Hospital

TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN

Dallas, TX · CCN 453314 · Rates published

5,046 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 · 2026-10-12
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
L7180 HCPCS	Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device	42	$28,740.02	$87,622.00	$53,887.53	nat. median $42,745 1.3× median
L7181 HCPCS	Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi…	42	$28,506.48	$86,910.00	$53,449.65	nat. median $48,410 1.1× median
L2006 HCPCS	Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance…	42	$27,059.02	$82,497.00	$50,735.65	nat. median $38,763 1.3× median
L6880 HCPCS	Electric Hand, Switch Or Myoelectric Controlled, Independently Articulating Digi…	42	$17,087.82	$52,097.00	$32,039.65	nat. median $28,867 1.1× median
L5856 HCPCS	Addition To Lower Extremity Prosthesis, Endoskeletal Knee-shin System, Microproc…	42	$17,078.63	$52,069.00	$32,022.43	nat. median $29,004 1.1× median
J0638 HCPCS	Injection, Canakinumab, 1 Mg	26	$194.27	$51,648.38	$28,406.61	nat. median $235 outlier · 121.0×
L6975 HCPCS	Interscapular-thoracic, External Power, Molded Inner Socket, Removable Shoulder…	42	$13,586.74	$41,423.00	$25,475.15	nat. median $21,202 1.2× median
L6970 HCPCS	Interscapular-thoracic, External Power, Molded Inner Socket, Removable Shoulder…	42	$13,514.26	$41,202.00	$25,339.23	nat. median $19,306 1.3× median
L6965 HCPCS	Shoulder Disarticulation, External Power, Molded Inner Socket, Removable Shoulde…	42	$13,295.48	$40,535.00	$24,929.03	nat. median $18,144 1.4× median
L5858 HCPCS	Addition To Lower Extremity Prosthesis, Endoskeletal Knee Shin System, Microproc…	42	$9,084.77	$40,311.00	$24,791.26	nat. median $22,455 1.1× median
L5973 HCPCS	Endoskeletal Ankle Foot System, Microprocessor Controlled Feature, Dorsiflexion…	42	$12,240.30	$37,318.00	$22,950.57	nat. median $21,313 1.1× median
L6955 HCPCS	Above Elbow, External Power, Molded Inner Socket, Removable Humeral Shell, Inter…	42	$9,230.25	$28,141.00	$17,306.72	nat. median $14,649 1.2× median
L6960 HCPCS	Shoulder Disarticulation, External Power, Molded Inner Socket, Removable Shoulde…	42	$9,101.34	$27,748.00	$17,065.02	nat. median $15,937 1.1× median
Q4104 HCPCS	Integra Bilayer Matrix Wound Dressing (bmwd), Per Square Centimeter	42	$6,023.00	$38,000.00	$16,720.00	nat. median $1,013 outlier · 16.5×
L7191 HCPCS	Electronic Elbow, Child, Variety Village Or Equal, Myoelectronically Controlled	42	$8,545.06	$26,052.00	$16,021.98	nat. median $12,134 1.3× median
L7186 HCPCS	Electronic Elbow, Child, Variety Village Or Equal, Switch Controlled	42	$8,039.28	$24,510.00	$15,073.65	nat. median $11,405 1.3× median
L6945 HCPCS	Elbow Disarticulation, External Power, Molded Inner Socket, Removable Humeral Sh…	42	$7,826.08	$23,860.00	$14,673.90	nat. median $13,336 1.1× median
L6950 HCPCS	Above Elbow, External Power, Molded Inner Socket, Removable Humeral Shell, Inter…	42	$7,355.40	$22,425.00	$13,791.38	nat. median $12,453 1.1× median
L7190 HCPCS	Electronic Elbow, Adolescent, Variety Village Or Equal, Myoelectronically Contro…	42	$7,087.10	$21,607.00	$13,288.31	nat. median $9,681 1.4× median
L6940 HCPCS	Elbow Disarticulation, External Power, Molded Inner Socket, Removable Humeral Sh…	42	$6,918.18	$21,092.00	$12,971.58	nat. median $11,589 1.1× median
L6935 HCPCS	Below Elbow, External Power, Self-suspended Inner Socket, Removable Forearm Shel…	42	$6,088.99	$18,564.00	$11,416.86	nat. median $10,753 1.1× median
L5857 HCPCS	Addition To Lower Extremity Prosthesis, Endoskeletal Knee-shin System, Microproc…	42	$6,060.46	$18,477.00	$11,363.35	nat. median $10,299 1.1× median
126857_ERX CDM	Revatio 10 Mg/ml Oral Susp	26	$10,665.26	$19,391.38	$11,091.87	—
L7185 HCPCS	Electronic Elbow, Adolescent, Variety Village Or Equal, Switch Controlled	42	$5,569.77	$16,981.00	$10,443.31	nat. median $8,183 1.3× median
L6930 HCPCS	Below Elbow, External Power, Self-suspended Inner Socket, Removable Forearm Shel…	42	$5,535.98	$16,878.00	$10,379.97	nat. median $8,815 1.2× median
C1768 HCPCS	Graft, Vascular	42	$4,470.00	$17,880.00	$10,370.40	nat. median $2,193 outlier · 4.7×
L7170 HCPCS	Electronic Elbow, Hosmer Or Equal, Switch Controlled	42	$5,500.56	$16,770.00	$10,313.55	nat. median $7,645 1.3× median
L6925 HCPCS	Wrist Disarticulation, External Power, Self-suspended Inner Socket, Removable Fo…	42	$5,444.47	$16,599.00	$10,208.39	nat. median $10,759 0.9× median
20808 HCPCS	Reattachment Of Cutoff Hand	42	$3,222.11	$14,049.00	$10,035.00	nat. median $13,221 0.8× median
L6920 HCPCS	Wrist Disarticulation, External Power, Self-suspended Inner Socket, Removable Fo…	42	$5,156.16	$15,720.00	$9,667.80	nat. median $9,035 1.1× median
L5987 HCPCS	All Lower Extremity Prosthesis, Shank Foot System With Vertical Loading Pylon	42	$5,117.78	$15,603.00	$9,595.85	nat. median $8,684 1.1× median
L7008 HCPCS	Electric Hand, Switch Or Myoelectric, Controlled, Pediatric	42	$5,081.05	$15,491.00	$9,526.97	nat. median $6,838 1.4× median
12480_SUP CDM	Plate Custom Infant Lcb 30mm 18 Hole	42	$4,511.50	$14,436.80	$8,600.73	—
12481_SUP CDM	Plate Custom Infant Lcb 35mm 18hole	42	$4,511.50	$14,436.80	$8,600.73	—
26554 HCPCS	Transfer Of 2 Toes To Hand	42	$3,079.53	$11,278.05	$8,055.75	nat. median $7,475 1.1× median
L5341 HCPCS	Hemipelvectomy, Canadian Type, Molded Socket, Endoskeletal System, Hip Joint, Si…	42	$4,253.50	$12,968.00	$7,975.32	nat. median $6,509 1.2× median
L5280 HCPCS	Hemipelvectomy, Canadian Type; Molded Socket, Hip Joint, Single Axis Constant Fr…	42	$3,904.83	$12,519.00	$7,699.19	nat. median $6,429 1.2× median
L5331 HCPCS	Hip Disarticulation, Canadian Type, Molded Socket, Endoskeletal System, Hip Join…	42	$4,075.40	$12,425.00	$7,641.38	nat. median $6,253 1.2× median
L5250 HCPCS	Hip Disarticulation, Canadian Type; Molded Socket, Hip Joint, Single Axis Consta…	42	$3,804.80	$12,102.00	$7,442.73	nat. median $6,543 1.1× median
26551 HCPCS	Transfer Of Great Toe To Hand	42	$2,656.00	$10,367.70	$7,405.50	nat. median $7,385 1.0× median
C1776 HCPCS	Joint Device (implantable)	42	$202.82	$37,492.00	$7,288.56	nat. median $3,543 outlier · 2.1×
26556 HCPCS	Transfer Of Toe And Joint To Finger	42	$2,741.88	$10,136.70	$7,240.50	nat. median $7,578 1.0× median
20805 HCPCS	Reattachment Of Cutoff Forearm	42	$2,663.30	$10,067.40	$7,191.00	nat. median $13,221 0.5× median
20969 HCPCS	Placement Of Skin And Bone Flap With Microvascular Connection	42	$2,221.24	$9,948.75	$7,106.25	nat. median $7,381 1.0× median
L5270 HCPCS	Hip Disarticulation, Tilt Table Type; Molded Socket, Locking Hip Joint, Single A…	42	$3,569.42	$11,500.00	$7,072.50	nat. median $6,442 1.1× median
19364 HCPCS	Reconstruction Of Breast With Tissue Graft	42	$2,237.52	$9,892.05	$7,065.75	nat. median $5,158 1.4× median
27077 HCPCS	Extensive Removal Of Growth Of Side Of Pelvic Bone	42	$2,303.48	$9,882.60	$7,059.00	nat. median $7,922 0.9× median
20970 HCPCS	Placement Of Bone And Skin Flap From Hip Bone With Connection Of Small Blood Ves…	42	$2,325.37	$9,820.65	$7,014.75	nat. median $7,416 0.9× median
20973 HCPCS	Placement Of Bone And Skin Flap From Big Toe With Connection Of Small Blood Vess…	42	$2,450.55	$9,742.95	$6,959.25	nat. median $7,193 1.0× median
99576_ERX CDM	Advate 2,401-3,600 Unit Vial	26	$6,608.95	$12,016.27	$6,873.31	—

Other procedures at this hospital

Browse this hospital's 5,046 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

L7180	HCPCS	Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device	50	42	$87,622.00	$87,622.00	$28,740.02	$87,622.00	$53,887.53	2026-04-23
L7181	HCPCS	Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi…	50	42	$86,910.00	$86,910.00	$28,506.48	$86,910.00	$53,449.65	2026-04-23
L2006	HCPCS	Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance…	50	42	$82,497.00	$82,497.00	$27,059.02	$82,497.00	$50,735.65	2026-04-23
L6880	HCPCS	Electric Hand, Switch Or Myoelectric Controlled, Independently Articulating Digi…	50	42	$52,097.00	$52,097.00	$17,087.82	$52,097.00	$32,039.65	2026-04-23
L5856	HCPCS	Addition To Lower Extremity Prosthesis, Endoskeletal Knee-shin System, Microproc…	50	42	$52,069.00	$52,069.00	$17,078.63	$52,069.00	$32,022.43	2026-04-23
L6975	HCPCS	Interscapular-thoracic, External Power, Molded Inner Socket, Removable Shoulder …	50	42	$41,423.00	$41,423.00	$13,586.74	$41,423.00	$25,475.15	2026-04-23
L6970	HCPCS	Interscapular-thoracic, External Power, Molded Inner Socket, Removable Shoulder …	50	42	$41,202.00	$41,202.00	$13,514.26	$41,202.00	$25,339.23	2026-04-23
L6965	HCPCS	Shoulder Disarticulation, External Power, Molded Inner Socket, Removable Shoulde…	50	42	$40,535.00	$40,535.00	$13,295.48	$40,535.00	$24,929.03	2026-04-23
L5973	HCPCS	Endoskeletal Ankle Foot System, Microprocessor Controlled Feature, Dorsiflexion …	50	42	$37,318.00	$37,318.00	$12,240.30	$37,318.00	$22,950.57	2026-04-23
126857_ERX	CDM	Revatio 10 Mg/ml Oral Susp	26	26	$24,239.23	$24,239.23	$10,665.26	$19,391.38	$11,091.87	2026-02-09
L6955	HCPCS	Above Elbow, External Power, Molded Inner Socket, Removable Humeral Shell, Inter…	50	42	$28,141.00	$28,141.00	$9,230.25	$28,141.00	$17,306.72	2026-04-23
L6960	HCPCS	Shoulder Disarticulation, External Power, Molded Inner Socket, Removable Shoulde…	50	42	$27,748.00	$27,748.00	$9,101.34	$27,748.00	$17,065.02	2026-04-23
L5858	HCPCS	Addition To Lower Extremity Prosthesis, Endoskeletal Knee Shin System, Microproc…	50	42	$40,311.00	$40,311.00	$9,084.77	$40,311.00	$24,791.26	2026-04-23
L7191	HCPCS	Electronic Elbow, Child, Variety Village Or Equal, Myoelectronically Controlled	50	42	$26,052.00	$26,052.00	$8,545.06	$26,052.00	$16,021.98	2026-04-23
L7186	HCPCS	Electronic Elbow, Child, Variety Village Or Equal, Switch Controlled	50	42	$24,510.00	$24,510.00	$8,039.28	$24,510.00	$15,073.65	2026-04-23
L6945	HCPCS	Elbow Disarticulation, External Power, Molded Inner Socket, Removable Humeral Sh…	50	42	$23,860.00	$23,860.00	$7,826.08	$23,860.00	$14,673.90	2026-04-23
L6950	HCPCS	Above Elbow, External Power, Molded Inner Socket, Removable Humeral Shell, Inter…	50	42	$22,425.00	$22,425.00	$7,355.40	$22,425.00	$13,791.38	2026-04-23
L7190	HCPCS	Electronic Elbow, Adolescent, Variety Village Or Equal, Myoelectronically Contro…	50	42	$21,607.00	$21,607.00	$7,087.10	$21,607.00	$13,288.31	2026-04-23
L6940	HCPCS	Elbow Disarticulation, External Power, Molded Inner Socket, Removable Humeral Sh…	50	42	$21,092.00	$21,092.00	$6,918.18	$21,092.00	$12,971.58	2026-04-23
99576_ERX	CDM	Advate 2,401-3,600 Unit Vial	26	26	$15,020.34	$15,020.34	$6,608.95	$12,016.27	$6,873.31	2026-02-09
L6935	HCPCS	Below Elbow, External Power, Self-suspended Inner Socket, Removable Forearm Shel…	50	42	$18,564.00	$18,564.00	$6,088.99	$18,564.00	$11,416.86	2026-04-23
L5857	HCPCS	Addition To Lower Extremity Prosthesis, Endoskeletal Knee-shin System, Microproc…	50	42	$18,477.00	$18,477.00	$6,060.46	$18,477.00	$11,363.35	2026-04-23
Q4104	HCPCS	Integra Bilayer Matrix Wound Dressing (bmwd), Per Square Centimeter	100	42	$31,046.00	$31,046.00	$6,023.00	$38,000.00	$16,720.00	2026-04-23
L7185	HCPCS	Electronic Elbow, Adolescent, Variety Village Or Equal, Switch Controlled	50	42	$16,981.00	$16,981.00	$5,569.77	$16,981.00	$10,443.31	2026-04-23
L6930	HCPCS	Below Elbow, External Power, Self-suspended Inner Socket, Removable Forearm Shel…	50	42	$16,878.00	$16,878.00	$5,535.98	$16,878.00	$10,379.97	2026-04-23
L7170	HCPCS	Electronic Elbow, Hosmer Or Equal, Switch Controlled	50	42	$16,770.00	$16,770.00	$5,500.56	$16,770.00	$10,313.55	2026-04-23
L6925	HCPCS	Wrist Disarticulation, External Power, Self-suspended Inner Socket, Removable Fo…	50	42	$16,599.00	$16,599.00	$5,444.47	$16,599.00	$10,208.39	2026-04-23
L6920	HCPCS	Wrist Disarticulation, External Power, Self-suspended Inner Socket, Removable Fo…	50	42	$15,720.00	$15,720.00	$5,156.16	$15,720.00	$9,667.80	2026-04-23
172329_ERX	CDM	Benlysta 200 Mg/ml Autoinject	26	26	$11,674.38	$11,674.38	$5,136.73	$9,339.50	$5,342.19	2026-02-09
L5987	HCPCS	All Lower Extremity Prosthesis, Shank Foot System With Vertical Loading Pylon	50	42	$15,603.00	$15,603.00	$5,117.78	$15,603.00	$9,595.85	2026-04-23
L7008	HCPCS	Electric Hand, Switch Or Myoelectric, Controlled, Pediatric	50	42	$15,491.00	$15,491.00	$5,081.05	$15,491.00	$9,526.97	2026-04-23
36000010	CDM	Operating Room Services - General Classification	50	42	$15,214.00	$15,214.00	$4,990.19	$12,171.20	$6,694.16	2026-04-23
36000008	CDM	Operating Room Services - General Classification	50	42	$14,819.00	$14,819.00	$4,860.63	$11,855.20	$6,520.36	2026-04-23
12481_SUP	CDM	Plate Custom Infant Lcb 35mm 18hole	50	42	$18,046.00	$18,046.00	$4,511.50	$14,436.80	$8,600.73	2026-04-23
12480_SUP	CDM	Plate Custom Infant Lcb 30mm 18 Hole	50	42	$18,046.00	$18,046.00	$4,511.50	$14,436.80	$8,600.73	2026-04-23
J0801	HCPCS	Injection, Corticotropin (acthar Gel), Up To 40 Units	21	21	$10,232.70	$10,232.70	$4,502.39	$8,186.16	$4,502.39	2026-02-09
C1768	HCPCS	Graft, Vascular	50	42	$17,880.00	$17,880.00	$4,470.00	$17,880.00	$10,370.40	2026-04-23
L5341	HCPCS	Hemipelvectomy, Canadian Type, Molded Socket, Endoskeletal System, Hip Joint, Si…	50	42	$12,968.00	$12,968.00	$4,253.50	$12,968.00	$7,975.32	2026-04-23
36000006	CDM	Operating Room Services - General Classification	50	42	$12,536.00	$12,536.00	$4,111.81	$10,028.80	$5,515.84	2026-04-23
L5331	HCPCS	Hip Disarticulation, Canadian Type, Molded Socket, Endoskeletal System, Hip Join…	50	42	$12,425.00	$12,425.00	$4,075.40	$12,425.00	$7,641.38	2026-04-23
L5280	HCPCS	Hemipelvectomy, Canadian Type; Molded Socket, Hip Joint, Single Axis Constant Fr…	50	42	$12,519.00	$12,519.00	$3,904.83	$12,519.00	$7,699.19	2026-04-23
L5250	HCPCS	Hip Disarticulation, Canadian Type; Molded Socket, Hip Joint, Single Axis Consta…	50	42	$12,102.00	$12,102.00	$3,804.80	$12,102.00	$7,442.73	2026-04-23
L5270	HCPCS	Hip Disarticulation, Tilt Table Type; Molded Socket, Locking Hip Joint, Single A…	50	42	$11,500.00	$11,500.00	$3,569.42	$11,500.00	$7,072.50	2026-04-23
L5961	HCPCS	Addition, Endoskeletal System, Polycentric Hip Joint, Pneumatic Or Hydraulic Con…	50	42	$10,281.00	$10,281.00	$3,372.17	$10,281.00	$6,322.81	2026-04-23
36000004	CDM	Operating Room Services - General Classification	50	42	$10,162.00	$10,162.00	$3,333.14	$8,129.60	$4,471.28	2026-04-23
L7009	HCPCS	Electric Hook, Switch Or Myoelectric Controlled, Adult	50	42	$10,042.00	$10,042.00	$3,293.78	$10,042.00	$6,175.83	2026-04-23
126579_ERX	CDM	Ryanodex 250 Mg Vial	50	42	$9,866.16	$9,866.16	$3,236.10	$7,892.93	$4,341.11	2026-04-23
L7007	HCPCS	Electric Hand, Switch Or Myoelectric Controlled, Adult	50	42	$9,842.00	$9,842.00	$3,228.18	$9,842.00	$6,052.83	2026-04-23
22837	HCPCS	Tethering Of 8 Or More Middle Spine Bones	37	33	$5,563.00	$5,563.00	$3,226.54	$5,841.15	$5,563.00	2026-04-23
20808	HCPCS	Reattachment Of Cutoff Hand	50	42	$13,380.00	$13,380.00	$3,222.11	$14,049.00	$10,035.00	2026-04-23
26554	HCPCS	Transfer Of 2 Toes To Hand	50	42	$10,741.00	$10,741.00	$3,079.53	$11,278.05	$8,055.75	2026-04-23
L5702	HCPCS	Replacement, Socket, Hip Disarticulation, Including Hip Joint, Molded To Patient…	50	42	$9,337.00	$9,337.00	$3,021.91	$9,337.00	$5,742.26	2026-04-23
L5782	HCPCS	Addition To Lower Limb Prosthesis, Vacuum Pump, Residual Limb Volume Management …	50	42	$9,149.00	$9,149.00	$3,000.87	$9,149.00	$5,626.64	2026-04-23
22836	HCPCS	Tethering Of 7 Or Fewer Middle Spine Bones	37	33	$5,135.00	$5,135.00	$2,978.30	$5,391.75	$5,135.00	2026-04-23
L5600	HCPCS	Preparatory, Hip Disarticulation-hemipelvectomy, Pylon, No Cover, Sach Foot, Lam…	50	42	$9,539.00	$9,539.00	$2,920.67	$9,539.00	$5,866.49	2026-04-23
L2005	HCPCS	Knee Ankle Foot Orthosis, Any Material, Single Or Double Upright, Stance Control…	50	42	$8,872.00	$8,872.00	$2,910.02	$8,872.00	$5,456.28	2026-04-23
L6881	HCPCS	Automatic Grasp Feature, Addition To Upper Limb Electric Prosthetic Terminal Dev…	50	42	$8,868.00	$8,868.00	$2,908.70	$8,868.00	$5,453.82	2026-04-23
L5160	HCPCS	Knee Disarticulation (or Through Knee), Molded Socket, Bent Knee Configuration, …	50	42	$9,347.00	$9,347.00	$2,864.71	$9,347.00	$5,748.41	2026-04-23
L5781	HCPCS	Addition To Lower Limb Prosthesis, Vacuum Pump, Residual Limb Volume Management …	50	42	$8,679.00	$8,679.00	$2,846.71	$8,679.00	$5,337.59	2026-04-23
L6570	HCPCS	Interscapular Thoracic, Molded Socket, Endoskeletal System, Including Soft Prost…	50	42	$9,388.00	$9,388.00	$2,802.70	$9,388.00	$5,773.62	2026-04-23
L5150	HCPCS	Knee Disarticulation (or Through Knee), Molded Socket, External Knee Joints, Shi…	50	42	$8,882.00	$8,882.00	$2,753.18	$8,882.00	$5,462.43	2026-04-23
C9352	HCPCS	Microporous Collagen Implantable Tube (neuragen Nerve Guide), Per Centimeter Len…	50	42	$10,996.00	$10,996.00	$2,749.00	$10,996.00	$6,377.68	2026-04-23
26556	HCPCS	Transfer Of Toe And Joint To Finger	50	42	$9,654.00	$9,654.00	$2,741.88	$10,136.70	$7,240.50	2026-04-23
L7259	HCPCS	Electronic Wrist Rotator, Any Type	50	42	$8,268.00	$8,268.00	$2,711.90	$8,268.00	$5,084.82	2026-04-23
L5321	HCPCS	Above Knee, Molded Socket, Open End, Sach Foot, Endoskeletal System, Single Axis…	50	42	$8,253.00	$8,253.00	$2,706.98	$8,253.00	$5,075.59	2026-04-23
L6624	HCPCS	Upper Extremity Addition, Flexion/extension And Rotation Wrist Unit	50	42	$8,168.00	$8,168.00	$2,679.10	$8,168.00	$5,023.32	2026-04-23
20805	HCPCS	Reattachment Of Cutoff Forearm	50	42	$9,588.00	$9,588.00	$2,663.30	$10,067.40	$7,191.00	2026-04-23
26551	HCPCS	Transfer Of Great Toe To Hand	50	42	$9,874.00	$9,874.00	$2,656.00	$10,367.70	$7,405.50	2026-04-23
L5200	HCPCS	Above Knee, Molded Socket, Single Axis Constant Friction Knee, Shin, Sach Foot	50	42	$8,123.00	$8,123.00	$2,652.11	$8,123.00	$4,995.65	2026-04-23
L6026	HCPCS	Transcarpal/metacarpal Or Partial Hand Disarticulation Prosthesis, External Powe…	50	42	$8,073.00	$8,073.00	$2,647.94	$8,073.00	$4,964.90	2026-04-23
L7040	HCPCS	Prehensile Actuator, Switch Controlled	50	42	$8,064.00	$8,064.00	$2,644.99	$8,064.00	$4,959.36	2026-04-23
L5814	HCPCS	Addition, Endoskeletal Knee-shin System, Polycentric, Hydraulic Swing Phase Cont…	50	42	$8,055.00	$8,055.00	$2,642.04	$8,055.00	$4,953.82	2026-04-23
26553	HCPCS	Transfer Of Toe To Hand	50	42	$8,654.00	$8,654.00	$2,638.04	$9,086.70	$6,490.50	2026-04-23
L5595	HCPCS	Preparatory, Hip Disarticulation-hemipelvectomy, Pylon, No Cover, Sach Foot, The…	50	42	$8,637.00	$8,637.00	$2,614.81	$8,637.00	$5,311.76	2026-04-23
L6300	HCPCS	Shoulder Disarticulation, Molded Socket, Shoulder Bulkhead, Humeral Section, Int…	50	42	$8,533.00	$8,533.00	$2,607.09	$8,533.00	$5,247.80	2026-04-23
36000002	CDM	Operating Room Services - General Classification	50	42	$7,905.00	$7,905.00	$2,592.84	$6,324.00	$3,478.20	2026-04-23
L5230	HCPCS	Above Knee, For Proximal Femoral Focal Deficiency, Constant Friction Knee, Shin,…	50	42	$8,939.00	$8,939.00	$2,588.51	$8,939.00	$5,497.49	2026-04-23
L5968	HCPCS	Addition To Lower Limb Prosthesis, Multiaxial Ankle With Swing Phase Active Dors…	50	42	$7,882.00	$7,882.00	$2,585.30	$7,882.00	$4,847.43	2026-04-23
L6350	HCPCS	Interscapular Thoracic, Molded Socket, Shoulder Bulkhead, Humeral Section, Inter…	50	42	$8,402.00	$8,402.00	$2,554.34	$8,402.00	$5,167.23	2026-04-23
L5312	HCPCS	Knee Disarticulation (or Through Knee), Molded Socket, Single Axis Knee, Pylon, …	50	42	$7,981.00	$7,981.00	$2,547.39	$7,981.00	$4,908.31	2026-04-23
L5980	HCPCS	All Lower Extremity Prostheses, Flex Foot System	50	42	$8,413.00	$8,413.00	$2,500.00	$8,413.00	$5,173.99	2026-04-23
L6550	HCPCS	Shoulder Disarticulation, Molded Socket, Endoskeletal System, Including Soft Pro…	50	42	$8,180.00	$8,180.00	$2,487.09	$8,180.00	$5,030.70	2026-04-23
20973	HCPCS	Placement Of Bone And Skin Flap From Big Toe With Connection Of Small Blood Vess…	50	42	$9,279.00	$9,279.00	$2,450.55	$9,742.95	$6,959.25	2026-04-23
L5105	HCPCS	Below Knee, Plastic Socket, Joints And Thigh Lacer, Sach Foot	50	42	$7,452.00	$7,452.00	$2,399.36	$7,452.00	$4,582.98	2026-04-23
L5930	HCPCS	Addition, Endoskeletal System, High Activity Knee Control Frame	50	42	$7,302.00	$7,302.00	$2,395.06	$7,302.00	$4,490.73	2026-04-23
L5701	HCPCS	Replacement, Socket, Above Knee/knee Disarticulation, Including Attachment Plate…	50	42	$7,380.00	$7,380.00	$2,388.59	$7,380.00	$4,538.70	2026-04-23
L6205	HCPCS	Elbow Disarticulation, Molded Socket With Expandable Interface, Outside Locking …	50	42	$7,812.00	$7,812.00	$2,362.09	$7,812.00	$4,804.38	2026-04-23
20970	HCPCS	Placement Of Bone And Skin Flap From Hip Bone With Connection Of Small Blood Ves…	50	42	$9,353.00	$9,353.00	$2,325.37	$9,820.65	$7,014.75	2026-04-23
20972	HCPCS	Placement Of Bone And Skin Flap From Foot Bone With Connection Of Small Blood Ve…	50	42	$7,515.00	$7,515.00	$2,320.03	$7,890.75	$5,636.25	2026-04-23
L6648	HCPCS	Upper Extremity Addition, Shoulder Lock Mechanism, External Powered Actuator	50	42	$7,056.00	$7,056.00	$2,314.37	$7,056.00	$4,339.44	2026-04-23
27077	HCPCS	Extensive Removal Of Growth Of Side Of Pelvic Bone	50	42	$9,412.00	$9,412.00	$2,303.48	$9,882.60	$7,059.00	2026-04-23
21160	HCPCS	Reconstruction Of Nose, Cheek, Mouth, And Forehead Bones With Bone Grafts And Re…	50	42	$8,863.00	$8,863.00	$2,286.07	$9,306.15	$6,647.25	2026-04-23
L1005	HCPCS	Tension Based Scoliosis Orthosis And Accessory Pads, Includes Fitting And Adjust…	50	42	$6,928.00	$6,928.00	$2,272.38	$6,928.00	$4,260.72	2026-04-23
20838	HCPCS	Reattachment Of Cutoff Foot	50	42	$8,643.00	$8,643.00	$2,264.74	$9,075.15	$6,482.25	2026-04-23
L6250	HCPCS	Above Elbow, Molded Double Wall Socket, Internal Locking Elbow, Forearm	50	42	$7,087.00	$7,087.00	$2,262.60	$7,087.00	$4,358.51	2026-04-23
L6646	HCPCS	Upper Extremity Addition, Shoulder Joint, Multipositional Locking, Flexion, Adju…	50	42	$6,840.00	$6,840.00	$2,243.52	$6,840.00	$4,206.60	2026-04-23
L6360	HCPCS	Interscapular Thoracic, Passive Restoration (complete Prosthesis)	50	42	$6,832.00	$6,832.00	$2,240.90	$6,832.00	$4,201.68	2026-04-23
L6885	HCPCS	Replacement Socket, Shoulder Disarticulation/interscapular Thoracic, Molded To P…	50	42	$6,832.00	$6,832.00	$2,240.90	$6,832.00	$4,201.68	2026-04-23
20957	HCPCS	Bone Graft Of Foot Bone With Microvascular Connection	50	42	$7,385.00	$7,385.00	$2,237.80	$7,754.25	$5,538.75	2026-04-23
19364	HCPCS	Reconstruction Of Breast With Tissue Graft	50	42	$9,421.00	$9,421.00	$2,237.52	$9,892.05	$7,065.75	2026-04-23
20802	HCPCS	Reattachment Of Cutoff Arm	50	42	$7,734.00	$7,734.00	$2,236.68	$8,120.70	$5,800.50	2026-04-23
L5826	HCPCS	Addition, Endoskeletal Knee-shin System, Single Axis, Hydraulic Swing Phase Cont…	50	42	$6,774.00	$6,774.00	$2,221.87	$6,774.00	$4,166.01	2026-04-23
20969	HCPCS	Placement Of Skin And Bone Flap With Microvascular Connection	50	42	$9,475.00	$9,475.00	$2,221.24	$9,948.75	$7,106.25	2026-04-23
L6882	HCPCS	Microprocessor Control Feature, Addition To Upper Limb Prosthetic Terminal Devic…	50	42	$6,726.00	$6,726.00	$2,206.13	$6,726.00	$4,136.49	2026-04-23
L5220	HCPCS	Above Knee, Short Prosthesis, No Knee Joint ('stubbies'), With Articulated Ankle…	50	42	$7,542.00	$7,542.00	$2,204.80	$7,542.00	$4,638.33	2026-04-23
15842	HCPCS	Microsurgical Muscle Graft To Treat Facial Paralysis	50	42	$8,415.00	$8,415.00	$2,204.68	$8,835.75	$6,311.25	2026-04-23
L0830	HCPCS	Halo Procedure, Cervical Halo Incorporated Into Milwaukee Type Orthosis	50	42	$7,453.00	$7,453.00	$2,198.97	$7,453.00	$4,583.59	2026-04-23
20962	HCPCS	Bone Graft With Microvascular Connection	50	42	$7,566.00	$7,566.00	$2,162.30	$7,944.30	$5,674.50	2026-04-23
L6310	HCPCS	Shoulder Disarticulation, Passive Restoration (complete Prosthesis)	50	42	$6,852.00	$6,852.00	$2,162.15	$6,852.00	$4,213.98	2026-04-23
L6200	HCPCS	Elbow Disarticulation, Molded Socket, Outside Locking Hinge, Forearm	50	42	$6,833.00	$6,833.00	$2,157.71	$6,833.00	$4,202.30	2026-04-23
L5783	HCPCS	Addition To Lower Extremity, User Adjustable, Mechanical, Residual Limb Volume M…	49	41	$6,575.00	$6,575.00	$2,156.60	$6,575.00	$3,813.50	2026-04-23
20956	HCPCS	Bone Graft Of Pelvic Bone With Microvascular Connection	50	42	$8,610.00	$8,610.00	$2,151.35	$9,040.50	$6,457.50	2026-04-23
L5981	HCPCS	All Lower Extremity Prostheses, Flex-walk System Or Equal	50	42	$6,426.00	$6,426.00	$2,107.73	$6,426.00	$3,951.99	2026-04-23
21159	HCPCS	Reconstruction Of Nose, Cheek, Mouth, And Forehead Bones With Bone Grafts	50	42	$8,436.00	$8,436.00	$2,107.57	$8,857.80	$6,327.00	2026-04-23
L6588	HCPCS	Preparatory, Shoulder Disarticulation Or Interscapular Thoracic, Single Wall Pla…	50	42	$6,469.00	$6,469.00	$2,076.56	$6,469.00	$3,978.44	2026-04-23
27076	HCPCS	Extensive Removal Of Growth Of Upper Pelvic Bone Including Hip Socket, Base Of P…	50	42	$8,249.00	$8,249.00	$2,063.78	$8,661.45	$6,186.75	2026-04-23
L6500	HCPCS	Above Elbow, Molded Socket, Endoskeletal System, Including Soft Prosthetic Tissu…	50	42	$6,672.00	$6,672.00	$2,053.82	$6,672.00	$4,103.28	2026-04-23
22819	HCPCS	Removal Of Parts Of 3 Or More Spine Bones To Correct Outward Curving Spine Defor…	50	42	$8,601.00	$8,601.00	$2,028.70	$9,031.05	$6,450.75	2026-04-23
L6693	HCPCS	Upper Extremity Addition, Locking Elbow, Forearm Counterbalance	50	42	$6,157.00	$6,157.00	$2,019.50	$6,157.00	$3,786.56	2026-04-23
21184	HCPCS	Reconstruction Of Eye, Forehead, And Nose Bones With Removal Of Growth With Bone…	50	42	$7,979.00	$7,979.00	$2,016.91	$8,377.95	$5,984.25	2026-04-23
20955	HCPCS	Bone Graft At Lower Leg With Microvascular Connection	50	42	$8,031.00	$8,031.00	$2,012.14	$8,432.55	$6,023.25	2026-04-23
22206	HCPCS	Incision Or Removal Of Segment Of Middle Spine Bone To Correct Deformity	50	42	$7,455.00	$7,455.00	$2,002.03	$7,827.75	$5,591.25	2026-04-23
L5100	HCPCS	Below Knee, Molded Socket, Shin, Sach Foot	50	42	$6,097.00	$6,097.00	$1,999.82	$6,097.00	$3,749.66	2026-04-23
21261	HCPCS	Repositioning Of Eye Socket Bone From Inside And Outside Skull With Bone Graft	50	42	$7,305.00	$7,305.00	$1,998.10	$7,670.25	$5,478.75	2026-04-23
L6450	HCPCS	Elbow Disarticulation, Molded Socket, Endoskeletal System, Including Soft Prosth…	50	42	$6,613.00	$6,613.00	$1,993.94	$6,613.00	$4,066.99	2026-04-23
L5700	HCPCS	Replacement, Socket, Below Knee, Molded To Patient Model	50	42	$6,145.00	$6,145.00	$1,988.95	$6,145.00	$3,779.18	2026-04-23
L6590	HCPCS	Preparatory, Shoulder Disarticulation Or Interscapular Thoracic, Single Wall Soc…	50	42	$6,345.00	$6,345.00	$1,987.15	$6,345.00	$3,902.18	2026-04-23
L5828	HCPCS	Addition, Endoskeletal Knee-shin System, Single Axis, Fluid Swing And Stance Pha…	50	42	$6,057.00	$6,057.00	$1,986.70	$6,057.00	$3,725.06	2026-04-23
22804	HCPCS	Fusion To Repair Spine Deformity Through Back, 13 Or More Bones	50	42	$7,655.00	$7,655.00	$1,982.67	$8,037.75	$5,741.25	2026-04-23
L6884	HCPCS	Replacement Socket, Above Elbow/elbow Disarticulation, Molded To Patient Model, …	50	42	$6,007.00	$6,007.00	$1,970.30	$6,007.00	$3,694.31	2026-04-23
22207	HCPCS	Incision Or Removal Of Lower Spine Bone Segment To Correct Deformity	50	42	$7,539.00	$7,539.00	$1,961.62	$7,915.95	$5,654.25	2026-04-23
C9353	HCPCS	Microporous Collagen Implantable Slit Tube (neurawrap Nerve Protector), Per Cent…	150	42	$8,916.00	$8,916.00	$1,941.00	$12,205.60	$5,370.46	2026-04-23
L5301	HCPCS	Below Knee, Molded Socket, Shin, Sach Foot, Endoskeletal System	50	42	$5,917.00	$5,917.00	$1,940.78	$5,917.00	$3,638.95	2026-04-23
L6120	HCPCS	Below Elbow, Molded Double Wall Split Socket, Step-up Hinges, Half Cuff	50	42	$6,061.00	$6,061.00	$1,937.07	$6,061.00	$3,727.52	2026-04-23
L5580	HCPCS	Preparatory, Above Knee - Knee Disarticulation Ischial Level Socket, Non-alignab…	50	42	$6,054.00	$6,054.00	$1,932.25	$6,054.00	$3,723.21	2026-04-23
L5590	HCPCS	Preparatory, Above Knee - Knee Disarticulation Ischial Level Socket, Non-alignab…	50	42	$5,944.00	$5,944.00	$1,921.37	$5,944.00	$3,655.56	2026-04-23
63101	HCPCS	Removal Of Middle Spine Bone With Release Of Spinal Cord And/or Nerves, Lateral …	50	42	$7,321.00	$7,321.00	$1,888.08	$7,687.05	$5,490.75	2026-04-23
L6055	HCPCS	Wrist Disarticulation, Molded Socket With Expandable Interface, Flexible Elbow H…	50	42	$6,090.00	$6,090.00	$1,875.19	$6,090.00	$3,745.35	2026-04-23
L5703	HCPCS	Ankle, Symes, Molded To Patient Model, Socket Without Solid Ankle Cushion Heel (…	50	42	$5,717.00	$5,717.00	$1,875.18	$5,717.00	$3,515.95	2026-04-23
21183	HCPCS	Reconstruction Of Eye, Forehead, And Nose Bones With Removal Of Growth With Bone…	50	42	$7,826.00	$7,826.00	$1,873.49	$8,217.30	$5,869.50	2026-04-23
L5585	HCPCS	Preparatory, Above Knee - Knee Disarticulation, Ischial Level Socket, Non-aligna…	50	42	$6,073.00	$6,073.00	$1,861.41	$6,073.00	$3,734.89	2026-04-23
15758	HCPCS	Tissue Graft With Repair Of Small Blood Vessel	50	42	$7,462.00	$7,462.00	$1,853.56	$7,835.10	$5,596.50	2026-04-23
15756	HCPCS	Muscle Graft With Repair Of Small Blood Vessel	50	42	$7,576.00	$7,576.00	$1,853.00	$7,954.80	$5,682.00	2026-04-23
21263	HCPCS	Repositioning Of Cheek Bone Prominence With Forehead Advancement	50	42	$6,342.00	$6,342.00	$1,847.38	$6,659.10	$4,756.50	2026-04-23
15757	HCPCS	Skin Graft With Repair Of Small Blood Vessel	50	42	$7,445.00	$7,445.00	$1,841.77	$7,817.25	$5,583.75	2026-04-23
63102	HCPCS	Removal Of Lower Spine Bone With Release Of Spinal Cord And/or Nerves, Lateral E…	50	42	$7,088.00	$7,088.00	$1,839.24	$7,442.40	$5,316.00	2026-04-23
L5050	HCPCS	Ankle, Symes, Molded Socket, Sach Foot	50	42	$6,205.00	$6,205.00	$1,834.75	$6,205.00	$3,816.07	2026-04-23
22812	HCPCS	Fusion Of Spine Bones For Correction Of Deformity, Anterior Approach, 8 Or More …	50	42	$6,994.00	$6,994.00	$1,797.98	$7,343.70	$5,245.50	2026-04-23
21175	HCPCS	Repair Of Bony Defect Of Lower Forehead And Both Outer Portions Of Eye Bones	50	42	$7,578.00	$7,578.00	$1,791.25	$7,956.90	$5,683.50	2026-04-23
19368	HCPCS	Reconstruction Of Breast With Abdominal Muscle And Skin Flap Graft	50	42	$7,543.00	$7,543.00	$1,783.39	$7,920.15	$5,657.25	2026-04-23
22818	HCPCS	Removal Of 1-2 Spine Bones To Correct Outward Curving Spine Deformity	50	42	$6,879.00	$6,879.00	$1,764.30	$7,222.95	$5,159.25	2026-04-23
21155	HCPCS	Reconstruction Of Midface Bones With Bone Graft With LeFort I (LeFort Iii)	50	42	$7,350.00	$7,350.00	$1,758.13	$7,717.50	$5,512.50	2026-04-23
L5210	HCPCS	Above Knee, Short Prosthesis, No Knee Joint ('stubbies'), With Foot Blocks, No A…	50	42	$6,004.00	$6,004.00	$1,753.37	$6,004.00	$3,692.46	2026-04-23
L6130	HCPCS	Below Elbow, Molded Double Wall Split Socket, Stump Activated Locking Hinge, Hal…	50	42	$5,617.00	$5,617.00	$1,749.29	$5,617.00	$3,454.45	2026-04-23
21182	HCPCS	Reconstruction Of Eye, Forehead, And Nose Bones With Removal Of Growth With Bone…	50	42	$6,599.00	$6,599.00	$1,719.40	$6,928.95	$4,949.25	2026-04-23
E0747	HCPCS	Osteogenesis Stimulator, Electrical, Non-invasive, Other Than Spinal Application…	95	42	$12,800.00	$12,800.00	$1,716.10	$12,800.00	$5,232.00	2026-04-23
22802	HCPCS	Fusion Of Spine Bones For Correction Of Deformity, Posterior Approach, 7 To 12 V…	50	42	$6,656.00	$6,656.00	$1,715.19	$6,988.80	$4,992.00	2026-04-23
L3904	HCPCS	Wrist Hand Finger Orthosis, External Powered, Electric, Custom Fabricated	50	42	$5,769.00	$5,769.00	$1,715.16	$5,769.00	$3,547.93	2026-04-23
21172	HCPCS	Reconstruction Of Outer Side Of Eye And Lower Forehead Bones	50	42	$6,110.00	$6,110.00	$1,707.89	$6,415.50	$4,582.50	2026-04-23
27075	HCPCS	Extensive Removal Of Growth Of Hip Bone	50	42	$7,028.00	$7,028.00	$1,704.52	$7,379.40	$5,271.00	2026-04-23
L5840	HCPCS	Addition, Endoskeletal Knee/shin System, 4-bar Linkage Or Multiaxial, Pneumatic …	50	42	$7,525.00	$7,525.00	$1,695.94	$7,525.00	$4,627.88	2026-04-23
22810	HCPCS	Fusion Of Spine Bones For Correction Of Deformity, Anterior Approach, 4 To 7 Ver…	50	42	$6,424.00	$6,424.00	$1,691.89	$6,745.20	$4,818.00	2026-04-23
27078	HCPCS	Extensive Removal Of Growth Of Base Of Pelvis And Upper End Of Thigh Bone	50	42	$6,647.00	$6,647.00	$1,680.66	$6,979.35	$4,985.25	2026-04-23
20824	HCPCS	Reattachment Of Cutoff Thumb	50	42	$7,359.00	$7,359.00	$1,677.86	$7,726.95	$5,519.25	2026-04-23
20816	HCPCS	Reattachment Of Cutoff Finger	50	42	$7,143.00	$7,143.00	$1,675.05	$7,500.15	$5,357.25	2026-04-23
27365	HCPCS	Extensive Removal Of Growth Of Thigh Or Knee Bone	50	42	$6,701.00	$6,701.00	$1,673.65	$7,036.05	$5,025.75	2026-04-23
22586	HCPCS	Fusion Of Lower Spine Or Sacral Bone With Removal Of Disc Using Image Guidance	50	42	$5,948.00	$5,948.00	$1,673.37	$6,245.40	$4,461.00	2026-04-23
19369	HCPCS	Reconstruction Of Breast With Abdominal Muscle And 2 Skin Flap Grafts	50	42	$6,984.00	$6,984.00	$1,656.25	$7,333.20	$5,238.00	2026-04-23
20697	HCPCS	Placement Of Multiple Direction External Bone Stabilizing Device To Arm Or Leg U…	50	42	$6,647.00	$6,647.00	$1,653.72	$6,979.35	$4,985.25	2026-04-23
21268	HCPCS	Repositioning Of Eye Bone From Inside And Outside Skull With Bone Graft	50	42	$6,059.00	$6,059.00	$1,653.44	$6,361.95	$4,544.25	2026-04-23
21436	HCPCS	Complicated Repair Of Broken Face And Skull Bones With Placement Of Stabilizing …	50	42	$6,971.00	$6,971.00	$1,651.19	$7,319.55	$5,228.25	2026-04-23
21077	HCPCS	Impression And Preparation Of Eye Socket Prosthesis	50	42	$6,980.00	$6,980.00	$1,627.62	$7,329.00	$5,235.00	2026-04-23
22548	HCPCS	Fusion Of Spine Bones At Base Of Neck, Oral Approach	50	42	$6,488.00	$6,488.00	$1,615.55	$6,812.40	$4,866.00	2026-04-23
61563	HCPCS	Removal Of Growth Of Skull Bone	50	42	$5,925.00	$5,925.00	$1,606.85	$6,221.25	$4,443.75	2026-04-23
C9399	HCPCS	Unclassified Drugs Or Biologicals	150	42	$12,200.00	$12,200.00	$1,589.00	$17,880.00	$6,716.00	2026-04-23
21154	HCPCS	Reconstruction Of Nose, Cheek, And Mouth Bones With Bone Grafts	50	42	$7,327.00	$7,327.00	$1,584.67	$7,693.35	$5,495.25	2026-04-23
23220	HCPCS	Extensive Removal Of Growth Of Upper End Of Upper Arm	50	42	$6,266.00	$6,266.00	$1,581.03	$6,579.30	$4,699.50	2026-04-23
63085	HCPCS	Removal Of Middle Spine Bone With Release Of Spinal Cord And/or Nerves, Transtho…	50	42	$5,728.00	$5,728.00	$1,564.19	$6,014.40	$4,296.00	2026-04-23
27134	HCPCS	Revision Of Thigh Bone And Hip Joint Prosthesis	50	42	$6,437.00	$6,437.00	$1,551.55	$6,758.85	$4,827.75	2026-04-23
63272	HCPCS	Removal Of Growth Of Lower Spine Bone Within Spine Membrane	50	42	$5,515.00	$5,515.00	$1,532.19	$5,790.75	$4,136.25	2026-04-23
27228	HCPCS	Treatment Of Broken Bones Of Front And Back Column Or Wall Of Hip Socket With Pl…	50	42	$6,342.00	$6,342.00	$1,525.73	$6,659.10	$4,756.50	2026-04-23
22633	HCPCS	Fusion Of Spine In Lower Back With Partial Removal Of Spine Bone And Disc	50	42	$6,186.00	$6,186.00	$1,511.42	$6,495.30	$4,639.50	2026-04-23
22808	HCPCS	Fusion Of Spine Bones For Correction Of Deformity, Anterior Approach, 2 To 3 Ver…	50	42	$5,760.00	$5,760.00	$1,508.89	$6,048.00	$4,320.00	2026-04-23
22319	HCPCS	Treatment Of Broken Or Dislocated Uppermost Spine Bone With Placement Of Stabili…	50	42	$6,039.00	$6,039.00	$1,504.96	$6,340.95	$4,529.25	2026-04-23
20827	HCPCS	Reattachment Of Part Of Cutoff Thumb	50	42	$6,030.00	$6,030.00	$1,478.58	$6,331.50	$4,522.50	2026-04-23
27059	HCPCS	Extensive Removal Of Growth Of Pelvis And Hip, 5.0 Cm Or More	50	42	$6,024.00	$6,024.00	$1,477.74	$6,325.20	$4,518.00	2026-04-23
21151	HCPCS	Reconstruction Of Midface Bones With Bone Graft (LeFort Ii)	50	42	$6,482.00	$6,482.00	$1,472.97	$6,806.10	$4,861.50	2026-04-23
22532	HCPCS	Fusion Of Middle Spine Bone Through Side With Partial Removal Of Disc, 1 Bone	50	42	$5,931.00	$5,931.00	$1,470.72	$6,227.55	$4,448.25	2026-04-23
22210	HCPCS	Incision Or Removal Of Upper Spine Bone Segment	50	42	$5,587.00	$5,587.00	$1,461.18	$5,866.35	$4,190.25	2026-04-23
63276	HCPCS	Removal Or Biopsy Of Growth Of Middle Spine Bone Outside Spine Membrane	50	42	$5,222.00	$5,222.00	$1,451.92	$5,483.10	$3,916.50	2026-04-23
15841	HCPCS	Muscle Graft To Treat Facial Paralysis	50	42	$5,490.00	$5,490.00	$1,447.43	$5,764.50	$4,117.50	2026-04-23
19367	HCPCS	Reconstruction Of Breast With Abdominal Muscle Flap	50	42	$6,122.00	$6,122.00	$1,445.46	$6,428.10	$4,591.50	2026-04-23
27645	HCPCS	Extensive Removal Of Growth Of Shin Bone	50	42	$5,763.00	$5,763.00	$1,443.78	$6,051.15	$4,322.25	2026-04-23
23210	HCPCS	Extensive Removal Of Growth Of Shoulder Blade	50	42	$5,715.00	$5,715.00	$1,443.78	$6,000.75	$4,286.25	2026-04-23
20822	HCPCS	Reattachment Of Part Of Cutoff Finger	50	42	$6,053.00	$6,053.00	$1,439.29	$6,355.65	$4,539.75	2026-04-23
22222	HCPCS	Incision Or Removal Of Middle Spine Bone And Removal Of Disc	50	42	$4,830.00	$4,830.00	$1,434.23	$5,071.50	$3,622.50	2026-04-23
21147	HCPCS	Repair Of Midface Bones With Bone Graft, 3 Or More Bones	50	42	$5,579.00	$5,579.00	$1,426.94	$5,857.95	$4,184.25	2026-04-23
27487	HCPCS	Revision Of Thigh And Lower Leg Bone Components Of Total Knee Joint Prosthesis	50	42	$5,900.00	$5,900.00	$1,423.85	$6,195.00	$4,425.00	2026-04-23
21433	HCPCS	Complicated Repair Of Broken Face And Skull Bones	50	42	$5,586.00	$5,586.00	$1,408.13	$5,865.30	$4,189.50	2026-04-23
22551	HCPCS	Fusion Of Upper Spine Bone With Removal Of Disc And Release Of Spinal Cord Or Ne…	50	42	$5,748.00	$5,748.00	$1,393.82	$6,035.40	$4,311.00	2026-04-23
27156	HCPCS	Incision And Reshaping Of Part Of Hip And Thigh Bones And Repair Of Dislocated H…	50	42	$5,419.00	$5,419.00	$1,391.29	$5,689.95	$4,064.25	2026-04-23
21180	HCPCS	Reconstruction Of Forehead And/or Upper Eye Bones With Bone Graft	50	42	$5,296.00	$5,296.00	$1,376.98	$5,560.80	$3,972.00	2026-04-23
21243	HCPCS	Repair Of Hinged Joint Of Upper And Lower Jaw Bones With Prosthesis	50	42	$5,626.00	$5,626.00	$1,373.05	$5,907.30	$4,219.50	2026-04-23
22556	HCPCS	Fusion Of Middle Spine Bone Through Side Of Chest With Partial Removal Of Disc	50	42	$5,547.00	$5,547.00	$1,363.50	$5,824.35	$4,160.25	2026-04-23
29868	HCPCS	Repair Of Knee Cartilage With Donor Cartilage Graft Using An Endoscope	50	42	$5,592.00	$5,592.00	$1,358.45	$5,871.60	$4,194.00	2026-04-23
27132	HCPCS	Total Hip Replacement After Previous Hip Surgery	50	42	$5,617.00	$5,617.00	$1,356.49	$5,897.85	$4,212.75	2026-04-23
21188	HCPCS	Reconstruction Of Midface Bones With Bone Graft	50	42	$5,419.00	$5,419.00	$1,354.80	$5,689.95	$4,064.25	2026-04-23
21146	HCPCS	Repair Of Midface Bones With Bone Graft, 2 Bones	50	42	$5,874.00	$5,874.00	$1,352.84	$6,167.70	$4,405.50	2026-04-23
22533	HCPCS	Fusion Of Lower Spine Bone Through Side With Partial Removal Of Disc, 1 Bone	50	42	$5,601.00	$5,601.00	$1,350.59	$5,881.05	$4,200.75	2026-04-23
27227	HCPCS	Treatment Of Broken Bones Of Front Or Back Column Of Hip Socket Or Across Hip So…	50	42	$5,556.00	$5,556.00	$1,345.82	$5,833.80	$4,167.00	2026-04-23
27412	HCPCS	Implantation Of Self Cartilage Into Knee Joint	50	42	$5,518.00	$5,518.00	$1,341.61	$5,793.90	$4,138.50	2026-04-23
27286	HCPCS	Fusion Of Hip Joint With Incision Or Partial Removal Of Thigh Bone Below Neck	50	42	$5,528.00	$5,528.00	$1,340.21	$5,804.40	$4,146.00	2026-04-23
21150	HCPCS	Reconstruction Of Midface Bones (LeFort Ii)	50	42	$5,595.00	$5,595.00	$1,338.24	$5,874.75	$4,196.25	2026-04-23
22318	HCPCS	Treatment Of Broken Or Dislocated Uppermost Spine Bone With Placement Of Stabili…	50	42	$5,419.00	$5,419.00	$1,337.40	$5,689.95	$4,064.25	2026-04-23
21247	HCPCS	Reconstruction Of Hinged Joint Of Jaw Bones With Insertion Of Rib Cartilage	50	42	$5,646.00	$5,646.00	$1,328.42	$5,928.30	$4,234.50	2026-04-23
15946	HCPCS	Removal Of Pressure Sore And Lower Pelvic Bone In Preparation Of Muscle Flap Or …	50	42	$5,541.00	$5,541.00	$1,321.68	$5,818.05	$4,155.75	2026-04-23
21267	HCPCS	Reconstruction Of Eye Bone From Outside Skull With Bone Graft	50	42	$5,251.00	$5,251.00	$1,320.56	$5,513.55	$3,938.25	2026-04-23
22220	HCPCS	Incision Or Removal Of Upper Spine Bone Segment And Removal Of Disc	50	42	$5,103.00	$5,103.00	$1,320.28	$5,358.15	$3,827.25	2026-04-23
63055	HCPCS	Release Of Middle Spinal Cord And/or Nerves, Single Segment	50	42	$4,978.00	$4,978.00	$1,320.00	$5,226.90	$3,733.50	2026-04-23
27290	HCPCS	Amputation Of Pelvic Structures	50	42	$5,385.00	$5,385.00	$1,319.44	$5,654.25	$4,038.75	2026-04-23
26550	HCPCS	Surgical Creation Of Thumb	50	42	$5,052.00	$5,052.00	$1,313.83	$5,304.60	$3,789.00	2026-04-23
27284	HCPCS	Fusion Of Hip Joint	50	42	$5,344.00	$5,344.00	$1,312.70	$5,611.20	$4,008.00	2026-04-23
21145	HCPCS	Reconstruction Of Midface Bones With Bone Graft, Single Piece (LeFort I)	50	42	$5,191.00	$5,191.00	$1,297.83	$5,450.55	$3,893.25	2026-04-23
27091	HCPCS	Removal Of Hip Prosthesis, Complicated	50	42	$5,344.00	$5,344.00	$1,293.06	$5,611.20	$4,008.00	2026-04-23
22612	HCPCS	Fusion Of Spine In Lower Back	50	42	$5,131.00	$5,131.00	$1,292.78	$5,387.55	$3,848.25	2026-04-23
22590	HCPCS	Fusion Of Skull And First 2 Upper Spine Bones Through Back	50	42	$5,114.00	$5,114.00	$1,290.81	$5,369.70	$3,835.50	2026-04-23
27151	HCPCS	Reshaping Of Part Of Hip Bone	50	42	$4,980.00	$4,980.00	$1,290.25	$5,229.00	$3,735.00	2026-04-23
22224	HCPCS	Incision Or Removal Of Lower Spine Bone Segment And Removal Of Disc	50	42	$4,995.00	$4,995.00	$1,288.28	$5,244.75	$3,746.25	2026-04-23
22630	HCPCS	Fusion Of Lower Spine Bone And Partial Removal Of Spine Bone Or Disc Through Bac…	50	42	$5,149.00	$5,149.00	$1,285.48	$5,406.45	$3,861.75	2026-04-23
19361	HCPCS	Reconstruction Of Breast With Shoulder Muscle Tissue Graft	50	42	$5,452.00	$5,452.00	$1,275.93	$5,724.60	$4,089.00	2026-04-23
27364	HCPCS	Extensive Removal Of Growth Of Thigh Or Knee, 5.0 Cm Or More	50	42	$5,226.00	$5,226.00	$1,269.20	$5,487.30	$3,919.50	2026-04-23
24150	HCPCS	Extensive Removal Of Growth Of Upper Arm Bone	50	42	$5,041.00	$5,041.00	$1,260.50	$5,293.05	$3,780.75	2026-04-23
27259	HCPCS	Treatment Of Spontaneous Dislocated Hip With Shortening Of Thigh Bone	50	42	$4,907.00	$4,907.00	$1,257.97	$5,152.35	$3,680.25	2026-04-23
27646	HCPCS	Extensive Removal Of Growth Of Outer Leg Bone	50	42	$4,991.00	$4,991.00	$1,251.80	$5,240.55	$3,743.25	2026-04-23
22558	HCPCS	Fusion Of Lower Spine Bone Through Abdomen With Partial Removal Of Disc	50	42	$4,902.00	$4,902.00	$1,248.71	$5,147.10	$3,676.50	2026-04-23
63200	HCPCS	Removal Of Lower Spine Bone With Release Of Frayed Spinal Cord	50	42	$4,909.00	$4,909.00	$1,240.29	$5,154.45	$3,681.75	2026-04-23
27138	HCPCS	Revision Of Thigh Bone Prosthesis	50	42	$5,140.00	$5,140.00	$1,238.89	$5,397.00	$3,855.00	2026-04-23
22327	HCPCS	Treatment Of Broken Or Dislocated Middle Spine Bone	50	42	$4,930.00	$4,930.00	$1,231.59	$5,176.50	$3,697.50	2026-04-23
22595	HCPCS	Fusion Of First 2 Spine Bones Through Back Of Neck	50	42	$4,915.00	$4,915.00	$1,231.59	$5,160.75	$3,686.25	2026-04-23
21179	HCPCS	Reconstruction Of Forehead And/or Upper Eye Bones With Bone Graft Or Implant	50	42	$4,861.00	$4,861.00	$1,230.19	$5,104.05	$3,645.75	2026-04-23
23200	HCPCS	Extensive Removal Of Growth Of Collar Bone	50	42	$4,879.00	$4,879.00	$1,227.94	$5,122.95	$3,659.25	2026-04-23
63077	HCPCS	Removal Of Middle Spine Disc And Release Of Spinal Cord And/or Nerves, Single In…	50	42	$4,732.00	$4,732.00	$1,224.29	$4,968.60	$3,549.00	2026-04-23
22214	HCPCS	Incision Or Removal Of Lower Spine Bone Segment	50	42	$4,679.00	$4,679.00	$1,218.12	$4,912.95	$3,509.25	2026-04-23
21080	HCPCS	Preparation Of Permanent Prosthesis To Close Mouth Opening	50	42	$5,169.00	$5,169.00	$1,217.56	$5,427.45	$3,876.75	2026-04-23
22212	HCPCS	Incision Or Removal Of Middle Spine Bone Segment	50	42	$4,646.00	$4,646.00	$1,213.06	$4,878.30	$3,484.50	2026-04-23
26580	HCPCS	Repair Of Deformed Hand	50	42	$4,780.00	$4,780.00	$1,209.42	$5,019.00	$3,585.00	2026-04-23
21086	HCPCS	Impression And Custom Preparation Of Outer Ear Prosthesis	50	42	$5,131.00	$5,131.00	$1,200.43	$5,387.55	$3,848.25	2026-04-23
21087	HCPCS	Impression And Custom Preparation Of Nasal Prosthesis	50	42	$5,089.00	$5,089.00	$1,200.43	$5,343.45	$3,816.75	2026-04-23
63015	HCPCS	Partial Removal Of Spine Bone With Exploration And/or Release Of Upper Spinal Co…	50	42	$4,612.00	$4,612.00	$1,200.43	$4,842.60	$3,459.00	2026-04-23
25170	HCPCS	Extensive Removal Of Growth Of Forearm Bone (radius Or Ulna)	50	42	$4,705.00	$4,705.00	$1,198.47	$4,940.25	$3,528.75	2026-04-23
27147	HCPCS	Incision Or Partial Removal Of Hip Bone And Repair Of Dislocated Hip Joint	50	42	$4,650.00	$4,650.00	$1,192.58	$4,882.50	$3,487.50	2026-04-23
27137	HCPCS	Revision Of Hip Socket Part Of Hip Prosthesis	50	42	$4,940.00	$4,940.00	$1,192.29	$5,187.00	$3,705.00	2026-04-23
21194	HCPCS	Reconstruction Of Lower Jaw Bone With Bone Graft	50	42	$4,685.00	$4,685.00	$1,189.77	$4,919.25	$3,513.75	2026-04-23
30450	HCPCS	Revision To Reshape Nasal Bones And Tip Of Nose After Previous Repair	50	42	$5,175.00	$5,175.00	$1,188.08	$5,433.75	$3,881.25	2026-04-23
21143	HCPCS	Repair Of Midface Bones, 3 Or More Bones	50	42	$4,933.00	$4,933.00	$1,187.80	$5,179.65	$3,699.75	2026-04-23
21196	HCPCS	Reconstruction Of Jaw Bones With Insertion Of Hardware	50	42	$5,000.00	$5,000.00	$1,183.87	$5,250.00	$3,750.00	2026-04-23
24363	HCPCS	Prosthetic Repair Of Elbow Joint	50	42	$5,003.00	$5,003.00	$1,177.70	$5,253.15	$3,752.25	2026-04-23
23472	HCPCS	Prosthetic Repair Of Shoulder Joint, Total Shoulder	50	42	$5,003.00	$5,003.00	$1,176.86	$5,253.15	$3,752.25	2026-04-23
27580	HCPCS	Fusion Of Knee Joint	50	42	$4,598.00	$4,598.00	$1,167.03	$4,827.90	$3,448.50	2026-04-23
23078	HCPCS	Extensive Removal Of Growth Of Shoulder, 5.0 Cm Or More	50	42	$4,756.00	$4,756.00	$1,164.23	$4,993.80	$3,567.00	2026-04-23
19357	HCPCS	Reconstruction Of Breast Using Tissue Expander	50	42	$5,112.00	$5,112.00	$1,154.20	$5,367.60	$3,834.00	2026-04-23
21936	HCPCS	Extensive Removal Of Growth Of Back Or Lower Side, 5.0 Cm Or More	50	42	$4,708.00	$4,708.00	$1,149.63	$4,943.40	$3,531.00	2026-04-23
C1763	HCPCS	Connective Tissue, Non-human (includes Synthetic)	150	42	$12,300.00	$12,300.00	$1,145.00	$12,512.00	$5,505.28	2026-04-23
21255	HCPCS	Reconstruction Of Cheek Bone With Bone Graft	50	42	$4,730.00	$4,730.00	$1,141.77	$4,966.50	$3,547.50	2026-04-23
21142	HCPCS	Repair Of Midface Bones, 2 Bones	50	42	$4,762.00	$4,762.00	$1,138.41	$5,000.10	$3,571.50	2026-04-23
27486	HCPCS	Revision Of Component Of Total Knee Joint Prosthesis	50	42	$4,714.00	$4,714.00	$1,137.84	$4,949.70	$3,535.50	2026-04-23
21435	HCPCS	Complicated Repair Of Broken Face And Skull Bones With Placement Of Stabilizing …	50	42	$4,654.00	$4,654.00	$1,136.44	$4,886.70	$3,490.50	2026-04-23
30462	HCPCS	Revision Of Congenital Nasal Defect With Lengthening Of Tip Of Nose	50	42	$5,331.00	$5,331.00	$1,124.09	$5,597.55	$3,998.25	2026-04-23
21081	HCPCS	Impression And Custom Preparation Of Lower Jaw Bone Prosthesis	50	42	$4,730.00	$4,730.00	$1,117.07	$4,966.50	$3,547.50	2026-04-23
21344	HCPCS	Treatment Of Complicated Broken Front Sinus Bone	50	42	$5,287.00	$5,287.00	$1,114.55	$5,551.35	$3,965.25	2026-04-23
21084	HCPCS	Impression And Custom Preparation Of Speech Aid Prosthesis	50	42	$4,778.00	$4,778.00	$1,113.99	$5,016.90	$3,583.50	2026-04-23
21141	HCPCS	Reconstruction Of Upper Jaw And Midface Bones	50	42	$4,673.00	$4,673.00	$1,107.53	$4,906.65	$3,504.75	2026-04-23
27130	HCPCS	Replacement Of Thigh Bone And Hip Joint With Prosthesis	50	42	$4,600.00	$4,600.00	$1,097.15	$4,830.00	$3,450.00	2026-04-23
27447	HCPCS	Replacement Of Knee Joint, Both Sides Of Knee	50	42	$5,153.00	$5,153.00	$1,096.59	$5,410.65	$3,864.75	2026-04-23
30420	HCPCS	Reshaping Of Bony Cartilage Dividing Nasal Passages	50	42	$4,688.00	$4,688.00	$1,090.69	$4,922.40	$3,516.00	2026-04-23
21079	HCPCS	Impression And Custom Preparation Of Temporary Oral Prosthesis	50	42	$4,642.00	$4,642.00	$1,090.41	$4,874.10	$3,481.50	2026-04-23
C2618	HCPCS	Probe/needle, Cryoablation	50	42	$10,600.00	$10,600.00	$552.93	$10,600.00	$6,148.00	2026-04-23
C1762	HCPCS	Connective Tissue, Human (includes Fascia Lata)	2,000	42	$9,636.00	$9,636.00	$472.00	$85,400.00	$5,377.76	2026-04-23
Q4122	HCPCS	Dermacell, Dermacell Awm Or Dermacell Awm Porous, Per Square Centimeter	200	42	$7,452.06	$7,452.06	$434.00	$13,040.72	$4,125.89	2026-04-23
26650	HCPCS	Placement Of Stabilizing Device For Broken Thumb At Wrist With Manipulation	50	42	$5,052.00	$5,052.00	$385.64	$5,304.60	$3,789.00	2026-04-23
22865	HCPCS	Revision Of Artificial Lower Spine Disc, Lumbar	50	42	$6,889.00	$6,889.00	$256.87	$7,233.45	$5,166.75	2026-04-23
C1776	HCPCS	Joint Device (implantable)	1,050	42	$13,226.00	$13,226.00	$202.82	$37,492.00	$7,288.56	2026-04-23
J0638	HCPCS	Injection, Canakinumab, 1 Mg	26	26	$64,560.48	$64,560.48	$194.27	$51,648.38	$28,406.61	2026-02-09
36578	HCPCS	Replacement Of Central Venous Tube, Tube Only	50	42	$7,846.00	$7,846.00	$50.00	$8,724.59	$3,452.24	2026-04-23
L8699	HCPCS	Prosthetic Implant, Not Otherwise Specified	2,450	42	$6,509.60	$6,509.60	$40.00	$27,328.00	$3,846.00	2026-04-23
22862	HCPCS	Revision Of Total Disc Replacement In Lower Back	50	42	$7,025.00	$7,025.00	$25.60	$7,376.25	$5,268.75	2026-04-23
22861	HCPCS	Revision Of Total Disc Replacement In Upper Back	50	42	$6,637.00	$6,637.00	$25.60	$6,968.85	$4,977.75	2026-04-23
22864	HCPCS	Revision Of Artificial Upper Spine Disc, Cervical	50	42	$6,392.00	$6,392.00	$25.60	$6,711.60	$4,794.00	2026-04-23
22856	HCPCS	Insertion Of Artificial Upper Spine Disc, Anterior Approach	50	42	$5,541.00	$5,541.00	$25.60	$5,818.05	$4,155.75	2026-04-23
22857	HCPCS	Insertion Of Artificial Disc Between Bones Of Lower Spine, Single Space	50	42	$5,535.00	$5,535.00	$25.60	$5,811.75	$4,151.25	2026-04-23
0656T	OTHER	Tethering Of 7 Or Fewer Lower Spine Bones	49	41	$6,393.00	$6,393.00	$24.00	$6,712.65	$4,794.75	2026-04-23
0657T	OTHER	Tethering Of 8 Or More Lower Spine Bones	49	41	$6,198.00	$6,198.00	$24.00	$6,507.90	$4,648.50	2026-04-23
S2115	HCPCS	Osteotomy, Periacetabular, With Internal Fixation	49	41	$6,174.00	$6,174.00	$24.00	$6,482.70	$4,630.50	2026-04-23
21603	HCPCS	Removal Of Growth Of Chest Wall And Rib With Reconstruction And Removal Of Lymph…	50	42	$6,047.00	$6,047.00	$24.00	$6,349.35	$4,535.25	2026-04-23
21602	HCPCS	Removal Of Growth Of Chest Wall And Rib With Reconstruction	50	42	$5,493.00	$5,493.00	$24.00	$5,767.65	$4,119.75	2026-04-23
0201T	OTHER	Injections Of Both Sides Of Sacrum For Enlargement, 2 Or More Needles, Accessed …	49	41	$5,066.00	$5,066.00	$24.00	$5,319.30	$3,799.50	2026-04-23
22899	HCPCS	Other Procedure On Spine	49	41	$5,066.00	$5,066.00	$24.00	$5,319.30	$3,799.50	2026-04-23
37799	HCPCS	Other Procedure On Blood Vessel	49	41	$4,855.00	$4,855.00	$24.00	$5,097.75	$3,641.25	2026-04-23
19366	HCPCS	Breast Reconstruction With Other Technique	49	41	$4,631.00	$4,631.00	$24.00	$4,862.55	$3,473.25	2026-04-23
J7187	HCPCS	Injection, Von Willebrand Factor Complex (humate-p), Per Iu Vwf:rco	72	42	$13,369.23	$13,369.23	$1.82	$13,369.23	$5,882.46	2026-04-23

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