Hospital

WHIDBEYHEALTH MEDICAL CENTER

Coupeville, WA · CCN 501339 · Rates published

3,414 distinct procedures filed

20 distinct payers

112,010 rate rows

2026-05-14 last MRF observed

Data quality

109,272 of 112,010 rate rows are consumer-grade (97.6%)

2,738 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
per-diem day rate — not a per-procedure price	1,361
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	1,316
exceeds 10× this hospital's gross charge — excluded from medians	59
placeholder amount (≤ $0.02) — excluded from medians	2

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

Source MRF file	https://whidbeyhealth.org/wp-content/uploads/2026/02/910843135_WhidbeyHealth_standardcharges.csv
Found on page	https://onlinepatientestimation.com/PatientPortal/facility
Discovered via	CMS hospital list
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-05-19

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
715 OTHER	Other Male Reproductive System O.r. Procedures For Malignancy With Cc/mcc	8	$4,939.00	$146,965.00	$146,965.00	nat. median $16,378 outlier · 9.0×
895 OTHER	Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy	7	$111,410.00	$111,410.00	$111,410.00	nat. median $11,066 outlier · 10.1×
792 OTHER	Prematurity Without Major Problems	9	$2,468.00	$103,645.95	$98,190.90	nat. median $18,745 outlier · 5.2×
673 OTHER	Other Kidney And Urinary Tract Procedures With Mcc	8	$4,939.00	$81,039.50	$81,039.50	nat. median $38,593 outlier · 2.1×
795 OTHER	Normal Newborn	9	$1,851.00	$76,508.25	$72,481.50	nat. median $2,766 outlier · 26.2×
417 OTHER	Laparoscopic Cholecystectomy Without C.d.e. With Mcc	8	$4,939.00	$66,883.50	$66,883.50	nat. median $22,360 outlier · 3.0×
5 OTHER	Liver Transplant With Mcc Or Intestinal Transplant	8	$4,939.00	$62,917.50	$62,917.50	nat. median $94,894 0.7× median
696 OTHER	Kidney And Urinary Tract Signs And Symptoms Without Mcc	7	$59,608.00	$59,608.00	$59,608.00	nat. median $6,958 outlier · 8.6×
698 OTHER	Other Kidney And Urinary Tract Diagnoses With Mcc	7	$56,484.00	$56,484.00	$56,484.00	nat. median $16,061 outlier · 3.5×
149 OTHER	Dysequilibrium	7	$56,059.00	$56,059.00	$56,059.00	nat. median $7,929 outlier · 7.1×
927 OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	8	$4,939.00	$54,554.50	$54,554.50	nat. median $146,562 outlier · 0.4×
445 OTHER	Disorders Of The Biliary Tract With Cc	7	$52,925.00	$52,925.00	$52,925.00	nat. median $10,866 outlier · 4.9×
928 OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	8	$4,939.00	$52,631.50	$52,631.50	nat. median $46,003 1.1× median
713 OTHER	Transurethral Prostatectomy With Cc/mcc	8	$4,939.00	$48,460.25	$48,460.25	nat. median $13,181 outlier · 3.7×
790 OTHER	Extreme Immaturity Or Respiratory Distress Syndrome, Neonate	9	$1,234.00	$47,911.82	$45,390.15	nat. median $42,432 1.1× median
14 OTHER	Allogeneic Bone Marrow Transplant	8	$4,939.00	$44,792.95	$44,792.95	nat. median $100,915 outlier · 0.4×
815 OTHER	Reticuloendothelial And Immunity Disorders With Cc	7	$42,101.50	$42,101.50	$42,101.50	nat. median $8,759 outlier · 4.8×
243 OTHER	Permanent Cardiac Pacemaker Implant With Cc	8	$4,939.00	$38,641.90	$38,641.90	nat. median $21,561 1.8× median
195 OTHER	Simple Pneumonia And Pleurisy Without Cc/mcc	7	$38,168.25	$38,168.25	$38,168.25	nat. median $6,715 outlier · 5.7×
420 OTHER	Hepatobiliary Diagnostic Procedures With Mcc	8	$4,939.00	$37,811.00	$37,811.00	nat. median $150 outlier · 252.6×
957 OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	8	$4,939.00	$37,558.00	$37,558.00	nat. median $68,309 0.5× median
662 OTHER	Minor Bladder Procedures With Mcc	8	$4,939.00	$36,488.00	$36,488.00	nat. median $28,274 1.3× median
235 OTHER	Coronary Bypass Without Cardiac Catheterization With Mcc	8	$4,939.00	$35,836.50	$35,836.50	nat. median $56,120 0.6× median
644 OTHER	Endocrine Disorders With Cc	7	$35,642.00	$35,642.00	$35,642.00	nat. median $10,379 outlier · 3.4×
864 OTHER	Fever And Inflammatory Conditions	7	$35,332.00	$35,332.00	$35,332.00	nat. median $7,202 outlier · 4.9×
234 OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	8	$4,939.00	$35,301.00	$35,301.00	nat. median $50,947 0.7× median
770 OTHER	Abortion With D&c, Aspiration Curettage Or Hysterotomy	8	$4,939.00	$34,435.75	$34,435.75	nat. median $7,632 outlier · 4.5×
207 OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	7	$34,291.00	$34,291.00	$34,291.00	nat. median $66,849 0.5× median
418 OTHER	Laparoscopic Cholecystectomy Without C.d.e. With Cc	8	$4,939.00	$34,137.76	$34,137.76	nat. median $16,499 outlier · 2.1×
798 OTHER	Vaginal Delivery With Sterilization And/or D&c Without Cc/mcc	8	$4,939.00	$33,797.00	$33,797.00	nat. median $7,824 outlier · 4.3×
769 OTHER	Postpartum And Post Abortion Diagnoses With O.r. Procedures	8	$4,939.00	$32,972.25	$32,972.25	nat. median $14,424 outlier · 2.3×
760 OTHER	Menstrual And Other Female Reproductive System Disorders With Cc/mcc	7	$32,817.50	$32,817.50	$32,817.50	nat. median $7,126 outlier · 4.6×
384 OTHER	Uncomplicated Peptic Ulcer Without Mcc	7	$32,776.50	$32,776.50	$32,776.50	nat. median $8,971 outlier · 3.7×
388 OTHER	Gastrointestinal Obstruction With Mcc	7	$32,158.20	$32,158.20	$32,158.20	nat. median $14,192 outlier · 2.3×
204 OTHER	Respiratory Signs And Symptoms	7	$32,158.20	$32,158.20	$32,158.20	nat. median $8,657 outlier · 3.7×
901 OTHER	Wound Debridements For Injuries With Mcc	8	$4,939.00	$31,955.50	$31,955.50	nat. median $29,541 1.1× median
793 OTHER	Full Term Neonate With Major Problems	9	$1,851.00	$32,886.15	$31,155.30	nat. median $30,947 1.0× median
671 OTHER	Urethral Procedures With Cc/mcc	8	$4,939.00	$30,058.50	$30,058.50	nat. median $16,818 1.8× median
242 OTHER	Permanent Cardiac Pacemaker Implant With Mcc	8	$4,939.00	$29,973.50	$29,973.50	nat. median $31,203 1.0× median
794 OTHER	Neonate With Other Significant Problems	9	$1,851.00	$30,953.85	$29,324.70	nat. median $11,749 outlier · 2.5×
146 OTHER	Ear, Nose, Mouth And Throat Malignancy With Mcc	7	$28,803.50	$28,803.50	$28,803.50	nat. median $20,031 1.4× median
814 OTHER	Reticuloendothelial And Immunity Disorders With Mcc	7	$28,101.50	$28,101.50	$28,101.50	nat. median $16,987 1.7× median
208 OTHER	Respiratory System Diagnosis With Ventilator Support <=96 Hours	7	$27,825.00	$27,825.00	$27,825.00	nat. median $26,262 1.1× median
C1813 OTHER	Reservoir Titan Cl	19	$27,676.00	$27,676.00	$27,676.00	nat. median $10,895 outlier · 2.5×
423 OTHER	Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc	8	$4,939.00	$27,415.50	$27,415.50	nat. median $36,508 0.8× median
811 OTHER	Red Blood Cell Disorders With Mcc	7	$26,798.50	$26,798.50	$26,798.50	nat. median $11,662 outlier · 2.3×
802 OTHER	Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc	8	$4,939.00	$26,669.25	$26,669.25	nat. median $27,488 1.0× median
740 OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Cc	8	$4,939.00	$26,617.25	$26,617.25	nat. median $1,846 outlier · 14.4×
799 OTHER	Splenic Procedures With Mcc	8	$4,939.00	$25,949.50	$25,949.50	nat. median $43,209 0.6× median
11 OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	8	$4,939.00	$25,885.50	$25,885.50	nat. median $49,519 0.5× median

Other procedures at this hospital

Browse this hospital's 3,414 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

1	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	8	8	$37,976.00	$37,976.00	$4,939.00	$22,414.50	$22,414.50	2026-05-14
10005	OTHER	Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion	24	19	$3,293.00	$3,293.00	$3,293.00	$3,293.00	$3,293.00	2026-05-14
10009	OTHER	Fine Needle Aspiration Biopsy, Including CT Guidance; First Lesion	24	19	$3,293.00	$3,293.00	$3,293.00	$3,293.00	$3,293.00	2026-05-14
10121	OTHER	Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated	24	19	$5,471.00	$5,471.00	$265.50	$5,471.00	$5,471.00	2026-05-14
10180	OTHER	Incision And Drainage, Complex, Postoperative Wound Infection	24	19	$6,589.00	$6,589.00	$256.50	$6,589.00	$6,589.00	2026-05-14
11	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	8	8	$44,918.00	$44,918.00	$4,939.00	$25,885.50	$25,885.50	2026-05-14
11010	OTHER	Debridement Including Removal Of Foreign Material At The Site Of An Open Fractur…	24	19	$6,042.00	$6,042.00	$402.00	$6,042.00	$6,042.00	2026-05-14
11011	OTHER	Debridement Including Removal Of Foreign Material At The Site Of An Open Fractur…	24	19	$4,592.00	$4,592.00	$428.00	$4,592.00	$4,592.00	2026-05-14
11012	OTHER	ER Fee Debrid Open Fx To Bone	24	19	$6,780.00	$6,780.00	$610.50	$6,780.00	$6,780.00	2026-05-14
11043	OTHER	ER Fee Debrid Skin To Muscle	24	19	$4,802.00	$4,802.00	$223.50	$4,802.00	$4,802.00	2026-05-14
11044	OTHER	ER Fee Deb Skin Subq Muscle Bo	24	19	$6,643.00	$6,643.00	$334.00	$6,643.00	$6,643.00	2026-05-14
11404	OTHER	Excision, Benign Lesion Including Margins, Except Skin Tag (unless Listed Elsewh…	24	19	$3,900.00	$3,900.00	$232.00	$3,900.00	$3,900.00	2026-05-14
11422	OTHER	Excision, Benign Lesion Including Margins, Except Skin Tag (unless Listed Elsewh…	24	19	$3,832.00	$3,832.00	$193.50	$3,832.00	$3,832.00	2026-05-14
11423	OTHER	Excision, Benign Lesion Including Margins, Except Skin Tag (unless Listed Elsewh…	24	19	$4,681.00	$4,681.00	$225.50	$4,681.00	$4,681.00	2026-05-14
11424	OTHER	Excision, Benign Lesion Including Margins, Except Skin Tag (unless Listed Elsewh…	24	19	$3,900.00	$3,900.00	$258.00	$3,900.00	$3,900.00	2026-05-14
11606	OTHER	Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Excised Diam…	24	19	$3,900.00	$3,900.00	$458.00	$3,900.00	$3,900.00	2026-05-14
11762	OTHER	Reconstruction Of Nail Bed With Graft	24	19	$4,611.00	$4,611.00	$265.50	$4,611.00	$4,611.00	2026-05-14
11982	OTHER	Removal, Non-biodegradable Drug Delivery Implant	24	19	$4,013.00	$4,013.00	$144.50	$4,013.00	$4,013.00	2026-05-14
12047	OTHER	Repair, Intermediate, Wounds Of Neck, Hands, Feet And/or External Genitalia; Ove…	24	19	$4,611.00	$4,611.00	$540.00	$4,611.00	$4,611.00	2026-05-14
13160	OTHER	Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated	24	19	$4,611.00	$4,611.00	$1,159.00	$4,611.00	$4,611.00	2026-05-14
14	OTHER	Allogeneic Bone Marrow Transplant	8	8	$78,904.90	$78,904.90	$4,939.00	$44,792.95	$44,792.95	2026-05-14
14021	OTHER	Adjacent Tissue Transfer Or Rearrangement, Scalp, Arms And/or Legs; Defect 10.1 …	24	19	$4,611.00	$4,611.00	$1,028.00	$4,611.00	$4,611.00	2026-05-14
14040	OTHER	Adjacent Tissue Transfer Or Rearrangement, Forehead, Cheeks, Chin, Mouth, Neck, …	24	19	$5,850.00	$5,850.00	$905.00	$5,850.00	$5,850.00	2026-05-14
14041	OTHER	Adjacent Tissue Transfer Or Rearrangement, Forehead, Cheeks, Chin, Mouth, Neck, …	24	19	$4,611.00	$4,611.00	$1,112.00	$4,611.00	$4,611.00	2026-05-14
14060	OTHER	Adjacent Tissue Transfer Or Rearrangement, Eyelids, Nose, Ears And/or Lips; Defe…	24	19	$4,611.00	$4,611.00	$963.50	$4,611.00	$4,611.00	2026-05-14
14061	OTHER	Adjacent Tissue Transfer Or Rearrangement, Eyelids, Nose, Ears And/or Lips; Defe…	24	19	$4,611.00	$4,611.00	$1,190.00	$4,611.00	$4,611.00	2026-05-14
14301	OTHER	Adjacent Tissue Transfer Or Rearrangement, Any Area; Defect 30.1 Sq Cm To 60.0 S…	24	19	$8,460.00	$8,460.00	$1,264.50	$8,460.00	$8,460.00	2026-05-14
146	OTHER	Ear, Nose, Mouth And Throat Malignancy With Mcc	7	7	$47,482.00	$47,482.00	$28,803.50	$28,803.50	$28,803.50	2026-05-14
149	OTHER	Dysequilibrium	7	7	$99,968.00	$99,968.00	$56,059.00	$56,059.00	$56,059.00	2026-05-14
150	OTHER	Epistaxis With Mcc	7	7	$36,688.50	$36,688.50	$19,356.75	$19,356.75	$19,356.75	2026-05-14
15002	OTHER	Surgical Preparation Or Creation Of Recipient Site By Excision Of Open Wounds, B…	24	19	$4,611.00	$4,611.00	$326.50	$4,611.00	$4,611.00	2026-05-14
15220	OTHER	Full Thickness Graft, Free, Including Direct Closure Of Donor Site, Scalp, Arms,…	24	19	$4,611.00	$4,611.00	$880.50	$4,611.00	$4,611.00	2026-05-14
15240	OTHER	Full Thickness Graft, Free, Including Direct Closure Of Donor Site, Forehead, Ch…	24	19	$4,611.00	$4,611.00	$1,146.00	$4,611.00	$4,611.00	2026-05-14
15273	OTHER	Application Of Skin Substitute Graft To Trunk, Arms, Legs, Total Wound Surface A…	24	19	$6,250.00	$6,250.00	$292.00	$6,250.00	$6,250.00	2026-05-14
15277	OTHER	Skn Sub Grft F/n/hf/g Child	23	19	$9,869.00	$9,869.00	$9,869.00	$9,869.00	$9,869.00	2026-05-14
15278	OTHER	Skn Sub Grft F/n/hf/g Ch Add	23	19	$5,119.00	$5,119.00	$5,119.00	$5,119.00	$5,119.00	2026-05-14
15733	OTHER	Muscle, Myocutaneous, Or Fasciocutaneous Flap; Head And Neck With Named Vascular…	24	19	$6,768.00	$6,768.00	$6,768.00	$6,768.00	$6,768.00	2026-05-14
15760	OTHER	Graft; Composite (eg, Full Thickness Of External Ear Or Nasal Ala), Including Pr…	24	19	$4,611.00	$4,611.00	$1,016.00	$4,611.00	$4,611.00	2026-05-14
19081	OTHER	Mm Bx Stereo Lt	24	19	$4,023.00	$4,023.00	$242.00	$4,023.00	$4,023.00	2026-05-14
19082	OTHER	Biopsy, Breast, With Placement Of Breast Localization Device(s) (eg, Clip, Metal…	24	19	$3,346.00	$3,346.00	$121.00	$3,346.00	$3,346.00	2026-05-14
19083	OTHER	Biopsy, Breast, With Placement Of Breast Localization Device(s) (eg, Clip, Metal…	24	19	$3,601.00	$3,601.00	$238.50	$3,601.00	$3,601.00	2026-05-14
19085	OTHER	Biopsy, Breast, With Placement Of Breast Localization Device(s) (eg, Clip, Metal…	52	20	$6,102.00	$6,102.00	$290.00	$6,102.00	$6,102.00	2026-05-14
19281	OTHER	Placement Of Breast Localization Device(s) (eg, Clip, Metallic Pellet, Wire/need…	76	20	$3,098.00	$3,098.00	$147.00	$3,255.00	$3,255.00	2026-05-14
19283	OTHER	Placement Of Breast Localization Device(s) (eg, Clip, Metallic Pellet, Wire/need…	76	20	$3,098.00	$3,098.00	$147.50	$3,255.00	$3,255.00	2026-05-14
19285	OTHER	Placement Of Breast Localization Device(s) (eg, Clip, Metallic Pellet, Wire/need…	24	19	$3,255.00	$3,255.00	$125.50	$3,255.00	$3,255.00	2026-05-14
19287	OTHER	Placement Of Breast Localization Device(s) (eg Clip, Metallic Pellet, Wire/needl…	76	20	$4,647.00	$4,647.00	$198.00	$4,883.00	$4,883.00	2026-05-14
195	OTHER	Simple Pneumonia And Pleurisy Without Cc/mcc	7	7	$66,211.50	$66,211.50	$38,168.25	$38,168.25	$38,168.25	2026-05-14
196	OTHER	Interstitial Lung Disease With Mcc	7	7	$34,170.00	$34,170.00	$21,438.80	$21,438.80	$21,438.80	2026-05-14
197	OTHER	Interstitial Lung Disease With Cc	7	7	$21,928.00	$21,928.00	$11,976.50	$11,976.50	$11,976.50	2026-05-14
20101	OTHER	Exploration Of Penetrating Wound (separate Procedure); Chest	24	19	$4,611.00	$4,611.00	$302.00	$4,611.00	$4,611.00	2026-05-14
20102	OTHER	Exploration Of Penetrating Wound (separate Procedure); Abdomen/flank/back	24	19	$4,611.00	$4,611.00	$368.00	$4,611.00	$4,611.00	2026-05-14
20206	OTHER	Muscle Biopsy Perc	24	19	$6,426.00	$6,426.00	$85.50	$6,426.00	$6,426.00	2026-05-14
20220	OTHER	Biopsy, Bone, Trocar, Or Needle; Superficial (eg, Ilium, Sternum, Spinous Proces…	24	19	$7,661.00	$7,661.00	$105.00	$7,661.00	$7,661.00	2026-05-14
20225	OTHER	Biopsy, Bone, Trocar, Or Needle; Deep (eg, Vertebral Body, Femur)	24	19	$6,426.00	$6,426.00	$158.00	$6,426.00	$6,426.00	2026-05-14
204	OTHER	Respiratory Signs And Symptoms	7	7	$39,958.00	$39,958.00	$32,158.20	$32,158.20	$32,158.20	2026-05-14
20520	OTHER	Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple	24	19	$4,218.00	$4,218.00	$210.50	$4,218.00	$4,218.00	2026-05-14
20525	OTHER	Removal Of Foreign Body In Muscle Or Tendon Sheath; Deep Or Complicated	24	19	$4,068.00	$4,068.00	$359.00	$4,068.00	$4,068.00	2026-05-14
206	OTHER	Other Respiratory System Diagnoses Without Mcc	7	7	$31,213.00	$31,213.00	$16,619.00	$16,619.00	$16,619.00	2026-05-14
207	OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	7	7	$58,457.00	$58,457.00	$34,291.00	$34,291.00	$34,291.00	2026-05-14
208	OTHER	Respiratory System Diagnosis With Ventilator Support <=96 Hours	7	7	$47,550.00	$47,550.00	$27,825.00	$27,825.00	$27,825.00	2026-05-14
21315	OTHER	Closed Treatment Of Nasal Bone Fracture With Manipulation; Without Stabilization	24	19	$3,868.00	$3,868.00	$219.50	$3,868.00	$3,868.00	2026-05-14
21320	OTHER	Closed Treatment Of Nasal Bone Fracture With Manipulation; With Stabilization	24	19	$5,954.00	$5,954.00	$195.00	$5,954.00	$5,954.00	2026-05-14
21337	OTHER	Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization	24	19	$7,443.00	$7,443.00	$425.00	$7,443.00	$7,443.00	2026-05-14
21401	OTHER	Closed Treatment Of Fracture Of Orbit, Except Blowout; With Manipulation	96	19	$3,835.00	$3,835.00	$441.00	$7,670.00	$3,835.00	2026-05-14
21421	OTHER	Closed Treatment Of Palatal Or Maxillary Fracture (LeFort I Type), With Interden…	24	19	$6,340.00	$6,340.00	$1,002.50	$6,340.00	$6,340.00	2026-05-14
21451	OTHER	Closed Treatment Of Mandibular Fracture; With Manipulation	24	19	$3,835.00	$3,835.00	$978.00	$3,835.00	$3,835.00	2026-05-14
21501	OTHER	Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax	24	19	$6,724.00	$6,724.00	$460.50	$6,724.00	$6,724.00	2026-05-14
21550	OTHER	Biopsy, Soft Tissue Of Neck Or Thorax	24	19	$7,661.00	$7,661.00	$227.00	$7,661.00	$7,661.00	2026-05-14
23333	OTHER	Removal Of Foreign Body, Shoulder; Deep (subfascial Or Intramuscular)	48	19	$9,883.50	$9,883.50	$654.00	$13,178.00	$6,589.00	2026-05-14
234	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	8	8	$58,007.00	$58,007.00	$4,939.00	$35,301.00	$35,301.00	2026-05-14
23473	OTHER	Revis Reconst Shoulder Joint	23	19	$3,343.00	$3,343.00	$3,343.00	$3,343.00	$3,343.00	2026-05-14
235	OTHER	Coronary Bypass Without Cardiac Catheterization With Mcc	8	8	$62,906.00	$62,906.00	$4,939.00	$35,836.50	$35,836.50	2026-05-14
23505	OTHER	Closed Treatment Of Clavicular Fracture; With Manipulation	112	19	$3,852.00	$3,852.00	$475.00	$7,703.00	$3,852.00	2026-05-14
23520	OTHER	Closed Treatment Of Sternoclavicular Dislocation; Without Manipulation	96	19	$3,852.00	$3,852.00	$335.00	$7,703.00	$3,852.00	2026-05-14
23575	OTHER	Closed Treatment Of Scapular Fracture; With Manipulation, With Or Without Skelet…	96	19	$3,852.00	$3,852.00	$537.50	$7,703.00	$3,852.00	2026-05-14
23625	OTHER	Closed Treatment Of Greater Humeral Tuberosity Fracture; With Manipulation	96	19	$3,852.00	$3,852.00	$506.00	$7,703.00	$3,852.00	2026-05-14
23655	OTHER	Closed Treatment Of Shoulder Dislocation, With Manipulation; Requiring Anesthesi…	112	19	$3,733.00	$3,733.00	$574.50	$7,703.00	$3,733.00	2026-05-14
23675	OTHER	Closed Treatment Of Shoulder Dislocation, With Surgical Or Anatomical Neck Fract…	96	19	$3,852.00	$3,852.00	$720.50	$7,703.00	$3,852.00	2026-05-14
23930	OTHER	Incision And Drainage, Upper Arm Or Elbow Area; Deep Abscess Or Hematoma	24	19	$6,475.00	$6,475.00	$309.50	$6,475.00	$6,475.00	2026-05-14
23931	OTHER	Incision And Drainage, Upper Arm Or Elbow Area; Bursa	24	19	$3,476.00	$3,476.00	$229.50	$3,476.00	$3,476.00	2026-05-14
242	OTHER	Permanent Cardiac Pacemaker Implant With Mcc	8	8	$49,266.00	$49,266.00	$4,939.00	$29,973.50	$29,973.50	2026-05-14
24200	OTHER	Removal Of Foreign Body, Upper Arm Or Elbow Area; Subcutaneous	48	19	$5,850.00	$5,850.00	$201.50	$7,800.00	$3,900.00	2026-05-14
24201	OTHER	Removal Of Foreign Body, Upper Arm Or Elbow Area; Deep (subfascial Or Intramuscu…	48	19	$9,883.50	$9,883.50	$526.50	$13,178.00	$6,589.00	2026-05-14
243	OTHER	Permanent Cardiac Pacemaker Implant With Cc	8	8	$45,466.00	$45,466.00	$4,939.00	$38,641.90	$38,641.90	2026-05-14
24565	OTHER	Closed Treatment Of Humeral Epicondylar Fracture, Medial Or Lateral; With Manipu…	96	19	$3,852.00	$3,852.00	$701.00	$7,703.00	$3,852.00	2026-05-14
24577	OTHER	Closed Treatment Of Humeral Condylar Fracture, Medial Or Lateral; With Manipulat…	96	19	$3,852.00	$3,852.00	$721.50	$7,703.00	$3,852.00	2026-05-14
24605	OTHER	Treatment Of Closed Elbow Dislocation; Requiring Anesthesia	96	19	$3,852.00	$3,852.00	$674.00	$7,703.00	$3,852.00	2026-05-14
24655	OTHER	Closed Treatment Of Radial Head Or Neck Fracture; With Manipulation	112	19	$3,852.00	$3,852.00	$564.00	$7,703.00	$3,852.00	2026-05-14
24675	OTHER	Closed Treatment Of Ulnar Fracture, Proximal End (eg, Olecranon Or Coronoid Proc…	96	19	$5,754.00	$5,754.00	$594.00	$7,703.00	$5,754.00	2026-05-14
25075	OTHER	Excision, Tumor, Soft Tissue Of Forearm And/or Wrist Area, Subcutaneous; Less Th…	24	19	$4,065.00	$4,065.00	$452.00	$4,065.00	$4,065.00	2026-05-14
25248	OTHER	Exploration With Removal Of Deep Foreign Body, Forearm Or Wrist	48	19	$5,777.50	$5,777.50	$593.50	$7,703.00	$3,852.00	2026-05-14
25260	OTHER	Repair, Tendon Or Muscle, Flexor, Forearm And/or Wrist; Primary, Single, Each Te…	24	19	$7,778.00	$7,778.00	$902.50	$7,778.00	$7,778.00	2026-05-14
25505	OTHER	Closed Treatment Of Radial Shaft Fracture; With Manipulation	112	19	$4,023.00	$4,023.00	$656.50	$7,703.00	$4,023.00	2026-05-14
25605	OTHER	Closed Treatment Of Distal Radial Fracture (eg, Colles Or Smith Type) Or Epiphys…	48	19	$5,480.50	$5,480.50	$732.50	$7,703.00	$3,258.00	2026-05-14
25624	OTHER	Closed Treatment Of Carpal Scaphoid (navicular) Fracture; With Manipulation	96	19	$3,852.00	$3,852.00	$623.50	$7,703.00	$3,852.00	2026-05-14
25635	OTHER	Closed Treatment Of Carpal Bone Fracture (excluding Carpal Scaphoid [navicular])…	96	19	$3,852.00	$3,852.00	$567.50	$7,703.00	$3,852.00	2026-05-14
25651	OTHER	Percutaneous Skeletal Fixation Of Ulnar Styloid Fracture	96	19	$7,778.00	$7,778.00	$692.50	$15,555.00	$7,778.00	2026-05-14
26236	OTHER	Partial Excision (craterization, Saucerization, Or Diaphysectomy) Bone (eg, Oste…	24	19	$4,519.00	$4,519.00	$629.00	$4,519.00	$4,519.00	2026-05-14
26350	OTHER	Repair Or Advancement, Flexor Tendon, Not In Zone 2 Digital Flexor Tendon Sheath…	24	19	$7,778.00	$7,778.00	$1,001.00	$7,778.00	$7,778.00	2026-05-14
26410	OTHER	Repair, Extensor Tendon, Hand, Primary Or Secondary; Without Free Graft, Each Te…	24	19	$5,145.00	$5,145.00	$793.00	$5,145.00	$5,145.00	2026-05-14
26418	OTHER	Repair, Extensor Tendon, Finger, Primary Or Secondary; Without Free Graft, Each …	24	19	$6,339.00	$6,339.00	$811.00	$6,339.00	$6,339.00	2026-05-14
26432	OTHER	Closed Treatment Of Distal Extensor Tendon Insertion, With Or Without Percutaneo…	24	19	$3,852.00	$3,852.00	$703.00	$3,852.00	$3,852.00	2026-05-14
26433	OTHER	Repair Of Extensor Tendon, Distal Insertion, Primary Or Secondary; Without Graft…	24	19	$6,927.00	$6,927.00	$746.50	$6,927.00	$6,927.00	2026-05-14
26540	OTHER	Repair Of Collateral Ligament, Metacarpophalangeal Or Interphalangeal Joint	24	19	$7,778.00	$7,778.00	$923.00	$7,778.00	$7,778.00	2026-05-14
26608	OTHER	Percutaneous Skeletal Fixation Of Metacarpal Fracture, Each Bone	96	19	$8,190.00	$8,190.00	$680.00	$15,555.00	$8,190.00	2026-05-14
26650	OTHER	Percutaneous Skeletal Fixation Of Carpometacarpal Fracture Dislocation, Thumb (b…	96	19	$7,778.00	$7,778.00	$684.50	$15,555.00	$7,778.00	2026-05-14
26675	OTHER	Closed Treatment Of Carpometacarpal Dislocation, Other Than Thumb, With Manipula…	96	19	$3,852.00	$3,852.00	$598.50	$7,703.00	$3,852.00	2026-05-14
26676	OTHER	Percutaneous Skeletal Fixation Of Carpometacarpal Dislocation, Other Than Thumb,…	112	19	$7,403.00	$7,403.00	$715.00	$15,555.00	$4,059.00	2026-05-14
26705	OTHER	Closed Treatment Of Metacarpophalangeal Dislocation, Single, With Manipulation; …	112	19	$3,852.00	$3,852.00	$545.00	$7,703.00	$3,852.00	2026-05-14
26706	OTHER	Percutaneous Skeletal Fixation Of Metacarpophalangeal Dislocation, Single, With …	96	19	$7,778.00	$7,778.00	$622.00	$15,555.00	$7,778.00	2026-05-14
26727	OTHER	Percutaneous Skeletal Fixation Of Unstable Phalangeal Shaft Fracture, Proximal O…	280	19	$7,778.00	$7,778.00	$670.00	$7,778.00	$7,778.00	2026-05-14
26735	OTHER	Open Treatment Of Phalangeal Shaft Fracture, Proximal Or Middle Phalanx, Finger …	24	19	$10,170.00	$10,170.00	$854.00	$10,170.00	$10,170.00	2026-05-14
26765	OTHER	Open Treatment Of Distal Phalangeal Fracture, Finger Or Thumb, Includes Internal…	24	19	$10,170.00	$10,170.00	$716.00	$10,170.00	$10,170.00	2026-05-14
26951	OTHER	Amputation, Finger Or Thumb, Primary Or Secondary, Any Joint Or Phalanx, Single,…	24	19	$5,224.00	$5,224.00	$919.00	$5,224.00	$5,224.00	2026-05-14
26952	OTHER	Amputation, Finger Or Thumb, Primary Or Secondary, Any Joint Or Phalanx, Single,…	24	19	$9,853.00	$9,853.00	$907.00	$9,853.00	$9,853.00	2026-05-14
27091	OTHER	Rmvlhip Prosth Cmpw/totpr Mma	23	19	$3,297.00	$3,297.00	$3,297.00	$3,297.00	$3,297.00	2026-05-14
27130	OTHER	Total Hip Arthroplasty	23	19	$3,234.00	$3,234.00	$3,234.00	$3,234.00	$3,234.00	2026-05-14
27132	OTHER	Tot Hip Arthro W/wo Agrft	23	19	$3,604.00	$3,604.00	$3,604.00	$3,604.00	$3,604.00	2026-05-14
27134	OTHER	Revise Hipjt Replac W/woagrft	23	19	$4,084.00	$4,084.00	$4,084.00	$4,084.00	$4,084.00	2026-05-14
27138	OTHER	Revise Hipjt Femonly W/woagrf	23	19	$3,447.00	$3,447.00	$3,447.00	$3,447.00	$3,447.00	2026-05-14
27257	OTHER	Treatment Of Spontaneous Hip Dislocation (developmental, Including Congenital Or…	72	19	$3,733.00	$3,733.00	$492.50	$3,733.00	$3,733.00	2026-05-14
27266	OTHER	ER Fee Treat Hip Dislocation	25	19	$3,914.00	$3,914.00	$837.00	$3,914.00	$3,914.00	2026-05-14
27301	OTHER	Ed Fee I & D Knee/thigh Bursa	39	19	$3,489.00	$3,489.00	$386.67	$3,489.00	$3,489.00	2026-05-14
27372	OTHER	Removal Of Foreign Body, Deep, Thigh Region Or Knee Area	24	19	$5,271.00	$5,271.00	$581.00	$5,271.00	$5,271.00	2026-05-14
27447	OTHER	Tka Wwo Ptla Rsrfcg	23	19	$3,454.00	$3,454.00	$3,454.00	$3,454.00	$3,454.00	2026-05-14
27487	OTHER	Rvsn Tka Wwo Algft Ttl	23	19	$3,954.00	$3,954.00	$3,954.00	$3,954.00	$3,954.00	2026-05-14
27513	OTHER	Pf Opn Tx Fem Supracondylar Fx	23	19	$3,580.00	$3,580.00	$3,580.00	$3,580.00	$3,580.00	2026-05-14
27562	OTHER	Closed Treatment Of Patellar Dislocation; Requiring Anesthesia	24	19	$4,546.00	$4,546.00	$695.50	$4,546.00	$4,546.00	2026-05-14
27768	OTHER	Closed Treatment Of Posterior Malleolus Fracture; With Manipulation	24	19	$3,836.00	$3,836.00	$633.00	$3,836.00	$3,836.00	2026-05-14
27810	OTHER	ER Fee Clsd Bimalleolar Fx W/r	40	19	$4,174.00	$4,174.00	$352.40	$4,174.00	$4,174.00	2026-05-14
28192	OTHER	Removal Of Foreign Body, Foot; Deep	24	19	$5,812.00	$5,812.00	$451.00	$5,812.00	$5,812.00	2026-05-14
28208	OTHER	Repair, Tendon, Extensor, Foot; Primary Or Secondary, Each Tendon	24	19	$5,845.00	$5,845.00	$449.00	$5,845.00	$5,845.00	2026-05-14
28665	OTHER	Closed Treatment Of Interphalangeal Joint Dislocation; Requiring Anesthesia	24	19	$3,575.00	$3,575.00	$189.50	$3,575.00	$3,575.00	2026-05-14
31612	OTHER	Ed Tracheostomy Puncture, Perc	23	19	$6,067.00	$6,067.00	$6,067.00	$6,067.00	$6,067.00	2026-05-14
31634	OTHER	Bronch W/balloon Occlusion	23	19	$4,372.00	$4,372.00	$4,372.00	$4,372.00	$4,372.00	2026-05-14
32100	OTHER	Thoracotomy; With Exploration	24	19	$3,232.00	$3,232.00	$1,174.50	$3,232.00	$3,232.00	2026-05-14
32160	OTHER	Thoracotomy; With Cardiac Massage	24	19	$3,232.00	$3,232.00	$1,143.00	$3,232.00	$3,232.00	2026-05-14
32400	OTHER	Biopsy, Pleura, Percutaneous Needle	24	19	$6,426.00	$6,426.00	$127.00	$6,426.00	$6,426.00	2026-05-14
32408	OTHER	Rt Lung Bx Perc	24	19	$6,426.00	$6,426.00	$6,426.00	$6,426.00	$6,426.00	2026-05-14
326	OTHER	Stomach, Esophageal And Duodenal Procedures With Mcc	8	8	$24,157.00	$24,157.00	$4,939.00	$17,425.10	$17,425.10	2026-05-14
329	OTHER	Major Small And Large Bowel Procedures With Mcc	8	8	$34,474.00	$34,474.00	$4,939.00	$20,663.50	$20,663.50	2026-05-14
33020	OTHER	ER Fee Pericardiotomy	24	19	$3,538.00	$3,538.00	$1,280.50	$3,538.00	$3,538.00	2026-05-14
33210	OTHER	Insertion Or Replacement Of Temporary Transvenous Single Chamber Cardiac Electro…	24	19	$8,587.00	$8,587.00	$259.50	$8,587.00	$8,587.00	2026-05-14
36555	OTHER	Insertion Of Non-tunneled Centrally Inserted Central Venous Catheter; Younger Th…	24	19	$4,691.00	$4,691.00	$169.00	$4,691.00	$4,691.00	2026-05-14
36556	OTHER	Insertion Of Non-tunneled Centrally Inserted Central Venous Catheter; Age 5 Year…	24	19	$3,974.00	$3,974.00	$175.00	$3,974.00	$3,974.00	2026-05-14
36569	OTHER	Insertion Of Peripherally Inserted Central Venous Catheter (picc), Without Subcu…	24	19	$3,888.00	$3,888.00	$133.00	$3,888.00	$3,888.00	2026-05-14
36640	OTHER	Arterial Catheterization For Prolonged Infusion Therapy (chemotherapy), Cutdown	24	19	$4,691.00	$4,691.00	$172.00	$4,691.00	$4,691.00	2026-05-14
36680	OTHER	Placement Of Needle For Intraosseous Infusion	24	19	$4,256.00	$4,256.00	$85.00	$4,256.00	$4,256.00	2026-05-14
378	OTHER	Gastrointestinal Hemorrhage With Cc	7	7	$25,667.00	$25,667.00	$13,846.00	$13,846.00	$13,846.00	2026-05-14
38222	OTHER	Dx Bone Marrow Bx & Aspir	24	19	$3,831.00	$3,831.00	$3,597.00	$3,831.00	$3,831.00	2026-05-14
383	OTHER	Uncomplicated Peptic Ulcer With Mcc	7	7	$30,546.00	$30,546.00	$21,438.80	$21,438.80	$21,438.80	2026-05-14
384	OTHER	Uncomplicated Peptic Ulcer Without Mcc	7	7	$57,453.00	$57,453.00	$32,776.50	$32,776.50	$32,776.50	2026-05-14
388	OTHER	Gastrointestinal Obstruction With Mcc	7	7	$40,319.00	$40,319.00	$32,158.20	$32,158.20	$32,158.20	2026-05-14
392	OTHER	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	7	7	$5,975.00	$5,975.00	$5,359.70	$5,359.70	$5,359.70	2026-05-14
394	OTHER	Other Digestive System Diagnoses With Cc	7	7	$26,207.00	$26,207.00	$15,128.50	$15,128.50	$15,128.50	2026-05-14
395	OTHER	Other Digestive System Diagnoses Without Cc/mcc	7	7	$37,585.00	$37,585.00	$21,830.00	$21,830.00	$21,830.00	2026-05-14
405	OTHER	Pancreas, Liver And Shunt Procedures With Mcc	8	8	$41,076.00	$41,076.00	$4,939.00	$23,007.50	$23,007.50	2026-05-14
40652	OTHER	Repair Lip, Full Thickness; Up To Half Vertical Height	24	19	$4,420.00	$4,420.00	$513.50	$4,420.00	$4,420.00	2026-05-14
40799	OTHER	ER Fee I & D Lip Abscess	23	19	$3,987.00	$3,987.00	$3,987.00	$3,987.00	$3,987.00	2026-05-14
408	OTHER	Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With…	8	8	$22,620.00	$22,620.00	$4,939.00	$14,736.50	$14,736.50	2026-05-14
409	OTHER	Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With…	8	8	$21,945.00	$21,945.00	$4,939.00	$17,425.10	$17,425.10	2026-05-14
41017	OTHER	Extraoral Incision And Drainage Of Abscess, Cyst, Or Hematoma Of Floor Of Mouth;…	24	19	$6,341.00	$6,341.00	$520.00	$6,341.00	$6,341.00	2026-05-14
411	OTHER	Cholecystectomy With C.d.e. With Mcc	8	8	$40,800.50	$40,800.50	$4,939.00	$22,869.75	$22,869.75	2026-05-14
412	OTHER	Cholecystectomy With C.d.e. With Cc	8	8	$34,183.00	$34,183.00	$4,939.00	$21,475.00	$21,475.00	2026-05-14
417	OTHER	Laparoscopic Cholecystectomy Without C.d.e. With Mcc	8	8	$123,086.00	$123,086.00	$4,939.00	$66,883.50	$66,883.50	2026-05-14
418	OTHER	Laparoscopic Cholecystectomy Without C.d.e. With Cc	8	8	$63,336.52	$63,336.52	$4,939.00	$34,137.76	$34,137.76	2026-05-14
420	OTHER	Hepatobiliary Diagnostic Procedures With Mcc	8	8	$61,113.00	$61,113.00	$4,939.00	$37,811.00	$37,811.00	2026-05-14
421	OTHER	Hepatobiliary Diagnostic Procedures With Cc	8	8	$21,558.00	$21,558.00	$4,939.00	$13,248.50	$13,248.50	2026-05-14
42145	OTHER	Palatopharyngoplasty (eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty)	24	19	$8,409.00	$8,409.00	$1,023.50	$8,409.00	$8,409.00	2026-05-14
423	OTHER	Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc	8	8	$44,150.00	$44,150.00	$4,939.00	$27,415.50	$27,415.50	2026-05-14
432	OTHER	Cirrhosis And Alcoholic Hepatitis With Mcc	7	7	$26,336.50	$26,336.50	$14,180.75	$14,180.75	$14,180.75	2026-05-14
43215	OTHER	Esophagoscopy, Flexible, Transoral; With Removal Of Foreign Body(s)	24	19	$4,134.00	$4,134.00	$218.00	$4,134.00	$4,134.00	2026-05-14
43226	OTHER	Esoph Endoscopy Dilation	23	19	$5,761.00	$5,761.00	$5,761.00	$5,761.00	$5,761.00	2026-05-14
43281	OTHER	Lap Paraesophag Hern Repair	23	19	$3,248.00	$3,248.00	$3,248.00	$3,248.00	$3,248.00	2026-05-14
43880	OTHER	Repair Stomach-bowel Fistula	23	19	$3,311.00	$3,311.00	$3,311.00	$3,311.00	$3,311.00	2026-05-14
441	OTHER	Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc	7	7	$31,804.00	$31,804.00	$17,927.00	$17,927.00	$17,927.00	2026-05-14
44141	OTHER	Prtl Clctmy W Clstmy	23	19	$4,049.00	$4,049.00	$4,049.00	$4,049.00	$4,049.00	2026-05-14
44143	OTHER	Prtl Clctmy W Clstmy Hm	23	19	$3,448.00	$3,448.00	$3,448.00	$3,448.00	$3,448.00	2026-05-14
44144	OTHER	Prtl Clctmy W Ileo & Fstula	23	19	$3,932.00	$3,932.00	$3,932.00	$3,932.00	$3,932.00	2026-05-14
44145	OTHER	Partial Removal Of Colon	23	19	$3,436.00	$3,436.00	$3,436.00	$3,436.00	$3,436.00	2026-05-14
44146	OTHER	Prtl Remvl Colon W Reattch	23	19	$4,398.00	$4,398.00	$4,398.00	$4,398.00	$4,398.00	2026-05-14
44147	OTHER	Partial Removal Of Colon	23	19	$4,297.00	$4,297.00	$4,297.00	$4,297.00	$4,297.00	2026-05-14
44204	OTHER	Laparo Partial Colectomy	23	19	$3,430.00	$3,430.00	$3,430.00	$3,430.00	$3,430.00	2026-05-14
44207	OTHER	Prtl Colectomy/coloproctstmy	23	19	$3,776.00	$3,776.00	$3,776.00	$3,776.00	$3,776.00	2026-05-14
44227	OTHER	Lap Close Enterostomy	23	19	$3,458.00	$3,458.00	$3,458.00	$3,458.00	$3,458.00	2026-05-14
445	OTHER	Disorders Of The Biliary Tract With Cc	7	7	$97,750.00	$97,750.00	$52,925.00	$52,925.00	$52,925.00	2026-05-14
44603	OTHER	Suture Small Intestine	23	19	$3,587.00	$3,587.00	$3,587.00	$3,587.00	$3,587.00	2026-05-14
44661	OTHER	Repair Bowel-bladder Fistula	23	19	$3,351.00	$3,351.00	$3,351.00	$3,351.00	$3,351.00	2026-05-14
46040	OTHER	Incision And Drainage Of Ischiorectal And/or Perirectal Abscess (separate Proced…	24	19	$4,956.00	$4,956.00	$596.50	$4,956.00	$4,956.00	2026-05-14
46320	OTHER	Excision Of Thrombosed Hemorrhoid, External	24	19	$3,864.00	$3,864.00	$160.00	$3,864.00	$3,864.00	2026-05-14
47000	OTHER	Biopsy Of Liver, Needle; Percutaneous	24	19	$6,426.00	$6,426.00	$150.00	$6,426.00	$6,426.00	2026-05-14
47531	OTHER	Injection Procedure For Cholangiography, Percutaneous, Complete Diagnostic Proce…	24	19	$7,474.00	$7,474.00	$7,474.00	$7,474.00	$7,474.00	2026-05-14
48000	OTHER	Plmt Drn Act Pncrtts	23	19	$4,104.00	$4,104.00	$4,104.00	$4,104.00	$4,104.00	2026-05-14
48001	OTHER	Plmt Drn Wcholy/gstro/jjntmy	23	19	$4,792.00	$4,792.00	$4,792.00	$4,792.00	$4,792.00	2026-05-14
48102	OTHER	Pancreas Bx Ndl Perc	24	19	$6,426.00	$6,426.00	$353.50	$6,426.00	$6,426.00	2026-05-14
49083	OTHER	Abdominal Paracentesis (diagnostic Or Therapeutic); With Imaging Guidance	24	19	$4,226.00	$4,226.00	$158.00	$4,226.00	$4,226.00	2026-05-14
49180	OTHER	Biopsy, Abdominal Or Retroperitoneal Mass, Percutaneous Needle	24	19	$6,426.00	$6,426.00	$125.00	$6,426.00	$6,426.00	2026-05-14
49405	OTHER	Liver Abscess/cyst Drain	24	19	$6,426.00	$6,426.00	$309.50	$6,426.00	$6,426.00	2026-05-14
49406	OTHER	Appendiceal Abscess Drain	24	19	$6,426.00	$6,426.00	$310.00	$6,426.00	$6,426.00	2026-05-14
49423	OTHER	Abscess Assessment	24	19	$6,937.00	$6,937.00	$105.50	$6,937.00	$6,937.00	2026-05-14
5	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	8	8	$113,240.00	$113,240.00	$4,939.00	$62,917.50	$62,917.50	2026-05-14
50081	OTHER	Perq Nl/pl Lithotrip Cplx>2cm	23	19	$5,282.00	$5,282.00	$5,282.00	$5,282.00	$5,282.00	2026-05-14
50200	OTHER	Renal Biopsy; Percutaneous, By Trocar Or Needle	24	19	$6,426.00	$6,426.00	$207.50	$6,426.00	$6,426.00	2026-05-14
50543	OTHER	Laparo Partial Nephrectomy	23	19	$6,984.00	$6,984.00	$6,984.00	$6,984.00	$6,984.00	2026-05-14
50544	OTHER	Laparoscopy Pyeloplasty	23	19	$5,813.00	$5,813.00	$5,813.00	$5,813.00	$5,813.00	2026-05-14
50545	OTHER	Laparo Radical Nephrectomy	23	19	$6,246.00	$6,246.00	$6,246.00	$6,246.00	$6,246.00	2026-05-14
50546	OTHER	Laparoscopic Nephrectomy	23	19	$5,646.00	$5,646.00	$5,646.00	$5,646.00	$5,646.00	2026-05-14
50650	OTHER	Removal Of Ureter	23	19	$4,869.00	$4,869.00	$4,869.00	$4,869.00	$4,869.00	2026-05-14
50948	OTHER	Laparo New Ureter/bladder	23	19	$5,962.00	$5,962.00	$5,962.00	$5,962.00	$5,962.00	2026-05-14
51100	OTHER	Aspiration Of Bladder; By Needle	24	19	$3,682.00	$3,682.00	$56.50	$3,682.00	$3,682.00	2026-05-14
51102	OTHER	Aspiration Of Bladder; With Insertion Of Suprapubic Catheter	24	19	$5,742.00	$5,742.00	$209.00	$5,742.00	$5,742.00	2026-05-14
55100	OTHER	Drainage Of Scrotal Wall Abscess	24	19	$4,071.00	$4,071.00	$239.00	$4,071.00	$4,071.00	2026-05-14
56441	OTHER	Lysis Of Labial Adhesions	24	19	$4,687.00	$4,687.00	$199.00	$4,687.00	$4,687.00	2026-05-14
57065	OTHER	Destruction Of Vaginal Lesion(s); Extensive (eg, Laser Surgery, Electrosurgery, …	24	19	$4,240.00	$4,240.00	$250.00	$4,240.00	$4,240.00	2026-05-14
57105	OTHER	Biopsy Of Vaginal Mucosa; Extensive, Requiring Suture (including Cysts)	24	19	$5,370.00	$5,370.00	$180.50	$5,370.00	$5,370.00	2026-05-14
57200	OTHER	Colporrhaphy, Suture Of Injury Of Vagina (nonobstetrical)	24	19	$3,927.00	$3,927.00	$430.50	$3,927.00	$3,927.00	2026-05-14
58294	OTHER	Vag Hyst W/enterocele Compl	23	19	$3,475.00	$3,475.00	$3,475.00	$3,475.00	$3,475.00	2026-05-14
58563	OTHER	Hysteroscopy Ablation	23	19	$3,911.00	$3,911.00	$3,911.00	$3,911.00	$3,911.00	2026-05-14
58999	OTHER	Unlisted Procedure, Female Genital System (nonobstetrical)	24	19	$5,678.00	$5,678.00	$5,678.00	$5,678.00	$5,678.00	2026-05-14
59400	OTHER	Vag Delivery W/ante & Post	23	19	$5,059.00	$5,059.00	$5,059.00	$5,059.00	$5,059.00	2026-05-14
59409	OTHER	ER Fee Vaginal Delivery	24	19	$6,829.00	$6,829.00	$1,187.50	$6,829.00	$6,829.00	2026-05-14
59510	OTHER	Csec Delivery W/ante & Post	23	19	$5,591.00	$5,591.00	$5,591.00	$5,591.00	$5,591.00	2026-05-14
59610	OTHER	Vbac Delivery	23	19	$5,301.00	$5,301.00	$5,301.00	$5,301.00	$5,301.00	2026-05-14
59618	OTHER	Attempted Vbac Delivery	23	19	$5,668.00	$5,668.00	$5,668.00	$5,668.00	$5,668.00	2026-05-14
60300	OTHER	Aspiration And/or Injection, Thyroid Cyst	24	19	$3,293.00	$3,293.00	$72.50	$3,293.00	$3,293.00	2026-05-14
604	OTHER	Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc	7	7	$31,025.00	$31,025.00	$21,438.80	$21,438.80	$21,438.80	2026-05-14
627	OTHER	Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/mcc	8	8	$25,798.00	$25,798.00	$4,939.00	$16,325.50	$16,325.50	2026-05-14
628	OTHER	Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc	8	8	$26,675.00	$26,675.00	$4,939.00	$16,764.00	$16,764.00	2026-05-14
629	OTHER	Other Endocrine, Nutritional And Metabolic O.r. Procedures With Cc	8	8	$19,934.00	$19,934.00	$4,939.00	$12,436.50	$12,436.50	2026-05-14
644	OTHER	Endocrine Disorders With Cc	7	7	$59,134.00	$59,134.00	$35,642.00	$35,642.00	$35,642.00	2026-05-14
662	OTHER	Minor Bladder Procedures With Mcc	8	8	$62,295.00	$62,295.00	$4,939.00	$36,488.00	$36,488.00	2026-05-14
663	OTHER	Minor Bladder Procedures With Cc	8	8	$25,144.00	$25,144.00	$4,939.00	$15,041.50	$15,041.50	2026-05-14
668	OTHER	Transurethral Procedures With Mcc	8	8	$24,922.00	$24,922.00	$4,939.00	$14,930.50	$14,930.50	2026-05-14
671	OTHER	Urethral Procedures With Cc/mcc	8	8	$53,264.00	$53,264.00	$4,939.00	$30,058.50	$30,058.50	2026-05-14
673	OTHER	Other Kidney And Urinary Tract Procedures With Mcc	8	8	$143,742.00	$143,742.00	$4,939.00	$81,039.50	$81,039.50	2026-05-14
696	OTHER	Kidney And Urinary Tract Signs And Symptoms Without Mcc	7	7	$105,041.00	$105,041.00	$59,608.00	$59,608.00	$59,608.00	2026-05-14
698	OTHER	Other Kidney And Urinary Tract Diagnoses With Mcc	7	7	$106,893.00	$106,893.00	$56,484.00	$56,484.00	$56,484.00	2026-05-14
713	OTHER	Transurethral Prostatectomy With Cc/mcc	8	8	$88,153.50	$88,153.50	$4,939.00	$48,460.25	$48,460.25	2026-05-14
715	OTHER	Other Male Reproductive System O.r. Procedures For Malignancy With Cc/mcc	8	8	$241,141.00	$241,141.00	$4,939.00	$146,965.00	$146,965.00	2026-05-14
73220	OTHER	Magnetic Resonance (eg, Proton) Imaging, Upper Extremity, Other Than Joint; With…	120	19	$4,419.00	$4,419.00	$251.00	$5,832.00	$4,419.00	2026-05-14
73222	OTHER	Magnetic Resonance (eg, Proton) Imaging, Any Joint Of Upper Extremity; With Cont…	120	19	$3,209.00	$3,209.00	$193.00	$4,814.00	$3,209.00	2026-05-14
73223	OTHER	Magnetic Resonance (eg, Proton) Imaging, Any Joint Of Upper Extremity; Without C…	120	19	$3,891.00	$3,891.00	$251.00	$5,390.00	$3,891.00	2026-05-14
73225	OTHER	Magnetic Resonance Angiography, Upper Extremity, With Or Without Contrast Materi…	120	19	$4,857.00	$4,857.00	$205.00	$7,284.00	$4,857.00	2026-05-14
73706	OTHER	Computed Tomographic Angiography, Lower Extremity, With Contrast Material(s), In…	120	19	$3,512.00	$3,512.00	$219.00	$4,066.00	$3,512.00	2026-05-14
73719	OTHER	Magnetic Resonance (eg, Proton) Imaging, Lower Extremity Other Than Joint; With …	120	19	$3,295.00	$3,295.00	$191.00	$4,943.00	$3,295.00	2026-05-14
73720	OTHER	Magnetic Resonance (eg, Proton) Imaging, Lower Extremity Other Than Joint; Witho…	120	19	$4,613.00	$4,613.00	$250.00	$6,919.00	$4,613.00	2026-05-14
73722	OTHER	Magnetic Resonance (eg, Proton) Imaging, Any Joint Of Lower Extremity; With Cont…	120	19	$3,291.00	$3,291.00	$193.00	$4,937.00	$3,291.00	2026-05-14
740	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Cc	8	8	$48,295.50	$48,295.50	$4,939.00	$26,617.25	$26,617.25	2026-05-14
742	OTHER	Uterine And Adnexa Procedures For Non-malignancy With Cc/mcc	8	8	$26,718.00	$26,718.00	$4,939.00	$15,828.50	$15,828.50	2026-05-14
760	OTHER	Menstrual And Other Female Reproductive System Disorders With Cc/mcc	7	7	$59,560.00	$59,560.00	$32,817.50	$32,817.50	$32,817.50	2026-05-14
769	OTHER	Postpartum And Post Abortion Diagnoses With O.r. Procedures	8	8	$55,263.50	$55,263.50	$4,939.00	$32,972.25	$32,972.25	2026-05-14
770	OTHER	Abortion With D&c, Aspiration Curettage Or Hysterotomy	8	8	$58,190.50	$58,190.50	$4,939.00	$34,435.75	$34,435.75	2026-05-14
77295	OTHER	3-dimensional Radiotherapy Plan, Including Dose-volume Histograms	40	19	$14,254.00	$14,254.00	$684.00	$14,254.00	$14,254.00	2026-05-14
77470	OTHER	Special Treatment Procedure (eg, Total Body Irradiation, Hemibody Radiation, Per…	40	19	$3,462.00	$3,462.00	$218.00	$3,462.00	$3,462.00	2026-05-14
77778	OTHER	Interstitial Radiation Source Application, Complex, Includes Supervision, Handli…	40	19	$6,325.00	$6,325.00	$1,221.00	$6,325.00	$6,325.00	2026-05-14
78452	OTHER	Myocardial Perfusion Imaging, Tomographic (spect) (including Attenuation Correct…	72	19	$4,092.00	$4,092.00	$185.00	$4,646.88	$3,594.75	2026-05-14
78453	OTHER	Myocardial Perfusion Imaging, Planar (including Qualitative Or Quantitative Wall…	64	19	$3,415.00	$3,415.00	$118.00	$4,646.88	$3,415.00	2026-05-14
788	OTHER	Cesarean Section Without Sterilization Without Cc/mcc	8	8	$40,791.00	$40,791.00	$4,618.00	$24,477.00	$24,477.00	2026-05-14
78814	OTHER	Pet/ct Limited Area	46	19	$4,145.00	$4,145.00	$205.00	$8,085.00	$4,145.00	2026-05-14
78815	OTHER	Pet/ct Skull Base To Mid Thigh	46	19	$5,662.00	$5,662.00	$259.00	$11,065.00	$5,662.00	2026-05-14
78816	OTHER	Pet/ct Whole Body	46	19	$6,228.00	$6,228.00	$300.00	$12,156.00	$6,228.00	2026-05-14
790	OTHER	Extreme Immaturity Or Respiratory Distress Syndrome, Neonate	9	9	$50,433.50	$50,433.50	$1,234.00	$47,911.82	$45,390.15	2026-05-14
792	OTHER	Prematurity Without Major Problems	9	9	$109,101.00	$109,101.00	$2,468.00	$103,645.95	$98,190.90	2026-05-14
793	OTHER	Full Term Neonate With Major Problems	9	9	$34,617.00	$34,617.00	$1,851.00	$32,886.15	$31,155.30	2026-05-14
794	OTHER	Neonate With Other Significant Problems	9	9	$32,583.00	$32,583.00	$1,851.00	$30,953.85	$29,324.70	2026-05-14
795	OTHER	Normal Newborn	9	9	$80,535.00	$80,535.00	$1,851.00	$76,508.25	$72,481.50	2026-05-14
798	OTHER	Vaginal Delivery With Sterilization And/or D&c Without Cc/mcc	8	8	$54,999.00	$54,999.00	$4,939.00	$33,797.00	$33,797.00	2026-05-14
799	OTHER	Splenic Procedures With Mcc	8	8	$45,046.00	$45,046.00	$4,939.00	$25,949.50	$25,949.50	2026-05-14
800	OTHER	Splenic Procedures With Cc	8	8	$20,518.00	$20,518.00	$4,939.00	$12,728.50	$12,728.50	2026-05-14
802	OTHER	Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc	8	8	$46,485.50	$46,485.50	$4,939.00	$26,669.25	$26,669.25	2026-05-14
806	OTHER	Vaginal Delivery Without Sterilization Or D&c With Cc	8	8	$44,732.50	$44,732.50	$2,963.00	$24,230.75	$24,230.75	2026-05-14
807	OTHER	Vaginal Delivery Without Sterilization Or D&c Without Cc/mcc	8	8	$26,773.00	$26,773.00	$2,963.00	$14,868.00	$14,868.00	2026-05-14
811	OTHER	Red Blood Cell Disorders With Mcc	7	7	$35,622.00	$35,622.00	$26,798.50	$26,798.50	$26,798.50	2026-05-14
81162	OTHER	Brca1 (brca1, DNA Repair Associated), Brca2 (brca2, DNA Repair Associated) (eg, …	24	19	$3,236.00	$3,236.00	$2,324.28	$3,236.00	$3,236.00	2026-05-14
81229	OTHER	Cytogenomic (genome-wide) Analysis For Constitutional Chromosomal Abnormalities;…	24	19	$4,462.00	$4,462.00	$604.63	$4,462.00	$4,462.00	2026-05-14
814	OTHER	Reticuloendothelial And Immunity Disorders With Mcc	7	7	$52,153.00	$52,153.00	$28,101.50	$28,101.50	$28,101.50	2026-05-14
81443	OTHER	Genetic Testing For Severe Inherited Conditions (eg, Cystic Fibrosis, Ashkenazi …	24	19	$3,207.00	$3,207.00	$3,207.00	$3,207.00	$3,207.00	2026-05-14
815	OTHER	Reticuloendothelial And Immunity Disorders With Cc	7	7	$80,153.00	$80,153.00	$42,101.50	$42,101.50	$42,101.50	2026-05-14
831	OTHER	Other Antepartum Diagnoses Without O.r. Procedures With Mcc	7	7	$36,926.00	$36,926.00	$19,475.50	$19,475.50	$19,475.50	2026-05-14
832	OTHER	Other Antepartum Diagnoses Without O.r. Procedures With Cc	7	7	$25,183.50	$25,183.50	$13,604.25	$13,604.25	$13,604.25	2026-05-14
864	OTHER	Fever And Inflammatory Conditions	7	7	$66,614.00	$66,614.00	$35,332.00	$35,332.00	$35,332.00	2026-05-14
87999	OTHER	Unlisted Microbiology Procedure	24	19	$3,747.00	$3,747.00	$3,747.00	$3,747.00	$3,747.00	2026-05-14
895	OTHER	Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy	7	7	$186,370.00	$186,370.00	$111,410.00	$111,410.00	$111,410.00	2026-05-14
901	OTHER	Wound Debridements For Injuries With Mcc	8	8	$51,316.00	$51,316.00	$4,939.00	$31,955.50	$31,955.50	2026-05-14
904	OTHER	Skin Grafts For Injuries With Cc/mcc	8	8	$40,286.00	$40,286.00	$4,939.00	$25,483.50	$25,483.50	2026-05-14
906	OTHER	Hand Procedures For Injuries	8	8	$21,479.00	$21,479.00	$4,939.00	$17,425.10	$17,425.10	2026-05-14
907	OTHER	Other O.r. Procedures For Injuries With Mcc	8	8	$29,171.00	$29,171.00	$4,939.00	$18,012.00	$18,012.00	2026-05-14
927	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	8	8	$73,021.00	$73,021.00	$4,939.00	$54,554.50	$54,554.50	2026-05-14
928	OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	8	8	$86,926.00	$86,926.00	$4,939.00	$52,631.50	$52,631.50	2026-05-14
957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	8	8	$60,607.00	$60,607.00	$4,939.00	$37,558.00	$37,558.00	2026-05-14
99285	OTHER	Emergency Department Visit For The Evaluation And Management Of A Patient, Which…	48	19	$3,283.00	$3,283.00	$246.50	$3,283.00	$3,283.00	2026-05-14
99291	OTHER	Critical Care, Evaluation And Management Of The Critically Ill Or Critically Inj…	47	19	$5,222.00	$5,222.00	$316.50	$5,222.00	$5,222.00	2026-05-14
A4264	OTHER	Essure Permanent Birth	23	19	$9,911.00	$9,911.00	$9,911.00	$9,911.00	$9,911.00	2026-05-14
A9586	OTHER	Florbetapir F18	23	19	$6,355.00	$6,355.00	$6,355.00	$6,355.00	$6,355.00	2026-05-14
C1748	OTHER	Ercp Single Use Scope Exalt	23	19	$8,290.00	$8,290.00	$8,290.00	$8,290.00	$8,290.00	2026-05-14
C1762	OTHER	Tendon Patellar Preshaped Fz/i	24	19	$12,990.00	$12,990.00	$10,202.00	$12,990.00	$12,990.00	2026-05-14
C1771	OTHER	Mini Arc 720046-01	23	19	$7,382.00	$7,382.00	$7,382.00	$7,382.00	$7,382.00	2026-05-14
C1776	OTHER	Head Radial Explor 10x22mm	23	19	$9,970.00	$9,970.00	$9,970.00	$9,970.00	$9,970.00	2026-05-14
C1813	OTHER	Reservoir Titan Cl	23	19	$27,676.00	$27,676.00	$27,676.00	$27,676.00	$27,676.00	2026-05-14
L8699	OTHER	Urolift 2 Implant Cartridge	23	19	$6,323.00	$6,323.00	$6,323.00	$6,323.00	$6,323.00	2026-05-14

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