Price Transparency Hospital negotiated rates

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

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Hospital

Utah Valley Specialty Hospital

Provo, UT · CCN 462005 · Rates published

7,925 distinct procedures filed
38 distinct payers
50,375 rate rows
2026-05-08 last MRF observed
Data quality

3,528 of 50,375 rate rows are consumer-grade (7.0%)

46,847 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 45,915
per-diem day rate — not a per-procedure price 932
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://ernesthealth.com/pricing/2026/203800889_utah-valley-specialty-hospital_standard-charges.json
Found on page https://uvsh.ernesthealth.com/price-transparency/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-05-17
Content fingerprint a5d312287a8766f9… · 15,972,860 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
LOCAL 		Other Respiratory System O.r. Procedures With Mcc 10 $111,836.95 $111,836.95 $111,836.95 nat. median
$2,975
outlier · 37.6×
207
LOCAL 		Respiratory System Diagnosis With Ventilator Support >96 Hours 10 $93,069.71 $93,069.71 $93,069.71 nat. median
$90,259
1.0× median
492
LOCAL 		Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc* 10 $74,866.50 $74,866.50 $74,866.50 nat. median
$900
outlier · 83.2×
488
LOCAL 		Knee Procedures Without Principal Diagnosis Of Infection With Cc/mcc 10 $74,866.50 $74,866.50 $74,866.50 nat. median
$900
outlier · 83.2×
539
LOCAL 		Osteomyelitis With Mcc* 10 $47,740.49 $47,740.49 $47,740.49 nat. median
$52,099
0.9× median
C0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier Tier 2 6 $45,370.02 $45,370.02 $45,370.02 nat. median
$46,986
1.0× median
637
LOCAL 		Diabetes With Mcc 10 $45,011.49 $45,011.49 $45,011.49 nat. median
$43,652
1.0× median
B0604
LOCAL 		Neurological M <43.50- Tier Tier 1 6 $44,826.43 $44,826.43 $44,826.43 nat. median
$46,423
1.0× median
388
LOCAL 		Gastrointestinal Obstruction With Mcc* 10 $43,862.16 $43,862.16 $43,862.16 nat. median
$20,105
outlier · 2.2×
727
LOCAL 		Inflammation Of The Male Reproductive System With Mcc 10 $43,492.95 $43,492.95 $43,492.95 nat. median
$603
outlier · 72.1×
559
LOCAL 		Aftercare, Musculoskeletal System And Connective Tissue With Mcc 10 $43,406.18 $43,406.18 $43,406.18 nat. median
$37,365
1.2× median
B0305
LOCAL 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 1 6 $42,920.26 $42,920.26 $42,920.26 nat. median
$44,232
1.0× median
682
LOCAL 		Renal Failure With Mcc* 10 $42,592.44 $42,592.44 $42,592.44 nat. median
$2,372
outlier · 18.0×
B0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 1 6 $41,890.68 $41,890.68 $41,890.68 nat. median
$43,383
1.0× median
D0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier Tier 3 6 $41,460.49 $41,460.49 $41,460.49 nat. median
$42,703
1.0× median
393
LOCAL 		Other Digestive System Diagnoses With Mcc 10 $40,167.18 $40,167.18 $40,167.18 nat. median
$46,143
0.9× median
C0205
LOCAL 		Traumatic Brain Injury M <35.50- Tier Tier 2 6 $39,953.35 $39,953.35 $39,953.35 nat. median
$40,508
1.0× median
177
LOCAL 		Respiratory Infections And Inflammations With Mcc* 10 $39,641.16 $39,641.16 $39,641.16 nat. median
$38,266
1.0× median
A0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier None 6 $39,511.12 $39,511.12 $39,511.12 nat. median
$39,573
1.0× median
56
LOCAL 		Degenerative Nervous System Disorders With Mcc 10 $38,691.47 $38,691.47 $38,691.47 nat. median
$3,500
outlier · 11.1×
540
LOCAL 		Osteomyelitis With Cc* 10 $38,305.81 $38,305.81 $38,305.81 nat. median
$36,255
1.1× median
189
LOCAL 		Pulmonary Edema And Respiratory Failure 10 $30,808.96 $45,392.33 $38,100.64 nat. median
$8,445
outlier · 4.5×
C1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 2 6 $37,338.35 $37,338.35 $37,338.35 nat. median
$37,992
1.0× median
D0105
LOCAL 		Stroke M <41.50 And A >=84.50- Tier Tier 3 6 $37,308.85 $37,308.85 $37,308.85 nat. median
$37,662
1.0× median
B0303
LOCAL 		Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 1 6 $37,236.83 $37,236.83 $37,236.83 nat. median
$34,839
1.1× median
B0603
LOCAL 		Neurological M >=43.50 And M <52.50- Tier Tier 1 6 $35,743.79 $35,743.79 $35,743.79 nat. median
$36,931
1.0× median
D1504
LOCAL 		Pulmonary M <45.50- Tier Tier 3 6 $35,116.40 $35,116.40 $35,116.40 nat. median
$32,186
1.1× median
A0105
LOCAL 		Stroke M <41.50 And A >=84.50- Tier None 6 $34,739.40 $34,739.40 $34,739.40 nat. median
$35,375
1.0× median
C0305
LOCAL 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 2 6 $34,338.01 $34,338.01 $34,338.01 nat. median
$35,561
1.0× median
D1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3 6 $33,974.42 $33,974.42 $33,974.42 nat. median
$34,992
1.0× median
C0604
LOCAL 		Neurological M <43.50- Tier Tier 2 6 $33,560.42 $33,560.42 $33,560.42 nat. median
$34,756
1.0× median
C0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 2 6 $32,404.84 $32,404.84 $32,404.84 nat. median
$33,146
1.0× median
D0305
LOCAL 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 3 6 $32,292.78 $32,292.78 $32,292.78 nat. median
$32,319
1.0× median
C2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 2 6 $31,935.05 $31,935.05 $31,935.05 nat. median
$32,921
1.0× median
D0604
LOCAL 		Neurological M <43.50- Tier Tier 3 6 $31,330.26 $32,226.39 $31,778.33 nat. median
$32,269
1.0× median
389
LOCAL 		Gastrointestinal Obstruction With Cc* 10 $31,728.18 $31,728.18 $31,728.18 nat. median
$16
outlier · 2031.9×
D1004
LOCAL 		Amputation Lower Extremity M <47.50- Tier Tier 3 6 $31,290.66 $31,290.66 $31,290.66 nat. median
$32,228
1.0× median
C0304
LOCAL 		Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 2 6 $31,135.87 $31,135.87 $31,135.87 nat. median
$32,043
1.0× median
C0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 2 6 $30,874.87 $30,874.87 $30,874.87 nat. median
$31,818
1.0× median
D0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 3 6 $30,696.67 $30,696.67 $30,696.67 nat. median
$31,616
1.0× median
C1404
LOCAL 		Cardiac M <45.50- Tier Tier 2 6 $30,426.68 $30,426.68 $30,426.68 nat. median
$30,962
1.0× median
C2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 2 6 $30,297.08 $30,297.08 $30,297.08 nat. median
$31,232
1.0× median
D2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 3 6 $29,832.69 $29,832.69 $29,832.69 nat. median
$30,727
1.0× median
A0305
LOCAL 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier None 6 $29,730.09 $29,730.09 $29,730.09 nat. median
$30,648
1.0× median
D0104
LOCAL 		Stroke M >=41.50 And M <50.50- Tier Tier 3 6 $29,150.50 $29,150.50 $29,150.50 nat. median
$30,024
1.0× median
D2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 3 6 $29,063.68 $29,063.68 $29,063.68 nat. median
$29,151
1.0× median
D1704
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 6 $28,950.70 $28,950.70 $28,950.70 nat. median
$29,818
1.0× median
D0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 3 6 $28,777.91 $28,777.91 $28,777.91 nat. median
$29,640
1.0× median
D0304
LOCAL 		Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 3 6 $28,601.51 $28,601.51 $28,601.51 nat. median
$29,475
1.0× median
A0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier None 6 $28,360.31 $28,360.31 $28,360.31 nat. median
$29,236
1.0× median

Other procedures at this hospital

Browse this hospital's 7,925 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
             
166 LOCAL Other Respiratory System O.r. Procedures With Mcc 18 10 — — $111,836.95 $111,836.95 $111,836.95 2026-03-23
207 LOCAL Respiratory System Diagnosis With Ventilator Support >96 Hours 18 10 — — $93,069.71 $93,069.71 $93,069.71 2026-03-23
488 LOCAL Knee Procedures Without Principal Diagnosis Of Infection With Cc/mcc 18 10 — — $74,866.50 $74,866.50 $74,866.50 2026-03-23
492 LOCAL Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc* 18 10 — — $74,866.50 $74,866.50 $74,866.50 2026-03-23
539 LOCAL Osteomyelitis With Mcc* 18 10 — — $47,740.49 $47,740.49 $47,740.49 2026-03-23
C0106 LOCAL Stroke M <41.50 And A <84.50- Tier Tier 2 14 6 — — $45,370.02 $45,370.02 $45,370.02 2026-03-23
637 LOCAL Diabetes With Mcc 18 10 — — $45,011.49 $45,011.49 $45,011.49 2026-03-23
B0604 LOCAL Neurological M <43.50- Tier Tier 1 14 6 — — $44,826.43 $44,826.43 $44,826.43 2026-03-23
388 LOCAL Gastrointestinal Obstruction With Mcc* 18 10 — — $43,862.16 $43,862.16 $43,862.16 2026-03-23
727 LOCAL Inflammation Of The Male Reproductive System With Mcc 18 10 — — $43,492.95 $43,492.95 $43,492.95 2026-03-23
559 LOCAL Aftercare, Musculoskeletal System And Connective Tissue With Mcc 18 10 — — $43,406.18 $43,406.18 $43,406.18 2026-03-23
B0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 1 14 6 — — $42,920.26 $42,920.26 $42,920.26 2026-03-23
682 LOCAL Renal Failure With Mcc* 18 10 — — $42,592.44 $42,592.44 $42,592.44 2026-03-23
B0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier Tier 1 14 6 — — $41,890.68 $41,890.68 $41,890.68 2026-03-23
D0106 LOCAL Stroke M <41.50 And A <84.50- Tier Tier 3 14 6 — — $41,460.49 $41,460.49 $41,460.49 2026-03-23
393 LOCAL Other Digestive System Diagnoses With Mcc 18 10 — — $40,167.18 $40,167.18 $40,167.18 2026-03-23
C0205 LOCAL Traumatic Brain Injury M <35.50- Tier Tier 2 14 6 — — $39,953.35 $39,953.35 $39,953.35 2026-03-23
177 LOCAL Respiratory Infections And Inflammations With Mcc* 18 10 — — $39,641.16 $39,641.16 $39,641.16 2026-03-23
A0106 LOCAL Stroke M <41.50 And A <84.50- Tier None 14 6 — — $39,511.12 $39,511.12 $39,511.12 2026-03-23
56 LOCAL Degenerative Nervous System Disorders With Mcc 18 10 — — $38,691.47 $38,691.47 $38,691.47 2026-03-23
540 LOCAL Osteomyelitis With Cc* 18 10 — — $38,305.81 $38,305.81 $38,305.81 2026-03-23
189 LOCAL Pulmonary Edema And Respiratory Failure 18 10 — — $30,808.96 $45,392.33 $38,100.64 2026-03-23
C1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 2 14 6 — — $37,338.35 $37,338.35 $37,338.35 2026-03-23
D0105 LOCAL Stroke M <41.50 And A >=84.50- Tier Tier 3 14 6 — — $37,308.85 $37,308.85 $37,308.85 2026-03-23
B0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 1 14 6 — — $37,236.83 $37,236.83 $37,236.83 2026-03-23
B0603 LOCAL Neurological M >=43.50 And M <52.50- Tier Tier 1 14 6 — — $35,743.79 $35,743.79 $35,743.79 2026-03-23
D1504 LOCAL Pulmonary M <45.50- Tier Tier 3 14 6 — — $35,116.40 $35,116.40 $35,116.40 2026-03-23
A0105 LOCAL Stroke M <41.50 And A >=84.50- Tier None 14 6 — — $34,739.40 $34,739.40 $34,739.40 2026-03-23
C0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 2 14 6 — — $34,338.01 $34,338.01 $34,338.01 2026-03-23
D1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3 14 6 — — $33,974.42 $33,974.42 $33,974.42 2026-03-23
C0604 LOCAL Neurological M <43.50- Tier Tier 2 14 6 — — $33,560.42 $33,560.42 $33,560.42 2026-03-23
C0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier Tier 2 14 6 — — $32,404.84 $32,404.84 $32,404.84 2026-03-23
D0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 3 14 6 — — $32,292.78 $32,292.78 $32,292.78 2026-03-23
C2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier Tier 2 14 6 — — $31,935.05 $31,935.05 $31,935.05 2026-03-23
D0604 LOCAL Neurological M <43.50- Tier Tier 3 14 6 — — $31,330.26 $32,226.39 $31,778.33 2026-03-23
389 LOCAL Gastrointestinal Obstruction With Cc* 18 10 — — $31,728.18 $31,728.18 $31,728.18 2026-03-23
D1004 LOCAL Amputation Lower Extremity M <47.50- Tier Tier 3 14 6 — — $31,290.66 $31,290.66 $31,290.66 2026-03-23
C0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 2 14 6 — — $31,135.87 $31,135.87 $31,135.87 2026-03-23
C0904 LOCAL Other Orthopedic M <44.5- Tier Tier 2 14 6 — — $30,874.87 $30,874.87 $30,874.87 2026-03-23
D0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier Tier 3 14 6 — — $30,696.67 $30,696.67 $30,696.67 2026-03-23
C1404 LOCAL Cardiac M <45.50- Tier Tier 2 14 6 — — $30,426.68 $30,426.68 $30,426.68 2026-03-23
C2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier Tier 2 14 6 — — $30,297.08 $30,297.08 $30,297.08 2026-03-23
D2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier Tier 3 14 6 — — $29,832.69 $29,832.69 $29,832.69 2026-03-23
A0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50- Tier None 14 6 — — $29,730.09 $29,730.09 $29,730.09 2026-03-23
D0104 LOCAL Stroke M >=41.50 And M <50.50- Tier Tier 3 14 6 — — $29,150.50 $29,150.50 $29,150.50 2026-03-23
D2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier Tier 3 14 6 — — $29,063.68 $29,063.68 $29,063.68 2026-03-23
D1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 14 6 — — $28,950.70 $28,950.70 $28,950.70 2026-03-23
D0904 LOCAL Other Orthopedic M <44.5- Tier Tier 3 14 6 — — $28,777.91 $28,777.91 $28,777.91 2026-03-23
D0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 3 14 6 — — $28,601.51 $28,601.51 $28,601.51 2026-03-23
A0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier None 14 6 — — $28,360.31 $28,360.31 $28,360.31 2026-03-23
D1404 LOCAL Cardiac M <45.50- Tier Tier 3 14 6 — — $28,290.11 $28,290.11 $28,290.11 2026-03-23
463 LOCAL Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 18 10 — — $28,264.46 $28,264.46 $28,264.46 2026-03-23
A0604 LOCAL Neurological M <43.50- Tier None 14 6 — — $28,255.91 $28,255.91 $28,255.91 2026-03-23
A0104 LOCAL Stroke M >=41.50 And M <50.50- Tier None 14 6 — — $27,780.72 $27,780.72 $27,780.72 2026-03-23
D0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 3 14 6 — — $27,735.72 $27,735.72 $27,735.72 2026-03-23
D0805 LOCAL Replacement Of Lower-extremity Joint M <42.50- Tier Tier 3 14 6 — — $27,143.53 $27,143.53 $27,143.53 2026-03-23
A0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier None 14 6 — — $26,958.14 $26,958.14 $26,958.14 2026-03-23
C0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 2 14 6 — — $26,853.74 $26,853.74 $26,853.74 2026-03-23
C0603 LOCAL Neurological M >=43.50 And M <52.50- Tier Tier 2 14 6 — — $26,760.14 $26,760.14 $26,760.14 2026-03-23
D1203 LOCAL Osteoarthritis M <49.50 And A >=74.50- Tier Tier 3 14 6 — — $26,718.74 $26,718.74 $26,718.74 2026-03-23
B2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier Tier 1 14 6 — — $26,491.95 $26,491.95 $26,491.95 2026-03-23
A0904 LOCAL Other Orthopedic M <44.5- Tier None 14 6 — — $26,329.95 $26,329.95 $26,329.95 2026-03-23
A1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 14 6 — — $26,265.15 $26,265.15 $26,265.15 2026-03-23
A0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier None 14 6 — — $26,113.95 $26,113.95 $26,113.95 2026-03-23
D0603 LOCAL Neurological M >=43.50 And M <52.50- Tier Tier 3 14 6 — — $24,981.77 $24,981.77 $24,981.77 2026-03-23
D0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 3 14 6 — — $24,668.58 $24,668.58 $24,668.58 2026-03-23
D0903 LOCAL Other Orthopedic M >=44.50 And M <51.50- Tier Tier 3 14 6 — — $24,016.99 $24,016.99 $24,016.99 2026-03-23
D2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier Tier 3 14 6 — — $23,671.39 $23,671.39 $23,671.39 2026-03-23
D1403 LOCAL Cardiac M >=45.50 And M <55.50- Tier Tier 3 14 6 — — $23,634.53 $23,634.53 $23,634.53 2026-03-23
A0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier None 14 6 — — $23,250.20 $23,250.20 $23,250.20 2026-03-23
D0103 LOCAL Stroke M >=50.50 And M <63.50- Tier Tier 3 14 6 — — $22,841.61 $22,841.61 $22,841.61 2026-03-23
C2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier Tier 2 14 6 — — $21,821.74 $21,821.74 $21,821.74 2026-03-23
A0103 LOCAL Stroke M >=50.50 And M <63.50- Tier None 14 6 — — $21,767.03 $21,767.03 $21,767.03 2026-03-23
A0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50- Tier None 14 6 — — $21,688.96 $21,688.96 $21,688.96 2026-03-23
C0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier Tier 2 14 6 — — $21,578.03 $21,578.03 $21,578.03 2026-03-23
D0602 LOCAL Neurological M >=52.50 And M <64.50- Tier Tier 3 14 6 — — $21,201.84 $21,201.84 $21,201.84 2026-03-23
D0302 LOCAL Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 3 14 6 — — $21,045.35 $21,045.35 $21,045.35 2026-03-23
D1002 LOCAL Amputation Lower Extremity M >=55.50 And M <64.50- Tier Tier 3 14 6 — — $20,861.64 $20,861.64 $20,861.64 2026-03-23
D0702 LOCAL Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier Tier 3 14 6 — — $20,433.25 $20,433.25 $20,433.25 2026-03-23
D0803 LOCAL Replacement Of Lower-extremity Joint M >=51.50 And M <57.50- Tier Tier 3 14 6 — — $20,201.05 $20,201.05 $20,201.05 2026-03-23
D2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier Tier 3 14 6 — — $19,767.26 $19,767.26 $19,767.26 2026-03-23
D1402 LOCAL Cardiac M >=55.50 And M <68.50- Tier Tier 3 14 6 — — $19,553.44 $19,553.44 $19,553.44 2026-03-23
A0302 LOCAL Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier None 14 6 — — $19,322.67 $19,322.67 $19,322.67 2026-03-23
A0803 LOCAL Replacement Of Lower-extremity Joint M >=51.50 And M <57.50- Tier None 14 6 — — $18,842.08 $18,842.08 $18,842.08 2026-03-23
A0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier None 14 6 — — $18,401.08 $18,401.08 $18,401.08 2026-03-23
C0601 LOCAL Neurological M >=64.50- Tier Tier 2 14 6 — — $17,906.09 $17,906.09 $17,906.09 2026-03-23
C2001 LOCAL Miscellaneous M >=66.50- Tier Tier 2 14 6 — — $16,971.91 $16,971.91 $16,971.91 2026-03-23
D0601 LOCAL Neurological M >=64.50- Tier Tier 3 14 6 — — $16,716.31 $16,716.31 $16,716.31 2026-03-23
D0701 LOCAL Fracture Of Lower Extremity M >=61.50- Tier Tier 3 14 6 — — $16,543.52 $16,543.52 $16,543.52 2026-03-23
D2001 LOCAL Miscellaneous M >=66.50- Tier Tier 3 14 6 — — $15,854.13 $15,854.13 $15,854.13 2026-03-23
D0101 LOCAL Stroke M >=72.50- Tier Tier 3 14 6 — — $14,345.58 $14,345.58 $14,345.58 2026-03-23
A0101 LOCAL Stroke M >=72.50- Tier None 14 6 — — $13,308.97 $13,308.97 $13,308.97 2026-03-23
602 LOCAL Cellulitis With Mcc 18 10 — — $10,276.80 $10,276.80 $10,276.80 2026-03-23
949 LOCAL Aftercare With Cc/mcc 18 10 — — $9,565.96 $9,565.96 $9,565.96 2026-03-23
208 LOCAL Respiratory System Diagnosis With Ventilator Support <=96 Hours 18 10 — — $7,230.47 $7,230.47 $7,230.47 2026-03-23
A2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier None 14 6 — — $4,293.53 $4,293.53 $4,293.53 2026-03-23
698 LOCAL Other Kidney And Urinary Tract Diagnoses With Mcc 18 10 — — $3,688.79 $3,688.79 $3,688.79 2026-03-23
0180 RC Leave Of Absence - General Classification 26 12 — — $2,125.00 $2,125.00 $2,125.00 2026-03-23
0200 RC Intensive Care Unit - General Classification 31 14 — — $2,012.50 $2,012.50 $2,012.50 2026-03-23
43845 HCPCS Gastroplasty Duodenal Switch 2 1 — — $2,001.13 $2,001.13 $2,001.13 2026-03-23
0206 RC Intensive Care Unit - Intermediate ICU 31 14 — — $1,925.00 $1,925.00 $1,925.00 2026-03-23
0111 RC Room & Board - Private (One Bed) - Medical/Surgical/GYN 31 14 — — $1,862.50 $1,862.50 $1,862.50 2026-03-23
0118 RC Room & Board - Private (One Bed) - Rehabilitation 32 15 — — $1,617.50 $1,862.50 $1,862.50 2026-03-23
0120 RC Room & Board - Semi-private (Two Beds) - General Classification 31 14 — — $1,862.50 $1,862.50 $1,862.50 2026-03-23
0110 RC Room & Board - Private (One Bed) - General Classification 31 14 — — $1,825.00 $1,825.00 $1,825.00 2026-03-23
43644 HCPCS Lap Gastric Bypass/roux-en-y 2 1 — — $1,784.65 $1,784.65 $1,784.65 2026-03-23
200 OTHER R&b - Hi Obs Private 5 2 $2,875.00 — $1,698.00 $1,698.00 $1,698.00 2026-05-08
206 OTHER R&b - Intermediate Private 5 2 $2,587.50 — $1,558.00 $1,558.00 $1,558.00 2026-05-08
0158 RC Room & Board - Ward - Rehabilitation 5 3 — — $1,517.50 $1,517.50 $1,517.50 2026-03-23
0138 RC Room & Board - Three And Four Beds - Rehabilitation 5 3 — — $1,517.50 $1,517.50 $1,517.50 2026-03-23
0128 RC Room & Board - Semi-private (Two Beds) - Rehabilitation 5 3 — — $1,517.50 $1,517.50 $1,517.50 2026-03-23
0148 RC Room & Board - Deluxe Private - Rehabilitation 5 3 — — $1,517.50 $1,517.50 $1,517.50 2026-03-23
118 OTHER R&b - Private - Iru 2 1 $2,000.00 — $1,500.00 $1,500.00 $1,500.00 2026-05-08
128 OTHER R&b - Semi Pvt - Iru 2 1 $2,000.00 — $1,500.00 $1,500.00 $1,500.00 2026-05-08
0732 RC EKG/ECG (Electrocardiogram) - Telemetry 1 1 — — $1,400.00 $1,400.00 $1,400.00 2026-03-23
110 OTHER R&b - Med/surge Private 5 2 $2,156.25 — $1,341.50 $1,341.50 $1,341.50 2026-05-08
43775 HCPCS Lap Sleeve Gastrectomy 2 1 — — $1,151.93 $1,151.93 $1,151.93 2026-03-23
0801 RC Inpatient Renal Dialysis - Hemodialysis 4 3 — — $464.00 $911.00 $550.00 2026-03-23
0809 RC Inpatient Renal Dialysis - Other 1 1 — — $439.00 $439.00 $439.00 2026-03-23
0800 RC Inpatient Renal Dialysis - General Classification 1 1 — — $439.00 $439.00 $439.00 2026-03-23
0802 RC Inpatient Renal Dialysis - Peritoneal Dialysis (non-capd) 4 3 — — $350.00 $911.00 $407.00 2026-03-23
0804 RC Inpatient Renal Dialysis - Continuous Cycling Peritoneal Dialysis (ccpd) 3 2 — — $350.00 $381.00 $350.00 2026-03-23
0803 RC Inpatient Renal Dialysis - Continuous Ambulatory Peritoneal Dialysis (capd) 3 2 — — $350.00 $381.00 $350.00 2026-03-23
92522 HCPCS Evaluate Speech Production 24 13 — — $150.00 $150.00 $150.00 2026-03-23
92521 HCPCS Evaluation Of Speech Fluency 2 2 — — $150.00 $150.00 $150.00 2026-03-23
92523 HCPCS Speech Sound Lang Comprehen 24 13 — — $150.00 $150.00 $150.00 2026-03-23
96105 HCPCS Assessment Of Aphasia 24 13 — — $150.00 $150.00 $150.00 2026-03-23
92524 HCPCS Behavral Qualit Analys Voice 24 13 — — $150.00 $150.00 $150.00 2026-03-23
97162 HCPCS Pt Eval Mod Complex 30 Min 26 15 — — $65.00 $150.00 $107.50 2026-03-23
97164 HCPCS Pt Re-eval Est Plan Care 26 15 — — $65.00 $150.00 $107.50 2026-03-23
97166 HCPCS Ot Eval Mod Complex 45 Min 26 15 — — $65.00 $150.00 $107.50 2026-03-23
97163 HCPCS Pt Eval High Complex 45 Min 26 15 — — $65.00 $150.00 $107.50 2026-03-23
97167 HCPCS Ot Eval High Complex 60 Min 26 15 — — $65.00 $150.00 $107.50 2026-03-23
97168 HCPCS Ot Re-eval Est Plan Care 26 15 — — $65.00 $150.00 $107.50 2026-03-23
97161 HCPCS Pt Eval Low Complex 20 Min 26 15 — — $65.00 $150.00 $107.50 2026-03-23
97165 HCPCS Ot Eval Low Complex 30 Min 26 15 — — $65.00 $150.00 $107.50 2026-03-23
0429 RC Physical Therapy - Other 9 5 — — $75.00 $100.00 $100.00 2026-03-23
0428 RC Physical Therapy - Other 9 5 — — $75.00 $100.00 $100.00 2026-03-23
0435 RC Occupational Therapy - Treatment 9 5 — — $75.00 $100.00 $100.00 2026-03-23
0425 RC Physical Therapy - Treatment 9 5 — — $75.00 $100.00 $100.00 2026-03-23
0448 RC Speech-language Pathology - Other 9 5 — — $75.00 $100.00 $100.00 2026-03-23
0437 RC Occupational Therapy - Observation/Hourly 9 5 — — $75.00 $100.00 $100.00 2026-03-23
0445 RC Speech-language Pathology - Treatment 9 5 — — $75.00 $100.00 $100.00 2026-03-23
0438 RC Occupational Therapy - Other 9 5 — — $75.00 $100.00 $100.00 2026-03-23
0439 RC Occupational Therapy - Other 9 5 — — $75.00 $100.00 $100.00 2026-03-23
0436 RC Occupational Therapy - Continuation 9 5 — — $75.00 $100.00 $100.00 2026-03-23
0447 RC Speech-language Pathology - Observation/Hourly 9 5 — — $75.00 $100.00 $100.00 2026-03-23
0446 RC Speech-language Pathology - Continuation 9 5 — — $75.00 $100.00 $100.00 2026-03-23
0426 RC Physical Therapy - Continuation 9 5 — — $75.00 $100.00 $100.00 2026-03-23
0427 RC Physical Therapy - Observation/Hourly 9 5 — — $75.00 $100.00 $100.00 2026-03-23
0449 RC Speech Therapy - Language Pathology - Other 9 5 — — $75.00 $100.00 $100.00 2026-03-23
0434 RC Occupational Therapy - Evaluation Or Reevaluation 49 19 — — $39.00 $150.00 $94.50 2026-03-23
0424 RC Physical Therapy - Evaluation Or Re-evaluation 49 19 — — $39.00 $150.00 $94.50 2026-03-23
92605 HCPCS Ex For Nonspeech Device Rx 2 2 — — $90.00 $90.00 $90.00 2026-03-23
92606 HCPCS Non-speech Device Service 2 2 — — $90.00 $90.00 $90.00 2026-03-23
92597 HCPCS Oral Speech Device Eval 2 2 — — $90.00 $90.00 $90.00 2026-03-23
92607 HCPCS Ex For Speech Device Rx 1hr 23 12 — — $90.00 $90.00 $90.00 2026-03-23
0444 RC Speech Therapy - Language Pathology - Evaluation Or Reevaluation 47 19 — — $19.50 $150.00 $84.75 2026-03-23
0440 RC Speech Therapy - Language Pathology - General Classification 51 19 — — $65.00 $100.00 $77.50 2026-03-23
97129 HCPCS Ther Ivntj 1st 15 Min 26 15 — — $65.00 $90.00 $77.50 2026-03-23
97032 HCPCS Appl Modality 1+estim Ea 15 23 15 — — $60.00 $90.00 $75.00 2026-03-23
97113 HCPCS Aquatic Therapy/exercises 27 16 — — $60.00 $90.00 $75.00 2026-03-23
97140 HCPCS Manual Therapy 1/> Regions 27 16 — — $60.00 $90.00 $75.00 2026-03-23
97124 HCPCS Massage Therapy 27 16 — — $60.00 $90.00 $75.00 2026-03-23
97110 HCPCS Therapeutic Exercises 27 16 — — $60.00 $90.00 $75.00 2026-03-23
0443 RC Speech Therapy - Language Pathology - Group Rate 12 7 — — $65.00 $100.00 $75.00 2026-03-23
0441 RC Speech Therapy - Language Pathology - Visit Charge 14 8 — — $65.00 $100.00 $75.00 2026-03-23
0442 RC Speech Therapy - Language Pathology - Hourly Charge 12 7 — — $65.00 $100.00 $75.00 2026-03-23
0432 RC Occupational Therapy - Hourly Charge 11 6 — — $65.00 $100.00 $75.00 2026-03-23
0431 RC Occupational Therapy - Visit Charge 13 7 — — $65.00 $100.00 $75.00 2026-03-23
0433 RC Occupational Therapy - Group Rate 11 6 — — $65.00 $100.00 $75.00 2026-03-23
0422 RC Physical Therapy - Hourly Charge 11 6 — — $65.00 $100.00 $75.00 2026-03-23
0423 RC Physical Therapy - Group Rate 11 6 — — $65.00 $100.00 $75.00 2026-03-23
97112 HCPCS Neuromuscular Reeducation 27 16 — — $60.00 $90.00 $75.00 2026-03-23
97116 HCPCS Gait Training Therapy 27 16 — — $60.00 $90.00 $75.00 2026-03-23
97537 HCPCS Community/work Reintegration 26 15 — — $60.00 $90.00 $75.00 2026-03-23
97535 HCPCS Self Care Mngment Training 27 16 — — $60.00 $90.00 $75.00 2026-03-23
97530 HCPCS Therapeutic Activities 27 16 — — $60.00 $90.00 $75.00 2026-03-23
92526 HCPCS Oral Function Therapy 27 16 — — $60.00 $90.00 $75.00 2026-03-23
92507 HCPCS Speech/hearing Therapy 25 14 — — $60.00 $90.00 $75.00 2026-03-23
0421 RC Physical Therapy - Visit Charge 50 18 — — $65.00 $100.00 $70.00 2026-03-23
97037 HCPCS Appl Modality 1+lllt Po Pain 2 2 — — $65.00 $65.00 $65.00 2026-03-23
97155 HCPCS Adapt Behavior Tx Phys/qhp 2 2 — — $65.00 $65.00 $65.00 2026-03-23
97156 HCPCS Fam Adapt Bhv Tx Gdn Phy/qhp 2 2 — — $65.00 $65.00 $65.00 2026-03-23
97139 HCPCS Unlisted Therapeutic Px 2 2 — — $65.00 $65.00 $65.00 2026-03-23
97172 HCPCS Athletic Trn Re-eval Plan Cr 2 2 — — $65.00 $65.00 $65.00 2026-03-23
97763 HCPCS Orthc/prostc Mgmt Sbsq Enc 25 14 — — $65.00 $65.00 $65.00 2026-03-23
97153 HCPCS Adaptive Behavior Tx By Tech 2 2 — — $65.00 $65.00 $65.00 2026-03-23
S8948 HCPCS Low-level Laser Trmt 15 Min 2 2 — — $65.00 $65.00 $65.00 2026-03-23
S9124 HCPCS Nursing Care, In The Home; B 2 2 — — $65.00 $65.00 $65.00 2026-03-23
S8990 HCPCS Pt Or Manip For Maint 2 2 — — $65.00 $65.00 $65.00 2026-03-23
S9150 HCPCS Evaluation By Ocularist 2 2 — — $65.00 $65.00 $65.00 2026-03-23
S9131 HCPCS Pt In The Home Per Diem 2 2 — — $65.00 $65.00 $65.00 2026-03-23
S9152 HCPCS Speech Therapy, Re-eval 2 2 — — $65.00 $65.00 $65.00 2026-03-23
S9126 HCPCS Hospice Care, In The Home, P 2 2 — — $65.00 $65.00 $65.00 2026-03-23
S9125 HCPCS Respite Care, In The Home, P 2 2 — — $65.00 $65.00 $65.00 2026-03-23
S9127 HCPCS Social Work Visit, In The Ho 2 2 — — $65.00 $65.00 $65.00 2026-03-23
S9122 HCPCS Home Health Aide Or Certifie 2 2 — — $65.00 $65.00 $65.00 2026-03-23
S9123 HCPCS Nursing Care In Home Rn 2 2 — — $65.00 $65.00 $65.00 2026-03-23
S9128 HCPCS Speech Therapy, In The Home, 2 2 — — $65.00 $65.00 $65.00 2026-03-23
S9129 HCPCS Occupational Therapy, In The 2 2 — — $65.00 $65.00 $65.00 2026-03-23
97799 HCPCS Unlisted Physcl Med/rehab Px 2 2 — — $65.00 $65.00 $65.00 2026-03-23
97171 HCPCS Athletic Trn Eval High Cmplx 2 2 — — $65.00 $65.00 $65.00 2026-03-23
97157 HCPCS Mult Fam Adapt Bhv Tx Gdn 2 2 — — $65.00 $65.00 $65.00 2026-03-23
97152 HCPCS Bhv Id Suprt Assmt By 1 Tech 2 2 — — $65.00 $65.00 $65.00 2026-03-23
97154 HCPCS Grp Adapt Bhv Tx By Tech 2 2 — — $65.00 $65.00 $65.00 2026-03-23
97158 HCPCS Grp Adapt Bhv Tx By Phy/qhp 2 2 — — $65.00 $65.00 $65.00 2026-03-23
97130 HCPCS Ther Ivntj Ea Addl 15 Min 25 14 — — $65.00 $65.00 $65.00 2026-03-23
S8940 HCPCS Hippotherapy Per Session 2 2 — — $65.00 $65.00 $65.00 2026-03-23
97039 HCPCS Unlisted Modality 2 2 — — $65.00 $65.00 $65.00 2026-03-23
97151 HCPCS Bhv Id Assmt By Phys/qhp 2 2 — — $65.00 $65.00 $65.00 2026-03-23
97169 HCPCS Athletic Trn Eval Low Cmplx 2 2 — — $65.00 $65.00 $65.00 2026-03-23
S8950 HCPCS Complex Lymphedema Therapy, 2 2 — — $65.00 $65.00 $65.00 2026-03-23
97170 HCPCS Athletic Trn Eval Mod Cmplx 2 2 — — $65.00 $65.00 $65.00 2026-03-23
0430 RC Occupational Therapy - General Classification 51 19 — — $39.00 $100.00 $64.50 2026-03-23
0420 RC Physical Therapy - General Classification 51 19 — — $39.00 $100.00 $64.50 2026-03-23
97010 HCPCS Hot Or Cold Packs Therapy 3 3 — — $60.00 $65.00 $62.50 2026-03-23
97018 HCPCS Paraffin Bath Therapy 22 14 — — $60.00 $65.00 $62.50 2026-03-23
97024 HCPCS Diathermy Eg Microwave 3 3 — — $60.00 $65.00 $62.50 2026-03-23
97026 HCPCS Infrared Therapy 3 3 — — $60.00 $65.00 $62.50 2026-03-23
97546 HCPCS Work Hardening Add-on 3 3 — — $60.00 $65.00 $62.50 2026-03-23
97755 HCPCS Assistive Technology Assess 3 3 — — $60.00 $65.00 $62.50 2026-03-23
97760 HCPCS Orthotic Mgmt&traing 1st Enc 26 15 — — $60.00 $65.00 $62.50 2026-03-23
97761 HCPCS Prosthetic Traing 1st Enc 25 14 — — $60.00 $65.00 $62.50 2026-03-23
97545 HCPCS Work Hardening 3 3 — — $60.00 $65.00 $62.50 2026-03-23
97750 HCPCS Physical Performance Test 26 15 — — $60.00 $65.00 $62.50 2026-03-23
97533 HCPCS Sensory Integration 25 14 — — $60.00 $65.00 $62.50 2026-03-23
97542 HCPCS Wheelchair Mngment Training 26 15 — — $60.00 $65.00 $62.50 2026-03-23
97150 HCPCS Group Therapeutic Procedures 3 3 — — $60.00 $65.00 $62.50 2026-03-23
97036 HCPCS App Mdlty 1+hubbrd Tnk Ea 15 3 3 — — $60.00 $65.00 $62.50 2026-03-23
97035 HCPCS App Mdlty 1+ultrasound Ea 15 26 15 — — $60.00 $65.00 $62.50 2026-03-23
97028 HCPCS Ultraviolet Therapy 3 3 — — $60.00 $65.00 $62.50 2026-03-23
97016 HCPCS Vasopneumatic Device Therapy 3 3 — — $60.00 $65.00 $62.50 2026-03-23
97022 HCPCS Whirlpool Therapy 3 3 — — $60.00 $65.00 $62.50 2026-03-23
97012 HCPCS Mechanical Traction Therapy 25 14 — — $60.00 $65.00 $62.50 2026-03-23
97014 HCPCS Electric Stimulation Therapy 22 14 — — $60.00 $65.00 $62.50 2026-03-23
97033 HCPCS App Mdlty 1+iontphrsis Ea 15 22 14 — — $60.00 $65.00 $62.50 2026-03-23
97034 HCPCS App Mdlty 1+cntrst Bth Ea 15 3 3 — — $60.00 $65.00 $62.50 2026-03-23
G0129 HCPCS Php/iop Ot Service 1 1 — — $60.00 $60.00 $60.00 2026-03-23
92610 HCPCS Evaluate Swallowing Function 24 13 — — $60.00 $60.00 $60.00 2026-03-23
444 OTHER St Aac Gen Device Ea Add 30m 3 3 $130.00 — $57.50 $57.50 $57.50 2026-05-08
420 OTHER Pt Adl Slf Care Trn 15min 3 3 $100.00 — $57.50 $57.50 $57.50 2026-05-08
424 OTHER Pt Re Eval 1unit 3 3 $260.00 — $57.50 $57.50 $57.50 2026-05-08
430 OTHER Ot Adl Slf Care Trn 15min 3 3 $111.00 — $57.50 $57.50 $57.50 2026-05-08
440 OTHER St Biofeedback 1unit 3 3 $126.00 — $57.50 $57.50 $57.50 2026-05-08
0300 RC Laboratory - General Classification 21 13 — — $41.57 $41.57 $41.57 2026-03-23
80053 HCPCS Comprehen Metabolic Panel 19 11 — — $30.15 $30.15 $30.15 2026-03-23
87086 HCPCS Urine Culture/colony Count 19 11 — — $23.03 $23.03 $23.03 2026-03-23
85025 HCPCS Complete Cbc W/auto Diff Wbc 19 11 — — $22.19 $22.19 $22.19 2026-03-23
87070 HCPCS Culture Othr Specimn Aerobic 19 11 — — $19.66 $19.66 $19.66 2026-03-23
0410 RC Respiratory Services - General Classification 25 14 — — $3.20 $3.20 $3.20 2026-03-23
12045 HCPCS Intmd Rpr N-hf/genit12.6-20 0 0 — — — — — 2026-03-23
12044 HCPCS Intmd Rpr N-hf/genit7.6-12.5 0 0 — — — — — 2026-03-23
0785T HCPCS Revj/rmvl Nea Spi W/nstim 0 0 — — — — — 2026-03-23
12042 HCPCS Intmd Rpr N-hf/genit2.6-7.5 0 0 — — — — — 2026-03-23
12041 HCPCS Intmd Rpr N-hf/genit 2.5cm/< 0 0 — — — — — 2026-03-23
0784T HCPCS Ins/rplmt Eltrd Ra Spi Nstim 0 0 — — — — — 2026-03-23
0511T HCPCS Rmvl&rinsj Sinus Tarsi Implt 0 0 — — — — — 2026-03-23
12037 HCPCS Intmd Rpr S/tr/ext >30.0 Cm 0 0 — — — — — 2026-03-23
12036 HCPCS Intmd Rpr S/a/t/ext 20.1-30 0 0 — — — — — 2026-03-23
0737T HCPCS Xenograft Impltj Artclr Surf 0 0 — — — — — 2026-03-23
12035 HCPCS Intmd Rpr S/a/t/ext 12.6-20 0 0 — — — — — 2026-03-23
12034 HCPCS Intmd Rpr S/tr/ext 7.6-12.5 0 0 — — — — — 2026-03-23
0718T HCPCS Adrc Ther Prtl Rc Tear Njx 0 0 — — — — — 2026-03-23
0510T HCPCS Rmvl Sinus Tarsi Implant 0 0 — — — — — 2026-03-23
0308T HCPCS Insj Ocular Telescope Prosth 0 0 — — — — — 2026-03-23
12032 HCPCS Intmd Rpr S/a/t/ext 2.6-7.5 0 0 — — — — — 2026-03-23
12031 HCPCS Intmd Rpr S/a/t/ext 2.5 Cm/< 0 0 — — — — — 2026-03-23
0717T HCPCS Adrc Ther Prtl Rc Tear 0 0 — — — — — 2026-03-23
12021 HCPCS Tx Supfc Wnd Dehsn W/packing 0 0 — — — — — 2026-03-23
12020 HCPCS Tx Supfc Wnd Dehsn Smpl Clsr 0 0 — — — — — 2026-03-23
0714T HCPCS Tprnl Lsr Ablt B9 Prst8 Hypr 0 0 — — — — — 2026-03-23
0479T HCPCS Fxjl Abl Lsr 1st 100 Sq Cm 0 0 — — — — — 2026-03-23
12018 HCPCS Rpr F/e/e/n/l/m >30.0 Cm 0 0 — — — — — 2026-03-23
12017 HCPCS Rpr Fe/e/en/l/m 20.1-30.0 Cm 0 0 — — — — — 2026-03-23
0707T HCPCS Njx B1 Sub Mtrl Sbchdrl Dfct 0 0 — — — — — 2026-03-23
12016 HCPCS Rpr Fe/e/en/l/m 12.6-20.0 Cm 0 0 — — — — — 2026-03-23
12015 HCPCS Rpr F/e/e/n/l/m 7.6-12.5 Cm 0 0 — — — — — 2026-03-23
0699T HCPCS Njx Pst Chmbr Eye Medication 0 0 — — — — — 2026-03-23
0449T HCPCS Insj Aqueous Drain Dev 1st 0 0 — — — — — 2026-03-23
0275T HCPCS Perq Lamot/lam Lumbar 0 0 — — — — — 2026-03-23
0200T HCPCS Perq Sacral Augmt Unilat Inj 0 0 — — — — — 2026-03-23
12013 HCPCS Rpr F/e/e/n/l/m 2.6-5.0 Cm 0 0 — — — — — 2026-03-23
12011 HCPCS Rpr F/e/e/n/l/m 2.5 Cm/< 0 0 — — — — — 2026-03-23
0698T HCPCS Quan Mr Tiss W/mri Mlt Orgn 0 0 — — — — — 2026-03-23
12007 HCPCS Rpr S/n/ax/gen/trnk >30.0 Cm 0 0 — — — — — 2026-03-23
12006 HCPCS Rpr S/n/a/gen/trk20.1-30.0cm 0 0 — — — — — 2026-03-23
0697T HCPCS Quan Mr Tis Wo MRI Mlt Orgn 0 0 — — — — — 2026-03-23
0448T HCPCS Remvl Insj Impltbl Gluc Sens 0 0 — — — — — 2026-03-23
12005 HCPCS Rpr S/n/a/gen/trk12.6-20.0cm 0 0 — — — — — 2026-03-23
12004 HCPCS Rpr S/n/ax/gen/trk7.6-12.5cm 0 0 — — — — — 2026-03-23
0689T HCPCS Quan US Tis Charac Without Dx US 0 0 — — — — — 2026-03-23
12002 HCPCS Rpr S/n/ax/gen/trnk2.6-7.5cm 0 0 — — — — — 2026-03-23
12001 HCPCS Rpr S/n/ax/gen/trnk 2.5cm/< 0 0 — — — — — 2026-03-23
0686T HCPCS Histotripsy Mal Hepatcel Tis 0 0 — — — — — 2026-03-23
0447T HCPCS Rmvl Impltbl Glucose Sensor 0 0 — — — — — 2026-03-23
0274T HCPCS Perq Lamot/lam Crv/thrc 0 0 — — — — — 2026-03-23
11976 HCPCS Remove Contraceptive Capsule 0 0 — — — — — 2026-03-23
11971 HCPCS Rmvl Tis Xpndr Wo Insj Implt 0 0 — — — — — 2026-03-23
0682T HCPCS Removal Pulse Gen Only Isdss 0 0 — — — — — 2026-03-23
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