APC/DRG Code APC/DRG Name # of Discharges Average of Charges 5341 Abdominal/Peritoneal/Biliary and Related Procedures 71 $9, ACUTE ADJUSTMENT

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1 5341 Abdominal/Peritoneal/Biliary and Related Procedures 71 $9, ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION MS 3 $8, ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W CC MS 10 $30, ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W MCC MS 4 $37, ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC MS 7 $20, ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC MS 17 $28, ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC MS 5 $26, ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC MS 1 $8, AFTERCARE W CC/MCC MS 3 $33, AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC MS 19 $16, AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC MS 6 $29, AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC MS 3 $13, ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC MS 2 $27, ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC MS 3 $12, ALLERGIC REACTIONS W MCC MS 3 $33, AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W CC MS 4 $21, APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC MS 2 $25, APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC MS 4 $15, ATHEROSCLEROSIS W MCC MS 2 $8, ATHEROSCLEROSIS W/O MCC MS 4 $12, BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W CC MS 1 $23, BENIGN PROSTATIC HYPERTROPHY W MCC MS 1 $12, BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC MS 2 $67, BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W MCC MS 1 $43, BRONCHITIS & ASTHMA W CC/MCC MS 10 $12, BRONCHITIS & ASTHMA W/O CC/MCC MS 3 $4, CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC MS 25 $12, CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC MS 26 $19, CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC MS 11 $13, CARDIAC CONGENITAL & VALVULAR DISORDERS W/O MCC MS 1 $23, Cardiac Rehabilitation 73 $2, CELLULITIS W MCC MS 5 $23, CELLULITIS W/O MCC MS 34 $12, CESAREAN SECTION W CC/MCC MS 53 $9, CESAREAN SECTION W/O CC/MCC MS 158 $7, CHEST PAIN MS 11 $12, CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W MCC MS 1 $42, CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC MS 19 $13, CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC MS 40 $15, CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC MS 11 $9, CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC MS 1 $35, CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC MS 23 $32, CIRRHOSIS & ALCOHOLIC HEPATITIS W CC MS 3 $14, CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC MS 3 $12, Clinic Visits and Related Services 2 $ COAGULATION DISORDERS MS 9 $27, Complex GI Procedures 3 $13, COMPLICATED PEPTIC ULCER W CC MS 1 $40, COMPLICATIONS OF TREATMENT W CC MS 2 $21, COMPLICATIONS OF TREATMENT W/O CC/MCC MS 2 $12, Comprehensive Observation Services 662 $8, CONNECTIVE TISSUE DISORDERS W CC MS 2 $30, CRANIAL & PERIPHERAL NERVE DISORDERS W MCC MS 1 $21, CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC MS 12 $15, Critical Care 255 $6, CT and CTA with Contrast Composite 476 $6, CT and CTA without Contrast Composite 308 $4, D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W CC/MCC MS 1 $17, DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC MS 17 $20, DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC MS 124 $23, Dental Procedures 3 $6, DEPRESSIVE NEUROSES MS 1 $20, DIABETES W CC MS 28 $11, DIABETES W MCC MS 14 $17, DIABETES W/O CC/MCC MS 7 $8, DIGESTIVE MALIGNANCY W CC MS 10 $7, DIGESTIVE MALIGNANCY W MCC MS 1 $21, DIGESTIVE MALIGNANCY W/O CC/MCC MS 1 $12, DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC MS 2 $12, DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W MCC MS 6 $25, DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC MS 15 $12, DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC MS 5 $27, DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC MS 8 $11, DISORDERS OF THE BILIARY TRACT W MCC MS 1 $16, DISORDERS OF THE BILIARY TRACT W/O CC/MCC MS 4 $7, DYSEQUILIBRIUM MS 3 $19, ECTOPIC PREGNANCY MS 1 $17, ENDOCRINE DISORDERS W CC MS 1 $11, ENDOCRINE DISORDERS W MCC MS 3 $15, ENDOCRINE DISORDERS W/O CC/MCC MS 1 $15, ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC MS 5 $13, ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC MS 39 $9, EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC MS 1 $41, EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC MS 4 $68, EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC MS 1 $8, EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE MS 2 $7, FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES MS 1 $14, FEVER MS 1 $9, FRACTURES OF FEMUR W MCC MS 1 $12, FRACTURES OF HIP & PELVIS W MCC MS 2 $14, FRACTURES OF HIP & PELVIS W/O MCC MS 3 $10,857

2 793 FULL TERM NEONATE W MAJOR PROBLEMS MS 28 $5, FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC MS 7 $12, G.I. HEMORRHAGE W CC MS 18 $11, G.I. HEMORRHAGE W MCC MS 11 $22, G.I. HEMORRHAGE W/O CC/MCC MS 2 $10, G.I. OBSTRUCTION W CC MS 10 $10, G.I. OBSTRUCTION W MCC MS 5 $11, G.I. OBSTRUCTION W/O CC/MCC MS 7 $9, HEADACHES W/O MCC MS 4 $20, HEART FAILURE & SHOCK W CC MS 24 $12, HEART FAILURE & SHOCK W MCC MS 124 $18, HEART FAILURE & SHOCK W/O CC/MCC MS 12 $9, HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W/O CC/MCC MS 2 $23, HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC MS 14 $26, HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC MS 4 $41, HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC MS 9 $24, Hyperbaric Oxygen 170 $1, HYPERTENSION W MCC MS 3 $23, HYPERTENSION W/O MCC MS 7 $12, HYPERTENSIVE ENCEPHALOPATHY W CC MS 4 $13, INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W CC MS 1 $10, INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC MS 1 $9, INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC MS 7 $33, INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC MS 14 $93, INFLAMMATORY BOWEL DISEASE W CC MS 4 $7, INFLAMMATORY BOWEL DISEASE W MCC MS 1 $11, INFLAMMATORY BOWEL DISEASE W/O CC/MCC MS 3 $7, INTERSTITIAL LUNG DISEASE W CC MS 1 $26, INTERSTITIAL LUNG DISEASE W MCC MS 3 $16, INTERSTITIAL LUNG DISEASE W/O CC/MCC MS 1 $4, INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS MS 35 $17, INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC MS 29 $25, INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC MS 15 $19, KIDNEY & URINARY TRACT INFECTIONS W MCC MS 28 $13, KIDNEY & URINARY TRACT INFECTIONS W/O MCC MS 28 $11, KNEE PROCEDURES W/O PDX OF INFECTION W CC/MCC MS 1 $25, LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC MS 5 $21, LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC MS 1 $19, LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC MS 8 $23, Level 1 Blood Product Exchange and Related Services 123 $2, Level 1 Breast/Lymphatic Surgery and Related Procedures 30 $11, Level 1 Drug Administration 1 $7, Level 1 Endovascular Procedures 218 $21, Level 1 ENT Procedures 45 $6, Level 1 Excision/ Biopsy/ Incision and Drainage 24 $3, Level 1 Gynecologic Procedures 386 $ Level 1 ICD and Similar Procedures 4 $80, Level 1 Imaging with Contrast 1164 $2, Level 1 Imaging without Contrast 9098 $ Level 1 Laparoscopy and Related Services 344 $12, Level 1 Lower GI Procedures 360 $2, Level 1 Minor Procedures 1 $ Level 1 Musculoskeletal Procedures 10 $ Level 1 Nerve Injections 33 $3, Level 1 Nerve Procedures 22 $5, Level 1 Nuclear Medicine and Related Services 143 $1, Level 1 Pathology 11 $1, Level 1 Skin Procedures 423 $ Level 1 Strapping and Cast Application 116 $ Level 1 Type A ED Visits 361 $ Level 1 Upper GI Procedures 258 $3, Level 1 Urology and Related Services 6 $ Level 1 Vascular Procedures 71 $3, Level 2 Breast/Lymphatic Surgery and Related Procedures 38 $22, Level 2 Diagnostic Tests and Related Services 132 $1, Level 2 Drug Administration 16 $ Level 2 Endovascular Procedures 19 $29, Level 2 Excision/ Biopsy/ Incision and Drainage 314 $3, Level 2 ICD and Similar Procedures 10 $97, Level 2 Imaging with Contrast 657 $2, Level 2 Imaging without Contrast 5213 $ Level 2 Laparoscopy and Related Services 40 $16, Level 2 Lower GI Procedures 335 $2, Level 2 Minor Procedures 1 $ Level 2 Musculoskeletal Procedures 77 $4, Level 2 Nerve Injections 38 $3, Level 2 Nuclear Medicine and Related Services 106 $1, Level 2 Pacemaker and Similar Procedures 16 $20, Level 2 Pathology 3 $ Level 2 Radiation Therapy 3 $4, Level 2 Skin Procedures 3031 $ Level 2 Strapping and Cast Application 62 $ Level 2 Therapeutic Radiation Treatment Preparation 13 $14, Level 2 Type A ED Visits 3481 $ Level 2 Upper GI Procedures 27 $4, Level 2 Vascular Procedures 101 $4, Level 3 Airway Endoscopy 14 $5, Level 3 Breast/Lymphatic Surgery and Related Procedures 6 $17, Level 3 Diagnostic Tests and Related Services 5 $1, Level 3 Drug Administration 218 $2, Level 3 Endovascular Procedures 60 $61,035

3 5163 Level 3 ENT Procedures 114 $3, Level 3 Excision/ Biopsy/ Incision and Drainage 35 $8, Level 3 Imaging with Contrast 8 $2, Level 3 Imaging without Contrast 2315 $1, Level 3 Lower GI Procedures 16 $9, Level 3 Minor Procedures 970 $ Level 3 Musculoskeletal Procedures 134 $9, Level 3 Nuclear Medicine and Related Services 687 $3, Level 3 Pacemaker and Similar Procedures 7 $31, Level 3 Pathology 19 $1, Level 3 Radiation Therapy 9 $16, Level 3 Skin Procedures 274 $1, Level 3 Therapeutic Radiation Treatment Preparation 102 $63, Level 3 Type A ED Visits 6301 $ Level 3 Vascular Procedures 48 $7, Level 4 Airway Endoscopy 24 $8, Level 4 Breast/Lymphatic Surgery and Related Procedures 1 $14, Level 4 Diagnostic Tests and Related Services 151 $2, Level 4 Drug Administration 9 $7, Level 4 Endovascular Procedures 3 $60, Level 4 ENT Procedures 78 $6, Level 4 Gynecologic Procedures 62 $5, Level 4 Imaging without Contrast 1552 $2, Level 4 Minor Procedures 243 $ Level 4 Musculoskeletal Procedures 128 $16, Level 4 Nuclear Medicine and Related Services 227 $4, Level 4 Pathology 1 $2, Level 4 Skin Procedures 116 $3, Level 4 Type A ED Visits 3205 $2, Level 5 Airway Endoscopy 24 $8, Level 5 ENT Procedures 104 $8, Level 5 Gynecologic Procedures 36 $12, Level 5 Musculoskeletal Procedures 27 $28, Level 5 Skin Procedures 15 $12, Level 5 Type A ED Visits 3532 $3, Level 6 Gynecologic Procedures 10 $16, Level1 Diagnostic Tests and Related Services 62 $ LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA MS 3 $42, LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W CC/MCC MS 1 $22, LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC MS 2 $30, LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W MCC MS 2 $51, LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC MS 4 $27, LYMPHOMA & NON-ACUTE LEUKEMIA W MCC MS 2 $37, LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W/O CC/MCC MS 1 $15, MAJOR CHEST PROCEDURES W MCC MS 1 $19, MAJOR CHEST TRAUMA W CC MS 1 $17, MAJOR CHEST TRAUMA W MCC MS 1 $43, MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC MS 5 $16, MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC MS 2 $33, MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC MS 4 $16, MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W MCC MS 1 $19, MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W/O CC/MCC MS 1 $15, MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC MS 14 $58, MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC MS 57 $41, MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES MS 4 $43, MAJOR SKIN DISORDERS W/O MCC MS 1 $3, MAJOR SMALL & LARGE BOWEL PROCEDURES W CC MS 9 $37, MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC MS 1 $66, MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC MS 5 $20, MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC MS 1 $14, MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC MS 3 $13, MALIGNANT BREAST DISORDERS W CC MS 1 $1, MEDICAL BACK PROBLEMS W MCC MS 3 $25, MEDICAL BACK PROBLEMS W/O MCC MS 3 $13, MINOR SMALL & LARGE BOWEL PROCEDURES W MCC MS 1 $43, MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W MCC MS 7 $15, MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W/O MCC MS 12 $8, MRI and MRA with Contrast Composite 144 $7, MRI and MRA without Contrast Composite 115 $4, MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W MCC MS 1 $24, MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W/O CC/MCC MS 3 $12, NEONATE W OTHER SIGNIFICANT PROBLEMS MS 153 $1, NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY MS 32 $3, NERVOUS SYSTEM NEOPLASMS W MCC MS 3 $19, NEUROLOGICAL EYE DISORDERS MS 1 $19, NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W MCC MS 4 $18, NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W/O CC/MCC MS 2 $15, NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC MS 1 $19, NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC MS 1 $19, NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC MS 1 $13, NORMAL NEWBORN MS 710 $1, O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W CC MS 1 $21, O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W MCC MS 1 $61, ORGANIC DISTURBANCES & MENTAL RETARDATION MS 29 $31, OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS MS 31 $4, OTHER ANTEPARTUM DIAGNOSES W/O MEDICAL COMPLICATIONS MS 1 $2, OTHER CIRCULATORY SYSTEM DIAGNOSES W CC MS 1 $41, OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC MS 5 $19, OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC MS 1 $2, OTHER DIGESTIVE SYSTEM DIAGNOSES W CC MS 5 $8, OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC MS 1 $6,862

4 395 OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC MS 2 $10, OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC MS 1 $17, OTHER DISORDERS OF NERVOUS SYSTEM W CC MS 7 $22, OTHER DISORDERS OF NERVOUS SYSTEM W MCC MS 4 $24, OTHER DISORDERS OF NERVOUS SYSTEM W/O CC/MCC MS 2 $21, OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W CC MS 1 $10, OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W MCC MS 1 $6, OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W CC/MCC MS 1 $13, OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC MS 4 $39, OTHER FACTORS INFLUENCING HEALTH STATUS MS 3 $4, OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC MS 2 $14, OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC MS 9 $16, OTHER KIDNEY & URINARY TRACT DIAGNOSES W/O CC/MCC MS 1 $3, OTHER MULTIPLE SIGNIFICANT TRAUMA W MCC MS 1 $19, OTHER MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC MS 1 $11, OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC MS 4 $14, OTHER O.R. PROCEDURES FOR INJURIES W CC MS 2 $24, OTHER O.R. PROCEDURES FOR INJURIES W MCC MS 1 $25, OTHER RESP SYSTEM O.R. PROCEDURES W CC MS 3 $19, OTHER RESP SYSTEM O.R. PROCEDURES W MCC MS 5 $24, OTHER RESPIRATORY SYSTEM DIAGNOSES W MCC MS 2 $45, OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC MS 1 $13, OTHER SKIN, SUBCUT TISS & BREAST PROC W CC MS 4 $22, OTHER SKIN, SUBCUT TISS & BREAST PROC W MCC MS 1 $25, OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC MS 7 $11, OTITIS MEDIA & URI W MCC MS 1 $7, OTITIS MEDIA & URI W/O MCC MS 5 $9, PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC MS 1 $7, PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W MCC MS 1 $14, PERC CARDIOVASC PROC W DRUG-ELUTING STENT W MCC OR 4+ VESSELS/STENTS MS 11 $85, PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC MS 33 $71, PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W MCC OR 4+ VES/STENTS MS 6 $95, PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W/O MCC MS 2 $60, PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W MCC MS 1 $85, PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W CC OR PERIPH NEUROSTIM MS 1 $42, PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W MCC MS 3 $72, PERIPHERAL VASCULAR DISORDERS W CC MS 1 $10, PERIPHERAL VASCULAR DISORDERS W MCC MS 3 $18, PERITONEAL ADHESIOLYSIS W CC MS 5 $43, PERITONEAL ADHESIOLYSIS W MCC MS 2 $37, PERMANENT CARDIAC PACEMAKER IMPLANT W CC MS 2 $80, PERMANENT CARDIAC PACEMAKER IMPLANT W MCC MS 6 $63, PERMANENT CARDIAC PACEMAKER IMPLANT W/O CC/MCC MS 1 $31, Plate pheres leukoredu irrad 1 $2, Platelet pheres leukoreduced 64 $2, PLEURAL EFFUSION W CC MS 1 $13, PNEUMOTHORAX W CC MS 3 $10, PNEUMOTHORAX W MCC MS 2 $16, PNEUMOTHORAX W/O CC/MCC MS 1 $5, POISONING & TOXIC EFFECTS OF DRUGS W MCC MS 15 $23, POISONING & TOXIC EFFECTS OF DRUGS W/O MCC MS 19 $11, POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W MCC MS 1 $13, POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC MS 6 $12, POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC MS 1 $8, PREMATURITY W MAJOR PROBLEMS MS 4 $5, PREMATURITY W/O MAJOR PROBLEMS MS 40 $2, PSYCHOSES MS 83 $23, PULMONARY EDEMA & RESPIRATORY FAILURE MS 46 $17, PULMONARY EMBOLISM W MCC MS 4 $15, PULMONARY EMBOLISM W/O MCC MS 9 $12, Pulmonary Treatment 9 $1, RBC leukocytes reduced 3 $ RED BLOOD CELL DISORDERS W MCC MS 9 $13, RED BLOOD CELL DISORDERS W/O MCC MS 21 $11, REHABILITATION W CC/MCC MS 8 $20, RENAL FAILURE W CC MS 30 $12, RENAL FAILURE W MCC MS 45 $16, RENAL FAILURE W/O CC/MCC MS 1 $11, RESPIRATORY INFECTIONS & INFLAMMATIONS W CC MS 7 $15, RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC MS 41 $26, RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC MS 3 $8, RESPIRATORY NEOPLASMS W CC MS 3 $2, RESPIRATORY NEOPLASMS W MCC MS 2 $10, RESPIRATORY SIGNS & SYMPTOMS MS 1 $9, RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <96 HOURS MS 13 $35, RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS MS 8 $64, Resuscitation and Cardioversion 9 $2, RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC MS 1 $41, RETICULOENDOTHELIAL & IMMUNITY DISORDERS W MCC MS 1 $22, REVISION OF HIP OR KNEE REPLACEMENT W MCC MS 1 $34, SEIZURES W MCC MS 7 $23, SEIZURES W/O MCC MS 13 $15, SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS MS 5 $62, SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC MS 149 $24, SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC MS 38 $13, SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W/O CC/MCC MS 1 $25, SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W MCC MS 1 $24, SIGNS & SYMPTOMS W MCC MS 1 $20, SIGNS & SYMPTOMS W/O MCC MS 7 $11, SIMPLE PNEUMONIA & PLEURISY W CC MS 35 $13, SIMPLE PNEUMONIA & PLEURISY W MCC MS 89 $20,128

5 195 SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC MS 13 $8, SKIN DEBRIDEMENT W CC MS 2 $18, SKIN DEBRIDEMENT W/O CC/MCC MS 1 $30, SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC MS 1 $11, SKIN GRAFTS FOR INJURIES W CC/MCC MS 1 $64, SKIN ULCERS W MCC MS 2 $10, SYNCOPE & COLLAPSE MS 11 $18, TENDONITIS, MYOSITIS & BURSITIS W MCC MS 1 $12, TENDONITIS, MYOSITIS & BURSITIS W/O MCC MS 5 $12, TRANSIENT ISCHEMIA MS 24 $18, Trauma Response with Critical Care 179 $8, TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC MS 3 $15, TRAUMATIC INJURY W/O MCC MS 1 $16, Ultrasound Composite 104 $ UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W CC MS 1 $18, UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC MS 19 $17, UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC MS 24 $14, UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W/O CC/MCC MS 1 $13, UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC/MCC MS 2 $15, VAGINA, CERVIX & VULVA PROCEDURES W CC/MCC MS 1 $22, VAGINAL DELIVERY W COMPLICATING DIAGNOSES MS 25 $5, VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C MS 6 $11, VAGINAL DELIVERY W STERILIZATION &/OR D&C MS 83 $8, VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES MS 629 $3, VIRAL ILLNESS W MCC MS 2 $16, VIRAL MENINGITIS W CC/MCC MS 2 $36, WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W CC MS 1 $17, WOUND DEBRIDEMENTS FOR INJURIES W CC MS 1 $21,426

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