| 057 DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC |
2 |
4.5 |
$9,249.04 |
| 064 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC |
1 |
4.0 |
$11,551.70 |
| 065 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS |
9 |
3.4 |
$7,562.70 |
| 066 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC |
3 |
2.7 |
$10,217.30 |
| 069 TRANSIENT ISCHEMIA W/O THROMBOLYTIC |
1 |
1.0 |
$5,369.40 |
| 083 TRAUMATIC STUPOR & COMA, COMA >1 HR W CC |
2 |
2.5 |
$6,256.90 |
| 086 TRAUMATIC STUPOR & COMA, COMA <1 HR W CC |
1 |
3.0 |
$8,926.65 |
| 091 OTHER DISORDERS OF NERVOUS SYSTEM W MCC |
1 |
1.0 |
$3,542.60 |
| 092 OTHER DISORDERS OF NERVOUS SYSTEM W CC |
3 |
1.3 |
$10,624.50 |
| 093 OTHER DISORDERS OF NERVOUS SYSTEM W/O CC/MCC |
1 |
1.0 |
$2,568.00 |
| 153 OTITIS MEDIA & URI W/O MCC |
5 |
3.4 |
$9,104.75 |
| 157 DENTAL & ORAL DISEASES W MCC |
1 |
7.0 |
$14,210.33 |
| 175 PULMONARY EMBOLISM W MCC |
1 |
3.0 |
$7,537.20 |
| 176 PULMONARY EMBOLISM W/O MCC |
5 |
2.2 |
$10,292.74 |
| 177 RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC |
2 |
6.0 |
$13,879.35 |
| 178 RESPIRATORY INFECTIONS & INFLAMMATIONS W CC |
6 |
5.3 |
$10,343.03 |
| 179 RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC |
4 |
4.3 |
$9,114.18 |
| 181 RESPIRATORY NEOPLASMS W CC |
2 |
1.5 |
$4,528.06 |
| 182 RESPIRATORY NEOPLASMS W/O CC/MCC |
1 |
1.0 |
$4,166.46 |
| 186 PLEURAL EFFUSION W MCC |
2 |
3.0 |
$8,281.63 |
| 187 PLEURAL EFFUSION W CC |
1 |
3.0 |
$11,279.95 |
| 189 PULMONARY EDEMA & RESPIRATORY FAILURE |
7 |
3.0 |
$7,414.76 |
| 190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC |
6 |
3.3 |
$9,169.50 |
| 191 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC |
7 |
3.0 |
$8,796.44 |
| 192 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC |
17 |
2.3 |
$5,588.00 |
| 193 SIMPLE PNEUMONIA & PLEURISY W MCC |
9 |
4.2 |
$10,600.02 |
| 194 SIMPLE PNEUMONIA & PLEURISY W CC |
46 |
4.2 |
$9,475.63 |
| 195 SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC |
18 |
3.2 |
$6,815.16 |
| 197 INTERSTITIAL LUNG DISEASE W CC |
1 |
7.0 |
$17,889.02 |
| 200 PNEUMOTHORAX W CC |
1 |
5.0 |
$15,081.88 |
| 201 PNEUMOTHORAX W/O CC/MCC |
1 |
2.0 |
$5,838.09 |
| 202 BRONCHITIS & ASTHMA W CC/MCC |
7 |
3.3 |
$6,342.96 |
| 203 BRONCHITIS & ASTHMA W/O CC/MCC |
9 |
3.9 |
$7,759.82 |
| 204 RESPIRATORY SIGNS & SYMPTOMS |
3 |
2.3 |
$4,945.31 |
| 206 OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC |
1 |
2.0 |
$4,846.48 |
| 208 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS |
1 |
7.0 |
$17,609.80 |
| 240 AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W CC |
1 |
7.0 |
$29,959.43 |
| 256 UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W CC |
2 |
3.5 |
$14,749.01 |
| 264 OTHER CIRCULATORY SYSTEM O.R. PROCEDURES |
1 |
1.0 |
$9,217.15 |
| 280 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC |
1 |
2.0 |
$6,171.85 |
| 281 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC |
1 |
3.0 |
$8,552.95 |
| 282 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC |
4 |
1.5 |
$6,018.95 |
| 291 HEART FAILURE & SHOCK W MCC |
6 |
3.8 |
$7,964.79 |
| 292 HEART FAILURE & SHOCK W CC |
21 |
3.6 |
$9,108.08 |
| 293 HEART FAILURE & SHOCK W/O CC/MCC |
21 |
3.0 |
$8,161.44 |
| 299 PERIPHERAL VASCULAR DISORDERS W MCC |
1 |
1.0 |
$3,282.65 |
| 300 PERIPHERAL VASCULAR DISORDERS W CC |
1 |
4.0 |
$8,657.05 |
| 301 PERIPHERAL VASCULAR DISORDERS W/O CC/MCC |
1 |
2.0 |
$5,468.95 |
| 303 ATHEROSCLEROSIS W/O MCC |
2 |
1.5 |
$5,628.01 |
| 305 HYPERTENSION W/O MCC |
5 |
2.0 |
$6,923.69 |
| 308 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC |
3 |
2.3 |
$10,086.99 |
| 309 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC |
7 |
2.9 |
$7,739.43 |
| 310 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC |
12 |
2.1 |
$6,275.59 |
| 312 SYNCOPE & COLLAPSE |
2 |
1.5 |
$9,194.71 |
| 313 CHEST PAIN |
4 |
1.5 |
$5,974.18 |
| 315 OTHER CIRCULATORY SYSTEM DIAGNOSES W CC |
3 |
2.0 |
$3,866.42 |
| 316 OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC |
3 |
2.0 |
$8,040.01 |
| 329 MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC |
1 |
5.0 |
$45,845.47 |
| 330 MAJOR SMALL & LARGE BOWEL PROCEDURES W CC |
5 |
8.6 |
$37,097.20 |
| 331 MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC |
4 |
3.8 |
$28,447.21 |
| 339 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC |
4 |
4.5 |
$18,883.63 |
| 340 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC |
4 |
3.5 |
$17,760.15 |
| 343 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC |
1 |
3.0 |
$17,364.10 |
| 349 ANAL & STOMAL PROCEDURES W/O CC/MCC |
1 |
2.0 |
$17,580.77 |
| 352 INGUINAL & FEMORAL HERNIA PROCEDURES W/O CC/MCC |
1 |
4.0 |
$18,118.94 |
| 354 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W CC |
1 |
3.0 |
$18,838.85 |
| 355 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W/O CC/MCC |
2 |
2.5 |
$16,878.42 |
| 356 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC |
1 |
25.0 |
$56,952.89 |
| 357 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC |
1 |
20.0 |
$62,646.02 |
| 372 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC |
3 |
5.3 |
$7,218.26 |
| 373 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W/O CC/MCC |
2 |
2.0 |
$8,530.95 |
| 375 DIGESTIVE MALIGNANCY W CC |
1 |
3.0 |
$8,266.10 |
| 377 G.I. HEMORRHAGE W MCC |
2 |
5.5 |
$11,136.56 |
| 378 G.I. HEMORRHAGE W CC |
4 |
3.0 |
$8,380.10 |
| 379 G.I. HEMORRHAGE W/O CC/MCC |
1 |
2.0 |
$8,450.08 |
| 388 G.I. OBSTRUCTION W MCC |
1 |
5.0 |
$21,210.55 |
| 389 G.I. OBSTRUCTION W CC |
7 |
4.1 |
$9,299.70 |
| 390 G.I. OBSTRUCTION W/O CC/MCC |
11 |
2.8 |
$7,734.07 |
| 391 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC |
2 |
2.5 |
$6,426.93 |
| 392 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC |
33 |
2.6 |
$6,873.09 |
| 393 OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC |
1 |
2.0 |
$5,180.15 |
| 394 OTHER DIGESTIVE SYSTEM DIAGNOSES W CC |
2 |
5.0 |
$9,112.68 |
| 395 OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC |
3 |
2.0 |
$6,519.95 |
| 415 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC |
2 |
2.5 |
$23,177.37 |
| 417 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC |
3 |
2.3 |
$18,874.23 |
| 418 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC |
8 |
5.5 |
$22,016.84 |
| 419 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC |
9 |
1.3 |
$17,596.38 |
| 433 CIRRHOSIS & ALCOHOLIC HEPATITIS W CC |
7 |
3.0 |
$9,128.16 |
| 435 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC |
1 |
2.0 |
$4,466.20 |
| 436 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC |
3 |
2.3 |
$6,282.72 |
| 439 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC |
6 |
4.0 |
$10,573.78 |
| 440 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC |
11 |
2.7 |
$7,480.64 |
| 441 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W MCC |
2 |
4.5 |
$14,668.31 |
| 442 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC |
3 |
2.3 |
$7,205.22 |
| 443 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC/MCC |
1 |
2.0 |
$4,202.10 |
| 444 DISORDERS OF THE BILIARY TRACT W MCC |
1 |
1.0 |
$3,938.00 |
| 460 SPINAL FUSION EXCEPT CERVICAL W/O MCC |
30 |
3.1 |
$58,634.00 |
| 463 WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC |
1 |
11.0 |
$35,206.42 |
| 465 WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W/O CC/MCC |
1 |
1.0 |
$34,029.25 |
| 467 REVISION OF HIP OR KNEE REPLACEMENT W CC |
4 |
3.5 |
$55,596.89 |
| 468 REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC |
2 |
2.5 |
$35,095.08 |
| 469 MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC OR |
1 |
8.0 |
$63,227.18 |
| 469 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC |
2 |
5.5 |
$48,058.44 |
| 470 MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC |
52 |
3.1 |
$37,396.09 |
| 470 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC |
65 |
3.6 |
$39,270.69 |
| 473 CERVICAL SPINAL FUSION W/O CC/MCC |
10 |
1.1 |
$41,602.35 |
| 474 AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W MCC |
1 |
4.0 |
$24,073.55 |
| 475 AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W CC |
3 |
2.7 |
$13,639.67 |
| 476 AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W/O CC/MCC |
1 |
2.0 |
$15,573.55 |
| 478 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC |
1 |
3.0 |
$24,338.30 |
| 479 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC |
1 |
3.0 |
$26,560.64 |
| 480 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC |
3 |
6.7 |
$32,692.54 |
| 481 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC |
9 |
4.2 |
$26,004.88 |
| 482 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC |
3 |
3.0 |
$25,612.32 |
| 483 MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES |
7 |
1.7 |
$46,330.28 |
| 487 KNEE PROCEDURES W PDX OF INFECTION W/O CC/MCC |
1 |
3.0 |
$18,876.45 |
| 489 KNEE PROCEDURES W/O PDX OF INFECTION W/O CC/MCC |
1 |
2.0 |
$14,270.45 |
| 492 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W MCC |
1 |
8.0 |
$33,912.10 |
| 493 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC |
2 |
3.5 |
$21,347.30 |
| 494 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC |
3 |
2.0 |
$26,208.92 |
| 501 SOFT TISSUE PROCEDURES W CC |
2 |
3.0 |
$16,152.31 |
| 511 SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W CC |
1 |
3.0 |
$25,666.20 |
| 517 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC/MCC |
4 |
1.8 |
$26,311.18 |
| 519 BACK & NECK PROC EXC SPINAL FUSION W CC |
1 |
1.0 |
$22,267.95 |
| 520 BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC |
4 |
1.5 |
$19,678.64 |
| 536 FRACTURES OF HIP & PELVIS W/O MCC |
6 |
2.5 |
$5,362.67 |
| 541 OSTEOMYELITIS W/O CC/MCC |
2 |
3.0 |
$8,146.45 |
| 543 PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC |
1 |
2.0 |
$4,488.01 |
| 549 SEPTIC ARTHRITIS W CC |
1 |
1.0 |
$3,427.39 |
| 552 MEDICAL BACK PROBLEMS W/O MCC |
4 |
2.0 |
$5,457.44 |
| 554 BONE DISEASES & ARTHROPATHIES W/O MCC |
1 |
3.0 |
$9,946.05 |
| 556 SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W/O MCC |
1 |
5.0 |
$5,287.35 |
| 558 TENDONITIS, MYOSITIS & BURSITIS W/O MCC |
6 |
3.3 |
$8,833.72 |
| 565 OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC |
3 |
4.0 |
$9,752.54 |
| 570 SKIN DEBRIDEMENT W MCC |
1 |
7.0 |
$17,076.21 |
| 571 SKIN DEBRIDEMENT W CC |
3 |
10.0 |
$25,990.29 |
| 572 SKIN DEBRIDEMENT W/O CC/MCC |
1 |
2.0 |
$6,356.95 |
| 580 OTHER SKIN, SUBCUT TISS & BREAST PROC W CC |
5 |
4.0 |
$20,062.56 |
| 581 OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC |
4 |
3.3 |
$13,920.49 |
| 598 MALIGNANT BREAST DISORDERS W CC |
2 |
3.0 |
$9,764.06 |
| 603 CELLULITIS W/O MCC |
30 |
3.2 |
$7,138.90 |
| 605 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC |
1 |
3.0 |
$11,649.25 |
| 616 AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W MCC |
1 |
7.0 |
$23,997.95 |
| 617 AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W CC |
6 |
5.3 |
$22,002.67 |
| 623 SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC |
4 |
5.5 |
$19,113.48 |
| 637 DIABETES W MCC |
2 |
4.0 |
$16,359.48 |
| 638 DIABETES W CC |
11 |
3.5 |
$10,831.42 |
| 639 DIABETES W/O CC/MCC |
5 |
1.6 |
$7,088.95 |
| 640 MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W MCC |
4 |
3.5 |
$7,446.89 |
| 641 MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W/O MCC |
27 |
3.1 |
$6,674.42 |
| 644 ENDOCRINE DISORDERS W CC |
2 |
3.0 |
$6,180.22 |
| 645 ENDOCRINE DISORDERS W/O CC/MCC |
2 |
4.0 |
$8,032.05 |
| 654 MAJOR BLADDER PROCEDURES W CC |
1 |
5.0 |
$19,394.38 |
| 682 RENAL FAILURE W MCC |
1 |
3.0 |
$5,718.56 |
| 683 RENAL FAILURE W CC |
11 |
3.1 |
$7,938.45 |
| 684 RENAL FAILURE W/O CC/MCC |
6 |
2.3 |
$5,842.73 |
| 687 KIDNEY & URINARY TRACT NEOPLASMS W CC |
1 |
2.0 |
$7,726.70 |
| 689 KIDNEY & URINARY TRACT INFECTIONS W MCC |
7 |
3.7 |
$6,424.85 |
| 690 KIDNEY & URINARY TRACT INFECTIONS W/O MCC |
34 |
3.8 |
$7,910.03 |
| 693 URINARY STONES W/O ESW LITHOTRIPSY W MCC |
1 |
3.0 |
$14,778.72 |
| 694 URINARY STONES W/O ESW LITHOTRIPSY W/O MCC |
1 |
3.0 |
$10,757.11 |
| 698 OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC |
1 |
3.0 |
$3,067.75 |
| 699 OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC |
4 |
3.8 |
$13,435.47 |
| 713 TRANSURETHRAL PROSTATECTOMY W CC/MCC |
2 |
2.0 |
$17,613.11 |
| 714 TRANSURETHRAL PROSTATECTOMY W/O CC/MCC |
1 |
1.0 |
$10,230.11 |
| 728 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W/O MCC |
1 |
3.0 |
$3,719.35 |
| 737 UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W CC |
1 |
3.0 |
$21,146.33 |
| 738 UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W/O CC/MCC |
1 |
3.0 |
$23,649.36 |
| 740 UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W CC |
1 |
5.0 |
$32,969.34 |
| 741 UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC/MCC |
1 |
1.0 |
$17,432.42 |
| 742 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC |
3 |
3.3 |
$19,702.94 |
| 747 VAGINA, CERVIX & VULVA PROCEDURES W/O CC/MCC |
1 |
9.0 |
$14,234.25 |
| 749 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W CC/MCC |
1 |
1.0 |
$10,998.49 |
| 759 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC |
1 |
4.0 |
$13,371.19 |
| 765 CESAREAN SECTION W CC/MCC |
22 |
2.5 |
$12,817.23 |
| 766 CESAREAN SECTION W/O CC/MCC |
65 |
2.2 |
$11,119.13 |
| 767 VAGINAL DELIVERY W STERILIZATION &/OR D&C |
8 |
1.8 |
$9,451.11 |
| 769 POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE |
2 |
22.5 |
$26,556.34 |
| 770 ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY |
1 |
2.0 |
$15,771.85 |
| 774 VAGINAL DELIVERY W COMPLICATING DIAGNOSES |
15 |
1.3 |
$3,571.54 |
| 775 VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES |
175 |
1.5 |
$3,393.24 |
| 778 THREATENED ABORTION |
2 |
1.0 |
$2,601.15 |
| 779 ABORTION W/O D&C |
1 |
1.0 |
$2,136.04 |
| 781 OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS |
5 |
2.0 |
$3,762.00 |
| 789 NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY |
8 |
1.4 |
$1,915.12 |
| 792 PREMATURITY W/O MAJOR PROBLEMS |
9 |
2.1 |
$1,334.85 |
| 793 FULL TERM NEONATE W MAJOR PROBLEMS |
3 |
2.3 |
$1,608.52 |
| 794 NEONATE W OTHER SIGNIFICANT PROBLEMS |
13 |
2.0 |
$1,663.00 |
| 795 NORMAL NEWBORN |
260 |
1.5 |
$815.25 |
| 809 MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC |
6 |
2.3 |
$7,130.29 |
| 810 MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W/O CC/MCC |
1 |
5.0 |
$12,464.00 |
| 811 RED BLOOD CELL DISORDERS W MCC |
1 |
1.0 |
$10,688.23 |
| 812 RED BLOOD CELL DISORDERS W/O MCC |
16 |
2.8 |
$8,849.03 |
| 813 COAGULATION DISORDERS |
2 |
5.0 |
$10,840.45 |
| 815 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC |
1 |
1.0 |
$3,989.30 |
| 816 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC/MCC |
1 |
2.0 |
$6,682.20 |
| 829 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS W OTHER PROCEDU |
1 |
1.0 |
$9,305.97 |
| 835 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W CC |
1 |
3.0 |
$10,810.42 |
| 836 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W/O CC/MCC |
1 |
1.0 |
$3,162.12 |
| 841 LYMPHOMA & NON-ACUTE LEUKEMIA W CC |
3 |
1.7 |
$5,612.83 |
| 853 INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC |
3 |
4.3 |
$22,805.21 |
| 854 INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC |
1 |
9.0 |
$25,759.17 |
| 856 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W MCC |
1 |
3.0 |
$12,945.41 |
| 858 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W/O CC/MCC |
1 |
7.0 |
$31,717.06 |
| 863 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC |
3 |
6.3 |
$15,086.24 |
| 864 FEVER |
5 |
2.8 |
$6,187.83 |
| 871 SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC |
11 |
5.2 |
$9,937.64 |
| 872 SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC |
36 |
3.9 |
$9,105.58 |
| 880 ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION |
2 |
3.5 |
$7,784.95 |
| 884 ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY |
2 |
2.5 |
$5,473.35 |
| 894 ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA |
1 |
1.0 |
$3,637.30 |
| 902 WOUND DEBRIDEMENTS FOR INJURIES W CC |
1 |
1.0 |
$9,147.68 |
| 908 OTHER O.R. PROCEDURES FOR INJURIES W CC |
1 |
6.0 |
$23,901.93 |
| 909 OTHER O.R. PROCEDURES FOR INJURIES W/O CC/MCC |
2 |
2.0 |
$17,986.79 |
| 917 POISONING & TOXIC EFFECTS OF DRUGS W MCC |
1 |
4.0 |
$6,593.33 |
| 918 POISONING & TOXIC EFFECTS OF DRUGS W/O MCC |
2 |
3.0 |
$6,970.57 |
| 921 COMPLICATIONS OF TREATMENT W/O CC/MCC |
1 |
3.0 |
$0.00 |
| 923 OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O MCC |
1 |
4.0 |
$6,079.92 |
| 935 NON-EXTENSIVE BURNS |
1 |
4.0 |
$12,306.72 |
| 947 SIGNS & SYMPTOMS W MCC |
1 |
3.0 |
$9,056.45 |
| 948 SIGNS & SYMPTOMS W/O MCC |
6 |
2.3 |
$9,883.83 |
| 951 OTHER FACTORS INFLUENCING HEALTH STATUS |
11 |
76.3 |
$18,491.15 |
| 964 OTHER MULTIPLE SIGNIFICANT TRAUMA W CC |
1 |
9.0 |
$19,064.99 |
| 982 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC |
2 |
7.0 |
$30,047.77 |
| 988 NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC |
1 |
6.0 |
$18,788.71 |
| 989 NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC |
1 |
1.0 |
$2,989.29 |
