|
Q2041
|
HCPCS
|
Axicabtagene Ciloleucel Car+
|
1
|
1
|
—
|
—
|
$387,472.40
|
$387,472.40
|
$387,472.40
|
2025-09-11
|
|
B0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
8
|
7
|
—
|
—
|
$94,479.88
|
$141,719.82
|
$94,479.88
|
2025-09-11
|
|
C0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
8
|
7
|
—
|
—
|
$84,019.11
|
$126,028.67
|
$84,019.11
|
2025-09-11
|
|
B1904
|
LOCAL
|
Guillain-barré M <38.50
|
8
|
7
|
—
|
—
|
$81,753.09
|
$122,629.64
|
$81,753.09
|
2025-09-11
|
|
D0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
8
|
7
|
—
|
—
|
$81,560.91
|
$122,341.37
|
$81,560.91
|
2025-09-11
|
|
B1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
8
|
7
|
—
|
—
|
$76,901.50
|
$115,352.25
|
$76,901.50
|
2025-09-11
|
|
A0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
8
|
7
|
—
|
—
|
$74,110.32
|
$111,165.48
|
$74,110.32
|
2025-09-11
|
|
B0406
|
LOCAL
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
8
|
7
|
—
|
—
|
$69,109.00
|
$103,663.50
|
$69,109.00
|
2025-09-11
|
|
B0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
8
|
7
|
—
|
—
|
$68,105.60
|
$102,158.40
|
$68,105.60
|
2025-09-11
|
|
B0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50
|
8
|
7
|
—
|
—
|
$67,406.13
|
$101,109.20
|
$67,406.13
|
2025-09-11
|
|
B0106
|
LOCAL
|
Stroke M <41.50 And A <84.50
|
8
|
7
|
—
|
—
|
$64,950.17
|
$97,425.26
|
$64,950.17
|
2025-09-11
|
|
C1904
|
LOCAL
|
Guillain-barré M <38.50
|
8
|
7
|
—
|
—
|
$62,851.76
|
$94,277.64
|
$62,851.76
|
2025-09-11
|
|
C0406
|
LOCAL
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
8
|
7
|
—
|
—
|
$61,457.28
|
$92,185.92
|
$61,457.28
|
2025-09-11
|
|
C1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
8
|
7
|
—
|
—
|
$61,347.78
|
$92,021.67
|
$61,347.78
|
2025-09-11
|
|
C0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
8
|
7
|
—
|
—
|
$60,565.63
|
$90,848.45
|
$60,565.63
|
2025-09-11
|
|
D0406
|
LOCAL
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
8
|
7
|
—
|
—
|
$59,658.33
|
$89,487.50
|
$59,658.33
|
2025-09-11
|
|
B0205
|
LOCAL
|
Traumatic Brain Injury M <35.50
|
8
|
7
|
—
|
—
|
$58,963.33
|
$88,445.00
|
$58,963.33
|
2025-09-11
|
|
D0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
8
|
7
|
—
|
—
|
$58,793.49
|
$88,190.24
|
$58,793.49
|
2025-09-11
|
|
D1904
|
LOCAL
|
Guillain-barré M <38.50
|
8
|
7
|
—
|
—
|
$58,648.23
|
$87,972.35
|
$58,648.23
|
2025-09-11
|
|
B1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
8
|
7
|
—
|
—
|
$58,594.60
|
$87,891.90
|
$58,594.60
|
2025-09-11
|
|
D1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
8
|
7
|
—
|
—
|
$58,241.51
|
$87,362.27
|
$58,241.51
|
2025-09-11
|
|
A1904
|
LOCAL
|
Guillain-barré M <38.50
|
8
|
7
|
—
|
—
|
$57,633.66
|
$86,450.49
|
$57,633.66
|
2025-09-11
|
|
B0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50
|
8
|
7
|
—
|
—
|
$57,104.03
|
$85,656.05
|
$57,104.03
|
2025-09-11
|
|
C0106
|
LOCAL
|
Stroke M <41.50 And A <84.50
|
8
|
7
|
—
|
—
|
$56,328.58
|
$84,492.87
|
$56,328.58
|
2025-09-11
|
|
B1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50
|
8
|
7
|
—
|
—
|
$56,122.99
|
$84,184.49
|
$56,122.99
|
2025-09-11
|
|
B0604
|
LOCAL
|
Neurological M <43.50
|
8
|
7
|
—
|
—
|
$55,653.69
|
$83,480.54
|
$55,653.69
|
2025-09-11
|
|
A0406
|
LOCAL
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
8
|
7
|
—
|
—
|
$54,210.06
|
$81,315.09
|
$54,210.06
|
2025-09-11
|
|
B0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
8
|
7
|
—
|
—
|
$54,160.89
|
$81,241.34
|
$54,160.89
|
2025-09-11
|
|
B1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
8
|
7
|
—
|
—
|
$54,149.72
|
$81,224.58
|
$54,149.72
|
2025-09-11
|
|
A1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
8
|
7
|
—
|
—
|
$53,999.99
|
$80,999.99
|
$53,999.99
|
2025-09-11
|
|
A0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
8
|
7
|
—
|
—
|
$53,423.43
|
$80,135.15
|
$53,423.43
|
2025-09-11
|
|
B0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
8
|
7
|
—
|
—
|
$53,287.12
|
$79,930.68
|
$53,287.12
|
2025-09-11
|
|
A5104
|
LOCAL
|
Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More
|
8
|
7
|
—
|
—
|
$53,262.53
|
$79,893.80
|
$53,262.53
|
2025-09-11
|
|
B1604
|
LOCAL
|
Pain Syndrome M <43.50
|
8
|
7
|
—
|
—
|
$52,460.27
|
$78,690.41
|
$52,460.27
|
2025-09-11
|
|
C0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50
|
8
|
7
|
—
|
—
|
$52,440.15
|
$78,660.23
|
$52,440.15
|
2025-09-11
|
|
B0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50
|
8
|
7
|
—
|
—
|
$52,008.85
|
$78,013.28
|
$52,008.85
|
2025-09-11
|
|
B2102
|
LOCAL
|
Burns M <52.50
|
8
|
7
|
—
|
—
|
$51,792.08
|
$77,688.12
|
$51,792.08
|
2025-09-11
|
|
D0106
|
LOCAL
|
Stroke M <41.50 And A <84.50
|
8
|
7
|
—
|
—
|
$51,474.75
|
$77,212.13
|
$51,474.75
|
2025-09-11
|
|
B1004
|
LOCAL
|
Amputation Lower Extremity M <47.50
|
8
|
7
|
—
|
—
|
$51,423.35
|
$77,135.03
|
$51,423.35
|
2025-09-11
|
|
B1504
|
LOCAL
|
Pulmonary M <45.50
|
8
|
7
|
—
|
—
|
$50,826.68
|
$76,240.02
|
$50,826.68
|
2025-09-11
|
|
B1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
8
|
7
|
—
|
—
|
$49,930.55
|
$74,895.83
|
$49,930.55
|
2025-09-11
|
|
B2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50
|
8
|
7
|
—
|
—
|
$49,637.80
|
$74,456.70
|
$49,637.80
|
2025-09-11
|
|
D0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50
|
8
|
7
|
—
|
—
|
$49,541.71
|
$74,312.57
|
$49,541.71
|
2025-09-11
|
|
C0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50
|
8
|
7
|
—
|
—
|
$49,523.83
|
$74,285.75
|
$49,523.83
|
2025-09-11
|
|
A0106
|
LOCAL
|
Stroke M <41.50 And A <84.50
|
8
|
7
|
—
|
—
|
$49,054.54
|
$73,581.81
|
$49,054.54
|
2025-09-11
|
|
B1204
|
LOCAL
|
Osteoarthritis M <49.50 And A <74.50
|
8
|
7
|
—
|
—
|
$48,799.78
|
$73,199.67
|
$48,799.78
|
2025-09-11
|
|
C0205
|
LOCAL
|
Traumatic Brain Injury M <35.50
|
8
|
7
|
—
|
—
|
$48,562.90
|
$72,844.35
|
$48,562.90
|
2025-09-11
|
|
B0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
8
|
7
|
—
|
—
|
$48,509.26
|
$72,763.89
|
$48,509.26
|
2025-09-11
|
|
B0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
8
|
7
|
—
|
—
|
$48,317.08
|
$72,475.62
|
$48,317.08
|
2025-09-11
|
|
C0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
8
|
7
|
—
|
—
|
$48,165.12
|
$72,247.68
|
$48,165.12
|
2025-09-11
|
|
B1404
|
LOCAL
|
Cardiac M <45.50
|
8
|
7
|
—
|
—
|
$47,952.82
|
$71,929.23
|
$47,952.82
|
2025-09-11
|
|
B0904
|
LOCAL
|
Other Orthopedic M <44.5
|
8
|
7
|
—
|
—
|
$47,858.96
|
$71,788.44
|
$47,858.96
|
2025-09-11
|
|
B1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
8
|
7
|
—
|
—
|
$47,858.96
|
$71,788.44
|
$47,858.96
|
2025-09-11
|
|
B2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50
|
8
|
7
|
—
|
—
|
$47,092.45
|
$70,638.68
|
$47,092.45
|
2025-09-11
|
|
D0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
8
|
7
|
—
|
—
|
$46,755.00
|
$70,132.50
|
$46,755.00
|
2025-09-11
|
|
B1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50
|
8
|
7
|
—
|
—
|
$46,536.00
|
$69,804.00
|
$46,536.00
|
2025-09-11
|
|
B0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50
|
8
|
7
|
—
|
—
|
$46,064.47
|
$69,096.71
|
$46,064.47
|
2025-09-11
|
|
B0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
8
|
7
|
—
|
—
|
$46,030.95
|
$69,046.43
|
$46,030.95
|
2025-09-11
|
|
B1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
8
|
7
|
—
|
—
|
$45,832.06
|
$68,748.09
|
$45,832.06
|
2025-09-11
|
|
B0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50
|
8
|
7
|
—
|
—
|
$45,666.69
|
$68,500.04
|
$45,666.69
|
2025-09-11
|
|
A0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50
|
8
|
7
|
—
|
—
|
$45,653.28
|
$68,479.92
|
$45,653.28
|
2025-09-11
|
|
C1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
8
|
7
|
—
|
—
|
$45,546.01
|
$68,319.02
|
$45,546.01
|
2025-09-11
|
|
D0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50
|
8
|
7
|
—
|
—
|
$45,255.50
|
$67,883.25
|
$45,255.50
|
2025-09-11
|
|
28730
|
CPT
|
Fusion Of Foot Bones
|
21
|
15
|
$57,929.13
|
$57,929.13
|
$701.72
|
$49,239.76
|
$44,895.07
|
2025-09-11
|
|
B1103
|
LOCAL
|
Amputation Non-lower Extremity M <52.50
|
8
|
7
|
—
|
—
|
$44,819.73
|
$67,229.60
|
$44,819.73
|
2025-09-11
|
|
B1804
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
8
|
7
|
—
|
—
|
$44,663.30
|
$66,994.95
|
$44,663.30
|
2025-09-11
|
|
B0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50
|
8
|
7
|
—
|
—
|
$44,377.25
|
$66,565.88
|
$44,377.25
|
2025-09-11
|
|
B1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50
|
8
|
7
|
—
|
—
|
$44,113.55
|
$66,170.33
|
$44,113.55
|
2025-09-11
|
|
D0205
|
LOCAL
|
Traumatic Brain Injury M <35.50
|
8
|
7
|
—
|
—
|
$44,109.08
|
$66,163.62
|
$44,109.08
|
2025-09-11
|
|
B0403
|
LOCAL
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
8
|
7
|
—
|
—
|
$43,619.68
|
$65,429.52
|
$43,619.68
|
2025-09-11
|
|
C1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
8
|
7
|
—
|
—
|
$43,197.31
|
$64,795.97
|
$43,197.31
|
2025-09-11
|
|
C1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50
|
8
|
7
|
—
|
—
|
$43,145.91
|
$64,718.87
|
$43,145.91
|
2025-09-11
|
|
A0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50
|
8
|
7
|
—
|
—
|
$43,130.27
|
$64,695.41
|
$43,130.27
|
2025-09-11
|
|
C0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
8
|
7
|
—
|
—
|
$42,631.93
|
$63,947.90
|
$42,631.93
|
2025-09-11
|
|
B0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50
|
8
|
7
|
—
|
—
|
$42,573.82
|
$63,860.73
|
$42,573.82
|
2025-09-11
|
|
C1004
|
LOCAL
|
Amputation Lower Extremity M <47.50
|
8
|
7
|
—
|
—
|
$42,529.13
|
$63,793.70
|
$42,529.13
|
2025-09-11
|
|
A0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
8
|
7
|
—
|
—
|
$42,484.43
|
$63,726.65
|
$42,484.43
|
2025-09-11
|
|
B1603
|
LOCAL
|
Pain Syndrome M >=43.50 And M <58.50
|
8
|
7
|
—
|
—
|
$42,341.41
|
$63,512.12
|
$42,341.41
|
2025-09-11
|
|
D1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
8
|
7
|
—
|
—
|
$42,180.51
|
$63,270.77
|
$42,180.51
|
2025-09-11
|
|
B0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50
|
8
|
7
|
—
|
—
|
$41,673.23
|
$62,509.85
|
$41,673.23
|
2025-09-11
|
|
C0604
|
LOCAL
|
Neurological M <43.50
|
8
|
7
|
—
|
—
|
$41,666.52
|
$62,499.78
|
$41,666.52
|
2025-09-11
|
|
A0205
|
LOCAL
|
Traumatic Brain Injury M <35.50
|
8
|
7
|
—
|
—
|
$41,527.97
|
$62,291.96
|
$41,527.97
|
2025-09-11
|
|
C1504
|
LOCAL
|
Pulmonary M <45.50
|
8
|
7
|
—
|
—
|
$41,253.10
|
$61,879.65
|
$41,253.10
|
2025-09-11
|
|
B1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50
|
8
|
7
|
—
|
—
|
$41,043.03
|
$61,564.55
|
$41,043.03
|
2025-09-11
|
|
D1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
8
|
7
|
—
|
—
|
$41,009.51
|
$61,514.27
|
$41,009.51
|
2025-09-11
|
|
L7180
|
HCPCS
|
Electronic Elbow Sequential
|
1
|
1
|
—
|
—
|
$40,925.01
|
$40,925.01
|
$40,925.01
|
2025-09-11
|
|
B1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50
|
8
|
7
|
—
|
—
|
$40,841.91
|
$61,262.87
|
$40,841.91
|
2025-09-11
|
|
B0503
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50
|
8
|
7
|
—
|
—
|
$40,808.39
|
$61,212.59
|
$40,808.39
|
2025-09-11
|
|
D1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50
|
8
|
7
|
—
|
—
|
$40,260.88
|
$60,391.32
|
$40,260.88
|
2025-09-11
|
|
C0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50
|
8
|
7
|
—
|
—
|
$40,231.83
|
$60,347.75
|
$40,231.83
|
2025-09-11
|
|
B1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50
|
8
|
7
|
—
|
—
|
$40,167.02
|
$60,250.53
|
$40,167.02
|
2025-09-11
|
|
A5102
|
LOCAL
|
Expired, Orthopedic, Length Of Stay Is 14 Days Or More
|
8
|
7
|
—
|
—
|
$40,059.75
|
$60,089.63
|
$40,059.75
|
2025-09-11
|
|
B0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50
|
8
|
7
|
—
|
—
|
$39,941.31
|
$59,911.97
|
$39,941.31
|
2025-09-11
|
|
C2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50
|
8
|
7
|
—
|
—
|
$39,648.56
|
$59,472.84
|
$39,648.56
|
2025-09-11
|
|
C0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50
|
8
|
7
|
—
|
—
|
$39,603.87
|
$59,405.81
|
$39,603.87
|
2025-09-11
|
|
C1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
8
|
7
|
—
|
—
|
$39,570.35
|
$59,355.53
|
$39,570.35
|
2025-09-11
|
|
A1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50
|
8
|
7
|
—
|
—
|
$39,563.64
|
$59,345.46
|
$39,563.64
|
2025-09-11
|
|
B2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50
|
8
|
7
|
—
|
—
|
$39,387.10
|
$59,080.65
|
$39,387.10
|
2025-09-11
|
|
D2102
|
LOCAL
|
Burns M <52.50
|
8
|
7
|
—
|
—
|
$39,355.81
|
$59,033.72
|
$39,355.81
|
2025-09-11
|
|
C2102
|
LOCAL
|
Burns M <52.50
|
8
|
7
|
—
|
—
|
$39,355.81
|
$59,033.72
|
$39,355.81
|
2025-09-11
|
|
D0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
8
|
7
|
—
|
—
|
$39,161.39
|
$58,742.09
|
$39,161.39
|
2025-09-11
|
|
B1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50
|
8
|
7
|
—
|
—
|
$39,134.58
|
$58,701.87
|
$39,134.58
|
2025-09-11
|
|
C1604
|
LOCAL
|
Pain Syndrome M <43.50
|
8
|
7
|
—
|
—
|
$38,964.74
|
$58,447.11
|
$38,964.74
|
2025-09-11
|
|
D0604
|
LOCAL
|
Neurological M <43.50
|
8
|
7
|
—
|
—
|
$38,897.69
|
$58,346.54
|
$38,897.69
|
2025-09-11
|
|
D1004
|
LOCAL
|
Amputation Lower Extremity M <47.50
|
8
|
7
|
—
|
—
|
$38,848.53
|
$58,272.80
|
$38,848.53
|
2025-09-11
|
|
C1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
8
|
7
|
—
|
—
|
$38,810.54
|
$58,215.81
|
$38,810.54
|
2025-09-11
|
|
D1504
|
LOCAL
|
Pulmonary M <45.50
|
8
|
7
|
—
|
—
|
$38,797.13
|
$58,195.70
|
$38,797.13
|
2025-09-11
|
|
C0403
|
LOCAL
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
8
|
7
|
—
|
—
|
$38,790.43
|
$58,185.65
|
$38,790.43
|
2025-09-11
|
|
C0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
8
|
7
|
—
|
—
|
$38,656.34
|
$57,984.51
|
$38,656.34
|
2025-09-11
|
|
B0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50
|
8
|
7
|
—
|
—
|
$38,408.29
|
$57,612.44
|
$38,408.29
|
2025-09-11
|
|
C0904
|
LOCAL
|
Other Orthopedic M <44.5
|
8
|
7
|
—
|
—
|
$38,332.31
|
$57,498.47
|
$38,332.31
|
2025-09-11
|
|
A1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
8
|
7
|
—
|
—
|
$38,267.50
|
$57,401.25
|
$38,267.50
|
2025-09-11
|
|
D0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50
|
8
|
7
|
—
|
—
|
$38,111.07
|
$57,166.61
|
$38,111.07
|
2025-09-11
|
|
A1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
8
|
7
|
—
|
—
|
$38,023.92
|
$57,035.88
|
$38,023.92
|
2025-09-11
|
|
C0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
8
|
7
|
—
|
—
|
$37,914.41
|
$56,871.62
|
$37,914.41
|
2025-09-11
|
|
B1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50
|
8
|
7
|
—
|
—
|
$37,896.54
|
$56,844.81
|
$37,896.54
|
2025-09-11
|
|
C1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
8
|
7
|
—
|
—
|
$37,894.30
|
$56,841.45
|
$37,894.30
|
2025-09-11
|
|
33208
|
CPT
|
Ins/Rplc Pacemkr; Atr+vnt
|
21
|
15
|
$48,848.87
|
$48,848.87
|
$487.43
|
$41,521.54
|
$37,857.88
|
2025-09-11
|
|
33207
|
CPT
|
Insrt Heart Pm Venticular
|
21
|
15
|
$48,848.87
|
$48,848.87
|
$450.33
|
$41,521.54
|
$37,857.88
|
2025-09-11
|
|
C1404
|
LOCAL
|
Cardiac M <45.50
|
8
|
7
|
—
|
—
|
$37,775.86
|
$56,663.79
|
$37,775.86
|
2025-09-11
|
|
D1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
8
|
7
|
—
|
—
|
$37,771.39
|
$56,657.09
|
$37,771.39
|
2025-09-11
|
|
C0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
8
|
7
|
—
|
—
|
$37,737.87
|
$56,606.81
|
$37,737.87
|
2025-09-11
|
|
B0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50
|
8
|
7
|
—
|
—
|
$37,661.89
|
$56,492.84
|
$37,661.89
|
2025-09-11
|
|
D0403
|
LOCAL
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
8
|
7
|
—
|
—
|
$37,655.19
|
$56,482.79
|
$37,655.19
|
2025-09-11
|
|
C2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50
|
8
|
7
|
—
|
—
|
$37,614.96
|
$56,422.44
|
$37,614.96
|
2025-09-11
|
|
B1902
|
LOCAL
|
Guillain-barré M >=51.50 And M <66.50
|
8
|
7
|
—
|
—
|
$37,197.07
|
$55,795.61
|
$37,197.07
|
2025-09-11
|
|
B1702
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50
|
8
|
7
|
—
|
—
|
$37,123.32
|
$55,684.98
|
$37,123.32
|
2025-09-11
|
|
B0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50
|
8
|
7
|
—
|
—
|
$37,114.38
|
$55,671.57
|
$37,114.38
|
2025-09-11
|
|
C1204
|
LOCAL
|
Osteoarthritis M <49.50 And A <74.50
|
8
|
7
|
—
|
—
|
$37,100.97
|
$55,651.46
|
$37,100.97
|
2025-09-11
|
|
D2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50
|
8
|
7
|
—
|
—
|
$37,038.40
|
$55,557.60
|
$37,038.40
|
2025-09-11
|
|
C0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50
|
8
|
7
|
—
|
—
|
$36,962.42
|
$55,443.63
|
$36,962.42
|
2025-09-11
|
|
A0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
8
|
7
|
—
|
—
|
$36,911.02
|
$55,366.53
|
$36,911.02
|
2025-09-11
|
|
37236
|
CPT
|
Open/Perq Place Stent 1st
|
21
|
15
|
$47,189.05
|
$47,189.05
|
$2,570.71
|
$40,110.69
|
$36,571.51
|
2025-09-11
|
|
A1504
|
LOCAL
|
Pulmonary M <45.50
|
8
|
7
|
—
|
—
|
$36,292.00
|
$54,438.00
|
$36,292.00
|
2025-09-11
|
|
D0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50
|
8
|
7
|
—
|
—
|
$36,191.44
|
$54,287.16
|
$36,191.44
|
2025-09-11
|
|
D1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
8
|
7
|
—
|
—
|
$36,171.33
|
$54,257.00
|
$36,171.33
|
2025-09-11
|
|
B1502
|
LOCAL
|
Pulmonary M >=56.50 And M <68.50
|
8
|
7
|
—
|
—
|
$36,113.22
|
$54,169.83
|
$36,113.22
|
2025-09-11
|
|
C1103
|
LOCAL
|
Amputation Non-lower Extremity M <52.50
|
8
|
7
|
—
|
—
|
$36,028.30
|
$54,042.45
|
$36,028.30
|
2025-09-11
|
|
D1103
|
LOCAL
|
Amputation Non-lower Extremity M <52.50
|
8
|
7
|
—
|
—
|
$36,028.30
|
$54,042.45
|
$36,028.30
|
2025-09-11
|
|
D1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
8
|
7
|
—
|
—
|
$35,943.38
|
$53,915.07
|
$35,943.38
|
2025-09-11
|
|
B1102
|
LOCAL
|
Amputation Non-lower Extremity M >=52.50 And M <58.50
|
8
|
7
|
—
|
—
|
$35,941.15
|
$53,911.73
|
$35,941.15
|
2025-09-11
|
|
B1202
|
LOCAL
|
Osteoarthritis M >=49.50 And M <61.50
|
8
|
7
|
—
|
—
|
$35,921.04
|
$53,881.56
|
$35,921.04
|
2025-09-11
|
|
B0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50
|
8
|
7
|
—
|
—
|
$35,782.48
|
$53,673.72
|
$35,782.48
|
2025-09-11
|
|
D0904
|
LOCAL
|
Other Orthopedic M <44.5
|
8
|
7
|
—
|
—
|
$35,728.85
|
$53,593.28
|
$35,728.85
|
2025-09-11
|
|
D0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
8
|
7
|
—
|
—
|
$35,652.87
|
$53,479.31
|
$35,652.87
|
2025-09-11
|
|
C1804
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
8
|
7
|
—
|
—
|
$35,630.52
|
$53,445.78
|
$35,630.52
|
2025-09-11
|
|
B0502
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50
|
8
|
7
|
—
|
—
|
$35,601.47
|
$53,402.21
|
$35,601.47
|
2025-09-11
|
|
D0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
8
|
7
|
—
|
—
|
$35,509.85
|
$53,264.78
|
$35,509.85
|
2025-09-11
|
|
C1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50
|
8
|
7
|
—
|
—
|
$35,378.00
|
$53,067.00
|
$35,378.00
|
2025-09-11
|
|
A1103
|
LOCAL
|
Amputation Non-lower Extremity M <52.50
|
8
|
7
|
—
|
—
|
$35,299.78
|
$52,949.67
|
$35,299.78
|
2025-09-11
|
|
D1604
|
LOCAL
|
Pain Syndrome M <43.50
|
8
|
7
|
—
|
—
|
$35,219.33
|
$52,829.00
|
$35,219.33
|
2025-09-11
|
|
A0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50
|
8
|
7
|
—
|
—
|
$35,210.39
|
$52,815.59
|
$35,210.39
|
2025-09-11
|
|
A1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
8
|
7
|
—
|
—
|
$35,138.88
|
$52,708.32
|
$35,138.88
|
2025-09-11
|
|
D2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50
|
8
|
7
|
—
|
—
|
$35,138.88
|
$52,708.32
|
$35,138.88
|
2025-09-11
|
|
D1404
|
LOCAL
|
Cardiac M <45.50
|
8
|
7
|
—
|
—
|
$35,123.24
|
$52,684.86
|
$35,123.24
|
2025-09-11
|
|
A0604
|
LOCAL
|
Neurological M <43.50
|
8
|
7
|
—
|
—
|
$35,080.78
|
$52,621.17
|
$35,080.78
|
2025-09-11
|
|
A1004
|
LOCAL
|
Amputation Lower Extremity M <47.50
|
8
|
7
|
—
|
—
|
$34,805.91
|
$52,208.87
|
$34,805.91
|
2025-09-11
|
|
D1204
|
LOCAL
|
Osteoarthritis M <49.50 And A <74.50
|
8
|
7
|
—
|
—
|
$34,785.79
|
$52,178.69
|
$34,785.79
|
2025-09-11
|
|
B0402
|
LOCAL
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50
|
8
|
7
|
—
|
—
|
$34,758.98
|
$52,138.47
|
$34,758.98
|
2025-09-11
|
|
B0302
|
LOCAL
|
Non-traumatic Brain Injury M >=52.50 And M <65.50
|
8
|
7
|
—
|
—
|
$34,633.83
|
$51,950.75
|
$34,633.83
|
2025-09-11
|
|
B0702
|
LOCAL
|
Fracture Of Lower Extremity M >=52.50 And M <61.50
|
8
|
7
|
—
|
—
|
$34,620.42
|
$51,930.63
|
$34,620.42
|
2025-09-11
|
|
A0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50
|
8
|
7
|
—
|
—
|
$34,490.81
|
$51,736.22
|
$34,490.81
|
2025-09-11
|
|
D0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
8
|
7
|
—
|
—
|
$34,434.94
|
$51,652.41
|
$34,434.94
|
2025-09-11
|
|
C1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50
|
8
|
7
|
—
|
—
|
$34,289.68
|
$51,434.52
|
$34,289.68
|
2025-09-11
|
|
B0803
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=51.50 And M <57.50
|
8
|
7
|
—
|
—
|
$34,282.98
|
$51,424.47
|
$34,282.98
|
2025-09-11
|
|
B1002
|
LOCAL
|
Amputation Lower Extremity M >=55.50 And M <64.50
|
8
|
7
|
—
|
—
|
$34,282.98
|
$51,424.47
|
$34,282.98
|
2025-09-11
|
|
A0403
|
LOCAL
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
8
|
7
|
—
|
—
|
$34,215.94
|
$51,323.91
|
$34,215.94
|
2025-09-11
|
|
D1804
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
8
|
7
|
—
|
—
|
$33,824.86
|
$50,737.29
|
$33,824.86
|
2025-09-11
|
|
A2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50
|
8
|
7
|
—
|
—
|
$33,713.12
|
$50,569.68
|
$33,713.12
|
2025-09-11
|
|
D0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50
|
8
|
7
|
—
|
—
|
$33,699.71
|
$50,549.57
|
$33,699.71
|
2025-09-11
|
|
A1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
8
|
7
|
—
|
—
|
$33,650.55
|
$50,475.83
|
$33,650.55
|
2025-09-11
|
|
B2101
|
LOCAL
|
Burns M >=52.50
|
8
|
7
|
—
|
—
|
$33,630.44
|
$50,445.66
|
$33,630.44
|
2025-09-11
|
|
A2102
|
LOCAL
|
Burns M <52.50
|
8
|
7
|
—
|
—
|
$33,610.33
|
$50,415.50
|
$33,610.33
|
2025-09-11
|
|
B1602
|
LOCAL
|
Pain Syndrome M >=58.50 And M <65.50
|
8
|
7
|
—
|
—
|
$33,527.64
|
$50,291.46
|
$33,527.64
|
2025-09-11
|
|
A0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
8
|
7
|
—
|
—
|
$33,469.54
|
$50,204.31
|
$33,469.54
|
2025-09-11
|
|
B0902
|
LOCAL
|
Other Orthopedic M >=51.50 And M <63.50
|
8
|
7
|
—
|
—
|
$33,447.19
|
$50,170.79
|
$33,447.19
|
2025-09-11
|
|
C0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50
|
8
|
7
|
—
|
—
|
$33,339.92
|
$50,009.88
|
$33,339.92
|
2025-09-11
|
|
B1302
|
LOCAL
|
Rheumatoid Other Arthritis M >=51.50 And M <62.50
|
8
|
7
|
—
|
—
|
$33,310.87
|
$49,966.31
|
$33,310.87
|
2025-09-11
|
|
C1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50
|
8
|
7
|
—
|
—
|
$33,310.87
|
$49,966.31
|
$33,310.87
|
2025-09-11
|
|
C0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50
|
8
|
7
|
—
|
—
|
$33,223.72
|
$49,835.58
|
$33,223.72
|
2025-09-11
|
|
C1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50
|
8
|
7
|
—
|
—
|
$33,219.25
|
$49,828.88
|
$33,219.25
|
2025-09-11
|
|
D1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50
|
8
|
7
|
—
|
—
|
$33,172.32
|
$49,758.48
|
$33,172.32
|
2025-09-11
|
|
C0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50
|
8
|
7
|
—
|
—
|
$32,933.20
|
$49,399.80
|
$32,933.20
|
2025-09-11
|
|
B2002
|
LOCAL
|
Miscellaneous M >=55.50 And M <66.50
|
8
|
7
|
—
|
—
|
$32,890.74
|
$49,336.11
|
$32,890.74
|
2025-09-11
|
|
A0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
8
|
7
|
—
|
—
|
$32,854.99
|
$49,282.49
|
$32,854.99
|
2025-09-11
|
|
A0904
|
LOCAL
|
Other Orthopedic M <44.5
|
8
|
7
|
—
|
—
|
$32,689.62
|
$49,034.43
|
$32,689.62
|
2025-09-11
|
|
A1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
8
|
7
|
—
|
—
|
$32,609.17
|
$48,913.76
|
$32,609.17
|
2025-09-11
|
|
A1604
|
LOCAL
|
Pain Syndrome M <43.50
|
8
|
7
|
—
|
—
|
$32,602.46
|
$48,903.69
|
$32,602.46
|
2025-09-11
|
|
C1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50
|
8
|
7
|
—
|
—
|
$32,582.35
|
$48,873.53
|
$32,582.35
|
2025-09-11
|
|
A0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
8
|
7
|
—
|
—
|
$32,421.45
|
$48,632.18
|
$32,421.45
|
2025-09-11
|
|
A1404
|
LOCAL
|
Cardiac M <45.50
|
8
|
7
|
—
|
—
|
$32,318.65
|
$48,477.98
|
$32,318.65
|
2025-09-11
|
|
C0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50
|
8
|
7
|
—
|
—
|
$31,990.15
|
$47,985.23
|
$31,990.15
|
2025-09-11
|
|
A2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50
|
8
|
7
|
—
|
—
|
$31,983.44
|
$47,975.16
|
$31,983.44
|
2025-09-11
|
|
B1402
|
LOCAL
|
Cardiac M >=55.50 And M <68.50
|
8
|
7
|
—
|
—
|
$31,983.44
|
$47,975.16
|
$31,983.44
|
2025-09-11
|
|
A1204
|
LOCAL
|
Osteoarthritis M <49.50 And A <74.50
|
8
|
7
|
—
|
—
|
$31,802.43
|
$47,703.65
|
$31,802.43
|
2025-09-11
|
|
B1802
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50
|
8
|
7
|
—
|
—
|
$31,789.02
|
$47,683.53
|
$31,789.02
|
2025-09-11
|
|
D1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50
|
8
|
7
|
—
|
—
|
$31,757.74
|
$47,636.61
|
$31,757.74
|
2025-09-11
|
|
C0503
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50
|
8
|
7
|
—
|
—
|
$31,746.56
|
$47,619.84
|
$31,746.56
|
2025-09-11
|
|
C2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50
|
8
|
7
|
—
|
—
|
$31,460.52
|
$47,190.78
|
$31,460.52
|
2025-09-11
|
|
C1603
|
LOCAL
|
Pain Syndrome M >=43.50 And M <58.50
|
8
|
7
|
—
|
—
|
$31,449.34
|
$47,174.01
|
$31,449.34
|
2025-09-11
|
|
A0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50
|
8
|
7
|
—
|
—
|
$31,431.46
|
$47,147.19
|
$31,431.46
|
2025-09-11
|
|
A1804
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
8
|
7
|
—
|
—
|
$31,362.19
|
$47,043.29
|
$31,362.19
|
2025-09-11
|
|
C1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50
|
8
|
7
|
—
|
—
|
$31,335.37
|
$47,003.06
|
$31,335.37
|
2025-09-11
|
|
D1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50
|
8
|
7
|
—
|
—
|
$31,328.67
|
$46,993.01
|
$31,328.67
|
2025-09-11
|
|
D0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50
|
8
|
7
|
—
|
—
|
$31,196.82
|
$46,795.23
|
$31,196.82
|
2025-09-11
|
|
C0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50
|
8
|
7
|
—
|
—
|
$31,033.68
|
$46,550.52
|
$31,033.68
|
2025-09-11
|
|
D0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50
|
8
|
7
|
—
|
—
|
$31,015.81
|
$46,523.72
|
$31,015.81
|
2025-09-11
|
|
D1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50
|
8
|
7
|
—
|
—
|
$30,933.12
|
$46,399.68
|
$30,933.12
|
2025-09-11
|
|
C0402
|
LOCAL
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50
|
8
|
7
|
—
|
—
|
$30,910.77
|
$46,366.16
|
$30,910.77
|
2025-09-11
|
|
C1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50
|
8
|
7
|
—
|
—
|
$30,830.32
|
$46,245.48
|
$30,830.32
|
2025-09-11
|
|
C0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50
|
8
|
7
|
—
|
—
|
$30,819.15
|
$46,228.73
|
$30,819.15
|
2025-09-11
|
|
B0802
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=57.50 And M <63.50
|
8
|
7
|
—
|
—
|
$30,801.27
|
$46,201.91
|
$30,801.27
|
2025-09-11
|
|
D0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50
|
8
|
7
|
—
|
—
|
$30,626.96
|
$45,940.44
|
$30,626.96
|
2025-09-11
|
|
C0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50
|
8
|
7
|
—
|
—
|
$30,568.86
|
$45,853.29
|
$30,568.86
|
2025-09-11
|
|
D1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50
|
8
|
7
|
—
|
—
|
$30,345.39
|
$45,518.09
|
$30,345.39
|
2025-09-11
|
|
A1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50
|
8
|
7
|
—
|
—
|
$30,325.27
|
$45,487.91
|
$30,325.27
|
2025-09-11
|
|
D0402
|
LOCAL
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50
|
8
|
7
|
—
|
—
|
$30,005.71
|
$45,008.57
|
$30,005.71
|
2025-09-11
|
|
D0503
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50
|
8
|
7
|
—
|
—
|
$29,992.30
|
$44,988.45
|
$29,992.30
|
2025-09-11
|
|
D1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50
|
8
|
7
|
—
|
—
|
$29,909.61
|
$44,864.42
|
$29,909.61
|
2025-09-11
|
|
B1701
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50
|
8
|
7
|
—
|
—
|
$29,880.56
|
$44,820.84
|
$29,880.56
|
2025-09-11
|
|
D0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50
|
8
|
7
|
—
|
—
|
$29,817.99
|
$44,726.99
|
$29,817.99
|
2025-09-11
|
|
B0202
|
LOCAL
|
Traumatic Brain Injury M >=61.50 And M <73.50
|
8
|
7
|
—
|
—
|
$29,802.35
|
$44,703.53
|
$29,802.35
|
2025-09-11
|
|
33216
|
CPT
|
Insert 1 Electrode Pm-defib
|
21
|
15
|
$38,328.90
|
$38,328.90
|
$350.84
|
$32,579.57
|
$29,704.90
|
2025-09-11
|
|
33217
|
CPT
|
Insert 2 Electrode Pm-defib
|
21
|
15
|
$38,328.90
|
$38,328.90
|
$348.27
|
$32,579.57
|
$29,704.90
|
2025-09-11
|
|
B0601
|
LOCAL
|
Neurological M >=64.50
|
8
|
7
|
—
|
—
|
$29,692.85
|
$44,539.28
|
$29,692.85
|
2025-09-11
|
|
B1201
|
LOCAL
|
Osteoarthritis M >=61.50
|
8
|
7
|
—
|
—
|
$29,670.50
|
$44,505.75
|
$29,670.50
|
2025-09-11
|
|
D2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50
|
8
|
7
|
—
|
—
|
$29,388.92
|
$44,083.38
|
$29,388.92
|
2025-09-11
|
|
C1502
|
LOCAL
|
Pulmonary M >=56.50 And M <68.50
|
8
|
7
|
—
|
—
|
$29,310.71
|
$43,966.07
|
$29,310.71
|
2025-09-11
|
|
A1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50
|
8
|
7
|
—
|
—
|
$29,306.24
|
$43,959.36
|
$29,306.24
|
2025-09-11
|
|
B1601
|
LOCAL
|
Pain Syndrome M >=65.50
|
8
|
7
|
—
|
—
|
$29,257.07
|
$43,885.61
|
$29,257.07
|
2025-09-11
|
|
C1102
|
LOCAL
|
Amputation Non-lower Extremity M >=52.50 And M <58.50
|
8
|
7
|
—
|
—
|
$28,890.58
|
$43,335.87
|
$28,890.58
|
2025-09-11
|
|
D1102
|
LOCAL
|
Amputation Non-lower Extremity M >=52.50 And M <58.50
|
8
|
7
|
—
|
—
|
$28,890.58
|
$43,335.87
|
$28,890.58
|
2025-09-11
|
|
A0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50
|
8
|
7
|
—
|
—
|
$28,866.00
|
$43,299.00
|
$28,866.00
|
2025-09-11
|
|
C1702
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50
|
8
|
7
|
—
|
—
|
$28,857.06
|
$43,285.59
|
$28,857.06
|
2025-09-11
|
|
A0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50
|
8
|
7
|
—
|
—
|
$28,823.54
|
$43,235.31
|
$28,823.54
|
2025-09-11
|
|
A1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50
|
8
|
7
|
—
|
—
|
$28,812.36
|
$43,218.54
|
$28,812.36
|
2025-09-11
|
|
A1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50
|
8
|
7
|
—
|
—
|
$28,680.51
|
$43,020.77
|
$28,680.51
|
2025-09-11
|
|
D1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50
|
8
|
7
|
—
|
—
|
$28,664.87
|
$42,997.31
|
$28,664.87
|
2025-09-11
|
|
C1902
|
LOCAL
|
Guillain-barré M >=51.50 And M <66.50
|
8
|
7
|
—
|
—
|
$28,597.83
|
$42,896.75
|
$28,597.83
|
2025-09-11
|
|
B1501
|
LOCAL
|
Pulmonary M >=68.50
|
8
|
7
|
—
|
—
|
$28,468.21
|
$42,702.32
|
$28,468.21
|
2025-09-11
|
|
D1603
|
LOCAL
|
Pain Syndrome M >=43.50 And M <58.50
|
8
|
7
|
—
|
—
|
$28,425.75
|
$42,638.63
|
$28,425.75
|
2025-09-11
|
|
B0501
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=60.50
|
8
|
7
|
—
|
—
|
$28,378.82
|
$42,568.23
|
$28,378.82
|
2025-09-11
|
|
D0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50
|
8
|
7
|
—
|
—
|
$28,358.71
|
$42,538.07
|
$28,358.71
|
2025-09-11
|
|
C1002
|
LOCAL
|
Amputation Lower Extremity M >=55.50 And M <64.50
|
8
|
7
|
—
|
—
|
$28,352.01
|
$42,528.02
|
$28,352.01
|
2025-09-11
|
|
A1102
|
LOCAL
|
Amputation Non-lower Extremity M >=52.50 And M <58.50
|
8
|
7
|
—
|
—
|
$28,307.31
|
$42,460.97
|
$28,307.31
|
2025-09-11
|
|
B1101
|
LOCAL
|
Amputation Non-lower Extremity M >=58.50
|
8
|
7
|
—
|
—
|
$28,269.32
|
$42,403.98
|
$28,269.32
|
2025-09-11
|
|
C0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50
|
8
|
7
|
—
|
—
|
$28,197.81
|
$42,296.72
|
$28,197.81
|
2025-09-11
|
|
D0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50
|
8
|
7
|
—
|
—
|
$28,099.48
|
$42,149.22
|
$28,099.48
|
2025-09-11
|
|
B0701
|
LOCAL
|
Fracture Of Lower Extremity M >=61.50
|
8
|
7
|
—
|
—
|
$28,027.97
|
$42,041.96
|
$28,027.97
|
2025-09-11
|
|
A0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50
|
8
|
7
|
—
|
—
|
$27,972.10
|
$41,958.15
|
$27,972.10
|
2025-09-11
|
|
A1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50
|
8
|
7
|
—
|
—
|
$27,824.61
|
$41,736.92
|
$27,824.61
|
2025-09-11
|
|
D0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50
|
8
|
7
|
—
|
—
|
$27,764.27
|
$41,646.41
|
$27,764.27
|
2025-09-11
|
|
B0102
|
LOCAL
|
Stroke M >=63.50 And M <72.50
|
8
|
7
|
—
|
—
|
$27,762.04
|
$41,643.06
|
$27,762.04
|
2025-09-11
|
|
C0302
|
LOCAL
|
Non-traumatic Brain Injury M >=52.50 And M <65.50
|
8
|
7
|
—
|
—
|
$27,710.64
|
$41,565.96
|
$27,710.64
|
2025-09-11
|
|
C0502
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50
|
8
|
7
|
—
|
—
|
$27,695.00
|
$41,542.50
|
$27,695.00
|
2025-09-11
|
|
A0503
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50
|
8
|
7
|
—
|
—
|
$27,639.13
|
$41,458.70
|
$27,639.13
|
2025-09-11
|
|
D1502
|
LOCAL
|
Pulmonary M >=56.50 And M <68.50
|
8
|
7
|
—
|
—
|
$27,565.38
|
$41,348.07
|
$27,565.38
|
2025-09-11
|
|
C1302
|
LOCAL
|
Rheumatoid Other Arthritis M >=51.50 And M <62.50
|
8
|
7
|
—
|
—
|
$27,543.04
|
$41,314.56
|
$27,543.04
|
2025-09-11
|
|
C0803
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=51.50 And M <57.50
|
8
|
7
|
—
|
—
|
$27,509.52
|
$41,264.28
|
$27,509.52
|
2025-09-11
|
|
C1202
|
LOCAL
|
Osteoarthritis M >=49.50 And M <61.50
|
8
|
7
|
—
|
—
|
$27,308.39
|
$40,962.59
|
$27,308.39
|
2025-09-11
|
|
A0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50
|
8
|
7
|
—
|
—
|
$27,281.57
|
$40,922.36
|
$27,281.57
|
2025-09-11
|
|
A0402
|
LOCAL
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50
|
8
|
7
|
—
|
—
|
$27,265.93
|
$40,898.90
|
$27,265.93
|
2025-09-11
|
|
A1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50
|
8
|
7
|
—
|
—
|
$27,187.71
|
$40,781.57
|
$27,187.71
|
2025-09-11
|
|
B0801
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=63.50
|
8
|
7
|
—
|
—
|
$27,167.60
|
$40,751.40
|
$27,167.60
|
2025-09-11
|
|
B1001
|
LOCAL
|
Amputation Lower Extremity M >=64.50
|
8
|
7
|
—
|
—
|
$27,062.57
|
$40,593.86
|
$27,062.57
|
2025-09-11
|
|
A0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50
|
8
|
7
|
—
|
—
|
$27,024.58
|
$40,536.87
|
$27,024.58
|
2025-09-11
|
|
B0401
|
LOCAL
|
Traumatic Spinal Cord Injury M >=56.50
|
8
|
7
|
—
|
—
|
$26,950.83
|
$40,426.25
|
$26,950.83
|
2025-09-11
|
|
B0901
|
LOCAL
|
Other Orthopedic M >=63.50
|
8
|
7
|
—
|
—
|
$26,854.74
|
$40,282.11
|
$26,854.74
|
2025-09-11
|
|
C0902
|
LOCAL
|
Other Orthopedic M >=51.50 And M <63.50
|
8
|
7
|
—
|
—
|
$26,789.93
|
$40,184.90
|
$26,789.93
|
2025-09-11
|
|
B0301
|
LOCAL
|
Non-traumatic Brain Injury M >=65.50
|
8
|
7
|
—
|
—
|
$26,787.70
|
$40,181.55
|
$26,787.70
|
2025-09-11
|
|
C0702
|
LOCAL
|
Fracture Of Lower Extremity M >=52.50 And M <61.50
|
8
|
7
|
—
|
—
|
$26,780.99
|
$40,171.49
|
$26,780.99
|
2025-09-11
|
|
A2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50
|
8
|
7
|
—
|
—
|
$26,749.71
|
$40,124.57
|
$26,749.71
|
2025-09-11
|
|
D1702
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50
|
8
|
7
|
—
|
—
|
$26,725.13
|
$40,087.70
|
$26,725.13
|
2025-09-11
|
|
D1902
|
LOCAL
|
Guillain-barré M >=51.50 And M <66.50
|
8
|
7
|
—
|
—
|
$26,684.90
|
$40,027.35
|
$26,684.90
|
2025-09-11
|
|
B2001
|
LOCAL
|
Miscellaneous M >=66.50
|
8
|
7
|
—
|
—
|
$26,378.74
|
$39,568.11
|
$26,378.74
|
2025-09-11
|
|
A1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50
|
8
|
7
|
—
|
—
|
$26,376.51
|
$39,564.77
|
$26,376.51
|
2025-09-11
|
|
D0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50
|
8
|
7
|
—
|
—
|
$26,322.87
|
$39,484.31
|
$26,322.87
|
2025-09-11
|
|
A1603
|
LOCAL
|
Pain Syndrome M >=43.50 And M <58.50
|
8
|
7
|
—
|
—
|
$26,313.94
|
$39,470.91
|
$26,313.94
|
2025-09-11
|
|
D1302
|
LOCAL
|
Rheumatoid Other Arthritis M >=51.50 And M <62.50
|
8
|
7
|
—
|
—
|
$26,291.59
|
$39,437.39
|
$26,291.59
|
2025-09-11
|
|
C2002
|
LOCAL
|
Miscellaneous M >=55.50 And M <66.50
|
8
|
7
|
—
|
—
|
$26,271.48
|
$39,407.22
|
$26,271.48
|
2025-09-11
|
|
A1902
|
LOCAL
|
Guillain-barré M >=51.50 And M <66.50
|
8
|
7
|
—
|
—
|
$26,222.31
|
$39,333.47
|
$26,222.31
|
2025-09-11
|
|
A0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50
|
8
|
7
|
—
|
—
|
$26,206.67
|
$39,310.01
|
$26,206.67
|
2025-09-11
|
|
D0502
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50
|
8
|
7
|
—
|
—
|
$26,166.44
|
$39,249.66
|
$26,166.44
|
2025-09-11
|
|
A0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50
|
8
|
7
|
—
|
—
|
$26,139.63
|
$39,209.45
|
$26,139.63
|
2025-09-11
|
|
D1002
|
LOCAL
|
Amputation Lower Extremity M >=55.50 And M <64.50
|
8
|
7
|
—
|
—
|
$25,900.51
|
$38,850.77
|
$25,900.51
|
2025-09-11
|
|
A1502
|
LOCAL
|
Pulmonary M >=56.50 And M <68.50
|
8
|
7
|
—
|
—
|
$25,786.54
|
$38,679.81
|
$25,786.54
|
2025-09-11
|
|
D1202
|
LOCAL
|
Osteoarthritis M >=49.50 And M <61.50
|
8
|
7
|
—
|
—
|
$25,605.53
|
$38,408.30
|
$25,605.53
|
2025-09-11
|
|
D2101
|
LOCAL
|
Burns M >=52.50
|
8
|
7
|
—
|
—
|
$25,554.13
|
$38,331.20
|
$25,554.13
|
2025-09-11
|
|
C2101
|
LOCAL
|
Burns M >=52.50
|
8
|
7
|
—
|
—
|
$25,554.13
|
$38,331.20
|
$25,554.13
|
2025-09-11
|
|
D0302
|
LOCAL
|
Non-traumatic Brain Injury M >=52.50 And M <65.50
|
8
|
7
|
—
|
—
|
$25,453.56
|
$38,180.34
|
$25,453.56
|
2025-09-11
|
|
D0702
|
LOCAL
|
Fracture Of Lower Extremity M >=52.50 And M <61.50
|
8
|
7
|
—
|
—
|
$25,368.64
|
$38,052.96
|
$25,368.64
|
2025-09-11
|
|
C1802
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50
|
8
|
7
|
—
|
—
|
$25,359.71
|
$38,039.57
|
$25,359.71
|
2025-09-11
|
|
B1401
|
LOCAL
|
Cardiac M >=68.50
|
8
|
7
|
—
|
—
|
$25,218.92
|
$37,828.38
|
$25,218.92
|
2025-09-11
|
|
C1402
|
LOCAL
|
Cardiac M >=55.50 And M <68.50
|
8
|
7
|
—
|
—
|
$25,196.57
|
$37,794.86
|
$25,196.57
|
2025-09-11
|
|
D0803
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=51.50 And M <57.50
|
8
|
7
|
—
|
—
|
$25,080.36
|
$37,620.54
|
$25,080.36
|
2025-09-11
|
|
D0902
|
LOCAL
|
Other Orthopedic M >=51.50 And M <63.50
|
8
|
7
|
—
|
—
|
$24,968.63
|
$37,452.95
|
$24,968.63
|
2025-09-11
|
|
C1602
|
LOCAL
|
Pain Syndrome M >=58.50 And M <65.50
|
8
|
7
|
—
|
—
|
$24,903.82
|
$37,355.73
|
$24,903.82
|
2025-09-11
|
|
C0802
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=57.50 And M <63.50
|
8
|
7
|
—
|
—
|
$24,716.10
|
$37,074.15
|
$24,716.10
|
2025-09-11
|
|
C0202
|
LOCAL
|
Traumatic Brain Injury M >=61.50 And M <73.50
|
8
|
7
|
—
|
—
|
$24,546.26
|
$36,819.39
|
$24,546.26
|
2025-09-11
|
|
D2002
|
LOCAL
|
Miscellaneous M >=55.50 And M <66.50
|
8
|
7
|
—
|
—
|
$24,541.79
|
$36,812.69
|
$24,541.79
|
2025-09-11
|