Hospital

SEARHC WRANGELL MEDICAL CENTER & LTC

Wrangell, AK · CCN 021305 · Rates published

Your selected procedure

You selected 93350 (HCPCS)

ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, DURING REST AND CARDIOVASCULAR STRESS TEST USING TREADMILL, BICYCLE EXERCISE AND/OR PHARMACOLOGICALLY INDUCED STRESS, WITH INTERPRETATION AND REPORT

This hospital’s price: $2,375 across 9 payers · range $72-$3,225

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbSARHCSITKAAK&type=CDMWithoutLabel&fileType=CSV · observed 2024-12-09

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

3,907 distinct procedures filed

9 distinct payers

71,236 rate rows

2024-12-09 last MRF observed · ⚠ 22 mo old

Data quality

68,914 of 71,236 rate rows are consumer-grade (96.7%)

2,322 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
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	1,659
per-diem day rate — not a per-procedure price	520
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	124
exceeds 10× this hospital's gross charge — excluded from medians	19

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 22 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

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

Source MRF file	https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbSARHCSITKAAK&type=CDMWithoutLabel&fileType=CSV
Found on page	https://searhc.org/patient-support/price-transparency/para-price-transparency/
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-10-19
Content fingerprint	4b69ccf800e6436d… · 31,011,317 bytes · first seen 2026-05-05

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
J9022 HCPCS	Injection, Atezolizumab, 10 Mg	9	$60,286.89	$71,635.01	$67,379.46	nat. median $6,720 outlier · 10.0×
J2350 HCPCS	Injection, Ocrelizumab, 1 Mg	9	$59,912.45	$66,960.97	$65,551.26	nat. median $414 outlier · 158.2×
J9144 HCPCS	Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj	9	$51,214.24	$60,854.57	$57,239.45	nat. median $211 outlier · 270.7×
J3380 HCPCS	Injection, Vedolizumab, Intravenous, 1 Mg	9	$51.98	$56,106.31	$47,218.18	nat. median $155 outlier · 305.5×
J9271 HCPCS	Injection, Pembrolizumab, 1 Mg	9	$32,054.95	$38,088.82	$35,826.12	nat. median $275 outlier · 130.5×
J9356 HCPCS	Injection, Trastuzumab, 10 Mg And Hyaluronidase-oysk	9	$28,625.66	$34,014.02	$31,993.39	nat. median $139 outlier · 230.2×
J9312 HCPCS	Injection, Rituximab, 10 Mg	9	$28,755.91	$32,138.96	$31,462.35	nat. median $1,063 outlier · 29.6×
J2506 HCPCS	Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg	9	$24,604.10	$29,235.46	$27,498.70	nat. median $1,659 outlier · 16.6×
J9173 HCPCS	Injection, Durvalumab, 10 Mg	9	$23,112.16	$27,462.69	$25,831.24	nat. median $1,119 outlier · 23.1×
Q5119 HCPCS	Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg	9	$216.64	$24,521.92	$21,940.67	nat. median $831 outlier · 26.4×
27447 HCPCS	Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compartments With Or…	9	$72.00	$24,422.17	$20,859.32	nat. median $12,739 1.6× median
27130 HCPCS	Arthroplasty, Acetabular And Proximal Femoral Prosthetic Replacement (total Hip…	9	$72.00	$21,322.43	$19,476.18	nat. median $13,091 1.5× median
43282 HCPCS	Laparoscopy, Surgical, Repair Of Paraesophageal Hernia, Includes Fundoplasty, Wh…	9	$72.00	$25,160.51	$18,971.39	nat. median $10,337 1.8× median
21613660_1 CDM	Rev - Ihs-moa Clinic Visit	9	$16,566.25	$19,684.60	$18,515.22	nat. median $18,515 1.0× median
58150 HCPCS	Total Abdominal Hysterectomy (corpus And Cervix), With Or Without Removal Of Tub…	9	$72.00	$25,281.76	$18,185.65	nat. median $3,275 outlier · 5.6×
2504932_1 CDM	Rev - Ihs-moa Clinic Visit	9	$15,753.06	$18,718.34	$17,606.36	nat. median $17,606 1.0× median
27245 HCPCS	Treatment Of Intertrochanteric, Peritrochanteric, Or Subtrochanteric Femoral Fra…	9	$72.00	$17,946.24	$15,476.74	nat. median $4,542 outlier · 3.4×
23515 HCPCS	Open Treatment Of Clavicular Fracture, Includes Internal Fixation, When Performe…	9	$72.00	$23,393.25	$15,021.02	nat. median $6,986 outlier · 2.2×
27822 HCPCS	Open Treatment Of Trimalleolar Ankle Fracture, Includes Internal Fixation, When…	9	$72.00	$20,279.12	$14,689.99	nat. median $7,108 outlier · 2.1×
27524 HCPCS	Open Treatment Of Patellar Fracture, With Internal Fixation And/or Partial Or Co…	9	$72.00	$20,722.50	$14,142.27	nat. median $6,994 outlier · 2.0×
J3101 HCPCS	Injection, Tenecteplase, 1 Mg	9	$207.92	$15,554.64	$13,771.67	nat. median $3,787 outlier · 3.6×
59514 HCPCS	Cesarean Delivery Only	9	$72.00	$15,534.03	$13,762.58	nat. median $2,430 outlier · 5.7×
60210 HCPCS	Partial Thyroid Lobectomy, Unilateral; With Or Without Isthmusectomy	9	$72.00	$19,824.30	$13,544.19	nat. median $5,904 outlier · 2.3×
24342 HCPCS	Reinsertion Of Ruptured Biceps Or Triceps Tendon, Distal, With Or Without Tendon…	9	$72.00	$18,188.83	$13,258.48	nat. median $6,958 1.9× median
25607 HCPCS	Open Treatment Of Distal Radial Extra-articular Fracture Or Epiphyseal Separatio…	9	$72.00	$17,874.90	$13,255.11	nat. median $7,088 1.9× median
59151 HCPCS	Laparoscopic Treatment Of Ectopic Pregnancy; With Salpingectomy And/or Oophorect…	9	$72.00	$16,551.76	$12,881.26	nat. median $6,193 outlier · 2.1×
21012 HCPCS	Excision, Tumor, Soft Tissue Of Face Or Scalp, Subcutaneous; 2 Cm Or Greater	9	$72.00	$43,746.45	$12,394.83	nat. median $1,788 outlier · 6.9×
J1459 HCPCS	Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui…	9	$4,988.44	$47,309.86	$11,839.22	nat. median $1,371 outlier · 8.6×
29835 HCPCS	Arthroscopy, Elbow, Surgical; Synovectomy, Partial	9	$72.00	$17,168.57	$11,284.42	nat. median $3,735 outlier · 3.0×
27650 HCPCS	Repair, Primary, Open Or Percutaneous, Ruptured Achilles Tendon	9	$72.00	$15,370.72	$11,250.99	nat. median $6,674 1.7× median
59510 HCPCS	Routine Obstetric Care Including Antepartum Care, Cesarean Delivery, And Postpar…	9	$72.00	$39,603.09	$11,220.88	nat. median $3,631 outlier · 3.1×
25447 HCPCS	Arthroplasty, Intercarpal Or Carpometacarpal Joints; Interposition (eg, Tendon)	9	$72.00	$12,768.66	$11,061.96	nat. median $3,801 outlier · 2.9×
47563 HCPCS	Laparoscopy, Surgical; Cholecystectomy With Cholangiography	9	$72.00	$13,760.14	$11,035.66	nat. median $6,020 1.8× median
29891 HCPCS	Arthroscopy, Ankle, Surgical, Excision Of Osteochondral Defect Of Talus And/or T…	9	$72.00	$13,967.80	$10,782.03	nat. median $3,805 outlier · 2.8×
44950 HCPCS	Appendectomy	9	$72.00	$14,043.64	$10,646.54	nat. median $5,994 1.8× median
25515 HCPCS	Open Treatment Of Radial Shaft Fracture, Includes Internal Fixation, When Perfor…	9	$72.00	$15,651.20	$10,549.61	nat. median $6,925 1.5× median
26123 HCPCS	Fasciectomy, Partial Palmar With Release Of Single Digit Including Proximal Inte…	9	$72.00	$12,159.74	$10,534.44	nat. median $3,840 outlier · 2.7×
Q5113 HCPCS	Injection, Trastuzumab-pkrb, Biosimilar, (herzuma), 10 Mg	9	$9,541.59	$10,664.13	$10,439.62	nat. median $218 outlier · 47.9×
29882 HCPCS	Arthroscopy, Knee, Surgical; With Meniscus Repair (medial Or Lateral)	9	$72.00	$12,077.92	$10,137.16	nat. median $3,854 outlier · 2.6×
59400 HCPCS	Routine Obstetric Care Including Antepartum Care, Vaginal Delivery (with Or With…	9	$72.00	$35,705.91	$10,116.67	nat. median $3,129 outlier · 3.2×
43632 HCPCS	Gastrectomy, Partial, Distal; With Gastrojejunostomy	9	$72.00	$30,304.86	$10,101.62	nat. median $3,244 outlier · 3.1×
44379 HCPCS	Small Intestinal Endoscopy, Enteroscopy Beyond Second Portion Of Duodenum, Inclu…	9	$72.00	$15,235.95	$9,978.83	nat. median $5,849 1.7× median
44970 HCPCS	Laparoscopy, Surgical, Appendectomy	9	$72.00	$13,104.05	$9,915.31	nat. median $6,040 1.6× median
26735 HCPCS	Open Treatment Of Phalangeal Shaft Fracture, Proximal Or Middle Phalanx, Finger…	9	$72.00	$13,005.84	$9,717.20	nat. median $3,745 outlier · 2.6×
59610 HCPCS	Routine Obstetric Care Including Antepartum Care, Vaginal Delivery (with Or With…	9	$72.00	$31,937.88	$9,711.00	nat. median $3,322 outlier · 2.9×
23294613_1 CDM	Lapiplasty Mini-incision System	9	$8,709.79	$9,734.47	$9,529.53	nat. median $9,530 1.0× median
27355 HCPCS	Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Femur	9	$72.00	$11,439.59	$9,136.30	nat. median $3,545 outlier · 2.6×
44207 HCPCS	Laparoscopy, Surgical; Colectomy, Partial, With Anastomosis, With Coloproctostom…	9	$72.00	$27,392.34	$9,130.78	nat. median $3,919 outlier · 2.3×
19303 HCPCS	Mastectomy, Simple, Complete	9	$72.00	$14,731.38	$8,978.78	nat. median $6,253 1.4× median
59150 HCPCS	Laparoscopic Treatment Of Ectopic Pregnancy; Without Salpingectomy And/or Oophor…	9	$72.00	$11,241.66	$8,944.85	nat. median $5,950 1.5× median

Other procedures at this hospital

Browse this hospital's 3,907 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

J9022	HCPCS	Injection, Atezolizumab, 10 Mg	9	9	$70,925.75	$70,925.75	$60,286.89	$71,635.01	$67,379.46	2024-12-09
J2350	HCPCS	Injection, Ocrelizumab, 1 Mg	9	9	$70,485.23	$70,485.23	$59,912.45	$66,960.97	$65,551.26	2024-12-09
J9144	HCPCS	Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj	9	9	$60,252.05	$60,252.05	$51,214.24	$60,854.57	$57,239.45	2024-12-09
J3380	HCPCS	Injection, Vedolizumab, Intravenous, 1 Mg	17	9	$55,550.80	$55,550.80	$51.98	$56,106.31	$47,218.18	2024-12-09
J9271	HCPCS	Injection, Pembrolizumab, 1 Mg	9	9	$37,711.70	$37,711.70	$32,054.95	$38,088.82	$35,826.12	2024-12-09
J9356	HCPCS	Injection, Trastuzumab, 10 Mg And Hyaluronidase-oysk	9	9	$33,677.25	$33,677.25	$28,625.66	$34,014.02	$31,993.39	2024-12-09
J9312	HCPCS	Injection, Rituximab, 10 Mg	9	9	$33,830.48	$33,830.48	$28,755.91	$32,138.96	$31,462.35	2024-12-09
J2506	HCPCS	Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg	9	9	$28,946.00	$28,946.00	$24,604.10	$29,235.46	$27,498.70	2024-12-09
J9173	HCPCS	Injection, Durvalumab, 10 Mg	9	9	$27,190.78	$27,190.78	$23,112.16	$27,462.69	$25,831.24	2024-12-09
Q5119	HCPCS	Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg	17	9	$25,812.55	$25,812.55	$216.64	$24,521.92	$21,940.67	2024-12-09
27447	HCPCS	Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compartments With Or…	18	9	$16,164.98	$16,164.98	$72.00	$24,422.17	$20,859.32	2024-12-09
27130	HCPCS	Arthroplasty, Acetabular And Proximal Femoral Prosthetic Replacement (total Hip …	18	9	$14,534.73	$14,534.73	$72.00	$21,322.43	$19,476.18	2024-12-09
43282	HCPCS	Laparoscopy, Surgical, Repair Of Paraesophageal Hernia, Includes Fundoplasty, Wh…	18	9	$15,250.38	$15,250.38	$72.00	$25,160.51	$18,971.39	2024-12-09
21613660_1	CDM	Rev - Ihs-moa Clinic Visit	9	9	$19,489.70	$19,489.70	$16,566.25	$19,684.60	$18,515.22	2024-12-09
58150	HCPCS	Total Abdominal Hysterectomy (corpus And Cervix), With Or Without Removal Of Tub…	18	9	$15,031.49	$15,031.49	$72.00	$25,281.76	$18,185.65	2024-12-09
2504932_1	CDM	Rev - Ihs-moa Clinic Visit	9	9	$18,533.01	$18,533.01	$15,753.06	$18,718.34	$17,606.36	2024-12-09
27245	HCPCS	Treatment Of Intertrochanteric, Peritrochanteric, Or Subtrochanteric Femoral Fra…	18	9	$11,834.89	$11,834.89	$72.00	$17,946.24	$15,476.74	2024-12-09
23515	HCPCS	Open Treatment Of Clavicular Fracture, Includes Internal Fixation, When Performe…	18	9	$13,306.59	$13,306.59	$72.00	$23,393.25	$15,021.02	2024-12-09
27822	HCPCS	Open Treatment Of Trimalleolar Ankle Fracture, Includes Internal Fixation, When …	18	9	$12,091.40	$12,091.40	$72.00	$20,279.12	$14,689.99	2024-12-09
27524	HCPCS	Open Treatment Of Patellar Fracture, With Internal Fixation And/or Partial Or Co…	18	9	$12,066.14	$12,066.14	$72.00	$20,722.50	$14,142.27	2024-12-09
J3101	HCPCS	Injection, Tenecteplase, 1 Mg	27	9	$14,808.25	$14,808.25	$207.92	$15,554.64	$13,771.67	2024-12-09
59514	HCPCS	Cesarean Delivery Only	18	9	$10,446.85	$10,446.85	$72.00	$15,534.03	$13,762.58	2024-12-09
60210	HCPCS	Partial Thyroid Lobectomy, Unilateral; With Or Without Isthmusectomy	18	9	$11,548.10	$11,548.10	$72.00	$19,824.30	$13,544.19	2024-12-09
24342	HCPCS	Reinsertion Of Ruptured Biceps Or Triceps Tendon, Distal, With Or Without Tendon…	18	9	$10,872.62	$10,872.62	$72.00	$18,188.83	$13,258.48	2024-12-09
25607	HCPCS	Open Treatment Of Distal Radial Extra-articular Fracture Or Epiphyseal Separatio…	18	9	$11,160.65	$11,160.65	$72.00	$17,874.90	$13,255.11	2024-12-09
59151	HCPCS	Laparoscopic Treatment Of Ectopic Pregnancy; With Salpingectomy And/or Oophorect…	18	9	$10,536.97	$10,536.97	$72.00	$16,551.76	$12,881.26	2024-12-09
21012	HCPCS	Excision, Tumor, Soft Tissue Of Face Or Scalp, Subcutaneous; 2 Cm Or Greater	9	9	$14,582.15	$14,582.15	$72.00	$43,746.45	$12,394.83	2024-12-09
J1459	HCPCS	Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui…	34	9	$11,722.00	$11,722.00	$4,988.44	$47,309.86	$11,839.22	2024-12-09
29835	HCPCS	Arthroscopy, Elbow, Surgical; Synovectomy, Partial	18	9	$10,237.34	$10,237.34	$72.00	$17,168.57	$11,284.42	2024-12-09
27650	HCPCS	Repair, Primary, Open Or Percutaneous, Ruptured Achilles Tendon	18	9	$9,203.64	$9,203.64	$72.00	$15,370.72	$11,250.99	2024-12-09
59510	HCPCS	Routine Obstetric Care Including Antepartum Care, Cesarean Delivery, And Postpar…	9	9	$13,201.03	$13,201.03	$72.00	$39,603.09	$11,220.88	2024-12-09
25447	HCPCS	Arthroplasty, Intercarpal Or Carpometacarpal Joints; Interposition (eg, Tendon)	18	9	$8,308.35	$8,308.35	$72.00	$12,768.66	$11,061.96	2024-12-09
47563	HCPCS	Laparoscopy, Surgical; Cholecystectomy With Cholangiography	18	9	$8,560.45	$8,560.45	$72.00	$13,760.14	$11,035.66	2024-12-09
29891	HCPCS	Arthroscopy, Ankle, Surgical, Excision Of Osteochondral Defect Of Talus And/or T…	18	9	$8,549.58	$8,549.58	$72.00	$13,967.80	$10,782.03	2024-12-09
44950	HCPCS	Appendectomy	18	9	$8,531.33	$8,531.33	$72.00	$14,043.64	$10,646.54	2024-12-09
25515	HCPCS	Open Treatment Of Radial Shaft Fracture, Includes Internal Fixation, When Perfor…	18	9	$9,420.06	$9,420.06	$72.00	$15,651.20	$10,549.61	2024-12-09
26123	HCPCS	Fasciectomy, Partial Palmar With Release Of Single Digit Including Proximal Inte…	18	9	$8,012.52	$8,012.52	$72.00	$12,159.74	$10,534.44	2024-12-09
Q5113	HCPCS	Injection, Trastuzumab-pkrb, Biosimilar, (herzuma), 10 Mg	9	9	$11,225.40	$11,225.40	$9,541.59	$10,664.13	$10,439.62	2024-12-09
29882	HCPCS	Arthroscopy, Knee, Surgical; With Meniscus Repair (medial Or Lateral)	18	9	$7,664.12	$7,664.12	$72.00	$12,077.92	$10,137.16	2024-12-09
59400	HCPCS	Routine Obstetric Care Including Antepartum Care, Vaginal Delivery (with Or With…	9	9	$11,901.97	$11,901.97	$72.00	$35,705.91	$10,116.67	2024-12-09
43632	HCPCS	Gastrectomy, Partial, Distal; With Gastrojejunostomy	9	9	$10,101.62	$10,101.62	$72.00	$30,304.86	$10,101.62	2024-12-09
44379	HCPCS	Small Intestinal Endoscopy, Enteroscopy Beyond Second Portion Of Duodenum, Inclu…	18	9	$9,073.17	$9,073.17	$72.00	$15,235.95	$9,978.83	2024-12-09
44970	HCPCS	Laparoscopy, Surgical, Appendectomy	18	9	$7,954.23	$7,954.23	$72.00	$13,104.05	$9,915.31	2024-12-09
26735	HCPCS	Open Treatment Of Phalangeal Shaft Fracture, Proximal Or Middle Phalanx, Finger …	18	9	$7,853.35	$7,853.35	$72.00	$13,005.84	$9,717.20	2024-12-09
59610	HCPCS	Routine Obstetric Care Including Antepartum Care, Vaginal Delivery (with Or With…	9	9	$10,645.96	$10,645.96	$72.00	$31,937.88	$9,711.00	2024-12-09
23294613_1	CDM	Lapiplasty Mini-incision System	9	9	$10,246.81	$10,246.81	$8,709.79	$9,734.47	$9,529.53	2024-12-09
27355	HCPCS	Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Femur	18	9	$7,104.03	$7,104.03	$72.00	$11,439.59	$9,136.30	2024-12-09
44207	HCPCS	Laparoscopy, Surgical; Colectomy, Partial, With Anastomosis, With Coloproctostom…	9	9	$9,130.78	$9,130.78	$72.00	$27,392.34	$9,130.78	2024-12-09
19303	HCPCS	Mastectomy, Simple, Complete	18	9	$7,585.97	$7,585.97	$72.00	$14,731.38	$8,978.78	2024-12-09
59150	HCPCS	Laparoscopic Treatment Of Ectopic Pregnancy; Without Salpingectomy And/or Oophor…	18	9	$6,984.95	$6,984.95	$72.00	$11,241.66	$8,944.85	2024-12-09
Q5111	HCPCS	Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg	9	9	$9,378.72	$9,378.72	$7,971.91	$9,472.51	$8,909.78	2024-12-09
23474	HCPCS	Revision Of Total Shoulder Arthroplasty, Including Allograft When Performed; Hum…	18	9	$7,796.29	$7,796.29	$72.00	$17,271.69	$8,853.41	2024-12-09
J0129	HCPCS	Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere…	9	9	$9,378.23	$9,378.23	$7,971.50	$8,909.32	$8,721.75	2024-12-09
21931	HCPCS	Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater	18	9	$7,387.17	$7,387.17	$72.00	$11,878.52	$8,720.02	2024-12-09
27487	HCPCS	Revision Of Total Knee Arthroplasty, With Or Without Allograft; Femoral And Enti…	9	9	$8,649.26	$8,649.26	$72.00	$25,947.78	$8,649.26	2024-12-09
58615	HCPCS	Occlusion Of Fallopian Tube(s) By Device (eg, Band, Clip, Falope Ring) Vaginal O…	18	9	$8,928.61	$8,928.61	$72.00	$17,070.47	$8,616.76	2024-12-09
28725	HCPCS	Arthrodesis; Subtalar	18	9	$6,790.47	$6,790.47	$72.00	$11,359.92	$8,570.01	2024-12-09
29999	HCPCS	Unlisted Procedure, Arthroscopy	9	9	$8,831.89	$8,831.89	$7,507.11	$8,920.21	$8,390.30	2024-12-09
27425	HCPCS	Lateral Retinacular Release, Open	18	9	$7,111.52	$7,111.52	$72.00	$11,504.37	$8,316.46	2024-12-09
59618	HCPCS	Routine Obstetric Care Including Antepartum Care, Cesarean Delivery, And Postpar…	9	9	$8,174.08	$8,174.08	$72.00	$24,522.24	$8,174.08	2024-12-09
46261	HCPCS	Hemorrhoidectomy, Internal And External, 2 Or More Columns/groups; With Fissurec…	18	9	$6,394.34	$6,394.34	$72.00	$10,344.34	$8,172.94	2024-12-09
44143	HCPCS	Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (hartmann T…	9	9	$8,144.14	$8,144.14	$72.00	$24,432.42	$8,144.14	2024-12-09
46258	HCPCS	Hemorrhoidectomy, Internal And External, Single Column/group; With Fistulectomy,…	18	9	$6,750.17	$6,750.17	$72.00	$11,391.16	$8,126.25	2024-12-09
44141	HCPCS	Colectomy, Partial; With Skin Level Cecostomy Or Colostomy	9	9	$8,088.39	$8,088.39	$72.00	$24,265.17	$8,088.39	2024-12-09
46262	HCPCS	Hemorrhoidectomy, Internal And External, 2 Or More Columns/groups; With Fistulec…	18	9	$6,048.69	$6,048.69	$72.00	$9,505.70	$8,028.62	2024-12-09
49618	HCPCS	Repair Of Anterior Abdominal Hernia(s) (ie, Epigastric, Incisional, Ventral, Umb…	9	9	$4,145.00	$4,145.00	$3,523.25	$12,435.00	$7,979.12	2024-12-09
24341	HCPCS	Repair, Tendon Or Muscle, Upper Arm Or Elbow, Each Tendon Or Muscle, Primary Or …	18	9	$6,333.08	$6,333.08	$72.00	$10,652.31	$7,975.97	2024-12-09
24358	HCPCS	Tenotomy, Elbow, Lateral Or Medial (eg, Epicondylitis, Tennis Elbow, Golfer's El…	18	9	$6,237.34	$6,237.34	$72.00	$9,488.85	$7,974.66	2024-12-09
44626	HCPCS	Closure Of Enterostomy, Large Or Small Intestine; With Resection And Colorectal …	9	9	$7,972.22	$7,972.22	$72.00	$23,916.66	$7,972.22	2024-12-09
2505525_1	CDM	Rev - Ihs-moa Clinic Visit	9	9	$8,309.08	$8,309.08	$7,062.72	$8,392.17	$7,893.63	2024-12-09
25628	HCPCS	Open Treatment Of Carpal Scaphoid (navicular) Fracture, Includes Internal Fixati…	18	9	$6,062.36	$6,062.36	$72.00	$9,350.94	$7,881.78	2024-12-09
46260	HCPCS	Hemorrhoidectomy, Internal And External, 2 Or More Columns/groups	18	9	$6,357.36	$6,357.36	$72.00	$10,520.71	$7,874.31	2024-12-09
29828	HCPCS	Arthroscopy, Shoulder, Surgical; Biceps Tenodesis	18	9	$6,675.30	$6,675.30	$72.00	$13,277.79	$7,809.07	2024-12-09
26113	HCPCS	Excision, Tumor, Soft Tissue, Or Vascular Malformation, Of Hand Or Finger, Subfa…	18	9	$5,838.82	$5,838.82	$72.00	$9,147.10	$7,780.69	2024-12-09
29827	HCPCS	Arthroscopy, Shoulder, Surgical; With Rotator Cuff Repair	18	9	$7,007.52	$7,007.52	$72.00	$15,444.00	$7,758.66	2024-12-09
29884	HCPCS	Arthroscopy, Knee, Surgical; With Lysis Of Adhesions, With Or Without Manipulati…	18	9	$6,540.68	$6,540.68	$72.00	$11,161.55	$7,742.17	2024-12-09
26746	HCPCS	Open Treatment Of Articular Fracture, Involving Metacarpophalangeal Or Interphal…	18	9	$5,725.98	$5,725.98	$72.00	$8,915.17	$7,689.02	2024-12-09
27301	HCPCS	Incision And Drainage, Deep Abscess, Bursa, Or Hematoma, Thigh Or Knee Region	18	9	$6,046.41	$6,046.41	$72.00	$9,955.62	$7,677.49	2024-12-09
44208	HCPCS	Laparoscopy, Surgical; Colectomy, Partial, With Anastomosis, With Coloproctostom…	9	9	$7,675.82	$7,675.82	$72.00	$23,027.46	$7,675.82	2024-12-09
45327	HCPCS	Proctosigmoidoscopy, Rigid; With Transendoscopic Stent Placement (includes Predi…	18	9	$8,304.45	$8,304.45	$72.00	$16,198.22	$7,672.67	2024-12-09
2504915_1	CDM	Rev - Ihs-moa Clinic Visit	9	9	$8,066.45	$8,066.45	$6,856.48	$8,147.11	$7,663.13	2024-12-09
26727	HCPCS	Percutaneous Skeletal Fixation Of Unstable Phalangeal Shaft Fracture, Proximal O…	18	9	$6,221.18	$6,221.18	$72.00	$10,340.14	$7,657.94	2024-12-09
2504922_1	CDM	Rev - Ihs-moa Clinic Visit	9	9	$8,010.60	$8,010.60	$6,809.01	$8,090.71	$7,610.07	2024-12-09
44146	HCPCS	Colectomy, Partial; With Coloproctostomy (low Pelvic Anastomosis), With Colostom…	9	9	$7,563.82	$7,563.82	$72.00	$22,691.46	$7,563.82	2024-12-09
90378	HCPCS	Respiratory Syncytial Virus, Monoclonal Antibody, Recombinant, For Intramuscular…	20	9	$8,643.44	$8,643.44	$330.31	$8,729.87	$7,563.01	2024-12-09
58561	HCPCS	Hysteroscopy, Surgical; With Removal Of Leiomyomata	19	9	$8,746.10	$8,746.10	$72.00	$8,833.56	$7,434.19	2024-12-09
58565	HCPCS	Hysteroscopy, Surgical; With Bilateral Fallopian Tube Cannulation To Induce Occl…	18	9	$6,015.83	$6,015.83	$72.00	$9,396.77	$7,414.30	2024-12-09
23430	HCPCS	Tenodesis Of Long Tendon Of Biceps	18	9	$6,019.67	$6,019.67	$72.00	$10,738.11	$7,402.48	2024-12-09
43276	HCPCS	Endoscopic Retrograde Cholangiopancreatography (ercp); With Removal And Exchange…	18	9	$5,491.77	$5,491.77	$72.00	$8,579.46	$7,343.71	2024-12-09
58563	HCPCS	Hysteroscopy, Surgical; With Endometrial Ablation (eg, Endometrial Resection, El…	20	9	$8,052.00	$8,052.00	$72.00	$19,114.38	$7,246.80	2024-12-09
29881	HCPCS	Arthroscopy, Knee, Surgical; With Meniscectomy (medial Or Lateral, Including Any…	18	9	$5,432.60	$5,432.60	$72.00	$7,865.56	$7,244.60	2024-12-09
46947	HCPCS	Hemorrhoidopexy (eg, For Prolapsing Internal Hemorrhoids) By Stapling	18	9	$6,177.13	$6,177.13	$72.00	$10,608.83	$7,239.81	2024-12-09
43281	HCPCS	Laparoscopy, Surgical, Repair Of Paraesophageal Hernia, Includes Fundoplasty, Wh…	9	9	$7,222.70	$7,222.70	$72.00	$21,668.10	$7,222.70	2024-12-09
44204	HCPCS	Laparoscopy, Surgical; Colectomy, Partial, With Anastomosis	9	9	$7,214.38	$7,214.38	$72.00	$21,643.14	$7,214.38	2024-12-09
23472	HCPCS	Arthroplasty, Glenohumeral Joint; Total Shoulder (glenoid And Proximal Humeral R…	9	9	$7,146.57	$7,146.57	$72.00	$21,439.71	$7,146.57	2024-12-09
29823	HCPCS	Arthroscopy, Shoulder, Surgical; Debridement, Extensive, 3 Or More Discrete Stru…	18	9	$5,546.94	$5,546.94	$72.00	$8,937.87	$7,100.27	2024-12-09
44227	HCPCS	Laparoscopy, Surgical, Closure Of Enterostomy, Large Or Small Intestine, With Re…	9	9	$7,081.88	$7,081.88	$72.00	$21,245.64	$7,081.88	2024-12-09
27422	HCPCS	Reconstruction Of Dislocating Patella; With Extensor Realignment And/or Muscle A…	18	9	$5,338.36	$5,338.36	$72.00	$7,915.12	$7,058.52	2024-12-09
44145	HCPCS	Colectomy, Partial; With Coloproctostomy (low Pelvic Anastomosis)	9	9	$7,048.29	$7,048.29	$72.00	$21,144.87	$7,048.29	2024-12-09
59820	HCPCS	Treatment Of Missed Abortion, Completed Surgically; First Trimester	20	9	$7,965.15	$7,965.15	$72.00	$8,044.80	$6,969.51	2024-12-09
11005	HCPCS	Debridement Of Skin, Subcutaneous Tissue, Muscle And Fascia For Necrotizing Soft…	18	9	$5,889.16	$5,889.16	$72.00	$11,726.22	$6,885.88	2024-12-09
27486	HCPCS	Revision Of Total Knee Arthroplasty, With Or Without Allograft; 1 Component	9	9	$6,855.16	$6,855.16	$72.00	$20,565.48	$6,855.16	2024-12-09
J1950	HCPCS	Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg	68	9	$7,495.23	$7,495.23	$39.15	$16,761.52	$6,711.80	2024-12-09
43840	HCPCS	Gastrorrhaphy, Suture Of Perforated Duodenal Or Gastric Ulcer, Wound, Or Injury	9	9	$6,702.38	$6,702.38	$72.00	$20,107.14	$6,702.38	2024-12-09
G0390	HCPCS	Trauma Response Team Associated With Hospital Critical Care Service	18	9	$7,465.23	$7,465.23	$3,714.39	$10,666.19	$6,695.03	2024-12-09
J2795	HCPCS	Injection, Ropivacaine Hydrochloride, 1 Mg	9	9	$7,041.60	$7,041.60	$5,985.36	$7,112.02	$6,689.52	2024-12-09
43265	HCPCS	Endoscopic Retrograde Cholangiopancreatography (ercp); With Destruction Of Calcu…	18	9	$5,035.37	$5,035.37	$72.00	$7,912.04	$6,684.89	2024-12-09
46257	HCPCS	Hemorrhoidectomy, Internal And External, Single Column/group; With Fissurectomy	18	9	$5,274.99	$5,274.99	$72.00	$8,608.98	$6,661.93	2024-12-09
44140	HCPCS	Colectomy, Partial; With Anastomosis	9	9	$6,655.69	$6,655.69	$72.00	$19,967.07	$6,655.69	2024-12-09
19120	HCPCS	Excision Of Cyst, Fibroadenoma, Or Other Benign Or Malignant Tumor, Aberrant Bre…	18	9	$5,317.10	$5,317.10	$72.00	$8,736.49	$6,652.57	2024-12-09
21552	HCPCS	Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or G…	18	9	$5,061.94	$5,061.94	$72.00	$8,037.35	$6,631.22	2024-12-09
14060	HCPCS	Adjacent Tissue Transfer Or Rearrangement, Eyelids, Nose, Ears And/or Lips; Defe…	18	9	$5,240.09	$5,240.09	$72.00	$8,785.29	$6,607.78	2024-12-09
49596	HCPCS	Repair Of Anterior Abdominal Hernia(s) (ie, Epigastric, Incisional, Ventral, Umb…	9	9	$3,420.85	$3,420.85	$2,907.72	$10,262.55	$6,585.14	2024-12-09
27506	HCPCS	Open Treatment Of Femoral Shaft Fracture, With Or Without External Fixation, Wit…	9	9	$6,569.06	$6,569.06	$72.00	$19,707.18	$6,569.06	2024-12-09
44206	HCPCS	Laparoscopy, Surgical; Colectomy, Partial, With End Colostomy And Closure Of Dis…	9	9	$6,567.08	$6,567.08	$72.00	$19,701.24	$6,567.08	2024-12-09
23120	HCPCS	Claviculectomy; Partial	18	9	$5,115.66	$5,115.66	$72.00	$8,331.33	$6,522.42	2024-12-09
31661	HCPCS	Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed…	18	9	$6,299.86	$6,299.86	$72.00	$10,941.31	$6,518.60	2024-12-09
20926	HCPCS	Tissue Grafts, Other (eg, Paratenon, Fat, Dermis)	17	9	$4,853.21	$4,853.21	$72.00	$7,276.91	$6,510.92	2024-12-09
31237	HCPCS	Nasal/sinus Endoscopy, Surgical; With Biopsy, Polypectomy Or Debridement (separa…	19	9	$7,649.72	$7,649.72	$72.00	$7,726.22	$6,502.26	2024-12-09
11446	HCPCS	Excision, Other Benign Lesion Including Margins, Except Skin Tag (unless Listed …	19	9	$7,641.19	$7,641.19	$72.00	$7,717.60	$6,495.01	2024-12-09
Q5103	HCPCS	Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg	9	9	$6,817.13	$6,817.13	$5,794.56	$6,885.30	$6,476.27	2024-12-09
59841	HCPCS	Induced Abortion, By Dilation And Evacuation	18	9	$5,386.52	$5,386.52	$72.00	$9,108.64	$6,464.72	2024-12-09
C1889	HCPCS	Implantable/insertable Device, Not Otherwise Classified	9	9	$6,799.00	$6,799.00	$5,779.15	$6,866.99	$6,459.05	2024-12-09
44188	HCPCS	Laparoscopy, Surgical, Colostomy Or Skin Level Cecostomy	9	9	$7,571.72	$7,571.72	$72.00	$22,715.16	$6,435.96	2024-12-09
29822	HCPCS	Arthroscopy, Shoulder, Surgical; Debridement, Limited, 1 Or 2 Discrete Structure…	18	9	$5,033.08	$5,033.08	$72.00	$8,182.83	$6,421.24	2024-12-09
45308	HCPCS	Proctosigmoidoscopy, Rigid; With Removal Of Single Tumor, Polyp, Or Other Lesion…	18	9	$7,024.62	$7,024.62	$72.00	$13,775.05	$6,412.32	2024-12-09
23405	HCPCS	Tenotomy, Shoulder Area; Single Tendon	18	9	$5,149.61	$5,149.61	$72.00	$8,975.94	$6,393.84	2024-12-09
29824	HCPCS	Arthroscopy, Shoulder, Surgical; Distal Claviculectomy Including Distal Articula…	18	9	$5,253.76	$5,253.76	$72.00	$9,628.62	$6,385.74	2024-12-09
21932	HCPCS	Excision, Tumor, Soft Tissue Of Back Or Flank, Subfascial (eg, Intramuscular); L…	18	9	$4,714.77	$4,714.77	$72.00	$6,882.48	$6,339.13	2024-12-09
29856	HCPCS	Arthroscopically Aided Treatment Of Tibial Fracture, Proximal (plateau); Bicondy…	18	9	$5,448.51	$5,448.51	$72.00	$10,990.83	$6,329.23	2024-12-09
56501	HCPCS	Destruction Of Lesion(s), Vulva; Simple (eg, Laser Surgery, Electrosurgery, Cryo…	20	9	$7,114.54	$7,114.54	$72.00	$7,185.69	$6,225.23	2024-12-09
19125	HCPCS	Excision Of Breast Lesion Identified By Preoperative Placement Of Radiological M…	18	9	$4,982.52	$4,982.52	$72.00	$8,216.33	$6,202.47	2024-12-09
J2426	HCPCS	Injection, Paliperidone Palmitate Extended Release (invega Sustenna), 1 Mg	71	9	$7,280.83	$7,280.83	$21.22	$26,587.73	$6,188.71	2024-12-09
44160	HCPCS	Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy	9	9	$6,138.91	$6,138.91	$72.00	$18,416.73	$6,138.91	2024-12-09
71552	HCPCS	Magnetic Resonance (eg, Proton) Imaging, Chest (eg, For Evaluation Of Hilar And …	18	9	$4,747.24	$4,747.24	$72.00	$7,567.86	$6,100.37	2024-12-09
46270	HCPCS	Surgical Treatment Of Anal Fistula (fistulectomy/fistulotomy); Subcutaneous	18	9	$4,815.72	$4,815.72	$72.00	$7,844.60	$6,097.71	2024-12-09
44120	HCPCS	Enterectomy, Resection Of Small Intestine; Single Resection And Anastomosis	9	9	$6,051.66	$6,051.66	$72.00	$18,154.98	$6,051.66	2024-12-09
44238	HCPCS	Unlisted Laparoscopy Procedure, Intestine (except Rectum)	8	8	$6,702.38	$6,702.38	$72.00	$20,107.14	$6,032.14	2024-12-09
44661	HCPCS	Closure Of Enterovesical Fistula; With Intestine And/or Bladder Resection	9	9	$6,030.65	$6,030.65	$72.00	$18,091.95	$6,030.65	2024-12-09
43260	HCPCS	Endoscopic Retrograde Cholangiopancreatography (ercp); Diagnostic, Including Col…	18	9	$4,993.15	$4,993.15	$72.00	$8,407.93	$6,030.40	2024-12-09
27244	HCPCS	Treatment Of Intertrochanteric, Peritrochanteric, Or Subtrochanteric Femoral Fra…	9	9	$6,014.84	$6,014.84	$72.00	$18,044.52	$6,014.84	2024-12-09
43277	HCPCS	Endoscopic Retrograde Cholangiopancreatography (ercp); With Trans-endoscopic Bal…	18	9	$4,581.05	$4,581.05	$72.00	$7,280.85	$5,993.72	2024-12-09
46040	HCPCS	Incision And Drainage Of Ischiorectal And/or Perirectal Abscess (separate Proced…	19	9	$7,050.99	$7,050.99	$72.00	$7,121.50	$5,993.34	2024-12-09
25111	HCPCS	Excision Of Ganglion, Wrist (dorsal Or Volar); Primary	18	9	$5,135.26	$5,135.26	$72.00	$8,860.65	$5,974.89	2024-12-09
53040	HCPCS	Drainage Of Deep Periurethral Abscess	18	9	$4,533.88	$4,533.88	$72.00	$7,167.40	$5,972.97	2024-12-09
49622	HCPCS	Repair Of Parastomal Hernia, Any Approach (ie, Open, Laparoscopic, Robotic), Ini…	9	9	$3,087.06	$3,087.06	$2,624.00	$9,261.18	$5,942.59	2024-12-09
30520	HCPCS	Septoplasty Or Submucous Resection, With Or Without Cartilage Scoring, Contourin…	18	9	$4,835.32	$4,835.32	$72.00	$8,738.82	$5,912.99	2024-12-09
64721	HCPCS	Neuroplasty And/or Transposition; Median Nerve At Carpal Tunnel	18	9	$4,401.48	$4,401.48	$72.00	$6,455.39	$5,899.67	2024-12-09
43263	HCPCS	Endoscopic Retrograde Cholangiopancreatography (ercp); With Pressure Measurement…	18	9	$4,606.32	$4,606.32	$72.00	$7,442.08	$5,897.91	2024-12-09
29825	HCPCS	Arthroscopy, Shoulder, Surgical; With Lysis And Resection Of Adhesions, With Or …	18	9	$4,748.80	$4,748.80	$72.00	$8,335.71	$5,879.15	2024-12-09
23130	HCPCS	Acromioplasty Or Acromionectomy, Partial, With Or Without Coracoacromial Ligamen…	18	9	$4,806.05	$4,806.05	$72.00	$8,692.32	$5,875.32	2024-12-09
31638	HCPCS	Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed…	18	9	$5,261.26	$5,261.26	$72.00	$9,323.88	$5,859.84	2024-12-09
44370	HCPCS	Small Intestinal Endoscopy, Enteroscopy Beyond Second Portion Of Duodenum, Not I…	18	9	$5,137.49	$5,137.49	$72.00	$8,999.51	$5,833.80	2024-12-09
14041	HCPCS	Adjacent Tissue Transfer Or Rearrangement, Forehead, Cheeks, Chin, Mouth, Neck, …	18	9	$4,733.24	$4,733.24	$72.00	$8,477.34	$5,810.61	2024-12-09
27236	HCPCS	Open Treatment Of Femoral Fracture, Proximal End, Neck, Internal Fixation Or Pro…	9	9	$5,810.58	$5,810.58	$72.00	$17,431.74	$5,810.58	2024-12-09
44378	HCPCS	Small Intestinal Endoscopy, Enteroscopy Beyond Second Portion Of Duodenum, Inclu…	18	9	$4,310.33	$4,310.33	$72.00	$6,701.55	$5,798.15	2024-12-09
44125	HCPCS	Enterectomy, Resection Of Small Intestine; With Enterostomy	9	9	$5,788.02	$5,788.02	$72.00	$17,364.06	$5,788.02	2024-12-09
49020	HCPCS	Drainage Of Peritoneal Abscess Or Localized Peritonitis, Exclusive Of Appendicea…	14	9	$5,976.78	$5,976.78	$72.00	$17,930.34	$5,746.83	2024-12-09
31641	HCPCS	Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed…	18	9	$5,068.81	$5,068.81	$72.00	$8,897.41	$5,736.40	2024-12-09
46250	HCPCS	Hemorrhoidectomy, External, 2 Or More Columns/groups	18	9	$4,818.94	$4,818.94	$72.00	$8,205.41	$5,723.35	2024-12-09
49617	HCPCS	Repair Of Anterior Abdominal Hernia(s) (ie, Epigastric, Incisional, Ventral, Umb…	9	9	$2,956.10	$2,956.10	$2,512.69	$8,868.30	$5,690.49	2024-12-09
54160	HCPCS	Circumcision, Surgical Excision Other Than Clamp, Device, Or Dorsal Slit; Neonat…	19	9	$6,685.85	$6,685.85	$72.00	$6,752.71	$5,682.97	2024-12-09
15823	HCPCS	Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid	18	9	$4,250.29	$4,250.29	$72.00	$6,555.97	$5,679.67	2024-12-09
27446	HCPCS	Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment	9	9	$5,651.67	$5,651.67	$72.00	$16,955.01	$5,651.67	2024-12-09
27619	HCPCS	Excision, Tumor, Soft Tissue Of Leg Or Ankle Area, Subfascial (eg, Intramuscular…	18	9	$4,534.14	$4,534.14	$72.00	$7,484.63	$5,636.11	2024-12-09
66999	HCPCS	Unlisted Procedure, Anterior Segment Of Eye	9	9	$6,055.92	$6,055.92	$5,147.53	$5,753.12	$5,632.01	2024-12-09
46999	HCPCS	Unlisted Procedure, Anus	9	9	$6,052.28	$6,052.28	$5,144.44	$5,749.67	$5,628.62	2024-12-09
27899	HCPCS	Unlisted Procedure, Leg Or Ankle	17	9	$3,958.30	$3,958.30	$72.00	$6,663.11	$5,607.57	2024-12-09
44650	HCPCS	Closure Of Enteroenteric Or Enterocolic Fistula	9	9	$5,606.43	$5,606.43	$72.00	$16,819.29	$5,606.43	2024-12-09
44320	HCPCS	Colostomy Or Skin Level Cecostomy	9	9	$5,596.24	$5,596.24	$72.00	$16,788.72	$5,596.24	2024-12-09
69610	HCPCS	Tympanic Membrane Repair, With Or Without Site Preparation Of Perforation For Cl…	18	9	$4,777.97	$4,777.97	$72.00	$8,210.66	$5,594.84	2024-12-09
29867	HCPCS	Arthroscopy, Knee, Surgical; Osteochondral Allograft (eg, Mosaicplasty)	9	9	$5,581.47	$5,581.47	$72.00	$16,744.41	$5,581.47	2024-12-09
26952	HCPCS	Amputation, Finger Or Thumb, Primary Or Secondary, Any Joint Or Phalanx, Single,…	18	9	$4,517.86	$4,517.86	$72.00	$7,984.08	$5,577.57	2024-12-09
31640	HCPCS	Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed…	18	9	$4,912.55	$4,912.55	$72.00	$8,609.82	$5,573.72	2024-12-09
43240	HCPCS	Esophagogastroduodenoscopy, Flexible, Transoral; With Transmural Drainage Of Pse…	18	9	$4,188.13	$4,188.13	$72.00	$6,416.37	$5,558.74	2024-12-09
42826	HCPCS	Tonsillectomy, Primary Or Secondary; Age 12 Or Over	18	9	$4,994.44	$4,994.44	$72.00	$8,855.40	$5,558.03	2024-12-09
43278	HCPCS	Endoscopic Retrograde Cholangiopancreatography (ercp); With Ablation Of Tumor(s)…	18	9	$4,283.24	$4,283.24	$72.00	$6,705.18	$5,539.99	2024-12-09
43261	HCPCS	Endoscopic Retrograde Cholangiopancreatography (ercp); With Biopsy, Single Or Mu…	18	9	$4,292.91	$4,292.91	$72.00	$6,908.38	$5,525.76	2024-12-09
54161	HCPCS	Circumcision, Surgical Excision Other Than Clamp, Device, Or Dorsal Slit; Older …	18	9	$5,249.40	$5,249.40	$72.00	$9,604.76	$5,525.32	2024-12-09
32601	HCPCS	Thoracoscopy, Diagnostic (separate Procedure); Lungs, Pericardial Sac, Mediastin…	18	9	$4,555.40	$4,555.40	$72.00	$7,648.80	$5,525.16	2024-12-09
59812	HCPCS	Treatment Of Incomplete Abortion, Any Trimester, Completed Surgically	18	9	$4,690.40	$4,690.40	$72.00	$8,031.36	$5,522.97	2024-12-09
49616	HCPCS	Repair Of Anterior Abdominal Hernia(s) (ie, Epigastric, Incisional, Ventral, Umb…	9	9	$2,864.56	$2,864.56	$2,434.88	$8,593.68	$5,514.28	2024-12-09
66984	HCPCS	Extracapsular Cataract Removal With Insertion Of Intraocular Lens Prosthesis (1 …	18	9	$4,690.87	$4,690.87	$72.00	$9,251.43	$5,510.69	2024-12-09
27488	HCPCS	Removal Of Prosthesis, Including Total Knee Prosthesis, Methylmethacrylate With …	9	9	$5,507.84	$5,507.84	$72.00	$16,523.52	$5,507.84	2024-12-09
74174	HCPCS	Computed Tomographic Angiography, Abdomen And Pelvis, With Contrast Material(s),…	18	9	$4,288.75	$4,288.75	$72.00	$6,920.04	$5,500.86	2024-12-09
31631	HCPCS	Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed…	18	9	$4,986.69	$4,986.69	$72.00	$8,362.63	$5,497.11	2024-12-09
57023	HCPCS	Incision And Drainage Of Vaginal Hematoma; Non-obstetrical (eg, Post-trauma, Spo…	18	9	$4,520.57	$4,520.57	$72.00	$7,583.05	$5,490.64	2024-12-09
26320	HCPCS	Removal Of Implant From Finger Or Hand	18	9	$4,384.33	$4,384.33	$72.00	$6,776.99	$5,484.28	2024-12-09
1307795_1	CDM	Room & Board - Semi-private (two Beds) - General Classification	7	7	$5,769.71	$5,769.71	$4,904.25	$5,481.22	$5,481.22	2024-12-09
1307793_1	CDM	Room & Board - Semi-private (two Beds) - General Classification	7	7	$5,769.71	$5,769.71	$4,904.25	$5,481.22	$5,481.22	2024-12-09
1307799_1	CDM	Room & Board - Semi-private (two Beds) - General Classification	7	7	$5,769.71	$5,769.71	$4,904.25	$5,481.22	$5,481.22	2024-12-09
1307797_1	CDM	Room & Board - Semi-private (two Beds) - General Classification	7	7	$5,769.71	$5,769.71	$4,904.25	$5,481.22	$5,481.22	2024-12-09
73706	HCPCS	Computed Tomographic Angiography, Lower Extremity, With Contrast Material(s), In…	36	9	$4,459.06	$4,459.06	$72.00	$7,419.19	$5,480.51	2024-12-09
11426	HCPCS	Excision, Benign Lesion Including Margins, Except Skin Tag (unless Listed Elsewh…	18	9	$4,751.14	$4,751.14	$72.00	$8,246.69	$5,475.98	2024-12-09
30130	HCPCS	Excision Inferior Turbinate, Partial Or Complete, Any Method	18	9	$4,234.31	$4,234.31	$72.00	$6,387.22	$5,475.27	2024-12-09
43212	HCPCS	Esophagoscopy, Flexible, Transoral; With Placement Of Endoscopic Stent (includes…	18	9	$5,217.47	$5,217.47	$72.00	$9,562.84	$5,474.14	2024-12-09
44005	HCPCS	Enterolysis (freeing Of Intestinal Adhesion) (separate Procedure)	9	9	$5,428.90	$5,428.90	$72.00	$16,286.70	$5,428.90	2024-12-09
11626	HCPCS	Excision, Malignant Lesion Including Margins, Scalp, Neck, Hands, Feet, Genitali…	18	9	$4,514.64	$4,514.64	$72.00	$7,656.26	$5,394.93	2024-12-09
43274	HCPCS	Endoscopic Retrograde Cholangiopancreatography (ercp); With Placement Of Endosco…	18	9	$4,275.44	$4,275.44	$72.00	$7,170.06	$5,390.75	2024-12-09
24120	HCPCS	Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Head Or Neck Of Radius Or …	18	9	$4,053.66	$4,053.66	$72.00	$6,210.91	$5,380.74	2024-12-09
37618	HCPCS	Ligation, Major Artery (eg, Post-traumatic, Rupture); Extremity	18	9	$4,086.84	$4,086.84	$72.00	$6,465.74	$5,378.66	2024-12-09
51715	HCPCS	Endoscopic Injection Of Implant Material Into The Submucosal Tissues Of The Uret…	18	9	$5,033.96	$5,033.96	$72.00	$9,137.01	$5,376.85	2024-12-09
45320	HCPCS	Proctosigmoidoscopy, Rigid; With Ablation Of Tumor(s), Polyp(s), Or Other Lesion…	18	9	$5,651.93	$5,651.93	$72.00	$10,251.29	$5,355.65	2024-12-09
11606	HCPCS	Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Excised Diam…	18	9	$4,297.80	$4,297.80	$72.00	$7,091.46	$5,345.56	2024-12-09
44602	HCPCS	Suture Of Small Intestine (enterorrhaphy) For Perforated Ulcer, Diverticulum, Wo…	9	9	$5,303.69	$5,303.69	$72.00	$15,911.07	$5,303.69	2024-12-09
58558	HCPCS	Hysteroscopy, Surgical; With Sampling (biopsy) Of Endometrium And/or Polypectomy…	18	9	$4,744.01	$4,744.01	$72.00	$8,392.17	$5,299.77	2024-12-09
46020	HCPCS	Placement Of Seton	18	9	$4,814.99	$4,814.99	$72.00	$8,594.69	$5,297.16	2024-12-09
31636	HCPCS	Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed…	18	9	$4,793.47	$4,793.47	$72.00	$8,536.39	$5,294.64	2024-12-09
69110	HCPCS	Excision External Ear; Partial, Simple Repair	18	9	$4,184.34	$4,184.34	$72.00	$6,822.25	$5,291.72	2024-12-09
31630	HCPCS	Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed…	18	9	$4,915.40	$4,915.40	$72.00	$8,366.18	$5,279.22	2024-12-09
74178	HCPCS	Computed Tomography, Abdomen And Pelvis; Without Contrast Material In One Or Bot…	19	9	$6,194.86	$6,194.86	$72.00	$6,256.81	$5,265.63	2024-12-09
38500	HCPCS	Biopsy Or Excision Of Lymph Node(s); Open, Superficial	18	9	$4,631.27	$4,631.27	$72.00	$8,110.66	$5,261.19	2024-12-09
47600	HCPCS	Cholecystectomy	9	9	$5,243.47	$5,243.47	$72.00	$15,730.41	$5,243.47	2024-12-09
43266	HCPCS	Esophagogastroduodenoscopy, Flexible, Transoral; With Placement Of Endoscopic St…	18	9	$4,723.62	$4,723.62	$72.00	$8,410.87	$5,218.72	2024-12-09
47605	HCPCS	Cholecystectomy; With Cholangiography	9	9	$5,211.13	$5,211.13	$72.00	$15,633.39	$5,211.13	2024-12-09
47562	HCPCS	Laparoscopy, Surgical; Cholecystectomy	18	9	$4,586.14	$4,586.14	$72.00	$9,650.46	$5,211.02	2024-12-09
44310	HCPCS	Ileostomy Or Jejunostomy, Non-tube	9	9	$5,197.50	$5,197.50	$72.00	$15,592.50	$5,197.50	2024-12-09
44202	HCPCS	Laparoscopy, Surgical; Enterectomy, Resection Of Small Intestine, Single Resecti…	9	9	$5,194.80	$5,194.80	$72.00	$15,584.40	$5,194.80	2024-12-09
74182	HCPCS	Magnetic Resonance (eg, Proton) Imaging, Abdomen; With Contrast Material(s)	18	9	$3,955.18	$3,955.18	$72.00	$5,993.27	$5,192.19	2024-12-09
27429	HCPCS	Ligamentous Reconstruction (augmentation), Knee; Intra-articular (open) And Extr…	9	9	$5,189.08	$5,189.08	$72.00	$15,567.24	$5,189.08	2024-12-09
25270	HCPCS	Repair, Tendon Or Muscle, Extensor, Forearm And/or Wrist; Primary, Single, Each …	18	9	$4,129.64	$4,129.64	$72.00	$7,046.22	$5,171.72	2024-12-09
54150	HCPCS	Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Bl…	19	9	$6,081.82	$6,081.82	$72.00	$6,142.64	$5,169.55	2024-12-09
49002	HCPCS	Reopening Of Recent Laparotomy	9	9	$5,164.43	$5,164.43	$72.00	$15,493.29	$5,164.43	2024-12-09
59821	HCPCS	Treatment Of Missed Abortion, Completed Surgically; Second Trimester	18	9	$3,901.24	$3,901.24	$72.00	$6,148.62	$5,159.41	2024-12-09
29806	HCPCS	Arthroscopy, Shoulder, Surgical; Capsulorrhaphy	9	9	$5,157.05	$5,157.05	$72.00	$15,471.15	$5,157.05	2024-12-09
16804257_1	CDM	Room & Board - Private (one Bed) - General Classification	7	7	$5,422.66	$5,422.66	$4,609.26	$5,151.53	$5,151.53	2024-12-09
43229	HCPCS	Esophagoscopy, Flexible, Transoral; With Ablation Of Tumor(s), Polyp(s), Or Othe…	18	9	$4,762.84	$4,762.84	$72.00	$8,089.65	$5,134.44	2024-12-09
15830	HCPCS	Excision, Excessive Skin And Subcutaneous Tissue (includes Lipectomy); Abdomen, …	9	9	$5,127.41	$5,127.41	$72.00	$15,382.23	$5,127.41	2024-12-09
46946	HCPCS	Hemorrhoidectomy, Internal, By Ligation Other Than Rubber Band; 2 Or More Hemorr…	18	9	$4,662.43	$4,662.43	$72.00	$8,340.60	$5,109.90	2024-12-09
22903	HCPCS	Excision, Tumor, Soft Tissue Of Abdominal Wall, Subcutaneous; 3 Cm Or Greater	18	9	$3,974.00	$3,974.00	$72.00	$6,352.02	$5,101.83	2024-12-09
25609	HCPCS	Open Treatment Of Distal Radial Intra-articular Fracture Or Epiphyseal Separatio…	9	9	$5,069.90	$5,069.90	$72.00	$15,209.70	$5,069.90	2024-12-09
72196	HCPCS	Magnetic Resonance (eg, Proton) Imaging, Pelvis; With Contrast Material(s)	18	9	$3,792.67	$3,792.67	$72.00	$5,849.78	$5,067.88	2024-12-09
26951	HCPCS	Amputation, Finger Or Thumb, Primary Or Secondary, Any Joint Or Phalanx, Single,…	18	9	$4,377.67	$4,377.67	$72.00	$8,896.98	$5,065.97	2024-12-09
73719	HCPCS	Magnetic Resonance (eg, Proton) Imaging, Lower Extremity Other Than Joint; With …	40	9	$5,627.65	$5,627.65	$72.00	$5,683.93	$5,064.89	2024-12-09
44055	HCPCS	Correction Of Malrotation By Lysis Of Duodenal Bands And/or Reduction Of Midgut …	9	9	$5,057.05	$5,057.05	$72.00	$15,171.15	$5,057.05	2024-12-09
42299	HCPCS	Unlisted Procedure, Palate, Uvula	9	9	$5,318.46	$5,318.46	$4,520.69	$5,371.64	$5,052.54	2024-12-09
37785	HCPCS	Ligation, Division, And/or Excision Of Varicose Vein Cluster(s), 1 Leg	18	9	$4,332.33	$4,332.33	$72.00	$7,021.22	$5,051.92	2024-12-09
81229	HCPCS	Cytogenomic (genome-wide) Analysis For Constitutional Chromosomal Abnormalities;…	7	7	$5,316.69	$5,316.69	$4,519.19	$5,369.86	$5,050.86	2024-12-09
99291	HCPCS	Critical Care, Evaluation And Management Of The Critically Ill Or Critically Inj…	29	9	$5,415.59	$5,415.59	$72.00	$5,469.75	$5,036.50	2024-12-09
43238	HCPCS	Esophagogastroduodenoscopy, Flexible, Transoral; With Transendoscopic Ultrasound…	18	9	$4,407.67	$4,407.67	$72.00	$7,695.02	$5,032.78	2024-12-09
29807	HCPCS	Arthroscopy, Shoulder, Surgical; Repair Of Slap Lesion	9	9	$5,031.83	$5,031.83	$72.00	$15,095.49	$5,031.83	2024-12-09
43280	HCPCS	Laparoscopy, Surgical, Esophagogastric Fundoplasty (eg, Nissen, Toupet Procedure…	9	9	$5,027.98	$5,027.98	$72.00	$15,083.94	$5,027.98	2024-12-09
42808	HCPCS	Excision Or Destruction Of Lesion Of Pharynx, Any Method	18	9	$4,903.34	$4,903.34	$72.00	$9,103.08	$5,021.10	2024-12-09
24071	HCPCS	Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 3 Cm Or G…	18	9	$3,842.23	$3,842.23	$72.00	$5,850.93	$5,017.38	2024-12-09
27696	HCPCS	Repair, Primary, Disrupted Ligament, Ankle; Both Collateral Ligaments	18	9	$3,788.49	$3,788.49	$72.00	$5,545.50	$5,012.41	2024-12-09
31647	HCPCS	Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed…	18	9	$4,495.30	$4,495.30	$72.00	$7,980.52	$4,991.77	2024-12-09
46924	HCPCS	Destruction Of Lesion(s), Anus (eg, Condyloma, Papilloma, Molluscum Contagiosum,…	18	9	$4,714.17	$4,714.17	$72.00	$8,100.91	$4,975.68	2024-12-09
43213	HCPCS	Esophagoscopy, Flexible, Transoral; With Dilation Of Esophagus, By Balloon Or Di…	18	9	$4,177.89	$4,177.89	$72.00	$7,101.97	$4,974.64	2024-12-09
35207	HCPCS	Repair Blood Vessel, Direct; Hand, Finger	18	9	$4,091.48	$4,091.48	$72.00	$7,494.33	$4,974.24	2024-12-09
29916	HCPCS	Arthroscopy, Hip, Surgical; With Labral Repair	9	9	$4,972.24	$4,972.24	$72.00	$14,916.72	$4,972.24	2024-12-09
56515	HCPCS	Destruction Of Lesion(s), Vulva; Extensive (eg, Laser Surgery, Electrosurgery, C…	18	9	$4,600.65	$4,600.65	$72.00	$8,299.52	$4,968.28	2024-12-09
49595	HCPCS	Repair Of Anterior Abdominal Hernia(s) (ie, Epigastric, Incisional, Ventral, Umb…	9	9	$2,571.66	$2,571.66	$2,185.91	$7,714.98	$4,950.44	2024-12-09
43242	HCPCS	Esophagogastroduodenoscopy, Flexible, Transoral; With Transendoscopic Ultrasound…	18	9	$4,103.78	$4,103.78	$72.00	$6,511.71	$4,942.85	2024-12-09
70542	HCPCS	Magnetic Resonance (eg, Proton) Imaging, Orbit, Face, And/or Neck; With Contrast…	18	9	$3,908.06	$3,908.06	$72.00	$6,387.69	$4,925.40	2024-12-09
27450	HCPCS	Osteotomy, Femur, Shaft Or Supracondylar; With Fixation	9	9	$4,896.22	$4,896.22	$72.00	$14,688.66	$4,896.22	2024-12-09
59830	HCPCS	Treatment Of Septic Abortion, Completed Surgically	18	9	$3,852.06	$3,852.06	$72.00	$6,335.79	$4,893.16	2024-12-09
43194	HCPCS	Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(s)	18	9	$4,512.19	$4,512.19	$72.00	$8,126.94	$4,886.62	2024-12-09
23462	HCPCS	Capsulorrhaphy, Anterior, Any Type; With Coracoid Process Transfer	9	9	$4,880.82	$4,880.82	$72.00	$14,642.46	$4,880.82	2024-12-09
26020	HCPCS	Drainage Of Tendon Sheath, Digit And/or Palm, Each	18	9	$3,799.80	$3,799.80	$72.00	$6,173.55	$4,849.02	2024-12-09
27759	HCPCS	Treatment Of Tibial Shaft Fracture (with Or Without Fibular Fracture) By Intrame…	9	9	$4,835.17	$4,835.17	$72.00	$14,505.51	$4,835.17	2024-12-09
43257	HCPCS	Esophagogastroduodenoscopy, Flexible, Transoral; With Delivery Of Thermal Energy…	18	9	$4,181.22	$4,181.22	$72.00	$7,243.77	$4,833.69	2024-12-09
29914	HCPCS	Arthroscopy, Hip, Surgical; With Femoroplasty (ie, Treatment Of Cam Lesion)	9	9	$4,824.77	$4,824.77	$72.00	$14,474.31	$4,824.77	2024-12-09
21337	HCPCS	Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization	18	9	$3,905.61	$3,905.61	$72.00	$6,478.87	$4,821.02	2024-12-09
J1930	HCPCS	Injection, Lanreotide, 1 Mg	18	9	$5,635.78	$5,635.78	$226.41	$11,115.25	$4,811.72	2024-12-09
49621	HCPCS	Repair Of Parastomal Hernia, Any Approach (ie, Open, Laparoscopic, Robotic), Ini…	9	9	$2,497.38	$2,497.38	$2,122.77	$7,492.14	$4,807.45	2024-12-09
11644	HCPCS	Excision, Malignant Lesion Including Margins, Face, Ears, Eyelids, Nose, Lips; E…	18	9	$3,883.67	$3,883.67	$72.00	$6,431.07	$4,806.06	2024-12-09
11646	HCPCS	Excision, Malignant Lesion Including Margins, Face, Ears, Eyelids, Nose, Lips; E…	18	9	$3,721.90	$3,721.90	$72.00	$5,857.80	$4,804.80	2024-12-09
37617	HCPCS	Ligation, Major Artery (eg, Post-traumatic, Rupture); Abdomen	9	9	$4,798.77	$4,798.77	$72.00	$14,396.31	$4,798.77	2024-12-09
49594	HCPCS	Repair Of Anterior Abdominal Hernia(s) (ie, Epigastric, Incisional, Ventral, Umb…	9	9	$2,486.72	$2,486.72	$2,113.71	$7,460.16	$4,786.94	2024-12-09
81162	HCPCS	Brca1 (brca1, DNA Repair Associated), Brca2 (brca2, DNA Repair Associated) (eg, …	8	8	$5,035.58	$5,035.58	$4,280.24	$5,085.94	$4,783.80	2024-12-09
29888	HCPCS	Arthroscopically Aided Anterior Cruciate Ligament Repair/augmentation Or Reconst…	9	9	$4,777.03	$4,777.03	$72.00	$14,331.09	$4,777.03	2024-12-09
44625	HCPCS	Closure Of Enterostomy, Large Or Small Intestine; With Resection And Anastomosis…	9	9	$4,769.96	$4,769.96	$72.00	$14,309.88	$4,769.96	2024-12-09
27507	HCPCS	Open Treatment Of Femoral Shaft Fracture With Plate/screws, With Or Without Cerc…	9	9	$4,754.46	$4,754.46	$72.00	$14,263.38	$4,754.46	2024-12-09
27870	HCPCS	Arthrodesis, Ankle, Open	9	9	$4,744.90	$4,744.90	$72.00	$14,234.70	$4,744.90	2024-12-09
70543	HCPCS	Magnetic Resonance (eg, Proton) Imaging, Orbit, Face, And/or Neck; Without Contr…	18	9	$3,627.57	$3,627.57	$72.00	$5,517.09	$4,739.09	2024-12-09
27514	HCPCS	Open Treatment Of Femoral Fracture, Distal End, Medial Or Lateral Condyle, Inclu…	9	9	$4,735.74	$4,735.74	$72.00	$14,207.22	$4,735.74	2024-12-09
46610	HCPCS	Anoscopy; With Removal Of Single Tumor, Polyp, Or Other Lesion By Hot Biopsy For…	18	9	$5,063.76	$5,063.76	$72.00	$9,240.76	$4,734.62	2024-12-09
44604	HCPCS	Suture Of Large Intestine (colorrhaphy) For Perforated Ulcer, Diverticulum, Woun…	9	9	$4,723.89	$4,723.89	$72.00	$14,171.67	$4,723.89	2024-12-09
70552	HCPCS	Magnetic Resonance (eg, Proton) Imaging, Brain (including Brain Stem); With Cont…	18	9	$3,754.19	$3,754.19	$72.00	$5,784.34	$4,717.13	2024-12-09
11443	HCPCS	Excision, Other Benign Lesion Including Margins, Except Skin Tag (unless Listed …	19	9	$5,532.59	$5,532.59	$72.00	$5,587.92	$4,702.70	2024-12-09
42831	HCPCS	Adenoidectomy, Primary; Age 12 Or Over	18	9	$4,148.24	$4,148.24	$72.00	$7,293.24	$4,682.13	2024-12-09
46045	HCPCS	Incision And Drainage Of Intramural, Intramuscular, Or Submucosal Abscess, Trans…	18	9	$3,717.28	$3,717.28	$72.00	$6,266.22	$4,677.58	2024-12-09
29915	HCPCS	Arthroscopy, Hip, Surgical; With Acetabuloplasty (ie, Treatment Of Pincer Lesion…	9	9	$4,677.19	$4,677.19	$72.00	$14,031.57	$4,677.19	2024-12-09
43772	HCPCS	Laparoscopy, Surgical, Gastric Restrictive Procedure; Removal Of Adjustable Gast…	9	9	$4,666.79	$4,666.79	$72.00	$14,000.37	$4,666.79	2024-12-09
72142	HCPCS	Magnetic Resonance (eg, Proton) Imaging, Spinal Canal And Contents, Cervical; Wi…	18	9	$3,663.40	$3,663.40	$72.00	$5,945.37	$4,662.22	2024-12-09
70545	HCPCS	Magnetic Resonance Angiography, Head; With Contrast Material(s)	18	9	$3,498.51	$3,498.51	$72.00	$5,375.42	$4,656.92	2024-12-09
31648	HCPCS	Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed…	18	9	$4,202.53	$4,202.53	$72.00	$7,470.97	$4,655.83	2024-12-09
29826	HCPCS	Arthroscopy, Shoulder, Surgical; Decompression Of Subacromial Space With Partial…	18	9	$4,354.84	$4,354.84	$72.00	$7,912.24	$4,643.08	2024-12-09
16804258_1	CDM	Room & Board - Semi-private (two Beds) - General Classification	7	7	$4,882.07	$4,882.07	$4,149.76	$4,637.97	$4,637.97	2024-12-09
1307792_1	CDM	Room & Board - Semi-private (two Beds) - General Classification	7	7	$4,882.07	$4,882.07	$4,149.76	$4,637.97	$4,637.97	2024-12-09
18609203_1	CDM	Room & Board - Semi-private (two Beds) - General Classification	7	7	$4,882.07	$4,882.07	$4,149.76	$4,637.97	$4,637.97	2024-12-09
1307796_1	CDM	Room & Board - Semi-private (two Beds) - General Classification	7	7	$4,882.07	$4,882.07	$4,149.76	$4,637.97	$4,637.97	2024-12-09
16804266_1	CDM	Room & Board - Semi-private (two Beds) - Obstetrics (ob)	7	7	$4,882.07	$4,882.07	$4,149.76	$4,637.97	$4,637.97	2024-12-09
1307801_1	CDM	Room & Board - Semi-private (two Beds) - General Classification	7	7	$4,882.07	$4,882.07	$4,149.76	$4,637.97	$4,637.97	2024-12-09
1307794_1	CDM	Room & Board - Semi-private (two Beds) - General Classification	7	7	$4,882.07	$4,882.07	$4,149.76	$4,637.97	$4,637.97	2024-12-09
18609204_1	CDM	Room & Board - Semi-private (two Beds) - General Classification	7	7	$4,882.07	$4,882.07	$4,149.76	$4,637.97	$4,637.97	2024-12-09
1307798_1	CDM	Room & Board - Semi-private (two Beds) - General Classification	7	7	$4,882.07	$4,882.07	$4,149.76	$4,637.97	$4,637.97	2024-12-09
1307800_1	CDM	Room & Board - Semi-private (two Beds) - General Classification	7	7	$4,882.07	$4,882.07	$4,149.76	$4,637.97	$4,637.97	2024-12-09
16804259_1	CDM	Room & Board - Semi-private (two Beds) - General Classification	7	7	$4,882.07	$4,882.07	$4,149.76	$4,637.97	$4,637.97	2024-12-09
18609205_1	CDM	Room & Board - Semi-private (two Beds) - General Classification	7	7	$4,882.07	$4,882.07	$4,149.76	$4,637.97	$4,637.97	2024-12-09

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