Jacksonville Memorial Hospital — Pricing
766 procedures published in this hospital's Machine-Readable File (MRF) — 0 with a comparable price, 766 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 766
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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.
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Showing all 766 procedures
Procedures with negotiated rates only
These 766 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 | $3,360 – $459,101 | 12 plans |
| 004 | TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES | $3,360 – $299,606 | 12 plans |
| 011 | TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC | $3,360 – $117,972 | 12 plans |
| 012 | TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC | $3,360 – $91,192 | 12 plans |
| 013 | TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC | $3,360 – $62,333 · median $3,444 | 12 plans |
| 020 | INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC | $3,360 – $177,571 | 12 plans |
| 021 | INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC | $3,360 – $143,837 | 12 plans |
| 022 | INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC | $3,360 – $79,089 · median $3,444 | 12 plans |
| 023 | CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR | $3,360 – $123,946 | 12 plans |
| 024 | CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC | $3,360 – $84,614 | 12 plans |
| 025 | CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC | $3,360 – $98,345 | 12 plans |
| 026 | CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC | $3,360 – $67,252 · median $3,444 | 12 plans |
| 027 | CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC | $3,360 – $54,570 · median $3,444 | 12 plans |
| 028 | SPINAL PROCEDURES WITH MCC | $3,360 – $129,960 | 12 plans |
| 029 | SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS | $3,360 – $73,793 · median $3,444 | 12 plans |
| 030 | SPINAL PROCEDURES WITHOUT CC/MCC | $3,360 – $47,482 · median $3,444 | 12 plans |
| 031 | VENTRICULAR SHUNT PROCEDURES WITH MCC | $3,360 – $158,706 | 12 plans |
| 032 | VENTRICULAR SHUNT PROCEDURES WITH CC | $3,360 – $46,094 · median $3,444 | 12 plans |
| 033 | VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC | $3,360 – $35,969 · median $3,444 | 12 plans |
| 037 | EXTRACRANIAL PROCEDURES WITH MCC | $3,360 – $71,208 · median $3,444 | 12 plans |
| 038 | EXTRACRANIAL PROCEDURES WITH CC | $3,360 – $35,097 · median $3,444 | 12 plans |
| 039 | EXTRACRANIAL PROCEDURES WITHOUT CC/MCC | $3,360 – $25,426 · median $3,444 | 12 plans |
| 040 | PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC | $3,360 – $84,912 | 12 plans |
| 041 | PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR | $3,360 – $47,558 · median $3,444 | 12 plans |
| 042 | PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC | $3,360 – $37,370 · median $3,444 | 12 plans |
| 052 | SPINAL DISORDERS AND INJURIES WITH CC/MCC | $3,360 – $39,178 · median $3,444 | 12 plans |
| 053 | SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC | $3,360 – $21,180 · median $3,444 | 12 plans |
| 054 | NERVOUS SYSTEM NEOPLASMS WITH MCC | $3,360 – $33,027 · median $3,444 | 12 plans |
| 055 | NERVOUS SYSTEM NEOPLASMS WITHOUT MCC | $3,360 – $22,054 · median $3,444 | 12 plans |
| 056 | DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC | $3,360 – $50,249 · median $3,444 | 12 plans |
| 057 | DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC | $3,360 – $28,024 · median $3,444 | 12 plans |
| 058 | MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC | $3,360 – $36,976 · median $3,444 | 12 plans |
| 059 | MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC | $3,360 – $26,841 · median $3,444 | 12 plans |
| 060 | MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC | $3,360 – $19,895 · median $3,444 | 12 plans |
| 062 | ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC | $3,360 – $47,958 · median $3,444 | 12 plans |
| 063 | ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC | $3,360 – $36,806 · median $3,444 | 12 plans |
| 064 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC | $3,360 – $43,498 · median $3,444 | 12 plans |
| 065 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS | $3,360 – $21,853 · median $3,444 | 12 plans |
| 066 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC | $3,360 – $15,253 · median $3,444 | 12 plans |
| 067 | NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC | $3,360 – $31,768 · median $3,444 | 12 plans |
| 068 | NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC | $3,360 – $18,697 · median $3,444 | 12 plans |
| 069 | TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC | $3,360 – $17,278 · median $3,444 | 12 plans |
| 070 | NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC | $3,360 – $37,314 · median $3,444 | 12 plans |
| 071 | NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC | $3,360 – $26,378 · median $3,444 | 12 plans |
| 072 | NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC | $3,360 – $16,357 · median $3,444 | 12 plans |
| 073 | CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC | $3,360 – $34,701 · median $3,444 | 12 plans |
| 074 | CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC | $3,360 – $22,296 · median $3,444 | 12 plans |
| 075 | VIRAL MENINGITIS WITH CC/MCC | $3,360 – $41,476 · median $3,444 | 12 plans |
| 076 | VIRAL MENINGITIS WITHOUT CC/MCC | $3,360 – $17,849 · median $3,444 | 12 plans |
| 080 | NONTRAUMATIC STUPOR AND COMA WITH MCC | $3,360 – $39,150 · median $3,444 | 12 plans |
| 081 | NONTRAUMATIC STUPOR AND COMA WITHOUT MCC | $3,360 – $19,372 · median $3,444 | 12 plans |
| 082 | TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC | $3,360 – $65,466 · median $3,444 | 12 plans |
| 083 | TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC | $3,360 – $30,191 · median $3,444 | 12 plans |
| 084 | TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC | $3,360 – $20,674 · median $3,444 | 12 plans |
| 085 | TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC | $3,360 – $49,141 · median $3,444 | 12 plans |
| 086 | TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC | $3,360 – $28,177 · median $3,444 | 12 plans |
| 087 | TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC | $3,360 – $19,785 · median $3,444 | 12 plans |
| 088 | CONCUSSION WITH MCC | $3,360 – $48,247 · median $3,444 | 12 plans |
| 089 | CONCUSSION WITH CC | $3,360 – $23,763 · median $3,444 | 12 plans |
| 090 | CONCUSSION WITHOUT CC/MCC | $3,360 – $17,806 · median $3,444 | 12 plans |
| 091 | OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC | $3,360 – $37,987 · median $3,444 | 12 plans |
| 092 | OTHER DISORDERS OF NERVOUS SYSTEM WITH CC | $3,360 – $22,127 · median $3,444 | 12 plans |
| 093 | OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC | $3,360 – $17,224 · median $3,444 | 12 plans |
| 094 | BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC | $3,360 – $77,877 · median $3,444 | 12 plans |
| 095 | BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC | $3,360 – $55,788 · median $3,444 | 12 plans |
| 096 | BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC | $3,360 – $55,788 · median $3,444 | 12 plans |
| 097 | NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC | $3,360 – $78,123 · median $3,444 | 12 plans |
| 098 | NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC | $3,360 – $49,639 · median $3,444 | 12 plans |
| 099 | NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC | $3,360 – $29,469 · median $3,444 | 12 plans |
| 100 | SEIZURES WITH MCC | $3,360 – $41,893 · median $3,444 | 12 plans |
| 101 | SEIZURES WITHOUT MCC | $3,360 – $19,523 · median $3,444 | 12 plans |
| 102 | HEADACHES WITH MCC | $3,360 – $24,245 · median $3,444 | 12 plans |
| 103 | HEADACHES WITHOUT MCC | $3,360 – $18,089 · median $3,444 | 12 plans |
| 113 | ORBITAL PROCEDURES WITH CC/MCC | $3,360 – $50,854 · median $3,444 | 12 plans |
| 114 | ORBITAL PROCEDURES WITHOUT CC/MCC | $3,360 – $29,265 · median $3,444 | 12 plans |
| 115 | EXTRAOCULAR PROCEDURES EXCEPT ORBIT | $3,360 – $33,200 · median $3,444 | 12 plans |
| 116 | INTRAOCULAR PROCEDURES WITH CC/MCC | $3,360 – $39,109 · median $3,444 | 12 plans |
| 117 | INTRAOCULAR PROCEDURES WITHOUT CC/MCC | $3,360 – $23,466 · median $3,444 | 12 plans |
| 121 | ACUTE MAJOR EYE INFECTIONS WITH CC/MCC | $3,360 – $25,162 · median $3,444 | 12 plans |
| 122 | ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC | $3,360 – $16,997 · median $3,444 | 12 plans |
| 123 | NEUROLOGICAL EYE DISORDERS | $3,360 – $17,274 · median $3,444 | 12 plans |
| 124 | OTHER DISORDERS OF THE EYE WITH MCC | $3,360 – $28,619 · median $3,444 | 12 plans |
| 125 | OTHER DISORDERS OF THE EYE WITHOUT MCC | $3,360 – $16,608 · median $3,444 | 12 plans |
| 135 | SINUS AND MASTOID PROCEDURES WITH CC/MCC | $3,360 – $46,937 · median $3,444 | 12 plans |
| 136 | SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC | $3,360 – $27,679 · median $3,444 | 12 plans |
| 137 | MOUTH PROCEDURES WITH CC/MCC | $3,360 – $32,298 · median $3,444 | 12 plans |
| 138 | MOUTH PROCEDURES WITHOUT CC/MCC | $3,360 – $19,169 · median $3,444 | 12 plans |
| 139 | SALIVARY GLAND PROCEDURES | $3,360 – $26,728 · median $3,444 | 12 plans |
| 146 | EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC | $3,360 – $45,799 · median $3,444 | 12 plans |
| 147 | EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC | $3,360 – $27,503 · median $3,444 | 12 plans |
| 148 | EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC | $3,360 – $17,241 · median $3,444 | 12 plans |
| 149 | DYSEQUILIBRIUM | $3,360 – $16,257 · median $3,444 | 12 plans |
| 151 | EPISTAXIS WITHOUT MCC | $3,360 – $15,876 · median $3,444 | 12 plans |
| 152 | OTITIS MEDIA AND URI WITH MCC | $3,360 – $25,571 · median $3,444 | 12 plans |
| 153 | OTITIS MEDIA AND URI WITHOUT MCC | $3,360 – $15,967 · median $3,444 | 12 plans |
| 154 | OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC | $3,360 – $33,819 · median $3,444 | 12 plans |
| 155 | OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC | $3,360 – $19,824 · median $3,444 | 12 plans |
| 156 | OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC | $3,360 – $14,948 · median $3,444 | 12 plans |
| 157 | DENTAL AND ORAL DISEASES WITH MCC | $3,360 – $37,134 · median $3,444 | 12 plans |
| 158 | DENTAL AND ORAL DISEASES WITH CC | $3,360 – $19,679 · median $3,444 | 12 plans |
| 159 | DENTAL AND ORAL DISEASES WITHOUT CC/MCC | $3,360 – $15,325 · median $3,444 | 12 plans |
| 163 | MAJOR CHEST PROCEDURES WITH MCC | $3,360 – $96,941 | 12 plans |
| 164 | MAJOR CHEST PROCEDURES WITH CC | $3,360 – $54,594 · median $3,444 | 12 plans |
| 165 | MAJOR CHEST PROCEDURES WITHOUT CC/MCC | $3,360 – $41,404 · median $3,444 | 12 plans |
| 166 | OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC | $3,360 – $80,846 | 12 plans |
| 167 | OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC | $3,360 – $39,008 · median $3,444 | 12 plans |
| 168 | OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC | $3,360 – $29,555 · median $3,444 | 12 plans |
| 173 | ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM | $3,360 – $64,380 · median $3,444 | 12 plans |
| 175 | PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE | $3,360 – $29,711 · median $3,444 | 12 plans |
| 176 | PULMONARY EMBOLISM WITHOUT MCC | $3,360 – $17,871 · median $3,444 | 12 plans |
| 177 | RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC | $3,360 – $34,196 · median $3,444 | 12 plans |
| 178 | RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC | $3,360 – $24,762 · median $3,444 | 12 plans |
| 179 | RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC | $3,360 – $16,331 · median $3,444 | 12 plans |
| 180 | RESPIRATORY NEOPLASMS WITH MCC | $3,360 – $38,199 · median $3,444 | 12 plans |
| 181 | RESPIRATORY NEOPLASMS WITH CC | $3,360 – $23,166 · median $3,444 | 12 plans |
| 182 | RESPIRATORY NEOPLASMS WITHOUT CC/MCC | $3,360 – $16,527 · median $3,444 | 12 plans |
| 183 | MAJOR CHEST TRAUMA WITH MCC | $3,360 – $33,092 · median $3,444 | 12 plans |
| 184 | MAJOR CHEST TRAUMA WITH CC | $3,360 – $23,016 · median $3,444 | 12 plans |
| 185 | MAJOR CHEST TRAUMA WITHOUT CC/MCC | $3,360 – $17,012 · median $3,444 | 12 plans |
| 186 | PLEURAL EFFUSION WITH MCC | $3,360 – $33,710 · median $3,444 | 12 plans |
| 187 | PLEURAL EFFUSION WITH CC | $3,360 – $21,394 · median $3,444 | 12 plans |
| 188 | PLEURAL EFFUSION WITHOUT CC/MCC | $3,360 – $15,513 · median $3,444 | 12 plans |
| 189 | PULMONARY EDEMA AND RESPIRATORY FAILURE | $3,360 – $26,722 · median $3,444 | 12 plans |
| 190 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC | $3,360 – $23,960 · median $3,444 | 12 plans |
| 191 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC | $3,360 – $18,234 · median $3,444 | 12 plans |
| 192 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC | $3,360 – $13,886 · median $3,444 | 12 plans |
| 193 | SIMPLE PNEUMONIA AND PLEURISY WITH MCC | $3,360 – $28,430 · median $3,444 | 12 plans |
| 194 | SIMPLE PNEUMONIA AND PLEURISY WITH CC | $3,360 – $17,432 · median $3,444 | 12 plans |
| 195 | SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC | $3,360 – $13,594 · median $3,444 | 12 plans |
| 196 | INTERSTITIAL LUNG DISEASE WITH MCC | $3,360 – $40,820 · median $3,444 | 12 plans |
| 197 | INTERSTITIAL LUNG DISEASE WITH CC | $3,360 – $20,529 · median $3,444 | 12 plans |
| 198 | INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC | $3,360 – $15,491 · median $3,444 | 12 plans |
| 199 | PNEUMOTHORAX WITH MCC | $3,360 – $38,157 · median $3,444 | 12 plans |
| 200 | PNEUMOTHORAX WITH CC | $3,360 – $23,778 · median $3,444 | 12 plans |
| 201 | PNEUMOTHORAX WITHOUT CC/MCC | $3,360 – $15,468 · median $3,444 | 12 plans |
| 202 | BRONCHITIS AND ASTHMA WITH CC/MCC | $3,360 – $21,007 · median $3,444 | 12 plans |
| 203 | BRONCHITIS AND ASTHMA WITHOUT CC/MCC | $3,360 – $14,492 · median $3,444 | 12 plans |
| 204 | RESPIRATORY SIGNS AND SYMPTOMS | $3,360 – $17,464 · median $3,444 | 12 plans |
| 205 | OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC | $3,360 – $39,605 · median $3,444 | 12 plans |
| 206 | OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC | $3,360 – $20,356 · median $3,444 | 12 plans |
| 207 | RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS | $3,360 – $139,183 | 12 plans |
| 208 | RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS | $3,360 – $59,454 · median $3,444 | 12 plans |
| 212 | HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE 0-17 | $3,360 – $235,207 | 12 plans |
| 215 | OTHER HEART ASSIST SYSTEM IMPLANT | $3,360 – $242,326 | 12 plans |
| 216 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC | $3,360 – $211,602 | 12 plans |
| 217 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC | $3,360 – $142,224 | 12 plans |
| 218 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC | $3,360 – $142,224 | 12 plans |
| 219 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC | $3,360 – $166,082 | 12 plans |
| 220 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC | $3,360 – $115,348 | 12 plans |
| 221 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC | $3,360 – $109,020 | 12 plans |
| 228 | OTHER CARDIOTHORACIC PROCEDURES WITH MCC | $3,360 – $195,595 | 12 plans |
| 229 | OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC | $3,360 – $73,784 · median $3,444 | 12 plans |
| 233 | CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC | $3,360 – $165,366 | 12 plans |
| 234 | CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC | $3,360 – $118,158 | 12 plans |
| 235 | CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC | $3,360 – $126,938 | 12 plans |
| 236 | CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC | $3,360 – $90,604 | 12 plans |
| 239 | AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC | $3,360 – $106,456 | 12 plans |
| 240 | AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC | $3,360 – $61,656 · median $3,444 | 12 plans |
| 241 | AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC | $3,360 – $31,770 · median $3,444 | 12 plans |
| 242 | PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC | $3,360 – $69,060 · median $3,444 | 12 plans |
| 243 | PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC | $3,360 – $46,091 · median $3,444 | 12 plans |
| 244 | PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC | $3,360 – $39,096 · median $3,444 | 12 plans |
| 245 | AICD GENERATOR PROCEDURES | $3,360 – $98,685 | 12 plans |
| 250 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC | $3,360 – $56,768 · median $3,444 | 12 plans |
| 251 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC | $3,360 – $32,326 · median $3,444 | 12 plans |
| 252 | OTHER VASCULAR PROCEDURES WITH MCC | $3,360 – $75,452 · median $3,444 | 12 plans |
| 253 | OTHER VASCULAR PROCEDURES WITH CC | $3,360 – $56,143 · median $3,444 | 12 plans |
| 254 | OTHER VASCULAR PROCEDURES WITHOUT CC/MCC | $3,360 – $38,538 · median $3,444 | 12 plans |
| 255 | UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC | $3,360 – $66,420 · median $3,444 | 12 plans |
| 256 | UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC | $3,360 – $36,726 · median $3,444 | 12 plans |
| 257 | UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC | $3,360 – $23,624 · median $3,444 | 12 plans |
| 259 | CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC | $3,360 – $43,738 · median $3,444 | 12 plans |
| 260 | CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC | $3,360 – $70,358 · median $3,444 | 12 plans |
| 261 | CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC | $3,360 – $40,892 · median $3,444 | 12 plans |
| 262 | CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC | $3,360 – $35,255 · median $3,444 | 12 plans |
| 263 | VEIN LIGATION AND STRIPPING | $3,360 – $66,132 · median $3,444 | 12 plans |
| 264 | OTHER CIRCULATORY SYSTEM O.R. PROCEDURES | $3,360 – $72,257 · median $3,444 | 12 plans |
| 265 | AICD LEAD PROCEDURES | $3,360 – $89,548 · median $3,444 | 12 plans |
| 275 | CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC | $3,360 – $154,231 | 12 plans |
| 276 | NON-MALIGANT BREAST DISORDERS | $3,360 – $129,923 | 12 plans |
| 277 | CELLULITIS AGE >17 W CC | $3,360 – $123,909 | 12 plans |
| 278 | CELLULITIS AGE >17 W/O CC | $3,360 – $120,397 | 12 plans |
| 279 | CELLULITIS AGE 0-17 | $3,360 – $78,006 · median $3,444 | 12 plans |
| 280 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC | $3,360 – $36,474 · median $3,444 | 12 plans |
| 281 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC | $3,360 – $25,633 · median $3,444 | 12 plans |
| 282 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC | $3,360 – $21,485 · median $3,444 | 12 plans |
| 283 | ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC | $3,360 – $42,845 · median $3,444 | 12 plans |
| 284 | ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC | $3,360 – $28,285 · median $3,444 | 12 plans |
| 285 | ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC | $3,360 – $17,884 · median $3,444 | 12 plans |
| 286 | CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC | $3,360 – $47,863 · median $3,444 | 12 plans |
| 287 | CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC | $3,360 – $23,146 · median $3,444 | 12 plans |
| 288 | ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC | $3,360 – $58,535 · median $3,444 | 12 plans |
| 289 | ACUTE AND SUBACUTE ENDOCARDITIS WITH CC | $3,360 – $36,920 · median $3,444 | 12 plans |
| 290 | ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC | $3,360 – $28,139 · median $3,444 | 12 plans |
| 291 | HEART FAILURE AND SHOCK WITH MCC | $3,360 – $27,769 · median $3,444 | 12 plans |
| 292 | HEART FAILURE AND SHOCK WITH CC | $3,360 – $18,364 · median $3,444 | 12 plans |
| 293 | HEART FAILURE AND SHOCK WITHOUT CC/MCC | $3,360 – $12,243 · median $3,444 | 12 plans |
| 296 | CARDIAC ARREST, UNEXPLAINED WITH MCC | $3,360 – $33,784 · median $3,444 | 12 plans |
| 297 | CARDIAC ARREST, UNEXPLAINED WITH CC | $3,360 – $27,886 · median $3,444 | 12 plans |
| 298 | CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC | $3,360 – $15,276 · median $3,444 | 12 plans |
| 299 | PERIPHERAL VASCULAR DISORDERS WITH MCC | $3,360 – $35,315 · median $3,444 | 12 plans |
| 300 | PERIPHERAL VASCULAR DISORDERS WITH CC | $3,360 – $23,090 · median $3,444 | 12 plans |
| 301 | PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC | $3,360 – $15,567 · median $3,444 | 12 plans |
| 302 | ATHEROSCLEROSIS WITH MCC | $3,360 – $25,882 · median $3,444 | 12 plans |
| 303 | ATHEROSCLEROSIS WITHOUT MCC | $3,360 – $14,561 · median $3,444 | 12 plans |
| 304 | HYPERTENSION WITH MCC | $3,360 – $25,740 · median $3,444 | 12 plans |
| 305 | HYPERTENSION WITHOUT MCC | $3,360 – $16,333 · median $3,444 | 12 plans |
| 306 | CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC | $3,360 – $58,943 · median $3,444 | 12 plans |
| 307 | CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC | $3,360 – $19,753 · median $3,444 | 12 plans |
| 308 | CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC | $3,360 – $26,043 · median $3,444 | 12 plans |
| 309 | CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC | $3,360 – $15,913 · median $3,444 | 12 plans |
| 310 | CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC | $3,360 – $12,245 · median $3,444 | 12 plans |
| 311 | ANGINA PECTORIS | $3,360 – $15,182 · median $3,444 | 12 plans |
| 312 | SYNCOPE AND COLLAPSE | $3,360 – $18,853 · median $3,444 | 12 plans |
| 313 | CHEST PAIN | $3,360 – $15,574 · median $3,444 | 12 plans |
| 314 | OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC | $3,360 – $45,103 · median $3,444 | 12 plans |
| 315 | OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC | $3,360 – $20,836 · median $3,444 | 12 plans |
| 316 | OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC | $3,360 – $14,754 · median $3,444 | 12 plans |
| 321 | KIDNEY & URINARY TRACT INFECTIONS AGE >17 W/O CC | $3,360 – $58,851 · median $3,444 | 12 plans |
| 322 | KIDNEY & URINARY TRACT INFECTIONS AGE 0-17 | $3,360 – $38,134 · median $3,444 | 12 plans |
| 323 | URINARY STONES W CC, &/OR ESW LITHOTRIPSY | $3,360 – $93,602 | 12 plans |
| 324 | URINARY STONES W/O CC | $3,360 – $68,156 · median $3,444 | 12 plans |
| 325 | CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE | $3,360 – $69,441 · median $3,444 | 12 plans |
| 326 | STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC | $3,360 – $107,877 | 12 plans |
| 327 | STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC | $3,360 – $52,868 · median $3,444 | 12 plans |
| 328 | STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC | $3,360 – $34,658 · median $3,444 | 12 plans |
| 329 | MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC | $3,360 – $99,422 | 12 plans |
| 330 | MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC | $3,360 – $51,851 · median $3,444 | 12 plans |
| 331 | MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC | $3,360 – $36,401 · median $3,444 | 12 plans |
| 332 | RECTAL RESECTION WITH MCC | $3,360 – $111,132 · median $3,444 | 12 plans |
| 333 | RECTAL RESECTION WITH CC | $3,360 – $50,662 · median $3,444 | 12 plans |
| 334 | RECTAL RESECTION WITHOUT CC/MCC | $3,360 – $35,428 · median $3,444 | 12 plans |
| 335 | PERITONEAL ADHESIOLYSIS WITH MCC | $3,360 – $77,239 · median $3,444 | 12 plans |
| 336 | PERITONEAL ADHESIOLYSIS WITH CC | $3,360 – $45,611 · median $3,444 | 12 plans |
| 337 | PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC | $3,360 – $33,202 · median $3,444 | 12 plans |
| 344 | MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC | $3,360 – $88,475 · median $3,444 | 12 plans |
| 345 | MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC | $3,360 – $32,547 · median $3,444 | 12 plans |
| 346 | MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC | $3,360 – $25,658 · median $3,444 | 12 plans |
| 347 | ANAL AND STOMAL PROCEDURES WITH MCC | $3,360 – $51,377 · median $3,444 | 12 plans |
| 348 | ANAL AND STOMAL PROCEDURES WITH CC | $3,360 – $28,309 · median $3,444 | 12 plans |
| 349 | ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC | $3,360 – $18,831 · median $3,444 | 12 plans |
| 350 | INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC | $3,360 – $67,336 · median $3,444 | 12 plans |
| 351 | INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC | $3,360 – $32,975 · median $3,444 | 12 plans |
| 352 | INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC | $3,360 – $25,260 · median $3,444 | 12 plans |
| 353 | HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC | $3,360 – $62,770 · median $3,444 | 12 plans |
| 354 | HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC | $3,360 – $36,390 · median $3,444 | 12 plans |
| 355 | HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC | $3,360 – $29,092 · median $3,444 | 12 plans |
| 356 | OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC | $3,360 – $95,016 | 12 plans |
| 357 | OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC | $3,360 – $50,301 · median $3,444 | 12 plans |
| 358 | OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC | $3,360 – $30,237 · median $3,444 | 12 plans |
| 368 | MAJOR ESOPHAGEAL DISORDERS WITH MCC | $3,360 – $50,156 · median $3,444 | 12 plans |
| 369 | MAJOR ESOPHAGEAL DISORDERS WITH CC | $3,360 – $21,634 · median $3,444 | 12 plans |
| 370 | MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC | $3,360 – $15,158 · median $3,444 | 12 plans |
| 371 | MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC | $3,360 – $38,352 · median $3,444 | 12 plans |
| 372 | MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC | $3,360 – $22,084 · median $3,444 | 12 plans |
| 373 | MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC | $3,360 – $15,734 · median $3,444 | 12 plans |
| 374 | DIGESTIVE MALIGNANCY WITH MCC | $3,360 – $46,260 · median $3,444 | 12 plans |
| 375 | DIGESTIVE MALIGNANCY WITH CC | $3,360 – $26,164 · median $3,444 | 12 plans |
| 376 | DIGESTIVE MALIGNANCY WITHOUT CC/MCC | $3,360 – $19,993 · median $3,444 | 12 plans |
| 377 | GASTROINTESTINAL HEMORRHAGE WITH MCC | $3,360 – $39,540 · median $3,444 | 12 plans |
| 378 | GASTROINTESTINAL HEMORRHAGE WITH CC | $3,360 – $21,213 · median $3,444 | 12 plans |
| 379 | GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC | $3,360 – $13,636 · median $3,444 | 12 plans |
| 380 | COMPLICATED PEPTIC ULCER WITH MCC | $3,360 – $42,442 · median $3,444 | 12 plans |
| 381 | COMPLICATED PEPTIC ULCER WITH CC | $3,360 – $23,436 · median $3,444 | 12 plans |
| 382 | COMPLICATED PEPTIC ULCER WITHOUT CC/MCC | $3,360 – $17,317 · median $3,444 | 12 plans |
| 383 | UNCOMPLICATED PEPTIC ULCER WITH MCC | $3,360 – $29,865 · median $3,444 | 12 plans |
| 384 | UNCOMPLICATED PEPTIC ULCER WITHOUT MCC | $3,360 – $18,489 · median $3,444 | 12 plans |
| 385 | INFLAMMATORY BOWEL DISEASE WITH MCC | $3,360 – $34,225 · median $3,444 | 12 plans |
| 386 | INFLAMMATORY BOWEL DISEASE WITH CC | $3,360 – $21,117 · median $3,444 | 12 plans |
| 387 | INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC | $3,360 – $14,737 · median $3,444 | 12 plans |
| 388 | GASTROINTESTINAL OBSTRUCTION WITH MCC | $3,360 – $31,943 · median $3,444 | 12 plans |
| 389 | GASTROINTESTINAL OBSTRUCTION WITH CC | $3,360 – $17,083 · median $3,444 | 12 plans |
| 390 | GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC | $3,360 – $11,767 · median $3,444 | 12 plans |
| 391 | ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC | $3,360 – $27,433 · median $3,444 | 12 plans |
| 392 | ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC | $3,360 – $16,863 · median $3,444 | 12 plans |
| 393 | OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC | $3,360 – $34,593 · median $3,444 | 12 plans |
| 394 | OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC | $3,360 – $20,239 · median $3,444 | 12 plans |
| 395 | OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC | $3,360 – $14,038 · median $3,444 | 12 plans |
| 397 | COAGULATION DISORDERS | $3,360 – $51,802 · median $3,444 | 12 plans |
| 398 | RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC | $3,360 – $43,867 · median $3,444 | 12 plans |
| 399 | RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC | $3,360 – $95,964 · median $3,444 | 12 plans |
| 405 | PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC | $3,360 – $118,327 | 12 plans |
| 406 | PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC | $3,360 – $62,731 · median $3,444 | 12 plans |
| 407 | PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC | $3,360 – $48,010 · median $3,444 | 12 plans |
| 408 | BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC | $3,360 – $77,124 · median $3,444 | 12 plans |
| 409 | BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC | $3,360 – $47,725 · median $3,444 | 12 plans |
| 410 | BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC | $3,360 – $34,342 · median $3,444 | 12 plans |
| 411 | CHOLECYSTECTOMY WITH C.D.E. WITH MCC | $3,360 – $71,450 · median $3,444 | 12 plans |
| 412 | CHOLECYSTECTOMY WITH C.D.E. WITH CC | $3,360 – $45,477 · median $3,444 | 12 plans |
| 413 | CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC | $3,360 – $35,917 · median $3,444 | 12 plans |
| 414 | CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC | $3,360 – $77,059 · median $3,444 | 12 plans |
| 415 | CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC | $3,360 – $44,703 · median $3,444 | 12 plans |
| 416 | CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC | $3,360 – $29,488 · median $3,444 | 12 plans |
| 417 | LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC | $3,360 – $51,618 · median $3,444 | 12 plans |
| 418 | LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC | $3,360 – $36,589 · median $3,444 | 12 plans |
| 419 | LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC | $3,360 – $29,542 · median $3,444 | 12 plans |
| 420 | HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC | $3,360 – $133,547 · median $3,444 | 12 plans |
| 421 | HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC | $3,360 – $52,357 · median $3,444 | 12 plans |
| 422 | HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC | $3,360 – $35,486 · median $3,444 | 12 plans |
| 423 | OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC | $3,360 – $117,737 | 12 plans |
| 424 | OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC | $3,360 – $63,907 · median $3,444 | 12 plans |
| 425 | OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC | $3,360 – $32,451 · median $3,444 | 12 plans |
| 432 | CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC | $3,360 – $42,572 · median $3,444 | 12 plans |
| 433 | CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC | $3,360 – $22,846 · median $3,444 | 12 plans |
| 434 | CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC | $3,360 – $15,411 · median $3,444 | 12 plans |
| 435 | MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC | $3,360 – $39,728 · median $3,444 | 12 plans |
| 436 | MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC | $3,360 – $24,466 · median $3,444 | 12 plans |
| 437 | MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC | $3,360 – $18,457 · median $3,444 | 12 plans |
| 438 | DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC | $3,360 – $35,261 · median $3,444 | 12 plans |
| 439 | DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC | $3,360 – $18,195 · median $3,444 | 12 plans |
| 440 | DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC | $3,360 – $13,441 · median $3,444 | 12 plans |
| 441 | DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC | $3,360 – $38,819 · median $3,444 | 12 plans |
| 442 | DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC | $3,360 – $20,879 · median $3,444 | 12 plans |
| 443 | DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC | $3,360 – $15,135 · median $3,444 | 12 plans |
| 444 | DISORDERS OF THE BILIARY TRACT WITH MCC | $3,360 – $36,142 · median $3,444 | 12 plans |
| 445 | DISORDERS OF THE BILIARY TRACT WITH CC | $3,360 – $23,672 · median $3,444 | 12 plans |
| 446 | DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC | $3,360 – $17,895 · median $3,444 | 12 plans |
| 456 | SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC | $3,360 – $181,766 | 12 plans |
| 457 | SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC | $3,360 – $128,982 | 12 plans |
| 458 | SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC | $3,360 – $90,253 | 12 plans |
| 461 | BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC | $3,360 – $119,462 | 12 plans |
| 462 | BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC | $3,360 – $57,536 · median $3,444 | 12 plans |
| 463 | WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC | $3,360 – $123,280 | 12 plans |
| 464 | WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC | $3,360 – $67,371 · median $3,444 | 12 plans |
| 465 | WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC | $3,360 – $39,447 · median $3,444 | 12 plans |
| 466 | REVISION OF HIP OR KNEE REPLACEMENT WITH MCC | $3,360 – $112,593 | 12 plans |
| 467 | REVISION OF HIP OR KNEE REPLACEMENT WITH CC | $3,360 – $76,280 · median $3,444 | 12 plans |
| 468 | REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC | $3,360 – $59,439 · median $3,444 | 12 plans |
| 469 | MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT | $3,360 – $65,608 · median $3,444 | 12 plans |
| 470 | MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC | $3,360 – $41,722 · median $3,444 | 12 plans |
| 471 | CERVICAL SPINAL FUSION WITH MCC | $3,360 – $104,445 | 12 plans |
| 472 | CERVICAL SPINAL FUSION WITH CC | $3,360 – $63,724 · median $3,444 | 12 plans |
| 473 | CERVICAL SPINAL FUSION WITHOUT CC/MCC | $3,360 – $52,805 · median $3,444 | 12 plans |
| 474 | AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC | $3,360 – $117,080 | 12 plans |
| 475 | AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC | $3,360 – $49,223 · median $3,444 | 12 plans |
| 476 | AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC | $3,360 – $25,528 · median $3,444 | 12 plans |
| 477 | BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC | $3,360 – $74,723 · median $3,444 | 12 plans |
| 478 | BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC | $3,360 – $53,193 · median $3,444 | 12 plans |
| 479 | BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC | $3,360 – $40,208 · median $3,444 | 12 plans |
| 480 | HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC | $3,360 – $62,993 · median $3,444 | 12 plans |
| 481 | HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC | $3,360 – $45,304 · median $3,444 | 12 plans |
| 482 | HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC | $3,360 – $35,279 · median $3,444 | 12 plans |
| 483 | MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES | $3,360 – $59,956 · median $3,444 | 12 plans |
| 485 | KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC | $3,360 – $69,802 · median $3,444 | 12 plans |
| 486 | KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC | $3,360 – $45,230 · median $3,444 | 12 plans |
| 487 | KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC | $3,360 – $33,877 · median $3,444 | 12 plans |
| 488 | KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC | $3,360 – $38,261 · median $3,444 | 12 plans |
| 489 | KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC | $3,360 – $24,156 · median $3,444 | 12 plans |
| 492 | LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC | $3,360 – $79,417 · median $3,444 | 12 plans |
| 493 | LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC | $3,360 – $54,856 · median $3,444 | 12 plans |
| 494 | LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC | $3,360 – $43,401 · median $3,444 | 12 plans |
| 495 | LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC | $3,360 – $78,424 · median $3,444 | 12 plans |
| 496 | LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC | $3,360 – $39,018 · median $3,444 | 12 plans |
| 497 | LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC | $3,360 – $26,136 · median $3,444 | 12 plans |
| 498 | LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC | $3,360 – $65,253 · median $3,444 | 12 plans |
| 499 | LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC | $3,360 – $43,580 · median $3,444 | 12 plans |
| 500 | SOFT TISSUE PROCEDURES WITH MCC | $3,360 – $71,839 · median $3,444 | 12 plans |
| 501 | SOFT TISSUE PROCEDURES WITH CC | $3,360 – $37,811 · median $3,444 | 12 plans |
| 502 | SOFT TISSUE PROCEDURES WITHOUT CC/MCC | $3,360 – $29,112 · median $3,444 | 12 plans |
| 503 | FOOT PROCEDURES WITH MCC | $3,360 – $60,371 · median $3,444 | 12 plans |
| 504 | FOOT PROCEDURES WITH CC | $3,360 – $40,431 · median $3,444 | 12 plans |
| 505 | FOOT PROCEDURES WITHOUT CC/MCC | $3,360 – $38,778 · median $3,444 | 12 plans |
| 506 | MAJOR THUMB OR JOINT PROCEDURES | $3,360 – $29,183 · median $3,444 | 12 plans |
| 507 | MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC | $3,360 – $39,072 · median $3,444 | 12 plans |
| 508 | MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC | $3,360 – $32,756 · median $3,444 | 12 plans |
| 510 | SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC | $3,360 – $65,333 · median $3,444 | 12 plans |
| 511 | SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC | $3,360 – $44,977 · median $3,444 | 12 plans |
| 512 | SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC | $3,360 – $35,806 · median $3,444 | 12 plans |
| 513 | HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC | $3,360 – $34,052 · median $3,444 | 12 plans |
| 514 | HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC | $3,360 – $22,112 · median $3,444 | 12 plans |
| 515 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC | $3,360 – $114,448 · median $3,444 | 12 plans |
| 516 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC | $3,360 – $44,949 · median $3,444 | 12 plans |
| 517 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC | $3,360 – $33,239 · median $3,444 | 12 plans |
| 534 | FRACTURES OF FEMUR WITHOUT MCC | $3,360 – $17,436 · median $3,444 | 12 plans |
| 535 | FRACTURES OF HIP AND PELVIS WITH MCC | $3,360 – $28,870 · median $3,444 | 12 plans |
| 536 | FRACTURES OF HIP AND PELVIS WITHOUT MCC | $3,360 – $17,468 · median $3,444 | 12 plans |
| 537 | SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC | $3,360 – $24,539 · median $3,444 | 12 plans |
| 538 | SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC | $3,360 – $15,580 · median $3,444 | 12 plans |
| 539 | OSTEOMYELITIS WITH MCC | $3,360 – $125,772 · median $3,444 | 12 plans |
| 540 | OSTEOMYELITIS WITH CC | $3,360 – $28,039 · median $3,444 | 12 plans |
| 541 | OSTEOMYELITIS WITHOUT CC/MCC | $3,360 – $17,031 · median $3,444 | 12 plans |
| 542 | PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC | $3,360 – $48,088 · median $3,444 | 12 plans |
| 543 | PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC | $3,360 – $22,236 · median $3,444 | 12 plans |
| 544 | PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC | $3,360 – $16,322 · median $3,444 | 12 plans |
| 545 | CONNECTIVE TISSUE DISORDERS WITH MCC | $3,360 – $53,679 · median $3,444 | 12 plans |
| 546 | CONNECTIVE TISSUE DISORDERS WITH CC | $3,360 – $24,948 · median $3,444 | 12 plans |
| 547 | CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC | $3,360 – $18,087 · median $3,444 | 12 plans |
| 548 | SEPTIC ARTHRITIS WITH MCC | $3,360 – $84,875 · median $3,444 | 12 plans |
| 549 | SEPTIC ARTHRITIS WITH CC | $3,360 – $26,112 · median $3,444 | 12 plans |
| 550 | SEPTIC ARTHRITIS WITHOUT CC/MCC | $3,360 – $18,907 · median $3,444 | 12 plans |
| 551 | MEDICAL BACK PROBLEMS WITH MCC | $3,360 – $36,254 · median $3,444 | 12 plans |
| 552 | MEDICAL BACK PROBLEMS WITHOUT MCC | $3,360 – $20,793 · median $3,444 | 12 plans |
| 553 | BONE DISEASES AND ARTHROPATHIES WITH MCC | $3,360 – $28,039 · median $3,444 | 12 plans |
| 554 | BONE DISEASES AND ARTHROPATHIES WITHOUT MCC | $3,360 – $17,955 · median $3,444 | 12 plans |
| 555 | SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC | $3,360 – $28,591 · median $3,444 | 12 plans |
| 556 | SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC | $3,360 – $17,966 · median $3,444 | 12 plans |
| 557 | TENDONITIS, MYOSITIS AND BURSITIS WITH MCC | $3,360 – $32,162 · median $3,444 | 12 plans |
| 558 | TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC | $3,360 – $19,320 · median $3,444 | 12 plans |
| 559 | AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC | $3,360 – $51,386 · median $3,444 | 12 plans |
| 560 | AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC | $3,360 – $24,358 · median $3,444 | 12 plans |
| 561 | AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC | $3,360 – $17,388 · median $3,444 | 12 plans |
| 562 | FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC | $3,360 – $30,818 · median $3,444 | 12 plans |
| 563 | FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC | $3,360 – $19,370 · median $3,444 | 12 plans |
| 564 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC | $3,360 – $33,388 · median $3,444 | 12 plans |
| 565 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC | $3,360 – $21,076 · median $3,444 | 12 plans |
| 566 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC | $3,360 – $16,207 · median $3,444 | 12 plans |
| 573 | SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC | $3,360 – $141,707 | 12 plans |
| 574 | SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC | $3,360 – $75,086 · median $3,444 | 12 plans |
| 575 | SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC | $3,360 – $38,869 · median $3,444 | 12 plans |
| 576 | SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC | $3,360 – $106,013 | 12 plans |
| 577 | SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC | $3,360 – $57,335 · median $3,444 | 12 plans |
| 578 | SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC | $3,360 – $34,746 · median $3,444 | 12 plans |
| 579 | OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC | $3,360 – $74,190 · median $3,444 | 12 plans |
| 580 | OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC | $3,360 – $37,377 · median $3,444 | 12 plans |
| 581 | OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC | $3,360 – $31,214 · median $3,444 | 12 plans |
| 582 | MASTECTOMY FOR MALIGNANCY WITH CC/MCC | $3,360 – $41,672 · median $3,444 | 12 plans |
| 583 | MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC | $3,360 – $37,299 · median $3,444 | 12 plans |
| 584 | BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC | $3,360 – $46,303 · median $3,444 | 12 plans |
| 585 | BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC | $3,360 – $41,726 · median $3,444 | 12 plans |
| 592 | SKIN ULCERS WITH MCC | $3,360 – $59,454 · median $3,444 | 12 plans |
| 593 | SKIN ULCERS WITH CC | $3,360 – $25,660 · median $3,444 | 12 plans |
| 594 | SKIN ULCERS WITHOUT CC/MCC | $3,360 – $18,749 · median $3,444 | 12 plans |
| 595 | MAJOR SKIN DISORDERS WITH MCC | $3,360 – $47,318 · median $3,444 | 12 plans |
| 596 | MAJOR SKIN DISORDERS WITHOUT MCC | $3,360 – $23,414 · median $3,444 | 12 plans |
| 597 | MALIGNANT BREAST DISORDERS WITH MCC | $3,360 – $42,773 · median $3,444 | 12 plans |
| 598 | MALIGNANT BREAST DISORDERS WITH CC | $3,360 – $24,470 · median $3,444 | 12 plans |
| 599 | MALIGNANT BREAST DISORDERS WITHOUT CC/MCC | $3,360 – $16,642 · median $3,444 | 12 plans |
| 600 | NON-MALIGNANT BREAST DISORDERS WITH CC/MCC | $3,360 – $22,530 · median $3,444 | 12 plans |
| 601 | NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC | $3,360 – $13,086 · median $3,444 | 12 plans |
| 602 | CELLULITIS WITH MCC | $3,360 – $30,743 · median $3,444 | 12 plans |
| 603 | CELLULITIS WITHOUT MCC | $3,360 – $18,838 · median $3,444 | 12 plans |
| 604 | TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC | $3,360 – $31,842 · median $3,444 | 12 plans |
| 605 | TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC | $3,360 – $19,813 · median $3,444 | 12 plans |
| 606 | MINOR SKIN DISORDERS WITH MCC | $3,360 – $32,731 · median $3,444 | 12 plans |
| 607 | MINOR SKIN DISORDERS WITHOUT MCC | $3,360 – $19,605 · median $3,444 | 12 plans |
| 614 | ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC | $3,360 – $47,409 · median $3,444 | 12 plans |
| 615 | ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC | $3,360 – $34,566 · median $3,444 | 12 plans |
| 616 | AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC | $3,360 – $85,238 · median $3,444 | 12 plans |
| 617 | AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC | $3,360 – $40,455 · median $3,444 | 12 plans |
| 618 | AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC | $3,360 – $33,967 · median $3,444 | 12 plans |
| 619 | O.R. PROCEDURES FOR OBESITY WITH MCC | $3,360 – $64,596 · median $3,444 | 12 plans |
| 620 | O.R. PROCEDURES FOR OBESITY WITH CC | $3,360 – $35,093 · median $3,444 | 12 plans |
| 621 | O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC | $3,360 – $32,627 · median $3,444 | 12 plans |
| 622 | SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC | $3,360 – $93,379 · median $3,444 | 12 plans |
| 623 | SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC | $3,360 – $38,802 · median $3,444 | 12 plans |
| 624 | SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC | $3,360 – $28,687 · median $3,444 | 12 plans |
| 625 | THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC | $3,360 – $99,261 · median $3,444 | 12 plans |
| 626 | THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC | $3,360 – $32,432 · median $3,444 | 12 plans |
| 627 | THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC | $3,360 – $28,731 · median $3,444 | 12 plans |
| 628 | OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC | $3,360 – $153,583 | 12 plans |
| 629 | OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC | $3,360 – $47,127 · median $3,444 | 12 plans |
| 630 | OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC | $3,360 – $51,767 · median $3,444 | 12 plans |
| 637 | DIABETES WITH MCC | $3,360 – $31,076 · median $3,444 | 12 plans |
| 638 | DIABETES WITH CC | $3,360 – $19,385 · median $3,444 | 12 plans |
| 639 | DIABETES WITHOUT CC/MCC | $3,360 – $13,437 · median $3,444 | 12 plans |
| 640 | MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC | $3,360 – $28,889 · median $3,444 | 12 plans |
| 641 | MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC | $3,360 – $16,832 · median $3,444 | 12 plans |
| 642 | INBORN AND OTHER DISORDERS OF METABOLISM | $3,360 – $30,760 · median $3,444 | 12 plans |
| 643 | ENDOCRINE DISORDERS WITH MCC | $3,360 – $56,746 · median $3,444 | 12 plans |
| 644 | ENDOCRINE DISORDERS WITH CC | $3,360 – $22,171 · median $3,444 | 12 plans |
| 645 | ENDOCRINE DISORDERS WITHOUT CC/MCC | $3,360 – $16,618 · median $3,444 | 12 plans |
| 653 | MAJOR BLADDER PROCEDURES WITH MCC | $3,360 – $130,571 | 12 plans |
| 654 | MAJOR BLADDER PROCEDURES WITH CC | $3,360 – $60,549 · median $3,444 | 12 plans |
| 655 | MAJOR BLADDER PROCEDURES WITHOUT CC/MCC | $3,360 – $49,988 · median $3,444 | 12 plans |
| 656 | KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC | $3,360 – $90,603 · median $3,444 | 12 plans |
| 657 | KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC | $3,360 – $39,583 · median $3,444 | 12 plans |
| 658 | KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC | $3,360 – $33,565 · median $3,444 | 12 plans |
| 659 | KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC | $3,360 – $82,241 · median $3,444 | 12 plans |
| 660 | KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC | $3,360 – $28,588 · median $3,444 | 12 plans |
| 661 | KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC | $3,360 – $22,396 · median $3,444 | 12 plans |
| 662 | MINOR BLADDER PROCEDURES WITH MCC | $3,360 – $66,220 · median $3,444 | 12 plans |
| 663 | MINOR BLADDER PROCEDURES WITH CC | $3,360 – $32,882 · median $3,444 | 12 plans |
| 664 | MINOR BLADDER PROCEDURES WITHOUT CC/MCC | $3,360 – $22,644 · median $3,444 | 12 plans |
| 666 | PROSTATECTOMY WITH CC | $3,360 – $37,837 · median $3,444 | 12 plans |
| 667 | PROSTATECTOMY WITHOUT CC/MCC | $3,360 – $23,927 · median $3,444 | 12 plans |
| 668 | TRANSURETHRAL PROCEDURES WITH MCC | $3,360 – $63,160 · median $3,444 | 12 plans |
| 669 | TRANSURETHRAL PROCEDURES WITH CC | $3,360 – $33,570 · median $3,444 | 12 plans |
| 670 | TRANSURETHRAL PROCEDURES WITHOUT CC/MCC | $3,360 – $21,139 · median $3,444 | 12 plans |
| 671 | URETHRAL PROCEDURES WITH CC/MCC | $3,360 – $38,826 · median $3,444 | 12 plans |
| 672 | URETHRAL PROCEDURES WITHOUT CC/MCC | $3,360 – $23,350 · median $3,444 | 12 plans |
| 673 | OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC | $3,360 – $90,881 | 12 plans |
| 674 | OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC | $3,360 – $50,584 · median $3,444 | 12 plans |
| 675 | OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC | $3,360 – $35,503 · median $3,444 | 12 plans |
| 682 | RENAL FAILURE WITH MCC | $3,360 – $32,034 · median $3,444 | 12 plans |
| 683 | RENAL FAILURE WITH CC | $3,360 – $18,944 · median $3,444 | 12 plans |
| 684 | RENAL FAILURE WITHOUT CC/MCC | $3,360 – $13,076 · median $3,444 | 12 plans |
| 686 | KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC | $3,360 – $46,311 · median $3,444 | 12 plans |
| 687 | KIDNEY AND URINARY TRACT NEOPLASMS WITH CC | $3,360 – $22,664 · median $3,444 | 12 plans |
| 688 | KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC | $3,360 – $17,094 · median $3,444 | 12 plans |
| 689 | KIDNEY AND URINARY TRACT INFECTIONS WITH MCC | $3,360 – $25,097 · median $3,444 | 12 plans |
| 690 | KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC | $3,360 – $17,509 · median $3,444 | 12 plans |
| 693 | URINARY STONES WITH MCC | $3,360 – $29,082 · median $3,444 | 12 plans |
| 694 | URINARY STONES WITHOUT MCC | $3,360 – $16,908 · median $3,444 | 12 plans |
| 696 | KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC | $3,360 – $14,903 · median $3,444 | 12 plans |
| 697 | URETHRAL STRICTURE | $3,360 – $23,313 · median $3,444 | 12 plans |
| 698 | OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC | $3,360 – $35,785 · median $3,444 | 12 plans |
| 699 | OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC | $3,360 – $21,954 · median $3,444 | 12 plans |
| 700 | OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC | $3,360 – $14,923 · median $3,444 | 12 plans |
| 707 | MAJOR MALE PELVIC PROCEDURES WITH CC/MCC | $3,360 – $43,266 · median $3,444 | 12 plans |
| 708 | MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC | $3,360 – $33,185 · median $3,444 | 12 plans |
| 709 | PENIS PROCEDURES WITH CC/MCC | $3,360 – $50,335 · median $3,444 | 12 plans |
| 710 | PENIS PROCEDURES WITHOUT CC/MCC | $3,360 – $30,308 · median $3,444 | 12 plans |
| 711 | TESTES PROCEDURES WITH CC/MCC | $3,360 – $64,546 · median $3,444 | 12 plans |
| 712 | TESTES PROCEDURES WITHOUT CC/MCC | $3,360 – $23,787 · median $3,444 | 12 plans |
| 713 | TRANSURETHRAL PROSTATECTOMY WITH CC/MCC | $3,360 – $32,519 · median $3,444 | 12 plans |
| 714 | TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC | $3,360 – $22,872 · median $3,444 | 12 plans |
| 715 | OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC | $3,360 – $48,393 · median $3,444 | 12 plans |
| 716 | OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC | $3,360 – $31,818 · median $3,444 | 12 plans |
| 717 | OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC | $3,360 – $40,892 · median $3,444 | 12 plans |
| 718 | OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC | $3,360 – $29,051 · median $3,444 | 12 plans |
| 722 | MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC | $3,360 – $39,144 · median $3,444 | 12 plans |
| 723 | MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC | $3,360 – $24,717 · median $3,444 | 12 plans |
| 724 | MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC | $3,360 – $14,183 · median $3,444 | 12 plans |
| 726 | BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC | $3,360 – $15,617 · median $3,444 | 12 plans |
| 727 | INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC | $3,360 – $36,985 · median $3,444 | 12 plans |
| 728 | INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC | $3,360 – $17,546 · median $3,444 | 12 plans |
| 729 | OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC | $3,360 – $22,900 · median $3,444 | 12 plans |
| 730 | OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC | $3,360 – $14,535 · median $3,444 | 12 plans |
| 734 | PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC | $3,360 – $60,218 · median $3,444 | 12 plans |
| 735 | PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC | $3,360 – $29,103 · median $3,444 | 12 plans |
| 736 | UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC | $3,360 – $93,291 · median $3,444 | 12 plans |
| 737 | UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC | $3,360 – $44,571 · median $3,444 | 12 plans |
| 738 | UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC | $3,360 – $31,764 · median $3,444 | 12 plans |
| 739 | UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC | $3,360 – $77,496 | 12 plans |
| 740 | UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC | $3,360 – $39,142 · median $3,444 | 12 plans |
| 741 | UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC | $3,360 – $30,847 · median $3,444 | 12 plans |
| 742 | UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC | $3,360 – $39,687 · median $3,444 | 12 plans |
| 743 | UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC | $3,360 – $26,836 · median $3,444 | 12 plans |
| 744 | D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC | $3,360 – $44,322 · median $3,444 | 12 plans |
| 745 | D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC | $3,360 – $24,604 · median $3,444 | 12 plans |
| 746 | VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC | $3,360 – $37,573 · median $3,444 | 12 plans |
| 747 | VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC | $3,360 – $18,595 · median $3,444 | 12 plans |
| 748 | FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES | $3,360 – $30,007 · median $3,444 | 12 plans |
| 749 | OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC | $3,360 – $55,537 · median $3,444 | 12 plans |
| 750 | OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC | $3,360 – $31,922 · median $3,444 | 12 plans |
| 754 | MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC | $3,360 – $39,836 · median $3,444 | 12 plans |
| 755 | MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC | $3,360 – $23,529 · median $3,444 | 12 plans |
| 756 | MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC | $3,360 – $20,776 · median $3,444 | 12 plans |
| 757 | INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC | $3,360 – $35,011 · median $3,444 | 12 plans |
| 758 | INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC | $3,360 – $21,176 · median $3,444 | 12 plans |
| 759 | INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC | $3,360 – $14,354 · median $3,444 | 12 plans |
| 760 | MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC | $3,360 – $21,792 · median $3,444 | 12 plans |
| 761 | MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC | $3,360 – $12,340 · median $3,444 | 12 plans |
| 768 | VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C | $2,940 – $15,959 · median $3,360 | 12 plans |
| 769 | POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES | $3,360 – $36,550 · median $3,444 | 12 plans |
| 770 | ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY | $3,360 – $21,688 · median $3,444 | 12 plans |
| 776 | POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES | $3,360 – $14,161 · median $3,444 | 12 plans |
| 779 | ABORTION WITHOUT D&C | $3,360 – $18,197 · median $3,444 | 12 plans |
| 789 | NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY | $3,360 – $38,982 · median $3,444 | 12 plans |
| 790 | EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE | $3,360 – $128,558 | 12 plans |
| 791 | PREMATURITY WITH MAJOR PROBLEMS | $3,360 – $87,796 · median $3,444 | 12 plans |
| 792 | PREMATURITY WITHOUT MAJOR PROBLEMS | $3,360 – $52,976 · median $3,444 | 12 plans |
| 793 | FULL TERM NEONATE WITH MAJOR PROBLEMS | $3,360 – $90,188 · median $3,444 | 12 plans |
| 794 | NEONATE WITH OTHER SIGNIFICANT PROBLEMS | $2,907 – $31,924 · median $3,360 | 12 plans |
| 795 | NORMAL NEWBORN | $1,706 – $4,322 · median $3,360 | 12 plans |
| 799 | SPLENECTOMY WITH MCC | $3,360 – $100,491 | 12 plans |
| 800 | SPLENECTOMY WITH CC | $3,360 – $60,767 · median $3,444 | 12 plans |
| 801 | SPLENECTOMY WITHOUT CC/MCC | $3,360 – $41,290 · median $3,444 | 12 plans |
| 802 | OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC | $3,360 – $86,176 | 12 plans |
| 803 | OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC | $3,360 – $40,208 · median $3,444 | 12 plans |
| 804 | OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC | $3,360 – $29,330 · median $3,444 | 12 plans |
| 808 | MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC | $3,360 – $143,541 · median $3,444 | 12 plans |
| 809 | MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC | $3,360 – $27,381 · median $3,444 | 12 plans |
| 810 | MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC | $3,360 – $22,638 · median $3,444 | 12 plans |
| 811 | RED BLOOD CELL DISORDERS WITH MCC | $3,360 – $30,375 · median $3,444 | 12 plans |
| 812 | RED BLOOD CELL DISORDERS WITHOUT MCC | $3,360 – $19,861 · median $3,444 | 12 plans |
| 813 | COAGULATION DISORDERS | $3,360 – $32,992 · median $3,444 | 12 plans |
| 814 | RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC | $3,360 – $46,001 · median $3,444 | 12 plans |
| 815 | RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC | $3,360 – $21,933 · median $3,444 | 12 plans |
| 816 | RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC | $3,360 – $13,670 · median $3,444 | 12 plans |
| 820 | LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC | $3,360 – $167,600 | 12 plans |
| 821 | LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC | $3,360 – $48,585 · median $3,444 | 12 plans |
| 822 | LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC | $3,360 – $27,548 · median $3,444 | 12 plans |
| 823 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC | $3,360 – $143,724 | 12 plans |
| 824 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC | $3,360 – $49,005 · median $3,444 | 12 plans |
| 825 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC | $3,360 – $29,188 · median $3,444 | 12 plans |
| 826 | MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC | $3,360 – $112,126 | 12 plans |
| 827 | MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC | $3,360 – $49,991 · median $3,444 | 12 plans |
| 828 | MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC | $3,360 – $36,853 · median $3,444 | 12 plans |
| 829 | MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC | $3,360 – $68,351 · median $3,444 | 12 plans |
| 830 | MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC | $3,360 – $32,553 · median $3,444 | 12 plans |
| 834 | ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC | $3,360 – $151,550 | 12 plans |
| 835 | ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC | $3,360 – $85,209 · median $3,444 | 12 plans |
| 836 | ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC | $3,360 – $26,378 · median $3,444 | 12 plans |
| 840 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC | $3,360 – $69,971 · median $3,444 | 12 plans |
| 841 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC | $3,360 – $35,287 · median $3,444 | 12 plans |
| 842 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC | $3,360 – $21,855 · median $3,444 | 12 plans |
| 843 | OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC | $3,360 – $48,426 · median $3,444 | 12 plans |
| 844 | OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC | $3,360 – $26,332 · median $3,444 | 12 plans |
| 845 | OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC | $3,360 – $18,420 · median $3,444 | 12 plans |
| 849 | RADIOTHERAPY | $3,360 – $58,606 · median $3,444 | 12 plans |
| 853 | INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC | $3,360 – $106,822 | 12 plans |
| 854 | INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC | $3,360 – $43,219 · median $3,444 | 12 plans |
| 855 | INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC | $3,360 – $32,384 · median $3,444 | 12 plans |
| 856 | POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC | $3,360 – $98,388 | 12 plans |
| 857 | POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC | $3,360 – $46,321 · median $3,444 | 12 plans |
| 858 | POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC | $3,360 – $30,128 · median $3,444 | 12 plans |
| 862 | POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC | $3,360 – $44,305 · median $3,444 | 12 plans |
| 863 | POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC | $3,360 – $21,585 · median $3,444 | 12 plans |
| 865 | VIRAL ILLNESS WITH MCC | $3,360 – $32,408 · median $3,444 | 12 plans |
| 866 | VIRAL ILLNESS WITHOUT MCC | $3,360 – $18,809 · median $3,444 | 12 plans |
| 867 | OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC | $3,360 – $45,276 · median $3,444 | 12 plans |
| 868 | OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC | $3,360 – $22,303 · median $3,444 | 12 plans |
| 869 | OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC | $3,360 – $15,783 · median $3,444 | 12 plans |
| 870 | SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS | $3,360 – $158,045 | 12 plans |
| 871 | SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC | $3,360 – $42,016 · median $3,444 | 12 plans |
| 872 | SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC | $3,360 – $22,134 · median $3,444 | 12 plans |
| 876 | O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS | $3,360 – $83,598 · median $3,444 | 12 plans |
| 880 | ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION | $3,360 – $20,769 · median $3,444 | 12 plans |
| 881 | DEPRESSIVE NEUROSES | $3,360 – $20,352 · median $3,444 | 12 plans |
| 882 | NEUROSES EXCEPT DEPRESSIVE | $3,360 – $23,226 · median $3,444 | 12 plans |
| 883 | DISORDERS OF PERSONALITY AND IMPULSE CONTROL | $3,360 – $42,531 · median $3,444 | 12 plans |
| 884 | ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY | $3,360 – $34,801 · median $3,444 | 12 plans |
| 885 | PSYCHOSES | $3,360 – $30,213 · median $3,444 | 12 plans |
| 886 | BEHAVIORAL AND DEVELOPMENTAL DISORDERS | $3,360 – $44,889 · median $3,444 | 12 plans |
| 887 | OTHER MENTAL DISORDER DIAGNOSES | $3,360 – $23,164 · median $3,444 | 12 plans |
| 894 | ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA | $3,360 – $13,344 · median $3,444 | 12 plans |
| 895 | ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY | $3,360 – $30,619 · median $3,444 | 12 plans |
| 896 | ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC | $3,360 – $37,747 · median $3,444 | 12 plans |
| 897 | ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC | $3,360 – $19,095 · median $3,444 | 12 plans |
| 901 | WOUND DEBRIDEMENTS FOR INJURIES WITH MCC | $3,360 – $90,772 | 12 plans |
| 902 | WOUND DEBRIDEMENTS FOR INJURIES WITH CC | $3,360 – $41,411 · median $3,444 | 12 plans |
| 903 | WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC | $3,360 – $25,298 · median $3,444 | 12 plans |
| 904 | SKIN GRAFTS FOR INJURIES WITH CC/MCC | $3,360 – $79,449 · median $3,444 | 12 plans |
| 905 | SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC | $3,360 – $32,086 · median $3,444 | 12 plans |
| 906 | HAND PROCEDURES FOR INJURIES | $3,360 – $42,488 · median $3,444 | 12 plans |
| 907 | OTHER O.R. PROCEDURES FOR INJURIES WITH MCC | $3,360 – $83,044 | 12 plans |
| 908 | OTHER O.R. PROCEDURES FOR INJURIES WITH CC | $3,360 – $43,156 · median $3,444 | 12 plans |
| 909 | OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC | $3,360 – $28,394 · median $3,444 | 12 plans |
| 913 | TRAUMATIC INJURY WITH MCC | $3,360 – $57,083 · median $3,444 | 12 plans |
| 914 | TRAUMATIC INJURY WITHOUT MCC | $3,360 – $19,153 · median $3,444 | 12 plans |
| 915 | ALLERGIC REACTIONS WITH MCC | $3,360 – $36,373 · median $3,444 | 12 plans |
| 916 | ALLERGIC REACTIONS WITHOUT MCC | $3,360 – $14,412 · median $3,444 | 12 plans |
| 917 | POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC | $3,360 – $33,924 · median $3,444 | 12 plans |
| 918 | POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC | $3,360 – $18,539 · median $3,444 | 12 plans |
| 919 | COMPLICATIONS OF TREATMENT WITH MCC | $3,360 – $39,600 · median $3,444 | 12 plans |
| 920 | COMPLICATIONS OF TREATMENT WITH CC | $3,360 – $21,680 · median $3,444 | 12 plans |
| 921 | COMPLICATIONS OF TREATMENT WITHOUT CC/MCC | $3,360 – $14,890 · median $3,444 | 12 plans |
| 922 | OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC | $3,360 – $47,024 · median $3,444 | 12 plans |
| 923 | OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC | $3,360 – $22,013 · median $3,444 | 12 plans |
| 927 | EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT | $3,360 – $461,811 | 12 plans |
| 928 | FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC | $3,360 – $155,146 | 12 plans |
| 929 | FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC | $3,360 – $69,666 · median $3,444 | 12 plans |
| 933 | EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT | $3,360 – $132,593 | 12 plans |
| 934 | FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY | $3,360 – $47,815 · median $3,444 | 12 plans |
| 935 | NON-EXTENSIVE BURNS | $3,360 – $44,558 · median $3,444 | 12 plans |
| 939 | O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC | $3,360 – $78,484 · median $3,444 | 12 plans |
| 940 | O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC | $3,360 – $50,547 · median $3,444 | 12 plans |
| 941 | O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC | $3,360 – $43,859 · median $3,444 | 12 plans |
| 945 | REHABILITATION WITH CC/MCC | $3,360 – $33,496 · median $3,444 | 12 plans |
| 946 | REHABILITATION WITHOUT CC/MCC | $3,360 – $24,805 · median $3,444 | 12 plans |
| 947 | SIGNS AND SYMPTOMS WITH MCC | $3,360 – $27,457 · median $3,444 | 12 plans |
| 948 | SIGNS AND SYMPTOMS WITHOUT MCC | $3,360 – $17,315 · median $3,444 | 12 plans |
| 949 | AFTERCARE WITH CC/MCC | $3,360 – $37,143 · median $3,444 | 12 plans |
| 950 | AFTERCARE WITHOUT CC/MCC | $3,360 – $13,577 · median $3,444 | 12 plans |
| 951 | OTHER FACTORS INFLUENCING HEALTH STATUS | $3,360 – $15,884 · median $3,444 | 12 plans |
| 955 | CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA | $3,360 – $145,594 | 12 plans |
| 956 | LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA | $3,360 – $81,394 | 12 plans |
| 957 | OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC | $3,360 – $164,818 | 12 plans |
| 958 | OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC | $3,360 – $91,147 | 12 plans |
| 959 | OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC | $3,360 – $63,681 · median $3,444 | 12 plans |
| 963 | OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC | $3,360 – $59,132 · median $3,444 | 12 plans |
| 964 | OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC | $3,360 – $33,150 · median $3,444 | 12 plans |
| 965 | OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC | $3,360 – $20,343 · median $3,444 | 12 plans |
| 969 | HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC | $3,360 – $132,404 | 12 plans |
| 974 | HIV WITH MAJOR RELATED CONDITION WITH MCC | $3,360 – $71,141 · median $3,444 | 12 plans |
| 975 | HIV WITH MAJOR RELATED CONDITION WITH CC | $3,360 – $47,066 · median $3,444 | 12 plans |
| 976 | HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC | $3,360 – $22,252 · median $3,444 | 12 plans |
| 977 | HIV WITH OR WITHOUT OTHER RELATED CONDITION | $3,360 – $28,069 · median $3,444 | 12 plans |
| 981 | EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC | $3,360 – $101,484 | 12 plans |
| 982 | EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC | $3,360 – $53,177 · median $3,444 | 12 plans |
| 983 | EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC | $3,360 – $37,074 · median $3,444 | 12 plans |
| 987 | NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC | $3,360 – $74,156 · median $3,444 | 12 plans |
| 988 | NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC | $3,360 – $35,551 · median $3,444 | 12 plans |
| 989 | NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC | $3,360 – $25,939 · median $3,444 | 12 plans |
| 001 | HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC | $3,360 – $534,751 | 10 plans |
| 002 | HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC | — | 10 plans |
| 005 | LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT | $3,360 – $320,040 | 10 plans |
| 006 | LIVER TRANSPLANT WITHOUT MCC | $3,360 – $241,726 | 10 plans |
| 007 | LUNG TRANSPLANT | $3,360 – $192,867 | 10 plans |
| 008 | SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT | $3,360 – $195,713 | 10 plans |
| 010 | PANCREAS TRANSPLANT | $3,360 – $156,710 | 10 plans |
| 034 | CAROTID ARTERY STENT PROCEDURES WITH MCC | $3,360 – $83,723 | 10 plans |
| 035 | CAROTID ARTERY STENT PROCEDURES WITH CC | $3,360 – $51,707 · median $3,360 | 10 plans |
| 036 | CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC | $3,360 – $42,023 · median $3,360 | 10 plans |
| 061 | ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC | $3,360 – $59,636 · median $3,360 | 10 plans |
| 077 | HYPERTENSIVE ENCEPHALOPATHY WITH MCC | $3,360 – $35,805 · median $3,360 | 10 plans |
| 078 | HYPERTENSIVE ENCEPHALOPATHY WITH CC | $3,360 – $28,247 · median $3,360 | 10 plans |
| 079 | HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC | $3,360 – $17,053 · median $3,360 | 10 plans |
| 140 | MAJOR HEAD AND NECK PROCEDURES WITH MCC | $3,360 – $92,258 | 10 plans |
| 141 | MAJOR HEAD AND NECK PROCEDURES WITH CC | $3,360 – $47,177 · median $3,360 | 10 plans |
| 142 | MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC | $3,360 – $34,530 · median $3,360 | 10 plans |
| 143 | OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC | $3,360 – $81,039 · median $3,360 | 10 plans |
| 144 | OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC | $3,360 – $37,483 · median $3,360 | 10 plans |
| 145 | OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC | $3,360 – $26,006 · median $3,360 | 10 plans |
| 150 | EPISTAXIS WITH MCC | $3,360 – $28,800 · median $3,360 | 10 plans |
| 231 | CORONARY BYPASS WITH PTCA WITH MCC | $3,360 – $182,339 | 10 plans |
| 232 | CORONARY BYPASS WITH PTCA WITHOUT MCC | $3,360 – $131,134 | 10 plans |
| 258 | CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC | $3,360 – $67,964 · median $3,360 | 10 plans |
| 266 | ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC | $3,360 – $132,557 | 10 plans |
| 267 | ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC | $3,360 – $102,976 | 10 plans |
| 268 | AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC | $3,360 – $148,769 | 10 plans |
| 269 | AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC | $3,360 – $91,348 | 10 plans |
| 270 | OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC | $3,360 – $114,126 | 10 plans |
| 271 | OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC | $3,360 – $76,923 | 10 plans |
| 272 | OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC | $3,360 – $55,221 · median $3,360 | 10 plans |
| 273 | PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC | $3,360 – $89,235 | 10 plans |
| 274 | PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC | $3,360 – $71,199 · median $3,360 | 10 plans |
| 294 | DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC | $3,360 – $19,620 · median $3,360 | 10 plans |
| 295 | DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC | $3,360 – $9,868 · median $3,360 | 10 plans |
| 319 | OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC | $3,360 – $96,533 | 10 plans |
| 320 | OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC | $3,360 – $52,027 · median $3,360 | 10 plans |
| 453 | COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC | $3,360 – $273,656 | 10 plans |
| 454 | COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC | $3,360 – $89,597 | 10 plans |
| 455 | COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC | $3,360 – $146,158 | 10 plans |
| 459 | SPINAL FUSION EXCEPT CERVICAL WITH MCC | $3,360 – $176,974 | 10 plans |
| 460 | SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC | $3,360 – $79,729 | 10 plans |
| 509 | ARTHROSCOPY | $3,360 – $136,253 · median $3,360 | 10 plans |
| 518 | BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR | $3,360 – $80,838 · median $3,360 | 10 plans |
| 519 | BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC | $3,360 – $43,264 · median $3,360 | 10 plans |
| 520 | BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC | $3,360 – $32,313 · median $3,360 | 10 plans |
| 521 | HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC | $3,360 – $62,082 · median $3,360 | 10 plans |
| 522 | HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC | $3,360 – $45,806 · median $3,360 | 10 plans |
| 533 | FRACTURES OF FEMUR WITH MCC | $3,360 – $33,909 · median $3,360 | 10 plans |
| 570 | SKIN DEBRIDEMENT WITH MCC | $3,360 – $63,616 · median $3,360 | 10 plans |
| 571 | SKIN DEBRIDEMENT WITH CC | $3,360 – $36,544 · median $3,360 | 10 plans |
| 572 | SKIN DEBRIDEMENT WITHOUT CC/MCC | $3,360 – $24,794 · median $3,360 | 10 plans |
| 652 | KIDNEY TRANSPLANT | $3,360 – $81,608 · median $3,360 | 10 plans |
| 665 | PROSTATECTOMY WITH MCC | $3,360 – $67,512 · median $3,360 | 10 plans |
| 695 | KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC | $3,360 – $24,740 · median $3,360 | 10 plans |
| 725 | BENIGN PROSTATIC HYPERTROPHY WITH MCC | $3,360 – $25,311 · median $3,360 | 10 plans |
| 783 | CESAREAN SECTION WITH STERILIZATION WITH MCC | $3,360 – $36,564 · median $3,360 | 10 plans |
| 784 | CESAREAN SECTION WITH STERILIZATION WITH CC | $3,360 – $15,788 · median $3,360 | 10 plans |
| 785 | CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC | $3,360 – $14,265 · median $3,360 | 10 plans |
| 786 | CESAREAN SECTION WITHOUT STERILIZATION WITH MCC | $3,360 – $24,566 · median $3,360 | 10 plans |
| 787 | CESAREAN SECTION WITHOUT STERILIZATION WITH CC | $3,360 – $16,633 · median $3,360 | 10 plans |
| 788 | CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC | $3,360 – $14,279 · median $3,360 | 10 plans |
| 796 | VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC | $3,360 – $17,380 · median $3,360 | 10 plans |
| 797 | VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC | $3,360 – $14,899 · median $3,360 | 10 plans |
| 798 | VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC | $3,360 – $14,254 · median $3,360 | 10 plans |
| 805 | VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC | $3,360 – $16,073 · median $3,360 | 10 plans |
| 806 | VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC | $3,360 – $11,229 · median $3,360 | 10 plans |
| 807 | VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC | $3,360 – $10,041 · median $3,360 | 10 plans |
| 817 | OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC | $3,360 – $49,351 · median $3,360 | 10 plans |
| 818 | OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC | $3,360 – $25,074 · median $3,360 | 10 plans |
| 819 | OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC | $3,360 – $18,600 · median $3,360 | 10 plans |
| 831 | OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC | $3,360 – $26,010 · median $3,360 | 10 plans |
| 832 | OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC | $3,360 – $15,608 · median $3,360 | 10 plans |
| 833 | OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC | $3,360 – $11,310 · median $3,360 | 10 plans |
| 837 | CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC | $3,360 – $103,917 | 10 plans |
| 838 | CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT | $3,360 – $45,150 · median $3,360 | 10 plans |
| 839 | CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC | $3,360 – $31,232 · median $3,360 | 10 plans |
| 846 | CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC | $3,360 – $56,076 · median $3,360 | 10 plans |
| 847 | CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC | $3,360 – $28,296 · median $3,360 | 10 plans |
| 848 | CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC | $3,360 – $18,373 · median $3,360 | 10 plans |
| 864 | FEVER AND INFLAMMATORY CONDITIONS | $3,360 – $19,201 · median $3,360 | 10 plans |
| 970 | HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC | $3,360 – $57,047 · median $3,360 | 10 plans |
| 998 | PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS | $3,360 – $11,378 · median $3,360 | 10 plans |
| 999 | UNGROUPABLE | $3,360 – $21,765 · median $3,360 | 10 plans |
| 014 | ALLOGENEIC BONE MARROW TRANSPLANT | $3,360 – $178,983 | 8 plans |
| 016 | AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC | $3,360 – $88,311 | 8 plans |
| 017 | AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC | $3,360 – $80,903 | 8 plans |
| 018 | CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES | — | 8 plans |
| 019 | SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS | $3,360 – $106,256 | 8 plans |
| 650 | KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC | $3,360 – $70,018 | 8 plans |
| 651 | KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC | $3,360 – $55,190 | 8 plans |
No procedures match that keyword.