A00.0|CHOLERA DUE TO VIBRIO CHOLERAE 01, BIOVAR CHOLERAE|7,800.00|5,460.00|2,340.00
A00.1|CHOLERA DUE TO VIBRIO CHOLERAE 01, BIOVAR ELTOR|7,800.00|5,460.00|2,340.00
A00.9|CHOLERA, UNSPECIFIED|7,800.00|5,460.00|2,340.00
A01.0|TYPHOID FEVER|13,000.00|9,100.00|3,900.00
A01.0+ J17.0*|PNEUMONIA IN TYPHOID FEVER|19,500.00|13,650.00|5,850.00
A01.1|PARATYPHOID FEVER A|13,000.00|9,100.00|3,900.00
A01.2|PARATYPHOID FEVER B|13,000.00|9,100.00|3,900.00
A01.3|PARATYPHOID FEVER C|13,000.00|9,100.00|3,900.00
A01.4|PARATYPHOID FEVER, UNSPECIFIED; INFECTION DUE TO SALMONELLA PARATYPHI NOS|13,000.00|9,100.00|3,900.00
A02.0|SALMONELLA ENTERITIS; SALMONELLOSIS|13,000.00|9,100.00|3,900.00
A02.1|SALMONELLA SEPTICAEMIA|13,000.00|9,100.00|3,900.00
A02.2|LOCALIZED SALMONELLA INFECTIONS|13,000.00|9,100.00|3,900.00
A02.2+ J17.0*|PNEUMONIA IN SALMONELLA INFECTION|19,500.00|13,650.00|5,850.00
A02.8|OTHER SPECIFIED SALMONELLA INFECTIONS|13,000.00|9,100.00|3,900.00
A02.9|SALMONELLA INFECTION, UNSPECIFIED|13,000.00|9,100.00|3,900.00
A03.0|SHIGELLOSIS DUE TO SHIGELLA DYSENTERIAE; GROUP A SHIGELLOSIS [SHIGA-KRUSE DYSENTERY]|7,800.00|5,460.00|2,340.00
A03.1|SHIGELLOSIS DUE TO SHIGELLA FLEXNERI;GROUP B SHIGELLOSIS|7,800.00|5,460.00|2,340.00
A03.2|SHIGELLOSIS DUE TO SHIGELLA BOYDII; GROUP C SHIGELLOSIS|7,800.00|5,460.00|2,340.00
A03.3|SHIGELLOSIS DUE TO SHIGELLA SONNEI; GROUP D SHIGELLOSIS|7,800.00|5,460.00|2,340.00
A03.8|OTHER SHIGELLOSIS|7,800.00|5,460.00|2,340.00
A03.9|SHIGELLOSIS, UNSPECIFIED; ; BACILLARY DYSENTERY NOS|7,800.00|5,460.00|2,340.00
A04.0|ENTEROPATHOGENIC ESCHERICHIA COLI INFECTION|7,800.00|5,460.00|2,340.00
A04.1|ENTEROTOXIGENIC ESCHERICHIA COLI INFECTION|7,800.00|5,460.00|2,340.00
A04.2|ENTEROINVASIVE ESCHERICHIA COLI INFECTION|7,800.00|5,460.00|2,340.00
A04.3|ENTEROHAEMORRHAGIC ESCHERICHIA COLI INFECTION|7,800.00|5,460.00|2,340.00
A04.4|OTHER INTESTINAL ESCHERICHIA COLI INFECTIONS|7,800.00|5,460.00|2,340.00
A04.5|CAMPYLOBACTER ENTERITIS|7,800.00|5,460.00|2,340.00
A04.6|ENTERITIS DUE TO YERSINIA ENTEROCOLITICA|7,800.00|5,460.00|2,340.00
A04.7|ENTEROCOLITIS DUE TO CLOSTRIDIUM DIFFICILE; FOODBORNE INTOXICATION BY CLOSTRIDIUM DIFFICILE; PSEUDOMEMBRANOUS COLITIS|7,800.00|5,460.00|2,340.00
A04.8|OTHER SPECIFIED BACTERIAL INTESTINAL INFECTIONS|7,800.00|5,460.00|2,340.00
A04.9|BACTERIAL INTESTINAL INFECTION, UNSPECIFIED. BACTERIAL ENTERITIS NOS|7,800.00|5,460.00|2,340.00
A05.0|FOODBORNE STAPHYLOCOCCAL INTOXICATION|7,800.00|5,460.00|2,340.00
A05.1|BOTULISM; CLASSICAL FOODBORNE INTOXICATION DUE TO CLOSTRIDIUM BOTULINUM|6,240.00|4,368.00|1,872.00
A05.2|FOODBORNE CLOSTRIDIUM PERFRINGENS [CLOSTRIDIUM WELCHII] INTOXICATION. ENTERITIS NECROTICANS. PIG-BEL|7,800.00|5,460.00|2,340.00
A05.3|FOODBORNE VIBRIO PARAHAEMOLYTICUS INTOXICATION|7,800.00|5,460.00|2,340.00
A05.4|FOODBORNE BACILLUS CEREUS INTOXICATION|7,800.00|5,460.00|2,340.00
A05.8|OTHER SPECIFIED BACTERIAL FOODBORNE INTOXICATIONS|7,800.00|5,460.00|2,340.00
A05.9|BACTERIAL FOODBORNE INTOXICATION, UNSPECIFIED|7,800.00|5,460.00|2,340.00
A06.0|ACUTE AMOEBIC DYSENTERY; ACUTE AMOEBIASIS; INTESTINAL AMOEBIASIS NOS|7,800.00|5,460.00|2,340.00
A06.1|CHRONIC INTESTINAL AMOEBIASIS|7,800.00|5,460.00|2,340.00
A06.2|AMOEBIC NONDYSENTERIC COLITIS|7,800.00|5,460.00|2,340.00
A06.3|AMOEBOMA OF INTESTINE; AMOEBOMA NOS|7,800.00|5,460.00|2,340.00
A06.4+ K77.0*|AMOEBIC LIVER ABSCESS;  HEPATIC AMOEBIASIS|13,000.00|9,100.00|3,900.00
A06.7|CUTANEOUS AMOEBIASIS|7,800.00|5,460.00|2,340.00
A06.8|AMOEBIC APPENDICITIS|7,800.00|5,460.00|2,340.00
A07.0|BALANTIDIASIS; BALANTIDIAL DYSENTERY|7,800.00|5,460.00|2,340.00
A07.1|GIARDIASIS [LAMBLIASIS]|7,800.00|5,460.00|2,340.00
A07.2|CRYPTOSPORIDIOSIS|7,800.00|5,460.00|2,340.00
A07.3|ISOSPORIASIS; INFECTION DUE TO ISOSPORA BELLI AND ISOSPORA HOMINIS; INTESTINAL COCCIDIOSIS; ISOSPOROSIS|7,800.00|5,460.00|2,340.00
A07.8|OTHER SPECIFIED PROTOZOAL INTESTINAL DISEASES; INTESTINAL TRICHOMONIASIS; SARCOCYSTOSIS; SARCOSPORIDIOSIS|7,800.00|5,460.00|2,340.00
A07.9|PROTOZOAL INTESTINAL DISEASE, UNSPECIFIED;FLAGELLATE DIARRHOEA; PROTOZOAL COLITIS;  PROTOZOAL DIARRHOEA; PROTOZOAL DYSENTERY|7,800.00|5,460.00|2,340.00
A08.0|ROTAVIRAL ENTERITIS|7,800.00|5,460.00|2,340.00
A08.1|ACUTE GASTROENTEROPATHY DUE TO NORWALK AGENT; SMALL ROUND STRUCTURED VIRUS ENTERITIS|7,800.00|5,460.00|2,340.00
A08.2|ADENOVIRAL ENTERITIS|7,800.00|5,460.00|2,340.00
A08.3|OTHER VIRAL ENTERITIS|7,800.00|5,460.00|2,340.00
A08.4|VIRAL INTESTINAL INFECTION, UNSPECIFIED; VIRAL ENTERITIS NOS;  VIRAL GASTROENTERITIS NOS; VIRAL GASTROENTEROPATHY NOS|7,800.00|5,460.00|2,340.00
A08.5|OTHER SPECIFIED INTESTINAL INFECTIONS|7,800.00|5,460.00|2,340.00
A09.0|INFECTIOUS DIARRHEA|7,800.00|5,460.00|2,340.00
A09.9|ACUTE GASTROENTERITIS|7,800.00|5,460.00|2,340.00
A15.0|TUBERCULOSIS OF LUNG, CONFIRMED BY SPUTUM MICROSCOPY WITH OR WITHOUT CULTURE; TUBERCULOUS BRONCHIECTASIS, CONFIRMED BY SPUTUM MICROSCOPY WITH OR WITHOUT CULTURE; TUBERCULOUS FIBROSIS OF LUNG, CONFIRMED BY SPUTUM MICROSCOPY WITH OR WITHOUT CULTURE; TUBERCU|12,740.00|8,918.00|3,822.00
A15.1|TUBERCULOSIS OF LUNG, CONFIRMED BY CULTURE ONLY; TUBERCULOUS BRONCHIECTASIS, CONFIRMED BY CULTURE ONLY; TUBERCULOUS FIBROSIS OF LUNG, CONFIRMED BY CULTURE ONLY;  TUBERCULOUS PNEUMONIA, CONFIRMED BY CULTURE ONLY; TUBERCULOUS  PNEUMOTHORAX, CONFIRMED BY CUL|12,740.00|8,918.00|3,822.00
A15.2|TUBERCULOSIS OF LUNG, CONFIRMED HISTOLOGICALLY ONLY; TUBERCULOUS BRONCHIECTASIS, CONFIRMED HISTOLOGICALLY  ONLY; TUBERCULOUS FIBROSIS OF LUNG, CONFIRMED HISTOLOGICALLY  ONLY; TUBERCULOUS PNEUMONIA, CONFIRMED HISTOLOGICALLY  ONLY; TUBERCULOUS PNEUMOTHORAX|12,740.00|8,918.00|3,822.00
A15.3|TUBERCULOSIS OF LUNG, CONFIRMED BY UNSPECIFIED MEANS;  TUBERCULOUS BRONCHIECTASIS,  CONFIRMED BUT UNSPECIFIED WHETHER BACTERIOLOGICALLY OR HISTOLOGICALLY; TUBERCULOUS FIBROSIS OF LUNG, CONFIRMED BUT UNSPECIFIED WHETHER BACTERIOLOGICALLY OR HISTOLOGICALLY|12,740.00|8,918.00|3,822.00
A15.4|TUBERCULOSIS OF INTRATHORACIC LYMPH NODES, CONFIRMED BACTERIOLOGICALLY & HISTOLOGICALY; TUBERCULOSIS OF HILAR LYMPH NODES, CONFIRMED BACTERIOLOGICALLY & HISTOLOGICALY; TUBERCULOSIS OF MEDIASTINAL, LYMPH NODES, CONFIRMED BACTERIOLOGICALLY & HISTOLOGICALY;|15,470.00|10,829.00|4,641.00
A15.5|TUBERCULOSIS OF LARYNX, TRACHEA AND BRONCHUS, CONFIRMED BACTERIOLOGICALLY AND HISTOLOGICALLY ; TUBERCULOSIS OF BRONCHUS,CONFIRMED BACTERIOLOGICALLY AND HISTOLOGICALLY;  TUBERCULOSIS OF  GLOTTIS, CONFIRMED BACTERIOLOGICALLY AND HISTOLOGICALLY; TUBERCULO|15,470.00|10,829.00|4,641.00
A15.6|TUBERCULOUS PLEURISY, CONFIRMED BACTERIOLOGICALLY AND HISTOLOGICALLY  [TUBERCULOSIS OF PLEURA,  CONFIRMED BACTERIOLOGICALLY AND HISTOLOGICALLY; TUBERCULOUS EMPYEMA, CONFIRMED BACTERIOLOGICALLY & HISTOLOGICALLY|15,470.00|10,829.00|4,641.00
A15.7|PRIMARY RESPIRATORY TUBERCULOSIS, CONFIRMED BACTERIOLOGICALLY AND HISTOLOGICALLY|12,740.00|8,918.00|3,822.00
A15.8|OTHER RESPIRATORY TUBERCULOSIS, CONFIRMED BACTERIOLOGICALLY AND HISTOLOGICALLY; MEDIASTINAL TUBERCULOSIS,  CONFIRMED BACTERIOLOGICALLY AND HISTOLOGICALLY; NASOPHARYNGEAL TUBERCULOSIS, CONFIRMED BACTERIOLOGICALLY AND HISTOLOGICALLY; TUBERCULOSIS OF NOSE,|15,470.00|10,829.00|4,641.00
A15.9|RESPIRATORY TUBERCULOSIS UNSPECIFIED, CONFIRMED BACTERIOLOGICALLY AND HISTOLOGICALLY|12,740.00|8,918.00|3,822.00
A16.0|TUBERCULOSIS OF LUNG, BACTERIOLOGICALLY AND HISTOLOGICALLY NEGATIVE; TUBERCULOUS BRONCHIECTASIS ,  BACTERIOLOGICALLY AND HISTOLOGICALLY NEGATIVE;  TUBERCULOUS FIBROSIS OF LUNG,  BACTERIOLOGICALLY AND HISTOLOGICALLY NEGATIVE;  TUBERCULOUS PNEUMONIA,  BAC|12,740.00|8,918.00|3,822.00
A16.1|TUBERCULOSIS OF LUNG, BACTERIOLOGICAL AND HISTOLOGICAL EXAMINATION NOT DONE; TUBERCULOUS BRONCHIECTASIS, BACTERIOLOGICAL AND HISTOLOGICAL EXAMINATION NOT DONE;  TUBERCULOUS FIBROSIS OF LUNG, BACTERIOLOGICAL AND HISTOLOGICAL EXAMINATION NOT DONE; TUBERCULO|12,740.00|8,918.00|3,822.00
A16.2|TUBERCULOSIS OF LUNG,  NOS,  WITHOUT MENTION OF BACTERIOLOGICAL OR HISTOLOGICAL CONFIRMATION; TUBERCULOUS BRONCHIECTASIS,  NOS,  WITHOUT MENTION OF BACTERIOLOGICAL OR HISTOLOGICAL CONFIRMATION; TUBERCULOUS  FIBROSIS OF LUNG,  NOS, WITHOUT MENTION OF BACT|12,740.00|8,918.00|3,822.00
A16.3|TUBERCULOSIS OF INTRATHORACIC LYMPH NODES, WITHOUT MENTION OF BACTERIOLOGICAL OR HISTOLOGICAL CONFIRMATION; TUBERCULOSIS OF  HILAR LYMPH NODES NOS WITHOUT MENTION OF BACTERIOLOGICAL OR HISTOLOGICAL CONFIRMATION; TUBERCULOSIS OF INTRATHORACIC LYMPH NODES,|15,470.00|10,829.00|4,641.00
A16.4|TUBERCULOSIS OF  BRONCHUS, NOS,  WITHOUT MENTION OF BACTERIOLOGICAL OR HISTOLOGICAL ONFIRMATION; TUBERCULOSIS OF  GLOTTIS, NOS,  WITHOUT MENTION OF BACTERIOLOGICAL OR HISTOLOGICAL ONFIRMATION; TUBERCULOSIS OF LARYNX, NOS,  WITHOUT MENTION OF BACTERIOLOGIC|15,470.00|10,829.00|4,641.00
A16.5|TUBERCULOUS PLEURISY, WITHOUT MENTION OF BACTERIOLOGICAL OR HISTOLOGICAL CONFIRMATION;  TUBERCULOSIS OF PLEURA,  NOS, WITHOUT MENTION OF BACTERIOLOGICAL OR HISTOLOGICAL CONFIRMATION;  TUBERCULOUS EMPYEMA, NOS,  WITHOUT MENTION OF BACTERIOLOGICAL OR HIS|15,470.00|10,829.00|4,641.00
A16.7|PRIMARY RESPIRATORY TUBERCULOSIS WITHOUT MENTION OF BACTERIOLOGICAL OR HISTOLOGICAL CONFIRMATION; PRIMARY  RESPIRATORY TUBERCULOSIS NOS;  PRIMARY  TUBERCULOUS COMPLEX|12,740.00|8,918.00|3,822.00
A16.8|OTHER RESPIRATORY TUBERCULOSIS, WITHOUT MENTION OF BACTERIOLOGICAL OR HISTOLOGICAL CONFIRMATION; MEDIASTINAL TUBERCULOSIS, NOS WITHOUT MENTION OF BACTERIOLOGICAL OR HISTOLOGICAL CONFIRMATION; NASOPHARYNGEAL TUBERCULOSIS, NOS WITHOUT MENTION OF BACTERIOLOG|15,470.00|10,829.00|4,641.00
A16.9|RESPIRATORY TUBERCULOSIS UNSPECIFIED, WITHOUT MENTION OF BACTERIOLOGICAL OR HISTOLOGICAL CONFIRMATION; RESPIRATORY TUBERCULOSIS NOS; TUBERCULOSIS NOS|12,740.00|8,918.00|3,822.00
A18.2|TUBERCULOUS PERIPHERAL LYMPHADENOPATHY; TUBERCULOUS ADENITIS|15,470.00|10,829.00|4,641.00
A18.3|TUBERCULOSIS OF INTESTINES, PERITONEUM AND MESENTERIC GLANDS; TUBERCULOSIS OF RETROPERITONEAL LYMPH NODES|15,470.00|10,829.00|4,641.00
A18.4|ERYTHEMA  TUBERCULOUS INDURATUM, ; LUPUS EXEDENS; LUPUS  VULGARIS; LUPUS EXEDENS, NOS; LUPUS VULGARIS, NOS;   SCROFULODERMA|15,470.00|10,829.00|4,641.00
A19.0|ACUTE MILIARY TUBERCULOSIS OF A SINGLE SPECIFIED SITE|19,630.00|13,741.00|5,889.00
A19.1|ACUTE MILIARY TUBERCULOSIS OF MULTIPLE SITES|19,630.00|13,741.00|5,889.00
A19.2|ACUTE MILIARY TUBERCULOSIS, UNSPECIFIED|19,630.00|13,741.00|5,889.00
A19.8|OTHER MILIARY TUBERCULOSIS|19,630.00|13,741.00|5,889.00
A19.9|MILIARY TUBERCULOSIS|19,630.00|13,741.00|5,889.00
A20.0|BUBONIC PLAGUE|15,210.00|10,647.00|4,563.00
A20.9|PLAGUE, UNSPECIFIED|15,210.00|10,647.00|4,563.00
A21.0|ULCEROGLANDULAR TULARAEMIA; OPHTHALMIC TULARAEMIA|15,210.00|10,647.00|4,563.00
A21.1|OCULOGLANDULAR TULARAEMIA; OPHTHALMIC TULARAEMIA|15,210.00|10,647.00|4,563.00
A21.2|PULMONARY TULARAEMIA|15,210.00|10,647.00|4,563.00
A21.2+ J17.0*|PNEUMONIA IN TULAREMIA|19,500.00|13,650.00|5,850.00
A21.3|GASTROINTESTINAL TULARAEMIA; ABDOMINAL TULARAEMIA|15,210.00|10,647.00|4,563.00
A21.9|TULARAEMIA, UNSPECIFIED|15,210.00|10,647.00|4,563.00
A22.0|CUTANEOUS ANTHRAX; MALIGNANT  CARBUNCLE; MALIGNANT PUSTULE|15,210.00|10,647.00|4,563.00
A22.1+ J17.0*|PNEUMONIA IN ANTHRAX|19,500.00|13,650.00|5,850.00
A22.2|GASTROINTESTINAL ANTHRAX|15,210.00|10,647.00|4,563.00
A22.7|ANTHRAX SEPTICAEMIA|15,210.00|10,647.00|4,563.00
A22.9|ANTHRAX, UNSPECIFIED|15,210.00|10,647.00|4,563.00
A23.1|BRUCELLOSIS DUE TO BRUCELLA ABORTUS|15,210.00|10,647.00|4,563.00
A23.9|BRUCELLOSIS, UNSPECIFIED|15,210.00|10,647.00|4,563.00
A24.0|GLANDERS; INFECTION DUE TO PSEUDOMONAS MALLEI; MALLEUS|15,210.00|10,647.00|4,563.00
A24.1|ACUTE AND FULMINATING MELIOIDOSIS;  MELIOIDOSIS PNEUMONIA ;  MELIOIDOSIS SEPTICAEMIA|15,210.00|10,647.00|4,563.00
A25.9|RAT-BITE FEVER, UNSPECIFIED|15,210.00|10,647.00|4,563.00
A26.8|OTHER FORMS OF ERYSIPELOID|15,210.00|10,647.00|4,563.00
A26.9|ERYSIPELOID, UNSPECIFIED|15,210.00|10,647.00|4,563.00
A27.0|LEPTOSPIROSIS ICTEROHAEMORRHAGICA; LEPTOSPIROSIS DUE TO LEPTOSPIRA INTERROGANS SEROVAR ICTEROHAEMORRHAGIAE|14,300.00|10,010.00|4,290.00
A27.8|OTHER FORMS OF LEPTOSPIROSIS|14,300.00|10,010.00|4,290.00
A27.9|LEPTOSPIROSIS, UNSPECIFIED|14,300.00|10,010.00|4,290.00
A28.0|PASTEURELLOSIS|15,210.00|10,647.00|4,563.00
A28.1|CAT-SCRATCH DISEASE; CAT-SCRATCH FEVER|15,210.00|10,647.00|4,563.00
A28.8|OTHER SPECIFIED ZOONOTIC BACTERIAL DISEASES, NOT ELSEWHERE CLASSIFIED|15,210.00|10,647.00|4,563.00
A28.9|ZOONOTIC BACTERIAL DISEASE, UNSPECIFIED|15,210.00|10,647.00|4,563.00
A30.0|HANSEN'S DISEASE: INDETERMINATE LEPROSY; I LEPROSY|11,440.00|8,008.00|3,432.00
A30.1|HANSEN'S DISEASE : TUBERCULOID LEPROSY; TT LEPROSY|11,440.00|8,008.00|3,432.00
A30.2|HANSEN'S DISEASE: BORDERLINE TUBERCULOID LEPROSY; BT LEPROSY|11,440.00|8,008.00|3,432.00
A30.4|HANSEN'S DISEASE: BORDERLINE LEPROMATOUS LEPROSY; BL LEPROSY|11,440.00|8,008.00|3,432.00
A30.5|HANSEN'S DISEASE: LEPROMATOUS LEPROSY; LL LEPROSY|11,440.00|8,008.00|3,432.00
A30.8|OTHER FORMS OF LEPROSY|11,440.00|8,008.00|3,432.00
A30.9|LEPROSY, UNSPECIFIED|11,440.00|8,008.00|3,432.00
A31.0|PULMONARY MYCOBACTERIAL INFECTION;  INFECTION DUE TO MYCOBACTERIUM AVIUM, MYCOBACTERIUM INTRACELLULARE [BATTEY BACILLUS]; MYCOBACTERIUM KANSASII|19,500.00|13,650.00|5,850.00
A31.8|OTHER MYCOBACTERIAL INFECTIONS|11,570.00|8,099.00|3,471.00
A31.9|MYCOBACTERIAL INFECTION, UNSPECIFIED ; ATYPICAL MYCOBACTERIUM INFECTION NOT OTHERWISE SPECIFIED; MYCOBACTERIOSIS NOS; LISTERIOSIS (LISTERIAL FOODBORNE INFECTION)|11,570.00|8,099.00|3,471.00
A33|TETANUS NEONATORUM|21,450.00|15,015.00|6,435.00
A34|OBSTETRICAL TETANUS|21,450.00|15,015.00|6,435.00
A35|OTHER TETANUS; TETANUS NOS|21,450.00|15,015.00|6,435.00
A36.0|PHARYNGEAL DIPHTHERIA; DIPHTHERITIC MEMBRANOUS ANGINA; TONSILLAR DIPHTHERIA|11,310.00|7,917.00|3,393.00
A36.3|CUTANEOUS DIPHTHERIA|11,310.00|7,917.00|3,393.00
A36.9|DIPHTHERIA, UNSPECIFIED|11,310.00|7,917.00|3,393.00
A37.0|WHOOPING COUGH DUE TO BORDETELLA PERTUSSIS|13,780.00|9,646.00|4,134.00
A37.0+ J17.0*|PNEUMONIA IN WHOOPING COUGH DUE TO BORDATELLA PERTUSIS|19,500.00|13,650.00|5,850.00
A37.1|WHOOPING COUGH DUE TO BORDETELLA PARAPERTUSSIS|13,780.00|9,646.00|4,134.00
A37.1+ J17.0*|PNEUMONIA IN WHOOPING COUGH DUE TO BORDATELLA PARAPERTUSIS|19,500.00|13,650.00|5,850.00
A37.8|WHOOPING COUGH DUE TO OTHER BORDETELLA SPECIES|13,780.00|9,646.00|4,134.00
A37.8+ J17.0*|PNEUMONIA IN WHOOPING COUGH DUE TO BORDATELLA SPECIES OTHER THAN PERTUSIS OR PARAPERTUSIS|19,500.00|13,650.00|5,850.00
A37.9|WHOOPING COUGH, UNSPECIFIED|13,780.00|9,646.00|4,134.00
A37.9+ J17.0*|PNEUMONIA IN WHOOPING COUGH|19,500.00|13,650.00|5,850.00
A38|SCARLET FEVER; SCARLATINA|10,790.00|7,553.00|3,237.00
A39.2|ACUTE MENINGOCOCCAEMIA|25,740.00|18,018.00|7,722.00
A39.3|CHRONIC MENINGOCOCCAEMIA|25,740.00|18,018.00|7,722.00
A39.4|MENINGOCOCCAEMIA, UNSPECIFIED; MENINGOCOCCAL BACTERAEMIA NOS|25,740.00|18,018.00|7,722.00
A39.9|MENINGOCOCCAL INFECTION, UNSPECIFIED; MENINGOCOCCAL DISEASE NOS|25,740.00|18,018.00|7,722.00
A40.0|SEPTICAEMIA DUE TO STREPTOCOCCUS, GROUP A|41,600.00|29,120.00|12,480.00
A40.1|SEPTICAEMIA DUE TO STREPTOCOCCUS, GROUP B|41,600.00|29,120.00|12,480.00
A40.3|SEPTICAEMIA DUE TO STREPTOCOCCUS PNEUMONIAE; PNEUMOCOCCAL SEPTICAEMIA|41,600.00|29,120.00|12,480.00
A40.8|OTHER STREPTOCOCCAL SEPTICAEMIA|41,600.00|29,120.00|12,480.00
A40.9|STREPTOCOCCAL SEPTICAEMIA, UNSPECIFIED|41,600.00|29,120.00|12,480.00
A41.0|SEPTICAEMIA DUE TO STAPHYLOCOCCUS AUREUS|41,600.00|29,120.00|12,480.00
A41.1|SEPTICAEMIA DUE TO OTHER SPECIFIED STAPHYLOCOCCUS; SEPTICAEMIA DUE TO COAGULASE- NEGATIVE STAPHYLOCOCCUS|41,600.00|29,120.00|12,480.00
A41.2|SEPTICAEMIA DUE TO UNSPECIFIED STAPHYLOCOCCUS|41,600.00|29,120.00|12,480.00
A41.3|SEPTICAEMIA DUE TO HAEMOPHILUS INFLUENZAE|41,600.00|29,120.00|12,480.00
A41.4|SEPTICAEMIA DUE TO ANAEROBES|41,600.00|29,120.00|12,480.00
A41.5|SEPTICAEMIA DUE TO OTHER GRAM-NEGATIVE ORGANISMS; GRAM-NEGATIVE SEPTICAEMIA NOS|41,600.00|29,120.00|12,480.00
A41.8|OTHER SPECIFIED SEPTICAEMIA|41,600.00|29,120.00|12,480.00
A41.9|SEPTICAEMIA, UNSPECIFIED; SEPTIC SHOCK|41,600.00|29,120.00|12,480.00
A42.0|PULMONARY ACTINOMYCOSIS|11,570.00|8,099.00|3,471.00
A42.0+ J17.0*|PNEUMONIA IN ACTINOMYCOSES|19,500.00|13,650.00|5,850.00
A42.1|ABDOMINAL ACTINOMYCOSIS|11,570.00|8,099.00|3,471.00
A42.2|CERVICOFACIAL ACTINOMYCOSIS|11,570.00|8,099.00|3,471.00
A42.7|ACTINOMYCOTIC SEPTICAEMIA|11,570.00|8,099.00|3,471.00
A42.8|OTHER FORMS OF ACTINOMYCOSIS|11,570.00|8,099.00|3,471.00
A42.9|ACTINOMYCOSIS, UNSPECIFIED|11,570.00|8,099.00|3,471.00
A43.1|CUTANEOUS NOCARDIOSIS|11,570.00|8,099.00|3,471.00
A43.9|NOCARDIOSIS, UNSPECIFIED|11,570.00|8,099.00|3,471.00
A44.1|CUTANEOUS AND MUCOCUTANEOUS BARTONELLOSIS; VERRUGA PERUANA|11,570.00|8,099.00|3,471.00
A44.9|BARTONELLOSIS, UNSPECIFIED|11,570.00|8,099.00|3,471.00
A46|ERYSIPELAS|12,480.00|8,736.00|3,744.00
A48.0|GAS GANGRENE; CLOSTRIDIAL CELLULITIS;  CLOSTRIDIAL MYONECROSIS|12,480.00|8,736.00|3,744.00
A48.1|LEGIONNAIRES' DISEASE|19,500.00|13,650.00|5,850.00
A48.3|TOXIC SHOCK SYNDROME|41,600.00|29,120.00|12,480.00
A48.8|OTHER SPECIFIED BACTERIAL DISEASES|11,570.00|8,099.00|3,471.00
A49.0|STAPHYLOCOCCAL INFECTION, UNSPECIFIED|11,570.00|8,099.00|3,471.00
A49.2|HAEMOPHILUS INFLUENZAE INFECTION, UNSPECIFIED|11,570.00|8,099.00|3,471.00
A49.3|MYCOPLASMA INFECTION, UNSPECIFIED|11,570.00|8,099.00|3,471.00
A49.8|OTHER BACTERIAL INFECTIONS OF UNSPECIFIED SITE|11,570.00|8,099.00|3,471.00
A49.9|BACTERIAL INFECTION, UNSPECIFIED; BACTERAEMIA NOS|11,570.00|8,099.00|3,471.00
A50.0|EARLY CUTANEOUS CONGENITAL SYPHILIS: , EARLY MUCOCUTANEOUS CONGENITAL SYPHILIS, EARLY VISCERAL CONGENITAL SYPHILIS; EARLY  CONGENITAL SYPHILITIC LARYNGITIS;  EARLY  CONGENITAL SYPHILITIC OCULOPATHY;  EARLY  CONGENITAL SYPHILITIC OSTEOCHONDROPATHY;  EAR|16,640.00|11,648.00|4,992.00
A50.2|EARLY CONGENITAL SYPHILIS, UNSPECIFIED; CONGENITAL SYPHILIS NOS LESS THAN TWO YEARS AFTER BIRTH.|16,640.00|11,648.00|4,992.00
A50.4|LATE CONGENITAL NEUROSYPHILIS [JUVENILE NEUROSYPHILIS]; DEMENTIA PARALYTICA JUVENILIS; JUVENILE GENERAL PARESIS ; JUVENILE TABES DORSALIS; JUVENILE TABOPARETIC NEUROSYPHILIS|16,640.00|11,648.00|4,992.00
A50.5|OTHER LATE CONGENITAL SYPHILIS, SYMPTOMATIC; SYPHILITIC SADDLE NOSE|16,640.00|11,648.00|4,992.00
A50.9|CONGENITAL SYPHILIS, UNSPECIFIED|16,640.00|11,648.00|4,992.00
A52.1|LATE SYMPTOMATIC NEUROSYPHILIS; TABES DORSALIS|7,150.00|5,005.00|2,145.00
A52.3|NEUROSYPHILIS, UNSPECIFIED;  SYPHILITIC GUMMA OF CENTRAL NERVOUS SYSTEM NOS;  LATE SYPHILIS OF CENTRAL NERVOUS SYSTEM NOS; SYPHILOMA OF CENTRAL NERVOUS SYSTEM NOS|7,150.00|5,005.00|2,145.00
A52.7|OTHER SYMPTOMATIC LATE SYPHILIS|7,150.00|5,005.00|2,145.00
A53.0|LATENT SYPHILIS, UNSPECIFIED AS EARLY OR LATE; LATENT SYPHILIS NOS; POSITIVE SEROLOGICAL REACTION FOR SYPHILIS|7,150.00|5,005.00|2,145.00
A53.0+ J17.0*|PNEUMONIA IN NOCARDIOSIS|19,500.00|13,650.00|5,850.00
A54.1|GONOCOCCAL INFECTION OF LOWER GENITOURINARY TRACT WITH PERIURETHRAL AND ACCESSORY GLAND ABSCESS; GONOCOCCAL BARTHOLIN'S GLAND ABSCESS|7,150.00|5,005.00|2,145.00
A54.2|GONOCOCCAL PELVIPERITONITIS AND OTHER GONOCOCCAL GENITOURINARY INFECTIONS|7,150.00|5,005.00|2,145.00
A54.8|GONOCOCCAL  SEPTICAEMIA;  GONOCOCCAL SKIN LESIONS|7,150.00|5,005.00|2,145.00
A54.8+ J17.0*|PNEUMONIA IN GONORRHEA|19,500.00|13,650.00|5,850.00
A55|CHLAMYDIAL LYMPHOGRANULOMA (VENEREUM); CLIMATIC OR TROPICAL BUBO ; DURAND-NICOLAS-FAVRE DISEASE; ESTHIOMENE; LYMPHOGRANULOMA INGUINALE|7,150.00|5,005.00|2,145.00
A56.1|CHLAMYDIAL INFECTION OF PELVIPERITONEUM AND OTHER GENITOURINARY ORGANS;|7,150.00|5,005.00|2,145.00
A56.4|CHLAMYDIAL INFECTION OF PHARYNX|11,050.00|7,735.00|3,315.00
A59|TRICHOMONIASIS|7,150.00|5,005.00|2,145.00
A66.9|YAWS, UNSPECIFIED|11,440.00|8,008.00|3,432.00
A67.1|INTERMEDIATE LESIONS OF PINTA; ERYTHEMATOUS PLAQUES OF CARATE PINTA; HYPERCHROMIC LESIONS OF CARATE PINTA; HYPERKERATOSIS OF CARATE PINTA; PINTIDS OF CARATE PINTA|11,440.00|8,008.00|3,432.00
A68.9|RELAPSING FEVER, UNSPECIFIED|11,440.00|8,008.00|3,432.00
A69.0|NECROTIZING ULCERATIVE STOMATITIS; CANCRUM ORIS; FUSOSPIROCHAETAL GANGRENE; NOMA; STOMATITIS GANGRENOSA|11,440.00|8,008.00|3,432.00
A69.1|OTHER VINCENT'S INFECTIONS; FUSOSPIROCHAETAL PHARYNGITIS ; ACUTE NECROTIZING ULCERATIVE GINGIVITIS;  ACUTE NECROTIZING ULCERATIVE GINGIVOSTOMATITIS;  SPIROCHAETAL STOMATITIS, TRENCH MOUTH; VINCENT'S  ANGINA; VINCENT’S GINGIVITIS|11,440.00|8,008.00|3,432.00
A69.2|LYME DISEASE; ERYTHEMA CHRONICUM MIGRANS DUE TO BORRELIA BURGDORFERI|11,440.00|8,008.00|3,432.00
A69.8+ J17.8*|PNEUMONIA IN SPIROCHAETAL|19,500.00|13,650.00|5,850.00
A69.9|SPIROCHAETAL INFECTION, UNSPECIFIED|11,440.00|8,008.00|3,432.00
A70+ J17.8*|PNEUMONIA IN ORNITHOSIS|19,500.00|13,650.00|5,850.00
A71.1|ACTIVE STAGE OF TRACHOMA; ACTIVE STAGE OF TRACHOMA; TRACHOMATOUS GRANULAR CONJUNCTIVITIS; TRACHOMATOUS FOLLICULAR CONJUNCTIVITIS; TRACHOMATOUS PANNUS|11,050.00|7,735.00|3,315.00
A71.9|TRACHOMA, UNSPECIFIED|11,050.00|7,735.00|3,315.00
A74.9|CHLAMYDIAL INFECTION, UNSPECIFIED; CHLAMYDIOSIS NOS|11,050.00|7,735.00|3,315.00
A75.0|EPIDEMIC LOUSE-BORNE TYPHUS FEVER DUE TO RICKETTSIA PROWAZEKII; CL ASSICAL TYPHUS FEVER; EPIDEMIC LOUSE-BORNE TYPHUS|9,100.00|6,370.00|2,730.00
A75.9|TYPHUS FEVER, UNSPECIFIED|9,100.00|6,370.00|2,730.00
A77.0|SPOTTED FEVER DUE TO RICKETTSIA RICKETTSII; ROCKY MOUNTAIN SPOTTED FEVER; SAO PAULO FEVER|9,100.00|6,370.00|2,730.00
A78+ J17.8*|PNEUMONIA IN Q FEVER|19,500.00|13,650.00|5,850.00
A79.0|TRENCH FEVER ; QUINTAN FEVER; WOLHYNIAN FEVER|9,100.00|6,370.00|2,730.00
A79.9|RICKETTSIOSIS, UNSPECIFIED; RICKETTSIAL INFECTION NOS|9,100.00|6,370.00|2,730.00
A81.0|CREUTZFELDT-JAKOB DISEASE; SUBACUTE SPONGIFORM ENCEPHALOPATHY|27,430.00|19,201.00|8,229.00
A81.1|SUBACUTE SCLEROSING PANENCEPHALITIS; DAWSON'S INCLUSION BODY ENCEPHALITIS ; VAN BOGAERT'S SCLEROSING LEUKOENCEPHALOPATHY|27,430.00|19,201.00|8,229.00
A81.2|PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY; MULTIFOCAL LEUKOENCEPHALOPATHY NOS|27,430.00|19,201.00|8,229.00
A81.9|ATYPICAL VIRUS INFECTION OF CENTRAL NERVOUS SYSTEM, UNSPECIFIED; PRION DISEASE OF CENTRAL NERVOUS SYSTEM NOS|27,430.00|19,201.00|8,229.00
A82.0|SYLVATIC RABIES|27,430.00|19,201.00|8,229.00
A82.1|URBAN RABIES|27,430.00|19,201.00|8,229.00
A82.9|RABIES, UNSPECIFIED|27,430.00|19,201.00|8,229.00
A83.0|JAPANESE ENCEPHALITIS|27,430.00|19,201.00|8,229.00
A83.2|EASTERN EQUINE ENCEPHALITIS|27,430.00|19,201.00|8,229.00
A83.5|CALIFORNIA ENCEPHALITIS; CALIFORNIA MENINGOENCEPHALITIS LA CROSSE ENCEPHALITIS|27,430.00|19,201.00|8,229.00
A83.8|OTHER MOSQUITO-BORNE VIRAL ENCEPHALITIS|27,430.00|19,201.00|8,229.00
A83.9|MOSQUITO-BORNE VIRAL ENCEPHALITIS, UNSPECIFIED|27,430.00|19,201.00|8,229.00
A85.2|ARTHROPOD-BORNE VIRAL ENCEPHALITIS, UNSPECIFIED;|27,430.00|19,201.00|8,229.00
A85.8|OTHER SPECIFIED VIRAL ENCEPHALITIS; ENCEPHALITIS LETHARGIC; VON ECONOMO-CRUCHET DISEASE|27,430.00|19,201.00|8,229.00
A86|UNSPECIFIED VIRAL ENCEPHALITIS; VIRAL ENCEPHALOMYELITIS NOS; VIRAL  MENINGOENCEPHALITIS NOS|27,430.00|19,201.00|8,229.00
A87.8|OTHER VIRAL MENINGITIS|33,410.00|23,387.00|10,023.00
A87.9|VIRAL MENINGITIS, UNSPECIFIED|33,410.00|23,387.00|10,023.00
A88.8|OTHER SPECIFIED VIRAL INFECTIONS OF CENTRAL NERVOUS SYSTEM|27,430.00|19,201.00|8,229.00
A89|UNSPECIFIED VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM|27,430.00|19,201.00|8,229.00
A92.0|CHIKUNGUNYA VIRUS DISEASE; CHIKUNGUNYA (HAEMORRHAGIC) FEVER|10,530.00|7,371.00|3,159.00
A92.1|O'NYONG-NYONG FEVER|10,530.00|7,371.00|3,159.00
A92.2|VENEZUELAN EQUINE FEVER;  VENEZUELAN EQUINE ENCEPHALITIS;  VENEZUELAN ENCEPHALOMYELITIS VIRUS DISEASE|10,530.00|7,371.00|3,159.00
A92.8|OTHER SPECIFIED MOSQUITO-BORNE VIRAL FEVERS|10,530.00|7,371.00|3,159.00
A93.1|SANDFLY FEVER; PAPPATACI FEVER; PHLEBOTOMUS FEVER|10,530.00|7,371.00|3,159.00
A93.8|OTHER SPECIFIED ARTHROPOD-BORNE VIRAL FEVERS; PIRY VIRUS DISEASE; VESICULAR STOMATITIS VIRUS DISEASE [INDIANA FEVER]|10,530.00|7,371.00|3,159.00
A94|UNSPECIFIED ARTHROPOD-BORNE VIRAL FEVER; UNSPECIFIED ARTHROPOD-BORNE VIRAL FEVER; ARBOVIRAL FEVER NOS; ARBOVIRUS INFECTION NOS|10,530.00|7,371.00|3,159.00
A96.0|JUNIN HAEMORRHAGIC FEVER; ARGENTINIAN HAEMORRHAGIC FEVER|10,270.00|7,189.00|3,081.00
A96.1|MACHUPO HAEMORRHAGIC FEVER; BOLIVIAN HAEMORRHAGIC FEVER|10,270.00|7,189.00|3,081.00
A97.0|DENGUE WITHOUT WARNING SIGNS; DENGUE FEVER (DF) DENGUE HAEMORRHAGIC FEVER GRADES 1 AND 2; DENGUE HAEMORRHAGIC FEVER WITHOUT WARNING SIGNS|13,000.00|9,100.00|3,900.00
A97.1|DENGUE WITH WARNING SIGNS; DENGUE HAEMORRHAGIC FEVER WITH WARNING SIGNS|13,000.00|9,100.00|3,900.00
A98.8|OTHER SPECIFIED VIRAL HAEMORRHAGIC FEVERS|10,270.00|7,189.00|3,081.00
A99|UNSPECIFIED VIRAL HAEMORRHAGIC FEVER|10,270.00|7,189.00|3,081.00
B01.2+ J17.1*|PNEUMONIA IN VARICELLA|19,500.00|13,650.00|5,850.00
B01.9|VARICELLA [CHICKENPOX] WITHOUT COMPLICATION|5,200.00|3,640.00|1,560.00
B05.0+ G05.1*|MEASLES COMPLICATED BY ENCEPHALITIS; ENCEPHALITIS, MYELITIS AND ENCEPHALOMYELITIS IN VIRAL DISEASES CLASSIFIED ELSEWHERE|28,080.00|19,656.00|8,424.00
B05.1+ G02.0*|MEASLES COMPLICATED BY MENINGITIS; MENINGITIS IN VIRAL DISEASES CLASSIFIED ELSEWHERE|33,410.00|23,387.00|10,023.00
B05.2+ J17.1*|PNEUMONIA IN MEASLES|19,500.00|13,650.00|5,850.00
B05.3+ H67.1*|MEASLES COMPLICATED BY OTITIS MEDIA; OTITIS MEDIA IN VIRAL DISEASES CLASSIFIED ELSEWHERE|10,140.00|7,098.00|3,042.00
B05.4|MEASLES WITH INTESTINAL COMPLICATIONS|12,350.00|8,645.00|3,705.00
B05.8|MEASLES WITH OTHER COMPLICATIONS|10,010.00|7,007.00|3,003.00
B05.9|MEASLES WITHOUT COMPLICATIONS|10,010.00|7,007.00|3,003.00
B06.8|RUBELLA WITH OTHER COMPLICATIONS|5,200.00|3,640.00|1,560.00
B06.8+ J17.1*|PNEUMONIA IN RUBELLA|19,500.00|13,650.00|5,850.00
B06.9|RUBELLA WITHOUT COMPLICATION|5,200.00|3,640.00|1,560.00
B09|VIRAL EXANTHEM|5,200.00|3,640.00|1,560.00
B15.0|ACUTE HEPATITIS A WITH HEPATIC COMA|15,340.00|10,738.00|4,602.00
B15.9|ACUTE HEPATITIS A WITHOUT HEPATIC COMA; HEPATITIS A (ACUTE)(VIRAL) NOS|15,340.00|10,738.00|4,602.00
B16.0|ACUTE HEPATITIS B WITH DELTA-AGENT (COINFECTION) WITH HEPATIC COMA|15,340.00|10,738.00|4,602.00
B16.1|ACUTE HEPATITIS B WITH DELTA-AGENT (COINFECTION) WITHOUT HEPATIC COMA|15,340.00|10,738.00|4,602.00
B16.2|ACUTE HEPATITIS B WITHOUT DELTA-AGENT WITH HEPATIC COMA|15,340.00|10,738.00|4,602.00
B16.9|ACUTE HEPATITIS B WITHOUT DELTA-AGENT AND WITHOUT HEPATIC COMA; HEPATITIS B (ACUTE)(VIRAL) NOS|15,340.00|10,738.00|4,602.00
B17.0|ACUTE DELTA-(SUPER)INFECTION OF HEPATITIS B CARRIER|15,340.00|10,738.00|4,602.00
B17.1|ACUTE HEPATITIS C|15,340.00|10,738.00|4,602.00
B17.2|ACUTE HEPATITIS E|15,340.00|10,738.00|4,602.00
B17.8|OTHER SPECIFIED ACUTE VIRAL HEPATITIS; HEPATITIS NON-A NON-B (ACUTE)(VIRAL) NEC|15,340.00|10,738.00|4,602.00
B18.0|CHRONIC VIRAL HEPATITIS B WITH DELTA-AGENT|15,340.00|10,738.00|4,602.00
B18.1|CHRONIC VIRAL HEPATITIS B WITHOUT DELTA-AGENT; CHRONIC (VIRAL) HEPATITIS B|15,340.00|10,738.00|4,602.00
B18.2|CHRONIC VIRAL HEPATITIS C|15,340.00|10,738.00|4,602.00
B18.8|OTHER CHRONIC VIRAL HEPATITIS|15,340.00|10,738.00|4,602.00
B18.9|CHRONIC VIRAL HEPATITIS, UNSPECIFIED|15,340.00|10,738.00|4,602.00
B19.0|UNSPECIFIED VIRAL HEPATITIS HEPATIC WITH COMA|15,340.00|10,738.00|4,602.00
B19.9|UNSPECIFIED VIRAL HEPATITIS WITHOUT HEPATIC COMA; VIRAL HEPATITIS NOS|15,340.00|10,738.00|4,602.00
B20.1|HIV DISEASE RESULTING IN OTHER BACTERIAL INFECTIONS|11,570.00|8,099.00|3,471.00
B21.0|HUMAN IMMUNODEFICIENCY VIRUS [HIV] DISEASE RESULTING IN KAPOSI'S SARCOMA|15,600.00|10,920.00|4,680.00
B21.1|HUMAN IMMUNODEFICIENCY VIRUS [HIV] DISEASE RESULTING IN BURKITT'S LYMPHOMA|18,070.00|12,649.00|5,421.00
B21.2|HUMAN IMMUNODEFICIENCY VIRUS [HIV] DISEASE RESULTING IN OTHER TYPES OF NON-HODGKIN'S LYMPHOMA|18,070.00|12,649.00|5,421.00
B21.3|HUMAN IMMUNODEFICIENCY VIRUS [HIV] DISEASE RESULTING IN OTHER MALIGNANT NEOPLASMS OF LYMPHOID, HAEMATOPOIETIC AND RELATED TISSUE|18,070.00|12,649.00|5,421.00
B22.0|HUMAN IMMUNODEFICIENCY VIRUS [HIV] DISEASE RESULTING IN ENCEPHALOPATHY; HUMAN IMMUNODEFICIENCY VIRUS [HIV] DEMENTIA|28,860.00|20,202.00|8,658.00
B25.0+ J17.1*|PNEUMONIA IN CYTOMEGALOVIRUS DISEASE|19,500.00|13,650.00|5,850.00
B34.1|ECHOVIRUS INFECTION NOS|5,200.00|3,640.00|1,560.00
B34.2|CORONAVIRUS INFECTION, UNSPECIFIED|5,200.00|3,640.00|1,560.00
B34.3|PARVOVIRUS INFECTION, UNSPECIFIED|5,200.00|3,640.00|1,560.00
B34.4|PAPOVAVIRUS INFECTION, UNSPECIFIED|5,200.00|3,640.00|1,560.00
B34.8|OTHER VIRAL INFECTIONS OF UNSPECIFIED SITE|5,200.00|3,640.00|1,560.00
B34.9|VIRAL INFECTION, UNSPECIFIED;|5,200.00|3,640.00|1,560.00
B37.1+ J17.2*|PNEUMONIA IN CANDIDIASIS|19,500.00|13,650.00|5,850.00
B38.0+ J17.2*|PNEUMONIA IN ACUTE PULMONARY COCCIDIOMYCOSIS|19,500.00|13,650.00|5,850.00
B38.1+ J17.2*|PNEUMONIA IN CHRONIC PULMONARY COCCIDIOMYCOSIS|19,500.00|13,650.00|5,850.00
B38.2+ J17.2*|PNEUMONIA IN PULMONARY COCCIDIOIDOMYCOSIS|19,500.00|13,650.00|5,850.00
B39.0+ J17.2*|PNEUMONIA IN ACUTE PULMONARY HISTOPLASMOSIS CAPSULATI|19,500.00|13,650.00|5,850.00
B39.1+ J17.2*|PNEUMONIA IN CHRONIC PULMONARY HISTOPLASMOSIS CAPSULATI|19,500.00|13,650.00|5,850.00
B39.2+ J17.2*|PNEUMONIA IN  PULMONARY HISTOPLASMOSIS CAPSULATI|19,500.00|13,650.00|5,850.00
B39.9+ J17.2*|PNEUMONIA IN HISTOPLASMOSIS|19,500.00|13,650.00|5,850.00
B44.0+ J17.2*|PNEUMONIA IN INVASIVE PULMONARY ASPERGILLOSIS|19,500.00|13,650.00|5,850.00
B44.1+ J17.2*|PNEUMONIA IN OTHER PULMONARY ASPERGILLOSIS|19,500.00|13,650.00|5,850.00
B50.9|PLASMODIUM FALCIPARUM MALARIA|5,200.00|3,640.00|1,560.00
B51.9|PLASMODIUM VIVAX MALARIA WITHOUT COMPLICATIONS|5,200.00|3,640.00|1,560.00
B52.9|PLASMODIUM MALARIAE MALARIA WITHOUT COMPLICATIONS|5,200.00|3,640.00|1,560.00
B58.3+ J17.3*|PNEUMONIA IN TAXOPLASMOSIS|19,500.00|13,650.00|5,850.00
B65.0+ J17.3*|PNEUMONIA IN  SCHISTOSOMIASIS DUE TO SCHISTOSOMA HEMATOBIUM|19,500.00|13,650.00|5,850.00
B65.1|SCHISTOSOMIASIS DUE TO SCHISTOSOMA MANSONI [INTESTINAL SCHISTOSOMIASIS]|5,200.00|3,640.00|1,560.00
B65.1+ J17.3*|PNEUMONIA IN  SCHISTOSOMIASIS DUE TO SCHISTOSOMA MANSONI|19,500.00|13,650.00|5,850.00
B65.2|SCHISTOSOMIASIS DUE TO SCHISTOSOMA JAPONICUM|5,200.00|3,640.00|1,560.00
B65.2+ J17.3*|PNEUMONIA IN  SCHISTOSOMIASIS DUE TO SCHISTOSOMA JAPONICUM|19,500.00|13,650.00|5,850.00
B65.3|CERCARIAL DERMATITIS;  SWIMMER'S ITCH|5,200.00|3,640.00|1,560.00
B65.8|INFECTION DUE TO SCHISTOSOMA INTERCALATUM, SCHISTOSOMA MATTHEEI , SCHISTOSOMA MEKONGI|5,200.00|3,640.00|1,560.00
B65.8+ J17.3*|PNEUMONIA IN  SCHISTOSOMIASIS DUE TO SCHISTOSOMA INTERCALATUM; MATTHEEI; MEKONGI|19,500.00|13,650.00|5,850.00
B65.9|SCHISTOSOMIASIS, UNSPECIFIED|5,200.00|3,640.00|1,560.00
B65.9+ J17.3*|PNEUMONIA IN  SCHISTOSOMIASIS|19,500.00|13,650.00|5,850.00
B77.8+ J17.3*|PNEUMONIA IN  ASCARIASIS|19,500.00|13,650.00|5,850.00
B77.9|ASCARIASIS|5,200.00|3,640.00|1,560.00
B82.0|INTESTINAL HELMINTHIASIS, UNSPECIFIED|5,200.00|3,640.00|1,560.00
B82.9|INTESTINAL PARASITISM, UNSPECIFIED|5,200.00|3,640.00|1,560.00
B90.0|SEQUELAE OF CENTRAL NERVOUS SYSTEM TUBERCULOSIS|13,910.00|9,737.00|4,173.00
B90.8|SEQUELAE OF TUBERCULOSIS OF OTHER ORGANS|13,910.00|9,737.00|4,173.00
B90.9|SEQUELAE OF RESPIRATORY AND UNSPECIFIED TUBERCULOSIS; SEQUELAE OF TUBERCULOSIS NOS|13,910.00|9,737.00|4,173.00
B94.1|SEQUELAE OF VIRAL ENCEPHALITIS|13,910.00|9,737.00|4,173.00
B94.2|SEQUELAE OF VIRAL HEPATITIS|13,910.00|9,737.00|4,173.00
B94.8|SEQUELAE OF OTHER SPECIFIED INFECTIOUS AND PARASITIC DISEASES|13,910.00|9,737.00|4,173.00
B94.9|SEQUELAE OF UNSPECIFIED INFECTIOUS OR PARASITIC DISEASE|13,910.00|9,737.00|4,173.00
C00.0|MALIGNANT NEOPLASM OF EXTERNAL UPPER LIP; MALIGNANT NEOPLASM OF UPPER LIP NOS;  MALIGNANT NEOPLASM OF UPPER LIP; MALIGNANT NEOPLASM OF LIPSTICK AREA; MALIGNANT NEOPLASM OF UPPER LIP, VERMILION BORDER|14,950.00|10,465.00|4,485.00
C00.9|MALIGNANT NEOPLASM OF LIP, UNSPECIFIED|14,950.00|10,465.00|4,485.00
C01|MALIGNANT NEOPLASM OF BASE OF DORSAL SURFACE OF TONGUE ; MALIGNANT NEOPLASM OF FIXED PART OF TONGUE NOS; MALIGNANT NEOPLASM OF POSTERIOR THIRD OF TONGUE|14,950.00|10,465.00|4,485.00
C02.0|MALIGNANT NEOPLASM OF DORSAL SURFACE OF BASE  OF TONGUE; MALIGNANT NEOPLASM OF ANTERIOR TWO- THIRDS OF DORSAL SURFACE OF TONGUE|14,950.00|10,465.00|4,485.00
C02.1|MALIGNANT NEOPLASM OF BORDER OF TONGUE; MALIGNANT NEOPLASM OF TIP OF TONGUE|14,950.00|10,465.00|4,485.00
C02.2|MALIGNANT NEOPLASM OF VENTRAL SURFACE OF TONGUE; MALIGNANT NEOPLASM OF ANTERIOR TWO-THIRDS OF VENTRAL SURFACE OF TONGUE; MALIGNANT NEOPLASM OF FRENULUM LINGUAE|14,950.00|10,465.00|4,485.00
C02.3|MALIGNANT NEOPLASM OF ANTERIOR TWO-THIRDS OF TONGUE, PART UNSPECIFIED; MALIGNANT NEOPLASM OF MIDDLE THIRD OF TONGUE NOS; MALIGNANT NEOPLASM OF MOBILE PART OF TONGUE NOS|14,950.00|10,465.00|4,485.00
C02.4|MALIGNANT NEOPLASM OF LINGUAL TONSIL|14,950.00|10,465.00|4,485.00
C02.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF TONGUE|14,950.00|10,465.00|4,485.00
C02.9|MALIGNANT NEOPLASM OF TONGUE, UNSPECIFIED|14,950.00|10,465.00|4,485.00
C03.0|MALIGNANT NEOPLASM OF UPPER GUM|14,950.00|10,465.00|4,485.00
C03.1|MALIGNANT NEOPLASM OF LOWER GUM|14,950.00|10,465.00|4,485.00
C03.9|MALIGNANT NEOPLASM OF GUM, UNSPECIFIED|14,950.00|10,465.00|4,485.00
C04.9|MALIGNANT NEOPLASM OF FLOOR OF MOUTH, UNSPECIFIED|14,950.00|10,465.00|4,485.00
C05.0|MALIGNANT NEOPLASM OF HARD PALATE|14,950.00|10,465.00|4,485.00
C05.1|MALIGNANT NEOPLASM OF SOFT PALATE|14,950.00|10,465.00|4,485.00
C05.9|MALIGNANT NEOPLASM OF PALATE, UNSPECIFIED|14,950.00|10,465.00|4,485.00
C06.0|MALIGNANT NEOPLASM OF CHEEK MUCOSA; MALIGNANT NEOPLASM OF BUCCAL MUCOSA NOS;  MALIGNANT NEOPLASM OF INTERNAL CHEEK|14,950.00|10,465.00|4,485.00
C06.1|MALIGNANT NEOPLASM OF VESTIBULE OF MOUTH; MALIGNANT NEOPLASM OF UPPER BUCCAL SULCUS; MALIGNANT NEOPLASM OF LOWER BUCCAL SULCUS; MALIGNANT NEOPLASM OF UPPER LABIAL SULCUS; MALIGNANT NEOPLASM OF LOWER  LABIAL SULCUS|14,950.00|10,465.00|4,485.00
C06.2|MALIGNANT NEOPLASM OF RETROMOLAR AREA|14,950.00|10,465.00|4,485.00
C06.9|MALIGNANT NEOPLASM OF MOUTH, UNSPECIFIED; MINOR MALIGNANT NEOPLASM OF MINOR SALIVARY GLAND, UNSPECIFIED SITE; MALIGNANT NEOPLASM OF ORAL CAVITY NOS|14,950.00|10,465.00|4,485.00
C07|MALIGNANT NEOPLASM OF PAROTID GLAND|14,950.00|10,465.00|4,485.00
C08.0|MALIGNANT NEOPLASM OF SUBMANDIBULAR GLAND; MALIGNANT NEOPLASM OF SUBMAXILLARY GLAND|14,950.00|10,465.00|4,485.00
C08.1|MALIGNANT NEOPLASM OF SUBLINGUAL GLAND|14,950.00|10,465.00|4,485.00
C08.9|MALIGNANT NEOPLASM OF MAJOR SALIVARY GLAND, UNSPECIFIED; MALIGNANT NEOPLASM OF MAJOR SALIVARY GLAND NOS|14,950.00|10,465.00|4,485.00
C09.0|MALIGNANT NEOPLASM OF TONSILLAR FOSSA|14,950.00|10,465.00|4,485.00
C09.9|MALIGNANT NEOPLASM OF TONSIL, UNSPECIFIED; MALIGNANT NEOPLASM OF TONSIL NOS; MALIGNANT NEOPLASM OF FAUCIAL TONSIL; MALIGNANT NEOPLASM OF PALATINE TONSIL|14,950.00|10,465.00|4,485.00
C10.0|MALIGNANT NEOPLASM OF VALLECULA|14,950.00|10,465.00|4,485.00
C10.3|MALIGNANT NEOPLASM OF POSTERIOR WALL OF OROPHARYNX|14,950.00|10,465.00|4,485.00
C10.4|MALIGNANT NEOPLASM OF BRANCHIAL CLEFT; MALIGNANT NEOPLASM OF BRANCHIAL CYST|14,950.00|10,465.00|4,485.00
C10.9|MALIGNANT NEOPLASM OF OROPHARYNX, UNSPECIFIED|14,950.00|10,465.00|4,485.00
C11.0|MALIGNANT NEOPLASM OF SUPERIOR WALL OF NASOPHARYNX;  MALIGNANT NEOPLASM OF ROOF OF NASOPHARYNX|14,950.00|10,465.00|4,485.00
C11.1|MALIGNANT NEOPLASM OF POSTERIOR WALL OF NASOPHARYNX; MALIGNANT NEOPLASM OF ADENOID; MALIGNANT NEOPLASM OF  PHARYNGEAL TONSIL|14,950.00|10,465.00|4,485.00
C11.2|MALIGNANT NEOPLASM OF LATERAL WALL OF NASOPHARYNX; MALIGNANT NEOPLASM OF FOSSA OF ROSENMüLLER; MALIGNANT NEOPLASM OF OPENING OF AUDITORY TUBE;  MALIGNANT NEOPLASM OF  PHARYNGEAL RECESS|14,950.00|10,465.00|4,485.00
C11.3|MALIGNANT NEOPLASM OF ANTERIOR WALL OF NASOPHARYNX; MALIGNANT NEOPLASM OF A NTERIOR NASOPHARYNGEAL  SURFACE OF SOFT PALATE; MALIGNANT NEOPLASM OF POSTERIOR  NASOPHARYNGEAL  SURFACE  OF SOFT PALATE; MALIGNANT NEOPLASM OF POSTERIOR MARGIN OF NASAL CHOANA;  M|14,950.00|10,465.00|4,485.00
C11.9|MALIGNANT NEOPLASM OF NASOPHARYNX, UNSPECIFIED|14,950.00|10,465.00|4,485.00
C13.1|MALIGNANT NEOPLASM OF ARYEPIGLOTTIC FOLD, HYPOPHARYNGEAL ASPECT HYPOPHARYNX ; MALIGNANT NEOPLASM OF ARYEPIGLOTTIC FOLD, HYPOPHARYNX NOS; MALIGNANT NEOPLASM OF ARYEPIGLOTTIC FOLD, MARGINAL ZONE, HYPOPHARYNX|14,950.00|10,465.00|4,485.00
C13.9|MALIGNANT NEOPLASM OF HYPOPHARYNX, UNSPECIFIED; MALIGNANT NEOPLASM OF HYPOPHARYNGEAL WALL NOS|14,950.00|10,465.00|4,485.00
C14.0|MALIGNANT NEOPLASM OF PHARYNX, UNSPECIFIED|14,950.00|10,465.00|4,485.00
C14.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF LIP, ORAL CAVITY AND PHARYNX|14,950.00|10,465.00|4,485.00
C15.0|MALIGNANT NEOPLASM OF CERVICAL PART OF OESOPHAGUS|18,460.00|12,922.00|5,538.00
C15.2|MALIGNANT NEOPLASM OF ABDOMINAL PART OF OESOPHAGUS|18,460.00|12,922.00|5,538.00
C15.3|MALIGNANT NEOPLASM OF UPPER THIRD OF OESOPHAGUS|18,460.00|12,922.00|5,538.00
C15.4|MALIGNANT NEOPLASM OF MIDDLE THIRD OF OESOPHAGUS|18,460.00|12,922.00|5,538.00
C15.5|MALIGNANT NEOPLASM OF LOWER THIRD OF OESOPHAGUS|18,460.00|12,922.00|5,538.00
C15.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF OESOPHAGUS|18,460.00|12,922.00|5,538.00
C15.9|MALIGNANT NEOPLASM OF OESOPHAGUS, UNSPECIFIED|18,460.00|12,922.00|5,538.00
C16|DERMATO(POLY)MYOSITIS IN MALIGNANT NEOPLASM OF STOMACH|18,460.00|12,922.00|5,538.00
C16.0|MALIGNANT NEOPLASM OF CARDIA; MALIGNANT NEOPLASM OF CARDIAC ORIFICE; MALIGNANT NEOPLASM OF CARDIO-OESOPHAGEAL JUNCTION; MALIGNANT NEOPLASM OF GASTRO-OESOPHAGEAL JUNCTION; MALIGNANT NEOPLASM OF OESOPHAGUS AND STOMACH|18,460.00|12,922.00|5,538.00
C16.1|MALIGNANT NEOPLASM OF FUNDUS OF STOMACH|18,460.00|12,922.00|5,538.00
C16.2|MALIGNANT NEOPLASM OF BODY OF STOMACH|18,460.00|12,922.00|5,538.00
C16.3|MALIGNANT NEOPLASM OF PYLORIC ANTRUM; MALIGNANT NEOPLASM OF GASTRIC ANTRUM|18,460.00|12,922.00|5,538.00
C16.4|MALIGNANT NEOPLASM OF PYLORUS; MALIGNANT NEOPLASM OF PREPYLORUS; MALIGNANT NEOPLASM OF PYLORIC CANAL|18,460.00|12,922.00|5,538.00
C16.5|MALIGNANT NEOPLASM OF LESSER CURVATURE OF STOMACH, UNSPECIFIED|18,460.00|12,922.00|5,538.00
C16.6|MALIGNANT NEOPLASM OF GREATER CURVATURE OF STOMACH, UNSPECIFIED|18,460.00|12,922.00|5,538.00
C16.9|MALIGNANT NEOPLASM OF STOMACH, UNSPECIFIED|18,460.00|12,922.00|5,538.00
C17.0|MALIGNANT NEOPLASM OF DUODENUM|18,460.00|12,922.00|5,538.00
C17.1|MALIGNANT NEOPLASM OF JEJUNUM|18,460.00|12,922.00|5,538.00
C17.2|MALIGNANT NEOPLASM OF ILEUM|18,460.00|12,922.00|5,538.00
C17.9|MALIGNANT NEOPLASM OF SMALL INTESTINE, UNSPECIFIED|18,460.00|12,922.00|5,538.00
C18.0|MALIGNANT NEOPLASM OF CAECUM; MALIGNANT NEOPLASM OF ILEOCAECAL VALVE|18,460.00|12,922.00|5,538.00
C18.1|MALIGNANT NEOPLASM OF APPENDIX|18,460.00|12,922.00|5,538.00
C18.2|MALIGNANT NEOPLASM OF ASCENDING COLON|18,460.00|12,922.00|5,538.00
C18.3|MALIGNANT NEOPLASM OF HEPATIC FLEXURE|18,460.00|12,922.00|5,538.00
C18.4|MALIGNANT NEOPLASM OF TRANSVERSE COLON|18,460.00|12,922.00|5,538.00
C18.5|MALIGNANT NEOPLASM OF SPLENIC FLEXURE|18,460.00|12,922.00|5,538.00
C18.6|MALIGNANT NEOPLASM OF DESCENDING COLON|18,460.00|12,922.00|5,538.00
C18.7|MALIGNANT NEOPLASM OF SIGMOID COLON; MALIGNANT NEOPLASM OF SIGMOID FLEXURE|18,460.00|12,922.00|5,538.00
C18.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF COLON|18,460.00|12,922.00|5,538.00
C18.9|MALIGNANT NEOPLASM OF COLON, UNSPECIFIED; MALIGNANT NEOPLASM OF LARGE INTESTINE NOS|18,460.00|12,922.00|5,538.00
C19|MALIGNANT NEOPLASM OF RECTOSIGMOID JUNCTION; MALIGNANT NEOPLASM OF COLON WITH RECTUM; MALIGNANT NEOPLASM OF RECTOSIGMOID COLON|18,460.00|12,922.00|5,538.00
C20|MALIGNANT NEOPLASM OF RECTUM; MALIGNANT NEOPLASM OF RECTAL AMPULLA|18,460.00|12,922.00|5,538.00
C21.0|MALIGNANT NEOPLASM OF ANUS, UNSPECIFIED|18,460.00|12,922.00|5,538.00
C21.1|MALIGNANT NEOPLASM OF ANAL CANAL; MALIGNANT NEOPLASM OF ANAL SPHINCTER|18,460.00|12,922.00|5,538.00
C21.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF RECTUM, ANUS AND ANAL CANAL; MALIGNANT NEOPLASM OF ANORECTAL JUNCTION; MALIGNANT NEOPLASM OF ANORECTUM|18,460.00|12,922.00|5,538.00
C22.0|LIVER CELL CARCINOMA; HEPATOCELLULAR CARCINOMA HEPATOMA|18,460.00|12,922.00|5,538.00
C22.1|INTRAHEPATIC BILE DUCT CARCINOMA; CHOLANGIOCARCINOMA|18,460.00|12,922.00|5,538.00
C22.2|HEPATOBLASTOMA|18,460.00|12,922.00|5,538.00
C22.3|ANGIOSARCOMA OF LIVER; KUPFFER CELL SARCOMA|18,460.00|12,922.00|5,538.00
C22.4|OTHER SARCOMAS OF LIVER|18,460.00|12,922.00|5,538.00
C22.7|OTHER SPECIFIED CARCINOMAS OF LIVER|18,460.00|12,922.00|5,538.00
C22.9|LIVER, UNSPECIFIED|18,460.00|12,922.00|5,538.00
C23|MALIGNANT NEOPLASM OF GALLBLADDER|18,460.00|12,922.00|5,538.00
C24.0|MALIGNANT NEOPLASM OF EXTRAHEPATIC BILE DUCT; MALIGNANT NEOPLASM OF BILIARY DUCT OR PASSAGE NOS; MALIGNANT NEOPLASM OF COMMON BILE DUCT; MALIGNANT NEOPLASM OF CYSTIC DUCT; MALIGNANT NEOPLASM OF HEPATIC DUCT|18,460.00|12,922.00|5,538.00
C24.1|MALIGNANT NEOPLASM OF AMPULLA OF VATER|18,460.00|12,922.00|5,538.00
C24.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF BILIARY TRACT|18,460.00|12,922.00|5,538.00
C24.9|MALIGNANT NEOPLASM OF BILIARY TRACT, UNSPECIFIED|18,460.00|12,922.00|5,538.00
C25.0|MALIGNANT NEOPLASM OF HEAD OF PANCREAS|18,460.00|12,922.00|5,538.00
C25.1|MALIGNANT NEOPLASM OF BODY OF PANCREAS|18,460.00|12,922.00|5,538.00
C25.2|MALIGNANT NEOPLASM OF TAIL OF PANCREAS|18,460.00|12,922.00|5,538.00
C25.3|MALIGNANT NEOPLASM OF PANCREATIC DUCT|18,460.00|12,922.00|5,538.00
C25.4|MALIGNANT NEOPLASM OF ENDOCRINE PANCREAS; MALIGNANT NEOPLASM OF ISLETS OF LANGERHANS|18,460.00|12,922.00|5,538.00
C25.7|MALIGNANT NEOPLASM OF OTHER PARTS OF PANCREAS; MALIGNANT NEOPLASM OF NECK OF PANCREAS|18,460.00|12,922.00|5,538.00
C25.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF PANCREAS|18,460.00|12,922.00|5,538.00
C25.9|MALIGNANT NEOPLASM OF PANCREAS, UNSPECIFIED|18,460.00|12,922.00|5,538.00
C26.0|MALIGNANT NEOPLASM OF INTESTINAL TRACT, PART UNSPECIFIED; MALIGNANT NEOPLASM OF INTESTINE NOS|18,460.00|12,922.00|5,538.00
C26.1|MALIGNANT NEOPLASM OF SPLEEN|18,460.00|12,922.00|5,538.00
C26.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF DIGESTIVE SYSTEM|18,460.00|12,922.00|5,538.00
C26.9|MALIGNANT NEOPLASM OF ILL-DEFINED SITES WITHIN THE DIGESTIVE SYSTEM; MALIGNANT NEOPLASM OF ALIMENTARY CANAL OR TRACT NOS; MALIGNANT NEOPLASM OF GASTROINTESTINAL TRACT NOS|18,460.00|12,922.00|5,538.00
C30.0|MALIGNANT NEOPLASM OF NASAL CAVITY; MALIGNANT NEOPLASM OF CARTILAGE OF NOSE; MALIGNANT NEOPLASM OF  NASAL CONCHA; MALIGNANT NEOPLASM OF INTERNAL NOSE; MALIGNANT NEOPLASM OF SEPTUM OF NOSE; MALIGNANT NEOPLASM OF VESTIBULE OF NOSE|13,390.00|9,373.00|4,017.00
C30.1|MALIGNANT NEOPLASM OF MIDDLE EAR; MALIGNANT NEOPLASM OF EUSTACHIAN TUBE; MALIGNANT NEOPLASM OF  INNER EAR; MALIGNANT NEOPLASM OF MASTOID AIR CELLS|13,390.00|9,373.00|4,017.00
C31.0|MALIGNANT NEOPLASM OF MAXILLARY SINUS; MALIGNANT NEOPLASM OF ANTRUM (HIGHMORE);  MALIGNANT NEOPLASM OF ANTRUM (MAXILLARY)|14,950.00|10,465.00|4,485.00
C31.1|MALIGNANT NEOPLASM OF ETHMOIDAL SINUS|14,950.00|10,465.00|4,485.00
C31.2|MALIGNANT NEOPLASM OF FRONTAL SINUS|14,950.00|10,465.00|4,485.00
C31.3|MALIGNANT NEOPLASM OF SPHENOIDAL SINUS|14,950.00|10,465.00|4,485.00
C31.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF ACCESSORY SINUSES|14,950.00|10,465.00|4,485.00
C31.9|MALIGNANT NEOPLASM OF ACCESSORY SINUS, UNSPECIFIED|14,950.00|10,465.00|4,485.00
C32.0|MALIGNANT NEOPLASM OF GLOTTIS; MALIGNANT NEOPLASM OF INTRINSIC LARYNX; MALIGNANT NEOPLASM OF TRUE VOCAL CORD NOS|18,980.00|13,286.00|5,694.00
C32.1|MALIGNANT NEOPLASM OF SUPRAGLOTTIS:  MALIGNANT NEOPLASM OF ARYEPIGLOTTIC FOLD, LARYNGEAL ASPECT; MALIGNANT NEOPLASM OF EPIGLOTTIS (SUPRAHYOID PORTION) NOS; MALIGNANT NEOPLASM OF EXTRINSIC LARYNX; MALIGNANT NEOPLASM OF FALSE VOCAL CORD; MALIGNANT NEOPLASM|18,980.00|13,286.00|5,694.00
C32.2|MALIGNANT NEOPLASM OF SUBGLOTTIS|18,980.00|13,286.00|5,694.00
C32.3|MALIGNANT NEOPLASM OF LARYNGEAL CARTILAGE|18,980.00|13,286.00|5,694.00
C32.9|MALIGNANT NEOPLASM OF LARYNX, UNSPECIFIED|18,980.00|13,286.00|5,694.00
C33|MALIGNANT NEOPLASM OF TRACHEA|18,980.00|13,286.00|5,694.00
C34.0|MALIGNANT NEOPLASM OF MAIN BRONCHUS; MALIGNANT NEOPLASM OF CARINA;  MALIGNANT NEOPLASM OF HILUS OF LUNG|18,980.00|13,286.00|5,694.00
C34.1|MALIGNANT NEOPLASM OF UPPER LOBE, BRONCHUS OR LUNG|18,980.00|13,286.00|5,694.00
C34.2|MALIGNANT NEOPLASM OF MIDDLE LOBE, BRONCHUS OR LUNG|18,980.00|13,286.00|5,694.00
C34.3|MALIGNANT NEOPLASM OF LOWER LOBE, BRONCHUS OR LUNG|18,980.00|13,286.00|5,694.00
C34.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF BRONCHUS AND LUNG|18,980.00|13,286.00|5,694.00
C34.9|MALIGNANT NEOPLASM OF BRONCHUS OR LUNG, UNSPECIFIED|18,980.00|13,286.00|5,694.00
C37|MALIGNANT NEOPLASM OF THYMUS|18,980.00|13,286.00|5,694.00
C38.0|MALIGNANT NEOPLASM OF HEART; MALIGNANT NEOPLASM OF PERICARDIUM|18,980.00|13,286.00|5,694.00
C38.1|MALIGNANT NEOPLASM OF ANTERIOR MEDIASTINUM|18,980.00|13,286.00|5,694.00
C38.3|MALIGNANT NEOPLASM OF MEDIASTINUM, PART UNSPECIFIED|18,980.00|13,286.00|5,694.00
C38.4|MALIGNANT NEOPLASM OF PLEURA|18,980.00|13,286.00|5,694.00
C38.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF HEART, MEDIASTINUM AND PLEURA|18,980.00|13,286.00|5,694.00
C39.0|MALIGNANT NEOPLASM OF UPPER RESPIRATORY TRACT, PART UNSPECIFIED|18,980.00|13,286.00|5,694.00
C39.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF RESPIRATORY AND INTRATHORACIC ORGANS|18,980.00|13,286.00|5,694.00
C39.9|MALIGNANT NEOPLASM OF ILL-DEFINED SITES WITHIN THE RESPIRATORY SYSTEM; RESPIRATORY TRACT NOS|18,980.00|13,286.00|5,694.00
C40.0|MALIGNANT NEOPLASM OF SCAPULA AND LONG BONES OF UPPER LIMB|21,450.00|15,015.00|6,435.00
C40.1|MALIGNANT NEOPLASM OF SHORT BONES OF UPPER LIMB|21,450.00|15,015.00|6,435.00
C40.2|MALIGNANT NEOPLASM OF LONG BONES OF LOWER LIMB|21,450.00|15,015.00|6,435.00
C40.3|MALIGNANT NEOPLASM OF SHORT BONES OF LOWER LIMB|21,450.00|15,015.00|6,435.00
C40.9|MALIGNANT NEOPLASM OF BONE AND ARTICULAR CARTILAGE OF LIMB, UNSPECIFIED|21,450.00|15,015.00|6,435.00
C41.0|MALIGNANT NEOPLASM OF BONES OF SKULL AND FACE; MALIGNANT NEOPLASM O F SUPERIOR MAXILLA; MALIGNANT NEOPLASM OF ORBITAL BONE|21,450.00|15,015.00|6,435.00
C41.1|MALIGNANT NEOPLASM OF MANDIBLE; MALIGNANT NEOPLASM OF LOWER JAW BONE|21,450.00|15,015.00|6,435.00
C41.2|MALIGNANT NEOPLASM OF VERTEBRAL COLUMN|21,450.00|15,015.00|6,435.00
C41.3|MALIGNANT NEOPLASM OF RIBS, STERNUM AND CLAVICLE|21,450.00|15,015.00|6,435.00
C41.4|MALIGNANT NEOPLASM OF PELVIC BONES, SACRUM AND COCCYX|21,450.00|15,015.00|6,435.00
C41.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF BONE AND ARTICULAR CARTILAGE|21,450.00|15,015.00|6,435.00
C41.9|MALIGNANT NEOPLASM OF BONE AND ARTICULAR CARTILAGE, UNSPECIFIED|21,450.00|15,015.00|6,435.00
C45.0|MESOTHELIOMA OF PLEURA|13,780.00|9,646.00|4,134.00
C45.1|MESOTHELIOMA OF PERITONEUM; MESOTHELIOMA OF MESENTERY; MESOTHELIOMA OF MESOCOLON; MESOTHELIOMA OF OMENTUM; MESOTHELIOMA OF PARIETAL PERITONEUM; MESOTHELIOMA OF  PELVIC PERITONEUM|18,460.00|12,922.00|5,538.00
C45.2|MESOTHELIOMA OF PERICARDIUM|13,780.00|9,646.00|4,134.00
C45.7|MESOTHELIOMA OF OTHER SITES|13,780.00|9,646.00|4,134.00
C45.9|MESOTHELIOMA, UNSPECIFIED|13,780.00|9,646.00|4,134.00
C46.9|KAPOSI'S SARCOMA, UNSPECIFIED|15,600.00|10,920.00|4,680.00
C47.0|MALIGNANT NEOPLASM OF PERIPHERAL NERVES OF HEAD, FACE AND NECK|17,290.00|12,103.00|5,187.00
C47.1|MALIGNANT NEOPLASM OF PERIPHERAL NERVES OF UPPER LIMB, INCLUDING SHOULDER|17,290.00|12,103.00|5,187.00
C47.2|MALIGNANT NEOPLASM OF PERIPHERAL NERVES OF LOWER LIMB, INCLUDING HIP|17,290.00|12,103.00|5,187.00
C47.3|MALIGNANT NEOPLASM OF PERIPHERAL NERVES OF THORAX|17,290.00|12,103.00|5,187.00
C47.4|MALIGNANT NEOPLASM OF PERIPHERAL NERVES OF ABDOMEN|17,290.00|12,103.00|5,187.00
C47.5|MALIGNANT NEOPLASM OF PERIPHERAL NERVES OF PELVIS|17,290.00|12,103.00|5,187.00
C47.6|MALIGNANT NEOPLASM OF PERIPHERAL NERVES OF TRUNK, UNSPECIFIED|17,290.00|12,103.00|5,187.00
C47.9|MALIGNANT NEOPLASM OF PERIPHERAL NERVES AND AUTONOMIC NERVOUS SYSTEM, UNSPECIFIED|17,290.00|12,103.00|5,187.00
C48.0|MALIGNANT NEOPLASM OF RETROPERITONEUM|13,780.00|9,646.00|4,134.00
C48.1|MALIGNANT NEOPLASM OF SPECIFIED PARTS OF PERITONEUM; MALIGNANT NEOPLASM OF MESENTERY; MALIGNANT NEOPLASM OF MESOCOLON; MALIGNANT NEOPLASM OF OMENTUM; MALIGNANT NEOPLASM OF PARIETAL PERITONEUM;  MALIGNANT NEOPLASM OF PELVIC PERITONEUM|18,460.00|12,922.00|5,538.00
C48.2|MALIGNANT NEOPLASM OF  PERITONEUM, UNSPECIFIED|18,460.00|12,922.00|5,538.00
C49.0|MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE OF HEAD, FACE AND NECK; MALIGNANT NEOPLASM OF CONNECTIVE TISSUE OF EAR; MALIGNANT NEOPLASM OF CONNECTIVE TISSUE OF EYELID|15,600.00|10,920.00|4,680.00
C49.1|MALIGNANT NEOPLASM OF  CONNECTIVE AND SOFT TISSUE OF UPPER LIMB, INCLUDING SHOULDER|15,600.00|10,920.00|4,680.00
C49.2|MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE OF LOWER LIMB, INCLUDING HIP|15,600.00|10,920.00|4,680.00
C49.3|MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE OF THORAX;  MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE  OF AXILLA;  MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE OF DIAPHRAGM; MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE OF GREAT VESSELS|15,600.00|10,920.00|4,680.00
C49.4|MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE OF ABDOMEN; MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE OF ABDOMINAL WALL; MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE OF HYPOCHONDRIUM|15,600.00|10,920.00|4,680.00
C49.5|MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE OF PELVIS;  MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE OF BUTTOCK; MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE OF  GROIN; MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE OF PERINEUM|15,600.00|10,920.00|4,680.00
C49.6|MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE OF TRUNK, UNSPECIFIED; MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE OF BACK NOS|15,600.00|10,920.00|4,680.00
C49.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF CONNECTIVE AND SOFT TISSUE|15,600.00|10,920.00|4,680.00
C49.9|MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE, UNSPECIFIED|15,600.00|10,920.00|4,680.00
C50.0|MALIGNANT NEOPLASM OF NIPPLE AND AREOLA, BREAST|15,340.00|10,738.00|4,602.00
C50.1|MALIGNANT NEOPLASM OF CENTRAL PORTION OF BREAST|15,340.00|10,738.00|4,602.00
C50.2|MALIGNANT NEOPLASM OF UPPER-INNER QUADRANT OF BREAST|15,340.00|10,738.00|4,602.00
C50.3|MALIGNANT NEOPLASM OF LOWER-INNER QUADRANT OF BREAST|15,340.00|10,738.00|4,602.00
C50.4|MALIGNANT NEOPLASM OF UPPER-OUTER QUADRANT OF BREAST|15,340.00|10,738.00|4,602.00
C50.6|MALIGNANT NEOPLASM OF AXILLARY TAIL OF BREAST|15,340.00|10,738.00|4,602.00
C50.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF BREAST|15,340.00|10,738.00|4,602.00
C50.9|MALIGNANT NEOPLASM OF BREAST, UNSPECIFIED|15,340.00|10,738.00|4,602.00
C51.0|MALIGNANT NEOPLASM OF LABIUM MAJUS; MALIGNANT NEOPLASM OF BARTHOLIN'S [GREATER VESTIBULAR] GLAND|14,820.00|10,374.00|4,446.00
C51.1|MALIGNANT NEOPLASM OF LABIUM MINUS|14,820.00|10,374.00|4,446.00
C51.2|MALIGNANT NEOPLASM OF CLITORIS|14,820.00|10,374.00|4,446.00
C51.9|MALIGNANT NEOPLASM OF VULVA, UNSPECIFIED; MALIGNANT NEOPLASM OF  EXTERNAL FEMALE GENITALIA NOS; MALIGNANT NEOPLASM OF PUDENDUM|14,820.00|10,374.00|4,446.00
C52|MALIGNANT NEOPLASM OF VAGINA|14,820.00|10,374.00|4,446.00
C53.0|MALIGNANT NEOPLASM OF ENDOCERVIX|14,820.00|10,374.00|4,446.00
C53.1|MALIGNANT NEOPLASM OF EXOCERVIX|14,820.00|10,374.00|4,446.00
C53.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF CERVIX UTERI|14,820.00|10,374.00|4,446.00
C53.9|MALIGNANT NEOPLASM OF CERVIX UTERI, UNSPECIFIED|14,820.00|10,374.00|4,446.00
C54.0|MALIGNANT NEOPLASM OF ISTHMUS UTERI; MALIGNANT NEOPLASM OF LOWER UTERINE SEGMENT|14,820.00|10,374.00|4,446.00
C54.1|MALIGNANT NEOPLASM OF ENDOMETRIUM|14,820.00|10,374.00|4,446.00
C54.2|MALIGNANT NEOPLASM OF MYOMETRIUM|14,820.00|10,374.00|4,446.00
C54.3|MALIGNANT NEOPLASM OF FUNDUS UTERI|14,820.00|10,374.00|4,446.00
C54.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF CORPUS UTERI|14,820.00|10,374.00|4,446.00
C54.9|CORPUS UTERI, UNSPECIFIED|14,820.00|10,374.00|4,446.00
C55|MALIGNANT NEOPLASM OF UTERUS, PART UNSPECIFIED|14,820.00|10,374.00|4,446.00
C56|MALIGNANT NEOPLASM OF OVARY|14,820.00|10,374.00|4,446.00
C57.0|MALIGNANT NEOPLASM OF FALLOPIAN TUBE;  MALIGNANT NEOPLASM OF OVIDUCT;  MALIGNANT NEOPLASM OF UTERINE TUBE|14,820.00|10,374.00|4,446.00
C57.3|MALIGNANT NEOPLASM OF PARAMETRIUM;  MALIGNANT NEOPLASM OF UTERINE LIGAMENT NOS|14,820.00|10,374.00|4,446.00
C57.4|MALIGNANT NEOPLASM OF UTERINE ADNEXA, UNSPECIFIED|14,820.00|10,374.00|4,446.00
C57.7|MALIGNANT NEOPLASM OF OTHER SPECIFIED FEMALE GENITAL ORGANS;  MALIGNANT NEOPLASM OF WOLFFIAN BODY OR DUCT|14,820.00|10,374.00|4,446.00
C57.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF FEMALE GENITAL ORGANS;   MALIGNANT NEOPLASM OF TUBO-OVARIAN;  MALIGNANT NEOPLASM OF UTERO- OVARIAN|14,820.00|10,374.00|4,446.00
C57.9|MALIGNANT NEOPLASM OF FEMALE GENITAL ORGAN, UNSPECIFIED;   MALIGNANT NEOPLASM OF FEMALE GENITOURINARY TRACT NOS|14,820.00|10,374.00|4,446.00
C58|MALIGNANT NEOPLASM OF PLACENTA; CHORIOCARCINOMA NOS; CHORIONEPITHELIOMA NOS|14,820.00|10,374.00|4,446.00
C60.9|MALIGNANT NEOPLASM OF PENIS, UNSPECIFIED; MALIGNANT NEOPLASM OF SKIN OF PENIS NOS|17,420.00|12,194.00|5,226.00
C61|MALIGNANT NEOPLASM OF PROSTATE|17,420.00|12,194.00|5,226.00
C62.0|MALIGNANT NEOPLASM OF UNDESCENDED TESTIS; ECTOPIC TESTIS ; MALIGNANT NEOPLASM OF RETAINED TESTIS|17,420.00|12,194.00|5,226.00
C62.1|MALIGNANT NEOPLASM OF DESCENDED TESTIS; MALIGNANT NEOPLASM OF SCROTAL TESTIS|17,420.00|12,194.00|5,226.00
C62.9|MALIGNANT NEOPLASM OF TESTIS, UNSPECIFIED|17,420.00|12,194.00|5,226.00
C63.0|MALIGNANT NEOPLASM OF EPIDIDYMIS|17,420.00|12,194.00|5,226.00
C63.1|MALIGNANT NEOPLASM OF SPERMATIC CORD|17,420.00|12,194.00|5,226.00
C63.2|MALIGNANT NEOPLASM OF SCROTUM;  MALIGNANT NEOPLASM OF SKIN OF SCROTUM|17,420.00|12,194.00|5,226.00
C63.7|MALIGNANT NEOPLASM OF SEMINAL VESICLE;  MALIGNANT NEOPLASM OF TUNICA VAGINALIS|17,420.00|12,194.00|5,226.00
C63.9|MALIGNANT NEOPLASM OF MALE GENITAL ORGAN, UNSPECIFIED; MALE GENITOURINARY TRACT NOS|17,420.00|12,194.00|5,226.00
C64|MALIGNANT NEOPLASM OF KIDNEY, EXCEPT RENAL PELVIS & RENAL CALYCES|18,330.00|12,831.00|5,499.00
C65|MALIGNANT NEOPLASM OF RENAL PELVIS; MALIGNANT NEOPLASM OF PELVIURETERIC JUNCTION; MALIGNANT NEOPLASM OF RENAL CALYCES|18,330.00|12,831.00|5,499.00
C66|MALIGNANT NEOPLASM OF URETER|18,330.00|12,831.00|5,499.00
C67.0|MALIGNANT NEOPLASM OF TRIGONE OF BLADDER|18,330.00|12,831.00|5,499.00
C67.1|MALIGNANT NEOPLASM OF DOME OF BLADDER|18,330.00|12,831.00|5,499.00
C67.2|MALIGNANT NEOPLASM OF LATERAL WALL OF BLADDER|18,330.00|12,831.00|5,499.00
C67.3|MALIGNANT NEOPLASM OF ANTERIOR WALL OF BLADDER|18,330.00|12,831.00|5,499.00
C67.5|MALIGNANT NEOPLASM OF BLADDER NECK;  MALIGNANT NEOPLASM OF INTERNAL URETHRAL ORIFICE|18,330.00|12,831.00|5,499.00
C67.6|MALIGNANT NEOPLASM OF URETERIC ORIFICE|18,330.00|12,831.00|5,499.00
C67.7|MALIGNANT NEOPLASM OF URACHUS|18,330.00|12,831.00|5,499.00
C67.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF BLADDER|18,330.00|12,831.00|5,499.00
C67.9|MALIGNANT NEOPLASM OF BLADDER, UNSPECIFIED|18,330.00|12,831.00|5,499.00
C68.0|MALIGNANT NEOPLASM OF URETHRA|18,330.00|12,831.00|5,499.00
C68.9|MALIGNANT NEOPLASM OF URINARY ORGAN, UNSPECIFIED;  MALIGNANT NEOPLASM OF  URINARY SYSTEM NOS|18,330.00|12,831.00|5,499.00
C69.1|MALIGNANT NEOPLASM OF CORNEA|21,970.00|15,379.00|6,591.00
C69.2|MALIGNANT NEOPLASM OF RETINA|21,970.00|15,379.00|6,591.00
C69.3|MALIGNANT NEOPLASM OF CHOROID|21,970.00|15,379.00|6,591.00
C69.4|MALIGNANT NEOPLASM OF CILIARY BODY;  MALIGNANT NEOPLASM OF EYEBALL|21,970.00|15,379.00|6,591.00
C69.5|MALIGNANT NEOPLASM OF LACRIMAL GLAND AND DUCT; MALIGNANT NEOPLASM OF LACRIMAL SAC;  MALIGNANT NEOPLASM OF NASOLACRIMAL DUCT|21,970.00|15,379.00|6,591.00
C69.6|MALIGNANT NEOPLASM OF ORBIT;   MALIGNANT NEOPLASM OF CONNECTIVE TISSUE OF ORBIT;  MALIGNANT NEOPLASM OF EXTRAOCULAR MUSCLE;  MALIGNANT NEOPLASM OF PERIPHERAL NERVES OF ORBIT;  MALIGNANT NEOPLASM OF RETROBULBAR TISSUE; MALIGNANT NEOPLASM OF RETRO-OCULAR|21,970.00|15,379.00|6,591.00
C69.9|MALIGNANT NEOPLASM OF EYE, UNSPECIFIED|21,970.00|15,379.00|6,591.00
C70.0|MALIGNANT NEOPLASM OF CEREBRAL MENINGES|21,970.00|15,379.00|6,591.00
C70.1|MALIGNANT NEOPLASM OF SPINAL MENINGES|21,970.00|15,379.00|6,591.00
C70.9|MALIGNANT NEOPLASM OF MENINGES, UNSPECIFIED|21,970.00|15,379.00|6,591.00
C71.0|MALIGNANT NEOPLASM OF CEREBRUM, EXCEPT LOBES AND VENTRICLES;  MALIGNANT NEOPLASM OF SUPRATENTORIAL NOS|21,970.00|15,379.00|6,591.00
C71.1|MALIGNANT NEOPLASM OF FRONTAL LOBE|21,970.00|15,379.00|6,591.00
C71.2|MALIGNANT NEOPLASM OF TEMPORAL LOBE|21,970.00|15,379.00|6,591.00
C71.3|MALIGNANT NEOPLASM OF PARIETAL LOBE|21,970.00|15,379.00|6,591.00
C71.4|MALIGNANT NEOPLASM OF OCCIPITAL LOBE|21,970.00|15,379.00|6,591.00
C71.5|MALIGNANT NEOPLASM OF CEREBRAL VENTRICLE|21,970.00|15,379.00|6,591.00
C71.6|MALIGNANT NEOPLASM OF CEREBELLUM|21,970.00|15,379.00|6,591.00
C71.7|MALIGNANT NEOPLASM OF BRAIN STEM; MALIGNANT NEOPLASM OF  FOURTH VENTRICLE; MALIGNANT NEOPLASM OF INFRATENTORIAL NOS|21,970.00|15,379.00|6,591.00
C71.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF BRAIN|21,970.00|15,379.00|6,591.00
C71.9|MALIGNANT NEOPLASM OF BRAIN, UNSPECIFIED|21,970.00|15,379.00|6,591.00
C72.0|MALIGNANT NEOPLASM OF SPINAL CORD|21,970.00|15,379.00|6,591.00
C72.1|MALIGNANT NEOPLASM OF CAUDA EQUINA|21,970.00|15,379.00|6,591.00
C72.2|MALIGNANT NEOPLASM OF OLFACTORY NERVE; MALIGNANT NEOPLASM OF  OLFACTORY BULB|21,970.00|15,379.00|6,591.00
C72.3|MALIGNANT NEOPLASM OF OPTIC NERVE|21,970.00|15,379.00|6,591.00
C72.4|MALIGNANT NEOPLASM OF ACOUSTIC NERVE|21,970.00|15,379.00|6,591.00
C72.5|MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED CRANIAL NERVES;   MALIGNANT NEOPLASM OF CRANIAL NERVE NOS|21,970.00|15,379.00|6,591.00
C72.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF BRAIN AND OTHER PARTS OF CENTRAL NERVOUS SYSTEM|21,970.00|15,379.00|6,591.00
C72.9|MALIGNANT NEOPLASM OF CENTRAL NERVOUS SYSTEM, UNSPECIFIED;  MALIGNANT NEOPLASM OF NERVOUS SYSTEM NOS|21,970.00|15,379.00|6,591.00
C73|MALIGNANT NEOPLASM OF THYROID GLAND|14,820.00|10,374.00|4,446.00
C74.0|MALIGNANT NEOPLASM OF CORTEX OF ADRENAL GLAND|14,820.00|10,374.00|4,446.00
C74.1|MALIGNANT NEOPLASM OF MEDULLA OF ADRENAL GLAND|14,820.00|10,374.00|4,446.00
C74.9|MALIGNANT NEOPLASM OF ADRENAL GLAND, UNSPECIFIED|14,820.00|10,374.00|4,446.00
C75.0|MALIGNANT NEOPLASM OF PARATHYROID GLAND|14,820.00|10,374.00|4,446.00
C75.1|MALIGNANT NEOPLASM OF PITUITARY GLAND|14,820.00|10,374.00|4,446.00
C75.3|MALIGNANT NEOPLASM OF PINEAL GLAND|14,820.00|10,374.00|4,446.00
C75.5|MALIGNANT NEOPLASM OF AORTIC BODY AND OTHER PARAGANGLIA|14,820.00|10,374.00|4,446.00
C75.9|MALIGNANT NEOPLASM OF ENDOCRINE GLAND, UNSPECIFIED|14,820.00|10,374.00|4,446.00
C76.0|MALIGNANT NEOPLASM OF HEAD, FACE AND NECK; MALIGNANT NEOPLASM OF CHEEK NOS;  MALIGNANT NEOPLASM OF NOSE NOS|14,950.00|10,465.00|4,485.00
C76.1|MALIGNANT NEOPLASM OF THORAX;   MALIGNANT NEOPLASM OF AXILLA NOS;  MALIGNANT NEOPLASM OF INTRATHORACIC NOS;  MALIGNANT NEOPLASM OF THORACIC NOS|18,980.00|13,286.00|5,694.00
C76.2|MALIGNANT NEOPLASM OF ABDOMEN|18,460.00|12,922.00|5,538.00
C76.3|MALIGNANT NEOPLASM OF PELVIS;  MALIGNANT NEOPLASM OF  GROIN NOS;  MALIGNANT NEOPLASM OF  SITES OVERLAPPING SYSTEMS WITHIN THE PELVIS, SUCH AS  RECTOVAGINAL (SEPTUM) & RECTOVESICAL (SEPTUM)|20,930.00|14,651.00|6,279.00
C76.4|MALIGNANT NEOPLASM OF UPPER LIMB|20,930.00|14,651.00|6,279.00
C76.5|MALIGNANT NEOPLASM OF LOWER LIMB|20,930.00|14,651.00|6,279.00
C76.7|MALIGNANT NEOPLASM OF OTHER ILL-DEFINED SITES|20,930.00|14,651.00|6,279.00
C76.8|MALIGNANT NEOPLASM OF OVERLAPPING LESION OF OTHER AND ILL-DEFINED SITES|20,930.00|14,651.00|6,279.00
C77.0|SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF LYMPH NODES OF HEAD, FACE AND NECK;  MALIGNANT NEOPLASM OF SUPRACLAVICULAR LYMPH NODES|14,950.00|10,465.00|4,485.00
C77.1|SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF INTRATHORACIC LYMPH NODES|18,980.00|13,286.00|5,694.00
C77.2|SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF INTRA-ABDOMINAL LYMPH NODES|18,460.00|12,922.00|5,538.00
C77.3|SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF AXILLARY AND UPPER LIMB LYMPH NODES; SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF PECTORAL LYMPH NODES|20,930.00|14,651.00|6,279.00
C77.9|SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF LYMPH NODE, UNSPECIFIED|20,930.00|14,651.00|6,279.00
C78.0|SECONDARY MALIGNANT NEOPLASM OF LUNG|18,980.00|13,286.00|5,694.00
C78.1|SECONDARY MALIGNANT NEOPLASM OF MEDIASTINUM|18,980.00|13,286.00|5,694.00
C78.2|SECONDARY MALIGNANT NEOPLASM OF PLEURA; MALIGNANT PLEURAL EFFUSION NOS|18,980.00|13,286.00|5,694.00
C78.3|SECONDARY MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED RESPIRATORY ORGANS|18,980.00|13,286.00|5,694.00
C78.4|SECONDARY MALIGNANT NEOPLASM OF SMALL INTESTINE|18,460.00|12,922.00|5,538.00
C78.5|SECONDARY MALIGNANT NEOPLASM OF LARGE INTESTINE AND RECTUM|18,460.00|12,922.00|5,538.00
C78.6|SECONDARY MALIGNANT NEOPLASM OF RETROPERITONEUM AND PERITONEUM; MALIGNANT ASCITES NOS|18,460.00|12,922.00|5,538.00
C78.7|SECONDARY MALIGNANT NEOPLASM OF LIVER|18,460.00|12,922.00|5,538.00
C78.8|SECONDARY MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED DIGESTIVE ORGANS|18,460.00|12,922.00|5,538.00
C79.0|SECONDARY MALIGNANT NEOPLASM OF KIDNEY AND RENAL PELVIS|18,330.00|12,831.00|5,499.00
C79.1|SECONDARY MALIGNANT NEOPLASM OF BLADDER AND OTHER AND UNSPECIFIED URINARY ORGANS|18,330.00|12,831.00|5,499.00
C79.3|SECONDARY MALIGNANT NEOPLASM OF BRAIN AND CEREBRAL MENINGES|21,970.00|15,379.00|6,591.00
C79.4|SECONDARY MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED PARTS OF NERVOUS SYSTEM|21,970.00|15,379.00|6,591.00
C79.5|SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE MARROW|21,450.00|15,015.00|6,435.00
C79.6|SECONDARY MALIGNANT NEOPLASM OF OVARY|14,820.00|10,374.00|4,446.00
C79.7|SECONDARY MALIGNANT NEOPLASM OF ADRENAL GLAND|20,930.00|14,651.00|6,279.00
C79.8|SECONDARY MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES|20,930.00|14,651.00|6,279.00
C80|MALIGNANT NEOPLASM WITHOUT SPECIFICATION OF SITE; UNSPECIFIED SITE WHETHER PRIMARY OR SECONDARY [CANCER, CARCINOMA, CARCINOMATOSIS, GENERALIZED CANCER, GENERALIZED MALIGNANCY, MALIGNANCY, MULTIPLE CANCER]; MALIGNANT CACHEXIA; MALIGNANT NEOPLASM OF PRIMARY|20,930.00|14,651.00|6,279.00
C81.0|HODGKIN'S DISEASE (LYMPHOCYTIC PREDOMINANCE); HODGKIN'S DISEASE (LYMPHOCYTIC-HISTIOCYTIC PREDOMINANCE)|18,070.00|12,649.00|5,421.00
C81.1|HODGKIN'S DISEASE( NODULAR SCLEROSIS)|18,070.00|12,649.00|5,421.00
C81.9|HODGKIN'S DISEASE, UNSPECIFIED|18,070.00|12,649.00|5,421.00
C82.0|SMALL CLEAVED CELL, FOLLICULAR NON-HODGKIN'S LYMPHOMA|18,070.00|12,649.00|5,421.00
C82.1|MIXED SMALL CLEAVED NON-HODGKIN'S LYMPHOMA AND LARGE CELL, FOLLICULAR NON-HODGKIN'S LYMPHOMA|18,070.00|12,649.00|5,421.00
C82.2|LARGE CELL, FOLLICULAR NON-HODGKIN'S LYMPHOMA|18,070.00|12,649.00|5,421.00
C82.7|OTHER TYPES OF FOLLICULAR NON-HODGKIN'S LYMPHOMA|18,070.00|12,649.00|5,421.00
C82.9|FOLLICULAR NON-HODGKIN'S LYMPHOMA, UNSPECIFIED; NODULAR NON-HODGKIN'S LYMPHOMA NOS|18,070.00|12,649.00|5,421.00
C83.0|SMALL CELL DIFFUSE NON-HODGKIN'S LYMPHOMA|18,070.00|12,649.00|5,421.00
C83.2|MIXED SMALL AND LARGE CELL DIFFUSE NON-HODGKIN'S LYMPHOMA|18,070.00|12,649.00|5,421.00
C83.3|LARGE CELL DIFFUSE NON-HODGKIN'S LYMPHOMA|18,070.00|12,649.00|5,421.00
C83.4|IMMUNOBLASTIC DIFFUSE NON-HODGKIN'S LYMPHOMA|18,070.00|12,649.00|5,421.00
C83.5|LYMPHOBLASTIC DIFFUSE NON-HODGKIN'S LYMPHOMA|18,070.00|12,649.00|5,421.00
C83.7|BURKITT'S TUMOUR|18,070.00|12,649.00|5,421.00
C83.8|OTHER TYPES OF DIFFUSE NON-HODGKIN'S LYMPHOMA|18,070.00|12,649.00|5,421.00
C83.9|DIFFUSE NON-HODGKIN'S LYMPHOMA, UNSPECIFIED|18,070.00|12,649.00|5,421.00
C84.0|MYCOSIS FUNGOIDES|18,070.00|12,649.00|5,421.00
C84.1|SéZARY'S DISEASE|18,070.00|12,649.00|5,421.00
C84.3|LYMPHOEPITHELIOID LYMPHOMA; LENNERT'S LYMPHOMA|18,070.00|12,649.00|5,421.00
C84.4|PERIPHERAL T-CELL LYMPHOMA|18,070.00|12,649.00|5,421.00
C84.5|OTHER AND UNSPECIFIED T-CELL LYMPHOMAS|18,070.00|12,649.00|5,421.00
C85.0|LYMPHOSARCOMA|18,070.00|12,649.00|5,421.00
C85.1|B-CELL LYMPHOMA, UNSPECIFIED|18,070.00|12,649.00|5,421.00
C85.7|OTHER SPECIFIED TYPES OF NON-HODGKIN'S LYMPHOMA; MALIGNANT  RETICULOENDOTHELIOSIS;  MALIGNANT RETICULOSIS; MICROGLIOMA|18,070.00|12,649.00|5,421.00
C85.9|NON-HODGKIN'S LYMPHOMA, UNSPECIFIED TYPE; LYMPHOMA NOS|18,070.00|12,649.00|5,421.00
C90.0|MULTIPLE MYELOMA; KAHLER'S DISEASE; MYELOMATOSIS|18,070.00|12,649.00|5,421.00
C90.1|PLASMA CELL LEUKAEMIA|18,070.00|12,649.00|5,421.00
C90.2|EXTRAMEDULLARY PLASMACYTOMA; MALIGNANT PLASMA CELL TUMOUR NOS; PLASMACYTOMA NOS ; SOLITARY MYELOMA|18,070.00|12,649.00|5,421.00
C91.0|ACUTE LYMPHOBLASTIC LEUKEMIA; ACUTE LYMPHOCYTIC LEUKEMIA|18,070.00|12,649.00|5,421.00
C91.1|CHRONIC LYMPHOCYTIC LEUKAEMIA|18,070.00|12,649.00|5,421.00
C91.2|SUBACUTE LYMPHOCYTIC LEUKAEMIA|18,070.00|12,649.00|5,421.00
C91.3|PROLYMPHOCYTIC LEUKAEMIA|18,070.00|12,649.00|5,421.00
C91.4|HAIRY-CELL LEUKAEMIA; LEUKAEMIC RETICULOENDOTHELIOSIS|18,070.00|12,649.00|5,421.00
C91.5|ADULT T-CELL LEUKAEMIA|18,070.00|12,649.00|5,421.00
C91.7|OTHER LYMPHOID LEUKAEMIA|18,070.00|12,649.00|5,421.00
C91.9|LYMPHOID LEUKAEMIA, UNSPECIFIED|18,070.00|12,649.00|5,421.00
C92.0|ACUTE MYELOID LEUKAEMIA|18,070.00|12,649.00|5,421.00
C92.1|CHRONIC MYELOID LEUKAEMIA|18,070.00|12,649.00|5,421.00
C92.2|SUBACUTE MYELOID LEUKAEMIA|18,070.00|12,649.00|5,421.00
C92.3|MYELOID SARCOMA; CHLOROMA; GRANULOCYTIC SARCOMA|18,070.00|12,649.00|5,421.00
C92.4|ACUTE PROMYELOCYTIC LEUKAEMIA|18,070.00|12,649.00|5,421.00
C92.5|ACUTE MYELOMONOCYTIC LEUKAEMIA|18,070.00|12,649.00|5,421.00
C92.7|OTHER MYELOID LEUKAEMIA|18,070.00|12,649.00|5,421.00
C92.9|MYELOID LEUKAEMIA, UNSPECIFIED|18,070.00|12,649.00|5,421.00
C93.0|ACUTE MONOCYTIC LEUKAEMIA|18,070.00|12,649.00|5,421.00
C93.1|CHRONIC MONOCYTIC LEUKAEMIA|18,070.00|12,649.00|5,421.00
C93.9|MONOCYTIC LEUKAEMIA, UNSPECIFIED|18,070.00|12,649.00|5,421.00
C94.0|ACUTE ERYTHRAEMIA AND ERYTHROLEUKAEMIA; ACUTE ERYTHRAEMIC MYELOSIS; DI GUGLIELMO'S DISEASE|18,070.00|12,649.00|5,421.00
C94.2|ACUTE MEGAKARYOBLASTIC LEUKAEMIA; ACUTE MEGAKARYOCYTIC LEUKAEMIA|18,070.00|12,649.00|5,421.00
C94.4|ACUTE PANMYELOSIS|18,070.00|12,649.00|5,421.00
C94.5|ACUTE MYELOFIBROSIS|18,070.00|12,649.00|5,421.00
C95.0|ACUTE LEUKAEMIA OF UNSPECIFIED CELL TYPE; BLAST CELL LEUKAEMIA; STEM CELL LEUKAEMIA|18,070.00|12,649.00|5,421.00
C95.1|CHRONIC LEUKAEMIA OF UNSPECIFIED CELL TYPE|18,070.00|12,649.00|5,421.00
C95.2|SUBACUTE LEUKAEMIA OF UNSPECIFIED CELL TYPE|18,070.00|12,649.00|5,421.00
C95.7|OTHER LEUKAEMIA OF UNSPECIFIED CELL TYPE|18,070.00|12,649.00|5,421.00
C95.9|LEUKAEMIA, UNSPECIFIED|18,070.00|12,649.00|5,421.00
C96.0|LETTERER-SIWE DISEASE; NONLIPID RETICULOENDOTHELIOSIS; NONLIPID RETICULOSIS|18,070.00|12,649.00|5,421.00
C96.1|MALIGNANT HISTIOCYTOSIS; HISTIOCYTIC MEDULLARY RETICULOSIS|18,070.00|12,649.00|5,421.00
C96.2|MALIGNANT MAST CELL TUMOUR; MALIGNANT MASTOCYTOMA; MALIGNANT MASTOCYTOSIS; MAST CELL SARCOMA|18,070.00|12,649.00|5,421.00
C96.7|OTHER SPECIFIED MALIGNANT NEOPLASMS OF LYMPHOID, HAEMATOPOIETIC AND RELATED TISSUE|18,070.00|12,649.00|5,421.00
C96.9|MALIGNANT NEOPLASM OF LYMPHOID, HAEMATOPOIETIC AND RELATED TISSUE, UNSPECIFIED|18,070.00|12,649.00|5,421.00
D10.0|BENIGN NEOPLASM OF LIP; BENIGN NEOPLASM OF FRENULUM OF LIP; BENIGN NEOPLASM OF INNER ASPECT OF LIP; BENIGN NEOPLASM OF MUCOSA OF LIP; VERMILION BORDER OF LIP|12,350.00|8,645.00|3,705.00
D10.1|BENIGN NEOPLASM OF TONGUE;BENIGN NEOPLASM OF LINGUAL TONSIL|12,350.00|8,645.00|3,705.00
D10.3|BENIGN NEOPLASM OF OTHER AND UNSPECIFIED PARTS OF MOUTH;  BENIGN NEOPLASM OF MINOR SALIVARY GLAND NOS|12,350.00|8,645.00|3,705.00
D10.6|BENIGN NEOPLASM OF NASOPHARYNX; BENIGN NEOPLASM OF PHARYNGEAL TONSIL; BENIGN NEOPLASM OF POSTERIOR MARGIN OF SEPTUM AND CHOANAE|12,350.00|8,645.00|3,705.00
D10.7|BENIGN NEOPLASM OF HYPOPHARYNX|12,350.00|8,645.00|3,705.00
D10.9|BENIGN NEOPLASM OF PHARYNX, UNSPECIFIED|12,350.00|8,645.00|3,705.00
D11.0|BENIGN NEOPLASM OF PAROTID GLAND|12,350.00|8,645.00|3,705.00
D11.7|BENIGN NEOPLASM OF OTHER MAJOR SALIVARY GLANDS|12,350.00|8,645.00|3,705.00
D11.9|BENIGN NEOPLASM OF MAJOR SALIVARY GLAND, UNSPECIFIED|12,350.00|8,645.00|3,705.00
D12.0|BENIGN NEOPLASM OF CAECUM;BENIGN NEOPLASM OF ILEOCAECAL VALVE|11,310.00|7,917.00|3,393.00
D12.1|BENIGN NEOPLASM OF APPENDIX|11,310.00|7,917.00|3,393.00
D12.3|BENIGN NEOPLASM OF TRANSVERSE COLON; BENIGN NEOPLASM OF HEPATIC FLEXURE; BENIGN NEOPLASM OF SPLENIC FLEXURE|11,310.00|7,917.00|3,393.00
D12.4|BENIGN NEOPLASM OF DESCENDING COLON|11,310.00|7,917.00|3,393.00
D12.5|BENIGN NEOPLASM OF SIGMOID COLON|11,310.00|7,917.00|3,393.00
D12.6|BENIGN NEOPLASM OF COLON, UNSPECIFIED; ADENOMATOSIS OF COLON; BENIGN NEOPLASM OF LARGE INTESTINE NOS; HEREDITARY POLYPOSIS OF COLON|11,310.00|7,917.00|3,393.00
D12.7|BENIGN NEOPLASM OF RECTOSIGMOID JUNCTION; ADENOMATOSIS OF COLON;  BENIGN NEOPLASM OF LARGE INTESTINE NOS; HEREDITARY POLYPOSIS OF COLON|11,310.00|7,917.00|3,393.00
D12.8|BENIGN NEOPLASM OF RECTUM|11,310.00|7,917.00|3,393.00
D12.9|BENIGN NEOPLASM OF ANUS AND ANAL CANAL|11,310.00|7,917.00|3,393.00
D13.0|BENIGN NEOPLASM OF OESOPHAGUS|11,310.00|7,917.00|3,393.00
D13.1|BENIGN NEOPLASM OF STOMACH|11,310.00|7,917.00|3,393.00
D13.2|BENIGN NEOPLASM OF DUODENUM|11,310.00|7,917.00|3,393.00
D13.3|BENIGN NEOPLASM OF OTHER AND UNSPECIFIED PARTS OF SMALL INTESTINE|11,310.00|7,917.00|3,393.00
D13.4|BENIGN NEOPLASM OF LIVER; BENIGN NEOPLASM OF INTRAHEPATIC BILE DUCTS|11,310.00|7,917.00|3,393.00
D13.5|BENIGN NEOPLASM OF EXTRAHEPATIC BILE DUCTS|11,310.00|7,917.00|3,393.00
D13.6|BENIGN NEOPLASM OF PANCREAS|11,310.00|7,917.00|3,393.00
D13.7|BENIGN NEOPLASM OF ENDOCRINE PANCREAS; BENIGN NEOPLASM OF ISLET CELL TUMOUR; BENIGN NEOPLASM OF ISLETS OF LANGERHANS|11,310.00|7,917.00|3,393.00
D13.9|BENIGN NEOPLASM OF ILL-DEFINED SITES WITHIN THE DIGESTIVE SYSTEM; BENIGN NEOPLASM OF  DIGESTIVE SYSTEM NOS; BENIGN NEOPLASM OF INTESTINE NOS; BENIGN NEOPLASM OF SPLEEN|11,310.00|7,917.00|3,393.00
D14.1|BENIGN NEOPLASM OF LARYNX;  BENIGN NEOPLASM OF SUPRAHYOID PORTION OF EPIGLOTTIS|12,350.00|8,645.00|3,705.00
D14.2|BENIGN NEOPLASM OF TRACHEA|12,350.00|8,645.00|3,705.00
D14.3|BENIGN NEOPLASM OF BRONCHUS AND LUNG|13,130.00|9,191.00|3,939.00
D14.4|BENIGN NEOPLASM OF RESPIRATORY SYSTEM, UNSPECIFIED|13,130.00|9,191.00|3,939.00
D15.0|BENIGN NEOPLASM OF THYMUS|13,130.00|9,191.00|3,939.00
D15.1|BENIGN NEOPLASM OF HEART|13,130.00|9,191.00|3,939.00
D15.2|BENIGN NEOPLASM OF MEDIASTINUM|13,130.00|9,191.00|3,939.00
D15.9|BENIGN NEOPLASM OF INTRATHORACIC ORGAN, UNSPECIFIED|13,130.00|9,191.00|3,939.00
D16.0|BENIGN NEOPLASM OF SCAPULA AND LONG BONES OF UPPER LIMB|13,650.00|9,555.00|4,095.00
D16.1|BENIGN NEOPLASM OF SHORT BONES OF UPPER LIMB|13,650.00|9,555.00|4,095.00
D16.2|BENIGN NEOPLASM OFLONG BONES OF LOWER LIMB|13,650.00|9,555.00|4,095.00
D16.3|BENIGN NEOPLASM OF SHORT BONES OF LOWER LIMB|13,650.00|9,555.00|4,095.00
D16.4|BENIGN NEOPLASM OF BONES OF SKULL AND FACE; BENIGN NEOPLASM OF  SUPERIOR MAXILLA; BENIGN NEOPLASM OF ORBITAL BONE|13,650.00|9,555.00|4,095.00
D16.5|BENIGN NEOPLASM OF LOWER JAW BONE|13,650.00|9,555.00|4,095.00
D16.6|BENIGN NEOPLASM OF VERTEBRAL COLUMN|13,650.00|9,555.00|4,095.00
D16.7|BENIGN NEOPLASM OF RIBS, STERNUM AND CLAVICLE|13,650.00|9,555.00|4,095.00
D16.8|BENIGN NEOPLASM OF PELVIC BONES, SACRUM AND COCCYX|13,650.00|9,555.00|4,095.00
D16.9|BENIGN NEOPLASM OF BONE AND ARTICULAR CARTILAGE, UNSPECIFIED|13,650.00|9,555.00|4,095.00
D17.4|BENIGN LIPOMATOUS NEOPLASM OF INTRATHORACIC ORGANS|13,130.00|9,191.00|3,939.00
D17.5|BENIGN LIPOMATOUS NEOPLASM OF INTRA-ABDOMINAL ORGANS|11,310.00|7,917.00|3,393.00
D17.6|BENIGN LIPOMATOUS NEOPLASM OF SPERMATIC CORD|11,310.00|7,917.00|3,393.00
D17.7|BENIGN LIPOMATOUS NEOPLASM OF OTHER SITES; BENIGN LIPOMATOUS NEOPLASM OF PERITONEUM;  BENIGN LIPOMATOUS NEOPLASM OF RETROPERITONEUM|11,310.00|7,917.00|3,393.00
D18.0|HAEMANGIOMA, ANY SITE; ANGIOMA NOS|11,700.00|8,190.00|3,510.00
D18.1|LYMPHANGIOMA, ANY SITE|11,700.00|8,190.00|3,510.00
D20.0|BENIGN NEOPLASM OF OF SOFT TISSUE OF RETROPERITONEUM|11,310.00|7,917.00|3,393.00
D20.1|BENIGN NEOPLASM OF OF SOFT TISSUE OF PERITONEUM|11,310.00|7,917.00|3,393.00
D21.3|BENIGN NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF THORAX; BENIGN NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF  AXILLA; BENIGN NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF DIAPHRAGM; BENIGN NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF GREAT V|13,130.00|9,191.00|3,939.00
D21.4|BENIGN NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF ABDOMEN|11,310.00|7,917.00|3,393.00
D25.0|SUBMUCOUS LEIOMYOMA OF UTERUS|12,480.00|8,736.00|3,744.00
D25.1|INTRAMURAL LEIOMYOMA OF UTERUS|12,480.00|8,736.00|3,744.00
D25.2|SUBSEROSAL LEIOMYOMA OF UTERUS|12,480.00|8,736.00|3,744.00
D25.9|LEIOMYOMA OF UTERUS, UNSPECIFIED|12,480.00|8,736.00|3,744.00
D26.0|OTHER BENIGN NEOPLASM OF CERVIX UTERI|12,480.00|8,736.00|3,744.00
D26.1|OTHER BENIGN NEOPLASM OF CORPUS UTERI|12,480.00|8,736.00|3,744.00
D26.7|OTHER BENIGN NEOPLASM OF OTHER PARTS OF UTERUS|12,480.00|8,736.00|3,744.00
D26.9|OTHER BENIGN NEOPLASM OF UTERUS, UNSPECIFIED|12,480.00|8,736.00|3,744.00
D27|BENIGN NEOPLASM OF OVARY|12,480.00|8,736.00|3,744.00
D28.0|BENIGN NEOPLASM OF VULVA|12,480.00|8,736.00|3,744.00
D28.1|BENIGN NEOPLASM OF VAGINA|12,480.00|8,736.00|3,744.00
D28.2|BENIGN NEOPLASM OF UTERINE TUBES AND LIGAMENTS; BENIGN NEOPLASM OF FALLOPIAN TUBES; BENIGN NEOPLASM OF UTERINE BROAD LIGAMENT; BENIGN NEOPLASM OF UTERINE ROUND LIGAMENT|12,480.00|8,736.00|3,744.00
D28.7|BENIGN NEOPLASM OF OTHER SPECIFIED FEMALE GENITAL ORGANS|12,480.00|8,736.00|3,744.00
D28.9|BENIGN NEOPLASM OF FEMALE GENITAL ORGAN, UNSPECIFIED|12,480.00|8,736.00|3,744.00
D29.0|BENIGN NEOPLASM OF PENIS|10,010.00|7,007.00|3,003.00
D29.1|BENIGN NEOPLASM OF PROSTATE|10,010.00|7,007.00|3,003.00
D29.2|BENIGN NEOPLASM OF TESTIS|10,010.00|7,007.00|3,003.00
D29.4|BENIGN NEOPLASM OF SCROTUM; BENIGN NEOPLASM OF SKIN OF SCROTUM|10,010.00|7,007.00|3,003.00
D30.0|BENIGN NEOPLASM OF KIDNEY|10,790.00|7,553.00|3,237.00
D30.1|BENIGN NEOPLASM OF RENAL PELVIS|10,790.00|7,553.00|3,237.00
D30.3|BENIGN NEOPLASM OF BLADDER; BENIGN NEOPLASM OF URETHRAL ORIFICE OF BLADDER; BENIGN NEOPLASM OF URETERIC ORIFICE OF BLADDER|10,790.00|7,553.00|3,237.00
D30.4|BENIGN NEOPLASM OF URETHRA|10,790.00|7,553.00|3,237.00
D30.9|BENIGN NEOPLASM OF URINARY ORGAN, UNSPECIFIED; BENIGN NEOPLASM OF URINARY SYSTEM NOS|10,790.00|7,553.00|3,237.00
D32.0|BENIGN NEOPLASM OF CEREBRAL MENINGES|19,240.00|13,468.00|5,772.00
D32.1|BENIGN NEOPLASM OF SPINAL MENINGES|19,240.00|13,468.00|5,772.00
D32.9|BENIGN NEOPLASM OF MENINGES, UNSPECIFIED; MENINGIOMA NOS|19,240.00|13,468.00|5,772.00
D33.0|BENIGN NEOPLASM OF BRAIN, SUPRATENTORIAL; BENIGN NEOPLASM OF CEREBRAL VENTRICLE; BENIGN NEOPLASM OF CEREBRUM; BENIGN NEOPLASM OF FRONTAL LOBE; BENIGN NEOPLASM OF OCCIPITAL LOBE; BENIGN NEOPLASM OF PARIETAL LOBE; BENIGN NEOPLASM OF TEMPORAL LOBE|19,240.00|13,468.00|5,772.00
D33.1|BENIGN NEOPLASM OF BRAIN, INFRATENTORIAL; BENIGN NEOPLASM OF BRAIN STEM; BENIGN NEOPLASM OF CEREBELLUM; BENIGN NEOPLASM OF FOURTH VENTRICLE|19,240.00|13,468.00|5,772.00
D33.2|BENIGN NEOPLASM OF BRAIN, UNSPECIFIED|19,240.00|13,468.00|5,772.00
D33.3|BENIGN NEOPLASM OF CRANIAL NERVES; BENIGN NEOPLASM OF OLFACTORY BULB|19,240.00|13,468.00|5,772.00
D33.4|BENIGN NEOPLASM OF SPINAL CORD|19,240.00|13,468.00|5,772.00
D33.7|BENIGN NEOPLASM OF OTHER SPECIFIED PARTS OF CENTRAL NERVOUS SYSTEM|19,240.00|13,468.00|5,772.00
D33.9|BENIGN NEOPLASM OF CENTRAL NERVOUS SYSTEM, UNSPECIFIED; CENTRAL NERVOUS SYSTEM NOS|19,240.00|13,468.00|5,772.00
D34|BENIGN NEOPLASM OF THYROID GLAND|15,600.00|10,920.00|4,680.00
D35.0|BENIGN NEOPLASM OF ADRENAL GLAND|15,600.00|10,920.00|4,680.00
D35.1|BENIGN NEOPLASM OF PARATHYROID GLAND|15,600.00|10,920.00|4,680.00
D35.2|BENIGN NEOPLASM OF PITUITARY GLAND|15,600.00|10,920.00|4,680.00
D35.3|BENIGN NEOPLASM OF CRANIOPHARYNGEAL DUCT|15,600.00|10,920.00|4,680.00
D35.4|BENIGN NEOPLASM OF PINEAL GLAND|15,600.00|10,920.00|4,680.00
D35.9|BENIGN NEOPLASM OF ENDOCRINE GLAND, UNSPECIFIED|15,600.00|10,920.00|4,680.00
D36.1|BENIGN NEOPLASM OF PERIPHERAL NERVES AND AUTONOMIC NERVOUS SYSTEM|19,240.00|13,468.00|5,772.00
D37.0|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF LIP, ORAL CAVITY AND PHARYNX; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF  ARYEPIGLOTTIC FOLD NOS; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF HYPOPHARYNGEAL ASPECT OF ARYEPIGLOTTIC FOLD ; NEOPLASM OF UN|15,860.00|11,102.00|4,758.00
D37.1|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF STOMACH|15,860.00|11,102.00|4,758.00
D37.2|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF SMALL INTESTINE|15,860.00|11,102.00|4,758.00
D37.3|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF APPENDIX|15,860.00|11,102.00|4,758.00
D37.4|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF COLON|15,860.00|11,102.00|4,758.00
D37.5|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF RECTUM; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF RECTOSIGMOID JUNCTION|15,860.00|11,102.00|4,758.00
D37.6|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF LIVER, GALLBLADDER AND BILE DUCTS; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF  AMPULLA OF VATER|15,860.00|11,102.00|4,758.00
D37.7|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF OTHER DIGESTIVE ORGANS; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF ANAL CANAL; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF ANAL SPHINCTER;  NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF ANUS NOS; NEOPLASM|15,860.00|11,102.00|4,758.00
D37.9|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF DIGESTIVE ORGAN, UNSPECIFIED|15,860.00|11,102.00|4,758.00
D38.0|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF LARYNX; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF LARYNGEAL ASPECT OF ARYEPIGLOTTIC FOLD; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF  SUPRAHYOID PORTION OF EPIGLOTTIS|15,860.00|11,102.00|4,758.00
D38.1|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF TRACHEA, BRONCHUS AND LUNG|15,860.00|11,102.00|4,758.00
D38.2|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF PLEURA|15,860.00|11,102.00|4,758.00
D38.3|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF MEDIASTINUM|15,860.00|11,102.00|4,758.00
D38.4|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF THYMUS|15,860.00|11,102.00|4,758.00
D38.5|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF OTHER RESPIRATORY ORGANS; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF  ACCESSORY SINUSES; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF CARTILAGE OF NOSE; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF MIDDLE|15,860.00|11,102.00|4,758.00
D38.6|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF RESPIRATORY ORGAN, UNSPECIFIED|15,860.00|11,102.00|4,758.00
D39.0|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF UTERUS|15,860.00|11,102.00|4,758.00
D39.1|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF OVARY|15,860.00|11,102.00|4,758.00
D39.2|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF PLACENTA; CHORIOADENOMA DESTRUENS; INVASIVE HYDATIDIFORM MOLE; MALIGNANT HYDATIDIFORM MOLE|15,860.00|11,102.00|4,758.00
D39.7|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF OTHER FEMALE GENITAL ORGANS; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF  SKIN OF FEMALE GENITAL ORGANS|15,860.00|11,102.00|4,758.00
D39.9|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF FEMALE GENITAL ORGAN, UNSPECIFIED|15,860.00|11,102.00|4,758.00
D40.0|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF PROSTATE|15,860.00|11,102.00|4,758.00
D40.1|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF TESTIS|15,860.00|11,102.00|4,758.00
D40.7|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF OTHER MALE GENITAL ORGANS; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF  SKIN OF MALE GENITAL ORGANS|15,860.00|11,102.00|4,758.00
D40.9|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF MALE GENITAL ORGAN, UNSPECIFIED|15,860.00|11,102.00|4,758.00
D41.0|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF KIDNEY|15,860.00|11,102.00|4,758.00
D41.1|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF RENAL PELVIS|15,860.00|11,102.00|4,758.00
D41.2|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF URETER|15,860.00|11,102.00|4,758.00
D41.3|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF URETHRA|15,860.00|11,102.00|4,758.00
D41.4|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF BLADDER|15,860.00|11,102.00|4,758.00
D41.9|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF URINARY ORGAN, UNSPECIFIED|15,860.00|11,102.00|4,758.00
D42.0|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF CEREBRAL MENINGES|15,860.00|11,102.00|4,758.00
D42.1|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF SPINAL MENINGES|15,860.00|11,102.00|4,758.00
D42.9|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF MENINGES, UNSPECIFIED|15,860.00|11,102.00|4,758.00
D43.0|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF BRAIN, SUPRATENTORIAL; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF CEREBRAL VENTRICLE; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF CEREBRUM; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF FRONTAL LOBE; NEOP|15,860.00|11,102.00|4,758.00
D43.1|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF BRAIN, INFRATENTORIAL; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF BRAIN STEM; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF CEREBELLUM; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF FOURTH VENTRICLE|15,860.00|11,102.00|4,758.00
D43.2|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF BRAIN, UNSPECIFIED|15,860.00|11,102.00|4,758.00
D43.3|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF CRANIAL NERVES|15,860.00|11,102.00|4,758.00
D43.4|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF SPINAL CORD|15,860.00|11,102.00|4,758.00
D43.7|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF OTHER PARTS OF CENTRAL NERVOUS SYSTEM|15,860.00|11,102.00|4,758.00
D43.9|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF CENTRAL NERVOUS SYSTEM, UNSPECIFIED; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF  CENTRAL NERVOUS SYSTEM NOS|15,860.00|11,102.00|4,758.00
D44.0|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF THYROID GLAND|15,860.00|11,102.00|4,758.00
D44.1|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF ADRENAL GLAND|15,860.00|11,102.00|4,758.00
D44.2|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF PARATHYROID GLAND|15,860.00|11,102.00|4,758.00
D44.3|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF PITUITARY GLAND|15,860.00|11,102.00|4,758.00
D44.4|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF CRANIOPHARYNGEAL DUCT|15,860.00|11,102.00|4,758.00
D44.5|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF PINEAL GLAND|15,860.00|11,102.00|4,758.00
D44.6|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF CAROTID BODY|15,860.00|11,102.00|4,758.00
D44.7|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF AORTIC BODY AND OTHER PARAGANGLIA|15,860.00|11,102.00|4,758.00
D44.8|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF PLURIGLANDULAR INVOLVEMENT; MULTIPLE ENDOCRINE ADENOMATOSIS|15,860.00|11,102.00|4,758.00
D44.9|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF ENDOCRINE GLAND, UNSPECIFIED|15,860.00|11,102.00|4,758.00
D45|POLYCYTHAEMIA VERA|15,860.00|11,102.00|4,758.00
D46|MYELODYSPLASTIC SYNDROMES|15,860.00|11,102.00|4,758.00
D46.7|OTHER MYELODYSPLASTIC SYNDROMES|15,860.00|11,102.00|4,758.00
D46.9|MYELODYSPLASTIC SYNDROME, UNSPECIFIED; MYELODYSPLASTIC SYNDROME NOS; MYELODYSPLASIA NOS; PRELEUKAEMIA SYNDROME NOS|15,860.00|11,102.00|4,758.00
D47.0|HISTIOCYTIC AND MAST CELL TUMOURS OF UNCERTAIN AND UNKNOWN BEHAVIOUR; MAST CELL TUMOUR NOS; MASTOCYTOMA NOS|15,860.00|11,102.00|4,758.00
D47.1|CHRONIC MYELOPROLIFERATIVE DISEASE; MYELOFIBROSIS WITH MYELOID METAPLASIA; MYELOPROLIFERATIVE DISEASE, UNSPECIFIED; MEGAKARYOCYTIC MYELOSCLEROSIS  WITH MYELOID METAPLASIA|15,860.00|11,102.00|4,758.00
D47.2|MONOCLONAL GAMMOPATHY|15,860.00|11,102.00|4,758.00
D47.3|ESSENTIAL THROMBOCYTHAEMIA; HAEMORRHAGIC THROMBOCYTHAEMIA; IDIOPATHIC HAEMORRHAGIC THROMBOCYTHAEMIA|15,860.00|11,102.00|4,758.00
D47.7|OTHER SPECIFIED NEOPLASMS OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF LYMPHOID, HAEMATOPOIETIC AND RELATED TISSUE|15,860.00|11,102.00|4,758.00
D47.9|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF LYMPHOID, HAEMATOPOIETIC AND RELATED TISSUE, UNSPECIFIED; LYMPHOPROLIFERATIVE DISEASE NOS|15,860.00|11,102.00|4,758.00
D48.0|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF BONE AND ARTICULAR CARTILAGE|15,860.00|11,102.00|4,758.00
D48.1|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF CONNECTIVE AND OTHER SOFT TISSUE; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF CONNECTIVE TISSUE OF  EAR; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF  EYELID|15,860.00|11,102.00|4,758.00
D48.2|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF PERIPHERAL NERVES AND AUTONOMIC NERVOUS SYSTEM|15,860.00|11,102.00|4,758.00
D48.3|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF RETROPERITONEUM|15,860.00|11,102.00|4,758.00
D48.4|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF PERITONEUM|15,860.00|11,102.00|4,758.00
D48.6|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF BREAST; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF CONNECTIVE TISSUE OF BREAST; CYSTOSARCOMA PHYLLODES|15,860.00|11,102.00|4,758.00
D48.7|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF OTHER SPECIFIED SITES; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF EYE; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF HEART; NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF PERIPHERAL NERVES OF ORBIT|15,860.00|11,102.00|4,758.00
D48.9|NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR, UNSPECIFIED; "GROWTH" NOS ; NEOPLASM NOS; NEW GROWTH NOS; TUMOUR NOS|15,860.00|11,102.00|4,758.00
D50.0|IRON DEFICIENCY ANAEMIA SECONDARY TO BLOOD LOSS (CHRONIC); POSTHAEMORRHAGIC ANAEMIA (CHRONIC)|13,000.00|9,100.00|3,900.00
D50.1|SIDEROPENIC DYSPHAGIA; KELLY-PATERSON SYNDROME; PLUMMER-VINSON SYNDROME|13,000.00|9,100.00|3,900.00
D50.8|OTHER IRON DEFICIENCY ANAEMIAS|13,000.00|9,100.00|3,900.00
D50.9|IRON DEFICIENCY ANAEMIA, UNSPECIFIED|13,000.00|9,100.00|3,900.00
D51.0|VITAMIN B12 DEFICIENCY ANAEMIA DUE TO INTRINSIC FACTOR DEFICIENCY;  ADDISON ANAEMIA; BIERMER ANAEMIA; CONGENITALPERNICIOUS  ANAEMIA; CONGENITAL INTRINSIC FACTOR DEFICIENCY|13,000.00|9,100.00|3,900.00
D51.8|OTHER VITAMIN B12 DEFICIENCY ANAEMIAS|13,000.00|9,100.00|3,900.00
D51.9|VITAMIN B12 DEFICIENCY ANAEMIA, UNSPECIFIED|13,000.00|9,100.00|3,900.00
D52.1|DRUG-INDUCED FOLATE DEFICIENCY ANAEMIA|13,000.00|9,100.00|3,900.00
D52.9|FOLATE DEFICIENCY ANAEMIA, UNSPECIFIED; FOLIC ACID DEFICIENCY ANAEMIA NOS|13,000.00|9,100.00|3,900.00
D53.0|PROTEIN DEFICIENCY ANAEMIA; AMINO-ACID  DEFICIENCY ANAEMIA; OROTACIDURIC ANAEMIA|13,000.00|9,100.00|3,900.00
D53.1|OTHER MEGALOBLASTIC ANAEMIAS, NOT ELSEWHERE CLASSIFIED; MEGALOBLASTIC ANAEMIA NOS|13,000.00|9,100.00|3,900.00
D53.2|SCORBUTIC ANAEMIA|13,000.00|9,100.00|3,900.00
D53.8|OTHER SPECIFIED NUTRITIONAL ANAEMIAS; ANAEMIA ASSOCIATED WITH DEFICIENCY OF COPPER;  ANAEMIA ASSOCIATED WITH DEFICIENCY OF MOLYBDENUM; ANAEMIA ASSOCIATED WITH DEFICIENCY OF  ZINC|13,000.00|9,100.00|3,900.00
D53.9|NUTRITIONAL ANAEMIA, UNSPECIFIED; SIMPLE CHRONIC ANAEMIA|13,000.00|9,100.00|3,900.00
D55.0|ANAEMIA DUE TO GLUCOSE-6-PHOSPHATE DEHYDROGENASE [G6PD] DEFICIENCY; FAVISM; G6PD DEFICIENCY ANAEMIA|13,000.00|9,100.00|3,900.00
D55.1|ANAEMIA DUE TO OTHER DISORDERS OF GLUTATHIONE METABOLISM; ANAEMIA DUE TO ENZYME DEFICIENCIES, EXCEPT G6PD, RELATED TO THE HEXOSE MONOPHOSPHATE [HMP] SHUNT PATHWAY;  ANAEMIA DUE TO HAEMOLYTIC NONSPHEROCYTIC HEREDITARY, TYPE I|13,000.00|9,100.00|3,900.00
D55.2|ANAEMIA DUE TO DISORDERS OF GLYCOLYTIC ENZYMES; HAEMOLYTIC NONSPHEROCYTIC HEREDITARY ANAEMIA, TYPE II;  HEXOKINASE DEFICIENCY ANAEMIA; PYRUVATE KINASE [PK] DEFICIENCY ANAEMIA; TRIOSE-PHOSPHATE ISOMERASE DEFICIENCY ANAEMIA|13,000.00|9,100.00|3,900.00
D55.8|OTHER ANAEMIAS DUE TO ENZYME DISORDERS|13,000.00|9,100.00|3,900.00
D55.9|ANAEMIA DUE TO ENZYME DISORDER, UNSPECIFIED|13,000.00|9,100.00|3,900.00
D56.0|ALPHA THALASSAEMIA|7,280.00|5,096.00|2,184.00
D56.1|BETA THALASSAEMIA; COOLEY'S ANAEMIA; SEVERE BETA THALASSAEMIA; THALASSAEMIA INTERMEDIA; THALASSAEMIA MAJOR;|7,280.00|5,096.00|2,184.00
D56.2|DELTA-BETA THALASSAEMIA|7,280.00|5,096.00|2,184.00
D56.3|THALASSAEMIA TRAIT|7,280.00|5,096.00|2,184.00
D56.4|HEREDITARY PERSISTENCE OF FETAL HAEMOGLOBIN [HPFH]|7,280.00|5,096.00|2,184.00
D56.8|OTHER THALASSAEMIAS|7,280.00|5,096.00|2,184.00
D56.9|MEDITERRANEAN ANAEMIA;  MEDITERRANEAN ANAEMIA WITH OTHER HAEMOGLOBINOPATHY; THALASSAEMIA MINOR WITH OTHER HAEMOGLOBINOPATHY; THALASSAEMIA MIXED WITH OTHER HAEMOGLOBINOPATHY;|13,000.00|9,100.00|3,900.00
D57.0|SICKLE-CELL ANAEMIA WITH CRISIS; HB-SS DISEASE WITH CRISIS|13,000.00|9,100.00|3,900.00
D57.1|SICKLE-CELL ANAEMIA WITHOUT CRISIS; SICKLE-CELL ANAEMIA NOS; SICKLE-CELL  DISEASE NOS ; SICKLE-CELL DISORDER NOS|13,000.00|9,100.00|3,900.00
D57.3|SICKLE-CELL TRAIT; HB-S TRAIT ; HETEROZYGOUS HAEMOGLOBIN S|13,000.00|9,100.00|3,900.00
D57.8|OTHER SICKLE-CELL DISORDERS|13,000.00|9,100.00|3,900.00
D58.0|HEREDITARY SPHEROCYTOSIS; ACHOLURIC (FAMILIAL) JAUNDICE; CONGENITAL (SPHEROCYTIC) HAEMOLYTIC ICTERUS; MINKOWSKI-CHAUFFARD SYNDROME|13,000.00|9,100.00|3,900.00
D58.1|HEREDITARY ELLIPTOCYTOSIS; CONGENITAL ELLIPTOCYTOSIS; CONGENITAL OVALOCYTOSIS; HEREDITARY OVALOCYTOSIS|13,000.00|9,100.00|3,900.00
D58.2|OTHER HAEMOGLOBINOPATHIES; ABNORMAL HAEMOGLOBIN NOS; CONGENITAL HEINZ BODY ANAEMIA; HB-C DISEASE;  HB-C DISEASE;  HB-D DISEASE;  HB-E DISEASE; HAEMOGLOBINOPATHY NOS;  UNSTABLE HAEMOGLOBIN HAEMOLYTIC DISEASE|13,000.00|9,100.00|3,900.00
D58.8|OTHER SPECIFIED HEREDITARY HAEMOLYTIC ANAEMIAS; STOMATOCYTOSIS|13,000.00|9,100.00|3,900.00
D58.9|HEREDITARY HAEMOLYTIC ANAEMIA, UNSPECIFIED; ACQUIRED HAEMOLYTIC ANAEMIA|13,000.00|9,100.00|3,900.00
D59.0|DRUG-INDUCED AUTOIMMUNE HAEMOLYTIC ANAEMIA|13,000.00|9,100.00|3,900.00
D59.1|OTHER AUTOIMMUNE HAEMOLYTIC ANAEMIAS; AUTOIMMUNE HAEMOLYTIC DISEASE,  COLD TYPE; (AUTOIMMUNE HAEMOLYTIC DISEASE, WARM TYPE; CHRONIC COLD HAEMAGGLUTININ DISEASE; COLD AGGLUTININ DISEASE;  COLD AGGLUTININ HAEMOGLOBINURIA;  SECONDARY SYMPTOMATIC HAEMOLYTIC A|13,000.00|9,100.00|3,900.00
D59.2|DRUG-INDUCED NONAUTOIMMUNE HAEMOLYTIC ANAEMIA; DRUG-INDUCED ENZYME DEFICIENCY ANAEMIA|13,000.00|9,100.00|3,900.00
D59.3|HAEMOLYTIC-URAEMIC SYNDROME|26,260.00|18,382.00|7,878.00
D59.4|OTHER NONAUTOIMMUNE HAEMOLYTIC ANAEMIAS; MECHANICAL HAEMOLYTIC ANAEMIA; MICROANGIOPATHIC HAEMOLYTIC ANAEMIA; TOXIC HAEMOLYTIC ANAEMIA|13,000.00|9,100.00|3,900.00
D59.5|PAROXYSMAL NOCTURNAL HAEMOGLOBINURIA [MARCHIAFAVA-MICHELI]|13,000.00|9,100.00|3,900.00
D59.6|HAEMOGLOBINURIA DUE TO HAEMOLYSIS FROM OTHER EXTERNAL CAUSES; HAEMOGLOBINURIA FROM EXERTION; HAEMOGLOBINURIA MARCH; HAEMOGLOBINURIA PAROXYSMAL COLD|13,000.00|9,100.00|3,900.00
D59.8|OTHER ACQUIRED HAEMOLYTIC ANAEMIAS|13,000.00|9,100.00|3,900.00
D59.9|ACQUIRED HAEMOLYTIC ANAEMIA, UNSPECIFIED; CHRONIC IDIOPATHIC HAEMOLYTIC ANAEMIA|13,000.00|9,100.00|3,900.00
D60.0|CHRONIC ACQUIRED PURE RED CELL APLASIA|9,490.00|6,643.00|2,847.00
D60.1|TRANSIENT ACQUIRED PURE RED CELL APLASIA|13,000.00|9,100.00|3,900.00
D60.8|OTHER ACQUIRED PURE RED CELL APLASIAS|9,490.00|6,643.00|2,847.00
D60.9|ACQUIRED PURE RED CELL APLASIA, UNSPECIFIED|9,490.00|6,643.00|2,847.00
D61.0|CONSTITUTIONAL APLASTIC ANAEMIA;  CONGENITAL PURE RED CELL  APLASIA;  PURE RED CELL  APLASIA OF INFANTS; PRIMARY PURE RED CELL  APLASIA; BLACKFAN-DIAMOND SYNDROME; FAMILIAL HYPOPLASTIC ANAEMIA; FANCONI'S ANAEMIA; PANCYTOPENIA WITH MALFORMATIONS|13,000.00|9,100.00|3,900.00
D61.1|DRUG-INDUCED APLASTIC ANAEMIA|13,000.00|9,100.00|3,900.00
D61.2|APLASTIC ANAEMIA DUE TO OTHER EXTERNAL AGENTS|13,000.00|9,100.00|3,900.00
D61.3|IDIOPATHIC APLASTIC ANAEMIA|13,000.00|9,100.00|3,900.00
D61.8|OTHER SPECIFIED APLASTIC ANAEMIAS|13,000.00|9,100.00|3,900.00
D61.9|APLASTIC ANAEMIA, UNSPECIFIED; HYPOPLASTIC ANAEMIA NOS; MEDULLARY HYPOPLASIA; PANMYELOPHTHISIS|13,000.00|9,100.00|3,900.00
D62|ACUTE POSTHAEMORRHAGIC ANAEMIA|13,000.00|9,100.00|3,900.00
D63.0*|ANAEMIA IN NEOPLASTIC DISEASE|13,000.00|9,100.00|3,900.00
D63.8*|ANAEMIA IN OTHER CHRONIC DISEASES CLASSIFIED ELSEWHERE|13,000.00|9,100.00|3,900.00
D64.0|HEREDITARY SIDEROBLASTIC ANAEMIA; SEX-LINKED HYPOCHROMIC SIDEROBLASTIC ANAEMIA|13,000.00|9,100.00|3,900.00
D64.1|SECONDARY SIDEROBLASTIC ANAEMIA DUE TO DISEASE|13,000.00|9,100.00|3,900.00
D64.2|SECONDARY SIDEROBLASTIC ANAEMIA DUE TO DRUGS AND TOXINS|13,000.00|9,100.00|3,900.00
D64.3|OTHER SIDEROBLASTIC ANAEMIAS; SIDEROBLASTIC ANAEMIA NOS;   PYRIDOXINE-RESPONSIVE NEC SIDEROBLASTIC ANAEMIA|13,000.00|9,100.00|3,900.00
D64.4|CONGENITAL DYSERYTHROPOIETIC ANAEMIA; CONGENITAL DYSHAEMATOPOIETIC ANAEMIA|5,200.00|3,640.00|1,560.00
D64.8|OTHER SPECIFIED ANAEMIAS; INFANTILE PSEUDOLEUKAEMIA; LEUKOERYTHROBLASTIC ANAEMIA|13,000.00|9,100.00|3,900.00
D64.9|ANAEMIA, UNSPECIFIED|13,000.00|9,100.00|3,900.00
D65|DISSEMINATED INTRAVASCULAR COAGULATION [DEFIBRINATION SYNDROME]; ACQUIRED AFIBRINOGENAEMIA; CONSUMPTION COAGULOPATHY; DIFFUSE OR DISSEMINATED INTRAVASCULAR COAGULATION [DIC] ;  ACQUIRED FIBRINOLYTIC HAEMORRHAGE; FIBRINOLYTIC PURPURA;  PURPURA FULMINANS;|41,600.00|29,120.00|12,480.00
D66|HEREDITARY FACTOR VIII DEFICIENCY; DEFICIENCY FACTOR VIII (WITH FUNCTIONAL DEFECT); HAEMOPHILIA NOS; HAEMOPHILIA  A;  CLASSICAL HAEMOPHILIA|16,640.00|11,648.00|4,992.00
D67|HEREDITARY FACTOR IX DEFICIENCY; CHRISTMAS DISEASE; FACTOR IX DEFICIENCY (WITH FUNCTIONAL DEFECT); PLASMA THROMBOPLASTIN COMPONENT [PTC] DEFICIENCY; HAEMOPHILIA B|16,640.00|11,648.00|4,992.00
D68.0|VON WILLEBRAND'S DISEASE; ANGIOHAEMOPHILIA; FACTOR VIII DEFICIENCY WITH VASCULAR DEFECT; VASCULAR HAEMOPHILIA|16,640.00|11,648.00|4,992.00
D68.1|HEREDITARY FACTOR XI DEFICIENCY; HAEMOPHILIA C PLASMA THROMOPLASTIN ANTECEDENT [PTA] DEFICIENCY|16,640.00|11,648.00|4,992.00
D68.2|HEREDITARY DEFICIENCY OF OTHER CLOTTING FACTORS; CONGENITAL AFIBRINOGENAEMIA; AC GLOBULIN DEFICIENCY; PROACCELERIN DEFICIENCY; DEFICIENCY OF FACTOR I [FIBRINOGEN];  DEFICIENCY OF FACTOR II [PROTHROMBIN]; DEFICIENCY OF FACTOR  V [LABILE]; DEFICIENCY OF FAC|16,640.00|11,648.00|4,992.00
D68.3|HAEMORRHAGIC DISORDER DUE TO CIRCULATING ANTICOAGULANTS; HAEMORRHAGE DURING LONG TERM USE OF ANTICOAGULANTS; HYPERHEPARINAEMIA; INCREASE IN ANTITHROMBIN; INCREASE IN ANTI-VIIIA; INCREASE IN ANTI-IXA; INCREASE IN ANTI-XA; INCREASE IN ANTI-XIA|16,640.00|11,648.00|4,992.00
D68.4|ACQUIRED COAGULATION FACTOR DEFICIENCY; DEFICIENCY OF COAGULATION FACTOR DUE TO LIVER DISEASE;  DEFICIENCY OF COAGULATION FACTOR DUE TO VITAMIN K DEFICIENCY|16,640.00|11,648.00|4,992.00
D68.8|OTHER SPECIFIED COAGULATION DEFECTS; PRESENCE OF SYSTEMIC LUPUS ERYTHEMATOSUS [SLE] INHIBITOR|16,640.00|11,648.00|4,992.00
D68.9|COAGULATION DEFECT, UNSPECIFIED|16,640.00|11,648.00|4,992.00
D69.0|ALLERGIC PURPURA;  ANAPHYLACTOID  PURPURA; HENOCH(-SCHöNLEIN) PURPURA; NONTHROMBOCYTOPENIC  PURPURA; HAEMORRHAGIC PURPURA; IDIOPATHIC PURPURA; VASCULAR PURPURA; ALLERGICVASCULITIS|16,640.00|11,648.00|4,992.00
D69.1|QUALITATIVE PLATELET DEFECTS; BERNARD-SOULIER [GIANT PLATELET] SYNDROME; GLANZMANN'S DISEASE; GREY PLATELET SYNDROME; HAEMORRHAGIC THROMBOASTHENIA; HEREDITARY THROMBOASTHENIA; THROMBOCYTOPATHY ;|16,640.00|11,648.00|4,992.00
D69.2|OTHER NONTHROMBOCYTOPENIC PURPURA; PURPURA NOS; SENILE PURPURA; SIMPLEX PURPURA|16,640.00|11,648.00|4,992.00
D69.3|IDIOPATHIC THROMBOCYTOPENIC PURPURA; EVANS' SYNDROME|16,640.00|11,648.00|4,992.00
D69.8|OTHER SPECIFIED HAEMORRHAGIC CONDITIONS; HEREDITARY CAPILLARY FRAGILITY; VASCULAR PSEUDOHAEMOPHILIA|16,640.00|11,648.00|4,992.00
D70|AGRANULOCYTOSIS; AGRANULOCYTIC ANGINA; INFANTILE GENETIC AGRANULOCYTOSIS; KOSTMANN'S DISEASE; NEUTROPENIA NOS;  CONGENITAL NEUTROPENIA; CYCLIC NEUTROPENIA; DRUG-INDUCED NEUTROPENIA; PERIODIC NEUTROPENIA;  PRIMARY SPLENIC NEUTROPENIA; TOXIC NEUTROPENIA;|15,730.00|11,011.00|4,719.00
D71|FUNCTIONAL DISORDERS OF POLYMORPHONUCLEAR NEUTROPHILS; CELL MEMBRANE RECEPTOR COMPLEX [CR3] DEFECT; CHRONIC (CHILDHOOD) GRANULOMATOUS DISEASE; CONGENITAL DYSPHAGOCYTOSIS; PROGRESSIVE SEPTIC GRANULOMATOSIS; OTHER DISORDERS OF WHITE BLOOD CELLS|15,730.00|11,011.00|4,719.00
D72.0|GENETIC ANOMALIES OF LEUKOCYTES; ALDER GRANULATION ANOMALY OR SYNDROME; ALDER GRANULOCYTE ANOMALY OR SYNDROME;  MAY-HEGGLIN GRANULATION ANOMALY OR SYNDROME;   MAY-HEGGLIN GRANULOCYTE ANOMALY OR SYNDROME;   PELGER-HUëT GRANULOCYTE ANOMALY OR SYNDROME;  P|15,730.00|11,011.00|4,719.00
D72.8|OTHER SPECIFIED DISORDERS OF WHITE BLOOD CELLS; LYMPHOCYTIC LEUKAEMOID REACTION; MONOCYTIC LEUKAEMOID REACTION; MYELOCYTIC LEUKAEMOID REACTION; LEUKOCYTOSIS;  SYMPTOMATIC LYMPHOCYTOSIS;  LYMPHOPENIA; SYMPTOMATIC MONOCYTOSIS;|15,730.00|11,011.00|4,719.00
D73.2|CHRONIC CONGESTIVE SPLENOMEGALY|15,730.00|11,011.00|4,719.00
D73.3|ABSCESS OF SPLEEN|15,730.00|11,011.00|4,719.00
D73.4|CYST OF SPLEEN|15,730.00|11,011.00|4,719.00
D73.5|INFARCTION OF SPLEEN;  NONTRAUMATIC SPLENIC RUPTURE; TORSION OF SPLEEN|15,730.00|11,011.00|4,719.00
D73.8|OTHER DISEASES OF SPLEEN; FIBROSIS OF SPLEEN NOS; PERISPLENITIS; SPLENITIS NOS|15,730.00|11,011.00|4,719.00
D74.0|CONGENITAL METHAEMOGLOBINAEMIA|5,200.00|3,640.00|1,560.00
D74.9|METHAEMOGLOBINAEMIA, UNSPECIFIED|15,730.00|11,011.00|4,719.00
D75.0|FAMILIAL ERYTHROCYTOSIS; BENIGN POLYCYTHAEMIA; FAMILIAL  POLYCYTHAEMIA|15,730.00|11,011.00|4,719.00
D75.1|SECONDARY POLYCYTHAEMIA;  ACQUIRED POLYCYTHAEMIA DUE TO ERYTHROPOIETIN;  ACQUIRED POLYCYTHAEMIA DUE TO FALL IN PLASMA VOLUME; ACQUIRED POLYCYTHAEMIA DUE TO HIGH ALTITUDE; ACQUIRED POLYCYTHAEMIA DUE TO  STRESS; EMOTIONAL POLYCYTHAEMIA; HYPOXAEMIC POLYCYTHA|15,730.00|11,011.00|4,719.00
D75.2|ESSENTIAL THROMBOCYTOSIS|15,730.00|11,011.00|4,719.00
D75.8|OTHER SPECIFIED DISEASES OF BLOOD AND BLOOD- FORMING ORGANS|15,730.00|11,011.00|4,719.00
D76.0|LANGERHANS' CELL HISTIOCYTOSIS, NOT ELSEWHERE CLASSIFIED|15,730.00|11,011.00|4,719.00
D76.1|HAEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS; EOSINOPHILIC GRANULOMA; HAND-SCHüLLER-CHRISTIAN DISEASE; CHRONIC HISTIOCYTOSIS X|15,730.00|11,011.00|4,719.00
D76.2|HAEMOPHAGOCYTIC SYNDROME, INFECTION-ASSOCIATED|15,730.00|11,011.00|4,719.00
D76.3|OTHER HISTIOCYTOSIS SYNDROMES; RETICULOHISTIOCYTOMA (GIANT-CELL); SINUS HISTIOCYTOSIS WITH MASSIVE LYMPHADENOPATHY; XANTHOGRANULOMA|15,730.00|11,011.00|4,719.00
D80.0|HEREDITARY HYPOGAMMAGLOBULINAEMIA; AUTOSOMAL RECESSIVE AGAMMAGLOBULINAEMIA (SWISS TYPE); X- LINKED AGAMMAGLOBULINAEMIA [BRUTON] (WITH GROWTH HORMONE DEFICIENCY)|15,080.00|10,556.00|4,524.00
D80.2|SELECTIVE DEFICIENCY OF IMMUNOGLOBULIN A [IGA]|15,080.00|10,556.00|4,524.00
D80.7|TRANSIENT HYPOGAMMAGLOBULINAEMIA OF INFANCY|15,080.00|10,556.00|4,524.00
D80.8|OTHER IMMUNODEFICIENCIES WITH PREDOMINANTLY ANTIBODY DEFECTS; KAPPA LIGHT CHAIN DEFICIENCY|15,080.00|10,556.00|4,524.00
D80.9|IMMUNODEFICIENCY WITH PREDOMINANTLY ANTIBODY DEFECTS, UNSPECIFIED|15,080.00|10,556.00|4,524.00
D81.1|SEVERE COMBINED IMMUNODEFICIENCY [SCID] WITH LOW T- AND B-CELL NUMBERS|15,080.00|10,556.00|4,524.00
D81.6|MAJOR HISTOCOMPATIBILITY COMPLEX CLASS I DEFICIENCY; BARE LYMPHOCYTE SYNDROME|15,080.00|10,556.00|4,524.00
D81.9|COMBINED IMMUNODEFICIENCY, UNSPECIFIED; SEVERE COMBINED IMMUNODEFICIENCY DISORDER [SCID] NOS|15,080.00|10,556.00|4,524.00
D82.0|WISKOTT-ALDRICH SYNDROME; IMMUNODEFICIENCY WITH THROMBOCYTOPENIA AND ECZEMA|15,080.00|10,556.00|4,524.00
D82.1|DI GEORGE'S SYNDROME; PHARYNGEAL POUCH SYNDROME; THYMIC  ALYMPHOPLASIA;  THYMIC APLASIA OR HYPOPLASIA WITH IMMUNODEFICIENCY|15,080.00|10,556.00|4,524.00
D82.3|IMMUNODEFICIENCY FOLLOWING HEREDITARY DEFECTIVE RESPONSE TO EPSTEIN-BARR VIRUS; X-LINKED LYMPHOPROLIFERATIVE DISEASE|15,080.00|10,556.00|4,524.00
D82.4|HYPERIMMUNOGLOBULIN E [IGE] SYNDROME|15,080.00|10,556.00|4,524.00
D82.9|IMMUNODEFICIENCY ASSOCIATED WITH MAJOR DEFECT, UNSPECIFIED|15,080.00|10,556.00|4,524.00
D83.0|COMMON VARIABLE IMMUNODEFICIENCY WITH PREDOMINANT ABNORMALITIES OF B-CELL NUMBERS AND FUNCTION|15,080.00|10,556.00|4,524.00
D83.1|COMMON VARIABLE IMMUNODEFICIENCY WITH PREDOMINANT IMMUNOREGULATORY T-CELL DISORDERS|15,080.00|10,556.00|4,524.00
D83.9|COMMON VARIABLE IMMUNODEFICIENCY, UNSPECIFIED|15,080.00|10,556.00|4,524.00
D84.8|OTHER SPECIFIED IMMUNODEFICIENCIES|15,080.00|10,556.00|4,524.00
D84.9|IMMUNODEFICIENCY, UNSPECIFIED|15,080.00|10,556.00|4,524.00
D86.1|SARCOIDOSIS OF LYMPH NODES|15,080.00|10,556.00|4,524.00
D86.8|SARCOIDOSIS OF OTHER AND COMBINED SITES; UVEOPAROTID FEVER [HEERFORDT]|15,080.00|10,556.00|4,524.00
D86.9|SARCOIDOSIS, UNSPECIFIED|15,080.00|10,556.00|4,524.00
D89.0|POLYCLONAL HYPERGAMMAGLOBULINAEMIA; BENIGN HYPERGAMMAGLOBULINAEMIC PURPURA;  POLYCLONAL GAMMOPATHY NOS|15,080.00|10,556.00|4,524.00
D89.1|CRYOGLOBULINAEMIA; ESSENTIAL CRYOGLOBULINAEMIA; IDIOPATHIC CRYOGLOBULINAEMIA; MIXED CRYOGLOBULINAEMIA; PRIMARY CRYOGLOBULINAEMIA; SECONDARY CRYOGLOBULINAEMIA; CRYOGLOBULINAEMIC PURPURA;  CRYOGLOBULINAEMIC  VASCULITIS|15,080.00|10,556.00|4,524.00
D89.2|HYPERGAMMAGLOBULINAEMIA, UNSPECIFIED|15,080.00|10,556.00|4,524.00
D89.8|OTHER SPECIFIED DISORDERS INVOLVING THE IMMUNE MECHANISM, NOT ELSEWHERE CLASSIFIED|15,080.00|10,556.00|4,524.00
D89.9|DISORDER INVOLVING THE IMMUNE MECHANISM, UNSPECIFIED; IMMUNE DISEASE NOS|15,080.00|10,556.00|4,524.00
E00.0|CONGENITAL IODINE-DEFICIENCY SYNDROME, NEUROLOGICAL TYPE; ENDEMIC CRETINISM, NEUROLOGICAL TYPE|12,870.00|9,009.00|3,861.00
E01.0|IODINE-DEFICIENCY-RELATED DIFFUSE (ENDEMIC) GOITRE|10,530.00|7,371.00|3,159.00
E01.1|IODINE-DEFICIENCY-RELATED MULTINODULAR (ENDEMIC) GOITRE; IODINE-DEFICIENCY-RELATED NODULAR GOITRE|10,530.00|7,371.00|3,159.00
E01.2|IODINE-DEFICIENCY-RELATED (ENDEMIC) GOITRE, UNSPECIFIED|10,530.00|7,371.00|3,159.00
E01.8|OTHER IODINE-DEFICIENCY-RELATED THYROID DISORDERS AND ALLIED CONDITIONS|10,530.00|7,371.00|3,159.00
E02|SUBCLINICAL IODINE-DEFICIENCY HYPOTHYROIDISM|10,530.00|7,371.00|3,159.00
E03.0|CONGENITAL HYPOTHYROIDISM WITH DIFFUSE GOITRE; NONTOXIC CONGENITAL GOITRE NOS;  NONTOXIC ONGENITAL PARENCHYMATOUS  GOITRE|12,870.00|9,009.00|3,861.00
E03.1|CONGENITAL HYPOTHYROIDISM WITHOUT GOITRE; APLASIA OF THYROID (WITH MYXOEDEMA); CONGENITAL ATROPHY OF THYROID;  CONGENITAL HYPOTHYROIDISM NOS|12,870.00|9,009.00|3,861.00
E03.2|HYPOTHYROIDISM DUE TO MEDICAMENTS AND OTHER EXOGENOUS SUBSTANCES|10,530.00|7,371.00|3,159.00
E03.5|MYXOEDEMA COMA|10,530.00|7,371.00|3,159.00
E03.8|OTHER SPECIFIED HYPOTHYROIDISM|10,530.00|7,371.00|3,159.00
E03.9|HYPOTHYROIDISM, UNSPECIFIED;|10,530.00|7,371.00|3,159.00
E05.0|THYROTOXICOSIS WITH DIFFUSE GOITRE; EXOPHTHALMIC OR TOXIC GOITRE NOS; GRAVES' DISEASE; TOXIC DIFFUSE GOITRE|11,050.00|7,735.00|3,315.00
E05.1|THYROTOXICOSIS WITH TOXIC SINGLE THYROID NODULE; THYROTOXICOSIS WITH TOXIC UNINODULAR GOITRE|11,050.00|7,735.00|3,315.00
E05.2|THYROTOXICOSIS WITH TOXIC MULTINODULAR GOITRE; TOXIC NODULAR GOITRE NOS|11,050.00|7,735.00|3,315.00
E05.3|THYROTOXICOSIS FROM ECTOPIC THYROID TISSUE|11,050.00|7,735.00|3,315.00
E05.4|THYROTOXICOSIS FACTITIA|11,050.00|7,735.00|3,315.00
E05.5|THYROID CRISIS OR STORM|11,050.00|7,735.00|3,315.00
E05.8|OTHER THYROTOXICOSIS; OVERPRODUCTION OF THYROID- STIMULATING HORMONE|11,050.00|7,735.00|3,315.00
E05.9|THYROTOXICOSIS, UNSPECIFIED; HYPERTHYROIDISM NOS; THYROIDITIS|11,050.00|7,735.00|3,315.00
E06.0|ACUTE THYROIDITIS; ABSCESS OF THYROID;  PYOGENIC THYROIDITIS; SUPPURATIVE THYROIDITIS|11,050.00|7,735.00|3,315.00
E06.1|SUBACUTE THYROIDITIS;  DE QUERVAIN THYROIDITIS; GIANT-CELL THYROIDITIS; GRANULOMATOUS THYROIDITIS; NONSUPPURATIVE THYROIDITIS|11,050.00|7,735.00|3,315.00
E06.2|CHRONIC THYROIDITIS WITH TRANSIENT THYROTOXICOSIS|11,050.00|7,735.00|3,315.00
E06.3|AUTOIMMUNE THYROIDITIS; HASHIMOTO'S THYROIDITIS ; TRANSIENT HASHITOXICOSIS; LYMPHADENOID GOITRE; LYMPHOCYTIC THYROIDITIS; STRUMA LYMPHOMATOSA|11,050.00|7,735.00|3,315.00
E06.5|OTHER CHRONIC THYROIDITIS; CHRONIC THYROIDITIS NOS;  CHRONIC FIBROUS THYROIDITIS; LIGNEOUS THYROIDITIS; RIEDEL THYROIDITIS|11,050.00|7,735.00|3,315.00
E06.9|THYROIDITIS, UNSPECIFIED|11,050.00|7,735.00|3,315.00
E07.0|HYPERSECRETION OF CALCITONIN; C-CELL HYPERPLASIA OF THYROID; HYPERSECRETION OF THYROCALCITONIN|11,050.00|7,735.00|3,315.00
E07.1|DYSHORMOGENETIC GOITRE; FAMILIAL DYSHORMOGENETIC GOITRE; PENDRED'S SYNDROME|11,050.00|7,735.00|3,315.00
E07.8|OTHER SPECIFIED DISORDERS OF THYROID; ABNORMALITY OF THYROID-BINDING GLOBULIN; HAEMORRHAGE OF THYROID; INFARCTION OF THYROID; SICK-EUTHYROID SYNDROME|11,050.00|7,735.00|3,315.00
E10.0|INSULIN-DEPENDENT DIABETES MELLITUS WITH COMA; BRITTLE DIABETES (MELLITUS) WITH COMA; JUVENILE- ONSET DIABETES (MELLITUS) WITHCOMA  ; KETOSIS- PRONE  DIABETES (MELLITUS) WITH COMA; TYPE I DIABETES (MELLITUS) WITH COMA;|20,540.00|14,378.00|6,162.00
E10.1|INSULIN-DEPENDENT DIABETES MELLITUS WITH ACIDIDOSIS/ KETOACIDOSIS WITHOUT MENTION OF COMA; DIABETIC ACIDIDOSIS WITHOUT MENTION OF COMA; DIABETIC KETOACIDOSIS WITHOUT MENTION OF COMA;|20,540.00|14,378.00|6,162.00
E10.2+ N08.3*|INSULIN-DEPENDENT DIABETES MELLITUS WITH RENAL COMPLICATIONS; GLOMERULAR DISORDERS IN DIABETES MELLITUS|16,380.00|11,466.00|4,914.00
E10.5|INSULIN-DEPENDENT DIABETES MELLITUS WITH DIABETIC GANGRENE/ ULCER|16,380.00|11,466.00|4,914.00
E10.6|INSULIN-DEPENDENT DIABETES MELLITUS WITH OTHER SPECIFIED COMPLICATIONS|16,380.00|11,466.00|4,914.00
E10.7|INSULIN-DEPENDENT DIABETES MELLITUS WITH MULTIPLE COMPLICATIONS|16,380.00|11,466.00|4,914.00
E10.8|INSULIN-DEPENDENT DIABETES MELLITUS  WITH UNSPECIFIED COMPLICATIONS|16,380.00|11,466.00|4,914.00
E10.9|INSULIN DEPENDENT DIABETES MELLITUS WITHOUT COMPLICATIONS|5,200.00|3,640.00|1,560.00
E11.0|NON-INSULIN-DEPENDENT DIABETES MELLITUS WITH COMA;  NONOBESE DIABETES (MELLITUS)  WITH COMA ; OBESE DIABETES MELLITUS WITH COMA  ; ADULT-ONSET DIABETES MELLITUS WITH COMA ; MATURITY-ONSET DIABETES MELLITUS WITH COMA ; NONKETOTIC DIABETES MELLITUS WITH COM|20,540.00|14,378.00|6,162.00
E11.1|NON-INSULIN-DEPENDENT DIABETES MELLITUS WITH KETOACIDOSIS WITHOUT MENTION OF COMA; ;  NONOBESE DIABETES (MELLITUS)  WITH KETOACIDOSIS WITHOUT MENTION OF COMA; OBESE DIABETES MELLITUS WITH KETOACIDOSIS WITHOUT MENTION OF COMA; ADULT- ONSET DIABETES MELLITU|20,540.00|14,378.00|6,162.00
E11.2+ N08.3*|NON-INSULIN-DEPENDENT DIABETES MELLITUS WITH RENAL COMPLICATIONS; GLOMERULAR DISORDERS IN DIABETES MELLITUS|16,380.00|11,466.00|4,914.00
E11.5|NON-INSULIN-DEPENDENT DIABETES MELLITUS WITH DIABETIC GANGRENE/ ULCER;  NONOBESE DIABETES (MELLITUS)  WITH  DIABETIC GANGRENE/ ULCER;  OBESE DIABETES MELLITUS WITH DIABETIC GANGRENE/ ULCER; ADULT-ONSET DIABETES MELLITUS WITH DIABETIC GANGRENE/ ULCER;  MAT|16,380.00|11,466.00|4,914.00
E11.6|NON-INSULIN-DEPENDENT DIABETES MELLITUS WITH OTHER SPECIFIED COMPLICATIONS|16,380.00|11,466.00|4,914.00
E11.7|NON-INSULIN-DEPENDENT DIABETES MELLITUS WITH MULTIPLE COMPLICATIONS ;  NONOBESE DIABETES (MELLITUS)  WITH  MULTIPLE COMPLICATIONS ; OBESE DIABETES MELLITUS WITH MULTIPLE COMPLICATIONS   ; ADULT-ONSET DIABETES MELLITUS WITH  MULTIPLE COMPLICATIONS ; MATUR|16,380.00|11,466.00|4,914.00
E11.9|NON-INSULIN-DEPENDENT DIABETES MELLITUS  WITHOUT COMPLICATIONS|5,200.00|3,640.00|1,560.00
E12.0|MALNUTRITION-RELATED DIABETES MELLITUS WITH COMA;  INSULIN-DEPENDENT MALNUTRITION-RELATED DIABETES MELLITUS WITH COMA ; NON-INSULIN- DEPENDENT MALNUTRITION-RELATED DIABETES MELLITUS WITH COMA|20,540.00|14,378.00|6,162.00
E12.2+ N08.3*|MALNUTRITION-RELATED DIABETES; GLOMERULAR DISORDERS IN DIABETES MELLITUS|16,380.00|11,466.00|4,914.00
E12.5|MALNUTRITION-RELATED DIABETES MELLITUS WITH DIABETIC GANGRENE/ ULCER;  INSULIN-DEPENDENT MALNUTRITION-RELATED DIABETES MELLITUS WITH DIABETIC GANGRENE/ ULCER; NON-INSULIN-DEPENDENT MALNUTRITION-RELATED DIABETES MELLITUS WITH DIABETIC GANGRENE/ ULCER|16,380.00|11,466.00|4,914.00
E12.6|MALNUTRITION-RELTAED DIABETES MELLITUS WITH OTHER SPECIFIED COMPLICATIONS|16,380.00|11,466.00|4,914.00
E12.8|MALNUTRITION-RELATED DIABETES MELLITUS WITH UNSPECIFIED  COMPLICATIONS;  INSULIN-DEPENDENT MALNUTRITION-RELATED DIABETES MELLITUS WITH UNSPECIFIED  COMPLICATIONS; NON-INSULIN-DEPENDENT MALNUTRITION-RELATED DIABETES MELLITUS WITH UNSPECIFIED  COMPLICATI|16,380.00|11,466.00|4,914.00
E13.0|OTHER SPECIFIED DIABETES MELLITUS WITH COMA|20,540.00|14,378.00|6,162.00
E13.1|OTHER SPECIFIED DIABETES MELLITUS WITH ACIDIDOSIS/ KETOACIDOSIS WITHOUT MENTION OF COMA|20,540.00|14,378.00|6,162.00
E13.2+ N08.3*|OTHER SPECIFIED DIABETES MELLITUS; GLOMERULAR DISORDERS IN DIABETES MELLITUS|16,380.00|11,466.00|4,914.00
E13.5|OTHER SPECIFIED DIABETES MELLITUS WITH DIABETIC GANGRENE/ ULCER|16,380.00|11,466.00|4,914.00
E13.6|OTHER SPECIFIED DIABETES MELLITUS WITH OTHER SPECIFIED COMPLICATIONS|16,380.00|11,466.00|4,914.00
E14.0|UNSPECIFIED DIABETES MELLITUS; DIABETES NOS WITH COMA|20,540.00|14,378.00|6,162.00
E14.1|UNSPECIFIED DIABETES MELLITUS; DIABETES NOS  WITH ACIDIDOSIS/ KETOACIDOSIS WITHOUT MENTION OF COMA|20,540.00|14,378.00|6,162.00
E14.2+ N08.3*|UNSPECIFIED DIABETES MELLITUS; GLOMERULAR DISORDERS IN DIABETES MELLITUS|16,380.00|11,466.00|4,914.00
E14.5|UNSPECIFIED DIABETES MELLITUS; DIABETES NOS WITH DIABETIC GANGRENE/ ULCER|16,380.00|11,466.00|4,914.00
E14.6|UNSPECIFIED DIABETES MELLITUS WITH OTHER SPECIFIED COMPLICATIONS|16,380.00|11,466.00|4,914.00
E14.7|UNSPECIFIED DIABETES MELLITUS; DIABETES NOS WITH MULTIPLE COMPLICATIONS|16,380.00|11,466.00|4,914.00
E15|NONDIABETIC HYPOGLYCAEMIC COMA; NONDIABETIC HYPOGLYCAEMIC COMA; DRUG-INDUCED INSULIN COMA IN NONDIABETIC; HYPERINSULINISM WITH HYPOGLYCAEMIC COMA; HYPOGLYCAEMIC COMA NOS|10,530.00|7,371.00|3,159.00
E16.0|DRUG-INDUCED HYPOGLYCAEMIA WITHOUT COMA|10,530.00|7,371.00|3,159.00
E16.1|OTHER HYPOGLYCAEMIA; FUNCTIONAL NONHYPERINSULINAEMIC HYPOGLYCAEMIA; HYPERINSULINISM NOS; FUNCTIONAL HYPERINSULINISM; HYPERPLASIA OF PANCREATIC ISLET BETA CELLS NOS; POSTHYPOGLYCAEMIC COMA ENCEPHALOPATHY|10,530.00|7,371.00|3,159.00
E16.2|HYPOGLYCEMIA|5,200.00|3,640.00|1,560.00
E16.3|INCREASED SECRETION OF GLUCAGON; HYPERPLASIA OF PANCREATIC ENDOCRINE CELLS WITH GLUCAGON EXCESS; HYPERPLASIA OF PANCREATIC ENDOCRINE CELLS WITH GLUCAGON EXCESS|10,530.00|7,371.00|3,159.00
E16.4|ABNORMAL SECRETION OF GASTRIN; HYPERGASTRINAEMIA|10,530.00|7,371.00|3,159.00
E16.8|OTHER SPECIFIED DISORDERS OF PANCREATIC INTERNAL SECRETION; INCREASED SECRETION FROM ENDOCRINE PANCREAS OF GROWTH HORMONE-RELEASING HORMONE; INCREASED SECRETION FROM ENDOCRINE PANCREAS OF PANCREATIC POLYPEPTIDE; INCREASED SECRETION FROM ENDOCRINE PANCREA|10,530.00|7,371.00|3,159.00
E16.9|DISORDER OF PANCREATIC INTERNAL SECRETION, UNSPECIFIED; ISLET-CELL HYPERPLASIA NOS; PANCREATIC ENDOCRINE CELL HYPERPLASIA NOS|10,530.00|7,371.00|3,159.00
E20.0|IDIOPATHIC HYPOPARATHYROIDISM|12,090.00|8,463.00|3,627.00
E20.8|OTHER HYPOPARATHYROIDISM|12,090.00|8,463.00|3,627.00
E20.9|HYPOPARATHYROIDISM, UNSPECIFIED; PARATHYROID TETANY|12,090.00|8,463.00|3,627.00
E21.0|PRIMARY HYPERPARATHYROIDISM; HYPERPLASIA OF PARATHYROID; OSTEITIS FIBROSA CYSTICA GENERALISATA [VON RECKLINGHAUSEN'S DISEASE OF BONE]|12,090.00|8,463.00|3,627.00
E21.4|OTHER SPECIFIED DISORDERS OF PARATHYROID GLAND|12,090.00|8,463.00|3,627.00
E21.5|DISORDER OF PARATHYROID GLAND, UNSPECIFIED|12,090.00|8,463.00|3,627.00
E22.2|SYNDROME OF INAPPROPRIATE SECRETION OF ANTIDIURETIC HORMONE|15,340.00|10,738.00|4,602.00
E23.0|HYPOPITUITARISM; FERTILE EUNUCH SYNDROME; HYPOGONADOTROPIC HYPOGONADISM; IDIOPATHIC GROWTH HORMONE DEFICIENCY; ISOLATED DEFICIENCY OF GONADOTROPIN; ISOLATED DEFICIENCY OF GROWTH HORMONE; ISOLATED DEFICIENCY OF PITUITARY HORMONE; KALLMANN'S SYNDROME; LORAI|15,340.00|10,738.00|4,602.00
E23.2|DIABETES INSIPIDUS|13,130.00|9,191.00|3,939.00
E24.0|PITUITARY-DEPENDENT CUSHING'S DISEASE; OVERPRODUCTION OF PITUITARY ACTH; PITUITARY- DEPENDENT HYPERADRENOCORTICISM|12,350.00|8,645.00|3,705.00
E24.1|NELSON'S SYNDROME|12,350.00|8,645.00|3,705.00
E24.2|DRUG-INDUCED CUSHING'S SYNDROME|12,350.00|8,645.00|3,705.00
E24.3|ECTOPIC ACTH SYNDROME|12,350.00|8,645.00|3,705.00
E24.8|OTHER CUSHING'S SYNDROME|12,350.00|8,645.00|3,705.00
E24.9|CUSHING'S SYNDROME, UNSPECIFIED|12,350.00|8,645.00|3,705.00
E25.0|CONGENITAL ADRENOGENITAL DISORDERS ASSOCIATED WITH ENZYME DEFICIENCY; CONGENITAL ADRENAL HYPERPLASIA; 21-HYDROXYLASE DEFICIENCY; SALT- LOSING CONGENITAL ADRENAL HYPERPLASIA|10,140.00|7,098.00|3,042.00
E25.9|ADRENOGENITAL DISORDER, UNSPECIFIED; ADRENOGENITAL SYNDROME NOS|14,170.00|9,919.00|4,251.00
E26.0|PRIMARY HYPERALDOSTERONISM; CONN'S SYNDROME; PRIMARY ALDOSTERONISM DUE TO ADRENAL HYPERPLASIA (BILATERAL)|12,870.00|9,009.00|3,861.00
E26.1|SECONDARY HYPERALDOSTERONISM|12,870.00|9,009.00|3,861.00
E26.8|OTHER HYPERALDOSTERONISM; BARTTER'S SYNDROME|12,870.00|9,009.00|3,861.00
E26.9|HYPERALDOSTERONISM, UNSPECIFIED; OTHER DISORDERS OF ADRENAL GLAND|12,870.00|9,009.00|3,861.00
E27.1|PRIMARY ADRENOCORTICAL INSUFFICIENCY; ADDISON'S DISEASE; AUTOIMMUNE ADRENALITIS|12,870.00|9,009.00|3,861.00
E27.2|ADDISONIAN CRISIS; ADRENAL CRISIS; ADRENOCORTICAL CRISIS|12,870.00|9,009.00|3,861.00
E27.3|DRUG-INDUCED ADRENOCORTICAL INSUFFICIENCY|12,870.00|9,009.00|3,861.00
E27.4|OTHER AND UNSPECIFIED ADRENOCORTICAL INSUFFICIENCY; ADRENAL HAEMORRHAGE;  ADRENAL INFARCTION; ADRENOCORTICAL INSUFFICIENCY NOS; HYPOALDOSTERONISM|12,870.00|9,009.00|3,861.00
E27.8|OTHER SPECIFIED DISORDERS OF ADRENAL GLAND; ABNORMALITY OF CORTISOL-BINDING GLOBULIN|12,870.00|9,009.00|3,861.00
E28.8|OTHER OVARIAN DYSFUNCTION|14,170.00|9,919.00|4,251.00
E29.1|TESTICULAR HYPOFUNCTION; DEFECTIVE BIOSYNTHESIS OF TESTICULAR ANDROGEN NOS; 5-A-REDUCTASE DEFICIENCY (WITH MALE PSEUDOHERMAPHRODITISM); TESTICULAR HYPOGONADISM NOS|14,170.00|9,919.00|4,251.00
E29.9|TESTICULAR DYSFUNCTION, UNSPECIFIED|14,170.00|9,919.00|4,251.00
E31.0|AUTOIMMUNE POLYGLANDULAR FAILURE|14,170.00|9,919.00|4,251.00
E31.1|POLYGLANDULAR HYPERFUNCTION|14,170.00|9,919.00|4,251.00
E31.9|POLYGLANDULAR DYSFUNCTION, UNSPECIFIED|14,170.00|9,919.00|4,251.00
E32.0|PERSISTENT HYPERPLASIA OF THYMUS; HYPERTROPHY OF THYMUS|14,170.00|9,919.00|4,251.00
E32.8|OTHER DISEASES OF THYMUS|14,170.00|9,919.00|4,251.00
E32.9|DISEASE OF THYMUS, UNSPECIFIED|14,170.00|9,919.00|4,251.00
E34.0|CARCINOID SYNDROME|14,170.00|9,919.00|4,251.00
E34.8|OTHER SPECIFIED ENDOCRINE DISORDERS; PINEAL GLAND DYSFUNCTION; PROGERIA|14,170.00|9,919.00|4,251.00
E34.9|ENDOCRINE DISORDER, UNSPECIFIED; ENDOCRINE DISTURBANCE NOS; HORMONE DISTURBANCE NOS|14,170.00|9,919.00|4,251.00
E40|KWASHIORKOR|15,210.00|10,647.00|4,563.00
E41|NUTRITIONAL MARASMUS; SEVERE MALNUTRITION WITH MARASMUS|15,210.00|10,647.00|4,563.00
E42|MARASMIC KWASHIORKOR; SEVERE PROTEIN-ENERGY MALNUTRITION, INTERMEDIATE FORM;  SEVERE PROTEIN- ENERGY MALNUTRITION WITH SIGNS OF BOTH KWASHIORKOR AND MARASMUS|15,210.00|10,647.00|4,563.00
E43|UNSPECIFIED SEVERE PROTEIN-ENERGY MALNUTRITION|15,210.00|10,647.00|4,563.00
E44.0|MODERATE PROTEIN-ENERGY MALNUTRITION|15,210.00|10,647.00|4,563.00
E44.1|MILD PROTEIN-ENERGY MALNUTRITION|15,210.00|10,647.00|4,563.00
E45|RETARDED DEVELOPMENT FOLLOWING PROTEIN-ENERGY MALNUTRITION; NUTRITIONAL  SHORT STATURE; NUTRITIONAL  STUNTING; PHYSICAL RETARDATION DUE TO MALNUTRITION|15,210.00|10,647.00|4,563.00
E46|UNSPECIFIED PROTEIN-ENERGY MALNUTRITION; MALNUTRITION NOS; PROTEIN-ENERGY IMBALANCE NOS|15,210.00|10,647.00|4,563.00
E50.0|VITAMIN A DEFICIENCY WITH CONJUNCTIVAL XEROSIS|11,960.00|8,372.00|3,588.00
E50.1|VITAMIN A DEFICIENCY WITH BITOT'S SPOT AND CONJUNCTIVAL XEROSIS; BITOT'S SPOT IN THE YOUNG CHILD|11,960.00|8,372.00|3,588.00
E50.8|OTHER MANIFESTATIONS OF VITAMIN A DEFICIENCY|11,960.00|8,372.00|3,588.00
E50.9|VITAMIN A DEFICIENCY, UNSPECIFIED; HYPOVITAMINOSIS A NOS|11,960.00|8,372.00|3,588.00
E51.1|DRY BERIBERI|11,960.00|8,372.00|3,588.00
E51.2|WERNICKE'S ENCEPHALOPATHY|11,960.00|8,372.00|3,588.00
E51.8|OTHER MANIFESTATIONS OF THIAMINE DEFICIENCY|11,960.00|8,372.00|3,588.00
E51.9|THIAMINE DEFICIENCY, UNSPECIFIED|11,960.00|8,372.00|3,588.00
E53.1|PYRIDOXINE DEFICIENCY; VITAMIN B6 DEFICIENCY|11,960.00|8,372.00|3,588.00
E53.8|DEFICIENCY OF OTHER SPECIFIED B GROUP VITAMINS; BIOTIN DEFICIENCY; CYANOCOBALAMIN DEFICIENCY; FOLATE DEFICIENCY; FOLIC ACID DEFICIENCY; PANTOTHENIC ACID DEFICIENCY; VITAMIN B12 DEFICIENCY|11,960.00|8,372.00|3,588.00
E53.9|VITAMIN B DEFICIENCY, UNSPECIFIED|11,960.00|8,372.00|3,588.00
E54|ASCORBIC ACID DEFICIENCY; DEFICIENCY OF VITAMIN C; SCURVY|11,960.00|8,372.00|3,588.00
E55.0|RICKETS, ACTIVE; INFANTILE OSTEOMALACIA;  JUVENILE OSTEOMALACIA|11,960.00|8,372.00|3,588.00
E55.9|VITAMIN D DEFICIENCY, UNSPECIFIED; AVITAMINOSIS D|11,960.00|8,372.00|3,588.00
E56.0|DEFICIENCY OF VITAMIN E|11,960.00|8,372.00|3,588.00
E56.1|DEFICIENCY OF VITAMIN K|11,960.00|8,372.00|3,588.00
E56.8|DEFICIENCY OF OTHER VITAMINS|11,960.00|8,372.00|3,588.00
E56.9|VITAMIN DEFICIENCY, UNSPECIFIED|11,960.00|8,372.00|3,588.00
E58|DIETARY CALCIUM DEFICIENCY|11,960.00|8,372.00|3,588.00
E60|DIETARY ZINC DEFICIENCY|11,960.00|8,372.00|3,588.00
E61.1|IRON DEFICIENCY|11,960.00|8,372.00|3,588.00
E61.2|MAGNESIUM DEFICIENCY|11,960.00|8,372.00|3,588.00
E61.6|VANADIUM DEFICIENCY|11,960.00|8,372.00|3,588.00
E61.9|DEFICIENCY OF NUTRIENT ELEMENT, UNSPECIFIED|11,960.00|8,372.00|3,588.00
E63.1|IMBALANCE OF CONSTITUENTS OF FOOD INTAKE|11,960.00|8,372.00|3,588.00
E63.8|OTHER SPECIFIED NUTRITIONAL DEFICIENCIES|11,960.00|8,372.00|3,588.00
E63.9|NUTRITIONAL DEFICIENCY, UNSPECIFIED|11,960.00|8,372.00|3,588.00
E64.8|SEQUELAE OF OTHER NUTRITIONAL DEFICIENCIES|11,440.00|8,008.00|3,432.00
E64.9|SEQUELAE OF UNSPECIFIED NUTRITIONAL DEFICIENCY|11,960.00|8,372.00|3,588.00
E66.2|EXTREME OBESITY WITH ALVEOLAR HYPOVENTILATION; PICKWICKIAN SYNDROME|17,680.00|12,376.00|5,304.00
E67.0|HYPERVITAMINOSIS A|11,960.00|8,372.00|3,588.00
E67.1|HYPERCAROTENAEMIA|11,960.00|8,372.00|3,588.00
E67.3|HYPERVITAMINOSIS D|11,960.00|8,372.00|3,588.00
E70.0|CLASSICAL PHENYLKETONURIA|13,780.00|9,646.00|4,134.00
E70.1|OTHER HYPERPHENYLALANINAEMIAS|13,780.00|9,646.00|4,134.00
E70.2|DISORDERS OF TYROSINE METABOLISM; ALKAPTONURIA; HYPERTYROSINAEMIA; OCHRONOSIS; TYROSINAEMIA; TYROSINOSIS|13,780.00|9,646.00|4,134.00
E70.3|ALBINISM;  OCULARALBINISM; OCULOCUTANEOUS ALBINISM CHEDIAK(-STEINBRINCK)-HIGASHI SYNDROME;  CROSS SYNDROME; HERMANSKY-PUDLAK SYNDROME|13,780.00|9,646.00|4,134.00
E70.8|OTHER DISORDERS OF AROMATIC AMINO-ACID METABOLISM; DISORDERS OF HISTIDINE METABOLISM; DISORDERS OF TRYPTOPHAN METABOLISM|13,780.00|9,646.00|4,134.00
E71.0|MAPLE-SYRUP-URINE DISEASE|13,780.00|9,646.00|4,134.00
E71.1|OTHER DISORDERS OF BRANCHED-CHAIN AMINO-ACID METABOLISM; HYPERLEUCINE-ISOLEUCINAEMIA; HYPERVALINAEMIA; ISOVALERIC ACIDAEMIA; METHYLMALONIC ACIDAEMIA; PROPIONIC ACIDAEMIA|13,780.00|9,646.00|4,134.00
E71.3|DISORDERS OF FATTY-ACID METABOLISM; ADRENOLEUKODYSTROPHY [ADDISON-SCHILDER]; MUSCLE CARNITINE PALMITYLTRANSFERASE DEFICIENCY|13,780.00|9,646.00|4,134.00
E72.0|DISORDERS OF AMINO-ACID TRANSPORT; CYSTINOSIS; CYSTINURIA; FANCONI(-DE TONI)(-DEBRé) SYNDROME; HARTNUP'S DISEASE; LOWE'S SYNDROME|13,780.00|9,646.00|4,134.00
E72.2|DISORDERS OF UREA CYCLE METABOLISM; ARGININAEMIA; ARGININOSUCCINIC ACIDURIA; CITRULLINAEMIA; HYPERAMMONAEMIA|13,780.00|9,646.00|4,134.00
E72.3|DISORDERS OF LYSINE AND HYDROXYLYSINE METABOLISM|13,780.00|9,646.00|4,134.00
E72.5|DISORDERS OF GLYCINE METABOLISM; HYPERHYDROXYPROLINAEMIA; HYPERPROLINAEMIA (TYPE I) , HYPERPROLINAEMIA TYPE II; NON-KETOTIC HYPERGLYCINAEMIA; SARCOSINAEMIA|13,780.00|9,646.00|4,134.00
E73.0|CONGENITAL LACTASE DEFICIENCY|7,540.00|5,278.00|2,262.00
E74.0|GLYCOGEN STORAGE DISEASE; CARDIAC GLYCOGENOSIS; ANDERSEN DISEASE;  CORI DISEASE; FORBES DISEASE; HERS DISEASE; MCARDLE DISEASE; POMPE DISEASE; TAURI DISEASE;  VON GIERKE DISEASE; LIVER PHOSPHORYLASE DEFICIENCY|7,540.00|5,278.00|2,262.00
E74.1|DISORDERS OF FRUCTOSE METABOLISM; ESSENTIAL FRUCTOSURIA; FRUCTOSE-1,6-DIPHOSPHATASE DEFICIENCY; HEREDITARY FRUCTOSE INTOLERANCE|7,540.00|5,278.00|2,262.00
E74.2|DISORDERS OF GALACTOSE METABOLISM; GALACTOKINASE DEFICIENCY; GALACTOSAEMIA|7,540.00|5,278.00|2,262.00
E74.3|OTHER DISORDERS OF INTESTINAL CARBOHYDRATE ABSORPTION; GLUCOSE-GALACTOSE MALABSORPTION; SUCRASE DEFICIENCY|7,540.00|5,278.00|2,262.00
E74.8|OTHER SPECIFIED DISORDERS OF CARBOHYDRATE METABOLISM|7,540.00|5,278.00|2,262.00
E75.2|OTHER SPHINGOLIPIDOSIS;  FABRY(-ANDERSON) DISEASE; GAUCHER  DISEASE; KRABBE DISEASE; NIEMANN-PICK DISEASE; FABER'S SYNDROME; METACHROMATIC LEUKODYSTROPHY; SULFATASE DEFICIENCY|10,530.00|7,371.00|3,159.00
E75.4|NEURONAL CEROID LIPOFUSCINOSIS; BATTEN DISEASE; BIELSCHOWSKY-JANSKY DISEASE; KUFS DISEASE; PIELMEYER-VOGT DISEASE|10,530.00|7,371.00|3,159.00
E75.5|OTHER LIPID STORAGE DISORDERS; CEREBROTENDINOUS CHOLESTEROSIS [VAN BOGAERT-SCHERER-EPSTEIN]; WOLMAN'S DISEASE|10,530.00|7,371.00|3,159.00
E75.6|LIPID STORAGE DISORDER, UNSPECIFIED|10,530.00|7,371.00|3,159.00
E76.0|MUCOPOLYSACCHARIDOSIS, TYPE I; HURLER  SYNDROME; HURLER-SCHEIE SYNDROME;  SCHEIE SYNDROME|14,170.00|9,919.00|4,251.00
E76.1|MUCOPOLYSACCHARIDOSIS, TYPE II; HUNTER'S SYNDROME|14,170.00|9,919.00|4,251.00
E76.2|OTHER MUCOPOLYSACCHARIDOSES; ß-GLUCURONIDASE DEFICIENCY; MUCOPOLYSACCHARIDOSIS, TYPE III; MUCOPOLYSACCHARIDOSIS IV, MUCOPOLYSACCHARIDOSIS VI, MUCOPOLYSACCHARIDOSIS VII; MILD MAROTEAUX-LAMY SYNDROME; SEVERE MAROTEAUX- LAMY SYNDROME; MORQUIO-LIKE SYNDROME;|14,170.00|9,919.00|4,251.00
E76.3|MUCOPOLYSACCHARIDOSIS, UNSPECIFIED|14,170.00|9,919.00|4,251.00
E76.8|OTHER DISORDERS OF GLUCOSAMINOGLYCAN METABOLISM|14,170.00|9,919.00|4,251.00
E77.8|OTHER DISORDERS OF GLYCOPROTEIN METABOLISM|13,780.00|9,646.00|4,134.00
E78.0|PURE HYPERCHOLESTEROLAEMIA; FAMILIAL HYPERCHOLESTEROLAEMIA; FREDRICKSON'S HYPERLIPOPROTEINAEMIA, TYPE IIA; HYPERBETALIPOPROTEINAEMIA; HYPERLIPIDAEMIA, GROUP A; LOW-DENSITY-LIPOPROTEIN-TYPE [LDL] HYPERLIPOPROTEINAEMIA|8,580.00|6,006.00|2,574.00
E78.1|PURE HYPERGLYCERIDAEMIA; ENDOGENOUS HYPERGLYCERIDAEMIA; FREDRICKSON'S HYPERLIPOPROTEINAEMIA, TYPE IV; HYPERLIPIDAEMIA, GROUP B; HYPERPREBETALIPOPROTEINAEMIA'; VERY-LOW- DENSITY-LIPOPROTEIN-TYPE [VLDL] HYPERLIPOPROTEINAEMIA|8,580.00|6,006.00|2,574.00
E78.2|MIXED HYPERLIPIDAEMIA; BROAD- OR FLOATING- BETALIPOPROTEINAEMIA; FREDRICKSON'S HYPERLIPOPROTEINAEMIA, TYPE IIB; FREDRICKSON'S HYPERLIPOPROTEINAEMIA TYPE III; HYPERBETALIPOPROTEINAEMIA WITH PREBETALIPOPROTEINAEMIA; HYPERCHOLESTEROLAEMIA WITH ENDOGENOUS HYPE|8,580.00|6,006.00|2,574.00
E78.3|HYPERCHYLOMICRONAEMIA; FREDRICKSON'S HYPERLIPOPROTEINAEMIA, TYPE I; FREDRICKSON'S HYPERLIPOPROTEINAEMIA, TYPE  V; HYPERLIPIDAEMIA, GROUP D; MIXED HYPERGLYCERIDAEMIA|8,580.00|6,006.00|2,574.00
E78.4|OTHER HYPERLIPIDAEMIA; FAMILIAL COMBINED HYPERLIPIDAEMIA|8,580.00|6,006.00|2,574.00
E78.6|LIPOPROTEIN DEFICIENCY; ABETALIPOPROTEINAEMIA; HIGH-DENSITY LIPOPROTEIN DEFICIENCY; HYPOALPHALIPOPROTEINAEMIA; FAMILIAL HYPOBETALIPOPROTEINAEMIA; LECITHIN CHOLESTEROL ACYLTRANSFERASE DEFICIENCY; TANGIER DISEASE|8,580.00|6,006.00|2,574.00
E78.8|OTHER DISORDERS OF LIPOPROTEIN METABOLISM|8,580.00|6,006.00|2,574.00
E79.8|OTHER DISORDERS OF PURINE AND PYRIMIDINE METABOLISM; HEREDITARY XANTHINURIA|9,100.00|6,370.00|2,730.00
E80.0|HEREDITARY ERYTHROPOIETIC PORPHYRIA; CONGENITAL ERYTHROPOIETIC PORPHYRIA; ERYTHROPOIETIC PROTOPORPHYRIA|12,740.00|8,918.00|3,822.00
E80.2|OTHER PORPHYRIA; HEREDITARY COPROPORPHYRIA PORPHYRIA NOS; ACUTE INTERMITTENT (HEPATIC) PORPHYRIA|12,740.00|8,918.00|3,822.00
E80.4|GILBERT'S SYNDROME|12,740.00|8,918.00|3,822.00
E80.5|CRIGLER-NAJJAR SYNDROME|12,740.00|8,918.00|3,822.00
E80.6|OTHER DISORDERS OF BILIRUBIN METABOLISM; DUBIN- JOHNSON SYNDROME; ROTOR'S SYNDROME|12,740.00|8,918.00|3,822.00
E83.0|DISORDERS OF COPPER METABOLISM; MENKES' KINKY HAIR DISEASE;  MENKES' STEELY HAIR DISEASE; WILSON'S DISEASE|9,490.00|6,643.00|2,847.00
E83.1|DISORDERS OF IRON METABOLISM; HAEMOCHROMATOSIS|9,490.00|6,643.00|2,847.00
E83.2|DISORDERS OF ZINC METABOLISM; ACRODERMATITIS ENTEROPATHICA|9,490.00|6,643.00|2,847.00
E83.3|DISORDERS OF PHOSPHORUS METABOLISM; ACID PHOSPHATASE DEFICIENCY; FAMILIAL HYPOPHOSPHATAEMIA; HYPOPHOSPHATASIA;  VITAMIN-D- RESISTANT OSTEOMALACIA;  VITAMIN-D-RESISTANT RICKETS|9,490.00|6,643.00|2,847.00
E83.4|DISORDERS OF MAGNESIUM METABOLISM; HYPERMAGNESAEMIA; HYPOMAGNESAEMIA|9,490.00|6,643.00|2,847.00
E83.5|DISORDERS OF CALCIUM METABOLISM; FAMILIAL HYPOCALCIURIC HYPERCALCAEMIA; IDIOPATHIC HYPERCALCIURIA|9,490.00|6,643.00|2,847.00
E83.8|OTHER DISORDERS OF MINERAL METABOLISM|9,490.00|6,643.00|2,847.00
E84.0|CYSTIC FIBROSIS WITH PULMONARY MANIFESTATIONS|9,490.00|6,643.00|2,847.00
E84.1|CYSTIC FIBROSIS WITH INTESTINAL MANIFESTATIONS|9,490.00|6,643.00|2,847.00
E84.8|CYSTIC FIBROSIS WITH OTHER MANIFESTATIONS; CYSTIC FIBROSIS WITH COMBINED MANIFESTATIONS|9,490.00|6,643.00|2,847.00
E84.9|CYSTIC FIBROSIS, UNSPECIFIED|9,490.00|6,643.00|2,847.00
E85.8|OTHER AMYLOIDOSIS; LOCALIZED AMYLOIDOSIS|14,430.00|10,101.00|4,329.00
E86.1|MODERATE DEHYDRATION|5,200.00|3,640.00|1,560.00
E86.2|SEVERE DEHYDRATION|5,200.00|3,640.00|1,560.00
E87.0|HYPEROSMOLALITY AND HYPERNATRAEMIA; SODIUM [NA] EXCESS; SODIUM [NA] OVERLOAD|11,050.00|7,735.00|3,315.00
E87.1|HYPO-OSMOLALITY AND HYPONATRAEMIA|11,050.00|7,735.00|3,315.00
E87.2|ACIDOSIS; ACIDOSIS NOS; LACTIC ACIDOSIS; METABOLIC ACIDOSIS; RESPIRATORY ACIDOSIS|11,050.00|7,735.00|3,315.00
E87.3|ALKALOSIS; ALKALOSIS NOS; METABOLIC ALKALOSIS; RESPIRATORY ALKALOSIS|11,050.00|7,735.00|3,315.00
E87.4|MIXED DISORDER OF ACID-BASE BALANCE|11,050.00|7,735.00|3,315.00
E87.5|HYPERKALAEMIA; POTASSIUM [K] EXCESS; POTASSIUM [K] OVERLOAD|11,050.00|7,735.00|3,315.00
E87.6|HYPOKALAEMIA; POTASSIUM [K] DEFICIENCY|11,050.00|7,735.00|3,315.00
E87.7|FLUID OVERLOAD|11,050.00|7,735.00|3,315.00
E87.8|OTHER DISORDERS OF ELECTROLYTE AND FLUID BALANCE, NOT ELSEWHERE CLASSIFIED; ELECTROLYTE IMBALANCE NOS; HYPERCHLORAEMIA; HYPOCHLORAEMIA; OTHER METABOLIC DISORDERS|11,050.00|7,735.00|3,315.00
E88.0|DISORDERS OF PLASMA-PROTEIN METABOLISM, NOT ELSEWHERE CLASSIFIED; A-1-ANTITRYPSIN DEFICIENCY; BISALBUMINAEMIA|13,910.00|9,737.00|4,173.00
E88.1|LIPODYSTROPHY, NOT ELSEWHERE CLASSIFIED; LIPODYSTROPHY NOS|13,910.00|9,737.00|4,173.00
E88.8|OTHER SPECIFIED METABOLIC DISORDERS; LAUNOIS- BENSAUDE ADENOLIPOMATOSIS; TRIMETHYLAMINURIA|13,910.00|9,737.00|4,173.00
E88.9|METABOLIC DISORDER, UNSPECIFIED|13,910.00|9,737.00|4,173.00
E89.0|POSTPROCEDURAL HYPOTHYROIDISM; POSTIRRADIATION HYPOTHYROIDISM; POSTSURGICAL HYPOTHYROIDISM|13,390.00|9,373.00|4,017.00
E89.2|POSTPROCEDURAL HYPOPARATHYROIDISM; PARATHYROPRIVAL TETANY|13,390.00|9,373.00|4,017.00
E89.3|POSTPROCEDURAL HYPOPITUITARISM; POSTIRRADIATION HYPOPITUITARISM|13,390.00|9,373.00|4,017.00
E89.4|POSTPROCEDURAL OVARIAN FAILURE|13,390.00|9,373.00|4,017.00
E89.5|POSTPROCEDURAL TESTICULAR HYPOFUNCTION|13,390.00|9,373.00|4,017.00
E89.6|POSTPROCEDURAL ADRENOCORTICAL HYPOFUNCTION; POSTPROCEDURAL ADRENO-MEDULLARY HYPOFUNCTION|13,390.00|9,373.00|4,017.00
E89.8|OTHER POSTPROCEDURAL ENDOCRINE AND METABOLIC DISORDERS|13,390.00|9,373.00|4,017.00
F01.0|VASCULAR DEMENTIA OF ACUTE ONSET|10,660.00|7,462.00|3,198.00
F01.1|MULTI-INFARCT DEMENTIA; PREDOMINANTLY CORTICAL DEMENTIA|10,140.00|7,098.00|3,042.00
F01.8|OTHER VASCULAR DEMENTIA|10,140.00|7,098.00|3,042.00
F01.9|VASCULAR DEMENTIA, UNSPECIFIED|10,140.00|7,098.00|3,042.00
F03|UNSPECIFIED DEMENTIA; PRESENILE DEMENTIA NOS; PRESENILE PSYCHOSIS NOS; SENILE DEMENTIA NOS; SENILE DEMENTIA DEPRESSED OR PARANOID TYPE; SENILE PSYCHOSIS NOS|10,140.00|7,098.00|3,042.00
F04|ORGANIC AMNESIC SYNDROME, NOT INDUCED BY ALCOHOL AND OTHER PSYCHOACTIVE SUBSTANCES; KORSAKOV'S PSYCHOSIS OR SYNDROME, NONALCOHOLIC|10,140.00|7,098.00|3,042.00
F05.0|DELIRIUM NOT SUPERIMPOSED ON DEMENTIA, SO DESCRIBED|10,140.00|7,098.00|3,042.00
F05.8|OTHER DELIRIUM|10,140.00|7,098.00|3,042.00
F05.9|OTHER DELIRIUM|10,140.00|7,098.00|3,042.00
F06.0|ORGANIC HALLUCINOSIS; ORGANIC HALLUCINATORY STATE (NONALCOHOLIC)|10,140.00|7,098.00|3,042.00
F06.2|ORGANIC DELUSIONAL [SCHIZOPHRENIA-LIKE] DISORDER; PARANOID AND PARANOID-HALLUCINATORY ORGANIC STATES; SCHIZOPHRENIA-LIKE PSYCHOSIS IN EPILEPSY|10,140.00|7,098.00|3,042.00
F06.3|ORGANIC MOOD [AFFECTIVE] DISORDERS|10,140.00|7,098.00|3,042.00
F06.4|ORGANIC ANXIETY DISORDER|10,140.00|7,098.00|3,042.00
F06.7|MILD COGNITIVE DISORDER|10,140.00|7,098.00|3,042.00
F06.8|OTHER SPECIFIED MENTAL DISORDERS DUE TO BRAIN DAMAGE AND DYSFUNCTION AND TO PHYSICAL DISEASE; EPILEPTIC PSYCHOSIS NOS|10,140.00|7,098.00|3,042.00
F06.9|UNSPECIFIED MENTAL DISORDER DUE TO BRAIN DAMAGE AND DYSFUNCTION AND TO PHYSICAL DISEASE; ORGANIC BRAIN SYNDROME NOS; ORGANIC MENTAL DISORDER NOS|10,140.00|7,098.00|3,042.00
F07.0|ORGANIC PERSONALITY DISORDER; ORGANIC PSEUDOPSYCHOPATHIC PERSONALITY; ORGANIC PSEUDORETARDED PERSONALITY;   FRONTAL LOBE SYNDROME;  LIMBIC EPILEPSY PERSONALITYSYNDROME ;  LOBOTOMY SYNDROME; POSTLEUCOTOMY SYNDROME|10,140.00|7,098.00|3,042.00
F07.1|POSTENCEPHALITIC SYNDROME|10,140.00|7,098.00|3,042.00
F07.2|POSTCONCUSSIONAL SYNDROME; POSTCONTUSIONAL SYNDROME (ENCEPHALOPATHY); POST-TRAUMATIC BRAIN SYNDROME, NONPSYCHOTIC|10,140.00|7,098.00|3,042.00
F07.9|UNSPECIFIED ORGANIC PERSONALITY AND BEHAVIOURAL DISORDER DUE TO BRAIN DISEASE, DAMAGE AND DYSFUNCTION; ORGANIC PSYCHOSYNDROME|10,140.00|7,098.00|3,042.00
F09|UNSPECIFIED ORGANIC OR SYMPTOMATIC MENTAL DISORDER;  ORGANIC PSYCHOSIS NOS; SYMPTOMATIC PSYCHOSIS  NOS|10,140.00|7,098.00|3,042.00
F10.0|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF ALCOHOL IN ACUTE INTOXICATION|10,140.00|7,098.00|3,042.00
F10.1|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF ALCOHOL:HARMFUL USE|10,140.00|7,098.00|3,042.00
F10.2|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF ALCOHOL: DEPENDENCY SYNDROME|10,140.00|7,098.00|3,042.00
F10.3|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF ALCOHOL:WITHDRAWAL STATE|10,140.00|7,098.00|3,042.00
F10.4|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF ALCOHOL: WITHDRAWAL STATE WITH DELIRIUM|10,140.00|7,098.00|3,042.00
F10.5|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF ALCOHOL: PSYCHOTIC DISORDER|10,140.00|7,098.00|3,042.00
F10.6|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF ALCOHOL: AMNESIC SYNDROME|10,140.00|7,098.00|3,042.00
F10.7|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF ALCOHOL: RESIDUAL AND LATE-ONSET PSYCHOTIC DISORDER|10,140.00|7,098.00|3,042.00
F10.8|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF ALCOHOL: OTHER MENTAL AND BEHAVIOURAL DISORDERS|10,140.00|7,098.00|3,042.00
F10.9|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF ALCOHOL: UNSPECIFIED MENTAL AND BEHAVIOURAL DISORDER|10,140.00|7,098.00|3,042.00
F11.1|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF OPIOIDS: HARMFUL USE|10,140.00|7,098.00|3,042.00
F11.2|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF OPIOIDS: DEPENDENCE SYNDROME|10,140.00|7,098.00|3,042.00
F11.5|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF OPIOIDS: PSYCHOTIC DISORDER|10,140.00|7,098.00|3,042.00
F11.9|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF OPIOIDS: UNSPECIFIED MENTAL AND BEHAVIOURAL DISORDER|10,140.00|7,098.00|3,042.00
F12.0|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF CANNABINOIDS: ACUTE INTOXICATION|10,140.00|7,098.00|3,042.00
F12.5|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF CANNABINOIDS: PSYCHOTIC DISORDER|10,140.00|7,098.00|3,042.00
F13.1|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF SEDATIVES OR HYPNOTICS: HARMFUL USE|10,140.00|7,098.00|3,042.00
F13.2|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF SEDATIVES OR HYPNOTICS: DEPENDENCE SYNDROME|10,140.00|7,098.00|3,042.00
F13.3|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF SEDATIVES OR HYPNOTICS: WITHDRAWAL STATE|10,140.00|7,098.00|3,042.00
F13.4|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF SEDATIVES OR HYPNOTICS: WITHDRAWAL STATE WITH DELIRIUM|10,140.00|7,098.00|3,042.00
F13.5|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF SEDATIVES OR HYPNOTICS: PSYCHOTIC DISORDER|10,140.00|7,098.00|3,042.00
F13.7|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF SEDATIVES OR HYPNOTICS: RESIDUAL AND LATE-ONSET PSYCHOTIC DISORDER|10,140.00|7,098.00|3,042.00
F14.0|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF COCAINE: ACUTE INTOXICATION|10,140.00|7,098.00|3,042.00
F14.2|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF COCAINE: DEPENDENCE SYNDROME|10,140.00|7,098.00|3,042.00
F14.5|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF COCAINE: PSYCHOTIC DISORDER|10,140.00|7,098.00|3,042.00
F14.6|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF COCAINE: AMNESIC SYNDROME|10,140.00|7,098.00|3,042.00
F14.9|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF COCAINE: UNSPECIFIED MENTAL AND BEHAVIOURAL DISORDER|10,140.00|7,098.00|3,042.00
F15.0|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF OTHER STIMULANTS, INCLUDING CAFFEINE: ACUTE INTOXICATION|10,140.00|7,098.00|3,042.00
F15.1|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF OTHER STIMULANTS, INCLUDING CAFFEINE: HARMFUL USE|10,140.00|7,098.00|3,042.00
F15.2|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF OTHER STIMULANTS, INCLUDING CAFFEINE: DEPENDENCE SYNDROME|10,140.00|7,098.00|3,042.00
F15.3|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF OTHER STIMULANTS, INCLUDING CAFFEINE: WITHDRAWAL STATE|10,140.00|7,098.00|3,042.00
F15.5|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF OTHER STIMULANTS, INCLUDING CAFFEINE: PSYCHOTIC DISORDER|10,140.00|7,098.00|3,042.00
F15.8|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF OTHER STIMULANTS, INCLUDING CAFFEINE: OTHER MENTAL AND BEHAVIOURAL DISORDERS|10,140.00|7,098.00|3,042.00
F15.9|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF OTHER STIMULANTS, INCLUDING CAFFEINE: UNSPECIFIED MENTAL AND BEHAVIOURAL DISORDER|10,140.00|7,098.00|3,042.00
F16.0|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF HALLUCINOGENS: ACUTE INTOXICATION|10,140.00|7,098.00|3,042.00
F16.1|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF HALLUCINOGENS: HARMFUL USE|10,140.00|7,098.00|3,042.00
F16.2|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF HALLUCINOGENS: DEPENDENCE SYNDROME|10,140.00|7,098.00|3,042.00
F16.5|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF HALLUCINOGENS: PSYCHOTIC DISORDER|10,140.00|7,098.00|3,042.00
F17.2|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF TOBACCO: DEPENDENCE SYNDROME|10,140.00|7,098.00|3,042.00
F17.3|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF TOBACCO: WITHDRAWAL STATE|10,140.00|7,098.00|3,042.00
F18.0|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF VOLATILE SOLVENTS: ACUTE INTOXICATION|10,140.00|7,098.00|3,042.00
F18.4|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF VOLATILE SOLVENTS: WITHDRAWAL STATE WITH DELIRIUM|10,140.00|7,098.00|3,042.00
F18.6|MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF VOLATILE SOLVENTS: AMNESIC SYNDROME|10,140.00|7,098.00|3,042.00
F19.1|MENTAL AND BEHAVIOURAL DISORDERS DUE TO MULTIPLE DRUG USE AND USE OF OTHER PSYCHOACTIVE SUBSTANCES; MISUSE OF DRUGS NOS: HARMFUL USE|10,140.00|7,098.00|3,042.00
F19.2|MENTAL AND BEHAVIOURAL DISORDERS DUE TO MULTIPLE DRUG USE AND USE OF OTHER PSYCHOACTIVE SUBSTANCES; MISUSE OF DRUGS NOS: DEPENDENCE SYNDROME|10,140.00|7,098.00|3,042.00
F19.3|MENTAL AND BEHAVIOURAL DISORDERS DUE TO MULTIPLE DRUG USE AND USE OF OTHER PSYCHOACTIVE SUBSTANCES; MISUSE OF DRUGS NOS: WITHDRAWAL STATE|10,140.00|7,098.00|3,042.00
F19.5|MENTAL AND BEHAVIOURAL DISORDERS DUE TO MULTIPLE DRUG USE AND USE OF OTHER PSYCHOACTIVE SUBSTANCES; MISUSE OF DRUGS NOS: PSYCHOTIC DISORDER|10,140.00|7,098.00|3,042.00
F19.7|MENTAL AND BEHAVIOURAL DISORDERS DUE TO MULTIPLE DRUG USE AND USE OF OTHER PSYCHOACTIVE SUBSTANCES; MISUSE OF DRUGS NOS: RESIDUAL AND LATE- ONSET PSYCHOTIC DISORDER|10,140.00|7,098.00|3,042.00
F19.8|MENTAL AND BEHAVIOURAL DISORDERS DUE TO MULTIPLE DRUG USE AND USE OF OTHER PSYCHOACTIVE SUBSTANCES; MISUSE OF DRUGS NOS: OTHER MENTAL AND BEHAVIOURAL DISORDERS|10,140.00|7,098.00|3,042.00
F19.9|MENTAL AND BEHAVIOURAL DISORDERS DUE TO MULTIPLE DRUG USE AND USE OF OTHER PSYCHOACTIVE SUBSTANCES; MISUSE OF DRUGS NOS: UNSPECIFIED MENTAL AND BEHAVIOURAL DISORDER|10,140.00|7,098.00|3,042.00
F20.0|PARANOID SCHIZOPHRENIA; PARAPHRENIC SCHIZOPHRENIA|10,140.00|7,098.00|3,042.00
F20.1|HEBEPHRENIC SCHIZOPHRENIA; DISORGANIZED SCHIZOPHRENIA; HEBEPHRENIA|10,140.00|7,098.00|3,042.00
F20.2|CATATONIC SCHIZOPHRENIA; CATATONIC STUPOR; SCHIZOPHRENIC CATALEPSY; SCHIZOPHRENIC CATATONIA; SCHIZOPHRENIC FLEXIBILITAS CEREA|10,140.00|7,098.00|3,042.00
F20.3|UNDIFFERENTIATED SCHIZOPHRENIA; ATYPICAL SCHIZOPHRENIA|10,140.00|7,098.00|3,042.00
F20.5|RESIDUAL SCHIZOPHRENIA; CHRONIC UNDIFFERENTIATED SCHIZOPHRENIA; RESTZUSTAND (SCHIZOPHRENIC); SCHIZOPHRENIC RESIDUAL STATE|10,140.00|7,098.00|3,042.00
F20.6|SIMPLE SCHIZOPHRENIA|10,140.00|7,098.00|3,042.00
F20.8|OTHER SCHIZOPHRENIA; CENESTHOPATHIC SCHIZOPHRENIA; SCHIZOPHRENIFORM DISORDER NOS; SCHIZOPHRENIFORM PSYCHOSIS NOS|10,140.00|7,098.00|3,042.00
F20.9|SCHIZOPHRENIA, UNSPECIFIED|10,140.00|7,098.00|3,042.00
F21|SCHIZOTYPAL DISORDER; LATENT SCHIZOPHRENIC REACTION; SCHIZOPHRENIA BORDERLINE; SCHIZOPHRENIA LATENT; SCHIZOPHRENIA PREPSYCHOTIC; SCHIZOPHRENIA PRODROMAL; SCHIZOPHRENIA PSEUDONEUROTIC; SCHIZOPHRENIA PSEUDOPSYCHOPATHIC; SCHIZOTYPAL PERSONALITY DISORDER|10,140.00|7,098.00|3,042.00
F22.0|DELUSIONAL DISORDER; PARANOIA; PARANOID PSYCHOSIS; PARANOID STATE; PARAPHRENIA (LATE); SENSITIVER BEZIEHUNGSWAHN|10,140.00|7,098.00|3,042.00
F22.8|OTHER PERSISTENT DELUSIONAL DISORDERS; DELUSIONAL DYSMORPHOPHOBIA; INVOLUTIONAL PARANOID STATE; PARANOIA QUERULANS|10,140.00|7,098.00|3,042.00
F23.0|ACUTE POLYMORPHIC PSYCHOTIC DISORDER WITHOUT SYMPTOMS OF SCHIZOPHRENIA; BOUFFéE DéLIRANTE WITHOUT SYMPTOMS OF SCHIZOPHRENIA OR UNSPECIFIED; CYCLOID PSYCHOSIS WITHOUT SYMPTOMS OF SCHIZOPHRENIA OR UNSPECIFIED|10,140.00|7,098.00|3,042.00
F23.1|ACUTE POLYMORPHIC PSYCHOTIC DISORDER WITH SYMPTOMS OF SCHIZOPHRENIA; BOUFFéE DéLIRANTE WITH SYMPTOMS OF SCHIZOPHRENIA; CYCLOID PSYCHOSIS WITH SYMPTOMS OF SCHIZOPHRENIA|10,140.00|7,098.00|3,042.00
F23.2|ACUTE SCHIZOPHRENIA-LIKE PSYCHOTIC DISORDER;ACUTE (UNDIFFERENTIATED) SCHIZOPHRENIA;BRIEF SCHIZOPHRENIFORM DISORDER;  BRIEF SCHIZOPHRENIFORM PSYCHOSIS; ONEIROPHRENIA; SCHIZOPHRENIC REACTION|10,140.00|7,098.00|3,042.00
F23.3|OTHER ACUTE PREDOMINANTLY DELUSIONAL PSYCHOTIC DISORDERS; PARANOID REACTION; PSYCHOGENIC PARANOID PSYCHOSIS|10,140.00|7,098.00|3,042.00
F23.8|OTHER ACUTE AND TRANSIENT PSYCHOTIC DISORDERS|10,140.00|7,098.00|3,042.00
F23.9|ACUTE AND TRANSIENT PSYCHOTIC DISORDER, UNSPECIFIED; BRIEF REACTIVE PSYCHOSIS NOS; REACTIVE PSYCHOSIS|10,140.00|7,098.00|3,042.00
F24|INDUCED DELUSIONAL DISORDER; FOLIE à DEUX; INDUCED PARANOID DISORDER; INDUCED PSYCHOTIC DISORDER|10,140.00|7,098.00|3,042.00
F25.0|SCHIZOAFFECTIVE DISORDER, MANIC TYPE; SCHIZOAFFECTIVE PSYCHOSIS, MANIC TYPE; SCHIZOPHRENIFORM PSYCHOSIS, MANIC TYPE|10,140.00|7,098.00|3,042.00
F25.1|SCHIZOAFFECTIVE DISORDER, DEPRESSIVE TYPE; SCHIZOAFFECTIVE PSYCHOSIS, DEPRESSIVE TYPE; SCHIZOPHRENIFORM PSYCHOSIS, DEPRESSIVE TYPE|10,140.00|7,098.00|3,042.00
F25.2|SCHIZOAFFECTIVE DISORDER, MIXED TYPE; CYCLIC SCHIZOPHRENIA; MIXED SCHIZOPHRENIC AND AFFECTIVE PSYCHOSIS|10,140.00|7,098.00|3,042.00
F25.8|OTHER SCHIZOAFFECTIVE DISORDERS|10,140.00|7,098.00|3,042.00
F25.9|SCHIZOAFFECTIVE DISORDER, UNSPECIFIED; SCHIZOAFFECTIVE PSYCHOSIS NOS|10,140.00|7,098.00|3,042.00
F28|OTHER NONORGANIC PSYCHOTIC DISORDERS; CHRONIC HALLUCINATORY PSYCHOSIS|10,140.00|7,098.00|3,042.00
F29|UNSPECIFIED NONORGANIC PSYCHOSIS; PSYCHOSIS NOS|10,140.00|7,098.00|3,042.00
F30.0|HYPOMANIA|10,140.00|7,098.00|3,042.00
F30.1|MANIA WITHOUT PSYCHOTIC SYMPTOMS|10,140.00|7,098.00|3,042.00
F30.2|MANIA WITH PSYCHOTIC SYMPTOMS; MANIA WITH MOOD- CONGRUENT PSYCHOTIC SYMPTOMS; MANIA WITH MOOD- INCONGRUENT PSYCHOTIC SYMPTOMS; MANIC STUPOR|10,140.00|7,098.00|3,042.00
F30.9|MANIC EPISODE, UNSPECIFIED; MANIA NOS|10,140.00|7,098.00|3,042.00
F31.0|BIPOLAR AFFECTIVE DISORDER, CURRENT EPISODE HYPOMANIC|10,140.00|7,098.00|3,042.00
F31.1|BIPOLAR AFFECTIVE DISORDER, CURRENT EPISODE MANIC WITHOUT PSYCHOTIC SYMPTOMS|10,140.00|7,098.00|3,042.00
F31.2|BIPOLAR AFFECTIVE DISORDER, CURRENT EPISODE MANIC WITH PSYCHOTIC SYMPTOMS|10,140.00|7,098.00|3,042.00
F31.3|BIPOLAR AFFECTIVE DISORDER, CURRENT EPISODE MILD OR MODERATE DEPRESSION|10,140.00|7,098.00|3,042.00
F31.5|BIPOLAR AFFECTIVE DISORDER, CURRENT EPISODE SEVERE DEPRESSION WITH PSYCHOTIC SYMPTOMS|10,140.00|7,098.00|3,042.00
F31.6|BIPOLAR AFFECTIVE DISORDER, CURRENT EPISODE MIXED|10,140.00|7,098.00|3,042.00
F31.7|BIPOLAR AFFECTIVE DISORDER, CURRENTLY IN REMISSION|10,140.00|7,098.00|3,042.00
F31.8|OTHER BIPOLAR AFFECTIVE DISORDERS; BIPOLAR II DISORDER; RECURRENT MANIC EPISODES NOS|10,140.00|7,098.00|3,042.00
F31.9|BIPOLAR AFFECTIVE DISORDER, UNSPECIFIED|10,140.00|7,098.00|3,042.00
F32.0|MILD DEPRESSIVE EPISODE|10,140.00|7,098.00|3,042.00
F32.1|MODERATE DEPRESSIVE EPISODE|10,140.00|7,098.00|3,042.00
F32.2|SEVERE DEPRESSIVE EPISODE WITHOUT PSYCHOTIC SYMPTOMS; [AGITATED DEPRESSION, MAJOR DEPRESSION, VITAL DEPRESSION] SINGLE EPISODE WITHOUT PSYCHOTIC SYMPTOMS|10,140.00|7,098.00|3,042.00
F32.3|SEVERE DEPRESSIVE EPISODE WITH PSYCHOTIC SYMPTOMS; SINGLE EPISODES OF MAJOR DEPRESSION WITH PSYCHOTIC SYMPTOMS; SINGLE EPISODES OF PSYCHOGENIC DEPRESSIVE PSYCHOSIS; SINGLE EPISODES OF PSYCHOTIC DEPRESSION; SINGLE EPISODES OF REACTIVE DEPRESSIVE PSYCHOSIS|10,140.00|7,098.00|3,042.00
F32.8|OTHER DEPRESSIVE EPISODES; ATYPICAL DEPRESSION; SINGLE EPISODES OF "MASKED" DEPRESSION NOS|10,140.00|7,098.00|3,042.00
F32.9|DEPRESSIVE EPISODE, UNSPECIFIED; DEPRESSION NOS; DEPRESSIVE DISORDER NOS|10,140.00|7,098.00|3,042.00
F33.2|RECURRENT DEPRESSIVE DISORDER, CURRENT EPISODE SEVERE WITHOUT PSYCHOTIC SYMPTOMS; ENDOGENOUS DEPRESSION WITHOUT PSYCHOTIC SYMPTOMS; MAJOR DEPRESSION, RECURRENT WITHOUT PSYCHOTIC SYMPTOMS; MANIC-DEPRESSIVE PSYCHOSIS, DEPRESSED TYPE WITHOUT PSYCHOTIC SYMPTO|10,140.00|7,098.00|3,042.00
F33.3|RECURRENT DEPRESSIVE DISORDER, CURRENT EPISODE SEVERE WITH PSYCHOTIC SYMPTOMS INCLUDING ENDOGENOUS DEPRESSION WITH PSYCHOTIC SYMPTOMS; MANIC-DEPRESSIVE PSYCHOSIS, DEPRESSED TYPE WITH PSYCHOTIC SYMPTOMS; RECURRENT SEVERE EPISODES OF MAJOR DEPRESSION WITH|10,140.00|7,098.00|3,042.00
F33.8|OTHER RECURRENT DEPRESSIVE DISORDERS|10,140.00|7,098.00|3,042.00
F33.9|RECURRENT DEPRESSIVE DISORDER, UNSPECIFIED; MONOPOLAR DEPRESSION NOS|10,140.00|7,098.00|3,042.00
F34.0|CYCLOTHYMIA; AFFECTIVE PERSONALITY DISORDER; CYCLOID PERSONALITY; CYCLOTHYMIC PERSONALITY|10,140.00|7,098.00|3,042.00
F34.1|DYSTHYMIA; DEPRESSIVE NEUROSIS; DEPRESSIVE PERSONALITY DISORDER; NEUROTIC DEPRESSION; PERSISTENT ANXIETY DEPRESSION|10,140.00|7,098.00|3,042.00
F42.1|PREDOMINANTLY COMPULSIVE ACTS [OBSESSIONAL RITUALS]|10,140.00|7,098.00|3,042.00
F42.2|MIXED OBSESSIONAL THOUGHTS AND ACTS|10,140.00|7,098.00|3,042.00
F42.8|OTHER OBSESSIVE-COMPULSIVE DISORDERS|10,140.00|7,098.00|3,042.00
F42.9|OBSESSIVE-COMPULSIVE DISORDER, UNSPECIFIED|10,140.00|7,098.00|3,042.00
F43.0|ACUTE STRESS REACTION INCLUDING  ACUTE CRISIS REACTION; ACUTE REACTION TO STRESS; COMBAT FATIGUE; CRISIS STATE; PSYCHIC SHOCK|10,140.00|7,098.00|3,042.00
F43.1|POST-TRAUMATIC STRESS DISORDER; TRAUMATIC NEUROSIS|10,140.00|7,098.00|3,042.00
F43.2|ADJUSTMENT DISORDERS; CULTURE SHOCK; GRIEF REACTION; HOSPITALISM IN CHILDREN|10,140.00|7,098.00|3,042.00
F43.8|OTHER REACTIONS TO SEVERE STRESS|10,140.00|7,098.00|3,042.00
F44.0|DISSOCIATIVE AMNESIA|10,140.00|7,098.00|3,042.00
F44.4|DISSOCIATIVE MOTOR DISORDERS; PSYCHOGENIC APHONIA; PSYCHOGENIC DYSPHONIA|10,140.00|7,098.00|3,042.00
F44.8|OTHER DISSOCIATIVE [CONVERSION] DISORDERS; GANSER'S SYNDROME; MULTIPLE PERSONALITY; PSYCHOGENIC CONFUSION; PSYCHOGENIC TWILIGHT STATE|10,140.00|7,098.00|3,042.00
F44.9|DISSOCIATIVE [CONVERSION] DISORDER, UNSPECIFIED|10,140.00|7,098.00|3,042.00
F45.0|SOMATIZATION DISORDER; BRIQUET’S DISORDER; MULTIPLE PSYCHOSOMATIC DISORDER|10,140.00|7,098.00|3,042.00
F45.1|UNDIFFERENTIATED SOMATOFORM DISORDER; UNDIFFERENTIATED PSYCHOSOMATIC DISORDER|10,140.00|7,098.00|3,042.00
F45.2|HYPOCHONDRIACAL DISORDER; BODY DYSMORPHIC DISORDER; DYSMORPHOPHOBIA (NONDELUSIONAL); HYPOCHONDRIACAL NEUROSIS; HYPOCHONDRIASIS; NOSOPHOBIA|10,140.00|7,098.00|3,042.00
F45.3|SOMATOFORM AUTONOMIC DYSFUNCTION; CARDIAC NEUROSIS; DA COSTA'S SYNDROME; GASTRIC NEUROSIS ; NEUROCIRCULATORY ASTHENIA PSYCHOGENIC FORMS OF AEROPHAGY; PSYCHOGENIC FORMS OF  COUGH, PSYCHOGENIC FORMS OF  DIARRHEA; PSYCHOGENIC FORMS OF DYSPEPSIA; PSYCHOGENIC|10,140.00|7,098.00|3,042.00
F45.4|PERSISTENT SOMATOFORM PAIN DISORDER; PSYCHALGIA; PSYCHOGENIC BACKACHE; PSYCHOGENIC HEADACHE; SOMATOFORM PAIN DISORDER|10,140.00|7,098.00|3,042.00
F45.8|OTHER SOMATOFORM DISORDERS; PSYCHOGENIC DYSMENORRHOEA; PSYCHOGENIC DYSPHAGIA, INCLUDING "GLOBUS HYSTERICUS"; PSYCHOGENIC PRURITUS; PSYCHOGENIC TORTICOLLIS; TEETH-GRINDING|10,140.00|7,098.00|3,042.00
F45.9|SOMATOFORM DISORDER, UNSPECIFIED; PSYCHOSOMATIC DISORDER NOS|10,140.00|7,098.00|3,042.00
F48.8|OTHER SPECIFIED NEUROTIC DISORDERS; DHAT SYNDROME; OCCUPATIONAL NEUROSIS, INCLUDING WRITER'S CRAMP; PSYCHASTHENIA; PSYCHASTHENIC NEUROSIS; PSYCHOGENIC SYNCOPE|10,140.00|7,098.00|3,042.00
F48.9|NEUROTIC DISORDER, UNSPECIFIED; NEUROSIS NOS|10,140.00|7,098.00|3,042.00
F50.2|BULIMIA NERVOSA; BULIMIA NOS; HYPEROREXIA NERVOSA|10,140.00|7,098.00|3,042.00
F53.0|MILD MENTAL AND BEHAVIOURAL DISORDERS ASSOCIATED WITH THE PUERPERIUM, NOT ELSEWHERE CLASSIFIED; DEPRESSION POSTNATAL NOS; DEPRESSION POSTPARTUM NOS|10,140.00|7,098.00|3,042.00
F53.1|SEVERE MENTAL AND BEHAVIOURAL DISORDERS ASSOCIATED WITH THE PUERPERIUM, NOT ELSEWHERE CLASSIFIED; PUERPERAL PSYCHOSIS NOS|10,140.00|7,098.00|3,042.00
F53.9|PUERPERAL MENTAL DISORDER, UNSPECIFIED|10,140.00|7,098.00|3,042.00
F55|ABUSE OF NON-DEPENDENCE-PRODUCING SUBSTANCES; ABUSE OF ANTACIDS; ABUSE OF HERBAL OR FOLK REMEDIES; ABUSE OF STEROIDS OR HORMONES; ABUSE OF VITAMINS; LAXATIVE HABIT|10,140.00|7,098.00|3,042.00
F59|UNSPECIFIED BEHAVIOURAL SYNDROMES ASSOCIATED WITH PHYSIOLOGICAL DISTURBANCES AND PHYSICAL FACTORS; PSYCHOGENIC PHYSIOLOGICAL DYSFUNCTION NOS|10,140.00|7,098.00|3,042.00
F70.0|MILD MENTAL RETARDATION; FEEBLE-MINDEDNESS; MILD MENTAL SUBNORMALITY WITH THE STATEMENT OF NO, OR MINIMAL, IMPAIRMENT OF BEHAVIOUR|10,140.00|7,098.00|3,042.00
F72.9|SEVERE MENTAL RETARDATION; SEVERE MENTAL SUBNORMALITY WITHOUT MENTION OF IMPAIRMENT OF BEHAVIOUR|10,140.00|7,098.00|3,042.00
F78.1|OTHER MENTAL RETARDATION WITH SIGNIFICANT IMPAIRMENT OF BEHAVIOUR REQUIRING ATTENTION OR TREATMENT|10,140.00|7,098.00|3,042.00
F78.8|OTHER MENTAL RETARDATION WITH OTHER IMPAIRMENTS OF BEHAVIOUR|10,140.00|7,098.00|3,042.00
F78.9|OTHER MENTAL RETARDATION WITHOUT MENTION OF IMPAIRMENT OF BEHAVIOUR|10,140.00|7,098.00|3,042.00
F79.8|UNSPECIFIED MENTAL RETARDATION; MENTAL DEFICIENCY NOS; MENTAL SUBNORMALITY NOS WITH OTHER IMPAIRMENTS OF BEHAVIOUR|10,140.00|7,098.00|3,042.00
F80.3|ACQUIRED APHASIA WITH EPILEPSY [LANDAU-KLEFFNER]|10,140.00|7,098.00|3,042.00
F82|SPECIFIC DEVELOPMENTAL DISORDER OF MOTOR FUNCTION; CLUMSY CHILD SYNDROME; DEVELOPMENTAL COORDINATION DISORDER; DEVELOPMENTAL DYSPRAXIA|10,140.00|7,098.00|3,042.00
F84.0|CHILDHOOD AUTISM; AUTISTIC DISORDER; INFANTILE AUTISM; INFANTILE PSYCHOSIS; KANNER'S SYNDROME|10,140.00|7,098.00|3,042.00
F84.2|RETT'S SYNDROME|10,140.00|7,098.00|3,042.00
F84.3|OTHER CHILDHOOD DISINTEGRATIVE DISORDER; DEMENTIA INFANTILIS; DISINTEGRATIVE PSYCHOSIS; HELLER'S SYNDROME; SYMBIOTIC PSYCHOSIS|10,140.00|7,098.00|3,042.00
F84.5|ASPERGER'S SYNDROME; AUTISTIC PSYCHOPATHY; SCHIZOID DISORDER OF CHILDHOOD|10,140.00|7,098.00|3,042.00
F84.9|PERVASIVE DEVELOPMENTAL DISORDER, UNSPECIFIED|10,140.00|7,098.00|3,042.00
F89|UNSPECIFIED DISORDER OF PSYCHOLOGICAL DEVELOPMENT; DEVELOPMENTAL DISORDER NOS|10,140.00|7,098.00|3,042.00
F90.8|OTHER HYPERKINETIC DISORDERS|10,140.00|7,098.00|3,042.00
F92.0|DEPRESSIVE CONDUCT DISORDER|10,140.00|7,098.00|3,042.00
F98.1|NONORGANIC ENCOPRESIS; FUNCTIONAL ENCOPRESIS; INCONTINENCE OF FAECES OF NONORGANIC ORIGIN; PSYCHOGENIC ENCOPRESIS|10,140.00|7,098.00|3,042.00
F99|MENTAL DISORDER, NOT OTHERWISE SPECIFIED; MENTAL ILLNESS NOS|10,140.00|7,098.00|3,042.00
G00.0|HAEMOPHILUS MENINGITIS; MENINGITIS DUE TO HAEMOPHILUS INFLUENZAE|33,410.00|23,387.00|10,023.00
G00.1|PNEUMOCOCCAL MENINGITIS|33,410.00|23,387.00|10,023.00
G00.2|STREPTOCOCCAL MENINGITIS|33,410.00|23,387.00|10,023.00
G00.3|STAPHYLOCOCCAL MENINGITIS|33,410.00|23,387.00|10,023.00
G00.8|OTHER BACTERIAL MENINGITIS; MENINGITIS DUE TO ESCHERICHIA COLI; MENINGITIS DUE TO FRIEDLäNDER BACILLUS; MENINGITIS DUE TO KLEBSIELLA|33,410.00|23,387.00|10,023.00
G00.9|BACTERIAL MENINGITIS, UNSPECIFIED; MENINGITIS PURULENT NOS; MENINGITIS PYOGENIC NOS; MENINGITIS SUPPURATIVE NOS|33,410.00|23,387.00|10,023.00
G03.0|NONPYOGENIC MENINGITIS; NONBACTERIAL MENINGITIS|33,410.00|23,387.00|10,023.00
G03.1|CHRONIC MENINGITIS|33,410.00|23,387.00|10,023.00
G03.8|MENINGITIS DUE TO OTHER SPECIFIED CAUSES|33,410.00|23,387.00|10,023.00
G03.9|MENINGITIS, UNSPECIFIED; ARACHNOIDITIS (SPINAL) NOS|33,410.00|23,387.00|10,023.00
G04.0|ACUTE DISSEMINATED ENCEPHALITIS; POSTIMMUNIZATION [ENCEPHALITIS; POSTIMMUNIZATION ENCEPHALOMYELITIS|28,080.00|19,656.00|8,424.00
G04.1|TROPICAL SPASTIC PARAPLEGIA|28,080.00|19,656.00|8,424.00
G04.2|BACTERIAL MENINGOENCEPHALITIS AND MENINGOMYELITIS, NOT ELSEWHERE CLASSIFIED|28,080.00|19,656.00|8,424.00
G04.8|OTHER ENCEPHALITIS, MYELITIS AND ENCEPHALOMYELITIS; POSTINFECTIOUS ENCEPHALITIS AND ENCEPHALOMYELITIS NOS|28,080.00|19,656.00|8,424.00
G04.9|ENCEPHALITIS, MYELITIS AND ENCEPHALOMYELITIS, UNSPECIFIED; VENTRICULITIS (CEREBRAL) NOS|28,080.00|19,656.00|8,424.00
G05.8*|ENCEPHALITIS, MYELITIS AND ENCEPHALOMYELITIS IN OTHER DISEASES CLASSIFIED ELSEWHERE|28,080.00|19,656.00|8,424.00
G06.0|INTRACRANIAL ABSCESS AND GRANULOMA; ABSCESS (EMBOLIC)(OF) BRAIN [ANY PART]; ABSCESS (EMBOLIC)(OF) CEREBELLAR; ABSCESS (EMBOLIC)(OF) CEREBRAL; ABSCESS (EMBOLIC)(OF) OTOGENIC; IINTRACRANIAL ABSCESS OR GRANULOMA, EPIDURAL; INTRACRANIAL ABSCESS OR GRANULOM|36,270.00|25,389.00|10,881.00
G06.1|INTRASPINAL ABSCESS AND GRANULOMA;  ABSCESS (EMBOLIC) OF SPINAL CORD [ANY PART];   INTRASPINAL ABSCESS OR GRANULOMA  EPIDURAL; INTRASPINAL ABSCESS OR GRANULOMA EXTRADURAL;   INTRASPINAL ABSCESS OR GRANULOMA  SUBDURAL|36,270.00|25,389.00|10,881.00
G06.2|ENCEPHALITIS, MYELITIS AND ENCEPHALOMYELITIS IN EXTRADURAL AND SUBDURAL ABSCESS, UNSPECIFIED|36,270.00|25,389.00|10,881.00
G07*|INTRACRANIAL AND INTRASPINAL ABSCESS AND GRANULOMA IN DISEASES CLASSIFIED ELSEWHERE|28,080.00|19,656.00|8,424.00
G08|INTRACRANIAL AND INTRASPINAL PHLEBITIS AND THROMBOPHLEBITIS; SEPTIC [EMBOLISM, ENDOPHLEBITIS, PHLEBITIS, THROMBOPHLEBITIS, THROMBOSIS] OF INTRACRANIAL OR INTRASPINAL VENOUS SINUSES AND VEINS|28,080.00|19,656.00|8,424.00
G09|SEQUELAE OF INFLAMMATORY DISEASES OF CENTRAL NERVOUS SYSTEM|10,400.00|7,280.00|3,120.00
G10|HUNTINGTON'S DISEASE; HUNTINGTON'S CHOREA|13,520.00|9,464.00|4,056.00
G11.0|CONGENITAL NONPROGRESSIVE ATAXIA|13,520.00|9,464.00|4,056.00
G11.1|EARLY-ONSET CEREBELLAR ATAXIA INCLUDING EARLY- ONSET CEREBELLAR ATAXIA WITH ESSENTIAL TREMOR; EARLY-ONSET CEREBELLAR ATAXIA WITH MYOCLONUS [HUNT'S ATAXIA]; EARLY-ONSET CEREBELLAR ATAXIA  WITH RETAINED TENDON REFLEXES; FRIEDREICH'S ATAXIA (AUTOSOMAL RECESSIV|13,520.00|9,464.00|4,056.00
G11.3|CEREBELLAR ATAXIA WITH DEFECTIVE DNA REPAIR; ATAXIA TELANGIECTASIA [LOUIS-BAR]|13,520.00|9,464.00|4,056.00
G11.9|HEREDITARY ATAXIA, UNSPECIFIED; HEREDITARY CEREBELLAR ATAXIA NOS; HEREDITARY CEREBELLAR DEGENERATION; HEREDITARY CEREBELLAR DISEASE; HEREDITARY CEREBELLAR SYNDROME|13,520.00|9,464.00|4,056.00
G12.0|INFANTILE SPINAL MUSCULAR ATROPHY, TYPE I [WERDNIG- HOFFMAN]|13,520.00|9,464.00|4,056.00
G12.1|OTHER INHERITED SPINAL MUSCULAR ATROPHY; PROGRESSIVE BULBAR PALSY OF CHILDHOOD [FAZIO- LONDE]; SPINAL MUSCULAR ATROPHY ADULT FORM SPINAL MUSCULAR ATROPHY CHILDHOOD FORM, TYPE II; SPINAL MUSCULAR ATROPHY DISTAL; SPINAL MUSCULAR ATROPHY JUVENILE FORM, TYPE|13,520.00|9,464.00|4,056.00
G12.2|MOTOR NEURON DISEASE; FAMILIAL MOTOR NEURON DISEASE; AMYOTROPHICLATERAL SCLEROSIS; PRIMARY LATERAL SCLEROSIS ; PROGRESSIVE BULBAR PALSY; PROGRESSIVE SPINAL MUSCULAR ATROPHY|13,520.00|9,464.00|4,056.00
G12.9|SPINAL MUSCULAR ATROPHY, UNSPECIFIED|13,520.00|9,464.00|4,056.00
G20|PARKINSON'S DISEASE; HEMIPARKINSONISM; PARALYSIS AGITANS; PARKINSONISM OR PARKINSON'S DISEASE NOS; IDIOPATHIC PARKINSONISM OR PARKINSON'S DISEASE; PRIMARY PARKINSONISM OR PARKINSON'S DISEASE|13,520.00|9,464.00|4,056.00
G21.0|MALIGNANT NEUROLEPTIC SYNDROME|10,790.00|7,553.00|3,237.00
G21.1|OTHER DRUG-INDUCED SECONDARY PARKINSONISM|10,790.00|7,553.00|3,237.00
G21.8|OTHER SECONDARY PARKINSONISM|10,790.00|7,553.00|3,237.00
G21.9|SECONDARY PARKINSONISM, UNSPECIFIED|10,790.00|7,553.00|3,237.00
G23.0|HALLERVORDEN-SPATZ DISEASE; PIGMENTARY PALLIDAL DEGENERATION|10,790.00|7,553.00|3,237.00
G23.1|PROGRESSIVE SUPRANUCLEAR OPHTHALMOPLEGIA [STEELE-RICHARDSON-OLSZEWSKI]|10,790.00|7,553.00|3,237.00
G23.8|OTHER SPECIFIED DEGENERATIVE DISEASES OF BASAL GANGLIA; CALCIFICATION OF BASAL GANGLIA|10,790.00|7,553.00|3,237.00
G23.9|DEGENERATIVE DISEASE OF BASAL GANGLIA, UNSPECIFIED|10,790.00|7,553.00|3,237.00
G24.0|CARCINOMATOUS NEUROMYOPATHY IN DRUG-INDUCED DYSTONIA|10,790.00|7,553.00|3,237.00
G24.1|IDIOPATHIC FAMILIAL DYSTONIA; IDIOPATHIC DYSTONIA NOS|10,790.00|7,553.00|3,237.00
G24.3|SPASMODIC TORTICOLLIS|10,790.00|7,553.00|3,237.00
G24.4|IDIOPATHIC OROFACIAL DYSTONIA; OROFACIAL DYSKINESIA|10,790.00|7,553.00|3,237.00
G24.8|OTHER DYSTONIA|10,790.00|7,553.00|3,237.00
G24.9|DYSTONIA, UNSPECIFIED; DYSKINESIA NOS|10,790.00|7,553.00|3,237.00
G25.3|MYOCLONUS; DRUG-INDUCED MYOCLONUS|10,790.00|7,553.00|3,237.00
G25.5|OTHER CHOREA; CHOREA NOS|10,790.00|7,553.00|3,237.00
G25.8|OTHER SPECIFIED EXTRAPYRAMIDAL AND MOVEMENT DISORDERS; RESTLESS LEGS SYNDROME; STIFF-MAN SYNDROME|10,790.00|7,553.00|3,237.00
G25.9|EXTRAPYRAMIDAL AND MOVEMENT DISORDER, UNSPECIFIED|10,790.00|7,553.00|3,237.00
G30.0|ALZHEIMER'S DISEASE WITH EARLY ONSET|13,000.00|9,100.00|3,900.00
G30.1|ALZHEIMER'S DISEASE WITH LATE ONSET|13,000.00|9,100.00|3,900.00
G30.8|OTHER ALZHEIMER'S DISEASE|13,000.00|9,100.00|3,900.00
G30.9+F00.9*|DEMENTIA IN ALZHEIMER'S DISEASE, UNSPECIFIED|13,000.00|9,100.00|3,900.00
G31.0|CIRCUMSCRIBED BRAIN ATROPHY; PICK'S DISEASE; PROGRESSIVE ISOLATED APHASIA|13,000.00|9,100.00|3,900.00
G31.1|SENILE DEGENERATION OF BRAIN, NOT ELSEWHERE CLASSIFIED|13,000.00|9,100.00|3,900.00
G31.2|DEGENERATION OF NERVOUS SYSTEM DUE TO ALCOHOL; ALCOHOLIC CEREBELLAR ATAXIA; ALCOHOLIC CEREBELLAR DEGENERATION; ALCOHOLIC CEREBRAL DEGENERATION; ALCOHOLIC ENCEPHALOPATHY; DYSFUNCTION OF AUTONOMIC NERVOUS SYSTEM DUE TO ALCOHOL|13,000.00|9,100.00|3,900.00
G31.8|OTHER SPECIFIED DEGENERATIVE DISEASES OF NERVOUS SYSTEM; GREY-MATTER DEGENERATION [ALPERS]; LEWY BODY (IES) DEMENTIA; LEWY BODY (IES) DISEASE; SUBACUTE NECROTIZING ENCEPHALOPATHY [LEIGH]|13,000.00|9,100.00|3,900.00
G32.8*|OTHER SPECIFIED DEGENERATIVE DISORDERS OF NERVOUS SYSTEM IN DISEASES CLASSIFIED ELSEWHERE|13,000.00|9,100.00|3,900.00
G35|MULTIPLE SCLEROSIS; MULTIPLE SCLEROSIS  NOS; MULTIPLE SCLEROSIS OF BRAIN STEM; MULTIPLE SCLEROSIS OF CORD; MULTIPLE SCLEROSIS, DISSEMINATED; MULTIPLE SCLEROSIS,  GENERALIZED|15,080.00|10,556.00|4,524.00
G36.0|NEUROMYELITIS OPTICA [DEVIC]; DEMYELINATION IN OPTIC NEURITIS|15,080.00|10,556.00|4,524.00
G36.1|ACUTE AND SUBACUTE HAEMORRHAGIC LEUKOENCEPHALITIS [HURST]|15,080.00|10,556.00|4,524.00
G36.8|OTHER SPECIFIED ACUTE DISSEMINATED DEMYELINATION|15,080.00|10,556.00|4,524.00
G36.9|ACUTE DISSEMINATED DEMYELINATION, UNSPECIFIED|15,080.00|10,556.00|4,524.00
G37.0|DIFFUSE SCLEROSIS; PERIAXIAL ENCEPHALITIS; SCHILDER'S DISEASE|15,080.00|10,556.00|4,524.00
G37.1|CENTRAL DEMYELINATION OF CORPUS CALLOSUM|15,080.00|10,556.00|4,524.00
G37.2|CENTRAL PONTINE MYELINOLYSIS|15,080.00|10,556.00|4,524.00
G37.3|ACUTE TRANSVERSE MYELITIS IN DEMYELINATING DISEASE OF CENTRAL NERVOUS SYSTEM; ACUTE TRANSVERSE MYELITIS NOS|15,080.00|10,556.00|4,524.00
G37.4|SUBACUTE NECROTIZING MYELITIS|15,080.00|10,556.00|4,524.00
G37.8|OTHER SPECIFIED DEMYELINATING DISEASES OF CENTRAL NERVOUS SYSTEM|15,080.00|10,556.00|4,524.00
G37.9|DEMYELINATING DISEASE OF CENTRAL NERVOUS SYSTEM, UNSPECIFIED|15,080.00|10,556.00|4,524.00
G40.0|LOCALIZATION-RELATED FOCAL IDIOPATHIC EPILEPSY AND EPILEPTIC SYNDROMES WITH SEIZURES OF LOCALIZED ONSET; LOCALIZATION-RELATED PARTIAL IDIOPATHIC EPILEPSY AND EPILEPTIC SYNDROMES WITH SEIZURES OF LOCALIZED ONSET; BENIGN CHILDHOOD EPILEPSY WITH CENTROTEMPOR|10,140.00|7,098.00|3,042.00
G40.1|LOCALIZATION-RELATED FOCAL SYMPTOMATIC EPILEPSY AND EPILEPTIC SYNDROMES WITH SIMPLE PARTIAL SEIZURES; LOCALIZATION-RELATED PARTIAL SYMPTOMATIC EPILEPSY AND EPILEPTIC SYNDROMES WITH SIMPLE PARTIAL SEIZURES; ATTACKS WITHOUT ALTERATION OF CONSCIOUSNESS ; SIM|10,140.00|7,098.00|3,042.00
G40.2|LOCALIZATION-RELATED FOCAL SYMPTOMATIC EPILEPSY AND EPILEPTIC SYNDROMES WITH COMPLEX PARTIAL SEIZURES; LOCALIZATION-RELATED PARTIAL SYMPTOMATIC EPILEPSY AND EPILEPTIC SYNDROMES WITH COMPLEX PARTIAL SEIZURES;  ATTACKS WITH ALTERATION OF CONSCIOUSNESS, OFTE|10,140.00|7,098.00|3,042.00
G40.3|GENERALIZED IDIOPATHIC EPILEPSY AND EPILEPTIC SYNDROMES; BENIGN MYOCLONIC EPILEPSY IN INFANCY; BENIGN  FAMILIAL NEONATAL CONVULSIONS; CHILDHOOD ABSENCE EPILEPSY [PYKNOLEPSY]; EPILEPSY WITH GRAND MAL SEIZURES ON AWAKENING; JUVENILE ABSENCE EPILEPSY; JUVENI|10,140.00|7,098.00|3,042.00
G40.4|OTHER GENERALIZED EPILEPSY AND EPILEPTIC SYNDROMES; EPILEPSY WITH MYOCLONIC ABSENCES; EPILEPSY WITH MYOCLONIC-ASTATIC SEIZURES; INFANTILE SPASMS; LENNOX-GASTAUT SYNDROME; SALAAM ATTACKS; SYMPTOMATIC EARLY MYOCLONIC; ENCEPHALOPATHY; WEST'S SYNDROME|10,140.00|7,098.00|3,042.00
G40.5|SPECIAL EPILEPTIC SYNDROMES; EPILEPSIA PARTIALIS CONTINUA [KOZHEVNIKOF]; EPILEPTIC SEIZURES RELATED TO ALCOHOL; EPILEPTIC SEIZURES RELATED TO DRUGS; EPILEPTIC SEIZURES RELATED TO HORMONAL CHANGES; EPILEPTIC SEIZURES RELATED TO SLEEP DEPRIVATION; EPILEPTIC|10,140.00|7,098.00|3,042.00
G40.6|GRAND MAL SEIZURES, UNSPECIFIED (WITH OR WITHOUT PETIT MAL)|10,140.00|7,098.00|3,042.00
G40.7|PETIT MAL, UNSPECIFIED, WITHOUT GRAND MAL SEIZURES|10,140.00|7,098.00|3,042.00
G40.8|OTHER EPILEPSY; EPILEPSIES AND EPILEPTIC SYNDROMES UNDETERMINED AS TO WHETHER THEY ARE FOCAL OR GENERALIZED|10,140.00|7,098.00|3,042.00
G40.9|EPILEPSY, UNSPECIFIED; EPILEPTIC CONVULSIONS NOS; EPILEPTIC FITS NOS; EPILEPTIC SEIZURES NOS|10,140.00|7,098.00|3,042.00
G41.0|GRAND MAL STATUS EPILEPTICUS; TONIC-CLONIC STATUS EPILEPTICUS|20,280.00|14,196.00|6,084.00
G41.1|PETIT MAL STATUS EPILEPTICUS; EPILEPTIC ABSENCE STATUS|20,280.00|14,196.00|6,084.00
G41.2|COMPLEX PARTIAL STATUS EPILEPTICUS|20,280.00|14,196.00|6,084.00
G41.8|OTHER STATUS EPILEPTICUS|20,280.00|14,196.00|6,084.00
G41.9|STATUS EPILEPTICUS, UNSPECIFIED|20,280.00|14,196.00|6,084.00
G43.0|MIGRAINE WITHOUT AURA [COMMON MIGRAINE]|7,150.00|5,005.00|2,145.00
G43.1|MIGRAINE WITH AURA [CLASSICAL MIGRAINE]; MIGRAINE AURA WITHOUT HEADACHE; MIGRAINE, BASILAR; MIGRAINE EQUIVALENTS; FAMILIAL HEMIPLEGIC MIGRAINE; MIGRAINE WITH ACUTE-ONSET AURA; MIGRAINE WITH PROLONGED AURA; MIGRAINE WITH TYPICAL AURA|7,150.00|5,005.00|2,145.00
G43.2|STATUS MIGRAINOSUS|7,150.00|5,005.00|2,145.00
G43.3|COMPLICATED MIGRAINE|7,150.00|5,005.00|2,145.00
G43.8|OTHER MIGRAINE; OPHTHALMOPLEGIC MIGRAINE; RETINAL MIGRAINE|7,150.00|5,005.00|2,145.00
G43.9|MIGRAINE, UNSPECIFIED|7,150.00|5,005.00|2,145.00
G44.0|CLUSTER HEADACHE SYNDROME; CHRONIC PAROXYSMAL HEMICRANIA; CHRONIC CLUSTER HEADACHE; EPISODIC CLUSTER HEADACHE|7,150.00|5,005.00|2,145.00
G44.1|VASCULAR HEADACHE, NOT ELSEWHERE CLASSIFIED; VASCULAR HEADACHE NOS|7,150.00|5,005.00|2,145.00
G44.2|TENSION-TYPE HEADACHE; CHRONIC TENSION-TYPE HEADACHE; EPISODIC TENSION HEADACHE; TENSION HEADACHE NOS|7,150.00|5,005.00|2,145.00
G44.3|CHRONIC POST-TRAUMATIC HEADACHE|7,150.00|5,005.00|2,145.00
G44.4|DRUG-INDUCED HEADACHE, NOT ELSEWHERE CLASSIFIED|7,150.00|5,005.00|2,145.00
G44.8|OTHER SPECIFIED HEADACHE SYNDROMES|7,150.00|5,005.00|2,145.00
G45.0|VERTEBRO-BASILAR ARTERY SYNDROME|9,490.00|6,643.00|2,847.00
G45.1|HEMISPHERIC CAROTID ARTERY SYNDROME|9,490.00|6,643.00|2,847.00
G45.2|MULTIPLE AND BILATERAL PRECEREBRAL ARTERY SYNDROMES|9,490.00|6,643.00|2,847.00
G45.3|AMAUROSIS FUGAX|9,490.00|6,643.00|2,847.00
G45.4|TRANSIENT GLOBAL AMNESIA|9,490.00|6,643.00|2,847.00
G45.8|OTHER TRANSIENT CEREBRAL ISCHAEMIC ATTACKS AND RELATED SYNDROMES|9,490.00|6,643.00|2,847.00
G45.9|TRANSIENT CEREBRAL ISCHAEMIC ATTACK, UNSPECIFIED; SPASM OF CEREBRAL ARTERY; TRANSIENT CEREBRAL ISCHAEMIA NOS|9,490.00|6,643.00|2,847.00
G47.3|SLEEP APNOEA; SLEEP APNOEA, CENTRAL;  SLEEP APNOEA, OBSTRUCTIVE|14,040.00|9,828.00|4,212.00
G50.0|TRIGEMINAL NEURALGIA; SYNDROME OF PAROXYSMAL FACIAL PAIN; TIC DOULOUREUX|9,620.00|6,734.00|2,886.00
G50.8|OTHER DISORDERS OF TRIGEMINAL NERVE|9,620.00|6,734.00|2,886.00
G51.0|BELL'S PALSY; FACIAL PALSY|9,620.00|6,734.00|2,886.00
G51.1|GENICULATE GANGLIONITIS|9,620.00|6,734.00|2,886.00
G51.3|CLONIC HEMIFACIAL SPASM|9,620.00|6,734.00|2,886.00
G51.4|FACIAL MYOKYMIA|9,620.00|6,734.00|2,886.00
G51.8|OTHER DISORDERS OF FACIAL NERVE|9,620.00|6,734.00|2,886.00
G51.9|DISORDER OF FACIAL NERVE, UNSPECIFIED|9,620.00|6,734.00|2,886.00
G52.0|DISORDERS OF OLFACTORY NERVE; DISORDER OF 1ST CRANIAL NERVE|9,620.00|6,734.00|2,886.00
G52.1|DISORDERS OF GLOSSOPHARYNGEAL NERVE; DISORDER OF 9TH CRANIAL NERVE; GLOSSOPHARYNGEAL NEURALGIA|9,620.00|6,734.00|2,886.00
G52.2|DISORDERS OF VAGUS NERVE; DISORDER OF PNEUMOGASTRIC [10TH] NERVE|9,620.00|6,734.00|2,886.00
G52.7|DISORDERS OF MULTIPLE CRANIAL NERVES; POLYNEURITIS CRANIALIS|9,620.00|6,734.00|2,886.00
G52.8|DISORDERS OF OTHER SPECIFIED CRANIAL NERVES|9,620.00|6,734.00|2,886.00
G54.0|BRACHIAL PLEXUS DISORDERS; THORACIC OUTLET SYNDROME|10,270.00|7,189.00|3,081.00
G54.1|LUMBOSACRAL PLEXUS DISORDERS|10,270.00|7,189.00|3,081.00
G54.2|CERVICAL ROOT DISORDERS, NOT ELSEWHERE CLASSIFIED|10,270.00|7,189.00|3,081.00
G54.3|THORACIC ROOT DISORDERS, NOT ELSEWHERE CLASSIFIED|10,270.00|7,189.00|3,081.00
G54.4|LUMBOSACRAL ROOT DISORDERS, NOT ELSEWHERE CLASSIFIED|10,270.00|7,189.00|3,081.00
G54.5|NEURALGIC AMYOTROPHY; PARSONAGE-ALDREN-TURNER SYNDROME; SHOULDER-GIRDLE NEURITIS|10,270.00|7,189.00|3,081.00
G54.8|OTHER NERVE ROOT AND PLEXUS DISORDERS|10,270.00|7,189.00|3,081.00
G54.9|NERVE ROOT AND PLEXUS DISORDER, UNSPECIFIED|10,270.00|7,189.00|3,081.00
G55.8*|NERVE ROOT AND PLEXUS COMPRESSIONS IN OTHER DISEASES CLASSIFIED ELSEWHERE|10,270.00|7,189.00|3,081.00
G60.0|HEREDITARY MOTOR AND SENSORY NEUROPATHY; DISEASE CHARCOT-MARIE-TOOTH; DISEASE DéJERINE- SOTTAS; HEREDITARY MOTOR AND SENSORY NEUROPATHY, TYPES I-IV; HYPERTROPHIC NEUROPATHY OF INFANCY; PERONEAL MUSCULAR ATROPHY AXONAL TYPE; PERONEAL MUSCULAR ATROPHY HYPERT|13,780.00|9,646.00|4,134.00
G60.1|REFSUM'S DISEASE|13,780.00|9,646.00|4,134.00
G60.2|NEUROPATHY IN ASSOCIATION WITH HEREDITARY ATAXIA|13,780.00|9,646.00|4,134.00
G60.3|IDIOPATHIC PROGRESSIVE NEUROPATHY|13,780.00|9,646.00|4,134.00
G60.8|OTHER HEREDITARY AND IDIOPATHIC NEUROPATHIES; MORVAN'S DISEASE; NELATON'S SYNDROME; SENSORY NEUROPATHY DOMINANTLY INHERITED; SENSORY NEUROPATHY RECESSIVELY INHERITED|13,780.00|9,646.00|4,134.00
G60.9|HEREDITARY AND IDIOPATHIC NEUROPATHY, UNSPECIFIED|13,780.00|9,646.00|4,134.00
G61.0|GUILLAIN-BARRé SYNDROME; ACUTE POST- INFECTIVE POLYNEURITIS; ACUTE INFECTIVE POLYNEURITIS|13,780.00|9,646.00|4,134.00
G61.8|OTHER INFLAMMATORY POLYNEUROPATHIES|13,780.00|9,646.00|4,134.00
G61.9|INFLAMMATORY POLYNEUROPATHY, UNSPECIFIED|13,780.00|9,646.00|4,134.00
G62.0|DRUG-INDUCED POLYNEUROPATHY|13,780.00|9,646.00|4,134.00
G62.1|ALCOHOLIC POLYNEUROPATHY|13,780.00|9,646.00|4,134.00
G62.2|POLYNEUROPATHY DUE TO OTHER TOXIC AGENTS|13,780.00|9,646.00|4,134.00
G62.8|OTHER SPECIFIED POLYNEUROPATHIES; RADIATION- INDUCED POLYNEUROPATHY|13,780.00|9,646.00|4,134.00
G62.9|POLYNEUROPATHY, UNSPECIFIED; NEUROPATHY NOS|13,780.00|9,646.00|4,134.00
G63.8*|POLYNEUROPATHY IN OTHER DISEASES CLASSIFIED ELSEWHERE|13,780.00|9,646.00|4,134.00
G64|OTHER DISORDERS OF PERIPHERAL NERVOUS SYSTEM; DISORDER OF PERIPHERAL NERVOUS SYSTEM NOS|13,780.00|9,646.00|4,134.00
G70.0|MYASTHENIA GRAVIS|10,270.00|7,189.00|3,081.00
G70.2|CONGENITAL AND DEVELOPMENTAL MYASTHENIA|10,270.00|7,189.00|3,081.00
G70.8|OTHER SPECIFIED MYONEURAL DISORDERS|10,270.00|7,189.00|3,081.00
G70.9|MYONEURAL DISORDER, UNSPECIFIED|10,270.00|7,189.00|3,081.00
G71.0|MUSCULAR DYSTROPHY; MUSCULAR DYSTROPHY AUTOSOMAL RECESSIVE, CHILDHOOD TYPE, RESEMBLING DUCHENNE OR BECKER; MUSCULAR DYSTROPHY BENIGN [BECKER]; MUSCULAR DYSTROPHY BENIGN; CAPULOPERONEAL WITH EARLY CONTRACTURES [EMERY- DREIFUSS]; MUSCULAR DYSTROPHY DISTAL;|10,270.00|7,189.00|3,081.00
G71.1|MYOTONIC DISORDERS; DYSTROPHIA MYOTONICA [STEINERT]; MYOTONIA, CHONDRODYSTROPHIC; MYOTONIA, DRUG-INDUCED; MYOTONIA, SYMPTOMATIC; MYOTONIA, CONGENITA NOS; MYOTONIA, CONGENITA DOMINANT [THOMSEN]; MYOTONIA, CONGENITAL RECESSIVE [BECKER]; NEUROMYOTONIA [ISAAC|10,270.00|7,189.00|3,081.00
G71.2|CONGENITAL MYOPATHIES; CONGENITAL MUSCULAR DYSTROPHY NOS; CONGENITAL MUSCULAR DYSTROPHY WITH SPECIFIC MORPHOLOGICAL ABNORMALITIES OF THE MUSCLE FIBRE; CENTRAL COREDISEASE ; MINICORE DISEASE ; MULTICOREDISEASE ; FIBRE-TYPE DISPROPORTION; MYOPATHY MYOTUBULA|10,270.00|7,189.00|3,081.00
G71.9|PRIMARY DISORDER OF MUSCLE, UNSPECIFIED; HEREDITARY MYOPATHY NOS|10,270.00|7,189.00|3,081.00
G72.0|DRUG-INDUCED MYOPATHY|10,270.00|7,189.00|3,081.00
G72.1|ALCOHOLIC MYOPATHY|10,270.00|7,189.00|3,081.00
G72.2|MYOPATHY DUE TO OTHER TOXIC AGENTS|10,270.00|7,189.00|3,081.00
G72.3|PERIODIC PARALYSIS; PERIODIC PARALYSIS (FAMILIAL) HYPERKALAEMIC; PERIODIC PARALYSIS (FAMILIAL) HYPOKALAEMIC; PERIODIC PARALYSIS (FAMILIAL) MYOTONIC; PERIODIC PARALYSIS (FAMILIAL) NORMOKALAEMIC|10,270.00|7,189.00|3,081.00
G72.4|INFLAMMATORY MYOPATHY, NOT ELSEWHERE CLASSIFIED|10,270.00|7,189.00|3,081.00
G72.8|OTHER SPECIFIED MYOPATHIES|10,270.00|7,189.00|3,081.00
G72.9|MYOPATHY, UNSPECIFIED|10,270.00|7,189.00|3,081.00
G80.0|SPASTIC CEREBRAL PALSY; CONGENITAL SPASTIC PARALYSIS (CEREBRAL); SPASTIC TETRAPLEGIC CEREBRAL PALSY|12,350.00|8,645.00|3,705.00
G80.1|SPASTIC DIPLEGIA; SPASTIC CEREBRAL PALSY NOS|12,350.00|8,645.00|3,705.00
G80.2|INFANTILE HEMIPLEGIA|12,350.00|8,645.00|3,705.00
G80.3|DYSKINETIC CEREBRAL PALSY; ATHETOID CEREBRAL PALSY; DYSTONIC CEREBRAL PALSY|12,350.00|8,645.00|3,705.00
G80.4|ATAXIC CEREBRAL PALSY|12,350.00|8,645.00|3,705.00
G80.8|OTHER INFANTILE CEREBRAL PALSY; MIXED CEREBRAL PALSY SYNDROMES|12,350.00|8,645.00|3,705.00
G80.9|INFANTILE CEREBRAL PALSY, UNSPECIFIED; CEREBRAL PALSY NOS|12,350.00|8,645.00|3,705.00
G83.4|CAUDA EQUINA SYNDROME; NEUROGENIC BLADDER DUE TO CAUDA EQUINA SYNDROME EXCLUDES: CORD BLADDER NOS (G95.8)|11,440.00|8,008.00|3,432.00
G90.0|IDIOPATHIC PERIPHERAL AUTONOMIC NEUROPATHY; CAROTID SINUS SYNCOPE|20,540.00|14,378.00|6,162.00
G90.1|FAMILIAL DYSAUTONOMIA [RILEY-DAY]|20,540.00|14,378.00|6,162.00
G90.2|HORNER'S SYNDROME; BERNARD(-HORNER) SYNDROME|20,540.00|14,378.00|6,162.00
G90.4|AUTONOMIC DYSREFLEXIA|20,540.00|14,378.00|6,162.00
G90.9|DISORDER OF AUTONOMIC NERVOUS SYSTEM, UNSPECIFIED; ACQUIRED HYDROCEPHALUS|20,540.00|14,378.00|6,162.00
G91.0|COMMUNICATING HYDROCEPHALUS|22,490.00|15,743.00|6,747.00
G91.1|OBSTRUCTIVE HYDROCEPHALUS|22,490.00|15,743.00|6,747.00
G91.2|NORMAL-PRESSURE HYDROCEPHALUS|22,490.00|15,743.00|6,747.00
G91.3|POST-TRAUMATIC HYDROCEPHALUS, UNSPECIFIED|22,490.00|15,743.00|6,747.00
G91.8|OTHER HYDROCEPHALUS|22,490.00|15,743.00|6,747.00
G91.9|HYDROCEPHALUS, UNSPECIFIED|22,490.00|15,743.00|6,747.00
G92|TOXIC ENCEPHALOPATHY|28,860.00|20,202.00|8,658.00
G93.0|CEREBRAL CYSTS; ARACHNOID CYST; PORENCEPHALIC CYST, ACQUIRED|20,540.00|14,378.00|6,162.00
G93.1|ANOXIC BRAIN DAMAGE, NOT ELSEWHERE CLASSIFIED|28,860.00|20,202.00|8,658.00
G93.2|BENIGN INTRACRANIAL HYPERTENSION|20,540.00|14,378.00|6,162.00
G93.3|POSTVIRAL FATIGUE SYNDROME; BENIGN MYALGIC ENCEPHALOMYELITIS|20,540.00|14,378.00|6,162.00
G93.4|ENCEPHALOPATHY, UNSPECIFIED|20,540.00|14,378.00|6,162.00
G93.5|COMPRESSION OF BRAIN; [COMPRESSION, HERNIATION] OF BRAIN (STEM)|29,120.00|20,384.00|8,736.00
G93.7|REYE'S SYNDROME|20,540.00|14,378.00|6,162.00
G93.8|OTHER SPECIFIED DISORDERS OF BRAIN|20,540.00|14,378.00|6,162.00
G93.9|DISORDER OF BRAIN, UNSPECIFIED|20,540.00|14,378.00|6,162.00
G94.8*|OTHER SPECIFIED DISORDERS OF BRAIN IN DISEASES CLASSIFIED ELSEWHERE|20,540.00|14,378.00|6,162.00
G95.0|SYRINGOMYELIA AND SYRINGOBULBIA|20,540.00|14,378.00|6,162.00
G95.1|VASCULAR MYELOPATHIES; ACUTE INFARCTION OF SPINAL CORD (EMBOLIC)(NONEMBOLIC); ARTERIAL THROMBOSIS OF SPINAL CORD; HAEMATOMYELIA; NONPYOGENIC INTRASPINAL PHLEBITIS AND THROMBOPHLEBITIS; OEDEMA OF SPINAL CORD; SUBACUTE NECROTIC MYELOPATHY|20,540.00|14,378.00|6,162.00
G95.2|CORD COMPRESSION, UNSPECIFIED|20,540.00|14,378.00|6,162.00
G95.8|OTHER SPECIFIED DISEASES OF SPINAL CORD; CORD BLADDER NOS; ELOPATHY DRUG-INDUCED; MYELOPATHY RADIATION-INDUCED|20,540.00|14,378.00|6,162.00
G95.9|DISEASE OF SPINAL CORD, UNSPECIFIED; MYELOPATHY NOS|20,540.00|14,378.00|6,162.00
G96.0|CEREBROSPINAL FLUID LEAK|20,540.00|14,378.00|6,162.00
G96.1|DISORDERS OF MENINGES, NOT ELSEWHERE CLASSIFIED; CEREBRAL MENINGEAL ADHESIONS; SPINAL   MENINGEAL ADHESIONS|20,540.00|14,378.00|6,162.00
G96.8|OTHER SPECIFIED DISORDERS OF CENTRAL NERVOUS SYSTEM|20,540.00|14,378.00|6,162.00
G96.9|DISORDER OF CENTRAL NERVOUS SYSTEM, UNSPECIFIED|20,540.00|14,378.00|6,162.00
G97.1|OTHER REACTION TO SPINAL AND LUMBAR PUNCTURE|13,390.00|9,373.00|4,017.00
G97.8|OTHER POSTPROCEDURAL DISORDERS OF NERVOUS SYSTEM|13,390.00|9,373.00|4,017.00
G98|OTHER DISORDERS OF NERVOUS SYSTEM, NOT ELSEWHERE CLASSIFIED; NERVOUS SYSTEM DISORDER NOS|20,540.00|14,378.00|6,162.00
H05.0|ACUTE INFLAMMATION OF ORBIT; ABSCESS OF ORBIT;CELLULITIS OF ORBIT; OSTEOMYELITIS OF ORBIT; PERIOSTITIS OF ORBIT, TENONITIS OF ORBIT|12,350.00|8,645.00|3,705.00
H05.2|EXOPHTHALMIC CONDITIONS; DISPLACEMENT OF GLOBE (LATERAL) NOS; HAEMORRHAGE OF ORBIT; OEDEMA OF ORBIT|12,350.00|8,645.00|3,705.00
H30.1|DISSEMINATED CHORIORETINAL INFLAMMATION; DISSEMINATED CHORIORETINITIS; DISSEMINATED CHOROIDITIS; DISSEMINATED RETINITIS;  DISSEMINATED RETINOCHOROIDITIS|5,980.00|4,186.00|1,794.00
H30.8|OTHER CHORIORETINAL INFLAMMATIONS; HARADA'S DISEASE|5,980.00|4,186.00|1,794.00
H31.3|CHOROIDAL HAEMORRHAGE AND RUPTURE; CHOROIDAL HAEMORRHAGE NOS; CHOROIDAL HAEMORRHAGE EXPULSIVE|5,980.00|4,186.00|1,794.00
H34.1|CENTRAL RETINAL ARTERY OCCLUSION|10,010.00|7,007.00|3,003.00
H34.2|OTHER RETINAL ARTERY OCCLUSIONS; HOLLENHORST'S PLAQUE; RETINAL ARTERY OCCLUSION; RETINAL ARTERY BRANCH OCCLUSION ; RETINAL ARTERY PARTIAL OCCLUSION; RETINAL MICROEMBOLISM|10,010.00|7,007.00|3,003.00
H34.8|OTHER RETINAL VASCULAR OCCLUSIONS; RETINAL CENTRAL VEIN OCCLUSION ; RETINAL VEIN OCCLUSION INCIPIENT; RETINAL VEIN OCCLUSION  PARTIAL; RETINAL VEIN OCCLUSION  TRIBUTARY|10,010.00|7,007.00|3,003.00
H34.9|RETINAL VASCULAR OCCLUSION, UNSPECIFIED|10,010.00|7,007.00|3,003.00
H40.0|GLAUCOMA SUSPECT; OCULAR HYPERTENSION|8,450.00|5,915.00|2,535.00
H40.1|PRIMARY OPEN-ANGLE GLAUCOMA; PRIMARY CAPSULAR WITH PSEUDOEXFOLIATION OF LENS GLAUCOMA; RESIDUAL STAGE CAPSULAR WITH PSEUDOEXFOLIATION OF LENS; PRIMARY CHRONIC SIMPLE GLAUCOMA; RESIDUAL STAGE CHRONIC SIMPLE GLAUCOMA; PRIMARY LOW-TENSION GLAUCOMA; RESIDUAL|8,450.00|5,915.00|2,535.00
H40.2|PRIMARY ANGLE-CLOSURE GLAUCOMA; PRIMARY ACUTE ANGLE-CLOSURE GLAUCOMA ; ACUTE RESIDUAL STAGE ANGLE-CLOSURE GLAUCOMA ; PRIMARY CHRONIC ANGLE- CLOSURE GLAUCOMA ; RESIDUAL STAGE CHRONIC ANGLE- CLOSURE GLAUCOMA; PRIMARY INTERMITTENT ANGLE- CLOURE GLAUCOMA; RESIDU|8,450.00|5,915.00|2,535.00
H40.3|GLAUCOMA SECONDARY TO EYE TRAUMA|8,450.00|5,915.00|2,535.00
H40.4|GLAUCOMA SECONDARY TO EYE INFLAMMATION|8,450.00|5,915.00|2,535.00
H40.5|GLAUCOMA SECONDARY TO OTHER EYE DISORDERS|8,450.00|5,915.00|2,535.00
H40.8|OTHER GLAUCOMA|8,450.00|5,915.00|2,535.00
H40.9|GLAUCOMA, UNSPECIFIED|8,450.00|5,915.00|2,535.00
H43.0|VITREOUS PROLAPSE|13,520.00|9,464.00|4,056.00
H43.1|VITREOUS HAEMORRHAGE|13,520.00|9,464.00|4,056.00
H44.0|PURULENT ENDOPHTHALMITIS; PANOPHTHALMITIS; VITREOUS ABSCESS|13,520.00|9,464.00|4,056.00
H44.1|OTHER ENDOPHTHALMITIS; PARASITIC ENDOPHTHALMITIS NOS; SYMPATHETIC UVEITIS|13,520.00|9,464.00|4,056.00
H44.5|DEGENERATED CONDITIONS OF GLOBE; ABSOLUTE GLAUCOMA; ATROPHY OF GLOBE; PHTHISIS BULBI|13,520.00|9,464.00|4,056.00
H46|OPTIC NEURITIS; OPTIC NEUROPATHY, EXCEPT ISCHAEMIC; OPTIC PAPILLITIS; RETROBULBAR NEURITIS NOS|9,620.00|6,734.00|2,886.00
H47.0|DISORDERS OF OPTIC NERVE, NOT ELSEWHERE CLASSIFIED; COMPRESSION OF OPTIC NERVE; HAEMORRHAGE IN OPTIC NERVE SHEATH; ISCHAEMIC OPTIC NEUROPATHY|9,620.00|6,734.00|2,886.00
H59.0|VITREOUS SYNDROME FOLLOWING CATARACT SURGERY|13,390.00|9,373.00|4,017.00
H59.8|OTHER POSTPROCEDURAL DISORDERS OF EYE AND ADNEXA; CHORIORETINAL SCARS AFTER SURGERY FOR DETACHMENT|13,390.00|9,373.00|4,017.00
H59.9|POSTPROCEDURAL DISORDER OF EYE AND ADNEXA, UNSPECIFIED|13,390.00|9,373.00|4,017.00
H60.1|CELLULITIS OF EXTERNAL EAR; CELLULITIS OF AURICLE; CELLULITIS OF EXTERNAL AUDITORY CANAL|11,700.00|8,190.00|3,510.00
H60.2|MALIGNANT OTITIS EXTERNA|11,700.00|8,190.00|3,510.00
H60.3|OTHER INFECTIVE OTITIS EXTERNA; DIFFUSE OTITIS EXTERNA ; HAEMORRHAGIC OTITIS EXTERNA ; SWIMMER'S EAR|11,700.00|8,190.00|3,510.00
H60.4|CHOLESTEATOMA OF EXTERNAL EAR; KERATOSIS OBTURANS OF EXTERNAL EAR (CANAL)|11,700.00|8,190.00|3,510.00
H65.0|ACUTE SEROUS OTITIS MEDIA; ACUTE AND SUBACUTE SECRETORY OTITIS MEDIA|10,140.00|7,098.00|3,042.00
H65.1|OTHER ACUTE NONSUPPURATIVE OTITIS MEDIA; ACUTE OTITIS MEDIA; S UBACUTE OTITIS MEDIA; ACUTE MUCOID ALLERGIC OTITIS MEDIA; SUBACUTE MUCOID   ALLERGIC OTITIS MEDIA; ACUTE ALLERGIC SANGUINOUS  OTITIS MEDIA; SUBACUTE SANGUINOUS ALLERGIC OTITIS MEDIA; ACUTE  A|10,140.00|7,098.00|3,042.00
H65.2|CHRONIC SEROUS OTITIS MEDIA; CHRONIC TUBOTYMPANAL CATARRH|10,140.00|7,098.00|3,042.00
H65.3|CHRONIC MUCOID OTITIS MEDIA; GLUE EAR; OTITIS MEDIA, CHRONIC MUCINOUS; OTITIS MEDIA, CHRONIC SECRETORY; OTITIS MEDIA, CHRONIC TRANSUDATIVE|10,140.00|7,098.00|3,042.00
H65.4|OTHER CHRONIC NONSUPPURATIVE OTITIS MEDIA; OTITIS MEDIA, CHRONIC ALLERGIC; OTITIS MEDIA, CHRONIC EXUDATIVE; OTITIS MEDIA, CHRONIC NONSUPPURATIVE NOS; OTITIS MEDIA, CHRONIC SEROMUCINOUS; OTITIS MEDIA, CHRONIC WITH EFFUSION (NONPURULENT)|10,140.00|7,098.00|3,042.00
H65.9|NONSUPPURATIVE OTITIS MEDIA, UNSPECIFIED; ALLERGIC OTITIS MEDIA ; CATARRHAL OTITIS MEDIA; EXUDATIVE OTITIS MEDIA ; MUCOID OTITIS MEDIA ; SECRETORY OTITIS MEDIA ; SEROMUCINOUS OTITIS MEDIA;  SEROUS OTITIS MEDIA; TRANSUDATIVE OTITIS MEDIA; OTITIS MEDIA WITH|10,140.00|7,098.00|3,042.00
H66.0|ACUTE SUPPURATIVE OTITIS MEDIA|10,140.00|7,098.00|3,042.00
H66.1|CHRONIC TUBOTYMPANIC SUPPURATIVE OTITIS MEDIA; BENIGN CHRONIC SUPPURATIVE OTITIS MEDIA; CHRONIC TUBOTYMPANIC DISEASE|10,140.00|7,098.00|3,042.00
H66.2|CHRONIC ATTICOANTRAL SUPPURATIVE OTITIS MEDIA; CHRONIC ATTICOANTRAL DISEASE|10,140.00|7,098.00|3,042.00
H66.3|OTHER CHRONIC SUPPURATIVE OTITIS MEDIA; CHRONIC SUPPURATIVE OTITIS MEDIA NOS|10,140.00|7,098.00|3,042.00
H66.4|SUPPURATIVE OTITIS MEDIA, UNSPECIFIED; PURULENT OTITIS MEDIA NOS|10,140.00|7,098.00|3,042.00
H66.9|OTITIS MEDIA, UNSPECIFIED; OTITIS MEDIA NOS; ACUTE OTITIS MEDIA  NOS;   CHRONIC OTITIS MEDIA NOS|10,140.00|7,098.00|3,042.00
H68.1|OBSTRUCTION OF EUSTACHIAN TUBE; COMPRESSION  OF EUSTACHIAN TUBE; STENOSIS OF EUSTACHIAN TUBE; STRICTURE OF EUSTACHIAN TUBE|13,520.00|9,464.00|4,056.00
H69.9|EUSTACHIAN TUBE DISORDER, UNSPECIFIED|13,520.00|9,464.00|4,056.00
H70.0|ACUTE MASTOIDITIS; ABSCESS OF MASTOID; EMPYEMA OF MASTOID|13,520.00|9,464.00|4,056.00
H70.1|CHRONIC MASTOIDITIS; CARIES OF MASTOID; FISTULA OF MASTOID|13,520.00|9,464.00|4,056.00
H70.2|PETROSITIS; ACUTE INFLAMMATION OF PETROUS BONE; CHRONIC INFLAMMATION OF PETROUS BONE|13,520.00|9,464.00|4,056.00
H70.8|OTHER MASTOIDITIS AND RELATED CONDITIONS|13,520.00|9,464.00|4,056.00
H70.9|MASTOIDITIS, UNSPECIFIED|13,520.00|9,464.00|4,056.00
H71|CHOLESTEATOMA OF MIDDLE EAR; CHOLESTEATOMA TYMPANI; PERFORATION OF TYMPANIC MEMBRANE; PERSISTENT POST-TRAUMATIC PERFORATION OF EAR DRUM; POSTINFLAMMATORY  PERFORATION OF EAR DRUM|13,520.00|9,464.00|4,056.00
H73.0|ACUTE MYRINGITIS; ACUTE TYMPANITIS; BULLOUS MYRINGITIS|13,520.00|9,464.00|4,056.00
H73.1|CHRONIC MYRINGITIS; CHRONIC TYMPANITIS|13,520.00|9,464.00|4,056.00
H73.8|OTHER SPECIFIED DISORDERS OF TYMPANIC MEMBRANE|13,520.00|9,464.00|4,056.00
H73.9|DISORDER OF TYMPANIC MEMBRANE, UNSPECIFIED|13,520.00|9,464.00|4,056.00
H74.8|OTHER SPECIFIED DISORDERS OF MIDDLE EAR AND MASTOID|13,520.00|9,464.00|4,056.00
H74.9|DISORDER OF MIDDLE EAR AND MASTOID, UNSPECIFIED|13,520.00|9,464.00|4,056.00
H81.0|MéNIèRE'S DISEASE; LABYRINTHINE HYDROPS; MéNIèRE'S SYNDROME OR VERTIGO|7,410.00|5,187.00|2,223.00
H81.1|BENIGN PAROXYSMAL VERTIGO|7,410.00|5,187.00|2,223.00
H81.2|VESTIBULAR NEURONITIS|7,410.00|5,187.00|2,223.00
H81.3|OTHER PERIPHERAL VERTIGO; LERMOYEZ' SYNDROME; AURAL VERTIGO ; OTOGENIC  VERTIGO;   PERIPHERAL NOS VERTIGO|7,410.00|5,187.00|2,223.00
H81.4|VERTIGO OF CENTRAL ORIGIN; CENTRAL POSITIONAL NYSTAGMUS|7,410.00|5,187.00|2,223.00
H81.8|OTHER DISORDERS OF VESTIBULAR FUNCTION|7,410.00|5,187.00|2,223.00
H81.9|DISORDER OF VESTIBULAR FUNCTION, UNSPECIFIED; VERTIGINOUS SYNDROME NOS|7,410.00|5,187.00|2,223.00
H83.0|LABYRINTHITIS|8,060.00|5,642.00|2,418.00
H83.1|LABYRINTHINE FISTULA|7,410.00|5,187.00|2,223.00
H83.2|LABYRINTHINE DYSFUNCTION; HYPERSENSITIVITY OF LABYRINTH; HYPOFUNCTION OF LABYRINTH; LOSS OF FUNCTION OF LABYRINTH|7,410.00|5,187.00|2,223.00
H83.8|OTHER SPECIFIED DISEASES OF INNER EAR|8,060.00|5,642.00|2,418.00
H95.8|OTHER POSTPROCEDURAL DISORDERS OF EAR AND MASTOID PROCESS|13,390.00|9,373.00|4,017.00
I00|RHEUMATIC FEVER WITHOUT MENTION OF  HEART INVOLVEMENT; ARTHRITIS, RHEUMATIC, ACUTE OR SUBACUTE INVOLVEMENT|13,130.00|9,191.00|3,939.00
I00+ J17.8*|PNEUMONIA IN RHEUMATIC FEVER|19,500.00|13,650.00|5,850.00
I01.0|ACUTE RHEUMATIC PERICARDITIS;  ACUTE RHEUMATIC PERICARDITIS|13,130.00|9,191.00|3,939.00
I01.1|ACUTE RHEUMATIC ENDOCARDITIS;  ACUTE RHEUMATIC VALVULITIS|13,130.00|9,191.00|3,939.00
I01.2|ACUTE RHEUMATIC MYOCARDITIS;|13,130.00|9,191.00|3,939.00
I01.8|OTHER ACUTE RHEUMATIC HEART DISEASE;  ACUTE RHEUMATIC PANCARDITIS|13,130.00|9,191.00|3,939.00
I01.9|ACUTE RHEUMATIC HEART DISEASE UNSPECIFIED;  ACUTE RHEUMATIC CARDITIS; ACTIVE RHEUMATIC HEART DISEASE; ACUTE RHEUMATIC HEART DISEASE|13,130.00|9,191.00|3,939.00
I02.0|RHEUMATIC CHOREA WITH HEART INVOLVEMENT; CHOREA NOS WITH HEART INVOLVEMENT|13,130.00|9,191.00|3,939.00
I02.9|RHEUMATIC CHOREA WITHOUT HEART INVOLVEMENT; RHEUMATIC CHOREA NOS|13,130.00|9,191.00|3,939.00
I05.0|MITRAL STENOSIS; RHEUMATIC MITRAL VALVE OBSTRUCTION|16,640.00|11,648.00|4,992.00
I05.1|RHEUMATIC MITRAL INSUFFICIENCY; RHEUMATIC MITRAL INCOMPETENCE; RHEUMATIC MITRAL REGURGITATION|16,640.00|11,648.00|4,992.00
I05.2|MITRAL STENOSIS WITH INSUFFICIENCY; MITRAL STENOSIS WITH INCOMPETENCE OR REGURGITATION|16,640.00|11,648.00|4,992.00
I05.8|OTHER MITRAL VALVE DISEASES; MITRAL VALVE FAILURE|16,640.00|11,648.00|4,992.00
I05.9|MITRAL VALVE DISEASE UNSPECIFIED; CHRONIC MITRAL VALVE DISORDER NOS|16,640.00|11,648.00|4,992.00
I06.0|RHEUMATIC AORTIC STENOSIS; RHEUMATIC AORTIC VALVE OBSTRUCTION|16,640.00|11,648.00|4,992.00
I06.1|RHEUMATIC AORTIC INSUFFICIENCY; RHEUMATIC AORTIC INCOMPETENCE; RHEUMATIC AORTIC REGURGITATION|16,640.00|11,648.00|4,992.00
I06.2|RHEUMATIC AORTIC STENOSIS WITH INSUFFICIENCY; RHEUMATIC AORTIC STENOSIS WITH INCOMPETENCE OR REGURGITATION|16,640.00|11,648.00|4,992.00
I06.8|OTHER RHEUMATIC AORTIC VALVE DISEASES|16,640.00|11,648.00|4,992.00
I06.9|RHEUMATIC AORTIC VALVE DISEASE UNSPECIFIED; RHEUMATIC AORTIC VALVE DISEASE NOS|16,640.00|11,648.00|4,992.00
I07.0|TRICUSPID STENOSIS; RHEUMATIC TRICUSPID VALVE STENOSIS|16,640.00|11,648.00|4,992.00
I07.1|TRICUSPID INSUFFICIENCY; RHEUMATIC TRICUSPID VALVE INSUFFICIENCY|16,640.00|11,648.00|4,992.00
I07.9|TRICUSPID VALVE DISEASE UNSPECIFIED; TRICUSPID VALVE DISORDER NOS|16,640.00|11,648.00|4,992.00
I08.0|DISORDERS OF BOTH MITRAL AND AORTIC VALVES; INVOLVEMENT OF BOTH MITRAL AND AORTIC VALVES WHETHER SPECIFIED AS RHEUMATIC OR OF UNSPECIFIED ORIGIN|16,640.00|11,648.00|4,992.00
I08.1|DISORDERS OF BOTH MITRAL AND TRICUSPID VALVES|16,640.00|11,648.00|4,992.00
I08.2|DISORDERS OF BOTH AORTIC AND TRICUSPID VALVES|16,640.00|11,648.00|4,992.00
I08.3|COMBINED DISORDERS OF MITRAL AORTIC AND TRICUSPID VALVES|16,640.00|11,648.00|4,992.00
I08.8|OTHER MULTIPLE VALVE DISEASES|16,640.00|11,648.00|4,992.00
I08.9|MULTIPLE VALVE DISEASE, UNSPECIFIED|16,640.00|11,648.00|4,992.00
I09.0|RHEUMATIC MYOCARDITIS|16,640.00|11,648.00|4,992.00
I09.1|RHEUMATIC DISEASES OF ENDOCARDIUM, VALVE UNSPECIFIED; CHRONIC RHEUMATIC ENDOCARDITIS; CHRONIC RHEUMATIC VALVULITIS|16,640.00|11,648.00|4,992.00
I09.2|CHRONIC RHEUMATIC PERICARDITIS; RHEUMATIC ADHERENT PERICARDIUM; CHRONIC RHEUMATIC MEDIASTINOPERICARDITIS; CHRONIC RHEUMATIC MYOPERICARDITIS|16,640.00|11,648.00|4,992.00
I09.8|OTHER SPECIFIED RHEUMATIC HEART DISEASES; RHEUMATIC DISEASE OF PULMONARY VALVE|16,640.00|11,648.00|4,992.00
I09.9|RHEUMATIC HEART DISEASE, UNSPECIFIED; RHEUMATIC CARDITIS; RHEUMATIC HEART FAILURE|20,410.00|14,287.00|6,123.00
I10.1|HYPERTENSION, STAGE II|11,700.00|8,190.00|3,510.00
I10.9|ESSENTIAL HYPERTENSION; MALIGNANT HYPERTENSION|11,700.00|8,190.00|3,510.00
I11.0|HYPERTENSIVE HEART DISEASE WITH (CONGESTIVE) HEART FAILURE; HYPERTENSIVE HEART FAILURE|11,700.00|8,190.00|3,510.00
I11.9|HYPERTENSIVE HEART DISEASE WITHOUT (CONGESTIVE) HEART FAILURE; HYPERTENSIVE HEART DISEASE NOS|11,700.00|8,190.00|3,510.00
I12.0|HYPERTENSIVE RENAL DISEASE WITH RENAL FAILURE; HYPERTENSIVE RENAL FAILURE|11,700.00|8,190.00|3,510.00
I12.9|HYPERTENSIVE RENAL DISEASE WITHOUT RENAL FAILURE; HYPERTENSIVE RENAL DISEASE NOS|11,700.00|8,190.00|3,510.00
I13.0|HYPERTENSIVE HEART AND RENAL DISEASE WITH (CONGESTIVE) HEART FAILURE|11,700.00|8,190.00|3,510.00
I13.1|HYPERTENSIVE HEART AND RENAL DISEASE WITH RENAL FAILURE|11,700.00|8,190.00|3,510.00
I13.2|HYPERTENSIVE HEART AND RENAL DISEASE WITH BOTH (CONGESTIVE) HEART FAILURE AND RENAL FAILURE|11,700.00|8,190.00|3,510.00
I13.9|HYPERTENSIVE HEART AND RENAL DISEASE, UNSPECIFIED|11,700.00|8,190.00|3,510.00
I15.0|RENOVASCULAR HYPERTENSION|11,700.00|8,190.00|3,510.00
I15.1|HYPERTENSION SECONDARY TO OTHER RENAL DISORDERS|11,700.00|8,190.00|3,510.00
I15.2|HYPERTENSION SECONDARY TO ENDOCRINE DISORDERS|11,700.00|8,190.00|3,510.00
I15.8|OTHER SECONDARY HYPERTENSION|11,700.00|8,190.00|3,510.00
I15.9|SECONDARY HYPERTENSION, UNSPECIFIED|11,700.00|8,190.00|3,510.00
I20.0|UNSTABLE ANGINA; ANGINA CRESCENDO; ANGINA DE NOVO EFFORT; ANGINA WORSENING EFFORT; INTERMEDIATE CORONARY SYNDROME; PREINFARCTION SYNDROME|15,600.00|10,920.00|4,680.00
I20.1|ANGINA PECTORIS WITH DOCUMENTED SPASM; ANGIOSPASTIC ANGINA ; PRINZMETAL ANGINA ; SPASM- INDUCED ANGINA ;  VARIANT ANGINA|15,600.00|10,920.00|4,680.00
I20.8|OTHER FORMS OF ANGINA PECTORIS; ANGINA OF EFFORT; STENOCARDIA|15,600.00|10,920.00|4,680.00
I20.9|ANGINA PECTORIS, UNSPECIFIED; ANGINA NOS; CARDIAC ANGINA ; ANGINAL SYNDROME; ISCHAEMIC CHEST PAIN|15,600.00|10,920.00|4,680.00
I21.0|ACUTE TRANSMURAL MYOCARDIAL INFARCTION OF ANTERIOR WALL [OR DURATION OF <4 WEEKS] KILLIPS STAGE UNSPECIFIED; ACUTE TRANSMURAL INFARCTION OF ANTERIOR WALL NOS [OR DURATION OF <4 WEEKS] KILLIPS STAGE UNSPECIFIED; ACUTE ANTEROAPICAL TRANSMURAL INFARCTION [OR|24,570.00|17,199.00|7,371.00
I21.1|ACUTE TRANSMURAL MYOCARDIAL INFARCTION OF INFERIOR WALL [OR DURATION OF <4 WEEKS] KILLIPS I; ACUTE TRANSMURAL INFARCTION OF DIAPHRAGMATIC WALL [OR DURATION OF <4 WEEKS] KILLIPS I; ACUTE TRANSMURAL INFARCTION OF INFERIOR WALL NOS [OR DURATION OF <4 WEEKS]|24,570.00|17,199.00|7,371.00
I21.2|ACUTE TRANSMURAL MYOCARDIAL INFARCTION OF OTHER SITES [OR DURATION OF <4 WEEKS]  KILLIPS II; ACUTE APICAL-LATERAL TRANSMURAL INFARCTION [OR DURATION OF <4 WEEKS]   KILLIPS II; ACUTE BASAL- LATERAL TRANSMURAL INFARCTION [OR DURATION OF <4 WEEKS]   KILLIPS I|24,570.00|17,199.00|7,371.00
I21.3|ACUTE TRANSMURAL MYOCARDIAL INFARCTION OF UNSPECIFIED SITE;  TRANSMURAL MYOCARDIAL INFARCTION NOS|24,570.00|17,199.00|7,371.00
I21.4|ACUTE SUBENDOCARDIAL MYOCARDIAL INFARCTION; NONTRANSMURAL MYOCARDIAL INFARCTION NOS|24,570.00|17,199.00|7,371.00
I22.0|SUBSEQUENT MYOCARDIAL INFARCTION OF ANTERIOR WALL; ACUTE SUBSEQUENT INFARCTION OF ANTERIOR WALL NOS; ACUTE SUBSEQUENT INFARCTION OF ANTEROAPICAL WALL; ACUTE SUBSEQUENT INFARCTION OF ANTEROLATERAL WALL; ACUTE SUBSEQUENT INFARCTION OF ANTEROSEPTAL WALL|24,570.00|17,199.00|7,371.00
I22.1|SUBSEQUENT MYOCARDIAL INFARCTION OF INFERIOR WALL; ACUTE SUBSEQUENT INFARCTION OF DIAPHRAGMATIC WALL; ACUTE SUBSEQUENT INFARCTION OF INFERIOR WALL NOS; ACUTE SUBSEQUENT INFARCTION OF INFEROLATERAL WALL; ACUTE SUBSEQUENT INFARCTION OF INFEROPOSTERIOR WALL|24,570.00|17,199.00|7,371.00
I22.8|SUBSEQUENT MYOCARDIAL INFARCTION OF OTHER SITES; ACUTE MYOCARDIAL INFARCTION OF APICAL-LATERAL WALL; ACUTE MYOCARDIAL INFARCTION OF BASAL- LATERAL WALL; ACUTE MYOCARDIAL INFARCTION OF HIGH LATERAL WALL; ACUTE MYOCARDIAL INFARCTION OF LATERAL WALL NOS; ACUT|24,570.00|17,199.00|7,371.00
I22.9|SUBSEQUENT MYOCARDIAL INFARCTION OF UNSPECIFIED SITE|24,570.00|17,199.00|7,371.00
I23.0|HAEMOPERICARDIUM AS CURRENT COMPLICATION FOLLOWING ACUTE MYOCARDIAL INFARCTION|24,570.00|17,199.00|7,371.00
I23.1|ATRIAL SEPTAL DEFECT AS CURRENT COMPLICATION FOLLOWING ACUTE MYOCARDIAL INFARCTION|24,570.00|17,199.00|7,371.00
I23.2|VENTRICULAR SEPTAL DEFECT AS CURRENT COMPLICATION FOLLOWING ACUTE MYOCARDIAL INFARCTION|24,570.00|17,199.00|7,371.00
I23.3|RUPTURE OF CARDIAC WALL WITHOUT HAEMOPERICARDIUM AS CURRENT COMPLICATION FOLLOWING ACUTE MYOCARDIAL INFARCTION|24,570.00|17,199.00|7,371.00
I23.4|RUPTURE OF CHORDAE TENDINEAE AS CURRENT COMPLICATION FOLLOWING ACUTE MYOCARDIAL INFARCTION|24,570.00|17,199.00|7,371.00
I23.5|RUPTURE OF PAPILLARY MUSCLE AS CURRENT COMPLICATION FOLLOWING ACUTE MYOCARDIAL INFARCTION|24,570.00|17,199.00|7,371.00
I23.8|OTHER CURRENT COMPLICATIONS FOLLOWING ACUTE MYOCARDIAL INFARCTION|24,570.00|17,199.00|7,371.00
I24.0|CORONARY THROMBOSIS NOT RESULTING IN MYOCARDIAL INFARCTION; CORONARY ARTERY EMBOLISM NOT RESULTING IN MYOCARDIAL INFACTION; CORONARY VEIN EMBOLISM NOT RESULTING IN MYOCARDIAL INFARCTION; CORONARY ARTERY OCCLUSION NOT RESULTING IN MYOCARDIAL INFARCTION; CO|15,600.00|10,920.00|4,680.00
I24.1|DRESSLER'S SYNDROME; POSTMYOCARDIAL INFARCTION SYNDROME|24,570.00|17,199.00|7,371.00
I24.8|OTHER FORMS OF ACUTE ISCHAEMIC HEART DISEASE; CORONARY FAILURE; CORONARY INSUFFICIENCY|15,600.00|10,920.00|4,680.00
I25.0|ATHEROSCLEROTIC CARDIOVASCULARDISEASE, SO DESCRIBED|5,200.00|3,640.00|1,560.00
I25.1|ATHEROSCLEROTIC HEAR TDISEASE; CORONARY ARTERY ATHEROMA; CORONARY ARTERY ATHEROSCLEROSIS; CORONARY ARTERY DISEASE; CORONARY ARTERY SCLEROSIS|5,200.00|3,640.00|1,560.00
I25.3|ANEURYSM OF HEART; MURAL ANEURYSM; VENTICULAR ANEURYSM|5,200.00|3,640.00|1,560.00
I25.4|CORONARY ARTERY ANEURYSM; CORONARY ARTERIOVENOUS FISTULA, ACQUIRED|5,200.00|3,640.00|1,560.00
I25.5|ISCHAEMIC CARDIOMYOPATHY|15,600.00|10,920.00|4,680.00
I25.6|SILENT MYOCARDIAL ISCHAEMIA|15,600.00|10,920.00|4,680.00
I25.8|OTHER FORMS OF CHRONIC ISCHAEMIC HEART DISEASE|15,600.00|10,920.00|4,680.00
I25.9|CHRONIC ISCHAEMIC HEART DISEASE, UNSPECIFIED; CHRONIC ISCHAEMIC HEART DISEASE NOS|15,600.00|10,920.00|4,680.00
I26.0|PULMONARY EMBOLISM WITH MENTION OF ACUTE COR PULMONALE; ACUTE COR PULMONALE NOS|31,590.00|22,113.00|9,477.00
I26.9|PULMONARY EMBOLISM WITHOUT MENTION OF ACUTE COR PULMONALE; PULMONARY EMBOLISM NOS|31,590.00|22,113.00|9,477.00
I27.0|PRIMARY PULMONARY HYPERTENSION|18,330.00|12,831.00|5,499.00
I27.1|KYPHOSCOLIOTIC HEART DISEASE|18,330.00|12,831.00|5,499.00
I27.2|OTHER SECONDARY PULMONARY HYPERTENSION; PULMONARY ARTERY HYPERTENSION|18,330.00|12,831.00|5,499.00
I27.8|OTHER SPECIFIED PULMONARY HEART DISEASES|18,330.00|12,831.00|5,499.00
I27.9|PULMONARY HEART DISEASE, UNSPECIFIED; CHRONIC CARDIOPULMONARY DISEASE; CHRONIC COR PULMONALE NOS|18,330.00|12,831.00|5,499.00
I28.8|OTHER SPECIFIED DISEASES OF PULMONARY VESSELS; RUPTURE OF PULMONARY VESSEL; STENOSIS OF PULMONARY VESSEL; STRICTURE OF PULMONARY VESSEL|17,030.00|11,921.00|5,109.00
I30.0|ACUTE NONSPECIFIC IDIOPATHIC PERICARDITIS|18,720.00|13,104.00|5,616.00
I30.1|INFECTIVE PERICARDITIS; PNEUMOCOCCAL PERICARDITIS; PURULENT PERICARDITIS; STAPHYLOCOCCAL PERICARDITIS; STREPTOCOCCAL PERICARDITIS; VIRAL PERICARDITIS; PYOPERICARDITIS|18,720.00|13,104.00|5,616.00
I30.8|OTHER FORMS OF ACUTE PERICARDITIS|18,720.00|13,104.00|5,616.00
I30.9|ACUTE PERICARDITIS, UNSPECIFIED|18,720.00|13,104.00|5,616.00
I31.0|CHRONIC ADHESIVE PERICARDITIS; ACCRETIO CORDIS; ADHERENT PERICARDIUM; ADHESIVE MEDIASTINOPERICARDITIS|18,720.00|13,104.00|5,616.00
I31.1|CHRONIC CONSTRICTIVE PERICARDITIS; CONCRETIO CORDIS; PERICARDIAL CALCIFICATION|18,720.00|13,104.00|5,616.00
I33.0|ACUTE AND SUBACUTE INFECTIVE ENDOCARDITIS; ACUTE BACTERIAL ENDOCARDITIS; SUBACUTE BACTERIAL ENDOCARDITIS; ACUTE INFECTIVE ENDOCARDITIS NOS; SUBACUTE INFECTIVE ENDOCARDITIS NOS; ACUTE LENTA ENDOCARDITIS; SUBACUTE LENTA ENDOCARDITIS; ACUTE MALIGNANT ENDOCAR|18,720.00|13,104.00|5,616.00
I33.9|ACUTE ENDOCARDITIS, UNSPECIFIED; ENDOCARDITIS, ACUTE OR SUBACUTE; MYOENDOCARDITIS, ACUTE OR SUBACUTE; PERIENDOCARDITIS, ACUTE OR SUBACUTE|18,720.00|13,104.00|5,616.00
I34.0|MITRAL (VALVE) INSUFFICIENCY; INCOMPETENCE MITRAL VALVE NOS OR OF SPECIFIED CAUSE, EXCEPT RHEUMATIC; REGURGITATION MITRAL VALVE NOS OR OF SPECIFIED CAUSE, EXCEPT RHEUMATIC|10,920.00|7,644.00|3,276.00
I34.1|MITRAL (VALVE) PROLAPSE; FLOPPY MITRAL VALVE SYNDROME|10,920.00|7,644.00|3,276.00
I34.2|NONRHEUMATIC MITRAL (VALVE) STENOSIS|10,920.00|7,644.00|3,276.00
I34.8|OTHER NONRHEUMATIC MITRAL HEART VALVE DISORDERS|10,920.00|7,644.00|3,276.00
I34.9|NONRHEUMATIC MITRAL VALVE DISORDER, UNSPECIFIED|10,920.00|7,644.00|3,276.00
I35.0|AORTIC (VALVE) STENOSIS|10,920.00|7,644.00|3,276.00
I35.1|AORTIC (VALVE) INSUFFICIENCY; INCOMPETENCE AORTIC VALVE NOS OR OF SPECIFIED CAUSE, EXCEPT RHEUMATIC; AORTIC VALVE REGURGITATION NOS OR OF SPECIFIED CAUSE, EXCEPT RHEUMATIC|10,920.00|7,644.00|3,276.00
I35.2|AORTIC (VALVE) STENOSIS WITH INSUFFICIENCY|10,920.00|7,644.00|3,276.00
I35.8|OTHER AORTIC HEART VALVE DISORDERS|10,920.00|7,644.00|3,276.00
I35.9|AORTIC VALVE DISORDER, UNSPECIFIED|10,920.00|7,644.00|3,276.00
I36.0|NONRHEUMATIC TRICUSPID (VALVE) STENOSIS|10,920.00|7,644.00|3,276.00
I36.1|NONRHEUMATIC TRICUSPID (VALVE) INSUFFICIENCY; INCOMPETENCE TRICUSPID VALVE OF SPECIFIED CAUSE, EXCEPT RHEUMATIC; TRICUSPID VALVE REGURGITATION OF SPECIFIED CAUSE, EXCEPT RHEUMATIC|10,920.00|7,644.00|3,276.00
I36.8|OTHER NONRHEUMATIC TRICUSPID VALVE DISORDERS|10,920.00|7,644.00|3,276.00
I36.9|NONRHEUMATIC TRICUSPID VALVE DISORDER, UNSPECIFIED|10,920.00|7,644.00|3,276.00
I37.0|PULMONARY VALVE STENOSIS|10,920.00|7,644.00|3,276.00
I37.1|PULMONARY VALVE INSUFFICIENCY; INCOMPETENCE PULMONARY VALVE NOS OR SPECIFIED CAUSE, EXCEPT RHEUMATIC; PULMONARY VALVE REGURGITATION NOS OR OF SPECIFIED CAUSE, EXCEPT RHEUMATIC|10,920.00|7,644.00|3,276.00
I37.8|OTHER PULMONARY HEART VALVE DISORDERS|10,920.00|7,644.00|3,276.00
I37.9|PULMONARY VALVE DISORDER, UNSPECIFIED|10,920.00|7,644.00|3,276.00
I38|ENDOCARDITIS, VALVE UNSPECIFIED; CHRONIC ENDOCARDITIS NOS; VALVULAR INCOMPETENCE OF UNSPECIFIED VALVE NOS OR OF SPECIFIED CAUSE, EXCEPT RHEUMATIC OR CONGENITAL; VALVULAR INSUFFICIENCY OF UNSPECIFIED VALVE NOS OR OF SPECIFIED CAUSE, EXCEPT RHEUMATIC OR CON|18,720.00|13,104.00|5,616.00
I40.0|INFECTIVE MYOCARDITIS; SEPTIC MYOCARDITIS|18,720.00|13,104.00|5,616.00
I40.1|ISOLATED MYOCARDITIS|18,720.00|13,104.00|5,616.00
I40.8|OTHER ACUTE MYOCARDITIS|18,720.00|13,104.00|5,616.00
I40.9|ACUTE MYOCARDITIS, UNSPECIFIED|18,720.00|13,104.00|5,616.00
I42.0|DILATED CARDIOMYOPATHY; CONGESTIVE CARDIOMYOPATHY|17,420.00|12,194.00|5,226.00
I42.1|OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY; HYPERTROPHIC SUBAORTIC STENOSIS|17,420.00|12,194.00|5,226.00
I42.2|OTHER HYPERTROPHIC CARDIOMYOPATHY; NONOBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY|17,420.00|12,194.00|5,226.00
I42.3|ENDOMYOCARDIAL (EOSINOPHILIC) DISEASE; ENDOMYOCARDIAL (TROPICAL) FIBROSIS; LöFFLER'S ENDOCARDITIS|17,420.00|12,194.00|5,226.00
I42.4|ENDOCARDIAL FIBROELASTOSIS; CONGENITAL CARDIOMYOPATHY|17,420.00|12,194.00|5,226.00
I42.5|OTHER RESTRICTIVE CARDIOMYOPATHY|17,420.00|12,194.00|5,226.00
I42.6|ALCOHOLIC CARDIOMYOPATHY|17,420.00|12,194.00|5,226.00
I42.7|CARDIO MYOPATHY DUE TO DRUGS AND OTHER EXTERNAL AGENTS|17,420.00|12,194.00|5,226.00
I42.8|OTHER CARDIOMYOPATHIES|17,420.00|12,194.00|5,226.00
I42.9|CARDIO MYOPATHY, UNSPECIFIED; PRIMARY CARDIOMYOPATHY NOS; SECONDARY CARDIOMYOPATHY NOS|17,420.00|12,194.00|5,226.00
I44.2|ATRIOVENTRICULAR BLOCK, COMPLETE; COMPLETE HEART BLOCK NOS; THIRD-DEGREE BLOCK|15,990.00|11,193.00|4,797.00
I44.3|OTHER AND UNSPECIFIED ATRIOVENTRICULAR BLOCK; ATRIOVENTRICULAR BLOCK NOS|15,990.00|11,193.00|4,797.00
I44.4|LEFT ANTERIOR FASCICULAR BLOCK|15,990.00|11,193.00|4,797.00
I45.5|OTHER SPECIFIED HEART BLOCKL; SINOATRIAL NOS; SINOAURICULAR BLOCK|15,990.00|11,193.00|4,797.00
I45.6|PRE-EXCITATION SYNDROME; ANOMALOUS ATRIOVENTICULAR EXCITATION; ATRIOVENTRICULAR CONDUCTION, ACCELERATED; ATRIOVENTICULAR CONDUCTION,  ACCESORY; ATRIOVENTICULAR CONDUCTION PRE-EXCITATION; LOWN-GANONG-LEVINE SYNDROME; WOLFF-PARKINSON-WHITE SYNDROME|15,990.00|11,193.00|4,797.00
I45.8|OTHER SPECIFIED HEART CONDUCTION DISORDERSS; ATRIOVENTICULAR [AV] DISSOCIATION; INTERFERENCE DISSOCIATION|15,990.00|11,193.00|4,797.00
I45.9|HEART CONDUCTION DISORDERS, UNSPECIFIED; HEART BLOCK NOS; STOKES-ADAMS SYNDROME|15,990.00|11,193.00|4,797.00
I47.0|RE-ENTRY VENTRICULAR ARRHYTHMIA|15,860.00|11,102.00|4,758.00
I47.1|SUPRAVENTRICULAR TACHYCARDIA; ATRIAL PAROXYSMAL TACHYCARDIA; ATRIOVENTRICULAR [AV] PAROXYSMAL TACHYCARDIA; JUNCTIONAL PAROXYSMAL TACHYCARDIA; NODAL PAROXYSMAL TACHYCARDIA|15,860.00|11,102.00|4,758.00
I47.2|VENTRICULAR TACHYCARDIA|15,860.00|11,102.00|4,758.00
I47.9|PAROXYSMAL TACHYCARDIA, UNSPECIFIED; BOUVERET (- HOFFMANN) SYNDROME|15,860.00|11,102.00|4,758.00
I48|ATRIAL FIBRILLATION AND FLUTTER|15,860.00|11,102.00|4,758.00
I49.0|VENTRICULAR FIBRILLATION AND FLUTTER|15,860.00|11,102.00|4,758.00
I49.1|ATRIAL PREMATURE DEPOLARIZATION; ATRIAL PREMATURE BEATS|15,860.00|11,102.00|4,758.00
I49.2|JUNCTIONAL PREMATURE DEPOLARIZATION|15,860.00|11,102.00|4,758.00
I49.3|VENTRICULAR PREMATURE DEPOLARIZATION|15,860.00|11,102.00|4,758.00
I49.4|OTHER AND UNSPECIFIED PREMATURE DEPOLARIZATION; ECTOPIC BEATS; EXTRASYSTOLES; EXTRASYSTOLIC ARRHYTHMIAS; PREMATURE BEATS NOS; PREMATURE CONTRACTIONS|15,860.00|11,102.00|4,758.00
I49.5|SICK SINUS SYNDROME; TACHYCARDIA-BRADYCARDIA SYNDROME|15,860.00|11,102.00|4,758.00
I49.8|OTHER SPECIFIED CARDIAC ARRHYTHMIAS; CORONARY SINUS RHYTHM DISORDER; ECTOPIC RHYTHM DISORDER; NODAL RHYTHM DISORDER|15,860.00|11,102.00|4,758.00
I49.9|CARDIAC ARRHYTHMIA, UNSPECIFIED; CARDIAC ARRHYTHMIA NOS|15,860.00|11,102.00|4,758.00
I50.0|CONGESTIVE HEART FAILURE; CONGESTIVE HEART DISEASE; RIGHT VENTICULAR FAILURE (SECONDARY TO LEFT HEART FAILURE)|20,410.00|14,287.00|6,123.00
I50.00|ADVANCED CONGESTIVE HEART FAILURE; GRAVE CONGESTIVE HEART FAILURE; SEVERE CONGESTIVE HEART FAILURE|20,410.00|14,287.00|6,123.00
I50.1|LEFT VENTRICULAR FAILURE; ACUTE OEDEMA OF LUNG WITH MENTION OF HEART DISEASE NOS OR HEART FAILURE; ACUTE PULMONARY OEDEMA WITH MENTION OF HEART DISEASE NOS OR HEART FAILURE; CARDIAC ASTHMA WITH MENTION OF HEART DISEASE NOS OR HEART FAILURE; LEFT HEART FAI|20,410.00|14,287.00|6,123.00
I50.9|HEART FAILURE, UNSPECIFIED; CARDIAC, HEART OR MYOCARDIAL FAILURE NOS|20,410.00|14,287.00|6,123.00
I51.0|CARDIAC SEPTAL DEFECT, ACQUIRED; ACQUIRED  ATRIAL SEPTAL DEFECT OLD; ACQUIRED AURICULAR SEPTAL DEFECT OLD ; ACQUIRED VENTRICULAR SEPTAL DEFECT OLD|18,720.00|13,104.00|5,616.00
I51.1|RUPTURE OF CHORDAE TENDINEAE, NOT ELSEWHERE CLASSIFIED|18,720.00|13,104.00|5,616.00
I51.2|RUPTURE OF PAPILLARY MUSCLE, NOT ELSEWHERE CLASSIFIED|18,720.00|13,104.00|5,616.00
I51.3|INTRA CARDIAC THROMBOSIS, NOTEL SEWHERE CLASSIFIED; OLD  APICAL THROMBOSIS;  OLD ATRIAL THROMBOSIS; OLD  AURICULAR THROMBOSIS; OLD VENTICULAR  THROMBOSIS|18,720.00|13,104.00|5,616.00
I51.4|MYOCARDITIS, UNSPECIFIED; MYOCARDIAL FIBROSIS; MYOCARDITIS NOS; CHRONIC INTERSTITIAL MYOCARDITIS|18,720.00|13,104.00|5,616.00
I51.5|MYOCARDIAL DEGENERATION; FATTY DEGENERATION OF HEART OR MYOCARDIUM FATTY;  SENILE DEGENERATION OF HEART OR MYOCARDIUM; MYOCARDIAL DISEASE|18,720.00|13,104.00|5,616.00
I51.8|OTHER ILL-DEFINED HEART DISEASES; ACUTE CARDITIS; CHRONIC CARDITIS; ACUTE PANCARDITIS; CHRONIC PANCARDITIS|18,720.00|13,104.00|5,616.00
I65.2|OCCLUSION AND STENOSIS OF CAROTID ARTERY|19,760.00|13,832.00|5,928.00
I67.0|DISSECTION OF CEREBRAL ARTERIES, NONRUPTURED|19,760.00|13,832.00|5,928.00
I67.1|CEREBRAL ANEURYSM, NONRUPTURED; CEREBRAL ANEURYSM NOS; CEREBRAL ARTERIOVENOUS FISTULA, ACQUIRED|19,760.00|13,832.00|5,928.00
I67.2|CEREBRAL ATHEROSCLEROSIS; ATHEROMA OF CEREBRAL ARTERIES|19,760.00|13,832.00|5,928.00
I67.3|PROGRESSIVE VASCULAR LEUKOENCEPHALOPATHY; BINSWANGER'S DISEASE|19,760.00|13,832.00|5,928.00
I67.4|HYPERTENSIVE ENCEPHALOPATHY|28,860.00|20,202.00|8,658.00
I67.5|MOYAMOYA DISEASE|19,760.00|13,832.00|5,928.00
I67.6|NONPYOGENIC THROMBOSIS OF INTRACRANIAL VENOUS SYSTEM; NONPYOGENIC THROMBOSIS OF CEREBRAL VEIN; NONPYOGENIC THROMBOSIS OF INTRACRANNIAL VENOUS SINUS|19,760.00|13,832.00|5,928.00
I67.7|CEREBRAL ARTERITIS, NOT ELSEWHERE CLASSIFIED|19,760.00|13,832.00|5,928.00
I67.8|OTHER SPECIFIED CEREBROVASCULAR DISEASES; ACUTE CEREBROVASCULAR INSUFFICIENCY NOS; CHRONIC CEREBRAL ISCHAEMIA|19,760.00|13,832.00|5,928.00
I67.9+G46.7*|OTHER LACUNAR SYNDROME IN UNSPECIFIED CEREBROVASCULAR DISEASE|19,760.00|13,832.00|5,928.00
I67.9+G46.8*|OTHER VASCULAR SYNDROME IN UNSPECIFIED CEREBROVASCULAR DISEASE|19,760.00|13,832.00|5,928.00
I69.0|SEQUELAE OF SUBARACHNOID HAEMORRHAGE|13,390.00|9,373.00|4,017.00
I69.1|SEQUELAE OF INTRACEREBRAL HAEMORRHAGE|13,390.00|9,373.00|4,017.00
I69.2|SEQUELAE OF OTHER NONTRAUMATIC INTRACRANIAL HAEMORRHAGE|13,390.00|9,373.00|4,017.00
I69.3|SEQUELAE OF CEREBRAL INFARCTION|13,390.00|9,373.00|4,017.00
I69.4|SEQUELAE OF STROKE, NOT SPECIFIED AS HAEMORRHAGE OR INFARCTION|13,390.00|9,373.00|4,017.00
I69.8|SEQUELAE OF OTHER AND UNSPECIFIED CEREBROVASCULAR DISEASES|13,390.00|9,373.00|4,017.00
I71.0|DISSECTION OF AORTA [ANYPART]; DISSECTING ANEURYSM OF AORTA (RUPTURED) [ANY PART]|17,030.00|11,921.00|5,109.00
I71.9|AORTIC ANEURYSM OF UNSPECIFIED SITE WITHOUT MENTION OF RUPTURE; ANEURYSM OF AORTA; DILATATION OF AORTA; HYALINE NECROSIS OF AORTA|17,030.00|11,921.00|5,109.00
I74.0|EMBOLISM AND THROMBOSIS OF ABDOMINAL AORTA; AORTIC BIFURCATION SYNDROME; LERICHE'S SYNDROME|17,030.00|11,921.00|5,109.00
I74.1|EMBOLISM AND THROMBOSIS OF OTHER AND UNSPECIFIED PARTS OF AORTA|17,030.00|11,921.00|5,109.00
I74.2|EMBOLISM AND THROMBOSIS OF ARTERIES OF UPPER EXTREMITIES|17,030.00|11,921.00|5,109.00
I74.3|EMBOLISM AND THROMBOSIS OF ARTERIES OF LOWER EXTREMITIES|17,030.00|11,921.00|5,109.00
I74.4|EMBOLISM AND THROMBOSIS OF ARTERIES OF EXTREMITIES, UNSPECIFIED; PERIPHERAL ARTERIAL EMBOLISM|17,030.00|11,921.00|5,109.00
I74.5|EMBOLISM AND THROMBOSIS OF ILIAC ARTERY|17,030.00|11,921.00|5,109.00
I74.8|EMBOLISM AND THROMBOSIS OF OTHER ARTERIES|17,030.00|11,921.00|5,109.00
I74.9|EMBOLISM AND THROMBOSIS OF UNSPECIFIED ARTERY|17,030.00|11,921.00|5,109.00
I77.4|COELIAC ARTERY COMPRESSION SYNDROME|17,030.00|11,921.00|5,109.00
I77.6|ARTERITIS, UNSPECIFIED; AORTITIS NOS; ENDARTERITIS NOS|17,030.00|11,921.00|5,109.00
I77.8|OTHER SPECIFIED DISORDERS OF ARTERIES AND ARTERIOLES|17,030.00|11,921.00|5,109.00
I80.0|PHLEBITIS AND THROMBOPHLEBITIS OF SUPERFICIAL VESSELS OF LOWER EXTREMITIES|16,120.00|11,284.00|4,836.00
I80.1|PHLEBITIS AND THROMBOPHLEBITIS OF FEMORAL VEIN|16,120.00|11,284.00|4,836.00
I80.2|PHLEBITIS AND THROMBOPHLEBITIS OF OTHER DEEP VESSELS OF LOWER EXTREMITIES; DEEP VEIN THROMBOSIS NOS|16,120.00|11,284.00|4,836.00
I80.3|PHLEBITIS AND THROMBOPHLEBITIS OF LOWER EXTREMITIES, UNSPECIFIED; EMBOLISM OR THROMBOSIS OF LOWER EXTERMITY NOS|16,120.00|11,284.00|4,836.00
I80.8|PHLEBITIS AND THROMBOPHLEBITIS OF OTHER SITES|16,120.00|11,284.00|4,836.00
I80.9|PHLEBITIS AND THROMBOPHLEBITIS OF UNSPECIFIED SITE|16,120.00|11,284.00|4,836.00
I81|PORTAL VEIN THROMBOSIS; PORTAL (VEIN) OBSTRUCTION|16,120.00|11,284.00|4,836.00
I82.0|BUDD-CHIARI SYNDROME|16,120.00|11,284.00|4,836.00
I82.1|THROMBOPHLEBITIS MIGRANS|16,120.00|11,284.00|4,836.00
I82.2|EMBOLISM AND THROMBOSIS OF VENA CAVA|16,120.00|11,284.00|4,836.00
I82.3|EMBOLISM AND THROMBOSIS OF RENAL VEIN|16,120.00|11,284.00|4,836.00
I82.8|EMBOLISM AND THROMBOSIS OF OTHER SPECIFIED VEINS|16,120.00|11,284.00|4,836.00
I82.9|EMBOLISM AND THROMBOSIS OF UNSPECIFIED VEIN|16,120.00|11,284.00|4,836.00
I85.0|OESOPHAGEAL VARICES WITH BLEEDING|17,030.00|11,921.00|5,109.00
I87.1|COMPRESSION OF VEIN; STRICTURE OF VEIN; INFERIOR VENA CAVA SYNDROME; SUPERIOR VENA CAVA SYNDROME|17,030.00|11,921.00|5,109.00
I88.0|NONSPECIFIC MESENTERIC LYMPHADENITIS; ACUTE MESENTERIC LYMPHADENITIS; CHRONIC MESENTERIC LYMPHADENITIS|8,840.00|6,188.00|2,652.00
I89.1|LYMPHANGITIS; LYMPHANGITIS NOS; CHRONIC LYMPHANGITIS; SUBACUTE LYMPHANGITIS|11,570.00|8,099.00|3,471.00
I89.8|OTHER SPECIFIED NONINFECTIVE DISORDERS OF LYMPHATIC VESSELS AND LYMPH NODES; CHYLOCELE (NONFILARIAL); LIPOMELANOTIC RETICULOSIS|11,570.00|8,099.00|3,471.00
I89.9|NONINFECTIVE DISORDER OF LYMPHATIC VESSELS AND LYMPH NODES, UNSPECIFIED; DISEASE OF LYMPHATIC VESSELS NOS|11,570.00|8,099.00|3,471.00
I97.0|POSTCARDIOTOMY SYNDROME|13,390.00|9,373.00|4,017.00
I97.2|POSTMASTECTOMY LYMPHOEDEMA SYNDROME; ELEPHANTIASIS DUE TO MASTECTOMY; OBLITERATION OF LYMPHATIC VESSELS DUE TO MASTECTOMY|13,390.00|9,373.00|4,017.00
J03.0|STREPTOCOCCAL TONSILLITIS|5,200.00|3,640.00|1,560.00
J03.8|ACUTE TONSILLITIS DUE TO OTHER SPECIFIED ORGANISMS|5,200.00|3,640.00|1,560.00
J03.9|ACUTE TONSILLITIS, UNSPECIFIED; ACUTE TONSILLITIS NOS; ACUTE FOLLICULAR TONSILLITIS; ACUTE GANGRENOUS TONSILLITIS; ACUTE INFECTIVE TONSILLITIS; ACUTE ULCERATIVE TONSILLITIS|5,200.00|3,640.00|1,560.00
J05.0|ACUTE OBSTRUCTIVE LARYNGITIS [CROUP]; OBSTRUCTIVE LARYNGITIS NOS|10,660.00|7,462.00|3,198.00
J05.1|ACUTE EPIGLOTTITIS; EPIGLOTTITIS NOS|12,610.00|8,827.00|3,783.00
J06.0|ACUTE LARYNGOPHARYNGITIS|5,200.00|3,640.00|1,560.00
J06.8|OTHER ACUTE UPPER RESPIRATORY INFECTIONS OF MULTIPLE SITES|5,200.00|3,640.00|1,560.00
J06.9|ACUTE UPPER RESPIRATORY INFECTION, UNSPECIFIED; ACUTE UPPER RESPIRATORY DISEASE; UPPER RESPIRATORY INFECTION NOS|5,200.00|3,640.00|1,560.00
J09|INFLUENZA A H5N1 (AVIAN INFLUENZA)|8,580.00|6,006.00|2,574.00
J10.0|INFLUENZA WITH PNEUMONIA, INFLUENZA VIRUS IDENTIFIED; INFLUENZAL (BRONCHO) PNEUMONIA, INFLUENZA VIRUS INDENTIFIED|8,580.00|6,006.00|2,574.00
J10.1|INFLUENZA WITH OTHER RESPIRATORY MANIFESTATIONS, INFLUENZA VIRUS IDENTIFIED; INFLUENZA, INFLUENZA VIRUS IDENTIFIED; ACUTE UPPER RESPIRATORY INFLUENZAL INFECTION, INFLUENZA VIRUS IDENTIFIED; INFLUENZAL LARYNGITIS, INFLUENZA VIRUS IDENTIFIED; INFLUENZAL PHA|8,580.00|6,006.00|2,574.00
J10.8|INFLUENZA WITH OTHER MANIFESTATIONS, INFLUENZA VIRUS IDENTIFIED; ENCEPHALOPATHY DUE TO INFLUENZA, INFLUENZA VIRUS IDENTIFIED; INFLUENZAL GASTROENTERITIS, INFLUENZA VIRUS IDENTIFIED; ACUTE INFLUENZAL MYOCARDITIS, INFLUENZA VIRUS IDENTIFIED|8,580.00|6,006.00|2,574.00
J11.0|INFLUENZA WITH PNEUMONIA, VIRUS NOT IDENTIFIED; INFLUENZAL (BRONCHO) PNEUMONIA, UNSPECIFIED OR SPECIFIC VIRUS NOT IDENTIFIED|8,580.00|6,006.00|2,574.00
J11.1|INFLUENZA WITH OTHER RESPIRATORY MANIFESTATIONS, VIRUS NOT IDENTIFIED; INFLUENZA NOS; INFLUENZAL ACUTE UPPER RESPIRATORY  INFECTION, UNSPECIFIED OR SPECIFIC VIRUS NOT IDENTIFIED; INFLUENZAL LARYNGITIS, UNSPECIFIED OR SPECIFIC VIRUS NOT IDENTIFIED; INFLUEN|8,580.00|6,006.00|2,574.00
J11.8|INFLUENZA WITH OTHER MANIFESTATIONS, VIRUS NOT IDENTIFIED; ENCEPHALOPATHY DUE TO INFLUENZA, UNSPECIFIED OR SPECIFIC VIRUS NOT IDENTIFIED; INFLUENZAL GASTROENTIRITIS, UNSPECIFIED OR SPECIFIC VIRUS NOT IDENTIFIED; ACUTE INFLUENZAL MYOCARDITIS, UNSPECIFIED O|8,580.00|6,006.00|2,574.00
J11.8+ I41.1*|ACUTE INFLUENZAL MYOCARDITIS, VIRUS NOT IDENTIFIED|8,580.00|6,006.00|2,574.00
J12.02|ADENOVIRAL PNEUMONIA, MODERATE RISK|19,500.00|13,650.00|5,850.00
J12.12|RESPIRATORY SYNCYTIAL VIRUS PNEUMONIA, MODERATE RISK|19,500.00|13,650.00|5,850.00
J12.22|PARAINFLUENZA VIRUS PNEUMONIA, MODERATE RISK|19,500.00|13,650.00|5,850.00
J12.32|HUMAN METAPNEUMOVIRUS PNEUMONIA, MODERATE RISK|19,500.00|13,650.00|5,850.00
J12.92|VIRAL PNEUMONIA, MODERATE RISK|19,500.00|13,650.00|5,850.00
J13.2|PNEUMONIA [BRONCHOPNEUMONIA] DUE TO STREPTOCOCCUS PNEUMONIAE, MODERATE RISK|19,500.00|13,650.00|5,850.00
J14.2|PNEUMONIA [BRONCHOPNEUMONIA]DUE TO HAEMOPHILUS INFLUENZAE, MODERATE RISK|19,500.00|13,650.00|5,850.00
J15.02|PNEUMONIA DUE TO KLEBSIELLA PNEUMONIAE, MODERATE RISK|19,500.00|13,650.00|5,850.00
J15.12|PNEUMONIA DUE TO PSEUDOMONAS, MODERATE RISK|19,500.00|13,650.00|5,850.00
J15.22|PNEUMONIA DUE TO STAPHYLOCOCCUS, MODERATE RISK|19,500.00|13,650.00|5,850.00
J15.32|PNEUMONIA DUE TO STREPTOCOCCUS, GROUP B, MODERATE RISK|19,500.00|13,650.00|5,850.00
J15.42|PNEUMONIA DUE TO OTHER STREPTOCOCCI, MODERATE RISK|19,500.00|13,650.00|5,850.00
J15.52|PNEUMONIA DUE TO ESCHERICHIA COLI, MODERATE RISK|19,500.00|13,650.00|5,850.00
J15.62|PNEUMONIA DUE TO OTHER AEROBIC GRAM-NEGATIVE BACTERIA; PNEUMONIA DUE TO SERRATIA MARCESCENS, MODERATE RISK|19,500.00|13,650.00|5,850.00
J15.72|PNEUMONIA DUE TO MYCOPLASMA PNEUMONIAE, MODERATE RISK|19,500.00|13,650.00|5,850.00
J15.92|BACTERIAL PNEUMONIA [BRONCHOPNEUMONIA], MODERATE RISK|19,500.00|13,650.00|5,850.00
J16.02|CHLAMYDIAL PNEUMONIA, MODERATE RISK|19,500.00|13,650.00|5,850.00
J18.02|BRONCHOPNEUMONIA, MODERATE RISK|19,500.00|13,650.00|5,850.00
J18.12|LOBAR PNEUMONIA, MODERATE RISK|19,500.00|13,650.00|5,850.00
J18.22|HYPOSTATIC PNEUMONIA, MODERATE RISK|19,500.00|13,650.00|5,850.00
J18.92|COMMUNITY-ACQUIRED PNEUMONIA III (THIS CLASSIFICATION UTILIZED THE AMERICAN THORACIC SOCIETY RECOMMENDATION. THIS IS EQUIVALENT TO CAP, MODERATE RISK IN THE PHILIPPINE CLINICAL PRACTICE GUIDELINES ON THE DIAGNOSIS, EMPIRIC MANAGEMENT, AND PREVENTION OF C|19,500.00|13,650.00|5,850.00
J20.0|ACUTE BRONCHITIS DUE TO MYCOPLASMA PNEUMONIAE|5,200.00|3,640.00|1,560.00
J20.1|ACUTE BRONCHITIS DUE TO HAEMOPHILUS INFLUENZAE|5,200.00|3,640.00|1,560.00
J20.2|ACUTE BRONCHITIS DUE TO STREPTOCOCCUS|5,200.00|3,640.00|1,560.00
J20.3|ACUTE BRONCHITIS DUE TO COXSACKIEVIRUS|5,200.00|3,640.00|1,560.00
J20.4|ACUTE BRONCHITIS DUE TO PARAINFLUENZA VIRUS|5,200.00|3,640.00|1,560.00
J20.5|ACUTE BRONCHITIS DUE TO RESPIRATORY SYNCYTIAL VIRUS|5,200.00|3,640.00|1,560.00
J20.6|ACUTE BRONCHITIS DUE TO RHINOVIRUS|5,200.00|3,640.00|1,560.00
J20.7|ACUTE BRONCHITIS DUE TO ECHOVIRUS|5,200.00|3,640.00|1,560.00
J20.8|ACUTE BRONCHITIS DUE TO OTHER SPECIFIED ORGANISMS|5,200.00|3,640.00|1,560.00
J20.9|ACUTE BRONCHITIS, UNSPECIFIED|5,200.00|3,640.00|1,560.00
J22|UNSPECIFIED ACUTE LOWER RESPIRATORY INFECTION|5,200.00|3,640.00|1,560.00
J36|PERITONSILLAR ABSCESS; ABSCESS OF TONSIL; PERITONSILLAR CELLULITIS; QUINSY|13,000.00|9,100.00|3,900.00
J38.7|OTHER DISEASES OF LARYNX; ABSCESS OF LARYNX; CELLULITIS OF LARYNX; DISEASE NOS OF LARYNX; NECROSIS OF LARYNX; PACHYDERMA OF LARYNX; PERICHONDRITIS OF LARYNX; ULCER OF LARYNX|13,000.00|9,100.00|3,900.00
J39.0|RETROPHARYNGEAL AND PARAPHARYNGEAL ABSCESS; PERIPHARYNGEAL ABSCESS|13,000.00|9,100.00|3,900.00
J39.1|OTHER ABSCESS OF PHARYNX; CELLULITIS OF PHARYNX; NASOPHARYNGEAL ABSCESS|13,000.00|9,100.00|3,900.00
J39.2|OTHER DISEASES OF PHARYNX; CYST OF PHARYNX OR NASOPHARYNX; OEDEMA OF PHARYNX OR NASOPHARYNX|13,000.00|9,100.00|3,900.00
J40|BRONCHITIS, NOT SPECIFIED AS ACUTE OR CHRONIC|5,200.00|3,640.00|1,560.00
J43.0|MACLEOD'S SYNDROME; UNILATERAL EMPHYSEMA; UNILATERAL TRANSPARENCY OF LUNG|14,820.00|10,374.00|4,446.00
J43.1|PANLOBULAR EMPHYSEMA; PANACINAR EMPHYSEMA|14,820.00|10,374.00|4,446.00
J43.2|CENTRILOBULAR EMPHYSEMA|14,820.00|10,374.00|4,446.00
J43.8|OTHER EMPHYSEMA|14,820.00|10,374.00|4,446.00
J43.9|EMPHYSEMA, UNSPECIFIED; LUNG EMPHYSEMA NOS; PULMONARY EMPHYSEMA NOS; BULLOUS LUNG EMPHYSEMA; BULLOUS PULMONARY EMPHYSEMA; VESICULAR LUNG EMPHYSEMA; VESUCULAR PULMONARY EMPHYSEMA; EMPHYSEMATOUS BLEB|14,820.00|10,374.00|4,446.00
J44.0|CHRONIC OBSTRUCTIVE/ ASTHMATIC/ EMPHYSEMATOUS PULMONARY DISEASE WITH ACUTE LOWER RESPIRATORY INFECTION|15,860.00|11,102.00|4,758.00
J44.1|CHRONIC OBSTRUCTIVE/ ASTHMATIC/ EMPHYSEMATOUS PULMONARY DISEASE WITH ACUTE EXACERBATION, UNSPECIFIED|15,860.00|11,102.00|4,758.00
J44.8|CHRONIC  ASTHMATIC (OBSTRUCTIVE) BRONCHITIS NOS; CHRONIC EMPHYSEMATOUS BRONCHITIS NOS; CHRONIC OBSTRUCTIVE BRONCHITIS NOS|15,860.00|11,102.00|4,758.00
J44.9|CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED; CHRONIC OBSTRUCTIVE AIRWAY DISEASE NOS; CHRONIC OBSTRUCTIVE LUNG DISEASE NOS|15,860.00|11,102.00|4,758.00
J45.00|PREDOMINANTLY ALLERGIC ASTHMA; ALLERGIC BRONCHITIS NOS; ALLERGIC RHINITIS WITH ASTHMA; ATOPIC ASTHMA; EXTRINSIC ALLERGIC ASTHMA; HAY FEVER WITH ASTHMA; IN ACUTE EXACERBATION|11,700.00|8,190.00|3,510.00
J45.10|NONALLERGIC ASTHMA; IDIOSYNCRATIC ASTHMA; INTRINSIC NONALLERGIC ASTHMA, IN ACUTE EXACERBATION|11,700.00|8,190.00|3,510.00
J45.80|MIXED ASTHMA, IN ACUTE EXACERBATION|11,700.00|8,190.00|3,510.00
J46|STATUS ASTHMATICUS; ACUTE SEVERE ASTHMA|11,700.00|8,190.00|3,510.00
J60|COALWORKER'S PNEUMOCONIOSIS; ANTHRACOSILICOSIS; ANTHRACOSIS; COALWORKER'S LUNG|19,110.00|13,377.00|5,733.00
J61|PNEUMOCONIOSIS DUE TO ASBESTOS AND OTHER MINERAL FIBRES; ASBESTOSIS|19,110.00|13,377.00|5,733.00
J62.0|PNEUMOCONIOSIS DUE TO TALC DUST|19,110.00|13,377.00|5,733.00
J62.8|PNEUMOCONIOSIS DUE TO OTHER DUST CONTAINING SILICA; SILICOSIS NOS|19,110.00|13,377.00|5,733.00
J63.0|ALUMINOSIS (OF LUNG)|19,110.00|13,377.00|5,733.00
J63.3|GRAPHITE FIBROSIS (OF LUNG)|19,110.00|13,377.00|5,733.00
J63.4|SIDEROSIS|19,110.00|13,377.00|5,733.00
J63.8|PNEUMOCONIOSIS DUE TO OTHER SPECIFIED INORGANIC DUSTS|19,110.00|13,377.00|5,733.00
J64|UNSPECIFIED PNEUMOCONIOSIS|19,110.00|13,377.00|5,733.00
J65|PNEUMOCONIOSIS ASSOCIATED WITH TUBERCULOSIS|19,110.00|13,377.00|5,733.00
J66.2|CANNABINOSIS|19,110.00|13,377.00|5,733.00
J66.8|AIRWAY DISEASE DUE TO OTHER SPECIFIC ORGANIC DUSTS|19,110.00|13,377.00|5,733.00
J67.0|FARMER'S LUNG; HARVESTER'S LUNG; HAYMAKER'S LUNG; MOULDY HAY DISEASE|19,110.00|13,377.00|5,733.00
J67.1|BAGASSOSIS; BAGASSE DISEASE; BAGASSE PNEUMONITIS|19,110.00|13,377.00|5,733.00
J67.5|MUSHROOM-WORKER'S LUNG|19,110.00|13,377.00|5,733.00
J67.7|AIR-CONDITIONER AND HUMIDIFIER LUNG; ALLERGIC ALVEOLITIS DUE TO FUNGI, THERMOPHILIC ACTINOMYCETEES AND OTHER ORGANISMS GROWING IN VENTILATION (AIR-CONDITIONING) SYSTEMS|19,110.00|13,377.00|5,733.00
J67.8|HYPERSENSITIVITY PNEUMONITIS DUE TO OTHER ORGANIC DUSTS; CHEESE-WASHER'S LUNG; COFFEE-WORKER'S LUNG; FISHMEAL-WORKER'S LUNG; FURRIER'S LUNG; SEQUOIOSIS|19,110.00|13,377.00|5,733.00
J67.9|HYPERSENSITIVITY PNEUMONITIS DUE TO UNSPECIFIED ORGANIC DUST; EXTRINSIC ALLERGIC ALVEOLITIS NOS; HYPERSENSITIVITY PNEUMONITIS NOS|19,110.00|13,377.00|5,733.00
J68.0|BRONCHITIS AND PNEUMONITIS DUE TO CHEMICALS, GASES, FUMES AND VAPOURS; ACUTE CHEMICAL BRONCHITIS|19,110.00|13,377.00|5,733.00
J68.1|ACUTE PULMONARY OEDEMA DUE TO CHEMICALS, GASES, FUMES AND VAPOURS; ACUTE CHEMICAL PULMONARY OEDEMA|19,110.00|13,377.00|5,733.00
J68.2|UPPER RESPIRATORY INFLAMMATION DUE TO CHEMICALS, GASES, FUMES AND VAPOURS, NOT ELSEWHERE CLASSIFIED|19,110.00|13,377.00|5,733.00
J68.3|OTHER ACUTE AND SUBACUTE RESPIRATORY CONDITIONS DUE TO CHEMICALS, GASES, FUMES AND VAPOURS; REACTIVE AIRWAYS DYSFUNCTION SYNDROME; HYPERACTIVE AIRWAY DISEASE|19,110.00|13,377.00|5,733.00
J68.4|CHRONIC RESPIRATORY CONDITIONS DUE TO CHEMICALS, GASES, FUMES AND VAPOURS; DIFFUSE EMPHYSEMA DUE TO INHALATION OF CHEMICALS, GASES, FUMES AND VAPOURS; CHRONIC EMPHYSEMA DUE TO INHALATION OF CHEMICALS, GASES, FUMES AND VAPOURS; CHRONIC OBLITERATIVE BRONCHI|19,110.00|13,377.00|5,733.00
J68.8|OTHER RESPIRATORY CONDITIONS DUE TO CHEMICALS, GASES, FUMES AND VAPOURS|19,110.00|13,377.00|5,733.00
J68.9|UNSPECIFIED RESPIRATORY CONDITION DUE TO CHEMICALS, GASES, FUMES AND VAPOURS|19,110.00|13,377.00|5,733.00
J69.0|PNEUMONITIS DUE TO FOOD AND VOMIT; ASPIRATION PNEUMONIA DUE TO NOS; ASPIRATION PNEUMONIA DUE TO REGURGITATED FOOD; ASPIRATION PNEUMONIA DUE TO GASTRIC SECRETIONS; ASPIRATION PNEUMONIA DUE TO MILK; ASPIRATION PNEUMONIA DUE TO VOMIT|19,110.00|13,377.00|5,733.00
J69.1|PNEUMONITIS DUE TO OILS AND ESSENCES; LIPID PNEUMONIA|19,110.00|13,377.00|5,733.00
J69.8|PNEUMONITIS DUE TO OTHER SOLIDS AND LIQUIDS; PNEUMONITIS DUE TO ASPIRATION OF BLOOD|19,110.00|13,377.00|5,733.00
J70.0|ACUTE PULMONARY MANIFESTATIONS DUE TO RADIATION; RADIATION PNEUMONITIS|19,110.00|13,377.00|5,733.00
J70.2|ACUTE DRUG-INDUCED INTERSTITIAL LUNG DISORDERS|19,110.00|13,377.00|5,733.00
J70.4|DRUG-INDUCED INTERSTITIAL LUNG DISORDERS, UNSPECIFIED|19,110.00|13,377.00|5,733.00
J70.8|RESPIRATORY CONDITIONS DUE TO OTHER SPECIFIED EXTERNAL AGENTS|19,110.00|13,377.00|5,733.00
J70.9|RESPIRATORY CONDITIONS DUE TO UNSPECIFIED EXTERNAL AGENT|19,110.00|13,377.00|5,733.00
J80|ADULT RESPIRATORY DISTRESS SYNDROME; ADULT HYALINE MEMBRANE DISEASE|41,600.00|29,120.00|12,480.00
J81|PULMONARY OEDEMA; ACUTE OEDEMA OF LUNG; PASSIVE PULMONARY CONGESTION; LUNG DROPSY|18,200.00|12,740.00|5,460.00
J82|PULMONARY EOSINOPHILIA, NOT ELSEWHERE CLASSIFIED; EOSINOPHILIC ASTHMA; LOFFLER'S PNEUMONIA; TROPICAL PULMONARY EOSINOPHILIA NOS|18,200.00|12,740.00|5,460.00
J84.0|ALVEOLAR AND PARIETOALVEOLAR CONDITIONS; ALVEOLAR PROTEINOSIS; PULMONARY ALVEOLAR MICROLITHIASIS|18,200.00|12,740.00|5,460.00
J84.1|OTHER INTERSTITIAL PULMONARY DISEASES WITH FIBROSIS; DIFFUSE PULMONARY FIBROSIS; CRYPTOGENIC FIBROSING ALVEOLITIS; HAMMAN-RICH SYNDROME; IDIOPATHIC PULMONARY FIBROSIS|18,200.00|12,740.00|5,460.00
J84.8|OTHER SPECIFIED INTERSTITIAL PULMONARY DISEASES|18,200.00|12,740.00|5,460.00
J84.9|INTERSTITIAL PULMONARY DISEASE, UNSPECIFIED; INTERSTITIAL PNEUMONIA NOS|18,200.00|12,740.00|5,460.00
J85.0|GANGRENE AND NECROSIS OF LUNG|17,160.00|12,012.00|5,148.00
J85.1|ABSCESS OF LUNG WITH PNEUMONIA|13,000.00|9,100.00|3,900.00
J85.2|ABSCESS OF LUNG WITHOUT PNEUMONIA; ABSCESS OF LUNG NOS|13,000.00|9,100.00|3,900.00
J85.3|ABSCESS OF MEDIASTINUM|13,000.00|9,100.00|3,900.00
J86.0|PYOTHORAX WITH FISTULA|13,000.00|9,100.00|3,900.00
J86.9|PYOTHORAX WITHOUT FISTULA; ABSCESS OF PLEURA; ABSCESS OF THORAX; EMPYEMA; PYOPNEUMOTHORAX|13,000.00|9,100.00|3,900.00
J90|PLEURAL EFFUSION, NOT ELSEWHERE CLASSIFIED; PLEURISY WITH EFFUSION|18,460.00|12,922.00|5,538.00
J91*|PLEURAL EFFUSION IN CONDITIONS CLASSIFIED ELSEWHERE|18,460.00|12,922.00|5,538.00
J92.9|PLEURAL PLAQUE WITHOUT ASBESTOS; PLEURAL PLAQUE NOS; PLEURAL THICKENING|17,550.00|12,285.00|5,265.00
J93.0|SPONTANEOUS TENSION PNEUMOTHORAX|19,890.00|13,923.00|5,967.00
J93.1|OTHER SPONTANEOUS PNEUMOTHORAX|19,890.00|13,923.00|5,967.00
J93.8|OTHER PNEUMOTHORAX|19,890.00|13,923.00|5,967.00
J93.9|PNEUMOTHORAX, UNSPECIFIED|19,890.00|13,923.00|5,967.00
J94.0|CHYLOUS EFFUSION; CHYLIFORM EFFUSION|17,550.00|12,285.00|5,265.00
J94.1|FIBROTHORAX|17,550.00|12,285.00|5,265.00
J94.8|OTHER SPECIFIED PLEURAL CONDITIONS; HYDROTHORAX|17,550.00|12,285.00|5,265.00
J94.9|PLEURAL CONDITION, UNSPECIFIED|17,550.00|12,285.00|5,265.00
J95.0|TRACHEOSTOMY MALFUNCTION; HAEMORRHAGE FROM TRACHEOSTOMY STOMA; OBSTRUCTION OF TRACHEOSTOMY AIRWAY; SEPSIS OF TRACHEOSTOMY STOMA; TRACHEO-OESOPHAGEAL FISTULA FOLLOWING TRACHEOSTOMY|13,390.00|9,373.00|4,017.00
J95.1|ACUTE PULMONARY INSUFFICIENCY FOLLOWING THORACIC SURGERY|13,390.00|9,373.00|4,017.00
J95.2|ACUTE PULMONARY INSUFFICIENCY FOLLOWING NONTHORACIC SURGERY|13,390.00|9,373.00|4,017.00
J95.4|MENDELSON'S SYNDROME|13,390.00|9,373.00|4,017.00
J95.5|POSTPROCEDURAL SUBGLOTTIC STENOSIS|13,390.00|9,373.00|4,017.00
J95.8|OTHER POSTPROCEDURAL RESPIRATORY DISORDERS|13,390.00|9,373.00|4,017.00
J95.9|POSTPROCEDURAL RESPIRATORY DISORDER, UNSPECIFIED|13,390.00|9,373.00|4,017.00
J96.0|ACUTE RESPIRATORY FAILURE|41,600.00|29,120.00|12,480.00
J96.1|CHRONIC RESPIRATORY FAILURE|41,600.00|29,120.00|12,480.00
J96.9|RESPIRATORY FAILURE, UNSPECIFIED|41,600.00|29,120.00|12,480.00
J98.0|DISEASES OF BRONCHUS, NOT ELSEWHERE CLASSIFIED; BRONCHOLITHIASIS; CALCIFICATION OF BRONCHUS; STENOSIS OF BRONCHUS; ULCER OF BRONCHUS; TRACHEOBRONCHIAL COLLAPSE; TRACHEOBRONCHIAL DYSKINESIA|13,260.00|9,282.00|3,978.00
J98.1|PULMONARY COLLAPSE; ATELECTASIS; COLLAPSE OF LUNG; BROCK'S SYNDROME|17,940.00|12,558.00|5,382.00
J98.2|INTERSTITIAL EMPHYSEMA; MEDIASTINAL EMPHYSEMA|14,820.00|10,374.00|4,446.00
J98.3|COMPENSATORY EMPHYSEMA|14,820.00|10,374.00|4,446.00
J98.4|OTHER DISORDERS OF LUNG; CALCIFICATION OF LUNG; ACQUIRED CYSTIC LUNG DISEASE; LUNG DISEASE NOS; PULMOLITHIASIS|13,260.00|9,282.00|3,978.00
J98.5|DISEASES OF MEDIASTINUM, NOT ELSEWHERE CLASSIFIED; FIBROSIS OF MEDIASTINUM; HERNIA OF MEDIASTINUM; RETRACTION OF MEDIASTINUM; MEDIASTINITIS OF MEDIASTINUM|13,260.00|9,282.00|3,978.00
J98.6|DISORDERS OF DIAPHRAGM; DIAPHRAGMATITIS; PARALYSIS OF DIAPHRAGM; RELAXATION OF DIAPHRAGM|13,260.00|9,282.00|3,978.00
J98.8|OTHER SPECIFIED RESPIRATORY DISORDERS|13,260.00|9,282.00|3,978.00
J98.9|RESPIRATORY DISORDER, UNSPECIFIED; CHRONIC RESPIRATORY DISEASE NOS|13,260.00|9,282.00|3,978.00
K04.0|PULPITIS; PULPAL ABSCESS; PULPAL POLYP; ACUTE PULPITIS; HYPERPLASTIC CHRONIC PULPITIS; ULCERATIVE CHRONIC PULPITIS; SUPPARATIVE PULPITIS|5,200.00|3,640.00|1,560.00
K04.1|NECROSIS OF PULP; PULPAL GANGRENE|5,200.00|3,640.00|1,560.00
K04.2|PULP DEGENERATION; DENTICLES; PULPAL CALCIFICATIONS; PULPAL STONES|5,200.00|3,640.00|1,560.00
K04.3|ABNORMAL HARD TISSUE FORMATION IN PULP; SECONDARY OR IRREGULAR DENTINE|5,200.00|3,640.00|1,560.00
K04.4|ACUTE APICAL PERIODONTITIS OF PULPAL ORIGIN; ACUTE APICAL PERIODONTITIS NOS|5,200.00|3,640.00|1,560.00
K04.5|CHRONIC APICAL PERIODONTITIS; APICAL OR PERIAPICAL GRANULOMA; APICAL PERIODONTITIS NOS|5,200.00|3,640.00|1,560.00
K04.6|PERIAPICAL ABSCESS WITH SINUS; DENTAL ABSCESS WITH SINUS; DENTOALVEOLAR ABSCESS WITH SINUS|5,200.00|3,640.00|1,560.00
K04.7|PERIAPICAL ABSCESS WITHOUT SINUS; DENTAL ABSCESS NOS; DENTOALVEOLAR ABSCESS NOS; PERIAPICAL ABSCESS NOS|5,200.00|3,640.00|1,560.00
K04.8|RADICULAR CYST; PERIODONTAL APICAL CYST; PERIAPICAL CYST; RESIDUAL RADICULAR CYST|5,200.00|3,640.00|1,560.00
K04.9|OTHER AND UNSPECIFIED DISEASES OF PULP AND PERIAPICAL TISSUES|5,200.00|3,640.00|1,560.00
K09.0|DEVELOPMENTAL ODONTOGENIC CYSTS; DENTIGEROUS CYST; ERUPTION CYST; FOLLICULAR CYST; GINGIVAL CYST; LATERAL PERIODONTAL CYST; PRIMORDIAL CYST; KERATOCYST|10,790.00|7,553.00|3,237.00
K09.1|DEVELOPMENTAL (NONODONTOGENIC) CYSTS OF ORAL REGION; CYST OF GLOBULOMAXILLARY; CYST OF INCISIVE CANAL; CYST OF MEDIAN PALATAL; CYST OF NASOPALATINE; CYST OF PALATINE PAPILLA|10,790.00|7,553.00|3,237.00
K09.2|OTHER CYSTS OF JAW; CYST OF JAW NOS; ANEURYSMAL CYST OF JAW; HAEMORRHAGIC CYST OF JAW; TRAUMATIC CYST OF JAW|10,790.00|7,553.00|3,237.00
K09.8|OTHER CYSTS OF ORAL REGION, NOT ELSEWHERE CLASSIFIED; DERMOID CYST OF MOUTH; EPIDERMOID CYST OF MOUTH; LYMPHOEPITHELIAL CYST OF MOUTH; EPSTEIN'S PEARL; NASOALVEOLAR CYST; NASOLABIAL CYST|10,790.00|7,553.00|3,237.00
K09.9|CYST OF ORAL REGION, UNSPECIFIED|10,790.00|7,553.00|3,237.00
K10.0|DEVELOPMENTAL DISORDERS OF JAWS; LATENT BONE CYST OF JAW; STAFNE'S CYST; TORUS MANDIBULARIS; TORUS PALATINUS|10,790.00|7,553.00|3,237.00
K10.1|GIANT CELL GRANULOMA, CENTRAL; GIANT CELL GRANULOMA NOS|10,790.00|7,553.00|3,237.00
K10.2|INFLAMMATORY CONDITIONS OF JAWS; ACUTE OSTEITIS OF JAW; CHRONIC OSTEITIS OF JAW; SUPPARATIVE OSTEITIS OF JAW; ACUTE NEONATAL OSTEOMYELITIS OF JAW; CHRONIC NEONATAL OSTEOMYELITIS OF JAW; SUPPARATIVE NEONATAL OSTEOMYELITIS OF JAW; ACUTE OSTEORADIONECROSIS O|10,790.00|7,553.00|3,237.00
K10.3|ALVEOLITIS OF JAWS; ALVEOLAR OSTEITIS; DRY SOCKET|10,790.00|7,553.00|3,237.00
K10.8|OTHER SPECIFIED DISEASES OF JAWS; CHERUBISM OF JAW; EXOSTOSIS OF JAW; FIBROUS DYSPLASIA OF JAW; UNILATERAL CONDYLAR HYPERPLASIA; UNILATERAL CONDYLAR HYPOPLASIA|10,790.00|7,553.00|3,237.00
K11.2|SIALOADENITIS|10,790.00|7,553.00|3,237.00
K11.3|ABSCESS OF SALIVARY GLAND|10,790.00|7,553.00|3,237.00
K11.4|FISTULA OF SALIVARY GLAND|10,790.00|7,553.00|3,237.00
K11.5|SIALOLITHIASIS; CALCULUS OF SALIVARY GLAND OR DUCT; STONE OF SALIVARY GLAND OR DUCT|10,790.00|7,553.00|3,237.00
K11.6|MUCOCELE OF SALIVARY GLAND; MUCOUS EXTRAVASATION CYST OF SALIVARY GLAND; MUCOUS RETENTION CYST OF SALIVARY GLAND; RANULA|10,790.00|7,553.00|3,237.00
K11.8|OTHER DISEASES OF SALIVARY GLANDS; BENIGN LYMPHOEPITHELIAL LESION OF SALIVARY GLAND; MIKULICZ' DISEASE; NECROTIZING SIALOMETAPLASIA; SIALECTASIA; STENOSIS OF SALIVARY DUCT; STRICTURE OF SALIVARY DUCT|10,790.00|7,553.00|3,237.00
K11.9|DISEASE OF SALIVARY GLAND, UNSPECIFIED; SIALOADENOPATHY NOS|10,790.00|7,553.00|3,237.00
K12.2|CELLULITIS AND ABSCESS OF MOUTH; CELLULITIS OF FLOOR OF MOUTH; SUBMANDIBULAR ABSCESS|10,790.00|7,553.00|3,237.00
K13.4|GRANULOMA AND GRANULOMA-LIKE LESIONS OF ORAL MUCOSA; EOSINOPHILIC GRANULOMA OF ORAL MUCOSA; GRANULOMA PYOGENICUM OF ORAL MUCOSA; VERRUCOUS XANTHOMA OF ORAL MUCOSA|10,790.00|7,553.00|3,237.00
K13.7|OTHER AND UNSPECIFIED LESIONS OF ORAL MUCOSA; FOCAL ORAL MUCINOSIS|10,790.00|7,553.00|3,237.00
K20|OESOPHAGITIS; ABSCESS OF OESOPHAGUS; OESOPHAGITIS NOS; CHEMICAL OESOPHAGITIS; PEPTIC OESOPHAGITIS|10,790.00|7,553.00|3,237.00
K21.0|GASTRO-OESOPHAGEAL REFLUX DISEASE WITH OESOPHAGITIS; REFLUX OESOPHAGITIS|7,930.00|5,551.00|2,379.00
K21.9|GASTRO-OESOPHAGEAL REFLUX DISEASE WITHOUT OESOPHAGITIS; OESOPHAGEAL REFLUX NOS|7,930.00|5,551.00|2,379.00
K22.0|ACHALASIA OF CARDIA; ACHALASIA NOS; CARDIOSPASM|10,790.00|7,553.00|3,237.00
K22.1|ULCER OF OESOPHAGUS; EROSION OF OESOPHAGUS; ULCER OF OESOPHAGUS NOS; ULCER OF OESOPHAGUS DUE TO INGESTION OF CHEMICALS; ULCER OF OESOPHAGUS DUE TO INGESTION OF DRUGS AND MEDICAMENTS; FUNGAL ULCER OF OESOPHAGUS; PEPTIC ULCER OF OESOPHAGUS|10,790.00|7,553.00|3,237.00
K22.2|OESOPHAGEAL OBSTRUCTION; COMPRESSION OF OESOPHAGUS; CONSTRICTION OF OESOPHAGUS; STENOSIS OF OESOPHAGUS; STRICTURE OF OESOPHAGUS;|10,790.00|7,553.00|3,237.00
K22.3|PERFORATION OF OESOPHAGUS; RUPTURE OF OESOPHAGUS|10,790.00|7,553.00|3,237.00
K22.4|DYSKINESIA OF OESOPHAGUS; CORKSREW OESOPHAGUS; DIFFUSE OESOPHAGEAL SPASM; SPASM OF OESOPHAGUS|10,790.00|7,553.00|3,237.00
K22.6|GASTRO-OESOPHAGEAL LACERATION-HAEMORRHAGE SYNDROME; MALLORY-WEISS SYNDROME|10,790.00|7,553.00|3,237.00
K22.7|BARRETT'S ESOPHAGUS; BARRET'S DISEASE; BARETT'S SYNDROME|10,790.00|7,553.00|3,237.00
K22.8|OTHER SPECIFIED DISEASES OF OESOPHAGUS; HAEMORRHAGE OF OESOPHAGUS NOS|10,790.00|7,553.00|3,237.00
K22.9|DISEASE OF OESOPHAGUS, UNSPECIFIED|10,790.00|7,553.00|3,237.00
K25.0|GASTRIC ULCER, ACUTE / ACUTE EROSION OF STOMACH/ PYLORUS PEPTIC ULCER / STOMACH PEPTIC ULCER WITH HEMORRHAGE|16,640.00|11,648.00|4,992.00
K25.1|GASTRIC ULCER, ACUTE/ ACUTE EROSION OF STOMACH/ PYLORUS PEPTIC ULCER / STOMACH PEPTIC ULCER WITH PERFORATION|16,640.00|11,648.00|4,992.00
K25.2|GASTRIC ULCER, ACUTE / ACUTE EROSION OF STOMACH/ PYLORUS PEPTIC ULCER / STOMACH PEPTIC ULCER WITH BOTH HAEMORRHAGE AND PERFORATION|16,640.00|11,648.00|4,992.00
K25.3|GASTRIC ULCER, ACUTE / ACUTE EROSION OF STOMACH/ PYLORUS PEPTIC ULCER / STOMACH PEPTIC ULCER WITHOUT HAEMORRHAGE OR PERFORATION|7,930.00|5,551.00|2,379.00
K25.4|GASTRIC/ PEPTIC/ PYLORIC ULCER/ EROSION, CHRONIC OR UNSPECIFIED WITH HAEMORRHAGE|16,640.00|11,648.00|4,992.00
K25.5|GASTRIC/ PEPTIC/ PYLORIC ULCER/ EROSION, CHRONIC OR UNSPECIFIED WITH PERFORATION|16,640.00|11,648.00|4,992.00
K25.6|GASTRIC/ PEPTIC/ PYLORIC ULCER/ EROSION, CHRONIC OR UNSPECIFIED WITH BOTH HAEMORRHAGE AND PERFORATION|16,640.00|11,648.00|4,992.00
K25.7|GASTRIC/ PEPTIC/ PYLORIC ULCER/ EROSION, CHRONIC WITHOUT HAEMORRHAGE OR PERFORATION|7,930.00|5,551.00|2,379.00
K25.9|GASTRIC/ PEPTIC/ PYLORIC ULCER/ EROSION, UNSPECIFIED AS ACUTE OR CHRONIC, WITHOUT HAEMORRHAGE OR PERFORATION|7,930.00|5,551.00|2,379.00
K26.0|DUODENAL ULCER, ACUTE / ACUTE EROSION OF DUODENUM/ DUODENAL PEPTIC  ULCER/ POSTPYLORIC PEPTIC  ULCER WITH HAEMORRHAGE|16,640.00|11,648.00|4,992.00
K26.1|DUODENAL ULCER, ACUTE / ACUTE EROSION OF DUODENUM/ DUODENAL PEPTIC  ULCER/ POSTPYLORIC PEPTIC  ULCER WITH PERFORATION|16,640.00|11,648.00|4,992.00
K26.3|DUODENAL ULCER, ACUTE / ACUTE EROSION OF DUODENUM/ DUODENAL PEPTIC  ULCER/ POSTPYLORIC PEPTIC  ULCER WITHOUT HAEMORRHAGE OR PERFORATION|7,930.00|5,551.00|2,379.00
K26.4|CHRONIC DUODENAL/ POSTPYLORIC ULCER/ EROSION, OR UNSPECIFIED WITH HAEMORRHAGE|16,640.00|11,648.00|4,992.00
K26.5|CHRONIC DUODENAL/ POSTPYLORIC ULCER/ EROSION, OR UNSPECIFIED WITH PERFORATION|16,640.00|11,648.00|4,992.00
K26.6|CHRONIC DUODENAL/ POSTPYLORIC ULCER/ EROSION, OR UNSPECIFIED WITH BOTH HAEMORRHAGE AND PERFORATION|16,640.00|11,648.00|4,992.00
K26.7|CHRONIC DUODENAL/ POSTPYLORIC ULCER/ EROSION, WITHOUT HAEMORRHAGE OR PERFORATION|7,930.00|5,551.00|2,379.00
K26.9|DUODENAL/ POSTPYLORIC ULCER/ EROSION, UNSPECIFIED AS ACUTE OR CHRONIC, WITHOUT HAEMORRHAGE OR PERFORATION|7,930.00|5,551.00|2,379.00
K27.0|ACUTE PEPTIC ULCER/ GASTRODUODENAL ULCER NOS, SITE UNSPECIFIED,  WITH HAEMORRHAGE|16,640.00|11,648.00|4,992.00
K27.1|ACUTE PEPTIC ULCER / GASTRODUODENAL ULCER, SITE UNSPECIFIED,  WITH PERFORATION|16,640.00|11,648.00|4,992.00
K27.2|ACUTE PEPTIC/ GASTRODUODENAL ULCER, SITE UNSPECIFIED,  WITH BOTH HAEMORRHAGE AND PERFORATION|16,640.00|11,648.00|4,992.00
K27.3|ACUTE PEPTIC/ GASTRODUODENAL ULCER, SITE UNSPECIFIED, WITHOUT HAEMORRHAGE OR PERFORATION|7,930.00|5,551.00|2,379.00
K27.4|CHRONIC  OR UNSPECIFIED PEPTIC/ GASTRODUODENAL ULCER, SITE UNSPECIFIED,  WITH HAEMORRHAGE|16,640.00|11,648.00|4,992.00
K27.5|CHRONIC OR UNSPECIFIED PEPTIC/ GASTRODUODENAL ULCER, SITE UNSPECIFIED  WITH PERFORATION|16,640.00|11,648.00|4,992.00
K27.6|CHRONIC OR UNSPECIFIED PEPTIC/ GASTRODUODENAL ULCER, SITE UNSPECIFIED, WITH BOTH HAEMORRHAGE AND PERFORATION|16,640.00|11,648.00|4,992.00
K27.7|CHRONIC PEPTIC/ GASTRODUODENAL ULCER, SITE UNSPECIFIED,  WITHOUT HAEMORRHAGE OR PERFORATION|7,930.00|5,551.00|2,379.00
K27.9|PEPTIC/ GASTRODUODENAL ULCER, UNSPECIFIED AS ACUTE OR CHRONIC, WITHOUT HAEMORRHAGE OR PERFORATION|7,930.00|5,551.00|2,379.00
K28.0|ACUTE GASTROJEJUNAL ULCER/ ANASTOMOTIC PEPTIC ULCER OR EROSION/ GASTROCOLIC PEPTIC ULCER OR EROSION/ GASTROINTESTINAL PEPTIC ULCER OR EROSION/ GASTROJEJUNAL PEPTIC ULCER OR EROSION/ JEJUNAL PEPTIC ULCER OR EROSION/ MARGINAL PEPTIC ULCER OR EROSION/ STOMAL|16,640.00|11,648.00|4,992.00
K28.1|ACUTE GASTROJEJUNAL ULCER/ ANASTOMOTIC PEPTIC ULCER OR EROSION/ GASTROCOLIC PEPTIC ULCER OR EROSION/ GASTROINTESTINAL PEPTIC ULCER OR EROSION/ GASTROJEJUNAL PEPTIC ULCER OR EROSION/ JEJUNAL PEPTIC ULCER OR EROSION/ MARGINAL PEPTIC ULCER OR EROSION/ STOMAL|16,640.00|11,648.00|4,992.00
K28.2|ACUTE GASTROJEJUNAL ULCER/ ANASTOMOTIC PEPTIC ULCER OR EROSION/ GASTROCOLIC PEPTIC ULCER OR EROSION/ GASTROINTESTINAL PEPTIC ULCER OR EROSION/ GASTROJEJUNAL PEPTIC ULCER OR EROSION/ JEJUNAL PEPTIC ULCER OR EROSION/ MARGINAL PEPTIC ULCER OR EROSION/ STOMAL|16,640.00|11,648.00|4,992.00
K28.3|ACUTE GASTROJEJUNAL ULCER/ ANASTOMOTIC PEPTIC ULCER OR EROSION/ GASTROCOLIC PEPTIC ULCER OR EROSION/ GASTROINTESTINAL PEPTIC ULCER OR EROSION/ GASTROJEJUNAL PEPTIC ULCER OR EROSION/ JEJUNAL PEPTIC ULCER OR EROSION/ MARGINAL PEPTIC ULCER OR EROSION/ STOMAL|16,640.00|11,648.00|4,992.00
K28.4|CHRONIC OR UNSPECIFIED GASTROJEJUNAL ULCER/ ANASTOMOTIC PEPTIC ULCER OR EROSION/ GASTROCOLIC PEPTIC ULCER OR EROSION/ GASTROINTESTINAL PEPTIC ULCER OR EROSION/ GASTROJEJUNAL PEPTIC ULCER OR EROSION/ JEJUNAL PEPTIC ULCER OR EROSION/ MARGINAL PEPTIC ULCER O|16,640.00|11,648.00|4,992.00
K28.5|CHRONIC OR UNSPECIFIED GASTROJEJUNAL ULCER/ ANASTOMOTIC PEPTIC ULCER OR EROSION/ GASTROCOLIC PEPTIC ULCER OR EROSION/ GASTROINTESTINAL PEPTIC ULCER OR EROSION/ GASTROJEJUNAL PEPTIC ULCER OR EROSION/ JEJUNAL PEPTIC ULCER OR EROSION/ MARGINAL PEPTIC ULCER O|16,640.00|11,648.00|4,992.00
K28.6|CHRONIC OR UNSPECIFIED GASTROJEJUNAL ULCER/ ANASTOMOTIC PEPTIC ULCER OR EROSION/ GASTROCOLIC PEPTIC ULCER OR EROSION/ GASTROINTESTINAL PEPTIC ULCER OR EROSION/ GASTROJEJUNAL PEPTIC ULCER OR EROSION/ JEJUNAL PEPTIC ULCER OR EROSION/ MARGINAL PEPTIC ULCER O|16,640.00|11,648.00|4,992.00
K28.7|CHRONIC GASTROJEJUNAL ULCER/ ANASTOMOTIC PEPTIC ULCER OR EROSION/ GASTROCOLIC PEPTIC ULCER OR EROSION/ GASTROINTESTINAL PEPTIC ULCER OR EROSION/ GASTROJEJUNAL PEPTIC ULCER OR EROSION/ JEJUNAL PEPTIC ULCER OR EROSION/ MARGINAL PEPTIC ULCER OR EROSION/ STOM|7,930.00|5,551.00|2,379.00
K28.9|UNSPECIFIED AS ACUTE OR CHRONIC GASTROJEJUNAL ULCER/ ANASTOMOTIC PEPTIC ULCER OR EROSION/ GASTROCOLIC PEPTIC ULCER OR EROSION/ GASTROINTESTINAL PEPTIC ULCER OR EROSION/ GASTROJEJUNAL PEPTIC ULCER OR EROSION/ JEJUNAL PEPTIC ULCER OR EROSION/ MARGINAL PEPTI|7,930.00|5,551.00|2,379.00
K29.0|ACUTE HAEMORRHAGIC GASTRITIS; ACUTE EROSIVE GASTRITIS WITH HAEMORRHAGE|16,640.00|11,648.00|4,992.00
K29.1|OTHER ACUTE GASTRITIS|7,930.00|5,551.00|2,379.00
K29.2|ALCOHOLIC GASTRITIS|7,930.00|5,551.00|2,379.00
K29.3|CHRONIC SUPERFICIAL GASTRITIS|7,930.00|5,551.00|2,379.00
K29.4|CHRONIC ATROPHIC GASTRITIS; GASTRIC ATROPHY|7,930.00|5,551.00|2,379.00
K29.5|CHRONIC GASTRITIS, UNSPECIFIED; CHRONIC ANTRAL GASTRITIS; CHRONIC FUNDAL GASTRITIS|7,930.00|5,551.00|2,379.00
K29.6|OTHER GASTRITIS; GIANT HYPERTROPHIC GASTRITIS; GRANULOMATOUS GASTRITIS; MENETRIER'S DISEASE|7,930.00|5,551.00|2,379.00
K29.7|GASTRITIS, UNSPECIFIED|7,930.00|5,551.00|2,379.00
K29.8|DUODENITIS|7,930.00|5,551.00|2,379.00
K29.9|GASTRODUODENITIS, UNSPECIFIED|7,930.00|5,551.00|2,379.00
K30|DYSPEPSIA|5,200.00|3,640.00|1,560.00
K31.0|ACUTE DILATATION OF STOMACH; ACUTE DISTENSION OF STOMACH|5,200.00|3,640.00|1,560.00
K31.1|ADULT HYPERTROPHIC PYLORIC STENOSIS; PYLORIC STENOSIS NOS|8,580.00|6,006.00|2,574.00
K31.2|HOURGLASS STRICTURE AND STENOSIS OF STOMACH|8,580.00|6,006.00|2,574.00
K31.3|PYLOROSPASM, NOT ELSEWHERE CLASSIFIED|8,580.00|6,006.00|2,574.00
K31.4|GASTRIC DIVERTICULUM|8,580.00|6,006.00|2,574.00
K31.5|OBSTRUCTION OF DUODENUM; CONSTRICTION OF DUODENUM; STENOSIS OF DUODENUM; STRICTURE OF DUODENUM; CHRONIC DUODENAL ILEUS|8,580.00|6,006.00|2,574.00
K31.6|FISTULA OF STOMACH AND DUODENUM; GASTROCOLIC FISTULA; GASTROJEJUNOCOLIC FISTULA|8,580.00|6,006.00|2,574.00
K31.7|POLYP OF STOMACH AND DUODENUM|8,580.00|6,006.00|2,574.00
K31.8|OTHER SPECIFIED DISEASES OF STOMACH AND DUODENUM; ACHLORHYDRIA; GASTROPTOSIS; HOURGLASS CONTRACTION OF STOMACH|8,580.00|6,006.00|2,574.00
K31.9|DISEASE OF STOMACH AND DUODENUM, UNSPECIFIED|5,200.00|3,640.00|1,560.00
K50.0|CROHN'S DISEASE OF SMALL INTESTINE; CROHN'S DISEASE [REGIONAL ENTERITIS] OF DUODENUM; CROHN'S DISEASE [REGIONAL ENTERITIS] OF ILEUM; CROHN'S DISEASE [REGIONAL ENTERITIS] OF JEJUNUM; REGIONAL ILEITIS; TERMINAL ILEITIS|11,830.00|8,281.00|3,549.00
K50.1|CROHN'S DISEASE OF LARGE INTESTINE; GRANULOMATOUS COLITIS; REGIONAL COLITIS; CROHN'S DISEASE [REGIONAL ENTERITIS] OF COLON; CROHN'S DISEASE [REGIONAL ENTERITIS] OF LARGE BOWEL; CROHN'S DISEASE [REGIONAL ENTERITIS] OF RECTUM|11,830.00|8,281.00|3,549.00
K50.8|OTHER CROHN'S DISEASE; CROHN'S DISEASE OF BOTH SMALL AND LARGE INTESTINE|11,830.00|8,281.00|3,549.00
K50.9|CROHN'S DISEASE [REGIONAL ENTERITIS], UNSPECIFIED; CROHN'S DISEASE NOS; REGIONAL ENTERITIS NOS; GRANULOMATOUS ENTERITIS NOS|11,830.00|8,281.00|3,549.00
K51.0|ULCERATIVE (CHRONIC) ENTEROCOLITIS|11,830.00|8,281.00|3,549.00
K51.1|ULCERATIVE (CHRONIC) ILEOCOLITIS|11,830.00|8,281.00|3,549.00
K51.2|ULCERATIVE (CHRONIC) PROCTITIS|11,830.00|8,281.00|3,549.00
K51.3|ULCERATIVE (CHRONIC) RECTOSIGMOIDITIS|11,830.00|8,281.00|3,549.00
K51.5|MUCOSAL PROCTOCOLITIS|11,830.00|8,281.00|3,549.00
K51.8|OTHER ULCERATIVE COLITIS|11,830.00|8,281.00|3,549.00
K51.9|ULCERATIVE COLITIS, UNSPECIFIED; ULCERATIVE ENTERITIS NOS|11,830.00|8,281.00|3,549.00
K52.0|GASTROENTERITIS AND COLITIS DUE TO RADIATION|7,800.00|5,460.00|2,340.00
K52.1|TOXIC GASTROENTERITIS AND COLITIS|7,800.00|5,460.00|2,340.00
K52.2|ALLERGIC AND DIETETIC GASTROENTERITIS AND COLITIS; FOOD HYPERSENSITIVITY GASTROENTERITIS OR COLITIS|7,800.00|5,460.00|2,340.00
K52.8|OTHER SPECIFIED NONINFECTIVE GASTROENTERITIS AND COLITIS; EOSINOPHILIC GASTRITIS OR GASTROENTERITIS|7,800.00|5,460.00|2,340.00
K52.9|NONINFECTIVE GASTROENTERITIS AND COLITIS, UNSPECIFIED; DIARRHOEA SPECIFIED AS NONINFECTIVE, OR NOS IN COUNTRIES WHERE THE CONDITIONS CAN BE PRESUMED TO BE OF NONINFECTIOUS ORIGIN; ENTERITIS SPECIFIED AS NONINFECTIVE, OR NOS IN COUNTRIES WHERE THE CONDITIO|7,800.00|5,460.00|2,340.00
K55.0|ACUTE VASCULAR DISORDERS OF INTESTINE; ACUTE FULMINANT ISCHAEMIC COLITIS; ACUTE INTESTINAL INFARCTION; ACUTE SMALL INTESTINE ISCHAEMIA; MESENTRIC ARTERY EMBOLISM; MESENTRIC VEIN EMBOLISM; MESENTRIC ARTERY INFARCTION; MESENTRIC VEIN INFARCTION; MESENTRIC A|12,350.00|8,645.00|3,705.00
K55.1|CHRONIC VASCULAR DISORDERS OF INTESTINE; CHRONIC ISCHAEMIC COLITIS; CHRONIC ISCHAEMIC ENTERITIS; CHRONIC ISCHAEMIC ENTEROCOLITIS; ISCHAEMIC STRICTURE OF INTESTINE; MESENTRIC ATHEROSCLEROSIS; MESENTRIC VASCULAR INSUFFICIENCY|12,350.00|8,645.00|3,705.00
K55.2|ANGIODYSPLASIA OF COLON|12,350.00|8,645.00|3,705.00
K55.9|VASCULAR DISORDER OF INTESTINE, UNSPECIFIED; ISCHAEMIC COLITIS NOS; ISCHAEMIC ENTERITIS NOS; ISCHAEMIC ENTEROCOLITIS NOS|12,350.00|8,645.00|3,705.00
K56.0|PARALYTIC ILEUS; PARALYSIS OF BOWEL; PARALYSIS OF COLON; PARALYSIS OF INTESTINE|13,130.00|9,191.00|3,939.00
K56.1|INTUSSUSCEPTION; INTUSSUSCEPTION OR INVAGINATION OF BOWEL; INTUSSUSCEPTION OR INVAGINATION OF COLON; INTUSSUSCEPTION OR INVAGINATION OF INTESTINE; INTUSSUSCEPTION OR INVAGINATION OF RECTUM|13,130.00|9,191.00|3,939.00
K56.2|VOLVULUS; STRANGULATION OF COLON OR INTESTINE; TORSION OF COLON OR INTESTINE; TWIST OF COLON OR INTESTINE|13,130.00|9,191.00|3,939.00
K56.3|GALLSTONE ILEUS; OBSTRUCTION OF INTESTINE BY GALLSTONE|13,130.00|9,191.00|3,939.00
K56.4|OTHER IMPACTION OF INTESTINE; ENTEROLITH; IMPACTION OF COLON; IMFACTION OF FAECAL|13,130.00|9,191.00|3,939.00
K56.5|INTESTINAL ADHESIONS [BANDS] WITH OBSTRUCTION; PERITONEAL ADHESIONS [BANDS] WITH INTESTINAL OBSTRUCTION|13,130.00|9,191.00|3,939.00
K56.6|OTHER AND UNSPECIFIED INTESTINAL OBSTRUCTION; ENTEROTENOSIS; OBSTRUCTIVE ILEUS NOS; OCCLUSION OF COLON OR INTESTINE; STENOSIS OF COLON OR INTESTINE; STRICTURE OF COLON OR INTESTINE|13,130.00|9,191.00|3,939.00
K56.7|ILEUS, UNSPECIFIED|13,130.00|9,191.00|3,939.00
K57.0|DIVERTICULAR DISEASE OF SMALL INTESTINE WITH PERFORATION AND ABSCESS; DIVERTICULAR DISEASE OF SMALL INTESTINE WITH PERITONITIS|12,350.00|8,645.00|3,705.00
K57.1|DIVERTICULAR DISEASE OF SMALL INTESTINE WITHOUT PERFORATION OR ABSCESS; DIVERTICULAR DISEASE OF SMALL INTESTINE NOS|12,350.00|8,645.00|3,705.00
K57.2|DIVERTICULAR DISEASE OF LARGE INTESTINE WITH PERFORATION AND ABSCESS; DIVERTICULAR DISEASE/ DIVERTICULITIS/ DIVERTICULOSIS/ DIVERTICULUM OF COLON WITH PERITONITIS|12,350.00|8,645.00|3,705.00
K57.3|DIVERTICULAR DISEASE OF LARGE INTESTINE WITHOUT PERFORATION OR ABSCESS; DIVERTICULAR DISEASE OF COLON NOS|12,350.00|8,645.00|3,705.00
K57.4|DIVERTICULAR DISEASE OF BOTH SMALL AND LARGE INTESTINE WITH PERFORATION AND ABSCESS; DIVERTICULAR DISEASE OF BOTH SMALL AND LARGE INTESTINE WITH PERITONITIS|12,350.00|8,645.00|3,705.00
K57.5|DIVERTICULAR DISEASE OF BOTH SMALL AND LARGE INTESTINE WITHOUT PERFORATION OR ABSCESS; DIVERTICULAR DISEASE OF BOTH SMALL AND LARGE INTESTINE NOS|12,350.00|8,645.00|3,705.00
K57.8|DIVERTICULAR DISEASE OF INTESTINE, PART UNSPECIFIED, WITH PERFORATION AND ABSCESS; DIVERTICULAR  DISEASE OF INTESTINE NOS WITH PERITONITIS|12,350.00|8,645.00|3,705.00
K57.9|DIVERTICULAR DISEASE OF INTESTINE, PART UNSPECIFIED, WITHOUT PERFORATION OR ABSCESS; DIVERTICULAR DISEASE OF INTESTINE NOS|12,350.00|8,645.00|3,705.00
K58.0|IRRITABLE BOWEL SYNDROME WITH DIARRHOEA|7,800.00|5,460.00|2,340.00
K59.0|CONSTIPATION|5,200.00|3,640.00|1,560.00
K59.3|MEGACOLON, NOT ELSEWHERE CLASSIFIED; DILATATION OF COLON; TOXIC MEGACOLON|12,350.00|8,645.00|3,705.00
K59.8|OTHER SPECIFIED FUNCTIONAL INTESTINAL DISORDERS; ATONY OF COLON|12,350.00|8,645.00|3,705.00
K59.9|FUNCTIONAL INTESTINAL DISORDER, UNSPECIFIED|12,350.00|8,645.00|3,705.00
K63.0|ABSCESS OF INTESTINE|12,350.00|8,645.00|3,705.00
K63.1|NONTRAUMATIC PERFORATION OF INTESTINE|12,350.00|8,645.00|3,705.00
K63.2|FISTULA OF INTESTINE|12,350.00|8,645.00|3,705.00
K63.3|ULCER OF INTESTINE; PRIMARY ULCER OF SMALL INTESTINE|12,350.00|8,645.00|3,705.00
K63.4|ENTEROPTOSIS|12,350.00|8,645.00|3,705.00
K63.5|POLYP OF COLON|12,350.00|8,645.00|3,705.00
K63.8|OTHER SPECIFIED DISEASES OF INTESTINE|12,350.00|8,645.00|3,705.00
K63.9|DISEASE OF INTESTINE, UNSPECIFIED|12,350.00|8,645.00|3,705.00
K65.0|ACUTE PERITONITIS; ABDOMINOPELVIC ABSCESS; MESENTERIC ABSCESS; ABSCESS OF OMENTUM; ABSCESS OF PERITONEUM; RETROCAECAL ABSCESS; RETROPERITONEAL ABSCESS; SUBDIAPHRAGMATIC ABSCESS; SUBHEPATIC ABSCESS; SUBPHRENIC ABSCESS; ACUTE GENERALIZED PERITONITIS; ACUTE|19,110.00|13,377.00|5,733.00
K65.8|OTHER PERITONITIS; CHRONIC PROLIFERATIVE PERITONITIS; MESENTRIC FAT NECROSIS; MESENTRIC SAPONIFICATION; PERITONITIS DUE TO BILE; PERITONITIS DUE TO URINE|19,110.00|13,377.00|5,733.00
K65.9|PERITONITIS, UNSPECIFIED|19,110.00|13,377.00|5,733.00
K66.0|PERITONEAL ADHESIONS; ADHESIONS OF ABDOMINAL WALL; ADHESIONS OF DIAPHRAGM; ADHESIONS OF INTESTINE; ADHESIONS OF MALE PELVIS; MESENTERICADHESIONS;  ADHESIONS OF OMENTUM; ADHESIONS OF STOMACH; ADHESIVE BANDS|14,040.00|9,828.00|4,212.00
K66.8|OTHER SPECIFIED DISORDERS OF PERITONEUM|14,040.00|9,828.00|4,212.00
K66.9|DISORDER OF PERITONEUM, UNSPECIFIED|14,040.00|9,828.00|4,212.00
K70.0|ALCOHOLIC FATTY LIVER|15,340.00|10,738.00|4,602.00
K70.1|ALCOHOLIC HEPATITIS|15,340.00|10,738.00|4,602.00
K70.2|ALCOHOLIC FIBROSIS AND SCLEROSIS OF LIVER|15,340.00|10,738.00|4,602.00
K70.3|ALCOHOLIC CIRRHOSIS OF LIVER; ALCOHOLIC CIRRHOSIS NOS; LAENNEC'S CIRRHOSIS|15,340.00|10,738.00|4,602.00
K70.4|ALCOHOLIC HEPATIC FAILURE; ALCOHOLIC HEPATIC FAILURE NOS; ACUTE ALCOHOLIC HEPATIC FAILURE; CHRONIC ALCOHOLIC HEPATIC FAILURE; SUBACUTE ALCOHOLIC HEPATIC FAILURE; ALCOHOLIC HEPATIC FAILURE WITH OR WITHOUT HEPATIC COMA|26,780.00|18,746.00|8,034.00
K70.9|ALCOHOLIC LIVER DISEASE, UNSPECIFIED|15,340.00|10,738.00|4,602.00
K71.0|TOXIC LIVER DISEASE WITH CHOLESTASIS; CHOLESTATIS WITH HEPATOCYTE INJURY; PURE CHOLESTASIS|15,340.00|10,738.00|4,602.00
K71.1|TOXIC LIVER DISEASE WITH HEPATIC NECROSIS; ACUTE HEPATIC FAILURE DUE TO DRUGS; CHRONIC HEPATIC FAILURE DUE TO DRUGS|15,340.00|10,738.00|4,602.00
K71.2|TOXIC LIVER DISEASE WITH ACUTE HEPATITIS|15,340.00|10,738.00|4,602.00
K71.3|TOXIC LIVER DISEASE WITH CHRONIC PERSISTENT HEPATITIS|15,340.00|10,738.00|4,602.00
K71.4|TOXIC LIVER DISEASE WITH CHRONIC LOBULAR HEPATITIS|19,630.00|13,741.00|5,889.00
K71.5|TOXIC LIVER DISEASE WITH CHRONIC ACTIVE HEPATITIS; TOXIC LIVER DISEASE WITH LUPOID HEPATITIS|15,340.00|10,738.00|4,602.00
K71.6|TOXIC LIVER DISEASE WITH HEPATITIS, NOT ELSEWHERE CLASSIFIED|15,340.00|10,738.00|4,602.00
K71.7|TOXIC LIVER DISEASE WITH FIBROSIS AND CIRRHOSIS OF LIVER|19,630.00|13,741.00|5,889.00
K71.8|TOXIC LIVER DISEASE WITH OTHER DISORDERS OF LIVER; TOXIC LIVER DISEASE WITH FOCAL NODULAR HYPERPLASIA; TOXIC LIVER DISEASE WITH HEPATIC GRANULOMAS; TOXIC LIVER DISEASE WITH PELIOSIS HEPATIS; TOXIC LIVER DISEASE WITH VENO-OCCLUSIVE DISEASE OF LIVER|15,340.00|10,738.00|4,602.00
K71.9|TOXIC LIVER DISEASE, UNSPECIFIED|15,340.00|10,738.00|4,602.00
K72.0|ACUTE AND SUBACUTE HEPATIC FAILURE|26,780.00|18,746.00|8,034.00
K72.1|CHRONIC HEPATIC FAILURE|26,780.00|18,746.00|8,034.00
K72.9|HEPATIC FAILURE|26,780.00|18,746.00|8,034.00
K73.0|CHRONIC PERSISTENT HEPATITIS, NOT ELSEWHERE CLASSIFIED|15,340.00|10,738.00|4,602.00
K73.2|CHRONIC ACTIVE HEPATITIS, NOT ELSEWHERE CLASSIFIED; LUPOID HEPATITIS NEC|15,340.00|10,738.00|4,602.00
K73.8|OTHER CHRONIC HEPATITIS, NOT ELSEWHERE CLASSIFIED|15,340.00|10,738.00|4,602.00
K73.9|CHRONIC HEPATITIS, UNSPECIFIED|15,340.00|10,738.00|4,602.00
K74.0|HEPATIC FIBROSIS|19,630.00|13,741.00|5,889.00
K74.1|HEPATIC SCLEROSIS|15,340.00|10,738.00|4,602.00
K74.2|HEPATIC FIBROSIS WITH HEPATIC SCLEROSIS|19,630.00|13,741.00|5,889.00
K74.3|PRIMARY BILIARY CIRRHOSIS; CHRONIC NONSUPPARATIVE DESTRUCTIVE CHOLANGITIS|17,160.00|12,012.00|5,148.00
K74.4|SECONDARY BILIARY CIRRHOSIS|12,740.00|8,918.00|3,822.00
K74.5|BILIARY CIRRHOSIS, UNSPECIFIED|12,740.00|8,918.00|3,822.00
K74.6|OTHER AND UNSPECIFIED CIRRHOSIS OF LIVER; CIRRHOSIS OF LIVER NOS; CRYPTOGENIC CIRRHOSIS OF LIVER; MACRONODULAR CIRRHOSIS OF LIVER; MICRONODULAR CIRRHOSIS OF LIVER; MIXED TYPE CIRRHOSIS OF LIVER; PORTAL CIRRHOSIS OF LIVER; POSTNECROTIC CIRRHOSIS OF LIVER;|19,630.00|13,741.00|5,889.00
K74.6+I98.2*|OESOPHAGEAL VARICES IN OTHER AND UNSPECIFIED CIRRHOSIS OF LIVER|15,340.00|10,738.00|4,602.00
K75.0|ABSCESS OF LIVER; HEPATIC ABSCESS NOS; CHOLANGITIC HEPATIC ABSCESS; HAEMATOGENIC HEPATIC ABSCESS; LYMPHOGENIC HEPATIC ABSCESS; PYLEPHLEBITIC HEPATIC ABSCESS|15,340.00|10,738.00|4,602.00
K75.1|PHLEBITIS OF PORTAL VEIN; PYLEPHLEBITIS|15,340.00|10,738.00|4,602.00
K75.2|NONSPECIFIC REACTIVE HEPATITIS|15,340.00|10,738.00|4,602.00
K75.3|GRANULOMATOUS HEPATITIS, NOT ELSEWHERE CLASSIFIED|15,340.00|10,738.00|4,602.00
K75.4|AUTOIMMUNE HEPATITIS|15,340.00|10,738.00|4,602.00
K75.8|OTHER SPECIFIED INFLAMMATORY LIVER DISEASES|15,340.00|10,738.00|4,602.00
K75.9|INFLAMMATORY LIVER DISEASE, UNSPECIFIED; HEPATITIS NOS|15,340.00|10,738.00|4,602.00
K76.0|FATTY (CHANGE OF) LIVER, NOT ELSEWHERE CLASSIFIED|15,340.00|10,738.00|4,602.00
K76.1|CHRONIC PASSIVE CONGESTION OF LIVER; CARDIAC CIRRHOSIS (SO-CALLED) OF LIVER; CARDIAC SCLEROSIS OF LIVER|19,630.00|13,741.00|5,889.00
K76.2|CENTRAL HAEMORRHAGIC NECROSIS OF LIVER|19,630.00|13,741.00|5,889.00
K76.3|INFARCTION OF LIVER|19,630.00|13,741.00|5,889.00
K76.4|PELIOSIS HEPATIS; HEPATIC ANGIOMATOSIS|19,630.00|13,741.00|5,889.00
K76.6|PORTAL HYPERTENSION|19,630.00|13,741.00|5,889.00
K76.7|HEPATORENAL SYNDROME|19,630.00|13,741.00|5,889.00
K76.8|OTHER SPECIFIED DISEASES OF LIVER; FOCAL NODULAR HYPERPLASIA OF LIVER; HEPATOPTOSIS|15,340.00|10,738.00|4,602.00
K76.9|LIVER DISEASE, UNSPECIFIED|15,340.00|10,738.00|4,602.00
K80.0|CALCULUS OF GALLBLADDER WITH ACUTE CHOLECYSTITIS; ANY CONDITION LISTED IN K80.2 WITH ACUTE CHOLECYSTITIS|14,690.00|10,283.00|4,407.00
K80.1|CALCULUS OF GALLBLADDER WITH OTHER CHOLECYSTITIS; ANY CONDITION LISTED IN K80.2 WITH CHRONIC CHOLECYSTITIS; CHOLECYSTITIS WITH CHOLELITHIASIS NOS|14,690.00|10,283.00|4,407.00
K80.2|CALCULUS OF GALLBLADDER WITHOUT CHOLECYSTITIS; CHOLECYSTOLITHIASIS UNSPECIFIED OR WITHOUT CHOLECYSTITIS; CHOLELITHIASIS UNSPECIFIED OR WITHOUT CHOLECYSTITIS; RECURRENT COLIC OF GALLBLADDER UNSPECIFIED OR WITHOUT CHOLECYSTITIS; IMPACTED GALLSTONE OF CYSTIC|12,740.00|8,918.00|3,822.00
K80.3|CALCULUS OF BILE DUCT WITH CHOLANGITIS; ANY CONDITION LISTED IN K80.5 WITH CHOLANGITIS|17,160.00|12,012.00|5,148.00
K80.4|CALCULUS OF BILE DUCT WITH CHOLECYSTITIS; ANY CONDITION LISTED IN K80.5 WITH CHOLECYSTITIS (WITH CHOLANGITIS)|14,690.00|10,283.00|4,407.00
K80.5|CALCULUS OF BILE DUCT WITHOUT CHOLANGITIS OR CHOLECYSTITIS; CHOLEDOCHOLITHIASIS UNSPECIFIED OR WITHOUT CHOLANGITIS OR CHOLECYSTITIS; IMPACTED GALLSTONE OF BILE DUCT NOS UNSPECIFIED OR WITHOUT CHOLANGITIS OR CHOLECYSTITIS; IMPACTED GALLSTONE OF COMMON DUCT|12,740.00|8,918.00|3,822.00
K80.8|OTHER CHOLELITHIASIS|12,740.00|8,918.00|3,822.00
K81.0|ACUTE CHOLECYSTITIS; ABSCESS OF GALLBLADDER WITHOUT CALCULUS; ANGIOCHOLECYSTITIS WITHOUT CALCULUS; ACUTE EMPHYSEMATOUS CHOLECYSTITIS WITHOUT CALCULUS; GANGRENOUS CHOLECYSTITIS WITHOUT CALCULUS; SUPPARATIVE CHOLECYSTITIS WITHOUT CALCULUS; EMPYEMA OF GALLBL|14,690.00|10,283.00|4,407.00
K81.1|CHRONIC CHOLECYSTITIS|14,690.00|10,283.00|4,407.00
K81.8|OTHER CHOLECYSTITIS|14,690.00|10,283.00|4,407.00
K82.0|OBSTRUCTION OF GALLBLADDER; OCCLUSION OF CYSTIC DUCT OF GALLBLADDER WITHOUT CALCULUS; STENOSIS OF CYSTIC DUCT OR GALLBLADDER WITHOUT CALCULUS; STRICTURE OF CYSTIC DUCT OR GALLBLADDER WITHOUT CALCULUS|12,740.00|8,918.00|3,822.00
K82.1|HYDROPS OF GALLBLADDER; MUCOCELE OF GALLBLADDER|12,740.00|8,918.00|3,822.00
K82.2|PERFORATION OF GALLBLADDER; RUPTURE OF CYSTIC DUCT OR GALLBLADDER|12,740.00|8,918.00|3,822.00
K82.3|FISTULA OF GALLBLADDER; CHOLECYSTOCOLIC FISTULA; CHOLECYSTODUODENAL FISTULA|12,740.00|8,918.00|3,822.00
K82.4|CHOLESTEROLOSIS OF GALLBLADDER; STRAWBERRY GALLBLADDER|12,740.00|8,918.00|3,822.00
K82.8|OTHER SPECIFIED DISEASES OF GALLBLADDER; ADHESIONS OF CYSTIC DUCT OR GALLBLADDER; ATROPHY OF CYSTIC DUCT OR GALLBLADDER; CYST OF CYSTIC DUCT OR GALLBLADDER; DYSKINESIA OF CYSTIC DUCT OR GALLBLADDER; HYPERTROPHY OF CYSTIC DUCT OR GALLBLADDER; NONFUNCTIONIN|12,740.00|8,918.00|3,822.00
K83.0|CHOLANGITIS; CHOLANGITIS NOS; ASCENDING CHOLANGITIS; PRIMARY CHOLANGITIS; RECURRENT CHOLANGITIS; SCLEROSING CHOLANGITIS; SECONDARY CHOLANGITIS; STENOSING CHOLANGITIS; SUPPURATIVE CHOLANGITIS|12,740.00|8,918.00|3,822.00
K83.1|OBSTRUCTION OF BILE DUCT; OCCLUSION OF BILE DUCT WITHOUT CALCULUS; STENOSIS OF BILE DUCT WITHOUT CALCULUS; STRICTURE OF BILE DUCT WITHOUT CALCULUS|12,740.00|8,918.00|3,822.00
K83.3|FISTULA OF BILE DUCT; CHOLEDOCHODUODENAL FISTULA|12,740.00|8,918.00|3,822.00
K83.4|SPASM OF SPHINCTER OF ODDI|12,740.00|8,918.00|3,822.00
K83.5|BILIARY CYST|12,740.00|8,918.00|3,822.00
K83.8|OTHER SPECIFIED DISEASES OF BILIARY TRACT; ADHESIONS OF BILE DUCT; ATROPHY OF BILE DUCT; HYPERTROPHY OF BILE DUCT; ULCER OF BILE DUCT|12,740.00|8,918.00|3,822.00
K85|ACUTE PANCREATITIS; ABSCESS OF PANCREAS; ACUTE NECROSIS OF PANCREAS; INFECTIVE NECROSIS OF PANCREAS; PANCREATITIS NOS; ACUTE RECURRENT PANCREATITIS; HAEMORRHAGIC PANCREATITIS; SUBACUTE PANCREATITIS; SUPPARATIVE PANCREATITIS|16,380.00|11,466.00|4,914.00
K85.0|IDIOPATHIC ACUTE PANCREATITIS|16,380.00|11,466.00|4,914.00
K85.1|BILIARY ACUTE PANCREATITIS; GALLSTONE PANCREATITIS|16,380.00|11,466.00|4,914.00
K85.2|ALCOHOL-INDUCED ACUTE PANCREATITIS|16,380.00|11,466.00|4,914.00
K85.8|OTHER ACUTE PANCREATITIS|16,380.00|11,466.00|4,914.00
K85.9|ACUTE PANCREATITIS, UNSPECIFIED; OTHER DISEASES OF PANCREAS|16,380.00|11,466.00|4,914.00
K86.0|ALCOHOL-INDUCED CHRONIC PANCREATITIS|16,380.00|11,466.00|4,914.00
K86.1|OTHER CHRONIC PANCREATITIS; CHRONIC PANCREATITIS NOS; INFECTIOUS CHRONIC PANCREATITIS; RECURRENT CHRONIC PANCREATITIS; RELAPSING CHRONIC PANCREATITIS|16,380.00|11,466.00|4,914.00
K86.2|CYST OF PANCREAS|16,380.00|11,466.00|4,914.00
K86.3|PSEUDOCYST OF PANCREAS|16,380.00|11,466.00|4,914.00
K86.8|OTHER SPECIFIED DISEASES OF PANCREAS; ATROPHY OF PANCREAS; CALCULUS OF PANCREAS; CIRRHOSIS OF PANCREAS; FIBROSIS OF PANCREAS; PANCREATIC INFANTILISM; PANCREATIC NECROSIS NOS; ASEPTIC PANCREATIC NECROSIS; FAT NECROSIS OF PANCREAS|16,380.00|11,466.00|4,914.00
K90.0|COELIAC DISEASE; GLUTEN-SENSITIVE ENTEROPATHY; IDIOPATHIC STEATORRHOEA; NONTROPICAL SPRUE|5,330.00|3,731.00|1,599.00
K90.1|TROPICAL SPRUE; SPRUE NOS; TROPICAL STEATORRHOEA|5,330.00|3,731.00|1,599.00
K90.2|BLIND LOOP SYNDROME, NOT ELSEWHERE CLASSIFIED; BLIND LOOP SYNDROME NOS|5,330.00|3,731.00|1,599.00
K90.3|PANCREATIC STEATORRHOEA|5,330.00|3,731.00|1,599.00
K90.4|MALABSORPTION DUE TO INTOLERANCE, NOT ELSEWHERE CLASSIFIED; MALABSORPTION DUE TO INTOLERANCE TO CARBOHYDRATE; MALABSORPTION DUE TO INTOLERANCE TO FAT; MALABSORPTION DUE TO INTOLERANCE TO PROTEIN; MALABSORPTION DUE TO INTOLERANCE TO STARCH|5,330.00|3,731.00|1,599.00
K90.8|OTHER INTESTINAL MALABSORPTION|5,330.00|3,731.00|1,599.00
K90.9|INTESTINAL MALABSORPTION, UNSPECIFIED|5,330.00|3,731.00|1,599.00
K91.0|VOMITING FOLLOWING GASTROINTESTINAL SURGERY|13,390.00|9,373.00|4,017.00
K91.1|POSTGASTRIC SURGERY SYNDROMES; DUMPING SYNDROME; POSTGASTRECTOMY SYNDROME; POSTVAGOTOMY SYNDROME|13,390.00|9,373.00|4,017.00
K91.2|POSTSURGICAL MALABSORPTION, NOT ELSEWHERE CLASSIFIED; POSTSURGICAL BLIND LOOP SYNDROME|13,390.00|9,373.00|4,017.00
K91.3|POSTOPERATIVE INTESTINAL OBSTRUCTION|13,390.00|9,373.00|4,017.00
K91.4|COLOSTOMY AND ENTEROSTOMY MALFUNCTION|13,390.00|9,373.00|4,017.00
K91.5|POSTCHOLECYSTECTOMY SYNDROME|13,390.00|9,373.00|4,017.00
K91.8|OTHER POSTPROCEDURAL DISORDERS OF DIGESTIVE SYSTEM, NOT ELSEWHERE CLASSIFIED|13,390.00|9,373.00|4,017.00
K91.9|POSTPROCEDURAL DISORDER OF DIGESTIVE SYSTEM, UNSPECIFIED|13,390.00|9,373.00|4,017.00
L00|STAPHYLOCOCCAL SCALDED SKIN SYNDROME; PEMPHIGUS NEONATORUM; RITTER'S DISEASE|13,260.00|9,282.00|3,978.00
L02.0|CUTANEOUS ABSCESS, FURUNCLE AND CARBUNCLE OF FACE|5,200.00|3,640.00|1,560.00
L02.1|CUTANEOUS ABSCESS, FURUNCLE AND CARBUNCLE OF NECK|5,200.00|3,640.00|1,560.00
L02.2|CUTANEOUS ABSCESS, FURUNCLE AND CARBUNCLE OF TRUNK; CUTANEOUS ABSCESS, FURUNCLE AND CARBUNCLE OF ABDOMINAL WALL; CUTANEOUS ABSCESS, FURUNCLE AND CARBUNCLE OF BACK [ANY PART, EXCEPT BUTTOCK]; CUTANEOUS ABSCESS, FURUNCLE AND CARBUNCLE OF CHEST WALL; CUTANEO|5,200.00|3,640.00|1,560.00
L02.3|CUTANEOUS ABSCESS, FURUNCLE AND CARBUNCLE OF BUTTOCK; CUTANEOUS ABSCESS, FURUNCLE AND CARBUNCLE OF GLUTEAL REGION|5,200.00|3,640.00|1,560.00
L02.4|CUTANEOUS ABSCESS, FURUNCLE AND CARBUNCLE OF LIMB,  AXILLA,  HIP & SHOULDER|5,200.00|3,640.00|1,560.00
L02.8|CUTANEOUS ABSCESS, FURUNCLE AND CARBUNCLE OF OTHER SITES: HEAD [ANY PART, EXCEPT FACE]; SCALP|5,200.00|3,640.00|1,560.00
L02.9|CUTANEOUS ABSCESS, FURUNCLE AND CARBUNCLE, UNSPECIFIED; FURUNCULOSIS NOS|5,200.00|3,640.00|1,560.00
L03.0|CELLULITIS OF FINGER AND TOE; INFECTION OF NAIL; ONYCHIA; PARONYCHIA; PERIONYCHIA|12,480.00|8,736.00|3,744.00
L03.1|CELLULITIS OF OTHER PARTS OF LIMB,  AXILLA; CELLULITIS OF HIP;CELLULITIS OF SHOULDER|12,480.00|8,736.00|3,744.00
L03.2|CELLULITIS OF FACE|12,480.00|8,736.00|3,744.00
L03.3|CELLULITIS OF TRUNK;CELLULITIS OF ABDOMINAL WALL;CELLULITIS OF BACK [ANY PART]; CELLULITIS OF CHEST WALL;CELLULITIS OF GROIN;CELLULITIS OF PERINEUM;CELLULITIS OF UMBILICUS|12,480.00|8,736.00|3,744.00
L03.8|CELLULITIS OF OTHER SITES; CELLULITIS OF HEAD [ANY PART, EXCEPT FACE];CELLULITIS OF SCALP|12,480.00|8,736.00|3,744.00
L03.9|CELLULITIS, UNSPECIFIED|12,480.00|8,736.00|3,744.00
L10.0|PEMPHIGUS VULGARIS|15,600.00|10,920.00|4,680.00
L10.1|PEMPHIGUS VEGETANS|15,600.00|10,920.00|4,680.00
L10.2|PEMPHIGUS FOLIACEUS|15,600.00|10,920.00|4,680.00
L10.4|PEMPHIGUS ERYTHEMATOSUS; SENEAR-USHER SYNDROME|15,600.00|10,920.00|4,680.00
L10.8|OTHER PEMPHIGUS|15,600.00|10,920.00|4,680.00
L10.9|PEMPHIGUS, UNSPECIFIED|15,600.00|10,920.00|4,680.00
L11.0|ACQUIRED KERATOSIS FOLLICULARIS|15,600.00|10,920.00|4,680.00
L11.1|TRANSIENT ACANTHOLYTIC DERMATOSIS [GROVER]|15,600.00|10,920.00|4,680.00
L11.9|ACANTHOLYTIC DISORDER, UNSPECIFIED|15,600.00|10,920.00|4,680.00
L12.0|BULLOUS PEMPHIGOID|15,600.00|10,920.00|4,680.00
L12.1|CICATRICIAL PEMPHIGOID; BENIGN MUCOUS MEMBRANE PEMPHIGOID|15,600.00|10,920.00|4,680.00
L12.2|CHRONIC BULLOUS DISEASE OF CHILDHOOD; JUVENILE DERMATITIS HERPETIFORMIS|15,600.00|10,920.00|4,680.00
L12.3|ACQUIRED EPIDERMOLYSIS BULLOSA|15,600.00|10,920.00|4,680.00
L12.8|OTHER PEMPHIGOID|15,600.00|10,920.00|4,680.00
L13.0|DERMATITIS HERPETIFORMIS; DUHRING'S DISEASE|15,600.00|10,920.00|4,680.00
L13.1|SUBCORNEAL PUSTULAR DERMATITIS; SNEDDON- WILKINSON DISEASE|15,600.00|10,920.00|4,680.00
L13.9|BULLOUS DISORDER, UNSPECIFIED|15,600.00|10,920.00|4,680.00
L51.1|BULLOUS ERYTHEMA MULTIFORME; STEVENS-JOHNSON SYNDROME|15,990.00|11,193.00|4,797.00
L51.2|TOXIC EPIDERMAL NECROLYSIS [LYELL]|20,670.00|14,469.00|6,201.00
L72.0|EPIDERMAL CYST|5,200.00|3,640.00|1,560.00
L72.1|TRICHILEMMAL CYST; PILAR CYST; SEBACEOUS CYST|5,200.00|3,640.00|1,560.00
L72.2|STEATOCYSTOMA MULTIPLEX|5,200.00|3,640.00|1,560.00
L72.8|OTHER FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS TISSUE|5,200.00|3,640.00|1,560.00
L72.9|FOLLICULAR CYST OF SKIN AND SUBCUTANEOUS TISSUE, UNSPECIFIED|5,200.00|3,640.00|1,560.00
L88|PYODERMA GANGRENOSUM; DERMATITIS GANGRENOSA; PHAGEDENIC PYODERMA|17,160.00|12,012.00|5,148.00
L93.0|DISCOID LUPUS ERYTHEMATOSUS; LUPUS ERYTHEMATOSUS|15,470.00|10,829.00|4,641.00
L93.1|SUBACUTE CUTANEOUS LUPUS ERYTHEMATOSUS|15,470.00|10,829.00|4,641.00
L93.2|LUPUS ERYMATOSUS PROFUNDUS; LUPUS PANNICULITIS|15,470.00|10,829.00|4,641.00
L98.3|EOSINOPHILIC CELLULITIS [WELLS]|12,480.00|8,736.00|3,744.00
M00.16|PNEUMOCOCCAL ARTHRITIS AND POLYARTHRITIS, LOWER LEG|12,610.00|8,827.00|3,783.00
M00.19|PNEUMOCOCCAL ARTHRITIS AND POLYARTHRITIS,  SITE UNSPECIFIED|12,610.00|8,827.00|3,783.00
M00.29|OTHER STREPTOCOCCAL ARTHRITIS AND POLYARTHRITIS, SITE UNSPECIFIED|12,610.00|8,827.00|3,783.00
M00.82|ARTHRITIS AND POLYARTHRITIS DUE TO OTHER SPECIFIED BACTERIAL AGENTS UPPER ARM|12,610.00|8,827.00|3,783.00
M00.90|PYOGENIC ARTHRITIS, UNSPECIFIED; INFECTIVE ARTHRITIS NOS MULTIPLE SITES|12,610.00|8,827.00|3,783.00
M00.91|PYOGENIC ARTHRITIS, UNSPECIFIED; INFECTIVE ARTHRITIS NOS SHOULDER REGION|12,610.00|8,827.00|3,783.00
M00.93|PYOGENIC ARTHRITIS, UNSPECIFIED; INFECTIVE ARTHRITIS NOS FOREARM|12,610.00|8,827.00|3,783.00
M00.94|PYOGENIC ARTHRITIS, UNSPECIFIED; INFECTIVE ARTHRITIS NOS HAND|12,610.00|8,827.00|3,783.00
M00.95|PYOGENIC ARTHRITIS, UNSPECIFIED; INFECTIVE ARTHRITIS NOS PELVIC REGION AND THIGH|12,610.00|8,827.00|3,783.00
M00.96|PYOGENIC ARTHRITIS, UNSPECIFIED; INFECTIVE ARTHRITIS NOS LOWER LEG|12,610.00|8,827.00|3,783.00
M00.97|PYOGENIC ARTHRITIS, UNSPECIFIED; INFECTIVE ARTHRITIS NOS ANKLE AND FOOT|12,610.00|8,827.00|3,783.00
M00.98|PYOGENIC ARTHRITIS, UNSPECIFIED; INFECTIVE ARTHRITIS NOS OTHER SITES|12,610.00|8,827.00|3,783.00
M00.99|PYOGENIC ARTHRITIS, UNSPECIFIED; INFECTIVE ARTHRITIS NOS SITE UNSPECIFIED|12,610.00|8,827.00|3,783.00
M02.39|REITER'S DISEASE, SITE UNSPECIFIED|12,610.00|8,827.00|3,783.00
M02.99|REACTIVE ARTHROPATHY, UNSPECIFIED, SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M05.99|SEROPOSITIVE RHEUMATOID ARTHRITIS, UNSPECIFIED, SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M06.01|SERONEGATIVE RHEUMATOID ARTHRITIS, SHOULDER REGION|9,100.00|6,370.00|2,730.00
M06.09|SERONEGATIVE RHEUMATOID ARTHRITIS, SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M06.19|ADULT-ONSET STILL'S DISEASE, SITE UNSPECIFIED|12,610.00|8,827.00|3,783.00
M06.36|RHEUMATOID NODULE, LOWER LEG|9,100.00|6,370.00|2,730.00
M06.45|INFLAMMATORY POLYARTHROPATHY, PELVIC REGION AND THIGH|9,100.00|6,370.00|2,730.00
M06.49|INFLAMMATORY POLYARTHROPATHY, SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M06.81|OTHER SPECIFIED RHEUMATOID ARTHRITIS, SHOULDER REGION|9,100.00|6,370.00|2,730.00
M06.86|OTHER SPECIFIED RHEUMATOID ARTHRITIS, LOWER LEG|9,100.00|6,370.00|2,730.00
M06.87|OTHER SPECIFIED RHEUMATOID ARTHRITIS, ANKLE AND FOOT|9,100.00|6,370.00|2,730.00
M06.89|OTHER SPECIFIED RHEUMATOID ARTHRITIS, SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M06.90|RHEUMATOID ARTHRITIS, UNSPECIFIED, MULTIPLE SITES|9,100.00|6,370.00|2,730.00
M06.91|RHEUMATOID ARTHRITIS, UNSPECIFIED, SHOULDER REGION|9,100.00|6,370.00|2,730.00
M06.93|RHEUMATOID ARTHRITIS, UNSPECIFIED, FOREARM|9,100.00|6,370.00|2,730.00
M06.94|RHEUMATOID ARTHRITIS, UNSPECIFIED, HAND|9,100.00|6,370.00|2,730.00
M06.95|RHEUMATOID ARTHRITIS, UNSPECIFIED, PELVIC REGION AND THIGH|9,100.00|6,370.00|2,730.00
M06.96|RHEUMATOID ARTHRITIS, UNSPECIFIED, LOWER LEG|9,100.00|6,370.00|2,730.00
M06.97|RHEUMATOID ARTHRITIS, UNSPECIFIED, ANKLE AND FOOT|9,100.00|6,370.00|2,730.00
M06.98|RHEUMATOID ARTHRITIS, UNSPECIFIED, OTHER SITES|9,100.00|6,370.00|2,730.00
M06.99|RHEUMATOID ARTHRITIS, UNSPECIFIED, SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M08.06|JUVENILE RHEUMATOID ARTHRITIS; JUVENILE RHEUMATOID ARTHRITIS WITH OR WITHOUT RHEUMATOID FACTOR  LOWER LEG|9,100.00|6,370.00|2,730.00
M08.07|JUVENILE RHEUMATOID ARTHRITIS; JUVENILE RHEUMATOID ARTHRITIS WITH OR WITHOUT RHEUMATOID FACTOR  ANKLE AND FOOT|9,100.00|6,370.00|2,730.00
M08.09|JUVENILE RHEUMATOID ARTHRITIS; JUVENILE RHEUMATOID ARTHRITIS WITH OR WITHOUT RHEUMATOID FACTOR  SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M08.19|JUVENILE ANKYLOSING SPONDYLITIS SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M08.29|JUVENILE ARTHRITIS WITH SYSTEMIC ONSET; STILL'S DISEASE NOS  SITE UNSPECIFIED|12,610.00|8,827.00|3,783.00
M08.86|OTHER JUVENILE ARTHRITIS LOWER LEG|9,100.00|6,370.00|2,730.00
M08.89|OTHER JUVENILE ARTHRITIS SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M08.91|JUVENILE ARTHRITIS, UNSPECIFIED SHOULDER REGION|9,100.00|6,370.00|2,730.00
M08.96|JUVENILE ARTHRITIS, UNSPECIFIED LOWER LEG|9,100.00|6,370.00|2,730.00
M08.99|JUVENILE ARTHRITIS, UNSPECIFIED SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M10.00|IDIOPATHIC GOUT; GOUTY BURSITIS; PRIMARY GOUT MULTIPLE SITES|9,100.00|6,370.00|2,730.00
M10.01|URATE TOPHUS OF HEART SHOULDER REGION|9,100.00|6,370.00|2,730.00
M10.02|URATE TOPHUS OF HEART UPPER ARM|9,100.00|6,370.00|2,730.00
M10.03|IDIOPATHIC GOUT; GOUTY BURSITIS; PRIMARY GOUT FOREARM|9,100.00|6,370.00|2,730.00
M10.04|URATE TOPHUS OF HEART HAND|9,100.00|6,370.00|2,730.00
M10.05|URATE TOPHUS OF HEART PELVIC REGION AND THIGH|9,100.00|6,370.00|2,730.00
M10.06|IDIOPATHIC GOUT; GOUTY BURSITIS; PRIMARY GOUT LOWER LEG|9,100.00|6,370.00|2,730.00
M10.07|URATE TOPHUS OF HEART ANKLE AND FOOT|9,100.00|6,370.00|2,730.00
M10.08|URATE TOPHUS OF HEART OTHER SITES|9,100.00|6,370.00|2,730.00
M10.09|URATE TOPHUS OF HEART SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M10.10|LEAD-INDUCED GOUT   MULTIPLE SITES|9,100.00|6,370.00|2,730.00
M10.29|DRUG-INDUCED GOUT SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M10.30|GOUT DUE TO IMPAIRMENT OF RENAL FUNCTION MULTIPLE SITES|9,100.00|6,370.00|2,730.00
M10.36|GOUT DUE TO IMPAIRMENT OF RENAL FUNCTION LOWER LEG|9,100.00|6,370.00|2,730.00
M10.39|GOUT DUE TO IMPAIRMENT OF RENAL FUNCTION SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M10.40|OTHER SECONDARY GOUT MULTIPLE SITES|9,100.00|6,370.00|2,730.00
M10.49|OTHER SECONDARY GOUT SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M10.90|GOUT, UNSPECIFIED MULTIPLE SITES|9,100.00|6,370.00|2,730.00
M10.91|GOUT, UNSPECIFIED SHOULDER REGION|9,100.00|6,370.00|2,730.00
M10.92|GOUT, UNSPECIFIED UPPER ARM|9,100.00|6,370.00|2,730.00
M10.93|GOUT, UNSPECIFIED FOREARM|9,100.00|6,370.00|2,730.00
M10.94|GOUT, UNSPECIFIED HAND|9,100.00|6,370.00|2,730.00
M10.96|GOUT, UNSPECIFIED LOWER LEG|9,100.00|6,370.00|2,730.00
M10.97|GOUT, UNSPECIFIED ANKLE AND FOOT|9,100.00|6,370.00|2,730.00
M10.98|GOUT, UNSPECIFIED OTHER SITES|9,100.00|6,370.00|2,730.00
M10.99|GOUT, UNSPECIFIED SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M11.89|OTHER SPECIFIED CRYSTAL ARTHROPATHIES SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M11.90|CRYSTAL ARTHROPATHY, UNSPECIFIED MULTIPLE SITES|9,100.00|6,370.00|2,730.00
M11.99|CRYSTAL ARTHROPATHY, UNSPECIFIED SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M12.26|VILLONODULAR SYNOVITIS (PIGMENTED) LOWER LEG|9,100.00|6,370.00|2,730.00
M12.39|PALINDROMIC RHEUMATISM SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M12.50|TRAUMATIC ARTHROPATHY MULTIPLE SITES|9,100.00|6,370.00|2,730.00
M12.52|TRAUMATIC ARTHROPATHY UPPER ARM|9,100.00|6,370.00|2,730.00
M12.53|TRAUMATIC ARTHROPATHY FOREARM|9,100.00|6,370.00|2,730.00
M12.54|TRAUMATIC ARTHROPATHY HAND|9,100.00|6,370.00|2,730.00
M12.55|TRAUMATIC ARTHROPATHY PELVIC REGION AND THIGH|9,100.00|6,370.00|2,730.00
M12.56|TRAUMATIC ARTHROPATHY LOWER LEG|9,100.00|6,370.00|2,730.00
M12.57|TRAUMATIC ARTHROPATHY ANKLE AND FOOT|9,100.00|6,370.00|2,730.00
M12.58|TRAUMATIC ARTHROPATHY OTHER SITES|9,100.00|6,370.00|2,730.00
M12.59|TRAUMATIC ARTHROPATHY SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M12.86|OTHER SPECIFIC ARTHROPATHIES, NOT ELSEWHERE CLASSIFIED; TRANSIENT ARTHROPATHY  LOWER LEG|9,100.00|6,370.00|2,730.00
M12.89|OTHER SPECIFIC ARTHROPATHIES, NOT ELSEWHERE CLASSIFIED; TRANSIENT ARTHROPATHY  SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M13.00|POLYARTHRITIS, UNSPECIFIED MULTIPLE SITES|9,100.00|6,370.00|2,730.00
M13.01|POLYARTHRITIS, UNSPECIFIED SHOULDER REGION|9,100.00|6,370.00|2,730.00
M13.02|POLYARTHRITIS, UNSPECIFIED UPPER ARM|9,100.00|6,370.00|2,730.00
M13.06|POLYARTHRITIS, UNSPECIFIED LOWER LEG|9,100.00|6,370.00|2,730.00
M13.09|POLYARTHRITIS, UNSPECIFIED SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M13.13|MONOARTHRITIS, NOT ELSEWHERE CLASSIFIED FOREARM|9,100.00|6,370.00|2,730.00
M13.16|MONOARTHRITIS, NOT ELSEWHERE CLASSIFIED LOWER LEG|9,100.00|6,370.00|2,730.00
M13.17|MONOARTHRITIS, NOT ELSEWHERE CLASSIFIED ANKLE AND FOOT|9,100.00|6,370.00|2,730.00
M13.18|MONOARTHRITIS, NOT ELSEWHERE CLASSIFIED OTHER SITES|9,100.00|6,370.00|2,730.00
M13.80|OTHER SPECIFIED ARTHRITIS; ALLERGIC ARTHRITIS MULTIPLE SITES|9,100.00|6,370.00|2,730.00
M13.81|OTHER SPECIFIED ARTHRITIS; ALLERGIC ARTHRITIS SHOULDER REGION|9,100.00|6,370.00|2,730.00
M13.85|OTHER SPECIFIED ARTHRITIS; ALLERGIC ARTHRITIS PELVIC REGION AND THIGH|9,100.00|6,370.00|2,730.00
M13.86|OTHER SPECIFIED ARTHRITIS; ALLERGIC ARTHRITIS LOWER LEG|9,100.00|6,370.00|2,730.00
M13.87|OTHER SPECIFIED ARTHRITIS; ALLERGIC ARTHRITIS ANKLE AND FOOT|9,100.00|6,370.00|2,730.00
M13.88|OTHER SPECIFIED ARTHRITIS; ALLERGIC ARTHRITIS OTHER SITES|9,100.00|6,370.00|2,730.00
M13.89|OTHER SPECIFIED ARTHRITIS; ALLERGIC ARTHRITIS  SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M13.90|ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS MULTIPLE SITES|9,100.00|6,370.00|2,730.00
M13.91|ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS SHOULDER REGION|9,100.00|6,370.00|2,730.00
M13.92|ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS UPPER ARM|9,100.00|6,370.00|2,730.00
M13.93|ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS FOREARM|9,100.00|6,370.00|2,730.00
M13.94|ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS HAND|9,100.00|6,370.00|2,730.00
M13.95|ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS PELVIC REGION AND THIGH|9,100.00|6,370.00|2,730.00
M13.96|ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS LOWER LEG|9,100.00|6,370.00|2,730.00
M13.97|ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS ANKLE AND FOOT|9,100.00|6,370.00|2,730.00
M13.98|ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS OTHER SITES|9,100.00|6,370.00|2,730.00
M13.99|ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M15.0|PRIMARY GENERALIZED (OSTEO)ARTHROSIS|9,100.00|6,370.00|2,730.00
M15.2|BOUCHARD'S NODES (WITH ARTHROPATHY)|9,100.00|6,370.00|2,730.00
M15.3|SECONDARY MULTIPLE ARTHROSIS; POST-TRAUMATIC POLYARTHROSIS|9,100.00|6,370.00|2,730.00
M15.4|EROSIVE (OSTEO)ARTHROSIS|9,100.00|6,370.00|2,730.00
M15.8|OTHER POLYARTHROSIS|9,100.00|6,370.00|2,730.00
M15.9|POLYARTHROSIS, UNSPECIFIED; GENERALIZED OSTEOARTHRITIS NOS|9,100.00|6,370.00|2,730.00
M16.0|PRIMARY COXARTHROSIS, BILATERAL|9,100.00|6,370.00|2,730.00
M16.1|OTHER PRIMARY COXARTHROSIS; PRIMARY COXARTHROSIS NOS; PRIMARY COXARTHROSIS UNILATERAL|9,100.00|6,370.00|2,730.00
M16.2|COXARTHROSIS RESULTING FROM DYSPLASIA, BILATERAL|9,100.00|6,370.00|2,730.00
M16.3|OTHER DYSPLASTIC COXARTHROSIS; DYSPLASTIC COXARTHROSIS NOS; DYSPLASTIC COXARTHROSIS UNILATERAL|9,100.00|6,370.00|2,730.00
M16.9|COXARTHROSIS, UNSPECIFIED|9,100.00|6,370.00|2,730.00
M17.0|PRIMARY GONARTHROSIS, BILATERAL|9,100.00|6,370.00|2,730.00
M17.1|OTHER PRIMARY GONARTHROSIS; PRIMARY GONARTHROSIS NOS; PRIMARY GONARTHROSIS UNILATERAL|9,100.00|6,370.00|2,730.00
M17.2|POST-TRAUMATIC GONARTHROSIS, BILATERAL|9,100.00|6,370.00|2,730.00
M17.3|OTHER POST-TRAUMATIC GONARTHROSIS; POST- TRAUMATIC GONARTHROSIS NOS; POST-TRAUMATIC GONARTHROSIS UNILATERAL|9,100.00|6,370.00|2,730.00
M17.5|OTHER SECONDARY GONARTHROSIS; SECONDARY GONARTHROSIS NOS; SECONDARY GONARTHROSIS UNILATERAL|9,100.00|6,370.00|2,730.00
M17.9|GONARTHROSIS, UNSPECIFIED|9,100.00|6,370.00|2,730.00
M18.0|PRIMARY ARTHROSIS OF FIRST CARPOMETACARPAL JOINTS, BILATERAL|9,100.00|6,370.00|2,730.00
M18.9|ARTHROSIS OF FIRST CARPOMETACARPAL JOINT, UNSPECIFIED|9,100.00|6,370.00|2,730.00
M19.00|PRIMARY ARTHROSIS OF OTHER JOINTS; PRIMARY ARTHROSIS NOSMULTIPLE SITES|9,100.00|6,370.00|2,730.00
M19.02|PRIMARY ARTHROSIS OF OTHER JOINTS; PRIMARY ARTHROSIS NOSUPPER ARM|9,100.00|6,370.00|2,730.00
M19.05|PRIMARY ARTHROSIS OF OTHER JOINTS; PRIMARY ARTHROSIS NOSPELVIC REGION AND THIGH|9,100.00|6,370.00|2,730.00
M19.06|PRIMARY ARTHROSIS OF OTHER JOINTS; PRIMARY ARTHROSIS NOSLOWER LEG|9,100.00|6,370.00|2,730.00
M19.08|PRIMARY ARTHROSIS OF OTHER JOINTS; PRIMARY ARTHROSIS NOSOTHER SITES|9,100.00|6,370.00|2,730.00
M19.09|PRIMARY ARTHROSIS OF OTHER JOINTS; PRIMARY ARTHROSIS NOSSITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M19.10|POST-TRAUMATIC ARTHROSIS OF OTHER JOINTS; POST- TRAUMATIC ARTHROSIS NOS MULTIPLE SITES|9,100.00|6,370.00|2,730.00
M19.11|POST-TRAUMATIC ARTHROSIS OF OTHER JOINTS; POST- TRAUMATIC ARTHROSIS NOS SHOULDER REGION|9,100.00|6,370.00|2,730.00
M19.12|POST-TRAUMATIC ARTHROSIS OF OTHER JOINTS; POST- TRAUMATIC ARTHROSIS NOS UPPER ARM|9,100.00|6,370.00|2,730.00
M19.19|POST-TRAUMATIC ARTHROSIS OF OTHER JOINTS; POST- TRAUMATIC ARTHROSIS NOS SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M19.21|OTHER SECONDARY ARTHROSIS; SECONDARY ARTHROSIS NOS SHOULDER REGION|9,100.00|6,370.00|2,730.00
M19.29|OTHER SECONDARY ARTHROSIS; SECONDARY ARTHROSIS NOS SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M19.81|OTHER SPECIFIED ARTHROSIS SHOULDER REGION|9,100.00|6,370.00|2,730.00
M19.86|OTHER SPECIFIED ARTHROSIS LOWER LEG|9,100.00|6,370.00|2,730.00
M19.87|OTHER SPECIFIED ARTHROSIS ANKLE AND FOOT|9,100.00|6,370.00|2,730.00
M19.88|OTHER SPECIFIED ARTHROSIS OTHER SITES|9,100.00|6,370.00|2,730.00
M19.89|OTHER SPECIFIED ARTHROSIS SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M19.90|ARTHROSIS, UNSPECIFIED MULTIPLE SITES|9,100.00|6,370.00|2,730.00
M19.91|ARTHROSIS, UNSPECIFIED SHOULDER REGION|9,100.00|6,370.00|2,730.00
M19.92|ARTHROSIS, UNSPECIFIED UPPER ARM|9,100.00|6,370.00|2,730.00
M19.93|ARTHROSIS, UNSPECIFIED FOREARM|9,100.00|6,370.00|2,730.00
M19.94|ARTHROSIS, UNSPECIFIED HAND|9,100.00|6,370.00|2,730.00
M19.95|ARTHROSIS, UNSPECIFIED PELVIC REGION AND THIGH|9,100.00|6,370.00|2,730.00
M19.96|ARTHROSIS, UNSPECIFIED LOWER LEG|9,100.00|6,370.00|2,730.00
M19.97|ARTHROSIS, UNSPECIFIED ANKLE AND FOOT|9,100.00|6,370.00|2,730.00
M19.98|ARTHROSIS, UNSPECIFIED OTHER SITES|9,100.00|6,370.00|2,730.00
M19.99|ARTHROSIS, UNSPECIFIED SITE UNSPECIFIED|9,100.00|6,370.00|2,730.00
M23.20|DERANGEMENT OF MENISCUS DUE TO OLD TEAR OR INJURY; OLD BUCKET-HANDLE TEAR MULTIPLE SITES|11,960.00|8,372.00|3,588.00
M23.21|DERANGEMENT OF MENISCUS DUE TO OLD TEAR OR INJURY; OLD BUCKET-HANDLE TEAR ANTERIOR CRUCIATE LIGAMENT OR ANTERIOR HORN OF MEDIAL MENISCUS|11,960.00|8,372.00|3,588.00
M23.22|DERANGEMENT OF MENISCUS DUE TO OLD TEAR OR INJURY; OLD BUCKET-HANDLE TEAR POSTERIOR CRUCIATE LIGAMENT OR POSTERIOR HORN OF MEDIAL MENISCUS|11,960.00|8,372.00|3,588.00
M23.25|DERANGEMENT OF MENISCUS DUE TO OLD TEAR OR INJURY; OLD BUCKET-HANDLE TEAR POSTERIOR HORN OF LATERAL MENISCUS|11,960.00|8,372.00|3,588.00
M23.46|LOOSE BODY IN KNEEOTHER AND UNSPECIFIED LATERAL MENISCUS|11,960.00|8,372.00|3,588.00
M23.5|CHRONIC INSTABILITY OF KNEE|11,960.00|8,372.00|3,588.00
M23.80|OTHER INTERNAL DERANGEMENTS OF KNEE; LAXITY OF LIGAMENT OF KNEE; SNAPPING KNEE MULTIPLE SITES|11,960.00|8,372.00|3,588.00
M23.9|INTERNAL DERANGEMENT OF KNEE|11,960.00|8,372.00|3,588.00
M23.91|INTERNAL DERANGEMENT OF KNEE, UNSPECIFIED ANTERIOR CRUCIATE LIGAMENT OR ANTERIOR HORN OF MEDIAL MENISCUS|11,960.00|8,372.00|3,588.00
M24.08|LOOSE BODY IN JOINT OTHER SITES|11,960.00|8,372.00|3,588.00
M24.1|OTHER ARTICULAR CARTILAGE DISORDERS|11,960.00|8,372.00|3,588.00
M24.2|DISORDER OF LIGAMENT; INSTABILITY SECONDARY TO OLD LIGAMENT INJURY; LIGAMENTOUS LAXITY NOS|11,960.00|8,372.00|3,588.00
M24.4|RECURRENT DISLOCATION AND SUBLUXATION OF JOINT|11,960.00|8,372.00|3,588.00
M24.41|RECURRENT DISLOCATION AND SUBLUXATION OF JOINT SHOULDER REGION|11,960.00|8,372.00|3,588.00
M24.50|CONTRACTURE OF JOINT MULTIPLE SITES|11,960.00|8,372.00|3,588.00
M24.54|CONTRACTURE OF JOINT HAND|11,960.00|8,372.00|3,588.00
M24.56|CONTRACTURE OF JOINT LOWER LEG|11,960.00|8,372.00|3,588.00
M24.6|ANKYLOSIS OF JOINT|11,960.00|8,372.00|3,588.00
M24.65|ANKYLOSIS OF JOINT PELVIC REGION AND THIGH|11,960.00|8,372.00|3,588.00
M24.66|ANKYLOSIS OF JOINT LOWER LEG|11,960.00|8,372.00|3,588.00
M24.69|ANKYLOSIS OF JOINT SITE UNSPECIFIED|11,960.00|8,372.00|3,588.00
M24.7|PROTRUSIO ACETABULI|11,960.00|8,372.00|3,588.00
M24.88|OTHER SPECIFIC JOINT DERANGEMENTS, NOT ELSEWHERE CLASSIFIED; IRRITABLE HIP OTHER SITES|11,960.00|8,372.00|3,588.00
M25.00|HAEMARTHROSIS MULTIPLE SITES|10,140.00|7,098.00|3,042.00
M25.01|HAEMARTHROSIS SHOULDER REGION|10,140.00|7,098.00|3,042.00
M25.05|HAEMARTHROSIS PELVIC REGION AND THIGH|10,140.00|7,098.00|3,042.00
M25.06|HAEMARTHROSIS LOWER LEG|10,140.00|7,098.00|3,042.00
M25.07|HAEMARTHROSIS ANKLE AND FOOT|10,140.00|7,098.00|3,042.00
M25.08|HAEMARTHROSIS OTHER SITES|10,140.00|7,098.00|3,042.00
M25.09|HAEMARTHROSIS SITE UNSPECIFIED|10,140.00|7,098.00|3,042.00
M25.38|OTHER INSTABILITY OF JOINT OTHER SITES|10,140.00|7,098.00|3,042.00
M25.40|EFFUSION OF JOINT MULTIPLE SITES|10,140.00|7,098.00|3,042.00
M25.41|EFFUSION OF JOINT SHOULDER REGION|10,140.00|7,098.00|3,042.00
M25.46|EFFUSION OF JOINT LOWER LEG|10,140.00|7,098.00|3,042.00
M25.47|EFFUSION OF JOINT ANKLE AND FOOT|10,140.00|7,098.00|3,042.00
M30.0|POLYARTERITIS NODOSA|17,940.00|12,558.00|5,382.00
M30.1|POLYARTERITIS WITH LUNG INVOLVEMENT [CHURG- STRAUSS]; ALLERGIC GRANULOMATOUS ANGIITIS|17,940.00|12,558.00|5,382.00
M30.2|JUVENILE POLYARTERITIS|17,940.00|12,558.00|5,382.00
M30.3|MUCOCUTANEOUS LYMPH NODE SYNDROME [KAWASAKI]|17,940.00|12,558.00|5,382.00
M30.8|OTHER CONDITIONS RELATED TO POLYARTERITIS NODOSA; POLYANGIITIS OVERLAP SYNDROME|17,940.00|12,558.00|5,382.00
M31.0|HYPERSENSITIVITY ANGIITIS; GOODPASTURE'S SYNDROME|17,940.00|12,558.00|5,382.00
M31.1|THROMBOTIC MICROANGIOPATHY; THROMBOTIC THROMBOCYTOPENIC PURPURA|17,940.00|12,558.00|5,382.00
M31.3|WEGENER'S GRANULOMATOSIS; NECROTIZING RESPIRATORY GRANULOMATOSIS|17,940.00|12,558.00|5,382.00
M31.4|AORTIC ARCH SYNDROME [TAKAYASU]|17,940.00|12,558.00|5,382.00
M31.6|OTHER GIANT CELL ARTERITIS|17,940.00|12,558.00|5,382.00
M31.8|OTHER SPECIFIED NECROTIZING VASCULOPATHIES; HYPOCOMPLEMENTAEMIC VASCULITIS|17,940.00|12,558.00|5,382.00
M31.9|NECROTIZING VASCULOPATHY, UNSPECIFIED|17,940.00|12,558.00|5,382.00
M32.0|DRUG-INDUCED SYSTEMIC LUPUS ERYTHEMATOSUS|15,470.00|10,829.00|4,641.00
M32.8|OTHER FORMS OF SYSTEMIC LUPUS ERYTHEMATOSUS|15,470.00|10,829.00|4,641.00
M32.9|SYSTEMIC LUPUS ERYTHEMATOSUS, UNSPECIFIED|15,470.00|10,829.00|4,641.00
M33.0|JUVENILE DERMATOMYOSITIS|17,940.00|12,558.00|5,382.00
M33.1|OTHER DERMATOMYOSITIS|17,940.00|12,558.00|5,382.00
M33.2|POLYMYOSITIS|17,940.00|12,558.00|5,382.00
M33.9|DERMATOPOLYMYOSITIS, UNSPECIFIED|17,940.00|12,558.00|5,382.00
M34.0|PROGRESSIVE SYSTEMIC SCLEROSIS|17,940.00|12,558.00|5,382.00
M34.1|CR(E)ST SYNDROME; COMBINATION OF CALCINOSIS, RAYNAUD'S PHENOMENON, (O)ESOPHAGEAL DYSFUNCTION, SCLERODACTYLY, TELANGIECTASIA|17,940.00|12,558.00|5,382.00
M34.2|SYSTEMIC SCLEROSIS INDUCED BY DRUGS AND CHEMICALS|17,940.00|12,558.00|5,382.00
M34.9|SYSTEMIC SCLEROSIS, UNSPECIFIED|17,940.00|12,558.00|5,382.00
M35.0|SICCA SYNDROME [SJÖGREN]|17,940.00|12,558.00|5,382.00
M35.1|OTHER OVERLAP SYNDROMES; MIXED CONNECTIVE TISSUE DISEASE|17,940.00|12,558.00|5,382.00
M35.2|BEHçET'S DISEASE|17,940.00|12,558.00|5,382.00
M35.3|POLYMYALGIA RHEUMATICA|17,940.00|12,558.00|5,382.00
M35.4|DIFFUSE (EOSINOPHILIC) FASCIITIS|17,940.00|12,558.00|5,382.00
M35.8|OTHER SPECIFIED SYSTEMIC INVOLVEMENT OF CONNECTIVE TISSUE|17,940.00|12,558.00|5,382.00
M35.9|SYSTEMIC INVOLVEMENT OF CONNECTIVE TISSUE, UNSPECIFIED; SYSTEMIC  AUTOIMMUNE DISEASE NOS; COLLAGEN (VASCULAR) DISEASE NOS|17,940.00|12,558.00|5,382.00
M42.1|ADULT OSTEOCHONDROSIS OF SPINE|9,880.00|6,916.00|2,964.00
M43.0|SPONDYLOLYSIS|10,790.00|7,553.00|3,237.00
M43.02|SPONDYLOLYSIS CERVICAL REGION|9,880.00|6,916.00|2,964.00
M43.03|SPONDYLOLYSIS CERVICOTHORACIC REGION|9,880.00|6,916.00|2,964.00
M43.04|SPONDYLOLYSIS THORACIC REGION|9,880.00|6,916.00|2,964.00
M43.06|SPONDYLOLYSIS LUMBAR REGION|9,880.00|6,916.00|2,964.00
M43.07|SPONDYLOLYSIS LUMBOSACRAL REGION|9,880.00|6,916.00|2,964.00
M43.09|SPONDYLOLYSIS SITE UNSPECIFIED|9,880.00|6,916.00|2,964.00
M43.1|SPONDYLOLISTHESIS|10,790.00|7,553.00|3,237.00
M43.10|SPONDYLOLISTHESIS MULTIPLE SITES IN SPINE|9,880.00|6,916.00|2,964.00
M43.12|SPONDYLOLISTHESIS CERVICAL REGION|9,880.00|6,916.00|2,964.00
M43.15|SPONDYLOLISTHESIS THORACOLUMBAR REGION|9,880.00|6,916.00|2,964.00
M43.16|SPONDYLOLISTHESIS LUMBAR REGION|9,880.00|6,916.00|2,964.00
M43.17|SPONDYLOLISTHESIS LUMBOSACRAL REGION|9,880.00|6,916.00|2,964.00
M43.18|SPONDYLOLISTHESIS SACRAL AND SACROCOCCYGEAL REGION|9,880.00|6,916.00|2,964.00
M43.19|SPONDYLOLISTHESIS SITE UNSPECIFIED|9,880.00|6,916.00|2,964.00
M43.2|OTHER FUSION OF SPINE; ANKYLOSIS OF SPINAL JOINT|10,790.00|7,553.00|3,237.00
M43.22|OTHER FUSION OF SPINE; ANKYLOSIS OF SPINAL JOINT CERVICAL REGION|9,880.00|6,916.00|2,964.00
M43.26|OTHER FUSION OF SPINE; ANKYLOSIS OF SPINAL JOINT LUMBAR REGION|9,880.00|6,916.00|2,964.00
M43.27|OTHER FUSION OF SPINE; ANKYLOSIS OF SPINAL JOINT LUMBOSACRAL REGION|9,880.00|6,916.00|2,964.00
M43.29|OTHER FUSION OF SPINE; ANKYLOSIS OF SPINAL JOINT SITE UNSPECIFIED|9,880.00|6,916.00|2,964.00
M43.42|OTHER RECURRENT ATLANTOAXIAL SUBLUXATION CERVICAL REGION|9,880.00|6,916.00|2,964.00
M43.49|OTHER RECURRENT ATLANTOAXIAL SUBLUXATION SITE UNSPECIFIED|9,880.00|6,916.00|2,964.00
M43.5|OTHER RECURRENT VERTEBRAL SUBLUXATION|10,790.00|7,553.00|3,237.00
M43.6|TORTICOLLIS|10,790.00|7,553.00|3,237.00
M43.60|TORTICOLLIS MULTIPLE SITES IN SPINE|9,880.00|6,916.00|2,964.00
M43.62|TORTICOLLIS CERVICAL REGION|9,880.00|6,916.00|2,964.00
M43.64|TORTICOLLIS THORACIC REGION|9,880.00|6,916.00|2,964.00
M43.66|TORTICOLLIS LUMBAR REGION|9,880.00|6,916.00|2,964.00
M43.68|TORTICOLLIS SACRAL AND SACROCOCCYGEAL REGION|9,880.00|6,916.00|2,964.00
M43.69|TORTICOLLIS SITE UNSPECIFIED|9,880.00|6,916.00|2,964.00
M43.8|OTHER SPECIFIED DEFORMING DORSOPATHIES|9,880.00|6,916.00|2,964.00
M43.82|OTHER SPECIFIED DEFORMING DORSOPATHIES CERVICAL REGION|9,880.00|6,916.00|2,964.00
M43.85|OTHER SPECIFIED DEFORMING DORSOPATHIES THORACOLUMBAR REGION|9,880.00|6,916.00|2,964.00
M43.86|OTHER SPECIFIED DEFORMING DORSOPATHIES LUMBAR REGION|9,880.00|6,916.00|2,964.00
M43.87|OTHER SPECIFIED DEFORMING DORSOPATHIES LUMBOSACRAL REGION|9,880.00|6,916.00|2,964.00
M43.88|OTHER SPECIFIED DEFORMING DORSOPATHIES SACRAL AND SACROCOCCYGEAL REGION|9,880.00|6,916.00|2,964.00
M43.89|OTHER SPECIFIED DEFORMING DORSOPATHIES SITE UNSPECIFIED|9,880.00|6,916.00|2,964.00
M43.9|DEFORMING DORSOPATHY, UNSPECIFIED; CURVATURE OF SPINE NOS|9,880.00|6,916.00|2,964.00
M43.94|DEFORMING DORSOPATHY, UNSPECIFIED; CURVATURE OF SPINE NOS  THORACIC REGION|9,880.00|6,916.00|2,964.00
M43.95|DEFORMING DORSOPATHY, UNSPECIFIED; CURVATURE OF SPINE NOS  THORACOLUMBAR REGION|9,880.00|6,916.00|2,964.00
M43.96|DEFORMING DORSOPATHY, UNSPECIFIED; CURVATURE OF SPINE NOS  LUMBAR REGION|9,880.00|6,916.00|2,964.00
M43.97|DEFORMING DORSOPATHY, UNSPECIFIED; CURVATURE OF SPINE NOS  LUMBOSACRAL REGION|9,880.00|6,916.00|2,964.00
M43.99|DEFORMING DORSOPATHY, UNSPECIFIED; CURVATURE OF SPINE NOS  SITE UNSPECIFIED|9,880.00|6,916.00|2,964.00
M45|ANKYLOSING SPONDYLITIS; RHEUMATOID ARTHRITIS OF SPINE|10,790.00|7,553.00|3,237.00
M46.0|SPINAL ENTHESOPATHY; DISORDER OF LIGAMENTOUS OR MUSCULAR ATTACHMENTS OF SPINE|10,790.00|7,553.00|3,237.00
M46.1|SACROILIITIS, NOT ELSEWHERE CLASSIFIED|10,790.00|7,553.00|3,237.00
M46.16|SACROILIITIS, NOT ELSEWHERE CLASSIFIED  LUMBAR REGION|10,790.00|7,553.00|3,237.00
M46.19|SACROILIITIS, NOT ELSEWHERE CLASSIFIED  SITE UNSPECIFIED|10,790.00|7,553.00|3,237.00
M46.2|OSTEOMYELITIS OF VERTEBRA|10,790.00|7,553.00|3,237.00
M46.28|OSTEOMYELITIS OF VERTEBRA  SACRAL AND SACROCOCCYGEAL REGION|10,790.00|7,553.00|3,237.00
M46.29|OSTEOMYELITIS OF VERTEBRA  SITE UNSPECIFIED|10,790.00|7,553.00|3,237.00
M46.3|INFECTION OF INTERVERTEBRAL DISC (PYOGENIC)|10,790.00|7,553.00|3,237.00
M46.36|INFECTION OF INTERVERTEBRAL DISC (PYOGENIC) LUMBAR REGION|10,790.00|7,553.00|3,237.00
M46.4|DISCITIS, UNSPECIFIED|10,790.00|7,553.00|3,237.00
M46.46|DISCITIS, UNSPECIFIED  LUMBAR REGION|10,790.00|7,553.00|3,237.00
M46.47|DISCITIS, UNSPECIFIED  LUMBOSACRAL REGION|10,790.00|7,553.00|3,237.00
M46.49|DISCITIS, UNSPECIFIED  SITE UNSPECIFIED|10,790.00|7,553.00|3,237.00
M46.5|OTHER INFECTIVE SPONDYLOPATHIES|10,790.00|7,553.00|3,237.00
M46.8|OTHER SPECIFIED INFLAMMATORY SPONDYLOPATHIES|10,790.00|7,553.00|3,237.00
M46.87|OTHER SPECIFIED INFLAMMATORY SPONDYLOPATHIES LUMBOSACRAL REGION|10,790.00|7,553.00|3,237.00
M46.9|INFLAMMATORY SPONDYLOPATHY, UNSPECIFIED|10,790.00|7,553.00|3,237.00
M46.92|INFLAMMATORY SPONDYLOPATHY, UNSPECIFIED CERVICAL REGION|10,790.00|7,553.00|3,237.00
M46.97|INFLAMMATORY SPONDYLOPATHY, UNSPECIFIED LUMBOSACRAL REGION|10,790.00|7,553.00|3,237.00
M46.98|INFLAMMATORY SPONDYLOPATHY, UNSPECIFIED  SACRAL AND SACROCOCCYGEAL REGION|10,790.00|7,553.00|3,237.00
M46.99|INFLAMMATORY SPONDYLOPATHY, UNSPECIFIED  SITE UNSPECIFIED|10,790.00|7,553.00|3,237.00
M47.1|OTHER SPONDYLOSIS WITH MYELOPATHY|10,790.00|7,553.00|3,237.00
M47.1+G99.2*|MYELOPATHY IN OTHER SPONDYLOSIS WITH MYELOPATHY|10,790.00|7,553.00|3,237.00
M47.2|OTHER SPONDYLOSIS WITH RADICULOPATHY|10,790.00|7,553.00|3,237.00
M47.20|OTHER SPONDYLOSIS WITH RADICULOPATHY  MULTIPLE SITES IN SPINE|10,790.00|7,553.00|3,237.00
M47.22|OTHER SPONDYLOSIS WITH RADICULOPATHY  CERVICAL REGION|10,790.00|7,553.00|3,237.00
M47.26|OTHER SPONDYLOSIS WITH RADICULOPATHY  LUMBAR REGION|10,790.00|7,553.00|3,237.00
M47.27|OTHER SPONDYLOSIS WITH RADICULOPATHY LUMBOSACRAL REGION|10,790.00|7,553.00|3,237.00
M47.29|OTHER SPONDYLOSIS WITH RADICULOPATHY  SITE UNSPECIFIED|10,790.00|7,553.00|3,237.00
M47.8|CERVICAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; LUMBOSACRAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; THORACIC SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY|10,790.00|7,553.00|3,237.00
M47.80|CERVICAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; LUMBOSACRAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; THORACIC SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY MULTIPLE SITES IN SPINE|10,790.00|7,553.00|3,237.00
M47.81|CERVICAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; LUMBOSACRAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; THORACIC SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY OCCIPITO-ATLANTO-AXIAL REGION|10,790.00|7,553.00|3,237.00
M47.82|CERVICAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; LUMBOSACRAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; THORACIC SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY CERVICAL REGION|10,790.00|7,553.00|3,237.00
M47.83|CERVICAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; LUMBOSACRAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; THORACIC SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY CERVICOTHORACIC REGION|10,790.00|7,553.00|3,237.00
M47.84|CERVICAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; LUMBOSACRAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; THORACIC SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY THORACIC REGION|10,790.00|7,553.00|3,237.00
M47.85|CERVICAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; LUMBOSACRAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; THORACIC SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY THORACOLUMBAR REGION|10,790.00|7,553.00|3,237.00
M47.86|CERVICAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; LUMBOSACRAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; THORACIC SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY LUMBAR REGION|10,790.00|7,553.00|3,237.00
M47.87|CERVICAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; LUMBOSACRAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; THORACIC SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY LUMBOSACRAL REGION|10,790.00|7,553.00|3,237.00
M47.88|CERVICAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; LUMBOSACRAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; THORACIC SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY SACRAL AND SACROCOCCYGEAL REGION|10,790.00|7,553.00|3,237.00
M47.89|CERVICAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; LUMBOSACRAL SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY; THORACIC SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY SITE UNSPECIFIED|10,790.00|7,553.00|3,237.00
M47.9|SPONDYLOSIS, UNSPECIFIED|10,790.00|7,553.00|3,237.00
M47.90|SPONDYLOSIS, UNSPECIFIED  MULTIPLE SITES IN SPINE|10,790.00|7,553.00|3,237.00
M47.92|SPONDYLOSIS, UNSPECIFIED  CERVICAL REGION|10,790.00|7,553.00|3,237.00
M47.94|SPONDYLOSIS, UNSPECIFIED  THORACIC REGION|10,790.00|7,553.00|3,237.00
M47.95|SPONDYLOSIS, UNSPECIFIED  THORACOLUMBAR REGION|10,790.00|7,553.00|3,237.00
M47.96|SPONDYLOSIS, UNSPECIFIED  LUMBAR REGION|10,790.00|7,553.00|3,237.00
M47.97|SPONDYLOSIS, UNSPECIFIED  LUMBOSACRAL REGION|10,790.00|7,553.00|3,237.00
M47.99|SPONDYLOSIS, UNSPECIFIED  SITE UNSPECIFIED|10,790.00|7,553.00|3,237.00
M48.0|SPINAL STENOSIS; CAUDAL STENOSIS|10,790.00|7,553.00|3,237.00
M48.00|SPINAL STENOSIS; CAUDAL STENOSIS MULTIPLE SITES IN SPINE|10,790.00|7,553.00|3,237.00
M48.02|SPINAL STENOSIS; CAUDAL STENOSIS CERVICAL REGION|10,790.00|7,553.00|3,237.00
M48.03|SPINAL STENOSIS; CAUDAL STENOSIS CERVICOTHORACIC REGION|10,790.00|7,553.00|3,237.00
M48.04|SPINAL STENOSIS; CAUDAL STENOSIS THORACIC REGION|10,790.00|7,553.00|3,237.00
M48.05|SPINAL STENOSIS; CAUDAL STENOSIS THORACOLUMBAR REGION|10,790.00|7,553.00|3,237.00
M48.06|SPINAL STENOSIS; CAUDAL STENOSIS LUMBAR REGION|10,790.00|7,553.00|3,237.00
M48.07|SPINAL STENOSIS; CAUDAL STENOSIS LUMBOSACRAL REGION|10,790.00|7,553.00|3,237.00
M48.08|SPINAL STENOSIS; CAUDAL STENOSIS SACRAL AND SACROCOCCYGEAL REGION|10,790.00|7,553.00|3,237.00
M48.09|SPINAL STENOSIS; CAUDAL STENOSIS SITE UNSPECIFIED|10,790.00|7,553.00|3,237.00
M48.1|ANKYLOSING HYPEROSTOSIS [FORESTIER]; DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS [DISH]|10,790.00|7,553.00|3,237.00
M48.16|ANKYLOSING HYPEROSTOSIS [FORESTIER]; DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS [DISH] LUMBAR REGION|10,790.00|7,553.00|3,237.00
M48.2|KISSING SPINE|10,790.00|7,553.00|3,237.00
M48.3|TRAUMATIC SPONDYLOPATHY|10,790.00|7,553.00|3,237.00
M48.32|TRAUMATIC SPONDYLOPATHY  CERVICAL REGION|10,790.00|7,553.00|3,237.00
M48.4|FATIGUE FRACTURE OF VERTEBRA; STRESS FRACTURE OF VERTEBRA|10,790.00|7,553.00|3,237.00
M48.5|COLLAPSED VERTEBRA NOS; WEDGING OF VERTEBRA NOS|10,790.00|7,553.00|3,237.00
M48.54|COLLAPSED VERTEBRA NOS; WEDGING OF VERTEBRA NOS THORACIC REGION|10,790.00|7,553.00|3,237.00
M48.56|COLLAPSED VERTEBRA NOS; WEDGING OF VERTEBRA NOS LUMBAR REGION|10,790.00|7,553.00|3,237.00
M48.57|COLLAPSED VERTEBRA NOS; WEDGING OF VERTEBRA NOS LUMBOSACRAL REGION|10,790.00|7,553.00|3,237.00
M48.8|OSSIFICATION OF POSTERIOR LONGITUDINAL LIGAMENT|10,790.00|7,553.00|3,237.00
M48.80|OSSIFICATION OF POSTERIOR LONGITUDINAL LIGAMENT MULTIPLE SITES IN SPINE|10,790.00|7,553.00|3,237.00
M48.85|OSSIFICATION OF POSTERIOR LONGITUDINAL LIGAMENT THORACOLUMBAR REGION|10,790.00|7,553.00|3,237.00
M48.86|OSSIFICATION OF POSTERIOR LONGITUDINAL LIGAMENT LUMBAR REGION|10,790.00|7,553.00|3,237.00
M48.89|OSSIFICATION OF POSTERIOR LONGITUDINAL LIGAMENT SITE UNSPECIFIED|10,790.00|7,553.00|3,237.00
M48.9|SPONDYLOPATHY, UNSPECIFIED|10,790.00|7,553.00|3,237.00
M48.92|SPONDYLOPATHY, UNSPECIFIED  CERVICAL REGION|10,790.00|7,553.00|3,237.00
M48.95|SPONDYLOPATHY, UNSPECIFIED  THORACOLUMBAR REGION|10,790.00|7,553.00|3,237.00
M48.96|SPONDYLOPATHY, UNSPECIFIED  LUMBAR REGION|10,790.00|7,553.00|3,237.00
M48.98|SPONDYLOPATHY, UNSPECIFIED  SACRAL AND SACROCOCCYGEAL REGION|10,790.00|7,553.00|3,237.00
M48.99|SPONDYLOPATHY, UNSPECIFIED  SITE UNSPECIFIED|10,790.00|7,553.00|3,237.00
M49.0*|POTT'S CURVATURE|10,790.00|7,553.00|3,237.00
M49.8*|SPONDYLOPATHY IN OTHER DISEASES CLASSIFIED ELSEWHERE|10,790.00|7,553.00|3,237.00
M50.1|CERVICAL DISC DISORDER WITH RADICULOPATHY|10,140.00|7,098.00|3,042.00
M50.2|OTHER CERVICAL DISC DISPLACEMENT|10,140.00|7,098.00|3,042.00
M50.3|OTHER CERVICAL DISC DEGENERATION|10,140.00|7,098.00|3,042.00
M50.8|OTHER CERVICAL VERTEBRAL DISC DISORDERS|10,140.00|7,098.00|3,042.00
M51.1|LUMBAR AND OTHER INTERVERTEBRAL DISC DISORDERS WITH RADICULOPATHY; SCIATICA DUE TO INTERVERTEBRAL DISC DISORDER|10,140.00|7,098.00|3,042.00
M51.2|OTHER SPECIFIED INTERVERTEBRAL DISC DISPLACEMENT LUMBAGO DUE TO DISPLACEMENT OF INTERVERTEBRAL DISC|10,140.00|7,098.00|3,042.00
M51.3|OTHER SPECIFIED INTERVERTEBRAL DISC DEGENERATIONS|10,140.00|7,098.00|3,042.00
M51.4|SCHMORL'S NODE|10,140.00|7,098.00|3,042.00
M51.8|OTHER SPECIFIED INTERVERTEBRAL VERTEBRAL DISC DISORDERS|10,140.00|7,098.00|3,042.00
M53.0|CERVICOCRANIAL SYNDROME; POSTERIOR CERVICAL SYMPATHETIC SYNDROME|9,880.00|6,916.00|2,964.00
M53.1|CERVICOBRACHIAL SYNDROME|9,880.00|6,916.00|2,964.00
M53.12|CERVICOBRACHIAL SYNDROME  CERVICAL REGION|9,880.00|6,916.00|2,964.00
M53.19|CERVICOBRACHIAL SYNDROME  SITE UNSPECIFIED|9,880.00|6,916.00|2,964.00
M53.2|SPINAL INSTABILITIES|9,880.00|6,916.00|2,964.00
M53.22|SPINAL INSTABILITIES  CERVICAL REGION|9,880.00|6,916.00|2,964.00
M53.24|SPINAL INSTABILITIES  THORACIC REGION|9,880.00|6,916.00|2,964.00
M53.26|SPINAL INSTABILITIES  LUMBAR REGION|9,880.00|6,916.00|2,964.00
M53.27|SPINAL INSTABILITIES  LUMBOSACRAL REGION|9,880.00|6,916.00|2,964.00
M53.28|SPINAL INSTABILITIES  SACRAL AND SACROCOCCYGEAL REGION|9,880.00|6,916.00|2,964.00
M53.29|SPINAL INSTABILITIES  SITE UNSPECIFIED|9,880.00|6,916.00|2,964.00
M53.3|COCCYGODYNIA|9,880.00|6,916.00|2,964.00
M53.38|COCCYGODYNIA SACRAL AND SACROCOCCYGEAL REGION|9,880.00|6,916.00|2,964.00
M53.8|OTHER SPECIFIED DORSOPATHIES|9,880.00|6,916.00|2,964.00
M53.86|OTHER SPECIFIED DORSOPATHIES  LUMBAR REGION|9,880.00|6,916.00|2,964.00
M53.87|OTHER SPECIFIED DORSOPATHIES  LUMBOSACRAL REGION|9,880.00|6,916.00|2,964.00
M53.89|OTHER SPECIFIED DORSOPATHIES  SITE UNSPECIFIED|9,880.00|6,916.00|2,964.00
M53.9|DORSOPATHY, UNSPECIFIED|9,880.00|6,916.00|2,964.00
M53.92|DORSOPATHY, UNSPECIFIED  CERVICAL REGION|9,880.00|6,916.00|2,964.00
M53.95|DORSOPATHY, UNSPECIFIED  THORACOLUMBAR REGION|9,880.00|6,916.00|2,964.00
M54|DORSALGIA|9,880.00|6,916.00|2,964.00
M54.01|PANNICULITIS AFFECTING REGIONS OF NECK AND BACK OCCIPITO-ATLANTO-AXIAL REGION|8,320.00|5,824.00|2,496.00
M54.06|PANNICULITIS AFFECTING REGIONS OF NECK AND BACK LUMBAR REGION|8,320.00|5,824.00|2,496.00
M54.08|PANNICULITIS AFFECTING REGIONS OF NECK AND BACK SACRAL AND SACROCOCCYGEAL REGION|8,320.00|5,824.00|2,496.00
M54.10|RADICULOPATHY; BRACHIAL NEURITIS OR RADICULITIS NOS;  LUMBAR NEURITIS OR RADICULITIS   NOS; LUMBOSACRAL; THORACIC NEURITIS OR RADICULITIS   NOS ; RADICULITIS NOS MULTIPLE SITES IN SPINE|8,320.00|5,824.00|2,496.00
M54.11|RADICULOPATHY; BRACHIAL NEURITIS OR RADICULITIS NOS;  LUMBAR NEURITIS OR RADICULITIS   NOS; LUMBOSACRAL; THORACIC NEURITIS OR RADICULITIS   NOS ; RADICULITIS NOS OCCIPITO-ATLANTO-AXIAL REGION|8,320.00|5,824.00|2,496.00
M54.12|RADICULOPATHY; BRACHIAL NEURITIS OR RADICULITIS NOS;  LUMBAR NEURITIS OR RADICULITIS   NOS; LUMBOSACRAL; THORACIC NEURITIS OR RADICULITIS   NOS ; RADICULITIS NOS CERVICAL REGION|8,320.00|5,824.00|2,496.00
M54.14|RADICULOPATHY; BRACHIAL NEURITIS OR RADICULITIS NOS;  LUMBAR NEURITIS OR RADICULITIS   NOS; LUMBOSACRAL; THORACIC NEURITIS OR RADICULITIS   NOS ; RADICULITIS NOS THORACIC REGION|8,320.00|5,824.00|2,496.00
M54.15|RADICULOPATHY; BRACHIAL NEURITIS OR RADICULITIS NOS;  LUMBAR NEURITIS OR RADICULITIS   NOS; LUMBOSACRAL; THORACIC NEURITIS OR RADICULITIS   NOS ; RADICULITIS NOS THORACOLUMBAR REGION|8,320.00|5,824.00|2,496.00
M54.16|RADICULOPATHY; BRACHIAL NEURITIS OR RADICULITIS NOS;  LUMBAR NEURITIS OR RADICULITIS   NOS; LUMBOSACRAL; THORACIC NEURITIS OR RADICULITIS   NOS ; RADICULITIS NOS LUMBAR REGION|8,320.00|5,824.00|2,496.00
M54.17|RADICULOPATHY; BRACHIAL NEURITIS OR RADICULITIS NOS;  LUMBAR NEURITIS OR RADICULITIS   NOS; LUMBOSACRAL; THORACIC NEURITIS OR RADICULITIS   NOS ; RADICULITIS NOS LUMBOSACRAL REGION|8,320.00|5,824.00|2,496.00
M54.18|RADICULOPATHY; BRACHIAL NEURITIS OR RADICULITIS NOS;  LUMBAR NEURITIS OR RADICULITIS   NOS; LUMBOSACRAL; THORACIC NEURITIS OR RADICULITIS   NOS ; RADICULITIS NOS SACRAL AND SACROCOCCYGEAL REGION|8,320.00|5,824.00|2,496.00
M54.19|RADICULOPATHY; BRACHIAL NEURITIS OR RADICULITIS NOS;  LUMBAR NEURITIS OR RADICULITIS   NOS; LUMBOSACRAL; THORACIC NEURITIS OR RADICULITIS   NOS ; RADICULITIS NOS SITE UNSPECIFIED|8,320.00|5,824.00|2,496.00
M54.2|CERVICALGIA|8,320.00|5,824.00|2,496.00
M54.20|CERVICALGIA  MULTIPLE SITES IN SPINE|8,320.00|5,824.00|2,496.00
M54.22|CERVICALGIA  CERVICAL REGION|8,320.00|5,824.00|2,496.00
M54.26|CERVICALGIA  LUMBAR REGION|8,320.00|5,824.00|2,496.00
M54.3|SCIATICA|8,320.00|5,824.00|2,496.00
M54.30|SCIATICA  MULTIPLE SITES IN SPINE|8,320.00|5,824.00|2,496.00
M54.31|SCIATICA  OCCIPITO-ATLANTO-AXIAL REGION|8,320.00|5,824.00|2,496.00
M54.35|SCIATICA  THORACOLUMBAR REGION|8,320.00|5,824.00|2,496.00
M54.36|SCIATICA  LUMBAR REGION|8,320.00|5,824.00|2,496.00
M54.37|SCIATICA  LUMBOSACRAL REGION|8,320.00|5,824.00|2,496.00
M54.38|SCIATICA  SACRAL AND SACROCOCCYGEAL REGION|8,320.00|5,824.00|2,496.00
M54.39|SCIATICA  SITE UNSPECIFIED|8,320.00|5,824.00|2,496.00
M54.4|LUMBAGO WITH SCIATICA|8,320.00|5,824.00|2,496.00
M54.41|LUMBAGO WITH SCIATICA  OCCIPITO-ATLANTO-AXIAL REGION|8,320.00|5,824.00|2,496.00
M54.44|LUMBAGO WITH SCIATICA  THORACIC REGION|8,320.00|5,824.00|2,496.00
M54.46|LUMBAGO WITH SCIATICA  LUMBAR REGION|8,320.00|5,824.00|2,496.00
M54.48|LUMBAGO WITH SCIATICA  SACRAL AND SACROCOCCYGEAL REGION|8,320.00|5,824.00|2,496.00
M54.49|LUMBAGO WITH SCIATICA  SITE UNSPECIFIED|8,320.00|5,824.00|2,496.00
M54.5|LOW BACK PAIN; LOIN PAIN; LOW BACK STRAIN; LUMBAGO NOS|8,320.00|5,824.00|2,496.00
M54.50|LOW BACK PAIN; LOIN PAIN; LOW BACK STRAIN; LUMBAGO NOS MULTIPLE SITES IN SPINE|8,320.00|5,824.00|2,496.00
M54.51|LOW BACK PAIN; LOIN PAIN; LOW BACK STRAIN; LUMBAGO NOS OCCIPITO-ATLANTO-AXIAL REGION|8,320.00|5,824.00|2,496.00
M54.52|LOW BACK PAIN; LOIN PAIN; LOW BACK STRAIN; LUMBAGO NOS CERVICAL REGION|8,320.00|5,824.00|2,496.00
M54.84|OTHER DORSALGIA  THORACIC REGION|8,320.00|5,824.00|2,496.00
M54.88|OTHER DORSALGIA  SACRAL AND SACROCOCCYGEAL REGION|8,320.00|5,824.00|2,496.00
M54.91|DORSALGIA, UNSPECIFIED; BACKACHE NOS OCCIPITO- ATLANTO-AXIAL REGION|8,320.00|5,824.00|2,496.00
M54.93|DORSALGIA, UNSPECIFIED; BACKACHE NOS CERVICOTHORACIC REGION|8,320.00|5,824.00|2,496.00
M54.96|DORSALGIA, UNSPECIFIED; BACKACHE NOS LUMBAR REGION|8,320.00|5,824.00|2,496.00
M54.97|DORSALGIA, UNSPECIFIED; BACKACHE NOS LUMBOSACRAL REGION|8,320.00|5,824.00|2,496.00
M54.98|DORSALGIA, UNSPECIFIED; BACKACHE NOS SACRAL AND SACROCOCCYGEAL REGION|8,320.00|5,824.00|2,496.00
M54.99|DORSALGIA, UNSPECIFIED; BACKACHE NOS SITE UNSPECIFIED|8,320.00|5,824.00|2,496.00
M60.0|INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS|8,450.00|5,915.00|2,535.00
M60.00|INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS MULTIPLE SITE|8,450.00|5,915.00|2,535.00
M60.01|INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS SHOULDER REGION|8,450.00|5,915.00|2,535.00
M60.02|INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS UPPER ARM|8,450.00|5,915.00|2,535.00
M60.05|INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS PELVIC REGION AND THIGH|8,450.00|5,915.00|2,535.00
M60.06|INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS LOWER LEG|8,450.00|5,915.00|2,535.00
M60.07|INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS ANKLE AND FOOT|8,450.00|5,915.00|2,535.00
M60.08|INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS OTHER|8,450.00|5,915.00|2,535.00
M60.09|INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS SITE UNSPECIFIED|8,450.00|5,915.00|2,535.00
M60.1|INTERSTITIAL MYOSITIS|8,450.00|5,915.00|2,535.00
M60.11|INTERSTITIAL MYOSITIS SHOULDER REGION|8,450.00|5,915.00|2,535.00
M60.2|FOREIGN BODY GRANULOMA OF SOFT TISSUE, NOT ELSEWHERE CLASSIFIED|8,450.00|5,915.00|2,535.00
M60.21|FOREIGN BODY GRANULOMA OF SOFT TISSUE, NOT ELSEWHERE CLASSIFIED SHOULDER REGION|8,450.00|5,915.00|2,535.00
M60.23|FOREIGN BODY GRANULOMA OF SOFT TISSUE, NOT ELSEWHERE CLASSIFIED FOREARM|8,450.00|5,915.00|2,535.00
M60.27|FOREIGN BODY GRANULOMA OF SOFT TISSUE, NOT ELSEWHERE CLASSIFIED ANKLE AND FOOT|8,450.00|5,915.00|2,535.00
M60.8|OTHER MYOSITIS|8,450.00|5,915.00|2,535.00
M60.80|OTHER MYOSITIS MULTIPLE SITE|8,450.00|5,915.00|2,535.00
M60.81|OTHER MYOSITIS SHOULDER REGION|8,450.00|5,915.00|2,535.00
M60.88|OTHER MYOSITIS OTHER|8,450.00|5,915.00|2,535.00
M60.89|OTHER MYOSITIS SITE UNSPECIFIED|8,450.00|5,915.00|2,535.00
M60.9|MYOSITIS, UNSPECIFIED|8,450.00|5,915.00|2,535.00
M60.90|MYOSITIS, UNSPECIFIED MULTIPLE SITE|8,450.00|5,915.00|2,535.00
M60.91|MYOSITIS, UNSPECIFIED SHOULDER REGION|8,450.00|5,915.00|2,535.00
M60.92|MYOSITIS, UNSPECIFIED UPPER ARM|8,450.00|5,915.00|2,535.00
M60.95|MYOSITIS, UNSPECIFIED PELVIC REGION AND THIGH|8,450.00|5,915.00|2,535.00
M60.96|MYOSITIS, UNSPECIFIED LOWER LEG|8,450.00|5,915.00|2,535.00
M60.98|MYOSITIS, UNSPECIFIED OTHER|8,450.00|5,915.00|2,535.00
M60.99|MYOSITIS, UNSPECIFIED SITE UNSPECIFIED|8,450.00|5,915.00|2,535.00
M61.3|CALCIFICATION AND OSSIFICATION OF MUSCLES ASSOCIATED WITH BURNS; MYOSITIS OSSIFICANS ASSOCIATED WITH BURNS|8,450.00|5,915.00|2,535.00
M61.55|OTHER OSSIFICATION OF MUSCLE PELVIC REGION AND THIGH|8,450.00|5,915.00|2,535.00
M61.59|OTHER OSSIFICATION OF MUSCLE SITE UNSPECIFIED|8,450.00|5,915.00|2,535.00
M61.9|CALCIFICATION AND OSSIFICATION OF MUSCLE, UNSPECIFIED|8,450.00|5,915.00|2,535.00
M62.0|DIASTASIS OF MUSCLE|8,450.00|5,915.00|2,535.00
M62.05|DIASTASIS OF MUSCLE  PELVIC REGION AND THIGH|8,450.00|5,915.00|2,535.00
M62.08|DIASTASIS OF MUSCLE  OTHER|8,450.00|5,915.00|2,535.00
M62.1|OTHER RUPTURE OF MUSCLE (NONTRAUMATIC)|8,450.00|5,915.00|2,535.00
M62.48|CONTRACTURE OF MUSCLE  OTHER|8,450.00|5,915.00|2,535.00
M62.49|CONTRACTURE OF MUSCLE  SITE UNSPECIFIED|8,450.00|5,915.00|2,535.00
M62.56|MUSCLE WASTING AND ATROPHY, NOT ELSEWHERE CLASSIFIED; DISUSE ATROPHY NEC LOWER LEG|8,450.00|5,915.00|2,535.00
M62.59|MUSCLE WASTING AND ATROPHY, NOT ELSEWHERE CLASSIFIED; DISUSE ATROPHY NEC SITE UNSPECIFIED|8,450.00|5,915.00|2,535.00
M62.60|MUSCLE STRAIN  MULTIPLE SITE|8,450.00|5,915.00|2,535.00
M62.61|MUSCLE STRAIN  SHOULDER REGION|8,450.00|5,915.00|2,535.00
M62.62|MUSCLE STRAIN  UPPER ARM|8,450.00|5,915.00|2,535.00
M62.63|MUSCLE STRAIN  FOREARM|8,450.00|5,915.00|2,535.00
M62.65|MUSCLE STRAIN  PELVIC REGION AND THIGH|8,450.00|5,915.00|2,535.00
M62.66|MUSCLE STRAIN  LOWER LEG|8,450.00|5,915.00|2,535.00
M62.67|MUSCLE STRAIN  ANKLE AND FOOT|8,450.00|5,915.00|2,535.00
M62.68|MUSCLE STRAIN  OTHER|8,450.00|5,915.00|2,535.00
M62.69|MUSCLE STRAIN  SITE UNSPECIFIED|8,450.00|5,915.00|2,535.00
M62.8|MUSCLE (SHEATH) HERNIA|8,450.00|5,915.00|2,535.00
M62.80|MUSCLE (SHEATH) HERNIA MULTIPLE SITE|8,450.00|5,915.00|2,535.00
M62.85|MUSCLE (SHEATH) HERNIA PELVIC REGION AND THIGH|8,450.00|5,915.00|2,535.00
M62.86|MUSCLE (SHEATH) HERNIA LOWER LEG|8,450.00|5,915.00|2,535.00
M62.88|MUSCLE (SHEATH) HERNIA OTHER|8,450.00|5,915.00|2,535.00
M62.89|MUSCLE (SHEATH) HERNIA SITE UNSPECIFIED|8,450.00|5,915.00|2,535.00
M62.9|DISORDER OF MUSCLE, UNSPECIFIED|8,450.00|5,915.00|2,535.00
M62.90|DISORDER OF MUSCLE, UNSPECIFIED  MULTIPLE SITE|8,450.00|5,915.00|2,535.00
M62.91|DISORDER OF MUSCLE, UNSPECIFIED  SHOULDER REGION|8,450.00|5,915.00|2,535.00
M62.95|DISORDER OF MUSCLE, UNSPECIFIED  PELVIC REGION AND THIGH|8,450.00|5,915.00|2,535.00
M62.96|DISORDER OF MUSCLE, UNSPECIFIED  LOWER LEG|8,450.00|5,915.00|2,535.00
M62.97|DISORDER OF MUSCLE, UNSPECIFIED  ANKLE AND FOOT|8,450.00|5,915.00|2,535.00
M62.98|DISORDER OF MUSCLE, UNSPECIFIED  OTHER|8,450.00|5,915.00|2,535.00
M62.99|DISORDER OF MUSCLE, UNSPECIFIED  SITE UNSPECIFIED|8,450.00|5,915.00|2,535.00
M65.0|ABSCESS OF TENDON SHEATH|8,450.00|5,915.00|2,535.00
M65.1|OTHER INFECTIVE TENOSYNOVITIS|8,450.00|5,915.00|2,535.00
M65.13|OTHER INFECTIVE (TENO)SYNOVITIS FOREARM|8,450.00|5,915.00|2,535.00
M65.2|CALCIFIC TENDINITIS|8,450.00|5,915.00|2,535.00
M65.20|CALCIFIC TENDINITIS MULTIPLE SITE|8,450.00|5,915.00|2,535.00
M65.22|CALCIFIC TENDINITIS UPPER ARM|8,450.00|5,915.00|2,535.00
M65.25|CALCIFIC TENDINITIS PELVIC REGION AND THIGH|8,450.00|5,915.00|2,535.00
M65.29|CALCIFIC TENDINITIS SITE UNSPECIFIED|8,450.00|5,915.00|2,535.00
M65.3|TRIGGER FINGER;NODULAR TENDINOUS DISEASE|8,450.00|5,915.00|2,535.00
M65.4|RADIAL STYLOID TENOSYNOVITIS [DE QUERVAIN]|8,450.00|5,915.00|2,535.00
M65.8|OTHER SYNOVITIS AND TENOSYNOVITIS|8,450.00|5,915.00|2,535.00
M65.80|OTHER SYNOVITIS AND TENOSYNOVITIS MULTIPLE SITE|8,450.00|5,915.00|2,535.00
M65.84|OTHER SYNOVITIS AND TENOSYNOVITIS HAND|8,450.00|5,915.00|2,535.00
M65.86|OTHER SYNOVITIS AND TENOSYNOVITIS LOWER LEG|8,450.00|5,915.00|2,535.00
M65.87|OTHER SYNOVITIS AND TENOSYNOVITIS ANKLE AND FOOT|8,450.00|5,915.00|2,535.00
M65.89|OTHER SYNOVITIS AND TENOSYNOVITIS SITE UNSPECIFIED|8,450.00|5,915.00|2,535.00
M65.9|SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED|8,450.00|5,915.00|2,535.00
M65.90|SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED MULTIPLE SITE|8,450.00|5,915.00|2,535.00
M65.91|SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED SHOULDER REGION|8,450.00|5,915.00|2,535.00
M65.92|SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED UPPER ARM|8,450.00|5,915.00|2,535.00
M65.93|SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED FOREARM|8,450.00|5,915.00|2,535.00
M65.94|SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED HAND|8,450.00|5,915.00|2,535.00
M65.95|SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED PELVIC REGION AND THIGH|8,450.00|5,915.00|2,535.00
M65.96|SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED LOWER LEG|8,450.00|5,915.00|2,535.00
M65.97|SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED ANKLE AND FOOT|8,450.00|5,915.00|2,535.00
M65.99|SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED SITE UNSPECIFIED|8,450.00|5,915.00|2,535.00
M66.0|RUPTURE OF POPLITEAL CYST|8,450.00|5,915.00|2,535.00
M66.4|SPONTANEOUS RUPTURE OF OTHER TENDONS|8,450.00|5,915.00|2,535.00
M66.5|SPONTANEOUS RUPTURE OF UNSPECIFIED TENDON; RUPTURE AT MUSCULOTENDINOUS JUNCTION, NONTRAUMATIC|8,450.00|5,915.00|2,535.00
M67.0|SHORT ACHILLES TENDON (ACQUIRED)|8,450.00|5,915.00|2,535.00
M67.1|OTHER CONTRACTURE OF TENDON (SHEATH)|8,450.00|5,915.00|2,535.00
M67.2|SYNOVIAL HYPERTROPHY, NOT ELSEWHERE CLASSIFIED|8,450.00|5,915.00|2,535.00
M67.3|TRANSIENT SYNOVITIS; TOXIC SYNOVITIS|8,450.00|5,915.00|2,535.00
M67.4|GANGLION; GANGLION OF JOINT OR TENDON (SHEATH)|8,450.00|5,915.00|2,535.00
M67.8|OTHER SPECIFIED DISORDERS OF SYNOVIUM AND TENDON|8,450.00|5,915.00|2,535.00
M67.9|DISORDER OF SYNOVIUM AND TENDON, UNSPECIFIED|8,450.00|5,915.00|2,535.00
M70.0|CHRONIC CREPITANT SYNOVITIS OF HAND AND WRIST|8,450.00|5,915.00|2,535.00
M70.1|BURSITIS OF HAND|8,450.00|5,915.00|2,535.00
M70.2|OLECRANON BURSITIS|8,450.00|5,915.00|2,535.00
M70.3|OTHER BURSITIS OF ELBOW|8,450.00|5,915.00|2,535.00
M70.4|PREPATELLAR BURSITIS|8,450.00|5,915.00|2,535.00
M70.5|OTHER BURSITIS OF KNEE|8,450.00|5,915.00|2,535.00
M70.6|TROCHANTERIC BURSITIS; TROCHANTERIC TENDINITIS SHOULDER REGION|8,450.00|5,915.00|2,535.00
M70.7|OTHER BURSITIS OF HIP; ISCHIAL BURSITIS|8,450.00|5,915.00|2,535.00
M70.8|OTHER SOFT TISSUE DISORDERS RELATED TO USE, OVERUSE AND PRESSURE|8,450.00|5,915.00|2,535.00
M70.9|UNSPECIFIED SOFT TISSUE DISORDER RELATED TO USE, OVERUSE AND PRESSURE|8,450.00|5,915.00|2,535.00
M71.1|OTHER INFECTIVE BURSITIS|8,450.00|5,915.00|2,535.00
M71.2|SYNOVIAL CYST OF POPLITEAL SPACE [BAKER]|8,450.00|5,915.00|2,535.00
M71.3|OTHER BURSAL CYST; SYNOVIAL CYST NOS|8,450.00|5,915.00|2,535.00
M71.31|OTHER BURSAL CYST; SYNOVIAL CYST NOS  SHOULDER REGION|8,450.00|5,915.00|2,535.00
M71.5|OTHER BURSITIS, NOT ELSEWHERE CLASSIFIED|8,450.00|5,915.00|2,535.00
M71.51|OTHER BURSITIS, NOT ELSEWHERE CLASSIFIED SHOULDER REGION|8,450.00|5,915.00|2,535.00
M71.8|OTHER SPECIFIED BURSOPATHIES|8,450.00|5,915.00|2,535.00
M71.9|BURSOPATHY, UNSPECIFIED|8,450.00|5,915.00|2,535.00
M71.91|BURSOPATHY, UNSPECIFIED SHOULDER REGION|8,450.00|5,915.00|2,535.00
M71.99|BURSOPATHY, UNSPECIFIED SITE UNSPECIFIED|8,450.00|5,915.00|2,535.00
M72.0|PALMAR FASCIAL FIBROMATOSIS [DUPUYTREN]|8,450.00|5,915.00|2,535.00
M72.2|PLANTAR FASCIAL FIBROMATOSIS; PLANTAR FASCIITIS|8,450.00|5,915.00|2,535.00
M72.5|FASCIITIS, NOT ELSEWHERE CLASSIFIED,|8,450.00|5,915.00|2,535.00
M72.88|OTHER FIBROBLASTIC DISORDERS; ABSCESS OF FASCIA OTHER|8,450.00|5,915.00|2,535.00
M72.9|FIBROBLASTIC DISORDER, UNSPECIFIED; FASCIITIS NOS; FIBROMATOSIS NOS|8,450.00|5,915.00|2,535.00
M72.98|FIBROBLASTIC DISORDER, UNSPECIFIED; FASCIITIS NOS; FIBROMATOSIS NOS  OTHER|8,450.00|5,915.00|2,535.00
M72.99|FIBROBLASTIC DISORDER, UNSPECIFIED; FASCIITIS NOS; FIBROMATOSIS NOS  SITE UNSPECIFIED|8,450.00|5,915.00|2,535.00
M75.0|ADHESIVE CAPSULITIS OF SHOULDER; FROZEN SHOULDER; PERIARTHRITIS OF SHOULDER|8,450.00|5,915.00|2,535.00
M75.1|ROTATOR CUFF SYNDROME; ROTATOR CUFF OR SUPRASPINATUS TEAR OR RUPTURE COMPLETE)(INCOMPLETE), NOT SPECIFIED AS TRAUMATIC; SUPRASPINATUS SYNDROME|8,450.00|5,915.00|2,535.00
M75.2|BICIPITAL TENDINITIS|8,450.00|5,915.00|2,535.00
M75.3|CALCIFIC TENDINITIS OF SHOULDER; CALCIFIED BURSA OF SHOULDER|8,450.00|5,915.00|2,535.00
M75.4|IMPINGEMENT SYNDROME OF SHOULDER|8,450.00|5,915.00|2,535.00
M75.5|BURSITIS OF SHOULDER|8,450.00|5,915.00|2,535.00
M75.8|OTHER SHOULDER LESIONS|8,450.00|5,915.00|2,535.00
M75.9|SHOULDER LESION, UNSPECIFIED|8,450.00|5,915.00|2,535.00
M76|ENTHESOPATHIES OF LOWER LIMB, EXCLUDING FOOT|8,450.00|5,915.00|2,535.00
M76.0|GLUTEAL TENDINITIS|8,450.00|5,915.00|2,535.00
M76.1|PSOAS TENDINITIS|8,450.00|5,915.00|2,535.00
M76.3|ILIOTIBIAL BAND SYNDROME|8,450.00|5,915.00|2,535.00
M76.4|TIBIAL COLLATERAL BURSITIS [PELLEGRINI-STIEDA]|8,450.00|5,915.00|2,535.00
M76.5|PATELLAR TENDINITIS|8,450.00|5,915.00|2,535.00
M76.6|ACHILLES TENDINITIS; ACHILLES BURSITIS|8,450.00|5,915.00|2,535.00
M76.7|PERONEAL TENDINITIS|8,450.00|5,915.00|2,535.00
M76.8|OTHER ENTHESOPATHIES OF LOWER LIMB, EXCLUDING FOOT; ANTERIOR TIBIAL SYNDROME; POSTERIOR TIBIAL TENDINITIS|8,450.00|5,915.00|2,535.00
M76.9|ENTHESOPATHY OF LOWER LIMB, UNSPECIFIED|8,450.00|5,915.00|2,535.00
M77.0|MEDIAL EPICONDYLITIS|8,450.00|5,915.00|2,535.00
M77.1|LATERAL EPICONDYLITIS; TENNIS ELBOW|8,450.00|5,915.00|2,535.00
M77.3|CALCANEAL SPUR|8,450.00|5,915.00|2,535.00
M77.5|OTHER ENTHESOPATHY OF FOOT|8,450.00|5,915.00|2,535.00
M77.8|OTHER ENTHESOPATHIES, NOT ELSEWHERE CLASSIFIED|8,450.00|5,915.00|2,535.00
M77.9|ENTHESOPATHY, UNSPECIFIED; BONE SPUR NOS; CAPSULITIS NOS; PERIARTHRITIS NOS; TENDINITIS NOS|8,450.00|5,915.00|2,535.00
M79.00|RHEUMATISM, UNSPECIFIED MULTIPLE SITE|7,670.00|5,369.00|2,301.00
M79.01|RHEUMATISM, UNSPECIFIED SHOULDER REGION|7,670.00|5,369.00|2,301.00
M79.02|RHEUMATISM, UNSPECIFIED UPPER ARM|7,670.00|5,369.00|2,301.00
M79.05|RHEUMATISM, UNSPECIFIED PELVIC REGION AND THIGH|7,670.00|5,369.00|2,301.00
M79.07|RHEUMATISM, UNSPECIFIED ANKLE AND FOOT|7,670.00|5,369.00|2,301.00
M79.08|RHEUMATISM, UNSPECIFIED OTHER|7,670.00|5,369.00|2,301.00
M79.09|RHEUMATISM, UNSPECIFIED SITE UNSPECIFIED|7,670.00|5,369.00|2,301.00
M79.10|MYALGIA MULTIPLE SITE|7,670.00|5,369.00|2,301.00
M79.11|MYALGIA SHOULDER REGION|7,670.00|5,369.00|2,301.00
M79.12|MYALGIA UPPER ARM|7,670.00|5,369.00|2,301.00
M79.15|MYALGIA PELVIC REGION AND THIGH|7,670.00|5,369.00|2,301.00
M79.16|MYALGIA LOWER LEG|7,670.00|5,369.00|2,301.00
M79.18|MYALGIA OTHER|7,670.00|5,369.00|2,301.00
M79.19|MYALGIA SITE UNSPECIFIED|7,670.00|5,369.00|2,301.00
M79.20|NEURALGIA AND NEURITIS, UNSPECIFIED MULTIPLE SITE|7,670.00|5,369.00|2,301.00
M79.21|NEURALGIA AND NEURITIS, UNSPECIFIED SHOULDER REGION|7,670.00|5,369.00|2,301.00
M79.22|NEURALGIA AND NEURITIS, UNSPECIFIED UPPER ARM|7,670.00|5,369.00|2,301.00
M79.25|NEURALGIA AND NEURITIS, UNSPECIFIED PELVIC REGION AND THIGH|7,670.00|5,369.00|2,301.00
M79.28|NEURALGIA AND NEURITIS, UNSPECIFIED OTHER|7,670.00|5,369.00|2,301.00
M79.29|NEURALGIA AND NEURITIS, UNSPECIFIED SITE UNSPECIFIED|7,670.00|5,369.00|2,301.00
M79.39|PANNICULITIS, UNSPECIFIED SITE UNSPECIFIED|7,670.00|5,369.00|2,301.00
M79.80|OTHER SPECIFIED SOFT TISSUE DISORDERS MULTIPLE SITE|8,450.00|5,915.00|2,535.00
M79.81|OTHER SPECIFIED SOFT TISSUE DISORDERS SHOULDER REGION|8,450.00|5,915.00|2,535.00
M79.82|OTHER SPECIFIED SOFT TISSUE DISORDERS UPPER ARM|8,450.00|5,915.00|2,535.00
M79.84|OTHER SPECIFIED SOFT TISSUE DISORDERS HAND|8,450.00|5,915.00|2,535.00
M79.85|OTHER SPECIFIED SOFT TISSUE DISORDERS PELVIC REGION AND THIGH|8,450.00|5,915.00|2,535.00
M79.86|OTHER SPECIFIED SOFT TISSUE DISORDERS LOWER LEG|8,450.00|5,915.00|2,535.00
M79.87|OTHER SPECIFIED SOFT TISSUE DISORDERS ANKLE AND FOOT|8,450.00|5,915.00|2,535.00
M79.88|OTHER SPECIFIED SOFT TISSUE DISORDERS OTHER|8,450.00|5,915.00|2,535.00
M79.89|OTHER SPECIFIED SOFT TISSUE DISORDERS SITE UNSPECIFIED|8,450.00|5,915.00|2,535.00
M79.91|SOFT TISSUE DISORDER, UNSPECIFIED SHOULDER REGION|8,450.00|5,915.00|2,535.00
M79.95|SOFT TISSUE DISORDER, UNSPECIFIED PELVIC REGION AND THIGH|8,450.00|5,915.00|2,535.00
M79.98|SOFT TISSUE DISORDER, UNSPECIFIED OTHER|8,450.00|5,915.00|2,535.00
M79.99|SOFT TISSUE DISORDER, UNSPECIFIED SITE UNSPECIFIED|8,450.00|5,915.00|2,535.00
M80.0|POSTMENOPAUSAL OSTEOPOROSIS WITH PATHOLOGICAL FRACTURE|10,270.00|7,189.00|3,081.00
M80.1|POSTOOPHORECTOMY OSTEOPOROSIS WITH PATHOLOGICAL FRACTURE|10,270.00|7,189.00|3,081.00
M80.3|POSTSURGICAL MALABSORPTION OSTEOPOROSIS WITH PATHOLOGICAL FRACTURE|10,270.00|7,189.00|3,081.00
M81.0|POSTMENOPAUSAL OSTEOPOROSIS|10,270.00|7,189.00|3,081.00
M81.08|POSTMENOPAUSAL OSTEOPOROSIS OTHER|10,270.00|7,189.00|3,081.00
M81.1|POSTOOPHORECTOMY OSTEOPOROSIS|10,270.00|7,189.00|3,081.00
M81.4|DRUG-INDUCED OSTEOPOROSIS|10,270.00|7,189.00|3,081.00
M81.40|DRUG-INDUCED OSTEOPOROSIS MULTIPLE SITE|10,270.00|7,189.00|3,081.00
M81.55|IDIOPATHIC OSTEOPOROSIS PELVIC REGION AND THIGH|10,270.00|7,189.00|3,081.00
M81.58|IDIOPATHIC OSTEOPOROSIS OTHER|10,270.00|7,189.00|3,081.00
M81.6|LOCALIZED OSTEOPOROSIS [LEQUESNE]|10,270.00|7,189.00|3,081.00
M81.8|OTHER OSTEOPOROSIS; SENILE OSTEOPOROSIS|10,270.00|7,189.00|3,081.00
M81.88|OTHER OSTEOPOROSIS; SENILE OSTEOPOROSIS  OTHER|10,270.00|7,189.00|3,081.00
M81.89|OTHER OSTEOPOROSIS; SENILE OSTEOPOROSIS  SITE UNSPECIFIED|10,270.00|7,189.00|3,081.00
M81.9|OSTEOPOROSIS, UNSPECIFIED|10,270.00|7,189.00|3,081.00
M81.95|OSTEOPOROSIS, UNSPECIFIED PELVIC REGION AND THIGH|10,270.00|7,189.00|3,081.00
M81.98|OSTEOPOROSIS, UNSPECIFIED OTHER|10,270.00|7,189.00|3,081.00
M83.2|ADULT OSTEOMALACIA DUE TO MALABSORPTION; POSTSURGICAL MALABSORPTION OSTEOMALACIA IN ADULTS|10,270.00|7,189.00|3,081.00
M83.4|ALUMINIUM BONE DISEASE|10,270.00|7,189.00|3,081.00
M83.8|OTHER ADULT OSTEOMALACIA|10,270.00|7,189.00|3,081.00
M83.87|OTHER ADULT OSTEOMALACIA ANKLE AND FOOT|10,270.00|7,189.00|3,081.00
M83.89|OTHER ADULT OSTEOMALACIA SITE UNSPECIFIED|10,270.00|7,189.00|3,081.00
M83.9|ADULT OSTEOMALACIA, UNSPECIFIED|10,270.00|7,189.00|3,081.00
M83.99|ADULT OSTEOMALACIA, UNSPECIFIED SITE UNSPECIFIED|10,270.00|7,189.00|3,081.00
M85.0|FIBROUS DYSPLASIA (MONOSTOTIC)|10,270.00|7,189.00|3,081.00
M85.1|SKELETAL FLUOROSIS MULTIPLE SITE|10,270.00|7,189.00|3,081.00
M85.2|HYPEROSTOSIS OF SKULL|10,270.00|7,189.00|3,081.00
M85.5|ANEURYSMAL BONE CYST|10,270.00|7,189.00|3,081.00
M85.55|ANEURYSMAL BONE CYST PELVIC REGION AND THIGH|10,270.00|7,189.00|3,081.00
M85.6|OTHER CYST OF BONE|10,270.00|7,189.00|3,081.00
M85.63|OTHER CYST OF BONE FOREARM|10,270.00|7,189.00|3,081.00
M85.65|OTHER CYST OF BONE PELVIC REGION AND THIGH|10,270.00|7,189.00|3,081.00
M85.8|OTHER SPECIFIED DISORDERS OF BONE DENSITY AND STRUCTURE; HYPEROSTOSIS OF BONES, EXCEPT SKULL|10,270.00|7,189.00|3,081.00
M85.88|OTHER SPECIFIED DISORDERS OF BONE DENSITY AND STRUCTURE; HYPEROSTOSIS OF BONES, EXCEPT SKULL OTHER|10,270.00|7,189.00|3,081.00
M86.0|ACUTE HAEMATOGENOUS OSTEOMYELITIS|16,900.00|11,830.00|5,070.00
M86.1|OTHER ACUTE OSTEOMYELITIS|16,900.00|11,830.00|5,070.00
M86.15|OTHER ACUTE OSTEOMYELITIS PELVIC REGION AND THIGH|16,900.00|11,830.00|5,070.00
M86.17|OTHER ACUTE OSTEOMYELITIS ANKLE AND FOOT|16,900.00|11,830.00|5,070.00
M86.19|OTHER ACUTE OSTEOMYELITIS SITE UNSPECIFIED|16,900.00|11,830.00|5,070.00
M86.2|SUBACUTE OSTEOMYELITIS|16,900.00|11,830.00|5,070.00
M86.29|SUBACUTE OSTEOMYELITIS SITE UNSPECIFIED|16,900.00|11,830.00|5,070.00
M86.4|CHRONIC OSTEOMYELITIS WITH DRAINING SINUS|16,900.00|11,830.00|5,070.00
M86.5|OTHER CHRONIC HAEMATOGENOUS OSTEOMYELITIS|16,900.00|11,830.00|5,070.00
M86.50|OTHER CHRONIC HAEMATOGENOUS OSTEOMYELITIS MULTIPLE SITE|16,900.00|11,830.00|5,070.00
M86.6|OTHER CHRONIC OSTEOMYELITIS|16,900.00|11,830.00|5,070.00
M86.60|OTHER CHRONIC OSTEOMYELITIS MULTIPLE SITE|16,900.00|11,830.00|5,070.00
M86.61|OTHER CHRONIC OSTEOMYELITIS SHOULDER REGION|16,900.00|11,830.00|5,070.00
M86.62|OTHER CHRONIC OSTEOMYELITIS UPPER ARM|16,900.00|11,830.00|5,070.00
M86.63|OTHER CHRONIC OSTEOMYELITIS FOREARM|16,900.00|11,830.00|5,070.00
M86.65|OTHER CHRONIC OSTEOMYELITIS PELVIC REGION AND THIGH|16,900.00|11,830.00|5,070.00
M86.66|OTHER CHRONIC OSTEOMYELITIS LOWER LEG|16,900.00|11,830.00|5,070.00
M86.67|OTHER CHRONIC OSTEOMYELITIS ANKLE AND FOOT|16,900.00|11,830.00|5,070.00
M86.68|OTHER CHRONIC OSTEOMYELITIS OTHER|16,900.00|11,830.00|5,070.00
M86.69|OTHER CHRONIC OSTEOMYELITIS SITE UNSPECIFIED|16,900.00|11,830.00|5,070.00
M86.8|OTHER OSTEOMYELITIS; BRODIE'S ABSCESS|16,900.00|11,830.00|5,070.00
M86.80|OTHER OSTEOMYELITIS; BRODIE'S ABSCESS  MULTIPLE SITE|16,900.00|11,830.00|5,070.00
M86.81|OTHER OSTEOMYELITIS; BRODIE'S ABSCESS  SHOULDER REGION|16,900.00|11,830.00|5,070.00
M86.88|OTHER OSTEOMYELITIS; BRODIE'S ABSCESS  OTHER|16,900.00|11,830.00|5,070.00
M86.9|OSTEOMYELITIS, UNSPECIFIED; INFECTION OF BONE NOS; PERIOSTITIS WITHOUT MENTION OF OSTEOMYELITIS|16,900.00|11,830.00|5,070.00
M86.90|OSTEOMYELITIS, UNSPECIFIED; INFECTION OF BONE NOS; PERIOSTITIS WITHOUT MENTION OF OSTEOMYELITIS MULTIPLE SITE|16,900.00|11,830.00|5,070.00
M86.91|OSTEOMYELITIS, UNSPECIFIED; INFECTION OF BONE NOS; PERIOSTITIS WITHOUT MENTION OF OSTEOMYELITIS SHOULDER REGION|16,900.00|11,830.00|5,070.00
M86.92|OSTEOMYELITIS, UNSPECIFIED; INFECTION OF BONE NOS; PERIOSTITIS WITHOUT MENTION OF OSTEOMYELITIS UPPER ARM|16,900.00|11,830.00|5,070.00
M86.94|OSTEOMYELITIS, UNSPECIFIED; INFECTION OF BONE NOS; PERIOSTITIS WITHOUT MENTION OF OSTEOMYELITIS HAND|16,900.00|11,830.00|5,070.00
M86.95|OSTEOMYELITIS, UNSPECIFIED; INFECTION OF BONE NOS; PERIOSTITIS WITHOUT MENTION OF OSTEOMYELITIS PELVIC REGION AND THIGH|16,900.00|11,830.00|5,070.00
M86.96|OSTEOMYELITIS, UNSPECIFIED; INFECTION OF BONE NOS; PERIOSTITIS WITHOUT MENTION OF OSTEOMYELITIS LOWER LEG|16,900.00|11,830.00|5,070.00
M86.97|OSTEOMYELITIS, UNSPECIFIED; INFECTION OF BONE NOS; PERIOSTITIS WITHOUT MENTION OF OSTEOMYELITIS ANKLE AND FOOT|16,900.00|11,830.00|5,070.00
M86.98|OSTEOMYELITIS, UNSPECIFIED; INFECTION OF BONE NOS; PERIOSTITIS WITHOUT MENTION OF OSTEOMYELITIS OTHER|16,900.00|11,830.00|5,070.00
M86.99|OSTEOMYELITIS, UNSPECIFIED; INFECTION OF BONE NOS; PERIOSTITIS WITHOUT MENTION OF OSTEOMYELITIS  SITE UNSPECIFIED|16,900.00|11,830.00|5,070.00
M87.05|IDIOPATHIC ASEPTIC NECROSIS OF BONE PELVIC REGION AND THIGH|16,900.00|11,830.00|5,070.00
M87.2|OSTEONECROSIS DUE TO PREVIOUS TRAUMA|16,900.00|11,830.00|5,070.00
M87.8|OTHER OSTEONECROSIS|16,900.00|11,830.00|5,070.00
M87.85|OTHER OSTEONECROSIS PELVIC REGION AND THIGH|16,900.00|11,830.00|5,070.00
M87.86|OTHER OSTEONECROSIS LOWER LEG|16,900.00|11,830.00|5,070.00
M87.9|OSTEONECROSIS, UNSPECIFIED|16,900.00|11,830.00|5,070.00
M87.90|OSTEONECROSIS, UNSPECIFIED MULTIPLE SITE|16,900.00|11,830.00|5,070.00
M87.91|OSTEONECROSIS, UNSPECIFIED SHOULDER REGION|16,900.00|11,830.00|5,070.00
M87.95|OSTEONECROSIS, UNSPECIFIED PELVIC REGION AND THIGH|16,900.00|11,830.00|5,070.00
M87.99|OSTEONECROSIS, UNSPECIFIED SITE UNSPECIFIED|16,900.00|11,830.00|5,070.00
M88.0|PAGET'S DISEASE OF SKULL|16,900.00|11,830.00|5,070.00
M88.9|PAGET'S DISEASE OF BONE, UNSPECIFIED|16,900.00|11,830.00|5,070.00
M89.0|ALGONEURODYSTROPHY; SHOULDER-HAND SYNDROME; SUDECK'S ATROPHY; SYMPATHETIC REFLEX DYSTROPHY|11,440.00|8,008.00|3,432.00
M89.01|ALGONEURODYSTROPHY; SHOULDER-HAND SYNDROME; SUDECK'S ATROPHY; SYMPATHETIC REFLEX DYSTROPHY SHOULDER REGION|11,440.00|8,008.00|3,432.00
M89.2|OTHER DISORDERS OF BONE DEVELOPMENT AND GROWTH|11,440.00|8,008.00|3,432.00
M89.38|HYPERTROPHY OF BONE OTHER|10,270.00|7,189.00|3,081.00
M89.4|OTHER HYPERTROPHIC OSTEOARTHROPATHY; MARIE- BAMBERGER DISEASE; PACHYDERMOPERIOSTOSIS|11,440.00|8,008.00|3,432.00
M89.48|OTHER HYPERTROPHIC OSTEOARTHROPATHY; MARIE- BAMBERGER DISEASE; PACHYDERMOPERIOSTOSIS  OTHER|11,440.00|8,008.00|3,432.00
M89.5|OSTEOLYSIS|11,440.00|8,008.00|3,432.00
M89.54|OSTEOLYSIS HAND|11,440.00|8,008.00|3,432.00
M89.6|OSTEOPATHY AFTER POLIOMYELITIS|11,440.00|8,008.00|3,432.00
M89.8|OTHER SPECIFIED DISORDERS OF BONE; INFANTILE CORTICAL HYPEROSTOSES; POST-TRAUMATIC SUBPERIOSTEAL OSSIFICATION|11,440.00|8,008.00|3,432.00
M89.85|OTHER SPECIFIED DISORDERS OF BONE; INFANTILE CORTICAL HYPEROSTOSES; POST-TRAUMATIC SUBPERIOSTEAL OSSIFICATION  PELVIC REGION AND THIGH|11,440.00|8,008.00|3,432.00
M89.86|OTHER SPECIFIED DISORDERS OF BONE; INFANTILE CORTICAL HYPEROSTOSES; POST-TRAUMATIC SUBPERIOSTEAL OSSIFICATION  LOWER LEG|11,440.00|8,008.00|3,432.00
M89.87|OTHER SPECIFIED DISORDERS OF BONE; INFANTILE CORTICAL HYPEROSTOSES; POST-TRAUMATIC SUBPERIOSTEAL OSSIFICATION  ANKLE AND FOOT|11,440.00|8,008.00|3,432.00
M89.88|OTHER SPECIFIED DISORDERS OF BONE; INFANTILE CORTICAL HYPEROSTOSES; POST-TRAUMATIC SUBPERIOSTEAL OSSIFICATION  OTHER|11,440.00|8,008.00|3,432.00
M89.89|OTHER SPECIFIED DISORDERS OF BONE; INFANTILE CORTICAL HYPEROSTOSES; POST-TRAUMATIC SUBPERIOSTEAL OSSIFICATION  SITE UNSPECIFIED|11,440.00|8,008.00|3,432.00
M89.95|DISORDER OF BONE, UNSPECIFIED PELVIC REGION AND THIGH|11,440.00|8,008.00|3,432.00
M89.98|DISORDER OF BONE, UNSPECIFIED OTHER|11,440.00|8,008.00|3,432.00
M89.99|DISORDER OF BONE, UNSPECIFIED SITE UNSPECIFIED|11,440.00|8,008.00|3,432.00
M91.1|JUVENILE OSTEOCHONDROSIS OF HEAD OF FEMUR [LEGG- CALVÉ-PERTHES]|11,440.00|8,008.00|3,432.00
M91.8|OTHER JUVENILE OSTEOCHONDROSIS OF HIP AND PELVIS; JUVENILE OSTEOCHONDROSIS AFTER REDUCTION OF CONGENITAL DISLOCATION OF HIP|11,440.00|8,008.00|3,432.00
M94.0|CHONDROCOSTAL JUNCTION SYNDROME [TIETZE]|11,440.00|8,008.00|3,432.00
M94.8|OTHER SPECIFIED DISORDERS OF CARTILAGE|11,440.00|8,008.00|3,432.00
M96.8|OTHER POSTPROCEDURAL MUSCULOSKELETAL DISORDERS|7,670.00|5,369.00|2,301.00
M99.0|SEGMENTAL AND SOMATIC DYSFUNCTION, RIB CAGE|10,140.00|7,098.00|3,042.00
M99.1|SUBLUXATION COMPLEX (VERTEBRAL)|10,140.00|7,098.00|3,042.00
M99.3|OSSEOUS STENOSIS OF NEURAL CANAL|10,140.00|7,098.00|3,042.00
M99.5|INTERVERTEBRAL DISC STENOSIS OF NEURAL CANAL|10,140.00|7,098.00|3,042.00
M99.7|CONNECTIVE TISSUE AND DISC STENOSIS OF INTERVERTEBRAL FORAMINA|10,140.00|7,098.00|3,042.00
M99.8|OTHER BIOMECHANICAL LESIONS|11,440.00|8,008.00|3,432.00
M99.9|BIOMECHANICAL LESION, UNSPECIFIED|11,440.00|8,008.00|3,432.00
N00.0|ACUTE NEPHRITIC SYNDROME INCLUDING  ACUTE GLOMERULAR DISEASE, ACUTE GLOMERULONEPHRITIS, ACUTE NEPHRITIS, ACUTE RENAL DISEASE NOS, WITH MINOR GLOMERULAR ABNORMALITY|13,000.00|9,100.00|3,900.00
N00.1|ACUTE NEPHRITIC SYNDROME INCLUDING ACUTE GLOMERULAR DISEASE, ACUTE GLOMERULONEPHRITIS, ACUTE NEPHRITIS,  ACUTE RENAL DISEASE NOS, WITH FOCAL AND SEGMENTAL GLOMERULAR LESIONS (WITH FOCAL AND SEGMENTAL HYALINOSIS; FOCAL AND SEGMENTAL SCLEROSIS) & FOCAL GLOM|13,000.00|9,100.00|3,900.00
N00.2|ACUTE NEPHRITIC SYNDROME INCLUDING ACUTE GLOMERULAR DISEASE,  ACUTE GLOMERULONEPHRITIS, ACUTE NEPHRITIS,  ACUTE RENAL DISEASE NOS WITH DIFFUSE MEMBRANOUS GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N00.3|ACUTE NEPHRITIC SYNDROME INCLUDING ACUTE GLOMERULAR DISEASE,  ACUTE GLOMERULONEPHRITIS, ACUTE NEPHRITIS,  ACUTE RENAL DISEASE NOS WITH DIFFUSE MESANGIAL PROLIFERATIVE GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N00.4|ACUTE NEPHRITIC SYNDROME INCLUDING  ACUTE GLOMERULAR DISEASE, ACUTE GLOMERULONEPHRITIS, ACUTE NEPHRITIS, ACUTE RENAL DISEASE NOS  WITH DIFFUSE ENDOCAPILLARY PROLIFERATIVE GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N00.5|ACUTE NEPHRITIC SYNDROME INCLUDING  ACUTE GLOMERULAR DISEASE,  ACUTE GLOMERULONEPHRITIS, ACUTE NEPHRITIS, ACUTE RENAL DISEASE NOS WITH DIFFUSE MESANGIOCAPILLARY GLOMERULONEPHRITIS (MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS, TYPES 1 AND 3, OR NOS)|13,000.00|9,100.00|3,900.00
N00.7|ACUTE NEPHRITIC SYNDROME INCLUDING ACUTE GLOMERULAR DISEASE, ACUTE GLOMERULONEPHRITIS, ACUTE NEPHRITIS, ACUTE RENAL DISEASE NOS WITH DIFFUSE CRESCENTIC GLOMERULONEPHRITIS (EXTRACPILLARY GLOMERULONEPHRITIS)|13,000.00|9,100.00|3,900.00
N00.8|ACUTE NEPHRITIC SYNDROME INCLUDING ACUTE GLOMERULAR DISEASE, ACUTE GLOMERULONEPHRITIS, ACUTE NEPHRITIS,  ACUTE RENAL DISEASE NOS WITH OTHER (PROLIFERATIVE GLOMERULONEPHRITIS NOS)|13,000.00|9,100.00|3,900.00
N00.9|ACUTE NEPHRITIC SYNDROME INCLUDING  ACUTE GLOMERULAR DISEASE,  ACUTE GLOMERULONEPHRITIS, ACUTE NEPHRITIS, ACUTE RENAL DISEASE NOS, UNSPECIFIED RENAL BIOPSY|13,000.00|9,100.00|3,900.00
N01.0|RAPIDLY PROGRESSIVE NEPHRITIC SYNDROME; RAPIDLY PROGRESSIVE GLOMERULAR DISEASE; RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS; RAPIDLY PROGRESSIVE NEPHRITIS, MINOR GLOMERULAR ABNORMALITY|13,000.00|9,100.00|3,900.00
N01.1|RAPIDLY PROGRESSIVE NEPHRITIC SYNDROME; RAPIDLY PROGRESSIVE GLOMERULAR DISEASE; RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS; RAPIDLY PROGRESSIVE NEPHRITIS, FOCAL AND SEGMENTAL GLOMERULAR LESIONS|13,000.00|9,100.00|3,900.00
N01.3|RAPIDLY PROGRESSIVE NEPHRITIC SYNDROME; RAPIDLY PROGRESSIVE GLOMERULAR DISEASE; RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS; RAPIDLY PROGRESSIVE NEPHRITIS, DIFFUSE MESANGIAL PROLIFERATIVE GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N01.5|RAPIDLY PROGRESSIVE NEPHRITIC SYNDROME; RAPIDLY PROGRESSIVE GLOMERULAR DISEASE; RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS; RAPIDLY PROGRESSIVE NEPHRITIS, DIFFUSE MESANGIOCAPILLARY GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N01.8|RAPIDLY PROGRESSIVE NEPHRITIC SYNDROME; RAPIDLY PROGRESSIVE GLOMERULAR DISEASE; RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS; RAPIDLY PROGRESSIVE NEPHRITIS, OTHER|13,000.00|9,100.00|3,900.00
N01.9|RAPIDLY PROGRESSIVE NEPHRITIC SYNDROME; RAPIDLY PROGRESSIVE GLOMERULAR DISEASE; RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS; RAPIDLY PROGRESSIVE NEPHRITIS, UNSPECIFIED|13,000.00|9,100.00|3,900.00
N02.0|RECURRENT AND PERSISTENT HAEMATURIA INCLUDING BENIGN FAMILIAL  HAEMATURIA;   BENIGN FAMILIAL HAEMATURIA OF CHILDHOOD; HAEMATURIA WITH MORPHOLOGICAL LESION SPECIFIED WITH  MINOR GLOMERULAR ABNORMALITY|13,000.00|9,100.00|3,900.00
N02.1|RECURRENT AND PERSISTENT HAEMATURIA INCLUDING BENIGN FAMILIAL  HAEMATURIA;   BENIGN FAMILIAL HAEMATURIA OF CHILDHOOD; HAEMATURIA WITH MORPHOLOGICAL LESION SPECIFIED WITH  FOCAL AND SEGMENTAL GLOMERULAR LESIONS|13,000.00|9,100.00|3,900.00
N02.2|RECURRENT AND PERSISTENT HAEMATURIA INCLUDING BENIGN FAMILIAL  HAEMATURIA;   BENIGN FAMILIAL HAEMATURIA OF CHILDHOOD; HAEMATURIA WITH MORPHOLOGICAL LESION SPECIFIED WITH DIFFUSE MEMBRANOUS GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N02.5|RECURRENT AND PERSISTENT HAEMATURIA INCLUDING BENIGN FAMILIAL  HAEMATURIA;   BENIGN FAMILIAL HAEMATURIA OF CHILDHOOD; HAEMATURIA WITH MORPHOLOGICAL LESION SPECIFIED WITH DIFFUSE MESANGIOCAPILLARY GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N02.8|RECURRENT AND PERSISTENT HAEMATURIA INCLUDING BENIGN FAMILIAL  HAEMATURIA;   BENIGN FAMILIAL HAEMATURIA OF CHILDHOOD; HAEMATURIA WITH MORPHOLOGICAL LESION SPECIFIED WITH OTHER (PROLIFERATIVE GLOMERULONEPHRITIS NOS)|13,000.00|9,100.00|3,900.00
N02.9|RECURRENT AND PERSISTENT HAEMATURIA INCLUDING BENIGN FAMILIAL  HAEMATURIA;   BENIGN FAMILIAL HAEMATURIA OF CHILDHOOD; HAEMATURIA WITH MORPHOLOGICAL LESION SPECIFIED WITH UNSPECIFIED RENAL BIOPSY|13,000.00|9,100.00|3,900.00
N03.0|CHRONIC NEPHRITIC SYNDROME INCLUDING  CHRONIC GLOMERULAR DISEASE,  CHRONIC GLOMERULONEPHRITIS, CHRONIC NEPHRITIS,  CHRONIC RENAL DISEASE NOS, WITH MINOR GLOMERULAR ABNORMALITY|13,000.00|9,100.00|3,900.00
N03.1|CHRONIC NEPHRITIC SYNDROME INCLUDING  CHRONIC GLOMERULAR DISEASE,  CHRONIC GLOMERULONEPHRITIS, CHRONIC NEPHRITIS,  CHRONIC RENAL DISEASE NOS, WITH FOCAL AND SEGMENTAL GLOMERULAR LESIONS|13,000.00|9,100.00|3,900.00
N03.2|CHRONIC NEPHRITIC SYNDROME INCLUDING  CHRONIC GLOMERULAR DISEASE,  CHRONIC GLOMERULONEPHRITIS, CHRONIC NEPHRITIS,  CHRONIC RENAL DISEASE NOS, WITHDIFFUSE MEMBRANOUS GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N03.3|CHRONIC NEPHRITIC SYNDROME INCLUDING  CHRONIC GLOMERULAR DISEASE,  CHRONIC GLOMERULONEPHRITIS, CHRONIC NEPHRITIS,  CHRONIC RENAL DISEASE NOS, WITH DIFFUSE MESANGIAL PROLIFERATIVE GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N03.4|CHRONIC NEPHRITIC SYNDROME INCLUDING  CHRONIC GLOMERULAR DISEASE,  CHRONIC GLOMERULONEPHRITIS, CHRONIC NEPHRITIS,  CHRONIC RENAL DISEASE NOS, WITH DIFFUSE ENDOCAPILLARY PROLIFERATIVE GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N03.5|CHRONIC NEPHRITIC SYNDROME INCLUDING  CHRONIC GLOMERULAR DISEASE,  CHRONIC GLOMERULONEPHRITIS, CHRONIC NEPHRITIS,  CHRONIC RENAL DISEASE NOS, WITH DIFFUSE MESANGIOCAPILLARY GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N03.7|CHRONIC NEPHRITIC SYNDROME INCLUDING  CHRONIC GLOMERULAR DISEASE,  CHRONIC GLOMERULONEPHRITIS, CHRONIC NEPHRITIS,  CHRONIC RENAL DISEASE NOS, WITH DIFFUSE CRESCENTIC GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N03.8|CHRONIC NEPHRITIC SYNDROME INCLUDING  CHRONIC GLOMERULAR DISEASE,  CHRONIC GLOMERULONEPHRITIS, CHRONIC NEPHRITIS,  CHRONIC RENAL DISEASE NOS, WITH OTHER (PROLIFERATIVE GLOMERULONEPHRITIS NOS)|13,000.00|9,100.00|3,900.00
N03.9|CHRONIC NEPHRITIC SYNDROME INCLUDING  CHRONIC GLOMERULAR DISEASE,  CHRONIC GLOMERULONEPHRITIS, CHRONIC NEPHRITIS,  CHRONIC RENAL DISEASE NOS, WITH UNSPECIFIED RENAL BIOPSY|13,000.00|9,100.00|3,900.00
N04.0|NEPHROTIC SYNDROME: MINOR GLOMERULAR ABNORMALITY; MINIMAL CHANGE LESION|13,000.00|9,100.00|3,900.00
N04.1|NEPHROTIC SYNDROME: FOCAL AND SEGMENTAL GLOMERULAR LESIONS; FOCAL AND SEGMENTAL HYALINOSIS; FOCAL AND SEGMENTAL  SCLEROSIS; FOCAL GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N04.2|NEPHROTIC SYNDROME: DIFFUSE MEMBRANOUS GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N04.3|NEPHROTIC SYNDROME: DIFFUSE MESANGIAL PROLIFERATIVE GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N04.4|NEPHROTIC SYNDROME: DIFFUSE ENDOCAPILLARY PROLIFERATIVE GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N04.5|NEPHROTIC SYNDROME: DIFFUSE MESANGIOCAPILLARY GLOMERULONEPHRITIS; MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS, TYPES 1 AND 3, OR NOS|13,000.00|9,100.00|3,900.00
N04.7|NEPHROTIC SYNDROME: DIFFUSE CRESCENTIC GLOMERULONEPHRITIS; EXTRACAPILLARY GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N04.8|NEPHROTIC SYNDROME: OTHER|13,000.00|9,100.00|3,900.00
N04.9|NEPHROTIC SYNDROME:UNSPECIFIED|13,000.00|9,100.00|3,900.00
N05.0|UNSPECIFIED NEPHRITIC SYNDROME INCLUDING GLOMERULAR DISEASE, GLOMERULONEPHRITIS, NEPHRITIS  NOS WITH MINOR GLOMERULAR ABNORMALITY, MINIMAL CHANGE LESION|13,000.00|9,100.00|3,900.00
N05.1|UNSPECIFIED NEPHRITIC SYNDROME INCLUDING GLOMERULAR DISEASE, GLOMERULONEPHRITIS, NEPHRITIS  NOS WITH FOCAL AND SEGMENTAL GLOMERULAR LESIONS (WITH FOCAL AND SEGMENTAL HYALINOSIS; FOCAL AND SEGMENTAL SCLEROSIS) & FOCAL GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N05.2|UNSPECIFIED NEPHRITIC SYNDROME INCLUDING GLOMERULAR DISEASE, GLOMERULONEPHRITIS, NEPHRITIS  NOS WITH DIFFUSE MEMBRANOUS GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N05.3|UNSPECIFIED NEPHRITIC SYNDROME INCLUDING GLOMERULAR DISEASE, GLOMERULONEPHRITIS, NEPHRITIS  NOS WITH DIFFUSE MESANGIAL PROLIFERATIVE GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N05.4|UNSPECIFIED NEPHRITIC SYNDROME INCLUDING GLOMERULAR DISEASE, GLOMERULONEPHRITIS, NEPHRITIS  NOS WITH DIFFUSE ENDOCAPILLARY PROLIFERATIVE GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N05.5|UNSPECIFIED NEPHRITIC SYNDROME INCLUDING GLOMERULAR DISEASE, GLOMERULONEPHRITIS, NEPHRITIS  NOS WITH  DIFFUSE MESANGIOCAPILLARY GLOMERULONEPHRITIS,  MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS, TYPES 1 AND 3, OR NOS|13,000.00|9,100.00|3,900.00
N05.6|UNSPECIFIED NEPHRITIC SYNDROME INCLUDING GLOMERULAR DISEASE, GLOMERULONEPHRITIS, NEPHRITIS  NOS WITH DENSE DEPOSIT DISEASE MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS, TYPE 2|13,000.00|9,100.00|3,900.00
N05.7|UNSPECIFIED NEPHRITIC SYNDROME INCLUDING GLOMERULAR DISEASE, GLOMERULONEPHRITIS, NEPHRITIS  NOS WITH DIFFUSE CRESCENTIC GLOMERULONEPHRITIS, EXTRACAPILLARY GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N05.8|UNSPECIFIED NEPHRITIC SYNDROME INCLUDING GLOMERULAR DISEASE, GLOMERULONEPHRITIS, NEPHRITIS  NOS WITH OTHER (PROLIFERATIVE GLOMERULONEPHRITIS NOS)|13,000.00|9,100.00|3,900.00
N05.9|UNSPECIFIED NEPHRITIC SYNDROME INCLUDING GLOMERULAR DISEASE, GLOMERULONEPHRITIS, NEPHRITIS  NOS WITH UNSPECIFIED RENAL BIOPSY|13,000.00|9,100.00|3,900.00
N06.0|ISOLATED PROTEINURIA WITH SPECIFIED MORPHOLOGICAL LESION WITH MORPHOLOGICAL LESION SPECIFIED WITH  MINOR GLOMERULAR ABNORMALITY|13,000.00|9,100.00|3,900.00
N06.8|ISOLATED PROTEINURIA WITH SPECIFIED MORPHOLOGICAL LESION WITH OTHER (PROLIFERATIVE GLOMERULONEPHRITIS NOS)|13,000.00|9,100.00|3,900.00
N06.9|ISOLATED PROTEINURIA WITH SPECIFIED MORPHOLOGICAL LESION WITH UNSPECIFIED RENAL BIOPSY|13,000.00|9,100.00|3,900.00
N07.0|HEREDITARY NEPHROPATHY, NOT ELSEWHERE CLASSIFIED WITH MINOR GLOMERULAR ABNORMALITY|13,000.00|9,100.00|3,900.00
N07.1|HEREDITARY NEPHROPATHY, NOT ELSEWHERE CLASSIFIED WITH FOCAL AND SEGMENTAL GLOMERULAR LESIONS (WITH FOCAL AND SEGMENTAL HYALINOSIS; FOCAL AND SEGMENTAL SCLEROSIS) & FOCAL GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N07.2|HEREDITARY NEPHROPATHY, NOT ELSEWHERE CLASSIFIED WITH DIFFUSE MEMBRANOUS GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N07.3|HEREDITARY NEPHROPATHY, NOT ELSEWHERE CLASSIFIED WITH DIFFUSE MESANGIAL PROLIFERATIVE GLOMERULONEPHRITIS|13,000.00|9,100.00|3,900.00
N07.5|HEREDITARY NEPHROPATHY, NOT ELSEWHERE CLASSIFIED WITH DIFFUSE MESANGIOCAPILLARY GLOMERULONEPHRITIS, MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS, TYPES 1 AND 3, OR NOS|13,000.00|9,100.00|3,900.00
N07.9|HEREDITARY NEPHROPATHY, NOT ELSEWHERE CLASSIFIED WITH UNSPECIFIED RENAL BIOPSY|13,000.00|9,100.00|3,900.00
N10|ACUTE TUBULO-INTERSTITIAL NEPHRITIS; PYELONEPHRITIS; ACUTE INFECTIOUS INTERSTITIAL NEPHRITIS; ACUTE PYELITIS; ACUTE PYELONEPHRITIS|13,000.00|9,100.00|3,900.00
N11.0|NONOBSTRUCTIVE REFLUX-ASSOCIATED CHRONIC PYELONEPHRITIS; CHRONIC PYELONEPHRITIS ASSOCIATED WITH VESICOURETERAL REFLUX|14,170.00|9,919.00|4,251.00
N11.1|CHRONIC OBSTRUCTIVE PYELONEPHRITIS; CHRONIC PYELONEPHRITIS ASSOCIATED WITH ANOMALY OF [PELVIURETERIC JUNCTION, PYELOURETERIC JUNCTION, URETER]; CHRONIC PYELONEPHRITIS ASSOCIATED WITH KINKING OF [PELVIURETERIC JUNCTION, PYELOURETERIC JUNCTION, URETER]; CHR|14,170.00|9,919.00|4,251.00
N11.8|OTHER CHRONIC TUBULO-INTERSTITIAL NEPHRITIS; NONOBSTRUCTIVE CHRONIC PYELONEPHRITIS NOS|14,170.00|9,919.00|4,251.00
N11.9|CHRONIC TUBULO-INTERSTITIAL NEPHRITIS, UNSPECIFIED; CHRONIC INTERSTITIAL NEPHRITIS NOS; CHRONIC PYELITIS NOS; CHRONIC PYELONEPHRITIS NOS|13,000.00|9,100.00|3,900.00
N12|TUBULO-INTERSTITIAL NEPHRITIS, NOT SPECIFIED AS ACUTE OR CHRONIC; INTERSTITIAL NEPHRITIS NOS; PYELITIS NOS; PYELONEPHRITIS NOS|13,000.00|9,100.00|3,900.00
N13.0|HYDRONEPHROSIS WITH URETEROPELVIC JUNCTION OBSTRUCTION|12,610.00|8,827.00|3,783.00
N13.1|HYDRONEPHROSIS WITH URETERAL STRICTURE, NOT ELSEWHERE CLASSIFIED|12,610.00|8,827.00|3,783.00
N13.2|HYDRONEPHROSIS WITH RENAL AND URETERAL CALCULOUS OBSTRUCTION|12,610.00|8,827.00|3,783.00
N13.3|OTHER AND UNSPECIFIED HYDRONEPHROSIS|12,610.00|8,827.00|3,783.00
N13.4|HYDROURETER|12,610.00|8,827.00|3,783.00
N13.5|KINKING AND STRICTURE OF URETER WITHOUT HYDRONEPHROSIS|12,610.00|8,827.00|3,783.00
N13.6|PYONEPHROSIS; CONDITIONS IN N13.0-N13.5 WITH INFECTION; OBSTRUCTIVE UROPATHY WITH INFECTION|12,610.00|8,827.00|3,783.00
N13.7|VESICOURETERAL-REFLUX-ASSOCIATED UROPATHY; VESICOURETERAL REFLUX NOS; VESICOURETERAL REFLUX WITH SCARRING|12,610.00|8,827.00|3,783.00
N13.8|OTHER OBSTRUCTIVE AND REFLUX UROPATHY|12,610.00|8,827.00|3,783.00
N13.9|OBSTRUCTIVE AND REFLUX UROPATHY, UNSPECIFIED; URINARY TRACT OBSTRUCTION NOS|12,610.00|8,827.00|3,783.00
N14.0|ANALGESIC NEPHROPATHY|13,000.00|9,100.00|3,900.00
N14.1|NEPHROPATHY INDUCED BY OTHER DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES|13,000.00|9,100.00|3,900.00
N14.2|NEPHROPATHY INDUCED BY UNSPECIFIED DRUG, MEDICAMENT OR BIOLOGICAL SUBSTANCE|13,000.00|9,100.00|3,900.00
N14.4|TOXIC NEPHROPATHY, NOT ELSEWHERE CLASSIFIED|13,000.00|9,100.00|3,900.00
N15.0|BALKAN NEPHROPATHY; BALKAN ENDEMIC NEPHROPATHY|13,000.00|9,100.00|3,900.00
N15.1|RENAL AND PERINEPHRIC ABSCESS|18,070.00|12,649.00|5,421.00
N15.8|OTHER SPECIFIED RENAL TUBULO-INTERSTITIAL DISEASES|13,000.00|9,100.00|3,900.00
N15.9|RENAL TUBULO-INTERSTITIAL DISEASE, UNSPECIFIED; INFECTION OF KIDNEY NOS|13,000.00|9,100.00|3,900.00
N17.0|ACUTE RENAL FAILURE WITH TUBULAR NECROSIS; TUBULAR NECROSIS NOS; ACUTE TUBULAR NECROSIS ; RENAL TUBULAR NECROSIS|25,090.00|17,563.00|7,527.00
N17.1|ACUTE RENAL FAILURE WITH ACUTE CORTICAL NECROSIS; CORTICAL NECROSIS NOS; ACUTE CORTICAL NECROSIS ; RENAL CORTICAL NECROSIS|25,090.00|17,563.00|7,527.00
N17.2|ACUTE RENAL FAILURE WITH MEDULLARY NECROSIS; MEDULLARY PAPILLARY NECROSIS, NOS; ACUTE MEDULLARY PAPILLARY NECROSIS;  RENAL MEDULLARY PAPILLARY NECROSIS|25,090.00|17,563.00|7,527.00
N17.8|OTHER ACUTE RENAL FAILURE|25,090.00|17,563.00|7,527.00
N17.9|ACUTE RENAL FAILURE, UNSPECIFIED;|25,090.00|17,563.00|7,527.00
N18.5|CHRONIC KIDNEY DISEASE, STAGE 5; CHRONIC URAEMIA; END STAGE KIDNEY DISEASE: IN ALLOGRAFT FAILURE, NOS, ON DIALYSIS, WITHOUT DIALYSIS OR TRANSPLANT; RENAL RETINITIS+(H32.8*); URAEMIC:  APOPLEXIA+(I68.8*), DEMENTIA+(F02.8*), NEUROPATHY+(G63.8*), PARALYSIS+(G99.8*), PERICARDITIS+(I32.8*)|18,850.00|13,195.00|5,655.00
N18.9|CHRONIC KIDNEY DISEASE, UNSPECIFIED|18,850.00|13,195.00|5,655.00
N19|UNSPECIFIED KIDNEY FAILURE; RENAL INSUFFICIENCY NOS|18,850.00|13,195.00|5,655.00
N20.0|CALCULUS OF KIDNEY; NEPHROLITHIASIS NOS; RENAL CALCULUS OR STONE; STAGHORN CALCULUS; STONE IN KIDNEY|5,200.00|3,640.00|1,560.00
N20.1|CALCULUS OF URETER; URETERIC STONE|5,200.00|3,640.00|1,560.00
N20.2|CALCULUS OF KIDNEY WITH CALCULUS OF URETER|5,200.00|3,640.00|1,560.00
N20.9|URINARY CALCULUS, UNSPECIFIED; CALCULOUS PYELONEPHRITIS|5,200.00|3,640.00|1,560.00
N25.0|RENAL OSTEODYSTROPHY; AZOTAEMIC OSTEODYSTROPHY; PHOSPHATE-LOSING TUBULAR DISORDERS; RENAL RICKETS; RENAL SHORT STATURE|12,350.00|8,645.00|3,705.00
N25.1|NEPHROGENIC DIABETES INSIPIDUS|13,130.00|9,191.00|3,939.00
N25.8|OTHER DISORDERS RESULTING FROM IMPAIRED RENAL TUBULAR FUNCTION; LIGHTWOOD-ALBRIGHT SYNDROME; RENAL TUBULAR ACIDOSIS NOS; SECONDARY HYPERPARATHYROIDISM OF RENAL ORIGIN|12,350.00|8,645.00|3,705.00
N25.9|DISORDER RESULTING FROM IMPAIRED RENAL TUBULAR FUNCTION, UNSPECIFIED|12,350.00|8,645.00|3,705.00
N26|UNSPECIFIED CONTRACTED KIDNEY; ATROPHY OF KIDNEY (TERMINAL); RENAL SCLEROSIS NOS|14,690.00|10,283.00|4,407.00
N27.0|SMALL KIDNEY, UNILATERAL|14,690.00|10,283.00|4,407.00
N27.1|SMALL KIDNEY, BILATERAL|14,690.00|10,283.00|4,407.00
N27.9|SMALL KIDNEY, UNSPECIFIED|14,690.00|10,283.00|4,407.00
N28.0|ISCHAEMIA AND INFARCTION OF KIDNEY; EMBOLISM OF RENAL ARTERY; OBSTRUCTION OF RENAL ARTERY; OCCLUSION OF RENAL ARTERY; THROMBOSIS OF RENAL ARTERY; RENAL INFARCT|12,480.00|8,736.00|3,744.00
N28.1|CYST OF KIDNEY, ACQUIRED; MULTIPLE CYST OF KIDNEY, ACQUIRED; SOLITARY CYST OF KIDNEY, ACQUIRED|12,350.00|8,645.00|3,705.00
N28.8|OTHER SPECIFIED DISORDERS OF KIDNEY AND URETER; HYPERTROPHY OF KIDNEY, MEGALOURETER, NEPHROPTOSIS, PYELITIS CYSTICA, PYELOURETERITIS CYSTICA, URETERITIS CYSTICA, URETEROCELE|14,690.00|10,283.00|4,407.00
N28.9|DISORDER OF KIDNEY AND URETER, UNSPECIFIED; NEPHROPATHY NOS; RENAL DISEASE NOS|14,690.00|10,283.00|4,407.00
N29.8*|OTHER DISORDERS OF KIDNEY AND URETER IN OTHER DISEASES CLASSIFIED ELSEWHERE|14,690.00|10,283.00|4,407.00
N30.0|ACUTE CYSTITIS|9,750.00|6,825.00|2,925.00
N30.1|CHRONIC INTERSTITIAL CYSTITIS|9,750.00|6,825.00|2,925.00
N30.2|OTHER CHRONIC CYSTITIS|9,750.00|6,825.00|2,925.00
N30.3|TRIGONITIS; URETHROTRIGONITIS|9,750.00|6,825.00|2,925.00
N30.4|IRRADIATION CYSTITIS|5,200.00|3,640.00|1,560.00
N30.8|OTHER CYSTITIS; ABSCESS OF BLADDER|18,070.00|12,649.00|5,421.00
N30.9|CYSTITIS, UNSPECIFIED|9,750.00|6,825.00|2,925.00
N31.0|UNINHIBITED NEUROPATHIC BLADDER, NOT ELSEWHERE CLASSIFIED|11,700.00|8,190.00|3,510.00
N31.1|REFLEX NEUROPATHIC BLADDER, NOT ELSEWHERE CLASSIFIED|11,700.00|8,190.00|3,510.00
N31.2|FLACCID NEUROPATHIC BLADDER, NOT ELSEWHERE CLASSIFIED; ATONIC  MOTOR NEUROPATHIC BLADDER; SENSORY ATONIC  MOTOR NEUROPATHIC BLADDER; AUTONOMOUS NEUROPATHIC BLADDER ;  NONREFLEX NEUROPATHIC BLADDER|11,700.00|8,190.00|3,510.00
N31.8|OTHER NEUROMUSCULAR DYSFUNCTION OF BLADDER|11,700.00|8,190.00|3,510.00
N31.9|NEUROMUSCULAR DYSFUNCTION OF BLADDER, UNSPECIFIED; NEUROGENIC BLADDER DYSFUNCTION NOS|11,700.00|8,190.00|3,510.00
N32.9|BLADDER DISORDER, UNSPECIFIED|11,700.00|8,190.00|3,510.00
N34.0|URETHRAL ABSCESS; ABSCESS OF COWPER'S GLAND; ABSCESS OF LITTRé'S GLAND; PERIURETHRAL ABSCESS  ; ABSCESS OF URETHRAL GLAND|18,070.00|12,649.00|5,421.00
N39.0|URINARY TRACT INFECTION, SITE NOT SPECIFIED|9,750.00|6,825.00|2,925.00
N39.1|PERSISTENT PROTEINURIA, UNSPECIFIED|13,000.00|9,100.00|3,900.00
N39.2|ORTHOSTATIC PROTEINURIA, UNSPECIFIED|13,000.00|9,100.00|3,900.00
N39.3|STRESS INCONTINENCE|11,700.00|8,190.00|3,510.00
N39.4|OTHER SPECIFIED URINARY INCONTINENCE; OVERFLOW INCONTINENCE, REFLEX INCONTINENCE, URGE INCONTINENCE|11,700.00|8,190.00|3,510.00
N40|HYPERPLASIA OF PROSTATE; ADENOFIBROMATOUS HYPERTROPHY OF PROSTATE; ADENOMA (BENIGN)OF PROSTATE ; ENLARGEMENT  OF PROSTATE (BENIGN); FIBROADENOMA OF PROSTATE; FIBROMA OF PROSTATE; HYPERTROPHY OF PROSTATE (BENIGN); MYOMA OF PROSTATE; MEDIAN BAR (PROSTATE),|11,960.00|8,372.00|3,588.00
N41.0|ACUTE PROSTATITIS|11,960.00|8,372.00|3,588.00
N41.1|CHRONIC PROSTATITIS|11,960.00|8,372.00|3,588.00
N41.2|ABSCESS OF PROSTATE|11,960.00|8,372.00|3,588.00
N41.3|PROSTATOCYSTITIS|11,960.00|8,372.00|3,588.00
N41.8|OTHER INFLAMMATORY DISEASES OF PROSTATE|11,960.00|8,372.00|3,588.00
N41.9|INFLAMMATORY DISEASE OF PROSTATE, UNSPECIFIED; PROSTATITIS NOS|11,960.00|8,372.00|3,588.00
N42.0|CALCULUS OF PROSTATE; PROSTATIC STONE|11,960.00|8,372.00|3,588.00
N42.1|CONGESTION AND HAEMORRHAGE OF PROSTATE|11,960.00|8,372.00|3,588.00
N42.2|ATROPHY OF PROSTATE|11,960.00|8,372.00|3,588.00
N42.8|OTHER SPECIFIED DISORDERS OF PROSTATE|11,960.00|8,372.00|3,588.00
N42.9|DISORDER OF PROSTATE, UNSPECIFIED|11,960.00|8,372.00|3,588.00
N45.0|ORCHITIS, EPIDIDYMITIS AND EPIDIDYMO-ORCHITIS WITH ABSCESS; ABSCESS OF EPIDIDYMIS OR TESTIS|10,270.00|7,189.00|3,081.00
N45.9|ORCHITIS, EPIDIDYMITIS AND EPIDIDYMO-ORCHITIS WITHOUT ABSCESS; EPIDIDYMITIS NOS; ORCHITIS NOS|10,270.00|7,189.00|3,081.00
N47|REDUNDANT PREPUCE, PHIMOSIS AND PARAPHIMOSIS; ADHERENT PREPUCE; TIGHT FORESKIN|8,320.00|5,824.00|2,496.00
N48.0|LEUKOPLAKIA OF PENIS; BALANITIS XEROTICA OBLITERANS; KRAUROSIS OF PENIS|11,700.00|8,190.00|3,510.00
N48.1|BALANOPOSTHITIS; BALANITIS|11,700.00|8,190.00|3,510.00
N48.2|OTHER INFLAMMATORY DISORDERS OF PENIS; ABSCESS OF CORPUS CAVERNOSUM AND PENIS; BOIL OF CORPUS CAVERNOSUM AND PENIS; CARBUNCLE OF CORPUS CAVERNOSUM AND PENIS; CELLULITIS OF CORPUS CAVERNOSUM AND PENIS; CAVERNITIS (PENIS) OF CORPUS CAVERNOSUM AND PENIS|11,700.00|8,190.00|3,510.00
N48.5|ULCER OF PENIS|11,700.00|8,190.00|3,510.00
N48.6|INDURATIO PENIS PLASTICA; PEYRONIE'S DISEASE; PLASTIC INDURATION OF PENIS|11,700.00|8,190.00|3,510.00
N48.8|OTHER SPECIFIED DISORDERS OF PENIS; ATROPHYOF CORPUS CAVERNOSUM AND PENIS ; HYPERTROPHY OF CORPUS CAVERNOSUM AND PENIS ; THROMBOSIS OF CORPUS CAVERNOSUM AND PENIS|8,320.00|5,824.00|2,496.00
N49.0|INFLAMMATORY DISORDERS OF SEMINAL VESICLE; VESICULITIS NOS|11,700.00|8,190.00|3,510.00
N49.1|INFLAMMATORY DISORDERS OF SPERMATIC CORD, TUNICA VAGINALIS AND VAS DEFERENS; VASITIS|11,700.00|8,190.00|3,510.00
N49.2|INFLAMMATORY DISORDERS OF SCROTUM|11,700.00|8,190.00|3,510.00
N49.8|INFLAMMATORY DISORDERS OF OTHER SPECIFIED MALE GENITAL ORGANS; INFLAMMATION OF MULTIPLE SITES IN MALE GENITAL ORGANS|11,700.00|8,190.00|3,510.00
N49.9|INFLAMMATORY DISORDER OF UNSPECIFIED MALE GENITAL ORGAN; ABSCESS OF UNSPECIFIED MALE GENITAL ORGAN; BOIL OF UNSPECIFIED MALE GENITAL ORGAN; CARBUNCLE OF UNSPECIFIED MALE GENITAL ORGAN; CELLULITIS OF UNSPECIFIED MALE GENITAL ORGAN|11,700.00|8,190.00|3,510.00
N50.0|ATROPHY OF TESTIS|8,320.00|5,824.00|2,496.00
N50.1|VASCULAR DISORDERS OF MALE GENITAL ORGANS; HAEMATOCELE OF MALE GENITAL ORGANS NOS; HAEMORRHAGE OF MALE GENITAL ORGANS;, THROMBOSIS OF MALE GENITAL ORGANS|8,320.00|5,824.00|2,496.00
N50.8|OTHER SPECIFIED DISORDERS OF MALE GENITAL ORGANS; ATROPHY OF SCROTUM, SEMINAL VESICLE, SPERMATIC CORD, TESTIS [EXCEPT ATROPHY], TUNICA VAGINALIS AND VAS DEFERENS; HYPERTROPHY OF SCROTUM, SEMINAL VESICLE, SPERMATIC CORD, TESTIS [EXCEPT ATROPHY], TUNICA VAG|8,320.00|5,824.00|2,496.00
N61|INFLAMMATORY DISORDERS OF BREAST; ACUTE ABSCESS OF NON PUERPERAL AREOLA; ACUTE ABSCESS NONPUERPERAL BREAST; CHRONIC ABSCESS OF NONPUERPERAL  AREOLA; CHRONIC ABSCESS OF NONPUERPERAL  BREAST; CARBUNCLE OF BREAST;  ACUTE MASTITIS NONPUERPERAL, NOS; ACUTE INF|10,270.00|7,189.00|3,081.00
N70.0|ACUTE SALPINGITIS AND OOPHORITIS|11,700.00|8,190.00|3,510.00
N70.1|CHRONIC SALPINGITIS AND OOPHORITIS; HYDROSALPINX|11,700.00|8,190.00|3,510.00
N70.9|SALPINGITIS AND OOPHORITIS, UNSPECIFIED|11,700.00|8,190.00|3,510.00
N71.0|ACUTE INFLAMMATORY DISEASE OF UTERUS|11,700.00|8,190.00|3,510.00
N71.1|CHRONIC INFLAMMATORY DISEASE OF UTERUS|11,700.00|8,190.00|3,510.00
N71.9|INFLAMMATORY DISEASE OF UTERUS, UNSPECIFIED|11,700.00|8,190.00|3,510.00
N72|INFLAMMATORY DISEASE OF CERVIX UTERI; CERVICITIS WITH OR WITHOUT EROSION OR ECTROPION; ENDOCERVICITIS WITH OR WITHOUT EROSION OR ECTROPION; EXOCERVICITIS WITH OR WITHOUT EROSION OR ECTROPION|11,700.00|8,190.00|3,510.00
N73.0|ACUTE PARAMETRITIS AND PELVIC CELLULITIS; ACUTE ABCESS OF BROAD LIGAMENT; ACUTE ABSCESS OF PARAMETRIUM; ACUTE PELVIC CELLULITIS, FEMALE|11,700.00|8,190.00|3,510.00
N73.1|CHRONIC PARAMETRITIS AND PELVIC CELLULITIS|11,700.00|8,190.00|3,510.00
N73.2|UNSPECIFIED PARAMETRITIS AND PELVIC CELLULITIS|11,700.00|8,190.00|3,510.00
N73.3|FEMALE ACUTE PELVIC PERITONITIS|11,700.00|8,190.00|3,510.00
N73.4|FEMALE CHRONIC PELVIC PERITONITIS|11,700.00|8,190.00|3,510.00
N73.5|FEMALE PELVIC PERITONITIS, UNSPECIFIED|11,700.00|8,190.00|3,510.00
N73.6|FEMALE PELVIC PERITONEAL ADHESIONS|11,700.00|8,190.00|3,510.00
N73.8|OTHER SPECIFIED FEMALE PELVIC INFLAMMATORY DISEASES|11,700.00|8,190.00|3,510.00
N73.9|FEMALE PELVIC INFLAMMATORY DISEASE, UNSPECIFIED; FEMALE PELVIC INFECTION OR INFLAMMATION NOS|11,700.00|8,190.00|3,510.00
N74.8*|FEMALE PELVIC INFLAMMATORY DISORDERS IN OTHER DISEASES CLASSIFIED ELSEWHERE|11,700.00|8,190.00|3,510.00
N80.0|ENDOMETRIOSIS OF UTERUS; ADENOMYOSIS|10,010.00|7,007.00|3,003.00
N80.1|ENDOMETRIOSIS OF OVARY|10,010.00|7,007.00|3,003.00
N80.2|ENDOMETRIOSIS OF FALLOPIAN TUBE|10,010.00|7,007.00|3,003.00
N80.3|ENDOMETRIOSIS OF PELVIC PERITONEUM|10,010.00|7,007.00|3,003.00
N80.4|ENDOMETRIOSIS OF RECTOVAGINAL SEPTUM AND VAGINA|10,010.00|7,007.00|3,003.00
N80.5|ENDOMETRIOSIS OF INTESTINE|10,010.00|7,007.00|3,003.00
N80.8|OTHER ENDOMETRIOSIS|10,010.00|7,007.00|3,003.00
N80.9|ENDOMETRIOSIS, UNSPECIFIED|10,010.00|7,007.00|3,003.00
N82.0|VESICOVAGINAL FISTULA|10,140.00|7,098.00|3,042.00
N83.0|FOLLICULAR CYST OF OVARY; CYST OF GRAAFIAN FOLLICLE; HAEMORRHAGIC FOLLICULAR CYST OF OVARY|10,140.00|7,098.00|3,042.00
N83.1|CORPUS LUTEUM CYST; HAEMORRHAGIC CORPUS LUTEUM CYST|10,140.00|7,098.00|3,042.00
N83.2|OTHER AND UNSPECIFIED OVARIAN CYSTS; RETENTION OF OVARY; SIMPLE CYST OF OVARY|10,270.00|7,189.00|3,081.00
N83.3|ACQUIRED ATROPHY OF OVARY AND FALLOPIAN TUBE|10,140.00|7,098.00|3,042.00
N83.6|HAEMATOSALPINX|10,140.00|7,098.00|3,042.00
N83.7|HAEMATOMA OF BROAD LIGAMENT|10,140.00|7,098.00|3,042.00
N83.8|OTHER NONINFLAMMATORY DISORDERS OF OVARY, FALLOPIAN TUBE AND BROAD LIGAMENT; BROAD LIGAMENT LACERATION SYNDROME [ALLEN-MASTERS]|11,050.00|7,735.00|3,315.00
N83.9|NONINFLAMMATORY DISORDER OF OVARY, FALLOPIAN TUBE AND BROAD LIGAMENT, UNSPECIFIED|11,050.00|7,735.00|3,315.00
N84.0|POLYP OF CORPUS UTERI; POLYP OF ENDOMETRIUM; POLYP OF UTERUS NOS|6,760.00|4,732.00|2,028.00
N84.1|POLYP OF CERVIX UTERI; MUCOUS POLYP OF CERVIX|6,760.00|4,732.00|2,028.00
N84.2|POLYP OF VAGINA|6,760.00|4,732.00|2,028.00
N84.3|POLYP OF VULVA; POLYP OF LABIA|6,760.00|4,732.00|2,028.00
N84.8|POLYP OF OTHER PARTS OF FEMALE GENITAL TRACT|6,760.00|4,732.00|2,028.00
N84.9|POLYP OF FEMALE GENITAL TRACT, UNSPECIFIED|6,760.00|4,732.00|2,028.00
N85.7|HAEMATOMETRA; HAEMATOSALPINX WITH HAEMATOMETRA|10,140.00|7,098.00|3,042.00
N85.8|OTHER SPECIFIED NONINFLAMMATORY DISORDERS OF UTERUS; ATROPHY OF UTERUS, ACQUIRED; FIBROSIS OF UTERUS NOS|11,050.00|7,735.00|3,315.00
N85.9|NONINFLAMMATORY DISORDER OF UTERUS, UNSPECIFIED; DISORDER OF UTERUS NOS|11,050.00|7,735.00|3,315.00
N89.7|HAEMATOCOLPOS; HAEMATOCOLPOS WITH HAEMATOMETRA OR HAEMATOSALPINX|10,140.00|7,098.00|3,042.00
N91.0|PRIMARY AMENORRHOEA; FAILURE TO START MENSTRUATION AT PUBERTY.|8,580.00|6,006.00|2,574.00
N91.1|SECONDARY AMENORRHOEA; ABSENCE OF MENSTRUATION IN A WOMAN WHO HAD PREVIOUSLY MENSTRUATED.|8,580.00|6,006.00|2,574.00
N91.2|AMENORRHOEA, UNSPECIFIED; ABSENCE OF MENSTRUATION NOS|8,580.00|6,006.00|2,574.00
N91.5|OLIGOMENORRHOEA, UNSPECIFIED; HYPOMENORRHOEA NOS|8,580.00|6,006.00|2,574.00
N92.0|EXCESSIVE AND FREQUENT MENSTRUATION WITH REGULAR CYCLE; HEAVY PERIODS NOS; MENORRHAGIA NOS; POLYMENORRHOEA|8,580.00|6,006.00|2,574.00
N92.1|EXCESSIVE AND FREQUENT MENSTRUATION WITH IRREGULAR CYCLE; IRREGULAR INTERMENSTRUAL BLEEDING; IRREGULAR, SHORTENED INTERVALS BETWEEN MENSTRUAL BLEEDING; MENOMETRORRHAGIA; METRORRHAGIA|8,580.00|6,006.00|2,574.00
N92.2|EXCESSIVE MENSTRUATION AT PUBERTY; EXCESSIVE BLEEDING ASSOCIATED WITH ONSET OF MENSTRUAL PERIODS; PUBERTAL MENORRHAGIA; PUBERTY BLEEDING|8,580.00|6,006.00|2,574.00
N92.3|OVULATION BLEEDING; REGULAR INTERMENSTRUAL BLEEDING|8,580.00|6,006.00|2,574.00
N92.4|EXCESSIVE BLEEDING IN THE PREMENOPAUSAL PERIOD; CLIMATERIC MENORRHAGIA OR METRORRHAGIA; MENOPAUSAL MENORRHAGIA OR METRORRHAGIA; PRECLIMATERIC MENORRHAGIA OR METRORRHAGIA; PREMENOPAUSAL MENORRHAGIA OR METRORRHAGIA|8,580.00|6,006.00|2,574.00
N92.5|OTHER SPECIFIED IRREGULAR MENSTRUATION|8,580.00|6,006.00|2,574.00
N92.6|IRREGULAR MENSTRUATION, UNSPECIFIED; IRREGULAR BLEEDING NOS; IRREGULAR PERIODS NOS|8,580.00|6,006.00|2,574.00
N93.0|POSTCOITAL AND CONTACT BLEEDING|8,580.00|6,006.00|2,574.00
N93.8|OTHER SPECIFIED ABNORMAL UTERINE AND VAGINAL BLEEDING; DYSFUNCTIONAL OR FUNCTIONAL UTERINE OR VAGINAL BLEEDING NOS|8,580.00|6,006.00|2,574.00
N93.9|ABNORMAL UTERINE AND VAGINAL BLEEDING, UNSPECIFIED|8,580.00|6,006.00|2,574.00
N94.0|MITTELSCHMERZ|6,240.00|4,368.00|1,872.00
N94.1|DYSPAREUNIA|6,240.00|4,368.00|1,872.00
N94.2|VAGINISMUS|6,240.00|4,368.00|1,872.00
N94.3|PREMENSTRUAL TENSION SYNDROME|6,240.00|4,368.00|1,872.00
N94.4|PRIMARY DYSMENORRHOEA|6,240.00|4,368.00|1,872.00
N94.5|SECONDARY DYSMENORRHOEA|6,240.00|4,368.00|1,872.00
N94.6|DYSMENORRHOEA, UNSPECIFIED|6,240.00|4,368.00|1,872.00
N94.8|OTHER SPECIFIED CONDITIONS ASSOCIATED WITH FEMALE GENITAL ORGANS AND MENSTRUAL CYCLE|8,580.00|6,006.00|2,574.00
N94.9|UNSPECIFIED CONDITION ASSOCIATED WITH FEMALE GENITAL ORGANS AND MENSTRUAL CYCLE|8,580.00|6,006.00|2,574.00
N95.0|POSTMENOPAUSAL BLEEDING|7,800.00|5,460.00|2,340.00
N99.0|POSTPROCEDURAL RENAL FAILURE|13,390.00|9,373.00|4,017.00
N99.1|POSTPROCEDURAL URETHRAL STRICTURE; POSTCATHETERIZATION URETHRAL STRICTURE|13,390.00|9,373.00|4,017.00
N99.4|POSTPROCEDURAL PELVIC PERITONEAL ADHESIONS|13,390.00|9,373.00|4,017.00
N99.8|OTHER POSTPROCEDURAL DISORDERS OF GENITOURINARY SYSTEM; RESIDUAL OVARY SYNDROME|13,390.00|9,373.00|4,017.00
N99.9|POSTPROCEDURAL DISORDER OF GENITOURINARY SYSTEM, UNSPECIFIED|13,390.00|9,373.00|4,017.00
O00.0|ABDOMINAL PREGNANCY|10,140.00|7,098.00|3,042.00
O00.1|TUBAL PREGNANCY; FALLOPIAN PREGNANCY; RUPTURE OF FALLOPIAN TUBE DUE TO PREGNANCY|10,140.00|7,098.00|3,042.00
O00.2|OVARIAN PREGNANCY|10,140.00|7,098.00|3,042.00
O00.8|OTHER ECTOPIC PREGNANCY; CERVICAL PREGNANCY; CORNUAL PREGNANCY; INTRALIGAMENTOUS PREGNANCY; MURAL PREGNANCY|10,140.00|7,098.00|3,042.00
O00.9|ECTOPIC PREGNANCY, UNSPECIFIED|10,140.00|7,098.00|3,042.00
O01.0|CLASSICAL HYDATIDIFORM MOLE; COMPLETE HYDATIDIFORM MOLE|8,580.00|6,006.00|2,574.00
O01.1|INCOMPLETE AND PARTIAL HYDATIDIFORM MOLE|8,580.00|6,006.00|2,574.00
O01.9|HYDATIDIFORM MOLE, UNSPECIFIED; TROPHOBLASTIC DISEASE NOS; VESICULAR MOLE NOS|8,580.00|6,006.00|2,574.00
O02.0|BLIGHTED OVUM AND NONHYDATIDIFORM MOLE; CARNEOUS MOLE; FLESHY MOLE; INTRAUTERINE MOLE NOS; PATHOLOGICAL OVUM|6,500.00|4,550.00|1,950.00
O02.1|MISSED ABORTION; EARLY FETAL DEATH WITH RETENTION OF DEAD FETUS|6,500.00|4,550.00|1,950.00
O02.8|OTHER SPECIFIED ABNORMAL PRODUCTS OF CONCEPTION|6,500.00|4,550.00|1,950.00
O02.9|ABNORMAL PRODUCT OF CONCEPTION, UNSPECIFIED|6,500.00|4,550.00|1,950.00
O03.0|SPONTANEOUS ABORTION, INCOMPLETE, COMPLICATED BY GENITAL TRACT AND PELVIC INFECTION WITH GENITAL TRACT AND PELVIC INFECTION FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; ENDOMETRITIS; OOPHORITIS; PARAMETRITIS; PELVIC PERITONITIS; SALPINGITIS; SALPIN|8,970.00|6,279.00|2,691.00
O03.1|SPONTANEOUS ABORTION, INCOMPLETE, COMPLICATED DELAYED OR EXCESSIVE HAEMORRHAGE WITH DELAYED OR EXCESSIVE HAEMORRHAGE FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; AFIBRINOGENAEMIA; DEFIBRINATION SYNDROME; INTRAVASCULAR COAGULATION|8,970.00|6,279.00|2,691.00
O03.2|SPONTANEOUS ABORTION, INCOMPLETE, COMPLICATED BY EMBOLISM WITH  EMBOLISM NOS OR AIR EMBOLISM OR AMNIOTIC FLUID EMBOLISM OR BLOOD-CLOT EMBOLISM OR PULMONARY EMBOLISM OR PYAEMIC EMBOLISM OR SEPTIC OR SEPTICOPYAEMIC EMBOLISM OR SOAP EMBOLISM|8,970.00|6,279.00|2,691.00
O03.3|SPONTANEOUS ABORTION, INCOMPLETE, WITH OTHER AND UNSPECIFIED COMPLICATIONS WITH SHOCK FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; CIRCULATORY COLLAPASE; POSTOPERATIVE SHOCK; RENAL FAILURE FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; OLIGURI|8,970.00|6,279.00|2,691.00
O03.4|SPONTANEOUS ABORTION, INCOMPLETE, WITHOUT COMPLICATION|6,500.00|4,550.00|1,950.00
O03.5|SPONTANEOUS ABORTION, COMPLETE, COMPLICATED BY GENITAL TRACT AND PELVIC INFECTION WITH GENITAL TRACT AND PELVIC INFECTION FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; ENDOMETRITIS; OOPHORITIS; PARAMETRITIS; PELVIC PERITONITIS; SALPINGITIS; SALPINGO|8,970.00|6,279.00|2,691.00
O03.6|SPONTANEOUS ABORTION, COMPLETE OR UNSPECIFIED, COMPLICATED DELAYED OR EXCESSIVE HAEMORRHAGE WITH DELAYED OR EXCESSIVE HAEMORRHAGE FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; AFIBRINOGENAEMIA; DEFIBRINATION SYNDROME; INTRAVASCULAR COAGULATION|8,970.00|6,279.00|2,691.00
O03.7|SPONTANEOUS ABORTION, COMPLETE OR UNSPECIFIED, WITH OTHER  COMPLICATED BY EMBOLISM WITH EMBOLISM FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; EMBOLISM NOS; AIR EMBOLISM; AMNIOTIC FLUID EMBOLISM; BLOOD-CLOT EMBOLISM; PULMONARY EMBOLISM; PYAEMIC EMBO|8,970.00|6,279.00|2,691.00
O03.8|SPONTANEOUS ABORTION, COMPLETE OR UNSPECIFIED, WITH OTHER AND UNSPECIFIED COMPLICATIONS WITH SHOCK FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; CIRCULATORY COLLAPASE; POSTOPERATIVE SHOCK; RENAL FAILURE FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREG|8,970.00|6,279.00|2,691.00
O03.9|SPONTANEOUS ABORTION, COMPLETE OR UNSPECIFIED, WITHOUT COMPLICATION|6,500.00|4,550.00|1,950.00
O05.0|OTHER ABORTION, INCOMPLETE, COMPLICATED BY GENITAL TRACT AND PELVIC INFECTION WITH ENDOMETRITIS AND/OR OOPHORITIS AND/OR PARAMETRITIS AND/OR PELVIC PERITONITIS AND/OR SALPINGITIS AND/OR SALPINGO-OOPHORITIS AND/OR SEPSIS AND/OR SEPTIC SHOCK AND/OR SEPTICAE|8,970.00|6,279.00|2,691.00
O05.1|OTHER ABORTION, INCOMPLETE, COMPLICATED DELAYED OR EXCESSIVE HAEMORRHAGE WITH DELAYED OR EXCESSIVE HAEMORRHAGE FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; AFIBRINOGENAEMIA; DEFIBRINATION SYNDROME; INTRAVASCULAR COAGULATION|8,970.00|6,279.00|2,691.00
O05.4|OTHER ABORTION, INCOMPLETE, WITHOUT COMPLICATION|6,500.00|4,550.00|1,950.00
O05.8|OTHER ABORTION, COMPLETE, WITH OTHER AND UNSPECIFIED COMPLICATIONS WITH  SHOCK FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; CIRCULATORY COLLAPASE; POSTOPERATIVE SHOCK; RENAL FAILURE FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; OLIGURIA ACUTE|8,970.00|6,279.00|2,691.00
O05.9|OTHER ABORTION, COMPLETE OR UNSPECIFIED, WITHOUT COMPLICATION|6,500.00|4,550.00|1,950.00
O06.0|UNSPECIFIED ABORTION OR INDUCED ABORTION NOS, INCOMPLETE, COMPLICATED BY GENITAL TRACT AND PELVIC INFECTION WITH  ENDOMETRITIS AND/OR OOPHORITIS AND/OR PARAMETRITIS AND/OR PELVIC PERITONITIS AND/OR SALPINGITIS AND/OR SALPINGO- OOPHORITIS AND/OR SEPSIS AND/|8,970.00|6,279.00|2,691.00
O06.1|UNSPECIFIED ABORTION OR INDUCED ABORTION NOS, INCOMPLETE, COMPLICATED DELAYED OR EXCESSIVE HAEMORRHAGE WITH  AFIBRINOGENAEMIA OR DEFIBRINATION SYNDROME OR INTRAVASCULAR COAGULATION|8,970.00|6,279.00|2,691.00
O06.2|UNSPECIFIED ABORTION OR INDUCED ABORTION NOS, INCOMPLETE, COMPLICATED BY EMBOLISM OR EMBOLISM NOS WITH  AIR EMBOLISM OR AMNIOTIC FLUID EMBOLISM OR BLOOD-CLOT EMBOLISM OR PULMONARY EMBOLISM OR PYAEMIC EMBOLISM OR SEPTIC OR SEPTICOPYAEMIC EMBOLISM OR SOAP E|8,970.00|6,279.00|2,691.00
O06.3|UNSPECIFIED ABORTION OR INDUCED ABORTION NOS, INCOMPLETE, WITH OTHER AND UNSPECIFIED COMPLICATIONS WITH  SHOCK FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; CIRCULATORY COLLAPASE; POSTOPERATIVE SHOCK; RENAL FAILURE FOLLOWING ABORTION AND ECTOPIC AND|8,970.00|6,279.00|2,691.00
O06.4|UNSPECIFIED ABORTION OR INDUCED ABORTION NOS, INCOMPLETE, WITHOUT COMPLICATION|6,500.00|4,550.00|1,950.00
O06.5|UNSPECIFIED ABORTION OR INDUCED ABORTION NOS, COMPLETE, OR UNSPECIFIED,  COMPLICATED BY GENITAL TRACT AND PELVIC INFECTION OR ENDOMETRITIS AND/OR OOPHORITIS AND/OR PARAMETRITIS AND/OR PELVIC PERITONITIS AND/OR SALPINGITIS AND/OR SALPINGO- OOPHORITIS AND/OR|8,970.00|6,279.00|2,691.00
O06.6|UNSPECIFIED ABORTION OR INDUCED ABORTION NOS, COMPLETE, COMPLICATED BY DELAYED OR EXCESSIVE HAEMORRHAGE OR AFIBRINOGENAEMIA OR DEFIBRINATION SYNDROME OR INTRAVASCULAR COAGULATION|8,970.00|6,279.00|2,691.00
O06.7|UNSPECIFIED ABORTION OR INDUCED ABORTION NOS, COMPLETE, COMPLICATED BY EMBOLISM OR EMBOLISM NOS OR AIR EMBOLISM OR AMNIOTIC FLUID EMBOLISM OR BLOOD-CLOT EMBOLISM OR PULMONARY EMBOLISM OR PYAEMIC EMBOLISM OR SEPTIC OR SEPTICOPYAEMIC EMBOLISM OR SOAP EMBOLI|8,970.00|6,279.00|2,691.00
O06.8|UNSPECIFIED ABORTION OR INDUCED ABORTION NOS, COMPLETE, WITH OTHER AND UNSPECIFIED COMPLICATIONS WITH  SHOCK FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; CIRCULATORY COLLAPASE; POSTOPERATIVE SHOCK; RENAL FAILURE FOLLOWING ABORTION AND ECTOPIC AND M|8,970.00|6,279.00|2,691.00
O06.9|UNSPECIFIED ABORTION OR INDUCED ABORTION NOS, COMPLETE OR UNSPECIFIED, WITHOUT COMPLICATION|6,500.00|4,550.00|1,950.00
O07.0|FAILED MEDICAL ABORTION, COMPLICATED BY GENITAL TRACT AND PELVIC INFECTION WITH ENDOMETRITIS; OOPHORITIS; PARAMETRITIS; PARAMETRITIS; PELVIC PERITONITIS; SALPINGITIS; SALPINGO-OOPHORITIS; SEPSIS; SEPTIC SHOCK; SEPTICAEMIA|6,500.00|4,550.00|1,950.00
O07.1|FAILED MEDICAL ABORTION COMPLICATED BY DELAYED OR EXCESSIVE HAEMORRHAGE; AFIBRINOGENAEMIA WITH DELAYED OR EXCESSIVE HAEMORRHAGE FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; AFIBRINOGENAEMIA; DEFIBRINATION SYNDROME; INTRAVASCULAR COAGULATION|8,970.00|6,279.00|2,691.00
O07.3|FAILED MEDICAL ABORTION WITH OTHER AND UNSPECIFIED COMPLICATIONS WITH SHOCK FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; CIRCULATORY COLLAPASE; POSTOPERATIVE SHOCK; RENAL FAILURE FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; OLIGURIA ACUTE RE|6,500.00|4,550.00|1,950.00
O07.4|FAILED MEDICAL ABORTION WITHOUT COMPLICATION; FAILED MEDICAL ABORTION NOS|6,500.00|4,550.00|1,950.00
O07.5|OTHER AND UNSPECIFIED FAILED ATTEMPTED ABORTION COMPLICATED BY GENITAL TRACT AND PELVIC INFECTION WITH  ENDOMETRITIS; OOPHORITIS; PARAMETRITIS; PELVIC PERITONITIS; SALPINGITIS; SALPINGO-OOPHORITIS; SEPSI; SEPTIC SHOCK; SEPTICAEMIA|8,970.00|6,279.00|2,691.00
O07.6|OTHER AND UNSPECIFIED FAILED ATTEMPTED ABORTION COMPLICATED BY DELAYED OR EXCESSIVE HAEMORRHAGE WITH DELAYED OR EXCESSIVE HAEMORRHAGE FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; AFIBRINOGENAEMIA; DEFIBRINATION SYNDROME; INTRAVASCULAR COAGULATION|8,970.00|6,279.00|2,691.00
O07.8|OTHER AND UNSPECIFIED FAILED ATTEMPTED ABORTION WITH OTHER AND UNSPECIFIED COMPLICATIONS WITH WITH  SHOCK FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; CIRCULATORY COLLAPASE; POSTOPERATIVE SHOCK; RENAL FAILURE FOLLOWING ABORTION AND ECTOPIC AND MOLA|6,500.00|4,550.00|1,950.00
O07.9|OTHER AND UNSPECIFIED FAILED ATTEMPTED ABORTION WITHOUT COMPLICATION; FAILED ATTEMPTED ABORTION NOS|6,500.00|4,550.00|1,950.00
O08.0|GENITAL TRACT AND PELVIC INFECTION FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; ENDOMETRITIS; OOPHORITIS; PARAMETRITIS; PELVIC PERITONITIS; SALPINGITIS; SALPINGO-OOPHORITIS; SEPSIS; SEPTIC SHOCK; SEPTICAEMIA|11,700.00|8,190.00|3,510.00
O08.1|DELAYED OR EXCESSIVE HAEMORRHAGE FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; AFIBRINOGENAEMIA; DEFIBRINATION SYNDROME; INTRAVASCULAR COAGULATION|9,100.00|6,370.00|2,730.00
O08.2|EMBOLISM FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; EMBOLISM NOS; AIR EMBOLISM; AMNIOTIC FLUID EMBOLISM; BLOOD-CLOT EMBOLISM; PULMONARY EMBOLISM; PYAEMIC EMBOLISM; SEPTIC OR SEPTICOPYAEMIC EMBOLISM; SOAP EMBOLISM|12,090.00|8,463.00|3,627.00
O08.3|SHOCK FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; CIRCULATORY COLLAPASE; POSTOPERATIVE SHOCK|8,970.00|6,279.00|2,691.00
O08.4|RENAL FAILURE FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; OLIGURIA ACUTE RENAL FAILURE; OLIGURIA RENAL SHUTDOWN; OLIGURIA RENAL TUBULAR NECROSIS; OLIGURIA URAEMIA|25,090.00|17,563.00|7,527.00
O08.5|METABOLIC DISORDERS FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY|12,090.00|8,463.00|3,627.00
O08.8|OTHER COMPLICATIONS FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY; CARDIAC ARREST; URINARY TRACT INFECTION|8,970.00|6,279.00|2,691.00
O08.9|COMPLICATION FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY, UNSPECIFIED|12,090.00|8,463.00|3,627.00
O10.0|PRE-EXISTING ESSENTIAL HYPERTENSION COMPLICATING PREGNANCY CHILD BIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O10.1|PRE-EXISTING HYPERTENSIVE HEART DISEASE COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O10.2|PRE-EXISTING HYPERTENSIVE RENAL DISEASE COMPLICATING PREGNANCY CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O10.3|PRE-EXISTING HYPERTENSIVE HEART AND RENAL DISEASE COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O10.4|PRE-EXISTING SECONDARY HYPERTENSION COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O10.9|UNSPECIFIED PRE-EXISTING HYPERTENSION COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O11|PRE-EXISTING HYPERTENSIVE DISORDER WITH SUPERIMPOSED PROTEINURIA|8,840.00|6,188.00|2,652.00
O12.1|GESTATIONAL PROTEINURIA|8,840.00|6,188.00|2,652.00
O12.2|GESTATIONAL OEDEMA WITH PROTEINURIA|8,840.00|6,188.00|2,652.00
O13|GESTATIONAL [PREGNANCY-INDUCED] HYPERTENSION WIHTOUT SIGNIFICANT PROTEINURIA; GESTATIONAL HYPERTENSION NOS; MILD PRE-ECLAMPSIA|8,840.00|6,188.00|2,652.00
O14.0|MODERATE PRE-ECLAMPSIA|8,840.00|6,188.00|2,652.00
O14.1|SEVERE PRE-ECLAMPSIA|8,840.00|6,188.00|2,652.00
O14.9|PRE-ECLAMPSIA, UNSPECIFIED|8,840.00|6,188.00|2,652.00
O15.0|ECLAMPSIA IN PREGNANCY|8,840.00|6,188.00|2,652.00
O15.1|ECLAMPSIA IN LABOUR|8,840.00|6,188.00|2,652.00
O15.2|ECLAMPSIA IN THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O15.9|ECLAMPSIA, UNSPECIFIED AS TO TIME PERIOD; ECLAMPSIA NOS|8,840.00|6,188.00|2,652.00
O16|UNSPECIFIED MATERNAL HYPERTENSION|8,840.00|6,188.00|2,652.00
O20.0|THREATENED ABORTION; HAEMORRHAGE SPECIFIED AS DUE TO THREATENED ABORTION|8,840.00|6,188.00|2,652.00
O20.8|OTHER HAEMORRHAGE IN EARLY PREGNANCY|8,840.00|6,188.00|2,652.00
O20.9|HAEMORRHAGE IN EARLY PREGNANCY, UNSPECIFIED|8,840.00|6,188.00|2,652.00
O21.0|MILD HYPEREMESIS GRAVIDARUM; HYPEREMESIS GRAVIDARUM, MILD OR UNSPECIFIED, STARTING BEFORE THE END OF THE 22ND WEEK OF GESTATION|8,840.00|6,188.00|2,652.00
O21.1|HYPEREMESIS GRAVIDARUM WITH METABOLIC DISTURBANCE; HYPEREMESIS GRAVIDARUM, STARTING BEFORE THE END OF THE 22ND WEEK OF GESTATION, WITH METABOLIC DISTURBANCE SUCH AS CARBOHYDRATE DEPLETION, DEHYDRATION, ELCTROLYTE IMBALANCE|8,840.00|6,188.00|2,652.00
O21.2|LATE VOMITING OF PREGNANCY; EXCESSIVE VOMITING STARTING AFTER 22 COMPLETED WEEKS OF GESTATION|8,840.00|6,188.00|2,652.00
O21.8|OTHER VOMITING COMPLICATING PREGNANCY; VOMITING DUE TO DISEASE CLASSIFIED ELSEWHERE, COMPLICATING PREGNANCY|8,840.00|6,188.00|2,652.00
O21.9|VOMITING OF PREGNANCY, UNSPECIFIED|8,840.00|6,188.00|2,652.00
O22.3|DEEP PHLEBOTHROMBOSIS IN PREGNANCY; DEEP-VEIN THROMBOSIS, ANTEPARTUM|8,840.00|6,188.00|2,652.00
O22.5|CEREBRAL VENOUS THROMBOSIS IN PREGNANCY; CEREBROVENOUS SINUS THROMBOSIS IN PREGNANCY|8,840.00|6,188.00|2,652.00
O22.9|VENOUS COMPLICATION IN PREGNANCY, UNSPECIFIED; GESTATIONAL PHLEBITIS NOS; GESTATIONAL PHLEBOPATHY NOS; GESTATIONAL THROMBOSIS NOS|8,840.00|6,188.00|2,652.00
O23.0|INFECTIONS OF KIDNEY IN PREGNANCY|8,840.00|6,188.00|2,652.00
O23.1|INFECTIONS OF BLADDER IN PREGNANCY|5,200.00|3,640.00|1,560.00
O23.2|INFECTIONS OF URETHRA IN PREGNANCY|5,200.00|3,640.00|1,560.00
O23.3|INFECTIONS OF OTHER PARTS OF URINARY TRACT IN PREGNANCY|8,840.00|6,188.00|2,652.00
O23.4|UNSPECIFIED INFECTION OF URINARY TRACT IN PREGNANCY|5,200.00|3,640.00|1,560.00
O23.5|INFECTIONS OF THE GENITAL TRACT IN PREGNANCY|5,200.00|3,640.00|1,560.00
O23.9|OTHER AND UNSPECIFIED GENITOURINARY TRACT INFECTION IN PREGNANCY; GENITOURINARY TRACT INFECTION IN PREGNANCY NOS|5,200.00|3,640.00|1,560.00
O24.0|PRE-EXISTING DIABETES MELLITUS, INSULIN-DEPENDENT|8,840.00|6,188.00|2,652.00
O24.1|PRE-EXISTING DIABETES MELLITUS, NON-INSULIN- DEPENDENT|8,840.00|6,188.00|2,652.00
O24.2|PRE-EXISTING MALNUTRITION-RELATED DIABETES MELLITUS|8,840.00|6,188.00|2,652.00
O24.3|PRE-EXISTING DIABETES MELLITUS, UNSPECIFIED|8,840.00|6,188.00|2,652.00
O24.4|DIABETES MELLITUS ARISING IN PREGNANCY; GESTATIONAL DIABETES MELLITUS NOS|8,840.00|6,188.00|2,652.00
O24.9|DIABETES MELLITUS IN PREGNANCY, UNSPECIFIED|8,840.00|6,188.00|2,652.00
O26.2|PREGNANCY CARE OF HABITUAL ABORTER|8,840.00|6,188.00|2,652.00
O26.3|RETAINED IN TRAUTERINE CONTRACEPTIVE DEVICE IN PREGNANCY|8,840.00|6,188.00|2,652.00
O26.4|HERPES GESTATIONIS|8,840.00|6,188.00|2,652.00
O26.5|MATERNAL HYPOTENSION SYNDROME; SUPINE HYPOTENSIVE SYNDROME|8,840.00|6,188.00|2,652.00
O26.6|LIVER DISORDERS IN PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O26.7|SUBLUXATION OF SYMPHYSIS (PUBIS) IN PREGNANCY CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O26.8|OTHER SPECIFIED PREGNANCY-RELATED CONDITIONS; EXHAUSTION AND FATIGUE PREGNANCY-RELATED; PERIPHERAL NEURITIS PREGNANCY-RELATED; RENAL DISEASE PREGNANCY-RELATED|8,840.00|6,188.00|2,652.00
O26.9|PREGNANCY-RELATEDCONDITION, UNSPECIFIED|8,840.00|6,188.00|2,652.00
O28.0|ABNORMAL HAEMATOLOGICAL FINDING ON ANTENATAL SCREENING OF MOTHER|8,840.00|6,188.00|2,652.00
O28.3|ABNORMAL ULTRASONIC FINDING ON ANTENATAL SCREENING OF MOTHER|8,840.00|6,188.00|2,652.00
O28.5|ABNORMAL CHROMOSOMAL AND GENETIC FINDING ON ANTENATAL SCREENING OF MOTHER|8,840.00|6,188.00|2,652.00
O28.8|OTHER ABNORMAL FINDINGS ON ANTENATAL SCREENING OF MOTHER|8,840.00|6,188.00|2,652.00
O28.9|ABNORMAL FINDING ON ANTENATAL SCREENING OF MOTHER, UNSPECIFIED|8,840.00|6,188.00|2,652.00
O29.8|OTHER COMPLICATIONS OF ANAESTHESIA DURING PREGNANCY|8,840.00|6,188.00|2,652.00
O30.0|TWIN PREGNANCY|8,840.00|6,188.00|2,652.00
O30.1|TRIPLET PREGNANCY|8,840.00|6,188.00|2,652.00
O30.8|OTHER MULTIPLE GESTATION|8,840.00|6,188.00|2,652.00
O30.9|MULTIPLE GESTATION, UNSPECIFIED; MULTIPLE PREGNANCY NOS|8,840.00|6,188.00|2,652.00
O31.0|PAPYRACEOUS FETUS; FETUS COMPRESSUS|8,840.00|6,188.00|2,652.00
O31.1|CONTINUING PREGNANCY AFTER ABORTION OF ONE FETUS OR MORE|8,840.00|6,188.00|2,652.00
O31.2|CONTINUING PREGNANCY AFTER INTRAUTERINE DEATH OF ONE FETUS OR MORE|8,840.00|6,188.00|2,652.00
O31.8|OTHER COMPLICATIONS SPECIFIC TO MULTIPLE GESTATION|8,840.00|6,188.00|2,652.00
O32.0|MATERNAL CARE FOR UNSTABLE LIE|8,840.00|6,188.00|2,652.00
O32.1|MATERNAL CARE FOR BREECH PRESENTATION|8,840.00|6,188.00|2,652.00
O32.2|MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE; OBLIQUE PRESENTATION; TRANSVERSE PRESENTATION|8,840.00|6,188.00|2,652.00
O32.3|MATERNAL CARE FOR FACE, BROW AND CHIN PRESENTATION|8,840.00|6,188.00|2,652.00
O32.4|MATERNAL CARE FOR HIGH HEAD AT TERM; FAILURE OF HEAD TO ENTER PELVIC BRIM|8,840.00|6,188.00|2,652.00
O32.5|MATERNAL CARE FOR MULTIPLE GESTATION WITH MALPRESENTATION OF ONE FETUS OR MORE|8,840.00|6,188.00|2,652.00
O32.6|MATERNAL CARE FOR COMPOUND PRESENTATION|8,840.00|6,188.00|2,652.00
O32.8|MATERNAL CARE FOR OTHER MALPRESENTATION OF FETUS|8,840.00|6,188.00|2,652.00
O32.9|MATERNAL CARE FOR MALPRESENTATION OF FETUS, UNSPECIFIED|8,840.00|6,188.00|2,652.00
O33.0|MATERNAL CARE FOR DISPROPORTION DUE TO DEFORMITY OF MATERNAL PELVIC BONES; PELVIC DEFORMITY CAUSING DISPROPORTION NOS|8,840.00|6,188.00|2,652.00
O33.1|MATERNAL CARE FOR DISPROPORTION DUE TO GENERALLY CONTRACTED PELVIS; CONTRACTED PELVIS NOS CAUSING DISPROPORTION|8,840.00|6,188.00|2,652.00
O33.2|MATERNAL CARE FOR DISPROPORTION DUE TO INLET CONTRACTION OF PELVIS; INLET CONTRACTION (PELVIS) CAUSING DISPROPORTION|8,840.00|6,188.00|2,652.00
O33.3|MATERNAL CARE FOR DISPROPORTION DUE TO OUTLET CONTRACTION OF PELVIS; MID-CAVITY CONTRACTION PELVIS CAUSING DISPROPORTION; OUTLET CONTRACTION PELVIS CAUSING DISPROPORTION|8,840.00|6,188.00|2,652.00
O33.4|MATERNAL CARE FOR DISPROPORTION OF MIXED MATERNAL AND FETAL ORIGIN|8,840.00|6,188.00|2,652.00
O33.5|MATERNAL CARE FOR DISPROPORTION DUE TO UNUSUALLY LARGE FETUS; DISPROPORTION OF FETAL ORIGIN WITH NORMALLY FORMED FETUS; FETAL DISPROPORTION NOS|8,840.00|6,188.00|2,652.00
O33.6|MATERNAL CARE FOR DISPROPORTION DUE TO HYDROCEPHALIC FETUS|8,840.00|6,188.00|2,652.00
O33.7|MATERNAL CARE FOR DISPROPORTION DUE TO OTHER FETAL DEFORMITIES; CONJOINED TWINS; FETAL ASCITES CAUSING DISPROPORTION; FETAL HYDROPS CAUSING DISPROPORTION; FETAL MEANINGOMYELOCELE CAUSING DISPROPORTION; FETAL TUMOUR CAUSING DISPROPORTION|8,840.00|6,188.00|2,652.00
O33.9|MATERNAL CARE FOR DISPROPORTION, UNSPECIFIED; CEPHALOPELVIC DISPROPORTION NOS; FETOPELVIC DISPROPORTION NOS|8,840.00|6,188.00|2,652.00
O34.0|MATERNAL CARE FOR CONGENITAL MALFORMATION OF UTERUS; MATERNAL CARE FOR DOUBLE UTERUS; MATERNAL CARE FOR UTERUS BICORNIS|8,840.00|6,188.00|2,652.00
O34.1|MATERNAL CARE FOR TUMOUR OF CORPUS UTERI; MATERNAL FOR POLYP OF CORPUS UTERI; MATERNAL CARE FOR UTERINE FIBROID|8,840.00|6,188.00|2,652.00
O34.2|MATERNAL CARE DUE TO UTERINE SCAR FROM PREVIOUS SURGERY; MATERNAL CARE FOR SCAR FROM PREVIOUS|8,840.00|6,188.00|2,652.00
O34.3|MATERNAL CARE FOR CERVICAL INCOMPETENCE; MATERNAL CARE FOR CERCLAGE WITH OR WITHOUT MENTION OF CERVICAL INCOMPETENCE; MATERNAL CARE FOR SHIRODKAR SUTURE WITH OR WITHOUT MENTION OF CERVICAL INCOMPETENCE|8,840.00|6,188.00|2,652.00
O34.4|MATERNAL CARE FOR OTHER ABNORMALITIES OF CERVIX; MATERNAL CARE FOR POLYP OF CERVIX; MATERNAL CARE FOR PREVIOUS SURGERY TO CERVIX; MATERNAL CARE FOR STRICTURE OR STENOSIS OF CERVIX; MATERNAL CARE FOR TUMOUR OF CERVIX|8,840.00|6,188.00|2,652.00
O34.5|MATERNAL CARE FOR OTHER ABNORMALITIES OF GRAVID UTERUS; MATERNAL CARE FOR INCARCERATIION OF GRAVID UTERUS; MATERNAL CARE FOR PROLAPSE OF GRAVID UTERUS; MATERNAL CARE FOR RETROVERSION OF GRAVID UTERUS|8,840.00|6,188.00|2,652.00
O34.6|MATERNAL CARE FOR ABNORMALITY OF VAGINA; MATERNAL CARE FOR PREVIOUS SURGERY TO VAGINA; MATERNAL CARE FOR SEPTATE VAGINA; MATERNAL CARE FOR ACQUIRED STENOSIS OF VAGINA; MATERNAL CARE FOR CONGENITAL STENOSIS OF VAGINA; MATERNAL CARE FOR TUMOUR OF VAGINA|8,840.00|6,188.00|2,652.00
O34.7|MATERNAL CARE FOR ABNORMALITY OF VULVA AND PERINEUM; MATERNAL CARE FOR FIBROSIS OF PERINEUM; MATERNAL CARE FOR PREVIOUS SURGERY TO PERINEUM OR VULVA; MATERNAL CARE FOR RIGID PERINEUM; MATERNAL CARE FOR TUMOUR OF VULVA|8,840.00|6,188.00|2,652.00
O34.8|MATERNAL CARE FOR OTHER ABNORMALITIES OF PELVIC ORGANS; MATERNAL CARE FOR CYSTOCELE; MATERNAL CARE FOR PREVIOUS PELVIC FLOOR REPAIR; MATERNAL CARE FOR PENDULOUS ABDOMEN; MATERNAL CARE FOR RECTOCELE; MATERNAL CARE FOR RIGID PELVIC FLOOR|8,840.00|6,188.00|2,652.00
O34.9|MATERNAL CARE FOR ABNORMALITY OF PELVIC ORGAN, UNSPECIFIED|8,840.00|6,188.00|2,652.00
O35.0|MATERNAL CARE FOR (SUSPECTED) CENTRAL NERVOUS SYSTEM MALFORMATION IN FETUS; MATERNAL CARE FOR SUSPECTED FETAL ANENCEPHALY; MATERNAL CARE FOR SUSPECTED FETAL SPINA BIFIDA|8,840.00|6,188.00|2,652.00
O35.2|MATERNAL CARE FOR (SUSPECTED) HEREDITARY DISEASE IN FETUS|8,840.00|6,188.00|2,652.00
O35.3|MATERNAL CARE FOR (SUSPECTED) DAMAGE TO FETUS FROM VIRAL DISEASE IN MOTHER; MATERNAL CARE FOR SUSPECTED DAMAGE TO FETUS FROM MATERNAL CYTOMEGALOVIRUS INFECTION; MATERNAL CARE FOR SUSPECTED DAMAGE TO FETUS FROM MATERNAL RUBELLA|8,840.00|6,188.00|2,652.00
O35.5|MATERNAL CARE FOR (SUSPECTED) DAMAGE TO FETUS BY DRUGS; MATERNAL CARE FOR SUSPECTED DAMAGE TO FETUS FROM DRUG ADDICTION|8,840.00|6,188.00|2,652.00
O35.8|MATERNAL CARE FOR OTHER (SUSPECTED) FETAL ABNORMALITY AND DAMAGE; MATERNAL CARE FOR SUSPECTED DAMAGE TO FETUS FROM MATERNAL LISTERIOSIS; MATERNAL CARE FOR SUSPECTED DAMAGE TO FETUS FROM MATERNAL TOXOPLASMOSIS|8,840.00|6,188.00|2,652.00
O35.9|MATERNAL CARE FOR (SUSPECTED) FETAL ABNORMALITY AND DAMAGE, UNSPECIFIED|8,840.00|6,188.00|2,652.00
O36.0|MATERNAL CARE FOR RHESUS ISOIMMUNIZATION; ANTI-D [RH] ANTIBODIES; RH INCOMPATIBILITY (WITH HYDROPS FETALIS)|8,840.00|6,188.00|2,652.00
O36.1|MATERNAL CARE FOR OTHER ISOIMMUNIZATION; ABO ISOIMMUNIZATION; ISOIMMUNIZATION NOS (WITH HYDROPS FETALIS)|8,840.00|6,188.00|2,652.00
O36.2|MATERNAL CARE FOR HYDROPS FETALIS; HYDROPS FETALIS NOS; HYDROPS FETALIS NOT ASSOCIATED WITH ISOIMMUNIZATION|8,840.00|6,188.00|2,652.00
O36.3|MATERNAL CARE FOR SIGNS OF FETAL HYPOXIA|8,840.00|6,188.00|2,652.00
O36.4|MATERNAL CARE FOR INTRAUTERINE DEATH|8,840.00|6,188.00|2,652.00
O36.5|MATERNAL CARE FOR POOR FETAL GROWTH; MATERNAL CARE FOR KNOWN OR SUSPECTED LIGHT-FOR-DATES; MATERNAL CARE FOR KNOWN OR SUSPECTED PLACENTAL INSUFFICIENCY; MATERNAL CARE FOR KNOWN OR SUSPECTED SMALL-FOR-DATES|8,840.00|6,188.00|2,652.00
O36.6|MATERNAL CARE FOR EXCESSIVE FETAL GROWTH; MATERNAL CARE FOR KNOWN OR SUSPECTED LARGE-FOR- DATES|8,840.00|6,188.00|2,652.00
O36.7|MATERNAL CARE FOR VIABLE FETUS IN ABDOMINAL PREGNANCY|10,140.00|7,098.00|3,042.00
O36.8|MATERNAL CARE FOR OTHER SPECIFIED FETAL PROBLEMS|8,840.00|6,188.00|2,652.00
O36.9|MATERNAL CARE FOR FETAL PROBLEM, UNSPECIFIED|8,840.00|6,188.00|2,652.00
O40|POLYHYDRAMNIOS; HYDRAMNIOS|8,840.00|6,188.00|2,652.00
O41.0|OLIGOHYDRAMNIOS; OLIGOHYDRAMNIOS WITHOUT MENTION OF RUPTURE OF MEMBRANE|8,840.00|6,188.00|2,652.00
O41.1|INFECTION OF AMNIOTIC SAC AND MEMBRANES; AMNIONITIS; CHORIOAMNIONITIS; MEMBRANITIS; PLACENTITIS|8,840.00|6,188.00|2,652.00
O41.8|OTHER SPECIFIED DISORDERS OF AMNIOTIC FLUID AND MEMBRANES|8,840.00|6,188.00|2,652.00
O41.9|DISORDER OF AMNIOTIC FLUID AND MEMBRANES, UNSPECIFIED; PREMATURE RUPTURE OF MEMBRANES|8,840.00|6,188.00|2,652.00
O42.0|PREMATURE RUPTURE OF MEMBRANES ON SET OF LABOUR WITHIN 24 HOURS|8,840.00|6,188.00|2,652.00
O42.1|PREMATURE RUPTURE OF MEMBRANES ON SET OF LABOUR AFTER 24 HOURS|8,840.00|6,188.00|2,652.00
O42.2|PREMATURE RUPTURE OF MEMBRANES, LABOUR DELAYED BY THERAPY|8,840.00|6,188.00|2,652.00
O42.9|PREMATURE RUPTURE OF MEMBRANES, UNSPECIFIED|8,840.00|6,188.00|2,652.00
O43.0|PLACENTAL TRANSFUSION SYNDROMES; FETOMATERNAL TRANSFUSION; MATERNOFETAL TRANSFUSION; TWIN-TO- TWIN TRANSFUSION|8,840.00|6,188.00|2,652.00
O43.1|MALFORMATION OF PLACENTA; ABNORMAL PLACENTA NOS; CIRCUMVALLATE PLACENTA|8,840.00|6,188.00|2,652.00
O43.8|OTHER PLACENTAL DISORDERS; PLACENTAL DYSFUNCTION; PLACENTAL INFARCTION|8,840.00|6,188.00|2,652.00
O43.9|PLACENTAL DISORDER, UNSPECIFIED|8,840.00|6,188.00|2,652.00
O44.0|PLACENTA PRAEVIA SPECIFIED AS WITHOUT HAEMORRHAGE; LOW IMPLANTATION OF PLACENTA, NOS OR WITH HAEMORRHAGE|8,840.00|6,188.00|2,652.00
O44.1|PLACENTA PRAEVIA WITH HAEMORRHAGE; LOW IMPLANTATION OF PLACENTA, NOS OR WITH HAEMORRHAGE; PLACENTA PRAEVIA, MARGINAL NOS OR WITH HAEMORRHAGE; PLACENTA PRAEVIA, PARTIAL NOS OR WITH HAEMORRHAGE; PLACENTA PRAEVIA, TOTAL NOS OR WITH HAEMORRHAGE|8,840.00|6,188.00|2,652.00
O45.0|PREMATURE SEPARATION OF PLACENTA WITH COAGULATION DEFECT; ABRUPTIO PLACENTAE WITH (EXCESSIVE) HAEMORRHAGE ASSOCIATED WITH AFIBRINOGENAEMIA;  ABRUPTIO PLACENTAE WITH (EXCESSIVE) HAEMORRHAGE ASSOCIATED WITH DISSEMINATED INTRAVASCULAR COAGULATION; ABRUPTIO|8,840.00|6,188.00|2,652.00
O45.8|OTHER PREMATURE SEPARATION OF PLACENTA|8,840.00|6,188.00|2,652.00
O45.9|PREMATURE SEPARATION OF PLACENTA, UNSPECIFIED; ABRUPTIO PLACENTA NOS|8,840.00|6,188.00|2,652.00
O46.0|ANTEPARTUM HAEMORRHAGE WITH COAGULATION DEFECT; ANTEPARTUM HAEMORRHAGE (EXCESSIVE) ASSOCIATED WITH AFIBRINOGENAEMIA; ANTEPARTUM HAEMORRHAGE (EXCESSIVE) ASSOCIATED WITH DISSEMINATED INTRAVASCULAR COAGULATION; ANTEPARTUM HAEMORRHAGE (EXCESSIVE) ASSOCIATED W|8,840.00|6,188.00|2,652.00
O46.8|OTHER ANTEPARTUM HAEMORRHAGE|8,840.00|6,188.00|2,652.00
O46.9|ANTEPARTUM HAEMORRHAGE, UNSPECIFIED|8,840.00|6,188.00|2,652.00
O47.0|FALSE LABOUR BEFORE 37 COMPLETED WEEKS OF GESTATION|8,840.00|6,188.00|2,652.00
O47.1|FALSE LABOUR AT OR AFTER 37 COMPLETED WEEKS OF GESTATION|8,840.00|6,188.00|2,652.00
O47.9|FALSE LABOUR, UNSPECIFIED|8,840.00|6,188.00|2,652.00
O48|PROLONGED PREGNANCY; POST-DATES; POST-TERM|8,840.00|6,188.00|2,652.00
O60.0|PRETERM LABOR, NOT RESULTING TO DELIVERY|8,840.00|6,188.00|2,652.00
O67.8|OTHER INTRAPARTUM HAEMORRHAGE; EXCESSIVE INTRAPARTUM HAEMORRHAGE|12,090.00|8,463.00|3,627.00
O71.0|RUPTURE OF UTERUS BEFORE ON SET OF LABOUR|12,090.00|8,463.00|3,627.00
O71.1|RUPTURE OF UTERUS DURING LABOUR; RUPTURE OF UTERUS NOT STATED AS OCCURING BEFORE ONSET OF LABOUR|12,090.00|8,463.00|3,627.00
O71.2|POST PARTUM INVERSION OF UTERUS|12,090.00|8,463.00|3,627.00
O71.3|OBSTETRIC LACERATION OF CERVIX; ANNULAR DETACHMENT OF CERVIX|12,090.00|8,463.00|3,627.00
O71.5|OTHER OBSTETRIC INJURY TO PELVIC ORGANS; OBSTETRIC INJURY TO BLADDER; OBSTETRIC INJURY TO URETHRA|12,090.00|8,463.00|3,627.00
O71.7|OBSTETRIC HAEMATOMA OF PELVIS; OBSTETRIC HAEMATOMA OF PERINEUM; OBSTETRIC HAEMATOMA OF VAGINA; OBSTETRIC HAEMATOMA OF VULVA|12,090.00|8,463.00|3,627.00
O71.8|OTHER SPECIFIED OBSTETRIC TRAUMA|12,090.00|8,463.00|3,627.00
O71.9|OBSTETRIC TRAUMA, UNSPECIFIED|12,090.00|8,463.00|3,627.00
O72.0|THIRD-STAGE HAEMORRHAGE; HAEMORRHAGE ASSOCIATED WITH RETAINED, TRAPPED OR ADHERENT PLACENTA; RETAINED PLACENTA NOS|9,100.00|6,370.00|2,730.00
O72.1|OTHER IMMEDIATE POSTPARTUM HAEMORRHAGE; HAEMORRHAGE FOLLOWING DELIVERY OF PLACENTA; POSTPARTUM ATOMIC HAEMORRHAGE NOS|9,100.00|6,370.00|2,730.00
O72.2|DELAYED AND SECONDARY POSTPARTUM HAEMORRHAGE; HAEMORRHAGE ASSOCIATED WITH RETAINED PORTIONS OF PLACENTA OR MEMBRANES; RETAINED PRODUCTS OF CONCEPCION NOS, FOLLOWING DELIVERY|9,100.00|6,370.00|2,730.00
O72.3|POSTPARTUM COAGULATION DEFECTS; AFIBRINOGENAEMIA POSTPARTUM; FIBRINOLYSIS POSTPARTUM|9,100.00|6,370.00|2,730.00
O73.0|RETAINED PLACENTA WITHOUT HAEMORRHAGE; PLACENTA ACCRETA WITHOUT HAEMORRHAGE|9,100.00|6,370.00|2,730.00
O73.1|RETAINED PORTIONS OF PLACENTA AND MEMBRANES WITHOUT HAEMORRHAGE; RETAINED PRODUCTS OF CONCEPTION FOLLOWING DELIVERY, WITHOUT HAEMORRHAGE|9,100.00|6,370.00|2,730.00
O74.0|ASPIRATION PNEUMONITIS DUE TO ANAESTHESIA DURING LABOUR AND DELIVERY; INHALATION OF STOMACH CONTENTS OR SECRETIONS NOS DUE TO ANAESTHESIA DURING LABOUR AND DELIVERY; MENDELSON'S SYNDROME DUE TO ANAESTHESIA DURING LABOUR AND DELIVERY|12,090.00|8,463.00|3,627.00
O74.2|CARDIAC COMPLICATIONS OF ANAESTHESIA DURING LABOUR AND DELIVERY; CARDIAC ARREST DUE TO ANAESTHESIA DURING LABOUR AND DELIVERY; CARDIAC FAILURE DUE TO ANAESTHESIA DURING LABOUR AND DELIVERY|12,090.00|8,463.00|3,627.00
O74.8|OTHER COMPLICATIONS OF ANAESTHESIA DURING LABOUR AND DELIVERY|12,090.00|8,463.00|3,627.00
O75.1|SHOCK DURING OR FOLLOWING LABOUR AND DELIVERY; OBSTETIC SHOCK|12,090.00|8,463.00|3,627.00
O75.8|OTHER SPECIFIED COMPLICATIONS OF LABOUR AND DELIVERY|12,090.00|8,463.00|3,627.00
O75.9|COMPLICATION OF LABOUR AND DELIVERY, UNSPECIFIED|12,090.00|8,463.00|3,627.00
O85|PUERPERAL SEPSIS; PUERPERAL ENDOMETRITIS; PUERPERAL  FEVER;  PUERPERAL  PERITONITIS; PUERPERAL  SEPTICAEMIA|13,780.00|9,646.00|4,134.00
O86.0|INFECTION OF OBSTETRIC SURGICAL WOUND; INFECTED CAESAREAN SECTION WOUND FOLLOWING DELIVERY; INFECTED PERINEAL REPAIR FOLLOWING DELIVERY|13,780.00|9,646.00|4,134.00
O86.1|OTHER INFECTION OF GENITAL TRACT FOLLOWING DELIVERY; CERVICITIS FOLLOWING DELIVERY; VAGINITIS FOLLOWING DELIVERY|13,780.00|9,646.00|4,134.00
O86.2|URINARY TRACT INFECTION FOLLOWING DELIVERY|13,780.00|9,646.00|4,134.00
O86.3|OTHER GENITOURINARY TRACT INFECTIONS FOLLOWING DELIVERY; PUERPERAL GENITOURINARY TRACT INFECTION NOS|13,780.00|9,646.00|4,134.00
O86.4|PYREXIA OF UNKNOWN ORIGIN FOLLOWING DELIVERY; PUERPERAL INFECTION NOS; PUERPERAL PYREXIA NOS|13,780.00|9,646.00|4,134.00
O86.8|OTHER SPECIFIED PUERPERA LINFECTIONS|13,780.00|9,646.00|4,134.00
O87.0|SUPERFICIAL THROMBOPHLEBITIS IN THE PUERPERIUM|13,780.00|9,646.00|4,134.00
O87.1|DEEP PHLEBOTHROMBOSIS IN THE PUERPERIUM; DEEP- VEIN THROMBOSIS, POSTPARTUM; PELVIC THROMBOPHLEBITIS, POSTPARTUM|13,780.00|9,646.00|4,134.00
O87.2|HAEMORRHOIDS IN THE PUERPERIUM|13,780.00|9,646.00|4,134.00
O87.8|OTHER VENOUS COMPLICATIONS IN THE PUERPERIUM; GENITAL VARICES IN THE PUERPERIUM|13,780.00|9,646.00|4,134.00
O87.9|VENOUS COMPLICATION IN THE PUERPERIUM, UNSPECIFIED; PUERPERAL PHLEBITIS NOS; PUERPERAL PHLEBOPATHY NOS; PUERPERAL THROMBOSIS NOS|12,090.00|8,463.00|3,627.00
O88.1|AMNIOTIC FLUID EMBOLISM|13,780.00|9,646.00|4,134.00
O88.2|OBSTETRIC BLOOD-CLOT EMBOLISM; OBSTETRIC PULMONARY EMBOLISM NOS; PUERPERAL PULMONARY EMBOLISM NOS|13,780.00|9,646.00|4,134.00
O89.0|PULMONARY COMPLICATIONS OF ANAESTHESIA DURING THE PUERPERIUM; ASPIRATION PNEUMONITIS DUE TO ANAESTHESIA DURING THE PUERPERIUM;  INHALATION OF STOMACH CONTENTS OR SECRETIONS NOS DUE TO ANAESTHESIA DURING THE PUERPERIUM MENDELSON'S SYNDROME  DUE TO ANAEST|13,780.00|9,646.00|4,134.00
O89.1|CARDIAC COMPLICATIONS OF ANAESTHESIA DURING THE PUERPERIUM; CARDIAC ARREST DUE TO ANAESTHESIA DURING THE PUERPERIUM; CARDIAC FAILURE DUE TO ANAESTHESIA DURING THE PUERPERIUM|13,780.00|9,646.00|4,134.00
O89.2|CENTRAL NERVOUS SYSTEM COMPLICATIONS OF ANAESTHESIA DURING THE PUERPERIUM; CEREBRAL ANOXIA DUE TO ANAESTHESIA DURING THE PUERPERIUM|13,780.00|9,646.00|4,134.00
O89.4|SPINAL AND EPIDURAL ANAESTHESIA-INDUCED HEADACHE DURING THE PUERPERIUM|13,780.00|9,646.00|4,134.00
O89.8|OTHER COMPLICATIONS OF ANAESTHESIA DURING THE PUERPERIUM|13,780.00|9,646.00|4,134.00
O89.9|COMPLICATION OF ANAESTHESIA DURING THE PUERPERIUM, UNSPECIFIED|13,780.00|9,646.00|4,134.00
O90.0|DISRUPTION OF CAESAREAN SECTION WOUND|13,780.00|9,646.00|4,134.00
O90.1|DISRUPTION OF PERINEAL OBSTETRIC WOUND; DISRUPTION OF WOUND OF EPISIOTOMY; DISRUPTION OF WOUND OF PERINEAL LACERATION; SECONDARY PERINEAL TEAR|13,780.00|9,646.00|4,134.00
O90.2|HAEMATOMA OF OBSTETRIC WOUND|13,780.00|9,646.00|4,134.00
O90.3|CARDIOMYOPATHY IN THE PUERPERIUM|13,780.00|9,646.00|4,134.00
O90.4|POSTPARTUM ACUTE RENAL FAILURE; HEPATORENAL SYNDROME FOLLOWING LABOUR AND DELIVERY|13,780.00|9,646.00|4,134.00
O90.5|POSTPARTUM THYROIDITIS|13,780.00|9,646.00|4,134.00
O90.8|OTHER COMPLICATIONS OF THE PUERPERIUM, NOT ELSEWHERE CLASSIFIED|13,780.00|9,646.00|4,134.00
O90.9|COMPLICATION OF THE PUERPERIUM, UNSPECIFIED|13,780.00|9,646.00|4,134.00
O91.0|INFECTION OF NIPPLE ASSOCIATED WITH CHILDBIRTH; GESTATIONAL ABSCESS OF NIPPLE; PUERPERAL ABSCESS OF NIPPLE|10,270.00|7,189.00|3,081.00
O91.1|ABSCESS OF BREAST ASSOCIATED WITH CHILDBIRTH; MAMMARY ABSCESS GESTATIONAL OR PUERPERAL; PURULENT MASTITIS GESTATIONAL OR PUERPERAL; SUBAREOLAR ABSCESS GESTATIONAL OR PUERPERAL|10,270.00|7,189.00|3,081.00
O91.2|NONPURULENT MASTITIS ASSOCIATED WITH CHILDBIRTH; LYMPHANGITIS OF BREAST GESTATIONAL OR PUERPERAL; MASTITIS NOS GESTATIONAL OR PUERPERAL; INTERSTITIAL MASTITIS GESTATIONAL OR PUERPERAL; PARENCHYMATOUS MASTITIS GESTATIONAL OR PUERPERAL|10,270.00|7,189.00|3,081.00
O92.0|RETRACTED NIPPLE ASSOCIATED WITH CHILDBIRTH|10,270.00|7,189.00|3,081.00
O92.1|CRACKED NIPPLE ASSOCIATED WITH CHILDBIRTH; FISSURE OF NIPPLE, GESTATIONAL OR PUERPERAL|10,270.00|7,189.00|3,081.00
O98.0|TUBERCULOSIS COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O98.1|SYPHILIS COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O98.2|GONORRHOEACOMPLICATINGPREGNANCYCHILDBIRTHAND THEPUERPERIUM|8,840.00|6,188.00|2,652.00
O98.3|OTHER INFECTIONS WITH APREDOMINANTLY SEXUAL MODE OF TRANSMISSION COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O98.4|VIRAL HEPATITIS COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O98.5|OTHER VIRAL DISEASES COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O98.6|PROTOZOAL DISEASES COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O98.8|OTHER MATERNAL INFECTIOUS AND PARASITIC DISEASES COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O98.9|UNSPECIFIED MATERNAL INFECTIOUS OR PARASITIC DISEASE COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O99.0|ANAEMIA COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O99.1|OTHER DISEASES OF THE BLOOD AND BLOOD-FORMING ORGANS AND CERTAIN DISORDERS INVOLVING THE IMMUNE MECHANISM COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O99.2|ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O99.3|MENTAL DISORDERS AND DISEASES OF THE NERVOUS SYSTEM COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O99.4|DISEASES OF THE CIRCULATORY SYSTEM COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O99.5|DISEASES OF THE RESPIRATORY SYSTEM COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O99.6|DISEASES OF THE DIGESTIVE SYSTEM COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O99.7|DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
O99.8|OTHER SPECIFIED DISEASES AND CONDITIONS COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM|8,840.00|6,188.00|2,652.00
P00.0|FETUS AND NEWBORN AFFECTED BY MATERNAL HYPERTENSIVE DISORDERS|10,010.00|7,007.00|3,003.00
P00.1|FETUS AND NEWBORN AFFECTED BY MATERNAL RENAL AND URINARY TRACT DISEASES|10,010.00|7,007.00|3,003.00
P00.2|FETUS AND NEWBORN AFFECTED BY MATERNAL INFECTIOUS AND PARASITIC DISEASES|10,010.00|7,007.00|3,003.00
P00.3|FETUS AND NEWBORN AFFECTED BY OTHER MATERNAL CIRCULATORY AND RESPIRATORY DISEASES|10,010.00|7,007.00|3,003.00
P00.4|FETUS AND NEWBORN AFFECTED BY MATERNAL NUTRITIONAL DISORDERS|10,010.00|7,007.00|3,003.00
P00.5|FETUS AND NEWBORN AFFECTED BY MATERNAL INJURY|10,010.00|7,007.00|3,003.00
P00.6|FETUS AND NEWBORN AFFECTED BY SURGICAL PROCEDURE ON MOTHER|10,010.00|7,007.00|3,003.00
P00.7|FETUS AND NEWBORN AFFECTED BY OTHER MEDICAL PROCEDURES ON MOTHER, NOT ELSEWHERE CLASSIFIED|10,010.00|7,007.00|3,003.00
P00.8|FETUS AND NEWBORN AFFECTED BY OTHER MATERNAL CONDITIONS|10,010.00|7,007.00|3,003.00
P00.9|FETUS AND NEWBORN AFFECTED BY UNSPECIFIED MATERNAL CONDITION|10,010.00|7,007.00|3,003.00
P01.0|FETUS AND NEWBORN AFFECTED BY INCOMPETENT CERVIX|10,010.00|7,007.00|3,003.00
P01.1|FETUS AND NEWBORN AFFECTED BY PREMATURE RUPTURE OF MEMBRANES|10,010.00|7,007.00|3,003.00
P01.2|FETUS AND NEWBORN AFFECTED BY OLIGOHYDRAMNIOS|10,010.00|7,007.00|3,003.00
P01.3|FETUS AND NEWBORN AFFECTED BY POLYHYDRAMNIOS; HYDRAMNIOS|10,010.00|7,007.00|3,003.00
P01.4|FETUS AND NEWBORN AFFECTED BY ECTOPIC PREGNANCY; ABDOMINAL PREGNANCY|10,010.00|7,007.00|3,003.00
P01.5|FETUS AND NEWBORN AFFECTED BY MULTIPLE PREGNANCY; TRIPLET PREGNANCE; TWIN PREGNANCY|10,010.00|7,007.00|3,003.00
P01.6|FETUS AND NEWBORN AFFECTED BY MATERNAL DEATH|10,010.00|7,007.00|3,003.00
P01.7|FETUS AND NEWBORN AFFECTED BY MALPRESENTATION BEFORE LABOUR; BREECH PRESENTATION BEFORE LABOR; EXTERNAL VERSION BEFORE LABOUR; FACE PRESENTATION BEFORE LABOUR; TRANSVERSE LIE BEFORE LABOUR; UNSTABLE LIE BEFORE LABOUR|10,010.00|7,007.00|3,003.00
P01.8|FETUS AND NEWBORN AFFECTED BY OTHER MATERNAL COMPLICATIONS OF PREGNANCY; SPONTANEOUS ABORTION, FETUS|10,010.00|7,007.00|3,003.00
P01.9|FETUS AND NEWBORN AFFECTED BY MATERNAL COMPLICATION OF PREGNANCY, UNSPECIFIED|10,010.00|7,007.00|3,003.00
P02.0|FETUS AND NEWBORN AFFECTED BY PLACENTA PRAEVIA|10,010.00|7,007.00|3,003.00
P02.1|FETUS AND NEWBORN AFFECTED BY OTHER FORMS OF PLACENTAL SEPARATION AND HAEMORRHAGE; ABRUPTIO PLACENTAE; ACCIDENTAL HAEMORRHAGE; ANTEPARTUM HAEMORRHAGE; DAMAGE TO PLACENTA FROM AMNIOCENTESIS, CAESARIAN SECTION OR SURGICAL INDUCTION; MATERNAL BLOOD LOSS; PRE|10,010.00|7,007.00|3,003.00
P02.2|FETUS AND NEWBORN AFFECTED BY OTHER AND UNSPECIFIED MORPHOLOGICAL AND FUNCTIONAL ABNORMALITIES OF PLACENTA; PLACENTAL DYSFUNCTION; PLACENTAL INFARCTION; PLACENTAL INSUFFICIENCY|10,010.00|7,007.00|3,003.00
P02.3|FETUS AND NEWBORN AFFECTED BY PLACENTAL TRANSFUSION SYNDROMES; PLACENTAL AND CORD ABNORMALITIES RESULTING IN TWIN-TO-TWIN OR OTHER TRANSPLACENTAL TRANSFUSION|10,010.00|7,007.00|3,003.00
P02.4|FETUS AND NEWBORN AFFECTED BY PROLAPSED CORD|10,010.00|7,007.00|3,003.00
P02.5|FETUS AND NEWBORN AFFECTED BY OTHER COMPRESSION OF UMBILICAL CORD; CORD (TIGHTLY) AROUND NECK; ENTANGLEMENT OF CORD; KNOT IN CORD|10,010.00|7,007.00|3,003.00
P02.6|FETUS AND NEWBORN AFFECTED BY OTHER AND UNSPECIFIED CONDITIONS OF UMBILICAL CORD; SHORT CORD; VASA PRAEVIA|10,010.00|7,007.00|3,003.00
P02.7|FETUS AND NEWBORN AFFECTED BY CHORIOAMNIONITIS; AMNIONITIS; MEMBRANITIS; PLACENTITIS|10,010.00|7,007.00|3,003.00
P02.8|FETUS AND NEWBORN AFFECTED BY OTHER ABNORMALITIES OF MEMBRANES|10,010.00|7,007.00|3,003.00
P02.9|FETUS AND NEWBORN AFFECTED BY ABNORMALITY OF MEMBRANES, UNSPECIFIED|10,010.00|7,007.00|3,003.00
P03.0|FETUS AND NEWBORN AFFECTED BY BREECH DELIVERY AND EXTRACTION|10,010.00|7,007.00|3,003.00
P03.1|FETUS AND NEWBORN AFFECTED BY OTHER MALPRESENTATION, MALPOSITION AND DISPROPORTION DURING LABOUR AND DELIVERY; CONTRACTED PELVIS; PERSISTENT OCCIPITOPOSTERIOR; TRANSVERSE LIE|10,010.00|7,007.00|3,003.00
P03.2|FETUS AND NEWBORN AFFECTED BY FORCEPS DELIVERY|10,010.00|7,007.00|3,003.00
P03.3|FETUS AND NEWBORN AFFECTED BY DELIVERY BY VACUUM EXTRACTOR [VENTOUSE]|10,010.00|7,007.00|3,003.00
P03.4|FETUS AND NEWBORN AFFECTED BY CAESAREAN DELIVERY|10,010.00|7,007.00|3,003.00
P03.5|FETUS AND NEWBORN AFFECTED BY PRECIPITATE DELIVERY|10,010.00|7,007.00|3,003.00
P03.6|FETUS AND NEWBORN AFFECTED BY ABNORMAL UTERINE CONTRACTIONS|10,010.00|7,007.00|3,003.00
P03.8|FETUS AND NEWBORN AFFECTED BY OTHER SPECIFIED COMPLICATIONS OF LABOUR AND DELIVERY|10,010.00|7,007.00|3,003.00
P03.9|FETUS AND NEWBORN AFFECTED BY COMPLICATION OF LABOUR AND DELIVERY, UNSPECIFIED|10,010.00|7,007.00|3,003.00
P04.0|FETUS AND NEWBORN AFFECTED BY MATERNAL ANAESTHESIA AND ANALGESIA IN PREGNANCY, LABOUR AND DELIVERY|10,010.00|7,007.00|3,003.00
P04.1|FETUS AND NEWBORN AFFECTED BY OTHER MATERNAL MEDICATION; CANCER CHEMOTHERAPY; CYTOTOXIC DRUGS|10,010.00|7,007.00|3,003.00
P04.2|FETUS AND NEWBORN AFFECTED BY MATERNAL USE OF TOBACCO|10,010.00|7,007.00|3,003.00
P04.3|FETUS AND NEWBORN AFFECTED BY MATERNAL USE OF ALCOHOL|10,010.00|7,007.00|3,003.00
P04.5|FETUS AND NEWBORN AFFECTED BY MATERNAL USE OF NUTRITIONAL CHEMICAL SUBSTANCES|10,010.00|7,007.00|3,003.00
P04.8|FETUS AND NEWBORN AFFECTED BY OTHER MATERNAL NOXIOUS INFLUENCES|10,010.00|7,007.00|3,003.00
P05.0|LIGHT FOR GESTATIONAL AGE|21,970.00|15,379.00|6,591.00
P05.1|SMALL FOR GESTATIONAL AGE|21,970.00|15,379.00|6,591.00
P05.2|FETAL MALNUTRITION WITHOUT MENTION OF LIGHT OR SMALL FOR GESTATIONAL AGE|21,970.00|15,379.00|6,591.00
P05.9|SLOW FETAL GROWTH, UNSPECIFIED|21,970.00|15,379.00|6,591.00
P07.0|EXTREMELY LOW BIRTH WEIGHT; BIRTH WEIGHT 999 G OR LESS.|21,970.00|15,379.00|6,591.00
P07.1|OTHER LOW BIRTH WEIGHT; BIRTH WEIGHT 1000-2499 G.|21,970.00|15,379.00|6,591.00
P07.2|EXTREME IMMATURITY; LESS THAN 28 COMPLETED WEEKS (LESS THAN 196 COMPLETED DAYS) OF GESTATION.|21,970.00|15,379.00|6,591.00
P07.3|OTHER PRETERM INFANTS; 28 COMPLETED WEEKS OR MORE BUT LESS THAN 37 COMPLETED WEEKS (196 COMPLETED DAYS BUT LESS THAN 259 COMPLETED DAYS) OF GESTATION; PREMATURITY NOS|21,970.00|15,379.00|6,591.00
P08.0|EXCEPTIONALLY LARGE BABY; USUALLY IMPLIES A BIRTH WEIGHT OF 4500 G OR MORE.|9,100.00|6,370.00|2,730.00
P08.1|OTHER HEAVY FOR GESTATIONAL AGE INFANTS; OTHER FETUS OR INFANT HEAVY- OR LARGE-FOR-DATES REGARDLESS OF PERIOD OF GESTATION.|9,100.00|6,370.00|2,730.00
P08.2|POST-TERM INFANT, NOT HEAVY FOR GESTATIONAL AGE; FETUS OR INFANT WITH GESTATION PERIOD OF 42 COMPLETED WEEKS OR MORE (294 DAYS OR MORE), NOT HEAVY- OR LARGE-FOR-DATES; POSTMATURITY NOS|9,750.00|6,825.00|2,925.00
P10.0|SUBDURAL HAEMORRHAGE DUE TO BIRTH INJURY; SUBDURAL HAEMATOMA (LOCALIZED) DUE TO BIRTH INJURY|17,940.00|12,558.00|5,382.00
P10.1|CEREBRAL HAEMORRHAGE DUE TO BIRTH INJURY|17,940.00|12,558.00|5,382.00
P10.2|INTRAVENTRICULAR HAEMORRHAGE DUE TO BIRTH INJURY|17,940.00|12,558.00|5,382.00
P10.3|SUBARACHNOID HAEMORRHAGE DUE TO BIRTH INJURY|17,940.00|12,558.00|5,382.00
P10.4|TENTORIAL TEAR DUE TO BIRTH INJURY|17,940.00|12,558.00|5,382.00
P10.9|UNSPECIFIED INTRACRANIAL LACERATION AND HAEMORRHAGE DUE TO BIRTH INJURY|17,940.00|12,558.00|5,382.00
P11.1|OTHER SPECIFIED BRAIN DAMAGE DUE TO BIRTH INJURY|17,940.00|12,558.00|5,382.00
P11.2|UNSPECIFIED BRAIN DAMAGE DUE TO BIRTH INJURY|17,940.00|12,558.00|5,382.00
P11.9|BIRTH INJURY TO CENTRAL NERVOUS SYSTEM, UNSPECIFIED|17,940.00|12,558.00|5,382.00
P12.0|CEPHALHAEMATOMA DUE TO BIRTH INJURY|17,940.00|12,558.00|5,382.00
P12.3|BRUISING OF SCALP DUE TO BIRTH INJURY|17,940.00|12,558.00|5,382.00
P12.8|OTHER BIRTH INJURIES TO SCALP|17,940.00|12,558.00|5,382.00
P12.9|BIRTH INJURY TO SCALP, UNSPECIFIED|17,940.00|12,558.00|5,382.00
P13.2|BIRTH INJURY TO FEMUR|17,940.00|12,558.00|5,382.00
P13.4|FRACTURE OF CLAVICLE DUE TO BIRTH INJURY|17,940.00|12,558.00|5,382.00
P13.8|BIRTH INJURIES TO OTHER PARTS OF SKELETON|17,940.00|12,558.00|5,382.00
P13.9|BIRTH INJURY TO SKELETON, UNSPECIFIED|17,940.00|12,558.00|5,382.00
P14.0|ERB'S PARALYSIS DUE TO BIRTH INJURY|17,940.00|12,558.00|5,382.00
P14.3|OTHER BRACHIAL PLEXUS BIRTH INJURIES|17,940.00|12,558.00|5,382.00
P15.4|BIRTH INJURY TO FACE; FACIAL CONGESTION DUE TO BIRTH INJURY|17,940.00|12,558.00|5,382.00
P15.5|BIRTH INJURY TO EXTERNAL GENITALIA|17,940.00|12,558.00|5,382.00
P15.8|OTHER SPECIFIED BIRTH INJURIES|17,940.00|12,558.00|5,382.00
P15.9|BIRTH INJURY, UNSPECIFIED|17,940.00|12,558.00|5,382.00
P20.0|INTRAUTERINE HYPOXIA FIRST NOTED BEFORE ONSET OF LABOUR|14,170.00|9,919.00|4,251.00
P20.1|INTRAUTERINE HYPOXIA FIRST NOTED DURING LABOUR AND DELIVERY|14,170.00|9,919.00|4,251.00
P20.9|INTRAUTERINE HYPOXIA, UNSPECIFIED|14,170.00|9,919.00|4,251.00
P21.0|SEVERE BIRTH ASPHYXIA; PULSE LESS THAN 100 PER MINUTE AT BIRTH AND FALLING OR STEADY, RESPIRATION ABSENT OR GASPING, COLOUR POOR, TONE ABSENT; ASPHYXIA WITH 1-MINUTE APGAR SCORE 0-3; WHITE ASPHYXIA|14,170.00|9,919.00|4,251.00
P21.1|MILD AND MODERATE BIRTH ASPHYXIA; NORMAL RESPIRATION NOT ESTABLISHED WITHIN ONE MINUTE, BUT HEART RATE 100 OR ABOVE, SOME MUSCLE TONE PRESENT, SOME RESPONSE TO STIMULATION; ASPHYXIA WITH 1-MINUTE APGAR SCORE 4- 7; BLUE ASPHYXIA|14,170.00|9,919.00|4,251.00
P21.9|BIRTH ASPHYXIA, UNSPECIFIED; ANOXIA, NOS; ASPHYXIA, NOS; HYPOXIA, NOS|14,170.00|9,919.00|4,251.00
P22.0|RESPIRATORY DISTRESS SYNDROME OF NEWBORN; HYALINE MEMBRANE DISEASE|14,170.00|9,919.00|4,251.00
P22.1|TRANSIENT TACHYPNOEA OF NEWBORN|14,170.00|9,919.00|4,251.00
P22.8|OTHER RESPIRATORY DISTRESS OF NEWBORN|14,170.00|9,919.00|4,251.00
P22.9|RESPIRATORY DISTRESS OF NEWBORN, UNSPECIFIED|14,170.00|9,919.00|4,251.00
P23.0|CONGENITAL PNEUMONIA DUE TO VIRAL AGENT|16,510.00|11,557.00|4,953.00
P23.1|CONGENITAL PNEUMONIA DUE TO CHLAMYDIA|16,510.00|11,557.00|4,953.00
P23.2|CONGENITAL PNEUMONIA DUE TO STAPHYLOCOCCUS|16,510.00|11,557.00|4,953.00
P23.3|CONGENITAL PNEUMONIA DUE TO STREPTOCOCCUS, GROUP B|16,510.00|11,557.00|4,953.00
P23.4|CONGENITAL PNEUMONIA DUE TO ESCHERICHIA COLI|16,510.00|11,557.00|4,953.00
P23.5|CONGENITAL PNEUMONIA DUE TO PSEUDOMONAS|16,510.00|11,557.00|4,953.00
P23.6|CONGENITAL PNEUMONIA DUE TO OTHER BACTERIAL AGENTS; HAEMOPHILUS INFLUENZAE; KLEBSIELLA PNEUMONIA; MYCOPLASMA; STREPTOCOCCUS, EXCEPT GROUP B|16,510.00|11,557.00|4,953.00
P23.9|CONGENITAL PNEUMONIA|16,510.00|11,557.00|4,953.00
P24.0|NEONATAL ASPIRATION OF MECONIUM|14,170.00|9,919.00|4,251.00
P24.1|NEONATAL ASPIRATION OF AMNIOTIC FLUID AND MUCUS;ASPIRATION OF LIQUOR (AMNII)|14,170.00|9,919.00|4,251.00
P24.2|NEONATAL ASPIRATION OF BLOOD|14,170.00|9,919.00|4,251.00
P24.3|NEONATAL ASPIRATION OF MILK AND REGURGITATED FOOD|14,170.00|9,919.00|4,251.00
P24.8|OTHER NEONATAL ASPIRATION SYNDROMES|14,170.00|9,919.00|4,251.00
P24.9|NEONATAL ASPIRATION SYNDROME, UNSPECIFIED; NEONATAL ASPIRATION PNEUMONIA NOS|14,170.00|9,919.00|4,251.00
P25.0|INTERSTITIAL EMPHYSEMA ORIGINATING IN THE PERINATAL PERIOD|14,170.00|9,919.00|4,251.00
P25.1|PNEUMOTHORAX ORIGINATING IN THE PERINATAL PERIOD|14,170.00|9,919.00|4,251.00
P25.2|PNEUMOMEDIASTINUM ORIGINATING IN THE PERINATAL PERIOD|14,170.00|9,919.00|4,251.00
P25.8|OTHER CONDITIONS RELATED TO INTERSTITIAL EMPHYSEMA ORIGINATING IN THE PERINATAL PERIOD|14,170.00|9,919.00|4,251.00
P26.0|TRACHEOBRONCHIAL HAEMORRHAGE ORIGINATING IN THE PERINATAL PERIOD|14,170.00|9,919.00|4,251.00
P26.1|MASSIVE PULMONARY HAEMORRHAGE ORIGINATING IN THE PERINATAL PERIOD|14,170.00|9,919.00|4,251.00
P26.8|OTHER PULMONARY HAEMORRHAGES ORIGINATING IN THE PERINATAL PERIOD|14,170.00|9,919.00|4,251.00
P26.9|UNSPECIFIED PULMONARY HAEMORRHAGE ORIGINATING IN THE PERINATAL PERIOD|14,170.00|9,919.00|4,251.00
P27.0|WILSON-MIKITY SYNDROME; PULMONARY DYSMATURITY|14,170.00|9,919.00|4,251.00
P27.1|BRONCHOPULMONARY DYSPLASIA ORIGINATING IN THE PERINATAL PERIOD|14,170.00|9,919.00|4,251.00
P27.8|OTHER CHRONIC RESPIRATORY DISEASES ORIGINATING IN THE PERINATAL PERIOD; CONGENITAL PULMONARY FIBROSIS; VENTILATOR LUNG IN NEWBORN|14,170.00|9,919.00|4,251.00
P27.9|UNSPECIFIED CHRONIC RESPIRATORY DISEASE ORIGINATING IN THE PERINATAL PERIOD|14,170.00|9,919.00|4,251.00
P28.0|PRIMARY ATELECTASIS OF NEWBORN; PRIMARY FAILURE TO EXPAND TERMINAL RESPIRATORY UNITS; PULMONARY HYPOPLASIA ASSOCIATED WITH SHORT GESTATION; PULMONARY IMMATURITY NOS|14,170.00|9,919.00|4,251.00
P28.1|OTHER AND UNSPECIFIED ATELECTASIS OF NEWBORN; ATELECTASIS, NOS; ATELECTASIS, PARTIAL; ATELECTASIS, SECONDARY; RESORPTION ATELECTASIS WITHOUT RESPIRATORY DISTRESS SYNDROME|14,170.00|9,919.00|4,251.00
P28.2|CYANOTIC ATTACKS OF NEWBORN|14,170.00|9,919.00|4,251.00
P28.3|PRIMARY SLEEP APNOEA OF NEWBORN; LEEP APNOEA OF NEWBORN NOS|14,170.00|9,919.00|4,251.00
P28.4|OTHER APNOEA OF NEWBORN|14,170.00|9,919.00|4,251.00
P28.5|RESPIRATORY FAILURE OF NEWBORN|14,170.00|9,919.00|4,251.00
P28.8|OTHER SPECIFIED RESPIRATORY CONDITIONS OF NEWBORN; CONGENITAL LARYNGEAL STRIDOR NOS; SNUFFLES IN NEWBORN|14,170.00|9,919.00|4,251.00
P29.0|NEONATAL CARDIAC FAILURE|29,510.00|20,657.00|8,853.00
P29.1|NEONATAL CARDIAC DYSRHYTHMIA|29,510.00|20,657.00|8,853.00
P29.2|NEONATAL HYPERTENSION|29,510.00|20,657.00|8,853.00
P29.3|PERSISTENT FETAL CIRCULATION; DELAYED CLOSURE OF DUCTUS ARTERIOSUS; PERSISTENT PULMONARY HYPERTENSION OF NEWBORN|14,170.00|9,919.00|4,251.00
P29.4|TRANSIENT MYOCARDIAL ISCHAEMIA OF NEWBORN|29,510.00|20,657.00|8,853.00
P29.8|OTHER CARDIOVASCULAR DISORDERS ORIGINATING IN THE PERINATAL PERIOD|29,510.00|20,657.00|8,853.00
P29.9|CARDIOVASCULAR DISORDER ORIGINATING IN THE PERINATAL PERIOD, UNSPECIFIED|14,170.00|9,919.00|4,251.00
P35.0|CONGENITAL RUBELLA SYNDROME; CONGENITAL RUBELLA PNEUMONITIS|16,510.00|11,557.00|4,953.00
P35.1|CONGENITAL CYTOMEGALOVIRUS INFECTION|16,510.00|11,557.00|4,953.00
P35.2|CONGENITAL HERPESVIRAL [HERPES SIMPLEX] INFECTION|16,510.00|11,557.00|4,953.00
P35.3|CONGENITAL VIRAL HEPATITIS|16,510.00|11,557.00|4,953.00
P35.8|OTHER CONGENITAL VIRAL DISEASES; CONGENITAL VARICELLA [CHICKENPOX]|16,510.00|11,557.00|4,953.00
P35.9|CONGENITAL VIRAL DISEASE, UNSPECIFIED|16,510.00|11,557.00|4,953.00
P36.0|SEPSIS OF NEWBORN DUE TO STREPTOCOCCUS, GROUP B|15,210.00|10,647.00|4,563.00
P36.1|SEPSIS OF NEWBORN DUE TO OTHER AND UNSPECIFIED STREPTOCOCCI|15,210.00|10,647.00|4,563.00
P36.2|SEPSIS OF NEWBORN DUE TO STAPHYLOCOCCUS AUREUS|15,210.00|10,647.00|4,563.00
P36.3|SEPSIS OF NEWBORN DUE TO OTHER AND UNSPECIFIED STAPHYLOCOCCI|15,210.00|10,647.00|4,563.00
P36.4|SEPSIS OF NEWBORN DUE TO ESCHERICHIA COLI|15,210.00|10,647.00|4,563.00
P36.5|SEPSIS OF NEWBORN DUE TO ANAEROBES|15,210.00|10,647.00|4,563.00
P36.8|OTHER BACTERIAL SEPSIS OF NEWBORN|15,210.00|10,647.00|4,563.00
P37.0|CONGENITAL TUBERCULOSIS|16,510.00|11,557.00|4,953.00
P37.1|CONGENITAL TOXOPLASMOSIS; HYDROCEPHALUS DUE TO CONGENITAL TOXOPLASMOSIS|16,510.00|11,557.00|4,953.00
P37.3|CONGENITAL FALCIPARUM MALARIA|16,510.00|11,557.00|4,953.00
P37.5|NEONATAL CANDIDIASIS|16,510.00|11,557.00|4,953.00
P37.8|OTHER SPECIFIED CONGENITAL INFECTIOUS AND PARASITIC DISEASES|16,510.00|11,557.00|4,953.00
P37.9|CONGENITAL INFECTIOUS AND PARASITIC DISEASE, UNSPECIFIED|16,510.00|11,557.00|4,953.00
P38|OMPHALITIS OF NEWBORN WITH OR WITHOUT MILD HAEMORRHAGE|16,510.00|11,557.00|4,953.00
P39.0|NEONATAL INFECTIVE MASTITIS|16,510.00|11,557.00|4,953.00
P39.1|NEONATAL CONJUNCTIVITIS AND DACRYOCYSTITIS; NEONATAL CHLAYDIAL CONJUNCTIVITIS; OPHTHALMIA NEONATORUM NOS|16,510.00|11,557.00|4,953.00
P39.2|INTRA-AMNIOTIC INFECTION OF FETUS, NOT ELSEWHERE CLASSIFIED|16,510.00|11,557.00|4,953.00
P39.3|NEONATAL URINARY TRACT INFECTION|16,510.00|11,557.00|4,953.00
P39.4|NEONATAL SKIN INFECTION; NEONATAL PYODERMA|16,510.00|11,557.00|4,953.00
P39.8|OTHER SPECIFIED INFECTIONS SPECIFIC TO THE PERINATAL PERIOD|16,510.00|11,557.00|4,953.00
P39.9|INFECTION SPECIFIC TO THE PERINATAL PERIOD, UNSPECIFIED|16,510.00|11,557.00|4,953.00
P50.0|FETAL BLOOD LOSS FROM VASA PRAEVIA|10,140.00|7,098.00|3,042.00
P50.1|FETAL BLOOD LOSS FROM RUPTURED CORD|10,140.00|7,098.00|3,042.00
P50.2|FETAL BLOOD LOSS FROM PLACENTA|10,140.00|7,098.00|3,042.00
P50.9|FETAL BLOOD LOSS, UNSPECIFIED; FETAL HAEMORRHAGE NOS|10,140.00|7,098.00|3,042.00
P51.9|UMBILICAL HAEMORRHAGE OF NEWBORN, UNSPECIFIED|10,140.00|7,098.00|3,042.00
P52.0|INTRAVENTRICULAR (NONTRAUMATIC) HAEMORRHAGE, GRADE 1, OF FETUS AND NEWBORN; SUBEPENDYMAL HAEMORRHAGE (WITHOUT INTRAVENTRICULAR EXTENSION)|33,280.00|23,296.00|9,984.00
P52.1|INTRAVENTRICULAR (NONTRAUMATIC) HAEMORRHAGE, GRADE 2, OF FETUS AND NEWBORN; SUBEPENDYMAL HAEMORRHAGE WITH INTRAVENTRICULAR EXTENSION|33,280.00|23,296.00|9,984.00
P52.3|UNSPECIFIED INTRAVENTRICULAR (NONTRAUMATIC) HAEMORRHAGE OF FETUS AND NEWBORN|33,280.00|23,296.00|9,984.00
P52.4|INTRACEREBRAL (NONTRAUMATIC) HAEMORRHAGE OF FETUS AND NEWBORN|33,280.00|23,296.00|9,984.00
P52.5|SUBARACHNOID (NONTRAUMATIC) HAEMORRHAGE OF FETUS AND NEWBORN|33,280.00|23,296.00|9,984.00
P52.6|CEREBELLAR (NONTRAUMATIC) AND POSTERIOR FOSSA HAEMORRHAGE OF FETUS AND NEWBORN|33,280.00|23,296.00|9,984.00
P52.8|OTHER INTRACRANIAL (NONTRAUMATIC) HAEMORRHAGES OF FETUS AND NEWBORN|33,280.00|23,296.00|9,984.00
P52.9|INTRACRANIAL (NONTRAUMATIC) HAEMORRHAGE OF FETUS AND NEWBORN, UNSPECIFIED|33,280.00|23,296.00|9,984.00
P53|HAEMORRHAGIC DISEASE OF FETUS AND NEWBORN; VITAMIN K DEFICIENCY OF NEWBORN|10,140.00|7,098.00|3,042.00
P54.0|NEONATAL HAEMATEMESIS|10,140.00|7,098.00|3,042.00
P54.2|NEONATAL RECTAL HAEMORRHAGE|10,140.00|7,098.00|3,042.00
P54.3|OTHER NEONATAL GASTROINTESTINAL HAEMORRHAGE|10,140.00|7,098.00|3,042.00
P54.4|NEONATAL ADRENAL HAEMORRHAGE|10,140.00|7,098.00|3,042.00
P54.5|NEONATAL CUTANEOUS HAEMORRHAGE; BRUISING IN FETUS OR NEWBORN; ECCHYMOSES IN FETUS OR NEWBORN; PETECHIAE IN FETUS OR NEWBORN; SUPERFICIAL HAEMATOMATA IN FETUS OR NEWBORN|10,140.00|7,098.00|3,042.00
P54.6|NEONATAL VAGINAL HAEMORRHAGE; PSEUDOMENSES|10,140.00|7,098.00|3,042.00
P54.8|OTHER SPECIFIED NEONATAL HAEMORRHAGES|10,140.00|7,098.00|3,042.00
P54.9|NEONATAL HAEMORRHAGE, UNSPECIFIED|10,140.00|7,098.00|3,042.00
P55.0|RH ISOIMMUNIZATION OF FETUS AND NEWBORN|10,140.00|7,098.00|3,042.00
P55.1|ABO ISOIMMUNIZATION OF FETUS AND NEWBORN|10,140.00|7,098.00|3,042.00
P55.8|OTHER HAEMOLYTIC DISEASES OF FETUS AND NEWBORN|10,140.00|7,098.00|3,042.00
P55.9|HAEMOLYTIC DISEASE OF FETUS AND NEWBORN, UNSPECIFIED|10,140.00|7,098.00|3,042.00
P56.0|HYDROPS FETALIS DUE TO ISOIMMUNIZATION|9,620.00|6,734.00|2,886.00
P56.9|HYDROPS FETALIS DUE TO OTHER AND UNSPECIFIED HAEMOLYTIC DISEASE|9,620.00|6,734.00|2,886.00
P57.0|KERNICTERUS DUE TO ISOIMMUNIZATION|9,620.00|6,734.00|2,886.00
P57.8|OTHER SPECIFIED KERNICTERUS|9,620.00|6,734.00|2,886.00
P57.9|KERNICTERUS, UNSPECIFIED|9,620.00|6,734.00|2,886.00
P58.1|NEONATAL JAUNDICE DUE TO BLEEDING|9,620.00|6,734.00|2,886.00
P58.2|NEONATAL JAUNDICE DUE TO INFECTION|9,620.00|6,734.00|2,886.00
P58.3|NEONATAL JAUNDICE DUE TO POLYCYTHAEMIA|9,620.00|6,734.00|2,886.00
P58.4|NEONATAL JAUNDICE DUE TO DRUGS OR TOXINS TRANSMITTED FROM MOTHER OR GIVEN TO NEWBORN|9,620.00|6,734.00|2,886.00
P58.8|NEONATAL JAUNDICE DUE TO OTHER SPECIFIED EXCESSIVE HAEMOLYSIS|9,620.00|6,734.00|2,886.00
P58.9|NEONATAL JAUNDICE DUE TO EXCESSIVE HAEMOLYSIS, UNSPECIFIED|9,620.00|6,734.00|2,886.00
P59.0|NEONATAL JAUNDICE ASSOCIATED WITH PRETERM DELIVERY; HYPERBILIRUBINAEMIA OF PREMATURITY; JAUNDICE DUE TO DELAYED CONJUCATION ASSOCIATED WITH PRETERM DELIVERY|9,620.00|6,734.00|2,886.00
P59.1|INSPISSATED BILE SYNDROME|9,620.00|6,734.00|2,886.00
P59.2|NEONATAL JAUNDICE FROM OTHER AND UNSPECIFIED HEPATOCELLULAR DAMAGE|9,620.00|6,734.00|2,886.00
P59.3|NEONATAL JAUNDICE FROM BREAST MILK INHIBITOR|9,620.00|6,734.00|2,886.00
P59.8|NEONATAL JAUNDICE FROM OTHER SPECIFIED CAUSES|9,620.00|6,734.00|2,886.00
P59.9|NEONATAL JAUNDICE, UNSPECIFIED; INTENSE PHYSIOLOGICAL JAUNDICE, NOS; PROLONGED PHYSIOLOGICAL JAUNDICE, NOS|9,620.00|6,734.00|2,886.00
P60|DISSEMINATED INTRAVASCULAR COAGULATION OF FETUS AND NEWBORN; DEFIBRINATION SYNDROME OF FETUS OR NEWBORN|41,600.00|29,120.00|12,480.00
P61.0|TRANSIENT NEONATAL THROMBOCYTOPENIA; NEONATAL THROMBOCYTOPENIA DUE TO EXCHANGE TRANSFUSION; NEONATAL THROMBOCYTOPENIA DUE TO IDIOPHATIC MATERNAL THROMBOCYTOPENIA; NEONATAL THROMBOCYTOPENIA  DUE TO ISOIMMUNIZATION|10,140.00|7,098.00|3,042.00
P61.1|POLYCYTHAEMIA NEONATORUM|10,140.00|7,098.00|3,042.00
P61.2|ANAEMIA OF PREMATURITY|19,760.00|13,832.00|5,928.00
P61.3|CONGENITAL ANAEMIA FROM FETAL BLOOD LOSS|19,760.00|13,832.00|5,928.00
P61.4|OTHER CONGENITAL ANAEMIAS, NOT ELSEWHERE CLASSIFIED; CONGENITAL ANAEMIA NOS|19,760.00|13,832.00|5,928.00
P61.5|TRANSIENT NEONATAL NEUTROPENIA|10,140.00|7,098.00|3,042.00
P61.6|OTHER TRANSIENT NEONATAL DISORDERS OF COAGULATION|10,140.00|7,098.00|3,042.00
P61.8|OTHER SPECIFIED PERINATAL HAEMATOLOGICAL DISORDERS|10,140.00|7,098.00|3,042.00
P61.9|PERINATAL HAEMATOLOGICAL DISORDER, UNSPECIFIED|10,140.00|7,098.00|3,042.00
P70.0|SYNDROME OF INFANT OF MOTHER WITH GESTATIONAL DIABETES|12,090.00|8,463.00|3,627.00
P70.1|SYNDROME OF INFANT OF A DIABETIC MOTHER; MATERNAL DIABETES MELLITUS (PRE-EXISTING) AFFECTING FETUS OR NEWBORN WITH HYPOGLYCAEMIA|12,090.00|8,463.00|3,627.00
P70.2|NEONATAL DIABETES MELLITUS|12,090.00|8,463.00|3,627.00
P70.3|IATROGENIC NEONATAL HYPOGLYCAEMIA|12,090.00|8,463.00|3,627.00
P70.4|OTHER NEONATAL HYPOGLYCAEMIA; TRANSITORY NEONATAL HYPOGLYCAEMIA|12,090.00|8,463.00|3,627.00
P70.9|TRANSITORY DISORDER OF CARBOHYDRATE METABOLISM OF FETUS AND NEWBORN, UNSPECIFIED|12,090.00|8,463.00|3,627.00
P71.0|COW'S MILK HYPOCALCAEMIA IN NEWBORN|12,090.00|8,463.00|3,627.00
P71.1|OTHER NEONATAL HYPOCALCAEMIA|12,090.00|8,463.00|3,627.00
P71.3|NEONATAL TETANY WITHOUT CALCIUM OR MAGNESIUM DEFICIENCY; NEONATAL TETANY NOS|12,090.00|8,463.00|3,627.00
P71.4|TRANSITORY NEONATAL HYPOPARATHYROIDISM|12,090.00|8,463.00|3,627.00
P71.9|TRANSITORY NEONATAL DISORDER OF CALCIUM AND MAGNESIUM METABOLISM, UNSPECIFIED|12,090.00|8,463.00|3,627.00
P72.0|NEONATAL GOITRE, NOT ELSEWHERE CLASSIFIED; TRANSITORY CONGENITAL GOITRE WITH NORMAL FUNCTION|12,090.00|8,463.00|3,627.00
P72.1|TRANSITORY NEONATAL HYPERTHYROIDISM; NEONATAL THYROTOXICOSIS|12,090.00|8,463.00|3,627.00
P72.2|OTHER TRANSITORY NEONATAL DISORDERS OF THYROID FUNCTION, NOT ELSEWHERE CLASSIFIED; TRANSITORY NEONATAL HYPOTHYROIDISM|12,090.00|8,463.00|3,627.00
P72.8|OTHER SPECIFIED TRANSITORY NEONATAL ENDOCRINE DISORDERS|12,090.00|8,463.00|3,627.00
P72.9|TRANSITORY NEONATAL ENDOCRINE DISORDER, UNSPECIFIED|12,090.00|8,463.00|3,627.00
P74.0|LATE METABOLIC ACIDOSIS OF NEWBORN|12,090.00|8,463.00|3,627.00
P74.1|DEHYDRATION OF NEWBORN|12,090.00|8,463.00|3,627.00
P74.2|DISTURBANCES OF SODIUM BALANCE OF NEWBORN|12,090.00|8,463.00|3,627.00
P74.4|OTHER TRANSITORY ELECTROLYTE DISTURBANCES OF NEWBORN|12,090.00|8,463.00|3,627.00
P74.8|OTHER TRANSITORY METABOLIC DISTURBANCES OF NEWBORN|12,090.00|8,463.00|3,627.00
P74.9|TRANSITORY METABOLIC DISTURBANCE OF NEWBORN, UNSPECIFIED|12,090.00|8,463.00|3,627.00
P76.0|MECONIUM PLUG SYNDROME|15,210.00|10,647.00|4,563.00
P76.1|TRANSITORY ILEUS OF NEWBORN|15,210.00|10,647.00|4,563.00
P76.8|OTHER SPECIFIED INTESTINAL OBSTRUCTION OF NEWBORN|15,210.00|10,647.00|4,563.00
P76.9|INTESTINAL OBSTRUCTION OF NEWBORN, UNSPECIFIED|15,210.00|10,647.00|4,563.00
P77|NECROTIZING ENTEROCOLITIS OF FETUS AND NEWBORN|15,210.00|10,647.00|4,563.00
P78.0|PERINATAL INTESTINAL PERFORATION; MECONIUM PERITONITIS|15,210.00|10,647.00|4,563.00
P78.2|NEONATAL HAEMATEMESIS AND MELAENA DUE TO SWALLOWED MATERNAL BLOOD|15,210.00|10,647.00|4,563.00
P78.3|NONINFECTIVE NEONATAL DIARRHOEA; NEONATAL DIARRHOEA NOS|15,210.00|10,647.00|4,563.00
P78.8|OTHER SPECIFIED PERINATAL DIGESTIVE SYSTEM DISORDERS; CONGENITAL CIRRHOSIS OF LIVER; PEPTIC ULCER OF NEWBORN|15,210.00|10,647.00|4,563.00
P78.9|PERINATAL DIGESTIVE SYSTEM DISORDER, UNSPECIFIED|15,210.00|10,647.00|4,563.00
P80.9|HYPOTHERMIA OF NEWBORN, UNSPECIFIED|12,090.00|8,463.00|3,627.00
P81.0|ENVIRONMENTAL HYPERTHERMIA OF NEWBORN|12,090.00|8,463.00|3,627.00
P81.8|OTHER SPECIFIED DISTURBANCES OF TEMPERATURE REGULATION OF NEWBORN|12,090.00|8,463.00|3,627.00
P81.9|DISTURBANCE OF TEMPERATURE REGULATION OF NEWBORN, UNSPECIFIED; FEVER OF NEWBORN NOS|12,090.00|8,463.00|3,627.00
P83.1|NEONATAL ERYTHEMA TOXICUM|12,090.00|8,463.00|3,627.00
P83.2|HYDROPS FETALIS NOT DUE TO HAEMOLYTIC DISEASE; HYDROPS FETALIS NOS|12,090.00|8,463.00|3,627.00
P83.4|BREAST ENGORGEMENT OF NEWBORN; NONINFECTIVE MASTITIS OF NEWBORN|12,090.00|8,463.00|3,627.00
P83.8|OTHER SPECIFIED CONDITIONS OF INTEGUMENT SPECIFIC TO FETUS AND NEWBORN; BRONZE BABY SYNDROME; NEONATAL SCLERODERMA; URTICARIA NEONATORUM|12,090.00|8,463.00|3,627.00
P90|CONVULSIONS OF NEWBORN|15,600.00|10,920.00|4,680.00
P91.0|NEONATAL CEREBRAL ISCHAEMIA|33,540.00|23,478.00|10,062.00
P91.1|ACQUIRED PERIVENTRICULAR CYSTS OF NEWBORN|15,600.00|10,920.00|4,680.00
P91.2|NEONATAL CEREBRAL LEUKOMALACIA|15,600.00|10,920.00|4,680.00
P91.3|NEONATAL CEREBRAL IRRITABILITY|15,600.00|10,920.00|4,680.00
P91.4|NEONATAL CEREBRAL DEPRESSION|15,600.00|10,920.00|4,680.00
P91.6|HYPOXIC ISCHEMIC ENCEPHALOPATHY OF NEWBORN|15,600.00|10,920.00|4,680.00
P91.8|OTHER SPECIFIED DISTURBANCES OF CEREBRAL STATUS OF NEWBORN|15,600.00|10,920.00|4,680.00
P91.9|DISTURBANCE OF CEREBRAL STATUS OF NEWBORN, UNSPECIFIED|15,600.00|10,920.00|4,680.00
P92.1|REGURGITATION AND RUMINATION IN NEWBORN|11,310.00|7,917.00|3,393.00
P92.2|SLOW FEEDING OF NEWBORN|11,310.00|7,917.00|3,393.00
P92.4|OVERFEEDING OF NEWBORN|11,310.00|7,917.00|3,393.00
P92.8|OTHER FEEDING PROBLEMS OF NEWBORN|11,310.00|7,917.00|3,393.00
P92.9|FEEDING PROBLEM OF NEWBORN, UNSPECIFIED|11,310.00|7,917.00|3,393.00
P94.0|TRANSIENT NEONATAL MYASTHENIA GRAVIS|15,080.00|10,556.00|4,524.00
P94.1|CONGENITAL HYPERTONIA|15,600.00|10,920.00|4,680.00
P94.2|CONGENITAL HYPOTONIA; NONSPECIFIC FLOPPY BABY SYNDROME|15,600.00|10,920.00|4,680.00
P94.9|DISORDER OF MUSCLE TONE OF NEWBORN, UNSPECIFIED|15,600.00|10,920.00|4,680.00
P96.0|CONGENITAL RENAL FAILURE; URAEMIA OF NEWBORN|11,830.00|8,281.00|3,549.00
P96.5|COMPLICATIONS OF INTRAUTERINE PROCEDURES, NOT ELSEWHERE CLASSIFIED|15,600.00|10,920.00|4,680.00
P96.8|OTHER SPECIFIED CONDITIONS ORIGINATING IN THE PERINATAL PERIOD|15,600.00|10,920.00|4,680.00
P96.9|CONDITION ORIGINATING IN THE PERINATAL PERIOD, UNSPECIFIED; CONGENITAL DEBILITY NOS|15,600.00|10,920.00|4,680.00
Q00.0|ANENCEPHALY; ACEPHALY; ACRANIA; AMYELENCEPHALY; HEMICEPHALY; HEMICEPHALY|16,900.00|11,830.00|5,070.00
Q01.0|FRONTAL ENCEPHALOCELE|16,900.00|11,830.00|5,070.00
Q01.1|NASOFRONTAL ENCEPHALOCELE|16,900.00|11,830.00|5,070.00
Q01.2|OCCIPITAL ENCEPHALOCELE|16,900.00|11,830.00|5,070.00
Q01.8|ENCEPHALOCELE OF OTHER SITES|16,900.00|11,830.00|5,070.00
Q02|MICROCEPHALY; HYDROMICROCEPHALY; MICRENCEPHALON|16,900.00|11,830.00|5,070.00
Q03.0|MALFORMATIONS OF AQUEDUCT OF SYLVIUS; ANOMALY OF AQUEDUCT OF SYLVIUS; OBSTRUCTION, CONGENITAL OF AQUEDUCT OF SYLVIUS; STENOSIS OF AQUEDUCT OF SYLVIUS|16,900.00|11,830.00|5,070.00
Q03.1|ATRESIA OF FORAMINA OF MAGENDIE AND LUSCHKA; DANDY-WALKER SYNDROME|16,900.00|11,830.00|5,070.00
Q03.8|OTHER CONGENITAL HYDROCEPHALUS|16,900.00|11,830.00|5,070.00
Q03.9|CONGENITAL HYDROCEPHALUS, UNSPECIFIED|22,490.00|15,743.00|6,747.00
Q04.0|CONGENITAL MALFORMATIONS OF CORPUS CALLOSUM; AGENESIS OF CORPUS CALLOSUM|16,900.00|11,830.00|5,070.00
Q04.2|HOLOPROSENCEPHALY|16,900.00|11,830.00|5,070.00
Q04.3|OTHER REDUCTION DEFORMITIES OF BRAIN; ABSENCE OF PART OF BRAIN; AGENESIS OF PART OF BRAIN; APLASIA OF PART OF BRAIN; HYPOPLASIA OF PART OF BRAIN ; AGYRIA; HYDRANENCEPHALY; LISSENCEPHALY; MICROGYRIA; PACHYGYRIA|16,900.00|11,830.00|5,070.00
Q04.4|SEPTO-OPTIC DYSPLASIA|16,900.00|11,830.00|5,070.00
Q04.6|CONGENITAL CEREBRAL CYSTS; PORENCEPHALY; SCHIZENCEPHALY|16,900.00|11,830.00|5,070.00
Q04.8|OTHER SPECIFIED CONGENITAL MALFORMATIONS OF BRAIN; MACROGYRIA|16,900.00|11,830.00|5,070.00
Q04.9|CONGENITAL MALFORMATION OF BRAIN, UNSPECIFIED; CONGENITAL ANOMALY NOS OF BRAIN; CONGENITAL DEFORMITY NOS OF BRAIN; CONGENITAL DISEASE OF LESION NOS OF BRAIN; CONGENITAL MULTIPLE ANOMALIS NOS OF BRAIN|16,900.00|11,830.00|5,070.00
Q05.1|THORACIC SPINA BIFIDA WITH HYDROCEPHALUS; DORSAL SPINA BIFIDA WITH HYDROCEPHALUS; THORACOLUMBAR SPINA BIFIDA WITH HYDROCEPHALUS|16,900.00|11,830.00|5,070.00
Q05.2|LUMBAR SPINA BIFIDA WITH HYDROCEPHALUS; LUMBOSACRAL SPINA BIFIDA WITH HYDROCEPHALUS|16,900.00|11,830.00|5,070.00
Q05.4|UNSPECIFIED SPINA BIFIDA WITH HYDROCEPHALUS|16,900.00|11,830.00|5,070.00
Q05.6|THORACIC SPINA BIFIDA WITHOUT HYDROCEPHALUS; DORSAL NOS SPINA BIFIDA; THORACOLUMBAR NOS SPINA BIFIDA|16,900.00|11,830.00|5,070.00
Q05.7|LUMBAR SPINA BIFIDA WITHOUT HYDROCEPHALUS; LUMBOSACRAL SPINA BIFIDA NOS|16,900.00|11,830.00|5,070.00
Q05.8|SACRAL SPINA BIFIDA WITHOUT HYDROCEPHALUS|16,900.00|11,830.00|5,070.00
Q05.9|SPINA BIFIDA, UNSPECIFIED|16,900.00|11,830.00|5,070.00
Q06.0|AMYELIA|16,900.00|11,830.00|5,070.00
Q06.2|DIASTEMATOMYELIA|16,900.00|11,830.00|5,070.00
Q06.4|HYDROMYELIA; HYDRORACHIS|16,900.00|11,830.00|5,070.00
Q06.8|OTHER SPECIFIED CONGENITAL MALFORMATIONS OF SPINAL CORD|16,900.00|11,830.00|5,070.00
Q06.9|CONGENITAL MALFORMATION OF SPINAL CORD, UNSPECIFIED; CONGENITAL ANOMALY NOS OF SPINAL CORD OR MENINGES; CONGENITAL DEFORMITY NOS OF SPINAL CORD OR MENINGES; CONGENITAL DISEASE OR LESION NOS OF SPINAL CORD OR MENINGES|16,900.00|11,830.00|5,070.00
Q07.0|ARNOLD-CHIARI SYNDROME|16,900.00|11,830.00|5,070.00
Q07.9|CONGENITAL MALFORMATION OF NERVOUS SYSTEM, UNSPECIFIED; CONGENITAL ANOMALY NOS OF NERVOUS SYSTEM; CONGENITAL DEFORMITY NOS OF NERVOUS SYSTEM; CONGENITAL DISEASE OR LESION NOS OF NERVOUS SYSTEM|16,900.00|11,830.00|5,070.00
Q12.2|COLOBOMA OF LENS|5,590.00|3,913.00|1,677.00
Q12.4|SPHEROPHAKIA|5,590.00|3,913.00|1,677.00
Q13.4|OTHER CONGENITAL CORNEAL MALFORMATIONS; CONGENITAL MALFORMATION OF CORNEA NOS; MICROCORNEA; PETER'S ANOMALY|5,590.00|3,913.00|1,677.00
Q14.0|CONGENITAL MALFORMATION OF VITREOUS HUMOUR; CONGENITAL VITREOUS OPACITY|5,590.00|3,913.00|1,677.00
Q14.1|CONGENITAL MALFORMATION OF RETINA; CONGENITAL RETINAL ANEURYSM|5,590.00|3,913.00|1,677.00
Q14.9|CONGENITAL MALFORMATION OF POSTERIOR SEGMENT OF EYE, UNSPECIFIED|5,590.00|3,913.00|1,677.00
Q15.0|CONGENITAL GLAUCOMA; BUPHTHALMOS; GLAUCOMA OF NEWBORN; HYDROPHTHALMOS; KERATOGLOBUS, CONGENITAL, WITH GLAUCOMA; MACROCORNEA WITH GLAUCOMA; MACROPHTHALMOS IN CONGENITAL GLAUCOMA; MEGALOCORNEA WITH GLAUCOMA|5,590.00|3,913.00|1,677.00
Q15.8|OTHER SPECIFIED CONGENITAL MALFORMATIONS OF EYE|5,590.00|3,913.00|1,677.00
Q15.9|CONGENITAL MALFORMATION OF EYE, UNSPECIFIED; CONGENITAL ANOMALY NOS OF EYE; CONGENITAL DEFORMITY NOS OF EYE|5,590.00|3,913.00|1,677.00
Q20.0|COMMON ARTERIAL TRUNK; PERSISTENT TRUNCUS ARTERIOSUS|15,080.00|10,556.00|4,524.00
Q20.1|DOUBLE OUTLET RIGHT VENTRICLE; TAUSSIG-BING SYNDROME|15,080.00|10,556.00|4,524.00
Q20.2|DOUBLE OUTLET LEFT VENTRICLE|15,080.00|10,556.00|4,524.00
Q20.3|DISCORDANT VENTRICULOARTERIAL CONNECTION; DEXTROTRANSPOSITION OF AORTA; TRANSPOSITION OF GREAT VESSELS (COMPLETE)|15,080.00|10,556.00|4,524.00
Q20.4|DOUBLE INLET VENTRICLE; COMMON VENTRICLE; COR TRILOCULARE BIATRIATUM; SINGLE VENTRICLE|15,080.00|10,556.00|4,524.00
Q20.5|DISCORDANT ATRIOVENTRICULAR CONNECTION; CORRECTED TRANSPOSITION; LAEVOTRANSPOSITION; VENTRICULAR INVERSION|15,080.00|10,556.00|4,524.00
Q20.9|CONGENITAL MALFORMATION OF CARDIAC CHAMBERS AND CONNECTIONS, UNSPECIFIED|15,080.00|10,556.00|4,524.00
Q21.0|VENTRICULAR SEPTAL DEFECT|15,080.00|10,556.00|4,524.00
Q21.1|ATRIAL SEPTAL DEFECT; CORONARY SINUS DEFECT; PATENT OR PERSISTENT FORAMEN OVALE; PATENT OR PERSISTENT OSTIUM SECUNDUM DEFECT (TYPE II); SINUS VENOSUS DEFECT|15,080.00|10,556.00|4,524.00
Q21.2|ATRIOVENTRICULAR SEPTAL DEFECT; COMMON ATRIOVENTRICULAR CANAL; ENDOCARDIAL CUSHION DEFECT; OSTIUM PRIMUM ATRIAL SEPTAL DEFECT (TYPE I)|15,080.00|10,556.00|4,524.00
Q21.3|TETRALOGY OF FALLOT; VENTRICULAR SEPTAL DEFECT WITH PULMONARY STENOSIS OR ATRESIA, DEXTROPOSITION OF AORTA AND HYPERTROPHY OF RIGHT VENTRICLE.|15,080.00|10,556.00|4,524.00
Q21.4|AORTOPULMONARY SEPTAL DEFECT; AORTIC SEPTAL DEFECT; AORTOPULMONARY WINDOW|15,080.00|10,556.00|4,524.00
Q21.8|OTHER CONGENITAL MALFORMATIONS OF CARDIAC SEPTA; EISENMENGER'S DEFECT; PENTALOGY OF FALLOT|15,080.00|10,556.00|4,524.00
Q21.9|CONGENITAL MALFORMATION OF CARDIAC SEPTUM, UNSPECIFIED; SEPTAL (HEART) DEFECT NOS|15,080.00|10,556.00|4,524.00
Q22.0|PULMONARY VALVE ATRESIA|15,080.00|10,556.00|4,524.00
Q22.1|CONGENITAL PULMONARY VALVE STENOSIS|15,080.00|10,556.00|4,524.00
Q22.2|CONGENITAL PULMONARY VALVE INSUFFICIENCY; CONGENITAL PULMONARY VALVE REGURGITATION|15,080.00|10,556.00|4,524.00
Q22.4|CONGENITAL TRICUSPID STENOSIS; TRICUSPID ATRESIA|15,080.00|10,556.00|4,524.00
Q22.5|EBSTEIN'S ANOMALY|15,080.00|10,556.00|4,524.00
Q22.6|HYPOPLASTIC RIGHT HEART SYNDROME|15,080.00|10,556.00|4,524.00
Q22.8|OTHER CONGENITAL MALFORMATIONS OF TRICUSPID VALVE|15,080.00|10,556.00|4,524.00
Q23.0|CONGENITAL STENOSIS OF AORTIC VALVE; CONGENITAL AORTIC ATRESIA; CONGENITAL AORTIC STENOSIS|15,080.00|10,556.00|4,524.00
Q23.1|CONGENITAL INSUFFICIENCY OF AORTIC VALVE; BICUSPID AORTIC VALVE; CONGENITAL AORTIC INSUFFICIENCY|15,080.00|10,556.00|4,524.00
Q23.2|CONGENITAL MITRAL STENOSIS; CONGENITAL MITRAL ATRESIA|15,080.00|10,556.00|4,524.00
Q23.3|CONGENITAL MITRAL INSUFFICIENCY|15,080.00|10,556.00|4,524.00
Q23.4|HYPOPLASTIC LEFT HEART SYNDROME; ATRESIA, OR MARKED HYPOPLASIA OF AORTIC ORIFICE OR VALVE, WITH HYPOPLASIA OF ASCENDING AORTA AND DEFECTIVE DEVELOPMENT OF LEFT VENTRICLE (WITH MITRAL VALVE STENOSIS OR ATRESIA).|15,080.00|10,556.00|4,524.00
Q23.8|OTHER CONGENITAL MALFORMATIONS OF AORTIC AND MITRAL VALVES|15,080.00|10,556.00|4,524.00
Q23.9|CONGENITAL MALFORMATION OF AORTIC AND MITRAL VALVES, UNSPECIFIED|15,080.00|10,556.00|4,524.00
Q24.0|DEXTROCARDIA|15,080.00|10,556.00|4,524.00
Q24.2|COR TRIATRIATUM|15,080.00|10,556.00|4,524.00
Q24.3|PULMONARY INFUNDIBULAR STENOSIS|15,080.00|10,556.00|4,524.00
Q24.4|CONGENITAL SUBAORTIC STENOSIS|15,080.00|10,556.00|4,524.00
Q24.5|MALFORMATION OF CORONARY VESSELS; CONGENITAL CORONARY (ARTERY) ANEURYSM|15,080.00|10,556.00|4,524.00
Q24.6|CONGENITAL HEART BLOCK|15,080.00|10,556.00|4,524.00
Q24.8|OTHER SPECIFIED CONGENITAL MALFORMATIONS OF HEART; CONGENITAL DIVERTICULUM OF LEFT VENTRICLE; CONGENITAL MALFORMATION OF MYOCARDIUM; CONGENITAL MALFORMATION OF PERICARDIUM; MALPOSITION OF HEART; UHL'S DISEASE|15,080.00|10,556.00|4,524.00
Q24.9|CONGENITAL MALFORMATION OF HEART, UNSPECIFIED; CONGENITAL ANOMALY NOS OF HEART; CONGENITAL DISEASE NOS OF HEART|15,080.00|10,556.00|4,524.00
Q25.0|PATENT DUCTUS ARTERIOSUS; PATENT DUCTUS BOTALLO; PERSISTENT DUCTUS ARTERIOSUS|15,080.00|10,556.00|4,524.00
Q25.1|COARCTATION OF AORTA; PREDUCTAL COARCTATION OF AORTA; POSTDUCTAL COARCTATION OF AORTA|15,080.00|10,556.00|4,524.00
Q25.2|ATRESIA OF AORTA|15,080.00|10,556.00|4,524.00
Q25.3|STENOSIS OF AORTA; SUPRAVALVULAR AORTIC STENOSIS|15,080.00|10,556.00|4,524.00
Q25.4|OTHER CONGENITAL MALFORMATIONS OF AORTA; ABSENCE OF AORTA; APLASIA OF AORTA; CONGENITAL ANEURYSM OF AORTA; CONGENITAL DILATATION OF AORTA; ANEURYSM OF SINUS OF VALSALVA (RUPTURE); DOUBLE AORTIC ARCH [VASCULAR RING OR AORTA]; HYPOPLASIA OF AORTA; PERSISTEN|15,080.00|10,556.00|4,524.00
Q25.5|ATRESIA OF PULMONARY ARTERY|15,080.00|10,556.00|4,524.00
Q25.6|STENOSIS OF PULMONARY ARTERY|15,080.00|10,556.00|4,524.00
Q25.7|OTHER CONGENITAL MALFORMATIONS OF PULMONARY ARTERY; ABERRANT PULMONARY ARTERY; AGENESIS OF PULMONARY ARTERY; ANEURYSM, CONGENITAL OF PULMONARY ARTERY; ANOMALY OF PULMONARY ARTERY; HYPOPLASIA OF PULMONARY ARTERY; PULMONARY ARTERIOVENOUS ANEURYSM|15,080.00|10,556.00|4,524.00
Q25.8|OTHER CONGENITAL MALFORMATIONS OF GREAT ARTERIES|15,080.00|10,556.00|4,524.00
Q25.9|CONGENITAL MALFORMATION OF GREAT ARTERIES, UNSPECIFIED|15,080.00|10,556.00|4,524.00
Q26.0|CONGENITAL STENOSIS OF VENA CAVA; CONGENITAL STENOSIS OF INFERIOR VENA CAVA;  CONGENITAL STENOSIS OFSUPERIOR VENA CAVA|15,080.00|10,556.00|4,524.00
Q26.2|TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION|15,080.00|10,556.00|4,524.00
Q26.4|ANOMALOUS PULMONARY VENOUS CONNECTION, UNSPECIFIED|15,080.00|10,556.00|4,524.00
Q26.8|OTHER CONGENITAL MALFORMATIONS OF GREAT VEINS; ABSENCE OF  INFERIOR VENA CAVA ;  ABSENCE OF SUPERIOR VENA CAVA ; AZYGOS CONTINUATION OF INFERIOR VENA CAVA; PERSISTENT LEFT POSTERIOR CARDINAL VEIN; SCIMITAR SYNDROME|15,080.00|10,556.00|4,524.00
Q26.9|CONGENITAL MALFORMATION OF GREAT VEIN, UNSPECIFIED;  ANOMALY OF INFERIOR  VENA CAVA NOS; ANOMALY OF  SUPERIOR VENA CAVA  NOS|15,080.00|10,556.00|4,524.00
Q27.1|CONGENITAL RENAL ARTERY STENOSIS|15,600.00|10,920.00|4,680.00
Q27.3|PERIPHERAL ARTERIOVENOUS MALFORMATION; ARTERIOVENOUS ANEURYSM|15,600.00|10,920.00|4,680.00
Q27.8|OTHER SPECIFIED CONGENITAL MALFORMATIONS OF PERIPHERAL VASCULAR SYSTEM; ABERRANT SUBCLAVIAN ARTERY; ABSENCE OF ARTERY OR VEIN NEC; ATRESIA OF ARTERY OR VEIN NEC; CONGENITAL ANEURYSM (PERIPHERAL); CONGENITAL STRICTURE, ARTERY; CONGENITAL VARIX|15,600.00|10,920.00|4,680.00
Q27.9|CONGENITAL MALFORMATION OF PERIPHERAL VASCULAR SYSTEM, UNSPECIFIED; ANOMALY OF ARTERY OR VEIN NOS|15,600.00|10,920.00|4,680.00
Q28.0|ARTERIOVENOUS MALFORMATION OF PRECEREBRAL VESSELS; CONGENITAL ARTERIOVENOUS PRECEREBRAL ANEURYSM (NONRUPTURED)|15,600.00|10,920.00|4,680.00
Q28.1|OTHER MALFORMATIONS OF PRECEREBRAL VESSELS; CONGENITAL MALFORMATION OF PRECEREBRAL VESSELS NOS; CONGENITAL PRECEREBRAL ANEURYSM (NONRUPTURED)|15,600.00|10,920.00|4,680.00
Q28.2|ARTERIOVENOUS MALFORMATION OF CEREBRAL VESSELS; ARTERIOVENOUS MALFORMATION OF BRAIN NOS; CONGENITAL ARTERIOVENOUS CEREBRAL ANEURYSM (NONRUPTURED)|15,600.00|10,920.00|4,680.00
Q28.3|OTHER MALFORMATIONS OF CEREBRAL VESSELS; CONGENITAL CEREBRAL ANEURYSM, NONRUPTURED; CONGENITAL MALFORMATION OF CEREBRAL VESSELS NOS|15,600.00|10,920.00|4,680.00
Q30.0|CHOANAL ATRESIA;  ABSENCE OF ANTERIOR NARES; ABSENCE OF POSTERIOR NARES; CONGENITAL STENOSIS OF ANTERIOR NARES;  CONGENITAL STENOSIS OF POSTERIOR NARES|14,300.00|10,010.00|4,290.00
Q30.1|AGENESIS AND UNDERDEVELOPMENT OF NOSE; CONGENITAL ABSENCE OF NOSE|14,300.00|10,010.00|4,290.00
Q30.2|FISSURED, NOTCHED AND CLEFT NOSE|14,300.00|10,010.00|4,290.00
Q31.3|LARYNGOCELE|14,300.00|10,010.00|4,290.00
Q31.5|CONGENITAL LARYNGOMALACIA|14,300.00|10,010.00|4,290.00
Q31.8|OTHER CONGENITAL MALFORMATIONS OF LARYNX; ABSENCE OF CRICOID CARTILAGE, EPIGLOTTIS, GLOTTIS, LARYNX OR THYROID CARTILAGE; AGENESIS OF CRICOID CARTILAGE, EPIGLOTTIS, GLOTTIS, LARYNX OR THYROID CARTILAGE;  ATRESIA OF CRICOID CARTILAGE, EPIGLOTTIS, GLOTTIS,|14,300.00|10,010.00|4,290.00
Q31.9|CONGENITAL MALFORMATION OF LARYNX, UNSPECIFIED|14,300.00|10,010.00|4,290.00
Q32.0|CONGENITAL TRACHEOMALACIA|28,210.00|19,747.00|8,463.00
Q32.4|OTHER CONGENITAL MALFORMATIONS OF BRONCHUS; ABSENCE OF BRONCHUS; AGENESIS OF BRONCHUS; ATRESIA OF BRONCHUS; CONGENITAL MALFORMATION NOS OF BRONCHUS; DIVERTICULUM OF BRONCHUS; CONGENITAL MALFORMATIONS OF LUNG] OF BRONCHUS|28,210.00|19,747.00|8,463.00
Q33.0|CONGENITAL CYSTIC LUNG; CONGENITAL HONEYCOMB LUNG; CONGENITAL CYSTIC LUNG DISEASE; CONGENITAL POLYCYSTIC LUNG DISEASE|28,210.00|19,747.00|8,463.00
Q33.2|SEQUESTRATION OF LUNG|28,210.00|19,747.00|8,463.00
Q33.3|AGENESIS OF LUNG; ABSENCE OF LUNG, LOBE|28,210.00|19,747.00|8,463.00
Q33.4|CONGENITAL BRONCHIECTASIS|28,210.00|19,747.00|8,463.00
Q33.6|HYPOPLASIA AND DYSPLASIA OF LUNG|28,210.00|19,747.00|8,463.00
Q34.1|CONGENITAL CYST OF MEDIASTINUM|28,210.00|19,747.00|8,463.00
Q34.8|OTHER SPECIFIED CONGENITAL MALFORMATIONS OF RESPIRATORY SYSTEM; ATRESIA OF NASOPHARYNX|28,210.00|19,747.00|8,463.00
Q34.9|CONGENITAL MALFORMATION OF RESPIRATORY SYSTEM, UNSPECIFIED; CONGENITAL ABSENCE OF RESPIRATORY ORGAN  ; CONGENITAL ANOMALY NOS OF RESPIRATORY ORGAN|28,210.00|19,747.00|8,463.00
Q35.0|CLEFT HARD PALATE, BILATERAL; BILATERAL FISSURE OF HARD PALATE; BILATERAL PALATOSCHISIS OF HARD PALATE|10,140.00|7,098.00|3,042.00
Q35.1|CLEFT HARD PALATE|10,140.00|7,098.00|3,042.00
Q35.3|CLEFT SOFT PALATE|10,140.00|7,098.00|3,042.00
Q35.5|CLEFT HARD PALATE WITH CLEFT SOFT PALATE|10,140.00|7,098.00|3,042.00
Q35.7|CLEFT UVULA|10,140.00|7,098.00|3,042.00
Q35.8|CLEFT PALATE, UNSPECIFIED, BILATERAL|10,140.00|7,098.00|3,042.00
Q35.9|CLEFT PALATE, UNSPECIFIED|10,140.00|7,098.00|3,042.00
Q36.0|CLEFT LIP, BILATERAL|10,140.00|7,098.00|3,042.00
Q36.1|CLEFT LIP, MEDIAN|10,140.00|7,098.00|3,042.00
Q36.9|CLEFT LIP, UNILATERAL; CLEFT LIP NOS|10,140.00|7,098.00|3,042.00
Q37.0|CLEFT HARD PALATE WITH BILATERAL CLEFT LIP|10,140.00|7,098.00|3,042.00
Q37.1|CLEFT HARD PALATE WITH UNILATERAL CLEFT LIP; CLEFT HARD PALATE WITH CLEFT LIP NOS|10,140.00|7,098.00|3,042.00
Q37.2|CLEFT SOFT PALATE WITH BILATERAL CLEFT LIP|10,140.00|7,098.00|3,042.00
Q37.3|CLEFT SOFT PALATE WITH UNILATERAL CLEFT LIP; CLEFT SOFT PALATE WITH CLEFT LIP NOS|10,140.00|7,098.00|3,042.00
Q37.4|CLEFT HARD AND SOFT PALATE WITH BILATERAL CLEFT LIP|10,140.00|7,098.00|3,042.00
Q37.5|CLEFT HARD AND SOFT PALATE WITH UNILATERAL CLEFT LIP; CLEFT HARD AND SOFT PALATE WITH CLEFT LIP NOS|10,140.00|7,098.00|3,042.00
Q37.8|UNSPECIFIED CLEFT PALATE WITH BILATERAL CLEFT LIP|10,140.00|7,098.00|3,042.00
Q37.9|UNSPECIFIED CLEFT PALATE WITH UNILATERAL CLEFT LIP; CLEFT PALATE WITH CLEFT LIP NOS|10,140.00|7,098.00|3,042.00
Q38.2|MACROGLOSSIA|5,200.00|3,640.00|1,560.00
Q38.5|CONGENITAL MALFORMATIONS OF PALATE, NOT ELSEWHERE CLASSIFIED; ABSENCE OF UVULA; CONGENITAL MALFORMATION OF PALATE NOS; HIGH ARCHED PALATE|5,200.00|3,640.00|1,560.00
Q38.6|OTHER CONGENITAL MALFORMATIONS OF MOUTH; CONGENITAL MALFORMATION OF MOUTH NOS|5,200.00|3,640.00|1,560.00
Q38.8|OTHER CONGENITAL MALFORMATIONS OF PHARYNX; CONGENITAL MALFORMATION OF PHARYNX NOS|5,200.00|3,640.00|1,560.00
Q39.0|ATRESIA OF OESOPHAGUS WITHOUT FISTULA; ATRESIA OF OESOPHAGUS NOS|14,690.00|10,283.00|4,407.00
Q39.1|ATRESIA OF OESOPHAGUS WITH TRACHEO-OESOPHAGEAL FISTULA; ATRESIA OF OESOPHAGUS WITH BRONCHO- OESOPHAGEAL FISTULA|14,690.00|10,283.00|4,407.00
Q39.2|CONGENITAL TRACHEO-OESOPHAGEAL FISTULA WITHOUT ATRESIA; CONGENITAL TRACHEO-OESOPHAGEAL FISTULA NOS|14,690.00|10,283.00|4,407.00
Q39.6|DIVERTICULUM OF OESOPHAGUS; OESOPHAGEAL POUCH|14,690.00|10,283.00|4,407.00
Q39.9|CONGENITAL MALFORMATION OF OESOPHAGUS, UNSPECIFIED|14,690.00|10,283.00|4,407.00
Q40.0|CONGENITAL HYPERTROPHIC PYLORIC STENOSIS; CONGENITAL OR INFANTILE CONSTRICTION OF PYLORUS; CONGENITAL OR INFANTILE HYPERTROPHY OF PYLORUS; CONGENITAL OR INFANTILE SPASM OF PYLORUS; CONGENITAL OR INFANTILE STENOSIS OF PYLORUS; CONGENITAL OR INFANTILE STRIC|14,690.00|10,283.00|4,407.00
Q40.1|CONGENITAL HIATUS HERNIA; DISPLACEMENT OF CARDIA THROUGH OESOPHAGEAL HIATUS|14,690.00|10,283.00|4,407.00
Q40.2|OTHER SPECIFIED CONGENITAL MALFORMATIONS OF STOMACH; CONGENITAL DISPLACEMENT OF STOMACH; CONGENITAL DIVERTICULUM OF STOMACH; CONGENITAL HOURGLASS STOMACH; DUPLICATION OF STOMACH; MEGALOGASTRIA; MICROGASTRIA|14,690.00|10,283.00|4,407.00
Q40.9|CONGENITAL MALFORMATION OF UPPER ALIMENTARY TRACT, UNSPECIFIED; CONGENITAL ANOMALY NOS OF UPPER ALIMENTARY TRACT; CONGENITAL DEFORMITY NOS OF UPPER ALIMENTARY TRACT|14,690.00|10,283.00|4,407.00
Q41.0|CONGENITAL ABSENCE, ATRESIA AND STENOSIS OF DUODENUM|14,690.00|10,283.00|4,407.00
Q41.1|CONGENITAL ABSENCE, ATRESIA AND STENOSIS OF JEJUNUM; APPLE PEEL SYNDROME; IMPERFORATE JEJUNUM|14,690.00|10,283.00|4,407.00
Q41.2|CONGENITAL ABSENCE, ATRESIA AND STENOSIS OF ILEUM|14,690.00|10,283.00|4,407.00
Q41.9|CONGENITAL ABSENCE, ATRESIA AND STENOSIS OF SMALL INTESTINE, PART UNSPECIFIED; CONGENITAL ABSENCE, ATRESIA AND STENOSIS OF INTESTINE NOS|14,690.00|10,283.00|4,407.00
Q42.0|CONGENITAL ABSENCE, ATRESIA AND STENOSIS OF RECTUM WITH FISTULA|14,690.00|10,283.00|4,407.00
Q42.1|CONGENITAL ABSENCE, ATRESIA AND STENOSIS OF RECTUM WITHOUT FISTULA; IMPERFORATE RECTUM|14,690.00|10,283.00|4,407.00
Q42.2|CONGENITAL ABSENCE, ATRESIA AND STENOSIS OF ANUS WITH FISTULA|14,690.00|10,283.00|4,407.00
Q42.3|CONGENITAL ABSENCE, ATRESIA AND STENOSIS OF ANUS WITHOUT FISTULA; IMPERFORATE ANUS|14,690.00|10,283.00|4,407.00
Q42.9|CONGENITAL ABSENCE, ATRESIA AND STENOSIS OF LARGE INTESTINE, PART UNSPECIFIED|14,690.00|10,283.00|4,407.00
Q43.0|MECKEL'S DIVERTICULUM; PERSISTENT OMPHALOMESENTERIC DUCT; PERSISTENT VITELLINE DUCT|14,690.00|10,283.00|4,407.00
Q43.1|HIRSCHSPRUNG'S DISEASE; AGANGLIONOSIS; CONGENITAL (AGANGLIONIC) MEGACOLON|14,690.00|10,283.00|4,407.00
Q43.2|OTHER CONGENITAL FUNCTIONAL DISORDERS OF COLON; CONGENITAL DILATATION OF COLON|14,690.00|10,283.00|4,407.00
Q43.3|CONGENITAL MALFORMATIONS OF INTESTINAL FIXATION; CONGENITAL ANOMALOUS OMENTAL   ADHESIONS [BANDS] ; CONGENITAL PERITONEAL ADHESIONS [BANDS]; JACKSON'S MEMBRANE; MALROTATION OF COLON; FAILURE OF ROTATION OF CAECUM AND COLON; INCOMPLETE ROTATION OF CAECUM A|14,690.00|10,283.00|4,407.00
Q43.4|DUPLICATION OF INTESTINE|14,690.00|10,283.00|4,407.00
Q43.5|ECTOPIC ANUS|14,690.00|10,283.00|4,407.00
Q43.6|CONGENITAL FISTULA OF RECTUM AND ANUS|14,690.00|10,283.00|4,407.00
Q43.7|PERSISTENT CLOACA; CLOACA NOS|14,690.00|10,283.00|4,407.00
Q43.8|OTHER SPECIFIED CONGENITAL MALFORMATIONS OF INTESTINE; CONGENITAL BLIND LOOP SYNDROME; CONGENITAL DIVERTICULITIS, COLON; CONGENITAL DIVERTICULUM, INTESTINE; DOLICHOCOLON; MEGALOAPPENDIX; MEGALODUODENUM; MICROCOLON; TRANSPOSITION OF APPENDIX; TRANSPOSITIO|14,690.00|10,283.00|4,407.00
Q43.9|CONGENITAL MALFORMATION OF INTESTINE, UNSPECIFIED|14,690.00|10,283.00|4,407.00
Q44.0|AGENESIS, APLASIA AND HYPOPLASIA OF GALLBLADDER; CONGENITAL ABSENCE OF GALLBLADDER|14,690.00|10,283.00|4,407.00
Q44.1|OTHER CONGENITAL MALFORMATIONS OF GALLBLADDER; CONGENITAL MALFORMATION OF GALLBLADDER NOS; INTRAHEPATIC GALLBLADDER|14,690.00|10,283.00|4,407.00
Q44.2|ATRESIA OF BILE DUCTS|14,690.00|10,283.00|4,407.00
Q44.3|CONGENITAL STENOSIS AND STRICTURE OF BILE DUCTS|14,690.00|10,283.00|4,407.00
Q44.4|CHOLEDOCHAL CYST|14,690.00|10,283.00|4,407.00
Q44.5|OTHER CONGENITAL MALFORMATIONS OF BILE DUCTS; ACCESSORY HEPATIC DUCT; CONGENITAL MALFORMATION OF BILE DUCT NOS;  BILIARY DUCT DUPLICATION;  CYSTIC DUCT DUPLICATION|14,690.00|10,283.00|4,407.00
Q44.6|CYSTIC DISEASE OF LIVER; FIBROCYSTIC DISEASE OF LIVER|14,690.00|10,283.00|4,407.00
Q44.7|OTHER CONGENITAL MALFORMATIONS OF LIVER; ACCESSORY LIVER; ALAGILLE'S SYNDROME; CONGENITAL ABSENCE OF LIVER; CONGENITAL HEPATOMEGALY; CONGENITAL MALFORMATION OF LIVER NOS|14,690.00|10,283.00|4,407.00
Q45.0|AGENESIS, APLASIA AND HYPOPLASIA OF PANCREAS; CONGENITAL ABSENCE OF PANCREAS|14,690.00|10,283.00|4,407.00
Q45.8|OTHER SPECIFIED CONGENITAL MALFORMATIONS OF DIGESTIVE SYSTEM; ABSENCE OF ALIMENTARY TRACT NOS, COMPLETE; ABSENCE OF ALIMENTARY TRACT NOS, PARTIAL; DUPLICATION OF DIGESTIVE ORGANS NOS; MALPOSITION, CONGENITAL OF DIGESTIVE ORGANS NOS|14,690.00|10,283.00|4,407.00
Q45.9|CONGENITAL MALFORMATION OF DIGESTIVE SYSTEM, UNSPECIFIED; CONGENITAL ANOMALY NOS OF DIGESTIVE SYSTEM  ; CONGENITAL DEFORMITY NOS OF DIGESTIVE SYSTEM|14,690.00|10,283.00|4,407.00
Q50.1|DEVELOPMENTAL OVARIAN CYST|12,090.00|8,463.00|3,627.00
Q50.3|OTHER CONGENITAL MALFORMATIONS OF OVARY; ACCESSORY OVARY; CONGENITAL MALFORMATION OF OVARY NOS; OVARIAN STREAK|12,090.00|8,463.00|3,627.00
Q50.4|EMBRYONIC CYST OF FALLOPIAN TUBE; FIMBRIAL CYST|12,090.00|8,463.00|3,627.00
Q50.5|EMBRYONIC CYST OF BROAD LIGAMENT; CYST EPOOPHORON;  GARTNER'S DUCT CYST; PAROVARIAN  CYST|12,090.00|8,463.00|3,627.00
Q50.6|OTHER CONGENITAL MALFORMATIONS OF FALLOPIAN TUBE AND BROAD LIGAMENT; ABSENCE OF FALLOPIAN TUBE OR BROAD LIGAMENT; ACCESSORY OF FALLOPIAN TUBE OR BROAD LIGAMENT;  ATRESIA OF FALLOPIAN TUBE OR BROAD LIGAMENT; CONGENITAL MALFORMATION OF FALLOPIAN TUBE OR BRO|12,090.00|8,463.00|3,627.00
Q51.0|AGENESIS AND APLASIA OF UTERUS; CONGENITAL ABSENCE OF UTERUS|12,090.00|8,463.00|3,627.00
Q51.2|OTHER DOUBLING OF UTERUS' DOUBLING OF UTERUS NOS|10,140.00|7,098.00|3,042.00
Q51.3|BICORNATE UTERUS|10,140.00|7,098.00|3,042.00
Q51.8|OTHER CONGENITAL MALFORMATIONS OF UTERUS AND CERVIX; HYPOPLASIA OF UTERUS AND CERVIX|10,140.00|7,098.00|3,042.00
Q51.9|CONGENITAL MALFORMATION OF UTERUS AND CERVIX, UNSPECIFIED|12,090.00|8,463.00|3,627.00
Q52.1|DOUBLING OF VAGINA; SEPTATE VAGINA|10,140.00|7,098.00|3,042.00
Q52.2|CONGENITAL RECTOVAGINAL FISTULA|10,140.00|7,098.00|3,042.00
Q52.3|IMPERFORATE HYMEN|10,140.00|7,098.00|3,042.00
Q52.8|OTHER SPECIFIED CONGENITAL MALFORMATIONS OF FEMALE GENITALIA|10,140.00|7,098.00|3,042.00
Q55.0|ABSENCE AND APLASIA OF TESTIS; MONORCHISM|8,320.00|5,824.00|2,496.00
Q55.1|HYPOPLASIA OF TESTIS AND SCROTUM; FUSION OF TESTES|8,320.00|5,824.00|2,496.00
Q55.2|OTHER CONGENITAL MALFORMATIONS OF TESTIS AND SCROTUM; CONGENITAL MALFORMATION OF TESTIS OR SCROTUM NOS; POLYORCHISM; RETRACTILE TESTIS; TESTIS MIGRANS|8,320.00|5,824.00|2,496.00
Q55.4|OTHER CONGENITAL MALFORMATIONS OF VAS DEFERENS, EPIDIDYMIS, SEMINAL VESICLES AND PROSTATE; ABSENCE OR APLASIA OF PROSTATE; ABSENCE OR APLASIA OF SPERMATIC CORD; CONGENITAL MALFORMATION OF VAS DEFERENS, EPIDIDYMIS, SEMINAL VESICLES OR PROSTATE NOS|8,320.00|5,824.00|2,496.00
Q55.6|OTHER CONGENITAL MALFORMATIONS OF PENIS; CONGENITAL MALFORMATION OF PENIS NOS; CURVATURE OF PENIS (LATERAL); HYPOPLASIA OF PENIS|8,320.00|5,824.00|2,496.00
Q55.9|CONGENITAL MALFORMATION OF MALE GENITAL ORGAN, UNSPECIFIED; CONGENITAL ANOMALYNOS OF MALE GENITAL ORGAN ; CONGENITAL DEFORMITY NOS OF MALE GENITAL ORGAN|8,320.00|5,824.00|2,496.00
Q56.1|MALE PSEUDOHERMAPHRODITISM, NOT ELSEWHERE CLASSIFIED; MALE PSEUDOHERMAPHRODITISM NOS|8,320.00|5,824.00|2,496.00
Q56.3|PSEUDOHERMAPHRODITISM, UNSPECIFIED|8,320.00|5,824.00|2,496.00
Q60.0|RENAL AGENESIS, UNILATERAL|11,830.00|8,281.00|3,549.00
Q60.1|RENAL AGENESIS, BILATERAL|11,830.00|8,281.00|3,549.00
Q60.2|RENAL AGENESIS, UNSPECIFIED|11,830.00|8,281.00|3,549.00
Q60.3|RENAL HYPOPLASIA, UNILATERAL|11,830.00|8,281.00|3,549.00
Q60.5|RENAL HYPOPLASIA, UNSPECIFIED|11,830.00|8,281.00|3,549.00
Q60.6|POTTER'S SYNDROME|11,830.00|8,281.00|3,549.00
Q61.0|CONGENITAL SINGLE RENAL CYST; CONGENITAL CYST OF KIDNEY; SINGLE CYST OF KIDNEY|11,830.00|8,281.00|3,549.00
Q61.1|POLYCYSTIC KIDNEY, AUTOSOMAL RECESSIVE; POLYCYSTIC KIDNEY, INFANTILE TYPE|11,830.00|8,281.00|3,549.00
Q61.2|POLYCYSTIC KIDNEY, AUTOSOMAL DOMINANT; POLYCYSTIC KIDNEY, ADULT TYPE|11,830.00|8,281.00|3,549.00
Q61.3|POLYCYSTIC KIDNEY, UNSPECIFIED|11,830.00|8,281.00|3,549.00
Q61.4|RENAL DYSPLASIA|11,830.00|8,281.00|3,549.00
Q61.5|MEDULLARY CYSTIC KIDNEY; SPONGE KIDNEY NOS|11,830.00|8,281.00|3,549.00
Q61.8|OTHER CYSTIC KIDNEY DISEASES; FIBROCYSTIC KIDNEY; FIBROCYSTIC RENAL DEGENERATION OR DISEASE|11,830.00|8,281.00|3,549.00
Q61.9|CYSTIC KIDNEY DISEASE, UNSPECIFIED; MECKEL-GRUBER SYNDROME|11,830.00|8,281.00|3,549.00
Q62.0|CONGENITAL HYDRONEPHROSIS|11,830.00|8,281.00|3,549.00
Q62.1|ATRESIA AND STENOSIS OF URETER; CONGENITAL OCCLUSION OF  URETER; CONGENITAL OCCLUSION OF URETEROPELVIC JUNCTION; CONGENITAL OCCLUSION OF URETEROVESICAL ORIFICE; IMPERVIOUS URETER|11,830.00|8,281.00|3,549.00
Q62.2|CONGENITAL MEGALOURETER; CONGENITAL DILATATION OF URETER|11,830.00|8,281.00|3,549.00
Q62.3|OTHER OBSTRUCTIVE DEFECTS OF RENAL PELVIS AND URETER; CONGENITAL URETEROCELE|11,830.00|8,281.00|3,549.00
Q62.5|DUPLICATION OF URETER; ACCESSORY OF URETER, DOUBLE OF URETER|11,830.00|8,281.00|3,549.00
Q62.6|MALPOSITION OF URETER; DEVIATION OF URETER OR URETERIC ORIFICE; DISPLACEMENT OF URETER OR URETERIC ORIFICE; ECTOPIC OF URETER OF URETERIC ORIFICE; IMPLANTATION, ANOMALOUS OF URETER OR URETERIC ORIFICE|11,830.00|8,281.00|3,549.00
Q62.7|CONGENITAL VESICO-URETERO-RENAL REFLUX|11,830.00|8,281.00|3,549.00
Q63.0|ACCESSORY KIDNEY|11,830.00|8,281.00|3,549.00
Q63.1|LOBULATED, FUSED AND HORSESHOE KIDNEY|11,830.00|8,281.00|3,549.00
Q63.2|ECTOPIC KIDNEY; CONGENITAL DISPLACED KIDNEY; MALROTATION OF KIDNEY|11,830.00|8,281.00|3,549.00
Q63.3|HYPERPLASTIC AND GIANT KIDNEY|11,830.00|8,281.00|3,549.00
Q63.8|OTHER SPECIFIED CONGENITAL MALFORMATIONS OF KIDNEY; CONGENITAL RENAL CALCULI|11,830.00|8,281.00|3,549.00
Q64.1|EXSTROPHY OF URINARY BLADDER; ECTOPIA VESICAE; EXTROVERSION OF BLADDER|11,830.00|8,281.00|3,549.00
Q64.2|CONGENITAL POSTERIOR URETHRAL VALVES|11,830.00|8,281.00|3,549.00
Q64.3|OTHER ATRESIA AND STENOSIS OF URETHRA AND BLADDER NECK; CONGENITAL BLADDER NECK OBSTRUCTION; CONGENITAL STRICTURE OF URETHRA; CONGENITAL STRICTURE OF URINARY MEATUS; CONGENITAL STRICTURE OF VESICOURETHRAL ORIFICE; IMPERVIOUS URETHRA|11,830.00|8,281.00|3,549.00
Q64.4|MALFORMATION OF URACHUS; CYST OF URACHUS; PATENT URACHUS; PROLAPSE OF URACHUS|11,830.00|8,281.00|3,549.00
Q64.7|OTHER CONGENITAL MALFORMATIONS OF BLADDER AND URETHRA; ACCESSORY BLADDER; ACCESSORY URETHRA; CONGENITAL HERNIA OF BLADDER; CONGENITAL MALFORMATION OF BLADDER OR URETHRA NOS; CONGENITAL PROLAPSE OF BLADDER (MUCOSA); CONGENITAL PROLAPSE OF URETHRA; CONGENIT|11,830.00|8,281.00|3,549.00
Q64.8|OTHER SPECIFIED CONGENITAL MALFORMATIONS OF URINARY SYSTEM|11,830.00|8,281.00|3,549.00
Q64.9|CONGENITAL MALFORMATION OF URINARY SYSTEM, UNSPECIFIED; CONGENITAL  ANOMALY NOS OF URINARY SYSTEM; CONGENITAL DEFORMITY NOS OF URINARY SYSTEM|11,830.00|8,281.00|3,549.00
Q65.6|UNSTABLE HIP; DISLOCATABLE HIP; SUBLUXATABLE HIP|6,890.00|4,823.00|2,067.00
Q67.3|PLAGIOCEPHALY|6,890.00|4,823.00|2,067.00
Q67.4|OTHER CONGENITAL DEFORMITIES OF SKULL, FACE AND JAW; DEPRESSIONS IN SKULL; DEVIATION OF NASAL SEPTUM, CONGENITAL; HEMIFACIAL ATROPHY OR HYPERTROPHY; SQUASHED OR BENT NOSE, CONGENITAL|6,890.00|4,823.00|2,067.00
Q67.6|PECTUS EXCAVATUM; CONGENITAL FUNNEL CHEST|6,890.00|4,823.00|2,067.00
Q67.7|PECTUS CARINATUM; CONGENITAL PIGEON CHEST|6,890.00|4,823.00|2,067.00
Q68.0|CONGENITAL DEFORMITY OF STERNOCLEIDOMASTOID MUSCLE; CONGENITAL, STERNOMASTOID TORTICOLLIS; CONTRACTURE OF STERNOCLEIDOMASTOID MUSCLE; STERNOMASTOID TUMOUR, CONGENITAL|6,890.00|4,823.00|2,067.00
Q74.3|ARTHROGRYPOSIS MULTIPLEX CONGENITA|16,900.00|11,830.00|5,070.00
Q75.0|CRANIOSYNOSTOSIS; ACROCEPHALY; ]IMPERFECT FUSION OF SKULL; OXYCEPHALY; TRIGONOCEPHALY|16,900.00|11,830.00|5,070.00
Q75.1|CRANIOFACIAL DYSOSTOSIS; CROUZON'S DISEASE|16,900.00|11,830.00|5,070.00
Q75.2|HYPERTELORISM|16,900.00|11,830.00|5,070.00
Q75.4|MANDIBULOFACIAL DYSOSTOSIS;  FRANCESCHETTI SYNDROME;  TREACHER COLLINS SYNDROME|16,900.00|11,830.00|5,070.00
Q75.8|OTHER SPECIFIED CONGENITAL MALFORMATIONS OF SKULL AND FACE BONES; ABSENCE OF SKULL BONE, CONGENITAL; CONGENITAL DEFORMITY OF FOREHEAD; PLATYBASIA|16,900.00|11,830.00|5,070.00
Q75.9|CONGENITAL MALFORMATION OF SKULL AND FACE BONES, UNSPECIFIED; CONGENITAL ANOMALY OF FACE BONES NOS; CONGENITAL ANOMALY OF SKULL NOS|16,900.00|11,830.00|5,070.00
Q76.0|SPINA BIFIDA OCCULTA|16,900.00|11,830.00|5,070.00
Q76.3|CONGENITAL SCOLIOSIS DUE TO CONGENITAL BONY MALFORMATION; HEMIVERTEBRA FUSION OR FAILURE OF SEGMENTATION WITH SCOLIOSIS|6,890.00|4,823.00|2,067.00
Q76.4|OTHER CONGENITAL MALFORMATIONS OF SPINE, NOT ASSOCIATED WITH SCOLIOSIS; CONGENITAL ABSENCE OF VERTEBRA UNSPECIFIED OR NOT ASSOCIATED WITH SCOLIOSIS; CONGENITAL FUSION OF SPINE UNSPECIFIED OR NOT ASSOCIATED WITH SCOLIOSIS; CONGENITAL KYPHOSIS UNSPECIFIED O|16,900.00|11,830.00|5,070.00
Q78.0|OSTEOGENESIS IMPERFECTA; FRAGILITAS OSSIUM|6,890.00|4,823.00|2,067.00
Q78.2|OSTEOPETROSIS; ALBERS-SCHöNBERG SYNDROME|6,890.00|4,823.00|2,067.00
Q78.8|OTHER SPECIFIED OSTEOCHONDRODYSPLASIAS; OSTEOPOIKILOSIS|6,890.00|4,823.00|2,067.00
Q78.9|OSTEOCHONDRODYSPLASIA, UNSPECIFIED; CHONDRODYSTROPHY NOS; OSTEODYSTROPHY NOS|6,890.00|4,823.00|2,067.00
Q79.0|CONGENITAL DIAPHRAGMATIC HERNIA|14,690.00|10,283.00|4,407.00
Q79.1|OTHER CONGENITAL MALFORMATIONS OF DIAPHRAGM; ABSENCE OF DIAPHRAGM; CONGENITAL MALFORMATION OF DIAPHRAGM NOS; EVENTRATION OF DIAPHRAGM|14,690.00|10,283.00|4,407.00
Q79.2|EXOMPHALOS; OMPHALOCELE|14,690.00|10,283.00|4,407.00
Q79.3|GASTROSCHISIS|14,690.00|10,283.00|4,407.00
Q79.4|PRUNE BELLY SYNDROME|14,690.00|10,283.00|4,407.00
Q79.5|OTHER CONGENITAL MALFORMATIONS OF ABDOMINAL WALL|14,690.00|10,283.00|4,407.00
Q80.2|LAMELLAR ICHTHYOSIS; COLLODION BABY|15,340.00|10,738.00|4,602.00
Q80.9|CONGENITAL ICHTHYOSIS, UNSPECIFIED|15,340.00|10,738.00|4,602.00
Q81.2|EPIDERMOLYSIS BULLOSA DYSTROPHICA|15,340.00|10,738.00|4,602.00
Q81.8|OTHER EPIDERMOLYSIS BULLOSA|15,340.00|10,738.00|4,602.00
Q81.9|EPIDERMOLYSIS BULLOSA, UNSPECIFIED|15,340.00|10,738.00|4,602.00
Q82.0|HEREDITARY LYMPHOEDEMA|15,340.00|10,738.00|4,602.00
Q82.2|MASTOCYTOSIS; URTICARIA PIGMENTOSA|15,340.00|10,738.00|4,602.00
Q82.3|INCONTINENTIA PIGMENTI|15,340.00|10,738.00|4,602.00
Q82.4|ECTODERMAL DYSPLASIA (ANHIDROTIC)|15,340.00|10,738.00|4,602.00
Q82.8|OTHER SPECIFIED CONGENITAL MALFORMATIONS OF SKIN; ABNORMAL PALMAR CREASES; ACCESSORY SKIN TAGS; BENIGN FAMILIAL PEMPHIGUS [HAILEY-HAILEY]; CUTIS LAXA (HYPERELASTICA); DERMATOGLYPHIC ANOMALIES; INHERITED KERATOSIS PALMARIS ET PLANTARIS; KERATOSIS FOLLICULA|15,340.00|10,738.00|4,602.00
Q84.8|OTHER SPECIFIED CONGENITAL MALFORMATIONS OF INTEGUMENT; APLASIA CUTIS CONGENITA|15,340.00|10,738.00|4,602.00
Q85.1|TUBEROUS SCLEROSIS; BOURNEVILLE'S DISEASE; EPILOIA|15,080.00|10,556.00|4,524.00
Q85.8|OTHER PHAKOMATOSES, NOT ELSEWHERE CLASSIFIED; PEUTZ-JEGHERS SYNDROME;  STURGE-WEBER(- DIMITRI)SYNDROME;  VON HIPPEL-LINDAU SYNDROME|14,040.00|9,828.00|4,212.00
Q85.9|PHAKOMATOSIS, UNSPECIFIED; HAMARTOSIS NOS|14,040.00|9,828.00|4,212.00
Q87.0|CONGENITAL MALFORMATION SYNDROMES PREDOMINANTLY AFFECTING FACIAL APPEARANCE; ACROCEPHALOPOLYSYNDACTYLY; ACROCEPHALOSYNDACTYLY [APERT]; CRYPTOPHTHALMOS SYNDROME; CYCLOPIA; SYNDROME  GOLDENHAR; MOEBIUS SYNDROME;  ORO-FACIAL-DIGITAL SYNDROME; ROBIN SYNDROM|15,080.00|10,556.00|4,524.00
Q87.1|CONGENITAL MALFORMATION SYNDROMES PREDOMINANTLY ASSOCIATED WITH SHORT STATURE; AARSKOG SYNDROME;  COCKAYNE SYNDROME; DE LANGE SYNDROME ;  DUBOWITZ SYNDROME;  NOONAN; SYNDROME PRADER-WILLI SYNDROME; ROBINOW-SILVERMAN-SMITH SYNDROME ; RUSSELL-SILVER; SYN|15,080.00|10,556.00|4,524.00
Q87.2|CONGENITAL MALFORMATION SYNDROMES PREDOMINANTLY INVOLVING LIMBS;  HOLT-ORAM SYNDROME;  KLIPPEL-TRéNAUNAY-WEBER SYNDROME; NAIL PATELLA SYNDROME; RUBINSTEIN-TAYBI SYNDROME;  SIRENOMELIA SYNDROME;  THROMBOCYTOPENIA SYNDROME WITH ABSENT RADIUS [TAR];  VAT|15,080.00|10,556.00|4,524.00
Q87.3|CONGENITAL MALFORMATION SYNDROMES INVOLVING EARLY OVERGROWTH;  BECKWITH-WIEDEMANN SYNDROME; SOTOS; SYNDROME WEAVER SYNDROME|15,080.00|10,556.00|4,524.00
Q87.4|MARFAN'S SYNDROME|15,080.00|10,556.00|4,524.00
Q87.5|OTHER CONGENITAL MALFORMATION SYNDROMES WITH OTHER SKELETAL CHANGES|6,890.00|4,823.00|2,067.00
Q87.8|OTHER SPECIFIED CONGENITAL MALFORMATION SYNDROMES, NOT ELSEWHERE CLASSIFIED;  ALPOR SYNDROME; LAURENCE-MOON(-BARDET)-BIEDL SYNDROME;  ZELLWEGER  SYNDROME|15,080.00|10,556.00|4,524.00
Q89.0|CONGENITAL MALFORMATIONS OF SPLEEN; ASPLENIA (CONGENITAL); CONGENITAL SPLENOMEGALY|15,080.00|10,556.00|4,524.00
Q89.1|CONGENITAL MALFORMATIONS OF ADRENAL GLAND|15,080.00|10,556.00|4,524.00
Q89.2|CONGENITAL MALFORMATIONS OF OTHER ENDOCRINE GLANDS; CONGENITAL MALFORMATION OF PARATHYROID OR THYROID GLAND; PERSISTENT THYROGLOSSAL DUCT; THYROGLOSSAL CYST|15,080.00|10,556.00|4,524.00
Q89.3|SITUS INVERSUS; DEXTROCARDIA WITH SITUS INVERSUS; MIRROR-IMAGE ATRIAL ARRANGEMENT WITH SITUS INVERSUS; SITUS INVERSUS OR TRANSVERSES ABDOMINALIS; SITUS INVERSUS OR TRANSVERSUS THORACIS; TRANSPOSITION OF  ABDOMINAL VISCERA; TRANSPOSITION OF THORACIC  VISCE|8,710.00|6,097.00|2,613.00
Q89.4|CONJOINED TWINS; CRANIOPAGUS; DICEPHALY; DOUBLE MONSTER; PYGOPAGUS; THORACOPAGUS|15,080.00|10,556.00|4,524.00
Q89.7|MULTIPLE CONGENITAL MALFORMATIONS, NOT ELSEWHERE CLASSIFIED; MONSTER NOS; MULTIPLE CONGENITAL ANOMALIES NOS; MULTIPLE CONGENITAL DEFORMITIES NOS|15,080.00|10,556.00|4,524.00
Q89.8|OTHER SPECIFIED CONGENITAL MALFORMATIONS|15,080.00|10,556.00|4,524.00
Q89.9|CONGENITAL MALFORMATION, UNSPECIFIED; CONGENITAL ANOMALY NOS; CONGENITAL DEFORMITY NOS|15,080.00|10,556.00|4,524.00
Q90.0|TRISOMY 21, MEIOTIC NONDISJUNCTION|16,510.00|11,557.00|4,953.00
Q90.2|TRISOMY 21, TRANSLOCATION|16,510.00|11,557.00|4,953.00
Q90.9|DOWN'S SYNDROME, UNSPECIFIED; TRISOMY 21 NOS|16,510.00|11,557.00|4,953.00
Q91.0|TRISOMY 18, MEIOTIC NONDISJUNCTION|16,510.00|11,557.00|4,953.00
Q91.2|TRISOMY 18, TRANSLOCATION|16,510.00|11,557.00|4,953.00
Q91.3|EDWARDS' SYNDROME, UNSPECIFIED|16,510.00|11,557.00|4,953.00
Q91.7|PATAU'S SYNDROME, UNSPECIFIED|16,510.00|11,557.00|4,953.00
Q92.9|TRISOMY AND PARTIAL TRISOMY OF AUTOSOMES, UNSPECIFIED|16,510.00|11,557.00|4,953.00
Q93.1|WHOLE CHROMOSOME MONOSOMY, MOSAICISM (MITOTIC NONDISJUNCTION)|16,510.00|11,557.00|4,953.00
Q93.2|CHROMOSOME REPLACED WITH RING OR DICENTRIC|16,510.00|11,557.00|4,953.00
Q93.4|DELETION OF SHORT ARM OF CHROMOSOME 5; CRI-DU- CHAT SYNDROME|16,510.00|11,557.00|4,953.00
Q93.5|OTHER DELETIONS OF PART OF A CHROMOSOME; ANGELMAN SYNDROME|16,510.00|11,557.00|4,953.00
Q93.7|DELETIONS WITH OTHER COMPLEX REARRANGEMENTS|16,510.00|11,557.00|4,953.00
Q93.9|DELETION FROM AUTOSOMES, UNSPECIFIED|16,510.00|11,557.00|4,953.00
Q95.9|BALANCED REARRANGEMENT AND STRUCTURAL MARKER, UNSPECIFIED|16,510.00|11,557.00|4,953.00
Q96.9|TURNER'S SYNDROME, UNSPECIFIED|16,510.00|11,557.00|4,953.00
Q97.9|SEX CHROMOSOME ABNORMALITY, FEMALE PHENOTYPE, UNSPECIFIED|16,510.00|11,557.00|4,953.00
Q98.4|KLINEFELTER'S SYNDROME, UNSPECIFIED|16,510.00|11,557.00|4,953.00
Q99.2|FRAGILE X CHROMOSOME;  FRAGILE X SYNDROME|16,510.00|11,557.00|4,953.00
Q99.8|OTHER SPECIFIED CHROMOSOME ABNORMALITIES|16,510.00|11,557.00|4,953.00
R02|GANGRENE, NOT ELSEWHERE CLASSIFIED|17,160.00|12,012.00|5,148.00
R29.0|TETANY; CARPOPEDAL SPASM|21,450.00|15,015.00|6,435.00
R32|UNSPECIFIED URINARY INCONTINENCE; ENURESIS NOS|11,700.00|8,190.00|3,510.00
R41.0|DISORIENTATION, UNSPECIFIED; CONFUSION NOS|10,660.00|7,462.00|3,198.00
R41.3|OTHER AMNESIA; AMNESIA NOS|10,660.00|7,462.00|3,198.00
R42|DIZZINESS AND GIDDINESS; LIGHT-HEADEDNESS; VERTIGO NOS|7,410.00|5,187.00|2,223.00
R50.9|FEVER, UNSPECIFIED; HYPERPYREXIA NOS; PYREXIA NOS|9,100.00|6,370.00|2,730.00
R51|HEADACHE; FACIAL PAIN NOS|7,150.00|5,005.00|2,145.00
R54|SENILITY; OLD AGE WITHOUT MENTION OF PSYCHOSIS; SENESCENCE WITHOUT MENTION OF PSYCHOSIS; SENILE ASTHENIA; SENILE DEBILITY|10,660.00|7,462.00|3,198.00
R56.0|FEBRILE CONVULSIONS|9,100.00|6,370.00|2,730.00
R56.8|OTHER AND UNSPECIFIED CONVULSIONS; FIT NOS; SEIZURE (CONVULSIVE) NOS|9,100.00|6,370.00|2,730.00
R57.0|CARDIOGENIC SHOCK|41,600.00|29,120.00|12,480.00
R57.1|HYPOVOLAEMIC SHOCK|41,600.00|29,120.00|12,480.00
R57.8|OTHER SHOCK; ENDOTOXIC SHOCK|41,600.00|29,120.00|12,480.00
R57.9|SHOCK, UNSPECIFIED; FAILURE OF PERIPHERAL CIRCULATION NOS|41,600.00|29,120.00|12,480.00
S00.0|SUPERFICIAL INJURY OF SCALP|5,200.00|3,640.00|1,560.00
S00.1|CONTUSION OF EYELID AND PERIOCULAR AREA; BLACK EYE|5,200.00|3,640.00|1,560.00
S00.2|OTHER SUPERFICIAL INJURIES OF EYELID AND PERIOCULAR AREA|5,200.00|3,640.00|1,560.00
S00.3|SUPERFICIAL INJURY OF NOSE|5,200.00|3,640.00|1,560.00
S00.4|SUPERFICIAL INJURY OF EAR|5,200.00|3,640.00|1,560.00
S00.5|SUPERFICIAL INJURY OF LIP AND ORAL CAVITY|5,200.00|3,640.00|1,560.00
S00.7|MULTIPLE SUPERFICIAL INJURIES OF HEAD|5,200.00|3,640.00|1,560.00
S00.8|SUPERFICIAL INJURY OF OTHER PARTS OF HEAD|5,200.00|3,640.00|1,560.00
S00.9|SUPERFICIAL INJURY OF HEAD, PART UNSPECIFIED|5,200.00|3,640.00|1,560.00
S01.0|OPEN WOUND OF SCALP|5,200.00|3,640.00|1,560.00
S01.1|OPEN WOUND OF EYELID AND PERIOCULAR AREA|5,200.00|3,640.00|1,560.00
S01.2|OPEN WOUND OF NOSE|5,200.00|3,640.00|1,560.00
S01.3|OPEN WOUND OF EAR|5,200.00|3,640.00|1,560.00
S01.4|OPEN WOUND OF CHEEK AND TEMPOROMANDIBULAR AREA|5,200.00|3,640.00|1,560.00
S01.5|OPEN WOUND OF LIP AND ORAL CAVITY|5,200.00|3,640.00|1,560.00
S01.7|MULTIPLE OPEN WOUNDS OF HEAD|5,200.00|3,640.00|1,560.00
S01.8|OPEN WOUND OF OTHER PARTS OF HEAD|5,200.00|3,640.00|1,560.00
S01.9|OPEN WOUND OF HEAD, PART UNSPECIFIED|5,200.00|3,640.00|1,560.00
S02.0|FRACTURE O F VAULT OF SKULL; FRACTURE OF FRONTAL BONE; FRACTURE OF PARIETAL BONE|13,910.00|9,737.00|4,173.00
S02.00|CLOSED FRACTURE OF VAULT OF SKULL/ FRONTAL BONE/ PARIETAL BONE|13,910.00|9,737.00|4,173.00
S02.01|OPEN FRACTURE OF VAULT OF SKULL/ FRONTAL BONE/ PARIETAL BONE|13,910.00|9,737.00|4,173.00
S02.1|FRACTURE OF BASE OF SKULL: FRACTURE OF ANTERIOR FOSSA, MIDDLE FOSSA, POSTERIOR FOSSA; FRACTURE OF OCCIPUT; FRACTURE OF ORBITAL ROOF; FRACTURE OF ETHMOID SINUS & FRONTAL SINUS; FRACTURE OF SPHENOID; FRACTURE OF TEMPORAL BONE|13,910.00|9,737.00|4,173.00
S02.10|CLOSED FRACTURE OF BASE OF SKULL/ ANTERIOR FOSSA/ MIDDLE FOSSA/ POSTERIOR FOSSA/ OCCIPUT/ ORBITAL ROOF/ ETHMOID SINUS/ FRONTAL SINUS/ SPHENOID/ TEMPORAL BONE|13,910.00|9,737.00|4,173.00
S02.11|OPEN FRACTURE OF BASE OF SKULL/ ANTERIOR FOSSA/ MIDDLE FOSSA/ POSTERIOR FOSSA/ OCCIPUT/ ORBITAL ROOF/ ETHMOID SINUS/ FRONTAL SINUS/ SPHENOID/ TEMPORAL BONE|13,910.00|9,737.00|4,173.00
S02.20|CLOSED FRACTURE OF NASAL BONES|13,910.00|9,737.00|4,173.00
S02.21|OPEN FRACTURE OF NASAL BONES|13,910.00|9,737.00|4,173.00
S02.30|CLOSED FRACTURE OF ORBITAL FLOOR|13,910.00|9,737.00|4,173.00
S02.31|OPEN FRACTURE OF ORBITAL FLOOR|13,910.00|9,737.00|4,173.00
S02.40|CLOSED FRACTURE OF MALAR AND MAXILLARY BONES|13,910.00|9,737.00|4,173.00
S02.41|OPEN FRACTURE OF MALAR AND MAXILLARY BONES|13,910.00|9,737.00|4,173.00
S02.50|CLOSED FRACTURE OF TOOTH|13,910.00|9,737.00|4,173.00
S02.60|CLOSED FRACTURE OF MANDIBLE|13,910.00|9,737.00|4,173.00
S02.61|OPEN FRACTURE OF MANDIBLE|13,910.00|9,737.00|4,173.00
S02.70|CLOSED MULTIPLE FRACTURES INVOLVING SKULL AND FACIAL BONES|13,910.00|9,737.00|4,173.00
S02.71|OPEN MULTIPLE FRACTURES INVOLVING SKULL AND FACIAL BONES|13,910.00|9,737.00|4,173.00
S02.80|CLOSED FRACTURES OF OTHER SKULL AND FACIAL BONES INCLUDING ALVEOLUS, ORBIT NOS, PALATE|13,910.00|9,737.00|4,173.00
S02.81|OPEN FRACTURES OF OTHER SKULL AND FACIAL BONES INCLUDING ALVEOLUS, ORBIT NOS, PALATE|13,910.00|9,737.00|4,173.00
S02.90|CLOSED FRACTURE OF SKULL AND FACIAL BONES, PART UNSPECIFIED|13,910.00|9,737.00|4,173.00
S02.91|OPEN FRACTURE OF SKULL AND FACIAL BONES, PART UNSPECIFIED|13,910.00|9,737.00|4,173.00
S04.0|INJURY OF OPTIC NERVE AND PATHWAYS; INJURY OF OPTIC CHIASM; INJURY OF 2ND CRANIAL NERVE; INJURY OF VISUAL CORTEX|11,440.00|8,008.00|3,432.00
S04.1|INJURY OF OCULOMOTOR NERVE; INJURY OF 3RD CRANIAL NERVE|11,440.00|8,008.00|3,432.00
S04.4|INJURY OF ABDUCENT NERVE; INJURY OF 6TH CRANIAL NERVE|11,440.00|8,008.00|3,432.00
S04.5|INJURY OF FACIAL NERVE; INJURY OF 7TH CRANIAL NERVE|11,440.00|8,008.00|3,432.00
S04.6|INJURY OF ACOUSTIC NERVE; INJURY OF AUDITORY NERVE; INJURY OF 8TH CRANIAL NERVE|11,440.00|8,008.00|3,432.00
S04.8|INJURY OF OTHER CRANIAL NERVES; INJURY OF GLOSSOPHARYNGEAL [9TH] NERVE; INJURY OF HYPOGLOSSAL [12TH] NERVE; INJURY OF; INJURY OF OLFACTORY [1ST] NERVE; INJURY OF VAGUS [10TH] NERVE|11,440.00|8,008.00|3,432.00
S04.9|INJURY OF UNSPECIFIED CRANIAL NERVE|11,440.00|8,008.00|3,432.00
S05.0|INJURY OF CONJUNCTIVA AND CORNEAL ABRASION WITHOUT MENTION OF FOREIGN BODY|11,440.00|8,008.00|3,432.00
S06.00|CONCUSSION; COMMOTIO CEREBRI (WITHOUT OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.01|CONCUSSION; COMMOTIO CEREBRI (WITH OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.10|TRAUMATIC CEREBRAL OEDEMA (WITHOUT OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.20|DIFFUSE BRAIN INJURY; CEREBRAL CONTUSION NOS; CEREBRAL LACERATION NOS; TRAUMATIC COMPRESSION OF BRAIN NOS (WITHOUT OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.21|DIFFUSE BRAIN INJURY; CEREBRAL CONTUSION NOS; CEREBRAL LACERATION NOS; TRAUMATIC COMPRESSION OF BRAIN NOS (WITHOUT OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.30|FOCAL BRAIN INJURY; FOCAL CEREBRAL; FOCAL CEREBRAL CONTUSION; FOCAL CEREBRAL LACERATION; FOCAL TRAUMATIC INTRACEREBRAL HAEMORRHAGE (WITHOUT OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.31|FOCAL BRAIN INJURY; FOCAL CEREBRAL; FOCAL CEREBRAL CONTUSION; FOCAL CEREBRAL LACERATION; FOCAL TRAUMATIC INTRACEREBRAL HAEMORRHAGE (WITH OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.40|EPIDURAL HAEMORRHAGE; EXTRADURAL HAEMORRHAGE, TRAUMATIC (WITHOUT OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.41|EPIDURAL HAEMORRHAGE; EXTRADURAL HAEMORRHAGE, TRAUMATIC (WITH OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.50|TRAUMATIC SUBDURAL HAEMORRHAGE (WITHOUT OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.51|TRAUMATIC SUBDURAL HAEMORRHAGE (WITH OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.60|TRAUMATIC SUBARACHNOID HAEMORRHAGE (WITHOUT OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.61|TRAUMATIC SUBARACHNOID HAEMORRHAGE (WITH OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.70|INTRACRANIAL INJURY WITH PROLONGED COMA (WITHOUT OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.80|OTHER INTRACRANIAL INJURIES; TRAUMATIC HAEMORRHAGE CEREBELLAR; TRAUMATIC HAEMORRHAGE INTRACRANIAL NOS (WITHOUT OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.81|OTHER INTRACRANIAL INJURIES; TRAUMATIC HAEMORRHAGE CEREBELLAR; TRAUMATIC HAEMORRHAGE INTRACRANIAL NOS (WITH OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.90|INTRACRANIAL INJURY, UNSPECIFIED; BRAIN INJURY NOS (WITHOUT OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S06.91|INTRACRANIAL INJURY, UNSPECIFIED; BRAIN INJURY NOS (WITH OPEN INTRACRANIAL WOUND)|11,440.00|8,008.00|3,432.00
S09.0|INJURY OF BLOOD VESSELS OF HEAD, NOT ELSEWHERE CLASSIFIED|11,440.00|8,008.00|3,432.00
S09.1|INJURY OF MUSCLE AND TENDON OF HEAD|11,440.00|8,008.00|3,432.00
S09.2|TRAUMATIC RUPTURE OF EAR DRUM|11,440.00|8,008.00|3,432.00
S09.7|MULTIPLE INJURIES OF HEAD|11,440.00|8,008.00|3,432.00
S09.8|OTHER SPECIFIED INJURIES OF HEAD|11,440.00|8,008.00|3,432.00
S09.9|UNSPECIFIED INJURY OF HEAD; INJURY OF FACE NOS; INJURY OF EAR NOS; INJURY OF NOSE NOS|11,440.00|8,008.00|3,432.00
S14.0|CONCUSSION AND OEDEMA OF CERVICAL SPINAL CORD|23,920.00|16,744.00|7,176.00
S16|INJURY OF MUSCLE AND TENDON AT NECK LEVEL|9,360.00|6,552.00|2,808.00
S22.00|FRACTURE OF THORACIC VERTEBRA; FRACTURE OF THORACIC SPINE NOS (CLOSED)|11,310.00|7,917.00|3,393.00
S22.10|MULTIPLE FRACTURES OF THORACIC SPINE (CLOSED)|11,310.00|7,917.00|3,393.00
S22.2|FRACTURE OF STERNUM|11,310.00|7,917.00|3,393.00
S22.20|FRACTURE OF STERNUM (CLOSED)|11,310.00|7,917.00|3,393.00
S22.3|FRACTURE OF RIB|11,310.00|7,917.00|3,393.00
S22.30|FRACTURE OF RIB  (CLOSED)|11,310.00|7,917.00|3,393.00
S22.31|FRACTURE OF RIB (OPEN)|11,310.00|7,917.00|3,393.00
S22.4|MULTIPLE FRACTURES OF RIBS|11,310.00|7,917.00|3,393.00
S22.40|MULTIPLE FRACTURES OF RIBS (CLOSED)|11,310.00|7,917.00|3,393.00
S22.41|MULTIPLE FRACTURES OF RIBS (OPEN)|11,310.00|7,917.00|3,393.00
S22.80|FRACTURE OF OTHER PARTS OF BONY THORAX  (CLOSED)|11,310.00|7,917.00|3,393.00
S22.90|FRACTURE OF BONY THORAX, PART UNSPECIFIED (CLOSED)|11,310.00|7,917.00|3,393.00
S34.0|CONCUSSION AND OEDEMA OF LUMBAR SPINAL CORD|23,920.00|16,744.00|7,176.00
S39.0|INJURY OF MUSCLE AND TENDON OF ABDOMEN, LOWER BACK AND PELVIS|9,360.00|6,552.00|2,808.00
S43.0|DISLOCATION OF SHOULDER JOINT; DISLOCATION OF GLENOHUMERAL JOINT|9,360.00|6,552.00|2,808.00
S43.4|SPRAIN AND STRAIN OF SHOULDER JOINT; SPRAIN AND STRAIN OF CORACOHUMERAL (LIGAMENT); SPRAIN AND STRAIN OF ROTATOR CUFF CAPSULE|9,360.00|6,552.00|2,808.00
S43.5|SPRAIN AND STRAIN OF ACROMIOCLAVICULAR JOINT; SPRAIN AND STRAIN OF ACROMIOCLAVICULAR LIGAMENT|9,360.00|6,552.00|2,808.00
S43.7|SPRAIN AND STRAIN OF OTHER AND UNSPECIFIED PARTS OF SHOULDER GIRDLE; SPRAIN AND STRAIN OF SHOULDER GIRDLE NOS|9,360.00|6,552.00|2,808.00
S46.0|INJURY OF TENDON OF THE ROTATOR CUFF OF SHOULDER|9,360.00|6,552.00|2,808.00
S46.1|INJURY OF MUSCLE AND TENDON OF LONG HEAD OF BICEPS|9,360.00|6,552.00|2,808.00
S46.2|INJURY OF MUSCLE AND TENDON OF OTHER PARTS OF BICEPS|9,360.00|6,552.00|2,808.00
S46.7|INJURY OF MULTIPLE MUSCLES AND TENDONS AT SHOULDER AND UPPER ARM LEVEL|9,360.00|6,552.00|2,808.00
S46.8|INJURY OF OTHER MUSCLES AND TENDONS AT SHOULDER AND UPPER ARM LEVEL|9,360.00|6,552.00|2,808.00
S46.9|INJURY OF UNSPECIFIED MUSCLE AND TENDON AT SHOULDER AND UPPER ARM LEVEL|9,360.00|6,552.00|2,808.00
S53.4|SPRAIN AND STRAIN OF ELBOW|9,360.00|6,552.00|2,808.00
S56.0|INJURY OF FLEXOR MUSCLE AND TENDON OF THUMB AT FOREARM LEVEL|9,360.00|6,552.00|2,808.00
S56.1|INJURY OF LONG FLEXOR MUSCLE AND TENDON OF OTHER FINGER(S) AT FOREARM LEVEL|9,360.00|6,552.00|2,808.00
S56.2|INJURY OF OTHER FLEXOR MUSCLE AND TENDON AT FOREARM LEVEL|9,360.00|6,552.00|2,808.00
S56.3|INJURY OF EXTENSOR OR ABDUCTOR MUSCLES AND TENDONS OF THUMB AT FOREARM LEVEL|9,360.00|6,552.00|2,808.00
S61.0|OPEN WOUND OF FINGER(S) WITHOUT DAMAGE TO NAIL; OPEN WOUND OF FINGER(S) NOS|5,200.00|3,640.00|1,560.00
S61.1|OPEN WOUND OF FINGER(S) WITH DAMAGE TO NAIL|5,200.00|3,640.00|1,560.00
S61.7|MULTIPLE OPEN WOUNDS OF WRIST AND HAND|5,200.00|3,640.00|1,560.00
S61.8|OPEN WOUND OF OTHER PARTS OF WRIST AND HAND|5,200.00|3,640.00|1,560.00
S61.9|OPEN WOUND OF WRIST AND HAND PART, PART UNSPECIFIED|5,200.00|3,640.00|1,560.00
S63.5|SPRAIN AND STRAIN OF WRIST; SPRAIN AND STRAIN OF CARPAL JOINT; SPRAIN AND STRAIN OF RADIOCARPAL JOINT;   SPRAIN AND STRAIN OF RADIOCARPAL LIGAMENT|9,360.00|6,552.00|2,808.00
S63.6|SPRAIN AND STRAIN OF FINGER(S); SPRAIN AND STRAIN OF INTERPHALANGEAL JOINT, HAND; SPRAIN AND STRAIN METACARPOPHALANGEAL JOINT; SPRAIN AND STRAIN OF PHALANX, HAND; SPRAIN AND STRAIN OF THUMB|9,360.00|6,552.00|2,808.00
S63.7|SPRAIN AND STRAIN OF OTHER AND UNSPECIFIED PARTS OF HAND|9,360.00|6,552.00|2,808.00
S66.1|INJURY OF FLEXOR MUSCLE AND TENDON OF OTHER FINGER AT WRIST AND HAND LEVEL|9,360.00|6,552.00|2,808.00
S66.3|INJURY OF EXTENSOR MUSCLE AND TENDON OF OTHER FINGER AT WRIST AND HAND LEVEL|9,360.00|6,552.00|2,808.00
S66.5|INJURY OF INTRINSIC MUSCLE AND TENDON OF OTHER FINGER AT WRIST AND HAND LEVEL|9,360.00|6,552.00|2,808.00
S66.6|INJURY OF MULTIPLE FLEXOR MUSCLES AND TENDONS AT WRIST AND HAND LEVEL|9,360.00|6,552.00|2,808.00
S66.8|INJURY OF OTHER MUSCLES AND TENDONS AT WRIST AND HAND LEVEL|9,360.00|6,552.00|2,808.00
S66.9|INJURY OF UNSPECIFIED MUSCLE AND TENDON AT WRIST AND HAND LEVEL|9,360.00|6,552.00|2,808.00
S73.1|SPRAIN AND STRAIN OF HIP|9,360.00|6,552.00|2,808.00
S76.1|INJURY OF QUADRICEPS MUSCLE AND TENDON; INJURY OF PATELLAR LIGAMENT (TENDON)|9,360.00|6,552.00|2,808.00
S76.2|INJURY OF ADDUCTOR MUSCLE AND TENDON OF THIGH|9,360.00|6,552.00|2,808.00
S76.3|INJURY OF MUSCLE AND TENDON OF THE POSTERIOR MUSCLE GROUP AT THIGH LEVEL|9,360.00|6,552.00|2,808.00
S76.4|INJURY OF OTHER AND UNSPECIFIED MUSCLES AND TENDONS AT THIGH LEVEL|9,360.00|6,552.00|2,808.00
S81.0|OPEN WOUND OF KNEE|5,200.00|3,640.00|1,560.00
S81.7|MULTIPLE OPEN WOUNDS OF LOWER LEG|5,200.00|3,640.00|1,560.00
S81.8|OPEN WOUND OF OTHER PARTS OF LOWER LEG|5,200.00|3,640.00|1,560.00
S81.9|OPEN WOUND OF LOWER LEG, PART UNSPECIFIED|5,200.00|3,640.00|1,560.00
S83.4|SPRAIN AND STRAIN INVOLVING FIBULAR COLLATERAL LIGAMENT OF KNEE; SPRAIN AND STRAIN INVOLVING TIBIAL COLLATERAL LIGAMENT OF KNEE|9,360.00|6,552.00|2,808.00
S83.5|SPRAIN AND STRAIN INVOLVING ANTERIOR CRUCIATE LIGAMENT OF KNEE; SPRAIN AND STRAIN INVOLVING POSTERIOR CRUCIATE LIGAMENT OF KNEE|9,360.00|6,552.00|2,808.00
S83.6|SPRAIN AND STRAIN OF OTHER AND UNSPECIFIED PARTS OF KNEE|9,360.00|6,552.00|2,808.00
S86.8|INJURY OF OTHER MUSCLES AND TENDONS AT LOWER LEG LEVEL|9,360.00|6,552.00|2,808.00
S86.9|INJURY OF UNSPECIFIED MUSCLE AND TENDON AT LOWER LEG LEVEL|9,360.00|6,552.00|2,808.00
S91.0|OPEN WOUND OF ANKLE|5,200.00|3,640.00|1,560.00
S91.1|OPEN WOUND OF TOE(S) WITHOUT DAMAGE TO NAIL; OPEN WOUND OF TOE (S) NOS|5,200.00|3,640.00|1,560.00
S91.2|OPEN WOUND OF TOE(S) WITH DAMAGE TO NAIL|5,200.00|3,640.00|1,560.00
S91.3|OPEN WOUND OF OTHER PARTS OF FOOT; OPEN WOUND OF FOOT NOS|5,200.00|3,640.00|1,560.00
S91.7|MULTIPLE OPEN WOUNDS OF ANKLE AND FOOT|5,200.00|3,640.00|1,560.00
S93.4|SPRAIN AND STRAIN OF ANKLE INCLUDING CALCANEOFIBULAR (LIGAMENT), DELTOID (LIGAMENT), INTERNAL COLLATERAL (LIGAMENT), TALOFIBULAR (LIGAMENT), TIBIOFIBULAR , DISTAL (LIGAMENT)|9,360.00|6,552.00|2,808.00
S93.5|SPRAIN AND STRAIN OF TOE(S) INCLUDING INTERPHALANGEAL (JOINT(S), METATARSOPHALANGEAL (JOINT(S)|9,360.00|6,552.00|2,808.00
S93.6|SPRAIN AND STRAIN OF OTHER AND UNSPECIFIED PARTS OF FOOT INCLUDING TARSAL (LIGAMENT), TARSOMETATARSAL (LIGAMENT)|9,360.00|6,552.00|2,808.00
S96.0|INJURY OF MUSCLE AND TENDON OF LONG FLEXOR MUSCLE OF TOE AT ANKLE AND FOOT LEVEL|9,360.00|6,552.00|2,808.00
S96.9|INJURY OF UNSPECIFIED MUSCLE AND TENDON AT ANKLE AND FOOT LEVEL|9,360.00|6,552.00|2,808.00
T00.0|SUPERFICIAL INJURIES INVOLVING HEAD WITH NECK|5,200.00|3,640.00|1,560.00
T00.1|SUPERFICIAL INJURIES INVOLVING THORAX WITH ABDOMEN LOWER BACK AND PELVIS|5,200.00|3,640.00|1,560.00
T00.2|SUPERFICIAL INJURIES INVOLVING MULTIPLE REGIONS OF UPPER LIMB(S)|5,200.00|3,640.00|1,560.00
T00.3|SUPERFICIAL INJURIES INVOLVING MULTIPLE REGIONS OF LOWER LIMB(S)|5,200.00|3,640.00|1,560.00
T00.6|SUPERFICIAL INJURIES INVOLVING MULTIPLE REGIONS OF UPPER LIMB(S) WITH LOWER LIMB(S)|5,200.00|3,640.00|1,560.00
T00.8|SUPERFICIAL INJURIES INVOLVING OTHER COMBINATIONS OF BODY REGIONS|5,200.00|3,640.00|1,560.00
T00.9|MULTIPLE SUPERFICIAL INJURIES, UNSPECIFIED; MULTIPLE ABRASIONS NOS; MULTIPLE NONTHERMAL BLISTERS NOS; MULTIPLE BRUISES NOS; MULTIPLE CONTUSIONS NOS; MULTIPLE HAEMATOMAS NOS; MULTIPLE NONVENOMOUS INSECT BITE NOS|5,200.00|3,640.00|1,560.00
T03.9|MULTIPLE DISLOCATIONS, SPRAINS AND STRAINS, UNSPECIFIED|9,360.00|6,552.00|2,808.00
T20.2|BURN OF SECOND DEGREE OF HEAD AND NECK|13,780.00|9,646.00|4,134.00
T20.3|BURN OF THIRD DEGREE OF HEAD AND NECK|13,780.00|9,646.00|4,134.00
T20.4|CORROSION OF UNSPECIFIED DEGREE OF HEAD AND NECK|11,050.00|7,735.00|3,315.00
T20.6|CORROSION OF SECOND DEGREE OF HEAD AND NECK|13,780.00|9,646.00|4,134.00
T21.0|BURN OF UNSPECIFIED DEGREE OF TRUNK|11,050.00|7,735.00|3,315.00
T21.2|BURN OF SECOND DEGREE OF TRUNK|11,050.00|7,735.00|3,315.00
T21.3|BURN OF THIRD DEGREE OF TRUNK|20,930.00|14,651.00|6,279.00
T21.5|CORROSION OF FIRST DEGREE OF TRUNK|11,050.00|7,735.00|3,315.00
T21.6|CORROSION OF SECOND DEGREE OF TRUNK|11,050.00|7,735.00|3,315.00
T22.2|BURN OF SECOND DEGREE OF SHOULDER AND UPPER LIMB, EXCEPT WRIST AND HAND|11,050.00|7,735.00|3,315.00
T22.3|BURN OF THIRD DEGREE OF SHOULDER AND UPPER LIMB, EXCEPT WRIST AND HAND|13,780.00|9,646.00|4,134.00
T22.5|CORROSION OF FIRST DEGREE OF SHOULDER AND UPPER LIMB, EXCEPT WRIST AND HAND|11,050.00|7,735.00|3,315.00
T22.6|CORROSION OF SECOND DEGREE OF SHOULDER AND UPPER LIMB, EXCEPT WRIST AND HAND|11,050.00|7,735.00|3,315.00
T23.2|BURN OF SECOND DEGREE OF WRIST AND HAND|11,050.00|7,735.00|3,315.00
T23.3|BURN OF THIRD DEGREE OF WRIST AND HAND|13,780.00|9,646.00|4,134.00
T23.4|CORROSION OF UNSPECIFIED DEGREE OF WRIST AND HAND|11,050.00|7,735.00|3,315.00
T23.6|CORROSION OF SECOND DEGREE OF WRIST AND HAND|13,780.00|9,646.00|4,134.00
T23.7|CORROSION OF THIRD DEGREE OF WRIST AND HAND|13,780.00|9,646.00|4,134.00
T24.2|BURN OF SECOND DEGREE OF HIP AND LOWER LIMB, EXCEPT ANKLE AND FOOT|11,050.00|7,735.00|3,315.00
T24.3|BURN OF THIRD DEGREE OF HIP AND LOWER LIMB, EXCEPT ANKLE AND FOOT|13,780.00|9,646.00|4,134.00
T24.5|CORROSION OF FIRST DEGREE OF HIP AND LOWER LIMB, EXCEPT ANKLE AND FOOT|11,050.00|7,735.00|3,315.00
T24.6|CORROSION OF SECOND DEGREE OF HIP AND LOWER LIMB, EXCEPT ANKLE AND FOOT|11,050.00|7,735.00|3,315.00
T24.7|CORROSION OF THIRD DEGREE OF HIP AND LOWER LIMB, EXCEPT ANKLE AND FOOT|13,780.00|9,646.00|4,134.00
T25.2|BURN OF SECOND DEGREE OF ANKLE AND FOOT|11,050.00|7,735.00|3,315.00
T25.3|BURN OF THIRD DEGREE OF ANKLE AND FOOT|13,780.00|9,646.00|4,134.00
T25.5|CORROSION OF FIRST DEGREE OF ANKLE AND FOOT|11,050.00|7,735.00|3,315.00
T26.0|BURN OF EYELID AND PERIOCULAR AREA|11,050.00|7,735.00|3,315.00
T26.1|BURN OF CORNEA AND CONJUNCTIVAL SAC|13,780.00|9,646.00|4,134.00
T26.2|BURN WITH RESULTING RUPTURE AND DESTRUCTION OF EYEBALL|13,780.00|9,646.00|4,134.00
T26.3|BURN OF OTHER PARTS OF EYE AND ADNEXA|13,780.00|9,646.00|4,134.00
T26.4|BURN OF EYE AND ADNEXA, PART UNSPECIFIED|11,050.00|7,735.00|3,315.00
T26.6|CORROSION OF CORNEA AND CONJUNCTIVAL SAC|13,780.00|9,646.00|4,134.00
T26.9|CORROSION OF EYE AND ADNEXA, PART UNSPECIFIED|11,050.00|7,735.00|3,315.00
T27.0|BURN OF LARYNX AND TRACHEA|13,780.00|9,646.00|4,134.00
T27.2|BURN OF OTHER PARTS OF RESPIRATORY TRACT; THORACIC CAVITY|13,780.00|9,646.00|4,134.00
T27.3|BURN OF RESPIRATORY TRACT, PART UNSPECIFIED|11,050.00|7,735.00|3,315.00
T27.7|CORROSION OF RESPIRATORY TRACT, PART UNSPECIFIED|11,050.00|7,735.00|3,315.00
T28.0|BURN OF MOUTH AND PHARYNX|13,780.00|9,646.00|4,134.00
T28.1|BURN OF OESOPHAGUS|13,780.00|9,646.00|4,134.00
T28.2|BURN OF OTHER PARTS OF ALIMENTARY TRACT|13,780.00|9,646.00|4,134.00
T28.3|BURN OF INTERNAL GENITOURINARY ORGANS|13,780.00|9,646.00|4,134.00
T28.5|CORROSION OF MOUTH AND PHARYNX|13,780.00|9,646.00|4,134.00
T28.6|CORROSION OF OESOPHAGUS|13,780.00|9,646.00|4,134.00
T28.7|CORROSION OF OTHER PARTS OF ALIMENTARY TRACT|13,780.00|9,646.00|4,134.00
T28.8|CORROSION OF INTERNAL GENITOURINARY ORGANS|13,780.00|9,646.00|4,134.00
T28.9|CORROSION OF OTHER AND UNSPECIFIED INTERNAL ORGANS|11,050.00|7,735.00|3,315.00
T29.1|BURNS OF MULTIPLE REGIONS, NO MORE THAN FIRST- DEGREE BURNS MENTIONED|11,050.00|7,735.00|3,315.00
T29.2|BURNS OF MULTIPLE REGIONS, NO MORE THAN SECOND- DEGREE BURNS MENTIONED|13,780.00|9,646.00|4,134.00
T29.3|BURNS OF MULTIPLE REGIONS, AT LEAST ONE BURN OF THIRD DEGREE MENTIONED|13,780.00|9,646.00|4,134.00
T29.6|CORROSIONS OF MULTIPLE REGIONS, NO MORE THAN SECOND-DEGREE CORROSIONS MENTIONED|13,780.00|9,646.00|4,134.00
T30.0|BURN OF UNSPECIFIED BODY REGION, UNSPECIFIED DEGREE; BURN NOS|11,050.00|7,735.00|3,315.00
T30.2|BURN OF SECOND DEGREE, BODY REGION UNSPECIFIED; SECODN-DEGREE BURN NOS|11,050.00|7,735.00|3,315.00
T30.3|BURN OF THIRD DEGREE, BODY REGION UNSPECIFIED; THIRD-DEGREE BURN NOS|11,050.00|7,735.00|3,315.00
T30.4|CORROSION OF UNSPECIFIED BODY REGION, UNSPECIFIED DEGREE; CORROSION NOS|11,050.00|7,735.00|3,315.00
T30.5|CORROSION OF FIRST DEGREE, BODY REGION UNSPECIFIED; FIRST-DEGREE CORROSION NOS|11,050.00|7,735.00|3,315.00
T30.6|CORROSION OF SECOND DEGREE, BODY REGION UNSPECIFIED; SECOND-DEGREE CORROSION NOS|11,050.00|7,735.00|3,315.00
T30.7|CORROSION OF THIRD DEGREE, BODY REGION UNSPECIFIED; THRID-DEGREE CORROSION NOS|11,050.00|7,735.00|3,315.00
T31.0|BURNS INVOLVING LESS THAN 10% OF BODY SURFACE|11,050.00|7,735.00|3,315.00
T31.1|BURNS INVOLVING 10-19% OF BODY SURFACE|11,050.00|7,735.00|3,315.00
T31.2|BURNS INVOLVING 20-29% OF BODY SURFACE|13,780.00|9,646.00|4,134.00
T31.3|BURNS INVOLVING 30-39% OF BODY SURFACE|13,780.00|9,646.00|4,134.00
T31.4|BURNS INVOLVING 40-49% OF BODY SURFACE|13,780.00|9,646.00|4,134.00
T31.5|BURNS INVOLVING 50-59% OF BODY SURFACE|13,780.00|9,646.00|4,134.00
T31.6|BURNS INVOLVING 60-69% OF BODY SURFACE|20,930.00|14,651.00|6,279.00
T31.7|BURNS INVOLVING 70-79% OF BODY SURFACE|20,930.00|14,651.00|6,279.00
T31.8|BURNS INVOLVING 80-89% OF BODY SURFACE|20,930.00|14,651.00|6,279.00
T31.9|BURNS INVOLVING 90% OR MORE OF BODY SURFACE|20,930.00|14,651.00|6,279.00
T32.0|CORROSIONS INVOLVING LESS THAN 10% OF BODY SURFACE|11,050.00|7,735.00|3,315.00
T32.1|CORROSIONS INVOLVING 10-19% OF BODY SURFACE|11,050.00|7,735.00|3,315.00
T32.2|CORROSIONS INVOLVING 20-29% OF BODY SURFACE|13,780.00|9,646.00|4,134.00
T32.3|CORROSIONS INVOLVING 30-39% OF BODY SURFACE|13,780.00|9,646.00|4,134.00
T32.4|CORROSIONS INVOLVING 40-49% OF BODY SURFACE|13,780.00|9,646.00|4,134.00
T32.9|CORROSIONS INVOLVING 90% OR MORE OF BODY SURFACE|20,930.00|14,651.00|6,279.00
T34.1|FROSTBITE WITH TISSUE NECROSIS OF NECK|11,050.00|7,735.00|3,315.00
T34.9|FROSTBITE WITH TISSUE NECROSIS OF OTHER AND UNSPECIFIED SITES; FROSBITE WITH TISSUE NECROSIS NOS; FROSBITE WITH TISSUE OF LEG NOS; FROSBITE WITH TISSUE NECROSIS OF TRUNK NOS|13,780.00|9,646.00|4,134.00
T35.0|SUPERFICIAL FROSTBITE INVOLVING MULTIPLE BODY REGIONS; MULTIPLE SUPERFICIAL FROSBITE NOS|11,050.00|7,735.00|3,315.00
T35.1|FROSTBITE WITH TISSUE NECROSIS INVOLVING MULTIPLE BODY REGIONS; MULTIPLE FROSBITE WITH TISSUE NECROSIS NOS|11,050.00|7,735.00|3,315.00
T36.0|POISONING BY PENICILLINS|9,490.00|6,643.00|2,847.00
T36.1|POISONING BY CEFALOSPORINS AND OTHER ß-LACTAM ANTIBIOTICS|9,490.00|6,643.00|2,847.00
T36.2|POISONING BY CHLORAMPHENICOL GROUP|9,490.00|6,643.00|2,847.00
T36.3|POISONING BY MACROLIDES|9,490.00|6,643.00|2,847.00
T36.4|POISONING BY TETRACYCLINES|9,490.00|6,643.00|2,847.00
T36.5|POISONING BY AMINOGLYCOSIDES; STREPTOMYCIN|9,490.00|6,643.00|2,847.00
T36.6|POISONING BY RIFAMYCINS|9,490.00|6,643.00|2,847.00
T36.8|POISONING BY OTHER SYSTEMIC ANTIBIOTICS|9,490.00|6,643.00|2,847.00
T36.9|POISONING BY SYSTEMIC ANTIBIOTIC, UNSPECIFIED|9,490.00|6,643.00|2,847.00
T37.0|POISONING BY SULFONAMIDES|9,490.00|6,643.00|2,847.00
T37.1|POISONING BY ANTIMYCOBACTERIAL DRUGS|9,490.00|6,643.00|2,847.00
T37.2|POISONING BY ANTIMALARIALS AND DRUGS ACTING ON OTHER BLOOD PROTOZOA|9,490.00|6,643.00|2,847.00
T37.4|POISONING BY ANTHELMINTHICS|9,490.00|6,643.00|2,847.00
T37.5|POISONING BY ANTIVIRAL DRUGS|9,490.00|6,643.00|2,847.00
T37.8|POISONING BY OTHER SPECIFIED SYSTEMIC ANTI- INFECTIVES AND ANTIPARASITICS; POISONING BY HYDROXYQUINOLINE DERIVATIVES|9,490.00|6,643.00|2,847.00
T37.9|POISONING BY SYSTEMIC ANTI-INFECTIVE AND ANTIPARASITIC, UNSPECIFIED|9,490.00|6,643.00|2,847.00
T38.0|POISONING BY GLUCOCORTICOIDS AND SYNTHETIC ANALOGUES|11,050.00|7,735.00|3,315.00
T38.1|POISONING BY THYROID HORMONES AND SUBSTITUTES|11,050.00|7,735.00|3,315.00
T38.2|POISONING BY ANTITHYROID DRUGS|11,050.00|7,735.00|3,315.00
T38.3|POISONING BY INSULIN AND ORAL HYPOGLYCAEMIC [ANTIDIABETIC] DRUGS|11,050.00|7,735.00|3,315.00
T38.4|POISONING BY ORAL CONTRACEPTIVES; POISONING BY MULTIPLE-AND-SINGLE-INGREDIENT PREPARATIONS|11,050.00|7,735.00|3,315.00
T38.5|POISONING BY OTHER ESTROGENS AND PROGESTOGENS; MIXTURES AND SUBSTITUTES|11,050.00|7,735.00|3,315.00
T38.6|POISONING BY ANTIGONADOTROPHINS, ANTIESTROGENS, ANTIANDROGENS, NOT ELSEWHERE CLASSIFIED; POISONING BY TAMOXIFEN|11,050.00|7,735.00|3,315.00
T38.7|POISONING BY ANDROGENS AND ANABOLIC CONGENERS|11,050.00|7,735.00|3,315.00
T39.0|POISONING BY SALICYLATES|9,620.00|6,734.00|2,886.00
T39.1|POISONING BY 4-AMINOPHENOL DERIVATIVES|9,620.00|6,734.00|2,886.00
T39.3|POISONING BY OTHER NONSTEROIDAL ANTI- INFLAMMATORY DRUGS [NSAID]|9,620.00|6,734.00|2,886.00
T39.8|POISONING BY OTHER NONOPIOID ANALGESICS AND ANTIPYRETICS, NOT ELSEWHERE CLASSIFIED|9,620.00|6,734.00|2,886.00
T39.9|POISONING BY NONOPIOID ANALGESIC, ANTIPYRETIC AND ANTIRHEUMATIC, UNSPECIFIED|9,620.00|6,734.00|2,886.00
T40.2|POISONING BY OTHEROPIOIDS; POISONING BY CODEINE; POISONING BY MORPHINE|8,710.00|6,097.00|2,613.00
T40.4|POISONING BY OTHER SYNTHETIC NARCOTICS; POISONING BY PETHIDINE|8,710.00|6,097.00|2,613.00
T40.6|POISONING BY OTHER AND UNSPECIFIED NARCOTICS|8,710.00|6,097.00|2,613.00
T40.7|POISONING BY CANNABIS (DERIVATIVES)|8,710.00|6,097.00|2,613.00
T40.9|POISONING BY OTHER AND UNSPECIFIED PSYCHODYSLEPTICS [HALLUCINOGENS]; POISONING BY MESCALINE; POISONING BY PSILOCIN; POISONING BY PSILOCYBINE|8,710.00|6,097.00|2,613.00
T41.0|POISONING BY INHALED ANAESTHETICS|8,710.00|6,097.00|2,613.00
T41.1|POISONING BY INTRAVENOUS ANAESTHETICS; THIOBARBITURATES|8,710.00|6,097.00|2,613.00
T41.3|POISONING BY LOCAL ANAESTHETICS|8,710.00|6,097.00|2,613.00
T41.5|POISONING BY THERAPEUTIC GASES; CARBON DIOXIDE; OXYGEN|8,710.00|6,097.00|2,613.00
T42.0|POISONING BY HYDANTOIN DERIVATIVES|8,710.00|6,097.00|2,613.00
T42.1|POISONING BY IMINOSTILBENES; CARBAMAZEPINE|8,710.00|6,097.00|2,613.00
T42.2|POISONING BY SUCCINIMIDES AND OXAZOLIDINEDIONES|8,710.00|6,097.00|2,613.00
T42.3|POISONING BY BARBITURATES|8,710.00|6,097.00|2,613.00
T42.4|POISONING BY BENZODIAZEPINES|8,710.00|6,097.00|2,613.00
T42.6|POISONING BY OTHER ANTIEPILEPTIC AND SEDATIVE- HYPNOTICDRUGS; POISONING BY METHAQUALONE;POISONING BY  VALPROIC ACID|8,710.00|6,097.00|2,613.00
T42.7|POISONING BY ANTIEPILEPTIC AND SEDATIVE-HYPNOTIC DRUGS, UNSPECIFIED; POISONING BY DRAUGHT SLEEPING NOS; POISONING BY SLEEPING DRUG NOS;POISONING BY SLEEPING TABLET NOS|8,710.00|6,097.00|2,613.00
T42.8|POISONING BY ANTIPARKINSONISM DRUGS AND OTHER CENTRAL MUSCLE-TONE DEPRESSANTS; POISONING BY AMANTADINE|8,710.00|6,097.00|2,613.00
T43.2|POISONING BY OTHER AND UNSPECIFIED ANTIDEPRESSANTS|8,710.00|6,097.00|2,613.00
T43.3|POISONING BY PHENOTHIAZINE ANTIPSYCHOTICS AND NEUROLEPTICS|8,710.00|6,097.00|2,613.00
T43.4|POISONING BY BUTYROPHENONE AND THIOXANTHENE NEUROLEPTICS|8,710.00|6,097.00|2,613.00
T43.5|POISONING BY OTHER AND UNSPECIFIED ANTIPSYCHOTICS AND NEUROLEPTICS|8,710.00|6,097.00|2,613.00
T43.6|POISONING BY PSYCHOSTIMULANTS WITH ABUSE POTENTIAL|8,710.00|6,097.00|2,613.00
T43.9|POISONING BY PSYCHOTROPIC DRUG, UNSPECIFIED|8,710.00|6,097.00|2,613.00
T44.1|POISONING BY OTHER PARASYMPATHOMIMETICS [CHOLINERGICS]|8,710.00|6,097.00|2,613.00
T44.2|POISONING BY GANGLIONIC BLOCKING DRUGS, NOT ELSEWHERE CLASSIFIED|8,710.00|6,097.00|2,613.00
T44.3|POISONING BY OTHER PARASYMPATHOLYTICS [ANTICHOLINERGICS AND ANTIMUSCARINICS] AND SPASMOLYTICS, NOT ELSEWHERE CLASSIFIED; POISONING BYPAPAVERINE|8,710.00|6,097.00|2,613.00
T44.4|POISONING BY PREDOMINANTLY ?-ADRENORECEPTOR AGONISTS, NOT ELSEWHERE CLASSIFIED; POISONING BY METARAMINOL|8,710.00|6,097.00|2,613.00
T44.5|POISONING BY PREDOMINANTLY ß-ADRENORECEPTOR AGONISTS, NOT ELSEWHERE CLASSIFIED|8,710.00|6,097.00|2,613.00
T44.6|POISONING BY ?-ADRENORECEPTOR ANTAGONISTS, NOT ELSEWHERE CLASSIFIED|8,710.00|6,097.00|2,613.00
T44.7|POISONING BY ß-ADRENORECEPTOR ANTAGONISTS, NOT ELSEWHERE CLASSIFIED|8,710.00|6,097.00|2,613.00
T44.9|POISONING BY OTHER AND UNSPECIFIED DRUGS PRIMARILY AFFECTING THE AUTONOMIC NERVOUS SYSTEM; DRUG STIMULATING BOTH  ?-AND ß- ADRENORECEPTORS|8,710.00|6,097.00|2,613.00
T45.0|POISONING BY ANTIALLERGIC AND ANTIEMETIC DRUGS|8,710.00|6,097.00|2,613.00
T45.1|POISONING BY ANTINEOPLASTIC AND IMMUNOSUPPRESSIVE DRUGS; POISONING BY ANTINEOPLASTIC ANTIBIOTICS; POISONING BY CYTARABINE|8,710.00|6,097.00|2,613.00
T45.2|POISONING BY VITAMINS, NOT ELSEWHERE CLASSIFIED|8,710.00|6,097.00|2,613.00
T45.3|POISONING BY ENZYMES, NOT ELSEWHERE CLASSIFIED|8,710.00|6,097.00|2,613.00
T45.4|POISONING BY IRON AND ITS COMPOUNDS|9,490.00|6,643.00|2,847.00
T45.5|POISONING BY ANTICOAGULANTS|9,490.00|6,643.00|2,847.00
T45.6|POISONING BY FIBRINOLYSIS-AFFECTING DRUGS|9,490.00|6,643.00|2,847.00
T45.7|POISONING BY ANTICOAGULANT ANTAGONISTS, VITAMIN K AND OTHER COAGULANTS|9,490.00|6,643.00|2,847.00
T45.8|POISONING BY OTHER PRIMARILY SYSTEMIC AND HAEMATOLOGICAL AGENTS; POISONING BY LIVER PREPARATIONS AND OTHER ANTIANAEMIC AGENTS; POISONING BY NATURAL BLOOD AND BLOOD PRODUCTS; POISONING BY PLASMA SUBSTITUTE|9,490.00|6,643.00|2,847.00
T45.9|PRIMARILY SYSTEMIC AND HAEMATOLOGICAL AGENT, UNSPECIFIED|9,490.00|6,643.00|2,847.00
T46.0|POISONING BY CARDIAC-STIMULANT GLYCOSIDES AND DRUGS OF SIMILAR ACTION|16,250.00|11,375.00|4,875.00
T46.1|POISONING BY CALCIUM-CHANNEL BLOCKERS|16,250.00|11,375.00|4,875.00
T46.2|POISONING BY OTHER ANTIDYSRHYTHMIC DRUGS, NOT ELSEWHERE CLASSIFIED|16,250.00|11,375.00|4,875.00
T46.3|POISONING BY CORONARY VASODILATORS, NOT ELSEWHERE CLASSIFIED; POISONING BY DIPYRIDAMOLE|16,250.00|11,375.00|4,875.00
T46.5|POISONING BY OTHER ANTIHYPERTENSIVE DRUGS, NOT ELSEWHERE CLASSIFIED; POISONING BY CLONIDINE;POISONING BY GUANETHIDINE; POISONING BY RAUWOLFIA|16,250.00|11,375.00|4,875.00
T46.6|POISONING BY ANTIHYPERLIPIDAEMIC AND ANTIARTERIOSCLEROTIC DRUGS|16,250.00|11,375.00|4,875.00
T46.7|POISONING BY PERIPHERAL VASODILATORS;POISONING BY NICOTIMIC ACID (DERIVATIVES)|16,250.00|11,375.00|4,875.00
T46.9|POISONING BY OTHER AND UNSPECIFIED AGENTS PRIMARILY AFFECTING THE CARDIOVASCULAR SYSTEM|16,250.00|11,375.00|4,875.00
T47.0|POISONING BY HISTAMINEH2-RECEPTOR ANTAGONISTS|10,790.00|7,553.00|3,237.00
T47.1|POISONING BY OTHER ANTACIDS AND ANTI-GASTRIC- SECRETION DRUGS|10,790.00|7,553.00|3,237.00
T47.2|POISONING BY STIMULANT LAXATIVES|10,790.00|7,553.00|3,237.00
T47.3|POISONING BY SALINE AND OSMOTIC LAXATIVES|10,790.00|7,553.00|3,237.00
T47.4|POISONING BY OTHER LAXATIVES; POISONING BY INTESTINAL ATONIA DRUGS|10,790.00|7,553.00|3,237.00
T47.5|POISONING BY DIGESTANTS|10,790.00|7,553.00|3,237.00
T47.6|POISONING BY ANTIDIARRHOEAL DRUGS|10,790.00|7,553.00|3,237.00
T47.8|POISONING BY OTHER AGENTS PRIMARILY AFFECTING THE GASTROINTESTINAL SYSTEM|10,790.00|7,553.00|3,237.00
T47.9|POISONING BY AGENT PRIMARILY AFFECTING THE GASTROINTESTINAL SYSTEM, UNSPECIFIED|10,790.00|7,553.00|3,237.00
T48.1|POISONING BY SKELETAL MUSCLE RELAXANTS [NEUROMUSCULAR BLOCKING AGENTS]|10,790.00|7,553.00|3,237.00
T48.3|POISONING BY ANTITUSSIVES|8,060.00|5,642.00|2,418.00
T48.4|POISONING BY EXPECTORANTS|8,060.00|5,642.00|2,418.00
T48.5|POISONING BY ANTI-COMMON-COLD DRUGS|8,060.00|5,642.00|2,418.00
T48.6|POISONING BY ANTIASTHMATICS, NOT ELSEWHERE CLASSIFIED; ?-ADRENORECEPTOR AGONISTS USED IN ASTHMA THERAPHY; POISONING BY SALBUTAMOL|8,060.00|5,642.00|2,418.00
T49.2|POISONING BY LOCAL ASTRINGENTS AND LOCAL DETERGENTS|6,890.00|4,823.00|2,067.00
T49.3|POISONING BY EMOLLIENTS, DEMULCENTS AND PROTECTANTS|6,890.00|4,823.00|2,067.00
T49.4|POISONING BY KERATOLYTICS, KERATOPLASTICS AND OTHER HAIR TREATMENT DRUGS AND PREPARATIONS|6,890.00|4,823.00|2,067.00
T49.5|POISONING BY OPHTHALMOLOGICAL DRUGS AND PREPARATIONS; POISONING BY EYE, NOSE AND THROAT ANTI-INFECTIVES|6,890.00|4,823.00|2,067.00
T49.7|POISONING BY DENTAL DRUGS, TOPICALLY APPLIED|6,890.00|4,823.00|2,067.00
T49.8|OTHERTOPICAL AGENTS; SPERMICIDES|6,890.00|4,823.00|2,067.00
T49.9|POISONING BY TOPICAL AGENT, UNSPECIFIED|6,890.00|4,823.00|2,067.00
T50.0|POISONING BY MINERALOCORTICOIDS AND THEIR ANTAGONISTS|8,190.00|5,733.00|2,457.00
T50.1|POISONING BY LOOP [HIGH-CEILING] DIURETICS|8,190.00|5,733.00|2,457.00
T50.2|POISONING BY CARBONIC-ANHYDRASE INHIBITORS, BENZOTHIADIAZIDES AND OTHER DIURETICS;POISONING BY ACETAZOLAMIDE|8,190.00|5,733.00|2,457.00
T50.4|POISONING BY DRUGS AFFECTING URIC ACID METABOLISM|8,190.00|5,733.00|2,457.00
T50.7|POISONING BY ANALEPTICS AND OPIOID RECEPTOR ANTAGONISTS|8,710.00|6,097.00|2,613.00
T50.9|POISONING BY OTHER AND UNSPECIFIED DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES; POISONING BY ACIDIFYING AGENTS; POISONING BY ALKALIZING AGENTS; POISONING BY IMMUNOGLOBULIN; POISONING BY IMMUNOLOGICALS; POISONING BY LIPOTROPIC DRUGS; POISONING BY PARATHY|8,190.00|5,733.00|2,457.00
T51.0|TOXIC EFFECT OF ETHANOL;TOXIC EFFECT OF  ETHYL ALCOHOL|8,320.00|5,824.00|2,496.00
T51.2|TOXIC EFFECT OF  2-PROPANOL; TOXIC EFFECT OF ISOPROPHYL ACLOHOL|8,320.00|5,824.00|2,496.00
T51.3|TOXIC EFFECT OF  FUSEL OIL; TOXIC EFFECT OF  AMYL ALCOHOL; TOXIC EFFECT OF BUTYL ALCOHOL [1-BUTANOL]; TOXIC EFFECT OF PROPYL ALCOHOL [1-PROPONOL]|8,320.00|5,824.00|2,496.00
T51.8|TOXIC EFFECT OF  OTHER ALCOHOLS|8,320.00|5,824.00|2,496.00
T51.9|TOXIC EFFECT OF  ALCOHOL, UNSPECIFIED|8,320.00|5,824.00|2,496.00
T52.0|TOXIC EFFECT OF  PETROLEUM PRODUCTS; TOXIC EFFECT OF  GASOLINE [PETROL];  TOXIC EFFECT OF  KEROSINE [PARAFFIN OIL]; TOXIC EFFECT OF PARAFFIN WAX;  TOXIC EFFECT OF  PETROLEUM ETHER;  TOXIC EFFECT OF PETROLEUM NAPHTHA; TOXIC EFFECT OF PETROLEUM SPIRITS|8,320.00|5,824.00|2,496.00
T52.2|TOXIC EFFECT OF  HOMOLOGUES OF BENZENE;  TOXIC EFFECT OF TOLUENE [METHYLBENZENE]; TOXIC EFFECT OF XYLENE [DIMETHYLBENZENE]|8,320.00|5,824.00|2,496.00
T52.4|TOXIC EFFECT OF  KETONES|8,320.00|5,824.00|2,496.00
T52.8|TOXIC EFFECT OF OTHER ORGANIC SOLVENTS|8,320.00|5,824.00|2,496.00
T52.9|TOXIC EFFECT OF  ORGANIC SOLVENT, UNSPECIFIED|8,320.00|5,824.00|2,496.00
T53.0|TOXIC EFFECT OF  CARBON TETRACHLORIDE;TOXIC EFFECT OF  TETRACHLOROMETHANE|8,320.00|5,824.00|2,496.00
T53.1|TOXIC EFFECT OF  CHLOROFORM; TOXIC EFFECT OF TRICHLOROMETHANE|8,320.00|5,824.00|2,496.00
T53.4|TOXIC EFFECT OF  DICHLOROMETHANE;TOXIC EFFECT OF METHYLENE CHLORIDE|8,320.00|5,824.00|2,496.00
T53.6|TOXIC EFFECT OF  OTHER HALOGEN DERIVATIVES OF ALIPHATIC HYDROCARBONS|8,320.00|5,824.00|2,496.00
T53.9|TOXIC EFFECT OF  HALOGEN DERIVATIVE OF ALIPHATIC AND AROMATIC HYDROCARBONS, UNSPECIFIED|8,320.00|5,824.00|2,496.00
T54.1|TOXIC EFFECT OF  OTHER CORROSIVE ORGANIC COMPOUNDS|8,320.00|5,824.00|2,496.00
T54.2|TOXIC EFFECT OF CORROSIVE ACIDS AND ACID-LIKE SUBSTANCES; TOXIC EFFECT OF  ACID HYDROCHLORIE;TOXIC EFFECT OF  ACID SULFURIE|8,320.00|5,824.00|2,496.00
T54.3|TOXIC EFFECT OF  CORROSIVE ALKALIS AND ALKALI-LIKE SUBSTANCES; TOXIC EFFECT OF  POTASSIUM HYDROXIDE;TOXIC EFFECT OF  SODIUM HYDROXIDE|8,320.00|5,824.00|2,496.00
T54.9|TOXIC EFFECT OF  CORROSIVE SUBSTANCE, UNSPECIFIED|8,320.00|5,824.00|2,496.00
T55|TOXIC EFFECT OF SOAPS AND DETERGENTS|8,320.00|5,824.00|2,496.00
T56.0|TOXIC EFFECT OF  LEAD AND ITS COMPOUNDS|8,320.00|5,824.00|2,496.00
T56.1|TOXIC EFFECT OF  MERCURY AND ITS COMPOUNDS|8,320.00|5,824.00|2,496.00
T56.5|TOXIC EFFECT OF  ZINC AND ITS COMPOUNDS|8,320.00|5,824.00|2,496.00
T56.8|TOXIC EFFECT OF  OTHER METALS|8,320.00|5,824.00|2,496.00
T57.0|TOXIC EFFECT OF  ARSENIC AND ITS COMPOUNDS|8,320.00|5,824.00|2,496.00
T57.1|TOXIC EFFECT OF  PHOSPHORUS AND ITS COMPOUNDS|8,320.00|5,824.00|2,496.00
T57.3|TOXIC EFFECT OF  HYDROGEN CYANIDE|8,320.00|5,824.00|2,496.00
T57.8|TOXIC EFFECT OF  OTHER SPECIFIED IN ORGANIC SUBSTANCES|8,320.00|5,824.00|2,496.00
T57.9|TOXIC EFFECT OF INORGANIC SUBSTANCE, UNSPECIFIED|8,320.00|5,824.00|2,496.00
T58|TOXIC EFFECT OF CARBON MONOXIDE FROM ALL SOURCES|8,320.00|5,824.00|2,496.00
T59.0|TOXIC EFFECT OF NITROGEN OXIDES|8,320.00|5,824.00|2,496.00
T59.2|TOXIC EFFECT OF  FORMAL DEHYDE|8,320.00|5,824.00|2,496.00
T59.3|TOXIC EFFECT OF  LACRIMOGENIC GAS; TOXIC EFFECT OF TEAR GAS|8,320.00|5,824.00|2,496.00
T59.4|TOXIC EFFECT OF  CHLORINE GAS|8,320.00|5,824.00|2,496.00
T59.7|TOXIC EFFECT OF  CARBON DIOXIDE|8,320.00|5,824.00|2,496.00
T59.8|TOXIC EFFECT OF  OTHER SPECIFIED GASES, FUMES AND VAPOURS|8,320.00|5,824.00|2,496.00
T59.9|TOXIC EFFECT OF  GASES, FUMES AND VAPOURS, UNSPECIFIED|8,320.00|5,824.00|2,496.00
T60.0|TOXIC EFFECT OF ORGANOPHOSPHATE AND CARBAMATE INSECTICIDES|8,320.00|5,824.00|2,496.00
T60.1|TOXIC EFFECT OF  HALOGENATED INSECTICIDES|8,320.00|5,824.00|2,496.00
T60.2|TOXIC EFFECT OF  OTHER INSECTICIDES|8,320.00|5,824.00|2,496.00
T60.3|TOXIC EFFECT OF  HERBICIDES AND FUNGICIDES|8,320.00|5,824.00|2,496.00
T60.4|TOXIC EFFECT OF  RODENTICIDES; TOXIC EFFECT OF THALLIUM|8,320.00|5,824.00|2,496.00
T60.8|TOXIC EFFECT OF  OTHER PESTICIDES|8,320.00|5,824.00|2,496.00
T60.9|TOXIC EFFECT OF  PESTICIDE, UNSPECIFIED|8,320.00|5,824.00|2,496.00
T61.0|TOXIC EFFECT OF  CIGUATERA FISH POISONING|7,410.00|5,187.00|2,223.00
T61.1|TOXIC EFFECT OF  SCOMBROID FISH POISONING;TOXIC EFFECT OF  HISTAMINE-LIKE SYNDROME|7,410.00|5,187.00|2,223.00
T61.2|TOXIC EFFECT OF  OTHER FISH AND SHELLFISH POISONING|7,410.00|5,187.00|2,223.00
T61.8|TOXIC EFFECT OF OTHER SEAFOODS|7,410.00|5,187.00|2,223.00
T61.9|TOXIC EFFECT OF UNSPECIFIED SEAFOOD|7,410.00|5,187.00|2,223.00
T62.0|TOXIC EFFECT OF INGESTED MUSHROOMS|7,410.00|5,187.00|2,223.00
T62.1|TOXIC EFFECT OF  INGESTED BERRIES|7,410.00|5,187.00|2,223.00
T62.2|TOXIC EFFECT OF OTHER INGESTED (PARTS OF) PLANT(S)|7,410.00|5,187.00|2,223.00
T62.8|TOXIC EFFECT OF  OTHER SPECIFIED NOXIOUS SUBSTANCES EATEN AS FOOD|7,410.00|5,187.00|2,223.00
T62.9|TOXIC EFFECT OF  NOXIOUS SUBSTANCE EATEN AS FOOD, UNSPECIFIED|7,410.00|5,187.00|2,223.00
T63.0|TOXIC EFFECT OF  SNAKE VENOM;TOXIC EFFECT OF  SEA- SNAKE VENOM|7,410.00|5,187.00|2,223.00
T63.1|TOXIC EFFECT OF  VENOM OF OTHER REPTILES; TOXIC EFFECT OF  LIZARD VENOM|7,410.00|5,187.00|2,223.00
T63.2|TOXIC EFFECT OF  VENOM OF SCORPION|7,410.00|5,187.00|2,223.00
T63.3|TOXIC EFFECT OF  VENOM OF SPIDER|7,410.00|5,187.00|2,223.00
T63.4|TOXIC EFFECT OF  VENOM OF OTHER ARTHROPODS;TOXIC EFFECT OF  INSECT BITE OR STING, VENOMOUS|7,410.00|5,187.00|2,223.00
T63.5|TOXIC EFFECT OF CONTACT WITH FISH|7,410.00|5,187.00|2,223.00
T63.6|TOXIC EFFECT OF CONTACT WITH OTHER MARINE ANIMALS; JELLYFISH; SEA ANEMONE; SHELLFISH; STARFISH|7,410.00|5,187.00|2,223.00
T63.8|TOXIC EFFECT OF CONTACT WITH OTHER VENOMOUS ANIMALS; VENOM OF AMPHIBIAN|7,410.00|5,187.00|2,223.00
T63.9|TOXIC EFFECT OF CONTACT WITH UNSPECIFIED VENOMOUS ANIMAL|7,410.00|5,187.00|2,223.00
T64|TOXIC EFFECT OF AFLATION AND OTHER MYCOTOXIN FOOD CONTAMINANTS|7,410.00|5,187.00|2,223.00
T65.0|TOXIC EFFECT OF CYANIDES|8,320.00|5,824.00|2,496.00
T65.2|TOXIC EFFECT OF  TOBACCO AND NICOTINE|7,410.00|5,187.00|2,223.00
T65.3|TOXIC EFFECT OF  NITRO DERIVATIVES AND AMINODERIVATIVES OF BENZENE AND ITS HOMOLOGUES; TOXIC EFFECT OF  ANILINE [BENZENAMINE]; TOXIC EFFECT OF  NITROBENZENE; TOXIC EFFECT OF  TRINITROTOLUENE|8,320.00|5,824.00|2,496.00
T65.4|TOXIC EFFECT OF CARBONDISULFIDE|8,320.00|5,824.00|2,496.00
T65.6|TOXIC EFFECT OF  PAINTS AND DYES, NOT ELSEWHERE CLASSIFIED|8,320.00|5,824.00|2,496.00
T65.8|TOXIC EFFECT OF OTHER SPECIFIED SUBSTANCES|8,320.00|5,824.00|2,496.00
T66|UNSPECIFIED EFFECTS OF RADIATION|12,090.00|8,463.00|3,627.00
T67.0|HEAT STROKE AND SUNSTROKE; HEAT APOPLEXY; HEAT PYREXIA; SIRIASIS; THERMOPLEGIA|8,450.00|5,915.00|2,535.00
T67.1|HEAT SYNCOPE; HEAT COLLAPSE|8,450.00|5,915.00|2,535.00
T67.2|HEAT CRAMP|8,450.00|5,915.00|2,535.00
T67.3|HEAT EXHAUSTION, ANHYDROTIC; HEAT PROSTRATION DUE TO WATER DEPLETION|8,450.00|5,915.00|2,535.00
T67.4|HEAT EXHAUSTION DUE TO SALT DEPLETION; HEAT PROSTATION DUE TO SALT (AND WATER) DEPLETION|8,450.00|5,915.00|2,535.00
T67.5|HEAT EXHAUSTION, UNSPECIFIED; HEAT PROSTRATION NOS|8,450.00|5,915.00|2,535.00
T67.6|HEAT FATIGUE, TRANSIENT|12,090.00|8,463.00|3,627.00
T67.8|OTHER EFFECTS OF HEAT AND LIGHT|12,090.00|8,463.00|3,627.00
T67.9|EFFECT OF HEAT AND LIGHT, UNSPECIFIED|8,450.00|5,915.00|2,535.00
T68|HYPOTHERMIA|12,090.00|8,463.00|3,627.00
T69.0|IMMERSION HAND AND FOOT; TRENCH FOOT|12,090.00|8,463.00|3,627.00
T69.9|EFFECT OF REDUCED TEMPERATURE, UNSPECIFIED|12,090.00|8,463.00|3,627.00
T70.0|OTITIC BAROTRAUMA; AERO-OTITIS MEDIA; EFFECTS OF CHANGE IN AMBIENT ATMOSPHERIC PRESSURE ON SINUSES|12,090.00|8,463.00|3,627.00
T70.2|OTHER AND UNSPECIFIED EFFECTS OF HIGH ALTITUDE; ALPINE SICKNESS; ANOXIA DUE TO HIGH ALTITUDE; BAROTRAUMA NOS; HYPOBAROPATHY; MOUNTAIN SICKNESS|12,090.00|8,463.00|3,627.00
T70.3|CAISSON DISEASE [DECOMPRESSION SICKNESS]; COMPRESSED-AIR DISEASE; DIVER'S PALSY OR PARALYSIS|12,090.00|8,463.00|3,627.00
T70.4|EFFECTS OF HIGH-PRESSURE FLUIDS; TRAUMATIC JET INJECTION (INDUSTRIAL)|12,090.00|8,463.00|3,627.00
T70.8|OTHER EFFECTS OF AIR PRESSURE AND WATER PRESSURE; BLAST INJURY SYNDROME|12,090.00|8,463.00|3,627.00
T70.9|EFFECT OF AIR PRESSURE AND WATER PRESSURE, UNSPECIFIED|12,090.00|8,463.00|3,627.00
T75.0|EFFECTS OF LIGHTNING; SHOCK FROM LIGHTNING; STRUCK BY LIGHTNING NOS|7,020.00|4,914.00|2,106.00
T75.1|DROWNING AND NONFATAL SUBMERSION; IMMERSION; SWIMMER'S CRAMP|9,230.00|6,461.00|2,769.00
T75.2|EFFECTS OF VIBRATION; PNEUMATIC HAMMER SYNDROME; TRAUMATIC VASOSPASTIC SYNDROME; VARTIGO FROM INFRASOUND|12,090.00|8,463.00|3,627.00
T75.4|EFFECTS OF ELECTRIC CURRENT; ELECTROCUTION; SHOCK FROM ELECTRIC CURRENT|7,020.00|4,914.00|2,106.00
T75.8|OTHER SPECIFIED INJURIES DUE TO ENVIRONMENTAL AND OTHER EXTERNAL FACTORS CAUSES;  EFFECTS OF ABNORMAL GRAVITATION [G] FORCES; EFFECTS OF WEIGHTLESSNESS|12,090.00|8,463.00|3,627.00
T78.0|ANAPHYLACTIC SHOCK DUE TO ADVERSE FOOD REACTION|9,880.00|6,916.00|2,964.00
T78.1|OTHER ADVERSE FOOD REACTIONS, NOT ELSEWHERE CLASSIFIED|8,060.00|5,642.00|2,418.00
T78.2|ANAPHYLACTIC SHOCK, UNSPECIFIED; ALLERGIC SHOCK NOS; ANAPHYLACTIC REACTION NOS; ANAPHYLAXIS NOS|9,880.00|6,916.00|2,964.00
T78.3|ANGIONEUROTIC OEDEMA; GIANT URTICARIA; QUINKE'S OEDEMA|8,060.00|5,642.00|2,418.00
T78.4|ALLERGY, UNSPECIFIED; ALLERGIC REACTION NOS; HYPERSENSITIVITY NOS; IDIOSYNCRACY NOS|8,060.00|5,642.00|2,418.00
T78.8|OTHER ADVERSE EFFECTS, NOT ELSEWHERE CLASSIFIED|8,060.00|5,642.00|2,418.00
T78.9|ADVERSE EFFECT, UNSPECIFIED|8,060.00|5,642.00|2,418.00
T79.0|AIR EMBOLISM (TRAUMATIC)|12,090.00|8,463.00|3,627.00
T79.1|FAT EMBOLISM (TRAUMATIC)|12,090.00|8,463.00|3,627.00
T79.2|TRAUMATIC SECONDARY AND RECURRENT HAEMORRHAGE|12,090.00|8,463.00|3,627.00
T79.3|POST-TRAUMATIC WOUND INFECTION, NOT ELSEWHERE CLASSIFIED|12,090.00|8,463.00|3,627.00
T79.4|TRAUMATIC SHOCK; IMMEDIATE SHOCK FOLLOWING INJURY; DELAYED SHOCK FOLLOWING INJURY|12,090.00|8,463.00|3,627.00
T79.5|TRAUMATIC ANURIA; CRUSH SYNDROME; RENAL FAILURE FOLLOWING CRUSHING|12,090.00|8,463.00|3,627.00
T79.6|TRAUMATIC ISCHAEMIA OF MUSCLE; COMPARTMENT SYNDROME; VOLKMANN'S ISCHAEMIC CONTRACTURE|12,090.00|8,463.00|3,627.00
T79.7|TRAUMATIC SUBCUTANEOUS EMPHYSEMA|12,090.00|8,463.00|3,627.00
T79.8|OTHER EARLY COMPLICATIONS OF TRAUMA|12,090.00|8,463.00|3,627.00
T81.0|HAEMORRHAGE AND HAEMATOMA COMPLICATING A PROCEDURE, NOT ELSEWHERE CLASSIFIED; HAEMORRHAGE AT ANY SITE RESULTING FROM A PROCEDURE|13,390.00|9,373.00|4,017.00
T81.1|SHOCK DURING OR RESULTING FROM A PROCEDURE NOT ELSEWHERE CLASSIFIED; COLLAPSE NOS DURING OR FOLLOWING A PROCEDURE; ENDOTOXIC SHOCK DURING OR FOLLOWING A PROCEDURE; HYPOVOLAEMIC DURING OR FOLLOWING A PROCEDURE; SEPTIC SHOCK DURING OR FOLLOWING A PROCEDURE;|13,390.00|9,373.00|4,017.00
T81.2|ACCIDENTAL PUNCTURE AND LACERATION DURING A PROCEDURE NOT ELSEWHERE CLASSIFIED; ACCIDENTAL PERFORATION OF BLOOD VESSEL BY CATHETER, ENDOSCOPE, INSTRUMENT, PROBE DURING A PROCEDURE; ACCIDENTAL PERFORATION OF NERVE BY CATHETER, ENDOSCOPE, INSTRUMENT, PROBE|13,390.00|9,373.00|4,017.00
T81.3|DISRUPTION OF OPERATION WOUND, NOT ELSEWHERE CLASSIFIED; DEHISCENE OF OPERATION WOUND; RUPTURE OF OPERATION WOUND|13,390.00|9,373.00|4,017.00
T81.4|INFECTION FOLLOWING A PROCEDURE, NOT ELSEWHERE CLASSIFIED; INTRA-ABDOMINAL ABSCESS POSTPROCEDURAL ABCESS; INTRA-ABDOMINAL STITCH POSTPROCEDURAL ABSCESS; INTRA-ABDOMINAL SUBPHRENIC POSTPROCEDURAL ABCESS; INTRA- ABDOMINAL WOUND POSTPROCEDURAL ABCESS; SEPTICA|13,390.00|9,373.00|4,017.00
T81.8|OTHER COMPLICATIONS OF PROCEDURES, NOT ELSEWHERE CLASSIFIED; COMPLICATION OF INHALATION THERAPY; EMPHYSEMA (SUBCUTANEOUS) RESULTING FROM A PROCEDURE; PERSISTENT POSTOPERATIVE FISTULA|13,390.00|9,373.00|4,017.00
T82.0|MECHANICAL COMPLICATION OF HEART VALVE PROSTHESIS; MECHANICAL BREAKDOWN DUE TO HEART VALVE PROSTHESIS; DISPLACEMENT DUE TO HEART VALVE PROSTHESIS; FAILURE DUE TO HEART VALVE PROSTHESIS; LEAKAGE DUE TO HEART VALVE PROSTHESIS; MALPOSITION DUE TO HEART VALVE|13,390.00|9,373.00|4,017.00
T82.1|MECHANICAL COMPLICATION OF CARDIAC ELECTRONIC DEVICE; CONDITIONS LISTED IN T82.0 DUE TO ELECTRODES; CONDITIONS LISTED IN T82.0 DUE TO PULSE GENERATOR (BATTERY)|13,390.00|9,373.00|4,017.00
T82.2|MECHANICAL COMPLICATION OF CORONARY ARTERY BYPASS AND VALVE GRAFTS|13,390.00|9,373.00|4,017.00
T82.3|MECHANICAL COMPLICATION OF OTHER VASCULAR GRAFTS; CONDITION LISTED IN T82.0 DUE TO AORTIC (BIFURCATION) GRAFT (REPLACEMENT); CONDITION LISTED IN T82.0 DUE TO ARTERIAL (CAROTID) (FEMORAL) GRAFT (BYPASS)|13,390.00|9,373.00|4,017.00
T82.4|MECHANICAL COMPLICATION OF VASCULAR DIALYSIS CATHETER|13,390.00|9,373.00|4,017.00
T82.5|MECHANICAL COMPLICATION OF OTHER CARDIAC AND VASCULAR DEVICES AND IMPLANTS; CONDITIONS LISTED IN T82.0 DUE TO ARTERIOVENOUS FISTULA  SURGICALLY CREATED; ARTERIVENOUS  SHUNT SURGICALLY CREATED; ARTIFICIAL HEART; BALLON COUNTERPULSATION DEVICE; INFUSION CAT|13,390.00|9,373.00|4,017.00
T82.7|INFECTION AND INFLAMMATORY REACTION DUE TO OTHER CARDIAC AND VASCULAR DEVICES, IMPLANTS AND GRAFTS|13,390.00|9,373.00|4,017.00
T82.8|OTHER COMPLICATIONS OF CARDIAC AND VASCULAR PROSTHETIC DEVICES, IMPLANTS AND GRAFTS; COMPLICATION DUE TO CARDIAC AND VASCULAR PROSTHETIC DEVICES, IMPLANTS AND GRAFTS; EMBOLISM DUE TO CARDIAC AND VASCULAR PROSTHETIC DEVICES, IMPLANTS AND GRAFTS; FIBROSIS D|13,390.00|9,373.00|4,017.00
T83.1|MECHANICAL COMPLICATION OF OTHER URINARY DEVICES AND IMPLANTS; CONCDITIONS LISTED IN T82.0 DUE TO URINARY ELECTRONIC STIMULTOR DEVICE; URINARY SPHINCTER IMPLANT; URINARY STENT|13,390.00|9,373.00|4,017.00
T83.2|MECHANICAL COMPLICATION OF GRAFT OF URINARY ORGAN|13,390.00|9,373.00|4,017.00
T83.3|MECHANICAL COMPLICATION OF INTRAUTERINE CONTRACEPTIVE DEVICE|13,390.00|9,373.00|4,017.00
T83.5|INFECTION AND INFLAMMATORY REACTION DUE TO PROSTHETIC DEVICE, IMPLANT AND GRAFT IN URINARY SYSTEM|13,390.00|9,373.00|4,017.00
T83.8|OTHER COMPLICATIONS OF GENITOURINARY PROSTHETIC DEVICES, IMPLANTS AND GRAFTS|13,390.00|9,373.00|4,017.00
T83.9|UNSPECIFIED COMPLICATION OF GENITOURINARY PROSTHETIC DEVICE, IMPLANTS AND  GRAFTS|13,390.00|9,373.00|4,017.00
T84.0|MECHANICAL COMPLICATION OF INTERNAL JOINT PROSTHESIS|13,390.00|9,373.00|4,017.00
T84.1|MECHANICAL COMPLICATION OF INTERNAL FIXATION DEVICE OF BONES OF LIMB|13,390.00|9,373.00|4,017.00
T84.2|MECHANICAL COMPLICATION OF INTERNAL FIXATION DEVICE OF OTHER BONES|13,390.00|9,373.00|4,017.00
T84.4|MECHANICAL COMPLICATION OF OTHER INTERNAL ORTHOPAEDIC DEVICES, IMPLANTS AND GRAFTS|13,390.00|9,373.00|4,017.00
T84.5|INFECTION AND INFLAMMATORY REACTION DUE TO INTERNAL JOINT PROSTHESIS|13,390.00|9,373.00|4,017.00
T84.6|INFECTION AND INFLAMMATORY REACTION DUE TO INTERNAL FIXATION DEVICE [ANY SITE]|13,390.00|9,373.00|4,017.00
T84.7|INFECTION AND INFLAMMATORY REACTION DUE TO OTHER INTERNAL ORTHOPAEDIC PROSTHETIC DEVICES, IMPLANTS AND GRAFTS|13,390.00|9,373.00|4,017.00
T84.8|OTHER COMPLICATIONS OF INTERNAL ORTHOPAEDIC PROSTHETIC DEVICES, IMPLANTS AND GRAFTS|13,390.00|9,373.00|4,017.00
T84.9|UNSPECIFIED COMPLICATION OF INTERNAL ORTHOPAEDIC PROSTHETIC DEVICE, IMPLANT AND GRAFT|13,390.00|9,373.00|4,017.00
T85.0|MECHANICAL COMPLICATION OF VENTRICULAR INTRACRANIAL (COMMUNICATING) SHUNT|13,390.00|9,373.00|4,017.00
T85.3|MECHANICAL COMPLICATION OF OTHER OCULAR PROSTHETIC DEVICES, IMPLANTS AND GRAFTS CONDITIONS LISTED IN T82.0 DUE TO CORNEAL GRAFT; CONDITIONS LISTED IN T82.0 DUE TO PROSTHETIC ORBIT OF EYE|13,390.00|9,373.00|4,017.00
T85.5|MECHANICALCOMPLICATIONOFGASTROINTESTINALPROST HETICDEVICESIMPLANTSAND; CONDITIONS LISTED IN T82.0 DUE TO BILE-DUCT PROSTHESIS; CONDITIONS LISTED IN T82.0 OESOPHAGEAL ANTI-REFLUX DEVICE|13,390.00|9,373.00|4,017.00
T85.6|MECHANICAL COMPLICATION OF OTHER SPECIFIED INTERNAL PROSTHETIC DEVICES, IMPLANTS AND GRAFTS; CONDITIONS LISTED IN T82.0 DUE TO EPIDURAL AND SUBDURAL INFUSION CATHETER; CONDITIONS LISTED IN T82.0 DUE TO INTRAPERITONAEL DIALYSIS CATHETER; CONDITIONS LISTED|13,390.00|9,373.00|4,017.00
T85.7|INFECTION AND INFLAMMATORY REACTION DUE TO OTHER INTERNAL PROSTHETIC DEVICES, IMPLANTS AND GRAFTS|13,390.00|9,373.00|4,017.00
T85.8|OTHER COMPLICATIONS OF INTERNAL PROSTHETIC DEVICES, IMPLANTS AND GRAFTS, NOT ELSEWHERE CLASSIFIED|13,390.00|9,373.00|4,017.00
T85.9|UNSPECIFIED COMPLICATION OF INTERNAL PROSTHETIC DEVICE, IMPLANT AND GRAFT; COMPLICATION OF INTERNAL PROSTHETIC DEVICE, IMPLANTS AND GRAFT NOS|13,390.00|9,373.00|4,017.00
T88.2|SHOCK DUE TO ANAESTHESIA; SHOCK DUE TO ANAESTHESIA IN WHICH THE CORRECT SUSTANCE WAS PROPERLY ADMINISTERED|41,600.00|29,120.00|12,480.00
T88.6|ANAPHYLACTIC SHOCK DUE TO ADVERSE EFFECT OF CORRECT DRUG OR MEDICAMENT PROPERLY ADMINISTERED|9,880.00|6,916.00|2,964.00
T88.7|UNSPECIFIED ADVERSE EFFECT OF DRUG OR MEDICAMENT; ADVERSE EFFECT OF CORRECT DRUG OR MEDICAMENT PROPERLY ADMINISTERED; ALLERGIC REACTIION TO CORRECT DRUG OR MEDICAMENT PROPERLY ADMINISTERED; HYPERSENSITIVITY TO CORRECT DRUG OR MEDICAMENT PROPERLY ADMINISTE|8,060.00|5,642.00|2,418.00
T90.0|SEQUELAE OF SUPERFICIAL INJURY OF HEAD|11,050.00|7,735.00|3,315.00
T90.1|SEQUELAE OF OPEN WOUND OF HEAD|11,050.00|7,735.00|3,315.00
T90.2|SEQUELAE OF FRACTURE OF SKULL AND FACIAL BONES|11,050.00|7,735.00|3,315.00
T90.5|SEQUELAE OF INTRA CRANIAL INJURY|11,050.00|7,735.00|3,315.00
T90.8|SEQUELAE OF OTHER SPECIFIED INJURIES OF HEAD|11,050.00|7,735.00|3,315.00
T90.9|SEQUELAE OF UNSPECIFIED INJURY OF HEAD|11,050.00|7,735.00|3,315.00
T91.0|SEQUELAE OF SUPERFICIAL INJURY AND OPEN WOUND OF NECK AND TRUNK|11,050.00|7,735.00|3,315.00
T91.1|SEQUELAE OF FRACTURE OF SPINE|11,050.00|7,735.00|3,315.00
T91.2|SEQUELAE OF OTHER FRACTURE OF THORAX AND PELVIS|11,050.00|7,735.00|3,315.00
T91.3|SEQUELAE OF INJURY OF SPINAL CORD|11,050.00|7,735.00|3,315.00
T92.0|SEQUELAE OF OPEN WOUND OF UPPER LIMB|11,050.00|7,735.00|3,315.00
T92.1|SEQUELAE OF FRACTURE OF ARM|11,050.00|7,735.00|3,315.00
T92.8|SEQUELAE OF OTHER SPECIFIED INJURIES OF UPPER LIMB|11,050.00|7,735.00|3,315.00
T93.0|SEQUELAE OF OPEN WOUND OF LOWER LIMB|11,050.00|7,735.00|3,315.00
T93.1|SEQUELAE OF FRACTURE OF FEMUR|11,050.00|7,735.00|3,315.00
T93.2|SEQUELAE OF OTHER FRACTURES OF LOWER LIMB|11,050.00|7,735.00|3,315.00
T93.3|SEQUELAE OF DISLOCATION SPRAIN AND STRAIN OF LOWER LIMB|11,050.00|7,735.00|3,315.00
T93.8|SEQUELAE OF OTHER SPECIFIED INJURIES OF LOWER LIMB|11,050.00|7,735.00|3,315.00
T94.0|SEQUELAE OF INJURIES INVOLVING MULTIPLE BODY REGIONS|11,050.00|7,735.00|3,315.00
T94.1|SEQUELAE OF INJURIES, NOT SPECIFIED BY BODY REGIONS|11,050.00|7,735.00|3,315.00
T95.0|SEQUELAE OF BURN, CORROSION AND FROSTBITE OF HEAD AND NECK|11,050.00|7,735.00|3,315.00
T95.2|SEQUELAE OF BURN, CORROSION AND FROSTBITE OF UPPER LIMB|11,050.00|7,735.00|3,315.00
T95.3|SEQUELAE OF BURN, CORROSION AND FROSTBITE OF LOWER LIMB|11,050.00|7,735.00|3,315.00
T95.8|SEQUELAE OF OTHER SPECIFIED BURN CORROSION AND FROSTBITE|11,050.00|7,735.00|3,315.00
T95.9|SEQUELAE OF UNSPECIFIED BURN, CORROSION AND FROSTBITE|11,050.00|7,735.00|3,315.00
T98.2|SEQUELAE OF CERTAIN EARLY COMPLICATIONS OF TRAUMA|11,050.00|7,735.00|3,315.00
Y40.0|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: SYSTEMIC ANTIBIOTICS: PENICILLINS|9,490.00|6,643.00|2,847.00
Y40.1|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: SYSTEMIC ANTIBIOTICS: CEFALOSPORINS AND OTHER BETA-LACTAM ANTIBIOTICS|9,490.00|6,643.00|2,847.00
Y40.2|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: SYSTEMIC ANTIBIOTICS: CHLORAMPHENICOL GROUP|9,490.00|6,643.00|2,847.00
Y40.4|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: SYSTEMIC ANTIBIOTICS: TETRACYCLINES|9,490.00|6,643.00|2,847.00
Y40.6|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: SYSTEMIC ANTIBIOTICS: RIFAMYCINS|9,490.00|6,643.00|2,847.00
Y40.8|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: SYSTEMIC ANTIBIOTICS: OTHER SYSTEMIC ANTIBIOTICS|9,490.00|6,643.00|2,847.00
Y40.9|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: SYSTEMIC ANTIBIOTICS: SYSTEMIC ANTIBIOTIC, UNSPECIFIED|9,490.00|6,643.00|2,847.00
Y41.0|SULFONAMIDES|9,490.00|6,643.00|2,847.00
Y41.1|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: SYSTEMIC ANTIBIOTICS: ANTIMYCOBACTERIAL DRUGS|9,490.00|6,643.00|2,847.00
Y41.5|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: SYSTEMIC ANTIBIOTICS: ANTIVIRAL DRUGS|9,490.00|6,643.00|2,847.00
Y41.8|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: SYSTEMIC ANTIBIOTICS: OTHER SPECIFIED SYSTEMIC ANTI- INFECTIVES AND ANTIPARASITICS; HYDROXYQUINOLINE DERIVATIVES|9,490.00|6,643.00|2,847.00
Y41.9|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: SYSTEMIC ANTI-INFECTIVE AND ANTIPARASITIC, UNSPECIFIED|9,490.00|6,643.00|2,847.00
Y42.0|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: GLUCOCORTICOIDS AND SYNTHETIC ANALOGUES|11,050.00|7,735.00|3,315.00
Y42.2|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: ANTITHYROID DRUGS|11,050.00|7,735.00|3,315.00
Y42.3|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: INSULIN AND ORAL HYPOGLYCAEMIC [ANTIDIABETIC] DRUGS|11,050.00|7,735.00|3,315.00
Y42.4|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: ORAL CONTRACEPTIVES;MULTIPLE-AND SINGLE- INGREDIENT PREPARATIONS|11,050.00|7,735.00|3,315.00
Y42.5|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: OTHER ESTROGENS AND PROGESTOGENS;MIXTURES AND SUBSTITUTES|11,050.00|7,735.00|3,315.00
Y43.0|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: ANTIALLERGIC AND ANTIEMETIC DRUGS|10,790.00|7,553.00|3,237.00
Y44.2|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: ANTICOAGULANTS|9,490.00|6,643.00|2,847.00
Y44.3|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: ANTICOAGULANT ANTAGONISTS, VITAMIN K AND OTHER COAGULANTS|9,490.00|6,643.00|2,847.00
Y45.1|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: SALICYLATES|11,050.00|7,735.00|3,315.00
Y45.2|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: PROPIONIC ACID DERIVATIVES;PROPANOIC ACID DERIVATIVES|11,050.00|7,735.00|3,315.00
Y45.3|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: OTHER NONSTEROIDAL ANTI-INFLAMMATORY DRUGS [NSAID]|11,050.00|7,735.00|3,315.00
Y45.5|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: 4-AMINOPHENOL DERIVATIVES|11,050.00|7,735.00|3,315.00
Y45.8|OTHER ANALGESICS AND ANTIPYRETICS|9,620.00|6,734.00|2,886.00
Y45.9|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: ANALGESIC, ANTIPYRETIC AND ANTI-INFLAMMATORY DRUG, UNSPECIFIED|9,620.00|6,734.00|2,886.00
Y46.2|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: HYDANTOIN DERIVATIVES|8,710.00|6,097.00|2,613.00
Y46.6|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: OTHER AND UNSPECIFIED ANTIEPILEPTICS|8,710.00|6,097.00|2,613.00
Y47.0|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: BARBITURATES, NOT ELSEWHERE CLASSIFIED|8,710.00|6,097.00|2,613.00
Y47.1|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: BENZODIAZEPINES|8,710.00|6,097.00|2,613.00
Y47.9|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: SEDATIVE, HYPNOTIC AND ANTIANXIETY DRUG, UNSPECIFIED;SLEEPING DRAUGHT NOS;SLEEPING DRUG NOS;SLEEPING TABLET NOS|8,710.00|6,097.00|2,613.00
Y49.5|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: OTHER ANTIPSYCHOTICS AND NEUROLEPTICS|8,710.00|6,097.00|2,613.00
Y49.6|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: PSYCHODYSLEPTICS [HALLUCINOGENS]|8,710.00|6,097.00|2,613.00
Y51.3|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: OTHER PARASYMPATHOLYTICS [ANTICHOLINERGICS AND ANTIMUSCARINICS] AND SPASMOLYTICS, NOT ELSEWHERE CLASSIFIED;PAPAVERINE|8,710.00|6,097.00|2,613.00
Y51.7|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: BETA-ADRENORECEPTOR ANTAGONISTS, NOT ELSEWHERE CLASSIFIED|8,710.00|6,097.00|2,613.00
Y52.0|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: CARDIAC-STIMULANT GLYCOSIDES AND DRUGS OF SIMILAR ACTION|16,250.00|11,375.00|4,875.00
Y52.2|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: OTHER ANTIDYSRHYTHMIC DRUGS, NOT ELSEWHERE CLASSIFIED|16,250.00|11,375.00|4,875.00
Y53.8|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: OTHER AGENTS PRIMARILY AFFECTING THE GASTROINTESTINAL SYSTEM|10,790.00|7,553.00|3,237.00
Y54.3|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: BENZOTHIADIAZINE DERIVATIVES|10,790.00|7,553.00|3,237.00
Y54.8|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: AGENTS AFFECTING URIC ACID METABOLISM|10,790.00|7,553.00|3,237.00
Y55.0|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: OXYTOCIC DRUGS;ERGOT ALKALOIDS|10,790.00|7,553.00|3,237.00
Y55.3|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: ANTITUSSIVES|8,060.00|5,642.00|2,418.00
Y55.4|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: EXPECTORANTS|8,060.00|5,642.00|2,418.00
Y55.6|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: ANTIASTHMATICS, NOT ELSEWHERE CLASSIFIED: AMINOPHYLLINE, SALBUTAMOL, THEOBROMINE;THEOPHYLLINE|8,060.00|5,642.00|2,418.00
Y56.0|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: LOCAL ANTIFUNGAL, ANTI-INFECTIVE AND ANTI- INFLAMMATORY DRUGS, NOT ELSEWHERE CLASSIFIED|9,490.00|6,643.00|2,847.00
Y56.2|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: LOCAL ASTRINGENTS AND LOCAL DETERGENTS|6,890.00|4,823.00|2,067.00
Y56.3|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: EMOLLIENTS, DEMULCENTS AND PROTECTANTS|6,890.00|4,823.00|2,067.00
Y56.6|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: OTORHINOLARYNGOLOGICAL DRUGS AND PREPARATIONS|10,790.00|7,553.00|3,237.00
Y58.0|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: BCG VACCINE|10,790.00|7,553.00|3,237.00
Y58.4|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: TETANUS VACCINE|10,790.00|7,553.00|3,237.00
Y59.9|DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE: VACCINE OR BIOLOGICAL SUBSTANCE, UNSPECIFIED|10,790.00|7,553.00|3,237.00
Z34.0|SUPERVISION OF NORMAL FIRST PREGNANCY|8,840.00|6,188.00|2,652.00
Z34.8|SUPERVISION OF OTHER NORMAL PREGNANCY|8,840.00|6,188.00|2,652.00
Z34.9|SUPERVISION OF NORMAL PREGNANCY, UNSPECIFIED|8,840.00|6,188.00|2,652.00
Z35.0|SUPERVISION OF PREGNANCY WITH HISTORY OF INFERTILITY|8,840.00|6,188.00|2,652.00
Z35.1|SUPERVISION OF PREGNANCY WITH HISTORY OF ABORTIVE OUTCOME|8,840.00|6,188.00|2,652.00
Z35.2|SUPERVISION OF PREGNANCY WITH OTHER POOR REPRODUCTIVE OR OBSTETRIC HISTORY|8,840.00|6,188.00|2,652.00
Z35.4|SUPERVISION OF PREGNANCY WITH GRAND MULTIPARITY|8,840.00|6,188.00|2,652.00
Z35.5|SUPERVISION OF ELDERLY PRIMIGRAVIDA|8,840.00|6,188.00|2,652.00
Z35.6|SUPERVISION OF VERY YOUNG PRIMIGRAVIDA|8,840.00|6,188.00|2,652.00
Z35.7|SUPERVISION OF HIGH-RISK PREGNANCY DUE TO SOCIAL PROBLEMS|8,840.00|6,188.00|2,652.00
Z35.8|SUPERVISION OF OTHER HIGH-RISK PREGNANCIES|8,840.00|6,188.00|2,652.00
Z35.9|SUPERVISION OF HIGH-RISK PREGNANCY, UNSPECIFIED|8,840.00|6,188.00|2,652.00
Z39.0|CARE AND EXAMINATION IMMEDIATELY AFTER DELIVERY|2,600.00|1,820.00|780.00