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

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Hospital

Mountain Valley Regional Rehabilitation Hospital

Prescott Valley, AZ · CCN 033036 · Rates published

2,164 distinct procedures filed
17 distinct payers
24,271 rate rows
2026-03-17 last MRF observed
Data quality

4,469 of 24,271 rate rows are consumer-grade (18.4%)

19,802 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 19,464
per-diem day rate — not a per-procedure price 338
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://ernesthealth.com/wp-content/uploads/2025/01/pricing/Mountain%20Valley%20Regional%20Rehabilitation%20Hospital/203166972_Mountain-Valley-Regional-Rehabilitation-Hospital_Standard-Charges.json
Found on page https://mvrrh.ernesthealth.com/price-transparency/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint 9c7ee059c82c2454… · 9,409,268 bytes · first seen 2026-05-08

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
C1806
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier Tier 2 11 $52,482.74 $52,482.74 $52,482.74 nat. median
$51,172
1.0× median
D1904
LOCAL 		Guillain-barré M <38.50- Tier Tier 3 11 $50,173.28 $50,173.28 $50,173.28 nat. median
$49,620
1.0× median
D1806
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier Tier 3 11 $49,825.34 $49,825.34 $49,825.34 nat. median
$48,581
1.0× median
A1904
LOCAL 		Guillain-barré M <38.50- Tier None 11 $49,305.33 $49,305.33 $49,305.33 nat. median
$48,824
1.0× median
D0404
LOCAL 		Traumatic Spinal Cord Injury M <31.50 And A <61.50- Tier Tier 3 11 $48,920.82 $48,920.82 $48,920.82 nat. median
$49,042
1.0× median
B0105
LOCAL 		Stroke M <41.50 And A >=84.50- Tier Tier 1 11 $48,852.23 $48,852.23 $48,852.23 nat. median
$48,375
1.0× median
B0604
LOCAL 		Neurological M <43.50- Tier Tier 1 11 $46,457.54 $46,457.54 $46,457.54 nat. median
$46,423
1.0× median
A1806
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier None 11 $46,196.74 $46,196.74 $46,196.74 nat. median
$45,144
1.0× median
C0505
LOCAL 		Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 2 11 $44,862.30 $44,862.30 $44,862.30 nat. median
$43,704
1.0× median
D0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier Tier 3 11 $43,155.68 $44,036.41 $43,596.04 nat. median
$42,703
1.0× median
B2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 1 11 $42,800.15 $42,800.15 $42,800.15 nat. median
$40,995
1.0× median
D0505
LOCAL 		Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 3 11 $42,382.70 $42,382.70 $42,382.70 nat. median
$41,099
1.0× median
B1404
LOCAL 		Cardiac M <45.50- Tier Tier 1 11 $41,023.41 $41,023.41 $41,023.41 nat. median
$39,603
1.0× median
B0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 1 11 $40,943.11 $40,943.11 $40,943.11 nat. median
$40,010
1.0× median
B0104
LOCAL 		Stroke M >=41.50 And M <50.50- Tier Tier 1 11 $39,067.64 $39,067.64 $39,067.64 nat. median
$38,092
1.0× median
A0505
LOCAL 		Non-traumatic Spinal Cord Injury M <39.50- Tier None 11 $39,035.10 $39,056.17 $39,045.64 nat. median
$37,907
1.0× median
C1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 2 11 $38,964.40 $38,964.40 $38,964.40 nat. median
$37,992
1.0× median
D0105
LOCAL 		Stroke M <41.50 And A >=84.50- Tier Tier 3 11 $38,715.87 $38,715.87 $38,715.87 nat. median
$37,662
1.0× median
C1805
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T… 11 $36,955.10 $39,247.34 $38,101.22 nat. median
$36,594
1.0× median
A0105
LOCAL 		Stroke M <41.50 And A >=84.50- Tier None 11 $36,159.79 $36,897.74 $36,528.76 nat. median
$35,375
1.0× median
C0305
LOCAL 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 2 11 $36,471.41 $36,471.41 $36,471.41 nat. median
$35,561
1.0× median
D1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3 11 $36,085.23 $36,085.23 $36,085.23 nat. median
$34,992
1.0× median
C1004
LOCAL 		Amputation Lower Extremity M <47.50- Tier Tier 2 11 $35,655.80 $35,655.80 $35,655.80 nat. median
$35,393
1.0× median
C0604
LOCAL 		Neurological M <43.50- Tier Tier 2 11 $35,645.51 $35,645.51 $35,645.51 nat. median
$34,756
1.0× median
A0205
LOCAL 		Traumatic Brain Injury M <35.50- Tier None 11 $35,526.98 $35,526.98 $35,526.98 nat. median
$33,234
1.1× median
D1805
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T… 11 $35,083.45 $35,083.45 $35,083.45 nat. median
$34,208
1.0× median
B1803
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50- T… 11 $34,940.06 $34,940.06 $34,940.06 nat. median
$34,599
1.0× median
C0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 2 11 $34,418.14 $34,783.41 $34,600.78 nat. median
$33,146
1.0× median
C2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 2 11 $33,919.16 $33,919.16 $33,919.16 nat. median
$32,921
1.0× median
D0305
LOCAL 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 3 11 $33,502.39 $33,502.39 $33,502.39 nat. median
$32,319
1.0× median
D0604
LOCAL 		Neurological M <43.50- Tier Tier 3 11 $33,276.79 $33,276.79 $33,276.79 nat. median
$32,269
1.0× median
A1903
LOCAL 		Guillain-barré M >=38.50 And M <51.50- Tier None 11 $32,819.00 $32,819.00 $32,819.00 nat. median
$33,075
1.0× median
C0304
LOCAL 		Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 2 11 $32,408.91 $33,070.32 $32,739.62 nat. median
$32,043
1.0× median
C0403
LOCAL 		Traumatic Spinal Cord Injury M >=41.50 And M <47.50- Tier Tier 2 11 $32,521.33 $32,521.33 $32,521.33 nat. median
$32,521
1.0× median
C0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 2 11 $32,137.25 $32,793.11 $32,465.18 nat. median
$31,818
1.0× median
B1303
LOCAL 		Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50- Tier Tier 1 11 $32,420.31 $32,420.31 $32,420.31 nat. median
$32,420
1.0× median
A1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier None 11 $32,082.92 $32,737.67 $32,410.29 nat. median
$31,920
1.0× median
C1404
LOCAL 		Cardiac M <45.50- Tier Tier 2 11 $32,317.07 $32,317.07 $32,317.07 nat. median
$30,962
1.0× median
D0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 3 11 $31,951.76 $32,603.84 $32,277.80 nat. median
$31,616
1.0× median
C2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 2 11 $32,179.42 $32,179.42 $32,179.42 nat. median
$31,232
1.0× median
C0504
LOCAL 		Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 2 11 $31,638.88 $32,284.57 $31,961.72 nat. median
$31,479
1.0× median
C0805
LOCAL 		Replacement Of Lower-extremity Joint M <42.50- Tier Tier 2 11 $31,621.18 $31,621.18 $31,621.18 nat. median
$30,832
1.0× median
D2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 3 11 $31,282.70 $31,921.12 $31,601.91 nat. median
$30,727
1.0× median
A0305
LOCAL 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier None 11 $31,577.20 $31,577.20 $31,577.20 nat. median
$30,648
1.0× median
D1004
LOCAL 		Amputation Lower Extremity M <47.50- Tier Tier 3 11 $28,574.76 $34,490.91 $31,532.83 nat. median
$32,228
1.0× median
D1704
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 11 $30,749.39 $30,749.39 $30,749.39 nat. median
$29,818
1.0× median
D0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 3 11 $29,954.54 $31,127.73 $30,541.13 nat. median
$29,640
1.0× median
D0304
LOCAL 		Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 3 11 $30,378.51 $30,378.51 $30,378.51 nat. median
$29,475
1.0× median
D1404
LOCAL 		Cardiac M <45.50- Tier Tier 3 11 $30,047.76 $30,325.02 $30,186.39 nat. median
$29,138
1.0× median
D1804
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50- T… 11 $30,094.40 $30,094.40 $30,094.40 nat. median
$28,077
1.1× median

Other procedures at this hospital

Browse this hospital's 2,164 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
00410 HCPCS Anesth Correct Heart Rhythm 0 0 — — — — — 2026-03-17
0118 RC Room & Board - Private (One Bed) - Rehabilitation 8 5 — — $1,011.49 $1,675.00 $1,675.00 2026-03-17
0128 RC Room & Board - Semi-private (Two Beds) - Rehabilitation 8 5 — — $1,011.49 $1,665.00 $1,665.00 2026-03-17
0138 RC Room & Board - Three And Four Beds - Rehabilitation 8 5 — — $1,675.00 $1,675.00 $1,675.00 2026-03-17
0148 RC Room & Board - Deluxe Private - Rehabilitation 8 5 — — $1,675.00 $1,675.00 $1,675.00 2026-03-17
0158 RC Room & Board - Ward - Rehabilitation 8 5 — — $1,675.00 $1,675.00 $1,675.00 2026-03-17
0420 RC Physical Therapy - General Classification 51 16 — — $70.00 $503.04 $503.04 2026-03-17
0421 RC Physical Therapy - Visit Charge 49 15 — — $70.00 $113.00 $91.50 2026-03-17
0422 RC Physical Therapy - Hourly Charge 21 9 — — $70.00 $113.00 $91.50 2026-03-17
0423 RC Physical Therapy - Group Rate 21 9 — — $70.00 $113.00 $91.50 2026-03-17
0424 RC Physical Therapy - Evaluation Or Re-evaluation 50 16 — — $70.00 $150.00 $110.00 2026-03-17
0425 RC Physical Therapy - Treatment 9 5 — — $70.00 $70.00 $70.00 2026-03-17
0426 RC Physical Therapy - Continuation 9 5 — — $70.00 $70.00 $70.00 2026-03-17
0427 RC Physical Therapy - Observation/Hourly 9 5 — — $70.00 $70.00 $70.00 2026-03-17
0428 RC Physical Therapy - Other 9 5 — — $70.00 $70.00 $70.00 2026-03-17
0429 RC Physical Therapy - Other 12 6 — — $70.00 $113.00 $91.50 2026-03-17
0430 RC Occupational Therapy - General Classification 50 16 — — $70.00 $503.04 $503.04 2026-03-17
0431 RC Occupational Therapy - Visit Charge 20 7 — — $70.00 $113.00 $91.50 2026-03-17
0432 RC Occupational Therapy - Hourly Charge 20 7 — — $70.00 $113.00 $91.50 2026-03-17
0433 RC Occupational Therapy - Group Rate 20 7 — — $70.00 $113.00 $91.50 2026-03-17
0434 RC Occupational Therapy - Evaluation Or Reevaluation 48 16 — — $70.00 $503.04 $503.04 2026-03-17
0435 RC Occupational Therapy - Treatment 9 5 — — $70.00 $70.00 $70.00 2026-03-17
0436 RC Occupational Therapy - Continuation 9 5 — — $70.00 $70.00 $70.00 2026-03-17
0437 RC Occupational Therapy - Observation/Hourly 9 5 — — $70.00 $70.00 $70.00 2026-03-17
0438 RC Occupational Therapy - Other 9 5 — — $70.00 $70.00 $70.00 2026-03-17
0439 RC Occupational Therapy - Other 12 6 — — $70.00 $113.00 $91.50 2026-03-17
0440 RC Speech Therapy - Language Pathology - General Classification 49 16 — — $70.00 $503.04 $503.04 2026-03-17
0441 RC Speech Therapy - Language Pathology - Visit Charge 20 7 — — $70.00 $113.00 $91.50 2026-03-17
0442 RC Speech Therapy - Language Pathology - Hourly Charge 20 7 — — $70.00 $113.00 $91.50 2026-03-17
0443 RC Speech Therapy - Language Pathology - Group Rate 20 7 — — $70.00 $113.00 $91.50 2026-03-17
0444 RC Speech Therapy - Language Pathology - Evaluation Or Reevaluation 43 15 — — $70.00 $150.00 $110.00 2026-03-17
0445 RC Speech-language Pathology - Treatment 9 5 — — $70.00 $70.00 $70.00 2026-03-17
0446 RC Speech-language Pathology - Continuation 9 5 — — $70.00 $70.00 $70.00 2026-03-17
0447 RC Speech-language Pathology - Observation/Hourly 9 5 — — $70.00 $70.00 $70.00 2026-03-17
0448 RC Speech-language Pathology - Other 9 5 — — $70.00 $70.00 $70.00 2026-03-17
0449 RC Speech Therapy - Language Pathology - Other 12 6 — — $70.00 $113.00 $91.50 2026-03-17
0671T HCPCS Insj Ant Sgm Aq DRG Dev 1+ 0 0 — — — — — 2026-03-17
0850 RC Continuous Cycling Peritoneal Dialysis (ccpd) - Outpatient Or Home - General Cla… 3 1 — — $650.00 $650.00 $650.00 2026-03-17
0851 RC Continuous Cycling Peritoneal Dialysis (ccpd) - Outpatient Or Home - CCPD/Compos… 3 1 — — $650.00 $650.00 $650.00 2026-03-17
0940 RC Other Therapeutic Services - General Classification 9 5 — — $147.00 $147.00 $147.00 2026-03-17
10005 HCPCS Fna Bx W/us Gdn 1st Les 0 0 — — — — — 2026-03-17
10060 HCPCS I&d Abscess Simple/single 0 0 — — — — — 2026-03-17
12032 HCPCS Intmd Rpr S/a/t/ext 2.6-7.5 0 0 — — — — — 2026-03-17
14000 HCPCS Tis Trnfr Trunk 10 Sq Cm/< 0 0 — — — — — 2026-03-17
14020 HCPCS Tis Trnfr S/a/l 10 Sq Cm/< 0 0 — — — — — 2026-03-17
15771 HCPCS Grfg Autol Fat Lipo 50 Cc/< 0 0 — — — — — 2026-03-17
15772 HCPCS Grfg Autol Fat Lipo Ea Addl 0 0 — — — — — 2026-03-17
15853 HCPCS Removal Sutr/stapl Xreq Anes 0 0 — — — — — 2026-03-17
22513 HCPCS Perq Vertebral Augmentation 0 0 — — — — — 2026-03-17
22514 HCPCS Perq Vertebral Augmentation 0 0 — — — — — 2026-03-17
22515 HCPCS Perq Vertebral Augmentation 0 0 — — — — — 2026-03-17
22548 HCPCS Arthrd Ant Toral/xoral C1-c2 0 0 — — — — — 2026-03-17
22552 HCPCS Arthrd Ant Ntrbd Cervical Ea 0 0 — — — — — 2026-03-17
23412 HCPCS Repair Rotator Cuff Chronic 0 0 — — — — — 2026-03-17
23515 HCPCS Optx Clavicular Fx W/int Fix 0 0 — — — — — 2026-03-17
23650 HCPCS Cltx Sho Dslc W/mnpj Wo Anes 0 0 — — — — — 2026-03-17
24344 HCPCS Reconstruct Elbow Lat Ligmnt 0 0 — — — — — 2026-03-17
24430 HCPCS Repair Of Humerus 0 0 — — — — — 2026-03-17
24516 HCPCS Treat Humerus Fracture 0 0 — — — — — 2026-03-17
24615 HCPCS Treat Elbow Dislocation 0 0 — — — — — 2026-03-17
31259 HCPCS Nsl/sins Ndsc Sphn Tiss Rmvl 0 0 — — — — — 2026-03-17
31267 HCPCS Endoscopy Maxillary Sinus 0 0 — — — — — 2026-03-17
31276 HCPCS Nsl/sins Ndsc Frnt Tiss Rmvl 0 0 — — — — — 2026-03-17
31288 HCPCS Nasal/sinus Endoscopy Surg 0 0 — — — — — 2026-03-17
31500 HCPCS Insert Emergency Airway 0 0 — — — — — 2026-03-17
32408 HCPCS Core Ndl Bx Lng/med Perq 0 0 — — — — — 2026-03-17
32555 HCPCS Aspirate Pleura With Imaging 0 0 — — — — — 2026-03-17
33207 HCPCS Insert Heart Pm Ventricular 0 0 — — — — — 2026-03-17
33227 HCPCS Remove&replace Pm Gen Singl 0 0 — — — — — 2026-03-17
33228 HCPCS Remv&replc Pm Gen Dual Lead 0 0 — — — — — 2026-03-17
36012 HCPCS Place Catheter In Vein 0 0 — — — — — 2026-03-17
36200 HCPCS Place Catheter In Aorta 0 0 — — — — — 2026-03-17
36225 HCPCS Place Cath Subclavian Art 0 0 — — — — — 2026-03-17
36247 HCPCS Ins Cath Abd/l-ext Art 3rd 0 0 — — — — — 2026-03-17
36248 HCPCS Ins Cath Abd/l-ext Art Addl 0 0 — — — — — 2026-03-17
36415 HCPCS Routine Venipuncture 0 0 — — — — — 2026-03-17
36430 HCPCS Transfusion Bld/bld Compnt 0 0 — — — — — 2026-03-17
36460 HCPCS Intrauterine Transfusion Ftl 0 0 — — — — — 2026-03-17
36514 HCPCS Apheresis Plasma 0 0 — — — — — 2026-03-17
36556 HCPCS Insert Non-tunnel Cv Cath 0 0 — — — — — 2026-03-17
36558 HCPCS Insert Tunneled Cv Cath 0 0 — — — — — 2026-03-17
36561 HCPCS Insert Tunneled Cv Cath 0 0 — — — — — 2026-03-17
36569 HCPCS Insj Picc 5 Yr+ Without Imaging 0 0 — — — — — 2026-03-17
36573 HCPCS Insj Picc Rs&i 5 Yr+ 0 0 — — — — — 2026-03-17
36589 HCPCS Removal Tunneled Cv Cath 0 0 — — — — — 2026-03-17
51702 HCPCS Insert Temp Bladder Cath 0 0 — — — — — 2026-03-17
51798 HCPCS US Urine Capacity Measure 0 0 — — — — — 2026-03-17
52204 HCPCS Cystoscopy W/biopsy(s) 0 0 — — — — — 2026-03-17
52224 HCPCS Cystoscopy And Treatment 0 0 — — — — — 2026-03-17
52234 HCPCS Cystoscopy And Treatment 0 0 — — — — — 2026-03-17
52235 HCPCS Cystoscopy And Treatment 0 0 — — — — — 2026-03-17
52240 HCPCS Cystoscopy And Treatment 0 0 — — — — — 2026-03-17
52310 HCPCS Cystoscopy And Treatment 0 0 — — — — — 2026-03-17
52317 HCPCS Remove Bladder Stone 0 0 — — — — — 2026-03-17
52332 HCPCS Cystoscopy And Treatment 0 0 — — — — — 2026-03-17
52356 HCPCS Cysto/uretero W/lithotripsy 0 0 — — — — — 2026-03-17
52601 HCPCS Prostatectomy (turp) 0 0 — — — — — 2026-03-17
53445 HCPCS Insert Uro/ves Nck Sphincter 0 0 — — — — — 2026-03-17
54161 HCPCS Circum 28 Days Or Older 0 0 — — — — — 2026-03-17
55040 HCPCS Removal Of Hydrocele 0 0 — — — — — 2026-03-17
55700 HCPCS Biopsy Of Prostate 0 0 — — — — — 2026-03-17
55880 HCPCS Abltj Mal Prst8 Tiss Hifu 0 0 — — — — — 2026-03-17
57260 HCPCS Cmbn Ant Pst Colprhy 0 0 — — — — — 2026-03-17
57288 HCPCS Repair Bladder Defect 0 0 — — — — — 2026-03-17
57461 HCPCS Conz Of Cervix W/scope Leep 0 0 — — — — — 2026-03-17
57522 HCPCS Conization Of Cervix 0 0 — — — — — 2026-03-17
58120 HCPCS Dilation And Curettage 0 0 — — — — — 2026-03-17
58301 HCPCS Remove Intrauterine Device 0 0 — — — — — 2026-03-17
58550 HCPCS Laparo-asst Vag Hysterectomy 0 0 — — — — — 2026-03-17
58552 HCPCS Laparo-vag Hyst Incl T/o 0 0 — — — — — 2026-03-17
58554 HCPCS Laparo-vag Hyst W/t/o Compl 0 0 — — — — — 2026-03-17
58558 HCPCS Hysteroscopy Biopsy 0 0 — — — — — 2026-03-17
58561 HCPCS Hysteroscopy Remove Myoma 0 0 — — — — — 2026-03-17
58563 HCPCS Hysteroscopy Ablation 0 0 — — — — — 2026-03-17
58570 HCPCS Tlh Uterus 250 G Or Less 0 0 — — — — — 2026-03-17
58571 HCPCS Tlh W/t/o 250 G Or Less 0 0 — — — — — 2026-03-17
58661 HCPCS Laparoscopy Remove Adnexa 0 0 — — — — — 2026-03-17
58662 HCPCS Laparoscopy Excise Lesions 0 0 — — — — — 2026-03-17
59012 HCPCS Fetal Cord Puncture Prenatal 0 0 — — — — — 2026-03-17
59025 HCPCS Fetal Non-stress Test 0 0 — — — — — 2026-03-17
59820 HCPCS Care Of Miscarriage 0 0 — — — — — 2026-03-17
59897 HCPCS Unlisted Fetal Invas Px W/us 0 0 — — — — — 2026-03-17
60220 HCPCS Partial Removal Of Thyroid 0 0 — — — — — 2026-03-17
61782 HCPCS Scan Proc Cranial Extra 0 0 — — — — — 2026-03-17
62270 HCPCS Dx Lmbr Spi Pnxr 0 0 — — — — — 2026-03-17
62328 HCPCS Dx Lmbr Spi Pnxr W/fluor/ct 0 0 — — — — — 2026-03-17
64450 HCPCS Njx Aa&/strd Other Pn/branch 0 0 — — — — — 2026-03-17
64718 HCPCS Revise Ulnar Nerve At Elbow 0 0 — — — — — 2026-03-17
64721 HCPCS Carpal Tunnel Surgery 0 0 — — — — — 2026-03-17
65426 HCPCS Removal Of Eye Lesion 0 0 — — — — — 2026-03-17
65730 HCPCS Corneal Transplant 0 0 — — — — — 2026-03-17
65755 HCPCS Corneal Transplant 0 0 — — — — — 2026-03-17
65756 HCPCS Corneal Trnspl Endothelial 0 0 — — — — — 2026-03-17
65820 HCPCS Relieve Inner Eye Pressure 0 0 — — — — — 2026-03-17
66170 HCPCS Glaucoma Surgery 0 0 — — — — — 2026-03-17
66180 HCPCS Aqueous Shunt Eye W/graft 0 0 — — — — — 2026-03-17
92507 HCPCS Speech/hearing Therapy 43 15 — — $26.64 $95.00 $60.82 2026-03-17
92521 HCPCS Evaluation Of Speech Fluency 5 2 — — $95.00 $150.00 $95.00 2026-03-17
92522 HCPCS Evaluate Speech Production 33 12 — — $95.00 $150.00 $122.50 2026-03-17
92523 HCPCS Speech Sound Lang Comprehen 40 14 — — $95.00 $220.64 $157.82 2026-03-17
92524 HCPCS Behavral Qualit Analys Voice 33 12 — — $95.00 $150.00 $122.50 2026-03-17
92526 HCPCS Oral Function Therapy 43 15 — — $85.00 $95.00 $90.00 2026-03-17
92597 HCPCS Oral Speech Device Eval 5 2 — — $90.00 $95.00 $95.00 2026-03-17
92605 HCPCS Ex For Nonspeech Device Rx 5 2 — — $90.00 $95.00 $95.00 2026-03-17
92606 HCPCS Non-speech Device Service 5 2 — — $90.00 $95.00 $95.00 2026-03-17
92607 HCPCS Ex For Speech Device Rx 1hr 33 12 — — $90.00 $95.00 $92.50 2026-03-17
96105 HCPCS Assessment Of Aphasia 33 12 — — $66.70 $150.00 $108.35 2026-03-17
97032 HCPCS Appl Modality 1+estim Ea 15 29 11 — — $90.00 $95.00 $92.50 2026-03-17
97035 HCPCS App Mdlty 1+ultrasound Ea 15 28 10 — — $9.89 $9.89 $9.89 2026-03-17
97110 HCPCS Therapeutic Exercises 28 10 — — $13.83 $95.00 $53.94 2026-03-17
97112 HCPCS Neuromuscular Reeducation 45 15 — — $19.91 $95.00 $57.45 2026-03-17
97113 HCPCS Aquatic Therapy/exercises 38 13 — — $85.00 $154.80 $119.90 2026-03-17
97116 HCPCS Gait Training Therapy 45 15 — — $17.57 $95.00 $56.28 2026-03-17
97124 HCPCS Massage Therapy 38 13 — — $58.52 $95.00 $76.76 2026-03-17
97129 HCPCS Ther Ivntj 1st 15 Min 38 13 — — $13.34 $95.00 $54.17 2026-03-17
97130 HCPCS Ther Ivntj Ea Addl 15 Min 28 10 — — $38.82 $38.82 $38.82 2026-03-17
97140 HCPCS Manual Therapy 1/> Regions 38 13 — — $18.61 $95.00 $56.80 2026-03-17
97161 HCPCS Pt Eval Low Complex 20 Min 45 15 — — $58.38 $150.00 $104.19 2026-03-17
97162 HCPCS Pt Eval Mod Complex 30 Min 45 15 — — $85.00 $150.00 $117.50 2026-03-17
97163 HCPCS Pt Eval High Complex 45 Min 45 15 — — $85.00 $150.00 $117.50 2026-03-17
97164 HCPCS Pt Re-eval Est Plan Care 45 15 — — $85.00 $150.00 $117.50 2026-03-17
97165 HCPCS Ot Eval Low Complex 30 Min 45 15 — — $85.00 $510.54 $510.54 2026-03-17
97166 HCPCS Ot Eval Mod Complex 45 Min 45 15 — — $58.77 $497.42 $150.00 2026-03-17
97167 HCPCS Ot Eval High Complex 60 Min 38 13 — — $85.00 $510.54 $510.54 2026-03-17
97168 HCPCS Ot Re-eval Est Plan Care 38 13 — — $85.00 $510.54 $510.54 2026-03-17
97530 HCPCS Therapeutic Activities 44 15 — — $30.65 $95.00 $63.78 2026-03-17
97533 HCPCS Sensory Integration 32 11 — — $85.00 $90.00 $87.50 2026-03-17
97535 HCPCS Self Care Mngment Training 44 15 — — $21.15 $95.00 $58.08 2026-03-17
97537 HCPCS Community/work Reintegration 37 13 — — $85.00 $95.00 $90.00 2026-03-17
97542 HCPCS Wheelchair Mngment Training 32 11 — — $85.00 $90.00 $87.50 2026-03-17
A0102 LOCAL Stroke M >=63.50 And M <72.50- Tier None 20 11 — — $17,938.42 $17,938.42 $17,938.42 2026-03-17
A0103 LOCAL Stroke M >=50.50 And M <63.50- Tier None 20 11 — — $20,024.33 $23,329.35 $21,676.84 2026-03-17
A0104 LOCAL Stroke M >=41.50 And M <50.50- Tier None 20 11 — — $28,916.59 $29,506.72 $29,211.65 2026-03-17
A0105 LOCAL Stroke M <41.50 And A >=84.50- Tier None 20 11 — — $36,159.79 $36,897.74 $36,528.76 2026-03-17
A0106 LOCAL Stroke M <41.50 And A <84.50- Tier None 20 11 — — $2,682.17 $41,965.93 $22,324.05 2026-03-17
A0201 LOCAL Traumatic Brain Injury M >=73.50- Tier None 20 11 — — $13,730.55 $13,730.55 $13,730.55 2026-03-17
A0202 LOCAL Traumatic Brain Injury M >=61.50 And M <73.50- Tier None 20 11 — — $17,957.54 $17,957.54 $17,957.54 2026-03-17
A0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50- Tier None 20 11 — — $22,362.33 $22,362.33 $22,362.33 2026-03-17
A0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier None 20 11 — — $27,736.40 $27,736.40 $27,736.40 2026-03-17
A0205 LOCAL Traumatic Brain Injury M <35.50- Tier None 20 11 — — $35,526.98 $35,526.98 $35,526.98 2026-03-17
A0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier None 20 11 — — $24,200.83 $24,694.72 $24,447.78 2026-03-17
A0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier None 20 11 — — $28,633.03 $28,633.03 $28,633.03 2026-03-17
A0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50- Tier None 20 11 — — $31,577.20 $31,577.20 $31,577.20 2026-03-17
A0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier None 20 11 — — $28,107.29 $28,107.29 $28,107.29 2026-03-17
A0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50- Tier None 20 11 — — $39,035.10 $39,056.17 $39,045.64 2026-03-17
A0601 LOCAL Neurological M >=64.50- Tier None 20 11 — — $16,013.24 $16,013.24 $16,013.24 2026-03-17
A0602 LOCAL Neurological M >=52.50 And M <64.50- Tier None 20 11 — — $20,309.05 $20,309.05 $20,309.05 2026-03-17
A0603 LOCAL Neurological M >=43.50 And M <52.50- Tier None 20 11 — — $23,930.00 $23,930.00 $23,930.00 2026-03-17
A0604 LOCAL Neurological M <43.50- Tier None 20 11 — — $30,011.44 $30,011.44 $30,011.44 2026-03-17
A0701 LOCAL Fracture Of Lower Extremity M >=61.50- Tier None 20 11 — — $16,473.36 $16,473.36 $16,473.36 2026-03-17
A0702 LOCAL Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier None 20 11 — — $20,050.96 $20,362.87 $20,206.92 2026-03-17
A0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier None 20 11 — — $24,165.23 $24,658.40 $24,411.81 2026-03-17
A0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier None 20 11 — — $19,753.68 $30,122.32 $24,938.00 2026-03-17
A0802 LOCAL Replacement Of Lower-extremity Joint M >=57.50 And M <63.50- Tier None 20 11 — — $10,223.36 $10,223.36 $10,223.36 2026-03-17
A0804 LOCAL Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier None 20 11 — — $22,419.68 $22,419.68 $22,419.68 2026-03-17
A0805 LOCAL Replacement Of Lower-extremity Joint M <42.50- Tier None 20 11 — — $26,889.47 $26,889.47 $26,889.47 2026-03-17
A0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier None 20 11 — — $19,544.33 $19,544.33 $19,544.33 2026-03-17
A0903 LOCAL Other Orthopedic M >=44.50 And M <51.50- Tier None 20 11 — — $23,339.26 $23,582.85 $23,461.06 2026-03-17
A0904 LOCAL Other Orthopedic M <44.5- Tier None 20 11 — — $27,406.49 $27,965.81 $27,686.15 2026-03-17
A1002 LOCAL Amputation Lower Extremity M >=55.50 And M <64.50- Tier None 20 11 — — $20,229.35 $20,229.35 $20,229.35 2026-03-17
A1004 LOCAL Amputation Lower Extremity M <47.50- Tier None 20 11 — — $29,180.76 $29,180.76 $29,180.76 2026-03-17
A1402 LOCAL Cardiac M >=55.50 And M <68.50- Tier None 20 11 — — $6,454.43 $6,454.43 $6,454.43 2026-03-17
A1403 LOCAL Cardiac M >=45.50 And M <55.50- Tier None 20 11 — — $22,806.88 $22,806.88 $22,806.88 2026-03-17
A1404 LOCAL Cardiac M <45.50- Tier None 20 11 — — $28,455.39 $28,455.39 $28,455.39 2026-03-17
A1701 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50- Tier None 20 11 — — $16,361.83 $16,361.83 $16,361.83 2026-03-17
A1703 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 20 11 — — $24,648.84 $24,648.84 $24,648.84 2026-03-17
A1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 20 11 — — $27,896.99 $27,896.99 $27,896.99 2026-03-17
A1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier None 20 11 — — $32,082.92 $32,737.67 $32,410.29 2026-03-17
A1803 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50- T… 20 11 — — $24,536.04 $24,536.04 $24,536.04 2026-03-17
A1804 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50- T… 20 11 — — $28,246.40 $28,246.40 $28,246.40 2026-03-17
A1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T… 20 11 — — $2,128.51 $32,529.28 $17,328.90 2026-03-17
A1806 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier None 20 11 — — $46,196.74 $46,196.74 $46,196.74 2026-03-17
A1903 LOCAL Guillain-barré M >=38.50 And M <51.50- Tier None 20 11 — — $32,819.00 $32,819.00 $32,819.00 2026-03-17
A1904 LOCAL Guillain-barré M <38.50- Tier None 20 11 — — $49,305.33 $49,305.33 $49,305.33 2026-03-17
A2001 LOCAL Miscellaneous M >=66.50- Tier None 20 11 — — $15,701.26 $15,701.26 $15,701.26 2026-03-17
A2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier None 20 11 — — $19,110.35 $19,110.35 $19,110.35 2026-03-17
A2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier None 20 11 — — $22,884.25 $22,884.25 $22,884.25 2026-03-17
A2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier None 20 11 — — $27,361.68 $27,361.68 $27,361.68 2026-03-17
A2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier None 20 11 — — $2,884.14 $28,841.42 $15,862.78 2026-03-17
B0104 LOCAL Stroke M >=41.50 And M <50.50- Tier Tier 1 20 11 — — $39,067.64 $39,067.64 $39,067.64 2026-03-17
B0105 LOCAL Stroke M <41.50 And A >=84.50- Tier Tier 1 20 11 — — $48,852.23 $48,852.23 $48,852.23 2026-03-17
B0604 LOCAL Neurological M <43.50- Tier Tier 1 20 11 — — $46,457.54 $46,457.54 $46,457.54 2026-03-17
B0904 LOCAL Other Orthopedic M <44.5- Tier Tier 1 20 11 — — $40,943.11 $40,943.11 $40,943.11 2026-03-17
B1303 LOCAL Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50- Tier Tier 1 20 11 — — $32,420.31 $32,420.31 $32,420.31 2026-03-17
B1404 LOCAL Cardiac M <45.50- Tier Tier 1 20 11 — — $41,023.41 $41,023.41 $41,023.41 2026-03-17
B1803 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50- T… 20 11 — — $34,940.06 $34,940.06 $34,940.06 2026-03-17
B2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier Tier 1 20 11 — — $42,800.15 $42,800.15 $42,800.15 2026-03-17
C0106 LOCAL Stroke M <41.50 And A <84.50- Tier Tier 2 20 11 — — $7,027.54 $7,027.54 $7,027.54 2026-03-17
C0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 2 20 11 — — $17,087.22 $17,087.22 $17,087.22 2026-03-17
C0205 LOCAL Traumatic Brain Injury M <35.50- Tier Tier 2 20 11 — — $10,043.56 $41,923.56 $25,983.56 2026-03-17
C0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 2 20 11 — — $27,951.71 $28,522.15 $28,236.93 2026-03-17
C0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 2 20 11 — — $32,408.91 $33,070.32 $32,739.62 2026-03-17
C0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 2 20 11 — — $36,471.41 $36,471.41 $36,471.41 2026-03-17
C0403 LOCAL Traumatic Spinal Cord Injury M >=41.50 And M <47.50- Tier Tier 2 20 11 — — $32,521.33 $32,521.33 $32,521.33 2026-03-17
C0503 LOCAL Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier Tier 2 20 11 — — $27,365.93 $27,365.93 $27,365.93 2026-03-17
C0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 2 20 11 — — $31,638.88 $32,284.57 $31,961.72 2026-03-17
C0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 2 20 11 — — $44,862.30 $44,862.30 $44,862.30 2026-03-17
C0603 LOCAL Neurological M >=43.50 And M <52.50- Tier Tier 2 20 11 — — $28,422.73 $28,422.73 $28,422.73 2026-03-17
C0604 LOCAL Neurological M <43.50- Tier Tier 2 20 11 — — $35,645.51 $35,645.51 $35,645.51 2026-03-17
C0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 2 20 11 — — $28,174.20 $28,174.20 $28,174.20 2026-03-17
C0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier Tier 2 20 11 — — $34,418.14 $34,783.41 $34,600.78 2026-03-17
C0805 LOCAL Replacement Of Lower-extremity Joint M <42.50- Tier Tier 2 20 11 — — $31,621.18 $31,621.18 $31,621.18 2026-03-17
C0904 LOCAL Other Orthopedic M <44.5- Tier Tier 2 20 11 — — $32,137.25 $32,793.11 $32,465.18 2026-03-17
C1004 LOCAL Amputation Lower Extremity M <47.50- Tier Tier 2 20 11 — — $35,655.80 $35,655.80 $35,655.80 2026-03-17
C1404 LOCAL Cardiac M <45.50- Tier Tier 2 20 11 — — $32,317.07 $32,317.07 $32,317.07 2026-03-17
C1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 2 20 11 — — $38,964.40 $38,964.40 $38,964.40 2026-03-17
C1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T… 20 11 — — $36,955.10 $39,247.34 $38,101.22 2026-03-17
C1806 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier Tier 2 20 11 — — $52,482.74 $52,482.74 $52,482.74 2026-03-17
C2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier Tier 2 20 11 — — $26,914.32 $26,914.32 $26,914.32 2026-03-17
C2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier Tier 2 20 11 — — $32,179.42 $32,179.42 $32,179.42 2026-03-17
C2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier Tier 2 20 11 — — $33,919.16 $33,919.16 $33,919.16 2026-03-17
D0102 LOCAL Stroke M >=63.50 And M <72.50- Tier Tier 3 20 11 — — $19,159.25 $19,159.25 $19,159.25 2026-03-17
D0103 LOCAL Stroke M >=50.50 And M <63.50- Tier Tier 3 20 11 — — $23,775.53 $24,260.74 $24,018.13 2026-03-17
D0104 LOCAL Stroke M >=41.50 And M <50.50- Tier Tier 3 20 11 — — $28,609.13 $30,961.60 $29,785.37 2026-03-17
D0105 LOCAL Stroke M <41.50 And A >=84.50- Tier Tier 3 20 11 — — $38,715.87 $38,715.87 $38,715.87 2026-03-17
D0106 LOCAL Stroke M <41.50 And A <84.50- Tier Tier 3 20 11 — — $43,155.68 $44,036.41 $43,596.04 2026-03-17
D0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 3 20 11 — — $23,277.17 $23,752.21 $23,514.69 2026-03-17
D0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 3 20 11 — — $28,869.75 $29,458.93 $29,164.34 2026-03-17
D0205 LOCAL Traumatic Brain Injury M <35.50- Tier Tier 3 20 11 — — $19,319.60 $37,735.11 $28,527.35 2026-03-17
D0301 LOCAL Non-traumatic Brain Injury M >=65.50- Tier Tier 3 20 11 — — $16,506.10 $16,842.96 $16,674.53 2026-03-17
D0302 LOCAL Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 3 20 11 — — $21,775.40 $21,775.40 $21,775.40 2026-03-17
D0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 3 20 11 — — $25,677.20 $26,201.22 $25,939.21 2026-03-17
D0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 3 20 11 — — $30,378.51 $30,378.51 $30,378.51 2026-03-17
D0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 3 20 11 — — $33,502.39 $33,502.39 $33,502.39 2026-03-17
D0402 LOCAL Traumatic Spinal Cord Injury M >=47.50 And M <56.50- Tier Tier 3 20 11 — — $25,669.74 $25,669.74 $25,669.74 2026-03-17
D0404 LOCAL Traumatic Spinal Cord Injury M <31.50 And A <61.50- Tier Tier 3 20 11 — — $48,920.82 $48,920.82 $48,920.82 2026-03-17
D0502 LOCAL Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50- Tier Tier 3 20 11 — — $22,385.27 $22,385.27 $22,385.27 2026-03-17
D0503 LOCAL Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier Tier 3 20 11 — — $25,658.27 $25,658.27 $25,658.27 2026-03-17
D0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 3 20 11 — — $42,382.70 $42,382.70 $42,382.70 2026-03-17
D0601 LOCAL Neurological M >=64.50- Tier Tier 3 20 11 — — $17,754.89 $17,754.89 $17,754.89 2026-03-17
D0602 LOCAL Neurological M >=52.50 And M <64.50- Tier Tier 3 20 11 — — $22,483.72 $22,483.72 $22,483.72 2026-03-17
D0603 LOCAL Neurological M >=43.50 And M <52.50- Tier Tier 3 20 11 — — $26,533.88 $26,533.88 $26,533.88 2026-03-17
D0604 LOCAL Neurological M <43.50- Tier Tier 3 20 11 — — $33,276.79 $33,276.79 $33,276.79 2026-03-17
D0702 LOCAL Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier Tier 3 20 11 — — $22,282.47 $22,282.47 $22,282.47 2026-03-17
D0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 3 20 11 — — $26,688.73 $26,688.73 $26,688.73 2026-03-17
D0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier Tier 3 20 11 — — $31,951.76 $32,603.84 $32,277.80 2026-03-17
D0803 LOCAL Replacement Of Lower-extremity Joint M >=51.50 And M <57.50- Tier Tier 3 20 11 — — $21,456.13 $21,456.13 $21,456.13 2026-03-17
D0804 LOCAL Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier Tier 3 20 11 — — $24,038.98 $24,457.51 $24,248.24 2026-03-17
D0805 LOCAL Replacement Of Lower-extremity Joint M <42.50- Tier Tier 3 20 11 — — $28,253.35 $30,462.07 $29,357.71 2026-03-17
D0901 LOCAL Other Orthopedic M >=63.50- Tier Tier 3 20 11 — — $17,148.70 $17,148.70 $17,148.70 2026-03-17
D0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier Tier 3 20 11 — — $21,360.54 $21,360.54 $21,360.54 2026-03-17
D0903 LOCAL Other Orthopedic M >=44.50 And M <51.50- Tier Tier 3 20 11 — — $25,509.15 $25,509.15 $25,509.15 2026-03-17
D0904 LOCAL Other Orthopedic M <44.5- Tier Tier 3 20 11 — — $29,954.54 $31,127.73 $30,541.13 2026-03-17
D1004 LOCAL Amputation Lower Extremity M <47.50- Tier Tier 3 20 11 — — $28,574.76 $34,490.91 $31,532.83 2026-03-17
D1203 LOCAL Osteoarthritis M <49.50 And A >=74.50- Tier Tier 3 20 11 — — $28,378.76 $28,378.76 $28,378.76 2026-03-17
D1402 LOCAL Cardiac M >=55.50 And M <68.50- Tier Tier 3 20 11 — — $20,041.40 $20,041.40 $20,041.40 2026-03-17
D1403 LOCAL Cardiac M >=45.50 And M <55.50- Tier Tier 3 20 11 — — $24,522.66 $24,522.66 $24,522.66 2026-03-17
D1404 LOCAL Cardiac M <45.50- Tier Tier 3 20 11 — — $30,047.76 $30,325.02 $30,186.39 2026-03-17
D1702 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 20 11 — — $6,668.44 $6,668.44 $6,668.44 2026-03-17
D1703 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 20 11 — — $27,168.59 $27,168.59 $27,168.59 2026-03-17
D1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 20 11 — — $30,749.39 $30,749.39 $30,749.39 2026-03-17
D1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3 20 11 — — $36,085.23 $36,085.23 $36,085.23 2026-03-17
D1804 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50- T… 20 11 — — $30,094.40 $30,094.40 $30,094.40 2026-03-17
D1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T… 20 11 — — $35,083.45 $35,083.45 $35,083.45 2026-03-17
D1806 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier Tier 3 20 11 — — $49,825.34 $49,825.34 $49,825.34 2026-03-17
D1904 LOCAL Guillain-barré M <38.50- Tier Tier 3 20 11 — — $50,173.28 $50,173.28 $50,173.28 2026-03-17
D2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier Tier 3 20 11 — — $20,995.39 $20,995.39 $20,995.39 2026-03-17
D2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier Tier 3 20 11 — — $25,142.08 $25,142.08 $25,142.08 2026-03-17
D2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier Tier 3 20 11 — — $30,061.15 $30,061.15 $30,061.15 2026-03-17
D2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier Tier 3 20 11 — — $31,282.70 $31,921.12 $31,601.91 2026-03-17
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