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

Northeast Rehabilitation Hospital

Salem, NH · CCN 303026 · Rates published

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You selected G0121 (HCPCS)

Colon ca scrn not hi rsk ind

This hospital’s price: $802 across 2 payers · range $612-$993

Source: https://www.northeastrehab.com/wp-content/uploads/2026/03/02-0369797_northeast-rehabilitation-hospital_standardcharges.csv · observed 2026-04-01

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

6,859 distinct procedures filed
225 distinct payers
129,443 rate rows
2026-04-01 last MRF observed
Data quality

49,301 of 129,443 rate rows are consumer-grade (38.1%)

80,142 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 80,068
placeholder amount (≤ $0.02) — excluded from medians 42
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 32
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.northeastrehab.com/wp-content/uploads/2026/03/02-0369797_northeast-rehabilitation-hospital_standardcharges.csv
Found on page https://www.northeastrehab.com/faqs/our-networks-standard-charges/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-10-01
Content fingerprint 3ebcb16ad98120f3… · 10,117,840 bytes · first seen 2026-06-05

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
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 1 $3,316,462.59 $3,316,462.59 $3,316,462.59 nat. median
$3,325,455
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel 2 $770,620.00 $1,271,523.00 $1,271,523.00 nat. median
$813,967
1.6× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 2 $591,726.20 $954,235.56 $954,235.56 nat. median
$621,313
1.5× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 2 $565,868.94 $913,075.07 $913,075.07 nat. median
$599,737
1.5× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 2 $562,538.19 $893,698.84 $893,698.84 nat. median
$579,571
1.5× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 2 $557,317.93 $893,079.74 $893,079.74 nat. median
$574,037
1.6× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 2 $533,230.17 $879,576.19 $879,576.19 nat. median
$562,501
1.6× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 2 $489,304.61 $808,038.00 $808,038.00 nat. median
$513,770
1.6× median
Q2058
HCPCS 		Obecbtge Autol Up To 400 Mil 2 $278,250.00 $446,118.75 $446,118.75 nat. median
$286,598
1.6× median
91
MS_DRG 		Other Disorders Of Nervous System With Mcc 1 $105,638.10 $105,638.10 $105,638.10 nat. median
$12,760
outlier · 8.3×
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 3 $38,035.21 $92,310.85 $92,310.85 nat. median
$63,499
1.5× median
J9226
HCPCS 		Supprelin La Implant 3 $26,164.11 $75,174.64 $75,174.64 nat. median
$57,036
1.3× median
J9266
HCPCS 		Pegaspargase Injection 3 $14,275.20 $46,899.70 $46,899.70 nat. median
$31,084
1.5× median
682
MS_DRG 		Renal Failure With Mcc 2 $23,114.00 $65,835.00 $44,474.50 nat. median
$11,096
outlier · 4.0×
J9600
HCPCS 		Porfimer Sodium Injection 3 $3,004.74 $39,976.89 $39,976.89 nat. median
$26,416
1.5× median
54
MS_DRG 		Nervous System Neoplasms With Mcc 1 $35,212.70 $35,212.70 $35,212.70 nat. median
$10,939
outlier · 3.2×
38240
HCPCS 		Transplt Allo Hct/donor 2 $2,888.70 $67,163.09 $35,025.89 nat. median
$28,331
1.2× median
J7330
HCPCS 		Cultured Chondrocytes Implnt 1 $31,905.54 $31,905.54 $31,905.54 nat. median
$92,809
outlier · 0.3×
64568
HCPCS 		Inc For Vagus N Elect Impl 2 $16,677.91 $47,030.92 $31,854.42 nat. median
$27,905
1.1× median
95
MS_DRG 		Bacterial And Tuberculous Infections Of Nervous System With Cc 1 $27,799.50 $27,799.50 $27,799.50 nat. median
$17,673
1.6× median
92
MS_DRG 		Other Disorders Of Nervous System With Cc 1 $27,705.85 $27,705.85 $27,705.85 nat. median
$7,741
outlier · 3.6×
948
MS_DRG 		Signs And Symptoms Without Mcc 2 $19,057.50 $36,080.00 $27,568.75 nat. median
$5,562
outlier · 5.0×
69930
HCPCS 		Implant Cochlear Device 2 $19,712.47 $35,206.20 $27,459.33 nat. median
$23,645
1.2× median
33249
HCPCS 		Insj/rplcmt Defib W/lead(s) 2 $19,942.01 $33,515.67 $26,728.84 nat. median
$32,069
0.8× median
94
MS_DRG 		Bacterial And Tuberculous Infections Of Nervous System With Mcc 1 $25,987.50 $25,987.50 $25,987.50 nat. median
$24,752
1.0× median
57
MS_DRG 		Degenerative Nervous System Disorders Without Mcc 6 $16,341.00 $53,880.00 $25,252.53 nat. median
$8,924
outlier · 2.8×
565
MS_DRG 		Other Musculoskeletal System And Connective Tissue Diagnoses With Cc 1 $24,892.00 $24,892.00 $24,892.00 nat. median
$7,411
outlier · 3.4×
33231
HCPCS 		Insrt Pulse Gen W/mult Leads 2 $14,632.83 $33,515.67 $24,074.25 nat. median
$31,377
0.8× median
33270
HCPCS 		Ins/rep Subq Defibrillator 2 $14,632.83 $33,515.67 $24,074.25 nat. median
$32,475
0.7× median
33264
HCPCS 		Rmvl & Rplcmt Dfb Gen Mlt Ld 2 $14,632.83 $33,515.67 $24,074.25 nat. median
$32,779
0.7× median
56
MS_DRG 		Degenerative Nervous System Disorders With Mcc 4 $16,865.09 $32,186.00 $23,743.60 nat. median
$14,194
1.7× median
61886
HCPCS 		Implant Neurostim Arrays 2 $13,391.46 $32,948.52 $23,169.99 nat. median
$23,007
1.0× median
73
MS_DRG 		Cranial And Peripheral Nerve Disorders With Mcc 1 $22,239.60 $22,239.60 $22,239.60 nat. median
$11,281
2.0× median
63685
HCPCS 		Insrt/redo Spine N Generator 2 $10,656.57 $32,948.52 $21,802.54 nat. median
$21,812
1.0× median
61885
HCPCS 		Insrt/redo Neurostim 1 Array 2 $10,656.57 $32,948.52 $21,802.54 nat. median
$18,802
1.2× median
J1412
HCPCS 		Inj Roctavian Ml 2x10^13vc G 2 $12,553.71 $20,407.55 $20,407.55 nat. median
$13,181
1.5× median
292
MS_DRG 		Heart Failure And Shock With Cc 1 $20,386.30 $20,386.30 $20,386.30 nat. median
$6,415
outlier · 3.2×
60
MS_DRG 		Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc 1 $20,386.30 $20,386.30 $20,386.30 nat. median
$6,744
outlier · 3.0×
G0448
HCPCS 		Place Perm Pacing Cardiovert 1 $19,942.01 $19,942.01 $19,942.01 nat. median
$14,452
1.4× median
93656
HCPCS 		Tx Atrial Fib Pulm Vein Isol 2 $11,145.72 $27,908.87 $19,527.29 nat. median
$26,469
0.7× median
93653
HCPCS 		Ep & Ablate Supravent Arrhyt 2 $11,145.72 $27,908.87 $19,527.29 nat. median
$25,502
0.8× median
93654
HCPCS 		Ep & Ablate Ventric Tachy 2 $11,145.72 $27,908.87 $19,527.29 nat. median
$26,477
0.7× median
33262
HCPCS 		Rmvl& Replc Pulse Gen 1 Lead 2 $14,632.83 $23,750.73 $19,191.78 nat. median
$23,514
0.8× median
33230
HCPCS 		Insrt Pulse Gen W/dual Leads 2 $14,632.83 $23,750.73 $19,191.78 nat. median
$23,060
0.8× median
33240
HCPCS 		Insrt Pulse Gen W/singl Lead 2 $14,632.83 $23,750.73 $19,191.78 nat. median
$23,398
0.8× median
33263
HCPCS 		Rmvl & Rplcmt Dfb Gen 2 Lead 2 $14,632.83 $23,750.73 $19,191.78 nat. median
$23,924
0.8× median
205
MS_DRG 		Other Respiratory System Diagnoses With Mcc 1 $17,325.00 $17,325.00 $17,325.00 nat. median
$13,001
1.3× median
841
MS_DRG 		Lymphoma And Non-acute Leukemia With Cc 1 $17,325.00 $17,325.00 $17,325.00 nat. median
$11,732
1.5× median
J7310
HCPCS 		Ganciclovir Long Act Implant 1 $16,960.00 $16,960.00 $16,960.00 nat. median
$13,629
1.2× median
21243
HCPCS 		Reconstruction Of Jaw Joint 2 $3,278.89 $28,972.53 $16,125.71 nat. median
$11,266
1.4× median

Other procedures at this hospital

Browse this hospital's 6,859 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
             
J1413 HCPCS Inj Delandistrogene Mox Rokl 3 1 — — $3,316,462.59 $3,316,462.59 $3,316,462.59 2026-04-01
Q2057 HCPCS Afamitresgene Autoleucel 12 2 — — $770,620.00 $1,271,523.00 $1,271,523.00 2026-04-01
Q2042 HCPCS Tisagenlecleucel Car-pos T 12 2 — — $591,726.20 $954,235.56 $954,235.56 2026-04-01
Q2056 HCPCS Ciltacabtagene Car-pos T 12 2 — — $565,868.94 $913,075.07 $913,075.07 2026-04-01
Q2054 HCPCS Lisocabtagene Mara Car Pos T 12 2 — — $562,538.19 $893,698.84 $893,698.84 2026-04-01
Q2055 HCPCS Idecabtagene Vicleucel Car 12 2 — — $557,317.93 $893,079.74 $893,079.74 2026-04-01
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 12 2 — — $533,230.17 $879,576.19 $879,576.19 2026-04-01
Q2053 HCPCS Brexucabtagene Car Pos T 12 2 — — $489,304.61 $808,038.00 $808,038.00 2026-04-01
Q2058 HCPCS Obecbtge Autol Up To 400 Mil 12 2 — — $278,250.00 $446,118.75 $446,118.75 2026-04-01
91 MS_DRG Other Disorders Of Nervous System With Mcc 3 1 — — $105,638.10 $105,638.10 $105,638.10 2026-04-01
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 15 3 — — $38,035.21 $92,310.85 $92,310.85 2026-04-01
J9226 HCPCS Supprelin La Implant 15 3 — — $26,164.11 $75,174.64 $75,174.64 2026-04-01
J9266 HCPCS Pegaspargase Injection 15 3 — — $14,275.20 $46,899.70 $46,899.70 2026-04-01
682 MS_DRG Renal Failure With Mcc 6 2 — — $23,114.00 $65,835.00 $44,474.50 2026-04-01
J9600 HCPCS Porfimer Sodium Injection 15 3 — — $3,004.74 $39,976.89 $39,976.89 2026-04-01
54 MS_DRG Nervous System Neoplasms With Mcc 3 1 — — $35,212.70 $35,212.70 $35,212.70 2026-04-01
38240 HCPCS Transplt Allo Hct/donor 6 2 — — $2,888.70 $67,163.09 $35,025.89 2026-04-01
J7330 HCPCS Cultured Chondrocytes Implnt 3 1 — — $31,905.54 $31,905.54 $31,905.54 2026-04-01
64568 HCPCS Inc For Vagus N Elect Impl 6 2 — — $16,677.91 $47,030.92 $31,854.42 2026-04-01
95 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Cc 3 1 — — $27,799.50 $27,799.50 $27,799.50 2026-04-01
92 MS_DRG Other Disorders Of Nervous System With Cc 3 1 — — $27,705.85 $27,705.85 $27,705.85 2026-04-01
948 MS_DRG Signs And Symptoms Without Mcc 6 2 — — $19,057.50 $36,080.00 $27,568.75 2026-04-01
69930 HCPCS Implant Cochlear Device 6 2 — — $19,712.47 $35,206.20 $27,459.33 2026-04-01
33249 HCPCS Insj/rplcmt Defib W/lead(s) 6 2 — — $19,942.01 $33,515.67 $26,728.84 2026-04-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 3 1 — — $25,987.50 $25,987.50 $25,987.50 2026-04-01
57 MS_DRG Degenerative Nervous System Disorders Without Mcc 18 6 — — $16,341.00 $53,880.00 $25,252.53 2026-04-01
565 MS_DRG Other Musculoskeletal System And Connective Tissue Diagnoses With Cc 3 1 — — $24,892.00 $24,892.00 $24,892.00 2026-04-01
33264 HCPCS Rmvl & Rplcmt Dfb Gen Mlt Ld 6 2 — — $14,632.83 $33,515.67 $24,074.25 2026-04-01
33270 HCPCS Ins/rep Subq Defibrillator 6 2 — — $14,632.83 $33,515.67 $24,074.25 2026-04-01
33231 HCPCS Insrt Pulse Gen W/mult Leads 6 2 — — $14,632.83 $33,515.67 $24,074.25 2026-04-01
56 MS_DRG Degenerative Nervous System Disorders With Mcc 12 4 — — $16,865.09 $32,186.00 $23,743.60 2026-04-01
61886 HCPCS Implant Neurostim Arrays 6 2 — — $13,391.46 $32,948.52 $23,169.99 2026-04-01
73 MS_DRG Cranial And Peripheral Nerve Disorders With Mcc 3 1 — — $22,239.60 $22,239.60 $22,239.60 2026-04-01
63685 HCPCS Insrt/redo Spine N Generator 6 2 — — $10,656.57 $32,948.52 $21,802.54 2026-04-01
61885 HCPCS Insrt/redo Neurostim 1 Array 6 2 — — $10,656.57 $32,948.52 $21,802.54 2026-04-01
J1412 HCPCS Inj Roctavian Ml 2x10^13vc G 12 2 — — $12,553.71 $20,407.55 $20,407.55 2026-04-01
292 MS_DRG Heart Failure And Shock With Cc 3 1 — — $20,386.30 $20,386.30 $20,386.30 2026-04-01
60 MS_DRG Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc 3 1 — — $20,386.30 $20,386.30 $20,386.30 2026-04-01
G0448 HCPCS Place Perm Pacing Cardiovert 3 1 — — $19,942.01 $19,942.01 $19,942.01 2026-04-01
93656 HCPCS Tx Atrial Fib Pulm Vein Isol 6 2 — — $11,145.72 $27,908.87 $19,527.29 2026-04-01
93654 HCPCS Ep & Ablate Ventric Tachy 6 2 — — $11,145.72 $27,908.87 $19,527.29 2026-04-01
93653 HCPCS Ep & Ablate Supravent Arrhyt 6 2 — — $11,145.72 $27,908.87 $19,527.29 2026-04-01
33263 HCPCS Rmvl & Rplcmt Dfb Gen 2 Lead 6 2 — — $14,632.83 $23,750.73 $19,191.78 2026-04-01
33262 HCPCS Rmvl& Replc Pulse Gen 1 Lead 6 2 — — $14,632.83 $23,750.73 $19,191.78 2026-04-01
33240 HCPCS Insrt Pulse Gen W/singl Lead 6 2 — — $14,632.83 $23,750.73 $19,191.78 2026-04-01
33230 HCPCS Insrt Pulse Gen W/dual Leads 6 2 — — $14,632.83 $23,750.73 $19,191.78 2026-04-01
205 MS_DRG Other Respiratory System Diagnoses With Mcc 3 1 — — $17,325.00 $17,325.00 $17,325.00 2026-04-01
841 MS_DRG Lymphoma And Non-acute Leukemia With Cc 3 1 — — $17,325.00 $17,325.00 $17,325.00 2026-04-01
J7310 HCPCS Ganciclovir Long Act Implant 3 1 — — $16,960.00 $16,960.00 $16,960.00 2026-04-01
21243 HCPCS Reconstruction Of Jaw Joint 6 2 — — $3,278.89 $28,972.53 $16,125.71 2026-04-01
291 MS_DRG Heart Failure And Shock With Mcc 6 2 — — $14,826.40 $17,325.00 $16,075.70 2026-04-01
93581 HCPCS Transcath Closure Of Vsd 6 2 — — $11,974.67 $19,573.73 $15,774.20 2026-04-01
93582 HCPCS Perq Transcath Closure Pda 6 2 — — $11,974.67 $19,573.73 $15,774.20 2026-04-01
93580 HCPCS Transcath Closure Of Asd 6 2 — — $11,974.67 $19,573.73 $15,774.20 2026-04-01
64590 HCPCS Insrt/redo Pn/gastr Stimul 6 2 — — $10,656.57 $20,714.60 $15,685.58 2026-04-01
20696 HCPCS Comp Multiplane Ext Fixation 6 2 — — $2,306.77 $28,972.53 $15,639.65 2026-04-01
372 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Cc 3 1 — — $15,592.50 $15,592.50 $15,592.50 2026-04-01
53445 HCPCS Insert Uro/ves Nck Sphincter 6 2 — — $8,134.72 $22,130.46 $15,132.59 2026-04-01
54405 HCPCS Insert Multi-comp Penis Pros 6 2 — — $8,134.72 $22,130.46 $15,132.59 2026-04-01
54401 HCPCS Insert Self-contd Prosthesis 6 2 — — $8,134.72 $22,130.46 $15,132.59 2026-04-01
54410 HCPCS Remove/replace Penis Prosth 6 2 — — $8,134.72 $22,130.46 $15,132.59 2026-04-01
53447 HCPCS Remove/replace Ur Sphincter 6 2 — — $8,134.72 $22,130.46 $15,132.59 2026-04-01
54416 HCPCS Remv/repl Penis Contain Pros 6 2 — — $8,134.72 $22,130.46 $15,132.59 2026-04-01
53444 HCPCS Insert Tandem Cuff 6 2 — — $7,635.32 $22,130.46 $14,882.89 2026-04-01
99 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc 3 1 — — $14,826.40 $14,826.40 $14,826.40 2026-04-01
74 MS_DRG Cranial And Peripheral Nerve Disorders Without Mcc 6 2 — — $12,628.00 $16,824.00 $14,726.00 2026-04-01
37227 HCPCS Fem/popl Revasc Stnt & Ather 3 1 — — $14,596.24 $14,596.24 $14,596.24 2026-04-01
37231 HCPCS Tib/per Revasc Stent & Ather 3 1 — — $14,596.24 $14,596.24 $14,596.24 2026-04-01
62362 HCPCS Implant Spine Infusion Pump 6 2 — — $9,172.31 $19,245.09 $14,208.70 2026-04-01
62361 HCPCS Implant Spine Infusion Pump 6 2 — — $9,172.31 $19,245.09 $14,208.70 2026-04-01
25442 HCPCS Reconstruct Wrist Joint 6 2 — — $9,601.88 $18,721.85 $14,161.86 2026-04-01
25446 HCPCS Wrist Replacement 6 2 — — $9,601.88 $18,721.85 $14,161.86 2026-04-01
24371 HCPCS Revise Reconst Elbow Joint 6 2 — — $9,601.88 $18,721.85 $14,161.86 2026-04-01
24361 HCPCS Reconstruct Elbow Joint 6 2 — — $9,601.88 $18,721.85 $14,161.86 2026-04-01
24363 HCPCS Replace Elbow Joint 6 2 — — $9,601.88 $18,721.85 $14,161.86 2026-04-01
27279 HCPCS Arthrodesis Sacroiliac Joint 6 2 — — $9,601.88 $18,721.85 $14,161.86 2026-04-01
64580 HCPCS Implant Neuroelectrodes 6 2 — — $6,792.04 $20,714.60 $13,753.32 2026-04-01
63655 HCPCS Implant Neuroelectrodes 6 2 — — $6,792.04 $20,714.60 $13,753.32 2026-04-01
C9602 HCPCS Perc D-e Cor Stent Ather S 6 2 — — $7,763.18 $19,573.73 $13,668.45 2026-04-01
C9607 HCPCS Perc D-e Cor Revasc Chro Sin 6 2 — — $7,763.18 $19,573.73 $13,668.45 2026-04-01
37242 HCPCS Vasc Embolize/occlude Artery 6 2 — — $7,671.18 $19,573.73 $13,622.45 2026-04-01
96 MS_DRG Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc 3 1 — — $12,973.10 $12,973.10 $12,973.10 2026-04-01
189 MS_DRG Pulmonary Edema And Respiratory Failure 3 1 — — $12,973.10 $12,973.10 $12,973.10 2026-04-01
92933 HCPCS Prq Card Stent/ath/angio 6 2 — — $6,110.44 $19,573.73 $12,842.08 2026-04-01
33221 HCPCS Insert Pulse Gen Mult Leads 6 2 — — $5,014.56 $20,566.80 $12,790.68 2026-04-01
33229 HCPCS Remv&replc Pm Gen Mult Leads 6 2 — — $5,014.56 $20,566.80 $12,790.68 2026-04-01
52 MS_DRG Spinal Disorders And Injuries With Cc/Mcc 3 1 — — $12,375.00 $12,375.00 $12,375.00 2026-04-01
65770 HCPCS Revise Cornea With Implant 6 2 — — $8,797.39 $15,488.99 $12,143.19 2026-04-01
23616 HCPCS Treat Humerus Fracture 6 2 — — $5,040.30 $18,721.85 $11,881.08 2026-04-01
25441 HCPCS Reconstruct Wrist Joint 6 2 — — $9,601.88 $13,708.59 $11,655.24 2026-04-01
23473 HCPCS Revis Reconst Shoulder Joint 6 2 — — $9,601.88 $13,708.59 $11,655.24 2026-04-01
27446 HCPCS Revision Of Knee Joint 6 2 — — $9,601.88 $13,708.59 $11,655.24 2026-04-01
69714 HCPCS Implant Temple Bone W/Stimul 6 2 — — $9,601.88 $13,708.59 $11,655.24 2026-04-01
24366 HCPCS Reconstruct Head Of Radius 6 2 — — $9,601.88 $13,708.59 $11,655.24 2026-04-01
24370 HCPCS Revise Reconst Elbow Joint 6 2 — — $9,601.88 $13,708.59 $11,655.24 2026-04-01
23470 HCPCS Reconstruct Shoulder Joint 6 2 — — $9,601.88 $13,708.59 $11,655.24 2026-04-01
28705 HCPCS Fusion Of Foot Bones 6 2 — — $4,327.81 $18,721.85 $11,524.83 2026-04-01
949 MS_DRG Aftercare With Cc/Mcc 9 3 — — $11,119.80 $21,648.00 $11,382.00 2026-04-01
947 MS_DRG Signs And Symptoms With Mcc 9 3 — — $2,597.08 $22,522.50 $11,340.00 2026-04-01
37184 HCPCS Prim Art M-thrmbc 1st Vsl 6 2 — — $3,100.23 $19,573.73 $11,336.98 2026-04-01
62360 HCPCS Insert Spine Infusion Device 6 2 — — $3,251.09 $19,245.09 $11,248.09 2026-04-01
22612 HCPCS Lumbar Spine Fusion 6 2 — — $3,758.59 $18,721.85 $11,240.22 2026-04-01
22856 HCPCS Cerv Artific Diskectomy 6 2 — — $3,758.59 $18,721.85 $11,240.22 2026-04-01
20982 HCPCS Ablate Bone Tumor(s) Perq 6 2 — — $3,437.59 $18,721.85 $11,079.72 2026-04-01
53440 HCPCS Male Sling Procedure 6 2 — — $7,635.32 $14,087.40 $10,861.36 2026-04-01
54400 HCPCS Insert Semi-rigid Prosthesis 6 2 — — $7,635.32 $14,087.40 $10,861.36 2026-04-01
950 MS_DRG Aftercare Without Cc/Mcc 9 3 — — $8,890.00 $14,826.40 $10,800.00 2026-04-01
J0600 HCPCS Edetate Calcium Disodium Inj 15 3 — — $5,594.42 $10,650.04 $10,650.04 2026-04-01
37236 HCPCS Open/perq Place Stent 1st 6 2 — — $8,656.82 $12,326.39 $10,491.60 2026-04-01
37238 HCPCS Open/perq Place Stent Same 6 2 — — $8,656.82 $12,326.39 $10,491.60 2026-04-01
47371 HCPCS Laparo Ablate Liver Cryosurg 6 2 — — $9,080.63 $11,350.08 $10,215.35 2026-04-01
47370 HCPCS Laparo Ablate Liver Tumor Rf 6 2 — — $9,080.63 $11,350.08 $10,215.35 2026-04-01
50542 HCPCS Laparo Ablate Renal Mass 6 2 — — $9,080.63 $11,350.08 $10,215.35 2026-04-01
C9604 HCPCS Perc D-e Cor Revasc T Cabg S 6 2 — — $7,763.18 $12,326.39 $10,044.78 2026-04-01
C9600 HCPCS Perc Drug-el Cor Stent Sing 6 2 — — $7,763.18 $12,326.39 $10,044.78 2026-04-01
61626 HCPCS Transcath Occlusion Non-cns 6 2 — — $7,671.18 $12,326.39 $9,998.78 2026-04-01
61623 HCPCS Endovasc Tempory Vessel Occl 6 2 — — $7,671.18 $12,326.39 $9,998.78 2026-04-01
37241 HCPCS Vasc Embolize/occlude Venous 6 2 — — $7,671.18 $12,326.39 $9,998.78 2026-04-01
92924 HCPCS Prq Card Angio/athrect 1 Art 6 2 — — $7,671.18 $12,326.39 $9,998.78 2026-04-01
37243 HCPCS Vasc Embolize/occlude Organ 6 2 — — $7,671.18 $12,326.39 $9,998.78 2026-04-01
37244 HCPCS Vasc Embolize/occlude Bleed 6 2 — — $7,671.18 $12,326.39 $9,998.78 2026-04-01
24498 HCPCS Reinforce Humerus 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
27429 HCPCS Reconstruction Knee 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
24435 HCPCS Repair Humerus With Graft 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
24802 HCPCS Fusion/graft Of Elbow Joint 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
27428 HCPCS Reconstruction Knee 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
24346 HCPCS Reconstruct Elbow Med Ligmnt 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
24430 HCPCS Repair Of Humerus 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
25365 HCPCS Revise Radius & Ulna 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
29889 HCPCS Knee Arthroscopy/surgery 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
23802 HCPCS Fusion Of Shoulder Joint 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
25391 HCPCS Lengthen Radius Or Ulna 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
25810 HCPCS Fusion/graft Of Wrist Joint 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
27871 HCPCS Fusion Of Tibiofibular Joint 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
23491 HCPCS Reinforce Shoulder Bones 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
23485 HCPCS Revision Of Collar Bone 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
27415 HCPCS Osteochondral Knee Allograft 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
27870 HCPCS Fusion Of Ankle Joint Open 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
28715 HCPCS Fusion Of Foot Bones 6 2 — — $5,862.48 $13,708.59 $9,785.53 2026-04-01
197 MS_DRG Interstitial Lung Disease With Cc 3 1 — — $9,729.83 $9,729.83 $9,729.83 2026-04-01
19357 HCPCS Breast Reconstruction 6 2 — — $4,562.00 $14,714.70 $9,638.35 2026-04-01
19298 HCPCS Place Breast Rad Tube/caths 6 2 — — $4,562.00 $14,714.70 $9,638.35 2026-04-01
69718 HCPCS Revise Temple Bone Implant 3 1 — — $9,601.88 $9,601.88 $9,601.88 2026-04-01
69715 HCPCS Temple Bne Implnt W/Stimulat 3 1 — — $9,601.88 $9,601.88 $9,601.88 2026-04-01
27828 HCPCS Treat Lower Leg Fracture 6 2 — — $5,040.30 $13,708.59 $9,374.44 2026-04-01
24516 HCPCS Treat Humerus Fracture 6 2 — — $5,040.30 $13,708.59 $9,374.44 2026-04-01
24515 HCPCS Treat Humerus Fracture 6 2 — — $5,040.30 $13,708.59 $9,374.44 2026-04-01
24546 HCPCS Treat Humerus Fracture 6 2 — — $5,040.30 $13,708.59 $9,374.44 2026-04-01
27827 HCPCS Treat Lower Leg Fracture 6 2 — — $5,040.30 $13,708.59 $9,374.44 2026-04-01
27759 HCPCS Treatment Of Tibia Fracture 6 2 — — $5,040.30 $13,708.59 $9,374.44 2026-04-01
24575 HCPCS Treat Humerus Fracture 6 2 — — $5,040.30 $13,708.59 $9,374.44 2026-04-01
24579 HCPCS Treat Humerus Fracture 6 2 — — $5,040.30 $13,708.59 $9,374.44 2026-04-01
24666 HCPCS Treat Radius Fracture 6 2 — — $5,040.30 $13,708.59 $9,374.44 2026-04-01
23615 HCPCS Treat Humerus Fracture 6 2 — — $5,040.30 $13,708.59 $9,374.44 2026-04-01
24545 HCPCS Treat Humerus Fracture 6 2 — — $5,040.30 $13,708.59 $9,374.44 2026-04-01
24587 HCPCS Treat Elbow Fracture 6 2 — — $5,040.30 $13,708.59 $9,374.44 2026-04-01
24586 HCPCS Treat Elbow Fracture 6 2 — — $5,040.30 $13,708.59 $9,374.44 2026-04-01
64575 HCPCS Implant Neuroelectrodes 6 2 — — $6,792.04 $11,897.69 $9,344.86 2026-04-01
43647 HCPCS Lap Impl Electrode Antrum 6 2 — — $6,792.04 $11,897.69 $9,344.86 2026-04-01
92943 HCPCS Prq Card Revasc Chronic 1vsl 6 2 — — $6,110.44 $12,326.39 $9,218.41 2026-04-01
92937 HCPCS Prq Revasc Byp Graft 1 Vsl 6 2 — — $6,110.44 $12,326.39 $9,218.41 2026-04-01
92928 HCPCS Prq Card Stent W/angio 1 Vsl 6 2 — — $6,110.44 $12,326.39 $9,218.41 2026-04-01
C9737 HCPCS Lap Esoph Augmentation 3 1 — — $9,080.63 $9,080.63 $9,080.63 2026-04-01
25444 HCPCS Reconstruct Wrist Joint 6 2 — — $4,450.11 $13,708.59 $9,079.35 2026-04-01
27438 HCPCS Revise Kneecap With Implant 6 2 — — $4,450.11 $13,708.59 $9,079.35 2026-04-01
24362 HCPCS Reconstruct Elbow Joint 6 2 — — $4,450.11 $13,708.59 $9,079.35 2026-04-01
28320 HCPCS Repair Of Foot Bones 6 2 — — $4,327.81 $13,708.59 $9,018.20 2026-04-01
28737 HCPCS Revision Of Foot Bones 6 2 — — $4,327.81 $13,708.59 $9,018.20 2026-04-01
28730 HCPCS Fusion Of Foot Bones 6 2 — — $4,327.81 $13,708.59 $9,018.20 2026-04-01
28735 HCPCS Fusion Of Foot Bones 6 2 — — $4,327.81 $13,708.59 $9,018.20 2026-04-01
28725 HCPCS Fusion Of Foot Bones 6 2 — — $4,327.81 $13,708.59 $9,018.20 2026-04-01
55873 HCPCS Cryoablate Prostate 6 2 — — $7,825.08 $10,107.88 $8,966.48 2026-04-01
67027 HCPCS Implant Eye Drug System 6 2 — — $2,913.76 $14,898.36 $8,906.06 2026-04-01
33224 HCPCS Insert Pacing Lead & Connect 6 2 — — $6,621.28 $11,160.19 $8,890.74 2026-04-01
33214 HCPCS Upgrade Of Pacemaker System 6 2 — — $6,621.28 $11,160.19 $8,890.74 2026-04-01
33208 HCPCS Insrt Heart Pm Atrial & Vent 6 2 — — $6,621.28 $11,160.19 $8,890.74 2026-04-01
29907 HCPCS Subtalar Arthro W/fusion 6 2 — — $3,880.22 $13,708.59 $8,794.41 2026-04-01
29856 HCPCS Tibial Arthroscopy/surgery 6 2 — — $3,880.22 $13,708.59 $8,794.41 2026-04-01
29867 HCPCS Allgrft Implnt Knee W/scope 6 2 — — $3,880.22 $13,708.59 $8,794.41 2026-04-01
J9015 HCPCS Aldesleukin Injection 15 3 — — $990.88 $8,747.08 $8,747.08 2026-04-01
28420 HCPCS Treat/graft Heel Fracture 6 2 — — $3,763.94 $13,708.59 $8,736.26 2026-04-01
27758 HCPCS Treatment Of Tibia Fracture 6 2 — — $3,763.94 $13,708.59 $8,736.26 2026-04-01
23680 HCPCS Treat Dislocation/fracture 6 2 — — $3,763.94 $13,708.59 $8,736.26 2026-04-01
22551 HCPCS Neck Spine Fuse&remov Bel C2 6 2 — — $3,758.59 $13,708.59 $8,733.59 2026-04-01
22554 HCPCS Neck Spine Fusion 6 2 — — $3,758.59 $13,708.59 $8,733.59 2026-04-01
69717 HCPCS Temple Bone Implant Revision 6 2 — — $7,747.87 $9,601.88 $8,674.88 2026-04-01
37226 HCPCS Fem/popl Revasc W/stent 3 1 — — $8,656.82 $8,656.82 $8,656.82 2026-04-01
37229 HCPCS Tib/per Revasc W/ather 3 1 — — $8,656.82 $8,656.82 $8,656.82 2026-04-01
37225 HCPCS Fem/popl Revas W/ather 3 1 — — $8,656.82 $8,656.82 $8,656.82 2026-04-01
37230 HCPCS Tib/per Revasc W/stent 3 1 — — $8,656.82 $8,656.82 $8,656.82 2026-04-01
37233 HCPCS Tibper Revasc W/ather Add-on 3 1 — — $8,656.82 $8,656.82 $8,656.82 2026-04-01
37237 HCPCS Open/perq Place Stent Ea Add 3 1 — — $8,656.82 $8,656.82 $8,656.82 2026-04-01
37221 HCPCS Iliac Revasc W/stent 3 1 — — $8,656.82 $8,656.82 $8,656.82 2026-04-01
37239 HCPCS Open/perq Place Stent Ea Add 3 1 — — $8,656.82 $8,656.82 $8,656.82 2026-04-01
24410 HCPCS Revision Of Humerus 6 2 — — $3,437.59 $13,708.59 $8,573.09 2026-04-01
25491 HCPCS Reinforce Ulna 6 2 — — $3,437.59 $13,708.59 $8,573.09 2026-04-01
24365 HCPCS Reconstruct Head Of Radius 6 2 — — $2,868.01 $13,708.59 $8,288.30 2026-04-01
27443 HCPCS Revision Of Knee Joint 6 2 — — $2,868.01 $13,708.59 $8,288.30 2026-04-01
27442 HCPCS Revision Of Knee Joint 6 2 — — $2,868.01 $13,708.59 $8,288.30 2026-04-01
27440 HCPCS Revision Of Knee Joint 6 2 — — $2,868.01 $13,708.59 $8,288.30 2026-04-01
27441 HCPCS Revision Of Knee Joint 6 2 — — $2,868.01 $13,708.59 $8,288.30 2026-04-01
J7504 HCPCS Lymphocyte Immune Globulin 15 3 — — $1,289.76 $8,271.63 $8,271.63 2026-04-01
33206 HCPCS Insert Heart Pm Atrial 6 2 — — $5,349.59 $11,160.19 $8,254.89 2026-04-01
33207 HCPCS Insert Heart Pm Ventricular 6 2 — — $5,349.59 $11,160.19 $8,254.89 2026-04-01
58544 HCPCS Lsh W/t/o Uterus Above 250 G 6 2 — — $5,121.39 $11,350.08 $8,235.74 2026-04-01
58541 HCPCS Lsh Uterus 250 G Or Less 6 2 — — $5,121.39 $11,350.08 $8,235.74 2026-04-01
43281 HCPCS Lap Paraesophag Hern Repair 6 2 — — $5,121.39 $11,350.08 $8,235.74 2026-04-01
58542 HCPCS Lsh W/t/o Ut 250 G Or Less 6 2 — — $5,121.39 $11,350.08 $8,235.74 2026-04-01
38571 HCPCS Laparoscopy Lymphadenectomy 6 2 — — $5,121.39 $11,350.08 $8,235.74 2026-04-01
58543 HCPCS Lsh Uterus Above 250 G 6 2 — — $5,121.39 $11,350.08 $8,235.74 2026-04-01
43280 HCPCS Laparoscopy Fundoplasty 6 2 — — $5,121.39 $11,350.08 $8,235.74 2026-04-01
43770 HCPCS Lap Place Gastr Adj Device 6 2 — — $5,121.39 $11,350.08 $8,235.74 2026-04-01
J1162 HCPCS Digoxin Immune Fab (ovine) 15 3 — — $3,039.53 $8,198.16 $8,198.16 2026-04-01
92990 HCPCS Revision Of Pulmonary Valve 6 2 — — $4,023.05 $12,326.39 $8,174.72 2026-04-01
92997 HCPCS Pul Art Balloon Repr Percut 6 2 — — $4,023.05 $12,326.39 $8,174.72 2026-04-01
92987 HCPCS Revision Of Mitral Valve 6 2 — — $4,023.05 $12,326.39 $8,174.72 2026-04-01
63664 HCPCS Revise Spine Eltrd Plate 6 2 — — $4,399.77 $11,897.69 $8,148.73 2026-04-01
64553 HCPCS Implant Neuroelectrodes 6 2 — — $4,399.77 $11,897.69 $8,148.73 2026-04-01
64569 HCPCS Revise/repl Vagus N Eltrd 6 2 — — $4,399.77 $11,897.69 $8,148.73 2026-04-01
33228 HCPCS Remv&replc Pm Gen Dual Lead 6 2 — — $5,014.56 $11,160.19 $8,087.38 2026-04-01
33213 HCPCS Insert Pulse Gen Dual Leads 6 2 — — $5,014.56 $11,160.19 $8,087.38 2026-04-01
28297 HCPCS Correction Hallux Valgus 6 2 — — $2,455.43 $13,708.59 $8,082.01 2026-04-01
J0716 HCPCS Centruroides Immune F(ab) 15 3 — — $4,169.83 $8,017.37 $8,017.37 2026-04-01
27356 HCPCS Remove Femur Lesion/graft 6 2 — — $2,306.77 $13,708.59 $8,007.68 2026-04-01
20692 HCPCS Apply Bone Fixation Device 6 2 — — $2,306.77 $13,708.59 $8,007.68 2026-04-01
27709 HCPCS Incision Of Tibia & Fibula 6 2 — — $2,306.77 $13,708.59 $8,007.68 2026-04-01
77371 HCPCS Srs Multisource 6 2 — — $7,864.34 $7,910.51 $7,887.43 2026-04-01
C9608 HCPCS Perc D-e Cor Revasc Chro Add 3 1 — — $7,763.18 $7,763.18 $7,763.18 2026-04-01
C9601 HCPCS Perc Drug-el Cor Stent Bran 3 1 — — $7,763.18 $7,763.18 $7,763.18 2026-04-01
C9606 HCPCS Perc D-e Cor Revasc W Ami S 3 1 — — $7,763.18 $7,763.18 $7,763.18 2026-04-01
C9603 HCPCS Perc D-e Cor Stent Ather Br 3 1 — — $7,763.18 $7,763.18 $7,763.18 2026-04-01
C9605 HCPCS Perc D-e Cor Revasc T Cabg B 3 1 — — $7,763.18 $7,763.18 $7,763.18 2026-04-01
37187 HCPCS Venous Mech Thrombectomy 6 2 — — $3,100.23 $12,326.39 $7,713.31 2026-04-01
J0480 HCPCS Basiliximab 15 3 — — $3,180.21 $7,709.58 $7,709.58 2026-04-01
50593 HCPCS Perc Cryo Ablate Renal Tum 6 2 — — $4,046.61 $11,350.08 $7,698.34 2026-04-01
47556 HCPCS Biliary Endoscopy Thru Skin 6 2 — — $4,046.61 $11,350.08 $7,698.34 2026-04-01
47383 HCPCS Perq Abltj Lvr Cryoablation 6 2 — — $4,046.61 $11,350.08 $7,698.34 2026-04-01
92925 HCPCS Prq Card Angio/athrect Addl 3 1 — — $7,671.18 $7,671.18 $7,671.18 2026-04-01
43210 HCPCS Egd Esophagogastrc Fndoplsty 6 2 — — $3,613.57 $11,350.08 $7,481.83 2026-04-01
50947 HCPCS Laparo New Ureter/Bladder 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
50948 HCPCS Laparo New Ureter/Bladder 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
50544 HCPCS Laparoscopy Pyeloplasty 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
58573 HCPCS Tlh W/t/o Uterus Over 250 G 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
58572 HCPCS Tlh Uterus Over 250 G 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
58673 HCPCS Laparoscopy Salpingostomy 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
50543 HCPCS Laparo Partial Nephrectomy 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
58571 HCPCS Tlh W/t/o 250 G Or Less 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
58553 HCPCS Laparo-vag Hyst Complex 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
58554 HCPCS Laparo-vag Hyst W/t/o Compl 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
58552 HCPCS Laparo-vag Hyst Incl T/o 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
58570 HCPCS Tlh Uterus 250 G Or Less 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
47564 HCPCS Laparo Cholecystectomy/explr 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
57425 HCPCS Laparoscopy Surg Colpopexy 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
58546 HCPCS Laparo-myomectomy Complex 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
38572 HCPCS Laparoscopy Lymphadenectomy 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
38120 HCPCS Laparoscopy Splenectomy 6 2 — — $3,487.15 $11,350.08 $7,418.61 2026-04-01
A9604 HCPCS Sm 153 Lexidronam 6 2 — — $3,159.80 $11,662.09 $7,410.95 2026-04-01
57423 HCPCS Repair Paravag Defect Lap 6 2 — — $3,405.53 $11,350.08 $7,377.81 2026-04-01
37183 HCPCS Remove Hepatic Shunt (tips) 6 2 — — $6,077.21 $8,656.82 $7,367.01 2026-04-01
61888 HCPCS Revise/remove Neuroreceiver 6 2 — — $2,598.26 $11,897.69 $7,247.98 2026-04-01
50541 HCPCS Laparo Ablate Renal Cyst 6 2 — — $2,730.07 $11,350.08 $7,040.08 2026-04-01
43648 HCPCS Lap Revise/remv Eltrd Antrum 6 2 — — $2,730.07 $11,350.08 $7,040.08 2026-04-01
22513 HCPCS Perq Vertebral Augmentation 12 3 — — $5,862.48 $10,000.00 $7,003.69 2026-04-01
32608 HCPCS Thoracoscopy W/bx Nodule 6 2 — — $2,564.75 $11,350.08 $6,957.41 2026-04-01
32604 HCPCS Thoracoscopy Wbx Sac 6 2 — — $2,564.75 $11,350.08 $6,957.41 2026-04-01
32607 HCPCS Thoracoscopy W/bx Infiltrate 6 2 — — $2,564.75 $11,350.08 $6,957.41 2026-04-01
J9200 HCPCS Floxuridine Injection 15 3 — — $16.28 $6,807.16 $6,807.16 2026-04-01
27179 HCPCS Revise Head/neck Of Femur 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
25440 HCPCS Repair/graft Wrist Bone 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
22514 HCPCS Perq Vertebral Augmentation 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
23460 HCPCS Repair Shoulder Capsule 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
24400 HCPCS Revision Of Humerus 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
25415 HCPCS Repair Radius & Ulna 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
25405 HCPCS Repair/graft Radius Or Ulna 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
24344 HCPCS Reconstruct Elbow Lat Ligmnt 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
25425 HCPCS Repair/graft Radius Or Ulna 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
25825 HCPCS Fuse Hand Bones With Graft 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
25420 HCPCS Repair/graft Radius & Ulna 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
25400 HCPCS Repair Radius Or Ulna 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
27745 HCPCS Reinforce Tibia 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
23465 HCPCS Repair Shoulder Capsule 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
24935 HCPCS Revision Of Amputation 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
25830 HCPCS Fusion Radioulnar Jnt/ulna 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
27407 HCPCS Repair Of Knee Ligament 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
29892 HCPCS Ankle Arthroscopy/surgery 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
25805 HCPCS Fusion/graft Of Wrist Joint 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
29888 HCPCS Knee Arthroscopy/surgery 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
25800 HCPCS Fusion Of Wrist Joint 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
23800 HCPCS Fusion Of Shoulder Joint 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
23455 HCPCS Repair Shoulder Capsule 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
27652 HCPCS Repair/graft Achilles Tendon 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
24330 HCPCS Revision Of Arm Muscles 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
27427 HCPCS Reconstruction Knee 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
25316 HCPCS Revise Palsy Hand Tendon(s) 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
23397 HCPCS Muscle Transfers 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
23490 HCPCS Reinforce Clavicle 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
27412 HCPCS Autochondrocyte Implant Knee 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
23450 HCPCS Repair Shoulder Capsule 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
27409 HCPCS Repair Of Knee Ligaments 6 2 — — $5,862.48 $7,747.87 $6,805.17 2026-04-01
0587T OTHER Perq Impltj/rplcmt Isdns Ptn 3 1 — — $6,804.81 $6,804.81 $6,804.81 2026-04-01
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