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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

Westborough, MA · CCN 222048 · Rates published

246 distinct procedures filed
21 distinct payers
2,859 rate rows
2025-12-15 last MRF observed
Data quality

2,817 of 2,859 rate rows are consumer-grade (98.5%)

42 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 42
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.whittierhealth.com/wp-content/uploads/2026/03/043158154_metro-west-rehab-corp_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 1c4a057f321fb829… · 880,842 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
166
MS_DRG 		Other Respiratory System O.r. Procedures With Mcc 1 $115,900.21 $115,900.21 $115,900.21 nat. median
$26,952
outlier · 4.3×
981
MS_DRG 		Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 1 $112,764.34 $112,764.34 $112,764.34 nat. median
$33,546
outlier · 3.4×
207
MS_DRG 		Respiratory System Diagnosis With Ventilator Support >96 Hours 1 $104,144.50 $104,144.50 $104,144.50 nat. median
$47,121
outlier · 2.2×
D0407
HCPCS 		Traumatic Spinal Cord Injury M <24.50 And A >=61.50 1 $74,644.00 $74,644.00 $74,644.00 nat. median
$69,540
1.1× median
622
MS_DRG 		Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 1 $64,796.17 $64,796.17 $64,796.17 nat. median
$24,822
outlier · 2.6×
463
MS_DRG 		Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective… 1 $63,240.94 $63,240.94 $63,240.94 nat. median
$38,795
1.6× median
939
MS_DRG 		O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 1 $58,412.61 $58,412.61 $58,412.61 nat. median
$22,461
outlier · 2.6×
C1904
HCPCS 		Guillain-barr� M <38.50 1 $55,159.88 $55,159.88 $55,159.88 nat. median
$59,669
0.9× median
C1806
HCPCS 		Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 1 $53,809.43 $53,809.43 $53,809.43 nat. median
$59,476
0.9× median
393
MS_DRG 		Other Digestive System Diagnoses With Mcc 1 $53,126.86 $53,126.86 $53,126.86 nat. median
$11,985
outlier · 4.4×
438
MS_DRG 		Disorders Of Pancreas Except Malignancy With Mcc* 1 $52,628.78 $52,628.78 $52,628.78 nat. median
$11,966
outlier · 4.4×
813
MS_DRG 		Coagulation Disorders 1 $48,110.48 $48,110.48 $48,110.48 nat. median
$11,108
outlier · 4.3×
808
MS_DRG 		Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 1 $48,110.48 $48,110.48 $48,110.48 nat. median
$15,758
outlier · 3.1×
441
MS_DRG 		Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc* 1 $48,079.99 $48,079.99 $48,079.99 nat. median
$13,138
outlier · 3.7×
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 3 $47,993.58 $47,993.58 $47,993.58 nat. median
$9,470
outlier · 5.1×
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×
D0106
HCPCS 		Stroke M <41.50 And A <84.50 1 $46,167.15 $46,167.15 $46,167.15 nat. median
$43,929
1.1× median
637
MS_DRG 		Diabetes With Mcc 1 $46,011.43 $46,011.43 $46,011.43 nat. median
$10,515
outlier · 4.4×
388
MS_DRG 		Gastrointestinal Obstruction With Mcc* 1 $45,122.00 $45,122.00 $45,122.00 nat. median
$10,670
outlier · 4.2×
B2005
HCPCS 		Miscellaneous M <46.50 And A <77.50 1 $44,329.97 $44,329.97 $44,329.97 nat. median
$42,636
1.0× median
C0505
HCPCS 		Non-traumatic Spinal Cord Injury M <39.50 1 $44,144.68 $44,144.68 $44,144.68 nat. median
$46,281
1.0× median
682
MS_DRG 		Renal Failure With Mcc* 1 $43,815.81 $43,815.81 $43,815.81 nat. median
$11,096
outlier · 3.9×
C0205
HCPCS 		Traumatic Brain Injury M <35.50 1 $43,555.55 $43,555.55 $43,555.55 nat. median
$41,763
1.0× median
C0405
HCPCS 		Traumatic Spinal Cord Injury M >=31.50 And M <41.50 1 $43,366.38 $43,366.38 $43,366.38 nat. median
$40,052
1.1× median
B1404
HCPCS 		Cardiac M <45.50 1 $43,008.38 $43,008.38 $43,008.38 nat. median
$41,383
1.0× median
B0904
HCPCS 		Other Orthopedic M <44.5 1 $42,741.34 $42,741.34 $42,741.34 nat. median
$43,337
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×
698
MS_DRG 		Other Kidney And Urinary Tract Diagnoses With Mcc 1 $41,742.17 $41,742.17 $41,742.17 nat. median
$12,136
outlier · 3.4×
D0505
HCPCS 		Non-traumatic Spinal Cord Injury M <39.50 1 $41,403.87 $41,403.87 $41,403.87 nat. median
$43,056
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×
A0106
HCPCS 		Stroke M <41.50 And A <84.50 2 $39,214.26 $42,854.03 $41,034.15 nat. median
$41,668
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×
291
MS_DRG 		Heart Failure And Shock With Mcc* 2 $39,739.68 $39,739.68 $39,739.68 nat. median
$9,572
outlier · 4.2×
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×
C0305
HCPCS 		Non-traumatic Brain Injury M <42.50 And A <78.50 2 $38,073.24 $38,269.64 $38,171.44 nat. median
$36,207
1.1× median
A0105
HCPCS 		Stroke M <41.50 And A >=84.50 1 $37,716.01 $37,716.01 $37,716.01 nat. median
$36,992
1.0× median
B1004
HCPCS 		Amputation Lower Extremity M <47.50 1 $37,625.07 $37,625.07 $37,625.07 nat. median
$45,558
0.8× median
444
MS_DRG 		Disorders Of The Biliary Tract With Mcc 1 $37,493.24 $37,493.24 $37,493.24 nat. median
$12,165
outlier · 3.1×
391
MS_DRG 		Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 1 $36,893.51 $36,893.51 $36,893.51 nat. median
$9,511
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×
C0604
HCPCS 		Neurological M <43.50 1 $36,271.14 $36,271.14 $36,271.14 nat. median
$35,764
1.0× median
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×
377
MS_DRG 		Gastrointestinal Hemorrhage With Mcc 1 $36,019.33 $36,019.33 $36,019.33 nat. median
$13,124
outlier · 2.7×
552
MS_DRG 		Medical Back Problems Without Mcc 1 $36,019.33 $36,019.33 $36,019.33 nat. median
$7,205
outlier · 5.0×
C2005
HCPCS 		Miscellaneous M <46.50 And A <77.50 1 $35,560.37 $35,560.37 $35,560.37 nat. median
$34,324
1.0× median
696
MS_DRG 		Kidney And Urinary Tract Signs And Symptoms Without Mcc 1 $35,511.09 $35,511.09 $35,511.09 nat. median
$5,070
outlier · 7.0×
D1004
HCPCS 		Amputation Lower Extremity M <47.50 1 $34,842.82 $34,842.82 $34,842.82 nat. median
$34,358
1.0× median
C0304
HCPCS 		Non-traumatic Brain Injury M <42.50 And A >=78.50 1 $34,522.76 $34,522.76 $34,522.76 nat. median
$33,053
1.0× median
C0904
HCPCS 		Other Orthopedic M <44.5 2 $34,379.83 $34,427.23 $34,403.53 nat. median
$32,826
1.0× median
B2003
HCPCS 		Miscellaneous M >=46.50 And M <55.50 1 $34,079.41 $34,079.41 $34,079.41 nat. median
$33,399
1.0× median

Other procedures at this hospital

Browse this hospital's 246 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
             
101 MS_DRG Seizures Without Mcc 1 1 — — $30,855.56 $30,855.56 $30,855.56 2025-12-15
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 1 1 — — $115,900.21 $115,900.21 $115,900.21 2025-12-15
189 MS_DRG Pulmonary Edema And Respiratory Failure 3 3 — — $47,993.58 $47,993.58 $47,993.58 2025-12-15
20610 CPT Major Joint Injection 1 1 $904.00 $904.00 $366.07 $366.07 $366.07 2025-12-15
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 1 1 — — $104,144.50 $104,144.50 $104,144.50 2025-12-15
280 MS_DRG Acute Myocardial Infarction, Discharged Alive With Mcc 1 1 — — $46,595.91 $46,595.91 $46,595.91 2025-12-15
282 MS_DRG Acute Myocardial Infarction, Discharged Alive Without Cc/mcc 1 1 — — $26,565.97 $26,565.97 $26,565.97 2025-12-15
291 MS_DRG Heart Failure And Shock With Mcc* 2 2 — — $39,739.68 $39,739.68 $39,739.68 2025-12-15
292 MS_DRG Heart Failure And Shock With Cc* 1 1 — — $38,621.55 $38,621.55 $38,621.55 2025-12-15
308 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Mcc 1 1 — — $41,106.86 $41,106.86 $41,106.86 2025-12-15
377 MS_DRG Gastrointestinal Hemorrhage With Mcc 1 1 — — $36,019.33 $36,019.33 $36,019.33 2025-12-15
388 MS_DRG Gastrointestinal Obstruction With Mcc* 1 1 — — $45,122.00 $45,122.00 $45,122.00 2025-12-15
391 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 1 1 — — $36,893.51 $36,893.51 $36,893.51 2025-12-15
393 MS_DRG Other Digestive System Diagnoses With Mcc 1 1 — — $53,126.86 $53,126.86 $53,126.86 2025-12-15
434 MS_DRG Cirrhosis And Alcoholic Hepatitis Without Cc/mcc* 1 1 — — $26,565.97 $26,565.97 $26,565.97 2025-12-15
438 MS_DRG Disorders Of Pancreas Except Malignancy With Mcc* 1 1 — — $52,628.78 $52,628.78 $52,628.78 2025-12-15
441 MS_DRG Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc* 1 1 — — $48,079.99 $48,079.99 $48,079.99 2025-12-15
442 MS_DRG Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc* 1 1 — — $30,855.56 $30,855.56 $30,855.56 2025-12-15
444 MS_DRG Disorders Of The Biliary Tract With Mcc 1 1 — — $37,493.24 $37,493.24 $37,493.24 2025-12-15
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 1 1 — — $63,240.94 $63,240.94 $63,240.94 2025-12-15
552 MS_DRG Medical Back Problems Without Mcc 1 1 — — $36,019.33 $36,019.33 $36,019.33 2025-12-15
559 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Mcc 1 1 — — $40,385.16 $40,385.16 $40,385.16 2025-12-15
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 1 1 — — $36,100.65 $36,100.65 $36,100.65 2025-12-15
561 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue Without Cc/mcc 1 1 — — $28,044.96 $28,044.96 $28,044.96 2025-12-15
607 MS_DRG Minor Skin Disorders Without Mcc 1 1 — — $30,855.56 $30,855.56 $30,855.56 2025-12-15
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 1 1 — — $64,796.17 $64,796.17 $64,796.17 2025-12-15
637 MS_DRG Diabetes With Mcc 1 1 — — $46,011.43 $46,011.43 $46,011.43 2025-12-15
644 MS_DRG Endocrine Disorders With Cc 1 1 — — $26,565.97 $26,565.97 $26,565.97 2025-12-15
64642 CPT Injection 1 Ex 4 Muscles 2 2 $2,122.00 $2,122.00 $841.85 $841.85 $841.85 2025-12-15
64644 CPT Injection 1 Extre 5 Muscles 1 1 $2,122.00 $2,122.00 $841.85 $841.85 $841.85 2025-12-15
682 MS_DRG Renal Failure With Mcc* 1 1 — — $43,815.81 $43,815.81 $43,815.81 2025-12-15
683 MS_DRG Renal Failure With Cc* 2 2 — — $28,710.77 $28,710.77 $28,710.77 2025-12-15
696 MS_DRG Kidney And Urinary Tract Signs And Symptoms Without Mcc 1 1 — — $35,511.09 $35,511.09 $35,511.09 2025-12-15
698 MS_DRG Other Kidney And Urinary Tract Diagnoses With Mcc 1 1 — — $41,742.17 $41,742.17 $41,742.17 2025-12-15
71045 CPT X-ray Chest 1 View 1 1 $150.00 $150.00 $103.78 $103.78 $103.78 2025-12-15
72040 CPT X-ray Neck Spine 2-3 Vw 5 4 $150.00 $150.00 $31.28 $103.78 $103.78 2025-12-15
72070 CPT X-ray Thorac Spine 2vws 3 2 $150.00 $150.00 $33.21 $124.68 $33.21 2025-12-15
72100 CPT X-ray L-s Spine 2/3 Vws 8 7 $150.00 $150.00 $11.91 $124.68 $118.59 2025-12-15
72170 CPT X-ray Pelvis 3 3 $150.00 $150.00 $29.35 $124.68 $124.68 2025-12-15
72190 CPT X-ray Pelvis Min 3v 1 1 $150.00 $150.00 $124.68 $124.68 $124.68 2025-12-15
73030 CPT X-ray Shoulder 1 1 $150.00 $150.00 $103.78 $103.78 $103.78 2025-12-15
73502 CPT X-ray Hip Uni 2-3 Views 23 14 $150.00 $150.00 $32.46 $145.05 $82.61 2025-12-15
73521 CPT X-ray Hips Bi 2 Views 6 6 $150.00 $150.00 $35.69 $135.39 $124.68 2025-12-15
73552 CPT X-ray Femur 2/> 2 2 $150.00 $150.00 $35.43 $103.78 $69.60 2025-12-15
73560 CPT X-ray Knee 1 Or 2 1 1 $150.00 $150.00 $103.78 $103.78 $103.78 2025-12-15
73562 CPT X-ray Knee 3 24 13 $270.00 $270.00 $10.14 $103.78 $73.97 2025-12-15
74230 CPT Mbs -swallowing Function, Phar 2 2 $456.00 $456.00 $209.18 $209.18 $209.18 2025-12-15
808 MS_DRG Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 1 1 — — $48,110.48 $48,110.48 $48,110.48 2025-12-15
813 MS_DRG Coagulation Disorders 1 1 — — $48,110.48 $48,110.48 $48,110.48 2025-12-15
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 1 1 — — $41,940.39 $41,940.39 $41,940.39 2025-12-15
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 1 1 — — $28,050.05 $28,050.05 $28,050.05 2025-12-15
92507 CPT St Speech/hearing Indiv Therpy 7 6 $337.00 $337.00 $59.61 $130.62 $78.50 2025-12-15
92508 CPT St Speech/hearing Group Therpy 2 2 $102.00 $102.00 $24.83 $76.74 $50.78 2025-12-15
92522 CPT St Evaluate Speech Production 4 4 $609.00 $609.00 $83.50 $115.11 $111.96 2025-12-15
92523 CPT St Speech Sound Lang Comp Eval 11 10 $609.00 $609.00 $100.00 $395.85 $228.15 2025-12-15
92524 CPT St Behavioral/qualitative Eval 1 1 $609.00 $609.00 $112.73 $112.73 $112.73 2025-12-15
92526 CPT St Oral Function Therapy 2 2 $372.00 $372.00 $86.89 $86.89 $86.89 2025-12-15
92610 CPT St Evaluate Swallowing Functio 2 1 $609.00 $609.00 $59.15 $70.91 $65.03 2025-12-15
92611 CPT St Motion Fluoroscopy/swallow 4 3 $737.00 $737.00 $92.04 $94.32 $93.18 2025-12-15
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 1 1 — — $58,412.61 $58,412.61 $58,412.61 2025-12-15
947 MS_DRG Signs And Symptoms With Mcc 1 1 — — $30,855.56 $30,855.56 $30,855.56 2025-12-15
949 MS_DRG Aftercare With Cc/mcc 2 2 — — $36,410.68 $36,410.68 $36,410.68 2025-12-15
950 MS_DRG Aftercare Without Cc/mcc 1 1 — — $30,855.56 $30,855.56 $30,855.56 2025-12-15
97016 CPT Ot Vasopneumatic Device Therap 2 2 $53.00 $53.00 $12.35 $12.35 $12.35 2025-12-15
97032 CPT Cota Electrical Stimulation 2 2 $63.00 $63.00 $20.62 $27.10 $23.86 2025-12-15
97035 CPT Cota Ultrasound Therapy 1 1 $62.00 $62.00 $14.78 $14.78 $14.78 2025-12-15
97110 CPT Cota Therapeutic Exercises 16 12 $131.00 $131.00 $13.00 $60.61 $29.96 2025-12-15
97112 CPT Cota Neuromuscular Reeducation 12 8 $150.00 $150.00 $13.00 $64.38 $33.76 2025-12-15
97113 CPT Cota Aquatic Therapy/exercises 8 7 $124.00 $124.00 $13.00 $47.90 $38.36 2025-12-15
97116 CPT Lpt Gait Training Therapy 9 7 $129.00 $129.00 $13.00 $53.42 $29.96 2025-12-15
97129 CPT St Ther Int 1st 15min Foc Cogn 2 2 $62.00 $62.00 $20.05 $20.05 $20.05 2025-12-15
97130 CPT St Ther Int Add 15min Foc Cog 2 2 $97.00 $97.00 $18.75 $18.75 $18.75 2025-12-15
97140 CPT Cota Manual Therapy 1/> Region 11 9 $120.00 $120.00 $17.52 $51.64 $28.58 2025-12-15
97161 CPT Pt Pt Eval Low Complex 20 Min 13 9 $365.00 $365.00 $60.95 $237.46 $101.06 2025-12-15
97162 CPT Pt Pt Eval Mod Complex 30 Min 18 13 $365.00 $365.00 $60.95 $237.25 $101.06 2025-12-15
97163 CPT Pt Pt Eval High Complex 45 Min 8 7 $365.00 $365.00 $89.45 $237.25 $101.92 2025-12-15
97164 CPT Pt Pt Re-eval Est Plan Care 7 5 $252.00 $252.00 $41.66 $101.92 $69.77 2025-12-15
97165 CPT Ot Ot Eval Low Complex 30 Min 6 5 $388.00 $388.00 $58.92 $103.88 $103.35 2025-12-15
97166 CPT Ot Ot Eval Mod Complex 45 Min 13 10 $387.00 $387.00 $58.92 $134.00 $103.35 2025-12-15
97167 CPT Ot Ot Eval High Complex 60 Min 4 4 $387.00 $387.00 $90.00 $251.55 $103.88 2025-12-15
97530 CPT Cota Therapeutic Activities 11 8 $169.00 $169.00 $26.40 $58.25 $36.30 2025-12-15
97535 CPT Cota Self Care Mngment Trainin 4 4 $223.00 $223.00 $26.36 $37.69 $33.47 2025-12-15
97542 CPT Cota Wheelchair Mngment Traini 8 8 $141.00 $141.00 $32.03 $101.52 $32.03 2025-12-15
97763 CPT Cota OrthCOTAic/prosthetic(s) 1 1 $227.00 $227.00 $54.40 $54.40 $54.40 2025-12-15
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 1 1 — — $112,764.34 $112,764.34 $112,764.34 2025-12-15
99213 CPT Psych - Est Pt Visit - Lvl 3 2 1 $550.00 $550.00 $58.12 $158.78 $108.45 2025-12-15
A0101 HCPCS Stroke M >=72.50 1 1 — — $14,819.83 $14,819.83 $14,819.83 2025-12-15
A0102 HCPCS Stroke M >=63.50 And M <72.50 2 2 — — $3,475.70 $18,806.39 $11,141.04 2025-12-15
A0103 HCPCS Stroke M >=50.50 And M <63.50 2 2 — — $24,144.70 $24,238.06 $24,191.38 2025-12-15
A0104 HCPCS Stroke M >=41.50 And M <50.50 1 1 — — $28,034.33 $28,034.33 $28,034.33 2025-12-15
A0105 HCPCS Stroke M <41.50 And A >=84.50 1 1 — — $37,716.01 $37,716.01 $37,716.01 2025-12-15
A0106 HCPCS Stroke M <41.50 And A <84.50 2 2 — — $39,214.26 $42,854.03 $41,034.15 2025-12-15
A0202 HCPCS Traumatic Brain Injury M >=61.50 And M <73.50 1 1 — — $18,793.63 $18,793.63 $18,793.63 2025-12-15
A0203 HCPCS Traumatic Brain Injury M >=49.50 And M <61.50 1 1 — — $23,344.47 $23,344.47 $23,344.47 2025-12-15
A0204 HCPCS Traumatic Brain Injury M >=35.50 And M <49.50 2 2 — — $27,560.60 $28,988.10 $28,274.35 2025-12-15
A0301 HCPCS Non-traumatic Brain Injury M >=65.50 1 1 — — $16,245.05 $16,245.05 $16,245.05 2025-12-15
A0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50 1 1 — — $20,450.71 $20,450.71 $20,450.71 2025-12-15
A0403 HCPCS Traumatic Spinal Cord Injury M >=41.50 And M <47.50 1 1 — — $27,769.43 $27,769.43 $27,769.43 2025-12-15
A0502 HCPCS Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50 1 1 — — $21,624.44 $21,624.44 $21,624.44 2025-12-15
A0504 HCPCS Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 1 1 — — $22,923.25 $22,923.25 $22,923.25 2025-12-15
A0505 HCPCS Non-traumatic Spinal Cord Injury M <39.50 1 1 — — $27,520.76 $27,520.76 $27,520.76 2025-12-15
A0601 HCPCS Neurological M >=64.50 1 1 — — $16,750.06 $16,750.06 $16,750.06 2025-12-15
A0602 HCPCS Neurological M >=52.50 And M <64.50 1 1 — — $21,291.72 $21,291.72 $21,291.72 2025-12-15
A0603 HCPCS Neurological M >=43.50 And M <52.50 2 2 — — $20,210.49 $24,981.00 $22,595.75 2025-12-15
A0604 HCPCS Neurological M <43.50 1 1 — — $28,513.85 $28,513.85 $28,513.85 2025-12-15
A0701 HCPCS Fracture Of Lower Extremity M >=61.50 1 1 — — $17,020.55 $17,020.55 $17,020.55 2025-12-15
A0702 HCPCS Fracture Of Lower Extremity M >=52.50 And M <61.50 1 1 — — $21,021.15 $21,021.15 $21,021.15 2025-12-15
A0703 HCPCS Fracture Of Lower Extremity M >=41.50 And M <52.50 1 1 — — $24,928.26 $24,928.26 $24,928.26 2025-12-15
A0704 HCPCS Fracture Of Lower Extremity M <41.50 1 1 — — $31,579.82 $31,579.82 $31,579.82 2025-12-15
A0802 HCPCS Replacement Of Lower-extremity Joint M >=57.50 And M <63.50 1 1 — — $18,768.20 $18,768.20 $18,768.20 2025-12-15
A0803 HCPCS Replacement Of Lower-extremity Joint M >=51.50 And M <57.50 1 1 — — $20,537.03 $20,537.03 $20,537.03 2025-12-15
A0804 HCPCS Replacement Of Lower-extremity Joint M >=42.50 And M <51.50 1 1 — — $22,429.17 $22,429.17 $22,429.17 2025-12-15
A0805 HCPCS Replacement Of Lower-extremity Joint M <42.50 1 1 — — $27,101.46 $27,101.46 $27,101.46 2025-12-15
A0901 HCPCS Other Orthopedic M >=63.50 1 1 — — $16,381.25 $16,381.25 $16,381.25 2025-12-15
A0902 HCPCS Other Orthopedic M >=51.50 And M <63.50 1 1 — — $20,490.01 $20,490.01 $20,490.01 2025-12-15
A0903 HCPCS Other Orthopedic M >=44.50 And M <51.50 1 1 — — $17,914.38 $17,914.38 $17,914.38 2025-12-15
A0904 HCPCS Other Orthopedic M <44.5 1 1 — — $28,220.94 $28,220.94 $28,220.94 2025-12-15
A1004 HCPCS Amputation Lower Extremity M <47.50 1 1 — — $31,084.06 $31,084.06 $31,084.06 2025-12-15
A1402 HCPCS Cardiac M >=55.50 And M <68.50 1 1 — — $19,367.05 $19,367.05 $19,367.05 2025-12-15
A1403 HCPCS Cardiac M >=45.50 And M <55.50 1 1 — — $22,216.56 $22,216.56 $22,216.56 2025-12-15
A1404 HCPCS Cardiac M <45.50 1 1 — — $17,523.83 $17,523.83 $17,523.83 2025-12-15
A1701 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50 1 1 — — $3,412.75 $3,412.75 $3,412.75 2025-12-15
A1702 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50 1 1 — — $21,746.71 $21,746.71 $21,746.71 2025-12-15
A1703 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50 1 1 — — $23,072.77 $23,072.77 $23,072.77 2025-12-15
A1704 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50 1 1 — — $29,122.23 $29,122.23 $29,122.23 2025-12-15
A1705 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 1 1 — — $29,034.18 $29,034.18 $29,034.18 2025-12-15
A2001 HCPCS Miscellaneous M >=66.50 1 1 — — $16,068.51 $16,068.51 $16,068.51 2025-12-15
A2002 HCPCS Miscellaneous M >=55.50 And M <66.50 2 2 — — $3,412.75 $20,072.03 $11,742.39 2025-12-15
A2003 HCPCS Miscellaneous M >=46.50 And M <55.50 1 1 — — $20,903.15 $20,903.15 $20,903.15 2025-12-15
B0202 HCPCS Traumatic Brain Injury M >=61.50 And M <73.50 1 1 — — $26,729.41 $26,729.41 $26,729.41 2025-12-15
B0203 HCPCS Traumatic Brain Injury M >=49.50 And M <61.50 1 1 — — $8,286.41 $8,286.41 $8,286.41 2025-12-15
B0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50 1 1 — — $31,062.71 $31,062.71 $31,062.71 2025-12-15
B0602 HCPCS Neurological M >=52.50 And M <64.50 1 1 — — $33,634.65 $33,634.65 $33,634.65 2025-12-15
B0803 HCPCS Replacement Of Lower-extremity Joint M >=51.50 And M <57.50 1 1 — — $30,617.05 $30,617.05 $30,617.05 2025-12-15
B0904 HCPCS Other Orthopedic M <44.5 1 1 — — $42,741.34 $42,741.34 $42,741.34 2025-12-15
B1004 HCPCS Amputation Lower Extremity M <47.50 1 1 — — $37,625.07 $37,625.07 $37,625.07 2025-12-15
B1401 HCPCS Cardiac M >=68.50 1 1 — — $22,047.73 $22,047.73 $22,047.73 2025-12-15
B1402 HCPCS Cardiac M >=55.50 And M <68.50 2 2 — — $27,373.27 $29,271.03 $28,322.15 2025-12-15
B1404 HCPCS Cardiac M <45.50 1 1 — — $43,008.38 $43,008.38 $43,008.38 2025-12-15
B2001 HCPCS Miscellaneous M >=66.50 1 1 — — $23,558.03 $23,558.03 $23,558.03 2025-12-15
B2002 HCPCS Miscellaneous M >=55.50 And M <66.50 1 1 — — $28,149.79 $28,149.79 $28,149.79 2025-12-15
B2003 HCPCS Miscellaneous M >=46.50 And M <55.50 1 1 — — $34,079.41 $34,079.41 $34,079.41 2025-12-15
B2004 HCPCS Miscellaneous M <46.50 And A >=77.50 1 1 — — $15,891.97 $15,891.97 $15,891.97 2025-12-15
B2005 HCPCS Miscellaneous M <46.50 And A <77.50 1 1 — — $44,329.97 $44,329.97 $44,329.97 2025-12-15
C0106 HCPCS Stroke M <41.50 And A <84.50 1 1 — — $34,013.88 $34,013.88 $34,013.88 2025-12-15
C0202 HCPCS Traumatic Brain Injury M >=61.50 And M <73.50 1 1 — — $13,759.55 $13,759.55 $13,759.55 2025-12-15
C0203 HCPCS Traumatic Brain Injury M >=49.50 And M <61.50 1 1 — — $24,675.19 $24,675.19 $24,675.19 2025-12-15
C0204 HCPCS Traumatic Brain Injury M >=35.50 And M <49.50 3 3 — — $16,607.95 $33,860.18 $25,405.30 2025-12-15
C0205 HCPCS Traumatic Brain Injury M <35.50 1 1 — — $43,555.55 $43,555.55 $43,555.55 2025-12-15
C0301 HCPCS Non-traumatic Brain Injury M >=65.50 2 2 — — $18,611.30 $18,612.60 $18,611.95 2025-12-15
C0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50 1 1 — — $23,716.36 $23,716.36 $23,716.36 2025-12-15
C0304 HCPCS Non-traumatic Brain Injury M <42.50 And A >=78.50 1 1 — — $34,522.76 $34,522.76 $34,522.76 2025-12-15
C0305 HCPCS Non-traumatic Brain Injury M <42.50 And A <78.50 2 2 — — $38,073.24 $38,269.64 $38,171.44 2025-12-15
C0405 HCPCS Traumatic Spinal Cord Injury M >=31.50 And M <41.50 1 1 — — $43,366.38 $43,366.38 $43,366.38 2025-12-15
C0501 HCPCS Non-traumatic Spinal Cord Injury M >=60.50 1 1 — — $15,235.23 $15,235.23 $15,235.23 2025-12-15
C0502 HCPCS Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50 1 1 — — $13,454.65 $13,454.65 $13,454.65 2025-12-15
C0505 HCPCS Non-traumatic Spinal Cord Injury M <39.50 1 1 — — $44,144.68 $44,144.68 $44,144.68 2025-12-15
C0601 HCPCS Neurological M >=64.50 1 1 — — $4,984.71 $4,984.71 $4,984.71 2025-12-15
C0602 HCPCS Neurological M >=52.50 And M <64.50 1 1 — — $25,290.32 $25,290.32 $25,290.32 2025-12-15
C0603 HCPCS Neurological M >=43.50 And M <52.50 2 2 — — $28,608.84 $29,671.06 $29,139.95 2025-12-15
C0604 HCPCS Neurological M <43.50 1 1 — — $36,271.14 $36,271.14 $36,271.14 2025-12-15
C0702 HCPCS Fracture Of Lower Extremity M >=52.50 And M <61.50 1 1 — — $24,019.58 $24,019.58 $24,019.58 2025-12-15
C0703 HCPCS Fracture Of Lower Extremity M >=41.50 And M <52.50 1 1 — — $29,537.44 $29,537.44 $29,537.44 2025-12-15
C0704 HCPCS Fracture Of Lower Extremity M <41.50 1 1 — — $28,976.96 $28,976.96 $28,976.96 2025-12-15
C0902 HCPCS Other Orthopedic M >=51.50 And M <63.50 1 1 — — $19,021.85 $19,021.85 $19,021.85 2025-12-15
C0903 HCPCS Other Orthopedic M >=44.50 And M <51.50 1 1 — — $28,691.63 $28,691.63 $28,691.63 2025-12-15
C0904 HCPCS Other Orthopedic M <44.5 2 2 — — $34,379.83 $34,427.23 $34,403.53 2025-12-15
C1004 HCPCS Amputation Lower Extremity M <47.50 1 1 — — $13,214.50 $13,214.50 $13,214.50 2025-12-15
C1401 HCPCS Cardiac M >=68.50 1 1 — — $17,767.50 $17,767.50 $17,767.50 2025-12-15
C1402 HCPCS Cardiac M >=55.50 And M <68.50 2 2 — — $22,502.27 $22,598.54 $22,550.40 2025-12-15
C1403 HCPCS Cardiac M >=45.50 And M <55.50 1 1 — — $14,813.24 $14,813.24 $14,813.24 2025-12-15
C1404 HCPCS Cardiac M <45.50 1 1 — — $22,234.25 $22,234.25 $22,234.25 2025-12-15
C1501 HCPCS Pulmonary M >=68.50 1 1 — — $20,709.65 $20,709.65 $20,709.65 2025-12-15
C1504 HCPCS Pulmonary M <45.50 1 1 — — $3,473.20 $3,473.20 $3,473.20 2025-12-15
C1701 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50 1 1 — — $19,799.18 $19,799.18 $19,799.18 2025-12-15
C1703 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50 1 1 — — $29,728.51 $29,728.51 $29,728.51 2025-12-15
C1705 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 2 2 — — $7,336.15 $15,366.05 $11,351.10 2025-12-15
C1802 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50 1 1 — — $22,647.96 $22,647.96 $22,647.96 2025-12-15
C1806 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 1 1 — — $53,809.43 $53,809.43 $53,809.43 2025-12-15
C1901 HCPCS Guillain-barr� M >=66.50 1 1 — — $18,636.88 $18,636.88 $18,636.88 2025-12-15
C1904 HCPCS Guillain-barr� M <38.50 1 1 — — $55,159.88 $55,159.88 $55,159.88 2025-12-15
C2001 HCPCS Miscellaneous M >=66.50 1 1 — — $18,898.58 $18,898.58 $18,898.58 2025-12-15
C2002 HCPCS Miscellaneous M >=55.50 And M <66.50 1 1 — — $23,663.16 $23,663.16 $23,663.16 2025-12-15
C2003 HCPCS Miscellaneous M >=46.50 And M <55.50 1 1 — — $28,249.24 $28,249.24 $28,249.24 2025-12-15
C2004 HCPCS Miscellaneous M <46.50 And A >=77.50 1 1 — — $30,573.67 $30,573.67 $30,573.67 2025-12-15
C2005 HCPCS Miscellaneous M <46.50 And A <77.50 1 1 — — $35,560.37 $35,560.37 $35,560.37 2025-12-15
D0101 HCPCS Stroke M >=72.50 1 1 — — $15,485.16 $15,485.16 $15,485.16 2025-12-15
D0102 HCPCS Stroke M >=63.50 And M <72.50 2 2 — — $19,648.32 $19,732.39 $19,690.35 2025-12-15
D0103 HCPCS Stroke M >=50.50 And M <63.50 1 1 — — $25,434.63 $25,434.63 $25,434.63 2025-12-15
D0104 HCPCS Stroke M >=41.50 And M <50.50 2 2 — — $27,269.59 $31,445.35 $29,357.47 2025-12-15
D0105 HCPCS Stroke M <41.50 And A >=84.50 1 1 — — $15,220.95 $15,220.95 $15,220.95 2025-12-15
D0106 HCPCS Stroke M <41.50 And A <84.50 1 1 — — $46,167.15 $46,167.15 $46,167.15 2025-12-15
D0202 HCPCS Traumatic Brain Injury M >=61.50 And M <73.50 1 1 — — $19,994.94 $19,994.94 $19,994.94 2025-12-15
D0203 HCPCS Traumatic Brain Injury M >=49.50 And M <61.50 1 1 — — $16,281.74 $16,281.74 $16,281.74 2025-12-15
D0204 HCPCS Traumatic Brain Injury M >=35.50 And M <49.50 3 3 — — $27,311.52 $30,965.44 $30,908.03 2025-12-15
D0205 HCPCS Traumatic Brain Injury M <35.50 1 1 — — $3,123.23 $3,123.23 $3,123.23 2025-12-15
D0301 HCPCS Non-traumatic Brain Injury M >=65.50 1 1 — — $17,582.70 $17,582.70 $17,582.70 2025-12-15
D0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50 2 2 — — $19,890.31 $22,828.94 $21,359.62 2025-12-15
D0303 HCPCS Non-traumatic Brain Injury M >=42.50 And M <52.50 1 1 — — $24,525.89 $24,525.89 $24,525.89 2025-12-15
D0304 HCPCS Non-traumatic Brain Injury M <42.50 And A >=78.50 1 1 — — $31,712.73 $31,712.73 $31,712.73 2025-12-15
D0305 HCPCS Non-traumatic Brain Injury M <42.50 And A <78.50 1 1 — — $25,826.05 $25,826.05 $25,826.05 2025-12-15
D0401 HCPCS Traumatic Spinal Cord Injury M >=56.50 1 1 — — $20,777.92 $20,777.92 $20,777.92 2025-12-15
D0407 HCPCS Traumatic Spinal Cord Injury M <24.50 And A >=61.50 1 1 — — $74,644.00 $74,644.00 $74,644.00 2025-12-15
D0501 HCPCS Non-traumatic Spinal Cord Injury M >=60.50 1 1 — — $18,626.49 $18,626.49 $18,626.49 2025-12-15
D0502 HCPCS Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50 1 1 — — $20,447.38 $20,447.38 $20,447.38 2025-12-15
D0504 HCPCS Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 1 1 — — $20,291.56 $20,291.56 $20,291.56 2025-12-15
D0505 HCPCS Non-traumatic Spinal Cord Injury M <39.50 1 1 — — $41,403.87 $41,403.87 $41,403.87 2025-12-15
D0601 HCPCS Neurological M >=64.50 1 1 — — $18,373.29 $18,373.29 $18,373.29 2025-12-15
D0602 HCPCS Neurological M >=52.50 And M <64.50 1 1 — — $14,726.09 $14,726.09 $14,726.09 2025-12-15
D0603 HCPCS Neurological M >=43.50 And M <52.50 1 1 — — $27,699.25 $27,699.25 $27,699.25 2025-12-15
D0604 HCPCS Neurological M <43.50 2 2 — — $29,469.37 $34,372.49 $31,920.93 2025-12-15
D0701 HCPCS Fracture Of Lower Extremity M >=61.50 1 1 — — $18,421.56 $18,421.56 $18,421.56 2025-12-15
D0702 HCPCS Fracture Of Lower Extremity M >=52.50 And M <61.50 1 1 — — $16,116.61 $16,116.61 $16,116.61 2025-12-15
D0703 HCPCS Fracture Of Lower Extremity M >=41.50 And M <52.50 2 2 — — $20,985.06 $23,800.00 $22,392.53 2025-12-15
D0704 HCPCS Fracture Of Lower Extremity M <41.50 1 1 — — $31,165.40 $31,165.40 $31,165.40 2025-12-15
D0801 HCPCS Replacement Of Lower-extremity Joint M >=63.50 1 1 — — $17,444.88 $17,444.88 $17,444.88 2025-12-15
D0802 HCPCS Replacement Of Lower-extremity Joint M >=57.50 And M <63.50 1 1 — — $20,123.31 $20,123.31 $20,123.31 2025-12-15
D0803 HCPCS Replacement Of Lower-extremity Joint M >=51.50 And M <57.50 1 1 — — $17,307.92 $17,307.92 $17,307.92 2025-12-15
D0804 HCPCS Replacement Of Lower-extremity Joint M >=42.50 And M <51.50 1 1 — — $10,617.01 $10,617.01 $10,617.01 2025-12-15
D0901 HCPCS Other Orthopedic M >=63.50 1 1 — — $14,983.84 $14,983.84 $14,983.84 2025-12-15
D0902 HCPCS Other Orthopedic M >=51.50 And M <63.50 1 1 — — $22,394.10 $22,394.10 $22,394.10 2025-12-15
D0903 HCPCS Other Orthopedic M >=44.50 And M <51.50 1 1 — — $26,743.45 $26,743.45 $26,743.45 2025-12-15
D0904 HCPCS Other Orthopedic M <44.5 2 2 — — $4,984.08 $29,040.61 $17,012.35 2025-12-15
D1002 HCPCS Amputation Lower Extremity M >=55.50 And M <64.50 1 1 — — $22,145.90 $22,145.90 $22,145.90 2025-12-15
D1003 HCPCS Amputation Lower Extremity M >=47.50 And M <55.50 1 1 — — $26,352.06 $26,352.06 $26,352.06 2025-12-15
D1004 HCPCS Amputation Lower Extremity M <47.50 1 1 — — $34,842.82 $34,842.82 $34,842.82 2025-12-15
D1301 HCPCS Rheumatoid Other Arthritis M >=62.50 1 1 — — $17,249.05 $17,249.05 $17,249.05 2025-12-15
D1303 HCPCS Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50 1 1 — — $25,578.24 $25,578.24 $25,578.24 2025-12-15
D1401 HCPCS Cardiac M >=68.50 1 1 — — $8,283.79 $8,283.79 $8,283.79 2025-12-15
D1402 HCPCS Cardiac M >=55.50 And M <68.50 1 1 — — $21,011.12 $21,011.12 $21,011.12 2025-12-15
D1403 HCPCS Cardiac M >=45.50 And M <55.50 1 1 — — $25,599.70 $25,599.70 $25,599.70 2025-12-15
D1502 HCPCS Pulmonary M >=56.50 And M <68.50 1 1 — — $24,617.78 $24,617.78 $24,617.78 2025-12-15
D1603 HCPCS Pain Syndrome M >=43.50 And M <58.50 1 1 — — $25,528.27 $25,528.27 $25,528.27 2025-12-15
D1701 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50 1 1 — — $19,083.37 $19,083.37 $19,083.37 2025-12-15
D1702 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50 1 1 — — $18,895.00 $18,895.00 $18,895.00 2025-12-15
D1703 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50 1 1 — — $28,361.84 $28,361.84 $28,361.84 2025-12-15
D1705 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 2 2 — — $30,862.34 $32,853.45 $31,857.89 2025-12-15
D1804 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50 1 1 — — $30,590.04 $30,590.04 $30,590.04 2025-12-15
D2001 HCPCS Miscellaneous M >=66.50 2 2 — — $14,711.59 $17,578.71 $16,145.15 2025-12-15
D2002 HCPCS Miscellaneous M >=55.50 And M <66.50 1 1 — — $22,011.27 $22,011.27 $22,011.27 2025-12-15
D2003 HCPCS Miscellaneous M >=46.50 And M <55.50 2 2 — — $25,416.95 $26,459.17 $25,938.06 2025-12-15
D2004 HCPCS Miscellaneous M <46.50 And A >=77.50 2 2 — — $26,151.19 $28,243.29 $27,197.24 2025-12-15
D2005 HCPCS Miscellaneous M <46.50 And A <77.50 2 2 — — $9,301.48 $32,181.24 $20,741.36 2025-12-15
G0281 HCPCS Pt Elec Stim Unattend For Pres 2 2 $59.00 $59.00 $12.00 $38.35 $25.18 2025-12-15
G0283 HCPCS Pt Elec Stim Other Than Wound 1 1 $59.00 $59.00 $38.14 $38.14 $38.14 2025-12-15
J0585 HCPCS Onabotulinumtoxina 1 Unit Vial1un 2 2 $26.00 $26.00 $6.51 $6.51 $6.51 2025-12-15
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