|
28730
|
CPT
|
Fusion Of Foot Bones
|
30
|
18
|
$57,929.13
|
$57,929.13
|
$40,550.39
|
$49,239.76
|
$44,895.07
|
2025-09-11
|
|
33208
|
CPT
|
Ins/Rplc Pacemkr; Atr+vnt
|
30
|
18
|
$48,848.87
|
$48,848.87
|
$34,194.21
|
$41,521.54
|
$37,857.88
|
2025-09-11
|
|
33207
|
CPT
|
Insrt Heart Pm Venticular
|
30
|
18
|
$48,848.87
|
$48,848.87
|
$34,194.21
|
$41,521.54
|
$37,857.88
|
2025-09-11
|
|
37236
|
CPT
|
Open/Perq Place Stent 1st
|
30
|
18
|
$47,189.05
|
$47,189.05
|
$33,032.34
|
$40,110.69
|
$36,571.51
|
2025-09-11
|
|
33217
|
CPT
|
Insert 2 Electrode Pm-defib
|
30
|
18
|
$38,328.90
|
$38,328.90
|
$26,830.23
|
$32,579.57
|
$29,704.90
|
2025-09-11
|
|
33216
|
CPT
|
Insert 1 Electrode Pm-defib
|
30
|
18
|
$38,328.90
|
$38,328.90
|
$26,830.23
|
$32,579.57
|
$29,704.90
|
2025-09-11
|
|
27893
|
CPT
|
Decompression Of Leg
|
30
|
18
|
$29,426.43
|
$29,426.43
|
$20,598.50
|
$25,012.47
|
$22,805.49
|
2025-09-11
|
|
24685
|
CPT
|
Treat Ulnar Fracture
|
30
|
18
|
$29,426.43
|
$29,426.43
|
$20,598.50
|
$25,012.47
|
$22,805.49
|
2025-09-11
|
|
B0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
16
|
13
|
—
|
—
|
$76,766.68
|
$127,944.47
|
$85,296.31
|
2025-09-11
|
|
C0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
16
|
13
|
—
|
—
|
$68,267.11
|
$113,778.51
|
$75,852.34
|
2025-09-11
|
|
B1904
|
LOCAL
|
Guillain-barré M <38.50
|
16
|
13
|
—
|
—
|
$66,425.93
|
$110,709.89
|
$73,806.59
|
2025-09-11
|
|
D0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
16
|
13
|
—
|
—
|
$66,269.77
|
$110,449.62
|
$73,633.08
|
2025-09-11
|
|
B1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
16
|
13
|
—
|
—
|
$62,483.91
|
$104,139.86
|
$69,426.57
|
2025-09-11
|
|
A0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
16
|
13
|
—
|
—
|
$60,216.03
|
$100,360.05
|
$66,906.70
|
2025-09-11
|
|
B0406
|
LOCAL
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
16
|
13
|
—
|
—
|
$56,152.36
|
$93,587.27
|
$62,391.51
|
2025-09-11
|
|
B0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
16
|
13
|
—
|
—
|
$55,337.09
|
$92,228.48
|
$61,485.65
|
2025-09-11
|
|
B0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50
|
16
|
13
|
—
|
—
|
$54,768.75
|
$91,281.26
|
$60,854.17
|
2025-09-11
|
|
B0106
|
LOCAL
|
Stroke M <41.50 And A <84.50
|
16
|
13
|
—
|
—
|
$52,773.24
|
$87,955.40
|
$58,636.93
|
2025-09-11
|
|
C1904
|
LOCAL
|
Guillain-barré M <38.50
|
16
|
13
|
—
|
—
|
$51,068.23
|
$85,113.72
|
$56,742.48
|
2025-09-11
|
|
C0406
|
LOCAL
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
16
|
13
|
—
|
—
|
$49,935.20
|
$83,225.34
|
$55,483.56
|
2025-09-11
|
|
C1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
16
|
13
|
—
|
—
|
$49,846.23
|
$83,077.05
|
$55,384.70
|
2025-09-11
|
|
C0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
16
|
13
|
—
|
—
|
$49,210.71
|
$82,017.86
|
$54,678.57
|
2025-09-11
|
|
D0406
|
LOCAL
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
16
|
13
|
—
|
—
|
$48,473.51
|
$80,789.19
|
$53,859.46
|
2025-09-11
|
|
B0205
|
LOCAL
|
Traumatic Brain Injury M <35.50
|
16
|
13
|
—
|
—
|
$47,908.81
|
$79,848.02
|
$53,232.01
|
2025-09-11
|
|
D0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
16
|
13
|
—
|
—
|
$47,770.81
|
$79,618.02
|
$53,078.68
|
2025-09-11
|
|
D1904
|
LOCAL
|
Guillain-barré M <38.50
|
16
|
13
|
—
|
—
|
$47,652.80
|
$79,421.33
|
$52,947.55
|
2025-09-11
|
|
B1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
16
|
13
|
—
|
—
|
$47,609.22
|
$79,348.70
|
$52,899.13
|
2025-09-11
|
|
D1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
16
|
13
|
—
|
—
|
$47,322.32
|
$78,870.54
|
$52,580.36
|
2025-09-11
|
|
A1904
|
LOCAL
|
Guillain-barré M <38.50
|
16
|
13
|
—
|
—
|
$46,828.44
|
$78,047.40
|
$52,031.60
|
2025-09-11
|
|
B0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50
|
16
|
13
|
—
|
—
|
$46,398.11
|
$77,330.18
|
$51,553.45
|
2025-09-11
|
|
C0106
|
LOCAL
|
Stroke M <41.50 And A <84.50
|
16
|
13
|
—
|
—
|
$45,768.03
|
$76,280.06
|
$50,853.37
|
2025-09-11
|
|
B1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50
|
16
|
13
|
—
|
—
|
$45,600.98
|
$76,001.64
|
$50,667.76
|
2025-09-11
|
|
B0604
|
LOCAL
|
Neurological M <43.50
|
16
|
13
|
—
|
—
|
$45,219.67
|
$75,366.12
|
$50,244.08
|
2025-09-11
|
|
A0406
|
LOCAL
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
16
|
13
|
—
|
—
|
$44,046.69
|
$73,411.16
|
$48,940.77
|
2025-09-11
|
|
B0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
16
|
13
|
—
|
—
|
$44,006.74
|
$73,344.57
|
$48,896.38
|
2025-09-11
|
|
B1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
16
|
13
|
—
|
—
|
$43,997.67
|
$73,329.45
|
$48,886.30
|
2025-09-11
|
|
A1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
16
|
13
|
—
|
—
|
$43,876.01
|
$73,126.68
|
$48,751.12
|
2025-09-11
|
|
A0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
16
|
13
|
—
|
—
|
$43,407.55
|
$72,345.92
|
$48,230.61
|
2025-09-11
|
|
B0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
16
|
13
|
—
|
—
|
$43,296.79
|
$72,161.31
|
$48,107.54
|
2025-09-11
|
|
A5104
|
LOCAL
|
Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More
|
16
|
13
|
—
|
—
|
$43,276.82
|
$72,128.03
|
$48,085.35
|
2025-09-11
|
|
B1604
|
LOCAL
|
Pain Syndrome M <43.50
|
16
|
13
|
—
|
—
|
$42,624.95
|
$71,041.59
|
$47,361.06
|
2025-09-11
|
|
C0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50
|
16
|
13
|
—
|
—
|
$42,608.61
|
$71,014.35
|
$47,342.90
|
2025-09-11
|
|
B0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50
|
16
|
13
|
—
|
—
|
$42,258.17
|
$70,430.28
|
$46,953.52
|
2025-09-11
|
|
B2102
|
LOCAL
|
Burns M <52.50
|
16
|
13
|
—
|
—
|
$42,082.04
|
$70,136.73
|
$46,757.82
|
2025-09-11
|
|
D0106
|
LOCAL
|
Stroke M <41.50 And A <84.50
|
16
|
13
|
—
|
—
|
$41,824.21
|
$69,707.01
|
$46,471.34
|
2025-09-11
|
|
B1004
|
LOCAL
|
Amputation Lower Extremity M <47.50
|
16
|
13
|
—
|
—
|
$41,782.44
|
$69,637.40
|
$46,424.93
|
2025-09-11
|
|
B1504
|
LOCAL
|
Pulmonary M <45.50
|
16
|
13
|
—
|
—
|
$41,297.63
|
$68,829.39
|
$45,886.26
|
2025-09-11
|
|
B1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
16
|
13
|
—
|
—
|
$40,569.52
|
$67,615.86
|
$45,077.24
|
2025-09-11
|
|
B2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50
|
16
|
13
|
—
|
—
|
$40,331.65
|
$67,219.41
|
$44,812.94
|
2025-09-11
|
|
D0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50
|
16
|
13
|
—
|
—
|
$40,253.57
|
$67,089.29
|
$44,726.19
|
2025-09-11
|
|
C0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50
|
16
|
13
|
—
|
—
|
$40,239.05
|
$67,065.08
|
$44,710.05
|
2025-09-11
|
|
A0106
|
LOCAL
|
Stroke M <41.50 And A <84.50
|
16
|
13
|
—
|
—
|
$39,857.73
|
$66,429.56
|
$44,286.37
|
2025-09-11
|
|
B1204
|
LOCAL
|
Osteoarthritis M <49.50 And A <74.50
|
16
|
13
|
—
|
—
|
$39,650.74
|
$66,084.57
|
$44,056.38
|
2025-09-11
|
|
C0205
|
LOCAL
|
Traumatic Brain Injury M <35.50
|
16
|
13
|
—
|
—
|
$39,458.27
|
$65,763.78
|
$43,842.52
|
2025-09-11
|
|
B0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
16
|
13
|
—
|
—
|
$39,414.69
|
$65,691.15
|
$43,794.10
|
2025-09-11
|
|
B0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
16
|
13
|
—
|
—
|
$39,258.53
|
$65,430.89
|
$43,620.59
|
2025-09-11
|
|
C0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
16
|
13
|
—
|
—
|
$39,135.06
|
$65,225.10
|
$43,483.40
|
2025-09-11
|
|
B1404
|
LOCAL
|
Cardiac M <45.50
|
16
|
13
|
—
|
—
|
$38,962.57
|
$64,937.61
|
$43,291.74
|
2025-09-11
|
|
B0904
|
LOCAL
|
Other Orthopedic M <44.5
|
16
|
13
|
—
|
—
|
$38,886.31
|
$64,810.52
|
$43,207.01
|
2025-09-11
|
|
B1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
16
|
13
|
—
|
—
|
$38,886.31
|
$64,810.52
|
$43,207.01
|
2025-09-11
|
|
B2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50
|
16
|
13
|
—
|
—
|
$38,263.50
|
$63,772.50
|
$42,515.00
|
2025-09-11
|
|
D0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
16
|
13
|
—
|
—
|
$37,989.32
|
$63,315.53
|
$42,210.35
|
2025-09-11
|
|
B1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50
|
16
|
13
|
—
|
—
|
$37,811.38
|
$63,018.96
|
$42,012.64
|
2025-09-11
|
|
B0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50
|
16
|
13
|
—
|
—
|
$37,428.25
|
$62,380.41
|
$41,586.94
|
2025-09-11
|
|
B0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
16
|
13
|
—
|
—
|
$37,401.01
|
$62,335.02
|
$41,556.68
|
2025-09-11
|
|
B1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
16
|
13
|
—
|
—
|
$37,239.41
|
$62,065.68
|
$41,377.12
|
2025-09-11
|
|
B0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50
|
16
|
13
|
—
|
—
|
$37,105.05
|
$61,841.75
|
$41,227.83
|
2025-09-11
|
|
A0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50
|
16
|
13
|
—
|
—
|
$37,094.15
|
$61,823.58
|
$41,215.72
|
2025-09-11
|
|
C1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
16
|
13
|
—
|
—
|
$37,006.99
|
$61,678.32
|
$41,118.88
|
2025-09-11
|
|
D0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50
|
16
|
13
|
—
|
—
|
$36,770.95
|
$61,284.92
|
$40,856.61
|
2025-09-11
|
|
B1103
|
LOCAL
|
Amputation Non-lower Extremity M <52.50
|
16
|
13
|
—
|
—
|
$36,416.87
|
$60,694.79
|
$40,463.19
|
2025-09-11
|
|
B1804
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
16
|
13
|
—
|
—
|
$36,289.77
|
$60,482.96
|
$40,321.97
|
2025-09-11
|
|
B0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50
|
16
|
13
|
—
|
—
|
$36,057.35
|
$60,095.58
|
$40,063.72
|
2025-09-11
|
|
B1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50
|
16
|
13
|
—
|
—
|
$35,843.09
|
$59,738.49
|
$39,825.66
|
2025-09-11
|
|
D0205
|
LOCAL
|
Traumatic Brain Injury M <35.50
|
16
|
13
|
—
|
—
|
$35,839.46
|
$59,732.43
|
$39,821.62
|
2025-09-11
|
|
B0403
|
LOCAL
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
16
|
13
|
—
|
—
|
$35,441.81
|
$59,069.69
|
$39,379.79
|
2025-09-11
|
|
C1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
16
|
13
|
—
|
—
|
$35,098.63
|
$58,497.72
|
$38,998.48
|
2025-09-11
|
|
C1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50
|
16
|
13
|
—
|
—
|
$35,056.87
|
$58,428.12
|
$38,952.08
|
2025-09-11
|
|
A0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50
|
16
|
13
|
—
|
—
|
$35,044.16
|
$58,406.93
|
$38,937.95
|
2025-09-11
|
|
C0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
16
|
13
|
—
|
—
|
$34,639.25
|
$57,732.08
|
$38,488.05
|
2025-09-11
|
|
B0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50
|
16
|
13
|
—
|
—
|
$34,592.03
|
$57,653.39
|
$38,435.59
|
2025-09-11
|
|
C1004
|
LOCAL
|
Amputation Lower Extremity M <47.50
|
16
|
13
|
—
|
—
|
$34,555.72
|
$57,592.86
|
$38,395.24
|
2025-09-11
|
|
A0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
16
|
13
|
—
|
—
|
$34,519.40
|
$57,532.34
|
$38,354.89
|
2025-09-11
|
|
B1603
|
LOCAL
|
Pain Syndrome M >=43.50 And M <58.50
|
16
|
13
|
—
|
—
|
$34,403.19
|
$57,338.66
|
$38,225.77
|
2025-09-11
|
|
D1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
16
|
13
|
—
|
—
|
$34,272.46
|
$57,120.77
|
$38,080.51
|
2025-09-11
|
|
B0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50
|
16
|
13
|
—
|
—
|
$33,860.29
|
$56,433.81
|
$37,622.54
|
2025-09-11
|
|
C0604
|
LOCAL
|
Neurological M <43.50
|
16
|
13
|
—
|
—
|
$33,854.83
|
$56,424.72
|
$37,616.48
|
2025-09-11
|
|
A0205
|
LOCAL
|
Traumatic Brain Injury M <35.50
|
16
|
13
|
—
|
—
|
$33,742.26
|
$56,237.10
|
$37,491.40
|
2025-09-11
|
|
C1504
|
LOCAL
|
Pulmonary M <45.50
|
16
|
13
|
—
|
—
|
$33,518.92
|
$55,864.86
|
$37,243.24
|
2025-09-11
|
|
B1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50
|
16
|
13
|
—
|
—
|
$33,348.24
|
$55,580.40
|
$37,053.60
|
2025-09-11
|
|
D1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
16
|
13
|
—
|
—
|
$33,321.01
|
$55,535.01
|
$37,023.34
|
2025-09-11
|
|
B1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50
|
16
|
13
|
—
|
—
|
$33,184.82
|
$55,308.03
|
$36,872.02
|
2025-09-11
|
|
B0503
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50
|
16
|
13
|
—
|
—
|
$33,157.58
|
$55,262.64
|
$36,841.76
|
2025-09-11
|
|
D1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50
|
16
|
13
|
—
|
—
|
$32,712.72
|
$54,521.21
|
$36,347.47
|
2025-09-11
|
|
C0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50
|
16
|
13
|
—
|
—
|
$32,689.12
|
$54,481.86
|
$36,321.24
|
2025-09-11
|
|
B1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50
|
16
|
13
|
—
|
—
|
$32,636.46
|
$54,394.10
|
$36,262.73
|
2025-09-11
|
|
A5102
|
LOCAL
|
Expired, Orthopedic, Length Of Stay Is 14 Days Or More
|
16
|
13
|
—
|
—
|
$32,549.30
|
$54,248.84
|
$36,165.89
|
2025-09-11
|
|
B0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50
|
16
|
13
|
—
|
—
|
$32,453.07
|
$54,088.46
|
$36,058.97
|
2025-09-11
|
|
C2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50
|
16
|
13
|
—
|
—
|
$32,215.20
|
$53,692.01
|
$35,794.67
|
2025-09-11
|
|
C0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50
|
16
|
13
|
—
|
—
|
$32,178.89
|
$53,631.48
|
$35,754.32
|
2025-09-11
|
|
C1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
16
|
13
|
—
|
—
|
$32,151.65
|
$53,586.09
|
$35,724.06
|
2025-09-11
|
|
A1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50
|
16
|
13
|
—
|
—
|
$32,146.21
|
$53,577.02
|
$35,718.01
|
2025-09-11
|
|
B2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50
|
16
|
13
|
—
|
—
|
$32,002.76
|
$53,337.93
|
$35,558.62
|
2025-09-11
|
|
D2102
|
LOCAL
|
Burns M <52.50
|
16
|
13
|
—
|
—
|
$31,977.34
|
$53,295.57
|
$35,530.38
|
2025-09-11
|
|
C2102
|
LOCAL
|
Burns M <52.50
|
16
|
13
|
—
|
—
|
$31,977.34
|
$53,295.57
|
$35,530.38
|
2025-09-11
|
|
D0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
16
|
13
|
—
|
—
|
$31,819.37
|
$53,032.28
|
$35,354.85
|
2025-09-11
|
|
B1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50
|
16
|
13
|
—
|
—
|
$31,797.58
|
$52,995.96
|
$35,330.64
|
2025-09-11
|
|
C1604
|
LOCAL
|
Pain Syndrome M <43.50
|
16
|
13
|
—
|
—
|
$31,659.58
|
$52,765.97
|
$35,177.31
|
2025-09-11
|
|
D0604
|
LOCAL
|
Neurological M <43.50
|
16
|
13
|
—
|
—
|
$31,605.11
|
$52,675.19
|
$35,116.79
|
2025-09-11
|
|
D1004
|
LOCAL
|
Amputation Lower Extremity M <47.50
|
16
|
13
|
—
|
—
|
$31,565.16
|
$52,608.60
|
$35,072.40
|
2025-09-11
|
|
C1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
16
|
13
|
—
|
—
|
$31,534.30
|
$52,557.17
|
$35,038.11
|
2025-09-11
|
|
D1504
|
LOCAL
|
Pulmonary M <45.50
|
16
|
13
|
—
|
—
|
$31,523.40
|
$52,539.00
|
$35,026.00
|
2025-09-11
|
|
C0403
|
LOCAL
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
16
|
13
|
—
|
—
|
$31,517.96
|
$52,529.93
|
$35,019.95
|
2025-09-11
|
|
C0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
16
|
13
|
—
|
—
|
$31,409.01
|
$52,348.35
|
$34,898.90
|
2025-09-11
|
|
B0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50
|
16
|
13
|
—
|
—
|
$31,207.46
|
$52,012.43
|
$34,674.95
|
2025-09-11
|
|
C0904
|
LOCAL
|
Other Orthopedic M <44.5
|
16
|
13
|
—
|
—
|
$31,145.72
|
$51,909.54
|
$34,606.36
|
2025-09-11
|
|
A1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
16
|
13
|
—
|
—
|
$31,093.07
|
$51,821.78
|
$34,547.85
|
2025-09-11
|
|
D0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50
|
16
|
13
|
—
|
—
|
$30,965.96
|
$51,609.93
|
$34,406.62
|
2025-09-11
|
|
A1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
16
|
13
|
—
|
—
|
$30,895.15
|
$51,491.91
|
$34,327.94
|
2025-09-11
|
|
C0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
16
|
13
|
—
|
—
|
$30,806.17
|
$51,343.62
|
$34,229.08
|
2025-09-11
|
|
B1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50
|
16
|
13
|
—
|
—
|
$30,791.65
|
$51,319.41
|
$34,212.94
|
2025-09-11
|
|
C1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
16
|
13
|
—
|
—
|
$30,789.84
|
$51,316.40
|
$34,210.93
|
2025-09-11
|
|
C1404
|
LOCAL
|
Cardiac M <45.50
|
16
|
13
|
—
|
—
|
$30,693.60
|
$51,156.00
|
$34,104.00
|
2025-09-11
|
|
D1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
16
|
13
|
—
|
—
|
$30,689.96
|
$51,149.94
|
$34,099.96
|
2025-09-11
|
|
C0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
16
|
13
|
—
|
—
|
$30,662.73
|
$51,104.55
|
$34,069.70
|
2025-09-11
|
|
B0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50
|
16
|
13
|
—
|
—
|
$30,600.99
|
$51,001.65
|
$34,001.10
|
2025-09-11
|
|
D0403
|
LOCAL
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
16
|
13
|
—
|
—
|
$30,595.55
|
$50,992.58
|
$33,995.05
|
2025-09-11
|
|
C2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50
|
16
|
13
|
—
|
—
|
$30,562.87
|
$50,938.11
|
$33,958.74
|
2025-09-11
|
|
B1902
|
LOCAL
|
Guillain-barré M >=51.50 And M <66.50
|
16
|
13
|
—
|
—
|
$30,223.31
|
$50,372.19
|
$33,581.46
|
2025-09-11
|
|
B1702
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50
|
16
|
13
|
—
|
—
|
$30,163.39
|
$50,272.32
|
$33,514.88
|
2025-09-11
|
|
B0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50
|
16
|
13
|
—
|
—
|
$30,156.13
|
$50,260.22
|
$33,506.81
|
2025-09-11
|
|
C1204
|
LOCAL
|
Osteoarthritis M <49.50 And A <74.50
|
16
|
13
|
—
|
—
|
$30,145.24
|
$50,242.07
|
$33,494.71
|
2025-09-11
|
|
D2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50
|
16
|
13
|
—
|
—
|
$30,094.40
|
$50,157.33
|
$33,438.22
|
2025-09-11
|
|
C0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50
|
16
|
13
|
—
|
—
|
$30,032.66
|
$50,054.43
|
$33,369.62
|
2025-09-11
|
|
A0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
16
|
13
|
—
|
—
|
$29,990.90
|
$49,984.83
|
$33,323.22
|
2025-09-11
|
|
A1504
|
LOCAL
|
Pulmonary M <45.50
|
16
|
13
|
—
|
—
|
$29,487.93
|
$49,146.56
|
$32,764.37
|
2025-09-11
|
|
D0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50
|
16
|
13
|
—
|
—
|
$29,406.22
|
$49,010.37
|
$32,673.58
|
2025-09-11
|
|
D1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
16
|
13
|
—
|
—
|
$29,389.89
|
$48,983.15
|
$32,655.43
|
2025-09-11
|
|
B1502
|
LOCAL
|
Pulmonary M >=56.50 And M <68.50
|
16
|
13
|
—
|
—
|
$29,342.67
|
$48,904.46
|
$32,602.97
|
2025-09-11
|
|
D1103
|
LOCAL
|
Amputation Non-lower Extremity M <52.50
|
16
|
13
|
—
|
—
|
$29,273.67
|
$48,789.45
|
$32,526.30
|
2025-09-11
|
|
C1103
|
LOCAL
|
Amputation Non-lower Extremity M <52.50
|
16
|
13
|
—
|
—
|
$29,273.67
|
$48,789.45
|
$32,526.30
|
2025-09-11
|
|
D1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
16
|
13
|
—
|
—
|
$29,204.68
|
$48,674.46
|
$32,449.64
|
2025-09-11
|
|
B1102
|
LOCAL
|
Amputation Non-lower Extremity M >=52.50 And M <58.50
|
16
|
13
|
—
|
—
|
$29,202.86
|
$48,671.43
|
$32,447.62
|
2025-09-11
|
|
B1202
|
LOCAL
|
Osteoarthritis M >=49.50 And M <61.50
|
16
|
13
|
—
|
—
|
$29,186.51
|
$48,644.19
|
$32,429.46
|
2025-09-11
|
|
B0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50
|
16
|
13
|
—
|
—
|
$29,073.94
|
$48,456.57
|
$32,304.38
|
2025-09-11
|
|
D0904
|
LOCAL
|
Other Orthopedic M <44.5
|
16
|
13
|
—
|
—
|
$29,030.36
|
$48,383.94
|
$32,255.96
|
2025-09-11
|
|
D0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
16
|
13
|
—
|
—
|
$28,968.62
|
$48,281.04
|
$32,187.36
|
2025-09-11
|
|
C1804
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
16
|
13
|
—
|
—
|
$28,950.47
|
$48,250.79
|
$32,167.19
|
2025-09-11
|
|
B0502
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50
|
16
|
13
|
—
|
—
|
$28,926.86
|
$48,211.44
|
$32,140.96
|
2025-09-11
|
|
D0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
16
|
13
|
—
|
—
|
$28,852.42
|
$48,087.36
|
$32,058.24
|
2025-09-11
|
|
C1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50
|
16
|
13
|
—
|
—
|
$28,745.29
|
$47,908.82
|
$31,939.21
|
2025-09-11
|
|
A1103
|
LOCAL
|
Amputation Non-lower Extremity M <52.50
|
16
|
13
|
—
|
—
|
$28,681.74
|
$47,802.90
|
$31,868.60
|
2025-09-11
|
|
D1604
|
LOCAL
|
Pain Syndrome M <43.50
|
16
|
13
|
—
|
—
|
$28,616.37
|
$47,693.96
|
$31,795.97
|
2025-09-11
|
|
A0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50
|
16
|
13
|
—
|
—
|
$28,609.11
|
$47,681.85
|
$31,787.90
|
2025-09-11
|
|
D2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50
|
16
|
13
|
—
|
—
|
$28,551.01
|
$47,585.01
|
$31,723.34
|
2025-09-11
|
|
A1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
16
|
13
|
—
|
—
|
$28,551.01
|
$47,585.01
|
$31,723.34
|
2025-09-11
|
|
D1404
|
LOCAL
|
Cardiac M <45.50
|
16
|
13
|
—
|
—
|
$28,538.29
|
$47,563.82
|
$31,709.21
|
2025-09-11
|
|
A0604
|
LOCAL
|
Neurological M <43.50
|
16
|
13
|
—
|
—
|
$28,503.79
|
$47,506.32
|
$31,670.88
|
2025-09-11
|
|
A1004
|
LOCAL
|
Amputation Lower Extremity M <47.50
|
16
|
13
|
—
|
—
|
$28,280.46
|
$47,134.10
|
$31,422.73
|
2025-09-11
|
|
D1204
|
LOCAL
|
Osteoarthritis M <49.50 And A <74.50
|
16
|
13
|
—
|
—
|
$28,264.11
|
$47,106.86
|
$31,404.57
|
2025-09-11
|
|
B0402
|
LOCAL
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50
|
16
|
13
|
—
|
—
|
$28,242.32
|
$47,070.54
|
$31,380.36
|
2025-09-11
|
|
B0302
|
LOCAL
|
Non-traumatic Brain Injury M >=52.50 And M <65.50
|
16
|
13
|
—
|
—
|
$28,140.64
|
$46,901.07
|
$31,267.38
|
2025-09-11
|
|
B0702
|
LOCAL
|
Fracture Of Lower Extremity M >=52.50 And M <61.50
|
16
|
13
|
—
|
—
|
$28,129.74
|
$46,882.91
|
$31,255.27
|
2025-09-11
|
|
A0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50
|
16
|
13
|
—
|
—
|
$28,024.43
|
$46,707.39
|
$31,138.26
|
2025-09-11
|
|
D0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
16
|
13
|
—
|
—
|
$27,979.04
|
$46,631.73
|
$31,087.82
|
2025-09-11
|
|
C1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50
|
16
|
13
|
—
|
—
|
$27,861.01
|
$46,435.02
|
$30,956.68
|
2025-09-11
|
|
B0803
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=51.50 And M <57.50
|
16
|
13
|
—
|
—
|
$27,855.57
|
$46,425.95
|
$30,950.63
|
2025-09-11
|
|
B1002
|
LOCAL
|
Amputation Lower Extremity M >=55.50 And M <64.50
|
16
|
13
|
—
|
—
|
$27,855.57
|
$46,425.95
|
$30,950.63
|
2025-09-11
|
|
A0403
|
LOCAL
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
16
|
13
|
—
|
—
|
$27,801.09
|
$46,335.15
|
$30,890.10
|
2025-09-11
|
|
D1804
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
16
|
13
|
—
|
—
|
$27,483.34
|
$45,805.56
|
$30,537.04
|
2025-09-11
|
|
A2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50
|
16
|
13
|
—
|
—
|
$27,392.54
|
$45,654.24
|
$30,436.16
|
2025-09-11
|
|
D0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50
|
16
|
13
|
—
|
—
|
$27,381.65
|
$45,636.09
|
$30,424.06
|
2025-09-11
|
|
A1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
16
|
13
|
—
|
—
|
$27,341.70
|
$45,569.51
|
$30,379.67
|
2025-09-11
|
|
B2101
|
LOCAL
|
Burns M >=52.50
|
16
|
13
|
—
|
—
|
$27,325.37
|
$45,542.28
|
$30,361.52
|
2025-09-11
|
|
A2102
|
LOCAL
|
Burns M <52.50
|
16
|
13
|
—
|
—
|
$27,309.02
|
$45,515.04
|
$30,343.36
|
2025-09-11
|
|
B1602
|
LOCAL
|
Pain Syndrome M >=58.50 And M <65.50
|
16
|
13
|
—
|
—
|
$27,241.84
|
$45,403.07
|
$30,268.71
|
2025-09-11
|
|
A0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
16
|
13
|
—
|
—
|
$27,194.63
|
$45,324.38
|
$30,216.25
|
2025-09-11
|
|
B0902
|
LOCAL
|
Other Orthopedic M >=51.50 And M <63.50
|
16
|
13
|
—
|
—
|
$27,176.47
|
$45,294.12
|
$30,196.08
|
2025-09-11
|
|
C0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50
|
16
|
13
|
—
|
—
|
$27,089.32
|
$45,148.86
|
$30,099.24
|
2025-09-11
|
|
C1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50
|
16
|
13
|
—
|
—
|
$27,065.71
|
$45,109.52
|
$30,073.01
|
2025-09-11
|
|
B1302
|
LOCAL
|
Rheumatoid Other Arthritis M >=51.50 And M <62.50
|
16
|
13
|
—
|
—
|
$27,065.71
|
$45,109.52
|
$30,073.01
|
2025-09-11
|
|
C0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50
|
16
|
13
|
—
|
—
|
$26,994.90
|
$44,991.50
|
$29,994.33
|
2025-09-11
|
|
C1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50
|
16
|
13
|
—
|
—
|
$26,991.26
|
$44,985.44
|
$29,990.29
|
2025-09-11
|
|
D1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50
|
16
|
13
|
—
|
—
|
$26,953.14
|
$44,921.90
|
$29,947.93
|
2025-09-11
|
|
C0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50
|
16
|
13
|
—
|
—
|
$26,758.85
|
$44,598.08
|
$29,732.05
|
2025-09-11
|
|
B2002
|
LOCAL
|
Miscellaneous M >=55.50 And M <66.50
|
16
|
13
|
—
|
—
|
$26,724.35
|
$44,540.58
|
$29,693.72
|
2025-09-11
|
|
A0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
16
|
13
|
—
|
—
|
$26,695.30
|
$44,492.16
|
$29,661.44
|
2025-09-11
|
|
A0904
|
LOCAL
|
Other Orthopedic M <44.5
|
16
|
13
|
—
|
—
|
$26,560.93
|
$44,268.21
|
$29,512.14
|
2025-09-11
|
|
A1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
16
|
13
|
—
|
—
|
$26,495.56
|
$44,159.27
|
$29,439.51
|
2025-09-11
|
|
A1604
|
LOCAL
|
Pain Syndrome M <43.50
|
16
|
13
|
—
|
—
|
$26,490.11
|
$44,150.19
|
$29,433.46
|
2025-09-11
|
|
C1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50
|
16
|
13
|
—
|
—
|
$26,473.77
|
$44,122.95
|
$29,415.30
|
2025-09-11
|
|
A0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
16
|
13
|
—
|
—
|
$26,343.04
|
$43,905.06
|
$29,270.04
|
2025-09-11
|
|
A1404
|
LOCAL
|
Cardiac M <45.50
|
16
|
13
|
—
|
—
|
$26,259.52
|
$43,765.86
|
$29,177.24
|
2025-09-11
|
|
C0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50
|
16
|
13
|
—
|
—
|
$25,992.59
|
$43,320.99
|
$28,880.66
|
2025-09-11
|
|
A2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50
|
16
|
13
|
—
|
—
|
$25,987.15
|
$43,311.92
|
$28,874.61
|
2025-09-11
|
|
B1402
|
LOCAL
|
Cardiac M >=55.50 And M <68.50
|
16
|
13
|
—
|
—
|
$25,987.15
|
$43,311.92
|
$28,874.61
|
2025-09-11
|
|
A1204
|
LOCAL
|
Osteoarthritis M <49.50 And A <74.50
|
16
|
13
|
—
|
—
|
$25,840.07
|
$43,066.79
|
$28,711.19
|
2025-09-11
|
|
B1802
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50
|
16
|
13
|
—
|
—
|
$25,829.18
|
$43,048.64
|
$28,699.09
|
2025-09-11
|
|
D1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50
|
16
|
13
|
—
|
—
|
$25,803.76
|
$43,006.26
|
$28,670.84
|
2025-09-11
|
|
C0503
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50
|
16
|
13
|
—
|
—
|
$25,794.68
|
$42,991.13
|
$28,660.75
|
2025-09-11
|
|
C2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50
|
16
|
13
|
—
|
—
|
$25,562.26
|
$42,603.77
|
$28,402.51
|
2025-09-11
|
|
C1603
|
LOCAL
|
Pain Syndrome M >=43.50 And M <58.50
|
16
|
13
|
—
|
—
|
$25,553.19
|
$42,588.65
|
$28,392.43
|
2025-09-11
|
|
A0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50
|
16
|
13
|
—
|
—
|
$25,538.66
|
$42,564.44
|
$28,376.29
|
2025-09-11
|
|
A1804
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
16
|
13
|
—
|
—
|
$25,482.37
|
$42,470.61
|
$28,313.74
|
2025-09-11
|
|
C1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50
|
16
|
13
|
—
|
—
|
$25,460.58
|
$42,434.30
|
$28,289.53
|
2025-09-11
|
|
D1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50
|
16
|
13
|
—
|
—
|
$25,455.13
|
$42,425.22
|
$28,283.48
|
2025-09-11
|
|
D0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50
|
16
|
13
|
—
|
—
|
$25,348.01
|
$42,246.68
|
$28,164.45
|
2025-09-11
|
|
C0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50
|
16
|
13
|
—
|
—
|
$25,215.45
|
$42,025.76
|
$28,017.17
|
2025-09-11
|
|
D0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50
|
16
|
13
|
—
|
—
|
$25,200.93
|
$42,001.55
|
$28,001.03
|
2025-09-11
|
|
D1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50
|
16
|
13
|
—
|
—
|
$25,133.74
|
$41,889.57
|
$27,926.38
|
2025-09-11
|
|
C0402
|
LOCAL
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50
|
16
|
13
|
—
|
—
|
$25,115.59
|
$41,859.32
|
$27,906.21
|
2025-09-11
|
|
C1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50
|
16
|
13
|
—
|
—
|
$25,050.22
|
$41,750.37
|
$27,833.58
|
2025-09-11
|
|
C0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50
|
16
|
13
|
—
|
—
|
$25,041.14
|
$41,735.24
|
$27,823.49
|
2025-09-11
|
|
B0802
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=57.50 And M <63.50
|
16
|
13
|
—
|
—
|
$25,026.62
|
$41,711.03
|
$27,807.35
|
2025-09-11
|
|
D0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50
|
16
|
13
|
—
|
—
|
$24,884.98
|
$41,474.97
|
$27,649.98
|
2025-09-11
|
|
C0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50
|
16
|
13
|
—
|
—
|
$24,837.78
|
$41,396.30
|
$27,597.53
|
2025-09-11
|
|
D1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50
|
16
|
13
|
—
|
—
|
$24,656.20
|
$41,093.67
|
$27,395.78
|
2025-09-11
|
|
A1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50
|
16
|
13
|
—
|
—
|
$24,639.86
|
$41,066.43
|
$27,377.62
|
2025-09-11
|
|
D0402
|
LOCAL
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50
|
16
|
13
|
—
|
—
|
$24,380.20
|
$40,633.67
|
$27,089.11
|
2025-09-11
|
|
D0503
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50
|
16
|
13
|
—
|
—
|
$24,369.31
|
$40,615.52
|
$27,077.01
|
2025-09-11
|
|
D1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50
|
16
|
13
|
—
|
—
|
$24,302.12
|
$40,503.54
|
$27,002.36
|
2025-09-11
|
|
B1701
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50
|
16
|
13
|
—
|
—
|
$24,278.52
|
$40,464.20
|
$26,976.13
|
2025-09-11
|
|
D0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50
|
16
|
13
|
—
|
—
|
$24,227.68
|
$40,379.46
|
$26,919.64
|
2025-09-11
|
|
B0202
|
LOCAL
|
Traumatic Brain Injury M >=61.50 And M <73.50
|
16
|
13
|
—
|
—
|
$24,214.97
|
$40,358.28
|
$26,905.52
|
2025-09-11
|
|
B0601
|
LOCAL
|
Neurological M >=64.50
|
16
|
13
|
—
|
—
|
$24,125.99
|
$40,209.99
|
$26,806.66
|
2025-09-11
|
|
B1201
|
LOCAL
|
Osteoarthritis M >=61.50
|
16
|
13
|
—
|
—
|
$24,107.84
|
$40,179.74
|
$26,786.49
|
2025-09-11
|
|
D2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50
|
16
|
13
|
—
|
—
|
$23,879.05
|
$39,798.42
|
$26,532.28
|
2025-09-11
|
|
C1502
|
LOCAL
|
Pulmonary M >=56.50 And M <68.50
|
16
|
13
|
—
|
—
|
$23,815.50
|
$39,692.51
|
$26,461.67
|
2025-09-11
|
|
A1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50
|
16
|
13
|
—
|
—
|
$23,811.87
|
$39,686.45
|
$26,457.63
|
2025-09-11
|
|
B1601
|
LOCAL
|
Pain Syndrome M >=65.50
|
16
|
13
|
—
|
—
|
$23,771.93
|
$39,619.88
|
$26,413.25
|
2025-09-11
|
|
C1102
|
LOCAL
|
Amputation Non-lower Extremity M >=52.50 And M <58.50
|
16
|
13
|
—
|
—
|
$23,474.14
|
$39,123.57
|
$26,082.38
|
2025-09-11
|
|
D1102
|
LOCAL
|
Amputation Non-lower Extremity M >=52.50 And M <58.50
|
16
|
13
|
—
|
—
|
$23,474.14
|
$39,123.57
|
$26,082.38
|
2025-09-11
|
|
A0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50
|
16
|
13
|
—
|
—
|
$23,454.16
|
$39,090.27
|
$26,060.18
|
2025-09-11
|
|
C1702
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50
|
16
|
13
|
—
|
—
|
$23,446.90
|
$39,078.17
|
$26,052.11
|
2025-09-11
|
|
A0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50
|
16
|
13
|
—
|
—
|
$23,419.67
|
$39,032.78
|
$26,021.85
|
2025-09-11
|
|
A1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50
|
16
|
13
|
—
|
—
|
$23,410.58
|
$39,017.64
|
$26,011.76
|
2025-09-11
|
|
A1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50
|
16
|
13
|
—
|
—
|
$23,303.46
|
$38,839.10
|
$25,892.73
|
2025-09-11
|
|
D1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50
|
16
|
13
|
—
|
—
|
$23,290.75
|
$38,817.92
|
$25,878.61
|
2025-09-11
|
|
C1902
|
LOCAL
|
Guillain-barré M >=51.50 And M <66.50
|
16
|
13
|
—
|
—
|
$23,236.27
|
$38,727.12
|
$25,818.08
|
2025-09-11
|
|
B1501
|
LOCAL
|
Pulmonary M >=68.50
|
16
|
13
|
—
|
—
|
$23,130.96
|
$38,551.61
|
$25,701.07
|
2025-09-11
|
|
D1603
|
LOCAL
|
Pain Syndrome M >=43.50 And M <58.50
|
16
|
13
|
—
|
—
|
$23,096.46
|
$38,494.10
|
$25,662.73
|
2025-09-11
|
|
B0501
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=60.50
|
16
|
13
|
—
|
—
|
$23,058.33
|
$38,430.56
|
$25,620.37
|
2025-09-11
|
|
D0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50
|
16
|
13
|
—
|
—
|
$23,041.99
|
$38,403.32
|
$25,602.21
|
2025-09-11
|
|
C1002
|
LOCAL
|
Amputation Lower Extremity M >=55.50 And M <64.50
|
16
|
13
|
—
|
—
|
$23,036.54
|
$38,394.24
|
$25,596.16
|
2025-09-11
|
|
A1102
|
LOCAL
|
Amputation Non-lower Extremity M >=52.50 And M <58.50
|
16
|
13
|
—
|
—
|
$23,000.23
|
$38,333.72
|
$25,555.81
|
2025-09-11
|
|
B1101
|
LOCAL
|
Amputation Non-lower Extremity M >=58.50
|
16
|
13
|
—
|
—
|
$22,969.36
|
$38,282.27
|
$25,521.51
|
2025-09-11
|
|
C0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50
|
16
|
13
|
—
|
—
|
$22,911.26
|
$38,185.43
|
$25,456.95
|
2025-09-11
|
|
D0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50
|
16
|
13
|
—
|
—
|
$22,831.36
|
$38,052.27
|
$25,368.18
|
2025-09-11
|
|
B0701
|
LOCAL
|
Fracture Of Lower Extremity M >=61.50
|
16
|
13
|
—
|
—
|
$22,773.26
|
$37,955.43
|
$25,303.62
|
2025-09-11
|
|
A0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50
|
16
|
13
|
—
|
—
|
$22,727.86
|
$37,879.77
|
$25,253.18
|
2025-09-11
|
|
A1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50
|
16
|
13
|
—
|
—
|
$22,608.02
|
$37,680.03
|
$25,120.02
|
2025-09-11
|
|
D0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50
|
16
|
13
|
—
|
—
|
$22,559.00
|
$37,598.33
|
$25,065.55
|
2025-09-11
|
|
B0102
|
LOCAL
|
Stroke M >=63.50 And M <72.50
|
16
|
13
|
—
|
—
|
$22,557.18
|
$37,595.30
|
$25,063.53
|
2025-09-11
|
|
C0302
|
LOCAL
|
Non-traumatic Brain Injury M >=52.50 And M <65.50
|
16
|
13
|
—
|
—
|
$22,515.42
|
$37,525.70
|
$25,017.13
|
2025-09-11
|
|
C0502
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50
|
16
|
13
|
—
|
—
|
$22,502.71
|
$37,504.52
|
$25,003.01
|
2025-09-11
|
|
A0503
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50
|
16
|
13
|
—
|
—
|
$22,457.31
|
$37,428.86
|
$24,952.57
|
2025-09-11
|
|
D1502
|
LOCAL
|
Pulmonary M >=56.50 And M <68.50
|
16
|
13
|
—
|
—
|
$22,397.39
|
$37,328.99
|
$24,885.99
|
2025-09-11
|
|
C1302
|
LOCAL
|
Rheumatoid Other Arthritis M >=51.50 And M <62.50
|
16
|
13
|
—
|
—
|
$22,379.24
|
$37,298.73
|
$24,865.82
|
2025-09-11
|
|
C0803
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=51.50 And M <57.50
|
16
|
13
|
—
|
—
|
$22,352.00
|
$37,253.33
|
$24,835.55
|
2025-09-11
|
|
C1202
|
LOCAL
|
Osteoarthritis M >=49.50 And M <61.50
|
16
|
13
|
—
|
—
|
$22,188.58
|
$36,980.97
|
$24,653.98
|
2025-09-11
|
|
A0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50
|
16
|
13
|
—
|
—
|
$22,166.79
|
$36,944.66
|
$24,629.77
|
2025-09-11
|
|
A0402
|
LOCAL
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50
|
16
|
13
|
—
|
—
|
$22,154.09
|
$36,923.48
|
$24,615.65
|
2025-09-11
|
|
A1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50
|
16
|
13
|
—
|
—
|
$22,090.53
|
$36,817.55
|
$24,545.03
|
2025-09-11
|
|
B0801
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=63.50
|
16
|
13
|
—
|
—
|
$22,074.19
|
$36,790.32
|
$24,526.88
|
2025-09-11
|
|
B1001
|
LOCAL
|
Amputation Lower Extremity M >=64.50
|
16
|
13
|
—
|
—
|
$21,988.85
|
$36,648.08
|
$24,432.05
|
2025-09-11
|
|
A0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50
|
16
|
13
|
—
|
—
|
$21,957.98
|
$36,596.63
|
$24,397.75
|
2025-09-11
|
|
B0401
|
LOCAL
|
Traumatic Spinal Cord Injury M >=56.50
|
16
|
13
|
—
|
—
|
$21,898.06
|
$36,496.77
|
$24,331.18
|
2025-09-11
|
|
B0901
|
LOCAL
|
Other Orthopedic M >=63.50
|
16
|
13
|
—
|
—
|
$21,819.98
|
$36,366.63
|
$24,244.42
|
2025-09-11
|
|
C0902
|
LOCAL
|
Other Orthopedic M >=51.50 And M <63.50
|
16
|
13
|
—
|
—
|
$21,767.33
|
$36,278.88
|
$24,185.92
|
2025-09-11
|
|
B0301
|
LOCAL
|
Non-traumatic Brain Injury M >=65.50
|
16
|
13
|
—
|
—
|
$21,765.51
|
$36,275.85
|
$24,183.90
|
2025-09-11
|
|
C0702
|
LOCAL
|
Fracture Of Lower Extremity M >=52.50 And M <61.50
|
16
|
13
|
—
|
—
|
$21,760.07
|
$36,266.78
|
$24,177.85
|
2025-09-11
|
|
A2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50
|
16
|
13
|
—
|
—
|
$21,734.64
|
$36,224.40
|
$24,149.60
|
2025-09-11
|
|
D1702
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50
|
16
|
13
|
—
|
—
|
$21,714.67
|
$36,191.12
|
$24,127.41
|
2025-09-11
|
|
D1902
|
LOCAL
|
Guillain-barré M >=51.50 And M <66.50
|
16
|
13
|
—
|
—
|
$21,681.98
|
$36,136.64
|
$24,091.09
|
2025-09-11
|
|
B2001
|
LOCAL
|
Miscellaneous M >=66.50
|
16
|
13
|
—
|
—
|
$21,433.22
|
$35,722.04
|
$23,814.69
|
2025-09-11
|
|
A1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50
|
16
|
13
|
—
|
—
|
$21,431.41
|
$35,719.02
|
$23,812.68
|
2025-09-11
|
|
D0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50
|
16
|
13
|
—
|
—
|
$21,387.83
|
$35,646.39
|
$23,764.26
|
2025-09-11
|
|
A1603
|
LOCAL
|
Pain Syndrome M >=43.50 And M <58.50
|
16
|
13
|
—
|
—
|
$21,380.57
|
$35,634.29
|
$23,756.19
|
2025-09-11
|
|
D1302
|
LOCAL
|
Rheumatoid Other Arthritis M >=51.50 And M <62.50
|
16
|
13
|
—
|
—
|
$21,362.41
|
$35,604.02
|
$23,736.01
|
2025-09-11
|
|
C2002
|
LOCAL
|
Miscellaneous M >=55.50 And M <66.50
|
16
|
13
|
—
|
—
|
$21,346.07
|
$35,576.78
|
$23,717.85
|
2025-09-11
|
|
A1902
|
LOCAL
|
Guillain-barré M >=51.50 And M <66.50
|
16
|
13
|
—
|
—
|
$21,306.12
|
$35,510.21
|
$23,673.47
|
2025-09-11
|
|
A0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50
|
16
|
13
|
—
|
—
|
$21,293.42
|
$35,489.03
|
$23,659.35
|
2025-09-11
|
|
D0502
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50
|
16
|
13
|
—
|
—
|
$21,260.73
|
$35,434.55
|
$23,623.03
|
2025-09-11
|
|
A0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50
|
16
|
13
|
—
|
—
|
$21,238.94
|
$35,398.23
|
$23,598.82
|
2025-09-11
|
|
D1002
|
LOCAL
|
Amputation Lower Extremity M >=55.50 And M <64.50
|
16
|
13
|
—
|
—
|
$21,044.66
|
$35,074.43
|
$23,382.95
|
2025-09-11
|
|
A1502
|
LOCAL
|
Pulmonary M >=56.50 And M <68.50
|
16
|
13
|
—
|
—
|
$20,952.05
|
$34,920.08
|
$23,280.05
|
2025-09-11
|
|
D1202
|
LOCAL
|
Osteoarthritis M >=49.50 And M <61.50
|
16
|
13
|
—
|
—
|
$20,804.98
|
$34,674.96
|
$23,116.64
|
2025-09-11
|
|
C2101
|
LOCAL
|
Burns M >=52.50
|
16
|
13
|
—
|
—
|
$20,763.21
|
$34,605.35
|
$23,070.23
|
2025-09-11
|
|
D2101
|
LOCAL
|
Burns M >=52.50
|
16
|
13
|
—
|
—
|
$20,763.21
|
$34,605.35
|
$23,070.23
|
2025-09-11
|
|
D0302
|
LOCAL
|
Non-traumatic Brain Injury M >=52.50 And M <65.50
|
16
|
13
|
—
|
—
|
$20,681.50
|
$34,469.16
|
$22,979.44
|
2025-09-11
|
|
D0702
|
LOCAL
|
Fracture Of Lower Extremity M >=52.50 And M <61.50
|
16
|
13
|
—
|
—
|
$20,612.50
|
$34,354.17
|
$22,902.78
|
2025-09-11
|
|
C1802
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50
|
16
|
13
|
—
|
—
|
$20,605.24
|
$34,342.07
|
$22,894.71
|
2025-09-11
|
|
B1401
|
LOCAL
|
Cardiac M >=68.50
|
16
|
13
|
—
|
—
|
$20,490.85
|
$34,151.42
|
$22,767.61
|
2025-09-11
|
|
C1402
|
LOCAL
|
Cardiac M >=55.50 And M <68.50
|
16
|
13
|
—
|
—
|
$20,472.69
|
$34,121.15
|
$22,747.43
|
2025-09-11
|
|
D0803
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=51.50 And M <57.50
|
16
|
13
|
—
|
—
|
$20,378.27
|
$33,963.78
|
$22,642.52
|
2025-09-11
|
|
D0902
|
LOCAL
|
Other Orthopedic M >=51.50 And M <63.50
|
16
|
13
|
—
|
—
|
$20,287.48
|
$33,812.46
|
$22,541.64
|
2025-09-11
|
|
C1602
|
LOCAL
|
Pain Syndrome M >=58.50 And M <65.50
|
16
|
13
|
—
|
—
|
$20,234.83
|
$33,724.71
|
$22,483.14
|
2025-09-11
|
|
C0802
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=57.50 And M <63.50
|
16
|
13
|
—
|
—
|
$20,082.30
|
$33,470.51
|
$22,313.67
|
2025-09-11
|
|
C0202
|
LOCAL
|
Traumatic Brain Injury M >=61.50 And M <73.50
|
16
|
13
|
—
|
—
|
$19,944.31
|
$33,240.51
|
$22,160.34
|
2025-09-11
|
|
D2002
|
LOCAL
|
Miscellaneous M >=55.50 And M <66.50
|
16
|
13
|
—
|
—
|
$19,940.67
|
$33,234.45
|
$22,156.30
|
2025-09-11
|