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

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Hospital

Whittier Rehabilitation Hospital - Bradford

Bradford, MA · CCN 222047 · Rates published

258 distinct procedures filed
14 distinct payers
3,281 rate rows
2025-12-31 last MRF observed
Data quality

3,180 of 3,281 rate rows are consumer-grade (96.9%)

101 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
per-diem day rate — not a per-procedure price 100
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.whittierhealth.com/wp-content/uploads/2026/03/510487386_brn-corporation_standardcharges.csv
Found on page https://www.whittierhealth.com/about-whittier-health-network/whittier-rehabilitation-hospitals-price-transparency/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-09-21
Content fingerprint c0178c8aa4c9917e… · 1,132,261 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
207
MS_DRG 		Respiratory System Diagnosis With Ventilator Support >96 Hours 2 $104,144.50 $104,144.50 $104,144.50 nat. median
$47,121
outlier · 2.2×
C0407
HCPCS 		Traumatic Spinal Cord Injury M <24.50 And A >=61.50 2 $65,475.63 $74,771.69 $70,123.66 nat. median
$73,713
1.0× median
B0106
HCPCS 		Stroke M <41.50 And A <84.50 2 $57,163.50 $57,305.96 $57,234.73 nat. median
$54,601
1.0× median
C1904
HCPCS 		Guillain-barr� M <38.50 1 $53,505.25 $53,505.25 $53,505.25 nat. median
$59,669
0.9× median
393
MS_DRG 		Other Digestive System Diagnoses With Mcc 2 $53,126.86 $53,126.86 $53,126.86 nat. median
$11,985
outlier · 4.4×
919
MS_DRG 		Complications Of Treatment With Mcc* 1 $50,321.35 $50,321.35 $50,321.35 nat. median
$13,090
outlier · 3.8×
288
MS_DRG 		Acute And Subacute Endocarditis With Mcc 1 $49,533.57 $49,533.57 $49,533.57 nat. median
$18,971
outlier · 2.6×
C0106
HCPCS 		Stroke M <41.50 And A <84.50 1 $48,388.77 $48,388.77 $48,388.77 nat. median
$48,486
1.0× median
A0406
HCPCS 		Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 1 $48,309.28 $48,309.28 $48,309.28 nat. median
$47,427
1.0× median
840
MS_DRG 		Lymphoma And Non-acute Leukemia With Mcc* 1 $48,110.48 $48,110.48 $48,110.48 nat. median
$22,339
outlier · 2.2×
843
MS_DRG 		Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses… 1 $48,110.48 $48,110.48 $48,110.48 nat. median
$13,716
outlier · 3.5×
441
MS_DRG 		Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc* 2 $48,079.99 $48,079.99 $48,079.99 nat. median
$13,138
outlier · 3.7×
A1806
HCPCS 		Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 1 $48,000.00 $48,000.00 $48,000.00 nat. median
$50,479
1.0× median
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 4 $47,993.58 $47,993.58 $47,993.58 nat. median
$9,470
outlier · 5.1×
B0604
HCPCS 		Neurological M <43.50 2 $47,318.70 $47,646.00 $47,482.35 nat. median
$47,224
1.0× median
280
MS_DRG 		Acute Myocardial Infarction, Discharged Alive With Mcc 1 $46,595.91 $46,595.91 $46,595.91 nat. median
$11,829
outlier · 3.9×
637
MS_DRG 		Diabetes With Mcc 1 $46,011.43 $46,011.43 $46,011.43 nat. median
$10,515
outlier · 4.4×
D0106
HCPCS 		Stroke M <41.50 And A <84.50 3 $43,334.74 $45,991.15 $45,787.96 nat. median
$43,929
1.0× median
592
MS_DRG 		Skin Ulcers With Mcc* 1 $45,599.75 $45,599.75 $45,599.75 nat. median
$13,680
outlier · 3.3×
862
MS_DRG 		Postoperative And Post-traumatic Infections With Mcc 1 $45,101.67 $45,101.67 $45,101.67 nat. median
$13,176
outlier · 3.4×
640
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 1 $44,679.83 $44,679.83 $44,679.83 nat. median
$9,697
outlier · 4.6×
371
MS_DRG 		Major Gastrointestinal Disorders And Peritoneal Infections With Mcc* 1 $44,537.52 $44,537.52 $44,537.52 nat. median
$12,655
outlier · 3.5×
727
MS_DRG 		Inflammation Of The Male Reproductive System With Mcc 1 $44,029.27 $44,029.27 $44,029.27 nat. median
$10,429
outlier · 4.2×
682
MS_DRG 		Renal Failure With Mcc* 1 $43,815.81 $43,815.81 $43,815.81 nat. median
$11,096
outlier · 3.9×
B0304
HCPCS 		Non-traumatic Brain Injury M <42.50 And A >=78.50 1 $43,804.67 $43,804.67 $43,804.67 nat. median
$41,705
1.1× median
B1404
HCPCS 		Cardiac M <45.50 1 $43,626.87 $43,626.87 $43,626.87 nat. median
$41,383
1.1× median
100
MS_DRG 		Seizures With Mcc 1 $43,592.18 $43,592.18 $43,592.18 nat. median
$13,848
outlier · 3.1×
B2005
HCPCS 		Miscellaneous M <46.50 And A <77.50 1 $42,263.77 $42,263.77 $42,263.77 nat. median
$42,636
1.0× median
D0505
HCPCS 		Non-traumatic Spinal Cord Injury M <39.50 2 $42,115.05 $42,124.05 $42,119.55 nat. median
$43,056
1.0× median
871
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 1 $41,940.39 $41,940.39 $41,940.39 nat. median
$14,442
outlier · 2.9×
C0105
HCPCS 		Stroke M <41.50 And A >=84.50 1 $41,692.34 $41,692.34 $41,692.34 nat. median
$43,210
1.0× median
A0106
HCPCS 		Stroke M <41.50 And A <84.50 1 $41,314.00 $41,314.00 $41,314.00 nat. median
$41,668
1.0× median
308
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders With Mcc 1 $41,106.86 $41,106.86 $41,106.86 nat. median
$8,963
outlier · 4.6×
C0205
HCPCS 		Traumatic Brain Injury M <35.50 1 $40,883.35 $40,883.35 $40,883.35 nat. median
$41,763
1.0× median
559
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Mcc 1 $40,385.16 $40,385.16 $40,385.16 nat. median
$13,403
outlier · 3.0×
299
MS_DRG 		Peripheral Vascular Disorders With Mcc 1 $40,039.55 $40,039.55 $40,039.55 nat. median
$11,794
outlier · 3.4×
177
MS_DRG 		Respiratory Infections And Inflammations With Mcc* 1 $39,932.82 $39,932.82 $39,932.82 nat. median
$11,701
outlier · 3.4×
291
MS_DRG 		Heart Failure And Shock With Mcc* 1 $39,739.68 $39,739.68 $39,739.68 nat. median
$9,572
outlier · 4.2×
D0405
HCPCS 		Traumatic Spinal Cord Injury M >=31.50 And M <41.50 1 $39,447.16 $39,447.16 $39,447.16 nat. median
$38,814
1.0× median
292
MS_DRG 		Heart Failure And Shock With Cc* 1 $38,621.55 $38,621.55 $38,621.55 nat. median
$6,415
outlier · 6.0×
D0105
HCPCS 		Stroke M <41.50 And A >=84.50 1 $38,098.97 $38,098.97 $38,098.97 nat. median
$38,998
1.0× median
C1504
HCPCS 		Pulmonary M <45.50 1 $38,011.46 $38,011.46 $38,011.46 nat. median
$36,307
1.0× median
B0703
HCPCS 		Fracture Of Lower Extremity M >=41.50 And M <52.50 1 $37,492.80 $37,492.80 $37,492.80 nat. median
$35,812
1.0× median
D0205
HCPCS 		Traumatic Brain Injury M <35.50 1 $37,133.84 $37,133.84 $37,133.84 nat. median
$38,154
1.0× median
193
MS_DRG 		Simple Pneumonia And Pleurisy With Mcc* 1 $36,598.73 $36,598.73 $36,598.73 nat. median
$9,802
outlier · 3.7×
540
MS_DRG 		Osteomyelitis With Cc* 1 $36,552.99 $36,552.99 $36,552.99 nat. median
$9,457
outlier · 3.9×
949
MS_DRG 		Aftercare With Cc/mcc 2 $36,410.68 $36,410.68 $36,410.68 nat. median
$8,367
outlier · 4.4×
560
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Cc 1 $36,100.65 $36,100.65 $36,100.65 nat. median
$8,402
outlier · 4.3×
809
MS_DRG 		Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 1 $36,019.33 $36,019.33 $36,019.33 nat. median
$9,154
outlier · 3.9×
206
MS_DRG 		Other Respiratory System Diagnoses Without Mcc 1 $36,019.33 $36,019.33 $36,019.33 nat. median
$6,811
outlier · 5.3×

Other procedures at this hospital

Browse this hospital's 258 published procedures. Use the slice to choose what to show, then sort or filter any column.

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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
             
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 2 2 — — $104,144.50 $104,144.50 $104,144.50 2025-12-31
C0407 HCPCS Traumatic Spinal Cord Injury M <24.50 And A >=61.50 2 2 — — $65,475.63 $74,771.69 $70,123.66 2025-12-31
B0106 HCPCS Stroke M <41.50 And A <84.50 2 2 — — $57,163.50 $57,305.96 $57,234.73 2025-12-31
C1904 HCPCS Guillain-barr� M <38.50 1 1 — — $53,505.25 $53,505.25 $53,505.25 2025-12-31
393 MS_DRG Other Digestive System Diagnoses With Mcc 2 2 — — $53,126.86 $53,126.86 $53,126.86 2025-12-31
919 MS_DRG Complications Of Treatment With Mcc* 1 1 — — $50,321.35 $50,321.35 $50,321.35 2025-12-31
288 MS_DRG Acute And Subacute Endocarditis With Mcc 1 1 — — $49,533.57 $49,533.57 $49,533.57 2025-12-31
C0106 HCPCS Stroke M <41.50 And A <84.50 1 1 — — $48,388.77 $48,388.77 $48,388.77 2025-12-31
A0406 HCPCS Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 1 1 — — $48,309.28 $48,309.28 $48,309.28 2025-12-31
843 MS_DRG Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses… 1 1 — — $48,110.48 $48,110.48 $48,110.48 2025-12-31
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc* 1 1 — — $48,110.48 $48,110.48 $48,110.48 2025-12-31
441 MS_DRG Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc* 2 2 — — $48,079.99 $48,079.99 $48,079.99 2025-12-31
A1806 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 1 1 — — $48,000.00 $48,000.00 $48,000.00 2025-12-31
189 MS_DRG Pulmonary Edema And Respiratory Failure 4 4 — — $47,993.58 $47,993.58 $47,993.58 2025-12-31
B0604 HCPCS Neurological M <43.50 2 2 — — $47,318.70 $47,646.00 $47,482.35 2025-12-31
280 MS_DRG Acute Myocardial Infarction, Discharged Alive With Mcc 1 1 — — $46,595.91 $46,595.91 $46,595.91 2025-12-31
637 MS_DRG Diabetes With Mcc 1 1 — — $46,011.43 $46,011.43 $46,011.43 2025-12-31
D0106 HCPCS Stroke M <41.50 And A <84.50 3 3 — — $43,334.74 $45,991.15 $45,787.96 2025-12-31
592 MS_DRG Skin Ulcers With Mcc* 1 1 — — $45,599.75 $45,599.75 $45,599.75 2025-12-31
862 MS_DRG Postoperative And Post-traumatic Infections With Mcc 1 1 — — $45,101.67 $45,101.67 $45,101.67 2025-12-31
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 1 1 — — $44,679.83 $44,679.83 $44,679.83 2025-12-31
371 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Mcc* 1 1 — — $44,537.52 $44,537.52 $44,537.52 2025-12-31
727 MS_DRG Inflammation Of The Male Reproductive System With Mcc 1 1 — — $44,029.27 $44,029.27 $44,029.27 2025-12-31
682 MS_DRG Renal Failure With Mcc* 1 1 — — $43,815.81 $43,815.81 $43,815.81 2025-12-31
B0304 HCPCS Non-traumatic Brain Injury M <42.50 And A >=78.50 1 1 — — $43,804.67 $43,804.67 $43,804.67 2025-12-31
B1404 HCPCS Cardiac M <45.50 1 1 — — $43,626.87 $43,626.87 $43,626.87 2025-12-31
100 MS_DRG Seizures With Mcc 1 1 — — $43,592.18 $43,592.18 $43,592.18 2025-12-31
B2005 HCPCS Miscellaneous M <46.50 And A <77.50 1 1 — — $42,263.77 $42,263.77 $42,263.77 2025-12-31
D0505 HCPCS Non-traumatic Spinal Cord Injury M <39.50 2 2 — — $42,115.05 $42,124.05 $42,119.55 2025-12-31
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 1 1 — — $41,940.39 $41,940.39 $41,940.39 2025-12-31
C0105 HCPCS Stroke M <41.50 And A >=84.50 1 1 — — $41,692.34 $41,692.34 $41,692.34 2025-12-31
A0106 HCPCS Stroke M <41.50 And A <84.50 1 1 — — $41,314.00 $41,314.00 $41,314.00 2025-12-31
308 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Mcc 1 1 — — $41,106.86 $41,106.86 $41,106.86 2025-12-31
C0205 HCPCS Traumatic Brain Injury M <35.50 1 1 — — $40,883.35 $40,883.35 $40,883.35 2025-12-31
559 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Mcc 1 1 — — $40,385.16 $40,385.16 $40,385.16 2025-12-31
299 MS_DRG Peripheral Vascular Disorders With Mcc 1 1 — — $40,039.55 $40,039.55 $40,039.55 2025-12-31
177 MS_DRG Respiratory Infections And Inflammations With Mcc* 1 1 — — $39,932.82 $39,932.82 $39,932.82 2025-12-31
291 MS_DRG Heart Failure And Shock With Mcc* 1 1 — — $39,739.68 $39,739.68 $39,739.68 2025-12-31
D0405 HCPCS Traumatic Spinal Cord Injury M >=31.50 And M <41.50 1 1 — — $39,447.16 $39,447.16 $39,447.16 2025-12-31
292 MS_DRG Heart Failure And Shock With Cc* 1 1 — — $38,621.55 $38,621.55 $38,621.55 2025-12-31
D0105 HCPCS Stroke M <41.50 And A >=84.50 1 1 — — $38,098.97 $38,098.97 $38,098.97 2025-12-31
C1504 HCPCS Pulmonary M <45.50 1 1 — — $38,011.46 $38,011.46 $38,011.46 2025-12-31
B0703 HCPCS Fracture Of Lower Extremity M >=41.50 And M <52.50 1 1 — — $37,492.80 $37,492.80 $37,492.80 2025-12-31
D0205 HCPCS Traumatic Brain Injury M <35.50 1 1 — — $37,133.84 $37,133.84 $37,133.84 2025-12-31
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc* 1 1 — — $36,598.73 $36,598.73 $36,598.73 2025-12-31
540 MS_DRG Osteomyelitis With Cc* 1 1 — — $36,552.99 $36,552.99 $36,552.99 2025-12-31
949 MS_DRG Aftercare With Cc/mcc 2 2 — — $36,410.68 $36,410.68 $36,410.68 2025-12-31
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 1 1 — — $36,100.65 $36,100.65 $36,100.65 2025-12-31
377 MS_DRG Gastrointestinal Hemorrhage With Mcc 1 1 — — $36,019.33 $36,019.33 $36,019.33 2025-12-31
555 MS_DRG Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc 1 1 — — $36,019.33 $36,019.33 $36,019.33 2025-12-31
312 MS_DRG Syncope And Collapse 1 1 — — $36,019.33 $36,019.33 $36,019.33 2025-12-31
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 1 1 — — $36,019.33 $36,019.33 $36,019.33 2025-12-31
809 MS_DRG Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 1 1 — — $36,019.33 $36,019.33 $36,019.33 2025-12-31
206 MS_DRG Other Respiratory System Diagnoses Without Mcc 1 1 — — $36,019.33 $36,019.33 $36,019.33 2025-12-31
868 MS_DRG Other Infectious And Parasitic Diseases Diagnoses With Cc 1 1 — — $36,019.33 $36,019.33 $36,019.33 2025-12-31
D1705 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 1 1 — — $35,510.25 $35,510.25 $35,510.25 2025-12-31
C1705 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 1 1 — — $33,550.60 $33,550.60 $33,550.60 2025-12-31
A1004 HCPCS Amputation Lower Extremity M <47.50 1 1 — — $33,433.56 $33,433.56 $33,433.56 2025-12-31
C2005 HCPCS Miscellaneous M <46.50 And A <77.50 3 3 — — $33,378.69 $33,704.95 $33,378.69 2025-12-31
D0305 HCPCS Non-traumatic Brain Injury M <42.50 And A <78.50 1 1 — — $33,290.83 $33,290.83 $33,290.83 2025-12-31
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc* 1 1 — — $33,188.41 $33,188.41 $33,188.41 2025-12-31
D0604 HCPCS Neurological M <43.50 3 3 — — $32,746.56 $33,066.65 $33,066.65 2025-12-31
C0305 HCPCS Non-traumatic Brain Injury M <42.50 And A <78.50 1 1 — — $33,056.83 $33,056.83 $33,056.83 2025-12-31
C0704 HCPCS Fracture Of Lower Extremity M <41.50 1 1 — — $32,928.90 $32,928.90 $32,928.90 2025-12-31
D1004 HCPCS Amputation Lower Extremity M <47.50 3 3 — — $32,396.48 $35,971.14 $32,705.17 2025-12-31
D1504 HCPCS Pulmonary M <45.50 1 1 — — $32,661.91 $32,661.91 $32,661.91 2025-12-31
389 MS_DRG Gastrointestinal Obstruction With Cc* 1 1 — — $32,639.50 $32,639.50 $32,639.50 2025-12-31
C0904 HCPCS Other Orthopedic M <44.5 1 1 — — $32,586.01 $32,586.01 $32,586.01 2025-12-31
A1705 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 1 1 — — $32,216.02 $32,216.02 $32,216.02 2025-12-31
D0704 HCPCS Fracture Of Lower Extremity M <41.50 1 1 — — $32,084.33 $32,084.33 $32,084.33 2025-12-31
C2004 HCPCS Miscellaneous M <46.50 And A >=77.50 1 1 — — $31,666.68 $31,666.68 $31,666.68 2025-12-31
D2005 HCPCS Miscellaneous M <46.50 And A <77.50 1 1 — — $31,181.29 $31,181.29 $31,181.29 2025-12-31
A0104 HCPCS Stroke M >=41.50 And M <50.50 1 1 — — $31,075.15 $31,075.15 $31,075.15 2025-12-31
C0204 HCPCS Traumatic Brain Injury M >=35.50 And M <49.50 1 1 — — $30,979.99 $30,979.99 $30,979.99 2025-12-31
950 MS_DRG Aftercare Without Cc/mcc 1 1 — — $30,855.56 $30,855.56 $30,855.56 2025-12-31
445 MS_DRG Disorders Of The Biliary Tract With Cc 1 1 — — $30,855.56 $30,855.56 $30,855.56 2025-12-31
D2004 HCPCS Miscellaneous M <46.50 And A >=77.50 2 2 — — $29,582.15 $31,853.11 $30,717.63 2025-12-31
D0104 HCPCS Stroke M >=41.50 And M <50.50 3 3 — — $30,468.26 $31,393.97 $30,468.26 2025-12-31
D0504 HCPCS Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 1 1 — — $30,014.85 $30,014.85 $30,014.85 2025-12-31
A1704 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50 1 1 — — $30,001.50 $30,001.50 $30,001.50 2025-12-31
A1504 HCPCS Pulmonary M <45.50 1 1 — — $29,823.17 $29,823.17 $29,823.17 2025-12-31
C1803 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50 1 1 — — $29,808.59 $29,808.59 $29,808.59 2025-12-31
A0704 HCPCS Fracture Of Lower Extremity M <41.50 1 1 — — $29,642.35 $29,642.35 $29,642.35 2025-12-31
A0604 HCPCS Neurological M <43.50 1 1 — — $29,533.23 $29,533.23 $29,533.23 2025-12-31
C1703 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50 1 1 — — $29,149.41 $29,149.41 $29,149.41 2025-12-31
603 MS_DRG Cellulitis Without Mcc 1 1 — — $29,097.03 $29,097.03 $29,097.03 2025-12-31
A2005 HCPCS Miscellaneous M <46.50 And A <77.50 1 1 — — $29,060.00 $29,060.00 $29,060.00 2025-12-31
D1804 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50 1 1 — — $28,754.26 $28,754.26 $28,754.26 2025-12-31
683 MS_DRG Renal Failure With Cc* 1 1 — — $28,710.77 $28,710.77 $28,710.77 2025-12-31
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 1 1 — — $28,370.24 $28,370.24 $28,370.24 2025-12-31
C0303 HCPCS Non-traumatic Brain Injury M >=42.50 And M <52.50 1 1 — — $28,067.68 $28,067.68 $28,067.68 2025-12-31
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 1 1 — — $28,050.05 $28,050.05 $28,050.05 2025-12-31
561 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue Without Cc/mcc 1 1 — — $28,044.96 $28,044.96 $28,044.96 2025-12-31
C0304 HCPCS Non-traumatic Brain Injury M <42.50 And A >=78.50 1 1 — — $28,028.90 $28,028.90 $28,028.90 2025-12-31
A0504 HCPCS Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 1 1 — — $27,659.43 $27,659.43 $27,659.43 2025-12-31
A0904 HCPCS Other Orthopedic M <44.5 1 1 — — $27,520.20 $27,520.20 $27,520.20 2025-12-31
C0903 HCPCS Other Orthopedic M >=44.50 And M <51.50 1 1 — — $27,194.60 $27,194.60 $27,194.60 2025-12-31
D0703 HCPCS Fracture Of Lower Extremity M >=41.50 And M <52.50 2 2 — — $26,297.00 $27,610.23 $26,953.61 2025-12-31
A2004 HCPCS Miscellaneous M <46.50 And A >=77.50 1 1 — — $26,925.70 $26,925.70 $26,925.70 2025-12-31
194 MS_DRG Simple Pneumonia And Pleurisy With Cc* 1 1 — — $26,804.85 $26,804.85 $26,804.85 2025-12-31
D1703 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50 1 1 — — $26,735.68 $26,735.68 $26,735.68 2025-12-31
A0805 HCPCS Replacement Of Lower-extremity Joint M <42.50 1 1 — — $26,719.65 $26,719.65 $26,719.65 2025-12-31
C2003 HCPCS Miscellaneous M >=46.50 And M <55.50 1 1 — — $26,611.18 $26,611.18 $26,611.18 2025-12-31
948 MS_DRG Signs And Symptoms Without Mcc 1 1 — — $26,565.97 $26,565.97 $26,565.97 2025-12-31
556 MS_DRG Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 1 1 — — $26,565.97 $26,565.97 $26,565.97 2025-12-31
181 MS_DRG Respiratory Neoplasms With Cc 1 1 — — $26,565.97 $26,565.97 $26,565.97 2025-12-31
378 MS_DRG Gastrointestinal Hemorrhage With Cc 1 1 — — $26,565.97 $26,565.97 $26,565.97 2025-12-31
B0601 HCPCS Neurological M >=64.50 1 1 — — $26,470.20 $26,470.20 $26,470.20 2025-12-31
D0303 HCPCS Non-traumatic Brain Injury M >=42.50 And M <52.50 1 1 — — $26,035.76 $26,035.76 $26,035.76 2025-12-31
D0805 HCPCS Replacement Of Lower-extremity Joint M <42.50 1 1 — — $25,783.08 $25,783.08 $25,783.08 2025-12-31
D1003 HCPCS Amputation Lower Extremity M >=47.50 And M <55.50 1 1 — — $25,546.68 $25,546.68 $25,546.68 2025-12-31
D0804 HCPCS Replacement Of Lower-extremity Joint M >=42.50 And M <51.50 1 1 — — $25,507.13 $25,507.13 $25,507.13 2025-12-31
D0603 HCPCS Neurological M >=43.50 And M <52.50 2 2 — — $25,020.60 $25,867.39 $25,443.99 2025-12-31
D0203 HCPCS Traumatic Brain Injury M >=49.50 And M <61.50 1 1 — — $25,262.94 $25,262.94 $25,262.94 2025-12-31
D0903 HCPCS Other Orthopedic M >=44.50 And M <51.50 1 1 — — $25,102.70 $25,102.70 $25,102.70 2025-12-31
A1703 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50 3 2 — — $24,256.09 $24,751.11 $24,751.11 2025-12-31
D2003 HCPCS Miscellaneous M >=46.50 And M <55.50 1 1 — — $24,741.47 $24,741.47 $24,741.47 2025-12-31
C0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50 1 1 — — $24,703.92 $24,703.92 $24,703.92 2025-12-31
D1403 HCPCS Cardiac M >=45.50 And M <55.50 1 1 — — $24,367.79 $24,367.79 $24,367.79 2025-12-31
A0303 HCPCS Non-traumatic Brain Injury M >=42.50 And M <52.50 1 1 — — $24,301.25 $24,301.25 $24,301.25 2025-12-31
A0703 HCPCS Fracture Of Lower Extremity M >=41.50 And M <52.50 1 1 — — $24,265.49 $24,265.49 $24,265.49 2025-12-31
D1603 HCPCS Pain Syndrome M >=43.50 And M <58.50 1 1 — — $24,164.53 $24,164.53 $24,164.53 2025-12-31
C0505 HCPCS Non-traumatic Spinal Cord Injury M <39.50 2 2 — — $4,752.64 $43,187.74 $23,970.19 2025-12-31
D0103 HCPCS Stroke M >=50.50 And M <63.50 2 2 — — $23,874.18 $23,874.18 $23,874.18 2025-12-31
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 1 1 — — $23,836.70 $23,836.70 $23,836.70 2025-12-31
C0602 HCPCS Neurological M >=52.50 And M <64.50 1 1 — — $23,738.73 $23,738.73 $23,738.73 2025-12-31
D1502 HCPCS Pulmonary M >=56.50 And M <68.50 1 1 — — $23,433.13 $23,433.13 $23,433.13 2025-12-31
D1404 HCPCS Cardiac M <45.50 2 2 — — $16,783.39 $29,858.01 $23,320.70 2025-12-31
C1403 HCPCS Cardiac M >=45.50 And M <55.50 1 1 — — $23,174.05 $23,174.05 $23,174.05 2025-12-31
A1003 HCPCS Amputation Lower Extremity M >=47.50 And M <55.50 1 1 — — $23,162.35 $23,162.35 $23,162.35 2025-12-31
A0103 HCPCS Stroke M >=50.50 And M <63.50 1 1 — — $22,751.01 $22,751.01 $22,751.01 2025-12-31
A2003 HCPCS Miscellaneous M >=46.50 And M <55.50 1 1 — — $22,739.72 $22,739.72 $22,739.72 2025-12-31
C0902 HCPCS Other Orthopedic M >=51.50 And M <63.50 1 1 — — $22,586.99 $22,586.99 $22,586.99 2025-12-31
D0602 HCPCS Neurological M >=52.50 And M <64.50 2 2 — — $22,160.27 $22,376.88 $22,268.58 2025-12-31
D0502 HCPCS Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50 1 1 — — $22,028.58 $22,028.58 $22,028.58 2025-12-31
A0203 HCPCS Traumatic Brain Injury M >=49.50 And M <61.50 1 1 — — $22,006.00 $22,006.00 $22,006.00 2025-12-31
A1502 HCPCS Pulmonary M >=56.50 And M <68.50 1 1 — — $21,920.94 $21,920.94 $21,920.94 2025-12-31
D1002 HCPCS Amputation Lower Extremity M >=55.50 And M <64.50 2 2 — — $21,804.71 $22,017.84 $21,911.28 2025-12-31
C2002 HCPCS Miscellaneous M >=55.50 And M <66.50 2 2 — — $21,195.47 $22,117.00 $21,656.24 2025-12-31
A0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50 1 1 — — $21,643.46 $21,643.46 $21,643.46 2025-12-31
D0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50 1 1 — — $21,637.89 $21,637.89 $21,637.89 2025-12-31
D0702 HCPCS Fracture Of Lower Extremity M >=52.50 And M <61.50 1 1 — — $21,565.69 $21,565.69 $21,565.69 2025-12-31
D0803 HCPCS Replacement Of Lower-extremity Joint M >=51.50 And M <57.50 1 1 — — $21,114.25 $21,114.25 $21,114.25 2025-12-31
D0902 HCPCS Other Orthopedic M >=51.50 And M <63.50 1 1 — — $21,020.19 $21,020.19 $21,020.19 2025-12-31
D2002 HCPCS Miscellaneous M >=55.50 And M <66.50 1 1 — — $20,660.84 $20,660.84 $20,660.84 2025-12-31
D0904 HCPCS Other Orthopedic M <44.5 2 2 — — $10,339.60 $30,422.34 $20,380.97 2025-12-31
C0102 HCPCS Stroke M >=63.50 And M <72.50 1 1 — — $20,353.34 $20,353.34 $20,353.34 2025-12-31
C1402 HCPCS Cardiac M >=55.50 And M <68.50 1 1 — — $20,328.24 $20,328.24 $20,328.24 2025-12-31
A0903 HCPCS Other Orthopedic M >=44.50 And M <51.50 1 1 — — $20,317.28 $20,317.28 $20,317.28 2025-12-31
A0602 HCPCS Neurological M >=52.50 And M <64.50 1 1 — — $20,180.80 $20,180.80 $20,180.80 2025-12-31
A0702 HCPCS Fracture Of Lower Extremity M >=52.50 And M <61.50 1 1 — — $19,924.34 $19,924.34 $19,924.34 2025-12-31
D1501 HCPCS Pulmonary M >=68.50 1 1 — — $19,912.87 $19,912.87 $19,912.87 2025-12-31
A0803 HCPCS Replacement Of Lower-extremity Joint M >=51.50 And M <57.50 1 1 — — $19,886.34 $19,886.34 $19,886.34 2025-12-31
A1702 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50 1 1 — — $19,753.20 $19,753.20 $19,753.20 2025-12-31
D1402 HCPCS Cardiac M >=55.50 And M <68.50 1 1 — — $19,722.06 $19,722.06 $19,722.06 2025-12-31
B0101 HCPCS Stroke M >=72.50 1 1 — — $19,521.66 $19,521.66 $19,521.66 2025-12-31
A0902 HCPCS Other Orthopedic M >=51.50 And M <63.50 1 1 — — $19,232.91 $19,232.91 $19,232.91 2025-12-31
D0802 HCPCS Replacement Of Lower-extremity Joint M >=57.50 And M <63.50 2 2 — — $18,969.53 $18,969.53 $18,969.53 2025-12-31
C1802 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50 1 1 — — $18,967.00 $18,967.00 $18,967.00 2025-12-31
D0202 HCPCS Traumatic Brain Injury M >=61.50 And M <73.50 2 2 — — $18,768.22 $18,939.47 $18,853.85 2025-12-31
C0601 HCPCS Neurological M >=64.50 1 1 — — $18,799.34 $18,799.34 $18,799.34 2025-12-31
D0102 HCPCS Stroke M >=63.50 And M <72.50 1 1 — — $18,521.76 $18,521.76 $18,521.76 2025-12-31
A0202 HCPCS Traumatic Brain Injury M >=61.50 And M <73.50 2 2 — — $17,877.65 $19,100.50 $18,489.08 2025-12-31
D1701 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50 1 1 — — $18,286.77 $18,286.77 $18,286.77 2025-12-31
A0802 HCPCS Replacement Of Lower-extremity Joint M >=57.50 And M <63.50 1 1 — — $17,865.04 $17,865.04 $17,865.04 2025-12-31
C2001 HCPCS Miscellaneous M >=66.50 1 1 — — $17,739.14 $17,739.14 $17,739.14 2025-12-31
D0501 HCPCS Non-traumatic Spinal Cord Injury M >=60.50 1 1 — — $17,730.15 $17,730.15 $17,730.15 2025-12-31
D0601 HCPCS Neurological M >=64.50 1 1 — — $17,471.98 $17,471.98 $17,471.98 2025-12-31
D1001 HCPCS Amputation Lower Extremity M >=64.50 1 1 — — $17,380.59 $17,380.59 $17,380.59 2025-12-31
D0701 HCPCS Fracture Of Lower Extremity M >=61.50 1 1 — — $17,291.37 $17,291.37 $17,291.37 2025-12-31
C0901 HCPCS Other Orthopedic M >=63.50 1 1 — — $17,202.48 $17,202.48 $17,202.48 2025-12-31
D0901 HCPCS Other Orthopedic M >=63.50 1 1 — — $16,877.47 $16,877.47 $16,877.47 2025-12-31
D0801 HCPCS Replacement Of Lower-extremity Joint M >=63.50 1 1 — — $16,732.62 $16,732.62 $16,732.62 2025-12-31
D2001 HCPCS Miscellaneous M >=66.50 2 2 — — $16,570.82 $16,767.79 $16,669.31 2025-12-31
D0301 HCPCS Non-traumatic Brain Injury M >=65.50 2 2 — — $16,574.58 $16,736.60 $16,655.59 2025-12-31
A1701 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50 1 1 — — $16,590.32 $16,590.32 $16,590.32 2025-12-31
A0102 HCPCS Stroke M >=63.50 And M <72.50 1 1 — — $15,983.00 $15,983.00 $15,983.00 2025-12-31
A0701 HCPCS Fracture Of Lower Extremity M >=61.50 1 1 — — $15,976.32 $15,976.32 $15,976.32 2025-12-31
A0601 HCPCS Neurological M >=64.50 1 1 — — $15,758.09 $15,758.09 $15,758.09 2025-12-31
A0801 HCPCS Replacement Of Lower-extremity Joint M >=63.50 1 1 — — $15,605.70 $15,605.70 $15,605.70 2025-12-31
A0901 HCPCS Other Orthopedic M >=63.50 1 1 — — $15,442.02 $15,442.02 $15,442.02 2025-12-31
D0101 HCPCS Stroke M >=72.50 1 1 — — $14,773.50 $14,773.50 $14,773.50 2025-12-31
A0201 HCPCS Traumatic Brain Injury M >=73.50 1 1 — — $13,511.76 $13,511.76 $13,511.76 2025-12-31
B0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50 1 1 — — $11,722.27 $11,722.27 $11,722.27 2025-12-31
A0505 HCPCS Non-traumatic Spinal Cord Injury M <39.50 1 1 — — $6,725.93 $6,725.93 $6,725.93 2025-12-31
A2002 HCPCS Miscellaneous M >=55.50 And M <66.50 1 1 — — $6,042.17 $6,042.17 $6,042.17 2025-12-31
D1704 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50 1 1 — — $4,774.25 $4,774.25 $4,774.25 2025-12-31
C1806 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 1 1 — — $4,611.29 $4,611.29 $4,611.29 2025-12-31
A1402 HCPCS Cardiac M >=55.50 And M <68.50 1 1 — — $4,581.20 $4,581.20 $4,581.20 2025-12-31
D1401 HCPCS Cardiac M >=68.50 1 1 — — $3,949.76 $3,949.76 $3,949.76 2025-12-31
D1903 HCPCS Guillain-barr� M >=38.50 And M <51.50 1 1 — — $3,217.08 $3,217.08 $3,217.08 2025-12-31
A0603 HCPCS Neurological M >=43.50 And M <52.50 1 1 — — $2,890.04 $2,890.04 $2,890.04 2025-12-31
A0204 HCPCS Traumatic Brain Injury M >=35.50 And M <49.50 1 1 — — $2,729.44 $2,729.44 $2,729.44 2025-12-31
15271 CPT Application Of Skin Subs Graft 1 1 $4,056.85 $4,056.85 $881.43 $881.43 $881.43 2025-12-31
11043 CPT Subcutaneous & Muscle 1 1 $1,242.55 $1,242.55 $881.43 $881.43 $881.43 2025-12-31
64644 CPT Injection 1 Extre 5 Muscles 6 5 $2,122.00 $2,122.00 $121.21 $1,527.84 $841.85 2025-12-31
64642 CPT Injection 1 Ex 4 Muscles 6 6 $2,122.00 $2,122.00 $458.45 $841.85 $841.85 2025-12-31
64643 CPT Injection Ea Add 4 Muscles 1 1 $840.00 $840.00 $604.80 $604.80 $604.80 2025-12-31
11042 CPT Debridement Subcutaneous Tissu 10 9 $1,204.00 $1,204.00 $131.77 $782.60 $484.81 2025-12-31
11104 CPT Punch Biopsy Of Skin, Single L 1 1 $436.82 $436.82 $484.81 $484.81 $484.81 2025-12-31
64616 CPT Chemodenervation Of Neck Musc 1 1 $654.42 $654.42 $366.07 $366.07 $366.07 2025-12-31
20553 CPT Single Or Mult Trigger Point 1 1 $654.42 $654.42 $366.07 $366.07 $366.07 2025-12-31
20610 CPT Major Joint Injection 2 2 $904.00 $904.00 $366.07 $366.07 $366.07 2025-12-31
97597 CPT Wnd Wound Care 20 Cm Or < 7 5 $436.82 $436.82 $235.97 $314.51 $239.28 2025-12-31
17250 CPT Cauterization 4 4 $609.00 $609.00 $27.92 $438.48 $239.28 2025-12-31
92523 CPT St Speech Sound Lang Comp Eval 11 9 $609.23 $609.23 $100.00 $396.00 $228.15 2025-12-31
74230 CPT Mbs -swallowing Function, Phar 2 2 $455.55 $455.55 $209.18 $209.18 $209.18 2025-12-31
G0463 HCPCS EMG - Outpatient Clinic Visit 2 2 $289.82 $289.82 $158.78 $158.78 $158.78 2025-12-31
94618 CPT Pulmonary Stress Testing 4 4 $71.30 $71.30 $158.67 $158.67 $158.67 2025-12-31
10060 CPT I&d Abscess Simple 2 2 $609.00 $609.00 $74.24 $239.28 $156.76 2025-12-31
99215 CPT EMG - Est Pt Visit - Lvl 5 17 9 $550.00 $550.00 $20.00 $189.05 $152.79 2025-12-31
99205 CPT Ndr - Arnp New Pt - Lvl 5 12 7 $550.00 $550.00 $20.00 $209.51 $147.68 2025-12-31
99204 CPT Ndr - Arnp New Pt - Lvl 4 23 12 $550.00 $550.00 $20.00 $175.24 $137.88 2025-12-31
72100 CPT X-ray L-s Spine 2/3 Vws 1 1 $150.00 $150.00 $124.68 $124.68 $124.68 2025-12-31
99203 CPT Ndr - Dr New Pt - Lvl 3 2 2 $550.00 $550.00 $84.43 $158.78 $121.61 2025-12-31
99214 CPT EMG - Est Pt Visit - Lvl 4 30 14 $550.00 $550.00 $20.00 $158.78 $108.23 2025-12-31
97166 CPT Ot Ot Eval Mod Complex 45 Min 12 10 $386.84 $386.84 $58.92 $251.45 $103.88 2025-12-31
97167 CPT Ot Ot Eval High Complex 60 Min 1 1 $386.84 $386.84 $103.88 $103.88 $103.88 2025-12-31
97165 CPT Ot Ot Eval Low Complex 30 Min 17 11 $388.36 $388.36 $58.92 $252.43 $103.88 2025-12-31
73552 CPT X-ray Femur 2/> 1 1 $150.00 $150.00 $103.78 $103.78 $103.78 2025-12-31
73560 CPT X-ray Knee 1 Or 2 1 1 $150.00 $150.00 $103.78 $103.78 $103.78 2025-12-31
73562 CPT X-ray Knee 3 5 5 $270.00 $270.00 $30.64 $103.78 $103.78 2025-12-31
73630 CPT X-ray Foot 3 3 $270.00 $270.00 $8.48 $103.78 $103.78 2025-12-31
73000 CPT X-ray Collar Bone 1 1 $150.00 $150.00 $103.78 $103.78 $103.78 2025-12-31
73030 CPT X-ray Shoulder 1 1 $150.00 $150.00 $103.78 $103.78 $103.78 2025-12-31
73130 CPT X-ray Hand Min 3 Views 1 1 $150.00 $150.00 $103.78 $103.78 $103.78 2025-12-31
97162 CPT Pt Pt Eval Mod Complex 30 Min 16 11 $365.32 $365.32 $60.95 $237.46 $101.06 2025-12-31
97163 CPT Pt Pt Eval High Complex 45 Min 6 6 $365.32 $365.32 $101.06 $237.46 $101.06 2025-12-31
97161 CPT Pt Pt Eval Low Complex 20 Min 19 12 $365.32 $365.32 $52.12 $237.46 $101.06 2025-12-31
92611 CPT St Motion Fluoroscopy/swallow 4 3 $393.04 $393.04 $92.04 $94.32 $93.18 2025-12-31
99211 CPT Psych - Est Pt Visit - Lvl 1 4 3 $550.00 $550.00 $6.61 $158.78 $89.39 2025-12-31
92526 CPT St Oral Function Therapy 5 5 $117.00 $117.00 $83.57 $86.89 $86.89 2025-12-31
73590 CPT X-ray Lower Leg 4 4 $150.00 $150.00 $20.65 $103.78 $83.32 2025-12-31
73110 CPT X-ray Wrist 1 1 $150.00 $150.00 $82.61 $82.61 $82.61 2025-12-31
92507 CPT St Speech/hearing Indiv Therpy 10 7 $337.08 $337.08 $59.61 $130.62 $78.50 2025-12-31
99213 CPT EMG - Est Pt Visit - Lvl 3 9 6 $550.00 $550.00 $20.00 $158.78 $78.35 2025-12-31
94625 CPT Copd/covid Pulm Rhb Without Mntr 8 6 $200.00 $200.00 $63.98 $70.54 $70.35 2025-12-31
92610 CPT St Evaluate Swallowing Functio 11 7 $609.23 $609.23 $59.15 $70.91 $69.73 2025-12-31
73502 CPT X-ray Hip Uni 2-3 Views 2 2 $150.00 $150.00 $32.46 $103.78 $68.12 2025-12-31
73610 CPT X-ray Ankle Complete 4 4 $150.00 $150.00 $8.87 $103.78 $64.18 2025-12-31
G0239 HCPCS Othr Resp Proc, Group 5 4 $120.00 $120.00 $44.54 $44.54 $44.54 2025-12-31
97113 CPT Cota Aquatic Therapy/exercises 13 9 $124.35 $124.35 $13.00 $64.17 $38.36 2025-12-31
97530 CPT Cota Therapeutic Activities 20 12 $169.12 $169.12 $25.70 $58.25 $36.30 2025-12-31
G0237 HCPCS Exercise 7 6 $175.00 $175.00 $25.23 $126.00 $34.49 2025-12-31
97112 CPT Cota Neuromuscular Reeducation 15 9 $150.32 $150.32 $13.00 $64.38 $33.76 2025-12-31
97535 CPT Cota Self Care Mngment Trainin 6 5 $222.64 $222.64 $26.36 $37.69 $33.47 2025-12-31
97537 CPT Cota Community/work Reintegrat 3 3 $139.68 $139.68 $32.21 $46.35 $33.09 2025-12-31
97116 CPT Lpt Gait Training Therapy 9 7 $129.12 $129.12 $13.00 $30.49 $29.96 2025-12-31
97110 CPT Cota Therapeutic Exercises 20 12 $130.64 $130.64 $13.00 $60.61 $29.96 2025-12-31
97140 CPT Cota Manual Therapy 1/> Region 16 11 $120.00 $120.00 $17.52 $51.64 $28.58 2025-12-31
92508 CPT St Speech/hearing Group Therpy 1 1 $102.32 $102.32 $24.83 $24.83 $24.83 2025-12-31
97032 CPT Cota Electrical Stimulation 1 1 $62.88 $62.88 $20.62 $20.62 $20.62 2025-12-31
99244 CPT Ndr - Dr New Pt - Lvl 4 1 1 $550.00 $550.00 $20.00 $20.00 $20.00 2025-12-31
G0238 HCPCS Othr Resp Proc, Individual 1 1 $58.00 $58.00 $19.55 $19.55 $19.55 2025-12-31
97035 CPT Cota Ultrasound Therapy 3 3 $61.56 $61.56 $14.78 $20.32 $14.78 2025-12-31
J0585 HCPCS Onabotulinumtoxina 1 Unit Vial1un 6 6 $26.04 $26.04 $6.12 $6.51 $6.51 2025-12-31
J0588 HCPCS Incobotulinumtoxina 1 Unit Vial1un 1 1 $20.00 $20.00 $5.25 $5.25 $5.25 2025-12-31
27D" OTHER Roylan Bed Wedge 12" Rise 0 0 — $1,024.32 — — — 2025-12-31
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