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Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

MARY RUTAN HOSPITAL

Bellefontaine, OH · CCN 360197 · Rates published

9,131 distinct procedures filed
18 distinct payers
78,026 rate rows
2026-04-01 last MRF observed
Data quality

50,737 of 78,026 rate rows are consumer-grade (65.0%)

27,289 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 — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 27,289
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://res.cloudinary.com/dpmykpsih/raw/upload/fl_attachment/mary-rutan-redesign-site-505/media/228f2582d2a14d72be45e6253f53e4ff/341407259_mary-rutan-hospital_standardcharges.json
Found on page https://www.maryrutan.org/cms-hpt.txt
Discovered viaCMS hospital list
Last fetch success · 2026-06-16
Content fingerprint 2aaaee72a85b638f… · 22,417,672 bytes · first seen 2026-06-16

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
18
MS_DRG 		Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 11 $249,452.97 $1,019,446.84 $313,675.95 nat. median
$370,174
0.8× median
Q0480
HCPCS 		Driver Pneumatic Vad, Rep 3 $110,901.76 $360,430.72 $255,074.05 nat. median
$111,989
outlier · 2.3×
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 11 $186,320.74 $661,579.98 $203,563.07 nat. median
$265,286
0.8× median
L8702
HCPCS 		Pow Ue Rom Dev Ewhf Uprt Cus 3 $68,801.71 $223,605.56 $158,243.93 nat. median
$70,825
outlier · 2.2×
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 11 $155,088.10 $504,036.32 $155,088.10 nat. median
$206,368
0.8× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 11 $141,760.77 $501,078.27 $154,177.93 nat. median
$202,986
0.8× median
L7181
HCPCS 		Electronic Elbo Simultaneous 3 $49,338.18 $160,349.08 $113,477.82 nat. median
$50,598
outlier · 2.2×
L7180
HCPCS 		Electronic Elbow Sequential 3 $47,919.99 $155,739.97 $110,215.98 nat. median
$49,027
outlier · 2.2×
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 11 $93,464.00 $326,999.79 $100,615.32 nat. median
$133,176
0.8× median
7
MS_DRG 		Lung Transplant 11 $86,444.16 $305,724.51 $94,069.08 nat. median
$122,708
0.8× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 11 $86,662.45 $283,715.06 $87,296.94 nat. median
$117,303
0.7× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 11 $72,895.32 $267,517.80 $82,313.17 nat. median
$108,660
0.8× median
209
MS_DRG 		Complex Aortic Arch Procedures 11 $82,218.74 $267,210.91 $82,218.74 nat. median
$98,017
0.8× median
L8701
HCPCS 		Pow Ue Rom Dev Ewh Uprt Cust 3 $34,970.13 $113,652.92 $80,431.30 nat. median
$35,999
outlier · 2.2×
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 11 $69,335.78 $260,185.25 $80,057.00 nat. median
$98,905
0.8× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 11 $72,057.86 $256,712.56 $78,988.48 nat. median
$102,358
0.8× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 11 $70,440.49 $243,407.25 $74,894.54 nat. median
$100,136
0.7× median
215
MS_DRG 		Other Heart Assist System Implant 11 $70,080.63 $235,061.94 $72,326.75 nat. median
$99,019
0.7× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 11 $63,837.40 $230,949.45 $71,061.37 nat. median
$93,672
0.8× median
L5856
HCPCS 		Elec Knee-shin Swing/stance 3 $29,559.78 $96,069.28 $67,987.49 nat. median
$30,273
outlier · 2.2×
L6700
HCPCS 		Ue Add Ext Power Myoel 3 $29,510.19 $95,908.12 $67,873.43 nat. median
$30,667
outlier · 2.2×
L6880
HCPCS 		Elec Hand Ind Art Digits 3 $29,420.21 $95,615.68 $67,666.49 nat. median
$30,168
outlier · 2.2×
429
MS_DRG 		Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 11 $55,169.10 $212,695.99 $65,444.92 nat. median
$82,712
0.8× median
850
MS_DRG 		Acute Leukemia With Other Procedures 11 $60,932.75 $204,430.92 $62,901.82 nat. median
$83,442
0.8× median
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 11 $56,051.54 $199,010.60 $61,234.03 nat. median
$79,312
0.8× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 11 $56,019.79 $198,385.00 $61,041.54 nat. median
$81,118
0.8× median
453
MS_DRG 		Combined Anterior And Posterior Spinal Fusion With Mcc 1 $58,618.16 $58,618.16 $58,618.16 nat. median
$87,411
0.7× median
20
MS_DRG 		Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 11 $53,320.21 $185,764.31 $57,158.25 nat. median
$77,576
0.7× median
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 11 $51,180.26 $181,267.06 $55,774.48 nat. median
$74,915
0.7× median
233
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 11 $51,701.52 $180,485.63 $55,534.04 nat. median
$73,807
0.8× median
957
MS_DRG 		Other O.r. Procedures For Multiple Significant Trauma With Mcc 11 $49,372.38 $179,888.34 $55,350.26 nat. median
$72,138
0.8× median
Q0483
HCPCS 		Monitor Elec Vad, Rep 3 $23,087.32 $75,033.79 $53,100.83 nat. median
$23,616
outlier · 2.2×
L5858
HCPCS 		Stance Phase Only 3 $22,885.05 $74,376.41 $52,635.61 nat. median
$23,442
outlier · 2.2×
427
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 12 $46,957.90 $170,414.60 $52,435.26 nat. median
$68,090
0.8× median
10
MS_DRG 		Pancreas Transplant 11 $52,123.64 $169,401.83 $52,123.64 nat. median
$68,882
0.8× median
928
MS_DRG 		Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc 11 $44,178.28 $169,330.98 $52,101.84 nat. median
$64,027
0.8× median
19
MS_DRG 		Simultaneous Pancreas And Kidney Transplant With Hemodialysis 11 $51,825.09 $168,431.54 $51,825.09 nat. median
$71,240
0.7× median
275
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 11 $46,744.90 $168,332.38 $51,794.58 nat. median
$68,887
0.8× median
222
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 $50,648.41 $50,648.41 $50,648.41 nat. median
$63,570
0.8× median
L6975
HCPCS 		Interscap-thor Myoelectronic 3 $21,834.21 $70,961.18 $50,218.68 nat. median
$23,177
outlier · 2.2×
870
MS_DRG 		Septicemia Or Severe Sepsis With Mv >96 Hours 11 $46,017.25 $163,171.74 $50,206.69 nat. median
$66,526
0.8× median
L5973
HCPCS 		Ank-foot Sys Dors-plant Flex 3 $21,739.52 $70,653.44 $50,000.90 nat. median
$21,820
outlier · 2.3×
268
MS_DRG 		Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 11 $44,103.53 $162,371.43 $49,960.44 nat. median
$65,950
0.8× median
955
MS_DRG 		Craniotomy For Multiple Significant Trauma 11 $45,166.56 $158,905.82 $48,894.10 nat. median
$64,732
0.8× median
317
MS_DRG 		Concomitant Left Atrial Appendage Closure And Cardiac Ablation 11 $40,920.39 $157,852.92 $48,570.13 nat. median
$60,691
0.8× median
447
MS_DRG 		Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 11 $44,348.28 $157,737.26 $48,534.54 nat. median
$63,738
0.8× median
217
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 11 $42,715.70 $155,227.73 $47,762.38 nat. median
$64,510
0.7× median
218
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 11 $39,353.30 $155,227.73 $47,762.38 nat. median
$61,920
0.8× median
573
MS_DRG 		Skin Graft For Skin Ulcer Or Cellulitis With Mcc 11 $40,733.85 $154,663.54 $47,588.78 nat. median
$59,793
0.8× median
224
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 $46,895.06 $46,895.06 $46,895.06 nat. median
$54,196
0.9× median

Other procedures at this hospital

Browse this hospital's 9,131 published procedures. Use the slice to choose what to show, then sort or filter any column.

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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
             
18 MS_DRG Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 16 11 — — $249,452.97 $1,019,446.84 $313,675.95 2026-04-01
Q0480 HCPCS Driver Pneumatic Vad, Rep 4 3 — — $110,901.76 $360,430.72 $255,074.05 2026-04-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 16 11 — — $186,320.74 $661,579.98 $203,563.07 2026-04-01
L8702 HCPCS Pow Ue Rom Dev Ewhf Uprt Cus 4 3 — — $68,801.71 $223,605.56 $158,243.93 2026-04-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 16 11 — — $155,088.10 $504,036.32 $155,088.10 2026-04-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 16 11 — — $141,760.77 $501,078.27 $154,177.93 2026-04-01
L7181 HCPCS Electronic Elbo Simultaneous 4 3 — — $49,338.18 $160,349.08 $113,477.82 2026-04-01
L7180 HCPCS Electronic Elbow Sequential 4 3 — — $47,919.99 $155,739.97 $110,215.98 2026-04-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 16 11 — — $93,464.00 $326,999.79 $100,615.32 2026-04-01
7 MS_DRG Lung Transplant 16 11 — — $86,444.16 $305,724.51 $94,069.08 2026-04-01
14 MS_DRG Allogeneic Bone Marrow Transplant 16 11 — — $86,662.45 $283,715.06 $87,296.94 2026-04-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 16 11 — — $72,895.32 $267,517.80 $82,313.17 2026-04-01
209 MS_DRG Complex Aortic Arch Procedures 15 11 — — $82,218.74 $267,210.91 $82,218.74 2026-04-01
L8701 HCPCS Pow Ue Rom Dev Ewh Uprt Cust 4 3 — — $34,970.13 $113,652.92 $80,431.30 2026-04-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 16 11 — — $69,335.78 $260,185.25 $80,057.00 2026-04-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 16 11 — — $72,057.86 $256,712.56 $78,988.48 2026-04-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 16 11 — — $70,440.49 $243,407.25 $74,894.54 2026-04-01
215 MS_DRG Other Heart Assist System Implant 16 11 — — $70,080.63 $235,061.94 $72,326.75 2026-04-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 16 11 — — $63,837.40 $230,949.45 $71,061.37 2026-04-01
L5856 HCPCS Elec Knee-shin Swing/stance 4 3 — — $29,559.78 $96,069.28 $67,987.49 2026-04-01
L6700 HCPCS Ue Add Ext Power Myoel 4 3 — — $29,510.19 $95,908.12 $67,873.43 2026-04-01
L6880 HCPCS Elec Hand Ind Art Digits 4 3 — — $29,420.21 $95,615.68 $67,666.49 2026-04-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 16 11 — — $55,169.10 $212,695.99 $65,444.92 2026-04-01
850 MS_DRG Acute Leukemia With Other Procedures 16 11 — — $60,932.75 $204,430.92 $62,901.82 2026-04-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 16 11 — — $56,051.54 $199,010.60 $61,234.03 2026-04-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 16 11 — — $56,019.79 $198,385.00 $61,041.54 2026-04-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 1 1 — — $58,618.16 $58,618.16 $58,618.16 2026-04-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 16 11 — — $53,320.21 $185,764.31 $57,158.25 2026-04-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 16 11 — — $51,180.26 $181,267.06 $55,774.48 2026-04-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 16 11 — — $51,701.52 $180,485.63 $55,534.04 2026-04-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 16 11 — — $49,372.38 $179,888.34 $55,350.26 2026-04-01
Q0483 HCPCS Monitor Elec Vad, Rep 4 3 — — $23,087.32 $75,033.79 $53,100.83 2026-04-01
L5858 HCPCS Stance Phase Only 4 3 — — $22,885.05 $74,376.41 $52,635.61 2026-04-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 19 12 — — $46,957.90 $170,414.60 $52,435.26 2026-04-01
10 MS_DRG Pancreas Transplant 16 11 — — $52,123.64 $169,401.83 $52,123.64 2026-04-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc 16 11 — — $44,178.28 $169,330.98 $52,101.84 2026-04-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 16 11 — — $51,825.09 $168,431.54 $51,825.09 2026-04-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 16 11 — — $46,744.90 $168,332.38 $51,794.58 2026-04-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 1 — — $50,648.41 $50,648.41 $50,648.41 2026-04-01
L6975 HCPCS Interscap-thor Myoelectronic 4 3 — — $21,834.21 $70,961.18 $50,218.68 2026-04-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 16 11 — — $46,017.25 $163,171.74 $50,206.69 2026-04-01
L5973 HCPCS Ank-foot Sys Dors-plant Flex 4 3 — — $21,739.52 $70,653.44 $50,000.90 2026-04-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 16 11 — — $44,103.53 $162,371.43 $49,960.44 2026-04-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 16 11 — — $45,166.56 $158,905.82 $48,894.10 2026-04-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 16 11 — — $40,920.39 $157,852.92 $48,570.13 2026-04-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 16 11 — — $44,348.28 $157,737.26 $48,534.54 2026-04-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 16 11 — — $39,353.30 $155,227.73 $47,762.38 2026-04-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 16 11 — — $42,715.70 $155,227.73 $47,762.38 2026-04-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 16 11 — — $40,733.85 $154,663.54 $47,588.78 2026-04-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 1 — — $46,895.06 $46,895.06 $46,895.06 2026-04-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 16 11 — — $42,783.84 $151,908.51 $46,741.08 2026-04-01
Q0489 HCPCS Pwr Pck Base Combo Vad, Rep 4 3 — — $20,015.46 $65,050.24 $46,035.56 2026-04-01
L6970 HCPCS Interscapular-thor Switch CT 4 3 — — $19,809.02 $64,379.32 $45,560.75 2026-04-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 16 11 — — $39,626.50 $144,677.45 $44,516.14 2026-04-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 16 11 — — $41,832.60 $144,509.85 $44,464.57 2026-04-01
5342 OTHER Level 2 Abdominal/Peritoneal/Biliary And Related Procedures 3 2 — — $4,311.29 $52,276.52 $44,245.67 2026-04-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 16 11 — — $40,406.40 $143,124.08 $44,038.18 2026-04-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 1 1 — — $43,872.66 $43,872.66 $43,872.66 2026-04-01
28 MS_DRG Spinal Procedures With Mcc 16 11 — — $40,213.25 $141,842.19 $43,643.75 2026-04-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 16 11 — — $40,973.31 $141,802.05 $43,631.40 2026-04-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 16 11 — — $37,963.49 $140,775.12 $43,315.42 2026-04-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 20 13 — — $2,148.56 $140,312.41 $43,173.05 2026-04-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/Mcc 16 11 — — $39,924.83 $139,986.60 $43,072.80 2026-04-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 16 11 — — $38,921.34 $138,544.18 $42,628.98 2026-04-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 16 11 — — $38,511.87 $138,454.48 $42,601.38 2026-04-01
L6965 HCPCS Shldr Disartic Myoelectronic 4 3 — — $18,506.37 $60,145.70 $42,564.65 2026-04-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 1 1 — — $42,341.95 $42,341.95 $42,341.95 2026-04-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 16 11 — — $36,184.71 $136,147.99 $41,891.69 2026-04-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 16 11 — — $37,736.59 $135,279.23 $41,624.38 2026-04-01
213 MS_DRG Endovascular Abdominal Aorta With Iliac Branch Procedures 15 11 — — $41,454.41 $134,726.83 $41,454.41 2026-04-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 16 11 — — $35,725.63 $134,552.11 $41,400.65 2026-04-01
Q0481 HCPCS Microprcsr Cu Elec Vad, Rep 4 3 — — $17,892.75 $58,151.44 $41,153.32 2026-04-01
L5859 HCPCS Knee-shin Pro Flex/ext Cont 4 3 — — $17,866.14 $58,064.96 $41,092.12 2026-04-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 16 11 — — $36,416.90 $132,722.52 $40,837.70 2026-04-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 16 11 — — $35,990.89 $132,311.76 $40,711.31 2026-04-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 1 1 — — $40,459.32 $40,459.32 $40,459.32 2026-04-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 16 11 — — $33,094.18 $131,405.20 $40,432.37 2026-04-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 16 11 — — $40,118.57 $130,385.35 $40,118.57 2026-04-01
834 MS_DRG Acute Leukemia With Mcc 16 11 — — $36,560.44 $129,603.96 $39,878.14 2026-04-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 16 11 — — $35,908.87 $129,145.96 $39,737.22 2026-04-01
22867 HCPCS Insj Stablj Dev W/dcmprn 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
0790T HCPCS Revj Rplcmt/rmvl Vrt Tethrg 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
23616 HCPCS Treat Humerus Fracture 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
25446 HCPCS Wrist Replacement 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
28705 HCPCS Fusion Of Foot Bones 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22810 HCPCS Ant Fusion 4-7 Vert Seg 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22861 HCPCS Revise Cerv Artific Disc 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22533 HCPCS Lat Lumbar Spine Fusion 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
27295 HCPCS Amputation Of Leg At Hip 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22800 HCPCS Post Fusion <=6 Vert Seg 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22808 HCPCS Ant Fusion 2-3 Vert Seg 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22802 HCPCS Post Fusion 7-12 Vert Seg 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22612 HCPCS Lumbar Spine Fusion 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
20838 HCPCS Replantation Foot Complete 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
27278 HCPCS Arthrd Si Jt Prq Wo Tfxj Dev 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
20805 HCPCS Replant Forearm Complete 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22600 HCPCS Neck Spine Fusion 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
23472 HCPCS Reconstruct Shoulder Joint 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
25442 HCPCS Reconstruct Wrist Joint 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
24371 HCPCS Revise Reconst Elbow Joint 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
0657T HCPCS Vrt Bdy Tethering Ant 8+ Seg 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
27487 HCPCS Revise/replace Knee Joint 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
24361 HCPCS Reconstruct Elbow Joint 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22856 HCPCS Cerv Artific Diskectomy 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
24363 HCPCS Replace Elbow Joint 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22857 HCPCS Lumbar Artif Diskectomy 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22586 HCPCS Prescrl Fuse With Instr L5-s1 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22804 HCPCS Post Fusion 13/> Vert Seg 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22610 HCPCS Thorax Spine Fusion 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22838 HCPCS Rev Rplc/rmv Thrc Vrt Tethrg 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
20982 HCPCS Ablate Bone Tumor(s) Perq 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
20808 HCPCS Replantation Hand Complete 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
20802 HCPCS Replantation Arm Complete 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22812 HCPCS Ant Fusion 8/> Vert Seg 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
27279 HCPCS Arthrodesis Sacroiliac Joint 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
27290 HCPCS Amputation Of Leg At Hip 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22818 HCPCS Kyphectomy 1-2 Segments 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22819 HCPCS Kyphectomy 3 Or More 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22836 HCPCS Ant Thrc Vrt Body Tethrg <7 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
27280 HCPCS Fusion Of Sacroiliac Joint 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22837 HCPCS Ant Thrc Vrt Body Tethrg 8+ 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22556 HCPCS Thorax Spine Fusion 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
27703 HCPCS Reconstruction Ankle Joint 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
C8003 HCPCS Imp Extar Knee Shck Absrb 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
22862 HCPCS Revise Lumbar Artif Disc 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
0656T HCPCS Vrt Bdy Tethering Ant 4 3 — — $17,276.22 $56,147.73 $39,735.32 2026-04-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 16 11 — — $35,191.14 $128,961.82 $39,680.56 2026-04-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 16 11 — — $35,691.89 $128,758.79 $39,618.09 2026-04-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/Mcc 16 11 — — $39,459.74 $128,244.16 $39,459.74 2026-04-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 16 11 — — $35,035.02 $125,895.19 $38,736.98 2026-04-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 17 11 — — $34,065.27 $125,819.62 $38,713.73 2026-04-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 16 11 — — $36,563.09 $124,974.46 $38,453.68 2026-04-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 16 11 — — $33,953.47 $124,561.35 $38,326.57 2026-04-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 16 11 — — $33,698.79 $122,887.54 $37,811.55 2026-04-01
653 MS_DRG Major Bladder Procedures With Mcc 16 11 — — $36,873.33 $122,675.08 $37,746.18 2026-04-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 16 11 — — $30,378.06 $118,987.57 $36,611.56 2026-04-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 19 12 — — $22,342.46 $117,741.06 $36,228.02 2026-04-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 16 11 — — $32,961.88 $116,796.78 $35,937.47 2026-04-01
L6960 HCPCS Shldr Disartic Switch Contro 4 3 — — $15,621.74 $50,770.66 $35,930.00 2026-04-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 20 12 — — $8,082.40 $116,589.00 $35,873.54 2026-04-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 16 11 — — $33,316.45 $116,190.04 $35,750.78 2026-04-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 16 11 — — $35,601.87 $115,706.08 $35,601.87 2026-04-01
471 MS_DRG Cervical Spinal Fusion With Mcc 16 11 — — $32,129.06 $113,994.53 $35,075.24 2026-04-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 16 11 — — $33,119.98 $113,418.50 $34,898.00 2026-04-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 16 11 — — $31,119.61 $112,391.56 $34,582.02 2026-04-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 1 — — $34,521.70 $34,521.70 $34,521.70 2026-04-01
L6955 HCPCS Above Elbow Myoelectronic CT 4 3 — — $14,850.10 $48,262.82 $34,155.23 2026-04-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 16 11 — — $30,475.31 $110,989.26 $34,150.54 2026-04-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 16 11 — — $31,449.69 $110,762.63 $34,080.81 2026-04-01
Q0479 HCPCS Power Module Combo Vad, Rep 4 3 — — $14,780.89 $48,037.89 $33,996.05 2026-04-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 16 11 — — $31,587.95 $110,432.14 $33,979.12 2026-04-01
6 MS_DRG Liver Transplant Without Mcc 16 11 — — $32,075.47 $109,468.94 $33,682.75 2026-04-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 16 11 — — $30,774.30 $109,032.20 $33,548.37 2026-04-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 1 — — $33,456.69 $33,456.69 $33,456.69 2026-04-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 19 11 — — $30,374.10 $108,512.82 $33,388.56 2026-04-01
5116 OTHER Level 6 Musculoskeletal Procedures 8 6 — — $14,846.47 $60,480.61 $33,360.35 2026-04-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 16 11 — — $30,952.91 $108,236.60 $33,303.57 2026-04-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 1 1 — — $33,211.93 $33,211.93 $33,211.93 2026-04-01
245 MS_DRG Aicd Generator Procedures 16 11 — — $32,324.20 $107,707.80 $33,140.86 2026-04-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 16 11 — — $29,842.25 $107,384.39 $33,041.35 2026-04-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 16 11 — — $29,582.28 $107,337.16 $33,026.82 2026-04-01
L6945 HCPCS Elbow Disart Myoelectronic C 4 3 — — $14,312.50 $46,515.62 $32,918.75 2026-04-01
799 MS_DRG Splenic Procedures With Mcc 16 11 — — $31,451.02 $106,916.94 $32,897.52 2026-04-01
163 MS_DRG Major Chest Procedures With Mcc 16 11 — — $30,487.87 $105,805.02 $32,555.39 2026-04-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 16 11 — — $27,718.83 $105,774.34 $32,545.95 2026-04-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 16 11 — — $29,056.39 $105,358.82 $32,418.10 2026-04-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 17 11 — — $28,215.62 $103,703.92 $31,908.90 2026-04-01
L7191 HCPCS Elbow Child Myoelectronic CT 4 3 — — $13,769.77 $44,751.75 $31,670.47 2026-04-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 16 11 — — $28,174.61 $102,159.98 $31,433.84 2026-04-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 16 11 — — $29,664.31 $101,345.53 $31,183.24 2026-04-01
140 MS_DRG Major Head And Neck Procedures With Mcc 16 11 — — $27,974.84 $100,693.94 $30,982.75 2026-04-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 17 11 — — $27,010.37 $134,893.84 $30,804.79 2026-04-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 16 11 — — $27,521.05 $99,700.06 $30,676.94 2026-04-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 16 11 — — $27,143.99 $99,530.08 $30,624.64 2026-04-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 16 11 — — $27,184.34 $99,480.52 $30,609.39 2026-04-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 16 11 — — $27,716.85 $99,190.13 $30,520.04 2026-04-01
901 MS_DRG Wound Debridements For Injuries With Mcc 16 11 — — $29,305.77 $99,072.09 $30,483.72 2026-04-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc 1 1 — — $30,466.04 $30,466.04 $30,466.04 2026-04-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 16 11 — — $27,199.56 $98,887.94 $30,427.06 2026-04-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 16 11 — — $28,561.59 $98,505.52 $30,309.39 2026-04-01
793 MS_DRG Full Term Neonate With Major Problems 24 14 — — $1,295.65 $98,434.70 $30,287.60 2026-04-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 16 11 — — $26,903.87 $98,042.82 $30,167.02 2026-04-01
L7186 HCPCS Electron Elbow Child Switch 4 3 — — $13,091.11 $42,546.11 $30,109.55 2026-04-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 16 11 — — $25,864.65 $97,393.60 $29,967.26 2026-04-01
L6940 HCPCS Elbow Disarticulation Switch 4 3 — — $12,829.08 $41,694.51 $29,506.88 2026-04-01
791 MS_DRG Prematurity With Major Problems 18 11 — — $2,287.57 $95,823.68 $29,484.21 2026-04-01
L6950 HCPCS Above Elbow Switch Control 4 3 — — $12,805.28 $41,617.16 $29,452.15 2026-04-01
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 16 11 — — $25,991.66 $94,914.79 $29,204.55 2026-04-01
22326 HCPCS Treat Neck Spine Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
22319 HCPCS Treat Odontoid Fx W/graft 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
22325 HCPCS Treat Spine Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
C9781 HCPCS Arthro/shoul Surg; W/spacer 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
C9757 HCPCS Spine/lumbar Disk Surgery 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
C9734 HCPCS U/s Trtmt, Not Leiomyomata 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
25491 HCPCS Reinforce Ulna 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
22327 HCPCS Treat Thorax Spine Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
25441 HCPCS Reconstruct Wrist Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
69730 HCPCS Rplc Oi Implt Sk Tc Esp>=100 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
25444 HCPCS Reconstruct Wrist Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
69719 HCPCS Revj/rplcmt Oi Implt Tc Esp 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
69714 HCPCS Implant Temple Bone W/Stimul 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
64628 HCPCS Trml Dstrj Ios Bvn 1st 2 L/s 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
69729 HCPCS Impl Oi Implt Sk Tc Esp>=100 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
23474 HCPCS Revis Reconst Shoulder Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
22318 HCPCS Treat Odontoid Fx Without Graft 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
23470 HCPCS Reconstruct Shoulder Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
25391 HCPCS Lengthen Radius Or Ulna 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
25365 HCPCS Revise Radius & Ulna 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
0220T HCPCS Plmt Post Facet Implt Thor 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
0219T HCPCS Plmt Post Facet Implt Cerv 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24940 HCPCS Revision Of Upper Arm 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24931 HCPCS Amputate Upper Arm & Implant 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
1003T HCPCS Arthrp 1st Crp/mtcrpl Prostc 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
25810 HCPCS Fusion/graft Of Wrist Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
22590 HCPCS Spine & Skull Spinal Fusion 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24666 HCPCS Treat Radius Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
22869 HCPCS Insj Stablj Dev Without Dcmprn 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
0202T HCPCS Post Vert Arthrplst 1 Lumbar 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24586 HCPCS Treat Elbow Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24587 HCPCS Treat Elbow Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24579 HCPCS Treat Humerus Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
22595 HCPCS Neck Spinal Fusion 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24802 HCPCS Fusion/graft Of Elbow Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24575 HCPCS Treat Humerus Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
20692 HCPCS Apply Bone Fixation Device 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24516 HCPCS Treat Humerus Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24900 HCPCS Amputation Of Upper Arm 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24920 HCPCS Amputation Of Upper Arm 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24498 HCPCS Reinforce Humerus 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24545 HCPCS Treat Humerus Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24515 HCPCS Treat Humerus Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24410 HCPCS Revision Of Humerus 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
0627T HCPCS Perq Njx Algc Fluor Lmbr 1st 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
69716 HCPCS Impltj Oi Implt Skl Tc Esp 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24430 HCPCS Repair Of Humerus 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
23485 HCPCS Revision Of Collar Bone 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24546 HCPCS Treat Humerus Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24370 HCPCS Revise Reconst Elbow Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24435 HCPCS Repair Humerus With Graft 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24346 HCPCS Reconstruct Elbow Med Ligmnt 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
29856 HCPCS Tibial Arthroscopy/surgery 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24362 HCPCS Reconstruct Elbow Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
29867 HCPCS Allgrft Implnt Knee W/scope 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
29889 HCPCS Knee Arthroscopy/surgery 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
28730 HCPCS Fusion Of Foot Bones 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
28725 HCPCS Fusion Of Foot Bones 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
28735 HCPCS Fusion Of Foot Bones 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
28715 HCPCS Fusion Of Foot Bones 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
28737 HCPCS Revision Of Foot Bones 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
28297 HCPCS Correction Hallux Valgus 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27871 HCPCS Fusion Of Tibiofibular Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
28320 HCPCS Repair Of Foot Bones 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27870 HCPCS Fusion Of Ankle Joint Open 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27758 HCPCS Treatment Of Tibia Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27827 HCPCS Treat Lower Leg Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
28420 HCPCS Treat/graft Heel Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27709 HCPCS Incision Of Tibia & Fibula 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27712 HCPCS Realignment Of Lower Leg 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27511 HCPCS Treatment Of Thigh Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27514 HCPCS Treatment Of Thigh Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
24365 HCPCS Reconstruct Head Of Radius 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27715 HCPCS Revision Of Lower Leg 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
29907 HCPCS Subtalar Arthro W/fusion 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27446 HCPCS Revision Of Knee Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27442 HCPCS Revision Of Knee Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27447 HCPCS Total Knee Arthroplasty 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27438 HCPCS Revise Kneecap With Implant 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27440 HCPCS Revision Of Knee Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27486 HCPCS Revise/replace Knee Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27488 HCPCS Removal Of Knee Prosthesis 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
23802 HCPCS Fusion Of Shoulder Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
23900 HCPCS Amputation Of Arm & Girdle 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27356 HCPCS Remove Femur Lesion/graft 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
22554 HCPCS Neck Spine Fusion 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
23920 HCPCS Amputation At Shoulder Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27286 HCPCS Fusion Of Hip Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
22532 HCPCS Lat Thorax Spine Fusion 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27138 HCPCS Revise Hip Joint Replacement 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27415 HCPCS Osteochondral Knee Allograft 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27428 HCPCS Reconstruction Knee 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
22551 HCPCS Neck Spine Fuse&remov Bel C2 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27429 HCPCS Reconstruction Knee 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
23615 HCPCS Treat Humerus Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27441 HCPCS Revision Of Knee Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
0629T HCPCS Perq Njx Algc CT Lmbr 1st 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27443 HCPCS Revision Of Knee Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
23473 HCPCS Revis Reconst Shoulder Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27134 HCPCS Revise Hip Joint Replacement 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
0737T HCPCS Xenograft Impltj Artclr Surf 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27513 HCPCS Treatment Of Thigh Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
23680 HCPCS Treat Dislocation/fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27137 HCPCS Revise Hip Joint Replacement 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27580 HCPCS Fusion Of Knee 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27130 HCPCS Total Hip Arthroplasty 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
23491 HCPCS Reinforce Shoulder Bones 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27759 HCPCS Treatment Of Tibia Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27828 HCPCS Treat Lower Leg Fracture 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27284 HCPCS Fusion Of Hip Joint 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
22849 HCPCS Reinsert Spinal Fixation 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
27120 HCPCS Reconstruction Of Hip Socket 4 3 — — $12,650.07 $41,112.71 $29,095.15 2026-04-01
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