103,400.00
|
$20,680.00
80% off
|
$19,646.00
|
$74,448.00
|
$53,199.30
|
2026-05-06
|
|
UMC Main-72168685
|
OTHER
|
Cci Grft Thoracoabdominal Bran
|
14
|
13
|
$101,500.00
|
$20,300.00
80% off
|
$19,285.00
|
$73,080.00
|
$52,221.75
|
2026-05-06
|
|
UMC Main-72169121
|
OTHER
|
Cci Excluder/tambe-stent
|
14
|
13
|
$101,500.00
|
$20,300.00
80% off
|
$19,285.00
|
$73,080.00
|
$52,221.75
|
2026-05-06
|
|
Both-35861228
|
OTHER
|
Or Matristem Surgical Thick
|
14
|
13
|
$97,637.40
|
$19,527.48
80% off
|
$18,551.11
|
$70,298.93
|
$50,234.44
|
2026-05-06
|
|
UMC Main-35861228
|
OTHER
|
Or Matristem Surgical Thick
|
14
|
13
|
$97,637.40
|
$19,527.48
80% off
|
$18,551.11
|
$70,298.93
|
$50,234.44
|
2026-05-06
|
|
367
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
1
|
1
|
—
|
—
|
$47,814.53
|
$47,814.53
|
$47,814.53
|
2026-05-06
|
|
UMC Main-35811389
|
OTHER
|
Ors Icd Defib Inogen
|
14
|
13
|
$92,610.00
|
$18,522.00
80% off
|
$17,595.90
|
$66,679.20
|
$47,647.85
|
2026-05-06
|
|
Both-35811389
|
OTHER
|
Ors Icd Defib Inogen
|
14
|
13
|
$92,610.00
|
$18,522.00
80% off
|
$17,595.90
|
$66,679.20
|
$47,647.85
|
2026-05-06
|
|
UMC Main-35865575
|
OTHER
|
Ors Nail Fem Trochanteric Aos 125d
|
14
|
13
|
$92,500.00
|
$18,500.00
80% off
|
$17,575.00
|
$66,600.00
|
$47,591.25
|
2026-05-06
|
|
Both-35865575
|
OTHER
|
Ors Nail Fem Trochanteric Aos 125d
|
14
|
13
|
$92,500.00
|
$18,500.00
80% off
|
$17,575.00
|
$66,600.00
|
$47,591.25
|
2026-05-06
|
|
UMC Main-35828649
|
OTHER
|
Ors Gen Neurostim Vns Model 102
|
14
|
13
|
$90,188.00
|
$18,037.60
80% off
|
$17,135.72
|
$64,935.36
|
$46,401.72
|
2026-05-06
|
|
Both-35828649
|
OTHER
|
Ors Gen Neurostim Vns Model 102
|
14
|
13
|
$90,188.00
|
$18,037.60
80% off
|
$17,135.72
|
$64,935.36
|
$46,401.72
|
2026-05-06
|
|
UMC Main-72125859
|
OTHER
|
Icd Dual Chamber
|
14
|
13
|
$88,311.72
|
$17,662.34
80% off
|
$16,779.23
|
$63,584.44
|
$45,436.38
|
2026-05-06
|
|
UMC Main-78419306
|
OTHER
|
Eps Icd Dual Chamber
|
14
|
13
|
$88,311.72
|
$17,662.34
80% off
|
$16,779.23
|
$63,584.44
|
$45,436.38
|
2026-05-06
|
|
UMC Main-72131816
|
OTHER
|
Neuro Stent Group F
|
14
|
13
|
$88,200.00
|
$17,640.00
80% off
|
$16,758.00
|
$63,504.00
|
$45,378.90
|
2026-05-06
|
|
UMC Main-78433463
|
OTHER
|
Eps Gallant Cdhf500d Generator
|
14
|
13
|
$87,355.00
|
$17,471.00
80% off
|
$16,597.45
|
$62,895.60
|
$44,944.15
|
2026-05-06
|
|
UMC Main-78433455
|
OTHER
|
Eps Gallant Hf Cd Umri Pr
|
14
|
13
|
$87,355.00
|
$17,471.00
80% off
|
$16,597.45
|
$62,895.60
|
$44,944.15
|
2026-05-06
|
|
UMC Main-35867142
|
OTHER
|
Ors Human Graft-artery
|
14
|
13
|
$86,450.00
|
$17,290.00
80% off
|
$16,425.50
|
$62,244.00
|
$44,478.53
|
2026-05-06
|
|
Both-35867142
|
OTHER
|
Ors Human Graft-artery
|
14
|
13
|
$86,450.00
|
$17,290.00
80% off
|
$16,425.50
|
$62,244.00
|
$44,478.53
|
2026-05-06
|
|
UMC Main-35857135
|
OTHER
|
Sys Neurostimulator Restore
|
14
|
13
|
$83,000.00
|
$16,600.00
80% off
|
$15,770.00
|
$59,760.00
|
$42,703.50
|
2026-05-06
|
|
Both-35857135
|
OTHER
|
Sys Neurostimulator Restore
|
14
|
13
|
$83,000.00
|
$16,600.00
80% off
|
$15,770.00
|
$59,760.00
|
$42,703.50
|
2026-05-06
|
|
UMC Main-35868470
|
OTHER
|
Ors Imp Neurostimulator
|
14
|
13
|
$80,647.00
|
$16,129.40
80% off
|
$15,322.93
|
$58,065.84
|
$41,492.88
|
2026-05-06
|
|
UMC Main-35871557
|
OTHER
|
Ors Sys Stimulation Percept Pc
|
14
|
13
|
$80,647.00
|
$16,129.40
80% off
|
$15,322.93
|
$58,065.84
|
$41,492.88
|
2026-05-06
|
|
Both-35871557
|
OTHER
|
Ors Sys Stimulation Percept Pc
|
14
|
13
|
$80,647.00
|
$16,129.40
80% off
|
$15,322.93
|
$58,065.84
|
$41,492.88
|
2026-05-06
|
|
Both-35868470
|
OTHER
|
Ors Imp Neurostimulator
|
14
|
13
|
$80,647.00
|
$16,129.40
80% off
|
$15,322.93
|
$58,065.84
|
$41,492.88
|
2026-05-06
|
|
UMC Main-35840933
|
OTHER
|
Impl Tmj Max
|
14
|
13
|
$79,800.00
|
$15,960.00
80% off
|
$15,162.00
|
$57,456.00
|
$41,057.10
|
2026-05-06
|
|
Both-35840933
|
OTHER
|
Impl Tmj Max
|
14
|
13
|
$79,800.00
|
$15,960.00
80% off
|
$15,162.00
|
$57,456.00
|
$41,057.10
|
2026-05-06
|
|
UMC Main-78433562
|
OTHER
|
Eps Cobalt Crtd Xt Hf MRI Df4
|
14
|
13
|
$78,780.00
|
$15,756.00
80% off
|
$14,968.20
|
$56,721.60
|
$40,532.31
|
2026-05-06
|
|
UMC Main-35865948
|
OTHER
|
Ors Stimulator Abbott Eterna
|
14
|
13
|
$78,750.00
|
$15,750.00
80% off
|
$14,962.50
|
$56,700.00
|
$40,516.88
|
2026-05-06
|
|
Both-35865948
|
OTHER
|
Ors Stimulator Abbott Eterna
|
14
|
13
|
$78,750.00
|
$15,750.00
80% off
|
$14,962.50
|
$56,700.00
|
$40,516.88
|
2026-05-06
|
|
Both-35861145
|
OTHER
|
Or Nail Femur Antegrade
|
14
|
13
|
$77,700.00
|
$15,540.00
80% off
|
$14,763.00
|
$55,944.00
|
$39,976.65
|
2026-05-06
|
|
UMC Main-35861145
|
OTHER
|
Or Nail Femur Antegrade
|
14
|
13
|
$77,700.00
|
$15,540.00
80% off
|
$14,763.00
|
$55,944.00
|
$39,976.65
|
2026-05-06
|
|
UMC Main-35814300
|
OTHER
|
Or Mesh Phasix
|
14
|
13
|
$76,468.35
|
$15,293.67
80% off
|
$14,528.99
|
$55,057.21
|
$39,342.97
|
2026-05-06
|
|
Both-35814300
|
OTHER
|
Or Mesh Phasix
|
14
|
13
|
$76,468.35
|
$15,293.67
80% off
|
$14,528.99
|
$55,057.21
|
$39,342.97
|
2026-05-06
|
|
Both-46047155
|
OTHER
|
Elranatamab Bcmm 76 mg/1.9mL Inj
|
14
|
13
|
$78,304.30
|
$15,660.86
80% off
|
$14,877.82
|
$56,379.10
|
$39,152.15
|
2026-05-06
|
|
UMC Main-35871581
|
OTHER
|
Ors Generator Proclaim Elite Ipg
|
14
|
13
|
$75,250.00
|
$15,050.00
80% off
|
$14,297.50
|
$54,180.00
|
$38,716.12
|
2026-05-06
|
|
Both-35871581
|
OTHER
|
Ors Generator Proclaim Elite Ipg
|
14
|
13
|
$75,250.00
|
$15,050.00
80% off
|
$14,297.50
|
$54,180.00
|
$38,716.12
|
2026-05-06
|
|
Both-46034567
|
OTHER
|
Histrelin 50 Mg Implant
|
19
|
17
|
$61,148.58
|
$12,229.72
80% off
|
$11,618.23
|
$45,020.65
|
$38,523.61
|
2026-05-06
|
|
UMC Main-87610000
|
OTHER
|
Impl Neurostim Gen 2+ Array
|
2
|
2
|
$103,552.02
|
$20,710.40
80% off
|
$9,115.20
|
$65,237.77
|
$37,176.49
|
2026-05-06
|
|
Both-87610000
|
OTHER
|
Impl Neurostim Gen 2+ Array
|
2
|
2
|
$103,552.02
|
$20,710.40
80% off
|
$9,115.20
|
$65,237.77
|
$37,176.49
|
2026-05-06
|
|
UMC Main-72169816
|
OTHER
|
Cci Thoracic Stent Graft Tag Gore
|
14
|
13
|
$71,988.00
|
$14,397.60
80% off
|
$13,677.72
|
$51,831.36
|
$37,037.82
|
2026-05-06
|
|
UMC Main-72169923
|
OTHER
|
Ors Stent Graft- Gore
|
14
|
13
|
$71,988.00
|
$14,397.60
80% off
|
$13,677.72
|
$51,831.36
|
$37,037.82
|
2026-05-06
|
|
UMC Main-72169410
|
OTHER
|
Cci Emblem MRI S-icd A219
|
14
|
13
|
$71,750.00
|
$14,350.00
80% off
|
$13,632.50
|
$51,660.00
|
$36,915.38
|
2026-05-06
|
|
UMC Main-72126303
|
OTHER
|
Icd Gem Vr
|
14
|
13
|
$71,271.48
|
$14,254.30
80% off
|
$13,541.58
|
$51,315.47
|
$36,669.18
|
2026-05-06
|
|
UMC Main-72125156
|
OTHER
|
Icd Ventak Vr
|
14
|
13
|
$71,271.48
|
$14,254.30
80% off
|
$13,541.58
|
$51,315.47
|
$36,669.18
|
2026-05-06
|
|
UMC Main-78419405
|
OTHER
|
Eps Dfb Imp Gem Vr 7227
|
14
|
13
|
$71,271.48
|
$14,254.30
80% off
|
$13,541.58
|
$51,315.47
|
$36,669.18
|
2026-05-06
|
|
UMC Main-72117708
|
OTHER
|
Cci Icd Single Chamber
|
14
|
13
|
$71,271.48
|
$14,254.30
80% off
|
$13,541.58
|
$51,315.47
|
$36,669.18
|
2026-05-06
|
|
773
|
OTHER
|
Inj, Beqvez, Per Tx Dose
|
23
|
10
|
—
|
—
|
$5,954.42
|
$4,866,750.00
|
$3,605,000.00
|
2026-05-23
|
|
9138
|
OTHER
|
Inj, Hemgenix, Per Tx Dose
|
28
|
9
|
—
|
—
|
$3,443,049.92
|
$4,975,110.00
|
$3,443,049.92
|
2026-05-23
|
|
9141
|
OTHER
|
Inj Onase Abepar-xioi Treat
|
28
|
9
|
—
|
—
|
$2,388,614.23
|
$3,314,399.32
|
$2,388,614.23
|
2026-05-23
|
|
9194
|
OTHER
|
Tisagenlecleucel Car-pos T
|
26
|
8
|
—
|
—
|
$529,192.86
|
$798,830.37
|
$529,192.86
|
2026-05-23
|
|
9498
|
OTHER
|
Ciltacabtagene Car-pos T
|
26
|
8
|
—
|
—
|
$527,123.43
|
$763,923.08
|
$527,123.43
|
2026-05-23
|
|
9422
|
OTHER
|
Idecabtagene Vicleucel Car
|
26
|
8
|
—
|
—
|
$526,587.59
|
$752,379.21
|
$526,587.59
|
2026-05-23
|
|
9413
|
OTHER
|
Lisocabtagene Car Pos T
|
26
|
8
|
—
|
—
|
$516,726.08
|
$759,426.55
|
$516,726.08
|
2026-05-23
|
|
9035
|
OTHER
|
Axicabtagene Ciloleucel Car+
|
26
|
8
|
—
|
—
|
$489,455.96
|
$719,860.73
|
$489,455.96
|
2026-05-23
|
|
9391
|
OTHER
|
Brexucabtagene Car Pos T
|
26
|
8
|
—
|
—
|
$431,710.41
|
$660,561.22
|
$431,710.41
|
2026-05-23
|
|
5834
|
OTHER
|
Neonate With Ecmo
|
13
|
5
|
—
|
—
|
$390,367.39
|
$642,707.02
|
$405,982.08
|
2026-05-23
|
|
5833
|
OTHER
|
Neonate With Ecmo
|
13
|
5
|
—
|
—
|
$330,548.76
|
$544,220.68
|
$343,770.71
|
2026-05-23
|
|
5884
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
13
|
5
|
—
|
—
|
$247,096.15
|
$406,823.00
|
$256,980.00
|
2026-05-23
|
|
1614
|
OTHER
|
Implantable Heart Assist Systems
|
13
|
5
|
—
|
—
|
$239,947.31
|
$395,053.04
|
$249,545.21
|
2026-05-23
|
|
18
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
35
|
11
|
—
|
—
|
$229,897.98
|
$1,186,533.80
|
$235,645.15
|
2026-05-23
|
|
612
|
OTHER
|
Neonate, Birth Weight <750 Grams, Discharged Alive
|
3
|
1
|
—
|
—
|
$219,596.96
|
$264,456.79
|
$219,596.96
|
2026-05-23
|
|
1
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
35
|
11
|
—
|
—
|
$171,714.52
|
$770,012.70
|
$203,923.19
|
2026-05-23
|
|
636
|
OTHER
|
Neonate, Birth Weight 1500-1999 Grams, With Significant O.r. Procedures, With Mu…
|
3
|
1
|
—
|
—
|
$169,573.19
|
$201,508.78
|
$201,508.78
|
2026-05-23
|
|
6304
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
13
|
5
|
—
|
—
|
$183,856.01
|
$302,703.43
|
$191,210.25
|
2026-05-23
|
|
6094
|
OTHER
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
13
|
5
|
—
|
—
|
$182,226.72
|
$300,020.94
|
$189,515.79
|
2026-05-23
|
|
633
|
OTHER
|
Neonate, Birth Weight 1000-1499 Grams, With Significant O.r. Procedures, Dischar…
|
3
|
1
|
—
|
—
|
$181,043.28
|
$288,594.30
|
$181,043.28
|
2026-05-23
|
|
631
|
OTHER
|
Neonate, Birth Weight 750-999 Grams, Discharged Alive
|
3
|
1
|
—
|
—
|
$176,367.01
|
$191,760.16
|
$176,367.01
|
2026-05-23
|
|
5832
|
OTHER
|
Neonate With Ecmo
|
13
|
5
|
—
|
—
|
$164,704.90
|
$271,172.74
|
$171,293.09
|
2026-05-23
|
|
2004
|
OTHER
|
Cardiac Structural And Valvular Disorders
|
13
|
5
|
—
|
—
|
$145,336.89
|
$239,284.95
|
$151,150.37
|
2026-05-23
|
|
5831
|
OTHER
|
Neonate With Ecmo
|
13
|
5
|
—
|
—
|
$145,025.94
|
$238,772.99
|
$150,826.97
|
2026-05-23
|
|
927
|
OTHER
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
63
|
11
|
—
|
—
|
$1.55
|
$614,420.52
|
$144,614.66
|
2026-05-23
|
|
1907
|
OTHER
|
New Technology - Level 52 ($145,001-$160,000)
|
26
|
8
|
—
|
—
|
$142,957.02
|
$202,429.32
|
$142,957.02
|
2026-05-23
|
|
1908
|
OTHER
|
New Technology - Level 52 ($145,001-$160,000)
|
34
|
12
|
—
|
—
|
$135,725.45
|
$202,429.32
|
$142,957.02
|
2026-05-23
|
|
5883
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
13
|
5
|
—
|
—
|
$132,583.70
|
$218,287.90
|
$137,887.05
|
2026-05-23
|
|
5882
|
OTHER
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
13
|
5
|
—
|
—
|
$131,977.73
|
$217,290.21
|
$137,256.84
|
2026-05-23
|
|
44
|
OTHER
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
13
|
5
|
—
|
—
|
$131,636.45
|
$216,728.33
|
$136,901.91
|
2026-05-23
|
|
8414
|
OTHER
|
Extensive Third Degree Burns With Skin Graft
|
13
|
5
|
—
|
—
|
$131,070.57
|
$215,796.65
|
$136,313.39
|
2026-05-23
|
|
6314
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
13
|
5
|
—
|
—
|
$129,761.48
|
$213,641.35
|
$134,951.94
|
2026-05-23
|
|
8504
|
OTHER
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…
|
13
|
5
|
—
|
—
|
$126,343.06
|
$208,013.20
|
$131,396.78
|
2026-05-23
|
|
3
|
OTHER
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
43
|
15
|
—
|
—
|
$123,427.80
|
$583,204.82
|
$130,647.46
|
2026-05-23
|
|
5914
|
OTHER
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
13
|
5
|
—
|
—
|
$125,211.29
|
$206,149.84
|
$130,219.74
|
2026-05-23
|
|
1906
|
OTHER
|
New Technology - Level 51 ($130,001-$145,000)
|
26
|
8
|
—
|
—
|
$128,895.72
|
$182,518.30
|
$128,895.72
|
2026-05-23
|
|
1905
|
OTHER
|
New Technology - Level 51 ($130,001-$145,000)
|
26
|
8
|
—
|
—
|
$128,895.72
|
$182,518.30
|
$128,895.72
|
2026-05-23
|
|
6814
|
OTHER
|
Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms
|
13
|
5
|
—
|
—
|
$111,433.24
|
$183,465.44
|
$115,890.57
|
2026-05-23
|
|
1604
|
OTHER
|
Major Cardiothoracic Repair Of Heart Anomaly
|
13
|
5
|
—
|
—
|
$111,371.05
|
$183,363.05
|
$115,825.89
|
2026-05-23
|
|
1904
|
OTHER
|
New Technology - Level 50 ($115,001-$130,000)
|
39
|
12
|
—
|
—
|
$12,799.96
|
$162,607.29
|
$114,834.42
|
2026-05-23
|
|
1903
|
OTHER
|
New Technology - Level 50 ($115,001-$130,000)
|
39
|
12
|
—
|
—
|
$7,253.69
|
$162,607.29
|
$114,834.42
|
2026-05-23
|
|
2464
|
OTHER
|
Gastrointestinal Vascular Insufficiency
|
13
|
5
|
—
|
—
|
$107,998.88
|
$177,811.06
|
$112,318.84
|
2026-05-23
|
|
6034
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
13
|
5
|
—
|
—
|
$107,441.73
|
$176,893.77
|
$111,739.40
|
2026-05-23
|
|
5891
|
OTHER
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
13
|
5
|
—
|
—
|
$104,260.76
|
$171,656.56
|
$108,431.19
|
2026-05-23
|
|
5934
|
OTHER
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
13
|
5
|
—
|
—
|
$103,948.78
|
$171,142.91
|
$108,106.73
|
2026-05-23
|
|
5892
|
OTHER
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
13
|
5
|
—
|
—
|
$101,049.98
|
$166,370.28
|
$105,091.98
|
2026-05-23
|
|
681
|
OTHER
|
Neonate, Birth Weight >2499 Grams, With Significant O.r. Procedures, With Multip…
|
3
|
1
|
—
|
—
|
$103,912.95
|
$115,500.82
|
$103,912.95
|
2026-05-23
|
|
1624
|
OTHER
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
13
|
5
|
—
|
—
|
$97,152.53
|
$159,953.46
|
$101,038.63
|
2026-05-23
|
|
1902
|
OTHER
|
New Technology - Level 49 ($100,001-$115,000)
|
39
|
12
|
—
|
—
|
$5,468.66
|
$142,696.27
|
$100,773.12
|
2026-05-23
|
|
1901
|
OTHER
|
New Technology - Level 49 ($100,001-$115,000)
|
39
|
12
|
—
|
—
|
$5,084.72
|
$142,696.27
|
$100,773.12
|
2026-05-23
|
|
6024
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
13
|
5
|
—
|
—
|
$95,558.19
|
$157,328.51
|
$99,380.52
|
2026-05-23
|
|
5893
|
OTHER
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
13
|
5
|
—
|
—
|
$94,782.60
|
$156,051.57
|
$98,573.91
|
2026-05-23
|
|
14
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
48
|
15
|
—
|
—
|
$79,868.83
|
$339,336.62
|
$95,842.60
|
2026-05-23
|
|
6214
|
OTHER
|
Neonate Birth Weight 2000-2499 Grams With Major Anomaly
|
13
|
5
|
—
|
—
|
$90,743.30
|
$149,401.20
|
$94,373.03
|
2026-05-23
|
|
7
|
OTHER
|
Lung Transplant
|
35
|
11
|
—
|
—
|
$79,667.67
|
$355,832.65
|
$94,235.50
|
2026-05-23
|
|
1612
|
OTHER
|
Implantable Heart Assist Systems
|
13
|
5
|
—
|
—
|
$89,901.41
|
$148,015.10
|
$93,497.47
|
2026-05-23
|
|
8634
|
OTHER
|
Neonatal Aftercare
|
13
|
5
|
—
|
—
|
$87,495.00
|
$144,053.14
|
$90,994.80
|
2026-05-23
|
|
6303
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
13
|
5
|
—
|
—
|
$86,654.65
|
$142,669.58
|
$90,120.84
|
2026-05-23
|
|
1585
|
OTHER
|
New Technology - Level 48 ($90,001-$100,000)
|
26
|
8
|
—
|
—
|
$89,055.37
|
$126,103.76
|
$89,055.37
|
2026-05-23
|
|
1599
|
OTHER
|
New Technology - Level 48 ($90,001-$100,000)
|
26
|
8
|
—
|
—
|
$89,055.37
|
$126,103.76
|
$89,055.37
|
2026-05-23
|
|
1611
|
OTHER
|
Implantable Heart Assist Systems
|
13
|
5
|
—
|
—
|
$85,263.33
|
$140,378.89
|
$88,673.86
|
2026-05-23
|
|
4404
|
OTHER
|
Kidney Transplant
|
13
|
5
|
—
|
—
|
$85,052.60
|
$140,031.94
|
$88,454.70
|
2026-05-23
|
|
43
|
OTHER
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
13
|
5
|
—
|
—
|
$84,635.26
|
$139,344.82
|
$88,020.67
|
2026-05-23
|
|
4
|
OTHER
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
43
|
15
|
—
|
—
|
$75,173.23
|
$380,594.92
|
$86,136.76
|
2026-05-23
|
|
635
|
OTHER
|
Neonate, Birth Weight 1000-1499 Grams, Died
|
3
|
1
|
—
|
—
|
$57,572.32
|
$85,877.84
|
$85,877.84
|
2026-05-23
|
|
6804
|
OTHER
|
Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms
|
13
|
5
|
—
|
—
|
$82,451.39
|
$135,749.26
|
$85,749.44
|
2026-05-23
|
|
5913
|
OTHER
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
13
|
5
|
—
|
—
|
$82,451.39
|
$135,749.26
|
$85,749.44
|
2026-05-23
|
|
6084
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition
|
13
|
5
|
—
|
—
|
$82,217.53
|
$135,364.24
|
$85,506.23
|
2026-05-23
|
|
4414
|
OTHER
|
Major Bladder Procedures
|
13
|
5
|
—
|
—
|
$80,490.59
|
$132,520.97
|
$83,710.21
|
2026-05-23
|
|
209
|
OTHER
|
Complex Aortic Arch Procedures
|
13
|
10
|
—
|
—
|
$3,733.10
|
$311,006.67
|
$82,364.19
|
2026-05-23
|
|
634
|
OTHER
|
Neonate, Birth Weight 1000-1499 Grams, Without Significant O.r. Procedures, Disc…
|
3
|
1
|
—
|
—
|
$81,512.79
|
$103,441.39
|
$81,512.79
|
2026-05-23
|
|
2
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
35
|
11
|
—
|
—
|
$67,176.31
|
$311,363.87
|
$80,611.57
|
2026-05-23
|
|
1584
|
OTHER
|
New Technology - Level 47 ($80,001-$90,000)
|
26
|
8
|
—
|
—
|
$79,681.17
|
$112,829.75
|
$79,681.17
|
2026-05-23
|
|
1598
|
OTHER
|
New Technology - Level 47 ($80,001-$90,000)
|
26
|
8
|
—
|
—
|
$79,681.17
|
$112,829.75
|
$79,681.17
|
2026-05-23
|
|
1784
|
OTHER
|
External Heart Assist Systems
|
13
|
5
|
—
|
—
|
$75,388.39
|
$124,120.63
|
$78,403.92
|
2026-05-23
|
|
613
|
OTHER
|
Neonate, Birth Weight <750 Grams, Died
|
3
|
1
|
—
|
—
|
$37,077.23
|
$77,886.61
|
$77,886.61
|
2026-05-23
|
|
5933
|
OTHER
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
13
|
5
|
—
|
—
|
$74,242.23
|
$122,233.57
|
$77,211.92
|
2026-05-23
|
|
6114
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Major Anomaly
|
13
|
5
|
—
|
—
|
$74,156.91
|
$122,093.10
|
$77,123.18
|
2026-05-23
|
|
1674
|
OTHER
|
Other Cardiothoracic And Thoracic Vascular Procedures
|
13
|
5
|
—
|
—
|
$73,828.99
|
$121,553.22
|
$76,782.15
|
2026-05-23
|
|
6904
|
OTHER
|
Acute Leukemia
|
13
|
5
|
—
|
—
|
$73,165.97
|
$120,461.61
|
$76,092.61
|
2026-05-23
|
|
5
|
OTHER
|
Liver Transplant With Mcc Or Intestinal Transplant
|
35
|
11
|
—
|
—
|
$64,918.96
|
$283,301.61
|
$75,027.03
|
2026-05-23
|
|
215
|
OTHER
|
Other Heart Assist System Implant
|
43
|
15
|
—
|
—
|
$64,586.11
|
$274,405.32
|
$72,454.70
|
2026-05-23
|
|
6334
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Major Anomaly
|
13
|
5
|
—
|
—
|
$68,961.68
|
$113,539.60
|
$71,720.15
|
2026-05-23
|
|
3034
|
OTHER
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
13
|
5
|
—
|
—
|
$68,541.25
|
$112,847.39
|
$71,282.90
|
2026-05-23
|
|
5912
|
OTHER
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
13
|
5
|
—
|
—
|
$68,076.62
|
$112,082.42
|
$70,799.68
|
2026-05-23
|
|
1597
|
OTHER
|
New Technology - Level 46 ($70,001-$80,000)
|
26
|
8
|
—
|
—
|
$70,306.97
|
$99,555.74
|
$70,306.97
|
2026-05-23
|
|
1583
|
OTHER
|
New Technology - Level 46 ($70,001-$80,000)
|
26
|
8
|
—
|
—
|
$70,306.97
|
$99,555.74
|
$70,306.97
|
2026-05-23
|
|
6074
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
13
|
5
|
—
|
—
|
$67,410.51
|
$110,985.73
|
$70,106.93
|
2026-05-23
|
|
46035390
|
OTHER
|
Botulism Immune Globulin 100 Mg Inj
|
30
|
13
|
$135,000.00
|
$27,000.00
80% off
|
$25,650.00
|
$97,200.00
|
$67,500.00
|
2026-05-23
|
|
2204
|
OTHER
|
Major Stomach, Esophageal And Duodenal Procedures
|
13
|
5
|
—
|
—
|
$64,236.22
|
$105,759.53
|
$66,805.67
|
2026-05-23
|
|
6134
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection
|
13
|
5
|
—
|
—
|
$63,886.21
|
$105,183.26
|
$66,441.65
|
2026-05-23
|
|
212
|
OTHER
|
Concomitant Aortic And Mitral Valve Procedures
|
48
|
15
|
—
|
—
|
$7,267.42
|
$298,787.65
|
$66,409.43
|
2026-05-23
|
|
4474
|
OTHER
|
Other Kidney, Urinary Tract And Related Procedures
|
13
|
5
|
—
|
—
|
$63,736.64
|
$104,937.01
|
$66,286.11
|
2026-05-23
|
|
1643
|
OTHER
|
Y90 Ibritumomab, Rx
|
26
|
8
|
—
|
—
|
$56,824.55
|
$88,393.39
|
$65,476.58
|
2026-05-23
|
|
632
|
OTHER
|
Neonate, Birth Weight 750-999 Grams, Died
|
3
|
1
|
—
|
—
|
$65,461.43
|
$94,111.87
|
$65,461.43
|
2026-05-23
|
|
216
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
43
|
15
|
—
|
—
|
$58,833.30
|
$268,802.00
|
$65,396.11
|
2026-05-23
|
|
6023
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
13
|
5
|
—
|
—
|
$61,758.88
|
$101,680.79
|
$64,229.23
|
2026-05-23
|
|
426
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
35
|
11
|
—
|
—
|
$12,033.18
|
$302,829.51
|
$63,858.25
|
2026-05-23
|
|
112
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
16
|
6
|
—
|
—
|
$2,666.30
|
$101,685.02
|
$61,761.45
|
2026-05-23
|
|
429
|
OTHER
|
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc
|
33
|
11
|
—
|
—
|
$50,844.46
|
$247,556.78
|
$61,013.36
|
2026-05-23
|
|
6093
|
OTHER
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
13
|
5
|
—
|
—
|
$58,617.48
|
$96,508.74
|
$60,962.18
|
2026-05-23
|
|
1582
|
OTHER
|
New Technology - Level 45 ($60,001-$70,000)
|
26
|
8
|
—
|
—
|
$60,932.77
|
$86,281.73
|
$60,932.77
|
2026-05-23
|
|
1596
|
OTHER
|
New Technology - Level 45 ($60,001-$70,000)
|
26
|
8
|
—
|
—
|
$60,932.77
|
$86,281.73
|
$60,932.77
|
2026-05-23
|
|
5932
|
OTHER
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
13
|
5
|
—
|
—
|
$58,329.14
|
$96,034.02
|
$60,662.31
|
2026-05-23
|
|
3033
|
OTHER
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
13
|
5
|
—
|
—
|
$57,983.24
|
$95,464.52
|
$60,302.57
|
2026-05-23
|
|
1634
|
OTHER
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
13
|
5
|
—
|
—
|
$57,902.03
|
$95,330.81
|
$60,218.11
|
2026-05-23
|
|
7924
|
OTHER
|
Extensive O.r. Procedures For Other Complications Of Treatment
|
13
|
5
|
—
|
—
|
$56,954.27
|
$93,770.40
|
$59,232.44
|
2026-05-23
|
|
3044
|
OTHER
|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
13
|
5
|
—
|
—
|
$56,940.39
|
$93,747.55
|
$59,218.00
|
2026-05-23
|
|
456
|
OTHER
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
47
|
16
|
—
|
—
|
$95.00
|
$230,900.22
|
$59,136.77
|
2026-05-23
|
|
2054
|
OTHER
|
Cardiomyopathy
|
13
|
5
|
—
|
—
|
$56,779.51
|
$93,482.69
|
$59,050.70
|
2026-05-23
|
|
6954
|
OTHER
|
Chemotherapy For Acute Leukemia
|
13
|
5
|
—
|
—
|
$56,706.53
|
$93,362.53
|
$58,974.79
|
2026-05-23
|
|
8413
|
OTHER
|
Extensive Third Degree Burns With Skin Graft
|
13
|
5
|
—
|
—
|
$56,648.45
|
$93,266.90
|
$58,914.39
|
2026-05-23
|
|
6514
|
OTHER
|
Other Procedures Of Blood And Blood-forming Organs
|
13
|
5
|
—
|
—
|
$55,510.00
|
$91,392.55
|
$57,730.40
|
2026-05-23
|
|
20
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
43
|
15
|
—
|
—
|
$49,140.63
|
$216,211.02
|
$57,259.37
|
2026-05-23
|
|
6144
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition
|
13
|
5
|
—
|
—
|
$54,755.49
|
$90,150.31
|
$56,945.71
|
2026-05-23
|
|
1623
|
OTHER
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
13
|
5
|
—
|
—
|
$54,662.46
|
$89,997.14
|
$56,848.96
|
2026-05-23
|
|
2304
|
OTHER
|
Major Small Bowel Procedures
|
13
|
5
|
—
|
—
|
$54,336.09
|
$89,459.80
|
$56,509.54
|
2026-05-23
|
|
850
|
OTHER
|
Acute Leukemia With Other Procedures
|
53
|
11
|
—
|
—
|
$370.18
|
$238,588.21
|
$56,155.93
|
2026-05-23
|
|
4424
|
OTHER
|
Kidney And Urinary Tract Procedures For Malignancy
|
13
|
5
|
—
|
—
|
$53,825.20
|
$88,618.66
|
$55,978.21
|
2026-05-23
|
|
9273
|
OTHER
|
Sipuleucel-t Auto Cd54+
|
28
|
9
|
—
|
—
|
$55,015.23
|
$4,676,294.13
|
$55,015.23
|
2026-05-23
|
|
35862648
|
OTHER
|
Ors Mesh Hernia Phasix St 30x35cm
|
22
|
11
|
$103,400.00
|
$20,680.00
80% off
|
$10,000.00
|
$74,448.00
|
$54,698.60
|
2026-05-23
|
|
214
|
OTHER
|
Open Craniotomy Except Trauma
|
16
|
6
|
—
|
—
|
$4,219.33
|
$89,783.90
|
$54,532.94
|
2026-05-23
|
|
4403
|
OTHER
|
Kidney Transplant
|
13
|
5
|
—
|
—
|
$52,056.11
|
$85,706.00
|
$54,138.36
|
2026-05-23
|
|
3154
|
OTHER
|
Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement
|
13
|
5
|
—
|
—
|
$52,052.51
|
$85,700.08
|
$54,134.61
|
2026-05-23
|
|
224
|
OTHER
|
Ventricular Shunt Procedures
|
21
|
9
|
—
|
—
|
$48,164.05
|
$89,106.93
|
$54,121.77
|
2026-05-23
|
|
1204
|
OTHER
|
Major Respiratory And Chest Procedures
|
13
|
5
|
—
|
—
|
$51,664.98
|
$85,062.04
|
$53,731.58
|
2026-05-23
|
|
4834
|
OTHER
|
Penis, Testes And Scrotal Procedures
|
13
|
5
|
—
|
—
|
$51,468.64
|
$84,738.78
|
$53,527.39
|
2026-05-23
|
|
361
|
OTHER
|
Cardiac Defibrillator Implant With Mcc
|
3
|
1
|
—
|
—
|
$39,476.39
|
$53,031.50
|
$53,031.50
|
2026-05-23
|
|
9124
|
OTHER
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
13
|
5
|
—
|
—
|
$50,849.31
|
$83,719.10
|
$52,883.28
|
2026-05-23
|
|
1304
|
OTHER
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
13
|
5
|
—
|
—
|
$50,836.46
|
$83,697.94
|
$52,869.91
|
2026-05-23
|
|
647
|
OTHER
|
Neonate, Birth Weight 1500-1999 Grams, Without Significant O.r. Procedures, With…
|
3
|
1
|
—
|
—
|
$52,649.80
|
$57,692.74
|
$52,649.80
|
2026-05-23
|
|
1654
|
OTHER
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
13
|
5
|
—
|
—
|
$50,079.38
|
$82,451.47
|
$52,082.55
|
2026-05-23
|
|
19
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
35
|
11
|
—
|
—
|
$48,324.98
|
$205,317.07
|
$51,916.77
|
2026-05-23
|
|
231
|
OTHER
|
Coronary Bypass With Ptca With Mcc
|
56
|
19
|
—
|
—
|
$10,320.56
|
$231,628.36
|
$51,657.06
|
2026-05-23
|
|
1595
|
OTHER
|
New Technology - Level 44 ($50,001-$60,000)
|
28
|
9
|
—
|
—
|
$51,558.57
|
$4,382,478.34
|
$51,558.57
|
2026-05-23
|
|
1581
|
OTHER
|
New Technology - Level 44 ($50,001-$60,000)
|
28
|
9
|
—
|
—
|
$51,558.57
|
$4,382,478.34
|
$51,558.57
|
2026-05-23
|
|
219
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
43
|
15
|
—
|
—
|
$47,167.95
|
$210,976.65
|
$51,054.73
|
2026-05-23
|
|
5911
|
OTHER
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
13
|
5
|
—
|
—
|
$49,083.81
|
$80,812.36
|
$51,047.16
|
2026-05-23
|
|
2604
|
OTHER
|
Major Pancreas, Liver And Shunt Procedures
|
13
|
5
|
—
|
—
|
$48,816.03
|
$80,371.49
|
$50,768.67
|
2026-05-23
|
|
1783
|
OTHER
|
External Heart Assist Systems
|
13
|
5
|
—
|
—
|
$48,244.50
|
$79,430.50
|
$50,174.28
|
2026-05-23
|
|
6313
|
OTHER
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
13
|
5
|
—
|
—
|
$48,040.45
|
$79,094.55
|
$49,962.07
|
2026-05-23
|
|
6254
|
OTHER
|
Neonate Birth Weight 2000-2499 Grams With Other Significant Condition
|
13
|
5
|
—
|
—
|
$47,652.40
|
$78,455.66
|
$49,558.50
|
2026-05-23
|
|
6124
|
OTHER
|
Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…
|
13
|
5
|
—
|
—
|
$47,515.17
|
$78,229.72
|
$49,415.78
|
2026-05-23
|
|
233
|
OTHER
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
56
|
19
|
—
|
—
|
$30,569.51
|
$210,067.16
|
$49,362.24
|
2026-05-23
|
|
957
|
OTHER
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
43
|
15
|
—
|
—
|
$45,501.91
|
$209,371.99
|
$49,059.45
|
2026-05-23
|
|
1603
|
OTHER
|
Major Cardiothoracic Repair Of Heart Anomaly
|
13
|
5
|
—
|
—
|
$47,064.42
|
$77,487.60
|
$48,946.99
|
2026-05-23
|
|
35865575
|
OTHER
|
Ors Nail Fem Trochanteric Aos 125d
|
22
|
11
|
$92,500.00
|
$18,500.00
80% off
|
$10,000.00
|
$66,600.00
|
$48,932.50
|
2026-05-23
|
|
2244
|
OTHER
|
Peritoneal Adhesiolysis
|
13
|
5
|
—
|
—
|
$46,989.38
|
$77,364.05
|
$48,868.95
|
2026-05-23
|
|
5244
|
OTHER
|
Level 4 Blood Product Exchange And Related Services
|
37
|
13
|
—
|
—
|
$33,317.93
|
$4,148,668.87
|
$48,807.87
|
2026-05-23
|
|
447
|
OTHER
|
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…
|
33
|
11
|
—
|
—
|
$40,871.99
|
$183,590.32
|
$48,620.40
|
2026-05-23
|
|
10
|
OTHER
|
Pancreas Transplant
|
35
|
11
|
—
|
—
|
$42,312.91
|
$206,500.70
|
$48,603.57
|
2026-05-23
|
|
6022
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
13
|
5
|
—
|
—
|
$46,661.98
|
$76,825.01
|
$48,528.46
|
2026-05-23
|
|
3614
|
OTHER
|
Skin Graft For Skin And Subcutaneous Tissue Diagnoses
|
13
|
5
|
—
|
—
|
$46,531.43
|
$76,610.07
|
$48,392.68
|
2026-05-23
|
|
21
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
56
|
19
|
—
|
—
|
$33,694.53
|
$145,457.74
|
$48,384.10
|
2026-05-23
|
|
35828649
|
OTHER
|
Ors Gen Neurostim Vns Model 102
|
22
|
11
|
$90,188.00
|
$18,037.60
80% off
|
$10,000.00
|
$64,935.36
|
$47,709.45
|
2026-05-23
|
|
51
|
OTHER
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
13
|
5
|
—
|
—
|
$45,497.32
|
$74,907.50
|
$47,317.21
|
2026-05-23
|
|
646
|
OTHER
|
Neonate, Birth Weight 1500-1999 Grams, With Significant O.r. Procedures, Without…
|
3
|
1
|
—
|
—
|
$47,216.46
|
$53,720.42
|
$47,216.46
|
2026-05-23
|
|
1814
|
OTHER
|
Lower Extremity Arterial Procedures
|
13
|
5
|
—
|
—
|
$45,058.38
|
$74,184.83
|
$46,860.72
|
2026-05-23
|
|
2274
|
OTHER
|
Hernia Procedures Except Inguinal, Femoral And Umbilical
|
13
|
5
|
—
|
—
|
$44,920.64
|
$73,958.05
|
$46,717.46
|
2026-05-23
|
|
6604
|
OTHER
|
Major Hematologic Or Immunologic Diagnoses Except Sickle Cell Crisis And Coagula…
|
13
|
5
|
—
|
—
|
$44,773.13
|
$73,715.18
|
$46,564.05
|
2026-05-23
|
|
6234
|
OTHER
|
Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection
|
13
|
5
|
—
|
—
|
$44,763.88
|
$73,699.95
|
$46,554.43
|
2026-05-23
|
|
8424
|
OTHER
|
Burns With Skin Graft Except Extensive Third Degree Burns
|
13
|
5
|
—
|
—
|
$44,713.51
|
$73,617.02
|
$46,502.05
|
2026-05-23
|
|
35867142
|
OTHER
|
Ors Human Graft-artery
|
22
|
11
|
$86,450.00
|
$17,290.00
80% off
|
$10,000.00
|
$62,244.00
|
$45,732.05
|
2026-05-23
|
|
1142
|
OTHER
|
Supprelin La Implant
|
41
|
13
|
—
|
—
|
$3,749.94
|
$3,854,768.36
|
$45,350.22
|
2026-05-23
|
|
1834
|
OTHER
|
Percutaneous Structural Cardiac Procedures
|
13
|
5
|
—
|
—
|
$43,573.52
|
$71,740.13
|
$45,316.46
|
2026-05-23
|
|
459
|
OTHER
|
Spinal Fusion Except Cervical W Mcc
|
10
|
5
|
—
|
—
|
$40,391.72
|
$44,620.22
|
$44,620.22
|
2026-05-23
|
|
2614
|
OTHER
|
Major Biliary Tract Procedures
|
13
|
5
|
—
|
—
|
$42,882.23
|
$70,601.97
|
$44,597.51
|
2026-05-23
|
|
266
|
OTHER
|
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc
|
43
|
15
|
—
|
—
|
$35,622.80
|
$168,390.05
|
$44,594.90
|
2026-05-23
|
|
6073
|
OTHER
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
13
|
5
|
—
|
—
|
$42,729.06
|
$70,349.80
|
$44,438.22
|
2026-05-23
|
|
72131816
|
OTHER
|
Neuro Stent Group F
|
22
|
11
|
$84,000.00
|
$16,800.00
80% off
|
$10,000.00
|
$60,480.00
|
$44,436.00
|
2026-05-23
|
|
317
|
OTHER
|
Concomitant Left Atrial Appendage Closure And Cardiac Ablation
|
35
|
11
|
—
|
—
|
$37,712.42
|
$183,724.96
|
$44,298.24
|
2026-05-23
|
|
1833
|
OTHER
|
Percutaneous Structural Cardiac Procedures
|
13
|
5
|
—
|
—
|
$42,503.43
|
$69,978.31
|
$44,203.57
|
2026-05-23
|
|
268
|
OTHER
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
43
|
15
|
—
|
—
|
$12,796.39
|
$188,984.06
|
$44,168.29
|
2026-05-23
|
|
35857135
|
OTHER
|
Sys Neurostimulator Restore
|
22
|
11
|
$83,000.00
|
$16,600.00
80% off
|
$10,000.00
|
$59,760.00
|
$43,907.00
|
2026-05-23
|
|
3032
|
OTHER
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
13
|
5
|
—
|
—
|
$42,069.64
|
$69,264.11
|
$43,752.42
|
2026-05-23
|
|
226
|
OTHER
|
Cardiac Defibrillator Implant Without Cardiac Cath W Mcc
|
8
|
4
|
—
|
—
|
$43,550.30
|
$43,550.30
|
$43,550.30
|
2026-05-23
|
|
217
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
43
|
15
|
—
|
—
|
$39,367.49
|
$180,669.52
|
$43,315.22
|
2026-05-23
|
|
427
|
OTHER
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
35
|
11
|
—
|
—
|
$11,582.58
|
$198,345.47
|
$43,298.20
|
2026-05-23
|
|
46034567
|
OTHER
|
Histrelin 50 Mg Implant
|
42
|
18
|
$61,148.58
|
$12,229.72
80% off
|
$11,618.23
|
$58,955.28
|
$43,241.39
|
2026-05-23
|
|
275
|
OTHER
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
35
|
11
|
—
|
—
|
$41,282.62
|
$195,922.00
|
$43,080.57
|
2026-05-23
|
|
1782
|
OTHER
|
External Heart Assist Systems
|
13
|
5
|
—
|
—
|
$41,406.61
|
$68,172.50
|
$43,062.88
|
2026-05-23
|
|
7104
|
OTHER
|
Infectious And Parasitic Diseases Including HIV With O.r. Procedure
|
13
|
5
|
—
|
—
|
$41,336.20
|
$68,056.57
|
$42,989.65
|
2026-05-23
|
|
6033
|
OTHER
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
13
|
5
|
—
|
—
|
$40,973.33
|
$67,459.14
|
$42,612.27
|
2026-05-23
|
|
16
|
OTHER
|
Autologous Bone Marrow Transplant With Cc/mcc
|
35
|
11
|
—
|
—
|
$36,794.97
|
$162,930.37
|
$42,600.37
|
2026-05-23
|
|
1622
|
OTHER
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
13
|
5
|
—
|
—
|
$40,817.09
|
$67,201.89
|
$42,449.77
|
2026-05-23
|
|
457
|
OTHER
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
43
|
15
|
—
|
—
|
$34,987.50
|
$163,848.10
|
$42,414.61
|
2026-05-23
|
|
870
|
OTHER
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
51
|
15
|
—
|
—
|
$82.08
|
$189,915.53
|
$42,406.96
|
2026-05-23
|
|
35840933
|
OTHER
|
Impl Tmj Max
|
22
|
11
|
$79,800.00
|
$15,960.00
80% off
|
$10,000.00
|
$57,456.00
|
$42,214.20
|
2026-05-23
|
|
1580
|
OTHER
|
New Technology - Level 43 ($40,001-$50,000)
|
28
|
9
|
—
|
—
|
$42,184.37
|
$3,585,671.34
|
$42,184.37
|
2026-05-23
|
|
1594
|
OTHER
|
New Technology - Level 43 ($40,001-$50,000)
|
28
|
9
|
—
|
—
|
$42,184.37
|
$3,585,671.34
|
$42,184.37
|
2026-05-23
|
|
2234
|
OTHER
|
Other Small And Large Bowel Procedures
|
13
|
5
|
—
|
—
|
$40,346.29
|
$66,426.76
|
$41,960.14
|
2026-05-23
|
|
6914
|
OTHER
|
Lymphoma, Myeloma And Non-acute Leukemia
|
13
|
5
|
—
|
—
|
$40,098.04
|
$66,018.04
|
$41,701.96
|
2026-05-23
|
|
23
|
OTHER
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
56
|
19
|
—
|
—
|
$34,778.40
|
$157,451.45
|
$41,698.02
|
2026-05-23
|
|
35865948
|
OTHER
|
Ors Stimulator Abbott Eterna
|
22
|
11
|
$78,750.00
|
$15,750.00
80% off
|
$10,000.00
|
$56,700.00
|
$41,658.75
|
2026-05-23
|
|
955
|
OTHER
|
Craniotomy For Multiple Significant Trauma
|
43
|
15
|
—
|
—
|
$39,596.22
|
$184,950.43
|
$41,625.45
|
2026-05-23
|
|
213
|
OTHER
|
Open Craniotomy Except Trauma
|
26
|
14
|
—
|
—
|
$13,831.62
|
$156,808.49
|
$41,527.74
|
2026-05-23
|
|
6944
|
OTHER
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
13
|
5
|
—
|
—
|
$39,692.00
|
$65,349.54
|
$41,279.68
|
2026-05-23
|
|
7234
|
OTHER
|
Viral Illness
|
13
|
5
|
—
|
—
|
$39,638.03
|
$65,260.68
|
$41,223.56
|
2026-05-23
|
|
928
|
OTHER
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
63
|
11
|
—
|
—
|
$1.65
|
$197,084.28
|
$40,714.71
|
2026-05-23
|
|
35814300
|
OTHER
|
Or Mesh Phasix
|
22
|
11
|
$76,468.35
|
$15,293.67
80% off
|
$10,000.00
|
$55,057.21
|
$40,451.76
|
2026-05-23
|
|
1633
|
OTHER
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
13
|
5
|
—
|
—
|
$38,778.67
|
$63,845.82
|
$40,329.82
|
2026-05-23
|
|
430
|
OTHER
|
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc
|
33
|
11
|
—
|
—
|
$33,348.28
|
$158,462.61
|
$40,017.93
|
2026-05-23
|
|
6614
|
OTHER
|
Coagulation And Platelet Disorders
|
13
|
5
|
—
|
—
|
$38,350.53
|
$63,140.92
|
$39,884.56
|
2026-05-23
|
|
8
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant
|
35
|
11
|
—
|
—
|
$33,169.05
|
$153,997.59
|
$39,802.87
|
2026-05-23
|
|
234
|
OTHER
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc
|
56
|
19
|
—
|
—
|
$32,432.05
|
$150,098.61
|
$39,750.76
|
2026-05-23
|
|
11
|
OTHER
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc
|
56
|
19
|
—
|
—
|
$32,194.03
|
$149,862.31
|
$39,688.18
|
2026-05-23
|
|
17
|
OTHER
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
35
|
11
|
—
|
—
|
$36,794.97
|
$156,329.81
|
$39,529.54
|
2026-05-23
|
|
1781
|
OTHER
|
External Heart Assist Systems
|
13
|
5
|
—
|
—
|
$37,956.83
|
$62,492.73
|
$39,475.11
|
2026-05-23
|
|
207
|
OTHER
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
43
|
15
|
—
|
—
|
$37,350.23
|
$176,806.25
|
$39,424.18
|
2026-05-23
|
|
924
|
OTHER
|
Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures
|
15
|
6
|
—
|
—
|
$89.00
|
$64,559.18
|
$39,211.95
|
2026-05-23
|
|
35861145
|
OTHER
|
Or Nail Femur Antegrade
|
22
|
11
|
$74,000.00
|
$14,800.00
80% off
|
$10,000.00
|
$53,280.00
|
$39,146.00
|
2026-05-23
|
|
1764
|
OTHER
|
Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices
|
13
|
5
|
—
|
—
|
$37,598.08
|
$61,902.07
|
$39,102.00
|
2026-05-23
|
|
1664
|
OTHER
|
Coronary Bypass Without Ami Or Complex Principal Diagnosis
|
21
|
11
|
—
|
—
|
$2,194.62
|
$63,719.73
|
$38,702.09
|
2026-05-23
|
|
969
|
OTHER
|
HIV With Extensive O.r. Procedures With Mcc
|
43
|
15
|
—
|
—
|
$37,787.18
|
$168,194.96
|
$38,553.06
|
2026-05-23
|
|
5134
|
OTHER
|
Uterine And Adnexa Procedures For Non-malignancy Except Leiomyoma
|
13
|
5
|
—
|
—
|
$37,065.09
|
$61,024.55
|
$38,547.69
|
2026-05-23
|
|
1794
|
OTHER
|
Defibrillator Implants
|
13
|
5
|
—
|
—
|
$37,042.48
|
$60,987.32
|
$38,524.18
|
2026-05-23
|
|
3124
|
OTHER
|
Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses
|
13
|
5
|
—
|
—
|
$36,992.11
|
$60,904.39
|
$38,471.79
|
2026-05-23
|
|
235
|
OTHER
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
43
|
15
|
—
|
—
|
$35,870.20
|
$161,251.52
|
$38,320.52
|
2026-05-23
|
|
8412
|
OTHER
|
Extensive Third Degree Burns With Skin Graft
|
13
|
5
|
—
|
—
|
$36,812.22
|
$60,608.21
|
$38,284.71
|
2026-05-23
|
|
1714
|
OTHER
|
Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock
|
13
|
5
|
—
|
—
|
$36,617.42
|
$60,287.50
|
$38,082.12
|
2026-05-23
|
|
834
|
OTHER
|
Acute Leukemia With Mcc
|
51
|
15
|
—
|
—
|
$19.47
|
$150,845.98
|
$38,046.36
|
2026-05-23
|
|
8411
|
OTHER
|
Extensive Third Degree Burns With Skin Graft
|
13
|
5
|
—
|
—
|
$36,525.93
|
$60,136.87
|
$37,986.97
|
2026-05-23
|
|
2644
|
OTHER
|
Other Hepatobiliary, Pancreas And Abdominal Procedures
|
13
|
5
|
—
|
—
|
$36,333.71
|
$59,820.39
|
$37,787.06
|
2026-05-23
|
|
276
|
OTHER
|
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator
|
35
|
11
|
—
|
—
|
$31,716.27
|
$165,043.35
|
$37,761.19
|
2026-05-23
|
|
450
|
OTHER
|
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically …
|
33
|
11
|
—
|
—
|
$31,395.11
|
$146,441.42
|
$37,674.14
|
2026-05-23
|
|
1621
|
OTHER
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
13
|
5
|
—
|
—
|
$36,216.52
|
$59,627.45
|
$37,665.18
|
2026-05-23
|
|
573
|
OTHER
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
56
|
19
|
—
|
—
|
$10,044.55
|
$180,012.82
|
$37,540.51
|
2026-05-23
|
|
608
|
OTHER
|
Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period
|
3
|
1
|
—
|
—
|
$31,374.02
|
$37,470.34
|
$37,470.34
|
2026-05-23
|
|
461
|
OTHER
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
56
|
19
|
—
|
—
|
$5,761.63
|
$158,940.53
|
$37,409.45
|
2026-05-23
|
|
5104
|
OTHER
|
Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced…
|
13
|
5
|
—
|
—
|
$35,826.93
|
$58,986.03
|
$37,260.01
|
2026-05-23
|
|
232
|
OTHER
|
Coronary Bypass With Ptca Without Mcc
|
56
|
19
|
—
|
—
|
$15,006.44
|
$166,582.06
|
$37,238.76
|
2026-05-23
|
|
7404
|
OTHER
|
Mental Illness Diagnosis With O.r. Procedure
|
13
|
5
|
—
|
—
|
$35,791.47
|
$58,927.64
|
$37,223.13
|
2026-05-23
|
|
3043
|
OTHER
|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
13
|
5
|
—
|
—
|
$35,653.72
|
$58,700.85
|
$37,079.87
|
2026-05-23
|
|
28
|
OTHER
|
Spinal Procedures With Mcc
|
43
|
15
|
—
|
—
|
$33,755.46
|
$165,090.06
|
$37,060.75
|
2026-05-23
|
|
225
|
OTHER
|
Cardiac Defib Implant W Cardiac Cath Without Ami/hf/shock Without Mcc
|
8
|
4
|
—
|
—
|
$36,784.99
|
$36,784.99
|
$36,784.99
|
2026-05-23
|
|
3104
|
OTHER
|
Intervertebral Disc Excision And Decompression
|
13
|
5
|
—
|
—
|
$35,275.95
|
$58,078.89
|
$36,686.99
|
2026-05-23
|