Baystate Franklin Medical Center — Pricing
770 procedures published in this hospital's Machine-Readable File (MRF) — 0 with a comparable price, 770 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 770
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Highest published price —
Gross charges are the hospital's listed price — almost no one pays this amount. Your actual cost depends on your insurance plan. Use the cash price (when shown) as a guide for what uninsured patients are charged, and contact the hospital or your insurer for a personalized cost estimate.
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Showing all 770 procedures
Procedures with negotiated rates only
These 770 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 |
|---|---|---|---|
| 001 | Heart Transplant or Implant of Heart Assist System with MCC | — | 1 plans |
| 002 | Heart Transplant or Implant of Heart Assist System without MCC | — | 1 plans |
| 003 | ECMO or Tracheostomy with MV >96 Hours or Principal Diagnosis Except Face, Mouth and Neck with Major O.R. Procedures | — | 1 plans |
| 004 | Tracheostomy with MV >96 Hours or Principal Diagnosis Except Face, Mouth and Neck without Major O.R. Procedures | — | 1 plans |
| 005 | Liver Transplant with MCC or Intestinal Transplant | — | 1 plans |
| 006 | Liver Transplant without MCC | — | 1 plans |
| 007 | Lung Transplant | — | 1 plans |
| 008 | Simultaneous Pancreas and Kidney Transplant | — | 1 plans |
| 010 | Pancreas Transplant | — | 1 plans |
| 011 | Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCC | — | 1 plans |
| 012 | Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 013 | Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 014 | Allogeneic Bone Marrow Transplant | — | 1 plans |
| 016 | Autologous Bone Marrow Transplant with CC/MCC | — | 1 plans |
| 017 | Autologous Bone Marrow Transplant without CC/MCC | — | 1 plans |
| 018 | Chimeric Antigen Receptor (CAR) T-Cell and Other Immunotherapies | — | 1 plans |
| 019 | Simultaneous Pancreas and Kidney Transplant with Hemodialysis | — | 1 plans |
| 020 | Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage with MCC | — | 1 plans |
| 021 | Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage with CC | — | 1 plans |
| 022 | Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 023 | Craniotomy with Major Device Implant or Acute Complex CNS Principal Diagnosis with MCC or Antineoplastic Implant or Epilepsy with Neurostimulator | — | 1 plans |
| 024 | Craniotomy with Major Device Implant or Acute Complex CNS Principal Diagnosis without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 025 | Craniotomy and Endovascular Intracranial Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 026 | Craniotomy and Endovascular Intracranial Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 027 | Craniotomy and Endovascular Intracranial Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 028 | Spinal Procedures with MCC | — | 1 plans |
| 029 | Spinal Procedures with CC or Spinal Neurostimulators | $8,480 – $8,480 · median $8,480 | 1 plans |
| 030 | Spinal Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 031 | Ventricular Shunt Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 032 | Ventricular Shunt Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 033 | Ventricular Shunt Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 034 | Carotid Artery Stent Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 035 | Carotid Artery Stent Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 036 | Carotid Artery Stent Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 037 | Extracranial Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 038 | Extracranial Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 039 | Extracranial Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 040 | Peripheral, Cranial Nerve and Other Nervous System Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 041 | Peripheral, Cranial Nerve and Other Nervous System Procedures with CC or Peripheral Neurostimulator | $8,480 – $8,480 · median $8,480 | 1 plans |
| 042 | Peripheral, Cranial Nerve and Other Nervous System Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 052 | Spinal Disorders and Injuries with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 053 | Spinal Disorders and Injuries without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 054 | Nervous System Neoplasms with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 055 | Nervous System Neoplasms without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 056 | Degenerative Nervous System Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 057 | Degenerative Nervous System Disorders without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 058 | Multiple Sclerosis and Cerebellar Ataxia with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 059 | Multiple Sclerosis and Cerebellar Ataxia with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 060 | Multiple Sclerosis and Cerebellar Ataxia without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 061 | Ischemic Stroke, Precerebral Occlusion or Transient Ischemia with Thrombolytic Agent with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 062 | Ischemic Stroke, Precerebral Occlusion or Transient Ischemia with Thrombolytic Agent with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 063 | Ischemic Stroke, Precerebral Occlusion or Transient Ischemia with Thrombolytic Agent without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 064 | Intracranial Hemorrhage or Cerebral Infarction with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 065 | Intracranial Hemorrhage or Cerebral Infarction with CC or tPA in 24 Hours | $8,480 – $8,480 · median $8,480 | 1 plans |
| 066 | Intracranial Hemorrhage or Cerebral Infarction without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 067 | Precerebral Occlusion without Infarction with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 068 | Precerebral Occlusion without Infarction without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 069 | Transient Ischemia without Thrombolytic | $8,480 – $8,480 · median $8,480 | 1 plans |
| 070 | Other Cerebrovascular Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 071 | Other Cerebrovascular Disorders with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 072 | Other Cerebrovascular Disorders without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 073 | Cranial and Peripheral Nerve Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 074 | Cranial and Peripheral Nerve Disorders without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 075 | Viral Meningitis with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 076 | Viral Meningitis without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 080 | Nontraumatic Stupor and Coma with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 081 | Nontraumatic Stupor and Coma without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 082 | Traumatic Stupor and Coma >1 Hour with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 083 | Traumatic Stupor and Coma >1 Hour with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 084 | Traumatic Stupor and Coma >1 Hour without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 085 | Traumatic Stupor and Coma <1 Hour with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 086 | Traumatic Stupor and Coma <1 Hour with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 087 | Traumatic Stupor and Coma <1 Hour without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 088 | Concussion with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 089 | Concussion with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 090 | Concussion without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 091 | Other Disorders of Nervous System with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 092 | Other Disorders of Nervous System with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 093 | Other Disorders of Nervous System without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 094 | Bacterial and Tuberculous Infections of Nervous System with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 095 | Bacterial and Tuberculous Infections of Nervous System with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 096 | Bacterial and Tuberculous Infections of Nervous System without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 097 | Non-Bacterial Infection of Nervous System Except Viral Meningitis with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 098 | Non-Bacterial Infection of Nervous System Except Viral Meningitis with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 099 | Non-Bacterial Infection of Nervous System Except Viral Meningitis without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 100 | Seizures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 101 | Seizures without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 102 | Headaches with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 103 | Headaches without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 113 | Orbital Procedures with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 114 | Orbital Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 115 | Extraocular Procedures Except Orbit | $8,480 – $8,480 · median $8,480 | 1 plans |
| 116 | Intraocular Procedures with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 117 | Intraocular Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 121 | Acute Major Eye Infections with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 122 | Acute Major Eye Infections without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 123 | Neurological Eye Disorders | $8,480 – $8,480 · median $8,480 | 1 plans |
| 124 | Other Disorders of the Eye with MCC or Thrombolytic Agent | $8,480 – $8,480 · median $8,480 | 1 plans |
| 125 | Other Disorders of the Eye without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 135 | Sinus and Mastoid Procedures with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 136 | Sinus and Mastoid Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 137 | Mouth Procedures with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 138 | Mouth Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 139 | Salivary Gland Procedures | $8,480 – $8,480 · median $8,480 | 1 plans |
| 140 | Major Head and Neck Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 141 | Major Head and Neck Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 142 | Major Head and Neck Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 143 | Other Ear, Nose, Mouth and Throat O.R. Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 144 | Other Ear, Nose, Mouth and Throat O.R. Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 145 | Other Ear, Nose, Mouth and Throat O.R. Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 146 | Ear, Nose, Mouth and Throat Malignancy with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 147 | Ear, Nose, Mouth and Throat Malignancy with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 148 | Ear, Nose, Mouth and Throat Malignancy without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 149 | Dysequilibrium | $8,480 – $8,480 · median $8,480 | 1 plans |
| 150 | Epistaxis with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 151 | Epistaxis without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 152 | Otitis Media and URI with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 153 | Otitis Media and URI without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 154 | Other Ear, Nose, Mouth and Throat Diagnoses with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 155 | Other Ear, Nose, Mouth and Throat Diagnoses with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 156 | Other Ear, Nose, Mouth and Throat Diagnoses without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 157 | Dental and Oral Diseases with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 158 | Dental and Oral Diseases with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 159 | Dental and Oral Diseases without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 163 | Major Chest Procedures with MCC | — | 1 plans |
| 164 | Major Chest Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 165 | Major Chest Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 166 | Other Respiratory System O.R. Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 167 | Other Respiratory System O.R. Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 168 | Other Respiratory System O.R. Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 173 | Ultrasound Accelerated and Other Thrombolysis with Principal Diagnosis Pulmonary Embolism | $8,480 – $8,480 · median $8,480 | 1 plans |
| 175 | Pulmonary Embolism with MCC or Acute Cor Pulmonale | $8,480 – $8,480 · median $8,480 | 1 plans |
| 176 | Pulmonary Embolism without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 177 | Respiratory Infections and Inflammations with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 178 | Respiratory Infections and Inflammations with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 179 | Respiratory Infections and Inflammations without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 180 | Respiratory Neoplasms with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 181 | Respiratory Neoplasms with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 182 | Respiratory Neoplasms without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 183 | Major Chest Trauma with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 184 | Major Chest Trauma with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 185 | Major Chest Trauma without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 186 | Pleural Effusion with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 187 | Pleural Effusion with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 188 | Pleural Effusion without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 189 | Pulmonary Edema and Respiratory Failure | $8,480 – $8,480 · median $8,480 | 1 plans |
| 190 | Chronic Obstructive Pulmonary Disease with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 191 | Chronic Obstructive Pulmonary Disease with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 192 | Chronic Obstructive Pulmonary Disease without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 193 | Simple Pneumonia and Pleurisy with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 194 | Simple Pneumonia and Pleurisy with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 195 | Simple Pneumonia and Pleurisy without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 196 | Interstitial Lung Disease with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 197 | Interstitial Lung Disease with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 198 | Interstitial Lung Disease without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 199 | Pneumothorax with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 200 | Pneumothorax with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 201 | Pneumothorax without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 202 | Bronchitis and Asthma with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 203 | Bronchitis and Asthma without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 204 | Respiratory Signs and Symptoms | $8,480 – $8,480 · median $8,480 | 1 plans |
| 205 | Other Respiratory System Diagnoses with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 206 | Other Respiratory System Diagnoses without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 207 | Respiratory System Diagnosis with Ventilator Support >96 Hours | — | 1 plans |
| 208 | Respiratory System Diagnosis with Ventilator Support <=96 Hours | $8,480 – $8,480 · median $8,480 | 1 plans |
| 209 | Complex Aortic Arch Procedures | — | 1 plans |
| 212 | Concomitant Aortic and Mitral Valve Procedures | — | 1 plans |
| 213 | Endovascular Abdominal Aorta with Iliac Branch Procedures | — | 1 plans |
| 215 | Other Heart Assist System Implant | — | 1 plans |
| 216 | Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC | — | 1 plans |
| 217 | Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with CC | — | 1 plans |
| 218 | Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization without CC/MCC | — | 1 plans |
| 219 | Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization with MCC | — | 1 plans |
| 220 | Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization with CC | — | 1 plans |
| 221 | Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization without CC/MCC | — | 1 plans |
| 228 | Other Cardiothoracic Procedures with MCC | — | 1 plans |
| 229 | Other Cardiothoracic Procedures without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 231 | Coronary Bypass with PTCA with MCC | — | 1 plans |
| 232 | Coronary Bypass with PTCA without MCC | — | 1 plans |
| 233 | Coronary Bypass with Cardiac Catheterization or Open Ablation with MCC | — | 1 plans |
| 234 | Coronary Bypass with Cardiac Catheterization or Open Ablation without MCC | — | 1 plans |
| 235 | Coronary Bypass without Cardiac Catheterization with MCC | — | 1 plans |
| 236 | Coronary Bypass without Cardiac Catheterization without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 239 | Amputation for Circulatory System Disorders Except Upper Limb and Toe with MCC | — | 1 plans |
| 240 | Amputation for Circulatory System Disorders Except Upper Limb and Toe with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 241 | Amputation for Circulatory System Disorders Except Upper Limb and Toe without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 242 | Permanent Cardiac Pacemaker Implant with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 243 | Permanent Cardiac Pacemaker Implant with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 244 | Permanent Cardiac Pacemaker Implant without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 245 | AICD Generator Procedures | — | 1 plans |
| 250 | Percutaneous Cardiovascular Procedures without Intraluminal Device with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 251 | Percutaneous Cardiovascular Procedures without Intraluminal Device without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 252 | Other Vascular Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 253 | Other Vascular Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 254 | Other Vascular Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 255 | Upper Limb and Toe Amputation for Circulatory System Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 256 | Upper Limb and Toe Amputation for Circulatory System Disorders with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 257 | Upper Limb and Toe Amputation for Circulatory System Disorders without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 258 | Cardiac Pacemaker Device Replacement with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 259 | Cardiac Pacemaker Device Replacement without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 260 | Cardiac Pacemaker Revision Except Device Replacement with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 261 | Cardiac Pacemaker Revision Except Device Replacement with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 262 | Cardiac Pacemaker Revision Except Device Replacement without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 263 | Vein Ligation and Stripping | $8,480 – $8,480 · median $8,480 | 1 plans |
| 264 | Other Circulatory System O.R. Procedures | $8,480 – $8,480 · median $8,480 | 1 plans |
| 265 | AICD Lead Procedures | $8,480 – $8,480 · median $8,480 | 1 plans |
| 266 | Endovascular Cardiac Valve Replacement and Supplement Procedures with MCC | — | 1 plans |
| 267 | Endovascular Cardiac Valve Replacement and Supplement Procedures without MCC | — | 1 plans |
| 268 | Aortic and Heart Assist Procedures Except Pulsation Balloon with MCC | — | 1 plans |
| 269 | Aortic and Heart Assist Procedures Except Pulsation Balloon without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 270 | Other Major Cardiovascular Procedures with MCC | — | 1 plans |
| 271 | Other Major Cardiovascular Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 272 | Other Major Cardiovascular Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 273 | Percutaneous and Other Intracardiac Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 274 | Percutaneous and Other Intracardiac Procedures without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 275 | Cardiac Defibrillator Implant with Cardiac Catheterization and MCC | — | 1 plans |
| 276 | Cardiac Defibrillator Implant with MCC or Carotid Sinus Neurostimulator | — | 1 plans |
| 277 | Cardiac Defibrillator Implant without MCC | — | 1 plans |
| 278 | Ultrasound Accelerated and Other Thrombolysis of Peripheral Vascular Structures with MCC | — | 1 plans |
| 279 | Ultrasound Accelerated and Other Thrombolysis of Peripheral Vascular Structures without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 280 | Acute Myocardial Infarction, Discharged Alive with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 281 | Acute Myocardial Infarction, Discharged Alive with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 282 | Acute Myocardial Infarction, Discharged Alive without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 283 | Acute Myocardial Infarction, Expired with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 284 | Acute Myocardial Infarction, Expired with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 285 | Acute Myocardial Infarction, Expired without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 286 | Circulatory Disorders Except AMI, with Cardiac Catheterization with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 287 | Circulatory Disorders Except AMI, with Cardiac Catheterization without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 288 | Acute and Subacute Endocarditis with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 289 | Acute and Subacute Endocarditis with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 290 | Acute and Subacute Endocarditis without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 291 | Heart Failure and Shock with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 292 | Heart Failure and Shock with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 293 | Heart Failure and Shock without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 296 | Cardiac Arrest, Unexplained with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 297 | Cardiac Arrest, Unexplained with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 298 | Cardiac Arrest, Unexplained without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 299 | Peripheral Vascular Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 300 | Peripheral Vascular Disorders with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 301 | Peripheral Vascular Disorders without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 302 | Atherosclerosis with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 303 | Atherosclerosis without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 304 | Hypertension with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 305 | Hypertension without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 306 | Cardiac Congenital and Valvular Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 307 | Cardiac Congenital and Valvular Disorders without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 308 | Cardiac Arrhythmia and Conduction Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 309 | Cardiac Arrhythmia and Conduction Disorders with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 310 | Cardiac Arrhythmia and Conduction Disorders without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 311 | Angina Pectoris | $8,480 – $8,480 · median $8,480 | 1 plans |
| 312 | Syncope and Collapse | $8,480 – $8,480 · median $8,480 | 1 plans |
| 313 | Chest Pain | $8,480 – $8,480 · median $8,480 | 1 plans |
| 314 | Other Circulatory System Diagnoses with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 315 | Other Circulatory System Diagnoses with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 316 | Other Circulatory System Diagnoses without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 317 | Concomitant Left Atrial Appendage Closure and Cardiac Ablation | — | 1 plans |
| 318 | Percutaneous Coronary Atherectomy without Intraluminal Device | $8,480 – $8,480 · median $8,480 | 1 plans |
| 319 | Other Endovascular Cardiac Valve Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 320 | Other Endovascular Cardiac Valve Procedures without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 321 | Percutaneous Cardiovascular Procedures with Intraluminal Device with MCC or 4+ Arteries/Intraluminal Devices | $8,480 – $8,480 · median $8,480 | 1 plans |
| 322 | Percutaneous Cardiovascular Procedures with Intraluminal Device without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 323 | Coronary Intravascular Lithotripsy with Intraluminal Device with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 324 | Coronary Intravascular Lithotripsy with Intraluminal Device without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 325 | Coronary Intravascular Lithotripsy without Intraluminal Device | $8,480 – $8,480 · median $8,480 | 1 plans |
| 326 | Stomach, Esophageal and Duodenal Procedures with MCC | — | 1 plans |
| 327 | Stomach, Esophageal and Duodenal Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 328 | Stomach, Esophageal and Duodenal Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 329 | Major Small and Large Bowel Procedures with MCC | — | 1 plans |
| 330 | Major Small and Large Bowel Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 331 | Major Small and Large Bowel Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 332 | Rectal Resection with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 333 | Rectal Resection with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 334 | Rectal Resection without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 335 | Peritoneal Adhesiolysis with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 336 | Peritoneal Adhesiolysis with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 337 | Peritoneal Adhesiolysis without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 344 | Minor Small and Large Bowel Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 345 | Minor Small and Large Bowel Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 346 | Minor Small and Large Bowel Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 347 | Anal and Stomal Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 348 | Anal and Stomal Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 349 | Anal and Stomal Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 350 | Inguinal and Femoral Hernia Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 351 | Inguinal and Femoral Hernia Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 352 | Inguinal and Femoral Hernia Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 353 | Hernia Procedures Except Inguinal and Femoral with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 354 | Hernia Procedures Except Inguinal and Femoral with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 355 | Hernia Procedures Except Inguinal and Femoral without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 356 | Other Digestive System O.R. Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 357 | Other Digestive System O.R. Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 358 | Other Digestive System O.R. Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 359 | Percutaneous Coronary Atherectomy with Intraluminal Device with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 360 | Percutaneous Coronary Atherectomy with Intraluminal Device without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 368 | Major Esophageal Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 369 | Major Esophageal Disorders with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 370 | Major Esophageal Disorders without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 371 | Major Gastrointestinal Disorders and Peritoneal Infections with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 372 | Major Gastrointestinal Disorders and Peritoneal Infections with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 373 | Major Gastrointestinal Disorders and Peritoneal Infections without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 374 | Digestive Malignancy with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 375 | Digestive Malignancy with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 376 | Digestive Malignancy without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 377 | Gastrointestinal Hemorrhage with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 378 | Gastrointestinal Hemorrhage with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 379 | Gastrointestinal Hemorrhage without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 380 | Complicated Peptic Ulcer with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 381 | Complicated Peptic Ulcer with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 382 | Complicated Peptic Ulcer without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 383 | Uncomplicated Peptic Ulcer with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 384 | Uncomplicated Peptic Ulcer without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 385 | Inflammatory Bowel Disease with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 386 | Inflammatory Bowel Disease with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 387 | Inflammatory Bowel Disease without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 388 | Gastrointestinal Obstruction with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 389 | Gastrointestinal Obstruction with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 390 | Gastrointestinal Obstruction without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 391 | Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 392 | Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 393 | Other Digestive System Diagnoses with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 394 | Other Digestive System Diagnoses with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 395 | Other Digestive System Diagnoses without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 397 | Appendix Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 398 | Appendix Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 399 | Appendix Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 402 | Single Level Combined Anterior and Posterior Spinal Fusion Except Cervical | $8,480 – $8,480 · median $8,480 | 1 plans |
| 405 | Pancreas, Liver and Shunt Procedures with MCC | — | 1 plans |
| 406 | Pancreas, Liver and Shunt Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 407 | Pancreas, Liver and Shunt Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 408 | Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E. with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 409 | Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E. with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 410 | Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E. without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 411 | Cholecystectomy with C.D.E. with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 412 | Cholecystectomy with C.D.E. with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 413 | Cholecystectomy with C.D.E. without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 414 | Cholecystectomy Except by Laparoscope without C.D.E. with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 415 | Cholecystectomy Except by Laparoscope without C.D.E. with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 416 | Cholecystectomy Except by Laparoscope without C.D.E. without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 417 | Laparoscopic Cholecystectomy without C.D.E. with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 418 | Laparoscopic Cholecystectomy without C.D.E. with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 419 | Laparoscopic Cholecystectomy without C.D.E. without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 420 | Hepatobiliary Diagnostic Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 421 | Hepatobiliary Diagnostic Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 422 | Hepatobiliary Diagnostic Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 423 | Other Hepatobiliary or Pancreas O.R. Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 424 | Other Hepatobiliary or Pancreas O.R. Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 425 | Other Hepatobiliary or Pancreas O.R. Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 426 | Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device | — | 1 plans |
| 427 | Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with CC | — | 1 plans |
| 428 | Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical without CC/MCC | — | 1 plans |
| 429 | Combined Anterior and Posterior Cervical Spinal Fusion with MCC | — | 1 plans |
| 430 | Combined Anterior and Posterior Cervical Spinal Fusion without MCC | — | 1 plans |
| 432 | Cirrhosis and Alcoholic Hepatitis with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 433 | Cirrhosis and Alcoholic Hepatitis with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 434 | Cirrhosis and Alcoholic Hepatitis without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 435 | Malignancy of Hepatobiliary System or Pancreas with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 436 | Malignancy of Hepatobiliary System or Pancreas with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 437 | Malignancy of Hepatobiliary System or Pancreas without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 438 | Disorders of Pancreas Except Malignancy with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 439 | Disorders of Pancreas Except Malignancy with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 440 | Disorders of Pancreas Except Malignancy without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 441 | Disorders of Liver Except Malignancy, Cirrhosis or Alcoholic Hepatitis with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 442 | Disorders of Liver Except Malignancy, Cirrhosis or Alcoholic Hepatitis with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 443 | Disorders of Liver Except Malignancy, Cirrhosis or Alcoholic Hepatitis without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 444 | Disorders of the Biliary Tract with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 445 | Disorders of the Biliary Tract with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 446 | Disorders of the Biliary Tract without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 447 | Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device | — | 1 plans |
| 448 | Multiple Level Spinal Fusion Except Cervical without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 450 | Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device | — | 1 plans |
| 451 | Single Level Spinal Fusion Except Cervical without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 456 | Spinal Fusion Except Cervical with Spinal Curvature, Malignancy, Infection or Extensive Fusions with MCC | — | 1 plans |
| 457 | Spinal Fusion Except Cervical with Spinal Curvature, Malignancy, Infection or Extensive Fusions with CC | — | 1 plans |
| 458 | Spinal Fusion Except Cervical with Spinal Curvature, Malignancy, Infection or Extensive Fusions without CC/MCC | — | 1 plans |
| 461 | Bilateral or Multiple Major Joint Procedures of Lower Extremity with MCC | — | 1 plans |
| 462 | Bilateral or Multiple Major Joint Procedures of Lower Extremity without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 463 | Wound Debridement and Skin Graft Except Hand for Musculoskeletal and Connective Tissue Disorders with MCC | — | 1 plans |
| 464 | Wound Debridement and Skin Graft Except Hand for Musculoskeletal and Connective Tissue Disorders with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 465 | Wound Debridement and Skin Graft Except Hand for Musculoskeletal and Connective Tissue Disorders without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 466 | Revision of Hip or Knee Replacement with MCC | — | 1 plans |
| 467 | Revision of Hip or Knee Replacement with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 468 | Revision of Hip or Knee Replacement without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 469 | Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity with MCC or Total Ankle Replacement | $8,480 – $8,480 · median $8,480 | 1 plans |
| 470 | Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 471 | Cervical Spinal Fusion with MCC | — | 1 plans |
| 472 | Cervical Spinal Fusion with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 473 | Cervical Spinal Fusion without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 474 | Amputation for Musculoskeletal System and Connective Tissue Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 475 | Amputation for Musculoskeletal System and Connective Tissue Disorders with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 476 | Amputation for Musculoskeletal System and Connective Tissue Disorders without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 477 | Biopsies of Musculoskeletal System and Connective Tissue with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 478 | Biopsies of Musculoskeletal System and Connective Tissue with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 479 | Biopsies of Musculoskeletal System and Connective Tissue without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 480 | Hip and Femur Procedures Except Major Joint with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 481 | Hip and Femur Procedures Except Major Joint with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 482 | Hip and Femur Procedures Except Major Joint without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 483 | Major Joint or Limb Reattachment Procedures of Upper Extremities | $8,480 – $8,480 · median $8,480 | 1 plans |
| 485 | Knee Procedures with Principal Diagnosis of Infection with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 486 | Knee Procedures with Principal Diagnosis of Infection with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 487 | Knee Procedures with Principal Diagnosis of Infection without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 488 | Knee Procedures without Principal Diagnosis of Infection with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 489 | Knee Procedures without Principal Diagnosis of Infection without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 492 | Lower Extremity and Humerus Procedures Except Hip, Foot and Femur with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 493 | Lower Extremity and Humerus Procedures Except Hip, Foot and Femur with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 494 | Lower Extremity and Humerus Procedures Except Hip, Foot and Femur without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 495 | Local Excision and Removal of Internal Fixation Devices Except Hip and Femur with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 496 | Local Excision and Removal of Internal Fixation Devices Except Hip and Femur with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 497 | Local Excision and Removal of Internal Fixation Devices Except Hip and Femur without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 498 | Local Excision and Removal of Internal Fixation Devices of Hip and Femur with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 499 | Local Excision and Removal of Internal Fixation Devices of Hip and Femur without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 500 | Soft Tissue Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 501 | Soft Tissue Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 502 | Soft Tissue Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 503 | Foot Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 504 | Foot Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 505 | Foot Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 506 | Major Thumb or Joint Procedures | $8,480 – $8,480 · median $8,480 | 1 plans |
| 507 | Major Shoulder or Elbow Joint Procedures with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 508 | Major Shoulder or Elbow Joint Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 510 | Shoulder, Elbow or Forearm Procedures, Except Major Joint Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 511 | Shoulder, Elbow or Forearm Procedures, Except Major Joint Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 512 | Shoulder, Elbow or Forearm Procedures, Except Major Joint Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 513 | Hand or Wrist Procedures, Except Major Thumb or Joint Procedures with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 514 | Hand or Wrist Procedures, Except Major Thumb or Joint Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 515 | Other Musculoskeletal System and Connective Tissue O.R. Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 516 | Other Musculoskeletal System and Connective Tissue O.R. Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 517 | Other Musculoskeletal System and Connective Tissue O.R. Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 518 | Back and Neck Procedures Except Spinal Fusion with MCC or Disc Device or Neurostimulator | $8,480 – $8,480 · median $8,480 | 1 plans |
| 519 | Back and Neck Procedures Except Spinal Fusion with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 520 | Back and Neck Procedures Except Spinal Fusion without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 521 | Hip Replacement with Principal Diagnosis of Hip Fracture with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 522 | Hip Replacement with Principal Diagnosis of Hip Fracture without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 533 | Fractures of Femur with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 534 | Fractures of Femur without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 535 | Fractures of Hip and Pelvis with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 536 | Fractures of Hip and Pelvis without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 537 | Sprains, Strains, and Dislocations of Hip, Pelvis and Thigh with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 538 | Sprains, Strains, and Dislocations of Hip, Pelvis and Thigh without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 539 | Osteomyelitis with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 540 | Osteomyelitis with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 541 | Osteomyelitis without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 542 | Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 543 | Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 544 | Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 545 | Connective Tissue Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 546 | Connective Tissue Disorders with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 547 | Connective Tissue Disorders without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 548 | Septic Arthritis with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 549 | Septic Arthritis with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 550 | Septic Arthritis without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 551 | Medical Back Problems with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 552 | Medical Back Problems without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 553 | Bone Diseases and Arthropathies with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 554 | Bone Diseases and Arthropathies without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 555 | Signs and Symptoms of Musculoskeletal System and Connective Tissue with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 556 | Signs and Symptoms of Musculoskeletal System and Connective Tissue without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 557 | Tendonitis, Myositis and Bursitis with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 558 | Tendonitis, Myositis and Bursitis without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 559 | Aftercare, Musculoskeletal System and Connective Tissue with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 560 | Aftercare, Musculoskeletal System and Connective Tissue with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 561 | Aftercare, Musculoskeletal System and Connective Tissue without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 562 | Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 563 | Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 564 | Other Musculoskeletal System and Connective Tissue Diagnoses with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 565 | Other Musculoskeletal System and Connective Tissue Diagnoses with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 566 | Other Musculoskeletal System and Connective Tissue Diagnoses without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 570 | Skin Debridement with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 571 | Skin Debridement with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 572 | Skin Debridement without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 573 | Skin Graft for Skin Ulcer or Cellulitis with MCC | — | 1 plans |
| 574 | Skin Graft for Skin Ulcer or Cellulitis with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 575 | Skin Graft for Skin Ulcer or Cellulitis without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 576 | Skin Graft Except for Skin Ulcer or Cellulitis with MCC | — | 1 plans |
| 577 | Skin Graft Except for Skin Ulcer or Cellulitis with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 578 | Skin Graft Except for Skin Ulcer or Cellulitis without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 579 | Other Skin, Subcutaneous Tissue and Breast Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 580 | Other Skin, Subcutaneous Tissue and Breast Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 581 | Other Skin, Subcutaneous Tissue and Breast Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 582 | Mastectomy for Malignancy with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 583 | Mastectomy for Malignancy without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 584 | Breast Biopsy, Local Excision and Other Breast Procedures with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 585 | Breast Biopsy, Local Excision and Other Breast Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 592 | Skin Ulcers with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 593 | Skin Ulcers with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 594 | Skin Ulcers without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 595 | Major Skin Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 596 | Major Skin Disorders without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 597 | Malignant Breast Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 598 | Malignant Breast Disorders with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 599 | Malignant Breast Disorders without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 600 | Non-Malignant Breast Disorders with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 601 | Non-Malignant Breast Disorders without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 602 | Cellulitis with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 603 | Cellulitis without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 604 | Trauma to the Skin, Subcutaneous Tissue and Breast with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 605 | Trauma to the Skin, Subcutaneous Tissue and Breast without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 606 | Minor Skin Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 607 | Minor Skin Disorders without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 614 | Adrenal and Pituitary Procedures with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 615 | Adrenal and Pituitary Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 616 | Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 617 | Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 618 | Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 619 | O.R. Procedures for Obesity with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 620 | O.R. Procedures for Obesity with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 621 | O.R. Procedures for Obesity without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 622 | Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 623 | Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 624 | Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 625 | Thyroid, Parathyroid and Thyroglossal Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 626 | Thyroid, Parathyroid and Thyroglossal Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 627 | Thyroid, Parathyroid and Thyroglossal Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 628 | Other Endocrine, Nutritional and Metabolic O.R. Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 629 | Other Endocrine, Nutritional and Metabolic O.R. Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 630 | Other Endocrine, Nutritional and Metabolic O.R. Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 637 | Diabetes with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 638 | Diabetes with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 639 | Diabetes without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 640 | Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 641 | Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 642 | Inborn and Other Disorders of Metabolism | $8,480 – $8,480 · median $8,480 | 1 plans |
| 643 | Endocrine Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 644 | Endocrine Disorders with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 645 | Endocrine Disorders without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 650 | Kidney Transplant with Hemodialysis with MCC | — | 1 plans |
| 651 | Kidney Transplant with Hemodialysis without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 652 | Kidney Transplant | $8,480 – $8,480 · median $8,480 | 1 plans |
| 653 | Major Bladder Procedures with MCC | — | 1 plans |
| 654 | Major Bladder Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 655 | Major Bladder Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 656 | Kidney and Ureter Procedures for Neoplasm with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 657 | Kidney and Ureter Procedures for Neoplasm with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 658 | Kidney and Ureter Procedures for Neoplasm without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 659 | Kidney and Ureter Procedures for Non-Neoplasm with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 660 | Kidney and Ureter Procedures for Non-Neoplasm with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 661 | Kidney and Ureter Procedures for Non-Neoplasm without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 662 | Minor Bladder Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 663 | Minor Bladder Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 664 | Minor Bladder Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 665 | Prostatectomy with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 666 | Prostatectomy with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 667 | Prostatectomy without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 668 | Transurethral Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 669 | Transurethral Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 670 | Transurethral Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 671 | Urethral Procedures with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 672 | Urethral Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 673 | Other Kidney and Urinary Tract Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 674 | Other Kidney and Urinary Tract Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 675 | Other Kidney and Urinary Tract Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 682 | Renal Failure with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 683 | Renal Failure with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 684 | Renal Failure without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 686 | Kidney and Urinary Tract Neoplasms with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 687 | Kidney and Urinary Tract Neoplasms with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 688 | Kidney and Urinary Tract Neoplasms without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 689 | Kidney and Urinary Tract Infections with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 690 | Kidney and Urinary Tract Infections without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 693 | Urinary Stones with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 694 | Urinary Stones without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 695 | Kidney and Urinary Tract Signs and Symptoms with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 696 | Kidney and Urinary Tract Signs and Symptoms without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 697 | Urethral Stricture | $8,480 – $8,480 · median $8,480 | 1 plans |
| 698 | Other Kidney and Urinary Tract Diagnoses with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 699 | Other Kidney and Urinary Tract Diagnoses with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 700 | Other Kidney and Urinary Tract Diagnoses without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 707 | Major Male Pelvic Procedures with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 708 | Major Male Pelvic Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 709 | Penis Procedures with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 710 | Penis Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 711 | Testes Procedures with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 712 | Testes Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 713 | Transurethral Prostatectomy with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 714 | Transurethral Prostatectomy without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 715 | Other Male Reproductive System O.R. Procedures for Malignancy with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 716 | Other Male Reproductive System O.R. Procedures for Malignancy without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 717 | Other Male Reproductive System O.R. Procedures Except Malignancy with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 718 | Other Male Reproductive System O.R. Procedures Except Malignancy without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 722 | Malignancy, Male Reproductive System with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 723 | Malignancy, Male Reproductive System with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 724 | Malignancy, Male Reproductive System without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 725 | Benign Prostatic Hypertrophy with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 726 | Benign Prostatic Hypertrophy without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 727 | Inflammation of the Male Reproductive System with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 728 | Inflammation of the Male Reproductive System without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 729 | Other Male Reproductive System Diagnoses with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 730 | Other Male Reproductive System Diagnoses without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 734 | Pelvic Evisceration, Radical Hysterectomy and Radical Vulvectomy with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 735 | Pelvic Evisceration, Radical Hysterectomy and Radical Vulvectomy without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 736 | Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 737 | Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 738 | Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 739 | Uterine and Adnexa Procedures for Non-Ovarian and Non-Adnexal Malignancy with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 740 | Uterine and Adnexa Procedures for Non-Ovarian and Non-Adnexal Malignancy with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 741 | Uterine and Adnexa Procedures for Non-Ovarian and Non-Adnexal Malignancy without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 742 | Uterine and Adnexa Procedures for Non-Malignancy with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 743 | Uterine and Adnexa Procedures for Non-Malignancy without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 744 | D&C, Conization, Laparoscopy and Tubal Interruption with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 745 | D&C, Conization, Laparoscopy and Tubal Interruption without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 746 | Vagina, Cervix and Vulva Procedures with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 747 | Vagina, Cervix and Vulva Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 748 | Female Reproductive System Reconstructive Procedures | $8,480 – $8,480 · median $8,480 | 1 plans |
| 749 | Other Female Reproductive System O.R. Procedures with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 750 | Other Female Reproductive System O.R. Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 754 | Malignancy, Female Reproductive System with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 755 | Malignancy, Female Reproductive System with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 756 | Malignancy, Female Reproductive System without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 757 | Infections, Female Reproductive System with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 758 | Infections, Female Reproductive System with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 759 | Infections, Female Reproductive System without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 760 | Menstrual and Other Female Reproductive System Disorders with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 761 | Menstrual and Other Female Reproductive System Disorders without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 768 | Vaginal Delivery with O.R. Procedures Except Sterilization and/or D&C | $8,480 – $8,480 · median $8,480 | 1 plans |
| 769 | Postpartum and Post Abortion Diagnoses with O.R. Procedures | $8,480 – $8,480 · median $8,480 | 1 plans |
| 770 | Abortion with D&C, Aspiration Curettage or Hysterotomy | $8,480 – $8,480 · median $8,480 | 1 plans |
| 776 | Postpartum and Post Abortion Diagnoses without O.R. Procedures | $8,480 – $8,480 · median $8,480 | 1 plans |
| 779 | Abortion without D&C | $8,480 – $8,480 · median $8,480 | 1 plans |
| 783 | Cesarean Section with Sterilization with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 784 | Cesarean Section with Sterilization with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 785 | Cesarean Section with Sterilization without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 786 | Cesarean Section without Sterilization with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 787 | Cesarean Section without Sterilization with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 788 | Cesarean Section without Sterilization without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 789 | Neonates, Died or Transferred to Another Acute Care Facility | $8,480 – $8,480 · median $8,480 | 1 plans |
| 790 | Extreme Immaturity or Respiratory Distress Syndrome, Neonate | — | 1 plans |
| 791 | Prematurity with Major Problems | $8,480 – $8,480 · median $8,480 | 1 plans |
| 792 | Prematurity without Major Problems | $8,480 – $8,480 · median $8,480 | 1 plans |
| 793 | Full Term Neonate with Major Problems | $8,480 – $8,480 · median $8,480 | 1 plans |
| 794 | Neonate with Other Significant Problems | $8,480 – $8,480 · median $8,480 | 1 plans |
| 795 | Normal Newborn | $8,480 – $8,480 · median $8,480 | 1 plans |
| 796 | Vaginal Delivery with Sterilization and/or D&C with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 797 | Vaginal Delivery with Sterilization and/or D&C with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 798 | Vaginal Delivery with Sterilization and/or D&C without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 799 | Splenic Procedures with MCC | — | 1 plans |
| 800 | Splenic Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 801 | Splenic Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 802 | Other O.R. Procedures of the Blood and Blood Forming Organs with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 803 | Other O.R. Procedures of the Blood and Blood Forming Organs with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 804 | Other O.R. Procedures of the Blood and Blood Forming Organs without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 805 | Vaginal Delivery without Sterilization or D&C with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 806 | Vaginal Delivery without Sterilization or D&C with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 807 | Vaginal Delivery without Sterilization or D&C without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 808 | Major Hematological and Immunological Diagnoses Except Sickle Cell Crisis and Coagulation Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 809 | Major Hematological and Immunological Diagnoses Except Sickle Cell Crisis and Coagulation Disorders with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 810 | Major Hematological and Immunological Diagnoses Except Sickle Cell Crisis and Coagulation Disorders without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 811 | Red Blood Cell Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 812 | Red Blood Cell Disorders without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 813 | Coagulation Disorders | $8,480 – $8,480 · median $8,480 | 1 plans |
| 814 | Reticuloendothelial and Immunity Disorders with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 815 | Reticuloendothelial and Immunity Disorders with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 816 | Reticuloendothelial and Immunity Disorders without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 817 | Other Antepartum Diagnoses with O.R. Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 818 | Other Antepartum Diagnoses with O.R. Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 819 | Other Antepartum Diagnoses with O.R. Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 820 | Lymphoma and Leukemia with Major O.R. Procedures with MCC | — | 1 plans |
| 821 | Lymphoma and Leukemia with Major O.R. Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 822 | Lymphoma and Leukemia with Major O.R. Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 823 | Lymphoma and Non-Acute Leukemia with Other Procedures with MCC | — | 1 plans |
| 824 | Lymphoma and Non-Acute Leukemia with Other Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 825 | Lymphoma and Non-Acute Leukemia with Other Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 826 | Myeloproliferative Disorders or Poorly Differentiated Neoplasms with Major O.R. Procedures with MCC | — | 1 plans |
| 827 | Myeloproliferative Disorders or Poorly Differentiated Neoplasms with Major O.R. Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 828 | Myeloproliferative Disorders or Poorly Differentiated Neoplasms with Major O.R. Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 829 | Myeloproliferative Disorders or Poorly Differentiated Neoplasms with Other Procedures with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 830 | Myeloproliferative Disorders or Poorly Differentiated Neoplasms with Other Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 831 | Other Antepartum Diagnoses without O.R. Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 832 | Other Antepartum Diagnoses without O.R. Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 833 | Other Antepartum Diagnoses without O.R. Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 834 | Acute Leukemia with MCC | — | 1 plans |
| 835 | Acute Leukemia with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 836 | Acute Leukemia without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 837 | Chemotherapy with Acute Leukemia as Secondary Diagnosis or with High Dose Chemotherapy Agent with MCC | — | 1 plans |
| 838 | Chemotherapy with Acute Leukemia as Secondary Diagnosis with CC or High Dose Chemotherapy Agent | $8,480 – $8,480 · median $8,480 | 1 plans |
| 839 | Chemotherapy with Acute Leukemia as Secondary Diagnosis without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 840 | Lymphoma and Non-Acute Leukemia with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 841 | Lymphoma and Non-Acute Leukemia with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 842 | Lymphoma and Non-Acute Leukemia without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 843 | Other Myeloproliferative Disorders or Poorly Differentiated Neoplastic Diagnoses with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 844 | Other Myeloproliferative Disorders or Poorly Differentiated Neoplastic Diagnoses with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 845 | Other Myeloproliferative Disorders or Poorly Differentiated Neoplastic Diagnoses without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 846 | Chemotherapy without Acute Leukemia as Secondary Diagnosis with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 847 | Chemotherapy without Acute Leukemia as Secondary Diagnosis with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 848 | Chemotherapy without Acute Leukemia as Secondary Diagnosis without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 849 | Radiotherapy | $8,480 – $8,480 · median $8,480 | 1 plans |
| 850 | Acute Leukemia with Other Procedures | — | 1 plans |
| 853 | Infectious and Parasitic Diseases with O.R. Procedures with MCC | — | 1 plans |
| 854 | Infectious and Parasitic Diseases with O.R. Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 855 | Infectious and Parasitic Diseases with O.R. Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 856 | Postoperative or Post-Traumatic Infections with O.R. Procedures with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 857 | Postoperative or Post-Traumatic Infections with O.R. Procedures with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 858 | Postoperative or Post-Traumatic Infections with O.R. Procedures without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 862 | Postoperative and Post-Traumatic Infections with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 863 | Postoperative and Post-Traumatic Infections without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 864 | Fever and Inflammatory Conditions | $8,480 – $8,480 · median $8,480 | 1 plans |
| 865 | Viral Illness with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 866 | Viral Illness without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 867 | Other Infectious and Parasitic Diseases Diagnoses with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 868 | Other Infectious and Parasitic Diseases Diagnoses with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 869 | Other Infectious and Parasitic Diseases Diagnoses without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 870 | Septicemia or Severe Sepsis with MV >96 Hours | — | 1 plans |
| 871 | Septicemia or Severe Sepsis without MV >96 Hours with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 872 | Septicemia or Severe Sepsis without MV >96 Hours without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 876 | O.R. Procedures with Principal Diagnosis of Mental Illness | $8,480 – $8,480 · median $8,480 | 1 plans |
| 880 | Acute Adjustment Reaction and Psychosocial Dysfunction | $8,480 – $8,480 · median $8,480 | 1 plans |
| 881 | Depressive Neuroses | $8,480 – $8,480 · median $8,480 | 1 plans |
| 882 | Neuroses Except Depressive | $8,480 – $8,480 · median $8,480 | 1 plans |
| 883 | Disorders of Personality and Impulse Control | $8,480 – $8,480 · median $8,480 | 1 plans |
| 884 | Organic Disturbances and Intellectual Disability | $8,480 – $8,480 · median $8,480 | 1 plans |
| 885 | Psychoses | $8,480 – $8,480 · median $8,480 | 1 plans |
| 886 | Behavioral and Developmental Disorders | $8,480 – $8,480 · median $8,480 | 1 plans |
| 887 | Other Mental Disorder Diagnoses | $8,480 – $8,480 · median $8,480 | 1 plans |
| 894 | Alcohol, Drug Abuse or Dependence, Left AMA | $8,480 – $8,480 · median $8,480 | 1 plans |
| 895 | Alcohol, Drug Abuse or Dependence with Rehabilitation Therapy | $8,480 – $8,480 · median $8,480 | 1 plans |
| 896 | Alcohol, Drug Abuse or Dependence without Rehabilitation Therapy with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 897 | Alcohol, Drug Abuse or Dependence without Rehabilitation Therapy without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 901 | Wound Debridements for Injuries with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 902 | Wound Debridements for Injuries with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 903 | Wound Debridements for Injuries without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 904 | Skin Grafts for Injuries with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 905 | Skin Grafts for Injuries without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 906 | Hand Procedures for Injuries | $8,480 – $8,480 · median $8,480 | 1 plans |
| 907 | Other O.R. Procedures for Injuries with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 908 | Other O.R. Procedures for Injuries with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 909 | Other O.R. Procedures for Injuries without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 913 | Traumatic Injury with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 914 | Traumatic Injury without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 915 | Allergic Reactions with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 916 | Allergic Reactions without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 917 | Poisoning and Toxic Effects of Drugs with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 918 | Poisoning and Toxic Effects of Drugs without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 919 | Complications of Treatment with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 920 | Complications of Treatment with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 921 | Complications of Treatment without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 922 | Other Injury, Poisoning and Toxic Effect Diagnoses with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 923 | Other Injury, Poisoning and Toxic Effect Diagnoses without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 927 | Extensive Burns or Full Thickness Burns with MV >96 Hours with Skin Graft | — | 1 plans |
| 928 | Full Thickness Burn with Skin Graft or Inhalation Injury with CC/MCC | — | 1 plans |
| 929 | Full Thickness Burn with Skin Graft or Inhalation Injury without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 933 | Extensive Burns or Full Thickness Burns with MV >96 Hours without Skin Graft | $8,480 – $8,480 · median $8,480 | 1 plans |
| 934 | Full Thickness Burn without Skin Graft or Inhalation Injury | $8,480 – $8,480 · median $8,480 | 1 plans |
| 935 | Non-Extensive Burns | $8,480 – $8,480 · median $8,480 | 1 plans |
| 939 | O.R. Procedures with Diagnoses of Other Contact with Health Services with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 940 | O.R. Procedures with Diagnoses of Other Contact with Health Services with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 941 | O.R. Procedures with Diagnoses of Other Contact with Health Services without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 945 | Rehabilitation with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 946 | Rehabilitation without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 947 | Signs and Symptoms with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 948 | Signs and Symptoms without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 949 | Aftercare with CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 950 | Aftercare without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 951 | Other Factors Influencing Health Status | $8,480 – $8,480 · median $8,480 | 1 plans |
| 955 | Craniotomy for Multiple Significant Trauma | — | 1 plans |
| 956 | Limb Reattachment, Hip and Femur Procedures for Multiple Significant Trauma | $8,480 – $8,480 · median $8,480 | 1 plans |
| 957 | Other O.R. Procedures for Multiple Significant Trauma with MCC | — | 1 plans |
| 958 | Other O.R. Procedures for Multiple Significant Trauma with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 959 | Other O.R. Procedures for Multiple Significant Trauma without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 963 | Other Multiple Significant Trauma with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 964 | Other Multiple Significant Trauma with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 965 | Other Multiple Significant Trauma without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 969 | HIV with Extensive O.R. Procedures with MCC | — | 1 plans |
| 970 | HIV with Extensive O.R. Procedures without MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 974 | HIV with Major Related Condition with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 975 | HIV with Major Related Condition with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 976 | HIV with Major Related Condition without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 977 | HIV with or without Other Related Condition | $8,480 – $8,480 · median $8,480 | 1 plans |
| 981 | Extensive O.R. Procedures Unrelated to Principal Diagnosis with MCC | — | 1 plans |
| 982 | Extensive O.R. Procedures Unrelated to Principal Diagnosis with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 983 | Extensive O.R. Procedures Unrelated to Principal Diagnosis without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 987 | Non-Extensive O.R. Procedures Unrelated to Principal Diagnosis with MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 988 | Non-Extensive O.R. Procedures Unrelated to Principal Diagnosis with CC | $8,480 – $8,480 · median $8,480 | 1 plans |
| 989 | Non-Extensive O.R. Procedures Unrelated to Principal Diagnosis without CC/MCC | $8,480 – $8,480 · median $8,480 | 1 plans |
No procedures match that keyword.