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Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN

Dallas, TX · CCN 453314 · Rates published

5,077 distinct procedures filed
30 distinct payers
184,512 rate rows
2026-02-09 last MRF observed
Data quality

184,066 of 184,512 rate rows are consumer-grade (99.8%)

446 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
per-diem day rate — not a per-procedure price 144
percent-of-charges filed in the dollar field — excluded from medians 114
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 104
template filing: same amount across many unrelated codes — excluded 79
placeholder amount (≤ $0.02) — excluded from medians 5
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbTXScottishRite&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/ScottishRite_V2.aspx
Discovered viaDiscovered by HANK
Last fetch success · 2026-05-18
Content fingerprint fd49de3dccab0513… · 112,548,251 bytes · first seen 2026-05-14

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
951
MS_DRG 		Other Factors Influencing Health Status 21 $253,390.20 $361,986.00 $253,390.20 nat. median
$6,587
outlier · 38.5×
42
MS_DRG 		Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/mcc 21 $236,570.88 $337,958.40 $236,570.88 nat. median
$18,118
outlier · 13.1×
121
MS_DRG 		Acute Major Eye Infections With Cc/mcc 21 $202,692.00 $289,560.00 $202,692.00 nat. median
$12,356
outlier · 16.4×
740
MS_DRG 		Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Cc 21 $170,912.56 $244,160.80 $170,912.56 nat. median
$18,694
outlier · 9.1×
23
MS_DRG 		Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 21 $114,863.41 $164,090.59 $114,863.41 nat. median
$55,916
outlier · 2.1×
711
MS_DRG 		Testes Procedures With Cc/mcc 21 $107,476.04 $153,537.20 $107,476.04 nat. median
$20,443
outlier · 5.3×
421
MS_DRG 		Hepatobiliary Diagnostic Procedures With Cc 21 $104,267.52 $148,953.60 $104,267.52 nat. median
$17,333
outlier · 6.0×
321
MS_DRG 		Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 21 $102,956.51 $147,080.73 $102,956.51 nat. median
$28,170
outlier · 3.7×
310
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 21 $97,558.16 $139,368.80 $97,558.16 nat. median
$6,746
outlier · 14.5×
315
MS_DRG 		Other Circulatory System Diagnoses With Cc 21 $96,613.63 $138,019.47 $96,613.63 nat. median
$10,513
outlier · 9.2×
950
MS_DRG 		Aftercare Without Cc/mcc 21 $91,400.59 $130,572.27 $91,400.59 nat. median
$7,552
outlier · 12.1×
380
MS_DRG 		Complicated Peptic Ulcer With Mcc 21 $89,189.74 $127,413.92 $89,189.74 nat. median
$19,314
outlier · 4.6×
303
MS_DRG 		Atherosclerosis Without Mcc 21 $83,627.89 $119,468.42 $83,627.89 nat. median
$7,837
outlier · 10.7×
254
MS_DRG 		Other Vascular Procedures Without Cc/mcc 21 $81,418.77 $116,312.53 $81,418.77 nat. median
$18,438
outlier · 4.4×
26
MS_DRG 		Craniotomy And Endovascular Intracranial Procedures With Cc 21 $80,700.48 $115,286.40 $80,700.48 nat. median
$31,106
outlier · 2.6×
384
MS_DRG 		Uncomplicated Peptic Ulcer Without Mcc 21 $79,966.32 $114,237.60 $79,966.32 nat. median
$9,522
outlier · 8.4×
304
MS_DRG 		Hypertension With Mcc 21 $77,742.84 $111,061.20 $77,742.84 nat. median
$12,521
outlier · 6.2×
300
MS_DRG 		Peripheral Vascular Disorders With Cc 21 $71,419.46 $102,027.80 $71,419.46 nat. median
$11,432
outlier · 6.2×
299
MS_DRG 		Peripheral Vascular Disorders With Mcc 21 $66,206.75 $94,581.07 $66,206.75 nat. median
$16,470
outlier · 4.0×
794
MS_DRG 		Neonate With Other Significant Problems 21 $59,536.96 $85,052.80 $59,536.96 nat. median
$12,681
outlier · 4.7×
54
MS_DRG 		Nervous System Neoplasms With Mcc 21 $57,360.24 $81,943.20 $57,360.24 nat. median
$15,454
outlier · 3.7×
313
MS_DRG 		Chest Pain 21 $57,205.77 $81,722.53 $57,205.77 nat. median
$8,214
outlier · 7.0×
314
MS_DRG 		Other Circulatory System Diagnoses With Mcc 21 $50,834.22 $72,620.32 $50,834.22 nat. median
$20,752
outlier · 2.4×
143
MS_DRG 		Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 21 $50,814.96 $72,592.80 $50,814.96 nat. median
$34,132
1.5× median
324
MS_DRG 		Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 21 $45,706.92 $65,295.60 $45,706.92 nat. median
$30,812
1.5× median
312
MS_DRG 		Syncope And Collapse 21 $44,836.96 $64,052.80 $44,836.96 nat. median
$9,478
outlier · 4.7×
309
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders With Cc 21 $42,612.82 $60,875.45 $42,612.82 nat. median
$8,433
outlier · 5.1×
308
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders With Mcc 21 $42,465.24 $60,664.62 $42,465.24 nat. median
$12,751
outlier · 3.3×
L7180
HCPCS 		Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device 26 $38,553.68 $65,716.50 $40,095.82 nat. median
$49,027
0.8× median
L7181
HCPCS 		Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 26 $38,240.40 $65,182.50 $39,770.01 nat. median
$50,598
0.8× median
320
MS_DRG 		Other Endovascular Cardiac Valve Procedures Without Mcc 21 $39,694.60 $56,706.58 $39,694.60 nat. median
$24,229
1.6× median
463
MS_DRG 		Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective… 21 $38,292.24 $54,703.20 $38,292.24 nat. median
$52,746
0.7× median
L2006
HCPCS 		Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance… 26 $36,298.68 $61,872.75 $37,750.62 nat. median
$39,823
0.9× median
813
MS_DRG 		Coagulation Disorders 21 $33,655.16 $48,078.80 $33,655.16 nat. median
$15,711
outlier · 2.1×
316
MS_DRG 		Other Circulatory System Diagnoses Without Cc/mcc 21 $29,576.40 $42,252.00 $29,576.40 nat. median
$7,972
outlier · 3.7×
305
MS_DRG 		Hypertension Without Mcc 21 $29,256.27 $41,794.67 $29,256.27 nat. median
$8,578
outlier · 3.4×
J0638
HCPCS 		Injection, Canakinumab, 1 Mg 26 $194.27 $51,648.38 $28,406.61 nat. median
$257
outlier · 110.6×
58
MS_DRG 		Multiple Sclerosis And Cerebellar Ataxia With Mcc 21 $26,507.46 $37,867.80 $26,507.46 nat. median
$17,928
1.5× median
347
MS_DRG 		Anal And Stomal Procedures With Mcc 21 $23,978.08 $34,254.40 $23,978.08 nat. median
$22,979
1.0× median
L6880
HCPCS 		Electric Hand, Switch Or Myoelectric Controlled, Independently Articulating Digi… 26 $22,922.68 $39,072.75 $23,839.58 nat. median
$30,168
0.8× median
L5856
HCPCS 		Addition To Lower Extremity Prosthesis, Endoskeletal Knee-shin System, Microproc… 26 $22,910.36 $39,051.75 $23,826.78 nat. median
$30,273
0.8× median
793
MS_DRG 		Full Term Neonate With Major Problems 21 $21,258.16 $30,368.80 $21,258.16 nat. median
$34,190
0.6× median
342
MS_DRG 		Appendectomy Without Complicated Principal Diagnosis With Cc 21 $21,152.88 $30,218.40 $21,152.88 nat. median
$13,424
1.6× median
L6975
HCPCS 		Interscapular-thoracic, External Power, Molded Inner Socket, Removable Shoulder… 26 $18,226.12 $31,067.25 $18,955.17 nat. median
$23,177
0.8× median
L6970
HCPCS 		Interscapular-thoracic, External Power, Molded Inner Socket, Removable Shoulder… 26 $18,128.88 $30,901.50 $18,854.03 nat. median
$22,513
0.8× median
L6965
HCPCS 		Shoulder Disarticulation, External Power, Molded Inner Socket, Removable Shoulde… 26 $17,835.40 $30,401.25 $18,548.81 nat. median
$22,149
0.8× median
L5858
HCPCS 		Addition To Lower Extremity Prosthesis, Endoskeletal Knee Shin System, Microproc… 26 $17,736.84 $30,233.25 $18,446.32 nat. median
$23,442
0.8× median
383
MS_DRG 		Uncomplicated Peptic Ulcer With Mcc 21 $17,705.52 $25,293.60 $17,705.52 nat. median
$13,810
1.3× median
L5973
HCPCS 		Endoskeletal Ankle Foot System, Microprocessor Controlled Feature, Dorsiflexion… 26 $16,419.92 $27,988.50 $17,076.72 nat. median
$21,820
0.8× median
Q4104
HCPCS 		Integra Bilayer Matrix Wound Dressing (bmwd), Per Square Centimeter 26 $6,023.00 $30,400.00 $16,720.00 nat. median
$268
outlier · 62.4×

Other procedures at this hospital

Browse this hospital's 5,077 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
951 MS_DRG Other Factors Influencing Health Status 21 21 $452,482.50 $452,482.50 $253,390.20 $361,986.00 $253,390.20 2026-02-09
42 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/mcc 21 21 $422,448.00 $422,448.00 $236,570.88 $337,958.40 $236,570.88 2026-02-09
121 MS_DRG Acute Major Eye Infections With Cc/mcc 21 21 $361,950.00 $361,950.00 $202,692.00 $289,560.00 $202,692.00 2026-02-09
740 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Cc 21 21 $305,201.00 $305,201.00 $170,912.56 $244,160.80 $170,912.56 2026-02-09
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 21 21 $205,113.24 $205,113.24 $114,863.41 $164,090.59 $114,863.41 2026-02-09
711 MS_DRG Testes Procedures With Cc/mcc 21 21 $191,921.50 $191,921.50 $107,476.04 $153,537.20 $107,476.04 2026-02-09
421 MS_DRG Hepatobiliary Diagnostic Procedures With Cc 21 21 $186,192.00 $186,192.00 $104,267.52 $148,953.60 $104,267.52 2026-02-09
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 21 21 $183,850.91 $183,850.91 $102,956.51 $147,080.73 $102,956.51 2026-02-09
310 MS_DRG Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 21 21 $174,211.00 $174,211.00 $97,558.16 $139,368.80 $97,558.16 2026-02-09
315 MS_DRG Other Circulatory System Diagnoses With Cc 21 21 $172,524.33 $172,524.33 $96,613.63 $138,019.47 $96,613.63 2026-02-09
950 MS_DRG Aftercare Without Cc/mcc 21 21 $163,215.33 $163,215.33 $91,400.59 $130,572.27 $91,400.59 2026-02-09
380 MS_DRG Complicated Peptic Ulcer With Mcc 21 21 $159,267.40 $159,267.40 $89,189.74 $127,413.92 $89,189.74 2026-02-09
303 MS_DRG Atherosclerosis Without Mcc 21 21 $149,335.52 $149,335.52 $83,627.89 $119,468.42 $83,627.89 2026-02-09
254 MS_DRG Other Vascular Procedures Without Cc/mcc 21 21 $145,390.67 $145,390.67 $81,418.77 $116,312.53 $81,418.77 2026-02-09
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 21 21 $144,108.00 $144,108.00 $80,700.48 $115,286.40 $80,700.48 2026-02-09
384 MS_DRG Uncomplicated Peptic Ulcer Without Mcc 21 21 $142,797.00 $142,797.00 $79,966.32 $114,237.60 $79,966.32 2026-02-09
304 MS_DRG Hypertension With Mcc 21 21 $138,826.50 $138,826.50 $77,742.84 $111,061.20 $77,742.84 2026-02-09
300 MS_DRG Peripheral Vascular Disorders With Cc 21 21 $127,534.75 $127,534.75 $71,419.46 $102,027.80 $71,419.46 2026-02-09
299 MS_DRG Peripheral Vascular Disorders With Mcc 21 21 $118,226.33 $118,226.33 $66,206.75 $94,581.07 $66,206.75 2026-02-09
794 MS_DRG Neonate With Other Significant Problems 21 21 $106,316.00 $106,316.00 $59,536.96 $85,052.80 $59,536.96 2026-02-09
54 MS_DRG Nervous System Neoplasms With Mcc 21 21 $102,429.00 $102,429.00 $57,360.24 $81,943.20 $57,360.24 2026-02-09
313 MS_DRG Chest Pain 21 21 $102,153.17 $102,153.17 $57,205.77 $81,722.53 $57,205.77 2026-02-09
314 MS_DRG Other Circulatory System Diagnoses With Mcc 21 21 $90,775.40 $90,775.40 $50,834.22 $72,620.32 $50,834.22 2026-02-09
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 21 21 $90,741.00 $90,741.00 $50,814.96 $72,592.80 $50,814.96 2026-02-09
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 21 21 $81,619.50 $81,619.50 $45,706.92 $65,295.60 $45,706.92 2026-02-09
312 MS_DRG Syncope And Collapse 21 21 $80,066.00 $80,066.00 $44,836.96 $64,052.80 $44,836.96 2026-02-09
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 21 21 $76,094.31 $76,094.31 $42,612.82 $60,875.45 $42,612.82 2026-02-09
308 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Mcc 21 21 $75,830.78 $75,830.78 $42,465.24 $60,664.62 $42,465.24 2026-02-09
L7180 HCPCS Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device 26 26 $87,622.00 $87,622.00 $38,553.68 $65,716.50 $40,095.82 2026-02-09
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 26 26 $86,910.00 $86,910.00 $38,240.40 $65,182.50 $39,770.01 2026-02-09
320 MS_DRG Other Endovascular Cardiac Valve Procedures Without Mcc 21 21 $70,883.22 $70,883.22 $39,694.60 $56,706.58 $39,694.60 2026-02-09
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 21 21 $68,379.00 $68,379.00 $38,292.24 $54,703.20 $38,292.24 2026-02-09
L2006 HCPCS Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance… 26 26 $82,497.00 $82,497.00 $36,298.68 $61,872.75 $37,750.62 2026-02-09
813 MS_DRG Coagulation Disorders 21 21 $60,098.50 $60,098.50 $33,655.16 $48,078.80 $33,655.16 2026-02-09
316 MS_DRG Other Circulatory System Diagnoses Without Cc/mcc 21 21 $52,815.00 $52,815.00 $29,576.40 $42,252.00 $29,576.40 2026-02-09
305 MS_DRG Hypertension Without Mcc 21 21 $52,243.33 $52,243.33 $29,256.27 $41,794.67 $29,256.27 2026-02-09
J0638 HCPCS Injection, Canakinumab, 1 Mg 26 26 $64,560.48 $64,560.48 $194.27 $51,648.38 $28,406.61 2026-02-09
58 MS_DRG Multiple Sclerosis And Cerebellar Ataxia With Mcc 21 21 $47,334.75 $47,334.75 $26,507.46 $37,867.80 $26,507.46 2026-02-09
347 MS_DRG Anal And Stomal Procedures With Mcc 21 21 $42,818.00 $42,818.00 $23,978.08 $34,254.40 $23,978.08 2026-02-09
L6880 HCPCS Electric Hand, Switch Or Myoelectric Controlled, Independently Articulating Digi… 26 26 $52,097.00 $52,097.00 $22,922.68 $39,072.75 $23,839.58 2026-02-09
L5856 HCPCS Addition To Lower Extremity Prosthesis, Endoskeletal Knee-shin System, Microproc… 26 26 $52,069.00 $52,069.00 $22,910.36 $39,051.75 $23,826.78 2026-02-09
793 MS_DRG Full Term Neonate With Major Problems 21 21 $37,961.00 $37,961.00 $21,258.16 $30,368.80 $21,258.16 2026-02-09
342 MS_DRG Appendectomy Without Complicated Principal Diagnosis With Cc 21 21 $37,773.00 $37,773.00 $21,152.88 $30,218.40 $21,152.88 2026-02-09
L6975 HCPCS Interscapular-thoracic, External Power, Molded Inner Socket, Removable Shoulder … 26 26 $41,423.00 $41,423.00 $18,226.12 $31,067.25 $18,955.17 2026-02-09
L6970 HCPCS Interscapular-thoracic, External Power, Molded Inner Socket, Removable Shoulder … 26 26 $41,202.00 $41,202.00 $18,128.88 $30,901.50 $18,854.03 2026-02-09
L6965 HCPCS Shoulder Disarticulation, External Power, Molded Inner Socket, Removable Shoulde… 26 26 $40,535.00 $40,535.00 $17,835.40 $30,401.25 $18,548.81 2026-02-09
L5858 HCPCS Addition To Lower Extremity Prosthesis, Endoskeletal Knee Shin System, Microproc… 26 26 $40,311.00 $40,311.00 $17,736.84 $30,233.25 $18,446.32 2026-02-09
383 MS_DRG Uncomplicated Peptic Ulcer With Mcc 21 21 $31,617.00 $31,617.00 $17,705.52 $25,293.60 $17,705.52 2026-02-09
L5973 HCPCS Endoskeletal Ankle Foot System, Microprocessor Controlled Feature, Dorsiflexion … 26 26 $37,318.00 $37,318.00 $16,419.92 $27,988.50 $17,076.72 2026-02-09
Q4104 HCPCS Integra Bilayer Matrix Wound Dressing (bmwd), Per Square Centimeter 52 26 $31,046.00 $31,046.00 $6,023.00 $30,400.00 $16,720.00 2026-02-09
251 MS_DRG Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc 21 21 $26,443.00 $26,443.00 $14,808.08 $21,154.40 $14,808.08 2026-02-09
349 MS_DRG Anal And Stomal Procedures Without Cc/mcc 21 21 $25,515.00 $25,515.00 $14,288.40 $20,412.00 $14,288.40 2026-02-09
20808 HCPCS Reattachment Of Cutoff Hand 26 26 $13,380.00 $13,380.00 $3,855.98 $14,049.00 $13,380.00 2026-02-09
346 MS_DRG Minor Small And Large Bowel Procedures Without Cc/mcc 21 21 $23,219.00 $23,219.00 $13,002.64 $18,575.20 $13,002.64 2026-02-09
L6955 HCPCS Above Elbow, External Power, Molded Inner Socket, Removable Humeral Shell, Inter… 26 26 $28,141.00 $28,141.00 $12,382.04 $21,105.75 $12,877.32 2026-02-09
L6960 HCPCS Shoulder Disarticulation, External Power, Molded Inner Socket, Removable Shoulde… 26 26 $27,748.00 $27,748.00 $12,209.12 $20,811.00 $12,697.49 2026-02-09
351 MS_DRG Inguinal And Femoral Hernia Procedures With Cc 21 21 $21,837.50 $21,837.50 $12,229.00 $17,470.00 $12,229.00 2026-02-09
L7191 HCPCS Electronic Elbow, Child, Variety Village Or Equal, Myoelectronically Controlled 26 26 $26,052.00 $26,052.00 $11,462.88 $19,539.00 $11,921.40 2026-02-09
L7186 HCPCS Electronic Elbow, Child, Variety Village Or Equal, Switch Controlled 26 26 $24,510.00 $24,510.00 $10,784.40 $18,382.50 $11,215.78 2026-02-09
126857_ERX CDM Revatio 10 Mg/ml Oral Susp 26 26 $24,239.23 $24,239.23 $10,665.26 $19,391.38 $11,091.87 2026-02-09
L6945 HCPCS Elbow Disarticulation, External Power, Molded Inner Socket, Removable Humeral Sh… 26 26 $23,860.00 $23,860.00 $10,498.40 $17,895.00 $10,918.33 2026-02-09
26554 HCPCS Transfer Of 2 Toes To Hand 26 26 $10,741.00 $10,741.00 $3,769.79 $11,278.05 $10,741.00 2026-02-09
L6950 HCPCS Above Elbow, External Power, Molded Inner Socket, Removable Humeral Shell, Inter… 26 26 $22,425.00 $22,425.00 $9,867.00 $16,818.75 $10,261.68 2026-02-09
L7190 HCPCS Electronic Elbow, Adolescent, Variety Village Or Equal, Myoelectronically Contro… 26 26 $21,607.00 $21,607.00 $9,507.08 $16,205.25 $9,887.36 2026-02-09
26551 HCPCS Transfer Of Great Toe To Hand 26 26 $9,874.00 $9,874.00 $3,264.06 $10,367.70 $9,874.00 2026-02-09
26556 HCPCS Transfer Of Toe And Joint To Finger 26 26 $9,654.00 $9,654.00 $3,370.70 $10,136.70 $9,654.00 2026-02-09
L6940 HCPCS Elbow Disarticulation, External Power, Molded Inner Socket, Removable Humeral Sh… 26 26 $21,092.00 $21,092.00 $9,280.48 $15,819.00 $9,651.69 2026-02-09
20805 HCPCS Reattachment Of Cutoff Forearm 26 26 $9,588.00 $9,588.00 $3,195.46 $10,067.40 $9,588.00 2026-02-09
20969 HCPCS Placement Of Skin And Bone Flap With Microvascular Connection 26 26 $9,475.00 $9,475.00 $2,667.42 $9,948.75 $9,475.00 2026-02-09
19364 HCPCS Reconstruction Of Breast With Tissue Graft 26 26 $9,421.00 $9,421.00 $2,683.76 $9,892.05 $9,421.00 2026-02-09
27077 HCPCS Extensive Removal Of Growth Of Side Of Pelvic Bone 26 26 $9,412.00 $9,412.00 $2,752.64 $9,882.60 $9,412.00 2026-02-09
20970 HCPCS Placement Of Bone And Skin Flap From Hip Bone With Connection Of Small Blood Ves… 26 26 $9,353.00 $9,353.00 $2,791.17 $9,820.65 $9,353.00 2026-02-09
20973 HCPCS Placement Of Bone And Skin Flap From Big Toe With Connection Of Small Blood Vess… 26 26 $9,279.00 $9,279.00 $2,939.37 $9,742.95 $9,279.00 2026-02-09
862 MS_DRG Postoperative And Post-traumatic Infections With Mcc 21 21 $15,978.29 $15,978.29 $8,947.84 $12,782.63 $8,947.84 2026-02-09
21160 HCPCS Reconstruction Of Nose, Cheek, Mouth, And Forehead Bones With Bone Grafts And Re… 26 26 $8,863.00 $8,863.00 $2,768.86 $9,306.15 $8,863.00 2026-02-09
26553 HCPCS Transfer Of Toe To Hand 26 26 $8,654.00 $8,654.00 $3,242.44 $9,086.70 $8,654.00 2026-02-09
20838 HCPCS Reattachment Of Cutoff Foot 26 26 $8,643.00 $8,643.00 $2,732.88 $9,075.15 $8,643.00 2026-02-09
20956 HCPCS Bone Graft Of Pelvic Bone With Microvascular Connection 26 26 $8,610.00 $8,610.00 $2,587.95 $9,040.50 $8,610.00 2026-02-09
22819 HCPCS Removal Of Parts Of 3 Or More Spine Bones To Correct Outward Curving Spine Defor… 26 26 $8,601.00 $8,601.00 $2,429.51 $9,031.05 $8,601.00 2026-02-09
12480_SUP CDM Plate Custom Infant Lcb 30mm 18 Hole 26 26 $18,046.00 $18,046.00 $4,511.50 $14,436.80 $8,600.73 2026-02-09
12481_SUP CDM Plate Custom Infant Lcb 35mm 18hole 26 26 $18,046.00 $18,046.00 $4,511.50 $14,436.80 $8,600.73 2026-02-09
C1768 HCPCS Graft, Vascular 26 26 $17,880.00 $17,880.00 $4,470.00 $14,304.00 $8,521.61 2026-02-09
L6935 HCPCS Below Elbow, External Power, Self-suspended Inner Socket, Removable Forearm Shel… 26 26 $18,564.00 $18,564.00 $8,168.16 $13,923.00 $8,494.89 2026-02-09
L5857 HCPCS Addition To Lower Extremity Prosthesis, Endoskeletal Knee-shin System, Microproc… 26 26 $18,477.00 $18,477.00 $8,129.88 $13,857.75 $8,455.08 2026-02-09
21159 HCPCS Reconstruction Of Nose, Cheek, Mouth, And Forehead Bones With Bone Grafts 26 26 $8,436.00 $8,436.00 $2,554.66 $8,857.80 $8,436.00 2026-02-09
15842 HCPCS Microsurgical Muscle Graft To Treat Facial Paralysis 26 26 $8,415.00 $8,415.00 $2,656.90 $8,835.75 $8,415.00 2026-02-09
27076 HCPCS Extensive Removal Of Growth Of Upper Pelvic Bone Including Hip Socket, Base Of P… 26 26 $8,249.00 $8,249.00 $2,469.08 $8,661.45 $8,249.00 2026-02-09
20955 HCPCS Bone Graft At Lower Leg With Microvascular Connection 26 26 $8,031.00 $8,031.00 $2,429.75 $8,432.55 $8,031.00 2026-02-09
21184 HCPCS Reconstruction Of Eye, Forehead, And Nose Bones With Removal Of Growth With Bone… 26 26 $7,979.00 $7,979.00 $2,439.85 $8,377.95 $7,979.00 2026-02-09
144 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Cc 21 21 $14,163.00 $14,163.00 $7,931.28 $11,330.40 $7,931.28 2026-02-09
21183 HCPCS Reconstruction Of Eye, Forehead, And Nose Bones With Removal Of Growth With Bone… 26 26 $7,826.00 $7,826.00 $2,268.70 $8,217.30 $7,826.00 2026-02-09
L7185 HCPCS Electronic Elbow, Adolescent, Variety Village Or Equal, Switch Controlled 26 26 $16,981.00 $16,981.00 $7,471.64 $12,735.75 $7,770.51 2026-02-09
20802 HCPCS Reattachment Of Cutoff Arm 26 26 $7,734.00 $7,734.00 $2,690.94 $8,120.70 $7,734.00 2026-02-09
L6930 HCPCS Below Elbow, External Power, Self-suspended Inner Socket, Removable Forearm Shel… 26 26 $16,878.00 $16,878.00 $7,426.32 $12,658.50 $7,723.38 2026-02-09
L7170 HCPCS Electronic Elbow, Hosmer Or Equal, Switch Controlled 26 26 $16,770.00 $16,770.00 $7,378.80 $12,577.50 $7,673.95 2026-02-09
22804 HCPCS Fusion To Repair Spine Deformity Through Back, 13 Or More Bones 26 26 $7,655.00 $7,655.00 $2,355.24 $8,037.75 $7,655.00 2026-02-09
L6925 HCPCS Wrist Disarticulation, External Power, Self-suspended Inner Socket, Removable Fo… 26 26 $16,599.00 $16,599.00 $7,303.56 $12,449.25 $7,595.70 2026-02-09
21175 HCPCS Repair Of Bony Defect Of Lower Forehead And Both Outer Portions Of Eye Bones 26 26 $7,578.00 $7,578.00 $2,183.59 $7,956.90 $7,578.00 2026-02-09
15756 HCPCS Muscle Graft With Repair Of Small Blood Vessel 26 26 $7,576.00 $7,576.00 $2,245.48 $7,954.80 $7,576.00 2026-02-09
20962 HCPCS Bone Graft With Microvascular Connection 26 26 $7,566.00 $7,566.00 $2,615.07 $7,944.30 $7,566.00 2026-02-09
19368 HCPCS Reconstruction Of Breast With Abdominal Muscle And Skin Flap Graft 26 26 $7,543.00 $7,543.00 $2,142.03 $7,920.15 $7,543.00 2026-02-09
22207 HCPCS Incision Or Removal Of Lower Spine Bone Segment To Correct Deformity 26 26 $7,539.00 $7,539.00 $2,312.52 $7,915.95 $7,539.00 2026-02-09
20972 HCPCS Placement Of Bone And Skin Flap From Foot Bone With Connection Of Small Blood Ve… 26 26 $7,515.00 $7,515.00 $2,783.62 $7,890.75 $7,515.00 2026-02-09
15758 HCPCS Tissue Graft With Repair Of Small Blood Vessel 26 26 $7,462.00 $7,462.00 $2,245.66 $7,835.10 $7,462.00 2026-02-09
22206 HCPCS Incision Or Removal Of Segment Of Middle Spine Bone To Correct Deformity 26 26 $7,455.00 $7,455.00 $2,351.76 $7,827.75 $7,455.00 2026-02-09
15757 HCPCS Skin Graft With Repair Of Small Blood Vessel 26 26 $7,445.00 $7,445.00 $2,236.35 $7,817.25 $7,445.00 2026-02-09
20957 HCPCS Bone Graft Of Foot Bone With Microvascular Connection 26 26 $7,385.00 $7,385.00 $2,695.68 $7,754.25 $7,385.00 2026-02-09
20824 HCPCS Reattachment Of Cutoff Thumb 26 26 $7,359.00 $7,359.00 $2,018.46 $7,726.95 $7,359.00 2026-02-09
21155 HCPCS Reconstruction Of Midface Bones With Bone Graft With LeFort I (LeFort Iii) 26 26 $7,350.00 $7,350.00 $2,134.97 $7,717.50 $7,350.00 2026-02-09
21154 HCPCS Reconstruction Of Nose, Cheek, And Mouth Bones With Bone Grafts 26 26 $7,327.00 $7,327.00 $1,927.44 $7,693.35 $7,327.00 2026-02-09
63101 HCPCS Removal Of Middle Spine Bone With Release Of Spinal Cord And/or Nerves, Lateral … 26 26 $7,321.00 $7,321.00 $2,219.36 $7,687.05 $7,321.00 2026-02-09
21261 HCPCS Repositioning Of Eye Socket Bone From Inside And Outside Skull With Bone Graft 26 26 $7,305.00 $7,305.00 $2,429.40 $7,670.25 $7,305.00 2026-02-09
L6920 HCPCS Wrist Disarticulation, External Power, Self-suspended Inner Socket, Removable Fo… 26 26 $15,720.00 $15,720.00 $6,916.80 $11,790.00 $7,193.47 2026-02-09
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/mcc 21 21 $12,792.00 $12,792.00 $7,163.52 $10,233.60 $7,163.52 2026-02-09
20816 HCPCS Reattachment Of Cutoff Finger 26 26 $7,143.00 $7,143.00 $2,014.95 $7,500.15 $7,143.00 2026-02-09
L5987 HCPCS All Lower Extremity Prosthesis, Shank Foot System With Vertical Loading Pylon 26 26 $15,603.00 $15,603.00 $6,865.32 $11,702.25 $7,139.93 2026-02-09
L7008 HCPCS Electric Hand, Switch Or Myoelectric, Controlled, Pediatric 26 26 $15,491.00 $15,491.00 $6,816.04 $11,618.25 $7,088.68 2026-02-09
63102 HCPCS Removal Of Lower Spine Bone With Release Of Spinal Cord And/or Nerves, Lateral E… 26 26 $7,088.00 $7,088.00 $2,181.17 $7,442.40 $7,088.00 2026-02-09
27075 HCPCS Extensive Removal Of Growth Of Hip Bone 26 26 $7,028.00 $7,028.00 $2,043.27 $7,379.40 $7,028.00 2026-02-09
22862 HCPCS Revision Of Total Disc Replacement In Lower Back 26 26 $7,025.00 $7,025.00 $2,019.73 $7,376.25 $7,025.00 2026-02-09
22812 HCPCS Fusion Of Spine Bones For Correction Of Deformity, Anterior Approach, 8 Or More … 26 26 $6,994.00 $6,994.00 $2,160.83 $7,343.70 $6,994.00 2026-02-09
19369 HCPCS Reconstruction Of Breast With Abdominal Muscle And 2 Skin Flap Grafts 26 26 $6,984.00 $6,984.00 $1,990.40 $7,333.20 $6,984.00 2026-02-09
21077 HCPCS Impression And Preparation Of Eye Socket Prosthesis 26 26 $6,980.00 $6,980.00 $1,756.30 $7,329.00 $6,980.00 2026-02-09
21436 HCPCS Complicated Repair Of Broken Face And Skull Bones With Placement Of Stabilizing … 26 26 $6,971.00 $6,971.00 $2,007.68 $7,319.55 $6,971.00 2026-02-09
36000010 CDM Operating Room Services - General Classification 26 26 $15,214.00 $15,214.00 $6,694.16 $12,171.20 $6,961.92 2026-02-09
22865 HCPCS Revision Of Artificial Lower Spine Disc, Lumbar 26 26 $6,889.00 $6,889.00 $2,072.67 $7,233.45 $6,889.00 2026-02-09
22818 HCPCS Removal Of 1-2 Spine Bones To Correct Outward Curving Spine Deformity 26 26 $6,879.00 $6,879.00 $2,111.03 $7,222.95 $6,879.00 2026-02-09
99576_ERX CDM Advate 2,401-3,600 Unit Vial 26 26 $15,020.34 $15,020.34 $6,608.95 $12,016.27 $6,873.31 2026-02-09
36000008 CDM Operating Room Services - General Classification 26 26 $14,819.00 $14,819.00 $6,520.36 $11,855.20 $6,781.18 2026-02-09
27365 HCPCS Extensive Removal Of Growth Of Thigh Or Knee Bone 26 26 $6,701.00 $6,701.00 $2,013.97 $7,036.05 $6,701.00 2026-02-09
C1776 HCPCS Joint Device (implantable) 546 26 $13,226.00 $13,226.00 $202.82 $29,993.60 $6,687.14 2026-02-09
22802 HCPCS Fusion Of Spine Bones For Correction Of Deformity, Posterior Approach, 7 To 12 V… 26 26 $6,656.00 $6,656.00 $2,047.72 $6,988.80 $6,656.00 2026-02-09
20697 HCPCS Placement Of Multiple Direction External Bone Stabilizing Device To Arm Or Leg U… 26 26 $6,647.00 $6,647.00 $2,147.21 $6,979.35 $6,647.00 2026-02-09
27078 HCPCS Extensive Removal Of Growth Of Base Of Pelvis And Upper End Of Thigh Bone 26 26 $6,647.00 $6,647.00 $2,015.52 $6,979.35 $6,647.00 2026-02-09
22861 HCPCS Revision Of Total Disc Replacement In Upper Back 26 26 $6,637.00 $6,637.00 $2,188.56 $6,968.85 $6,637.00 2026-02-09
21182 HCPCS Reconstruction Of Eye, Forehead, And Nose Bones With Removal Of Growth With Bone… 26 26 $6,599.00 $6,599.00 $2,085.24 $6,928.95 $6,599.00 2026-02-09
22548 HCPCS Fusion Of Spine Bones At Base Of Neck, Oral Approach 26 26 $6,488.00 $6,488.00 $1,861.01 $6,812.40 $6,488.00 2026-02-09
21151 HCPCS Reconstruction Of Midface Bones With Bone Graft (LeFort Ii) 26 26 $6,482.00 $6,482.00 $1,792.43 $6,806.10 $6,482.00 2026-02-09
27134 HCPCS Revision Of Thigh Bone And Hip Joint Prosthesis 26 26 $6,437.00 $6,437.00 $1,868.23 $6,758.85 $6,437.00 2026-02-09
22810 HCPCS Fusion Of Spine Bones For Correction Of Deformity, Anterior Approach, 4 To 7 Ver… 26 26 $6,424.00 $6,424.00 $2,003.69 $6,745.20 $6,424.00 2026-02-09
0656T HCPCS Tethering Of 7 Or Fewer Lower Spine Bones 25 25 $6,393.00 $6,393.00 $24.00 $6,712.65 $6,393.00 2026-02-09
22864 HCPCS Revision Of Artificial Upper Spine Disc, Cervical 26 26 $6,392.00 $6,392.00 $1,955.77 $6,711.60 $6,392.00 2026-02-09
21263 HCPCS Repositioning Of Cheek Bone Prominence With Forehead Advancement 26 26 $6,342.00 $6,342.00 $2,249.47 $6,659.10 $6,342.00 2026-02-09
27228 HCPCS Treatment Of Broken Bones Of Front And Back Column Or Wall Of Hip Socket With Pl… 26 26 $6,342.00 $6,342.00 $1,839.72 $6,659.10 $6,342.00 2026-02-09
23220 HCPCS Extensive Removal Of Growth Of Upper End Of Upper Arm 26 26 $6,266.00 $6,266.00 $1,898.89 $6,579.30 $6,266.00 2026-02-09
0657T HCPCS Tethering Of 8 Or More Lower Spine Bones 25 25 $6,198.00 $6,198.00 $24.00 $6,507.90 $6,198.00 2026-02-09
22633 HCPCS Fusion Of Spine In Lower Back With Partial Removal Of Spine Bone And Disc 26 26 $6,186.00 $6,186.00 $1,782.10 $6,495.30 $6,186.00 2026-02-09
S2115 HCPCS Osteotomy, Periacetabular, With Internal Fixation 25 25 $6,174.00 $6,174.00 $24.00 $6,482.70 $6,174.00 2026-02-09
19367 HCPCS Reconstruction Of Breast With Abdominal Muscle Flap 26 26 $6,122.00 $6,122.00 $1,744.12 $6,428.10 $6,122.00 2026-02-09
21172 HCPCS Reconstruction Of Outer Side Of Eye And Lower Forehead Bones 26 26 $6,110.00 $6,110.00 $2,012.06 $6,415.50 $6,110.00 2026-02-09
21268 HCPCS Repositioning Of Eye Bone From Inside And Outside Skull With Bone Graft 26 26 $6,059.00 $6,059.00 $2,018.05 $6,361.95 $6,059.00 2026-02-09
20822 HCPCS Reattachment Of Part Of Cutoff Finger 26 26 $6,053.00 $6,053.00 $1,740.45 $6,355.65 $6,053.00 2026-02-09
21603 HCPCS Removal Of Growth Of Chest Wall And Rib With Reconstruction And Removal Of Lymph… 26 26 $6,047.00 $6,047.00 $24.00 $6,349.35 $6,047.00 2026-02-09
22319 HCPCS Treatment Of Broken Or Dislocated Uppermost Spine Bone With Placement Of Stabili… 26 26 $6,039.00 $6,039.00 $1,735.36 $6,340.95 $6,039.00 2026-02-09
20827 HCPCS Reattachment Of Part Of Cutoff Thumb 26 26 $6,030.00 $6,030.00 $1,787.24 $6,331.50 $6,030.00 2026-02-09
27059 HCPCS Extensive Removal Of Growth Of Pelvis And Hip, 5.0 Cm Or More 26 26 $6,024.00 $6,024.00 $1,767.50 $6,325.20 $6,024.00 2026-02-09
22586 HCPCS Fusion Of Lower Spine Or Sacral Bone With Removal Of Disc Using Image Guidance 26 26 $5,948.00 $5,948.00 $1,925.37 $6,245.40 $5,948.00 2026-02-09
L5341 HCPCS Hemipelvectomy, Canadian Type, Molded Socket, Endoskeletal System, Hip Joint, Si… 26 26 $12,968.00 $12,968.00 $5,705.92 $9,726.00 $5,934.16 2026-02-09
22532 HCPCS Fusion Of Middle Spine Bone Through Side With Partial Removal Of Disc, 1 Bone 26 26 $5,931.00 $5,931.00 $1,728.98 $6,227.55 $5,931.00 2026-02-09
61563 HCPCS Removal Of Growth Of Skull Bone 26 26 $5,925.00 $5,925.00 $1,874.78 $6,221.25 $5,925.00 2026-02-09
27487 HCPCS Revision Of Thigh And Lower Leg Bone Components Of Total Knee Joint Prosthesis 26 26 $5,900.00 $5,900.00 $1,721.56 $6,195.00 $5,900.00 2026-02-09
J7187 HCPCS Injection, Von Willebrand Factor Complex (humate-p), Per Iu Vwf:rco 48 26 $8,954.05 $8,954.05 $1.82 $10,695.38 $5,882.46 2026-02-09
21146 HCPCS Repair Of Midface Bones With Bone Graft, 2 Bones 26 26 $5,874.00 $5,874.00 $1,626.56 $6,167.70 $5,874.00 2026-02-09
27645 HCPCS Extensive Removal Of Growth Of Shin Bone 26 26 $5,763.00 $5,763.00 $1,736.19 $6,051.15 $5,763.00 2026-02-09
22808 HCPCS Fusion Of Spine Bones For Correction Of Deformity, Anterior Approach, 2 To 3 Ver… 26 26 $5,760.00 $5,760.00 $1,763.14 $6,048.00 $5,760.00 2026-02-09
22551 HCPCS Fusion Of Upper Spine Bone With Removal Of Disc And Release Of Spinal Cord Or Ne… 26 26 $5,748.00 $5,748.00 $1,634.32 $6,035.40 $5,748.00 2026-02-09
36000006 CDM Operating Room Services - General Classification 26 26 $12,536.00 $12,536.00 $5,515.84 $10,028.80 $5,736.48 2026-02-09
L5280 HCPCS Hemipelvectomy, Canadian Type; Molded Socket, Hip Joint, Single Axis Constant Fr… 26 26 $12,519.00 $12,519.00 $5,508.36 $9,389.25 $5,728.69 2026-02-09
63085 HCPCS Removal Of Middle Spine Bone With Release Of Spinal Cord And/or Nerves, Transtho… 26 26 $5,728.00 $5,728.00 $1,846.34 $6,014.40 $5,728.00 2026-02-09
23210 HCPCS Extensive Removal Of Growth Of Shoulder Blade 26 26 $5,715.00 $5,715.00 $1,736.19 $6,000.75 $5,715.00 2026-02-09
L5331 HCPCS Hip Disarticulation, Canadian Type, Molded Socket, Endoskeletal System, Hip Join… 26 26 $12,425.00 $12,425.00 $5,467.00 $9,318.75 $5,685.68 2026-02-09
21247 HCPCS Reconstruction Of Hinged Joint Of Jaw Bones With Insertion Of Rib Cartilage 26 26 $5,646.00 $5,646.00 $1,589.21 $5,928.30 $5,646.00 2026-02-09
21243 HCPCS Repair Of Hinged Joint Of Upper And Lower Jaw Bones With Prosthesis 26 26 $5,626.00 $5,626.00 $1,612.92 $5,907.30 $5,626.00 2026-02-09
27132 HCPCS Total Hip Replacement After Previous Hip Surgery 26 26 $5,617.00 $5,617.00 $1,640.88 $5,897.85 $5,617.00 2026-02-09
22533 HCPCS Fusion Of Lower Spine Bone Through Side With Partial Removal Of Disc, 1 Bone 26 26 $5,601.00 $5,601.00 $1,613.50 $5,881.05 $5,601.00 2026-02-09
21150 HCPCS Reconstruction Of Midface Bones (LeFort Ii) 26 26 $5,595.00 $5,595.00 $1,630.35 $5,874.75 $5,595.00 2026-02-09
29868 HCPCS Repair Of Knee Cartilage With Donor Cartilage Graft Using An Endoscope 26 26 $5,592.00 $5,592.00 $1,640.61 $5,871.60 $5,592.00 2026-02-09
22210 HCPCS Incision Or Removal Of Upper Spine Bone Segment 26 26 $5,587.00 $5,587.00 $1,731.26 $5,866.35 $5,587.00 2026-02-09
21433 HCPCS Complicated Repair Of Broken Face And Skull Bones 26 26 $5,586.00 $5,586.00 $1,709.58 $5,865.30 $5,586.00 2026-02-09
445 MS_DRG Disorders Of The Biliary Tract With Cc 21 21 $9,975.00 $9,975.00 $5,586.00 $7,980.00 $5,586.00 2026-02-09
21147 HCPCS Repair Of Midface Bones With Bone Graft, 3 Or More Bones 26 26 $5,579.00 $5,579.00 $1,712.52 $5,857.95 $5,579.00 2026-02-09
22837 HCPCS Tethering Of 8 Or More Middle Spine Bones 19 19 $5,563.00 $5,563.00 $3,894.10 $5,841.15 $5,563.00 2026-02-09
27227 HCPCS Treatment Of Broken Bones Of Front Or Back Column Of Hip Socket Or Across Hip So… 26 26 $5,556.00 $5,556.00 $1,622.22 $5,833.80 $5,556.00 2026-02-09
22556 HCPCS Fusion Of Middle Spine Bone Through Side Of Chest With Partial Removal Of Disc 26 26 $5,547.00 $5,547.00 $1,606.66 $5,824.35 $5,547.00 2026-02-09
22856 HCPCS Insertion Of Artificial Upper Spine Disc, Anterior Approach 26 26 $5,541.00 $5,541.00 $1,569.76 $5,818.05 $5,541.00 2026-02-09
15946 HCPCS Removal Of Pressure Sore And Lower Pelvic Bone In Preparation Of Muscle Flap Or … 26 26 $5,541.00 $5,541.00 $1,590.98 $5,818.05 $5,541.00 2026-02-09
L5250 HCPCS Hip Disarticulation, Canadian Type; Molded Socket, Hip Joint, Single Axis Consta… 26 26 $12,102.00 $12,102.00 $5,324.88 $9,076.50 $5,537.88 2026-02-09
22857 HCPCS Insertion Of Artificial Disc Between Bones Of Lower Spine, Single Space 26 26 $5,535.00 $5,535.00 $1,735.96 $5,811.75 $5,535.00 2026-02-09
27286 HCPCS Fusion Of Hip Joint With Incision Or Partial Removal Of Thigh Bone Below Neck 26 26 $5,528.00 $5,528.00 $1,613.78 $5,804.40 $5,528.00 2026-02-09
27412 HCPCS Implantation Of Self Cartilage Into Knee Joint 26 26 $5,518.00 $5,518.00 $1,620.05 $5,793.90 $5,518.00 2026-02-09
63272 HCPCS Removal Of Growth Of Lower Spine Bone Within Spine Membrane 26 26 $5,515.00 $5,515.00 $1,786.71 $5,790.75 $5,515.00 2026-02-09
21602 HCPCS Removal Of Growth Of Chest Wall And Rib With Reconstruction 26 26 $5,493.00 $5,493.00 $24.00 $5,767.65 $5,493.00 2026-02-09
15841 HCPCS Muscle Graft To Treat Facial Paralysis 26 26 $5,490.00 $5,490.00 $1,753.04 $5,764.50 $5,490.00 2026-02-09
C1763 HCPCS Connective Tissue, Non-human (includes Synthetic) 78 26 $12,300.00 $12,300.00 $1,145.00 $10,009.60 $5,458.64 2026-02-09
19361 HCPCS Reconstruction Of Breast With Shoulder Muscle Tissue Graft 26 26 $5,452.00 $5,452.00 $1,537.78 $5,724.60 $5,452.00 2026-02-09
C9399 HCPCS Unclassified Drugs Or Biologicals 78 26 $12,200.00 $12,200.00 $1,589.00 $14,304.00 $5,448.52 2026-02-09
E0747 HCPCS Osteogenesis Stimulator, Electrical, Non-invasive, Other Than Spinal Application… 51 26 $12,800.00 $12,800.00 $2,302.08 $10,240.00 $5,444.48 2026-02-09
27156 HCPCS Incision And Reshaping Of Part Of Hip And Thigh Bones And Repair Of Dislocated H… 26 26 $5,419.00 $5,419.00 $1,673.72 $5,689.95 $5,419.00 2026-02-09
22318 HCPCS Treatment Of Broken Or Dislocated Uppermost Spine Bone With Placement Of Stabili… 26 26 $5,419.00 $5,419.00 $1,564.04 $5,689.95 $5,419.00 2026-02-09
21188 HCPCS Reconstruction Of Midface Bones With Bone Graft 26 26 $5,419.00 $5,419.00 $1,617.26 $5,689.95 $5,419.00 2026-02-09
27290 HCPCS Amputation Of Pelvic Structures 26 26 $5,385.00 $5,385.00 $1,597.24 $5,654.25 $5,385.00 2026-02-09
C9353 HCPCS Microporous Collagen Implantable Slit Tube (neurawrap Nerve Protector), Per Cent… 78 26 $8,916.00 $8,916.00 $1,941.00 $9,764.48 $5,370.46 2026-02-09
27091 HCPCS Removal Of Hip Prosthesis, Complicated 26 26 $5,344.00 $5,344.00 $1,564.21 $5,611.20 $5,344.00 2026-02-09
27284 HCPCS Fusion Of Hip Joint 26 26 $5,344.00 $5,344.00 $1,575.01 $5,611.20 $5,344.00 2026-02-09
172329_ERX CDM Benlysta 200 Mg/ml Autoinject 26 26 $11,674.38 $11,674.38 $5,136.73 $9,339.50 $5,342.19 2026-02-09
30462 HCPCS Revision Of Congenital Nasal Defect With Lengthening Of Tip Of Nose 26 26 $5,331.00 $5,331.00 $1,609.90 $5,597.55 $5,331.00 2026-02-09
21180 HCPCS Reconstruction Of Forehead And/or Upper Eye Bones With Bone Graft 26 26 $5,296.00 $5,296.00 $1,676.89 $5,560.80 $5,296.00 2026-02-09
21344 HCPCS Treatment Of Complicated Broken Front Sinus Bone 26 26 $5,287.00 $5,287.00 $1,376.26 $5,551.35 $5,287.00 2026-02-09
L5270 HCPCS Hip Disarticulation, Tilt Table Type; Molded Socket, Locking Hip Joint, Single A… 26 26 $11,500.00 $11,500.00 $5,060.00 $8,625.00 $5,262.40 2026-02-09
21267 HCPCS Reconstruction Of Eye Bone From Outside Skull With Bone Graft 26 26 $5,251.00 $5,251.00 $1,615.73 $5,513.55 $5,251.00 2026-02-09
C9352 HCPCS Microporous Collagen Implantable Tube (neuragen Nerve Guide), Per Centimeter Len… 26 26 $10,996.00 $10,996.00 $2,749.00 $8,796.80 $5,240.69 2026-02-09
27364 HCPCS Extensive Removal Of Growth Of Thigh Or Knee, 5.0 Cm Or More 26 26 $5,226.00 $5,226.00 $1,526.36 $5,487.30 $5,226.00 2026-02-09
63276 HCPCS Removal Or Biopsy Of Growth Of Middle Spine Bone Outside Spine Membrane 26 26 $5,222.00 $5,222.00 $1,705.81 $5,483.10 $5,222.00 2026-02-09
21145 HCPCS Reconstruction Of Midface Bones With Bone Graft, Single Piece (LeFort I) 26 26 $5,191.00 $5,191.00 $1,558.14 $5,450.55 $5,191.00 2026-02-09
30450 HCPCS Revision To Reshape Nasal Bones And Tip Of Nose After Previous Repair 26 26 $5,175.00 $5,175.00 $1,651.00 $5,433.75 $5,175.00 2026-02-09
21080 HCPCS Preparation Of Permanent Prosthesis To Close Mouth Opening 26 26 $5,169.00 $5,169.00 $1,346.12 $5,427.45 $5,169.00 2026-02-09
27447 HCPCS Replacement Of Knee Joint, Both Sides Of Knee 26 26 $5,153.00 $5,153.00 $1,262.24 $5,410.65 $5,153.00 2026-02-09
22630 HCPCS Fusion Of Lower Spine Bone And Partial Removal Of Spine Bone Or Disc Through Bac… 26 26 $5,149.00 $5,149.00 $1,515.44 $5,406.45 $5,149.00 2026-02-09
27138 HCPCS Revision Of Thigh Bone Prosthesis 26 26 $5,140.00 $5,140.00 $1,495.71 $5,397.00 $5,140.00 2026-02-09
22836 HCPCS Tethering Of 7 Or Fewer Middle Spine Bones 19 19 $5,135.00 $5,135.00 $3,594.50 $5,391.75 $5,135.00 2026-02-09
22612 HCPCS Fusion Of Spine In Lower Back 26 26 $5,131.00 $5,131.00 $1,536.66 $5,387.55 $5,131.00 2026-02-09
21086 HCPCS Impression And Custom Preparation Of Outer Ear Prosthesis 26 26 $5,131.00 $5,131.00 $1,295.53 $5,387.55 $5,131.00 2026-02-09
22590 HCPCS Fusion Of Skull And First 2 Upper Spine Bones Through Back 26 26 $5,114.00 $5,114.00 $1,516.53 $5,369.70 $5,114.00 2026-02-09
19357 HCPCS Reconstruction Of Breast Using Tissue Expander 26 26 $5,112.00 $5,112.00 $1,154.20 $5,367.60 $5,112.00 2026-02-09
C1762 HCPCS Connective Tissue, Human (includes Fascia Lata) 1,040 26 $9,636.00 $9,636.00 $472.00 $68,320.00 $5,104.00 2026-02-09
22220 HCPCS Incision Or Removal Of Upper Spine Bone Segment And Removal Of Disc 26 26 $5,103.00 $5,103.00 $1,565.97 $5,358.15 $5,103.00 2026-02-09
21087 HCPCS Impression And Custom Preparation Of Nasal Prosthesis 26 26 $5,089.00 $5,089.00 $1,295.53 $5,343.45 $5,089.00 2026-02-09
22899 HCPCS Other Procedure On Spine 25 25 $5,066.00 $5,066.00 $24.00 $5,319.30 $5,066.00 2026-02-09
0201T HCPCS Injections Of Both Sides Of Sacrum For Enlargement, 2 Or More Needles, Accessed … 25 25 $5,066.00 $5,066.00 $24.00 $5,319.30 $5,066.00 2026-02-09
26650 HCPCS Placement Of Stabilizing Device For Broken Thumb At Wrist With Manipulation 26 26 $5,052.00 $5,052.00 $484.90 $5,304.60 $5,052.00 2026-02-09
26550 HCPCS Surgical Creation Of Thumb 26 26 $5,052.00 $5,052.00 $1,658.11 $5,304.60 $5,052.00 2026-02-09
24150 HCPCS Extensive Removal Of Growth Of Upper Arm Bone 26 26 $5,041.00 $5,041.00 $1,519.06 $5,293.05 $5,041.00 2026-02-09
24363 HCPCS Prosthetic Repair Of Elbow Joint 26 26 $5,003.00 $5,003.00 $1,427.05 $5,253.15 $5,003.00 2026-02-09
23472 HCPCS Prosthetic Repair Of Shoulder Joint, Total Shoulder 26 26 $5,003.00 $5,003.00 $1,425.02 $5,253.15 $5,003.00 2026-02-09
21196 HCPCS Reconstruction Of Jaw Bones With Insertion Of Hardware 26 26 $5,000.00 $5,000.00 $1,400.69 $5,250.00 $5,000.00 2026-02-09
22224 HCPCS Incision Or Removal Of Lower Spine Bone Segment And Removal Of Disc 26 26 $4,995.00 $4,995.00 $1,551.29 $5,244.75 $4,995.00 2026-02-09
27646 HCPCS Extensive Removal Of Growth Of Outer Leg Bone 26 26 $4,991.00 $4,991.00 $1,508.28 $5,240.55 $4,991.00 2026-02-09
27151 HCPCS Reshaping Of Part Of Hip Bone 26 26 $4,980.00 $4,980.00 $1,554.38 $5,229.00 $4,980.00 2026-02-09
63055 HCPCS Release Of Middle Spinal Cord And/or Nerves, Single Segment 26 26 $4,978.00 $4,978.00 $1,552.46 $5,226.90 $4,978.00 2026-02-09
27137 HCPCS Revision Of Hip Socket Part Of Hip Prosthesis 26 26 $4,940.00 $4,940.00 $1,439.83 $5,187.00 $4,940.00 2026-02-09
21143 HCPCS Repair Of Midface Bones, 3 Or More Bones 26 26 $4,933.00 $4,933.00 $1,424.11 $5,179.65 $4,933.00 2026-02-09
22327 HCPCS Treatment Of Broken Or Dislocated Middle Spine Bone 26 26 $4,930.00 $4,930.00 $1,472.73 $5,176.50 $4,930.00 2026-02-09
22595 HCPCS Fusion Of First 2 Spine Bones Through Back Of Neck 26 26 $4,915.00 $4,915.00 $1,448.78 $5,160.75 $4,915.00 2026-02-09
63200 HCPCS Removal Of Lower Spine Bone With Release Of Frayed Spinal Cord 26 26 $4,909.00 $4,909.00 $1,453.29 $5,154.45 $4,909.00 2026-02-09
27259 HCPCS Treatment Of Spontaneous Dislocated Hip With Shortening Of Thigh Bone 26 26 $4,907.00 $4,907.00 $1,517.07 $5,152.35 $4,907.00 2026-02-09
22558 HCPCS Fusion Of Lower Spine Bone Through Abdomen With Partial Removal Of Disc 26 26 $4,902.00 $4,902.00 $1,481.29 $5,147.10 $4,902.00 2026-02-09
23200 HCPCS Extensive Removal Of Growth Of Collar Bone 26 26 $4,879.00 $4,879.00 $1,480.36 $5,122.95 $4,879.00 2026-02-09
21179 HCPCS Reconstruction Of Forehead And/or Upper Eye Bones With Bone Graft Or Implant 26 26 $4,861.00 $4,861.00 $1,501.72 $5,104.05 $4,861.00 2026-02-09
37799 HCPCS Other Procedure On Blood Vessel 25 25 $4,855.00 $4,855.00 $24.00 $5,097.75 $4,855.00 2026-02-09
22222 HCPCS Incision Or Removal Of Middle Spine Bone And Removal Of Disc 26 26 $4,830.00 $4,830.00 $1,670.29 $5,071.50 $4,830.00 2026-02-09
26580 HCPCS Repair Of Deformed Hand 26 26 $4,780.00 $4,780.00 $1,536.68 $5,019.00 $4,780.00 2026-02-09
21084 HCPCS Impression And Custom Preparation Of Speech Aid Prosthesis 26 26 $4,778.00 $4,778.00 $1,203.25 $5,016.90 $4,778.00 2026-02-09
21142 HCPCS Repair Of Midface Bones, 2 Bones 26 26 $4,762.00 $4,762.00 $1,375.89 $5,000.10 $4,762.00 2026-02-09
23078 HCPCS Extensive Removal Of Growth Of Shoulder, 5.0 Cm Or More 26 26 $4,756.00 $4,756.00 $1,400.76 $4,993.80 $4,756.00 2026-02-09
C2618 HCPCS Probe/needle, Cryoablation 26 26 $10,600.00 $10,600.00 $552.93 $8,480.00 $4,733.96 2026-02-09
63077 HCPCS Removal Of Middle Spine Disc And Release Of Spinal Cord And/or Nerves, Single In… 26 26 $4,732.00 $4,732.00 $1,444.83 $4,968.60 $4,732.00 2026-02-09
21255 HCPCS Reconstruction Of Cheek Bone With Bone Graft 26 26 $4,730.00 $4,730.00 $1,372.03 $4,966.50 $4,730.00 2026-02-09
21081 HCPCS Impression And Custom Preparation Of Lower Jaw Bone Prosthesis 26 26 $4,730.00 $4,730.00 $1,231.72 $4,966.50 $4,730.00 2026-02-09
27486 HCPCS Revision Of Component Of Total Knee Joint Prosthesis 26 26 $4,714.00 $4,714.00 $1,381.57 $4,949.70 $4,714.00 2026-02-09
21936 HCPCS Extensive Removal Of Growth Of Back Or Lower Side, 5.0 Cm Or More 26 26 $4,708.00 $4,708.00 $1,375.03 $4,943.40 $4,708.00 2026-02-09
25170 HCPCS Extensive Removal Of Growth Of Forearm Bone (radius Or Ulna) 26 26 $4,705.00 $4,705.00 $1,444.16 $4,940.25 $4,705.00 2026-02-09
L5961 HCPCS Addition, Endoskeletal System, Polycentric Hip Joint, Pneumatic Or Hydraulic Con… 26 26 $10,281.00 $10,281.00 $4,523.64 $7,710.75 $4,704.59 2026-02-09
30420 HCPCS Reshaping Of Bony Cartilage Dividing Nasal Passages 26 26 $4,688.00 $4,688.00 $1,449.18 $4,922.40 $4,688.00 2026-02-09
21194 HCPCS Reconstruction Of Lower Jaw Bone With Bone Graft 26 26 $4,685.00 $4,685.00 $1,432.02 $4,919.25 $4,685.00 2026-02-09
22214 HCPCS Incision Or Removal Of Lower Spine Bone Segment 26 26 $4,679.00 $4,679.00 $1,464.87 $4,912.95 $4,679.00 2026-02-09
21141 HCPCS Reconstruction Of Upper Jaw And Midface Bones 26 26 $4,673.00 $4,673.00 $1,340.27 $4,906.65 $4,673.00 2026-02-09
21435 HCPCS Complicated Repair Of Broken Face And Skull Bones With Placement Of Stabilizing … 26 26 $4,654.00 $4,654.00 $1,387.82 $4,886.70 $4,654.00 2026-02-09
36000004 CDM Operating Room Services - General Classification 26 26 $10,162.00 $10,162.00 $4,471.28 $8,129.60 $4,650.13 2026-02-09
27147 HCPCS Incision Or Partial Removal Of Hip Bone And Repair Of Dislocated Hip Joint 26 26 $4,650.00 $4,650.00 $1,438.00 $4,882.50 $4,650.00 2026-02-09
22212 HCPCS Incision Or Removal Of Middle Spine Bone Segment 26 26 $4,646.00 $4,646.00 $1,461.53 $4,878.30 $4,646.00 2026-02-09
21079 HCPCS Impression And Custom Preparation Of Temporary Oral Prosthesis 26 26 $4,642.00 $4,642.00 $1,181.87 $4,874.10 $4,642.00 2026-02-09
19366 HCPCS Breast Reconstruction With Other Technique 25 25 $4,631.00 $4,631.00 $24.00 $4,862.55 $4,631.00 2026-02-09
63015 HCPCS Partial Removal Of Spine Bone With Exploration And/or Release Of Upper Spinal Co… 26 26 $4,612.00 $4,612.00 $1,413.92 $4,842.60 $4,612.00 2026-02-09
27130 HCPCS Replacement Of Thigh Bone And Hip Joint With Prosthesis 26 26 $4,600.00 $4,600.00 $1,263.67 $4,830.00 $4,600.00 2026-02-09
27580 HCPCS Fusion Of Knee Joint 26 26 $4,598.00 $4,598.00 $1,448.40 $4,827.90 $4,598.00 2026-02-09
L7009 HCPCS Electric Hook, Switch Or Myoelectric Controlled, Adult 26 26 $10,042.00 $10,042.00 $4,418.48 $7,531.50 $4,595.22 2026-02-09
22325 HCPCS Treatment Of Broken Or Dislocated Lower Spine Bone 26 26 $4,587.00 $4,587.00 $1,415.05 $4,816.35 $4,587.00 2026-02-09
64898 HCPCS Graft Of Multiple Arm Or Leg Nerves, More Than 4.0 Cm 26 26 $4,583.00 $4,583.00 $1,346.67 $4,812.15 $4,583.00 2026-02-09
27415 HCPCS Implantation Of Donor Cartilage Cells Into Knee Joint 26 26 $4,577.00 $4,577.00 $1,351.99 $4,805.85 $4,577.00 2026-02-09
23900 HCPCS Amputation Of Entire Arm With Removal Shoulder Blade And A Portion Of Collar Bon… 26 26 $4,574.00 $4,574.00 $1,362.76 $4,802.70 $4,574.00 2026-02-09
21195 HCPCS Reconstruction Of Lower Jaw Bones 26 26 $4,568.00 $4,568.00 $1,376.21 $4,796.40 $4,568.00 2026-02-09
64861 HCPCS Suture Of Arm Nerve Bundle 26 26 $4,533.00 $4,533.00 $1,444.36 $4,759.65 $4,533.00 2026-02-09
21558 HCPCS Extensive Removal Of Growth Of Neck Or Front Of Chest, 5.0 Cm Or More 26 26 $4,533.00 $4,533.00 $1,309.95 $4,759.65 $4,533.00 2026-02-09
126579_ERX CDM Ryanodex 250 Mg Vial 26 26 $9,866.16 $9,866.16 $4,341.11 $7,892.93 $4,514.76 2026-02-09
L7007 HCPCS Electric Hand, Switch Or Myoelectric Controlled, Adult 26 26 $9,842.00 $9,842.00 $4,330.48 $7,381.50 $4,503.69 2026-02-09
J0801 HCPCS Injection, Corticotropin (acthar Gel), Up To 40 Units 21 21 $10,232.70 $10,232.70 $4,502.39 $8,186.16 $4,502.39 2026-02-09
27468 HCPCS Lengthening And Shortening Of Thigh Bone 26 26 $4,476.00 $4,476.00 $1,320.58 $4,699.80 $4,476.00 2026-02-09
27049 HCPCS Extensive Removal Of Growth Of Pelvis And Hip, Less Than 5.0 Cm 26 26 $4,472.00 $4,472.00 $1,311.66 $4,695.60 $4,472.00 2026-02-09
63056 HCPCS Release Of Lower Spinal Cord And/or Nerves, Single Segment 26 26 $4,467.00 $4,467.00 $1,433.00 $4,690.35 $4,467.00 2026-02-09
22905 HCPCS Extensive Removal Of Growth Of Soft Tissue Of Abdominal Wall, 5.0 Cm Or More 26 26 $4,463.00 $4,463.00 $1,285.47 $4,686.15 $4,463.00 2026-02-09
21082 HCPCS Impression And Custom Preparation Of Prosthesis For Roof Of Mouth Enlargement 26 26 $4,435.00 $4,435.00 $1,119.94 $4,656.75 $4,435.00 2026-02-09
27158 HCPCS Incision Or Partial Removal Of Both Sides Of Pelvic Bones 26 26 $4,415.00 $4,415.00 $1,377.03 $4,635.75 $4,415.00 2026-02-09
21193 HCPCS Reconstruction Of Jaw Bone 26 26 $4,412.00 $4,412.00 $1,238.88 $4,632.60 $4,412.00 2026-02-09
30410 HCPCS Reshaping Of Bone, Cartilage, And/or Tip Of Nose 26 26 $4,403.00 $4,403.00 $1,315.36 $4,623.15 $4,403.00 2026-02-09
64895 HCPCS Graft Of Multiple Hand Or Foot Nerves, 4.0 Cm Or Less 26 26 $4,391.00 $4,391.00 $1,301.33 $4,610.55 $4,391.00 2026-02-09
26555 HCPCS Transfer Of Finger 26 26 $4,390.00 $4,390.00 $1,397.41 $4,609.50 $4,390.00 2026-02-09
21047 HCPCS Removal Of Growth Or Cyst Of Part Of Lower Jaw Bone 26 26 $4,387.00 $4,387.00 $1,259.78 $4,606.35 $4,387.00 2026-02-09
L5600 HCPCS Preparatory, Hip Disarticulation-hemipelvectomy, Pylon, No Cover, Sach Foot, Lam… 26 26 $9,539.00 $9,539.00 $4,197.16 $7,154.25 $4,365.05 2026-02-09
32905 HCPCS Removal Of Infected Area Of Chest Cavity 26 26 $4,351.00 $4,351.00 $1,278.95 $4,568.55 $4,351.00 2026-02-09
27165 HCPCS Incision Or Partial Removal Of Thigh Bone Below Neck With Placement Of Stabilizi… 26 26 $4,350.00 $4,350.00 $1,357.27 $4,567.50 $4,350.00 2026-02-09
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