|
A0104
|
HCPCS
|
Stroke M >=41.50 And M <50.50- Tier None
|
26
|
11
|
—
|
—
|
$28,269.21
|
$28,269.21
|
$28,269.21
|
2026-03-17
|
|
A0205
|
HCPCS
|
Traumatic Brain Injury M <35.50- Tier None
|
26
|
11
|
—
|
—
|
$34,036.98
|
$34,036.98
|
$34,036.98
|
2026-03-17
|
|
A0304
|
HCPCS
|
Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier None
|
26
|
11
|
—
|
—
|
$29,480.44
|
$29,480.44
|
$29,480.44
|
2026-03-17
|
|
A0604
|
HCPCS
|
Neurological M <43.50- Tier None
|
26
|
11
|
—
|
—
|
$28,752.76
|
$28,752.76
|
$28,752.76
|
2026-03-17
|
|
A0704
|
HCPCS
|
Fracture Of Lower Extremity M <41.50- Tier None
|
26
|
11
|
—
|
—
|
$28,281.82
|
$28,859.00
|
$28,570.41
|
2026-03-17
|
|
A0805
|
HCPCS
|
Replacement Of Lower-extremity Joint M <42.50- Tier None
|
26
|
11
|
—
|
—
|
$29,054.93
|
$29,054.93
|
$29,054.93
|
2026-03-17
|
|
A0904
|
HCPCS
|
Other Orthopedic M <44.5- Tier None
|
26
|
11
|
—
|
—
|
$26,257.07
|
$26,792.93
|
$26,525.00
|
2026-03-17
|
|
A1705
|
HCPCS
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier None
|
26
|
11
|
—
|
—
|
$31,364.65
|
$31,364.65
|
$31,364.65
|
2026-03-17
|
|
A2004
|
HCPCS
|
Miscellaneous M <46.50 And A >=77.50- Tier None
|
26
|
11
|
—
|
—
|
$26,214.14
|
$26,214.14
|
$26,214.14
|
2026-03-17
|
|
A2005
|
HCPCS
|
Miscellaneous M <46.50 And A <77.50- Tier None
|
26
|
11
|
—
|
—
|
$27,631.81
|
$29,748.36
|
$28,690.08
|
2026-03-17
|
|
B0105
|
HCPCS
|
Stroke M <41.50 And A >=84.50- Tier Tier 1
|
26
|
11
|
—
|
—
|
$49,536.60
|
$49,536.60
|
$49,536.60
|
2026-03-17
|
|
B0203
|
HCPCS
|
Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 1
|
26
|
11
|
—
|
—
|
$30,419.54
|
$30,419.54
|
$30,419.54
|
2026-03-17
|
|
B0305
|
HCPCS
|
Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 1
|
26
|
11
|
—
|
—
|
$43,674.96
|
$63,978.14
|
$53,826.55
|
2026-03-17
|
|
B0604
|
HCPCS
|
Neurological M <43.50- Tier Tier 1
|
26
|
11
|
—
|
—
|
$44,702.36
|
$60,937.99
|
$52,820.18
|
2026-03-17
|
|
B0703
|
HCPCS
|
Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 1
|
26
|
11
|
—
|
—
|
$34,894.18
|
$34,894.18
|
$34,894.18
|
2026-03-17
|
|
B0903
|
HCPCS
|
Other Orthopedic M >=44.50 And M <51.50- Tier Tier 1
|
26
|
11
|
—
|
—
|
$32,736.53
|
$32,736.53
|
$32,736.53
|
2026-03-17
|
|
B0904
|
HCPCS
|
Other Orthopedic M <44.5- Tier Tier 1
|
26
|
11
|
—
|
—
|
$44,288.63
|
$44,288.63
|
$44,288.63
|
2026-03-17
|
|
B1004
|
HCPCS
|
Amputation Lower Extremity M <47.50- Tier Tier 1
|
26
|
11
|
—
|
—
|
$42,147.39
|
$42,147.39
|
$42,147.39
|
2026-03-17
|
|
B1403
|
HCPCS
|
Cardiac M >=45.50 And M <55.50- Tier Tier 1
|
26
|
11
|
—
|
—
|
$32,075.32
|
$32,075.32
|
$32,075.32
|
2026-03-17
|
|
B1504
|
HCPCS
|
Pulmonary M <45.50- Tier Tier 1
|
26
|
11
|
—
|
—
|
$73,468.39
|
$73,468.39
|
$73,468.39
|
2026-03-17
|
|
B1704
|
HCPCS
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50…
|
26
|
11
|
—
|
—
|
$40,923.87
|
$40,923.87
|
$40,923.87
|
2026-03-17
|
|
B2002
|
HCPCS
|
Miscellaneous M >=55.50 And M <66.50- Tier Tier 1
|
26
|
11
|
—
|
—
|
$26,957.77
|
$26,957.77
|
$26,957.77
|
2026-03-17
|
|
B2003
|
HCPCS
|
Miscellaneous M >=46.50 And M <55.50- Tier Tier 1
|
26
|
11
|
—
|
—
|
$32,282.29
|
$32,282.29
|
$32,282.29
|
2026-03-17
|
|
B2004
|
HCPCS
|
Miscellaneous M <46.50 And A >=77.50- Tier Tier 1
|
26
|
11
|
—
|
—
|
$38,597.72
|
$38,597.72
|
$38,597.72
|
2026-03-17
|
|
B2005
|
HCPCS
|
Miscellaneous M <46.50 And A <77.50- Tier Tier 1
|
26
|
11
|
—
|
—
|
$30,605.13
|
$40,683.93
|
$35,644.53
|
2026-03-17
|
|
C0104
|
HCPCS
|
Stroke M >=41.50 And M <50.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$32,459.96
|
$32,459.96
|
$32,459.96
|
2026-03-17
|
|
C0105
|
HCPCS
|
Stroke M <41.50 And A >=84.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$40,590.52
|
$40,590.52
|
$40,590.52
|
2026-03-17
|
|
C0205
|
HCPCS
|
Traumatic Brain Injury M <35.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$39,802.92
|
$39,802.92
|
$39,802.92
|
2026-03-17
|
|
C0303
|
HCPCS
|
Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$23,417.37
|
$27,325.93
|
$25,371.65
|
2026-03-17
|
|
C0304
|
HCPCS
|
Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$31,683.35
|
$31,683.35
|
$31,683.35
|
2026-03-17
|
|
C0305
|
HCPCS
|
Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$34,941.80
|
$34,941.80
|
$34,941.80
|
2026-03-17
|
|
C0402
|
HCPCS
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$25,334.96
|
$25,334.96
|
$25,334.96
|
2026-03-17
|
|
C0407
|
HCPCS
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$15,946.51
|
$68,863.39
|
$42,404.95
|
2026-03-17
|
|
C0603
|
HCPCS
|
Neurological M >=43.50 And M <52.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$28,899.30
|
$28,899.30
|
$28,899.30
|
2026-03-17
|
|
C0604
|
HCPCS
|
Neurological M <43.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$19,447.46
|
$34,150.54
|
$26,799.00
|
2026-03-17
|
|
C0703
|
HCPCS
|
Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$26,992.58
|
$26,992.58
|
$26,992.58
|
2026-03-17
|
|
C0704
|
HCPCS
|
Fracture Of Lower Extremity M <41.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$32,974.64
|
$32,974.64
|
$32,974.64
|
2026-03-17
|
|
C0904
|
HCPCS
|
Other Orthopedic M <44.5- Tier Tier 2
|
26
|
11
|
—
|
—
|
$31,417.77
|
$31,417.77
|
$31,417.77
|
2026-03-17
|
|
C1004
|
HCPCS
|
Amputation Lower Extremity M <47.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$34,857.55
|
$34,857.55
|
$34,857.55
|
2026-03-17
|
|
C1304
|
HCPCS
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$32,432.48
|
$32,432.48
|
$32,432.48
|
2026-03-17
|
|
C1403
|
HCPCS
|
Cardiac M >=45.50 And M <55.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$25,269.02
|
$25,269.02
|
$25,269.02
|
2026-03-17
|
|
C1404
|
HCPCS
|
Cardiac M <45.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$30,961.69
|
$34,068.48
|
$32,515.08
|
2026-03-17
|
|
C1504
|
HCPCS
|
Pulmonary M <45.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$33,811.69
|
$33,811.69
|
$33,811.69
|
2026-03-17
|
|
C1704
|
HCPCS
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50…
|
26
|
11
|
—
|
—
|
$29,554.28
|
$29,554.28
|
$29,554.28
|
2026-03-17
|
|
C1705
|
HCPCS
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$37,330.24
|
$37,330.24
|
$37,330.24
|
2026-03-17
|
|
C1805
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T…
|
26
|
11
|
—
|
—
|
$39,954.72
|
$39,954.72
|
$39,954.72
|
2026-03-17
|
|
C2003
|
HCPCS
|
Miscellaneous M >=46.50 And M <55.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$25,785.54
|
$25,785.54
|
$25,785.54
|
2026-03-17
|
|
C2004
|
HCPCS
|
Miscellaneous M <46.50 And A >=77.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$33,382.93
|
$33,382.93
|
$33,382.93
|
2026-03-17
|
|
C2005
|
HCPCS
|
Miscellaneous M <46.50 And A <77.50- Tier Tier 2
|
26
|
11
|
—
|
—
|
$32,496.59
|
$32,496.59
|
$32,496.59
|
2026-03-17
|
|
CMG-0103B
|
LOCAL
|
Inpatient Rehab Per Discharge: Stroke
|
19
|
13
|
$30,273.89
|
—
|
$30,273.89
|
$34,814.97
|
$30,273.89
|
2026-07-15
|
|
CMG-0103C
|
LOCAL
|
Inpatient Rehab Per Discharge: Stroke
|
19
|
13
|
$26,256.15
|
—
|
$26,256.15
|
$30,194.57
|
$26,256.15
|
2026-07-15
|
|
CMG-0104A
|
LOCAL
|
Inpatient Rehab Per Discharge: Stroke
|
19
|
13
|
$29,181.06
|
—
|
$29,181.06
|
$33,558.22
|
$29,181.06
|
2026-07-15
|
|
CMG-0104B
|
LOCAL
|
Inpatient Rehab Per Discharge: Stroke
|
19
|
13
|
$38,636.45
|
—
|
$38,636.45
|
$44,431.92
|
$38,636.45
|
2026-07-15
|
|
CMG-0104C
|
LOCAL
|
Inpatient Rehab Per Discharge: Stroke
|
19
|
13
|
$33,506.99
|
—
|
$33,506.99
|
$38,533.04
|
$33,506.99
|
2026-07-15
|
|
CMG-0104D
|
LOCAL
|
Inpatient Rehab Per Discharge: Stroke
|
19
|
13
|
$30,619.89
|
—
|
$30,619.89
|
$35,212.87
|
$30,619.89
|
2026-07-15
|
|
CMG-0105A
|
LOCAL
|
Inpatient Rehab Per Discharge: Stroke
|
19
|
13
|
$36,490.51
|
—
|
$36,490.51
|
$41,964.09
|
$36,490.51
|
2026-07-15
|
|
CMG-0105B
|
LOCAL
|
Inpatient Rehab Per Discharge: Stroke
|
19
|
13
|
$48,313.06
|
—
|
$48,313.06
|
$55,560.02
|
$48,313.06
|
2026-07-15
|
|
CMG-0105C
|
LOCAL
|
Inpatient Rehab Per Discharge: Stroke
|
19
|
13
|
$41,899.80
|
—
|
$41,899.80
|
$48,184.77
|
$41,899.80
|
2026-07-15
|
|
CMG-0105D
|
LOCAL
|
Inpatient Rehab Per Discharge: Stroke
|
19
|
13
|
$38,288.57
|
—
|
$38,288.57
|
$44,031.86
|
$38,288.57
|
2026-07-15
|
|
CMG-0106A
|
LOCAL
|
Inpatient Rehab Per Discharge: Stroke
|
19
|
13
|
$41,502.76
|
—
|
$41,502.76
|
$47,728.17
|
$41,502.76
|
2026-07-15
|
|
CMG-0106B
|
LOCAL
|
Inpatient Rehab Per Discharge: Stroke
|
19
|
13
|
$54,951.30
|
—
|
$54,951.30
|
$63,194.00
|
$54,951.30
|
2026-07-15
|
|
CMG-0106C
|
LOCAL
|
Inpatient Rehab Per Discharge: Stroke
|
19
|
13
|
$47,656.98
|
—
|
$47,656.98
|
$54,805.53
|
$47,656.98
|
2026-07-15
|
|
CMG-0106D
|
LOCAL
|
Inpatient Rehab Per Discharge: Stroke
|
19
|
13
|
$43,550.38
|
—
|
$43,550.38
|
$50,082.94
|
$43,550.38
|
2026-07-15
|
|
CMG-0202B
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Brain Injury
|
19
|
13
|
$25,214.38
|
—
|
$25,214.38
|
$28,996.54
|
$25,214.38
|
2026-07-15
|
|
CMG-0203B
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Brain Injury
|
19
|
13
|
$31,400.75
|
—
|
$31,400.75
|
$36,110.86
|
$31,400.75
|
2026-07-15
|
|
CMG-0203C
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Brain Injury
|
19
|
13
|
$25,862.89
|
—
|
$25,862.89
|
$29,742.32
|
$25,862.89
|
2026-07-15
|
|
CMG-0204A
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Brain Injury
|
19
|
13
|
$27,430.28
|
—
|
$27,430.28
|
$31,544.82
|
$27,430.28
|
2026-07-15
|
|
CMG-0204B
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Brain Injury
|
19
|
13
|
$38,944.64
|
—
|
$38,944.64
|
$44,786.34
|
$38,944.64
|
2026-07-15
|
|
CMG-0204C
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Brain Injury
|
19
|
13
|
$32,077.62
|
—
|
$32,077.62
|
$36,889.26
|
$32,077.62
|
2026-07-15
|
|
CMG-0204D
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Brain Injury
|
19
|
13
|
$29,133.80
|
—
|
$29,133.80
|
$33,503.87
|
$29,133.80
|
2026-07-15
|
|
CMG-0205A
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Brain Injury
|
19
|
13
|
$35,134.88
|
—
|
$35,134.88
|
$40,405.11
|
$35,134.88
|
2026-07-15
|
|
CMG-0205B
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Brain Injury
|
19
|
13
|
$49,886.12
|
—
|
$49,886.12
|
$57,369.04
|
$49,886.12
|
2026-07-15
|
|
CMG-0205C
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Brain Injury
|
19
|
13
|
$41,086.80
|
—
|
$41,086.80
|
$47,249.82
|
$41,086.80
|
2026-07-15
|
|
CMG-0205D
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Brain Injury
|
19
|
13
|
$37,318.64
|
—
|
$37,318.64
|
$42,916.44
|
$37,318.64
|
2026-07-15
|
|
CMG-0302B
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Brain Injury
|
19
|
13
|
$29,302.07
|
—
|
$29,302.07
|
$33,697.38
|
$29,302.07
|
2026-07-15
|
|
CMG-0303A
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Brain Injury
|
19
|
13
|
$24,422.17
|
—
|
$24,422.17
|
$28,085.50
|
$24,422.17
|
2026-07-15
|
|
CMG-0303B
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Brain Injury
|
19
|
13
|
$35,257.77
|
—
|
$35,257.77
|
$40,546.44
|
$35,257.77
|
2026-07-15
|
|
CMG-0303C
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Brain Injury
|
19
|
13
|
$28,207.35
|
—
|
$28,207.35
|
$32,438.45
|
$28,207.35
|
2026-07-15
|
|
CMG-0303D
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Brain Injury
|
19
|
13
|
$25,912.04
|
—
|
$25,912.04
|
$29,798.85
|
$25,912.04
|
2026-07-15
|
|
CMG-0304A
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Brain Injury
|
19
|
13
|
$28,317.01
|
—
|
$28,317.01
|
$32,564.56
|
$28,317.01
|
2026-07-15
|
|
CMG-0304B
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Brain Injury
|
19
|
13
|
$40,878.82
|
—
|
$40,878.82
|
$47,010.64
|
$40,878.82
|
2026-07-15
|
|
CMG-0304C
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Brain Injury
|
19
|
13
|
$32,705.33
|
—
|
$32,705.33
|
$37,611.13
|
$32,705.33
|
2026-07-15
|
|
CMG-0304D
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Brain Injury
|
19
|
13
|
$30,043.22
|
—
|
$30,043.22
|
$34,549.70
|
$30,043.22
|
2026-07-15
|
|
CMG-0305A
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Brain Injury
|
19
|
13
|
$31,228.69
|
—
|
$31,228.69
|
$35,912.99
|
$31,228.69
|
2026-07-15
|
|
CMG-0305B
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Brain Injury
|
19
|
13
|
$45,083.74
|
—
|
$45,083.74
|
$51,846.30
|
$45,083.74
|
2026-07-15
|
|
CMG-0305C
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Brain Injury
|
19
|
13
|
$36,068.88
|
—
|
$36,068.88
|
$41,479.21
|
$36,068.88
|
2026-07-15
|
|
CMG-0305D
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Brain Injury
|
19
|
13
|
$33,132.63
|
—
|
$33,132.63
|
$38,102.52
|
$33,132.63
|
2026-07-15
|
|
CMG-0402B
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$29,407.95
|
—
|
$29,407.95
|
$33,819.14
|
$29,407.95
|
2026-07-15
|
|
CMG-0402C
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$26,152.16
|
—
|
$26,152.16
|
$30,074.98
|
$26,152.16
|
2026-07-15
|
|
CMG-0402D
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$25,386.43
|
—
|
$25,386.43
|
$29,194.39
|
$25,386.43
|
2026-07-15
|
|
CMG-0403A
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$28,948.51
|
—
|
$28,948.51
|
$33,290.79
|
$28,948.51
|
2026-07-15
|
|
CMG-0403B
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$36,904.57
|
—
|
$36,904.57
|
$42,440.26
|
$36,904.57
|
2026-07-15
|
|
CMG-0403C
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$32,818.77
|
—
|
$32,818.77
|
$37,741.59
|
$32,818.77
|
2026-07-15
|
|
CMG-0403D
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$31,858.30
|
—
|
$31,858.30
|
$36,637.04
|
$31,858.30
|
2026-07-15
|
|
CMG-0404A
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$45,199.07
|
—
|
$45,199.07
|
$51,978.93
|
$45,199.07
|
2026-07-15
|
|
CMG-0404B
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$57,620.97
|
—
|
$57,620.97
|
$66,264.12
|
$57,620.97
|
2026-07-15
|
|
CMG-0404C
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$51,241.75
|
—
|
$51,241.75
|
$58,928.01
|
$51,241.75
|
2026-07-15
|
|
CMG-0404D
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$49,742.43
|
—
|
$49,742.43
|
$57,203.79
|
$49,742.43
|
2026-07-15
|
|
CMG-0405A
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$35,944.10
|
—
|
$35,944.10
|
$41,335.71
|
$35,944.10
|
2026-07-15
|
|
CMG-0405B
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$45,823.01
|
—
|
$45,823.01
|
$52,696.46
|
$45,823.01
|
2026-07-15
|
|
CMG-0405C
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$40,750.26
|
—
|
$40,750.26
|
$46,862.80
|
$40,750.26
|
2026-07-15
|
|
CMG-0405D
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$39,557.23
|
—
|
$39,557.23
|
$45,490.81
|
$39,557.23
|
2026-07-15
|
|
CMG-0406A
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$45,864.60
|
—
|
$45,864.60
|
$52,744.29
|
$45,864.60
|
2026-07-15
|
|
CMG-0406B
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$58,469.90
|
—
|
$58,469.90
|
$67,240.38
|
$58,469.90
|
2026-07-15
|
|
CMG-0406C
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$51,996.14
|
—
|
$51,996.14
|
$59,795.56
|
$51,996.14
|
2026-07-15
|
|
CMG-0406D
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$50,474.13
|
—
|
$50,474.13
|
$58,045.25
|
$50,474.13
|
2026-07-15
|
|
CMG-0407A
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$62,701.28
|
—
|
$62,701.28
|
$72,106.47
|
$62,701.28
|
2026-07-15
|
|
CMG-0407B
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$79,935.01
|
—
|
$79,935.01
|
$91,925.26
|
$79,935.01
|
2026-07-15
|
|
CMG-0407C
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$71,084.65
|
—
|
$71,084.65
|
$81,747.35
|
$71,084.65
|
2026-07-15
|
|
CMG-0407D
|
LOCAL
|
Inpatient Rehab Per Discharge: Traumatic Spinal Cord Injury
|
19
|
13
|
$69,004.88
|
—
|
$69,004.88
|
$79,355.61
|
$69,004.88
|
2026-07-15
|
|
CMG-0502B
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Spinal Cord Injury
|
19
|
13
|
$30,120.74
|
—
|
$30,120.74
|
$34,638.85
|
$30,120.74
|
2026-07-15
|
|
CMG-0503B
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Spinal Cord Injury
|
19
|
13
|
$34,526.07
|
—
|
$34,526.07
|
$39,704.98
|
$34,526.07
|
2026-07-15
|
|
CMG-0503C
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Spinal Cord Injury
|
19
|
13
|
$26,859.28
|
—
|
$26,859.28
|
$30,888.17
|
$26,859.28
|
2026-07-15
|
|
CMG-0503D
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Spinal Cord Injury
|
19
|
13
|
$25,375.08
|
—
|
$25,375.08
|
$29,181.34
|
$25,375.08
|
2026-07-15
|
|
CMG-0504A
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Spinal Cord Injury
|
19
|
13
|
$27,797.07
|
—
|
$27,797.07
|
$31,966.63
|
$27,797.07
|
2026-07-15
|
|
CMG-0504B
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Spinal Cord Injury
|
19
|
13
|
$41,041.42
|
—
|
$41,041.42
|
$47,197.63
|
$41,041.42
|
2026-07-15
|
|
CMG-0504C
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Spinal Cord Injury
|
19
|
13
|
$31,928.25
|
—
|
$31,928.25
|
$36,717.49
|
$31,928.25
|
2026-07-15
|
|
CMG-0504D
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Spinal Cord Injury
|
19
|
13
|
$30,164.23
|
—
|
$30,164.23
|
$34,688.86
|
$30,164.23
|
2026-07-15
|
|
CMG-0505A
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Spinal Cord Injury
|
19
|
13
|
$38,625.11
|
—
|
$38,625.11
|
$44,418.88
|
$38,625.11
|
2026-07-15
|
|
CMG-0505B
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Spinal Cord Injury
|
19
|
13
|
$57,029.18
|
—
|
$57,029.18
|
$65,583.56
|
$57,029.18
|
2026-07-15
|
|
CMG-0505C
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Spinal Cord Injury
|
19
|
13
|
$44,367.17
|
—
|
$44,367.17
|
$51,022.25
|
$44,367.17
|
2026-07-15
|
|
CMG-0505D
|
LOCAL
|
Inpatient Rehab Per Discharge: Non-traumatic Spinal Cord Injury
|
19
|
13
|
$41,914.93
|
—
|
$41,914.93
|
$48,202.17
|
$41,914.93
|
2026-07-15
|
|
CMG-0601B
|
LOCAL
|
Inpatient Rehab Per Discharge: Neurological
|
19
|
13
|
$25,121.73
|
—
|
$25,121.73
|
$28,889.99
|
$25,121.73
|
2026-07-15
|
|
CMG-0602B
|
LOCAL
|
Inpatient Rehab Per Discharge: Neurological
|
19
|
13
|
$31,863.97
|
—
|
$31,863.97
|
$36,643.57
|
$31,863.97
|
2026-07-15
|
|
CMG-0603B
|
LOCAL
|
Inpatient Rehab Per Discharge: Neurological
|
19
|
13
|
$37,545.52
|
—
|
$37,545.52
|
$43,177.35
|
$37,545.52
|
2026-07-15
|
|
CMG-0603C
|
LOCAL
|
Inpatient Rehab Per Discharge: Neurological
|
19
|
13
|
$28,109.04
|
—
|
$28,109.04
|
$32,325.40
|
$28,109.04
|
2026-07-15
|
|
CMG-0603D
|
LOCAL
|
Inpatient Rehab Per Discharge: Neurological
|
19
|
13
|
$26,241.03
|
—
|
$26,241.03
|
$30,177.18
|
$26,241.03
|
2026-07-15
|
|
CMG-0604A
|
LOCAL
|
Inpatient Rehab Per Discharge: Neurological
|
19
|
13
|
$29,680.21
|
—
|
$29,680.21
|
$34,132.24
|
$29,680.21
|
2026-07-15
|
|
CMG-0604B
|
LOCAL
|
Inpatient Rehab Per Discharge: Neurological
|
19
|
13
|
$47,085.99
|
—
|
$47,085.99
|
$54,148.89
|
$47,085.99
|
2026-07-15
|
|
CMG-0604C
|
LOCAL
|
Inpatient Rehab Per Discharge: Neurological
|
19
|
13
|
$35,252.10
|
—
|
$35,252.10
|
$40,539.92
|
$35,252.10
|
2026-07-15
|
|
CMG-0604D
|
LOCAL
|
Inpatient Rehab Per Discharge: Neurological
|
19
|
13
|
$32,909.52
|
—
|
$32,909.52
|
$37,845.95
|
$32,909.52
|
2026-07-15
|
|
CMG-0702B
|
LOCAL
|
Inpatient Rehab Per Discharge: Fracture Of Lower Extremity
|
19
|
13
|
$29,290.72
|
—
|
$29,290.72
|
$33,684.33
|
$29,290.72
|
2026-07-15
|
|
CMG-0703A
|
LOCAL
|
Inpatient Rehab Per Discharge: Fracture Of Lower Extremity
|
19
|
13
|
$24,386.25
|
—
|
$24,386.25
|
$28,044.19
|
$24,386.25
|
2026-07-15
|
|
CMG-0703B
|
LOCAL
|
Inpatient Rehab Per Discharge: Fracture Of Lower Extremity
|
19
|
13
|
$36,019.73
|
—
|
$36,019.73
|
$41,422.69
|
$36,019.73
|
2026-07-15
|
|
CMG-0703C
|
LOCAL
|
Inpatient Rehab Per Discharge: Fracture Of Lower Extremity
|
19
|
13
|
$27,863.25
|
—
|
$27,863.25
|
$32,042.74
|
$27,863.25
|
2026-07-15
|
|
CMG-0703D
|
LOCAL
|
Inpatient Rehab Per Discharge: Fracture Of Lower Extremity
|
19
|
13
|
$26,394.17
|
—
|
$26,394.17
|
$30,353.30
|
$26,394.17
|
2026-07-15
|
|
CMG-0704A
|
LOCAL
|
Inpatient Rehab Per Discharge: Fracture Of Lower Extremity
|
19
|
13
|
$29,789.87
|
—
|
$29,789.87
|
$34,258.35
|
$29,789.87
|
2026-07-15
|
|
CMG-0704B
|
LOCAL
|
Inpatient Rehab Per Discharge: Fracture Of Lower Extremity
|
19
|
13
|
$44,002.26
|
—
|
$44,002.26
|
$50,602.60
|
$44,002.26
|
2026-07-15
|
|
CMG-0704C
|
LOCAL
|
Inpatient Rehab Per Discharge: Fracture Of Lower Extremity
|
19
|
13
|
$34,038.27
|
—
|
$34,038.27
|
$39,144.01
|
$34,038.27
|
2026-07-15
|
|
CMG-0704D
|
LOCAL
|
Inpatient Rehab Per Discharge: Fracture Of Lower Extremity
|
19
|
13
|
$32,244.00
|
—
|
$32,244.00
|
$37,080.60
|
$32,244.00
|
2026-07-15
|
|
CMG-0802B
|
LOCAL
|
Inpatient Rehab Per Discharge: Replacement Of Lower Extremity Joint
|
19
|
13
|
$26,059.52
|
—
|
$26,059.52
|
$29,968.45
|
$26,059.52
|
2026-07-15
|
|
CMG-0803B
|
LOCAL
|
Inpatient Rehab Per Discharge: Replacement Of Lower Extremity Joint
|
19
|
13
|
$29,005.23
|
—
|
$29,005.23
|
$33,356.01
|
$29,005.23
|
2026-07-15
|
|
CMG-0804B
|
LOCAL
|
Inpatient Rehab Per Discharge: Replacement Of Lower Extremity Joint
|
19
|
13
|
$32,495.46
|
—
|
$32,495.46
|
$37,369.78
|
$32,495.46
|
2026-07-15
|
|
CMG-0804C
|
LOCAL
|
Inpatient Rehab Per Discharge: Replacement Of Lower Extremity Joint
|
19
|
13
|
$26,074.64
|
—
|
$26,074.64
|
$29,985.84
|
$26,074.64
|
2026-07-15
|
|
CMG-0805A
|
LOCAL
|
Inpatient Rehab Per Discharge: Replacement Of Lower Extremity Joint
|
19
|
13
|
$26,592.70
|
—
|
$26,592.70
|
$30,581.60
|
$26,592.70
|
2026-07-15
|
|
CMG-0805B
|
LOCAL
|
Inpatient Rehab Per Discharge: Replacement Of Lower Extremity Joint
|
19
|
13
|
$38,973.00
|
—
|
$38,973.00
|
$44,818.95
|
$38,973.00
|
2026-07-15
|
|
CMG-0805C
|
LOCAL
|
Inpatient Rehab Per Discharge: Replacement Of Lower Extremity Joint
|
19
|
13
|
$31,272.18
|
—
|
$31,272.18
|
$35,963.01
|
$31,272.18
|
2026-07-15
|
|
CMG-0805D
|
LOCAL
|
Inpatient Rehab Per Discharge: Replacement Of Lower Extremity Joint
|
19
|
13
|
$28,511.76
|
—
|
$28,511.76
|
$32,788.52
|
$28,511.76
|
2026-07-15
|
|
CMG-0902B
|
LOCAL
|
Inpatient Rehab Per Discharge: Other Orthopedic
|
19
|
13
|
$28,298.11
|
—
|
$28,298.11
|
$32,542.83
|
$28,298.11
|
2026-07-15
|
|
CMG-0903B
|
LOCAL
|
Inpatient Rehab Per Discharge: Other Orthopedic
|
19
|
13
|
$33,792.48
|
—
|
$33,792.48
|
$38,861.35
|
$33,792.48
|
2026-07-15
|
|
CMG-0903C
|
LOCAL
|
Inpatient Rehab Per Discharge: Other Orthopedic
|
19
|
13
|
$27,065.37
|
—
|
$27,065.37
|
$31,125.18
|
$27,065.37
|
2026-07-15
|
|
CMG-0903D
|
LOCAL
|
Inpatient Rehab Per Discharge: Other Orthopedic
|
19
|
13
|
$25,227.61
|
—
|
$25,227.61
|
$29,011.75
|
$25,227.61
|
2026-07-15
|
|
CMG-0904A
|
LOCAL
|
Inpatient Rehab Per Discharge: Other Orthopedic
|
19
|
13
|
$27,657.16
|
—
|
$27,657.16
|
$31,805.73
|
$27,657.16
|
2026-07-15
|
|
CMG-0904B
|
LOCAL
|
Inpatient Rehab Per Discharge: Other Orthopedic
|
19
|
13
|
$40,491.23
|
—
|
$40,491.23
|
$46,564.91
|
$40,491.23
|
2026-07-15
|
|
CMG-0904C
|
LOCAL
|
Inpatient Rehab Per Discharge: Other Orthopedic
|
19
|
13
|
$32,431.18
|
—
|
$32,431.18
|
$37,295.86
|
$32,431.18
|
2026-07-15
|
|
CMG-0904D
|
LOCAL
|
Inpatient Rehab Per Discharge: Other Orthopedic
|
19
|
13
|
$30,228.51
|
—
|
$30,228.51
|
$34,762.79
|
$30,228.51
|
2026-07-15
|
|
CMG-1002B
|
LOCAL
|
Inpatient Rehab Per Discharge: Amputation, Lower Extremity
|
19
|
13
|
$29,005.23
|
—
|
$29,005.23
|
$33,356.01
|
$29,005.23
|
2026-07-15
|
|
CMG-1003B
|
LOCAL
|
Inpatient Rehab Per Discharge: Amputation, Lower Extremity
|
19
|
13
|
$33,983.44
|
—
|
$33,983.44
|
$39,080.96
|
$33,983.44
|
2026-07-15
|
|
CMG-1003C
|
LOCAL
|
Inpatient Rehab Per Discharge: Amputation, Lower Extremity
|
19
|
13
|
$28,105.26
|
—
|
$28,105.26
|
$32,321.05
|
$28,105.26
|
2026-07-15
|
|
CMG-1003D
|
LOCAL
|
Inpatient Rehab Per Discharge: Amputation, Lower Extremity
|
19
|
13
|
$25,673.82
|
—
|
$25,673.82
|
$29,524.89
|
$25,673.82
|
2026-07-15
|
|
CMG-1004A
|
LOCAL
|
Inpatient Rehab Per Discharge: Amputation, Lower Extremity
|
19
|
13
|
$29,447.65
|
—
|
$29,447.65
|
$33,864.80
|
$29,447.65
|
2026-07-15
|
|
CMG-1004B
|
LOCAL
|
Inpatient Rehab Per Discharge: Amputation, Lower Extremity
|
19
|
13
|
$43,506.90
|
—
|
$43,506.90
|
$50,032.93
|
$43,506.90
|
2026-07-15
|
|
CMG-1004C
|
LOCAL
|
Inpatient Rehab Per Discharge: Amputation, Lower Extremity
|
19
|
13
|
$35,981.91
|
—
|
$35,981.91
|
$41,379.20
|
$35,981.91
|
2026-07-15
|
|
CMG-1004D
|
LOCAL
|
Inpatient Rehab Per Discharge: Amputation, Lower Extremity
|
19
|
13
|
$32,867.93
|
—
|
$32,867.93
|
$37,798.12
|
$32,867.93
|
2026-07-15
|
|
CMG-1102B
|
LOCAL
|
Inpatient Rehab Per Discharge: Amputation, Non-lower Extremity
|
19
|
13
|
$30,408.13
|
—
|
$30,408.13
|
$34,969.35
|
$30,408.13
|
2026-07-15
|
|
CMG-1102C
|
LOCAL
|
Inpatient Rehab Per Discharge: Amputation, Non-lower Extremity
|
19
|
13
|
$24,442.97
|
—
|
$24,442.97
|
$28,109.42
|
$24,442.97
|
2026-07-15
|
|
CMG-1102D
|
LOCAL
|
Inpatient Rehab Per Discharge: Amputation, Non-lower Extremity
|
19
|
13
|
$24,442.97
|
—
|
$24,442.97
|
$28,109.42
|
$24,442.97
|
2026-07-15
|
|
CMG-1103A
|
LOCAL
|
Inpatient Rehab Per Discharge: Amputation, Non-lower Extremity
|
19
|
13
|
$29,865.50
|
—
|
$29,865.50
|
$34,345.32
|
$29,865.50
|
2026-07-15
|
|
CMG-1103B
|
LOCAL
|
Inpatient Rehab Per Discharge: Amputation, Non-lower Extremity
|
19
|
13
|
$37,919.88
|
—
|
$37,919.88
|
$43,607.86
|
$37,919.88
|
2026-07-15
|
|
CMG-1103C
|
LOCAL
|
Inpatient Rehab Per Discharge: Amputation, Non-lower Extremity
|
19
|
13
|
$30,481.87
|
—
|
$30,481.87
|
$35,054.15
|
$30,481.87
|
2026-07-15
|
|
CMG-1103D
|
LOCAL
|
Inpatient Rehab Per Discharge: Amputation, Non-lower Extremity
|
19
|
13
|
$30,481.87
|
—
|
$30,481.87
|
$35,054.15
|
$30,481.87
|
2026-07-15
|
|
CMG-1201B
|
LOCAL
|
Inpatient Rehab Per Discharge: Osteoarthritis
|
19
|
13
|
$25,102.82
|
—
|
$25,102.82
|
$28,868.24
|
$25,102.82
|
2026-07-15
|
|
CMG-1202B
|
LOCAL
|
Inpatient Rehab Per Discharge: Osteoarthritis
|
19
|
13
|
$30,391.11
|
—
|
$30,391.11
|
$34,949.78
|
$30,391.11
|
2026-07-15
|
|
CMG-1203A
|
LOCAL
|
Inpatient Rehab Per Discharge: Osteoarthritis
|
19
|
13
|
$25,656.80
|
—
|
$25,656.80
|
$29,505.32
|
$25,656.80
|
2026-07-15
|
|
CMG-1203B
|
LOCAL
|
Inpatient Rehab Per Discharge: Osteoarthritis
|
19
|
13
|
$39,371.94
|
—
|
$39,371.94
|
$45,277.73
|
$39,371.94
|
2026-07-15
|
|
CMG-1203C
|
LOCAL
|
Inpatient Rehab Per Discharge: Osteoarthritis
|
19
|
13
|
$29,931.67
|
—
|
$29,931.67
|
$34,421.42
|
$29,931.67
|
2026-07-15
|
|
CMG-1203D
|
LOCAL
|
Inpatient Rehab Per Discharge: Osteoarthritis
|
19
|
13
|
$28,065.55
|
—
|
$28,065.55
|
$32,275.38
|
$28,065.55
|
2026-07-15
|
|
CMG-1204A
|
LOCAL
|
Inpatient Rehab Per Discharge: Osteoarthritis
|
19
|
13
|
$26,906.55
|
—
|
$26,906.55
|
$30,942.53
|
$26,906.55
|
2026-07-15
|
|
CMG-1204B
|
LOCAL
|
Inpatient Rehab Per Discharge: Osteoarthritis
|
19
|
13
|
$41,287.22
|
—
|
$41,287.22
|
$47,480.30
|
$41,287.22
|
2026-07-15
|
|
CMG-1204C
|
LOCAL
|
Inpatient Rehab Per Discharge: Osteoarthritis
|
19
|
13
|
$31,389.40
|
—
|
$31,389.40
|
$36,097.81
|
$31,389.40
|
2026-07-15
|
|
CMG-1204D
|
LOCAL
|
Inpatient Rehab Per Discharge: Osteoarthritis
|
19
|
13
|
$29,430.64
|
—
|
$29,430.64
|
$33,845.24
|
$29,430.64
|
2026-07-15
|
|
CMG-1302B
|
LOCAL
|
Inpatient Rehab Per Discharge: Rheumatoid Other Arthritis
|
19
|
13
|
$28,182.77
|
—
|
$28,182.77
|
$32,410.19
|
$28,182.77
|
2026-07-15
|
|
CMG-1303B
|
LOCAL
|
Inpatient Rehab Per Discharge: Rheumatoid Other Arthritis
|
19
|
13
|
$32,062.49
|
—
|
$32,062.49
|
$36,871.86
|
$32,062.49
|
2026-07-15
|
|
CMG-1303C
|
LOCAL
|
Inpatient Rehab Per Discharge: Rheumatoid Other Arthritis
|
19
|
13
|
$26,511.40
|
—
|
$26,511.40
|
$30,488.11
|
$26,511.40
|
2026-07-15
|
|
CMG-1303D
|
LOCAL
|
Inpatient Rehab Per Discharge: Rheumatoid Other Arthritis
|
19
|
13
|
$25,305.13
|
—
|
$25,305.13
|
$29,100.90
|
$25,305.13
|
2026-07-15
|
|
CMG-1304A
|
LOCAL
|
Inpatient Rehab Per Discharge: Rheumatoid Other Arthritis
|
19
|
13
|
$29,729.37
|
—
|
$29,729.37
|
$34,188.78
|
$29,729.37
|
2026-07-15
|
|
CMG-1304B
|
LOCAL
|
Inpatient Rehab Per Discharge: Rheumatoid Other Arthritis
|
19
|
13
|
$40,491.23
|
—
|
$40,491.23
|
$46,564.91
|
$40,491.23
|
2026-07-15
|
|
CMG-1304C
|
LOCAL
|
Inpatient Rehab Per Discharge: Rheumatoid Other Arthritis
|
19
|
13
|
$33,478.62
|
—
|
$33,478.62
|
$38,500.41
|
$33,478.62
|
2026-07-15
|
|
CMG-1304D
|
LOCAL
|
Inpatient Rehab Per Discharge: Rheumatoid Other Arthritis
|
19
|
13
|
$31,956.61
|
—
|
$31,956.61
|
$36,750.10
|
$31,956.61
|
2026-07-15
|
|
CMG-1305A
|
LOCAL
|
Inpatient Rehab Per Discharge: Rheumatoid Other Arthritis
|
19
|
13
|
$28,470.16
|
—
|
$28,470.16
|
$32,740.68
|
$28,470.16
|
2026-07-15
|
|
CMG-1305B
|
LOCAL
|
Inpatient Rehab Per Discharge: Rheumatoid Other Arthritis
|
19
|
13
|
$38,776.37
|
—
|
$38,776.37
|
$44,592.83
|
$38,776.37
|
2026-07-15
|
|
CMG-1305C
|
LOCAL
|
Inpatient Rehab Per Discharge: Rheumatoid Other Arthritis
|
19
|
13
|
$32,060.60
|
—
|
$32,060.60
|
$36,869.69
|
$32,060.60
|
2026-07-15
|
|
CMG-1305D
|
LOCAL
|
Inpatient Rehab Per Discharge: Rheumatoid Other Arthritis
|
19
|
13
|
$30,602.87
|
—
|
$30,602.87
|
$35,193.30
|
$30,602.87
|
2026-07-15
|
|
CMG-1402B
|
LOCAL
|
Inpatient Rehab Per Discharge: Cardiac
|
19
|
13
|
$27,059.70
|
—
|
$27,059.70
|
$31,118.65
|
$27,059.70
|
2026-07-15
|
|
CMG-1403B
|
LOCAL
|
Inpatient Rehab Per Discharge: Cardiac
|
19
|
13
|
$33,109.94
|
—
|
$33,109.94
|
$38,076.43
|
$33,109.94
|
2026-07-15
|
|
CMG-1403C
|
LOCAL
|
Inpatient Rehab Per Discharge: Cardiac
|
19
|
13
|
$26,084.10
|
—
|
$26,084.10
|
$29,996.72
|
$26,084.10
|
2026-07-15
|
|
CMG-1404A
|
LOCAL
|
Inpatient Rehab Per Discharge: Cardiac
|
19
|
13
|
$27,343.30
|
—
|
$27,343.30
|
$31,444.79
|
$27,343.30
|
2026-07-15
|
|
CMG-1404B
|
LOCAL
|
Inpatient Rehab Per Discharge: Cardiac
|
19
|
13
|
$40,570.64
|
—
|
$40,570.64
|
$46,656.24
|
$40,570.64
|
2026-07-15
|
|
CMG-1404C
|
LOCAL
|
Inpatient Rehab Per Discharge: Cardiac
|
19
|
13
|
$31,960.39
|
—
|
$31,960.39
|
$36,754.45
|
$31,960.39
|
2026-07-15
|
|
CMG-1404D
|
LOCAL
|
Inpatient Rehab Per Discharge: Cardiac
|
19
|
13
|
$29,716.13
|
—
|
$29,716.13
|
$34,173.55
|
$29,716.13
|
2026-07-15
|
|
CMG-1502B
|
LOCAL
|
Inpatient Rehab Per Discharge: Pulmonary
|
19
|
13
|
$30,553.71
|
—
|
$30,553.71
|
$35,136.77
|
$30,553.71
|
2026-07-15
|
|
CMG-1502C
|
LOCAL
|
Inpatient Rehab Per Discharge: Pulmonary
|
19
|
13
|
$24,798.42
|
—
|
$24,798.42
|
$28,518.18
|
$24,798.42
|
2026-07-15
|
|
CMG-1503A
|
LOCAL
|
Inpatient Rehab Per Discharge: Pulmonary
|
19
|
13
|
$24,794.64
|
—
|
$24,794.64
|
$28,513.84
|
$24,794.64
|
2026-07-15
|
|
CMG-1503B
|
LOCAL
|
Inpatient Rehab Per Discharge: Pulmonary
|
19
|
13
|
$34,724.60
|
—
|
$34,724.60
|
$39,933.29
|
$34,724.60
|
2026-07-15
|
|
CMG-1503C
|
LOCAL
|
Inpatient Rehab Per Discharge: Pulmonary
|
19
|
13
|
$28,182.77
|
—
|
$28,182.77
|
$32,410.19
|
$28,182.77
|
2026-07-15
|
|
CMG-1503D
|
LOCAL
|
Inpatient Rehab Per Discharge: Pulmonary
|
19
|
13
|
$26,505.72
|
—
|
$26,505.72
|
$30,481.58
|
$26,505.72
|
2026-07-15
|
|
CMG-1504A
|
LOCAL
|
Inpatient Rehab Per Discharge: Pulmonary
|
19
|
13
|
$30,704.97
|
—
|
$30,704.97
|
$35,310.72
|
$30,704.97
|
2026-07-15
|
|
CMG-1504B
|
LOCAL
|
Inpatient Rehab Per Discharge: Pulmonary
|
19
|
13
|
$43,002.08
|
—
|
$43,002.08
|
$49,452.39
|
$43,002.08
|
2026-07-15
|
|
CMG-1504C
|
LOCAL
|
Inpatient Rehab Per Discharge: Pulmonary
|
19
|
13
|
$34,902.32
|
—
|
$34,902.32
|
$40,137.67
|
$34,902.32
|
2026-07-15
|
|
CMG-1504D
|
LOCAL
|
Inpatient Rehab Per Discharge: Pulmonary
|
19
|
13
|
$32,824.44
|
—
|
$32,824.44
|
$37,748.11
|
$32,824.44
|
2026-07-15
|
|
CMG-1601B
|
LOCAL
|
Inpatient Rehab Per Discharge: Pain Syndrome
|
19
|
13
|
$24,753.04
|
—
|
$24,753.04
|
$28,466.00
|
$24,753.04
|
2026-07-15
|
|
CMG-1602B
|
LOCAL
|
Inpatient Rehab Per Discharge: Pain Syndrome
|
19
|
13
|
$28,366.17
|
—
|
$28,366.17
|
$32,621.10
|
$28,366.17
|
2026-07-15
|
|
CMG-1603B
|
LOCAL
|
Inpatient Rehab Per Discharge: Pain Syndrome
|
19
|
13
|
$35,823.09
|
—
|
$35,823.09
|
$41,196.55
|
$35,823.09
|
2026-07-15
|
|
CMG-1603C
|
LOCAL
|
Inpatient Rehab Per Discharge: Pain Syndrome
|
19
|
13
|
$26,607.82
|
—
|
$26,607.82
|
$30,598.99
|
$26,607.82
|
2026-07-15
|
|
CMG-1604A
|
LOCAL
|
Inpatient Rehab Per Discharge: Pain Syndrome
|
19
|
13
|
$27,583.42
|
—
|
$27,583.42
|
$31,720.93
|
$27,583.42
|
2026-07-15
|
|
CMG-1604B
|
LOCAL
|
Inpatient Rehab Per Discharge: Pain Syndrome
|
19
|
13
|
$44,384.18
|
—
|
$44,384.18
|
$51,041.81
|
$44,384.18
|
2026-07-15
|
|
CMG-1604C
|
LOCAL
|
Inpatient Rehab Per Discharge: Pain Syndrome
|
19
|
13
|
$32,966.25
|
—
|
$32,966.25
|
$37,911.19
|
$32,966.25
|
2026-07-15
|
|
CMG-1604D
|
LOCAL
|
Inpatient Rehab Per Discharge: Pain Syndrome
|
19
|
13
|
$29,797.43
|
—
|
$29,797.43
|
$34,267.04
|
$29,797.43
|
2026-07-15
|
|
CMG-1701B
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma Without Brain Or Spinal Cor…
|
19
|
13
|
$25,280.55
|
—
|
$25,280.55
|
$29,072.63
|
$25,280.55
|
2026-07-15
|
|
CMG-1702B
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma Without Brain Or Spinal Cor…
|
19
|
13
|
$31,408.31
|
—
|
$31,408.31
|
$36,119.56
|
$31,408.31
|
2026-07-15
|
|
CMG-1702C
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma Without Brain Or Spinal Cor…
|
19
|
13
|
$24,414.61
|
—
|
$24,414.61
|
$28,076.80
|
$24,414.61
|
2026-07-15
|
|
CMG-1703B
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma Without Brain Or Spinal Cor…
|
19
|
13
|
$37,322.42
|
—
|
$37,322.42
|
$42,920.78
|
$37,322.42
|
2026-07-15
|
|
CMG-1703C
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma Without Brain Or Spinal Cor…
|
19
|
13
|
$29,010.90
|
—
|
$29,010.90
|
$33,362.54
|
$29,010.90
|
2026-07-15
|
|
CMG-1703D
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma Without Brain Or Spinal Cor…
|
19
|
13
|
$26,868.74
|
—
|
$26,868.74
|
$30,899.05
|
$26,868.74
|
2026-07-15
|
|
CMG-1704A
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma Without Brain Or Spinal Cor…
|
19
|
13
|
$27,589.09
|
—
|
$27,589.09
|
$31,727.45
|
$27,589.09
|
2026-07-15
|
|
CMG-1704B
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma Without Brain Or Spinal Cor…
|
19
|
13
|
$42,243.91
|
—
|
$42,243.91
|
$48,580.50
|
$42,243.91
|
2026-07-15
|
|
CMG-1704C
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma Without Brain Or Spinal Cor…
|
19
|
13
|
$32,835.79
|
—
|
$32,835.79
|
$37,761.16
|
$32,835.79
|
2026-07-15
|
|
CMG-1704D
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma Without Brain Or Spinal Cor…
|
19
|
13
|
$30,410.02
|
—
|
$30,410.02
|
$34,971.52
|
$30,410.02
|
2026-07-15
|
|
CMG-1705A
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma Without Brain Or Spinal Cor…
|
19
|
13
|
$32,376.35
|
—
|
$32,376.35
|
$37,232.80
|
$32,376.35
|
2026-07-15
|
|
CMG-1705B
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma Without Brain Or Spinal Cor…
|
19
|
13
|
$49,574.15
|
—
|
$49,574.15
|
$57,010.27
|
$49,574.15
|
2026-07-15
|
|
CMG-1705C
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma Without Brain Or Spinal Cor…
|
19
|
13
|
$38,534.36
|
—
|
$38,534.36
|
$44,314.51
|
$38,534.36
|
2026-07-15
|
|
CMG-1705D
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma Without Brain Or Spinal Cor…
|
19
|
13
|
$35,686.96
|
—
|
$35,686.96
|
$41,040.00
|
$35,686.96
|
2026-07-15
|
|
CMG-1802B
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma With Brain Or Spinal Cord I…
|
19
|
13
|
$26,895.21
|
—
|
$26,895.21
|
$30,929.49
|
$26,895.21
|
2026-07-15
|
|
CMG-1803B
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma With Brain Or Spinal Cord I…
|
19
|
13
|
$34,554.43
|
—
|
$34,554.43
|
$39,737.59
|
$34,554.43
|
2026-07-15
|
|
CMG-1803C
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma With Brain Or Spinal Cord I…
|
19
|
13
|
$27,566.41
|
—
|
$27,566.41
|
$31,701.37
|
$27,566.41
|
2026-07-15
|
|
CMG-1803D
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma With Brain Or Spinal Cord I…
|
19
|
13
|
$26,171.07
|
—
|
$26,171.07
|
$30,096.73
|
$26,171.07
|
2026-07-15
|
|
CMG-1804A
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma With Brain Or Spinal Cord I…
|
19
|
13
|
$26,534.08
|
—
|
$26,534.08
|
$30,514.19
|
$26,534.08
|
2026-07-15
|
|
CMG-1804B
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma With Brain Or Spinal Cord I…
|
19
|
13
|
$37,787.53
|
—
|
$37,787.53
|
$43,455.66
|
$37,787.53
|
2026-07-15
|
|
CMG-1804C
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma With Brain Or Spinal Cord I…
|
19
|
13
|
$30,145.32
|
—
|
$30,145.32
|
$34,667.12
|
$30,145.32
|
2026-07-15
|
|
CMG-1804D
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma With Brain Or Spinal Cord I…
|
19
|
13
|
$28,617.64
|
—
|
$28,617.64
|
$32,910.29
|
$28,617.64
|
2026-07-15
|
|
CMG-1805A
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma With Brain Or Spinal Cord I…
|
19
|
13
|
$32,170.26
|
—
|
$32,170.26
|
$36,995.80
|
$32,170.26
|
2026-07-15
|
|
CMG-1805B
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma With Brain Or Spinal Cord I…
|
19
|
13
|
$45,813.55
|
—
|
$45,813.55
|
$52,685.58
|
$45,813.55
|
2026-07-15
|
|
CMG-1805C
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma With Brain Or Spinal Cord I…
|
19
|
13
|
$36,547.23
|
—
|
$36,547.23
|
$42,029.31
|
$36,547.23
|
2026-07-15
|
|
CMG-1805D
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma With Brain Or Spinal Cord I…
|
19
|
13
|
$34,696.24
|
—
|
$34,696.24
|
$39,900.68
|
$34,696.24
|
2026-07-15
|
|
CMG-1806A
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma With Brain Or Spinal Cord I…
|
19
|
13
|
$45,686.87
|
—
|
$45,686.87
|
$52,539.90
|
$45,686.87
|
2026-07-15
|
|
CMG-1806B
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma With Brain Or Spinal Cord I…
|
19
|
13
|
$65,062.77
|
—
|
$65,062.77
|
$74,822.19
|
$65,062.77
|
2026-07-15
|
|
CMG-1806C
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma With Brain Or Spinal Cord I…
|
19
|
13
|
$51,903.50
|
—
|
$51,903.50
|
$59,689.03
|
$51,903.50
|
2026-07-15
|
|
CMG-1806D
|
LOCAL
|
Inpatient Rehab Per Discharge: Major Multiple Trauma With Brain Or Spinal Cord I…
|
19
|
13
|
$49,275.42
|
—
|
$49,275.42
|
$56,666.73
|
$49,275.42
|
2026-07-15
|
|
CMG-1902B
|
LOCAL
|
Inpatient Rehab Per Discharge: Guillain-barre
|
19
|
13
|
$31,470.70
|
—
|
$31,470.70
|
$36,191.31
|
$31,470.70
|
2026-07-15
|
|
CMG-1903A
|
LOCAL
|
Inpatient Rehab Per Discharge: Guillain-barre
|
19
|
13
|
$33,472.95
|
—
|
$33,472.95
|
$38,493.89
|
$33,472.95
|
2026-07-15
|
|
CMG-1903B
|
LOCAL
|
Inpatient Rehab Per Discharge: Guillain-barre
|
19
|
13
|
$47,483.04
|
—
|
$47,483.04
|
$54,605.50
|
$47,483.04
|
2026-07-15
|
|
CMG-1903C
|
LOCAL
|
Inpatient Rehab Per Discharge: Guillain-barre
|
19
|
13
|
$36,503.74
|
—
|
$36,503.74
|
$41,979.30
|
$36,503.74
|
2026-07-15
|
|
CMG-1903D
|
LOCAL
|
Inpatient Rehab Per Discharge: Guillain-barre
|
19
|
13
|
$34,062.85
|
—
|
$34,062.85
|
$39,172.28
|
$34,062.85
|
2026-07-15
|
|
CMG-1904A
|
LOCAL
|
Inpatient Rehab Per Discharge: Guillain-barre
|
19
|
13
|
$48,761.15
|
—
|
$48,761.15
|
$56,075.32
|
$48,761.15
|
2026-07-15
|
|
CMG-1904B
|
LOCAL
|
Inpatient Rehab Per Discharge: Guillain-barre
|
19
|
13
|
$69,167.48
|
—
|
$69,167.48
|
$79,542.60
|
$69,167.48
|
2026-07-15
|
|
CMG-1904C
|
LOCAL
|
Inpatient Rehab Per Discharge: Guillain-barre
|
19
|
13
|
$53,175.94
|
—
|
$53,175.94
|
$61,152.33
|
$53,175.94
|
2026-07-15
|
|
CMG-1904D
|
LOCAL
|
Inpatient Rehab Per Discharge: Guillain-barre
|
19
|
13
|
$49,619.53
|
—
|
$49,619.53
|
$57,062.46
|
$49,619.53
|
2026-07-15
|
|
CMG-2002B
|
LOCAL
|
Inpatient Rehab Per Discharge: Miscellaneous
|
19
|
13
|
$27,827.32
|
—
|
$27,827.32
|
$32,001.42
|
$27,827.32
|
2026-07-15
|
|
CMG-2003B
|
LOCAL
|
Inpatient Rehab Per Discharge: Miscellaneous
|
19
|
13
|
$33,323.59
|
—
|
$33,323.59
|
$38,322.13
|
$33,323.59
|
2026-07-15
|
|
CMG-2003C
|
LOCAL
|
Inpatient Rehab Per Discharge: Miscellaneous
|
19
|
13
|
$26,617.27
|
—
|
$26,617.27
|
$30,609.86
|
$26,617.27
|
2026-07-15
|
|
CMG-2003D
|
LOCAL
|
Inpatient Rehab Per Discharge: Miscellaneous
|
19
|
13
|
$24,864.60
|
—
|
$24,864.60
|
$28,594.29
|
$24,864.60
|
2026-07-15
|
|
CMG-2004A
|
LOCAL
|
Inpatient Rehab Per Discharge: Miscellaneous
|
19
|
13
|
$27,059.70
|
—
|
$27,059.70
|
$31,118.65
|
$27,059.70
|
2026-07-15
|
|
CMG-2004B
|
LOCAL
|
Inpatient Rehab Per Discharge: Miscellaneous
|
19
|
13
|
$39,842.72
|
—
|
$39,842.72
|
$45,819.13
|
$39,842.72
|
2026-07-15
|
|
CMG-2004C
|
LOCAL
|
Inpatient Rehab Per Discharge: Miscellaneous
|
19
|
13
|
$31,824.26
|
—
|
$31,824.26
|
$36,597.90
|
$31,824.26
|
2026-07-15
|
|
CMG-2004D
|
LOCAL
|
Inpatient Rehab Per Discharge: Miscellaneous
|
19
|
13
|
$29,729.37
|
—
|
$29,729.37
|
$34,188.78
|
$29,729.37
|
2026-07-15
|
|
CMG-2005A
|
LOCAL
|
Inpatient Rehab Per Discharge: Miscellaneous
|
19
|
13
|
$28,523.10
|
—
|
$28,523.10
|
$32,801.57
|
$28,523.10
|
2026-07-15
|
|
CMG-2005B
|
LOCAL
|
Inpatient Rehab Per Discharge: Miscellaneous
|
19
|
13
|
$41,996.23
|
—
|
$41,996.23
|
$48,295.66
|
$41,996.23
|
2026-07-15
|
|
CMG-2005C
|
LOCAL
|
Inpatient Rehab Per Discharge: Miscellaneous
|
19
|
13
|
$33,544.80
|
—
|
$33,544.80
|
$38,576.52
|
$33,544.80
|
2026-07-15
|
|
CMG-2005D
|
LOCAL
|
Inpatient Rehab Per Discharge: Miscellaneous
|
19
|
13
|
$31,336.46
|
—
|
$31,336.46
|
$36,036.93
|
$31,336.46
|
2026-07-15
|
|
CMG-2101B
|
LOCAL
|
Inpatient Rehab Per Discharge: Burns
|
19
|
13
|
$28,453.14
|
—
|
$28,453.14
|
$32,721.11
|
$28,453.14
|
2026-07-15
|
|
CMG-2102A
|
LOCAL
|
Inpatient Rehab Per Discharge: Burns
|
19
|
13
|
$28,436.13
|
—
|
$28,436.13
|
$32,701.55
|
$28,436.13
|
2026-07-15
|
|
CMG-2102B
|
LOCAL
|
Inpatient Rehab Per Discharge: Burns
|
19
|
13
|
$43,818.86
|
—
|
$43,818.86
|
$50,391.69
|
$43,818.86
|
2026-07-15
|
|
CMG-2102C
|
LOCAL
|
Inpatient Rehab Per Discharge: Burns
|
19
|
13
|
$33,297.12
|
—
|
$33,297.12
|
$38,291.69
|
$33,297.12
|
2026-07-15
|
|
CMG-2102D
|
LOCAL
|
Inpatient Rehab Per Discharge: Burns
|
19
|
13
|
$33,297.12
|
—
|
$33,297.12
|
$38,291.69
|
$33,297.12
|
2026-07-15
|
|
CMG-5102A
|
LOCAL
|
Inpatient Rehab Per Discharge: Expired Orthopedic 14 Days Or More
|
18
|
12
|
$33,892.69
|
—
|
$33,892.69
|
$33,892.69
|
$33,892.69
|
2026-07-15
|
|
CMG-5104A
|
LOCAL
|
Inpatient Rehab Per Discharge: Expired Not Orthopedic 16 Days Or More
|
18
|
12
|
$45,062.94
|
—
|
$45,062.94
|
$45,062.94
|
$45,062.94
|
2026-07-15
|
|
D0104
|
HCPCS
|
Stroke M >=41.50 And M <50.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$19,705.17
|
$29,663.08
|
$24,684.12
|
2026-03-17
|
|
D0105
|
HCPCS
|
Stroke M <41.50 And A >=84.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$36,350.28
|
$39,854.25
|
$38,102.26
|
2026-03-17
|
|
D0106
|
HCPCS
|
Stroke M <41.50 And A <84.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$18,556.84
|
$44,390.61
|
$31,473.72
|
2026-03-17
|
|
D0303
|
HCPCS
|
Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$24,600.29
|
$25,102.34
|
$24,851.31
|
2026-03-17
|
|
D0304
|
HCPCS
|
Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$29,104.43
|
$29,104.43
|
$29,104.43
|
2026-03-17
|
|
D0305
|
HCPCS
|
Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$24,720.29
|
$32,097.30
|
$28,408.79
|
2026-03-17
|
|
D0403
|
HCPCS
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$30,862.79
|
$30,862.79
|
$30,862.79
|
2026-03-17
|
|
D0504
|
HCPCS
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$29,221.66
|
$29,221.66
|
$29,221.66
|
2026-03-17
|
|
D0505
|
HCPCS
|
Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$40,605.17
|
$40,605.17
|
$40,605.17
|
2026-03-17
|
|
D0603
|
HCPCS
|
Neurological M >=43.50 And M <52.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$25,421.05
|
$25,421.05
|
$25,421.05
|
2026-03-17
|
|
D0604
|
HCPCS
|
Neurological M <43.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$31,881.17
|
$31,881.17
|
$31,881.17
|
2026-03-17
|
|
D0704
|
HCPCS
|
Fracture Of Lower Extremity M <41.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$18,604.37
|
$31,236.44
|
$24,920.40
|
2026-03-17
|
|
D0805
|
HCPCS
|
Replacement Of Lower-extremity Joint M <42.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$25,536.32
|
$27,620.82
|
$26,578.57
|
2026-03-17
|
|
D0903
|
HCPCS
|
Other Orthopedic M >=44.50 And M <51.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$24,439.30
|
$24,439.30
|
$24,439.30
|
2026-03-17
|
|
D0904
|
HCPCS
|
Other Orthopedic M <44.5- Tier Tier 3
|
26
|
11
|
—
|
—
|
$28,698.25
|
$29,283.93
|
$28,991.09
|
2026-03-17
|
|
D1004
|
HCPCS
|
Amputation Lower Extremity M <47.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$31,840.87
|
$31,840.87
|
$31,840.87
|
2026-03-17
|
|
D1303
|
HCPCS
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$24,514.39
|
$24,514.39
|
$24,514.39
|
2026-03-17
|
|
D1404
|
HCPCS
|
Cardiac M <45.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$20,285.71
|
$30,871.59
|
$25,578.65
|
2026-03-17
|
|
D1503
|
HCPCS
|
Pulmonary M >=45.50 And M <56.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$25,677.47
|
$25,677.47
|
$25,677.47
|
2026-03-17
|
|
D1703
|
HCPCS
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50…
|
26
|
11
|
—
|
—
|
$26,029.14
|
$26,029.14
|
$26,029.14
|
2026-03-17
|
|
D1704
|
HCPCS
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50…
|
26
|
11
|
—
|
—
|
$29,459.77
|
$29,459.77
|
$29,459.77
|
2026-03-17
|
|
D1804
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50- T…
|
26
|
11
|
—
|
—
|
$27,723.39
|
$27,723.39
|
$27,723.39
|
2026-03-17
|
|
D1904
|
HCPCS
|
Guillain-barré M <38.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$29,603.91
|
$29,603.91
|
$29,603.91
|
2026-03-17
|
|
D2004
|
HCPCS
|
Miscellaneous M <46.50 And A >=77.50- Tier Tier 3
|
26
|
11
|
—
|
—
|
$26,779.01
|
$28,800.38
|
$27,789.69
|
2026-03-17
|