Price Transparency Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

Rehabilitation Hospital Of Northwest Ohio Llc

Toledo, OH · CCN 363040 · Rates published

2,713 distinct procedures filed
35 distinct payers
26,770 rate rows
2026-05-06 last MRF observed
Data quality

10,978 of 26,770 rate rows are consumer-grade (41.0%)

15,792 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 14,076
per-diem day rate — not a per-procedure price 1,716
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://ernesthealth.com/pricing/2026/464161868_rehabilitation-hospital-of-northwest-ohio_standard-charges.json
Found on page https://rhno.ernesthealth.com/price-transparency/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-05-17
Content fingerprint 8ebf49e0e40a269a… · 7,204,377 bytes · first seen 2026-05-05

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
D0404
LOCAL 		Traumatic Spinal Cord Injury M <31.50 And A <61.50- Tier Tier 3 1 $45,004.05 $72,132.98 $58,568.51 nat. median
$49,042
1.2× median
C1806
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier Tier 2 1 $52,309.80 $52,309.80 $52,309.80 nat. median
$51,172
1.0× median
B0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier Tier 1 4 $47,882.43 $68,578.82 $47,882.43 nat. median
$53,762
0.9× median
C0406
LOCAL 		Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50- Tier Tier 2 1 $46,232.06 $46,232.06 $46,232.06 nat. median
$52,063
0.9× median
B1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 1 1 $45,495.37 $45,495.37 $45,495.37 nat. median
$48,876
0.9× median
C0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier Tier 2 1 $44,776.19 $44,776.19 $44,776.19 nat. median
$46,986
1.0× median
A0406
LOCAL 		Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50- Tier None 1 $40,780.23 $40,780.23 $40,780.23 nat. median
$45,230
0.9× median
D0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier Tier 3 8 $20,901.33 $40,567.91 $37,948.11 nat. median
$42,703
0.9× median
D0505
LOCAL 		Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 3 3 $36,523.04 $37,268.41 $37,268.41 nat. median
$41,099
0.9× median
B2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 1 1 $36,864.08 $36,864.08 $36,864.08 nat. median
$39,191
0.9× median
C0205
LOCAL 		Traumatic Brain Injury M <35.50- Tier Tier 2 1 $36,532.08 $36,532.08 $36,532.08 nat. median
$40,508
0.9× median
C0105
LOCAL 		Stroke M <41.50 And A >=84.50- Tier Tier 2 1 $36,509.86 $36,509.86 $36,509.86 nat. median
$41,402
0.9× median
A0106
LOCAL 		Stroke M <41.50 And A <84.50- Tier None 6 $36,163.89 $37,710.19 $36,163.89 nat. median
$39,573
0.9× median
B1404
LOCAL 		Cardiac M <45.50- Tier Tier 1 1 $36,073.14 $36,073.14 $36,073.14 nat. median
$39,603
0.9× median
B0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 1 1 $36,002.54 $36,002.54 $36,002.54 nat. median
$40,010
0.9× median
A1806
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier None 1 $33,483.31 $33,483.31 $33,483.31 nat. median
$45,144
0.7× median
D0105
LOCAL 		Stroke M <41.50 And A >=84.50- Tier Tier 3 4 $33,363.17 $36,014.28 $33,363.17 nat. median
$37,662
0.9× median
D0205
LOCAL 		Traumatic Brain Injury M <35.50- Tier Tier 3 1 $33,181.64 $33,181.64 $33,181.64 nat. median
$36,592
0.9× median
C1805
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T… 1 $32,495.75 $32,495.75 $32,495.75 nat. median
$36,594
0.9× median
C0305
LOCAL 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 2 1 $32,070.43 $32,070.43 $32,070.43 nat. median
$35,561
0.9× median
A0105
LOCAL 		Stroke M <41.50 And A >=84.50- Tier None 3 $31,796.41 $32,445.32 $31,796.41 nat. median
$35,375
0.9× median
D1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3 3 $30,069.61 $31,730.85 $31,730.85 nat. median
$34,992
0.9× median
A1805
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T… 2 $30,550.56 $32,473.10 $31,511.83 nat. median
$31,725
1.0× median
A0205
LOCAL 		Traumatic Brain Injury M <35.50- Tier None 2 $30,615.17 $31,239.97 $30,927.57 nat. median
$33,234
0.9× median
A1705
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier None 1 $30,807.33 $30,807.33 $30,807.33 nat. median
$31,920
1.0× median
C0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 2 1 $30,264.93 $30,264.93 $30,264.93 nat. median
$33,146
0.9× median
C2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 2 2 $29,826.16 $29,826.16 $29,826.16 nat. median
$32,921
0.9× median
B2003
LOCAL 		Miscellaneous M >=46.50 And M <55.50- Tier Tier 1 1 $29,629.47 $29,629.47 $29,629.47 nat. median
$32,854
0.9× median
D0604
LOCAL 		Neurological M <43.50- Tier Tier 3 3 $28,676.08 $29,261.31 $29,261.31 nat. median
$32,269
0.9× median
D0305
LOCAL 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 3 4 $28,870.49 $29,459.68 $28,870.49 nat. median
$32,319
0.9× median
C0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 2 1 $28,835.99 $28,835.99 $28,835.99 nat. median
$31,818
0.9× median
B0103
LOCAL 		Stroke M >=50.50 And M <63.50- Tier Tier 1 1 $28,759.79 $28,759.79 $28,759.79 nat. median
$29,914
1.0× median
D1004
LOCAL 		Amputation Lower Extremity M <47.50- Tier Tier 3 3 $28,639.83 $29,224.32 $28,639.83 nat. median
$32,228
0.9× median
D0304
LOCAL 		Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 3 1 $28,455.75 $28,455.75 $28,455.75 nat. median
$29,475
1.0× median
D1304
LOCAL 		Rheumatoid Other Arthritis M <44.50 And A >=64.50- Tier Tier 3 1 $28,414.03 $28,414.03 $28,414.03 nat. median
$31,538
0.9× median
D0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier Tier 3 5 $15,735.32 $28,669.56 $28,382.86 nat. median
$31,616
0.9× median
C1404
LOCAL 		Cardiac M <45.50- Tier Tier 2 2 $27,849.04 $28,417.39 $28,133.22 nat. median
$30,962
0.9× median
A0604
LOCAL 		Neurological M <43.50- Tier None 1 $27,941.28 $27,941.28 $27,941.28 nat. median
$28,952
1.0× median
A0305
LOCAL 		Non-traumatic Brain Injury M <42.50 And A <78.50- Tier None 2 $27,766.80 $28,598.41 $27,766.80 nat. median
$30,648
0.9× median
C2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 2 1 $27,730.42 $27,730.42 $27,730.42 nat. median
$31,232
0.9× median
D2005
LOCAL 		Miscellaneous M <46.50 And A <77.50- Tier Tier 3 6 $23,470.36 $27,862.63 $27,305.38 nat. median
$30,727
0.9× median
A1504
LOCAL 		Pulmonary M <45.50- Tier None 1 $27,301.14 $27,301.14 $27,301.14 nat. median
$30,273
0.9× median
D0904
LOCAL 		Other Orthopedic M <44.5- Tier Tier 3 4 $26,877.50 $28,062.83 $26,877.50 nat. median
$29,640
0.9× median
D0504
LOCAL 		Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 3 4 $26,283.93 $26,873.96 $26,820.34 nat. median
$29,577
0.9× median
D0104
LOCAL 		Stroke M >=41.50 And M <50.50- Tier Tier 3 10 $5,955.58 $28,899.00 $26,680.98 nat. median
$30,024
0.9× median
A1704
LOCAL 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 1 $26,463.76 $26,463.76 $26,463.76 nat. median
$27,261
1.0× median
D2004
LOCAL 		Miscellaneous M <46.50 And A >=77.50- Tier Tier 3 3 $25,905.02 $26,433.69 $25,905.02 nat. median
$29,151
0.9× median
A0505
LOCAL 		Non-traumatic Spinal Cord Injury M <39.50- Tier None 2 $2,575.75 $35,909.82 $19,242.78 nat. median
$37,907
0.5× median
D1404
LOCAL 		Cardiac M <45.50- Tier Tier 3 2 $11,697.85 $26,421.92 $19,059.88 nat. median
$29,138
0.7× median
A0704
LOCAL 		Fracture Of Lower Extremity M <41.50- Tier None 4 $17,248.41 $26,487.48 $17,248.41 nat. median
$29,236
0.6× median

Other procedures at this hospital

Browse this hospital's 2,713 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
C1806 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier Tier 2 1 1 — — $52,309.80 $52,309.80 $52,309.80 2026-03-17
B0106 LOCAL Stroke M <41.50 And A <84.50- Tier Tier 1 7 4 — — $47,882.43 $68,578.82 $47,882.43 2026-03-17
C0406 LOCAL Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50- Tier Tier 2 1 1 — — $46,232.06 $46,232.06 $46,232.06 2026-03-17
B1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 1 1 1 — — $45,495.37 $45,495.37 $45,495.37 2026-03-17
D0404 LOCAL Traumatic Spinal Cord Injury M <31.50 And A <61.50- Tier Tier 3 2 1 — — $45,004.05 $72,132.98 $58,568.51 2026-03-17
C0106 LOCAL Stroke M <41.50 And A <84.50- Tier Tier 2 1 1 — — $44,776.19 $44,776.19 $44,776.19 2026-03-17
A0406 LOCAL Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50- Tier None 1 1 — — $40,780.23 $40,780.23 $40,780.23 2026-03-17
B2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier Tier 1 1 1 — — $36,864.08 $36,864.08 $36,864.08 2026-03-17
C0205 LOCAL Traumatic Brain Injury M <35.50- Tier Tier 2 1 1 — — $36,532.08 $36,532.08 $36,532.08 2026-03-17
D0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 3 4 3 — — $36,523.04 $37,268.41 $37,268.41 2026-03-17
C0105 LOCAL Stroke M <41.50 And A >=84.50- Tier Tier 2 1 1 — — $36,509.86 $36,509.86 $36,509.86 2026-03-17
A0106 LOCAL Stroke M <41.50 And A <84.50- Tier None 10 6 — — $36,163.89 $37,710.19 $36,163.89 2026-03-17
B1404 LOCAL Cardiac M <45.50- Tier Tier 1 1 1 — — $36,073.14 $36,073.14 $36,073.14 2026-03-17
B0904 LOCAL Other Orthopedic M <44.5- Tier Tier 1 2 1 — — $36,002.54 $36,002.54 $36,002.54 2026-03-17
A1806 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier None 1 1 — — $33,483.31 $33,483.31 $33,483.31 2026-03-17
D0105 LOCAL Stroke M <41.50 And A >=84.50- Tier Tier 3 4 4 — — $33,363.17 $36,014.28 $33,363.17 2026-03-17
D0205 LOCAL Traumatic Brain Injury M <35.50- Tier Tier 3 1 1 — — $33,181.64 $33,181.64 $33,181.64 2026-03-17
C1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T… 1 1 — — $32,495.75 $32,495.75 $32,495.75 2026-03-17
C0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 2 1 1 — — $32,070.43 $32,070.43 $32,070.43 2026-03-17
A0105 LOCAL Stroke M <41.50 And A >=84.50- Tier None 3 3 — — $31,796.41 $32,445.32 $31,796.41 2026-03-17
A1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier None 1 1 — — $30,807.33 $30,807.33 $30,807.33 2026-03-17
A0205 LOCAL Traumatic Brain Injury M <35.50- Tier None 2 2 — — $30,615.17 $31,239.97 $30,927.57 2026-03-17
A1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T… 2 2 — — $30,550.56 $32,473.10 $31,511.83 2026-03-17
C0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier Tier 2 1 1 — — $30,264.93 $30,264.93 $30,264.93 2026-03-17
D1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3 4 3 — — $30,069.61 $31,730.85 $31,730.85 2026-03-17
C2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier Tier 2 3 2 — — $29,826.16 $29,826.16 $29,826.16 2026-03-17
B2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier Tier 1 2 1 — — $29,629.47 $29,629.47 $29,629.47 2026-03-17
D0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 3 4 4 — — $28,870.49 $29,459.68 $28,870.49 2026-03-17
C0904 LOCAL Other Orthopedic M <44.5- Tier Tier 2 1 1 — — $28,835.99 $28,835.99 $28,835.99 2026-03-17
B0103 LOCAL Stroke M >=50.50 And M <63.50- Tier Tier 1 1 1 — — $28,759.79 $28,759.79 $28,759.79 2026-03-17
D0604 LOCAL Neurological M <43.50- Tier Tier 3 4 3 — — $28,676.08 $29,261.31 $29,261.31 2026-03-17
D1004 LOCAL Amputation Lower Extremity M <47.50- Tier Tier 3 3 3 — — $28,639.83 $29,224.32 $28,639.83 2026-03-17
D0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 3 1 1 — — $28,455.75 $28,455.75 $28,455.75 2026-03-17
D1304 LOCAL Rheumatoid Other Arthritis M <44.50 And A >=64.50- Tier Tier 3 1 1 — — $28,414.03 $28,414.03 $28,414.03 2026-03-17
A0604 LOCAL Neurological M <43.50- Tier None 2 1 — — $27,941.28 $27,941.28 $27,941.28 2026-03-17
C1404 LOCAL Cardiac M <45.50- Tier Tier 2 2 2 — — $27,849.04 $28,417.39 $28,133.22 2026-03-17
A0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50- Tier None 3 2 — — $27,766.80 $28,598.41 $27,766.80 2026-03-17
C2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier Tier 2 1 1 — — $27,730.42 $27,730.42 $27,730.42 2026-03-17
A1504 LOCAL Pulmonary M <45.50- Tier None 1 1 — — $27,301.14 $27,301.14 $27,301.14 2026-03-17
D0904 LOCAL Other Orthopedic M <44.5- Tier Tier 3 5 4 — — $26,877.50 $28,062.83 $26,877.50 2026-03-17
A1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 1 1 — — $26,463.76 $26,463.76 $26,463.76 2026-03-17
D0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 3 5 4 — — $26,283.93 $26,873.96 $26,820.34 2026-03-17
D2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier Tier 3 3 3 — — $25,905.02 $26,433.69 $25,905.02 2026-03-17
D2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier Tier 3 7 6 — — $23,470.36 $27,862.63 $27,305.38 2026-03-17
D0106 LOCAL Stroke M <41.50 And A <84.50- Tier Tier 3 13 8 — — $20,901.33 $40,567.91 $37,948.11 2026-03-17
A0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier None 7 4 — — $17,248.41 $26,487.48 $17,248.41 2026-03-17
D0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier Tier 3 6 5 — — $15,735.32 $28,669.56 $28,382.86 2026-03-17
A1404 LOCAL Cardiac M <45.50- Tier None 28 13 — — $13,748.58 $26,177.15 $13,748.58 2026-03-17
A0904 LOCAL Other Orthopedic M <44.5- Tier None 28 13 — — $13,721.88 $26,123.75 $13,721.88 2026-03-17
A0104 LOCAL Stroke M >=41.50 And M <50.50- Tier None 28 13 — — $13,633.08 $25,946.17 $13,633.08 2026-03-17
D0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 3 28 13 — — $13,612.07 $25,904.14 $13,612.07 2026-03-17
A2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier None 28 13 — — $13,340.57 $25,361.14 $13,340.57 2026-03-17
D0805 LOCAL Replacement Of Lower-extremity Joint M <42.50- Tier Tier 3 28 13 — — $13,335.53 $25,351.06 $13,335.53 2026-03-17
C0603 LOCAL Neurological M >=43.50 And M <52.50- Tier Tier 2 28 13 — — $13,156.49 $24,992.98 $13,156.49 2026-03-17
D1703 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 28 13 — — $13,150.44 $24,980.89 $13,150.44 2026-03-17
D1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 28 13 — — $13,136.79 $24,953.58 $13,136.79 2026-03-17
A0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier None 28 13 — — $12,854.73 $24,389.46 $12,854.73 2026-03-17
B2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier Tier 1 28 13 — — $12,783.83 $24,247.65 $12,783.83 2026-03-17
D0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 3 28 13 — — $12,670.69 $24,021.39 $12,670.69 2026-03-17
A0805 LOCAL Replacement Of Lower-extremity Joint M <42.50- Tier None 28 13 — — $12,482.37 $23,644.74 $12,482.37 2026-03-17
D1503 LOCAL Pulmonary M >=45.50 And M <56.50- Tier Tier 3 28 13 — — $12,443.70 $23,567.40 $12,443.70 2026-03-17
D0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 3 28 13 — — $12,394.11 $23,468.22 $12,394.11 2026-03-17
D0603 LOCAL Neurological M >=43.50 And M <52.50- Tier Tier 3 28 13 — — $12,326.02 $23,332.05 $12,326.02 2026-03-17
D1803 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50- T… 28 13 — — $12,294.92 $23,269.85 $12,294.92 2026-03-17
D1003 LOCAL Amputation Lower Extremity M >=47.50 And M <55.50- Tier Tier 3 28 13 — — $12,073.86 $22,827.72 $12,073.86 2026-03-17
D0503 LOCAL Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier Tier 3 28 13 — — $11,941.05 $22,562.10 $11,941.05 2026-03-17
C0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 2 28 13 — — $11,927.95 $22,535.91 $11,927.95 2026-03-17
D0903 LOCAL Other Orthopedic M >=44.50 And M <51.50- Tier Tier 3 28 13 — — $11,875.49 $22,430.98 $11,875.49 2026-03-17
D0103 LOCAL Stroke M >=50.50 And M <63.50- Tier Tier 3 28 13 — — $11,746.61 $22,173.23 $11,746.61 2026-03-17
D2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier Tier 3 28 13 — — $11,714.10 $22,108.21 $11,714.10 2026-03-17
D1404 LOCAL Cardiac M <45.50- Tier Tier 3 2 2 — — $11,697.85 $26,421.92 $19,059.88 2026-03-17
A0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier None 28 13 — — $11,517.42 $21,714.83 $11,517.42 2026-03-17
A0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier None 28 13 — — $11,501.44 $21,682.89 $11,501.44 2026-03-17
A1703 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 28 13 — — $11,497.24 $21,674.48 $11,497.24 2026-03-17
D1403 LOCAL Cardiac M >=45.50 And M <55.50- Tier Tier 3 28 13 — — $11,441.76 $21,563.53 $11,441.76 2026-03-17
D0804 LOCAL Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier Tier 3 28 13 — — $11,229.10 $21,138.21 $11,229.10 2026-03-17
A0603 LOCAL Neurological M >=43.50 And M <52.50- Tier None 28 13 — — $11,181.19 $21,042.39 $11,181.19 2026-03-17
D0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 3 28 13 — — $11,103.02 $20,886.04 $11,103.02 2026-03-17
D1502 LOCAL Pulmonary M >=56.50 And M <68.50- Tier Tier 3 28 13 — — $11,028.21 $20,736.42 $11,028.21 2026-03-17
A0903 LOCAL Other Orthopedic M >=44.50 And M <51.50- Tier None 28 13 — — $10,921.46 $20,522.92 $10,921.46 2026-03-17
A2003 LOCAL Miscellaneous M >=46.50 And M <55.50- Tier None 28 13 — — $10,721.41 $20,122.82 $10,721.41 2026-03-17
D0602 LOCAL Neurological M >=52.50 And M <64.50- Tier Tier 3 28 13 — — $10,560.86 $19,801.73 $10,560.86 2026-03-17
C2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier Tier 2 28 13 — — $10,541.53 $19,763.07 $10,541.53 2026-03-17
A0804 LOCAL Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier None 28 13 — — $10,517.16 $19,714.31 $10,517.16 2026-03-17
D1002 LOCAL Amputation Lower Extremity M >=55.50 And M <64.50- Tier Tier 3 28 13 — — $10,402.00 $19,484.00 $10,402.00 2026-03-17
A1502 LOCAL Pulmonary M >=56.50 And M <68.50- Tier None 28 13 — — $10,359.14 $19,398.27 $10,359.14 2026-03-17
D1202 LOCAL Osteoarthritis M >=49.50 And M <61.50- Tier Tier 3 28 13 — — $10,291.05 $19,262.10 $10,291.05 2026-03-17
C0602 LOCAL Neurological M >=52.50 And M <64.50- Tier Tier 2 28 13 — — $10,240.04 $19,160.08 $10,240.04 2026-03-17
D0302 LOCAL Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 3 28 13 — — $10,233.89 $19,147.78 $10,233.89 2026-03-17
D0803 LOCAL Replacement Of Lower-extremity Joint M >=51.50 And M <57.50- Tier Tier 3 28 13 — — $10,093.52 $18,867.04 $10,093.52 2026-03-17
D0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier Tier 3 28 13 — — $10,051.49 $18,782.98 $10,051.49 2026-03-17
D0702 LOCAL Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier Tier 3 28 13 — — $10,011.11 $18,702.22 $10,011.11 2026-03-17
A0302 LOCAL Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier None 28 13 — — $9,978.51 $18,637.03 $9,978.51 2026-03-17
D2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier Tier 3 28 13 — — $9,890.94 $18,461.89 $9,890.94 2026-03-17
A1702 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 28 13 — — $9,779.99 $18,239.98 $9,779.99 2026-03-17
A0502 LOCAL Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50- Tier None 28 13 — — $9,728.72 $18,137.44 $9,728.72 2026-03-17
A0602 LOCAL Neurological M >=52.50 And M <64.50- Tier None 28 13 — — $9,589.18 $17,858.37 $9,589.18 2026-03-17
D1402 LOCAL Cardiac M >=55.50 And M <68.50- Tier Tier 3 28 13 — — $9,471.51 $17,623.02 $9,471.51 2026-03-17
A0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier None 28 13 — — $9,252.97 $17,185.93 $9,252.97 2026-03-17
D0802 LOCAL Replacement Of Lower-extremity Joint M >=57.50 And M <63.50- Tier Tier 3 28 13 — — $8,965.78 $16,611.57 $8,965.78 2026-03-17
D0102 LOCAL Stroke M >=63.50 And M <72.50- Tier Tier 3 28 13 — — $8,935.24 $16,550.47 $8,935.24 2026-03-17
A1402 LOCAL Cardiac M >=55.50 And M <68.50- Tier None 28 13 — — $8,767.97 $16,215.93 $8,767.97 2026-03-17
A0102 LOCAL Stroke M >=63.50 And M <72.50- Tier None 28 13 — — $8,546.90 $15,773.80 $8,546.90 2026-03-17
D0901 LOCAL Other Orthopedic M >=63.50- Tier Tier 3 28 13 — — $8,200.59 $15,081.19 $8,200.59 2026-03-17
D0801 LOCAL Replacement Of Lower-extremity Joint M >=63.50- Tier Tier 3 28 13 — — $7,986.35 $14,652.71 $7,986.35 2026-03-17
A0501 LOCAL Non-traumatic Spinal Cord Injury M >=60.50- Tier None 28 13 — — $7,888.75 $14,457.50 $7,888.75 2026-03-17
A0301 LOCAL Non-traumatic Brain Injury M >=65.50- Tier None 28 13 — — $7,639.10 $13,958.21 $7,639.10 2026-03-17
A1301 LOCAL Rheumatoid Other Arthritis M >=62.50- Tier None 28 13 — — $7,389.46 $13,458.92 $7,389.46 2026-03-17
B2005 LOCAL Miscellaneous M <46.50 And A <77.50- Tier Tier 1 5 4 — — $6,822.63 $37,340.69 $7,502.82 2026-03-17
D0104 LOCAL Stroke M >=41.50 And M <50.50- Tier Tier 3 14 10 — — $5,955.58 $28,899.00 $26,680.98 2026-03-17
A2004 LOCAL Miscellaneous M <46.50 And A >=77.50- Tier None 28 13 — — $5,872.68 $24,059.97 $12,689.99 2026-03-17
A0103 LOCAL Stroke M >=50.50 And M <63.50- Tier None 28 13 — — $5,363.88 $20,329.60 $10,824.80 2026-03-17
A0702 LOCAL Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier None 28 13 — — $4,257.40 $16,569.70 $8,944.85 2026-03-17
A0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50- Tier None 2 2 — — $2,575.75 $35,909.82 $19,242.78 2026-03-17
A1403 LOCAL Cardiac M >=45.50 And M <55.50- Tier None 28 13 — — $2,480.26 $19,842.08 $10,581.04 2026-03-17
C1102 LOCAL Amputation Non-lower Extremity M >=52.50 And M <58.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0903 LOCAL Other Orthopedic M >=44.50 And M <51.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C1103 LOCAL Amputation Non-lower Extremity M <52.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0604 LOCAL Neurological M <43.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0502 LOCAL Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0804 LOCAL Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C1002 LOCAL Amputation Lower Extremity M >=55.50 And M <64.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C1101 LOCAL Amputation Non-lower Extremity M >=58.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0601 LOCAL Neurological M >=64.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0801 LOCAL Replacement Of Lower-extremity Joint M >=63.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C1201 LOCAL Osteoarthritis M >=61.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0403 LOCAL Traumatic Spinal Cord Injury M >=41.50 And M <47.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0404 LOCAL Traumatic Spinal Cord Injury M <31.50 And A <61.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0301 LOCAL Non-traumatic Brain Injury M >=65.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0201 LOCAL Traumatic Brain Injury M >=73.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0302 LOCAL Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0405 LOCAL Traumatic Spinal Cord Injury M >=31.50 And M <41.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0104 LOCAL Stroke M >=41.50 And M <50.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B5103 LOCAL Expired, Not Orthopedic, Length Of Stay Is 15 Days Or Fewer- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0101 LOCAL Stroke M >=72.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B2102 LOCAL Burns M <52.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B5101 LOCAL Expired, Orthopedic, Length Of Stay Is 13 Days Or Fewer- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B2101 LOCAL Burns M >=52.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B5102 LOCAL Expired, Orthopedic, Length Of Stay Is 14 Days Or More- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C1202 LOCAL Osteoarthritis M >=49.50 And M <61.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1903 LOCAL Guillain-barré M >=38.50 And M <51.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1806 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1904 LOCAL Guillain-barré M <38.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1802 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50- T… 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1803 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50- T… 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B2001 LOCAL Miscellaneous M >=66.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1603 LOCAL Pain Syndrome M >=43.50 And M <58.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1504 LOCAL Pulmonary M <45.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1604 LOCAL Pain Syndrome M <43.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1402 LOCAL Cardiac M >=55.50 And M <68.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1304 LOCAL Rheumatoid Other Arthritis M <44.50 And A >=64.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1401 LOCAL Cardiac M >=68.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1501 LOCAL Pulmonary M >=68.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1701 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1204 LOCAL Osteoarthritis M <49.50 And A <74.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1201 LOCAL Osteoarthritis M >=61.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1301 LOCAL Rheumatoid Other Arthritis M >=62.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1004 LOCAL Amputation Lower Extremity M <47.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1001 LOCAL Amputation Lower Extremity M >=64.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1101 LOCAL Amputation Non-lower Extremity M >=58.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1302 LOCAL Rheumatoid Other Arthritis M >=51.50 And M <62.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0805 LOCAL Replacement Of Lower-extremity Joint M <42.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0802 LOCAL Replacement Of Lower-extremity Joint M >=57.50 And M <63.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0901 LOCAL Other Orthopedic M >=63.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0702 LOCAL Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0601 LOCAL Neurological M >=64.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0603 LOCAL Neurological M >=43.50 And M <52.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0902 LOCAL Other Orthopedic M >=51.50 And M <63.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1303 LOCAL Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C1203 LOCAL Osteoarthritis M <49.50 And A >=74.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0407 LOCAL Traumatic Spinal Cord Injury M <24.50 And A >=61.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0404 LOCAL Traumatic Spinal Cord Injury M <31.50 And A <61.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0501 LOCAL Non-traumatic Spinal Cord Injury M >=60.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0301 LOCAL Non-traumatic Brain Injury M >=65.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0205 LOCAL Traumatic Brain Injury M <35.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0302 LOCAL Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0401 LOCAL Traumatic Spinal Cord Injury M >=56.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0402 LOCAL Traumatic Spinal Cord Injury M >=47.50 And M <56.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0403 LOCAL Traumatic Spinal Cord Injury M >=41.50 And M <47.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0405 LOCAL Traumatic Spinal Cord Injury M >=31.50 And M <41.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0406 LOCAL Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0502 LOCAL Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0602 LOCAL Neurological M >=52.50 And M <64.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0604 LOCAL Neurological M <43.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0701 LOCAL Fracture Of Lower Extremity M >=61.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0704 LOCAL Fracture Of Lower Extremity M <41.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0801 LOCAL Replacement Of Lower-extremity Joint M >=63.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0803 LOCAL Replacement Of Lower-extremity Joint M >=51.50 And M <57.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0804 LOCAL Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0903 LOCAL Other Orthopedic M >=44.50 And M <51.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0201 LOCAL Traumatic Brain Injury M >=73.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1002 LOCAL Amputation Lower Extremity M >=55.50 And M <64.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1003 LOCAL Amputation Lower Extremity M >=47.50 And M <55.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1102 LOCAL Amputation Non-lower Extremity M >=52.50 And M <58.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1103 LOCAL Amputation Non-lower Extremity M <52.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1202 LOCAL Osteoarthritis M >=49.50 And M <61.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1203 LOCAL Osteoarthritis M <49.50 And A >=74.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0202 LOCAL Traumatic Brain Injury M >=61.50 And M <73.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1305 LOCAL Rheumatoid Other Arthritis M <51.50 And A <64.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0104 LOCAL Stroke M >=41.50 And M <50.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1403 LOCAL Cardiac M >=45.50 And M <55.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1502 LOCAL Pulmonary M >=56.50 And M <68.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1503 LOCAL Pulmonary M >=45.50 And M <56.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1601 LOCAL Pain Syndrome M >=65.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1602 LOCAL Pain Syndrome M >=58.50 And M <65.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1702 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1703 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0105 LOCAL Stroke M <41.50 And A >=84.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1801 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=67.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1804 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50- T… 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T… 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1901 LOCAL Guillain-barré M >=66.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B1902 LOCAL Guillain-barré M >=51.50 And M <66.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A5104 LOCAL Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A5103 LOCAL Expired, Not Orthopedic, Length Of Stay Is 15 Days Or Fewer- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B5001 LOCAL Short-stay Cases, Length Of Stay Is 3 Days Or Fewer- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0101 LOCAL Stroke M >=72.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B5104 LOCAL Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0102 LOCAL Stroke M >=63.50 And M <72.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0103 LOCAL Stroke M >=50.50 And M <63.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A5101 LOCAL Expired, Orthopedic, Length Of Stay Is 13 Days Or Fewer- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0202 LOCAL Traumatic Brain Injury M >=61.50 And M <73.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A5001 LOCAL Short-stay Cases, Length Of Stay Is 3 Days Or Fewer- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A5102 LOCAL Expired, Orthopedic, Length Of Stay Is 14 Days Or More- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0401 LOCAL Traumatic Spinal Cord Injury M >=56.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0402 LOCAL Traumatic Spinal Cord Injury M >=47.50 And M <56.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0407 LOCAL Traumatic Spinal Cord Injury M <24.50 And A >=61.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0501 LOCAL Non-traumatic Spinal Cord Injury M >=60.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0503 LOCAL Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0102 LOCAL Stroke M >=63.50 And M <72.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0701 LOCAL Fracture Of Lower Extremity M >=61.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0702 LOCAL Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0802 LOCAL Replacement Of Lower-extremity Joint M >=57.50 And M <63.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0803 LOCAL Replacement Of Lower-extremity Joint M >=51.50 And M <57.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0805 LOCAL Replacement Of Lower-extremity Joint M <42.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C0901 LOCAL Other Orthopedic M >=63.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0503 LOCAL Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C1001 LOCAL Amputation Lower Extremity M >=64.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C1003 LOCAL Amputation Lower Extremity M >=47.50 And M <55.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
C1004 LOCAL Amputation Lower Extremity M <47.50- Tier Tier 2 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A2002 LOCAL Miscellaneous M >=55.50 And M <66.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1904 LOCAL Guillain-barré M <38.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1903 LOCAL Guillain-barré M >=38.50 And M <51.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A2001 LOCAL Miscellaneous M >=66.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1901 LOCAL Guillain-barré M >=66.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1803 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50- T… 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1802 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50- T… 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1804 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50- T… 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1902 LOCAL Guillain-barré M >=51.50 And M <66.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A2101 LOCAL Burns M >=52.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1604 LOCAL Pain Syndrome M <43.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1603 LOCAL Pain Syndrome M >=43.50 And M <58.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1701 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1503 LOCAL Pulmonary M >=45.50 And M <56.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1601 LOCAL Pain Syndrome M >=65.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1501 LOCAL Pulmonary M >=68.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1602 LOCAL Pain Syndrome M >=58.50 And M <65.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1801 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=67.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A2102 LOCAL Burns M <52.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
B0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 1 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1303 LOCAL Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1302 LOCAL Rheumatoid Other Arthritis M >=51.50 And M <62.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1304 LOCAL Rheumatoid Other Arthritis M <44.50 And A >=64.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1204 LOCAL Osteoarthritis M <49.50 And A <74.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1203 LOCAL Osteoarthritis M <49.50 And A >=74.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1305 LOCAL Rheumatoid Other Arthritis M <51.50 And A <64.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1103 LOCAL Amputation Non-lower Extremity M <52.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1102 LOCAL Amputation Non-lower Extremity M >=52.50 And M <58.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1201 LOCAL Osteoarthritis M >=61.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1004 LOCAL Amputation Lower Extremity M <47.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1003 LOCAL Amputation Lower Extremity M >=47.50 And M <55.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1101 LOCAL Amputation Non-lower Extremity M >=58.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1202 LOCAL Osteoarthritis M >=49.50 And M <61.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1401 LOCAL Cardiac M >=68.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A0901 LOCAL Other Orthopedic M >=63.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A0802 LOCAL Replacement Of Lower-extremity Joint M >=57.50 And M <63.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A0801 LOCAL Replacement Of Lower-extremity Joint M >=63.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A1001 LOCAL Amputation Lower Extremity M >=64.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A0601 LOCAL Neurological M >=64.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A0701 LOCAL Fracture Of Lower Extremity M >=61.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A0407 LOCAL Traumatic Spinal Cord Injury M <24.50 And A >=61.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A0405 LOCAL Traumatic Spinal Cord Injury M >=31.50 And M <41.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A0803 LOCAL Replacement Of Lower-extremity Joint M >=51.50 And M <57.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A0404 LOCAL Traumatic Spinal Cord Injury M <31.50 And A <61.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
A0503 LOCAL Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50- Tier None 28 13 — — $1,320.00 $1,320.00 $1,320.00 2026-03-17
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