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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

RIVERVIEW HEALTH

Noblesville, IN · CCN 150059 · Rates published

3,525 distinct procedures filed
14 distinct payers
66,627 rate rows
2026-04-01 last MRF observed
Data quality

52,131 of 66,627 rate rows are consumer-grade (78.2%)

14,496 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 12,283
template filing: same amount across many unrelated codes — excluded 1,197
placeholder amount (≤ $0.02) — excluded from medians 1,016
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://riverview.org/sites/default/files/pdf/25-005054-1_riverview-health_standardcharges.csv
Found on page https://www.riverview.org/cost-estimates
Discovered viaCMS hospital list
Last fetch not_modified · 2026-08-05
Content fingerprint fc35862ce549d908… · 11,493,179 bytes · first seen 2026-05-13

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
5224
OTHER 		Level 4 Pacemaker And Similar Procedures 1 $46,995.30 $46,995.30 $46,995.30 nat. median
$19,789
outlier · 2.4×
5232
OTHER 		Level 2 Icd And Similar Procedures 5 $13,080.09 $72,998.09 $32,915.33 nat. median
$32,779
1.0× median
5465
OTHER 		Level 5 Neurostimulator And Related Procedures 5 $2,160.99 $50,724.76 $31,285.55 nat. median
$31,928
1.0× median
5200
OTHER 		Implantation Wireless Pa Pressure Monitor 1 $29,185.33 $29,185.33 $29,185.33 nat. median
$29,513
1.0× median
5213
OTHER 		Level 3 Electrophysiologic Procedures 2 $14,588.47 $43,031.15 $28,809.81 nat. median
$26,520
1.1× median
0870T
CPT 		Imp Subq Prtl Ascts Pmp Sys 6 $5,076.00 $90,614.54 $24,000.00 nat. median
$8,576
outlier · 2.8×
0796T
CPT 		Tcat Ins 2chmbr Ldls Pm Ra 6 $6,002.00 $58,834.82 $24,000.00 nat. median
$20,641
1.2× median
0871T
CPT 		Rplcmt Subq Prtl Ascites Pmp 6 $5,076.00 $71,197.42 $24,000.00 nat. median
$9,360
outlier · 2.6×
0571T
CPT 		Insj/rplcmt Icds Ss Eltrd 6 $522.68 $83,024.34 $23,565.00 nat. median
$32,069
0.7× median
0915T
CPT 		Insj Perm Ccm-d Sys Pg&eltrd 6 $989.28 $83,024.34 $23,565.00 nat. median
$32,635
0.7× median
0408T
CPT 		Insj/rplc Cardiac Modulj Sys 6 $661.61 $83,024.34 $23,565.00 nat. median
$32,062
0.7× median
0614T
CPT 		Rmvl&rplcmt Ss Impl Dfb Pg 6 $468.23 $58,834.82 $23,533.93 nat. median
$23,432
1.0× median
0916T
CPT 		Insj Perm Ccm-d Sys Pg Only 6 $690.80 $58,834.82 $23,533.93 nat. median
$23,439
1.0× median
0414T
CPT 		Rmvl & Rpl Car Modulj Pls Gn 6 $551.74 $58,834.82 $23,533.93 nat. median
$23,105
1.0× median
0515T
CPT 		Insj Wcs Lv Compl Sys 6 $854.91 $58,834.82 $23,533.93 nat. median
$22,690
1.0× median
0923T
CPT 		Rmvl&rplcmt Perm Ccm-d Pg 6 $320.30 $58,834.82 $23,533.93 nat. median
$22,725
1.0× median
0409T
CPT 		Insj/rplc Car Modulj Pls Gn 6 $534.00 $58,834.82 $23,533.93 nat. median
$23,132
1.0× median
22633
HCPCS 		Lumbar Spine Fusion Combined 6 $2,127.83 $71,770.17 $23,386.00 nat. median
$17,296
1.4× median
22630
HCPCS 		Lumbar Spine Fusion 6 $1,954.30 $71,770.17 $23,386.00 nat. median
$16,992
1.4× median
0620T
CPT 		Evasc Ven Artlz Tibl/prnl Vn 6 $6,002.00 $116,504.04 $22,947.59 nat. median
$32,810
0.7× median
0505T
CPT 		Ev Fempop Artl Revsc 6 $3,070.00 $39,838.89 $22,765.08 nat. median
$12,899
1.8× median
5231
OTHER 		Level 1 Icd And Similar Procedures 3 $22,627.40 $62,924.72 $22,765.01 nat. median
$23,228
1.0× median
5093
OTHER 		Level 3 Breast/Lymphatic Surgery And Related Procedures 2 $8,546.41 $24,792.72 $22,537.57 nat. median
$8,962
outlier · 2.5×
0268T
CPT 		Implt/rpl Crtd Sns Dev Gen 2 $6,002.00 $24,000.00 $21,997.00 nat. median
$29,816
0.7× median
0266T
CPT 		Implt/rpl Crtd Sns Dev Total 2 $6,002.00 $24,000.00 $21,997.00 nat. median
$42,997
0.5× median
5115
OTHER 		Level 5 Musculoskeletal Procedures 9 $13,209.44 $46,601.11 $21,583.36 nat. median
$13,671
1.6× median
5116
OTHER 		Level 6 Musculoskeletal Procedures 8 $259.44 $83,450.48 $20,831.68 nat. median
$18,671
1.1× median
0801T
CPT 		Tcat Rmv&rpl 2chmbr Ldls Pm 6 $6,002.00 $50,947.66 $20,786.65 nat. median
$19,264
1.1× median
0797T
CPT 		Tcat Ins 2chmbr Ldls Pm Rv 6 $6,002.00 $50,947.66 $20,786.65 nat. median
$19,703
1.1× median
0802T
CPT 		Tcat Rmv&rpl2chmb Ldls Pm Ra 6 $6,002.00 $50,947.66 $20,786.65 nat. median
$19,166
1.1× median
0803T
CPT 		Tcat Rmv&rpl2chmb Ldls Pm Rv 6 $6,002.00 $50,947.66 $20,786.65 nat. median
$19,429
1.1× median
0795T
CPT 		Tcat Ins 2chmbr Ldls Pm Cmpl 6 $6,002.00 $50,947.66 $20,786.65 nat. median
$21,490
1.0× median
0981T
CPT 		Tcat Impl Wrls Ivc Snr 4 $19,395.06 $48,487.64 $19,976.91 nat. median
$18,746
1.1× median
0793T
CPT 		Prq Tcat Thrm Ablt Nrv P-art 6 $6,002.00 $48,487.64 $19,782.96 nat. median
$18,266
1.1× median
0525T
CPT 		Insj/rplcmt Compl Iims 6 $762.10 $50,947.66 $19,477.00 nat. median
$17,941
1.1× median
0825T
CPT 		Tcat Rmv&rpl1chmb Ldls Pm Ra 6 $480.52 $50,947.66 $19,477.00 nat. median
$19,864
1.0× median
0817T
CPT 		Opn Insj/rplcmt Ins Ptn Subf 6 $271.50 $51,313.79 $19,477.00 nat. median
$21,273
0.9× median
0816T
CPT 		Opn Insj/rplcmt Ins Ptn Subq 6 $271.50 $51,313.79 $19,477.00 nat. median
$21,551
0.9× median
0823T
CPT 		Tcat Ins 1chmbr Ldls Pm Ra 6 $480.52 $58,834.82 $19,477.00 nat. median
$21,679
0.9× median
0645T
CPT 		Tcat Impltj C Sins Rdctj Dev 6 $1,337.35 $48,487.64 $19,395.06 nat. median
$17,957
1.1× median
0238T
CPT 		Trluml Perip Athrc Iliac Art 6 $614.90 $48,487.64 $19,395.06 nat. median
$17,473
1.1× median
27278
HCPCS 		Arthrd Si Jt Prq Wo Tfxj Dev 6 $6,002.00 $46,377.39 $19,274.22 nat. median
$17,334
1.1× median
0888T
CPT 		Histotripsy Mal Renal Tissue 6 $4,823.00 $45,307.92 $19,029.33 nat. median
$18,098
1.1× median
0656T
CPT 		Vrt Bdy Tethering Ant 6 $5,076.00 $46,377.39 $18,921.97 nat. median
$10,371
1.8× median
0657T
CPT 		Vrt Bdy Tethering Ant 8+ Seg 6 $5,076.00 $46,377.39 $18,921.97 nat. median
$10,868
1.7× median
0790T
CPT 		Revj Rplcmt/rmvl Vrt Tethrg 6 $5,076.00 $46,377.39 $18,921.97 nat. median
$12,650
1.5× median
22612
HCPCS 		Lumbar Spine Fusion 6 $1,983.90 $46,377.39 $18,921.97 nat. median
$15,238
1.2× median
22856
HCPCS 		Cerv Artific Diskectomy 6 $2,166.37 $46,377.39 $18,921.97 nat. median
$16,588
1.1× median
20838
HCPCS 		Replantation Foot Complete 6 $3,714.00 $46,377.39 $18,550.96 nat. median
$7,735
outlier · 2.4×
22818
HCPCS 		Kyphectomy 1-2 Segments 6 $2,878.70 $46,377.39 $18,550.96 nat. median
$8,159
outlier · 2.3×

Other procedures at this hospital

Browse this hospital's 3,525 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
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
             
5224 OTHER Level 4 Pacemaker And Similar Procedures 1 1 — — $46,995.30 $46,995.30 $46,995.30 2026-04-01
5232 OTHER Level 2 Icd And Similar Procedures 7 5 — — $13,080.09 $72,998.09 $32,915.33 2026-04-01
5465 OTHER Level 5 Neurostimulator And Related Procedures 9 5 — — $2,160.99 $50,724.76 $31,285.55 2026-04-01
5200 OTHER Implantation Wireless Pa Pressure Monitor 1 1 — — $29,185.33 $29,185.33 $29,185.33 2026-04-01
5213 OTHER Level 3 Electrophysiologic Procedures 2 2 — — $14,588.47 $43,031.15 $28,809.81 2026-04-01
0871T CPT Rplcmt Subq Prtl Ascites Pmp 13 6 — — $5,076.00 $71,197.42 $24,000.00 2026-04-01
0870T CPT Imp Subq Prtl Ascts Pmp Sys 13 6 — — $5,076.00 $90,614.54 $24,000.00 2026-04-01
0796T CPT Tcat Ins 2chmbr Ldls Pm Ra 13 6 — — $6,002.00 $58,834.82 $24,000.00 2026-04-01
0408T CPT Insj/rplc Cardiac Modulj Sys 19 6 — — $661.61 $83,024.34 $23,565.00 2026-04-01
0915T CPT Insj Perm Ccm-d Sys Pg&eltrd 19 6 — — $989.28 $83,024.34 $23,565.00 2026-04-01
0571T CPT Insj/rplcmt Icds Ss Eltrd 19 6 — — $522.68 $83,024.34 $23,565.00 2026-04-01
0916T CPT Insj Perm Ccm-d Sys Pg Only 19 6 — — $690.80 $58,834.82 $23,533.93 2026-04-01
0515T CPT Insj Wcs Lv Compl Sys 19 6 — — $854.91 $58,834.82 $23,533.93 2026-04-01
0614T CPT Rmvl&rplcmt Ss Impl Dfb Pg 19 6 — — $468.23 $58,834.82 $23,533.93 2026-04-01
0414T CPT Rmvl & Rpl Car Modulj Pls Gn 19 6 — — $551.74 $58,834.82 $23,533.93 2026-04-01
0409T CPT Insj/rplc Car Modulj Pls Gn 19 6 — — $534.00 $58,834.82 $23,533.93 2026-04-01
0923T CPT Rmvl&rplcmt Perm Ccm-d Pg 19 6 — — $320.30 $58,834.82 $23,533.93 2026-04-01
22630 HCPCS Lumbar Spine Fusion 25 6 — — $1,954.30 $71,770.17 $23,386.00 2026-04-01
22633 HCPCS Lumbar Spine Fusion Combined 25 6 — — $2,127.83 $71,770.17 $23,386.00 2026-04-01
0620T CPT Evasc Ven Artlz Tibl/prnl Vn 19 6 — — $6,002.00 $116,504.04 $22,947.59 2026-04-01
0505T CPT Ev Fempop Artl Revsc 19 6 — — $3,070.00 $39,838.89 $22,765.08 2026-04-01
5231 OTHER Level 1 Icd And Similar Procedures 3 3 — — $22,627.40 $62,924.72 $22,765.01 2026-04-01
5093 OTHER Level 3 Breast/Lymphatic Surgery And Related Procedures 3 2 — — $8,546.41 $24,792.72 $22,537.57 2026-04-01
0266T CPT Implt/rpl Crtd Sns Dev Total 8 2 — — $6,002.00 $24,000.00 $21,997.00 2026-04-01
0268T CPT Implt/rpl Crtd Sns Dev Gen 8 2 — — $6,002.00 $24,000.00 $21,997.00 2026-04-01
5115 OTHER Level 5 Musculoskeletal Procedures 21 9 — — $13,209.44 $46,601.11 $21,583.36 2026-04-01
5116 OTHER Level 6 Musculoskeletal Procedures 17 8 — — $259.44 $83,450.48 $20,831.68 2026-04-01
0795T CPT Tcat Ins 2chmbr Ldls Pm Cmpl 13 6 — — $6,002.00 $50,947.66 $20,786.65 2026-04-01
0802T CPT Tcat Rmv&rpl2chmb Ldls Pm Ra 13 6 — — $6,002.00 $50,947.66 $20,786.65 2026-04-01
0801T CPT Tcat Rmv&rpl 2chmbr Ldls Pm 13 6 — — $6,002.00 $50,947.66 $20,786.65 2026-04-01
0803T CPT Tcat Rmv&rpl2chmb Ldls Pm Rv 13 6 — — $6,002.00 $50,947.66 $20,786.65 2026-04-01
0797T CPT Tcat Ins 2chmbr Ldls Pm Rv 13 6 — — $6,002.00 $50,947.66 $20,786.65 2026-04-01
0981T CPT Tcat Impl Wrls Ivc Snr 5 4 — — $19,395.06 $48,487.64 $19,976.91 2026-04-01
0793T CPT Prq Tcat Thrm Ablt Nrv P-art 13 6 — — $6,002.00 $48,487.64 $19,782.96 2026-04-01
0823T CPT Tcat Ins 1chmbr Ldls Pm Ra 19 6 — — $480.52 $58,834.82 $19,477.00 2026-04-01
0816T CPT Opn Insj/rplcmt Ins Ptn Subq 19 6 — — $271.50 $51,313.79 $19,477.00 2026-04-01
0825T CPT Tcat Rmv&rpl1chmb Ldls Pm Ra 19 6 — — $480.52 $50,947.66 $19,477.00 2026-04-01
0817T CPT Opn Insj/rplcmt Ins Ptn Subf 19 6 — — $271.50 $51,313.79 $19,477.00 2026-04-01
0525T CPT Insj/rplcmt Compl Iims 19 6 — — $762.10 $50,947.66 $19,477.00 2026-04-01
0238T CPT Trluml Perip Athrc Iliac Art 19 6 — — $614.90 $48,487.64 $19,395.06 2026-04-01
0645T CPT Tcat Impltj C Sins Rdctj Dev 19 6 — — $1,337.35 $48,487.64 $19,395.06 2026-04-01
27278 HCPCS Arthrd Si Jt Prq Wo Tfxj Dev 19 6 — — $6,002.00 $46,377.39 $19,274.22 2026-04-01
0888T CPT Histotripsy Mal Renal Tissue 13 6 — — $4,823.00 $45,307.92 $19,029.33 2026-04-01
0656T CPT Vrt Bdy Tethering Ant 13 6 — — $5,076.00 $46,377.39 $18,921.97 2026-04-01
0657T CPT Vrt Bdy Tethering Ant 8+ Seg 13 6 — — $5,076.00 $46,377.39 $18,921.97 2026-04-01
0790T CPT Revj Rplcmt/rmvl Vrt Tethrg 13 6 — — $5,076.00 $46,377.39 $18,921.97 2026-04-01
22856 HCPCS Cerv Artific Diskectomy 25 6 — — $2,166.37 $46,377.39 $18,921.97 2026-04-01
22612 HCPCS Lumbar Spine Fusion 25 6 — — $1,983.90 $46,377.39 $18,921.97 2026-04-01
22861 HCPCS Revise Cerv Artific Disc 19 6 — — $2,664.65 $46,377.39 $18,550.96 2026-04-01
24361 HCPCS Reconstruct Elbow Joint 19 6 — — $1,295.40 $46,377.39 $18,550.96 2026-04-01
22819 HCPCS Kyphectomy 3 Or More 19 6 — — $3,163.40 $46,377.39 $18,550.96 2026-04-01
22804 HCPCS Post Fusion 13/> Vert Seg 19 6 — — $3,145.10 $46,377.39 $18,550.96 2026-04-01
20805 HCPCS Replant Forearm Complete 19 6 — — $4,601.40 $46,377.39 $18,550.96 2026-04-01
22802 HCPCS Post Fusion 7-12 Vert Seg 19 6 — — $2,806.00 $46,377.39 $18,550.96 2026-04-01
27279 HCPCS Arthrodesis Sacroiliac Joint 19 6 — — $617.47 $46,377.39 $18,550.96 2026-04-01
24371 HCPCS Revise Reconst Elbow Joint 19 6 — — $2,344.62 $46,377.39 $18,550.96 2026-04-01
22818 HCPCS Kyphectomy 1-2 Segments 19 6 — — $2,878.70 $46,377.39 $18,550.96 2026-04-01
22586 HCPCS Prescrl Fuse With Instr L5-s1 19 6 — — $1,999.92 $46,377.39 $18,550.96 2026-04-01
24363 HCPCS Replace Elbow Joint 19 6 — — $1,772.80 $46,377.39 $18,550.96 2026-04-01
25446 HCPCS Wrist Replacement 19 6 — — $1,643.40 $46,377.39 $18,550.96 2026-04-01
20838 HCPCS Replantation Foot Complete 19 6 — — $3,714.00 $46,377.39 $18,550.96 2026-04-01
22610 HCPCS Thorax Spine Fusion 19 6 — — $1,592.30 $46,377.39 $18,550.96 2026-04-01
22857 HCPCS Lumbar Artif Diskectomy 19 6 — — $1,866.72 $46,377.39 $18,550.96 2026-04-01
23472 HCPCS Reconstruct Shoulder Joint 19 6 — — $1,673.90 $46,377.39 $18,550.96 2026-04-01
20808 HCPCS Replantation Hand Complete 19 6 — — $5,554.00 $46,377.39 $18,550.96 2026-04-01
22862 HCPCS Revise Lumbar Artif Disc 19 6 — — $2,247.13 $46,377.39 $18,550.96 2026-04-01
20802 HCPCS Replantation Arm Complete 19 6 — — $3,585.00 $46,377.39 $18,550.96 2026-04-01
22533 HCPCS Lat Lumbar Spine Fusion 19 6 — — $1,894.80 $46,377.39 $18,550.96 2026-04-01
27487 HCPCS Revise/replace Knee Joint 19 6 — — $2,439.30 $46,377.39 $18,550.96 2026-04-01
25442 HCPCS Reconstruct Wrist Joint 19 6 — — $997.60 $46,377.39 $18,550.96 2026-04-01
22812 HCPCS Ant Fusion 8/> Vert Seg 19 6 — — $2,851.50 $46,377.39 $18,550.96 2026-04-01
22600 HCPCS Neck Spine Fusion 19 6 — — $1,616.60 $46,377.39 $18,550.96 2026-04-01
5194 OTHER Level 4 Endovascular Procedures 5 4 — — $17,393.61 $88,715.20 $18,434.88 2026-04-01
0308T CPT Insj Ocular Telescope Prosth 13 6 — — $6,002.00 $43,539.30 $18,286.51 2026-04-01
0686T CPT Histotripsy Mal Hepatcel Tis 19 6 — — $1,434.20 $45,307.92 $18,123.17 2026-04-01
5094 OTHER Level 4 Breast/Lymphatic Surgery And Related Procedures 1 1 — — $17,484.34 $17,484.34 $17,484.34 2026-04-01
23616 HCPCS Treat Humerus Fracture 19 6 — — $2,019.50 $46,377.39 $17,416.00 2026-04-01
28705 HCPCS Fusion Of Foot Bones 19 6 — — $1,438.11 $46,377.39 $17,416.00 2026-04-01
27703 HCPCS Reconstruction Ankle Joint 19 6 — — $1,425.30 $46,377.39 $17,416.00 2026-04-01
22867 HCPCS Insj Stablj Dev W/dcmprn 19 6 — — $916.74 $46,377.39 $17,416.00 2026-04-01
5193 OTHER Level 3 Endovascular Procedures 16 7 — — $11,649.55 $49,028.05 $16,767.01 2026-04-01
5362 OTHER Level 2 Laparoscopy And Related Services 13 7 — — $4,315.74 $38,272.83 $16,660.62 2026-04-01
5376 OTHER Level 6 Urology And Related Services 6 5 — — $9,501.29 $31,233.40 $16,571.24 2026-04-01
0632T CPT Perq Tcat US Abltj Nrv P-art 19 6 — — $1,181.86 $48,487.64 $16,500.00 2026-04-01
0269T CPT Rev/remvl Crtd Sns Dev Total 8 2 — — $4,531.00 $17,416.00 $16,500.00 2026-04-01
21243 HCPCS Reconstruction Of Jaw Joint 19 6 — — $1,731.10 $71,770.17 $15,660.00 2026-04-01
20982 HCPCS Ablate Bone Tumor(s) Perq 19 6 — — $5,354.60 $46,377.39 $15,660.00 2026-04-01
19357 HCPCS Breast Reconstruction 19 6 — — $1,942.41 $36,450.97 $14,580.39 2026-04-01
19298 HCPCS Place Breast Rad Tube/caths 19 6 — — $2,278.87 $36,450.97 $14,580.39 2026-04-01
27137 HCPCS Revise Hip Joint Replacement 25 6 — — $2,073.90 $35,000.00 $14,262.63 2026-04-01
22554 HCPCS Neck Spine Fusion 25 6 — — $1,841.30 $33,958.64 $14,262.63 2026-04-01
27134 HCPCS Revise Hip Joint Replacement 25 6 — — $2,745.50 $40,000.00 $14,262.63 2026-04-01
27447 HCPCS Total Knee Arthroplasty 25 6 — — $2,089.40 $43,000.00 $14,262.63 2026-04-01
22551 HCPCS Neck Spine Fuse&remov Bel C2 25 6 — — $2,265.41 $33,958.64 $14,262.63 2026-04-01
27138 HCPCS Revise Hip Joint Replacement 25 6 — — $2,158.80 $35,000.00 $14,262.63 2026-04-01
1003T CPT Arthrp 1st Crp/mtcrpl Prostc 5 4 — — $13,583.45 $33,958.64 $13,990.96 2026-04-01
5623 OTHER Level 3 Radiation Therapy 13 6 — — $5,082.71 $42,580.07 $13,639.52 2026-04-01
24498 HCPCS Reinforce Humerus 19 6 — — $1,146.70 $33,958.64 $13,583.45 2026-04-01
24410 HCPCS Revision Of Humerus 19 6 — — $1,406.10 $33,958.64 $13,583.45 2026-04-01
24515 HCPCS Treat Humerus Fracture 19 6 — — $1,085.30 $33,958.64 $13,583.45 2026-04-01
24575 HCPCS Treat Humerus Fracture 19 6 — — $929.60 $33,958.64 $13,583.45 2026-04-01
25444 HCPCS Reconstruct Wrist Joint 19 6 — — $1,098.90 $33,958.64 $13,583.45 2026-04-01
24365 HCPCS Reconstruct Head Of Radius 19 6 — — $796.40 $33,958.64 $13,583.45 2026-04-01
29889 HCPCS Knee Arthroscopy/surgery 19 6 — — $1,338.10 $33,958.64 $13,583.45 2026-04-01
24362 HCPCS Reconstruct Elbow Joint 19 6 — — $1,352.10 $33,958.64 $13,583.45 2026-04-01
24346 HCPCS Reconstruct Elbow Med Ligmnt 19 6 — — $1,257.90 $33,958.64 $13,583.45 2026-04-01
27441 HCPCS Revision Of Knee Joint 19 6 — — $1,003.20 $33,958.64 $13,583.45 2026-04-01
23491 HCPCS Reinforce Shoulder Bones 19 6 — — $1,333.80 $33,958.64 $13,583.45 2026-04-01
27438 HCPCS Revise Kneecap With Implant 19 6 — — $1,135.00 $33,958.64 $13,583.45 2026-04-01
0629T CPT Perq Njx Algc CT Lmbr 1st 19 6 — — $230.95 $33,958.64 $13,583.45 2026-04-01
27428 HCPCS Reconstruction Knee 19 6 — — $1,349.30 $33,958.64 $13,583.45 2026-04-01
27415 HCPCS Osteochondral Knee Allograft 19 6 — — $1,658.85 $33,958.64 $13,583.45 2026-04-01
22532 HCPCS Lat Thorax Spine Fusion 19 6 — — $2,031.20 $35,000.00 $13,583.45 2026-04-01
24666 HCPCS Treat Radius Fracture 19 6 — — $964.30 $33,958.64 $13,583.45 2026-04-01
23680 HCPCS Treat Dislocation/fracture 19 6 — — $1,006.90 $33,958.64 $13,583.45 2026-04-01
24546 HCPCS Treat Humerus Fracture 19 6 — — $1,356.80 $33,958.64 $13,583.45 2026-04-01
24579 HCPCS Treat Humerus Fracture 19 6 — — $1,027.10 $33,958.64 $13,583.45 2026-04-01
24545 HCPCS Treat Humerus Fracture 19 6 — — $1,007.90 $33,958.64 $13,583.45 2026-04-01
23802 HCPCS Fusion Of Shoulder Joint 19 6 — — $1,458.60 $33,958.64 $13,583.45 2026-04-01
24435 HCPCS Repair Humerus With Graft 19 6 — — $1,343.20 $33,958.64 $13,583.45 2026-04-01
27442 HCPCS Revision Of Knee Joint 19 6 — — $1,190.30 $33,958.64 $13,583.45 2026-04-01
24370 HCPCS Revise Reconst Elbow Joint 19 6 — — $2,034.68 $33,958.64 $13,583.45 2026-04-01
0220T CPT Plmt Post Facet Implt Thor 19 6 — — $2,926.00 $35,000.00 $13,583.45 2026-04-01
24516 HCPCS Treat Humerus Fracture 19 6 — — $1,097.00 $33,958.64 $13,583.45 2026-04-01
24366 HCPCS Reconstruct Head Of Radius 19 6 — — $906.10 $33,958.64 $13,583.45 2026-04-01
22869 HCPCS Insj Stablj Dev Without Dcmprn 19 6 — — $508.88 $33,958.64 $13,583.45 2026-04-01
23615 HCPCS Treat Humerus Fracture 19 6 — — $959.10 $33,958.64 $13,583.45 2026-04-01
24586 HCPCS Treat Elbow Fracture 19 6 — — $1,400.40 $33,958.64 $13,583.45 2026-04-01
29907 HCPCS Subtalar Arthro W/fusion 19 6 — — $1,167.52 $33,958.64 $13,583.45 2026-04-01
29867 HCPCS Allgrft Implnt Knee W/scope 19 6 — — $1,546.76 $33,958.64 $13,583.45 2026-04-01
29856 HCPCS Tibial Arthroscopy/surgery 19 6 — — $1,311.80 $33,958.64 $13,583.45 2026-04-01
28737 HCPCS Revision Of Foot Bones 19 6 — — $842.62 $33,958.64 $13,583.45 2026-04-01
0219T CPT Plmt Post Facet Implt Cerv 19 6 — — $2,926.00 $35,000.00 $13,583.45 2026-04-01
23474 HCPCS Revis Reconst Shoulder Joint 19 6 — — $2,321.76 $33,958.64 $13,583.45 2026-04-01
28725 HCPCS Fusion Of Foot Bones 19 6 — — $889.30 $33,958.64 $13,583.45 2026-04-01
28730 HCPCS Fusion Of Foot Bones 19 6 — — $912.77 $33,958.64 $13,583.45 2026-04-01
28715 HCPCS Fusion Of Foot Bones 19 6 — — $1,064.47 $33,958.64 $13,583.45 2026-04-01
23470 HCPCS Reconstruct Shoulder Joint 19 6 — — $1,641.50 $33,958.64 $13,583.45 2026-04-01
23485 HCPCS Revision Of Collar Bone 19 6 — — $1,259.30 $33,958.64 $13,583.45 2026-04-01
28735 HCPCS Fusion Of Foot Bones 19 6 — — $875.10 $33,958.64 $13,583.45 2026-04-01
25810 HCPCS Fusion/graft Of Wrist Joint 19 6 — — $1,074.00 $33,958.64 $13,583.45 2026-04-01
27871 HCPCS Fusion Of Tibiofibular Joint 19 6 — — $899.10 $33,958.64 $13,583.45 2026-04-01
28420 HCPCS Treat/graft Heel Fracture 19 6 — — $1,311.18 $33,958.64 $13,583.45 2026-04-01
24587 HCPCS Treat Elbow Fracture 19 6 — — $1,362.40 $33,958.64 $13,583.45 2026-04-01
27870 HCPCS Fusion Of Ankle Joint Open 19 6 — — $1,352.60 $33,958.64 $13,583.45 2026-04-01
27758 HCPCS Treatment Of Tibia Fracture 19 6 — — $1,188.40 $33,958.64 $13,583.45 2026-04-01
27759 HCPCS Treatment Of Tibia Fracture 19 6 — — $1,345.60 $33,958.64 $13,583.45 2026-04-01
27828 HCPCS Treat Lower Leg Fracture 19 6 — — $2,057.50 $33,958.64 $13,583.45 2026-04-01
23473 HCPCS Revis Reconst Shoulder Joint 19 6 — — $2,149.54 $33,958.64 $13,583.45 2026-04-01
27488 HCPCS Removal Of Knee Prosthesis 19 6 — — $1,532.70 $35,000.00 $13,583.45 2026-04-01
27486 HCPCS Revise/replace Knee Joint 19 6 — — $1,887.30 $35,000.00 $13,583.45 2026-04-01
27827 HCPCS Treat Lower Leg Fracture 19 6 — — $1,887.30 $33,958.64 $13,583.45 2026-04-01
27443 HCPCS Revision Of Knee Joint 19 6 — — $1,105.00 $33,958.64 $13,583.45 2026-04-01
27440 HCPCS Revision Of Knee Joint 19 6 — — $1,044.90 $33,958.64 $13,583.45 2026-04-01
27429 HCPCS Reconstruction Knee 19 6 — — $1,357.30 $33,958.64 $13,583.45 2026-04-01
27130 HCPCS Total Hip Arthroplasty 19 6 — — $1,975.00 $35,000.00 $13,583.45 2026-04-01
27132 HCPCS Total Hip Arthroplasty 19 6 — — $2,268.60 $35,000.00 $13,583.45 2026-04-01
25491 HCPCS Reinforce Ulna 19 6 — — $1,072.60 $33,958.64 $13,583.45 2026-04-01
24430 HCPCS Repair Of Humerus 19 6 — — $1,288.30 $33,958.64 $13,583.45 2026-04-01
27446 HCPCS Revision Of Knee Joint 19 6 — — $1,574.40 $33,958.64 $13,583.45 2026-04-01
25365 HCPCS Revise Radius & Ulna 19 6 — — $1,295.80 $33,958.64 $13,583.45 2026-04-01
25391 HCPCS Lengthen Radius Or Ulna 19 6 — — $1,438.00 $33,958.64 $13,583.45 2026-04-01
24802 HCPCS Fusion/graft Of Elbow Joint 19 6 — — $1,258.80 $33,958.64 $13,583.45 2026-04-01
25441 HCPCS Reconstruct Wrist Joint 19 6 — — $1,222.20 $33,958.64 $13,583.45 2026-04-01
0627T CPT Perq Njx Algc Fluor Lmbr 1st 19 6 — — $230.95 $33,958.64 $13,583.45 2026-04-01
28320 HCPCS Repair Of Foot Bones 19 6 — — $702.35 $33,958.64 $13,583.45 2026-04-01
0895T CPT Connj Lvr Algrft Prfu Dev 1 6 1 — — $4,823.00 $22,000.00 $13,411.50 2026-04-01
5222 OTHER Level 2 Pacemaker And Similar Procedures 6 5 — — $8,130.95 $26,103.48 $13,230.23 2026-04-01
28297 HCPCS Correction Hallux Valgus 19 6 — — $825.08 $35,000.00 $12,569.00 2026-04-01
27709 HCPCS Incision Of Tibia & Fibula 19 6 — — $1,027.10 $33,958.64 $12,569.00 2026-04-01
20696 HCPCS Comp Multiplane Ext Fixation 19 6 — — $1,434.52 $71,770.17 $12,569.00 2026-04-01
27356 HCPCS Remove Femur Lesion/graft 19 6 — — $939.90 $33,958.64 $12,569.00 2026-04-01
20692 HCPCS Apply Bone Fixation Device 19 6 — — $1,264.46 $33,958.64 $12,569.00 2026-04-01
5155 OTHER Level 5 Airway Endoscopy 7 6 — — $3,702.69 $32,124.15 $12,256.13 2026-04-01
0913T CPT Prq Tcat Ther Rx Ntrac Balo1 13 6 — — $989.28 $30,534.67 $12,213.87 2026-04-01
0237T CPT Trluml Perip Athrc Brchiocph 19 6 — — $909.40 $30,534.67 $12,213.87 2026-04-01
0236T CPT Trluml Perip Athrc Abd Aorta 19 6 — — $602.70 $30,534.67 $12,213.87 2026-04-01
0234T CPT Trluml Perip Athrc Renal Art 19 6 — — $996.20 $30,534.67 $12,213.87 2026-04-01
5342 OTHER Level 2 Abdominal/Peritoneal/Biliary And Related Procedures 6 3 — — $6,250.42 $35,821.43 $12,007.99 2026-04-01
22326 HCPCS Treat Neck Spine Fracture 19 6 — — $1,822.50 $33,958.64 $12,000.00 2026-04-01
22325 HCPCS Treat Spine Fracture 19 6 — — $1,499.40 $33,958.64 $12,000.00 2026-04-01
27120 HCPCS Reconstruction Of Hip Socket 19 6 — — $1,709.00 $33,958.64 $12,000.00 2026-04-01
0271T CPT Rev/remvl Crtd Sns Dev Gen 8 2 — — $4,384.00 $12,569.00 $12,000.00 2026-04-01
22318 HCPCS Treat Odontoid Fx Without Graft 19 6 — — $1,870.80 $33,958.64 $12,000.00 2026-04-01
22319 HCPCS Treat Odontoid Fx W/graft 19 6 — — $2,113.30 $33,958.64 $12,000.00 2026-04-01
22556 HCPCS Thorax Spine Fusion 19 6 — — $2,189.80 $46,377.39 $12,000.00 2026-04-01
0202T CPT Post Vert Arthrplst 1 Lumbar 19 6 — — $1,436.00 $33,958.64 $12,000.00 2026-04-01
22327 HCPCS Treat Thorax Spine Fracture 19 6 — — $1,769.50 $33,958.64 $12,000.00 2026-04-01
22590 HCPCS Spine & Skull Spinal Fusion 19 6 — — $2,020.00 $33,958.64 $12,000.00 2026-04-01
22558 HCPCS Lumbar Spine Fusion 19 6 — — $2,032.20 $71,770.17 $12,000.00 2026-04-01
22808 HCPCS Ant Fusion 2-3 Vert Seg 19 6 — — $2,299.00 $46,377.39 $12,000.00 2026-04-01
22548 HCPCS Neck Spine Fusion 19 6 — — $2,421.00 $33,958.64 $12,000.00 2026-04-01
0267T CPT Implt/rpl Crtd Sns Dev Lead 8 2 — — $4,384.00 $12,569.00 $12,000.00 2026-04-01
23900 HCPCS Amputation Of Arm & Girdle 19 6 — — $1,663.50 $33,958.64 $12,000.00 2026-04-01
23920 HCPCS Amputation At Shoulder Joint 19 6 — — $1,385.90 $33,958.64 $12,000.00 2026-04-01
24920 HCPCS Amputation Of Upper Arm 19 6 — — $906.60 $33,958.64 $12,000.00 2026-04-01
24900 HCPCS Amputation Of Upper Arm 19 6 — — $915.00 $33,958.64 $12,000.00 2026-04-01
27715 HCPCS Revision Of Lower Leg 19 6 — — $1,369.90 $33,958.64 $12,000.00 2026-04-01
27712 HCPCS Realignment Of Lower Leg 19 6 — — $930.79 $33,958.64 $12,000.00 2026-04-01
27702 HCPCS Reconstruct Ankle Joint 19 6 — — $1,362.00 $71,770.17 $12,000.00 2026-04-01
24931 HCPCS Amputate Upper Arm & Implant 19 6 — — $1,132.60 $33,958.64 $12,000.00 2026-04-01
27514 HCPCS Treatment Of Thigh Fracture 19 6 — — $1,607.30 $33,958.64 $12,000.00 2026-04-01
0270T CPT Rev/remvl Crtd Sns Dev Lead 8 2 — — $4,384.00 $12,569.00 $12,000.00 2026-04-01
27580 HCPCS Fusion Of Knee 19 6 — — $1,752.70 $33,958.64 $12,000.00 2026-04-01
27513 HCPCS Treatment Of Thigh Fracture 19 6 — — $1,665.40 $33,958.64 $12,000.00 2026-04-01
27511 HCPCS Treatment Of Thigh Fracture 19 6 — — $1,365.70 $33,958.64 $12,000.00 2026-04-01
22800 HCPCS Post Fusion <=6 Vert Seg 19 6 — — $1,771.90 $46,377.39 $12,000.00 2026-04-01
27295 HCPCS Amputation Of Leg At Hip 19 6 — — $1,699.20 $46,377.39 $12,000.00 2026-04-01
27280 HCPCS Fusion Of Sacroiliac Joint 19 6 — — $1,256.90 $46,377.39 $12,000.00 2026-04-01
27284 HCPCS Fusion Of Hip Joint 19 6 — — $1,529.90 $33,958.64 $12,000.00 2026-04-01
27125 HCPCS Partial Hip Replacement 19 6 — — $1,461.90 $33,958.64 $12,000.00 2026-04-01
27286 HCPCS Fusion Of Hip Joint 19 6 — — $1,602.10 $33,958.64 $12,000.00 2026-04-01
27290 HCPCS Amputation Of Leg At Hip 19 6 — — $2,209.50 $46,377.39 $12,000.00 2026-04-01
22810 HCPCS Ant Fusion 4-7 Vert Seg 19 6 — — $2,511.00 $46,377.39 $12,000.00 2026-04-01
22595 HCPCS Neck Spinal Fusion 19 6 — — $1,931.80 $33,958.64 $12,000.00 2026-04-01
24940 HCPCS Revision Of Upper Arm 19 6 — — $1,420.00 $33,958.64 $12,000.00 2026-04-01
0339T CPT Trnscth Renal Symp Denrv Bil 19 6 — — $2,375.00 $24,000.00 $11,789.72 2026-04-01
0784T CPT Ins/rplmt Eltrd Ra Spi Nstim 19 6 — — $655.20 $30,000.00 $11,789.08 2026-04-01
0786T CPT Insj/rplcmt Prq Ra Sac Nstim 19 6 — — $271.50 $30,000.00 $11,789.08 2026-04-01
5303 OTHER Level 3 Upper Gi Procedures 2 1 — — $3,617.74 $19,390.55 $11,504.15 2026-04-01
0601T CPT Ire Abltj 1+tumors Open 19 6 — — $854.50 $28,116.18 $11,246.47 2026-04-01
0600T CPT Ire Abltj 1+tum Organ Perq 19 6 — — $854.50 $28,116.18 $11,246.47 2026-04-01
5192 OTHER Level 2 Endovascular Procedures 10 5 — — $5,436.84 $25,985.50 $11,161.96 2026-04-01
0516T CPT Insj Wcs Lv Eltrd Only 19 6 — — $711.91 $30,000.00 $11,058.32 2026-04-01
0520T CPT Rmvl&rplcmt Pg Wcs New Eltrd 19 6 — — $625.50 $27,645.79 $11,058.32 2026-04-01
0517T CPT Insj Wcs Lv Pg Compnt 19 6 — — $716.11 $30,000.00 $11,058.32 2026-04-01
0519T CPT Rmvl & Rplcmt Pg Compnt Wcs 19 6 — — $95.03 $27,645.79 $11,058.32 2026-04-01
5223 OTHER Level 3 Pacemaker And Similar Procedures 8 4 — — $8,712.09 $72,252.89 $10,857.28 2026-04-01
5626 OTHER Level 6 Radiation Therapy 10 6 — — $165.75 $46,299.63 $10,572.45 2026-04-01
0617T CPT Insj Iris Prosth W/rmvl&insj 6 1 — — $4,531.00 $16,500.00 $10,515.50 2026-04-01
0618T CPT Insj Iris Prosth Sec Io Lens 6 1 — — $4,531.00 $16,500.00 $10,515.50 2026-04-01
0991T CPT Cysto Lo-nrg Lithtrp&mcrsphr 5 4 — — $10,015.61 $25,039.03 $10,316.08 2026-04-01
0950T CPT Abltj B9 Prst8 Tissue Hifu 5 4 — — $10,015.61 $25,039.03 $10,316.08 2026-04-01
5694 OTHER Level 4 Drug Administration 18 9 — — $927.86 $27,915.86 $10,265.35 2026-04-01
5622 OTHER Level 2 Radiation Therapy 17 8 — — $523.43 $37,853.71 $9,845.75 2026-04-01
788 OTHER Inj Cefazolin Sodium, Hikma 1 1 — — $9,501.29 $9,501.29 $9,501.29 2026-04-01
5493 OTHER Level 3 Intraocular Procedures 2 2 — — $5,405.21 $13,253.41 $9,329.31 2026-04-01
0442T CPT Abltj Perc Plex/trncl Nrv 19 6 — — $125.11 $23,212.34 $9,284.94 2026-04-01
27091 HCPCS Removal Of Hip Prosthesis 19 6 — — $2,023.30 $33,958.64 $9,243.00 2026-04-01
5055 OTHER Level 5 Skin Procedures 5 2 — — $3,112.61 $12,553.79 $9,109.00 2026-04-01
19296 HCPCS Place Po Breast Cath For Rad 19 6 — — $3,070.00 $30,000.00 $9,079.90 2026-04-01
5212 OTHER Level 2 Electrophysiologic Procedures 3 2 — — $6,232.12 $17,784.69 $8,852.18 2026-04-01
0526T CPT Insj/rplcmt Iims Eltrd Only 19 6 — — $619.10 $30,000.00 $8,755.45 2026-04-01
0527T CPT Insj/rplcmt Iims Implt Mntr 19 6 — — $619.10 $30,000.00 $8,755.45 2026-04-01
0572T CPT Insertion Ss Dfb Electrode 19 6 — — $420.56 $30,000.00 $8,755.45 2026-04-01
0411T CPT Insj/rplc Car Modulj Vnt Elt 19 6 — — $547.91 $30,000.00 $8,755.45 2026-04-01
0917T CPT Insj Perm Ccm-d Sys 1 Lead 19 6 — — $690.80 $30,000.00 $8,755.45 2026-04-01
0410T CPT Insj/rplc Car Modulj Atr Elt 19 6 — — $547.91 $30,000.00 $8,755.45 2026-04-01
0918T CPT Insj Perm Ccm-d Sys Dual Ld 19 6 — — $807.78 $30,000.00 $8,755.45 2026-04-01
5375 OTHER Level 5 Urology And Related Services 18 10 — — $4,761.36 $15,447.94 $8,683.74 2026-04-01
19340 HCPCS Immediate Breast Prosthesis 19 6 — — $986.47 $24,000.00 $8,647.53 2026-04-01
19342 HCPCS Delayed Breast Prosthesis 19 6 — — $1,026.60 $30,000.00 $8,647.53 2026-04-01
19325 HCPCS Enlarge Breast With Implant 19 6 — — $699.30 $30,000.00 $8,647.53 2026-04-01
5191 OTHER Level 1 Endovascular Procedures 18 10 — — $3,285.56 $14,438.00 $8,589.53 2026-04-01
0315U CPT Onc Cutan Sq Cll Ca Mrna 40 13 6 — — $1,549.20 $21,250.00 $8,500.00 2026-04-01
0211U CPT Onc Pan-tum Dna&rna Gnrj Seq 13 6 — — $208.00 $21,137.50 $8,455.00 2026-04-01
5415 OTHER Level 5 Gynecologic Procedures 5 4 — — $1,905.42 $16,070.91 $8,216.96 2026-04-01
0896T CPT Connj Lvr Algrft Prfu Dev Ea 6 1 — — $4,384.00 $12,000.00 $8,192.00 2026-04-01
0338T CPT Trnscth Renal Symp Denrv Unl 19 6 — — $2,375.00 $24,000.00 $8,107.55 2026-04-01
0274T CPT Perq Lamot/lam Crv/thrc 13 6 — — $5,554.00 $35,000.00 $8,061.01 2026-04-01
22513 HCPCS Perq Vertebral Augmentation 19 6 — — $5,554.00 $35,000.00 $8,061.01 2026-04-01
22514 HCPCS Perq Vertebral Augmentation 19 6 — — $5,554.00 $35,000.00 $8,061.01 2026-04-01
20983 HCPCS Ablate Bone Tumor(s) Perq 19 6 — — $5,554.00 $35,000.00 $8,061.01 2026-04-01
26554 HCPCS Double Transfer Toe-hand 19 6 — — $4,384.00 $19,192.87 $8,061.01 2026-04-01
5165 OTHER Level 5 ENT Procedures 10 6 — — $3,121.64 $30,608.01 $8,022.01 2026-04-01
27713 HCPCS Osteot Tibia Imed Lngth Dev 5 4 — — $7,677.15 $19,192.87 $7,907.46 2026-04-01
27458 HCPCS Osteot Femur Imed Lngth Dev 5 4 — — $7,677.15 $19,192.87 $7,907.46 2026-04-01
5341 OTHER Level 1 Abdominal/Peritoneal/Biliary And Related Procedures 14 8 — — $3,410.43 $37,667.75 $7,854.49 2026-04-01
5627 OTHER Level 7 Radiation Therapy 3 3 — — $6,278.44 $44,330.03 $7,848.05 2026-04-01
0582U CPT Rare Ds Rpd Whlgen DNA Vrnts 5 4 — — $7,582.20 $18,955.50 $7,809.67 2026-04-01
5114 OTHER Level 4 Musculoskeletal Procedures 24 12 — — $3,121.64 $32,068.15 $7,805.37 2026-04-01
11970 HCPCS Replace Tissue Expander 19 6 — — $731.46 $35,000.00 $7,677.15 2026-04-01
0511T CPT Rmvl&rinsj Sinus Tarsi Implt 19 6 — — $1,067.16 $35,000.00 $7,677.15 2026-04-01
24495 HCPCS Decompression Of Forearm 19 6 — — $791.20 $35,000.00 $7,677.15 2026-04-01
24420 HCPCS Revision Of Humerus 19 6 — — $1,347.90 $35,000.00 $7,677.15 2026-04-01
24400 HCPCS Revision Of Humerus 19 6 — — $1,056.20 $35,000.00 $7,677.15 2026-04-01
22224 HCPCS Incis W/discectomy Lumbar 19 6 — — $1,844.60 $19,192.87 $7,677.15 2026-04-01
21600 HCPCS Partial Removal Of Rib 19 6 — — $672.10 $35,000.00 $7,677.15 2026-04-01
22220 HCPCS Incis W/discectomy Cervical 19 6 — — $1,920.10 $19,192.87 $7,677.15 2026-04-01
22222 HCPCS Incis W/discectomy Thoracic 19 6 — — $1,710.00 $19,192.87 $7,677.15 2026-04-01
24635 HCPCS Treat Elbow Fracture 19 6 — — $1,416.40 $35,000.00 $7,677.15 2026-04-01
0335T CPT Extraosseous Joint Stblztion 19 6 — — $1,067.16 $35,000.00 $7,677.15 2026-04-01
24345 HCPCS Repr Elbw Med Ligmnt W/tissu 19 6 — — $833.40 $35,000.00 $7,677.15 2026-04-01
24360 HCPCS Reconstruct Elbow Joint 19 6 — — $1,198.80 $35,000.00 $7,677.15 2026-04-01
24538 HCPCS Treat Humerus Fracture 19 6 — — $906.10 $35,000.00 $7,677.15 2026-04-01
25135 HCPCS Remove & Graft Wrist Lesion 19 6 — — $672.10 $19,192.87 $7,677.15 2026-04-01
25136 HCPCS Remove & Graft Wrist Lesion 19 6 — — $581.60 $35,000.00 $7,677.15 2026-04-01
0201T CPT Perq Sacral Augmt Bilat Inj 19 6 — — $499.00 $35,000.00 $7,677.15 2026-04-01
24331 HCPCS Revision Of Arm Muscles 19 6 — — $988.20 $35,000.00 $7,677.15 2026-04-01
0200T CPT Perq Sacral Augmt Unilat Inj 19 6 — — $499.00 $35,000.00 $7,677.15 2026-04-01
22207 HCPCS Incis Spine 3 Column Lumbar 19 6 — — $3,204.07 $35,000.00 $7,677.15 2026-04-01
24330 HCPCS Revision Of Arm Muscles 19 6 — — $900.50 $19,192.87 $7,677.15 2026-04-01
24340 HCPCS Repair Of Biceps Tendon 19 6 — — $743.40 $35,000.00 $7,677.15 2026-04-01
22210 HCPCS Incis 1 Vertebral Seg Cerv 19 6 — — $2,016.70 $19,192.87 $7,677.15 2026-04-01
24320 HCPCS Repair Of Arm Tendon 19 6 — — $1,006.50 $35,000.00 $7,677.15 2026-04-01
24341 HCPCS Repair Arm Tendon/muscle 19 6 — — $748.10 $35,000.00 $7,677.15 2026-04-01
24342 HCPCS Repair Of Ruptured Tendon 19 6 — — $1,012.10 $35,000.00 $7,677.15 2026-04-01
24344 HCPCS Reconstruct Elbow Lat Ligmnt 19 6 — — $1,257.90 $35,000.00 $7,677.15 2026-04-01
20969 HCPCS Bone/skin Graft Microvasc 19 6 — — $3,960.70 $35,000.00 $7,677.15 2026-04-01
24150 HCPCS Resect Distal Humerus Tumor 19 6 — — $1,347.90 $35,000.00 $7,677.15 2026-04-01
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