Appendix 6 Large Claim Exhibit.xlsx

XLSX spreadsheet 237 KB Posted Jun 8, 2026

Attached to: Open Market Competitive Sealed Proposal IL|26-416CMS-BENF4-P-92831
Contract number: 26-416CMS-BENF4-P-92831
Issued by: Illinois

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Written by GovTribe AI · Jun 10, 2026

This document is a Large Claim Exhibit appendix related to a state and local contract award. The specific states, agencies, consortiums, jurisdictions, and companies involved are not clearly identifiable from the file name alone, as "Appendix 6 Large Claim Exhibit.xlsx" appears to be a supporting document in a larger contract file set. The exhibit likely documents significant claims or billing items associated with a contract award and would typically reference the primary contracting parties, though those details would be contained within the spreadsheet itself.

Without access to the actual content of the Excel file, specific information regarding goods or services, pricing terms, set-asides, option periods, renewal terms, contract amounts, and funding sources cannot be determined from the file name. To provide accurate details on these contractual elements, the contents of the Appendix 6 Large Claim Exhibit.xlsx spreadsheet would need to be reviewed directly. This document type typically contains itemized claims, billing documentation, or detailed expenditure records associated with contract performance.

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Current Year

STATE OF IL (STATE PPO)

Large Claim Listing	Effective Date: January 1, 2025
Contractholder Number - 285658

Total Group

Claimants with over $100,000 in claims for 6/1/2024 - 5/31/2025

Claimant Exp. Group Amount Rx Pooled Total ICD-10 Code Description Relationship Structure SSN DOB Name Gender ICD10

Claimant 1	$1,727,611	Chronic Respiratory Failure With Hypoxia
Claimant 2	$1,333,277	Encounter For Antineoplastic Immunotherapy
Claimant 3	$1,225,353	Malformations Of Aqueduct Of Sylvius
Claimant 4	$1,138,615	Encounter For Antineoplastic Chemotherapy
Claimant 5	$987,483	Secondary Malignant Neoplasm Of Left Lung
Claimant 6	$880,017	Infection Following A Procedure, Deep Incisional Surgical Site, Initial Encounter
Claimant 7	$861,378	Hypertensive Heart And Chronic Kidney Disease With Heart Failure And Stage 1 Through Stage 4 Chronic Kidney Disease, Or Unspecified Chronic Kidney Disease
Claimant 8	$848,582	Encounter For Antineoplastic Chemotherapy
Claimant 9	$833,646	Malignant Neoplasm Of Middle Lobe, Bronchus Or Lung
Claimant 10	$822,685	Encounter For Antineoplastic Chemotherapy
Claimant 11	$822,242	Neuromyelitis Optica (devic)
Claimant 12	$810,464	Encounter For Aftercare Following Liver Transplant
Claimant 13	$808,346	Paroxysmal Atrial Fibrillation
Claimant 14	$800,759	Urinary Tract Infection, Site Not Specified
Claimant 15	$798,392	Encounter For Antineoplastic Chemotherapy
Claimant 16	$758,578	Restricted Diagnosis
Claimant 17	$753,376	Thrombosis Due To Cardiac Prosthetic Devices, Implants And Grafts, Initial Encounter
Claimant 18	$719,551	Sepsis Following A Procedure, Initial Encounter
Claimant 19	$707,937	Age-related Osteoporosis With Current Pathological Fracture, Vertebra(e), Initial Encounter For Fracture
Claimant 20	$658,175	Infection And Inflammatory Reaction Due To Indwelling Urethral Catheter, Initial Encounter
Claimant 21	$654,739	Pathological Fracture In Neoplastic Disease, Other Specified Site, Initial Encounter For Fracture
Claimant 22	$653,615	Atherosclerosis Of Native Arteries Of Extremities With Intermittent Claudication, Right Leg
Claimant 23	$643,917	Multiple Myeloma In Relapse
Claimant 24	$642,323	Congenital Diaphragmatic Hernia
Claimant 25	$638,292	Pulmonary Fibrosis, Unspecified
Claimant 26	$630,523	Traumatic Subarachnoid Hemorrhage Without Loss Of Consciousness, Initial Encounter
Claimant 27	$627,383	Malignant Carcinoid Tumor Of The Rectum
Claimant 28	$621,984	Leakage Of Other Specified Internal Prosthetic Devices, Implants And Grafts, Initial Encounter
Claimant 29	$617,723	Sepsis Due To Methicillin Resistant Staphylococcus Aureus
Claimant 30	$574,841	Encounter For Antineoplastic Chemotherapy
Claimant 31	$571,770	Acute Respiratory Failure With Hypoxia
Claimant 32	$565,107	Multiple Myeloma In Relapse
Claimant 33	$561,765	Thrombosis Due To Vascular Prosthetic Devices, Implants And Grafts, Initial Encounter
Claimant 34	$556,920	Other Cirrhosis Of Liver
Claimant 35	$556,722	Di George's Syndrome
Claimant 36	$553,187	Neuropathic Heredofamilial Amyloidosis
Claimant 37	$552,907	Unspecified Effects Of Drowning And Nonfatal Submersion, Initial Encounter
Claimant 38	$541,524	Encounter For Antineoplastic Immunotherapy
Claimant 39	$538,112	Secondary Malignant Neoplasm Of Retroperitoneum And Peritoneum
Claimant 40	$533,519	Encounter For Antineoplastic Radiation Therapy
Claimant 41	$511,174	Restricted Diagnosis
Claimant 42	$510,177	Restricted Diagnosis
Claimant 43	$503,180	Thoracoabdominal Aortic Aneurysm, Without Rupture, Unspecified
Claimant 44	$501,211	Encounter For Antineoplastic Chemotherapy
Claimant 45	$499,249	Acute Respiratory Failure, Unspecified Whether With Hypoxia Or Hypercapnia
Claimant 46	$496,512	Restricted Diagnosis
Claimant 47	$494,146	Gaucher Disease
Claimant 48	$492,363	Dissection Of Thoracoabdominal Aorta
Claimant 49	$492,068	Traumatic Subdural Hemorrhage With Loss Of Consciousness Of Unspecified Duration, Initial Encounter
Claimant 50	$491,725	Encounter For Antineoplastic Radiation Therapy
Claimant 51	$490,577	Acute Respiratory Failure With Hypoxia
Claimant 52	$489,425	Encounter For Antineoplastic Immunotherapy
Claimant 53	$489,094	Malignant Neoplasm Of Parotid Gland
Claimant 54	$480,548	Malignant Neoplasm Of Pyloric Antrum
Claimant 55	$474,638	Thyrotoxicosis With Diffuse Goiter Without Thyrotoxic Crisis Or Storm
Claimant 56	$473,185	Sepsis, Unspecified Organism
Claimant 57	$472,299	Malignant Melanoma Of Skin, Unspecified
Claimant 58	$468,376	Kidney Transplant Failure
Claimant 59	$468,119	Unspecified Fracture Of First Lumbar Vertebra, Initial Encounter For Closed Fracture
Claimant 60	$465,804	Thyrotoxicosis, Unspecified Without Thyrotoxic Crisis Or Storm
Claimant 61	$464,281	Polymyositis, Organ Involvement Unspecified
Claimant 62	$454,714	Nontraumatic Intracerebral Hemorrhage In Hemisphere, Unspecified
Claimant 63	$453,588	Encounter For Antineoplastic Radiation Therapy
Claimant 64	$450,222	Encounter For Antineoplastic Immunotherapy
Claimant 65	$442,234	Encounter For Antineoplastic Chemotherapy
Claimant 66	$442,073	Nontraumatic Subarachnoid Hemorrhage From Right Posterior Communicating Artery
Claimant 67	$435,766	Malignant Neoplasm Of Overlapping Sites Of Right Female Breast
Claimant 68	$435,488	Restricted Diagnosis
Claimant 69	$434,173	Other Hypotension
Claimant 70	$433,127	Multiple Myeloma Not Having Achieved Remission
Claimant 71	$423,178	Encounter For General Adult Medical Examination Without Abnormal Findings
Claimant 72	$421,989	Unspecified Acute Lower Respiratory Infection
Claimant 73	$417,766	Restricted Diagnosis
Claimant 74	$414,726	Refractory Anemia With Ring Sideroblasts
Claimant 75	$413,732	Malignant Neoplasm Of Unspecified Part Of Unspecified Bronchus Or Lung
Claimant 76	$405,423	Other Specified Diseases Of Biliary Tract
Claimant 77	$404,820	Fusion Of Spine, Cervical Region
Claimant 78	$403,453	Acute Pancreatitis With Uninfected Necrosis, Unspecified
Claimant 79	$401,695	Neutropenia, Unspecified
Claimant 80	$399,773	Encounter For Antineoplastic Chemotherapy
Claimant 81	$398,952	Encounter For Antineoplastic Chemotherapy
Claimant 82	$396,151	Other Toxic Encephalopathy
Claimant 83	$394,423	Amyotrophic Lateral Sclerosis
Claimant 84	$391,258	Traumatic Subarachnoid Hemorrhage Without Loss Of Consciousness, Initial Encounter
Claimant 85	$390,143	Spinal Muscular Atrophy, Unspecified
Claimant 86	$389,339	Restricted Diagnosis
Claimant 87	$389,149	Myelodysplastic Syndrome, Unspecified
Claimant 88	$388,044	Other Dermatomyositis Without Myopathy
Claimant 89	$385,505	Gaucher Disease
Claimant 90	$381,957	Restricted Diagnosis
Claimant 91	$380,060	Osteomyelitis Of Vertebra, Lumbar Region
Claimant 92	$379,618	Encounter For Antineoplastic Radiation Therapy
Claimant 93	$379,271	Malignant Neoplasm Of Parietal Lobe
Claimant 94	$378,630	Other Displaced Fracture Of Upper End Of Left Humerus, Initial Encounter For Closed Fracture
Claimant 95	$377,794	St Elevation (stemi) Myocardial Infarction Involving Other Coronary Artery Of Anterior Wall
Claimant 96	$376,457	Other Partial Intestinal Obstruction
Claimant 97	$373,574	Encounter For Antineoplastic Immunotherapy
Claimant 98	$372,904	Encounter For Antineoplastic Radiation Therapy
Claimant 99	$372,210	Nausea With Vomiting, Unspecified
Claimant 100	$369,063	Restricted Diagnosis
Claimant 101	$363,945	Encounter For Antineoplastic Chemotherapy
Claimant 102	$360,484	Ulcer Of Intestine
Claimant 103	$360,080	Encounter For Antineoplastic Immunotherapy
Claimant 104	$360,010	Hypertensive Heart Disease With Heart Failure
Claimant 105	$356,649	Unspecified Transplanted Organ And Tissue Rejection
Claimant 106	$356,185	Traumatic Subarachnoid Hemorrhage With Loss Of Consciousness Status Unknown, Initial Encounter
Claimant 107	$355,175	Awaiting Organ Transplant Status
Claimant 108	$354,831	Hypertensive Heart Disease With Heart Failure
Claimant 109	$353,542	Pathological Fracture, Right Tibia, Initial Encounter For Fracture
Claimant 110	$350,108	Other Congenital Malformations Of Musculoskeletal System
Claimant 111	$348,949	Renal Sclerosis, Unspecified
Claimant 112	$348,653	Hb-ss Disease With Crisis, Unspecified
Claimant 113	$348,426	Sepsis, Unspecified Organism
Claimant 114	$347,897	Hypertensive Heart Disease With Heart Failure
Claimant 115	$346,602	Nonrheumatic Mitral (valve) Insufficiency
Claimant 116	$346,398	Encounter For Antineoplastic Chemotherapy
Claimant 117	$342,267	Encounter For Antineoplastic Immunotherapy
Claimant 118	$339,639	Hepatic Encephalopathy
Claimant 119	$336,442	Infection Following A Procedure, Superficial Incisional Surgical Site, Initial Encounter
Claimant 120	$333,778	Pneumonia Due To Methicillin Susceptible Staphylococcus Aureus
Claimant 121	$331,762	Acute Kidney Failure, Unspecified
Claimant 122	$328,712	Infection And Inflammatory Reaction Due To Indwelling Urethral Catheter, Initial Encounter
Claimant 123	$327,754	Interstitial Pulmonary Disease, Unspecified
Claimant 124	$324,747	End Stage Renal Disease
Claimant 125	$323,432	Abdominal Aortic Aneurysm, Without Rupture, Unspecified
Claimant 126	$321,004	Postprocedural Hemorrhage Of A Genitourinary System Organ Or Structure Following A Genitourinary System Procedure
Claimant 127	$320,580	Melanoma In Situ Of Other Part Of Trunk
Claimant 128	$319,226	Parkinsonism, Unspecified
Claimant 129	$317,963	Bloodstream Infection Due To Central Venous Catheter, Initial Encounter
Claimant 130	$317,293	Other Inherited Spinal Muscular Atrophy
Claimant 131	$316,353	Restricted Diagnosis
Claimant 132	$315,885	Encounter For Antineoplastic Chemotherapy
Claimant 133	$313,916	Atrioventricular Block, Complete
Claimant 134	$312,451	Dependence On Respirator (ventilator) Status
Claimant 135	$305,155	Stenosis Of Peripheral Vascular Stent, Initial Encounter
Claimant 136	$304,083	Encounter For Antineoplastic Chemotherapy
Claimant 137	$301,906	Malignant Neoplasm Of Rectum
Claimant 138	$300,097	Restricted Diagnosis
Claimant 139	$299,277	Encounter For Antineoplastic Immunotherapy
Claimant 140	$299,195	Benign Neoplasm Of Pituitary Gland
Claimant 141	$296,041	Malignant Neoplasm Of Frontal Lobe
Claimant 142	$295,626	Encounter For Antineoplastic Chemotherapy
Claimant 143	$295,073	Malignant Neoplasm Of Parietal Lobe
Claimant 144	$294,779	Secondary Malignant Neoplasm Of Left Lung
Claimant 145	$291,477	Encounter For Antineoplastic Chemotherapy
Claimant 146	$290,887	Restricted Diagnosis
Claimant 147	$288,111	Restricted Diagnosis
Claimant 148	$286,755	Encounter For Antineoplastic Immunotherapy
Claimant 149	$284,600	Sepsis Due To Streptococcus Pneumoniae
Claimant 150	$284,374	Acute Tracheitis Without Obstruction
Claimant 151	$282,958	Pneumonia Due To Pseudomonas
Claimant 152	$282,608	Malignant Neoplasm Of Overlapping Sites Of Right Bronchus And Lung
Claimant 153	$281,592	Other Malignant Neuroendocrine Tumors
Claimant 154	$281,036	Sepsis, Unspecified Organism
Claimant 155	$280,056	Rheumatic Disorders Of Both Mitral And Tricuspid Valves
Claimant 156	$279,929	Encounter For Antineoplastic Chemotherapy
Claimant 157	$279,207	Acute Cystitis Without Hematuria
Claimant 158	$277,630	Encounter For Antineoplastic Immunotherapy
Claimant 159	$277,095	Other Specified Disorders Of Bladder
Claimant 160	$276,980	Breakdown (mechanical) Of Surgically Created Arteriovenous Fistula, Initial Encounter
Claimant 161	$273,809	End Stage Renal Disease
Claimant 162	$271,482	Spinal Stenosis, Lumbar Region Without Neurogenic Claudication
Claimant 163	$271,273	Malignant Neoplasm Of Bladder, Unspecified
Claimant 164	$270,841	Encounter For Antineoplastic Immunotherapy
Claimant 165	$270,734	Encounter For Antineoplastic Chemotherapy
Claimant 166	$270,243	Encounter For Other Orthopedic Aftercare
Claimant 167	$269,181	Neuromyelitis Optica (devic)
Claimant 168	$266,102	Encounter For Antineoplastic Chemotherapy
Claimant 169	$265,944	Encounter For Antineoplastic Chemotherapy
Claimant 170	$265,913	Malignant Neoplasm Of Bladder, Unspecified
Claimant 171	$265,158	Encounter For Aftercare Following Kidney Transplant
Claimant 172	$264,827	Stenosis Of Other Cardiac Prosthetic Devices, Implants And Grafts, Initial Encounter
Claimant 173	$264,786	Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Non-dominant Side
Claimant 174	$264,656	Restricted Diagnosis
Claimant 175	$260,274	Acquired Pure Red Cell Aplasia, Unspecified
Claimant 176	$257,737	Sepsis, Unspecified Organism
Claimant 177	$256,973	Encounter For Antineoplastic Immunotherapy
Claimant 178	$256,162	Encounter For Antineoplastic Chemotherapy
Claimant 179	$255,699	Pyogenic Arthritis, Unspecified
Claimant 180	$254,332	Malignant Neoplasm Of Unspecified Ovary
Claimant 181	$252,574	Bloodstream Infection Due To Central Venous Catheter, Initial Encounter
Claimant 182	$251,324	Restricted Diagnosis
Claimant 183	$250,370	Encounter For Antineoplastic Chemotherapy
Claimant 184	$249,918	Atherosclerotic Heart Disease Of Native Coronary Artery With Unstable Angina Pectoris
Claimant 185	$249,895	Encounter For Antineoplastic Chemotherapy
Claimant 186	$249,492	Moderate Hypoxic Ischemic Encephalopathy (hie)
Claimant 187	$249,164	Aneurysm Of The Ascending Aorta, Without Rupture
Claimant 188	$248,959	Benign Neoplasm Of Colon, Unspecified
Claimant 189	$248,876	Malignant Neoplasm Of Unspecified Part Of Unspecified Bronchus Or Lung
Claimant 190	$248,246	Nonrheumatic Mitral (valve) Insufficiency
Claimant 191	$245,702	Sepsis, Unspecified Organism
Claimant 192	$245,044	Restricted Diagnosis
Claimant 193	$244,309	Biventricular Heart Failure
Claimant 194	$244,024	Restricted Diagnosis
Claimant 195	$243,312	Sepsis, Unspecified Organism
Claimant 196	$243,047	Instability Of Internal Left Knee Prosthesis, Initial Encounter
Claimant 197	$242,154	Paroxysmal Atrial Fibrillation
Claimant 198	$241,105	Encounter For Antineoplastic Chemotherapy
Claimant 199	$239,169	Encounter For Antineoplastic Chemotherapy
Claimant 200	$238,317	Atrioventricular Block, Second Degree
Claimant 201	$238,182	Multiple Myeloma Not Having Achieved Remission
Claimant 202	$237,826	Restricted Diagnosis
Claimant 203	$237,633	Ischemic Cardiomyopathy
Claimant 204	$236,159	Restricted Diagnosis
Claimant 205	$235,310	Acute Embolism And Thrombosis Of Left Femoral Vein
Claimant 206	$235,082	Radiculopathy, Lumbosacral Region
Claimant 207	$234,323	Encounter For Antineoplastic Immunotherapy
Claimant 208	$233,857	Spinal Stenosis, Lumbar Region With Neurogenic Claudication
Claimant 209	$233,838	Malignant Neoplasm Of Unspecified Site Of Left Female Breast
Claimant 210	$232,281	Ventricular Fibrillation
Claimant 211	$232,123	Chronic Respiratory Failure, Unspecified Whether With Hypoxia Or Hypercapnia
Claimant 212	$231,698	Acute Kidney Failure, Unspecified
Claimant 213	$227,386	Malignant Neoplasm Of Brain, Unspecified
Claimant 214	$227,228	Thrombotic Microangiopathy, Unspecified
Claimant 215	$226,681	Multiple Sclerosis
Claimant 216	$226,174	Malignant Neoplasm Of Head Of Pancreas
Claimant 217	$226,157	Atherosclerosis Of Native Arteries Of Extremities With Rest Pain, Bilateral Legs
Claimant 218	$226,029	Infection Following A Procedure, Superficial Incisional Surgical Site, Initial Encounter
Claimant 219	$224,212	Other Complications Of Intestinal Pouch
Claimant 220	$223,716	Ventricular Fibrillation
Claimant 221	$222,521	Hydronephrosis With Ureteral Stricture, Not Elsewhere Classified
Claimant 222	$222,174	Squamous Cell Carcinoma Of Skin Of Right Ear And External Auricular Canal
Claimant 223	$221,861	Encounter For Antineoplastic Immunotherapy
Claimant 224	$221,774	Other Abnormalities Of Breathing
Claimant 225	$221,353	Residual Hemorrhoidal Skin Tags
Claimant 226	$221,054	Nonrheumatic Aortic (valve) Stenosis
Claimant 227	$220,925	Restricted Diagnosis
Claimant 228	$219,605	Nonrheumatic Mitral (valve) Insufficiency
Claimant 229	$218,764	Other Specified Noninflammatory Disorders Of Uterus
Claimant 230	$218,262	Malignant Neoplasm Of Brain, Unspecified
Claimant 231	$218,162	Malignant Neoplasm Of Vulva, Unspecified
Claimant 232	$216,528	Hepatic Encephalopathy
Claimant 233	$216,262	Restricted Diagnosis
Claimant 234	$215,293	Infection Of Amputation Stump, Right Lower Extremity
Claimant 235	$215,188	Dissection Of Ascending Aorta
Claimant 236	$215,060	Multiple Sclerosis
Claimant 237	$214,791	Encounter For Prophylactic Removal Of Breast
Claimant 238	$213,603	Diffuse Large B-cell Lymphoma, Lymph Nodes Of Multiple Sites
Claimant 239	$213,124	Hypertensive Heart Disease Without Heart Failure
Claimant 240	$212,899	Nonrheumatic Aortic (valve) Stenosis With Insufficiency
Claimant 241	$212,628	Multiple Sclerosis
Claimant 242	$211,574	Noninfective Gastroenteritis And Colitis, Unspecified
Claimant 243	$211,315	Restricted Diagnosis
Claimant 244	$210,997	Stiff-man Syndrome
Claimant 245	$210,820	Bloodstream Infection Due To Central Venous Catheter, Initial Encounter
Claimant 246	$208,864	Breakdown (mechanical) Of Ventricular Intracranial (communicating) Shunt, Initial Encounter
Claimant 247	$207,402	Encounter For Breast Reconstruction Following Mastectomy
Claimant 248	$206,339	Other Malignant Neuroendocrine Tumors
Claimant 249	$205,984	Acute Kidney Failure, Unspecified
Claimant 250	$205,812	Non-st Elevation (nstemi) Myocardial Infarction
Claimant 251	$205,240	Atherosclerotic Heart Disease Of Native Coronary Artery With Unspecified Angina Pectoris
Claimant 252	$204,456	Displaced Trimalleolar Fracture Of Right Lower Leg, Initial Encounter For Open Fracture Type I Or Ii
Claimant 253	$204,343	Multiple Sclerosis
Claimant 254	$202,902	Restricted Diagnosis
Claimant 255	$202,711	Fracture Of Unspecified Part Of Neck Of Left Femur, Initial Encounter For Closed Fracture
Claimant 256	$202,388	4-part Fracture Of Surgical Neck Of Right Humerus, Initial Encounter For Closed Fracture
Claimant 257	$202,232	Encounter For Antineoplastic Immunotherapy
Claimant 258	$201,122	Spinal Stenosis, Lumbosacral Region
Claimant 259	$200,734	Nontraumatic Subarachnoid Hemorrhage, Unspecified
Claimant 260	$200,682	Restricted Diagnosis
Claimant 261	$200,330	Restricted Diagnosis
Claimant 262	$199,915	Spondyloepiphyseal Dysplasia
Claimant 263	$199,664	Small Cell B-cell Lymphoma, Extranodal And Solid Organ Sites
Claimant 264	$199,573	Stenosis Of Other Vascular Prosthetic Devices, Implants And Grafts, Initial Encounter
Claimant 265	$199,354	Restricted Diagnosis
Claimant 266	$199,298	Nonrheumatic Aortic (valve) Insufficiency
Claimant 267	$198,489	Staphylococcal Arthritis, Left Hip
Claimant 268	$198,434	Acute Respiratory Failure With Hypercapnia
Claimant 269	$198,222	Nondisplaced Fracture Of Greater Trochanter Of Right Femur, Initial Encounter For Closed Fracture
Claimant 270	$197,948	Angiodysplasia Of Colon With Hemorrhage
Claimant 271	$195,271	Multiple Endocrine Neoplasia (men) Type Iia
Claimant 272	$195,235	Restricted Diagnosis
Claimant 273	$194,817	Type 2 Diabetes Mellitus With Diabetic Chronic Kidney Disease
Claimant 274	$194,413	Transitional Atrioventricular Septal Defect
Claimant 275	$194,324	Paroxysmal Atrial Fibrillation
Claimant 276	$193,974	Malignant Neoplasm Of Right Ovary
Claimant 277	$192,624	Malignant Neoplasm Of Glottis
Claimant 278	$192,553	Hypertensive Heart Disease With Heart Failure
Claimant 279	$192,447	Longstanding Persistent Atrial Fibrillation
Claimant 280	$191,283	Other Specified Mycoses
Claimant 281	$191,255	Systemic Lupus Erythematosus, Unspecified
Claimant 282	$190,673	Single Subsegmental Thrombotic Pulmonary Embolism Without Acute Cor Pulmonale
Claimant 283	$189,608	Restricted Diagnosis
Claimant 284	$189,534	Chronic Or Unspecified Gastric Ulcer With Perforation
Claimant 285	$189,280	Encounter For Antineoplastic Chemotherapy
Claimant 286	$189,240	Unspecified Appendicitis
Claimant 287	$189,111	Encounter For Antineoplastic Chemotherapy
Claimant 288	$187,782	Malignant Neoplasm Of Head Of Pancreas
Claimant 289	$187,516	Sepsis, Unspecified Organism
Claimant 290	$187,259	Spinal Stenosis, Lumbar Region With Neurogenic Claudication
Claimant 291	$186,730	Multiple Sclerosis
Claimant 292	$186,663	Encounter For Attention To Gastrostomy
Claimant 293	$186,640	Benign Neoplasm Of Heart
Claimant 294	$186,168	Dislocation Of Internal Left Hip Prosthesis, Initial Encounter
Claimant 295	$186,113	Bilateral Primary Osteoarthritis Of Knee
Claimant 296	$186,111	Restricted Diagnosis
Claimant 297	$186,016	Laceration Of Other Part Of Small Intestine, Initial Encounter
Claimant 298	$185,813	Other Malignant Neuroendocrine Tumors
Claimant 299	$185,726	Spondylosis Without Myelopathy Or Radiculopathy, Cervical Region
Claimant 300	$184,796	Infection And Inflammatory Reaction Due To Other Prosthetic Device, Implant And Graft In Urinary System, Initial Encounter
Claimant 301	$184,066	Benign Neoplasm Of Cerebral Meninges
Claimant 302	$183,910	Atherosclerotic Heart Disease Of Native Coronary Artery Without Angina Pectoris
Claimant 303	$182,853	Diffuse Large B-cell Lymphoma, Lymph Nodes Of Head, Face, And Neck
Claimant 304	$182,512	Duodenal Ulcer, Unspecified As Acute Or Chronic, Without Hemorrhage Or Perforation
Claimant 305	$182,432	Malignant Neoplasm Of Tongue, Unspecified
Claimant 306	$182,227	Unspecified B-cell Lymphoma, Lymph Nodes Of Inguinal Region And Lower Limb
Claimant 307	$181,939	Sick Sinus Syndrome
Claimant 308	$181,601	Malignant Neoplasm Of Lower-outer Quadrant Of Right Female Breast
Claimant 309	$181,379	Restricted Diagnosis
Claimant 310	$180,673	Encounter For Antineoplastic Chemotherapy
Claimant 311	$180,521	Other Persistent Atrial Fibrillation
Claimant 312	$180,395	Unilateral Primary Osteoarthritis, Right Hip
Claimant 313	$180,282	Unilateral Primary Osteoarthritis, Left Knee
Claimant 314	$178,468	Calculus Of Gallbladder With Acute And Chronic Cholecystitis Without Obstruction
Claimant 315	$178,378	Multiple Sclerosis
Claimant 316	$177,836	Malignant Neoplasm Of Brain, Unspecified
Claimant 317	$177,823	Restricted Diagnosis
Claimant 318	$177,477	Encounter For Antineoplastic Chemotherapy
Claimant 319	$177,072	Encounter For Antineoplastic Chemotherapy
Claimant 320	$175,045	Malignant Neoplasm Of Pharynx, Unspecified
Claimant 321	$174,660	Other Specified Diseases Of Pancreas
Claimant 322	$174,568	Parkinson's Disease With Dyskinesia, With Fluctuations
Claimant 323	$173,998	Atherosclerotic Heart Disease Of Native Coronary Artery With Other Forms Of Angina Pectoris
Claimant 324	$173,708	Rising Psa Following Treatment For Malignant Neoplasm Of Prostate
Claimant 325	$173,629	St Elevation (stemi) Myocardial Infarction Involving Other Coronary Artery Of Inferior Wall
Claimant 326	$173,596	Spondylolisthesis, Lumbar Region
Claimant 327	$173,249	Calculus Of Kidney With Calculus Of Ureter
Claimant 328	$173,061	Infection Of Incontinent External Stoma Of Urinary Tract
Claimant 329	$172,998	Restricted Diagnosis
Claimant 330	$172,798	Infection And Inflammatory Reaction Due To Other Internal Orthopedic Prosthetic Devices, Implants And Grafts, Initial Encounter
Claimant 331	$172,478	Restricted Diagnosis
Claimant 332	$172,467	Duodenitis Without Bleeding
Claimant 333	$172,371	Traumatic Subdural Hemorrhage Without Loss Of Consciousness, Initial Encounter
Claimant 334	$171,424	Cerebral Infarction Due To Embolism Of Unspecified Cerebral Artery
Claimant 335	$171,323	Encounter For Antineoplastic Chemotherapy
Claimant 336	$170,819	Cerebral Infarction Due To Unspecified Occlusion Or Stenosis Of Left Carotid Arteries
Claimant 337	$170,752	Atherosclerotic Heart Disease Of Native Coronary Artery Without Angina Pectoris
Claimant 338	$170,724	Obstruction Of Duodenum
Claimant 339	$169,988	Restricted Diagnosis
Claimant 340	$169,985	Encounter For Attention To Ileostomy
Claimant 341	$169,984	Restricted Diagnosis
Claimant 342	$169,786	Encounter For Breast Reconstruction Following Mastectomy
Claimant 343	$169,146	Sepsis Following A Procedure, Initial Encounter
Claimant 344	$168,837	Malignant Neoplasm Of Unspecified Part Of Right Bronchus Or Lung
Claimant 345	$168,483	Nonrheumatic Aortic (valve) Stenosis
Claimant 346	$168,386	Dermatopolymyositis, Unspecified, Organ Involvement Unspecified
Claimant 347	$168,353	End Stage Renal Disease
Claimant 348	$168,318	Other Persistent Atrial Fibrillation
Claimant 349	$168,079	Encounter For Antineoplastic Chemotherapy
Claimant 350	$167,684	Sepsis Due To Methicillin Resistant Staphylococcus Aureus
Claimant 351	$167,141	Encounter For Adjustment And Management Of Automatic Implantable Cardiac Defibrillator
Claimant 352	$166,342	Nonrheumatic Mitral (valve) Insufficiency
Claimant 353	$165,660	Encounter For Antineoplastic Radiation Therapy
Claimant 354	$165,615	Neoplasm Of Uncertain Behavior Of Brain, Supratentorial
Claimant 355	$165,452	Nonfamilial Hypogammaglobulinemia
Claimant 356	$165,373	Diverticulitis Of Large Intestine With Perforation And Abscess Without Bleeding
Claimant 357	$164,403	Lung Transplant Rejection
Claimant 358	$164,225	Other Nontraumatic Intracerebral Hemorrhage
Claimant 359	$164,050	Malignant Neoplasm Of Cerebrum, Except Lobes And Ventricles
Claimant 360	$163,893	Spinal Stenosis, Lumbar Region With Neurogenic Claudication
Claimant 361	$163,787	Malignant Neoplasm Of Unspecified Site Of Left Female Breast
Claimant 362	$163,766	Parkinsonism, Unspecified
Claimant 363	$161,763	Dysarthria Following Cerebral Infarction
Claimant 364	$161,117	Obstructive Sleep Apnea (adult) (pediatric)
Claimant 365	$160,885	Hypertensive Heart Disease With Heart Failure
Claimant 366	$160,089	Intraductal Carcinoma In Situ Of Right Breast
Claimant 367	$160,082	Restricted Diagnosis
Claimant 368	$159,804	Cervical Spina Bifida With Hydrocephalus
Claimant 369	$159,505	Unspecified Urethral Stricture, Male, Meatal
Claimant 370	$159,415	Atrial Septal Defect, Unspecified
Claimant 371	$158,770	Intussusception
Claimant 372	$158,700	Nonrheumatic Aortic (valve) Stenosis
Claimant 373	$158,009	Hemiplegia, Unspecified Affecting Right Dominant Side
Claimant 374	$157,773	Other Fatigue
Claimant 375	$157,738	Intraductal Carcinoma In Situ Of Left Breast
Claimant 376	$157,312	Sepsis, Unspecified Organism
Claimant 377	$156,501	St Elevation (stemi) Myocardial Infarction Involving Other Coronary Artery Of Inferior Wall
Claimant 378	$156,459	Localized Enlarged Lymph Nodes
Claimant 379	$156,074	Malignant Neoplasm Of Lower Lobe, Right Bronchus Or Lung
Claimant 380	$155,731	Laceration Of Liver, Unspecified Degree, Initial Encounter
Claimant 381	$155,679	Encounter For Antineoplastic Immunotherapy
Claimant 382	$155,448	Squamous Cell Carcinoma Of Skin Of Unspecified Parts Of Face
Claimant 383	$154,239	Multiple Sclerosis
Claimant 384	$153,739	Encounter For Antineoplastic Chemotherapy
Claimant 385	$153,526	Encounter For Other Preprocedural Examination
Claimant 386	$152,903	Paroxysmal Atrial Fibrillation
Claimant 387	$152,708	Diffuse Traumatic Brain Injury With Loss Of Consciousness Of Unspecified Duration, Initial Encounter
Claimant 388	$152,510	Malignant Neoplasm Of Endometrium
Claimant 389	$152,444	Age-related Osteoporosis With Current Pathological Fracture, Vertebra(e), Initial Encounter For Fracture
Claimant 390	$152,431	Encounter For Antineoplastic Chemotherapy
Claimant 391	$151,897	Spinal Stenosis, Lumbar Region Without Neurogenic Claudication
Claimant 392	$151,607	Dissection Of Ascending Aorta
Claimant 393	$151,412	Antibody Deficiency With Near-normal Immunoglobulins Or With Hyperimmunoglobulinemia
Claimant 394	$151,112	Ulcerative (chronic) Pancolitis Without Complications
Claimant 395	$151,075	Encounter For Attention To Ileostomy
Claimant 396	$150,767	Malignant Neoplasm Of Head Of Pancreas
Claimant 397	$150,675	Infection And Inflammatory Reaction Due To Internal Left Hip Prosthesis, Initial Encounter
Claimant 398	$150,347	Malignant Neoplasm Of Rectum
Claimant 399	$150,021	Nausea With Vomiting, Unspecified
Claimant 400	$149,980	Sepsis, Unspecified Organism
Claimant 401	$149,787	Acute Respiratory Failure With Hypoxia
Claimant 402	$149,489	Encounter For Screening For Malignant Neoplasm Of Colon
Claimant 403	$149,092	Malignant Neoplasm Of Prostate
Claimant 404	$149,084	Malignant Neoplasm Of Connective And Soft Tissue Of Right Upper Limb, Including Shoulder
Claimant 405	$148,904	Urinary Tract Infection, Site Not Specified
Claimant 406	$148,866	Generalized Idiopathic Epilepsy And Epileptic Syndromes, Not Intractable, Without Status Epilepticus
Claimant 407	$148,836	Malignant Neoplasm Of Unspecified Part Of Unspecified Bronchus Or Lung
Claimant 408	$148,789	Hb-ss Disease With Crisis, Unspecified
Claimant 409	$147,635	Restricted Diagnosis
Claimant 410	$147,591	Cellulitis Of Right Lower Limb
Claimant 411	$147,574	Ulcerative Colitis, Unspecified, Without Complications
Claimant 412	$147,450	Ulcerative Colitis, Unspecified With Unspecified Complications
Claimant 413	$147,394	Unspecified Abdominal Pain
Claimant 414	$147,254	Other Benign Neuroendocrine Tumors
Claimant 415	$147,249	Restricted Diagnosis
Claimant 416	$146,753	Intervertebral Disc Disorders With Myelopathy, Thoracic Region
Claimant 417	$146,348	Migraine With Aura, Intractable, Without Status Migrainosus
Claimant 418	$146,307	Malignant Neoplasm Of Prostate
Claimant 419	$146,298	Restricted Diagnosis
Claimant 420	$145,950	Calculus Of Ureter
Claimant 421	$145,854	Spinal Stenosis, Lumbar Region Without Neurogenic Claudication
Claimant 422	$145,255	Personal History Of Urinary Calculi
Claimant 423	$145,255	Other Gram-negative Sepsis
Claimant 424	$144,933	Covid-19
Claimant 425	$144,801	Atherosclerosis Of Autologous Vein Coronary Artery Bypass Graft(s) With Unspecified Angina Pectoris
Claimant 426	$144,673	Breakdown (mechanical) Of Heart Valve Prosthesis, Initial Encounter
Claimant 427	$144,130	Severe Persistent Asthma, Uncomplicated
Claimant 428	$143,712	Other Atherosclerosis Of Native Arteries Of Extremities, Left Leg
Claimant 429	$143,350	Unilateral Primary Osteoarthritis, Right Knee
Claimant 430	$143,087	Multiple Sclerosis
Claimant 431	$142,550	Restricted Diagnosis
Claimant 432	$142,463	Unilateral Primary Osteoarthritis, Right Knee
Claimant 433	$142,411	Traumatic Subdural Hemorrhage With Loss Of Consciousness Of Any Duration With Death Due To Brain Injury Before Regaining Consciousness, Initial Encounter
Claimant 434	$142,382	Restricted Diagnosis
Claimant 435	$142,055	Sepsis, Unspecified Organism
Claimant 436	$141,775	Ischemic Cardiomyopathy
Claimant 437	$141,672	Lobular Carcinoma In Situ Of Right Breast
Claimant 438	$141,511	Nontraumatic Intracerebral Hemorrhage In Hemisphere, Cortical
Claimant 439	$141,218	Other Malignant Neuroendocrine Tumors
Claimant 440	$141,100	Non-pressure Chronic Ulcer Of Other Part Of Right Lower Leg With Unspecified Severity
Claimant 441	$140,923	Encounter For Antineoplastic Immunotherapy
Claimant 442	$140,705	Malignant Neoplasm Of Prostate
Claimant 443	$140,178	Rising Psa Following Treatment For Malignant Neoplasm Of Prostate
Claimant 444	$140,091	Malignant Neoplasm Of Rectum
Claimant 445	$139,729	Incomplete Rotator Cuff Tear Or Rupture Of Right Shoulder, Not Specified As Traumatic
Claimant 446	$139,502	Restricted Diagnosis
Claimant 447	$139,322	Encounter For Antineoplastic Chemotherapy
Claimant 448	$139,287	Restricted Diagnosis
Claimant 449	$139,178	Carcinoma In Situ Of Anus And Anal Canal
Claimant 450	$138,338	Restricted Diagnosis
Claimant 451	$137,220	Chronic Lymphocytic Leukemia Of B-cell Type Not Having Achieved Remission
Claimant 452	$136,868	Secondary Malignant Neoplasm Of Bone
Claimant 453	$136,751	Malignant Neoplasm Of Unspecified Site Of Right Female Breast
Claimant 454	$136,719	Unspecified Acute Appendicitis
Claimant 455	$136,676	Restricted Diagnosis
Claimant 456	$136,640	Cerebral Infarction, Unspecified
Claimant 457	$136,403	Displaced Trimalleolar Fracture Of Right Lower Leg, Initial Encounter For Closed Fracture
Claimant 458	$136,301	Osteomyelitis Of Vertebra, Lumbar Region
Claimant 459	$135,986	Pelvic And Perineal Pain
Claimant 460	$135,977	Saddle Embolus Of Pulmonary Artery With Acute Cor Pulmonale
Claimant 461	$135,907	Atherosclerotic Heart Disease Of Native Coronary Artery With Unstable Angina Pectoris
Claimant 462	$135,803	Malignant Neoplasm Of Overlapping Sites Of Left Female Breast
Claimant 463	$135,090	Restricted Diagnosis
Claimant 464	$134,757	Sepsis, Unspecified Organism
Claimant 465	$134,099	Restricted Diagnosis
Claimant 466	$134,017	Restricted Diagnosis
Claimant 467	$133,982	Disproportion Of Reconstructed Breast
Claimant 468	$133,701	Encounter For Antineoplastic Immunotherapy
Claimant 469	$133,086	Crohn's Disease, Unspecified, Without Complications
Claimant 470	$132,898	Other Headache Syndrome
Claimant 471	$132,615	Major Laceration Of Liver, Initial Encounter
Claimant 472	$132,551	Sepsis Due To Streptococcus, Group A
Claimant 473	$132,343	Malignant Neoplasm Of Prostate
Claimant 474	$132,115	Unspecified Fracture Of Third Metacarpal Bone, Right Hand, Initial Encounter For Closed Fracture
Claimant 475	$131,906	Parkinson's Disease With Dyskinesia, With Fluctuations
Claimant 476	$131,785	Restricted Diagnosis
Claimant 477	$131,467	Malignant Neoplasm Of Body Of Pancreas
Claimant 478	$131,464	Encounter For Other Preprocedural Examination
Claimant 479	$131,300	Frequency Of Micturition
Claimant 480	$131,271	Encounter For Antineoplastic Immunotherapy
Claimant 481	$131,224	Diverticulitis Of Large Intestine Without Perforation Or Abscess With Bleeding
Claimant 482	$131,198	Non-st Elevation (nstemi) Myocardial Infarction
Claimant 483	$130,946	Immune Thrombocytopenic Purpura
Claimant 484	$130,904	Unilateral Primary Osteoarthritis, Right Hip
Claimant 485	$130,286	Urinary Tract Infection, Site Not Specified
Claimant 486	$130,264	Acute Kidney Failure, Unspecified
Claimant 487	$130,135	Spinal Stenosis, Lumbar Region With Neurogenic Claudication
Claimant 488	$130,101	Acute And Chronic Respiratory Failure With Hypoxia
Claimant 489	$129,913	Primary Osteoarthritis, Right Shoulder
Claimant 490	$129,268	Other Toxic Encephalopathy
Claimant 491	$129,169	Adult Hypertrophic Pyloric Stenosis
Claimant 492	$129,070.60	Combined Forms Of Age-related Cataract, Left Eye
Claimant 493	$129,048.89	Hypertensive Heart And Chronic Kidney Disease With Heart Failure And Stage 1 Through Stage 4 Chronic Kidney Disease, Or Unspecified Chronic Kidney Disease
Claimant 494	$128,741.46	Other Specified Disorders Of Kidney And Ureter
Claimant 495	$128,455.07	Ventricular Premature Depolarization
Claimant 496	$128,155.25	Angiodysplasia Of Stomach And Duodenum With Bleeding
Claimant 497	$128,106.38	Other Pericardial Effusion (noninflammatory)
Claimant 498	$127,972.37	St Elevation (stemi) Myocardial Infarction Involving Left Anterior Descending Coronary Artery
Claimant 499	$127,806.00	Restricted Diagnosis
Claimant 500	$127,324.69	Sprain Of Anterior Cruciate Ligament Of Right Knee, Initial Encounter
Claimant 501	$127,171.25	Gastrointestinal Stromal Tumor Of Stomach
Claimant 502	$126,932.94	Sepsis, Unspecified Organism
Claimant 503	$126,915.12	Hypertrophic Scar
Claimant 504	$126,783.46	Other Mechanical Complication Of Internal Left Knee Prosthesis, Initial Encounter
Claimant 505	$126,645.94	Malignant Neoplasm Of Lower-outer Quadrant Of Left Female Breast
Claimant 506	$126,549.76	Malignant Neoplasm Of Upper-outer Quadrant Of Right Female Breast
Claimant 507	$126,494.35	Multifocal Motor Neuropathy
Claimant 508	$125,889.66	Restricted Diagnosis
Claimant 509	$125,760.32	Unspecified Atrial Flutter
Claimant 510	$125,552.36	Rheumatoid Arthritis Without Rheumatoid Factor, Multiple Sites
Claimant 511	$125,332.81	Restricted Diagnosis
Claimant 512	$125,285.89	Syncope And Collapse
Claimant 513	$124,877.24	Type 2 Diabetes Mellitus With Diabetic Peripheral Angiopathy With Gangrene
Claimant 514	$124,658.41	Malignant Neoplasm Of Tonsil, Unspecified
Claimant 515	$124,600.09	Atherosclerotic Heart Disease Of Native Coronary Artery With Unspecified Angina Pectoris
Claimant 516	$124,207.50	Systemic Lupus Erythematosus, Unspecified
Claimant 517	$124,029.88	Aneurysm Of Iliac Artery
Claimant 518	$123,704.03	Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Right Dominant Side
Claimant 519	$123,358.15	Spondylosis Without Myelopathy Or Radiculopathy, Lumbar Region
Claimant 520	$123,176.89	Encounter For Adjustment And Management Of Automatic Implantable Cardiac Defibrillator
Claimant 521	$123,137.21	Sepsis, Unspecified Organism
Claimant 522	$122,978.68	Encounter For Antineoplastic Chemotherapy
Claimant 523	$122,845.81	Displaced Bicondylar Fracture Of Right Tibia, Initial Encounter For Closed Fracture
Claimant 524	$122,791.03	Primary Osteoarthritis, Left Ankle And Foot
Claimant 525	$122,784.55	Unilateral Primary Osteoarthritis, Right Knee
Claimant 526	$122,664.82	Restricted Diagnosis
Claimant 527	$122,591.67	Malignant Neoplasm Of Lower Lobe, Right Bronchus Or Lung
Claimant 528	$122,403.05	St Elevation (stemi) Myocardial Infarction Involving Left Anterior Descending Coronary Artery
Claimant 529	$121,978.56	Osteomyelitis, Unspecified
Claimant 530	$121,932.43	Unilateral Primary Osteoarthritis, Right Knee
Claimant 531	$121,438.77	Unilateral Primary Osteoarthritis, Left Knee
Claimant 532	$121,331.05	Nondisplaced Midcervical Fracture Of Right Femur, Initial Encounter For Closed Fracture
Claimant 533	$121,299.80	Breakdown (mechanical) Of Unspecified Vascular Grafts, Initial Encounter
Claimant 534	$121,160.98	Multiple Sclerosis
Claimant 535	$120,939.60	Unspecified Fracture Of Shaft Of Left Fibula, Subsequent Encounter For Closed Fracture With Nonunion
Claimant 536	$120,924.34	Restricted Diagnosis
Claimant 537	$120,901.13	Non-st Elevation (nstemi) Myocardial Infarction
Claimant 538	$120,897.08	Paroxysmal Atrial Fibrillation
Claimant 539	$120,412.23	Nonfamilial Hypogammaglobulinemia
Claimant 540	$119,746.28	Acute Diastolic (congestive) Heart Failure
Claimant 541	$119,653.20	Malignant Neoplasm Of Prostate
Claimant 542	$119,633.32	Chronic Gout, Unspecified, With Tophus (tophi)
Claimant 543	$119,620.97	Unspecified Atrial Fibrillation
Claimant 544	$119,514.94	Hb-ss Disease With Acute Chest Syndrome
Claimant 545	$119,407.28	Restricted Diagnosis
Claimant 546	$119,317.15	Unilateral Primary Osteoarthritis, Left Knee
Claimant 547	$119,202.11	Hypersensitivity Angiitis
Claimant 548	$119,014.76	Malignant Neoplasm Of Sigmoid Colon
Claimant 549	$118,948.55	Immunodeficiency, Unspecified
Claimant 550	$118,358.58	Intraductal Carcinoma In Situ Of Left Breast
Claimant 551	$118,129.85	Encounter For Antineoplastic Radiation Therapy
Claimant 552	$117,540.62	Benign Prostatic Hyperplasia With Lower Urinary Tract Symptoms
Claimant 553	$116,707.18	Restricted Diagnosis
Claimant 554	$116,670.68	Encounter For Antineoplastic Immunotherapy
Claimant 555	$116,376.48	Acute Kidney Failure, Unspecified
Claimant 556	$116,344.48	Restricted Diagnosis
Claimant 557	$116,321.90	Restricted Diagnosis
Claimant 558	$116,243.53	Macular Cyst, Hole, Or Pseudohole, Left Eye
Claimant 559	$116,242.50	Restricted Diagnosis
Claimant 560	$116,229.95	Intervertebral Disc Disorders With Radiculopathy, Lumbosacral Region
Claimant 561	$116,042.88	Malignant Neoplasm Of Duodenum
Claimant 562	$115,953.12	Complete Rotator Cuff Tear Or Rupture Of Left Shoulder, Not Specified As Traumatic
Claimant 563	$115,460.42	Paroxysmal Atrial Fibrillation
Claimant 564	$115,376.00	Restricted Diagnosis
Claimant 565	$115,325.54	Malignant Neoplasm Of Thyroid Gland
Claimant 566	$115,246.34	Iron Deficiency Anemia, Unspecified
Claimant 567	$115,245.22	Restricted Diagnosis
Claimant 568	$115,218.14	Restricted Diagnosis
Claimant 569	$115,217.18	Calculus Of Kidney
Claimant 570	$115,212.72	Hypokalemia
Claimant 571	$115,130.95	Type 2 Diabetes Mellitus With Hypoglycemia Without Coma
Claimant 572	$114,884.65	Chronic Lymphocytic Leukemia Of B-cell Type Not Having Achieved Remission
Claimant 573	$114,487.25	Ventricular Premature Depolarization
Claimant 574	$114,474.51	Restricted Diagnosis
Claimant 575	$114,254.11	Sprain Of Calcaneofibular Ligament Of Left Ankle, Initial Encounter
Claimant 576	$113,932.74	Displaced Intertrochanteric Fracture Of Right Femur, Subsequent Encounter For Closed Fracture With Routine Healing
Claimant 577	$113,797.98	Age-related Osteoporosis With Current Pathological Fracture, Vertebra(e), Initial Encounter For Fracture
Claimant 578	$113,640.24	Valgus Deformity, Not Elsewhere Classified, Right Knee
Claimant 579	$113,638.05	Secondary Malignant Neoplasm Of Bone
Claimant 580	$113,481.66	Sepsis, Unspecified Organism
Claimant 581	$113,154.94	Restricted Diagnosis
Claimant 582	$113,148.19	Spinal Stenosis, Lumbar Region With Neurogenic Claudication
Claimant 583	$113,116.27	Unspecified Rotator Cuff Tear Or Rupture Of Left Shoulder, Not Specified As Traumatic
Claimant 584	$113,083.23	Malignant Neoplasm Of Bones Of Skull And Face
Claimant 585	$113,082.81	Restricted Diagnosis
Claimant 586	$112,916.92	Restricted Diagnosis
Claimant 587	$112,900.49	Encounter For Antineoplastic Chemotherapy
Claimant 588	$112,671.79	Displaced Intertrochanteric Fracture Of Right Femur, Initial Encounter For Closed Fracture
Claimant 589	$112,535.85	Benign Neoplasm Of Pituitary Gland
Claimant 590	$112,370.54	Multiple Fractures Of Ribs, Right Side, Initial Encounter For Closed Fracture
Claimant 591	$112,201.16	Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Right Dominant Side
Claimant 592	$112,173.96	Other Persistent Atrial Fibrillation
Claimant 593	$112,137.21	Other Postprocedural Complications And Disorders Of Digestive System
Claimant 594	$111,665.79	Unilateral Primary Osteoarthritis, Right Knee
Claimant 595	$111,651.93	Malignant Neoplasm Of Upper Lobe, Right Bronchus Or Lung
Claimant 596	$111,592.36	Malignant Neoplasm Of Rectosigmoid Junction
Claimant 597	$111,459.91	Restricted Diagnosis
Claimant 598	$111,452.26	Atherosclerotic Heart Disease Of Native Coronary Artery Without Angina Pectoris
Claimant 599	$111,179.24	Chronic Diastolic (congestive) Heart Failure
Claimant 600	$110,853.05	Multiple Sclerosis
Claimant 601	$110,604.93	Malignant Neoplasm Of Sigmoid Colon
Claimant 602	$110,418.65	Obstructive Sleep Apnea (adult) (pediatric)
Claimant 603	$110,321.37	Restricted Diagnosis
Claimant 604	$110,206.57	Calculus Of Kidney With Calculus Of Ureter
Claimant 605	$110,159.81	Atherosclerosis Of Native Arteries Of Extremities With Intermittent Claudication, Bilateral Legs
Claimant 606	$110,157.44	Nonrheumatic Mitral (valve) Insufficiency
Claimant 607	$110,129.28	Restricted Diagnosis
Claimant 608	$110,090.13	Myoclonus
Claimant 609	$109,888.32	Bloodstream Infection Due To Central Venous Catheter, Initial Encounter
Claimant 610	$109,731.72	Restricted Diagnosis
Claimant 611	$109,689.02	Hypertensive Chronic Kidney Disease With Stage 5 Chronic Kidney Disease Or End Stage Renal Disease
Claimant 612	$109,678.85	Restricted Diagnosis
Claimant 613	$109,550.42	Generalized Enlarged Lymph Nodes
Claimant 614	$108,799.06	Mantle Cell Lymphoma, Intra-abdominal Lymph Nodes
Claimant 615	$108,661.56	Unilateral Primary Osteoarthritis, Left Hip
Claimant 616	$108,451.81	Localization-related (focal) (partial) Symptomatic Epilepsy And Epileptic Syndromes With Simple Partial Seizures, Intractable, Without Status Epilepticus
Claimant 617	$108,298.34	Restricted Diagnosis
Claimant 618	$108,232.94	Restricted Diagnosis
Claimant 619	$108,169.27	Malignant Neoplasm Of Overlapping Sites Of Left Female Breast
Claimant 620	$108,142.13	Restricted Diagnosis
Claimant 621	$108,060.34	Restricted Diagnosis
Claimant 622	$107,951.30	Abnormal Findings On Diagnostic Imaging Of Other Specified Body Structures
Claimant 623	$107,949.68	Age-related Nuclear Cataract, Left Eye
Claimant 624	$107,736.86	Strain Of Muscle, Fascia And Tendon Of Long Head Of Biceps, Right Arm, Initial Encounter
Claimant 625	$107,495.25	Encounter For Antineoplastic Radiation Therapy
Claimant 626	$107,490.12	Malignant Neoplasm Of Prostate
Claimant 627	$107,432.10	Restricted Diagnosis
Claimant 628	$107,404.26	Bunion Of Left Foot
Claimant 629	$107,240.83	Gastro-esophageal Reflux Disease With Esophagitis, Without Bleeding
Claimant 630	$107,238.56	Restricted Diagnosis
Claimant 631	$107,216.10	Abnormal Findings On Diagnostic Imaging Of Skull And Head, Not Elsewhere Classified
Claimant 632	$107,175.44	Unilateral Primary Osteoarthritis, Left Hip
Claimant 633	$107,156.24	Multiple Endocrine Neoplasia (men) Type I
Claimant 634	$106,958.83	Other Ventricular Tachycardia
Claimant 635	$106,934.31	Atherosclerotic Heart Disease Of Native Coronary Artery Without Angina Pectoris
Claimant 636	$106,882.91	Crohn's Disease Of Small Intestine Without Complications
Claimant 637	$106,778.01	Restricted Diagnosis
Claimant 638	$106,778.00	Restricted Diagnosis
Claimant 639	$106,744.04	Restricted Diagnosis
Claimant 640	$106,719.10	Nonrheumatic Aortic (valve) Stenosis
Claimant 641	$106,670.38	Pseudarthrosis After Fusion Or Arthrodesis
Claimant 642	$106,573.57	Restricted Diagnosis
Claimant 643	$106,236.26	Malignant Neoplasm Of Upper-outer Quadrant Of Left Female Breast
Claimant 644	$106,222.59	Restricted Diagnosis
Claimant 645	$106,112.71	Bilateral Primary Osteoarthritis Of Knee
Claimant 646	$106,066.43	Encounter For Adjustment And Management Of Automatic Implantable Cardiac Defibrillator
Claimant 647	$106,047.36	Cervical Disc Disorder With Myelopathy, Mid-cervical Region, Unspecified Level
Claimant 648	$105,965.97	Gross Hematuria
Claimant 649	$105,874.37	Bicipital Tendinitis, Right Shoulder
Claimant 650	$105,725.50	Spondylolisthesis, Lumbosacral Region
Claimant 651	$105,676.57	Hydronephrosis With Ureteral Stricture, Not Elsewhere Classified
Claimant 652	$105,599.30	Displaced Intertrochanteric Fracture Of Right Femur, Initial Encounter For Closed Fracture
Claimant 653	$105,126.48	Infrarenal Abdominal Aortic Aneurysm, Without Rupture
Claimant 654	$105,092.65	Hypertensive Heart Disease With Heart Failure
Claimant 655	$104,775.41	Encounter For Adjustment And Management Of Automatic Implantable Cardiac Defibrillator
Claimant 656	$104,479.11	Immune Thrombocytopenic Purpura
Claimant 657	$104,452.17	Restricted Diagnosis
Claimant 658	$104,244.11	Multiple Sclerosis
Claimant 659	$104,111.84	Malignant Neoplasm Of Ascending Colon
Claimant 660	$104,083.55	Unspecified Hydronephrosis
Claimant 661	$104,061.06	Sepsis Due To Escherichia Coli (e. Coli)
Claimant 662	$103,970.11	Restricted Diagnosis
Claimant 663	$103,675.32	Other Malignant Neuroendocrine Tumors
Claimant 664	$103,598.46	Restricted Diagnosis
Claimant 665	$103,466.26	Displaced Comminuted Fracture Of Shaft Of Right Tibia, Initial Encounter For Closed Fracture
Claimant 666	$103,384.43	Unilateral Primary Osteoarthritis, Right Hip
Claimant 667	$103,176.44	Restricted Diagnosis
Claimant 668	$103,174.61	Autoimmune Hemolytic Anemia, Unspecified
Claimant 669	$103,018.74	Secondary Malignant Neoplasm Of Bone
Claimant 670	$102,984.21	Other Complications Of Lung Transplant
Claimant 671	$102,922.58	Pyonephrosis
Claimant 672	$102,866.79	St Elevation (stemi) Myocardial Infarction Involving Other Coronary Artery Of Anterior Wall
Claimant 673	$102,825.55	Other Intestinal Obstruction Unspecified As To Partial Versus Complete Obstruction
Claimant 674	$102,790.14	Rheumatic Disorders Of Both Mitral And Aortic Valves
Claimant 675	$102,710.33	Addisonian Crisis
Claimant 676	$102,705.96	Restricted Diagnosis
Claimant 677	$102,625.18	Benign Carcinoid Tumor Of Unspecified Site
Claimant 678	$102,616.14	Malignant Neoplasm Of Rectosigmoid Junction
Claimant 679	$102,607.07	Type 2 Diabetes Mellitus With Diabetic Peripheral Angiopathy With Gangrene
Claimant 680	$102,600.42	Neoplasm Of Unspecified Behavior Of Brain
Claimant 681	$102,303.09	Hypertensive Heart Disease With Heart Failure
Claimant 682	$101,985.21	Multiple Sclerosis
Claimant 683	$101,809.46	Malignant Neoplasm Of Unspecified Ovary
Claimant 684	$101,559.49	Benign Neoplasm Of Pituitary Gland
Claimant 685	$101,552.85	Malignant Neoplasm Of Overlapping Sites Of Left Female Breast
Claimant 686	$101,352.35	Rheumatoid Arthritis Without Rheumatoid Factor, Unspecified Site
Claimant 687	$101,312.70	Non-st Elevation (nstemi) Myocardial Infarction
Claimant 688	$101,266.41	Atherosclerotic Heart Disease Of Native Coronary Artery With Unstable Angina Pectoris
Claimant 689	$101,263.07	Crohn's Disease Of Large Intestine With Intestinal Obstruction
Claimant 690	$101,258.94	Unspecified Intracapsular Fracture Of Right Femur, Initial Encounter For Closed Fracture
Claimant 691	$101,215.65	Restricted Diagnosis
Claimant 692	$101,083.94	Bilateral Primary Osteoarthritis Of Hip
Claimant 693	$101,059.03	Restricted Diagnosis
Claimant 694	$100,864.32	Restricted Diagnosis
Claimant 695	$100,654.99	Malignant Neoplasm Of Prostate
Claimant 696	$100,575.34	Localized Swelling, Mass And Lump, Unspecified
Claimant 697	$100,462.62	Encounter For Antineoplastic Immunotherapy
Claimant 698	$100,212.95	Incisional Hernia Without Obstruction Or Gangrene
Claimant 699	$100,101.51	Malignant Neoplasm Of Thyroid Gland
Claimant 700	$100,050.06	Spinal Stenosis, Cervical Region
Claimant 701	$100,027.93	Lobular Carcinoma In Situ Of Right Breast

&"Calibri,Regular"&9&K414141&D	&G
	&9&K414141Large Claim Exhibit

Prior Year

STATE OF IL (STATE PPO)

Large Claim Listing	Effective Date: January 1, 2025
Contractholder Number - 285658

Total Group

Claimants with over $100,000 in claims for 6/1/2023 - 5/31/2024

Claimant Exp. Group Amount Rx Pooled Total ICD-10 Code Description Relationship Structure SSN DOB Name Gender ICD10

Claimant 1	$2,124,371	Encounter For Antineoplastic Immunotherapy
Claimant 2	$1,316,216	Infective Myocarditis
Claimant 3	$1,162,359	Lung Transplant Rejection
Claimant 4	$1,112,045	Malignant Neoplasm Of Prostate
Claimant 5	$1,011,387	Chronic Inflammatory Demyelinating Polyneuritis
Claimant 6	$985,522	Other Intraoperative Cardiac Functional Disturbances During Cardiac Surgery
Claimant 7	$916,944	Neuromyelitis Optica (devic)
Claimant 8	$841,764	Encounter For Antineoplastic Immunotherapy
Claimant 9	$831,817	Polymyositis, Organ Involvement Unspecified
Claimant 10	$815,001	Restricted Diagnosis
Claimant 11	$764,344	Spinal Stenosis, Lumbar Region Without Neurogenic Claudication
Claimant 12	$737,323	Secondary Malignant Neoplasm Of Brain
Claimant 13	$723,156	Malignant Neoplasm Of Prostate
Claimant 14	$700,547	Other Malignant Neuroendocrine Tumors
Claimant 15	$693,055	Malignant Neoplasm Of Urinary Organ, Unspecified
Claimant 16	$683,769	Encounter For Antineoplastic Immunotherapy
Claimant 17	$683,061	Gaucher Disease
Claimant 18	$675,340	Hypertensive Heart Disease With Heart Failure
Claimant 19	$672,514	Multiple Myeloma Not Having Achieved Remission
Claimant 20	$649,455	Encounter For Antineoplastic Immunotherapy
Claimant 21	$642,285	Encounter For Antineoplastic Chemotherapy
Claimant 22	$641,845	Obstructive Hypertrophic Cardiomyopathy
Claimant 23	$640,591	Encounter For Antineoplastic Immunotherapy
Claimant 24	$639,151	Intrahepatic Bile Duct Carcinoma
Claimant 25	$618,585	Encounter For Antineoplastic Chemotherapy

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File details come from the government source that posted it. Updated Jun 10, 2026.