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

COMMUNITY HOSPITAL ASSOCIATION

Fairfax, MO · CCN 261303 · Rates published

21,058 distinct procedures filed
7 distinct payers
81,309 rate rows
2026-08-21 last MRF observed
Data quality

67,944 of 81,309 rate rows are consumer-grade (83.6%)

13,365 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
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 6,160
professional (physician) fee — not the facility price 3,771
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 3,339
placeholder amount (≤ $0.02) — excluded from medians 50
per-diem day rate — not a per-procedure price 24
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 14
exceeds 10× this hospital's gross charge — excluded from medians 6
percent-of-charges filed in the dollar field — excluded from medians 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://fairfax.pt.panaceainc.com/MRFDownload/fairfax/fairfax
Found on page https://fairfaxmed.com/price-transparency/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-10-08
Content fingerprint 50a744477765071c… · 27,445,094 bytes · first seen 2026-09-21

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
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 1 $2,322,044.36 $2,322,044.36 $2,322,044.36 nat. median
$2,455,111
0.9× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 1 $606,049.34 $606,049.34 $606,049.34 nat. median
$621,313
1.0× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 1 $533,171.93 $533,171.93 $533,171.93 nat. median
$599,737
0.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 1 $524,291.46 $524,291.46 $524,291.46 nat. median
$574,037
0.9× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 1 $512,793.30 $512,793.30 $512,793.30 nat. median
$579,571
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 1 $486,161.07 $486,161.07 $486,161.07 nat. median
$562,501
0.9× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 1 $486,161.07 $486,161.07 $486,161.07 nat. median
$513,770
0.9× median
A9543
HCPCS 		Y90 Ibritumomab, Rx 1 $70,418.21 $70,418.21 $70,418.21 nat. median
$65,477
1.1× median
64654 50
OTHER 		1st Opn Implt Bat Modulj Sys 1 $66,825.75 $66,825.75 $66,825.75 nat. median
$66,826
1.0× median
6465450
OTHER 		1st Opn Implt Bat Modulj Sys 2 $64,031.22 $66,825.75 $65,428.49 nat. median
$65,428
1.0× median
E0766
HCPCS 		Elec Stim Cancer Treatment 1 $62,397.88 $62,397.88 $62,397.88 nat. median
$16,158
outlier · 3.9×
E0766NU
OTHER 		Elec Stim Cancer Treatment 1 $62,397.88 $62,397.88 $62,397.88 nat. median
$62,398
1.0× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 1 $60,092.70 $60,092.70 $60,092.70 nat. median
$63,499
0.9× median
38240
HCPCS 		Transplt Allo Hct/donor 3 $53,140.29 $55,459.50 $55,459.50 nat. median
$28,331
2.0× median
J7330
HCPCS 		Cultured Chondrocytes Implnt 1 $53,819.56 $53,819.56 $53,819.56 nat. median
$92,809
0.6× median
Q0480
HCPCS 		Driver Pneumatic Vad, Rep 1 $48,735.87 $48,735.87 $48,735.87 nat. median
$108,243
outlier · 0.5×
J9226
HCPCS 		Supprelin La Implant 1 $48,229.38 $48,229.38 $48,229.38 nat. median
$57,036
0.8× median
E0766UE
OTHER 		Elec Stim Cancer Treatment 1 $46,798.51 $46,798.51 $46,798.51 nat. median
$46,799
1.0× median
64656 50
OTHER 		Revj/rplcmt Bat Mod Sys Pg 1 $45,897.45 $45,897.45 $45,897.45 nat. median
$45,897
1.0× median
6465650
OTHER 		Revj/rplcmt Bat Mod Sys Pg 2 $43,978.10 $45,897.45 $44,937.77 nat. median
$44,938
1.0× median
69930 50
OTHER 		Implant Cochlear Device 1 $44,740.70 $44,740.70 $44,740.70 nat. median
$44,741
1.0× median
33276
HCPCS 		Insj Phrnc Nrv Stim Sys 3 $42,687.47 $44,550.50 $44,550.50 nat. median
$44,163
1.0× median
64654
HCPCS 		1st Opn Implt Bat Modulj Sys 3 $42,687.47 $44,550.50 $44,550.50 nat. median
$36,847
1.2× median
6993050
OTHER 		Implant Cochlear Device 2 $42,869.72 $44,740.70 $43,805.21 nat. median
$43,805
1.0× median
64568 50
OTHER 		Opn Impltj Crnl Nrv Nea&pg 1 $42,863.96 $42,863.96 $42,863.96 nat. median
$42,864
1.0× median
64582 50
OTHER 		Opn Mpltj Hpglsl Nstm Ary Pg 1 $42,863.96 $42,863.96 $42,863.96 nat. median
$42,864
1.0× median
6456850
OTHER 		Opn Impltj Crnl Nrv Nea&pg 2 $41,071.47 $42,863.96 $41,967.71 nat. median
$41,968
1.0× median
6458250
OTHER 		Opn Mpltj Hpglsl Nstm Ary Pg 2 $41,071.47 $42,863.96 $41,967.71 nat. median
$41,968
1.0× median
64656
HCPCS 		Revj/rplcmt Bat Mod Sys Pg 3 $29,318.73 $30,598.29 $30,598.29 nat. median
$31,011
1.0× median
61891 50
OTHER 		Rev/rplcmt Sk-mnt Crnl Nstm 1 $30,163.55 $30,163.55 $30,163.55 nat. median
$30,164
1.0× median
61885 50
OTHER 		Insrt/redo Neurostim 1 Array 1 $30,163.55 $30,163.55 $30,163.55 nat. median
$30,164
1.0× median
33270
HCPCS 		Ins/rep Subq Defibrillator 3 $28,807.81 $30,065.08 $30,065.08 nat. median
$32,475
0.9× median
33249
HCPCS 		Insj/rplcmt Defib W/lead(s) 3 $28,807.81 $30,065.08 $30,065.08 nat. median
$32,069
0.9× median
33231
HCPCS 		Insrt Pulse Gen W/mult Leads 3 $28,807.81 $30,065.08 $30,065.08 nat. median
$31,377
1.0× median
33264
HCPCS 		Rmvl & Rplcmt Dfb Gen Mlt Ld 3 $28,807.81 $30,065.08 $30,065.08 nat. median
$32,779
0.9× median
69930
HCPCS 		Implant Cochlear Device 3 $28,579.81 $29,827.13 $29,827.13 nat. median
$23,645
1.3× median
6188550
OTHER 		Insrt/redo Neurostim 1 Array 2 $28,902.17 $30,163.55 $29,532.86 nat. median
$29,533
1.0× median
6189150
OTHER 		Rev/rplcmt Sk-mnt Crnl Nstm 2 $28,902.17 $30,163.55 $29,532.86 nat. median
$29,533
1.0× median
63685
HCPCS 		Ins/rplc Spi Npg/rcvr Pocket 3 $27,380.98 $28,575.98 $28,575.98 nat. median
$21,812
1.3× median
64568
HCPCS 		Opn Impltj Crnl Nrv Nea&pg 3 $27,380.98 $28,575.98 $28,575.98 nat. median
$27,905
1.0× median
33287
HCPCS 		Rmv&rplcmt Phrnc Nrv Stim Pg 3 $27,380.98 $28,575.98 $28,575.98 nat. median
$27,599
1.0× median
61886
HCPCS 		Implant Neurostim Arrays 3 $27,380.98 $28,575.98 $28,575.98 nat. median
$23,007
1.2× median
64582
HCPCS 		Opn Mpltj Hpglsl Nstm Ary Pg 3 $27,380.98 $28,575.98 $28,575.98 nat. median
$29,815
1.0× median
37284 50
OTHER 		Revsc Evasc Tpvt St Sf 1st 1 $27,266.31 $27,266.31 $27,266.31 nat. median
$27,266
1.0× median
37275 50
OTHER 		Rvsc Evsc Fpvt St Athrc Sf 1 1 $27,266.31 $27,266.31 $27,266.31 nat. median
$27,266
1.0× median
37273 50
OTHER 		Revsc Evsc Fpvt Athrc Cplx 1 1 $27,266.31 $27,266.31 $27,266.31 nat. median
$27,266
1.0× median
37290 50
OTHER 		Revsc Evsc Tpvt Athrc Cplx 1 1 $27,266.31 $27,266.31 $27,266.31 nat. median
$27,266
1.0× median
37271 50
OTHER 		Revsc Evsc Fpvt Athrc Sf 1st 1 $27,266.31 $27,266.31 $27,266.31 nat. median
$27,266
1.0× median
37288 50
OTHER 		Revsc Evsc Tpvt Athrc Sf 1st 1 $27,266.31 $27,266.31 $27,266.31 nat. median
$27,266
1.0× median
37286 50
OTHER 		Revsc Evasc Tpvt St Cplx 1st 1 $27,266.31 $27,266.31 $27,266.31 nat. median
$27,266
1.0× median

Other procedures at this hospital

Browse this hospital's 21,058 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
             
64654 50 OTHER 1st Opn Implt Bat Modulj Sys 1 1 — — $66,825.75 $66,825.75 $66,825.75 2026-08-21
6465450 OTHER 1st Opn Implt Bat Modulj Sys 2 2 — — $64,031.22 $66,825.75 $65,428.49 2026-08-21
64654 HCPCS 1st Opn Implt Bat Modulj Sys 3 3 — — $42,687.47 $44,550.50 $44,550.50 2026-08-21
20982 50 OTHER Ablate Bone Tumor(s) Perq 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2098250 OTHER Ablate Bone Tumor(s) Perq 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
29867 50 OTHER Allgrft Implnt Knee W/scope 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2986750 OTHER Allgrft Implnt Knee W/scope 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
20696 HCPCS App Mltpln Uni Xtrnl Fix 1st 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
22633 HCPCS Arthrd Cmbn 1ntrspc Lumbar 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
24802 50 OTHER Arthrd Elbow Jt Autog Graft 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2480250 OTHER Arthrd Elbow Jt Autog Graft 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
23802 50 OTHER Arthrd Glenohumeral Jt W/grf 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2380250 OTHER Arthrd Glenohumeral Jt W/grf 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
22630 HCPCS Arthrd Pst Tq 1ntrspc Lum 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
22612 HCPCS Arthrd Pst Tq 1ntrspc Lumbar 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
27278 50 OTHER Arthrd Si Jt Plmt Iartic Dev 1 1 — — $25,867.34 $25,867.34 $25,867.34 2026-08-21
2727850 OTHER Arthrd Si Jt Plmt Iartic Dev 2 2 — — $24,785.61 $25,867.34 $25,326.47 2026-08-21
27278 HCPCS Arthrd Si Jt Plmt Iartic Dev 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
27279 50 OTHER Arthrd Si Jt Plmt Tartclr Dv 1 1 — — $25,867.34 $25,867.34 $25,867.34 2026-08-21
2727950 OTHER Arthrd Si Jt Plmt Tartclr Dv 2 2 — — $24,785.61 $25,867.34 $25,326.47 2026-08-21
27279 HCPCS Arthrd Si Jt Plmt Tartclr Dv 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
25810 50 OTHER Arthrd Wrst Iliac/oth Agrft 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2581050 OTHER Arthrd Wrst Iliac/oth Agrft 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
28705 50 OTHER Arthrodesis Pantalar 1 1 — — $25,867.34 $25,867.34 $25,867.34 2026-08-21
2870550 OTHER Arthrodesis Pantalar 2 2 — — $24,785.61 $25,867.34 $25,326.47 2026-08-21
28705 HCPCS Arthrodesis Pantalar 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
28725 50 OTHER Arthrodesis Subtalar 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2872550 OTHER Arthrodesis Subtalar 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
28715 50 OTHER Arthrodesis Triple 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2871550 OTHER Arthrodesis Triple 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
25446 50 OTHER Arthrp W/prostc Dst Rds&crps 1 1 — — $25,867.34 $25,867.34 $25,867.34 2026-08-21
2544650 OTHER Arthrp W/prostc Dst Rds&crps 2 2 — — $24,785.61 $25,867.34 $25,326.47 2026-08-21
25446 HCPCS Arthrp W/prostc Dst Rds&crps 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
25441 50 OTHER Arthrp W/prostc Dstl Rds 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2544150 OTHER Arthrp W/prostc Dstl Rds 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
25442 50 OTHER Arthrp W/prostc Dstl Ulna 1 1 — — $25,867.34 $25,867.34 $25,867.34 2026-08-21
2544250 OTHER Arthrp W/prostc Dstl Ulna 2 2 — — $24,785.61 $25,867.34 $25,326.47 2026-08-21
25442 HCPCS Arthrp W/prostc Dstl Ulna 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
25444 50 OTHER Arthrp W/prostc Lunate 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2544450 OTHER Arthrp W/prostc Lunate 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
29889 50 OTHER Arthrs Aid Pcl Rpr/agmntj 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2988950 OTHER Arthrs Aid Pcl Rpr/agmntj 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 1 1 — — $486,161.07 $486,161.07 $486,161.07 2026-08-21
C9782 HCPCS Blind Myocar Trpl Bon Marrow 3 3 — — $16,600.97 $17,325.50 $17,325.50 2026-08-21
Q2053 HCPCS Brexucabtagene Car Pos T 1 1 — — $486,161.07 $486,161.07 $486,161.07 2026-08-21
Q2056 HCPCS Ciltacabtagene Car-pos T 1 1 — — $533,171.93 $533,171.93 $533,171.93 2026-08-21
93656 HCPCS Compre Ep Eval Abltj Atr Fib 3 3 — — $22,042.65 $23,004.66 $23,004.66 2026-08-21
93653 HCPCS Compre Ep Eval Tx Svt 3 3 — — $22,042.65 $23,004.66 $23,004.66 2026-08-21
93654 HCPCS Compre Ep Eval Tx Vt 3 3 — — $22,042.65 $23,004.66 $23,004.66 2026-08-21
28297 50 OTHER Cor Hlx Vlgs Jt Arthrd 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2829750 OTHER Cor Hlx Vlgs Jt Arthrd 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
J7330 HCPCS Cultured Chondrocytes Implnt 1 1 — — $53,819.56 $53,819.56 $53,819.56 2026-08-21
Q0480 HCPCS Driver Pneumatic Vad, Rep 1 1 — — $48,735.87 $48,735.87 $48,735.87 2026-08-21
E0766 HCPCS Elec Stim Cancer Treatment 1 1 — — $62,397.88 $62,397.88 $62,397.88 2026-08-21
E0766NU OTHER Elec Stim Cancer Treatment 1 1 — — $62,397.88 $62,397.88 $62,397.88 2026-08-21
E0766UE OTHER Elec Stim Cancer Treatment 1 1 — — $46,798.51 $46,798.51 $46,798.51 2026-08-21
L7181 HCPCS Electronic Elbo Simultaneous 1 1 — — $21,681.68 $21,681.68 $21,681.68 2026-08-21
L7180 HCPCS Electronic Elbow Sequential 1 1 — — $19,537.48 $19,537.48 $19,537.48 2026-08-21
7053138 CDM Epifex 7x7 Cm 13 5 $29,436.00 $20,605.20 30% off $2,266.00 $28,258.56 $25,020.60 2026-08-21
27870 50 OTHER Fusion Of Ankle Joint Open 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2787050 OTHER Fusion Of Ankle Joint Open 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
28735 50 OTHER Fusion Of Foot Bones 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
28730 50 OTHER Fusion Of Foot Bones 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2873550 OTHER Fusion Of Foot Bones 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
2873050 OTHER Fusion Of Foot Bones 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
27871 50 OTHER Fusion Of Tibiofibular Joint 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2787150 OTHER Fusion Of Tibiofibular Joint 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
J7310 HCPCS Ganciclovir Long Act Implant 1 1 — — $19,200.00 $19,200.00 $19,200.00 2026-08-21
Q2055 HCPCS Idecabtagene Vicleucel Car 1 1 — — $524,291.46 $524,291.46 $524,291.46 2026-08-21
C8003 HCPCS Imp Extar Knee Shck Absrb 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
69716 50 OTHER Impl Oi Implt Sk Tc Esp<100 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
6971650 OTHER Impl Oi Implt Sk Tc Esp<100 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
69729 50 OTHER Impl Oi Implt Sk Tc Esp>=100 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
6972950 OTHER Impl Oi Implt Sk Tc Esp>=100 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
69714 50 OTHER Impl Oi Implt Skull Perq Esp 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
6971450 OTHER Impl Oi Implt Skull Perq Esp 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
69930 50 OTHER Implant Cochlear Device 1 1 — — $44,740.70 $44,740.70 $44,740.70 2026-08-21
6993050 OTHER Implant Cochlear Device 2 2 — — $42,869.72 $44,740.70 $43,805.21 2026-08-21
69930 HCPCS Implant Cochlear Device 3 3 — — $28,579.81 $29,827.13 $29,827.13 2026-08-21
67027 50 OTHER Implant Eye Drug System 1 1 — — $21,612.09 $21,612.09 $21,612.09 2026-08-21
6702750 OTHER Implant Eye Drug System 2 2 — — $20,708.31 $21,612.09 $21,160.20 2026-08-21
63655 HCPCS Implant Neuroelectrodes 3 3 — — $19,268.11 $20,109.03 $20,109.03 2026-08-21
61886 HCPCS Implant Neurostim Arrays 3 3 — — $27,380.98 $28,575.98 $28,575.98 2026-08-21
66683 50 OTHER Implantation Iris Prosthesis 1 1 — — $23,091.28 $23,091.28 $23,091.28 2026-08-21
6668350 OTHER Implantation Iris Prosthesis 2 2 — — $22,125.64 $23,091.28 $22,608.46 2026-08-21
J3399 HCPCS Inj Onase Abepar-xioi Treat 1 1 — — $2,322,044.36 $2,322,044.36 $2,322,044.36 2026-08-21
33270 HCPCS Ins/rep Subq Defibrillator 3 3 — — $28,807.81 $30,065.08 $30,065.08 2026-08-21
63685 HCPCS Ins/rplc Spi Npg/rcvr Pocket 3 3 — — $27,380.98 $28,575.98 $28,575.98 2026-08-21
33221 HCPCS Insert Pulse Gen Mult Leads 3 3 — — $17,135.73 $17,883.59 $17,883.59 2026-08-21
53444 HCPCS Insert Tandem Cuff 3 3 — — $18,085.82 $18,875.14 $18,875.14 2026-08-21
53445 HCPCS Insert Uro/ves Nck Sphincter 3 3 — — $18,085.82 $18,875.14 $18,875.14 2026-08-21
33276 HCPCS Insj Phrnc Nrv Stim Sys 3 3 — — $42,687.47 $44,550.50 $44,550.50 2026-08-21
22867 HCPCS Insj Stablj Dev W/dcmprn 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
33249 HCPCS Insj/rplcmt Defib W/lead(s) 3 3 — — $28,807.81 $30,065.08 $30,065.08 2026-08-21
33230 HCPCS Insrt Pulse Gen W/dual Leads 3 3 — — $20,168.25 $21,048.46 $21,048.46 2026-08-21
33231 HCPCS Insrt Pulse Gen W/mult Leads 3 3 — — $28,807.81 $30,065.08 $30,065.08 2026-08-21
33240 HCPCS Insrt Pulse Gen W/singl Lead 3 3 — — $20,168.25 $21,048.46 $21,048.46 2026-08-21
61885 50 OTHER Insrt/redo Neurostim 1 Array 1 1 — — $30,163.55 $30,163.55 $30,163.55 2026-08-21
6188550 OTHER Insrt/redo Neurostim 1 Array 2 2 — — $28,902.17 $30,163.55 $29,532.86 2026-08-21
61885 HCPCS Insrt/redo Neurostim 1 Array 3 3 — — $19,268.11 $20,109.03 $20,109.03 2026-08-21
64590 HCPCS Interstim Generator Implantation 16 7 $28,061.00 $19,642.70 30% off $2,266.00 $26,938.56 $20,109.03 2026-08-21
L2006 HCPCS Kaf Sng/dbl Swg/stn Mcpr Cus 1 1 — — $20,295.26 $20,295.26 $20,295.26 2026-08-21
65770 50 OTHER Keratoprosthesis 1 1 — — $20,099.24 $20,099.24 $20,099.24 2026-08-21
6577050 OTHER Keratoprosthesis 2 2 — — $19,258.73 $20,099.24 $19,678.99 2026-08-21
25391 50 OTHER Lengthen Radius Or Ulna 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2539150 OTHER Lengthen Radius Or Ulna 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
Q2054 HCPCS Lisocabtagene Mara Car Pos T 1 1 — — $512,793.30 $512,793.30 $512,793.30 2026-08-21
24410 50 OTHER Mlt Osteot Rlgnm Imed Rd Hum 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2441050 OTHER Mlt Osteot Rlgnm Imed Rd Hum 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
64568 50 OTHER Opn Impltj Crnl Nrv Nea&pg 1 1 — — $42,863.96 $42,863.96 $42,863.96 2026-08-21
6456850 OTHER Opn Impltj Crnl Nrv Nea&pg 2 2 — — $41,071.47 $42,863.96 $41,967.71 2026-08-21
64568 HCPCS Opn Impltj Crnl Nrv Nea&pg 3 3 — — $27,380.98 $28,575.98 $28,575.98 2026-08-21
64580 HCPCS Opn Impltj Nea Neuromuscular 3 3 — — $19,268.11 $20,109.03 $20,109.03 2026-08-21
64582 50 OTHER Opn Mpltj Hpglsl Nstm Ary Pg 1 1 — — $42,863.96 $42,863.96 $42,863.96 2026-08-21
6458250 OTHER Opn Mpltj Hpglsl Nstm Ary Pg 2 2 — — $41,071.47 $42,863.96 $41,967.71 2026-08-21
64582 HCPCS Opn Mpltj Hpglsl Nstm Ary Pg 3 3 — — $27,380.98 $28,575.98 $28,575.98 2026-08-21
28420 50 OTHER Optx Calcaneal Fx W/bone Grf 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2842050 OTHER Optx Calcaneal Fx W/bone Grf 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
24546 50 OTHER Optx Hum Fx W/ntrcndylr Xtn 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2454650 OTHER Optx Hum Fx W/ntrcndylr Xtn 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
24545 50 OTHER Optx Hum Fx Wo Ntrcndylr Xtn 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2454550 OTHER Optx Hum Fx Wo Ntrcndylr Xtn 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
24575 50 OTHER Optx Humeral Epcndylr Fx 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2457550 OTHER Optx Humeral Epcndylr Fx 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
24579 50 OTHER Optx Humrl Cndylr Fracture 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2457950 OTHER Optx Humrl Cndylr Fracture 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
24515 50 OTHER Optx Humrl Shft Fx Plate/scr 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2451550 OTHER Optx Humrl Shft Fx Plate/scr 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
24586 50 OTHER Optx Partclr Fx&/dislc Elbow 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2458650 OTHER Optx Partclr Fx&/dislc Elbow 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
24587 50 OTHER Optx Partclr Fx&/dslc Elbw W 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2458750 OTHER Optx Partclr Fx&/dslc Elbw W 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
23615 50 OTHER Optx Prox Humrl Fx W/int Fix 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2361550 OTHER Optx Prox Humrl Fx W/int Fix 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
23616 50 OTHER Optx Prx Hmrl Fx Fix Rpr Rpl 1 1 — — $25,867.34 $25,867.34 $25,867.34 2026-08-21
2361650 OTHER Optx Prx Hmrl Fx Fix Rpr Rpl 2 2 — — $24,785.61 $25,867.34 $25,326.47 2026-08-21
23616 HCPCS Optx Prx Hmrl Fx Fix Rpr Rpl 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
24666 50 OTHER Optx Radial Head/nck Fx Rplc 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2466650 OTHER Optx Radial Head/nck Fx Rplc 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
23680 50 OTHER Optx Sho Dislc Neck Fx Fixj 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2368050 OTHER Optx Sho Dislc Neck Fx Fixj 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
27415 50 OTHER Osteochondral Knee Allograft 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2741550 OTHER Osteochondral Knee Allograft 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
27709 50 OTHER Osteotomy Tibia & Fibula 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2770950 OTHER Osteotomy Tibia & Fibula 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
J9266 HCPCS Pegaspargase Injection 1 1 — — $26,246.16 $26,246.16 $26,246.16 2026-08-21
J9600 HCPCS Porfimer Sodium Injection 1 1 — — $24,101.00 $24,101.00 $24,101.00 2026-08-21
37184 50 OTHER Prim Art M-thrmbc 1st Vsl 1 1 — — $25,257.83 $25,257.83 $25,257.83 2026-08-21
3718450 OTHER Prim Art M-thrmbc 1st Vsl 2 2 — — $24,201.59 $25,257.83 $24,729.71 2026-08-21
24498 50 OTHER Proph Tx W/wo Mthylmthcrylt 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2449850 OTHER Proph Tx W/wo Mthylmthcrylt 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
25491 50 OTHER Prophylactic Tx Ulna 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2549150 OTHER Prophylactic Tx Ulna 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
92930 HCPCS Prq Tcat Plmt Ntrac St 2+les 3 3 — — $17,417.39 $18,177.54 $18,177.54 2026-08-21
27702 50 OTHER Reconstruct Ankle Joint 1 1 — — $25,867.34 $25,867.34 $25,867.34 2026-08-21
2770250 OTHER Reconstruct Ankle Joint 2 2 — — $24,785.61 $25,867.34 $25,326.47 2026-08-21
27702 HCPCS Reconstruct Ankle Joint 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
24361 50 OTHER Reconstruct Elbow Joint 1 1 — — $25,867.34 $25,867.34 $25,867.34 2026-08-21
2436150 OTHER Reconstruct Elbow Joint 2 2 — — $24,785.61 $25,867.34 $25,326.47 2026-08-21
24362 50 OTHER Reconstruct Elbow Joint 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2436250 OTHER Reconstruct Elbow Joint 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
24361 HCPCS Reconstruct Elbow Joint 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
24346 50 OTHER Reconstruct Elbow Med Ligmnt 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2434650 OTHER Reconstruct Elbow Med Ligmnt 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
24366 50 OTHER Reconstruct Head Of Radius 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
24365 50 OTHER Reconstruct Head Of Radius 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2436650 OTHER Reconstruct Head Of Radius 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
2436550 OTHER Reconstruct Head Of Radius 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
23472 50 OTHER Reconstruct Shoulder Joint 1 1 — — $25,867.34 $25,867.34 $25,867.34 2026-08-21
2347250 OTHER Reconstruct Shoulder Joint 2 2 — — $24,785.61 $25,867.34 $25,326.47 2026-08-21
23470 50 OTHER Reconstruct Shoulder Joint 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2347050 OTHER Reconstruct Shoulder Joint 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
23472 HCPCS Reconstruct Shoulder Joint 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
27428 50 OTHER Reconstruction Knee 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
27429 50 OTHER Reconstruction Knee 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2742950 OTHER Reconstruction Knee 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
2742850 OTHER Reconstruction Knee 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
21243 50 OTHER Reconstruction Of Jaw Joint 1 1 — — $25,867.34 $25,867.34 $25,867.34 2026-08-21
2124350 OTHER Reconstruction Of Jaw Joint 2 2 — — $24,785.61 $25,867.34 $25,326.47 2026-08-21
21243 HCPCS Reconstruction Of Jaw Joint 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
23491 50 OTHER Reinforce Shoulder Bones 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2349150 OTHER Reinforce Shoulder Bones 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
27356 50 OTHER Remove Femur Lesion/graft 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2735650 OTHER Remove Femur Lesion/graft 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
53447 HCPCS Remove/replace Ur Sphincter 3 3 — — $18,085.82 $18,875.14 $18,875.14 2026-08-21
33229 HCPCS Remv&replc Pm Gen Mult Leads 3 3 — — $17,135.73 $17,883.59 $17,883.59 2026-08-21
28320 50 OTHER Repair Of Foot Bones 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2832050 OTHER Repair Of Foot Bones 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
24363 50 OTHER Replace Elbow Joint 1 1 — — $25,867.34 $25,867.34 $25,867.34 2026-08-21
2436350 OTHER Replace Elbow Joint 2 2 — — $24,785.61 $25,867.34 $25,326.47 2026-08-21
24363 HCPCS Replace Elbow Joint 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
61891 50 OTHER Rev/rplcmt Sk-mnt Crnl Nstm 1 1 — — $30,163.55 $30,163.55 $30,163.55 2026-08-21
6189150 OTHER Rev/rplcmt Sk-mnt Crnl Nstm 2 2 — — $28,902.17 $30,163.55 $29,532.86 2026-08-21
61891 HCPCS Rev/rplcmt Sk-mnt Crnl Nstm 3 3 — — $19,268.11 $20,109.03 $20,109.03 2026-08-21
64583 50 OTHER Rev/rplct Hpglsl Nstm Ary Pg 1 1 — — $17,540.68 $17,540.68 $17,540.68 2026-08-21
6458350 OTHER Rev/rplct Hpglsl Nstm Ary Pg 2 2 — — $16,807.16 $17,540.68 $17,173.92 2026-08-21
23473 50 OTHER Revis Reconst Shoulder Joint 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2347350 OTHER Revis Reconst Shoulder Joint 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
27438 50 OTHER Revise Kneecap With Implant 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2743850 OTHER Revise Kneecap With Implant 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
25365 50 OTHER Revise Radius & Ulna 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2536550 OTHER Revise Radius & Ulna 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
24371 50 OTHER Revise Reconst Elbow Joint 1 1 — — $25,867.34 $25,867.34 $25,867.34 2026-08-21
2437150 OTHER Revise Reconst Elbow Joint 2 2 — — $24,785.61 $25,867.34 $25,326.47 2026-08-21
24370 50 OTHER Revise Reconst Elbow Joint 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2437050 OTHER Revise Reconst Elbow Joint 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
24371 HCPCS Revise Reconst Elbow Joint 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
61888 50 OTHER Revise/remove Neuroreceiver 1 1 — — $17,540.68 $17,540.68 $17,540.68 2026-08-21
6188850 OTHER Revise/remove Neuroreceiver 2 2 — — $16,807.16 $17,540.68 $17,173.92 2026-08-21
64569 50 OTHER Revise/repl Vagus N Eltrd 1 1 — — $17,540.68 $17,540.68 $17,540.68 2026-08-21
6456950 OTHER Revise/repl Vagus N Eltrd 2 2 — — $16,807.16 $17,540.68 $17,173.92 2026-08-21
23485 50 OTHER Revision Of Collar Bone 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2348550 OTHER Revision Of Collar Bone 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
28737 50 OTHER Revision Of Foot Bones 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2873750 OTHER Revision Of Foot Bones 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
27446 50 OTHER Revision Of Knee Joint 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
27442 50 OTHER Revision Of Knee Joint 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
27440 50 OTHER Revision Of Knee Joint 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
27443 50 OTHER Revision Of Knee Joint 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
27441 50 OTHER Revision Of Knee Joint 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2744350 OTHER Revision Of Knee Joint 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
2744250 OTHER Revision Of Knee Joint 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
2744150 OTHER Revision Of Knee Joint 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
2744650 OTHER Revision Of Knee Joint 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
2744050 OTHER Revision Of Knee Joint 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
64656 50 OTHER Revj/rplcmt Bat Mod Sys Pg 1 1 — — $45,897.45 $45,897.45 $45,897.45 2026-08-21
6465650 OTHER Revj/rplcmt Bat Mod Sys Pg 2 2 — — $43,978.10 $45,897.45 $44,937.77 2026-08-21
64656 HCPCS Revj/rplcmt Bat Mod Sys Pg 3 3 — — $29,318.73 $30,598.29 $30,598.29 2026-08-21
37258 50 OTHER Revsc Evasc Ivt Stent Sf 1st 1 1 — — $17,170.71 $17,170.71 $17,170.71 2026-08-21
37286 50 OTHER Revsc Evasc Tpvt St Cplx 1st 1 1 — — $27,266.31 $27,266.31 $27,266.31 2026-08-21
3728650 OTHER Revsc Evasc Tpvt St Cplx 1st 2 2 — — $26,126.08 $27,266.31 $26,696.19 2026-08-21
37286 HCPCS Revsc Evasc Tpvt St Cplx 1st 3 3 — — $17,417.39 $18,177.54 $18,177.54 2026-08-21
37284 50 OTHER Revsc Evasc Tpvt St Sf 1st 1 1 — — $27,266.31 $27,266.31 $27,266.31 2026-08-21
3728450 OTHER Revsc Evasc Tpvt St Sf 1st 2 2 — — $26,126.08 $27,266.31 $26,696.19 2026-08-21
37284 HCPCS Revsc Evasc Tpvt St Sf 1st 3 3 — — $17,417.39 $18,177.54 $18,177.54 2026-08-21
37273 50 OTHER Revsc Evsc Fpvt Athrc Cplx 1 1 1 — — $27,266.31 $27,266.31 $27,266.31 2026-08-21
3727350 OTHER Revsc Evsc Fpvt Athrc Cplx 1 2 2 — — $26,126.08 $27,266.31 $26,696.19 2026-08-21
37273 HCPCS Revsc Evsc Fpvt Athrc Cplx 1 3 3 — — $17,417.39 $18,177.54 $18,177.54 2026-08-21
37271 50 OTHER Revsc Evsc Fpvt Athrc Sf 1st 1 1 — — $27,266.31 $27,266.31 $27,266.31 2026-08-21
3727150 OTHER Revsc Evsc Fpvt Athrc Sf 1st 2 2 — — $26,126.08 $27,266.31 $26,696.19 2026-08-21
37271 HCPCS Revsc Evsc Fpvt Athrc Sf 1st 3 3 — — $17,417.39 $18,177.54 $18,177.54 2026-08-21
37267 50 OTHER Revsc Evsc Fpvt Stent Sf 1st 1 1 — — $17,170.71 $17,170.71 $17,170.71 2026-08-21
37290 50 OTHER Revsc Evsc Tpvt Athrc Cplx 1 1 1 — — $27,266.31 $27,266.31 $27,266.31 2026-08-21
3729050 OTHER Revsc Evsc Tpvt Athrc Cplx 1 2 2 — — $26,126.08 $27,266.31 $26,696.19 2026-08-21
37290 HCPCS Revsc Evsc Tpvt Athrc Cplx 1 3 3 — — $17,417.39 $18,177.54 $18,177.54 2026-08-21
37288 50 OTHER Revsc Evsc Tpvt Athrc Sf 1st 1 1 — — $27,266.31 $27,266.31 $27,266.31 2026-08-21
3728850 OTHER Revsc Evsc Tpvt Athrc Sf 1st 2 2 — — $26,126.08 $27,266.31 $26,696.19 2026-08-21
37288 HCPCS Revsc Evsc Tpvt Athrc Sf 1st 3 3 — — $17,417.39 $18,177.54 $18,177.54 2026-08-21
33287 HCPCS Rmv&rplcmt Phrnc Nrv Stim Pg 3 3 — — $27,380.98 $28,575.98 $28,575.98 2026-08-21
33263 HCPCS Rmvl & Rplcmt Dfb Gen 2 Lead 3 3 — — $20,168.25 $21,048.46 $21,048.46 2026-08-21
33264 HCPCS Rmvl & Rplcmt Dfb Gen Mlt Ld 3 3 — — $28,807.81 $30,065.08 $30,065.08 2026-08-21
33262 HCPCS Rmvl& Replc Pulse Gen 1 Lead 3 3 — — $20,168.25 $21,048.46 $21,048.46 2026-08-21
69730 50 OTHER Rplc Oi Implt Sk Tc Esp>=100 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
6973050 OTHER Rplc Oi Implt Sk Tc Esp>=100 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
69719 50 OTHER Rplcm Oi Implt Sk Tc Esp<100 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
6971950 OTHER Rplcm Oi Implt Sk Tc Esp<100 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
24435 50 OTHER Rpr Non/mal Hum With Agrft 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2443550 OTHER Rpr Non/mal Hum With Agrft 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
24430 50 OTHER Rpr Non/mal Humerus Wo Graft 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2443050 OTHER Rpr Non/mal Humerus Wo Graft 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
37277 50 OTHER Rvsc Evsc Fpvt St Athr Cpx 1 1 1 — — $27,266.31 $27,266.31 $27,266.31 2026-08-21
3727750 OTHER Rvsc Evsc Fpvt St Athr Cpx 1 2 2 — — $26,126.08 $27,266.31 $26,696.19 2026-08-21
37277 HCPCS Rvsc Evsc Fpvt St Athr Cpx 1 3 3 — — $17,417.39 $18,177.54 $18,177.54 2026-08-21
37275 50 OTHER Rvsc Evsc Fpvt St Athrc Sf 1 1 1 — — $27,266.31 $27,266.31 $27,266.31 2026-08-21
3727550 OTHER Rvsc Evsc Fpvt St Athrc Sf 1 2 2 — — $26,126.08 $27,266.31 $26,696.19 2026-08-21
37275 HCPCS Rvsc Evsc Fpvt St Athrc Sf 1 3 3 — — $17,417.39 $18,177.54 $18,177.54 2026-08-21
37294 50 OTHER Rvsc Evsc Tpvt St Athr Cpx 1 1 1 — — $27,266.31 $27,266.31 $27,266.31 2026-08-21
3729450 OTHER Rvsc Evsc Tpvt St Athr Cpx 1 2 2 — — $26,126.08 $27,266.31 $26,696.19 2026-08-21
37294 HCPCS Rvsc Evsc Tpvt St Athr Cpx 1 3 3 — — $17,417.39 $18,177.54 $18,177.54 2026-08-21
37292 50 OTHER Rvsc Evsc Tpvt St Athrc Sf 1 1 1 — — $27,266.31 $27,266.31 $27,266.31 2026-08-21
3729250 OTHER Rvsc Evsc Tpvt St Athrc Sf 1 2 2 — — $26,126.08 $27,266.31 $26,696.19 2026-08-21
37292 HCPCS Rvsc Evsc Tpvt St Athrc Sf 1 3 3 — — $17,417.39 $18,177.54 $18,177.54 2026-08-21
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 1 1 — — $60,092.70 $60,092.70 $60,092.70 2026-08-21
29907 50 OTHER Subtalar Arthro W/fusion 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2990750 OTHER Subtalar Arthro W/fusion 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
J9226 HCPCS Supprelin La Implant 1 1 — — $48,229.38 $48,229.38 $48,229.38 2026-08-21
33289 HCPCS Tcat Impl Wrls P-art Prs Snr 3 3 — — $25,543.28 $26,658.07 $26,658.07 2026-08-21
33274 HCPCS Tcat Insj/rpl Perm Ldls Pm 3 3 — — $17,135.73 $17,883.59 $17,883.59 2026-08-21
29856 50 OTHER Tibial Arthroscopy/surgery 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2985650 OTHER Tibial Arthroscopy/surgery 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
Q2042 HCPCS Tisagenlecleucel Car-pos T 1 1 — — $606,049.34 $606,049.34 $606,049.34 2026-08-21
19357 50 OTHER Tiss Xpndr Plmt Brst Rcnstj 1 1 — — $24,472.43 $24,472.43 $24,472.43 2026-08-21
1935750 OTHER Tiss Xpndr Plmt Brst Rcnstj 2 2 — — $23,449.03 $24,472.43 $23,960.73 2026-08-21
22856 HCPCS Tot Disc Arthrp 1ntrspc Crv 3 3 — — $16,523.74 $17,244.89 $17,244.89 2026-08-21
27130 50 OTHER Total Hip Arthroplasty 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2713050 OTHER Total Hip Arthroplasty 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
27447 50 OTHER Total Knee Arthroplasty 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2744750 OTHER Total Knee Arthroplasty 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
38240 HCPCS Transplt Allo Hct/donor 3 3 — — $53,140.29 $55,459.50 $55,459.50 2026-08-21
27828 50 OTHER Treat Lower Leg Fracture 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
27827 50 OTHER Treat Lower Leg Fracture 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2782850 OTHER Treat Lower Leg Fracture 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
2782750 OTHER Treat Lower Leg Fracture 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
27759 50 OTHER Treatment Of Tibia Fracture 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
27758 50 OTHER Treatment Of Tibia Fracture 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2775950 OTHER Treatment Of Tibia Fracture 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
2775850 OTHER Treatment Of Tibia Fracture 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
24516 50 OTHER Tx Humrl Shaft Fx Imed Implt 1 1 — — $18,098.39 $18,098.39 $18,098.39 2026-08-21
2451650 OTHER Tx Humrl Shaft Fx Imed Implt 2 2 — — $17,341.55 $18,098.39 $17,719.97 2026-08-21
A9543 HCPCS Y90 Ibritumomab, Rx 1 1 — — $70,418.21 $70,418.21 $70,418.21 2026-08-21
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