|
83205-0001-2 [386990]
|
OTHER
|
Afamitresgene Autoleucel 2.68x 10exp9 To 10x 10exp9 Cell IV Suspension [205503]
|
45
|
26
|
$799,700.00
|
—
|
$79,970.00
|
$679,745.00
|
$599,775.00
|
2026-05-06
|
|
0078-0846-19 [301288]
|
OTHER
|
Tisagenlecleucel 0.2 X10exp6 To 2.5x10exp8 Cell Intravenous Suspension [183167]
|
45
|
27
|
$652,886.70
|
—
|
$65,288.67
|
$927,623.10
|
$489,665.03
|
2026-05-06
|
|
73776-001-11 [380874]
|
OTHER
|
Lifileucel 7.5 X 10exp9 To 72 X 10exp9 Cell Intravenous Suspension [203845]
|
2
|
2
|
$618,200.00
|
—
|
$432,740.00
|
$494,560.00
|
$463,650.00
|
2026-05-06
|
|
73776-001-12 [380875]
|
OTHER
|
Lifileucel 7.5 X 10exp9 To 72 X 10exp9 Cell Intravenous Suspension [203845]
|
2
|
2
|
$618,200.00
|
—
|
$432,740.00
|
$494,560.00
|
$463,650.00
|
2026-05-06
|
|
57894-111-01 [355195]
|
OTHER
|
Ciltacabtagene Autoleucel 0.5 X 10exp6 To 1x 10exp8 Cell IV Suspension [196949]
|
44
|
26
|
$610,841.50
|
—
|
$61,084.15
|
$904,162.08
|
$458,131.13
|
2026-05-06
|
|
57894-111-02 [355196]
|
OTHER
|
Ciltacabtagene Autoleucel 0.5 X 10exp6 To 1x 10exp8 Cell IV Suspension [196949]
|
44
|
26
|
$610,841.50
|
—
|
$61,084.15
|
$904,162.08
|
$458,131.13
|
2026-05-06
|
|
73153-901-08 [344357]
|
OTHER
|
Lisocabtagene Maraleucel(cd8) 1.5x To 70x 10exp6 Cell/ml IV Susp(1of2) [40800003…
|
44
|
26
|
$584,485.45
|
—
|
$58,448.54
|
$847,036.99
|
$438,364.09
|
2026-05-06
|
|
73153-900-01 [343995]
|
OTHER
|
Lisocabtagene Maraleucel 1.5 X 10exp6 To 70 X 10exp6 Cell/ml IV Susp [193841]
|
44
|
26
|
$584,485.45
|
—
|
$58,448.54
|
$847,036.99
|
$438,364.09
|
2026-05-06
|
|
59572-515-01 [344806]
|
OTHER
|
Idecabtagene Vicleucel 300 X 10exp6 To 510 X 10exp6 Cell IV Suspension [194238]
|
44
|
26
|
$581,143.70
|
—
|
$24.42
|
$866,432.39
|
$435,857.78
|
2026-05-06
|
|
59572-515-03 [344808]
|
OTHER
|
Idecabtagene Vicleucel 300 X 10exp6 To 510 X 10exp6 Cell IV Suspension [194238]
|
44
|
26
|
$581,143.70
|
—
|
$72.25
|
$866,432.39
|
$435,857.78
|
2026-05-06
|
|
59572-515-02 [344807]
|
OTHER
|
Idecabtagene Vicleucel 300 X 10exp6 To 510 X 10exp6 Cell IV Suspension [194238]
|
44
|
26
|
$581,143.70
|
—
|
$36.80
|
$866,432.39
|
$435,857.78
|
2026-05-06
|
|
71287-119-01 [302981]
|
OTHER
|
Axicabtagene Ciloleucel Intravenous Suspension [183620]
|
45
|
27
|
$553,938.00
|
—
|
$55,393.80
|
$802,808.13
|
$415,453.50
|
2026-05-06
|
|
0078-0958-19 [308872]
|
OTHER
|
Tisagenlecleucel 0.6 X 10exp8 To 6 X10exp8 Cell Intravenous Suspension [185152]
|
45
|
27
|
$537,819.65
|
—
|
$53,781.96
|
$927,623.10
|
$403,364.74
|
2026-05-06
|
|
71287-220-02 [352195]
|
OTHER
|
Brexucabtagene Autoleucel 1x 10exp6 To 1x 10exp8 Cell IV Suspension [196078]
|
44
|
26
|
$508,200.00
|
—
|
$50,820.00
|
$800,404.48
|
$381,150.00
|
2026-05-06
|
|
71287-220-01 [351628]
|
OTHER
|
Brexucabtagene Autoleucel 1x 10exp6 To 1x 10exp8 Cell IV Suspension [196078]
|
44
|
26
|
$508,200.00
|
—
|
$50,820.00
|
$800,404.48
|
$381,150.00
|
2026-05-06
|
|
71287-219-02 [336953]
|
OTHER
|
Brexucabtagene Autoleucel 2x 10exp6 To 2x 10exp8 Cell IV Suspension [192076]
|
44
|
26
|
$508,200.00
|
—
|
$50,820.00
|
$800,404.48
|
$381,150.00
|
2026-05-06
|
|
71287-219-01 [336952]
|
OTHER
|
Brexucabtagene Autoleucel 2x 10exp6 To 2x 10exp8 Cell IV Suspension [192076]
|
44
|
26
|
$508,200.00
|
—
|
$50,820.00
|
$800,404.48
|
$381,150.00
|
2026-05-06
|
|
83047-010-10 [389040]
|
OTHER
|
Obecabtagene Autoleucel Intravenous Suspension 10 X 10exp6 Cell Intravenous Susp…
|
48
|
28
|
$288,750.00
|
—
|
$80,850.00
|
$525,000.00
|
$216,562.50
|
2026-05-06
|
|
83047-100-10 [389041]
|
OTHER
|
Obecabtagene Autoleucel Intravenous Suspension 100 X 10exp6 Cell Intravenous Sus…
|
48
|
28
|
$288,750.00
|
—
|
$80,850.00
|
$525,000.00
|
$216,562.50
|
2026-05-06
|
|
83047-100-30 [389042]
|
OTHER
|
Obecabtagene Autoleucel Intravenous Suspension 100 X 10exp6 Cell Intravenous Sus…
|
48
|
28
|
$288,750.00
|
—
|
$80,850.00
|
$525,000.00
|
$216,562.50
|
2026-05-06
|
|
16
|
OTHER
|
Stem Cell Transplant- Single- Allo Unrelated
|
4
|
4
|
—
|
—
|
$160,000.00
|
$186,960.00
|
$176,250.00
|
2026-05-06
|
|
11
|
OTHER
|
Stem Cell Transplant- Tandem- Auto/Allo Unrelated
|
2
|
2
|
—
|
—
|
$112,000.00
|
$240,000.00
|
$176,000.00
|
2026-05-06
|
|
17
|
OTHER
|
Stem Cell Transplant- Single- Mismatch Allo Related/Unrelated
|
2
|
2
|
—
|
—
|
$160,000.00
|
$180,000.00
|
$170,000.00
|
2026-05-06
|
|
1907
|
OTHER
|
New Technology - Level 52 ($145,001-$160,000)
|
1
|
1
|
—
|
—
|
$152,500.50
|
$152,500.50
|
$152,500.50
|
2026-05-06
|
|
1908
|
OTHER
|
New Technology - Level 52 ($145,001-$160,000)
|
1
|
1
|
—
|
—
|
$152,500.50
|
$152,500.50
|
$152,500.50
|
2026-05-06
|
|
15
|
OTHER
|
Stem Cell Transplant- Single- Allo Related With Aml, Cml, Lymphoma And Renal Cell
|
1
|
1
|
—
|
—
|
$145,000.00
|
$145,000.00
|
$145,000.00
|
2026-05-06
|
|
55566-1050-1 [371473]
|
OTHER
|
Nadofaragene Firadenovec-vncg 3x10exp11 Vp/ml Intravesical Suspension [201881]
|
81
|
34
|
$190,800.00
|
—
|
$53,424.00
|
$164,088.00
|
$141,192.00
|
2026-05-06
|
|
55566-1050-0 [371472]
|
OTHER
|
Nadofaragene Firadenovec-vncg 3x10exp11 Vp/ml Intravesical Suspension [201881]
|
81
|
34
|
$190,800.00
|
—
|
$53,424.00
|
$164,088.00
|
$141,192.00
|
2026-05-06
|
|
1905
|
OTHER
|
New Technology - Level 51 ($130,001-$145,000)
|
1
|
1
|
—
|
—
|
$137,500.50
|
$137,500.50
|
$137,500.50
|
2026-05-06
|
|
1906
|
OTHER
|
New Technology - Level 51 ($130,001-$145,000)
|
1
|
1
|
—
|
—
|
$137,500.50
|
$137,500.50
|
$137,500.50
|
2026-05-06
|
|
30237-8900-6 [193937]
|
OTHER
|
Sipuleucel-t In Lactated Ringers 50 Million Cell/250 Ml IV Suspension [104852]
|
80
|
34
|
$184,051.35
|
—
|
$51,534.38
|
$158,284.16
|
$137,118.26
|
2026-05-06
|
|
9
|
OTHER
|
Stem Cell Transplant- Tandem Auto To Auto
|
1
|
1
|
—
|
—
|
$135,000.00
|
$135,000.00
|
$135,000.00
|
2026-05-06
|
|
13
|
OTHER
|
Stem Cell Transplant- Single- Allo Related
|
5
|
5
|
—
|
—
|
$130,000.00
|
$145,000.00
|
$135,000.00
|
2026-05-06
|
|
12
|
OTHER
|
Stem Cell Transplant- Tandem- Auto/Allo Unrelated With Aml, Cml, Lymphoma And Rena…
|
2
|
2
|
—
|
—
|
$122,500.00
|
$137,500.00
|
$130,000.00
|
2026-05-06
|
|
18
|
OTHER
|
Stem Cell Transplant- Single- Mismatch Allo Related/Unrelated With Aml, Cml, Lymph…
|
2
|
2
|
—
|
—
|
$82,500.00
|
$175,000.00
|
$128,750.00
|
2026-05-06
|
|
1904
|
OTHER
|
New Technology - Level 50 ($115,001-$130,000)
|
1
|
1
|
—
|
—
|
$122,500.50
|
$122,500.50
|
$122,500.50
|
2026-05-06
|
|
1903
|
OTHER
|
New Technology - Level 50 ($115,001-$130,000)
|
1
|
1
|
—
|
—
|
$122,500.50
|
$122,500.50
|
$122,500.50
|
2026-05-06
|
|
10
|
OTHER
|
Stem Cell Transplant- Tandem Auto To Allo Related With Aml, Cml, Lymphoma And Rena…
|
2
|
2
|
—
|
—
|
$101,500.00
|
$129,375.00
|
$115,437.50
|
2026-05-06
|
|
88880-5018-00 [313224]
|
OTHER
|
Factor Xa,inactivated-zhzo (recombinant) High-dose Infusion 1760 Mg In 176 Ml (1…
|
81
|
34
|
$153,912.00
|
—
|
$131.80
|
$132,364.32
|
$113,894.88
|
2026-05-06
|
|
1901
|
OTHER
|
New Technology - Level 49 ($100,001-$115,000)
|
1
|
1
|
—
|
—
|
$107,500.50
|
$107,500.50
|
$107,500.50
|
2026-05-06
|
|
1902
|
OTHER
|
New Technology - Level 49 ($100,001-$115,000)
|
1
|
1
|
—
|
—
|
$107,500.50
|
$107,500.50
|
$107,500.50
|
2026-05-06
|
|
67979-002-01 [152036]
|
OTHER
|
Histrelin 50 Mg (65 Mcg/day) Implant Kit [164961]
|
81
|
34
|
$143,376.10
|
—
|
$4.35
|
$123,303.45
|
$106,098.31
|
2026-05-06
|
|
19
|
OTHER
|
Car-t Therapy Infusion
|
2
|
2
|
—
|
—
|
$82,500.00
|
$120,000.00
|
$101,250.00
|
2026-05-06
|
|
50633-210-11 [229846]
|
OTHER
|
Glucarpidase 1,000 Unit Intravenous Solution [116024]
|
81
|
34
|
$130,933.35
|
—
|
$73.92
|
$112,602.68
|
$98,200.01
|
2026-05-06
|
|
0310-4535-30 [363166]
|
OTHER
|
Tremelimumab-actl 20 Mg/ml Intravenous Solution [199299]
|
80
|
34
|
$129,030.45
|
—
|
$138.43
|
$110,966.19
|
$96,127.68
|
2026-05-06
|
|
1599
|
OTHER
|
New Technology - Level 48 ($90,001-$100,000)
|
1
|
1
|
—
|
—
|
$95,000.50
|
$95,000.50
|
$95,000.50
|
2026-05-06
|
|
1585
|
OTHER
|
New Technology - Level 48 ($90,001-$100,000)
|
1
|
1
|
—
|
—
|
$95,000.50
|
$95,000.50
|
$95,000.50
|
2026-05-06
|
|
81900013
|
OTHER
|
Hc Marrow Collection
|
81
|
34
|
$116,477.00
|
—
|
$2,688.42
|
$100,170.22
|
$87,357.75
|
2026-05-06
|
|
6
|
OTHER
|
Ccu- Intermediate Per Diem
|
6
|
6
|
$3,129.00
|
—
|
$2,659.65
|
$110,000.00
|
$86,500.00
|
2026-05-06
|
|
66658-510-01 [343712]
|
OTHER
|
Emapalumab-lzsg 5 Mg/ml Intravenous Solution [187168]
|
81
|
34
|
$115,484.90
|
—
|
$376.57
|
$99,317.01
|
$85,458.83
|
2026-05-06
|
|
1598
|
OTHER
|
New Technology - Level 47 ($80,001-$90,000)
|
1
|
1
|
—
|
—
|
$85,000.50
|
$85,000.50
|
$85,000.50
|
2026-05-06
|
|
1584
|
OTHER
|
New Technology - Level 47 ($80,001-$90,000)
|
1
|
1
|
—
|
—
|
$85,000.50
|
$85,000.50
|
$85,000.50
|
2026-05-06
|
|
4
|
OTHER
|
Medical/Surgical Per Diem
|
1
|
1
|
—
|
—
|
$84,360.00
|
$84,360.00
|
$84,360.00
|
2026-05-06
|
|
81481-803-01 [383019]
|
OTHER
|
Nogapendekin Alfa Inbakicept-pmln 400 Mcg/0.4 Ml Intravesical Solution [204422]
|
81
|
34
|
$113,844.00
|
—
|
$94.87
|
$97,905.84
|
$84,244.56
|
2026-05-06
|
|
0003-2328-22 [204101]
|
OTHER
|
Ipilimumab 200 Mg/40 Ml (5 Mg/ml) Intravenous Solution [108956]
|
83
|
34
|
$112,917.80
|
—
|
$63.22
|
$97,109.31
|
$83,559.17
|
2026-05-06
|
|
8
|
OTHER
|
Stem Cell Transplant- Tandem Auto To Allo 1st Attempt Related
|
3
|
3
|
—
|
—
|
$82,500.00
|
$195,000.00
|
$83,000.00
|
2026-05-06
|
|
7
|
OTHER
|
Stem Cell Transplant- Tandem Auto To Auto 1st Atempt
|
3
|
3
|
—
|
—
|
$82,500.00
|
$135,000.00
|
$83,000.00
|
2026-05-06
|
|
14
|
OTHER
|
Stem Cell Transplant- Tandem Auto To Allo 1st Attempt Unrelated
|
1
|
1
|
—
|
—
|
$82,500.00
|
$82,500.00
|
$82,500.00
|
2026-05-06
|
|
88880-3330-01 [317963]
|
OTHER
|
Tagraxofusp-erzs Injection 100 Mcg/ml (ip-cmpd) [40800003330]
|
80
|
34
|
$107,412.30
|
—
|
$338.89
|
$92,374.58
|
$80,022.17
|
2026-05-06
|
|
72187-0401-1 [317962]
|
OTHER
|
Tagraxofusp-erzs 1,000 Mcg/ml Intravenous Solution [187739]
|
80
|
34
|
$107,346.15
|
—
|
$338.89
|
$92,317.69
|
$79,972.88
|
2026-05-06
|
|
81900007
|
OTHER
|
Hc Secondary Pbsc Collection
|
80
|
34
|
$101,773.00
|
—
|
$28,496.44
|
$87,524.78
|
$76,329.75
|
2026-05-06
|
|
81900005
|
OTHER
|
Hc Primary Pbsc Collection
|
80
|
34
|
$101,773.00
|
—
|
$28,496.44
|
$87,524.78
|
$76,329.75
|
2026-05-06
|
|
1583
|
OTHER
|
New Technology - Level 46 ($70,001-$80,000)
|
1
|
1
|
—
|
—
|
$75,000.50
|
$75,000.50
|
$75,000.50
|
2026-05-06
|
|
1597
|
OTHER
|
New Technology - Level 46 ($70,001-$80,000)
|
1
|
1
|
—
|
—
|
$75,000.50
|
$75,000.50
|
$75,000.50
|
2026-05-06
|
|
72694-515-01 [327796]
|
OTHER
|
Calaspargase Pegol-mknl 750 Unit/ml Intravenous Solution [189288]
|
80
|
34
|
$92,334.90
|
—
|
$25,853.77
|
$79,408.01
|
$69,251.18
|
2026-05-06
|
|
57894-061-03 [189875]
|
OTHER
|
Ustekinumab 90 Mg/ml Subcutaneous Syringe [108054]
|
80
|
34
|
$92,701.65
|
—
|
$155.88
|
$79,723.42
|
$69,062.73
|
2026-05-06
|
|
79952-110-01 [346488]
|
OTHER
|
Loncastuximab Tesirine-lpyl 10 Mg Intravenous Solution [194597]
|
81
|
34
|
$88,297.20
|
—
|
$212.12
|
$75,935.59
|
$65,339.93
|
2026-05-06
|
|
1582
|
OTHER
|
New Technology - Level 45 ($60,001-$70,000)
|
1
|
1
|
—
|
—
|
$65,000.50
|
$65,000.50
|
$65,000.50
|
2026-05-06
|
|
1596
|
OTHER
|
New Technology - Level 45 ($60,001-$70,000)
|
1
|
1
|
—
|
—
|
$65,000.50
|
$65,000.50
|
$65,000.50
|
2026-05-06
|
|
72694-954-01 [333316]
|
OTHER
|
Pegaspargase 750 Unit/ml Injection Solution [12519]
|
80
|
34
|
$85,272.20
|
—
|
$23,876.22
|
$73,334.09
|
$63,527.79
|
2026-05-06
|
|
73042-201-01 [341976]
|
OTHER
|
Naxitamab-gqgk 4 Mg/ml Intravenous Solution [193283]
|
81
|
34
|
$82,889.60
|
—
|
$642.29
|
$71,285.06
|
$61,338.30
|
2026-05-06
|
|
0187-0007-14 [12582]
|
OTHER
|
Ribavirin 6 Gram Solution For Inhalation [11285]
|
79
|
34
|
$79,376.80
|
—
|
$22,225.50
|
$68,264.05
|
$59,532.60
|
2026-05-06
|
|
5244
|
OTHER
|
Level 4 Blood Product Exchange And Related Services
|
1
|
1
|
—
|
—
|
$59,142.33
|
$59,142.33
|
$59,142.33
|
2026-05-06
|
|
81900028
|
OTHER
|
Hc Cord Blood Unit Shipment
|
81
|
34
|
$78,137.00
|
—
|
$716.98
|
$67,197.82
|
$58,602.75
|
2026-05-06
|
|
72493-103-03 [334342]
|
OTHER
|
Mitomycin 4 Mg/ml Intra-pyelocalyceal Solution [40800003543]
|
81
|
34
|
$77,846.40
|
—
|
$311.36
|
$66,947.90
|
$57,606.34
|
2026-05-06
|
|
88880-5020-00 [313235]
|
OTHER
|
Factor Xa,inactivated-zhzo (recombinant) Low-dose Infusion 880 Mg In 88 Ml (10 M…
|
81
|
34
|
$76,956.00
|
—
|
$131.80
|
$66,182.16
|
$56,947.44
|
2026-05-06
|
|
25682-028-01 [339398]
|
OTHER
|
Ravulizumab-cwvz 100 Mg/ml Intravenous Solution [192897]
|
80
|
34
|
$76,164.10
|
—
|
$220.59
|
$65,501.13
|
$56,742.25
|
2026-05-06
|
|
3
|
OTHER
|
Leukemia Per Diem
|
2
|
2
|
—
|
—
|
$49,800.00
|
$61,875.00
|
$55,837.50
|
2026-05-06
|
|
36100434
|
OTHER
|
Hc Enterolysis Freeing Intestinal Adhesion
|
80
|
34
|
$73,919.00
|
—
|
$20,697.32
|
$63,570.34
|
$55,439.25
|
2026-05-06
|
|
1595
|
OTHER
|
New Technology - Level 44 ($50,001-$60,000)
|
1
|
1
|
—
|
—
|
$55,000.50
|
$55,000.50
|
$55,000.50
|
2026-05-06
|
|
1581
|
OTHER
|
New Technology - Level 44 ($50,001-$60,000)
|
1
|
1
|
—
|
—
|
$55,000.50
|
$55,000.50
|
$55,000.50
|
2026-05-06
|
|
3877924719 [234683]
|
OTHER
|
Glutamine (bulk) Powder [13713]
|
80
|
34
|
$71,899.80
|
—
|
$94.33
|
$61,833.83
|
$53,924.85
|
2026-05-06
|
|
0008-0100-01 [301278]
|
OTHER
|
Inotuzumab Ozogamicin 0.9 Mg(0.25 Mg/ml Initial Concentration) IV Soln [183134]
|
82
|
34
|
$72,847.45
|
—
|
$20.07
|
$62,648.81
|
$53,907.11
|
2026-05-06
|
|
33300025
|
OTHER
|
Hc Srs Gamma Knife
|
81
|
34
|
$68,704.00
|
—
|
$2,216.74
|
$59,085.44
|
$51,528.00
|
2026-05-06
|
|
5
|
OTHER
|
Ccu/picu Per Diem
|
2
|
2
|
$4,266.00
|
—
|
$3,626.10
|
$94,500.00
|
$49,063.05
|
2026-05-06
|
|
27500029
|
OTHER
|
Hc Hv Generator Quadra Stjud
|
81
|
34
|
$65,146.00
|
—
|
$18,240.88
|
$56,025.56
|
$48,859.50
|
2026-05-06
|
|
80446-401-01 [354755]
|
OTHER
|
Tebentafusp-tebn 100 Mcg/0.5 Ml Intravenous Solution [196717]
|
80
|
34
|
$65,126.40
|
—
|
$214.76
|
$56,008.70
|
$48,519.17
|
2026-05-06
|
|
88880-1008-01 [282149]
|
OTHER
|
Ribavirin Inh 40 Mg/ml (ip-cmpd) [40800001008]
|
79
|
34
|
$63,600.00
|
—
|
$17,808.00
|
$54,696.00
|
$47,700.00
|
2026-05-06
|
|
68382-395-04 [295657]
|
OTHER
|
Ribavirin 6 Gram Solution For Inhalation [11285]
|
79
|
34
|
$63,600.00
|
—
|
$17,808.00
|
$54,696.00
|
$47,700.00
|
2026-05-06
|
|
36100432
|
OTHER
|
Hc Hepatectomy Resection Of Liver; Partial Lopectomy
|
80
|
34
|
$61,257.00
|
—
|
$17,151.96
|
$52,681.02
|
$45,942.75
|
2026-05-06
|
|
66302-014-01 [279600]
|
OTHER
|
Dinutuximab 3.5 Mg/ml Intravenous Solution [173725]
|
80
|
34
|
$60,570.35
|
—
|
$16,959.70
|
$52,090.50
|
$45,427.76
|
2026-05-06
|
|
1594
|
OTHER
|
New Technology - Level 43 ($40,001-$50,000)
|
1
|
1
|
—
|
—
|
$45,000.50
|
$45,000.50
|
$45,000.50
|
2026-05-06
|
|
1580
|
OTHER
|
New Technology - Level 43 ($40,001-$50,000)
|
1
|
1
|
—
|
—
|
$45,000.50
|
$45,000.50
|
$45,000.50
|
2026-05-06
|
|
27500028
|
OTHER
|
Hc Hv Generator Assura Stjud
|
81
|
34
|
$60,000.00
|
—
|
$16,800.00
|
$51,600.00
|
$45,000.00
|
2026-05-06
|
|
50242-105-01 [323683]
|
OTHER
|
Polatuzumab Vedotin-piiq 140 Mg Intravenous Solution [188465]
|
80
|
34
|
$59,184.30
|
—
|
$132.92
|
$50,898.50
|
$44,092.30
|
2026-05-06
|
|
50242-142-01 [364462]
|
OTHER
|
Mosunetuzumab-axgb 1 Mg/ml Intravenous Solution [199784]
|
81
|
34
|
$59,553.95
|
—
|
$641.07
|
$51,216.40
|
$44,069.92
|
2026-05-06
|
|
36100433
|
OTHER
|
Hc Exploratory Laparotomy Celiotomy W/wo Biopsy
|
80
|
34
|
$58,109.00
|
—
|
$16,270.52
|
$49,973.74
|
$43,581.75
|
2026-05-06
|
|
27500088
|
OTHER
|
Hc Icd Defib Claria MRI Quad Dtma1qq
|
81
|
34
|
$57,627.00
|
—
|
$16,135.56
|
$49,559.22
|
$43,220.25
|
2026-05-06
|
|
27500098
|
OTHER
|
Hc Crt-d Cobalt Hf MRI Surescan
|
81
|
34
|
$57,338.00
|
—
|
$16,054.64
|
$49,310.68
|
$43,003.50
|
2026-05-06
|
|
66658-505-01 [343711]
|
OTHER
|
Emapalumab-lzsg 5 Mg/ml Intravenous Solution [187168]
|
81
|
34
|
$57,742.45
|
—
|
$376.57
|
$49,658.51
|
$42,729.41
|
2026-05-06
|
|
27500079
|
OTHER
|
Hc Icd Defib Claria Crt-d
|
81
|
34
|
$56,468.00
|
—
|
$15,811.04
|
$48,562.48
|
$42,351.00
|
2026-05-06
|
|
27500092
|
OTHER
|
Hc Crtd Surescan Claria MRI Generator
|
81
|
34
|
$56,468.00
|
—
|
$15,811.04
|
$48,562.48
|
$42,351.00
|
2026-05-06
|
|
81900158
|
OTHER
|
Hc Mnc Aperhersis T-cells Mnc(a)
|
80
|
34
|
$56,466.00
|
—
|
$15,810.48
|
$48,560.76
|
$42,349.50
|
2026-05-06
|
|
27500085
|
OTHER
|
Hc Icd Defib Amplia MRI Quad Crt-d
|
81
|
34
|
$55,727.00
|
—
|
$15,603.56
|
$47,925.22
|
$41,795.25
|
2026-05-06
|
|
27500075
|
OTHER
|
Hc Quadra Assura Mp Cd3369-4q
|
81
|
34
|
$53,590.00
|
—
|
$15,005.20
|
$46,087.40
|
$40,192.50
|
2026-05-06
|
|
36100075
|
OTHER
|
Hc Tib/per Rvscuni Wstn&athr
|
81
|
34
|
$51,892.00
|
—
|
$14,529.76
|
$44,627.12
|
$38,919.00
|
2026-05-06
|
|
36100039
|
OTHER
|
Hc Fm/pop Rvscuni Wstnt&athr
|
81
|
34
|
$51,892.00
|
—
|
$14,529.76
|
$44,627.12
|
$38,919.00
|
2026-05-06
|
|
88880-2871-01 [313059]
|
OTHER
|
Yttrium-90 Therasphere Injection [40800002871]
|
80
|
34
|
$51,132.00
|
—
|
$14,316.96
|
$43,973.52
|
$38,349.00
|
2026-05-06
|
|
82705-010-01 [369963]
|
OTHER
|
Epcoritamab-bysp 48 Mg/0.8 Ml Subcutaneous Solution [201328]
|
81
|
34
|
$51,379.80
|
—
|
$55.19
|
$44,186.63
|
$38,021.05
|
2026-05-06
|
|
0078-0748-81 [311977]
|
OTHER
|
Pasireotide Pamoate 10 Mg IM Suspension [186119]
|
80
|
34
|
$50,708.25
|
—
|
$481.00
|
$43,609.10
|
$37,777.65
|
2026-05-06
|
|
88880-2872-01 [313060]
|
OTHER
|
Yttrium-90 Sir-spheres Injection [40800002872]
|
80
|
34
|
$50,082.00
|
—
|
$14,022.96
|
$43,070.52
|
$37,561.50
|
2026-05-06
|
|
27500071
|
OTHER
|
Hc Defib S/d Ch Icd Quadra Assura Cd3365-40q
|
81
|
34
|
$49,990.00
|
—
|
$13,997.20
|
$42,991.40
|
$37,492.50
|
2026-05-06
|
|
27500023
|
OTHER
|
Hc Cardio Defib S/d Concerto
|
81
|
34
|
$49,080.00
|
—
|
$13,742.40
|
$42,208.80
|
$36,810.00
|
2026-05-06
|
|
27500072
|
OTHER
|
Hc Defib S/d Ch Icd Unify Quadra Crt-d System
|
81
|
34
|
$48,455.00
|
—
|
$13,567.40
|
$41,671.30
|
$36,341.25
|
2026-05-06
|
|
27500026
|
OTHER
|
Hc Cario Defib Oths/d Vivaxt
|
81
|
34
|
$48,312.00
|
—
|
$13,527.36
|
$41,548.32
|
$36,234.00
|
2026-05-06
|
|
27500025
|
OTHER
|
Hc Cario Defib Oth S/d Cham
|
81
|
34
|
$48,280.00
|
—
|
$13,518.40
|
$41,520.80
|
$36,210.00
|
2026-05-06
|
|
27500076
|
OTHER
|
Hc Evera MRI Xt Dr Surescan
|
81
|
34
|
$47,716.00
|
—
|
$13,360.48
|
$41,035.76
|
$35,787.00
|
2026-05-06
|
|
0003-7125-11 [355696]
|
OTHER
|
Nivolumab 240 Mg-relatlimab-rmbw 80 Mg/20 Ml Intravenous Solution [197151]
|
81
|
34
|
$48,080.30
|
—
|
$193.86
|
$41,349.06
|
$35,579.42
|
2026-05-06
|
|
55513-077-01 [383509]
|
OTHER
|
Tarlatamab-dlle 10 Mg Intravenous Solution [204733]
|
80
|
34
|
$47,700.00
|
—
|
$1,575.42
|
$41,022.00
|
$35,536.50
|
2026-05-06
|
|
55513-069-01 [384410]
|
OTHER
|
Tarlatamab-dlle 2.4 Mg/ml Injection [40800003635]
|
80
|
34
|
$47,700.00
|
—
|
$1,575.42
|
$41,022.00
|
$35,536.50
|
2026-05-06
|
|
27500024
|
OTHER
|
Hc Cario Defib Incepta Bost
|
81
|
34
|
$47,000.00
|
—
|
$13,160.00
|
$40,420.00
|
$35,250.00
|
2026-05-06
|
|
1579
|
OTHER
|
New Technology - Level 42 ($30,001-$40,000)
|
1
|
1
|
—
|
—
|
$35,000.50
|
$35,000.50
|
$35,000.50
|
2026-05-06
|
|
1593
|
OTHER
|
New Technology - Level 42 ($30,001-$40,000)
|
1
|
1
|
—
|
—
|
$35,000.50
|
$35,000.50
|
$35,000.50
|
2026-05-06
|
|
27500074
|
OTHER
|
Hc Icd Defib Viva Xt Crt-d Dtba1d1
|
81
|
34
|
$46,636.00
|
—
|
$13,058.08
|
$40,106.96
|
$34,977.00
|
2026-05-06
|
|
27500066
|
OTHER
|
Hc Cardio Defibrillator Single/dual Viva Xt Dtb1d1
|
81
|
34
|
$46,636.00
|
—
|
$13,058.08
|
$40,106.96
|
$34,977.00
|
2026-05-06
|
|
72893-005-01 [353232]
|
OTHER
|
Pralatrexate 20 Mg/ml Inj Container [40800000211]
|
80
|
34
|
$46,659.70
|
—
|
$373.77
|
$40,127.34
|
$34,761.48
|
2026-05-06
|
|
57894-060-03 [189874]
|
OTHER
|
Ustekinumab 45 Mg/0.5 Ml Subcutaneous Syringe [129587]
|
80
|
34
|
$46,350.90
|
—
|
$155.88
|
$39,861.77
|
$34,531.43
|
2026-05-06
|
|
57894-060-02 [296511]
|
OTHER
|
Ustekinumab 45 Mg/0.5 Ml Subcutaneous Solution [99447]
|
80
|
34
|
$46,350.90
|
—
|
$155.88
|
$39,861.77
|
$34,531.43
|
2026-05-06
|
|
50881-006-03 [367267]
|
OTHER
|
Retifanlimab-dlwr 500 Mg/20 Ml Intravenous Solution [200729]
|
80
|
34
|
$45,963.75
|
—
|
$29.26
|
$39,528.82
|
$34,242.99
|
2026-05-06
|
|
38779-1754-8 [148958]
|
OTHER
|
Ketamine (bulk) 100 % Powder [23101]
|
80
|
34
|
$45,297.70
|
—
|
$20.74
|
$38,956.02
|
$33,973.28
|
2026-05-06
|
|
0024-5823-15 [303098]
|
OTHER
|
Cabazitaxel 10 Mg/ml (first Dilution) Intravenous Solution [105644]
|
81
|
34
|
$45,660.85
|
—
|
$224.09
|
$39,268.33
|
$33,789.03
|
2026-05-06
|
|
0024-5824-11 [195524]
|
OTHER
|
Cabazitaxel 10 Mg/ml (first Dilution) Intravenous Solution [105644]
|
81
|
34
|
$45,660.85
|
—
|
$224.09
|
$39,268.33
|
$33,789.03
|
2026-05-06
|
|
27500082
|
OTHER
|
Hc Icd-vr Dvfb1d4 Visia MRI Af US Df4
|
81
|
34
|
$44,086.00
|
—
|
$12,344.08
|
$37,913.96
|
$33,064.50
|
2026-05-06
|
|
0169-7215-11 [344072]
|
OTHER
|
Coagulation Factor Viia Recomb 5 Mg (5,000 Mcg) Intravenous Solution [92855]
|
81
|
34
|
$44,679.00
|
—
|
$2.55
|
$38,423.94
|
$33,062.46
|
2026-05-06
|
|
0169-7205-01 [238548]
|
OTHER
|
Coagulation Factor Viia 1 Mg/ml Inj Container [40800000404]
|
81
|
34
|
$44,679.00
|
—
|
$2.55
|
$38,423.94
|
$33,062.46
|
2026-05-06
|
|
50242-245-01 [335798]
|
OTHER
|
Pertuzumab 1,200 Mg-trastuzumab 600 Mg-hyaluron-zzxf/15 Ml Subcut Soln [191789]
|
80
|
34
|
$44,254.55
|
—
|
$63.88
|
$38,058.91
|
$32,969.64
|
2026-05-06
|
|
27500097
|
OTHER
|
Hc Cardio Defib Single Chamb Cobalt Dvpb3d4
|
81
|
34
|
$43,866.00
|
—
|
$12,282.48
|
$37,724.76
|
$32,899.50
|
2026-05-06
|
|
36100431
|
OTHER
|
Hc Laparoscopic Procedure Liver
|
81
|
34
|
$43,493.00
|
—
|
$9,568.35
|
$37,403.98
|
$32,619.75
|
2026-05-06
|
|
0069-4494-01 [378589]
|
OTHER
|
Elranatamab-bcmm 40 Mg/ml Subcutaneous Solution [202348]
|
81
|
34
|
$43,766.70
|
—
|
$177.65
|
$37,639.36
|
$32,387.36
|
2026-05-06
|
|
0069-4494-02 [373282]
|
OTHER
|
Elranatamab-bcmm 40 Mg/ml Subcutaneous Solution [202348]
|
81
|
34
|
$43,766.70
|
—
|
$177.65
|
$37,639.36
|
$32,387.36
|
2026-05-06
|
|
48818-001-02 [188564]
|
OTHER
|
Pralatrexate 20 Mg/ml Inj Container [40800000211]
|
80
|
34
|
$43,168.65
|
—
|
$373.77
|
$37,125.04
|
$32,160.65
|
2026-05-06
|
|
5232
|
OTHER
|
Level 2 Icd And Similar Procedures
|
1
|
1
|
—
|
—
|
$32,061.58
|
$32,061.58
|
$32,061.58
|
2026-05-06
|
|
5166
|
OTHER
|
Cochlear Implant Procedure
|
1
|
1
|
—
|
—
|
$31,807.82
|
$31,807.82
|
$31,807.82
|
2026-05-06
|
|
76100578
|
OTHER
|
Hc Inc&plct Spinl Neu Gen
|
81
|
34
|
$42,066.00
|
—
|
$11,778.48
|
$49,976.69
|
$31,549.50
|
2026-05-06
|
|
27500058
|
OTHER
|
Hc Defib D/chamb Medteveraxt
|
81
|
34
|
$42,052.00
|
—
|
$11,774.56
|
$36,164.72
|
$31,539.00
|
2026-05-06
|
|
27500027
|
OTHER
|
Hc Energen Crt-d/df4 Boston
|
81
|
34
|
$42,000.00
|
—
|
$11,760.00
|
$36,120.00
|
$31,500.00
|
2026-05-06
|
|
27500069
|
OTHER
|
Hc Defib S/ch Icd MRI Evera Xt Vr Dvmb1d4
|
81
|
34
|
$41,380.00
|
—
|
$11,586.40
|
$35,586.80
|
$31,035.00
|
2026-05-06
|
|
27500059
|
OTHER
|
Hc Cardio Defib S/chamb Dvmb
|
81
|
34
|
$41,380.00
|
—
|
$11,586.40
|
$35,586.80
|
$31,035.00
|
2026-05-06
|
|
27500080
|
OTHER
|
Hc Icd Defib Dynagen X4 Crt-d
|
81
|
34
|
$41,000.00
|
—
|
$11,480.00
|
$35,260.00
|
$30,750.00
|
2026-05-06
|
|
27500060
|
OTHER
|
Hc Inogenx4 Crtdis-1/df4bost
|
81
|
34
|
$41,000.00
|
—
|
$11,480.00
|
$35,260.00
|
$30,750.00
|
2026-05-06
|
|
5465
|
OTHER
|
Level 5 Neurostimulator And Related Procedures
|
1
|
1
|
—
|
—
|
$30,473.59
|
$30,473.59
|
$30,473.59
|
2026-05-06
|
|
27500096
|
OTHER
|
Hc Aicd Single Chamber Gallant Vr_icd_umri_us
|
81
|
34
|
$40,406.00
|
—
|
$11,313.68
|
$34,749.16
|
$30,304.50
|
2026-05-06
|
|
27500065
|
OTHER
|
Hc Cardio-defibrill Single Chamber Cd1357-4q St Jude
|
81
|
34
|
$40,186.00
|
—
|
$11,252.08
|
$34,559.96
|
$30,139.50
|
2026-05-06
|
|
27500001
|
OTHER
|
Hc Cardio Defib D/chamb Virt
|
81
|
34
|
$40,000.00
|
—
|
$11,200.00
|
$34,400.00
|
$30,000.00
|
2026-05-06
|
|
5199908
|
OTHER
|
Pr Robotic Pelvic Exenteration, Complete, For Vesical, Prostatic Orurethral Mali…
|
28
|
21
|
$39,879.00
|
—
|
$23,927.40
|
$35,891.10
|
$29,909.25
|
2026-05-06
|
|
36200007
|
OTHER
|
Hc Txprep Tumorcell Dep
|
81
|
34
|
$39,010.00
|
—
|
$76.37
|
$33,548.60
|
$29,257.50
|
2026-05-06
|
|
72493-101-40 [335605]
|
OTHER
|
Mitomycin 4 Mg/ml Intra-pyelocalyceal Solution [40800003543]
|
81
|
34
|
$38,923.20
|
—
|
$311.36
|
$33,473.95
|
$28,803.17
|
2026-05-06
|
|
51144-050-01 [212963]
|
OTHER
|
Brentuximab Vedotin 50 Mg Intravenous Solution [111348]
|
81
|
34
|
$38,796.00
|
—
|
$248.93
|
$33,364.56
|
$28,709.04
|
2026-05-06
|
|
27500057
|
OTHER
|
Hc Defib D/chamb Ellipstjudec1721
|
81
|
34
|
$38,145.00
|
—
|
$10,680.60
|
$32,804.70
|
$28,608.75
|
2026-05-06
|
|
27500054
|
OTHER
|
Hc Defib D/chamb Fortassurdr
|
81
|
34
|
$38,145.00
|
—
|
$10,680.60
|
$32,804.70
|
$28,608.75
|
2026-05-06
|
|
27500004
|
OTHER
|
Hc Cardio Defib S/chamb Virt
|
81
|
34
|
$38,140.00
|
—
|
$10,679.20
|
$32,800.40
|
$28,605.00
|
2026-05-06
|
|
59572-775-01 [329189]
|
OTHER
|
Luspatercept-aamt 50 Mg/ml Subcutaneous Injection [40800003411]
|
81
|
34
|
$38,469.80
|
—
|
$41.28
|
$33,084.03
|
$28,467.65
|
2026-05-06
|
|
5200
|
OTHER
|
Implantation Wireless Pa Pressure Monitor
|
1
|
1
|
—
|
—
|
$28,428.33
|
$28,428.33
|
$28,428.33
|
2026-05-06
|
|
27500002
|
OTHER
|
Hc Cardio Defib S/chamb Prot
|
81
|
34
|
$37,359.00
|
—
|
$10,460.52
|
$32,128.74
|
$28,019.25
|
2026-05-06
|
|
38779-0330-5 [44708]
|
OTHER
|
Haloperidol (bulk) Powder [17126]
|
80
|
34
|
$37,295.60
|
—
|
$22.08
|
$32,074.22
|
$27,971.70
|
2026-05-06
|
|
0173-0898-03 [346526]
|
OTHER
|
Dostarlimab-gxly 50 Mg/ml Intravenous Solution [194605]
|
81
|
34
|
$37,506.15
|
—
|
$240.06
|
$32,255.29
|
$27,754.55
|
2026-05-06
|
|
81900011
|
OTHER
|
Hc Allo Txprep Tcell Dep
|
81
|
34
|
$36,878.00
|
—
|
$83.59
|
$31,715.08
|
$27,658.50
|
2026-05-06
|
|
50881-023-11 [392113]
|
OTHER
|
Axatilimab-csfr 50 Mg/ml Intravenous Solution [207071]
|
80
|
34
|
$36,729.00
|
—
|
$10,284.12
|
$31,586.94
|
$27,546.75
|
2026-05-06
|
|
1592
|
OTHER
|
New Technology - Level 41 ($25,001-$30,000)
|
1
|
1
|
—
|
—
|
$27,500.50
|
$27,500.50
|
$27,500.50
|
2026-05-06
|
|
1578
|
OTHER
|
New Technology - Level 41 ($25,001-$30,000)
|
1
|
1
|
—
|
—
|
$27,500.50
|
$27,500.50
|
$27,500.50
|
2026-05-06
|
|
27500005
|
OTHER
|
Hc Cardio Defib S/chambstjud
|
81
|
34
|
$36,529.00
|
—
|
$10,228.12
|
$31,414.94
|
$27,396.75
|
2026-05-06
|
|
27801906
|
OTHER
|
Hc Cardiomems Pa Sensor Delivery System
|
80
|
34
|
$36,000.00
|
—
|
$10,080.00
|
$30,960.00
|
$27,000.00
|
2026-05-06
|
|
3877924718 [234682]
|
OTHER
|
Glutamine (bulk) Powder [13713]
|
80
|
34
|
$35,949.90
|
—
|
$62.55
|
$30,916.91
|
$26,962.42
|
2026-05-06
|
|
27500006
|
OTHER
|
Hc Icd-vr Dvbb1d4 Evera Xt
|
81
|
34
|
$35,878.00
|
—
|
$10,045.84
|
$30,855.08
|
$26,908.50
|
2026-05-06
|
|
36200030
|
OTHER
|
Hc Auto Txprep Tcell Dep
|
81
|
34
|
$35,718.00
|
—
|
$83.59
|
$30,717.48
|
$26,788.50
|
2026-05-06
|
|
27500068
|
OTHER
|
Hc Icd Defib Ellipse Vr-36 Df4 Cd1411-36q
|
81
|
34
|
$35,444.00
|
—
|
$9,924.32
|
$30,481.84
|
$26,583.00
|
2026-05-06
|
|
50242-917-01 [288227]
|
OTHER
|
Atezolizumab 1,200 Mg/20 Ml (60 Mg/ml) Intravenous Solution [178549]
|
81
|
34
|
$35,780.80
|
—
|
$88.22
|
$30,771.49
|
$26,477.79
|
2026-05-06
|
|
57894-470-01 [372789]
|
OTHER
|
Talquetamab-tgvs 40 Mg/ml Subcutaneous Solution [202319]
|
80
|
34
|
$35,427.85
|
—
|
$69.97
|
$30,467.95
|
$26,393.75
|
2026-05-06
|
|
36000190
|
OTHER
|
Hc Histosonics Procedure
|
81
|
34
|
$35,179.00
|
—
|
$9,850.12
|
$30,253.94
|
$26,384.25
|
2026-05-06
|
|
27802166
|
OTHER
|
Hc Mesh Hernia Ovitex 40x25in 2s Perm Grid
|
81
|
34
|
$35,000.00
|
—
|
$672.86
|
$30,100.00
|
$26,250.00
|
2026-05-06
|
|
55292-702-55 [299298]
|
OTHER
|
Hemin Ivpb 7 Mg/ml [40800000366]
|
81
|
34
|
$34,790.80
|
—
|
$8.70
|
$29,920.09
|
$25,745.19
|
2026-05-06
|
|
55292-702-54 [299297]
|
OTHER
|
Hemin Ivpb 7 Mg/ml [40800000366]
|
81
|
34
|
$34,790.80
|
—
|
$23.08
|
$29,920.09
|
$25,745.19
|
2026-05-06
|
|
33935
|
OTHER
|
Pr Heart-lung Trnspl W/recipient Cardiectomy-pnumec
|
44
|
24
|
$40,568.00
|
—
|
$3,541.25
|
$34,482.80
|
$25,638.97
|
2026-05-06
|
|
36100347
|
OTHER
|
Hc Upgrade Pm Sys Sngl-dual
|
81
|
34
|
$33,904.00
|
—
|
$9,493.12
|
$29,157.44
|
$25,428.00
|
2026-05-06
|
|
68727-745-02 [301068]
|
OTHER
|
Daunorubicin 44 Mg And Cytarabine 100 Mg In Liposome IV Solution [183121]
|
81
|
34
|
$34,240.65
|
—
|
$248.41
|
$29,446.96
|
$25,338.08
|
2026-05-06
|
|
68727-745-01 [301067]
|
OTHER
|
Daunorubicin 44 Mg And Cytarabine 100 Mg In Liposome IV Solution [183121]
|
81
|
34
|
$34,240.65
|
—
|
$248.41
|
$29,446.96
|
$25,338.08
|
2026-05-06
|
|
36000181
|
OTHER
|
Hc Brain Suite
|
81
|
34
|
$33,769.00
|
—
|
$9,455.32
|
$29,041.34
|
$25,326.75
|
2026-05-06
|
|
36100240
|
OTHER
|
Hc Trnscth Venous Stent Init
|
81
|
34
|
$33,627.00
|
—
|
$9,415.56
|
$28,919.22
|
$25,220.25
|
2026-05-06
|
|
36100238
|
OTHER
|
Hc Trnscth Artery Stent Init
|
81
|
34
|
$33,627.00
|
—
|
$9,415.56
|
$28,919.22
|
$25,220.25
|
2026-05-06
|
|
36100533
|
OTHER
|
Hc Endovascular Venous Arterialization Tibl/prnl Vn, Rs&i
|
80
|
34
|
$33,627.00
|
—
|
$9,415.56
|
$57,400.82
|
$25,220.25
|
2026-05-06
|
|
61755-008-01 [313044]
|
OTHER
|
Cemiplimab-rwlc 50 Mg/ml Intravenous Solution [186523]
|
81
|
34
|
$33,729.55
|
—
|
$28.21
|
$29,007.41
|
$24,959.87
|
2026-05-06
|
|
50242-127-01 [370395]
|
OTHER
|
Glofitamab-gxbm 1 Mg/ml Intravenous Solution [201679]
|
81
|
34
|
$33,471.25
|
—
|
$11.71
|
$28,785.28
|
$24,768.72
|
2026-05-06
|
|
27800186
|
OTHER
|
Hc Brachytherapy Seed, Yttrium-90
|
81
|
34
|
$33,000.00
|
—
|
$9,240.00
|
$28,380.00
|
$24,750.00
|
2026-05-06
|
|
5213
|
OTHER
|
Level 3 Electrophysiologic Procedures
|
1
|
1
|
—
|
—
|
$24,532.30
|
$24,532.30
|
$24,532.30
|
2026-05-06
|
|
48100076
|
OTHER
|
Hc Tcat Impl Wrls P-art Prs Snr L-t Hemodyn Mntr
|
81
|
34
|
$32,691.00
|
—
|
$9,153.48
|
$46,622.46
|
$24,518.25
|
2026-05-06
|
|
27802078
|
OTHER
|
Hc Surpass Flow Diverter Intracranial Stent Delivery System B
|
81
|
34
|
$32,300.00
|
—
|
$1,834.90
|
$27,778.00
|
$24,225.00
|
2026-05-06
|
|
27500003
|
OTHER
|
Hc Cardio Defib S/chamb Teli
|
81
|
34
|
$32,000.00
|
—
|
$8,960.00
|
$27,520.00
|
$24,000.00
|
2026-05-06
|
|
82959-111-01 [384942]
|
OTHER
|
Imetelstat 188 Mg Intravenous Solution [205019]
|
82
|
34
|
$32,374.10
|
—
|
$23.08
|
$27,841.73
|
$23,956.83
|
2026-05-06
|
|
27801981
|
OTHER
|
Hc Zenith Alpha Thoracic Endovascular Graft
|
81
|
34
|
$31,930.00
|
—
|
$2,196.10
|
$27,459.80
|
$23,947.50
|
2026-05-06
|
|
27801286
|
OTHER
|
Hc Restore Neurostimc1820
|
81
|
34
|
$31,850.00
|
—
|
$8,918.00
|
$27,391.00
|
$23,887.50
|
2026-05-06
|
|
57894-450-01 [362636]
|
OTHER
|
Teclistamab-cqyv 90 Mg/ml Subcutaneous Solution [199303]
|
80
|
34
|
$32,037.80
|
—
|
$32.55
|
$27,552.51
|
$23,868.16
|
2026-05-06
|
|
0008-4510-01 [301279]
|
OTHER
|
Gemtuzumab Ozogamicin 4.5 Mg (1 Mg/ml Initial Concentration) IV Soln [183174]
|
82
|
34
|
$31,943.10
|
—
|
$53.19
|
$27,471.07
|
$23,637.89
|
2026-05-06
|
|
0024-5862-01 [264183]
|
OTHER
|
Plerixafor 24 Mg/1.2 Ml (20 Mg/ml) Subcutaneous Solution [95849]
|
80
|
34
|
$31,698.50
|
—
|
$37.08
|
$27,260.71
|
$23,615.39
|
2026-05-06
|
|
36100244
|
OTHER
|
Hc Emb Organ/tumorhae/tace
|
81
|
34
|
$31,453.00
|
—
|
$8,806.84
|
$27,049.58
|
$23,589.75
|
2026-05-06
|
|
36100245
|
OTHER
|
Hc Emb Vascgi Bleed/lymext
|
81
|
34
|
$31,453.00
|
—
|
$8,806.84
|
$27,049.58
|
$23,589.75
|
2026-05-06
|
|
36100242
|
OTHER
|
Hc Emb Vein Wimg Notumr/hemr
|
81
|
34
|
$31,453.00
|
—
|
$8,806.84
|
$27,049.58
|
$23,589.75
|
2026-05-06
|
|
36100243
|
OTHER
|
Hc Emb Artry Wimg Notumr/hmr
|
81
|
34
|
$31,453.00
|
—
|
$8,806.84
|
$29,449.02
|
$23,589.75
|
2026-05-06
|
|
36000183
|
OTHER
|
Hc Ioct Suite
|
81
|
34
|
$31,353.00
|
—
|
$8,778.84
|
$26,963.58
|
$23,514.75
|
2026-05-06
|
|
36100019
|
OTHER
|
Hc Remov/repl Pulse Multlead
|
81
|
34
|
$31,075.00
|
—
|
$8,701.00
|
$31,276.70
|
$23,306.25
|
2026-05-06
|
|
47135
|
OTHER
|
Pr Lvr Altrnsplj Orthotopic Prtl/whl Don Any Age
|
44
|
24
|
$36,455.00
|
—
|
$3,972.11
|
$36,025.43
|
$23,039.56
|
2026-05-06
|
|
1577
|
OTHER
|
New Technology - Level 40 ($20,001-$25,000)
|
1
|
1
|
—
|
—
|
$22,500.50
|
$22,500.50
|
$22,500.50
|
2026-05-06
|
|
1591
|
OTHER
|
New Technology - Level 40 ($20,001-$25,000)
|
1
|
1
|
—
|
—
|
$22,500.50
|
$22,500.50
|
$22,500.50
|
2026-05-06
|
|
36100072
|
OTHER
|
Hc Tib/per Rvsc Uni Vs Wstnt
|
81
|
34
|
$29,964.00
|
—
|
$8,389.92
|
$29,449.02
|
$22,473.00
|
2026-05-06
|
|
36100038
|
OTHER
|
Hc Fm/pop Rvsc Uni Vsl Wstnt
|
81
|
34
|
$29,964.00
|
—
|
$8,389.92
|
$25,769.04
|
$22,473.00
|
2026-05-06
|
|
36100073
|
OTHER
|
Hc Tib/per Rvsc Uni W/athrct
|
81
|
34
|
$29,964.00
|
—
|
$8,389.92
|
$29,449.02
|
$22,473.00
|
2026-05-06
|
|
5231
|
OTHER
|
Level 1 Icd And Similar Procedures
|
1
|
1
|
—
|
—
|
$22,446.19
|
$22,446.19
|
$22,446.19
|
2026-05-06
|
|
33300026
|
OTHER
|
Hc Srs Stereo Radsrg Sgl Ses
|
81
|
34
|
$29,911.00
|
—
|
$8,375.08
|
$25,723.46
|
$22,433.25
|
2026-05-06
|
|
27802077
|
OTHER
|
Hc Surpass Flow Diverter Intracranial Stent Delivery System A
|
81
|
34
|
$29,700.00
|
—
|
$1,834.90
|
$25,542.00
|
$22,275.00
|
2026-05-06
|
|
76100568
|
OTHER
|
Hc Impl/re Dev-epi Inf Noprg
|
81
|
34
|
$29,656.00
|
—
|
$8,303.68
|
$28,985.56
|
$22,242.00
|
2026-05-06
|
|
43288
|
OTHER
|
Pr Esophagectomy Total Near Total W/thrsc Moblj
|
49
|
28
|
$37,036.00
|
—
|
$2,725.79
|
$33,332.40
|
$22,221.60
|
2026-05-06
|
|
76100567
|
OTHER
|
Hc Implnt/repl Dev Epi Resv
|
81
|
34
|
$29,623.00
|
—
|
$8,294.44
|
$28,985.56
|
$22,217.25
|
2026-05-06
|
|
64764-300-20 [263056]
|
OTHER
|
Vedolizumab 300 Mg Intravenous Solution [164372]
|
80
|
34
|
$29,764.55
|
—
|
$21.67
|
$25,597.51
|
$22,174.59
|
2026-05-06
|
|
36100428
|
OTHER
|
Hc Thoracoscopy With Lobectomy Single Lobe
|
80
|
34
|
$29,563.00
|
—
|
$8,277.64
|
$25,424.18
|
$22,172.25
|
2026-05-06
|
|
70114-340-01 [376722]
|
OTHER
|
Toripalimab-tpzi 240 Mg/6 Ml (40 Mg/ml) Intravenous Solution [203182]
|
80
|
34
|
$29,553.15
|
—
|
$39.32
|
$25,415.71
|
$22,017.10
|
2026-05-06
|
|
50242-260-01 [335799]
|
OTHER
|
Pertuzumab 600 Mg-trastuzumab 600 Mg-hyaluronid-zzxf/10 Ml Subcut Soln [191790]
|
80
|
34
|
$29,501.90
|
—
|
$63.88
|
$25,371.63
|
$21,978.92
|
2026-05-06
|
|
4757903
|
OTHER
|
Pr Unlisted Laparoscopy Px, Biliary Tract (lap Hepaticoduodenostomy)
|
28
|
21
|
$29,213.00
|
—
|
$1,106.24
|
$24,831.05
|
$21,909.75
|
2026-05-06
|
|
55566-9800-0 [364485]
|
OTHER
|
Fecal Microbiota, Live-jslm 150 Ml Rectal Suspension Enema [199654]
|
81
|
34
|
$29,049.30
|
—
|
$33.78
|
$24,982.40
|
$21,496.48
|
2026-05-06
|
|
55566-9800-2 [364486]
|
OTHER
|
Fecal Microbiota, Live-jslm 150 Ml Rectal Suspension Enema [199654]
|
81
|
34
|
$29,049.30
|
—
|
$36.13
|
$24,982.40
|
$21,496.48
|
2026-05-06
|
|
5464
|
OTHER
|
Level 4 Neurostimulator And Related Procedures
|
1
|
1
|
—
|
—
|
$21,444.39
|
$21,444.39
|
$21,444.39
|
2026-05-06
|
|
36100458
|
OTHER
|
Hc Evasc Rpr Dplmnt Aorto-aortic Ndgf, S & I
|
80
|
34
|
$28,224.00
|
—
|
$7,902.72
|
$24,272.64
|
$21,168.00
|
2026-05-06
|
|
36100464
|
OTHER
|
Hc Evasc Rpr Dplmnt Ilio-iliac Ndgft, S & I
|
80
|
34
|
$28,224.00
|
—
|
$7,902.72
|
$24,272.64
|
$21,168.00
|
2026-05-06
|
|
36100460
|
OTHER
|
Hc Evasc Rpr Dplmnt Aorto-un-iliac Ndgft, S & I
|
80
|
34
|
$28,224.00
|
—
|
$7,902.72
|
$24,272.64
|
$21,168.00
|
2026-05-06
|
|
36100459
|
OTHER
|
Hc Evasc Rpr Dplmnt Aorto-aortic Ndgft Rupture, S & I
|
80
|
34
|
$28,224.00
|
—
|
$7,902.72
|
$24,272.64
|
$21,168.00
|
2026-05-06
|
|
36100461
|
OTHER
|
Hc Evasc Rpr Dplmnt Aorto-un-iliac Ndgft Rupture, S & I
|
80
|
34
|
$28,224.00
|
—
|
$7,902.72
|
$24,272.64
|
$21,168.00
|
2026-05-06
|
|
36100463
|
OTHER
|
Hc Evasc Rpr Dplmnt Aorto-bi-iliac Ndgft Rupture, S & I
|
80
|
34
|
$28,224.00
|
—
|
$7,902.72
|
$24,272.64
|
$21,168.00
|
2026-05-06
|
|
36100465
|
OTHER
|
Hc Evasc Rpr Dplmnt Ilio-iliac Ndgft Rupture, S & I
|
80
|
34
|
$28,224.00
|
—
|
$7,902.72
|
$24,272.64
|
$21,168.00
|
2026-05-06
|
|
36100462
|
OTHER
|
Hc Evasc Rpr Dplmnt Aorto-bi-iliac Ndgft, S & I
|
80
|
34
|
$28,224.00
|
—
|
$7,902.72
|
$24,272.64
|
$21,168.00
|
2026-05-06
|
|
5199904
|
OTHER
|
Pr Unlisted Laparoscopy Proc, Bladder (robotic-assisted Cystectomy & Bilateral L…
|
28
|
21
|
$28,202.00
|
—
|
$16,921.20
|
$25,381.80
|
$21,151.50
|
2026-05-06
|
|
36100429
|
OTHER
|
Hc Thoracoscopy With Mediastinal & Regional Lymphdenectomy
|
80
|
34
|
$27,917.00
|
—
|
$7,816.76
|
$24,008.62
|
$20,937.75
|
2026-05-06
|
|
0003-2327-11 [204100]
|
OTHER
|
Ipilimumab 5 Mg/ml Inj Container [40800000416]
|
83
|
34
|
$28,229.50
|
—
|
$31.11
|
$24,277.37
|
$20,889.83
|
2026-05-06
|
|
15054-1120-4 [326080]
|
OTHER
|
Lanreotide 120 Mg/0.5 Ml Subcutaneous Syringe [87861]
|
81
|
34
|
$28,112.30
|
—
|
$44.98
|
$24,176.58
|
$20,803.10
|
2026-05-06
|
|
27800456
|
OTHER
|
Hc Ans Gene Xp8-ch Imp P-genc1767
|
81
|
34
|
$27,590.00
|
—
|
$7,725.20
|
$23,727.40
|
$20,692.50
|
2026-05-06
|
|
43287
|
OTHER
|
Pr Esophagectomy Distal 2/3 W/laparoscopic Moblj
|
49
|
28
|
$33,829.00
|
—
|
$2,584.63
|
$30,446.10
|
$20,297.40
|
2026-05-06
|
|
50242-070-01 [251664]
|
OTHER
|
Obinutuzumab 1,000 Mg/40 Ml Intravenous Solution [132573]
|
81
|
34
|
$27,388.50
|
—
|
$74.83
|
$23,554.11
|
$20,267.49
|
2026-05-06
|
|
27802170
|
OTHER
|
Hc Mesh Hernia Ovitex 40x25in 1s Perm Grid
|
81
|
34
|
$27,000.00
|
—
|
$672.86
|
$23,220.00
|
$20,250.00
|
2026-05-06
|
|
27800089
|
OTHER
|
Hc Endoprothesis K
|
81
|
34
|
$26,963.00
|
—
|
$1,352.95
|
$23,188.18
|
$20,222.25
|
2026-05-06
|
|
5199902
|
OTHER
|
Pr Unlisted Robotic-assisted Radical Cystectomy W/ileal Conduit Urinary Diversio…
|
28
|
21
|
$26,910.00
|
—
|
$16,146.00
|
$24,219.00
|
$20,182.50
|
2026-05-06
|
|
5378
|
OTHER
|
Level 8 Urology And Related Services
|
1
|
1
|
—
|
—
|
$20,128.56
|
$20,128.56
|
$20,128.56
|
2026-05-06
|
|
33783
|
OTHER
|
Pr A-root Tlcj Vsd Pulm Stns Rpr W/rimpltj C Ostia
|
49
|
28
|
$33,447.00
|
—
|
$2,509.62
|
$30,102.30
|
$20,068.20
|
2026-05-06
|
|
33945
|
OTHER
|
Pr Heart Transplant W/wo Recipient Cardiectomy
|
44
|
24
|
$31,633.00
|
—
|
$3,172.32
|
$26,888.05
|
$19,992.06
|
2026-05-06
|
|
36100145
|
OTHER
|
Hc Lv Lead Placem W/nw Genrt
|
80
|
34
|
$26,527.00
|
—
|
$7,427.56
|
$22,813.22
|
$19,895.25
|
2026-05-06
|
|
36100352
|
OTHER
|
Hc Rem/repl Pm Gen Dual
|
81
|
34
|
$26,403.00
|
—
|
$7,392.84
|
$22,706.58
|
$19,802.25
|
2026-05-06
|
|
36100076
|
OTHER
|
Hc Tib/per Rvsun Adl Vswathr
|
80
|
34
|
$26,373.00
|
—
|
$7,384.44
|
$22,680.78
|
$19,779.75
|
2026-05-06
|
|
48100029
|
OTHER
|
Hc R/l Cat Coron Ang Graf Lv
|
81
|
34
|
$26,343.00
|
—
|
$5,274.91
|
$22,654.98
|
$19,757.25
|
2026-05-06
|
|
57894-503-01 [334654]
|
OTHER
|
Daratumumab 1,800 Mg-hyaluronidase-fihj 30,000 Unit/15 Ml Subcut Soln [408000026…
|
81
|
34
|
$26,604.45
|
—
|
$51.39
|
$22,879.83
|
$19,687.29
|
2026-05-06
|
|
48100028
|
OTHER
|
Hc R/l Cath Coronary Angio Lv
|
81
|
34
|
$26,104.00
|
—
|
$5,274.91
|
$22,449.44
|
$19,578.00
|
2026-05-06
|
|
27802165
|
OTHER
|
Hc Mesh Hernia Ovitex 30x25in 2s Perm Grid
|
81
|
34
|
$26,000.00
|
—
|
$672.86
|
$22,360.00
|
$19,500.00
|
2026-05-06
|
|
61553-287-50 [293849]
|
OTHER
|
Bupivacaine 0.075%-fentanyl 5 Mcg/ml Epidural Infusion (premix) [40800000704]
|
80
|
34
|
$25,608.20
|
—
|
$7,170.30
|
$22,023.05
|
$19,206.15
|
2026-05-06
|
|
68727-712-01 [335635]
|
OTHER
|
Lurbinectedin 0.5 Mg/ml Intravenous Solution [40800003600]
|
81
|
34
|
$25,789.80
|
—
|
$204.90
|
$22,179.23
|
$19,084.45
|
2026-05-06
|
|
5224
|
OTHER
|
Level 4 Pacemaker And Similar Procedures
|
1
|
1
|
—
|
—
|
$19,071.16
|
$19,071.16
|
$19,071.16
|
2026-05-06
|
|
80803-153-50 [353245]
|
OTHER
|
Sirolimus-protein Bound 5 Mg/ml Intravenous Suspension [40800003820]
|
80
|
34
|
$25,371.75
|
—
|
$117.45
|
$21,819.71
|
$18,901.96
|
2026-05-06
|
|
36100343
|
OTHER
|
Hc Ins/rpl Pm S/ld Art W/gen
|
81
|
34
|
$25,125.00
|
—
|
$7,035.00
|
$21,607.50
|
$18,843.75
|
2026-05-06
|
|
33622
|
OTHER
|
Pr Reconstruction Complex Cardiac Anomaly
|
49
|
28
|
$31,297.00
|
—
|
$2,469.04
|
$28,167.30
|
$18,778.20
|
2026-05-06
|
|
51927-2909-0 [101816]
|
OTHER
|
Ursodiol (bulk) 100 % Powder [35168]
|
79
|
34
|
$25,010.70
|
—
|
$7,003.00
|
$21,509.20
|
$18,758.03
|
2026-05-06
|
|
0069-2522-01 [378588]
|
OTHER
|
Elranatamab-bcmm 40 Mg/ml Subcutaneous Solution [202348]
|
81
|
34
|
$25,338.60
|
—
|
$177.65
|
$21,791.20
|
$18,750.56
|
2026-05-06
|
|
0069-2522-02 [373281]
|
OTHER
|
Elranatamab-bcmm 40 Mg/ml Subcutaneous Solution [202348]
|
81
|
34
|
$25,338.60
|
—
|
$177.65
|
$21,791.20
|
$18,750.56
|
2026-05-06
|
|
36100300
|
OTHER
|
Hc Tc Prm Oclu/embl P Ncnshn
|
81
|
34
|
$24,922.00
|
—
|
$6,978.16
|
$21,432.92
|
$18,691.50
|
2026-05-06
|
|
36100299
|
OTHER
|
Hc Tc Perm Occlu/embol P Cns
|
80
|
34
|
$24,922.00
|
—
|
$6,978.16
|
$21,432.92
|
$18,691.50
|
2026-05-06
|
|
D7949
|
OTHER
|
Pr Lefort Ii Or Lefort Iii - With Bone Graft
|
40
|
23
|
$24,916.00
|
—
|
$4,999.34
|
$22,424.40
|
$18,562.42
|
2026-05-06
|
|
50242-918-01 [320144]
|
OTHER
|
Atezolizumab 60 Mg/ml Injection Container [40800003336]
|
81
|
34
|
$25,046.55
|
—
|
$88.22
|
$21,540.03
|
$18,534.45
|
2026-05-06
|
|
33782
|
OTHER
|
Pr A-root Tlcj Vsd Pulm Stns Rpr Without C Ost Rimpltj
|
49
|
28
|
$30,876.00
|
—
|
$2,322.48
|
$27,788.40
|
$18,525.60
|
2026-05-06
|
|
33864
|
OTHER
|
Pr Ascending Aorta Grf Valve Spare Root Remodel
|
49
|
28
|
$30,835.00
|
—
|
$2,311.90
|
$30,323.71
|
$18,501.00
|
2026-05-06
|
|
5199903
|
OTHER
|
Pr Unlisted Robotic-assisted Radical Cystectomy With Ileal Conduit Urinary Diversi…
|
28
|
21
|
$24,542.00
|
—
|
$14,725.20
|
$22,087.80
|
$18,406.50
|
2026-05-06
|
|
49190
|
OTHER
|
Pr Open Exc/dstrj Intra-abdl Tumor/cyst >30 Cm
|
49
|
28
|
$27,711.00
|
—
|
$2,127.21
|
$24,939.90
|
$18,400.10
|
2026-05-06
|
|
5116
|
OTHER
|
Level 6 Musculoskeletal Procedures
|
1
|
1
|
—
|
—
|
$18,390.05
|
$18,390.05
|
$18,390.05
|
2026-05-06
|
|
36100427
|
OTHER
|
Hc Thoracoscopy W/therapeutic Wedge Resection, Initial Unilateral
|
80
|
34
|
$24,456.00
|
—
|
$6,847.68
|
$21,032.16
|
$18,342.00
|
2026-05-06
|
|
76100575
|
OTHER
|
Hc Percu Implt Elc Arry Epi
|
81
|
34
|
$24,451.00
|
—
|
$6,846.28
|
$21,027.86
|
$18,338.25
|
2026-05-06
|
|
0003-3734-13 [304768]
|
OTHER
|
Nivolumab 10 Mg/ml Inj Container [40800001603]
|
81
|
34
|
$24,763.70
|
—
|
$32.30
|
$21,296.78
|
$18,325.14
|
2026-05-06
|
|
48100025
|
OTHER
|
Hc Rhc Coronary Angio Grafts
|
81
|
34
|
$24,403.00
|
—
|
$5,274.91
|
$20,986.58
|
$18,302.25
|
2026-05-06
|
|
50242-120-47 [327335]
|
OTHER
|
Tenecteplase 50 Mg Intravenous Solution [184741]
|
80
|
34
|
$24,393.95
|
—
|
$162.43
|
$20,978.80
|
$18,173.49
|
2026-05-06
|
|
36100154
|
OTHER
|
Hc Ev Rpr Dta Ic Lsc Int Ep
|
80
|
34
|
$24,095.00
|
—
|
$6,746.60
|
$20,721.70
|
$18,071.25
|
2026-05-06
|
|
36100172
|
OTHER
|
Hc Rp Iaa+rp Artrm-f Evr Tbp
|
80
|
34
|
$24,095.00
|
—
|
$6,746.60
|
$20,721.70
|
$18,071.25
|
2026-05-06
|
|
36100173
|
OTHER
|
Hc Rpiaa+rp Artrm-f Evr Abip
|
80
|
34
|
$24,095.00
|
—
|
$6,746.60
|
$20,721.70
|
$18,071.25
|
2026-05-06
|
|
36100174
|
OTHER
|
Hc Rpiaa+rp Artrm-f Evr Abfp
|
80
|
34
|
$24,095.00
|
—
|
$6,746.60
|
$20,721.70
|
$18,071.25
|
2026-05-06
|
|
5194
|
OTHER
|
Level 4 Endovascular Procedures
|
1
|
1
|
—
|
—
|
$17,956.72
|
$17,956.72
|
$17,956.72
|
2026-05-06
|
|
27500093
|
OTHER
|
Hc Percepta Quad Crt-p MRI Surescan Pacemaker Generator
|
81
|
34
|
$23,900.00
|
—
|
$6,692.00
|
$20,554.00
|
$17,925.00
|
2026-05-06
|
|
93581
|
OTHER
|
Pr Prq Tcat Clsr Cgen Ventr Septal Dfct W/implt
|
49
|
28
|
$29,851.00
|
—
|
$948.27
|
$26,865.90
|
$17,910.60
|
2026-05-06
|
|
5389911
|
OTHER
|
Pr Unlisted Proc Urinary System Removal & Replacement Of Neobladder
|
28
|
21
|
$23,845.00
|
—
|
$1,386.92
|
$20,268.25
|
$17,883.75
|
2026-05-06
|
|
36100334
|
OTHER
|
Hc Arth Brach-ceph Trk/brnch
|
80
|
34
|
$23,843.00
|
—
|
$656.35
|
$20,504.98
|
$17,882.25
|
2026-05-06
|
|
36100079
|
OTHER
|
Hc Trnslm Peri Abdaorta Athr
|
80
|
34
|
$23,843.00
|
—
|
$6,676.04
|
$20,504.98
|
$17,882.25
|
2026-05-06
|
|
36100077
|
OTHER
|
Hc Translm Periph Renal Athr
|
80
|
34
|
$23,843.00
|
—
|
$6,676.04
|
$20,504.98
|
$17,882.25
|
2026-05-06
|
|
36100081
|
OTHER
|
Hc Trnslm Priph Iliac Atherc
|
80
|
34
|
$23,843.00
|
—
|
$800.83
|
$20,504.98
|
$17,882.25
|
2026-05-06
|
|
36100078
|
OTHER
|
Hc Translum Periph Visc Athr
|
79
|
34
|
$23,843.00
|
—
|
$6,676.04
|
$20,504.98
|
$17,882.25
|
2026-05-06
|
|
36100080
|
OTHER
|
Hc Trnslm Peri Brchocph Athr
|
80
|
34
|
$23,843.00
|
—
|
$656.35
|
$20,504.98
|
$17,882.25
|
2026-05-06
|
|
36100345
|
OTHER
|
Hc Ins/rpl Pm D/ld A&v W/gen
|
81
|
34
|
$23,836.00
|
—
|
$6,674.08
|
$20,498.96
|
$17,877.00
|
2026-05-06
|
|
50242-109-01 [299247]
|
OTHER
|
Rituximab 1,600 Mg/13.4 Ml (120 Mg/ml)-hyaluronidase Subcutaneous Soln [182432]
|
80
|
34
|
$23,901.20
|
—
|
$36.58
|
$20,555.03
|
$17,806.40
|
2026-05-06
|
|
27801249
|
OTHER
|
Hc Pump Med Synchr 20/40ml
|
80
|
34
|
$23,600.00
|
—
|
$6,608.00
|
$20,296.00
|
$17,700.00
|
2026-05-06
|
|
5471
|
OTHER
|
Implantation Of Drug Infusion Device
|
1
|
1
|
—
|
—
|
$17,674.12
|
$17,674.12
|
$17,674.12
|
2026-05-06
|
|
15054-1090-4 [326079]
|
OTHER
|
Lanreotide 90 Mg/0.3 Ml Subcutaneous Syringe [87860]
|
81
|
34
|
$23,837.55
|
—
|
$10.70
|
$20,500.29
|
$17,639.79
|
2026-05-06
|
|
4737910
|
OTHER
|
Pr Unlisted Laparoscopic Proc, Liver, Mis Extended Hepatectomy W/ultrasound
|
28
|
21
|
$23,491.00
|
—
|
$2,448.59
|
$19,967.35
|
$17,618.25
|
2026-05-06
|