Hospital

Everest Rehabilitation Hospital Longview

Longview, TX · CCN 673073 · Rates published

17,934 distinct procedures filed

10 distinct payers

203,500 rate rows

2026-03-16 last MRF observed

Data quality

147,432 of 203,500 rate rows are consumer-grade (72.4%)

56,068 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 — reason	Rows
per-diem day rate — not a per-procedure price	56,057
placeholder amount (≤ $0.02) — excluded from medians	11

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://www.longviewrehabhospital.com/docs/irflongviewrehabilitationhospitallibraries/mar2026/921253139_longview-rehabilitation-hospital_standardcharges.csv.zip
Discovered via	Discovered by HANK (automated)
Last fetch	not_modified · 2026-05-18
Content fingerprint	96228d344c61d2f4… · 1,702,292 bytes · first seen 2026-05-13

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
B0407 OTHER	Traumatic Spinal Cord Injury M <24.50 And A >=61.50	8	$82,215.93	$82,215.93	$82,215.93	nat. median $86,320 1.0× median
B1904 OTHER	Guillain-barr� M <38.50	8	$76,970.42	$76,970.42	$76,970.42	nat. median $80,609 1.0× median
C0407 OTHER	Traumatic Spinal Cord Injury M <24.50 And A >=61.50	8	$67,201.29	$67,201.29	$67,201.29	nat. median $71,021 0.9× median
D0407 OTHER	Traumatic Spinal Cord Injury M <24.50 And A >=61.50	8	$65,432.83	$65,432.83	$65,432.83	nat. median $68,708 1.0× median
B1806 OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50	8	$65,149.88	$65,149.88	$65,149.88	nat. median $68,402 1.0× median
B0406 OTHER	Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50	8	$60,036.78	$60,036.78	$60,036.78	nat. median $62,870 1.0× median
A0407 OTHER	Traumatic Spinal Cord Injury M <24.50 And A >=61.50	8	$59,209.69	$59,209.69	$59,209.69	nat. median $62,810 0.9× median
B0404 OTHER	Traumatic Spinal Cord Injury M <31.50 And A <61.50	8	$57,615.36	$57,615.36	$57,615.36	nat. median $60,491 1.0× median
B0505 OTHER	Non-traumatic Spinal Cord Injury M <39.50	8	$56,666.74	$56,666.74	$56,666.74	nat. median $59,495 1.0× median
74080532 CDM	Occ/emb Hemorrhag/lymph	8	$56,399.93	$56,399.93	$56,399.93	nat. median $55,326 1.0× median
74080530 CDM	Occ/emb Non Hemorr Art	8	$56,399.93	$56,399.93	$56,399.93	nat. median $55,326 1.0× median
74080531 CDM	Occ/emb Tumor/organ Infar	8	$56,399.93	$56,399.93	$56,399.93	nat. median $55,326 1.0× median
74080529 CDM	Occ/emb Non Hemorr Venous	8	$56,399.93	$56,399.93	$56,399.93	nat. median $55,326 1.0× median
C1904 OTHER	Guillain-barr� M <38.50	8	$54,397.68	$54,397.68	$54,397.68	nat. median $57,113 1.0× median
C1806 OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50	8	$53,298.51	$53,298.51	$53,298.51	nat. median $55,837 1.0× median
B0106 OTHER	Stroke M <41.50 And A <84.50	8	$51,375.89	$51,375.89	$51,375.89	nat. median $54,065 1.0× median
B1903 OTHER	Guillain-barr� M >=38.50 And M <51.50	8	$50,055.44	$50,055.44	$50,055.44	nat. median $52,554 1.0× median
B0205 OTHER	Traumatic Brain Injury M <35.50	8	$49,422.42	$49,422.42	$49,422.42	nat. median $51,964 1.0× median
C0406 OTHER	Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50	8	$49,072.36	$49,072.36	$49,072.36	nat. median $51,880 0.9× median
D1806 OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50	8	$49,030.64	$49,030.64	$49,030.64	nat. median $51,478 1.0× median
74080268 CDM	Insert Tips	8	$48,288.18	$48,288.18	$48,288.18	nat. median $47,368 1.0× median
D0406 OTHER	Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50	8	$47,780.93	$47,780.93	$47,780.93	nat. median $50,515 0.9× median
A1904 OTHER	Guillain-barr� M <38.50	8	$47,303.90	$47,303.90	$47,303.90	nat. median $50,010 0.9× median
D1904 OTHER	Guillain-barr� M <38.50	8	$47,289.39	$47,289.39	$47,289.39	nat. median $49,901 0.9× median
C0404 OTHER	Traumatic Spinal Cord Injury M <31.50 And A <61.50	8	$47,093.50	$47,093.50	$47,093.50	nat. median $49,743 0.9× median
74080483 CDM	Revise Tips	8	$47,034.04	$47,034.04	$47,034.04	nat. median $46,138 1.0× median
B1705 OTHER	Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50	8	$46,355.29	$46,355.29	$46,355.29	nat. median $48,669 1.0× median
B2102 OTHER	Burns M <52.50	8	$46,163.02	$46,163.02	$46,163.02	nat. median $48,467 1.0× median
A1806 OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50	8	$46,019.73	$46,019.73	$46,019.73	nat. median $48,628 0.9× median
D0404 OTHER	Traumatic Spinal Cord Injury M <31.50 And A <61.50	8	$45,854.68	$45,854.68	$45,854.68	nat. median $48,434 0.9× median
B0405 OTHER	Traumatic Spinal Cord Injury M >=31.50 And M <41.50	8	$45,637.02	$45,637.02	$45,637.02	nat. median $47,915 1.0× median
C0106 OTHER	Stroke M <41.50 And A <84.50	8	$45,622.51	$45,622.51	$45,622.51	nat. median $47,971 1.0× median
B0105 OTHER	Stroke M <41.50 And A >=84.50	8	$45,609.81	$45,609.81	$45,609.81	nat. median $47,979 1.0× median
B1805 OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50	8	$44,967.73	$44,967.73	$44,967.73	nat. median $47,212 1.0× median
B0604 OTHER	Neurological M <43.50	8	$44,434.47	$44,434.47	$44,434.47	nat. median $46,755 1.0× median
C0505 OTHER	Non-traumatic Spinal Cord Injury M <39.50	8	$43,547.52	$43,547.52	$43,547.52	nat. median $45,787 1.0× median
A0406 OTHER	Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50	8	$43,237.36	$43,237.36	$43,237.36	nat. median $45,990 0.9× median
B0305 OTHER	Non-traumatic Brain Injury M <42.50 And A <78.50	8	$42,985.25	$42,985.25	$42,985.25	nat. median $45,142 1.0× median
B1004 OTHER	Amputation Lower Extremity M <47.50	8	$42,867.35	$42,867.35	$42,867.35	nat. median $45,008 1.0× median
B1504 OTHER	Pulmonary M <45.50	8	$42,488.26	$42,488.26	$42,488.26	nat. median $44,609 1.0× median
76085035 CDM	Sm153 Lexidron To 150mci	8	$41,825.76	$41,825.76	$41,825.76	nat. median $41,029 1.0× median
B0704 OTHER	Fracture Of Lower Extremity M <41.50	8	$41,608.57	$41,608.57	$41,608.57	nat. median $43,748 1.0× median
B1304 OTHER	Rheumatoid Other Arthritis M <44.50 And A >=64.50	8	$41,557.79	$41,557.79	$41,557.79	nat. median $43,632 1.0× median
A0404 OTHER	Traumatic Spinal Cord Injury M <31.50 And A <61.50	8	$41,494.30	$41,494.30	$41,494.30	nat. median $43,915 0.9× median
B1305 OTHER	Rheumatoid Other Arthritis M <51.50 And A <64.50	8	$41,476.16	$41,476.16	$41,476.16	nat. median $43,434 1.0× median
D0106 OTHER	Stroke M <41.50 And A <84.50	8	$41,334.69	$41,334.69	$41,334.69	nat. median $43,510 1.0× median
B0904 OTHER	Other Orthopedic M <44.5	8	$40,777.85	$40,777.85	$40,777.85	nat. median $42,813 1.0× median
D0505 OTHER	Non-traumatic Spinal Cord Injury M <39.50	8	$40,513.04	$40,513.04	$40,513.04	nat. median $42,599 1.0× median
C0105 OTHER	Stroke M <41.50 And A >=84.50	8	$40,502.15	$40,502.15	$40,502.15	nat. median $42,585 1.0× median
B2005 OTHER	Miscellaneous M <46.50 And A <77.50	8	$40,117.63	$40,117.63	$40,117.63	nat. median $42,136 1.0× median

Other procedures at this hospital

Browse this hospital's 17,934 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

B1004	OTHER	Amputation Lower Extremity M <47.50	8	8	$42,867.35	$42,867.35	$42,867.35	$42,867.35	$42,867.35	2026-03-16
C1004	OTHER	Amputation Lower Extremity M <47.50	8	8	$35,619.40	$35,619.40	$35,619.40	$35,619.40	$35,619.40	2026-03-16
D1004	OTHER	Amputation Lower Extremity M <47.50	8	8	$32,329.17	$32,329.17	$32,329.17	$32,329.17	$32,329.17	2026-03-16
A1004	OTHER	Amputation Lower Extremity M <47.50	8	8	$30,018.39	$30,018.39	$30,018.39	$30,018.39	$30,018.39	2026-03-16
B1003	OTHER	Amputation Lower Extremity M >=47.50 And M <55.50	8	8	$32,227.60	$32,227.60	$32,227.60	$32,227.60	$32,227.60	2026-03-16
C1003	OTHER	Amputation Lower Extremity M >=47.50 And M <55.50	8	8	$26,778.94	$26,778.94	$26,778.94	$26,778.94	$26,778.94	2026-03-16
D1003	OTHER	Amputation Lower Extremity M >=47.50 And M <55.50	8	8	$24,304.92	$24,304.92	$24,304.92	$24,304.92	$24,304.92	2026-03-16
A1003	OTHER	Amputation Lower Extremity M >=47.50 And M <55.50	8	8	$22,567.30	$22,567.30	$22,567.30	$22,567.30	$22,567.30	2026-03-16
B1002	OTHER	Amputation Lower Extremity M >=55.50 And M <64.50	8	8	$27,078.22	$27,078.22	$27,078.22	$27,078.22	$27,078.22	2026-03-16
C1002	OTHER	Amputation Lower Extremity M >=55.50 And M <64.50	8	8	$22,500.19	$22,500.19	$22,500.19	$22,500.19	$22,500.19	2026-03-16
B1001	OTHER	Amputation Lower Extremity M >=64.50	8	8	$22,289.79	$22,289.79	$22,289.79	$22,289.79	$22,289.79	2026-03-16
B1103	OTHER	Amputation Non-lower Extremity M <52.50	8	8	$35,086.15	$35,086.15	$35,086.15	$35,086.15	$35,086.15	2026-03-16
C1103	OTHER	Amputation Non-lower Extremity M <52.50	8	8	$33,216.12	$33,216.12	$33,216.12	$33,216.12	$33,216.12	2026-03-16
D1103	OTHER	Amputation Non-lower Extremity M <52.50	8	8	$28,585.49	$28,585.49	$28,585.49	$28,585.49	$28,585.49	2026-03-16
A1103	OTHER	Amputation Non-lower Extremity M <52.50	8	8	$25,010.49	$25,010.49	$25,010.49	$25,010.49	$25,010.49	2026-03-16
B1102	OTHER	Amputation Non-lower Extremity M >=52.50 And M <58.50	8	8	$28,012.33	$28,012.33	$28,012.33	$28,012.33	$28,012.33	2026-03-16
C1102	OTHER	Amputation Non-lower Extremity M >=52.50 And M <58.50	8	8	$26,519.57	$26,519.57	$26,519.57	$26,519.57	$26,519.57	2026-03-16
D1102	OTHER	Amputation Non-lower Extremity M >=52.50 And M <58.50	8	8	$22,821.23	$22,821.23	$22,821.23	$22,821.23	$22,821.23	2026-03-16
B1101	OTHER	Amputation Non-lower Extremity M >=58.50	8	8	$24,529.83	$24,529.83	$24,529.83	$24,529.83	$24,529.83	2026-03-16
C1101	OTHER	Amputation Non-lower Extremity M >=58.50	8	8	$23,223.90	$23,223.90	$23,223.90	$23,223.90	$23,223.90	2026-03-16
B2102	OTHER	Burns M <52.50	8	8	$46,163.02	$46,163.02	$46,163.02	$46,163.02	$46,163.02	2026-03-16
C2102	OTHER	Burns M <52.50	8	8	$38,809.88	$38,809.88	$38,809.88	$38,809.88	$38,809.88	2026-03-16
D2102	OTHER	Burns M <52.50	8	8	$29,267.48	$29,267.48	$29,267.48	$29,267.48	$29,267.48	2026-03-16
A2102	OTHER	Burns M <52.50	8	8	$28,066.74	$28,066.74	$28,066.74	$28,066.74	$28,066.74	2026-03-16
B2101	OTHER	Burns M >=52.50	8	8	$29,131.44	$29,131.44	$29,131.44	$29,131.44	$29,131.44	2026-03-16
C2101	OTHER	Burns M >=52.50	8	8	$24,491.74	$24,491.74	$24,491.74	$24,491.74	$24,491.74	2026-03-16
B1404	OTHER	Cardiac M <45.50	8	8	$38,938.66	$38,938.66	$38,938.66	$38,938.66	$38,938.66	2026-03-16
C1404	OTHER	Cardiac M <45.50	8	8	$31,367.86	$31,367.86	$31,367.86	$31,367.86	$31,367.86	2026-03-16
D1404	OTHER	Cardiac M <45.50	8	8	$29,004.48	$29,004.48	$29,004.48	$29,004.48	$29,004.48	2026-03-16
A1404	OTHER	Cardiac M <45.50	8	8	$26,671.93	$26,671.93	$26,671.93	$26,671.93	$26,671.93	2026-03-16
B1403	OTHER	Cardiac M >=45.50 And M <55.50	8	8	$31,210.06	$31,210.06	$31,210.06	$31,210.06	$31,210.06	2026-03-16
C1403	OTHER	Cardiac M >=45.50 And M <55.50	8	8	$25,141.08	$25,141.08	$25,141.08	$25,141.08	$25,141.08	2026-03-16
D1403	OTHER	Cardiac M >=45.50 And M <55.50	8	8	$23,245.66	$23,245.66	$23,245.66	$23,245.66	$23,245.66	2026-03-16
B1402	OTHER	Cardiac M >=55.50 And M <68.50	8	8	$25,821.26	$25,821.26	$25,821.26	$25,821.26	$25,821.26	2026-03-16
A5104	OTHER	Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More	8	8	$39,687.76	$39,687.76	$39,687.76	$39,687.76	$39,687.76	2026-03-16
A5102	OTHER	Expired, Orthopedic, Length Of Stay Is 14 Days Or More	8	8	$37,155.69	$37,155.69	$37,155.69	$37,155.69	$37,155.69	2026-03-16
B0704	OTHER	Fracture Of Lower Extremity M <41.50	8	8	$41,608.57	$41,608.57	$41,608.57	$41,608.57	$41,608.57	2026-03-16
C0704	OTHER	Fracture Of Lower Extremity M <41.50	8	8	$33,268.72	$33,268.72	$33,268.72	$33,268.72	$33,268.72	2026-03-16
D0704	OTHER	Fracture Of Lower Extremity M <41.50	8	8	$31,596.40	$31,596.40	$31,596.40	$31,596.40	$31,596.40	2026-03-16
A0704	OTHER	Fracture Of Lower Extremity M <41.50	8	8	$28,872.07	$28,872.07	$28,872.07	$28,872.07	$28,872.07	2026-03-16
B0703	OTHER	Fracture Of Lower Extremity M >=41.50 And M <52.50	8	8	$33,696.78	$33,696.78	$33,696.78	$33,696.78	$33,696.78	2026-03-16
C0703	OTHER	Fracture Of Lower Extremity M >=41.50 And M <52.50	8	8	$26,942.19	$26,942.19	$26,942.19	$26,942.19	$26,942.19	2026-03-16
D0703	OTHER	Fracture Of Lower Extremity M >=41.50 And M <52.50	8	8	$25,589.09	$25,589.09	$25,589.09	$25,589.09	$25,589.09	2026-03-16
A0703	OTHER	Fracture Of Lower Extremity M >=41.50 And M <52.50	8	8	$23,383.51	$23,383.51	$23,383.51	$23,383.51	$23,383.51	2026-03-16
B0702	OTHER	Fracture Of Lower Extremity M >=52.50 And M <61.50	8	8	$27,506.28	$27,506.28	$27,506.28	$27,506.28	$27,506.28	2026-03-16
C0702	OTHER	Fracture Of Lower Extremity M >=52.50 And M <61.50	8	8	$21,992.33	$21,992.33	$21,992.33	$21,992.33	$21,992.33	2026-03-16
B0701	OTHER	Fracture Of Lower Extremity M >=61.50	8	8	$22,253.51	$22,253.51	$22,253.51	$22,253.51	$22,253.51	2026-03-16
92218460	CDM	Gamunex-c 1 Gm/10 Ml Sol	8	8	$29,397.06	$29,397.06	$29,397.06	$29,397.06	$29,397.06	2026-03-16
B1904	OTHER	Guillain-barr� M <38.50	8	8	$76,970.42	$76,970.42	$76,970.42	$76,970.42	$76,970.42	2026-03-16
C1904	OTHER	Guillain-barr� M <38.50	8	8	$54,397.68	$54,397.68	$54,397.68	$54,397.68	$54,397.68	2026-03-16
A1904	OTHER	Guillain-barr� M <38.50	8	8	$47,303.90	$47,303.90	$47,303.90	$47,303.90	$47,303.90	2026-03-16
D1904	OTHER	Guillain-barr� M <38.50	8	8	$47,289.39	$47,289.39	$47,289.39	$47,289.39	$47,289.39	2026-03-16
B1903	OTHER	Guillain-barr� M >=38.50 And M <51.50	8	8	$50,055.44	$50,055.44	$50,055.44	$50,055.44	$50,055.44	2026-03-16
C1903	OTHER	Guillain-barr� M >=38.50 And M <51.50	8	8	$35,376.36	$35,376.36	$35,376.36	$35,376.36	$35,376.36	2026-03-16
A1903	OTHER	Guillain-barr� M >=38.50 And M <51.50	8	8	$30,762.05	$30,762.05	$30,762.05	$30,762.05	$30,762.05	2026-03-16
D1903	OTHER	Guillain-barr� M >=38.50 And M <51.50	8	8	$30,754.79	$30,754.79	$30,754.79	$30,754.79	$30,754.79	2026-03-16
B1902	OTHER	Guillain-barr� M >=51.50 And M <66.50	8	8	$35,378.17	$35,378.17	$35,378.17	$35,378.17	$35,378.17	2026-03-16
C1902	OTHER	Guillain-barr� M >=51.50 And M <66.50	8	8	$25,003.23	$25,003.23	$25,003.23	$25,003.23	$25,003.23	2026-03-16
B1901	OTHER	Guillain-barr� M >=66.50	8	8	$24,317.62	$24,317.62	$24,317.62	$24,317.62	$24,317.62	2026-03-16
76085053	CDM	In-111 Capromab To 10mci	8	8	$22,383.90	$22,383.90	$22,383.90	$22,383.90	$22,383.90	2026-03-16
76085056	CDM	In-111 Pentetr Dx To 6mci	8	8	$23,220.35	$23,220.35	$23,220.35	$23,220.35	$23,220.35	2026-03-16
76085057	CDM	In111 Satumomab Dx To 6mc	8	8	$24,275.29	$24,275.29	$24,275.29	$24,275.29	$24,275.29	2026-03-16
74080268	CDM	Insert Tips	8	8	$48,288.18	$48,288.18	$48,288.18	$48,288.18	$48,288.18	2026-03-16
92220143	CDM	Interferon Beta-1a30mcg/0.5ml	8	8	$26,703.08	$26,703.08	$26,703.08	$26,703.08	$26,703.08	2026-03-16
36901	CPT	Intro Dial Graft	8	8	$28,319.15	$28,319.15	$28,319.15	$28,319.15	$28,319.15	2026-03-16
77020083	CDM	Liver Tumor Ablat Rf Perc	8	8	$25,297.02	$25,297.02	$25,297.02	$25,297.02	$25,297.02	2026-03-16
B1806	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50	8	8	$65,149.88	$65,149.88	$65,149.88	$65,149.88	$65,149.88	2026-03-16
C1806	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50	8	8	$53,298.51	$53,298.51	$53,298.51	$53,298.51	$53,298.51	2026-03-16
D1806	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50	8	8	$49,030.64	$49,030.64	$49,030.64	$49,030.64	$49,030.64	2026-03-16
A1806	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50	8	8	$46,019.73	$46,019.73	$46,019.73	$46,019.73	$46,019.73	2026-03-16
B1805	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50	8	8	$44,967.73	$44,967.73	$44,967.73	$44,967.73	$44,967.73	2026-03-16
C1805	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50	8	8	$36,787.49	$36,787.49	$36,787.49	$36,787.49	$36,787.49	2026-03-16
D1805	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50	8	8	$33,841.88	$33,841.88	$33,841.88	$33,841.88	$33,841.88	2026-03-16
A1805	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50	8	8	$31,763.27	$31,763.27	$31,763.27	$31,763.27	$31,763.27	2026-03-16
B1804	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50	8	8	$37,482.18	$37,482.18	$37,482.18	$37,482.18	$37,482.18	2026-03-16
C1804	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50	8	8	$30,664.10	$30,664.10	$30,664.10	$30,664.10	$30,664.10	2026-03-16
D1804	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50	8	8	$28,208.22	$28,208.22	$28,208.22	$28,208.22	$28,208.22	2026-03-16
A1804	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50	8	8	$26,476.04	$26,476.04	$26,476.04	$26,476.04	$26,476.04	2026-03-16
B1803	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50	8	8	$32,093.38	$32,093.38	$32,093.38	$32,093.38	$32,093.38	2026-03-16
C1803	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50	8	8	$26,254.76	$26,254.76	$26,254.76	$26,254.76	$26,254.76	2026-03-16
D1803	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50	8	8	$24,152.56	$24,152.56	$24,152.56	$24,152.56	$24,152.56	2026-03-16
A1803	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50	8	8	$22,668.87	$22,668.87	$22,668.87	$22,668.87	$22,668.87	2026-03-16
B1802	OTHER	Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50	8	8	$25,797.68	$25,797.68	$25,797.68	$25,797.68	$25,797.68	2026-03-16
B1705	OTHER	Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50	8	8	$46,355.29	$46,355.29	$46,355.29	$46,355.29	$46,355.29	2026-03-16
C1705	OTHER	Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50	8	8	$36,724.01	$36,724.01	$36,724.01	$36,724.01	$36,724.01	2026-03-16
D1705	OTHER	Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50	8	8	$34,097.63	$34,097.63	$34,097.63	$34,097.63	$34,097.63	2026-03-16
A1705	OTHER	Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50	8	8	$31,389.62	$31,389.62	$31,389.62	$31,389.62	$31,389.62	2026-03-16
B1704	OTHER	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50	8	8	$39,818.35	$39,818.35	$39,818.35	$39,818.35	$39,818.35	2026-03-16
C1704	OTHER	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50	8	8	$31,545.61	$31,545.61	$31,545.61	$31,545.61	$31,545.61	2026-03-16
D1704	OTHER	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50	8	8	$29,289.24	$29,289.24	$29,289.24	$29,289.24	$29,289.24	2026-03-16
A1704	OTHER	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50	8	8	$26,963.95	$26,963.95	$26,963.95	$26,963.95	$26,963.95	2026-03-16
B1703	OTHER	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50	8	8	$34,603.68	$34,603.68	$34,603.68	$34,603.68	$34,603.68	2026-03-16
C1703	OTHER	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50	8	8	$27,413.77	$27,413.77	$27,413.77	$27,413.77	$27,413.77	2026-03-16
D1703	OTHER	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50	8	8	$25,453.06	$25,453.06	$25,453.06	$25,453.06	$25,453.06	2026-03-16
A1703	OTHER	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50	8	8	$23,432.48	$23,432.48	$23,432.48	$23,432.48	$23,432.48	2026-03-16
B1702	OTHER	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50	8	8	$29,492.39	$29,492.39	$29,492.39	$29,492.39	$29,492.39	2026-03-16
C1702	OTHER	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50	8	8	$23,363.56	$23,363.56	$23,363.56	$23,363.56	$23,363.56	2026-03-16
B1701	OTHER	Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50	8	8	$23,925.84	$23,925.84	$23,925.84	$23,925.84	$23,925.84	2026-03-16
B2005	OTHER	Miscellaneous M <46.50 And A <77.50	8	8	$40,117.63	$40,117.63	$40,117.63	$40,117.63	$40,117.63	2026-03-16
C2005	OTHER	Miscellaneous M <46.50 And A <77.50	8	8	$32,173.18	$32,173.18	$32,173.18	$32,173.18	$32,173.18	2026-03-16
D2005	OTHER	Miscellaneous M <46.50 And A <77.50	8	8	$29,920.44	$29,920.44	$29,920.44	$29,920.44	$29,920.44	2026-03-16
A2005	OTHER	Miscellaneous M <46.50 And A <77.50	8	8	$27,390.19	$27,390.19	$27,390.19	$27,390.19	$27,390.19	2026-03-16
B2004	OTHER	Miscellaneous M <46.50 And A >=77.50	8	8	$38,327.41	$38,327.41	$38,327.41	$38,327.41	$38,327.41	2026-03-16
C2004	OTHER	Miscellaneous M <46.50 And A >=77.50	8	8	$30,736.65	$30,736.65	$30,736.65	$30,736.65	$30,736.65	2026-03-16
D2004	OTHER	Miscellaneous M <46.50 And A >=77.50	8	8	$28,585.49	$28,585.49	$28,585.49	$28,585.49	$28,585.49	2026-03-16
A2004	OTHER	Miscellaneous M <46.50 And A >=77.50	8	8	$26,167.69	$26,167.69	$26,167.69	$26,167.69	$26,167.69	2026-03-16
B2003	OTHER	Miscellaneous M >=46.50 And M <55.50	8	8	$31,425.90	$31,425.90	$31,425.90	$31,425.90	$31,425.90	2026-03-16
C2003	OTHER	Miscellaneous M >=46.50 And M <55.50	8	8	$25,202.75	$25,202.75	$25,202.75	$25,202.75	$25,202.75	2026-03-16
D2003	OTHER	Miscellaneous M >=46.50 And M <55.50	8	8	$23,437.92	$23,437.92	$23,437.92	$23,437.92	$23,437.92	2026-03-16
B2002	OTHER	Miscellaneous M >=55.50 And M <66.50	8	8	$26,762.62	$26,762.62	$26,762.62	$26,762.62	$26,762.62	2026-03-16
74080421	CDM	Nephrostolithotm/pyel<2cm	8	8	$23,284.61	$23,284.61	$23,284.61	$23,284.61	$23,284.61	2026-03-16
B0604	OTHER	Neurological M <43.50	8	8	$44,434.47	$44,434.47	$44,434.47	$44,434.47	$44,434.47	2026-03-16
C0604	OTHER	Neurological M <43.50	8	8	$33,651.43	$33,651.43	$33,651.43	$33,651.43	$33,651.43	2026-03-16
D0604	OTHER	Neurological M <43.50	8	8	$31,696.15	$31,696.15	$31,696.15	$31,696.15	$31,696.15	2026-03-16
A0604	OTHER	Neurological M <43.50	8	8	$28,469.40	$28,469.40	$28,469.40	$28,469.40	$28,469.40	2026-03-16
B0603	OTHER	Neurological M >=43.50 And M <52.50	8	8	$35,133.31	$35,133.31	$35,133.31	$35,133.31	$35,133.31	2026-03-16
C0603	OTHER	Neurological M >=43.50 And M <52.50	8	8	$26,608.45	$26,608.45	$26,608.45	$26,608.45	$26,608.45	2026-03-16
D0603	OTHER	Neurological M >=43.50 And M <52.50	8	8	$25,061.27	$25,061.27	$25,061.27	$25,061.27	$25,061.27	2026-03-16
A0603	OTHER	Neurological M >=43.50 And M <52.50	8	8	$22,511.07	$22,511.07	$22,511.07	$22,511.07	$22,511.07	2026-03-16
B0602	OTHER	Neurological M >=52.50 And M <64.50	8	8	$29,544.99	$29,544.99	$29,544.99	$29,544.99	$29,544.99	2026-03-16
C0602	OTHER	Neurological M >=52.50 And M <64.50	8	8	$22,376.85	$22,376.85	$22,376.85	$22,376.85	$22,376.85	2026-03-16
B0601	OTHER	Neurological M >=64.50	8	8	$23,751.71	$23,751.71	$23,751.71	$23,751.71	$23,751.71	2026-03-16
B0305	OTHER	Non-traumatic Brain Injury M <42.50 And A <78.50	8	8	$42,985.25	$42,985.25	$42,985.25	$42,985.25	$42,985.25	2026-03-16
C0305	OTHER	Non-traumatic Brain Injury M <42.50 And A <78.50	8	8	$34,068.61	$34,068.61	$34,068.61	$34,068.61	$34,068.61	2026-03-16
D0305	OTHER	Non-traumatic Brain Injury M <42.50 And A <78.50	8	8	$31,761.45	$31,761.45	$31,761.45	$31,761.45	$31,761.45	2026-03-16
A0305	OTHER	Non-traumatic Brain Injury M <42.50 And A <78.50	8	8	$29,733.62	$29,733.62	$29,733.62	$29,733.62	$29,733.62	2026-03-16
B0304	OTHER	Non-traumatic Brain Injury M <42.50 And A >=78.50	8	8	$39,241.56	$39,241.56	$39,241.56	$39,241.56	$39,241.56	2026-03-16
C0304	OTHER	Non-traumatic Brain Injury M <42.50 And A >=78.50	8	8	$31,101.23	$31,101.23	$31,101.23	$31,101.23	$31,101.23	2026-03-16
D0304	OTHER	Non-traumatic Brain Injury M <42.50 And A >=78.50	8	8	$28,993.59	$28,993.59	$28,993.59	$28,993.59	$28,993.59	2026-03-16
A0304	OTHER	Non-traumatic Brain Injury M <42.50 And A >=78.50	8	8	$27,143.52	$27,143.52	$27,143.52	$27,143.52	$27,143.52	2026-03-16
B0303	OTHER	Non-traumatic Brain Injury M >=42.50 And M <52.50	8	8	$33,123.62	$33,123.62	$33,123.62	$33,123.62	$33,123.62	2026-03-16
C0303	OTHER	Non-traumatic Brain Injury M >=42.50 And M <52.50	8	8	$26,252.94	$26,252.94	$26,252.94	$26,252.94	$26,252.94	2026-03-16
D0303	OTHER	Non-traumatic Brain Injury M >=42.50 And M <52.50	8	8	$24,475.42	$24,475.42	$24,475.42	$24,475.42	$24,475.42	2026-03-16
A0303	OTHER	Non-traumatic Brain Injury M >=42.50 And M <52.50	8	8	$22,913.74	$22,913.74	$22,913.74	$22,913.74	$22,913.74	2026-03-16
B0302	OTHER	Non-traumatic Brain Injury M >=52.50 And M <65.50	8	8	$28,014.14	$28,014.14	$28,014.14	$28,014.14	$28,014.14	2026-03-16
C0302	OTHER	Non-traumatic Brain Injury M >=52.50 And M <65.50	8	8	$22,202.73	$22,202.73	$22,202.73	$22,202.73	$22,202.73	2026-03-16
B0505	OTHER	Non-traumatic Spinal Cord Injury M <39.50	8	8	$56,666.74	$56,666.74	$56,666.74	$56,666.74	$56,666.74	2026-03-16
C0505	OTHER	Non-traumatic Spinal Cord Injury M <39.50	8	8	$43,547.52	$43,547.52	$43,547.52	$43,547.52	$43,547.52	2026-03-16
D0505	OTHER	Non-traumatic Spinal Cord Injury M <39.50	8	8	$40,513.04	$40,513.04	$40,513.04	$40,513.04	$40,513.04	2026-03-16
A0505	OTHER	Non-traumatic Spinal Cord Injury M <39.50	8	8	$37,335.26	$37,335.26	$37,335.26	$37,335.26	$37,335.26	2026-03-16
B0504	OTHER	Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50	8	8	$39,883.65	$39,883.65	$39,883.65	$39,883.65	$39,883.65	2026-03-16
C0504	OTHER	Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50	8	8	$30,649.59	$30,649.59	$30,649.59	$30,649.59	$30,649.59	2026-03-16
D0504	OTHER	Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50	8	8	$28,512.94	$28,512.94	$28,512.94	$28,512.94	$28,512.94	2026-03-16
A0504	OTHER	Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50	8	8	$26,276.52	$26,276.52	$26,276.52	$26,276.52	$26,276.52	2026-03-16
B0503	OTHER	Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50	8	8	$33,377.55	$33,377.55	$33,377.55	$33,377.55	$33,377.55	2026-03-16
C0503	OTHER	Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50	8	8	$25,650.76	$25,650.76	$25,650.76	$25,650.76	$25,650.76	2026-03-16
D0503	OTHER	Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50	8	8	$23,862.35	$23,862.35	$23,862.35	$23,862.35	$23,862.35	2026-03-16
A0503	OTHER	Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50	8	8	$21,990.51	$21,990.51	$21,990.51	$21,990.51	$21,990.51	2026-03-16
B0502	OTHER	Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50	8	8	$29,476.06	$29,476.06	$29,476.06	$29,476.06	$29,476.06	2026-03-16
C0502	OTHER	Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50	8	8	$22,652.55	$22,652.55	$22,652.55	$22,652.55	$22,652.55	2026-03-16
B0501	OTHER	Non-traumatic Spinal Cord Injury M >=60.50	8	8	$23,742.64	$23,742.64	$23,742.64	$23,742.64	$23,742.64	2026-03-16
74080532	CDM	Occ/emb Hemorrhag/lymph	8	8	$56,399.93	$56,399.93	$56,399.93	$56,399.93	$56,399.93	2026-03-16
74080530	CDM	Occ/emb Non Hemorr Art	8	8	$56,399.93	$56,399.93	$56,399.93	$56,399.93	$56,399.93	2026-03-16
74080529	CDM	Occ/emb Non Hemorr Venous	8	8	$56,399.93	$56,399.93	$56,399.93	$56,399.93	$56,399.93	2026-03-16
74080531	CDM	Occ/emb Tumor/organ Infar	8	8	$56,399.93	$56,399.93	$56,399.93	$56,399.93	$56,399.93	2026-03-16
B1204	OTHER	Osteoarthritis M <49.50 And A <74.50	8	8	$38,933.22	$38,933.22	$38,933.22	$38,933.22	$38,933.22	2026-03-16
C1204	OTHER	Osteoarthritis M <49.50 And A <74.50	8	8	$30,901.71	$30,901.71	$30,901.71	$30,901.71	$30,901.71	2026-03-16
D1204	OTHER	Osteoarthritis M <49.50 And A <74.50	8	8	$27,615.10	$27,615.10	$27,615.10	$27,615.10	$27,615.10	2026-03-16
A1204	OTHER	Osteoarthritis M <49.50 And A <74.50	8	8	$25,574.58	$25,574.58	$25,574.58	$25,574.58	$25,574.58	2026-03-16
B1203	OTHER	Osteoarthritis M <49.50 And A >=74.50	8	8	$37,817.73	$37,817.73	$37,817.73	$37,817.73	$37,817.73	2026-03-16
C1203	OTHER	Osteoarthritis M <49.50 And A >=74.50	8	8	$30,014.76	$30,014.76	$30,014.76	$30,014.76	$30,014.76	2026-03-16
D1203	OTHER	Osteoarthritis M <49.50 And A >=74.50	8	8	$26,822.47	$26,822.47	$26,822.47	$26,822.47	$26,822.47	2026-03-16
A1203	OTHER	Osteoarthritis M <49.50 And A >=74.50	8	8	$24,841.80	$24,841.80	$24,841.80	$24,841.80	$24,841.80	2026-03-16
B1202	OTHER	Osteoarthritis M >=49.50 And M <61.50	8	8	$28,251.75	$28,251.75	$28,251.75	$28,251.75	$28,251.75	2026-03-16
C1202	OTHER	Osteoarthritis M >=49.50 And M <61.50	8	8	$22,422.20	$22,422.20	$22,422.20	$22,422.20	$22,422.20	2026-03-16
B1201	OTHER	Osteoarthritis M >=61.50	8	8	$24,027.41	$24,027.41	$24,027.41	$24,027.41	$24,027.41	2026-03-16
B0904	OTHER	Other Orthopedic M <44.5	8	8	$40,777.85	$40,777.85	$40,777.85	$40,777.85	$40,777.85	2026-03-16
C0904	OTHER	Other Orthopedic M <44.5	8	8	$30,887.20	$30,887.20	$30,887.20	$30,887.20	$30,887.20	2026-03-16
D0904	OTHER	Other Orthopedic M <44.5	8	8	$29,176.79	$29,176.79	$29,176.79	$29,176.79	$29,176.79	2026-03-16
A0904	OTHER	Other Orthopedic M <44.5	8	8	$26,617.51	$26,617.51	$26,617.51	$26,617.51	$26,617.51	2026-03-16
B0903	OTHER	Other Orthopedic M >=44.50 And M <51.50	8	8	$33,863.65	$33,863.65	$33,863.65	$33,863.65	$33,863.65	2026-03-16
C0903	OTHER	Other Orthopedic M >=44.50 And M <51.50	8	8	$25,648.95	$25,648.95	$25,648.95	$25,648.95	$25,648.95	2026-03-16
D0903	OTHER	Other Orthopedic M >=44.50 And M <51.50	8	8	$24,228.74	$24,228.74	$24,228.74	$24,228.74	$24,228.74	2026-03-16
A0903	OTHER	Other Orthopedic M >=44.50 And M <51.50	8	8	$22,104.78	$22,104.78	$22,104.78	$22,104.78	$22,104.78	2026-03-16
B0902	OTHER	Other Orthopedic M >=51.50 And M <63.50	8	8	$28,536.52	$28,536.52	$28,536.52	$28,536.52	$28,536.52	2026-03-16
B0901	OTHER	Other Orthopedic M >=63.50	8	8	$22,463.91	$22,463.91	$22,463.91	$22,463.91	$22,463.91	2026-03-16
B1604	OTHER	Pain Syndrome M <43.50	8	8	$36,364.88	$36,364.88	$36,364.88	$36,364.88	$36,364.88	2026-03-16
C1604	OTHER	Pain Syndrome M <43.50	8	8	$32,590.36	$32,590.36	$32,590.36	$32,590.36	$32,590.36	2026-03-16
D1604	OTHER	Pain Syndrome M <43.50	8	8	$29,811.62	$29,811.62	$29,811.62	$29,811.62	$29,811.62	2026-03-16
A1604	OTHER	Pain Syndrome M <43.50	8	8	$27,021.99	$27,021.99	$27,021.99	$27,021.99	$27,021.99	2026-03-16
B1603	OTHER	Pain Syndrome M >=43.50 And M <58.50	8	8	$27,781.97	$27,781.97	$27,781.97	$27,781.97	$27,781.97	2026-03-16
C1603	OTHER	Pain Syndrome M >=43.50 And M <58.50	8	8	$24,898.03	$24,898.03	$24,898.03	$24,898.03	$24,898.03	2026-03-16
D1603	OTHER	Pain Syndrome M >=43.50 And M <58.50	8	8	$22,775.89	$22,775.89	$22,775.89	$22,775.89	$22,775.89	2026-03-16
B1602	OTHER	Pain Syndrome M >=58.50 And M <65.50	8	8	$22,940.94	$22,940.94	$22,940.94	$22,940.94	$22,940.94	2026-03-16
92214439	CDM	Pegfilgrastim 6mg/0.6ml Sol	8	8	$22,453.20	$22,453.20	$22,453.20	$22,453.20	$22,453.20	2026-03-16
74080582	CDM	Pl St Bile Duct Cth Nw Ea	8	8	$24,053.59	$24,053.59	$24,053.59	$24,053.59	$24,053.59	2026-03-16
74080661	CDM	Pl St Bile Duct Cth Nw Ea	8	8	$24,053.59	$24,053.59	$24,053.59	$24,053.59	$24,053.59	2026-03-16
36224	CPT	Place Cath Int Carotid Art Bi	8	8	$35,853.69	$35,853.69	$35,853.69	$35,853.69	$35,853.69	2026-03-16
36226	CPT	Place Cath Vertebral Art Bi	8	8	$29,036.88	$29,036.88	$29,036.88	$29,036.88	$29,036.88	2026-03-16
74080659	CDM	Plc Stent Bile Duct Ex Ea	8	8	$24,053.59	$24,053.59	$24,053.59	$24,053.59	$24,053.59	2026-03-16
74080580	CDM	Plc Stent Bile Duct Ex Ea	8	8	$24,053.59	$24,053.59	$24,053.59	$24,053.59	$24,053.59	2026-03-16
74080581	CDM	Plc Stnt Bile Duct New Ea	8	8	$24,053.59	$24,053.59	$24,053.59	$24,053.59	$24,053.59	2026-03-16
74080660	CDM	Plc Stnt Bile Duct New Ea	8	8	$24,053.59	$24,053.59	$24,053.59	$24,053.59	$24,053.59	2026-03-16
36907	CPT	Pta Central Dial Seg Add On	8	8	$22,581.68	$22,581.68	$22,581.68	$22,581.68	$22,581.68	2026-03-16
B1504	OTHER	Pulmonary M <45.50	8	8	$42,488.26	$42,488.26	$42,488.26	$42,488.26	$42,488.26	2026-03-16
C1504	OTHER	Pulmonary M <45.50	8	8	$34,162.92	$34,162.92	$34,162.92	$34,162.92	$34,162.92	2026-03-16
D1504	OTHER	Pulmonary M <45.50	8	8	$31,993.62	$31,993.62	$31,993.62	$31,993.62	$31,993.62	2026-03-16
A1504	OTHER	Pulmonary M <45.50	8	8	$30,584.30	$30,584.30	$30,584.30	$30,584.30	$30,584.30	2026-03-16
B1503	OTHER	Pulmonary M >=45.50 And M <56.50	8	8	$33,881.78	$33,881.78	$33,881.78	$33,881.78	$33,881.78	2026-03-16
C1503	OTHER	Pulmonary M >=45.50 And M <56.50	8	8	$27,243.28	$27,243.28	$27,243.28	$27,243.28	$27,243.28	2026-03-16
D1503	OTHER	Pulmonary M >=45.50 And M <56.50	8	8	$25,512.91	$25,512.91	$25,512.91	$25,512.91	$25,512.91	2026-03-16
A1503	OTHER	Pulmonary M >=45.50 And M <56.50	8	8	$24,388.35	$24,388.35	$24,388.35	$24,388.35	$24,388.35	2026-03-16
B1502	OTHER	Pulmonary M >=56.50 And M <68.50	8	8	$29,060.70	$29,060.70	$29,060.70	$29,060.70	$29,060.70	2026-03-16
C1502	OTHER	Pulmonary M >=56.50 And M <68.50	8	8	$23,367.19	$23,367.19	$23,367.19	$23,367.19	$23,367.19	2026-03-16
D1502	OTHER	Pulmonary M >=56.50 And M <68.50	8	8	$21,883.50	$21,883.50	$21,883.50	$21,883.50	$21,883.50	2026-03-16
B1501	OTHER	Pulmonary M >=68.50	8	8	$23,766.22	$23,766.22	$23,766.22	$23,766.22	$23,766.22	2026-03-16
B0805	OTHER	Replacement Of Lower-extremity Joint M <42.50	8	8	$37,926.56	$37,926.56	$37,926.56	$37,926.56	$37,926.56	2026-03-16
C0805	OTHER	Replacement Of Lower-extremity Joint M <42.50	8	8	$31,942.83	$31,942.83	$31,942.83	$31,942.83	$31,942.83	2026-03-16
D0805	OTHER	Replacement Of Lower-extremity Joint M <42.50	8	8	$28,552.84	$28,552.84	$28,552.84	$28,552.84	$28,552.84	2026-03-16
A0805	OTHER	Replacement Of Lower-extremity Joint M <42.50	8	8	$26,751.74	$26,751.74	$26,751.74	$26,751.74	$26,751.74	2026-03-16
B0804	OTHER	Replacement Of Lower-extremity Joint M >=42.50 And M <51.50	8	8	$30,450.07	$30,450.07	$30,450.07	$30,450.07	$30,450.07	2026-03-16
C0804	OTHER	Replacement Of Lower-extremity Joint M >=42.50 And M <51.50	8	8	$25,647.13	$25,647.13	$25,647.13	$25,647.13	$25,647.13	2026-03-16
D0804	OTHER	Replacement Of Lower-extremity Joint M >=42.50 And M <51.50	8	8	$22,924.62	$22,924.62	$22,924.62	$22,924.62	$22,924.62	2026-03-16
B0803	OTHER	Replacement Of Lower-extremity Joint M >=51.50 And M <57.50	8	8	$26,804.34	$26,804.34	$26,804.34	$26,804.34	$26,804.34	2026-03-16
C0803	OTHER	Replacement Of Lower-extremity Joint M >=51.50 And M <57.50	8	8	$22,576.37	$22,576.37	$22,576.37	$22,576.37	$22,576.37	2026-03-16
B0802	OTHER	Replacement Of Lower-extremity Joint M >=57.50 And M <63.50	8	8	$24,355.71	$24,355.71	$24,355.71	$24,355.71	$24,355.71	2026-03-16
74080468	CDM	Revas Fem Pop Atherectomy	8	8	$25,905.35	$25,905.35	$25,905.35	$25,905.35	$25,905.35	2026-03-16
74080469	CDM	Revas Fem Pop Stent Ather	8	8	$25,905.35	$25,905.35	$25,905.35	$25,905.35	$25,905.35	2026-03-16
74080471	CDM	Revas Femoral Poplt Stent	8	8	$25,905.35	$25,905.35	$25,905.35	$25,905.35	$25,905.35	2026-03-16
74080477	CDM	Revas Tib Peron Ather Add	8	8	$26,002.81	$26,002.81	$26,002.81	$26,002.81	$26,002.81	2026-03-16
74080478	CDM	Revas Tib Peron Ather Ini	8	8	$26,002.81	$26,002.81	$26,002.81	$26,002.81	$26,002.81	2026-03-16
74080479	CDM	Revas Tib Peron Stent Ini	8	8	$26,002.81	$26,002.81	$26,002.81	$26,002.81	$26,002.81	2026-03-16
74080481	CDM	Revas Tib Pr Stnt Ath Ini	8	8	$26,002.81	$26,002.81	$26,002.81	$26,002.81	$26,002.81	2026-03-16
74080483	CDM	Revise Tips	8	8	$47,034.04	$47,034.04	$47,034.04	$47,034.04	$47,034.04	2026-03-16
B1304	OTHER	Rheumatoid Other Arthritis M <44.50 And A >=64.50	8	8	$41,557.79	$41,557.79	$41,557.79	$41,557.79	$41,557.79	2026-03-16
C1304	OTHER	Rheumatoid Other Arthritis M <44.50 And A >=64.50	8	8	$33,225.19	$33,225.19	$33,225.19	$33,225.19	$33,225.19	2026-03-16
D1304	OTHER	Rheumatoid Other Arthritis M <44.50 And A >=64.50	8	8	$30,442.82	$30,442.82	$30,442.82	$30,442.82	$30,442.82	2026-03-16
A1304	OTHER	Rheumatoid Other Arthritis M <44.50 And A >=64.50	8	8	$27,653.19	$27,653.19	$27,653.19	$27,653.19	$27,653.19	2026-03-16
B1305	OTHER	Rheumatoid Other Arthritis M <51.50 And A <64.50	8	8	$41,476.16	$41,476.16	$41,476.16	$41,476.16	$41,476.16	2026-03-16
C1305	OTHER	Rheumatoid Other Arthritis M <51.50 And A <64.50	8	8	$33,158.08	$33,158.08	$33,158.08	$33,158.08	$33,158.08	2026-03-16
D1305	OTHER	Rheumatoid Other Arthritis M <51.50 And A <64.50	8	8	$30,381.15	$30,381.15	$30,381.15	$30,381.15	$30,381.15	2026-03-16
A1305	OTHER	Rheumatoid Other Arthritis M <51.50 And A <64.50	8	8	$27,598.78	$27,598.78	$27,598.78	$27,598.78	$27,598.78	2026-03-16
B1303	OTHER	Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50	8	8	$32,198.58	$32,198.58	$32,198.58	$32,198.58	$32,198.58	2026-03-16
C1303	OTHER	Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50	8	8	$25,741.45	$25,741.45	$25,741.45	$25,741.45	$25,741.45	2026-03-16
D1303	OTHER	Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50	8	8	$23,586.66	$23,586.66	$23,586.66	$23,586.66	$23,586.66	2026-03-16
B1302	OTHER	Rheumatoid Other Arthritis M >=51.50 And M <62.50	8	8	$27,859.97	$27,859.97	$27,859.97	$27,859.97	$27,859.97	2026-03-16
C1302	OTHER	Rheumatoid Other Arthritis M >=51.50 And M <62.50	8	8	$22,273.46	$22,273.46	$22,273.46	$22,273.46	$22,273.46	2026-03-16
B1301	OTHER	Rheumatoid Other Arthritis M >=62.50	8	8	$22,721.47	$22,721.47	$22,721.47	$22,721.47	$22,721.47	2026-03-16
76085035	CDM	Sm153 Lexidron To 150mci	8	8	$41,825.76	$41,825.76	$41,825.76	$41,825.76	$41,825.76	2026-03-16
92218223	CDM	Soliris 10mg/ml Inj	8	8	$24,656.94	$24,656.94	$24,656.94	$24,656.94	$24,656.94	2026-03-16
74080527	CDM	Stnt Plc Transc Vein Ini	8	8	$39,032.60	$39,032.60	$39,032.60	$39,032.60	$39,032.60	2026-03-16
74080525	CDM	Stnt Plc Transcth Art Ini	8	8	$38,869.80	$38,869.80	$38,869.80	$38,869.80	$38,869.80	2026-03-16
B0106	OTHER	Stroke M <41.50 And A <84.50	8	8	$51,375.89	$51,375.89	$51,375.89	$51,375.89	$51,375.89	2026-03-16
C0106	OTHER	Stroke M <41.50 And A <84.50	8	8	$45,622.51	$45,622.51	$45,622.51	$45,622.51	$45,622.51	2026-03-16
D0106	OTHER	Stroke M <41.50 And A <84.50	8	8	$41,334.69	$41,334.69	$41,334.69	$41,334.69	$41,334.69	2026-03-16
A0106	OTHER	Stroke M <41.50 And A <84.50	8	8	$39,207.10	$39,207.10	$39,207.10	$39,207.10	$39,207.10	2026-03-16
B0105	OTHER	Stroke M <41.50 And A >=84.50	8	8	$45,609.81	$45,609.81	$45,609.81	$45,609.81	$45,609.81	2026-03-16
C0105	OTHER	Stroke M <41.50 And A >=84.50	8	8	$40,502.15	$40,502.15	$40,502.15	$40,502.15	$40,502.15	2026-03-16
D0105	OTHER	Stroke M <41.50 And A >=84.50	8	8	$36,694.99	$36,694.99	$36,694.99	$36,694.99	$36,694.99	2026-03-16
A0105	OTHER	Stroke M <41.50 And A >=84.50	8	8	$34,806.82	$34,806.82	$34,806.82	$34,806.82	$34,806.82	2026-03-16
B0104	OTHER	Stroke M >=41.50 And M <50.50	8	8	$36,597.04	$36,597.04	$36,597.04	$36,597.04	$36,597.04	2026-03-16
C0104	OTHER	Stroke M >=41.50 And M <50.50	8	8	$32,499.67	$32,499.67	$32,499.67	$32,499.67	$32,499.67	2026-03-16
D0104	OTHER	Stroke M >=41.50 And M <50.50	8	8	$29,445.23	$29,445.23	$29,445.23	$29,445.23	$29,445.23	2026-03-16
A0104	OTHER	Stroke M >=41.50 And M <50.50	8	8	$27,928.89	$27,928.89	$27,928.89	$27,928.89	$27,928.89	2026-03-16
B0103	OTHER	Stroke M >=50.50 And M <63.50	8	8	$28,654.41	$28,654.41	$28,654.41	$28,654.41	$28,654.41	2026-03-16
C0103	OTHER	Stroke M >=50.50 And M <63.50	8	8	$25,445.80	$25,445.80	$25,445.80	$25,445.80	$25,445.80	2026-03-16
D0103	OTHER	Stroke M >=50.50 And M <63.50	8	8	$23,053.40	$23,053.40	$23,053.40	$23,053.40	$23,053.40	2026-03-16
A0103	OTHER	Stroke M >=50.50 And M <63.50	8	8	$21,867.17	$21,867.17	$21,867.17	$21,867.17	$21,867.17	2026-03-16
B0102	OTHER	Stroke M >=63.50 And M <72.50	8	8	$22,320.62	$22,320.62	$22,320.62	$22,320.62	$22,320.62	2026-03-16
76085037	CDM	Strontium Sr-89 Thera/mci	8	8	$38,865.52	$38,865.52	$38,865.52	$38,865.52	$38,865.52	2026-03-16
B0205	OTHER	Traumatic Brain Injury M <35.50	8	8	$49,422.42	$49,422.42	$49,422.42	$49,422.42	$49,422.42	2026-03-16
C0205	OTHER	Traumatic Brain Injury M <35.50	8	8	$39,295.98	$39,295.98	$39,295.98	$39,295.98	$39,295.98	2026-03-16
D0205	OTHER	Traumatic Brain Injury M <35.50	8	8	$35,900.54	$35,900.54	$35,900.54	$35,900.54	$35,900.54	2026-03-16
A0205	OTHER	Traumatic Brain Injury M <35.50	8	8	$33,729.42	$33,729.42	$33,729.42	$33,729.42	$33,729.42	2026-03-16
B0204	OTHER	Traumatic Brain Injury M >=35.50 And M <49.50	8	8	$38,523.30	$38,523.30	$38,523.30	$38,523.30	$38,523.30	2026-03-16
C0204	OTHER	Traumatic Brain Injury M >=35.50 And M <49.50	8	8	$30,629.64	$30,629.64	$30,629.64	$30,629.64	$30,629.64	2026-03-16
D0204	OTHER	Traumatic Brain Injury M >=35.50 And M <49.50	8	8	$27,983.31	$27,983.31	$27,983.31	$27,983.31	$27,983.31	2026-03-16
A0204	OTHER	Traumatic Brain Injury M >=35.50 And M <49.50	8	8	$26,291.03	$26,291.03	$26,291.03	$26,291.03	$26,291.03	2026-03-16
B0203	OTHER	Traumatic Brain Injury M >=49.50 And M <61.50	8	8	$31,257.22	$31,257.22	$31,257.22	$31,257.22	$31,257.22	2026-03-16
C0203	OTHER	Traumatic Brain Injury M >=49.50 And M <61.50	8	8	$24,852.69	$24,852.69	$24,852.69	$24,852.69	$24,852.69	2026-03-16
D0203	OTHER	Traumatic Brain Injury M >=49.50 And M <61.50	8	8	$22,705.15	$22,705.15	$22,705.15	$22,705.15	$22,705.15	2026-03-16
B0202	OTHER	Traumatic Brain Injury M >=61.50 And M <73.50	8	8	$25,141.08	$25,141.08	$25,141.08	$25,141.08	$25,141.08	2026-03-16
B0407	OTHER	Traumatic Spinal Cord Injury M <24.50 And A >=61.50	8	8	$82,215.93	$82,215.93	$82,215.93	$82,215.93	$82,215.93	2026-03-16
C0407	OTHER	Traumatic Spinal Cord Injury M <24.50 And A >=61.50	8	8	$67,201.29	$67,201.29	$67,201.29	$67,201.29	$67,201.29	2026-03-16
D0407	OTHER	Traumatic Spinal Cord Injury M <24.50 And A >=61.50	8	8	$65,432.83	$65,432.83	$65,432.83	$65,432.83	$65,432.83	2026-03-16
A0407	OTHER	Traumatic Spinal Cord Injury M <24.50 And A >=61.50	8	8	$59,209.69	$59,209.69	$59,209.69	$59,209.69	$59,209.69	2026-03-16
B0404	OTHER	Traumatic Spinal Cord Injury M <31.50 And A <61.50	8	8	$57,615.36	$57,615.36	$57,615.36	$57,615.36	$57,615.36	2026-03-16
C0404	OTHER	Traumatic Spinal Cord Injury M <31.50 And A <61.50	8	8	$47,093.50	$47,093.50	$47,093.50	$47,093.50	$47,093.50	2026-03-16
D0404	OTHER	Traumatic Spinal Cord Injury M <31.50 And A <61.50	8	8	$45,854.68	$45,854.68	$45,854.68	$45,854.68	$45,854.68	2026-03-16
A0404	OTHER	Traumatic Spinal Cord Injury M <31.50 And A <61.50	8	8	$41,494.30	$41,494.30	$41,494.30	$41,494.30	$41,494.30	2026-03-16
B0406	OTHER	Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50	8	8	$60,036.78	$60,036.78	$60,036.78	$60,036.78	$60,036.78	2026-03-16
C0406	OTHER	Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50	8	8	$49,072.36	$49,072.36	$49,072.36	$49,072.36	$49,072.36	2026-03-16
D0406	OTHER	Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50	8	8	$47,780.93	$47,780.93	$47,780.93	$47,780.93	$47,780.93	2026-03-16
A0406	OTHER	Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50	8	8	$43,237.36	$43,237.36	$43,237.36	$43,237.36	$43,237.36	2026-03-16
B0405	OTHER	Traumatic Spinal Cord Injury M >=31.50 And M <41.50	8	8	$45,637.02	$45,637.02	$45,637.02	$45,637.02	$45,637.02	2026-03-16
C0405	OTHER	Traumatic Spinal Cord Injury M >=31.50 And M <41.50	8	8	$37,302.61	$37,302.61	$37,302.61	$37,302.61	$37,302.61	2026-03-16
D0405	OTHER	Traumatic Spinal Cord Injury M >=31.50 And M <41.50	8	8	$36,321.35	$36,321.35	$36,321.35	$36,321.35	$36,321.35	2026-03-16
A0405	OTHER	Traumatic Spinal Cord Injury M >=31.50 And M <41.50	8	8	$32,867.87	$32,867.87	$32,867.87	$32,867.87	$32,867.87	2026-03-16
B0403	OTHER	Traumatic Spinal Cord Injury M >=41.50 And M <47.50	8	8	$35,557.74	$35,557.74	$35,557.74	$35,557.74	$35,557.74	2026-03-16
C0403	OTHER	Traumatic Spinal Cord Injury M >=41.50 And M <47.50	8	8	$29,064.33	$29,064.33	$29,064.33	$29,064.33	$29,064.33	2026-03-16
D0403	OTHER	Traumatic Spinal Cord Injury M >=41.50 And M <47.50	8	8	$28,298.91	$28,298.91	$28,298.91	$28,298.91	$28,298.91	2026-03-16
A0403	OTHER	Traumatic Spinal Cord Injury M >=41.50 And M <47.50	8	8	$25,607.23	$25,607.23	$25,607.23	$25,607.23	$25,607.23	2026-03-16
B0402	OTHER	Traumatic Spinal Cord Injury M >=47.50 And M <56.50	8	8	$30,807.39	$30,807.39	$30,807.39	$30,807.39	$30,807.39	2026-03-16
C0402	OTHER	Traumatic Spinal Cord Injury M >=47.50 And M <56.50	8	8	$25,180.99	$25,180.99	$25,180.99	$25,180.99	$25,180.99	2026-03-16
D0402	OTHER	Traumatic Spinal Cord Injury M >=47.50 And M <56.50	8	8	$24,518.95	$24,518.95	$24,518.95	$24,518.95	$24,518.95	2026-03-16
A0402	OTHER	Traumatic Spinal Cord Injury M >=47.50 And M <56.50	8	8	$22,186.40	$22,186.40	$22,186.40	$22,186.40	$22,186.40	2026-03-16
B0401	OTHER	Traumatic Spinal Cord Injury M >=56.50	8	8	$24,573.36	$24,573.36	$24,573.36	$24,573.36	$24,573.36	2026-03-16
74080549	CDM	Verteb Augm Ea Add W Imag	8	8	$38,769.13	$38,769.13	$38,769.13	$38,769.13	$38,769.13	2026-03-16
74080548	CDM	Verteb Augm Lumbar W Imag	8	8	$38,769.13	$38,769.13	$38,769.13	$38,769.13	$38,769.13	2026-03-16
74080547	CDM	Verteb Augm Thorac W Imag	8	8	$38,769.13	$38,769.13	$38,769.13	$38,769.13	$38,769.13	2026-03-16

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