WakeMed DRG* Data 2019

Transcription

1 WakeMed DRG* Data 2019 *Diagnosis-Related Groups (DRGs or MS-DRGs) A DRG (diagnosis-related group) is the system Medicare and some insurance companies use to classify and categorize charges for inpatient hospitalization. The DRG is based on a patient s diagnoses and surgery when performed. Medicare and/or other payers use the assigned DRG to pay the hospital a set (fixed) amount regardless of the actual charges for the patient s hospital stay. DRG NUMBER DRG NAME AVERAGE CHARGES MS003 ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R. $ 498, MS004 TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. $ 375, MS011 TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY W MCC $ 163, MS012 TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY W CC $ 104, MS013 TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY W/O CC/MCC $ 70, MS020 INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W MCC $ 426, MS021 INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W CC $ 396, MS023 CRANIOTOMY W MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX W MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY W NEUROSTIMULATOR $ 194, MS024 CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W/O MCC $ 117, MS025 CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCC $ 168, MS026 CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W CC $ 109, MS027 CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W/O CC/MCC $ 112, MS028 SPINAL PROCEDURES W MCC $ 208, MS029 SPINAL PROCEDURES W CC OR SPINAL NEUROSTIMULATORS $ 105, MS030 SPINAL PROCEDURES W/O CC/MCC $ 101, MS031 VENTRICULAR SHUNT PROCEDURES W MCC $ 67, MS032 VENTRICULAR SHUNT PROCEDURES W CC $ 95, MS033 VENTRICULAR SHUNT PROCEDURES W/O CC/MCC $ 76, MS036 CAROTID ARTERY STENT PROCEDURE W/O CC/MCC $ 99, MS037 EXTRACRANIAL PROCEDURES W MCC $ 77, MS038 EXTRACRANIAL PROCEDURES W CC $ 47, MS039 EXTRACRANIAL PROCEDURES W/O CC/MCC $ 39, MS040 PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W MCC $ 158, MS041 PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W CC OR PERIPH NEUROSTIM $ 85, MS042 PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W/O CC/MCC $ 71, MS052 SPINAL DISORDERS & INJURIES W CC/MCC $ 75, MS053 SPINAL DISORDERS & INJURIES W/O CC/MCC $ 46, MS054 NERVOUS SYSTEM NEOPLASMS W MCC $ 38, MS055 NERVOUS SYSTEM NEOPLASMS W/O MCC $ 31, MS056 DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC $ 89, MS057 DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC $ 60, MS058 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W MCC $ 46, MS059 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W CC $ 58, MS060 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W/O CC/MCC $ 26, MS061 ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA W THROMBOLYTIC AGENT W MCC $ 85, MS062 ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA W THROMBOLYTIC AGENT W CC $ 77, MS063 ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA W THROMBOLYTIC AGENT W/O CC/MCC $ 71, MS064 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC $ 55, MS065 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS $ 34, MS066 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC $ 26, MS067 NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W MCC $ 17, MS068 NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W/O MCC $ 26, MS069 TRANSIENT ISCHEMIA W/O THROMBOLYTIC $ 22, MS070 NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC $ 55, MS071 NONSPECIFIC CEREBROVASCULAR DISORDERS W CC $ 37, MS072 NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC $ 18, MS073 CRANIAL & PERIPHERAL NERVE DISORDERS W MCC $ 20, MS074 CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC $ 9,252.63

2 MS075 VIRAL MENINGITIS W CC/MCC $ 27, MS076 VIRAL MENINGITIS W/O CC/MCC $ 13, MS077 HYPERTENSIVE ENCEPHALOPATHY W MCC $ 57, MS078 HYPERTENSIVE ENCEPHALOPATHY W CC $ 25, MS079 HYPERTENSIVE ENCEPHALOPATHY W/O CC/MCC $ 23, MS080 NONTRAUMATIC STUPOR & COMA W MCC $ 32, MS081 NONTRAUMATIC STUPOR & COMA W/O MCC $ 9, MS082 TRAUMATIC STUPOR & COMA, COMA >1 HR W MCC $ 74, MS083 TRAUMATIC STUPOR & COMA, COMA >1 HR W CC $ 41, MS084 TRAUMATIC STUPOR & COMA, COMA >1 HR W/O CC/MCC $ 20, MS085 TRAUMATIC STUPOR & COMA, COMA <1 HR W MCC $ 69, MS086 TRAUMATIC STUPOR & COMA, COMA <1 HR W CC $ 31, MS087 TRAUMATIC STUPOR & COMA, COMA <1 HR W/O CC/MCC $ 15, MS088 CONCUSSION W MCC $ 28, MS089 CONCUSSION W CC $ 16, MS090 CONCUSSION W/O CC/MCC $ 6, MS091 OTHER DISORDERS OF NERVOUS SYSTEM W MCC $ 46, MS092 OTHER DISORDERS OF NERVOUS SYSTEM W CC $ 18, MS093 OTHER DISORDERS OF NERVOUS SYSTEM W/O CC/MCC $ 7, MS094 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W MCC $ 105, MS095 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W CC $ 74, MS096 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W/O CC/MCC $ 64, MS097 NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W MCC $ 126, MS098 NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W CC $ 73, MS099 NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W/O CC/MCC $ 39, MS100 SEIZURES W MCC $ 40, MS101 SEIZURES W/O MCC $ 9, MS102 HEADACHES W MCC $ 11, MS103 HEADACHES W/O MCC $ 5, MS121 ACUTE MAJOR EYE INFECTIONS W CC/MCC $ 16, MS122 ACUTE MAJOR EYE INFECTIONS W/O CC/MCC $ 4, MS123 NEUROLOGICAL EYE DISORDERS $ 13, MS124 OTHER DISORDERS OF THE EYE W MCC $ 9, MS125 OTHER DISORDERS OF THE EYE W/O MCC $ 6, MS129 MAJOR HEAD & NECK PROCEDURES W CC/MCC OR MAJOR DEVICE $ 62, MS131 CRANIAL/FACIAL PROCEDURES W CC/MCC $ 81, MS132 CRANIAL/FACIAL PROCEDURES W/O CC/MCC $ 49, MS133 OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W CC/MCC $ 46, MS134 OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCC $ 29, MS137 MOUTH PROCEDURES W CC/MCC $ 34, MS138 MOUTH PROCEDURES W/O CC/MCC $ 24, MS146 EAR, NOSE, MOUTH & THROAT MALIGNANCY W MCC $ 49, MS147 EAR, NOSE, MOUTH & THROAT MALIGNANCY W CC $ 35, MS148 EAR, NOSE, MOUTH & THROAT MALIGNANCY W/O CC/MCC $ 19, MS149 DYSEQUILIBRIUM $ 7, MS150 EPISTAXIS W MCC $ 10, MS151 EPISTAXIS W/O MCC $ 2, MS152 OTITIS MEDIA & URI W MCC $ 6, MS153 OTITIS MEDIA & URI W/O MCC $ 2, MS154 OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W MCC $ 21, MS155 OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W CC $ 11, MS156 OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W/O CC/MCC $ 5, MS157 DENTAL & ORAL DISEASES W MCC $ 19, MS158 DENTAL & ORAL DISEASES W CC $ 12, MS159 DENTAL & ORAL DISEASES W/O CC/MCC $ 5, MS163 MAJOR CHEST PROCEDURES W MCC $ 168,526.55

3 MS164 MAJOR CHEST PROCEDURES W CC $ 85, MS165 MAJOR CHEST PROCEDURES W/O CC/MCC $ 65, MS166 OTHER RESP SYSTEM O.R. PROCEDURES W MCC $ 111, MS167 OTHER RESP SYSTEM O.R. PROCEDURES W CC $ 62, MS168 OTHER RESP SYSTEM O.R. PROCEDURES W/O CC/MCC $ 52, MS175 PULMONARY EMBOLISM W MCC $ 39, MS176 PULMONARY EMBOLISM W/O MCC $ 21, MS177 RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC $ 45, MS178 RESPIRATORY INFECTIONS & INFLAMMATIONS W CC $ 30, MS179 RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC $ 15, MS180 RESPIRATORY NEOPLASMS W MCC $ 41, MS181 RESPIRATORY NEOPLASMS W CC $ 25, MS182 RESPIRATORY NEOPLASMS W/O CC/MCC $ 18, MS183 MAJOR CHEST TRAUMA W MCC $ 42, MS184 MAJOR CHEST TRAUMA W CC $ 33, MS185 MAJOR CHEST TRAUMA W/O CC/MCC $ 14, MS186 PLEURAL EFFUSION W MCC $ 31, MS187 PLEURAL EFFUSION W CC $ 20, MS188 PLEURAL EFFUSION W/O CC/MCC $ 11, MS189 PULMONARY EDEMA & RESPIRATORY FAILURE $ 32, MS190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC $ 27, MS191 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC $ 19, MS192 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC $ 9, MS193 SIMPLE PNEUMONIA & PLEURISY W MCC $ 34, MS194 SIMPLE PNEUMONIA & PLEURISY W CC $ 17, MS195 SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC $ 5, MS196 INTERSTITIAL LUNG DISEASE W MCC $ 36, MS197 INTERSTITIAL LUNG DISEASE W CC $ 18, MS198 INTERSTITIAL LUNG DISEASE W/O CC/MCC $ 10, MS199 PNEUMOTHORAX W MCC $ 58, MS200 PNEUMOTHORAX W CC $ 35, MS201 PNEUMOTHORAX W/O CC/MCC $ 13, MS202 BRONCHITIS & ASTHMA W CC/MCC $ 13, MS203 BRONCHITIS & ASTHMA W/O CC/MCC $ 4, MS204 RESPIRATORY SIGNS & SYMPTOMS $ 4, MS205 OTHER RESPIRATORY SYSTEM DIAGNOSES W MCC $ 28, MS206 OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC $ 9, MS207 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS OR PERIPHERAL EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) $ 183, MS208 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS $ 78, MS215 OTHER HEART ASSIST SYSTEM IMPLANT $ 356, MS216 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W MCC $ 314, MS217 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W CC $ 224, MS218 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W/O CC/MCC $ 200, MS219 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W MCC $ 241, MS220 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W CC $ 179, MS221 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W/O CC/MCC $ 165, MS222 CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W MCC $ 275, MS223 CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W/O MCC $ 199, MS224 CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W MCC $ 296, MS225 CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W/O MCC $ 231, MS226 CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W MCC $ 235, MS227 CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W/O MCC $ 207, MS228 OTHER CARDIOTHORACIC PROCEDURES W MCC $ 217, MS229 OTHER CARDIOTHORACIC PROCEDURES W/O MCC $ 161, MS231 CORONARY BYPASS W PTCA W MCC $ 199, MS232 CORONARY BYPASS W PTCA W/O MCC $ 230,774.55

4 MS233 CORONARY BYPASS W CARDIAC CATH W MCC $ 223, MS234 CORONARY BYPASS W CARDIAC CATH W/O MCC $ 170, MS235 CORONARY BYPASS W/O CARDIAC CATH W MCC $ 157, MS236 CORONARY BYPASS W/O CARDIAC CATH W/O MCC $ 134, MS239 AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W MCC $ 137, MS240 AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W CC $ 75, MS241 AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W/O CC/MCC $ 64, MS242 PERMANENT CARDIAC PACEMAKER IMPLANT W MCC $ 139, MS243 PERMANENT CARDIAC PACEMAKER IMPLANT W CC $ 105, MS244 PERMANENT CARDIAC PACEMAKER IMPLANT W/O CC/MCC $ 79, MS245 AICD GENERATOR PROCEDURES $ 242, MS246 PERCUTANEOUS CARDIOVASCULAR PROCEDURES W DRUG-ELUTING STENT W MCC OR 4+ ARTERIES OR STENTS $ 111, MS247 PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC $ 83, MS248 PERCUTANEOUS CARDIOVASCULAR PROCEDURES W NON-DRUG-ELUTING STENT W MCC OR 4+ ARTERIES OR STENTS $ 120, MS249 PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W/O MCC $ 80, MS250 PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W MCC $ 102, MS251 PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W/O MCC $ 71, MS252 OTHER VASCULAR PROCEDURES W MCC $ 107, MS253 OTHER VASCULAR PROCEDURES W CC $ 94, MS254 OTHER VASCULAR PROCEDURES W/O CC/MCC $ 68, MS255 UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W MCC $ 69, MS256 UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W CC $ 63, MS257 UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W/O CC/MCC $ 34, MS258 CARDIAC PACEMAKER DEVICE REPLACEMENT W MCC $ 82, MS259 CARDIAC PACEMAKER DEVICE REPLACEMENT W/O MCC $ 84, MS260 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W MCC $ 130, MS261 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W CC $ 62, MS262 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W/O CC/MCC $ 48, MS263 VEIN LIGATION & STRIPPING $ 71, MS264 OTHER CIRCULATORY SYSTEM O.R. PROCEDURES $ 143, MS265 AICD LEAD PROCEDURES $ 158, MS266 ENDOVASCULAR CARDIAC VALVE REPLACEMENT W MCC $ 144, MS267 ENDOVASCULAR CARDIAC VALVE REPLACEMENT W/O MCC $ 108, MS268 AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W MCC $ 241, MS269 AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W/O MCC $ 188, MS270 OTHER MAJOR CARDIOVASCULAR PROCEDURES W MCC $ 170, MS271 OTHER MAJOR CARDIOVASCULAR PROCEDURES W CC $ 131, MS272 OTHER MAJOR CARDIOVASCULAR PROCEDURES W/O CC/MCC $ 105, MS273 PERCUTANEOUS INTRACARDIAC PROCEDURES W MCC $ 184, MS274 PERCUTANEOUS INTRACARDIAC PROCEDURES W/O MCC $ 151, MS280 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC $ 48, MS281 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC $ 33, MS282 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC $ 21, MS283 ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC $ 81, MS284 ACUTE MYOCARDIAL INFARCTION, EXPIRED W CC $ 45, MS285 ACUTE MYOCARDIAL INFARCTION, EXPIRED W/O CC/MCC $ 13, MS286 CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC $ 56, MS287 CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC $ 39, MS288 ACUTE & SUBACUTE ENDOCARDITIS W MCC $ 78, MS289 ACUTE & SUBACUTE ENDOCARDITIS W CC $ 40, MS290 ACUTE & SUBACUTE ENDOCARDITIS W/O CC/MCC $ 26, MS291 HEART FAILURE & SHOCK W MCC OR PERIPHERAL EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) $ 32, MS292 HEART FAILURE & SHOCK W CC $ 42, MS293 HEART FAILURE & SHOCK W/O CC/MCC $ 23, MS294 DEEP VEIN THROMBOPHLEBITIS W CC/MCC $ 18, MS295 DEEP VEIN THROMBOPHLEBITIS W/O CC/MCC $ 3,049.01

5 MS296 CARDIAC ARREST, UNEXPLAINED W MCC OR PERIPHERAL EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) $ 46, MS297 CARDIAC ARREST, UNEXPLAINED W CC $ 16, MS298 CARDIAC ARREST, UNEXPLAINED W/O CC/MCC $ 11, MS299 PERIPHERAL VASCULAR DISORDERS W MCC $ 49, MS300 PERIPHERAL VASCULAR DISORDERS W CC $ 49, MS301 PERIPHERAL VASCULAR DISORDERS W/O CC/MCC $ 22, MS302 ATHEROSCLEROSIS W MCC $ 49, MS303 ATHEROSCLEROSIS W/O MCC $ 39, MS304 HYPERTENSION W MCC $ 23, MS305 HYPERTENSION W/O MCC $ 7, MS306 CARDIAC CONGENITAL & VALVULAR DISORDERS W MCC $ 30, MS307 CARDIAC CONGENITAL & VALVULAR DISORDERS W/O MCC $ 22, MS308 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC $ 40, MS309 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC $ 39, MS310 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC $ 21, MS311 ANGINA PECTORIS $ 14, MS312 SYNCOPE & COLLAPSE $ 9, MS313 CHEST PAIN $ 8, MS314 OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC $ 31, MS315 OTHER CIRCULATORY SYSTEM DIAGNOSES W CC $ 56, MS316 OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC $ 14, MS326 STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC $ 133, MS327 STOMACH, ESOPHAGEAL & DUODENAL PROC W CC $ 66, MS328 STOMACH, ESOPHAGEAL & DUODENAL PROC W/O CC/MCC $ 44, MS329 MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC $ 135, MS330 MAJOR SMALL & LARGE BOWEL PROCEDURES W CC $ 83, MS331 MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC $ 58, MS333 RECTAL RESECTION W CC $ 59, MS334 RECTAL RESECTION W/O CC/MCC $ 51, MS335 PERITONEAL ADHESIOLYSIS W MCC $ 148, MS336 PERITONEAL ADHESIOLYSIS W CC $ 66, MS337 PERITONEAL ADHESIOLYSIS W/O CC/MCC $ 50, MS338 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W MCC $ 81, MS339 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC $ 51, MS340 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC $ 41, MS341 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W MCC $ 87, MS342 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC $ 50, MS343 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC $ 36, MS344 MINOR SMALL & LARGE BOWEL PROCEDURES W MCC $ 82, MS345 MINOR SMALL & LARGE BOWEL PROCEDURES W CC $ 47, MS346 MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC $ 45, MS347 ANAL & STOMAL PROCEDURES W MCC $ 92, MS348 ANAL & STOMAL PROCEDURES W CC $ 42, MS349 ANAL & STOMAL PROCEDURES W/O CC/MCC $ 34, MS350 INGUINAL & FEMORAL HERNIA PROCEDURES W MCC $ 99, MS351 INGUINAL & FEMORAL HERNIA PROCEDURES W CC $ 49, MS352 INGUINAL & FEMORAL HERNIA PROCEDURES W/O CC/MCC $ 39, MS353 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W MCC $ 59, MS354 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W CC $ 51, MS355 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W/O CC/MCC $ 41, MS356 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC $ 115, MS357 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC $ 70, MS358 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC $ 49, MS368 MAJOR ESOPHAGEAL DISORDERS W MCC $ 55, MS369 MAJOR ESOPHAGEAL DISORDERS W CC $ 28, MS370 MAJOR ESOPHAGEAL DISORDERS W/O CC/MCC $ 10,483.67

6 MS371 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC $ 42, MS372 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC $ 28, MS373 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W/O CC/MCC $ 28, MS374 DIGESTIVE MALIGNANCY W MCC $ 64, MS375 DIGESTIVE MALIGNANCY W CC $ 29, MS376 DIGESTIVE MALIGNANCY W/O CC/MCC $ 15, MS377 G.I. HEMORRHAGE W MCC $ 48, MS378 G.I. HEMORRHAGE W CC $ 31, MS379 G.I. HEMORRHAGE W/O CC/MCC $ 8, MS380 COMPLICATED PEPTIC ULCER W MCC $ 43, MS381 COMPLICATED PEPTIC ULCER W CC $ 28, MS382 COMPLICATED PEPTIC ULCER W/O CC/MCC $ 14, MS383 UNCOMPLICATED PEPTIC ULCER W MCC $ 25, MS384 UNCOMPLICATED PEPTIC ULCER W/O MCC $ 15, MS385 INFLAMMATORY BOWEL DISEASE W MCC $ 31, MS386 INFLAMMATORY BOWEL DISEASE W CC $ 21, MS387 INFLAMMATORY BOWEL DISEASE W/O CC/MCC $ 18, MS388 G.I. OBSTRUCTION W MCC $ 41, MS389 G.I. OBSTRUCTION W CC $ 26, MS390 G.I. OBSTRUCTION W/O CC/MCC $ 15, MS391 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC $ 16, MS392 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC $ 7, MS393 OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC $ 35, MS394 OTHER DIGESTIVE SYSTEM DIAGNOSES W CC $ 17, MS395 OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC $ 16, MS405 PANCREAS, LIVER & SHUNT PROCEDURES W MCC $ 275, MS406 PANCREAS, LIVER & SHUNT PROCEDURES W CC $ 129, MS407 PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/MCC $ 102, MS409 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W CC $ 72, MS410 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W/O CC/MCC $ 48, MS411 CHOLECYSTECTOMY W C.D.E. W MCC $ 52, MS412 CHOLECYSTECTOMY W C.D.E. W CC $ 58, MS413 CHOLECYSTECTOMY W C.D.E. W/O CC/MCC $ 117, MS414 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W MCC $ 101, MS415 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC $ 65, MS416 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC/MCC $ 50, MS417 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC $ 74, MS418 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC $ 59, MS419 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC $ 48, MS420 HEPATOBILIARY DIAGNOSTIC PROCEDURES W MCC $ 180, MS421 HEPATOBILIARY DIAGNOSTIC PROCEDURES W CC $ 64, MS422 HEPATOBILIARY DIAGNOSTIC PROCEDURES W/O CC/MCC $ 38, MS423 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W MCC $ 244, MS432 CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC $ 48, MS433 CIRRHOSIS & ALCOHOLIC HEPATITIS W CC $ 26, MS434 CIRRHOSIS & ALCOHOLIC HEPATITIS W/O CC/MCC $ 13, MS435 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC $ 55, MS436 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC $ 28, MS437 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W/O CC/MCC $ 21, MS438 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC $ 51, MS439 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC $ 25, MS440 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC $ 14, MS441 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W MCC $ 55, MS442 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC $ 23, MS443 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC/MCC $ 15, MS444 DISORDERS OF THE BILIARY TRACT W MCC $ 56,056.71

7 MS445 DISORDERS OF THE BILIARY TRACT W CC $ 28, MS446 DISORDERS OF THE BILIARY TRACT W/O CC/MCC $ 21, MS453 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W MCC $ 318, MS454 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W CC $ 241, MS455 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O CC/MCC $ 186, MS456 SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W MCC $ 323, MS457 SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W CC $ 211, MS458 SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W/O CC/MCC $ 163, MS459 SPINAL FUSION EXCEPT CERVICAL W MCC $ 201, MS460 SPINAL FUSION EXCEPT CERVICAL W/O MCC $ 149, MS461 BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W MCC $ 131, MS462 BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC $ 110, MS463 WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC $ 182, MS464 WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W CC $ 82, MS465 WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W/O CC/MCC $ 68, MS466 REVISION OF HIP OR KNEE REPLACEMENT W MCC $ 138, MS467 REVISION OF HIP OR KNEE REPLACEMENT W CC $ 131, MS468 REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC $ 122, MS469 MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC OR TOTAL ANKLE REPLACEMENT $ 109, MS470 MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC $ 72, MS471 CERVICAL SPINAL FUSION W MCC $ 179, MS472 CERVICAL SPINAL FUSION W CC $ 109, MS473 CERVICAL SPINAL FUSION W/O CC/MCC $ 98, MS474 AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W MCC $ 119, MS475 AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W CC $ 73, MS476 AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W/O CC/MCC $ 35, MS477 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC $ 75, MS478 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC $ 64, MS479 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC $ 60, MS480 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC $ 118, MS481 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC $ 86, MS482 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC $ 61, MS483 MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES $ 83, MS485 KNEE PROCEDURES W PDX OF INFECTION W MCC $ 65, MS486 KNEE PROCEDURES W PDX OF INFECTION W CC $ 59, MS487 KNEE PROCEDURES W PDX OF INFECTION W/O CC/MCC $ 57, MS488 KNEE PROCEDURES W/O PDX OF INFECTION W CC/MCC $ 106, MS489 KNEE PROCEDURES W/O PDX OF INFECTION W/O CC/MCC $ 63, MS492 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W MCC $ 123, MS493 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC $ 89, MS494 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC $ 63, MS495 LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W MCC $ 153, MS496 LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W CC $ 61, MS497 LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W/O CC/MCC $ 36, MS498 LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W CC/MCC $ 173, MS499 LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W/O CC/MCC $ 32, MS500 SOFT TISSUE PROCEDURES W MCC $ 137, MS501 SOFT TISSUE PROCEDURES W CC $ 62, MS502 SOFT TISSUE PROCEDURES W/O CC/MCC $ 51, MS503 FOOT PROCEDURES W MCC $ 86, MS504 FOOT PROCEDURES W CC $ 62, MS505 FOOT PROCEDURES W/O CC/MCC $ 70, MS506 MAJOR THUMB OR JOINT PROCEDURES $ 45, MS507 MAJOR SHOULDER OR ELBOW JOINT PROCEDURES W CC/MCC $ 40, MS510 SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W MCC $ 104, MS511 SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W CC $ 74,157.05

8 MS512 SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W/O CC/MCC $ 56, MS513 HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W CC/MCC $ 65, MS514 HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W/O CC/MCC $ 31, MS515 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W MCC $ 115, MS516 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC $ 70, MS517 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC/MCC $ 63, MS518 BACK & NECK PROC EXC SPINAL FUSION W MCC OR DISC DEVICE/NEUROSTIM $ 108, MS519 BACK & NECK PROC EXC SPINAL FUSION W CC $ 70, MS520 BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC $ 46, MS533 FRACTURES OF FEMUR W MCC $ 17, MS534 FRACTURES OF FEMUR W/O MCC $ 16, MS535 FRACTURES OF HIP & PELVIS W MCC $ 33, MS536 FRACTURES OF HIP & PELVIS W/O MCC $ 15, MS537 SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH W CC/MCC $ 17, MS538 SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH W/O CC/MCC $ 9, MS539 OSTEOMYELITIS W MCC $ 40, MS540 OSTEOMYELITIS W CC $ 31, MS541 OSTEOMYELITIS W/O CC/MCC $ 13, MS542 PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W MCC $ 29, MS543 PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC $ 26, MS544 PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W/O CC/MCC $ 25, MS545 CONNECTIVE TISSUE DISORDERS W MCC $ 54, MS546 CONNECTIVE TISSUE DISORDERS W CC $ 47, MS547 CONNECTIVE TISSUE DISORDERS W/O CC/MCC $ 12, MS548 SEPTIC ARTHRITIS W MCC $ 83, MS549 SEPTIC ARTHRITIS W CC $ 35, MS550 SEPTIC ARTHRITIS W/O CC/MCC $ 26, MS551 MEDICAL BACK PROBLEMS W MCC $ 22, MS552 MEDICAL BACK PROBLEMS W/O MCC $ 7, MS553 BONE DISEASES & ARTHROPATHIES W MCC $ 22, MS554 BONE DISEASES & ARTHROPATHIES W/O MCC $ 20, MS555 SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W MCC $ 7, MS556 SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W/O MCC $ 3, MS557 TENDONITIS, MYOSITIS & BURSITIS W MCC $ 34, MS558 TENDONITIS, MYOSITIS & BURSITIS W/O MCC $ 13, MS559 AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC $ 81, MS560 AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC $ 59, MS561 AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC $ 22, MS562 FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W MCC $ 15, MS563 FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC $ 6, MS564 OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W MCC $ 33, MS565 OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC $ 21, MS566 OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W/O CC/MCC $ 15, MS570 SKIN DEBRIDEMENT W MCC $ 51, MS571 SKIN DEBRIDEMENT W CC $ 62, MS572 SKIN DEBRIDEMENT W/O CC/MCC $ 33, MS575 SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W/O CC/MCC $ 40, MS577 SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W CC $ 79, MS579 OTHER SKIN, SUBCUT TISS & BREAST PROC W MCC $ 50, MS580 OTHER SKIN, SUBCUT TISS & BREAST PROC W CC $ 47, MS581 OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC $ 30, MS582 MASTECTOMY FOR MALIGNANCY W CC/MCC $ 57, MS583 MASTECTOMY FOR MALIGNANCY W/O CC/MCC $ 60, MS584 BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W CC/MCC $ 26, MS585 BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W/O CC/MCC $ 44, MS592 SKIN ULCERS W MCC $ 17,975.88

9 MS593 SKIN ULCERS W CC $ 18, MS594 SKIN ULCERS W/O CC/MCC $ 7, MS595 MAJOR SKIN DISORDERS W MCC $ 3, MS596 MAJOR SKIN DISORDERS W/O MCC $ 3, MS597 MALIGNANT BREAST DISORDERS W MCC $ 37, MS598 MALIGNANT BREAST DISORDERS W CC $ 34, MS599 MALIGNANT BREAST DISORDERS W/O CC/MCC $ 37, MS600 NON-MALIGNANT BREAST DISORDERS W CC/MCC $ 18, MS601 NON-MALIGNANT BREAST DISORDERS W/O CC/MCC $ 10, MS602 CELLULITIS W MCC $ 28, MS603 CELLULITIS W/O MCC $ 5, MS604 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W MCC $ 12, MS605 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC $ 4, MS606 MINOR SKIN DISORDERS W MCC $ 15, MS607 MINOR SKIN DISORDERS W/O MCC $ 2, MS614 ADRENAL & PITUITARY PROCEDURES W CC/MCC $ 85, MS615 ADRENAL & PITUITARY PROCEDURES W/O CC/MCC $ 55, MS616 AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W MCC $ 102, MS617 AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W CC $ 57, MS619 O.R. PROCEDURES FOR OBESITY W MCC $ 147, MS620 O.R. PROCEDURES FOR OBESITY W CC $ 63, MS621 O.R. PROCEDURES FOR OBESITY W/O CC/MCC $ 56, MS622 SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W MCC $ 99, MS623 SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC $ 59, MS624 SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W/O CC/MCC $ 17, MS625 THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W MCC $ 52, MS626 THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W CC $ 57, MS627 THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W/O CC/MCC $ 57, MS628 OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W MCC $ 77, MS629 OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC $ 68, MS630 OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W/O CC/MCC $ 43, MS637 DIABETES W MCC $ 35, MS638 DIABETES W CC $ 17, MS639 DIABETES W/O CC/MCC $ 7, MS640 MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W MCC $ 30, MS641 MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W/O MCC $ 9, MS642 INBORN AND OTHER DISORDERS OF METABOLISM $ 14, MS643 ENDOCRINE DISORDERS W MCC $ 41, MS644 ENDOCRINE DISORDERS W CC $ 22, MS645 ENDOCRINE DISORDERS W/O CC/MCC $ 18, MS653 MAJOR BLADDER PROCEDURES W MCC $ 56, MS654 MAJOR BLADDER PROCEDURES W CC $ 45, MS655 MAJOR BLADDER PROCEDURES W/O CC/MCC $ 63, MS656 KIDNEY & URETER PROCEDURES FOR NEOPLASM W MCC $ 89, MS657 KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC $ 63, MS658 KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC $ 55, MS659 KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W MCC $ 88, MS660 KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC $ 52, MS661 KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC $ 47, MS662 MINOR BLADDER PROCEDURES W MCC $ 55, MS663 MINOR BLADDER PROCEDURES W CC $ 65, MS664 MINOR BLADDER PROCEDURES W/O CC/MCC $ 64, MS665 PROSTATECTOMY W MCC $ 88, MS666 PROSTATECTOMY W CC $ 65, MS668 TRANSURETHRAL PROCEDURES W MCC $ 81, MS669 TRANSURETHRAL PROCEDURES W CC $ 42,543.03

10 MS670 TRANSURETHRAL PROCEDURES W/O CC/MCC $ 40, MS672 URETHRAL PROCEDURES W/O CC/MCC $ 31, MS673 OTHER KIDNEY & URINARY TRACT PROCEDURES W MCC $ 100, MS674 OTHER KIDNEY & URINARY TRACT PROCEDURES W CC $ 68, MS675 OTHER KIDNEY & URINARY TRACT PROCEDURES W/O CC/MCC $ 68, MS682 RENAL FAILURE W MCC $ 35, MS683 RENAL FAILURE W CC $ 24, MS684 RENAL FAILURE W/O CC/MCC $ 12, MS685 ADMIT FOR RENAL DIALYSIS $ 3, MS686 KIDNEY & URINARY TRACT NEOPLASMS W MCC $ 54, MS687 KIDNEY & URINARY TRACT NEOPLASMS W CC $ 24, MS688 KIDNEY & URINARY TRACT NEOPLASMS W/O CC/MCC $ 20, MS689 KIDNEY & URINARY TRACT INFECTIONS W MCC $ 26, MS690 KIDNEY & URINARY TRACT INFECTIONS W/O MCC $ 7, MS693 URINARY STONES W/O ESW LITHOTRIPSY W MCC $ 26, MS694 URINARY STONES W/O ESW LITHOTRIPSY W/O MCC $ 15, MS695 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W MCC $ 9, MS696 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W/O MCC $ 5, MS697 URETHRAL STRICTURE $ 15, MS698 OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC $ 40, MS699 OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC $ 17, MS700 OTHER KIDNEY & URINARY TRACT DIAGNOSES W/O CC/MCC $ 8, MS707 MAJOR MALE PELVIC PROCEDURES W CC/MCC $ 68, MS708 MAJOR MALE PELVIC PROCEDURES W/O CC/MCC $ 51, MS710 PENIS PROCEDURES W/O CC/MCC $ 74, MS711 TESTES PROCEDURES W CC/MCC $ 82, MS712 TESTES PROCEDURES W/O CC/MCC $ 34, MS713 TRANSURETHRAL PROSTATECTOMY W CC/MCC $ 53, MS714 TRANSURETHRAL PROSTATECTOMY W/O CC/MCC $ 31, MS716 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC FOR MALIGNANCY W/O CC/MCC $ 27, MS717 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W CC/MCC $ 144, MS718 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W/O CC/MCC $ 78, MS722 MALIGNANCY, MALE REPRODUCTIVE SYSTEM W MCC $ 51, MS723 MALIGNANCY, MALE REPRODUCTIVE SYSTEM W CC $ 26, MS724 MALIGNANCY, MALE REPRODUCTIVE SYSTEM W/O CC/MCC $ 30, MS725 BENIGN PROSTATIC HYPERTROPHY W MCC $ 67, MS726 BENIGN PROSTATIC HYPERTROPHY W/O MCC $ 15, MS727 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W MCC $ 22, MS728 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W/O MCC $ 7, MS729 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES W CC/MCC $ 13, MS730 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES W/O CC/MCC $ 11, MS736 UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W MCC $ 76, MS742 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC $ 48, MS743 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC $ 38, MS744 D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W CC/MCC $ 58, MS745 D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W/O CC/MCC $ 46, MS746 VAGINA, CERVIX & VULVA PROCEDURES W CC/MCC $ 39, MS747 VAGINA, CERVIX & VULVA PROCEDURES W/O CC/MCC $ 27, MS748 FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES $ 48, MS749 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W CC/MCC $ 48, MS750 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC $ 58, MS754 MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W MCC $ 42, MS755 MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC $ 29, MS756 MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC $ 26, MS757 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W MCC $ 16, MS758 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W CC $ 5,408.80

11 MS759 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC $ 4, MS760 MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W CC/MCC $ 13, MS761 MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W/O CC/MCC $ 13, MS765 CESAREAN SECTION W CC/MCC $ 33, MS766 CESAREAN SECTION W/O CC/MCC $ 26, MS767 VAGINAL DELIVERY W STERILIZATION &/OR D&C $ 20, MS768 VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C $ 16, MS769 POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE $ 47, MS770 ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY $ 42, MS774 VAGINAL DELIVERY W COMPLICATING DIAGNOSES $ 15, MS775 VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES $ 13, MS776 POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE $ 9, MS777 ECTOPIC PREGNANCY $ 22, MS778 THREATENED ABORTION $ 5, MS779 ABORTION W/O D&C $ 9, MS780 FALSE LABOR $ 1, MS781 OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS $ 3, MS782 OTHER ANTEPARTUM DIAGNOSES W/O MEDICAL COMPLICATIONS $ 3, MS789 NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY $ 48, MS790 EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE $ 298, MS791 PREMATURITY W MAJOR PROBLEMS $ 70, MS792 PREMATURITY W/O MAJOR PROBLEMS $ 28, MS793 FULL TERM NEONATE W MAJOR PROBLEMS $ 31, MS794 NEONATE W OTHER SIGNIFICANT PROBLEMS $ 6, MS795 NORMAL NEWBORN $ 4, MS799 SPLENECTOMY W MCC $ 64, MS800 SPLENECTOMY W CC $ 213, MS801 SPLENECTOMY W/O CC/MCC $ 53, MS802 OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W MCC $ 62, MS803 OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W CC $ 75, MS804 OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W/O CC/MCC $ 48, MS808 MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W MCC $ 43, MS809 MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC $ 23, MS810 MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W/O CC/MCC $ 12, MS811 RED BLOOD CELL DISORDERS W MCC $ 31, MS812 RED BLOOD CELL DISORDERS W/O MCC $ 10, MS813 COAGULATION DISORDERS $ 29, MS814 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W MCC $ 47, MS815 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC $ 20, MS816 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC/MCC $ 7, MS821 LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W CC $ 154, MS823 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER PROC W MCC $ 116, MS824 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER PROC W CC $ 96, MS825 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER PROC W/O CC/MCC $ 68, MS827 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W CC $ 93, MS829 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS W OTHER PROCEDURE W CC/MCC $ 46, MS834 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W MCC $ 69, MS835 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W CC $ 20, MS836 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W/O CC/MCC $ 6, MS840 LYMPHOMA & NON-ACUTE LEUKEMIA W MCC $ 90, MS841 LYMPHOMA & NON-ACUTE LEUKEMIA W CC $ 31, MS842 LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC/MCC $ 17, MS843 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W MCC $ 60, MS844 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC $ 38, MS845 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC/MCC $ 28, MS846 CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W MCC $ 62,200.04

12 MS847 CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W CC $ 36, MS848 CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W/O CC/MCC $ 16, MS853 INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC $ 173, MS854 INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC $ 71, MS855 INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W/O CC/MCC $ 43, MS856 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W MCC $ 139, MS857 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC $ 58, MS858 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W/O CC/MCC $ 47, MS862 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W MCC $ 36, MS863 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC $ 13, MS864 FEVER AND INFLAMMATORY CONDITIONS $ 2, MS865 VIRAL ILLNESS W MCC $ 18, MS866 VIRAL ILLNESS W/O MCC $ 2, MS867 OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W MCC $ 37, MS868 OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W CC $ 16, MS869 OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W/O CC/MCC $ 4, MS870 SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS OR PERIPHERAL EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) $ 187, MS871 SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC $ 49, MS872 SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC $ 27, MS876 O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF MENTAL ILLNESS $ 147, MS880 ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION $ 6, MS881 DEPRESSIVE NEUROSES $ 7, MS882 NEUROSES EXCEPT DEPRESSIVE $ 6, MS883 DISORDERS OF PERSONALITY & IMPULSE CONTROL $ 16, MS884 ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY $ 13, MS885 PSYCHOSES $ 14, MS886 BEHAVIORAL & DEVELOPMENTAL DISORDERS $ 6, MS887 OTHER MENTAL DISORDER DIAGNOSES $ 3, MS894 ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA $ 10, MS895 ALCOHOL/DRUG ABUSE OR DEPENDENCE W REHABILITATION THERAPY $ 20, MS896 ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC $ 55, MS897 ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC $ 7, MS901 WOUND DEBRIDEMENTS FOR INJURIES W MCC $ 110, MS902 WOUND DEBRIDEMENTS FOR INJURIES W CC $ 51, MS903 WOUND DEBRIDEMENTS FOR INJURIES W/O CC/MCC $ 28, MS905 SKIN GRAFTS FOR INJURIES W/O CC/MCC $ 88, MS906 HAND PROCEDURES FOR INJURIES $ 60, MS907 OTHER O.R. PROCEDURES FOR INJURIES W MCC $ 102, MS908 OTHER O.R. PROCEDURES FOR INJURIES W CC $ 77, MS909 OTHER O.R. PROCEDURES FOR INJURIES W/O CC/MCC $ 56, MS913 TRAUMATIC INJURY W MCC $ 8, MS914 TRAUMATIC INJURY W/O MCC $ 5, MS915 ALLERGIC REACTIONS W MCC $ 35, MS916 ALLERGIC REACTIONS W/O MCC $ 3, MS917 POISONING & TOXIC EFFECTS OF DRUGS W MCC $ 43, MS918 POISONING & TOXIC EFFECTS OF DRUGS W/O MCC $ 7, MS919 COMPLICATIONS OF TREATMENT W MCC $ 29, MS920 COMPLICATIONS OF TREATMENT W CC $ 19, MS921 COMPLICATIONS OF TREATMENT W/O CC/MCC $ 9, MS922 OTHER INJURY, POISONING & TOXIC EFFECT DIAG W MCC $ 43, MS923 OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O MCC $ 3, MS934 FULL THICKNESS BURN W/O SKIN GRAFT OR INHAL INJ $ 4, MS935 NON-EXTENSIVE BURNS $ 3, MS939 O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W MCC $ 194, MS940 O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W CC $ 77, MS941 O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W/O CC/MCC $ 60,379.46

13 MS945 REHABILITATION W CC/MCC $ 89, MS946 REHABILITATION W/O CC/MCC $ 56, MS947 SIGNS & SYMPTOMS W MCC $ 13, MS948 SIGNS & SYMPTOMS W/O MCC $ 7, MS949 AFTERCARE W CC/MCC $ 39, MS950 AFTERCARE W/O CC/MCC $ 4, MS951 OTHER FACTORS INFLUENCING HEALTH STATUS $ 5, MS955 CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA $ 308, MS956 LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA $ 208, MS957 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W MCC $ 254, MS958 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W CC $ 147, MS959 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC $ 68, MS963 OTHER MULTIPLE SIGNIFICANT TRAUMA W MCC $ 120, MS964 OTHER MULTIPLE SIGNIFICANT TRAUMA W CC $ 48, MS965 OTHER MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC $ 41, MS969 HIV W EXTENSIVE O.R. PROCEDURE W MCC $ 145, MS974 HIV W MAJOR RELATED CONDITION W MCC $ 67, MS975 HIV W MAJOR RELATED CONDITION W CC $ 27, MS976 HIV W MAJOR RELATED CONDITION W/O CC/MCC $ 17, MS977 HIV W OR W/O OTHER RELATED CONDITION $ 37, MS981 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC $ 140, MS982 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC $ 82, MS983 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC $ 61, MS987 NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC $ 137, MS988 NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC $ 49, MS989 NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC $ 67, MS998 PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS $ 2,350.69