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

2,343 distinct procedures filed
31 distinct payers
25,042 rate rows
2026-05-21 last MRF observed
Data quality

3,457 of 25,042 rate rows are consumer-grade (13.8%)

21,585 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 21,331
per-diem day rate — not a per-procedure price 254
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 · 2026-05-18
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
LOCAL 		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
$70,083
1.0× median
D0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier Tier 3 7 $40,043.84 $92,165.98 $66,104.91 nat. median
$42,703
1.5× median
C1806
LOCAL 		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
$51,172
1.2× median
B0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier Tier 1 7 $51,557.95 $51,557.95 $51,557.95 nat. median
$53,762
1.0× median
D1904
LOCAL 		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
LOCAL 		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
$48,876
1.0× median
B1504
LOCAL 		Pulmonary M <45.50- Tier Tier 1 7 $44,184.06 $44,184.06 $44,184.06 nat. median
$43,057
1.0× median
B0305
LOCAL 		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
$44,232
1.0× median
C0505
LOCAL 		Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 2 7 $41,627.40 $41,627.40 $41,627.40 nat. median
$43,704
1.0× median
B0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 1 7 $41,285.03 $41,285.03 $41,285.03 nat. median
$43,383
1.0× median
B1004
LOCAL 		Amputation Lower Extremity M <47.50- Tier Tier 1 7 $40,820.26 $40,820.26 $40,820.26 nat. median
$42,470
1.0× median
A0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier None 7 $38,939.88 $38,939.88 $38,939.88 nat. median
$39,573
1.0× median
D0505
LOCAL 		Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 3 7 $38,454.56 $38,454.56 $38,454.56 nat. median
$41,099
0.9× median
B2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 1 7 $38,079.24 $38,079.24 $38,079.24 nat. median
$40,995
0.9× median
B0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 1 7 $37,990.82 $37,990.82 $37,990.82 nat. median
$40,010
0.9× median
B2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 1 7 $37,382.35 $37,382.35 $37,382.35 nat. median
$39,191
1.0× median
C0205
LOCAL 		Traumatic Brain Injury M <35.50- Tier Tier 2 7 $37,299.34 $37,299.34 $37,299.34 nat. median
$40,508
0.9× median
B1305
LOCAL 		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
$38,316
0.9× median
D0105
LOCAL 		Stroke M <41.50 And A >=84.50- Tier Tier 3 7 $35,924.17 $35,924.17 $35,924.17 nat. median
$37,662
1.0× median
B0603
LOCAL 		Neurological M >=43.50 And M <52.50- Tier Tier 1 7 $35,227.01 $35,227.01 $35,227.01 nat. median
$36,931
1.0× median
D0205
LOCAL 		Traumatic Brain Injury M <35.50- Tier Tier 3 7 $35,014.14 $35,014.14 $35,014.14 nat. median
$36,592
1.0× median
A0105
LOCAL 		Stroke M <41.50 And A >=84.50- Tier None 7 $34,237.15 $34,237.15 $34,237.15 nat. median
$35,375
1.0× median
C1004
LOCAL 		Amputation Lower Extremity M <47.50- Tier Tier 2 7 $33,759.96 $33,759.96 $33,759.96 nat. median
$35,393
1.0× median
A0405
LOCAL 		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
$35,438
1.0× median
D1705
LOCAL 		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
$34,992
1.0× median
A0205
LOCAL 		Traumatic Brain Injury M <35.50- Tier None 7 $32,965.23 $32,965.23 $32,965.23 nat. median
$33,234
1.0× median
C0305
LOCAL 		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
$35,561
0.9× median
C0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 2 7 $31,936.34 $31,936.34 $31,936.34 nat. median
$33,146
1.0× median
B0903
LOCAL 		Other Orthopedic M >=44.50 And M <51.50- Tier Tier 1 7 $31,705.73 $31,705.73 $31,705.73 nat. median
$33,505
0.9× median
C2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 2 7 $31,473.34 $31,473.34 $31,473.34 nat. median
$32,921
1.0× median
B0303
LOCAL 		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
$34,839
0.9× median
B2003
LOCAL 		Miscellaneous M >=46.50 And M <55.50- Tier Tier 1 7 $31,265.79 $31,265.79 $31,265.79 nat. median
$32,854
1.0× median
B1403
LOCAL 		Cardiac M >=45.50 And M <55.50- Tier Tier 1 7 $31,065.33 $31,065.33 $31,065.33 nat. median
$32,487
1.0× median
C0304
LOCAL 		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
$32,043
1.0× median
D1004
LOCAL 		Amputation Lower Extremity M <47.50- Tier Tier 3 7 $30,221.50 $30,838.27 $30,529.88 nat. median
$32,228
0.9× median
C0604
LOCAL 		Neurological M <43.50- Tier Tier 2 7 $27,839.78 $33,075.21 $30,457.49 nat. median
$34,756
0.9× median
A1705
LOCAL 		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
$31,920
1.0× median
D0305
LOCAL 		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
$32,319
0.9× median
D0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 3 7 $30,252.87 $30,252.87 $30,252.87 nat. median
$31,616
1.0× median
C2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 2 7 $29,859.05 $29,859.05 $29,859.05 nat. median
$31,232
1.0× median
D0604
LOCAL 		Neurological M <43.50- Tier Tier 3 7 $28,755.43 $30,877.30 $29,816.37 nat. median
$32,269
0.9× median
D2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 3 7 $29,401.37 $29,401.37 $29,401.37 nat. median
$30,727
1.0× median
C0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 2 7 $29,317.81 $29,421.14 $29,369.47 nat. median
$31,818
0.9× median
A1504
LOCAL 		Pulmonary M <45.50- Tier None 7 $28,808.87 $28,808.87 $28,808.87 nat. median
$30,273
1.0× median
D0104
LOCAL 		Stroke M >=41.50 And M <50.50- Tier Tier 3 7 $28,729.05 $28,729.05 $28,729.05 nat. median
$30,024
1.0× median
D0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 3 7 $28,361.84 $28,361.84 $28,361.84 nat. median
$29,640
1.0× median
D0304
LOCAL 		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
$29,475
1.0× median
A0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier None 7 $27,950.29 $27,950.29 $27,950.29 nat. median
$29,236
1.0× median
D2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 3 7 $27,893.52 $27,893.52 $27,893.52 nat. median
$29,151
1.0× median
D1404
LOCAL 		Cardiac M <45.50- Tier Tier 3 7 $27,881.10 $27,881.10 $27,881.10 nat. median
$29,138
1.0× median

Other procedures at this hospital

Browse this hospital's 2,343 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL Guillain-barré M <38.50- Tier Tier 3 17 7 — — $46,555.43 $46,555.43 $46,555.43 2026-03-17
B1705 LOCAL 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 LOCAL Pulmonary M <45.50- Tier Tier 1 17 7 — — $44,184.06 $44,184.06 $44,184.06 2026-03-17
B0305 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL Amputation Lower Extremity M <47.50- Tier Tier 1 17 7 — — $40,820.26 $40,820.26 $40,820.26 2026-03-17
A0106 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL Other Orthopedic M <44.5- Tier Tier 1 17 7 — — $37,990.82 $37,990.82 $37,990.82 2026-03-17
B2004 LOCAL 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 LOCAL Traumatic Brain Injury M <35.50- Tier Tier 2 17 7 — — $37,299.34 $37,299.34 $37,299.34 2026-03-17
B1305 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL Traumatic Brain Injury M <35.50- Tier Tier 3 17 7 — — $35,014.14 $35,014.14 $35,014.14 2026-03-17
A0105 LOCAL 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 LOCAL Amputation Lower Extremity M <47.50- Tier Tier 2 17 7 — — $33,759.96 $33,759.96 $33,759.96 2026-03-17
A0405 LOCAL 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 LOCAL 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 LOCAL Traumatic Brain Injury M <35.50- Tier None 17 7 — — $32,965.23 $32,965.23 $32,965.23 2026-03-17
C0305 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL Amputation Lower Extremity M <47.50- Tier Tier 3 17 7 — — $30,221.50 $30,838.27 $30,529.88 2026-03-17
C0604 LOCAL Neurological M <43.50- Tier Tier 2 17 7 — — $27,839.78 $33,075.21 $30,457.49 2026-03-17
A1705 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL Neurological M <43.50- Tier Tier 3 17 7 — — $28,755.43 $30,877.30 $29,816.37 2026-03-17
D2005 LOCAL 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 LOCAL Other Orthopedic M <44.5- Tier Tier 2 17 7 — — $29,317.81 $29,421.14 $29,369.47 2026-03-17
A1504 LOCAL Pulmonary M <45.50- Tier None 17 7 — — $28,808.87 $28,808.87 $28,808.87 2026-03-17
D0104 LOCAL 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 LOCAL Other Orthopedic M <44.5- Tier Tier 3 17 7 — — $28,361.84 $28,361.84 $28,361.84 2026-03-17
D0304 LOCAL 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 LOCAL Fracture Of Lower Extremity M <41.50- Tier None 17 7 — — $27,950.29 $27,950.29 $27,950.29 2026-03-17
D2004 LOCAL 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 LOCAL Cardiac M <45.50- Tier Tier 3 17 7 — — $27,881.10 $27,881.10 $27,881.10 2026-03-17
D1704 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL Neurological M <43.50- Tier None 17 7 — — $27,022.87 $27,597.99 $27,310.43 2026-03-17
D0805 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL 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 LOCAL Other Orthopedic M <44.5- Tier None 17 7 — — $5,933.73 $25,949.27 $15,941.50 2026-03-17
D2001 LOCAL Miscellaneous M >=66.50- Tier Tier 3 17 7 — — $15,260.62 $15,260.62 $15,260.62 2026-03-17
D1703 LOCAL 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 LOCAL 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 LOCAL Neurological M >=64.50- Tier Tier 2 17 7 — — $6,176.52 $6,176.52 $6,176.52 2026-03-17
A0702 LOCAL 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 LOCAL Cardiac M >=68.50- Tier Tier 3 17 7 — — $2,443.91 $2,443.91 $2,443.91 2026-03-17
0158 RC Room & Board - Ward - Rehabilitation 15 6 — — $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
0118 RC Room & Board - Private (One Bed) - Rehabilitation 16 7 — — $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
118 OTHER R&b - Private - Irf 8 1 $1,050.00 — $1,200.00 $1,200.00 $1,200.00 2026-05-21
0128 RC Room & Board - Semi-private (Two Beds) - Rehabilitation 15 6 — — $1,130.00 $1,130.00 $1,130.00 2026-03-17
128 OTHER R&b - Semi Pvt - Irf 8 1 $1,050.00 — $987.50 $987.50 $987.50 2026-05-21
0801 RC Inpatient Renal Dialysis - Hemodialysis 5 4 — — $427.50 $550.00 $457.00 2026-03-17
0805 RC Inpatient Renal Dialysis - Treatment 2 1 — — $427.50 $450.00 $438.75 2026-03-17
0806 RC Inpatient Renal Dialysis - Continuation 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
0803 RC Inpatient Renal Dialysis - Continuous Ambulatory Peritoneal Dialysis (capd) 3 2 — — $350.00 $427.50 $406.00 2026-03-17
0804 RC Inpatient Renal Dialysis - Continuous Cycling Peritoneal Dialysis (ccpd) 3 2 — — $350.00 $427.50 $406.00 2026-03-17
92523 HCPCS Speech Sound Lang Comprehen 37 14 — — $150.00 $150.00 $150.00 2026-03-17
97164 HCPCS Pt Re-eval Est Plan Care 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
96105 HCPCS Assessment Of Aphasia 36 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
0444 RC Speech Therapy - Language Pathology - Evaluation Or Reevaluation 40 16 — — $59.00 $150.00 $104.50 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
97537 HCPCS Community/work Reintegration 36 14 — — $90.00 $90.00 $90.00 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
92597 HCPCS Oral Speech Device Eval 6 3 — — $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
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
420 OTHER Pt Adl Slf Care Trn 15min 50 10 $122.89 — $79.50 $79.50 $79.50 2026-05-21
424 OTHER Pt Eval High Complex 1unit 32 10 $260.00 — $79.50 $79.50 $79.50 2026-05-21
430 OTHER Ot Adl Slf Care Trn 15min 56 10 $140.97 — $79.50 $79.50 $79.50 2026-05-21
434 OTHER Ot Eval High Complex 1unit 28 10 $260.00 — $79.50 $79.50 $79.50 2026-05-21
440 OTHER St Cog Tx Ea Addl 15min 28 10 $65.00 — $79.50 $79.50 $79.50 2026-05-21
444 OTHER St Aphasia Assessment 1unit 28 10 $260.00 — $79.50 $79.50 $79.50 2026-05-21
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
0420 RC Physical Therapy - 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
0429 RC Physical Therapy - Other 2 2 — — $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
0426 RC Physical Therapy - Continuation 2 2 — — $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
0446 RC Speech-language Pathology - 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
0447 RC Speech-language Pathology - 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
0448 RC Speech-language Pathology - Other 2 2 — — $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
0439 RC Occupational Therapy - 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
0449 RC Speech Therapy - Language Pathology - Other 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
0433 RC Occupational Therapy - Group Rate 7 4 — — $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
0428 RC Physical Therapy - Other 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
0431 RC Occupational Therapy - Visit 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
0422 RC Physical Therapy - Hourly Charge 7 4 — — $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
0423 RC Physical Therapy - Group Rate 7 4 — — $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
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
J0630 HCPCS Calcitonin Salmon Injection 0 0 — — — — — 2026-03-17
J0600 HCPCS Edetate Calcium Disodium Inj 0 0 — — — — — 2026-03-17
J0598 HCPCS C-1 Esterase, Cinryze 0 0 — — — — — 2026-03-17
J0596 HCPCS Injection, Ruconest 0 0 — — — — — 2026-03-17
J0588 HCPCS Incobotulinumtoxin A 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
J0586 HCPCS Abobotulinumtoxina 0 0 — — — — — 2026-03-17
J0584 HCPCS Injection, Burosumab-twza 1m 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
J0224 HCPCS Inj. Lumasiran, 0.5 Mg 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
J0223 HCPCS Inj Givosiran 0.5 Mg 0 0 — — — — — 2026-03-17
J0222 HCPCS Inj., Patisiran, 0.1 Mg 0 0 — — — — — 2026-03-17
97139 HCPCS Unlisted Therapeutic Px 0 0 — — — — — 2026-03-17
J0221 HCPCS Lumizyme Injection 0 0 — — — — — 2026-03-17
J0219 HCPCS Inj Aval Alfa-nqpt 4mg 0 0 — — — — — 2026-03-17
97130 HCPCS Ther Ivntj Ea Addl 15 Min 0 0 — — — — — 2026-03-17
J0225 HCPCS Inj, Vutrisiran, 1 Mg 0 0 — — — — — 2026-03-17
J0256 HCPCS Alpha 1 Proteinase Inhibitor 0 0 — — — — — 2026-03-17
J0257 HCPCS Glassia Injection 0 0 — — — — — 2026-03-17
J0287 HCPCS Amphotericin B Lipid Complex 0 0 — — — — — 2026-03-17
J0289 HCPCS Amphotericin B Liposome Inj 0 0 — — — — — 2026-03-17
J0291 HCPCS Inj., Plazomicin, 5 Mg 0 0 — — — — — 2026-03-17
J0349 HCPCS Inj, Rezafungin, 1 Mg 0 0 — — — — — 2026-03-17
J0391 HCPCS Inj, Artesunate, 1mg 0 0 — — — — — 2026-03-17
J0401 HCPCS Inj Aripiprazole Ext Rel 1mg 0 0 — — — — — 2026-03-17
J0402 HCPCS Inj, Abilify Asimtufii, 1 Mg 0 0 — — — — — 2026-03-17
J0475 HCPCS Baclofen 10 Mg Injection 0 0 — — — — — 2026-03-17
J0480 HCPCS Basiliximab 0 0 — — — — — 2026-03-17
J0485 HCPCS Belatacept Injection 0 0 — — — — — 2026-03-17
J0490 HCPCS Belimumab Injection 0 0 — — — — — 2026-03-17
J0491 HCPCS Inj Anifrolumab-fnia 1mg 0 0 — — — — — 2026-03-17
J0517 HCPCS Inj., Benralizumab, 1 Mg 0 0 — — — — — 2026-03-17
J0558 HCPCS Peng Benzathine/procaine Inj 0 0 — — — — — 2026-03-17
J0561 HCPCS Penicillin G Benzathine Inj 0 0 — — — — — 2026-03-17
J0565 HCPCS Inj, Bezlotoxumab, 10 Mg 0 0 — — — — — 2026-03-17
90378 HCPCS Rsv Mab IM 50mg 0 0 — — — — — 2026-03-17
J0585 HCPCS Injection,onabotulinumtoxina 0 0 — — — — — 2026-03-17
J0218 HCPCS Inj Olipudase Alfa-rpcp 1mg 0 0 — — — — — 2026-03-17
J0587 HCPCS Inj, Rimabotulinumtoxinb 0 0 — — — — — 2026-03-17
J0217 HCPCS Inj Velmanase Alfa-tycv 1 Mg 0 0 — — — — — 2026-03-17
J0594 HCPCS Busulfan Injection 0 0 — — — — — 2026-03-17
J0208 HCPCS Inj Sodium Thiosulfate 100mg 0 0 — — — — — 2026-03-17
J0597 HCPCS C-1 Esterase, Berinert 0 0 — — — — — 2026-03-17
J0206 HCPCS Inj Allopurinol Sodium 1 Mg 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
J0638 HCPCS Canakinumab Injection 0 0 — — — — — 2026-03-17
J0202 HCPCS Injection, Alemtuzumab 0 0 — — — — — 2026-03-17
J0185 HCPCS Inj., Aprepitant, 1 Mg 0 0 — — — — — 2026-03-17
J0184 HCPCS Inj, Amisulpride, 1 Mg 0 0 — — — — — 2026-03-17
J0180 HCPCS Agalsidase Beta Injection 0 0 — — — — — 2026-03-17
90376 HCPCS Rabies Ig Heat Treated 0 0 — — — — — 2026-03-17
J0179 HCPCS Inj, Brolucizumab-dbll, 1 Mg 0 0 — — — — — 2026-03-17
J0178 HCPCS Aflibercept Injection 0 0 — — — — — 2026-03-17
J0174 HCPCS Inj, Lecanemab-irmb, 1 Mg 0 0 — — — — — 2026-03-17
J0172 HCPCS Inj, Aducanumab-avwa, 2 Mg 0 0 — — — — — 2026-03-17
90375 HCPCS Rabies Ig Im/sc 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
J0135 HCPCS Injection, Adalimumab, 20 Mg 0 0 — — — — — 2026-03-17
J0129 HCPCS Abatacept Injection 0 0 — — — — — 2026-03-17
97039 HCPCS Unlisted Modality 0 0 — — — — — 2026-03-17
J0121 HCPCS Inj., Omadacycline, 1 Mg 0 0 — — — — — 2026-03-17
A9800 HCPCS Gallium Locametz 1 Millicuri 0 0 — — — — — 2026-03-17
97037 HCPCS Appl Modality 1+lllt Po Pain 0 0 — — — — — 2026-03-17
90371 HCPCS Hep B Ig IM 0 0 — — — — — 2026-03-17
A9697 HCPCS Inj, Magtrace Per Study Dose 0 0 — — — — — 2026-03-17
A9607 HCPCS Lutetium Lu 177 Vipivotide 0 0 — — — — — 2026-03-17
97036 HCPCS App Mdlty 1+hubbrd Tnk Ea 15 0 0 — — — — — 2026-03-17
A9606 HCPCS Radium Ra223 Dichloride Ther 0 0 — — — — — 2026-03-17
A9604 HCPCS Sm 153 Lexidronam 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
A9602 HCPCS Fluorodopa F-18 Diag Per Mci 0 0 — — — — — 2026-03-17
A9601 HCPCS Flortaucipir Inj 1 Millicuri 0 0 — — — — — 2026-03-17
97034 HCPCS App Mdlty 1+cntrst Bth Ea 15 0 0 — — — — — 2026-03-17
A9596 HCPCS Gallium Illuccix 1 Millicure 0 0 — — — — — 2026-03-17
A9595 HCPCS Piflu F-18, Dia 1 Millicurie 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
A9594 HCPCS Gallium Ga-68 Psma-11, Ucla 0 0 — — — — — 2026-03-17
A9593 HCPCS Gallium Ga-68 Psma-11 Ucsf 0 0 — — — — — 2026-03-17
A9592 HCPCS Copper Cu 64 Dotatate Diag 0 0 — — — — — 2026-03-17
A9591 HCPCS Fluoroestradiol F 18 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
A9588 HCPCS Fluciclovine F-18 0 0 — — — — — 2026-03-17
A9587 HCPCS Gallium Ga-68 0 0 — — — — — 2026-03-17
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