Hospital

BELLVILLE MEDICAL CENTER

Bellville, TX · CCN 450253 · Rates published

4,542 distinct procedures filed

13 distinct payers

109,048 rate rows

2026-05-18 last MRF observed

Data quality

108,824 of 109,048 rate rows are consumer-grade (99.8%)

224 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
placeholder amount (≤ $0.02) — excluded from medians	203
per-diem day rate — not a per-procedure price	18
exceeds 10× this hospital's gross charge — excluded from medians	3

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

Source MRF file	https://app.box.com/shared/static/3mydfralbd8qx0h8vqu7j9wbf4ps63x7.csv
Found on page	https://midcoasthealthsystem.org/pricing-transparency/
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-05-19
Content fingerprint	ce0da0ce3617d45d… · 4,220,112 bytes · first seen 2026-05-18

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
3160433 OTHER	Insert/replace Ns Generat	13	$500.00	$71,404.00	$25,273.98	nat. median $25,274 1.0× median
3161176 OTHER	Removal Implant Defibrillator Pulse Gene	13	$1,475.00	$80,512.80	$25,004.78	nat. median $25,005 1.0× median
3161110 OTHER	Cardioverter-defibrillator Lead Placemen	13	$675.00	$84,480.00	$24,821.79	nat. median $24,822 1.0× median
3162007 OTHER	Insertion Penile Prosthesis	13	$7,095.00	$46,308.00	$20,259.75	nat. median $20,260 1.0× median
3162054 OTHER	Remove/replace Penile Prosthesis	13	$7,095.00	$46,160.00	$20,195.00	nat. median $20,195 1.0× median
3161082 OTHER	Removal Implantable Defibrillator Pulse	13	$1,475.00	$24,984.00	$19,112.53	nat. median $19,113 1.0× median
3160432 OTHER	Insert/replace Neurostimu	13	$500.00	$39,919.20	$18,989.47	nat. median $18,989 1.0× median
3162009 OTHER	Insertion Urethra/bladder Neck Sphincter	13	$1,475.00	$46,280.00	$16,731.14	nat. median $16,731 1.0× median
3162011 OTHER	Arthroscopy Total Knee	13	$5,506.00	$32,000.00	$14,000.00	nat. median $14,000 1.0× median
3162040 OTHER	Arthroplasty Total Shoulder Lt	13	$2,171.06	$42,620.00	$13,992.24	nat. median $13,992 1.0× median
3162041 OTHER	Arthroplasty Total Shoulder Rt	13	$2,171.06	$42,620.00	$13,992.24	nat. median $13,992 1.0× median
3161139 OTHER	Removal Perm Pacemaker Pulse Generator	13	$1,475.00	$44,666.40	$12,857.15	nat. median $12,857 1.0× median
3161196 OTHER	Open Implant Ns Electrode Peripheral Ner	13	$1,475.00	$29,390.22	$11,344.43	nat. median $11,344 1.0× median
3160464 OTHER	Laparoscopy Esphagogastri	13	$2,479.00	$15,692.42	$9,807.76	nat. median $9,808 1.0× median
3160036 OTHER	Arthrodesis Midtarsal T	13	$900.00	$15,223.00	$9,737.93	nat. median $9,271 1.1× median
3160913 OTHER	Arthrodesis	13	$725.00	$15,223.00	$9,587.80	nat. median $9,271 1.0× median
3161028 OTHER	Arthrodesis, Ankle, Open	13	$725.00	$26,400.00	$9,293.53	nat. median $9,294 1.0× median
3162075 OTHER	Arthroplasty, Prosthetic Replace Rt	13	$2,023.78	$30,160.00	$9,238.05	nat. median $9,238 1.0× median
3160987 OTHER	Open Trmt Humeral Fx W/internal Fixation	13	$725.00	$26,722.40	$8,862.74	nat. median $8,863 1.0× median
3160986 OTHER	Open Trmt Humeral Fx W/internal Fixation	13	$725.00	$26,722.40	$8,862.74	nat. median $8,863 1.0× median
3160998 OTHER	Open Trmt Tibia Orif	13	$675.00	$26,400.00	$8,750.14	nat. median $8,750 1.0× median
3161026 OTHER	Application Unilaterl External Fixation	13	$675.00	$26,400.00	$8,186.63	nat. median $8,187 1.0× median
2100149 OTHER	Insertion Transvenous Pac	13	$900.00	$16,038.40	$8,094.61	nat. median $8,095 1.0× median
3160968 OTHER	Cystorrhaphy	13	$1,132.00	$11,497.00	$7,889.54	nat. median $830 outlier · 9.5×
3161042 OTHER	Insertion Permanent Pacemaker	13	$900.00	$26,083.20	$7,632.78	nat. median $7,633 1.0× median
3500041 OTHER	Alteplase 100mg/100 Ml Inj (activase)	13	$88.97	$17,224.80	$7,535.85	nat. median $1,925 outlier · 3.9×
3162001 OTHER	Removal Permanent Pacemaker Pulse Genera	13	$1,475.00	$20,240.00	$7,459.91	nat. median $7,460 1.0× median
3160543 OTHER	Open Trmt Femoral Fx W/fi	13	$1,835.67	$20,896.00	$7,313.60	nat. median $9,142 0.8× median
3160560 OTHER	Paravaginal Defect Repair	13	$2,076.00	$11,519.68	$7,199.80	nat. median $7,200 1.0× median
3161087 OTHER	Insertion Cardiac Rhythm Monitor	13	$1,475.00	$20,240.00	$6,898.31	nat. median $6,898 1.0× median
3160624 OTHER	Repair Ext Tendon Foot	13	$675.00	$12,178.40	$6,816.33	nat. median $6,816 1.0× median
3160028 OTHER	Appendectomy	13	$1,588.00	$9,004.00	$6,343.32	nat. median $5,483 1.2× median
3160465 OTHER	**laparoscopy Hernia Repair	13	$1,100.00	$17,262.40	$6,041.84	nat. median $6,042 1.0× median
3160481 OTHER	**laparoscopy Incisional H	13	$1,100.00	$17,262.40	$6,041.84	nat. median $6,042 1.0× median
3160461 OTHER	**laparoscopic Hernia Repai	13	$1,100.00	$17,262.40	$6,041.84	nat. median $6,042 1.0× median
3161124 OTHER	Insertion Pacemaker/defibrillator	13	$900.00	$19,560.00	$5,640.16	nat. median $5,640 1.0× median
3160544 OTHER	Open Trmt Fx Orbit Blowou	13	$2,076.00	$12,344.80	$5,579.71	nat. median $5,580 1.0× median
3161134 OTHER	Removal Permanent Pacemaker	13	$400.00	$19,600.00	$5,576.69	nat. median $5,577 1.0× median
3161102 OTHER	Excision Rectal Tumor Transanal Endoscop	13	$196.00	$12,628.00	$5,524.75	nat. median $5,525 1.0× median
3160486 OTHER	Laparoscopy Unlisted	13	$400.00	$9,504.00	$5,497.59	nat. median $5,498 1.0× median
3160462 OTHER	Laparoscopic Procedure L	13	$400.00	$8,796.14	$5,497.59	nat. median $5,359 1.0× median
3160484 OTHER	Laparoscopy Spermatic Co	13	$400.00	$8,796.14	$5,497.59	nat. median $5,359 1.0× median
3160733 OTHER	Unlisted Lap Proc Biliar	13	$400.00	$8,796.14	$5,497.59	nat. median $5,358 1.0× median
3160480 OTHER	Laparoscopy Enterolysis	13	$2,479.00	$8,820.00	$5,497.59	nat. median $5,498 1.0× median
3160485 OTHER	Laparoscopy Surgical ENT	13	$2,479.00	$8,820.00	$5,497.59	nat. median $5,498 1.0× median
3160906 OTHER	Laparoscopy W/transhepati	13	$400.00	$8,796.14	$5,497.59	nat. median $5,486 1.0× median
3160482 OTHER	Laparoscopy Jejunostomy	13	$2,479.00	$8,820.00	$5,497.59	nat. median $5,498 1.0× median
3160476 OTHER	Laparoscopy Appendectomy	13	$2,479.00	$8,796.14	$5,497.59	nat. median $5,498 1.0× median
3160467 OTHER	Laparoscopy Procedure	13	$400.00	$8,796.14	$5,497.59	nat. median $5,359 1.0× median
3160381 OTHER	Inc Implant Of Neurostimu	13	$400.00	$12,344.80	$5,356.46	nat. median $5,356 1.0× median

Other procedures at this hospital

Browse this hospital's 4,542 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

3160433	OTHER	Insert/replace Ns Generat	24	13	$89,255.00	$89,255.00	$500.00	$71,404.00	$25,273.98	2026-05-18
3161176	OTHER	Removal Implant Defibrillator Pulse Gene	24	13	$100,641.00	$100,641.00	$1,475.00	$80,512.80	$25,004.78	2026-05-18
3161110	OTHER	Cardioverter-defibrillator Lead Placemen	24	13	$105,600.00	$105,600.00	$675.00	$84,480.00	$24,821.79	2026-05-18
3162007	OTHER	Insertion Penile Prosthesis	24	13	$57,885.00	$57,885.00	$7,095.00	$46,308.00	$20,259.75	2026-05-18
3162054	OTHER	Remove/replace Penile Prosthesis	24	13	$57,700.00	$57,700.00	$7,095.00	$46,160.00	$20,195.00	2026-05-18
3161082	OTHER	Removal Implantable Defibrillator Pulse	24	13	$24,984.00	$24,984.00	$1,475.00	$24,984.00	$19,112.53	2026-05-18
3160432	OTHER	Insert/replace Neurostimu	24	13	$49,899.00	$49,899.00	$500.00	$39,919.20	$18,989.47	2026-05-18
3162009	OTHER	Insertion Urethra/bladder Neck Sphincter	24	13	$57,850.00	$57,850.00	$1,475.00	$46,280.00	$16,731.14	2026-05-18
3162011	OTHER	Arthroscopy Total Knee	24	13	$40,000.00	$40,000.00	$5,506.00	$32,000.00	$14,000.00	2026-05-18
3162041	OTHER	Arthroplasty Total Shoulder Rt	24	13	$53,275.00	$53,275.00	$2,171.06	$42,620.00	$13,992.24	2026-05-18
3162040	OTHER	Arthroplasty Total Shoulder Lt	24	13	$53,275.00	$53,275.00	$2,171.06	$42,620.00	$13,992.24	2026-05-18
3161139	OTHER	Removal Perm Pacemaker Pulse Generator	24	13	$55,833.00	$55,833.00	$1,475.00	$44,666.40	$12,857.15	2026-05-18
3161196	OTHER	Open Implant Ns Electrode Peripheral Ner	24	13	$35,860.00	$35,860.00	$1,475.00	$29,390.22	$11,344.43	2026-05-18
3160464	OTHER	Laparoscopy Esphagogastri	24	13	$15,982.00	$15,982.00	$2,479.00	$15,692.42	$9,807.76	2026-05-18
3160036	OTHER	Arthrodesis Midtarsal T	24	13	$15,223.00	$15,223.00	$900.00	$15,223.00	$9,737.93	2026-05-18
3160913	OTHER	Arthrodesis	24	13	$15,223.00	$15,223.00	$725.00	$15,223.00	$9,587.80	2026-05-18
3161028	OTHER	Arthrodesis, Ankle, Open	24	13	$33,000.00	$33,000.00	$725.00	$26,400.00	$9,293.53	2026-05-18
3162075	OTHER	Arthroplasty, Prosthetic Replace Rt	24	13	$37,700.00	$37,700.00	$2,023.78	$30,160.00	$9,238.05	2026-05-18
3160987	OTHER	Open Trmt Humeral Fx W/internal Fixation	24	13	$33,403.00	$33,403.00	$725.00	$26,722.40	$8,862.74	2026-05-18
3160986	OTHER	Open Trmt Humeral Fx W/internal Fixation	24	13	$33,403.00	$33,403.00	$725.00	$26,722.40	$8,862.74	2026-05-18
3160998	OTHER	Open Trmt Tibia Orif	24	13	$33,000.00	$33,000.00	$675.00	$26,400.00	$8,750.14	2026-05-18
3161026	OTHER	Application Unilaterl External Fixation	24	13	$33,000.00	$33,000.00	$675.00	$26,400.00	$8,186.63	2026-05-18
2100149	OTHER	Insertion Transvenous Pac	24	13	$20,048.00	$20,048.00	$900.00	$16,038.40	$8,094.61	2026-05-18
3160968	OTHER	Cystorrhaphy	24	13	$11,497.00	$11,497.00	$1,132.00	$11,497.00	$7,889.54	2026-05-18
3161042	OTHER	Insertion Permanent Pacemaker	24	13	$32,604.00	$32,604.00	$900.00	$26,083.20	$7,632.78	2026-05-18
3500041	OTHER	Alteplase 100mg/100 Ml Inj (activase)	24	13	$21,531.00	$21,531.00	$88.97	$17,224.80	$7,535.85	2026-05-18
3162001	OTHER	Removal Permanent Pacemaker Pulse Genera	24	13	$25,300.00	$25,300.00	$1,475.00	$20,240.00	$7,459.91	2026-05-18
3160543	OTHER	Open Trmt Femoral Fx W/fi	24	13	$26,120.00	$26,120.00	$1,835.67	$20,896.00	$7,313.60	2026-05-18
3160560	OTHER	Paravaginal Defect Repair	24	13	$11,606.00	$11,606.00	$2,076.00	$11,519.68	$7,199.80	2026-05-18
3161087	OTHER	Insertion Cardiac Rhythm Monitor	24	13	$25,300.00	$25,300.00	$1,475.00	$20,240.00	$6,898.31	2026-05-18
3160624	OTHER	Repair Ext Tendon Foot	24	13	$15,223.00	$15,223.00	$675.00	$12,178.40	$6,816.33	2026-05-18
3160028	OTHER	Appendectomy	24	13	$9,004.00	$9,004.00	$1,588.00	$9,004.00	$6,343.32	2026-05-18
3160461	OTHER	**laparoscopic Hernia Repai	24	13	$21,578.00	$21,578.00	$1,100.00	$17,262.40	$6,041.84	2026-05-18
3160465	OTHER	**laparoscopy Hernia Repair	24	13	$21,578.00	$21,578.00	$1,100.00	$17,262.40	$6,041.84	2026-05-18
3160481	OTHER	**laparoscopy Incisional H	24	13	$21,578.00	$21,578.00	$1,100.00	$17,262.40	$6,041.84	2026-05-18
3161124	OTHER	Insertion Pacemaker/defibrillator	24	13	$24,450.00	$24,450.00	$900.00	$19,560.00	$5,640.16	2026-05-18
3160544	OTHER	Open Trmt Fx Orbit Blowou	24	13	$15,431.00	$15,431.00	$2,076.00	$12,344.80	$5,579.71	2026-05-18
3161134	OTHER	Removal Permanent Pacemaker	24	13	$24,500.00	$24,500.00	$400.00	$19,600.00	$5,576.69	2026-05-18
3161102	OTHER	Excision Rectal Tumor Transanal Endoscop	24	13	$15,785.00	$15,785.00	$196.00	$12,628.00	$5,524.75	2026-05-18
3160733	OTHER	Unlisted Lap Proc Biliar	24	13	$8,798.00	$8,798.00	$400.00	$8,796.14	$5,497.59	2026-05-18
3160467	OTHER	Laparoscopy Procedure	24	13	$8,800.00	$8,800.00	$400.00	$8,796.14	$5,497.59	2026-05-18
3160906	OTHER	Laparoscopy W/transhepati	24	13	$9,009.00	$9,009.00	$400.00	$8,796.14	$5,497.59	2026-05-18
3160480	OTHER	Laparoscopy Enterolysis	24	13	$11,025.00	$11,025.00	$2,479.00	$8,820.00	$5,497.59	2026-05-18
3160482	OTHER	Laparoscopy Jejunostomy	24	13	$11,025.00	$11,025.00	$2,479.00	$8,820.00	$5,497.59	2026-05-18
3160476	OTHER	Laparoscopy Appendectomy	24	13	$10,749.00	$10,749.00	$2,479.00	$8,796.14	$5,497.59	2026-05-18
3160486	OTHER	Laparoscopy Unlisted	24	13	$11,880.00	$11,880.00	$400.00	$9,504.00	$5,497.59	2026-05-18
3160484	OTHER	Laparoscopy Spermatic Co	24	13	$8,800.00	$8,800.00	$400.00	$8,796.14	$5,497.59	2026-05-18
3160485	OTHER	Laparoscopy Surgical ENT	24	13	$11,025.00	$11,025.00	$2,479.00	$8,820.00	$5,497.59	2026-05-18
3160462	OTHER	Laparoscopic Procedure L	24	13	$8,800.00	$8,800.00	$400.00	$8,796.14	$5,497.59	2026-05-18
3160381	OTHER	Inc Implant Of Neurostimu	24	13	$15,431.00	$15,431.00	$400.00	$12,344.80	$5,356.46	2026-05-18
3161108	OTHER	Insertion Vena Cava Filter	24	13	$15,180.00	$15,180.00	$2,479.00	$12,144.00	$5,313.00	2026-05-18
3162094	OTHER	Cystourethroscopy W/dilation	24	13	$14,800.00	$14,800.00	$2,471.16	$11,840.00	$5,180.00	2026-05-18
3161033	OTHER	Bone Graft, Any Area	24	13	$18,810.00	$18,810.00	$675.00	$15,048.00	$5,077.91	2026-05-18
3160380	OTHER	Implant Neurostimulator E	24	13	$15,431.00	$15,431.00	$675.00	$12,344.80	$5,037.27	2026-05-18
3160568	OTHER	Percutaneous Implant Ns E	24	13	$18,959.00	$18,959.00	$500.00	$15,167.20	$4,948.60	2026-05-18
3160359	OTHER	Hallux Valgus Correction	24	13	$10,540.00	$10,540.00	$675.00	$8,970.27	$4,899.62	2026-05-18
3162042	OTHER	Resection Biceps Tendon Lt	24	13	$20,450.00	$20,450.00	$725.00	$16,360.00	$4,872.64	2026-05-18
3162043	OTHER	Resection Biceps Tendon Rt	24	13	$20,450.00	$20,450.00	$725.00	$16,360.00	$4,872.64	2026-05-18
3160984	OTHER	Revision Neurostimulator Electrode	24	13	$19,984.00	$19,984.00	$900.00	$15,987.20	$4,861.09	2026-05-18
8182459	OTHER	Fx Care Forearm/wrist Int. Fix 3 Or More	24	13	$4,840.00	$4,840.00	$900.00	$4,840.00	$4,840.00	2026-05-18
3160478	OTHER	Laparoscopy Colectomy With	24	13	$17,042.00	$17,042.00	$385.00	$13,633.60	$4,771.76	2026-05-18
3500822	OTHER	Tenecteplase 50mg Vial	24	13	$13,552.25	$13,552.25	$153.11	$10,841.80	$4,743.29	2026-05-18
3161062	OTHER	Ovarian Cystectomy Uni Or Bil	24	13	$13,200.00	$13,200.00	$1,588.00	$10,560.00	$4,739.10	2026-05-18
3160561	OTHER	Paravaginal Defect Repair	24	13	$11,606.00	$11,606.00	$2,076.00	$9,284.80	$4,739.10	2026-05-18
3161059	OTHER	Endometrial Ablation, Thermal Wo Hystero	24	13	$13,200.00	$13,200.00	$400.00	$10,560.00	$4,739.10	2026-05-18
3161155	OTHER	Exc Cervical Stump Vag Approach	24	13	$13,510.00	$13,510.00	$1,588.00	$10,808.00	$4,739.10	2026-05-18
3160299	OTHER	Exc/curettage Bone Cyst W	24	13	$15,224.00	$15,224.00	$675.00	$12,179.20	$4,654.04	2026-05-18
3160358	OTHER	Hallux Valgus Correction	24	13	$10,540.00	$10,540.00	$1,475.00	$8,970.27	$4,644.95	2026-05-18
3161075	OTHER	Application Unilateral External Fixation	24	13	$19,250.00	$19,250.00	$500.00	$15,400.00	$4,633.03	2026-05-18
3160997	OTHER	Open Trmt Distal Radius Orif	24	13	$17,600.00	$17,600.00	$900.00	$14,080.00	$4,597.82	2026-05-18
3161034	OTHER	Repair Of Fibula Nonunion	24	13	$18,810.00	$18,810.00	$1,475.00	$15,048.00	$4,574.26	2026-05-18
3160338	OTHER	Fx Care Distal Radius Ope	24	13	$16,246.00	$16,246.00	$900.00	$12,996.80	$4,549.27	2026-05-18
3162021	OTHER	Percutaneous Nephro/pyelo Lt	24	13	$25,675.00	$25,675.00	$1,475.00	$20,540.00	$4,545.51	2026-05-18
3162023	OTHER	Percutaneous Nephro/pyelo Rt	24	13	$25,675.00	$25,675.00	$1,475.00	$20,540.00	$4,545.51	2026-05-18
3162022	OTHER	Percutaneous Nephro/pyelo Rt	24	13	$25,675.00	$25,675.00	$1,475.00	$20,540.00	$4,545.51	2026-05-18
3160475	OTHER	Laparoscopy W/tah Uterus>	24	13	$11,025.00	$11,025.00	$1,475.00	$11,025.00	$4,540.64	2026-05-18
3160951	OTHER	Laparoscopy W/vag Hystere	24	13	$22,990.00	$22,990.00	$1,475.00	$18,392.00	$4,540.64	2026-05-18
3160469	OTHER	Laparoscopy Supracervical	24	13	$15,983.00	$15,983.00	$1,475.00	$12,786.40	$4,540.64	2026-05-18
3160048	OTHER	Biliary Endoscopy W/stone	24	13	$5,349.00	$5,349.00	$675.00	$5,349.00	$4,540.64	2026-05-18
3160468	OTHER	Laparoscopy Supracervical	24	13	$15,982.00	$15,982.00	$1,475.00	$12,785.60	$4,540.64	2026-05-18
3160948	OTHER	Laparoscopy W Vag Hystere	24	13	$22,990.00	$22,990.00	$1,475.00	$18,392.00	$4,540.64	2026-05-18
3160460	OTHER	Laparoscopic Cholecystect	24	13	$11,025.00	$11,025.00	$1,100.00	$8,820.00	$4,540.64	2026-05-18
3161035	OTHER	Repair Of Radius/ulna Nonunion	24	13	$18,810.00	$18,810.00	$675.00	$15,048.00	$4,521.74	2026-05-18
3500261	OTHER	Digoxin Immune Fab 40mg Vial (digifab)	24	13	$8,520.25	$8,520.25	$2,982.09	$6,816.20	$4,518.78	2026-05-18
3161095	OTHER	Arthroscopicall Aided Anterior Cruciate	24	13	$19,800.00	$19,800.00	$675.00	$15,840.00	$4,497.04	2026-05-18
3161022	OTHER	Open Trmt Calcaneal Fx	24	13	$18,810.00	$18,810.00	$675.00	$15,048.00	$4,477.16	2026-05-18
3160466	OTHER	**laparoscopy Inc Hernia St	24	13	$15,983.00	$15,983.00	$1,100.00	$12,786.40	$4,475.24	2026-05-18
3160622	OTHER	Repair Disrupted Ligament	24	13	$7,590.00	$7,590.00	$500.00	$7,590.00	$4,438.84	2026-05-18
3161136	OTHER	Open Trmt Metatarsal Fx With Int Fixatio	24	13	$18,800.00	$18,800.00	$725.00	$15,040.00	$4,384.04	2026-05-18
10136882	OTHER	Open Trmt Metatarsal Fx With Int Fixatio	24	13	$18,800.00	$18,800.00	$725.00	$15,040.00	$4,384.04	2026-05-18
3160549	OTHER	Orif Tib/fib/patella	24	13	$12,332.00	$12,332.00	$675.00	$9,865.60	$4,382.90	2026-05-18
3160337	OTHER	Fx Care Distal Fib W/without	24	13	$12,332.00	$12,332.00	$675.00	$9,865.60	$4,343.72	2026-05-18
3160353	OTHER	Hallux Valgus By Dbl Oste	24	13	$7,808.00	$7,808.00	$900.00	$6,930.43	$4,331.52	2026-05-18
3161020	OTHER	Open Tmt Ulnar Fx	24	13	$18,810.00	$18,810.00	$675.00	$15,048.00	$4,319.88	2026-05-18
3508465	OTHER	Oritavancin 1200mg Vial (kimyrsa)	24	13	$12,307.00	$12,307.00	$40.92	$9,845.60	$4,307.45	2026-05-18
3160354	OTHER	Hallux Valgus Correct (ak	24	13	$7,808.00	$7,808.00	$675.00	$7,808.00	$4,292.62	2026-05-18
3161005	OTHER	Open Tmt Humeral Fx	24	13	$16,500.00	$16,500.00	$900.00	$13,200.00	$4,247.76	2026-05-18
3161096	OTHER	Open Trmt Greater Humeral Tuberosity Fx	24	13	$19,800.00	$19,800.00	$900.00	$15,840.00	$4,247.76	2026-05-18
2100094	OTHER	Fx Care Distal Fibula W/w	24	13	$4,224.00	$4,224.00	$675.00	$4,224.00	$4,224.00	2026-05-18
3160555	OTHER	Osteotomy Proximal Phala	24	13	$5,086.00	$5,086.00	$675.00	$5,086.00	$4,150.59	2026-05-18
3160515	OTHER	Mastectomy Modified Radi	24	13	$12,104.00	$12,104.00	$2,076.00	$9,683.20	$4,146.98	2026-05-18
3161031	OTHER	Chromotubation Of Oviduct	24	13	$13,640.00	$13,640.00	$1,588.00	$10,912.00	$4,095.45	2026-05-18
3160137	OTHER	Colpopexy Vaginal	24	13	$11,606.00	$11,606.00	$2,076.00	$10,059.78	$4,062.10	2026-05-18
3161038	OTHER	Cath Plmt With Left Heart Catheterization	24	13	$12,375.00	$12,375.00	$2,076.00	$9,900.00	$4,051.58	2026-05-18
3161109	OTHER	Left Heart Catheterization	24	13	$12,375.00	$12,375.00	$2,076.00	$9,900.00	$4,051.58	2026-05-18
3160694	OTHER	Tah With Bil Salpingo-oopho	24	13	$14,080.00	$14,080.00	$1,496.13	$11,264.00	$3,942.40	2026-05-18
3160176	OTHER	Discography Cerv/thor Sup	24	13	$10,992.00	$10,992.00	$1,839.63	$8,793.60	$3,847.20	2026-05-18
3160702	OTHER	Thyroidectomy Removal Th	24	13	$10,880.00	$10,880.00	$2,076.00	$8,704.00	$3,808.00	2026-05-18
3980306	OTHER	Xr Angiography Extremity Unilateral	24	13	$6,622.00	$6,622.00	$125.00	$6,622.00	$3,753.50	2026-05-18
3988000	OTHER	Aortography Abdominal By Serialography	24	13	$12,040.00	$12,040.00	$125.00	$9,632.00	$3,753.50	2026-05-18
3500688	OTHER	Phentolamine 5mg/2ml Vial (regitine)	24	13	$10,710.00	$10,710.00	$446.80	$8,568.00	$3,748.50	2026-05-18
3161126	OTHER	Endoscopy Small Intestine	24	13	$4,875.00	$4,875.00	$1,588.00	$4,875.00	$3,741.62	2026-05-18
3161125	OTHER	Removal Electrode By Transvenous Extract	24	13	$10,320.00	$10,320.00	$1,588.00	$8,256.00	$3,741.62	2026-05-18
3160634	OTHER	Repair Recurrent Ing Hern	24	13	$8,824.00	$8,824.00	$900.00	$7,059.20	$3,722.39	2026-05-18
3161181	OTHER	Repair Of Anterior Abdominal Hernia	24	13	$10,625.00	$10,625.00	$1,621.81	$8,500.00	$3,718.75	2026-05-18
3162004	OTHER	Repair Anterior Abdominal Hernia Reducib	24	13	$10,500.00	$10,500.00	$1,621.81	$8,400.00	$3,675.00	2026-05-18
3161032	OTHER	Laparoscopy Surgical Sling	24	13	$15,180.00	$15,180.00	$900.00	$12,144.00	$3,664.88	2026-05-18
3160095	OTHER	Cholangiopancreatography	24	13	$6,442.00	$6,442.00	$500.00	$5,838.34	$3,648.96	2026-05-18
3160976	OTHER	Destruction Nerve Lumbar	24	13	$10,316.00	$10,316.00	$196.00	$8,252.80	$3,610.60	2026-05-18
3200035	OTHER	Skin Sub Graft T/arm/leg Child	24	13	$8,945.00	$8,945.00	$1,475.00	$7,156.00	$3,418.26	2026-05-18
3161178	OTHER	Repair Anterior Abdominal Hernia	24	13	$9,750.00	$9,750.00	$1,621.81	$7,800.00	$3,412.50	2026-05-18
3161188	OTHER	Lithotripsy, Rt	24	13	$9,700.00	$9,700.00	$2,716.00	$7,760.00	$3,395.00	2026-05-18
3161187	OTHER	Lithotripsy, Lt	24	13	$9,700.00	$9,700.00	$2,716.00	$7,760.00	$3,395.00	2026-05-18
3161175	OTHER	Arthrodesis Great Toe	24	13	$19,200.00	$19,200.00	$725.00	$15,360.00	$3,392.92	2026-05-18
3162032	OTHER	Repair Tendon Muscle Humerus/elbow	24	13	$19,842.00	$19,842.00	$675.00	$15,873.60	$3,392.92	2026-05-18
3161132	OTHER	Arthroscopy Shoulder, Biceps Tenodesis	24	13	$18,800.00	$18,800.00	$1,475.00	$15,040.00	$3,392.92	2026-05-18
3160955	OTHER	Repair Ruptured Cuff	24	13	$17,232.00	$17,232.00	$900.00	$13,785.60	$3,392.92	2026-05-18
3161003	OTHER	Open Trmt Shoulder Dislocation	24	13	$18,480.00	$18,480.00	$675.00	$14,784.00	$3,392.92	2026-05-18
3161079	OTHER	Open Tmt Proximal Fibula W Int Fixation	24	13	$19,690.00	$19,690.00	$675.00	$15,752.00	$3,392.92	2026-05-18
3161078	OTHER	Open Tmt Malleolus Fx W Int Fixation	24	13	$19,690.00	$19,690.00	$675.00	$15,752.00	$3,392.92	2026-05-18
3160637	OTHER	Repair Ruptured Tendon	24	13	$10,989.00	$10,989.00	$675.00	$8,791.20	$3,392.92	2026-05-18
3161048	OTHER	Open Trmt Patellar Fx W Int Fixation	24	13	$18,700.00	$18,700.00	$675.00	$14,960.00	$3,392.92	2026-05-18
3160450	OTHER	Kidner Procedure	24	13	$15,224.00	$15,224.00	$675.00	$12,179.20	$3,392.92	2026-05-18
3161046	OTHER	Arthroscopy Shoulder With Rotator Cuff	24	13	$18,810.00	$18,810.00	$675.00	$15,048.00	$3,392.92	2026-05-18
3161165	OTHER	Arthroscopy Shoulder Rpr Slap Lesion Rt	24	13	$19,200.00	$19,200.00	$675.00	$15,360.00	$3,392.92	2026-05-18
3160934	OTHER	Arthrodesis Elbow Joint	24	13	$12,408.00	$12,408.00	$725.00	$9,926.40	$3,392.92	2026-05-18
3160631	OTHER	Repair Musculotendinous C	24	13	$10,976.00	$10,976.00	$1,300.00	$8,970.27	$3,392.92	2026-05-18
3160584	OTHER	Reconstruction Rotator Cu	24	13	$10,976.00	$10,976.00	$1,300.00	$8,970.27	$3,392.92	2026-05-18
3161163	OTHER	Grafting Autologous Soft Tissue	24	13	$10,790.00	$10,790.00	$1,588.00	$8,632.00	$3,377.07	2026-05-18
3161041	OTHER	Cath Plmt With Rt&lt Heart Catheterization	24	13	$12,375.00	$12,375.00	$1,632.45	$9,900.00	$3,331.75	2026-05-18
3161039	OTHER	Cath Plmt With Right Heart Catheterization	24	13	$12,375.00	$12,375.00	$1,632.45	$9,900.00	$3,331.75	2026-05-18
3160989	OTHER	Colpopexy Abdominal	24	13	$11,606.00	$11,606.00	$1,132.00	$9,284.80	$3,249.68	2026-05-18
3161090	OTHER	Catheter Placement For Coronary Angiogra	24	13	$9,147.00	$9,147.00	$1,588.00	$7,317.60	$3,201.45	2026-05-18
3161151	OTHER	Left Heart Cath W/intraprocedural Inject	24	13	$8,900.00	$8,900.00	$2,076.00	$7,120.00	$3,115.00	2026-05-18
3160017	OTHER	Amputation Through Foot	24	13	$4,950.00	$4,950.00	$1,132.00	$4,934.45	$3,084.03	2026-05-18
2100205	OTHER	Repair Extensor Tendon Fo	24	13	$5,340.00	$5,340.00	$675.00	$4,272.00	$3,084.03	2026-05-18
3161061	OTHER	Percutaneous Fixation Phalangeal Fractur	24	13	$8,657.00	$8,657.00	$425.00	$6,925.60	$3,084.03	2026-05-18
8182461	OTHER	Fx-care Medial Malleolus Fx, W/int. Fixa	24	13	$3,080.00	$3,080.00	$675.00	$3,080.00	$3,080.00	2026-05-18
3160779	OTHER	Tracheostomy Planned	24	13	$5,676.00	$5,676.00	$1,132.00	$4,908.19	$3,067.62	2026-05-18
2100303	OTHER	Closed Tx Nasal Fx	24	13	$7,508.00	$7,508.00	$500.00	$6,006.40	$3,067.62	2026-05-18
8182477	OTHER	Pf- Amputation, Any Finger/thumb, Single	24	13	$3,058.00	$3,058.00	$500.00	$3,058.00	$3,058.00	2026-05-18
3162090	OTHER	Cystourethroscopy W/turp/inc Ejac Ducts	24	13	$10,000.00	$10,000.00	$1,132.00	$8,000.00	$3,050.89	2026-05-18
3161056	OTHER	Nonselective Catheter Placement Thoracic	24	13	$8,690.00	$8,690.00	$425.00	$6,952.00	$3,041.50	2026-05-18
2100375	OTHER	Insertion Cvp	24	13	$7,745.00	$7,745.00	$675.00	$6,196.00	$3,037.01	2026-05-18
3160319	OTHER	Exploration Postop Hemorr	24	13	$7,293.00	$7,293.00	$1,588.00	$5,834.40	$3,037.01	2026-05-18
3160508	OTHER	Ligation Of Vein Upper L	24	13	$7,293.00	$7,293.00	$1,588.00	$5,834.40	$3,037.01	2026-05-18
3162000	OTHER	Selective Cath Placement	24	13	$3,300.00	$3,300.00	$1,155.00	$3,300.00	$3,037.01	2026-05-18
2100399	OTHER	Ligation Varicose Vein	24	13	$8,400.00	$8,400.00	$675.00	$6,720.00	$3,037.01	2026-05-18
2100260	OTHER	Vaginal Delivery	24	13	$6,393.00	$6,393.00	$2,237.55	$5,114.40	$2,978.77	2026-05-18
2100318	OTHER	Treatment Incomplete Abortion	24	13	$8,085.00	$8,085.00	$500.00	$6,468.00	$2,978.77	2026-05-18
3161055	OTHER	Hysteroscopy Surgical W/removal Of Fb	24	13	$7,791.00	$7,791.00	$400.00	$6,232.80	$2,978.77	2026-05-18
3161094	OTHER	Catheter Placement For Coronary Angiogra	24	13	$9,460.00	$9,460.00	$1,632.45	$7,568.00	$2,961.46	2026-05-18
3161091	OTHER	Catheter Placement Coronary Angio	24	13	$9,405.00	$9,405.00	$1,632.45	$7,524.00	$2,951.84	2026-05-18
3161182	OTHER	Insertion Tunneled Central Cvp	24	13	$15,419.00	$15,419.00	$675.00	$12,335.20	$2,903.10	2026-05-18
3160683	OTHER	Stapedectomy/stapedotomy	24	13	$10,890.00	$10,890.00	$900.00	$8,712.00	$2,760.82	2026-05-18
3160885	OTHER	Rpr Fistula Oromaxillary	24	13	$10,880.00	$10,880.00	$725.00	$8,704.00	$2,760.82	2026-05-18
3160645	OTHER	Revision Mastoidectomy	24	13	$10,890.00	$10,890.00	$1,300.00	$8,712.00	$2,760.82	2026-05-18
3160648	OTHER	Revision Stapedectomy	24	13	$15,431.00	$15,431.00	$900.00	$12,344.80	$2,760.82	2026-05-18
3160646	OTHER	Revision Mastoidectomy	24	13	$10,890.00	$10,890.00	$1,300.00	$8,712.00	$2,760.82	2026-05-18
3160520	OTHER	Mastoidectomy Radical	24	13	$10,890.00	$10,890.00	$1,300.00	$8,712.00	$2,760.82	2026-05-18
3160675	OTHER	Sinusotomy Maxillary Ra	24	13	$10,890.00	$10,890.00	$675.00	$8,712.00	$2,760.82	2026-05-18
3160674	OTHER	Sinusotomy Maxillary Ra	24	13	$10,890.00	$10,890.00	$725.00	$8,712.00	$2,760.82	2026-05-18
3160519	OTHER	Mastoidectomy Modified Ra	24	13	$10,890.00	$10,890.00	$1,300.00	$8,712.00	$2,760.82	2026-05-18
3160282	OTHER	Exc Sublingual Gland	24	13	$10,880.00	$10,880.00	$500.00	$8,704.00	$2,760.82	2026-05-18
3160583	OTHER	Reconstruction Ext Audito	24	13	$10,890.00	$10,890.00	$675.00	$8,712.00	$2,760.82	2026-05-18
3160284	OTHER	Exc Submandibular/maxilla	24	13	$10,890.00	$10,890.00	$675.00	$8,712.00	$2,760.82	2026-05-18
3160202	OTHER	Ethmoidectomy Intranasal	24	13	$10,890.00	$10,890.00	$500.00	$8,712.00	$2,760.82	2026-05-18
3160722	OTHER	Tympanoplasty W/mastoidec	24	13	$10,890.00	$10,890.00	$1,300.00	$8,712.00	$2,760.82	2026-05-18
3160724	OTHER	Tympanoplasty W/ossicular	24	13	$15,431.00	$15,431.00	$1,300.00	$12,344.80	$2,760.82	2026-05-18
3160723	OTHER	Tympanoplasty Without Mastoid	24	13	$10,890.00	$10,890.00	$900.00	$8,712.00	$2,760.82	2026-05-18
3160710	OTHER	Transmastoid Antrotomy	24	13	$10,890.00	$10,890.00	$1,300.00	$8,712.00	$2,760.82	2026-05-18
3160720	OTHER	Tympanoplasty W/antrotomy	24	13	$10,890.00	$10,890.00	$1,300.00	$8,712.00	$2,760.82	2026-05-18
3160721	OTHER	Tympanoplasty W/mastoidec	24	13	$10,890.00	$10,890.00	$1,300.00	$8,712.00	$2,760.82	2026-05-18
3160223	OTHER	Exc External Ear Complet	24	13	$5,676.00	$5,676.00	$500.00	$5,676.00	$2,760.82	2026-05-18
3160692	OTHER	T & A Under Age 12	24	13	$7,666.00	$7,666.00	$500.00	$6,942.06	$2,760.82	2026-05-18
3160704	OTHER	Tonsillectomy Under Age 1	24	13	$12,302.00	$12,302.00	$500.00	$9,841.60	$2,760.82	2026-05-18
3160676	OTHER	Sling Operation/stress In	24	13	$11,606.00	$11,606.00	$1,475.00	$9,284.80	$2,750.64	2026-05-18
3160729	OTHER	**umbilical Hernia Repair	24	13	$9,726.00	$9,726.00	$725.00	$7,780.80	$2,723.28	2026-05-18
3160483	OTHER	Laparoscopy Repair Ing H	24	13	$11,025.00	$11,025.00	$725.00	$8,820.00	$2,705.46	2026-05-18
3160285	OTHER	Exc Thyroglossal Duct Cys	24	13	$12,365.00	$12,365.00	$725.00	$9,892.00	$2,705.46	2026-05-18
3160705	OTHER	Total Thyroid Lobectomy	24	13	$12,365.00	$12,365.00	$500.00	$9,892.00	$2,705.46	2026-05-18
3160474	OTHER	Laparoscopy W/remov Tubes	24	13	$11,025.00	$11,025.00	$900.00	$8,820.00	$2,705.46	2026-05-18
3160456	OTHER	Lap Cholecystectomy W/cho	24	13	$15,166.00	$15,166.00	$1,100.00	$12,132.80	$2,705.46	2026-05-18
3160487	OTHER	Laparoscopy W/fulguratio	24	13	$27,918.00	$27,918.00	$725.00	$22,334.40	$2,705.46	2026-05-18
3160459	OTHER	Laparoscopic Cholecystect	24	13	$12,800.00	$12,800.00	$1,100.00	$10,240.00	$2,705.46	2026-05-18
3160471	OTHER	Laparoscopy W/biopsy Lymp	24	13	$12,467.00	$12,467.00	$725.00	$9,973.60	$2,705.46	2026-05-18
3160472	OTHER	Laparoscopy W/fulguration	24	13	$11,025.00	$11,025.00	$900.00	$8,820.00	$2,705.46	2026-05-18
3160458	OTHER	Lap Repair Rec Inguinal	24	13	$11,025.00	$11,025.00	$1,300.00	$8,820.00	$2,705.46	2026-05-18
3160473	OTHER	Laparoscopy W/lysis Adhes	24	13	$11,025.00	$11,025.00	$900.00	$8,820.00	$2,705.46	2026-05-18
3160047	OTHER	Axillary Lymphadenectomy	24	13	$12,365.00	$12,365.00	$500.00	$9,892.00	$2,705.46	2026-05-18
3160942	OTHER	Exc Urachal Cyst	24	13	$11,914.00	$11,914.00	$725.00	$9,531.20	$2,705.46	2026-05-18
3160463	OTHER	Laparoscopy	24	13	$11,880.00	$11,880.00	$675.00	$9,504.00	$2,705.46	2026-05-18
3160457	OTHER	Lap Rpr Ing (bilateral)	24	13	$16,539.00	$16,539.00	$725.00	$13,231.20	$2,705.46	2026-05-18
3160470	OTHER	Laparoscopy W/aspiration	24	13	$8,798.00	$8,798.00	$725.00	$7,181.89	$2,705.46	2026-05-18
3160489	OTHER	Laparoscopy Surgical Abdo	24	13	$8,798.00	$8,798.00	$725.00	$7,181.89	$2,705.46	2026-05-18
3160706	OTHER	Total Thyroid Lobectomy	24	13	$12,210.00	$12,210.00	$675.00	$9,768.00	$2,705.46	2026-05-18
3161030	OTHER	Laparoscopy With Occlusion Of Oviducts	24	13	$15,180.00	$15,180.00	$725.00	$12,144.00	$2,705.46	2026-05-18
2100024	OTHER	Central Line Insert Under	24	13	$2,701.00	$2,701.00	$675.00	$2,701.00	$2,701.00	2026-05-18
3161135	OTHER	Repair Transvenous Electrodes	24	13	$10,320.00	$10,320.00	$675.00	$8,256.00	$2,660.08	2026-05-18
3160517	OTHER	Mastectomy Partial W/lym	24	13	$12,104.00	$12,104.00	$1,300.00	$9,683.20	$2,535.97	2026-05-18
3160518	OTHER	Mastectomy Simple	24	13	$8,789.00	$8,789.00	$725.00	$7,699.01	$2,535.97	2026-05-18
3161191	OTHER	Cysto/uretero W/lith Lt	24	13	$14,100.00	$14,100.00	$1,475.00	$11,280.00	$2,471.16	2026-05-18
3161190	OTHER	Cystourethroscopy W/fulg	24	13	$14,100.00	$14,100.00	$675.00	$11,280.00	$2,471.16	2026-05-18
3162061	OTHER	Urethroplasty Anterior	24	13	$15,000.00	$15,000.00	$500.00	$12,000.00	$2,471.16	2026-05-18
3161192	OTHER	Cysto/uretero W/lith Rt	24	13	$14,100.00	$14,100.00	$1,475.00	$11,280.00	$2,471.16	2026-05-18
3162062	OTHER	Scrotoplasty Complicated	24	13	$15,000.00	$15,000.00	$500.00	$12,000.00	$2,471.16	2026-05-18
3162049	OTHER	Cystourethroscopy Right	24	13	$14,800.00	$14,800.00	$725.00	$11,840.00	$2,471.16	2026-05-18
3160954	OTHER	Laser Vaporization Prosta	24	13	$13,268.00	$13,268.00	$725.00	$10,614.40	$2,471.16	2026-05-18
3165003	OTHER	Cystolithotomy, Cystotomy W/rem Calculus	24	13	$14,136.00	$14,136.00	$725.00	$11,308.80	$2,471.16	2026-05-18
3162050	OTHER	Cystourethroscopy W/ureteroscopy	24	13	$14,800.00	$14,800.00	$725.00	$11,840.00	$2,471.16	2026-05-18
3161194	OTHER	Turp W/control Postop Bleed	24	13	$14,100.00	$14,100.00	$725.00	$11,280.00	$2,471.16	2026-05-18
3162081	OTHER	Cystourethroscopy W/ureteroscopy	24	13	$14,800.00	$14,800.00	$725.00	$11,840.00	$2,471.16	2026-05-18
3162018	OTHER	Transurethral Resection W/control Bleed	24	13	$14,125.00	$14,125.00	$500.00	$11,300.00	$2,471.16	2026-05-18
3162109	OTHER	Cystouret W/exc Tumor	24	13	$15,250.00	$15,250.00	$500.00	$12,200.00	$2,471.16	2026-05-18
3162028	OTHER	Cystourethroscopy W/inc/resection	24	13	$14,125.00	$14,125.00	$500.00	$11,300.00	$2,471.16	2026-05-18
3162048	OTHER	Cystourethroscopy Left	24	13	$14,800.00	$14,800.00	$725.00	$11,840.00	$2,471.16	2026-05-18
3161036	OTHER	Open Tmt Tibial Fx W Or Wo Internal Fix	24	13	$8,657.00	$8,657.00	$1,773.13	$6,925.60	$2,423.96	2026-05-18
3160364	OTHER	Hemorrhoidopexy By Stapli	24	13	$7,587.00	$7,587.00	$1,349.06	$6,069.60	$2,406.97	2026-05-18
5361009	OTHER	Next Generation Sequencing Panel	24	13	$2,352.00	$2,352.00	$12.42	$2,352.00	$2,352.00	2026-05-18
3160533	OTHER	Nasal/sinus Endoscopy W/s	24	13	$8,956.00	$8,956.00	$675.00	$7,782.67	$2,301.07	2026-05-18
3160672	OTHER	Sinus Endoscopy With Expl	24	13	$8,956.00	$8,956.00	$675.00	$7,782.67	$2,301.07	2026-05-18
3160670	OTHER	Sinus Endoscopy W/ethmoid	24	13	$7,917.00	$7,917.00	$675.00	$7,782.67	$2,301.07	2026-05-18
3160187	OTHER	Endoscopy W/ethmoidectomy	24	13	$8,956.00	$8,956.00	$900.00	$7,782.67	$2,301.07	2026-05-18
3160529	OTHER	Nasal Endoscopy	24	13	$5,864.00	$5,864.00	$675.00	$5,864.00	$2,301.07	2026-05-18
3165004	OTHER	Endoscopic Inj Implant	24	13	$9,965.00	$9,965.00	$500.00	$7,972.00	$2,248.20	2026-05-18
2100254	OTHER	Unlisted Proc Anterior E	24	13	$2,310.00	$2,310.00	$400.00	$2,310.00	$2,220.35	2026-05-18
3160742	OTHER	Unlisted Procedure Anter	24	13	$2,195.00	$2,195.00	$400.00	$2,195.00	$2,195.00	2026-05-18
3160623	OTHER	**repair Epigastric Hernia	24	13	$7,805.00	$7,805.00	$725.00	$6,244.00	$2,185.40	2026-05-18
3160639	OTHER	**repair Umbilical Hernia W	24	13	$7,805.00	$7,805.00	$725.00	$6,244.00	$2,185.40	2026-05-18
3160627	OTHER	**repair Incisional/ventral	24	13	$7,805.00	$7,805.00	$725.00	$7,181.89	$2,185.40	2026-05-18
3160628	OTHER	**repair Incisional/ventral	24	13	$7,805.00	$7,805.00	$900.00	$7,181.89	$2,185.40	2026-05-18
3160626	OTHER	**repair Incision/ventral H	24	13	$7,805.00	$7,805.00	$725.00	$6,244.00	$2,185.40	2026-05-18
3160625	OTHER	**repair Inc/ventral Hernia	24	13	$7,805.00	$7,805.00	$725.00	$6,244.00	$2,185.40	2026-05-18
3160488	OTHER	Laparoscopy W/partial Co	24	13	$7,762.00	$7,762.00	$282.69	$6,209.60	$2,173.36	2026-05-18
2100073	OTHER	Excision Of External Hemo	24	13	$2,137.00	$2,137.00	$675.00	$2,137.00	$2,137.00	2026-05-18
3160763	OTHER	Vaginal Hysterectomy	24	13	$11,606.00	$11,606.00	$1,475.00	$9,284.80	$2,135.57	2026-05-18
3160959	OTHER	Vaginal Hysterectomy	24	13	$13,615.00	$13,615.00	$1,475.00	$10,892.00	$2,135.57	2026-05-18
3161086	OTHER	Anteroposterior Colporrhaphy W Enterocel	24	13	$14,097.00	$14,097.00	$1,300.00	$11,277.60	$2,135.57	2026-05-18
3160027	OTHER	Anteroposterior Colporrha	24	13	$11,606.00	$11,606.00	$900.00	$9,284.80	$2,135.57	2026-05-18
3160573	OTHER	Posterior Colporrhaphy	24	13	$11,606.00	$11,606.00	$900.00	$9,284.80	$2,135.57	2026-05-18
3160365	OTHER	Hysteroscopy W/endometria	24	13	$11,606.00	$11,606.00	$725.00	$9,284.80	$2,135.57	2026-05-18
3160966	OTHER	Anterior Colporrhaphy	24	13	$12,540.00	$12,540.00	$900.00	$10,032.00	$2,135.57	2026-05-18
3160118	OTHER	Colectomy Partial W/anas	24	13	$6,157.00	$6,157.00	$385.00	$4,925.60	$2,081.87	2026-05-18
2100289	OTHER	Drainage Lymph Node Lesio	24	13	$3,263.00	$3,263.00	$400.00	$2,707.35	$2,072.01	2026-05-18
3160767	OTHER	Vitrectomy Mechanical	24	13	$9,108.00	$9,108.00	$725.00	$7,286.40	$2,045.03	2026-05-18
3160001	OTHER	Abdominal Lymphadenectomy	24	13	$7,277.00	$7,277.00	$385.00	$5,821.60	$2,037.56	2026-05-18
3161142	OTHER	Rem Transvenous Pacemaker	24	13	$10,320.00	$10,320.00	$400.00	$8,256.00	$2,037.07	2026-05-18
3161128	OTHER	Removal Implantable Defibrillator	24	13	$10,400.00	$10,400.00	$675.00	$8,320.00	$2,037.07	2026-05-18
3160608	OTHER	Removal Of Implanted Pump	24	13	$6,844.00	$6,844.00	$400.00	$5,475.20	$2,037.07	2026-05-18
3500133	OTHER	Calcitonin 400unit/2ml Inj (miacalcin)	24	13	$5,754.50	$5,754.50	$1,069.50	$4,603.60	$2,014.08	2026-05-18
3161016	OTHER	Replacement Catheter Central Venous Devi	24	13	$8,800.00	$8,800.00	$500.00	$7,040.00	$1,984.13	2026-05-18
3160479	OTHER	Laparoscopy Enterectomy	24	13	$5,660.00	$5,660.00	$1,584.80	$4,528.00	$1,981.00	2026-05-18
3160477	OTHER	Laparoscopy Colectomy Pa	24	13	$5,660.00	$5,660.00	$1,584.80	$4,528.00	$1,981.00	2026-05-18
3161141	OTHER	Transcatheter Therapy	24	13	$8,600.00	$8,600.00	$400.00	$6,880.00	$1,963.15	2026-05-18
3160350	OTHER	Gastrostomy Open Without Tub	24	13	$5,584.00	$5,584.00	$1,132.00	$4,467.20	$1,954.40	2026-05-18
3160910	OTHER	Replacement Venous Cath	24	13	$6,523.00	$6,523.00	$500.00	$5,218.40	$1,942.81	2026-05-18
2100355	OTHER	I & D	24	13	$5,670.00	$5,670.00	$500.00	$4,536.00	$1,940.66	2026-05-18
2100431	OTHER	Slitting Prepuce Except Nb	24	13	$5,775.00	$5,775.00	$500.00	$4,620.00	$1,940.66	2026-05-18
2100025	OTHER	Central Line Insertion 5	24	13	$3,488.00	$3,488.00	$400.00	$3,037.01	$1,934.10	2026-05-18
3162053	OTHER	Rev/rem Peripheral Neurostimulator	24	13	$9,727.00	$9,727.00	$400.00	$7,781.60	$1,898.16	2026-05-18
3160985	OTHER	Revision Of Implanted Neurostimulator	24	13	$9,503.00	$9,503.00	$400.00	$7,602.40	$1,898.16	2026-05-18
3165002	OTHER	Revision/removal Peripheral Or Gastric N	24	13	$9,741.00	$9,741.00	$400.00	$7,792.80	$1,898.16	2026-05-18
3160267	OTHER	Exc Nail/nail Matrix	24	13	$5,320.00	$5,320.00	$1,489.60	$4,256.00	$1,862.00	2026-05-18
3160682	OTHER	Split-thickness Autograft	24	13	$6,712.00	$6,712.00	$500.00	$5,369.60	$1,861.02	2026-05-18
3160333	OTHER	Formation Of Direct Pedic	24	13	$4,105.00	$4,105.00	$500.00	$4,105.00	$1,861.02	2026-05-18
3160777	OTHER	Dermal Autograft	24	13	$4,106.00	$4,106.00	$500.00	$4,106.00	$1,861.02	2026-05-18
3160332	OTHER	Flap Neurovascular Pedic	24	13	$4,106.00	$4,106.00	$500.00	$4,106.00	$1,861.02	2026-05-18
3160992	OTHER	Destruction Neurolytic	24	13	$5,170.00	$5,170.00	$196.00	$4,136.00	$1,809.50	2026-05-18
3160960	OTHER	Closure Of Gastrostomy	24	13	$8,283.00	$8,283.00	$400.00	$6,626.40	$1,799.09	2026-05-18
3161174	OTHER	Angiography	24	13	$5,000.00	$5,000.00	$1,400.00	$4,000.00	$1,750.00	2026-05-18
3161060	OTHER	Destruction Of Anal Lesion Electrodesicc	24	13	$5,108.00	$5,108.00	$135.91	$4,086.40	$1,737.53	2026-05-18
2100085	OTHER	Full Thickness Graft 20	24	13	$4,311.00	$4,311.00	$675.00	$3,448.80	$1,737.53	2026-05-18
3200022	OTHER	Wound Prep Trk/arm/leg	24	13	$5,176.00	$5,176.00	$500.00	$4,140.80	$1,737.53	2026-05-18
3200104	OTHER	App Skin Graft Greater 100 Sq Trunk	24	13	$4,870.00	$4,870.00	$1,704.50	$3,896.00	$1,737.53	2026-05-18
2100242	OTHER	Incision Pleura Without Imagi	24	13	$1,733.00	$1,733.00	$172.16	$1,733.00	$1,733.00	2026-05-18
21000501	OTHER	Clsd Reduction Fx Hip	24	13	$4,830.00	$4,830.00	$1,531.33	$3,864.00	$1,690.50	2026-05-18
3507016	OTHER	Golimumab 50mg/4ml	24	13	$4,807.19	$4,807.19	$1,346.01	$3,845.75	$1,682.52	2026-05-18
8182476	OTHER	Pf-removal Fb In Muscle/tendon	24	13	$1,639.00	$1,639.00	$675.00	$1,639.00	$1,639.00	2026-05-18
3160892	OTHER	Fixation Testis	24	13	$5,287.00	$5,287.00	$675.00	$4,314.82	$1,626.11	2026-05-18
3162015	OTHER	Cystourethroscopy, W/fulguration/resecti	24	13	$9,615.00	$9,615.00	$675.00	$7,692.00	$1,626.11	2026-05-18
3162068	OTHER	Biopsy Prostate Needle	24	13	$10,000.00	$10,000.00	$400.00	$8,000.00	$1,626.11	2026-05-18
3162010	OTHER	Scrotoplasty Simple	24	13	$9,700.00	$9,700.00	$400.00	$7,760.00	$1,626.11	2026-05-18
3162033	OTHER	Distal Hypospadias Repair W/urethroplast	24	13	$9,650.00	$9,650.00	$675.00	$7,720.00	$1,626.11	2026-05-18
3162095	OTHER	Reduction Torsion Testis	24	13	$10,000.00	$10,000.00	$725.00	$8,000.00	$1,626.11	2026-05-18
3162016	OTHER	Excision/fulguration Urethral Prolapse	24	13	$9,615.00	$9,615.00	$500.00	$7,692.00	$1,626.11	2026-05-18
3162031	OTHER	Transurethral Electrosurgical Resection	24	13	$9,700.00	$9,700.00	$675.00	$7,760.00	$1,626.11	2026-05-18
3162069	OTHER	Cystourethroscopy W Ureteroscopy	24	13	$10,000.00	$10,000.00	$675.00	$8,000.00	$1,626.11	2026-05-18
3162073	OTHER	Cystourethroscopy W/tmt Upj Stricture Rt	24	13	$10,000.00	$10,000.00	$675.00	$8,000.00	$1,626.11	2026-05-18
3162099	OTHER	Exc Varicocele/ligation	24	13	$9,965.00	$9,965.00	$725.00	$7,972.00	$1,626.11	2026-05-18
3160238	OTHER	Exc Lesion Of Spermatic C	24	13	$5,287.00	$5,287.00	$725.00	$4,314.82	$1,626.11	2026-05-18

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