Price Transparency Hospital negotiated rates

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

Rehabilitation Hospital Of Northern Arizona

Flagstaff, AZ · CCN 033041 · Rates published

1,132 distinct procedures filed
14 distinct payers
11,941 rate rows
2026-03-17 last MRF observed
Data quality

3,295 of 11,941 rate rows are consumer-grade (27.6%)

8,646 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 8,226
per-diem day rate — not a per-procedure price 420
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://ernesthealth.com/wp-content/uploads/2025/01/pricing/Rehabilitation%20Hospital%20of%20Northern%20Arizona/364820127_Rehabilitation-Hospital-of-Northern-Arizona_Standard-Charges.json
Found on page https://rhna.ernesthealth.com/price-transparency/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-18
Content fingerprint e769af4ccdfad46c… · 4,622,555 bytes · first seen 2026-05-09

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
D0407
LOCAL 		Traumatic Spinal Cord Injury M <24.50 And A >=61.50- Tier Tier 3 8 $73,728.24 $73,728.24 $73,728.24 nat. median
$67,662
1.1× median
B1004
LOCAL 		Amputation Lower Extremity M <47.50- Tier Tier 1 8 $48,301.96 $48,301.96 $48,301.96 nat. median
$42,470
1.1× median
B0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier Tier 1 8 $37,356.35 $57,889.19 $47,622.77 nat. median
$53,762
0.9× median
B0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 1 8 $46,883.60 $46,883.60 $46,883.60 nat. median
$43,383
1.1× median
A1806
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier None 8 $46,838.95 $46,838.95 $46,838.95 nat. median
$45,144
1.0× median
B1704
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 8 $46,361.17 $46,361.17 $46,361.17 nat. median
$41,742
1.1× median
B2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 1 8 $45,203.64 $46,089.35 $45,646.50 nat. median
$40,995
1.1× median
B0504
LOCAL 		Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 1 8 $44,940.00 $44,940.00 $44,940.00 nat. median
$41,330
1.1× median
B0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 1 8 $44,437.67 $44,437.67 $44,437.67 nat. median
$40,010
1.1× median
C0205
LOCAL 		Traumatic Brain Injury M <35.50- Tier Tier 2 8 $44,189.46 $44,277.82 $44,233.64 nat. median
$40,508
1.1× median
B2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 1 8 $43,725.95 $43,725.95 $43,725.95 nat. median
$39,191
1.1× median
D0405
LOCAL 		Traumatic Spinal Cord Injury M >=31.50 And M <41.50- Tier Tier 3 8 $43,412.63 $43,412.63 $43,412.63 nat. median
$38,816
1.1× median
B0104
LOCAL 		Stroke M >=41.50 And M <50.50- Tier Tier 1 8 $42,402.12 $42,402.12 $42,402.12 nat. median
$38,092
1.1× median
C1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 2 8 $42,290.07 $42,290.07 $42,290.07 nat. median
$37,992
1.1× median
C0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier Tier 2 8 $31,343.52 $52,301.82 $41,822.67 nat. median
$46,986
0.9× median
A0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier None 8 $37,511.49 $45,547.78 $41,529.64 nat. median
$39,573
1.0× median
D0205
LOCAL 		Traumatic Brain Injury M <35.50- Tier Tier 3 8 $40,955.86 $40,955.86 $40,955.86 nat. median
$36,592
1.1× median
A0505
LOCAL 		Non-traumatic Spinal Cord Injury M <39.50- Tier None 8 $40,305.09 $40,973.68 $40,639.39 nat. median
$37,907
1.1× median
D0105
LOCAL 		Stroke M <41.50 And A >=84.50- Tier Tier 3 8 $37,128.93 $42,020.32 $39,574.62 nat. median
$37,662
1.1× median
A0105
LOCAL 		Stroke M <41.50 And A >=84.50- Tier None 8 $39,219.54 $39,246.08 $39,232.81 nat. median
$35,375
1.1× median
D1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3 8 $38,381.86 $39,165.16 $38,773.51 nat. median
$34,992
1.1× median
C0604
LOCAL 		Neurological M <43.50- Tier Tier 2 8 $37,914.15 $38,687.91 $38,301.03 nat. median
$34,756
1.1× median
A0205
LOCAL 		Traumatic Brain Injury M <35.50- Tier None 8 $37,788.07 $38,559.26 $38,173.67 nat. median
$33,234
1.1× median
B0703
LOCAL 		Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 1 8 $37,968.77 $37,968.77 $37,968.77 nat. median
$35,512
1.1× median
D1805
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T… 8 $37,316.31 $38,077.87 $37,697.09 nat. median
$34,208
1.1× median
B0503
LOCAL 		Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier Tier 1 8 $37,609.07 $37,609.07 $37,609.07 nat. median
$34,570
1.1× median
B1003
LOCAL 		Amputation Lower Extremity M >=47.50 And M <55.50- Tier Tier 1 8 $37,295.60 $37,295.60 $37,295.60 nat. median
$34,027
1.1× median
B0903
LOCAL 		Other Orthopedic M >=44.50 And M <51.50- Tier Tier 1 8 $37,086.03 $37,086.03 $37,086.03 nat. median
$33,505
1.1× median
C2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 2 8 $36,814.21 $36,814.21 $36,814.21 nat. median
$32,921
1.1× median
B2003
LOCAL 		Miscellaneous M >=46.50 And M <55.50- Tier Tier 1 8 $36,571.44 $36,571.44 $36,571.44 nat. median
$32,854
1.1× median
D1504
LOCAL 		Pulmonary M <45.50- Tier Tier 3 8 $36,049.69 $36,049.69 $36,049.69 nat. median
$32,186
1.1× median
A1805
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T… 8 $35,790.13 $35,790.13 $35,790.13 nat. median
$31,725
1.1× median
C0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 2 8 $35,592.05 $35,592.05 $35,592.05 nat. median
$31,818
1.1× median
A1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier None 8 $35,369.12 $35,369.12 $35,369.12 nat. median
$31,920
1.1× median
C0204
LOCAL 		Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 2 8 $35,204.03 $35,204.03 $35,204.03 nat. median
$31,314
1.1× median
C1404
LOCAL 		Cardiac M <45.50- Tier Tier 2 8 $35,075.38 $35,075.38 $35,075.38 nat. median
$30,962
1.1× median
D0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 3 8 $34,678.90 $35,386.63 $35,032.76 nat. median
$31,616
1.1× median
C2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 2 8 $34,925.98 $34,925.98 $34,925.98 nat. median
$31,232
1.1× median
C0504
LOCAL 		Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 2 8 $34,535.27 $35,040.11 $34,787.69 nat. median
$31,479
1.1× median
D0604
LOCAL 		Neurological M <43.50- Tier Tier 3 8 $33,119.21 $36,117.02 $34,618.11 nat. median
$32,269
1.1× median
B0203
LOCAL 		Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 1 8 $34,461.19 $34,461.19 $34,461.19 nat. median
$31,028
1.1× median
A1504
LOCAL 		Pulmonary M <45.50- Tier None 8 $33,697.60 $33,697.60 $33,697.60 nat. median
$30,273
1.1× median
D1704
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 8 $33,373.90 $33,373.90 $33,373.90 nat. median
$29,818
1.1× median
D0304
LOCAL 		Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 3 8 $32,971.36 $32,971.36 $32,971.36 nat. median
$29,475
1.1× median
D1404
LOCAL 		Cardiac M <45.50- Tier Tier 3 8 $32,612.38 $32,612.38 $32,612.38 nat. median
$29,138
1.1× median
D0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier Tier 3 8 $17,367.37 $47,794.98 $32,581.17 nat. median
$42,703
0.8× median
D2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 3 8 $32,209.48 $32,626.91 $32,418.19 nat. median
$29,151
1.1× median
A1004
LOCAL 		Amputation Lower Extremity M <47.50- Tier None 8 $32,317.74 $32,317.74 $32,317.74 nat. median
$29,040
1.1× median
A0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier None 8 $31,881.75 $32,693.31 $32,287.53 nat. median
$29,236
1.1× median
B0902
LOCAL 		Other Orthopedic M >=51.50 And M <63.50- Tier Tier 1 8 $32,154.30 $32,154.30 $32,154.30 nat. median
$27,907
1.2× median

Other procedures at this hospital

Browse this hospital's 1,132 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
             
D0407 LOCAL Traumatic Spinal Cord Injury M <24.50 And A >=61.50- Tier Tier 3 15 8 — — $73,728.24 $73,728.24 $73,728.24 2026-03-17
B1004 LOCAL Amputation Lower Extremity M <47.50- Tier Tier 1 15 8 — — $48,301.96 $48,301.96 $48,301.96 2026-03-17
B0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier Tier 1 15 8 — — $46,883.60 $46,883.60 $46,883.60 2026-03-17
A1806 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier None 15 8 — — $46,838.95 $46,838.95 $46,838.95 2026-03-17
B1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 15 8 — — $46,361.17 $46,361.17 $46,361.17 2026-03-17
B2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier Tier 1 15 8 — — $45,203.64 $46,089.35 $45,646.50 2026-03-17
B0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 1 15 8 — — $44,940.00 $44,940.00 $44,940.00 2026-03-17
B0904 LOCAL Other Orthopedic M <44.5- Tier Tier 1 15 8 — — $44,437.67 $44,437.67 $44,437.67 2026-03-17
C0205 LOCAL Traumatic Brain Injury M <35.50- Tier Tier 2 15 8 — — $44,189.46 $44,277.82 $44,233.64 2026-03-17
B2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier Tier 1 15 8 — — $43,725.95 $43,725.95 $43,725.95 2026-03-17
D0405 LOCAL Traumatic Spinal Cord Injury M >=31.50 And M <41.50- Tier Tier 3 15 8 — — $43,412.63 $43,412.63 $43,412.63 2026-03-17
B0104 LOCAL Stroke M >=41.50 And M <50.50- Tier Tier 1 15 8 — — $42,402.12 $42,402.12 $42,402.12 2026-03-17
C1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 2 15 8 — — $42,290.07 $42,290.07 $42,290.07 2026-03-17
D0205 LOCAL Traumatic Brain Injury M <35.50- Tier Tier 3 15 8 — — $40,955.86 $40,955.86 $40,955.86 2026-03-17
A0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50- Tier None 15 8 — — $40,305.09 $40,973.68 $40,639.39 2026-03-17
A0105 LOCAL Stroke M <41.50 And A >=84.50- Tier None 15 8 — — $39,219.54 $39,246.08 $39,232.81 2026-03-17
D1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3 15 8 — — $38,381.86 $39,165.16 $38,773.51 2026-03-17
B0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 1 15 8 — — $37,968.77 $37,968.77 $37,968.77 2026-03-17
C0604 LOCAL Neurological M <43.50- Tier Tier 2 15 8 — — $37,914.15 $38,687.91 $38,301.03 2026-03-17
A0205 LOCAL Traumatic Brain Injury M <35.50- Tier None 15 8 — — $37,788.07 $38,559.26 $38,173.67 2026-03-17
B0503 LOCAL Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier Tier 1 15 8 — — $37,609.07 $37,609.07 $37,609.07 2026-03-17
A0106 LOCAL Stroke M <41.50 And A <84.50- Tier None 15 8 — — $37,511.49 $45,547.78 $41,529.64 2026-03-17
B0106 LOCAL Stroke M <41.50 And A <84.50- Tier Tier 1 15 8 — — $37,356.35 $57,889.19 $47,622.77 2026-03-17
D1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T… 15 8 — — $37,316.31 $38,077.87 $37,697.09 2026-03-17
B1003 LOCAL Amputation Lower Extremity M >=47.50 And M <55.50- Tier Tier 1 15 8 — — $37,295.60 $37,295.60 $37,295.60 2026-03-17
D0105 LOCAL Stroke M <41.50 And A >=84.50- Tier Tier 3 15 8 — — $37,128.93 $42,020.32 $39,574.62 2026-03-17
B0903 LOCAL Other Orthopedic M >=44.50 And M <51.50- Tier Tier 1 15 8 — — $37,086.03 $37,086.03 $37,086.03 2026-03-17
C2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier Tier 2 15 8 — — $36,814.21 $36,814.21 $36,814.21 2026-03-17
B2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier Tier 1 15 8 — — $36,571.44 $36,571.44 $36,571.44 2026-03-17
D1504 LOCAL Pulmonary M <45.50- Tier Tier 3 15 8 — — $36,049.69 $36,049.69 $36,049.69 2026-03-17
A1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T… 15 8 — — $35,790.13 $35,790.13 $35,790.13 2026-03-17
C0904 LOCAL Other Orthopedic M <44.5- Tier Tier 2 15 8 — — $35,592.05 $35,592.05 $35,592.05 2026-03-17
A1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier None 15 8 — — $35,369.12 $35,369.12 $35,369.12 2026-03-17
C0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 2 15 8 — — $35,204.03 $35,204.03 $35,204.03 2026-03-17
C1404 LOCAL Cardiac M <45.50- Tier Tier 2 15 8 — — $35,075.38 $35,075.38 $35,075.38 2026-03-17
C2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier Tier 2 15 8 — — $34,925.98 $34,925.98 $34,925.98 2026-03-17
D0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier Tier 3 15 8 — — $34,678.90 $35,386.63 $35,032.76 2026-03-17
C0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 2 15 8 — — $34,535.27 $35,040.11 $34,787.69 2026-03-17
B0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 1 15 8 — — $34,461.19 $34,461.19 $34,461.19 2026-03-17
A1504 LOCAL Pulmonary M <45.50- Tier None 15 8 — — $33,697.60 $33,697.60 $33,697.60 2026-03-17
D1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 15 8 — — $33,373.90 $33,373.90 $33,373.90 2026-03-17
D0604 LOCAL Neurological M <43.50- Tier Tier 3 15 8 — — $33,119.21 $36,117.02 $34,618.11 2026-03-17
D0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 3 15 8 — — $32,971.36 $32,971.36 $32,971.36 2026-03-17
D1404 LOCAL Cardiac M <45.50- Tier Tier 3 15 8 — — $32,612.38 $32,612.38 $32,612.38 2026-03-17
A1004 LOCAL Amputation Lower Extremity M <47.50- Tier None 15 8 — — $32,317.74 $32,317.74 $32,317.74 2026-03-17
D2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier Tier 3 15 8 — — $32,209.48 $32,626.91 $32,418.19 2026-03-17
B0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier Tier 1 15 8 — — $32,154.30 $32,154.30 $32,154.30 2026-03-17
A0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier None 15 8 — — $31,881.75 $32,693.31 $32,287.53 2026-03-17
C0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 2 15 8 — — $31,579.01 $31,579.01 $31,579.01 2026-03-17
C0106 LOCAL Stroke M <41.50 And A <84.50- Tier Tier 2 15 8 — — $31,343.52 $52,301.82 $41,822.67 2026-03-17
D0805 LOCAL Replacement Of Lower-extremity Joint M <42.50- Tier Tier 3 15 8 — — $31,290.63 $31,290.63 $31,290.63 2026-03-17
C0603 LOCAL Neurological M >=43.50 And M <52.50- Tier Tier 2 15 8 — — $30,848.66 $30,848.66 $30,848.66 2026-03-17
C1503 LOCAL Pulmonary M >=45.50 And M <56.50- Tier Tier 2 15 8 — — $30,697.11 $30,697.11 $30,697.11 2026-03-17
C0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 2 15 8 — — $30,578.91 $30,578.91 $30,578.91 2026-03-17
A1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 15 8 — — $30,382.37 $30,382.37 $30,382.37 2026-03-17
A0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier None 15 8 — — $30,103.74 $30,103.74 $30,103.74 2026-03-17
A2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier None 15 8 — — $29,697.04 $29,697.04 $29,697.04 2026-03-17
A1404 LOCAL Cardiac M <45.50- Tier None 15 8 — — $29,452.26 $29,452.26 $29,452.26 2026-03-17
A2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier None 15 8 — — $29,294.33 $31,303.08 $30,298.71 2026-03-17
A0805 LOCAL Replacement Of Lower-extremity Joint M <42.50- Tier None 15 8 — — $29,184.53 $29,184.53 $29,184.53 2026-03-17
D1503 LOCAL Pulmonary M >=45.50 And M <56.50- Tier Tier 3 15 8 — — $29,089.08 $29,089.08 $29,089.08 2026-03-17
C0503 LOCAL Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier Tier 2 15 8 — — $28,902.70 $28,902.70 $28,902.70 2026-03-17
D0603 LOCAL Neurological M >=43.50 And M <52.50- Tier Tier 3 15 8 — — $28,798.58 $28,798.58 $28,798.58 2026-03-17
D1803 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50- T… 15 8 — — $28,721.81 $28,721.81 $28,721.81 2026-03-17
C2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier Tier 2 15 8 — — $28,397.89 $28,397.89 $28,397.89 2026-03-17
C0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 2 15 8 — — $28,383.59 $28,383.59 $28,383.59 2026-03-17
D2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier Tier 3 15 8 — — $28,277.70 $34,390.64 $31,334.17 2026-03-17
D0903 LOCAL Other Orthopedic M >=44.50 And M <51.50- Tier Tier 3 15 8 — — $27,686.39 $27,686.39 $27,686.39 2026-03-17
B0202 LOCAL Traumatic Brain Injury M >=61.50 And M <73.50- Tier Tier 1 15 8 — — $27,671.87 $27,671.87 $27,671.87 2026-03-17
A0604 LOCAL Neurological M <43.50- Tier None 15 8 — — $27,377.33 $32,572.96 $29,975.15 2026-03-17
D0104 LOCAL Stroke M >=41.50 And M <50.50- Tier Tier 3 15 8 — — $27,193.36 $33,604.22 $30,398.79 2026-03-17
D1403 LOCAL Cardiac M >=45.50 And M <55.50- Tier Tier 3 15 8 — — $26,615.71 $26,615.71 $26,615.71 2026-03-17
D2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier Tier 3 15 8 — — $26,409.32 $27,288.00 $26,848.66 2026-03-17
A1703 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 15 8 — — $26,403.19 $26,403.19 $26,403.19 2026-03-17
D0503 LOCAL Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier Tier 3 15 8 — — $25,870.00 $27,848.24 $26,859.12 2026-03-17
D0804 LOCAL Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier Tier 3 15 8 — — $25,830.94 $26,090.74 $25,960.84 2026-03-17
A0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier None 15 8 — — $25,818.68 $25,818.68 $25,818.68 2026-03-17
D1502 LOCAL Pulmonary M >=56.50 And M <68.50- Tier Tier 3 15 8 — — $25,594.82 $25,594.82 $25,594.82 2026-03-17
D0103 LOCAL Stroke M >=50.50 And M <63.50- Tier Tier 3 15 8 — — $25,456.53 $26,331.44 $25,893.99 2026-03-17
A0104 LOCAL Stroke M >=41.50 And M <50.50- Tier None 15 8 — — $25,435.87 $32,025.17 $28,730.52 2026-03-17
A0603 LOCAL Neurological M >=43.50 And M <52.50- Tier None 15 8 — — $25,364.97 $25,453.01 $25,408.99 2026-03-17
A0903 LOCAL Other Orthopedic M >=44.50 And M <51.50- Tier None 15 8 — — $24,907.17 $25,331.30 $25,119.24 2026-03-17
C0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier Tier 2 15 8 — — $24,874.80 $24,874.80 $24,874.80 2026-03-17
A0804 LOCAL Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier None 15 8 — — $24,333.23 $24,333.23 $24,333.23 2026-03-17
C2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier Tier 2 15 8 — — $24,183.68 $24,183.68 $24,183.68 2026-03-17
D0302 LOCAL Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 3 15 8 — — $23,633.97 $23,633.97 $23,633.97 2026-03-17
D1003 LOCAL Amputation Lower Extremity M >=47.50 And M <55.50- Tier Tier 3 15 8 — — $23,620.51 $28,176.09 $25,898.30 2026-03-17
D0702 LOCAL Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier Tier 3 15 8 — — $23,555.12 $23,555.12 $23,555.12 2026-03-17
D0602 LOCAL Neurological M >=52.50 And M <64.50- Tier Tier 3 15 8 — — $23,271.39 $24,441.13 $23,856.26 2026-03-17
D1702 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 15 8 — — $22,732.35 $24,443.24 $23,587.79 2026-03-17
D0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier Tier 3 15 8 — — $22,721.13 $23,183.70 $22,952.42 2026-03-17
A0904 LOCAL Other Orthopedic M <44.5- Tier None 15 8 — — $22,507.30 $30,352.74 $26,430.02 2026-03-17
D0803 LOCAL Replacement Of Lower-extremity Joint M >=51.50 And M <57.50- Tier Tier 3 15 8 — — $22,442.50 $23,287.45 $22,864.97 2026-03-17
A0302 LOCAL Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier None 15 8 — — $22,274.86 $22,274.86 $22,274.86 2026-03-17
A1803 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50- T… 15 8 — — $22,165.89 $22,165.89 $22,165.89 2026-03-17
D0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 3 15 8 — — $21,783.51 $33,104.15 $27,443.83 2026-03-17
A0702 LOCAL Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier None 15 8 — — $21,762.34 $21,762.34 $21,762.34 2026-03-17
D1402 LOCAL Cardiac M >=55.50 And M <68.50- Tier Tier 3 15 8 — — $21,751.96 $21,751.96 $21,751.96 2026-03-17
A1002 LOCAL Amputation Lower Extremity M >=55.50 And M <64.50- Tier None 15 8 — — $21,544.47 $21,544.47 $21,544.47 2026-03-17
A0803 LOCAL Replacement Of Lower-extremity Joint M >=51.50 And M <57.50- Tier None 15 8 — — $21,304.04 $21,304.04 $21,304.04 2026-03-17
A0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier None 15 8 — — $21,212.47 $21,212.47 $21,212.47 2026-03-17
A2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier None 15 8 — — $20,741.45 $20,741.45 $20,741.45 2026-03-17
D2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier Tier 3 15 8 — — $20,526.54 $22,787.38 $21,656.96 2026-03-17
D0102 LOCAL Stroke M >=63.50 And M <72.50- Tier Tier 3 15 8 — — $20,235.16 $20,235.16 $20,235.16 2026-03-17
D0904 LOCAL Other Orthopedic M <44.5- Tier Tier 3 15 8 — — $20,071.16 $33,174.70 $26,622.93 2026-03-17
A2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier None 15 8 — — $19,513.83 $24,837.45 $22,175.64 2026-03-17
A0102 LOCAL Stroke M >=63.50 And M <72.50- Tier None 15 8 — — $19,469.49 $19,469.49 $19,469.49 2026-03-17
A0802 LOCAL Replacement Of Lower-extremity Joint M >=57.50 And M <63.50- Tier None 15 8 — — $19,358.39 $19,358.39 $19,358.39 2026-03-17
D1703 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 15 8 — — $19,016.19 $29,487.47 $24,251.83 2026-03-17
D0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 3 15 8 — — $18,384.52 $36,361.87 $27,373.19 2026-03-17
D2001 LOCAL Miscellaneous M >=66.50- Tier Tier 3 15 8 — — $18,276.38 $18,276.38 $18,276.38 2026-03-17
C0302 LOCAL Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 2 15 8 — — $17,569.31 $17,569.31 $17,569.31 2026-03-17
D0106 LOCAL Stroke M <41.50 And A <84.50- Tier Tier 3 15 8 — — $17,367.37 $47,794.98 $32,581.17 2026-03-17
A0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier None 15 8 — — $16,090.91 $30,506.29 $23,298.60 2026-03-17
D1004 LOCAL Amputation Lower Extremity M <47.50- Tier Tier 3 15 8 — — $15,301.29 $36,071.37 $25,686.33 2026-03-17
D0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 3 15 8 — — $14,794.81 $31,973.29 $23,384.05 2026-03-17
A0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50- Tier None 15 8 — — $14,502.17 $24,270.98 $19,386.58 2026-03-17
D0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 3 15 8 — — $14,158.94 $46,000.12 $30,079.53 2026-03-17
D0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 3 15 8 — — $13,215.08 $25,583.65 $19,399.37 2026-03-17
D0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 3 15 8 — — $11,250.94 $28,966.65 $20,108.79 2026-03-17
A0103 LOCAL Stroke M >=50.50 And M <63.50- Tier None 15 8 — — $8,635.56 $25,092.67 $16,864.12 2026-03-17
D0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 3 15 8 — — $6,698.79 $28,437.53 $17,568.16 2026-03-17
A0202 LOCAL Traumatic Brain Injury M >=61.50 And M <73.50- Tier None 15 8 — — $4,833.47 $4,833.47 $4,833.47 2026-03-17
A0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier None 15 8 — — $3,147.45 $26,763.03 $14,955.24 2026-03-17
0128 RC Room & Board - Semi-private (Two Beds) - Rehabilitation 7 4 — — $1,716.25 $1,716.25 $1,716.25 2026-03-17
0138 RC Room & Board - Three And Four Beds - Rehabilitation 7 4 — — $1,716.25 $1,716.25 $1,716.25 2026-03-17
0148 RC Room & Board - Deluxe Private - Rehabilitation 7 4 — — $1,716.25 $1,716.25 $1,716.25 2026-03-17
0158 RC Room & Board - Ward - Rehabilitation 7 4 — — $1,716.25 $1,716.25 $1,716.25 2026-03-17
0127 RC Room & Board - Semi-private (Two Beds) - Oncology 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0111 RC Room & Board - Private (One Bed) - Medical/Surgical/GYN 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0112 RC Room & Board - Private (One Bed) - Obstetrics (ob) 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0117 RC Room & Board - Private (One Bed) - Oncology 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0137 RC Room & Board - Three And Four Beds - Oncology 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0100 RC All Inclusive Rate - Room And Board Plus Ancillary 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0121 RC Room & Board - Semi-private (Two Beds) - Medical/Surgical/GYN 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0101 RC All Inclusive Rate - Room And Board 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0131 RC Room & Board - Three And Four Beds - Medical/Surgical/GYN 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0142 RC Room & Board - Deluxe Private - Obstetrics (ob) 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0143 RC Room & Board - Deluxe Private - Pediatric 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0133 RC Room & Board - Three And Four Beds - Pediatric 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0151 RC Room & Board - Ward - Medical/Surgical/GYN 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0147 RC Room & Board - Deluxe Private - Oncology 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0153 RC Room & Board - Ward - Pediatrics 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0157 RC Room & Board - Ward - Oncology 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0171 RC Nursery - Newborn - Level I 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0172 RC Nursery - Newborn - Level Ii 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0160 RC Room & Board - Other - General Classification 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0211 RC Coronary Care Unit - Myocardial Infarction 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0202 RC Intensive Care Unit - Medical 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0201 RC Intensive Care Unit - Surgical 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0164 RC Room & Board - Other - Sterile Environment 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0210 RC Coronary Care Unit - General Classification 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0212 RC Coronary Care Unit - Pulmonary Care 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0179 RC Nursery - Other 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0214 RC Coronary Care Unit - Intermediate Ccu 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0219 RC Coronary Care Unit - Other 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0169 RC Room & Board - Other - Other 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0203 RC Intensive Care Unit - Pediatric 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0200 RC Intensive Care Unit - General Classification 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0206 RC Intensive Care Unit - Intermediate ICU 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0173 RC Nursery - Newborn - Level Iii 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0170 RC Nursery - General Classification 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0174 RC Nursery - Newborn - Level IV 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0207 RC Intensive Care Unit - Burn Care 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0208 RC Intensive Care Unit - Trauma 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0161 RC Room & Board - Hospital At Home 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0209 RC Intensive Care Unit - Other 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0152 RC Room & Board - Ward - Obstetrics (ob) 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0141 RC Room & Board - Deluxe Private - Medical/Surgical/GYN 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0132 RC Room & Board - Three And Four Beds - Obstetrics (ob) 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0122 RC Room & Board - Semi-private (Two Beds) - Obstetrics (ob) 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0123 RC Room & Board - Semi-private (Two Beds) - Pediatric 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0113 RC Room & Board - Private (One Bed) - Pediatric 3 1 — — $1,339.00 $1,339.00 $1,339.00 2026-03-17
0139 RC Room & Board - Three And Four Beds - Other 3 1 — — $1,325.00 $1,325.00 $1,325.00 2026-03-17
0159 RC Room & Board - Ward - Other 3 1 — — $1,325.00 $1,325.00 $1,325.00 2026-03-17
0150 RC Room & Board - Ward - General Classification 3 1 — — $1,325.00 $1,325.00 $1,325.00 2026-03-17
0149 RC Room & Board - Deluxe Private - Other 3 1 — — $1,325.00 $1,325.00 $1,325.00 2026-03-17
0140 RC Room & Board - Deluxe Private - General Classification 3 1 — — $1,325.00 $1,325.00 $1,325.00 2026-03-17
0130 RC Room & Board - Three And Four Beds - General Classification 3 1 — — $1,325.00 $1,325.00 $1,325.00 2026-03-17
0129 RC Room & Board - Semi-private (Two Beds) - Other 3 1 — — $1,325.00 $1,325.00 $1,325.00 2026-03-17
0120 RC Room & Board - Semi-private (Two Beds) - General Classification 3 1 — — $1,325.00 $1,325.00 $1,325.00 2026-03-17
0119 RC Room & Board - Private (One Bed) - Other 3 1 — — $1,325.00 $1,325.00 $1,325.00 2026-03-17
0110 RC Room & Board - Private (One Bed) - General Classification 3 1 — — $1,325.00 $1,325.00 $1,325.00 2026-03-17
0118 RC Room & Board - Private (One Bed) - Rehabilitation 7 4 — — $960.92 $1,705.46 $1,705.46 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
0850 RC Continuous Cycling Peritoneal Dialysis (ccpd) - Outpatient Or Home - General Cla… 3 1 — — $650.00 $650.00 $650.00 2026-03-17
0431 RC Occupational Therapy - Visit Charge 1 1 — — $113.00 $113.00 $113.00 2026-03-17
0441 RC Speech Therapy - Language Pathology - Visit Charge 1 1 — — $113.00 $113.00 $113.00 2026-03-17
0442 RC Speech Therapy - Language Pathology - Hourly Charge 1 1 — — $113.00 $113.00 $113.00 2026-03-17
0449 RC Speech Therapy - Language Pathology - Other 1 1 — — $113.00 $113.00 $113.00 2026-03-17
0443 RC Speech Therapy - Language Pathology - Group Rate 1 1 — — $113.00 $113.00 $113.00 2026-03-17
0433 RC Occupational Therapy - Group Rate 1 1 — — $113.00 $113.00 $113.00 2026-03-17
0439 RC Occupational Therapy - Other 1 1 — — $113.00 $113.00 $113.00 2026-03-17
0429 RC Physical Therapy - Other 1 1 — — $113.00 $113.00 $113.00 2026-03-17
0432 RC Occupational Therapy - Hourly Charge 1 1 — — $113.00 $113.00 $113.00 2026-03-17
0421 RC Physical Therapy - Visit Charge 34 7 — — $90.00 $113.00 $101.50 2026-03-17
97542 HCPCS Wheelchair Mngment Training 33 7 — — $90.00 $90.00 $90.00 2026-03-17
97533 HCPCS Sensory Integration 33 7 — — $90.00 $90.00 $90.00 2026-03-17
0422 RC Physical Therapy - Hourly Charge 3 2 — — $90.00 $113.00 $90.00 2026-03-17
0423 RC Physical Therapy - Group Rate 3 2 — — $90.00 $113.00 $90.00 2026-03-17
0434 RC Occupational Therapy - Evaluation Or Reevaluation 36 9 — — $85.00 $150.00 $117.50 2026-03-17
0424 RC Physical Therapy - Evaluation Or Re-evaluation 36 9 — — $85.00 $150.00 $117.50 2026-03-17
97168 HCPCS Ot Re-eval Est Plan Care 35 9 — — $85.00 $150.00 $117.50 2026-03-17
97167 HCPCS Ot Eval High Complex 60 Min 35 9 — — $85.00 $150.00 $117.50 2026-03-17
97166 HCPCS Ot Eval Mod Complex 45 Min 35 9 — — $85.00 $150.00 $117.50 2026-03-17
97165 HCPCS Ot Eval Low Complex 30 Min 35 9 — — $85.00 $150.00 $117.50 2026-03-17
97164 HCPCS Pt Re-eval Est Plan Care 35 9 — — $85.00 $150.00 $117.50 2026-03-17
97163 HCPCS Pt Eval High Complex 45 Min 35 9 — — $85.00 $150.00 $117.50 2026-03-17
97162 HCPCS Pt Eval Mod Complex 30 Min 35 9 — — $85.00 $150.00 $117.50 2026-03-17
97161 HCPCS Pt Eval Low Complex 20 Min 35 9 — — $85.00 $150.00 $117.50 2026-03-17
96105 HCPCS Assessment Of Aphasia 33 9 — — $85.00 $150.00 $117.50 2026-03-17
0444 RC Speech Therapy - Language Pathology - Evaluation Or Reevaluation 34 9 — — $85.00 $150.00 $117.50 2026-03-17
92524 HCPCS Behavral Qualit Analys Voice 33 9 — — $85.00 $150.00 $117.50 2026-03-17
92523 HCPCS Speech Sound Lang Comprehen 33 9 — — $85.00 $150.00 $117.50 2026-03-17
92522 HCPCS Evaluate Speech Production 33 9 — — $85.00 $150.00 $117.50 2026-03-17
92521 HCPCS Evaluation Of Speech Fluency 2 2 — — $85.00 $150.00 $117.50 2026-03-17
0440 RC Speech Therapy - Language Pathology - General Classification 34 9 — — $85.00 $113.00 $99.00 2026-03-17
0430 RC Occupational Therapy - General Classification 36 9 — — $85.00 $113.00 $99.00 2026-03-17
0420 RC Physical Therapy - General Classification 36 9 — — $85.00 $113.00 $99.00 2026-03-17
92507 HCPCS Speech/hearing Therapy 33 9 — — $85.00 $90.00 $87.50 2026-03-17
97537 HCPCS Community/work Reintegration 35 9 — — $85.00 $90.00 $87.50 2026-03-17
97535 HCPCS Self Care Mngment Training 35 9 — — $85.00 $90.00 $87.50 2026-03-17
97530 HCPCS Therapeutic Activities 35 9 — — $85.00 $90.00 $87.50 2026-03-17
97140 HCPCS Manual Therapy 1/> Regions 35 9 — — $85.00 $90.00 $87.50 2026-03-17
97129 HCPCS Ther Ivntj 1st 15 Min 35 9 — — $85.00 $90.00 $87.50 2026-03-17
97124 HCPCS Massage Therapy 35 9 — — $85.00 $90.00 $87.50 2026-03-17
97116 HCPCS Gait Training Therapy 35 9 — — $85.00 $90.00 $87.50 2026-03-17
97113 HCPCS Aquatic Therapy/exercises 35 9 — — $85.00 $90.00 $87.50 2026-03-17
97112 HCPCS Neuromuscular Reeducation 35 9 — — $85.00 $90.00 $87.50 2026-03-17
97110 HCPCS Therapeutic Exercises 35 9 — — $85.00 $90.00 $87.50 2026-03-17
97032 HCPCS Appl Modality 1+estim Ea 15 33 9 — — $85.00 $90.00 $87.50 2026-03-17
92607 HCPCS Ex For Speech Device Rx 1hr 33 9 — — $85.00 $90.00 $87.50 2026-03-17
92606 HCPCS Non-speech Device Service 2 2 — — $85.00 $90.00 $87.50 2026-03-17
92605 HCPCS Ex For Nonspeech Device Rx 2 2 — — $85.00 $90.00 $87.50 2026-03-17
92597 HCPCS Oral Speech Device Eval 2 2 — — $85.00 $90.00 $87.50 2026-03-17
92526 HCPCS Oral Function Therapy 33 9 — — $85.00 $90.00 $87.50 2026-03-17
A9543 HCPCS Y90 Ibritumomab, Rx 0 0 — — — — — 2026-03-17
J1447 HCPCS Inj Tbo Filgrastim 1 Microg 0 0 — — — — — 2026-03-17
A9542 HCPCS In111 Ibritumomab, Dx 0 0 — — — — — 2026-03-17
A9530 HCPCS I131 Iodide Sol, Rx 0 0 — — — — — 2026-03-17
A9521 HCPCS Tc99m Exametazime 0 0 — — — — — 2026-03-17
90999 HCPCS Unlisted Dialysis Procedure 0 0 — — — — — 2026-03-17
83036 HCPCS Hemoglobin Glycosylated A1c 0 0 — — — — — 2026-03-17
J1430 HCPCS Ethanolamine Oleate 100 Mg 0 0 — — — — — 2026-03-17
J1410 HCPCS Inj Estrogen Conjugate 25 Mg 0 0 — — — — — 2026-03-17
A9517 HCPCS I131 Iodide Cap, Rx 0 0 — — — — — 2026-03-17
J1437 HCPCS Inj. Fe Derisomaltose 10 Mg 0 0 — — — — — 2026-03-17
J1438 HCPCS Etanercept Injection 0 0 — — — — — 2026-03-17
J1439 HCPCS Inj Ferric Carboxymaltos 1mg 0 0 — — — — — 2026-03-17
J1442 HCPCS Inj Filgrastim Excl Biosimil 0 0 — — — — — 2026-03-17
J1322 HCPCS Elosulfase Alfa, Injection 0 0 — — — — — 2026-03-17
J1448 HCPCS Injection, Trilaciclib, 1mg 0 0 — — — — — 2026-03-17
J1449 HCPCS Inj Eflapegrastim-xnst 0.1mg 0 0 — — — — — 2026-03-17
J1451 HCPCS Fomepizole, 15 Mg 0 0 — — — — — 2026-03-17
J1306 HCPCS Injection, Inclisiran, 1 Mg 0 0 — — — — — 2026-03-17
A9515 HCPCS Choline C-11 0 0 — — — — — 2026-03-17
90993 HCPCS Dialysis Training Incompl 0 0 — — — — — 2026-03-17
J1305 HCPCS Inj, Evinacumab-dgnb, 5mg 0 0 — — — — — 2026-03-17
J1304 HCPCS Inj Tofersen Intrathec 1 Mg 0 0 — — — — — 2026-03-17
A9513 HCPCS Lutetium Lu 177 Dotatat Ther 0 0 — — — — — 2026-03-17
J1303 HCPCS Inj., Ravulizumab-cwvz 10 Mg 0 0 — — — — — 2026-03-17
J1302 HCPCS Inj, Sutimlimab-jome, 10 Mg 0 0 — — — — — 2026-03-17
99499 HCPCS Unlisted E&m Service 0 0 — — — — — 2026-03-17
90937 HCPCS Hemodialysis Repeated Eval 0 0 — — — — — 2026-03-17
82962 HCPCS Glucose Blood Test 0 0 — — — — — 2026-03-17
73610 HCPCS X-ray Exam Of Ankle 0 0 — — — — — 2026-03-17
J1301 HCPCS Injection, Edaravone, 1 Mg 0 0 — — — — — 2026-03-17
J1300 HCPCS Eculizumab Injection 0 0 — — — — — 2026-03-17
99232 HCPCS Sbsq Hosp Ip/obs Moderate 35 0 0 — — — — — 2026-03-17
J1290 HCPCS Ecallantide Injection 0 0 — — — — — 2026-03-17
J1212 HCPCS Dimethyl Sulfoxide 50% 50 Ml 0 0 — — — — — 2026-03-17
99231 HCPCS Sbsq Hosp Ip/obs Sf/low 25 0 0 — — — — — 2026-03-17
90935 HCPCS Hemodialysis One Evaluation 0 0 — — — — — 2026-03-17
J1201 HCPCS Inj. Cetirizine Hcl 0.5mg 0 0 — — — — — 2026-03-17
J1190 HCPCS Dexrazoxane Hcl Injection 0 0 — — — — — 2026-03-17
99223 HCPCS 1st Hosp Ip/obs High 75 0 0 — — — — — 2026-03-17
J1171 HCPCS Injection, Hydromorphone, 0.1 Mg 0 0 — — — — — 2026-03-17
J1162 HCPCS Digoxin Immune Fab (ovine) 0 0 — — — — — 2026-03-17
99199 HCPCS Unlisted Special Svc Px/rprt 0 0 — — — — — 2026-03-17
90676 HCPCS Rabies Vaccine Id 0 0 — — — — — 2026-03-17
82948 HCPCS Reagent Strip/blood Glucose 0 0 — — — — — 2026-03-17
J1105 HCPCS Dexmedetomidine Film, 1 Mcg 0 0 — — — — — 2026-03-17
J0898 HCPCS Argatroban Nonesrd (auromed) 0 0 — — — — — 2026-03-17
97763 HCPCS Orthc/prostc Mgmt Sbsq Enc 0 0 — — — — — 2026-03-17
J0897 HCPCS Denosumab Injection 0 0 — — — — — 2026-03-17
J0896 HCPCS Inj Luspatercept-aamt 0.25mg 0 0 — — — — — 2026-03-17
97761 HCPCS Prosthetic Traing 1st Enc 0 0 — — — — — 2026-03-17
90675 HCPCS Rabies Vaccine IM 0 0 — — — — — 2026-03-17
J0891 HCPCS Argatroban Nonesrd (accord) 0 0 — — — — — 2026-03-17
J0888 HCPCS Epoetin Beta Non Esrd 0 0 — — — — — 2026-03-17
97760 HCPCS Orthotic Mgmt&traing 1st Enc 0 0 — — — — — 2026-03-17
J0885 HCPCS Epoetin Alfa, Non-esrd 0 0 — — — — — 2026-03-17
J0883 HCPCS Argatroban Nonesrd Use 1mg 0 0 — — — — — 2026-03-17
97750 HCPCS Physical Performance Test 0 0 — — — — — 2026-03-17
90396 HCPCS Varicella-zoster Ig IM 0 0 — — — — — 2026-03-17
82945 HCPCS Glucose Other Fluid 0 0 — — — — — 2026-03-17
73560 HCPCS X-ray Exam Of Knee 1 Or 2 0 0 — — — — — 2026-03-17
70470 HCPCS CT Head/brain Without & With Contrast 0 0 — — — — — 2026-03-17
J0882 HCPCS Darbepoetin Alfa, Esrd Use 0 0 — — — — — 2026-03-17
J0881 HCPCS Darbepoetin Alfa, Non-esrd 0 0 — — — — — 2026-03-17
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