004 TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. $134, TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W MCC $27,845.

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Horace Austin
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1 DRG Number DRG Name DRG Average Charge 004 TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. $134, TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W MCC $27, TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W CC 014 ALLOGENEIC BONE MARROW TRANSPLANT $20, NULL $11, CRANIAL & PERIPHERAL NERVE DISORDERS W CC $4, CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W/O MCC $11, CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCC $35, SPINAL PROCEDURES W MCC $63, EXTRACRANIAL PROCEDURES W MCC $20, EXTRACRANIAL PROCEDURES W CC $22, EXTRACRANIAL PROCEDURES W/O CC/MCC $16, PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W/O CC/MCC $7, NEUROLOGICAL EYE DISORDERS $27, SPINAL DISORDERS & INJURIES W/O CC/MCC $11, NERVOUS SYSTEM NEOPLASMS W MCC $12, DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC 057 DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC $7, MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W CC $8, ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA W THROM $8, ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA W THROM $15, INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC $19, INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS $10, INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC $9, NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W/O MCC $7, TRANSIENT ISCHEMIA W/O THROMBOLYTIC $8, NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC $13, NONSPECIFIC CEREBROVASCULAR DISORDERS W CC $9, NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC $13, CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC $11, VIRAL MENINGITIS W/O CC/MCC $58, HYPERTENSIVE ENCEPHALOPATHY W CC $10, HYPERTENSIVE ENCEPHALOPATHY W/O CC/MCC $9, NONTRAUMATIC STUPOR & COMA W MCC $7, TRAUMATIC STUPOR & COMA, COMA >1 HR W MCC $7, TRAUMATIC STUPOR & COMA, COMA <1 HR W MCC $20, TRAUMATIC STUPOR & COMA, COMA <1 HR W/O CC/MCC $13, CONCUSSION W MCC $7, CONCUSSION W CC $9, CONCUSSION W/O CC/MCC $3, OTHER DISORDERS OF NERVOUS SYSTEM W MCC $14, OTHER DISORDERS OF NERVOUS SYSTEM W CC $8, OTHER DISORDERS OF NERVOUS SYSTEM W/O CC/MCC $4, BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W CC $21, BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W/O CC/MCC $9, NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W MCC $16, NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W CC $2, SEIZURES W MCC $13, SEIZURES W/O MCC $10, HEADACHES W MCC $5, HEADACHES W/O MCC $7, NULL $40, INTRAOCULAR PROCEDURES W CC/MCC $46, OTHER CIRCULATORY SYSTEM O.R. PROCEDURES $15,225.59

2 121 ACUTE MAJOR EYE INFECTIONS W CC/MCC $24, NEUROLOGICAL EYE DISORDERS $12, OTHER DISORDERS OF THE EYE W MCC $15, OTHER DISORDERS OF THE EYE W/O MCC $7, ACUTE & SUBACUTE ENDOCARDITIS $5, HEART FAILURE & SHOCK $9, MAJOR HEAD & NECK PROCEDURES W CC/MCC OR MAJOR DEVICE $8, OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W CC/MCC $11, OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCC $2, MOUTH PROCEDURES W CC/MCC $8, MOUTH PROCEDURES W/O CC/MCC $5, SALIVARY GLAND PROCEDURES $11, ANGINA PECTORIS $17, SYNCOPE & COLLAPSE W CC $11, CHEST PAIN $5, OTHER CIRCULATORY SYSTEM DIAGNOSES W CC $10, EAR, NOSE, MOUTH & THROAT MALIGNANCY W/O CC/MCC $33, DYSEQUILIBRIUM $5, EPISTAXIS W MCC $4, OTITIS MEDIA & URI W MCC $8, OTITIS MEDIA & URI W/O MCC $3, OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W MCC $29, OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W CC $3, DENTAL & ORAL DISEASES W CC $4, DENTAL & ORAL DISEASES W/O CC/MCC $3, MAJOR CHEST PROCEDURES W CC $32, OTHER RESP SYSTEM O.R. PROCEDURES W MCC $33, OTHER RESP SYSTEM O.R. PROCEDURES W CC $28, G.I. HEMORRHAGE W CC $7, PULMONARY EMBOLISM W MCC $10, PULMONARY EMBOLISM W/O MCC $6, RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC $16, RESPIRATORY INFECTIONS & INFLAMMATIONS W CC $9, RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC $6, RESPIRATORY NEOPLASMS W MCC $15, RESPIRATORY NEOPLASMS W CC $11, RESPIRATORY NEOPLASMS W/O CC/MCC $9, MAJOR CHEST TRAUMA W MCC $7, MAJOR CHEST TRAUMA W CC $7, MAJOR CHEST TRAUMA W/O CC/MCC $4, PLEURAL EFFUSION W MCC $6, PLEURAL EFFUSION W CC $5, PLEURAL EFFUSION W/O CC/MCC $6, PULMONARY EDEMA & RESPIRATORY FAILURE $15, CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC $10, CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC $9, CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC $7, SIMPLE PNEUMONIA & PLEURISY W MCC $12, SIMPLE PNEUMONIA & PLEURISY W CC $8, SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC $4, PNEUMOTHORAX W MCC $9, PNEUMOTHORAX W CC $7, PNEUMOTHORAX W/O CC/MCC $13, BRONCHITIS & ASTHMA W CC/MCC $7, BRONCHITIS & ASTHMA W/O CC/MCC $4,166.57

3 204 RESPIRATORY SIGNS & SYMPTOMS $10, OTHER RESPIRATORY SYSTEM DIAGNOSES W MCC $11, OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC $7, RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS $45, RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS $28, NULL $28, HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W CC $24, HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W/O CC $23, CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W CC $30, CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W/O MCC $7, OTHER CARDIOTHORACIC PROCEDURES W/O MCC $28, CORONARY BYPASS W PTCA W MCC $20, CORONARY BYPASS W/O CARDIAC CATH W MCC $11, CORONARY BYPASS W/O CARDIAC CATH W/O MCC $5, AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W CC $12, PERMANENT CARDIAC PACEMAKER IMPLANT W MCC $57, PERMANENT CARDIAC PACEMAKER IMPLANT W CC $34, PERMANENT CARDIAC PACEMAKER IMPLANT W/O CC/MCC $32, AICD GENERATOR PROCEDURES $8, PERCUTANEOUS CARDIOVASCULAR PROCEDURES W DRUG-ELUTING STENT W MCC OR $47, PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC $42, PERCUTANEOUS CARDIOVASCULAR PROCEDURES W NON-DRUG-ELUTING STENT W MC $27, PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W/O MCC $45, PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W MCC $64, PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W/O MCC $27, CARDIAC PACEMAKER DEVICE REPLACEMENT W/O MCC $36, CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W MCC $4, CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W CC $38, VEIN LIGATION & STRIPPING $13, OTHER CIRCULATORY SYSTEM O.R. PROCEDURES $21, AICD LEAD PROCEDURES $12, ENDOVASCULAR CARDIAC VALVE REPLACEMENT W MCC $34, AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W/O MCC $41, OTHER MAJOR CARDIOVASCULAR PROCEDURES W MCC $54, OTHER MAJOR CARDIOVASCULAR PROCEDURES W CC $30, PERCUTANEOUS INTRACARDIAC PROCEDURES W MCC $3, CELLULITIS AGE >17 W CC $4, CELLULITIS AGE >17 W/O CC $5, CELLULITIS AGE 0-17 $2, ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC $16, ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC $13, ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC $13, ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC $4, ACUTE MYOCARDIAL INFARCTION, EXPIRED W CC $6, ACUTE MYOCARDIAL INFARCTION, EXPIRED W/O CC/MCC $20, CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC $22, CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC $16, ACUTE & SUBACUTE ENDOCARDITIS W MCC $12, HEART FAILURE & SHOCK W MCC $11, HEART FAILURE & SHOCK W CC $8, HEART FAILURE & SHOCK W/O CC/MCC $6, DEEP VEIN THROMBOPHLEBITIS W CC/MCC $7, DEEP VEIN THROMBOPHLEBITIS W/O CC/MCC $7, CARDIAC ARREST, UNEXPLAINED W MCC $12, PERIPHERAL VASCULAR DISORDERS W MCC $5,275.55

4 300 PERIPHERAL VASCULAR DISORDERS W CC $12, PERIPHERAL VASCULAR DISORDERS W/O CC/MCC $7, ATHEROSCLEROSIS W MCC $11, ATHEROSCLEROSIS W/O MCC $7, HYPERTENSION W MCC $15, HYPERTENSION W/O MCC $8, CARDIAC CONGENITAL & VALVULAR DISORDERS W MCC $16, CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC $13, CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC $8, CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC $7, SYNCOPE & COLLAPSE $8, CHEST PAIN $7, OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC $14, OTHER CIRCULATORY SYSTEM DIAGNOSES W CC $9, OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC $7, KIDNEY & URINARY TRACT INFECTIONS AGE >17 W CC $4, KIDNEY & URINARY TRACT INFECTIONS AGE >17 W/O CC $6, URINARY STONES W CC, &/OR ESW LITHOTRIPSY $17, MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC $39, MAJOR SMALL & LARGE BOWEL PROCEDURES W CC $27, MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC $24, RECTAL RESECTION W CC $26, PERITONEAL ADHESIOLYSIS W CC $18, PERITONEAL ADHESIOLYSIS W/O CC/MCC $15, APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W MCC $1, APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC $10, APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC $11, APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W MCC $9, APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC $3, APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC $7, MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC $6, INGUINAL & FEMORAL HERNIA PROCEDURES W MCC $6, INGUINAL & FEMORAL HERNIA PROCEDURES W/O CC/MCC $11, HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W MCC $15, HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W CC $4, HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W/O CC/MCC $13, OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC $19, UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC $18, LAPAROSCOPY & INCISIONAL TUBAL INTERRUPTION $7, D&C, CONIZATION EXCEPT FOR MALIGNANCY $25, MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC $4, MAJOR ESOPHAGEAL DISORDERS W MCC $2, MAJOR ESOPHAGEAL DISORDERS W/O CC/MCC $13, MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC $11, MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC $10, MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W/O CC/MCC $9, DIGESTIVE MALIGNANCY W MCC $9, DIGESTIVE MALIGNANCY W CC $8, DIGESTIVE MALIGNANCY W/O CC/MCC $4, G.I. HEMORRHAGE W MCC $13, G.I. HEMORRHAGE W CC $8, G.I. HEMORRHAGE W/O CC/MCC $3, COMPLICATED PEPTIC ULCER W MCC $8, COMPLICATED PEPTIC ULCER W CC $13, UNCOMPLICATED PEPTIC ULCER W MCC $7,193.92

5 384 UNCOMPLICATED PEPTIC ULCER W/O MCC $9, INFLAMMATORY BOWEL DISEASE W MCC $14, INFLAMMATORY BOWEL DISEASE W CC $6, INFLAMMATORY BOWEL DISEASE W/O CC/MCC $6, G.I. OBSTRUCTION W MCC $9, G.I. OBSTRUCTION W CC $5, G.I. OBSTRUCTION W/O CC/MCC $3, ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC $9, ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC $6, OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC $7, OTHER DIGESTIVE SYSTEM DIAGNOSES W CC $8, OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC $7, BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W/O CC/MCC $13, CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W MCC $42, CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC $20, CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC/MCC $15, LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC $28, LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC $16, LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC $14, HEPATOBILIARY DIAGNOSTIC PROCEDURES W MCC $6, HEPATOBILIARY DIAGNOSTIC PROCEDURES W/O CC/MCC $6, CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC $3, CIRRHOSIS & ALCOHOLIC HEPATITIS W CC $3, CIRRHOSIS & ALCOHOLIC HEPATITIS W/O CC/MCC $5, MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC $3, MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC $7, DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC $19, DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC $6, DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC $5, DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W MCC $10, DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC $9, DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC/MCC $5, DISORDERS OF THE BILIARY TRACT W MCC $13, DISORDERS OF THE BILIARY TRACT W CC $10, DISORDERS OF THE BILIARY TRACT W/O CC/MCC $5, POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W CC $7, COMPLICATIONS OF TREATMENT W CC $4, COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W MCC $5, BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W MCC $59, BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC $44, WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC $21, WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W CC $20, WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W/O CC/MCC $50, REVISION OF HIP OR KNEE REPLACEMENT W MCC $61, REVISION OF HIP OR KNEE REPLACEMENT W CC $51, REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC $35, MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREM $29, MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREM $27, AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W CC $20, BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC $21, BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC $20, HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC $27, HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC $23, HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC $20, MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES $35,556.08

6 485 KNEE PROCEDURES W PDX OF INFECTION W MCC $41, KNEE PROCEDURES W PDX OF INFECTION W CC $18, KNEE PROCEDURES W PDX OF INFECTION W/O CC/MCC $19, KNEE PROCEDURES W/O PDX OF INFECTION W CC/MCC $24, KNEE PROCEDURES W/O PDX OF INFECTION W/O CC/MCC $17, NULL $39, LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W MCC $38, LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC $34, LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC $25, LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W CC $32, SOFT TISSUE PROCEDURES W CC $10, SOFT TISSUE PROCEDURES W/O CC/MCC $1, FOOT PROCEDURES W CC $5, SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W CC $15, SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W/O CC/MCC $11, HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W CC/MCC $12, OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W MCC $22, OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC/MCC $23, FRACTURES OF FEMUR W MCC $13, FRACTURES OF FEMUR W/O MCC $3, FRACTURES OF HIP & PELVIS W MCC $5, FRACTURES OF HIP & PELVIS W/O MCC $5, OSTEOMYELITIS W MCC $19, OSTEOMYELITIS W CC $13, OSTEOMYELITIS W/O CC/MCC $10, PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W MCC $9, PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC $13, PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W/O CC/MCC $3, CONNECTIVE TISSUE DISORDERS W CC $7, MEDICAL BACK PROBLEMS W MCC $11, MEDICAL BACK PROBLEMS W/O MCC $7, BONE DISEASES & ARTHROPATHIES W MCC $6, BONE DISEASES & ARTHROPATHIES W/O MCC $4, SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W MCC $2, SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W/O MCC $6, TENDONITIS, MYOSITIS & BURSITIS W MCC $18, TENDONITIS, MYOSITIS & BURSITIS W/O MCC $7, AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC 560 AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC $10, AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC $5, FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W MCC $7, FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC $7, OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC $7, OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W/O CC/MCC $ SKIN DEBRIDEMENT W MCC $22, SKIN DEBRIDEMENT W CC $13, SKIN DEBRIDEMENT W/O CC/MCC $14, SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W CC $13, OTHER SKIN, SUBCUT TISS & BREAST PROC W MCC $30, OTHER SKIN, SUBCUT TISS & BREAST PROC W CC $16, OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC $5, BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W CC/MCC $ BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W/O CC/MCC $17, SKIN ULCERS W MCC $7, SKIN ULCERS W CC $25,244.34

7 595 MAJOR SKIN DISORDERS W MCC $3, MAJOR SKIN DISORDERS W/O MCC $6, CELLULITIS W MCC $8, CELLULITIS W/O MCC $5, TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W MCC $8, TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC $2, MINOR SKIN DISORDERS W/O MCC $5, AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W MCC $33, AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W CC $19, SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W MCC $23, SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC $15, OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W MCC $31, OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC $18, DIABETES W MCC $9, DIABETES W CC $6, DIABETES W/O CC/MCC $5, MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W MCC $10, MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W/O MCC $6, INBORN AND OTHER DISORDERS OF METABOLISM $3, ENDOCRINE DISORDERS W MCC $15, ENDOCRINE DISORDERS W CC $9, ENDOCRINE DISORDERS W/O CC/MCC $2, MAJOR BLADDER PROCEDURES W CC $26, MAJOR BLADDER PROCEDURES W/O CC/MCC $8, KIDNEY & URETER PROCEDURES FOR NEOPLASM W MCC $54, KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC $23, KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC $27, KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC $8, KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC $8, PROSTATECTOMY W MCC $2, PROSTATECTOMY W CC $13, TRANSURETHRAL PROCEDURES W MCC $24, TRANSURETHRAL PROCEDURES W CC $10, TRANSURETHRAL PROCEDURES W/O CC/MCC $9, URETHRAL PROCEDURES W/O CC/MCC $5, OTHER KIDNEY & URINARY TRACT PROCEDURES W MCC $50, OTHER KIDNEY & URINARY TRACT PROCEDURES W CC $25, RENAL FAILURE W MCC $12, RENAL FAILURE W CC $7, RENAL FAILURE W/O CC/MCC $3, KIDNEY & URINARY TRACT NEOPLASMS W CC $2, KIDNEY & URINARY TRACT INFECTIONS W MCC $7, KIDNEY & URINARY TRACT INFECTIONS W/O MCC $6, URINARY STONES W ESW LITHOTRIPSY W CC/MCC $14, URINARY STONES W/O ESW LITHOTRIPSY W MCC $12, URINARY STONES W/O ESW LITHOTRIPSY W/O MCC $5, URETHRAL STRICTURE $18, OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC $13, OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC $7, MAJOR MALE PELVIC PROCEDURES W CC/MCC $31, MAJOR MALE PELVIC PROCEDURES W/O CC/MCC $27, PENIS PROCEDURES W/O CC/MCC $12, TESTES PROCEDURES W CC/MCC $8, TRANSURETHRAL PROSTATECTOMY W CC/MCC $13, TRANSURETHRAL PROSTATECTOMY W/O CC/MCC $10,627.25

8 720 NULL $13, BENIGN PROSTATIC HYPERTROPHY W MCC $16, INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W MCC $8, INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W/O MCC $3, UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC $19, UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC $12, FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES $11, MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC $8, INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W CC $6, CESAREAN SECTION W CC/MCC $14, CESAREAN SECTION W/O CC/MCC $11, VAGINAL DELIVERY W STERILIZATION &/OR D&C $9, VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C $17, POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE $11, ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY $4, BC/BS $3, VAGINAL DELIVERY W COMPLICATING DIAGNOSES $10, VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES $9, POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE $4, ABORTION W/O D&C $6, OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS $3, NULL $12, NULL $9, NULL $19, NULL $12, NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY $1, PREMATURITY W MAJOR PROBLEMS $2, FULL TERM NEONATE W MAJOR PROBLEMS $3, NEONATE W OTHER SIGNIFICANT PROBLEMS $1, NORMAL NEWBORN $1, NULL $12, SPLENECTOMY W CC $19, TRAINING ALLERGY $7, NULL $10, NULL $9, MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W MCC $13, MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC $11, MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W/O CC/MCC $6, RED BLOOD CELL DISORDERS W MCC $9, RED BLOOD CELL DISORDERS W/O MCC $8, COAGULATION DISORDERS $5, RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC/MCC $2, NULL $12, LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER PROC W/O CC/MCC $11, NULL $5, NULL $10, ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W MCC $17, LYMPHOMA & NON-ACUTE LEUKEMIA W MCC $14, CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W MCC $1, CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W CC $2, INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC $48, INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC $17, POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W MCC $38, POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC $16, POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W MCC $11,945.06

9 863 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC $10, FEVER $5, VIRAL ILLNESS W MCC $18, VIRAL ILLNESS W/O MCC $8, OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W/O CC/MCC $7, SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS $48, SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC $14, SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC $7, ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION $6, NEUROSES EXCEPT DEPRESSIVE $14, ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY $7, ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA $3, ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC $14, ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC $4, WOUND DEBRIDEMENTS FOR INJURIES W MCC $25, OTHER O.R. PROCEDURES FOR INJURIES W MCC $15, OTHER O.R. PROCEDURES FOR INJURIES W CC $21, OTHER O.R. PROCEDURES FOR INJURIES W/O CC/MCC $16, TRAUMATIC INJURY W/O MCC $5, ALLERGIC REACTIONS W MCC $16, ALLERGIC REACTIONS W/O MCC $12, POISONING & TOXIC EFFECTS OF DRUGS W MCC $13, POISONING & TOXIC EFFECTS OF DRUGS W/O MCC $4, COMPLICATIONS OF TREATMENT W MCC $16, COMPLICATIONS OF TREATMENT W CC $4, COMPLICATIONS OF TREATMENT W/O CC/MCC $2, OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O MCC $2, NON-EXTENSIVE BURNS $5, O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W MCC 940 O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W CC 947 SIGNS & SYMPTOMS W MCC $8, SIGNS & SYMPTOMS W/O MCC $8, AFTERCARE W CC/MCC $4, AFTERCARE W/O CC/MCC $34, OTHER FACTORS INFLUENCING HEALTH STATUS $10, LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA $30, EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC $42, EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC $13, NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC $24, NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC $14, NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC $6,411.26

DRG Code DRG Description FY18 Average Charge

DRG Code DRG Description FY18 Average Charge 3 ECMO OR TRACH W MV 96+ HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O $ 665,511 4 TRACH W MV 96+ HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. $ 422,497 37 EXTRACRANIAL