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 The Northwest

Post Falls, ID · CCN 133027 · Rates published

1,052 distinct procedures filed
18 distinct payers
14,984 rate rows
2026-03-17 last MRF observed
Data quality

4,261 of 14,984 rate rows are consumer-grade (28.4%)

10,723 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 10,218
per-diem day rate — not a per-procedure price 505
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://ernesthealth.com/wp-content/uploads/2025/01/pricing/Rehabilitation%20Hospital%20of%20the%20Northwest/461337794_Rehabilitation-Hospital-of-the-Northwest_Standard-Charges.json
Found on page https://rhn.ernesthealth.com/price-transparency/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint da7bf292c80e7028… · 5,825,028 bytes · first seen 2026-05-06

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 11 $64,949.05 $64,949.05 $64,949.05 nat. median
$67,662
1.0× median
B0505
LOCAL 		Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 1 11 $53,677.24 $53,677.24 $53,677.24 nat. median
$56,226
1.0× median
C0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier Tier 2 11 $44,855.90 $44,855.90 $44,855.90 nat. median
$46,986
1.0× median
B0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 1 11 $44,390.79 $44,390.79 $44,390.79 nat. median
$43,383
1.0× median
B0604
LOCAL 		Neurological M <43.50- Tier Tier 1 11 $44,318.47 $44,318.47 $44,318.47 nat. median
$46,423
1.0× median
B1004
LOCAL 		Amputation Lower Extremity M <47.50- Tier Tier 1 11 $40,949.74 $45,733.74 $43,341.74 nat. median
$42,470
1.0× median
C0105
LOCAL 		Stroke M <41.50 And A >=84.50- Tier Tier 2 11 $43,210.39 $43,210.39 $43,210.39 nat. median
$41,402
1.0× median
D0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier Tier 3 11 $40,170.86 $44,098.59 $42,134.72 nat. median
$42,703
1.0× median
A0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier None 11 $38,945.84 $41,828.74 $40,387.29 nat. median
$39,573
1.0× median
B2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 1 11 $39,527.86 $39,527.86 $39,527.86 nat. median
$40,995
1.0× median
C1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 2 11 $36,269.46 $36,269.46 $36,269.46 nat. median
$37,992
1.0× median
D0105
LOCAL 		Stroke M <41.50 And A >=84.50- Tier Tier 3 11 $31,818.62 $39,148.65 $35,483.64 nat. median
$37,662
0.9× median
D0205
LOCAL 		Traumatic Brain Injury M <35.50- Tier Tier 3 11 $35,125.20 $35,125.20 $35,125.20 nat. median
$36,592
1.0× median
C0604
LOCAL 		Neurological M <43.50- Tier Tier 2 11 $33,180.12 $35,901.58 $34,540.85 nat. median
$34,756
1.0× median
C2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 2 11 $34,324.49 $34,324.49 $34,324.49 nat. median
$32,921
1.0× median
C0305
LOCAL 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 2 11 $33,948.90 $33,948.90 $33,948.90 nat. median
$35,561
1.0× median
C1004
LOCAL 		Amputation Lower Extremity M <47.50- Tier Tier 2 11 $33,867.04 $33,867.04 $33,867.04 nat. median
$35,393
1.0× median
D1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3 11 $33,589.43 $33,589.43 $33,589.43 nat. median
$34,992
1.0× median
A1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier None 11 $30,473.39 $36,542.40 $33,507.89 nat. median
$31,920
1.0× median
A0205
LOCAL 		Traumatic Brain Injury M <35.50- Tier None 11 $33,069.79 $33,069.79 $33,069.79 nat. median
$33,234
1.0× median
D1903
LOCAL 		Guillain-barré M >=38.50 And M <51.50- Tier Tier 3 11 $32,060.77 $32,060.77 $32,060.77 nat. median
$33,429
1.0× median
C0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 2 11 $32,037.64 $32,037.64 $32,037.64 nat. median
$33,146
1.0× median
D1704
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 11 $31,247.71 $31,247.71 $31,247.71 nat. median
$29,818
1.0× median
D1004
LOCAL 		Amputation Lower Extremity M <47.50- Tier Tier 3 11 $30,936.08 $30,936.08 $30,936.08 nat. median
$32,228
1.0× median
D0304
LOCAL 		Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 3 11 $30,932.29 $30,932.29 $30,932.29 nat. median
$29,475
1.0× median
C1704
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 11 $30,905.83 $30,905.83 $30,905.83 nat. median
$32,382
1.0× median
D1504
LOCAL 		Pulmonary M <45.50- Tier Tier 3 11 $30,895.15 $30,895.15 $30,895.15 nat. median
$32,186
1.0× median
C0304
LOCAL 		Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 2 11 $30,783.04 $30,783.04 $30,783.04 nat. median
$32,043
1.0× median
D2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 3 11 $29,494.63 $31,921.12 $30,707.88 nat. median
$30,727
1.0× median
C0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 2 11 $30,525.00 $30,525.00 $30,525.00 nat. median
$31,818
1.0× median
C0204
LOCAL 		Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 2 11 $30,192.22 $30,192.22 $30,192.22 nat. median
$31,314
1.0× median
C1404
LOCAL 		Cardiac M <45.50- Tier Tier 2 11 $30,081.89 $30,081.89 $30,081.89 nat. median
$30,962
1.0× median
B0602
LOCAL 		Neurological M >=52.50 And M <64.50- Tier Tier 1 11 $29,991.13 $29,991.13 $29,991.13 nat. median
$31,650
0.9× median
C2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 2 11 $29,953.76 $29,953.76 $29,953.76 nat. median
$31,232
1.0× median
A1004
LOCAL 		Amputation Lower Extremity M <47.50- Tier None 11 $27,716.84 $32,025.61 $29,871.22 nat. median
$29,040
1.0× median
D0305
LOCAL 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 3 11 $27,881.97 $31,185.22 $29,533.60 nat. median
$32,319
0.9× median
D1404
LOCAL 		Cardiac M <45.50- Tier Tier 3 11 $27,969.54 $30,943.90 $29,456.72 nat. median
$29,138
1.0× median
A0305
LOCAL 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier None 11 $29,393.19 $29,393.19 $29,393.19 nat. median
$30,648
1.0× median
D1103
LOCAL 		Amputation Non-lower Extremity M <52.50- Tier Tier 3 11 $28,690.26 $28,690.26 $28,690.26 nat. median
$30,053
1.0× median
D0805
LOCAL 		Replacement Of Lower-extremity Joint M <42.50- Tier Tier 3 11 $26,835.95 $30,462.07 $28,649.01 nat. median
$27,957
1.0× median
D0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 3 11 $28,451.80 $28,451.80 $28,451.80 nat. median
$29,640
1.0× median
D0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 3 11 $22,428.45 $33,709.13 $28,068.79 nat. median
$31,616
0.9× median
A0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier None 11 $28,038.94 $28,038.94 $28,038.94 nat. median
$29,236
1.0× median
D2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 3 11 $27,981.99 $27,981.99 $27,981.99 nat. median
$29,151
1.0× median
A0604
LOCAL 		Neurological M <43.50- Tier None 11 $27,935.72 $27,935.72 $27,935.72 nat. median
$28,952
1.0× median
A0104
LOCAL 		Stroke M >=41.50 And M <50.50- Tier None 11 $27,465.92 $27,465.92 $27,465.92 nat. median
$28,703
1.0× median
C0503
LOCAL 		Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier Tier 2 11 $27,365.93 $27,365.93 $27,365.93 nat. median
$27,048
1.0× median
D0604
LOCAL 		Neurological M <43.50- Tier Tier 3 11 $23,530.48 $30,975.23 $27,252.85 nat. median
$32,269
0.8× median
D0504
LOCAL 		Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 3 11 $26,037.16 $28,391.30 $27,214.23 nat. median
$29,577
0.9× median
C0603
LOCAL 		Neurological M >=43.50 And M <52.50- Tier Tier 2 11 $26,456.90 $27,824.53 $27,140.72 nat. median
$27,713
1.0× median

Other procedures at this hospital

Browse this hospital's 1,052 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 21 11 — — $64,949.05 $64,949.05 $64,949.05 2026-03-17
B0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 1 21 11 — — $53,677.24 $53,677.24 $53,677.24 2026-03-17
C0106 LOCAL Stroke M <41.50 And A <84.50- Tier Tier 2 21 11 — — $44,855.90 $44,855.90 $44,855.90 2026-03-17
B0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier Tier 1 21 11 — — $44,390.79 $44,390.79 $44,390.79 2026-03-17
B0604 LOCAL Neurological M <43.50- Tier Tier 1 21 11 — — $44,318.47 $44,318.47 $44,318.47 2026-03-17
B1004 LOCAL Amputation Lower Extremity M <47.50- Tier Tier 1 21 11 — — $40,949.74 $45,733.74 $43,341.74 2026-03-17
C0105 LOCAL Stroke M <41.50 And A >=84.50- Tier Tier 2 21 11 — — $43,210.39 $43,210.39 $43,210.39 2026-03-17
D0106 LOCAL Stroke M <41.50 And A <84.50- Tier Tier 3 21 11 — — $40,170.86 $44,098.59 $42,134.72 2026-03-17
A0106 LOCAL Stroke M <41.50 And A <84.50- Tier None 21 11 — — $38,945.84 $41,828.74 $40,387.29 2026-03-17
B2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier Tier 1 21 11 — — $39,527.86 $39,527.86 $39,527.86 2026-03-17
C1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 2 21 11 — — $36,269.46 $36,269.46 $36,269.46 2026-03-17
D0105 LOCAL Stroke M <41.50 And A >=84.50- Tier Tier 3 21 11 — — $31,818.62 $39,148.65 $35,483.64 2026-03-17
D0205 LOCAL Traumatic Brain Injury M <35.50- Tier Tier 3 21 11 — — $35,125.20 $35,125.20 $35,125.20 2026-03-17
C0604 LOCAL Neurological M <43.50- Tier Tier 2 21 11 — — $33,180.12 $35,901.58 $34,540.85 2026-03-17
C2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier Tier 2 21 11 — — $34,324.49 $34,324.49 $34,324.49 2026-03-17
C0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 2 21 11 — — $33,948.90 $33,948.90 $33,948.90 2026-03-17
C1004 LOCAL Amputation Lower Extremity M <47.50- Tier Tier 2 21 11 — — $33,867.04 $33,867.04 $33,867.04 2026-03-17
D1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3 21 11 — — $33,589.43 $33,589.43 $33,589.43 2026-03-17
A1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier None 21 11 — — $30,473.39 $36,542.40 $33,507.89 2026-03-17
A0205 LOCAL Traumatic Brain Injury M <35.50- Tier None 21 11 — — $33,069.79 $33,069.79 $33,069.79 2026-03-17
D1903 LOCAL Guillain-barré M >=38.50 And M <51.50- Tier Tier 3 21 11 — — $32,060.77 $32,060.77 $32,060.77 2026-03-17
C0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier Tier 2 21 11 — — $32,037.64 $32,037.64 $32,037.64 2026-03-17
D1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 21 11 — — $31,247.71 $31,247.71 $31,247.71 2026-03-17
D1004 LOCAL Amputation Lower Extremity M <47.50- Tier Tier 3 21 11 — — $30,936.08 $30,936.08 $30,936.08 2026-03-17
D0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 3 21 11 — — $30,932.29 $30,932.29 $30,932.29 2026-03-17
C1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 21 11 — — $30,905.83 $30,905.83 $30,905.83 2026-03-17
D1504 LOCAL Pulmonary M <45.50- Tier Tier 3 21 11 — — $30,895.15 $30,895.15 $30,895.15 2026-03-17
C0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 2 21 11 — — $30,783.04 $30,783.04 $30,783.04 2026-03-17
D2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier Tier 3 21 11 — — $29,494.63 $31,921.12 $30,707.88 2026-03-17
C0904 LOCAL Other Orthopedic M <44.5- Tier Tier 2 21 11 — — $30,525.00 $30,525.00 $30,525.00 2026-03-17
C0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 2 21 11 — — $30,192.22 $30,192.22 $30,192.22 2026-03-17
C1404 LOCAL Cardiac M <45.50- Tier Tier 2 21 11 — — $30,081.89 $30,081.89 $30,081.89 2026-03-17
B0602 LOCAL Neurological M >=52.50 And M <64.50- Tier Tier 1 21 11 — — $29,991.13 $29,991.13 $29,991.13 2026-03-17
C2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier Tier 2 21 11 — — $29,953.76 $29,953.76 $29,953.76 2026-03-17
A1004 LOCAL Amputation Lower Extremity M <47.50- Tier None 21 11 — — $27,716.84 $32,025.61 $29,871.22 2026-03-17
D0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 3 21 11 — — $27,881.97 $31,185.22 $29,533.60 2026-03-17
D1404 LOCAL Cardiac M <45.50- Tier Tier 3 21 11 — — $27,969.54 $30,943.90 $29,456.72 2026-03-17
A0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50- Tier None 21 11 — — $29,393.19 $29,393.19 $29,393.19 2026-03-17
D1103 LOCAL Amputation Non-lower Extremity M <52.50- Tier Tier 3 21 11 — — $28,690.26 $28,690.26 $28,690.26 2026-03-17
D0805 LOCAL Replacement Of Lower-extremity Joint M <42.50- Tier Tier 3 21 11 — — $26,835.95 $30,462.07 $28,649.01 2026-03-17
D0904 LOCAL Other Orthopedic M <44.5- Tier Tier 3 21 11 — — $28,451.80 $28,451.80 $28,451.80 2026-03-17
D0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier Tier 3 21 11 — — $22,428.45 $33,709.13 $28,068.79 2026-03-17
A0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier None 21 11 — — $28,038.94 $28,038.94 $28,038.94 2026-03-17
D2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier Tier 3 21 11 — — $27,981.99 $27,981.99 $27,981.99 2026-03-17
A0604 LOCAL Neurological M <43.50- Tier None 21 11 — — $27,935.72 $27,935.72 $27,935.72 2026-03-17
A0104 LOCAL Stroke M >=41.50 And M <50.50- Tier None 21 11 — — $27,465.92 $27,465.92 $27,465.92 2026-03-17
C0503 LOCAL Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier Tier 2 21 11 — — $27,365.93 $27,365.93 $27,365.93 2026-03-17
D0604 LOCAL Neurological M <43.50- Tier Tier 3 21 11 — — $23,530.48 $30,975.23 $27,252.85 2026-03-17
D0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 3 21 11 — — $26,037.16 $28,391.30 $27,214.23 2026-03-17
C0603 LOCAL Neurological M >=43.50 And M <52.50- Tier Tier 2 21 11 — — $26,456.90 $27,824.53 $27,140.72 2026-03-17
A0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier None 21 11 — — $25,818.03 $28,049.02 $26,933.53 2026-03-17
A0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier None 21 11 — — $26,163.27 $26,163.27 $26,163.27 2026-03-17
A0904 LOCAL Other Orthopedic M <44.5- Tier None 21 11 — — $26,031.58 $26,031.58 $26,031.58 2026-03-17
C2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier Tier 2 21 11 — — $25,052.82 $26,887.97 $25,970.40 2026-03-17
A1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 21 11 — — $25,967.52 $25,967.52 $25,967.52 2026-03-17
A2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier None 21 11 — — $25,469.24 $25,469.24 $25,469.24 2026-03-17
D1703 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 21 11 — — $25,289.50 $25,289.50 $25,289.50 2026-03-17
D1003 LOCAL Amputation Lower Extremity M >=47.50 And M <55.50- Tier Tier 3 21 11 — — $24,164.81 $25,930.10 $25,047.46 2026-03-17
A0805 LOCAL Replacement Of Lower-extremity Joint M <42.50- Tier None 21 11 — — $25,029.68 $25,029.68 $25,029.68 2026-03-17
D2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier Tier 3 21 11 — — $25,005.13 $25,005.13 $25,005.13 2026-03-17
D1503 LOCAL Pulmonary M >=45.50 And M <56.50- Tier Tier 3 21 11 — — $24,947.82 $24,947.82 $24,947.82 2026-03-17
D0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 3 21 11 — — $24,842.83 $24,842.83 $24,842.83 2026-03-17
D0104 LOCAL Stroke M >=41.50 And M <50.50- Tier Tier 3 21 11 — — $20,863.25 $28,820.17 $24,841.71 2026-03-17
D0603 LOCAL Neurological M >=43.50 And M <52.50- Tier Tier 3 21 11 — — $24,698.68 $24,698.68 $24,698.68 2026-03-17
C1403 LOCAL Cardiac M >=45.50 And M <55.50- Tier Tier 2 21 11 — — $24,550.98 $24,550.98 $24,550.98 2026-03-17
D0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 3 21 11 — — $24,389.04 $24,389.04 $24,389.04 2026-03-17
D0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 3 21 11 — — $20,122.75 $27,421.43 $23,772.09 2026-03-17
B0601 LOCAL Neurological M >=64.50- Tier Tier 1 21 11 — — $23,645.18 $23,645.18 $23,645.18 2026-03-17
D1702 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 21 11 — — $23,143.58 $23,143.58 $23,143.58 2026-03-17
C0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier Tier 2 21 11 — — $23,060.38 $23,060.38 $23,060.38 2026-03-17
A0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier None 21 11 — — $22,952.92 $22,952.92 $22,952.92 2026-03-17
A1703 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 21 11 — — $22,944.02 $22,944.02 $22,944.02 2026-03-17
A0804 LOCAL Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier None 21 11 — — $22,915.24 $22,915.24 $22,915.24 2026-03-17
A2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier None 21 11 — — $22,892.02 $22,892.02 $22,892.02 2026-03-17
A1803 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50- T… 21 11 — — $22,839.03 $22,839.03 $22,839.03 2026-03-17
D0804 LOCAL Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier Tier 3 21 11 — — $22,376.34 $22,376.34 $22,376.34 2026-03-17
D0702 LOCAL Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier Tier 3 21 11 — — $22,282.47 $22,282.47 $22,282.47 2026-03-17
A0603 LOCAL Neurological M >=43.50 And M <52.50- Tier None 21 11 — — $22,274.91 $22,274.91 $22,274.91 2026-03-17
D0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 3 21 11 — — $22,109.41 $22,109.41 $22,109.41 2026-03-17
A0402 LOCAL Traumatic Spinal Cord Injury M >=47.50 And M <56.50- Tier None 21 11 — — $21,712.56 $21,712.56 $21,712.56 2026-03-17
A1003 LOCAL Amputation Lower Extremity M >=47.50 And M <55.50- Tier None 21 11 — — $21,650.28 $21,650.28 $21,650.28 2026-03-17
A1403 LOCAL Cardiac M >=45.50 And M <55.50- Tier None 21 11 — — $21,004.29 $21,004.29 $21,004.29 2026-03-17
D0602 LOCAL Neurological M >=52.50 And M <64.50- Tier Tier 3 21 11 — — $20,961.58 $20,961.58 $20,961.58 2026-03-17
C2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier Tier 2 21 11 — — $20,920.65 $20,920.65 $20,920.65 2026-03-17
A1902 LOCAL Guillain-barré M >=51.50 And M <66.50- Tier None 21 11 — — $20,881.50 $20,881.50 $20,881.50 2026-03-17
D0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 3 21 11 — — $13,731.57 $27,696.17 $20,713.87 2026-03-17
A1502 LOCAL Pulmonary M >=56.50 And M <68.50- Tier None 21 11 — — $20,534.48 $20,534.48 $20,534.48 2026-03-17
A1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T… 21 11 — — $20,428.08 $20,428.08 $20,428.08 2026-03-17
D0302 LOCAL Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 3 21 11 — — $20,269.33 $20,269.33 $20,269.33 2026-03-17
A1002 LOCAL Amputation Lower Extremity M >=55.50 And M <64.50- Tier None 21 11 — — $20,229.35 $20,229.35 $20,229.35 2026-03-17
A0103 LOCAL Stroke M >=50.50 And M <63.50- Tier None 21 11 — — $18,413.88 $21,520.37 $19,967.12 2026-03-17
A0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50- Tier None 21 11 — — $17,171.61 $22,758.50 $19,965.06 2026-03-17
D0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier Tier 3 21 11 — — $19,883.16 $19,883.16 $19,883.16 2026-03-17
A0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier None 21 11 — — $19,873.30 $19,873.30 $19,873.30 2026-03-17
D2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier Tier 3 21 11 — — $19,543.26 $19,543.26 $19,543.26 2026-03-17
A1702 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 21 11 — — $19,308.36 $19,308.36 $19,308.36 2026-03-17
D0103 LOCAL Stroke M >=50.50 And M <63.50- Tier Tier 3 21 11 — — $13,811.48 $24,594.90 $19,203.19 2026-03-17
D0903 LOCAL Other Orthopedic M >=44.50 And M <51.50- Tier Tier 3 21 11 — — $14,527.50 $23,744.83 $19,136.17 2026-03-17
A0302 LOCAL Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier None 21 11 — — $19,103.71 $19,103.71 $19,103.71 2026-03-17
A0602 LOCAL Neurological M >=52.50 And M <64.50- Tier None 21 11 — — $18,904.40 $18,904.40 $18,904.40 2026-03-17
A1402 LOCAL Cardiac M >=55.50 And M <68.50- Tier None 21 11 — — $18,868.99 $18,868.99 $18,868.99 2026-03-17
A0702 LOCAL Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier None 21 11 — — $18,664.15 $18,664.15 $18,664.15 2026-03-17
D1402 LOCAL Cardiac M >=55.50 And M <68.50- Tier Tier 3 21 11 — — $18,655.26 $18,655.26 $18,655.26 2026-03-17
A2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier None 21 11 — — $17,788.60 $19,494.02 $18,641.31 2026-03-17
D0802 LOCAL Replacement Of Lower-extremity Joint M >=57.50 And M <63.50- Tier Tier 3 21 11 — — $17,943.43 $17,943.43 $17,943.43 2026-03-17
D0202 LOCAL Traumatic Brain Injury M >=61.50 And M <73.50- Tier Tier 3 21 11 — — $17,753.01 $17,753.01 $17,753.01 2026-03-17
D0102 LOCAL Stroke M >=63.50 And M <72.50- Tier Tier 3 21 11 — — $17,519.89 $17,519.89 $17,519.89 2026-03-17
A0105 LOCAL Stroke M <41.50 And A >=84.50- Tier None 21 11 — — $17,425.68 $17,425.68 $17,425.68 2026-03-17
D2001 LOCAL Miscellaneous M >=66.50- Tier Tier 3 21 11 — — $17,152.57 $17,152.57 $17,152.57 2026-03-17
A0802 LOCAL Replacement Of Lower-extremity Joint M >=57.50 And M <63.50- Tier None 21 11 — — $16,735.10 $16,735.10 $16,735.10 2026-03-17
D1002 LOCAL Amputation Lower Extremity M >=55.50 And M <64.50- Tier Tier 3 21 11 — — $16,710.15 $16,710.15 $16,710.15 2026-03-17
A0102 LOCAL Stroke M >=63.50 And M <72.50- Tier None 21 11 — — $16,697.73 $16,697.73 $16,697.73 2026-03-17
A1804 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50- T… 21 11 — — $16,550.98 $16,550.98 $16,550.98 2026-03-17
D0701 LOCAL Fracture Of Lower Extremity M >=61.50- Tier Tier 3 21 11 — — $16,356.05 $16,356.05 $16,356.05 2026-03-17
A0601 LOCAL Neurological M >=64.50- Tier None 21 11 — — $16,235.34 $16,235.34 $16,235.34 2026-03-17
D0301 LOCAL Non-traumatic Brain Injury M >=65.50- Tier Tier 3 21 11 — — $15,678.03 $15,678.03 $15,678.03 2026-03-17
A2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier None 21 11 — — $2,684.66 $26,846.63 $14,765.65 2026-03-17
A1404 LOCAL Cardiac M <45.50- Tier None 21 11 — — $2,757.45 $25,736.17 $14,246.81 2026-03-17
A0903 LOCAL Other Orthopedic M >=44.50 And M <51.50- Tier None 21 11 — — $4,177.89 $21,725.02 $12,951.45 2026-03-17
A0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier None 21 11 — — $2,462.86 $22,986.73 $12,724.80 2026-03-17
D1403 LOCAL Cardiac M >=45.50 And M <55.50- Tier Tier 3 21 11 — — $4,769.23 $4,769.23 $4,769.23 2026-03-17
0545 RC Ambulance - Air Ambulance 1 1 — — $2,300.00 $2,300.00 $2,300.00 2026-03-17
0148 RC Room & Board - Deluxe Private - Rehabilitation 18 10 — — $1,350.00 $1,350.00 $1,350.00 2026-03-17
0138 RC Room & Board - Three And Four Beds - Rehabilitation 18 10 — — $1,350.00 $1,350.00 $1,350.00 2026-03-17
0158 RC Room & Board - Ward - Rehabilitation 17 9 — — $1,350.00 $1,350.00 $1,350.00 2026-03-17
0128 RC Room & Board - Semi-private (Two Beds) - Rehabilitation 18 10 — — $1,337.50 $1,337.50 $1,337.50 2026-03-17
0275 RC Medical/Surgical Supplies And Devices - Pacemaker 2 1 — — $1,250.00 $1,250.00 $1,250.00 2026-03-17
0636 RC Pharmacy - Drugs Requiring Detailed Coding 3 2 — — $1,250.00 $1,250.00 $1,250.00 2026-03-17
0274 RC Medical/Surgical Supplies And Devices - Prosthetic/Orthotic Devices 2 1 — — $1,250.00 $1,250.00 $1,250.00 2026-03-17
0278 RC Medical/Surgical Supplies And Devices - Other Implants 2 1 — — $1,250.00 $1,250.00 $1,250.00 2026-03-17
0118 RC Room & Board - Private (One Bed) - Rehabilitation 18 10 — — $805.00 $1,177.50 $1,177.50 2026-03-17
0805 RC Inpatient Renal Dialysis - Treatment 18 2 — — $600.00 $612.00 $612.00 2026-03-17
0800 RC Inpatient Renal Dialysis - General Classification 19 3 — — $600.00 $627.00 $612.00 2026-03-17
0804 RC Inpatient Renal Dialysis - Continuous Cycling Peritoneal Dialysis (ccpd) 19 3 — — $600.00 $627.00 $612.00 2026-03-17
0808 RC Inpatient Renal Dialysis - Other 18 2 — — $600.00 $612.00 $612.00 2026-03-17
0809 RC Inpatient Renal Dialysis - Other 19 3 — — $600.00 $627.00 $612.00 2026-03-17
0806 RC Inpatient Renal Dialysis - Continuation 18 2 — — $600.00 $612.00 $612.00 2026-03-17
0802 RC Inpatient Renal Dialysis - Peritoneal Dialysis (non-capd) 19 3 — — $580.00 $612.00 $612.00 2026-03-17
0803 RC Inpatient Renal Dialysis - Continuous Ambulatory Peritoneal Dialysis (capd) 19 3 — — $600.00 $627.00 $612.00 2026-03-17
0807 RC Inpatient Renal Dialysis - Observation/Hourly 18 2 — — $600.00 $612.00 $612.00 2026-03-17
0801 RC Inpatient Renal Dialysis - Hemodialysis 19 3 — — $580.00 $612.00 $612.00 2026-03-17
0548 RC Ambulance - EKG Transmission 1 1 — — $350.00 $350.00 $350.00 2026-03-17
0543 RC Ambulance - Heart Mobile 1 1 — — $350.00 $350.00 $350.00 2026-03-17
0547 RC Ambulance - Pharmacy 1 1 — — $350.00 $350.00 $350.00 2026-03-17
0540 RC Ambulance - General Classification 1 1 — — $350.00 $350.00 $350.00 2026-03-17
0542 RC Ambulance - Medical Transport 1 1 — — $350.00 $350.00 $350.00 2026-03-17
0549 RC Ambulance - Other 1 1 — — $350.00 $350.00 $350.00 2026-03-17
0546 RC Ambulance - Neonatal Ambulance 1 1 — — $350.00 $350.00 $350.00 2026-03-17
0421 RC Physical Therapy - Visit Charge 41 10 — — $150.00 $150.00 $150.00 2026-03-17
0410 RC Respiratory Services - General Classification 41 10 — — $150.00 $150.00 $150.00 2026-03-17
97168 HCPCS Ot Re-eval Est Plan Care 42 11 — — $150.00 $150.00 $150.00 2026-03-17
97167 HCPCS Ot Eval High Complex 60 Min 42 11 — — $150.00 $150.00 $150.00 2026-03-17
97166 HCPCS Ot Eval Mod Complex 45 Min 42 11 — — $150.00 $150.00 $150.00 2026-03-17
97165 HCPCS Ot Eval Low Complex 30 Min 42 11 — — $150.00 $150.00 $150.00 2026-03-17
97164 HCPCS Pt Re-eval Est Plan Care 42 11 — — $150.00 $150.00 $150.00 2026-03-17
97163 HCPCS Pt Eval High Complex 45 Min 42 11 — — $150.00 $150.00 $150.00 2026-03-17
97162 HCPCS Pt Eval Mod Complex 30 Min 42 11 — — $150.00 $150.00 $150.00 2026-03-17
97161 HCPCS Pt Eval Low Complex 20 Min 42 11 — — $150.00 $150.00 $150.00 2026-03-17
96105 HCPCS Assessment Of Aphasia 42 11 — — $150.00 $150.00 $150.00 2026-03-17
92524 HCPCS Behavral Qualit Analys Voice 42 11 — — $150.00 $150.00 $150.00 2026-03-17
0444 RC Speech Therapy - Language Pathology - Evaluation Or Reevaluation 40 10 — — $150.00 $150.00 $150.00 2026-03-17
0434 RC Occupational Therapy - Evaluation Or Reevaluation 42 11 — — $150.00 $150.00 $150.00 2026-03-17
92523 HCPCS Speech Sound Lang Comprehen 42 11 — — $150.00 $150.00 $150.00 2026-03-17
0424 RC Physical Therapy - Evaluation Or Re-evaluation 42 11 — — $150.00 $150.00 $150.00 2026-03-17
92522 HCPCS Evaluate Speech Production 42 11 — — $150.00 $150.00 $150.00 2026-03-17
92521 HCPCS Evaluation Of Speech Fluency 1 1 — — $150.00 $150.00 $150.00 2026-03-17
0440 RC Speech Therapy - Language Pathology - General Classification 42 11 — — $90.00 $120.00 $120.00 2026-03-17
0420 RC Physical Therapy - General Classification 42 11 — — $90.00 $120.00 $120.00 2026-03-17
0430 RC Occupational Therapy - General Classification 42 11 — — $90.00 $120.00 $120.00 2026-03-17
92507 HCPCS Speech/hearing Therapy 42 11 — — $90.00 $90.00 $90.00 2026-03-17
97537 HCPCS Community/work Reintegration 42 11 — — $90.00 $90.00 $90.00 2026-03-17
97535 HCPCS Self Care Mngment Training 42 11 — — $90.00 $90.00 $90.00 2026-03-17
97530 HCPCS Therapeutic Activities 42 11 — — $90.00 $90.00 $90.00 2026-03-17
97140 HCPCS Manual Therapy 1/> Regions 42 11 — — $90.00 $90.00 $90.00 2026-03-17
97129 HCPCS Ther Ivntj 1st 15 Min 42 11 — — $90.00 $90.00 $90.00 2026-03-17
97124 HCPCS Massage Therapy 42 11 — — $90.00 $90.00 $90.00 2026-03-17
97116 HCPCS Gait Training Therapy 42 11 — — $90.00 $90.00 $90.00 2026-03-17
97113 HCPCS Aquatic Therapy/exercises 42 11 — — $90.00 $90.00 $90.00 2026-03-17
97112 HCPCS Neuromuscular Reeducation 42 11 — — $90.00 $90.00 $90.00 2026-03-17
97110 HCPCS Therapeutic Exercises 42 11 — — $90.00 $90.00 $90.00 2026-03-17
97032 HCPCS Appl Modality 1+estim Ea 15 42 11 — — $90.00 $90.00 $90.00 2026-03-17
92607 HCPCS Ex For Speech Device Rx 1hr 42 11 — — $90.00 $90.00 $90.00 2026-03-17
92606 HCPCS Non-speech Device Service 1 1 — — $90.00 $90.00 $90.00 2026-03-17
92605 HCPCS Ex For Nonspeech Device Rx 1 1 — — $90.00 $90.00 $90.00 2026-03-17
92597 HCPCS Oral Speech Device Eval 1 1 — — $90.00 $90.00 $90.00 2026-03-17
92526 HCPCS Oral Function Therapy 42 11 — — $90.00 $90.00 $90.00 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
A9517 HCPCS I131 Iodide Cap, Rx 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
A9513 HCPCS Lutetium Lu 177 Dotatat Ther 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
99232 HCPCS Sbsq Hosp Ip/obs Moderate 35 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
99223 HCPCS 1st Hosp Ip/obs High 75 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
97763 HCPCS Orthc/prostc Mgmt Sbsq Enc 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
97760 HCPCS Orthotic Mgmt&traing 1st Enc 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
97550 HCPCS Caregiver Traing 1st 30 Min 0 0 — — — — — 2026-03-17
J0875 HCPCS Injection, Dalbavancin 0 0 — — — — — 2026-03-17
J0873 HCPCS Inj, Daptomycin (xellia) 0 0 — — — — — 2026-03-17
J0883 HCPCS Argatroban Nonesrd Use 1mg 0 0 — — — — — 2026-03-17
J0885 HCPCS Epoetin Alfa, Non-esrd 0 0 — — — — — 2026-03-17
J0888 HCPCS Epoetin Beta Non Esrd 0 0 — — — — — 2026-03-17
J0891 HCPCS Argatroban Nonesrd (accord) 0 0 — — — — — 2026-03-17
J0896 HCPCS Inj Luspatercept-aamt 0.25mg 0 0 — — — — — 2026-03-17
J0897 HCPCS Denosumab Injection 0 0 — — — — — 2026-03-17
J0898 HCPCS Argatroban Nonesrd (auromed) 0 0 — — — — — 2026-03-17
J1105 HCPCS Dexmedetomidine Film, 1 Mcg 0 0 — — — — — 2026-03-17
J1162 HCPCS Digoxin Immune Fab (ovine) 0 0 — — — — — 2026-03-17
J1171 HCPCS Injection, Hydromorphone, 0.1 Mg 0 0 — — — — — 2026-03-17
J1190 HCPCS Dexrazoxane Hcl Injection 0 0 — — — — — 2026-03-17
J1201 HCPCS Inj. Cetirizine Hcl 0.5mg 0 0 — — — — — 2026-03-17
J1212 HCPCS Dimethyl Sulfoxide 50% 50 Ml 0 0 — — — — — 2026-03-17
J1290 HCPCS Ecallantide Injection 0 0 — — — — — 2026-03-17
J1300 HCPCS Eculizumab Injection 0 0 — — — — — 2026-03-17
J1301 HCPCS Injection, Edaravone, 1 Mg 0 0 — — — — — 2026-03-17
J1302 HCPCS Inj, Sutimlimab-jome, 10 Mg 0 0 — — — — — 2026-03-17
J1303 HCPCS Inj., Ravulizumab-cwvz 10 Mg 0 0 — — — — — 2026-03-17
J1304 HCPCS Inj Tofersen Intrathec 1 Mg 0 0 — — — — — 2026-03-17
J1305 HCPCS Inj, Evinacumab-dgnb, 5mg 0 0 — — — — — 2026-03-17
J1306 HCPCS Injection, Inclisiran, 1 Mg 0 0 — — — — — 2026-03-17
J1322 HCPCS Elosulfase Alfa, Injection 0 0 — — — — — 2026-03-17
J1410 HCPCS Inj Estrogen Conjugate 25 Mg 0 0 — — — — — 2026-03-17
J1430 HCPCS Ethanolamine Oleate 100 Mg 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
97542 HCPCS Wheelchair Mngment Training 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
90378 HCPCS Rsv Mab IM 50mg 0 0 — — — — — 2026-03-17
J0850 HCPCS Cytomegalovirus Imm IV /vial 0 0 — — — — — 2026-03-17
J0841 HCPCS Inj Crotalidae IM F(ab')2 Eq 0 0 — — — — — 2026-03-17
J0840 HCPCS Crotalidae Poly Immune Fab 0 0 — — — — — 2026-03-17
J0791 HCPCS Inj Crizanlizumab-tmca 5mg 0 0 — — — — — 2026-03-17
90377 HCPCS Rabies Ig Ht&sol Human Im/sc 0 0 — — — — — 2026-03-17
82805 HCPCS Blood Gases W/o2 Saturation 0 0 — — — — — 2026-03-17
J0775 HCPCS Collagenase, Clost Hist Inj 0 0 — — — — — 2026-03-17
J0742 HCPCS Inj Imip 4 Cilas 4 Releb 2mg 0 0 — — — — — 2026-03-17
97533 HCPCS Sensory Integration 0 0 — — — — — 2026-03-17
J0741 HCPCS Inj, Cabote Rilpivir 2mg 3mg 0 0 — — — — — 2026-03-17
J0740 HCPCS Cidofovir Injection 0 0 — — — — — 2026-03-17
90376 HCPCS Rabies Ig Heat Treated 0 0 — — — — — 2026-03-17
J0717 HCPCS Certolizumab Pegol Inj 1mg 0 0 — — — — — 2026-03-17
J0716 HCPCS Centruroides Immune F(ab) 0 0 — — — — — 2026-03-17
J0714 HCPCS Ceftazidime And Avibactam 0 0 — — — — — 2026-03-17
J0712 HCPCS Ceftaroline Fosamil Inj 0 0 — — — — — 2026-03-17
90375 HCPCS Rabies Ig Im/sc 0 0 — — — — — 2026-03-17
82803 HCPCS Blood Gases Any Combination 0 0 — — — — — 2026-03-17
73100 HCPCS X-ray Exam Of Wrist 0 0 — — — — — 2026-03-17
J0699 HCPCS Inj, Cefiderocol, 10 Mg 0 0 — — — — — 2026-03-17
J0695 HCPCS Inj Ceftolozane Tazobactam 0 0 — — — — — 2026-03-17
J0688 HCPCS Inj Cefazolin Sodium, Hikma 0 0 — — — — — 2026-03-17
J0638 HCPCS Canakinumab Injection 0 0 — — — — — 2026-03-17
90371 HCPCS Hep B Ig IM 0 0 — — — — — 2026-03-17
J0630 HCPCS Calcitonin Salmon Injection 0 0 — — — — — 2026-03-17
J0600 HCPCS Edetate Calcium Disodium Inj 0 0 — — — — — 2026-03-17
J0598 HCPCS C-1 Esterase, Cinryze 0 0 — — — — — 2026-03-17
J0597 HCPCS C-1 Esterase, Berinert 0 0 — — — — — 2026-03-17
87635 HCPCS Sars-cov-2 Covid-19 Amp Prb 0 0 — — — — — 2026-03-17
82728 HCPCS Assay Of Ferritin 0 0 — — — — — 2026-03-17
J0596 HCPCS Injection, Ruconest 0 0 — — — — — 2026-03-17
J0594 HCPCS Busulfan Injection 0 0 — — — — — 2026-03-17
J0588 HCPCS Incobotulinumtoxin A 0 0 — — — — — 2026-03-17
J0587 HCPCS Inj, Rimabotulinumtoxinb 0 0 — — — — — 2026-03-17
87633 HCPCS Resp Virus 12-25 Targets 0 0 — — — — — 2026-03-17
J0586 HCPCS Abobotulinumtoxina 0 0 — — — — — 2026-03-17
J0585 HCPCS Injection,onabotulinumtoxina 0 0 — — — — — 2026-03-17
J0584 HCPCS Injection, Burosumab-twza 1m 0 0 — — — — — 2026-03-17
J0565 HCPCS Inj, Bezlotoxumab, 10 Mg 0 0 — — — — — 2026-03-17
97130 HCPCS Ther Ivntj Ea Addl 15 Min 0 0 — — — — — 2026-03-17
87493 HCPCS C Diff Amplified Probe 0 0 — — — — — 2026-03-17
82330 HCPCS Assay Of Calcium 0 0 — — — — — 2026-03-17
73030 HCPCS X-ray Exam Of Shoulder 0 0 — — — — — 2026-03-17
29130 HCPCS Application Of Finger Splint 0 0 — — — — — 2026-03-17
20561 HCPCS Ndl Insj Without Njx 3+ Musc 0 0 — — — — — 2026-03-17
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