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

CHESHIRE MEDICAL CENTER

Keene, NH · CCN 300019 · Rates published

11,366 distinct procedures filed
17 distinct payers
131,516 rate rows
2026-07-15 last MRF observed
Data quality

128,222 of 131,516 rate rows are consumer-grade (97.5%)

3,294 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
placeholder amount (≤ $0.02) — excluded from medians 1,926
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 819
template filing: same amount across many unrelated codes — excluded 361
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 188
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.cheshiremed.org/02-0354549_Cheshire%20Medical%20Center_standardcharges.zip
Found on page https://www.cheshiremed.org/patients-visitors/charges-for-services
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-12
Content fingerprint 535ddd27754ac733… · 12,956,206 bytes · first seen 2026-05-08

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
Q2056
HCPCS 		Ciltacabtagene Car-pos T 2 $569,980.19 $1,282,090.80 $926,035.49 nat. median
$599,737
1.5× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 2 $557,498.26 $1,228,590.56 $893,044.41 nat. median
$574,037
1.6× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 2 $557,884.73 $1,201,088.12 $879,486.43 nat. median
$579,571
1.5× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 6 $75,611.00 $1,134,963.79 $373,000.00 nat. median
$513,770
0.7× median
K1007
HCPCS 		Bil Hkaf Pc S/d Micro Sensor 5 $96,013.20 $216,775.44 $156,394.32 nat. median
$95,583
1.6× median
L8702
HCPCS 		Ewhf S/d Uprt Micro Sensor 4 $69,476.24 $156,861.16 $113,168.70 nat. median
$68,802
1.6× median
J9029
HCPCS 		Instill Adstiladrin Tx Dose 2 $65,333.98 $147,441.45 $106,387.71 nat. median
$66,211
1.6× median
Q0480
HCPCS 		Driver Pneumatic Vad Rep 14 $40,833.94 $232,549.79 $88,414.08 nat. median
$108,243
0.8× median
C9150
HCPCS 		Xe129 Xenon- Diagnostic 1 $76,908.00 $76,908.00 $76,908.00 nat. median
$77,438
1.0× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 5 $0.88 $1,138,372.25 $75,611.00 nat. median
$562,501
outlier · 0.1×
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 4 $38,016.99 $96,356.43 $67,186.71 nat. median
$2,455,111
outlier · 0.0×
L2006
HCPCS 		Kaf Sng/dbl Swg/stn Mcpr Cus 5 $41,018.10 $92,609.32 $66,813.71 nat. median
$38,763
1.7× median
A9543
HCPCS 		Y90 Ibritumomab Rx 11 $38,870.82 $91,358.37 $63,005.77 nat. median
$65,477
1.0× median
A9545
HCPCS 		I131 Tositumomab - Rx 3 $60,173.68 $60,173.68 $60,173.68 nat. median
$41,848
1.4× median
L8701
HCPCS 		Ewh S/d Uprt Micro Sensor 4 $35,312.97 $79,728.47 $57,520.72 nat. median
$34,970
1.6× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 17 $12,014.48 $129,150.13 $51,712.98 nat. median
$63,499
0.8× median
J7330
HCPCS 		Cultured Chondrocytes Implnt 12 $5,990.05 $83,577.40 $44,783.72 nat. median
$92,809
outlier · 0.5×
J9226
HCPCS 		Supprelin La Implant 17 $21,750.57 $105,256.31 $41,645.55 nat. median
$57,036
0.7× median
L7181
HCPCS 		Electronic Elbo Simultaneous 14 $22,842.07 $109,789.81 $39,333.82 nat. median
$48,410
0.8× median
L7180
HCPCS 		Electronic Elbow Sequential 16 $22,185.51 $105,061.32 $37,602.19 nat. median
$42,745
0.9× median
J7310
HCPCS 		Ganciclovir Long Act Implant 11 $14,076.80 $56,741.71 $36,530.86 nat. median
$13,629
outlier · 2.7×
L6700
HCPCS 		Ue Add Ext Power Myoel 3 $29,799.51 $29,799.51 $29,799.51 nat. median
$30,100
1.0× median
C1767
HCPCS 		Generator Neuro Non-recharg 3 $25,348.43 $25,348.43 $25,348.43 nat. median
$25,172
1.0× median
L5856
HCPCS 		Elec Knee-shin Swing/stance 16 $11,826.18 $66,527.53 $23,810.69 nat. median
$29,004
0.8× median
C1882
HCPCS 		Aicd Other Than Sing/dual 3 $23,589.58 $23,589.58 $23,589.58 nat. median
$24,131
1.0× median
L6880
HCPCS 		Elec Hand Ind Art Digits 14 $12,062.52 $68,543.50 $23,454.66 nat. median
$28,867
0.8× median
J9266
HCPCS 		Pegaspargase Injection 17 $11,546.32 $62,952.53 $21,544.13 nat. median
$31,084
0.7× median
C1721
HCPCS 		Aicd Dual Chamber 3 $21,008.48 $21,008.48 $21,008.48 nat. median
$19,958
1.1× median
C1722
HCPCS 		Aicd Single Chamber 5 $19,185.60 $20,297.31 $19,741.46 nat. median
$19,800
1.0× median
L5991
HCPCS 		Low Pros Ext Osseo Connector 2 $11,870.29 $26,800.34 $19,335.32 nat. median
$11,755
1.6× median
L8614
HCPCS 		Cochlear Device 16 $11,079.09 $53,439.92 $19,126.53 nat. median
$22,495
0.9× median
L6975
HCPCS 		Interscap-thor Myoelectronic 16 $10,108.58 $52,617.04 $18,832.03 nat. median
$21,202
0.9× median
Q0483
HCPCS 		Monitor Elec Vad Rep 14 $8,500.74 $51,375.13 $18,405.90 nat. median
$22,635
0.8× median
L5858
HCPCS 		Stance Phase Only 14 $10,595.08 $50,924.96 $18,244.61 nat. median
$22,455
0.8× median
J9600
HCPCS 		Porfimer Sodium Injection 9 $3,004.74 $41,534.64 $17,657.72 nat. median
$26,416
0.7× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 5 $2.81 $1,315,358.24 $17,418.89 nat. median
$621,313
outlier · 0.0×
L5973
HCPCS 		Ank-foot Sys Dors-plant Flex 14 $9,309.20 $60,410.53 $17,223.17 nat. median
$21,313
0.8× median
L6970
HCPCS 		Interscapular-thor Switch CT 16 $9,170.98 $46,682.83 $16,708.12 nat. median
$19,306
0.9× median
A9604
HCPCS 		Sm 153 Lexidronam 12 $9,775.57 $41,878.65 $16,608.54 nat. median
$11,059
1.5× median
C1816
HCPCS 		Receiver/transmitter Neuro 3 $16,116.00 $16,116.00 $16,116.00 nat. median
$9,555
1.7× median
Q0489
HCPCS 		Pwr Pck Base Combo Vad Rep 14 $7,369.68 $44,539.42 $15,956.91 nat. median
$19,623
0.8× median
L6965
HCPCS 		Shldr Disartic Myoelectronic 16 $8,567.88 $43,612.36 $15,609.17 nat. median
$18,144
0.9× median
S0590
HCPCS 		Misc Integral Lens Serv 3 $15,248.64 $15,248.64 $15,248.64 —
L8687
HCPCS 		Implt Nrostm Pls Gen Dua Rec 9 $7,302.10 $36,050.02 $15,030.09 nat. median
$15,408
1.0× median
L5615
HCPCS 		Ak 4 Bar Link Hydl Swg/stanc 2 $9,130.96 $20,615.58 $14,873.27 nat. median
$6,855
outlier · 2.2×
C1820
HCPCS 		Generator Neuro Rechg Bat Sy 3 $14,448.64 $14,448.64 $14,448.64 nat. median
$21,100
0.7× median
Q0481
HCPCS 		Microprcsr Cu Elec Vad Rep 14 $6,588.08 $39,815.70 $14,264.56 nat. median
$16,720
0.9× median
L5859
HCPCS 		Knee-shin Pro Flex/ext Cont 14 $6,255.50 $48,284.68 $14,243.42 nat. median
$17,530
0.8× median
C2616
HCPCS 		Brachytx Non-str Yttrium-90 6 $9,975.00 $18,228.47 $14,101.74 nat. median
$22,121
0.6× median
L6960
HCPCS 		Shldr Disartic Switch Contro 16 $7,232.40 $37,170.51 $13,316.88 nat. median
$15,937
0.8× median

Other procedures at this hospital

Browse this hospital's 11,366 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
             
Q2056 HCPCS Ciltacabtagene Car-pos T 2 2 — — $569,980.19 $1,282,090.80 $926,035.49 2026-07-15
Q2055 HCPCS Idecabtagene Vicleucel Car 2 2 — — $557,498.26 $1,228,590.56 $893,044.41 2026-07-15
Q2054 HCPCS Lisocabtagene Mara Car Pos T 2 2 — — $557,884.73 $1,201,088.12 $879,486.43 2026-07-15
Q2053 HCPCS Brexucabtagene Car Pos T 6 6 — — $75,611.00 $1,134,963.79 $373,000.00 2026-07-15
K1007 HCPCS Bil Hkaf Pc S/d Micro Sensor 5 5 — — $96,013.20 $216,775.44 $156,394.32 2026-07-15
L8702 HCPCS Ewhf S/d Uprt Micro Sensor 4 4 — — $69,476.24 $156,861.16 $113,168.70 2026-07-15
J9029 HCPCS Instill Adstiladrin Tx Dose 2 2 — — $65,333.98 $147,441.45 $106,387.71 2026-07-15
Q0480 HCPCS Driver Pneumatic Vad Rep 25 14 — — $40,833.94 $232,549.79 $88,414.08 2026-07-15
C9150 HCPCS Xe129 Xenon- Diagnostic 1 1 — — $76,908.00 $76,908.00 $76,908.00 2026-07-15
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 7 5 — — $0.88 $1,138,372.25 $75,611.00 2026-07-15
J3399 HCPCS Inj Onase Abepar-xioi Treat 5 4 — — $38,016.99 $96,356.43 $67,186.71 2026-07-15
L2006 HCPCS Kaf Sng/dbl Swg/stn Mcpr Cus 5 5 — — $41,018.10 $92,609.32 $66,813.71 2026-07-15
A9543 HCPCS Y90 Ibritumomab Rx 14 11 — — $38,870.82 $91,358.37 $63,005.77 2026-07-15
A9545 HCPCS I131 Tositumomab - Rx 3 3 — — $60,173.68 $60,173.68 $60,173.68 2026-07-15
L8701 HCPCS Ewh S/d Uprt Micro Sensor 4 4 — — $35,312.97 $79,728.47 $57,520.72 2026-07-15
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 29 17 — — $12,014.48 $129,150.13 $51,712.98 2026-07-15
J7330 HCPCS Cultured Chondrocytes Implnt 17 12 — — $5,990.05 $83,577.40 $44,783.72 2026-07-15
J9226 HCPCS Supprelin La Implant 29 17 — — $21,750.57 $105,256.31 $41,645.55 2026-07-15
L7181 HCPCS Electronic Elbo Simultaneous 25 14 — — $22,842.07 $109,789.81 $39,333.82 2026-07-15
L7180 HCPCS Electronic Elbow Sequential 28 16 — — $22,185.51 $105,061.32 $37,602.19 2026-07-15
J7310 HCPCS Ganciclovir Long Act Implant 15 11 — — $14,076.80 $56,741.71 $36,530.86 2026-07-15
L6700 HCPCS Ue Add Ext Power Myoel 3 3 — — $29,799.51 $29,799.51 $29,799.51 2026-07-15
C1767 HCPCS Generator Neuro Non-recharg 4 3 — — $25,348.43 $25,348.43 $25,348.43 2026-07-15
L5856 HCPCS Elec Knee-shin Swing/stance 28 16 — — $11,826.18 $66,527.53 $23,810.69 2026-07-15
C1882 HCPCS Aicd Other Than Sing/dual 4 3 — — $23,589.58 $23,589.58 $23,589.58 2026-07-15
L6880 HCPCS Elec Hand Ind Art Digits 28 14 — — $12,062.52 $68,543.50 $23,454.66 2026-07-15
J9266 HCPCS Pegaspargase Injection 29 17 — — $11,546.32 $62,952.53 $21,544.13 2026-07-15
C1721 HCPCS Aicd Dual Chamber 4 3 — — $21,008.48 $21,008.48 $21,008.48 2026-07-15
C1722 HCPCS Aicd Single Chamber 7 5 — — $19,185.60 $20,297.31 $19,741.46 2026-07-15
L5991 HCPCS Low Pros Ext Osseo Connector 2 2 — — $11,870.29 $26,800.34 $19,335.32 2026-07-15
L8614 HCPCS Cochlear Device 28 16 — — $11,079.09 $53,439.92 $19,126.53 2026-07-15
L6975 HCPCS Interscap-thor Myoelectronic 28 16 — — $10,108.58 $52,617.04 $18,832.03 2026-07-15
Q0483 HCPCS Monitor Elec Vad Rep 25 14 — — $8,500.74 $51,375.13 $18,405.90 2026-07-15
L5858 HCPCS Stance Phase Only 25 14 — — $10,595.08 $50,924.96 $18,244.61 2026-07-15
J9600 HCPCS Porfimer Sodium Injection 14 9 — — $3,004.74 $41,534.64 $17,657.72 2026-07-15
Q2042 HCPCS Tisagenlecleucel Car-pos T 7 5 — — $2.81 $1,315,358.24 $17,418.89 2026-07-15
L5973 HCPCS Ank-foot Sys Dors-plant Flex 25 14 — — $9,309.20 $60,410.53 $17,223.17 2026-07-15
L6970 HCPCS Interscapular-thor Switch CT 28 16 — — $9,170.98 $46,682.83 $16,708.12 2026-07-15
A9604 HCPCS Sm 153 Lexidronam 17 12 — — $9,775.57 $41,878.65 $16,608.54 2026-07-15
C1816 HCPCS Receiver/transmitter Neuro 4 3 — — $16,116.00 $16,116.00 $16,116.00 2026-07-15
Q0489 HCPCS Pwr Pck Base Combo Vad Rep 25 14 — — $7,369.68 $44,539.42 $15,956.91 2026-07-15
L6965 HCPCS Shldr Disartic Myoelectronic 28 16 — — $8,567.88 $43,612.36 $15,609.17 2026-07-15
S0590 HCPCS Misc Integral Lens Serv 4 3 — — $15,248.64 $15,248.64 $15,248.64 2026-07-15
L8687 HCPCS Implt Nrostm Pls Gen Dua Rec 14 9 — — $7,302.10 $36,050.02 $15,030.09 2026-07-15
L5615 HCPCS Ak 4 Bar Link Hydl Swg/stanc 2 2 — — $9,130.96 $20,615.58 $14,873.27 2026-07-15
C1820 HCPCS Generator Neuro Rechg Bat Sy 4 3 — — $14,448.64 $14,448.64 $14,448.64 2026-07-15
Q0481 HCPCS Microprcsr Cu Elec Vad Rep 26 14 — — $6,588.08 $39,815.70 $14,264.56 2026-07-15
L5859 HCPCS Knee-shin Pro Flex/ext Cont 28 14 — — $6,255.50 $48,284.68 $14,243.42 2026-07-15
C2616 HCPCS Brachytx Non-str Yttrium-90 8 6 — — $9,975.00 $18,228.47 $14,101.74 2026-07-15
L6960 HCPCS Shldr Disartic Switch Contro 28 16 — — $7,232.40 $37,170.51 $13,316.88 2026-07-15
E0766 HCPCS Elec Stim Cancer Treatment 24 8 — — $202.56 $92,533.97 $12,874.63 2026-07-15
D7949 HCPCS Reconstruct Midface W/graft 12 10 — — $5,415.65 $19,929.69 $12,672.67 2026-07-15
C2619 HCPCS Pmkr Dual Non Rate-resp 4 3 — — $8,125.14 $16,494.03 $12,309.58 2026-07-15
L6955 HCPCS Above Elbow Myoelectronic CT 29 16 — — $6,875.15 $33,721.82 $12,081.34 2026-07-15
L8685 HCPCS Implt Nrostm Pls Gen Sng Rec 14 9 — — $5,610.82 $27,700.96 $11,845.31 2026-07-15
G0251 HCPCS Linear Acc Based Stero Radio 4 3 — — $11,793.42 $11,793.43 $11,793.43 2026-07-15
Q0479 HCPCS Power Module Combo Vad Rep 26 14 — — $5,433.39 $34,648.89 $11,736.12 2026-07-15
C9758 HCPCS Blind Interatrial Shunt Ide 1 1 — — $11,724.22 $11,724.22 $11,724.22 2026-07-15
S2066 HCPCS Breast Gap Flap Reconst 10 8 — — $6,475.76 $16,474.90 $11,475.33 2026-07-15
Q0224 HCPCS Inj Pemivibart 4500 Mg 2 2 — — $7,456.17 $15,309.93 $11,383.05 2026-07-15
C9757 HCPCS Spine Device Implant Surgery 1 1 — — $11,161.68 $11,161.68 $11,161.68 2026-07-15
C1895 HCPCS Lead Aicd Endo Dual Coil 4 3 — — $7,184.43 $14,584.39 $10,884.41 2026-07-15
L6945 HCPCS Elbow Disart Myoelectronic C 28 16 — — $6,626.26 $30,153.90 $10,803.07 2026-07-15
L6025 HCPCS Part Hand Disart Myoelectric 3 3 — — $10,777.59 $10,777.59 $10,777.59 2026-07-15
Q4244 HCPCS Procenta- Per 200 Mg 7 6 — — $10,480.26 $10,480.26 $10,480.26 2026-07-15
L7191 HCPCS Elbow Child Myoelectronic CT 29 16 — — $6,374.98 $28,596.39 $10,245.08 2026-07-15
D7858 HCPCS Tmj Reconstruction 12 10 — — $3,368.93 $17,112.75 $10,240.84 2026-07-15
C2621 HCPCS Pmkr Other Than Sing/dual 4 3 — — $10,163.55 $10,163.55 $10,163.55 2026-07-15
S4015 HCPCS Complete Ivf Nos Case Rate 10 7 — — $4,826.34 $15,373.49 $10,099.92 2026-07-15
C1724 HCPCS Cath Trans Atherec Rotation 4 3 — — $10,069.44 $10,069.44 $10,069.44 2026-07-15
C1817 HCPCS Septal Defect Imp Sys 5 3 — — $6,634.99 $13,469.03 $10,052.00 2026-07-15
L5969 HCPCS Ak/ft Power Asst Incl Motors 11 9 — — $8,533.79 $31,042.85 $10,035.41 2026-07-15
S2067 HCPCS Breast 10 8 — — $3,645.60 $16,378.01 $10,011.81 2026-07-15
C1778 HCPCS Lead Neurostimulator 4 3 — — $10,004.83 $10,004.83 $10,004.83 2026-07-15
L6950 HCPCS Above Elbow Switch Control 28 16 — — $5,928.46 $27,853.61 $9,978.96 2026-07-15
L8688 HCPCS Implt Nrostm Pls Gen Dua Non 14 9 — — $4,659.38 $23,002.82 $9,836.32 2026-07-15
L7274 HCPCS Proportional Ctl 12 Volt Uta 4 3 — — $9,756.03 $9,756.04 $9,756.04 2026-07-15
L7186 HCPCS Electron Elbow Child Switch 28 16 — — $6,060.78 $27,163.65 $9,731.78 2026-07-15
C1899 HCPCS Lead Pmkr/aicd Combination 4 3 — — $6,412.06 $13,016.48 $9,714.27 2026-07-15
D7948 HCPCS Reconstruct Midface No Graft 13 10 — — $3,820.46 $15,301.64 $9,561.05 2026-07-15
A0431 HCPCS Rotary Wing Air Transport 12 10 — — $3,570.59 $15,822.14 $9,528.09 2026-07-15
L6940 HCPCS Elbow Disarticulation Switch 28 16 — — $5,939.48 $26,491.86 $9,491.09 2026-07-15
C1813 HCPCS Prosthesis Penile Inflatab 4 3 — — $6,024.61 $12,229.95 $9,127.28 2026-07-15
L6925 HCPCS Wrist Disart Myoelectronic C 26 14 — — $5,301.21 $24,749.92 $8,867.03 2026-07-15
D7946 HCPCS Reconstruction Maxilla Total 13 10 — — $3,433.94 $14,018.44 $8,726.19 2026-07-15
S2115 HCPCS Periacetabular Osteotomy 7 5 — — $2,972.76 $14,375.28 $8,674.02 2026-07-15
L6935 HCPCS Below Elbow Myoelectronic CT 28 16 — — $5,477.46 $24,164.25 $8,657.19 2026-07-15
L5857 HCPCS Elec Knee-shin Swing Only 26 14 — — $4,856.05 $24,090.13 $8,630.65 2026-07-15
D7780 HCPCS Reduct Compnd Facial Bone Fx 13 10 — — $3,361.58 $13,830.45 $8,596.01 2026-07-15
D5915 HCPCS Orbital Prosthesis 10 7 — — $3,421.00 $13,379.12 $8,400.06 2026-07-15
L7190 HCPCS Elbow Adolescent Myoelectron 29 16 — — $4,783.71 $23,067.80 $8,264.38 2026-07-15
L8619 HCPCS Coch Imp Ext Proc/contr Rplc 29 16 — — $12.47 $22,941.43 $8,219.11 2026-07-15
K0891 HCPCS Pwc Gp5 Ped Mult Pow Opt S/b 13 5 — — $86.50 $9,876.92 $8,156.60 2026-07-15
J9219 HCPCS Leuprolide Acetate Implant 12 8 — — $139.84 $16,125.29 $8,025.75 2026-07-15
L8679 HCPCS Imp Neurosti Pls Gn Any Type 31 16 — — $3,626.03 $22,863.29 $7,781.55 2026-07-15
L6920 HCPCS Wrist Disarticul Switch Ctrl 28 16 — — $4,775.54 $21,288.14 $7,626.79 2026-07-15
L8686 HCPCS Implt Nrostm Pls Gen Sng Non 14 9 — — $3,580.22 $17,675.38 $7,558.23 2026-07-15
C9288 HCPCS Inj - Centruroides (scorpion) 3 3 — — $7,549.06 $7,549.06 $7,549.06 2026-07-15
D7947 HCPCS Reconstruct Maxilla Segment 12 10 — — $3,290.98 $11,790.26 $7,540.62 2026-07-15
L6930 HCPCS Below Elbow Switch Control 29 16 — — $4,599.50 $20,755.76 $7,436.05 2026-07-15
A9515 HCPCS Choline C-11 13 10 — — $5,100.00 $52,617.00 $7,395.00 2026-07-15
C1777 HCPCS Lead Aicd Endo Single Coil 7 5 — — $4,324.80 $14,889.48 $7,334.72 2026-07-15
C1785 HCPCS Pmkr Dual Rate-resp 7 5 — — $5,006.88 $14,838.32 $7,309.52 2026-07-15
D7945 HCPCS Bone Cutting Body Mandible 12 10 — — $3,017.71 $11,316.05 $7,166.88 2026-07-15
D7865 HCPCS Tmj Reshaping Components 12 10 — — $2,457.94 $11,754.71 $7,106.32 2026-07-15
A9582 HCPCS Iodine I-123 Iobenguane 17 12 — — $4,594.86 $15,185.20 $7,073.62 2026-07-15
G2170 HCPCS Avf By Tissue W Thermal E 18 12 — — $633.99 $7,056.34 $7,056.34 2026-07-15
L5987 HCPCS Shank Ft W Vert Load Pylon 28 16 — — $4,410.66 $19,711.36 $7,054.83 2026-07-15
L8627 HCPCS Cid Ext Speech Process Repl 25 14 — — $4,038.73 $24,569.04 $7,004.68 2026-07-15
D7941 HCPCS Bone Cutting Ramus Closed 12 10 — — $3,505.12 $10,387.02 $6,946.07 2026-07-15
A9572 HCPCS Indium In-111 Pentetreotide 19 14 — — $6,878.13 $15,979.09 $6,878.13 2026-07-15
S2068 HCPCS Breast Diep Or Siea Flap 8 6 — — $1,476.46 $64,933.75 $6,679.69 2026-07-15
D7490 HCPCS Maxilla Or Mandible Resectio 12 10 — — $3,164.49 $10,133.80 $6,649.15 2026-07-15
J0801 HCPCS Inj. Acthar Gel To 40 Units 2 2 — — $4,313.05 $8,901.61 $6,607.33 2026-07-15
D7943 HCPCS Cutting Ramus Open W/graft 12 10 — — $3,491.30 $9,542.68 $6,516.99 2026-07-15
D7680 HCPCS Reduct Simple Facial Bone Fx 12 10 — — $2,591.78 $10,371.98 $6,481.88 2026-07-15
L7261 HCPCS Electron Wrist Rotator Utah 4 3 — — $6,478.15 $6,478.16 $6,478.15 2026-07-15
A9570 HCPCS Indium In-111 Auto Wbc 11 9 — — $3,647.78 $9,197.92 $6,422.85 2026-07-15
A9571 HCPCS Indium In-111 Auto Platelet 11 9 — — $3,647.78 $9,197.92 $6,422.85 2026-07-15
L8609 HCPCS Artificial Cornea 25 14 — — $3,732.91 $17,852.86 $6,396.05 2026-07-15
A9544 HCPCS I131 Tositumomab - Dx 3 3 — — $6,238.21 $6,238.21 $6,238.21 2026-07-15
G0173 HCPCS Linear Acc Stereo Radsur Com 3 3 — — $6,169.21 $6,169.21 $6,169.21 2026-07-15
L7185 HCPCS Electron Elbow Adolescent Sw 28 16 — — $3,605.17 $17,212.77 $6,160.57 2026-07-15
L7008 HCPCS Pediatric Electric Hand 28 16 — — $3,228.92 $17,097.89 $6,119.47 2026-07-15
S4011 HCPCS Ivf Package 7 5 — — $5,119.94 $12,342.40 $6,080.00 2026-07-15
D5932 HCPCS Postsurgical Obturator 12 10 — — $2,062.30 $9,956.16 $6,009.23 2026-07-15
L5280 HCPCS Hemipelvect Canad Sing Axis 28 16 — — $3,452.14 $16,724.62 $5,985.86 2026-07-15
L5270 HCPCS Tilt Table Locking Hip Sing 28 16 — — $3,551.46 $16,696.25 $5,975.70 2026-07-15
S2095 HCPCS Transcath Emboliz Microspher 10 8 — — $653.75 $11,193.00 $5,923.38 2026-07-15
L7170 HCPCS Electronic Elbow Hosmer Swit 28 16 — — $3,429.16 $16,525.07 $5,914.44 2026-07-15
G3001 HCPCS Admin + Supply - Tositumomab 4 3 — — $5,891.64 $5,891.65 $5,891.65 2026-07-15
J0802 HCPCS Inj. (ani) Up To 40 Units 2 2 — — $3,653.74 $8,066.81 $5,860.27 2026-07-15
L8682 HCPCS Implt Neurostim Radiofq Rec 25 14 — — $3,454.31 $16,335.50 $5,852.43 2026-07-15
L5600 HCPCS Hip Disart Sach Laminat Mold 28 16 — — $2,972.82 $17,088.90 $5,847.59 2026-07-15
L5841 HCPCS Addition Endoskletl Knee-shi 2 2 — — $3,565.85 $8,050.86 $5,808.35 2026-07-15
E0783 HCPCS Programmable Infusion Pump 41 14 — — $408.67 $22,065.66 $5,769.83 2026-07-15
G2072 HCPCS Med Tx Insert/remove Imp 5 4 — — $5,557.24 $5,717.87 $5,717.87 2026-07-15
J0600 HCPCS Edetate Calcium Disodium Inj 27 15 — — $443.79 $14,148.58 $5,708.59 2026-07-15
Q4303 HCPCS Complete Aa Per Sq Cm 2 2 — — $3,469.04 $7,936.43 $5,702.74 2026-07-15
D7944 HCPCS Bone Cutting Segmented 12 10 — — $2,816.51 $8,504.70 $5,660.60 2026-07-15
J9300 HCPCS Gemtuzumab Ozogamicin Inj 3 3 — — $5,567.45 $5,567.45 $5,567.45 2026-07-15
L5250 HCPCS Hip Canad Sing Axi Cons Fric 28 16 — — $3,187.46 $15,551.22 $5,565.90 2026-07-15
L6570 HCPCS Scap Thorac Prosth Tiss Shap 28 16 — — $2,878.67 $15,515.95 $5,553.26 2026-07-15
D5934 HCPCS Mandibular Flange Prosthesis 12 10 — — $2,005.83 $9,074.09 $5,539.96 2026-07-15
D7854 HCPCS Tmj Excisn Of Joint Membrane 12 10 — — $2,570.60 $8,461.20 $5,515.90 2026-07-15
G2070 HCPCS Med Assist Tx Implant 5 4 — — $5,334.18 $5,491.97 $5,491.97 2026-07-15
E0786 HCPCS Implantable Pump Replacement 41 14 — — $398.62 $20,746.90 $5,425.00 2026-07-15
D7852 HCPCS Tmj Repair Of Joint Disc 12 10 — — $2,513.53 $8,200.18 $5,356.85 2026-07-15
K0890 HCPCS Pwc Gp5 Ped Sing Pow Opt S/b 12 5 — — $86.50 $6,035.40 $5,325.35 2026-07-15
T1999 HCPCS Noc Retail Items Andsupplies 5 5 — — $5,314.81 $5,314.81 $5,314.81 2026-07-15
J0716 HCPCS Centruroides Immune F(ab) 14 11 — — $3,495.29 $11,327.06 $5,223.62 2026-07-15
D5954 HCPCS Superimposed Prosthesis 12 10 — — $2,125.84 $8,279.20 $5,202.52 2026-07-15
L5783 HCPCS Add Low Ext Mec Limb Vol Lam 2 2 — — $3,180.95 $7,181.84 $5,181.40 2026-07-15
J9225 HCPCS Vantas Implant 28 17 — — $2,604.57 $9,842.27 $5,166.29 2026-07-15
E0483 HCPCS Hi Freq Chest Wall Oscil Sys 34 12 — — $624.50 $12,677.25 $5,163.75 2026-07-15
L8683 HCPCS Radiofq Trsmtr For Implt Neu 25 14 — — $3,229.16 $14,378.92 $5,151.46 2026-07-15
L5331 HCPCS Hip Disart Canadian Sach Ft 28 16 — — $2,958.13 $14,393.15 $5,151.42 2026-07-15
D7730 HCPCS Open Reduct Compd Mandble Fx 14 11 — — $750.50 $9,533.27 $5,141.89 2026-07-15
A4594 HCPCS Neuromod Adj Rehab Mouthpie 2 2 — — $3,125.46 $7,056.57 $5,091.01 2026-07-15
L5341 HCPCS Hemipelvectomy Canadian Sach 28 16 — — $2,766.97 $14,106.44 $5,048.79 2026-07-15
D5953 HCPCS Adult Speech Aid 12 10 — — $1,143.08 $8,936.69 $5,039.89 2026-07-15
D5936 HCPCS Temp Obturator Prosthesis 12 10 — — $1,091.31 $8,869.07 $4,980.19 2026-07-15
L6300 HCPCS Shlder Disart Int Lock Elbow 28 16 — — $2,784.06 $13,856.65 $4,959.40 2026-07-15
L5595 HCPCS Hip Disartic Sach Thermopls 28 16 — — $2,612.00 $13,803.38 $4,940.33 2026-07-15
E2510 HCPCS Sgd W Multi Methods Msg/accs 44 14 — — $337.84 $21,991.23 $4,934.83 2026-07-15
J0225 HCPCS Inj Vutrisiran 1 Mg 6 4 — — $4,727.70 $11,436.23 $4,930.53 2026-07-15
C1815 HCPCS Pros Urinary Sph Imp 4 3 — — $4,916.51 $4,916.51 $4,916.51 2026-07-15
D5935 HCPCS Mandibular Denture Prosth 12 10 — — $1,929.94 $7,895.46 $4,912.70 2026-07-15
D7876 HCPCS Tmj Arthroscopy Discectomy 12 10 — — $1,353.69 $8,457.76 $4,905.73 2026-07-15
C1731 HCPCS Cath Ep 20 Or More Elec 4 3 — — $4,828.51 $4,828.51 $4,828.51 2026-07-15
E0652 HCPCS Pneum Compres W/cal Pressure 46 16 — — $261.61 $17,225.37 $4,782.10 2026-07-15
D5955 HCPCS Palatal Lift Prosthesis 12 10 — — $1,725.21 $7,659.28 $4,692.24 2026-07-15
L8690 HCPCS Aud Osseo Dev Int/ext Comp 25 14 — — $3,022.77 $13,035.06 $4,670.01 2026-07-15
J9286 HCPCS Inj Glofitamab Gxbm 2.5 Mg 2 2 — — $2,853.69 $6,443.75 $4,648.72 2026-07-15
L6205 HCPCS Elbow Molded With Expand Inter 28 16 — — $2,572.45 $12,860.71 $4,602.94 2026-07-15
A9542 HCPCS In111 Ibritumomab Dx 24 15 — — $2,992.50 $10,625.91 $4,573.87 2026-07-15
D7875 HCPCS Tmj Arthroscopy Synovectomy 12 10 — — $1,283.98 $7,844.87 $4,564.43 2026-07-15
L5961 HCPCS Endo Poly Hip Pneu/hyd/rot 31 16 — — $2,721.75 $15,471.76 $4,563.98 2026-07-15
L5702 HCPCS Replace Socket Hip 28 16 — — $2,734.12 $12,716.86 $4,551.44 2026-07-15
Q4316 HCPCS Amchoplast Per Sq Cm 1 1 — — $4,548.45 $4,548.45 $4,548.45 2026-07-15
E2513 HCPCS Sgd Accessory EMG Sensor 1 1 — — $4,535.03 $4,535.03 $4,535.03 2026-07-15
L5311 HCPCS Knee Disart, Sach Ft, Endo 4 3 — — $4,525.21 $4,525.22 $4,525.21 2026-07-15
D7630 HCPCS Open Red Simpl Mandible Fx 12 10 — — $1,799.63 $7,193.03 $4,496.33 2026-07-15
Q0482 HCPCS Microprcsr Cu Combo Vad Rep 25 14 — — $2,063.52 $12,471.03 $4,467.94 2026-07-15
D6040 HCPCS Odontics Eposteal Implant 9 7 — — $2,504.71 $10,640.08 $4,412.78 2026-07-15
C9724 HCPCS Eps Gast Cardia Plic 5 5 — — $2,126.10 $4,373.35 $4,373.35 2026-07-15
L5980 HCPCS Flex Foot System 28 16 — — $2,029.92 $12,148.67 $4,348.10 2026-07-15
D7877 HCPCS Tmj Arthroscopy Debridement 12 10 — — $1,229.56 $7,464.57 $4,347.06 2026-07-15
S3865 HCPCS Comp Genet Test Hyp Cardiomy 4 3 — — $4,332.95 $4,332.95 $4,332.95 2026-07-15
G0339 HCPCS Robot Lin-radsurg Com First 24 15 — — $2,146.14 $17,200.62 $4,313.66 2026-07-15
C9600 HCPCS Perc Drug-el Cor Stent Sing 8 6 — — $780.00 $9,146.81 $4,277.84 2026-07-15
L5105 HCPCS Plast Socket Jts/thgh Lacer 28 16 — — $2,194.97 $11,876.19 $4,250.57 2026-07-15
L6026 HCPCS Part Hand Myo Exclu Term Dev 25 14 — — $2,426.50 $11,808.14 $4,230.44 2026-07-15
L7259 HCPCS Electronic Wrist Rotator Any 28 16 — — $2,251.79 $11,770.89 $4,212.89 2026-07-15
C9274 HCPCS Crotalidae Poly Immune Fab 3 3 — — $4,208.49 $4,208.49 $4,208.49 2026-07-15
L5160 HCPCS Mold Socket Bent Knee Shin S 28 16 — — $2,679.32 $11,757.84 $4,208.23 2026-07-15
D7860 HCPCS Tmj Cutting Into Joint 12 10 — — $1,076.60 $7,294.92 $4,185.76 2026-07-15
L5200 HCPCS Kne Sing Axis Fric Shin Sach 28 16 — — $1,991.57 $11,692.47 $4,184.82 2026-07-15
D7874 HCPCS Tmj Arthroscopy Disc Reposit 12 10 — — $1,189.55 $7,160.95 $4,175.25 2026-07-15
D7710 HCPCS Maxilla Open Reduct Compound 12 10 — — $1,816.39 $6,500.02 $4,158.20 2026-07-15
L5782 HCPCS Hd Low Limb Pros Vacuum Pump 28 16 — — $2,404.69 $11,558.01 $4,136.69 2026-07-15
J1162 HCPCS Digoxin Immune Fab (ovine) 29 17 — — $2,522.81 $11,790.24 $4,128.19 2026-07-15
S2117 HCPCS Arthroereisis, Subtalar 4 3 — — $4,102.83 $4,102.83 $4,102.83 2026-07-15
D5913 HCPCS Nasal Prosthesis 9 7 — — $2,532.36 $9,887.46 $4,100.51 2026-07-15
Q0495 HCPCS Charger Elec/combo Vad Rep 25 14 — — $1,893.82 $11,445.48 $4,100.51 2026-07-15
D5914 HCPCS Auricular Prosthesis 9 7 — — $2,532.36 $9,887.46 $4,100.51 2026-07-15
L6550 HCPCS Shldr Disar Prosth Tiss Shap 28 16 — — $2,578.60 $11,423.76 $4,088.64 2026-07-15
L6450 HCPCS Elb Disart Prosth Tiss Shap 28 16 — — $1,983.86 $11,269.81 $4,033.55 2026-07-15
J0480 HCPCS Basiliximab 29 17 — — $2,652.77 $10,831.20 $4,029.23 2026-07-15
L2005 HCPCS Kafo Sng/dbl Mechanical Act 28 16 — — $2,012.35 $11,871.42 $4,014.79 2026-07-15
L6881 HCPCS Term Dev Auto Grasp Feature 28 16 — — $2,044.88 $11,202.14 $4,009.32 2026-07-15
Q4279 HCPCS Vendaje Ac Per Sq Cm 2 2 — — $2,456.55 $5,546.32 $4,001.43 2026-07-15
C2622 HCPCS Prosthesis Penile Non-inf 4 3 — — $3,989.95 $3,989.95 $3,989.95 2026-07-15
L5230 HCPCS Fem Focal Defic Constant Fri 28 16 — — $2,082.73 $11,140.52 $3,987.28 2026-07-15
L5781 HCPCS Lower Limb Pros Vacuum Pump 28 16 — — $2,107.31 $10,963.52 $3,923.92 2026-07-15
L6350 HCPCS Thoracic Intern Lock Elbow 28 16 — — $2,535.26 $10,932.78 $3,912.92 2026-07-15
Q4280 HCPCS Xcell Amnio Matrix Per Sq Cm 2 2 — — $2,979.64 $4,791.45 $3,885.55 2026-07-15
J9015 HCPCS Aldesleukin Injection 14 9 — — $2,110.63 $9,245.80 $3,882.97 2026-07-15
D7810 HCPCS Tmj Open Reduct-dislocation 12 10 — — $1,667.55 $6,083.10 $3,875.32 2026-07-15
J0800 HCPCS Corticotropin Injection 27 17 — — $2,950.94 $10,590.64 $3,870.33 2026-07-15
K0014 HCPCS Other Power Whlchr Base 8 3 — — $86.50 $8,971.04 $3,812.69 2026-07-15
D7750 HCPCS Open Red Comp Malar/zygma Fx 12 10 — — $1,693.28 $5,917.98 $3,807.91 2026-07-15
L1681 HCPCS Ho Bilateral Hip Abduction 2 2 — — $2,333.98 $5,269.58 $3,801.78 2026-07-15
L7009 HCPCS Adult Electric Hook 28 16 — — $2,001.39 $10,607.88 $3,796.64 2026-07-15
Q4328 HCPCS Most Per Sq Cm 1 1 — — $3,783.51 $3,783.51 $3,783.51 2026-07-15
E0194 HCPCS Air Fluidized Bed 29 9 — — $1,911.64 $38,806.25 $3,780.69 2026-07-15
L5828 HCPCS Endo Knee-shin Fluid Swg/sta 28 16 — — $1,546.07 $10,509.42 $3,761.40 2026-07-15
L5840 HCPCS Multi-axial Knee/shin System 28 16 — — $2,397.88 $10,340.34 $3,700.89 2026-07-15
L6624 HCPCS Flex/ext/rotation Wrist Unit 28 16 — — $2,146.97 $10,319.45 $3,693.41 2026-07-15
D7856 HCPCS Tmj Cutting Of A Muscle 12 10 — — $1,378.99 $6,004.08 $3,691.53 2026-07-15
Q4298 HCPCS Amnicore Pro Per Sq Cm 2 2 — — $2,289.86 $5,051.95 $3,670.90 2026-07-15
Q4162 HCPCS Wndex Flw Bioskn Flw 0.5cc 11 9 — — $1,870.00 $5,452.16 $3,661.08 2026-07-15
C9601 HCPCS Perc Drug-el Cor Stent Bran 7 5 — — $1,559.20 $5,731.83 $3,645.51 2026-07-15
L5814 HCPCS Endo Knee-shin Hydral Swg Ph 28 16 — — $1,826.95 $10,176.18 $3,642.13 2026-07-15
A0430 HCPCS Fixed Wing Air Transport 12 10 — — $2,520.00 $4,755.24 $3,637.62 2026-07-15
Q4313 HCPCS Dermabind Fm Per Sq Cm 1 1 — — $3,626.31 $3,626.31 $3,626.31 2026-07-15
L7007 HCPCS Adult Electric Hand 28 16 — — $2,298.45 $10,118.95 $3,621.65 2026-07-15
L5701 HCPCS Replace Socket Above Knee 28 16 — — $1,861.53 $10,089.93 $3,611.26 2026-07-15
K0861 HCPCS Pwc Gp3 Std Mult Pow Opt S/b 33 12 — — $423.21 $8,758.70 $3,595.01 2026-07-15
L8035 HCPCS Custom Breast Prosthesis 28 16 — — $2,220.35 $10,038.65 $3,592.91 2026-07-15
L5150 HCPCS Mold Sckt Ext Knee Shin Sach 28 16 — — $2,325.06 $10,026.37 $3,588.51 2026-07-15
L7260 HCPCS Electron Wrist Rotator Otto 4 3 — — $3,586.23 $3,586.24 $3,586.24 2026-07-15
Q0484 HCPCS Monitor Elec Or Comb Vad Rep 25 14 — — $1,650.82 $9,976.91 $3,574.38 2026-07-15
C9756 HCPCS Fluorescence Lymph Map W/icg 5 4 — — $3,573.08 $3,573.08 $3,573.08 2026-07-15
J3398 HCPCS Inj Luxturna 1 Billion Vec G 14 11 — — $2,459.53 $6,584.02 $3,566.00 2026-07-15
L5968 HCPCS Multiaxial Ankle W Dorsiflex 28 16 — — $1,787.62 $9,957.26 $3,563.78 2026-07-15
S2120 HCPCS Low Density Lipoprotein(ldl) 4 3 — — $3,556.29 $3,556.29 $3,556.29 2026-07-15
C1786 HCPCS Pmkr Single Rate-resp 4 3 — — $3,550.50 $3,550.50 $3,550.50 2026-07-15
Q4300 HCPCS Acesso Tl Per Sq Cm 2 2 — — $2,178.14 $4,917.73 $3,547.93 2026-07-15
J9160 HCPCS Denileukin Diftitox Inj 12 8 — — $1,584.06 $5,507.49 $3,545.78 2026-07-15
D7610 HCPCS Maxilla Open Reduct Simple 12 10 — — $1,531.06 $5,530.78 $3,530.92 2026-07-15
C1733 HCPCS Cath Ep Othr Than Cool-tip 4 3 — — $3,520.18 $3,520.18 $3,520.18 2026-07-15
L0830 HCPCS Halo Cerv Into Milwaukee Typ 28 16 — — $1,830.54 $9,813.24 $3,512.23 2026-07-15
L6588 HCPCS Shdr Fair Lead Cable Molded 28 16 — — $2,031.28 $9,742.10 $3,486.77 2026-07-15
L6500 HCPCS Above Elbow Prosth Tiss Shap 28 16 — — $2,168.72 $9,714.29 $3,476.81 2026-07-15
Q4270 HCPCS Complete Sl Per Sq Cm 1 1 — — $3,471.92 $3,471.92 $3,471.92 2026-07-15
L5930 HCPCS High Activity Knee Frame 28 16 — — $1,666.39 $9,688.31 $3,467.52 2026-07-15
L5321 HCPCS Ak Open End Sach 28 16 — — $1,811.20 $9,658.94 $3,457.01 2026-07-15
D8050 HCPCS Intercep Dental Tx Primary 4 4 — — $2,638.05 $4,222.40 $3,430.22 2026-07-15
L8044 HCPCS Hemi-facial Prosthesis 46 16 — — $1,142.38 $11,699.87 $3,392.93 2026-07-15
C1896 HCPCS Lead Aicd Non Sing/dual 4 3 — — $3,375.31 $3,375.31 $3,375.31 2026-07-15
Q9982 HCPCS Flutemetamol F18 Diagnostic 9 7 — — $2,940.32 $8,487.41 $3,366.00 2026-07-15
V5250 HCPCS Hearing Aid Prog Bin Cic 9 6 — — $522.90 $6,168.35 $3,345.62 2026-07-15
V5249 HCPCS Hearing Aid Binaural Itc 11 9 — — $522.90 $6,168.35 $3,345.62 2026-07-15
V5252 HCPCS Hearing Aid Prog Bin Ite 11 9 — — $522.90 $6,168.35 $3,345.62 2026-07-15
C1900 HCPCS Lead Coronary Venous 4 3 — — $3,337.93 $3,337.93 $3,337.93 2026-07-15
S4021 HCPCS Ivf Canc P Aspir Case Rate 8 5 — — $247.58 $5,212.16 $3,336.41 2026-07-15
E0694 HCPCS Uvl Md Cabinet Sys 6 Ft 43 14 — — $260.07 $14,385.22 $3,335.86 2026-07-15
D7991 HCPCS Dental Coronoidectomy 12 10 — — $1,582.25 $5,067.99 $3,325.12 2026-07-15
L6200 HCPCS Elbow Mold Outsid Lock Hinge 28 16 — — $1,967.06 $9,277.47 $3,320.47 2026-07-15
J9371 HCPCS Inj Vincristine Sul Lip 1mg 25 17 — — $2,080.39 $6,071.93 $3,320.42 2026-07-15
L6055 HCPCS Wrst Mold Sock W/exp Interfa 28 16 — — $1,807.55 $9,273.09 $3,318.91 2026-07-15
V5213 HCPCS Hearing Aid Binaural Ite/bte 6 6 — — $3,308.07 $3,308.07 $3,308.07 2026-07-15
V5212 HCPCS Hearing Aid Binaural Ite/itc 6 6 — — $3,308.07 $3,308.07 $3,308.07 2026-07-15
V5215 HCPCS Hearing Aid Binaural Itc/bte 6 6 — — $3,308.07 $3,308.07 $3,308.07 2026-07-15
V5211 HCPCS Hearing Aid Binaural Ite/ite 6 6 — — $3,308.07 $3,308.07 $3,308.07 2026-07-15
L5312 HCPCS Knee Disart Sach Ft Endo 28 14 — — $2,134.97 $11,302.12 $3,298.41 2026-07-15
D6050 HCPCS Odontics Transosteal Implnt 9 7 — — $1,964.06 $7,937.70 $3,291.93 2026-07-15
L5613 HCPCS Ak 4 Bar Ling W/hydraul Swig 28 16 — — $1,389.03 $9,548.91 $3,267.52 2026-07-15
L5981 HCPCS Flex-walk Sys Low Ext Prosth 28 16 — — $1,576.85 $9,047.64 $3,238.22 2026-07-15
L1500 HCPCS Thkao Mobility Frame 3 3 — — $3,218.91 $3,218.91 $3,218.91 2026-07-15
S4023 HCPCS Incompl Donor Egg Case Rate 4 3 — — $3,209.03 $3,209.03 $3,209.03 2026-07-15
L1520 HCPCS Thkao Swivel Walker 4 3 — — $3,191.07 $3,191.08 $3,191.07 2026-07-15
L8043 HCPCS Upper Facial Prosthesis 46 16 — — $1,031.81 $10,567.68 $3,190.24 2026-07-15
L6648 HCPCS Ext Pwrd Shlder Lock/unlock 28 16 — — $1,854.42 $8,913.18 $3,190.10 2026-07-15
Q4310 HCPCS Procenta Per 100 Mg 2 2 — — $1,356.88 $5,011.40 $3,184.14 2026-07-15
L6885 HCPCS Replc Sockt Shldr Dis/interc 28 16 — — $1,966.37 $8,890.34 $3,181.92 2026-07-15
L6360 HCPCS Thoracic Passive Restor Comp 28 16 — — $2,061.63 $8,890.34 $3,181.92 2026-07-15
Q4301 HCPCS Activate Matrix Per Sq Cm 2 2 — — $1,860.53 $4,499.67 $3,180.10 2026-07-15
L0810 HCPCS Halo Cervical Into Jckt Vest 28 16 — — $1,325.54 $8,860.36 $3,171.19 2026-07-15
L5728 HCPCS Knee-shin Fluid Swg & Stance 28 16 — — $1,496.80 $8,855.41 $3,169.41 2026-07-15
Q4341 HCPCS Simplimax Per Sq Cm 1 1 — — $3,163.42 $3,163.42 $3,163.42 2026-07-15
J7352 HCPCS Afamelanotide Implant 1 Mg 10 8 — — $2,996.20 $4,395.95 $3,138.43 2026-07-15
D5931 HCPCS Surgical Obturator 12 10 — — $948.94 $5,323.39 $3,136.16 2026-07-15
S2053 HCPCS Transplantation Of Small Int 4 3 — — $3,135.99 $3,135.99 $3,135.99 2026-07-15
S2054 HCPCS Transplantation Of Multivisc 4 3 — — $3,135.99 $3,135.99 $3,135.99 2026-07-15
C8926 HCPCS Tee W Or Without Fol W/cont Cong 5 4 — — $616.12 $3,135.93 $3,135.93 2026-07-15
C9740 HCPCS Cysto Impl 4 Or More 8 6 — — $2,469.36 $6,989.85 $3,134.68 2026-07-15
L1005 HCPCS Tension Based Scoliosis Orth 28 16 — — $1,698.53 $8,753.00 $3,132.75 2026-07-15
L5826 HCPCS Miniature Knee Joint 28 16 — — $1,924.84 $8,702.56 $3,114.71 2026-07-15
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