Price Transparencybeta Hospital negotiated rates

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

JEWISH HOME & REHAB CENTER

San Francisco, CA · CCN 054089 · Rates published

44,418 distinct procedures filed
17 distinct payers
288,116 rate rows
2026-04-30 last MRF observed
Data quality

278,452 of 288,116 rate rows are consumer-grade (96.6%)

9,664 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 9,469
placeholder amount (≤ $0.02) — excluded from medians 98
per-diem day rate — not a per-procedure price 95
exceeds 10× this hospital's gross charge — excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://jewishliving.pt.panaceainc.com/MRFDownload/jewishliving/sfcampus
Found on page https://sfcjl.org/care_price_transparency.htm
Discovered viaCMS hospital list
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-05-18
Content fingerprint 2040e676290f35b5… · 92,987,540 bytes · first seen 2026-05-09

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
J3391
HCPCS 		Inj, Atidarsagene Autotemcel 7 $4,279,750.00 $4,505,000.00 $4,505,000.00 nat. median
$4,505,000
1.0× median
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 7 $3,501,003.33 $3,685,266.66 $3,685,266.66 nat. median
$3,710,000
1.0× median
J3389
HCPCS 		Topi Adm Prad Zami Per Treat 7 $3,169,029.00 $3,335,820.00 $3,335,820.00 nat. median
$3,335,820
1.0× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 7 $3,161,466.73 $3,327,859.72 $3,327,859.72 nat. median
$3,325,455
1.0× median
J1411N/A
HCPCS 		Inj, Hemgenix, Per Tx Dose 1 $3,306,566.25 $3,306,566.25 $3,306,566.25 —
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 7 $3,089,882.67 $3,252,508.07 $3,252,508.07 nat. median
$3,286,000
1.0× median
J3387
HCPCS 		Inj Elivaldogene Autotemecel 7 $3,021,000.00 $3,180,000.00 $3,180,000.00 nat. median
$3,180,000
1.0× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 7 $2,792,970.44 $2,939,968.88 $2,939,968.88 nat. median
$3,004,655
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 7 $2,459,532.16 $2,588,981.22 $2,588,981.22 nat. median
$2,468,984
1.0× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 7 $2,215,400.00 $2,332,000.00 $2,332,000.00 nat. median
$2,448,600
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel 8 $732,089.00 $770,620.00 $770,620.00 nat. median
$824,563
0.9× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 8 $558,267.09 $588,494.81 $587,649.57 nat. median
$674,867
0.9× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 8 $538,204.74 $614,180.81 $566,531.30 nat. median
$753,246
0.8× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 8 $534,091.18 $562,260.84 $562,201.24 nat. median
$673,137
0.8× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 8 $530,177.63 $559,781.08 $558,081.72 nat. median
$625,184
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 8 $505,582.63 $532,192.24 $532,192.24 nat. median
$634,303
0.8× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 8 $464,977.69 $489,450.20 $489,450.20 nat. median
$619,808
0.8× median
Q2058
HCPCS 		Obecbtge Autol Up To 400 Mil 7 $264,337.50 $278,250.00 $278,250.00 nat. median
$324,450
0.9× median
J3403
HCPCS 		Revakinagene, Per Implant 8 $251,750.00 $265,000.00 $265,000.00 nat. median
$265,000
1.0× median
J3402
HCPCS 		Inj. Remestemcel-l-rknd/ Td 8 $191,585.57 $202,713.58 $201,669.02 nat. median
$209,753
1.0× median
Q0480
HCPCS 		Driver Pneumatic Vad, Rep 1 $108,243.35 $108,243.35 $108,243.35 nat. median
$111,989
1.0× median
J3399N/A
HCPCS 		Inj Onase Abepar-xioi Treat 1 $108,157.44 $108,157.44 $108,157.44 —
K1007
HCPCS 		Bil Hkaf Pc S/d Micro Sensor 1 $95,081.03 $95,081.03 $95,081.03 nat. median
$96,983
1.0× median
A9543N/A
HCPCS 		Y90 Ibritumomab, Rx 1 $70,944.59 $70,944.59 $70,944.59 —
L8702
HCPCS 		Ewhf S/d Uprt Micro Sensor 1 $68,801.71 $68,801.71 $68,801.71 nat. median
$70,825
1.0× median
C1604N/A
HCPCS 		Grft, Trnsmurl/trnsvens Byps 1 $68,624.55 $68,624.55 $68,624.55 —
J9029
HCPCS 		Instill Adstiladrin, Tx Dose 8 $61,061.05 $64,282.30 $64,274.79 nat. median
$69,774
0.9× median
38240
HCPCS 		Transplt Allo Hct/donor 7 $61,050.34 $64,263.52 $64,263.52 nat. median
$15,979
outlier · 4.0×
A9543
HCPCS 		Y90 Ibritumomab, Rx 7 $53,983.31 $56,824.54 $56,824.54 nat. median
$62,507
0.9× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 8 $51,683.90 $56,269.19 $54,404.10 nat. median
$66,682
0.8× median
J7330N/A
HCPCS 		Cultured Chondrocytes Implnt 1 $49,142.15 $49,142.15 $49,142.15 —
L7181
HCPCS 		Electronic Elbo Simultaneous 1 $48,155.50 $48,155.50 $48,155.50 nat. median
$50,598
1.0× median
64568
HCPCS 		Opn Impltj Crnl Nrv Nea&pg 7 $42,750.48 $45,000.50 $45,000.50 nat. median
$27,591
1.6× median
64654
HCPCS 		1st Opn Implt Bat Modulj Sys 7 $42,750.48 $45,000.50 $45,000.50 nat. median
$43,888
1.0× median
33276
HCPCS 		Insj Phrnc Nrv Stim Sys 7 $42,750.48 $45,000.50 $45,000.50 nat. median
$43,787
1.0× median
0620T
HCPCS 		Evasc Ven Artlz Tibl/prnl Vn 7 $42,750.48 $45,000.50 $45,000.50 nat. median
$33,076
1.4× median
L7180
HCPCS 		Electronic Elbow Sequential 1 $44,356.85 $44,356.85 $44,356.85 nat. median
$49,027
0.9× median
J9226
HCPCS 		Supprelin La Implant 8 $41,026.06 $43,185.33 $43,185.33 nat. median
$60,368
0.7× median
C1825N/A
HCPCS 		Gen, Neuro, Carot Sinus Baro 1 $40,135.67 $40,135.67 $40,135.67 —
L2006
HCPCS 		Kaf Sng/dbl Swg/stn Mcpr Cus 1 $39,938.10 $39,938.10 $39,938.10 nat. median
$39,823
1.0× median
S2079N/A
HCPCS 		Lap Esophagomyotomy 1 $35,629.96 $35,629.96 $35,629.96 —
0870T
HCPCS 		Imp Subq Prtl Ascts Pmp Sys 7 $33,250.48 $35,000.50 $35,000.50 nat. median
$8,550
outlier · 4.1×
L8701
HCPCS 		Ewh S/d Uprt Micro Sensor 1 $34,970.13 $34,970.13 $34,970.13 nat. median
$35,999
1.0× median
69930
HCPCS 		Implant Cochlear Device 7 $32,001.97 $33,686.28 $33,686.28 nat. median
$29,690
1.1× median
C1826N/A
HCPCS 		Gen, Neuro, Clo Loop, Rechg 1 $33,459.93 $33,459.93 $33,459.93 —
J1413N/A
HCPCS 		Inj Delandistrogene Mox Rokl 1 $33,120.00 $33,120.00 $33,120.00 —
S2150N/A
HCPCS 		Bmt Harv/transpl 28d Pkg 1 $32,723.22 $32,723.22 $32,723.22 —
33249
HCPCS 		Insj/rplcmt Defib W/lead(s) 7 $30,465.29 $32,068.73 $32,068.73 nat. median
$31,833
1.0× median
33231
HCPCS 		Insrt Pulse Gen W/mult Leads 7 $30,465.29 $32,068.73 $32,068.73 nat. median
$30,121
1.1× median
33270
HCPCS 		Ins/rep Subq Defibrillator 7 $30,465.29 $32,068.73 $32,068.73 nat. median
$32,221
1.0× median

Other procedures at this hospital

Browse this hospital's 44,418 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
             
J3391 HCPCS Inj, Atidarsagene Autotemcel 10 7 — — $4,279,750.00 $4,505,000.00 $4,505,000.00 2026-04-30
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 10 7 — — $3,501,003.33 $3,685,266.66 $3,685,266.66 2026-04-30
J3389 HCPCS Topi Adm Prad Zami Per Treat 10 7 — — $3,169,029.00 $3,335,820.00 $3,335,820.00 2026-04-30
J1413 HCPCS Inj Delandistrogene Mox Rokl 10 7 — — $3,161,466.73 $3,327,859.72 $3,327,859.72 2026-04-30
J1411N/A HCPCS Inj, Hemgenix, Per Tx Dose 1 1 — — $3,306,566.25 $3,306,566.25 $3,306,566.25 2026-04-30
J3394 HCPCS Inj, Lovotibeglogene Autotem 10 7 — — $3,089,882.67 $3,252,508.07 $3,252,508.07 2026-04-30
J3387 HCPCS Inj Elivaldogene Autotemecel 10 7 — — $3,021,000.00 $3,180,000.00 $3,180,000.00 2026-04-30
J3393 HCPCS Inj, Betibeglogene Autotemce 10 7 — — $2,792,970.44 $2,939,968.88 $2,939,968.88 2026-04-30
J3399 HCPCS Inj Onase Abepar-xioi Treat 10 7 — — $2,459,532.16 $2,588,981.22 $2,588,981.22 2026-04-30
J3392 HCPCS Inj, Exagamglogene Autotem 10 7 — — $2,215,400.00 $2,332,000.00 $2,332,000.00 2026-04-30
Q2057 HCPCS Afamitresgene Autoleucel 12 8 — — $732,089.00 $770,620.00 $770,620.00 2026-04-30
Q2056 HCPCS Ciltacabtagene Car-pos T 12 8 — — $558,267.09 $588,494.81 $587,649.57 2026-04-30
Q2042 HCPCS Tisagenlecleucel Car-pos T 12 8 — — $538,204.74 $614,180.81 $566,531.30 2026-04-30
Q2054 HCPCS Lisocabtagene Mara Car Pos T 12 8 — — $534,091.18 $562,260.84 $562,201.24 2026-04-30
Q2055 HCPCS Idecabtagene Vicleucel Car 12 8 — — $530,177.63 $559,781.08 $558,081.72 2026-04-30
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 12 8 — — $505,582.63 $532,192.24 $532,192.24 2026-04-30
Q2053 HCPCS Brexucabtagene Car Pos T 12 8 — — $464,977.69 $489,450.20 $489,450.20 2026-04-30
Q2058 HCPCS Obecbtge Autol Up To 400 Mil 10 7 — — $264,337.50 $278,250.00 $278,250.00 2026-04-30
J3403 HCPCS Revakinagene, Per Implant 12 8 — — $251,750.00 $265,000.00 $265,000.00 2026-04-30
J3402 HCPCS Inj. Remestemcel-l-rknd/ Td 12 8 — — $191,585.57 $202,713.58 $201,669.02 2026-04-30
Q0480 HCPCS Driver Pneumatic Vad, Rep 1 1 — — $108,243.35 $108,243.35 $108,243.35 2026-04-30
J3399N/A HCPCS Inj Onase Abepar-xioi Treat 1 1 — — $108,157.44 $108,157.44 $108,157.44 2026-04-30
K1007 HCPCS Bil Hkaf Pc S/d Micro Sensor 1 1 — — $95,081.03 $95,081.03 $95,081.03 2026-04-30
A9543N/A HCPCS Y90 Ibritumomab, Rx 1 1 — — $70,944.59 $70,944.59 $70,944.59 2026-04-30
L8702 HCPCS Ewhf S/d Uprt Micro Sensor 1 1 — — $68,801.71 $68,801.71 $68,801.71 2026-04-30
C1604N/A HCPCS Grft, Trnsmurl/trnsvens Byps 1 1 — — $68,624.55 $68,624.55 $68,624.55 2026-04-30
J9029 HCPCS Instill Adstiladrin, Tx Dose 12 8 — — $61,061.05 $64,282.30 $64,274.79 2026-04-30
38240 HCPCS Transplt Allo Hct/donor 10 7 — — $61,050.34 $64,263.52 $64,263.52 2026-04-30
A9543 HCPCS Y90 Ibritumomab, Rx 10 7 — — $53,983.31 $56,824.54 $56,824.54 2026-04-30
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 12 8 — — $51,683.90 $56,269.19 $54,404.10 2026-04-30
J7330N/A HCPCS Cultured Chondrocytes Implnt 1 1 — — $49,142.15 $49,142.15 $49,142.15 2026-04-30
L7181 HCPCS Electronic Elbo Simultaneous 1 1 — — $48,155.50 $48,155.50 $48,155.50 2026-04-30
64654 HCPCS 1st Opn Implt Bat Modulj Sys 10 7 — — $42,750.48 $45,000.50 $45,000.50 2026-04-30
0620T HCPCS Evasc Ven Artlz Tibl/prnl Vn 10 7 — — $42,750.48 $45,000.50 $45,000.50 2026-04-30
33276 HCPCS Insj Phrnc Nrv Stim Sys 10 7 — — $42,750.48 $45,000.50 $45,000.50 2026-04-30
64568 HCPCS Opn Impltj Crnl Nrv Nea&pg 10 7 — — $42,750.48 $45,000.50 $45,000.50 2026-04-30
L7180 HCPCS Electronic Elbow Sequential 1 1 — — $44,356.85 $44,356.85 $44,356.85 2026-04-30
J9226 HCPCS Supprelin La Implant 12 8 — — $41,026.06 $43,185.33 $43,185.33 2026-04-30
C1825N/A HCPCS Gen, Neuro, Carot Sinus Baro 1 1 — — $40,135.67 $40,135.67 $40,135.67 2026-04-30
L2006 HCPCS Kaf Sng/dbl Swg/stn Mcpr Cus 1 1 — — $39,938.10 $39,938.10 $39,938.10 2026-04-30
S2079N/A HCPCS Lap Esophagomyotomy 1 1 — — $35,629.96 $35,629.96 $35,629.96 2026-04-30
0870T HCPCS Imp Subq Prtl Ascts Pmp Sys 10 7 — — $33,250.48 $35,000.50 $35,000.50 2026-04-30
L8701 HCPCS Ewh S/d Uprt Micro Sensor 1 1 — — $34,970.13 $34,970.13 $34,970.13 2026-04-30
69930 HCPCS Implant Cochlear Device 10 7 — — $32,001.97 $33,686.28 $33,686.28 2026-04-30
C1826N/A HCPCS Gen, Neuro, Clo Loop, Rechg 1 1 — — $33,459.93 $33,459.93 $33,459.93 2026-04-30
J1413N/A HCPCS Inj Delandistrogene Mox Rokl 1 1 — — $33,120.00 $33,120.00 $33,120.00 2026-04-30
S2150N/A HCPCS Bmt Harv/transpl 28d Pkg 1 1 — — $32,723.22 $32,723.22 $32,723.22 2026-04-30
33270 HCPCS Ins/rep Subq Defibrillator 10 7 — — $30,465.29 $32,068.73 $32,068.73 2026-04-30
0408T HCPCS Insj/rplc Cardiac Modulj Sys 10 7 — — $30,465.29 $32,068.73 $32,068.73 2026-04-30
33231 HCPCS Insrt Pulse Gen W/mult Leads 10 7 — — $30,465.29 $32,068.73 $32,068.73 2026-04-30
0571T HCPCS Insj/rplcmt Icds Ss Eltrd 10 7 — — $30,465.29 $32,068.73 $32,068.73 2026-04-30
0915T HCPCS Insj Perm Ccm-d Sys Pg&eltrd 10 7 — — $30,465.29 $32,068.73 $32,068.73 2026-04-30
33264 HCPCS Rmvl & Rplcmt Dfb Gen Mlt Ld 10 7 — — $30,465.29 $32,068.73 $32,068.73 2026-04-30
33249 HCPCS Insj/rplcmt Defib W/lead(s) 10 7 — — $30,465.29 $32,068.73 $32,068.73 2026-04-30
64582 HCPCS Opn Mpltj Hpglsl Nstm Ary Pg 10 7 — — $29,949.76 $31,526.06 $31,526.06 2026-04-30
0674T HCPCS Laps Insj Nw/rpcmt Prm Isdss 10 7 — — $29,949.76 $31,526.06 $31,526.06 2026-04-30
61891 HCPCS Rev/rplcmt Sk-mnt Crnl Nstm 10 7 — — $29,949.76 $31,526.06 $31,526.06 2026-04-30
61885 HCPCS Insrt/redo Neurostim 1 Array 10 7 — — $29,949.76 $31,526.06 $31,526.06 2026-04-30
64656 HCPCS Revj/rplcmt Bat Mod Sys Pg 10 7 — — $29,949.76 $31,526.06 $31,526.06 2026-04-30
61886 HCPCS Implant Neurostim Arrays 10 7 — — $29,949.76 $31,526.06 $31,526.06 2026-04-30
33287 HCPCS Rmv&rplcmt Phrnc Nrv Stim Pg 10 7 — — $29,949.76 $31,526.06 $31,526.06 2026-04-30
0908T HCPCS Opn Imp Int Nstm Sys Vgs Nrv 10 7 — — $29,949.76 $31,526.06 $31,526.06 2026-04-30
63685 HCPCS Ins/rplc Spi Npg/rcvr Pocket 10 7 — — $29,949.76 $31,526.06 $31,526.06 2026-04-30
0909T HCPCS Rplcmt Int Nstim Sys Vgs Nrv 10 7 — — $29,949.76 $31,526.06 $31,526.06 2026-04-30
C9775N/A HCPCS Revasc Lith-sten-ath Tib/per 1 1 — — $31,194.14 $31,194.14 $31,194.14 2026-04-30
C1822N/A HCPCS Gen, Neuro, Hf, Rechg Bat 1 1 — — $29,643.76 $29,643.76 $29,643.76 2026-04-30
L6700 HCPCS Ue Add Ext Power Myoel 1 1 — — $29,510.19 $29,510.19 $29,510.19 2026-04-30
C2624N/A HCPCS Wireless Pressure Sensor 1 1 — — $29,342.72 $29,342.72 $29,342.72 2026-04-30
33289 HCPCS Tcat Impl Wrls P-art Prs Snr 10 7 — — $27,839.39 $29,304.62 $29,304.62 2026-04-30
L5856 HCPCS Elec Knee-shin Swing/stance 1 1 — — $28,851.23 $28,851.23 $28,851.23 2026-04-30
L6880 HCPCS Elec Hand Ind Art Digits 1 1 — — $28,715.00 $28,715.00 $28,715.00 2026-04-30
J9266 HCPCS Pegaspargase Injection 12 8 — — $27,002.85 $28,424.06 $28,424.05 2026-04-30
C1882N/A HCPCS Aicd, Other Than Sing/dual 1 1 — — $28,258.17 $28,258.17 $28,258.17 2026-04-30
21243 HCPCS Reconstruction Of Jaw Joint 10 7 — — $26,335.64 $27,721.73 $27,721.73 2026-04-30
22630 HCPCS Arthrd Pst Tq 1ntrspc Lum 10 7 — — $26,335.64 $27,721.73 $27,721.73 2026-04-30
0956T HCPCS Prt Crn Ch Cr&tun Elt S-sclp 10 7 — — $26,335.64 $27,721.73 $27,721.73 2026-04-30
0960T HCPCS Rpl S-sclp Eltr Ra Rcvr&tlmt 10 7 — — $26,335.64 $27,721.73 $27,721.73 2026-04-30
27702 HCPCS Reconstruct Ankle Joint 10 7 — — $26,335.64 $27,721.73 $27,721.73 2026-04-30
22558 HCPCS Arthrd Ant Ntrbd Min Dsc Lum 10 7 — — $26,335.64 $27,721.73 $27,721.73 2026-04-30
20696 HCPCS App Mltpln Uni Xtrnl Fix 1st 10 7 — — $26,335.64 $27,721.73 $27,721.73 2026-04-30
22633 HCPCS Arthrd Cmbn 1ntrspc Lumbar 10 7 — — $26,335.64 $27,721.73 $27,721.73 2026-04-30
C2619N/A HCPCS Pmkr, Dual, Non Rate-resp 1 1 — — $27,521.49 $27,521.49 $27,521.49 2026-04-30
0871T HCPCS Rplcmt Subq Prtl Ascites Pmp 10 7 — — $26,125.48 $27,500.50 $27,500.50 2026-04-30
C9760 HCPCS Non-blind Interatrial Shunt 10 7 — — $26,125.48 $27,500.50 $27,500.50 2026-04-30
93654 HCPCS Compre Ep Eval Tx Vt 10 7 — — $25,368.79 $26,703.99 $26,703.99 2026-04-30
93653 HCPCS Compre Ep Eval Tx Svt 10 7 — — $25,368.79 $26,703.99 $26,703.99 2026-04-30
93656 HCPCS Compre Ep Eval Abltj Atr Fib 10 7 — — $25,368.79 $26,703.99 $26,703.99 2026-04-30
C1767N/A HCPCS Generator, Neuro Non-recharg 1 1 — — $24,914.59 $24,914.59 $24,914.59 2026-04-30
J9600 HCPCS Porfimer Sodium Injection 10 7 — — $23,017.00 $24,228.42 $24,228.42 2026-04-30
L8614 HCPCS Cochlear Device 1 1 — — $24,149.06 $24,149.06 $24,149.06 2026-04-30
C1722N/A HCPCS Aicd, Single Chamber 1 1 — — $23,331.40 $23,331.40 $23,331.40 2026-04-30
C9095N/A HCPCS Inj, Tebentafusp-tebn, 1 Mcg 1 1 — — $23,157.68 $23,157.68 $23,157.68 2026-04-30
L6975 HCPCS Interscap-thor Myoelectronic 1 1 — — $22,747.26 $22,747.26 $22,747.26 2026-04-30
33240 HCPCS Insrt Pulse Gen W/singl Lead 10 7 — — $21,589.09 $22,725.36 $22,725.36 2026-04-30
0916T HCPCS Insj Perm Ccm-d Sys Pg Only 10 7 — — $21,589.09 $22,725.36 $22,725.36 2026-04-30
33230 HCPCS Insrt Pulse Gen W/dual Leads 10 7 — — $21,589.09 $22,725.36 $22,725.36 2026-04-30
0923T HCPCS Rmvl&rplcmt Perm Ccm-d Pg 10 7 — — $21,589.09 $22,725.36 $22,725.36 2026-04-30
0409T HCPCS Insj/rplc Car Modulj Pls Gn 10 7 — — $21,589.09 $22,725.36 $22,725.36 2026-04-30
0614T HCPCS Rmvl&rplcmt Ss Impl Dfb Pg 10 7 — — $21,589.09 $22,725.36 $22,725.36 2026-04-30
0414T HCPCS Rmvl & Rpl Car Modulj Pls Gn 10 7 — — $21,589.09 $22,725.36 $22,725.36 2026-04-30
0515T HCPCS Insj Wcs Lv Compl Sys 10 7 — — $21,589.09 $22,725.36 $22,725.36 2026-04-30
33262 HCPCS Rmvl& Replc Pulse Gen 1 Lead 10 7 — — $21,589.09 $22,725.36 $22,725.36 2026-04-30
33263 HCPCS Rmvl & Rplcmt Dfb Gen 2 Lead 10 7 — — $21,589.09 $22,725.36 $22,725.36 2026-04-30
Q0483 HCPCS Monitor Elec Vad, Rep 1 1 — — $22,533.92 $22,533.92 $22,533.92 2026-04-30
L5858 HCPCS Stance Phase Only 1 1 — — $22,336.47 $22,336.47 $22,336.47 2026-04-30
G0458N/A HCPCS Ldr Prostate Brachy Comp Rat 1 1 — — $22,143.36 $22,143.36 $22,143.36 2026-04-30
C1820N/A HCPCS Generator Neuro Rechg Bat Sy 1 1 — — $21,826.26 $21,826.26 $21,826.26 2026-04-30
C1721N/A HCPCS Aicd, Dual Chamber 1 1 — — $21,644.06 $21,644.06 $21,644.06 2026-04-30
C1823N/A HCPCS Gen, Neuro, Trans Sen/stim 1 1 — — $21,538.39 $21,538.39 $21,538.39 2026-04-30
C2616N/A HCPCS Brachytx, Non-str,yttrium-90 1 1 — — $21,524.14 $21,524.14 $21,524.14 2026-04-30
54405 HCPCS Insert Multi-comp Penis Pros 10 7 — — $20,116.29 $21,175.04 $21,175.04 2026-04-30
53444 HCPCS Insert Tandem Cuff 10 7 — — $20,116.29 $21,175.04 $21,175.04 2026-04-30
54410 HCPCS Remove/replace Penis Prosth 10 7 — — $20,116.29 $21,175.04 $21,175.04 2026-04-30
54417 HCPCS Remv/replc Penis Pros Compl 10 7 — — $20,116.29 $21,175.04 $21,175.04 2026-04-30
54416 HCPCS Remv/repl Penis Contain Pros 10 7 — — $20,116.29 $21,175.04 $21,175.04 2026-04-30
54411 HCPCS Remov/replc Penis Pros Comp 10 7 — — $20,116.29 $21,175.04 $21,175.04 2026-04-30
54401 HCPCS Insert Self-contd Prosthesis 10 7 — — $20,116.29 $21,175.04 $21,175.04 2026-04-30
53447 HCPCS Remove/replace Ur Sphincter 10 7 — — $20,116.29 $21,175.04 $21,175.04 2026-04-30
53445 HCPCS Insert Uro/ves Nck Sphincter 10 7 — — $20,116.29 $21,175.04 $21,175.04 2026-04-30
L5973 HCPCS Ank-foot Sys Dors-plant Flex 1 1 — — $21,127.66 $21,127.66 $21,127.66 2026-04-30
J9600N/A HCPCS Porfimer Sodium Injection 1 1 — — $20,842.46 $20,842.46 $20,842.46 2026-04-30
C7508N/A HCPCS Perq Lumb&thor Vert Aug 1 1 — — $20,102.55 $20,102.55 $20,102.55 2026-04-30
0680T HCPCS Insj/rplcmt Pg Only Isdss 10 7 — — $18,829.29 $19,820.31 $19,820.31 2026-04-30
64590 HCPCS Ins/rpl Prph Sac/gstr Npg/r 10 7 — — $18,829.29 $19,820.31 $19,820.31 2026-04-30
1013T HCPCS Lap Srg Imp/rpl Eso Nea&pg/r 10 7 — — $18,829.29 $19,820.31 $19,820.31 2026-04-30
0817T HCPCS Opn Insj/rplcmt Ins Ptn Subf 10 7 — — $18,829.29 $19,820.31 $19,820.31 2026-04-30
64580 HCPCS Opn Impltj Nea Neuromuscular 10 7 — — $18,829.29 $19,820.31 $19,820.31 2026-04-30
63655 HCPCS Implant Neuroelectrodes 10 7 — — $18,829.29 $19,820.31 $19,820.31 2026-04-30
0816T HCPCS Opn Insj/rplcmt Ins Ptn Subq 10 7 — — $18,829.29 $19,820.31 $19,820.31 2026-04-30
0525T HCPCS Insj/rplcmt Compl Iims 10 7 — — $18,694.95 $19,678.89 $19,678.89 2026-04-30
0797T HCPCS Tcat Ins 2chmbr Ldls Pm Rv 10 7 — — $18,694.95 $19,678.89 $19,678.89 2026-04-30
0796T HCPCS Tcat Ins 2chmbr Ldls Pm Ra 10 7 — — $18,694.95 $19,678.89 $19,678.89 2026-04-30
33229 HCPCS Remv&replc Pm Gen Mult Leads 10 7 — — $18,694.95 $19,678.89 $19,678.89 2026-04-30
0803T HCPCS Tcat Rmv&rpl2chmb Ldls Pm Rv 10 7 — — $18,694.95 $19,678.89 $19,678.89 2026-04-30
33221 HCPCS Insert Pulse Gen Mult Leads 10 7 — — $18,694.95 $19,678.89 $19,678.89 2026-04-30
0825T HCPCS Tcat Rmv&rpl1chmb Ldls Pm Ra 10 7 — — $18,694.95 $19,678.89 $19,678.89 2026-04-30
33274 HCPCS Tcat Insj/rpl Perm Ldls Pm 10 7 — — $18,694.95 $19,678.89 $19,678.89 2026-04-30
0801T HCPCS Tcat Rmv&rpl 2chmbr Ldls Pm 10 7 — — $18,694.95 $19,678.89 $19,678.89 2026-04-30
0802T HCPCS Tcat Rmv&rpl2chmb Ldls Pm Ra 10 7 — — $18,694.95 $19,678.89 $19,678.89 2026-04-30
0795T HCPCS Tcat Ins 2chmbr Ldls Pm Cmpl 10 7 — — $18,694.95 $19,678.89 $19,678.89 2026-04-30
0823T HCPCS Tcat Ins 1chmbr Ldls Pm Ra 10 7 — — $18,694.95 $19,678.89 $19,678.89 2026-04-30
Q0489 HCPCS Pwr Pck Base Combo Vad, Rep 1 1 — — $19,535.67 $19,535.67 $19,535.67 2026-04-30
L6970 HCPCS Interscapular-thor Switch CT 1 1 — — $19,237.24 $19,237.24 $19,237.24 2026-04-30
C1827N/A HCPCS Gen, Neuro, Imp Led, Ex Cntr 1 1 — — $19,159.64 $19,159.64 $19,159.64 2026-04-30
C1824N/A HCPCS Generator, Ccm, Implant 1 1 — — $19,005.36 $19,005.36 $19,005.36 2026-04-30
C9766 HCPCS Revasc Intra Lithotrip-ather 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
C9607 HCPCS Perc D-e Cor Revasc Chro Sin 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
37284 HCPCS Revsc Evasc Tpvt St Sf 1st 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
37286 HCPCS Revsc Evasc Tpvt St Cplx 1st 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
0645T HCPCS Tcat Impltj C Sins Rdctj Dev 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
C9767 HCPCS Revasc Lithotrip-stent-ather 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
37242 HCPCS Vasc Embolize/occlude Artery 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
0238T HCPCS Trluml Perip Athrc Iliac Art 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
37288 HCPCS Revsc Evsc Tpvt Athrc Sf 1st 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
93581 HCPCS Transcath Closure Of Vsd 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
36836 HCPCS Prq Av Fstl Crtj Uxtr 1 Acs 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
33902 HCPCS Perq P-art Revsc 1 Abnor Uni 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
37271 HCPCS Revsc Evsc Fpvt Athrc Sf 1st 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
37294 HCPCS Rvsc Evsc Tpvt St Athr Cpx 1 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
C9765 HCPCS Revasc Intra Lithotrip-stent 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
37273 HCPCS Revsc Evsc Fpvt Athrc Cplx 1 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
37292 HCPCS Rvsc Evsc Tpvt St Athrc Sf 1 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
37277 HCPCS Rvsc Evsc Fpvt St Athr Cpx 1 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
37290 HCPCS Revsc Evsc Tpvt Athrc Cplx 1 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
37182 HCPCS Insert Hepatic Shunt (tips) 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
61624 HCPCS Tcat Perm Occls/embolj Cns 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
0793T HCPCS Prq Tcat Thrm Ablt Nrv P-art 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
0981T HCPCS Tcat Impl Wrls Ivc Snr 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
93590 HCPCS Perq Transcath Cls Mitral 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
93591 HCPCS Perq Transcath Cls Aortic 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
93582 HCPCS Perq Transcath Closure Pda 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
C9775 HCPCS Revasc Lith-sten-ath Tib/per 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
C9773 HCPCS Revasc Lithotr-stent Tib/per 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
C9774 HCPCS Revasc Lithotr-ather Tib/per 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
C9797 HCPCS Vasc Emb/occ W/prs Cath 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
0632T HCPCS Perq Tcat US Abltj Nrv P-art 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
92930 HCPCS Prq Tcat Plmt Ntrac St 2+les 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
C9602 HCPCS Perc D-e Cor Stent Ather S 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
92933 HCPCS Prq Trlml C Athrc St Angiop1 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
36837 HCPCS Prq Av Fstl Crt Uxtr Sep Acs 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
36906 HCPCS Thrmbc/nfs Dialysis Circuit 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
93580 HCPCS Transcath Closure Of Asd 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
37275 HCPCS Rvsc Evsc Fpvt St Athrc Sf 1 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
37184 HCPCS Prim Art M-thrmbc 1st Vsl 10 7 — — $17,792.26 $18,728.69 $18,728.69 2026-04-30
C1839N/A HCPCS Iris Prosthesis 1 1 — — $18,661.45 $18,661.45 $18,661.45 2026-04-30
62362 HCPCS Implant Spine Infusion Pump 10 7 — — $17,493.53 $18,414.24 $18,414.24 2026-04-30
62360 HCPCS Insert Spine Infusion Device 10 7 — — $17,493.53 $18,414.24 $18,414.24 2026-04-30
62361 HCPCS Implant Spine Infusion Pump 10 7 — — $17,493.53 $18,414.24 $18,414.24 2026-04-30
K0891NU HCPCS Pwc Gp5 Ped Mult Pow Opt S/b 1 1 — — $18,289.37 $18,289.37 $18,289.37 2026-04-30
L6965 HCPCS Shldr Disartic Myoelectronic 1 1 — — $18,164.17 $18,164.17 $18,164.17 2026-04-30
24363 HCPCS Replace Elbow Joint 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
24371 HCPCS Revise Reconst Elbow Joint 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
27487 HCPCS Revise/replace Knee Joint 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
24361 HCPCS Reconstruct Elbow Joint 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
0657T HCPCS Ant Lmbr Vrt Bdy Teth 8+ Seg 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22533 HCPCS Arthrd Lat Xtrcvtry Tq Lmbr 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
20982 HCPCS Ablate Bone Tumor(s) Perq 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
0656T HCPCS Ant Lmbr Vrt Bdy Teth <7 Seg 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22808 HCPCS Arthrd Ant Dfrm 2-3 Vrt Sgm 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
23616 HCPCS Optx Prx Hmrl Fx Fix Rpr Rpl 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
23472 HCPCS Reconstruct Shoulder Joint 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
20838 HCPCS Replantation Foot Complete 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
0790T HCPCS Revj Rplcmt/rmvl Vrt Tethrg 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22556 HCPCS Arthrd Ant Ntrbd Min Dsc Thc 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
28705 HCPCS Arthrodesis Pantalar 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22818 HCPCS Kyphectomy 1-2 Segments 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
27703 HCPCS Reconstruction Ankle Joint 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
20802 HCPCS Replantation Arm Complete 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
20808 HCPCS Replantation Hand Complete 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22586 HCPCS Arthrd Pre-sac Ntrbdy L5-s1 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
20805 HCPCS Replant Forearm Complete 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
27280 HCPCS Arthr Si Jt Opn B1grf Instrm 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
27290 HCPCS Amputation Of Leg At Hip 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
27278 HCPCS Arthrd Si Jt Plmt Iartic Dev 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
27295 HCPCS Amputation Of Leg At Hip 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
27279 HCPCS Arthrd Si Jt Plmt Tartclr Dv 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22600 HCPCS Arthrd Pst Tq 1ntrspc Crv 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22867 HCPCS Insj Stablj Dev W/dcmprn 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22812 HCPCS Arthrd Ant Dfrm 8+ Vrt Sgm 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22857 HCPCS Tot Disc Arthrp 1ntrspc Lmbr 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22856 HCPCS Tot Disc Arthrp 1ntrspc Crv 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22861 HCPCS Rev Rplcm Arthrp 1ntrspc Crv 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
25446 HCPCS Arthrp W/prostc Dst Rds&crps 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22862 HCPCS Rev Rplcm Rthrp 1ntrspc Lmbr 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
25442 HCPCS Arthrp W/prostc Dstl Ulna 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22838 HCPCS Rev Rplc/rmv Thrc Vrt Tethrg 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22819 HCPCS Kyphectomy 3 Or More 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22810 HCPCS Arthrd Ant Dfrm 4-7 Vrt Sgm 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
C8003 HCPCS Imp Extar Knee Shck Absrb 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22836 HCPCS Ant Thrc Vrt Body Tethrg <7 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22804 HCPCS Arthrd Pst Dfrm 13+ Vrt Sgm 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22800 HCPCS Arthrd Pst Dfrm<6 Vrt Sgm 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22610 HCPCS Arthrd Pst Tq 1ntrspc Thrc 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22612 HCPCS Arthrd Pst Tq 1ntrspc Lumbar 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22837 HCPCS Ant Thrc Vrt Body Tethrg 8+ 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
22802 HCPCS Arthrd Pst Dfrm 7-12 Vrt Sgm 10 7 — — $17,017.91 $17,913.59 $17,913.59 2026-04-30
C2616 HCPCS Brachytx, Non-str,yttrium-90 10 7 — — $16,882.46 $17,771.01 $17,771.01 2026-04-30
0888T HCPCS Histotripsy Mal Renal Tissue 10 7 — — $16,625.48 $17,500.50 $17,500.50 2026-04-30
C9782 HCPCS Blind Myocar Trpl Bon Marrow 10 7 — — $16,625.48 $17,500.50 $17,500.50 2026-04-30
0686T HCPCS Histotripsy Mal Hepatcel Tis 10 7 — — $16,625.48 $17,500.50 $17,500.50 2026-04-30
C9758 HCPCS Blind Interatrial Shunt Ide 10 7 — — $16,625.48 $17,500.50 $17,500.50 2026-04-30
C8005 HCPCS Pef Bronch Ablt 3d Nav Ebus 10 7 — — $16,625.48 $17,500.50 $17,500.50 2026-04-30
Q0481 HCPCS Microprcsr Cu Elec Vad, Rep 1 1 — — $17,463.78 $17,463.78 $17,463.78 2026-04-30
L5859 HCPCS Knee-shin Pro Flex/ext Cont 1 1 — — $17,437.90 $17,437.90 $17,437.90 2026-04-30
C9607N/A HCPCS Perc D-e Cor Revasc Chro Sin 1 1 — — $17,394.41 $17,394.41 $17,394.41 2026-04-30
C9765N/A HCPCS Revasc Intra Lithotrip-stent 1 1 — — $17,314.01 $17,314.01 $17,314.01 2026-04-30
L8687N/A HCPCS Implt Nrostm Pls Gen Dua Rec 1 1 — — $17,249.85 $17,249.85 $17,249.85 2026-04-30
C9602N/A HCPCS Perc D-e Cor Stent Ather S 1 1 — — $17,153.05 $17,153.05 $17,153.05 2026-04-30
S2152N/A HCPCS Solid Organ Transpl Pkg 1 1 — — $17,021.63 $17,021.63 $17,021.63 2026-04-30
66683 HCPCS Implantation Iris Prosthesis 10 7 — — $15,976.49 $16,817.36 $16,817.36 2026-04-30
0308T HCPCS Insj Ocular Telescope Prosth 10 7 — — $15,976.49 $16,817.36 $16,817.36 2026-04-30
E0766 HCPCS Elec Stim Cancer Treatment 1 1 — — $16,384.73 $16,384.73 $16,384.73 2026-04-30
S2115N/A HCPCS Periacetabular Osteotomy 1 1 — — $16,011.53 $16,011.53 $16,011.53 2026-04-30
C7539N/A HCPCS Insrt A & V Pm W/l Vent Lead 1 1 — — $15,919.08 $15,919.08 $15,919.08 2026-04-30
L6960 HCPCS Shldr Disartic Switch Contro 1 1 — — $15,644.23 $15,644.23 $15,644.23 2026-04-30
C9604N/A HCPCS Perc D-e Cor Revasc T Cabg S 1 1 — — $15,493.38 $15,493.38 $15,493.38 2026-04-30
C1772N/A HCPCS Infusion Pump, Programmable 1 1 — — $14,831.86 $14,831.86 $14,831.86 2026-04-30
65770 HCPCS Keratoprosthesis 10 7 — — $14,079.29 $14,820.30 $14,820.30 2026-04-30
L6955 HCPCS Above Elbow Myoelectronic CT 1 1 — — $14,621.82 $14,621.82 $14,621.82 2026-04-30
Q0479 HCPCS Power Module Combo Vad, Rep 1 1 — — $14,386.80 $14,386.80 $14,386.80 2026-04-30
67027 HCPCS Implant Eye Drug System 10 7 — — $13,542.41 $14,255.17 $14,255.17 2026-04-30
19357 HCPCS Tiss Xpndr Plmt Brst Rcnstj 10 7 — — $13,375.47 $14,079.44 $14,079.44 2026-04-30
19298 HCPCS Place Breast Rad Tube/caths 10 7 — — $13,375.47 $14,079.44 $14,079.44 2026-04-30
C1817N/A HCPCS Septal Defect Imp Sys 1 1 — — $13,773.81 $13,773.81 $13,773.81 2026-04-30
C9606N/A HCPCS Perc D-e Cor Revasc W Ami S 1 1 — — $13,758.49 $13,758.49 $13,758.49 2026-04-30
C1813N/A HCPCS Prosthesis, Penile, Inflatab 1 1 — — $13,533.60 $13,533.60 $13,533.60 2026-04-30
0582T HCPCS Trurl Abltj Mal Prst8 Tiss 10 7 — — $12,805.26 $13,479.22 $13,479.22 2026-04-30
53440 HCPCS Male Sling Procedure 10 7 — — $12,805.26 $13,479.22 $13,479.22 2026-04-30
55882 HCPCS Ablt Trurl Prst8 Tis Trnsdcr 10 7 — — $12,805.26 $13,479.22 $13,479.22 2026-04-30
53451 HCPCS Tprnl Balo Cntnc Dev Bi 10 7 — — $12,805.26 $13,479.22 $13,479.22 2026-04-30
54400 HCPCS Insert Semi-rigid Prosthesis 10 7 — — $12,805.26 $13,479.22 $13,479.22 2026-04-30
24366 HCPCS Reconstruct Head Of Radius 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
0220T HCPCS Plmt Post Facet Implt Thor 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
0219T HCPCS Plmt Post Facet Implt Cerv 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
24370 HCPCS Revise Reconst Elbow Joint 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
24410 HCPCS Mlt Osteot Rlgnm Imed Rd Hum 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
24362 HCPCS Reconstruct Elbow Joint 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
24365 HCPCS Reconstruct Head Of Radius 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
22532 HCPCS Arthrd Lat Xtrcvtry Tq Thrc 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
22554 HCPCS Arthrd Ant Ntrbd Min Dsc Crv 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
24346 HCPCS Reconstruct Elbow Med Ligmnt 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
0629T HCPCS Perq Njx Algc CT Lmbr 1st 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
69729 HCPCS Impl Oi Implt Sk Tc Esp>=100 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
69730 HCPCS Rplc Oi Implt Sk Tc Esp>=100 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
22595 HCPCS Arthrd Pst Tq Atlas-axis 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
24579 HCPCS Optx Humrl Cndylr Fracture 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
22551 HCPCS Arthrd Ant Ntrbdy Cervical 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
24545 HCPCS Optx Hum Fx Wo Ntrcndylr Xtn 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
24546 HCPCS Optx Hum Fx W/ntrcndylr Xtn 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
23900 HCPCS Interthoracoscplr Amputation 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
23920 HCPCS Disarticulation Shoulder 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
69714 HCPCS Impl Oi Implt Skull Perq Esp 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
23680 HCPCS Optx Sho Dislc Neck Fx Fixj 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
0202T HCPCS Post Vert Arthrplst 1 Lumbar 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
23802 HCPCS Arthrd Glenohumeral Jt W/grf 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
24575 HCPCS Optx Humeral Epcndylr Fx 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
69716 HCPCS Impl Oi Implt Sk Tc Esp<100 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
23615 HCPCS Optx Prox Humrl Fx W/int Fix 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
23491 HCPCS Reinforce Shoulder Bones 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
24498 HCPCS Proph Tx W/wo Mthylmthcrylt 10 7 — — $12,460.92 $13,116.76 $13,116.76 2026-04-30
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