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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

Advanced Care Hospital Of Montana

Billings, MT · CCN 272001 · Rates published

2,582 distinct procedures filed
17 distinct payers
40,904 rate rows
2026-09-09 last MRF observed
Data quality

2,549 of 40,904 rate rows are consumer-grade (6.2%)

38,355 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 38,180
per-diem day rate — not a per-procedure price 175
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://ernesthealth.com/pricing/2026/205292745_advanced-care-hospital-of-montana_standard-charges.json
Found on page https://achm.ernesthealth.com/price-transparency/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-09-21
Content fingerprint 9326fa4892bc9e6e… · 15,134,596 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
981
LOCAL 		Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 13 $115,873.96 $115,873.96 $115,873.96 nat. median
$701
outlier · 165.3×
C1806
HCPCS 		Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier Tier 2 4 $91,582.88 $91,582.88 $91,582.88 nat. median
$53,363
1.7× median
207
LOCAL 		Respiratory System Diagnosis With Ventilator Support >96 Hours 13 $90,258.74 $90,258.74 $90,258.74 nat. median
$90,259
1.0× median
163
LOCAL 		Major Chest Procedures With Mcc 13 $83,256.13 $83,256.13 $83,256.13 nat. median
$900
outlier · 92.5×
853
LOCAL 		Infectious And Parasitic Diseases With O.r. Procedures With Mcc 13 $79,192.62 $79,192.62 $79,192.62 nat. median
$8
outlier · 10205.2×
628
LOCAL 		Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 13 $72,605.31 $72,605.31 $72,605.31 nat. median
$900
outlier · 80.7×
653
LOCAL 		Major Bladder Procedures With Mcc 13 $72,605.31 $72,605.31 $72,605.31 nat. median
$72,605
1.0× median
205
LOCAL 		Other Respiratory System Diagnoses With Mcc 13 $68,495.84 $68,495.84 $68,495.84 nat. median
$2,621
outlier · 26.1×
385
LOCAL 		Inflammatory Bowel Disease With Mcc 13 $68,442.08 $68,442.08 $68,442.08 nat. median
$68,442
1.0× median
D1004
HCPCS 		Amputation Lower Extremity M <47.50- Tier Tier 3 4 $37,531.74 $59,559.15 $59,559.15 nat. median
$33,591
1.8× median
C0205
HCPCS 		Traumatic Brain Injury M <35.50- Tier Tier 2 4 $57,546.28 $57,546.28 $57,546.28 nat. median
$41,257
1.4× median
94
LOCAL 		Bacterial And Tuberculous Infections Of Nervous System With Mcc 13 $55,947.70 $55,947.70 $55,947.70 nat. median
$900
outlier · 62.2×
939
LOCAL 		O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 13 $54,043.61 $54,043.61 $54,043.61 nat. median
$54,044
1.0× median
539
LOCAL 		Osteomyelitis With Mcc* 13 $45,204.17 $58,994.67 $52,099.42 nat. median
$47,206
1.1× median
919
LOCAL 		Complications Of Treatment With Mcc* 13 $50,954.62 $50,954.62 $50,954.62 nat. median
$111
outlier · 459.4×
C0604
HCPCS 		Neurological M <43.50- Tier Tier 2 4 $33,243.76 $68,333.88 $50,788.82 nat. median
$35,373
1.4× median
208
LOCAL 		Respiratory System Diagnosis With Ventilator Support <=96 Hours 13 $49,785.83 $49,785.83 $49,785.83 nat. median
$2,406
outlier · 20.7×
A0106
HCPCS 		Stroke M <41.50 And A <84.50- Tier None 4 $49,262.18 $51,854.53 $49,262.18 nat. median
$41,164
1.2× median
D0505
HCPCS 		Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 3 4 $48,974.99 $48,974.99 $48,974.99 nat. median
$42,098
1.2× median
908
LOCAL 		Other O.r. Procedures For Injuries With Cc* 13 $48,588.99 $48,588.99 $48,588.99 nat. median
$48,589
1.0× median
D0106
HCPCS 		Stroke M <41.50 And A <84.50- Tier Tier 3 4 $40,833.94 $51,796.51 $48,335.61 nat. median
$43,148
1.1× median
D1705
HCPCS 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3 4 $46,258.82 $46,258.82 $46,258.82 nat. median
$71
outlier · 655.8×
393
LOCAL 		Other Digestive System Diagnoses With Mcc 13 $43,133.53 $49,153.22 $46,143.38 nat. median
$47,648
1.0× median
288
LOCAL 		Acute And Subacute Endocarditis With Mcc 13 $45,828.68 $45,828.68 $45,828.68 nat. median
$45,829
1.0× median
A1806
HCPCS 		Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier None 4 $45,462.23 $45,462.23 $45,462.23 nat. median
$47,794
1.0× median
C1704
HCPCS 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 4 $45,395.47 $45,395.47 $45,395.47 nat. median
$33,073
1.4× median
576
LOCAL 		Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 13 $44,512.04 $44,512.04 $44,512.04 nat. median
$44,512
1.0× median
637
LOCAL 		Diabetes With Mcc 13 $43,652.02 $43,652.02 $43,652.02 nat. median
$43,652
1.0× median
C1804
HCPCS 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50- T… 4 $42,616.33 $42,616.33 $42,616.33 nat. median
$32,005
1.3× median
907
LOCAL 		Other O.r. Procedures For Injuries With Mcc* 13 $40,591.37 $40,591.37 $40,591.37 nat. median
$40,591
1.0× median
D0105
HCPCS 		Stroke M <41.50 And A >=84.50- Tier Tier 3 4 $36,250.45 $43,566.71 $39,908.58 nat. median
$38,427
1.0× median
70
LOCAL 		Other Cerebrovascular Disorders With Mcc* 13 $39,466.46 $39,466.46 $39,466.46 nat. median
$8,418
outlier · 4.7×
D0604
HCPCS 		Neurological M <43.50- Tier Tier 3 4 $31,312.17 $49,920.10 $38,825.09 nat. median
$107
outlier · 363.8×
177
LOCAL 		Respiratory Infections And Inflammations With Mcc* 13 $38,443.88 $38,443.88 $38,443.88 nat. median
$38,266
1.0× median
56
LOCAL 		Degenerative Nervous System Disorders With Mcc 13 $37,522.87 $37,522.87 $37,522.87 nat. median
$3,190
outlier · 11.8×
559
LOCAL 		Aftercare, Musculoskeletal System And Connective Tissue With Mcc 13 $37,364.53 $37,364.53 $37,364.53 nat. median
$33,655
1.1× median
D0104
HCPCS 		Stroke M >=41.50 And M <50.50- Tier Tier 3 4 $30,948.19 $37,211.00 $37,211.00 nat. median
$30,758
1.2× median
A0505
HCPCS 		Non-traumatic Spinal Cord Injury M <39.50- Tier None 4 $36,882.96 $36,882.96 $36,882.96 nat. median
$39,049
0.9× median
291
LOCAL 		Heart Failure And Shock With Mcc* 13 $36,767.34 $36,767.34 $36,767.34 nat. median
$23,347
1.6× median
565
LOCAL 		Other Musculoskeletal System And Connective Tissue Diagnoses With Cc* 13 $36,718.75 $36,718.75 $36,718.75 nat. median
$36,719
1.0× median
D2005
HCPCS 		Miscellaneous M <46.50 And A <77.50- Tier Tier 3 4 $33,240.87 $41,636.41 $35,797.56 nat. median
$31,377
1.1× median
D2003
HCPCS 		Miscellaneous M >=46.50 And M <55.50- Tier Tier 3 4 $24,287.35 $35,487.30 $35,487.30 nat. median
$24,659
1.4× median
D0205
HCPCS 		Traumatic Brain Injury M <35.50- Tier Tier 3 4 $35,465.63 $35,465.63 $35,465.63 nat. median
$37,483
0.9× median
D0103
HCPCS 		Stroke M >=50.50 And M <63.50- Tier Tier 3 4 $23,378.99 $35,294.72 $35,294.72 nat. median
$24,141
1.5× median
189
LOCAL 		Pulmonary Edema And Respiratory Failure 13 $25,134.28 $44,021.35 $34,577.82 nat. median
$2,583
outlier · 13.4×
D1703
HCPCS 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 4 $33,981.85 $33,981.85 $33,981.85 nat. median
$88
outlier · 385.1×
901
LOCAL 		Wound Debridements For Injuries With Mcc 13 $33,842.46 $33,842.46 $33,842.46 nat. median
$3,091
outlier · 10.9×
A0405
HCPCS 		Traumatic Spinal Cord Injury M >=31.50 And M <41.50- Tier None 4 $33,248.46 $33,248.46 $33,248.46 nat. median
$35,062
0.9× median
949
LOCAL 		Aftercare With Cc/mcc 13 $33,174.97 $33,174.97 $33,174.97 nat. median
$32,692
1.0× median
C0902
HCPCS 		Other Orthopedic M >=51.50 And M <63.50- Tier Tier 2 4 $32,942.18 $32,942.18 $32,942.18 nat. median
$22,754
1.4× median

Other procedures at this hospital

Browse this hospital's 2,582 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
             
0118 RC Room & Board - Private (One Bed) - Rehabilitation 8 3 — — $1,500.00 $1,700.00 $1,500.00 2026-03-23
0128 RC Room & Board - Semi-private (Two Beds) - Rehabilitation 8 3 — — $1,772.50 $1,772.50 $1,772.50 2026-03-23
0138 RC Room & Board - Three And Four Beds - Rehabilitation 8 3 — — $1,772.50 $1,772.50 $1,772.50 2026-03-23
0148 RC Room & Board - Deluxe Private - Rehabilitation 8 3 — — $1,772.50 $1,772.50 $1,772.50 2026-03-23
0158 RC Room & Board - Ward - Rehabilitation 8 3 — — $1,772.50 $1,772.50 $1,772.50 2026-03-23
0180 RC Leave Of Absence - General Classification 25 10 — — $1,800.00 $1,800.00 $1,800.00 2026-03-23
0410 RC Respiratory Services - General Classification 13 6 — — $140.00 $140.00 $140.00 2026-03-23
0412 RC Respiratory Services - Inhalation Services 1 1 — — $140.00 $140.00 $140.00 2026-03-23
0420 RC Physical Therapy - General Classification 13 6 — — $140.00 $140.00 $140.00 2026-03-23
0424 RC Physical Therapy - Evaluation Or Re-evaluation 13 6 — — $150.00 $150.00 $150.00 2026-03-23
0430 RC Occupational Therapy - General Classification 13 6 — — $140.00 $140.00 $140.00 2026-03-23
0434 RC Occupational Therapy - Evaluation Or Reevaluation 13 6 — — $150.00 $150.00 $150.00 2026-03-23
0440 RC Speech Therapy - Language Pathology - General Classification 13 6 — — $140.00 $140.00 $140.00 2026-03-23
0444 RC Speech Therapy - Language Pathology - Evaluation Or Reevaluation 6 6 — — $150.00 $150.00 $150.00 2026-03-23
0671T CPT Insj Ant Sgm Aq DRG Dev 1+ 0 0 — — — — — 2026-03-23
0800 RC Inpatient Renal Dialysis - General Classification 3 2 — — $600.00 $600.00 $600.00 2026-03-23
0801 RC Inpatient Renal Dialysis - Hemodialysis 3 2 — — $600.00 $600.00 $600.00 2026-03-23
0802 RC Inpatient Renal Dialysis - Peritoneal Dialysis (non-capd) 3 2 — — $600.00 $600.00 $600.00 2026-03-23
0803 RC Inpatient Renal Dialysis - Continuous Ambulatory Peritoneal Dialysis (capd) 3 2 — — $600.00 $600.00 $600.00 2026-03-23
0804 RC Inpatient Renal Dialysis - Continuous Cycling Peritoneal Dialysis (ccpd) 3 2 — — $600.00 $600.00 $600.00 2026-03-23
0805 RC Inpatient Renal Dialysis - Treatment 2 1 — — $600.00 $600.00 $600.00 2026-03-23
0806 RC Inpatient Renal Dialysis - Continuation 2 1 — — $600.00 $600.00 $600.00 2026-03-23
0807 RC Inpatient Renal Dialysis - Observation/Hourly 2 1 — — $600.00 $600.00 $600.00 2026-03-23
0808 RC Inpatient Renal Dialysis - Other 2 1 — — $600.00 $600.00 $600.00 2026-03-23
0809 RC Inpatient Renal Dialysis - Other 3 2 — — $600.00 $600.00 $600.00 2026-03-23
163 LOCAL Major Chest Procedures With Mcc 28 13 — — $83,256.13 $83,256.13 $83,256.13 2026-03-23
177 LOCAL Respiratory Infections And Inflammations With Mcc* 28 13 — — $38,443.88 $38,443.88 $38,443.88 2026-03-23
189 LOCAL Pulmonary Edema And Respiratory Failure 28 13 — — $25,134.28 $44,021.35 $34,577.82 2026-03-23
200 LOCAL Pneumothorax With Cc 28 13 — — $15,139.39 $15,139.39 $15,139.39 2026-03-23
205 LOCAL Other Respiratory System Diagnoses With Mcc 28 13 — — $68,495.84 $68,495.84 $68,495.84 2026-03-23
20561 HCPCS Ndl Insj Without Njx 3+ Musc 0 0 — — — — — 2026-09-09
207 LOCAL Respiratory System Diagnosis With Ventilator Support >96 Hours 28 13 — — $90,258.74 $90,258.74 $90,258.74 2026-03-23
208 LOCAL Respiratory System Diagnosis With Ventilator Support <=96 Hours 28 13 — — $49,785.83 $49,785.83 $49,785.83 2026-03-23
288 LOCAL Acute And Subacute Endocarditis With Mcc 28 13 — — $45,828.68 $45,828.68 $45,828.68 2026-03-23
291 LOCAL Heart Failure And Shock With Mcc* 28 13 — — $36,767.34 $36,767.34 $36,767.34 2026-03-23
29125 HCPCS Apply Forearm Splint 0 0 — — — — — 2026-09-09
314 LOCAL Other Circulatory System Diagnoses With Mcc 28 13 — — $10,827.44 $41,866.10 $26,346.77 2026-03-23
36830 HCPCS Artery-vein Nonautograft 0 0 — — — — — 2026-03-23
36832 HCPCS Av Fistula Revision Open 0 0 — — — — — 2026-03-23
36901 HCPCS Intro Cath Dialysis Circuit 0 0 — — — — — 2026-03-23
36902 HCPCS Intro Cath Dialysis Circuit 0 0 — — — — — 2026-03-23
371 LOCAL Major Gastrointestinal Disorders And Peritoneal Infections With Mcc* 28 13 — — $8,693.32 $8,693.32 $8,693.32 2026-03-23
37225 HCPCS Fem/popl Revas W/ather 0 0 — — — — — 2026-03-23
37228 HCPCS Tib/per Revasc W/tla 0 0 — — — — — 2026-03-23
37229 HCPCS Tib/per Revasc W/ather 0 0 — — — — — 2026-03-23
37232 HCPCS Tib/per Revasc Add-on 0 0 — — — — — 2026-03-23
37233 HCPCS Tibper Revasc W/ather Add-on 0 0 — — — — — 2026-03-23
37238 HCPCS Open/perq Place Stent Same 0 0 — — — — — 2026-03-23
37239 HCPCS Open/perq Place Stent Ea Add 0 0 — — — — — 2026-03-23
37243 HCPCS Vasc Embolize/occlude Organ 0 0 — — — — — 2026-03-23
385 LOCAL Inflammatory Bowel Disease With Mcc 28 13 — — $68,442.08 $68,442.08 $68,442.08 2026-03-23
393 LOCAL Other Digestive System Diagnoses With Mcc 28 13 — — $43,133.53 $49,153.22 $46,143.38 2026-03-23
539 LOCAL Osteomyelitis With Mcc* 28 13 — — $45,204.17 $58,994.67 $52,099.42 2026-03-23
559 LOCAL Aftercare, Musculoskeletal System And Connective Tissue With Mcc 28 13 — — $37,364.53 $37,364.53 $37,364.53 2026-03-23
56 LOCAL Degenerative Nervous System Disorders With Mcc 28 13 — — $37,522.87 $37,522.87 $37,522.87 2026-03-23
560 LOCAL Aftercare, Musculoskeletal System And Connective Tissue With Cc 28 13 — — $32,819.66 $32,819.66 $32,819.66 2026-03-23
565 LOCAL Other Musculoskeletal System And Connective Tissue Diagnoses With Cc* 28 13 — — $36,718.75 $36,718.75 $36,718.75 2026-03-23
576 LOCAL Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 28 13 — — $44,512.04 $44,512.04 $44,512.04 2026-03-23
628 LOCAL Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 28 13 — — $72,605.31 $72,605.31 $72,605.31 2026-03-23
637 LOCAL Diabetes With Mcc 28 13 — — $43,652.02 $43,652.02 $43,652.02 2026-03-23
640 LOCAL Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 28 13 — — $8,684.45 $8,684.45 $8,684.45 2026-03-23
653 LOCAL Major Bladder Procedures With Mcc 28 13 — — $72,605.31 $72,605.31 $72,605.31 2026-03-23
699 LOCAL Other Kidney And Urinary Tract Diagnoses With Cc 28 13 — — $28,340.85 $28,340.85 $28,340.85 2026-03-23
70 LOCAL Other Cerebrovascular Disorders With Mcc* 28 13 — — $39,466.46 $39,466.46 $39,466.46 2026-03-23
80053 HCPCS Comprehen Metabolic Panel 0 0 — — — — — 2026-09-09
80069 HCPCS Renal Function Panel 0 0 — — — — — 2026-09-09
80202 HCPCS Assay Of Vancomycin 0 0 — — — — — 2026-09-09
81001 HCPCS Urinalysis Auto W/scope 0 0 — — — — — 2026-09-09
82330 HCPCS Assay Of Calcium 0 0 — — — — — 2026-09-09
82728 HCPCS Assay Of Ferritin 0 0 — — — — — 2026-09-09
82803 HCPCS Blood Gases Any Combination 0 0 — — — — — 2026-09-09
82805 HCPCS Blood Gases W/o2 Saturation 0 0 — — — — — 2026-09-09
82945 HCPCS Glucose Other Fluid 0 0 — — — — — 2026-09-09
82948 HCPCS Reagent Strip/blood Glucose 0 0 — — — — — 2026-09-09
82962 HCPCS Glucose Blood Test 0 0 — — — — — 2026-09-09
83036 HCPCS Hemoglobin Glycosylated A1c 0 0 — — — — — 2026-09-09
83735 HCPCS Assay Of Magnesium 0 0 — — — — — 2026-09-09
83880 HCPCS Assay Of Natriuretic Peptide 0 0 — — — — — 2026-09-09
84100 HCPCS Assay Of Phosphorus 0 0 — — — — — 2026-09-09
84134 HCPCS Assay Of Prealbumin 0 0 — — — — — 2026-09-09
84145 HCPCS Procalcitonin (pct) 0 0 — — — — — 2026-09-09
853 LOCAL Infectious And Parasitic Diseases With O.r. Procedures With Mcc 28 13 — — $79,192.62 $79,192.62 $79,192.62 2026-03-23
85730 HCPCS Thromboplastin Time Partial 0 0 — — — — — 2026-03-23
86022 HCPCS Platelet Antibodies 0 0 — — — — — 2026-03-23
86038 HCPCS Antinuclear Antibodies 0 0 — — — — — 2026-03-23
86140 HCPCS C-reactive Protein 0 0 — — — — — 2026-09-09
862 LOCAL Postoperative And Post-traumatic Infections With Mcc 28 13 — — $10,635.23 $43,249.95 $26,942.59 2026-03-23
86225 HCPCS DNA Antibody Native 0 0 — — — — — 2026-03-23
86235 HCPCS Nuclear Antigen Antibody 0 0 — — — — — 2026-03-23
86256 HCPCS Fluorescent Antibody Titer 0 0 — — — — — 2026-03-23
86300 HCPCS Immunoassay Tumor Ca 15-3 0 0 — — — — — 2026-03-23
86301 HCPCS Immunoassay Tumor Ca 19-9 0 0 — — — — — 2026-03-23
86304 HCPCS Immunoassay Tumor Ca 125 0 0 — — — — — 2026-03-23
86905 HCPCS Blood Typing Rbc Antigens 0 0 — — — — — 2026-09-09
87040 HCPCS Blood Culture For Bacteria 0 0 — — — — — 2026-09-09
87070 HCPCS Culture Othr Specimn Aerobic 0 0 — — — — — 2026-09-09
87077 HCPCS Culture Aerobic Identify 0 0 — — — — — 2026-03-23
87086 HCPCS Urine Culture/colony Count 0 0 — — — — — 2026-09-09
87088 HCPCS Urine Bacteria Culture 0 0 — — — — — 2026-03-23
87101 HCPCS Skin Fungi Culture 0 0 — — — — — 2026-03-23
87106 HCPCS Fungi Identification Yeast 0 0 — — — — — 2026-03-23
87116 HCPCS Mycobacteria Culture 0 0 — — — — — 2026-03-23
87147 HCPCS Culture Type Immunologic 0 0 — — — — — 2026-03-23
87150 HCPCS Dna/rna Amplified Probe 0 0 — — — — — 2026-03-23
87340 HCPCS Hepatitis B Surface Ag Ia 0 0 — — — — — 2026-09-09
87493 HCPCS C Diff Amplified Probe 0 0 — — — — — 2026-09-09
87556 HCPCS M.tuberculo DNA Amp Probe 0 0 — — — — — 2026-03-23
87591 HCPCS N.gonorrhoeae DNA Amp Prob 0 0 — — — — — 2026-03-23
87633 HCPCS Resp Virus 12-25 Targets 0 0 — — — — — 2026-09-09
87635 HCPCS Sars-cov-2 Covid-19 Amp Prb 0 0 — — — — — 2026-09-09
87650 HCPCS Strep A DNA Dir Probe 0 0 — — — — — 2026-03-23
87651 HCPCS Strep A DNA Amp Probe 0 0 — — — — — 2026-03-23
87804 HCPCS Influenza Assay W/optic 0 0 — — — — — 2026-03-23
87806 HCPCS HIV Ag W/hiv1&2 Antb W/optic 0 0 — — — — — 2026-03-23
87811 HCPCS Sars-cov-2 Covid19 W/optic 0 0 — — — — — 2026-03-23
87880 HCPCS Strep A Assay W/optic 0 0 — — — — — 2026-03-23
88108 HCPCS Cytopath Concentrate Tech 0 0 — — — — — 2026-03-23
88112 HCPCS Cytopath Cell Enhance Tech 0 0 — — — — — 2026-03-23
901 LOCAL Wound Debridements For Injuries With Mcc 28 13 — — $33,842.46 $33,842.46 $33,842.46 2026-03-23
907 LOCAL Other O.r. Procedures For Injuries With Mcc* 28 13 — — $40,591.37 $40,591.37 $40,591.37 2026-03-23
908 LOCAL Other O.r. Procedures For Injuries With Cc* 28 13 — — $48,588.99 $48,588.99 $48,588.99 2026-03-23
917 LOCAL Poisoning And Toxic Effects Of Drugs With Mcc* 28 13 — — $21,332.78 $21,332.78 $21,332.78 2026-03-23
919 LOCAL Complications Of Treatment With Mcc* 28 13 — — $50,954.62 $50,954.62 $50,954.62 2026-03-23
920 LOCAL Complications Of Treatment With Cc* 28 13 — — $27,125.90 $27,125.90 $27,125.90 2026-03-23
92507 HCPCS Speech/hearing Therapy 28 6 — — $140.00 $140.00 $140.00 2026-09-09
92521 HCPCS Evaluation Of Speech Fluency 2 1 — — $150.00 $150.00 $150.00 2026-09-09
92522 HCPCS Evaluate Speech Production 28 6 — — $150.00 $150.00 $150.00 2026-09-09
92523 HCPCS Speech Sound Lang Comprehen 28 6 — — $150.00 $150.00 $150.00 2026-09-09
92524 HCPCS Behavral Qualit Analys Voice 28 6 — — $150.00 $150.00 $150.00 2026-09-09
92526 HCPCS Oral Function Therapy 28 6 — — $140.00 $140.00 $140.00 2026-09-09
92597 HCPCS Oral Speech Device Eval 2 1 — — $140.00 $140.00 $140.00 2026-09-09
92605 HCPCS Ex For Nonspeech Device Rx 2 1 — — $140.00 $140.00 $140.00 2026-09-09
92606 HCPCS Non-speech Device Service 2 1 — — $140.00 $140.00 $140.00 2026-09-09
92607 HCPCS Ex For Speech Device Rx 1hr 28 6 — — $140.00 $140.00 $140.00 2026-09-09
92950 HCPCS Heart/lung Resuscitation Cpr 0 0 — — — — — 2026-03-23
92960 HCPCS Cardioversion Electric Ext 0 0 — — — — — 2026-03-23
92978 HCPCS Endoluminl Ivus Oct C 1st 0 0 — — — — — 2026-03-23
93005 HCPCS Electrocardiogram Tracing 0 0 — — — — — 2026-03-23
93017 HCPCS Cardiovascular Stress Test 0 0 — — — — — 2026-03-23
93225 HCPCS ECG Monit/reprt Up To 48 Hrs 0 0 — — — — — 2026-03-23
93226 HCPCS ECG Monit/reprt Up To 48 Hrs 0 0 — — — — — 2026-03-23
93306 HCPCS Tte W/doppler Complete 0 0 — — — — — 2026-03-23
93308 HCPCS Tte F-up Or Lmtd 0 0 — — — — — 2026-03-23
93312 HCPCS Echo Transesophageal 0 0 — — — — — 2026-03-23
93454 HCPCS Coronary Artery Angio S&i 0 0 — — — — — 2026-03-23
93458 HCPCS L Hrt Artery/ventricle Angio 0 0 — — — — — 2026-03-23
93459 HCPCS L Hrt Art/grft Angio 0 0 — — — — — 2026-03-23
93460 HCPCS R&l Hrt Art/ventricle Angio 0 0 — — — — — 2026-03-23
93571 HCPCS Heart Flow Reserve Measure 0 0 — — — — — 2026-03-23
93572 HCPCS Heart Flow Reserve Measure 0 0 — — — — — 2026-03-23
93798 HCPCS Cardiac Rehab/monitor 0 0 — — — — — 2026-03-23
93880 HCPCS Extracranial Bilat Study 0 0 — — — — — 2026-03-23
939 LOCAL O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 28 13 — — $54,043.61 $54,043.61 $54,043.61 2026-03-23
93925 HCPCS Lower Extremity Study 0 0 — — — — — 2026-03-23
93926 HCPCS Lower Extremity Study 0 0 — — — — — 2026-09-09
93930 HCPCS Upper Extremity Study 0 0 — — — — — 2026-03-23
93970 HCPCS Extremity Study 0 0 — — — — — 2026-09-09
93971 HCPCS Extremity Study 0 0 — — — — — 2026-09-09
93985 HCPCS Dup-scan Hemo Compl Bi Std 0 0 — — — — — 2026-03-23
93990 HCPCS Doppler Flow Testing 0 0 — — — — — 2026-03-23
94 LOCAL Bacterial And Tuberculous Infections Of Nervous System With Mcc 28 13 — — $55,947.70 $55,947.70 $55,947.70 2026-03-23
94002 HCPCS Vent Mgmt Inpat Init Day 0 0 — — — — — 2026-09-09
94003 HCPCS Vent Mgmt Inpat Subq Day 0 0 — — — — — 2026-09-09
94010 HCPCS Breathing Capacity Test 2 1 — — $140.00 $140.00 $140.00 2026-09-09
94060 HCPCS Evaluation Of Wheezing 2 1 — — $140.00 $140.00 $140.00 2026-09-09
94640 HCPCS Airway Inhalation Treatment 2 1 — — $140.00 $140.00 $140.00 2026-09-09
94660 HCPCS Pos Airway Pressure Cpap 2 1 — — $140.00 $140.00 $140.00 2026-09-09
94664 HCPCS Evaluate Pt Use Of Inhaler 2 1 — — $140.00 $140.00 $140.00 2026-09-09
94760 HCPCS Measure Blood Oxygen Level 0 0 — — — — — 2026-03-23
94761 HCPCS Measure Blood Oxygen Level 0 0 — — — — — 2026-03-23
94799 HCPCS Unlisted Pulmonary Svc/px 0 0 — — — — — 2026-03-23
949 LOCAL Aftercare With Cc/mcc 28 13 — — $33,174.97 $33,174.97 $33,174.97 2026-03-23
951 LOCAL Other Factors Influencing Health Status 28 13 — — $1,376.31 $1,376.31 $1,376.31 2026-03-23
95816 HCPCS EEG Awake And Drowsy 0 0 — — — — — 2026-03-23
95819 HCPCS EEG Awake And Asleep 0 0 — — — — — 2026-03-23
95886 HCPCS Musc Test Done W/n Test Comp 0 0 — — — — — 2026-03-23
95913 HCPCS Nrv Cndj Test 13/> Studies 0 0 — — — — — 2026-03-23
95992 HCPCS Canalith Repositioning Proc 0 0 — — — — — 2026-09-09
96105 HCPCS Assessment Of Aphasia 28 6 — — $150.00 $150.00 $150.00 2026-09-09
96125 HCPCS Cognitive Test By Hc Pro 0 0 — — — — — 2026-09-09
96360 HCPCS Hydration IV Infusion Init 0 0 — — — — — 2026-03-23
96361 HCPCS Hydrate IV Infusion Add-on 0 0 — — — — — 2026-03-23
96365 HCPCS Ther/proph/diag IV Inf Init 0 0 — — — — — 2026-03-23
96366 HCPCS Ther/proph/diag IV Inf Addon 0 0 — — — — — 2026-03-23
96367 HCPCS Tx/proph/dg Addl Seq IV Inf 0 0 — — — — — 2026-03-23
96368 HCPCS Ther/diag Concurrent Inf 0 0 — — — — — 2026-03-23
96372 HCPCS Ther/proph/diag Inj Sc/im 0 0 — — — — — 2026-03-23
96374 HCPCS Ther/proph/diag Inj IV Push 0 0 — — — — — 2026-03-23
96375 HCPCS Tx/pro/dx Inj New Drug Addon 0 0 — — — — — 2026-03-23
96376 HCPCS Tx/pro/dx Inj Same Drug Adon 0 0 — — — — — 2026-03-23
97012 HCPCS Mechanical Traction Therapy 0 0 — — — — — 2026-09-09
97014 HCPCS Electric Stimulation Therapy 0 0 — — — — — 2026-09-09
97018 HCPCS Paraffin Bath Therapy 0 0 — — — — — 2026-09-09
97032 HCPCS Appl Modality 1+estim Ea 15 28 6 — — $140.00 $140.00 $140.00 2026-09-09
97033 HCPCS App Mdlty 1+iontphrsis Ea 15 0 0 — — — — — 2026-09-09
97035 HCPCS App Mdlty 1+ultrasound Ea 15 0 0 — — — — — 2026-09-09
97039 HCPCS Unlisted Modality 0 0 — — — — — 2026-03-23
97110 HCPCS Therapeutic Exercises 28 6 — — $140.00 $140.00 $140.00 2026-09-09
97112 HCPCS Neuromuscular Reeducation 28 6 — — $140.00 $140.00 $140.00 2026-09-09
97113 HCPCS Aquatic Therapy/exercises 28 6 — — $140.00 $140.00 $140.00 2026-09-09
97116 HCPCS Gait Training Therapy 28 6 — — $140.00 $140.00 $140.00 2026-09-09
97124 HCPCS Massage Therapy 28 6 — — $140.00 $140.00 $140.00 2026-09-09
97129 HCPCS Ther Ivntj 1st 15 Min 28 6 — — $140.00 $140.00 $140.00 2026-09-09
97130 HCPCS Ther Ivntj Ea Addl 15 Min 0 0 — — — — — 2026-09-09
97140 HCPCS Manual Therapy 1/> Regions 28 6 — — $140.00 $140.00 $140.00 2026-09-09
97161 HCPCS Pt Eval Low Complex 20 Min 28 6 — — $150.00 $150.00 $150.00 2026-09-09
97162 HCPCS Pt Eval Mod Complex 30 Min 28 6 — — $150.00 $150.00 $150.00 2026-09-09
97163 HCPCS Pt Eval High Complex 45 Min 28 6 — — $150.00 $150.00 $150.00 2026-09-09
97164 HCPCS Pt Re-eval Est Plan Care 28 6 — — $150.00 $150.00 $150.00 2026-09-09
97165 HCPCS Ot Eval Low Complex 30 Min 28 6 — — $150.00 $150.00 $150.00 2026-09-09
97166 HCPCS Ot Eval Mod Complex 45 Min 28 6 — — $150.00 $150.00 $150.00 2026-09-09
97167 HCPCS Ot Eval High Complex 60 Min 28 6 — — $150.00 $150.00 $150.00 2026-09-09
97168 HCPCS Ot Re-eval Est Plan Care 28 6 — — $150.00 $150.00 $150.00 2026-09-09
97530 HCPCS Therapeutic Activities 28 6 — — $140.00 $140.00 $140.00 2026-09-09
97535 HCPCS Self Care Mngment Training 28 6 — — $140.00 $140.00 $140.00 2026-09-09
97537 HCPCS Community/work Reintegration 28 6 — — $140.00 $140.00 $140.00 2026-09-09
981 LOCAL Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 28 13 — — $115,873.96 $115,873.96 $115,873.96 2026-03-23
A0102 HCPCS Stroke M >=63.50 And M <72.50- Tier None 10 4 — — $16,828.84 $21,192.28 $16,828.84 2026-09-09
A0103 HCPCS Stroke M >=50.50 And M <63.50- Tier None 10 4 — — $21,602.26 $23,225.62 $21,602.26 2026-09-09
A0104 HCPCS Stroke M >=41.50 And M <50.50- Tier None 4 4 — — $30,969.87 $30,969.87 $30,969.87 2026-09-09
A0106 HCPCS Stroke M <41.50 And A <84.50- Tier None 10 4 — — $49,262.18 $51,854.53 $49,262.18 2026-09-09
A0202 HCPCS Traumatic Brain Injury M >=61.50 And M <73.50- Tier None 6 4 — — $16,950.68 $16,950.68 $16,950.68 2026-09-09
A0204 HCPCS Traumatic Brain Injury M >=35.50 And M <49.50- Tier None 6 4 — — $25,972.53 $25,972.53 $25,972.53 2026-09-09
A0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier None 4 4 — — $25,732.74 $25,732.74 $25,732.74 2026-09-09
A0304 HCPCS Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier None 6 4 — — $26,814.69 $26,814.69 $26,814.69 2026-09-09
A0401 HCPCS Traumatic Spinal Cord Injury M >=56.50- Tier None 4 4 — — $23,918.87 $23,918.87 $23,918.87 2026-09-09
A0405 HCPCS Traumatic Spinal Cord Injury M >=31.50 And M <41.50- Tier None 4 4 — — $33,248.46 $33,248.46 $33,248.46 2026-09-09
A0505 HCPCS Non-traumatic Spinal Cord Injury M <39.50- Tier None 6 4 — — $36,882.96 $36,882.96 $36,882.96 2026-09-09
A0602 HCPCS Neurological M >=52.50 And M <64.50- Tier None 4 4 — — $20,017.44 $20,017.44 $20,017.44 2026-09-09
A0603 HCPCS Neurological M >=43.50 And M <52.50- Tier None 6 4 — — $22,238.36 $22,238.36 $22,238.36 2026-09-09
A0604 HCPCS Neurological M <43.50- Tier None 10 4 — — $27,571.50 $33,325.34 $29,424.72 2026-09-09
A0704 HCPCS Fracture Of Lower Extremity M <41.50- Tier None 10 4 — — $28,522.30 $38,651.56 $28,522.30 2026-09-09
A0804 HCPCS Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier None 4 4 — — $23,505.56 $23,505.56 $23,505.56 2026-09-09
A0805 HCPCS Replacement Of Lower-extremity Joint M <42.50- Tier None 6 4 — — $27,737.98 $27,737.98 $27,737.98 2026-09-09
A0902 HCPCS Other Orthopedic M >=51.50 And M <63.50- Tier None 4 4 — — $19,726.01 $19,726.01 $19,726.01 2026-09-09
A0904 HCPCS Other Orthopedic M <44.5- Tier None 10 4 — — $2,629.51 $26,295.06 $26,295.06 2026-09-09
A1004 HCPCS Amputation Lower Extremity M <47.50- Tier None 6 4 — — $29,654.73 $29,654.73 $29,654.73 2026-09-09
A1404 HCPCS Cardiac M <45.50- Tier None 6 4 — — $26,348.81 $26,348.81 $26,348.81 2026-09-09
A1705 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier None 6 4 — — $31,009.35 $31,009.35 $31,009.35 2026-09-09
A1802 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50- T… 6 4 — — $30,028.51 $30,028.51 $30,028.51 2026-09-09
A1806 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier None 4 4 — — $45,462.23 $45,462.23 $45,462.23 2026-09-09
A2002 HCPCS Miscellaneous M >=55.50 And M <66.50- Tier None 4 4 — — $21,005.13 $21,005.13 $21,005.13 2026-09-09
A2003 HCPCS Miscellaneous M >=46.50 And M <55.50- Tier None 10 4 — — $21,197.31 $21,663.15 $21,197.31 2026-09-09
A2004 HCPCS Miscellaneous M <46.50 And A >=77.50- Tier None 6 4 — — $25,850.69 $25,850.69 $25,850.69 2026-09-09
A2005 HCPCS Miscellaneous M <46.50 And A <77.50- Tier None 10 4 — — $27,058.38 $31,211.35 $27,058.38 2026-09-09
C0205 HCPCS Traumatic Brain Injury M <35.50- Tier Tier 2 4 4 — — $57,546.28 $57,546.28 $57,546.28 2026-09-09
C0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 2 10 4 — — $21,933.75 $23,788.63 $21,933.75 2026-09-09
C0303 HCPCS Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 2 4 4 — — $28,722.58 $28,722.58 $28,722.58 2026-09-09
C0603 HCPCS Neurological M >=43.50 And M <52.50- Tier Tier 2 10 4 — — $29,080.97 $29,544.28 $29,080.97 2026-09-09
C0604 HCPCS Neurological M <43.50- Tier Tier 2 6 4 — — $33,243.76 $68,333.88 $50,788.82 2026-09-09
C0703 HCPCS Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 2 4 4 — — $30,161.04 $30,161.04 $30,161.04 2026-09-09
C0704 HCPCS Fracture Of Lower Extremity M <41.50- Tier Tier 2 10 4 — — $32,865.69 $47,777.19 $32,865.69 2026-09-09
C0902 HCPCS Other Orthopedic M >=51.50 And M <63.50- Tier Tier 2 4 4 — — $32,942.18 $32,942.18 $32,942.18 2026-09-09
C0904 HCPCS Other Orthopedic M <44.5- Tier Tier 2 10 4 — — $30,513.02 $30,513.02 $30,513.02 2026-09-09
C1403 HCPCS Cardiac M >=45.50 And M <55.50- Tier Tier 2 4 4 — — $32,670.92 $32,670.92 $32,670.92 2026-09-09
C1704 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 4 4 — — $45,395.47 $45,395.47 $45,395.47 2026-09-09
C1802 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50- T… 4 4 — — $22,629.89 $22,629.89 $22,629.89 2026-09-09
C1804 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50- T… 4 4 — — $42,616.33 $42,616.33 $42,616.33 2026-09-09
C1806 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier Tier 2 6 4 — — $91,582.88 $91,582.88 $91,582.88 2026-09-09
C2004 HCPCS Miscellaneous M <46.50 And A >=77.50- Tier Tier 2 4 4 — — $31,829.78 $31,829.78 $31,829.78 2026-09-09
C2005 HCPCS Miscellaneous M <46.50 And A <77.50- Tier Tier 2 4 4 — — $32,524.53 $32,524.53 $32,524.53 2026-09-09
D0101 HCPCS Stroke M >=72.50- Tier Tier 3 4 4 — — $15,990.49 $15,990.49 $15,990.49 2026-09-09
D0102 HCPCS Stroke M >=63.50 And M <72.50- Tier Tier 3 6 4 — — $23,920.56 $23,920.56 $23,920.56 2026-09-09
D0103 HCPCS Stroke M >=50.50 And M <63.50- Tier Tier 3 10 4 — — $23,378.99 $35,294.72 $35,294.72 2026-09-09
D0104 HCPCS Stroke M >=41.50 And M <50.50- Tier Tier 3 10 4 — — $30,948.19 $37,211.00 $37,211.00 2026-09-09
D0105 HCPCS Stroke M <41.50 And A >=84.50- Tier Tier 3 6 4 — — $36,250.45 $43,566.71 $39,908.58 2026-09-09
D0106 HCPCS Stroke M <41.50 And A <84.50- Tier Tier 3 10 4 — — $40,833.94 $51,796.51 $48,335.61 2026-09-09
D0203 HCPCS Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 3 4 4 — — $22,848.29 $22,848.29 $22,848.29 2026-09-09
D0205 HCPCS Traumatic Brain Injury M <35.50- Tier Tier 3 10 4 — — $35,465.63 $35,465.63 $35,465.63 2026-09-09
D0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 3 4 4 — — $26,203.49 $26,203.49 $26,203.49 2026-09-09
D0303 HCPCS Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 3 10 4 — — $25,128.01 $39,109.65 $25,128.01 2026-09-09
D0304 HCPCS Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 3 6 4 — — $28,642.35 $28,642.35 $28,642.35 2026-09-09
D0505 HCPCS Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 3 4 4 — — $48,974.99 $48,974.99 $48,974.99 2026-09-09
D0601 HCPCS Neurological M >=64.50- Tier Tier 3 4 4 — — $20,024.24 $20,024.24 $20,024.24 2026-09-09
D0602 HCPCS Neurological M >=52.50 And M <64.50- Tier Tier 3 10 4 — — $20,819.24 $25,316.46 $20,819.24 2026-09-09
D0603 HCPCS Neurological M >=43.50 And M <52.50- Tier Tier 3 10 4 — — $28,871.01 $30,773.10 $30,773.10 2026-09-09
D0604 HCPCS Neurological M <43.50- Tier Tier 3 10 4 — — $31,312.17 $49,920.10 $38,825.09 2026-09-09
D0701 HCPCS Fracture Of Lower Extremity M >=61.50- Tier Tier 3 4 4 — — $16,590.67 $16,590.67 $16,590.67 2026-09-09
D0703 HCPCS Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 3 10 4 — — $28,231.04 $32,549.21 $32,549.21 2026-09-09
D0704 HCPCS Fracture Of Lower Extremity M <41.50- Tier Tier 3 10 4 — — $31,213.62 $34,781.26 $31,213.62 2026-09-09
D0802 HCPCS Replacement Of Lower-extremity Joint M >=57.50 And M <63.50- Tier Tier 3 4 4 — — $17,634.22 $17,634.22 $17,634.22 2026-09-09
D0803 HCPCS Replacement Of Lower-extremity Joint M >=51.50 And M <57.50- Tier Tier 3 4 4 — — $29,351.45 $29,351.45 $29,351.45 2026-09-09
D0804 HCPCS Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier Tier 3 10 4 — — $24,042.67 $26,305.85 $26,305.85 2026-09-09
D0805 HCPCS Replacement Of Lower-extremity Joint M <42.50- Tier Tier 3 6 4 — — $28,206.94 $28,206.94 $28,206.94 2026-09-09
D0902 HCPCS Other Orthopedic M >=51.50 And M <63.50- Tier Tier 3 10 4 — — $20,170.59 $25,420.74 $20,170.59 2026-09-09
D0903 HCPCS Other Orthopedic M >=44.50 And M <51.50- Tier Tier 3 10 4 — — $28,251.13 $32,447.57 $28,251.13 2026-09-09
D0904 HCPCS Other Orthopedic M <44.5- Tier Tier 3 10 4 — — $28,823.33 $35,291.00 $32,026.21 2026-09-09
D1004 HCPCS Amputation Lower Extremity M <47.50- Tier Tier 3 10 4 — — $37,531.74 $59,559.15 $59,559.15 2026-09-09
D1303 HCPCS Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50- Tier Tier 3 6 4 — — $23,300.92 $23,300.92 $23,300.92 2026-09-09
D1401 HCPCS Cardiac M >=68.50- Tier Tier 3 4 4 — — $14,456.46 $14,456.46 $14,456.46 2026-09-09
D1402 HCPCS Cardiac M >=55.50 And M <68.50- Tier Tier 3 4 4 — — $22,336.59 $22,336.59 $22,336.59 2026-09-09
D1403 HCPCS Cardiac M >=45.50 And M <55.50- Tier Tier 3 6 4 — — $22,964.05 $22,964.05 $22,964.05 2026-09-09
D1404 HCPCS Cardiac M <45.50- Tier Tier 3 6 4 — — $28,653.10 $28,653.10 $28,653.10 2026-09-09
D1703 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 6 4 — — $33,981.85 $33,981.85 $33,981.85 2026-09-09
D1705 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3 4 4 — — $46,258.82 $46,258.82 $46,258.82 2026-09-09
D2001 HCPCS Miscellaneous M >=66.50- Tier Tier 3 4 4 — — $15,882.75 $15,882.75 $15,882.75 2026-09-09
D2002 HCPCS Miscellaneous M >=55.50 And M <66.50- Tier Tier 3 10 4 — — $28,801.63 $30,382.01 $30,382.01 2026-09-09
D2003 HCPCS Miscellaneous M >=46.50 And M <55.50- Tier Tier 3 10 4 — — $24,287.35 $35,487.30 $35,487.30 2026-09-09
D2004 HCPCS Miscellaneous M <46.50 And A >=77.50- Tier Tier 3 10 4 — — $28,239.19 $30,675.82 $28,239.19 2026-09-09
D2005 HCPCS Miscellaneous M <46.50 And A <77.50- Tier Tier 3 10 4 — — $33,240.87 $41,636.41 $35,797.56 2026-09-09
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