Mountainview Hospital (Acute Care) — Pricing
760 procedures published in this hospital's Machine-Readable File (MRF) — 0 with a comparable price, 760 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 760
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Gross charges are the hospital's listed price — almost no one pays this amount. Your actual cost depends on your insurance plan. Use the cash price (when shown) as a guide for what uninsured patients are charged, and contact the hospital or your insurer for a personalized cost estimate.
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Showing all 760 procedures
Procedures with negotiated rates only
These 760 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 |
|---|---|---|---|
| 216 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZA | $45,363 – $131,690 · median $84,216 | 17 plans |
| 217 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZA | $45,363 – $131,690 · median $77,558 | 17 plans |
| 218 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZA | $45,363 – $131,690 · median $77,558 | 17 plans |
| 219 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETER | $45,363 – $131,690 · median $81,291 | 17 plans |
| 220 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETER | $45,363 – $131,690 · median $78,127 | 17 plans |
| 221 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETER | $45,363 – $131,690 · median $78,127 | 17 plans |
| 232 | CORONARY BYPASS WITH PTCA WITHOUT MCC | $33,250 – $127,904 · median $77,558 | 17 plans |
| 233 | CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC | $31,450 – $127,904 · median $71,916 | 17 plans |
| 234 | CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC | $31,450 – $127,904 · median $71,916 | 17 plans |
| 235 | CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC | $25,650 – $127,904 · median $71,916 | 17 plans |
| 236 | CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC | $25,650 – $127,904 · median $71,916 | 17 plans |
| 250 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC | $7,800 – $35,154 · median $23,088 | 17 plans |
| 251 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC | $7,800 – $35,154 · median $23,088 | 17 plans |
| 471 | CERVICAL SPINAL FUSION WITH MCC | $10,500 – $42,574 · median $24,886 | 17 plans |
| 472 | CERVICAL SPINAL FUSION WITH CC | $10,500 – $42,574 · median $24,886 | 17 plans |
| 473 | CERVICAL SPINAL FUSION WITHOUT CC/MCC | $10,500 – $42,574 · median $24,229 | 17 plans |
| 020 | INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC | $5,670 – $91,896 · median $56,660 | 16 plans |
| 021 | INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC | $5,670 – $91,896 · median $56,660 | 16 plans |
| 022 | INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/ | $5,670 – $91,896 · median $56,660 | 16 plans |
| 023 | CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WI | $16,120 – $70,825 · median $45,336 | 16 plans |
| 024 | CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WI | $16,120 – $70,825 · median $45,336 | 16 plans |
| 025 | CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC | $16,120 – $70,825 · median $33,941 | 16 plans |
| 026 | CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC | $16,120 – $70,825 · median $35,302 | 16 plans |
| 027 | CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC | $16,120 – $70,825 · median $33,941 | 16 plans |
| 231 | CORONARY BYPASS WITH PTCA WITH MCC | $45,363 – $127,904 · median $77,843 | 16 plans |
| 456 | SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EX | $16,120 – $94,825 · median $38,631 | 15 plans |
| 457 | SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EX | $16,120 – $94,825 · median $38,631 | 15 plans |
| 458 | SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EX | $16,120 – $94,825 · median $38,631 | 15 plans |
| 266 | ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC | $52,200 – $131,664 · median $92,463 | 14 plans |
| 267 | ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC | $52,200 – $131,664 · median $81,945 | 14 plans |
| 273 | PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC | $7,800 – $37,947 · median $25,443 | 14 plans |
| 274 | PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC | $7,800 – $37,947 · median $22,540 | 14 plans |
| 215 | OTHER HEART ASSIST SYSTEM IMPLANT | $45,363 – $252,357 · median $78,127 | 13 plans |
| 466 | REVISION OF HIP OR KNEE REPLACEMENT WITH MCC | $16,120 – $44,506 · median $32,820 | 13 plans |
| 467 | REVISION OF HIP OR KNEE REPLACEMENT WITH CC | $16,120 – $44,506 · median $32,820 | 13 plans |
| 468 | REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC | $16,120 – $57,292 · median $32,820 | 13 plans |
| 469 | MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC | $16,120 – $41,611 · median $25,392 | 13 plans |
| 470 | MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT | $16,120 – $41,611 · median $32,812 | 13 plans |
| 229 | OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC | $31,450 – $90,365 · median $58,973 | 12 plans |
| 242 | PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC | $4,300 – $78,127 · median $44,644 | 12 plans |
| 243 | PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC | $4,300 – $78,127 · median $44,644 | 12 plans |
| 244 | PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC | $4,300 – $78,127 · median $23,646 | 12 plans |
| 245 | AICD GENERATOR PROCEDURES | $4,300 – $78,127 · median $23,646 | 12 plans |
| 258 | CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC | $4,300 – $78,127 · median $21,736 | 12 plans |
| 259 | CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC | $4,300 – $78,127 · median $21,736 | 12 plans |
| 260 | CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC | $4,300 – $78,127 · median $21,736 | 12 plans |
| 261 | CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC | $4,300 – $78,127 · median $21,736 | 12 plans |
| 262 | CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC | $4,300 – $78,127 · median $21,736 | 12 plans |
| 518 | BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROST | $4,500 – $27,428 · median $19,501 | 12 plans |
| 519 | BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC | $4,500 – $27,428 · median $19,501 | 12 plans |
| 520 | BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC | $4,500 – $27,428 · median $18,102 | 12 plans |
| 228 | OTHER CARDIOTHORACIC PROCEDURES WITH MCC | $31,450 – $90,365 · median $62,501 | 10 plans |
| 253 | OTHER VASCULAR PROCEDURES WITH CC | $13,109 – $78,127 · median $21,736 | 10 plans |
| 254 | OTHER VASCULAR PROCEDURES WITHOUT CC/MCC | $13,109 – $78,127 · median $21,736 | 10 plans |
| 461 | BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC | $32,820 – $51,800 · median $39,357 | 10 plans |
| 462 | BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC | $32,820 – $51,800 · median $39,357 | 10 plans |
| 041 | PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHE | $16,120 – $42,913 · median $30,295 | 9 plans |
| 042 | PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC | $16,120 – $42,913 · median $30,295 | 9 plans |
| 459 | SPINAL FUSION EXCEPT CERVICAL WITH MCC | $31,286 – $62,074 · median $49,659 | 9 plans |
| 460 | SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC | $31,286 – $62,074 · median $39,709 | 9 plans |
| 521 | HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC | $18,475 – $41,025 · median $25,392 | 9 plans |
| 522 | HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC | $19,161 – $41,025 · median $32,812 | 9 plans |
| 028 | SPINAL PROCEDURES WITH MCC | $16,120 – $32,326 · median $23,575 | 8 plans |
| 029 | SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS | $16,120 – $32,326 · median $23,575 | 8 plans |
| 030 | SPINAL PROCEDURES WITHOUT CC/MCC | $5,800 – $32,326 · median $23,575 | 8 plans |
| 252 | OTHER VASCULAR PROCEDURES WITH MCC | $13,109 – $27,170 · median $21,736 | 8 plans |
| 265 | AICD LEAD PROCEDURES | $4,300 – $32,500 · median $22,691 | 8 plans |
| 268 | AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC | $18,000 – $82,382 · median $59,938 | 8 plans |
| 269 | AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC | $18,000 – $78,127 · median $36,070 | 8 plans |
| 270 | OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC | $18,000 – $78,127 · median $43,389 | 8 plans |
| 271 | OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC | $18,000 – $78,127 · median $29,841 | 8 plans |
| 272 | OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC | $18,000 – $78,127 · median $28,109 | 8 plans |
| 037 | EXTRACRANIAL PROCEDURES WITH MCC | $13,037 – $27,428 · median $17,915 | 7 plans |
| 038 | EXTRACRANIAL PROCEDURES WITH CC | $13,037 – $27,428 · median $17,915 | 7 plans |
| 039 | EXTRACRANIAL PROCEDURES WITHOUT CC/MCC | $13,037 – $27,428 · median $17,915 | 7 plans |
| 040 | PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC | $16,120 – $53,642 · median $39,616 | 7 plans |
| 286 | CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC | $9,974 – $21,499 · median $13,110 | 7 plans |
| 287 | CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC | $8,984 – $14,480 · median $10,534 | 7 plans |
| 319 | OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC | $38,389 – $115,579 · median $92,463 | 7 plans |
| 320 | OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC | $21,978 – $115,579 · median $92,463 | 7 plans |
| 321 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ A | $21,991 – $35,154 · median $26,420 | 7 plans |
| 619 | O.R. PROCEDURES FOR OBESITY WITH MCC | $21,039 – $27,428 · median $22,602 | 7 plans |
| 620 | O.R. PROCEDURES FOR OBESITY WITH CC | $21,039 – $27,428 · median $22,602 | 7 plans |
| 621 | O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC | $21,039 – $27,428 · median $22,602 | 7 plans |
| 275 | CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC | $56,552 – $131,690 · median $62,497 | 6 plans |
| 276 | CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR | $56,552 – $90,365 · median $62,501 | 6 plans |
| 277 | CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC | $56,552 – $131,690 · median $64,202 | 6 plans |
| 322 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC | $21,991 – $35,154 · median $23,639 | 6 plans |
| 480 | HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC | $11,068 – $47,853 · median $14,038 | 6 plans |
| 481 | HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC | $14,038 – $41,611 · median $20,053 | 6 plans |
| 482 | HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC | $14,038 – $33,289 · median $20,053 | 6 plans |
| 740 | UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC | $14,284 – $22,786 · median $20,793 | 6 plans |
| 741 | UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT | $10,926 – $22,786 · median $18,486 | 6 plans |
| 742 | UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC | $10,836 – $22,786 · median $16,229 | 6 plans |
| 743 | UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC | $7,327 – $22,786 · median $13,817 | 6 plans |
| 768 | VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C | $4,030 – $11,586 · median $9,269 | 6 plans |
| 003 | ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH | $9,401 – $471,562 · median $377,250 | 5 plans |
| 004 | TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NEC | $9,401 – $278,449 · median $222,759 | 5 plans |
| 193 | SIMPLE PNEUMONIA AND PLEURISY WITH MCC | $6,141 – $29,015 · median $23,212 | 5 plans |
| 194 | SIMPLE PNEUMONIA AND PLEURISY WITH CC | $6,141 – $29,015 · median $23,212 | 5 plans |
| 195 | SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC | $6,141 – $29,015 · median $23,212 | 5 plans |
| 323 | CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC | $9,401 – $38,048 · median $23,716 | 5 plans |
| 324 | CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC | $9,401 – $38,358 · median $23,716 | 5 plans |
| 392 | ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC | $6,141 – $18,605 · median $14,884 | 5 plans |
| 603 | CELLULITIS WITHOUT MCC | $6,141 – $18,605 · median $14,884 | 5 plans |
| 683 | RENAL FAILURE WITH CC | $6,141 – $18,605 · median $14,884 | 5 plans |
| 689 | KIDNEY AND URINARY TRACT INFECTIONS WITH MCC | $6,141 – $29,015 · median $23,212 | 5 plans |
| 690 | KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC | $6,141 – $18,605 · median $14,884 | 5 plans |
| 748 | FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES | $10,937 – $16,671 · median $12,131 | 5 plans |
| 783 | CESAREAN SECTION WITH STERILIZATION WITH MCC | $8,497 – $15,186 · median $12,149 | 5 plans |
| 784 | CESAREAN SECTION WITH STERILIZATION WITH CC | $8,497 – $15,186 · median $12,149 | 5 plans |
| 785 | CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC | $8,497 – $15,186 · median $12,149 | 5 plans |
| 786 | CESAREAN SECTION WITHOUT STERILIZATION WITH MCC | $8,497 – $15,186 · median $12,149 | 5 plans |
| 787 | CESAREAN SECTION WITHOUT STERILIZATION WITH CC | $8,497 – $15,186 · median $12,149 | 5 plans |
| 788 | CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC | $8,497 – $15,186 · median $12,149 | 5 plans |
| 796 | VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC | $6,645 – $11,586 · median $9,269 | 5 plans |
| 797 | VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC | $6,645 – $11,586 · median $9,269 | 5 plans |
| 798 | VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC | $6,645 – $11,586 · median $9,269 | 5 plans |
| 805 | VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC | $6,645 – $11,586 · median $9,269 | 5 plans |
| 806 | VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC | $6,645 – $11,586 · median $9,269 | 5 plans |
| 807 | VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC | $6,645 – $11,586 · median $9,269 | 5 plans |
| 871 | SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC | $6,141 – $29,015 · median $23,212 | 5 plans |
| 872 | SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC | $6,141 – $18,605 · median $14,884 | 5 plans |
| 031 | VENTRICULAR SHUNT PROCEDURES WITH MCC | $18,677 – $31,759 · median $23,108 | 4 plans |
| 032 | VENTRICULAR SHUNT PROCEDURES WITH CC | $17,433 – $31,759 · median $23,108 | 4 plans |
| 033 | VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC | $16,188 – $31,759 · median $23,108 | 4 plans |
| 064 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC | $6,141 – $25,654 · median $13,672 | 4 plans |
| 212 | CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES | $9,401 – $131,690 · median $74,737 | 4 plans |
| 246 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ AR | $8,850 – $24,220 · median $23,654 | 4 plans |
| 248 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4 | $16,994 – $78,127 · median $42,148 | 4 plans |
| 417 | LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC | $9,401 – $12,790 · median $11,928 | 4 plans |
| 418 | LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC | $9,401 – $11,928 · median $11,720 | 4 plans |
| 419 | LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC | $9,401 – $11,230 · median $10,796 | 4 plans |
| 463 | WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE | $34,731 – $71,294 · median $41,234 | 4 plans |
| 464 | WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE | $34,731 – $71,294 · median $41,234 | 4 plans |
| 465 | WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE | $34,731 – $71,294 · median $41,234 | 4 plans |
| 483 | MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES | $9,401 – $41,611 · median $20,868 | 4 plans |
| 485 | KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC | $25,847 – $53,057 · median $30,686 | 4 plans |
| 486 | KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC | $25,847 – $53,057 · median $30,686 | 4 plans |
| 487 | KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC | $25,847 – $53,057 · median $30,686 | 4 plans |
| 488 | KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC | $12,934 – $26,545 · median $15,355 | 4 plans |
| 489 | KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC | $12,934 – $26,545 · median $15,355 | 4 plans |
| 492 | LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC | $15,578 – $39,291 · median $18,816 | 4 plans |
| 493 | LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC | $15,578 – $31,432 · median $18,816 | 4 plans |
| 494 | LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC | $15,578 – $27,502 · median $18,816 | 4 plans |
| 515 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC | $17,359 – $31,176 · median $20,967 | 4 plans |
| 516 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC | $17,359 – $31,176 · median $20,967 | 4 plans |
| 517 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MC | $17,359 – $24,941 · median $20,967 | 4 plans |
| 739 | UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MC | $21,955 – $54,527 · median $39,674 | 4 plans |
| 001 | HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC | $221,676 – $304,689 · median $221,676 | 3 plans |
| 002 | HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC | $221,676 – $304,689 · median $221,676 | 3 plans |
| 034 | CAROTID ARTERY STENT PROCEDURES WITH MCC | $9,239 – $12,696 · median $9,239 | 3 plans |
| 035 | CAROTID ARTERY STENT PROCEDURES WITH CC | $9,239 – $12,696 · median $9,239 | 3 plans |
| 036 | CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC | $9,239 – $12,696 · median $9,239 | 3 plans |
| 067 | NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC | $6,141 – $18,978 · median $18,978 | 3 plans |
| 068 | NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC | $6,141 – $9,766 · median $9,766 | 3 plans |
| 143 | OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC | $9,401 – $14,063 · median $14,063 | 3 plans |
| 144 | OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC | $9,401 – $14,063 · median $14,063 | 3 plans |
| 222 | CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK | $31,150 – $82,226 · median $82,226 | 3 plans |
| 223 | CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK | $31,150 – $82,226 · median $82,226 | 3 plans |
| 224 | CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SH | $31,150 – $60,961 · median $60,961 | 3 plans |
| 225 | CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SH | $31,150 – $60,961 · median $60,961 | 3 plans |
| 226 | CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC | $26,700 – $52,404 · median $52,404 | 3 plans |
| 227 | CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC | $26,700 – $52,404 · median $52,404 | 3 plans |
| 247 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC | $8,850 – $20,078 · median $20,078 | 3 plans |
| 249 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC | $16,994 – $23,088 · median $16,994 | 3 plans |
| 263 | VEIN LIGATION AND STRIPPING | $12,562 – $17,267 · median $12,562 | 3 plans |
| 264 | OTHER CIRCULATORY SYSTEM O.R. PROCEDURES | $18,475 – $25,392 · median $18,475 | 3 plans |
| 280 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC | $14,403 – $19,794 · median $14,403 | 3 plans |
| 281 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC | $14,403 – $19,794 · median $14,403 | 3 plans |
| 282 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC | $14,403 – $19,794 · median $14,403 | 3 plans |
| 283 | ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC | $12,563 – $17,267 · median $12,563 | 3 plans |
| 284 | ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC | $12,563 – $17,267 · median $12,563 | 3 plans |
| 285 | ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC | $12,563 – $17,267 · median $12,563 | 3 plans |
| 288 | ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC | $18,475 – $25,392 · median $18,475 | 3 plans |
| 289 | ACUTE AND SUBACUTE ENDOCARDITIS WITH CC | $18,475 – $25,392 · median $18,475 | 3 plans |
| 290 | ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC | $18,475 – $25,392 · median $18,475 | 3 plans |
| 291 | HEART FAILURE AND SHOCK WITH MCC | $19,298 – $27,385 · median $19,298 | 3 plans |
| 292 | HEART FAILURE AND SHOCK WITH CC | $9,609 – $13,206 · median $9,609 | 3 plans |
| 293 | HEART FAILURE AND SHOCK WITHOUT CC/MCC | $9,609 – $13,206 · median $9,609 | 3 plans |
| 299 | PERIPHERAL VASCULAR DISORDERS WITH MCC | $10,005 – $13,749 · median $10,005 | 3 plans |
| 300 | PERIPHERAL VASCULAR DISORDERS WITH CC | $10,005 – $13,749 · median $10,005 | 3 plans |
| 301 | PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC | $8,870 – $12,188 · median $8,870 | 3 plans |
| 313 | CHEST PAIN | $3,695 – $5,078 · median $3,695 | 3 plans |
| 325 | CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE | $9,401 – $23,716 · median $21,991 | 3 plans |
| 326 | STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC | $9,401 – $31,652 · median $31,652 | 3 plans |
| 327 | STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC | $9,401 – $28,814 · median $28,814 | 3 plans |
| 453 | COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC | $49,058 – $65,427 · median $49,058 | 3 plans |
| 454 | COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC | $49,058 – $65,427 · median $49,058 | 3 plans |
| 455 | COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC | $51,346 – $65,427 · median $51,346 | 3 plans |
| 495 | LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WIT | $10,899 – $14,979 · median $10,899 | 3 plans |
| 496 | LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WIT | $10,899 – $14,979 · median $10,899 | 3 plans |
| 497 | LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WIT | $10,899 – $14,979 · median $10,899 | 3 plans |
| 503 | FOOT PROCEDURES WITH MCC | $11,824 – $16,250 · median $11,824 | 3 plans |
| 504 | FOOT PROCEDURES WITH CC | $11,824 – $16,250 · median $11,824 | 3 plans |
| 505 | FOOT PROCEDURES WITHOUT CC/MCC | $11,824 – $16,250 · median $11,824 | 3 plans |
| 507 | MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC | $16,994 – $23,357 · median $16,994 | 3 plans |
| 508 | MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC | $16,994 – $23,357 · median $16,994 | 3 plans |
| 510 | SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC | $16,994 – $23,357 · median $16,994 | 3 plans |
| 511 | SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC | $16,994 – $23,357 · median $16,994 | 3 plans |
| 512 | SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/ | $16,994 – $23,357 · median $16,994 | 3 plans |
| 658 | KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC | $17,138 – $23,554 · median $17,138 | 3 plans |
| 659 | KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC | $40,272 – $55,352 · median $40,272 | 3 plans |
| 660 | KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC | $17,996 – $24,734 · median $17,996 | 3 plans |
| 661 | KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC | $9,906 – $13,615 · median $9,906 | 3 plans |
| 693 | URINARY STONES WITH MCC | $7,391 – $10,156 · median $7,391 | 3 plans |
| 694 | URINARY STONES WITHOUT MCC | $7,391 – $10,156 · median $7,391 | 3 plans |
| 707 | MAJOR MALE PELVIC PROCEDURES WITH CC/MCC | $20,232 – $27,806 · median $20,232 | 3 plans |
| 708 | MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC | $7,862 – $10,805 · median $7,862 | 3 plans |
| 011 | TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC | — | 2 plans |
| 012 | TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC | — | 2 plans |
| 013 | TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 065 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS | $6,141 – $25,654 · median $15,898 | 2 plans |
| 066 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC | $6,141 – $10,262 · median $8,202 | 2 plans |
| 113 | ORBITAL PROCEDURES WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 114 | ORBITAL PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 115 | EXTRAOCULAR PROCEDURES EXCEPT ORBIT | $5,190 – $5,190 · median $5,190 | 2 plans |
| 116 | INTRAOCULAR PROCEDURES WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 117 | INTRAOCULAR PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 135 | SINUS AND MASTOID PROCEDURES WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 136 | SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 137 | MOUTH PROCEDURES WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 138 | MOUTH PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 139 | SALIVARY GLAND PROCEDURES | $5,190 – $5,190 · median $5,190 | 2 plans |
| 140 | MAJOR HEAD AND NECK PROCEDURES WITH MCC | — | 2 plans |
| 141 | MAJOR HEAD AND NECK PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 142 | MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 145 | OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 163 | MAJOR CHEST PROCEDURES WITH MCC | — | 2 plans |
| 164 | MAJOR CHEST PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 165 | MAJOR CHEST PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 166 | OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC | — | 2 plans |
| 167 | OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 168 | OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 173 | ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY | — | 2 plans |
| 239 | AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC | — | 2 plans |
| 240 | AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC | — | 2 plans |
| 241 | AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 255 | UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 256 | UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 257 | UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 278 | ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES | — | 2 plans |
| 279 | ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES | — | 2 plans |
| 317 | CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION | — | 2 plans |
| 328 | STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 329 | MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC | $9,401 – $28,791 · median $19,096 | 2 plans |
| 330 | MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC | $9,401 – $25,591 · median $17,496 | 2 plans |
| 331 | MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC | $9,401 – $23,994 · median $16,698 | 2 plans |
| 332 | RECTAL RESECTION WITH MCC | — | 2 plans |
| 333 | RECTAL RESECTION WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 334 | RECTAL RESECTION WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 335 | PERITONEAL ADHESIOLYSIS WITH MCC | — | 2 plans |
| 336 | PERITONEAL ADHESIOLYSIS WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 337 | PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 344 | MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 345 | MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 346 | MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 347 | ANAL AND STOMAL PROCEDURES WITH MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 348 | ANAL AND STOMAL PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 349 | ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 350 | INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 351 | INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 352 | INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 353 | HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC | — | 2 plans |
| 354 | HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 355 | HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 356 | OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC | — | 2 plans |
| 357 | OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 358 | OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 397 | APPENDIX PROCEDURES WITH MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 398 | APPENDIX PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 399 | APPENDIX PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 402 | SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL | $20,650 – $40,973 · median $30,812 | 2 plans |
| 405 | PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC | — | 2 plans |
| 406 | PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC | — | 2 plans |
| 407 | PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 408 | BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH | — | 2 plans |
| 409 | BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH | $5,190 – $5,190 · median $5,190 | 2 plans |
| 410 | BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH | $5,190 – $5,190 · median $5,190 | 2 plans |
| 411 | CHOLECYSTECTOMY WITH C.D.E. WITH MCC | — | 2 plans |
| 412 | CHOLECYSTECTOMY WITH C.D.E. WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 413 | CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 414 | CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC | — | 2 plans |
| 415 | CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 416 | CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 420 | HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC | — | 2 plans |
| 421 | HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 422 | HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 423 | OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC | — | 2 plans |
| 424 | OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 425 | OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 426 | MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WIT | $20,650 – $109,711 · median $65,181 | 2 plans |
| 427 | MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WIT | $20,650 – $74,388 · median $47,519 | 2 plans |
| 428 | MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WIT | $20,650 – $57,645 · median $39,148 | 2 plans |
| 429 | COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC | $20,650 – $87,353 · median $54,002 | 2 plans |
| 430 | COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC | $20,650 – $57,293 · median $38,972 | 2 plans |
| 447 | MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALL | — | 2 plans |
| 448 | MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC | $17,900 – $42,767 · median $30,334 | 2 plans |
| 450 | SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY | $17,900 – $53,938 · median $35,919 | 2 plans |
| 451 | SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC | $17,900 – $32,320 · median $25,110 | 2 plans |
| 474 | AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC | — | 2 plans |
| 475 | AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 476 | AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 477 | BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC | — | 2 plans |
| 478 | BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 479 | BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 498 | LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 499 | LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT | $5,190 – $5,190 · median $5,190 | 2 plans |
| 500 | SOFT TISSUE PROCEDURES WITH MCC | — | 2 plans |
| 501 | SOFT TISSUE PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 502 | SOFT TISSUE PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 506 | MAJOR THUMB OR JOINT PROCEDURES | $5,190 – $5,190 · median $5,190 | 2 plans |
| 509 | ARTHROSCOPY | $5,190 – $5,190 · median $5,190 | 2 plans |
| 513 | HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 514 | HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 570 | SKIN DEBRIDEMENT WITH MCC | — | 2 plans |
| 571 | SKIN DEBRIDEMENT WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 572 | SKIN DEBRIDEMENT WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 573 | SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC | — | 2 plans |
| 574 | SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC | — | 2 plans |
| 575 | SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 576 | SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC | — | 2 plans |
| 577 | SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 578 | SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 579 | OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC | — | 2 plans |
| 580 | OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 581 | OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 582 | MASTECTOMY FOR MALIGNANCY WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 583 | MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 584 | BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 585 | BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 614 | ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 615 | ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 616 | AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH | — | 2 plans |
| 617 | AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH | $5,190 – $5,190 · median $5,190 | 2 plans |
| 618 | AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH | $5,190 – $5,190 · median $5,190 | 2 plans |
| 622 | SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISOR | — | 2 plans |
| 623 | SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISOR | $5,190 – $5,190 · median $5,190 | 2 plans |
| 624 | SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISOR | $5,190 – $5,190 · median $5,190 | 2 plans |
| 625 | THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC | — | 2 plans |
| 626 | THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 627 | THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 628 | OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC | — | 2 plans |
| 629 | OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 630 | OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 653 | MAJOR BLADDER PROCEDURES WITH MCC | — | 2 plans |
| 654 | MAJOR BLADDER PROCEDURES WITH CC | — | 2 plans |
| 655 | MAJOR BLADDER PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 656 | KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC | — | 2 plans |
| 657 | KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 662 | MINOR BLADDER PROCEDURES WITH MCC | — | 2 plans |
| 663 | MINOR BLADDER PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 664 | MINOR BLADDER PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 665 | PROSTATECTOMY WITH MCC | — | 2 plans |
| 666 | PROSTATECTOMY WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 667 | PROSTATECTOMY WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 668 | TRANSURETHRAL PROCEDURES WITH MCC | — | 2 plans |
| 669 | TRANSURETHRAL PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 670 | TRANSURETHRAL PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 671 | URETHRAL PROCEDURES WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 672 | URETHRAL PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 673 | OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC | — | 2 plans |
| 674 | OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 675 | OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 709 | PENIS PROCEDURES WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 710 | PENIS PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 711 | TESTES PROCEDURES WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 712 | TESTES PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 713 | TRANSURETHRAL PROSTATECTOMY WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 714 | TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 715 | OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 716 | OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 717 | OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 718 | OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 734 | PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 735 | PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 736 | UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC | — | 2 plans |
| 737 | UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 738 | UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 744 | D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 745 | D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 746 | VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 747 | VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 749 | OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 750 | OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 769 | POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES | $5,190 – $5,190 · median $5,190 | 2 plans |
| 770 | ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY | $5,190 – $5,190 · median $5,190 | 2 plans |
| 790 | EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE | $25,840 – $25,840 · median $25,840 | 2 plans |
| 799 | SPLENIC PROCEDURES WITH MCC | — | 2 plans |
| 800 | SPLENIC PROCEDURES WITH CC | — | 2 plans |
| 801 | SPLENIC PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 802 | OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC | — | 2 plans |
| 803 | OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 804 | OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 820 | LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC | — | 2 plans |
| 821 | LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 822 | LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 823 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC | — | 2 plans |
| 824 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 825 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 826 | MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. | — | 2 plans |
| 827 | MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. | $5,190 – $5,190 · median $5,190 | 2 plans |
| 828 | MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. | $5,190 – $5,190 · median $5,190 | 2 plans |
| 829 | MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCE | — | 2 plans |
| 830 | MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCE | $5,190 – $5,190 · median $5,190 | 2 plans |
| 853 | INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC | — | 2 plans |
| 854 | INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 855 | INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 856 | POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC | — | 2 plans |
| 857 | POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 858 | POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 876 | O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS | — | 2 plans |
| 901 | WOUND DEBRIDEMENTS FOR INJURIES WITH MCC | — | 2 plans |
| 902 | WOUND DEBRIDEMENTS FOR INJURIES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 903 | WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 904 | SKIN GRAFTS FOR INJURIES WITH CC/MCC | — | 2 plans |
| 905 | SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 906 | HAND PROCEDURES FOR INJURIES | $5,190 – $5,190 · median $5,190 | 2 plans |
| 907 | OTHER O.R. PROCEDURES FOR INJURIES WITH MCC | — | 2 plans |
| 908 | OTHER O.R. PROCEDURES FOR INJURIES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 909 | OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 927 | EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT | — | 2 plans |
| 928 | FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC | — | 2 plans |
| 929 | FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC | — | 2 plans |
| 939 | O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC | — | 2 plans |
| 940 | O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 941 | O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/ | $5,190 – $5,190 · median $5,190 | 2 plans |
| 955 | CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA | — | 2 plans |
| 957 | OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC | — | 2 plans |
| 958 | OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC | — | 2 plans |
| 969 | HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC | — | 2 plans |
| 970 | HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 981 | EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC | — | 2 plans |
| 982 | EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 983 | EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 987 | NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC | — | 2 plans |
| 988 | NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 989 | NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC | $5,190 – $5,190 · median $5,190 | 2 plans |
| 052 | SPINAL DISORDERS AND INJURIES WITH CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 053 | SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 054 | NERVOUS SYSTEM NEOPLASMS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 055 | NERVOUS SYSTEM NEOPLASMS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 056 | DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 057 | DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 058 | MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 059 | MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 060 | MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 061 | ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC A | $6,141 – $6,141 · median $6,141 | 1 plans |
| 062 | ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC A | $6,141 – $6,141 · median $6,141 | 1 plans |
| 063 | ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC A | $6,141 – $6,141 · median $6,141 | 1 plans |
| 069 | TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC Adult | $6,160 – $6,160 · median $6,160 | 1 plans |
| 070 | NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 071 | NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 072 | NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 073 | CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 074 | CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 075 | VIRAL MENINGITIS WITH CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 076 | VIRAL MENINGITIS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 077 | HYPERTENSIVE ENCEPHALOPATHY WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 078 | HYPERTENSIVE ENCEPHALOPATHY WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 079 | HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 080 | NONTRAUMATIC STUPOR AND COMA WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 081 | NONTRAUMATIC STUPOR AND COMA WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 082 | TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 083 | TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 084 | TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 085 | TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 086 | TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 087 | TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 088 | CONCUSSION WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 089 | CONCUSSION WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 090 | CONCUSSION WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 091 | OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 092 | OTHER DISORDERS OF NERVOUS SYSTEM WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 093 | OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 094 | BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC | — | 1 plans |
| 095 | BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 096 | BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 097 | NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC | — | 1 plans |
| 098 | NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 099 | NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 100 | SEIZURES WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 101 | SEIZURES WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 102 | HEADACHES WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 103 | HEADACHES WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 121 | ACUTE MAJOR EYE INFECTIONS WITH CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 122 | ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 123 | NEUROLOGICAL EYE DISORDERS | $6,141 – $6,141 · median $6,141 | 1 plans |
| 124 | OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT | $6,141 – $6,141 · median $6,141 | 1 plans |
| 125 | OTHER DISORDERS OF THE EYE WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 146 | EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 147 | EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 148 | EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 149 | DYSEQUILIBRIUM | $6,141 – $6,141 · median $6,141 | 1 plans |
| 150 | EPISTAXIS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 151 | EPISTAXIS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 152 | OTITIS MEDIA AND URI WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 153 | OTITIS MEDIA AND URI WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 154 | OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 155 | OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 156 | OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 157 | DENTAL AND ORAL DISEASES WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 158 | DENTAL AND ORAL DISEASES WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 159 | DENTAL AND ORAL DISEASES WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 175 | PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE | $6,141 – $6,141 · median $6,141 | 1 plans |
| 176 | PULMONARY EMBOLISM WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 177 | RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 178 | RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 179 | RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 180 | RESPIRATORY NEOPLASMS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 181 | RESPIRATORY NEOPLASMS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 182 | RESPIRATORY NEOPLASMS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 183 | MAJOR CHEST TRAUMA WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 184 | MAJOR CHEST TRAUMA WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 185 | MAJOR CHEST TRAUMA WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 186 | PLEURAL EFFUSION WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 187 | PLEURAL EFFUSION WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 188 | PLEURAL EFFUSION WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 189 | PULMONARY EDEMA AND RESPIRATORY FAILURE | $6,141 – $6,141 · median $6,141 | 1 plans |
| 190 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 191 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 192 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 196 | INTERSTITIAL LUNG DISEASE WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 197 | INTERSTITIAL LUNG DISEASE WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 198 | INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 199 | PNEUMOTHORAX WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 200 | PNEUMOTHORAX WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 201 | PNEUMOTHORAX WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 202 | BRONCHITIS AND ASTHMA WITH CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 203 | BRONCHITIS AND ASTHMA WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 204 | RESPIRATORY SIGNS AND SYMPTOMS | $6,141 – $6,141 · median $6,141 | 1 plans |
| 205 | OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 206 | OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 207 | RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS | — | 1 plans |
| 208 | RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS | $6,141 – $6,141 · median $6,141 | 1 plans |
| 237 | MAJOR CARDIOVASC PROCEDURES W MCC | $18,000 – $18,000 · median $18,000 | 1 plans |
| 238 | MAJOR CARDIOVASC PROCEDURES W/O MCC | $18,000 – $18,000 · median $18,000 | 1 plans |
| 294 | DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 295 | DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 296 | CARDIAC ARREST, UNEXPLAINED WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 297 | CARDIAC ARREST, UNEXPLAINED WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 298 | CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 302 | ATHEROSCLEROSIS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 303 | ATHEROSCLEROSIS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 304 | HYPERTENSION WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 305 | HYPERTENSION WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 306 | CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 307 | CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 308 | CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 309 | CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 310 | CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 311 | ANGINA PECTORIS | $6,141 – $6,141 · median $6,141 | 1 plans |
| 312 | SYNCOPE AND COLLAPSE | $6,141 – $6,141 · median $6,141 | 1 plans |
| 314 | OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 315 | OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 316 | OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 368 | MAJOR ESOPHAGEAL DISORDERS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 369 | MAJOR ESOPHAGEAL DISORDERS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 370 | MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 371 | MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 372 | MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 373 | MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 374 | DIGESTIVE MALIGNANCY WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 375 | DIGESTIVE MALIGNANCY WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 376 | DIGESTIVE MALIGNANCY WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 377 | GASTROINTESTINAL HEMORRHAGE WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 378 | GASTROINTESTINAL HEMORRHAGE WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 379 | GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 380 | COMPLICATED PEPTIC ULCER WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 381 | COMPLICATED PEPTIC ULCER WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 382 | COMPLICATED PEPTIC ULCER WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 383 | UNCOMPLICATED PEPTIC ULCER WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 384 | UNCOMPLICATED PEPTIC ULCER WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 385 | INFLAMMATORY BOWEL DISEASE WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 386 | INFLAMMATORY BOWEL DISEASE WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 387 | INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 388 | GASTROINTESTINAL OBSTRUCTION WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 389 | GASTROINTESTINAL OBSTRUCTION WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 390 | GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 391 | ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 393 | OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 394 | OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 395 | OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 432 | CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 433 | CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 434 | CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 435 | MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 436 | MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 437 | MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 438 | DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 439 | DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 440 | DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 441 | DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 442 | DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 443 | DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT C | $6,141 – $6,141 · median $6,141 | 1 plans |
| 444 | DISORDERS OF THE BILIARY TRACT WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 445 | DISORDERS OF THE BILIARY TRACT WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 446 | DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 533 | FRACTURES OF FEMUR WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 534 | FRACTURES OF FEMUR WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 535 | FRACTURES OF HIP AND PELVIS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 536 | FRACTURES OF HIP AND PELVIS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 537 | SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 538 | SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 539 | OSTEOMYELITIS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 540 | OSTEOMYELITIS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 541 | OSTEOMYELITIS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 542 | PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH | $6,141 – $6,141 · median $6,141 | 1 plans |
| 543 | PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH | $6,141 – $6,141 · median $6,141 | 1 plans |
| 544 | PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH | $6,141 – $6,141 · median $6,141 | 1 plans |
| 545 | CONNECTIVE TISSUE DISORDERS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 546 | CONNECTIVE TISSUE DISORDERS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 547 | CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 548 | SEPTIC ARTHRITIS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 549 | SEPTIC ARTHRITIS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 550 | SEPTIC ARTHRITIS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 551 | MEDICAL BACK PROBLEMS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 552 | MEDICAL BACK PROBLEMS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 553 | BONE DISEASES AND ARTHROPATHIES WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 554 | BONE DISEASES AND ARTHROPATHIES WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 555 | SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 556 | SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 557 | TENDONITIS, MYOSITIS AND BURSITIS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 558 | TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 559 | AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 560 | AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 561 | AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 562 | FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WIT | $6,141 – $6,141 · median $6,141 | 1 plans |
| 563 | FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WIT | $6,141 – $6,141 · median $6,141 | 1 plans |
| 564 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 565 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 566 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 592 | SKIN ULCERS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 593 | SKIN ULCERS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 594 | SKIN ULCERS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 595 | MAJOR SKIN DISORDERS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 596 | MAJOR SKIN DISORDERS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 597 | MALIGNANT BREAST DISORDERS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 598 | MALIGNANT BREAST DISORDERS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 599 | MALIGNANT BREAST DISORDERS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 600 | NON-MALIGNANT BREAST DISORDERS WITH CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 601 | NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 602 | CELLULITIS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 604 | TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 605 | TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 606 | MINOR SKIN DISORDERS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 607 | MINOR SKIN DISORDERS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 637 | DIABETES WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 638 | DIABETES WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 639 | DIABETES WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 640 | MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH M | $6,141 – $6,141 · median $6,141 | 1 plans |
| 641 | MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOU | $6,141 – $6,141 · median $6,141 | 1 plans |
| 642 | INBORN AND OTHER DISORDERS OF METABOLISM | $6,141 – $6,141 · median $6,141 | 1 plans |
| 643 | ENDOCRINE DISORDERS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 644 | ENDOCRINE DISORDERS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 645 | ENDOCRINE DISORDERS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 682 | RENAL FAILURE WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 684 | RENAL FAILURE WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 686 | KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 687 | KIDNEY AND URINARY TRACT NEOPLASMS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 688 | KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 695 | KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 696 | KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 697 | URETHRAL STRICTURE | $6,141 – $6,141 · median $6,141 | 1 plans |
| 698 | OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 699 | OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 700 | OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 722 | MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 723 | MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 724 | MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 725 | BENIGN PROSTATIC HYPERTROPHY WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 726 | BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 727 | INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 728 | INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 729 | OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 730 | OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 754 | MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 755 | MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 756 | MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 757 | INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 758 | INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 759 | INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 760 | MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 761 | MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 776 | POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES | $6,141 – $6,141 · median $6,141 | 1 plans |
| 779 | ABORTION WITHOUT D&C | $6,141 – $6,141 · median $6,141 | 1 plans |
| 808 | MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND CO | $6,141 – $6,141 · median $6,141 | 1 plans |
| 809 | MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND CO | $6,141 – $6,141 · median $6,141 | 1 plans |
| 810 | MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND CO | $6,141 – $6,141 · median $6,141 | 1 plans |
| 811 | RED BLOOD CELL DISORDERS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 812 | RED BLOOD CELL DISORDERS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 813 | COAGULATION DISORDERS | $6,141 – $6,141 · median $6,141 | 1 plans |
| 814 | RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 815 | RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 816 | RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 834 | ACUTE LEUKEMIA WITH MCC | — | 1 plans |
| 835 | ACUTE LEUKEMIA WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 836 | ACUTE LEUKEMIA WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 837 | CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOT | — | 1 plans |
| 838 | CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHE | $6,141 – $6,141 · median $6,141 | 1 plans |
| 839 | CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 840 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 841 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 842 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 843 | OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES | $6,141 – $6,141 · median $6,141 | 1 plans |
| 844 | OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES | $6,141 – $6,141 · median $6,141 | 1 plans |
| 845 | OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES | $6,141 – $6,141 · median $6,141 | 1 plans |
| 846 | CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 847 | CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 848 | CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 849 | RADIOTHERAPY | $6,141 – $6,141 · median $6,141 | 1 plans |
| 862 | POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 863 | POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 864 | FEVER AND INFLAMMATORY CONDITIONS | $6,141 – $6,141 · median $6,141 | 1 plans |
| 865 | VIRAL ILLNESS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 866 | VIRAL ILLNESS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 867 | OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 868 | OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 869 | OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 870 | SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS Adult | — | 1 plans |
| 880 | ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION | $6,141 – $6,141 · median $6,141 | 1 plans |
| 881 | DEPRESSIVE NEUROSES | $6,141 – $6,141 · median $6,141 | 1 plans |
| 882 | NEUROSES EXCEPT DEPRESSIVE | $6,141 – $6,141 · median $6,141 | 1 plans |
| 883 | DISORDERS OF PERSONALITY AND IMPULSE CONTROL | $6,141 – $6,141 · median $6,141 | 1 plans |
| 884 | ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY | $6,141 – $6,141 · median $6,141 | 1 plans |
| 885 | PSYCHOSES | $6,141 – $6,141 · median $6,141 | 1 plans |
| 886 | BEHAVIORAL AND DEVELOPMENTAL DISORDERS | $6,141 – $6,141 · median $6,141 | 1 plans |
| 887 | OTHER MENTAL DISORDER DIAGNOSES | $6,141 – $6,141 · median $6,141 | 1 plans |
| 894 | ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA | $6,141 – $6,141 · median $6,141 | 1 plans |
| 895 | ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY | $6,141 – $6,141 · median $6,141 | 1 plans |
| 896 | ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 897 | ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 913 | TRAUMATIC INJURY WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 914 | TRAUMATIC INJURY WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 915 | ALLERGIC REACTIONS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 916 | ALLERGIC REACTIONS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 917 | POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 918 | POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 919 | COMPLICATIONS OF TREATMENT WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 920 | COMPLICATIONS OF TREATMENT WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 921 | COMPLICATIONS OF TREATMENT WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 922 | OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 923 | OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 933 | EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT | — | 1 plans |
| 934 | FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY | $6,141 – $6,141 · median $6,141 | 1 plans |
| 935 | NON-EXTENSIVE BURNS | $6,141 – $6,141 · median $6,141 | 1 plans |
| 947 | SIGNS AND SYMPTOMS WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 948 | SIGNS AND SYMPTOMS WITHOUT MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 949 | AFTERCARE WITH CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 950 | AFTERCARE WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 951 | OTHER FACTORS INFLUENCING HEALTH STATUS | $6,141 – $6,141 · median $6,141 | 1 plans |
| 956 | LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA | $9,401 – $9,401 · median $9,401 | 1 plans |
| 959 | OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC | $9,401 – $9,401 · median $9,401 | 1 plans |
| 963 | OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 964 | OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 965 | OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 974 | HIV WITH MAJOR RELATED CONDITION WITH MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 975 | HIV WITH MAJOR RELATED CONDITION WITH CC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 976 | HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC | $6,141 – $6,141 · median $6,141 | 1 plans |
| 977 | HIV WITH OR WITHOUT OTHER RELATED CONDITION | $6,141 – $6,141 · median $6,141 | 1 plans |
No procedures match that keyword.