|
845
|
OTHER
|
Inj, Atidarsagene Autotem
|
24
|
10
|
—
|
—
|
$4,505,000.00
|
$4,955,500.00
|
$4,640,150.00
|
2026-09-01
|
|
9138
|
OTHER
|
Inj, Hemgenix, Per Tx Dos
|
39
|
12
|
—
|
—
|
$3,672,900.00
|
$4,429,740.00
|
$3,802,193.50
|
2026-09-01
|
|
773
|
OTHER
|
Inj, Beqvez, Per Tx Dose
|
11
|
9
|
—
|
—
|
$3,605,000.00
|
$4,326,000.00
|
$3,713,150.00
|
2024-10-01
|
|
908
|
OTHER
|
Topi Adm Prad Zami Per Tr
|
28
|
12
|
—
|
—
|
$3,285,783.00
|
$4,002,984.00
|
$3,435,894.60
|
2026-09-01
|
|
714
|
OTHER
|
Inj Delandistrogene Mox R
|
39
|
12
|
—
|
—
|
$3,316,897.00
|
$3,993,432.00
|
$3,427,695.80
|
2026-09-01
|
|
748
|
OTHER
|
Inj, Lovotibeglogene Auto
|
39
|
12
|
—
|
—
|
$3,235,304.00
|
$3,943,200.00
|
$3,364,716.16
|
2026-09-01
|
|
906
|
OTHER
|
Inj Elivaldogene Autoteme
|
28
|
12
|
—
|
—
|
$3,180,000.00
|
$3,816,000.00
|
$3,291,300.00
|
2026-09-01
|
|
746
|
OTHER
|
Inj, Betibeglogene Autote
|
39
|
12
|
—
|
—
|
$2,930,260.00
|
$3,561,600.00
|
$3,047,470.40
|
2026-09-01
|
|
922
|
OTHER
|
Inj Onase Abepar-brve Trea
|
14
|
12
|
—
|
—
|
$2,664,228.00
|
$3,197,073.60
|
$2,757,475.98
|
2026-09-01
|
|
9141
|
OTHER
|
Inj Onase Abepar-xioi Tre
|
39
|
12
|
—
|
—
|
$2,388,614.00
|
$3,216,045.60
|
$2,680,038.00
|
2026-09-01
|
|
824
|
OTHER
|
Inj, Exagamglogene Autote
|
28
|
12
|
—
|
—
|
$2,300,907.00
|
$2,798,400.00
|
$2,401,960.00
|
2026-09-01
|
|
Q2042
|
HCPCS
|
Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka…
|
12
|
1
|
—
|
—
|
$1,369,371.65
|
$1,369,371.65
|
$1,369,371.65
|
2026-09-01
|
|
Q2056
|
HCPCS
|
Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…
|
12
|
1
|
—
|
—
|
$1,328,128.35
|
$1,328,128.35
|
$1,328,128.35
|
2026-09-01
|
|
Q2041
|
HCPCS
|
Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…
|
12
|
1
|
—
|
—
|
$1,279,600.63
|
$1,279,600.63
|
$1,279,600.63
|
2026-09-01
|
|
Q2053
|
HCPCS
|
Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V…
|
12
|
1
|
—
|
—
|
$1,175,752.00
|
$1,175,752.00
|
$1,175,752.00
|
2026-09-01
|
|
2067
|
OTHER
|
Afamitresgene Autoleucel
|
28
|
12
|
—
|
—
|
$770,620.00
|
$976,760.88
|
$831,258.18
|
2026-09-01
|
|
9194
|
OTHER
|
Tisagenlecleucel Car-pos
|
39
|
12
|
—
|
—
|
$529,192.90
|
$734,031.84
|
$611,693.20
|
2026-09-01
|
|
9498
|
OTHER
|
Ciltacabtagene Car-pos T
|
39
|
12
|
—
|
—
|
$527,123.40
|
$705,573.36
|
$599,737.36
|
2026-09-01
|
|
9413
|
OTHER
|
Lisocabtagene Car Pos T
|
39
|
12
|
—
|
—
|
$516,726.10
|
$695,484.72
|
$579,570.60
|
2026-09-01
|
|
9422
|
OTHER
|
Idecabtagene Vicleucel Ca
|
39
|
12
|
—
|
—
|
$526,587.60
|
$681,573.36
|
$574,824.25
|
2026-09-01
|
|
9035
|
OTHER
|
Axicabtagene Ciloleucel C
|
39
|
12
|
—
|
—
|
$489,456.00
|
$675,001.08
|
$562,500.90
|
2026-09-01
|
|
9391
|
OTHER
|
Brexucabtagene Car Pos T
|
39
|
12
|
—
|
—
|
$460,530.40
|
$612,124.68
|
$510,103.90
|
2026-09-01
|
|
831
|
OTHER
|
Obecbtge Autol Up To 400
|
28
|
12
|
—
|
—
|
$278,250.00
|
$333,900.00
|
$287,988.75
|
2026-09-01
|
|
897
|
OTHER
|
Revakinagene, Per Implant
|
28
|
12
|
—
|
—
|
$261,579.70
|
$318,000.00
|
$272,950.00
|
2026-09-01
|
|
886
|
OTHER
|
Inj. Remestemcel-l-rknd/
|
28
|
12
|
—
|
—
|
$201,669.00
|
$244,391.76
|
$209,769.59
|
2026-09-01
|
|
J9999
|
HCPCS
|
Carmustine 8 Wafers/box
|
18
|
10
|
$305,385.18
|
$305,385.18
|
$76,346.29
|
$250,415.85
|
$187,964.58
|
2026-09-01
|
|
C9293
|
HCPCS
|
Glucarpidase 1000 U Inj
|
22
|
10
|
$307,704.18
|
$307,704.18
|
$76,926.04
|
$252,317.43
|
$186,791.83
|
2026-09-01
|
|
J9029
|
HCPCS
|
Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose
|
12
|
1
|
—
|
—
|
$166,116.65
|
$166,116.65
|
$166,116.65
|
2026-09-01
|
|
1907
|
OTHER
|
New Technology - Level 52
|
39
|
12
|
—
|
—
|
$141,474.70
|
$171,208.08
|
$146,953.60
|
2026-09-01
|
|
1908
|
OTHER
|
New Technology - Level 52
|
39
|
12
|
—
|
—
|
$141,474.70
|
$171,208.08
|
$146,953.60
|
2026-09-01
|
|
Q2043
|
HCPCS
|
Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm…
|
12
|
1
|
—
|
—
|
$145,223.54
|
$145,223.54
|
$145,223.54
|
2026-09-01
|
|
1905
|
OTHER
|
New Technology - Level 51
|
39
|
12
|
—
|
—
|
$127,559.20
|
$154,368.00
|
$132,499.20
|
2026-09-01
|
|
1906
|
OTHER
|
New Technology - Level 51
|
39
|
12
|
—
|
—
|
$127,559.20
|
$154,368.00
|
$132,499.20
|
2026-09-01
|
|
924
|
OTHER
|
Inj Zopapogene Per Ther Do
|
14
|
12
|
—
|
—
|
$121,900.00
|
$146,280.00
|
$126,166.50
|
2026-09-01
|
|
1903
|
OTHER
|
New Technology - Level 50
|
39
|
12
|
—
|
—
|
$113,643.70
|
$137,527.92
|
$118,044.80
|
2026-09-01
|
|
1904
|
OTHER
|
New Technology - Level 50
|
39
|
12
|
—
|
—
|
$113,643.70
|
$137,527.92
|
$118,044.80
|
2026-09-01
|
|
Q0480
|
HCPCS
|
Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only
|
39
|
12
|
—
|
—
|
$99,999.90
|
$133,803.60
|
$113,733.06
|
2026-09-01
|
|
J9226
|
HCPCS
|
Histrelin Implant (supprelin La), 50 Mg
|
12
|
1
|
—
|
—
|
$110,645.59
|
$110,645.59
|
$110,645.59
|
2026-09-01
|
|
1902
|
OTHER
|
New Technology - Level 49
|
39
|
12
|
—
|
—
|
$99,728.21
|
$120,687.84
|
$103,590.40
|
2026-09-01
|
|
1901
|
OTHER
|
New Technology - Level 49
|
39
|
12
|
—
|
—
|
$99,728.21
|
$120,687.84
|
$103,590.40
|
2026-09-01
|
|
K1007
|
HCPCS
|
Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin…
|
39
|
12
|
—
|
—
|
$91,031.90
|
$114,097.20
|
$97,933.43
|
2026-09-01
|
|
1585
|
OTHER
|
New Technology - Level 48
|
39
|
12
|
—
|
—
|
$88,131.96
|
$106,654.39
|
$91,545.02
|
2026-09-01
|
|
1599
|
OTHER
|
New Technology - Level 48
|
39
|
12
|
—
|
—
|
$88,131.96
|
$106,654.39
|
$91,545.02
|
2026-09-01
|
|
J2350
|
HCPCS
|
Ocrelizumab 300 Mg Inj
|
29
|
10
|
$150,336.52
|
$150,336.52
|
$157.62
|
$123,275.95
|
$88,172.37
|
2026-09-01
|
|
1598
|
OTHER
|
New Technology - Level 47
|
39
|
12
|
—
|
—
|
$78,854.96
|
$95,427.68
|
$81,908.76
|
2026-09-01
|
|
1584
|
OTHER
|
New Technology - Level 47
|
39
|
12
|
—
|
—
|
$78,854.96
|
$95,427.68
|
$81,908.76
|
2026-09-01
|
|
J9266
|
HCPCS
|
Pegasparga Single Vl Inj
|
29
|
10
|
$125,252.60
|
$125,252.60
|
$67,636.40
|
$102,707.13
|
$77,781.86
|
2026-09-01
|
|
926
|
OTHER
|
Gemcitabine Intravesical S
|
14
|
12
|
—
|
—
|
$72,984.24
|
$87,581.09
|
$75,538.69
|
2026-09-01
|
|
1583
|
OTHER
|
New Technology - Level 46
|
39
|
12
|
—
|
—
|
$69,577.96
|
$84,200.96
|
$72,272.49
|
2026-09-01
|
|
1597
|
OTHER
|
New Technology - Level 46
|
39
|
12
|
—
|
—
|
$69,577.96
|
$84,200.96
|
$72,272.49
|
2026-09-01
|
|
487218
|
CDM
|
Valve Tavr 34mm
|
22
|
10
|
$108,570.00
|
$108,570.00
|
$29,317.50
|
$96,161.40
|
$71,188.76
|
2026-03-01
|
|
L8702
|
HCPCS
|
Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge…
|
39
|
12
|
—
|
—
|
$65,871.70
|
$82,562.04
|
$70,865.75
|
2026-09-01
|
|
717
|
OTHER
|
Instill Adstiladrin, Tx D
|
39
|
12
|
—
|
—
|
$63,354.77
|
$77,197.93
|
$66,203.03
|
2026-09-01
|
|
1582
|
OTHER
|
New Technology - Level 45
|
39
|
12
|
—
|
—
|
$60,300.96
|
$72,974.24
|
$62,636.23
|
2026-09-01
|
|
1596
|
OTHER
|
New Technology - Level 45
|
39
|
12
|
—
|
—
|
$60,300.96
|
$72,974.24
|
$62,636.23
|
2026-09-01
|
|
1643
|
OTHER
|
Y90 Ibritumomab, Rx
|
39
|
12
|
—
|
—
|
$56,824.55
|
$78,571.90
|
$61,370.51
|
2026-09-01
|
|
5244
|
OTHER
|
Level 4 Blood Product Exc
|
39
|
12
|
—
|
—
|
$48,301.79
|
$72,146.86
|
$61,324.83
|
2026-09-01
|
|
B0404
|
HCPCS
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
3
|
1
|
—
|
—
|
$56,180.30
|
$60,247.12
|
$60,083.31
|
2026-09-01
|
|
B0505
|
HCPCS
|
Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2
|
3
|
1
|
—
|
—
|
$55,603.31
|
$59,255.18
|
$59,094.06
|
2026-09-01
|
|
9273
|
OTHER
|
Sipuleucel-t Auto Cd54+
|
39
|
12
|
—
|
—
|
$54,404.11
|
$67,118.92
|
$57,051.08
|
2026-09-01
|
|
J3357
|
HCPCS
|
Ustekinumab 1 Mg Inj
|
66
|
10
|
$101,787.63
|
$101,787.63
|
$378.69
|
$175,111.30
|
$55,677.83
|
2026-09-01
|
|
B0106
|
HCPCS
|
Stroke; M > 30.05 & M < 34.25
|
3
|
1
|
—
|
—
|
$53,576.57
|
$53,722.64
|
$53,577.38
|
2026-09-01
|
|
1595
|
OTHER
|
New Technology - Level 44
|
39
|
12
|
—
|
—
|
$51,023.96
|
$61,747.52
|
$52,999.96
|
2026-09-01
|
|
1581
|
OTHER
|
New Technology - Level 44
|
39
|
12
|
—
|
—
|
$51,023.96
|
$61,747.52
|
$52,999.96
|
2026-09-01
|
|
B1903
|
HCPCS
|
Guillian Barre; M < 18.05
|
3
|
1
|
—
|
—
|
$46,295.84
|
$52,341.88
|
$52,199.57
|
2026-09-01
|
|
B0205
|
HCPCS
|
Traumatic Brain Injury; M > 28.75 & M < 40.65
|
3
|
1
|
—
|
—
|
$48,638.84
|
$51,679.95
|
$51,539.43
|
2026-09-01
|
|
L7181
|
HCPCS
|
Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi…
|
39
|
12
|
—
|
—
|
$47,493.00
|
$59,526.48
|
$51,093.56
|
2026-09-01
|
|
J9119
|
HCPCS
|
Cemiplimab-rwlc 350mginj
|
29
|
10
|
$84,188.44
|
$84,188.44
|
$72.46
|
$69,034.52
|
$49,376.52
|
2026-09-01
|
|
C0404
|
HCPCS
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
3
|
1
|
—
|
—
|
$49,110.76
|
$49,960.58
|
$49,244.65
|
2026-09-01
|
|
B2102
|
HCPCS
|
Burns; M=12-45
|
3
|
1
|
—
|
—
|
$42,723.28
|
$48,271.67
|
$48,140.42
|
2026-09-01
|
|
D0404
|
HCPCS
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
3
|
1
|
—
|
—
|
$47,818.87
|
$48,498.74
|
$47,949.24
|
2026-09-01
|
|
B0405
|
HCPCS
|
Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5
|
3
|
1
|
—
|
—
|
$44,677.31
|
$47,721.64
|
$47,591.89
|
2026-09-01
|
|
C0106
|
HCPCS
|
Stroke; M > 30.05 & M < 34.25
|
3
|
1
|
—
|
—
|
$46,465.44
|
$47,706.47
|
$47,576.75
|
2026-09-01
|
|
B0105
|
HCPCS
|
Stroke; M > 34.25 & M < 38.85
|
3
|
1
|
—
|
—
|
$47,105.11
|
$47,693.19
|
$47,563.51
|
2026-09-01
|
|
B0604
|
HCPCS
|
Neurological; M < 25.85
|
3
|
1
|
—
|
—
|
$45,908.72
|
$46,464.16
|
$46,337.83
|
2026-09-01
|
|
J2327
|
HCPCS
|
Risankizum-rzaa 1mg Inj
|
29
|
10
|
$78,308.83
|
$78,308.83
|
$39.21
|
$64,213.24
|
$45,928.13
|
2026-09-01
|
|
C0505
|
HCPCS
|
Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2
|
3
|
1
|
—
|
—
|
$43,257.87
|
$45,536.70
|
$45,412.89
|
2026-09-01
|
|
B1004
|
HCPCS
|
Amputation, Lower Extremity; M=39-45
|
3
|
1
|
—
|
—
|
$42,419.11
|
$44,825.45
|
$44,703.57
|
2026-09-01
|
|
1142
|
OTHER
|
Supprelin La Implant
|
39
|
12
|
—
|
—
|
$37,491.97
|
$54,420.25
|
$44,480.90
|
2026-09-01
|
|
B1504
|
HCPCS
|
Pulmonary; M < 29.15
|
3
|
1
|
—
|
—
|
$41,926.92
|
$44,429.05
|
$44,308.25
|
2026-09-01
|
|
B0704
|
HCPCS
|
Fracture Of Lower Extremity; M < 28.15
|
3
|
1
|
—
|
—
|
$42,902.09
|
$43,509.18
|
$43,390.88
|
2026-09-01
|
|
A0404
|
HCPCS
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
3
|
1
|
—
|
—
|
$43,271.71
|
$44,068.98
|
$43,389.69
|
2026-09-01
|
|
1594
|
OTHER
|
New Technology - Level 43
|
39
|
12
|
—
|
—
|
$41,746.96
|
$50,520.80
|
$43,363.69
|
2026-09-01
|
|
1580
|
OTHER
|
New Technology - Level 43
|
39
|
12
|
—
|
—
|
$41,746.96
|
$50,520.80
|
$43,363.69
|
2026-09-01
|
|
B1304
|
HCPCS
|
Rheumatoid, Other Arthritis; M=12-35
|
3
|
1
|
—
|
—
|
$39,478.85
|
$43,456.07
|
$43,337.92
|
2026-09-01
|
|
D0106
|
HCPCS
|
Stroke; M > 30.05 & M < 34.25
|
3
|
1
|
—
|
—
|
$42,461.51
|
$43,222.78
|
$43,105.26
|
2026-09-01
|
|
B0904
|
HCPCS
|
Other Orthopedic; M < 24.15
|
3
|
1
|
—
|
—
|
$39,478.85
|
$42,640.51
|
$42,524.57
|
2026-09-01
|
|
D0505
|
HCPCS
|
Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2
|
3
|
1
|
—
|
—
|
$40,866.95
|
$42,363.60
|
$42,248.42
|
2026-09-01
|
|
C0105
|
HCPCS
|
Stroke; M > 34.25 & M < 38.85
|
3
|
1
|
—
|
—
|
$40,852.20
|
$42,352.22
|
$42,237.07
|
2026-09-01
|
|
941
|
OTHER
|
Riboflavin Epioxa/hd<=2ml
|
14
|
12
|
—
|
—
|
$40,427.50
|
$48,513.00
|
$41,842.46
|
2026-09-01
|
|
B2005
|
HCPCS
|
Miscellaneous; M=12-32 And A Tm81
|
3
|
1
|
—
|
—
|
$40,946.21
|
$41,950.13
|
$41,836.07
|
2026-09-01
|
|
B0504
|
HCPCS
|
Nontraumatic Spinal Cord Injury; M > 29.25 & M < 3
|
3
|
1
|
—
|
—
|
$40,015.28
|
$41,705.46
|
$41,592.07
|
2026-09-01
|
|
B1704
|
HCPCS
|
Major Multiple Trauma,no Brain Or Spinal Cord Inju
|
3
|
1
|
—
|
—
|
$41,187.70
|
$41,637.18
|
$41,523.97
|
2026-09-01
|
|
A5104
|
HCPCS
|
Expired, Not Orthopedic, Length Of Stay Is 16 Days
|
3
|
1
|
—
|
—
|
$41,387.79
|
$43,936.25
|
$41,500.62
|
2026-09-01
|
|
L7180
|
HCPCS
|
Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device…
|
39
|
12
|
—
|
—
|
$38,289.50
|
$47,991.12
|
$41,192.38
|
2026-09-01
|
|
C0205
|
HCPCS
|
Traumatic Brain Injury; M > 28.75 & M < 40.65
|
3
|
1
|
—
|
—
|
$40,059.53
|
$41,090.95
|
$40,979.22
|
2026-09-01
|
|
B0304
|
HCPCS
|
Nontraumatic Brain Injury; M < 26.15
|
3
|
1
|
—
|
—
|
$39,856.75
|
$41,034.05
|
$40,922.48
|
2026-09-01
|
|
A0106
|
HCPCS
|
Stroke; M > 30.05 & M < 34.25
|
3
|
1
|
—
|
—
|
$40,465.08
|
$40,998.01
|
$40,886.54
|
2026-09-01
|
|
J9228
|
HCPCS
|
Ipilimumab 1 Mg Inj
|
63
|
10
|
$69,399.15
|
$69,399.15
|
$427.29
|
$227,628.52
|
$40,702.60
|
2026-09-01
|
|
B1404
|
HCPCS
|
Cardiac; M < 31.15
|
3
|
1
|
—
|
—
|
$39,556.27
|
$40,717.31
|
$40,606.60
|
2026-09-01
|
|
B1204
|
HCPCS
|
Osteoarthritis; M=39-47
|
3
|
1
|
—
|
—
|
$40,254.93
|
$40,711.62
|
$40,600.92
|
2026-09-01
|
|
L2006
|
HCPCS
|
Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance…
|
39
|
12
|
—
|
—
|
$37,701.50
|
$47,254.08
|
$40,559.75
|
2026-09-01
|
|
C2102
|
HCPCS
|
Burns; M=12-45
|
3
|
1
|
—
|
—
|
$32,464.60
|
$40,582.65
|
$40,472.30
|
2026-09-01
|
|
B0204
|
HCPCS
|
Traumatic Brain Injury; M > 40.65 & M < 44.25
|
3
|
1
|
—
|
—
|
$37,970.92
|
$40,282.97
|
$40,173.45
|
2026-09-01
|
|
B2004
|
HCPCS
|
Miscellaneous; M < 27.85
|
3
|
1
|
—
|
—
|
$38,846.55
|
$40,078.14
|
$39,969.16
|
2026-09-01
|
|
B0805
|
HCPCS
|
Replacement Of Lower Extremity Joint; M > 22.05 &
|
3
|
1
|
—
|
—
|
$37,998.57
|
$39,658.98
|
$39,551.14
|
2026-09-01
|
|
B1203
|
HCPCS
|
Osteoarthritis; M < 30.75
|
3
|
1
|
—
|
—
|
$38,387.54
|
$39,545.18
|
$39,437.65
|
2026-09-01
|
|
B1804
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Code In
|
3
|
1
|
—
|
—
|
$36,842.74
|
$39,194.30
|
$39,087.73
|
2026-09-01
|
|
C0405
|
HCPCS
|
Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5
|
3
|
1
|
—
|
—
|
$38,900.47
|
$39,731.40
|
$39,006.53
|
2026-09-01
|
|
A0505
|
HCPCS
|
Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2
|
3
|
1
|
—
|
—
|
$37,659.38
|
$39,040.67
|
$38,934.52
|
2026-09-01
|
|
D0105
|
HCPCS
|
Stroke; M > 34.25 & M < 38.85
|
3
|
1
|
—
|
—
|
$37,331.25
|
$38,371.15
|
$38,266.82
|
2026-09-01
|
|
B0104
|
HCPCS
|
Stroke; M > 38.85 & M < 44.45
|
3
|
1
|
—
|
—
|
$37,670.44
|
$38,268.73
|
$38,164.68
|
2026-09-01
|
|
D0405
|
HCPCS
|
Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5
|
3
|
1
|
—
|
—
|
$37,877.17
|
$38,568.19
|
$37,980.44
|
2026-09-01
|
|
D0205
|
HCPCS
|
Traumatic Brain Injury; M > 28.75 & M < 40.65
|
3
|
1
|
—
|
—
|
$36,385.57
|
$37,540.42
|
$37,438.35
|
2026-09-01
|
|
C1004
|
HCPCS
|
Amputation, Lower Extremity; M=39-45
|
3
|
1
|
—
|
—
|
$35,082.27
|
$37,246.44
|
$37,145.16
|
2026-09-01
|
|
B0403
|
HCPCS
|
Traumatic Spinal Cord Injury; M > 16.05 & M < 30.3
|
3
|
1
|
—
|
—
|
$35,981.86
|
$37,181.95
|
$37,080.85
|
2026-09-01
|
|
B1902
|
HCPCS
|
Guillian Barre; M > 18.05 & M < 35.95
|
3
|
1
|
—
|
—
|
$30,683.85
|
$36,994.18
|
$36,893.60
|
2026-09-01
|
|
C1903
|
HCPCS
|
Guillian Barre; M < 18.05
|
3
|
1
|
—
|
—
|
$35,591.06
|
$36,992.28
|
$36,891.70
|
2026-09-01
|
|
B1103
|
HCPCS
|
Amputation, Non-lower Extremity; M=12-37
|
3
|
1
|
—
|
—
|
$36,589.06
|
$36,971.78
|
$36,688.82
|
2026-09-01
|
|
J1930
|
HCPCS
|
Lanreotide 120 Mg Inj
|
63
|
10
|
$62,502.98
|
$62,502.98
|
$124.20
|
$60,439.35
|
$36,658.00
|
2026-09-01
|
|
B0603
|
HCPCS
|
Neurological; M > 25.85 & M < 37.35
|
3
|
1
|
—
|
—
|
$36,606.79
|
$36,738.13
|
$36,638.24
|
2026-09-01
|
|
A0105
|
HCPCS
|
Stroke; M > 34.25 & M < 38.85
|
3
|
1
|
—
|
—
|
$35,578.15
|
$36,396.74
|
$36,297.77
|
2026-09-01
|
|
B1703
|
HCPCS
|
Maj Mult Trauma No Brain Or Spinal Cord Injury; M
|
3
|
1
|
—
|
—
|
$36,085.93
|
$36,389.26
|
$36,184.31
|
2026-09-01
|
|
L8701
|
HCPCS
|
Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand With S…
|
39
|
12
|
—
|
—
|
$33,480.90
|
$41,964.12
|
$36,019.20
|
2026-09-01
|
|
J9022
|
HCPCS
|
Atezolizumab 10 Mg Inj
|
63
|
10
|
$61,362.10
|
$61,362.10
|
$224.39
|
$68,380.19
|
$35,988.87
|
2026-09-01
|
|
C1504
|
HCPCS
|
Pulmonary; M < 29.15
|
3
|
1
|
—
|
—
|
$34,029.67
|
$35,723.42
|
$35,626.29
|
2026-09-01
|
|
C1721
|
HCPCS
|
Icd Defb Dlchmbr MRI Is1
|
44
|
10
|
$54,781.00
|
$54,781.00
|
$13,695.25
|
$48,515.30
|
$35,359.96
|
2026-03-01
|
|
B1503
|
HCPCS
|
Pulmonary; M > 29.15 & M < 39.05
|
3
|
1
|
—
|
—
|
$33,856.39
|
$35,429.44
|
$35,333.11
|
2026-09-01
|
|
B0903
|
HCPCS
|
Other Orthopedic; M > 24.15 & M < 34.35
|
3
|
1
|
—
|
—
|
$32,947.58
|
$35,410.48
|
$35,314.20
|
2026-09-01
|
|
A0205
|
HCPCS
|
Traumatic Brain Injury; M > 28.75 & M < 40.65
|
3
|
1
|
—
|
—
|
$34,256.42
|
$35,270.13
|
$35,174.23
|
2026-09-01
|
|
B0703
|
HCPCS
|
Fracture Of Lower Extremity; M > 28.15 & M < 34.15
|
3
|
1
|
—
|
—
|
$35,119.14
|
$35,235.99
|
$35,140.18
|
2026-09-01
|
|
J3380
|
HCPCS
|
Vedolizumab 300 Mg IV
|
29
|
10
|
$59,846.88
|
$59,846.88
|
$56.80
|
$49,074.44
|
$35,100.20
|
2026-09-01
|
|
C0604
|
HCPCS
|
Neurological; M < 25.85
|
3
|
1
|
—
|
—
|
$34,370.71
|
$35,188.57
|
$35,092.89
|
2026-09-01
|
|
B0503
|
HCPCS
|
Nontraumatic Spinal Cord Injury; M > 31.25 & M < 4
|
3
|
1
|
—
|
—
|
$33,662.83
|
$34,902.18
|
$34,807.28
|
2026-09-01
|
|
J1303
|
HCPCS
|
Ravuliz-cwvz 1100mg Inj
|
63
|
10
|
$59,246.46
|
$59,246.46
|
$578.70
|
$164,846.66
|
$34,748.05
|
2026-09-01
|
|
C0704
|
HCPCS
|
Fracture Of Lower Extremity; M < 28.15
|
3
|
1
|
—
|
—
|
$33,187.23
|
$34,788.38
|
$34,693.79
|
2026-09-01
|
|
C1304
|
HCPCS
|
Rheumatoid, Other Arthritis; M=12-35
|
3
|
1
|
—
|
—
|
$32,641.57
|
$34,742.86
|
$34,648.39
|
2026-09-01
|
|
C1103
|
HCPCS
|
Amputation, Non-lower Extremity; M=12-37
|
3
|
1
|
—
|
—
|
$29,719.74
|
$34,733.37
|
$34,638.93
|
2026-09-01
|
|
B0303
|
HCPCS
|
Nontraumatic Brain Injury; M > 26.15 & M < 35.05
|
3
|
1
|
—
|
—
|
$34,376.24
|
$34,636.64
|
$34,542.47
|
2026-09-01
|
|
J1932
|
HCPCS
|
505cp Lanreot 120 Mg Inj
|
29
|
10
|
$58,861.81
|
$58,861.81
|
$110.78
|
$48,266.68
|
$34,522.45
|
2026-09-01
|
|
A0405
|
HCPCS
|
Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5
|
3
|
1
|
—
|
—
|
$34,275.77
|
$35,045.40
|
$34,369.22
|
2026-09-01
|
|
566176
|
CDM
|
Device Emblz 5mm 20mm
|
22
|
10
|
$52,060.00
|
$52,060.00
|
$14,057.75
|
$46,109.42
|
$34,135.03
|
2026-03-01
|
|
C0104
|
HCPCS
|
Stroke; M > 38.85 & M < 44.45
|
3
|
1
|
—
|
—
|
$32,669.22
|
$33,984.20
|
$33,891.79
|
2026-09-01
|
|
J3101
|
HCPCS
|
Tenecteplase 1 Mg Inj
|
63
|
10
|
$57,533.64
|
$57,533.64
|
$468.10
|
$51,437.75
|
$33,743.48
|
2026-09-01
|
|
1579
|
OTHER
|
New Technology - Level 42
|
39
|
12
|
—
|
—
|
$32,469.96
|
$39,294.08
|
$33,727.42
|
2026-09-01
|
|
1593
|
OTHER
|
New Technology - Level 42
|
39
|
12
|
—
|
—
|
$32,469.96
|
$39,294.08
|
$33,727.42
|
2026-09-01
|
|
D1004
|
HCPCS
|
Amputation, Lower Extremity; M=39-45
|
3
|
1
|
—
|
—
|
$32,046.15
|
$33,805.91
|
$33,713.99
|
2026-09-01
|
|
B1003
|
HCPCS
|
Amputation, Lower Extremity; M < 36.25
|
3
|
1
|
—
|
—
|
$33,133.77
|
$33,699.70
|
$33,608.07
|
2026-09-01
|
|
B1303
|
HCPCS
|
Rheumatoid, Other Arthritis; M < 26.15
|
3
|
1
|
—
|
—
|
$31,260.85
|
$33,669.35
|
$33,577.81
|
2026-09-01
|
|
B1803
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord In
|
3
|
1
|
—
|
—
|
$33,468.10
|
$33,690.48
|
$33,559.35
|
2026-09-01
|
|
C2005
|
HCPCS
|
Miscellaneous; M=12-32 And A Tm81
|
3
|
1
|
—
|
—
|
$32,706.09
|
$33,642.80
|
$33,551.32
|
2026-09-01
|
|
D1504
|
HCPCS
|
Pulmonary; M < 29.15
|
3
|
1
|
—
|
—
|
$32,003.75
|
$33,455.03
|
$33,364.07
|
2026-09-01
|
|
C0805
|
HCPCS
|
Replacement Of Lower Extremity Joint; M > 22.05 &
|
3
|
1
|
—
|
—
|
$30,490.29
|
$33,401.92
|
$33,311.10
|
2026-09-01
|
|
D0604
|
HCPCS
|
Neurological; M < 25.85
|
3
|
1
|
—
|
—
|
$32,086.70
|
$33,143.98
|
$33,053.86
|
2026-09-01
|
|
D0704
|
HCPCS
|
Fracture Of Lower Extremity; M < 28.15
|
3
|
1
|
—
|
—
|
$31,437.81
|
$33,039.66
|
$32,949.83
|
2026-09-01
|
|
C1704
|
HCPCS
|
Major Multiple Trauma,no Brain Or Spinal Cord Inju
|
3
|
1
|
—
|
—
|
$32,014.81
|
$32,986.56
|
$32,896.87
|
2026-09-01
|
|
B2003
|
HCPCS
|
Miscellaneous; M > 27.85 & M < 38.75
|
3
|
1
|
—
|
—
|
$32,490.41
|
$32,861.38
|
$32,772.03
|
2026-09-01
|
|
C1404
|
HCPCS
|
Cardiac; M < 31.15
|
3
|
1
|
—
|
—
|
$31,161.30
|
$32,800.69
|
$32,711.50
|
2026-09-01
|
|
B0203
|
HCPCS
|
Traumatic Brain Injury; M > 44.25 & C < 23.5
|
3
|
1
|
—
|
—
|
$30,615.65
|
$32,684.99
|
$32,596.12
|
2026-09-01
|
|
B1403
|
HCPCS
|
Cardiac; M > 31.15 & M < 38.55
|
3
|
1
|
—
|
—
|
$32,282.10
|
$32,635.68
|
$32,546.94
|
2026-09-01
|
|
C0304
|
HCPCS
|
Nontraumatic Brain Injury; M < 26.15
|
3
|
1
|
—
|
—
|
$31,887.61
|
$32,521.88
|
$32,433.45
|
2026-09-01
|
|
779339
|
CDM
|
Cannula Dual 31fr 51cm
|
23
|
11
|
$47,047.00
|
$47,047.00
|
$10,670.40
|
$43,748.64
|
$32,229.94
|
2026-03-01
|
|
779338
|
CDM
|
Cannula Introd 29fx46cm
|
23
|
11
|
$47,047.00
|
$47,047.00
|
$10,670.40
|
$43,748.64
|
$32,229.94
|
2026-03-01
|
|
C1204
|
HCPCS
|
Osteoarthritis; M=39-47
|
3
|
1
|
—
|
—
|
$30,604.59
|
$32,313.25
|
$32,225.39
|
2026-09-01
|
|
C0904
|
HCPCS
|
Other Orthopedic; M < 24.15
|
3
|
1
|
—
|
—
|
$31,620.31
|
$32,298.07
|
$32,210.26
|
2026-09-01
|
|
A1903
|
HCPCS
|
Guillian Barre; M < 18.05
|
3
|
1
|
—
|
—
|
$32,079.74
|
$32,636.04
|
$32,167.20
|
2026-09-01
|
|
D1903
|
HCPCS
|
Guillian Barre; M < 18.05
|
3
|
1
|
—
|
—
|
$32,072.18
|
$33,211.19
|
$32,159.62
|
2026-09-01
|
|
5166
|
OTHER
|
Cochlear Implant Procedur
|
39
|
12
|
—
|
—
|
$29,641.31
|
$37,818.65
|
$32,145.85
|
2026-09-01
|
|
B0402
|
HCPCS
|
Traumatic Spinal Cord Injury; M > 30.35 & M < 48.4
|
3
|
1
|
—
|
—
|
$28,672.67
|
$32,214.62
|
$32,127.03
|
2026-09-01
|
|
C2004
|
HCPCS
|
Miscellaneous; M < 27.85
|
3
|
1
|
—
|
—
|
$31,028.57
|
$32,140.65
|
$32,053.26
|
2026-09-01
|
|
C1804
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Code In
|
3
|
1
|
—
|
—
|
$29,391.61
|
$32,064.78
|
$31,977.60
|
2026-09-01
|
|
C0504
|
HCPCS
|
Nontraumatic Spinal Cord Injury; M > 29.25 & M < 3
|
3
|
1
|
—
|
—
|
$31,129.96
|
$32,049.61
|
$31,962.47
|
2026-09-01
|
|
C0204
|
HCPCS
|
Traumatic Brain Injury; M > 40.65 & M < 44.25
|
3
|
1
|
—
|
—
|
$31,275.59
|
$32,028.75
|
$31,941.66
|
2026-09-01
|
|
J9307
|
HCPCS
|
Pralatrexate 20 Mg Inj
|
63
|
10
|
$54,403.52
|
$54,403.52
|
$723.00
|
$89,221.75
|
$31,907.66
|
2026-09-01
|
|
A1504
|
HCPCS
|
Pulmonary; M < 29.15
|
3
|
1
|
—
|
—
|
$29,937.26
|
$31,981.33
|
$31,894.38
|
2026-09-01
|
|
B0804
|
HCPCS
|
Replacement Of Lower Ext Joint; M > 28.65 & M < 37
|
3
|
1
|
—
|
—
|
$31,682.99
|
$31,840.98
|
$31,754.41
|
2026-09-01
|
|
D1304
|
HCPCS
|
Rheumatoid, Other Arthritis; M=12-35
|
3
|
1
|
—
|
—
|
$31,157.61
|
$31,833.39
|
$31,746.84
|
2026-09-01
|
|
A1004
|
HCPCS
|
Amputation, Lower Extremity; M=39-45
|
3
|
1
|
—
|
—
|
$28,711.39
|
$31,389.58
|
$31,304.23
|
2026-09-01
|
|
C1203
|
HCPCS
|
Osteoarthritis; M < 30.75
|
3
|
1
|
—
|
—
|
$29,183.30
|
$31,385.78
|
$31,300.45
|
2026-09-01
|
|
D2005
|
HCPCS
|
Miscellaneous; M=12-32 And A Tm81
|
3
|
1
|
—
|
—
|
$30,552.97
|
$31,287.16
|
$31,202.09
|
2026-09-01
|
|
C1722
|
HCPCS
|
Icd Xt MRI Df4
|
44
|
10
|
$51,998.00
|
$51,998.00
|
$12,568.75
|
$42,638.36
|
$31,076.60
|
2026-03-01
|
|
5232
|
OTHER
|
Level 2 Icd And Similar P
|
39
|
12
|
—
|
—
|
$29,079.67
|
$36,002.66
|
$30,902.29
|
2026-09-01
|
|
B0602
|
HCPCS
|
Neurological; M > 37.35 & M < 47.75
|
3
|
1
|
—
|
—
|
$30,810.55
|
$31,067.29
|
$30,894.55
|
2026-09-01
|
|
B1702
|
HCPCS
|
Maj Mult Trauma No Brain Or Spinal Cord Injury; M
|
3
|
1
|
—
|
—
|
$30,623.02
|
$30,839.55
|
$30,755.70
|
2026-09-01
|
|
B0502
|
HCPCS
|
Nontraumatic Spinal Cord Injury; M > 40.15 & M < 5
|
3
|
1
|
—
|
—
|
$29,367.65
|
$30,822.48
|
$30,738.67
|
2026-09-01
|
|
D0104
|
HCPCS
|
Stroke; M > 38.85 & M < 44.45
|
3
|
1
|
—
|
—
|
$29,854.31
|
$30,790.24
|
$30,706.52
|
2026-09-01
|
|
L5856
|
HCPCS
|
Addition To Lower Extremity Prosthesis, Endoskeletal Knee-shin System, Microproc…
|
39
|
12
|
—
|
—
|
$28,454.30
|
$35,664.00
|
$30,611.60
|
2026-09-01
|
|
D2102
|
HCPCS
|
Burns; M=12-45
|
3
|
1
|
—
|
—
|
$30,521.15
|
$32,464.60
|
$30,604.36
|
2026-09-01
|
|
D1704
|
HCPCS
|
Major Multiple Trauma,no Brain Or Spinal Cord Inju
|
3
|
1
|
—
|
—
|
$29,649.69
|
$30,627.12
|
$30,543.85
|
2026-09-01
|
|
L6700
|
HCPCS
|
Upper Extremity Addition, External Powered Feature, Myoelectronic Control Module…
|
28
|
12
|
—
|
—
|
$29,510.20
|
$35,412.24
|
$30,543.06
|
2026-09-01
|
|
L6880
|
HCPCS
|
Electric Hand, Switch Or Myoelectric Controlled, Independently Articulating Digi…
|
39
|
12
|
—
|
—
|
$28,320.00
|
$35,495.64
|
$30,467.09
|
2026-09-01
|
|
D0904
|
HCPCS
|
Other Orthopedic; M < 24.15
|
3
|
1
|
—
|
—
|
$29,472.72
|
$30,509.53
|
$30,426.58
|
2026-09-01
|
|
C0403
|
HCPCS
|
Traumatic Spinal Cord Injury; M > 16.05 & M < 30.3
|
3
|
1
|
—
|
—
|
$30,309.30
|
$31,998.22
|
$30,391.94
|
2026-09-01
|
|
B2101
|
HCPCS
|
Burns; M > 0
|
3
|
1
|
—
|
—
|
$27,741.74
|
$30,462.11
|
$30,379.29
|
2026-09-01
|
|
C1882
|
HCPCS
|
Defib Cardiac Crtd
|
132
|
10
|
$50,436.00
|
$50,436.00
|
$8,692.00
|
$50,395.56
|
$30,351.30
|
2026-03-01
|
|
B1502
|
HCPCS
|
Pulmonary; M > 39.05 & M < 49.25
|
3
|
1
|
—
|
—
|
$29,789.79
|
$30,388.15
|
$30,305.52
|
2026-09-01
|
|
D1404
|
HCPCS
|
Cardiac; M < 31.15
|
3
|
1
|
—
|
—
|
$28,973.15
|
$30,329.35
|
$30,246.88
|
2026-09-01
|
|
D0304
|
HCPCS
|
Nontraumatic Brain Injury; M < 26.15
|
3
|
1
|
—
|
—
|
$29,292.06
|
$30,317.97
|
$30,235.54
|
2026-09-01
|
|
A0704
|
HCPCS
|
Fracture Of Lower Extremity; M < 28.15
|
3
|
1
|
—
|
—
|
$29,045.05
|
$30,190.89
|
$30,108.81
|
2026-09-01
|
|
5465
|
OTHER
|
Level 5 Neurostimulator A
|
39
|
12
|
—
|
—
|
$27,447.20
|
$35,393.42
|
$30,084.41
|
2026-09-01
|
|
B0103
|
HCPCS
|
Stroke; M > 44.45 & M < 51.05 & C < 18.5
|
3
|
1
|
—
|
—
|
$29,516.96
|
$29,963.30
|
$29,881.83
|
2026-09-01
|
|
D1103
|
HCPCS
|
Amputation, Non-lower Extremity; M=12-37
|
3
|
1
|
—
|
—
|
$29,719.74
|
$29,891.22
|
$29,809.95
|
2026-09-01
|
|
D2004
|
HCPCS
|
Miscellaneous; M < 27.85
|
3
|
1
|
—
|
—
|
$28,986.06
|
$29,891.22
|
$29,809.95
|
2026-09-01
|
|
D0805
|
HCPCS
|
Replacement Of Lower Extremity Joint; M > 22.05 &
|
3
|
1
|
—
|
—
|
$27,798.89
|
$29,857.08
|
$29,775.90
|
2026-09-01
|
|
B0902
|
HCPCS
|
Other Orthopedic; M > 34.35 & M < 44.75
|
3
|
1
|
—
|
—
|
$27,590.58
|
$29,840.01
|
$29,758.88
|
2026-09-01
|
|
D0504
|
HCPCS
|
Nontraumatic Spinal Cord Injury; M > 29.25 & M < 3
|
3
|
1
|
—
|
—
|
$29,410.04
|
$29,815.36
|
$29,734.29
|
2026-09-01
|
|
A0604
|
HCPCS
|
Neurological; M < 25.85
|
3
|
1
|
—
|
—
|
$28,938.13
|
$29,769.84
|
$29,688.89
|
2026-09-01
|
|
843
|
OTHER
|
Pegaspargase Injection
|
39
|
12
|
—
|
—
|
$27,070.53
|
$35,596.75
|
$29,663.96
|
2026-09-01
|
|
D0403
|
HCPCS
|
Traumatic Spinal Cord Injury; M > 16.05 & M < 30.3
|
3
|
1
|
—
|
—
|
$29,511.09
|
$31,061.76
|
$29,591.55
|
2026-09-01
|
|
B1202
|
HCPCS
|
Osteoarthritis; M > 30.75 & M < 37.65
|
3
|
1
|
—
|
—
|
$29,461.91
|
$29,631.26
|
$29,542.24
|
2026-09-01
|
|
D1804
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Code In
|
3
|
1
|
—
|
—
|
$27,902.12
|
$29,496.72
|
$29,416.52
|
2026-09-01
|
|
J1299
|
HCPCS
|
Eculizumab 300 Mg Inj
|
21
|
10
|
$48,029.48
|
$48,029.48
|
$19,538.39
|
$39,384.17
|
$29,297.98
|
2026-09-01
|
|
B1102
|
HCPCS
|
Amputation, Non-lower Extremity; M < 36.35
|
3
|
1
|
—
|
—
|
$29,212.24
|
$29,647.85
|
$29,291.88
|
2026-09-01
|
|
A2102
|
HCPCS
|
Burns; M=12-45
|
3
|
1
|
—
|
—
|
$27,725.15
|
$29,348.78
|
$29,268.98
|
2026-09-01
|
|
B0302
|
HCPCS
|
Nontraumatic Brain Injury; M > 35.05 & M < 41.05
|
3
|
1
|
—
|
—
|
$28,569.44
|
$29,293.78
|
$29,214.13
|
2026-09-01
|
|
D0204
|
HCPCS
|
Traumatic Brain Injury; M > 40.65 & M < 44.25
|
3
|
1
|
—
|
—
|
$28,405.38
|
$29,261.53
|
$29,181.97
|
2026-09-01
|
|
A0104
|
HCPCS
|
Stroke; M > 38.85 & M < 44.45
|
3
|
1
|
—
|
—
|
$28,451.46
|
$29,204.63
|
$29,125.23
|
2026-09-01
|
|
B1302
|
HCPCS
|
Rheumatoid, Other Arthritis; M > 26.15 & M < 36.35
|
3
|
1
|
—
|
—
|
$27,478.13
|
$29,132.56
|
$29,053.35
|
2026-09-01
|
|
B1603
|
HCPCS
|
Pain Syndrome: M < 26.75
|
3
|
1
|
—
|
—
|
$28,972.02
|
$34,927.42
|
$29,051.01
|
2026-09-01
|
|
A1304
|
HCPCS
|
Rheumatoid, Other Arthritis; M=12-35
|
3
|
1
|
—
|
—
|
$28,837.72
|
$28,986.06
|
$28,916.34
|
2026-09-01
|
|
D1204
|
HCPCS
|
Osteoarthritis; M=39-47
|
3
|
1
|
—
|
—
|
$28,694.79
|
$28,876.51
|
$28,798.00
|
2026-09-01
|
|
J1412
|
HCPCS
|
Injection, Valoctocogene Roxaparvovec-rvox, Per Ml, Containing Nominal 2 X 10°13…
|
12
|
1
|
—
|
—
|
$28,750.78
|
$28,750.78
|
$28,750.78
|
2026-09-01
|
|
B0702
|
HCPCS
|
Fracture Of Lower Extremity; M > 34.15 & M < 42.15
|
3
|
1
|
—
|
—
|
$28,558.38
|
$28,762.72
|
$28,684.51
|
2026-09-01
|
|
J2323
|
HCPCS
|
Natalizumab 300 Mg Inj
|
29
|
10
|
$48,744.97
|
$48,744.97
|
$59.77
|
$39,970.88
|
$28,588.92
|
2026-09-01
|
|
C1703
|
HCPCS
|
Maj Mult Trauma No Brain Or Spinal Cord Injury; M
|
3
|
1
|
—
|
—
|
$28,285.55
|
$28,665.99
|
$28,588.04
|
2026-09-01
|
|
A2005
|
HCPCS
|
Miscellaneous; M=12-32 And A Tm81
|
3
|
1
|
—
|
—
|
$27,809.95
|
$28,641.33
|
$28,563.45
|
2026-09-01
|
|
C1503
|
HCPCS
|
Pulmonary; M > 29.15 & M < 39.05
|
3
|
1
|
—
|
—
|
$27,478.13
|
$28,487.70
|
$28,410.24
|
2026-09-01
|
|
A0304
|
HCPCS
|
Nontraumatic Brain Injury; M < 26.15
|
3
|
1
|
—
|
—
|
$27,609.02
|
$28,383.38
|
$28,306.21
|
2026-09-01
|
|
B1002
|
HCPCS
|
Amputation, Lower Extremity; M > 36.25 & M < 47.65
|
3
|
1
|
—
|
—
|
$28,238.12
|
$28,315.11
|
$28,280.02
|
2026-09-01
|
|
A1704
|
HCPCS
|
Major Multiple Trauma,no Brain Or Spinal Cord Inju
|
3
|
1
|
—
|
—
|
$26,899.30
|
$28,195.62
|
$28,118.95
|
2026-09-01
|
|
C0703
|
HCPCS
|
Fracture Of Lower Extremity; M > 28.15 & M < 34.15
|
3
|
1
|
—
|
—
|
$27,166.59
|
$28,172.86
|
$28,096.26
|
2026-09-01
|
|
B0803
|
HCPCS
|
Replacement Of Lower Ext Joint; M > 28.65 & M < 37
|
3
|
1
|
—
|
—
|
$27,952.50
|
$28,280.02
|
$28,028.71
|
2026-09-01
|
|
D1203
|
HCPCS
|
Osteoarthritis; M < 30.75
|
3
|
1
|
—
|
—
|
$27,363.84
|
$28,047.68
|
$27,971.42
|
2026-09-01
|
|
5200
|
OTHER
|
Implantation Wireless Pa
|
39
|
12
|
—
|
—
|
$25,690.30
|
$32,899.48
|
$27,964.55
|
2026-09-01
|
|
C1003
|
HCPCS
|
Amputation, Lower Extremity; M < 36.25
|
3
|
1
|
—
|
—
|
$27,402.55
|
$28,002.16
|
$27,926.02
|
2026-09-01
|
|
B2002
|
HCPCS
|
Miscellaneous; M > 38.75 & M < 49.15
|
3
|
1
|
—
|
—
|
$27,131.57
|
$27,985.09
|
$27,909.00
|
2026-09-01
|
|
A0805
|
HCPCS
|
Replacement Of Lower Extremity Joint; M > 22.05 &
|
3
|
1
|
—
|
—
|
$25,927.81
|
$27,973.71
|
$27,897.65
|
2026-09-01
|
|
A1404
|
HCPCS
|
Cardiac; M < 31.15
|
3
|
1
|
—
|
—
|
$26,659.65
|
$27,890.26
|
$27,814.42
|
2026-09-01
|
|
A0904
|
HCPCS
|
Other Orthopedic; M < 24.15
|
3
|
1
|
—
|
—
|
$26,965.66
|
$27,833.36
|
$27,757.68
|
2026-09-01
|
|
C0603
|
HCPCS
|
Neurological; M > 25.85 & M < 37.35
|
3
|
1
|
—
|
—
|
$27,406.24
|
$27,823.87
|
$27,748.22
|
2026-09-01
|
|
C1102
|
HCPCS
|
Amputation, Non-lower Extremity; M < 36.35
|
3
|
1
|
—
|
—
|
$23,831.83
|
$27,730.94
|
$27,655.54
|
2026-09-01
|
|
A1804
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Code In
|
3
|
1
|
—
|
—
|
$25,870.66
|
$27,685.42
|
$27,610.14
|
2026-09-01
|
|
C0303
|
HCPCS
|
Nontraumatic Brain Injury; M > 26.15 & M < 35.05
|
3
|
1
|
—
|
—
|
$27,377.49
|
$27,502.10
|
$27,452.13
|
2026-09-01
|
|
A0204
|
HCPCS
|
Traumatic Brain Injury; M > 40.65 & M < 44.25
|
3
|
1
|
—
|
—
|
$26,744.45
|
$27,491.96
|
$27,417.21
|
2026-09-01
|
|
A0504
|
HCPCS
|
Nontraumatic Spinal Cord Injury; M > 29.25 & M < 3
|
3
|
1
|
—
|
—
|
$27,102.07
|
$27,476.79
|
$27,402.08
|
2026-09-01
|
|
C1803
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord In
|
3
|
1
|
—
|
—
|
$26,877.17
|
$27,454.03
|
$27,379.38
|
2026-09-01
|
|
A2004
|
HCPCS
|
Miscellaneous; M < 27.85
|
3
|
1
|
—
|
—
|
$26,383.14
|
$27,362.99
|
$27,288.59
|
2026-09-01
|
|
B1402
|
HCPCS
|
Cardiac; M > 38.55 & M < 48.85
|
3
|
1
|
—
|
—
|
$26,383.14
|
$27,000.73
|
$26,927.31
|
2026-09-01
|
|
B1802
|
HCPCS
|
Maj Mult Trauma W Brain Or Spinal Cord Injury; M >
|
3
|
1
|
—
|
—
|
$26,222.76
|
$26,976.07
|
$26,902.72
|
2026-09-01
|
|
C1303
|
HCPCS
|
Rheumatoid, Other Arthritis; M < 26.15
|
3
|
1
|
—
|
—
|
$25,848.54
|
$26,917.27
|
$26,844.09
|
2026-09-01
|
|
5117
|
OTHER
|
Level 7 Musculoskeletal P
|
28
|
12
|
—
|
—
|
$25,935.34
|
$31,122.41
|
$26,843.08
|
2026-09-01
|
|
A0403
|
HCPCS
|
Traumatic Spinal Cord Injury; M > 16.05 & M < 30.3
|
3
|
1
|
—
|
—
|
$26,704.12
|
$28,224.72
|
$26,776.92
|
2026-09-01
|
|
C0503
|
HCPCS
|
Nontraumatic Spinal Cord Injury; M > 31.25 & M < 4
|
3
|
1
|
—
|
—
|
$26,187.73
|
$26,822.44
|
$26,749.51
|
2026-09-01
|
|
C0903
|
HCPCS
|
Other Orthopedic; M > 24.15 & M < 34.35
|
3
|
1
|
—
|
—
|
$26,388.67
|
$26,820.54
|
$26,747.62
|
2026-09-01
|
|
C0804
|
HCPCS
|
Replacement Of Lower Ext Joint; M > 28.65 & M < 37
|
3
|
1
|
—
|
—
|
$25,422.71
|
$26,818.65
|
$26,745.73
|
2026-09-01
|
|
D0703
|
HCPCS
|
Fracture Of Lower Extremity; M > 28.15 & M < 34.15
|
3
|
1
|
—
|
—
|
$25,734.25
|
$26,757.95
|
$26,685.20
|
2026-09-01
|
|
A1204
|
HCPCS
|
Osteoarthritis; M=39-47
|
3
|
1
|
—
|
—
|
$26,233.82
|
$26,742.78
|
$26,670.07
|
2026-09-01
|
|
D1503
|
HCPCS
|
Pulmonary; M > 29.15 & M < 39.05
|
3
|
1
|
—
|
—
|
$25,843.01
|
$26,678.30
|
$26,605.76
|
2026-09-01
|
|
D1703
|
HCPCS
|
Maj Mult Trauma No Brain Or Spinal Cord Injury; M
|
3
|
1
|
—
|
—
|
$26,196.95
|
$26,615.71
|
$26,543.34
|
2026-09-01
|
|
C0103
|
HCPCS
|
Stroke; M > 44.45 & M < 51.05 & C < 18.5
|
3
|
1
|
—
|
—
|
$25,599.68
|
$26,608.12
|
$26,535.77
|
2026-09-01
|
|
1578
|
OTHER
|
New Technology - Level 41
|
39
|
12
|
—
|
—
|
$25,512.21
|
$30,874.04
|
$26,500.22
|
2026-09-01
|
|
1592
|
OTHER
|
New Technology - Level 41
|
39
|
12
|
—
|
—
|
$25,512.21
|
$30,874.04
|
$26,500.22
|
2026-09-01
|
|
C2003
|
HCPCS
|
Miscellaneous; M > 27.85 & M < 38.75
|
3
|
1
|
—
|
—
|
$25,951.77
|
$26,353.97
|
$26,282.31
|
2026-09-01
|
|
C0402
|
HCPCS
|
Traumatic Spinal Cord Injury; M > 30.35 & M < 48.4
|
3
|
1
|
—
|
—
|
$25,498.29
|
$26,331.21
|
$26,259.61
|
2026-09-01
|
|
B0202
|
HCPCS
|
Traumatic Brain Injury; M > 44.25 & M < 53.35 & C
|
3
|
1
|
—
|
—
|
$24,583.95
|
$26,289.48
|
$26,218.00
|
2026-09-01
|
|
C1403
|
HCPCS
|
Cardiac; M > 31.15 & M < 38.55
|
3
|
1
|
—
|
—
|
$25,431.93
|
$26,289.48
|
$26,218.00
|
2026-09-01
|
|
A1103
|
HCPCS
|
Amputation, Non-lower Extremity; M=12-37
|
3
|
1
|
—
|
—
|
$26,081.81
|
$29,118.78
|
$26,152.92
|
2026-09-01
|
|
D0603
|
HCPCS
|
Neurological; M > 25.85 & M < 37.35
|
3
|
1
|
—
|
—
|
$25,584.93
|
$26,206.03
|
$26,134.78
|
2026-09-01
|
|
C1902
|
HCPCS
|
Guillian Barre; M > 18.05 & M < 35.95
|
3
|
1
|
—
|
—
|
$23,590.34
|
$26,145.34
|
$26,074.25
|
2026-09-01
|
|
C1603
|
HCPCS
|
Pain Syndrome: M < 26.75
|
3
|
1
|
—
|
—
|
$25,942.56
|
$26,035.33
|
$25,964.54
|
2026-09-01
|
|
C0203
|
HCPCS
|
Traumatic Brain Injury; M > 44.25 & C < 23.5
|
3
|
1
|
—
|
—
|
$25,216.25
|
$25,987.91
|
$25,917.25
|
2026-09-01
|
|
A1203
|
HCPCS
|
Osteoarthritis; M < 30.75
|
3
|
1
|
—
|
—
|
$25,015.31
|
$25,976.53
|
$25,905.91
|
2026-09-01
|
|
B0401
|
HCPCS
|
Traumatic Spinal Cord Injury; M > 48.45
|
3
|
1
|
—
|
—
|
$22,231.74
|
$25,695.83
|
$25,625.96
|
2026-09-01
|
|
B1101
|
HCPCS
|
Amputation, Non-lower Extremity; M > 36.35
|
3
|
1
|
—
|
—
|
$23,319.36
|
$25,650.31
|
$25,580.57
|
2026-09-01
|
|
D0402
|
HCPCS
|
Traumatic Spinal Cord Injury; M > 30.35 & M < 48.4
|
3
|
1
|
—
|
—
|
$24,751.70
|
$25,638.93
|
$25,569.22
|
2026-09-01
|
|
C2101
|
HCPCS
|
Burns; M > 0
|
3
|
1
|
—
|
—
|
$21,079.59
|
$25,610.48
|
$25,540.85
|
2026-09-01
|
|
D0303
|
HCPCS
|
Nontraumatic Brain Injury; M > 26.15 & M < 35.05
|
3
|
1
|
—
|
—
|
$25,264.18
|
$25,593.41
|
$25,523.82
|
2026-09-01
|
|
5213
|
OTHER
|
Level 3 Electrophysiologi
|
39
|
12
|
—
|
—
|
$20,993.10
|
$29,979.83
|
$25,482.85
|
2026-09-01
|
|
A1503
|
HCPCS
|
Pulmonary; M > 29.15 & M < 39.05
|
3
|
1
|
—
|
—
|
$24,174.71
|
$25,502.37
|
$25,433.03
|
2026-09-01
|
|
B0802
|
HCPCS
|
Replacement Of Lower Extremity Joint; M > 37.05 &
|
3
|
1
|
—
|
—
|
$25,398.98
|
$25,468.23
|
$25,407.96
|
2026-09-01
|
|
0128
|
RC
|
Room & Board - Semi-private (Two Beds) Rehabilitation
|
9,311
|
11
|
—
|
—
|
$1,583.00
|
$66,040.12
|
$25,407.71
|
2026-09-01
|
|
0118
|
RC
|
Room & Board - Private (One Bed) Rehabilitation
|
9,311
|
11
|
—
|
—
|
$1,552.00
|
$66,040.12
|
$25,407.71
|
2026-09-01
|
|
0148
|
RC
|
Room & Board - Deluxe Private Rehabilitation
|
9,311
|
11
|
—
|
—
|
$1,583.00
|
$66,040.12
|
$25,407.71
|
2026-09-01
|
|
0138
|
RC
|
Room & Board - Three And Four Beds Rehabilitation
|
9,311
|
11
|
—
|
—
|
$1,583.00
|
$66,040.12
|
$25,407.71
|
2026-09-01
|
|
0158
|
RC
|
Room & Board - Ward Rehabilitation
|
8,617
|
10
|
—
|
—
|
$1,583.00
|
$66,040.12
|
$25,368.40
|
2026-09-01
|
|
B1901
|
HCPCS
|
Guillian Barre; M > 35.95
|
3
|
1
|
—
|
—
|
$19,175.33
|
$25,428.40
|
$25,359.26
|
2026-09-01
|
|
D1003
|
HCPCS
|
Amputation, Lower Extremity; M < 36.25
|
3
|
1
|
—
|
—
|
$25,031.90
|
$25,415.13
|
$25,346.02
|
2026-09-01
|
|
D0903
|
HCPCS
|
Other Orthopedic; M > 24.15 & M < 34.35
|
3
|
1
|
—
|
—
|
$24,596.85
|
$25,335.47
|
$25,266.58
|
2026-09-01
|
|
D1803
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord In
|
3
|
1
|
—
|
—
|
$25,187.14
|
$25,516.73
|
$25,255.81
|
2026-09-01
|
|
0024
|
RC
|
Maj Mult Trauma No Brain Or Spinal Cord Injury; M
|
3,452
|
3
|
—
|
—
|
$3,031.02
|
$66,040.12
|
$25,139.75
|
2026-09-01
|
|
B1201
|
HCPCS
|
Osteoarthritis; M > 37.65
|
3
|
1
|
—
|
—
|
$24,475.19
|
$25,124.94
|
$25,056.62
|
2026-09-01
|
|
B1701
|
HCPCS
|
Major Multiple Trauma No Brain Or Spinal Cord Inju
|
3
|
1
|
—
|
—
|
$24,648.47
|
$25,018.73
|
$24,950.70
|
2026-09-01
|
|
D0503
|
HCPCS
|
Nontraumatic Spinal Cord Injury; M > 31.25 & M < 4
|
3
|
1
|
—
|
—
|
$24,740.64
|
$24,952.34
|
$24,884.50
|
2026-09-01
|
|
856
|
OTHER
|
Porfimer Sodium Injection
|
25
|
12
|
—
|
—
|
$23,870.14
|
$29,074.10
|
$24,824.95
|
2026-03-01
|
|
B1501
|
HCPCS
|
Pulmonary; M > 49.25
|
3
|
1
|
—
|
—
|
$23,483.42
|
$24,851.82
|
$24,784.25
|
2026-09-01
|
|
B0601
|
HCPCS
|
Neurological; M > 47.75
|
3
|
1
|
—
|
—
|
$24,493.62
|
$24,836.65
|
$24,769.12
|
2026-09-01
|
|
B0501
|
HCPCS
|
Nontraumatic Spinal Cord Injury; M > 51.35
|
3
|
1
|
—
|
—
|
$23,409.69
|
$24,827.16
|
$24,759.66
|
2026-09-01
|
|
D1303
|
HCPCS
|
Rheumatoid, Other Arthritis; M < 26.15
|
3
|
1
|
—
|
—
|
$24,596.99
|
$24,672.44
|
$24,664.05
|
2026-09-01
|
|
D2003
|
HCPCS
|
Miscellaneous; M > 27.85 & M < 38.75
|
3
|
1
|
—
|
—
|
$24,242.92
|
$24,508.53
|
$24,441.89
|
2026-09-01
|
|
A1703
|
HCPCS
|
Maj Mult Trauma No Brain Or Spinal Cord Injury; M
|
3
|
1
|
—
|
—
|
$23,767.31
|
$24,502.84
|
$24,436.21
|
2026-09-01
|