Price Transparencybeta 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

Northern Utah Rehabilitation Hospital

South Ogden, UT · CCN 463027 · Rates published

1,125 distinct procedures filed
17 distinct payers
12,931 rate rows
2026-03-17 last MRF observed
Data quality

3,339 of 12,931 rate rows are consumer-grade (25.8%)

9,592 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 9,426
per-diem day rate — not a per-procedure price 166
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://nurh.ernesthealth.com/wp-content/uploads/sites/20/2024/12/462249421_Northern-Utah-Rehabilitation-Hospital_Standard-Charges.csv
Found on page https://nurh.ernesthealth.com/price-transparency/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-12
Content fingerprint d8a3f179f0a6f686… · 2,676,650 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
C0407
HCPCS 		Traumatic Spinal Cord Injury M <24.50 And A >=61.50- Tier Tier 2 7 $66,695.03 $66,695.03 $66,695.03 nat. median
$70,140
1.0× median
D0106
HCPCS 		Stroke M <41.50 And A <84.50- Tier Tier 3 7 $40,043.84 $92,165.98 $66,104.91 nat. median
$43,154
1.5× median
C1806
HCPCS 		Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier Tier 2 7 $59,721.80 $59,721.80 $59,721.80 nat. median
$53,054
1.1× median
B0106
HCPCS 		Stroke M <41.50 And A <84.50- Tier Tier 1 7 $51,557.95 $51,557.95 $51,557.95 nat. median
$53,961
1.0× median
D1904
HCPCS 		Guillain-barré M <38.50- Tier Tier 3 7 $46,555.43 $46,555.43 $46,555.43 nat. median
$49,620
0.9× median
B1705
HCPCS 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 1 7 $46,512.85 $46,512.85 $46,512.85 nat. median
$48,739
1.0× median
B1504
HCPCS 		Pulmonary M <45.50- Tier Tier 1 7 $44,184.06 $44,184.06 $44,184.06 nat. median
$44,462
1.0× median
B0305
HCPCS 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 1 7 $42,299.73 $42,299.73 $42,299.73 nat. median
$44,642
0.9× median
C0505
HCPCS 		Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 2 7 $41,627.40 $41,627.40 $41,627.40 nat. median
$45,226
0.9× median
B0704
HCPCS 		Fracture Of Lower Extremity M <41.50- Tier Tier 1 7 $41,285.03 $41,285.03 $41,285.03 nat. median
$43,685
0.9× median
B1004
HCPCS 		Amputation Lower Extremity M <47.50- Tier Tier 1 7 $40,820.26 $40,820.26 $40,820.26 nat. median
$44,520
0.9× median
A0106
HCPCS 		Stroke M <41.50 And A <84.50- Tier None 7 $38,939.88 $38,939.88 $38,939.88 nat. median
$41,163
0.9× median
D0505
HCPCS 		Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 3 7 $38,454.56 $38,454.56 $38,454.56 nat. median
$42,098
0.9× median
B2005
HCPCS 		Miscellaneous M <46.50 And A <77.50- Tier Tier 1 7 $38,079.24 $38,079.24 $38,079.24 nat. median
$41,981
0.9× median
B0904
HCPCS 		Other Orthopedic M <44.5- Tier Tier 1 7 $37,990.82 $37,990.82 $37,990.82 nat. median
$42,433
0.9× median
B2004
HCPCS 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 1 7 $37,382.35 $37,382.35 $37,382.35 nat. median
$40,123
0.9× median
C0205
HCPCS 		Traumatic Brain Injury M <35.50- Tier Tier 2 7 $37,299.34 $37,299.34 $37,299.34 nat. median
$41,221
0.9× median
B1305
HCPCS 		Rheumatoid Other Arthritis M <51.50 And A <64.50- Tier Tier 1 7 $36,381.85 $36,381.85 $36,381.85 nat. median
$41,688
0.9× median
D0105
HCPCS 		Stroke M <41.50 And A >=84.50- Tier Tier 3 7 $35,924.17 $35,924.17 $35,924.17 nat. median
$38,427
0.9× median
B0603
HCPCS 		Neurological M >=43.50 And M <52.50- Tier Tier 1 7 $35,227.01 $35,227.01 $35,227.01 nat. median
$37,050
1.0× median
D0205
HCPCS 		Traumatic Brain Injury M <35.50- Tier Tier 3 7 $35,014.14 $35,014.14 $35,014.14 nat. median
$37,471
0.9× median
A0105
HCPCS 		Stroke M <41.50 And A >=84.50- Tier None 7 $34,237.15 $34,237.15 $34,237.15 nat. median
$36,596
0.9× median
C1004
HCPCS 		Amputation Lower Extremity M <47.50- Tier Tier 2 7 $33,759.96 $33,759.96 $33,759.96 nat. median
$36,992
0.9× median
A0405
HCPCS 		Traumatic Spinal Cord Injury M >=31.50 And M <41.50- Tier None 7 $33,724.48 $33,724.48 $33,724.48 nat. median
$35,062
1.0× median
D1705
HCPCS 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3 7 $33,483.22 $33,483.22 $33,483.22 nat. median
$71
outlier · 474.7×
A0205
HCPCS 		Traumatic Brain Injury M <35.50- Tier None 7 $32,965.23 $32,965.23 $32,965.23 nat. median
$35,382
0.9× median
C0305
HCPCS 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 2 7 $32,337.57 $32,337.57 $32,337.57 nat. median
$35,651
0.9× median
C0704
HCPCS 		Fracture Of Lower Extremity M <41.50- Tier Tier 2 7 $31,936.34 $31,936.34 $31,936.34 nat. median
$34,601
0.9× median
B0903
HCPCS 		Other Orthopedic M >=44.50 And M <51.50- Tier Tier 1 7 $31,705.73 $31,705.73 $31,705.73 nat. median
$35,388
0.9× median
C2005
HCPCS 		Miscellaneous M <46.50 And A <77.50- Tier Tier 2 7 $31,473.34 $31,473.34 $31,473.34 nat. median
$33,749
0.9× median
B0303
HCPCS 		Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 1 7 $31,440.59 $31,440.59 $31,440.59 nat. median
$35,035
0.9× median
B2003
HCPCS 		Miscellaneous M >=46.50 And M <55.50- Tier Tier 1 7 $31,265.79 $31,265.79 $31,265.79 nat. median
$33,095
0.9× median
B1403
HCPCS 		Cardiac M >=45.50 And M <55.50- Tier Tier 1 7 $31,065.33 $31,065.33 $31,065.33 nat. median
$32,872
0.9× median
C0304
HCPCS 		Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 2 7 $30,685.71 $30,685.71 $30,685.71 nat. median
$32,700
0.9× median
D1004
HCPCS 		Amputation Lower Extremity M <47.50- Tier Tier 3 7 $30,221.50 $30,838.27 $30,529.88 nat. median
$33,575
0.9× median
C0604
HCPCS 		Neurological M <43.50- Tier Tier 2 7 $27,839.78 $33,075.21 $30,457.49 nat. median
$35,373
0.9× median
A1705
HCPCS 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier None 7 $30,377.04 $30,377.04 $30,377.04 nat. median
$32,738
0.9× median
D0305
HCPCS 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 3 7 $29,544.69 $31,086.62 $30,315.65 nat. median
$32,729
0.9× median
D0704
HCPCS 		Fracture Of Lower Extremity M <41.50- Tier Tier 3 7 $30,252.87 $30,252.87 $30,252.87 nat. median
$30,260
1.0× median
C2004
HCPCS 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 2 7 $29,859.05 $29,859.05 $29,859.05 nat. median
$32,081
0.9× median
D0604
HCPCS 		Neurological M <43.50- Tier Tier 3 7 $28,755.43 $30,877.30 $29,816.37 nat. median
$107
outlier · 279.4×
D2005
HCPCS 		Miscellaneous M <46.50 And A <77.50- Tier Tier 3 7 $29,401.37 $29,401.37 $29,401.37 nat. median
$31,377
0.9× median
C0904
HCPCS 		Other Orthopedic M <44.5- Tier Tier 2 7 $29,317.81 $29,421.14 $29,369.47 nat. median
$32,428
0.9× median
A1504
HCPCS 		Pulmonary M <45.50- Tier None 7 $28,808.87 $28,808.87 $28,808.87 nat. median
$32,028
0.9× median
D0104
HCPCS 		Stroke M >=41.50 And M <50.50- Tier Tier 3 7 $28,729.05 $28,729.05 $28,729.05 nat. median
$30,758
0.9× median
D0904
HCPCS 		Other Orthopedic M <44.5- Tier Tier 3 7 $28,361.84 $28,361.84 $28,361.84 nat. median
$30,444
0.9× median
D0304
HCPCS 		Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 3 7 $28,187.99 $28,187.99 $28,187.99 nat. median
$30,379
0.9× median
A0704
HCPCS 		Fracture Of Lower Extremity M <41.50- Tier None 7 $27,950.29 $27,950.29 $27,950.29 nat. median
$30,144
0.9× median
D2004
HCPCS 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 3 7 $27,893.52 $27,893.52 $27,893.52 nat. median
$29,889
0.9× median
D1404
HCPCS 		Cardiac M <45.50- Tier Tier 3 7 $27,881.10 $27,881.10 $27,881.10 nat. median
$30,122
0.9× median

Other procedures at this hospital

Browse this hospital's 1,125 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
             
C0407 HCPCS Traumatic Spinal Cord Injury M <24.50 And A >=61.50- Tier Tier 2 17 7 — — $66,695.03 $66,695.03 $66,695.03 2026-03-17
D0106 HCPCS Stroke M <41.50 And A <84.50- Tier Tier 3 17 7 — — $40,043.84 $92,165.98 $66,104.91 2026-03-17
C1806 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier Tier 2 17 7 — — $59,721.80 $59,721.80 $59,721.80 2026-03-17
B0106 HCPCS Stroke M <41.50 And A <84.50- Tier Tier 1 17 7 — — $51,557.95 $51,557.95 $51,557.95 2026-03-17
D1904 HCPCS Guillain-barré M <38.50- Tier Tier 3 17 7 — — $46,555.43 $46,555.43 $46,555.43 2026-03-17
B1705 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 1 17 7 — — $46,512.85 $46,512.85 $46,512.85 2026-03-17
B1504 HCPCS Pulmonary M <45.50- Tier Tier 1 17 7 — — $44,184.06 $44,184.06 $44,184.06 2026-03-17
B0305 HCPCS Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 1 17 7 — — $42,299.73 $42,299.73 $42,299.73 2026-03-17
C0505 HCPCS Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 2 17 7 — — $41,627.40 $41,627.40 $41,627.40 2026-03-17
B0704 HCPCS Fracture Of Lower Extremity M <41.50- Tier Tier 1 17 7 — — $41,285.03 $41,285.03 $41,285.03 2026-03-17
B1004 HCPCS Amputation Lower Extremity M <47.50- Tier Tier 1 17 7 — — $40,820.26 $40,820.26 $40,820.26 2026-03-17
A0106 HCPCS Stroke M <41.50 And A <84.50- Tier None 17 7 — — $38,939.88 $38,939.88 $38,939.88 2026-03-17
D0505 HCPCS Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 3 17 7 — — $38,454.56 $38,454.56 $38,454.56 2026-03-17
B2005 HCPCS Miscellaneous M <46.50 And A <77.50- Tier Tier 1 17 7 — — $38,079.24 $38,079.24 $38,079.24 2026-03-17
B0904 HCPCS Other Orthopedic M <44.5- Tier Tier 1 17 7 — — $37,990.82 $37,990.82 $37,990.82 2026-03-17
B2004 HCPCS Miscellaneous M <46.50 And A >=77.50- Tier Tier 1 17 7 — — $37,382.35 $37,382.35 $37,382.35 2026-03-17
C0205 HCPCS Traumatic Brain Injury M <35.50- Tier Tier 2 17 7 — — $37,299.34 $37,299.34 $37,299.34 2026-03-17
B1305 HCPCS Rheumatoid Other Arthritis M <51.50 And A <64.50- Tier Tier 1 17 7 — — $36,381.85 $36,381.85 $36,381.85 2026-03-17
D0105 HCPCS Stroke M <41.50 And A >=84.50- Tier Tier 3 17 7 — — $35,924.17 $35,924.17 $35,924.17 2026-03-17
B0603 HCPCS Neurological M >=43.50 And M <52.50- Tier Tier 1 17 7 — — $35,227.01 $35,227.01 $35,227.01 2026-03-17
D0205 HCPCS Traumatic Brain Injury M <35.50- Tier Tier 3 17 7 — — $35,014.14 $35,014.14 $35,014.14 2026-03-17
A0105 HCPCS Stroke M <41.50 And A >=84.50- Tier None 17 7 — — $34,237.15 $34,237.15 $34,237.15 2026-03-17
C1004 HCPCS Amputation Lower Extremity M <47.50- Tier Tier 2 17 7 — — $33,759.96 $33,759.96 $33,759.96 2026-03-17
A0405 HCPCS Traumatic Spinal Cord Injury M >=31.50 And M <41.50- Tier None 17 7 — — $33,724.48 $33,724.48 $33,724.48 2026-03-17
D1705 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3 17 7 — — $33,483.22 $33,483.22 $33,483.22 2026-03-17
A0205 HCPCS Traumatic Brain Injury M <35.50- Tier None 17 7 — — $32,965.23 $32,965.23 $32,965.23 2026-03-17
C0305 HCPCS Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 2 17 7 — — $32,337.57 $32,337.57 $32,337.57 2026-03-17
C0704 HCPCS Fracture Of Lower Extremity M <41.50- Tier Tier 2 17 7 — — $31,936.34 $31,936.34 $31,936.34 2026-03-17
B0903 HCPCS Other Orthopedic M >=44.50 And M <51.50- Tier Tier 1 17 7 — — $31,705.73 $31,705.73 $31,705.73 2026-03-17
C2005 HCPCS Miscellaneous M <46.50 And A <77.50- Tier Tier 2 17 7 — — $31,473.34 $31,473.34 $31,473.34 2026-03-17
B0303 HCPCS Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 1 17 7 — — $31,440.59 $31,440.59 $31,440.59 2026-03-17
B2003 HCPCS Miscellaneous M >=46.50 And M <55.50- Tier Tier 1 17 7 — — $31,265.79 $31,265.79 $31,265.79 2026-03-17
B1403 HCPCS Cardiac M >=45.50 And M <55.50- Tier Tier 1 17 7 — — $31,065.33 $31,065.33 $31,065.33 2026-03-17
C0304 HCPCS Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 2 17 7 — — $30,685.71 $30,685.71 $30,685.71 2026-03-17
D1004 HCPCS Amputation Lower Extremity M <47.50- Tier Tier 3 17 7 — — $30,221.50 $30,838.27 $30,529.88 2026-03-17
C0604 HCPCS Neurological M <43.50- Tier Tier 2 17 7 — — $27,839.78 $33,075.21 $30,457.49 2026-03-17
A1705 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier None 17 7 — — $30,377.04 $30,377.04 $30,377.04 2026-03-17
D0305 HCPCS Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 3 17 7 — — $29,544.69 $31,086.62 $30,315.65 2026-03-17
D0704 HCPCS Fracture Of Lower Extremity M <41.50- Tier Tier 3 17 7 — — $30,252.87 $30,252.87 $30,252.87 2026-03-17
C2004 HCPCS Miscellaneous M <46.50 And A >=77.50- Tier Tier 2 17 7 — — $29,859.05 $29,859.05 $29,859.05 2026-03-17
D0604 HCPCS Neurological M <43.50- Tier Tier 3 17 7 — — $28,755.43 $30,877.30 $29,816.37 2026-03-17
D2005 HCPCS Miscellaneous M <46.50 And A <77.50- Tier Tier 3 17 7 — — $29,401.37 $29,401.37 $29,401.37 2026-03-17
C0904 HCPCS Other Orthopedic M <44.5- Tier Tier 2 17 7 — — $29,317.81 $29,421.14 $29,369.47 2026-03-17
A1504 HCPCS Pulmonary M <45.50- Tier None 17 7 — — $28,808.87 $28,808.87 $28,808.87 2026-03-17
D0104 HCPCS Stroke M >=41.50 And M <50.50- Tier Tier 3 17 7 — — $28,729.05 $28,729.05 $28,729.05 2026-03-17
D0904 HCPCS Other Orthopedic M <44.5- Tier Tier 3 17 7 — — $28,361.84 $28,361.84 $28,361.84 2026-03-17
D0304 HCPCS Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 3 17 7 — — $28,187.99 $28,187.99 $28,187.99 2026-03-17
A0704 HCPCS Fracture Of Lower Extremity M <41.50- Tier None 17 7 — — $27,950.29 $27,950.29 $27,950.29 2026-03-17
D2004 HCPCS Miscellaneous M <46.50 And A >=77.50- Tier Tier 3 17 7 — — $27,893.52 $27,893.52 $27,893.52 2026-03-17
D1404 HCPCS Cardiac M <45.50- Tier Tier 3 17 7 — — $27,881.10 $27,881.10 $27,881.10 2026-03-17
D1704 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 17 7 — — $27,801.05 $27,801.05 $27,801.05 2026-03-17
A0104 HCPCS Stroke M >=41.50 And M <50.50- Tier None 17 7 — — $27,379.07 $27,379.07 $27,379.07 2026-03-17
D0204 HCPCS Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 3 17 7 — — $27,334.73 $27,334.73 $27,334.73 2026-03-17
A0604 HCPCS Neurological M <43.50- Tier None 17 7 — — $27,022.87 $27,597.99 $27,310.43 2026-03-17
D0805 HCPCS Replacement Of Lower-extremity Joint M <42.50- Tier Tier 3 17 7 — — $26,751.10 $26,751.10 $26,751.10 2026-03-17
B2002 HCPCS Miscellaneous M >=55.50 And M <66.50- Tier Tier 1 17 7 — — $26,108.93 $26,108.93 $26,108.93 2026-03-17
A2005 HCPCS Miscellaneous M <46.50 And A <77.50- Tier None 17 7 — — $25,998.49 $25,998.49 $25,998.49 2026-03-17
A1704 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 17 7 — — $25,885.41 $25,885.41 $25,885.41 2026-03-17
A0304 HCPCS Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier None 17 7 — — $25,764.35 $25,764.35 $25,764.35 2026-03-17
C0603 HCPCS Neurological M >=43.50 And M <52.50- Tier Tier 2 17 7 — — $24,751.33 $26,373.25 $25,562.29 2026-03-17
C0903 HCPCS Other Orthopedic M >=44.50 And M <51.50- Tier Tier 2 17 7 — — $25,394.03 $25,394.03 $25,394.03 2026-03-17
A2004 HCPCS Miscellaneous M <46.50 And A >=77.50- Tier None 17 7 — — $25,388.71 $25,388.71 $25,388.71 2026-03-17
A0805 HCPCS Replacement Of Lower-extremity Joint M <42.50- Tier None 17 7 — — $24,950.54 $24,950.54 $24,950.54 2026-03-17
D0603 HCPCS Neurological M >=43.50 And M <52.50- Tier Tier 3 17 7 — — $24,620.59 $24,620.59 $24,620.59 2026-03-17
D0303 HCPCS Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 3 17 7 — — $24,311.92 $24,311.92 $24,311.92 2026-03-17
D0503 HCPCS Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier Tier 3 17 7 — — $23,808.12 $23,808.12 $23,808.12 2026-03-17
D0903 HCPCS Other Orthopedic M >=44.50 And M <51.50- Tier Tier 3 17 7 — — $23,669.75 $23,669.75 $23,669.75 2026-03-17
D2003 HCPCS Miscellaneous M >=46.50 And M <55.50- Tier Tier 3 17 7 — — $23,329.16 $23,329.16 $23,329.16 2026-03-17
A2003 HCPCS Miscellaneous M >=46.50 And M <55.50- Tier None 17 7 — — $20,367.00 $25,664.55 $23,015.78 2026-03-17
A0303 HCPCS Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier None 17 7 — — $22,914.05 $22,914.05 $22,914.05 2026-03-17
A0703 HCPCS Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier None 17 7 — — $22,880.35 $22,880.35 $22,880.35 2026-03-17
A1703 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 17 7 — — $22,871.48 $22,871.48 $22,871.48 2026-03-17
D1403 HCPCS Cardiac M >=45.50 And M <55.50- Tier Tier 3 17 7 — — $22,299.31 $22,754.40 $22,526.85 2026-03-17
D0103 HCPCS Stroke M >=50.50 And M <63.50- Tier Tier 3 17 7 — — $22,511.37 $22,511.37 $22,511.37 2026-03-17
C0602 HCPCS Neurological M >=52.50 And M <64.50- Tier Tier 2 17 7 — — $22,383.64 $22,383.64 $22,383.64 2026-03-17
D0804 HCPCS Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier Tier 3 17 7 — — $22,305.59 $22,305.59 $22,305.59 2026-03-17
A0103 HCPCS Stroke M >=50.50 And M <63.50- Tier None 17 7 — — $21,452.32 $21,452.32 $21,452.32 2026-03-17
A0603 HCPCS Neurological M >=43.50 And M <52.50- Tier None 17 7 — — $21,367.28 $21,367.28 $21,367.28 2026-03-17
D1702 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 17 7 — — $21,214.61 $21,214.61 $21,214.61 2026-03-17
A0903 HCPCS Other Orthopedic M >=44.50 And M <51.50- Tier None 17 7 — — $20,981.63 $20,981.63 $20,981.63 2026-03-17
D0502 HCPCS Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50- Tier Tier 3 17 7 — — $20,771.13 $20,771.13 $20,771.13 2026-03-17
D0703 HCPCS Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 3 17 7 — — $16,747.78 $24,764.28 $20,756.03 2026-03-17
A1502 HCPCS Pulmonary M >=56.50 And M <68.50- Tier None 17 7 — — $20,469.56 $20,469.56 $20,469.56 2026-03-17
A0804 HCPCS Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier None 17 7 — — $20,387.66 $20,387.66 $20,387.66 2026-03-17
D0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 3 17 7 — — $20,205.24 $20,205.24 $20,205.24 2026-03-17
D0702 HCPCS Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier Tier 3 17 7 — — $20,137.83 $20,137.83 $20,137.83 2026-03-17
D0602 HCPCS Neurological M >=52.50 And M <64.50- Tier Tier 3 17 7 — — $20,003.74 $20,003.74 $20,003.74 2026-03-17
D2002 HCPCS Miscellaneous M >=55.50 And M <66.50- Tier Tier 3 17 7 — — $19,481.47 $19,481.47 $19,481.47 2026-03-17
D0902 HCPCS Other Orthopedic M >=51.50 And M <63.50- Tier Tier 3 17 7 — — $19,380.50 $19,380.50 $19,380.50 2026-03-17
A0602 HCPCS Neurological M >=52.50 And M <64.50- Tier None 17 7 — — $18,844.62 $18,844.62 $18,844.62 2026-03-17
D1402 HCPCS Cardiac M >=55.50 And M <68.50- Tier Tier 3 17 7 — — $18,596.27 $18,596.27 $18,596.27 2026-03-17
C0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 2 17 7 — — $14,917.78 $21,996.92 $18,457.35 2026-03-17
A0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier None 17 7 — — $18,392.28 $18,392.28 $18,392.28 2026-03-17
A2002 HCPCS Miscellaneous M >=55.50 And M <66.50- Tier None 17 7 — — $17,732.36 $17,732.36 $17,732.36 2026-03-17
A0902 HCPCS Other Orthopedic M >=51.50 And M <63.50- Tier None 17 7 — — $17,681.25 $17,681.25 $17,681.25 2026-03-17
A0904 HCPCS Other Orthopedic M <44.5- Tier None 17 7 — — $5,933.73 $25,949.27 $15,941.50 2026-03-17
D2001 HCPCS Miscellaneous M >=66.50- Tier Tier 3 17 7 — — $15,260.62 $15,260.62 $15,260.62 2026-03-17
D1703 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 17 7 — — $12,847.33 $12,847.33 $12,847.33 2026-03-17
D0407 HCPCS Traumatic Spinal Cord Injury M <24.50 And A >=61.50- Tier Tier 3 17 7 — — $6,866.76 $6,866.76 $6,866.76 2026-03-17
C0601 HCPCS Neurological M >=64.50- Tier Tier 2 17 7 — — $6,176.52 $6,176.52 $6,176.52 2026-03-17
A0702 HCPCS Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier None 17 7 — — $4,228.44 $4,228.44 $4,228.44 2026-03-17
D1401 HCPCS Cardiac M >=68.50- Tier Tier 3 17 7 — — $2,443.91 $2,443.91 $2,443.91 2026-03-17
0118 RC Room & Board - Private (One Bed) - Rehabilitation 16 7 — — $1,216.00 $1,216.00 $1,216.00 2026-03-17
0138 RC Room & Board - Three And Four Beds - Rehabilitation 15 6 — — $1,216.00 $1,216.00 $1,216.00 2026-03-17
0148 RC Room & Board - Deluxe Private - Rehabilitation 15 6 — — $1,216.00 $1,216.00 $1,216.00 2026-03-17
0158 RC Room & Board - Ward - Rehabilitation 15 6 — — $1,216.00 $1,216.00 $1,216.00 2026-03-17
0128 RC Room & Board - Semi-private (Two Beds) - Rehabilitation 15 6 — — $1,130.00 $1,130.00 $1,130.00 2026-03-17
0801 RC Inpatient Renal Dialysis - Hemodialysis 5 4 — — $427.50 $550.00 $457.00 2026-03-17
0806 RC Inpatient Renal Dialysis - Continuation 2 1 — — $427.50 $450.00 $438.75 2026-03-17
0805 RC Inpatient Renal Dialysis - Treatment 2 1 — — $427.50 $450.00 $438.75 2026-03-17
0808 RC Inpatient Renal Dialysis - Other 2 1 — — $427.50 $450.00 $438.75 2026-03-17
0807 RC Inpatient Renal Dialysis - Observation/Hourly 2 1 — — $427.50 $450.00 $438.75 2026-03-17
0809 RC Inpatient Renal Dialysis - Other 3 2 — — $413.00 $450.00 $427.50 2026-03-17
0800 RC Inpatient Renal Dialysis - General Classification 3 2 — — $413.00 $450.00 $427.50 2026-03-17
0802 RC Inpatient Renal Dialysis - Peritoneal Dialysis (non-capd) 5 4 — — $350.00 $464.00 $407.00 2026-03-17
0804 RC Inpatient Renal Dialysis - Continuous Cycling Peritoneal Dialysis (ccpd) 3 2 — — $350.00 $427.50 $406.00 2026-03-17
0803 RC Inpatient Renal Dialysis - Continuous Ambulatory Peritoneal Dialysis (capd) 3 2 — — $350.00 $427.50 $406.00 2026-03-17
97164 HCPCS Pt Re-eval Est Plan Care 37 14 — — $150.00 $150.00 $150.00 2026-03-17
96105 HCPCS Assessment Of Aphasia 36 14 — — $150.00 $150.00 $150.00 2026-03-17
92523 HCPCS Speech Sound Lang Comprehen 37 14 — — $150.00 $150.00 $150.00 2026-03-17
92522 HCPCS Evaluate Speech Production 37 14 — — $150.00 $150.00 $150.00 2026-03-17
97168 HCPCS Ot Re-eval Est Plan Care 37 14 — — $150.00 $150.00 $150.00 2026-03-17
92521 HCPCS Evaluation Of Speech Fluency 6 3 — — $150.00 $150.00 $150.00 2026-03-17
97167 HCPCS Ot Eval High Complex 60 Min 37 14 — — $150.00 $150.00 $150.00 2026-03-17
92524 HCPCS Behavral Qualit Analys Voice 37 14 — — $103.75 $150.00 $126.88 2026-03-17
97161 HCPCS Pt Eval Low Complex 20 Min 37 14 — — $100.20 $150.00 $125.10 2026-03-17
97165 HCPCS Ot Eval Low Complex 30 Min 37 14 — — $97.19 $150.00 $123.59 2026-03-17
97163 HCPCS Pt Eval High Complex 45 Min 37 14 — — $94.78 $150.00 $122.39 2026-03-17
97166 HCPCS Ot Eval Mod Complex 45 Min 37 14 — — $93.63 $150.00 $121.81 2026-03-17
97162 HCPCS Pt Eval Mod Complex 30 Min 37 14 — — $91.31 $150.00 $120.66 2026-03-17
0434 RC Occupational Therapy - Evaluation Or Reevaluation 40 16 — — $59.00 $150.00 $104.50 2026-03-17
0424 RC Physical Therapy - Evaluation Or Re-evaluation 40 16 — — $59.00 $150.00 $104.50 2026-03-17
0444 RC Speech Therapy - Language Pathology - Evaluation Or Reevaluation 40 16 — — $59.00 $150.00 $104.50 2026-03-17
97124 HCPCS Massage Therapy 37 14 — — $90.00 $90.00 $90.00 2026-03-17
97113 HCPCS Aquatic Therapy/exercises 37 14 — — $90.00 $90.00 $90.00 2026-03-17
97032 HCPCS Appl Modality 1+estim Ea 15 35 13 — — $90.00 $90.00 $90.00 2026-03-17
92607 HCPCS Ex For Speech Device Rx 1hr 37 14 — — $90.00 $90.00 $90.00 2026-03-17
92606 HCPCS Non-speech Device Service 6 3 — — $90.00 $90.00 $90.00 2026-03-17
92605 HCPCS Ex For Nonspeech Device Rx 6 3 — — $90.00 $90.00 $90.00 2026-03-17
92597 HCPCS Oral Speech Device Eval 6 3 — — $90.00 $90.00 $90.00 2026-03-17
97537 HCPCS Community/work Reintegration 36 14 — — $90.00 $90.00 $90.00 2026-03-17
96125 HCPCS Cognitive Test By Hc Pro 35 13 — — $77.39 $96.63 $87.01 2026-03-17
92526 HCPCS Oral Function Therapy 37 14 — — $80.16 $90.00 $85.08 2026-03-17
92507 HCPCS Speech/hearing Therapy 37 14 — — $72.83 $90.00 $81.42 2026-03-17
0420 RC Physical Therapy - General Classification 40 16 — — $59.00 $95.00 $77.00 2026-03-17
0430 RC Occupational Therapy - General Classification 40 16 — — $59.00 $95.00 $77.00 2026-03-17
0440 RC Speech Therapy - Language Pathology - General Classification 40 16 — — $59.00 $95.00 $77.00 2026-03-17
97112 HCPCS Neuromuscular Reeducation 37 14 — — $59.66 $90.00 $74.83 2026-03-17
0448 RC Speech-language Pathology - Other 2 2 — — $59.00 $85.00 $72.00 2026-03-17
0447 RC Speech-language Pathology - Observation/Hourly 2 2 — — $59.00 $85.00 $72.00 2026-03-17
0449 RC Speech Therapy - Language Pathology - Other 2 2 — — $59.00 $85.00 $72.00 2026-03-17
0442 RC Speech Therapy - Language Pathology - Hourly Charge 7 4 — — $59.00 $85.00 $72.00 2026-03-17
0441 RC Speech Therapy - Language Pathology - Visit Charge 7 4 — — $59.00 $85.00 $72.00 2026-03-17
0445 RC Speech-language Pathology - Treatment 2 2 — — $59.00 $85.00 $72.00 2026-03-17
0437 RC Occupational Therapy - Observation/Hourly 2 2 — — $59.00 $85.00 $72.00 2026-03-17
0433 RC Occupational Therapy - Group Rate 7 4 — — $59.00 $85.00 $72.00 2026-03-17
0432 RC Occupational Therapy - Hourly Charge 7 4 — — $59.00 $85.00 $72.00 2026-03-17
0438 RC Occupational Therapy - Other 2 2 — — $59.00 $85.00 $72.00 2026-03-17
0446 RC Speech-language Pathology - Continuation 2 2 — — $59.00 $85.00 $72.00 2026-03-17
0426 RC Physical Therapy - Continuation 2 2 — — $59.00 $85.00 $72.00 2026-03-17
0435 RC Occupational Therapy - Treatment 2 2 — — $59.00 $85.00 $72.00 2026-03-17
0436 RC Occupational Therapy - Continuation 2 2 — — $59.00 $85.00 $72.00 2026-03-17
0439 RC Occupational Therapy - Other 2 2 — — $59.00 $85.00 $72.00 2026-03-17
0425 RC Physical Therapy - Treatment 2 2 — — $59.00 $85.00 $72.00 2026-03-17
0427 RC Physical Therapy - Observation/Hourly 2 2 — — $59.00 $85.00 $72.00 2026-03-17
0443 RC Speech Therapy - Language Pathology - Group Rate 7 4 — — $59.00 $85.00 $72.00 2026-03-17
0423 RC Physical Therapy - Group Rate 7 4 — — $59.00 $85.00 $72.00 2026-03-17
0422 RC Physical Therapy - Hourly Charge 7 4 — — $59.00 $85.00 $72.00 2026-03-17
0428 RC Physical Therapy - Other 2 2 — — $59.00 $85.00 $72.00 2026-03-17
0421 RC Physical Therapy - Visit Charge 38 15 — — $59.00 $85.00 $72.00 2026-03-17
0429 RC Physical Therapy - Other 2 2 — — $59.00 $85.00 $72.00 2026-03-17
0431 RC Occupational Therapy - Visit Charge 7 4 — — $59.00 $85.00 $72.00 2026-03-17
97530 HCPCS Therapeutic Activities 36 14 — — $33.24 $90.00 $61.62 2026-03-17
97535 HCPCS Self Care Mngment Training 36 14 — — $30.85 $90.00 $60.42 2026-03-17
97116 HCPCS Gait Training Therapy 37 14 — — $26.82 $90.00 $58.41 2026-03-17
97110 HCPCS Therapeutic Exercises 37 14 — — $26.82 $90.00 $58.41 2026-03-17
97140 HCPCS Manual Therapy 1/> Regions 37 14 — — $25.32 $90.00 $57.66 2026-03-17
97129 HCPCS Ther Ivntj 1st 15 Min 37 14 — — $21.00 $90.00 $55.50 2026-03-17
A1805 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T… 0 0 — — — — — 2026-03-17
A1804 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50- T… 0 0 — — — — — 2026-03-17
A1803 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50- T… 0 0 — — — — — 2026-03-17
A1801 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=67.50- Tier None 0 0 — — — — — 2026-03-17
90999 HCPCS Unlisted Dialysis Procedure 0 0 — — — — — 2026-03-17
83036 HCPCS Hemoglobin Glycosylated A1c 0 0 — — — — — 2026-03-17
A1702 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 0 0 — — — — — 2026-03-17
A1604 HCPCS Pain Syndrome M <43.50- Tier None 0 0 — — — — — 2026-03-17
90993 HCPCS Dialysis Training Incompl 0 0 — — — — — 2026-03-17
97158 HCPCS Grp Adapt Bhv Tx By Phy/qhp 0 0 — — — — — 2026-03-17
97157 HCPCS Mult Fam Adapt Bhv Tx Gdn 0 0 — — — — — 2026-03-17
90937 HCPCS Hemodialysis Repeated Eval 0 0 — — — — — 2026-03-17
82962 HCPCS Glucose Blood Test 0 0 — — — — — 2026-03-17
73610 HCPCS X-ray Exam Of Ankle 0 0 — — — — — 2026-03-17
97156 HCPCS Fam Adapt Bhv Tx Gdn Phy/qhp 0 0 — — — — — 2026-03-17
97155 HCPCS Adapt Behavior Tx Phys/qhp 0 0 — — — — — 2026-03-17
90935 HCPCS Hemodialysis One Evaluation 0 0 — — — — — 2026-03-17
97154 HCPCS Grp Adapt Bhv Tx By Tech 0 0 — — — — — 2026-03-17
97153 HCPCS Adaptive Behavior Tx By Tech 0 0 — — — — — 2026-03-17
90676 HCPCS Rabies Vaccine Id 0 0 — — — — — 2026-03-17
82948 HCPCS Reagent Strip/blood Glucose 0 0 — — — — — 2026-03-17
97152 HCPCS Bhv Id Suprt Assmt By 1 Tech 0 0 — — — — — 2026-03-17
97151 HCPCS Bhv Id Assmt By Phys/qhp 0 0 — — — — — 2026-03-17
90675 HCPCS Rabies Vaccine IM 0 0 — — — — — 2026-03-17
97150 HCPCS Group Therapeutic Procedures 0 0 — — — — — 2026-03-17
A1201 HCPCS Osteoarthritis M >=61.50- Tier None 0 0 — — — — — 2026-03-17
90396 HCPCS Varicella-zoster Ig IM 0 0 — — — — — 2026-03-17
82945 HCPCS Glucose Other Fluid 0 0 — — — — — 2026-03-17
73560 HCPCS X-ray Exam Of Knee 1 Or 2 0 0 — — — — — 2026-03-17
70470 HCPCS CT Head/brain Without & With Contrast 0 0 — — — — — 2026-03-17
97139 HCPCS Unlisted Therapeutic Px 0 0 — — — — — 2026-03-17
97130 HCPCS Ther Ivntj Ea Addl 15 Min 0 0 — — — — — 2026-03-17
90378 HCPCS Rsv Mab IM 50mg 0 0 — — — — — 2026-03-17
A1002 HCPCS Amputation Lower Extremity M >=55.50 And M <64.50- Tier None 0 0 — — — — — 2026-03-17
A1001 HCPCS Amputation Lower Extremity M >=64.50- Tier None 0 0 — — — — — 2026-03-17
90377 HCPCS Rabies Ig Ht&sol Human Im/sc 0 0 — — — — — 2026-03-17
82805 HCPCS Blood Gases W/o2 Saturation 0 0 — — — — — 2026-03-17
A0901 HCPCS Other Orthopedic M >=63.50- Tier None 0 0 — — — — — 2026-03-17
90376 HCPCS Rabies Ig Heat Treated 0 0 — — — — — 2026-03-17
A1003 HCPCS Amputation Lower Extremity M >=47.50 And M <55.50- Tier None 0 0 — — — — — 2026-03-17
A1004 HCPCS Amputation Lower Extremity M <47.50- Tier None 0 0 — — — — — 2026-03-17
A1101 HCPCS Amputation Non-lower Extremity M >=58.50- Tier None 0 0 — — — — — 2026-03-17
A1102 HCPCS Amputation Non-lower Extremity M >=52.50 And M <58.50- Tier None 0 0 — — — — — 2026-03-17
A1103 HCPCS Amputation Non-lower Extremity M <52.50- Tier None 0 0 — — — — — 2026-03-17
A0803 HCPCS Replacement Of Lower-extremity Joint M >=51.50 And M <57.50- Tier None 0 0 — — — — — 2026-03-17
A1202 HCPCS Osteoarthritis M >=49.50 And M <61.50- Tier None 0 0 — — — — — 2026-03-17
A1203 HCPCS Osteoarthritis M <49.50 And A >=74.50- Tier None 0 0 — — — — — 2026-03-17
A1204 HCPCS Osteoarthritis M <49.50 And A <74.50- Tier None 0 0 — — — — — 2026-03-17
A1301 HCPCS Rheumatoid Other Arthritis M >=62.50- Tier None 0 0 — — — — — 2026-03-17
A1302 HCPCS Rheumatoid Other Arthritis M >=51.50 And M <62.50- Tier None 0 0 — — — — — 2026-03-17
A1303 HCPCS Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50- Tier None 0 0 — — — — — 2026-03-17
A1304 HCPCS Rheumatoid Other Arthritis M <44.50 And A >=64.50- Tier None 0 0 — — — — — 2026-03-17
A1305 HCPCS Rheumatoid Other Arthritis M <51.50 And A <64.50- Tier None 0 0 — — — — — 2026-03-17
A1401 HCPCS Cardiac M >=68.50- Tier None 0 0 — — — — — 2026-03-17
A1402 HCPCS Cardiac M >=55.50 And M <68.50- Tier None 0 0 — — — — — 2026-03-17
A1403 HCPCS Cardiac M >=45.50 And M <55.50- Tier None 0 0 — — — — — 2026-03-17
A1404 HCPCS Cardiac M <45.50- Tier None 0 0 — — — — — 2026-03-17
A1501 HCPCS Pulmonary M >=68.50- Tier None 0 0 — — — — — 2026-03-17
A0802 HCPCS Replacement Of Lower-extremity Joint M >=57.50 And M <63.50- Tier None 0 0 — — — — — 2026-03-17
A1503 HCPCS Pulmonary M >=45.50 And M <56.50- Tier None 0 0 — — — — — 2026-03-17
A0801 HCPCS Replacement Of Lower-extremity Joint M >=63.50- Tier None 0 0 — — — — — 2026-03-17
A1601 HCPCS Pain Syndrome M >=65.50- Tier None 0 0 — — — — — 2026-03-17
A1602 HCPCS Pain Syndrome M >=58.50 And M <65.50- Tier None 0 0 — — — — — 2026-03-17
A1603 HCPCS Pain Syndrome M >=43.50 And M <58.50- Tier None 0 0 — — — — — 2026-03-17
90375 HCPCS Rabies Ig Im/sc 0 0 — — — — — 2026-03-17
A1701 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50- Tier None 0 0 — — — — — 2026-03-17
82803 HCPCS Blood Gases Any Combination 0 0 — — — — — 2026-03-17
73100 HCPCS X-ray Exam Of Wrist 0 0 — — — — — 2026-03-17
97039 HCPCS Unlisted Modality 0 0 — — — — — 2026-03-17
A0701 HCPCS Fracture Of Lower Extremity M >=61.50- Tier None 0 0 — — — — — 2026-03-17
97037 HCPCS Appl Modality 1+lllt Po Pain 0 0 — — — — — 2026-03-17
A1802 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50- T… 0 0 — — — — — 2026-03-17
90371 HCPCS Hep B Ig IM 0 0 — — — — — 2026-03-17
97036 HCPCS App Mdlty 1+hubbrd Tnk Ea 15 0 0 — — — — — 2026-03-17
A0601 HCPCS Neurological M >=64.50- Tier None 0 0 — — — — — 2026-03-17
A1806 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier None 0 0 — — — — — 2026-03-17
97035 HCPCS App Mdlty 1+ultrasound Ea 15 0 0 — — — — — 2026-03-17
87635 HCPCS Sars-cov-2 Covid-19 Amp Prb 0 0 — — — — — 2026-03-17
82728 HCPCS Assay Of Ferritin 0 0 — — — — — 2026-03-17
A0505 HCPCS Non-traumatic Spinal Cord Injury M <39.50- Tier None 0 0 — — — — — 2026-03-17
A0504 HCPCS Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier None 0 0 — — — — — 2026-03-17
97034 HCPCS App Mdlty 1+cntrst Bth Ea 15 0 0 — — — — — 2026-03-17
A0503 HCPCS Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier None 0 0 — — — — — 2026-03-17
A0502 HCPCS Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50- Tier None 0 0 — — — — — 2026-03-17
97033 HCPCS App Mdlty 1+iontphrsis Ea 15 0 0 — — — — — 2026-03-17
87633 HCPCS Resp Virus 12-25 Targets 0 0 — — — — — 2026-03-17
A0501 HCPCS Non-traumatic Spinal Cord Injury M >=60.50- Tier None 0 0 — — — — — 2026-03-17
A0407 HCPCS Traumatic Spinal Cord Injury M <24.50 And A >=61.50- Tier None 0 0 — — — — — 2026-03-17
A0406 HCPCS Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50- Tier None 0 0 — — — — — 2026-03-17
97028 HCPCS Ultraviolet Therapy 0 0 — — — — — 2026-03-17
87493 HCPCS C Diff Amplified Probe 0 0 — — — — — 2026-03-17
82330 HCPCS Assay Of Calcium 0 0 — — — — — 2026-03-17
73030 HCPCS X-ray Exam Of Shoulder 0 0 — — — — — 2026-03-17
29130 HCPCS Application Of Finger Splint 0 0 — — — — — 2026-03-17
20561 HCPCS Ndl Insj Without Njx 3+ Musc 0 0 — — — — — 2026-03-17
A0404 HCPCS Traumatic Spinal Cord Injury M <31.50 And A <61.50- Tier None 0 0 — — — — — 2026-03-17
A0403 HCPCS Traumatic Spinal Cord Injury M >=41.50 And M <47.50- Tier None 0 0 — — — — — 2026-03-17
97026 HCPCS Infrared Therapy 0 0 — — — — — 2026-03-17
A0402 HCPCS Traumatic Spinal Cord Injury M >=47.50 And M <56.50- Tier None 0 0 — — — — — 2026-03-17
A0401 HCPCS Traumatic Spinal Cord Injury M >=56.50- Tier None 0 0 — — — — — 2026-03-17
97024 HCPCS Diathermy Eg Microwave 0 0 — — — — — 2026-03-17
87340 HCPCS Hepatitis B Surface Ag Ia 0 0 — — — — — 2026-03-17
A0305 HCPCS Non-traumatic Brain Injury M <42.50 And A <78.50- Tier None 0 0 — — — — — 2026-03-17
97022 HCPCS Whirlpool Therapy 0 0 — — — — — 2026-03-17
97018 HCPCS Paraffin Bath Therapy 0 0 — — — — — 2026-03-17
87086 HCPCS Urine Culture/colony Count 0 0 — — — — — 2026-03-17
81001 HCPCS Urinalysis Auto W/scope 0 0 — — — — — 2026-03-17
A0301 HCPCS Non-traumatic Brain Injury M >=65.50- Tier None 0 0 — — — — — 2026-03-17
97016 HCPCS Vasopneumatic Device Therapy 0 0 — — — — — 2026-03-17
A0204 HCPCS Traumatic Brain Injury M >=35.50 And M <49.50- Tier None 0 0 — — — — — 2026-03-17
A0203 HCPCS Traumatic Brain Injury M >=49.50 And M <61.50- Tier None 0 0 — — — — — 2026-03-17
97014 HCPCS Electric Stimulation Therapy 0 0 — — — — — 2026-03-17
87070 HCPCS Culture Othr Specimn Aerobic 0 0 — — — — — 2026-03-17
A0202 HCPCS Traumatic Brain Injury M >=61.50 And M <73.50- Tier None 0 0 — — — — — 2026-03-17
A0201 HCPCS Traumatic Brain Injury M >=73.50- Tier None 0 0 — — — — — 2026-03-17
97012 HCPCS Mechanical Traction Therapy 0 0 — — — — — 2026-03-17
97010 HCPCS Hot Or Cold Packs Therapy 0 0 — — — — — 2026-03-17
87040 HCPCS Blood Culture For Bacteria 0 0 — — — — — 2026-03-17
80202 HCPCS Assay Of Vancomycin 0 0 — — — — — 2026-03-17
72170 HCPCS X-ray Exam Of Pelvis 0 0 — — — — — 2026-03-17
A0102 HCPCS Stroke M >=63.50 And M <72.50- Tier None 0 0 — — — — — 2026-03-17
A0101 HCPCS Stroke M >=72.50- Tier None 0 0 — — — — — 2026-03-17
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