Hospital

Vibra Hospital Of Boise

Boise, ID · CCN 132002 · Rates published

5,081 distinct procedures filed

61 distinct payers

414,473 rate rows

2026-05-09 last MRF observed

Data quality

391,408 of 414,473 rate rows are consumer-grade (94.4%)

23,065 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reason	Rows
template filing: same amount across many unrelated codes — excluded	23,049
per-diem day rate — not a per-procedure price	16

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

Source MRF file	https://vhboise.com/wp-content/uploads/sites/24/2025/09/462349174_vibra-hospital-of-boise_standardcharges.csv
Found on page	https://vhboise.com/about-us/price-transparency/
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-05-18
Content fingerprint	21625c8c6369aeb1… · 11,908,110 bytes · first seen 2026-05-09

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
3 OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	20	$158,497.39	$158,497.39	$158,497.39	nat. median $181,005 0.9× median
4 OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	31	$76,628.62	$130,362.83	$130,362.83	nat. median $134,983 1.0× median
165 OTHER	Major Chest Procedures Without Cc/mcc	20	$107,587.45	$107,587.45	$107,587.45	nat. median $19,105 outlier · 5.6×
163 OTHER	Major Chest Procedures With Mcc	20	$107,587.45	$107,587.45	$107,587.45	nat. median $47,944 outlier · 2.2×
164 OTHER	Major Chest Procedures With Cc	20	$107,587.45	$107,587.45	$107,587.45	nat. median $24,249 outlier · 4.4×
166 OTHER	Other Respiratory System O.r. Procedures With Mcc	32	$95,322.89	$106,212.49	$106,212.49	nat. median $38,129 outlier · 2.8×
140 OTHER	Major Head And Neck Procedures With Mcc	20	$106,212.49	$106,212.49	$106,212.49	nat. median $37,242 outlier · 2.9×
11 OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	20	$106,212.49	$106,212.49	$106,212.49	nat. median $49,519 outlier · 2.1×
981 OTHER	Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc	20	$106,198.88	$106,198.88	$106,198.88	nat. median $33,955 outlier · 3.1×
68875010201 OTHER	Gattex	38	$20,697.11	$99,999.99	$99,999.99	nat. median $100,000 1.0× median
870 OTHER	Septicemia Or Severe Sepsis With Mv >96 Hours	20	$94,028.41	$94,028.41	$94,028.41	nat. median $54,603 1.7× median
207 OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	32	$70,707.53	$88,242.68	$88,242.68	nat. median $66,849 1.3× median
173 OTHER	Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary…	20	$71,575.22	$71,575.22	$71,575.22	nat. median $25,789 outlier · 2.8×
12 OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc	20	$71,575.22	$71,575.22	$71,575.22	nat. median $39,504 1.8× median
167 OTHER	Other Respiratory System O.r. Procedures With Cc	20	$71,575.22	$71,575.22	$71,575.22	nat. median $18,396 outlier · 3.9×
168 OTHER	Other Respiratory System O.r. Procedures Without Cc/mcc	20	$71,575.22	$71,575.22	$71,575.22	nat. median $12,971 outlier · 5.5×
853 OTHER	Infectious And Parasitic Diseases With O.r. Procedures With Mcc	20	$68,802.60	$68,802.60	$68,802.60	nat. median $39,509 1.7× median
40 OTHER	Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc	31	$59,168.23	$66,660.75	$66,660.75	nat. median $35,347 1.9× median
799 OTHER	Splenic Procedures With Mcc	20	$63,339.06	$63,339.06	$63,339.06	nat. median $43,209 1.5× median
356 OTHER	Other Digestive System O.r. Procedures With Mcc	31	$62,072.28	$63,339.06	$63,339.06	nat. median $43,743 1.4× median
573 OTHER	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	20	$63,098.55	$63,098.55	$63,098.55	nat. median $54,881 1.1× median
579 OTHER	Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc	20	$61,555.69	$61,555.69	$61,555.69	nat. median $30,752 outlier · 2.0×
582 OTHER	Mastectomy For Malignancy With Cc/mcc	20	$61,555.69	$61,555.69	$61,555.69	nat. median $18,095 outlier · 3.4×
856 OTHER	Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc	31	$59,928.78	$61,151.82	$61,151.82	nat. median $32,385 1.9× median
205 OTHER	Other Respiratory System Diagnoses With Mcc	20	$59,509.13	$59,509.13	$59,509.13	nat. median $17,709 outlier · 3.4×
619 OTHER	O.r. Procedures For Obesity With Mcc	20	$59,336.69	$59,336.69	$59,336.69	nat. median $26,261 outlier · 2.3×
622 OTHER	Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor…	31	$12,641.31	$59,336.69	$59,336.69	nat. median $31,621 1.9× median
551 OTHER	Medical Back Problems With Mcc	20	$59,259.54	$59,259.54	$59,259.54	nat. median $15,276 outlier · 3.9×
61 OTHER	Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A…	20	$59,028.11	$59,028.11	$59,028.11	nat. median $26,323 outlier · 2.2×
64 OTHER	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	31	$57,847.56	$59,028.11	$59,028.11	nat. median $19,110 outlier · 3.1×
901 OTHER	Wound Debridements For Injuries With Mcc	31	$21,739.29	$58,224.92	$58,224.92	nat. median $29,541 2.0× median
245 OTHER	Aicd Generator Procedures	20	$57,657.69	$57,657.69	$57,657.69	nat. median $43,285 1.3× median
264 OTHER	Other Circulatory System O.r. Procedures	31	$6,630.74	$57,657.69	$57,657.69	nat. median $32,470 1.8× median
263 OTHER	Vein Ligation And Stripping	20	$57,657.69	$57,657.69	$57,657.69	nat. median $26,524 outlier · 2.2×
253 OTHER	Other Vascular Procedures With Cc	20	$57,281.05	$57,281.05	$57,281.05	nat. median $24,609 outlier · 2.3×
217 OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	20	$57,281.05	$57,281.05	$57,281.05	nat. median $60,727 0.9× median
254 OTHER	Other Vascular Procedures Without Cc/mcc	20	$57,281.05	$57,281.05	$57,281.05	nat. median $16,771 outlier · 3.4×
220 OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	20	$57,281.05	$57,281.05	$57,281.05	nat. median $50,021 1.1× median
216 OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	20	$57,281.05	$57,281.05	$57,281.05	nat. median $90,130 0.6× median
252 OTHER	Other Vascular Procedures With Mcc	20	$57,281.05	$57,281.05	$57,281.05	nat. median $25,377 outlier · 2.3×
255 OTHER	Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc	20	$57,281.05	$57,281.05	$57,281.05	nat. median $21,899 outlier · 2.6×
250 OTHER	Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc	20	$57,281.05	$57,281.05	$57,281.05	nat. median $54 outlier · 1067.3×
242 OTHER	Permanent Cardiac Pacemaker Implant With Mcc	20	$57,281.05	$57,281.05	$57,281.05	nat. median $31,203 1.8× median
221 OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	20	$57,281.05	$57,281.05	$57,281.05	nat. median $44,853 1.3× median
25 OTHER	Craniotomy And Endovascular Intracranial Procedures With Mcc	20	$57,281.05	$57,281.05	$57,281.05	nat. median $42,589 1.3× median
251 OTHER	Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc	20	$57,281.05	$57,281.05	$57,281.05	nat. median $11,991 outlier · 4.8×
256 OTHER	Upper Limb And Toe Amputation For Circulatory System Disorders With Cc	20	$57,281.05	$57,281.05	$57,281.05	nat. median $16,548 outlier · 3.5×
215 OTHER	Other Heart Assist System Implant	20	$57,281.05	$57,281.05	$57,281.05	nat. median $92,359 0.6× median
257 OTHER	Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/mcc	20	$57,281.05	$57,281.05	$57,281.05	nat. median $9,847 outlier · 5.8×
236 OTHER	Coronary Bypass Without Cardiac Catheterization Without Mcc	20	$57,281.05	$57,281.05	$57,281.05	nat. median $40,949 1.4× median

Other procedures at this hospital

Browse this hospital's 5,081 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

3	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	24	20	$158,497.39	$158,497.39	$158,497.39	$158,497.39	$158,497.39	2026-05-09
4	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	43	31	$130,362.83	$130,362.83	$76,628.62	$130,362.83	$130,362.83	2026-05-09
165	OTHER	Major Chest Procedures Without Cc/mcc	24	20	$107,587.45	$107,587.45	$107,587.45	$107,587.45	$107,587.45	2026-05-09
164	OTHER	Major Chest Procedures With Cc	24	20	$107,587.45	$107,587.45	$107,587.45	$107,587.45	$107,587.45	2026-05-09
163	OTHER	Major Chest Procedures With Mcc	24	20	$107,587.45	$107,587.45	$107,587.45	$107,587.45	$107,587.45	2026-05-09
140	OTHER	Major Head And Neck Procedures With Mcc	24	20	$106,212.49	$106,212.49	$106,212.49	$106,212.49	$106,212.49	2026-05-09
11	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	24	20	$106,212.49	$106,212.49	$106,212.49	$106,212.49	$106,212.49	2026-05-09
166	OTHER	Other Respiratory System O.r. Procedures With Mcc	47	32	$106,212.49	$106,212.49	$95,322.89	$106,212.49	$106,212.49	2026-05-09
981	OTHER	Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc	24	20	$106,198.88	$106,198.88	$106,198.88	$106,198.88	$106,198.88	2026-05-09
68875010201	OTHER	Gattex	82	38	$99,999.99	$99,999.99	$20,697.11	$99,999.99	$99,999.99	2026-05-09
870	OTHER	Septicemia Or Severe Sepsis With Mv >96 Hours	24	20	$94,028.41	$94,028.41	$94,028.41	$94,028.41	$94,028.41	2026-05-09
207	OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	45	32	$88,242.68	$88,242.68	$70,707.53	$88,242.68	$88,242.68	2026-05-09
167	OTHER	Other Respiratory System O.r. Procedures With Cc	24	20	$71,575.22	$71,575.22	$71,575.22	$71,575.22	$71,575.22	2026-05-09
12	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc	24	20	$71,575.22	$71,575.22	$71,575.22	$71,575.22	$71,575.22	2026-05-09
173	OTHER	Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary…	24	20	$71,575.22	$71,575.22	$71,575.22	$71,575.22	$71,575.22	2026-05-09
168	OTHER	Other Respiratory System O.r. Procedures Without Cc/mcc	24	20	$71,575.22	$71,575.22	$71,575.22	$71,575.22	$71,575.22	2026-05-09
853	OTHER	Infectious And Parasitic Diseases With O.r. Procedures With Mcc	24	20	$68,802.60	$68,802.60	$68,802.60	$68,802.60	$68,802.60	2026-05-09
40	OTHER	Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc	44	31	$66,660.75	$66,660.75	$59,168.23	$66,660.75	$66,660.75	2026-05-09
799	OTHER	Splenic Procedures With Mcc	24	20	$63,339.06	$63,339.06	$63,339.06	$63,339.06	$63,339.06	2026-05-09
356	OTHER	Other Digestive System O.r. Procedures With Mcc	44	31	$63,339.06	$63,339.06	$62,072.28	$63,339.06	$63,339.06	2026-05-09
573	OTHER	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	24	20	$63,098.55	$63,098.55	$63,098.55	$63,098.55	$63,098.55	2026-05-09
582	OTHER	Mastectomy For Malignancy With Cc/mcc	24	20	$61,555.69	$61,555.69	$61,555.69	$61,555.69	$61,555.69	2026-05-09
579	OTHER	Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc	24	20	$61,555.69	$61,555.69	$61,555.69	$61,555.69	$61,555.69	2026-05-09
856	OTHER	Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc	43	31	$61,151.82	$61,151.82	$59,928.78	$61,151.82	$61,151.82	2026-05-09
205	OTHER	Other Respiratory System Diagnoses With Mcc	24	20	$59,509.13	$59,509.13	$59,509.13	$59,509.13	$59,509.13	2026-05-09
622	OTHER	Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor…	43	31	$59,336.69	$59,336.69	$12,641.31	$59,336.69	$59,336.69	2026-05-09
619	OTHER	O.r. Procedures For Obesity With Mcc	24	20	$59,336.69	$59,336.69	$59,336.69	$59,336.69	$59,336.69	2026-05-09
551	OTHER	Medical Back Problems With Mcc	24	20	$59,259.54	$59,259.54	$59,259.54	$59,259.54	$59,259.54	2026-05-09
64	OTHER	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	43	31	$59,028.11	$59,028.11	$57,847.56	$59,028.11	$59,028.11	2026-05-09
61	OTHER	Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A…	24	20	$59,028.11	$59,028.11	$59,028.11	$59,028.11	$59,028.11	2026-05-09
901	OTHER	Wound Debridements For Injuries With Mcc	45	31	$58,224.92	$58,224.92	$21,739.29	$58,224.92	$58,224.92	2026-05-09
263	OTHER	Vein Ligation And Stripping	24	20	$57,657.69	$57,657.69	$57,657.69	$57,657.69	$57,657.69	2026-05-09
245	OTHER	Aicd Generator Procedures	24	20	$57,657.69	$57,657.69	$57,657.69	$57,657.69	$57,657.69	2026-05-09
264	OTHER	Other Circulatory System O.r. Procedures	44	31	$57,657.69	$57,657.69	$6,630.74	$57,657.69	$57,657.69	2026-05-09
36	OTHER	Carotid Artery Stent Procedures Without Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
739	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
215	OTHER	Other Heart Assist System Implant	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
474	OTHER	Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
493	OTHER	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
970	OTHER	HIV With Extensive O.r. Procedures Without Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
737	OTHER	Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
748	OTHER	Female Reproductive System Reconstructive Procedures	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
234	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
735	OTHER	Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
519	OTHER	Back And Neck Procedures Except Spinal Fusion With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
749	OTHER	Other Female Reproductive System O.r. Procedures With Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
221	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
784	OTHER	Cesarean Section With Sterilization With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
477	OTHER	Biopsies Of Musculoskeletal System And Connective Tissue With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
202	OTHER	Bronchitis And Asthma With Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
823	OTHER	Lymphoma And Non-acute Leukemia With Other Procedures With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
483	OTHER	Major Joint Or Limb Reattachment Procedures Of Upper Extremities	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
738	OTHER	Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
233	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
829	OTHER	Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
740	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
786	OTHER	Cesarean Section Without Sterilization With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
787	OTHER	Cesarean Section Without Sterilization With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
217	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
34	OTHER	Carotid Artery Stent Procedures With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
344	OTHER	Minor Small And Large Bowel Procedures With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
405	OTHER	Pancreas, Liver And Shunt Procedures With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
251	OTHER	Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
821	OTHER	Lymphoma And Leukemia With Major O.r. Procedures With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
820	OTHER	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
499	OTHER	Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
495	OTHER	Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
269	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
20	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
498	OTHER	Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
275	OTHER	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
857	OTHER	Postoperative Or Post-traumatic Infections With O.r. Procedures With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
385	OTHER	Inflammatory Bowel Disease With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
267	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
742	OTHER	Uterine And Adnexa Procedures For Non-malignancy With Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
917	OTHER	Poisoning And Toxic Effects Of Drugs With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
746	OTHER	Vagina, Cervix And Vulva Procedures With Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
271	OTHER	Other Major Cardiovascular Procedures With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
754	OTHER	Malignancy, Female Reproductive System With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
643	OTHER	Endocrine Disorders With Mcc*	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
73	OTHER	Cranial And Peripheral Nerve Disorders With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
231	OTHER	Coronary Bypass With Ptca With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
826	OTHER	Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
229	OTHER	Other Cardiothoracic Procedures Without Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
423	OTHER	Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc	43	31	$57,281.05	$57,281.05	$7,648.48	$57,281.05	$57,281.05	2026-05-09
250	OTHER	Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
42	OTHER	Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
22	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
745	OTHER	D&c, Conization, Laparoscopy And Tubal Interruption Without Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
272	OTHER	Other Major Cardiovascular Procedures Without Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
39	OTHER	Extracranial Procedures Without Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
24	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
35	OTHER	Carotid Artery Stent Procedures With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
27	OTHER	Craniotomy And Endovascular Intracranial Procedures Without Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
38	OTHER	Extracranial Procedures With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
266	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
492	OTHER	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
228	OTHER	Other Cardiothoracic Procedures With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
485	OTHER	Knee Procedures With Principal Diagnosis Of Infection With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
220	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
33	OTHER	Ventricular Shunt Procedures Without Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
469	OTHER	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
31	OTHER	Ventricular Shunt Procedures With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
239	OTHER	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
783	OTHER	Cesarean Section With Sterilization With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
969	OTHER	HIV With Extensive O.r. Procedures With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
734	OTHER	Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
353	OTHER	Hernia Procedures Except Inguinal And Femoral With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
736	OTHER	Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
843	OTHER	Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
257	OTHER	Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
236	OTHER	Coronary Bypass Without Cardiac Catheterization Without Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
273	OTHER	Percutaneous And Other Intracardiac Procedures With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
850	OTHER	Acute Leukemia With Other Procedures	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
235	OTHER	Coronary Bypass Without Cardiac Catheterization With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
32	OTHER	Ventricular Shunt Procedures With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
824	OTHER	Lymphoma And Non-acute Leukemia With Other Procedures With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
329	OTHER	Major Small And Large Bowel Procedures With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
26	OTHER	Craniotomy And Endovascular Intracranial Procedures With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
258	OTHER	Cardiac Pacemaker Device Replacement With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
23	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
21	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
817	OTHER	Other Antepartum Diagnoses With O.r. Procedures With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
274	OTHER	Percutaneous And Other Intracardiac Procedures Without Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
741	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy Without…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
240	OTHER	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
253	OTHER	Other Vascular Procedures With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
252	OTHER	Other Vascular Procedures With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
242	OTHER	Permanent Cardiac Pacemaker Implant With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
256	OTHER	Upper Limb And Toe Amputation For Circulatory System Disorders With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
219	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
37	OTHER	Extracranial Procedures With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
255	OTHER	Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
518	OTHER	Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
562	OTHER	Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
750	OTHER	Other Female Reproductive System O.r. Procedures Without Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
218	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
747	OTHER	Vagina, Cervix And Vulva Procedures Without Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
241	OTHER	Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
693	OTHER	Urinary Stones With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
254	OTHER	Other Vascular Procedures Without Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
54	OTHER	Nervous System Neoplasms With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
963	OTHER	Other Multiple Significant Trauma With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
744	OTHER	D&c, Conization, Laparoscopy And Tubal Interruption With Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
466	OTHER	Revision Of Hip Or Knee Replacement With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
743	OTHER	Uterine And Adnexa Procedures For Non-malignancy Without Cc/mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
808	OTHER	Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
755	OTHER	Malignancy, Female Reproductive System With Cc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
232	OTHER	Coronary Bypass With Ptca Without Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
827	OTHER	Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
41	OTHER	Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Periphe…	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
25	OTHER	Craniotomy And Endovascular Intracranial Procedures With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
268	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
918	OTHER	Poisoning And Toxic Effects Of Drugs Without Mcc	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
212	OTHER	Concomitant Aortic And Mitral Valve Procedures	24	20	$57,281.05	$57,281.05	$57,281.05	$57,281.05	$57,281.05	2026-05-09
463	OTHER	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …	45	32	$57,226.60	$57,226.60	$23,379.99	$57,226.60	$57,226.60	2026-05-09
822	OTHER	Lymphoma And Leukemia With Major O.r. Procedures Without Cc/mcc	24	20	$57,058.70	$57,058.70	$57,058.70	$57,058.70	$57,058.70	2026-05-09
907	OTHER	Other O.r. Procedures For Injuries With Mcc*	24	20	$57,058.70	$57,058.70	$57,058.70	$57,058.70	$57,058.70	2026-05-09
957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	24	20	$57,058.70	$57,058.70	$57,058.70	$57,058.70	$57,058.70	2026-05-09
958	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Cc	24	20	$57,058.70	$57,058.70	$57,058.70	$57,058.70	$57,058.70	2026-05-09
956	OTHER	Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma	24	20	$57,058.70	$57,058.70	$57,058.70	$57,058.70	$57,058.70	2026-05-09
908	OTHER	Other O.r. Procedures For Injuries With Cc*	24	20	$57,058.70	$57,058.70	$57,058.70	$57,058.70	$57,058.70	2026-05-09
828	OTHER	Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …	24	20	$57,058.70	$57,058.70	$57,058.70	$57,058.70	$57,058.70	2026-05-09
955	OTHER	Craniotomy For Multiple Significant Trauma	24	20	$57,058.70	$57,058.70	$57,058.70	$57,058.70	$57,058.70	2026-05-09
500	OTHER	Soft Tissue Procedures With Mcc	24	20	$55,892.47	$55,892.47	$55,892.47	$55,892.47	$55,892.47	2026-05-09
29	OTHER	Spinal Procedures With Cc Or Spinal Neurostimulators	24	20	$54,408.60	$54,408.60	$54,408.60	$54,408.60	$54,408.60	2026-05-09
28	OTHER	Spinal Procedures With Mcc	24	20	$54,408.60	$54,408.60	$54,408.60	$54,408.60	$54,408.60	2026-05-09
515	OTHER	Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc	24	20	$54,408.60	$54,408.60	$54,408.60	$54,408.60	$54,408.60	2026-05-09
673	OTHER	Other Kidney And Urinary Tract Procedures With Mcc*	44	32	$54,322.38	$54,322.38	$40,460.46	$54,322.38	$54,322.38	2026-05-09
665	OTHER	Prostatectomy With Mcc	24	20	$54,322.38	$54,322.38	$54,322.38	$54,322.38	$54,322.38	2026-05-09
653	OTHER	Major Bladder Procedures With Mcc	24	20	$54,322.38	$54,322.38	$54,322.38	$54,322.38	$54,322.38	2026-05-09
939	OTHER	O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc	43	31	$53,791.46	$53,791.46	$32,888.84	$53,791.46	$53,791.46	2026-05-09
208	OTHER	Respiratory System Diagnosis With Ventilator Support <=96 Hours	44	31	$53,582.72	$53,582.72	$6,630.74	$53,582.72	$53,582.72	2026-05-09
570	OTHER	Skin Debridement With Mcc*	46	32	$53,423.89	$53,423.89	$19,229.76	$56,721.42	$53,423.89	2026-05-09
974	OTHER	HIV With Major Related Condition With Mcc*	24	20	$51,713.13	$51,713.13	$51,713.13	$51,713.13	$51,713.13	2026-05-09
55292070255	OTHER	Hemin For Injection	82	38	$51,333.70	$51,333.70	$20,697.11	$55,049.72	$51,333.70	2026-05-09
583	OTHER	Mastectomy For Malignancy Without Cc/mcc	24	20	$50,587.75	$50,587.75	$50,587.75	$50,587.75	$50,587.75	2026-05-09
580	OTHER	Other Skin, Subcutaneous Tissue And Breast Procedures With Cc	24	20	$50,587.75	$50,587.75	$50,587.75	$50,587.75	$50,587.75	2026-05-09
581	OTHER	Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/mcc	24	20	$50,587.75	$50,587.75	$50,587.75	$50,587.75	$50,587.75	2026-05-09
82	OTHER	Traumatic Stupor And Coma >1 Hour With Mcc*	24	20	$48,686.40	$48,686.40	$48,686.40	$48,686.40	$48,686.40	2026-05-09
919	OTHER	Complications Of Treatment With Mcc	44	32	$48,663.71	$48,663.71	$35,976.88	$48,663.71	$48,663.71	2026-05-09
94	OTHER	Bacterial And Tuberculous Infections Of Nervous System With Mcc*	43	31	$48,609.25	$48,609.25	$46,899.73	$48,609.25	$48,609.25	2026-05-09
426	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	24	20	$48,241.69	$48,241.69	$48,241.69	$48,241.69	$48,241.69	2026-05-09
429	OTHER	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	24	20	$48,241.69	$48,241.69	$48,241.69	$48,241.69	$48,241.69	2026-05-09
427	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	24	20	$48,241.69	$48,241.69	$48,241.69	$48,241.69	$48,241.69	2026-05-09
53	OTHER	Spinal Disorders And Injuries Without Cc/mcc	24	20	$48,241.69	$48,241.69	$48,241.69	$48,241.69	$48,241.69	2026-05-09
447	OTHER	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	24	20	$48,241.69	$48,241.69	$48,241.69	$48,241.69	$48,241.69	2026-05-09
448	OTHER	Multiple Level Spinal Fusion Except Cervical Without Mcc	24	20	$48,241.69	$48,241.69	$48,241.69	$48,241.69	$48,241.69	2026-05-09
52	OTHER	Spinal Disorders And Injuries With Cc/mcc	24	20	$48,241.69	$48,241.69	$48,241.69	$48,241.69	$48,241.69	2026-05-09
438	OTHER	Disorders Of Pancreas Except Malignancy With Mcc	43	31	$47,542.86	$47,542.86	$11,538.37	$47,542.86	$47,542.86	2026-05-09
674	OTHER	Other Kidney And Urinary Tract Procedures With Cc*	24	20	$47,488.41	$47,488.41	$47,488.41	$47,488.41	$47,488.41	2026-05-09
675	OTHER	Other Kidney And Urinary Tract Procedures Without Cc/mcc*	24	20	$47,488.41	$47,488.41	$47,488.41	$47,488.41	$47,488.41	2026-05-09
666	OTHER	Prostatectomy With Cc	24	20	$47,488.41	$47,488.41	$47,488.41	$47,488.41	$47,488.41	2026-05-09
654	OTHER	Major Bladder Procedures With Cc	24	20	$47,488.41	$47,488.41	$47,488.41	$47,488.41	$47,488.41	2026-05-09
288	OTHER	Acute And Subacute Endocarditis With Mcc	44	31	$46,240.51	$46,240.51	$18,647.86	$46,240.51	$46,240.51	2026-05-09
393	OTHER	Other Digestive System Diagnoses With Mcc	43	31	$46,104.37	$46,104.37	$39,774.16	$46,104.37	$46,104.37	2026-05-09
388	OTHER	Gastrointestinal Obstruction With Mcc	24	20	$44,838.32	$44,838.32	$44,838.32	$44,838.32	$44,838.32	2026-05-09
189	OTHER	Pulmonary Edema And Respiratory Failure	48	32	$65,883.04	$44,411.76 33% off	$6,724.38	$44,411.76	$44,411.76	2026-05-09
640	OTHER	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M…	43	31	$44,398.15	$44,398.15	$41,960.14	$44,398.15	$44,398.15	2026-05-09
539	OTHER	Osteomyelitis With Mcc*	44	31	$43,985.20	$43,985.20	$15,757.48	$43,985.20	$43,985.20	2026-05-09
414	OTHER	Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc	24	20	$43,458.81	$43,458.81	$43,458.81	$43,458.81	$43,458.81	2026-05-09
380	OTHER	Complicated Peptic Ulcer With Mcc	43	31	$43,458.81	$43,458.81	$43,458.81	$43,458.81	$43,458.81	2026-05-09
411	OTHER	Cholecystectomy With C.d.e. With Mcc	24	20	$43,458.81	$43,458.81	$43,458.81	$43,458.81	$43,458.81	2026-05-09
417	OTHER	Laparoscopic Cholecystectomy Without C.d.e. With Mcc	24	20	$43,458.81	$43,458.81	$43,458.81	$43,458.81	$43,458.81	2026-05-09
464	OTHER	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …	44	32	$43,277.30	$43,277.30	$18,709.76	$43,277.30	$43,277.30	2026-05-09
623	OTHER	Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor…	43	31	$43,050.41	$43,050.41	$26,751.81	$43,050.41	$43,050.41	2026-05-09
620	OTHER	O.r. Procedures For Obesity With Cc	24	20	$43,050.41	$43,050.41	$43,050.41	$43,050.41	$43,050.41	2026-05-09
902	OTHER	Wound Debridements For Injuries With Cc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
387	OTHER	Inflammatory Bowel Disease Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
671	OTHER	Urethral Procedures With Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
672	OTHER	Urethral Procedures Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
904	OTHER	Skin Grafts For Injuries With Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
667	OTHER	Prostatectomy Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
157	OTHER	Dental And Oral Diseases With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
668	OTHER	Transurethral Procedures With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
669	OTHER	Transurethral Procedures With Cc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
154	OTHER	Other Ear, Nose, Mouth And Throat Diagnoses With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
854	OTHER	Infectious And Parasitic Diseases With O.r. Procedures With Cc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
152	OTHER	Otitis Media And Uri With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
312	OTHER	Syncope And Collapse	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
670	OTHER	Transurethral Procedures Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
903	OTHER	Wound Debridements For Injuries Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
905	OTHER	Skin Grafts For Injuries Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
575	OTHER	Skin Graft For Skin Ulcer Or Cellulitis Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
574	OTHER	Skin Graft For Skin Ulcer Or Cellulitis With Cc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
663	OTHER	Minor Bladder Procedures With Cc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
155	OTHER	Other Ear, Nose, Mouth And Throat Diagnoses With Cc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
145	OTHER	Other Ear, Nose, Mouth And Throat O.r. Procedures Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
661	OTHER	Kidney And Ureter Procedures For Non-neoplasm Without Cc/mcc*	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
144	OTHER	Other Ear, Nose, Mouth And Throat O.r. Procedures With Cc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
576	OTHER	Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc*	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
198	OTHER	Interstitial Lung Disease Without Cc/mcc*	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
662	OTHER	Minor Bladder Procedures With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
386	OTHER	Inflammatory Bowel Disease With Cc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
664	OTHER	Minor Bladder Procedures Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
660	OTHER	Kidney And Ureter Procedures For Non-neoplasm With Cc*	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
577	OTHER	Skin Graft Except For Skin Ulcer Or Cellulitis With Cc*	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
488	OTHER	Knee Procedures Without Principal Diagnosis Of Infection With Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
578	OTHER	Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/mcc*	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
115	OTHER	Extraocular Procedures Except Orbit	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
658	OTHER	Kidney And Ureter Procedures For Neoplasm Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
114	OTHER	Orbital Procedures Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
659	OTHER	Kidney And Ureter Procedures For Non-neoplasm With Mcc*	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
709	OTHER	Penis Procedures With Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
657	OTHER	Kidney And Ureter Procedures For Neoplasm With Cc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
501	OTHER	Soft Tissue Procedures With Cc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
435	OTHER	Malignancy Of Hepatobiliary System Or Pancreas With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
113	OTHER	Orbital Procedures With Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
818	OTHER	Other Antepartum Diagnoses With O.r. Procedures With Cc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
922	OTHER	Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
143	OTHER	Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
142	OTHER	Major Head And Neck Procedures Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
141	OTHER	Major Head And Neck Procedures With Cc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
278	OTHER	Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures …	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
139	OTHER	Salivary Gland Procedures	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
304	OTHER	Hypertension With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
326	OTHER	Stomach, Esophageal And Duodenal Procedures With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
138	OTHER	Mouth Procedures Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
137	OTHER	Mouth Procedures With Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
306	OTHER	Cardiac Congenital And Valvular Disorders With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
928	OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
136	OTHER	Sinus And Mastoid Procedures Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
656	OTHER	Kidney And Ureter Procedures For Neoplasm With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
78	OTHER	Hypertensive Encephalopathy With Cc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
655	OTHER	Major Bladder Procedures Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
77	OTHER	Hypertensive Encephalopathy With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
135	OTHER	Sinus And Mastoid Procedures With Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
277	OTHER	Cardiac Defibrillator Implant Without Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
604	OTHER	Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
927	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
934	OTHER	Full Thickness Burn Without Skin Graft Or Inhalation Injury	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
319	OTHER	Other Endovascular Cardiac Valve Procedures With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
628	OTHER	Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
625	OTHER	Thyroid, Parathyroid And Thyroglossal Procedures With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
283	OTHER	Acute Myocardial Infarction, Expired With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
940	OTHER	O.r. Procedures With Diagnoses Of Other Contact With Health Services With Cc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
13	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
545	OTHER	Connective Tissue Disorders With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
197	OTHER	Interstitial Lung Disease With Cc*	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
713	OTHER	Transurethral Prostatectomy With Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
715	OTHER	Other Male Reproductive System O.r. Procedures For Malignancy With Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
941	OTHER	O.r. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/…	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
616	OTHER	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
276	OTHER	Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
617	OTHER	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
717	OTHER	Other Male Reproductive System O.r. Procedures Except Malignancy With Cc/mcc	44	31	$42,859.82	$42,859.82	$25,170.88	$42,859.82	$42,859.82	2026-05-09
929	OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
615	OTHER	Adrenal And Pituitary Procedures Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
707	OTHER	Major Male Pelvic Procedures With Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
260	OTHER	Cardiac Pacemaker Revision Except Device Replacement With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
279	OTHER	Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures …	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
117	OTHER	Intraocular Procedures Without Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
606	OTHER	Minor Skin Disorders With Mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
614	OTHER	Adrenal And Pituitary Procedures With Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
196	OTHER	Interstitial Lung Disease With Mcc*	43	31	$42,859.82	$42,859.82	$19,412.42	$42,859.82	$42,859.82	2026-05-09
374	OTHER	Digestive Malignancy With Mcc*	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
116	OTHER	Intraocular Procedures With Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
711	OTHER	Testes Procedures With Cc/mcc	24	20	$42,859.82	$42,859.82	$42,859.82	$42,859.82	$42,859.82	2026-05-09
441	OTHER	Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc	24	20	$42,251.75	$42,251.75	$42,251.75	$42,251.75	$42,251.75	2026-05-09

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