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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

5,087 distinct procedures filed
46 distinct payers
330,446 rate rows
2026-04-23 last MRF observed
Data quality

328,857 of 330,446 rate rows are consumer-grade (99.5%)

1,589 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 966
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 200
percent-of-charges filed in the dollar field — excluded from medians 183
per-diem day rate — not a per-procedure price 156
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=dbSRFCOASMCFRISCOTX&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/ScottishRite_V2.aspx
Discovered viaCMS hospital list
Last fetch not_modified · 2026-10-08
Content fingerprint 3968a93e648029a1… · 96,215,691 bytes · first seen 2026-08-17

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 $1,196,022.64 $262,546.01 nat. median
$4,231
outlier · 62.0×
42
MS_DRG 		Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/mcc 21 $236,570.88 $967,234.56 $256,043.72 nat. median
$12,708
outlier · 20.1×
121
MS_DRG 		Acute Major Eye Infections With Cc/mcc 21 $202,692.00 $296,873.40 $220,057.09 nat. median
$8,182
outlier · 26.9×
740
MS_DRG 		Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Cc 21 $170,912.56 $276,505.61 $185,659.72 nat. median
$12,892
outlier · 14.4×
23
MS_DRG 		Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 21 $114,863.41 $191,843.50 $124,420.72 nat. median
$40,301
outlier · 3.1×
711
MS_DRG 		Testes Procedures With Cc/mcc 21 $107,476.04 $384,299.70 $116,348.42 nat. median
$14,310
outlier · 8.1×
421
MS_DRG 		Hepatobiliary Diagnostic Procedures With Cc 21 $104,267.52 $544,370.85 $112,850.08 nat. median
$12,327
outlier · 9.2×
321
MS_DRG 		Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 21 $102,956.51 $155,243.26 $111,808.28 nat. median
$20,638
outlier · 5.4×
310
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 21 $97,558.16 $152,873.18 $105,597.81 nat. median
$4,383
outlier · 24.1×
315
MS_DRG 		Other Circulatory System Diagnoses With Cc 21 $96,613.63 $164,592.96 $104,569.53 nat. median
$7,244
outlier · 14.4×
380
MS_DRG 		Complicated Peptic Ulcer With Mcc 21 $89,189.74 $451,167.52 $96,531.21 nat. median
$13,929
outlier · 6.9×
950
MS_DRG 		Aftercare Without Cc/mcc 21 $91,400.59 $140,136.09 $94,746.37 nat. median
$4,481
outlier · 21.1×
303
MS_DRG 		Atherosclerosis Without Mcc 21 $83,627.89 $129,126.72 $90,596.31 nat. median
$5,236
outlier · 17.3×
254
MS_DRG 		Other Vascular Procedures Without Cc/mcc 21 $81,418.77 $366,230.96 $88,120.59 nat. median
$13,169
outlier · 6.7×
26
MS_DRG 		Craniotomy And Endovascular Intracranial Procedures With Cc 21 $80,700.48 $289,914.90 $87,343.17 nat. median
$22,161
outlier · 3.9×
384
MS_DRG 		Uncomplicated Peptic Ulcer Without Mcc 21 $79,966.32 $437,525.40 $86,548.58 nat. median
$6,528
outlier · 13.3×
304
MS_DRG 		Hypertension With Mcc 21 $77,742.84 $111,061.20 $84,208.16 nat. median
$8,742
outlier · 9.6×
300
MS_DRG 		Peripheral Vascular Disorders With Cc 21 $71,419.46 $102,027.80 $74,259.01 nat. median
$7,999
outlier · 9.3×
299
MS_DRG 		Peripheral Vascular Disorders With Mcc 21 $66,206.75 $94,581.07 $71,668.01 nat. median
$11,794
outlier · 6.1×
54
MS_DRG 		Nervous System Neoplasms With Mcc 21 $57,360.24 $270,396.30 $62,081.73 nat. median
$10,939
outlier · 5.7×
794
MS_DRG 		Neonate With Other Significant Problems 21 $59,536.96 $100,326.00 $61,969.74 nat. median
$5,568
outlier · 11.1×
313
MS_DRG 		Chest Pain 21 $57,205.77 $204,490.20 $59,245.73 nat. median
$5,565
outlier · 10.6×
314
MS_DRG 		Other Circulatory System Diagnoses With Mcc 21 $50,834.22 $207,185.49 $55,021.25 nat. median
$15,450
outlier · 3.6×
143
MS_DRG 		Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 21 $50,814.96 $228,110.70 $54,997.69 nat. median
$24,795
outlier · 2.2×
L7180
HCPCS 		Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device 34 $28,740.02 $87,622.00 $50,398.42 nat. median
$42,745
1.2× median
L7181
HCPCS 		Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 34 $28,506.48 $86,910.00 $49,988.89 nat. median
$48,410
1.0× median
324
MS_DRG 		Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 21 $45,706.92 $163,157.10 $49,472.75 nat. median
$22,248
outlier · 2.2×
L2006
HCPCS 		Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance… 34 $27,059.02 $82,497.00 $46,436.81 nat. median
$38,763
1.2× median
312
MS_DRG 		Syncope And Collapse 21 $44,836.96 $179,072.94 $46,395.70 nat. median
$6,528
outlier · 7.1×
309
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders With Cc 21 $42,612.82 $65,807.27 $46,129.74 nat. median
$5,574
outlier · 8.3×
308
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders With Mcc 21 $42,465.24 $64,698.98 $45,974.95 nat. median
$8,963
outlier · 5.1×
320
MS_DRG 		Other Endovascular Cardiac Valve Procedures Without Mcc 21 $39,694.60 $56,706.58 $42,964.73 nat. median
$16,917
outlier · 2.5×
463
MS_DRG 		Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective… 21 $38,292.24 $189,009.60 $41,444.19 nat. median
$38,795
1.1× median
813
MS_DRG 		Coagulation Disorders 21 $33,655.16 $168,106.85 $34,824.09 nat. median
$11,108
outlier · 3.1×
J0638
HCPCS 		Injection, Canakinumab, 1 Mg 22 $194.27 $51,648.38 $34,003.42 nat. median
$235
outlier · 144.8×
305
MS_DRG 		Hypertension Without Mcc 21 $29,256.27 $41,794.67 $31,676.87 nat. median
$5,752
outlier · 5.5×
316
MS_DRG 		Other Circulatory System Diagnoses Without Cc/mcc 21 $29,576.40 $50,197.57 $30,655.19 nat. median
$5,125
outlier · 6.0×
L5856
HCPCS 		Addition To Lower Extremity Prosthesis, Endoskeletal Knee-shin System, Microproc… 34 $17,078.63 $52,069.00 $29,583.00 nat. median
$29,004
1.0× median
L6880
HCPCS 		Electric Hand, Switch Or Myoelectric Controlled, Independently Articulating Digi… 34 $17,087.82 $52,097.00 $29,324.93 nat. median
$28,867
1.0× median
58
MS_DRG 		Multiple Sclerosis And Cerebellar Ataxia With Mcc 21 $26,507.46 $110,178.95 $28,689.37 nat. median
$12,201
outlier · 2.4×
347
MS_DRG 		Anal And Stomal Procedures With Mcc 21 $23,978.08 $99,668.64 $25,951.79 nat. median
$16,717
1.6× median
L6975
HCPCS 		Interscapular-thoracic, External Power, Molded Inner Socket, Removable Shoulder… 34 $13,586.74 $41,423.00 $23,825.68 nat. median
$21,202
1.1× median
L6970
HCPCS 		Interscapular-thoracic, External Power, Molded Inner Socket, Removable Shoulder… 34 $13,514.26 $41,202.00 $23,698.57 nat. median
$19,306
1.2× median
L6965
HCPCS 		Shoulder Disarticulation, External Power, Molded Inner Socket, Removable Shoulde… 34 $13,295.48 $40,535.00 $23,314.92 nat. median
$18,144
1.3× median
L5858
HCPCS 		Addition To Lower Extremity Prosthesis, Endoskeletal Knee Shin System, Microproc… 34 $9,084.77 $40,311.00 $23,186.08 nat. median
$22,455
1.0× median
342
MS_DRG 		Appendectomy Without Complicated Principal Diagnosis With Cc 21 $21,152.88 $32,898.10 $22,894.04 nat. median
$2,024
outlier · 11.3×
793
MS_DRG 		Full Term Neonate With Major Problems 21 $21,258.16 $32,830.20 $22,007.22 nat. median
$15,882
1.4× median
L5973
HCPCS 		Endoskeletal Ankle Foot System, Microprocessor Controlled Feature, Dorsiflexion… 34 $12,240.30 $37,318.00 $21,464.57 nat. median
$21,313
1.0× median
383
MS_DRG 		Uncomplicated Peptic Ulcer With Mcc 21 $17,705.52 $72,888.90 $19,162.91 nat. median
$9,578
outlier · 2.0×
Q4104
HCPCS 		Integra Bilayer Matrix Wound Dressing (bmwd), Per Square Centimeter 34 $6,023.00 $38,000.00 $17,541.13 nat. median
$1,013
outlier · 17.3×

Other procedures at this hospital

Browse this hospital's 5,087 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 24 21 $452,482.50 $452,482.50 $253,390.20 $1,196,022.64 $262,546.01 2026-02-09
42 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/mcc 24 21 $422,448.00 $422,448.00 $236,570.88 $967,234.56 $256,043.72 2026-02-09
121 MS_DRG Acute Major Eye Infections With Cc/mcc 24 21 $361,950.00 $361,950.00 $202,692.00 $296,873.40 $220,057.09 2026-02-09
740 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Cc 24 21 $305,201.00 $305,201.00 $170,912.56 $276,505.61 $185,659.72 2026-02-09
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 24 21 $205,113.24 $205,113.24 $114,863.41 $191,843.50 $124,420.72 2026-02-09
711 MS_DRG Testes Procedures With Cc/mcc 24 21 $191,921.50 $191,921.50 $107,476.04 $384,299.70 $116,348.42 2026-02-09
421 MS_DRG Hepatobiliary Diagnostic Procedures With Cc 24 21 $186,192.00 $186,192.00 $104,267.52 $544,370.85 $112,850.08 2026-02-09
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 24 21 $183,850.91 $183,850.91 $102,956.51 $155,243.26 $111,808.28 2026-02-09
310 MS_DRG Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 24 21 $174,211.00 $174,211.00 $97,558.16 $152,873.18 $105,597.81 2026-02-09
315 MS_DRG Other Circulatory System Diagnoses With Cc 24 21 $172,524.33 $172,524.33 $96,613.63 $164,592.96 $104,569.53 2026-02-09
380 MS_DRG Complicated Peptic Ulcer With Mcc 24 21 $159,267.40 $159,267.40 $89,189.74 $451,167.52 $96,531.21 2026-02-09
950 MS_DRG Aftercare Without Cc/mcc 24 21 $163,215.33 $163,215.33 $91,400.59 $140,136.09 $94,746.37 2026-02-09
303 MS_DRG Atherosclerosis Without Mcc 24 21 $149,335.52 $149,335.52 $83,627.89 $129,126.72 $90,596.31 2026-02-09
254 MS_DRG Other Vascular Procedures Without Cc/mcc 24 21 $145,390.67 $145,390.67 $81,418.77 $366,230.96 $88,120.59 2026-02-09
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 24 21 $144,108.00 $144,108.00 $80,700.48 $289,914.90 $87,343.17 2026-02-09
384 MS_DRG Uncomplicated Peptic Ulcer Without Mcc 24 21 $142,797.00 $142,797.00 $79,966.32 $437,525.40 $86,548.58 2026-02-09
304 MS_DRG Hypertension With Mcc 24 21 $138,826.50 $138,826.50 $77,742.84 $111,061.20 $84,208.16 2026-02-09
300 MS_DRG Peripheral Vascular Disorders With Cc 24 21 $127,534.75 $127,534.75 $71,419.46 $102,027.80 $74,259.01 2026-02-09
299 MS_DRG Peripheral Vascular Disorders With Mcc 24 21 $118,226.33 $118,226.33 $66,206.75 $94,581.07 $71,668.01 2026-02-09
54 MS_DRG Nervous System Neoplasms With Mcc 24 21 $102,429.00 $102,429.00 $57,360.24 $270,396.30 $62,081.73 2026-02-09
794 MS_DRG Neonate With Other Significant Problems 24 21 $106,316.00 $106,316.00 $59,536.96 $100,326.00 $61,969.74 2026-02-09
313 MS_DRG Chest Pain 24 21 $102,153.17 $102,153.17 $57,205.77 $204,490.20 $59,245.73 2026-02-09
314 MS_DRG Other Circulatory System Diagnoses With Mcc 24 21 $90,775.40 $90,775.40 $50,834.22 $207,185.49 $55,021.25 2026-02-09
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 24 21 $90,741.00 $90,741.00 $50,814.96 $228,110.70 $54,997.69 2026-02-09
L7180 HCPCS Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device 50 34 $87,622.00 $87,622.00 $28,740.02 $87,622.00 $50,398.42 2026-04-23
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 50 34 $86,910.00 $86,910.00 $28,506.48 $86,910.00 $49,988.89 2026-04-23
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 24 21 $81,619.50 $81,619.50 $45,706.92 $163,157.10 $49,472.75 2026-02-09
L2006 HCPCS Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance… 50 34 $82,497.00 $82,497.00 $27,059.02 $82,497.00 $46,436.81 2026-04-23
312 MS_DRG Syncope And Collapse 24 21 $80,066.00 $80,066.00 $44,836.96 $179,072.94 $46,395.70 2026-02-09
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 24 21 $76,094.31 $76,094.31 $42,612.82 $65,807.27 $46,129.74 2026-02-09
308 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Mcc 24 21 $75,830.78 $75,830.78 $42,465.24 $64,698.98 $45,974.95 2026-02-09
320 MS_DRG Other Endovascular Cardiac Valve Procedures Without Mcc 24 21 $70,883.22 $70,883.22 $39,694.60 $56,706.58 $42,964.73 2026-02-09
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 24 21 $68,379.00 $68,379.00 $38,292.24 $189,009.60 $41,444.19 2026-02-09
813 MS_DRG Coagulation Disorders 24 21 $60,098.50 $60,098.50 $33,655.16 $168,106.85 $34,824.09 2026-02-09
J0638 HCPCS Injection, Canakinumab, 1 Mg 26 22 $64,560.48 $64,560.48 $194.27 $51,648.38 $34,003.42 2026-02-09
305 MS_DRG Hypertension Without Mcc 24 21 $52,243.33 $52,243.33 $29,256.27 $41,794.67 $31,676.87 2026-02-09
316 MS_DRG Other Circulatory System Diagnoses Without Cc/mcc 24 21 $52,815.00 $52,815.00 $29,576.40 $50,197.57 $30,655.19 2026-02-09
L5856 HCPCS Addition To Lower Extremity Prosthesis, Endoskeletal Knee-shin System, Microproc… 50 34 $52,069.00 $52,069.00 $17,078.63 $52,069.00 $29,583.00 2026-04-23
L6880 HCPCS Electric Hand, Switch Or Myoelectric Controlled, Independently Articulating Digi… 50 34 $52,097.00 $52,097.00 $17,087.82 $52,097.00 $29,324.93 2026-04-23
58 MS_DRG Multiple Sclerosis And Cerebellar Ataxia With Mcc 24 21 $47,334.75 $47,334.75 $26,507.46 $110,178.95 $28,689.37 2026-02-09
347 MS_DRG Anal And Stomal Procedures With Mcc 24 21 $42,818.00 $42,818.00 $23,978.08 $99,668.64 $25,951.79 2026-02-09
L6975 HCPCS Interscapular-thoracic, External Power, Molded Inner Socket, Removable Shoulder … 50 34 $41,423.00 $41,423.00 $13,586.74 $41,423.00 $23,825.68 2026-04-23
L6970 HCPCS Interscapular-thoracic, External Power, Molded Inner Socket, Removable Shoulder … 50 34 $41,202.00 $41,202.00 $13,514.26 $41,202.00 $23,698.57 2026-04-23
L6965 HCPCS Shoulder Disarticulation, External Power, Molded Inner Socket, Removable Shoulde… 50 34 $40,535.00 $40,535.00 $13,295.48 $40,535.00 $23,314.92 2026-04-23
L5858 HCPCS Addition To Lower Extremity Prosthesis, Endoskeletal Knee Shin System, Microproc… 50 34 $40,311.00 $40,311.00 $9,084.77 $40,311.00 $23,186.08 2026-04-23
342 MS_DRG Appendectomy Without Complicated Principal Diagnosis With Cc 24 21 $37,773.00 $37,773.00 $21,152.88 $32,898.10 $22,894.04 2026-02-09
793 MS_DRG Full Term Neonate With Major Problems 24 21 $37,961.00 $37,961.00 $21,258.16 $32,830.20 $22,007.22 2026-02-09
L5973 HCPCS Endoskeletal Ankle Foot System, Microprocessor Controlled Feature, Dorsiflexion … 50 34 $37,318.00 $37,318.00 $12,240.30 $37,318.00 $21,464.57 2026-04-23
383 MS_DRG Uncomplicated Peptic Ulcer With Mcc 24 21 $31,617.00 $31,617.00 $17,705.52 $72,888.90 $19,162.91 2026-02-09
Q4104 HCPCS Integra Bilayer Matrix Wound Dressing (bmwd), Per Square Centimeter 100 34 $38,000.00 $38,000.00 $6,023.00 $38,000.00 $17,541.13 2026-04-23
L6955 HCPCS Above Elbow, External Power, Molded Inner Socket, Removable Humeral Shell, Inter… 50 34 $28,141.00 $28,141.00 $9,230.25 $28,141.00 $16,186.14 2026-04-23
251 MS_DRG Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc 24 21 $26,443.00 $26,443.00 $14,808.08 $64,331.10 $16,026.98 2026-02-09
L6960 HCPCS Shoulder Disarticulation, External Power, Molded Inner Socket, Removable Shoulde… 50 34 $27,748.00 $27,748.00 $9,101.34 $27,748.00 $15,960.09 2026-04-23
349 MS_DRG Anal And Stomal Procedures Without Cc/mcc 24 21 $25,515.00 $25,515.00 $14,288.40 $67,867.90 $15,464.52 2026-02-09
L7191 HCPCS Electronic Elbow, Child, Variety Village Or Equal, Myoelectronically Controlled 50 34 $26,052.00 $26,052.00 $8,545.06 $26,052.00 $14,984.59 2026-04-23
L7186 HCPCS Electronic Elbow, Child, Variety Village Or Equal, Switch Controlled 50 34 $24,510.00 $24,510.00 $8,039.28 $24,510.00 $14,097.66 2026-04-23
346 MS_DRG Minor Small And Large Bowel Procedures Without Cc/mcc 24 21 $23,219.00 $23,219.00 $13,002.64 $51,143.10 $14,072.93 2026-02-09
L6945 HCPCS Elbow Disarticulation, External Power, Molded Inner Socket, Removable Humeral Sh… 50 34 $23,860.00 $23,860.00 $7,826.08 $23,860.00 $13,723.79 2026-04-23
351 MS_DRG Inguinal And Femoral Hernia Procedures With Cc 24 21 $21,837.50 $21,837.50 $12,229.00 $19,017.75 $13,241.17 2026-02-09
L6950 HCPCS Above Elbow, External Power, Molded Inner Socket, Removable Humeral Shell, Inter… 50 34 $22,425.00 $22,425.00 $7,355.40 $22,425.00 $12,898.41 2026-04-23
36000010 CDM Operating Room Services - General Classification 50 34 $15,214.00 $15,214.00 $4,990.19 $12,171.20 $12,884.72 2026-04-23
36000008 CDM Operating Room Services - General Classification 50 34 $14,819.00 $14,819.00 $4,860.63 $11,855.20 $12,727.14 2026-04-23
L7190 HCPCS Electronic Elbow, Adolescent, Variety Village Or Equal, Myoelectronically Contro… 50 34 $21,607.00 $21,607.00 $7,087.10 $21,607.00 $12,427.91 2026-04-23
L6940 HCPCS Elbow Disarticulation, External Power, Molded Inner Socket, Removable Humeral Sh… 50 34 $21,092.00 $21,092.00 $6,918.18 $21,092.00 $12,131.70 2026-04-23
36000006 CDM Operating Room Services - General Classification 50 34 $12,536.00 $12,536.00 $4,111.81 $10,028.80 $11,816.41 2026-04-23
12480_SUP CDM Plate Custom Infant Lcb 30mm 18 Hole 50 34 $18,046.00 $18,046.00 $4,511.50 $14,436.80 $11,797.83 2026-04-23
12481_SUP CDM Plate Custom Infant Lcb 35mm 18hole 50 34 $18,046.00 $18,046.00 $4,511.50 $14,436.80 $11,797.83 2026-04-23
36000004 CDM Operating Room Services - General Classification 50 34 $10,162.00 $10,162.00 $3,333.14 $8,129.60 $10,869.37 2026-04-23
L6935 HCPCS Below Elbow, External Power, Self-suspended Inner Socket, Removable Forearm Shel… 50 34 $18,564.00 $18,564.00 $6,088.99 $18,564.00 $10,677.64 2026-04-23
L5857 HCPCS Addition To Lower Extremity Prosthesis, Endoskeletal Knee-shin System, Microproc… 50 34 $18,477.00 $18,477.00 $6,060.46 $18,477.00 $10,627.60 2026-04-23
27269 HCPCS Treatment Of Broken Head Of Thigh Bone 50 34 $3,957.00 $3,957.00 $1,005.93 $4,154.85 $10,360.94 2026-04-23
C1768 HCPCS Graft, Vascular 50 34 $17,880.00 $17,880.00 $4,470.00 $17,880.00 $9,985.46 2026-04-23
36000002 CDM Operating Room Services - General Classification 50 34 $7,905.00 $7,905.00 $2,592.84 $6,324.00 $9,969.01 2026-04-23
L7185 HCPCS Electronic Elbow, Adolescent, Variety Village Or Equal, Switch Controlled 50 34 $16,981.00 $16,981.00 $5,569.77 $16,981.00 $9,767.13 2026-04-23
L6930 HCPCS Below Elbow, External Power, Self-suspended Inner Socket, Removable Forearm Shel… 50 34 $16,878.00 $16,878.00 $5,535.98 $16,878.00 $9,707.89 2026-04-23
862 MS_DRG Postoperative And Post-traumatic Infections With Mcc 24 21 $15,978.29 $15,978.29 $8,947.84 $41,045.55 $9,684.56 2026-02-09
20808 HCPCS Reattachment Of Cutoff Hand 50 34 $13,380.00 $13,380.00 $3,222.11 $14,049.00 $9,663.33 2026-04-23
L7170 HCPCS Electronic Elbow, Hosmer Or Equal, Switch Controlled 50 34 $16,770.00 $16,770.00 $5,500.56 $16,770.00 $9,645.77 2026-04-23
L6925 HCPCS Wrist Disarticulation, External Power, Self-suspended Inner Socket, Removable Fo… 50 34 $16,599.00 $16,599.00 $5,444.47 $16,599.00 $9,547.41 2026-04-23
C1762 HCPCS Connective Tissue, Human (includes Fascia Lata) 2,000 34 $85,400.00 $85,400.00 $472.00 $85,400.00 $9,272.72 2026-04-23
L6920 HCPCS Wrist Disarticulation, External Power, Self-suspended Inner Socket, Removable Fo… 50 34 $15,720.00 $15,720.00 $5,156.16 $15,720.00 $9,041.83 2026-04-23
L5987 HCPCS All Lower Extremity Prosthesis, Shank Foot System With Vertical Loading Pylon 50 34 $15,603.00 $15,603.00 $5,117.78 $15,603.00 $8,950.38 2026-04-23
L7008 HCPCS Electric Hand, Switch Or Myoelectric, Controlled, Pediatric 50 34 $15,491.00 $15,491.00 $5,081.05 $15,491.00 $8,910.11 2026-04-23
C1776 HCPCS Joint Device (implantable) 1,050 34 $37,492.00 $37,492.00 $202.82 $37,492.00 $8,633.38 2026-04-23
144 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Cc 24 21 $14,163.00 $14,163.00 $7,931.28 $40,527.00 $8,584.13 2026-02-09
36000011 CDM Operating Room Services - General Classification 50 34 $3,829.00 $3,829.00 $1,255.91 $3,063.20 $8,343.01 2026-04-23
36000009 CDM Operating Room Services - General Classification 50 34 $3,452.00 $3,452.00 $1,132.26 $2,761.60 $8,192.62 2026-04-23
36000000 CDM Operating Room Services - General Classification 50 34 $3,014.00 $3,014.00 $988.59 $2,411.20 $8,017.89 2026-04-23
36000007 CDM Operating Room Services - General Classification 50 34 $2,506.00 $2,506.00 $821.97 $2,004.80 $7,815.24 2026-04-23
36000005 CDM Operating Room Services - General Classification 50 34 $2,366.00 $2,366.00 $776.05 $1,892.80 $7,759.39 2026-04-23
26554 HCPCS Transfer Of 2 Toes To Hand 50 34 $10,741.00 $10,741.00 $3,079.53 $11,278.05 $7,757.39 2026-04-23
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/mcc 24 21 $12,792.00 $12,792.00 $7,163.52 $49,974.00 $7,753.17 2026-02-09
12300000 CDM Room & Board - Semi-private (two Beds) - Pediatric 46 32 $4,275.00 $4,275.00 $2,394.00 $9,250.00 $7,589.58 2026-04-23
36000003 CDM Operating Room Services - General Classification 50 34 $1,841.00 $1,841.00 $603.85 $1,472.80 $7,549.96 2026-04-23
L5341 HCPCS Hemipelvectomy, Canadian Type, Molded Socket, Endoskeletal System, Hip Joint, Si… 50 34 $12,968.00 $12,968.00 $4,253.50 $12,968.00 $7,458.93 2026-04-23
12431_SUP CDM Plate Anterior Distal Tibial Plate 50 34 $7,080.00 $7,080.00 $1,770.00 $5,664.00 $7,438.19 2026-04-23
L5280 HCPCS Hemipelvectomy, Canadian Type; Molded Socket, Hip Joint, Single Axis Constant Fr… 50 34 $12,519.00 $12,519.00 $3,904.83 $12,519.00 $7,200.68 2026-04-23
L5331 HCPCS Hip Disarticulation, Canadian Type, Molded Socket, Endoskeletal System, Hip Join… 50 34 $12,425.00 $12,425.00 $4,075.40 $12,425.00 $7,146.61 2026-04-23
26551 HCPCS Transfer Of Great Toe To Hand 50 34 $9,874.00 $9,874.00 $2,656.00 $10,367.70 $7,131.22 2026-04-23
36000001 CDM Operating Room Services - General Classification 50 34 $739.00 $739.00 $242.39 $591.20 $7,110.35 2026-04-23
26556 HCPCS Transfer Of Toe And Joint To Finger 50 34 $9,654.00 $9,654.00 $2,741.88 $10,136.70 $6,972.33 2026-04-23
L5250 HCPCS Hip Disarticulation, Canadian Type; Molded Socket, Hip Joint, Single Axis Consta… 50 34 $12,102.00 $12,102.00 $3,804.80 $12,102.00 $6,960.83 2026-04-23
20805 HCPCS Reattachment Of Cutoff Forearm 50 34 $9,588.00 $9,588.00 $2,663.30 $10,067.40 $6,924.67 2026-04-23
20969 HCPCS Placement Of Skin And Bone Flap With Microvascular Connection 50 34 $9,475.00 $9,475.00 $2,221.24 $9,948.75 $6,843.06 2026-04-23
19364 HCPCS Reconstruction Of Breast With Tissue Graft 50 34 $9,421.00 $9,421.00 $2,237.52 $9,892.05 $6,804.06 2026-04-23
27077 HCPCS Extensive Removal Of Growth Of Side Of Pelvic Bone 50 34 $9,412.00 $9,412.00 $2,303.48 $9,882.60 $6,797.56 2026-04-23
20970 HCPCS Placement Of Bone And Skin Flap From Hip Bone With Connection Of Small Blood Ves… 50 34 $9,353.00 $9,353.00 $2,325.37 $9,820.65 $6,754.94 2026-04-23
20973 HCPCS Placement Of Bone And Skin Flap From Big Toe With Connection Of Small Blood Vess… 50 34 $9,279.00 $9,279.00 $2,450.55 $9,742.95 $6,701.50 2026-04-23
20962 HCPCS Bone Graft With Microvascular Connection 50 34 $7,566.00 $7,566.00 $2,162.30 $7,944.30 $6,622.67 2026-04-23
L5270 HCPCS Hip Disarticulation, Tilt Table Type; Molded Socket, Locking Hip Joint, Single A… 50 34 $11,500.00 $11,500.00 $3,569.42 $11,500.00 $6,614.57 2026-04-23
C9399 HCPCS Unclassified Drugs Or Biologicals 150 34 $17,880.00 $17,880.00 $1,589.00 $17,880.00 $6,512.65 2026-04-23
21160 HCPCS Reconstruction Of Nose, Cheek, Mouth, And Forehead Bones With Bone Grafts And Re… 50 34 $8,863.00 $8,863.00 $2,286.07 $9,306.15 $6,401.06 2026-04-23
J7187 HCPCS Injection, Von Willebrand Factor Complex (humate-p), Per Iu Vwf:rco 72 34 $13,369.23 $13,369.23 $1.82 $13,369.23 $6,364.57 2026-04-23
13268_SUP CDM Receiver Fitbone 50 34 $4,100.00 $4,100.00 $1,025.00 $3,280.00 $6,253.46 2026-04-23
26553 HCPCS Transfer Of Toe To Hand 50 34 $8,654.00 $8,654.00 $2,638.04 $9,086.70 $6,250.11 2026-04-23
20838 HCPCS Reattachment Of Cutoff Foot 50 34 $8,643.00 $8,643.00 $2,264.74 $9,075.15 $6,242.17 2026-04-23
20956 HCPCS Bone Graft Of Pelvic Bone With Microvascular Connection 50 34 $8,610.00 $8,610.00 $2,151.35 $9,040.50 $6,218.33 2026-04-23
22819 HCPCS Removal Of Parts Of 3 Or More Spine Bones To Correct Outward Curving Spine Defor… 50 34 $8,601.00 $8,601.00 $2,028.70 $9,031.05 $6,211.83 2026-04-23
C9352 HCPCS Microporous Collagen Implantable Tube (neuragen Nerve Guide), Per Centimeter Len… 50 34 $10,996.00 $10,996.00 $2,749.00 $10,996.00 $6,140.95 2026-04-23
21159 HCPCS Reconstruction Of Nose, Cheek, Mouth, And Forehead Bones With Bone Grafts 50 34 $8,436.00 $8,436.00 $2,107.57 $8,857.80 $6,092.67 2026-04-23
15842 HCPCS Microsurgical Muscle Graft To Treat Facial Paralysis 50 34 $8,415.00 $8,415.00 $2,204.68 $8,835.75 $6,077.50 2026-04-23
445 MS_DRG Disorders Of The Biliary Tract With Cc 24 21 $9,975.00 $9,975.00 $5,586.00 $23,052.60 $6,045.80 2026-02-09
27076 HCPCS Extensive Removal Of Growth Of Upper Pelvic Bone Including Hip Socket, Base Of P… 50 34 $8,249.00 $8,249.00 $2,063.78 $8,661.45 $5,957.61 2026-04-23
L5961 HCPCS Addition, Endoskeletal System, Polycentric Hip Joint, Pneumatic Or Hydraulic Con… 50 34 $10,281.00 $10,281.00 $3,372.17 $10,281.00 $5,913.43 2026-04-23
C2618 HCPCS Probe/needle, Cryoablation 50 34 $10,600.00 $10,600.00 $552.93 $10,600.00 $5,891.43 2026-04-23
20955 HCPCS Bone Graft At Lower Leg With Microvascular Connection 50 34 $8,031.00 $8,031.00 $2,012.14 $8,432.55 $5,800.17 2026-04-23
L7009 HCPCS Electric Hook, Switch Or Myoelectric Controlled, Adult 50 34 $10,042.00 $10,042.00 $3,293.78 $10,042.00 $5,775.96 2026-04-23
21184 HCPCS Reconstruction Of Eye, Forehead, And Nose Bones With Removal Of Growth With Bone… 50 34 $7,979.00 $7,979.00 $2,016.91 $8,377.95 $5,762.61 2026-04-23
L7007 HCPCS Electric Hand, Switch Or Myoelectric Controlled, Adult 50 34 $9,842.00 $9,842.00 $3,228.18 $9,842.00 $5,660.92 2026-04-23
21183 HCPCS Reconstruction Of Eye, Forehead, And Nose Bones With Removal Of Growth With Bone… 50 34 $7,826.00 $7,826.00 $1,873.49 $8,217.30 $5,652.11 2026-04-23
20802 HCPCS Reattachment Of Cutoff Arm 50 34 $7,734.00 $7,734.00 $2,236.68 $8,120.70 $5,585.67 2026-04-23
11916_SUP CDM Connector Rss,4.5 5.0-4.5 5.0mm Rod O-c 50 34 $2,300.00 $2,300.00 $575.00 $1,840.00 $5,537.85 2026-04-23
L5600 HCPCS Preparatory, Hip Disarticulation-hemipelvectomy, Pylon, No Cover, Sach Foot, Lam… 50 34 $9,539.00 $9,539.00 $2,920.67 $9,539.00 $5,486.64 2026-04-23
21175 HCPCS Repair Of Bony Defect Of Lower Forehead And Both Outer Portions Of Eye Bones 50 34 $7,578.00 $7,578.00 $1,791.25 $7,956.90 $5,473.00 2026-04-23
15756 HCPCS Muscle Graft With Repair Of Small Blood Vessel 50 34 $7,576.00 $7,576.00 $1,853.00 $7,954.80 $5,471.56 2026-04-23
C1763 HCPCS Connective Tissue, Non-human (includes Synthetic) 150 34 $12,512.00 $12,512.00 $1,145.00 $12,512.00 $5,471.53 2026-04-23
19368 HCPCS Reconstruction Of Breast With Abdominal Muscle And Skin Flap Graft 50 34 $7,543.00 $7,543.00 $1,783.39 $7,920.15 $5,447.72 2026-04-23
22207 HCPCS Incision Or Removal Of Lower Spine Bone Segment To Correct Deformity 50 34 $7,539.00 $7,539.00 $1,961.62 $7,915.95 $5,444.83 2026-04-23
20972 HCPCS Placement Of Bone And Skin Flap From Foot Bone With Connection Of Small Blood Ve… 50 34 $7,515.00 $7,515.00 $2,320.03 $7,890.75 $5,427.50 2026-04-23
L6570 HCPCS Interscapular Thoracic, Molded Socket, Endoskeletal System, Including Soft Prost… 50 34 $9,388.00 $9,388.00 $2,802.70 $9,388.00 $5,399.79 2026-04-23
15758 HCPCS Tissue Graft With Repair Of Small Blood Vessel 50 34 $7,462.00 $7,462.00 $1,853.56 $7,835.10 $5,389.22 2026-04-23
22206 HCPCS Incision Or Removal Of Segment Of Middle Spine Bone To Correct Deformity 50 34 $7,455.00 $7,455.00 $2,002.03 $7,827.75 $5,384.17 2026-04-23
C9353 HCPCS Microporous Collagen Implantable Slit Tube (neurawrap Nerve Protector), Per Cent… 150 34 $12,205.60 $12,205.60 $1,941.00 $12,205.60 $5,377.26 2026-04-23
15757 HCPCS Skin Graft With Repair Of Small Blood Vessel 50 34 $7,445.00 $7,445.00 $1,841.77 $7,817.25 $5,376.94 2026-04-23
L5160 HCPCS Knee Disarticulation (or Through Knee), Molded Socket, Bent Knee Configuration, … 50 34 $9,347.00 $9,347.00 $2,864.71 $9,347.00 $5,376.21 2026-04-23
L5702 HCPCS Replacement, Socket, Hip Disarticulation, Including Hip Joint, Molded To Patient… 50 34 $9,337.00 $9,337.00 $3,021.91 $9,337.00 $5,370.46 2026-04-23
20957 HCPCS Bone Graft Of Foot Bone With Microvascular Connection 50 34 $7,385.00 $7,385.00 $2,237.80 $7,754.25 $5,333.61 2026-04-23
20824 HCPCS Reattachment Of Cutoff Thumb 50 34 $7,359.00 $7,359.00 $1,677.86 $7,726.95 $5,314.83 2026-04-23
21155 HCPCS Reconstruction Of Midface Bones With Bone Graft With LeFort I (LeFort Iii) 50 34 $7,350.00 $7,350.00 $1,758.13 $7,717.50 $5,308.33 2026-04-23
J0801 HCPCS Injection, Corticotropin (acthar Gel), Up To 40 Units 21 19 $10,232.70 $10,232.70 $4,502.39 $8,186.16 $5,305.02 2026-02-09
21154 HCPCS Reconstruction Of Nose, Cheek, And Mouth Bones With Bone Grafts 50 34 $7,327.00 $7,327.00 $1,584.67 $7,693.35 $5,291.72 2026-04-23
63101 HCPCS Removal Of Middle Spine Bone With Release Of Spinal Cord And/or Nerves, Lateral … 50 34 $7,321.00 $7,321.00 $1,888.08 $7,687.05 $5,287.39 2026-04-23
21261 HCPCS Repositioning Of Eye Socket Bone From Inside And Outside Skull With Bone Graft 50 34 $7,305.00 $7,305.00 $1,998.10 $7,670.25 $5,275.83 2026-04-23
16827_SUP CDM 3.0 Cannulated Screw Gold 18mm 50 34 $1,440.00 $1,440.00 $360.00 $1,152.00 $5,195.95 2026-04-23
12238_SUP CDM Screw Cannulated Pt 3.0x32 50 34 $1,436.00 $1,436.00 $359.00 $1,148.80 $5,194.36 2026-04-23
L5230 HCPCS Above Knee, For Proximal Femoral Focal Deficiency, Constant Friction Knee, Shin,… 50 34 $8,939.00 $8,939.00 $2,588.51 $8,939.00 $5,188.46 2026-04-23
20816 HCPCS Reattachment Of Cutoff Finger 50 34 $7,143.00 $7,143.00 $1,675.05 $7,500.15 $5,158.83 2026-04-23
L5782 HCPCS Addition To Lower Limb Prosthesis, Vacuum Pump, Residual Limb Volume Management … 50 34 $9,149.00 $9,149.00 $3,000.87 $9,149.00 $5,149.89 2026-04-23
63102 HCPCS Removal Of Lower Spine Bone With Release Of Spinal Cord And/or Nerves, Lateral E… 50 34 $7,088.00 $7,088.00 $1,839.24 $7,442.40 $5,119.11 2026-04-23
E0747 HCPCS Osteogenesis Stimulator, Electrical, Non-invasive, Other Than Spinal Application… 95 34 $12,800.00 $12,800.00 $1,716.10 $12,800.00 $5,118.13 2026-04-23
L5150 HCPCS Knee Disarticulation (or Through Knee), Molded Socket, External Knee Joints, Shi… 50 34 $8,882.00 $8,882.00 $2,753.18 $8,882.00 $5,108.75 2026-04-23
L2005 HCPCS Knee Ankle Foot Orthosis, Any Material, Single Or Double Upright, Stance Control… 50 34 $8,872.00 $8,872.00 $2,910.02 $8,872.00 $5,103.00 2026-04-23
L6881 HCPCS Automatic Grasp Feature, Addition To Upper Limb Electric Prosthetic Terminal Dev… 50 34 $8,868.00 $8,868.00 $2,908.70 $8,868.00 $5,100.70 2026-04-23
27075 HCPCS Extensive Removal Of Growth Of Hip Bone 50 34 $7,028.00 $7,028.00 $1,704.52 $7,379.40 $5,075.78 2026-04-23
22862 HCPCS Revision Of Total Disc Replacement In Lower Back 50 34 $7,025.00 $7,025.00 $25.60 $7,376.25 $5,073.61 2026-04-23
22812 HCPCS Fusion Of Spine Bones For Correction Of Deformity, Anterior Approach, 8 Or More … 50 34 $6,994.00 $6,994.00 $1,797.98 $7,343.70 $5,051.22 2026-04-23
19369 HCPCS Reconstruction Of Breast With Abdominal Muscle And 2 Skin Flap Grafts 50 34 $6,984.00 $6,984.00 $1,656.25 $7,333.20 $5,044.00 2026-04-23
21077 HCPCS Impression And Preparation Of Eye Socket Prosthesis 50 34 $6,980.00 $6,980.00 $1,627.62 $7,329.00 $5,041.11 2026-04-23
22804 HCPCS Fusion To Repair Spine Deformity Through Back, 13 Or More Bones 50 34 $7,655.00 $7,655.00 $1,982.67 $8,037.75 $5,039.75 2026-04-23
21436 HCPCS Complicated Repair Of Broken Face And Skull Bones With Placement Of Stabilizing … 50 34 $6,971.00 $6,971.00 $1,651.19 $7,319.55 $5,034.61 2026-04-23
22865 HCPCS Revision Of Artificial Lower Spine Disc, Lumbar 50 34 $6,889.00 $6,889.00 $256.87 $7,233.45 $4,975.39 2026-04-23
22818 HCPCS Removal Of 1-2 Spine Bones To Correct Outward Curving Spine Deformity 50 34 $6,879.00 $6,879.00 $1,764.30 $7,222.95 $4,968.17 2026-04-23
L5595 HCPCS Preparatory, Hip Disarticulation-hemipelvectomy, Pylon, No Cover, Sach Foot, The… 50 34 $8,637.00 $8,637.00 $2,614.81 $8,637.00 $4,967.83 2026-04-23
126857_ERX CDM Revatio 10 Mg/ml Oral Susp 26 22 $24,239.23 $24,239.23 $10,665.26 $19,391.38 $4,928.05 2026-02-09
L6300 HCPCS Shoulder Disarticulation, Molded Socket, Shoulder Bulkhead, Humeral Section, Int… 50 34 $8,533.00 $8,533.00 $2,607.09 $8,533.00 $4,908.01 2026-04-23
L5781 HCPCS Addition To Lower Limb Prosthesis, Vacuum Pump, Residual Limb Volume Management … 50 34 $8,679.00 $8,679.00 $2,846.71 $8,679.00 $4,885.33 2026-04-23
27365 HCPCS Extensive Removal Of Growth Of Thigh Or Knee Bone 50 34 $6,701.00 $6,701.00 $1,673.65 $7,036.05 $4,839.61 2026-04-23
L6350 HCPCS Interscapular Thoracic, Molded Socket, Shoulder Bulkhead, Humeral Section, Inter… 50 34 $8,402.00 $8,402.00 $2,554.34 $8,402.00 $4,832.66 2026-04-23
27078 HCPCS Extensive Removal Of Growth Of Base Of Pelvis And Upper End Of Thigh Bone 50 34 $6,647.00 $6,647.00 $1,680.66 $6,979.35 $4,800.61 2026-04-23
20697 HCPCS Placement Of Multiple Direction External Bone Stabilizing Device To Arm Or Leg U… 50 34 $6,647.00 $6,647.00 $1,653.72 $6,979.35 $4,800.61 2026-04-23
22861 HCPCS Revision Of Total Disc Replacement In Upper Back 50 34 $6,637.00 $6,637.00 $25.60 $6,968.85 $4,793.39 2026-04-23
23550 HCPCS Treatment Of Dislocated Joint Between Collar Bone And Shoulder 96 34 $11,729.00 $11,729.00 $426.76 $19,622.47 $4,779.72 2026-04-23
21182 HCPCS Reconstruction Of Eye, Forehead, And Nose Bones With Removal Of Growth With Bone… 50 34 $6,599.00 $6,599.00 $1,719.40 $6,928.95 $4,765.94 2026-04-23
L5321 HCPCS Above Knee, Molded Socket, Open End, Sach Foot, Endoskeletal System, Single Axis… 50 34 $8,253.00 $8,253.00 $2,706.98 $8,253.00 $4,746.96 2026-04-23
L8699 HCPCS Prosthetic Implant, Not Otherwise Specified 2,450 34 $27,328.00 $27,328.00 $40.00 $27,328.00 $4,737.08 2026-04-23
L5814 HCPCS Addition, Endoskeletal Knee-shin System, Polycentric, Hydraulic Swing Phase Cont… 50 34 $8,055.00 $8,055.00 $2,642.04 $8,055.00 $4,729.09 2026-04-23
L5980 HCPCS All Lower Extremity Prostheses, Flex Foot System 50 34 $8,413.00 $8,413.00 $2,500.00 $8,413.00 $4,727.47 2026-04-23
L6550 HCPCS Shoulder Disarticulation, Molded Socket, Endoskeletal System, Including Soft Pro… 50 34 $8,180.00 $8,180.00 $2,487.09 $8,180.00 $4,704.97 2026-04-23
L6624 HCPCS Upper Extremity Addition, Flexion/extension And Rotation Wrist Unit 50 34 $8,168.00 $8,168.00 $2,679.10 $8,168.00 $4,698.07 2026-04-23
22548 HCPCS Fusion Of Spine Bones At Base Of Neck, Oral Approach 50 34 $6,488.00 $6,488.00 $1,615.55 $6,812.40 $4,685.78 2026-04-23
21151 HCPCS Reconstruction Of Midface Bones With Bone Graft (LeFort Ii) 50 34 $6,482.00 $6,482.00 $1,472.97 $6,806.10 $4,681.44 2026-04-23
L7259 HCPCS Electronic Wrist Rotator, Any Type 50 34 $8,268.00 $8,268.00 $2,711.90 $8,268.00 $4,653.98 2026-04-23
27134 HCPCS Revision Of Thigh Bone And Hip Joint Prosthesis 50 34 $6,437.00 $6,437.00 $1,551.55 $6,758.85 $4,648.94 2026-04-23
L5200 HCPCS Above Knee, Molded Socket, Single Axis Constant Friction Knee, Shin, Sach Foot 50 34 $8,123.00 $8,123.00 $2,652.11 $8,123.00 $4,642.85 2026-04-23
22810 HCPCS Fusion Of Spine Bones For Correction Of Deformity, Anterior Approach, 4 To 7 Ver… 50 34 $6,424.00 $6,424.00 $1,691.89 $6,745.20 $4,639.56 2026-04-23
L7040 HCPCS Prehensile Actuator, Switch Controlled 50 34 $8,064.00 $8,064.00 $2,644.99 $8,064.00 $4,638.25 2026-04-23
22802 HCPCS Fusion Of Spine Bones For Correction Of Deformity, Posterior Approach, 7 To 12 V… 50 34 $6,656.00 $6,656.00 $1,715.19 $6,988.80 $4,633.66 2026-04-23
22864 HCPCS Revision Of Artificial Upper Spine Disc, Cervical 50 34 $6,392.00 $6,392.00 $25.60 $6,711.60 $4,616.44 2026-04-23
L5312 HCPCS Knee Disarticulation (or Through Knee), Molded Socket, Single Axis Knee, Pylon, … 50 34 $7,981.00 $7,981.00 $2,547.39 $7,981.00 $4,599.95 2026-04-23
11300000 CDM Room & Board - Private (one Bed) - Pediatric 46 32 $4,705.00 $4,705.00 $2,634.80 $9,250.00 $4,589.59 2026-04-23
21263 HCPCS Repositioning Of Cheek Bone Prominence With Forehead Advancement 50 34 $6,342.00 $6,342.00 $1,847.38 $6,659.10 $4,580.33 2026-04-23
27228 HCPCS Treatment Of Broken Bones Of Front And Back Column Or Wall Of Hip Socket With Pl… 50 34 $6,342.00 $6,342.00 $1,525.73 $6,659.10 $4,580.33 2026-04-23
C1889 HCPCS Implantable/insertable Device, Not Otherwise Classified 6,350 34 $89,700.00 $89,700.00 $4.17 $89,700.00 $4,567.96 2026-04-23
L6026 HCPCS Transcarpal/metacarpal Or Partial Hand Disarticulation Prosthesis, External Powe… 50 34 $8,073.00 $8,073.00 $2,647.94 $8,073.00 $4,544.22 2026-04-23
0656T OTHER Tethering Of 7 Or Fewer Lower Spine Bones 50 34 $6,393.00 $6,393.00 $24.00 $6,712.65 $4,539.03 2026-04-23
L5968 HCPCS Addition To Lower Limb Prosthesis, Multiaxial Ankle With Swing Phase Active Dors… 50 34 $7,882.00 $7,882.00 $2,585.30 $7,882.00 $4,533.57 2026-04-23
23220 HCPCS Extensive Removal Of Growth Of Upper End Of Upper Arm 50 34 $6,266.00 $6,266.00 $1,581.03 $6,579.30 $4,525.44 2026-04-23
L6205 HCPCS Elbow Disarticulation, Molded Socket With Expandable Interface, Outside Locking … 50 34 $7,812.00 $7,812.00 $2,362.09 $7,812.00 $4,493.31 2026-04-23
22633 HCPCS Fusion Of Spine In Lower Back With Partial Removal Of Spine Bone And Disc 50 34 $6,186.00 $6,186.00 $1,511.42 $6,495.30 $4,467.67 2026-04-23
19367 HCPCS Reconstruction Of Breast With Abdominal Muscle Flap 50 34 $6,122.00 $6,122.00 $1,445.46 $6,428.10 $4,421.44 2026-04-23
21172 HCPCS Reconstruction Of Outer Side Of Eye And Lower Forehead Bones 50 34 $6,110.00 $6,110.00 $1,707.89 $6,415.50 $4,412.78 2026-04-23
0657T OTHER Tethering Of 8 Or More Lower Spine Bones 50 34 $6,198.00 $6,198.00 $24.00 $6,507.90 $4,400.58 2026-04-23
S2115 HCPCS Osteotomy, Periacetabular, With Internal Fixation 50 34 $6,174.00 $6,174.00 $24.00 $6,482.70 $4,383.54 2026-04-23
21268 HCPCS Repositioning Of Eye Bone From Inside And Outside Skull With Bone Graft 50 34 $6,059.00 $6,059.00 $1,653.44 $6,361.95 $4,375.94 2026-04-23
20822 HCPCS Reattachment Of Part Of Cutoff Finger 50 34 $6,053.00 $6,053.00 $1,439.29 $6,355.65 $4,371.61 2026-04-23
21603 HCPCS Removal Of Growth Of Chest Wall And Rib With Reconstruction And Removal Of Lymph… 50 34 $6,047.00 $6,047.00 $24.00 $6,349.35 $4,367.28 2026-04-23
22319 HCPCS Treatment Of Broken Or Dislocated Uppermost Spine Bone With Placement Of Stabili… 50 34 $6,039.00 $6,039.00 $1,504.96 $6,340.95 $4,361.50 2026-04-23
20827 HCPCS Reattachment Of Part Of Cutoff Thumb 50 34 $6,030.00 $6,030.00 $1,478.58 $6,331.50 $4,355.00 2026-04-23
27059 HCPCS Extensive Removal Of Growth Of Pelvis And Hip, 5.0 Cm Or More 50 34 $6,024.00 $6,024.00 $1,477.74 $6,325.20 $4,350.67 2026-04-23
L5220 HCPCS Above Knee, Short Prosthesis, No Knee Joint ('stubbies'), With Articulated Ankle… 50 34 $7,542.00 $7,542.00 $2,204.80 $7,542.00 $4,338.01 2026-04-23
L5840 HCPCS Addition, Endoskeletal Knee/shin System, 4-bar Linkage Or Multiaxial, Pneumatic … 50 34 $7,525.00 $7,525.00 $1,695.94 $7,525.00 $4,299.82 2026-04-23
22586 HCPCS Fusion Of Lower Spine Or Sacral Bone With Removal Of Disc Using Image Guidance 50 34 $5,948.00 $5,948.00 $1,673.37 $6,245.40 $4,295.78 2026-04-23
L0830 HCPCS Halo Procedure, Cervical Halo Incorporated Into Milwaukee Type Orthosis 50 34 $7,453.00 $7,453.00 $2,198.97 $7,453.00 $4,286.82 2026-04-23
L5105 HCPCS Below Knee, Plastic Socket, Joints And Thigh Lacer, Sach Foot 50 34 $7,452.00 $7,452.00 $2,399.36 $7,452.00 $4,286.24 2026-04-23
22532 HCPCS Fusion Of Middle Spine Bone Through Side With Partial Removal Of Disc, 1 Bone 50 34 $5,931.00 $5,931.00 $1,470.72 $6,227.55 $4,283.50 2026-04-23
61563 HCPCS Removal Of Growth Of Skull Bone 50 34 $5,925.00 $5,925.00 $1,606.85 $6,221.25 $4,279.17 2026-04-23
27487 HCPCS Revision Of Thigh And Lower Leg Bone Components Of Total Knee Joint Prosthesis 50 34 $5,900.00 $5,900.00 $1,423.85 $6,195.00 $4,261.11 2026-04-23
36578 HCPCS Replacement Of Central Venous Tube, Tube Only 50 34 $7,846.00 $7,846.00 $50.00 $8,724.59 $4,251.19 2026-04-23
21146 HCPCS Repair Of Midface Bones With Bone Graft, 2 Bones 50 34 $5,874.00 $5,874.00 $1,352.84 $6,167.70 $4,242.33 2026-04-23
L5701 HCPCS Replacement, Socket, Above Knee/knee Disarticulation, Including Attachment Plate… 50 34 $7,380.00 $7,380.00 $2,388.59 $7,380.00 $4,242.32 2026-04-23
L5930 HCPCS Addition, Endoskeletal System, High Activity Knee Control Frame 50 34 $7,302.00 $7,302.00 $2,395.06 $7,302.00 $4,199.96 2026-04-23
27645 HCPCS Extensive Removal Of Growth Of Shin Bone 50 34 $5,763.00 $5,763.00 $1,443.78 $6,051.15 $4,162.17 2026-04-23
22808 HCPCS Fusion Of Spine Bones For Correction Of Deformity, Anterior Approach, 2 To 3 Ver… 50 34 $5,760.00 $5,760.00 $1,508.89 $6,048.00 $4,160.00 2026-04-23
22551 HCPCS Fusion Of Upper Spine Bone With Removal Of Disc And Release Of Spinal Cord Or Ne… 50 34 $5,748.00 $5,748.00 $1,393.82 $6,035.40 $4,151.33 2026-04-23
Q4122 HCPCS Dermacell, Dermacell Awm Or Dermacell Awm Porous, Per Square Centimeter 200 34 $13,040.72 $13,040.72 $434.00 $13,040.72 $4,143.97 2026-04-23
63085 HCPCS Removal Of Middle Spine Bone With Release Of Spinal Cord And/or Nerves, Transtho… 50 34 $5,728.00 $5,728.00 $1,564.19 $6,014.40 $4,136.89 2026-04-23
23210 HCPCS Extensive Removal Of Growth Of Shoulder Blade 50 34 $5,715.00 $5,715.00 $1,443.78 $6,000.75 $4,127.50 2026-04-23
21247 HCPCS Reconstruction Of Hinged Joint Of Jaw Bones With Insertion Of Rib Cartilage 50 34 $5,646.00 $5,646.00 $1,328.42 $5,928.30 $4,077.67 2026-04-23
L6250 HCPCS Above Elbow, Molded Double Wall Socket, Internal Locking Elbow, Forearm 50 34 $7,087.00 $7,087.00 $2,262.60 $7,087.00 $4,076.30 2026-04-23
21243 HCPCS Repair Of Hinged Joint Of Upper And Lower Jaw Bones With Prosthesis 50 34 $5,626.00 $5,626.00 $1,373.05 $5,907.30 $4,063.22 2026-04-23
L6648 HCPCS Upper Extremity Addition, Shoulder Lock Mechanism, External Powered Actuator 50 34 $7,056.00 $7,056.00 $2,314.37 $7,056.00 $4,058.47 2026-04-23
27132 HCPCS Total Hip Replacement After Previous Hip Surgery 50 34 $5,617.00 $5,617.00 $1,356.49 $5,897.85 $4,056.72 2026-04-23
22533 HCPCS Fusion Of Lower Spine Bone Through Side With Partial Removal Of Disc, 1 Bone 50 34 $5,601.00 $5,601.00 $1,350.59 $5,881.05 $4,045.17 2026-04-23
21150 HCPCS Reconstruction Of Midface Bones (LeFort Ii) 50 34 $5,595.00 $5,595.00 $1,338.24 $5,874.75 $4,040.83 2026-04-23
29868 HCPCS Repair Of Knee Cartilage With Donor Cartilage Graft Using An Endoscope 50 34 $5,592.00 $5,592.00 $1,358.45 $5,871.60 $4,038.67 2026-04-23
22210 HCPCS Incision Or Removal Of Upper Spine Bone Segment 50 34 $5,587.00 $5,587.00 $1,461.18 $5,866.35 $4,035.06 2026-04-23
21433 HCPCS Complicated Repair Of Broken Face And Skull Bones 50 34 $5,586.00 $5,586.00 $1,408.13 $5,865.30 $4,034.33 2026-04-23
21147 HCPCS Repair Of Midface Bones With Bone Graft, 3 Or More Bones 50 34 $5,579.00 $5,579.00 $1,426.94 $5,857.95 $4,029.28 2026-04-23
27227 HCPCS Treatment Of Broken Bones Of Front Or Back Column Of Hip Socket Or Across Hip So… 50 34 $5,556.00 $5,556.00 $1,345.82 $5,833.80 $4,012.67 2026-04-23
22556 HCPCS Fusion Of Middle Spine Bone Through Side Of Chest With Partial Removal Of Disc 50 34 $5,547.00 $5,547.00 $1,363.50 $5,824.35 $4,006.17 2026-04-23
22856 HCPCS Insertion Of Artificial Upper Spine Disc, Anterior Approach 50 34 $5,541.00 $5,541.00 $25.60 $5,818.05 $4,001.83 2026-04-23
15946 HCPCS Removal Of Pressure Sore And Lower Pelvic Bone In Preparation Of Muscle Flap Or … 50 34 $5,541.00 $5,541.00 $1,321.68 $5,818.05 $4,001.83 2026-04-23
22857 HCPCS Insertion Of Artificial Disc Between Bones Of Lower Spine, Single Space 50 34 $5,535.00 $5,535.00 $25.60 $5,811.75 $3,997.50 2026-04-23
22837 HCPCS Tethering Of 8 Or More Middle Spine Bones 37 29 $5,563.00 $5,563.00 $3,226.54 $5,841.15 $3,996.80 2026-04-23
27286 HCPCS Fusion Of Hip Joint With Incision Or Partial Removal Of Thigh Bone Below Neck 50 34 $5,528.00 $5,528.00 $1,340.21 $5,804.40 $3,992.44 2026-04-23
27412 HCPCS Implantation Of Self Cartilage Into Knee Joint 50 34 $5,518.00 $5,518.00 $1,341.61 $5,793.90 $3,985.22 2026-04-23
L1005 HCPCS Tension Based Scoliosis Orthosis And Accessory Pads, Includes Fitting And Adjust… 50 34 $6,928.00 $6,928.00 $2,272.38 $6,928.00 $3,984.85 2026-04-23
63272 HCPCS Removal Of Growth Of Lower Spine Bone Within Spine Membrane 50 34 $5,515.00 $5,515.00 $1,532.19 $5,790.75 $3,983.06 2026-04-23
21602 HCPCS Removal Of Growth Of Chest Wall And Rib With Reconstruction 50 34 $5,493.00 $5,493.00 $24.00 $5,767.65 $3,967.17 2026-04-23
15841 HCPCS Muscle Graft To Treat Facial Paralysis 50 34 $5,490.00 $5,490.00 $1,447.43 $5,764.50 $3,965.00 2026-04-23
L6310 HCPCS Shoulder Disarticulation, Passive Restoration (complete Prosthesis) 50 34 $6,852.00 $6,852.00 $2,162.15 $6,852.00 $3,941.13 2026-04-23
19361 HCPCS Reconstruction Of Breast With Shoulder Muscle Tissue Graft 50 34 $5,452.00 $5,452.00 $1,275.93 $5,724.60 $3,937.56 2026-04-23
L6646 HCPCS Upper Extremity Addition, Shoulder Joint, Multipositional Locking, Flexion, Adju… 50 34 $6,840.00 $6,840.00 $2,243.52 $6,840.00 $3,934.23 2026-04-23
L6360 HCPCS Interscapular Thoracic, Passive Restoration (complete Prosthesis) 50 34 $6,832.00 $6,832.00 $2,240.90 $6,832.00 $3,929.63 2026-04-23
L6885 HCPCS Replacement Socket, Shoulder Disarticulation/interscapular Thoracic, Molded To P… 50 34 $6,832.00 $6,832.00 $2,240.90 $6,832.00 $3,929.63 2026-04-23
21188 HCPCS Reconstruction Of Midface Bones With Bone Graft 50 34 $5,419.00 $5,419.00 $1,354.80 $5,689.95 $3,913.72 2026-04-23
27156 HCPCS Incision And Reshaping Of Part Of Hip And Thigh Bones And Repair Of Dislocated H… 50 34 $5,419.00 $5,419.00 $1,391.29 $5,689.95 $3,913.72 2026-04-23
22318 HCPCS Treatment Of Broken Or Dislocated Uppermost Spine Bone With Placement Of Stabili… 50 34 $5,419.00 $5,419.00 $1,337.40 $5,689.95 $3,913.72 2026-04-23
L6200 HCPCS Elbow Disarticulation, Molded Socket, Outside Locking Hinge, Forearm 50 34 $6,833.00 $6,833.00 $2,157.71 $6,833.00 $3,908.98 2026-04-23
L5826 HCPCS Addition, Endoskeletal Knee-shin System, Single Axis, Hydraulic Swing Phase Cont… 50 34 $6,774.00 $6,774.00 $2,221.87 $6,774.00 $3,896.27 2026-04-23
27290 HCPCS Amputation Of Pelvic Structures 50 34 $5,385.00 $5,385.00 $1,319.44 $5,654.25 $3,889.17 2026-04-23
20982 HCPCS Destruction Of Growths And Adjacent Soft Tissue 96 34 $9,343.00 $9,343.00 $296.95 $19,622.47 $3,880.69 2026-04-23
L6882 HCPCS Microprocessor Control Feature, Addition To Upper Limb Prosthetic Terminal Devic… 50 34 $6,726.00 $6,726.00 $2,206.13 $6,726.00 $3,868.66 2026-04-23
27091 HCPCS Removal Of Hip Prosthesis, Complicated 50 34 $5,344.00 $5,344.00 $1,293.06 $5,611.20 $3,859.56 2026-04-23
27284 HCPCS Fusion Of Hip Joint 50 34 $5,344.00 $5,344.00 $1,312.70 $5,611.20 $3,859.56 2026-04-23
30462 HCPCS Revision Of Congenital Nasal Defect With Lengthening Of Tip Of Nose 50 34 $5,331.00 $5,331.00 $1,124.09 $5,597.55 $3,850.17 2026-04-23
L6500 HCPCS Above Elbow, Molded Socket, Endoskeletal System, Including Soft Prosthetic Tissu… 50 34 $6,672.00 $6,672.00 $2,053.82 $6,672.00 $3,837.60 2026-04-23
21180 HCPCS Reconstruction Of Forehead And/or Upper Eye Bones With Bone Graft 50 34 $5,296.00 $5,296.00 $1,376.98 $5,560.80 $3,824.89 2026-04-23
21344 HCPCS Treatment Of Complicated Broken Front Sinus Bone 50 34 $5,287.00 $5,287.00 $1,114.55 $5,551.35 $3,818.39 2026-04-23
L6450 HCPCS Elbow Disarticulation, Molded Socket, Endoskeletal System, Including Soft Prosth… 50 34 $6,613.00 $6,613.00 $1,993.94 $6,613.00 $3,803.67 2026-04-23
21267 HCPCS Reconstruction Of Eye Bone From Outside Skull With Bone Graft 50 34 $5,251.00 $5,251.00 $1,320.56 $5,513.55 $3,792.39 2026-04-23
27364 HCPCS Extensive Removal Of Growth Of Thigh Or Knee, 5.0 Cm Or More 50 34 $5,226.00 $5,226.00 $1,269.20 $5,487.30 $3,774.33 2026-04-23
63276 HCPCS Removal Or Biopsy Of Growth Of Middle Spine Bone Outside Spine Membrane 50 34 $5,222.00 $5,222.00 $1,451.92 $5,483.10 $3,771.44 2026-04-23
21145 HCPCS Reconstruction Of Midface Bones With Bone Graft, Single Piece (LeFort I) 50 34 $5,191.00 $5,191.00 $1,297.83 $5,450.55 $3,749.06 2026-04-23
30450 HCPCS Revision To Reshape Nasal Bones And Tip Of Nose After Previous Repair 50 34 $5,175.00 $5,175.00 $1,188.08 $5,433.75 $3,737.50 2026-04-23
21080 HCPCS Preparation Of Permanent Prosthesis To Close Mouth Opening 50 34 $5,169.00 $5,169.00 $1,217.56 $5,427.45 $3,733.17 2026-04-23
27447 HCPCS Replacement Of Knee Joint, Both Sides Of Knee 50 34 $5,153.00 $5,153.00 $1,096.59 $5,410.65 $3,721.61 2026-04-23
L6588 HCPCS Preparatory, Shoulder Disarticulation Or Interscapular Thoracic, Single Wall Pla… 50 34 $6,469.00 $6,469.00 $2,076.56 $6,469.00 $3,720.84 2026-04-23
22630 HCPCS Fusion Of Lower Spine Bone And Partial Removal Of Spine Bone Or Disc Through Bac… 50 34 $5,149.00 $5,149.00 $1,285.48 $5,406.45 $3,718.72 2026-04-23
27138 HCPCS Revision Of Thigh Bone Prosthesis 50 34 $5,140.00 $5,140.00 $1,238.89 $5,397.00 $3,712.22 2026-04-23
21086 HCPCS Impression And Custom Preparation Of Outer Ear Prosthesis 50 34 $5,131.00 $5,131.00 $1,200.43 $5,387.55 $3,705.72 2026-04-23
22612 HCPCS Fusion Of Spine In Lower Back 50 34 $5,131.00 $5,131.00 $1,292.78 $5,387.55 $3,705.72 2026-04-23
L5783 HCPCS Addition To Lower Extremity, User Adjustable, Mechanical, Residual Limb Volume M… 49 33 $6,575.00 $6,575.00 $2,156.60 $6,575.00 $3,695.74 2026-04-23
22590 HCPCS Fusion Of Skull And First 2 Upper Spine Bones Through Back 50 34 $5,114.00 $5,114.00 $1,290.81 $5,369.70 $3,693.44 2026-04-23
19357 HCPCS Reconstruction Of Breast Using Tissue Expander 50 34 $5,112.00 $5,112.00 $1,154.20 $5,367.60 $3,692.00 2026-04-23
22220 HCPCS Incision Or Removal Of Upper Spine Bone Segment And Removal Of Disc 50 34 $5,103.00 $5,103.00 $1,320.28 $5,358.15 $3,685.50 2026-04-23
21087 HCPCS Impression And Custom Preparation Of Nasal Prosthesis 50 34 $5,089.00 $5,089.00 $1,200.43 $5,343.45 $3,675.39 2026-04-23
J7189 HCPCS Factor Viia (antihemophilic Factor, Recombinant), (novoseven Rt), 1 Microgram 26 22 $6,936.90 $6,936.90 $3.18 $5,549.52 $3,653.61 2026-02-09
L6590 HCPCS Preparatory, Shoulder Disarticulation Or Interscapular Thoracic, Single Wall Soc… 50 34 $6,345.00 $6,345.00 $1,987.15 $6,345.00 $3,649.52 2026-04-23
26650 HCPCS Placement Of Stabilizing Device For Broken Thumb At Wrist With Manipulation 50 34 $5,052.00 $5,052.00 $385.64 $5,304.60 $3,648.67 2026-04-23
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