|
0118
|
RC
|
Room & Board - Private (One Bed) - Rehabilitation
|
2
|
2
|
—
|
—
|
$1.00
|
$1.00
|
$1.00
|
2026-03-17
|
|
0422
|
RC
|
Physical Therapy - Hourly Charge
|
17
|
5
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0444
|
RC
|
Speech Therapy - Language Pathology - Evaluation Or Reevaluation
|
34
|
12
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0443
|
RC
|
Speech Therapy - Language Pathology - Group Rate
|
17
|
5
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0449
|
RC
|
Speech Therapy - Language Pathology - Other
|
16
|
5
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0440
|
RC
|
Speech Therapy - Language Pathology - General Classification
|
35
|
12
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0439
|
RC
|
Occupational Therapy - Other
|
16
|
5
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0441
|
RC
|
Speech Therapy - Language Pathology - Visit Charge
|
17
|
5
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0433
|
RC
|
Occupational Therapy - Group Rate
|
17
|
5
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0432
|
RC
|
Occupational Therapy - Hourly Charge
|
17
|
5
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0434
|
RC
|
Occupational Therapy - Evaluation Or Reevaluation
|
35
|
12
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0442
|
RC
|
Speech Therapy - Language Pathology - Hourly Charge
|
17
|
5
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0424
|
RC
|
Physical Therapy - Evaluation Or Re-evaluation
|
35
|
12
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0423
|
RC
|
Physical Therapy - Group Rate
|
17
|
5
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0429
|
RC
|
Physical Therapy - Other
|
16
|
5
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0420
|
RC
|
Physical Therapy - General Classification
|
35
|
12
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0421
|
RC
|
Physical Therapy - Visit Charge
|
35
|
12
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0430
|
RC
|
Occupational Therapy - General Classification
|
35
|
12
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0431
|
RC
|
Occupational Therapy - Visit Charge
|
17
|
5
|
—
|
—
|
$106.10
|
$180.00
|
$143.05
|
2026-03-17
|
|
0419
|
RC
|
Respiratory Services - Other
|
14
|
4
|
—
|
—
|
$110.00
|
$180.00
|
$145.00
|
2026-03-17
|
|
0412
|
RC
|
Respiratory Services - Inhalation Services
|
14
|
4
|
—
|
—
|
$110.00
|
$180.00
|
$145.00
|
2026-03-17
|
|
0410
|
RC
|
Respiratory Services - General Classification
|
32
|
11
|
—
|
—
|
$110.00
|
$180.00
|
$145.00
|
2026-03-17
|
|
97112
|
HCPCS
|
Neuromuscular Reeducation
|
25
|
11
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97039
|
HCPCS
|
Unlisted Modality
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97129
|
HCPCS
|
Ther Ivntj 1st 15 Min
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97026
|
HCPCS
|
Infrared Therapy
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97016
|
HCPCS
|
Vasopneumatic Device Therapy
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97032
|
HCPCS
|
Appl Modality 1+estim Ea 15
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97130
|
HCPCS
|
Ther Ivntj Ea Addl 15 Min
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97010
|
HCPCS
|
Hot Or Cold Packs Therapy
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97024
|
HCPCS
|
Diathermy Eg Microwave
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
92526
|
HCPCS
|
Oral Function Therapy
|
25
|
11
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97037
|
HCPCS
|
Appl Modality 1+lllt Po Pain
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97113
|
HCPCS
|
Aquatic Therapy/exercises
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97033
|
HCPCS
|
App Mdlty 1+iontphrsis Ea 15
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97014
|
HCPCS
|
Electric Stimulation Therapy
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97158
|
HCPCS
|
Grp Adapt Bhv Tx By Phy/qhp
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97156
|
HCPCS
|
Fam Adapt Bhv Tx Gdn Phy/qhp
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97164
|
HCPCS
|
Pt Re-eval Est Plan Care
|
25
|
11
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97155
|
HCPCS
|
Adapt Behavior Tx Phys/qhp
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97172
|
HCPCS
|
Athletic Trn Re-eval Plan Cr
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97537
|
HCPCS
|
Community/work Reintegration
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97168
|
HCPCS
|
Ot Re-eval Est Plan Care
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97150
|
HCPCS
|
Group Therapeutic Procedures
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
S9124
|
HCPCS
|
Nursing Care, In The Home; B
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
S9125
|
HCPCS
|
Respite Care, In The Home, P
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97761
|
HCPCS
|
Prosthetic Traing 1st Enc
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
S9152
|
HCPCS
|
Speech Therapy, Re-eval
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97760
|
HCPCS
|
Orthotic Mgmt&traing 1st Enc
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97140
|
HCPCS
|
Manual Therapy 1/> Regions
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97161
|
HCPCS
|
Pt Eval Low Complex 20 Min
|
25
|
11
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97165
|
HCPCS
|
Ot Eval Low Complex 30 Min
|
25
|
11
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
S9129
|
HCPCS
|
Occupational Therapy, In The
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
S9122
|
HCPCS
|
Home Health Aide Or Certifie
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97530
|
HCPCS
|
Therapeutic Activities
|
25
|
11
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97167
|
HCPCS
|
Ot Eval High Complex 60 Min
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97535
|
HCPCS
|
Self Care Mngment Training
|
25
|
11
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97546
|
HCPCS
|
Work Hardening Add-on
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97750
|
HCPCS
|
Physical Performance Test
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
S9150
|
HCPCS
|
Evaluation By Ocularist
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
S9128
|
HCPCS
|
Speech Therapy, In The Home,
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
S9131
|
HCPCS
|
Pt In The Home Per Diem
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
S9126
|
HCPCS
|
Hospice Care, In The Home, P
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
S8990
|
HCPCS
|
Pt Or Manip For Maint
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
S9123
|
HCPCS
|
Nursing Care In Home Rn
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
S9127
|
HCPCS
|
Social Work Visit, In The Ho
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97763
|
HCPCS
|
Orthc/prostc Mgmt Sbsq Enc
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97755
|
HCPCS
|
Assistive Technology Assess
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97799
|
HCPCS
|
Unlisted Physcl Med/rehab Px
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97542
|
HCPCS
|
Wheelchair Mngment Training
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97533
|
HCPCS
|
Sensory Integration
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97545
|
HCPCS
|
Work Hardening
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
S8940
|
HCPCS
|
Hippotherapy Per Session
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97169
|
HCPCS
|
Athletic Trn Eval Low Cmplx
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97166
|
HCPCS
|
Ot Eval Mod Complex 45 Min
|
25
|
11
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97170
|
HCPCS
|
Athletic Trn Eval Mod Cmplx
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97162
|
HCPCS
|
Pt Eval Mod Complex 30 Min
|
25
|
11
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97157
|
HCPCS
|
Mult Fam Adapt Bhv Tx Gdn
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97163
|
HCPCS
|
Pt Eval High Complex 45 Min
|
25
|
11
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97171
|
HCPCS
|
Athletic Trn Eval High Cmplx
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
S8948
|
HCPCS
|
Low-level Laser Trmt 15 Min
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97151
|
HCPCS
|
Bhv Id Assmt By Phys/qhp
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97139
|
HCPCS
|
Unlisted Therapeutic Px
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97152
|
HCPCS
|
Bhv Id Suprt Assmt By 1 Tech
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97116
|
HCPCS
|
Gait Training Therapy
|
25
|
11
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97110
|
HCPCS
|
Therapeutic Exercises
|
25
|
11
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97124
|
HCPCS
|
Massage Therapy
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97153
|
HCPCS
|
Adaptive Behavior Tx By Tech
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97034
|
HCPCS
|
App Mdlty 1+cntrst Bth Ea 15
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97028
|
HCPCS
|
Ultraviolet Therapy
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97035
|
HCPCS
|
App Mdlty 1+ultrasound Ea 15
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97018
|
HCPCS
|
Paraffin Bath Therapy
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97012
|
HCPCS
|
Mechanical Traction Therapy
|
19
|
9
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97022
|
HCPCS
|
Whirlpool Therapy
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97036
|
HCPCS
|
App Mdlty 1+hubbrd Tnk Ea 15
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
97154
|
HCPCS
|
Grp Adapt Bhv Tx By Tech
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
S8950
|
HCPCS
|
Complex Lymphedema Therapy,
|
1
|
1
|
—
|
—
|
$180.00
|
$180.00
|
$180.00
|
2026-03-17
|
|
0825
|
RC
|
Hemodialysis - Outpatient Or Home - Support Services
|
3
|
1
|
—
|
—
|
$475.00
|
$475.00
|
$475.00
|
2026-03-17
|
|
0824
|
RC
|
Hemodialysis - Outpatient Or Home - Maintenance 100%
|
3
|
1
|
—
|
—
|
$475.00
|
$475.00
|
$475.00
|
2026-03-17
|
|
0829
|
RC
|
Hemodialysis - Outpatient Or Home - Other Op Hemodialysis
|
4
|
2
|
—
|
—
|
$475.00
|
$475.00
|
$475.00
|
2026-03-17
|
|
0822
|
RC
|
Hemodialysis - Outpatient Or Home - Home Supplies
|
3
|
1
|
—
|
—
|
$475.00
|
$475.00
|
$475.00
|
2026-03-17
|
|
0821
|
RC
|
Hemodialysis - Outpatient Or Home - Hemodialysis Composite Or Other Rate
|
4
|
2
|
—
|
—
|
$475.00
|
$475.00
|
$475.00
|
2026-03-17
|
|
0823
|
RC
|
Hemodialysis - Outpatient Or Home - Home Equipment
|
3
|
1
|
—
|
—
|
$475.00
|
$475.00
|
$475.00
|
2026-03-17
|
|
0820
|
RC
|
Hemodialysis - Outpatient Or Home - General Classification
|
4
|
2
|
—
|
—
|
$475.00
|
$475.00
|
$475.00
|
2026-03-17
|
|
0801
|
RC
|
Inpatient Renal Dialysis - Hemodialysis
|
5
|
3
|
—
|
—
|
$495.00
|
$670.00
|
$670.00
|
2026-03-17
|
|
0800
|
RC
|
Inpatient Renal Dialysis - General Classification
|
4
|
2
|
—
|
—
|
$605.00
|
$670.00
|
$670.00
|
2026-03-17
|
|
0802
|
RC
|
Inpatient Renal Dialysis - Peritoneal Dialysis (non-capd)
|
4
|
2
|
—
|
—
|
$605.00
|
$670.00
|
$670.00
|
2026-03-17
|
|
0803
|
RC
|
Inpatient Renal Dialysis - Continuous Ambulatory Peritoneal Dialysis (capd)
|
4
|
2
|
—
|
—
|
$605.00
|
$670.00
|
$670.00
|
2026-03-17
|
|
0809
|
RC
|
Inpatient Renal Dialysis - Other
|
4
|
2
|
—
|
—
|
$605.00
|
$670.00
|
$670.00
|
2026-03-17
|
|
0804
|
RC
|
Inpatient Renal Dialysis - Continuous Cycling Peritoneal Dialysis (ccpd)
|
4
|
2
|
—
|
—
|
$605.00
|
$670.00
|
$670.00
|
2026-03-17
|
|
0128
|
RC
|
Room & Board - Semi-private (Two Beds) - Rehabilitation
|
8
|
7
|
—
|
—
|
$1,586.50
|
$1,586.50
|
$1,586.50
|
2026-03-17
|
|
0138
|
RC
|
Room & Board - Three And Four Beds - Rehabilitation
|
6
|
5
|
—
|
—
|
$1,586.50
|
$1,586.50
|
$1,586.50
|
2026-03-17
|
|
0158
|
RC
|
Room & Board - Ward - Rehabilitation
|
6
|
5
|
—
|
—
|
$1,586.50
|
$1,586.50
|
$1,586.50
|
2026-03-17
|
|
0148
|
RC
|
Room & Board - Deluxe Private - Rehabilitation
|
6
|
5
|
—
|
—
|
$1,586.50
|
$1,586.50
|
$1,586.50
|
2026-03-17
|
|
A0102
|
LOCAL
|
Stroke M >=63.50 And M <72.50- Tier None
|
18
|
10
|
—
|
—
|
$7,248.57
|
$7,248.57
|
$7,248.57
|
2026-03-17
|
|
C1404
|
LOCAL
|
Cardiac M <45.50- Tier Tier 2
|
18
|
10
|
—
|
—
|
$7,841.29
|
$7,841.29
|
$7,841.29
|
2026-03-17
|
|
A1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50- Tier None
|
18
|
10
|
—
|
—
|
$15,549.82
|
$15,549.82
|
$15,549.82
|
2026-03-17
|
|
D1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50- T…
|
18
|
10
|
—
|
—
|
$15,807.15
|
$15,807.15
|
$15,807.15
|
2026-03-17
|
|
A0301
|
LOCAL
|
Non-traumatic Brain Injury M >=65.50- Tier None
|
18
|
10
|
—
|
—
|
$18,326.41
|
$18,326.41
|
$18,326.41
|
2026-03-17
|
|
D0901
|
LOCAL
|
Other Orthopedic M >=63.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$19,800.82
|
$19,800.82
|
$19,800.82
|
2026-03-17
|
|
A0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier None
|
18
|
10
|
—
|
—
|
$14,638.75
|
$27,821.42
|
$21,230.08
|
2026-03-17
|
|
D0102
|
LOCAL
|
Stroke M >=63.50 And M <72.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$21,729.92
|
$22,035.80
|
$21,882.86
|
2026-03-17
|
|
A2002
|
LOCAL
|
Miscellaneous M >=55.50 And M <66.50- Tier None
|
18
|
10
|
—
|
—
|
$22,063.20
|
$22,063.20
|
$22,063.20
|
2026-03-17
|
|
D0802
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=57.50 And M <63.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$22,255.23
|
$22,255.23
|
$22,255.23
|
2026-03-17
|
|
A0902
|
LOCAL
|
Other Orthopedic M >=51.50 And M <63.50- Tier None
|
18
|
10
|
—
|
—
|
$22,617.43
|
$22,617.43
|
$22,617.43
|
2026-03-17
|
|
A0702
|
LOCAL
|
Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier None
|
18
|
10
|
—
|
—
|
$23,149.15
|
$23,149.15
|
$23,149.15
|
2026-03-17
|
|
A0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50- Tier None
|
18
|
10
|
—
|
—
|
$23,447.12
|
$23,447.12
|
$23,447.12
|
2026-03-17
|
|
D0501
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=60.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$23,878.02
|
$23,878.02
|
$23,878.02
|
2026-03-17
|
|
A1302
|
LOCAL
|
Rheumatoid Other Arthritis M >=51.50 And M <62.50- Tier None
|
18
|
10
|
—
|
—
|
$24,155.63
|
$24,155.63
|
$24,155.63
|
2026-03-17
|
|
D2002
|
LOCAL
|
Miscellaneous M >=55.50 And M <66.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$24,239.51
|
$24,239.51
|
$24,239.51
|
2026-03-17
|
|
D0803
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=51.50 And M <57.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$24,771.44
|
$24,771.44
|
$24,771.44
|
2026-03-17
|
|
D0902
|
LOCAL
|
Other Orthopedic M >=51.50 And M <63.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$24,791.08
|
$24,791.08
|
$24,791.08
|
2026-03-17
|
|
D0302
|
LOCAL
|
Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$25,140.04
|
$25,140.04
|
$25,140.04
|
2026-03-17
|
|
A1502
|
LOCAL
|
Pulmonary M >=56.50 And M <68.50- Tier None
|
18
|
10
|
—
|
—
|
$25,468.92
|
$25,468.92
|
$25,468.92
|
2026-03-17
|
|
A0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50- Tier None
|
18
|
10
|
—
|
—
|
$25,817.66
|
$25,817.66
|
$25,817.66
|
2026-03-17
|
|
A0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier None
|
18
|
10
|
—
|
—
|
$25,883.87
|
$25,883.87
|
$25,883.87
|
2026-03-17
|
|
C2002
|
LOCAL
|
Miscellaneous M >=55.50 And M <66.50- Tier Tier 2
|
18
|
10
|
—
|
—
|
$25,947.88
|
$25,947.88
|
$25,947.88
|
2026-03-17
|
|
D0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$25,998.65
|
$25,998.65
|
$25,998.65
|
2026-03-17
|
|
A2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50- Tier None
|
18
|
10
|
—
|
—
|
$26,420.22
|
$26,420.22
|
$26,420.22
|
2026-03-17
|
|
A0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50- Tier None
|
18
|
10
|
—
|
—
|
$26,839.20
|
$26,839.20
|
$26,839.20
|
2026-03-17
|
|
A1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50- Tier None
|
18
|
10
|
—
|
—
|
$27,400.78
|
$27,400.78
|
$27,400.78
|
2026-03-17
|
|
D0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$27,422.29
|
$27,422.29
|
$27,422.29
|
2026-03-17
|
|
A1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50- Tier None
|
18
|
10
|
—
|
—
|
$27,481.89
|
$27,481.89
|
$27,481.89
|
2026-03-17
|
|
A0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50- Tier None
|
18
|
10
|
—
|
—
|
$27,627.56
|
$27,627.56
|
$27,627.56
|
2026-03-17
|
|
D0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$27,753.37
|
$27,753.37
|
$27,753.37
|
2026-03-17
|
|
A0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier None
|
18
|
10
|
—
|
—
|
$27,123.94
|
$28,468.51
|
$27,796.22
|
2026-03-17
|
|
D0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$28,009.41
|
$28,009.41
|
$28,009.41
|
2026-03-17
|
|
D1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$28,311.80
|
$28,311.80
|
$28,311.80
|
2026-03-17
|
|
A1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50- T…
|
18
|
10
|
—
|
—
|
$28,327.25
|
$28,327.25
|
$28,327.25
|
2026-03-17
|
|
A1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50…
|
18
|
10
|
—
|
—
|
$28,457.47
|
$28,457.47
|
$28,457.47
|
2026-03-17
|
|
D2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$29,026.93
|
$29,026.93
|
$29,026.93
|
2026-03-17
|
|
D0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$29,450.71
|
$29,450.71
|
$29,450.71
|
2026-03-17
|
|
D1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$29,541.21
|
$29,541.21
|
$29,541.21
|
2026-03-17
|
|
C0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 2
|
18
|
10
|
—
|
—
|
$27,578.22
|
$31,875.82
|
$29,727.02
|
2026-03-17
|
|
A1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50- Tier None
|
18
|
10
|
—
|
—
|
$29,951.75
|
$29,951.75
|
$29,951.75
|
2026-03-17
|
|
D0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$30,249.72
|
$30,249.72
|
$30,249.72
|
2026-03-17
|
|
C0402
|
LOCAL
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50- Tier Tier 2
|
18
|
10
|
—
|
—
|
$30,530.03
|
$30,530.03
|
$30,530.03
|
2026-03-17
|
|
A1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50- Tier None
|
18
|
10
|
—
|
—
|
$30,532.90
|
$30,532.90
|
$30,532.90
|
2026-03-17
|
|
D0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$30,633.77
|
$30,633.77
|
$30,633.77
|
2026-03-17
|
|
A0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50- Tier None
|
18
|
10
|
—
|
—
|
$31,044.31
|
$31,044.31
|
$31,044.31
|
2026-03-17
|
|
A0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50- Tier None
|
18
|
10
|
—
|
—
|
$27,787.56
|
$34,776.69
|
$31,282.12
|
2026-03-17
|
|
A0302
|
LOCAL
|
Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier None
|
18
|
10
|
—
|
—
|
$31,489.13
|
$31,489.13
|
$31,489.13
|
2026-03-17
|
|
D0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$30,812.56
|
$33,395.85
|
$32,104.21
|
2026-03-17
|
|
A0904
|
LOCAL
|
Other Orthopedic M <44.5- Tier None
|
18
|
10
|
—
|
—
|
$32,318.48
|
$32,318.48
|
$32,318.48
|
2026-03-17
|
|
A1404
|
LOCAL
|
Cardiac M <45.50- Tier None
|
18
|
10
|
—
|
—
|
$32,384.55
|
$32,384.55
|
$32,384.55
|
2026-03-17
|
|
C0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 2
|
18
|
10
|
—
|
—
|
$32,712.69
|
$32,712.69
|
$32,712.69
|
2026-03-17
|
|
A1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50…
|
18
|
10
|
—
|
—
|
$32,739.11
|
$32,739.11
|
$32,739.11
|
2026-03-17
|
|
A0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier None
|
18
|
10
|
—
|
—
|
$33,057.28
|
$33,057.28
|
$33,057.28
|
2026-03-17
|
|
D0904
|
LOCAL
|
Other Orthopedic M <44.5- Tier Tier 3
|
18
|
10
|
—
|
—
|
$30,771.21
|
$35,425.90
|
$33,098.56
|
2026-03-17
|
|
A2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50- Tier None
|
18
|
10
|
—
|
—
|
$33,256.65
|
$33,256.65
|
$33,256.65
|
2026-03-17
|
|
D0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$33,284.62
|
$33,284.62
|
$33,284.62
|
2026-03-17
|
|
C1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T…
|
18
|
10
|
—
|
—
|
$33,530.26
|
$33,530.26
|
$33,530.26
|
2026-03-17
|
|
D0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$34,010.79
|
$34,010.79
|
$34,010.79
|
2026-03-17
|
|
C0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50- Tier Tier 2
|
18
|
10
|
—
|
—
|
$34,023.01
|
$34,023.01
|
$34,023.01
|
2026-03-17
|
|
A0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50- Tier None
|
18
|
10
|
—
|
—
|
$34,065.97
|
$34,065.97
|
$34,065.97
|
2026-03-17
|
|
D0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$34,619.86
|
$34,619.86
|
$34,619.86
|
2026-03-17
|
|
D2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$34,707.95
|
$34,707.95
|
$34,707.95
|
2026-03-17
|
|
D0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$35,203.47
|
$35,203.47
|
$35,203.47
|
2026-03-17
|
|
D1404
|
LOCAL
|
Cardiac M <45.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$35,216.68
|
$35,216.68
|
$35,216.68
|
2026-03-17
|
|
B0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50- Tier Tier 1
|
18
|
10
|
—
|
—
|
$35,341.74
|
$35,341.74
|
$35,341.74
|
2026-03-17
|
|
D1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$35,725.79
|
$35,725.79
|
$35,725.79
|
2026-03-17
|
|
D0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$35,745.66
|
$35,745.66
|
$35,745.66
|
2026-03-17
|
|
D1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$36,033.72
|
$36,033.72
|
$36,033.72
|
2026-03-17
|
|
A0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50- Tier None
|
18
|
10
|
—
|
—
|
$36,456.37
|
$36,456.37
|
$36,456.37
|
2026-03-17
|
|
D2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$36,582.19
|
$36,582.19
|
$36,582.19
|
2026-03-17
|
|
C2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50- Tier Tier 2
|
18
|
10
|
—
|
—
|
$37,151.64
|
$37,151.64
|
$37,151.64
|
2026-03-17
|
|
D0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$19,694.93
|
$54,633.65
|
$37,164.29
|
2026-03-17
|
|
B0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50- Tier Tier 1
|
18
|
10
|
—
|
—
|
$37,198.00
|
$37,198.00
|
$37,198.00
|
2026-03-17
|
|
D1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$37,306.15
|
$37,306.15
|
$37,306.15
|
2026-03-17
|
|
C0904
|
LOCAL
|
Other Orthopedic M <44.5- Tier Tier 2
|
18
|
10
|
—
|
—
|
$37,502.65
|
$37,502.65
|
$37,502.65
|
2026-03-17
|
|
A1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T…
|
18
|
10
|
—
|
—
|
$37,555.56
|
$37,555.56
|
$37,555.56
|
2026-03-17
|
|
A0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50- Tier None
|
18
|
10
|
—
|
—
|
$37,850.98
|
$37,850.98
|
$37,850.98
|
2026-03-17
|
|
A1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier None
|
18
|
10
|
—
|
—
|
$38,112.68
|
$38,112.68
|
$38,112.68
|
2026-03-17
|
|
B2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50- Tier Tier 1
|
18
|
10
|
—
|
—
|
$38,156.72
|
$38,156.72
|
$38,156.72
|
2026-03-17
|
|
C0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 2
|
18
|
10
|
—
|
—
|
$38,180.20
|
$38,180.20
|
$38,180.20
|
2026-03-17
|
|
D1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$34,819.43
|
$41,660.96
|
$38,240.19
|
2026-03-17
|
|
D1504
|
LOCAL
|
Pulmonary M <45.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$38,319.25
|
$38,319.25
|
$38,319.25
|
2026-03-17
|
|
D0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$38,679.03
|
$38,679.03
|
$38,679.03
|
2026-03-17
|
|
A1504
|
LOCAL
|
Pulmonary M <45.50- Tier None
|
18
|
10
|
—
|
—
|
$38,711.10
|
$38,711.10
|
$38,711.10
|
2026-03-17
|
|
C2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50- Tier Tier 2
|
18
|
10
|
—
|
—
|
$39,160.20
|
$39,160.20
|
$39,160.20
|
2026-03-17
|
|
B1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50- Tier Tier 1
|
18
|
10
|
—
|
—
|
$39,672.27
|
$39,672.27
|
$39,672.27
|
2026-03-17
|
|
A1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50- Tier None
|
18
|
10
|
—
|
—
|
$39,940.56
|
$39,940.56
|
$39,940.56
|
2026-03-17
|
|
C0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50- Tier Tier 2
|
18
|
10
|
—
|
—
|
$40,394.24
|
$40,394.24
|
$40,394.24
|
2026-03-17
|
|
A0205
|
LOCAL
|
Traumatic Brain Injury M <35.50- Tier None
|
18
|
10
|
—
|
—
|
$40,953.62
|
$40,953.62
|
$40,953.62
|
2026-03-17
|
|
D1004
|
LOCAL
|
Amputation Lower Extremity M <47.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$40,960.59
|
$40,960.59
|
$40,960.59
|
2026-03-17
|
|
C0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 2
|
18
|
10
|
—
|
—
|
$40,038.76
|
$42,106.82
|
$41,072.79
|
2026-03-17
|
|
C0604
|
LOCAL
|
Neurological M <43.50- Tier Tier 2
|
18
|
10
|
—
|
—
|
$41,153.30
|
$41,153.30
|
$41,153.30
|
2026-03-17
|
|
C1504
|
LOCAL
|
Pulmonary M <45.50- Tier Tier 2
|
18
|
10
|
—
|
—
|
$41,479.97
|
$41,479.97
|
$41,479.97
|
2026-03-17
|
|
A0106
|
LOCAL
|
Stroke M <41.50 And A <84.50- Tier None
|
18
|
10
|
—
|
—
|
$33,024.43
|
$50,197.19
|
$41,610.81
|
2026-03-17
|
|
D0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$41,947.68
|
$41,947.68
|
$41,947.68
|
2026-03-17
|
|
D0205
|
LOCAL
|
Traumatic Brain Injury M <35.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$43,565.78
|
$43,565.78
|
$43,565.78
|
2026-03-17
|
|
B0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50- Tier Tier 1
|
18
|
10
|
—
|
—
|
$44,342.87
|
$44,342.87
|
$44,342.87
|
2026-03-17
|
|
B0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 1
|
18
|
10
|
—
|
—
|
$44,394.58
|
$44,394.58
|
$44,394.58
|
2026-03-17
|
|
C1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 2
|
18
|
10
|
—
|
—
|
$44,985.01
|
$44,985.01
|
$44,985.01
|
2026-03-17
|
|
A0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50- Tier None
|
18
|
10
|
—
|
—
|
$45,090.95
|
$45,090.95
|
$45,090.95
|
2026-03-17
|
|
A0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50- Tier None
|
18
|
10
|
—
|
—
|
$45,422.80
|
$45,422.80
|
$45,422.80
|
2026-03-17
|
|
A2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50- Tier None
|
18
|
10
|
—
|
—
|
$31,589.49
|
$59,457.63
|
$45,523.56
|
2026-03-17
|
|
A0604
|
LOCAL
|
Neurological M <43.50- Tier None
|
18
|
10
|
—
|
—
|
$34,648.68
|
$57,938.91
|
$46,293.79
|
2026-03-17
|
|
B2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50- Tier Tier 1
|
18
|
10
|
—
|
—
|
$46,512.39
|
$46,512.39
|
$46,512.39
|
2026-03-17
|
|
C0205
|
LOCAL
|
Traumatic Brain Injury M <35.50- Tier Tier 2
|
18
|
10
|
—
|
—
|
$47,712.42
|
$47,712.42
|
$47,712.42
|
2026-03-17
|
|
B2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50- Tier Tier 1
|
18
|
10
|
—
|
—
|
$49,026.40
|
$49,026.40
|
$49,026.40
|
2026-03-17
|
|
D0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$50,893.07
|
$50,893.07
|
$50,893.07
|
2026-03-17
|
|
A1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier None
|
18
|
10
|
—
|
—
|
$53,334.86
|
$53,334.86
|
$53,334.86
|
2026-03-17
|
|
B0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 1
|
18
|
10
|
—
|
—
|
$54,431.20
|
$55,994.47
|
$55,212.83
|
2026-03-17
|
|
B0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 1
|
18
|
10
|
—
|
—
|
$55,316.07
|
$55,316.07
|
$55,316.07
|
2026-03-17
|
|
D0106
|
LOCAL
|
Stroke M <41.50 And A <84.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$51,960.95
|
$61,595.17
|
$56,778.06
|
2026-03-17
|
|
B1004
|
LOCAL
|
Amputation Lower Extremity M <47.50- Tier Tier 1
|
18
|
10
|
—
|
—
|
$57,428.20
|
$57,428.20
|
$57,428.20
|
2026-03-17
|
|
A1904
|
LOCAL
|
Guillain-barré M <38.50- Tier None
|
18
|
10
|
—
|
—
|
$57,435.49
|
$57,435.49
|
$57,435.49
|
2026-03-17
|
|
B0205
|
LOCAL
|
Traumatic Brain Injury M <35.50- Tier Tier 1
|
18
|
10
|
—
|
—
|
$58,237.06
|
$58,237.06
|
$58,237.06
|
2026-03-17
|
|
B0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50- Tier Tier 1
|
18
|
10
|
—
|
—
|
$58,308.71
|
$58,308.71
|
$58,308.71
|
2026-03-17
|
|
D0604
|
LOCAL
|
Neurological M <43.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$32,578.30
|
$85,133.29
|
$58,855.79
|
2026-03-17
|
|
B0604
|
LOCAL
|
Neurological M <43.50- Tier Tier 1
|
18
|
10
|
—
|
—
|
$60,652.68
|
$60,652.68
|
$60,652.68
|
2026-03-17
|
|
C0106
|
LOCAL
|
Stroke M <41.50 And A <84.50- Tier Tier 2
|
18
|
10
|
—
|
—
|
$61,383.30
|
$61,383.30
|
$61,383.30
|
2026-03-17
|
|
D1904
|
LOCAL
|
Guillain-barré M <38.50- Tier Tier 3
|
18
|
10
|
—
|
—
|
$67,940.99
|
$67,940.99
|
$67,940.99
|
2026-03-17
|
|
B0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 1
|
18
|
10
|
—
|
—
|
$68,803.67
|
$68,803.67
|
$68,803.67
|
2026-03-17
|
|
36589
|
HCPCS
|
Removal Tunneled Cv Cath
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36573
|
HCPCS
|
Insj Picc Rs&i 5 Yr+
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
24615
|
HCPCS
|
Treat Elbow Dislocation
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36569
|
HCPCS
|
Insj Picc 5 Yr+ Without Imaging
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36561
|
HCPCS
|
Insert Tunneled Cv Cath
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
24516
|
HCPCS
|
Treat Humerus Fracture
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
15853
|
HCPCS
|
Removal Sutr/stapl Xreq Anes
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
64718
|
HCPCS
|
Revise Ulnar Nerve At Elbow
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
64450
|
HCPCS
|
Njx Aa&/strd Other Pn/branch
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36558
|
HCPCS
|
Insert Tunneled Cv Cath
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
62328
|
HCPCS
|
Dx Lmbr Spi Pnxr W/fluor/ct
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
64721
|
HCPCS
|
Carpal Tunnel Surgery
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
65426
|
HCPCS
|
Removal Of Eye Lesion
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
65730
|
HCPCS
|
Corneal Transplant
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
65755
|
HCPCS
|
Corneal Transplant
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
65756
|
HCPCS
|
Corneal Trnspl Endothelial
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
65820
|
HCPCS
|
Relieve Inner Eye Pressure
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
66170
|
HCPCS
|
Glaucoma Surgery
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
66180
|
HCPCS
|
Aqueous Shunt Eye W/graft
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
62270
|
HCPCS
|
Dx Lmbr Spi Pnxr
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36556
|
HCPCS
|
Insert Non-tunnel Cv Cath
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
24430
|
HCPCS
|
Repair Of Humerus
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
61782
|
HCPCS
|
Scan Proc Cranial Extra
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
60220
|
HCPCS
|
Partial Removal Of Thyroid
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36514
|
HCPCS
|
Apheresis Plasma
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
59897
|
HCPCS
|
Unlisted Fetal Invas Px W/us
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
59820
|
HCPCS
|
Care Of Miscarriage
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36460
|
HCPCS
|
Intrauterine Transfusion Ftl
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
24344
|
HCPCS
|
Reconstruct Elbow Lat Ligmnt
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
15772
|
HCPCS
|
Grfg Autol Fat Lipo Ea Addl
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
10060
|
HCPCS
|
I&d Abscess Simple/single
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
59025
|
HCPCS
|
Fetal Non-stress Test
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
59012
|
HCPCS
|
Fetal Cord Puncture Prenatal
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36430
|
HCPCS
|
Transfusion Bld/bld Compnt
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58662
|
HCPCS
|
Laparoscopy Excise Lesions
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58661
|
HCPCS
|
Laparoscopy Remove Adnexa
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36415
|
HCPCS
|
Routine Venipuncture
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
23650
|
HCPCS
|
Cltx Sho Dslc W/mnpj Wo Anes
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58571
|
HCPCS
|
Tlh W/t/o 250 G Or Less
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58570
|
HCPCS
|
Tlh Uterus 250 G Or Less
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36248
|
HCPCS
|
Ins Cath Abd/l-ext Art Addl
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58563
|
HCPCS
|
Hysteroscopy Ablation
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58561
|
HCPCS
|
Hysteroscopy Remove Myoma
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36247
|
HCPCS
|
Ins Cath Abd/l-ext Art 3rd
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
23515
|
HCPCS
|
Optx Clavicular Fx W/int Fix
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
15771
|
HCPCS
|
Grfg Autol Fat Lipo 50 Cc/<
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58558
|
HCPCS
|
Hysteroscopy Biopsy
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58554
|
HCPCS
|
Laparo-vag Hyst W/t/o Compl
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36225
|
HCPCS
|
Place Cath Subclavian Art
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58552
|
HCPCS
|
Laparo-vag Hyst Incl T/o
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58550
|
HCPCS
|
Laparo-asst Vag Hysterectomy
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36200
|
HCPCS
|
Place Catheter In Aorta
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
23412
|
HCPCS
|
Repair Rotator Cuff Chronic
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58301
|
HCPCS
|
Remove Intrauterine Device
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58120
|
HCPCS
|
Dilation And Curettage
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36012
|
HCPCS
|
Place Catheter In Vein
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
57522
|
HCPCS
|
Conization Of Cervix
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
57461
|
HCPCS
|
Conz Of Cervix W/scope Leep
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
33228
|
HCPCS
|
Remv&replc Pm Gen Dual Lead
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
22552
|
HCPCS
|
Arthrd Ant Ntrbd Cervical Ea
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
14020
|
HCPCS
|
Tis Trnfr S/a/l 10 Sq Cm/<
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
10005
|
HCPCS
|
Fna Bx W/us Gdn 1st Les
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
00410
|
HCPCS
|
Anesth Correct Heart Rhythm
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
57288
|
HCPCS
|
Repair Bladder Defect
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
57260
|
HCPCS
|
Cmbn Ant Pst Colprhy
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|