ALL Other (MS) DRG 2015

ALL Other (MS) DRG 2015 DRG DRG Description Avg. Charge 770 ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY $8,072.48 779 ABORTION W/O D&C $9,405.76 289 ACUTE & SUBACUTE ENDOCARDITIS W CC $20,196.02 880 ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION $9,627.24 062 ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W CC $30,454.33 061 ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W MCC $33,156.63 063 ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W/O CC/MCC $13,028.58 834 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W MCC $30,126.47 836 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W/O CC/MCC $13,648.49 121 ACUTE MAJOR EYE INFECTIONS W CC/MCC $12,160.61 281 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC $20,433.39 280 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC $22,900.62 282 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC $18,523.94 284 ACUTE MYOCARDIAL INFARCTION, EXPIRED W CC $10,197.20 283 ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC $19,683.84 685 ADMIT FOR RENAL DIALYSIS $31,330.69 614 ADRENAL & PITUITARY PROCEDURES W CC/MCC $25,559.11 560 AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC $15,303.54 559 AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC $28,635.89 561 AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC $11,677.94 895 ALCOHOL/DRUG ABUSE OR DEPENDENCE W REHABILITATION THERAPY $16,501.96 897 ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY $12,274.39 896 ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY $15,522.61 894 ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA $8,935.01 915 ALLERGIC REACTIONS W MCC $11,293.76 916 ALLERGIC REACTIONS W/O MCC $9,610.05 617 AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W C $31,293.22 616 AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W M $40,596.38 240 AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W CC $65,972.70 239 AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W MCC $60,281.07 475 AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W CC $28,926.31 474 AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W MCC $115,152.27 348 ANAL & STOMAL PROCEDURES W CC $17,815.18 349 ANAL & STOMAL PROCEDURES W/O CC/MCC $16,458.75 311 ANGINA PECTORIS $12,330.79 140 ANGINA PECTORIS $11,943.09 339 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC $28,114.61 338 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W MCC $23,849.40 340 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC $13,065.95 341 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W MCC $26,392.39 343 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC $13,552.35 302 ATHEROSCLEROSIS W MCC $17,072.37 303 ATHEROSCLEROSIS W/O MCC $11,794.84 519 BACK & NECK PROC EXC SPINAL FUSION W CC $33,856.67

518 BACK & NECK PROC EXC SPINAL FUSION W MCC OR DISC DEVICE/NEUR $55,376.85 520 BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC $19,153.55 095 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W CC $32,046.10 094 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W MCC $50,665.75 886 BEHAVIORAL & DEVELOPMENTAL DISORDERS $21,127.81 725 BENIGN PROSTATIC HYPERTROPHY W MCC $9,455.81 726 BENIGN PROSTATIC HYPERTROPHY W/O MCC $13,481.48 461 BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W $57,521.94 409 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W C $17,069.08 408 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W M $58,048.37 410 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W/O $23,182.92 478 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC $24,848.07 477 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC $38,623.19 479 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O C $25,014.53 553 BONE DISEASES & ARTHROPATHIES W MCC $14,082.60 554 BONE DISEASES & ARTHROPATHIES W/O MCC $10,700.86 585 BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W/O $10,994.04 202 BRONCHITIS & ASTHMA W CC/MCC $11,183.92 203 BRONCHITIS & ASTHMA W/O CC/MCC $9,584.65 296 CARDIAC ARREST, UNEXPLAINED W MCC $13,677.20 309 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC $12,848.64 308 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC $17,881.68 310 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC $11,526.02 307 CARDIAC CONGENITAL & VALVULAR DISORDERS W/O MCC $14,863.09 279 CELLULITIS AGE 0-17 $17,204.13 602 CELLULITIS W MCC $20,349.43 603 CELLULITIS W/O MCC $12,749.00 472 CERVICAL SPINAL FUSION W CC $36,156.57 473 CERVICAL SPINAL FUSION W/O CC/MCC $21,434.60 765 CESAREAN SECTION W CC/MCC $11,228.97 766 CESAREAN SECTION W/O CC/MCC $9,857.06 847 CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W CC $10,353.73 846 CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W MCC $10,046.05 313 CHEST PAIN $9,062.39 415 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC $18,145.42 414 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W MCC $45,204.70 191 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC $12,963.58 190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC $15,197.52 192 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC $10,935.28 286 CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC $27,782.16 287 CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC $21,321.93 433 CIRRHOSIS & ALCOHOLIC HEPATITIS W CC $18,541.69 432 CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC $32,598.04 434 CIRRHOSIS & ALCOHOLIC HEPATITIS W/O CC/MCC $14,584.11 813 COAGULATION DISORDERS $27,095.67 381 COMPLICATED PEPTIC ULCER W CC $19,916.70 380 COMPLICATED PEPTIC ULCER W MCC $21,894.04

382 COMPLICATED PEPTIC ULCER W/O CC/MCC $11,561.98 920 COMPLICATIONS OF TREATMENT W CC $12,562.18 919 COMPLICATIONS OF TREATMENT W MCC $19,213.09 921 COMPLICATIONS OF TREATMENT W/O CC/MCC $11,062.36 546 CONNECTIVE TISSUE DISORDERS W CC $9,927.77 545 CONNECTIVE TISSUE DISORDERS W MCC $15,614.15 547 CONNECTIVE TISSUE DISORDERS W/O CC/MCC $10,519.61 073 CRANIAL & PERIPHERAL NERVE DISORDERS W MCC $13,320.72 074 CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC $13,738.17 131 CRANIAL/FACIAL PROCEDURES W CC/MCC $19,003.31 132 CRANIAL/FACIAL PROCEDURES W/O CC/MCC $13,673.87 023 CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W MCC OR CHEMO $95,340.00 026 CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W CC $27,939.33 025 CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCC $44,807.97 027 CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W/O CC/MCC $39,729.58 744 D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W CC/MCC $8,583.38 745 D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W/O CC/MCC $10,935.08 056 DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC $21,542.88 057 DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC $23,111.78 158 DENTAL & ORAL DISEASES W CC $11,658.02 157 DENTAL & ORAL DISEASES W MCC $14,918.59 159 DENTAL & ORAL DISEASES W/O CC/MCC $8,669.88 881 DEPRESSIVE NEUROSES $10,012.13 638 DIABETES W CC $14,277.10 637 DIABETES W MCC $20,476.57 639 DIABETES W/O CC/MCC $11,067.50 375 DIGESTIVE MALIGNANCY W CC $24,945.96 374 DIGESTIVE MALIGNANCY W MCC $24,794.16 173 DIGESTIVE MALIGNANCY W/O CC $75,194.31 376 DIGESTIVE MALIGNANCY W/O CC/MCC $19,823.30 442 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC $18,365.58 441 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W MCC $21,372.56 443 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC/MCC $14,971.56 439 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC $19,375.84 438 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC $40,700.78 440 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC $9,367.13 883 DISORDERS OF PERSONALITY & IMPULSE CONTROL $7,912.78 445 DISORDERS OF THE BILIARY TRACT W CC $17,867.46 444 DISORDERS OF THE BILIARY TRACT W MCC $22,973.12 446 DISORDERS OF THE BILIARY TRACT W/O CC/MCC $10,552.43 149 DYSEQUILIBRIUM $10,643.81 147 EAR, NOSE, MOUTH & THROAT MALIGNANCY W CC $14,664.63 148 EAR, NOSE, MOUTH & THROAT MALIGNANCY W/O CC/MCC $23,631.94 003 ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W M $137,966.63 777 ECTOPIC PREGNANCY $10,069.20 644 ENDOCRINE DISORDERS W CC $12,468.82 643 ENDOCRINE DISORDERS W MCC $20,854.81

645 ENDOCRINE DISORDERS W/O CC/MCC $10,341.90 150 EPISTAXIS W MCC $53,936.80 151 EPISTAXIS W/O MCC $9,966.67 391 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC $16,308.74 392 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC $11,229.38 981 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W $43,055.38 982 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W $50,078.54 038 EXTRACRANIAL PROCEDURES W CC $62,361.40 039 EXTRACRANIAL PROCEDURES W/O CC/MCC $17,448.58 115 EXTRAOCULAR PROCEDURES EXCEPT ORBIT $28,764.48 864 FEVER $13,131.17 504 FOOT PROCEDURES W CC $30,147.01 503 FOOT PROCEDURES W MCC $46,278.95 533 FRACTURES OF FEMUR W MCC $23,296.77 535 FRACTURES OF HIP & PELVIS W MCC $28,711.92 536 FRACTURES OF HIP & PELVIS W/O MCC $16,322.00 793 FULL TERM NEONATE W MAJOR PROBLEMS $7,616.04 562 FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W MC $30,753.78 563 FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O $15,011.23 378 G.I. HEMORRHAGE W CC $17,128.13 377 G.I. HEMORRHAGE W MCC $29,869.21 379 G.I. HEMORRHAGE W/O CC/MCC $12,020.04 389 G.I. OBSTRUCTION W CC $16,111.97 388 G.I. OBSTRUCTION W MCC $20,384.25 390 G.I. OBSTRUCTION W/O CC/MCC $12,951.23 513 HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W CC/MC $39,781.64 514 HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W/O CC/ $26,543.47 102 HEADACHES W MCC $8,210.13 103 HEADACHES W/O MCC $8,603.96 292 HEART FAILURE & SHOCK W CC $15,993.70 291 HEART FAILURE & SHOCK W MCC $21,303.33 293 HEART FAILURE & SHOCK W/O CC/MCC $10,559.56 421 HEPATOBILIARY DIAGNOSTIC PROCEDURES W CC $22,985.61 420 HEPATOBILIARY DIAGNOSTIC PROCEDURES W MCC $13,807.61 354 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W CC $9,242.49 355 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W/O CC/MCC $15,523.74 481 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC $40,277.28 480 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC $46,930.73 482 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC $42,497.48 969 HIV W EXTENSIVE O.R. PROCEDURE W MCC $62,973.34 975 HIV W MAJOR RELATED CONDITION W CC $18,635.37 974 HIV W MAJOR RELATED CONDITION W MCC $41,916.13 976 HIV W MAJOR RELATED CONDITION W/O CC/MCC $12,265.04 977 HIV W OR W/O OTHER RELATED CONDITION $14,410.56 304 HYPERTENSION W MCC $28,047.22 305 HYPERTENSION W/O MCC $10,302.70 078 HYPERTENSIVE ENCEPHALOPATHY W CC $12,834.30

077 HYPERTENSIVE ENCEPHALOPATHY W MCC $18,266.80 642 INBORN AND OTHER DISORDERS OF METABOLISM $16,498.60 758 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W CC $9,798.91 759 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC $10,259.25 854 INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC $53,493.06 853 INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC $63,750.43 727 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W MCC $23,568.47 728 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W/O MCC $14,272.80 386 INFLAMMATORY BOWEL DISEASE W CC $16,909.22 385 INFLAMMATORY BOWEL DISEASE W MCC $35,222.79 387 INFLAMMATORY BOWEL DISEASE W/O CC/MCC $13,630.37 351 INGUINAL & FEMORAL HERNIA PROCEDURES W CC $14,662.96 352 INGUINAL & FEMORAL HERNIA PROCEDURES W/O CC/MCC $12,542.19 197 INTERSTITIAL LUNG DISEASE W CC $9,603.96 196 INTERSTITIAL LUNG DISEASE W MCC $35,262.69 198 INTERSTITIAL LUNG DISEASE W/O CC/MCC $8,466.66 065 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA I $21,263.23 064 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC $31,210.50 066 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC $15,846.09 116 INTRAOCULAR PROCEDURES W CC/MCC $49,367.91 117 INTRAOCULAR PROCEDURES W/O CC/MCC $12,274.99 657 KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC $39,551.46 656 KIDNEY & URETER PROCEDURES FOR NEOPLASM W MCC $71,205.88 658 KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC $21,541.18 660 KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC $26,797.50 659 KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W MCC $58,573.26 661 KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC $16,966.39 321 KIDNEY & URINARY TRACT INFECTIONS AGE >17 W/O CC $47,525.48 689 KIDNEY & URINARY TRACT INFECTIONS W MCC $16,850.87 690 KIDNEY & URINARY TRACT INFECTIONS W/O MCC $12,949.57 687 KIDNEY & URINARY TRACT NEOPLASMS W CC $15,375.09 695 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W MCC $19,671.29 696 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W/O MCC $11,173.83 486 KNEE PROCEDURES W PDX OF INFECTION W CC $46,623.10 485 KNEE PROCEDURES W PDX OF INFECTION W MCC $40,451.37 488 KNEE PROCEDURES W/O PDX OF INFECTION W CC/MCC $10,699.90 418 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC $28,901.47 417 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC $42,733.94 419 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC $15,762.17 496 LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W C $58,339.15 497 LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W/O $12,835.79 499 LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W/O $10,198.43 493 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC $23,685.46 494 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC $21,963.80 841 LYMPHOMA & NON-ACUTE LEUKEMIA W CC $9,994.68 824 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W CC $23,873.06 823 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W MCC $23,377.48

825 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W/O CC/MCC $15,775.59 842 LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC/MCC $5,857.56 654 MAJOR BLADDER PROCEDURES W CC $46,286.90 237 MAJOR CARDIOVASC PROCEDURES W MCC $57,661.71 238 MAJOR CARDIOVASC PROCEDURES W/O MCC $36,680.03 111 MAJOR CARDIOVASCULAR PROCEDURES W/O CC $9,582.40 164 MAJOR CHEST PROCEDURES W CC $23,191.45 163 MAJOR CHEST PROCEDURES W MCC $58,321.11 165 MAJOR CHEST PROCEDURES W/O CC/MCC $32,018.65 184 MAJOR CHEST TRAUMA W CC $12,352.30 183 MAJOR CHEST TRAUMA W MCC $20,846.59 369 MAJOR ESOPHAGEAL DISORDERS W CC $20,476.30 368 MAJOR ESOPHAGEAL DISORDERS W MCC $14,416.87 372 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W C $22,141.60 371 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W M $30,578.18 373 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W/O $23,768.71 049 MAJOR HEAD & NECK PROCEDURES $7,324.12 809 MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W C $22,061.36 808 MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W M $31,201.42 470 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W $28,077.64 469 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W $55,414.60 707 MAJOR MALE PELVIC PROCEDURES W CC/MCC $24,512.47 708 MAJOR MALE PELVIC PROCEDURES W/O CC/MCC $17,890.66 596 MAJOR SKIN DISORDERS W/O MCC $10,620.60 330 MAJOR SMALL & LARGE BOWEL PROCEDURES W CC $39,099.31 329 MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC $70,395.17 331 MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC $22,469.33 436 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC $34,221.76 435 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC $35,723.34 755 MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC $25,990.02 723 MALIGNANCY, MALE REPRODUCTIVE SYSTEM W CC $27,989.97 722 MALIGNANCY, MALE REPRODUCTIVE SYSTEM W MCC $24,108.86 724 MALIGNANCY, MALE REPRODUCTIVE SYSTEM W/O CC/MCC $7,725.63 598 MALIGNANT BREAST DISORDERS W CC $15,057.42 582 MASTECTOMY FOR MALIGNANCY W CC/MCC $41,047.87 583 MASTECTOMY FOR MALIGNANCY W/O CC/MCC $12,049.57 551 MEDICAL BACK PROBLEMS W MCC $26,604.93 552 MEDICAL BACK PROBLEMS W/O MCC $11,587.31 760 MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W CC/ $11,097.47 761 MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W/O C $12,772.93 663 MINOR BLADDER PROCEDURES W CC $29,582.11 664 MINOR BLADDER PROCEDURES W/O CC/MCC $12,252.90 606 MINOR SKIN DISORDERS W MCC $9,091.99 607 MINOR SKIN DISORDERS W/O MCC $11,783.71 345 MINOR SMALL & LARGE BOWEL PROCEDURES W CC $45,763.65 346 MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC $20,468.83 641 MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W $13,850.82

640 MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W $15,818.25 137 MOUTH PROCEDURES W CC/MCC $9,267.04 138 MOUTH PROCEDURES W/O CC/MCC $14,382.82 059 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W CC $9,384.43 060 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W/O CC/MCC $16,318.55 829 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R. PROC W $10,572.35 794 NEONATE W OTHER SIGNIFICANT PROBLEMS $6,481.36 054 NERVOUS SYSTEM NEOPLASMS W MCC $20,935.34 055 NERVOUS SYSTEM NEOPLASMS W/O MCC $11,852.23 123 NEUROLOGICAL EYE DISORDERS $14,676.58 882 NEUROSES EXCEPT DEPRESSIVE $18,381.49 097 NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W M $50,972.85 935 NON-EXTENSIVE BURNS $11,718.75 988 NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W C $30,477.58 987 NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W M $41,314.46 989 NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W/O $9,391.79 600 NON-MALIGNANT BREAST DISORDERS W CC/MCC $12,109.49 601 NON-MALIGNANT BREAST DISORDERS W/O CC/MCC $10,627.11 071 NONSPECIFIC CEREBROVASCULAR DISORDERS W CC $14,746.14 070 NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC $14,904.07 068 NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W/O MCC $14,956.56 080 NONTRAUMATIC STUPOR & COMA W MCC $10,386.78 081 NONTRAUMATIC STUPOR & COMA W/O MCC $9,505.39 795 NORMAL NEWBORN $6,067.82 940 O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W C $11,514.23 941 O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W/O $12,451.06 876 O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF MENTAL ILLNESS $10,195.38 620 O.R. PROCEDURES FOR OBESITY W CC $17,207.14 621 O.R. PROCEDURES FOR OBESITY W/O CC/MCC $13,161.93 114 ORBITAL PROCEDURES W/O CC/MCC $23,223.81 884 ORGANIC DISTURBANCES & MENTAL RETARDATION $16,463.09 540 OSTEOMYELITIS W CC $22,629.36 539 OSTEOMYELITIS W MCC $30,718.40 541 OSTEOMYELITIS W/O CC/MCC $13,694.58 781 OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS $13,212.51 782 OTHER ANTEPARTUM DIAGNOSES W/O MEDICAL COMPLICATIONS $5,351.24 228 OTHER CARDIOTHORACIC PROCEDURES W MCC $34,172.36 315 OTHER CIRCULATORY SYSTEM DIAGNOSES W CC $13,703.85 144 OTHER CIRCULATORY SYSTEM DIAGNOSES W CC $6,465.15 314 OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC $20,927.27 316 OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC $21,256.72 264 OTHER CIRCULATORY SYSTEM O.R. PROCEDURES $41,544.27 394 OTHER DIGESTIVE SYSTEM DIAGNOSES W CC $14,541.49 393 OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC $36,501.65 395 OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC $13,762.63 357 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC $32,956.22 356 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC $44,911.68

092 OTHER DISORDERS OF NERVOUS SYSTEM W CC $15,868.73 091 OTHER DISORDERS OF NERVOUS SYSTEM W MCC $13,702.88 093 OTHER DISORDERS OF NERVOUS SYSTEM W/O CC/MCC $12,155.38 047 OTHER DISORDERS OF THE EYE AGE >17 W/O CC $7,856.76 124 OTHER DISORDERS OF THE EYE W MCC $9,804.95 125 OTHER DISORDERS OF THE EYE W/O MCC $13,877.21 155 OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W CC $12,828.33 154 OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W MCC $10,374.13 156 OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W/O CC/MCC $9,707.43 133 OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W CC/MCC $21,761.06 134 OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCC $12,298.22 629 OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC $28,641.09 628 OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W MCC $71,591.39 630 OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W/O CC/MCC $14,656.46 951 OTHER FACTORS INFLUENCING HEALTH STATUS $17,369.00 423 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W MCC $90,308.74 868 OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W CC $13,166.66 867 OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W MCC $32,202.60 869 OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W/O CC/MCC $12,405.65 922 OTHER INJURY, POISONING & TOXIC EFFECT DIAG W MCC $30,058.14 923 OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O MCC $16,686.54 699 OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC $14,743.81 698 OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC $16,240.07 700 OTHER KIDNEY & URINARY TRACT DIAGNOSES W/O CC/MCC $11,875.77 674 OTHER KIDNEY & URINARY TRACT PROCEDURES W CC $37,475.88 673 OTHER KIDNEY & URINARY TRACT PROCEDURES W MCC $32,565.46 270 OTHER MAJOR CARDIOVASCULAR PROCEDURES W MCC $72,575.29 965 OTHER MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC $12,035.01 515 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W MCC $47,086.71 517 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC/MCC $18,140.50 565 OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC $20,883.34 564 OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W MC $31,726.71 566 OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W/O $21,648.38 844 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC $32,359.17 843 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W MCC $33,339.81 803 OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W CC $31,796.33 802 OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W MCC $31,351.41 908 OTHER O.R. PROCEDURES FOR INJURIES W CC $30,539.02 907 OTHER O.R. PROCEDURES FOR INJURIES W MCC $21,433.92 909 OTHER O.R. PROCEDURES FOR INJURIES W/O CC/MCC $18,650.96 167 OTHER RESP SYSTEM O.R. PROCEDURES W CC $28,966.97 166 OTHER RESP SYSTEM O.R. PROCEDURES W MCC $32,141.95 168 OTHER RESP SYSTEM O.R. PROCEDURES W/O CC/MCC $24,605.01 205 OTHER RESPIRATORY SYSTEM DIAGNOSES W MCC $25,577.73 206 OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC $10,290.60 580 OTHER SKIN, SUBCUT TISS & BREAST PROC W CC $36,149.22 579 OTHER SKIN, SUBCUT TISS & BREAST PROC W MCC $48,886.25

581 OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC $17,930.66 253 OTHER VASCULAR PROCEDURES W CC $45,156.70 252 OTHER VASCULAR PROCEDURES W MCC $51,461.87 254 OTHER VASCULAR PROCEDURES W/O CC/MCC $30,347.47 152 OTITIS MEDIA & URI W MCC $7,325.70 153 OTITIS MEDIA & URI W/O MCC $10,152.67 406 PANCREAS, LIVER & SHUNT PROCEDURES W CC $45,226.88 405 PANCREAS, LIVER & SHUNT PROCEDURES W MCC $46,023.89 543 PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W C $21,698.15 544 PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W/O $11,020.68 734 PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY W CC/ $13,051.17 735 PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY W/O C $15,406.58 709 PENIS PROCEDURES W CC/MCC $9,667.18 246 PERC CARDIOVASC PROC W DRUG-ELUTING STENT W MCC OR 4+ VESSEL $39,569.04 247 PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC $28,418.18 249 PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W/O MCC $25,028.87 250 PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W MCC $37,266.17 251 PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W/O MCC $21,840.24 041 PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W CC OR PERIPH N $35,554.95 040 PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W MCC $54,293.42 300 PERIPHERAL VASCULAR DISORDERS W CC $18,655.99 299 PERIPHERAL VASCULAR DISORDERS W MCC $26,005.52 301 PERIPHERAL VASCULAR DISORDERS W/O CC/MCC $14,024.32 336 PERITONEAL ADHESIOLYSIS W CC $35,825.74 335 PERITONEAL ADHESIOLYSIS W MCC $50,973.41 337 PERITONEAL ADHESIOLYSIS W/O CC/MCC $17,877.77 244 PERMANENT CARDIAC PACEMAKER IMPLANT W/O CC/MCC $12,343.35 187 PLEURAL EFFUSION W CC $15,140.82 186 PLEURAL EFFUSION W MCC $32,396.02 188 PLEURAL EFFUSION W/O CC/MCC $8,960.21 199 PNEUMOTHORAX W MCC $20,277.77 201 PNEUMOTHORAX W/O CC/MCC $10,108.80 917 POISONING & TOXIC EFFECTS OF DRUGS W MCC $18,982.64 918 POISONING & TOXIC EFFECTS OF DRUGS W/O MCC $10,301.54 862 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W MCC $21,020.84 863 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC $15,007.16 856 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W MCC $30,772.06 769 POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE $11,138.31 776 POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE $9,553.31 792 PREMATURITY W/O MAJOR PROBLEMS $8,529.42 666 PROSTATECTOMY W CC $24,473.07 665 PROSTATECTOMY W MCC $9,548.85 885 PSYCHOSES $29,037.70 189 PULMONARY EDEMA & RESPIRATORY FAILURE $19,337.06 175 PULMONARY EMBOLISM W MCC $24,247.10 176 PULMONARY EMBOLISM W/O MCC $21,176.98 849 RADIOTHERAPY $10,027.82

811 RED BLOOD CELL DISORDERS W MCC $19,161.09 812 RED BLOOD CELL DISORDERS W/O MCC $16,372.34 683 RENAL FAILURE W CC $15,811.97 682 RENAL FAILURE W MCC $18,558.84 684 RENAL FAILURE W/O CC/MCC $10,598.53 178 RESPIRATORY INFECTIONS & INFLAMMATIONS W CC $16,462.73 177 RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC $28,945.13 179 RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC $27,834.26 181 RESPIRATORY NEOPLASMS W CC $17,484.36 180 RESPIRATORY NEOPLASMS W MCC $30,130.99 204 RESPIRATORY SIGNS & SYMPTOMS $9,785.74 208 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <96 HOURS $35,228.38 207 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS $47,372.30 815 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC $15,708.74 816 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC/MCC $9,419.27 467 REVISION OF HIP OR KNEE REPLACEMENT W CC $47,361.34 468 REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC $73,697.72 139 SALIVARY GLAND PROCEDURES $11,819.45 100 SEIZURES W MCC $18,112.40 101 SEIZURES W/O MCC $10,969.59 550 SEPTIC ARTHRITIS W/O CC/MCC $10,443.95 870 SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS $59,368.72 871 SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC $27,411.17 872 SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC $21,031.68 555 SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W M $16,170.52 556 SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W/O $12,725.26 947 SIGNS & SYMPTOMS W MCC $17,473.62 948 SIGNS & SYMPTOMS W/O MCC $12,571.95 194 SIMPLE PNEUMONIA & PLEURISY W CC $14,486.64 193 SIMPLE PNEUMONIA & PLEURISY W MCC $22,324.53 195 SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC $11,400.13 571 SKIN DEBRIDEMENT W CC $31,526.26 570 SKIN DEBRIDEMENT W MCC $34,514.37 572 SKIN DEBRIDEMENT W/O CC/MCC $14,672.68 577 SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W CC $20,741.12 578 SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W/O CC/MCC $16,555.06 573 SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W MCC $34,394.25 623 SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W C $44,749.60 622 SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W M $44,887.11 593 SKIN ULCERS W CC $14,077.46 592 SKIN ULCERS W MCC $29,582.20 501 SOFT TISSUE PROCEDURES W CC $12,869.12 052 SPINAL DISORDERS & INJURIES W CC/MCC $11,831.48 457 SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W C $46,134.41 459 SPINAL FUSION EXCEPT CERVICAL W MCC $42,204.70 460 SPINAL FUSION EXCEPT CERVICAL W/O MCC $46,545.32 029 SPINAL PROCEDURES W CC OR SPINAL NEUROSTIMULATORS $48,783.64

532 SPINAL PROCEDURES W/O CC $9,490.43 030 SPINAL PROCEDURES W/O CC/MCC $11,949.23 327 STOMACH, ESOPHAGEAL & DUODENAL PROC W CC $22,142.31 326 STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC $79,941.90 328 STOMACH, ESOPHAGEAL & DUODENAL PROC W/O CC/MCC $19,924.87 312 SYNCOPE & COLLAPSE $12,038.87 557 TENDONITIS, MYOSITIS & BURSITIS W MCC $14,214.65 558 TENDONITIS, MYOSITIS & BURSITIS W/O MCC $15,346.96 711 TESTES PROCEDURES W CC/MCC $10,919.22 778 THREATENED ABORTION $6,454.42 626 THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W CC $13,343.51 627 THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W/O CC/MCC $14,135.00 004 TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R $113,528.61 012 TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W CC $63,844.18 011 TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W MCC $30,692.91 069 TRANSIENT ISCHEMIA $13,997.89 669 TRANSURETHRAL PROCEDURES W CC $16,241.74 668 TRANSURETHRAL PROCEDURES W MCC $32,165.85 670 TRANSURETHRAL PROCEDURES W/O CC/MCC $9,484.58 713 TRANSURETHRAL PROSTATECTOMY W CC/MCC $11,577.02 714 TRANSURETHRAL PROSTATECTOMY W/O CC/MCC $10,054.19 604 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W MCC $16,916.54 605 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC $12,043.52 914 TRAUMATIC INJURY W/O MCC $11,161.78 086 TRAUMATIC STUPOR & COMA, COMA <1 HR W CC $18,081.96 087 TRAUMATIC STUPOR & COMA, COMA <1 HR W/O CC/MCC $13,577.32 083 TRAUMATIC STUPOR & COMA, COMA >1 HR W CC $21,500.87 384 UNCOMPLICATED PEPTIC ULCER W/O MCC $16,848.56 256 UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W CC $21,698.17 671 URETHRAL PROCEDURES W CC/MCC $14,429.93 697 URETHRAL STRICTURE $18,696.99 693 URINARY STONES W/O ESW LITHOTRIPSY W MCC $10,138.90 694 URINARY STONES W/O ESW LITHOTRIPSY W/O MCC $11,267.37 742 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC $18,394.34 743 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC $14,036.15 737 UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W CC $29,062.32 738 UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W/O $19,526.47 740 UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W CC $15,649.11 741 UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC/MCC $15,300.84 747 VAGINA, CERVIX & VULVA PROCEDURES W/O CC/MCC $13,209.35 774 VAGINAL DELIVERY W COMPLICATING DIAGNOSES $9,010.21 767 VAGINAL DELIVERY W STERILIZATION &/OR D&C $8,773.22 775 VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES $9,230.52 263 VEIN LIGATION & STRIPPING $36,779.72 032 VENTRICULAR SHUNT PROCEDURES W CC $16,431.04 866 VIRAL ILLNESS W/O MCC $14,199.14 075 VIRAL MENINGITIS W CC/MCC $35,597.44

463 WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W $56,662.43 464 WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W $42,453.17 902 WOUND DEBRIDEMENTS FOR INJURIES W CC $24,485.39 901 WOUND DEBRIDEMENTS FOR INJURIES W MCC $35,472.76