Hospital

FAMILY HEALTH WEST HOSPITAL

Fruita, CO · CCN 061302 · Rates published

2,665 distinct procedures filed

8 distinct payers

28,932 rate rows

2026-05-18 last MRF observed

Data quality

26,683 of 28,932 rate rows are consumer-grade (92.2%)

2,249 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	2,231
per-diem day rate — not a per-procedure price	9
placeholder amount (≤ $0.02) — excluded from medians	8
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	1

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

Source MRF file	https://www.fhw.org/wp-content/uploads/2026/03/84-0447998_Family_Health_West_standardcharges.csv
Found on page	https://fhw.org/patient-resources/price-transparency/
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-10-01
Content fingerprint	5dcbf375d3882bd5… · 4,681,118 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
583-4 OTHER	Neonate With Ecmo	1	$287,982.13	$287,982.13	$287,982.13	nat. median $256,360 1.1× median
588-4 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	1	$236,223.95	$236,223.95	$236,223.95	nat. median $237,575 1.0× median
583-3 OTHER	Neonate With Ecmo	1	$228,087.63	$228,087.63	$228,087.63	nat. median $243,309 0.9× median
161-4 OTHER	Implantable Heart Assist Systems	1	$225,858.15	$225,858.15	$225,858.15	nat. median $160,594 1.4× median
2-4 OTHER	Heart And/or Lung Transplant	1	$217,959.74	$217,959.74	$217,959.74	nat. median $217,960 1.0× median
161-3 OTHER	Implantable Heart Assist Systems	1	$173,030.84	$173,030.84	$173,030.84	nat. median $123,032 1.4× median
630-4 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	1	$171,460.35	$171,460.35	$171,460.35	nat. median $195,063 0.9× median
583-2 OTHER	Neonate With Ecmo	1	$168,192.40	$168,192.40	$168,192.40	nat. median $180,145 0.9× median
841-4 OTHER	Extensive Third Degree Burns With Skin Graft	1	$159,275.94	$159,275.94	$159,275.94	nat. median $113,251 1.4× median
593-4 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	1	$154,062.40	$154,062.40	$154,062.40	nat. median $130,075 1.2× median
588-3 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	1	$152,183.94	$152,183.94	$152,183.94	nat. median $151,101 1.0× median
588-2 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	1	$149,018.16	$149,018.16	$149,018.16	nat. median $133,956 1.1× median
591-4 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	1	$148,772.95	$148,772.95	$148,772.95	nat. median $134,440 1.1× median
11-4 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	$148,581.75	$148,581.75	$148,581.75	nat. median $148,582 1.0× median
609-4 OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	1	$147,824.24	$147,824.24	$147,824.24	nat. median $168,174 0.9× median
583-1 OTHER	Neonate With Ecmo	1	$145,348.82	$145,348.82	$145,348.82	nat. median $161,998 0.9× median
7-4 OTHER	Allogeneic Bone Marrow Transplant	1	$142,890.92	$142,890.92	$142,890.92	nat. median $142,891 1.0× median
631-4 OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	1	$141,917.40	$141,917.40	$141,917.40	nat. median $186,977 0.8× median
4-4 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	1	$141,534.26	$141,534.26	$141,534.26	nat. median $141,534 1.0× median
1-4 OTHER	Liver Transplant And/or Intestinal Transplant	1	$139,333.25	$139,333.25	$139,333.25	nat. median $139,333 1.0× median
161-2 OTHER	Implantable Heart Assist Systems	1	$138,928.95	$138,928.95	$138,928.95	nat. median $98,784 1.4× median
9-4 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	1	$138,565.52	$138,565.52	$138,565.52	nat. median $138,566 1.0× median
2-3 OTHER	Heart And/or Lung Transplant	1	$134,783.07	$134,783.07	$134,783.07	nat. median $134,783 1.0× median
161-1 OTHER	Implantable Heart Assist Systems	1	$131,981.44	$131,981.44	$131,981.44	nat. median $93,844 1.4× median
603-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	1	$123,840.02	$123,840.02	$123,840.02	nat. median $96,000 1.3× median
6-4 OTHER	Pancreas Transplant	1	$123,047.48	$123,047.48	$123,047.48	nat. median $123,047 1.0× median
602-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	1	$110,432.50	$110,432.50	$110,432.50	nat. median $108,600 1.0× median
589-1 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	1	$107,009.10	$107,009.10	$107,009.10	nat. median $62,432 1.7× median
910-4 OTHER	Craniotomy For Multiple Significant Trauma	1	$103,611.25	$103,611.25	$103,611.25	nat. median $44,381 outlier · 2.3×
2-2 OTHER	Heart And/or Lung Transplant	1	$100,023.65	$100,023.65	$100,023.65	nat. median $100,024 1.0× median
593-3 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	1	$99,072.74	$99,072.74	$99,072.74	nat. median $104,150 1.0× median
588-1 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	1	$98,089.00	$98,089.00	$98,089.00	nat. median $98,306 1.0× median
911-4 OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	1	$97,886.12	$97,886.12	$97,886.12	nat. median $41,928 outlier · 2.3×
589-2 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	1	$97,281.86	$97,281.86	$97,281.86	nat. median $43,588 outlier · 2.2×
4-3 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	1	$96,855.67	$96,855.67	$96,855.67	nat. median $96,856 1.0× median
160-4 OTHER	Major Cardiothoracic Repair Of Heart Anomaly	1	$95,570.53	$95,570.53	$95,570.53	nat. median $70,619 1.4× median
912-4 OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	1	$95,105.66	$95,105.66	$95,105.66	nat. median $42,788 outlier · 2.2×
5-4 OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	1	$93,273.91	$93,273.91	$93,273.91	nat. median $93,274 1.0× median
162-4 OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	1	$90,073.10	$90,073.10	$90,073.10	nat. median $64,046 1.4× median
589-3 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	1	$88,438.39	$88,438.39	$88,438.39	nat. median $54,353 1.6× median
591-3 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	1	$87,158.36	$87,158.36	$87,158.36	nat. median $95,550 0.9× median
602-3 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	1	$87,078.81	$87,078.81	$87,078.81	nat. median $93,264 0.9× median
6-3 OTHER	Pancreas Transplant	1	$86,520.53	$86,520.53	$86,520.53	nat. median $86,521 1.0× median
303-4 OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	1	$86,112.58	$86,112.58	$86,112.58	nat. median $78,865 1.1× median
2-1 OTHER	Heart And/or Lung Transplant	1	$85,746.96	$85,746.96	$85,746.96	nat. median $85,747 1.0× median
607-4 OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	1	$84,821.60	$84,821.60	$84,821.60	nat. median $98,925 0.9× median
7-3 OTHER	Allogeneic Bone Marrow Transplant	1	$84,209.31	$84,209.31	$84,209.31	nat. median $84,209 1.0× median
630-3 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	1	$82,845.36	$82,845.36	$82,845.36	nat. median $95,000 0.9× median
440-4 OTHER	Kidney Transplant	1	$81,865.26	$81,865.26	$81,865.26	nat. median $76,896 1.1× median
1-3 OTHER	Liver Transplant And/or Intestinal Transplant	1	$80,553.12	$80,553.12	$80,553.12	nat. median $80,553 1.0× median

Other procedures at this hospital

Browse this hospital's 2,665 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

1-1	OTHER	Liver Transplant And/or Intestinal Transplant	1	1	—	—	$59,942.67	$59,942.67	$59,942.67	2026-05-18
1-2	OTHER	Liver Transplant And/or Intestinal Transplant	1	1	—	—	$67,512.68	$67,512.68	$67,512.68	2026-05-18
1-3	OTHER	Liver Transplant And/or Intestinal Transplant	1	1	—	—	$80,553.12	$80,553.12	$80,553.12	2026-05-18
1-4	OTHER	Liver Transplant And/or Intestinal Transplant	1	1	—	—	$139,333.25	$139,333.25	$139,333.25	2026-05-18
11-1	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	1	—	—	$26,108.61	$26,108.61	$26,108.61	2026-05-18
11-2	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	1	—	—	$38,739.64	$38,739.64	$38,739.64	2026-05-18
11-3	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	1	—	—	$73,135.63	$73,135.63	$73,135.63	2026-05-18
11-4	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	1	—	—	$148,581.75	$148,581.75	$148,581.75	2026-05-18
120-3	OTHER	Major Respiratory And Chest Procedures	1	1	—	—	$29,052.54	$29,052.54	$29,052.54	2026-05-18
120-4	OTHER	Major Respiratory And Chest Procedures	1	1	—	—	$50,677.38	$50,677.38	$50,677.38	2026-05-18
121-4	OTHER	Other Respiratory And Chest Procedures	1	1	—	—	$41,435.45	$41,435.45	$41,435.45	2026-05-18
130-1	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	1	1	—	—	$30,323.82	$30,323.82	$30,323.82	2026-05-18
130-2	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	1	1	—	—	$30,331.12	$30,331.12	$30,331.12	2026-05-18
130-3	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	1	1	—	—	$37,127.56	$37,127.56	$37,127.56	2026-05-18
130-4	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	1	1	—	—	$48,092.50	$48,092.50	$48,092.50	2026-05-18
160-1	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	1	1	—	—	$26,994.56	$26,994.56	$26,994.56	2026-05-18
160-2	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	1	1	—	—	$33,249.51	$33,249.51	$33,249.51	2026-05-18
160-3	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	1	1	—	—	$51,302.07	$51,302.07	$51,302.07	2026-05-18
160-4	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	1	1	—	—	$95,570.53	$95,570.53	$95,570.53	2026-05-18
161-1	OTHER	Implantable Heart Assist Systems	1	1	—	—	$131,981.44	$131,981.44	$131,981.44	2026-05-18
161-2	OTHER	Implantable Heart Assist Systems	1	1	—	—	$138,928.95	$138,928.95	$138,928.95	2026-05-18
161-3	OTHER	Implantable Heart Assist Systems	1	1	—	—	$173,030.84	$173,030.84	$173,030.84	2026-05-18
161-4	OTHER	Implantable Heart Assist Systems	1	1	—	—	$225,858.15	$225,858.15	$225,858.15	2026-05-18
162-1	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	1	1	—	—	$41,724.44	$41,724.44	$41,724.44	2026-05-18
162-2	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	1	1	—	—	$48,893.80	$48,893.80	$48,893.80	2026-05-18
162-3	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	1	1	—	—	$61,692.68	$61,692.68	$61,692.68	2026-05-18
162-4	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	1	1	—	—	$90,073.10	$90,073.10	$90,073.10	2026-05-18
163-1	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	1	1	—	—	$36,493.38	$36,493.38	$36,493.38	2026-05-18
163-2	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	1	1	—	—	$40,382.38	$40,382.38	$40,382.38	2026-05-18
163-3	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	1	1	—	—	$51,025.49	$51,025.49	$51,025.49	2026-05-18
163-4	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	1	1	—	—	$76,646.60	$76,646.60	$76,646.60	2026-05-18
165-1	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	1	1	—	—	$35,357.11	$35,357.11	$35,357.11	2026-05-18
165-2	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	1	1	—	—	$43,055.56	$43,055.56	$43,055.56	2026-05-18
165-3	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	1	1	—	—	$51,767.67	$51,767.67	$51,767.67	2026-05-18
165-4	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	1	1	—	—	$70,091.72	$70,091.72	$70,091.72	2026-05-18
166-1	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	1	1	—	—	$32,548.92	$32,548.92	$32,548.92	2026-05-18
166-2	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	1	1	—	—	$36,242.33	$36,242.33	$36,242.33	2026-05-18
166-3	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	1	1	—	—	$43,038.78	$43,038.78	$43,038.78	2026-05-18
166-4	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	1	1	—	—	$63,181.43	$63,181.43	$63,181.43	2026-05-18
167-1	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	1	1	—	—	$27,364.56	$27,364.56	$27,364.56	2026-05-18
167-2	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	1	1	—	—	$28,443.91	$28,443.91	$28,443.91	2026-05-18
167-3	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	1	1	—	—	$42,941.71	$42,941.71	$42,941.71	2026-05-18
167-4	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	1	1	—	—	$68,944.51	$68,944.51	$68,944.51	2026-05-18
169-1	OTHER	Major Abdominal Vascular Procedures	1	1	—	—	$27,447.76	$27,447.76	$27,447.76	2026-05-18
169-2	OTHER	Major Abdominal Vascular Procedures	1	1	—	—	$27,817.75	$27,817.75	$27,817.75	2026-05-18
169-3	OTHER	Major Abdominal Vascular Procedures	1	1	—	—	$36,350.34	$36,350.34	$36,350.34	2026-05-18
169-4	OTHER	Major Abdominal Vascular Procedures	1	1	—	—	$59,135.53	$59,135.53	$59,135.53	2026-05-18
170-3	OTHER	Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock	1	1	—	—	$29,656.07	$29,656.07	$29,656.07	2026-05-18
170-4	OTHER	Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock	1	1	—	—	$41,698.17	$41,698.17	$41,698.17	2026-05-18
171-4	OTHER	Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock	1	1	—	—	$33,299.86	$33,299.86	$33,299.86	2026-05-18
174-4	OTHER	Percutaneous Cardiac Intervention With Ami	1	1	—	—	$35,306.76	$35,306.76	$35,306.76	2026-05-18
175-3	OTHER	Percutaneous Cardiac Intervention Without Ami	1	1	—	—	$26,659.59	$26,659.59	$26,659.59	2026-05-18
175-4	OTHER	Percutaneous Cardiac Intervention Without Ami	1	1	—	—	$39,012.58	$39,012.58	$39,012.58	2026-05-18
176-3	OTHER	Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices	1	1	—	—	$29,000.73	$29,000.73	$29,000.73	2026-05-18
176-4	OTHER	Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices	1	1	—	—	$48,033.39	$48,033.39	$48,033.39	2026-05-18
177-4	OTHER	Cardiac Pacemaker And Defibrillator Revision Except Device Replacement	1	1	—	—	$30,255.95	$30,255.95	$30,255.95	2026-05-18
178-1	OTHER	External Heart Assist Systems	1	1	—	—	$46,805.17	$46,805.17	$46,805.17	2026-05-18
178-2	OTHER	External Heart Assist Systems	1	1	—	—	$52,477.02	$52,477.02	$52,477.02	2026-05-18
178-3	OTHER	External Heart Assist Systems	1	1	—	—	$56,324.42	$56,324.42	$56,324.42	2026-05-18
178-4	OTHER	External Heart Assist Systems	1	1	—	—	$76,135.03	$76,135.03	$76,135.03	2026-05-18
179-1	OTHER	Defibrillator Implants	1	1	—	—	$32,517.54	$32,517.54	$32,517.54	2026-05-18
179-2	OTHER	Defibrillator Implants	1	1	—	—	$36,850.97	$36,850.97	$36,850.97	2026-05-18
179-3	OTHER	Defibrillator Implants	1	1	—	—	$45,228.85	$45,228.85	$45,228.85	2026-05-18
179-4	OTHER	Defibrillator Implants	1	1	—	—	$62,029.11	$62,029.11	$62,029.11	2026-05-18
180-4	OTHER	Other Circulatory System Procedures	1	1	—	—	$35,186.34	$35,186.34	$35,186.34	2026-05-18
181-3	OTHER	Lower Extremity Arterial Procedures	1	1	—	—	$31,360.84	$31,360.84	$31,360.84	2026-05-18
181-4	OTHER	Lower Extremity Arterial Procedures	1	1	—	—	$48,893.80	$48,893.80	$48,893.80	2026-05-18
182-4	OTHER	Other Peripheral Vascular And Related Procedures	1	1	—	—	$41,540.54	$41,540.54	$41,540.54	2026-05-18
183-1	OTHER	Percutaneous Structural Cardiac Procedures	1	1	—	—	$38,104.00	$38,104.00	$38,104.00	2026-05-18
183-2	OTHER	Percutaneous Structural Cardiac Procedures	1	1	—	—	$39,195.75	$39,195.75	$39,195.75	2026-05-18
183-3	OTHER	Percutaneous Structural Cardiac Procedures	1	1	—	—	$45,638.25	$45,638.25	$45,638.25	2026-05-18
183-4	OTHER	Percutaneous Structural Cardiac Procedures	1	1	—	—	$64,969.39	$64,969.39	$64,969.39	2026-05-18
2-1	OTHER	Heart And/or Lung Transplant	1	1	—	—	$85,746.96	$85,746.96	$85,746.96	2026-05-18
2-2	OTHER	Heart And/or Lung Transplant	1	1	—	—	$100,023.65	$100,023.65	$100,023.65	2026-05-18
2-3	OTHER	Heart And/or Lung Transplant	1	1	—	—	$134,783.07	$134,783.07	$134,783.07	2026-05-18
2-4	OTHER	Heart And/or Lung Transplant	1	1	—	—	$217,959.74	$217,959.74	$217,959.74	2026-05-18
20-3	OTHER	Open Craniotomy For Trauma	1	1	—	—	$32,566.43	$32,566.43	$32,566.43	2026-05-18
20-4	OTHER	Open Craniotomy For Trauma	1	1	—	—	$50,912.37	$50,912.37	$50,912.37	2026-05-18
21-3	OTHER	Open Craniotomy Except Trauma	1	1	—	—	$35,370.98	$35,370.98	$35,370.98	2026-05-18
21-4	OTHER	Open Craniotomy Except Trauma	1	1	—	—	$55,185.23	$55,185.23	$55,185.23	2026-05-18
22-4	OTHER	Ventricular Shunt Procedures	1	1	—	—	$42,171.07	$42,171.07	$42,171.07	2026-05-18
220-3	OTHER	Major Stomach, Esophageal And Duodenal Procedures	1	1	—	—	$29,266.37	$29,266.37	$29,266.37	2026-05-18
220-4	OTHER	Major Stomach, Esophageal And Duodenal Procedures	1	1	—	—	$52,271.22	$52,271.22	$52,271.22	2026-05-18
222-4	OTHER	Other Stomach, Esophageal And Duodenal Procedures	1	1	—	—	$38,395.92	$38,395.92	$38,395.92	2026-05-18
223-4	OTHER	Other Small And Large Bowel Procedures	1	1	—	—	$36,903.52	$36,903.52	$36,903.52	2026-05-18
224-4	OTHER	Peritoneal Adhesiolysis	1	1	—	—	$35,839.50	$35,839.50	$35,839.50	2026-05-18
227-4	OTHER	Hernia Procedures Except Inguinal, Femoral And Umbilical	1	1	—	—	$36,122.65	$36,122.65	$36,122.65	2026-05-18
228-4	OTHER	Inguinal, Femoral And Umbilical Hernia Procedures	1	1	—	—	$25,741.53	$25,741.53	$25,741.53	2026-05-18
229-4	OTHER	Other Digestive System And Abdominal Procedures	1	1	—	—	$38,377.67	$38,377.67	$38,377.67	2026-05-18
23-3	OTHER	Spinal Procedures	1	1	—	—	$34,381.40	$34,381.40	$34,381.40	2026-05-18
23-4	OTHER	Spinal Procedures	1	1	—	—	$55,952.23	$55,952.23	$55,952.23	2026-05-18
230-4	OTHER	Major Small Bowel Procedures	1	1	—	—	$46,849.69	$46,849.69	$46,849.69	2026-05-18
231-4	OTHER	Major Large Bowel Procedures	1	1	—	—	$41,221.62	$41,221.62	$41,221.62	2026-05-18
232-4	OTHER	Gastric Fundoplication	1	1	—	—	$38,487.14	$38,487.14	$38,487.14	2026-05-18
233-4	OTHER	Appendectomy With Complex Principal Diagnosis	1	1	—	—	$27,190.87	$27,190.87	$27,190.87	2026-05-18
24-4	OTHER	Open Extracranial Vascular Procedures	1	1	—	—	$36,901.33	$36,901.33	$36,901.33	2026-05-18
24685	CPT	Optx Ulnar Fx Prox End W/fix	16	8	—	—	$8,660.05	$46,163.01	$27,411.53	2026-05-18
26-4	OTHER	Other Nervous System And Related Procedures	1	1	—	—	$42,425.76	$42,425.76	$42,425.76	2026-05-18
260-3	OTHER	Major Pancreas, Liver And Shunt Procedures	1	1	—	—	$28,857.69	$28,857.69	$28,857.69	2026-05-18
260-4	OTHER	Major Pancreas, Liver And Shunt Procedures	1	1	—	—	$54,483.19	$54,483.19	$54,483.19	2026-05-18
261-4	OTHER	Major Biliary Tract Procedures	1	1	—	—	$47,889.62	$47,889.62	$47,889.62	2026-05-18
263-4	OTHER	Cholecystectomy	1	1	—	—	$30,185.89	$30,185.89	$30,185.89	2026-05-18
264-4	OTHER	Other Hepatobiliary, Pancreas And Abdominal Procedures	1	1	—	—	$42,538.15	$42,538.15	$42,538.15	2026-05-18
27-3	OTHER	Other Open Craniotomy	1	1	—	—	$29,502.09	$29,502.09	$29,502.09	2026-05-18
27-4	OTHER	Other Open Craniotomy	1	1	—	—	$48,642.76	$48,642.76	$48,642.76	2026-05-18
27640	CPT	Partial Removal Of Tibia	16	8	—	—	$12,265.27	$44,443.51	$28,354.39	2026-05-18
29-4	OTHER	Other Percutaneous Intracranial Procedures	1	1	—	—	$39,435.85	$39,435.85	$39,435.85	2026-05-18
30-3	OTHER	Percutaneous Intracranial And Extracranial Vascular Procedures	1	1	—	—	$32,613.14	$32,613.14	$32,613.14	2026-05-18
30-4	OTHER	Percutaneous Intracranial And Extracranial Vascular Procedures	1	1	—	—	$43,057.75	$43,057.75	$43,057.75	2026-05-18
303-1	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	1	1	—	—	$39,440.96	$39,440.96	$39,440.96	2026-05-18
303-2	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	1	1	—	—	$47,372.21	$47,372.21	$47,372.21	2026-05-18
303-3	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	1	1	—	—	$65,201.46	$65,201.46	$65,201.46	2026-05-18
303-4	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	1	1	—	—	$86,112.58	$86,112.58	$86,112.58	2026-05-18
304-1	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	1	1	—	—	$26,656.67	$26,656.67	$26,656.67	2026-05-18
304-2	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	1	1	—	—	$31,667.34	$31,667.34	$31,667.34	2026-05-18
304-3	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	1	1	—	—	$44,667.64	$44,667.64	$44,667.64	2026-05-18
304-4	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	1	1	—	—	$66,095.44	$66,095.44	$66,095.44	2026-05-18
305-4	OTHER	Amputation Of Lower Limb Except Toes	1	1	—	—	$37,316.57	$37,316.57	$37,316.57	2026-05-18
308-4	OTHER	Hip And Femur Fracture Repair	1	1	—	—	$29,176.60	$29,176.60	$29,176.60	2026-05-18
309-4	OTHER	Other Significant Hip And Femur Surgery	1	1	—	—	$39,123.51	$39,123.51	$39,123.51	2026-05-18
310-4	OTHER	Vertebral And Intervertebral Spinal Procedures Including Disc Procedures	1	1	—	—	$34,160.27	$34,160.27	$34,160.27	2026-05-18
312-3	OTHER	Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses	1	1	—	—	$28,949.64	$28,949.64	$28,949.64	2026-05-18
312-4	OTHER	Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses	1	1	—	—	$58,710.80	$58,710.80	$58,710.80	2026-05-18
313-4	OTHER	Knee And Lower Leg Procedures Except Foot	1	1	—	—	$37,157.48	$37,157.48	$37,157.48	2026-05-18
314-4	OTHER	Foot And Toe Procedures	1	1	—	—	$26,976.32	$26,976.32	$26,976.32	2026-05-18
315-4	OTHER	Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement	1	1	—	—	$35,370.98	$35,370.98	$35,370.98	2026-05-18
316-4	OTHER	Hand And Wrist Procedures	1	1	—	—	$29,221.12	$29,221.12	$29,221.12	2026-05-18
317-4	OTHER	Tendon, Muscle And Other Soft Tissue Procedures	1	1	—	—	$32,745.23	$32,745.23	$32,745.23	2026-05-18
320-4	OTHER	Other Musculoskeletal System And Connective Tissue Procedures	1	1	—	—	$34,527.35	$34,527.35	$34,527.35	2026-05-18
321-3	OTHER	Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures	1	1	—	—	$27,743.32	$27,743.32	$27,743.32	2026-05-18
321-4	OTHER	Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures	1	1	—	—	$43,373.74	$43,373.74	$43,373.74	2026-05-18
322-4	OTHER	Shoulder And Elbow Joint Replacement	1	1	—	—	$32,873.67	$32,873.67	$32,873.67	2026-05-18
323-4	OTHER	Non-elective Or Complex Hip Joint Replacement	1	1	—	—	$33,143.69	$33,143.69	$33,143.69	2026-05-18
324-4	OTHER	Elective Hip Joint Replacement	1	1	—	—	$33,175.07	$33,175.07	$33,175.07	2026-05-18
325-3	OTHER	Non-elective Or Complex Knee Joint Replacement	1	1	—	—	$30,357.39	$30,357.39	$30,357.39	2026-05-18
325-4	OTHER	Non-elective Or Complex Knee Joint Replacement	1	1	—	—	$42,258.64	$42,258.64	$42,258.64	2026-05-18
326-4	OTHER	Elective Knee Joint Replacement	1	1	—	—	$27,963.71	$27,963.71	$27,963.71	2026-05-18
361-4	OTHER	Skin Graft For Skin And Subcutaneous Tissue Diagnoses	1	1	—	—	$49,719.91	$49,719.91	$49,719.91	2026-05-18
362-4	OTHER	Mastectomy Procedures	1	1	—	—	$36,516.00	$36,516.00	$36,516.00	2026-05-18
363-4	OTHER	Breast Procedures Except Mastectomy	1	1	—	—	$29,510.84	$29,510.84	$29,510.84	2026-05-18
364-4	OTHER	Other Skin, Subcutaneous Tissue And Related Procedures	1	1	—	—	$28,067.34	$28,067.34	$28,067.34	2026-05-18
4-1	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	1	1	—	—	$44,466.95	$44,466.95	$44,466.95	2026-05-18
4-2	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	1	1	—	—	$66,588.78	$66,588.78	$66,588.78	2026-05-18
4-3	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	1	1	—	—	$96,855.67	$96,855.67	$96,855.67	2026-05-18
4-4	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	1	1	—	—	$141,534.26	$141,534.26	$141,534.26	2026-05-18
40-4	OTHER	Spinal Disorders And Injuries	1	1	—	—	$26,345.06	$26,345.06	$26,345.06	2026-05-18
401-3	OTHER	Adrenal Procedures	1	1	—	—	$27,327.34	$27,327.34	$27,327.34	2026-05-18
401-4	OTHER	Adrenal Procedures	1	1	—	—	$45,882.73	$45,882.73	$45,882.73	2026-05-18
403-4	OTHER	Procedures For Obesity	1	1	—	—	$36,325.53	$36,325.53	$36,325.53	2026-05-18
404-4	OTHER	Thyroid, Parathyroid And Thyroglossal Procedures	1	1	—	—	$45,090.19	$45,090.19	$45,090.19	2026-05-18
405-4	OTHER	Other Procedures For Endocrine, Nutritional And Metabolic Disorders	1	1	—	—	$42,076.93	$42,076.93	$42,076.93	2026-05-18
43-4	OTHER	Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies	1	1	—	—	$29,037.22	$29,037.22	$29,037.22	2026-05-18
440-1	OTHER	Kidney Transplant	1	1	—	—	$41,325.98	$41,325.98	$41,325.98	2026-05-18
440-2	OTHER	Kidney Transplant	1	1	—	—	$46,281.19	$46,281.19	$46,281.19	2026-05-18
440-3	OTHER	Kidney Transplant	1	1	—	—	$53,962.12	$53,962.12	$53,962.12	2026-05-18
440-4	OTHER	Kidney Transplant	1	1	—	—	$81,865.26	$81,865.26	$81,865.26	2026-05-18
441-3	OTHER	Major Bladder Procedures	1	1	—	—	$28,005.31	$28,005.31	$28,005.31	2026-05-18
441-4	OTHER	Major Bladder Procedures	1	1	—	—	$55,175.75	$55,175.75	$55,175.75	2026-05-18
442-4	OTHER	Kidney And Urinary Tract Procedures For Malignancy	1	1	—	—	$38,910.41	$38,910.41	$38,910.41	2026-05-18
443-4	OTHER	Kidney And Urinary Tract Procedures For Non-malignancy	1	1	—	—	$31,619.91	$31,619.91	$31,619.91	2026-05-18
444-4	OTHER	Renal Dialysis Access Device Procedures	1	1	—	—	$32,767.12	$32,767.12	$32,767.12	2026-05-18
445-4	OTHER	Other Bladder Procedures	1	1	—	—	$30,255.22	$30,255.22	$30,255.22	2026-05-18
447-4	OTHER	Other Kidney, Urinary Tract And Related Procedures	1	1	—	—	$40,748.00	$40,748.00	$40,748.00	2026-05-18
480-4	OTHER	Major Male Pelvic Procedures	1	1	—	—	$34,842.62	$34,842.62	$34,842.62	2026-05-18
483-4	OTHER	Penis, Testes And Scrotal Procedures	1	1	—	—	$31,794.33	$31,794.33	$31,794.33	2026-05-18
484-4	OTHER	Other Male Reproductive System And Related Procedures	1	1	—	—	$35,339.60	$35,339.60	$35,339.60	2026-05-18
49-4	OTHER	Bacterial And Tuberculous Infections Of Nervous System	1	1	—	—	$32,636.49	$32,636.49	$32,636.49	2026-05-18
5-1	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	1	1	—	—	$41,749.98	$41,749.98	$41,749.98	2026-05-18
5-2	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	1	1	—	—	$50,276.73	$50,276.73	$50,276.73	2026-05-18
5-3	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	1	1	—	—	$68,685.43	$68,685.43	$68,685.43	2026-05-18
5-4	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	1	1	—	—	$93,273.91	$93,273.91	$93,273.91	2026-05-18
50-4	OTHER	Non-bacterial Infections Of Nervous System Except Viral Meningitis	1	1	—	—	$34,512.76	$34,512.76	$34,512.76	2026-05-18
510-4	OTHER	Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced…	1	1	—	—	$46,832.17	$46,832.17	$46,832.17	2026-05-18
511-4	OTHER	Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy	1	1	—	—	$42,276.89	$42,276.89	$42,276.89	2026-05-18
512-4	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy	1	1	—	—	$37,541.34	$37,541.34	$37,541.34	2026-05-18
513-4	OTHER	Uterine And Adnexa Procedures For Non-malignancy Except Leiomyoma	1	1	—	—	$28,223.51	$28,223.51	$28,223.51	2026-05-18
514-4	OTHER	Female Reproductive System Reconstructive Procedures	1	1	—	—	$36,037.27	$36,037.27	$36,037.27	2026-05-18
518-4	OTHER	Other Female Reproductive System And Related Procedures	1	1	—	—	$34,577.71	$34,577.71	$34,577.71	2026-05-18
519-4	OTHER	Uterine And Adnexa Procedures For Leiomyoma	1	1	—	—	$33,789.54	$33,789.54	$33,789.54	2026-05-18
548-4	OTHER	Postpartum And Post Abortion Diagnosis With O.r. Procedure	1	1	—	—	$30,812.04	$30,812.04	$30,812.04	2026-05-18
583-1	OTHER	Neonate With Ecmo	1	1	—	—	$145,348.82	$145,348.82	$145,348.82	2026-05-18
583-2	OTHER	Neonate With Ecmo	1	1	—	—	$168,192.40	$168,192.40	$168,192.40	2026-05-18
583-3	OTHER	Neonate With Ecmo	1	1	—	—	$228,087.63	$228,087.63	$228,087.63	2026-05-18
583-4	OTHER	Neonate With Ecmo	1	1	—	—	$287,982.13	$287,982.13	$287,982.13	2026-05-18
588-1	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	1	1	—	—	$98,089.00	$98,089.00	$98,089.00	2026-05-18
588-2	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	1	1	—	—	$149,018.16	$149,018.16	$149,018.16	2026-05-18
588-3	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	1	1	—	—	$152,183.94	$152,183.94	$152,183.94	2026-05-18
588-4	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	1	1	—	—	$236,223.95	$236,223.95	$236,223.95	2026-05-18
589-1	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	1	1	—	—	$107,009.10	$107,009.10	$107,009.10	2026-05-18
589-2	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	1	1	—	—	$97,281.86	$97,281.86	$97,281.86	2026-05-18
589-3	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	1	1	—	—	$88,438.39	$88,438.39	$88,438.39	2026-05-18
591-2	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	1	1	—	—	$46,378.98	$46,378.98	$46,378.98	2026-05-18
591-3	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	1	1	—	—	$87,158.36	$87,158.36	$87,158.36	2026-05-18
591-4	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	1	1	—	—	$148,772.95	$148,772.95	$148,772.95	2026-05-18
593-2	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	1	1	—	—	$78,524.33	$78,524.33	$78,524.33	2026-05-18
593-3	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	1	1	—	—	$99,072.74	$99,072.74	$99,072.74	2026-05-18
593-4	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	1	1	—	—	$154,062.40	$154,062.40	$154,062.40	2026-05-18
6-1	OTHER	Pancreas Transplant	1	1	—	—	$59,038.47	$59,038.47	$59,038.47	2026-05-18
6-2	OTHER	Pancreas Transplant	1	1	—	—	$75,108.23	$75,108.23	$75,108.23	2026-05-18
6-3	OTHER	Pancreas Transplant	1	1	—	—	$86,520.53	$86,520.53	$86,520.53	2026-05-18
6-4	OTHER	Pancreas Transplant	1	1	—	—	$123,047.48	$123,047.48	$123,047.48	2026-05-18
602-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$66,444.28	$66,444.28	$66,444.28	2026-05-18
602-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$87,078.81	$87,078.81	$87,078.81	2026-05-18
602-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$110,432.50	$110,432.50	$110,432.50	2026-05-18
603-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	1	1	—	—	$29,734.16	$29,734.16	$29,734.16	2026-05-18
603-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	1	1	—	—	$60,264.50	$60,264.50	$60,264.50	2026-05-18
603-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	1	1	—	—	$123,840.02	$123,840.02	$123,840.02	2026-05-18
607-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$51,095.55	$51,095.55	$51,095.55	2026-05-18
607-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$65,986.71	$65,986.71	$65,986.71	2026-05-18
607-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$84,821.60	$84,821.60	$84,821.60	2026-05-18
608-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	1	1	—	—	$37,758.82	$37,758.82	$37,758.82	2026-05-18
608-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	1	1	—	—	$51,148.09	$51,148.09	$51,148.09	2026-05-18
608-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	1	1	—	—	$53,705.97	$53,705.97	$53,705.97	2026-05-18
609-1	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	1	1	—	—	$33,231.99	$33,231.99	$33,231.99	2026-05-18
609-2	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	1	1	—	—	$34,981.27	$34,981.27	$34,981.27	2026-05-18
609-3	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	1	1	—	—	$73,646.48	$73,646.48	$73,646.48	2026-05-18
609-4	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	1	1	—	—	$147,824.24	$147,824.24	$147,824.24	2026-05-18
611-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	1	1	—	—	$41,983.51	$41,983.51	$41,983.51	2026-05-18
611-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	1	1	—	—	$64,457.82	$64,457.82	$64,457.82	2026-05-18
612-2	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$33,569.15	$33,569.15	$33,569.15	2026-05-18
612-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$43,348.93	$43,348.93	$43,348.93	2026-05-18
612-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$61,637.95	$61,637.95	$61,637.95	2026-05-18
613-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	1	1	—	—	$39,435.12	$39,435.12	$39,435.12	2026-05-18
613-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	1	1	—	—	$60,474.68	$60,474.68	$60,474.68	2026-05-18
614-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	1	1	—	—	$37,281.54	$37,281.54	$37,281.54	2026-05-18
614-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	1	1	—	—	$48,598.24	$48,598.24	$48,598.24	2026-05-18
621-3	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	1	1	—	—	$29,683.07	$29,683.07	$29,683.07	2026-05-18
621-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	1	1	—	—	$50,568.65	$50,568.65	$50,568.65	2026-05-18
622-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$39,913.13	$39,913.13	$39,913.13	2026-05-18
623-3	OTHER	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	1	1	—	—	$30,206.32	$30,206.32	$30,206.32	2026-05-18
623-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	1	1	—	—	$36,630.58	$36,630.58	$36,630.58	2026-05-18
625-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Other Significant Condition	1	1	—	—	$33,745.76	$33,745.76	$33,745.76	2026-05-18
630-2	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	1	1	—	—	$52,562.40	$52,562.40	$52,562.40	2026-05-18
630-3	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	1	1	—	—	$82,845.36	$82,845.36	$82,845.36	2026-05-18
630-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	1	1	—	—	$171,460.35	$171,460.35	$171,460.35	2026-05-18
631-2	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	1	1	—	—	$33,424.65	$33,424.65	$33,424.65	2026-05-18
631-3	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	1	1	—	—	$54,499.97	$54,499.97	$54,499.97	2026-05-18
631-4	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	1	1	—	—	$141,917.40	$141,917.40	$141,917.40	2026-05-18
633-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Anomaly	1	1	—	—	$45,961.54	$45,961.54	$45,961.54	2026-05-18
634-4	OTHER	Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…	1	1	—	—	$35,225.75	$35,225.75	$35,225.75	2026-05-18
636-4	OTHER	Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection	1	1	—	—	$29,162.01	$29,162.01	$29,162.01	2026-05-18
650-4	OTHER	Splenectomy	1	1	—	—	$41,376.34	$41,376.34	$41,376.34	2026-05-18
651-4	OTHER	Other Procedures Of Blood And Blood-forming Organs	1	1	—	—	$45,593.01	$45,593.01	$45,593.01	2026-05-18
680-3	OTHER	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	1	1	—	—	$32,243.87	$32,243.87	$32,243.87	2026-05-18
680-4	OTHER	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	1	1	—	—	$61,772.23	$61,772.23	$61,772.23	2026-05-18
681-4	OTHER	Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	1	1	—	—	$52,674.06	$52,674.06	$52,674.06	2026-05-18
690-3	OTHER	Acute Leukemia	1	1	—	—	$28,958.40	$28,958.40	$28,958.40	2026-05-18
690-4	OTHER	Acute Leukemia	1	1	—	—	$50,419.77	$50,419.77	$50,419.77	2026-05-18
691-4	OTHER	Lymphoma, Myeloma And Non-acute Leukemia	1	1	—	—	$29,629.07	$29,629.07	$29,629.07	2026-05-18
692-4	OTHER	Radiotherapy	1	1	—	—	$31,463.73	$31,463.73	$31,463.73	2026-05-18
695-4	OTHER	Chemotherapy For Acute Leukemia	1	1	—	—	$47,452.48	$47,452.48	$47,452.48	2026-05-18
7-1	OTHER	Allogeneic Bone Marrow Transplant	1	1	—	—	$58,651.69	$58,651.69	$58,651.69	2026-05-18
7-2	OTHER	Allogeneic Bone Marrow Transplant	1	1	—	—	$65,869.21	$65,869.21	$65,869.21	2026-05-18
7-3	OTHER	Allogeneic Bone Marrow Transplant	1	1	—	—	$84,209.31	$84,209.31	$84,209.31	2026-05-18
7-4	OTHER	Allogeneic Bone Marrow Transplant	1	1	—	—	$142,890.92	$142,890.92	$142,890.92	2026-05-18
710-4	OTHER	Infectious And Parasitic Diseases Including HIV With O.r. Procedure	1	1	—	—	$42,400.95	$42,400.95	$42,400.95	2026-05-18
711-4	OTHER	Post-operative, Post-trauma, Other Device Infections With O.r. Procedure	1	1	—	—	$39,997.78	$39,997.78	$39,997.78	2026-05-18
73-4	OTHER	Orbit And Eye Procedures	1	1	—	—	$32,843.75	$32,843.75	$32,843.75	2026-05-18
740-4	OTHER	Mental Illness Diagnosis With O.r. Procedure	1	1	—	—	$53,785.52	$53,785.52	$53,785.52	2026-05-18
752-4	OTHER	Disorders Of Personality And Impulse Control	1	1	—	—	$35,271.00	$35,271.00	$35,271.00	2026-05-18
759-4	OTHER	Eating Disorders	1	1	—	—	$50,330.01	$50,330.01	$50,330.01	2026-05-18
792-4	OTHER	Extensive O.r. Procedures For Other Complications Of Treatment	1	1	—	—	$45,978.33	$45,978.33	$45,978.33	2026-05-18
793-4	OTHER	Moderately Extensive O.r. Procedures For Other Complications Of Treatment	1	1	—	—	$36,203.66	$36,203.66	$36,203.66	2026-05-18
794-4	OTHER	Non-extensive O.r. Procedures For Other Complications Of Treatment	1	1	—	—	$26,995.29	$26,995.29	$26,995.29	2026-05-18
8-1	OTHER	Autologous Bone Marrow Transplant	1	1	—	—	$28,616.86	$28,616.86	$28,616.86	2026-05-18
8-2	OTHER	Autologous Bone Marrow Transplant	1	1	—	—	$38,081.38	$38,081.38	$38,081.38	2026-05-18
8-3	OTHER	Autologous Bone Marrow Transplant	1	1	—	—	$45,514.92	$45,514.92	$45,514.92	2026-05-18
8-4	OTHER	Autologous Bone Marrow Transplant	1	1	—	—	$72,282.52	$72,282.52	$72,282.52	2026-05-18
841-3	OTHER	Extensive Third Degree Burns With Skin Graft	1	1	—	—	$58,452.46	$58,452.46	$58,452.46	2026-05-18
841-4	OTHER	Extensive Third Degree Burns With Skin Graft	1	1	—	—	$159,275.94	$159,275.94	$159,275.94	2026-05-18
842-3	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	1	1	—	—	$33,195.50	$33,195.50	$33,195.50	2026-05-18
842-4	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	1	1	—	—	$80,494.00	$80,494.00	$80,494.00	2026-05-18
850-3	OTHER	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	1	1	—	—	$26,403.44	$26,403.44	$26,403.44	2026-05-18
850-4	OTHER	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	1	1	—	—	$56,095.27	$56,095.27	$56,095.27	2026-05-18
863-3	OTHER	Neonatal Aftercare	1	1	—	—	$40,546.58	$40,546.58	$40,546.58	2026-05-18
863-4	OTHER	Neonatal Aftercare	1	1	—	—	$63,192.38	$63,192.38	$63,192.38	2026-05-18
89-3	OTHER	Major Cranial Or Facial Bone Procedures	1	1	—	—	$36,056.24	$36,056.24	$36,056.24	2026-05-18
89-4	OTHER	Major Cranial Or Facial Bone Procedures	1	1	—	—	$51,918.01	$51,918.01	$51,918.01	2026-05-18
9-1	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	1	1	—	—	$38,227.34	$38,227.34	$38,227.34	2026-05-18
9-2	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	1	1	—	—	$46,580.40	$46,580.40	$46,580.40	2026-05-18
9-3	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	1	1	—	—	$63,863.78	$63,863.78	$63,863.78	2026-05-18
9-4	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	1	1	—	—	$138,565.52	$138,565.52	$138,565.52	2026-05-18
91-3	OTHER	Other Major Head And Neck Procedures	1	1	—	—	$37,277.16	$37,277.16	$37,277.16	2026-05-18
91-4	OTHER	Other Major Head And Neck Procedures	1	1	—	—	$58,402.83	$58,402.83	$58,402.83	2026-05-18
910-1	OTHER	Craniotomy For Multiple Significant Trauma	1	1	—	—	$28,877.39	$28,877.39	$28,877.39	2026-05-18
910-2	OTHER	Craniotomy For Multiple Significant Trauma	1	1	—	—	$33,034.22	$33,034.22	$33,034.22	2026-05-18
910-3	OTHER	Craniotomy For Multiple Significant Trauma	1	1	—	—	$37,190.32	$37,190.32	$37,190.32	2026-05-18
910-4	OTHER	Craniotomy For Multiple Significant Trauma	1	1	—	—	$103,611.25	$103,611.25	$103,611.25	2026-05-18
911-3	OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	1	1	—	—	$27,750.61	$27,750.61	$27,750.61	2026-05-18
911-4	OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	1	1	—	—	$97,886.12	$97,886.12	$97,886.12	2026-05-18
912-3	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	1	1	—	—	$32,267.22	$32,267.22	$32,267.22	2026-05-18
912-4	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	1	1	—	—	$95,105.66	$95,105.66	$95,105.66	2026-05-18
92-4	OTHER	Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures	1	1	—	—	$46,202.37	$46,202.37	$46,202.37	2026-05-18
930-4	OTHER	Multiple Significant Trauma Without O.r. Procedure	1	1	—	—	$43,963.41	$43,963.41	$43,963.41	2026-05-18
950-3	OTHER	Extensive O.r. Procedure Unrelated To Principal Diagnosis	1	1	—	—	$28,176.08	$28,176.08	$28,176.08	2026-05-18
950-4	OTHER	Extensive O.r. Procedure Unrelated To Principal Diagnosis	1	1	—	—	$51,406.43	$51,406.43	$51,406.43	2026-05-18
951-4	OTHER	Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis	1	1	—	—	$38,207.63	$38,207.63	$38,207.63	2026-05-18
952-4	OTHER	Non-extensive O.r. Procedure Unrelated To Principal Diagnosis	1	1	—	—	$32,849.59	$32,849.59	$32,849.59	2026-05-18
98-4	OTHER	Other Ear, Nose, Mouth And Throat Procedures	1	1	—	—	$31,360.11	$31,360.11	$31,360.11	2026-05-18
J2350	HCPCS	Injection, Ocrelizumab, 1 Mg	10	4	—	—	$59.32	$38,215.05	$31,175.48	2026-05-18

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