Hospital

Pam Health Rehabilitation Hospital Of Surprise

Surprise, AZ · CCN 033039 · Rates published

15,540 distinct procedures filed

22 distinct payers

85,779 rate rows

2025-09-11 last MRF observed · ⚠ 13 mo old

Data quality

85,126 of 85,779 rate rows are consumer-grade (99.2%)

653 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 — reason	Rows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	386
per-diem day rate — not a per-procedure price	224
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	33
percent-of-charges filed in the dollar field — excluded from medians	10

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 13 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://sthpiprd.blob.core.windows.net/machine-readable-files/9954/455112416_cobalt-rehabilitation-hospital-iv-llc_standardcharges.csv
Found on page	https://search.hospitalpriceindex.com/hpi2/machineReadable/RehabilitationHospitalofSurprise/9954
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-09-21
Content fingerprint	68bb64e9425546ff… · 39,107,437 bytes · first seen 2026-05-08

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
B0407 HCPCS	Traumatic Spinal Cord Injury M <24.50 And A >=61.50	15	$78,903.85	$102,918.06	$85,765.05	nat. median $90,183 1.0× median
E0766 HCPCS	Elec Stim Cancer Treatment	1	$78,768.03	$78,768.03	$78,768.03	nat. median $16,158 outlier · 4.9×
C0407 HCPCS	Traumatic Spinal Cord Injury M <24.50 And A >=61.50	15	$70,167.65	$91,523.03	$76,269.19	nat. median $73,713 1.0× median
B1904 HCPCS	Guillain-barré M <38.50	15	$68,275.21	$89,054.63	$74,212.19	nat. median $84,429 0.9× median
D0407 HCPCS	Traumatic Spinal Cord Injury M <24.50 And A >=61.50	15	$68,114.71	$88,845.28	$74,037.73	nat. median $69,540 1.1× median
B1806 HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50	15	$64,223.45	$83,769.72	$69,808.10	nat. median $71,463 1.0× median
A0407 HCPCS	Traumatic Spinal Cord Injury M <24.50 And A >=61.50	15	$61,892.43	$80,729.26	$67,274.38	nat. median $64,947 1.0× median
B0406 HCPCS	Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50	15	$57,715.63	$75,281.26	$62,734.38	nat. median $65,854 1.0× median
B0404 HCPCS	Traumatic Spinal Cord Injury M <31.50 And A <61.50	15	$56,877.66	$74,188.25	$61,823.54	nat. median $61,232 1.0× median
B0505 HCPCS	Non-traumatic Spinal Cord Injury M <39.50	14	$56,293.50	$73,426.31	$61,188.59	nat. median $60,224 1.0× median
A9543 HCPCS	Y90 Ibritumomab, Rx	1	$60,040.79	$60,040.79	$60,040.79	nat. median $65,477 0.9× median
Q2043 HCPCS	Sipuleucel-t Auto Cd54+	1	$58,993.41	$58,993.41	$58,993.41	nat. median $63,499 0.9× median
B0106 HCPCS	Stroke M <41.50 And A <84.50	15	$54,242.43	$70,750.99	$58,959.16	nat. median $54,601 1.1× median
C1904 HCPCS	Guillain-barré M <38.50	15	$52,489.97	$68,465.17	$57,054.31	nat. median $59,669 1.0× median
C0406 HCPCS	Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50	15	$51,325.38	$66,946.15	$55,788.46	nat. median $53,828 1.0× median
Q0480 HCPCS	Driver Pneumatic Vad, Rep	1	$55,753.92	$55,753.92	$55,753.92	nat. median $108,243 0.5× median
C1806 HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50	15	$51,233.94	$66,826.87	$55,689.06	nat. median $59,476 0.9× median
C0404 HCPCS	Traumatic Spinal Cord Injury M <31.50 And A <61.50	15	$50,580.73	$65,974.86	$54,979.05	nat. median $50,092 1.1× median
D0406 HCPCS	Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50	15	$49,823.00	$64,986.53	$54,155.44	nat. median $52,411 1.0× median
B0205 HCPCS	Traumatic Brain Injury M <35.50	14	$49,242.59	$64,229.46	$53,524.55	nat. median $52,525 1.0× median
D0404 HCPCS	Traumatic Spinal Cord Injury M <31.50 And A <61.50	15	$49,100.75	$64,044.46	$53,370.38	nat. median $48,733 1.1× median
D1904 HCPCS	Guillain-barré M <38.50	15	$48,979.44	$63,886.22	$53,238.52	nat. median $51,872 1.0× median
B1705 HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50	15	$48,934.64	$63,827.80	$53,189.83	nat. median $50,847 1.0× median
D1806 HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50	15	$48,639.77	$63,443.17	$52,869.31	nat. median $53,782 1.0× median
A1904 HCPCS	Guillain-barré M <38.50	15	$48,132.13	$62,781.04	$52,317.53	nat. median $51,888 1.0× median
B0105 HCPCS	Stroke M <41.50 And A >=84.50	15	$47,689.82	$62,204.11	$51,836.76	nat. median $48,473 1.1× median
C0106 HCPCS	Stroke M <41.50 And A <84.50	15	$47,042.20	$61,359.40	$51,132.83	nat. median $48,486 1.1× median
B1903 HCPCS	Guillain-barré M >=38.50 And M <51.50	15	$46,870.50	$61,135.44	$50,946.20	nat. median $53,197 1.0× median
J7330 HCPCS	Cultured Chondrocytes Implnt	1	$50,788.94	$50,788.94	$50,788.94	nat. median $92,809 0.5× median
C9150 HCPCS	Amfs	1	$50,544.00	$50,544.00	$50,544.00	nat. median $77,438 0.7× median
B0604 HCPCS	Neurological M <43.50	15	$46,478.58	$60,624.24	$50,520.20	nat. median $47,224 1.1× median
A0406 HCPCS	Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50	15	$45,272.94	$59,051.66	$49,209.72	nat. median $47,427 1.0× median
B0405 HCPCS	Traumatic Spinal Cord Injury M >=31.50 And M <41.50	15	$45,231.88	$58,998.11	$49,165.09	nat. median $48,502 1.0× median
B1805 HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50	15	$45,222.55	$58,985.94	$49,154.95	nat. median $49,325 1.0× median
A1806 HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50	15	$45,097.51	$58,822.84	$49,019.03	nat. median $50,479 1.0× median
A0404 HCPCS	Traumatic Spinal Cord Injury M <31.50 And A <61.50	15	$44,616.01	$58,194.79	$48,495.66	nat. median $44,160 1.1× median
B0305 HCPCS	Non-traumatic Brain Injury M <42.50 And A <78.50	15	$44,502.16	$58,046.29	$48,371.91	nat. median $47,151 1.0× median
A5104 HCPCS	Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More	14	$44,481.63	$58,019.52	$48,349.60	nat. median $43,534 1.1× median
J9226 HCPCS	Supprelin La Implant	1	$47,895.10	$47,895.10	$47,895.10	nat. median $57,036 0.8× median
B1604 HCPCS	Pain Syndrome M <43.50	15	$43,811.62	$57,145.60	$47,621.33	nat. median $41,103 1.2× median
C0505 HCPCS	Non-traumatic Spinal Cord Injury M <39.50	15	$43,794.82	$57,123.68	$47,603.07	nat. median $46,281 1.0× median
B0704 HCPCS	Fracture Of Lower Extremity M <41.50	15	$43,434.63	$56,653.86	$47,211.55	nat. median $44,391 1.1× median
B2102 HCPCS	Burns M <52.50	15	$43,253.60	$56,417.74	$47,014.78	nat. median $49,061 1.0× median
D0106 HCPCS	Stroke M <41.50 And A <84.50	15	$42,988.58	$56,072.06	$46,726.72	nat. median $43,929 1.1× median
B1004 HCPCS	Amputation Lower Extremity M <47.50	15	$42,945.66	$56,016.07	$46,680.06	nat. median $45,558 1.0× median
B1504 HCPCS	Pulmonary M <45.50	15	$42,447.36	$55,366.12	$46,138.43	nat. median $45,155 1.0× median
B1704 HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50	15	$41,698.96	$54,389.95	$45,324.96	nat. median $42,318 1.1× median
B2005 HCPCS	Miscellaneous M <46.50 And A <77.50	15	$41,454.47	$54,071.05	$45,059.21	nat. median $42,636 1.1× median
D0505 HCPCS	Non-traumatic Spinal Cord Injury M <39.50	15	$41,374.22	$53,966.38	$44,971.98	nat. median $43,056 1.0× median
C0105 HCPCS	Stroke M <41.50 And A >=84.50	15	$41,359.29	$53,946.90	$44,955.75	nat. median $43,210 1.0× median

Other procedures at this hospital

Browse this hospital's 15,540 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

B0407	HCPCS	Traumatic Spinal Cord Injury M <24.50 And A >=61.50	15	15	—	—	$78,903.85	$102,918.06	$85,765.05	2025-09-11
E0766	HCPCS	Elec Stim Cancer Treatment	1	1	—	—	$78,768.03	$78,768.03	$78,768.03	2025-09-11
C0407	HCPCS	Traumatic Spinal Cord Injury M <24.50 And A >=61.50	15	15	—	—	$70,167.65	$91,523.03	$76,269.19	2025-09-11
B1904	HCPCS	Guillain-barré M <38.50	15	15	—	—	$68,275.21	$89,054.63	$74,212.19	2025-09-11
D0407	HCPCS	Traumatic Spinal Cord Injury M <24.50 And A >=61.50	15	15	—	—	$68,114.71	$88,845.28	$74,037.73	2025-09-11
B1806	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50	15	15	—	—	$64,223.45	$83,769.72	$69,808.10	2025-09-11
A0407	HCPCS	Traumatic Spinal Cord Injury M <24.50 And A >=61.50	15	15	—	—	$61,892.43	$80,729.26	$67,274.38	2025-09-11
B0406	HCPCS	Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50	15	15	—	—	$57,715.63	$75,281.26	$62,734.38	2025-09-11
B0404	HCPCS	Traumatic Spinal Cord Injury M <31.50 And A <61.50	15	15	—	—	$56,877.66	$74,188.25	$61,823.54	2025-09-11
B0505	HCPCS	Non-traumatic Spinal Cord Injury M <39.50	14	14	—	—	$56,293.50	$73,426.31	$61,188.59	2025-09-11
A9543	HCPCS	Y90 Ibritumomab, Rx	1	1	—	—	$60,040.79	$60,040.79	$60,040.79	2025-09-11
Q2043	HCPCS	Sipuleucel-t Auto Cd54+	1	1	—	—	$58,993.41	$58,993.41	$58,993.41	2025-09-11
B0106	HCPCS	Stroke M <41.50 And A <84.50	15	15	—	—	$54,242.43	$70,750.99	$58,959.16	2025-09-11
C1904	HCPCS	Guillain-barré M <38.50	15	15	—	—	$52,489.97	$68,465.17	$57,054.31	2025-09-11
C0406	HCPCS	Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50	15	15	—	—	$51,325.38	$66,946.15	$55,788.46	2025-09-11
Q0480	HCPCS	Driver Pneumatic Vad, Rep	1	1	—	—	$55,753.92	$55,753.92	$55,753.92	2025-09-11
C1806	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50	15	15	—	—	$51,233.94	$66,826.87	$55,689.06	2025-09-11
C0404	HCPCS	Traumatic Spinal Cord Injury M <31.50 And A <61.50	15	15	—	—	$50,580.73	$65,974.86	$54,979.05	2025-09-11
D0406	HCPCS	Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50	15	15	—	—	$49,823.00	$64,986.53	$54,155.44	2025-09-11
B0205	HCPCS	Traumatic Brain Injury M <35.50	14	14	—	—	$49,242.59	$64,229.46	$53,524.55	2025-09-11
D0404	HCPCS	Traumatic Spinal Cord Injury M <31.50 And A <61.50	15	15	—	—	$49,100.75	$64,044.46	$53,370.38	2025-09-11
D1904	HCPCS	Guillain-barré M <38.50	15	15	—	—	$48,979.44	$63,886.22	$53,238.52	2025-09-11
B1705	HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50	15	15	—	—	$48,934.64	$63,827.80	$53,189.83	2025-09-11
D1806	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50	15	15	—	—	$48,639.77	$63,443.17	$52,869.31	2025-09-11
A1904	HCPCS	Guillain-barré M <38.50	15	15	—	—	$48,132.13	$62,781.04	$52,317.53	2025-09-11
B0105	HCPCS	Stroke M <41.50 And A >=84.50	15	15	—	—	$47,689.82	$62,204.11	$51,836.76	2025-09-11
C0106	HCPCS	Stroke M <41.50 And A <84.50	15	15	—	—	$47,042.20	$61,359.40	$51,132.83	2025-09-11
B1903	HCPCS	Guillain-barré M >=38.50 And M <51.50	15	15	—	—	$46,870.50	$61,135.44	$50,946.20	2025-09-11
J7330	HCPCS	Cultured Chondrocytes Implnt	1	1	—	—	$50,788.94	$50,788.94	$50,788.94	2025-09-11
C9150	HCPCS	Amfs	1	1	—	—	$50,544.00	$50,544.00	$50,544.00	2025-09-11
B0604	HCPCS	Neurological M <43.50	15	15	—	—	$46,478.58	$60,624.24	$50,520.20	2025-09-11
A0406	HCPCS	Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50	15	15	—	—	$45,272.94	$59,051.66	$49,209.72	2025-09-11
B0405	HCPCS	Traumatic Spinal Cord Injury M >=31.50 And M <41.50	15	15	—	—	$45,231.88	$58,998.11	$49,165.09	2025-09-11
B1805	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50	15	15	—	—	$45,222.55	$58,985.94	$49,154.95	2025-09-11
A1806	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50	15	15	—	—	$45,097.51	$58,822.84	$49,019.03	2025-09-11
A0404	HCPCS	Traumatic Spinal Cord Injury M <31.50 And A <61.50	15	15	—	—	$44,616.01	$58,194.79	$48,495.66	2025-09-11
B0305	HCPCS	Non-traumatic Brain Injury M <42.50 And A <78.50	15	15	—	—	$44,502.16	$58,046.29	$48,371.91	2025-09-11
A5104	HCPCS	Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More	14	14	—	—	$44,481.63	$58,019.52	$48,349.60	2025-09-11
J9226	HCPCS	Supprelin La Implant	1	1	—	—	$47,895.10	$47,895.10	$47,895.10	2025-09-11
B1604	HCPCS	Pain Syndrome M <43.50	15	15	—	—	$43,811.62	$57,145.60	$47,621.33	2025-09-11
C0505	HCPCS	Non-traumatic Spinal Cord Injury M <39.50	15	15	—	—	$43,794.82	$57,123.68	$47,603.07	2025-09-11
B0704	HCPCS	Fracture Of Lower Extremity M <41.50	15	15	—	—	$43,434.63	$56,653.86	$47,211.55	2025-09-11
B2102	HCPCS	Burns M <52.50	15	15	—	—	$43,253.60	$56,417.74	$47,014.78	2025-09-11
D0106	HCPCS	Stroke M <41.50 And A <84.50	15	15	—	—	$42,988.58	$56,072.06	$46,726.72	2025-09-11
B1004	HCPCS	Amputation Lower Extremity M <47.50	15	15	—	—	$42,945.66	$56,016.07	$46,680.06	2025-09-11
B1504	HCPCS	Pulmonary M <45.50	15	15	—	—	$42,447.36	$55,366.12	$46,138.43	2025-09-11
B1704	HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50	15	15	—	—	$41,698.96	$54,389.95	$45,324.96	2025-09-11
B2005	HCPCS	Miscellaneous M <46.50 And A <77.50	15	15	—	—	$41,454.47	$54,071.05	$45,059.21	2025-09-11
D0505	HCPCS	Non-traumatic Spinal Cord Injury M <39.50	15	15	—	—	$41,374.22	$53,966.38	$44,971.98	2025-09-11
C0105	HCPCS	Stroke M <41.50 And A >=84.50	15	15	—	—	$41,359.29	$53,946.90	$44,955.75	2025-09-11
A0106	HCPCS	Stroke M <41.50 And A <84.50	15	15	—	—	$40,967.37	$53,435.70	$44,529.75	2025-09-11
B1204	HCPCS	Osteoarthritis M <49.50 And A <74.50	15	15	—	—	$40,754.61	$53,158.19	$44,298.49	2025-09-11
C0205	HCPCS	Traumatic Brain Injury M <35.50	15	15	—	—	$40,556.78	$52,900.15	$44,083.46	2025-09-11
B0504	HCPCS	Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50	14	14	—	—	$40,511.99	$52,841.72	$44,034.77	2025-09-11
B0304	HCPCS	Non-traumatic Brain Injury M <42.50 And A >=78.50	15	15	—	—	$40,351.49	$52,632.37	$43,860.31	2025-09-11
C0405	HCPCS	Traumatic Spinal Cord Injury M >=31.50 And M <41.50	15	15	—	—	$40,224.58	$52,466.84	$43,722.37	2025-09-11
B1404	HCPCS	Cardiac M <45.50	15	15	—	—	$40,047.28	$52,235.58	$43,529.65	2025-09-11
B0904	HCPCS	Other Orthopedic M <44.5	14	14	—	—	$39,968.89	$52,133.34	$43,444.45	2025-09-11
B1304	HCPCS	Rheumatoid Other Arthritis M <44.50 And A >=64.50	14	14	—	—	$39,968.89	$52,133.34	$43,444.45	2025-09-11
B2004	HCPCS	Miscellaneous M <46.50 And A >=77.50	15	15	—	—	$39,328.75	$51,298.37	$42,748.64	2025-09-11
D0405	HCPCS	Traumatic Spinal Cord Injury M >=31.50 And M <41.50	15	15	—	—	$39,046.93	$50,930.78	$42,442.32	2025-09-11
B1203	HCPCS	Osteoarthritis M <49.50 And A >=74.50	15	15	—	—	$38,864.04	$50,692.22	$42,243.52	2025-09-11
28730	CPT	Fusion Of Foot Bones	34	22	$57,929.13	$57,929.13	$667.57	$43,446.85	$41,998.62	2025-09-11
B0805	HCPCS	Replacement Of Lower-extremity Joint M <42.50	14	14	—	—	$38,470.24	$50,178.58	$41,815.48	2025-09-11
B0204	HCPCS	Traumatic Brain Injury M >=35.50 And M <49.50	15	15	—	—	$38,442.25	$50,142.06	$41,785.05	2025-09-11
B1305	HCPCS	Rheumatoid Other Arthritis M <51.50 And A <64.50	15	15	—	—	$38,276.15	$49,925.41	$41,604.51	2025-09-11
B0104	HCPCS	Stroke M >=41.50 And M <50.50	14	14	—	—	$38,138.04	$49,745.27	$41,454.39	2025-09-11
A0505	HCPCS	Non-traumatic Spinal Cord Injury M <39.50	14	14	—	—	$38,126.84	$49,730.66	$41,442.22	2025-09-11
C1705	HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50	15	15	—	—	$38,037.26	$49,613.82	$41,344.85	2025-09-11
D0105	HCPCS	Stroke M <41.50 And A >=84.50	15	15	—	—	$37,794.64	$49,297.36	$41,081.13	2025-09-11
B1103	HCPCS	Amputation Non-lower Extremity M <52.50	15	15	—	—	$37,430.72	$48,822.67	$40,685.56	2025-09-11
B1804	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50	15	15	—	—	$37,300.07	$48,652.26	$40,543.55	2025-09-11
B0603	HCPCS	Neurological M >=43.50 And M <52.50	15	15	—	—	$37,061.18	$48,340.67	$40,283.89	2025-09-11
B1703	HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50	15	15	—	—	$36,840.96	$48,053.42	$40,044.52	2025-09-11
D0205	HCPCS	Traumatic Brain Injury M <35.50	15	15	—	—	$36,837.22	$48,048.55	$40,040.46	2025-09-11
B0403	HCPCS	Traumatic Spinal Cord Injury M >=41.50 And M <47.50	15	15	—	—	$36,428.50	$47,515.44	$39,596.20	2025-09-11
C1805	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50	15	15	—	—	$36,075.77	$47,055.35	$39,212.79	2025-09-11
C1903	HCPCS	Guillain-barré M >=38.50 And M <51.50	15	15	—	—	$36,032.85	$46,999.37	$39,166.14	2025-09-11
A0105	HCPCS	Stroke M <41.50 And A >=84.50	15	15	—	—	$36,019.78	$46,982.33	$39,151.94	2025-09-11
C0305	HCPCS	Non-traumatic Brain Injury M <42.50 And A <78.50	15	15	—	—	$35,603.60	$46,439.47	$38,699.56	2025-09-11
B0703	HCPCS	Fracture Of Lower Extremity M >=41.50 And M <52.50	15	15	—	—	$35,555.07	$46,376.17	$38,646.81	2025-09-11
C1004	HCPCS	Amputation Lower Extremity M <47.50	15	15	—	—	$35,517.74	$46,327.49	$38,606.24	2025-09-11
A0405	HCPCS	Traumatic Spinal Cord Injury M >=31.50 And M <41.50	14	14	—	—	$35,480.42	$46,278.80	$38,565.67	2025-09-11
B1603	HCPCS	Pain Syndrome M >=43.50 And M <58.50	15	15	—	—	$35,360.97	$46,123.01	$38,435.84	2025-09-11
D1705	HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50	16	15	—	—	$40.00	$45,947.74	$38,289.78	2025-09-11
B0303	HCPCS	Non-traumatic Brain Injury M >=42.50 And M <52.50	15	15	—	—	$34,802.95	$45,395.15	$37,829.29	2025-09-11
C0604	HCPCS	Neurological M <43.50	15	15	—	—	$34,797.34	$45,387.84	$37,823.20	2025-09-11
A0205	HCPCS	Traumatic Brain Injury M <35.50	15	15	—	—	$34,681.64	$45,236.92	$37,697.43	2025-09-11
C1504	HCPCS	Pulmonary M <45.50	15	15	—	—	$34,452.08	$44,937.49	$37,447.91	2025-09-11
B1503	HCPCS	Pulmonary M >=45.50 And M <56.50	15	15	—	—	$34,276.64	$44,708.66	$37,257.22	2025-09-11
D1805	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50	15	15	—	—	$34,248.66	$44,672.16	$37,226.80	2025-09-11
B1803	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50	15	15	—	—	$34,108.68	$44,489.58	$37,074.65	2025-09-11
B0503	HCPCS	Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50	15	15	—	—	$34,080.68	$44,453.06	$37,044.22	2025-09-11
D1903	HCPCS	Guillain-barré M >=38.50 And M <51.50	15	15	—	—	$33,623.44	$43,856.66	$36,547.22	2025-09-11
C0704	HCPCS	Fracture Of Lower Extremity M <41.50	15	15	—	—	$33,599.17	$43,825.01	$36,520.84	2025-09-11
B1003	HCPCS	Amputation Lower Extremity M >=47.50 And M <55.50	15	15	—	—	$33,545.05	$43,754.41	$36,462.01	2025-09-11
A5102	HCPCS	Expired, Orthopedic, Length Of Stay Is 14 Days Or More	16	15	—	—	$14.34	$43,637.57	$36,364.64	2025-09-11
B0903	HCPCS	Other Orthopedic M >=44.50 And M <51.50	14	14	—	—	$33,356.56	$43,508.56	$36,257.13	2025-09-11
C2005	HCPCS	Miscellaneous M <46.50 And A <77.50	15	15	—	—	$33,112.07	$43,189.66	$35,991.38	2025-09-11
C0104	HCPCS	Stroke M >=41.50 And M <50.50	15	15	—	—	$33,074.75	$43,140.97	$35,950.81	2025-09-11
C1304	HCPCS	Rheumatoid Other Arthritis M <44.50 And A >=64.50	15	15	—	—	$33,046.75	$43,104.46	$35,920.38	2025-09-11
A1903	HCPCS	Guillain-barré M >=38.50 And M <51.50	15	15	—	—	$33,041.15	$43,097.15	$35,914.29	2025-09-11
B2003	HCPCS	Miscellaneous M >=46.50 And M <55.50	15	15	—	—	$32,893.71	$42,904.84	$35,754.03	2025-09-11
C2102	HCPCS	Burns M <52.50	15	15	—	—	$32,867.58	$42,870.76	$35,725.63	2025-09-11
D2102	HCPCS	Burns M <52.50	15	15	—	—	$32,867.58	$42,870.76	$35,725.63	2025-09-11
D0305	HCPCS	Non-traumatic Brain Injury M <42.50 And A <78.50	15	15	—	—	$32,705.22	$42,658.98	$35,549.15	2025-09-11
B1403	HCPCS	Cardiac M >=45.50 And M <55.50	15	15	—	—	$32,682.82	$42,629.76	$35,524.80	2025-09-11
33207	CPT	Insrt Heart Pm Venticular	34	22	$48,848.87	$48,848.87	$483.19	$36,636.65	$35,415.43	2025-09-11
33208	CPT	Ins/Rplc Pacemkr; Atr+vnt	34	22	$48,848.87	$48,848.87	$524.18	$36,636.65	$35,415.43	2025-09-11
C1604	HCPCS	Pain Syndrome M <43.50	15	15	—	—	$32,540.98	$42,444.76	$35,370.63	2025-09-11
D0604	HCPCS	Neurological M <43.50	16	15	—	—	$41.61	$42,371.72	$35,309.77	2025-09-11
D1004	HCPCS	Amputation Lower Extremity M <47.50	15	15	—	—	$32,443.93	$42,318.17	$35,265.14	2025-09-11
C1704	HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50	15	15	—	—	$32,412.21	$42,276.79	$35,230.66	2025-09-11
D1504	HCPCS	Pulmonary M <45.50	15	15	—	—	$32,401.00	$42,262.18	$35,218.48	2025-09-11
C0403	HCPCS	Traumatic Spinal Cord Injury M >=41.50 And M <47.50	15	15	—	—	$32,395.41	$42,254.88	$35,212.40	2025-09-11
C0304	HCPCS	Non-traumatic Brain Injury M <42.50 And A >=78.50	15	15	—	—	$32,283.43	$42,108.82	$35,090.68	2025-09-11
B0804	HCPCS	Replacement Of Lower-extremity Joint M >=42.50 And M <51.50	15	15	—	—	$32,076.27	$41,838.61	$34,865.51	2025-09-11
C0904	HCPCS	Other Orthopedic M <44.5	15	15	—	—	$32,012.82	$41,755.85	$34,796.54	2025-09-11
A1705	HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50	14	14	—	—	$31,958.69	$41,685.25	$34,737.71	2025-09-11
D0704	HCPCS	Fracture Of Lower Extremity M <41.50	15	15	—	—	$31,828.04	$41,514.84	$34,595.70	2025-09-11
A1805	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50	15	15	—	—	$31,755.26	$41,419.91	$34,516.59	2025-09-11
C0204	HCPCS	Traumatic Brain Injury M >=35.50 And M <49.50	15	15	—	—	$31,663.81	$41,300.63	$34,417.19	2025-09-11
B1303	HCPCS	Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50	14	14	—	—	$31,648.88	$41,281.15	$34,400.96	2025-09-11
C1305	HCPCS	Rheumatoid Other Arthritis M <51.50 And A <64.50	15	15	—	—	$31,647.02	$41,278.72	$34,398.93	2025-09-11
C1404	HCPCS	Cardiac M <45.50	15	15	—	—	$31,548.11	$41,149.70	$34,291.42	2025-09-11
D1304	HCPCS	Rheumatoid Other Arthritis M <44.50 And A >=64.50	15	15	—	—	$31,544.37	$41,144.83	$34,287.36	2025-09-11
C0504	HCPCS	Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50	15	15	—	—	$31,516.38	$41,108.32	$34,256.93	2025-09-11
37236	CPT	Open/Perq Place Stent 1st	34	22	$47,189.05	$47,189.05	$441.97	$35,391.79	$34,212.07	2025-09-11
B0602	HCPCS	Neurological M >=52.50 And M <64.50	15	15	—	—	$31,452.92	$41,025.55	$34,187.96	2025-09-11
D0403	HCPCS	Traumatic Spinal Cord Injury M >=41.50 And M <47.50	15	15	—	—	$31,447.32	$41,018.24	$34,181.87	2025-09-11
C2004	HCPCS	Miscellaneous M <46.50 And A >=77.50	15	15	—	—	$31,413.73	$40,974.43	$34,145.36	2025-09-11
B1902	HCPCS	Guillain-barré M >=51.50 And M <66.50	15	15	—	—	$31,064.73	$40,519.21	$33,766.01	2025-09-11
B1702	HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50	15	15	—	—	$31,003.14	$40,438.87	$33,699.06	2025-09-11
B0203	HCPCS	Traumatic Brain Injury M >=49.50 And M <61.50	14	14	—	—	$30,995.67	$40,429.14	$33,690.95	2025-09-11
C1204	HCPCS	Osteoarthritis M <49.50 And A <74.50	15	15	—	—	$30,984.48	$40,414.54	$33,678.78	2025-09-11
D2005	HCPCS	Miscellaneous M <46.50 And A <77.50	15	15	—	—	$30,932.22	$40,346.38	$33,621.98	2025-09-11
C0805	HCPCS	Replacement Of Lower-extremity Joint M <42.50	15	15	—	—	$30,868.77	$40,263.61	$33,553.01	2025-09-11
A0305	HCPCS	Non-traumatic Brain Injury M <42.50 And A <78.50	15	15	—	—	$30,825.84	$40,207.62	$33,506.35	2025-09-11
A1504	HCPCS	Pulmonary M <45.50	15	15	—	—	$30,308.88	$39,533.32	$32,944.43	2025-09-11
D0104	HCPCS	Stroke M >=41.50 And M <50.50	15	15	—	—	$30,224.89	$39,423.77	$32,853.14	2025-09-11
D1305	HCPCS	Rheumatoid Other Arthritis M <51.50 And A <64.50	15	15	—	—	$30,208.09	$39,401.86	$32,834.88	2025-09-11
B1502	HCPCS	Pulmonary M >=56.50 And M <68.50	15	15	—	—	$30,159.57	$39,338.57	$32,782.14	2025-09-11
D1103	HCPCS	Amputation Non-lower Extremity M <52.50	15	15	—	—	$30,088.65	$39,246.06	$32,705.05	2025-09-11
C1103	HCPCS	Amputation Non-lower Extremity M <52.50	15	15	—	—	$30,088.65	$39,246.06	$32,705.05	2025-09-11
D1704	HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50	16	15	—	—	$40.00	$39,153.56	$32,627.97	2025-09-11
B1102	HCPCS	Amputation Non-lower Extremity M >=52.50 And M <58.50	15	15	—	—	$30,015.86	$39,151.13	$32,625.94	2025-09-11
B1202	HCPCS	Osteoarthritis M >=49.50 And M <61.50	15	15	—	—	$29,999.07	$39,129.22	$32,607.68	2025-09-11
B0103	HCPCS	Stroke M >=50.50 And M <63.50	15	15	—	—	$29,883.36	$38,978.29	$32,481.91	2025-09-11
D0904	HCPCS	Other Orthopedic M <44.5	15	15	—	—	$29,838.56	$38,919.86	$32,433.22	2025-09-11
D0504	HCPCS	Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50	15	15	—	—	$29,775.11	$38,837.10	$32,364.25	2025-09-11
C1804	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50	15	15	—	—	$29,756.44	$38,812.75	$32,343.96	2025-09-11
B0502	HCPCS	Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50	15	15	—	—	$29,732.18	$38,781.11	$32,317.59	2025-09-11
D0304	HCPCS	Non-traumatic Brain Injury M <42.50 And A >=78.50	15	15	—	—	$29,655.67	$38,681.30	$32,234.42	2025-09-11
C1203	HCPCS	Osteoarthritis M <49.50 And A >=74.50	15	15	—	—	$29,545.55	$38,537.68	$32,114.73	2025-09-11
A1103	HCPCS	Amputation Non-lower Extremity M <52.50	15	15	—	—	$29,480.23	$38,452.48	$32,043.73	2025-09-11
D1604	HCPCS	Pain Syndrome M <43.50	15	15	—	—	$29,413.04	$38,364.84	$31,970.70	2025-09-11
A0704	HCPCS	Fracture Of Lower Extremity M <41.50	15	15	—	—	$29,405.57	$38,355.10	$31,962.58	2025-09-11
D2004	HCPCS	Miscellaneous M <46.50 And A >=77.50	15	15	—	—	$29,345.86	$38,277.20	$31,897.67	2025-09-11
A1304	HCPCS	Rheumatoid Other Arthritis M <44.50 And A >=64.50	15	15	—	—	$29,345.86	$38,277.20	$31,897.67	2025-09-11
D1404	HCPCS	Cardiac M <45.50	15	15	—	—	$29,332.79	$38,260.16	$31,883.47	2025-09-11
A0604	HCPCS	Neurological M <43.50	15	15	—	—	$29,297.34	$38,213.92	$31,844.93	2025-09-11
A1004	HCPCS	Amputation Lower Extremity M <47.50	15	15	—	—	$29,067.78	$37,914.49	$31,595.41	2025-09-11
D1204	HCPCS	Osteoarthritis M <49.50 And A <74.50	15	15	—	—	$29,050.98	$37,892.58	$31,577.15	2025-09-11
B0402	HCPCS	Traumatic Spinal Cord Injury M >=47.50 And M <56.50	14	14	—	—	$29,028.59	$37,863.37	$31,552.81	2025-09-11
B0302	HCPCS	Non-traumatic Brain Injury M >=52.50 And M <65.50	15	15	—	—	$28,924.07	$37,727.05	$31,439.21	2025-09-11
B0702	HCPCS	Fracture Of Lower Extremity M >=52.50 And M <61.50	15	15	—	—	$28,912.88	$37,712.45	$31,427.04	2025-09-11
A0104	HCPCS	Stroke M >=41.50 And M <50.50	15	15	—	—	$28,804.63	$37,571.26	$31,309.38	2025-09-11
D0204	HCPCS	Traumatic Brain Injury M >=35.50 And M <49.50	15	15	—	—	$28,757.97	$37,510.39	$31,258.66	2025-09-11
C1703	HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50	15	15	—	—	$28,636.66	$37,352.16	$31,126.80	2025-09-11
B1002	HCPCS	Amputation Lower Extremity M >=55.50 And M <64.50	15	15	—	—	$28,631.06	$37,344.86	$31,120.72	2025-09-11
B0803	HCPCS	Replacement Of Lower-extremity Joint M >=51.50 And M <57.50	14	14	—	—	$28,631.06	$37,344.86	$31,120.72	2025-09-11
A0403	HCPCS	Traumatic Spinal Cord Injury M >=41.50 And M <47.50	15	15	—	—	$28,575.07	$37,271.83	$31,059.86	2025-09-11
D1804	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50	15	15	—	—	$28,248.46	$36,845.82	$30,704.85	2025-09-11
A2005	HCPCS	Miscellaneous M <46.50 And A <77.50	15	15	—	—	$28,155.15	$36,724.10	$30,603.42	2025-09-11
D0805	HCPCS	Replacement Of Lower-extremity Joint M <42.50	15	15	—	—	$28,143.95	$36,709.50	$30,591.25	2025-09-11
A1305	HCPCS	Rheumatoid Other Arthritis M <51.50 And A <64.50	15	15	—	—	$28,102.89	$36,655.94	$30,546.62	2025-09-11
B2101	HCPCS	Burns M >=52.50	15	15	—	—	$28,086.10	$36,634.04	$30,528.37	2025-09-11
A2102	HCPCS	Burns M <52.50	15	15	—	—	$28,069.30	$36,612.13	$30,510.11	2025-09-11
B1602	HCPCS	Pain Syndrome M >=58.50 And M <65.50	15	15	—	—	$28,000.25	$36,522.06	$30,435.05	2025-09-11
A0304	HCPCS	Non-traumatic Brain Injury M <42.50 And A >=78.50	15	15	—	—	$27,951.73	$36,458.77	$30,382.31	2025-09-11
B0902	HCPCS	Other Orthopedic M >=51.50 And M <63.50	15	15	—	—	$27,933.06	$36,434.42	$30,362.02	2025-09-11
C0303	HCPCS	Non-traumatic Brain Injury M >=42.50 And M <52.50	15	15	—	—	$27,843.48	$36,317.58	$30,264.65	2025-09-11
B1302	HCPCS	Rheumatoid Other Arthritis M >=51.50 And M <62.50	15	15	—	—	$27,819.22	$36,285.94	$30,238.28	2025-09-11
C1503	HCPCS	Pulmonary M >=45.50 And M <56.50	15	15	—	—	$27,819.22	$36,285.94	$30,238.28	2025-09-11
C0603	HCPCS	Neurological M >=43.50 And M <52.50	15	15	—	—	$27,746.43	$36,190.99	$30,159.16	2025-09-11
C1003	HCPCS	Amputation Lower Extremity M >=47.50 And M <55.50	15	15	—	—	$27,742.69	$36,186.12	$30,155.10	2025-09-11
D1203	HCPCS	Osteoarthritis M <49.50 And A >=74.50	15	15	—	—	$27,703.50	$36,135.00	$30,112.50	2025-09-11
C0703	HCPCS	Fracture Of Lower Extremity M >=41.50 And M <52.50	15	15	—	—	$27,503.80	$35,874.53	$29,895.44	2025-09-11
B2002	HCPCS	Miscellaneous M >=55.50 And M <66.50	15	15	—	—	$27,468.35	$35,828.28	$29,856.90	2025-09-11
A0504	HCPCS	Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50	14	14	—	—	$27,438.48	$35,789.33	$29,824.44	2025-09-11
A0904	HCPCS	Other Orthopedic M <44.5	15	15	—	—	$27,300.38	$35,609.20	$29,674.33	2025-09-11
A1704	HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50	14	14	—	—	$27,233.20	$35,521.56	$29,601.30	2025-09-11
A1604	HCPCS	Pain Syndrome M <43.50	14	14	—	—	$27,227.59	$35,514.25	$29,595.21	2025-09-11
C1803	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50	15	15	—	—	$27,210.79	$35,492.34	$29,576.95	2025-09-11
A0204	HCPCS	Traumatic Brain Injury M >=35.50 And M <49.50	15	15	—	—	$27,076.43	$35,317.08	$29,430.90	2025-09-11
A1404	HCPCS	Cardiac M <45.50	15	15	—	—	$26,990.57	$35,205.10	$29,337.58	2025-09-11
C0903	HCPCS	Other Orthopedic M >=44.50 And M <51.50	15	15	—	—	$26,716.23	$34,847.26	$29,039.38	2025-09-11
B1402	HCPCS	Cardiac M >=55.50 And M <68.50	14	14	—	—	$26,710.63	$34,839.95	$29,033.29	2025-09-11
A2004	HCPCS	Miscellaneous M <46.50 And A >=77.50	15	15	—	—	$12.64	$34,839.95	$29,033.29	2025-09-11
A1204	HCPCS	Osteoarthritis M <49.50 And A <74.50	15	15	—	—	$26,559.45	$34,642.76	$28,868.97	2025-09-11
B1802	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50	15	15	—	—	$26,548.26	$34,628.16	$28,856.80	2025-09-11
D1703	HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50	16	15	—	—	$40.00	$34,594.08	$28,828.40	2025-09-11
C0503	HCPCS	Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50	15	15	—	—	$26,512.80	$34,581.91	$28,818.26	2025-09-11
C2003	HCPCS	Miscellaneous M >=46.50 And M <55.50	15	15	—	—	$26,273.91	$34,270.32	$28,558.60	2025-09-11
C1603	HCPCS	Pain Syndrome M >=43.50 And M <58.50	15	15	—	—	$26,264.58	$34,258.15	$28,548.46	2025-09-11
A0805	HCPCS	Replacement Of Lower-extremity Joint M <42.50	15	15	—	—	$26,249.65	$34,238.68	$28,532.23	2025-09-11
A1804	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50	15	15	—	—	$26,191.79	$34,163.21	$28,469.34	2025-09-11
C1303	HCPCS	Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50	15	15	—	—	$26,169.40	$34,134.00	$28,445.00	2025-09-11
D1503	HCPCS	Pulmonary M >=45.50 And M <56.50	15	15	—	—	$26,163.80	$34,126.69	$28,438.91	2025-09-11
D0703	HCPCS	Fracture Of Lower Extremity M >=41.50 And M <52.50	16	15	—	—	$16.70	$33,983.06	$28,319.22	2025-09-11
C0103	HCPCS	Stroke M >=50.50 And M <63.50	15	15	—	—	$25,917.45	$33,805.37	$28,171.14	2025-09-11
D0603	HCPCS	Neurological M >=43.50 And M <52.50	16	15	—	—	$4.53	$33,785.89	$28,154.91	2025-09-11
D1803	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50	15	15	—	—	$25,833.46	$33,695.82	$28,079.85	2025-09-11
C0402	HCPCS	Traumatic Spinal Cord Injury M >=47.50 And M <56.50	15	15	—	—	$25,814.80	$33,671.47	$28,059.56	2025-09-11
C1403	HCPCS	Cardiac M >=45.50 And M <55.50	15	15	—	—	$25,747.61	$33,583.84	$27,986.53	2025-09-11
C0804	HCPCS	Replacement Of Lower-extremity Joint M >=42.50 And M <51.50	15	15	—	—	$25,738.28	$33,571.67	$27,976.39	2025-09-11
B0802	HCPCS	Replacement Of Lower-extremity Joint M >=57.50 And M <63.50	15	15	—	—	$25,723.35	$33,552.19	$27,960.16	2025-09-11
D0303	HCPCS	Non-traumatic Brain Injury M >=42.50 And M <52.50	15	15	—	—	$25,577.78	$33,362.32	$27,801.93	2025-09-11
33217	CPT	Insert 2 Electrode Pm-defib	34	22	$38,328.90	$38,328.90	$372.33	$28,746.68	$27,788.46	2025-09-11
33216	CPT	Insert 1 Electrode Pm-defib	34	22	$38,328.90	$38,328.90	$375.70	$28,746.68	$27,788.46	2025-09-11
C0203	HCPCS	Traumatic Brain Injury M >=49.50 And M <61.50	15	15	—	—	$25,529.25	$33,299.03	$27,749.19	2025-09-11
D1003	HCPCS	Amputation Lower Extremity M >=47.50 And M <55.50	15	15	—	—	$25,342.62	$33,055.60	$27,546.33	2025-09-11
A1203	HCPCS	Osteoarthritis M <49.50 And A >=74.50	15	15	—	—	$25,325.82	$33,033.68	$27,528.07	2025-09-11
D0402	HCPCS	Traumatic Spinal Cord Injury M >=47.50 And M <56.50	15	15	—	—	$25,058.94	$32,685.58	$27,237.98	2025-09-11
D0503	HCPCS	Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50	15	15	—	—	$25,047.75	$32,670.97	$27,225.81	2025-09-11
D1303	HCPCS	Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50	15	15	—	—	$24,978.69	$32,580.90	$27,150.75	2025-09-11
B1701	HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50	15	15	—	—	$24,954.43	$32,549.26	$27,124.38	2025-09-11
D0903	HCPCS	Other Orthopedic M >=44.50 And M <51.50	15	15	—	—	$24,902.17	$32,481.10	$27,067.58	2025-09-11
B0202	HCPCS	Traumatic Brain Injury M >=61.50 And M <73.50	15	15	—	—	$24,889.11	$32,464.06	$27,053.38	2025-09-11
B0601	HCPCS	Neurological M >=64.50	14	14	—	—	$24,797.66	$32,344.78	$26,953.98	2025-09-11
B1201	HCPCS	Osteoarthritis M >=61.50	15	15	—	—	$24,778.99	$32,320.43	$26,933.69	2025-09-11
D2003	HCPCS	Miscellaneous M >=46.50 And M <55.50	15	15	—	—	$24,543.84	$32,013.71	$26,678.09	2025-09-11
C1502	HCPCS	Pulmonary M >=56.50 And M <68.50	15	15	—	—	$24,478.52	$31,928.51	$26,607.09	2025-09-11
A1503	HCPCS	Pulmonary M >=45.50 And M <56.50	14	14	—	—	$24,474.79	$31,923.64	$26,603.03	2025-09-11
B1601	HCPCS	Pain Syndrome M >=65.50	15	15	—	—	$24,433.73	$31,870.08	$26,558.40	2025-09-11
D1102	HCPCS	Amputation Non-lower Extremity M >=52.50 And M <58.50	15	15	—	—	$24,127.65	$31,470.85	$26,225.71	2025-09-11
C1102	HCPCS	Amputation Non-lower Extremity M >=52.50 And M <58.50	15	15	—	—	$24,127.65	$31,470.85	$26,225.71	2025-09-11
A0303	HCPCS	Non-traumatic Brain Injury M >=42.50 And M <52.50	15	15	—	—	$24,107.13	$31,444.08	$26,203.40	2025-09-11
C1702	HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50	15	15	—	—	$24,099.66	$31,434.34	$26,195.28	2025-09-11
A0703	HCPCS	Fracture Of Lower Extremity M >=41.50 And M <52.50	15	15	—	—	$24,071.66	$31,397.82	$26,164.85	2025-09-11
A1703	HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50	15	15	—	—	$24,062.33	$31,385.65	$26,154.71	2025-09-11
A1803	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50	14	14	—	—	$23,952.22	$31,242.02	$26,035.02	2025-09-11
D1403	HCPCS	Cardiac M >=45.50 And M <55.50	15	15	—	—	$23,939.15	$31,224.98	$26,020.82	2025-09-11
C1902	HCPCS	Guillain-barré M >=51.50 And M <66.50	15	15	—	—	$23,883.16	$31,151.95	$25,959.96	2025-09-11
J9266	HCPCS	Pegaspargase Injection	1	1	—	—	$25,934.71	$25,934.71	$25,934.71	2025-09-11
B1501	HCPCS	Pulmonary M >=68.50	15	15	—	—	$23,774.93	$31,010.77	$25,842.31	2025-09-11
D1603	HCPCS	Pain Syndrome M >=43.50 And M <58.50	15	15	—	—	$23,739.46	$30,964.51	$25,803.76	2025-09-11
B0501	HCPCS	Non-traumatic Spinal Cord Injury M >=60.50	15	15	—	—	$23,700.27	$30,913.39	$25,761.16	2025-09-11
D0103	HCPCS	Stroke M >=50.50 And M <63.50	15	15	—	—	$23,683.47	$30,891.48	$25,742.90	2025-09-11
C1002	HCPCS	Amputation Lower Extremity M >=55.50 And M <64.50	15	15	—	—	$23,677.87	$30,884.18	$25,736.82	2025-09-11
A1102	HCPCS	Amputation Non-lower Extremity M >=52.50 And M <58.50	15	15	—	—	$23,640.55	$30,835.50	$25,696.25	2025-09-11
B1101	HCPCS	Amputation Non-lower Extremity M >=58.50	15	15	—	—	$23,608.82	$30,794.11	$25,661.76	2025-09-11
C0602	HCPCS	Neurological M >=52.50 And M <64.50	15	15	—	—	$23,549.10	$30,716.22	$25,596.85	2025-09-11
D0804	HCPCS	Replacement Of Lower-extremity Joint M >=42.50 And M <51.50	16	15	—	—	$16.56	$30,609.11	$25,507.59	2025-09-11
B0701	HCPCS	Fracture Of Lower Extremity M >=61.50	15	15	—	—	$23,407.26	$30,531.20	$25,442.67	2025-09-11
A0603	HCPCS	Neurological M >=43.50 And M <52.50	15	15	—	—	$23,360.60	$30,470.35	$25,391.96	2025-09-11
A1303	HCPCS	Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50	15	15	—	—	$23,237.42	$30,309.68	$25,258.07	2025-09-11
D0203	HCPCS	Traumatic Brain Injury M >=49.50 And M <61.50	15	15	—	—	$23,187.04	$30,243.96	$25,203.30	2025-09-11
B0102	HCPCS	Stroke M >=63.50 And M <72.50	15	15	—	—	$23,185.17	$30,241.52	$25,201.27	2025-09-11
C0302	HCPCS	Non-traumatic Brain Injury M >=52.50 And M <65.50	15	15	—	—	$23,142.24	$30,185.53	$25,154.61	2025-09-11
C0502	HCPCS	Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50	15	15	—	—	$23,129.18	$30,168.49	$25,140.41	2025-09-11
A0503	HCPCS	Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50	15	15	—	—	$23,082.52	$30,107.64	$25,089.70	2025-09-11
D1502	HCPCS	Pulmonary M >=56.50 And M <68.50	15	15	—	—	$23,020.93	$30,027.30	$25,022.75	2025-09-11
C1302	HCPCS	Rheumatoid Other Arthritis M >=51.50 And M <62.50	15	15	—	—	$23,002.27	$30,002.96	$25,002.47	2025-09-11
C0803	HCPCS	Replacement Of Lower-extremity Joint M >=51.50 And M <57.50	15	15	—	—	$22,974.28	$29,966.45	$24,972.04	2025-09-11
C1202	HCPCS	Osteoarthritis M >=49.50 And M <61.50	15	15	—	—	$22,806.30	$29,747.35	$24,789.46	2025-09-11
A0903	HCPCS	Other Orthopedic M >=44.50 And M <51.50	14	14	—	—	$22,783.91	$29,718.14	$24,765.12	2025-09-11
A0402	HCPCS	Traumatic Spinal Cord Injury M >=47.50 And M <56.50	14	14	—	—	$22,770.85	$29,701.10	$24,750.92	2025-09-11
A1003	HCPCS	Amputation Lower Extremity M >=47.50 And M <55.50	15	15	—	—	$22,705.53	$29,615.90	$24,679.92	2025-09-11
B0801	HCPCS	Replacement Of Lower-extremity Joint M >=63.50	15	15	—	—	$22,688.73	$29,593.99	$24,661.66	2025-09-11
B1001	HCPCS	Amputation Lower Extremity M >=64.50	15	15	—	—	$22,601.01	$29,479.58	$24,566.32	2025-09-11
A0103	HCPCS	Stroke M >=50.50 And M <63.50	15	15	—	—	$22,569.28	$29,438.20	$24,531.83	2025-09-11
B0401	HCPCS	Traumatic Spinal Cord Injury M >=56.50	14	14	—	—	$22,507.70	$29,357.87	$24,464.89	2025-09-11
B0901	HCPCS	Other Orthopedic M >=63.50	14	14	—	—	$22,427.45	$29,253.19	$24,377.66	2025-09-11
C0902	HCPCS	Other Orthopedic M >=51.50 And M <63.50	15	15	—	—	$22,373.32	$29,182.60	$24,318.83	2025-09-11
B0301	HCPCS	Non-traumatic Brain Injury M >=65.50	15	15	—	—	$22,371.46	$29,180.16	$24,316.80	2025-09-11
C0702	HCPCS	Fracture Of Lower Extremity M >=52.50 And M <61.50	15	15	—	—	$22,365.85	$29,172.85	$24,310.71	2025-09-11
A2003	HCPCS	Miscellaneous M >=46.50 And M <55.50	15	15	—	—	$22,339.73	$29,138.77	$24,282.31	2025-09-11
D1702	HCPCS	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50	16	15	—	—	$40.00	$29,112.00	$24,260.00	2025-09-11
D1902	HCPCS	Guillain-barré M >=51.50 And M <66.50	15	15	—	—	$22,285.60	$29,068.18	$24,223.48	2025-09-11
B2001	HCPCS	Miscellaneous M >=66.50	15	15	—	—	$22,029.92	$28,734.68	$23,945.57	2025-09-11
A1403	HCPCS	Cardiac M >=45.50 And M <55.50	15	15	—	—	$22,028.06	$28,732.25	$23,943.54	2025-09-11
D0602	HCPCS	Neurological M >=52.50 And M <64.50	16	15	—	—	$4.53	$28,673.82	$23,894.85	2025-09-11
A1603	HCPCS	Pain Syndrome M >=43.50 And M <58.50	15	15	—	—	$21,975.80	$28,664.09	$23,886.74	2025-09-11
D1302	HCPCS	Rheumatoid Other Arthritis M >=51.50 And M <62.50	15	15	—	—	$21,957.13	$28,639.74	$23,866.45	2025-09-11
C2002	HCPCS	Miscellaneous M >=55.50 And M <66.50	15	15	—	—	$21,940.33	$28,617.83	$23,848.19	2025-09-11
A1902	HCPCS	Guillain-barré M >=51.50 And M <66.50	14	14	—	—	$21,899.28	$28,564.28	$23,803.57	2025-09-11
A0804	HCPCS	Replacement Of Lower-extremity Joint M >=42.50 And M <51.50	15	15	—	—	$21,886.21	$28,547.23	$23,789.36	2025-09-11
D0502	HCPCS	Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50	16	15	—	—	$41.89	$28,503.42	$23,752.85	2025-09-11
A0203	HCPCS	Traumatic Brain Injury M >=49.50 And M <61.50	15	15	—	—	$21,830.23	$28,474.21	$23,728.51	2025-09-11
D1002	HCPCS	Amputation Lower Extremity M >=55.50 And M <64.50	15	15	—	—	$21,630.53	$28,213.74	$23,511.45	2025-09-11
A1502	HCPCS	Pulmonary M >=56.50 And M <68.50	15	15	—	—	$21,535.35	$28,089.59	$23,407.99	2025-09-11
D1202	HCPCS	Osteoarthritis M >=49.50 And M <61.50	15	15	—	—	$21,384.18	$27,892.40	$23,243.67	2025-09-11
C2101	HCPCS	Burns M >=52.50	15	15	—	—	$21,341.25	$27,836.41	$23,197.01	2025-09-11
D2101	HCPCS	Burns M >=52.50	15	15	—	—	$21,341.25	$27,836.41	$23,197.01	2025-09-11
D0302	HCPCS	Non-traumatic Brain Injury M >=52.50 And M <65.50	15	15	—	—	$21,257.27	$27,726.88	$23,105.73	2025-09-11
D0702	HCPCS	Fracture Of Lower Extremity M >=52.50 And M <61.50	16	15	—	—	$33.11	$27,634.37	$23,028.64	2025-09-11
C1802	HCPCS	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50	15	15	—	—	$21,178.89	$27,624.64	$23,020.53	2025-09-11
B1401	HCPCS	Cardiac M >=68.50	14	14	—	—	$21,061.30	$27,471.26	$22,892.72	2025-09-11
C1402	HCPCS	Cardiac M >=55.50 And M <68.50	15	15	—	—	$21,042.64	$27,446.93	$22,872.44	2025-09-11

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