Mountains Community Hospital — Pricing

673 procedures published in this hospital's Machine-Readable File (MRF) — 0 with a comparable price, 673 with per-payer negotiated rates only. Prices shown are pre-insurance; actual cost depends on your plan, Medicare/Medicaid coverage, or cash-pay discounts.

Procedures published 673
Lowest published price —
Average published price —
Highest published price —

Gross charges are the hospital's listed price — almost no one pays this amount. Your actual cost depends on your insurance plan. Use the cash price (when shown) as a guide for what uninsured patients are charged, and contact the hospital or your insurer for a personalized cost estimate.

Showing all 673 procedures

Procedures with negotiated rates only

These 673 procedures have published per-payer insurance agreements but no single comparable dollar amount in the MRF — typically because the agreement is expressed as a percentage of charge, a fee schedule reference, or a contract algorithm. The number of payers indicates how many insurance plans have a negotiated rate on file.

DRG Description Insurance rate range Payers
003 ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES — 2 plans
004 TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES — 2 plans
010 Pancreas transplant — 2 plans
012 Tracheostomy for face,mouth & neck diagnoses w CC — 2 plans
013 Tracheostomy for face,mouth & neck diagnoses w/o CC/MCC — 2 plans
027 CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC — 2 plans
030 SPINAL PROCEDURES WITHOUT CC/MCC — 2 plans
032 VENTRICULAR SHUNT PROCEDURES WITH CC — 2 plans
033 VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC — 2 plans
035 CAROTID ARTERY STENT PROCEDURES WITH CC — 2 plans
036 CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC — 2 plans
038 EXTRACRANIAL PROCEDURES WITH CC — 2 plans
039 EXTRACRANIAL PROCEDURES WITHOUT CC/MCC — 2 plans
041 PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR — 2 plans
042 PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC — 2 plans
052 SPINAL DISORDERS AND INJURIES WITH CC/MCC — 2 plans
053 SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
054 NERVOUS SYSTEM NEOPLASMS WITH MCC — 2 plans
055 NERVOUS SYSTEM NEOPLASMS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
056 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC — 2 plans
057 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC — 2 plans
058 MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC — 2 plans
059 MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC — 2 plans
060 MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
061 ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC — 2 plans
062 ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC — 2 plans
063 ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC — 2 plans
064 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC — 2 plans
065 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS $1,910 – $2,120 · median $2,015 2 plans
066 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
067 NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC — 2 plans
068 NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
069 TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC $1,910 – $2,120 · median $2,015 2 plans
070 NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC — 2 plans
071 NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC $1,910 – $2,120 · median $2,015 2 plans
072 NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
073 CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC — 2 plans
074 CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
075 VIRAL MENINGITIS WITH CC/MCC — 2 plans
076 VIRAL MENINGITIS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
077 HYPERTENSIVE ENCEPHALOPATHY WITH MCC — 2 plans
078 HYPERTENSIVE ENCEPHALOPATHY WITH CC $1,910 – $2,120 · median $2,015 2 plans
079 HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
080 NONTRAUMATIC STUPOR AND COMA WITH MCC — 2 plans
081 NONTRAUMATIC STUPOR AND COMA WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
082 TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC — 2 plans
083 TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC — 2 plans
084 TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
085 TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC — 2 plans
086 TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC — 2 plans
087 TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
088 CONCUSSION WITH MCC — 2 plans
089 CONCUSSION WITH CC $1,910 – $2,120 · median $2,015 2 plans
090 CONCUSSION WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
091 OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC — 2 plans
092 OTHER DISORDERS OF NERVOUS SYSTEM WITH CC $1,910 – $2,120 · median $2,015 2 plans
093 OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
094 BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC — 2 plans
095 BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC — 2 plans
096 BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC — 2 plans
097 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC — 2 plans
098 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC — 2 plans
099 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC — 2 plans
100 SEIZURES WITH MCC — 2 plans
101 SEIZURES WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
102 HEADACHES WITH MCC — 2 plans
103 HEADACHES WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
113 ORBITAL PROCEDURES WITH CC/MCC — 2 plans
114 ORBITAL PROCEDURES WITHOUT CC/MCC — 2 plans
115 Extraocular procedures except orbit — 2 plans
116 INTRAOCULAR PROCEDURES WITH CC/MCC — 2 plans
117 INTRAOCULAR PROCEDURES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
121 ACUTE MAJOR EYE INFECTIONS WITH CC/MCC — 2 plans
122 ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
123 Neurological eye disorders $1,910 – $2,120 · median $2,015 2 plans
124 OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT — 2 plans
125 OTHER DISORDERS OF THE EYE WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
135 SINUS AND MASTOID PROCEDURES WITH CC/MCC — 2 plans
136 SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
137 MOUTH PROCEDURES WITH CC/MCC — 2 plans
138 MOUTH PROCEDURES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
139 Salivary gland procedures — 2 plans
140 MAJOR HEAD AND NECK PROCEDURES WITH MCC — 2 plans
141 MAJOR HEAD AND NECK PROCEDURES WITH CC — 2 plans
142 MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC — 2 plans
143 OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC — 2 plans
144 OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC — 2 plans
145 OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC — 2 plans
146 EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC — 2 plans
147 EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC — 2 plans
148 EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
149 Dysequilibrium $1,910 – $2,120 · median $2,015 2 plans
150 EPISTAXIS WITH MCC — 2 plans
151 EPISTAXIS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
152 OTITIS MEDIA AND URI WITH MCC — 2 plans
153 OTITIS MEDIA AND URI WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
154 OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC — 2 plans
155 OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC $1,910 – $2,120 · median $2,015 2 plans
156 OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
157 DENTAL AND ORAL DISEASES WITH MCC — 2 plans
158 DENTAL AND ORAL DISEASES WITH CC $1,910 – $2,120 · median $2,015 2 plans
159 DENTAL AND ORAL DISEASES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
164 MAJOR CHEST PROCEDURES WITH CC — 2 plans
165 MAJOR CHEST PROCEDURES WITHOUT CC/MCC — 2 plans
166 OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC — 2 plans
167 OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC — 2 plans
168 OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC — 2 plans
175 PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE — 2 plans
176 PULMONARY EMBOLISM WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
177 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC — 2 plans
178 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC $1,910 – $2,120 · median $2,015 2 plans
179 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
180 RESPIRATORY NEOPLASMS WITH MCC — 2 plans
181 RESPIRATORY NEOPLASMS WITH CC $1,910 – $2,120 · median $2,015 2 plans
182 RESPIRATORY NEOPLASMS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
183 MAJOR CHEST TRAUMA WITH MCC — 2 plans
184 MAJOR CHEST TRAUMA WITH CC $1,910 – $2,120 · median $2,015 2 plans
185 MAJOR CHEST TRAUMA WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
186 PLEURAL EFFUSION WITH MCC — 2 plans
187 PLEURAL EFFUSION WITH CC $1,910 – $2,120 · median $2,015 2 plans
188 PLEURAL EFFUSION WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
189 PULMONARY EDEMA AND RESPIRATORY FAILURE — 2 plans
190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC — 2 plans
191 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC $1,910 – $2,120 · median $2,015 2 plans
192 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
193 SIMPLE PNEUMONIA AND PLEURISY WITH MCC — 2 plans
194 SIMPLE PNEUMONIA AND PLEURISY WITH CC $1,910 – $2,120 · median $2,015 2 plans
195 SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
196 INTERSTITIAL LUNG DISEASE WITH MCC — 2 plans
197 INTERSTITIAL LUNG DISEASE WITH CC $1,910 – $2,120 · median $2,015 2 plans
198 INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
199 PNEUMOTHORAX WITH MCC — 2 plans
200 PNEUMOTHORAX WITH CC $1,910 – $2,120 · median $2,015 2 plans
201 PNEUMOTHORAX WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
202 BRONCHITIS AND ASTHMA WITH CC/MCC $1,910 – $2,120 · median $2,015 2 plans
203 BRONCHITIS AND ASTHMA WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
204 RESPIRATORY SIGNS AND SYMPTOMS $1,910 – $2,120 · median $2,015 2 plans
205 OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC — 2 plans
206 OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
207 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS — 2 plans
208 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS — 2 plans
215 Other heart assist system implant — 2 plans
216 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC — 2 plans
217 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC — 2 plans
218 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC — 2 plans
219 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC — 2 plans
220 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC — 2 plans
231 CORONARY BYPASS WITH PTCA WITH MCC — 2 plans
232 CORONARY BYPASS WITH PTCA WITHOUT MCC — 2 plans
233 CORONARY BYPASS WITH CARDIAC CATHETERIZATION WITH MCC — 2 plans
234 CORONARY BYPASS WITH CARDIAC CATHETERIZATION WITHOUT MCC — 2 plans
240 AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC — 2 plans
241 AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC — 2 plans
243 PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC — 2 plans
244 PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC — 2 plans
250 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC — 2 plans
251 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC — 2 plans
253 OTHER VASCULAR PROCEDURES WITH CC — 2 plans
254 OTHER VASCULAR PROCEDURES WITHOUT CC/MCC — 2 plans
255 UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC — 2 plans
256 UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC — 2 plans
257 UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
258 CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC — 2 plans
259 CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC — 2 plans
260 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC — 2 plans
261 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC — 2 plans
262 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC — 2 plans
263 VEIN LIGATION AND STRIPPING — 2 plans
264 Other circulatory system O.R. procedures — 2 plans
267 ENDOVASCULAR CARDIAC VALVE REPLACEMENT W/O MCC — 2 plans
268 AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC — 2 plans
269 AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC — 2 plans
270 OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC — 2 plans
271 OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC — 2 plans
272 OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC — 2 plans
280 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC — 2 plans
281 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC $1,910 – $2,120 · median $2,015 2 plans
282 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
283 ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC — 2 plans
284 ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC $1,910 – $2,120 · median $2,015 2 plans
285 ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
286 CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC — 2 plans
287 CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC — 2 plans
288 ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC — 2 plans
289 ACUTE AND SUBACUTE ENDOCARDITIS WITH CC — 2 plans
290 ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
291 HEART FAILURE AND SHOCK WITH MCC — 2 plans
292 HEART FAILURE AND SHOCK WITH CC $1,910 – $2,120 · median $2,015 2 plans
293 HEART FAILURE AND SHOCK WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
294 DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC — 2 plans
295 DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
296 CARDIAC ARREST, UNEXPLAINED WITH MCC — 2 plans
297 CARDIAC ARREST, UNEXPLAINED WITH CC $1,910 – $2,120 · median $2,015 2 plans
298 CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
299 PERIPHERAL VASCULAR DISORDERS WITH MCC — 2 plans
300 PERIPHERAL VASCULAR DISORDERS WITH CC $1,910 – $2,120 · median $2,015 2 plans
301 PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
302 ATHEROSCLEROSIS WITH MCC — 2 plans
303 ATHEROSCLEROSIS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
304 HYPERTENSION WITH MCC — 2 plans
305 HYPERTENSION WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
306 CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC — 2 plans
307 CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
308 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC — 2 plans
309 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC $1,910 – $2,120 · median $2,015 2 plans
310 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
311 Angina pectoris $1,910 – $2,120 · median $2,015 2 plans
312 SYNCOPE AND COLLAPSE $1,910 – $2,120 · median $2,015 2 plans
313 Chest pain $1,910 – $2,120 · median $2,015 2 plans
314 OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC — 2 plans
315 OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC $1,910 – $2,120 · median $2,015 2 plans
316 OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
320 OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC — 2 plans
326 STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC — 2 plans
327 STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC — 2 plans
328 STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC — 2 plans
329 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC — 2 plans
330 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC — 2 plans
331 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC — 2 plans
333 RECTAL RESECTION WITH CC — 2 plans
334 RECTAL RESECTION WITHOUT CC/MCC — 2 plans
336 PERITONEAL ADHESIOLYSIS WITH CC — 2 plans
337 PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC — 2 plans
344 MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC — 2 plans
345 MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC — 2 plans
346 MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC — 2 plans
347 ANAL AND STOMAL PROCEDURES WITH MCC — 2 plans
348 ANAL AND STOMAL PROCEDURES WITH CC — 2 plans
349 ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
350 INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC — 2 plans
351 INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC — 2 plans
352 INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC — 2 plans
353 HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC — 2 plans
354 HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC — 2 plans
355 HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC — 2 plans
356 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC — 2 plans
357 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC — 2 plans
358 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC — 2 plans
368 MAJOR ESOPHAGEAL DISORDERS WITH MCC — 2 plans
369 MAJOR ESOPHAGEAL DISORDERS WITH CC $1,910 – $2,120 · median $2,015 2 plans
370 MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
371 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC — 2 plans
372 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC $1,910 – $2,120 · median $2,015 2 plans
373 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
374 DIGESTIVE MALIGNANCY WITH MCC — 2 plans
375 DIGESTIVE MALIGNANCY WITH CC — 2 plans
376 DIGESTIVE MALIGNANCY WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
377 GASTROINTESTINAL HEMORRHAGE WITH MCC — 2 plans
378 GASTROINTESTINAL HEMORRHAGE WITH CC $1,910 – $2,120 · median $2,015 2 plans
379 GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
380 COMPLICATED PEPTIC ULCER WITH MCC — 2 plans
381 COMPLICATED PEPTIC ULCER WITH CC $1,910 – $2,120 · median $2,015 2 plans
382 COMPLICATED PEPTIC ULCER WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
383 UNCOMPLICATED PEPTIC ULCER WITH MCC — 2 plans
384 UNCOMPLICATED PEPTIC ULCER WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
385 INFLAMMATORY BOWEL DISEASE WITH MCC — 2 plans
386 INFLAMMATORY BOWEL DISEASE WITH CC $1,910 – $2,120 · median $2,015 2 plans
387 INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
388 GASTROINTESTINAL OBSTRUCTION WITH MCC — 2 plans
389 GASTROINTESTINAL OBSTRUCTION WITH CC $1,910 – $2,120 · median $2,015 2 plans
390 GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
391 ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC — 2 plans
392 ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
393 OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC — 2 plans
394 OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC $1,910 – $2,120 · median $2,015 2 plans
395 OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
405 PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC — 2 plans
406 PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC — 2 plans
407 PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC — 2 plans
409 BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC — 2 plans
410 BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC — 2 plans
411 CHOLECYSTECTOMY WITH C.D.E. WITH MCC — 2 plans
412 CHOLECYSTECTOMY WITH C.D.E. WITH CC — 2 plans
413 CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC — 2 plans
414 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC — 2 plans
415 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC — 2 plans
416 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC — 2 plans
417 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC — 2 plans
418 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC — 2 plans
419 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC — 2 plans
420 HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC — 2 plans
421 HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC — 2 plans
422 HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC — 2 plans
423 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC — 2 plans
424 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC — 2 plans
425 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC — 2 plans
432 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC — 2 plans
433 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC $1,910 – $2,120 · median $2,015 2 plans
434 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
435 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC — 2 plans
436 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC — 2 plans
437 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
438 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC — 2 plans
439 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC $1,910 – $2,120 · median $2,015 2 plans
440 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
441 DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC — 2 plans
442 DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC $1,910 – $2,120 · median $2,015 2 plans
443 DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
444 DISORDERS OF THE BILIARY TRACT WITH MCC — 2 plans
445 DISORDERS OF THE BILIARY TRACT WITH CC $1,910 – $2,120 · median $2,015 2 plans
446 DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
453 Combined anterior/posterior spinal fusion w MCC — 2 plans
454 Combined anterior/posterior spinal fusion w CC — 2 plans
455 Combined anterior/posterior spinal fusion w/o CC/MCC — 2 plans
459 SPINAL FUSION EXCEPT CERVICAL WITH MCC — 2 plans
462 Bilateral or multiple major joint procs of lower extremity w/o MCC — 2 plans
463 WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC — 2 plans
464 WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC — 2 plans
465 WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC — 2 plans
468 REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC — 2 plans
470 Major joint replacement or reattachment of lower extremity w/o MCC — 2 plans
472 CERVICAL SPINAL FUSION WITH CC — 2 plans
473 CERVICAL SPINAL FUSION WITHOUT CC/MCC — 2 plans
474 AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC — 2 plans
475 AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC — 2 plans
476 AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC — 2 plans
477 BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC — 2 plans
478 BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC — 2 plans
479 BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC — 2 plans
480 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC — 2 plans
481 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC — 2 plans
482 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC — 2 plans
483 MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES — 2 plans
486 KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC — 2 plans
487 KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC — 2 plans
488 KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC — 2 plans
489 KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC — 2 plans
493 LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC — 2 plans
494 LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC — 2 plans
496 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC — 2 plans
497 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC — 2 plans
498 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC — 2 plans
499 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC — 2 plans
500 SOFT TISSUE PROCEDURES WITH MCC — 2 plans
501 SOFT TISSUE PROCEDURES WITH CC — 2 plans
502 SOFT TISSUE PROCEDURES WITHOUT CC/MCC — 2 plans
503 FOOT PROCEDURES WITH MCC — 2 plans
504 FOOT PROCEDURES WITH CC — 2 plans
505 FOOT PROCEDURES WITHOUT CC/MCC — 2 plans
506 Major thumb or joint procedures — 2 plans
507 MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC — 2 plans
508 MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC — 2 plans
509 Arthroscopy — 2 plans
510 Shoulder,elbow or forearm proc,exc major joint proc w MCC — 2 plans
511 Shoulder,elbow or forearm proc,exc major joint proc w CC — 2 plans
512 Shoulder,elbow or forearm proc,exc major joint proc w/o CC/MCC — 2 plans
513 HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC — 2 plans
514 HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
516 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC — 2 plans
517 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC — 2 plans
518 BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR — 2 plans
519 BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC — 2 plans
520 BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC — 2 plans
522 HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC — 2 plans
533 FRACTURES OF FEMUR WITH MCC — 2 plans
534 FRACTURES OF FEMUR WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
535 FRACTURES OF HIP AND PELVIS WITH MCC — 2 plans
536 FRACTURES OF HIP AND PELVIS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
537 SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC $1,910 – $2,120 · median $2,015 2 plans
538 SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
539 OSTEOMYELITIS WITH MCC — 2 plans
540 OSTEOMYELITIS WITH CC — 2 plans
541 OSTEOMYELITIS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
542 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC — 2 plans
543 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC $1,910 – $2,120 · median $2,015 2 plans
544 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
545 CONNECTIVE TISSUE DISORDERS WITH MCC — 2 plans
546 CONNECTIVE TISSUE DISORDERS WITH CC — 2 plans
547 CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
548 SEPTIC ARTHRITIS WITH MCC — 2 plans
549 SEPTIC ARTHRITIS WITH CC — 2 plans
550 SEPTIC ARTHRITIS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
551 MEDICAL BACK PROBLEMS WITH MCC — 2 plans
552 MEDICAL BACK PROBLEMS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
553 BONE DISEASES AND ARTHROPATHIES WITH MCC — 2 plans
554 BONE DISEASES AND ARTHROPATHIES WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
555 SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC — 2 plans
556 SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
557 TENDONITIS, MYOSITIS AND BURSITIS WITH MCC — 2 plans
558 TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
559 AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC — 2 plans
560 AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC — 2 plans
561 AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
562 Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC — 2 plans
563 Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC $1,910 – $2,120 · median $2,015 2 plans
564 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC — 2 plans
565 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC $1,910 – $2,120 · median $2,015 2 plans
566 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
570 SKIN DEBRIDEMENT WITH MCC — 2 plans
571 SKIN DEBRIDEMENT WITH CC — 2 plans
572 SKIN DEBRIDEMENT WITHOUT CC/MCC — 2 plans
573 SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC — 2 plans
574 SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC — 2 plans
575 SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC — 2 plans
576 SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC — 2 plans
577 SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC — 2 plans
578 SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC — 2 plans
579 OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC — 2 plans
580 OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC — 2 plans
581 OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC — 2 plans
582 MASTECTOMY FOR MALIGNANCY WITH CC/MCC — 2 plans
583 MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC — 2 plans
584 BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC — 2 plans
585 BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC — 2 plans
592 SKIN ULCERS WITH MCC — 2 plans
593 SKIN ULCERS WITH CC — 2 plans
594 SKIN ULCERS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
595 MAJOR SKIN DISORDERS WITH MCC — 2 plans
596 MAJOR SKIN DISORDERS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
597 MALIGNANT BREAST DISORDERS WITH MCC — 2 plans
598 MALIGNANT BREAST DISORDERS WITH CC $1,910 – $2,120 · median $2,015 2 plans
599 MALIGNANT BREAST DISORDERS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
600 NON-MALIGNANT BREAST DISORDERS WITH CC/MCC $1,910 – $2,120 · median $2,015 2 plans
601 NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
602 CELLULITIS WITH MCC — 2 plans
603 CELLULITIS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
604 TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC — 2 plans
605 TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
606 MINOR SKIN DISORDERS WITH MCC — 2 plans
607 MINOR SKIN DISORDERS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
614 ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC — 2 plans
615 ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC — 2 plans
616 AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC — 2 plans
617 AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC — 2 plans
618 AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC — 2 plans
619 O.R. PROCEDURES FOR OBESITY WITH MCC — 2 plans
620 O.R. PROCEDURES FOR OBESITY WITH CC — 2 plans
621 O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC — 2 plans
622 SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC — 2 plans
623 SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC — 2 plans
624 SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC — 2 plans
625 THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC — 2 plans
626 THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC — 2 plans
627 THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC — 2 plans
628 OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC — 2 plans
629 OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC — 2 plans
630 OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC — 2 plans
637 DIABETES WITH MCC — 2 plans
638 DIABETES WITH CC $1,910 – $2,120 · median $2,015 2 plans
639 DIABETES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
640 Nutritional & misc metabolic disorders w MCC — 2 plans
641 Nutritional & misc metabolic disorders w/o MCC $1,910 – $2,120 · median $2,015 2 plans
642 Inborn errors of metabolism — 2 plans
643 ENDOCRINE DISORDERS WITH MCC — 2 plans
644 ENDOCRINE DISORDERS WITH CC $1,910 – $2,120 · median $2,015 2 plans
645 ENDOCRINE DISORDERS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
654 MAJOR BLADDER PROCEDURES WITH CC — 2 plans
655 MAJOR BLADDER PROCEDURES WITHOUT CC/MCC — 2 plans
656 KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC — 2 plans
657 KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC — 2 plans
658 KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC — 2 plans
659 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC — 2 plans
660 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC — 2 plans
661 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC — 2 plans
662 MINOR BLADDER PROCEDURES WITH MCC — 2 plans
663 MINOR BLADDER PROCEDURES WITH CC — 2 plans
664 MINOR BLADDER PROCEDURES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
666 PROSTATECTOMY WITH CC — 2 plans
667 PROSTATECTOMY WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
668 TRANSURETHRAL PROCEDURES WITH MCC — 2 plans
669 TRANSURETHRAL PROCEDURES WITH CC — 2 plans
670 TRANSURETHRAL PROCEDURES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
671 URETHRAL PROCEDURES WITH CC/MCC — 2 plans
672 URETHRAL PROCEDURES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
674 OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC — 2 plans
675 OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC — 2 plans
682 RENAL FAILURE WITH MCC — 2 plans
683 RENAL FAILURE WITH CC $1,910 – $2,120 · median $2,015 2 plans
684 RENAL FAILURE WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
686 KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC — 2 plans
687 KIDNEY AND URINARY TRACT NEOPLASMS WITH CC $1,910 – $2,120 · median $2,015 2 plans
688 KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
689 KIDNEY AND URINARY TRACT INFECTIONS WITH MCC — 2 plans
690 KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
693 URINARY STONES WITH MCC — 2 plans
694 URINARY STONES WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
695 KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC — 2 plans
696 KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
697 Urethral stricture $1,910 – $2,120 · median $2,015 2 plans
698 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC — 2 plans
699 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC $1,910 – $2,120 · median $2,015 2 plans
700 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
707 MAJOR MALE PELVIC PROCEDURES WITH CC/MCC — 2 plans
708 MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC — 2 plans
709 PENIS PROCEDURES WITH CC/MCC — 2 plans
710 PENIS PROCEDURES WITHOUT CC/MCC — 2 plans
711 TESTES PROCEDURES WITH CC/MCC — 2 plans
712 TESTES PROCEDURES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
713 TRANSURETHRAL PROSTATECTOMY WITH CC/MCC — 2 plans
714 TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
715 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC — 2 plans
716 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC — 2 plans
717 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC — 2 plans
718 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC — 2 plans
722 MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC — 2 plans
723 MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC — 2 plans
724 MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
725 BENIGN PROSTATIC HYPERTROPHY WITH MCC — 2 plans
726 BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
727 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC — 2 plans
728 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
729 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC $1,910 – $2,120 · median $2,015 2 plans
730 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
734 PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC — 2 plans
735 PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC — 2 plans
737 UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC — 2 plans
738 UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC — 2 plans
740 Uterine,adnexa proc for non-ovarian/adnexal malig w CC — 2 plans
741 Uterine,adnexa proc for non-ovarian/adnexal malig w/o CC/MCC — 2 plans
742 UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC — 2 plans
743 UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC — 2 plans
744 D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC — 2 plans
745 D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
746 VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC — 2 plans
747 VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
748 Female reproductive system reconstructive procedures — 2 plans
749 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC — 2 plans
750 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC — 2 plans
754 MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC — 2 plans
755 MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC $1,910 – $2,120 · median $2,015 2 plans
756 MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
757 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC — 2 plans
758 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC $1,910 – $2,120 · median $2,015 2 plans
759 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
760 MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC $1,910 – $2,120 · median $2,015 2 plans
761 MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
768 VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C $3,230 – $3,816 · median $3,523 2 plans
769 POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES — 2 plans
770 ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY $1,910 – $2,120 · median $2,015 2 plans
776 POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES $1,910 – $2,120 · median $2,015 2 plans
779 ABORTION WITHOUT D&C $1,910 – $2,120 · median $2,015 2 plans
783 CESAREAN SECTION WITH STERILIZATION WITH MCC $3,816 – $4,685 · median $4,251 2 plans
784 CESAREAN SECTION WITH STERILIZATION WITH CC $3,816 – $4,685 · median $4,251 2 plans
785 CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC $3,816 – $4,685 · median $4,251 2 plans
786 CESAREAN SECTION WITHOUT STERILIZATION WITH MCC $3,816 – $4,685 · median $4,251 2 plans
787 CESAREAN SECTION WITHOUT STERILIZATION WITH CC $3,816 – $4,685 · median $4,251 2 plans
788 CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC $3,816 – $4,685 · median $4,251 2 plans
789 Neonates, died or transferred to another acute care facility — 2 plans
790 Extreme immaturity or respiratory distress syndrome, neonate — 2 plans
791 PREMATURITY WITH MAJOR PROBLEMS — 2 plans
792 PREMATURITY WITHOUT MAJOR PROBLEMS — 2 plans
793 FULL TERM NEONATE WITH MAJOR PROBLEMS — 2 plans
794 NEONATE WITH OTHER SIGNIFICANT PROBLEMS — 2 plans
795 Normal newborn $479 – $490 · median $485 2 plans
796 VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC $3,230 – $3,816 · median $3,523 2 plans
797 VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC $3,230 – $3,816 · median $3,523 2 plans
798 VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC $3,230 – $3,816 · median $3,523 2 plans
800 SPLENIC PROCEDURES WITH CC — 2 plans
801 SPLENIC PROCEDURES WITHOUT CC/MCC — 2 plans
802 OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC — 2 plans
803 OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC — 2 plans
804 OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC — 2 plans
805 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC $3,230 – $3,816 · median $3,523 2 plans
806 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC $3,230 – $3,816 · median $3,523 2 plans
807 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC $3,230 – $3,816 · median $3,523 2 plans
808 MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC — 2 plans
809 MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC — 2 plans
810 MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
811 RED BLOOD CELL DISORDERS WITH MCC — 2 plans
812 RED BLOOD CELL DISORDERS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
813 Coagulation disorders — 2 plans
814 RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC — 2 plans
815 RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC $1,910 – $2,120 · median $2,015 2 plans
816 RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
817 OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC — 2 plans
818 OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC — 2 plans
819 OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
821 LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC — 2 plans
822 LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC — 2 plans
824 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC — 2 plans
825 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC — 2 plans
827 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC — 2 plans
828 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC — 2 plans
829 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC — 2 plans
830 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC — 2 plans
831 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC — 2 plans
832 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC $1,910 – $2,120 · median $2,015 2 plans
833 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
834 ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC — 2 plans
835 ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC — 2 plans
836 ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC — 2 plans
837 CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC — 2 plans
838 CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT — 2 plans
839 CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC — 2 plans
840 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC — 2 plans
841 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC — 2 plans
842 LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
843 OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC — 2 plans
844 OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC — 2 plans
845 OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
846 CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC — 2 plans
847 CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC — 2 plans
848 CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
849 Radiotherapy — 2 plans
853 INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC — 2 plans
854 INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC — 2 plans
855 INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC — 2 plans
857 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC — 2 plans
858 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC — 2 plans
862 POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC — 2 plans
863 POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
864 FEVER AND INFLAMMATORY CONDITIONS $1,910 – $2,120 · median $2,015 2 plans
865 VIRAL ILLNESS WITH MCC — 2 plans
866 VIRAL ILLNESS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
867 OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC — 2 plans
868 OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC $1,910 – $2,120 · median $2,015 2 plans
869 OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
870 SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS — 2 plans
871 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC — 2 plans
872 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
876 O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS — 2 plans
880 ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION $1,910 – $2,120 · median $2,015 2 plans
881 Depressive neuroses $1,910 – $2,120 · median $2,015 2 plans
882 Neuroses except depressive $1,910 – $2,120 · median $2,015 2 plans
883 DISORDERS OF PERSONALITY AND IMPULSE CONTROL — 2 plans
884 ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY — 2 plans
885 Psychoses — 2 plans
886 BEHAVIORAL AND DEVELOPMENTAL DISORDERS — 2 plans
887 Other mental disorder diagnoses — 2 plans
894 Alcohol/drug abuse or dependence, left AMA $1,910 – $2,120 · median $2,015 2 plans
895 Alcohol/drug abuse or dependence w rehabilitation therapy — 2 plans
896 Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC — 2 plans
897 Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC $1,910 – $2,120 · median $2,015 2 plans
902 WOUND DEBRIDEMENTS FOR INJURIES WITH CC — 2 plans
903 WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC — 2 plans
904 SKIN GRAFTS FOR INJURIES WITH CC/MCC — 2 plans
905 SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC — 2 plans
906 Hand procedures for injuries — 2 plans
908 OTHER O.R. PROCEDURES FOR INJURIES WITH CC — 2 plans
909 OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC — 2 plans
913 TRAUMATIC INJURY WITH MCC — 2 plans
914 TRAUMATIC INJURY WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
915 ALLERGIC REACTIONS WITH MCC — 2 plans
916 ALLERGIC REACTIONS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
917 POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC — 2 plans
918 POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
919 COMPLICATIONS OF TREATMENT WITH MCC — 2 plans
920 COMPLICATIONS OF TREATMENT WITH CC $1,910 – $2,120 · median $2,015 2 plans
921 COMPLICATIONS OF TREATMENT WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
922 OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC — 2 plans
923 OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
927 EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT — 2 plans
928 FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC — 2 plans
929 FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC — 2 plans
933 EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT — 2 plans
934 FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY — 2 plans
935 Non-extensive burns — 2 plans
939 O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC — 2 plans
940 O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC — 2 plans
941 O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC — 2 plans
945 REHABILITATION WITH CC/MCC — 2 plans
946 REHABILITATION WITHOUT CC/MCC — 2 plans
947 SIGNS AND SYMPTOMS WITH MCC — 2 plans
948 SIGNS AND SYMPTOMS WITHOUT MCC $1,910 – $2,120 · median $2,015 2 plans
949 AFTERCARE WITH CC/MCC — 2 plans
950 AFTERCARE WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
951 Other factors influencing health status $1,910 – $2,120 · median $2,015 2 plans
955 Craniotomy for multiple significant trauma — 2 plans
959 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC — 2 plans
963 OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC — 2 plans
964 OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC — 2 plans
965 OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
970 HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC — 2 plans
974 HIV WITH MAJOR RELATED CONDITION WITH MCC — 2 plans
975 HIV WITH MAJOR RELATED CONDITION WITH CC — 2 plans
976 HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC $1,910 – $2,120 · median $2,015 2 plans
977 HIV WITH OR WITHOUT OTHER RELATED CONDITION — 2 plans
981 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC — 2 plans
982 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC — 2 plans
983 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC — 2 plans
987 NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC — 2 plans
988 NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC — 2 plans
989 NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC — 2 plans
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