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

Vibra Rehabilitation Hospital Of Rancho Mirage

Rancho Mirage, CA · CCN 053041 · Rates published

2,642 distinct procedures filed
38 distinct payers
40,032 rate rows
2026-05-09 last MRF observed
Data quality

7,595 of 40,032 rate rows are consumer-grade (19.0%)

32,437 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 32,110
per-diem day rate — not a per-procedure price 327
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://rhsc.ernesthealth.com/wp-content/uploads/sites/39/2024/12/811012327_Rehabilitation-Hospital-of-Southern-CA_Standard-Charges.csv
Found on page https://rhsc.ernesthealth.com/price-transparency/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-18
Content fingerprint c0ae24ad706b3688… · 3,839,783 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
D0406
LOCAL 		Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50- Tier Tier 3 12 $103,236.11 $103,236.11 $103,236.11 nat. median
$49,763
outlier · 2.1×
A2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier None 12 $35,359.63 $166,359.50 $100,859.57 nat. median
$27,843
outlier · 3.6×
C0505
LOCAL 		Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 2 12 $76,912.44 $92,831.32 $84,871.88 nat. median
$43,704
1.9× median
D2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 3 12 $28,576.73 $136,769.64 $82,673.18 nat. median
$30,727
outlier · 2.7×
C2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 2 12 $64,150.41 $64,150.41 $64,150.41 nat. median
$32,921
1.9× median
D0505
LOCAL 		Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 3 3 $5,507.60 $130,143.94 $64,111.74 nat. median
$41,099
1.6× median
A0505
LOCAL 		Non-traumatic Spinal Cord Injury M <39.50- Tier None 12 $63,046.66 $63,116.17 $63,081.42 nat. median
$37,907
1.7× median
C0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 2 12 $59,510.27 $59,510.27 $59,510.27 nat. median
$33,146
1.8× median
C0903
LOCAL 		Other Orthopedic M >=44.50 And M <51.50- Tier Tier 2 12 $59,422.07 $59,422.07 $59,422.07 nat. median
$26,684
outlier · 2.2×
D0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier Tier 3 12 $50,357.94 $68,098.25 $59,228.10 nat. median
$42,703
1.4× median
B0604
LOCAL 		Neurological M <43.50- Tier Tier 1 12 $54,446.21 $63,351.61 $58,898.91 nat. median
$46,423
1.3× median
A0603
LOCAL 		Neurological M >=43.50 And M <52.50- Tier None 12 $27,153.64 $90,205.64 $58,679.64 nat. median
$23,102
outlier · 2.5×
C1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 2 12 $57,202.14 $57,202.14 $57,202.14 nat. median
$37,992
1.5× median
D0604
LOCAL 		Neurological M <43.50- Tier Tier 3 12 $56,802.36 $56,802.36 $56,802.36 nat. median
$32,269
1.8× median
B0302
LOCAL 		Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 1 12 $56,469.78 $56,469.78 $56,469.78 nat. median
$29,357
1.9× median
A0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier None 12 $44,011.71 $68,795.57 $56,403.64 nat. median
$29,236
1.9× median
C0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier Tier 2 12 $55,106.46 $55,106.46 $55,106.46 nat. median
$46,986
1.2× median
C1304
LOCAL 		Rheumatoid Other Arthritis M <44.50 And A >=64.50- Tier Tier 2 12 $54,336.96 $54,336.96 $54,336.96 nat. median
$33,081
1.6× median
C2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 2 12 $53,982.93 $53,982.93 $53,982.93 nat. median
$31,232
1.7× median
A0105
LOCAL 		Stroke M <41.50 And A >=84.50- Tier None 12 $53,749.29 $53,749.29 $53,749.29 nat. median
$35,375
1.5× median
C2003
LOCAL 		Miscellaneous M >=46.50 And M <55.50- Tier Tier 2 12 $53,223.42 $53,223.42 $53,223.42 nat. median
$26,301
outlier · 2.0×
D1004
LOCAL 		Amputation Lower Extremity M <47.50- Tier Tier 3 12 $52,127.36 $52,127.36 $52,127.36 nat. median
$32,228
1.6× median
D0105
LOCAL 		Stroke M <41.50 And A >=84.50- Tier Tier 3 12 $52,097.49 $52,097.49 $52,097.49 nat. median
$37,662
1.4× median
C0305
LOCAL 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 2 12 $41,706.97 $60,424.00 $51,065.49 nat. median
$35,561
1.4× median
C0804
LOCAL 		Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier Tier 2 12 $51,027.40 $51,027.40 $51,027.40 nat. median
$26,258
1.9× median
D0205
LOCAL 		Traumatic Brain Injury M <35.50- Tier Tier 3 12 $50,826.20 $50,826.20 $50,826.20 nat. median
$36,592
1.4× median
C0703
LOCAL 		Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 2 12 $50,537.63 $50,537.63 $50,537.63 nat. median
$28,059
1.8× median
C0205
LOCAL 		Traumatic Brain Injury M <35.50- Tier Tier 2 12 $50,299.05 $50,299.05 $50,299.05 nat. median
$40,508
1.2× median
A1703
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 12 $48,158.93 $48,158.93 $48,158.93 nat. median
$23,796
outlier · 2.0×
C0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 2 12 $48,022.26 $48,022.26 $48,022.26 nat. median
$31,818
1.5× median
A1004
LOCAL 		Amputation Lower Extremity M <47.50- Tier None 12 $47,098.12 $47,098.12 $47,098.12 nat. median
$29,040
1.6× median
D1304
LOCAL 		Rheumatoid Other Arthritis M <44.50 And A >=64.50- Tier Tier 3 12 $47,015.26 $47,015.26 $47,015.26 nat. median
$31,538
1.5× median
C0204
LOCAL 		Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 2 12 $37,091.81 $56,747.28 $46,919.54 nat. median
$31,314
1.5× median
D0703
LOCAL 		Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 3 12 $42,508.25 $50,671.22 $46,589.74 nat. median
$25,880
1.8× median
A0904
LOCAL 		Other Orthopedic M <44.5- Tier None 12 $38,787.97 $53,857.53 $46,322.75 nat. median
$26,978
1.7× median
B0703
LOCAL 		Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 1 12 $46,153.25 $46,153.25 $46,153.25 nat. median
$35,512
1.3× median
D1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3 12 $44,261.01 $44,261.01 $44,261.01 nat. median
$34,992
1.3× median
A0805
LOCAL 		Replacement Of Lower-extremity Joint M <42.50- Tier None 12 $44,217.83 $44,217.83 $44,217.83 nat. median
$26,090
1.7× median
A0504
LOCAL 		Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier None 12 $44,122.43 $44,122.43 $44,122.43 nat. median
$27,406
1.6× median
A1704
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 12 $43,449.90 $43,449.90 $43,449.90 nat. median
$27,261
1.6× median
D0503
LOCAL 		Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier Tier 3 12 $43,389.83 $43,389.83 $43,389.83 nat. median
$25,018
1.7× median
D0504
LOCAL 		Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 3 12 $43,121.00 $43,121.00 $43,121.00 nat. median
$29,577
1.5× median
D0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 3 12 $38,112.68 $47,264.59 $42,688.64 nat. median
$31,616
1.4× median
A1403
LOCAL 		Cardiac M >=45.50 And M <55.50- Tier None 12 $42,571.55 $42,571.55 $42,571.55 nat. median
$22,015
1.9× median
D0805
LOCAL 		Replacement Of Lower-extremity Joint M <42.50- Tier Tier 3 12 $37,930.56 $45,254.65 $41,592.61 nat. median
$27,957
1.5× median
A0104
LOCAL 		Stroke M >=41.50 And M <50.50- Tier None 12 $41,316.71 $41,316.71 $41,316.71 nat. median
$28,703
1.4× median
D0104
LOCAL 		Stroke M >=41.50 And M <50.50- Tier Tier 3 12 $35,517.87 $46,604.46 $41,061.17 nat. median
$30,024
1.4× median
C0604
LOCAL 		Neurological M <43.50- Tier Tier 2 12 $41,023.04 $41,023.04 $41,023.04 nat. median
$34,756
1.2× median
A0204
LOCAL 		Traumatic Brain Injury M >=35.50 And M <49.50- Tier None 12 $40,738.71 $40,738.71 $40,738.71 nat. median
$26,934
1.5× median
D0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 3 12 $34,953.66 $44,648.86 $39,801.26 nat. median
$29,640
1.3× median

Other procedures at this hospital

Browse this hospital's 2,642 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
             
D0406 LOCAL Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50- Tier Tier 3 28 12 — — $103,236.11 $103,236.11 $103,236.11 2026-03-17
A2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier None 28 12 — — $35,359.63 $166,359.50 $100,859.57 2026-03-17
C0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 2 28 12 — — $76,912.44 $92,831.32 $84,871.88 2026-03-17
D2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier Tier 3 28 12 — — $28,576.73 $136,769.64 $82,673.18 2026-03-17
C2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier Tier 2 28 12 — — $64,150.41 $64,150.41 $64,150.41 2026-03-17
D0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 3 4 3 — — $5,507.60 $130,143.94 $64,111.74 2026-03-17
A0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50- Tier None 28 12 — — $63,046.66 $63,116.17 $63,081.42 2026-03-17
C0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier Tier 2 28 12 — — $59,510.27 $59,510.27 $59,510.27 2026-03-17
C0903 LOCAL Other Orthopedic M >=44.50 And M <51.50- Tier Tier 2 28 12 — — $59,422.07 $59,422.07 $59,422.07 2026-03-17
D0106 LOCAL Stroke M <41.50 And A <84.50- Tier Tier 3 28 12 — — $50,357.94 $68,098.25 $59,228.10 2026-03-17
B0604 LOCAL Neurological M <43.50- Tier Tier 1 28 12 — — $54,446.21 $63,351.61 $58,898.91 2026-03-17
A0603 LOCAL Neurological M >=43.50 And M <52.50- Tier None 28 12 — — $27,153.64 $90,205.64 $58,679.64 2026-03-17
C1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 2 28 12 — — $57,202.14 $57,202.14 $57,202.14 2026-03-17
D0604 LOCAL Neurological M <43.50- Tier Tier 3 28 12 — — $56,802.36 $56,802.36 $56,802.36 2026-03-17
B0302 LOCAL Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 1 28 12 — — $56,469.78 $56,469.78 $56,469.78 2026-03-17
A0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier None 28 12 — — $44,011.71 $68,795.57 $56,403.64 2026-03-17
C0106 LOCAL Stroke M <41.50 And A <84.50- Tier Tier 2 28 12 — — $55,106.46 $55,106.46 $55,106.46 2026-03-17
C1304 LOCAL Rheumatoid Other Arthritis M <44.50 And A >=64.50- Tier Tier 2 28 12 — — $54,336.96 $54,336.96 $54,336.96 2026-03-17
C2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier Tier 2 28 12 — — $53,982.93 $53,982.93 $53,982.93 2026-03-17
A0105 LOCAL Stroke M <41.50 And A >=84.50- Tier None 28 12 — — $53,749.29 $53,749.29 $53,749.29 2026-03-17
C2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier Tier 2 28 12 — — $53,223.42 $53,223.42 $53,223.42 2026-03-17
D1004 LOCAL Amputation Lower Extremity M <47.50- Tier Tier 3 28 12 — — $52,127.36 $52,127.36 $52,127.36 2026-03-17
D0105 LOCAL Stroke M <41.50 And A >=84.50- Tier Tier 3 28 12 — — $52,097.49 $52,097.49 $52,097.49 2026-03-17
C0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 2 28 12 — — $41,706.97 $60,424.00 $51,065.49 2026-03-17
C0804 LOCAL Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier Tier 2 28 12 — — $51,027.40 $51,027.40 $51,027.40 2026-03-17
D0205 LOCAL Traumatic Brain Injury M <35.50- Tier Tier 3 28 12 — — $50,826.20 $50,826.20 $50,826.20 2026-03-17
C0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 2 28 12 — — $50,537.63 $50,537.63 $50,537.63 2026-03-17
C0205 LOCAL Traumatic Brain Injury M <35.50- Tier Tier 2 28 12 — — $50,299.05 $50,299.05 $50,299.05 2026-03-17
A1703 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 28 12 — — $48,158.93 $48,158.93 $48,158.93 2026-03-17
C0904 LOCAL Other Orthopedic M <44.5- Tier Tier 2 28 12 — — $48,022.26 $48,022.26 $48,022.26 2026-03-17
A1004 LOCAL Amputation Lower Extremity M <47.50- Tier None 28 12 — — $47,098.12 $47,098.12 $47,098.12 2026-03-17
D1304 LOCAL Rheumatoid Other Arthritis M <44.50 And A >=64.50- Tier Tier 3 28 12 — — $47,015.26 $47,015.26 $47,015.26 2026-03-17
C0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 2 28 12 — — $37,091.81 $56,747.28 $46,919.54 2026-03-17
D0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 3 28 12 — — $42,508.25 $50,671.22 $46,589.74 2026-03-17
A0904 LOCAL Other Orthopedic M <44.5- Tier None 28 12 — — $38,787.97 $53,857.53 $46,322.75 2026-03-17
B0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 1 28 12 — — $46,153.25 $46,153.25 $46,153.25 2026-03-17
D1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3 28 12 — — $44,261.01 $44,261.01 $44,261.01 2026-03-17
A0805 LOCAL Replacement Of Lower-extremity Joint M <42.50- Tier None 28 12 — — $44,217.83 $44,217.83 $44,217.83 2026-03-17
A0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier None 28 12 — — $44,122.43 $44,122.43 $44,122.43 2026-03-17
A1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 28 12 — — $43,449.90 $43,449.90 $43,449.90 2026-03-17
D0503 LOCAL Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier Tier 3 28 12 — — $43,389.83 $43,389.83 $43,389.83 2026-03-17
D0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 3 28 12 — — $43,121.00 $43,121.00 $43,121.00 2026-03-17
D0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier Tier 3 28 12 — — $38,112.68 $47,264.59 $42,688.64 2026-03-17
A1403 LOCAL Cardiac M >=45.50 And M <55.50- Tier None 28 12 — — $42,571.55 $42,571.55 $42,571.55 2026-03-17
D0805 LOCAL Replacement Of Lower-extremity Joint M <42.50- Tier Tier 3 28 12 — — $37,930.56 $45,254.65 $41,592.61 2026-03-17
A0104 LOCAL Stroke M >=41.50 And M <50.50- Tier None 28 12 — — $41,316.71 $41,316.71 $41,316.71 2026-03-17
D0104 LOCAL Stroke M >=41.50 And M <50.50- Tier Tier 3 28 12 — — $35,517.87 $46,604.46 $41,061.17 2026-03-17
C0604 LOCAL Neurological M <43.50- Tier Tier 2 28 12 — — $41,023.04 $41,023.04 $41,023.04 2026-03-17
A0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier None 28 12 — — $40,738.71 $40,738.71 $40,738.71 2026-03-17
D0904 LOCAL Other Orthopedic M <44.5- Tier Tier 3 28 12 — — $34,953.66 $44,648.86 $39,801.26 2026-03-17
D1703 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 28 12 — — $39,707.35 $39,707.35 $39,707.35 2026-03-17
A0106 LOCAL Stroke M <41.50 And A <84.50- Tier None 28 12 — — $5,374.20 $74,039.48 $39,706.84 2026-03-17
A2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier None 28 12 — — $38,894.96 $38,894.96 $38,894.96 2026-03-17
A0804 LOCAL Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier None 28 12 — — $36,269.21 $41,279.90 $38,774.56 2026-03-17
D0903 LOCAL Other Orthopedic M >=44.50 And M <51.50- Tier Tier 3 28 12 — — $38,023.72 $38,023.72 $38,023.72 2026-03-17
A1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier None 28 12 — — $37,863.26 $37,863.26 $37,863.26 2026-03-17
C0603 LOCAL Neurological M >=43.50 And M <52.50- Tier Tier 2 28 12 — — $36,629.83 $37,537.14 $37,083.49 2026-03-17
C0502 LOCAL Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50- Tier Tier 2 28 12 — — $36,800.21 $36,800.21 $36,800.21 2026-03-17
D2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier Tier 3 28 12 — — $36,709.32 $36,709.32 $36,709.32 2026-03-17
D0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 3 28 12 — — $36,523.57 $36,523.57 $36,523.57 2026-03-17
B0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 1 28 12 — — $36,309.13 $36,309.13 $36,309.13 2026-03-17
A0604 LOCAL Neurological M <43.50- Tier None 28 12 — — $36,283.07 $36,283.07 $36,283.07 2026-03-17
D2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier Tier 3 28 12 — — $36,241.80 $36,241.80 $36,241.80 2026-03-17
C0805 LOCAL Replacement Of Lower-extremity Joint M <42.50- Tier Tier 2 28 12 — — $36,160.47 $36,160.47 $36,160.47 2026-03-17
D0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 3 28 12 — — $35,797.25 $35,797.25 $35,797.25 2026-03-17
A0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier None 28 12 — — $35,198.36 $35,198.36 $35,198.36 2026-03-17
D0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 3 28 12 — — $34,973.09 $34,973.09 $34,973.09 2026-03-17
A1502 LOCAL Pulmonary M >=56.50 And M <68.50- Tier None 28 12 — — $34,742.63 $34,742.63 $34,742.63 2026-03-17
D1403 LOCAL Cardiac M >=45.50 And M <55.50- Tier Tier 3 28 12 — — $34,589.23 $34,589.23 $34,589.23 2026-03-17
D2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier Tier 3 28 12 — — $24,009.33 $44,293.74 $34,151.54 2026-03-17
D0401 LOCAL Traumatic Spinal Cord Injury M >=56.50- Tier Tier 3 28 12 — — $33,262.45 $33,262.45 $33,262.45 2026-03-17
D1702 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 28 12 — — $32,995.90 $32,995.90 $32,995.90 2026-03-17
A0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier None 28 12 — — $32,743.37 $32,743.37 $32,743.37 2026-03-17
D0603 LOCAL Neurological M >=43.50 And M <52.50- Tier Tier 3 28 12 — — $30,342.88 $34,753.12 $32,548.00 2026-03-17
A0702 LOCAL Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier None 28 12 — — $32,467.80 $32,467.80 $32,467.80 2026-03-17
A1404 LOCAL Cardiac M <45.50- Tier None 28 12 — — $32,172.62 $32,172.62 $32,172.62 2026-03-17
A1303 LOCAL Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50- Tier None 28 12 — — $31,012.06 $31,012.06 $31,012.06 2026-03-17
D1503 LOCAL Pulmonary M >=45.50 And M <56.50- Tier Tier 3 28 12 — — $30,774.57 $30,774.57 $30,774.57 2026-03-17
D0804 LOCAL Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier Tier 3 28 12 — — $27,652.48 $33,854.11 $30,753.29 2026-03-17
A0903 LOCAL Other Orthopedic M >=44.50 And M <51.50- Tier None 28 12 — — $26,663.56 $33,998.54 $30,331.05 2026-03-17
C0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 2 28 12 — — $29,978.18 $29,978.18 $29,978.18 2026-03-17
D0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 3 28 12 — — $29,523.11 $29,523.11 $29,523.11 2026-03-17
A0502 LOCAL Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50- Tier None 28 12 — — $28,815.91 $28,815.91 $28,815.91 2026-03-17
D0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier Tier 3 28 12 — — $24,628.84 $32,438.30 $28,533.57 2026-03-17
D0103 LOCAL Stroke M >=50.50 And M <63.50- Tier Tier 3 28 12 — — $27,807.82 $27,807.82 $27,807.82 2026-03-17
A0103 LOCAL Stroke M >=50.50 And M <63.50- Tier None 28 12 — — $27,718.29 $27,718.29 $27,718.29 2026-03-17
A0503 LOCAL Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier None 28 12 — — $27,097.17 $27,097.17 $27,097.17 2026-03-17
A0601 LOCAL Neurological M >=64.50- Tier None 28 12 — — $25,756.00 $25,756.00 $25,756.00 2026-03-17
D0602 LOCAL Neurological M >=52.50 And M <64.50- Tier Tier 3 28 12 — — $25,751.76 $25,751.76 $25,751.76 2026-03-17
A0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50- Tier None 28 12 — — $25,572.49 $25,572.49 $25,572.49 2026-03-17
B0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier Tier 1 28 12 — — $25,029.43 $25,029.43 $25,029.43 2026-03-17
D0302 LOCAL Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 3 28 12 — — $24,901.32 $24,901.32 $24,901.32 2026-03-17
D0702 LOCAL Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier Tier 3 28 12 — — $24,818.24 $24,818.24 $24,818.24 2026-03-17
D0803 LOCAL Replacement Of Lower-extremity Joint M >=51.50 And M <57.50- Tier Tier 3 28 12 — — $24,573.97 $24,573.97 $24,573.97 2026-03-17
D0102 LOCAL Stroke M >=63.50 And M <72.50- Tier Tier 3 28 12 — — $21,523.57 $27,090.91 $24,307.24 2026-03-17
A0801 LOCAL Replacement Of Lower-extremity Joint M >=63.50- Tier None 28 12 — — $23,827.91 $23,827.91 $23,827.91 2026-03-17
A1702 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 28 12 — — $23,720.74 $23,720.74 $23,720.74 2026-03-17
D0802 LOCAL Replacement Of Lower-extremity Joint M >=57.50 And M <63.50- Tier Tier 3 28 12 — — $23,565.65 $23,565.65 $23,565.65 2026-03-17
A0302 LOCAL Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier None 28 12 — — $23,469.33 $23,469.33 $23,469.33 2026-03-17
A0202 LOCAL Traumatic Brain Injury M >=61.50 And M <73.50- Tier None 28 12 — — $23,300.51 $23,300.51 $23,300.51 2026-03-17
A0602 LOCAL Neurological M >=52.50 And M <64.50- Tier None 28 12 — — $23,224.47 $23,224.47 $23,224.47 2026-03-17
A0803 LOCAL Replacement Of Lower-extremity Joint M >=51.50 And M <57.50- Tier None 28 12 — — $22,885.60 $22,885.60 $22,885.60 2026-03-17
A0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier None 28 12 — — $22,349.97 $22,349.97 $22,349.97 2026-03-17
A2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier None 28 12 — — $22,040.59 $22,040.59 $22,040.59 2026-03-17
D0601 LOCAL Neurological M >=64.50- Tier Tier 3 28 12 — — $21,777.18 $21,777.18 $21,777.18 2026-03-17
A0802 LOCAL Replacement Of Lower-extremity Joint M >=57.50 And M <63.50- Tier None 28 12 — — $20,559.44 $20,559.44 $20,559.44 2026-03-17
A0102 LOCAL Stroke M >=63.50 And M <72.50- Tier None 28 12 — — $20,513.52 $20,513.52 $20,513.52 2026-03-17
A2001 LOCAL Miscellaneous M >=66.50- Tier None 28 12 — — $17,527.12 $17,527.12 $17,527.12 2026-03-17
B1403 LOCAL Cardiac M >=45.50 And M <55.50- Tier Tier 1 28 12 — — $9,571.38 $9,571.38 $9,571.38 2026-03-17
D1002 LOCAL Amputation Lower Extremity M >=55.50 And M <64.50- Tier Tier 3 28 12 — — $7,390.41 $7,390.41 $7,390.41 2026-03-17
A2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier None 28 12 — — $5,451.95 $5,451.95 $5,451.95 2026-03-17
A0501 LOCAL Non-traumatic Spinal Cord Injury M >=60.50- Tier None 28 12 — — $4,717.59 $4,717.59 $4,717.59 2026-03-17
A0205 LOCAL Traumatic Brain Injury M <35.50- Tier None 28 12 — — $3,385.58 $3,385.58 $3,385.58 2026-03-17
128 OTHER *r&b - Semi Pvt - Irf 9 7 $2,444.55 — $2,444.00 $2,444.00 $2,444.00 2026-05-09
118 OTHER *r&b - Private - Irf 9 7 $2,444.55 — $2,444.00 $2,444.00 $2,444.00 2026-05-09
0158 RC Room & Board - Ward - Rehabilitation 10 6 — — $2,319.00 $2,319.00 $2,319.00 2026-03-17
0128 RC Room & Board - Semi-private (Two Beds) - Rehabilitation 15 8 — — $2,319.00 $2,319.00 $2,319.00 2026-03-17
0148 RC Room & Board - Deluxe Private - Rehabilitation 10 6 — — $2,319.00 $2,319.00 $2,319.00 2026-03-17
0138 RC Room & Board - Three And Four Beds - Rehabilitation 10 6 — — $2,319.00 $2,319.00 $2,319.00 2026-03-17
0118 RC Room & Board - Private (One Bed) - Rehabilitation 4 2 — — $1.00 $1,294.65 $647.88 2026-03-17
0800 RC Inpatient Renal Dialysis - General Classification 11 5 — — $438.00 $690.00 $600.00 2026-03-17
0809 RC Inpatient Renal Dialysis - Other 11 5 — — $438.00 $690.00 $600.00 2026-03-17
0803 RC Inpatient Renal Dialysis - Continuous Ambulatory Peritoneal Dialysis (capd) 15 6 — — $377.00 $690.00 $500.00 2026-03-17
0801 RC Inpatient Renal Dialysis - Hemodialysis 15 6 — — $438.00 $690.00 $500.00 2026-03-17
0802 RC Inpatient Renal Dialysis - Peritoneal Dialysis (non-capd) 15 6 — — $377.00 $690.00 $500.00 2026-03-17
0804 RC Inpatient Renal Dialysis - Continuous Cycling Peritoneal Dialysis (ccpd) 15 6 — — $377.00 $690.00 $500.00 2026-03-17
0808 RC Inpatient Renal Dialysis - Other 4 2 — — $438.00 $500.00 $438.00 2026-03-17
0806 RC Inpatient Renal Dialysis - Continuation 4 2 — — $438.00 $500.00 $438.00 2026-03-17
0805 RC Inpatient Renal Dialysis - Treatment 4 2 — — $438.00 $500.00 $438.00 2026-03-17
0807 RC Inpatient Renal Dialysis - Observation/Hourly 4 2 — — $438.00 $500.00 $438.00 2026-03-17
0559 RC Skilled Nursing - Other 3 1 — — $220.00 $220.00 $220.00 2026-03-17
S9122 HCPCS Home Health Aide Or Certifie 1 1 — — $185.00 $185.00 $185.00 2026-03-17
S8948 HCPCS Low-level Laser Trmt 15 Min 1 1 — — $185.00 $185.00 $185.00 2026-03-17
S9125 HCPCS Respite Care, In The Home, P 1 1 — — $185.00 $185.00 $185.00 2026-03-17
S9123 HCPCS Nursing Care In Home Rn 1 1 — — $185.00 $185.00 $185.00 2026-03-17
S8940 HCPCS Hippotherapy Per Session 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97016 HCPCS Vasopneumatic Device Therapy 1 1 — — $185.00 $185.00 $185.00 2026-03-17
S9150 HCPCS Evaluation By Ocularist 5 2 — — $185.00 $185.00 $185.00 2026-03-17
S9131 HCPCS Pt In The Home Per Diem 1 1 — — $185.00 $185.00 $185.00 2026-03-17
S9152 HCPCS Speech Therapy, Re-eval 5 2 — — $185.00 $185.00 $185.00 2026-03-17
S9127 HCPCS Social Work Visit, In The Ho 1 1 — — $185.00 $185.00 $185.00 2026-03-17
S9124 HCPCS Nursing Care, In The Home; B 1 1 — — $185.00 $185.00 $185.00 2026-03-17
S9128 HCPCS Speech Therapy, In The Home, 1 1 — — $185.00 $185.00 $185.00 2026-03-17
S8950 HCPCS Complex Lymphedema Therapy, 1 1 — — $185.00 $185.00 $185.00 2026-03-17
S9129 HCPCS Occupational Therapy, In The 1 1 — — $185.00 $185.00 $185.00 2026-03-17
S8990 HCPCS Pt Or Manip For Maint 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97010 HCPCS Hot Or Cold Packs Therapy 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97799 HCPCS Unlisted Physcl Med/rehab Px 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97755 HCPCS Assistive Technology Assess 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97546 HCPCS Work Hardening Add-on 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97545 HCPCS Work Hardening 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97171 HCPCS Athletic Trn Eval High Cmplx 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97170 HCPCS Athletic Trn Eval Mod Cmplx 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97172 HCPCS Athletic Trn Re-eval Plan Cr 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97169 HCPCS Athletic Trn Eval Low Cmplx 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97156 HCPCS Fam Adapt Bhv Tx Gdn Phy/qhp 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97155 HCPCS Adapt Behavior Tx Phys/qhp 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97157 HCPCS Mult Fam Adapt Bhv Tx Gdn 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97153 HCPCS Adaptive Behavior Tx By Tech 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97152 HCPCS Bhv Id Suprt Assmt By 1 Tech 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97154 HCPCS Grp Adapt Bhv Tx By Tech 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97158 HCPCS Grp Adapt Bhv Tx By Phy/qhp 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97150 HCPCS Group Therapeutic Procedures 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97139 HCPCS Unlisted Therapeutic Px 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97151 HCPCS Bhv Id Assmt By Phys/qhp 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97037 HCPCS Appl Modality 1+lllt Po Pain 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97039 HCPCS Unlisted Modality 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97034 HCPCS App Mdlty 1+cntrst Bth Ea 15 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97036 HCPCS App Mdlty 1+hubbrd Tnk Ea 15 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97022 HCPCS Whirlpool Therapy 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97024 HCPCS Diathermy Eg Microwave 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97026 HCPCS Infrared Therapy 1 1 — — $185.00 $185.00 $185.00 2026-03-17
97028 HCPCS Ultraviolet Therapy 1 1 — — $185.00 $185.00 $185.00 2026-03-17
S9126 HCPCS Hospice Care, In The Home, P 1 1 — — $185.00 $185.00 $185.00 2026-03-17
0443 RC Speech Therapy - Language Pathology - Group Rate 22 9 — — $163.00 $185.00 $174.00 2026-03-17
0442 RC Speech Therapy - Language Pathology - Hourly Charge 22 9 — — $163.00 $185.00 $174.00 2026-03-17
0433 RC Occupational Therapy - Group Rate 18 8 — — $163.00 $185.00 $174.00 2026-03-17
0432 RC Occupational Therapy - Hourly Charge 18 8 — — $163.00 $185.00 $174.00 2026-03-17
0429 RC Physical Therapy - Other 17 8 — — $163.00 $185.00 $174.00 2026-03-17
0439 RC Occupational Therapy - Other 17 8 — — $163.00 $185.00 $174.00 2026-03-17
0449 RC Speech Therapy - Language Pathology - Other 17 8 — — $163.00 $185.00 $174.00 2026-03-17
0422 RC Physical Therapy - Hourly Charge 18 8 — — $163.00 $185.00 $174.00 2026-03-17
0423 RC Physical Therapy - Group Rate 18 8 — — $163.00 $185.00 $174.00 2026-03-17
97014 HCPCS Electric Stimulation Therapy 26 12 — — $150.00 $185.00 $167.50 2026-03-17
97763 HCPCS Orthc/prostc Mgmt Sbsq Enc 26 12 — — $150.00 $185.00 $167.50 2026-03-17
97761 HCPCS Prosthetic Traing 1st Enc 26 12 — — $150.00 $185.00 $167.50 2026-03-17
97760 HCPCS Orthotic Mgmt&traing 1st Enc 26 12 — — $150.00 $185.00 $167.50 2026-03-17
97542 HCPCS Wheelchair Mngment Training 30 13 — — $150.00 $185.00 $167.50 2026-03-17
97750 HCPCS Physical Performance Test 30 13 — — $150.00 $185.00 $167.50 2026-03-17
97533 HCPCS Sensory Integration 26 12 — — $150.00 $185.00 $167.50 2026-03-17
97130 HCPCS Ther Ivntj Ea Addl 15 Min 26 12 — — $150.00 $185.00 $167.50 2026-03-17
97033 HCPCS App Mdlty 1+iontphrsis Ea 15 26 12 — — $150.00 $185.00 $167.50 2026-03-17
97035 HCPCS App Mdlty 1+ultrasound Ea 15 26 12 — — $150.00 $185.00 $167.50 2026-03-17
97018 HCPCS Paraffin Bath Therapy 26 12 — — $150.00 $185.00 $167.50 2026-03-17
97012 HCPCS Mechanical Traction Therapy 26 12 — — $150.00 $185.00 $167.50 2026-03-17
0448 RC Speech-language Pathology - Other 15 7 — — $163.00 $163.00 $163.00 2026-03-17
0447 RC Speech-language Pathology - Observation/Hourly 15 7 — — $163.00 $163.00 $163.00 2026-03-17
0445 RC Speech-language Pathology - Treatment 15 7 — — $163.00 $163.00 $163.00 2026-03-17
0446 RC Speech-language Pathology - Continuation 15 7 — — $163.00 $163.00 $163.00 2026-03-17
0436 RC Occupational Therapy - Continuation 15 7 — — $163.00 $163.00 $163.00 2026-03-17
0435 RC Occupational Therapy - Treatment 15 7 — — $163.00 $163.00 $163.00 2026-03-17
0437 RC Occupational Therapy - Observation/Hourly 15 7 — — $163.00 $163.00 $163.00 2026-03-17
0438 RC Occupational Therapy - Other 15 7 — — $163.00 $163.00 $163.00 2026-03-17
0428 RC Physical Therapy - Other 15 7 — — $163.00 $163.00 $163.00 2026-03-17
0426 RC Physical Therapy - Continuation 15 7 — — $163.00 $163.00 $163.00 2026-03-17
0425 RC Physical Therapy - Treatment 15 7 — — $163.00 $163.00 $163.00 2026-03-17
0427 RC Physical Therapy - Observation/Hourly 15 7 — — $163.00 $163.00 $163.00 2026-03-17
0444 RC Speech Therapy - Language Pathology - Evaluation Or Reevaluation 43 17 — — $131.00 $185.00 $158.00 2026-03-17
0434 RC Occupational Therapy - Evaluation Or Reevaluation 46 18 — — $131.00 $185.00 $158.00 2026-03-17
97167 HCPCS Ot Eval High Complex 60 Min 31 14 — — $131.00 $185.00 $158.00 2026-03-17
97166 HCPCS Ot Eval Mod Complex 45 Min 40 17 — — $131.00 $185.00 $158.00 2026-03-17
97168 HCPCS Ot Re-eval Est Plan Care 31 14 — — $131.00 $185.00 $158.00 2026-03-17
97164 HCPCS Pt Re-eval Est Plan Care 36 16 — — $131.00 $185.00 $158.00 2026-03-17
97165 HCPCS Ot Eval Low Complex 30 Min 40 17 — — $131.00 $185.00 $158.00 2026-03-17
97161 HCPCS Pt Eval Low Complex 20 Min 36 16 — — $131.00 $185.00 $158.00 2026-03-17
97162 HCPCS Pt Eval Mod Complex 30 Min 36 16 — — $131.00 $185.00 $158.00 2026-03-17
97163 HCPCS Pt Eval High Complex 45 Min 36 16 — — $131.00 $185.00 $158.00 2026-03-17
0424 RC Physical Therapy - Evaluation Or Re-evaluation 42 17 — — $131.00 $185.00 $158.00 2026-03-17
0300 RC Laboratory - General Classification 38 14 — — $150.00 $150.00 $150.00 2026-03-17
0301 RC Laboratory - Chemistry 38 14 — — $150.00 $150.00 $150.00 2026-03-17
99232 HCPCS Sbsq Hosp Ip/obs Moderate 35 25 11 — — $150.00 $150.00 $150.00 2026-03-17
20561 HCPCS Ndl Insj Without Njx 3+ Musc 26 11 — — $150.00 $150.00 $150.00 2026-03-17
99499 HCPCS Unlisted E&m Service 25 11 — — $150.00 $150.00 $150.00 2026-03-17
20560 HCPCS Ndl Insj Without Njx 1 Or 2 Musc 26 11 — — $150.00 $150.00 $150.00 2026-03-17
99199 HCPCS Unlisted Special Svc Px/rprt 34 14 — — $150.00 $150.00 $150.00 2026-03-17
29130 HCPCS Application Of Finger Splint 26 11 — — $150.00 $150.00 $150.00 2026-03-17
97550 HCPCS Caregiver Traing 1st 30 Min 25 11 — — $150.00 $150.00 $150.00 2026-03-17
29126 HCPCS Apply Forearm Splint 26 11 — — $150.00 $150.00 $150.00 2026-03-17
99223 HCPCS 1st Hosp Ip/obs High 75 25 11 — — $150.00 $150.00 $150.00 2026-03-17
29125 HCPCS Apply Forearm Splint 35 14 — — $150.00 $150.00 $150.00 2026-03-17
99231 HCPCS Sbsq Hosp Ip/obs Sf/low 25 25 11 — — $150.00 $150.00 $150.00 2026-03-17
11721 HCPCS Debride Nail 6 Or More 26 11 — — $150.00 $150.00 $150.00 2026-03-17
96125 HCPCS Cognitive Test By Hc Pro 25 11 — — $150.00 $150.00 $150.00 2026-03-17
95992 HCPCS Canalith Repositioning Proc 25 11 — — $150.00 $150.00 $150.00 2026-03-17
93926 HCPCS Lower Extremity Study 34 14 — — $150.00 $150.00 $150.00 2026-03-17
92609 HCPCS Use Of Speech Device Service 25 11 — — $150.00 $150.00 $150.00 2026-03-17
94003 HCPCS Vent Mgmt Inpat Subq Day 34 14 — — $150.00 $150.00 $150.00 2026-03-17
71045 HCPCS X-ray Exam Chest 1 View 35 14 — — $150.00 $150.00 $150.00 2026-03-17
93971 HCPCS Extremity Study 34 14 — — $150.00 $150.00 $150.00 2026-03-17
94002 HCPCS Vent Mgmt Inpat Init Day 34 14 — — $150.00 $150.00 $150.00 2026-03-17
87635 HCPCS Sars-cov-2 Covid-19 Amp Prb 34 14 — — $150.00 $150.00 $150.00 2026-03-17
87340 HCPCS Hepatitis B Surface Ag Ia 34 14 — — $150.00 $150.00 $150.00 2026-03-17
87633 HCPCS Resp Virus 12-25 Targets 25 11 — — $150.00 $150.00 $150.00 2026-03-17
87070 HCPCS Culture Othr Specimn Aerobic 34 14 — — $150.00 $150.00 $150.00 2026-03-17
85610 HCPCS Prothrombin Time 34 14 — — $150.00 $150.00 $150.00 2026-03-17
70470 HCPCS CT Head/brain Without & With Contrast 26 11 — — $150.00 $150.00 $150.00 2026-03-17
86140 HCPCS C-reactive Protein 34 14 — — $150.00 $150.00 $150.00 2026-03-17
87086 HCPCS Urine Culture/colony Count 34 14 — — $150.00 $150.00 $150.00 2026-03-17
84443 HCPCS Assay Thyroid Stim Hormone 34 14 — — $150.00 $150.00 $150.00 2026-03-17
84100 HCPCS Assay Of Phosphorus 34 14 — — $150.00 $150.00 $150.00 2026-03-17
84481 HCPCS Free Assay (ft-3) 34 14 — — $150.00 $150.00 $150.00 2026-03-17
82962 HCPCS Glucose Blood Test 25 11 — — $150.00 $150.00 $150.00 2026-03-17
82805 HCPCS Blood Gases W/o2 Saturation 34 14 — — $150.00 $150.00 $150.00 2026-03-17
83036 HCPCS Hemoglobin Glycosylated A1c 34 14 — — $150.00 $150.00 $150.00 2026-03-17
85025 HCPCS Complete Cbc W/auto Diff Wbc 34 14 — — $150.00 $150.00 $150.00 2026-03-17
80069 HCPCS Renal Function Panel 34 14 — — $150.00 $150.00 $150.00 2026-03-17
80053 HCPCS Comprehen Metabolic Panel 34 14 — — $150.00 $150.00 $150.00 2026-03-17
80202 HCPCS Assay Of Vancomycin 34 14 — — $150.00 $150.00 $150.00 2026-03-17
76700 HCPCS US Exam Abdom Complete 34 14 — — $150.00 $150.00 $150.00 2026-03-17
74177 HCPCS CT Abd & Pelv W/contrast 34 14 — — $150.00 $150.00 $150.00 2026-03-17
80048 HCPCS Metabolic Panel Total Ca 34 14 — — $150.00 $150.00 $150.00 2026-03-17
81001 HCPCS Urinalysis Auto W/scope 34 14 — — $150.00 $150.00 $150.00 2026-03-17
82728 HCPCS Assay Of Ferritin 34 14 — — $150.00 $150.00 $150.00 2026-03-17
82803 HCPCS Blood Gases Any Combination 34 14 — — $150.00 $150.00 $150.00 2026-03-17
82945 HCPCS Glucose Other Fluid 34 14 — — $150.00 $150.00 $150.00 2026-03-17
82948 HCPCS Reagent Strip/blood Glucose 34 14 — — $150.00 $150.00 $150.00 2026-03-17
83735 HCPCS Assay Of Magnesium 34 14 — — $150.00 $150.00 $150.00 2026-03-17
83880 HCPCS Assay Of Natriuretic Peptide 34 14 — — $150.00 $150.00 $150.00 2026-03-17
84134 HCPCS Assay Of Prealbumin 34 14 — — $150.00 $150.00 $150.00 2026-03-17
84145 HCPCS Procalcitonin (pct) 34 14 — — $150.00 $150.00 $150.00 2026-03-17
73560 HCPCS X-ray Exam Of Knee 1 Or 2 34 14 — — $150.00 $150.00 $150.00 2026-03-17
73100 HCPCS X-ray Exam Of Wrist 34 14 — — $150.00 $150.00 $150.00 2026-03-17
86905 HCPCS Blood Typing Rbc Antigens 34 14 — — $150.00 $150.00 $150.00 2026-03-17
87040 HCPCS Blood Culture For Bacteria 34 14 — — $150.00 $150.00 $150.00 2026-03-17
73610 HCPCS X-ray Exam Of Ankle 34 14 — — $150.00 $150.00 $150.00 2026-03-17
87493 HCPCS C Diff Amplified Probe 25 11 — — $150.00 $150.00 $150.00 2026-03-17
72170 HCPCS X-ray Exam Of Pelvis 34 14 — — $150.00 $150.00 $150.00 2026-03-17
90935 HCPCS Hemodialysis One Evaluation 34 14 — — $150.00 $150.00 $150.00 2026-03-17
72158 HCPCS MRI Lumbar Spine Without & With Contrast 26 11 — — $150.00 $150.00 $150.00 2026-03-17
73030 HCPCS X-ray Exam Of Shoulder 34 14 — — $150.00 $150.00 $150.00 2026-03-17
74018 HCPCS X-ray Exam Abdomen 1 View 34 14 — — $150.00 $150.00 $150.00 2026-03-17
71046 HCPCS X-ray Exam Chest 2 Views 35 14 — — $150.00 $150.00 $150.00 2026-03-17
82330 HCPCS Assay Of Calcium 34 14 — — $150.00 $150.00 $150.00 2026-03-17
93970 HCPCS Extremity Study 34 14 — — $150.00 $150.00 $150.00 2026-03-17
92610 HCPCS Evaluate Swallowing Function 34 14 — — $150.00 $150.00 $150.00 2026-03-17
92612 HCPCS Endoscopy Swallow (fees) Vid 25 11 — — $150.00 $150.00 $150.00 2026-03-17
85027 HCPCS Complete Cbc Automated 34 14 — — $150.00 $150.00 $150.00 2026-03-17
0441 RC Speech Therapy - Language Pathology - Visit Charge 26 10 — — $99.00 $185.00 $142.00 2026-03-17
0431 RC Occupational Therapy - Visit Charge 22 9 — — $99.00 $185.00 $142.00 2026-03-17
0412 RC Respiratory Services - Inhalation Services 22 9 — — $99.00 $185.00 $142.00 2026-03-17
0410 RC Respiratory Services - General Classification 41 16 — — $99.00 $185.00 $142.00 2026-03-17
0419 RC Respiratory Services - Other 19 8 — — $99.00 $185.00 $142.00 2026-03-17
0421 RC Physical Therapy - Visit Charge 41 16 — — $99.00 $185.00 $142.00 2026-03-17
92521 HCPCS Evaluation Of Speech Fluency 5 2 — — $131.00 $150.00 $141.00 2026-03-17
96105 HCPCS Assessment Of Aphasia 26 12 — — $131.00 $150.00 $140.50 2026-03-17
92524 HCPCS Behavral Qualit Analys Voice 26 12 — — $131.00 $150.00 $140.50 2026-03-17
92523 HCPCS Speech Sound Lang Comprehen 35 15 — — $131.00 $150.00 $140.50 2026-03-17
92522 HCPCS Evaluate Speech Production 26 12 — — $131.00 $150.00 $140.50 2026-03-17
0440 RC Speech Therapy - Language Pathology - General Classification 46 18 — — $90.00 $185.00 $137.50 2026-03-17
0430 RC Occupational Therapy - General Classification 46 18 — — $90.00 $185.00 $137.50 2026-03-17
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