62333.33 |
24000.00 |
31666.67 |
General symptoms |
49333.33 |
24166.67 |
29200.00 |
Diseases of hard tissues of teeth |
45333.33 |
15416.67 |
21400.00 |
Symptoms involving head and neck |
40333.33 |
25000.00 |
28066.67 |
Gingival and periodontal diseases |
37333.33 |
17583.33 |
21533.33 |
Functional digestive disorders, not elsewhere classified |
36333.33 |
17083.33 |
20933.33 |
Gastritis and duodenitis |
34000.00 |
18583.33 |
21666.67 |
Contact dermatitis and other eczema |
32000.00 |
13250.00 |
17000.00 |
Other noninfectious gastroenteritis and colitis |
32000.00 |
14583.33 |
18066.67 |
Other symptoms involving abdomen and pelvis |
31666.67 |
15416.67 |
18666.67 |
Disorders of function of stomach |
29333.33 |
16666.67 |
19200.00 |
Other disorders of soft tissues |
28000.00 |
13500.00 |
16400.00 |
Diseases of pulp and periapical tissues |
28000.00 |
18583.33 |
20466.67 |
Other and unspecified disorders of back |
28000.00 |
15250.00 |
17800.00 |
Symptoms involving respiratory system and other chest symptoms |
24666.67 |
14000.00 |
16133.33 |
Essential hypertension |
23000.00 |
11083.33 |
13466.67 |
Other disorders of urethra and urinary tract |
22666.67 |
14000.00 |
15733.33 |
Osteoarthrosis and allied disorders |
21333.33 |
10416.67 |
12600.00 |
Neurotic disorders |
21333.33 |
12833.33 |
14533.33 |
Inflammatory disease of cervix, vagina and vulva |
20333.33 |
11500.00 |
13266.67 |
Diseases of the oral soft tissues, excluding lesions specific for gingiva and tongue |
20000.00 |
9333.33 |
11466.67 |
Spondylosis and allied disorders |
20000.00 |
6416.67 |
9133.33 |
Symptoms involving digestive system |
18333.33 |
8833.33 |
10733.33 |
Allergic rhinitis |
17000.00 |
8583.33 |
10266.67 |
Peptic ulcer, site unspecified |
16666.67 |
8833.33 |
10400.00 |
Disorders of menstruation and other abnormal bleeding from female genital tract |
15666.67 |
7916.67 |
9466.67 |
Other disorders of bone and cartilage |
15000.00 |
9500.00 |
10600.00 |
Cataract |
15000.00 |
11166.67 |
11933.33 |
Other and unspecified disorder of joint |
14333.33 |
7000.00 |
8466.67 |
Diabetes mellitus |
14000.00 |
8083.33 |
9266.67 |
Hypertensive heart disease |
13000.00 |
9333.33 |
10066.67 |
Disorders of lipoid metabolism |
12666.67 |
7500.00 |
8533.33 |
Peripheral enthesopathies and allied syndromes |
12333.33 |
7083.33 |
8133.33 |
Vertiginous syndromes and other disorders of vestibular system |
12333.33 |
8583.33 |
9333.33 |
Menopausal and postmenopausal disorders |
12000.00 |
5000.00 |
6400.00 |
Asthma |
12000.00 |
6250.00 |
7400.00 |
Other diseases and conditions of the teeth and supporting structures |
12000.00 |
6666.67 |
7733.33 |
Urticaria |
11666.67 |
4666.67 |
6066.67 |
Disorders of refraction and accommodation |
11333.33 |
9250.00 |
9666.67 |
Pruritus and related conditions |
11333.33 |
8083.33 |
8733.33 |
Other disorders of synovium, tendon and bursa |
11000.00 |
4916.67 |
6133.33 |
Intervertebral disc disorders |
10333.33 |
4750.00 |
5866.67 |
Other diseases of upper respiratory tract |
10333.33 |
6666.67 |
7400.00 |
Chronic liver disease and cirrhosis |
10000.00 |
750.00 |
2600.00 |
Parkinson's disease |
10000.00 |
5833.33 |
6666.67 |
Chronic bronchitis |
9666.67 |
6333.33 |
7000.00 |
Other and unspecified arthropathies |
9333.33 |
2500.00 |
3866.67 |
Suppurative and unspecified otitis media |
8666.67 |
3666.67 |
4666.67 |
Special symptoms or syndromes not elsewhere classified |
8666.67 |
6500.00 |
6933.33 |
Other forms of chronic ischemic heart disease |
8666.67 |
5000.00 |
5733.33 |
Chronic pharyngitis and nasopharyngitis |
8333.33 |
4583.33 |
5333.33 |
Symptoms involving skin and other integumentary tissue |
8333.33 |
4166.67 |
5000.00 |
Symptoms involving urinary system |
8333.33 |
5833.33 |
6333.33 |
Dermatophytosis |
7666.67 |
2666.67 |
3666.67 |
Gastric ulcer |
7666.67 |
4500.00 |
5133.33 |
Diseases of sebaceous glands |
7333.33 |
5750.00 |
6066.67 |
Cardiac dysrhythmias |
7333.33 |
2833.33 |
3733.33 |
Other disorders of cervical region |
7333.33 |
3416.67 |
4200.00 |
Disorders of muscle, ligament and fascia |
7000.00 |
2500.00 |
3400.00 |
Other and unspecified anemias |
7000.00 |
4666.67 |
5133.33 |
Diseases of esophagus |
6666.67 |
250.00 |
1533.33 |
Epilepsy |
6666.67 |
4250.00 |
4733.33 |
Visual disturbances |
6000.00 |
4000.00 |
4400.00 |
Disorders of lacrimal system |
5666.67 |
916.67 |
1866.67 |
Senile and presenile organic psychotic conditions |
5666.67 |
833.33 |
1800.00 |
Specific diseases due to Coxsackie virus |
5333.33 |
1500.00 |
2266.67 |
Migraine |
5333.33 |
2083.33 |
2733.33 |
Atopic dermatitis and related conditions |
5000.00 |
500.00 |
1400.00 |
Other extrapyramidal disease and abnormal movement disorders |
5000.00 |
3250.00 |
3600.00 |
Pain and other symptoms associated with female genital organs |
5000.00 |
4750.00 |
4800.00 |
Symptoms involving cardiovascular system |
4666.67 |
1166.67 |
1866.67 |
Affective psychoses |
4666.67 |
3583.33 |
3800.00 |
Candidiasis |
4333.33 |
2000.00 |
2466.67 |
Benign neoplasm of skin |
4333.33 |
166.67 |
1000.00 |
Other cerebral degenerations |
4333.33 |
3000.00 |
3266.67 |
Other disorders of skin and subcutaneous tissue |
4000.00 |
833.33 |
1466.67 |
Thyrotoxicosis with or without goiter |
4000.00 |
1916.67 |
2333.33 |
Physiological malfunction arising from mental factors |
4000.00 |
916.67 |
1533.33 |
Group B streptococcus infections of unspecified site |
4000.00 |
1500.00 |
2000.00 |
Nerve root and plexus disorders |
4000.00 |
2750.00 |
3000.00 |
Other disorders of eyelids |
4000.00 |
833.33 |
1466.67 |
Nonsuppurative otitis media and eustachian tube disorders |
4000.00 |
1666.67 |
2133.33 |
Herpes zoster |
4000.00 |
916.67 |
1533.33 |
Acute, but ill-defined, cerebrovascular disease |
4000.00 |
1500.00 |
2000.00 |
Other and ill-defined cerebrovascular disease |
4000.00 |
3750.00 |
3800.00 |
Hemorrhoids |
4000.00 |
583.33 |
1266.67 |
Other diseases of lung |
4000.00 |
2333.33 |
2666.67 |
Duodenal ulcer |
4000.00 |
3000.00 |
3200.00 |
Other disorders of breast |
3666.67 |
3416.67 |
3466.67 |
Gout |
3666.67 |
1666.67 |
2066.67 |
Other disorders of eye |
3666.67 |
2583.33 |
2800.00 |
Angina pectoris |
3333.33 |
166.67 |
800.00 |
Benign neoplasm of brain and other parts of nervous system |
3333.33 |
500.00 |
1066.67 |
Other organic psychotic conditions (chronic) |
3333.33 |
416.67 |
1000.00 |
Depressive disorder, not elsewhere classified |
3333.33 |
1000.00 |
1466.67 |
Inflammatory and toxic neuropathy |
3333.33 |
1750.00 |
2066.67 |
Glaucoma |
3333.33 |
1583.33 |
1933.33 |
Late effects of cerebrovascular disease |
3333.33 |
2083.33 |
2333.33 |
Noninflammatory disorders of vagina |
3000.00 |
2666.67 |
2733.33 |
Other disorders of ear |
3000.00 |
2333.33 |
2466.67 |
Other diseases due to viruses and Chlamydiae |
3000.00 |
416.67 |
933.33 |
Viral and chlamydial infection in conditions classified elsewhere and of unspecified site |
2666.67 |
1500.00 |
1733.33 |
Uterine leiomyoma |
2666.67 |
833.33 |
1200.00 |
Simple and unspecified goiter |
2666.67 |
750.00 |
1133.33 |
Other paralytic syndromes |
2666.67 |
2000.00 |
2133.33 |
Other diseases of endocardium |
2666.67 |
1416.67 |
1666.67 |
Chronic sinusitis |
2666.67 |
583.33 |
1000.00 |
Disorders of tooth development and eruption |
2666.67 |
750.00 |
1133.33 |
Dermatitis due to substances taken internally |
2666.67 |
1083.33 |
1400.00 |
Rheumatoid arthritis and other inflammatory polyarthropathies |
2333.33 |
1166.67 |
1400.00 |
Neoplasm of unspecified nature |
2333.33 |
583.33 |
933.33 |
Pulmonary tuberculosis |
2333.33 |
1916.67 |
2000.00 |
Mononeuritis of upper limb and mononeuritis multiplex |
2333.33 |
2583.33 |
2533.33 |
Other retinal disorders |
2333.33 |
833.33 |
1133.33 |
Herpes simplex |
2333.33 |
1500.00 |
1666.67 |
Ill-defined descriptions and complications of heart disease |
2333.33 |
1250.00 |
1466.67 |
Chronic airways obstruction, not elsewhere classified |
2333.33 |
666.67 |
1000.00 |
Hydronephrosis |
2333.33 |
1250.00 |
1466.67 |
Hemorrhage in early pregnancy |
2333.33 |
833.33 |
1133.33 |
Erythematosquamous dermatosis |
2000.00 |
1583.33 |
1666.67 |
Benign neoplasm of breast |
2000.00 |
1000.00 |
1200.00 |
Other disorders of thyroid |
2000.00 |
250.00 |
600.00 |
Other conditions of brain |
2000.00 |
750.00 |
1000.00 |
Hereditary and idiopathic peripheral neuropathy |
2000.00 |
1416.67 |
1533.33 |
Other disorders of liver |
2000.00 |
916.67 |
1133.33 |
Normal delivery |
2000.00 |
916.67 |
1133.33 |
Diseases of hair and hair follicles |
2000.00 |
500.00 |
800.00 |
Chronic ulcer of skin |
2000.00 |
1083.33 |
1266.67 |
Diffuse diseases of connective tissue |
1666.67 |
1583.33 |
1600.00 |
Iron deficiency anemias |
1666.67 |
333.33 |
600.00 |
Hemiplegia and hemiparesis |
1666.67 |
83.33 |
400.00 |
Facial nerve disorders |
1666.67 |
1583.33 |
1600.00 |
Hearing loss |
1666.67 |
2500.00 |
2333.33 |
Heart failure |
1666.67 |
750.00 |
933.33 |
Nephritis and nephropathy, not specified as acute or chronic |
1666.67 |
1000.00 |
1133.33 |
Chronic renal failure |
1666.67 |
750.00 |
933.33 |
Disorders of uterus, not elsewhere classified |
1666.67 |
2000.00 |
1933.33 |
Noninflammatory disorders of cervix |
1666.67 |
666.67 |
866.67 |
Other dermatoses |
1666.67 |
1000.00 |
1133.33 |
Disorders of sweat glands |
1666.67 |
500.00 |
733.33 |
Ankylosing spondylitis and other inflammatory spondylopathies |
1666.67 |
750.00 |
933.33 |
Other acquired deformity |
1666.67 |
416.67 |
666.67 |
Symptoms involving nervous and musculoskeletal systems |
1666.67 |
916.67 |
1066.67 |
Dermatomycosis, other and unspecified |
1333.33 |
83.33 |
333.33 |
Benign neoplasm of lip, oral cavity and pharynx |
1333.33 |
666.67 |
800.00 |
Nontoxic nodular goiter |
1333.33 |
666.67 |
800.00 |
Acquired hypothyroidism |
1333.33 |
500.00 |
666.67 |
Disorders of the pituitary gland and its hypothalamic control |
1333.33 |
250.00 |
466.67 |
Diseases of white blood cells |
1333.33 |
83.33 |
333.33 |
Specific delays in development |
1333.33 |
166.67 |
400.00 |
Other disorders of middle ear and mastoid |
1333.33 |
333.33 |
533.33 |
Chickenpox |
1333.33 |
750.00 |
866.67 |
Other diseases of respiratory system |
1333.33 |
1666.67 |
1600.00 |
Viral hepatitis |
1333.33 |
250.00 |
466.67 |
Diseases of the salivary glands |
1333.33 |
1166.67 |
1200.00 |
Regional enteritis |
1333.33 |
416.67 |
600.00 |
Chronic glomerulonephritis |
1333.33 |
1500.00 |
1466.67 |
Other disorders of bladder |
1333.33 |
416.67 |
600.00 |
Early or threatened labor |
1333.33 |
1000.00 |
1066.67 |
Other derangement of joint |
1333.33 |
500.00 |
666.67 |
Other congenital musculoskeletal anomalies |
1333.33 |
416.67 |
600.00 |
Acariasis |
1000.00 |
500.00 |
600.00 |
Malignant neoplasm of female breast |
1000.00 |
166.67 |
333.33 |
Other benign neoplasm of uterus |
1000.00 |
1166.67 |
1133.33 |
Benign neoplasm of ovary |
1000.00 |
250.00 |
400.00 |
Benign neoplasm of other and unspecified sites |
1000.00 |
83.33 |
266.67 |
Disorders of adrenal glands |
1000.00 |
166.67 |
333.33 |
Deficiency of B -complex components |
1000.00 |
333.33 |
466.67 |
Hereditary hemolytic anemias |
1000.00 |
500.00 |
600.00 |
Purpura and other hemorrhagic conditions |
1000.00 |
250.00 |
400.00 |
Transient organic psychotic conditions |
1000.00 |
166.67 |
333.33 |
Acute reaction to stress |
1000.00 |
250.00 |
400.00 |
Disorders of iris and ciliary body |
1000.00 |
750.00 |
800.00 |
Bronchiectasis |
1000.00 |
750.00 |
800.00 |
Dentofacial anomalies, including malocclusion |
1000.00 |
1000.00 |
1000.00 |
Other disorders of intestine |
1000.00 |
250.00 |
400.00 |
Nephrotic syndrome |
1000.00 |
83.33 |
266.67 |
Acute renal failure |
1000.00 |
166.67 |
333.33 |
Renal failure, unspecified |
1000.00 |
750.00 |
800.00 |
Benign mammary dysplasias |
1000.00 |
1166.67 |
1133.33 |
Excessive vomiting in pregnancy |
1000.00 |
416.67 |
533.33 |
Corns and callosities |
1000.00 |
833.33 |
866.67 |
Curvature of spine |
1000.00 |
916.67 |
933.33 |
Nonspecific abnormal results of function studies |
666.67 |
166.67 |
266.67 |
Malignant neoplasm of trachea, bronchus and lung |
666.67 |
83.33 |
200.00 |
Lipoma |
666.67 |
1000.00 |
933.33 |
Other benign neoplasm of connective and other soft tissue |
666.67 |
166.67 |
266.67 |
Benign neoplasm of thyroid glands |
666.67 |
83.33 |
200.00 |
Benign neoplasm of other endocrine glands and related structures |
666.67 |
250.00 |
333.33 |
Thyroiditis |
666.67 |
833.33 |
800.00 |
Ovarian dysfunction |
666.67 |
166.67 |
266.67 |
Obesity and other hyperalimentation |
666.67 |
83.33 |
200.00 |
Aplastic anemia |
666.67 |
416.67 |
466.67 |
Other diseases of blood and blood-forming organs |
666.67 |
250.00 |
333.33 |
Schizophrenic disorders |
666.67 |
250.00 |
333.33 |
Other nonorganic psychoses |
666.67 |
250.00 |
333.33 |
Nondependent abuse of drugs |
666.67 |
166.67 |
266.67 |
Trigeminal nerve disorders |
666.67 |
833.33 |
800.00 |
Mononeuritis of lower limb |
666.67 |
333.33 |
400.00 |
Disorders of the globe |
666.67 |
416.67 |
466.67 |
Disorders of optic nerve and visual pathways |
666.67 |
83.33 |
200.00 |
Strabismus and other disorders of binocular eye movements |
666.67 |
583.33 |
600.00 |
Coronary occlusion without myocardial infarction |
666.67 |
583.33 |
600.00 |
Other peripheral vascular disease |
666.67 |
416.67 |
466.67 |
Arterial embolism and thrombosis |
666.67 |
250.00 |
333.33 |
Hypotension |
666.67 |
250.00 |
333.33 |
Chronic disease of tonsils and adenoids |
666.67 |
250.00 |
333.33 |
Chronic laryngitis and laryngotracheitis |
666.67 |
333.33 |
400.00 |
Emphysema |
666.67 |
333.33 |
400.00 |
Gastrojejunal ulcer |
666.67 |
83.33 |
200.00 |
Disorders resulting from impaired renal function |
666.67 |
833.33 |
800.00 |
Infertility, female |
666.67 |
333.33 |
400.00 |
Ectopic pregnancy |
666.67 |
416.67 |
466.67 |
Other current conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium |
666.67 |
583.33 |
600.00 |
Psoriasis and similar disorders |
666.67 |
666.67 |
666.67 |
Other hypertrophic and atrophic conditions of skin |
666.67 |
666.67 |
666.67 |
Nonspecific findings on examination of blood |
666.67 |
416.67 |
466.67 |
Nonspecific findings on examination of urine |
666.67 |
583.33 |
600.00 |
Other ill-defined and unknown causes of morbidity and mortality |
666.67 |
416.67 |
466.67 |
Late effects of tuberculosis |
333.33 |
166.67 |
200.00 |
Malignant neoplasm of liver and intrahepatic bile ducts |
333.33 |
416.67 |
400.00 |
Malignant neoplasm of cervix uteri |
333.33 |
166.67 |
200.00 |
Malignant neoplasm of kidney and other and unspecified urinary organs |
333.33 |
83.33 |
133.33 |
Secondary malignant neoplasm of respiratory and digestive systems |
333.33 |
666.67 |
600.00 |
Benign neoplasm of other parts of digestive system |
333.33 |
166.67 |
200.00 |
Benign neoplasm of other female genital organs |
333.33 |
500.00 |
466.67 |
Carcinoma in situ of breast and genitourinary system |
333.33 |
166.67 |
200.00 |
Neoplasm of uncertain behavior of digestive and respiratory systems |
333.33 |
166.67 |
200.00 |
Neoplasm of uncertain behavior of other and unspecified sites and tissues |
333.33 |
166.67 |
200.00 |
Disorders of parathyroid gland |
333.33 |
416.67 |
400.00 |
Other endocrine disorders |
333.33 |
166.67 |
200.00 |
Disorders of mineral metabolism |
333.33 |
83.33 |
133.33 |
Disorders involving the immune mechanism |
333.33 |
416.67 |
400.00 |
Other deficiency anemias |
333.33 |
83.33 |
133.33 |
Personality disorders |
333.33 |
83.33 |
133.33 |
Psychic factors associated with diseases classified elsewhere |
333.33 |
83.33 |
133.33 |
Other diseases of spinal cord |
333.33 |
166.67 |
200.00 |
Myoneural disorders |
333.33 |
250.00 |
266.67 |
Retinal detachments and defects |
333.33 |
583.33 |
533.33 |
Corneal opacity and other disorders of cornea |
333.33 |
416.67 |
400.00 |
Diseases of mitral and aortic valves |
333.33 |
83.33 |
133.33 |
Diseases of other endocardial structures |
333.33 |
83.33 |
133.33 |
Other rheumatic heart disease |
333.33 |
333.33 |
333.33 |
Hypertensive heart and renal disease |
333.33 |
166.67 |
200.00 |
Conduction disorders |
333.33 |
666.67 |
600.00 |
Atherosclerosis |
333.33 |
83.33 |
133.33 |
Polyarteritis nodosa and allied conditions |
333.33 |
583.33 |
533.33 |
Other disorders of arteries and arterioles |
333.33 |
250.00 |
266.67 |
Other venous embolism and thrombosis |
333.33 |
250.00 |
266.67 |
Varicose veins of lower extremities |
333.33 |
166.67 |
200.00 |
Other disorders of circulatory system |
333.33 |
83.33 |
133.33 |
Pneumonitis due to solids and liquids |
333.33 |
166.67 |
200.00 |
Diseases of the jaws |
333.33 |
333.33 |
333.33 |
Other disorders of stomach and duodenum |
333.33 |
166.67 |
200.00 |
Liver abscess and sequelae of chronic liver disease |
333.33 |
416.67 |
400.00 |
Endometriosis |
333.33 |
666.67 |
600.00 |
Genital prolapse |
333.33 |
750.00 |
666.67 |
Noninflammatory disorders of ovary, fallopian tube and broad ligament |
333.33 |
750.00 |
666.67 |
Other disorders of female genital organs |
333.33 |
166.67 |
200.00 |
Other complications of pregnancy, not elsewhere classified |
333.33 |
166.67 |
200.00 |
Malposition and malpresentation of fetus |
333.33 |
166.67 |
200.00 |
Other fetal and placental problems affecting management of mother |
333.33 |
83.33 |
133.33 |
Other complications of labor and delivery, not elsewhere classified |
333.33 |
500.00 |
466.67 |
Erythematous conditions |
333.33 |
166.67 |
200.00 |
Arthropathy associated with infections |
333.33 |
666.67 |
600.00 |
Arthropathy associated with other disorders classified elsewhere |
333.33 |
1333.33 |
1133.33 |
Internal derangement of knee |
333.33 |
83.33 |
133.33 |
Relapsing fever |
333.33 |
333.33 |
333.33 |
Osteomyelitis,periostitis and other infections involving bone |
333.33 |
83.33 |
133.33 |
Spina bifida |
333.33 |
83.33 |
133.33 |
Certain congenital musculoskeletal deformities |
333.33 |
83.33 |
133.33 |
Disorders relating to short gestation and unspecified low birthweight |
333.33 |
83.33 |
133.33 |
Malignant neoplasm of nasopharynx |