Norton Hospitals, Inc — Pricing

740 procedures published in this hospital's Machine-Readable File (MRF) — 739 with a comparable price, 1 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 740
Lowest published price $28,703
Average published price $52,825
Highest published price $213,309

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 740 procedures

Published charges

Showing all 739 procedures with a comparable published price (gross, cash, or insurance-negotiated median), sorted highest to lowest. Green = this hospital prices below the median; amber = above.

Across 242 procedures, this hospital's negotiated rates average ≈502% of what Medicare pays.

DRG Description Published price Cash price vs. KY median vs. National median vs Medicare
003 ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck with major O.R. procedures $213,309 $213,309 $343,325 −38% $371,366 −43% —
004 Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck without major O.R. procedures $175,445 $175,445 $248,002 −29% $248,521 −29% ≈249% of Medicare
163 Major chest procedures with MCC $144,793 $144,793 $144,793 +0% $90,195 +61% ≈484% of Medicare
164 Major chest procedures with CC $144,793 $144,793 $39,391 +268% $56,755 +155% ≈685% of Medicare
165 Major chest procedures without CC/MCC $144,793 $144,793 $27,387 +429% $46,340 +212% —
011 Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCC $142,943 $142,943 $73,038 +96% $101,576 +41% —
140 Major head and neck procedures with MCC $142,943 $142,943 $58,085 +146% $60,098 +138% —
166 Other respiratory system O.R. procedures with MCC $142,943 $142,943 $56,889 +151% $75,573 +89% ≈604% of Medicare
981 Extensive O.R. procedures unrelated to principal diagnosis with MCC $142,924 $142,924 $114,909 +24% $90,775 +57% ≈469% of Medicare
870 Septicemia or severe sepsis with MV >96 hours $126,545 $126,545 $170,239 −26% $148,832 −15% ≈298% of Medicare
207 Respiratory system diagnosis with ventilator support >96 hours $118,759 $118,759 $147,096 −19% $116,058 +2% ≈283% of Medicare
012 Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CC $96,327 $96,327 $56,456 +71% $79,836 +21% —
167 Other respiratory system O.R. procedures with CC $96,327 $96,327 $40,642 +137% $40,642 +137% —
168 Other respiratory system O.R. procedures without CC/MCC $96,327 $96,327 $27,988 +244% $29,949 +222% —
173 Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism $96,327 $96,327 $43,021 +124% $60,407 +59% —
853 Infectious and parasitic diseases with O.R. procedures with MCC $92,596 $92,596 $110,649 −16% $93,172 −1% ≈277% of Medicare
040 Peripheral, cranial nerve and other nervous system procedures with MCC $89,713 $89,713 $52,152 +72% $74,257 +21% ≈384% of Medicare
356 Other digestive system O.R. procedures with MCC $85,243 $85,243 $83,430 +2% $82,561 +3% ≈242% of Medicare
799 Splenic procedures with MCC $85,243 $85,243 $76,920 +11% $82,218 +4% —
573 Skin graft for skin ulcer or cellulitis with MCC $84,919 $84,919 $82,731 +3% $98,912 −14% —
579 Other skin, subcutaneous tissue and breast procedures with MCC $82,843 $82,843 $45,498 +82% $58,745 +41% —
582 Mastectomy for malignancy with CC/MCC $82,843 $82,843 $25,923 +220% $35,849 +131% —
856 Postoperative or post-traumatic infections with O.R. procedures with MCC $82,299 $82,299 $56,996 +44% $76,001 +8% ≈291% of Medicare
205 Other respiratory system diagnoses with MCC $80,088 $80,088 $27,695 +189% $33,255 +141% ≈667% of Medicare
619 O.R. procedures for obesity with MCC $79,856 $79,856 $38,581 +107% $51,746 +54% —
622 Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with MCC $79,856 $79,856 $62,850 +27% $61,470 +30% —
551 Medical back problems with MCC $79,753 $79,753 $29,332 +172% $34,017 +134% ≈763% of Medicare
061 Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with MCC $79,441 $79,441 $99,124 −20% $62,264 +28% —
064 Intracranial hemorrhage or cerebral infarction with MCC $79,441 $79,441 $32,815 +142% $39,106 +103% ≈670% of Medicare
901 Wound debridements for injuries with MCC $78,360 $78,360 $60,697 +29% $70,177 +12% —
245 AICD generator procedures $77,597 $77,597 $66,564 +17% $72,076 +8% —
263 Vein ligation and stripping $77,597 $77,597 $38,005 +104% $51,253 +51% —
264 Other circulatory system O.R. procedures $77,597 $77,597 $61,215 +27% $51,953 +49% ≈358% of Medicare
020 Intracranial vascular procedures with principal diagnosis hemorrhage with MCC $77,090 $77,090 $106,929 −28% $148,686 −48% —
021 Intracranial vascular procedures with principal diagnosis hemorrhage with CC $77,090 $77,090 $74,709 +3% $106,057 −27% —
022 Intracranial vascular procedures with principal diagnosis hemorrhage without CC/MCC $77,090 $77,090 $49,015 +57% $66,848 +15% —
023 Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC or chemotherapy implant or epilepsy with neurostimulator $77,090 $77,090 $77,030 +0% $106,778 −28% ≈200% of Medicare
024 Craniotomy with major device implant or acute complex CNS principal diagnosis without MCC $77,090 $77,090 $52,536 +47% $74,755 +3% —
025 Craniotomy and endovascular intracranial procedures with MCC $77,090 $77,090 $61,240 +26% $88,307 −13% ≈277% of Medicare
026 Craniotomy and endovascular intracranial procedures with CC $77,090 $77,090 $49,485 +56% $64,523 +19% ≈294% of Medicare
027 Craniotomy and endovascular intracranial procedures without CC/MCC $77,090 $77,090 $35,224 +119% $54,583 +41% ≈448% of Medicare
031 Ventricular shunt procedures with MCC $77,090 $77,090 $57,584 +34% $72,962 +6% —
032 Ventricular shunt procedures with CC $77,090 $77,090 $30,912 +149% $46,724 +65% —
033 Ventricular shunt procedures without CC/MCC $77,090 $77,090 $23,902 +223% $35,419 +118% —
034 Carotid artery stent procedures with MCC $77,090 $77,090 $53,665 +44% $76,219 +1% ≈306% of Medicare
035 Carotid artery stent procedures with CC $77,090 $77,090 $32,719 +136% $49,066 +57% ≈462% of Medicare
036 Carotid artery stent procedures without CC/MCC $77,090 $77,090 $39,530 +95% $40,694 +89% ≈645% of Medicare
037 Extracranial procedures with MCC $77,090 $77,090 $62,896 +23% $66,666 +16% —
038 Extracranial procedures with CC $77,090 $77,090 $36,935 +109% $35,770 +116% ≈727% of Medicare
039 Extracranial procedures without CC/MCC $77,090 $77,090 $22,027 +250% $26,618 +190% ≈1220% of Medicare
041 Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurostimulator $77,090 $77,090 $91,063 −15% $49,418 +56% ≈550% of Medicare
042 Peripheral, cranial nerve and other nervous system procedures without CC/MCC $77,090 $77,090 $26,006 +196% $39,018 +98% —
054 Nervous system neoplasms with MCC $77,090 $77,090 $22,651 +240% $30,502 +153% ≈834% of Medicare
073 Cranial and peripheral nerve disorders with MCC $77,090 $77,090 $25,833 +198% $30,010 +157% ≈966% of Medicare
202 Bronchitis and asthma with CC/MCC $77,090 $77,090 $22,232 +247% $17,724 +335% ≈1404% of Medicare
212 Concomitant aortic and mitral valve procedures $77,090 $77,090 $142,952 −46% $196,346 −61% —
215 Other heart assist system implant $77,090 $77,090 $139,148 −45% $208,939 −63% —
216 Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC $77,090 $77,090 $127,148 −39% $188,171 −59% ≈106% of Medicare
217 Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with CC $77,090 $77,090 $86,542 −11% $123,995 −38% —
218 Cardiac valve and other major cardiothoracic procedures with cardiac catheterization without CC/MCC $77,090 $77,090 $80,075 −4% $103,455 −25% —
219 Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with MCC $77,090 $77,090 $102,814 −25% $143,242 −46% ≈114% of Medicare
220 Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with CC $77,090 $77,090 $71,776 +7% $111,320 −31% ≈202% of Medicare
221 Cardiac valve and other major cardiothoracic procedures without cardiac catheterization without CC/MCC $77,090 $77,090 $62,801 +23% $90,331 −15% —
228 Other cardiothoracic procedures with MCC $77,090 $77,090 $72,440 +6% $96,905 −20% ≈235% of Medicare
229 Other cardiothoracic procedures without MCC $77,090 $77,090 $60,300 +28% $65,325 +18% ≈359% of Medicare
231 Coronary bypass with PTCA with MCC $77,090 $77,090 $112,178 −31% $147,227 −48% —
232 Coronary bypass with PTCA without MCC $77,090 $77,090 $82,102 −6% $115,839 −33% —
233 Coronary bypass with cardiac catheterization or open ablation with MCC $77,090 $77,090 $103,817 −26% $144,569 −47% ≈158% of Medicare
234 Coronary bypass with cardiac catheterization or open ablation without MCC $77,090 $77,090 $72,075 +7% $102,573 −25% ≈268% of Medicare
235 Coronary bypass without cardiac catheterization with MCC $77,090 $77,090 $79,247 −3% $112,062 −31% ≈211% of Medicare
236 Coronary bypass without cardiac catheterization without MCC $77,090 $77,090 $56,565 +36% $82,247 −6% ≈295% of Medicare
239 Amputation for circulatory system disorders except upper limb and toe with MCC $77,090 $77,090 $77,090 +0% $93,390 −17% ≈218% of Medicare
240 Amputation for circulatory system disorders except upper limb and toe with CC $77,090 $77,090 $40,991 +88% $59,790 +29% ≈519% of Medicare
241 Amputation for circulatory system disorders except upper limb and toe without CC/MCC $77,090 $77,090 $35,649 +116% $30,770 +151% —
242 Permanent cardiac pacemaker implant with MCC $77,090 $77,090 $109,863 −30% $70,132 +10% ≈332% of Medicare
250 Percutaneous cardiovascular procedures without intraluminal device with MCC $77,090 $77,090 $84,405 −9% $59,629 +29% —
251 Percutaneous cardiovascular procedures without intraluminal device without MCC $77,090 $77,090 $67,497 +14% $46,295 +67% —
252 Other vascular procedures with MCC $77,090 $77,090 $60,309 +28% $68,508 +13% ≈327% of Medicare
253 Other vascular procedures with CC $77,090 $77,090 $88,518 −13% $57,454 +34% ≈453% of Medicare
254 Other vascular procedures without CC/MCC $77,090 $77,090 $65,428 +18% $38,836 +99% ≈603% of Medicare
255 Upper limb and toe amputation for circulatory system disorders with MCC $77,090 $77,090 $65,742 +17% $46,453 +66% —
256 Upper limb and toe amputation for circulatory system disorders with CC $77,090 $77,090 $25,176 +206% $32,944 +134% —
257 Upper limb and toe amputation for circulatory system disorders without CC/MCC $77,090 $77,090 $14,770 +422% $15,764 +389% —
258 Cardiac pacemaker device replacement with MCC $77,090 $77,090 $39,606 +95% $52,986 +45% —
266 Endovascular cardiac valve replacement and supplement procedures with MCC $77,090 $77,090 $80,603 −4% $113,855 −32% ≈125% of Medicare
267 Endovascular cardiac valve replacement and supplement procedures without MCC $77,090 $77,090 $64,248 +20% $92,217 −16% ≈192% of Medicare
268 Aortic and heart assist procedures except pulsation balloon with MCC $77,090 $77,090 $89,209 −14% $125,242 −38% —
269 Aortic and heart assist procedures except pulsation balloon without MCC $77,090 $77,090 $77,090 +0% $85,159 −9% ≈265% of Medicare
270 Other major cardiovascular procedures with MCC $77,090 $77,090 $146,941 −48% $99,423 −22% ≈212% of Medicare
271 Other major cardiovascular procedures with CC $77,090 $77,090 $119,602 −36% $71,014 +9% ≈366% of Medicare
272 Other major cardiovascular procedures without CC/MCC $77,090 $77,090 $118,849 −35% $55,162 +40% ≈342% of Medicare
273 Percutaneous and other intracardiac procedures with MCC $77,090 $77,090 $53,945 +43% $78,852 −2% ≈337% of Medicare
274 Percutaneous and other intracardiac procedures without MCC $77,090 $77,090 $43,701 +76% $65,573 +18% ≈368% of Medicare
275 Cardiac defibrillator implant with cardiac catheterization and MCC $77,090 $77,090 $94,288 −18% $131,961 −42% —
329 Major small and large bowel procedures with MCC $77,090 $77,090 $120,161 −36% $88,050 −12% ≈248% of Medicare
344 Minor small and large bowel procedures with MCC $77,090 $77,090 $44,955 +71% $44,546 +73% —
353 Hernia procedures except inguinal and femoral with MCC $77,090 $77,090 $78,680 −2% $60,170 +28% —
385 Inflammatory bowel disease with MCC $77,090 $77,090 $25,998 +197% $27,617 +179% —
405 Pancreas, liver and shunt procedures with MCC $77,090 $77,090 $73,455 +5% $102,128 −25% ≈228% of Medicare
423 Other hepatobiliary or pancreas O.R. procedures with MCC $77,090 $77,090 $55,985 +38% $79,225 −3% —
466 Revision of hip or knee replacement with MCC $77,090 $77,090 $77,090 +0% $96,507 −20% —
469 Major hip and knee joint replacement or reattachment of lower extremity with MCC or total ankle replacement $77,090 $77,090 $49,655 +55% $65,788 +17% —
474 Amputation for musculoskeletal system and connective tissue disorders with MCC $77,090 $77,090 $78,803 −2% $84,692 −9% —
477 Biopsies of musculoskeletal system and connective tissue with MCC $77,090 $77,090 $55,135 +40% $68,653 +12% —
483 Major joint or limb reattachment procedures of upper extremities $77,090 $77,090 $116,959 −34% $58,707 +31% ≈470% of Medicare
485 Knee procedures with principal diagnosis of infection with MCC $77,090 $77,090 $111,366 −31% $72,424 +6% —
492 Lower extremity and humerus procedures except hip, foot and femur with MCC $77,090 $77,090 $87,107 −12% $70,564 +9% ≈448% of Medicare
493 Lower extremity and humerus procedures except hip, foot and femur with CC $77,090 $77,090 $73,758 +5% $59,651 +29% ≈571% of Medicare
495 Local excision and removal of internal fixation devices except hip and femur with MCC $77,090 $77,090 $48,887 +58% $56,964 +35% —
498 Local excision and removal of internal fixation devices of hip and femur with CC/MCC $77,090 $77,090 $39,624 +95% $49,423 +56% —
499 Local excision and removal of internal fixation devices of hip and femur without CC/MCC $77,090 $77,090 $18,260 +322% $21,230 +263% —
518 Back and neck procedures except spinal fusion with MCC or disc device or neurostimulator $77,090 $77,090 $49,711 +55% $71,092 +8% —
519 Back and neck procedures except spinal fusion with CC $77,090 $77,090 $37,413 +106% $44,139 +75% ≈636% of Medicare
562 Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCC $77,090 $77,090 $27,810 +177% $29,743 +159% —
643 Endocrine disorders with MCC* $77,090 $77,090 $39,983 +93% $33,563 +130% ≈756% of Medicare
693 Urinary stones with MCC $77,090 $77,090 $31,040 +148% $23,892 +223% —
734 Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC $77,090 $77,090 $30,486 +153% $42,795 +80% —
735 Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC $77,090 $77,090 $18,949 +307% $26,948 +186% —
736 Uterine and adnexa procedures for ovarian or adnexal malignancy with MCC $77,090 $77,090 $54,300 +42% $61,832 +25% —
737 Uterine and adnexa procedures for ovarian or adnexal malignancy with CC $77,090 $77,090 $29,131 +165% $44,363 +74% —
738 Uterine and adnexa procedures for ovarian or adnexal malignancy without CC/MCC $77,090 $77,090 $22,882 +237% $33,674 +129% —
739 Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with MCC $77,090 $77,090 $54,862 +41% $62,300 +24% —
740 Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with CC $77,090 $77,090 $26,794 +188% $40,365 +91% —
741 Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy without CC/MCC $77,090 $77,090 $21,022 +267% $30,493 +153% —
742 Uterine and adnexa procedures for non-malignancy with CC/MCC $77,090 $77,090 $27,515 +180% $40,552 +90% —
743 Uterine and adnexa procedures for non-malignancy without CC/MCC $77,090 $77,090 $36,384 +112% $30,784 +150% ≈1236% of Medicare
744 D&C, conization, laparoscopy and tubal interruption with CC/MCC $77,090 $77,090 $28,555 +170% $38,861 +98% —
745 D&C, conization, laparoscopy and tubal interruption without CC/MCC $77,090 $77,090 $18,769 +311% $18,348 +320% —
746 Vagina, cervix and vulva procedures with CC/MCC $77,090 $77,090 $24,928 +209% $29,916 +158% —
747 Vagina, cervix and vulva procedures without CC/MCC $77,090 $77,090 $16,474 +368% $19,594 +293% —
748 Female reproductive system reconstructive procedures $77,090 $77,090 $20,875 +269% $30,242 +155% —
749 Other female reproductive system O.R. procedures with CC/MCC $77,090 $77,090 $36,791 +110% $45,167 +71% —
750 Other female reproductive system O.R. procedures without CC/MCC $77,090 $77,090 $19,930 +287% $27,989 +175% —
754 Malignancy, female reproductive system with MCC $77,090 $77,090 $26,677 +189% $32,433 +138% —
755 Malignancy, female reproductive system with CC $77,090 $77,090 $19,048 +305% $18,459 +318% —
783 Cesarean section with sterilization with MCC $77,090 $77,090 $37,387 +106% $29,221 +164% —
784 Cesarean section with sterilization with CC $77,090 $77,090 $25,129 +207% $23,283 +231% —
786 Cesarean section without sterilization with MCC $77,090 $77,090 $27,118 +184% $27,152 +184% —
787 Cesarean section without sterilization with CC $77,090 $77,090 $20,571 +275% $23,571 +227% —
808 Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with MCC $77,090 $77,090 $41,516 +86% $39,181 +97% ≈575% of Medicare
817 Other antepartum diagnoses with O.R. procedures with MCC $77,090 $77,090 $36,097 +114% $39,173 +97% —
820 Lymphoma and leukemia with major O.R. procedures with MCC $77,090 $77,090 $78,460 −2% $96,192 −20% —
821 Lymphoma and leukemia with major O.R. procedures with CC $77,090 $77,090 $32,168 +140% $47,789 +61% —
823 Lymphoma and non-acute leukemia with other procedures with MCC $77,090 $77,090 $99,813 −23% $87,761 −12% —
824 Lymphoma and non-acute leukemia with other procedures with CC $77,090 $77,090 $31,740 +143% $41,608 +85% —
826 Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with MCC $77,090 $77,090 $65,149 +18% $90,724 −15% —
827 Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with CC $77,090 $77,090 $33,823 +128% $50,498 +53% —
829 Myeloproliferative disorders or poorly differentiated neoplasms with other procedures with CC/MCC $77,090 $77,090 $43,218 +78% $53,864 +43% —
843 Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with MCC $77,090 $77,090 $78,561 −2% $36,431 +112% —
850 Acute leukemia with other procedures $77,090 $77,090 $121,563 −37% $121,563 −37% —
857 Postoperative or post-traumatic infections with O.R. procedures with CC $77,090 $77,090 $35,421 +118% $45,333 +70% ≈457% of Medicare
917 Poisoning and toxic effects of drugs with MCC $77,090 $77,090 $32,091 +140% $30,235 +155% ≈747% of Medicare
918 Poisoning and toxic effects of drugs without MCC $77,090 $77,090 $16,819 +358% $15,452 +399% ≈1607% of Medicare
963 Other multiple significant trauma with MCC $77,090 $77,090 $38,454 +100% $43,491 +77% —
969 HIV with extensive O.R. procedures with MCC $77,090 $77,090 $84,844 −9% $109,331 −29% —
970 HIV with extensive O.R. procedures without MCC $77,090 $77,090 $37,631 +105% $44,222 +74% —
463 Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with MCC* $77,017 $77,017 $73,103 +5% $89,207 −14% ≈196% of Medicare
822 Lymphoma and leukemia with major O.R. procedures without CC/MCC $76,791 $76,791 $18,038 +326% $25,390 +202% —
828 Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures without CC/MCC $76,791 $76,791 $28,104 +173% $35,584 +116% —
907 Other O.R. procedures for injuries with MCC* $76,791 $76,791 $54,898 +40% $77,817 −1% ≈323% of Medicare
908 Other O.R. procedures for injuries with CC* $76,791 $76,791 $47,008 +63% $42,914 +79% ≈583% of Medicare
955 Craniotomy for multiple significant trauma $76,791 $76,791 $91,253 −16% $102,600 −25% —
956 Limb reattachment, hip and femur procedures for multiple significant trauma $76,791 $76,791 $78,776 −3% $75,103 +2% ≈323% of Medicare
957 Other O.R. procedures for multiple significant trauma with MCC $76,791 $76,791 $99,339 −23% $120,573 −36% —
958 Other O.R. procedures for multiple significant trauma with CC $76,791 $76,791 $56,535 +36% $73,120 +5% —
500 Soft tissue procedures with MCC $75,221 $75,221 $44,320 +70% $61,872 +22% —
028 Spinal procedures with MCC $73,224 $73,224 $81,731 −10% $113,077 −35% —
029 Spinal procedures with CC or spinal neurostimulators $73,224 $73,224 $46,760 +57% $67,268 +9% —
515 Other musculoskeletal system and connective tissue O.R. procedures with MCC $73,224 $73,224 $64,691 +13% $62,821 +17% ≈373% of Medicare
653 Major bladder procedures with MCC $73,108 $73,108 $100,871 −28% $104,583 −30% —
665 Prostatectomy with MCC $73,108 $73,108 $54,072 +35% $54,072 +35% —
673 Other kidney and urinary tract procedures with MCC* $73,108 $73,108 $98,638 −26% $77,990 −6% ≈350% of Medicare
939 O.R. procedures with diagnoses of other contact with health services with MCC $72,393 $72,393 $44,389 +63% $55,289 +31% —
208 Respiratory system diagnosis with ventilator support <=96 hours $72,113 $72,113 $70,030 +3% $52,405 +38% ≈407% of Medicare
570 Skin debridement with MCC* $71,899 $71,899 $60,276 +19% $52,435 +37% —
974 HIV with major related condition with MCC* $69,596 $69,596 $41,952 +66% $46,402 +50% —
580 Other skin, subcutaneous tissue and breast procedures with CC $68,082 $68,082 $34,854 +95% $38,101 +79% ≈580% of Medicare
581 Other skin, subcutaneous tissue and breast procedures without CC/MCC $68,082 $68,082 $29,153 +134% $26,932 +153% —
583 Mastectomy for malignancy without CC/MCC $68,082 $68,082 $24,514 +178% $35,831 +90% —
082 Traumatic stupor and coma >1 hour with MCC* $65,523 $65,523 $38,890 +68% $36,489 +80% ≈493% of Medicare
919 Complications of treatment with MCC $65,492 $65,492 $36,329 +80% $31,105 +111% ≈585% of Medicare
094 Bacterial and tuberculous infections of nervous system with MCC* $65,419 $65,419 $50,550 +29% $68,639 −5% —
052 Spinal disorders and injuries with CC/MCC $64,925 $64,925 $29,314 +121% $32,031 +103% —
053 Spinal disorders and injuries without CC/MCC $64,925 $64,925 $15,153 +328% $20,455 +217% —
426 Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device $64,925 $64,925 $137,630 −53% $142,326 −54% ≈102% of Medicare
427 Multiple level combined anterior and posterior spinal fusion except cervical with CC $64,925 $64,925 $94,742 −31% $132,794 −51% ≈121% of Medicare
429 Combined anterior and posterior cervical spinal fusion with MCC $64,925 $64,925 $110,483 −41% $144,774 −55% —
447 Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device $64,925 $64,925 $89,681 −28% $126,098 −49% —
448 Multiple level spinal fusion except cervical without MCC $64,925 $64,925 $56,194 +16% $81,998 −21% ≈234% of Medicare
438 Disorders of pancreas except malignancy with MCC $63,984 $63,984 $40,406 +58% $32,628 +96% —
654 Major bladder procedures with CC $63,911 $63,911 $53,779 +19% $58,274 +10% —
666 Prostatectomy with CC $63,911 $63,911 $24,574 +160% $31,906 +100% —
674 Other kidney and urinary tract procedures with CC* $63,911 $63,911 $40,976 +56% $50,394 +27% ≈466% of Medicare
675 Other kidney and urinary tract procedures without CC/MCC* $63,911 $63,911 $23,510 +172% $34,749 +84% —
288 Acute and subacute endocarditis with MCC $62,231 $62,231 $51,699 +20% $50,618 +23% —
393 Other digestive system diagnoses with MCC $62,048 $62,048 $40,375 +54% $34,192 +81% ≈601% of Medicare
388 Gastrointestinal obstruction with MCC $60,344 $60,344 $32,399 +86% $30,571 +97% ≈631% of Medicare
189 Pulmonary edema and respiratory failure $59,770 $59,770 $32,631 +83% $26,580 +125% ≈796% of Medicare
640 Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCC $59,752 $59,752 $32,757 +82% $25,463 +135% ≈741% of Medicare
539 Osteomyelitis with MCC* $59,196 $59,196 $39,199 +51% $37,609 +57% —
380 Complicated peptic ulcer with MCC $58,488 $58,488 $41,251 +42% $39,627 +48% ≈535% of Medicare
411 Cholecystectomy with C.D.E. with MCC $58,488 $58,488 $38,709 +51% $48,358 +21% —
414 Cholecystectomy except by laparoscope without C.D.E. with MCC $58,488 $58,488 $53,579 +9% $69,743 −16% —
417 Laparoscopic cholecystectomy without C.D.E. with MCC $58,488 $58,488 $62,554 −7% $53,451 +9% ≈381% of Medicare
464 Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with CC* $58,243 $58,243 $41,464 +40% $58,228 +0% ≈343% of Medicare
620 O.R. procedures for obesity with CC $57,938 $57,938 $38,153 +52% $35,453 +63% —
623 Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with CC $57,938 $57,938 $40,130 +44% $34,459 +68% ≈507% of Medicare
013 Tracheostomy for face, mouth and neck diagnoses or laryngectomy without CC/MCC $57,682 $57,682 $37,588 +53% $48,687 +18% —
077 Hypertensive encephalopathy with MCC $57,682 $57,682 $57,682 +0% $24,550 +135% —
078 Hypertensive encephalopathy with CC $57,682 $57,682 $58,134 −1% $17,698 +226% —
113 Orbital procedures with CC/MCC $57,682 $57,682 $32,482 +78% $36,167 +59% —
114 Orbital procedures without CC/MCC $57,682 $57,682 $18,536 +211% $19,598 +194% —
115 Extraocular procedures except orbit $57,682 $57,682 $23,065 +150% $25,703 +124% —
116 Intraocular procedures with CC/MCC $57,682 $57,682 $24,851 +132% $29,126 +98% —
117 Intraocular procedures without CC/MCC $57,682 $57,682 $17,193 +235% $17,193 +235% —
135 Sinus and mastoid procedures with CC/MCC $57,682 $57,682 $34,487 +67% $42,186 +37% —
136 Sinus and mastoid procedures without CC/MCC $57,682 $57,682 $15,890 +263% $17,404 +231% —
137 Mouth procedures with CC/MCC $57,682 $57,682 $21,346 +170% $27,861 +107% —
138 Mouth procedures without CC/MCC $57,682 $57,682 $14,786 +290% $19,119 +202% —
139 Salivary gland procedures $57,682 $57,682 $21,014 +174% $23,612 +144% —
141 Major head and neck procedures with CC $57,682 $57,682 $31,079 +86% $37,267 +55% ≈368% of Medicare
142 Major head and neck procedures without CC/MCC $57,682 $57,682 $23,602 +144% $34,906 +65% —
143 Other ear, nose, mouth and throat O.R. procedures with MCC $57,682 $57,682 $46,049 +25% $52,908 +9% —
144 Other ear, nose, mouth and throat O.R. procedures with CC $57,682 $57,682 $25,994 +122% $30,553 +89% —
145 Other ear, nose, mouth and throat O.R. procedures without CC/MCC $57,682 $57,682 $18,572 +211% $25,712 +124% —
152 Otitis media and URI with MCC $57,682 $57,682 $17,922 +222% $20,247 +185% —
154 Other ear, nose, mouth and throat diagnoses with MCC $57,682 $57,682 $24,302 +137% $27,633 +109% —
155 Other ear, nose, mouth and throat diagnoses with CC $57,682 $57,682 $15,311 +277% $16,968 +240% —
157 Dental and oral diseases with MCC $57,682 $57,682 $24,447 +136% $31,300 +84% —
196 Interstitial lung disease with MCC* $57,682 $57,682 $27,647 +109% $32,637 +77% ≈531% of Medicare
197 Interstitial lung disease with CC* $57,682 $57,682 $16,923 +241% $21,941 +163% —
198 Interstitial lung disease without CC/MCC* $57,682 $57,682 $19,306 +199% $15,549 +271% —
260 Cardiac pacemaker revision except device replacement with MCC $57,682 $57,682 $47,403 +22% $70,371 −18% —
276 Cardiac defibrillator implant with MCC or carotid sinus neurostimulator $57,682 $57,682 $83,192 −31% $117,280 −51% —
277 Cardiac defibrillator implant without MCC $57,682 $57,682 $63,571 −9% $91,329 −37% —
278 Ultrasound accelerated and other thrombolysis of peripheral vascular structures with MCC $57,682 $57,682 $68,045 −15% $93,238 −38% —
279 Ultrasound accelerated and other thrombolysis of peripheral vascular structures without MCC $57,682 $57,682 $44,783 +29% $63,928 −10% —
283 Acute myocardial infarction, expired with MCC $57,682 $57,682 $38,806 +49% $39,955 +44% —
304 Hypertension with MCC $57,682 $57,682 $21,518 +168% $26,080 +121% ≈810% of Medicare
306 Cardiac congenital and valvular disorders with MCC $57,682 $57,682 $22,628 +155% $24,586 +135% —
312 Syncope and collapse $57,682 $57,682 $22,612 +155% $19,342 +198% ≈1138% of Medicare
319 Other endovascular cardiac valve procedures with MCC $57,682 $57,682 $60,208 −4% $86,970 −34% —
326 Stomach, esophageal and duodenal procedures with MCC $57,682 $57,682 $77,786 −26% $80,793 −29% ≈191% of Medicare
374 Digestive malignancy with MCC* $57,682 $57,682 $37,644 +53% $39,958 +44% ≈460% of Medicare
386 Inflammatory bowel disease with CC $57,682 $57,682 $29,116 +98% $22,033 +162% ≈951% of Medicare
387 Inflammatory bowel disease without CC/MCC $57,682 $57,682 $25,241 +129% $16,288 +254% —
435 Malignancy of hepatobiliary system or pancreas with MCC $57,682 $57,682 $29,985 +92% $37,950 +52% ≈549% of Medicare
488 Knee procedures without principal diagnosis of infection with CC/MCC $57,682 $57,682 $37,866 +52% $43,631 +32% —
501 Soft tissue procedures with CC $57,682 $57,682 $31,927 +81% $39,619 +46% —
545 Connective tissue disorders with MCC $57,682 $57,682 $35,990 +60% $40,362 +43% —
574 Skin graft for skin ulcer or cellulitis with CC $57,682 $57,682 $48,165 +20% $52,036 +11% —
575 Skin graft for skin ulcer or cellulitis without CC/MCC $57,682 $57,682 $29,109 +98% $29,611 +95% —
576 Skin graft except for skin ulcer or cellulitis with MCC* $57,682 $57,682 $73,030 −21% $90,401 −36% —
577 Skin graft except for skin ulcer or cellulitis with CC* $57,682 $57,682 $37,754 +53% $47,945 +20% ≈328% of Medicare
578 Skin graft except for skin ulcer or cellulitis without CC/MCC* $57,682 $57,682 $25,133 +130% $29,079 +98% —
604 Trauma to the skin, subcutaneous tissue and breast with MCC $57,682 $57,682 $43,771 +32% $28,140 +105% —
606 Minor skin disorders with MCC $57,682 $57,682 $33,799 +71% $27,975 +106% —
614 Adrenal and pituitary procedures with CC/MCC $57,682 $57,682 $32,773 +76% $48,349 +19% —
615 Adrenal and pituitary procedures without CC/MCC $57,682 $57,682 $21,793 +165% $32,833 +76% —
616 Amputation of lower limb for endocrine, nutritional and metabolic disorders with MCC $57,682 $57,682 $55,519 +4% $66,685 −14% ≈233% of Medicare
617 Amputation of lower limb for endocrine, nutritional and metabolic disorders with CC $57,682 $57,682 $44,022 +31% $42,881 +35% ≈494% of Medicare
625 Thyroid, parathyroid and thyroglossal procedures with MCC $57,682 $57,682 $40,406 +43% $59,031 −2% —
628 Other endocrine, nutritional and metabolic O.R. procedures with MCC $57,682 $57,682 $57,682 +0% $71,795 −20% ≈214% of Medicare
655 Major bladder procedures without CC/MCC $57,682 $57,682 $47,191 +22% $43,174 +34% —
656 Kidney and ureter procedures for neoplasm with MCC $57,682 $57,682 $45,479 +27% $65,608 −12% —
657 Kidney and ureter procedures for neoplasm with CC $57,682 $57,682 $35,373 +63% $43,298 +33% —
658 Kidney and ureter procedures for neoplasm without CC/MCC $57,682 $57,682 $34,243 +68% $36,253 +59% —
659 Kidney and ureter procedures for non-neoplasm with MCC* $57,682 $57,682 $56,247 +3% $52,178 +11% ≈353% of Medicare
660 Kidney and ureter procedures for non-neoplasm with CC* $57,682 $57,682 $34,165 +69% $31,264 +84% ≈744% of Medicare
661 Kidney and ureter procedures for non-neoplasm without CC/MCC* $57,682 $57,682 $30,304 +90% $25,970 +122% ≈1011% of Medicare
662 Minor bladder procedures with MCC $57,682 $57,682 $44,100 +31% $54,562 +6% —
663 Minor bladder procedures with CC $57,682 $57,682 $36,581 +58% $33,103 +74% —
664 Minor bladder procedures without CC/MCC $57,682 $57,682 $17,209 +235% $22,314 +158% —
667 Prostatectomy without CC/MCC $57,682 $57,682 $16,534 +249% $16,703 +245% —
668 Transurethral procedures with MCC $57,682 $57,682 $41,045 +41% $51,608 +12% —
669 Transurethral procedures with CC $57,682 $57,682 $30,775 +87% $34,354 +68% —
670 Transurethral procedures without CC/MCC $57,682 $57,682 $33,073 +74% $20,911 +176% —
671 Urethral procedures with CC/MCC $57,682 $57,682 $25,566 +126% $27,233 +112% —
672 Urethral procedures without CC/MCC $57,682 $57,682 $17,398 +232% $17,398 +232% —
707 Major male pelvic procedures with CC/MCC $57,682 $57,682 $28,381 +103% $43,080 +34% —
709 Penis procedures with CC/MCC $57,682 $57,682 $35,636 +62% $34,535 +67% —
711 Testes procedures with CC/MCC $57,682 $57,682 $27,991 +106% $38,343 +50% —
713 Transurethral prostatectomy with CC/MCC $57,682 $57,682 $24,610 +134% $32,100 +80% —
715 Other male reproductive system O.R. procedures for malignancy with CC/MCC $57,682 $57,682 $32,504 +77% $38,998 +48% —
717 Other male reproductive system O.R. procedures except malignancy with CC/MCC $57,682 $57,682 $27,276 +111% $36,670 +57% —
818 Other antepartum diagnoses with O.R. procedures with CC $57,682 $57,682 $19,911 +190% $26,870 +115% —
854 Infectious and parasitic diseases with O.R. procedures with CC $57,682 $57,682 $56,995 +1% $43,943 +31% ≈432% of Medicare
902 Wound debridements for injuries with CC $57,682 $57,682 $33,800 +71% $40,562 +42% —
903 Wound debridements for injuries without CC/MCC $57,682 $57,682 $19,017 +203% $25,581 +125% —
904 Skin grafts for injuries with CC/MCC $57,682 $57,682 $53,307 +8% $59,594 −3% —
905 Skin grafts for injuries without CC/MCC $57,682 $57,682 $24,586 +135% $25,197 +129% —
922 Other injury, poisoning and toxic effect diagnoses with MCC $57,682 $57,682 $25,121 +130% $31,563 +83% —
927 Extensive burns or full thickness burns with MV >96 hours with skin graft $57,682 $57,682 $306,087 −81% $306,087 −81% —
928 Full thickness burn with skin graft or inhalation injury with CC/MCC $57,682 $57,682 $89,353 −35% $89,353 −35% —
929 Full thickness burn with skin graft or inhalation injury without CC/MCC $57,682 $57,682 $44,472 +30% $44,472 +30% —
934 Full thickness burn without skin graft or inhalation injury $57,682 $57,682 $31,044 +86% $31,044 +86% —
940 O.R. procedures with diagnoses of other contact with health services with CC $57,682 $57,682 $30,598 +89% $43,650 +32% —
941 O.R. procedures with diagnoses of other contact with health services without CC/MCC $57,682 $57,682 $28,559 +102% $29,524 +95% —
441 Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCC $56,863 $56,863 $42,046 +35% $33,985 +67% ≈513% of Medicare
757 Infections, female reproductive system with MCC $56,814 $56,814 $21,563 +163% $26,280 +116% —
760 Menstrual and other female reproductive system disorders with CC/MCC $56,814 $56,814 $15,986 +255% $20,895 +172% —
769 Postpartum and post abortion diagnoses with O.R. procedures $56,814 $56,814 $21,228 +168% $25,094 +126% —
770 Abortion with D&C, aspiration curettage or hysterotomy $56,814 $56,814 $17,159 +231% $18,956 +200% —
790 Extreme immaturity or respiratory distress syndrome, neonate $56,814 $56,814 $80,018 −29% $80,018 −29% —
791 Prematurity with major problems $56,814 $56,814 $55,055 +3% $42,679 +33% —
793 Full term neonate with major problems $56,814 $56,814 $57,323 −1% $18,649 +205% —
796 Vaginal delivery with sterilization and/or D&C with MCC $56,814 $56,814 $16,434 +246% $22,557 +152% —
805 Vaginal delivery without sterilization or D&C with MCC $56,814 $56,814 $14,535 +291% $15,370 +270% —
811 Red blood cell disorders with MCC $56,814 $56,814 $24,733 +130% $28,226 +101% ≈666% of Medicare
831 Other antepartum diagnoses without O.R. procedures with MCC $56,814 $56,814 $18,133 +213% $18,133 +213% —
097 Non-bacterial infection of nervous system except viral meningitis with MCC $56,808 $56,808 $49,718 +14% $59,533 −5% —
862 Postoperative and post-traumatic infections with MCC $56,271 $56,271 $33,854 +66% $32,859 +71% ≈494% of Medicare
867 Other infectious and parasitic diseases diagnoses with MCC $55,965 $55,965 $35,153 +59% $38,070 +47% —
465 Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders without CC/MCC* $55,917 $55,917 $25,727 +117% $32,443 +72% —
056 Degenerative nervous system disorders with MCC $55,459 $55,459 $49,675 +12% $39,973 +39% ≈377% of Medicare
557 Tendonitis, myositis and bursitis with MCC $55,300 $55,300 $51,211 +8% $32,877 +68% —
975 HIV with major related condition with CC* $54,604 $54,604 $21,642 +152% $27,808 +96% —
976 HIV with major related condition without CC/MCC* $54,604 $54,604 $16,212 +237% $16,212 +237% —
347 Anal and stomal procedures with MCC $54,567 $54,567 $36,341 +50% $40,548 +35% —
350 Inguinal and femoral hernia procedures with MCC $54,567 $54,567 $49,941 +9% $50,046 +9% —
371 Major gastrointestinal disorders and peritoneal infections with MCC $54,567 $54,567 $54,567 +0% $33,555 +63% ≈545% of Medicare
397 Appendix procedures with MCC $54,567 $54,567 $47,356 +15% $53,257 +2% —
698 Other kidney and urinary tract diagnoses with MCC $54,072 $54,072 $35,896 +51% $32,496 +66% ≈546% of Medicare
637 Diabetes with MCC $53,999 $53,999 $32,615 +66% $30,100 +79% ≈608% of Medicare
314 Other circulatory system diagnoses with MCC $53,932 $53,932 $39,353 +37% $38,666 +39% ≈436% of Medicare
592 Skin ulcers with MCC $53,742 $53,742 $29,882 +80% $33,246 +62% —
428 Multiple level combined anterior and posterior spinal fusion except cervical without CC/MCC $53,565 $53,565 $74,414 −28% $105,899 −49% —
450 Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device $53,565 $53,565 $69,912 −23% $99,943 −46% —
461 Bilateral or multiple major joint procedures of lower extremity with MCC $53,565 $53,565 $82,458 −35% $108,472 −51% —
478 Biopsies of musculoskeletal system and connective tissue with CC $53,565 $53,565 $36,918 +45% $50,139 +7% —
479 Biopsies of musculoskeletal system and connective tissue without CC/MCC $53,565 $53,565 $26,242 +104% $34,276 +56% —
502 Soft tissue procedures without CC/MCC $53,565 $53,565 $28,160 +90% $31,017 +73% —
564 Other musculoskeletal system and connective tissue diagnoses with MCC $53,565 $53,565 $53,565 +0% $33,653 +59% —
682 Renal failure with MCC $53,297 $53,297 $35,346 +51% $29,064 +83% ≈585% of Medicare
571 Skin debridement with CC* $52,148 $52,148 $50,449 +3% $37,169 +40% ≈578% of Medicare
572 Skin debridement without CC/MCC* $52,148 $52,148 $22,580 +131% $24,944 +109% —
584 Breast biopsy, local excision and other breast procedures with CC/MCC $52,148 $52,148 $45,398 +15% $35,030 +49% —
548 Septic arthritis with MCC $51,996 $51,996 $76,195 −32% $31,346 +66% —
871 Septicemia or severe sepsis without MV >96 hours with MCC $51,843 $51,843 $37,691 +38% $35,628 +46% ≈428% of Medicare
308 Cardiac arrhythmia and conduction disorders with MCC $51,129 $51,129 $45,317 +13% $26,770 +91% ≈700% of Medicare
088 Concussion with MCC $50,835 $50,835 $21,503 +136% $24,402 +108% —
091 Other disorders of nervous system with MCC $50,835 $50,835 $36,090 +41% $37,387 +36% ≈489% of Medicare
280 Acute myocardial infarction, discharged alive with MCC $50,072 $50,072 $40,467 +24% $30,828 +62% ≈504% of Medicare
070 Nonspecific cerebrovascular disorders with MCC* $49,925 $49,925 $34,755 +44% $31,951 +56% ≈440% of Medicare
177 Respiratory infections and inflammations with MCC* $49,504 $49,504 $31,922 +55% $33,707 +47% ≈500% of Medicare
722 Malignancy, male reproductive system with MCC $49,321 $49,321 $25,633 +92% $29,826 +65% —
727 Inflammation of the male reproductive system with MCC $49,321 $49,321 $23,552 +109% $26,463 +86% —
559 Aftercare, musculoskeletal system and connective tissue with MCC* $49,223 $49,223 $44,069 +12% $33,047 +49% —
391 Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC $47,293 $47,293 $31,730 +49% $28,050 +69% ≈624% of Medicare
186 Pleural effusion with MCC* $47,202 $47,202 $41,699 +13% $33,834 +40% ≈461% of Medicare
291 Heart failure and shock with MCC $46,994 $46,994 $27,950 +68% $26,776 +76% ≈594% of Medicare
296 Cardiac arrest, unexplained with MCC $46,994 $46,994 $43,196 +9% $33,661 +40% —
444 Disorders of the biliary tract with MCC* $46,444 $46,444 $38,406 +21% $34,273 +36% ≈401% of Medicare
294 Deep vein thrombophlebitis with CC/MCC $46,304 $46,304 $19,132 +142% $19,132 +142% —
299 Peripheral vascular disorders with MCC $46,304 $46,304 $29,466 +57% $27,316 +70% ≈429% of Medicare
432 Cirrhosis and alcoholic hepatitis with MCC $45,070 $45,070 $32,942 +37% $40,213 +12% ≈361% of Medicare
327 Stomach, esophageal and duodenal procedures with CC $44,301 $44,301 $94,359 −53% $59,421 −25% ≈297% of Medicare
332 Rectal resection with MCC $44,301 $44,301 $48,214 −8% $58,125 −24% —
333 Rectal resection with CC $44,301 $44,301 $30,778 +44% $37,154 +19% —
345 Minor small and large bowel procedures with CC $44,301 $44,301 $25,298 +75% $33,048 +34% —
348 Anal and stomal procedures with CC $44,301 $44,301 $38,329 +16% $27,947 +59% —
351 Inguinal and femoral hernia procedures with CC $44,301 $44,301 $41,895 +6% $36,505 +21% —
354 Hernia procedures except inguinal and femoral with CC $44,301 $44,301 $61,483 −28% $43,477 +2% —
372 Major gastrointestinal disorders and peritoneal infections with CC $44,301 $44,301 $25,422 +74% $22,850 +94% ≈681% of Medicare
398 Appendix procedures with CC $44,301 $44,301 $51,309 −14% $40,162 +10% —
418 Laparoscopic cholecystectomy without C.D.E. with CC $44,301 $44,301 $57,572 −23% $44,606 −1% ≈433% of Medicare
419 Laparoscopic cholecystectomy without C.D.E. without CC/MCC $44,301 $44,301 $36,937 +20% $36,937 +20% ≈615% of Medicare
520 Back and neck procedures except spinal fusion without CC/MCC $44,301 $44,301 $21,795 +103% $35,465 +25% —
533 Fractures of femur with MCC $44,301 $44,301 $26,082 +70% $25,945 +71% —
534 Fractures of femur without MCC $44,301 $44,301 $17,559 +152% $17,559 +152% —
602 Cellulitis with MCC $43,953 $43,953 $36,196 +21% $30,598 +44% ≈527% of Medicare
394 Other digestive system diagnoses with CC $43,916 $43,916 $29,543 +49% $20,181 +118% ≈776% of Medicare
408 Biliary tract procedures except only cholecystectomy with or without C.D.E. with MCC $43,916 $43,916 $48,637 −10% $62,583 −30% —
415 Cholecystectomy except by laparoscope without C.D.E. with CC $43,916 $43,916 $30,551 +44% $43,913 +0% —
416 Cholecystectomy except by laparoscope without C.D.E. without CC/MCC $43,916 $43,916 $20,978 +109% $30,418 +44% —
420 Hepatobiliary diagnostic procedures with MCC $43,916 $43,916 $49,003 −10% $50,919 −14% —
289 Acute and subacute endocarditis with CC $43,727 $43,727 $23,658 +85% $32,697 +34% —
377 Gastrointestinal hemorrhage with MCC $43,440 $43,440 $52,078 −17% $37,842 +15% ≈370% of Medicare
540 Osteomyelitis with CC* $43,440 $43,440 $31,282 +39% $26,676 +63% —
638 Diabetes with CC $42,976 $42,976 $19,243 +123% $19,661 +119% ≈878% of Medicare
175 Pulmonary embolism with MCC or acute cor pulmonale $42,933 $42,933 $39,472 +9% $30,959 +39% ≈507% of Medicare
402 Single level combined anterior and posterior spinal fusion except cervical $42,933 $42,933 $53,970 −20% $79,116 −46% ≈151% of Medicare
430 Combined anterior and posterior cervical spinal fusion without MCC $42,933 $42,933 $73,986 −42% $101,618 −58% —
451 Single Level Spinal Fusion Except Cervical without MCC $42,933 $42,933 $43,247 −1% $65,216 −34% —
456 Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with MCC $42,933 $42,933 $112,119 −62% $153,282 −72% —
457 Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with CC $42,933 $42,933 $77,406 −45% $107,355 −60% ≈76% of Medicare
458 Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions without CC/MCC $42,933 $42,933 $59,237 −28% $83,441 −49% —
462 Bilateral or multiple major joint procedures of lower extremity without MCC $42,933 $42,933 $40,363 +6% $58,975 −27% —
471 Cervical spinal fusion with MCC $42,933 $42,933 $66,189 −35% $92,515 −54% —
472 Cervical spinal fusion with CC $42,933 $42,933 $41,865 +3% $59,537 −28% ≈250% of Medicare
473 Cervical spinal fusion without CC/MCC $42,933 $42,933 $33,920 +27% $50,624 −15% —
510 Shoulder, elbow or forearm procedures, except major joint procedures with MCC $42,933 $42,933 $40,289 +7% $49,839 −14% —
521 Hip replacement with principal diagnosis of hip fracture with MCC $42,933 $42,933 $100,074 −57% $70,467 −39% ≈198% of Medicare
565 Other musculoskeletal system and connective tissue diagnoses with CC $42,933 $42,933 $21,605 +99% $22,506 +91% ≈794% of Medicare
566 Other musculoskeletal system and connective tissue diagnoses without CC/MCC $42,933 $42,933 $12,903 +233% $14,716 +192% —
593 Skin ulcers with CC $42,835 $42,835 $29,409 +46% $22,886 +87% —
558 Tendonitis, myositis and bursitis without MCC $42,817 $42,817 $16,076 +166% $18,602 +130% —
949 Aftercare with CC/MCC $42,481 $42,481 $37,741 +13% $23,953 +77% —
193 Simple pneumonia and pleurisy with MCC $42,450 $42,450 $31,466 +35% $27,275 +56% ≈535% of Medicare
445 Disorders of the biliary tract with CC* $42,420 $42,420 $31,283 +36% $23,319 +82% ≈615% of Medicare
920 Complications of treatment with CC $41,968 $41,968 $24,091 +74% $22,468 +87% ≈617% of Medicare
016 Autologous bone marrow transplant with CC/MCC $41,620 $41,620 $81,176 −49% $98,260 −58% —
062 Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with CC $41,620 $41,620 $65,200 −36% $52,075 −20% —
065 Intracranial hemorrhage or cerebral infarction with CC or tPA in 24 hours $41,620 $41,620 $33,054 +26% $23,940 +74% ≈729% of Medicare
079 Hypertensive encephalopathy without CC/MCC $41,620 $41,620 $24,001 +73% $11,847 +251% —
080 Nontraumatic stupor and coma with MCC $41,620 $41,620 $35,307 +18% $36,249 +15% —
081 Nontraumatic stupor and coma without MCC $41,620 $41,620 $14,937 +179% $16,552 +151% —
085 Traumatic stupor and coma <1 hour with MCC $41,620 $41,620 $32,604 +28% $41,892 −1% ≈304% of Medicare
095 Bacterial and tuberculous infections of nervous system with CC* $41,620 $41,620 $88,128 −53% $47,583 −13% —
096 Bacterial and tuberculous infections of nervous system without CC/MCC* $41,620 $41,620 $125,467 −67% $41,620 +0% —
100 Seizures with MCC $41,620 $41,620 $34,570 +20% $35,481 +17% ≈352% of Medicare
101 Seizures without MCC $41,620 $41,620 $17,956 +132% $20,461 +103% ≈854% of Medicare
102 Headaches with MCC $41,620 $41,620 $18,243 +128% $25,740 +62% —
103 Headaches without MCC $41,620 $41,620 $20,630 +102% $21,280 +96% ≈855% of Medicare
124 Other disorders of the eye with MCC or thrombolytic agent $41,620 $41,620 $20,117 +107% $21,894 +90% —
125 Other disorders of the eye without MCC $41,620 $41,620 $15,868 +162% $17,298 +141% —
158 Dental and oral diseases with CC $41,620 $41,620 $19,778 +110% $18,466 +125% —
159 Dental and oral diseases without CC/MCC $41,620 $41,620 $11,755 +254% $13,633 +205% —
199 Pneumothorax with MCC $41,620 $41,620 $40,222 +3% $33,787 +23% ≈378% of Medicare
200 Pneumothorax with CC $41,620 $41,620 $17,568 +137% $21,368 +95% ≈633% of Medicare
201 Pneumothorax without CC/MCC $41,620 $41,620 $11,982 +247% $14,053 +196% —
265 AICD lead procedures $41,620 $41,620 $49,492 −16% $63,171 −34% —
286 Circulatory disorders except AMI, with cardiac catheterization with MCC $41,620 $41,620 $54,337 −23% $46,283 −10% ≈301% of Medicare
287 Circulatory disorders except AMI, with cardiac catheterization without MCC $41,620 $41,620 $41,620 +0% $32,021 +30% ≈649% of Medicare
290 Acute and subacute endocarditis without CC/MCC $41,620 $41,620 $15,901 +162% $15,901 +162% —
305 Hypertension without MCC $41,620 $41,620 $27,094 +54% $18,086 +130% ≈1017% of Medicare
311 Angina pectoris $41,620 $41,620 $19,453 +114% $15,502 +168% —
313 Chest pain $41,620 $41,620 $17,918 +132% $16,440 +153% ≈1032% of Medicare
357 Other digestive system O.R. procedures with CC $41,620 $41,620 $44,618 −7% $48,682 −15% —
358 Other digestive system O.R. procedures without CC/MCC $41,620 $41,620 $29,026 +43% $30,083 +38% —
368 Major esophageal disorders with MCC* $41,620 $41,620 $29,372 +42% $33,876 +23% ≈372% of Medicare
369 Major esophageal disorders with CC* $41,620 $41,620 $23,734 +75% $25,303 +64% —
381 Complicated peptic ulcer with CC $41,620 $41,620 $32,483 +28% $24,177 +72% ≈681% of Medicare
383 Uncomplicated peptic ulcer with MCC $41,620 $41,620 $41,620 +0% $27,426 +52% —
389 Gastrointestinal obstruction with CC $41,620 $41,620 $17,991 +131% $17,578 +137% ≈933% of Medicare
406 Pancreas, liver and shunt procedures with CC $41,620 $41,620 $39,644 +5% $58,043 −28% ≈246% of Medicare
412 Cholecystectomy with C.D.E. with CC $41,620 $41,620 $30,860 +35% $42,906 −3% —
439 Disorders of pancreas except malignancy with CC $41,620 $41,620 $21,120 +97% $19,096 +118% ≈885% of Medicare
470 Major hip and knee joint replacement or reattachment of lower extremity without MCC $41,620 $41,620 $69,428 −40% $50,607 −18% ≈274% of Medicare
475 Amputation for musculoskeletal system and connective tissue disorders with CC $41,620 $41,620 $31,193 +33% $45,877 −9% —
476 Amputation for musculoskeletal system and connective tissue disorders without CC/MCC $41,620 $41,620 $18,290 +128% $23,443 +78% —
480 Hip and femur procedures except major joint with MCC $41,620 $41,620 $80,371 −48% $65,653 −37% ≈217% of Medicare
481 Hip and femur procedures except major joint with CC $41,620 $41,620 $78,716 −47% $52,751 −21% ≈317% of Medicare
482 Hip and femur procedures except major joint without CC/MCC $41,620 $41,620 $60,868 −32% $41,955 −1% ≈469% of Medicare
496 Local excision and removal of internal fixation devices except hip and femur with CC $41,620 $41,620 $45,946 −9% $43,800 −5% —
549 Septic arthritis with CC $41,620 $41,620 $41,585 +0% $24,056 +73% —
552 Medical back problems without MCC $41,620 $41,620 $25,521 +63% $21,396 +95% ≈757% of Medicare
553 Bone diseases and arthropathies with MCC $41,620 $41,620 $20,145 +107% $26,051 +60% —
595 Major skin disorders with MCC $41,620 $41,620 $30,646 +36% $34,598 +20% —
597 Malignant breast disorders with MCC $41,620 $41,620 $29,733 +40% $33,386 +25% —
598 Malignant breast disorders with CC $41,620 $41,620 $17,197 +142% $19,073 +118% —
605 Trauma to the skin, subcutaneous tissue and breast without MCC $41,620 $41,620 $25,095 +66% $20,506 +103% ≈743% of Medicare
618 Amputation of lower limb for endocrine, nutritional and metabolic disorders without CC/MCC $41,620 $41,620 $19,354 +115% $19,354 +115% —
621 O.R. procedures for obesity without CC/MCC $41,620 $41,620 $44,110 −6% $32,451 +28% —
624 Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders without CC/MCC $41,620 $41,620 $16,213 +157% $17,737 +135% —
626 Thyroid, parathyroid and thyroglossal procedures with CC $41,620 $41,620 $22,783 +83% $33,454 +24% —
627 Thyroid, parathyroid and thyroglossal procedures without CC/MCC $41,620 $41,620 $20,242 +106% $28,125 +48% —
629 Other endocrine, nutritional and metabolic O.R. procedures with CC $41,620 $41,620 $32,385 +29% $47,737 −13% ≈274% of Medicare
630 Other endocrine, nutritional and metabolic O.R. procedures without CC/MCC $41,620 $41,620 $21,661 +92% $22,393 +86% —
694 Urinary stones without MCC $41,620 $41,620 $22,004 +89% $17,345 +140% —
723 Malignancy, male reproductive system with CC $41,620 $41,620 $17,768 +134% $19,815 +110% —
756 Malignancy, female reproductive system without CC/MCC $41,620 $41,620 $15,589 +167% $15,589 +167% —
758 Infections, female reproductive system with CC $41,620 $41,620 $22,879 +82% $20,901 +99% —
759 Infections, female reproductive system without CC/MCC $41,620 $41,620 $10,171 +309% $14,250 +192% —
761 Menstrual and other female reproductive system disorders without CC/MCC $41,620 $41,620 $11,421 +264% $11,421 +264% —
768 Vaginal delivery with O.R. procedures except sterilization and/or D&C $41,620 $41,620 $17,725 +135% $16,846 +147% —
776 Postpartum and post abortion diagnoses without O.R. procedures $41,620 $41,620 $12,454 +234% $12,454 +234% —
779 Abortion without D&C $41,620 $41,620 $15,327 +172% $15,327 +172% —
789 Neonates, died or transferred to another acute care facility $41,620 $41,620 $26,590 +57% $16,351 +155% —
792 Prematurity without major problems $41,620 $41,620 $34,988 +19% $12,229 +240% —
794 Neonate with other significant problems $41,620 $41,620 $15,240 +173% $8,445 +393% —
797 Vaginal delivery with sterilization and/or D&C with CC $41,620 $41,620 $19,978 +108% $19,962 +108% —
798 Vaginal delivery with sterilization and/or D&C without CC/MCC $41,620 $41,620 $14,414 +189% $18,452 +126% —
800 Splenic procedures with CC $41,620 $41,620 $41,012 +1% $49,184 −15% —
806 Vaginal delivery without sterilization or D&C with CC $41,620 $41,620 $15,085 +176% $13,275 +214% —
813 Coagulation disorders $41,620 $41,620 $24,365 +71% $33,296 +25% ≈362% of Medicare
814 Reticuloendothelial and immunity disorders with MCC* $41,620 $41,620 $30,326 +37% $33,851 +23% —
815 Reticuloendothelial and immunity disorders with CC* $41,620 $41,620 $16,382 +154% $19,264 +116% —
816 Reticuloendothelial and immunity disorders without CC/MCC* $41,620 $41,620 $11,752 +254% $14,638 +184% —
832 Other antepartum diagnoses without O.R. procedures with CC $41,620 $41,620 $11,484 +262% $12,895 +223% —
834 Acute leukemia with MCC $41,620 $41,620 $74,709 −44% $85,566 −51% ≈98% of Medicare
837 Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy agent with MCC $41,620 $41,620 $68,095 −39% $77,055 −46% —
840 Lymphoma and non-acute leukemia with MCC $41,620 $41,620 $44,584 −7% $49,710 −16% ≈198% of Medicare
846 Chemotherapy without acute leukemia as secondary diagnosis with MCC $41,620 $41,620 $36,339 +15% $38,878 +7% ≈162% of Medicare
849 Radiotherapy $41,620 $41,620 $37,862 +10% $37,862 +10% —
864 Fever and inflammatory conditions $41,620 $41,620 $26,362 +58% $18,640 +123% —
865 Viral illness with MCC $41,620 $41,620 $22,618 +84% $26,910 +55% —
866 Viral illness without MCC $41,620 $41,620 $14,678 +184% $17,081 +144% —
868 Other infectious and parasitic diseases diagnoses with CC $41,620 $41,620 $25,400 +64% $22,763 +83% —
869 Other infectious and parasitic diseases diagnoses without CC/MCC $41,620 $41,620 $12,771 +226% $12,559 +231% —
921 Complications of treatment without CC/MCC $41,620 $41,620 $26,949 +54% $14,415 +189% —
977 HIV with or without other related condition $41,620 $41,620 $21,908 +90% $22,525 +85% —
489 Knee procedures without principal diagnosis of infection without CC/MCC $41,260 $41,260 $37,051 +11% $28,320 +46% —
541 Osteomyelitis without CC/MCC* $41,260 $41,260 $14,549 +184% $15,215 +171% —
724 Malignancy, male reproductive system without CC/MCC $40,130 $40,130 $12,650 +217% $12,768 +214% —
728 Inflammation of the male reproductive system without MCC $40,130 $40,130 $20,206 +99% $17,118 +134% —
190 Chronic obstructive pulmonary disease with MCC* $39,910 $39,910 $29,232 +37% $24,386 +64% ≈611% of Medicare
191 Chronic obstructive pulmonary disease with CC* $39,910 $39,910 $27,183 +47% $18,807 +112% ≈806% of Medicare
192 Chronic obstructive pulmonary disease without CC/MCC* $39,910 $39,910 $19,614 +103% $14,368 +178% —
067 Nonspecific CVA and precerebral occlusion without infarction with MCC $39,006 $39,006 $22,077 +77% $24,941 +56% —
075 Viral meningitis with CC/MCC $39,006 $39,006 $39,006 +0% $30,447 +28% —
076 Viral meningitis without CC/MCC $39,006 $39,006 $15,094 +158% $17,135 +128% —
083 Traumatic stupor and coma >1 hour with CC* $39,006 $39,006 $24,877 +57% $27,285 +43% ≈473% of Medicare
084 Traumatic stupor and coma >1 hour without CC/MCC* $39,006 $39,006 $15,603 +150% $19,924 +96% —
086 Traumatic stupor and coma <1 hour with CC $39,006 $39,006 $32,559 +20% $27,043 +44% ≈495% of Medicare
087 Traumatic stupor and coma <1 hour without CC/MCC $39,006 $39,006 $14,668 +166% $16,520 +136% —
098 Non-bacterial infection of nervous system except viral meningitis with CC $39,006 $39,006 $31,349 +24% $42,901 −9% —
146 Ear, nose, mouth and throat malignancy with MCC* $39,006 $39,006 $32,969 +18% $40,108 −3% —
147 Ear, nose, mouth and throat malignancy with CC* $39,006 $39,006 $19,350 +102% $22,851 +71% —
148 Ear, nose, mouth and throat malignancy without CC/MCC* $39,006 $39,006 $13,586 +187% $13,586 +187% —
153 Otitis media and URI without MCC $39,006 $39,006 $20,533 +90% $14,583 +167% —
156 Other ear, nose, mouth and throat diagnoses without CC/MCC $39,006 $39,006 $11,921 +227% $14,549 +168% —
176 Pulmonary embolism without MCC $39,006 $39,006 $24,353 +60% $18,081 +116% ≈928% of Medicare
204 Respiratory signs and symptoms $39,006 $39,006 $13,720 +184% $18,004 +117% —
206 Other respiratory system diagnoses without MCC $39,006 $39,006 $19,117 +104% $18,488 +111% —
243 Permanent cardiac pacemaker implant with CC $39,006 $39,006 $110,293 −65% $50,011 −22% ≈276% of Medicare
261 Cardiac pacemaker revision except device replacement with CC $39,006 $39,006 $41,108 −5% $42,126 −7% —
281 Acute myocardial infarction, discharged alive with CC $39,006 $39,006 $29,140 +34% $20,463 +91% ≈768% of Medicare
284 Acute myocardial infarction, expired with CC $39,006 $39,006 $11,329 +244% $16,450 +137% —
302 Atherosclerosis with MCC $39,006 $39,006 $19,372 +101% $22,446 +74% —
307 Cardiac congenital and valvular disorders without MCC $39,006 $39,006 $15,217 +156% $20,566 +90% —
320 Other endovascular cardiac valve procedures without MCC $39,006 $39,006 $33,237 +17% $40,060 −3% —
321 Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/intraluminal devices $39,006 $39,006 $124,873 −69% $81,706 −52% ≈188% of Medicare
323 Coronary intravascular lithotripsy with intraluminal device with MCC $39,006 $39,006 $58,476 −33% $101,510 −62% —
325 Coronary intravascular lithotripsy without intraluminal device $39,006 $39,006 $145,959 −73% $61,217 −36% —
328 Stomach, esophageal and duodenal procedures without CC/MCC $39,006 $39,006 $48,482 −20% $39,006 +0% ≈370% of Medicare
330 Major small and large bowel procedures with CC $39,006 $39,006 $59,500 −34% $59,500 −34% ≈243% of Medicare
331 Major small and large bowel procedures without CC/MCC $39,006 $39,006 $51,962 −25% $44,117 −12% ≈363% of Medicare
334 Rectal resection without CC/MCC $39,006 $39,006 $24,721 +58% $36,820 +6% —
335 Peritoneal adhesiolysis with MCC $39,006 $39,006 $71,508 −45% $71,755 −46% —
336 Peritoneal adhesiolysis with CC $39,006 $39,006 $51,108 −24% $50,463 −23% ≈278% of Medicare
337 Peritoneal adhesiolysis without CC/MCC $39,006 $39,006 $44,310 −12% $39,211 −1% —
346 Minor small and large bowel procedures without CC/MCC $39,006 $39,006 $36,599 +7% $27,297 +43% —
349 Anal and stomal procedures without CC/MCC $39,006 $39,006 $14,627 +167% $19,854 +96% —
352 Inguinal and femoral hernia procedures without CC/MCC $39,006 $39,006 $33,589 +16% $27,843 +40% —
355 Hernia procedures except inguinal and femoral without CC/MCC $39,006 $39,006 $45,971 −15% $32,841 +19% ≈510% of Medicare
373 Major gastrointestinal disorders and peritoneal infections without CC/MCC $39,006 $39,006 $17,527 +123% $16,767 +133% —
375 Digestive malignancy with CC* $39,006 $39,006 $24,270 +61% $27,277 +43% ≈541% of Medicare
376 Digestive malignancy without CC/MCC* $39,006 $39,006 $14,654 +166% $16,998 +129% —
378 Gastrointestinal hemorrhage with CC $39,006 $39,006 $33,279 +17% $22,098 +77% ≈682% of Medicare
379 Gastrointestinal hemorrhage without CC/MCC $39,006 $39,006 $20,048 +95% $15,038 +159% —
382 Complicated peptic ulcer without CC/MCC $39,006 $39,006 $12,919 +202% $16,634 +134% —
399 Appendix procedures without CC/MCC $39,006 $39,006 $39,586 −1% $31,321 +25% —
407 Pancreas, liver and shunt procedures without CC/MCC $39,006 $39,006 $30,914 +26% $46,727 −17% ≈274% of Medicare
409 Biliary tract procedures except only cholecystectomy with or without C.D.E. with CC $39,006 $39,006 $30,404 +28% $46,066 −15% —
410 Biliary tract procedures except only cholecystectomy with or without C.D.E. without CC/MCC $39,006 $39,006 $23,326 +67% $34,434 +13% —
413 Cholecystectomy with C.D.E. without CC/MCC $39,006 $39,006 $24,771 +57% $29,316 +33% —
421 Hepatobiliary diagnostic procedures with CC $39,006 $39,006 $24,448 +60% $36,354 +7% —
422 Hepatobiliary diagnostic procedures without CC/MCC $39,006 $39,006 $22,265 +75% $25,073 +56% —
424 Other hepatobiliary or pancreas O.R. procedures with CC $39,006 $39,006 $32,829 +19% $42,415 −8% —
425 Other hepatobiliary or pancreas O.R. procedures without CC/MCC $39,006 $39,006 $23,257 +68% $26,598 +47% —
433 Cirrhosis and alcoholic hepatitis with CC $39,006 $39,006 $29,825 +31% $23,749 +64% ≈569% of Medicare
436 Malignancy of hepatobiliary system or pancreas with CC $39,006 $39,006 $37,880 +3% $25,034 +56% ≈605% of Medicare
437 Malignancy of hepatobiliary system or pancreas without CC/MCC $39,006 $39,006 $16,441 +137% $14,014 +178% —
440 Disorders of pancreas except malignancy without CC/MCC $39,006 $39,006 $17,275 +126% $15,183 +157% ≈1498% of Medicare
446 Disorders of the biliary tract without CC/MCC* $39,006 $39,006 $34,577 +13% $17,700 +120% ≈1011% of Medicare
503 Foot procedures with MCC $39,006 $39,006 $73,699 −47% $47,540 −18% —
504 Foot procedures with CC $39,006 $39,006 $39,089 −0% $38,960 +0% —
505 Foot procedures without CC/MCC $39,006 $39,006 $26,308 +48% $34,937 +12% —
507 Major shoulder or elbow joint procedures with CC/MCC $39,006 $39,006 $28,350 +38% $37,240 +5% —
509 Arthroscopy $39,006 $39,006 $25,994 +50% $25,994 +50% —
511 Shoulder, elbow or forearm procedures, except major joint procedures with CC $39,006 $39,006 $39,006 +0% $43,538 −10% —
522 Hip replacement with principal diagnosis of hip fracture without MCC $39,006 $39,006 $74,394 −48% $58,280 −33% ≈283% of Medicare
535 Fractures of hip and pelvis with MCC $39,006 $39,006 $33,107 +18% $24,552 +59% —
537 Sprains, strains, and dislocations of hip, pelvis and thigh with CC/MCC $39,006 $39,006 $15,121 +158% $18,072 +116% —
542 Pathological fractures and musculoskeletal and connective tissue malignancy with MCC* $39,006 $39,006 $39,006 +0% $36,792 +6% ≈442% of Medicare
543 Pathological fractures and musculoskeletal and connective tissue malignancy with CC* $39,006 $39,006 $22,205 +76% $23,551 +66% ≈608% of Medicare
546 Connective tissue disorders with CC $39,006 $39,006 $18,220 +114% $25,700 +52% —
550 Septic arthritis without CC/MCC $39,006 $39,006 $14,383 +171% $19,138 +104% —
555 Signs and symptoms of musculoskeletal system and connective tissue with MCC $39,006 $39,006 $30,021 +30% $24,127 +62% —
556 Signs and symptoms of musculoskeletal system and connective tissue without MCC $39,006 $39,006 $13,791 +183% $18,126 +115% ≈763% of Medicare
596 Major skin disorders without MCC $39,006 $39,006 $17,226 +126% $17,226 +126% —
599 Malignant breast disorders without CC/MCC $39,006 $39,006 $14,290 +173% $14,290 +173% —
600 Non-malignant breast disorders with CC/MCC* $39,006 $39,006 $15,610 +150% $16,700 +134% —
601 Non-malignant breast disorders without CC/MCC* $39,006 $39,006 $10,975 +255% $10,975 +255% —
607 Minor skin disorders without MCC $39,006 $39,006 $29,306 +33% $15,889 +145% ≈738% of Medicare
639 Diabetes without CC/MCC $39,006 $39,006 $18,007 +117% $13,910 +180% ≈999% of Medicare
644 Endocrine disorders with CC* $39,006 $39,006 $20,072 +94% $23,198 +68% ≈617% of Medicare
645 Endocrine disorders without CC/MCC* $39,006 $39,006 $14,675 +166% $15,428 +153% —
695 Kidney and urinary tract signs and symptoms with MCC $39,006 $39,006 $24,656 +58% $24,566 +59% —
696 Kidney and urinary tract signs and symptoms without MCC $39,006 $39,006 $15,788 +147% $14,689 +166% —
697 Urethral stricture $39,006 $39,006 $16,196 +141% $18,428 +112% —
708 Major male pelvic procedures without CC/MCC $39,006 $39,006 $22,435 +74% $36,988 +5% —
710 Penis procedures without CC/MCC $39,006 $39,006 $22,681 +72% $26,436 +48% —
712 Testes procedures without CC/MCC $39,006 $39,006 $17,076 +128% $18,898 +106% —
714 Transurethral prostatectomy without CC/MCC $39,006 $39,006 $16,402 +138% $17,934 +118% —
716 Other male reproductive system O.R. procedures for malignancy without CC/MCC $39,006 $39,006 $21,615 +80% $22,620 +72% —
718 Other male reproductive system O.R. procedures except malignancy without CC/MCC $39,006 $39,006 $22,960 +70% $19,270 +102% —
729 Other male reproductive system diagnoses with CC/MCC $39,006 $39,006 $17,483 +123% $17,483 +123% —
730 Other male reproductive system diagnoses without CC/MCC $39,006 $39,006 $11,071 +252% $11,071 +252% —
785 Cesarean section with sterilization without CC/MCC $39,006 $39,006 $21,775 +79% $19,846 +97% —
788 Cesarean section without sterilization without CC/MCC $39,006 $39,006 $20,139 +94% $20,084 +94% —
809 Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with CC $39,006 $39,006 $24,572 +59% $22,458 +74% ≈455% of Medicare
810 Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without CC/MCC $39,006 $39,006 $40,293 −3% $18,316 +113% —
812 Red blood cell disorders without MCC $39,006 $39,006 $22,569 +73% $20,488 +90% ≈719% of Medicare
825 Lymphoma and non-acute leukemia with other procedures without CC/MCC $39,006 $39,006 $19,169 +103% $27,323 +43% —
830 Myeloproliferative disorders or poorly differentiated neoplasms with other procedures without CC/MCC $39,006 $39,006 $22,175 +76% $31,170 +25% —
855 Infectious and parasitic diseases with O.R. procedures without CC/MCC $39,006 $39,006 $24,292 +61% $28,202 +38% —
858 Postoperative or post-traumatic infections with O.R. procedures without CC/MCC $39,006 $39,006 $19,916 +96% $25,748 +51% —
913 Traumatic injury with MCC $39,006 $39,006 $27,649 +41% $24,198 +61% —
915 Allergic reactions with MCC $39,006 $39,006 $41,366 −6% $32,645 +19% —
916 Allergic reactions without MCC $39,006 $39,006 $15,322 +155% $13,942 +180% —
923 Other injury, poisoning and toxic effect diagnoses without MCC $39,006 $39,006 $18,375 +112% $17,601 +122% —
933 Extensive burns or full thickness burns with MV >96 hours without skin graft $39,006 $39,006 $59,352 −34% $59,352 −34% —
947 Signs and symptoms with MCC $39,006 $39,006 $32,529 +20% $27,401 +42% ≈543% of Medicare
964 Other multiple significant trauma with CC $39,006 $39,006 $23,966 +63% $27,394 +42% —
965 Other multiple significant trauma without CC/MCC $39,006 $39,006 $16,434 +137% $20,259 +93% —
057 Degenerative nervous system disorders without MCC $38,908 $38,908 $30,644 +27% $27,543 +41% ≈487% of Medicare
689 Kidney and urinary tract infections with MCC $38,585 $38,585 $26,858 +44% $23,617 +63% ≈560% of Medicare
089 Concussion with CC $38,432 $38,432 $17,109 +125% $18,821 +104% —
092 Other disorders of nervous system with CC $38,432 $38,432 $33,295 +15% $24,914 +54% ≈627% of Medicare
560 Aftercare, musculoskeletal system and connective tissue with CC* $38,377 $38,377 $21,201 +81% $25,279 +52% —
392 Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC $38,255 $38,255 $18,806 +103% $17,322 +121% ≈841% of Medicare
068 Nonspecific CVA and precerebral occlusion without infarction without MCC $38,084 $38,084 $26,359 +44% $19,569 +95% ≈818% of Medicare
069 Transient ischemia without thrombolytic $38,084 $38,084 $27,659 +38% $21,056 +81% ≈887% of Medicare
071 Nonspecific cerebrovascular disorders with CC* $38,084 $38,084 $22,313 +71% $23,488 +62% ≈602% of Medicare
072 Nonspecific cerebrovascular disorders without CC/MCC* $38,084 $38,084 $16,925 +125% $19,037 +100% —
315 Other circulatory system diagnoses with CC $37,962 $37,962 $20,809 +82% $21,363 +78% ≈666% of Medicare
863 Postoperative and post-traumatic infections without MCC $37,956 $37,956 $19,734 +92% $20,957 +81% ≈733% of Medicare
699 Other kidney and urinary tract diagnoses with CC $37,803 $37,803 $22,138 +71% $21,275 +78% ≈596% of Medicare
641 Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCC $37,553 $37,553 $19,935 +88% $17,038 +120% ≈827% of Medicare
547 Connective tissue disorders without CC/MCC $37,504 $37,504 $17,357 +116% $16,565 +126% —
561 Aftercare, musculoskeletal system and connective tissue without CC/MCC* $37,504 $37,504 $27,428 +37% $18,150 +107% —
563 Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCC $37,504 $37,504 $20,530 +83% $19,842 +89% ≈789% of Medicare
683 Renal failure with CC $36,966 $36,966 $16,816 +120% $19,130 +93% ≈704% of Medicare
187 Pleural effusion with CC* $36,160 $36,160 $22,677 +59% $21,789 +66% —
188 Pleural effusion without CC/MCC* $36,160 $36,160 $12,723 +184% $14,514 +149% —
872 Septicemia or severe sepsis without MV >96 hours without MCC $34,737 $34,737 $24,661 +41% $22,888 +52% ≈576% of Medicare
300 Peripheral vascular disorders with CC $33,900 $33,900 $23,406 +45% $20,422 +66% ≈552% of Medicare
292 Heart failure and shock with CC $33,369 $33,369 $22,544 +48% $16,371 +104% ≈649% of Medicare
297 Cardiac arrest, unexplained with CC $33,369 $33,369 $50,570 −34% $12,336 +171% —
298 Cardiac arrest, unexplained without CC/MCC $33,369 $33,369 $8,927 +274% $8,927 +274% —
194 Simple pneumonia and pleurisy with CC $32,575 $32,575 $24,273 +34% $18,204 +79% ≈727% of Medicare
178 Respiratory infections and inflammations with CC* $31,824 $31,824 $28,603 +11% $22,024 +44% ≈537% of Medicare
179 Respiratory infections and inflammations without CC/MCC* $31,824 $31,824 $15,326 +108% $14,648 +117% —
603 Cellulitis without MCC $29,406 $29,406 $21,796 +35% $18,530 +59% ≈575% of Medicare
014 Allogeneic bone marrow transplant $29,192 $29,192 $171,028 −83% $182,314 −84% —
017 Autologous bone marrow transplant without CC/MCC $29,192 $29,192 $81,176 −64% $81,176 −64% —
030 Spinal procedures without CC/MCC $29,192 $29,192 $32,077 −9% $45,866 −36% —
055 Nervous system neoplasms without MCC $29,192 $29,192 $41,432 −30% $20,926 +40% —
058 Multiple sclerosis and cerebellar ataxia with MCC $29,192 $29,192 $32,985 −11% $30,243 −3% —
059 Multiple sclerosis and cerebellar ataxia with CC $29,192 $29,192 $21,446 +36% $27,163 +7% —
060 Multiple sclerosis and cerebellar ataxia without CC/MCC $29,192 $29,192 $25,981 +12% $22,148 +32% —
063 Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent without CC/MCC $29,192 $29,192 $49,318 −41% $39,887 −27% —
066 Intracranial hemorrhage or cerebral infarction without CC/MCC $29,192 $29,192 $20,876 +40% $20,781 +40% ≈850% of Medicare
074 Cranial and peripheral nerve disorders without MCC $29,192 $29,192 $29,080 +0% $23,141 +26% ≈472% of Medicare
090 Concussion without CC/MCC $29,192 $29,192 $14,321 +104% $15,412 +89% —
093 Other disorders of nervous system without CC/MCC $29,192 $29,192 $18,755 +56% $17,620 +66% —
099 Non-bacterial infection of nervous system except viral meningitis without CC/MCC $29,192 $29,192 $21,277 +37% $27,119 +8% —
121 Acute major eye infections with CC/MCC $29,192 $29,192 $18,291 +60% $19,412 +50% —
122 Acute major eye infections without CC/MCC $29,192 $29,192 $11,997 +143% $11,997 +143% —
123 Neurological eye disorders $29,192 $29,192 $13,618 +114% $19,745 +48% —
149 Dysequilibrium $29,192 $29,192 $21,737 +34% $18,096 +61% ≈697% of Medicare
150 Epistaxis with MCC $29,192 $29,192 $21,133 +38% $23,171 +26% —
151 Epistaxis without MCC $29,192 $29,192 $13,032 +124% $13,032 +124% —
180 Respiratory neoplasms with MCC* $29,192 $29,192 $41,406 −29% $36,658 −20% ≈270% of Medicare
181 Respiratory neoplasms with CC* $29,192 $29,192 $29,493 −1% $23,573 +24% ≈404% of Medicare
182 Respiratory neoplasms without CC/MCC* $29,192 $29,192 $14,064 +108% $14,064 +108% —
183 Major chest trauma with MCC $29,192 $29,192 $23,796 +23% $29,933 −2% —
184 Major chest trauma with CC $29,192 $29,192 $20,832 +40% $22,432 +30% —
185 Major chest trauma without CC/MCC $29,192 $29,192 $13,288 +120% $17,124 +70% —
195 Simple pneumonia and pleurisy without CC/MCC $29,192 $29,192 $14,615 +100% $13,824 +111% —
203 Bronchitis and asthma without CC/MCC $29,192 $29,192 $12,235 +139% $12,252 +138% —
244 Permanent cardiac pacemaker implant without CC/MCC $29,192 $29,192 $84,875 −66% $41,591 −30% —
259 Cardiac pacemaker device replacement without MCC $29,192 $29,192 $27,599 +6% $39,020 −25% —
262 Cardiac pacemaker revision except device replacement without CC/MCC $29,192 $29,192 $26,043 +12% $33,694 −13% —
282 Acute myocardial infarction, discharged alive without CC/MCC $29,192 $29,192 $32,532 −10% $19,227 +52% ≈785% of Medicare
285 Acute myocardial infarction, expired without CC/MCC $29,192 $29,192 $10,480 +179% $10,480 +179% —
293 Heart failure and shock without CC/MCC $29,192 $29,192 $10,316 +183% $12,999 +125% —
295 Deep vein thrombophlebitis without CC/MCC $29,192 $29,192 $13,445 +117% $13,445 +117% —
301 Peripheral vascular disorders without CC/MCC $29,192 $29,192 $15,461 +89% $15,837 +84% ≈717% of Medicare
303 Atherosclerosis without MCC $29,192 $29,192 $20,526 +42% $14,927 +96% ≈796% of Medicare
309 Cardiac arrhythmia and conduction disorders with CC $29,192 $29,192 $21,581 +35% $17,303 +69% ≈720% of Medicare
310 Cardiac arrhythmia and conduction disorders without CC/MCC $29,192 $29,192 $20,885 +40% $13,384 +118% ≈1114% of Medicare
316 Other circulatory system diagnoses without CC/MCC $29,192 $29,192 $12,578 +132% $13,651 +114% —
317 Concomitant left atrial appendage closure and cardiac ablation $29,192 $29,192 $83,090 −65% $88,566 −67% —
322 Percutaneous cardiovascular procedures with intraluminal device without MCC $29,192 $29,192 $90,850 −68% $58,809 −50% ≈271% of Medicare
324 Coronary intravascular lithotripsy with intraluminal device without MCC $29,192 $29,192 $76,704 −62% $71,464 −59% ≈140% of Medicare
370 Major esophageal disorders without CC/MCC* $29,192 $29,192 $24,272 +20% $15,495 +88% —
384 Uncomplicated peptic ulcer without MCC $29,192 $29,192 $24,084 +21% $19,305 +51% —
390 Gastrointestinal obstruction without CC/MCC $29,192 $29,192 $16,503 +77% $13,361 +118% ≈1093% of Medicare
395 Other digestive system diagnoses without CC/MCC $29,192 $29,192 $16,396 +78% $14,128 +107% ≈875% of Medicare
434 Cirrhosis and alcoholic hepatitis without CC/MCC $29,192 $29,192 $12,234 +139% $12,460 +134% —
442 Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CC $29,192 $29,192 $21,410 +36% $21,449 +36% ≈527% of Medicare
443 Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without CC/MCC $29,192 $29,192 $17,650 +65% $15,600 +87% —
467 Revision of hip or knee replacement with CC $29,192 $29,192 $50,408 −42% $70,847 −59% ≈123% of Medicare
468 Revision of hip or knee replacement without CC/MCC $29,192 $29,192 $37,242 −22% $54,929 −47% ≈164% of Medicare
486 Knee procedures with principal diagnosis of infection with CC $29,192 $29,192 $47,529 −39% $49,351 −41% —
487 Knee procedures with principal diagnosis of infection without CC/MCC $29,192 $29,192 $23,703 +23% $35,074 −17% —
494 Lower extremity and humerus procedures except hip, foot and femur without CC/MCC $29,192 $29,192 $80,287 −64% $47,711 −39% ≈240% of Medicare
497 Local excision and removal of internal fixation devices except hip and femur without CC/MCC $29,192 $29,192 $20,619 +42% $29,805 −2% —
506 Major thumb or joint procedures $29,192 $29,192 $22,651 +29% $30,557 −4% —
508 Major shoulder or elbow joint procedures without CC/MCC $29,192 $29,192 $19,945 +46% $22,811 +28% —
512 Shoulder, elbow or forearm procedures, except major joint procedures without CC/MCC $29,192 $29,192 $26,756 +9% $35,692 −18% —
513 Hand or wrist procedures, except major thumb or joint procedures with CC/MCC $29,192 $29,192 $26,787 +9% $33,424 −13% —
514 Hand or wrist procedures, except major thumb or joint procedures without CC/MCC $29,192 $29,192 $16,427 +78% $22,635 +29% —
516 Other musculoskeletal system and connective tissue O.R. procedures with CC $29,192 $29,192 $29,304 −0% $46,090 −37% ≈228% of Medicare
517 Other musculoskeletal system and connective tissue O.R. procedures without CC/MCC $29,192 $29,192 $25,880 +13% $33,393 −13% —
536 Fractures of hip and pelvis without MCC $29,192 $29,192 $18,064 +62% $18,002 +62% ≈706% of Medicare
538 Sprains, strains, and dislocations of hip, pelvis and thigh without CC/MCC $29,192 $29,192 $11,909 +145% $11,909 +145% —
544 Pathological fractures and musculoskeletal and connective tissue malignancy without CC/MCC* $29,192 $29,192 $23,768 +23% $16,776 +74% —
554 Bone diseases and arthropathies without MCC $29,192 $29,192 $15,310 +91% $18,528 +58% ≈615% of Medicare
585 Breast biopsy, local excision and other breast procedures without CC/MCC $29,192 $29,192 $28,958 +1% $32,574 −10% —
594 Skin ulcers without CC/MCC $29,192 $29,192 $14,209 +105% $14,209 +105% —
642 Inborn and other disorders of metabolism $29,192 $29,192 $17,545 +66% $20,727 +41% —
684 Renal failure without CC/MCC $29,192 $29,192 $13,284 +120% $13,642 +114% ≈1067% of Medicare
686 Kidney and urinary tract neoplasms with MCC $29,192 $29,192 $27,668 +6% $37,844 −23% —
687 Kidney and urinary tract neoplasms with CC $29,192 $29,192 $16,857 +73% $20,232 +44% —
688 Kidney and urinary tract neoplasms without CC/MCC $29,192 $29,192 $12,593 +132% $12,593 +132% —
700 Other kidney and urinary tract diagnoses without CC/MCC $29,192 $29,192 $12,204 +139% $14,797 +97% —
725 Benign prostatic hypertrophy with MCC $29,192 $29,192 $19,581 +49% $22,320 +31% —
726 Benign prostatic hypertrophy without MCC $29,192 $29,192 $19,874 +47% $15,019 +94% —
795 Normal newborn $29,192 — $7,412 +294% $4,720 +518% —
801 Splenic procedures without CC/MCC $29,192 $29,192 $24,502 +19% $36,445 −20% —
802 Other O.R. procedures of the blood and blood forming organs with MCC $29,192 $29,192 $49,721 −41% $66,711 −56% —
803 Other O.R. procedures of the blood and blood forming organs with CC $29,192 $29,192 $26,296 +11% $39,515 −26% —
804 Other O.R. procedures of the blood and blood forming organs without CC/MCC $29,192 $29,192 $17,544 +66% $24,544 +19% —
807 Vaginal delivery without sterilization or D&C without CC/MCC $29,192 $29,192 $14,153 +106% $12,078 +142% —
819 Other antepartum diagnoses with O.R. procedures without CC/MCC $29,192 $29,192 $13,791 +112% $18,126 +61% —
833 Other antepartum diagnoses without O.R. procedures without CC/MCC $29,192 $29,192 $9,940 +194% $9,940 +194% —
835 Acute leukemia with CC $29,192 $29,192 $30,915 −6% $35,569 −18% —
836 Acute leukemia without CC/MCC $29,192 $29,192 $19,686 +48% $19,686 +48% —
838 Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapy agent $29,192 $29,192 $29,518 −1% $31,134 −6% —
839 Chemotherapy with acute leukemia as secondary diagnosis without CC/MCC $29,192 $29,192 $20,980 +39% $20,980 +39% —
841 Lymphoma and non-acute leukemia with CC $29,192 $29,192 $28,685 +2% $33,633 −13% ≈229% of Medicare
842 Lymphoma and non-acute leukemia without CC/MCC $29,192 $29,192 $16,847 +73% $19,657 +49% —
844 Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with CC $29,192 $29,192 $18,707 +56% $21,847 +34% —
845 Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses without CC/MCC $29,192 $29,192 $14,055 +108% $14,055 +108% —
847 Chemotherapy without acute leukemia as secondary diagnosis with CC $29,192 $29,192 $19,686 +48% $23,498 +24% ≈356% of Medicare
848 Chemotherapy without acute leukemia as secondary diagnosis without CC/MCC $29,192 $29,192 $13,822 +111% $14,501 +101% —
906 Hand procedures for injuries $29,192 $29,192 $31,520 −7% $32,065 −9% —
909 Other O.R. procedures for injuries without CC/MCC* $29,192 $29,192 $19,655 +49% $28,156 +4% —
914 Traumatic injury without MCC $29,192 $29,192 $20,851 +40% $15,855 +84% —
935 Non-extensive burns $29,192 $29,192 $30,446 −4% $31,701 −8% —
948 Signs and symptoms without MCC $29,192 $29,192 $22,268 +31% $17,921 +63% ≈625% of Medicare
950 Aftercare without CC/MCC $29,192 $29,192 $25,102 +16% $13,527 +116% —
951 Other factors influencing health status $29,192 $29,192 $10,553 +177% $10,160 +187% —
959 Other O.R. procedures for multiple significant trauma without CC/MCC $29,192 $29,192 $37,509 −22% $41,422 −30% —
690 Kidney and urinary tract infections without MCC $28,703 $28,703 $17,494 +64% $17,674 +62% ≈632% of Medicare

Procedures with negotiated rates only

These 1 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
018 Chimeric antigen receptor (CAR) T-cell and other immunotherapies — 12 plans
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