|
0100T
|
CPT
|
Prosth Retina Receive&gen
|
2
|
1
|
—
|
—
|
$132,300.54
|
$132,300.54
|
$132,300.54
|
2025-09-11
|
|
B0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
42
|
20
|
—
|
—
|
$63,182.18
|
$108,934.79
|
$72,623.19
|
2025-09-11
|
|
C0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
42
|
20
|
—
|
—
|
$56,186.67
|
$96,873.57
|
$64,582.38
|
2025-09-11
|
|
B1904
|
LOCAL
|
Guillain-barré M <38.50
|
42
|
20
|
—
|
—
|
$54,671.30
|
$94,260.87
|
$62,840.58
|
2025-09-11
|
|
D0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
42
|
20
|
—
|
—
|
$54,542.79
|
$94,039.29
|
$62,692.86
|
2025-09-11
|
|
B1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
42
|
20
|
—
|
—
|
$51,426.87
|
$88,667.01
|
$59,111.34
|
2025-09-11
|
|
A0407
|
LOCAL
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
42
|
20
|
—
|
—
|
$49,560.30
|
$85,448.79
|
$56,965.86
|
2025-09-11
|
|
B0406
|
LOCAL
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
42
|
20
|
—
|
—
|
$46,215.73
|
$79,682.30
|
$53,121.53
|
2025-09-11
|
|
B0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
42
|
20
|
—
|
—
|
$45,544.73
|
$78,525.39
|
$52,350.26
|
2025-09-11
|
|
B0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50
|
42
|
20
|
—
|
—
|
$45,076.96
|
$77,718.90
|
$51,812.60
|
2025-09-11
|
|
B0106
|
LOCAL
|
Stroke M <41.50 And A <84.50
|
42
|
20
|
—
|
—
|
$43,434.57
|
$74,887.19
|
$49,924.79
|
2025-09-11
|
|
C1904
|
LOCAL
|
Guillain-barré M <38.50
|
42
|
20
|
—
|
—
|
$42,031.28
|
$72,467.73
|
$48,311.82
|
2025-09-11
|
|
C0406
|
LOCAL
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
42
|
20
|
—
|
—
|
$41,098.75
|
$70,859.91
|
$47,239.94
|
2025-09-11
|
|
C1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
42
|
20
|
—
|
—
|
$41,025.52
|
$70,733.66
|
$47,155.77
|
2025-09-11
|
|
C0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
42
|
20
|
—
|
—
|
$40,502.47
|
$69,831.84
|
$46,554.56
|
2025-09-11
|
|
D0406
|
LOCAL
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
42
|
20
|
—
|
—
|
$39,895.72
|
$68,785.73
|
$45,857.15
|
2025-09-11
|
|
B0205
|
LOCAL
|
Traumatic Brain Injury M <35.50
|
42
|
20
|
—
|
—
|
$39,430.95
|
$67,984.40
|
$45,322.93
|
2025-09-11
|
|
D0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
42
|
20
|
—
|
—
|
$39,317.37
|
$67,788.57
|
$45,192.38
|
2025-09-11
|
|
D1904
|
LOCAL
|
Guillain-barré M <38.50
|
42
|
20
|
—
|
—
|
$39,220.24
|
$67,621.10
|
$45,080.73
|
2025-09-11
|
|
B1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
42
|
20
|
—
|
—
|
$39,184.37
|
$67,559.25
|
$45,039.50
|
2025-09-11
|
|
28730
|
CPT
|
Fusion Of Foot Bones
|
92
|
29
|
$57,929.13
|
$57,929.13
|
$10,932.75
|
$49,239.76
|
$44,895.07
|
2025-09-11
|
|
D1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
42
|
20
|
—
|
—
|
$38,948.25
|
$67,152.15
|
$44,768.10
|
2025-09-11
|
|
A1904
|
LOCAL
|
Guillain-barré M <38.50
|
42
|
20
|
—
|
—
|
$38,541.76
|
$66,451.31
|
$44,300.87
|
2025-09-11
|
|
B0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50
|
42
|
20
|
—
|
—
|
$38,187.57
|
$65,840.64
|
$43,893.76
|
2025-09-11
|
|
C0106
|
LOCAL
|
Stroke M <41.50 And A <84.50
|
42
|
20
|
—
|
—
|
$37,669.00
|
$64,946.55
|
$43,297.70
|
2025-09-11
|
|
B1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50
|
42
|
20
|
—
|
—
|
$37,531.51
|
$64,709.51
|
$43,139.67
|
2025-09-11
|
|
B0604
|
LOCAL
|
Neurological M <43.50
|
42
|
20
|
—
|
—
|
$37,217.68
|
$64,168.41
|
$42,778.94
|
2025-09-11
|
|
A0406
|
LOCAL
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
42
|
20
|
—
|
—
|
$36,252.26
|
$62,503.91
|
$41,669.27
|
2025-09-11
|
|
B0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
42
|
20
|
—
|
—
|
$36,219.39
|
$62,447.22
|
$41,631.48
|
2025-09-11
|
|
B1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
42
|
20
|
—
|
—
|
$36,211.91
|
$62,434.34
|
$41,622.89
|
2025-09-11
|
|
A1806
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
42
|
20
|
—
|
—
|
$36,111.79
|
$62,261.70
|
$41,507.80
|
2025-09-11
|
|
A0404
|
LOCAL
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
42
|
20
|
—
|
—
|
$35,726.22
|
$61,596.93
|
$41,064.62
|
2025-09-11
|
|
B0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
42
|
20
|
—
|
—
|
$35,635.06
|
$61,439.76
|
$40,959.84
|
2025-09-11
|
|
A5104
|
LOCAL
|
Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More
|
42
|
20
|
—
|
—
|
$35,618.62
|
$61,411.41
|
$40,940.94
|
2025-09-11
|
|
B1604
|
LOCAL
|
Pain Syndrome M <43.50
|
42
|
20
|
—
|
—
|
$35,082.11
|
$60,486.41
|
$40,324.27
|
2025-09-11
|
|
C0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50
|
42
|
20
|
—
|
—
|
$35,068.66
|
$60,463.22
|
$40,308.81
|
2025-09-11
|
|
B0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50
|
42
|
20
|
—
|
—
|
$34,780.23
|
$59,965.92
|
$39,977.28
|
2025-09-11
|
|
B2102
|
LOCAL
|
Burns M <52.50
|
42
|
20
|
—
|
—
|
$34,635.27
|
$59,715.99
|
$39,810.66
|
2025-09-11
|
|
D0106
|
LOCAL
|
Stroke M <41.50 And A <84.50
|
42
|
20
|
—
|
—
|
$34,423.06
|
$59,350.11
|
$39,566.74
|
2025-09-11
|
|
B1004
|
LOCAL
|
Amputation Lower Extremity M <47.50
|
42
|
20
|
—
|
—
|
$34,388.69
|
$59,290.85
|
$39,527.23
|
2025-09-11
|
|
B1504
|
LOCAL
|
Pulmonary M <45.50
|
42
|
20
|
—
|
—
|
$33,989.67
|
$58,602.89
|
$39,068.59
|
2025-09-11
|
|
B1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
42
|
20
|
—
|
—
|
$33,390.40
|
$57,569.66
|
$38,379.77
|
2025-09-11
|
|
B2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50
|
42
|
20
|
—
|
—
|
$33,194.62
|
$57,232.11
|
$38,154.74
|
2025-09-11
|
|
D0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50
|
42
|
20
|
—
|
—
|
$33,130.37
|
$57,121.32
|
$38,080.88
|
2025-09-11
|
|
C0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50
|
42
|
20
|
—
|
—
|
$33,118.41
|
$57,100.71
|
$38,067.14
|
2025-09-11
|
|
33207
|
CPT
|
Insrt Heart Pm Venticular
|
92
|
29
|
$48,848.87
|
$48,848.87
|
$10,527.83
|
$41,521.54
|
$37,857.88
|
2025-09-11
|
|
33208
|
CPT
|
Ins/Rplc Pacemkr; Atr+vnt
|
92
|
29
|
$48,848.87
|
$48,848.87
|
$10,527.83
|
$41,521.54
|
$37,857.88
|
2025-09-11
|
|
A0106
|
LOCAL
|
Stroke M <41.50 And A <84.50
|
42
|
20
|
—
|
—
|
$32,804.58
|
$56,559.62
|
$37,706.41
|
2025-09-11
|
|
B1204
|
LOCAL
|
Osteoarthritis M <49.50 And A <74.50
|
42
|
20
|
—
|
—
|
$32,634.21
|
$56,265.89
|
$37,510.59
|
2025-09-11
|
|
C0205
|
LOCAL
|
Traumatic Brain Injury M <35.50
|
42
|
20
|
—
|
—
|
$32,475.80
|
$55,992.75
|
$37,328.50
|
2025-09-11
|
|
B0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
42
|
20
|
—
|
—
|
$32,439.93
|
$55,930.92
|
$37,287.28
|
2025-09-11
|
|
B0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
42
|
20
|
—
|
—
|
$32,311.41
|
$55,709.33
|
$37,139.55
|
2025-09-11
|
|
C0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
42
|
20
|
—
|
—
|
$32,209.78
|
$55,534.11
|
$37,022.74
|
2025-09-11
|
|
B1404
|
LOCAL
|
Cardiac M <45.50
|
42
|
20
|
—
|
—
|
$32,067.82
|
$55,289.34
|
$36,859.56
|
2025-09-11
|
|
B0904
|
LOCAL
|
Other Orthopedic M <44.5
|
42
|
20
|
—
|
—
|
$32,005.05
|
$55,181.12
|
$36,787.41
|
2025-09-11
|
|
B1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
42
|
20
|
—
|
—
|
$32,005.05
|
$55,181.12
|
$36,787.41
|
2025-09-11
|
|
37236
|
CPT
|
Open/Perq Place Stent 1st
|
92
|
29
|
$47,189.05
|
$47,189.05
|
$11,351.30
|
$40,110.69
|
$36,571.51
|
2025-09-11
|
|
B2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50
|
42
|
20
|
—
|
—
|
$31,492.45
|
$54,297.33
|
$36,198.22
|
2025-09-11
|
|
D0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
42
|
20
|
—
|
—
|
$31,266.79
|
$53,908.26
|
$35,938.84
|
2025-09-11
|
|
B1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50
|
42
|
20
|
—
|
—
|
$31,120.34
|
$53,655.75
|
$35,770.50
|
2025-09-11
|
|
B0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50
|
42
|
20
|
—
|
—
|
$30,805.01
|
$53,112.09
|
$35,408.06
|
2025-09-11
|
|
B0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
42
|
20
|
—
|
—
|
$30,782.59
|
$53,073.44
|
$35,382.29
|
2025-09-11
|
|
B1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
42
|
20
|
—
|
—
|
$30,649.59
|
$52,844.12
|
$35,229.41
|
2025-09-11
|
|
69930
|
CPT
|
Implant Cochlear Device
|
2
|
1
|
—
|
—
|
$35,207.98
|
$35,207.98
|
$35,207.98
|
2025-09-11
|
|
B0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50
|
42
|
20
|
—
|
—
|
$30,539.00
|
$52,653.45
|
$35,102.30
|
2025-09-11
|
|
A0505
|
LOCAL
|
Non-traumatic Spinal Cord Injury M <39.50
|
42
|
20
|
—
|
—
|
$30,530.03
|
$52,637.99
|
$35,091.99
|
2025-09-11
|
|
C1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
42
|
20
|
—
|
—
|
$30,458.30
|
$52,514.31
|
$35,009.54
|
2025-09-11
|
|
D0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50
|
42
|
20
|
—
|
—
|
$30,264.02
|
$52,179.35
|
$34,786.23
|
2025-09-11
|
|
B1103
|
LOCAL
|
Amputation Non-lower Extremity M <52.50
|
42
|
20
|
—
|
—
|
$29,972.60
|
$51,676.91
|
$34,451.27
|
2025-09-11
|
|
B1804
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
42
|
20
|
—
|
—
|
$29,867.99
|
$51,496.53
|
$34,331.02
|
2025-09-11
|
|
B0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50
|
42
|
20
|
—
|
—
|
$29,676.70
|
$51,166.73
|
$34,111.15
|
2025-09-11
|
|
B1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50
|
42
|
20
|
—
|
—
|
$29,500.36
|
$50,862.69
|
$33,908.46
|
2025-09-11
|
|
D0205
|
LOCAL
|
Traumatic Brain Injury M <35.50
|
42
|
20
|
—
|
—
|
$29,497.37
|
$50,857.53
|
$33,905.02
|
2025-09-11
|
|
B0403
|
LOCAL
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
42
|
20
|
—
|
—
|
$29,170.08
|
$50,293.25
|
$33,528.83
|
2025-09-11
|
|
33270
|
CPT
|
Ins/rep Subq Defibrillator
|
2
|
1
|
—
|
—
|
$33,439.10
|
$33,439.10
|
$33,439.10
|
2025-09-11
|
|
33231
|
CPT
|
Insrt Pulse Gen W/mult Leads
|
2
|
1
|
—
|
—
|
$33,439.10
|
$33,439.10
|
$33,439.10
|
2025-09-11
|
|
33264
|
CPT
|
Rmvl & Rplcmt Dfb Gen Mlt Ld
|
2
|
1
|
—
|
—
|
$33,439.10
|
$33,439.10
|
$33,439.10
|
2025-09-11
|
|
33249
|
CPT
|
Insj/rplcmt Defib W/lead(s)
|
2
|
1
|
—
|
—
|
$33,439.10
|
$33,439.10
|
$33,439.10
|
2025-09-11
|
|
C1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
42
|
20
|
—
|
—
|
$28,887.64
|
$49,806.27
|
$33,204.18
|
2025-09-11
|
|
C1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50
|
42
|
20
|
—
|
—
|
$28,853.26
|
$49,747.01
|
$33,164.67
|
2025-09-11
|
|
A0105
|
LOCAL
|
Stroke M <41.50 And A >=84.50
|
42
|
20
|
—
|
—
|
$28,842.81
|
$49,728.98
|
$33,152.65
|
2025-09-11
|
|
38240
|
CPT
|
Transplt Allo Hct/donor
|
2
|
1
|
—
|
—
|
$32,878.89
|
$32,878.89
|
$32,878.89
|
2025-09-11
|
|
C0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
42
|
20
|
—
|
—
|
$28,509.54
|
$49,154.39
|
$32,769.59
|
2025-09-11
|
|
B0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50
|
42
|
20
|
—
|
—
|
$28,470.69
|
$49,087.40
|
$32,724.93
|
2025-09-11
|
|
C1004
|
LOCAL
|
Amputation Lower Extremity M <47.50
|
42
|
20
|
—
|
—
|
$28,440.80
|
$49,035.86
|
$32,690.57
|
2025-09-11
|
|
A0405
|
LOCAL
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
42
|
20
|
—
|
—
|
$28,410.90
|
$48,984.32
|
$32,656.21
|
2025-09-11
|
|
B1603
|
LOCAL
|
Pain Syndrome M >=43.50 And M <58.50
|
42
|
20
|
—
|
—
|
$28,315.26
|
$48,819.42
|
$32,546.28
|
2025-09-11
|
|
D1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
42
|
20
|
—
|
—
|
$28,207.66
|
$48,633.90
|
$32,422.60
|
2025-09-11
|
|
B0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50
|
42
|
20
|
—
|
—
|
$27,868.42
|
$48,049.01
|
$32,032.67
|
2025-09-11
|
|
C0604
|
LOCAL
|
Neurological M <43.50
|
42
|
20
|
—
|
—
|
$27,863.94
|
$48,041.28
|
$32,027.52
|
2025-09-11
|
|
A0205
|
LOCAL
|
Traumatic Brain Injury M <35.50
|
42
|
20
|
—
|
—
|
$27,771.29
|
$47,881.53
|
$31,921.02
|
2025-09-11
|
|
C1504
|
LOCAL
|
Pulmonary M <45.50
|
42
|
20
|
—
|
—
|
$27,587.47
|
$47,564.60
|
$31,709.73
|
2025-09-11
|
|
33289
|
CPT
|
Tcat Impl Wrls P-art Prs Snr
|
2
|
1
|
—
|
—
|
$31,687.99
|
$31,687.99
|
$31,687.99
|
2025-09-11
|
|
B1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50
|
42
|
20
|
—
|
—
|
$27,446.99
|
$47,322.39
|
$31,548.26
|
2025-09-11
|
|
D1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
42
|
20
|
—
|
—
|
$27,424.58
|
$47,283.75
|
$31,522.50
|
2025-09-11
|
|
B1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50
|
42
|
20
|
—
|
—
|
$27,312.49
|
$47,090.51
|
$31,393.67
|
2025-09-11
|
|
B0503
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50
|
42
|
20
|
—
|
—
|
$27,290.07
|
$47,051.85
|
$31,367.90
|
2025-09-11
|
|
D1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50
|
42
|
20
|
—
|
—
|
$26,923.93
|
$46,420.58
|
$30,947.05
|
2025-09-11
|
|
C0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50
|
42
|
20
|
—
|
—
|
$26,904.51
|
$46,387.08
|
$30,924.72
|
2025-09-11
|
|
B1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50
|
42
|
20
|
—
|
—
|
$26,861.16
|
$46,312.35
|
$30,874.90
|
2025-09-11
|
|
A5102
|
LOCAL
|
Expired, Orthopedic, Length Of Stay Is 14 Days Or More
|
42
|
20
|
—
|
—
|
$26,789.43
|
$46,188.68
|
$30,792.45
|
2025-09-11
|
|
B0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50
|
42
|
20
|
—
|
—
|
$26,710.23
|
$46,052.12
|
$30,701.41
|
2025-09-11
|
|
C2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50
|
42
|
20
|
—
|
—
|
$26,514.46
|
$45,714.59
|
$30,476.39
|
2025-09-11
|
|
C0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50
|
42
|
20
|
—
|
—
|
$26,484.57
|
$45,663.05
|
$30,442.03
|
2025-09-11
|
|
C1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
42
|
20
|
—
|
—
|
$26,462.15
|
$45,624.39
|
$30,416.26
|
2025-09-11
|
|
A1903
|
LOCAL
|
Guillain-barré M >=38.50 And M <51.50
|
42
|
20
|
—
|
—
|
$26,457.67
|
$45,616.67
|
$30,411.11
|
2025-09-11
|
|
B2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50
|
42
|
20
|
—
|
—
|
$26,339.61
|
$45,413.12
|
$30,275.41
|
2025-09-11
|
|
D2102
|
LOCAL
|
Burns M <52.50
|
42
|
20
|
—
|
—
|
$26,318.68
|
$45,377.04
|
$30,251.36
|
2025-09-11
|
|
C2102
|
LOCAL
|
Burns M <52.50
|
42
|
20
|
—
|
—
|
$26,318.68
|
$45,377.04
|
$30,251.36
|
2025-09-11
|
|
0312T
|
CPT
|
Fee Schedule
|
2
|
1
|
—
|
—
|
$30,123.13
|
$30,123.13
|
$30,123.13
|
2025-09-11
|
|
63685
|
CPT
|
Ins/rplc Spi Npg/rcvr Pocket
|
2
|
1
|
—
|
—
|
$30,123.13
|
$30,123.13
|
$30,123.13
|
2025-09-11
|
|
61886
|
CPT
|
Implant Neurostim Arrays
|
2
|
1
|
—
|
—
|
$30,123.13
|
$30,123.13
|
$30,123.13
|
2025-09-11
|
|
64568
|
CPT
|
Opn Impltj Crnl Nrv Nea&pg
|
2
|
1
|
—
|
—
|
$30,123.13
|
$30,123.13
|
$30,123.13
|
2025-09-11
|
|
0424T
|
CPT
|
Fee Schedule
|
2
|
1
|
—
|
—
|
$30,123.13
|
$30,123.13
|
$30,123.13
|
2025-09-11
|
|
D0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
42
|
20
|
—
|
—
|
$26,188.67
|
$45,152.88
|
$30,101.92
|
2025-09-11
|
|
B1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50
|
42
|
20
|
—
|
—
|
$26,170.73
|
$45,121.95
|
$30,081.30
|
2025-09-11
|
|
C1604
|
LOCAL
|
Pain Syndrome M <43.50
|
42
|
20
|
—
|
—
|
$26,057.15
|
$44,926.13
|
$29,950.75
|
2025-09-11
|
|
D0604
|
LOCAL
|
Neurological M <43.50
|
42
|
20
|
—
|
—
|
$26,012.32
|
$44,848.83
|
$29,899.22
|
2025-09-11
|
|
D1004
|
LOCAL
|
Amputation Lower Extremity M <47.50
|
42
|
20
|
—
|
—
|
$25,979.44
|
$44,792.15
|
$29,861.43
|
2025-09-11
|
|
C1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
42
|
20
|
—
|
—
|
$25,954.04
|
$44,748.35
|
$29,832.23
|
2025-09-11
|
|
D1504
|
LOCAL
|
Pulmonary M <45.50
|
42
|
20
|
—
|
—
|
$25,945.07
|
$44,732.88
|
$29,821.92
|
2025-09-11
|
|
C0403
|
LOCAL
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
42
|
20
|
—
|
—
|
$25,940.59
|
$44,725.16
|
$29,816.77
|
2025-09-11
|
|
C0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
42
|
20
|
—
|
—
|
$25,850.92
|
$44,570.55
|
$29,713.70
|
2025-09-11
|
|
33216
|
CPT
|
Insert 1 Electrode Pm-defib
|
92
|
29
|
$38,328.90
|
$38,328.90
|
$7,960.67
|
$32,579.57
|
$29,704.90
|
2025-09-11
|
|
33217
|
CPT
|
Insert 2 Electrode Pm-defib
|
92
|
29
|
$38,328.90
|
$38,328.90
|
$7,960.67
|
$32,579.57
|
$29,704.90
|
2025-09-11
|
|
B0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50
|
42
|
20
|
—
|
—
|
$25,685.04
|
$44,284.55
|
$29,523.03
|
2025-09-11
|
|
C0904
|
LOCAL
|
Other Orthopedic M <44.5
|
42
|
20
|
—
|
—
|
$25,634.23
|
$44,196.95
|
$29,464.63
|
2025-09-11
|
|
A1705
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
42
|
20
|
—
|
—
|
$25,590.88
|
$44,122.22
|
$29,414.81
|
2025-09-11
|
|
D0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50
|
42
|
20
|
—
|
—
|
$25,486.28
|
$43,941.86
|
$29,294.57
|
2025-09-11
|
|
A1805
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
42
|
20
|
—
|
—
|
$25,427.99
|
$43,841.37
|
$29,227.58
|
2025-09-11
|
|
C0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
42
|
20
|
—
|
—
|
$25,354.77
|
$43,715.12
|
$29,143.41
|
2025-09-11
|
|
B1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50
|
42
|
20
|
—
|
—
|
$25,342.81
|
$43,694.51
|
$29,129.67
|
2025-09-11
|
|
C1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
42
|
20
|
—
|
—
|
$25,341.32
|
$43,691.93
|
$29,127.95
|
2025-09-11
|
|
C1404
|
LOCAL
|
Cardiac M <45.50
|
42
|
20
|
—
|
—
|
$25,262.11
|
$43,555.37
|
$29,036.91
|
2025-09-11
|
|
D1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
42
|
20
|
—
|
—
|
$25,259.12
|
$43,550.21
|
$29,033.47
|
2025-09-11
|
|
C0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
42
|
20
|
—
|
—
|
$25,236.71
|
$43,511.57
|
$29,007.71
|
2025-09-11
|
|
B0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50
|
42
|
20
|
—
|
—
|
$25,185.89
|
$43,423.95
|
$28,949.30
|
2025-09-11
|
|
D0403
|
LOCAL
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
42
|
20
|
—
|
—
|
$25,181.41
|
$43,416.23
|
$28,944.15
|
2025-09-11
|
|
C2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50
|
42
|
20
|
—
|
—
|
$25,154.51
|
$43,369.85
|
$28,913.23
|
2025-09-11
|
|
B1902
|
LOCAL
|
Guillain-barré M >=51.50 And M <66.50
|
42
|
20
|
—
|
—
|
$24,875.05
|
$42,888.02
|
$28,592.01
|
2025-09-11
|
|
B1702
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50
|
42
|
20
|
—
|
—
|
$24,825.73
|
$42,802.98
|
$28,535.32
|
2025-09-11
|
|
B0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50
|
42
|
20
|
—
|
—
|
$24,819.75
|
$42,792.68
|
$28,528.45
|
2025-09-11
|
|
C1204
|
LOCAL
|
Osteoarthritis M <49.50 And A <74.50
|
42
|
20
|
—
|
—
|
$24,810.79
|
$42,777.23
|
$28,518.15
|
2025-09-11
|
|
D2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50
|
42
|
20
|
—
|
—
|
$24,768.94
|
$42,705.08
|
$28,470.05
|
2025-09-11
|
|
C0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50
|
42
|
20
|
—
|
—
|
$24,718.14
|
$42,617.48
|
$28,411.65
|
2025-09-11
|
|
A0305
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
42
|
20
|
—
|
—
|
$24,683.76
|
$42,558.21
|
$28,372.14
|
2025-09-11
|
|
A1504
|
LOCAL
|
Pulmonary M <45.50
|
42
|
20
|
—
|
—
|
$24,269.80
|
$41,844.48
|
$27,896.32
|
2025-09-11
|
|
D0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50
|
42
|
20
|
—
|
—
|
$24,202.55
|
$41,728.53
|
$27,819.02
|
2025-09-11
|
|
D1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
42
|
20
|
—
|
—
|
$24,189.10
|
$41,705.34
|
$27,803.56
|
2025-09-11
|
|
B1502
|
LOCAL
|
Pulmonary M >=56.50 And M <68.50
|
42
|
20
|
—
|
—
|
$24,150.24
|
$41,638.35
|
$27,758.90
|
2025-09-11
|
|
C1103
|
LOCAL
|
Amputation Non-lower Extremity M <52.50
|
42
|
20
|
—
|
—
|
$24,093.45
|
$41,540.43
|
$27,693.62
|
2025-09-11
|
|
D1103
|
LOCAL
|
Amputation Non-lower Extremity M <52.50
|
42
|
20
|
—
|
—
|
$24,093.45
|
$41,540.43
|
$27,693.62
|
2025-09-11
|
|
D1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
42
|
20
|
—
|
—
|
$24,036.66
|
$41,442.53
|
$27,628.35
|
2025-09-11
|
|
B1102
|
LOCAL
|
Amputation Non-lower Extremity M >=52.50 And M <58.50
|
42
|
20
|
—
|
—
|
$24,035.17
|
$41,439.95
|
$27,626.63
|
2025-09-11
|
|
B1202
|
LOCAL
|
Osteoarthritis M >=49.50 And M <61.50
|
42
|
20
|
—
|
—
|
$24,021.72
|
$41,416.76
|
$27,611.17
|
2025-09-11
|
|
B0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50
|
42
|
20
|
—
|
—
|
$23,929.06
|
$41,257.01
|
$27,504.67
|
2025-09-11
|
|
D0904
|
LOCAL
|
Other Orthopedic M <44.5
|
42
|
20
|
—
|
—
|
$23,893.20
|
$41,195.18
|
$27,463.45
|
2025-09-11
|
|
D0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
42
|
20
|
—
|
—
|
$23,842.38
|
$41,107.56
|
$27,405.04
|
2025-09-11
|
|
C1804
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
42
|
20
|
—
|
—
|
$23,827.44
|
$41,081.79
|
$27,387.86
|
2025-09-11
|
|
B0502
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50
|
42
|
20
|
—
|
—
|
$23,808.01
|
$41,048.30
|
$27,365.53
|
2025-09-11
|
|
D0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
42
|
20
|
—
|
—
|
$23,746.75
|
$40,942.67
|
$27,295.11
|
2025-09-11
|
|
C1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50
|
42
|
20
|
—
|
—
|
$23,658.57
|
$40,790.64
|
$27,193.76
|
2025-09-11
|
|
A1103
|
LOCAL
|
Amputation Non-lower Extremity M <52.50
|
42
|
20
|
—
|
—
|
$23,606.27
|
$40,700.46
|
$27,133.64
|
2025-09-11
|
|
D1604
|
LOCAL
|
Pain Syndrome M <43.50
|
42
|
20
|
—
|
—
|
$23,552.47
|
$40,607.70
|
$27,071.80
|
2025-09-11
|
|
A0704
|
LOCAL
|
Fracture Of Lower Extremity M <41.50
|
42
|
20
|
—
|
—
|
$23,546.49
|
$40,597.40
|
$27,064.93
|
2025-09-11
|
|
A1304
|
LOCAL
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
42
|
20
|
—
|
—
|
$23,498.67
|
$40,514.94
|
$27,009.96
|
2025-09-11
|
|
D2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50
|
42
|
20
|
—
|
—
|
$23,498.67
|
$40,514.94
|
$27,009.96
|
2025-09-11
|
|
D1404
|
LOCAL
|
Cardiac M <45.50
|
42
|
20
|
—
|
—
|
$23,488.20
|
$40,496.90
|
$26,997.93
|
2025-09-11
|
|
A0604
|
LOCAL
|
Neurological M <43.50
|
42
|
20
|
—
|
—
|
$23,459.81
|
$40,447.95
|
$26,965.30
|
2025-09-11
|
|
A1004
|
LOCAL
|
Amputation Lower Extremity M <47.50
|
42
|
20
|
—
|
—
|
$23,275.99
|
$40,131.02
|
$26,754.01
|
2025-09-11
|
|
D1204
|
LOCAL
|
Osteoarthritis M <49.50 And A <74.50
|
42
|
20
|
—
|
—
|
$23,262.54
|
$40,107.83
|
$26,738.55
|
2025-09-11
|
|
B0402
|
LOCAL
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50
|
42
|
20
|
—
|
—
|
$23,244.61
|
$40,076.91
|
$26,717.94
|
2025-09-11
|
|
B0302
|
LOCAL
|
Non-traumatic Brain Injury M >=52.50 And M <65.50
|
42
|
20
|
—
|
—
|
$23,160.92
|
$39,932.63
|
$26,621.75
|
2025-09-11
|
|
B0702
|
LOCAL
|
Fracture Of Lower Extremity M >=52.50 And M <61.50
|
42
|
20
|
—
|
—
|
$23,151.95
|
$39,917.16
|
$26,611.44
|
2025-09-11
|
|
A0104
|
LOCAL
|
Stroke M >=41.50 And M <50.50
|
42
|
20
|
—
|
—
|
$23,065.27
|
$39,767.72
|
$26,511.81
|
2025-09-11
|
|
D0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
42
|
20
|
—
|
—
|
$23,027.92
|
$39,703.31
|
$26,468.87
|
2025-09-11
|
|
C1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50
|
42
|
20
|
—
|
—
|
$22,930.77
|
$39,535.82
|
$26,357.21
|
2025-09-11
|
|
B1002
|
LOCAL
|
Amputation Lower Extremity M >=55.50 And M <64.50
|
42
|
20
|
—
|
—
|
$22,926.29
|
$39,528.09
|
$26,352.06
|
2025-09-11
|
|
B0803
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=51.50 And M <57.50
|
42
|
20
|
—
|
—
|
$22,926.29
|
$39,528.09
|
$26,352.06
|
2025-09-11
|
|
A0403
|
LOCAL
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
42
|
20
|
—
|
—
|
$22,881.46
|
$39,450.80
|
$26,300.53
|
2025-09-11
|
|
D1804
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
42
|
20
|
—
|
—
|
$22,619.93
|
$38,999.88
|
$25,999.92
|
2025-09-11
|
|
A2005
|
LOCAL
|
Miscellaneous M <46.50 And A <77.50
|
42
|
20
|
—
|
—
|
$22,545.21
|
$38,871.05
|
$25,914.03
|
2025-09-11
|
|
D0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50
|
42
|
20
|
—
|
—
|
$22,536.25
|
$38,855.60
|
$25,903.73
|
2025-09-11
|
|
A1305
|
LOCAL
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
42
|
20
|
—
|
—
|
$22,503.36
|
$38,798.90
|
$25,865.93
|
2025-09-11
|
|
B2101
|
LOCAL
|
Burns M >=52.50
|
42
|
20
|
—
|
—
|
$22,489.91
|
$38,775.71
|
$25,850.47
|
2025-09-11
|
|
A2102
|
LOCAL
|
Burns M <52.50
|
42
|
20
|
—
|
—
|
$22,476.47
|
$38,752.53
|
$25,835.02
|
2025-09-11
|
|
B1602
|
LOCAL
|
Pain Syndrome M >=58.50 And M <65.50
|
42
|
20
|
—
|
—
|
$22,421.17
|
$38,657.19
|
$25,771.46
|
2025-09-11
|
|
A0304
|
LOCAL
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
42
|
20
|
—
|
—
|
$22,382.32
|
$38,590.20
|
$25,726.80
|
2025-09-11
|
|
B0902
|
LOCAL
|
Other Orthopedic M >=51.50 And M <63.50
|
42
|
20
|
—
|
—
|
$22,367.37
|
$38,564.43
|
$25,709.62
|
2025-09-11
|
|
C0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50
|
42
|
20
|
—
|
—
|
$22,295.64
|
$38,440.76
|
$25,627.17
|
2025-09-11
|
|
C1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50
|
42
|
20
|
—
|
—
|
$22,276.21
|
$38,407.26
|
$25,604.84
|
2025-09-11
|
|
B1302
|
LOCAL
|
Rheumatoid Other Arthritis M >=51.50 And M <62.50
|
42
|
20
|
—
|
—
|
$22,276.21
|
$38,407.26
|
$25,604.84
|
2025-09-11
|
|
C0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50
|
42
|
20
|
—
|
—
|
$22,217.92
|
$38,306.76
|
$25,537.84
|
2025-09-11
|
|
C1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50
|
42
|
20
|
—
|
—
|
$22,214.94
|
$38,301.62
|
$25,534.41
|
2025-09-11
|
|
D1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50
|
42
|
20
|
—
|
—
|
$22,183.56
|
$38,247.51
|
$25,498.34
|
2025-09-11
|
|
C0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50
|
42
|
20
|
—
|
—
|
$22,023.65
|
$37,971.81
|
$25,314.54
|
2025-09-11
|
|
B2002
|
LOCAL
|
Miscellaneous M >=55.50 And M <66.50
|
42
|
20
|
—
|
—
|
$21,995.25
|
$37,922.85
|
$25,281.90
|
2025-09-11
|
|
A0504
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
42
|
20
|
—
|
—
|
$21,971.34
|
$37,881.62
|
$25,254.41
|
2025-09-11
|
|
A0904
|
LOCAL
|
Other Orthopedic M <44.5
|
42
|
20
|
—
|
—
|
$21,860.75
|
$37,690.95
|
$25,127.30
|
2025-09-11
|
|
A1704
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
42
|
20
|
—
|
—
|
$21,806.95
|
$37,598.19
|
$25,065.46
|
2025-09-11
|
|
A1604
|
LOCAL
|
Pain Syndrome M <43.50
|
42
|
20
|
—
|
—
|
$21,802.47
|
$37,590.47
|
$25,060.31
|
2025-09-11
|
|
C1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50
|
42
|
20
|
—
|
—
|
$21,789.02
|
$37,567.28
|
$25,044.85
|
2025-09-11
|
|
A0204
|
LOCAL
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
42
|
20
|
—
|
—
|
$21,681.42
|
$37,381.76
|
$24,921.17
|
2025-09-11
|
|
A1404
|
LOCAL
|
Cardiac M <45.50
|
42
|
20
|
—
|
—
|
$21,612.67
|
$37,263.23
|
$24,842.15
|
2025-09-11
|
|
C0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50
|
42
|
20
|
—
|
—
|
$21,392.99
|
$36,884.46
|
$24,589.64
|
2025-09-11
|
|
B1402
|
LOCAL
|
Cardiac M >=55.50 And M <68.50
|
42
|
20
|
—
|
—
|
$21,388.51
|
$36,876.74
|
$24,584.49
|
2025-09-11
|
|
A2004
|
LOCAL
|
Miscellaneous M <46.50 And A >=77.50
|
42
|
20
|
—
|
—
|
$21,388.51
|
$36,876.74
|
$24,584.49
|
2025-09-11
|
|
A1204
|
LOCAL
|
Osteoarthritis M <49.50 And A <74.50
|
42
|
20
|
—
|
—
|
$21,267.45
|
$36,668.03
|
$24,445.35
|
2025-09-11
|
|
B1802
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50
|
42
|
20
|
—
|
—
|
$21,258.49
|
$36,652.58
|
$24,435.05
|
2025-09-11
|
|
D1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50
|
42
|
20
|
—
|
—
|
$21,237.57
|
$36,616.50
|
$24,411.00
|
2025-09-11
|
|
C0503
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50
|
42
|
20
|
—
|
—
|
$21,230.10
|
$36,603.62
|
$24,402.41
|
2025-09-11
|
|
C2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50
|
42
|
20
|
—
|
—
|
$21,038.81
|
$36,273.81
|
$24,182.54
|
2025-09-11
|
|
C1603
|
LOCAL
|
Pain Syndrome M >=43.50 And M <58.50
|
42
|
20
|
—
|
—
|
$21,031.34
|
$36,260.93
|
$24,173.95
|
2025-09-11
|
|
A0805
|
LOCAL
|
Replacement Of Lower-extremity Joint M <42.50
|
42
|
20
|
—
|
—
|
$21,019.38
|
$36,240.32
|
$24,160.21
|
2025-09-11
|
|
A1804
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
42
|
20
|
—
|
—
|
$20,973.05
|
$36,160.43
|
$24,106.95
|
2025-09-11
|
|
C1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50
|
42
|
20
|
—
|
—
|
$20,955.12
|
$36,129.51
|
$24,086.34
|
2025-09-11
|
|
D1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50
|
42
|
20
|
—
|
—
|
$20,950.64
|
$36,121.79
|
$24,081.19
|
2025-09-11
|
|
D0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50
|
42
|
20
|
—
|
—
|
$20,862.46
|
$35,969.76
|
$23,979.84
|
2025-09-11
|
|
0414T
|
CPT
|
Rmvl & Rpl Car Modulj Pls Gn
|
2
|
1
|
—
|
—
|
$23,879.36
|
$23,879.36
|
$23,879.36
|
2025-09-11
|
|
0409T
|
CPT
|
Insj/rplc Car Modulj Pls Gn
|
2
|
1
|
—
|
—
|
$23,879.36
|
$23,879.36
|
$23,879.36
|
2025-09-11
|
|
0408T
|
CPT
|
Insj/rplc Cardiac Modulj Sys
|
2
|
1
|
—
|
—
|
$23,879.36
|
$23,879.36
|
$23,879.36
|
2025-09-11
|
|
33263
|
CPT
|
Rmvl & Rplcmt Dfb Gen 2 Lead
|
2
|
1
|
—
|
—
|
$23,879.36
|
$23,879.36
|
$23,879.36
|
2025-09-11
|
|
33262
|
CPT
|
Rmvl& Replc Pulse Gen 1 Lead
|
2
|
1
|
—
|
—
|
$23,879.36
|
$23,879.36
|
$23,879.36
|
2025-09-11
|
|
33240
|
CPT
|
Insrt Pulse Gen W/singl Lead
|
2
|
1
|
—
|
—
|
$23,879.36
|
$23,879.36
|
$23,879.36
|
2025-09-11
|
|
33230
|
CPT
|
Insrt Pulse Gen W/dual Leads
|
2
|
1
|
—
|
—
|
$23,879.36
|
$23,879.36
|
$23,879.36
|
2025-09-11
|
|
C0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50
|
42
|
20
|
—
|
—
|
$20,753.37
|
$35,781.68
|
$23,854.45
|
2025-09-11
|
|
D0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50
|
42
|
20
|
—
|
—
|
$20,741.41
|
$35,761.05
|
$23,840.70
|
2025-09-11
|
|
D1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50
|
42
|
20
|
—
|
—
|
$20,686.12
|
$35,665.73
|
$23,777.15
|
2025-09-11
|
|
C0402
|
LOCAL
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50
|
42
|
20
|
—
|
—
|
$20,671.17
|
$35,639.96
|
$23,759.97
|
2025-09-11
|
|
0520T
|
CPT
|
Rmv&rplcmt Pg Wcs Lv Battery
|
2
|
1
|
—
|
—
|
$23,756.18
|
$23,756.18
|
$23,756.18
|
2025-09-11
|
|
0515T
|
CPT
|
Insj Wcs Lv Compl Sys
|
2
|
1
|
—
|
—
|
$23,756.18
|
$23,756.18
|
$23,756.18
|
2025-09-11
|
|
C1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50
|
42
|
20
|
—
|
—
|
$20,617.37
|
$35,547.20
|
$23,698.13
|
2025-09-11
|
|
C0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50
|
42
|
20
|
—
|
—
|
$20,609.90
|
$35,534.31
|
$23,689.54
|
2025-09-11
|
|
B0802
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=57.50 And M <63.50
|
42
|
20
|
—
|
—
|
$20,597.95
|
$35,513.70
|
$23,675.80
|
2025-09-11
|
|
D0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50
|
42
|
20
|
—
|
—
|
$20,481.37
|
$35,312.72
|
$23,541.81
|
2025-09-11
|
|
C0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50
|
42
|
20
|
—
|
—
|
$20,442.52
|
$35,245.73
|
$23,497.15
|
2025-09-11
|
|
D1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50
|
42
|
20
|
—
|
—
|
$20,293.08
|
$34,988.07
|
$23,325.38
|
2025-09-11
|
|
A1203
|
LOCAL
|
Osteoarthritis M <49.50 And A >=74.50
|
42
|
20
|
—
|
—
|
$20,279.63
|
$34,964.88
|
$23,309.92
|
2025-09-11
|
|
D0402
|
LOCAL
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50
|
42
|
20
|
—
|
—
|
$20,065.92
|
$34,596.42
|
$23,064.28
|
2025-09-11
|
|
D0503
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50
|
42
|
20
|
—
|
—
|
$20,056.95
|
$34,580.96
|
$23,053.97
|
2025-09-11
|
|
D1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50
|
42
|
20
|
—
|
—
|
$20,001.67
|
$34,485.63
|
$22,990.42
|
2025-09-11
|
|
B1701
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50
|
42
|
20
|
—
|
—
|
$19,982.23
|
$34,452.12
|
$22,968.08
|
2025-09-11
|
|
D0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50
|
42
|
20
|
—
|
—
|
$19,940.39
|
$34,379.99
|
$22,919.99
|
2025-09-11
|
|
B0202
|
LOCAL
|
Traumatic Brain Injury M >=61.50 And M <73.50
|
42
|
20
|
—
|
—
|
$19,929.93
|
$34,361.94
|
$22,907.96
|
2025-09-11
|
|
B0601
|
LOCAL
|
Neurological M >=64.50
|
42
|
20
|
—
|
—
|
$19,856.70
|
$34,235.69
|
$22,823.79
|
2025-09-11
|
|
B1201
|
LOCAL
|
Osteoarthritis M >=61.50
|
42
|
20
|
—
|
—
|
$19,841.76
|
$34,209.93
|
$22,806.62
|
2025-09-11
|
|
24685
|
CPT
|
Treat Ulnar Fracture
|
92
|
29
|
$29,426.43
|
$29,426.43
|
$6,054.93
|
$25,012.47
|
$22,805.49
|
2025-09-11
|
|
27893
|
CPT
|
Decompression Of Leg
|
92
|
29
|
$29,426.43
|
$29,426.43
|
$6,054.93
|
$25,012.47
|
$22,805.49
|
2025-09-11
|
|
D2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50
|
42
|
20
|
—
|
—
|
$19,653.46
|
$33,885.27
|
$22,590.18
|
2025-09-11
|
|
C1502
|
LOCAL
|
Pulmonary M >=56.50 And M <68.50
|
42
|
20
|
—
|
—
|
$19,601.15
|
$33,795.09
|
$22,530.06
|
2025-09-11
|
|
A1503
|
LOCAL
|
Pulmonary M >=45.50 And M <56.50
|
42
|
20
|
—
|
—
|
$19,598.16
|
$33,789.93
|
$22,526.62
|
2025-09-11
|
|
B1601
|
LOCAL
|
Pain Syndrome M >=65.50
|
42
|
20
|
—
|
—
|
$19,565.28
|
$33,733.25
|
$22,488.83
|
2025-09-11
|
|
D1102
|
LOCAL
|
Amputation Non-lower Extremity M >=52.50 And M <58.50
|
42
|
20
|
—
|
—
|
$19,320.19
|
$33,310.68
|
$22,207.12
|
2025-09-11
|
|
C1102
|
LOCAL
|
Amputation Non-lower Extremity M >=52.50 And M <58.50
|
42
|
20
|
—
|
—
|
$19,320.19
|
$33,310.68
|
$22,207.12
|
2025-09-11
|
|
A0303
|
LOCAL
|
Non-traumatic Brain Injury M >=42.50 And M <52.50
|
42
|
20
|
—
|
—
|
$19,303.75
|
$33,282.33
|
$22,188.22
|
2025-09-11
|
|
C1702
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50
|
42
|
20
|
—
|
—
|
$19,297.77
|
$33,272.03
|
$22,181.35
|
2025-09-11
|
|
A0703
|
LOCAL
|
Fracture Of Lower Extremity M >=41.50 And M <52.50
|
42
|
20
|
—
|
—
|
$19,275.36
|
$33,233.39
|
$22,155.59
|
2025-09-11
|
|
A1703
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50
|
42
|
20
|
—
|
—
|
$19,267.89
|
$33,220.50
|
$22,147.00
|
2025-09-11
|
|
A1803
|
LOCAL
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50
|
42
|
20
|
—
|
—
|
$19,179.72
|
$33,068.48
|
$22,045.65
|
2025-09-11
|
|
D1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50
|
42
|
20
|
—
|
—
|
$19,169.26
|
$33,050.45
|
$22,033.63
|
2025-09-11
|
|
C1902
|
LOCAL
|
Guillain-barré M >=51.50 And M <66.50
|
42
|
20
|
—
|
—
|
$19,124.42
|
$32,973.14
|
$21,982.09
|
2025-09-11
|
|
B1501
|
LOCAL
|
Pulmonary M >=68.50
|
42
|
20
|
—
|
—
|
$19,037.74
|
$32,823.69
|
$21,882.46
|
2025-09-11
|
|
D1603
|
LOCAL
|
Pain Syndrome M >=43.50 And M <58.50
|
42
|
20
|
—
|
—
|
$19,009.35
|
$32,774.75
|
$21,849.83
|
2025-09-11
|
|
B0501
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=60.50
|
42
|
20
|
—
|
—
|
$18,977.96
|
$32,720.63
|
$21,813.75
|
2025-09-11
|
|
D0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50
|
42
|
20
|
—
|
—
|
$18,964.51
|
$32,697.44
|
$21,798.29
|
2025-09-11
|
|
C1002
|
LOCAL
|
Amputation Lower Extremity M >=55.50 And M <64.50
|
42
|
20
|
—
|
—
|
$18,960.03
|
$32,689.71
|
$21,793.14
|
2025-09-11
|
|
A1102
|
LOCAL
|
Amputation Non-lower Extremity M >=52.50 And M <58.50
|
42
|
20
|
—
|
—
|
$18,930.15
|
$32,638.19
|
$21,758.79
|
2025-09-11
|
|
B1101
|
LOCAL
|
Amputation Non-lower Extremity M >=58.50
|
42
|
20
|
—
|
—
|
$18,904.73
|
$32,594.37
|
$21,729.58
|
2025-09-11
|
|
C0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50
|
42
|
20
|
—
|
—
|
$18,856.92
|
$32,511.93
|
$21,674.62
|
2025-09-11
|
|
D0804
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50
|
42
|
20
|
—
|
—
|
$18,791.16
|
$32,398.55
|
$21,599.03
|
2025-09-11
|
|
B0701
|
LOCAL
|
Fracture Of Lower Extremity M >=61.50
|
42
|
20
|
—
|
—
|
$18,743.34
|
$32,316.11
|
$21,544.07
|
2025-09-11
|
|
A0603
|
LOCAL
|
Neurological M >=43.50 And M <52.50
|
42
|
20
|
—
|
—
|
$18,705.97
|
$32,251.68
|
$21,501.12
|
2025-09-11
|
|
A1303
|
LOCAL
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50
|
42
|
20
|
—
|
—
|
$18,607.34
|
$32,081.63
|
$21,387.75
|
2025-09-11
|
|
D0203
|
LOCAL
|
Traumatic Brain Injury M >=49.50 And M <61.50
|
42
|
20
|
—
|
—
|
$18,566.99
|
$32,012.06
|
$21,341.37
|
2025-09-11
|
|
B0102
|
LOCAL
|
Stroke M >=63.50 And M <72.50
|
42
|
20
|
—
|
—
|
$18,565.50
|
$32,009.48
|
$21,339.65
|
2025-09-11
|
|
C0302
|
LOCAL
|
Non-traumatic Brain Injury M >=52.50 And M <65.50
|
42
|
20
|
—
|
—
|
$18,531.13
|
$31,950.23
|
$21,300.15
|
2025-09-11
|
|
C0502
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50
|
42
|
20
|
—
|
—
|
$18,520.66
|
$31,932.18
|
$21,288.12
|
2025-09-11
|
|
A0503
|
LOCAL
|
Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50
|
42
|
20
|
—
|
—
|
$18,483.31
|
$31,867.77
|
$21,245.18
|
2025-09-11
|
|
D1502
|
LOCAL
|
Pulmonary M >=56.50 And M <68.50
|
42
|
20
|
—
|
—
|
$18,433.99
|
$31,782.74
|
$21,188.49
|
2025-09-11
|
|
C1302
|
LOCAL
|
Rheumatoid Other Arthritis M >=51.50 And M <62.50
|
42
|
20
|
—
|
—
|
$18,419.04
|
$31,756.97
|
$21,171.31
|
2025-09-11
|
|
C0803
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=51.50 And M <57.50
|
42
|
20
|
—
|
—
|
$18,396.63
|
$31,718.33
|
$21,145.55
|
2025-09-11
|
|
C1202
|
LOCAL
|
Osteoarthritis M >=49.50 And M <61.50
|
42
|
20
|
—
|
—
|
$18,262.13
|
$31,486.43
|
$20,990.95
|
2025-09-11
|
|
A0903
|
LOCAL
|
Other Orthopedic M >=44.50 And M <51.50
|
42
|
20
|
—
|
—
|
$18,244.20
|
$31,455.51
|
$20,970.34
|
2025-09-11
|
|
A0402
|
LOCAL
|
Traumatic Spinal Cord Injury M >=47.50 And M <56.50
|
42
|
20
|
—
|
—
|
$18,233.73
|
$31,437.47
|
$20,958.31
|
2025-09-11
|
|
A1003
|
LOCAL
|
Amputation Lower Extremity M >=47.50 And M <55.50
|
42
|
20
|
—
|
—
|
$18,181.43
|
$31,347.29
|
$20,898.19
|
2025-09-11
|
|
B0801
|
LOCAL
|
Replacement Of Lower-extremity Joint M >=63.50
|
42
|
20
|
—
|
—
|
$18,167.98
|
$31,324.10
|
$20,882.73
|
2025-09-11
|
|
B1001
|
LOCAL
|
Amputation Lower Extremity M >=64.50
|
42
|
20
|
—
|
—
|
$18,097.74
|
$31,203.00
|
$20,802.00
|
2025-09-11
|
|
A0103
|
LOCAL
|
Stroke M >=50.50 And M <63.50
|
42
|
20
|
—
|
—
|
$18,072.34
|
$31,159.20
|
$20,772.80
|
2025-09-11
|
|
B0401
|
LOCAL
|
Traumatic Spinal Cord Injury M >=56.50
|
42
|
20
|
—
|
—
|
$18,023.02
|
$31,074.17
|
$20,716.11
|
2025-09-11
|
|
B0901
|
LOCAL
|
Other Orthopedic M >=63.50
|
42
|
20
|
—
|
—
|
$17,958.76
|
$30,963.38
|
$20,642.25
|
2025-09-11
|
|
C0902
|
LOCAL
|
Other Orthopedic M >=51.50 And M <63.50
|
42
|
20
|
—
|
—
|
$17,915.41
|
$30,888.65
|
$20,592.43
|
2025-09-11
|
|
B0301
|
LOCAL
|
Non-traumatic Brain Injury M >=65.50
|
42
|
20
|
—
|
—
|
$17,913.92
|
$30,886.07
|
$20,590.71
|
2025-09-11
|
|
C0702
|
LOCAL
|
Fracture Of Lower Extremity M >=52.50 And M <61.50
|
42
|
20
|
—
|
—
|
$17,909.44
|
$30,878.34
|
$20,585.56
|
2025-09-11
|
|
A2003
|
LOCAL
|
Miscellaneous M >=46.50 And M <55.50
|
42
|
20
|
—
|
—
|
$17,888.51
|
$30,842.27
|
$20,561.51
|
2025-09-11
|
|
D1702
|
LOCAL
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50
|
42
|
20
|
—
|
—
|
$17,872.08
|
$30,813.93
|
$20,542.62
|
2025-09-11
|
|
D1902
|
LOCAL
|
Guillain-barré M >=51.50 And M <66.50
|
42
|
20
|
—
|
—
|
$17,845.18
|
$30,767.55
|
$20,511.70
|
2025-09-11
|
|
B2001
|
LOCAL
|
Miscellaneous M >=66.50
|
42
|
20
|
—
|
—
|
$17,640.43
|
$30,414.54
|
$20,276.36
|
2025-09-11
|
|
A1403
|
LOCAL
|
Cardiac M >=45.50 And M <55.50
|
42
|
20
|
—
|
—
|
$17,638.95
|
$30,411.98
|
$20,274.65
|
2025-09-11
|
|
D0602
|
LOCAL
|
Neurological M >=52.50 And M <64.50
|
42
|
20
|
—
|
—
|
$17,603.08
|
$30,350.13
|
$20,233.42
|
2025-09-11
|
|
A1603
|
LOCAL
|
Pain Syndrome M >=43.50 And M <58.50
|
42
|
20
|
—
|
—
|
$17,597.10
|
$30,339.83
|
$20,226.55
|
2025-09-11
|