Hospital

RIVERTON HOSPITAL

Riverton, UT · CCN 460058 · Rates published

23,686 distinct procedures filed

43 distinct payers

2,119,198 rate rows

2026-05-22 last MRF observed

Data quality

2,115,484 of 2,119,198 rate rows are consumer-grade (99.8%)

3,714 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
template filing: same amount across many unrelated codes — excluded	1,848
placeholder amount (≤ $0.02) — excluded from medians	1,536
per-diem day rate — not a per-procedure price	192
percent-of-charges filed in the dollar field — excluded from medians	124
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	14

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

Source MRF file	https://intermountainhealthcare.org/-/media/files/intermountain-health/locations/hospital-prices/942854057_riverton-hospital_standardcharges.ashx
Found on page	https://intermountainhealthcare.org/locations/riverton-hospital/about/price-transparency
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-05-19
Content fingerprint	aa771a9f97357083… · 7,650,493 bytes · first seen 2026-05-17

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
J3391 OTHER	Inj Atidarsagene Autotemcel	10	$3,727,887.50	$4,955,500.00	$4,685,200.00	nat. median $4,505,000 1.0× median
C9172 OTHER	Inj- Beqvez- Per Tx Dose	2	$3,780,000.00	$3,780,000.00	$3,780,000.00	nat. median $3,675,000 1.0× median
J1411 OTHER	Inj Hemgenix Per Tx Dose	12	$3,049,558.17	$4,212,259.80	$3,780,000.00	nat. median $3,685,267 1.0× median
J1414 OTHER	Inj Beqvez Per Tx Dose	1	$3,710,000.00	$3,710,000.00	$3,710,000.00	nat. median $3,710,000 1.0× median
J3389 OTHER	Topi Adm Prad Zami Per Treat	10	$2,760,391.05	$3,812,842.26	$3,469,252.80	nat. median $3,469,253 1.0× median
J1413 OTHER	Inj Delandistrogene Mox Rokl	12	$2,753,803.93	$3,803,743.67	$3,456,000.00	nat. median $3,327,860 1.0× median
J3394 OTHER	Inj Lovotibeglogene Autotem	12	$2,691,450.44	$3,717,616.74	$3,348,000.00	nat. median $3,286,000 1.0× median
J3387 OTHER	Inj Elivaldogene Autotemecel	10	$2,631,450.00	$3,634,740.00	$3,307,200.00	nat. median $3,307,200 1.0× median
J3393 OTHER	Inj Betibeglogene Autotemce	12	$2,432,824.26	$3,360,384.44	$3,024,000.00	nat. median $2,968,000 1.0× median
J3399 OTHER	Inj Onase Abepar-xioi Treat	12	$2,142,381.97	$2,959,205.55	$2,588,981.23	nat. median $2,472,216 1.0× median
J3392 OTHER	Inj Exagamglogene Autotem	11	$1,929,730.00	$2,665,476.00	$2,425,280.00	nat. median $2,332,000 1.0× median
Q2057 OTHER	Afamitresgene Autoleucel	10	$637,688.05	$880,818.66	$801,444.80	nat. median $770,620 1.0× median
Q2056 OTHER	Ciltacabtagene Car-pos T	12	$486,280.02	$671,683.46	$614,776.73	nat. median $583,076 1.1× median
Q2042 OTHER	Tisagenlecleucel Car-pos T	12	$468,804.65	$647,545.28	$592,875.01	nat. median $591,726 1.0× median
Q2054 OTHER	Lisocabtagene Mara Car Pos T	12	$465,221.53	$642,596.02	$588,343.59	nat. median $562,538 1.0× median
Q2055 OTHER	Idecabtagene Vicleucel Car	12	$461,812.63	$637,887.42	$584,032.53	nat. median $558,082 1.0× median
Q2041 OTHER	Axicabtagene Ciloleucel Car+	12	$440,389.08	$608,295.73	$556,939.18	nat. median $533,230 1.0× median
Q2053 OTHER	Brexucabtagene Car Pos T	12	$405,020.04	$559,441.58	$512,209.64	nat. median $489,720 1.0× median
018 OTHER	Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies	3	$424,867.81	$424,867.81	$424,867.81	nat. median $424,868 1.0× median
MS-927 OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	14	$142,839.74	$644,785.70	$330,996.80	nat. median $175,322 1.9× median
MS-018 OTHER	Chimeric Antigen Receptor (car) T-cell Immunotherapy	14	$288,902.84	$330,215.94	$309,559.39	nat. median $309,559 1.0× median
MS-633 OTHER	Neonate- Birth Weight 1000-1499 Grams- With Significant O.r. Procedures- Dischar…	1	$297,836.48	$297,836.48	$297,836.48	nat. median $297,836 1.0× median
Q2058 OTHER	Obecbtge Autol Up To 400 Mil	10	$230,251.88	$318,039.75	$289,380.00	nat. median $281,111 1.0× median
J3403 OTHER	Revakinagene Per Implant	10	$219,287.50	$302,895.00	$275,600.00	nat. median $265,000 1.0× median
MS-612 OTHER	Neonate- Birth Weight <750 Grams- Discharged Alive	1	$272,925.97	$272,925.97	$272,925.97	nat. median $272,926 1.0× median
MS-001 OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	25	$336.30	$495,000.00	$261,938.99	nat. median $224,278 1.2× median
003 OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	3	$237,876.58	$237,876.58	$237,876.58	nat. median $218,232 1.1× median
MS-005 OTHER	Liver Transplant With Mcc Or Intestinal Transplant	25	$68,979.61	$403,000.00	$235,989.80	nat. median $85,046 outlier · 2.8×
005 OTHER	Liver Transplant With Mcc Or Intestinal Transplant	3	$224,031.78	$224,031.78	$224,031.78	nat. median $104,489 outlier · 2.1×
927 OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	3	$223,125.35	$223,125.35	$223,125.35	nat. median $146,562 1.5× median
MS-006 OTHER	Liver Transplant Without Mcc	25	$31,022.59	$403,000.00	$217,011.30	nat. median $38,759 outlier · 5.6×
J3402 OTHER	Inj. Remestemcel-l-rknd/ Td	10	$166,881.11	$230,507.69	$209,735.78	nat. median $205,640 1.0× median
MS-631 OTHER	Neonate- Birth Weight 750-999 Grams- Discharged Alive	1	$197,901.24	$197,901.24	$197,901.24	nat. median $197,901 1.0× median
001 OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	3	$189,523.66	$189,523.66	$189,523.66	nat. median $263,894 0.7× median
MS-003 OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth…	14	$142,001.46	$421,287.28	$176,908.11	nat. median $169,886 1.0× median
MS-636 OTHER	Neonate- Birth Weight 1500-1999 Grams- With Significant O.r. Procedures- With Mu…	1	$175,003.73	$175,003.73	$175,003.73	nat. median $183,596 1.0× median
MS-008 OTHER	Simultaneous Pancreas/kidney Transplant	25	$37,496.06	$300,000.00	$168,748.03	nat. median $43,329 outlier · 3.9×
002 OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	3	$158,369.67	$158,369.67	$158,369.67	nat. median $117,167 1.4× median
MS-215 OTHER	Other Heart Assist System Implant	14	$66,614.61	$385,268.35	$157,339.17	nat. median $80,736 1.9× median
007 OTHER	Lung Transplant	3	$143,490.78	$143,490.78	$143,490.78	nat. median $141,082 1.0× median
004 OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	3	$139,439.13	$139,439.13	$139,439.13	nat. median $150,232 0.9× median
MS-651 OTHER	Kidney Transplant With Hemodialysis Without Mcc	25	$24,792.65	$245,000.00	$134,896.33	nat. median $29,775 outlier · 4.5×
MS-650 OTHER	Kidney Transplant With Hemodialysis With Mcc	25	$23,159.20	$245,000.00	$134,079.60	nat. median $36,289 outlier · 3.7×
MS-652 OTHER	Kidney Transplant	25	$21,606.10	$245,000.00	$133,303.05	nat. median $25,862 outlier · 5.2×
MS-020 OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	14	$52,644.08	$323,526.26	$132,124.41	nat. median $64,597 outlier · 2.0×
014 OTHER	Allogeneic Bone Marrow Transplant	3	$131,567.94	$131,567.94	$131,567.94	nat. median $105,808 1.2× median
MS-426 OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	14	$17,773.09	$290,983.64	$125,790.46	nat. median $84,247 1.5× median
MS-212 OTHER	Testes Procedures Age 0-17	14	$72,750.22	$299,616.01	$124,111.54	nat. median $87,208 1.4× median
215 OTHER	Other Heart Assist System Implant	3	$121,108.61	$121,108.61	$121,108.61	nat. median $92,359 1.3× median
MS-456 OTHER	Spinal Fusion Except Cervical With Spinal Curvature- Malignancy- Infection Or Ex…	14	$56,220.67	$292,492.13	$119,450.43	nat. median $65,528 1.8× median

Other procedures at this hospital

Browse this hospital's 23,686 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

2782649771	OTHER	Hc Valve Implant Lvl 71	118	35	$155,720.60	$116,790.45 25% off	$5,605.94	$140,148.54	$110,561.63	2026-05-22
2722109771	OTHER	Hc Percutaneous Ventricular Assist Device Lvl 71	118	35	$155,720.60	$116,790.45 25% off	$5,605.94	$140,148.54	$110,561.63	2026-05-22
2721649601	OTHER	Hc Kit Pump Device Cardiac Ventricular Smartassist 5.5 S2	118	35	$149,468.00	$112,101.00 25% off	$5,380.85	$134,521.20	$106,122.28	2026-05-22
278TRIG470	OTHER	Hc Ntap Triclip G4 Vlv Rpr Systm	118	35	$148,305.25	$111,228.94 25% off	$5,338.99	$133,474.72	$105,296.73	2026-05-22
2782649770	OTHER	Hc Valve Implant Lvl 70	118	35	$148,305.25	$111,228.94 25% off	$5,338.99	$133,474.72	$105,296.73	2026-05-22
2721040201	OTHER	Hc Berlin Heart Pump Replacement	118	35	$148,265.45	$111,199.09 25% off	$5,337.56	$133,438.91	$105,268.47	2026-05-22
2721649701	OTHER	Hc Pump Blood Vad With Valves	118	35	$148,265.45	$111,199.09 25% off	$5,337.56	$133,438.91	$105,268.47	2026-05-22
275C188267	OTHER	Hc Icd Biv/crt-d Lvl 67	118	35	$128,111.55	$96,083.66 25% off	$4,612.02	$115,300.40	$90,959.20	2026-05-22
278C188966	OTHER	Hc Implantable-insertable Device Noc Lvl 66	118	35	$122,011.00	$91,508.25 25% off	$4,392.40	$109,809.90	$86,627.81	2026-05-22
2782649766	OTHER	Hc Valve Implant Lvl 66	118	35	$122,011.00	$91,508.25 25% off	$4,392.40	$109,809.90	$86,627.81	2026-05-22
278C182366	OTHER	Hc Neurostim Generator/lead Lvl 66	118	35	$122,011.00	$91,508.25 25% off	$4,392.40	$109,809.90	$86,627.81	2026-05-22
4813324901	OTHER	Hc Implant/repos Defib Pulse Gen W/leads Sng/dual	118	35	$118,743.74	$89,057.80 25% off	$4,274.77	$106,869.37	$84,308.06	2026-05-22
2782649765	OTHER	Hc Valve Implant Lvl 65	118	35	$116,200.90	$87,150.68 25% off	$4,183.23	$104,580.81	$82,502.64	2026-05-22
4813326401	OTHER	Hc Remove & Replac Defib Pulse Gen Mult Leads	118	35	$114,039.16	$85,529.37 25% off	$4,105.41	$102,635.24	$80,967.80	2026-05-22
2782669764	OTHER	Hc Vascular Stent Graft Implant Lvl 64	118	35	$110,667.50	$83,000.62 25% off	$3,984.03	$99,600.75	$78,573.92	2026-05-22
2782649764	OTHER	Hc Valve Implant Lvl 64	118	35	$110,667.50	$83,000.62 25% off	$3,984.03	$99,600.75	$78,573.92	2026-05-22
278C188963	OTHER	Hc Implantable-insertable Device Noc Lvl 63	118	35	$105,397.55	$79,048.16 25% off	$3,794.31	$94,857.80	$74,832.26	2026-05-22
2782649763	OTHER	Hc Valve Implant Lvl 63	118	35	$105,397.55	$79,048.16 25% off	$3,794.31	$94,857.80	$74,832.26	2026-05-22
278C187462	OTHER	Hc Stent Coated/covered Implant Lvl 62	118	35	$100,378.60	$75,283.95 25% off	$3,613.63	$90,340.74	$71,268.81	2026-05-22
278C188962	OTHER	Hc Implantable-insertable Device Noc Lvl 62	118	35	$100,378.60	$75,283.95 25% off	$3,613.63	$90,340.74	$71,268.81	2026-05-22
2782669762	OTHER	Hc Vascular Stent Graft Implant Lvl 62	118	35	$100,378.60	$75,283.95 25% off	$3,613.63	$90,340.74	$71,268.81	2026-05-22
4813327001	OTHER	Hc Insert/replmnt Subq Impl Defib W Sbq Electrode	118	35	$98,012.87	$73,509.65 25% off	$3,528.46	$88,211.58	$69,589.14	2026-05-22
278C182361	OTHER	Hc Neurostim Generator/lead Lvl 61	118	35	$95,598.65	$71,698.99 25% off	$3,441.55	$86,038.78	$67,875.04	2026-05-22
2782649761	OTHER	Hc Valve Implant Lvl 61	118	35	$95,598.65	$71,698.99 25% off	$3,441.55	$86,038.78	$67,875.04	2026-05-22
2722109761	OTHER	Hc Percutaneous Ventricular Assist Device Lvl 61	118	35	$95,598.65	$71,698.99 25% off	$3,441.55	$86,038.78	$67,875.04	2026-05-22
4819365401	OTHER	Hc Ep & Ablate Ventricular Tachycardia	118	35	$93,711.57	$70,283.68 25% off	$3,373.62	$84,340.41	$66,535.21	2026-05-22
2721649501	OTHER	Hc Set Pump Impella Cp W/smart Assist	118	35	$91,719.00	$68,789.25 25% off	$3,301.88	$82,547.10	$65,120.49	2026-05-22
2722109760	OTHER	Hc Percutaneous Ventricular Assist Device Lvl 60	118	35	$91,046.30	$68,284.73 25% off	$3,277.67	$81,941.67	$64,642.87	2026-05-22
4819365601	OTHER	Hc Tx Atrial Fib Ablate Pulm Vein Isol	118	35	$90,864.19	$68,148.14 25% off	$3,271.11	$81,777.77	$64,513.57	2026-05-22
278C182359	OTHER	Hc Neurostim Generator/lead Lvl 59	118	35	$86,710.75	$65,033.06 25% off	$3,121.59	$78,039.68	$61,564.63	2026-05-22
272C176959	OTHER	Hc Guidewire Lvl 59	118	35	$86,710.75	$65,033.06 25% off	$3,121.59	$78,039.68	$61,564.63	2026-05-22
278LIMFW59	OTHER	Hc Ntap Limflow System	118	35	$86,710.75	$65,033.06 25% off	$3,121.59	$78,039.68	$61,564.63	2026-05-22
275C188259	OTHER	Hc Icd Biv/crt-d Lvl 59	118	35	$86,710.75	$65,033.06 25% off	$3,121.59	$78,039.68	$61,564.63	2026-05-22
278C262459	OTHER	Hc Wireless Pressure Sensor Lvl 59	118	35	$86,710.75	$65,033.06 25% off	$3,121.59	$78,039.68	$61,564.63	2026-05-22
278C188959	OTHER	Hc Implantable-insertable Device Noc Lvl 59	118	35	$86,710.75	$65,033.06 25% off	$3,121.59	$78,039.68	$61,564.63	2026-05-22
2782649759	OTHER	Hc Valve Implant Lvl 59	118	35	$86,710.75	$65,033.06 25% off	$3,121.59	$78,039.68	$61,564.63	2026-05-22
275C172159	OTHER	Hc Icd Dual Chamber Lvl 59	118	35	$86,710.75	$65,033.06 25% off	$3,121.59	$78,039.68	$61,564.63	2026-05-22
2722109759	OTHER	Hc Percutaneous Ventricular Assist Device Lvl 59	118	35	$86,710.75	$65,033.06 25% off	$3,121.59	$78,039.68	$61,564.63	2026-05-22
4819365301	OTHER	Hc Ep & Ablate Supravent Arryth	118	35	$84,959.97	$63,719.98 25% off	$3,058.56	$76,463.97	$60,321.58	2026-05-22
2782649758	OTHER	Hc Valve Implant Lvl 58	118	35	$82,581.60	$61,936.20 25% off	$2,972.94	$74,323.44	$58,632.94	2026-05-22
2722109758	OTHER	Hc Percutaneous Ventricular Assist Device Lvl 58	118	35	$82,581.60	$61,936.20 25% off	$2,972.94	$74,323.44	$58,632.94	2026-05-22
4813470501	OTHER	Hc Evasc Rpr Dplmnt Aorto Bi-iliac Ndgft	118	35	$81,825.48	$61,369.11 25% off	$2,945.72	$73,642.93	$58,096.09	2026-05-22
4813326301	OTHER	Hc Remove & Replac Defib Pulse Gen Dual Leads	118	35	$80,305.93	$60,229.45 25% off	$2,891.01	$72,275.34	$57,017.21	2026-05-22
2722109757	OTHER	Hc Percutaneous Ventricular Assist Device Lvl 57	118	35	$78,649.10	$58,986.82 25% off	$2,831.37	$70,784.19	$55,840.86	2026-05-22
4813326201	OTHER	Hc Remove & Repl Implant Defib Pls Gen Single Lead	118	35	$76,368.99	$57,276.74 25% off	$2,749.28	$68,732.09	$54,221.98	2026-05-22
3337737101	OTHER	Hc Srs Rad Tx Multisource	118	35	$75,516.27	$56,637.20 25% off	$2,718.59	$67,964.64	$53,616.55	2026-05-22
278C182656	OTHER	Hc Gen Neuro Rchg W Bat & Lds & Cmpnts Implant Lvl 56	118	35	$74,903.90	$56,177.92 25% off	$2,696.54	$67,413.51	$53,181.77	2026-05-22
275C188256	OTHER	Hc Icd Biv/crt-d Lvl 56	118	35	$74,903.90	$56,177.92 25% off	$2,696.54	$67,413.51	$53,181.77	2026-05-22
2721489756	OTHER	Hc Cardiovascular Non Implant Supply Lvl 56	118	35	$74,903.90	$56,177.92 25% off	$2,696.54	$67,413.51	$53,181.77	2026-05-22
275C172256	OTHER	Hc Icd Single Chamber Lvl 56	118	35	$74,903.90	$56,177.92 25% off	$2,696.54	$67,413.51	$53,181.77	2026-05-22
2782669755	OTHER	Hc Vascular Stent Graft Implant Lvl 55	118	35	$71,337.00	$53,502.75 25% off	$2,568.13	$64,203.30	$50,649.27	2026-05-22
275C188255	OTHER	Hc Icd Biv/crt-d Lvl 55	118	35	$71,337.00	$53,502.75 25% off	$2,568.13	$64,203.30	$50,649.27	2026-05-22
2782649755	OTHER	Hc Valve Implant Lvl 55	118	35	$71,337.00	$53,502.75 25% off	$2,568.13	$64,203.30	$50,649.27	2026-05-22
4813336201	OTHER	Hc Replace Aortic Valve Open Femoral Art Approach	118	35	$70,480.54	$52,860.40 25% off	$2,537.30	$63,432.49	$50,041.18	2026-05-22
4813347701	OTHER	Hc Pulmonary Valve Implatantation Perq	118	35	$68,599.57	$51,449.68 25% off	$2,469.58	$61,739.61	$48,705.69	2026-05-22
275C188254	OTHER	Hc Icd Biv/crt-d Lvl 54	118	35	$67,939.95	$50,954.96 25% off	$2,445.84	$61,145.96	$48,237.36	2026-05-22
2782669754	OTHER	Hc Vascular Stent Graft Implant Lvl 54	118	35	$67,939.95	$50,954.96 25% off	$2,445.84	$61,145.96	$48,237.36	2026-05-22
4813322901	OTHER	Hc Remv&replc Pm Gen Mult Leads	118	35	$67,424.84	$50,568.63 25% off	$2,427.29	$60,682.36	$47,871.64	2026-05-22
7613722902	OTHER	Hc Revasc Tib Pero Arther Pta/initial Unilateral	118	35	$66,279.61	$49,709.71 25% off	$2,386.07	$59,651.65	$47,058.52	2026-05-22
J3391	OTHER	Inj Atidarsagene Autotemcel	30	10	—	—	$3,727,887.50	$4,955,500.00	$4,685,200.00	2026-05-22
C9172	OTHER	Inj- Beqvez- Per Tx Dose	14	2	—	—	$3,780,000.00	$3,780,000.00	$3,780,000.00	2026-05-22
J1411	OTHER	Inj Hemgenix Per Tx Dose	48	12	—	—	$3,049,558.17	$4,212,259.80	$3,780,000.00	2026-05-22
J1414	OTHER	Inj Beqvez Per Tx Dose	2	1	—	—	$3,710,000.00	$3,710,000.00	$3,710,000.00	2026-05-22
J3389	OTHER	Topi Adm Prad Zami Per Treat	32	10	—	—	$2,760,391.05	$3,812,842.26	$3,469,252.80	2026-05-22
J1413	OTHER	Inj Delandistrogene Mox Rokl	48	12	—	—	$2,753,803.93	$3,803,743.67	$3,456,000.00	2026-05-22
J3394	OTHER	Inj Lovotibeglogene Autotem	48	12	—	—	$2,691,450.44	$3,717,616.74	$3,348,000.00	2026-05-22
J3387	OTHER	Inj Elivaldogene Autotemecel	32	10	—	—	$2,631,450.00	$3,634,740.00	$3,307,200.00	2026-05-22
J3393	OTHER	Inj Betibeglogene Autotemce	48	12	—	—	$2,432,824.26	$3,360,384.44	$3,024,000.00	2026-05-22
J3399	OTHER	Inj Onase Abepar-xioi Treat	48	12	—	—	$2,142,381.97	$2,959,205.55	$2,588,981.23	2026-05-22
J3392	OTHER	Inj Exagamglogene Autotem	34	11	—	—	$1,929,730.00	$2,665,476.00	$2,425,280.00	2026-05-22
Q2057	OTHER	Afamitresgene Autoleucel	32	10	—	—	$637,688.05	$880,818.66	$801,444.80	2026-05-22
Q2056	OTHER	Ciltacabtagene Car-pos T	48	12	—	—	$486,280.02	$671,683.46	$614,776.73	2026-05-22
Q2042	OTHER	Tisagenlecleucel Car-pos T	48	12	—	—	$468,804.65	$647,545.28	$592,875.01	2026-05-22
Q2054	OTHER	Lisocabtagene Mara Car Pos T	48	12	—	—	$465,221.53	$642,596.02	$588,343.59	2026-05-22
Q2055	OTHER	Idecabtagene Vicleucel Car	48	12	—	—	$461,812.63	$637,887.42	$584,032.53	2026-05-22
Q2041	OTHER	Axicabtagene Ciloleucel Car+	48	12	—	—	$440,389.08	$608,295.73	$556,939.18	2026-05-22
Q2053	OTHER	Brexucabtagene Car Pos T	48	12	—	—	$405,020.04	$559,441.58	$512,209.64	2026-05-22
018	OTHER	Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies	6	3	—	—	$424,867.81	$424,867.81	$424,867.81	2026-05-22
MS-927	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	60	14	—	—	$142,839.74	$644,785.70	$330,996.80	2026-05-22
MS-018	OTHER	Chimeric Antigen Receptor (car) T-cell Immunotherapy	60	14	—	—	$288,902.84	$330,215.94	$309,559.39	2026-05-22
MS-633	OTHER	Neonate- Birth Weight 1000-1499 Grams- With Significant O.r. Procedures- Dischar…	2	1	—	—	$297,836.48	$297,836.48	$297,836.48	2026-05-22
Q2058	OTHER	Obecbtge Autol Up To 400 Mil	32	10	—	—	$230,251.88	$318,039.75	$289,380.00	2026-05-22
J3403	OTHER	Revakinagene Per Implant	32	10	—	—	$219,287.50	$302,895.00	$275,600.00	2026-05-22
MS-612	OTHER	Neonate- Birth Weight <750 Grams- Discharged Alive	2	1	—	—	$272,925.97	$272,925.97	$272,925.97	2026-05-22
MS-001	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	90	25	—	—	$336.30	$495,000.00	$261,938.99	2026-05-22
003	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	6	3	—	—	$237,876.58	$237,876.58	$237,876.58	2026-05-22
MS-005	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	88	25	—	—	$68,979.61	$403,000.00	$235,989.80	2026-05-22
005	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	6	3	—	—	$224,031.78	$224,031.78	$224,031.78	2026-05-22
927	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	6	3	—	—	$223,125.35	$223,125.35	$223,125.35	2026-05-22
MS-006	OTHER	Liver Transplant Without Mcc	88	25	—	—	$31,022.59	$403,000.00	$217,011.30	2026-05-22
J3402	OTHER	Inj. Remestemcel-l-rknd/ Td	32	10	—	—	$166,881.11	$230,507.69	$209,735.78	2026-05-22
MS-631	OTHER	Neonate- Birth Weight 750-999 Grams- Discharged Alive	2	1	—	—	$197,901.24	$197,901.24	$197,901.24	2026-05-22
001	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	6	3	—	—	$189,523.66	$189,523.66	$189,523.66	2026-05-22
MS-003	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth…	60	14	—	—	$142,001.46	$421,287.28	$176,908.11	2026-05-22
MS-636	OTHER	Neonate- Birth Weight 1500-1999 Grams- With Significant O.r. Procedures- With Mu…	2	1	—	—	$175,003.73	$175,003.73	$175,003.73	2026-05-22
MS-008	OTHER	Simultaneous Pancreas/kidney Transplant	86	25	—	—	$37,496.06	$300,000.00	$168,748.03	2026-05-22
002	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	6	3	—	—	$158,369.67	$158,369.67	$158,369.67	2026-05-22
MS-215	OTHER	Other Heart Assist System Implant	60	14	—	—	$66,614.61	$385,268.35	$157,339.17	2026-05-22
007	OTHER	Lung Transplant	6	3	—	—	$143,490.78	$143,490.78	$143,490.78	2026-05-22
004	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	6	3	—	—	$139,439.13	$139,439.13	$139,439.13	2026-05-22
MS-651	OTHER	Kidney Transplant With Hemodialysis Without Mcc	88	25	—	—	$24,792.65	$245,000.00	$134,896.33	2026-05-22
MS-650	OTHER	Kidney Transplant With Hemodialysis With Mcc	88	25	—	—	$23,159.20	$245,000.00	$134,079.60	2026-05-22
MS-652	OTHER	Kidney Transplant	88	25	—	—	$21,606.10	$245,000.00	$133,303.05	2026-05-22
MS-020	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	60	14	—	—	$52,644.08	$323,526.26	$132,124.41	2026-05-22
014	OTHER	Allogeneic Bone Marrow Transplant	6	3	—	—	$131,567.94	$131,567.94	$131,567.94	2026-05-22
MS-426	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	64	14	—	—	$17,773.09	$290,983.64	$125,790.46	2026-05-22
MS-212	OTHER	Testes Procedures Age 0-17	64	14	—	—	$72,750.22	$299,616.01	$124,111.54	2026-05-22
215	OTHER	Other Heart Assist System Implant	6	3	—	—	$121,108.61	$121,108.61	$121,108.61	2026-05-22
MS-456	OTHER	Spinal Fusion Except Cervical With Spinal Curvature- Malignancy- Infection Or Ex…	60	14	—	—	$56,220.67	$292,492.13	$119,450.43	2026-05-22
MS-681	OTHER	Neonate- Birth Weight >2499 Grams- With Significant O.r. Procedures- With Multip…	2	1	—	—	$119,199.71	$119,199.71	$119,199.71	2026-05-22
Q0480	OTHER	Driver Pneumatic Vad Rep	48	12	—	—	$92,962.98	$303,449.79	$117,565.87	2026-05-22
MS-216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	60	14	—	—	$65,449.18	$284,278.34	$116,096.01	2026-05-22
216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	6	3	—	—	$114,510.60	$114,510.60	$114,510.60	2026-05-22
MS-219	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	60	14	—	—	$51,369.59	$277,021.28	$113,132.31	2026-05-22
020	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	6	3	—	—	$109,355.21	$109,355.21	$109,355.21	2026-05-22
MS-957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	60	14	—	—	$50,978.88	$266,108.51	$108,675.66	2026-05-22
834	OTHER	Acute Leukemia Without Major O.r. Procedures With Mcc	6	3	—	—	$106,798.41	$106,798.41	$106,798.41	2026-05-22
MS-634	OTHER	Neonate- Birth Weight 1000-1499 Grams- Without Significant O.r. Procedures- Disc…	2	1	—	—	$106,754.08	$106,754.08	$106,754.08	2026-05-22
MS-928	OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	60	14	—	—	$30,111.07	$181,709.17	$105,910.12	2026-05-22
MS-231	OTHER	Coronary Bypass With Ptca With Mcc	60	14	—	—	$51,850.66	$258,185.54	$105,440.01	2026-05-22
MS-004	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth And Nec…	60	14	—	—	$92,669.04	$242,190.11	$104,494.61	2026-05-22
MS-233	OTHER	Coronary Bypass With Cardiac Catheterization With Mcc	60	14	—	—	$51,148.14	$255,187.58	$104,215.68	2026-05-22
MS-429	OTHER	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	64	14	—	—	$60,276.29	$228,464.21	$102,831.07	2026-05-22
MS-021	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	60	14	—	—	$35,416.74	$247,367.90	$101,022.21	2026-05-22
957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	6	3	—	—	$99,520.29	$99,520.29	$99,520.29	2026-05-22
456	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	6	3	—	—	$99,316.02	$99,316.02	$99,316.02	2026-05-22
MS-850	OTHER	Acute Leukemia With Other Procedures	64	14	—	—	$57,934.04	$250,586.01	$98,835.21	2026-05-22
231	OTHER	Coronary Bypass With Ptca With Mcc	6	3	—	—	$98,657.96	$98,657.96	$98,657.96	2026-05-22
212	OTHER	Concomitant Aortic And Mitral Valve?Procedures	6	3	—	—	$98,459.50	$98,459.50	$98,459.50	2026-05-22
MS-010	OTHER	Pancreas Transplant	86	25	—	—	$48,007.08	$148,117.00	$98,062.04	2026-05-22
219	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	6	3	—	—	$97,528.70	$97,528.70	$97,528.70	2026-05-22
MS-632	OTHER	Neonate- Birth Weight 750-999 Grams- Died	2	1	—	—	$97,125.78	$97,125.78	$97,125.78	2026-05-22
MS-007	OTHER	Lung Transplant	60	14	—	—	$86,639.81	$103,943.75	$95,291.78	2026-05-22
8801	OTHER	945/946 - Rehab - Spinal/quad	6	3	—	—	$94,424.09	$94,424.09	$94,424.09	2026-05-22
MS-014	OTHER	Allogeneic Bone Marrow Transplant	86	25	—	—	$80,402.51	$233,504.06	$91,599.86	2026-05-22
MS-002	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	90	25	—	—	$75,812.34	$495,000.00	$91,434.18	2026-05-22
MS-266	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	60	14	—	—	$36,763.61	$220,285.75	$89,962.17	2026-05-22
MS-217	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	60	14	—	—	$43,990.27	$219,424.14	$89,610.30	2026-05-22
MS-457	OTHER	Spinal Fusion Except Cervical With Spinal Curvature- Malignancy- Infection Or Ex…	60	14	—	—	$39,894.51	$217,007.84	$88,623.51	2026-05-22
233	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	6	3	—	—	$88,055.88	$88,055.88	$88,055.88	2026-05-22
MS-870	OTHER	Septicemia Or Severe Sepsis With Mv >96 Hours	60	14	—	—	$46,241.53	$212,017.59	$86,585.55	2026-05-22
MS-232	OTHER	Coronary Bypass With Ptca Without Mcc	60	14	—	—	$40,560.18	$211,528.35	$86,385.75	2026-05-22
969	OTHER	HIV With Extensive O.r. Procedures With Mcc	6	3	—	—	$85,191.52	$85,191.52	$85,191.52	2026-05-22
MS-235	OTHER	Coronary Bypass Without Cardiac Catheterization With Mcc	60	14	—	—	$39,262.28	$207,927.00	$84,915.00	2026-05-22
275	OTHER	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	6	3	—	—	$84,666.93	$84,666.93	$84,666.93	2026-05-22
790	OTHER	Extreme Immaturity Or Respiratory Distress Syndrome, Neonate	6	3	—	—	$84,628.63	$84,628.63	$84,628.63	2026-05-22
MS-365	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	2	1	—	—	$84,612.76	$84,612.76	$84,612.76	2026-05-22
MS-209	OTHER	Kidney And Urinary Tract Signs And Symptoms Age 0-17	52	14	—	—	$4,656.17	$268,708.31	$84,168.75	2026-05-22
019	OTHER	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	6	3	—	—	$83,863.80	$83,863.80	$83,863.80	2026-05-22
870	OTHER	Septicemia Or Severe Sepsis With Mv >96 Hours	6	3	—	—	$83,080.39	$83,080.39	$83,080.39	2026-05-22
MS-268	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	60	14	—	—	$13,206.19	$202,787.26	$82,815.99	2026-05-22
MS-427	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	64	14	—	—	$13,323.47	$196,728.84	$82,389.49	2026-05-22
MS-275	OTHER	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	64	14	—	—	$47,704.01	$194,163.05	$81,382.82	2026-05-22
268	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	6	3	—	—	$81,349.94	$81,349.94	$81,349.94	2026-05-22
021	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	6	3	—	—	$79,804.02	$79,804.02	$79,804.02	2026-05-22
955	OTHER	Craniotomy For Multiple Significant Trauma	6	3	—	—	$79,178.45	$79,178.45	$79,178.45	2026-05-22
MS-447	OTHER	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	64	14	—	—	$44,701.44	$183,070.89	$78,355.12	2026-05-22
MS-405	OTHER	Pancreas- Liver And Shunt Procedures With Mcc	60	14	—	—	$36,598.90	$191,765.77	$78,314.94	2026-05-22
MS-218	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	60	14	—	—	$43,990.27	$190,852.52	$77,941.98	2026-05-22
207	OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	6	3	—	—	$77,941.25	$77,941.25	$77,941.25	2026-05-22
MS-023	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	60	14	—	—	$38,337.02	$190,651.39	$77,859.84	2026-05-22
266	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	6	3	—	—	$77,587.27	$77,587.27	$77,587.27	2026-05-22
MS-228	OTHER	Other Cardiothoracic Procedures With Mcc	60	14	—	—	$33,099.24	$187,946.98	$76,755.39	2026-05-22
MS-220	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	60	14	—	—	$35,677.66	$187,479.49	$76,564.47	2026-05-22
MS-955	OTHER	Craniotomy For Multiple Significant Trauma	60	14	—	—	$45,032.60	$181,796.15	$76,340.34	2026-05-22
MS-317	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	64	14	—	—	$44,734.22	$169,907.62	$76,316.37	2026-05-22
461	OTHER	Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc	6	3	—	—	$75,407.66	$75,407.66	$75,407.66	2026-05-22
MS-573	OTHER	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	64	14	—	—	$43,830.37	$167,488.60	$74,774.40	2026-05-22
217	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	6	3	—	—	$74,626.58	$74,626.58	$74,626.58	2026-05-22
928	OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc	6	3	—	—	$72,775.42	$72,775.42	$72,775.42	2026-05-22
L8702	OTHER	Ewhf S/d Uprt Micro Sensor	34	11	—	—	$56,933.42	$78,640.35	$71,553.78	2026-05-22
016	OTHER	Autologous Bone Marrow Transplant With Cc/Mcc	6	3	—	—	$71,518.49	$71,518.49	$71,518.49	2026-05-22
MS-234	OTHER	Coronary Bypass With Cardiac Catheterization Without Mcc	60	14	—	—	$36,546.72	$174,185.75	$71,135.46	2026-05-22
235	OTHER	Coronary Bypass Without Cardiac Catheterization With Mcc	6	3	—	—	$70,408.96	$70,408.96	$70,408.96	2026-05-22
MS-207	OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	60	14	—	—	$43,049.62	$171,484.06	$70,032.12	2026-05-22
MS-969	OTHER	HIV With Extensive O.r. Procedures With Mcc	64	14	—	—	$40,952.90	$168,116.45	$69,865.46	2026-05-22
218	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	6	3	—	—	$69,806.61	$69,806.61	$69,806.61	2026-05-22
MS-267	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc	60	14	—	—	$3,542.02	$169,690.18	$69,299.52	2026-05-22
028	OTHER	Spinal Procedures With Mcc	6	3	—	—	$69,087.04	$69,087.04	$69,087.04	2026-05-22
573	OTHER	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	6	3	—	—	$69,004.63	$69,004.63	$69,004.63	2026-05-22
232	OTHER	Coronary Bypass With Ptca Without Mcc	6	3	—	—	$68,854.92	$68,854.92	$68,854.92	2026-05-22
MS-276	OTHER	Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator	64	14	—	—	$32,973.91	$169,983.72	$68,556.33	2026-05-22
MS-163	OTHER	Major Chest Procedures With Mcc	60	14	—	—	$29,984.27	$166,004.57	$67,794.36	2026-05-22
MS-853	OTHER	Infectious And Parasitic Diseases With O.r. Procedures With Mcc	60	14	—	—	$33,040.37	$165,104.91	$67,426.95	2026-05-22
276	OTHER	Cardiac Defibrillator Implant With Mcc	6	3	—	—	$67,365.87	$67,365.87	$67,365.87	2026-05-22
234	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	6	3	—	—	$67,340.33	$67,340.33	$67,340.33	2026-05-22
J9029	OTHER	Instill Adstiladrin Tx Dose	48	12	—	—	$53,187.39	$74,113.13	$67,263.57	2026-05-22
MS-820	OTHER	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	64	14	—	—	$39,236.86	$157,630.41	$66,937.89	2026-05-22
576	OTHER	Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc	6	3	—	—	$66,401.41	$66,401.41	$66,401.41	2026-05-22
MS-221	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	60	14	—	—	$33,720.09	$162,403.22	$66,323.61	2026-05-22
MS-430	OTHER	Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc	64	14	—	—	$38,583.22	$150,740.28	$65,822.79	2026-05-22
008	OTHER	Simultaneous Pancreas And Kidney Transplant	6	3	—	—	$65,720.14	$65,720.14	$65,720.14	2026-05-22
J7330	OTHER	Cultured Chondrocytes Implnt	14	2	—	—	$65,518.20	$65,518.20	$65,518.20	2026-05-22
MS-458	OTHER	Spinal Fusion Except Cervical With Spinal Curvature- Malignancy- Infection Or Ex…	60	14	—	—	$27,915.65	$160,220.66	$65,432.28	2026-05-22
653	OTHER	Major Bladder Procedures With Mcc	6	3	—	—	$65,316.25	$65,316.25	$65,316.25	2026-05-22
405	OTHER	Pancreas, Liver And Shunt Procedures With Mcc	6	3	—	—	$65,142.16	$65,142.16	$65,142.16	2026-05-22
MS-981	OTHER	Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc	60	14	—	—	$31,389.22	$159,073.67	$64,963.86	2026-05-22
MS-326	OTHER	Stomach- Esophageal And Duodenal Procedures With Mcc	60	14	—	—	$33,366.85	$158,725.76	$64,821.78	2026-05-22
MS-366	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	2	1	—	—	$64,396.93	$64,396.93	$64,396.93	2026-05-22
MS-834	OTHER	Acute Leukemia Without Major O.r. Procedures With Mcc	64	14	—	—	$36,728.69	$149,778.11	$64,380.06	2026-05-22
MS-428	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	64	14	—	—	$10,123.67	$151,732.35	$64,166.69	2026-05-22
L8614	OTHER	Cochlear Device	14	2	—	—	$56,406.93	$67,303.72	$64,098.78	2026-05-22
MS-245	OTHER	Aicd Generator Procedures	60	14	—	—	$30,523.50	$155,703.35	$63,587.46	2026-05-22
MS-278	OTHER	Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures …	64	14	—	—	$28,561.05	$135,617.33	$63,529.82	2026-05-22
837	OTHER	Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…	6	3	—	—	$63,265.47	$63,265.47	$63,265.47	2026-05-22
220	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	6	3	—	—	$62,719.98	$62,719.98	$62,719.98	2026-05-22
MS-790	OTHER	Extreme Immaturity Or Respiratory Distress Syndrome- Neonate	60	14	—	—	$6,428.49	$153,297.92	$62,605.11	2026-05-22
820	OTHER	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	6	3	—	—	$62,505.27	$62,505.27	$62,505.27	2026-05-22
MS-270	OTHER	Other Major Cardiovascular Procedures With Mcc	60	14	—	—	$3,196.30	$152,784.22	$62,395.32	2026-05-22
MS-019	OTHER	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	86	25	—	—	$47,732.11	$77,013.23	$62,372.67	2026-05-22
MS-736	OTHER	Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc	60	14	—	—	$23,914.22	$152,675.50	$62,350.92	2026-05-22
MS-025	OTHER	Craniotomy And Endovascular Intracranial Procedures With Mcc	60	14	—	—	$30,418.47	$151,175.16	$61,738.20	2026-05-22
466	OTHER	Revision Of Hip Or Knee Replacement With Mcc	6	3	—	—	$61,653.39	$61,653.39	$61,653.39	2026-05-22
463	OTHER	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …	6	3	—	—	$61,612.77	$61,612.77	$61,612.77	2026-05-22
MS-826	OTHER	Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …	60	14	—	—	$31,295.55	$149,938.47	$61,233.15	2026-05-22
799	OTHER	Splenic Procedures With Mcc	6	3	—	—	$61,213.53	$61,213.53	$61,213.53	2026-05-22
MS-423	OTHER	Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc	60	14	—	—	$27,784.52	$149,753.65	$61,157.67	2026-05-22
MS-450	OTHER	Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically …	64	14	—	—	$35,656.25	$139,968.85	$60,829.39	2026-05-22
011	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	6	3	—	—	$60,714.47	$60,714.47	$60,714.47	2026-05-22
MS-463	OTHER	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …	60	14	—	—	$38,130.96	$148,389.21	$60,600.45	2026-05-22
826	OTHER	Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …	6	3	—	—	$60,440.57	$60,440.57	$60,440.57	2026-05-22
MS-933	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft	60	14	—	—	$26,053.09	$117,216.47	$60,371.79	2026-05-22
MS-011	OTHER	Tracheostomy For Face- Mouth And Neck Diagnoses Or Laryngectomy With Mcc	60	14	—	—	$36,489.18	$147,810.28	$60,364.02	2026-05-22
270	OTHER	Other Major Cardiovascular Procedures With Mcc	6	3	—	—	$60,095.87	$60,095.87	$60,095.87	2026-05-22
652	OTHER	Kidney Transplant	6	3	—	—	$59,892.76	$59,892.76	$59,892.76	2026-05-22
MS-647	OTHER	Neonate- Birth Weight 1500-1999 Grams- Without Significant O.r. Procedures- With…	2	1	—	—	$59,540.34	$59,540.34	$59,540.34	2026-05-22
A9543	OTHER	Y90 Ibritumomab Rx	48	12	—	—	$47,022.32	$213,684.06	$59,466.90	2026-05-22
MS-635	OTHER	Neonate- Birth Weight 1000-1499 Grams- Died	2	1	—	—	$59,416.06	$59,416.06	$59,416.06	2026-05-22
MS-466	OTHER	Revision Of Hip Or Knee Replacement With Mcc	64	14	—	—	$34,825.32	$139,449.71	$59,411.84	2026-05-22
MS-653	OTHER	Major Bladder Procedures With Mcc	64	14	—	—	$31,973.54	$151,292.03	$59,309.11	2026-05-22
228	OTHER	Other Cardiothoracic Procedures With Mcc	6	3	—	—	$57,929.03	$57,929.03	$57,929.03	2026-05-22
MS-236	OTHER	Coronary Bypass Without Cardiac Catheterization Without Mcc	60	14	—	—	$28,024.03	$141,846.98	$57,928.68	2026-05-22
MS-907	OTHER	Other O.r. Procedures For Injuries With Mcc	60	14	—	—	$25,685.80	$140,958.20	$57,565.71	2026-05-22
245	OTHER	Aicd Generator Procedures	6	3	—	—	$57,315.07	$57,315.07	$57,315.07	2026-05-22
MS-239	OTHER	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	60	14	—	—	$32,927.30	$139,615.51	$57,017.37	2026-05-22
163	OTHER	Major Chest Procedures With Mcc	6	3	—	—	$56,935.55	$56,935.55	$56,935.55	2026-05-22
MS-040	OTHER	Peripheral- Cranial Nerve And Other Nervous System Procedures With Mcc	60	14	—	—	$25,832.31	$139,229.55	$56,859.75	2026-05-22
025	OTHER	Craniotomy And Endovascular Intracranial Procedures With Mcc	6	3	—	—	$56,532.83	$56,532.83	$56,532.83	2026-05-22
006	OTHER	Liver Transplant Without Mcc	6	3	—	—	$56,530.50	$56,530.50	$56,530.50	2026-05-22
MS-576	OTHER	Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc	64	14	—	—	$32,790.15	$146,453.99	$55,939.85	2026-05-22
MS-474	OTHER	Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc	60	14	—	—	$28,720.49	$136,916.53	$55,915.14	2026-05-22
221	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	6	3	—	—	$55,617.11	$55,617.11	$55,617.11	2026-05-22
MS-646	OTHER	Neonate- Birth Weight 1500-1999 Grams- With Significant O.r. Procedures- Without…	2	1	—	—	$55,440.81	$55,440.81	$55,440.81	2026-05-22
MS-837	OTHER	Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…	64	14	—	—	$32,141.87	$135,209.63	$54,833.88	2026-05-22
MS-024	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	60	14	—	—	$26,171.51	$134,100.68	$54,765.18	2026-05-22
239	OTHER	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	6	3	—	—	$54,659.62	$54,659.62	$54,659.62	2026-05-22
650	OTHER	Kidney Transplant With Hemodialysis With Mcc	6	3	—	—	$54,586.50	$54,586.50	$54,586.50	2026-05-22
853	OTHER	Infectious And Parasitic Diseases With O.r. Procedures With Mcc	6	3	—	—	$54,475.08	$54,475.08	$54,475.08	2026-05-22
Q2043	OTHER	Sipuleucel-t Auto Cd54+	80	12	—	—	$45,019.40	$64,357.43	$54,404.11	2026-05-22
MS-012	OTHER	Tracheostomy For Face- Mouth And Neck Diagnoses Or Laryngectomy With Cc	60	14	—	—	$28,206.01	$131,466.94	$53,689.59	2026-05-22
MS-031	OTHER	Ventricular Shunt Procedures With Mcc	60	14	—	—	$21,645.94	$130,790.16	$53,413.20	2026-05-22
023	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	6	3	—	—	$53,059.15	$53,059.15	$53,059.15	2026-05-22
MS-277	OTHER	Other Major Cardiovascular Procedures With Mcc	64	14	—	—	$30,898.82	$128,507.04	$52,713.25	2026-05-22
L7181	OTHER	Electronic Elbo Simultaneous	48	12	—	—	$41,274.99	$141,240.29	$52,198.52	2026-05-22
8800	OTHER	945/946 - Rehab - Spinal/para	6	3	—	—	$52,167.81	$52,167.81	$52,167.81	2026-05-22
MS-269	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	60	14	—	—	$6,003.13	$127,555.74	$52,092.30	2026-05-22
856	OTHER	Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc	6	3	—	—	$51,869.54	$51,869.54	$51,869.54	2026-05-22
901	OTHER	Wound Debridements For Injuries With Mcc	6	3	—	—	$51,703.57	$51,703.57	$51,703.57	2026-05-22
MS-823	OTHER	Lymphoma And Non-acute Leukemia With Other Procedures With Mcc	60	14	—	—	$30,673.36	$126,473.98	$51,650.52	2026-05-22
90288	OTHER	Botulism Ig IV	14	2	—	—	$51,570.00	$51,570.00	$51,570.00	2026-05-22
017	OTHER	Autologous Bone Marrow Transplant Without Cc/Mcc	6	3	—	—	$51,368.16	$51,368.16	$51,368.16	2026-05-22
022	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…	6	3	—	—	$51,232.37	$51,232.37	$51,232.37	2026-05-22
MS-958	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Cc	60	14	—	—	$28,191.96	$125,299.80	$51,171.00	2026-05-22
MS-461	OTHER	Bilateral Or Multiple Major Joint Procs Of Lower Extremity W Mcc	60	14	—	—	$36,950.14	$121,502.75	$51,021.77	2026-05-22
471	OTHER	Cervical Spinal Fusion With Mcc	6	3	—	—	$50,996.76	$50,996.76	$50,996.76	2026-05-22
MS-319	OTHER	Other Endovascular Cardiac Valve Procedures With Mcc	64	14	—	—	$29,857.82	$119,282.15	$50,937.31	2026-05-22
MS-799	OTHER	Splenic Procedures With Mcc	60	14	—	—	$30,299.38	$124,701.84	$50,926.80	2026-05-22
823	OTHER	Lymphoma And Non-acute Leukemia With Other Procedures With Mcc	6	3	—	—	$50,854.01	$50,854.01	$50,854.01	2026-05-22
MS-956	OTHER	Limb Reattachment- Hip And Femur Procedures For Multiple Significant Trauma	60	14	—	—	$25,175.33	$120,665.61	$50,670.24	2026-05-22
319	OTHER	Other Endovascular Cardiac Valve Procedures With Mcc	6	3	—	—	$50,621.89	$50,621.89	$50,621.89	2026-05-22
269	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	6	3	—	—	$50,265.59	$50,265.59	$50,265.59	2026-05-22
MS-166	OTHER	Other Respiratory System O.r. Procedures With Mcc	60	14	—	—	$25,006.07	$122,956.88	$50,214.18	2026-05-22
MS-229	OTHER	Other Cardiothoracic Procedures Without Mcc	60	14	—	—	$21,070.88	$122,728.57	$50,120.94	2026-05-22
MS-929	OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/mcc	60	14	—	—	$15,248.96	$86,538.40	$49,932.06	2026-05-22
236	OTHER	Coronary Bypass Without Cardiac Catheterization Without Mcc	6	3	—	—	$49,929.01	$49,929.01	$49,929.01	2026-05-22
MS-323	OTHER	Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc	64	14	—	—	$28,951.30	$116,575.02	$49,390.78	2026-05-22
MS-367	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	2	1	—	—	$49,345.78	$49,345.78	$49,345.78	2026-05-22
140	OTHER	Major Head And Neck Procedures With Mcc	6	3	—	—	$48,855.46	$48,855.46	$48,855.46	2026-05-22
MS-616	OTHER	Amputation Of Lower Limb For Endocrine- Nutritional And Metabolic Disorders With…	60	14	—	—	$21,489.28	$119,616.46	$48,849.99	2026-05-22
277	OTHER	Cardiac Defibrillator Implant Without Mcc	6	3	—	—	$48,791.62	$48,791.62	$48,791.62	2026-05-22
010	OTHER	Pancreas Transplant	6	3	—	—	$48,742.88	$48,742.88	$48,742.88	2026-05-22
MS-140	OTHER	Major Head And Neck Procedures With Mcc	64	14	—	—	$4,562.52	$115,444.33	$48,682.00	2026-05-22
MS-329	OTHER	Major Small And Large Bowel Procedures With Mcc	60	14	—	—	$30,751.64	$119,021.22	$48,606.90	2026-05-22
031	OTHER	Ventricular Shunt Procedures With Mcc	6	3	—	—	$48,439.96	$48,439.96	$48,439.96	2026-05-22
MS-448	OTHER	Multiple Level Spinal Fusion Except Cervical Without Mcc	64	14	—	—	$28,371.92	$112,720.90	$48,402.37	2026-05-22
323	OTHER	Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc	6	3	—	—	$48,048.84	$48,048.84	$48,048.84	2026-05-22
MS-901	OTHER	Wound Debridements For Injuries With Mcc	64	14	—	—	$28,076.22	$118,871.73	$47,897.90	2026-05-22
273	OTHER	Percutaneous And Other Intracardiac Procedures With Mcc	6	3	—	—	$47,849.22	$47,849.22	$47,849.22	2026-05-22
332	OTHER	Rectal Resection With Mcc	6	3	—	—	$47,726.19	$47,726.19	$47,726.19	2026-05-22
MS-856	OTHER	Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc	60	14	—	—	$30,431.85	$116,623.94	$47,627.88	2026-05-22
MS-017	OTHER	Autologous Bone Marrow Transplant Without Cc/mcc	86	25	—	—	$36,343.33	$58,637.99	$47,490.66	2026-05-22
MS-252	OTHER	Other Vascular Procedures With Mcc	60	14	—	—	$23,337.53	$115,909.11	$47,335.95	2026-05-22
MS-485	OTHER	Knee Procedures With Principal Diagnosis Of Infection With Mcc	60	14	—	—	$21,590.04	$115,860.19	$47,315.97	2026-05-22
MS-403	OTHER	Concomitant Left Atrial Appendage Closure And Cardiac Ablation	2	1	—	—	$47,202.36	$47,202.36	$47,202.36	2026-05-22
MS-656	OTHER	Kidney And Ureter Procedures For Neoplasm With Mcc	60	14	—	—	$21,300.35	$115,210.58	$47,050.68	2026-05-22
MS-492	OTHER	Lower Extremity And Humerus Procedures Except Hip- Foot And Femur With Mcc	60	14	—	—	$24,563.85	$115,196.99	$47,045.13	2026-05-22
034	OTHER	Carotid Artery Stent Procedures With Mcc	6	3	—	—	$47,011.26	$47,011.26	$47,011.26	2026-05-22
MS-037	OTHER	Extracranial Procedures With Mcc	60	14	—	—	$22,024.90	$114,599.03	$46,800.93	2026-05-22
MS-260	OTHER	Cardiac Pacemaker Revision Except Device Replacement With Mcc	60	14	—	—	$21,761.98	$110,611.73	$46,448.38	2026-05-22
024	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	6	3	—	—	$46,415.88	$46,415.88	$46,415.88	2026-05-22

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