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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 —
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
$59,476
1.5× median
207
LOCAL 		Respiratory System Diagnosis With Ventilator Support >96 Hours 13 $90,258.74 $90,258.74 $90,258.74 —
163
LOCAL 		Major Chest Procedures With Mcc 13 $83,256.13 $83,256.13 $83,256.13 —
853
LOCAL 		Infectious And Parasitic Diseases With O.r. Procedures With Mcc 13 $79,192.62 $79,192.62 $79,192.62 —
628
LOCAL 		Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 13 $72,605.31 $72,605.31 $72,605.31 —
653
LOCAL 		Major Bladder Procedures With Mcc 13 $72,605.31 $72,605.31 $72,605.31 —
205
LOCAL 		Other Respiratory System Diagnoses With Mcc 13 $68,495.84 $68,495.84 $68,495.84 —
385
LOCAL 		Inflammatory Bowel Disease With Mcc 13 $68,442.08 $68,442.08 $68,442.08 —
D1004
HCPCS 		Amputation Lower Extremity M <47.50- Tier Tier 3 4 $37,531.74 $59,559.15 $59,559.15 nat. median
$34,358
1.7× median
C0205
HCPCS 		Traumatic Brain Injury M <35.50- Tier Tier 2 4 $57,546.28 $57,546.28 $57,546.28 nat. median
$41,763
1.4× median
94
LOCAL 		Bacterial And Tuberculous Infections Of Nervous System With Mcc 13 $55,947.70 $55,947.70 $55,947.70 —
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 —
539
LOCAL 		Osteomyelitis With Mcc* 13 $45,204.17 $58,994.67 $52,099.42 —
919
LOCAL 		Complications Of Treatment With Mcc* 13 $50,954.62 $50,954.62 $50,954.62 —
C0604
HCPCS 		Neurological M <43.50- Tier Tier 2 4 $33,243.76 $68,333.88 $50,788.82 nat. median
$35,764
1.4× median
208
LOCAL 		Respiratory System Diagnosis With Ventilator Support <=96 Hours 13 $49,785.83 $49,785.83 $49,785.83 —
A0106
HCPCS 		Stroke M <41.50 And A <84.50- Tier None 4 $49,262.18 $51,854.53 $49,262.18 nat. median
$41,668
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
$43,056
1.1× median
908
LOCAL 		Other O.r. Procedures For Injuries With Cc* 13 $48,588.99 $48,588.99 $48,588.99 —
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
$43,929
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
$33,589
1.4× median
393
LOCAL 		Other Digestive System Diagnoses With Mcc 13 $43,133.53 $49,153.22 $46,143.38 —
288
LOCAL 		Acute And Subacute Endocarditis With Mcc 13 $45,828.68 $45,828.68 $45,828.68 —
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
$50,479
0.9× 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
$33,526
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 —
637
LOCAL 		Diabetes With Mcc 13 $43,652.02 $43,652.02 $43,652.02 —
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
$32,589
1.3× median
907
LOCAL 		Other O.r. Procedures For Injuries With Mcc* 13 $40,591.37 $40,591.37 $40,591.37 —
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
$38,998
1.0× median
70
LOCAL 		Other Cerebrovascular Disorders With Mcc* 13 $39,466.46 $39,466.46 $39,466.46 —
D0604
HCPCS 		Neurological M <43.50- Tier Tier 3 4 $31,312.17 $49,920.10 $38,825.09 nat. median
$30,918
1.3× median
177
LOCAL 		Respiratory Infections And Inflammations With Mcc* 13 $38,443.88 $38,443.88 $38,443.88 —
56
LOCAL 		Degenerative Nervous System Disorders With Mcc 13 $37,522.87 $37,522.87 $37,522.87 —
559
LOCAL 		Aftercare, Musculoskeletal System And Connective Tissue With Mcc 13 $37,364.53 $37,364.53 $37,364.53 —
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
$31,294
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
$39,679
0.9× median
291
LOCAL 		Heart Failure And Shock With Mcc* 13 $36,767.34 $36,767.34 $36,767.34 —
565
LOCAL 		Other Musculoskeletal System And Connective Tissue Diagnoses With Cc* 13 $36,718.75 $36,718.75 $36,718.75 —
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
$31,799
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
$25,005
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
$38,154
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
$24,500
1.4× median
189
LOCAL 		Pulmonary Edema And Respiratory Failure 13 $25,134.28 $44,021.35 $34,577.82 —
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
$25,290
1.3× median
901
LOCAL 		Wound Debridements For Injuries With Mcc 13 $33,842.46 $33,842.46 $33,842.46 —
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
$35,266
0.9× median
949
LOCAL 		Aftercare With Cc/mcc 13 $33,174.97 $33,174.97 $33,174.97 —
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
$23,060
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.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
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
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
207 LOCAL Respiratory System Diagnosis With Ventilator Support >96 Hours 28 13 — — $90,258.74 $90,258.74 $90,258.74 2026-03-23
163 LOCAL Major Chest Procedures With Mcc 28 13 — — $83,256.13 $83,256.13 $83,256.13 2026-03-23
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
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
653 LOCAL Major Bladder Procedures With Mcc 28 13 — — $72,605.31 $72,605.31 $72,605.31 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
385 LOCAL Inflammatory Bowel Disease With Mcc 28 13 — — $68,442.08 $68,442.08 $68,442.08 2026-03-23
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
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
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
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
539 LOCAL Osteomyelitis With Mcc* 28 13 — — $45,204.17 $58,994.67 $52,099.42 2026-03-23
919 LOCAL Complications Of Treatment With Mcc* 28 13 — — $50,954.62 $50,954.62 $50,954.62 2026-03-23
C0604 HCPCS Neurological M <43.50- Tier Tier 2 6 4 — — $33,243.76 $68,333.88 $50,788.82 2026-09-09
208 LOCAL Respiratory System Diagnosis With Ventilator Support <=96 Hours 28 13 — — $49,785.83 $49,785.83 $49,785.83 2026-03-23
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
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
908 LOCAL Other O.r. Procedures For Injuries With Cc* 28 13 — — $48,588.99 $48,588.99 $48,588.99 2026-03-23
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
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
393 LOCAL Other Digestive System Diagnoses With Mcc 28 13 — — $43,133.53 $49,153.22 $46,143.38 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
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
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
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
637 LOCAL Diabetes With Mcc 28 13 — — $43,652.02 $43,652.02 $43,652.02 2026-03-23
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
907 LOCAL Other O.r. Procedures For Injuries With Mcc* 28 13 — — $40,591.37 $40,591.37 $40,591.37 2026-03-23
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
70 LOCAL Other Cerebrovascular Disorders With Mcc* 28 13 — — $39,466.46 $39,466.46 $39,466.46 2026-03-23
D0604 HCPCS Neurological M <43.50- Tier Tier 3 10 4 — — $31,312.17 $49,920.10 $38,825.09 2026-09-09
177 LOCAL Respiratory Infections And Inflammations With Mcc* 28 13 — — $38,443.88 $38,443.88 $38,443.88 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
559 LOCAL Aftercare, Musculoskeletal System And Connective Tissue With Mcc 28 13 — — $37,364.53 $37,364.53 $37,364.53 2026-03-23
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
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
291 LOCAL Heart Failure And Shock With Mcc* 28 13 — — $36,767.34 $36,767.34 $36,767.34 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
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
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
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
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
189 LOCAL Pulmonary Edema And Respiratory Failure 28 13 — — $25,134.28 $44,021.35 $34,577.82 2026-03-23
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
901 LOCAL Wound Debridements For Injuries With Mcc 28 13 — — $33,842.46 $33,842.46 $33,842.46 2026-03-23
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
949 LOCAL Aftercare With Cc/mcc 28 13 — — $33,174.97 $33,174.97 $33,174.97 2026-03-23
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
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
560 LOCAL Aftercare, Musculoskeletal System And Connective Tissue With Cc 28 13 — — $32,819.66 $32,819.66 $32,819.66 2026-03-23
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
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
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
D0904 HCPCS Other Orthopedic M <44.5- Tier Tier 3 10 4 — — $28,823.33 $35,291.00 $32,026.21 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
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
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
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
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
C0904 HCPCS Other Orthopedic M <44.5- Tier Tier 2 10 4 — — $30,513.02 $30,513.02 $30,513.02 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
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
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
A1004 HCPCS Amputation Lower Extremity M <47.50- Tier None 6 4 — — $29,654.73 $29,654.73 $29,654.73 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
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
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
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
D1404 HCPCS Cardiac M <45.50- Tier Tier 3 6 4 — — $28,653.10 $28,653.10 $28,653.10 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
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
699 LOCAL Other Kidney And Urinary Tract Diagnoses With Cc 28 13 — — $28,340.85 $28,340.85 $28,340.85 2026-03-23
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
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
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
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
920 LOCAL Complications Of Treatment With Cc* 28 13 — — $27,125.90 $27,125.90 $27,125.90 2026-03-23
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
862 LOCAL Postoperative And Post-traumatic Infections With Mcc 28 13 — — $10,635.23 $43,249.95 $26,942.59 2026-03-23
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
A1404 HCPCS Cardiac M <45.50- Tier None 6 4 — — $26,348.81 $26,348.81 $26,348.81 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
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
A0904 HCPCS Other Orthopedic M <44.5- Tier None 10 4 — — $2,629.51 $26,295.06 $26,295.06 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
917 LOCAL Poisoning And Toxic Effects Of Drugs With Mcc* 28 13 — — $21,332.78 $21,332.78 $21,332.78 2026-03-23
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
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
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
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
D0601 HCPCS Neurological M >=64.50- Tier Tier 3 4 4 — — $20,024.24 $20,024.24 $20,024.24 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
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
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
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
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
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
D0101 HCPCS Stroke M >=72.50- Tier Tier 3 4 4 — — $15,990.49 $15,990.49 $15,990.49 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
200 LOCAL Pneumothorax With Cc 28 13 — — $15,139.39 $15,139.39 $15,139.39 2026-03-23
D1401 HCPCS Cardiac M >=68.50- Tier Tier 3 4 4 — — $14,456.46 $14,456.46 $14,456.46 2026-09-09
371 LOCAL Major Gastrointestinal Disorders And Peritoneal Infections With Mcc* 28 13 — — $8,693.32 $8,693.32 $8,693.32 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
0180 RC Leave Of Absence - General Classification 25 10 — — $1,800.00 $1,800.00 $1,800.00 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
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
0138 RC Room & Board - Three And Four Beds - Rehabilitation 8 3 — — $1,772.50 $1,772.50 $1,772.50 2026-03-23
0118 RC Room & Board - Private (One Bed) - Rehabilitation 8 3 — — $1,500.00 $1,700.00 $1,500.00 2026-03-23
951 LOCAL Other Factors Influencing Health Status 28 13 — — $1,376.31 $1,376.31 $1,376.31 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
0805 RC Inpatient Renal Dialysis - Treatment 2 1 — — $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
0806 RC Inpatient Renal Dialysis - Continuation 2 1 — — $600.00 $600.00 $600.00 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
97161 HCPCS Pt Eval Low Complex 20 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
96105 HCPCS Assessment Of Aphasia 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
97162 HCPCS Pt Eval Mod Complex 30 Min 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
92522 HCPCS Evaluate Speech Production 28 6 — — $150.00 $150.00 $150.00 2026-09-09
92521 HCPCS Evaluation Of Speech Fluency 2 1 — — $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
0444 RC Speech Therapy - Language Pathology - Evaluation Or Reevaluation 6 6 — — $150.00 $150.00 $150.00 2026-03-23
0434 RC Occupational Therapy - Evaluation Or Reevaluation 13 6 — — $150.00 $150.00 $150.00 2026-03-23
0424 RC Physical Therapy - Evaluation Or Re-evaluation 13 6 — — $150.00 $150.00 $150.00 2026-03-23
97168 HCPCS Ot Re-eval Est Plan Care 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
97166 HCPCS Ot Eval Mod Complex 45 Min 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
94060 HCPCS Evaluation Of Wheezing 2 1 — — $140.00 $140.00 $140.00 2026-09-09
97112 HCPCS Neuromuscular Reeducation 28 6 — — $140.00 $140.00 $140.00 2026-09-09
97110 HCPCS Therapeutic 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
97032 HCPCS Appl Modality 1+estim Ea 15 28 6 — — $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
97113 HCPCS Aquatic Therapy/exercises 28 6 — — $140.00 $140.00 $140.00 2026-09-09
97140 HCPCS Manual Therapy 1/> Regions 28 6 — — $140.00 $140.00 $140.00 2026-09-09
94010 HCPCS Breathing Capacity Test 2 1 — — $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
97124 HCPCS Massage Therapy 28 6 — — $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
94640 HCPCS Airway Inhalation Treatment 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
92606 HCPCS Non-speech Device Service 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
92597 HCPCS Oral Speech Device Eval 2 1 — — $140.00 $140.00 $140.00 2026-09-09
92526 HCPCS Oral Function Therapy 28 6 — — $140.00 $140.00 $140.00 2026-09-09
92507 HCPCS Speech/hearing Therapy 28 6 — — $140.00 $140.00 $140.00 2026-09-09
0440 RC Speech Therapy - Language Pathology - General Classification 13 6 — — $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
0430 RC Occupational Therapy - General Classification 13 6 — — $140.00 $140.00 $140.00 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
97537 HCPCS Community/work Reintegration 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
97530 HCPCS Therapeutic Activities 28 6 — — $140.00 $140.00 $140.00 2026-09-09
88112 HCPCS Cytopath Cell Enhance Tech 0 0 — — — — — 2026-03-23
88108 HCPCS Cytopath Concentrate Tech 0 0 — — — — — 2026-03-23
84145 HCPCS Procalcitonin (pct) 0 0 — — — — — 2026-09-09
87880 HCPCS Strep A Assay W/optic 0 0 — — — — — 2026-03-23
87811 HCPCS Sars-cov-2 Covid19 W/optic 0 0 — — — — — 2026-03-23
84134 HCPCS Assay Of Prealbumin 0 0 — — — — — 2026-09-09
37243 HCPCS Vasc Embolize/occlude Organ 0 0 — — — — — 2026-03-23
87806 HCPCS HIV Ag W/hiv1&2 Antb W/optic 0 0 — — — — — 2026-03-23
87804 HCPCS Influenza Assay W/optic 0 0 — — — — — 2026-03-23
84100 HCPCS Assay Of Phosphorus 0 0 — — — — — 2026-09-09
87651 HCPCS Strep A DNA Amp Probe 0 0 — — — — — 2026-03-23
87650 HCPCS Strep A DNA Dir Probe 0 0 — — — — — 2026-03-23
83880 HCPCS Assay Of Natriuretic Peptide 0 0 — — — — — 2026-09-09
37239 HCPCS Open/perq Place Stent Ea Add 0 0 — — — — — 2026-03-23
36902 HCPCS Intro Cath Dialysis Circuit 0 0 — — — — — 2026-03-23
87635 HCPCS Sars-cov-2 Covid-19 Amp Prb 0 0 — — — — — 2026-09-09
87633 HCPCS Resp Virus 12-25 Targets 0 0 — — — — — 2026-09-09
83735 HCPCS Assay Of Magnesium 0 0 — — — — — 2026-09-09
87591 HCPCS N.gonorrhoeae DNA Amp Prob 0 0 — — — — — 2026-03-23
87556 HCPCS M.tuberculo DNA Amp Probe 0 0 — — — — — 2026-03-23
83036 HCPCS Hemoglobin Glycosylated A1c 0 0 — — — — — 2026-09-09
37238 HCPCS Open/perq Place Stent Same 0 0 — — — — — 2026-03-23
87493 HCPCS C Diff Amplified Probe 0 0 — — — — — 2026-09-09
87340 HCPCS Hepatitis B Surface Ag Ia 0 0 — — — — — 2026-09-09
82962 HCPCS Glucose Blood Test 0 0 — — — — — 2026-09-09
87150 HCPCS Dna/rna Amplified Probe 0 0 — — — — — 2026-03-23
87147 HCPCS Culture Type Immunologic 0 0 — — — — — 2026-03-23
82948 HCPCS Reagent Strip/blood Glucose 0 0 — — — — — 2026-09-09
37233 HCPCS Tibper Revasc W/ather Add-on 0 0 — — — — — 2026-03-23
36901 HCPCS Intro Cath Dialysis Circuit 0 0 — — — — — 2026-03-23
29125 HCPCS Apply Forearm Splint 0 0 — — — — — 2026-09-09
87116 HCPCS Mycobacteria Culture 0 0 — — — — — 2026-03-23
87106 HCPCS Fungi Identification Yeast 0 0 — — — — — 2026-03-23
82945 HCPCS Glucose Other Fluid 0 0 — — — — — 2026-09-09
94799 HCPCS Unlisted Pulmonary Svc/px 0 0 — — — — — 2026-03-23
94761 HCPCS Measure Blood Oxygen Level 0 0 — — — — — 2026-03-23
87101 HCPCS Skin Fungi Culture 0 0 — — — — — 2026-03-23
94760 HCPCS Measure Blood Oxygen Level 0 0 — — — — — 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
87088 HCPCS Urine Bacteria Culture 0 0 — — — — — 2026-03-23
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
82805 HCPCS Blood Gases W/o2 Saturation 0 0 — — — — — 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
37232 HCPCS Tib/per Revasc Add-on 0 0 — — — — — 2026-03-23
87086 HCPCS Urine Culture/colony Count 0 0 — — — — — 2026-09-09
87077 HCPCS Culture Aerobic Identify 0 0 — — — — — 2026-03-23
82803 HCPCS Blood Gases Any Combination 0 0 — — — — — 2026-09-09
94003 HCPCS Vent Mgmt Inpat Subq Day 0 0 — — — — — 2026-09-09
94002 HCPCS Vent Mgmt Inpat Init Day 0 0 — — — — — 2026-09-09
97130 HCPCS Ther Ivntj Ea Addl 15 Min 0 0 — — — — — 2026-09-09
87070 HCPCS Culture Othr Specimn Aerobic 0 0 — — — — — 2026-09-09
93990 HCPCS Doppler Flow Testing 0 0 — — — — — 2026-03-23
93985 HCPCS Dup-scan Hemo Compl Bi Std 0 0 — — — — — 2026-03-23
87040 HCPCS Blood Culture For Bacteria 0 0 — — — — — 2026-09-09
82728 HCPCS Assay Of Ferritin 0 0 — — — — — 2026-09-09
37229 HCPCS Tib/per Revasc W/ather 0 0 — — — — — 2026-03-23
36832 HCPCS Av Fistula Revision Open 0 0 — — — — — 2026-03-23
93971 HCPCS Extremity Study 0 0 — — — — — 2026-09-09
93970 HCPCS Extremity Study 0 0 — — — — — 2026-09-09
86905 HCPCS Blood Typing Rbc Antigens 0 0 — — — — — 2026-09-09
93930 HCPCS Upper Extremity Study 0 0 — — — — — 2026-03-23
93926 HCPCS Lower Extremity Study 0 0 — — — — — 2026-09-09
86304 HCPCS Immunoassay Tumor Ca 125 0 0 — — — — — 2026-03-23
82330 HCPCS Assay Of Calcium 0 0 — — — — — 2026-09-09
93925 HCPCS Lower Extremity Study 0 0 — — — — — 2026-03-23
93880 HCPCS Extracranial Bilat Study 0 0 — — — — — 2026-03-23
86301 HCPCS Immunoassay Tumor Ca 19-9 0 0 — — — — — 2026-03-23
93798 HCPCS Cardiac Rehab/monitor 0 0 — — — — — 2026-03-23
93572 HCPCS Heart Flow Reserve Measure 0 0 — — — — — 2026-03-23
86300 HCPCS Immunoassay Tumor Ca 15-3 0 0 — — — — — 2026-03-23
81001 HCPCS Urinalysis Auto W/scope 0 0 — — — — — 2026-09-09
37228 HCPCS Tib/per Revasc W/tla 0 0 — — — — — 2026-03-23
93571 HCPCS Heart Flow Reserve Measure 0 0 — — — — — 2026-03-23
93460 HCPCS R&l Hrt Art/ventricle Angio 0 0 — — — — — 2026-03-23
86256 HCPCS Fluorescent Antibody Titer 0 0 — — — — — 2026-03-23
93459 HCPCS L Hrt Art/grft Angio 0 0 — — — — — 2026-03-23
93458 HCPCS L Hrt Artery/ventricle Angio 0 0 — — — — — 2026-03-23
86235 HCPCS Nuclear Antigen Antibody 0 0 — — — — — 2026-03-23
80202 HCPCS Assay Of Vancomycin 0 0 — — — — — 2026-09-09
93454 HCPCS Coronary Artery Angio S&i 0 0 — — — — — 2026-03-23
93312 HCPCS Echo Transesophageal 0 0 — — — — — 2026-03-23
86225 HCPCS DNA Antibody Native 0 0 — — — — — 2026-03-23
93308 HCPCS Tte F-up Or Lmtd 0 0 — — — — — 2026-03-23
93306 HCPCS Tte W/doppler Complete 0 0 — — — — — 2026-03-23
86140 HCPCS C-reactive Protein 0 0 — — — — — 2026-09-09
80069 HCPCS Renal Function Panel 0 0 — — — — — 2026-09-09
37225 HCPCS Fem/popl Revas W/ather 0 0 — — — — — 2026-03-23
36830 HCPCS Artery-vein Nonautograft 0 0 — — — — — 2026-03-23
20561 HCPCS Ndl Insj Without Njx 3+ Musc 0 0 — — — — — 2026-09-09
0671T CPT Insj Ant Sgm Aq DRG Dev 1+ 0 0 — — — — — 2026-03-23
93226 HCPCS ECG Monit/reprt Up To 48 Hrs 0 0 — — — — — 2026-03-23
93225 HCPCS ECG Monit/reprt Up To 48 Hrs 0 0 — — — — — 2026-03-23
86038 HCPCS Antinuclear Antibodies 0 0 — — — — — 2026-03-23
93017 HCPCS Cardiovascular Stress Test 0 0 — — — — — 2026-03-23
93005 HCPCS Electrocardiogram Tracing 0 0 — — — — — 2026-03-23
86022 HCPCS Platelet Antibodies 0 0 — — — — — 2026-03-23
80053 HCPCS Comprehen Metabolic Panel 0 0 — — — — — 2026-09-09
92978 HCPCS Endoluminl Ivus Oct C 1st 0 0 — — — — — 2026-03-23
92960 HCPCS Cardioversion Electric Ext 0 0 — — — — — 2026-03-23
85730 HCPCS Thromboplastin Time Partial 0 0 — — — — — 2026-03-23
92950 HCPCS Heart/lung Resuscitation Cpr 0 0 — — — — — 2026-03-23
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