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Hospital

Advanced Specialty Hospital Of Toledo

Toledo, OH · CCN 362038 · Rates published

337 distinct procedures filed
19 distinct payers
30,331 rate rows
2026-05-09 last MRF observed
Data quality

13,144 of 30,331 rate rows are consumer-grade (43.3%)

17,187 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
per-diem day rate — not a per-procedure price 16,850
template filing: same amount across many unrelated codes — excluded 337
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://advancedspecialtyhospitals.com/wp-content/uploads/2026/03/MRF_advanced-specialty-hospitals-of-toledo.csv
Discovered viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-05-17
Content fingerprint 224f76e158c43d15… · 63,101,689 bytes · first seen 2026-05-09

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
101
OTHER 		Seizures Without Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$7,470
outlier · 0.2×
12
OTHER 		Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$39,504
outlier · 0.0×
125
OTHER 		Other Disorders Of The Eye Without Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$7,914
outlier · 0.2×
146
OTHER 		Ear, Nose, Mouth And Throat Malignancy With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$20,031
outlier · 0.1×
147
OTHER 		Ear, Nose, Mouth And Throat Malignancy With Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$12,394
outlier · 0.1×
148
OTHER 		Ear, Nose, Mouth And Throat Malignancy Without Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$8,470
outlier · 0.2×
149
OTHER 		Dysequilibrium 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$7,929
outlier · 0.2×
150
OTHER 		Epistaxis With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$12,874
outlier · 0.1×
152
OTHER 		Otitis Media And Uri With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$11,127
outlier · 0.1×
153
OTHER 		Otitis Media And Uri Without Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$7,429
outlier · 0.2×
154
OTHER 		Other Ear, Nose, Mouth And Throat Diagnoses With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$15,473
outlier · 0.1×
157
OTHER 		Dental And Oral Diseases With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$16,192
outlier · 0.1×
158
OTHER 		Dental And Oral Diseases With Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$9,098
outlier · 0.2×
163
OTHER 		Major Chest Procedures With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$47,944
outlier · 0.0×
166
OTHER 		Other Resp System O.r. Procedures W Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$38,129
outlier · 0.0×
167
OTHER 		Other Respiratory System O.r. Procedures With Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$18,396
outlier · 0.1×
168
OTHER 		Other Respiratory System O.r. Procedures Without Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$12,971
outlier · 0.1×
175
OTHER 		Pulmonary Embolism With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$13,922
outlier · 0.1×
176
OTHER 		Pulmonary Embolism Without Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$8,622
outlier · 0.2×
177
OTHER 		Respiratory Infections And Inflammations With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$16,359
outlier · 0.1×
178
OTHER 		Respiratory Infections And Inflammations With Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$10,321
outlier · 0.2×
179
OTHER 		Respiratory Infections And Inflammations Without Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$8,079
outlier · 0.2×
180
OTHER 		Respiratory Neoplasms With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$16,982
outlier · 0.1×
181
OTHER 		Respiratory Neoplasms With Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$11,076
outlier · 0.1×
183
OTHER 		Major Chest Trauma With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$15,060
outlier · 0.1×
186
OTHER 		Pleural Effusion With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$14,911
outlier · 0.1×
187
OTHER 		Pleural Effusion With Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$9,891
outlier · 0.2×
189
OTHER 		Pulmonary Edema & Respiratory Failure 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$12,533
outlier · 0.1×
190
OTHER 		Chronic Obstructive Pulmonary Disease With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$10,982
outlier · 0.1×
191
OTHER 		Chronic Obstructive Pulmonary Disease With Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$8,914
outlier · 0.2×
192
OTHER 		Chronic Obstructive Pulmonary Disease Without Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$6,927
outlier · 0.2×
193
OTHER 		Simple Pneumonia And Pleurisy With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$12,881
outlier · 0.1×
194
OTHER 		Simple Pneumonia And Pleurisy With Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$8,630
outlier · 0.2×
195
OTHER 		Simple Pneumonia And Pleurisy Without Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$6,715
outlier · 0.2×
196
OTHER 		Interstitial Lung Disease With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$17,974
outlier · 0.1×
199
OTHER 		Pneumothorax With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$17,276
outlier · 0.1×
200
OTHER 		Pneumothorax With Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$10,206
outlier · 0.2×
202
OTHER 		Bronchitis And Asthma With Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$9,777
outlier · 0.2×
204
OTHER 		Respiratory Signs And Symptoms 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$8,657
outlier · 0.2×
205
OTHER 		Other Respiratory System Diagnoses With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$17,709
outlier · 0.1×
206
OTHER 		Other Respiratory System Diagnoses Without Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$9,116
outlier · 0.2×
207
OTHER 		Respiratory System Diagnosis W Ventilator Support >96 Hours 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$66,849
outlier · 0.0×
208
OTHER 		Respiratory System Diagnosis W Ventilator Support <=96 Hours 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$26,262
outlier · 0.1×
228
OTHER 		Other Cardiothoracic Procedures With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$48,497
outlier · 0.0×
23
OTHER 		Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$56,822
outlier · 0.0×
239
OTHER 		Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$46,864
outlier · 0.0×
240
OTHER 		Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$27,988
outlier · 0.1×
242
OTHER 		Permanent Cardiac Pacemaker Implant With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$31,203
outlier · 0.1×
252
OTHER 		Other Vascular Procedures With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$25,377
outlier · 0.1×
100
OTHER 		Seizures With Mcc 15 $1,600.00 $1,600.00 $1,600.00 nat. median
$17,793
outlier · 0.1×

Other procedures at this hospital

Browse this hospital's 337 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
100 OTHER Seizures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
101 OTHER Seizures Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
12 OTHER Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
125 OTHER Other Disorders Of The Eye Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
146 OTHER Ear, Nose, Mouth And Throat Malignancy With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
147 OTHER Ear, Nose, Mouth And Throat Malignancy With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
148 OTHER Ear, Nose, Mouth And Throat Malignancy Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
149 OTHER Dysequilibrium 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
150 OTHER Epistaxis With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
152 OTHER Otitis Media And Uri With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
153 OTHER Otitis Media And Uri Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
154 OTHER Other Ear, Nose, Mouth And Throat Diagnoses With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
157 OTHER Dental And Oral Diseases With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
158 OTHER Dental And Oral Diseases With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
163 OTHER Major Chest Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
166 OTHER Other Resp System O.r. Procedures W Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
167 OTHER Other Respiratory System O.r. Procedures With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
168 OTHER Other Respiratory System O.r. Procedures Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
175 OTHER Pulmonary Embolism With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
176 OTHER Pulmonary Embolism Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
177 OTHER Respiratory Infections And Inflammations With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
178 OTHER Respiratory Infections And Inflammations With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
179 OTHER Respiratory Infections And Inflammations Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
180 OTHER Respiratory Neoplasms With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
181 OTHER Respiratory Neoplasms With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
183 OTHER Major Chest Trauma With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
186 OTHER Pleural Effusion With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
187 OTHER Pleural Effusion With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
189 OTHER Pulmonary Edema & Respiratory Failure 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
190 OTHER Chronic Obstructive Pulmonary Disease With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
191 OTHER Chronic Obstructive Pulmonary Disease With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
192 OTHER Chronic Obstructive Pulmonary Disease Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
193 OTHER Simple Pneumonia And Pleurisy With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
194 OTHER Simple Pneumonia And Pleurisy With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
195 OTHER Simple Pneumonia And Pleurisy Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
196 OTHER Interstitial Lung Disease With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
199 OTHER Pneumothorax With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
200 OTHER Pneumothorax With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
202 OTHER Bronchitis And Asthma With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
204 OTHER Respiratory Signs And Symptoms 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
205 OTHER Other Respiratory System Diagnoses With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
206 OTHER Other Respiratory System Diagnoses Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
207 OTHER Respiratory System Diagnosis W Ventilator Support >96 Hours 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
208 OTHER Respiratory System Diagnosis W Ventilator Support <=96 Hours 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
228 OTHER Other Cardiothoracic Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
23 OTHER Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
239 OTHER Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
240 OTHER Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
242 OTHER Permanent Cardiac Pacemaker Implant With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
252 OTHER Other Vascular Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
255 OTHER Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
256 OTHER Upper Limb And Toe Amputation For Circulatory System Disorders With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
264 OTHER Other Circulatory System O.r. Procedures 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
265 OTHER Aicd Lead Procedures 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
266 OTHER Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
270 OTHER Other Major Cardiovascular Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
273 OTHER Percutaneous And Other Intracardiac Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
28 OTHER Spinal Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
280 OTHER Acute Myocardial Infarction, Discharged Alive With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
281 OTHER Acute Myocardial Infarction, Discharged Alive With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
283 OTHER Acute Myocardial Infarction, Expired With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
284 OTHER Acute Myocardial Infarction, Expired With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
287 OTHER Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
288 OTHER Acute And Subacute Endocarditis With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
289 OTHER Acute And Subacute Endocarditis With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
290 OTHER Acute And Subacute Endocarditis Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
291 OTHER Heart Failure And Shock With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
292 OTHER Heart Failure And Shock With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
294 OTHER Deep Vein Thrombophlebitis With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
295 OTHER Deep Vein Thrombophlebitis Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
299 OTHER Peripheral Vascular Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
3 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
300 OTHER Peripheral Vascular Disorders With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
302 OTHER Atherosclerosis With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
304 OTHER Hypertension With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
305 OTHER Hypertension Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
306 OTHER Cardiac Congenital And Valvular Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
307 OTHER Cardiac Congenital And Valvular Disorders Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
308 OTHER Cardiac Arrhythmia And Conduction Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
309 OTHER Cardiac Arrhythmia And Conduction Disorders With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
310 OTHER Cardiac Arrhythmia And Conduction Disorders Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
312 OTHER Syncope And Collapse 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
314 OTHER Other Circulatory System Diagnoses With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
315 OTHER Other Circulatory System Diagnoses With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
316 OTHER Other Circulatory System Diagnoses Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
326 OTHER Stomach, Esophageal And Duodenal Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
329 OTHER Major Small And Large Bowel Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
330 OTHER Major Small And Large Bowel Procedures With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
344 OTHER Minor Small And Large Bowel Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
356 OTHER Other Digestive System O.r. Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
357 OTHER Other Digestive System O.r. Procedures With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
368 OTHER Major Esophageal Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
371 OTHER Major Gastrointestinal Disorders And Peritoneal Infections With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
372 OTHER Major Gastrointestinal Disorders And Peritoneal Infections With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
373 OTHER Major Gastrointestinal Disorders And Peritoneal Infections Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
374 OTHER Digestive Malignancy With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
375 OTHER Digestive Malignancy With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
377 OTHER Gastrointestinal Hemorrhage With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
378 OTHER Gastrointestinal Hemorrhage With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
380 OTHER Complicated Peptic Ulcer With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
381 OTHER Complicated Peptic Ulcer With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
383 OTHER Uncomplicated Peptic Ulcer With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
385 OTHER Inflammatory Bowel Disease With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
386 OTHER Inflammatory Bowel Disease With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
388 OTHER Gastrointestinal Obstruction With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
389 OTHER Gastrointestinal Obstruction With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
391 OTHER Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
392 OTHER Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
393 OTHER Other Digestive System Diagnoses With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
394 OTHER Other Digestive System Diagnoses With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
395 OTHER Other Digestive System Diagnoses Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
4 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
40 OTHER Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
405 OTHER Pancreas, Liver And Shunt Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
41 OTHER Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
417 OTHER Laparoscopic Cholecystectomy Without C.d.e. With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
432 OTHER Cirrhosis And Alcoholic Hepatitis With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
433 OTHER Cirrhosis And Alcoholic Hepatitis With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
434 OTHER Cirrhosis And Alcoholic Hepatitis Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
435 OTHER Malignancy Of Hepatobiliary System Or Pancreas With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
438 OTHER Disorders Of Pancreas Except Malignancy With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
439 OTHER Disorders Of Pancreas Except Malignancy With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
441 OTHER Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
442 OTHER Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
444 OTHER Disorders Of The Biliary Tract With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
445 OTHER Disorders Of The Biliary Tract With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
456 OTHER Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
463 OTHER Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
464 OTHER Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
465 OTHER Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
466 OTHER Revision Of Hip Or Knee Replacement With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
474 OTHER Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
475 OTHER Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
477 OTHER Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
492 OTHER Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
498 OTHER Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
500 OTHER Soft Tissue Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
501 OTHER Soft Tissue Procedures With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
503 OTHER Foot Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
504 OTHER Foot Procedures With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
513 OTHER Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
515 OTHER Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
516 OTHER Other Musculoskeletal System And Connective Tissue O.r. Procedures With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
517 OTHER Other Musculoskeletal System And Connective Tissue O.r. Procedures Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
518 OTHER Back And Neck Procedures Except Spinal Fusion With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
52 OTHER Spinal Disorders And Injuries With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
53 OTHER Spinal Disorders And Injuries Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
533 OTHER Fractures Of Femur With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
535 OTHER Fractures Of Hip And Pelvis With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
539 OTHER Osteomyelitis With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
54 OTHER Nervous System Neoplasms With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
540 OTHER Osteomyelitis With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
541 OTHER Osteomyelitis Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
542 OTHER Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
543 OTHER Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
544 OTHER Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
545 OTHER Connective Tissue Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
548 OTHER Septic Arthritis With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
549 OTHER Septic Arthritis With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
55 OTHER Nervous System Neoplasms Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
550 OTHER Septic Arthritis Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
551 OTHER Medical Back Problems With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
552 OTHER Medical Back Problems Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
553 OTHER Bone Diseases And Arthropathies With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
554 OTHER Bone Diseases And Arthropathies Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
555 OTHER Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
556 OTHER Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
557 OTHER Tendonitis, Myositis And Bursitis With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
558 OTHER Tendonitis, Myositis And Bursitis Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
559 OTHER Aftercare, Musculoskeletal System And Connective Tissue With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
56 OTHER Degenerative Nervous System Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
560 OTHER Aftercare, Musculoskeletal System And Connective Tissue With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
561 OTHER Aftercare, Musculoskeletal System And Connective Tissue Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
562 OTHER Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
564 OTHER Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
565 OTHER Other Musculoskeletal System And Connective Tissue Diagnoses With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
57 OTHER Degenerative Nervous System Disorders Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
570 OTHER Skin Debridement With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
571 OTHER Skin Debridement With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
572 OTHER Skin Debridement Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
573 OTHER Skin Graft For Skin Ulcer Or Cellulitis With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
574 OTHER Skin Graft For Skin Ulcer Or Cellulitis With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
576 OTHER Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
577 OTHER Skin Graft Except For Skin Ulcer Or Cellulitis With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
578 OTHER Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
579 OTHER Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
58 OTHER Multiple Sclerosis And Cerebellar Ataxia With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
580 OTHER Other Skin, Subcutaneous Tissue And Breast Procedures With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
592 OTHER Skin Ulcers With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
593 OTHER Skin Ulcers With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
594 OTHER Skin Ulcers Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
595 OTHER Major Skin Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
596 OTHER Major Skin Disorders Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
597 OTHER Malignant Breast Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
598 OTHER Malignant Breast Disorders With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
600 OTHER Non-malignant Breast Disorders With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
602 OTHER Cellulitis With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
603 OTHER Cellulitis Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
604 OTHER Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
605 OTHER Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
606 OTHER Minor Skin Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
607 OTHER Minor Skin Disorders Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
616 OTHER Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
617 OTHER Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
619 OTHER O.r. Procedures For Obesity With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
622 OTHER Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
623 OTHER Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
628 OTHER Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
629 OTHER Other Endocrine, Nutritional And Metabolic O.r. Procedures With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
637 OTHER Diabetes With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
638 OTHER Diabetes With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
64 OTHER Intracranial Hemorrhage Or Cerebral Infarction With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
640 OTHER Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
641 OTHER Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
642 OTHER Inborn And Other Disorders Of Metabolism 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
643 OTHER Endocrine Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
644 OTHER Endocrine Disorders With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
645 OTHER Endocrine Disorders Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
65 OTHER Intracranial Hemorrhage Or Cerebral Infarction With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
659 OTHER Kidney And Ureter Procedures For Non-neoplasm With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
66 OTHER Intracranial Hemorrhage Or Cerebral Infarction Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
660 OTHER Kidney And Ureter Procedures For Non-neoplasm With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
662 OTHER Minor Bladder Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
673 OTHER Other Kidney And Urinary Tract Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
674 OTHER Other Kidney And Urinary Tract Procedures With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
675 OTHER Other Kidney And Urinary Tract Procedures Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
682 OTHER Renal Failure With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
683 OTHER Renal Failure With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
684 OTHER Renal Failure Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
686 OTHER Kidney And Urinary Tract Neoplasms With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
687 OTHER Kidney And Urinary Tract Neoplasms With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
689 OTHER Kidney And Urinary Tract Infections With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
690 OTHER Kidney And Urinary Tract Infections Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
693 OTHER Urinary Stones With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
696 OTHER Kidney And Urinary Tract Signs And Symptoms Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
698 OTHER Other Kidney And Urinary Tract Diagnoses With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
699 OTHER Other Kidney And Urinary Tract Diagnoses With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
70 OTHER Nonspecific Cerebrovascular Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
700 OTHER Other Kidney And Urinary Tract Diagnoses Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
71 OTHER Nonspecific Cerebrovascular Disorders With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
711 OTHER Testes Procedures With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
717 OTHER Other Male Reproductive System O.r. Procedures Except Malignancy With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
72 OTHER Nonspecific Cerebrovascular Disorders Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
725 OTHER Benign Prostatic Hypertrophy With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
727 OTHER Inflammation Of The Male Reproductive System With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
728 OTHER Inflammation Of The Male Reproductive System Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
729 OTHER Other Male Reproductive System Diagnoses With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
73 OTHER Cranial And Peripheral Nerve Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
74 OTHER Cranial And Peripheral Nerve Disorders Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
749 OTHER Other Female Reproductive System O.r. Procedures With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
75 OTHER Viral Meningitis With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
754 OTHER Malignancy, Female Reproductive System With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
755 OTHER Malignancy, Female Reproductive System With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
757 OTHER Infections, Female Reproductive System With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
758 OTHER Infections, Female Reproductive System With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
759 OTHER Infections, Female Reproductive System Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
760 OTHER Menstrual And Other Female Reproductive System Disorders With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
80 OTHER Nontraumatic Stupor And Coma With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
802 OTHER Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
803 OTHER Other O.r. Procedures Of The Blood And Blood Forming Organs With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
808 OTHER Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
809 OTHER Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
811 OTHER Red Blood Cell Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
812 OTHER Red Blood Cell Disorders Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
813 OTHER Coagulation Disorders 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
814 OTHER Reticuloendothelial And Immunity Disorders With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
82 OTHER Traumatic Stupor And Coma >1 Hour With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
823 OTHER Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
824 OTHER Lymphoma And Non-acute Leukemia With Other Procedures With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
83 OTHER Traumatic Stupor And Coma >1 Hour With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
834 OTHER Acute Leukemia Without Major O.r. Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
837 OTHER Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
84 OTHER Traumatic Stupor And Coma >1 Hour Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
840 OTHER Lymphoma And Non-acute Leukemia With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
841 OTHER Lymphoma And Non-acute Leukemia With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
843 OTHER Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses… 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
846 OTHER Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
85 OTHER Traumatic Stupor And Coma <1 Hour With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
853 OTHER Infectious And Parasitic Diseases With O.r. Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
854 OTHER Infectious And Parasitic Diseases With O.r. Procedures With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
856 OTHER Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
857 OTHER Postoperative Or Post-traumatic Infections With O.r. Procedures With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
858 OTHER Postoperative Or Post-traumatic Infections With O.r. Procedures Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
86 OTHER Traumatic Stupor And Coma <1 Hour With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
862 OTHER Postoperative And Post-traumatic Infections With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
863 OTHER Postoperative And Post-traumatic Infections Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
865 OTHER Viral Illness With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
866 OTHER Viral Illness Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
867 OTHER Other Infectious And Parasitic Diseases Diagnoses With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
868 OTHER Other Infectious And Parasitic Diseases Diagnoses With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
870 OTHER Septicemia Or Severe Sepsis With Mv >96 Hours 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
871 OTHER Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
872 OTHER Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
901 OTHER Wound Debridements For Injuries With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
902 OTHER Wound Debridements For Injuries With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
903 OTHER Wound Debridements For Injuries Without Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
904 OTHER Skin Grafts For Injuries With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
907 OTHER Other O.r. Procedures For Injuries With Mcc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
908 OTHER Other O.r. Procedures For Injuries With Cc 39 15 — — $1,600.00 $1,600.00 $1,600.00 2026-05-09
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