|
112
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
3
|
3
|
—
|
—
|
$39,130.05
|
$41,086.55
|
$39,130.05
|
2025-09-11
|
|
113
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
3
|
3
|
—
|
—
|
$56,307.35
|
$59,122.72
|
$56,307.35
|
2025-09-11
|
|
114
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
3
|
3
|
—
|
—
|
$99,088.76
|
$104,043.20
|
$99,088.76
|
2025-09-11
|
|
1204
|
APR_DRG
|
Major Respiratory And Chest Procedures
|
3
|
3
|
—
|
—
|
$32,733.26
|
$34,369.92
|
$32,733.26
|
2025-09-11
|
|
1214
|
APR_DRG
|
Other Respiratory And Chest Procedures
|
3
|
3
|
—
|
—
|
$30,548.56
|
$32,075.99
|
$30,548.56
|
2025-09-11
|
|
1304
|
APR_DRG
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
3
|
3
|
—
|
—
|
$32,208.33
|
$33,818.75
|
$32,208.33
|
2025-09-11
|
|
1603
|
APR_DRG
|
Major Cardiothoracic Repair Of Heart Anomaly
|
3
|
3
|
—
|
—
|
$29,818.49
|
$31,309.41
|
$29,818.49
|
2025-09-11
|
|
1604
|
APR_DRG
|
Major Cardiothoracic Repair Of Heart Anomaly
|
3
|
3
|
—
|
—
|
$70,561.09
|
$74,089.14
|
$70,561.09
|
2025-09-11
|
|
1611
|
APR_DRG
|
Implantable Heart Assist Systems
|
3
|
3
|
—
|
—
|
$54,020.08
|
$56,721.08
|
$54,020.08
|
2025-09-11
|
|
1612
|
APR_DRG
|
Implantable Heart Assist Systems
|
3
|
3
|
—
|
—
|
$56,958.62
|
$59,806.55
|
$56,958.62
|
2025-09-11
|
|
1613
|
APR_DRG
|
Implantable Heart Assist Systems
|
3
|
3
|
—
|
—
|
$79,236.36
|
$83,198.18
|
$79,236.36
|
2025-09-11
|
|
1614
|
APR_DRG
|
Implantable Heart Assist Systems
|
3
|
3
|
—
|
—
|
$152,022.84
|
$159,623.98
|
$152,022.84
|
2025-09-11
|
|
1623
|
APR_DRG
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
3
|
3
|
—
|
—
|
$34,632.37
|
$36,363.99
|
$34,632.37
|
2025-09-11
|
|
1624
|
APR_DRG
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
3
|
3
|
—
|
—
|
$61,552.69
|
$64,630.32
|
$61,552.69
|
2025-09-11
|
|
1634
|
APR_DRG
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
3
|
3
|
—
|
—
|
$36,684.85
|
$38,519.09
|
$36,684.85
|
2025-09-11
|
|
1654
|
APR_DRG
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
3
|
3
|
—
|
—
|
$31,728.67
|
$33,315.10
|
$31,728.67
|
2025-09-11
|
|
1674
|
APR_DRG
|
Other Cardiothoracic And Thoracic Vascular Procedures
|
3
|
3
|
—
|
—
|
$46,775.66
|
$49,114.44
|
$46,775.66
|
2025-09-11
|
|
1694
|
APR_DRG
|
Major Abdominal Vascular Procedures
|
3
|
3
|
—
|
—
|
$32,866.77
|
$34,510.11
|
$32,866.77
|
2025-09-11
|
|
1783
|
APR_DRG
|
External Heart Assist Systems
|
3
|
3
|
—
|
—
|
$30,566.15
|
$32,094.46
|
$30,566.15
|
2025-09-11
|
|
1784
|
APR_DRG
|
External Heart Assist Systems
|
3
|
3
|
—
|
—
|
$47,763.64
|
$50,151.82
|
$47,763.64
|
2025-09-11
|
|
1814
|
APR_DRG
|
Lower Extremity Arterial Procedures
|
3
|
3
|
—
|
—
|
$28,547.53
|
$29,974.91
|
$28,547.53
|
2025-09-11
|
|
1824
|
APR_DRG
|
Other Peripheral Vascular Procedures
|
3
|
3
|
—
|
—
|
$36,706.67
|
$38,542.00
|
$36,706.67
|
2025-09-11
|
|
1833
|
APR_DRG
|
Percutaneous Structural Cardiac Procedures
|
3
|
3
|
—
|
—
|
$26,928.79
|
$28,275.23
|
$26,928.79
|
2025-09-11
|
|
1834
|
APR_DRG
|
Percutaneous Structural Cardiac Procedures
|
3
|
3
|
—
|
—
|
$27,606.77
|
$28,987.11
|
$27,606.77
|
2025-09-11
|
|
2004
|
APR_DRG
|
Cardiac Structural And Valvular Disorders
|
3
|
3
|
—
|
—
|
$92,080.74
|
$96,684.78
|
$92,080.74
|
2025-09-11
|
|
204
|
APR_DRG
|
Open Craniotomy For Trauma
|
3
|
3
|
—
|
—
|
$29,022.96
|
$30,474.11
|
$29,022.96
|
2025-09-11
|
|
2054
|
APR_DRG
|
Cardiomyopathy
|
3
|
3
|
—
|
—
|
$35,973.66
|
$37,772.34
|
$35,973.66
|
2025-09-11
|
|
214
|
APR_DRG
|
Open Craniotomy Except Trauma
|
3
|
3
|
—
|
—
|
$34,550.31
|
$36,277.83
|
$34,550.31
|
2025-09-11
|
|
2204
|
APR_DRG
|
Major Stomach, Esophageal And Duodenal Procedures
|
3
|
3
|
—
|
—
|
$40,697.99
|
$42,732.89
|
$40,697.99
|
2025-09-11
|
|
224
|
APR_DRG
|
Ventricular Shunt Procedures
|
3
|
3
|
—
|
—
|
$34,289.80
|
$36,004.29
|
$34,289.80
|
2025-09-11
|
|
2244
|
APR_DRG
|
Peritoneal Adhesiolysis
|
3
|
3
|
—
|
—
|
$29,770.95
|
$31,259.50
|
$29,770.95
|
2025-09-11
|
|
2274
|
APR_DRG
|
Hernia Procedures Except Inguinal, Femoral And Umbilical
|
3
|
3
|
—
|
—
|
$28,460.26
|
$29,883.27
|
$28,460.26
|
2025-09-11
|
|
2304
|
APR_DRG
|
Major Small Bowel Procedures
|
3
|
3
|
—
|
—
|
$34,425.59
|
$36,146.87
|
$34,425.59
|
2025-09-11
|
|
234
|
APR_DRG
|
Spinal Procedures
|
3
|
3
|
—
|
—
|
$39,783.28
|
$41,772.44
|
$39,783.28
|
2025-09-11
|
|
2464
|
APR_DRG
|
Gastrointestinal Vascular Insufficiency
|
3
|
3
|
—
|
—
|
$68,424.59
|
$71,845.82
|
$68,424.59
|
2025-09-11
|
|
2604
|
APR_DRG
|
Major Pancreas, Liver And Shunt Procedures
|
3
|
3
|
—
|
—
|
$30,928.26
|
$32,474.67
|
$30,928.26
|
2025-09-11
|
|
2614
|
APR_DRG
|
Major Biliary Tract Procedures
|
3
|
3
|
—
|
—
|
$27,168.79
|
$28,527.23
|
$27,168.79
|
2025-09-11
|
|
264
|
APR_DRG
|
Other Nervous System And Related Procedures
|
3
|
3
|
—
|
—
|
$37,115.67
|
$38,971.45
|
$37,115.67
|
2025-09-11
|
|
28730
|
CPT
|
Fusion Of Foot Bones
|
44
|
30
|
$57,929.13
|
$57,929.13
|
$40,550.39
|
$49,239.76
|
$44,895.07
|
2025-09-11
|
|
3032
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
3
|
3
|
—
|
—
|
$26,653.96
|
$27,986.66
|
$26,653.96
|
2025-09-11
|
|
3033
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
3
|
3
|
—
|
—
|
$36,736.30
|
$38,573.12
|
$36,736.30
|
2025-09-11
|
|
3034
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
3
|
3
|
—
|
—
|
$43,425.51
|
$45,596.79
|
$43,425.51
|
2025-09-11
|
|
3044
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
3
|
3
|
—
|
—
|
$36,075.58
|
$37,879.36
|
$36,075.58
|
2025-09-11
|
|
3154
|
APR_DRG
|
Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement
|
3
|
3
|
—
|
—
|
$32,978.79
|
$34,627.73
|
$32,978.79
|
2025-09-11
|
|
33207
|
CPT
|
Insrt Heart Pm Venticular
|
44
|
30
|
$48,848.87
|
$48,848.87
|
$34,194.21
|
$41,521.54
|
$37,857.88
|
2025-09-11
|
|
33208
|
CPT
|
Ins/Rplc Pacemkr; Atr+vnt
|
44
|
30
|
$48,848.87
|
$48,848.87
|
$34,194.21
|
$41,521.54
|
$37,857.88
|
2025-09-11
|
|
33216
|
CPT
|
Insert 1 Electrode Pm-defib
|
44
|
30
|
$38,328.90
|
$38,328.90
|
$26,830.23
|
$32,579.57
|
$29,704.90
|
2025-09-11
|
|
33217
|
CPT
|
Insert 2 Electrode Pm-defib
|
44
|
30
|
$38,328.90
|
$38,328.90
|
$26,830.23
|
$32,579.57
|
$29,704.90
|
2025-09-11
|
|
3614
|
APR_DRG
|
Skin Graft For Skin And Subcutaneous Tissue Diagnoses
|
3
|
3
|
—
|
—
|
$29,480.80
|
$30,954.84
|
$29,480.80
|
2025-09-11
|
|
37236
|
CPT
|
Open/Perq Place Stent 1st
|
44
|
30
|
$47,189.05
|
$47,189.05
|
$33,032.34
|
$40,110.69
|
$36,571.51
|
2025-09-11
|
|
41
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
3
|
3
|
—
|
—
|
$28,770.27
|
$30,208.78
|
$28,770.27
|
2025-09-11
|
|
42
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
3
|
3
|
—
|
—
|
$35,059.60
|
$36,812.58
|
$35,059.60
|
2025-09-11
|
|
43
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
3
|
3
|
—
|
—
|
$53,622.15
|
$56,303.26
|
$53,622.15
|
2025-09-11
|
|
434
|
APR_DRG
|
Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies
|
3
|
3
|
—
|
—
|
$46,071.63
|
$48,375.21
|
$46,071.63
|
2025-09-11
|
|
44
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
3
|
3
|
—
|
—
|
$83,400.59
|
$87,570.62
|
$83,400.59
|
2025-09-11
|
|
4414
|
APR_DRG
|
Major Bladder Procedures
|
3
|
3
|
—
|
—
|
$50,996.23
|
$53,546.04
|
$50,996.23
|
2025-09-11
|
|
4424
|
APR_DRG
|
Kidney And Urinary Tract Procedures For Malignancy
|
3
|
3
|
—
|
—
|
$34,101.90
|
$35,807.00
|
$34,101.90
|
2025-09-11
|
|
4474
|
APR_DRG
|
Other Kidney, Urinary Tract And Related Procedures
|
3
|
3
|
—
|
—
|
$40,381.47
|
$42,400.54
|
$40,381.47
|
2025-09-11
|
|
4834
|
APR_DRG
|
Penis, Testes And Scrotal Procedures
|
3
|
3
|
—
|
—
|
$32,608.86
|
$34,239.30
|
$32,608.86
|
2025-09-11
|
|
51
|
APR_DRG
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
3
|
3
|
—
|
—
|
$28,825.62
|
$30,266.90
|
$28,825.62
|
2025-09-11
|
|
52
|
APR_DRG
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
3
|
3
|
—
|
—
|
$35,287.55
|
$37,051.93
|
$35,287.55
|
2025-09-11
|
|
53
|
APR_DRG
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
3
|
3
|
—
|
—
|
$38,640.62
|
$40,572.65
|
$38,640.62
|
2025-09-11
|
|
54
|
APR_DRG
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
3
|
3
|
—
|
—
|
$53,640.39
|
$56,322.41
|
$53,640.39
|
2025-09-11
|
|
6514
|
APR_DRG
|
Other Procedures Of Blood And Blood-forming Organs
|
3
|
3
|
—
|
—
|
$35,169.34
|
$36,927.81
|
$35,169.34
|
2025-09-11
|
|
6604
|
APR_DRG
|
Major Hematologic Or Immunologic Diagnoses Except Sickle Cell Crisis And Coagula…
|
3
|
3
|
—
|
—
|
$28,366.80
|
$29,785.14
|
$28,366.80
|
2025-09-11
|
|
6804
|
APR_DRG
|
Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms
|
3
|
3
|
—
|
—
|
$52,238.53
|
$54,850.46
|
$52,238.53
|
2025-09-11
|
|
6814
|
APR_DRG
|
Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms
|
3
|
3
|
—
|
—
|
$70,600.49
|
$74,130.51
|
$70,600.49
|
2025-09-11
|
|
6904
|
APR_DRG
|
Acute Leukemia
|
3
|
3
|
—
|
—
|
$46,355.59
|
$48,673.37
|
$46,355.59
|
2025-09-11
|
|
6954
|
APR_DRG
|
Chemotherapy For Acute Leukemia
|
3
|
3
|
—
|
—
|
$35,927.42
|
$37,723.79
|
$35,927.42
|
2025-09-11
|
|
7924
|
APR_DRG
|
Extensive O.r. Procedures For Other Complications Of Treatment
|
3
|
3
|
—
|
—
|
$36,084.38
|
$37,888.60
|
$36,084.38
|
2025-09-11
|
|
8413
|
APR_DRG
|
Extensive Third Degree Burns With Skin Graft
|
3
|
3
|
—
|
—
|
$35,890.62
|
$37,685.15
|
$35,890.62
|
2025-09-11
|
|
8414
|
APR_DRG
|
Extensive Third Degree Burns With Skin Graft
|
3
|
3
|
—
|
—
|
$83,042.06
|
$87,194.16
|
$83,042.06
|
2025-09-11
|
|
8424
|
APR_DRG
|
Burns With Skin Graft Except Extensive Third Degree Burns
|
3
|
3
|
—
|
—
|
$28,329.03
|
$29,745.48
|
$28,329.03
|
2025-09-11
|
|
8504
|
APR_DRG
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…
|
3
|
3
|
—
|
—
|
$80,046.86
|
$84,049.20
|
$80,046.86
|
2025-09-11
|
|
894
|
APR_DRG
|
Major Cranial Or Facial Bone Procedures
|
3
|
3
|
—
|
—
|
$32,259.13
|
$33,872.09
|
$32,259.13
|
2025-09-11
|
|
91
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
3
|
3
|
—
|
—
|
$44,630.04
|
$46,861.54
|
$44,630.04
|
2025-09-11
|
|
9104
|
APR_DRG
|
Craniotomy For Multiple Significant Trauma
|
3
|
3
|
—
|
—
|
$39,639.34
|
$41,621.31
|
$39,639.34
|
2025-09-11
|
|
9114
|
APR_DRG
|
Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma
|
3
|
3
|
—
|
—
|
$33,582.84
|
$35,261.98
|
$33,582.84
|
2025-09-11
|
|
9124
|
APR_DRG
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
3
|
3
|
—
|
—
|
$32,216.47
|
$33,827.29
|
$32,216.47
|
2025-09-11
|
|
914
|
APR_DRG
|
Other Major Head And Neck Procedures
|
3
|
3
|
—
|
—
|
$29,322.22
|
$30,788.33
|
$29,322.22
|
2025-09-11
|
|
92
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
3
|
3
|
—
|
—
|
$46,019.86
|
$48,320.85
|
$46,019.86
|
2025-09-11
|
|
93
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
3
|
3
|
—
|
—
|
$69,971.36
|
$73,469.93
|
$69,971.36
|
2025-09-11
|
|
94
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
3
|
3
|
—
|
—
|
$142,421.46
|
$149,542.53
|
$142,421.46
|
2025-09-11
|
|
9504
|
APR_DRG
|
Extensive O.r. Procedure Unrelated To Principal Diagnosis
|
3
|
3
|
—
|
—
|
$38,462.50
|
$40,385.63
|
$38,462.50
|
2025-09-11
|
|
9514
|
APR_DRG
|
Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis
|
3
|
3
|
—
|
—
|
$26,823.29
|
$28,164.45
|
$26,823.29
|
2025-09-11
|
|
9524
|
APR_DRG
|
Non-extensive O.r. Procedure Unrelated To Principal Diagnosis
|
3
|
3
|
—
|
—
|
$33,892.52
|
$35,587.15
|
$33,892.52
|
2025-09-11
|
|
A0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50
|
25
|
23
|
—
|
—
|
$27,503.13
|
$45,838.55
|
$30,559.03
|
2025-09-11
|
|
A0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50
|
25
|
23
|
—
|
—
|
$34,392.28
|
$57,320.46
|
$38,213.64
|
2025-09-11
|
|
A0106
|
LOCAL
|
Stroke M <41.50 And A <84.50
|
25
|
23
|
—
|
—
|
$39,116.31
|
$65,193.86
|
$43,462.57
|
2025-09-11
|
|
A0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
25
|
23
|
—
|
—
|
$25,853.01
|
$43,088.36
|
$28,725.57
|
2025-09-11
|
|
A0205
|
LOCAL
|
Traumatic Brain Injury M <35.50
|
25
|
23
|
—
|
—
|
$33,114.60
|
$55,191.00
|
$36,794.00
|
2025-09-11
|
|
A0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
25
|
23
|
—
|
—
|
$26,688.76
|
$44,481.27
|
$29,654.18
|
2025-09-11
|
|
A0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
25
|
23
|
—
|
—
|
$29,433.02
|
$49,055.03
|
$32,703.35
|
2025-09-11
|
|
A0403
|
LOCAL
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
25
|
23
|
—
|
—
|
$27,283.95
|
$45,473.25
|
$30,315.50
|
2025-09-11
|
|
A0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
25
|
23
|
—
|
—
|
$42,600.10
|
$71,000.16
|
$47,333.44
|
2025-09-11
|
|
A0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
25
|
23
|
—
|
—
|
$33,877.29
|
$56,462.15
|
$37,641.43
|
2025-09-11
|
|
A0406
|
LOCAL
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
25
|
23
|
—
|
—
|
$43,227.35
|
$72,045.59
|
$48,030.39
|
2025-09-11
|
|
A0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
25
|
23
|
—
|
—
|
$59,095.92
|
$98,493.20
|
$65,662.13
|
2025-09-11
|
|
A0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
25
|
23
|
—
|
—
|
$26,198.72
|
$43,664.54
|
$29,109.69
|
2025-09-11
|
|
A0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50
|
25
|
23
|
—
|
—
|
$36,404.14
|
$60,673.56
|
$40,449.04
|
2025-09-11
|
|
A0604
|
LOCAL
|
Neurological M <43.50
|
25
|
23
|
—
|
—
|
$27,973.58
|
$46,622.63
|
$31,081.75
|
2025-09-11
|
|
A0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50
|
25
|
23
|
—
|
—
|
$28,076.93
|
$46,794.89
|
$31,196.59
|
2025-09-11
|
|
A0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50
|
25
|
23
|
—
|
—
|
$25,063.60
|
$41,772.66
|
$27,848.44
|
2025-09-11
|
|
A0904
|
LOCAL
|
Other Orthopedic M <44.5
|
25
|
23
|
—
|
—
|
$26,066.85
|
$43,444.76
|
$28,963.17
|
2025-09-11
|
|
A1004
|
LOCAL
|
Amputation Lower Extremity M <47.50
|
25
|
23
|
—
|
—
|
$27,754.39
|
$46,257.32
|
$30,838.21
|
2025-09-11
|
|
A1103
|
LOCAL
|
Amputation Non-lower Extremity M <52.50
|
25
|
23
|
—
|
—
|
$28,148.21
|
$46,913.69
|
$31,275.79
|
2025-09-11
|
|
A1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50
|
25
|
23
|
—
|
—
|
$24,181.52
|
$40,302.53
|
$26,868.35
|
2025-09-11
|
|
A1204
|
LOCAL
|
Osteoarthritis M <49.50 And A <74.50
|
25
|
23
|
—
|
—
|
$25,359.41
|
$42,265.68
|
$28,177.12
|
2025-09-11
|
|
A1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
25
|
23
|
—
|
—
|
$28,019.91
|
$46,699.85
|
$31,133.23
|
2025-09-11
|
|
A1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
25
|
23
|
—
|
—
|
$26,833.10
|
$44,721.84
|
$29,814.56
|
2025-09-11
|
|
A1404
|
LOCAL
|
Cardiac M <45.50
|
25
|
23
|
—
|
—
|
$25,771.04
|
$42,951.74
|
$28,634.49
|
2025-09-11
|
|
A1504
|
LOCAL
|
Pulmonary M <45.50
|
25
|
23
|
—
|
—
|
$28,939.41
|
$48,232.35
|
$32,154.90
|
2025-09-11
|
|
A1604
|
LOCAL
|
Pain Syndrome M <43.50
|
25
|
23
|
—
|
—
|
$25,997.36
|
$43,328.93
|
$28,885.95
|
2025-09-11
|
|
A1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
25
|
23
|
—
|
—
|
$26,002.70
|
$43,337.84
|
$28,891.89
|
2025-09-11
|
|
A1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
25
|
23
|
—
|
—
|
$30,514.68
|
$50,857.80
|
$33,905.20
|
2025-09-11
|
|
A1804
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
25
|
23
|
—
|
—
|
$25,008.35
|
$41,680.59
|
$27,787.06
|
2025-09-11
|
|
A1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
25
|
23
|
—
|
—
|
$30,320.45
|
$50,534.09
|
$33,689.39
|
2025-09-11
|
|
A1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
25
|
23
|
—
|
—
|
$43,059.84
|
$71,766.41
|
$47,844.27
|
2025-09-11
|
|
A1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50
|
25
|
23
|
—
|
—
|
$31,548.23
|
$52,580.39
|
$35,053.59
|
2025-09-11
|
|
A1904
|
LOCAL
|
Guillain-barré M <38.50
|
25
|
23
|
—
|
—
|
$45,957.35
|
$76,595.58
|
$51,063.72
|
2025-09-11
|
|
A2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50
|
25
|
23
|
—
|
—
|
$25,503.75
|
$42,506.25
|
$28,337.50
|
2025-09-11
|
|
A2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50
|
25
|
23
|
—
|
—
|
$26,883.00
|
$44,805.00
|
$29,870.00
|
2025-09-11
|
|
A2102
|
LOCAL
|
Burns M <52.50
|
25
|
23
|
—
|
—
|
$26,801.03
|
$44,668.38
|
$29,778.92
|
2025-09-11
|
|
A5102
|
LOCAL
|
Expired, Orthopedic, Length Of Stay Is 14 Days Or More
|
25
|
23
|
—
|
—
|
$31,943.84
|
$53,239.73
|
$35,493.15
|
2025-09-11
|
|
A5104
|
LOCAL
|
Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More
|
25
|
23
|
—
|
—
|
$42,471.79
|
$70,786.32
|
$47,190.88
|
2025-09-11
|
|
B0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50
|
25
|
23
|
—
|
—
|
$28,533.11
|
$47,555.19
|
$31,703.46
|
2025-09-11
|
|
B0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50
|
25
|
23
|
—
|
—
|
$36,414.83
|
$60,691.38
|
$40,460.92
|
2025-09-11
|
|
B0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50
|
25
|
23
|
—
|
—
|
$45,535.02
|
$75,891.71
|
$50,594.47
|
2025-09-11
|
|
B0106
|
LOCAL
|
Stroke M <41.50 And A <84.50
|
25
|
23
|
—
|
—
|
$51,791.56
|
$86,319.27
|
$57,546.18
|
2025-09-11
|
|
B0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50
|
25
|
23
|
—
|
—
|
$29,595.18
|
$49,325.30
|
$32,883.53
|
2025-09-11
|
|
B0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
25
|
23
|
—
|
—
|
$36,705.29
|
$61,175.49
|
$40,783.66
|
2025-09-11
|
|
B0205
|
LOCAL
|
Traumatic Brain Injury M <35.50
|
25
|
23
|
—
|
—
|
$47,017.63
|
$78,362.72
|
$52,241.81
|
2025-09-11
|
|
B0302
|
LOCAL
|
Non-traumatic Brain Injury M >=52.50 And M <65.50
|
25
|
23
|
—
|
—
|
$27,617.18
|
$46,028.63
|
$30,685.75
|
2025-09-11
|
|
B0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50
|
25
|
23
|
—
|
—
|
$33,230.43
|
$55,384.05
|
$36,922.70
|
2025-09-11
|
|
B0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
25
|
23
|
—
|
—
|
$38,528.26
|
$64,213.77
|
$42,809.18
|
2025-09-11
|
|
B0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
25
|
23
|
—
|
—
|
$42,491.39
|
$70,818.99
|
$47,212.66
|
2025-09-11
|
|
B0402
|
LOCAL
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50
|
25
|
23
|
—
|
—
|
$27,716.97
|
$46,194.95
|
$30,796.63
|
2025-09-11
|
|
B0403
|
LOCAL
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
25
|
23
|
—
|
—
|
$34,782.53
|
$57,970.89
|
$38,647.26
|
2025-09-11
|
|
B0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
25
|
23
|
—
|
—
|
$54,307.73
|
$90,512.88
|
$60,341.92
|
2025-09-11
|
|
B0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
25
|
23
|
—
|
—
|
$43,188.15
|
$71,980.25
|
$47,986.83
|
2025-09-11
|
|
B0406
|
LOCAL
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
25
|
23
|
—
|
—
|
$55,107.84
|
$91,846.40
|
$61,230.93
|
2025-09-11
|
|
B0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
25
|
23
|
—
|
—
|
$75,338.69
|
$125,564.49
|
$83,709.66
|
2025-09-11
|
|
B0502
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50
|
25
|
23
|
—
|
—
|
$28,388.78
|
$47,314.64
|
$31,543.09
|
2025-09-11
|
|
B0503
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50
|
25
|
23
|
—
|
—
|
$32,540.80
|
$54,234.66
|
$36,156.44
|
2025-09-11
|
|
B0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
25
|
23
|
—
|
—
|
$38,681.51
|
$64,469.19
|
$42,979.46
|
2025-09-11
|
|
B0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50
|
25
|
23
|
—
|
—
|
$53,749.96
|
$89,583.27
|
$59,722.18
|
2025-09-11
|
|
B0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50
|
25
|
23
|
—
|
—
|
$30,031.77
|
$50,052.95
|
$33,368.63
|
2025-09-11
|
|
B0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50
|
25
|
23
|
—
|
—
|
$35,386.62
|
$58,977.71
|
$39,318.47
|
2025-09-11
|
|
B0604
|
LOCAL
|
Neurological M <43.50
|
25
|
23
|
—
|
—
|
$44,378.51
|
$73,964.19
|
$49,309.46
|
2025-09-11
|
|
B0702
|
LOCAL
|
Fracture Of Lower Extremity M >=52.50 And M <61.50
|
25
|
23
|
—
|
—
|
$27,606.48
|
$46,010.81
|
$30,673.87
|
2025-09-11
|
|
B0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50
|
25
|
23
|
—
|
—
|
$33,948.57
|
$56,580.95
|
$37,720.63
|
2025-09-11
|
|
B0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50
|
25
|
23
|
—
|
—
|
$41,472.10
|
$69,120.17
|
$46,080.11
|
2025-09-11
|
|
B0802
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=57.50 And M <63.50
|
25
|
23
|
—
|
—
|
$24,561.08
|
$40,935.14
|
$27,290.09
|
2025-09-11
|
|
B0803
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=51.50 And M <57.50
|
25
|
23
|
—
|
—
|
$27,337.41
|
$45,562.35
|
$30,374.90
|
2025-09-11
|
|
B0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50
|
25
|
23
|
—
|
—
|
$30,626.95
|
$51,044.91
|
$34,029.94
|
2025-09-11
|
|
B0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50
|
25
|
23
|
—
|
—
|
$36,732.02
|
$61,220.04
|
$40,813.36
|
2025-09-11
|
|
B0902
|
LOCAL
|
Other Orthopedic M >=51.50 And M <63.50
|
25
|
23
|
—
|
—
|
$26,670.94
|
$44,451.57
|
$29,634.38
|
2025-09-11
|
|
B0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50
|
25
|
23
|
—
|
—
|
$31,849.39
|
$53,082.32
|
$35,388.21
|
2025-09-11
|
|
B0904
|
LOCAL
|
Other Orthopedic M <44.5
|
25
|
23
|
—
|
—
|
$38,162.95
|
$63,604.92
|
$42,403.28
|
2025-09-11
|
|
B1002
|
LOCAL
|
Amputation Lower Extremity M >=55.50 And M <64.50
|
25
|
23
|
—
|
—
|
$27,337.41
|
$45,562.35
|
$30,374.90
|
2025-09-11
|
|
B1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50
|
25
|
23
|
—
|
—
|
$32,029.37
|
$53,382.29
|
$35,588.19
|
2025-09-11
|
|
B1004
|
LOCAL
|
Amputation Lower Extremity M <47.50
|
25
|
23
|
—
|
—
|
$41,005.22
|
$68,342.03
|
$45,561.35
|
2025-09-11
|
|
B1102
|
LOCAL
|
Amputation Non-lower Extremity M >=52.50 And M <58.50
|
25
|
23
|
—
|
—
|
$28,659.64
|
$47,766.06
|
$31,844.04
|
2025-09-11
|
|
B1103
|
LOCAL
|
Amputation Non-lower Extremity M <52.50
|
25
|
23
|
—
|
—
|
$35,739.46
|
$59,565.77
|
$39,710.51
|
2025-09-11
|
|
B1202
|
LOCAL
|
Osteoarthritis M >=49.50 And M <61.50
|
25
|
23
|
—
|
—
|
$28,643.60
|
$47,739.33
|
$31,826.22
|
2025-09-11
|
|
B1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50
|
25
|
23
|
—
|
—
|
$37,108.03
|
$61,846.71
|
$41,231.14
|
2025-09-11
|
|
B1204
|
LOCAL
|
Osteoarthritis M <49.50 And A <74.50
|
25
|
23
|
—
|
—
|
$38,913.17
|
$64,855.29
|
$43,236.86
|
2025-09-11
|
|
B1302
|
LOCAL
|
Rheumatoid Other Arthritis M >=51.50 And M <62.50
|
25
|
23
|
—
|
—
|
$26,562.24
|
$44,270.40
|
$29,513.60
|
2025-09-11
|
|
B1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50
|
25
|
23
|
—
|
—
|
$30,218.88
|
$50,364.80
|
$33,576.53
|
2025-09-11
|
|
B1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
25
|
23
|
—
|
—
|
$38,162.95
|
$63,604.92
|
$42,403.28
|
2025-09-11
|
|
B1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
25
|
23
|
—
|
—
|
$36,546.70
|
$60,911.16
|
$40,607.44
|
2025-09-11
|
|
B1402
|
LOCAL
|
Cardiac M >=55.50 And M <68.50
|
25
|
23
|
—
|
—
|
$25,503.75
|
$42,506.25
|
$28,337.50
|
2025-09-11
|
|
B1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50
|
25
|
23
|
—
|
—
|
$31,206.10
|
$52,010.16
|
$34,673.44
|
2025-09-11
|
|
B1404
|
LOCAL
|
Cardiac M <45.50
|
25
|
23
|
—
|
—
|
$38,237.80
|
$63,729.66
|
$42,486.44
|
2025-09-11
|
|
B1502
|
LOCAL
|
Pulmonary M >=56.50 And M <68.50
|
25
|
23
|
—
|
—
|
$28,796.85
|
$47,994.75
|
$31,996.50
|
2025-09-11
|
|
B1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50
|
25
|
23
|
—
|
—
|
$32,727.91
|
$54,546.51
|
$36,364.34
|
2025-09-11
|
|
B1504
|
LOCAL
|
Pulmonary M <45.50
|
25
|
23
|
—
|
—
|
$40,529.43
|
$67,549.05
|
$45,032.70
|
2025-09-11
|
|
B1602
|
LOCAL
|
Pain Syndrome M >=58.50 And M <65.50
|
25
|
23
|
—
|
—
|
$26,735.09
|
$44,558.49
|
$29,705.66
|
2025-09-11
|
|
B1603
|
LOCAL
|
Pain Syndrome M >=43.50 And M <58.50
|
25
|
23
|
—
|
—
|
$33,763.24
|
$56,272.07
|
$37,514.71
|
2025-09-11
|
|
B1604
|
LOCAL
|
Pain Syndrome M <43.50
|
25
|
23
|
—
|
—
|
$41,832.06
|
$69,720.11
|
$46,480.07
|
2025-09-11
|
|
B1701
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50
|
25
|
23
|
—
|
—
|
$23,826.90
|
$39,711.50
|
$26,474.33
|
2025-09-11
|
|
B1702
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50
|
25
|
23
|
—
|
—
|
$29,602.31
|
$49,337.18
|
$32,891.45
|
2025-09-11
|
|
B1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50
|
25
|
23
|
—
|
—
|
$35,176.36
|
$58,627.26
|
$39,084.84
|
2025-09-11
|
|
B1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
25
|
23
|
—
|
—
|
$39,814.86
|
$66,358.10
|
$44,238.73
|
2025-09-11
|
|
B1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
25
|
23
|
—
|
—
|
$46,723.61
|
$77,872.68
|
$51,915.12
|
2025-09-11
|
|
B1802
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50
|
25
|
23
|
—
|
—
|
$25,348.72
|
$42,247.86
|
$28,165.24
|
2025-09-11
|
|
B1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50
|
25
|
23
|
—
|
—
|
$32,567.53
|
$54,279.21
|
$36,186.14
|
2025-09-11
|
|
B1804
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
25
|
23
|
—
|
—
|
$35,614.72
|
$59,357.87
|
$39,571.91
|
2025-09-11
|
|
B1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
25
|
23
|
—
|
—
|
$43,179.24
|
$71,965.40
|
$47,976.93
|
2025-09-11
|
|
B1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
25
|
23
|
—
|
—
|
$61,321.61
|
$102,202.68
|
$68,135.12
|
2025-09-11
|
|
B1902
|
LOCAL
|
Guillain-barré M >=51.50 And M <66.50
|
25
|
23
|
—
|
—
|
$29,661.11
|
$49,435.19
|
$32,956.79
|
2025-09-11
|
|
B1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50
|
25
|
23
|
—
|
—
|
$44,752.73
|
$74,587.89
|
$49,725.26
|
2025-09-11
|
|
B1904
|
LOCAL
|
Guillain-barré M <38.50
|
25
|
23
|
—
|
—
|
$65,190.29
|
$108,650.49
|
$72,433.66
|
2025-09-11
|
|
B2002
|
LOCAL
|
Miscellaneous M >=55.50 And M <66.50
|
25
|
23
|
—
|
—
|
$26,227.23
|
$43,712.06
|
$29,141.37
|
2025-09-11
|
|
B2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50
|
25
|
23
|
—
|
—
|
$31,407.45
|
$52,345.76
|
$34,897.17
|
2025-09-11
|
|
B2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50
|
25
|
23
|
—
|
—
|
$37,551.74
|
$62,586.23
|
$41,724.15
|
2025-09-11
|
|
B2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50
|
25
|
23
|
—
|
—
|
$39,581.42
|
$65,969.03
|
$43,979.35
|
2025-09-11
|
|
B2101
|
LOCAL
|
Burns M >=52.50
|
25
|
23
|
—
|
—
|
$26,817.07
|
$44,695.11
|
$29,796.74
|
2025-09-11
|
|
B2102
|
LOCAL
|
Burns M <52.50
|
25
|
23
|
—
|
—
|
$41,299.25
|
$68,832.08
|
$45,888.05
|
2025-09-11
|
|
C0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50
|
25
|
23
|
—
|
—
|
$24,746.40
|
$41,244.00
|
$27,496.00
|
2025-09-11
|
|
C0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50
|
25
|
23
|
—
|
—
|
$31,580.31
|
$52,633.85
|
$35,089.23
|
2025-09-11
|
|
C0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50
|
25
|
23
|
—
|
—
|
$39,490.53
|
$65,817.56
|
$43,878.37
|
2025-09-11
|
|
C0106
|
LOCAL
|
Stroke M <41.50 And A <84.50
|
25
|
23
|
—
|
—
|
$44,916.67
|
$74,861.12
|
$49,907.41
|
2025-09-11
|
|
C0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50
|
25
|
23
|
—
|
—
|
$24,375.75
|
$40,626.26
|
$27,084.17
|
2025-09-11
|
|
C0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
25
|
23
|
—
|
—
|
$30,233.13
|
$50,388.56
|
$33,592.37
|
2025-09-11
|
|
C0205
|
LOCAL
|
Traumatic Brain Injury M <35.50
|
25
|
23
|
—
|
—
|
$38,724.28
|
$64,540.47
|
$43,026.98
|
2025-09-11
|
|
C0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50
|
25
|
23
|
—
|
—
|
$26,585.41
|
$44,309.01
|
$29,539.34
|
2025-09-11
|
|
C0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
25
|
23
|
—
|
—
|
$30,824.75
|
$51,374.58
|
$34,249.72
|
2025-09-11
|
|
C0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
25
|
23
|
—
|
—
|
$33,994.90
|
$56,658.17
|
$37,772.11
|
2025-09-11
|
|
C0402
|
LOCAL
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50
|
25
|
23
|
—
|
—
|
$24,648.39
|
$41,080.65
|
$27,387.10
|
2025-09-11
|
|
C0403
|
LOCAL
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
25
|
23
|
—
|
—
|
$30,931.67
|
$51,552.78
|
$34,368.52
|
2025-09-11
|
|
C0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
25
|
23
|
—
|
—
|
$48,295.31
|
$80,492.19
|
$53,661.46
|
2025-09-11
|
|
C0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
25
|
23
|
—
|
—
|
$38,407.09
|
$64,011.81
|
$42,674.54
|
2025-09-11
|
|
C0406
|
LOCAL
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
25
|
23
|
—
|
—
|
$49,006.32
|
$81,677.21
|
$54,451.47
|
2025-09-11
|
|
C0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
25
|
23
|
—
|
—
|
$66,997.23
|
$111,662.06
|
$74,441.37
|
2025-09-11
|
|
C0503
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50
|
25
|
23
|
—
|
—
|
$25,314.86
|
$42,191.43
|
$28,127.62
|
2025-09-11
|
|
C0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
25
|
23
|
—
|
—
|
$30,092.36
|
$50,153.93
|
$33,435.95
|
2025-09-11
|
|
C0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50
|
25
|
23
|
—
|
—
|
$41,816.03
|
$69,693.38
|
$46,462.25
|
2025-09-11
|
|
C0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50
|
25
|
23
|
—
|
—
|
$26,492.75
|
$44,154.59
|
$29,436.39
|
2025-09-11
|
|
C0604
|
LOCAL
|
Neurological M <43.50
|
25
|
23
|
—
|
—
|
$33,225.08
|
$55,375.14
|
$36,916.76
|
2025-09-11
|
|
C0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50
|
25
|
23
|
—
|
—
|
$26,261.09
|
$43,768.49
|
$29,178.99
|
2025-09-11
|
|
C0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50
|
25
|
23
|
—
|
—
|
$32,081.05
|
$53,468.42
|
$35,645.61
|
2025-09-11
|
|
C0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50
|
25
|
23
|
—
|
—
|
$24,575.34
|
$40,958.90
|
$27,305.93
|
2025-09-11
|
|
C0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50
|
25
|
23
|
—
|
—
|
$29,474.00
|
$49,123.34
|
$32,748.89
|
2025-09-11
|
|
C0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50
|
25
|
23
|
—
|
—
|
$25,509.10
|
$42,515.16
|
$28,343.44
|
2025-09-11
|
|
C0904
|
LOCAL
|
Other Orthopedic M <44.5
|
25
|
23
|
—
|
—
|
$30,566.36
|
$50,943.93
|
$33,962.62
|
2025-09-11
|
|
C1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50
|
25
|
23
|
—
|
—
|
$26,489.19
|
$44,148.65
|
$29,432.43
|
2025-09-11
|
|
C1004
|
LOCAL
|
Amputation Lower Extremity M <47.50
|
25
|
23
|
—
|
—
|
$33,912.93
|
$56,521.55
|
$37,681.03
|
2025-09-11
|
|
C1103
|
LOCAL
|
Amputation Non-lower Extremity M <52.50
|
25
|
23
|
—
|
—
|
$28,729.13
|
$47,881.89
|
$31,921.26
|
2025-09-11
|
|
C1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50
|
25
|
23
|
—
|
—
|
$28,210.58
|
$47,017.64
|
$31,345.09
|
2025-09-11
|
|
C1204
|
LOCAL
|
Osteoarthritis M <49.50 And A <74.50
|
25
|
23
|
—
|
—
|
$29,584.49
|
$49,307.48
|
$32,871.65
|
2025-09-11
|
|
C1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50
|
25
|
23
|
—
|
—
|
$24,986.97
|
$41,644.95
|
$27,763.30
|
2025-09-11
|
|
C1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
25
|
23
|
—
|
—
|
$31,553.58
|
$52,589.30
|
$35,059.53
|
2025-09-11
|
|
C1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
25
|
23
|
—
|
—
|
$30,217.10
|
$50,361.83
|
$33,574.55
|
2025-09-11
|
|
C1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50
|
25
|
23
|
—
|
—
|
$24,584.25
|
$40,973.75
|
$27,315.83
|
2025-09-11
|
|
C1404
|
LOCAL
|
Cardiac M <45.50
|
25
|
23
|
—
|
—
|
$30,122.65
|
$50,204.42
|
$33,469.61
|
2025-09-11
|
|
C1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50
|
25
|
23
|
—
|
—
|
$26,562.24
|
$44,270.40
|
$29,513.60
|
2025-09-11
|
|
C1504
|
LOCAL
|
Pulmonary M <45.50
|
25
|
23
|
—
|
—
|
$32,895.41
|
$54,825.69
|
$36,550.46
|
2025-09-11
|
|
C1603
|
LOCAL
|
Pain Syndrome M >=43.50 And M <58.50
|
25
|
23
|
—
|
—
|
$25,077.85
|
$41,796.42
|
$27,864.28
|
2025-09-11
|
|
C1604
|
LOCAL
|
Pain Syndrome M <43.50
|
25
|
23
|
—
|
—
|
$31,070.66
|
$51,784.44
|
$34,522.96
|
2025-09-11
|
|
C1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50
|
25
|
23
|
—
|
—
|
$27,342.76
|
$45,571.26
|
$30,380.84
|
2025-09-11
|
|
C1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
25
|
23
|
—
|
—
|
$30,947.71
|
$51,579.51
|
$34,386.34
|
2025-09-11
|
|
C1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
25
|
23
|
—
|
—
|
$36,318.60
|
$60,531.00
|
$40,354.00
|
2025-09-11
|
|
C1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50
|
25
|
23
|
—
|
—
|
$25,981.32
|
$43,302.20
|
$28,868.13
|
2025-09-11
|
|
C1804
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
25
|
23
|
—
|
—
|
$28,411.95
|
$47,353.25
|
$31,568.83
|
2025-09-11
|
|
C1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
25
|
23
|
—
|
—
|
$34,445.74
|
$57,409.56
|
$38,273.04
|
2025-09-11
|
|
C1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
25
|
23
|
—
|
—
|
$48,919.01
|
$81,531.68
|
$54,354.45
|
2025-09-11
|
|
C1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50
|
25
|
23
|
—
|
—
|
$34,404.75
|
$57,341.25
|
$38,227.50
|
2025-09-11
|
|
C1904
|
LOCAL
|
Guillain-barré M <38.50
|
25
|
23
|
—
|
—
|
$50,118.28
|
$83,530.47
|
$55,686.98
|
2025-09-11
|
|
C2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50
|
25
|
23
|
—
|
—
|
$25,086.76
|
$41,811.27
|
$27,874.18
|
2025-09-11
|
|
C2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50
|
25
|
23
|
—
|
—
|
$29,994.35
|
$49,990.58
|
$33,327.05
|
2025-09-11
|
|
C2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50
|
25
|
23
|
—
|
—
|
$31,615.95
|
$52,693.25
|
$35,128.83
|
2025-09-11
|
|
C2102
|
LOCAL
|
Burns M <52.50
|
25
|
23
|
—
|
—
|
$31,382.51
|
$52,304.18
|
$34,869.45
|
2025-09-11
|
|
D0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50
|
25
|
23
|
—
|
—
|
$28,859.22
|
$48,098.70
|
$32,065.80
|
2025-09-11
|
|
D0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50
|
25
|
23
|
—
|
—
|
$36,086.95
|
$60,144.92
|
$40,096.61
|
2025-09-11
|
|
D0106
|
LOCAL
|
Stroke M <41.50 And A <84.50
|
25
|
23
|
—
|
—
|
$41,046.20
|
$68,410.34
|
$45,606.89
|
2025-09-11
|
|
D0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
25
|
23
|
—
|
—
|
$27,458.59
|
$45,764.31
|
$30,509.54
|
2025-09-11
|
|
D0205
|
LOCAL
|
Traumatic Brain Injury M <35.50
|
25
|
23
|
—
|
—
|
$35,172.79
|
$58,621.32
|
$39,080.88
|
2025-09-11
|
|
D0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50
|
25
|
23
|
—
|
—
|
$24,422.09
|
$40,703.48
|
$27,135.65
|
2025-09-11
|
|
D0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
25
|
23
|
—
|
—
|
$28,315.72
|
$47,192.87
|
$31,461.91
|
2025-09-11
|
|
D0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
25
|
23
|
—
|
—
|
$31,227.48
|
$52,045.80
|
$34,697.20
|
2025-09-11
|
|
D0402
|
LOCAL
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50
|
25
|
23
|
—
|
—
|
$23,926.69
|
$39,877.82
|
$26,585.21
|
2025-09-11
|
|
D0403
|
LOCAL
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
25
|
23
|
—
|
—
|
$30,026.42
|
$50,044.04
|
$33,362.69
|
2025-09-11
|
|
D0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
25
|
23
|
—
|
—
|
$46,882.20
|
$78,137.00
|
$52,091.33
|
2025-09-11
|
|
D0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
25
|
23
|
—
|
—
|
$37,282.65
|
$62,137.76
|
$41,425.17
|
2025-09-11
|
|
D0406
|
LOCAL
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
25
|
23
|
—
|
—
|
$47,571.83
|
$79,286.39
|
$52,857.59
|
2025-09-11
|
|
D0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
25
|
23
|
—
|
—
|
$65,037.05
|
$108,395.09
|
$72,263.39
|
2025-09-11
|
|
D0503
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50
|
25
|
23
|
—
|
—
|
$23,916.00
|
$39,860.00
|
$26,573.33
|
2025-09-11
|
|
D0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
25
|
23
|
—
|
—
|
$28,429.77
|
$47,382.95
|
$31,588.63
|
2025-09-11
|
|
D0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50
|
25
|
23
|
—
|
—
|
$39,504.79
|
$65,841.32
|
$43,894.21
|
2025-09-11
|
|
D0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50
|
25
|
23
|
—
|
—
|
$24,732.14
|
$41,220.24
|
$27,480.16
|
2025-09-11
|
|
D0604
|
LOCAL
|
Neurological M <43.50
|
25
|
23
|
—
|
—
|
$31,017.20
|
$51,695.34
|
$34,463.56
|
2025-09-11
|
|
D0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50
|
25
|
23
|
—
|
—
|
$24,876.49
|
$41,460.81
|
$27,640.54
|
2025-09-11
|
|
D0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50
|
25
|
23
|
—
|
—
|
$30,389.94
|
$50,649.90
|
$33,766.60
|
2025-09-11
|
|
D0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50
|
25
|
23
|
—
|
—
|
$26,872.31
|
$44,787.18
|
$29,858.12
|
2025-09-11
|
|
D0904
|
LOCAL
|
Other Orthopedic M <44.5
|
25
|
23
|
—
|
—
|
$28,490.35
|
$47,483.91
|
$31,655.94
|
2025-09-11
|
|
D1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50
|
25
|
23
|
—
|
—
|
$24,197.55
|
$40,329.26
|
$26,886.17
|
2025-09-11
|
|
D1004
|
LOCAL
|
Amputation Lower Extremity M <47.50
|
25
|
23
|
—
|
—
|
$30,978.00
|
$51,630.00
|
$34,420.00
|
2025-09-11
|
|
D1103
|
LOCAL
|
Amputation Non-lower Extremity M <52.50
|
25
|
23
|
—
|
—
|
$28,729.13
|
$47,881.89
|
$31,921.26
|
2025-09-11
|
|
D1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50
|
25
|
23
|
—
|
—
|
$26,451.77
|
$44,086.28
|
$29,390.85
|
2025-09-11
|
|
D1204
|
LOCAL
|
Osteoarthritis M <49.50 And A <74.50
|
25
|
23
|
—
|
—
|
$27,738.35
|
$46,230.59
|
$30,820.39
|
2025-09-11
|
|
D1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50
|
25
|
23
|
—
|
—
|
$23,850.06
|
$39,750.11
|
$26,500.07
|
2025-09-11
|
|
D1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
25
|
23
|
—
|
—
|
$30,119.09
|
$50,198.48
|
$33,465.65
|
2025-09-11
|
|
D1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
25
|
23
|
—
|
—
|
$28,843.18
|
$48,071.97
|
$32,047.98
|
2025-09-11
|
|
D1404
|
LOCAL
|
Cardiac M <45.50
|
25
|
23
|
—
|
—
|
$28,007.43
|
$46,679.06
|
$31,119.37
|
2025-09-11
|
|
D1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50
|
25
|
23
|
—
|
—
|
$24,981.62
|
$41,636.04
|
$27,757.36
|
2025-09-11
|
|
D1504
|
LOCAL
|
Pulmonary M <45.50
|
25
|
23
|
—
|
—
|
$30,937.01
|
$51,561.69
|
$34,374.46
|
2025-09-11
|
|
D1604
|
LOCAL
|
Pain Syndrome M <43.50
|
25
|
23
|
—
|
—
|
$28,084.06
|
$46,806.77
|
$31,204.51
|
2025-09-11
|
|
D1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50
|
25
|
23
|
—
|
—
|
$25,323.77
|
$42,206.28
|
$28,137.52
|
2025-09-11
|
|
D1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
25
|
23
|
—
|
—
|
$28,661.42
|
$47,769.03
|
$31,846.02
|
2025-09-11
|
|
D1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
25
|
23
|
—
|
—
|
$33,634.94
|
$56,058.23
|
$37,372.15
|
2025-09-11
|
|
D1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50
|
25
|
23
|
—
|
—
|
$24,666.21
|
$41,110.35
|
$27,406.90
|
2025-09-11
|
|
D1804
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
25
|
23
|
—
|
—
|
$26,972.10
|
$44,953.50
|
$29,969.00
|
2025-09-11
|
|
D1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
25
|
23
|
—
|
—
|
$32,701.18
|
$54,501.96
|
$36,334.64
|
2025-09-11
|
|
D1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
25
|
23
|
—
|
—
|
$46,442.05
|
$77,403.42
|
$51,602.28
|
2025-09-11
|
|
D1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50
|
25
|
23
|
—
|
—
|
$32,104.22
|
$53,507.03
|
$35,671.35
|
2025-09-11
|
|
D1904
|
LOCAL
|
Guillain-barré M <38.50
|
25
|
23
|
—
|
—
|
$46,766.38
|
$77,943.96
|
$51,962.64
|
2025-09-11
|
|
D2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50
|
25
|
23
|
—
|
—
|
$28,019.91
|
$46,699.85
|
$31,133.23
|
2025-09-11
|
|
D2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50
|
25
|
23
|
—
|
—
|
$29,534.59
|
$49,224.32
|
$32,816.21
|
2025-09-11
|
|
D2102
|
LOCAL
|
Burns M <52.50
|
25
|
23
|
—
|
—
|
$31,382.51
|
$52,304.18
|
$34,869.45
|
2025-09-11
|