Good Samaritan Hospital — Pricing
633 procedures published in this hospital's Machine-Readable File (MRF) — 0 with a comparable price, 633 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 633
Lowest published price —
Average published price —
Highest published price —
Gross charges are the hospital's listed price — almost no one pays this amount. Your actual cost depends on your insurance plan. Use the cash price (when shown) as a guide for what uninsured patients are charged, and contact the hospital or your insurer for a personalized cost estimate.
Showing all 633 procedures
Procedures with negotiated rates only
These 633 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 |
|---|---|---|---|
| 880 | ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION | $450 – $19,000 · median $6,175 | 149 plans |
| 884 | ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY | $450 – $31,837 · median $10,346 | 149 plans |
| 885 | PSYCHOSES | $450 – $27,640 · median $8,982 | 149 plans |
| 894 | ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA | $450 – $12,207 · median $3,967 | 149 plans |
| 896 | ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC | $450 – $31,110 · median $11,222 | 148 plans |
| 083 | TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC | $450 – $29,274 · median $8,976 | 147 plans |
| 135 | SINUS AND MASTOID PROCEDURES WITH CC/MCC | $450 – $45,511 · median $13,955 | 147 plans |
| 136 | SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC | $450 – $21,294 · median $6,529 | 147 plans |
| 461 | BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC | $450 – $109,968 · median $35,517 | 147 plans |
| 011 | TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC | $450 – $114,389 · median $35,073 | 146 plans |
| 012 | TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC | $450 – $88,422 · median $27,112 | 146 plans |
| 013 | TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC | $450 – $60,440 · median $18,532 | 146 plans |
| 024 | CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC | $450 – $82,044 · median $25,156 | 146 plans |
| 028 | SPINAL PROCEDURES WITH MCC | $450 – $126,012 · median $38,637 | 146 plans |
| 029 | SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS | $450 – $71,551 · median $21,939 | 146 plans |
| 030 | SPINAL PROCEDURES WITHOUT CC/MCC | $450 – $46,040 · median $14,117 | 146 plans |
| 034 | CAROTID ARTERY STENT PROCEDURES WITH MCC | $450 – $81,180 · median $24,891 | 146 plans |
| 035 | CAROTID ARTERY STENT PROCEDURES WITH CC | $450 – $50,136 · median $15,372 | 146 plans |
| 036 | CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC | $450 – $40,746 · median $12,493 | 146 plans |
| 037 | EXTRACRANIAL PROCEDURES WITH MCC | $450 – $69,045 · median $21,170 | 146 plans |
| 038 | EXTRACRANIAL PROCEDURES WITH CC | $450 – $34,031 · median $10,434 | 146 plans |
| 039 | EXTRACRANIAL PROCEDURES WITHOUT CC/MCC | $450 – $24,654 · median $7,559 | 146 plans |
| 040 | PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC | $450 – $80,981 · median $24,830 | 146 plans |
| 041 | PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR | $450 – $46,113 · median $14,139 | 146 plans |
| 042 | PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC | $450 – $36,235 · median $11,110 | 146 plans |
| 053 | SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC | $450 – $20,537 · median $6,297 | 146 plans |
| 054 | NERVOUS SYSTEM NEOPLASMS WITH MCC | $450 – $32,024 · median $9,819 | 146 plans |
| 055 | NERVOUS SYSTEM NEOPLASMS WITHOUT MCC | $450 – $21,384 · median $6,557 | 146 plans |
| 056 | DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC | $450 – $48,722 · median $14,939 | 146 plans |
| 057 | DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC | $450 – $27,173 · median $8,332 | 146 plans |
| 058 | MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC | $450 – $35,853 · median $10,993 | 146 plans |
| 059 | MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC | $450 – $26,025 · median $7,980 | 146 plans |
| 061 | ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC | $450 – $57,825 · median $17,730 | 146 plans |
| 062 | ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC | $450 – $36,854 · median $11,300 | 146 plans |
| 063 | ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC | $450 – $29,442 · median $9,027 | 146 plans |
| 064 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC | $450 – $42,177 · median $12,932 | 146 plans |
| 065 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS | $450 – $21,189 · median $6,497 | 146 plans |
| 066 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC | $450 – $14,354 · median $4,401 | 146 plans |
| 067 | PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC | $450 – $30,803 · median $9,445 | 146 plans |
| 068 | PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC | $450 – $18,129 · median $5,559 | 146 plans |
| 069 | TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC | $450 – $16,753 · median $5,137 | 146 plans |
| 070 | OTHER CEREBROVASCULAR DISORDERS WITH MCC | $450 – $34,916 · median $10,706 | 146 plans |
| 071 | OTHER CEREBROVASCULAR DISORDERS WITH CC | $450 – $21,518 · median $6,598 | 146 plans |
| 072 | OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC | $450 – $15,860 · median $4,863 | 146 plans |
| 073 | CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC | $450 – $33,647 · median $10,317 | 146 plans |
| 074 | CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC | $450 – $21,619 · median $6,629 | 146 plans |
| 075 | VIRAL MENINGITIS WITH CC/MCC | $450 – $40,216 · median $12,331 | 146 plans |
| 080 | NONTRAUMATIC STUPOR AND COMA WITH MCC | $450 – $37,961 · median $11,639 | 146 plans |
| 081 | NONTRAUMATIC STUPOR AND COMA WITHOUT MCC | $450 – $18,783 · median $5,759 | 146 plans |
| 082 | TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC | $450 – $47,936 · median $14,698 | 146 plans |
| 084 | TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC | $450 – $20,046 · median $6,146 | 146 plans |
| 085 | TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC | $450 – $47,649 · median $14,610 | 146 plans |
| 086 | TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC | $450 – $27,322 · median $8,377 | 146 plans |
| 087 | TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC | $450 – $19,184 · median $5,882 | 146 plans |
| 088 | CONCUSSION WITH MCC | $450 – $28,351 · median $8,693 | 146 plans |
| 089 | CONCUSSION WITH CC | $450 – $23,041 · median $7,065 | 146 plans |
| 090 | CONCUSSION WITHOUT CC/MCC | $450 – $17,265 · median $5,294 | 146 plans |
| 091 | OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC | $450 – $36,833 · median $11,294 | 146 plans |
| 092 | OTHER DISORDERS OF NERVOUS SYSTEM WITH CC | $450 – $21,455 · median $6,579 | 146 plans |
| 094 | BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC | $450 – $73,812 · median $22,632 | 146 plans |
| 096 | BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC | $450 – $54,094 · median $16,586 | 146 plans |
| 098 | NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC | $450 – $48,131 · median $14,758 | 146 plans |
| 100 | SEIZURES WITH MCC | $450 – $40,621 · median $12,455 | 146 plans |
| 101 | SEIZURES WITHOUT MCC | $450 – $18,930 · median $5,804 | 146 plans |
| 103 | HEADACHES WITHOUT MCC | $450 – $17,540 · median $5,378 | 146 plans |
| 113 | ORBITAL PROCEDURES WITH CC/MCC | $450 – $49,310 · median $15,119 | 146 plans |
| 115 | EXTRAOCULAR PROCEDURES EXCEPT ORBIT | $450 – $32,191 · median $9,870 | 146 plans |
| 122 | ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC | $450 – $16,481 · median $5,053 | 146 plans |
| 123 | NEUROLOGICAL EYE DISORDERS | $450 – $16,749 · median $5,136 | 146 plans |
| 125 | OTHER DISORDERS OF THE EYE WITHOUT MCC | $450 – $16,103 · median $4,937 | 146 plans |
| 137 | MOUTH PROCEDURES WITH CC/MCC | $450 – $31,317 · median $9,602 | 146 plans |
| 138 | MOUTH PROCEDURES WITHOUT CC/MCC | $450 – $18,586 · median $5,699 | 146 plans |
| 140 | MAJOR HEAD AND NECK PROCEDURES WITH MCC | $450 – $89,456 · median $27,429 | 146 plans |
| 141 | MAJOR HEAD AND NECK PROCEDURES WITH CC | $450 – $45,744 · median $14,026 | 146 plans |
| 144 | OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC | $450 – $36,344 · median $11,144 | 146 plans |
| 149 | DYSEQUILIBRIUM | $450 – $15,763 · median $4,833 | 146 plans |
| 150 | EPISTAXIS WITH MCC | $450 – $27,926 · median $8,562 | 146 plans |
| 151 | EPISTAXIS WITHOUT MCC | $450 – $15,394 · median $4,720 | 146 plans |
| 152 | OTITIS MEDIA AND URI WITH MCC | $450 – $24,794 · median $7,602 | 146 plans |
| 153 | OTITIS MEDIA AND URI WITHOUT MCC | $450 – $15,482 · median $4,747 | 146 plans |
| 154 | OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC | $450 – $32,791 · median $10,054 | 146 plans |
| 155 | OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC | $450 – $19,222 · median $5,894 | 146 plans |
| 157 | DENTAL AND ORAL DISEASES WITH MCC | $450 – $36,006 · median $11,040 | 146 plans |
| 163 | MAJOR CHEST PROCEDURES WITH MCC | $450 – $93,997 · median $28,821 | 146 plans |
| 164 | MAJOR CHEST PROCEDURES WITH CC | $450 – $52,936 · median $16,231 | 146 plans |
| 165 | MAJOR CHEST PROCEDURES WITHOUT CC/MCC | $450 – $40,147 · median $12,310 | 146 plans |
| 166 | OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC | $450 – $78,391 · median $24,036 | 146 plans |
| 167 | OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC | $450 – $37,823 · median $11,597 | 146 plans |
| 168 | OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC | $450 – $28,658 · median $8,787 | 146 plans |
| 173 | ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM | $450 – $62,424 · median $19,140 | 146 plans |
| 175 | PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE | $450 – $28,809 · median $8,833 | 146 plans |
| 176 | PULMONARY EMBOLISM WITHOUT MCC | $450 – $16,883 · median $5,177 | 146 plans |
| 177 | RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC | $450 – $32,775 · median $10,049 | 146 plans |
| 178 | RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC | $450 – $20,470 · median $6,276 | 146 plans |
| 179 | RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC | $450 – $15,835 · median $4,855 | 146 plans |
| 180 | RESPIRATORY NEOPLASMS WITH MCC | $450 – $37,038 · median $11,357 | 146 plans |
| 181 | RESPIRATORY NEOPLASMS WITH CC | $450 – $22,462 · median $6,887 | 146 plans |
| 183 | MAJOR CHEST TRAUMA WITH MCC | $450 – $32,087 · median $9,838 | 146 plans |
| 184 | MAJOR CHEST TRAUMA WITH CC | $450 – $22,317 · median $6,843 | 146 plans |
| 185 | MAJOR CHEST TRAUMA WITHOUT CC/MCC | $450 – $16,495 · median $5,058 | 146 plans |
| 186 | PLEURAL EFFUSION WITH MCC | $450 – $32,686 · median $10,022 | 146 plans |
| 187 | PLEURAL EFFUSION WITH CC | $450 – $20,744 · median $6,361 | 146 plans |
| 188 | PLEURAL EFFUSION WITHOUT CC/MCC | $450 – $15,042 · median $4,612 | 146 plans |
| 189 | PULMONARY EDEMA AND RESPIRATORY FAILURE | $450 – $25,910 · median $7,944 | 146 plans |
| 190 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC | $450 – $23,232 · median $7,123 | 146 plans |
| 191 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC | $450 – $17,680 · median $5,421 | 146 plans |
| 192 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC | $450 – $13,465 · median $4,128 | 146 plans |
| 193 | SIMPLE PNEUMONIA AND PLEURISY WITH MCC | $450 – $27,567 · median $8,452 | 146 plans |
| 194 | SIMPLE PNEUMONIA AND PLEURISY WITH CC | $450 – $16,902 · median $5,182 | 146 plans |
| 195 | SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC | $450 – $13,182 · median $4,042 | 146 plans |
| 196 | INTERSTITIAL LUNG DISEASE WITH MCC | $450 – $39,580 · median $12,136 | 146 plans |
| 197 | INTERSTITIAL LUNG DISEASE WITH CC | $450 – $19,905 · median $6,103 | 146 plans |
| 198 | INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC | $450 – $15,021 · median $4,606 | 146 plans |
| 199 | PNEUMOTHORAX WITH MCC | $450 – $36,998 · median $11,344 | 146 plans |
| 200 | PNEUMOTHORAX WITH CC | $450 – $23,056 · median $7,069 | 146 plans |
| 201 | PNEUMOTHORAX WITHOUT CC/MCC | $450 – $14,998 · median $4,599 | 146 plans |
| 202 | BRONCHITIS AND ASTHMA WITH CC/MCC | $450 – $20,369 · median $6,245 | 146 plans |
| 204 | RESPIRATORY SIGNS AND SYMPTOMS | $450 – $16,934 · median $5,192 | 146 plans |
| 205 | OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC | $450 – $38,402 · median $11,775 | 146 plans |
| 206 | OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC | $450 – $19,738 · median $6,052 | 146 plans |
| 208 | RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS | $450 – $57,648 · median $17,676 | 146 plans |
| 229 | OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC | $450 – $73,816 · median $20,253 | 146 plans |
| 231 | CORONARY BYPASS WITH PTCA WITH MCC | $450 – $176,800 · median $54,210 | 146 plans |
| 234 | CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC | $450 – $114,569 · median $35,129 | 146 plans |
| 235 | CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC | $450 – $123,082 · median $37,739 | 146 plans |
| 239 | AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC | $450 – $103,223 · median $31,650 | 146 plans |
| 240 | AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC | $450 – $59,784 · median $18,331 | 146 plans |
| 241 | AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC | $450 – $29,035 · median $8,903 | 146 plans |
| 242 | PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC | $450 – $66,963 · median $20,532 | 146 plans |
| 243 | PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC | $450 – $44,691 · median $13,703 | 146 plans |
| 244 | PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC | $450 – $37,909 · median $11,623 | 146 plans |
| 245 | AICD GENERATOR PROCEDURES | $450 – $95,687 · median $29,339 | 146 plans |
| 250 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC | $450 – $45,774 · median $14,035 | 146 plans |
| 251 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC | $450 – $31,344 · median $9,611 | 146 plans |
| 252 | OTHER VASCULAR PROCEDURES WITH MCC | $450 – $73,160 · median $22,432 | 146 plans |
| 253 | OTHER VASCULAR PROCEDURES WITH CC | $450 – $54,438 · median $16,691 | 146 plans |
| 254 | OTHER VASCULAR PROCEDURES WITHOUT CC/MCC | $450 – $37,368 · median $11,458 | 146 plans |
| 255 | UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC | $450 – $56,573 · median $17,346 | 146 plans |
| 256 | UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC | $450 – $35,610 · median $10,919 | 146 plans |
| 257 | UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC | $450 – $22,907 · median $7,024 | 146 plans |
| 258 | CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC | $450 – $65,899 · median $20,206 | 146 plans |
| 259 | CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC | $450 – $42,410 · median $13,003 | 146 plans |
| 260 | CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC | $450 – $68,221 · median $20,918 | 146 plans |
| 261 | CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC | $450 – $39,649 · median $12,157 | 146 plans |
| 264 | OTHER CIRCULATORY SYSTEM O.R. PROCEDURES | $450 – $70,062 · median $21,482 | 146 plans |
| 265 | AICD LEAD PROCEDURES | $450 – $75,885 · median $23,267 | 146 plans |
| 267 | ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC | $450 – $99,848 · median $30,615 | 146 plans |
| 269 | AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC | $450 – $88,573 · median $27,158 | 146 plans |
| 271 | OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC | $450 – $74,586 · median $22,869 | 146 plans |
| 272 | OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC | $450 – $73,517 · median $16,417 | 146 plans |
| 273 | PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC | $450 – $86,524 · median $26,530 | 146 plans |
| 274 | PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC | $450 – $69,037 · median $21,168 | 146 plans |
| 276 | CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR | $450 – $125,976 · median $38,626 | 146 plans |
| 277 | CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC | $450 – $114,590 · median $29,700 | 146 plans |
| 278 | ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC | $450 – $116,740 · median $35,794 | 146 plans |
| 280 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC | $450 – $33,643 · median $10,315 | 146 plans |
| 281 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC | $450 – $19,276 · median $5,910 | 146 plans |
| 282 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC | $450 – $15,166 · median $4,650 | 146 plans |
| 283 | ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC | $450 – $41,543 · median $12,738 | 146 plans |
| 286 | CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC | $450 – $46,409 · median $14,230 | 146 plans |
| 287 | CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC | $450 – $22,443 · median $6,881 | 146 plans |
| 289 | ACUTE AND SUBACUTE ENDOCARDITIS WITH CC | $450 – $35,799 · median $10,976 | 146 plans |
| 290 | ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC | $450 – $19,499 · median $5,979 | 146 plans |
| 291 | HEART FAILURE AND SHOCK WITH MCC | $450 – $26,925 · median $8,256 | 146 plans |
| 292 | HEART FAILURE AND SHOCK WITH CC | $450 – $17,806 · median $5,460 | 146 plans |
| 293 | HEART FAILURE AND SHOCK WITHOUT CC/MCC | $450 – $11,871 · median $3,640 | 146 plans |
| 296 | CARDIAC ARREST, UNEXPLAINED WITH MCC | $450 – $32,758 · median $10,044 | 146 plans |
| 297 | CARDIAC ARREST, UNEXPLAINED WITH CC | $450 – $13,297 · median $4,077 | 146 plans |
| 298 | CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC | $450 – $10,403 · median $2,927 | 146 plans |
| 299 | PERIPHERAL VASCULAR DISORDERS WITH MCC | $450 – $34,243 · median $10,499 | 146 plans |
| 300 | PERIPHERAL VASCULAR DISORDERS WITH CC | $450 – $22,389 · median $6,865 | 146 plans |
| 301 | PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC | $450 – $15,094 · median $4,628 | 146 plans |
| 302 | ATHEROSCLEROSIS WITH MCC | $450 – $25,096 · median $7,695 | 146 plans |
| 303 | ATHEROSCLEROSIS WITHOUT MCC | $450 – $14,119 · median $4,329 | 146 plans |
| 304 | HYPERTENSION WITH MCC | $450 – $24,958 · median $7,652 | 146 plans |
| 305 | HYPERTENSION WITHOUT MCC | $450 – $15,837 · median $4,856 | 146 plans |
| 306 | CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC | $450 – $33,049 · median $10,133 | 146 plans |
| 307 | CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC | $450 – $19,153 · median $5,872 | 146 plans |
| 308 | CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC | $450 – $25,251 · median $7,743 | 146 plans |
| 309 | CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC | $450 – $15,430 · median $4,731 | 146 plans |
| 310 | CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC | $450 – $11,873 · median $3,640 | 146 plans |
| 311 | ANGINA PECTORIS | $450 – $14,721 · median $4,514 | 146 plans |
| 312 | SYNCOPE AND COLLAPSE | $450 – $18,280 · median $5,605 | 146 plans |
| 314 | OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC | $450 – $43,733 · median $13,409 | 146 plans |
| 315 | OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC | $450 – $20,203 · median $6,195 | 146 plans |
| 319 | OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC | $450 – $93,600 · median $28,699 | 146 plans |
| 320 | OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC | $450 – $50,446 · median $15,468 | 146 plans |
| 321 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES | $450 – $57,063 · median $17,497 | 146 plans |
| 322 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC | $450 – $36,975 · median $11,337 | 146 plans |
| 324 | CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC | $450 – $66,086 · median $20,263 | 146 plans |
| 325 | CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE | $450 – $67,332 · median $20,645 | 146 plans |
| 327 | STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC | $450 – $51,262 · median $15,718 | 146 plans |
| 328 | STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC | $450 – $33,605 · median $10,304 | 146 plans |
| 329 | MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC | $450 – $96,402 · median $29,559 | 146 plans |
| 330 | MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC | $450 – $50,276 · median $15,416 | 146 plans |
| 331 | MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC | $450 – $35,295 · median $10,822 | 146 plans |
| 333 | RECTAL RESECTION WITH CC | $450 – $49,123 · median $15,062 | 146 plans |
| 335 | PERITONEAL ADHESIOLYSIS WITH MCC | $450 – $74,892 · median $22,963 | 146 plans |
| 336 | PERITONEAL ADHESIOLYSIS WITH CC | $450 – $44,226 · median $13,560 | 146 plans |
| 337 | PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC | $450 – $32,194 · median $9,871 | 146 plans |
| 344 | MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC | $450 – $54,169 · median $16,609 | 146 plans |
| 345 | MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC | $450 – $31,558 · median $9,676 | 146 plans |
| 346 | MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC | $450 – $24,878 · median $7,628 | 146 plans |
| 348 | ANAL AND STOMAL PROCEDURES WITH CC | $450 – $27,449 · median $8,416 | 146 plans |
| 349 | ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC | $450 – $18,259 · median $5,599 | 146 plans |
| 350 | INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC | $450 – $52,263 · median $16,025 | 146 plans |
| 351 | INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC | $450 – $31,973 · median $9,804 | 146 plans |
| 352 | INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC | $450 – $24,492 · median $7,510 | 146 plans |
| 353 | HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC | $450 – $60,864 · median $18,662 | 146 plans |
| 354 | HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC | $450 – $35,285 · median $10,819 | 146 plans |
| 355 | HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC | $450 – $28,209 · median $8,649 | 146 plans |
| 356 | OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC | $450 – $92,130 · median $28,249 | 146 plans |
| 357 | OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC | $450 – $48,773 · median $14,955 | 146 plans |
| 358 | OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC | $450 – $29,318 · median $8,989 | 146 plans |
| 368 | MAJOR ESOPHAGEAL DISORDERS WITH MCC | $450 – $33,387 · median $10,237 | 146 plans |
| 369 | MAJOR ESOPHAGEAL DISORDERS WITH CC | $450 – $20,977 · median $6,432 | 146 plans |
| 371 | MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC | $450 – $37,187 · median $11,402 | 146 plans |
| 372 | MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC | $450 – $21,413 · median $6,566 | 146 plans |
| 373 | MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC | $450 – $15,256 · median $4,678 | 146 plans |
| 374 | DIGESTIVE MALIGNANCY WITH MCC | $450 – $44,855 · median $13,753 | 146 plans |
| 375 | DIGESTIVE MALIGNANCY WITH CC | $450 – $25,369 · median $7,779 | 146 plans |
| 376 | DIGESTIVE MALIGNANCY WITHOUT CC/MCC | $450 – $19,385 · median $5,944 | 146 plans |
| 377 | GASTROINTESTINAL HEMORRHAGE WITH MCC | $450 – $38,339 · median $11,755 | 146 plans |
| 378 | GASTROINTESTINAL HEMORRHAGE WITH CC | $450 – $20,568 · median $6,307 | 146 plans |
| 379 | GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC | $450 – $13,221 · median $4,054 | 146 plans |
| 380 | COMPLICATED PEPTIC ULCER WITH MCC | $450 – $41,153 · median $12,618 | 146 plans |
| 381 | COMPLICATED PEPTIC ULCER WITH CC | $450 – $22,724 · median $6,968 | 146 plans |
| 382 | COMPLICATED PEPTIC ULCER WITHOUT CC/MCC | $450 – $16,791 · median $5,148 | 146 plans |
| 384 | UNCOMPLICATED PEPTIC ULCER WITHOUT MCC | $450 – $17,928 · median $5,497 | 146 plans |
| 385 | INFLAMMATORY BOWEL DISEASE WITH MCC | $450 – $33,186 · median $10,175 | 146 plans |
| 386 | INFLAMMATORY BOWEL DISEASE WITH CC | $450 – $20,476 · median $6,278 | 146 plans |
| 387 | INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC | $450 – $14,289 · median $4,381 | 146 plans |
| 388 | GASTROINTESTINAL OBSTRUCTION WITH MCC | $450 – $30,973 · median $9,497 | 146 plans |
| 389 | GASTROINTESTINAL OBSTRUCTION WITH CC | $450 – $16,564 · median $5,079 | 146 plans |
| 390 | GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC | $450 – $11,409 · median $3,498 | 146 plans |
| 391 | ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC | $450 – $26,600 · median $8,156 | 146 plans |
| 392 | ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC | $450 – $16,351 · median $5,013 | 146 plans |
| 393 | OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC | $450 – $33,542 · median $10,285 | 146 plans |
| 394 | OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC | $450 – $19,624 · median $6,017 | 146 plans |
| 395 | OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC | $450 – $13,611 · median $4,174 | 146 plans |
| 397 | APPENDIX PROCEDURES WITH MCC | $450 – $50,228 · median $15,401 | 146 plans |
| 402 | SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL | $450 – $106,191 · median $25,854 | 146 plans |
| 405 | PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC | $450 – $114,733 · median $35,179 | 146 plans |
| 406 | PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC | $450 – $60,826 · median $18,650 | 146 plans |
| 409 | BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC | $450 – $45,665 · median $14,001 | 146 plans |
| 416 | CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC | $450 – $28,592 · median $8,767 | 146 plans |
| 417 | LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC | $450 – $50,050 · median $15,346 | 146 plans |
| 418 | LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC | $450 – $35,478 · median $10,878 | 146 plans |
| 419 | LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC | $450 – $28,645 · median $8,783 | 146 plans |
| 420 | HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC | $450 – $71,457 · median $21,910 | 146 plans |
| 423 | OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC | $450 – $87,101 · median $26,707 | 146 plans |
| 424 | OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC | $450 – $45,887 · median $14,070 | 146 plans |
| 425 | OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC | $450 – $31,466 · median $9,648 | 146 plans |
| 426 | MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE | $450 – $231,148 · median $70,874 | 146 plans |
| 427 | MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC | $450 – $151,396 · median $46,420 | 146 plans |
| 428 | MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC | $450 – $117,910 · median $36,153 | 146 plans |
| 430 | COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC | $450 – $120,953 · median $37,086 | 146 plans |
| 432 | CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC | $450 – $41,279 · median $12,657 | 146 plans |
| 433 | CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC | $450 – $22,152 · median $6,792 | 146 plans |
| 435 | MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC | $450 – $38,521 · median $11,811 | 146 plans |
| 436 | MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC | $450 – $23,723 · median $7,274 | 146 plans |
| 437 | MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC | $450 – $17,896 · median $5,487 | 146 plans |
| 438 | DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC | $450 – $34,190 · median $10,483 | 146 plans |
| 439 | DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC | $450 – $17,642 · median $5,409 | 146 plans |
| 440 | DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC | $450 – $13,033 · median $3,996 | 146 plans |
| 441 | DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC | $450 – $37,640 · median $11,541 | 146 plans |
| 442 | DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC | $450 – $20,245 · median $6,208 | 146 plans |
| 443 | DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC | $450 – $14,675 · median $4,500 | 146 plans |
| 444 | DISORDERS OF THE BILIARY TRACT WITH MCC | $450 – $35,044 · median $10,745 | 146 plans |
| 445 | DISORDERS OF THE BILIARY TRACT WITH CC | $450 – $22,953 · median $7,038 | 146 plans |
| 446 | DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC | $450 – $17,351 · median $5,320 | 146 plans |
| 447 | MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE | $450 – $140,133 · median $42,967 | 146 plans |
| 448 | MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC | $450 – $88,942 · median $27,271 | 146 plans |
| 450 | SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE | $450 – $111,778 · median $34,273 | 146 plans |
| 451 | SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC | $450 – $80,797 · median $20,774 | 146 plans |
| 456 | SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC | $450 – $167,320 · median $54,039 | 146 plans |
| 457 | SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC | $450 – $118,731 · median $38,347 | 146 plans |
| 463 | WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC | $450 – $113,483 · median $36,652 | 146 plans |
| 464 | WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC | $450 – $62,017 · median $20,030 | 146 plans |
| 465 | WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC | $450 – $36,312 · median $11,728 | 146 plans |
| 466 | REVISION OF HIP OR KNEE REPLACEMENT WITH MCC | $450 – $103,645 · median $33,474 | 146 plans |
| 467 | REVISION OF HIP OR KNEE REPLACEMENT WITH CC | $450 – $70,218 · median $22,678 | 146 plans |
| 468 | REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC | $450 – $54,715 · median $17,671 | 146 plans |
| 469 | MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT | $450 – $60,394 · median $19,505 | 146 plans |
| 470 | MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC | $450 – $43,140 · median $12,404 | 146 plans |
| 471 | CERVICAL SPINAL FUSION WITH MCC | $450 – $96,144 · median $31,052 | 146 plans |
| 472 | CERVICAL SPINAL FUSION WITH CC | $450 – $58,660 · median $18,945 | 146 plans |
| 473 | CERVICAL SPINAL FUSION WITHOUT CC/MCC | $450 – $48,609 · median $15,699 | 146 plans |
| 474 | AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC | $450 – $85,476 · median $27,606 | 146 plans |
| 475 | AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC | $450 – $45,311 · median $14,634 | 146 plans |
| 477 | BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC | $450 – $68,785 · median $22,215 | 146 plans |
| 478 | BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC | $450 – $48,965 · median $15,814 | 146 plans |
| 479 | BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC | $450 – $37,013 · median $11,954 | 146 plans |
| 480 | HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC | $450 – $57,987 · median $18,728 | 146 plans |
| 481 | HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC | $450 – $41,704 · median $13,469 | 146 plans |
| 482 | HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC | $450 – $32,475 · median $10,488 | 146 plans |
| 483 | MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES | $450 – $55,191 · median $17,825 | 146 plans |
| 485 | KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC | $450 – $64,255 · median $20,752 | 146 plans |
| 486 | KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC | $450 – $41,636 · median $13,447 | 146 plans |
| 487 | KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC | $450 – $31,185 · median $10,072 | 146 plans |
| 488 | KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC | $450 – $35,221 · median $11,375 | 146 plans |
| 489 | KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC | $450 – $22,237 · median $7,182 | 146 plans |
| 492 | LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC | $450 – $73,105 · median $23,611 | 146 plans |
| 493 | LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC | $450 – $50,496 · median $16,309 | 146 plans |
| 494 | LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC | $450 – $39,951 · median $12,903 | 146 plans |
| 495 | LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC | $450 – $72,191 · median $23,316 | 146 plans |
| 497 | LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC | $450 – $24,058 · median $7,770 | 146 plans |
| 498 | LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC | $450 – $60,068 · median $19,400 | 146 plans |
| 499 | LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC | $450 – $40,117 · median $12,956 | 146 plans |
| 500 | SOFT TISSUE PROCEDURES WITH MCC | $450 – $63,014 · median $20,352 | 146 plans |
| 501 | SOFT TISSUE PROCEDURES WITH CC | $450 – $34,591 · median $11,241 | 146 plans |
| 502 | SOFT TISSUE PROCEDURES WITHOUT CC/MCC | $450 – $26,798 · median $8,655 | 146 plans |
| 503 | FOOT PROCEDURES WITH MCC | $450 – $55,574 · median $17,949 | 146 plans |
| 504 | FOOT PROCEDURES WITH CC | $450 – $37,218 · median $12,020 | 146 plans |
| 505 | FOOT PROCEDURES WITHOUT CC/MCC | $450 – $35,696 · median $11,529 | 146 plans |
| 506 | MAJOR THUMB OR JOINT PROCEDURES | $450 – $26,864 · median $8,676 | 146 plans |
| 507 | MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC | $450 – $35,967 · median $11,616 | 146 plans |
| 511 | SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC | $450 – $41,403 · median $13,372 | 146 plans |
| 512 | SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC | $450 – $32,961 · median $10,645 | 146 plans |
| 513 | HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC | $450 – $31,346 · median $10,124 | 146 plans |
| 515 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC | $450 – $63,454 · median $20,494 | 146 plans |
| 516 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC | $450 – $41,377 · median $13,364 | 146 plans |
| 517 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC | $450 – $34,512 · median $9,882 | 146 plans |
| 519 | BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC | $450 – $39,826 · median $12,863 | 146 plans |
| 520 | BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC | $450 – $39,612 · median $9,607 | 146 plans |
| 521 | HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC | $450 – $56,796 · median $18,457 | 146 plans |
| 522 | HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC | $450 – $43,140 · median $13,618 | 146 plans |
| 533 | FRACTURES OF FEMUR WITH MCC | $450 – $31,214 · median $10,081 | 146 plans |
| 534 | FRACTURES OF FEMUR WITHOUT MCC | $450 – $16,050 · median $5,184 | 146 plans |
| 535 | FRACTURES OF HIP AND PELVIS WITH MCC | $450 – $25,526 · median $8,244 | 146 plans |
| 536 | FRACTURES OF HIP AND PELVIS WITHOUT MCC | $450 – $16,080 · median $5,193 | 146 plans |
| 537 | SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC | $450 – $19,001 · median $6,137 | 146 plans |
| 539 | OSTEOMYELITIS WITH MCC | $450 – $39,219 · median $12,666 | 146 plans |
| 540 | OSTEOMYELITIS WITH CC | $450 – $25,811 · median $8,336 | 146 plans |
| 542 | PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC | $450 – $35,173 · median $11,360 | 146 plans |
| 543 | PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC | $450 – $20,469 · median $6,611 | 146 plans |
| 544 | PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC | $450 – $15,025 · median $4,853 | 146 plans |
| 545 | CONNECTIVE TISSUE DISORDERS WITH MCC | $450 – $49,413 · median $15,959 | 146 plans |
| 546 | CONNECTIVE TISSUE DISORDERS WITH CC | $450 – $22,965 · median $7,417 | 146 plans |
| 548 | SEPTIC ARTHRITIS WITH MCC | $450 – $38,446 · median $12,417 | 146 plans |
| 549 | SEPTIC ARTHRITIS WITH CC | $450 – $24,037 · median $7,763 | 146 plans |
| 551 | MEDICAL BACK PROBLEMS WITH MCC | $450 – $33,373 · median $10,778 | 146 plans |
| 552 | MEDICAL BACK PROBLEMS WITHOUT MCC | $450 – $25,393 · median $6,182 | 146 plans |
| 553 | BONE DISEASES AND ARTHROPATHIES WITH MCC | $450 – $25,811 · median $8,336 | 146 plans |
| 554 | BONE DISEASES AND ARTHROPATHIES WITHOUT MCC | $450 – $16,528 · median $5,338 | 146 plans |
| 555 | SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC | $450 – $26,318 · median $8,500 | 146 plans |
| 556 | SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC | $450 – $16,538 · median $5,341 | 146 plans |
| 557 | TENDONITIS, MYOSITIS AND BURSITIS WITH MCC | $450 – $29,606 · median $9,562 | 146 plans |
| 558 | TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC | $450 – $17,785 · median $5,744 | 146 plans |
| 560 | AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC | $450 – $22,422 · median $7,242 | 146 plans |
| 562 | FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC | $450 – $28,369 · median $9,162 | 146 plans |
| 563 | FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC | $450 – $17,830 · median $5,759 | 146 plans |
| 564 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC | $450 – $30,735 · median $9,926 | 146 plans |
| 565 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC | $450 – $19,401 · median $6,266 | 146 plans |
| 566 | OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC | $450 – $14,919 · median $4,818 | 146 plans |
| 570 | SKIN DEBRIDEMENT WITH MCC | $450 – $61,684 · median $18,913 | 146 plans |
| 571 | SKIN DEBRIDEMENT WITH CC | $450 – $35,434 · median $10,865 | 146 plans |
| 572 | SKIN DEBRIDEMENT WITHOUT CC/MCC | $450 – $24,041 · median $7,371 | 146 plans |
| 573 | SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC | $450 – $137,403 · median $42,130 | 146 plans |
| 574 | SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC | $450 – $72,806 · median $22,323 | 146 plans |
| 575 | SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC | $450 – $37,688 · median $11,556 | 146 plans |
| 578 | SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC | $450 – $33,691 · median $10,330 | 146 plans |
| 579 | OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC | $450 – $67,921 · median $20,826 | 146 plans |
| 580 | OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC | $450 – $36,241 · median $11,112 | 146 plans |
| 581 | OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC | $450 – $30,266 · median $9,280 | 146 plans |
| 582 | MASTECTOMY FOR MALIGNANCY WITH CC/MCC | $450 – $40,407 · median $12,389 | 146 plans |
| 583 | MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC | $450 – $36,166 · median $11,089 | 146 plans |
| 585 | BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC | $450 – $40,459 · median $12,405 | 146 plans |
| 592 | SKIN ULCERS WITH MCC | $450 – $40,589 · median $12,445 | 146 plans |
| 593 | SKIN ULCERS WITH CC | $450 – $24,880 · median $7,629 | 146 plans |
| 595 | MAJOR SKIN DISORDERS WITH MCC | $450 – $44,477 · median $13,638 | 146 plans |
| 596 | MAJOR SKIN DISORDERS WITHOUT MCC | $450 – $22,703 · median $6,961 | 146 plans |
| 597 | MALIGNANT BREAST DISORDERS WITH MCC | $450 – $34,964 · median $10,721 | 146 plans |
| 598 | MALIGNANT BREAST DISORDERS WITH CC | $450 – $23,727 · median $7,275 | 146 plans |
| 599 | MALIGNANT BREAST DISORDERS WITHOUT CC/MCC | $450 – $16,137 · median $4,948 | 146 plans |
| 601 | NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC | $450 – $12,689 · median $3,891 | 146 plans |
| 602 | CELLULITIS WITH MCC | $450 – $29,809 · median $9,140 | 146 plans |
| 603 | CELLULITIS WITHOUT MCC | $450 – $18,265 · median $5,600 | 146 plans |
| 604 | TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC | $450 – $30,874 · median $9,467 | 146 plans |
| 605 | TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC | $450 – $19,211 · median $5,890 | 146 plans |
| 606 | MINOR SKIN DISORDERS WITH MCC | $450 – $31,736 · median $9,731 | 146 plans |
| 607 | MINOR SKIN DISORDERS WITHOUT MCC | $450 – $19,010 · median $5,829 | 146 plans |
| 616 | AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC | $450 – $73,141 · median $22,426 | 146 plans |
| 617 | AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC | $450 – $39,226 · median $12,027 | 146 plans |
| 618 | AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC | $450 – $29,746 · median $9,121 | 146 plans |
| 622 | SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC | $450 – $74,647 · median $22,888 | 146 plans |
| 623 | SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC | $450 – $37,623 · median $11,536 | 146 plans |
| 627 | THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC | $450 – $27,858 · median $8,542 | 146 plans |
| 628 | OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC | $450 – $78,162 · median $23,966 | 146 plans |
| 629 | OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC | $450 – $45,696 · median $14,011 | 146 plans |
| 637 | DIABETES WITH MCC | $450 – $30,132 · median $9,239 | 146 plans |
| 638 | DIABETES WITH CC | $450 – $18,796 · median $5,763 | 146 plans |
| 639 | DIABETES WITHOUT CC/MCC | $450 – $13,028 · median $3,995 | 146 plans |
| 640 | MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC | $450 – $28,012 · median $8,589 | 146 plans |
| 641 | MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC | $450 – $16,321 · median $5,004 | 146 plans |
| 643 | ENDOCRINE DISORDERS WITH MCC | $450 – $34,524 · median $10,586 | 146 plans |
| 644 | ENDOCRINE DISORDERS WITH CC | $450 – $21,497 · median $6,591 | 146 plans |
| 645 | ENDOCRINE DISORDERS WITHOUT CC/MCC | $450 – $16,114 · median $4,941 | 146 plans |
| 653 | MAJOR BLADDER PROCEDURES WITH MCC | $450 – $108,984 · median $33,416 | 146 plans |
| 654 | MAJOR BLADDER PROCEDURES WITH CC | $450 – $58,710 · median $18,001 | 146 plans |
| 655 | MAJOR BLADDER PROCEDURES WITHOUT CC/MCC | $450 – $44,391 · median $13,611 | 146 plans |
| 657 | KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC | $450 – $38,381 · median $11,768 | 146 plans |
| 658 | KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC | $450 – $32,546 · median $9,979 | 146 plans |
| 659 | KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC | $450 – $53,290 · median $16,340 | 146 plans |
| 660 | KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC | $450 – $27,720 · median $8,499 | 146 plans |
| 662 | MINOR BLADDER PROCEDURES WITH MCC | $450 – $64,209 · median $19,687 | 146 plans |
| 664 | MINOR BLADDER PROCEDURES WITHOUT CC/MCC | $450 – $21,957 · median $6,732 | 146 plans |
| 665 | PROSTATECTOMY WITH MCC | $450 – $65,461 · median $20,071 | 146 plans |
| 666 | PROSTATECTOMY WITH CC | $450 – $36,688 · median $11,249 | 146 plans |
| 667 | PROSTATECTOMY WITHOUT CC/MCC | $450 – $23,200 · median $7,114 | 146 plans |
| 668 | TRANSURETHRAL PROCEDURES WITH MCC | $450 – $61,241 · median $18,778 | 146 plans |
| 669 | TRANSURETHRAL PROCEDURES WITH CC | $450 – $32,550 · median $9,980 | 146 plans |
| 670 | TRANSURETHRAL PROCEDURES WITHOUT CC/MCC | $450 – $20,497 · median $6,285 | 146 plans |
| 671 | URETHRAL PROCEDURES WITH CC/MCC | $450 – $37,647 · median $11,543 | 146 plans |
| 673 | OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC | $450 – $88,120 · median $27,019 | 146 plans |
| 674 | OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC | $450 – $49,047 · median $15,039 | 146 plans |
| 675 | OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC | $450 – $34,425 · median $10,555 | 146 plans |
| 682 | RENAL FAILURE WITH MCC | $450 – $31,061 · median $9,524 | 146 plans |
| 683 | RENAL FAILURE WITH CC | $450 – $18,368 · median $5,632 | 146 plans |
| 684 | RENAL FAILURE WITHOUT CC/MCC | $450 – $12,590 · median $3,860 | 146 plans |
| 686 | KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC | $450 – $37,829 · median $11,599 | 146 plans |
| 687 | KIDNEY AND URINARY TRACT NEOPLASMS WITH CC | $450 – $21,976 · median $6,738 | 146 plans |
| 689 | KIDNEY AND URINARY TRACT INFECTIONS WITH MCC | $450 – $24,335 · median $7,461 | 146 plans |
| 690 | KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC | $450 – $16,978 · median $5,206 | 146 plans |
| 693 | URINARY STONES WITH MCC | $450 – $28,198 · median $8,646 | 146 plans |
| 694 | URINARY STONES WITHOUT MCC | $450 – $16,395 · median $5,027 | 146 plans |
| 696 | KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC | $450 – $14,450 · median $4,431 | 146 plans |
| 698 | OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC | $450 – $34,698 · median $10,639 | 146 plans |
| 699 | OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC | $450 – $21,288 · median $6,527 | 146 plans |
| 707 | MAJOR MALE PELVIC PROCEDURES WITH CC/MCC | $450 – $41,952 · median $12,863 | 146 plans |
| 708 | MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC | $450 – $32,177 · median $9,866 | 146 plans |
| 709 | PENIS PROCEDURES WITH CC/MCC | $450 – $48,806 · median $14,965 | 146 plans |
| 710 | PENIS PROCEDURES WITHOUT CC/MCC | $450 – $29,387 · median $9,011 | 146 plans |
| 711 | TESTES PROCEDURES WITH CC/MCC | $450 – $43,704 · median $13,400 | 146 plans |
| 713 | TRANSURETHRAL PROSTATECTOMY WITH CC/MCC | $450 – $31,531 · median $9,668 | 146 plans |
| 714 | TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC | $450 – $22,177 · median $6,800 | 146 plans |
| 717 | OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC | $450 – $39,649 · median $12,157 | 146 plans |
| 718 | OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC | $450 – $28,169 · median $8,637 | 146 plans |
| 722 | MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC | $450 – $37,955 · median $11,638 | 146 plans |
| 723 | MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC | $450 – $23,966 · median $7,348 | 146 plans |
| 724 | MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC | $450 – $13,752 · median $4,217 | 146 plans |
| 725 | BENIGN PROSTATIC HYPERTROPHY WITH MCC | $450 – $24,543 · median $7,525 | 146 plans |
| 726 | BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC | $450 – $15,143 · median $4,643 | 146 plans |
| 727 | INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC | $450 – $31,101 · median $9,536 | 146 plans |
| 728 | INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC | $450 – $17,013 · median $5,217 | 146 plans |
| 730 | OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC | $450 – $14,094 · median $4,321 | 146 plans |
| 734 | PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC | $450 – $44,672 · median $13,697 | 146 plans |
| 737 | UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC | $450 – $43,217 · median $13,251 | 146 plans |
| 739 | UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC | $450 – $75,142 · median $23,040 | 146 plans |
| 740 | UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC | $450 – $37,953 · median $11,637 | 146 plans |
| 742 | UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC | $450 – $38,481 · median $11,799 | 146 plans |
| 743 | UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC | $450 – $26,021 · median $7,979 | 146 plans |
| 744 | D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC | $450 – $42,976 · median $13,177 | 146 plans |
| 745 | D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC | $450 – $23,857 · median $7,315 | 146 plans |
| 746 | VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC | $450 – $36,432 · median $11,171 | 146 plans |
| 749 | OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC | $450 – $53,850 · median $16,511 | 146 plans |
| 754 | MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC | $450 – $38,626 · median $11,843 | 146 plans |
| 755 | MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC | $450 – $22,814 · median $6,995 | 146 plans |
| 757 | INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC | $450 – $30,031 · median $9,208 | 146 plans |
| 758 | INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC | $450 – $20,533 · median $6,296 | 146 plans |
| 759 | INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC | $450 – $13,918 · median $4,267 | 146 plans |
| 760 | MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC | $450 – $21,130 · median $6,479 | 146 plans |
| 769 | POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES | $450 – $35,440 · median $10,867 | 146 plans |
| 770 | ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY | $450 – $21,030 · median $6,448 | 146 plans |
| 776 | POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES | $450 – $13,731 · median $4,210 | 146 plans |
| 779 | ABORTION WITHOUT D&C | $450 – $17,645 · median $5,410 | 146 plans |
| 790 | EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE | $450 – $124,653 · median $38,221 | 146 plans |
| 791 | PREMATURITY WITH MAJOR PROBLEMS | $450 – $85,129 · median $26,102 | 146 plans |
| 792 | PREMATURITY WITHOUT MAJOR PROBLEMS | $450 – $51,367 · median $15,750 | 146 plans |
| 793 | FULL TERM NEONATE WITH MAJOR PROBLEMS | $450 – $87,449 · median $26,813 | 146 plans |
| 794 | NEONATE WITH OTHER SIGNIFICANT PROBLEMS | $450 – $30,954 · median $9,491 | 146 plans |
| 799 | SPLENIC PROCEDURES WITH MCC | $450 – $94,985 · median $29,124 | 146 plans |
| 802 | OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC | $450 – $83,559 · median $25,620 | 146 plans |
| 803 | OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC | $450 – $38,987 · median $11,954 | 146 plans |
| 804 | OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC | $450 – $28,439 · median $8,720 | 146 plans |
| 808 | MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC | $450 – $46,306 · median $14,198 | 146 plans |
| 809 | MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC | $450 – $26,550 · median $8,141 | 146 plans |
| 810 | MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC | $450 – $21,950 · median $6,730 | 146 plans |
| 811 | RED BLOOD CELL DISORDERS WITH MCC | $450 – $29,452 · median $9,031 | 146 plans |
| 812 | RED BLOOD CELL DISORDERS WITHOUT MCC | $450 – $19,257 · median $5,905 | 146 plans |
| 813 | COAGULATION DISORDERS | $450 – $31,990 · median $9,809 | 146 plans |
| 814 | RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC | $450 – $44,603 · median $13,676 | 146 plans |
| 815 | RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC | $450 – $21,267 · median $6,521 | 146 plans |
| 819 | OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC | $450 – $18,035 · median $5,530 | 146 plans |
| 823 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC | $450 – $96,157 · median $29,483 | 146 plans |
| 824 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC | $450 – $47,516 · median $14,569 | 146 plans |
| 826 | MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC | $450 – $98,108 · median $30,081 | 146 plans |
| 827 | MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC | $450 – $48,473 · median $14,863 | 146 plans |
| 828 | MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC | $450 – $35,734 · median $10,957 | 146 plans |
| 829 | MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC | $450 – $66,275 · median $20,321 | 146 plans |
| 830 | MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC | $450 – $31,564 · median $9,678 | 146 plans |
| 832 | OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC | $450 – $15,134 · median $4,640 | 146 plans |
| 833 | OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC | $450 – $10,967 · median $3,363 | 146 plans |
| 834 | ACUTE LEUKEMIA WITH MCC | $450 – $115,140 · median $35,304 | 146 plans |
| 835 | ACUTE LEUKEMIA WITH CC | $450 – $43,745 · median $13,413 | 146 plans |
| 840 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC | $450 – $67,846 · median $20,803 | 146 plans |
| 841 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC | $450 – $34,215 · median $10,491 | 146 plans |
| 842 | LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC | $450 – $21,191 · median $6,498 | 146 plans |
| 843 | OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC | $450 – $41,837 · median $12,828 | 146 plans |
| 844 | OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC | $450 – $25,533 · median $7,829 | 146 plans |
| 845 | OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC | $450 – $17,861 · median $5,476 | 146 plans |
| 847 | CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC | $450 – $27,437 · median $8,413 | 146 plans |
| 849 | RADIOTHERAPY | $450 – $56,826 · median $17,424 | 146 plans |
| 853 | INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC | $450 – $103,577 · median $31,758 | 146 plans |
| 854 | INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC | $450 – $41,906 · median $12,849 | 146 plans |
| 856 | POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC | $450 – $95,400 · median $29,251 | 146 plans |
| 857 | POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC | $450 – $44,914 · median $13,771 | 146 plans |
| 858 | POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC | $450 – $29,213 · median $8,957 | 146 plans |
| 862 | POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC | $450 – $38,248 · median $11,728 | 146 plans |
| 863 | POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC | $450 – $20,929 · median $6,417 | 146 plans |
| 864 | FEVER AND INFLAMMATORY CONDITIONS | $450 – $18,618 · median $5,709 | 146 plans |
| 865 | VIRAL ILLNESS WITH MCC | $450 – $31,424 · median $9,635 | 146 plans |
| 866 | VIRAL ILLNESS WITHOUT MCC | $450 – $18,238 · median $5,592 | 146 plans |
| 868 | OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC | $450 – $21,625 · median $6,631 | 146 plans |
| 869 | OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC | $450 – $15,304 · median $4,692 | 146 plans |
| 870 | SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS | $450 – $144,961 · median $44,447 | 146 plans |
| 871 | SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC | $450 – $40,740 · median $12,492 | 146 plans |
| 872 | SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC | $450 – $21,462 · median $6,580 | 146 plans |
| 901 | WOUND DEBRIDEMENTS FOR INJURIES WITH MCC | $450 – $88,015 · median $26,987 | 146 plans |
| 902 | WOUND DEBRIDEMENTS FOR INJURIES WITH CC | $450 – $40,153 · median $12,312 | 146 plans |
| 903 | WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC | $450 – $24,530 · median $7,521 | 146 plans |
| 904 | SKIN GRAFTS FOR INJURIES WITH CC/MCC | $450 – $77,036 · median $23,620 | 146 plans |
| 905 | SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC | $450 – $31,111 · median $9,539 | 146 plans |
| 908 | OTHER O.R. PROCEDURES FOR INJURIES WITH CC | $450 – $41,845 · median $12,830 | 146 plans |
| 909 | OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC | $450 – $27,531 · median $8,442 | 146 plans |
| 913 | TRAUMATIC INJURY WITH MCC | $450 – $34,282 · median $10,512 | 146 plans |
| 914 | TRAUMATIC INJURY WITHOUT MCC | $450 – $18,572 · median $5,694 | 146 plans |
| 915 | ALLERGIC REACTIONS WITH MCC | $450 – $35,268 · median $10,814 | 146 plans |
| 916 | ALLERGIC REACTIONS WITHOUT MCC | $450 – $13,974 · median $4,285 | 146 plans |
| 917 | POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC | $450 – $32,894 · median $10,086 | 146 plans |
| 918 | POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC | $450 – $17,976 · median $5,512 | 146 plans |
| 919 | COMPLICATIONS OF TREATMENT WITH MCC | $450 – $38,397 · median $11,773 | 146 plans |
| 920 | COMPLICATIONS OF TREATMENT WITH CC | $450 – $21,021 · median $6,445 | 146 plans |
| 921 | COMPLICATIONS OF TREATMENT WITHOUT CC/MCC | $450 – $14,438 · median $4,427 | 146 plans |
| 923 | OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC | $450 – $21,344 · median $6,544 | 146 plans |
| 934 | FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY | $450 – $46,363 · median $14,216 | 146 plans |
| 935 | NON-EXTENSIVE BURNS | $450 – $43,204 · median $13,247 | 146 plans |
| 939 | O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC | $450 – $76,101 · median $23,334 | 146 plans |
| 940 | O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC | $450 – $49,012 · median $15,028 | 146 plans |
| 947 | SIGNS AND SYMPTOMS WITH MCC | $450 – $26,623 · median $8,163 | 146 plans |
| 949 | AFTERCARE WITH CC/MCC | $450 – $24,952 · median $7,651 | 146 plans |
| 951 | OTHER FACTORS INFLUENCING HEALTH STATUS | $450 – $11,661 · median $3,575 | 146 plans |
| 956 | LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA | $450 – $78,921 · median $24,199 | 146 plans |
| 957 | OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC | $450 – $159,812 · median $49,001 | 146 plans |
| 958 | OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC | $450 – $88,378 · median $27,098 | 146 plans |
| 963 | OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC | $450 – $57,336 · median $17,580 | 146 plans |
| 964 | OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC | $450 – $32,143 · median $9,856 | 146 plans |
| 965 | OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC | $450 – $19,725 · median $6,048 | 146 plans |
| 975 | HIV WITH MAJOR RELATED CONDITION WITH CC | $450 – $27,160 · median $8,328 | 146 plans |
| 981 | EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC | $450 – $98,401 · median $30,171 | 146 plans |
| 982 | EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC | $450 – $51,562 · median $15,810 | 146 plans |
| 983 | EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC | $450 – $35,948 · median $11,022 | 146 plans |
| 987 | NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC | $450 – $71,904 · median $22,047 | 146 plans |
| 988 | NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC | $450 – $34,471 · median $10,569 | 146 plans |
| 989 | NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC | $450 – $25,151 · median $7,712 | 146 plans |
| 789 | NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY | $450 – $37,798 · median $11,589 | 145 plans |
| 052 | SPINAL DISORDERS AND INJURIES WITH CC/MCC | $10,250 – $37,988 · median $11,648 | 144 plans |
| 093 | OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC | $4,020 – $16,701 · median $5,121 | 144 plans |
| 099 | NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC | $7,097 – $28,574 · median $8,761 | 144 plans |
| 102 | HEADACHES WITH MCC | $5,906 – $23,509 · median $7,208 | 144 plans |
| 139 | SALIVARY GLAND PROCEDURES | $6,993 – $25,916 · median $7,946 | 144 plans |
| 158 | DENTAL AND ORAL DISEASES WITH CC | $4,791 – $19,081 · median $5,851 | 144 plans |
| 284 | ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC | $3,774 – $14,518 · median $4,451 | 144 plans |
| 370 | MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC | $3,555 – $14,698 · median $4,507 | 144 plans |
| 383 | UNCOMPLICATED PEPTIC ULCER WITH MCC | $6,439 – $28,957 · median $8,879 | 144 plans |
| 561 | AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC | $4,164 – $16,006 · median $5,170 | 144 plans |
| 663 | MINOR BLADDER PROCEDURES WITH CC | $7,780 – $31,883 · median $9,776 | 144 plans |
| 750 | OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC | $6,568 – $30,952 · median $9,490 | 144 plans |
| 761 | MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC | $3,229 – $11,965 · median $3,669 | 144 plans |
| 816 | RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC | $3,359 – $13,255 · median $4,064 | 144 plans |
| 817 | OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC | $10,403 – $47,852 · median $14,672 | 144 plans |
| 831 | OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC | $5,013 – $25,220 · median $7,733 | 144 plans |
| 886 | BEHAVIORAL AND DEVELOPMENTAL DISORDERS | $1,660 – $43,525 · median $13,346 | 144 plans |
| 950 | AFTERCARE WITHOUT CC/MCC | $2,985 – $18,006 · median $4,037 | 144 plans |
| 897 | ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC | $450 – $17,469 · median $5,677 | 143 plans |
| 076 | VIRAL MENINGITIS WITHOUT CC/MCC | $450 – $17,307 · median $5,307 | 140 plans |
| 316 | OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC | $450 – $14,306 · median $4,386 | 140 plans |
| 398 | APPENDIX PROCEDURES WITH CC | $450 – $31,745 · median $9,733 | 140 plans |
| 948 | SIGNS AND SYMPTOMS WITHOUT MCC | $450 – $16,789 · median $5,148 | 140 plans |
| 318 | PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE | $450 – $50,801 · median $15,576 | 139 plans |
| 360 | PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC | $450 – $50,635 · median $15,526 | 139 plans |
| 399 | APPENDIX PROCEDURES WITHOUT CC/MCC | $5,724 – $24,008 · median $7,361 | 138 plans |
| 661 | KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC | $5,229 – $21,715 · median $6,658 | 138 plans |
| 795 | NORMAL NEWBORN | $450 – $4,190 · median $1,285 | 138 plans |
| 220 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC | $450 – $105,525 · median $34,293 | 136 plans |
| 907 | OTHER O.R. PROCEDURES FOR INJURIES WITH MCC | $450 – $75,972 · median $24,689 | 136 plans |
| 001 | HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC | $450 – $525,616 · median $180,212 | 135 plans |
| 003 | ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES | $450 – $398,100 · median $136,492 | 135 plans |
| 004 | TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES | $450 – $259,797 · median $89,074 | 135 plans |
| 020 | INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC | $450 – $147,587 · median $50,602 | 135 plans |
| 095 | BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC | $450 – $48,375 · median $16,586 | 135 plans |
| 207 | RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS | $450 – $120,689 · median $41,379 | 135 plans |
| 212 | CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES | $450 – $203,955 · median $69,928 | 135 plans |
| 215 | OTHER HEART ASSIST SYSTEM IMPLANT | $450 – $186,753 · median $64,030 | 135 plans |
| 216 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC | $450 – $183,486 · median $62,910 | 135 plans |
| 217 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC | $450 – $123,326 · median $42,284 | 135 plans |
| 218 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC | $450 – $123,326 · median $42,284 | 135 plans |
| 219 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC | $450 – $144,014 · median $49,377 | 135 plans |
| 221 | CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC | $450 – $94,534 · median $32,412 | 135 plans |
| 228 | OTHER CARDIOTHORACIC PROCEDURES WITH MCC | $450 – $92,793 · median $31,815 | 135 plans |
| 233 | CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC | $450 – $143,393 · median $49,164 | 135 plans |
| 266 | ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC | $450 – $114,944 · median $39,410 | 135 plans |
| 268 | AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC | $450 – $129,002 · median $44,229 | 135 plans |
| 270 | OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC | $450 – $98,962 · median $33,930 | 135 plans |
| 275 | CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC | $450 – $133,738 · median $45,853 | 135 plans |
| 279 | ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC | $450 – $67,642 · median $23,192 | 135 plans |
| 288 | ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC | $450 – $50,757 · median $17,403 | 135 plans |
| 317 | CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION | $450 – $125,412 · median $42,999 | 135 plans |
| 323 | CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC | $450 – $81,165 · median $27,828 | 135 plans |
| 326 | STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC | $450 – $93,544 · median $32,072 | 135 plans |
| 429 | COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC | $450 – $179,390 · median $57,938 | 135 plans |
| 462 | BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC | $450 – $52,963 · median $17,106 | 135 plans |
| 820 | LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC | $450 – $110,000 · median $37,715 | 135 plans |
| 023 | CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR | $450 – $120,182 · median $36,850 | 133 plans |
| 097 | NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC | $450 – $75,750 · median $23,226 | 133 plans |
| 347 | ANAL AND STOMAL PROCEDURES WITH MCC | $450 – $48,146 · median $14,762 | 133 plans |
| 559 | AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC | $450 – $34,657 · median $11,993 | 133 plans |
| 695 | KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC | $450 – $23,989 · median $7,355 | 133 plans |
| 359 | PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC | $450 – $68,043 · median $22,112 | 129 plans |
| 768 | VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C | $450 – $22,475 · median $6,891 | 120 plans |
| 783 | CESAREAN SECTION WITH STERILIZATION WITH MCC | $450 – $51,491 · median $15,788 | 120 plans |
| 784 | CESAREAN SECTION WITH STERILIZATION WITH CC | $450 – $22,233 · median $6,817 | 120 plans |
| 785 | CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC | $450 – $20,088 · median $6,159 | 120 plans |
| 787 | CESAREAN SECTION WITHOUT STERILIZATION WITH CC | $450 – $23,423 · median $7,182 | 120 plans |
| 788 | CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC | $450 – $20,109 · median $6,166 | 120 plans |
| 797 | VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC | $450 – $20,981 · median $6,433 | 120 plans |
| 805 | VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC | $450 – $22,634 · median $6,940 | 120 plans |
| 806 | VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC | $450 – $15,814 · median $4,849 | 120 plans |
| 807 | VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC | $450 – $14,140 · median $4,336 | 120 plans |
| 786 | CESAREAN SECTION WITHOUT STERILIZATION WITH MCC | $450 – $34,595 · median $10,607 | 114 plans |
| 798 | VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC | $450 – $20,073 · median $6,155 | 114 plans |
| 313 | CHEST PAIN | $7,983 – $10,403 · median $10,403 | 26 plans |
| 741 | UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC | $7,983 – $8,870 · median $8,870 | 8 plans |
No procedures match that keyword.