|
C0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$69,841.94
|
$69,841.94
|
$69,841.94
|
2026-03-17
|
|
B0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 1
|
24
|
11
|
—
|
—
|
$56,095.73
|
$56,095.73
|
$56,095.73
|
2026-03-17
|
|
B0106
|
LOCAL
|
Stroke M <41.50 And A <84.50- Tier Tier 1
|
24
|
11
|
—
|
—
|
$54,051.86
|
$54,051.86
|
$54,051.86
|
2026-03-17
|
|
C1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$51,053.94
|
$51,053.94
|
$51,053.94
|
2026-03-17
|
|
C0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$50,403.03
|
$50,403.03
|
$50,403.03
|
2026-03-17
|
|
B0205
|
LOCAL
|
Traumatic Brain Injury M <35.50- Tier Tier 1
|
24
|
11
|
—
|
—
|
$49,069.58
|
$49,069.58
|
$49,069.58
|
2026-03-17
|
|
D1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$48,468.88
|
$48,468.88
|
$48,468.88
|
2026-03-17
|
|
B0604
|
LOCAL
|
Neurological M <43.50- Tier Tier 1
|
24
|
11
|
—
|
—
|
$46,315.29
|
$46,315.29
|
$46,315.29
|
2026-03-17
|
|
A1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50- Tier None
|
24
|
11
|
—
|
—
|
$44,939.07
|
$44,939.07
|
$44,939.07
|
2026-03-17
|
|
B1004
|
LOCAL
|
Amputation Lower Extremity M <47.50- Tier Tier 1
|
24
|
11
|
—
|
—
|
$42,794.78
|
$44,551.81
|
$43,673.29
|
2026-03-17
|
|
C0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$43,640.96
|
$43,640.96
|
$43,640.96
|
2026-03-17
|
|
B2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50- Tier Tier 1
|
24
|
11
|
—
|
—
|
$41,308.83
|
$41,308.83
|
$41,308.83
|
2026-03-17
|
|
B0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 1
|
24
|
11
|
—
|
—
|
$40,037.06
|
$40,037.06
|
$40,037.06
|
2026-03-17
|
|
B2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50- Tier Tier 1
|
24
|
11
|
—
|
—
|
$39,190.58
|
$39,190.58
|
$39,190.58
|
2026-03-17
|
|
C1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$37,903.63
|
$37,903.63
|
$37,903.63
|
2026-03-17
|
|
D0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$37,661.86
|
$37,661.86
|
$37,661.86
|
2026-03-17
|
|
D0205
|
LOCAL
|
Traumatic Brain Injury M <35.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$37,311.24
|
$37,311.24
|
$37,311.24
|
2026-03-17
|
|
C0205
|
LOCAL
|
Traumatic Brain Injury M <35.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$33,536.85
|
$40,414.29
|
$36,975.57
|
2026-03-17
|
|
B0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50- Tier Tier 1
|
24
|
11
|
—
|
—
|
$36,930.98
|
$36,930.98
|
$36,930.98
|
2026-03-17
|
|
C1004
|
LOCAL
|
Amputation Lower Extremity M <47.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$35,392.96
|
$35,392.96
|
$35,392.96
|
2026-03-17
|
|
A0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50- Tier None
|
24
|
11
|
—
|
—
|
$35,355.76
|
$35,355.76
|
$35,355.76
|
2026-03-17
|
|
D1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$35,102.84
|
$35,102.84
|
$35,102.84
|
2026-03-17
|
|
B0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 1
|
24
|
11
|
—
|
—
|
$34,680.67
|
$34,680.67
|
$34,680.67
|
2026-03-17
|
|
C0604
|
LOCAL
|
Neurological M <43.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$34,675.10
|
$34,675.10
|
$34,675.10
|
2026-03-17
|
|
A0106
|
LOCAL
|
Stroke M <41.50 And A <84.50- Tier None
|
24
|
11
|
—
|
—
|
$28,216.29
|
$40,823.44
|
$34,519.86
|
2026-03-17
|
|
D1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T…
|
24
|
11
|
—
|
—
|
$34,128.33
|
$34,128.33
|
$34,128.33
|
2026-03-17
|
|
C0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$32,811.51
|
$33,481.13
|
$33,146.32
|
2026-03-17
|
|
C2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$32,995.74
|
$32,995.74
|
$32,995.74
|
2026-03-17
|
|
C0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$32,958.54
|
$32,958.54
|
$32,958.54
|
2026-03-17
|
|
B2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50- Tier Tier 1
|
24
|
11
|
—
|
—
|
$32,778.15
|
$32,778.15
|
$32,778.15
|
2026-03-17
|
|
D0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$32,590.31
|
$32,590.31
|
$32,590.31
|
2026-03-17
|
|
D0106
|
LOCAL
|
Stroke M <41.50 And A <84.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$21,812.53
|
$42,837.55
|
$32,325.04
|
2026-03-17
|
|
D1504
|
LOCAL
|
Pulmonary M <45.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$32,287.17
|
$32,287.17
|
$32,287.17
|
2026-03-17
|
|
C0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$32,170.01
|
$32,323.34
|
$32,246.67
|
2026-03-17
|
|
C0904
|
LOCAL
|
Other Orthopedic M <44.5- Tier Tier 2
|
24
|
11
|
—
|
—
|
$31,900.34
|
$32,100.90
|
$32,000.62
|
2026-03-17
|
|
A1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T…
|
24
|
11
|
—
|
—
|
$31,643.70
|
$31,643.70
|
$31,643.70
|
2026-03-17
|
|
D1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$31,433.55
|
$31,433.55
|
$31,433.55
|
2026-03-17
|
|
C0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$31,405.65
|
$31,405.65
|
$31,405.65
|
2026-03-17
|
|
B0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50- Tier Tier 1
|
24
|
11
|
—
|
—
|
$31,342.42
|
$31,342.42
|
$31,342.42
|
2026-03-17
|
|
C2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$31,303.36
|
$31,303.36
|
$31,303.36
|
2026-03-17
|
|
D1004
|
LOCAL
|
Amputation Lower Extremity M <47.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$27,962.10
|
$33,599.53
|
$30,780.81
|
2026-03-17
|
|
C0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$30,760.31
|
$30,760.31
|
$30,760.31
|
2026-03-17
|
|
A0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50- Tier None
|
24
|
11
|
—
|
—
|
$30,717.54
|
$30,717.54
|
$30,717.54
|
2026-03-17
|
|
A1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50- Tier None
|
24
|
11
|
—
|
—
|
$28,586.79
|
$32,623.07
|
$30,604.93
|
2026-03-17
|
|
D0604
|
LOCAL
|
Neurological M <43.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$28,429.45
|
$32,370.86
|
$30,400.15
|
2026-03-17
|
|
A1504
|
LOCAL
|
Pulmonary M <45.50- Tier None
|
24
|
11
|
—
|
—
|
$30,202.39
|
$30,202.39
|
$30,202.39
|
2026-03-17
|
|
D0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$30,118.70
|
$30,118.70
|
$30,118.70
|
2026-03-17
|
|
A0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50- Tier None
|
24
|
11
|
—
|
—
|
$23,433.78
|
$36,174.54
|
$29,804.16
|
2026-03-17
|
|
D0904
|
LOCAL
|
Other Orthopedic M <44.5- Tier Tier 3
|
24
|
11
|
—
|
—
|
$29,733.73
|
$29,733.73
|
$29,733.73
|
2026-03-17
|
|
D1404
|
LOCAL
|
Cardiac M <45.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$29,229.74
|
$30,144.20
|
$29,686.97
|
2026-03-17
|
|
D0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$27,486.23
|
$31,716.23
|
$29,601.23
|
2026-03-17
|
|
D2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$29,242.76
|
$29,708.74
|
$29,475.75
|
2026-03-17
|
|
A0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50- Tier None
|
24
|
11
|
—
|
—
|
$29,302.27
|
$29,302.27
|
$29,302.27
|
2026-03-17
|
|
A1004
|
LOCAL
|
Amputation Lower Extremity M <47.50- Tier None
|
24
|
11
|
—
|
—
|
$28,965.65
|
$28,965.65
|
$28,965.65
|
2026-03-17
|
|
C0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$22,046.49
|
$35,478.51
|
$28,762.50
|
2026-03-17
|
|
A0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50- Tier None
|
24
|
11
|
—
|
—
|
$28,703.43
|
$28,703.43
|
$28,703.43
|
2026-03-17
|
|
D0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$28,656.93
|
$28,656.93
|
$28,656.93
|
2026-03-17
|
|
A2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50- Tier None
|
24
|
11
|
—
|
—
|
$28,466.48
|
$28,466.48
|
$28,466.48
|
2026-03-17
|
|
A1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50…
|
24
|
11
|
—
|
—
|
$28,023.49
|
$28,023.49
|
$28,023.49
|
2026-03-17
|
|
A0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50- Tier None
|
24
|
11
|
—
|
—
|
$27,853.52
|
$27,853.52
|
$27,853.52
|
2026-03-17
|
|
A0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50- Tier None
|
24
|
11
|
—
|
—
|
$27,802.94
|
$27,802.94
|
$27,802.94
|
2026-03-17
|
|
C0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$27,745.66
|
$27,745.66
|
$27,745.66
|
2026-03-17
|
|
C0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$27,648.95
|
$27,648.95
|
$27,648.95
|
2026-03-17
|
|
C0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$27,407.18
|
$27,407.18
|
$27,407.18
|
2026-03-17
|
|
A0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50- Tier None
|
24
|
11
|
—
|
—
|
$27,342.09
|
$27,342.09
|
$27,342.09
|
2026-03-17
|
|
A0904
|
LOCAL
|
Other Orthopedic M <44.5- Tier None
|
24
|
11
|
—
|
—
|
$27,204.47
|
$27,204.47
|
$27,204.47
|
2026-03-17
|
|
A0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50- Tier None
|
24
|
11
|
—
|
—
|
$26,981.30
|
$26,981.30
|
$26,981.30
|
2026-03-17
|
|
A1404
|
LOCAL
|
Cardiac M <45.50- Tier None
|
24
|
11
|
—
|
—
|
$26,895.75
|
$26,895.75
|
$26,895.75
|
2026-03-17
|
|
C0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$26,622.36
|
$26,622.36
|
$26,622.36
|
2026-03-17
|
|
C0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$20,917.80
|
$31,552.57
|
$26,235.19
|
2026-03-17
|
|
A2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50- Tier None
|
24
|
11
|
—
|
—
|
$25,807.05
|
$26,616.79
|
$26,211.92
|
2026-03-17
|
|
C2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$26,181.60
|
$26,181.60
|
$26,181.60
|
2026-03-17
|
|
D0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$22,569.14
|
$29,674.81
|
$26,121.97
|
2026-03-17
|
|
D0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$25,962.15
|
$25,962.15
|
$25,962.15
|
2026-03-17
|
|
A0604
|
LOCAL
|
Neurological M <43.50- Tier None
|
24
|
11
|
—
|
—
|
$22,630.41
|
$29,194.40
|
$25,912.40
|
2026-03-17
|
|
D1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50- T…
|
24
|
11
|
—
|
—
|
$25,742.70
|
$25,742.70
|
$25,742.70
|
2026-03-17
|
|
C1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$25,657.15
|
$25,657.15
|
$25,657.15
|
2026-03-17
|
|
D0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$25,487.92
|
$25,487.92
|
$25,487.92
|
2026-03-17
|
|
C0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$25,439.56
|
$25,439.56
|
$25,439.56
|
2026-03-17
|
|
A1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50- Tier None
|
24
|
11
|
—
|
—
|
$25,236.85
|
$25,236.85
|
$25,236.85
|
2026-03-17
|
|
D0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$24,814.68
|
$24,814.68
|
$24,814.68
|
2026-03-17
|
|
C1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50- T…
|
24
|
11
|
—
|
—
|
$21,358.51
|
$28,076.46
|
$24,717.49
|
2026-03-17
|
|
B0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50- Tier Tier 1
|
24
|
11
|
—
|
—
|
$6,006.05
|
$43,282.03
|
$24,644.04
|
2026-03-17
|
|
D2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$24,457.61
|
$24,457.61
|
$24,457.61
|
2026-03-17
|
|
D2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$17,655.56
|
$30,823.55
|
$24,239.56
|
2026-03-17
|
|
A0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50- Tier None
|
24
|
11
|
—
|
—
|
$24,022.43
|
$24,022.43
|
$24,022.43
|
2026-03-17
|
|
A1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50…
|
24
|
11
|
—
|
—
|
$23,977.80
|
$23,977.80
|
$23,977.80
|
2026-03-17
|
|
D0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$6,698.52
|
$41,228.86
|
$23,963.69
|
2026-03-17
|
|
D1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$23,855.05
|
$23,855.05
|
$23,855.05
|
2026-03-17
|
|
D0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$23,128.26
|
$23,959.27
|
$23,543.76
|
2026-03-17
|
|
C0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$23,466.36
|
$23,466.36
|
$23,466.36
|
2026-03-17
|
|
D0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$23,384.53
|
$23,384.53
|
$23,384.53
|
2026-03-17
|
|
D0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$20,526.43
|
$25,811.51
|
$23,168.97
|
2026-03-17
|
|
D0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$23,105.57
|
$23,105.57
|
$23,105.57
|
2026-03-17
|
|
C0302
|
LOCAL
|
Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$23,060.94
|
$23,060.94
|
$23,060.94
|
2026-03-17
|
|
A1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50- Tier None
|
24
|
11
|
—
|
—
|
$22,625.76
|
$22,625.76
|
$22,625.76
|
2026-03-17
|
|
A0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50- Tier None
|
24
|
11
|
—
|
—
|
$22,489.99
|
$22,489.99
|
$22,489.99
|
2026-03-17
|
|
A0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50- Tier None
|
24
|
11
|
—
|
—
|
$20,966.78
|
$23,987.09
|
$22,476.94
|
2026-03-17
|
|
C0902
|
LOCAL
|
Other Orthopedic M >=51.50 And M <63.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$22,294.72
|
$22,294.72
|
$22,294.72
|
2026-03-17
|
|
C0702
|
LOCAL
|
Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$22,287.28
|
$22,287.28
|
$22,287.28
|
2026-03-17
|
|
A2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50- Tier None
|
24
|
11
|
—
|
—
|
$22,261.24
|
$22,261.24
|
$22,261.24
|
2026-03-17
|
|
A1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50- Tier None
|
24
|
11
|
—
|
—
|
$21,950.66
|
$21,950.66
|
$21,950.66
|
2026-03-17
|
|
D0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$21,906.03
|
$21,906.03
|
$21,906.03
|
2026-03-17
|
|
C2002
|
LOCAL
|
Miscellaneous M >=55.50 And M <66.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$21,863.26
|
$21,863.26
|
$21,863.26
|
2026-03-17
|
|
A0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50- Tier None
|
24
|
11
|
—
|
—
|
$21,753.53
|
$21,753.53
|
$21,753.53
|
2026-03-17
|
|
A0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50- Tier None
|
24
|
11
|
—
|
—
|
$4,749.11
|
$37,992.89
|
$21,371.00
|
2026-03-17
|
|
D0302
|
LOCAL
|
Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$21,182.59
|
$21,182.59
|
$21,182.59
|
2026-03-17
|
|
D0702
|
LOCAL
|
Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$20,689.68
|
$21,111.92
|
$20,900.80
|
2026-03-17
|
|
D0803
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=51.50 And M <57.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$20,872.01
|
$20,872.01
|
$20,872.01
|
2026-03-17
|
|
D2002
|
LOCAL
|
Miscellaneous M >=55.50 And M <66.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$20,423.81
|
$20,423.81
|
$20,423.81
|
2026-03-17
|
|
A0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50- Tier None
|
24
|
11
|
—
|
—
|
$17,478.62
|
$22,703.86
|
$20,091.24
|
2026-03-17
|
|
A0302
|
LOCAL
|
Non-traumatic Brain Injury M >=52.50 And M <65.50- Tier None
|
24
|
11
|
—
|
—
|
$19,964.45
|
$19,964.45
|
$19,964.45
|
2026-03-17
|
|
A0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50- Tier None
|
24
|
11
|
—
|
—
|
$19,756.16
|
$19,756.16
|
$19,756.16
|
2026-03-17
|
|
D1402
|
LOCAL
|
Cardiac M >=55.50 And M <68.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$19,495.79
|
$19,495.79
|
$19,495.79
|
2026-03-17
|
|
A0803
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=51.50 And M <57.50- Tier None
|
24
|
11
|
—
|
—
|
$19,467.89
|
$19,467.89
|
$19,467.89
|
2026-03-17
|
|
A0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50- Tier None
|
24
|
11
|
—
|
—
|
$16,832.82
|
$21,809.32
|
$19,321.07
|
2026-03-17
|
|
A0702
|
LOCAL
|
Fracture Of Lower Extremity M >=52.50 And M <61.50- Tier None
|
24
|
11
|
—
|
—
|
$19,124.10
|
$19,505.09
|
$19,314.60
|
2026-03-17
|
|
A0902
|
LOCAL
|
Other Orthopedic M >=51.50 And M <63.50- Tier None
|
24
|
11
|
—
|
—
|
$19,012.26
|
$19,012.26
|
$19,012.26
|
2026-03-17
|
|
A0205
|
LOCAL
|
Traumatic Brain Injury M <35.50- Tier None
|
24
|
11
|
—
|
—
|
$2,879.98
|
$34,559.79
|
$18,719.88
|
2026-03-17
|
|
A2002
|
LOCAL
|
Miscellaneous M >=55.50 And M <66.50- Tier None
|
24
|
11
|
—
|
—
|
$18,590.09
|
$18,590.09
|
$18,590.09
|
2026-03-17
|
|
A0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50- Tier None
|
24
|
11
|
—
|
—
|
$12,908.21
|
$23,278.53
|
$18,093.37
|
2026-03-17
|
|
A0802
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=57.50 And M <63.50- Tier None
|
24
|
11
|
—
|
—
|
$17,489.12
|
$17,489.12
|
$17,489.12
|
2026-03-17
|
|
D0601
|
LOCAL
|
Neurological M >=64.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$17,271.53
|
$17,271.53
|
$17,271.53
|
2026-03-17
|
|
D0902
|
LOCAL
|
Other Orthopedic M >=51.50 And M <63.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$13,535.65
|
$20,779.02
|
$17,157.33
|
2026-03-17
|
|
A2001
|
LOCAL
|
Miscellaneous M >=66.50- Tier None
|
24
|
11
|
—
|
—
|
$14,909.64
|
$14,909.64
|
$14,909.64
|
2026-03-17
|
|
D0101
|
LOCAL
|
Stroke M >=72.50- Tier Tier 3
|
24
|
11
|
—
|
—
|
$14,429.82
|
$14,429.82
|
$14,429.82
|
2026-03-17
|
|
A1402
|
LOCAL
|
Cardiac M >=55.50 And M <68.50- Tier None
|
24
|
11
|
—
|
—
|
$12,640.01
|
$12,640.01
|
$12,640.01
|
2026-03-17
|
|
C1404
|
LOCAL
|
Cardiac M <45.50- Tier Tier 2
|
24
|
11
|
—
|
—
|
$6,876.90
|
$6,876.90
|
$6,876.90
|
2026-03-17
|
|
128
|
OTHER
|
R&b - Semi Pvt - Irf
|
4
|
3
|
$1,150.00
|
—
|
$1,662.50
|
$1,662.50
|
$1,662.50
|
2026-05-08
|
|
118
|
OTHER
|
R&b - Private - Irf
|
4
|
3
|
$1,150.00
|
—
|
$1,662.50
|
$1,662.50
|
$1,662.50
|
2026-05-08
|
|
0138
|
RC
|
Room & Board - Three And Four Beds - Rehabilitation
|
9
|
4
|
—
|
—
|
$1,650.00
|
$1,650.00
|
$1,650.00
|
2026-03-17
|
|
0128
|
RC
|
Room & Board - Semi-private (Two Beds) - Rehabilitation
|
9
|
4
|
—
|
—
|
$1,650.00
|
$1,650.00
|
$1,650.00
|
2026-03-17
|
|
0158
|
RC
|
Room & Board - Ward - Rehabilitation
|
9
|
4
|
—
|
—
|
$1,650.00
|
$1,650.00
|
$1,650.00
|
2026-03-17
|
|
0148
|
RC
|
Room & Board - Deluxe Private - Rehabilitation
|
9
|
4
|
—
|
—
|
$1,650.00
|
$1,650.00
|
$1,650.00
|
2026-03-17
|
|
0118
|
RC
|
Room & Board - Private (One Bed) - Rehabilitation
|
9
|
4
|
—
|
—
|
$575.00
|
$1,512.50
|
$1,512.50
|
2026-03-17
|
|
0362
|
RC
|
Operating Room Services - Organ Transplant - Other Than Kidney
|
11
|
5
|
—
|
—
|
$1,035.00
|
$1,035.00
|
$1,035.00
|
2026-03-17
|
|
0363
|
RC
|
Operating Room Services - Assessment
|
11
|
5
|
—
|
—
|
$1,035.00
|
$1,035.00
|
$1,035.00
|
2026-03-17
|
|
0365
|
RC
|
Operating Room Services - Treatment
|
11
|
5
|
—
|
—
|
$1,035.00
|
$1,035.00
|
$1,035.00
|
2026-03-17
|
|
0790
|
RC
|
Extra-corporeal Shock Wave Therapy - General Classification
|
2
|
1
|
—
|
—
|
$1,035.00
|
$1,035.00
|
$1,035.00
|
2026-03-17
|
|
0750
|
RC
|
Gastro-intestinal (gi) Services - General Classification
|
2
|
1
|
—
|
—
|
$1,035.00
|
$1,035.00
|
$1,035.00
|
2026-03-17
|
|
0481
|
RC
|
Cardiology - Cardiac Cath Lab
|
11
|
5
|
—
|
—
|
$1,035.00
|
$1,035.00
|
$1,035.00
|
2026-03-17
|
|
0366
|
RC
|
Operating Room Services - Continuation
|
11
|
5
|
—
|
—
|
$1,035.00
|
$1,035.00
|
$1,035.00
|
2026-03-17
|
|
0480
|
RC
|
Cardiology - General Classification
|
11
|
5
|
—
|
—
|
$1,035.00
|
$1,035.00
|
$1,035.00
|
2026-03-17
|
|
0367
|
RC
|
Operating Room Services - Kidney Transplant
|
11
|
5
|
—
|
—
|
$1,035.00
|
$1,035.00
|
$1,035.00
|
2026-03-17
|
|
0364
|
RC
|
Operating Room Services - Evaluation Or Testing
|
11
|
5
|
—
|
—
|
$1,035.00
|
$1,035.00
|
$1,035.00
|
2026-03-17
|
|
0368
|
RC
|
Operating Room Services - Other
|
11
|
5
|
—
|
—
|
$1,035.00
|
$1,035.00
|
$1,035.00
|
2026-03-17
|
|
0360
|
RC
|
Operating Room Services - General Classification
|
11
|
5
|
—
|
—
|
$1,035.00
|
$1,035.00
|
$1,035.00
|
2026-03-17
|
|
0361
|
RC
|
Operating Room Services - Minor Surgery
|
11
|
5
|
—
|
—
|
$1,035.00
|
$1,035.00
|
$1,035.00
|
2026-03-17
|
|
0369
|
RC
|
Operating Room Services - Other
|
11
|
5
|
—
|
—
|
$1,035.00
|
$1,035.00
|
$1,035.00
|
2026-03-17
|
|
0801
|
RC
|
Inpatient Renal Dialysis - Hemodialysis
|
11
|
4
|
—
|
—
|
$400.00
|
$600.00
|
$600.00
|
2026-03-17
|
|
0800
|
RC
|
Inpatient Renal Dialysis - General Classification
|
11
|
4
|
—
|
—
|
$400.00
|
$600.00
|
$600.00
|
2026-03-17
|
|
0806
|
RC
|
Inpatient Renal Dialysis - Continuation
|
10
|
3
|
—
|
—
|
$400.00
|
$600.00
|
$600.00
|
2026-03-17
|
|
0805
|
RC
|
Inpatient Renal Dialysis - Treatment
|
10
|
3
|
—
|
—
|
$400.00
|
$600.00
|
$600.00
|
2026-03-17
|
|
0807
|
RC
|
Inpatient Renal Dialysis - Observation/Hourly
|
10
|
3
|
—
|
—
|
$400.00
|
$600.00
|
$600.00
|
2026-03-17
|
|
0802
|
RC
|
Inpatient Renal Dialysis - Peritoneal Dialysis (non-capd)
|
11
|
4
|
—
|
—
|
$400.00
|
$600.00
|
$600.00
|
2026-03-17
|
|
0803
|
RC
|
Inpatient Renal Dialysis - Continuous Ambulatory Peritoneal Dialysis (capd)
|
11
|
4
|
—
|
—
|
$400.00
|
$600.00
|
$600.00
|
2026-03-17
|
|
0808
|
RC
|
Inpatient Renal Dialysis - Other
|
10
|
3
|
—
|
—
|
$400.00
|
$600.00
|
$600.00
|
2026-03-17
|
|
0809
|
RC
|
Inpatient Renal Dialysis - Other
|
11
|
4
|
—
|
—
|
$400.00
|
$600.00
|
$600.00
|
2026-03-17
|
|
0804
|
RC
|
Inpatient Renal Dialysis - Continuous Cycling Peritoneal Dialysis (ccpd)
|
11
|
4
|
—
|
—
|
$400.00
|
$600.00
|
$600.00
|
2026-03-17
|
|
0831
|
RC
|
Peritoneal Dialysis - Outpatient Or Home - Peritoneal/Composite Or Other Rate
|
5
|
2
|
—
|
—
|
$400.00
|
$400.00
|
$400.00
|
2026-03-17
|
|
0821
|
RC
|
Hemodialysis - Outpatient Or Home - Hemodialysis Composite Or Other Rate
|
5
|
2
|
—
|
—
|
$400.00
|
$400.00
|
$400.00
|
2026-03-17
|
|
0851
|
RC
|
Continuous Cycling Peritoneal Dialysis (ccpd) - Outpatient Or Home - CCPD/Compos…
|
4
|
1
|
—
|
—
|
$400.00
|
$400.00
|
$400.00
|
2026-03-17
|
|
92523
|
HCPCS
|
Speech Sound Lang Comprehen
|
66
|
17
|
—
|
—
|
$120.00
|
$218.02
|
$169.01
|
2026-03-17
|
|
96105
|
HCPCS
|
Assessment Of Aphasia
|
57
|
13
|
—
|
—
|
$120.00
|
$150.00
|
$135.00
|
2026-03-17
|
|
97164
|
HCPCS
|
Pt Re-eval Est Plan Care
|
67
|
18
|
—
|
—
|
$120.00
|
$150.00
|
$135.00
|
2026-03-17
|
|
92521
|
HCPCS
|
Evaluation Of Speech Fluency
|
4
|
3
|
—
|
—
|
$120.00
|
$150.00
|
$135.00
|
2026-03-17
|
|
92522
|
HCPCS
|
Evaluate Speech Production
|
59
|
14
|
—
|
—
|
$120.00
|
$150.00
|
$135.00
|
2026-03-17
|
|
97168
|
HCPCS
|
Ot Re-eval Est Plan Care
|
60
|
15
|
—
|
—
|
$120.00
|
$150.00
|
$135.00
|
2026-03-17
|
|
97167
|
HCPCS
|
Ot Eval High Complex 60 Min
|
60
|
15
|
—
|
—
|
$97.79
|
$150.00
|
$123.89
|
2026-03-17
|
|
97166
|
HCPCS
|
Ot Eval Mod Complex 45 Min
|
67
|
18
|
—
|
—
|
$97.79
|
$150.00
|
$123.89
|
2026-03-17
|
|
97162
|
HCPCS
|
Pt Eval Mod Complex 30 Min
|
67
|
18
|
—
|
—
|
$95.34
|
$150.00
|
$122.67
|
2026-03-17
|
|
97165
|
HCPCS
|
Ot Eval Low Complex 30 Min
|
67
|
18
|
—
|
—
|
$92.90
|
$150.00
|
$121.45
|
2026-03-17
|
|
97161
|
HCPCS
|
Pt Eval Low Complex 20 Min
|
67
|
18
|
—
|
—
|
$90.57
|
$150.00
|
$120.28
|
2026-03-17
|
|
0410
|
RC
|
Respiratory Services - General Classification
|
64
|
16
|
—
|
—
|
$120.00
|
$120.00
|
$120.00
|
2026-03-17
|
|
92524
|
HCPCS
|
Behavral Qualit Analys Voice
|
59
|
14
|
—
|
—
|
$74.06
|
$150.00
|
$112.03
|
2026-03-17
|
|
97163
|
HCPCS
|
Pt Eval High Complex 45 Min
|
67
|
18
|
—
|
—
|
$72.51
|
$150.00
|
$111.25
|
2026-03-17
|
|
0424
|
RC
|
Physical Therapy - Evaluation Or Re-evaluation
|
73
|
19
|
—
|
—
|
$62.00
|
$150.00
|
$106.00
|
2026-03-17
|
|
0444
|
RC
|
Speech Therapy - Language Pathology - Evaluation Or Reevaluation
|
73
|
19
|
—
|
—
|
$62.00
|
$150.00
|
$106.00
|
2026-03-17
|
|
0434
|
RC
|
Occupational Therapy - Evaluation Or Reevaluation
|
73
|
19
|
—
|
—
|
$62.00
|
$150.00
|
$106.00
|
2026-03-17
|
|
92605
|
HCPCS
|
Ex For Nonspeech Device Rx
|
4
|
3
|
—
|
—
|
$90.00
|
$120.00
|
$105.00
|
2026-03-17
|
|
92606
|
HCPCS
|
Non-speech Device Service
|
4
|
3
|
—
|
—
|
$90.00
|
$120.00
|
$105.00
|
2026-03-17
|
|
97113
|
HCPCS
|
Aquatic Therapy/exercises
|
60
|
15
|
—
|
—
|
$90.00
|
$120.00
|
$105.00
|
2026-03-17
|
|
97032
|
HCPCS
|
Appl Modality 1+estim Ea 15
|
57
|
14
|
—
|
—
|
$90.00
|
$120.00
|
$105.00
|
2026-03-17
|
|
97129
|
HCPCS
|
Ther Ivntj 1st 15 Min
|
60
|
15
|
—
|
—
|
$90.00
|
$120.00
|
$105.00
|
2026-03-17
|
|
97537
|
HCPCS
|
Community/work Reintegration
|
58
|
14
|
—
|
—
|
$90.00
|
$120.00
|
$105.00
|
2026-03-17
|
|
92607
|
HCPCS
|
Ex For Speech Device Rx 1hr
|
59
|
14
|
—
|
—
|
$90.00
|
$120.00
|
$105.00
|
2026-03-17
|
|
92597
|
HCPCS
|
Oral Speech Device Eval
|
4
|
3
|
—
|
—
|
$90.00
|
$120.00
|
$105.00
|
2026-03-17
|
|
92526
|
HCPCS
|
Oral Function Therapy
|
67
|
18
|
—
|
—
|
$80.63
|
$120.00
|
$100.31
|
2026-03-17
|
|
92507
|
HCPCS
|
Speech/hearing Therapy
|
66
|
17
|
—
|
—
|
$73.22
|
$120.00
|
$96.61
|
2026-03-17
|
|
0425
|
RC
|
Physical Therapy - Treatment
|
14
|
6
|
—
|
—
|
$95.00
|
$95.00
|
$95.00
|
2026-03-17
|
|
0436
|
RC
|
Occupational Therapy - Continuation
|
14
|
6
|
—
|
—
|
$95.00
|
$95.00
|
$95.00
|
2026-03-17
|
|
0445
|
RC
|
Speech-language Pathology - Treatment
|
13
|
6
|
—
|
—
|
$95.00
|
$95.00
|
$95.00
|
2026-03-17
|
|
0446
|
RC
|
Speech-language Pathology - Continuation
|
13
|
6
|
—
|
—
|
$95.00
|
$95.00
|
$95.00
|
2026-03-17
|
|
0447
|
RC
|
Speech-language Pathology - Observation/Hourly
|
13
|
6
|
—
|
—
|
$95.00
|
$95.00
|
$95.00
|
2026-03-17
|
|
0437
|
RC
|
Occupational Therapy - Observation/Hourly
|
14
|
6
|
—
|
—
|
$95.00
|
$95.00
|
$95.00
|
2026-03-17
|
|
0448
|
RC
|
Speech-language Pathology - Other
|
13
|
6
|
—
|
—
|
$95.00
|
$95.00
|
$95.00
|
2026-03-17
|
|
0438
|
RC
|
Occupational Therapy - Other
|
14
|
6
|
—
|
—
|
$95.00
|
$95.00
|
$95.00
|
2026-03-17
|
|
0428
|
RC
|
Physical Therapy - Other
|
14
|
6
|
—
|
—
|
$95.00
|
$95.00
|
$95.00
|
2026-03-17
|
|
0426
|
RC
|
Physical Therapy - Continuation
|
14
|
6
|
—
|
—
|
$95.00
|
$95.00
|
$95.00
|
2026-03-17
|
|
0427
|
RC
|
Physical Therapy - Observation/Hourly
|
14
|
6
|
—
|
—
|
$95.00
|
$95.00
|
$95.00
|
2026-03-17
|
|
0435
|
RC
|
Occupational Therapy - Treatment
|
14
|
6
|
—
|
—
|
$95.00
|
$95.00
|
$95.00
|
2026-03-17
|
|
444
|
OTHER
|
St Aphasia Assessment 1unit
|
15
|
11
|
$260.00
|
—
|
$91.00
|
$91.00
|
$91.00
|
2026-05-08
|
|
434
|
OTHER
|
Ot Eval High Complex 1unit
|
17
|
11
|
$260.00
|
—
|
$91.00
|
$91.00
|
$91.00
|
2026-05-08
|
|
424
|
OTHER
|
Pt Eval High Complex 1unit
|
18
|
12
|
$260.00
|
—
|
$91.00
|
$91.00
|
$91.00
|
2026-05-08
|
|
0423
|
RC
|
Physical Therapy - Group Rate
|
16
|
7
|
—
|
—
|
$85.00
|
$95.00
|
$90.00
|
2026-03-17
|
|
0430
|
RC
|
Occupational Therapy - General Classification
|
73
|
19
|
—
|
—
|
$60.00
|
$120.00
|
$90.00
|
2026-03-17
|
|
440
|
OTHER
|
St Cog Tx Ea Addl 15min
|
17
|
11
|
$65.00
|
—
|
$90.00
|
$90.00
|
$90.00
|
2026-05-08
|
|
430
|
OTHER
|
Ot Adl Slf Care Trn 15min
|
17
|
11
|
$100.00
|
—
|
$90.00
|
$90.00
|
$90.00
|
2026-05-08
|
|
420
|
OTHER
|
Pt Adl Slf Care Trn 15min
|
17
|
11
|
$100.00
|
—
|
$90.00
|
$90.00
|
$90.00
|
2026-05-08
|
|
0443
|
RC
|
Speech Therapy - Language Pathology - Group Rate
|
16
|
7
|
—
|
—
|
$85.00
|
$95.00
|
$90.00
|
2026-03-17
|
|
0449
|
RC
|
Speech Therapy - Language Pathology - Other
|
14
|
7
|
—
|
—
|
$85.00
|
$95.00
|
$90.00
|
2026-03-17
|
|
0440
|
RC
|
Speech Therapy - Language Pathology - General Classification
|
73
|
19
|
—
|
—
|
$60.00
|
$120.00
|
$90.00
|
2026-03-17
|
|
0439
|
RC
|
Occupational Therapy - Other
|
15
|
7
|
—
|
—
|
$85.00
|
$95.00
|
$90.00
|
2026-03-17
|
|
0442
|
RC
|
Speech Therapy - Language Pathology - Hourly Charge
|
16
|
7
|
—
|
—
|
$85.00
|
$95.00
|
$90.00
|
2026-03-17
|
|
0429
|
RC
|
Physical Therapy - Other
|
15
|
7
|
—
|
—
|
$85.00
|
$95.00
|
$90.00
|
2026-03-17
|
|
0432
|
RC
|
Occupational Therapy - Hourly Charge
|
16
|
7
|
—
|
—
|
$85.00
|
$95.00
|
$90.00
|
2026-03-17
|
|
0422
|
RC
|
Physical Therapy - Hourly Charge
|
16
|
7
|
—
|
—
|
$85.00
|
$95.00
|
$90.00
|
2026-03-17
|
|
0420
|
RC
|
Physical Therapy - General Classification
|
73
|
19
|
—
|
—
|
$60.00
|
$120.00
|
$90.00
|
2026-03-17
|
|
0433
|
RC
|
Occupational Therapy - Group Rate
|
16
|
7
|
—
|
—
|
$85.00
|
$95.00
|
$90.00
|
2026-03-17
|
|
0441
|
RC
|
Speech Therapy - Language Pathology - Visit Charge
|
18
|
7
|
—
|
—
|
$60.00
|
$95.00
|
$77.50
|
2026-03-17
|
|
0431
|
RC
|
Occupational Therapy - Visit Charge
|
18
|
7
|
—
|
—
|
$60.00
|
$95.00
|
$77.50
|
2026-03-17
|
|
0421
|
RC
|
Physical Therapy - Visit Charge
|
71
|
17
|
—
|
—
|
$60.00
|
$95.00
|
$77.50
|
2026-03-17
|
|
97110
|
HCPCS
|
Therapeutic Exercises
|
67
|
18
|
—
|
—
|
$33.75
|
$120.00
|
$76.88
|
2026-03-17
|
|
97535
|
HCPCS
|
Self Care Mngment Training
|
67
|
18
|
—
|
—
|
$31.06
|
$120.00
|
$75.53
|
2026-03-17
|
|
97124
|
HCPCS
|
Massage Therapy
|
60
|
15
|
—
|
—
|
$28.16
|
$120.00
|
$74.08
|
2026-03-17
|
|
97530
|
HCPCS
|
Therapeutic Activities
|
67
|
18
|
—
|
—
|
$26.85
|
$120.00
|
$73.42
|
2026-03-17
|
|
97116
|
HCPCS
|
Gait Training Therapy
|
67
|
18
|
—
|
—
|
$26.60
|
$120.00
|
$73.30
|
2026-03-17
|
|
97140
|
HCPCS
|
Manual Therapy 1/> Regions
|
60
|
15
|
—
|
—
|
$26.44
|
$120.00
|
$73.22
|
2026-03-17
|
|
97112
|
HCPCS
|
Neuromuscular Reeducation
|
67
|
18
|
—
|
—
|
$24.75
|
$120.00
|
$72.38
|
2026-03-17
|
|
92610
|
HCPCS
|
Evaluate Swallowing Function
|
64
|
15
|
—
|
—
|
$67.41
|
$67.41
|
$67.41
|
2026-03-17
|
|
36556
|
HCPCS
|
Insert Non-tunnel Cv Cath
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36514
|
HCPCS
|
Apheresis Plasma
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
24516
|
HCPCS
|
Treat Humerus Fracture
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36460
|
HCPCS
|
Intrauterine Transfusion Ftl
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36430
|
HCPCS
|
Transfusion Bld/bld Compnt
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
24430
|
HCPCS
|
Repair Of Humerus
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
15772
|
HCPCS
|
Grfg Autol Fat Lipo Ea Addl
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36415
|
HCPCS
|
Routine Venipuncture
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58571
|
HCPCS
|
Tlh W/t/o 250 G Or Less
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58570
|
HCPCS
|
Tlh Uterus 250 G Or Less
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36248
|
HCPCS
|
Ins Cath Abd/l-ext Art Addl
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
24344
|
HCPCS
|
Reconstruct Elbow Lat Ligmnt
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58563
|
HCPCS
|
Hysteroscopy Ablation
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58561
|
HCPCS
|
Hysteroscopy Remove Myoma
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58661
|
HCPCS
|
Laparoscopy Remove Adnexa
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58662
|
HCPCS
|
Laparoscopy Excise Lesions
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
59012
|
HCPCS
|
Fetal Cord Puncture Prenatal
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
59025
|
HCPCS
|
Fetal Non-stress Test
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
59820
|
HCPCS
|
Care Of Miscarriage
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
59897
|
HCPCS
|
Unlisted Fetal Invas Px W/us
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
60220
|
HCPCS
|
Partial Removal Of Thyroid
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
61782
|
HCPCS
|
Scan Proc Cranial Extra
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
62270
|
HCPCS
|
Dx Lmbr Spi Pnxr
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
62328
|
HCPCS
|
Dx Lmbr Spi Pnxr W/fluor/ct
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36247
|
HCPCS
|
Ins Cath Abd/l-ext Art 3rd
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58558
|
HCPCS
|
Hysteroscopy Biopsy
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58554
|
HCPCS
|
Laparo-vag Hyst W/t/o Compl
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36225
|
HCPCS
|
Place Cath Subclavian Art
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
23650
|
HCPCS
|
Cltx Sho Dslc W/mnpj Wo Anes
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
15771
|
HCPCS
|
Grfg Autol Fat Lipo 50 Cc/<
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
10030
|
HCPCS
|
Img Gid Flu Coll DRG Sft Tis
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58552
|
HCPCS
|
Laparo-vag Hyst Incl T/o
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58550
|
HCPCS
|
Laparo-asst Vag Hysterectomy
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36217
|
HCPCS
|
Place Catheter In Artery
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58301
|
HCPCS
|
Remove Intrauterine Device
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
58120
|
HCPCS
|
Dilation And Curettage
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36216
|
HCPCS
|
Place Catheter In Artery
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
23515
|
HCPCS
|
Optx Clavicular Fx W/int Fix
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
57522
|
HCPCS
|
Conization Of Cervix
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
57461
|
HCPCS
|
Conz Of Cervix W/scope Leep
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36215
|
HCPCS
|
Place Catheter In Artery
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
57288
|
HCPCS
|
Repair Bladder Defect
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
57260
|
HCPCS
|
Cmbn Ant Pst Colprhy
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36200
|
HCPCS
|
Place Catheter In Aorta
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
23412
|
HCPCS
|
Repair Rotator Cuff Chronic
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
14020
|
HCPCS
|
Tis Trnfr S/a/l 10 Sq Cm/<
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
55880
|
HCPCS
|
Abltj Mal Prst8 Tiss Hifu
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
55700
|
HCPCS
|
Biopsy Of Prostate
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36140
|
HCPCS
|
Intro Ndl Icath Upr/lxtr Art
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
55040
|
HCPCS
|
Removal Of Hydrocele
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
54161
|
HCPCS
|
Circum 28 Days Or Older
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
36012
|
HCPCS
|
Place Catheter In Vein
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
22552
|
HCPCS
|
Arthrd Ant Ntrbd Cervical Ea
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
53445
|
HCPCS
|
Insert Uro/ves Nck Sphincter
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
52601
|
HCPCS
|
Prostatectomy (turp)
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
33228
|
HCPCS
|
Remv&replc Pm Gen Dual Lead
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
52356
|
HCPCS
|
Cysto/uretero W/lithotripsy
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
52332
|
HCPCS
|
Cystoscopy And Treatment
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
33227
|
HCPCS
|
Remove&replace Pm Gen Singl
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
22548
|
HCPCS
|
Arthrd Ant Toral/xoral C1-c2
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
14000
|
HCPCS
|
Tis Trnfr Trunk 10 Sq Cm/<
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
10005
|
HCPCS
|
Fna Bx W/us Gdn 1st Les
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
00410
|
HCPCS
|
Anesth Correct Heart Rhythm
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
52317
|
HCPCS
|
Remove Bladder Stone
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
52310
|
HCPCS
|
Cystoscopy And Treatment
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
33207
|
HCPCS
|
Insert Heart Pm Ventricular
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
52240
|
HCPCS
|
Cystoscopy And Treatment
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
52235
|
HCPCS
|
Cystoscopy And Treatment
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
32555
|
HCPCS
|
Aspirate Pleura With Imaging
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|
|
22515
|
HCPCS
|
Perq Vertebral Augmentation
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-03-17
|