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 — reason	Rows
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 via	CMS hospital list
Last fetch	not_modified · 2026-10-09
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.

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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
C1768	HCPCS	Graft, Vascular	50	34	$17,880.00	$17,880.00	$4,470.00	$17,880.00	$9,985.46	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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
C2618	HCPCS	Probe/needle, Cryoablation	50	34	$10,600.00	$10,600.00	$552.93	$10,600.00	$5,891.43	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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
36000001	CDM	Operating Room Services - General Classification	50	34	$739.00	$739.00	$242.39	$591.20	$7,110.35	2026-04-23

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