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| 011 | TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY W MCC | $65,165.89 | $65,165.89 |
| 025 | CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCC | $82,660.36 | $112,969.93 |
| 028 | SPINAL PROCEDURES W MCC | $70,022.21 | $70,022.21 |
| 030 | SPINAL PROCEDURES W/O CC/MCC | $20,128.02 | $20,128.02 |
| 037 | EXTRACRANIAL PROCEDURES W MCC | $17,345.40 | $33,945.68 |
| 038 | EXTRACRANIAL PROCEDURES W CC | $35,873.14 | $35,873.14 |
| 039 | EXTRACRANIAL PROCEDURES W/O CC/MCC | $16,342.64 | $29,476.27 |
| 040 | PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W MCC | $39,848.25 | $39,848.25 |
| 041 | PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W CC OR PERIPH NEUROSTIM | $27,018.04 | $27,018.04 |
| 054 | NERVOUS SYSTEM NEOPLASMS W MCC | $7,965.39 | $81,647.51 |
| 056 | DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC | $22,216.38 | $65,380.25 |
| 057 | DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC | $22,715.79 | $44,811.55 |
| 060 | MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W/O CC/MCC | $22,651.43 | $22,651.43 |
| 062 | ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA W THROMBOLYTIC AGENT W CC | $62,859.83 | $64,855.64 |
| 064 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC | $1,946.17 | $57,053.48 |
| 065 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS | $10,033.81 | $49,986.63 |
| 066 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC | $10,062.39 | $28,824.67 |
| 069 | TRANSIENT ISCHEMIA W/O THROMBOLYTIC | $6,633.61 | $54,828.41 |
| 070 | NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC | $20,627.11 | $49,731.65 |
| 071 | NONSPECIFIC CEREBROVASCULAR DISORDERS W CC | $15,613.89 | $31,102.81 |
| 072 | NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC | $9,058.13 | $11,644.00 |
| 073 | CRANIAL & PERIPHERAL NERVE DISORDERS W MCC | $17,123.83 | $37,795.48 |
| 074 | CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC | $14,157.97 | $95,995.81 |
| 077 | HYPERTENSIVE ENCEPHALOPATHY W MCC | $15,666.98 | $22,143.44 |
| 078 | HYPERTENSIVE ENCEPHALOPATHY W CC | $11,412.22 | $51,662.06 |
| 082 | TRAUMATIC STUPOR & COMA, COMA >1 HR W MCC | $3,746.52 | $20,993.03 |
| 087 | TRAUMATIC STUPOR & COMA, COMA <1 HR W/O CC/MCC | $6,757.29 | $6,757.29 |
| 090 | CONCUSSION W/O CC/MCC | $16,190.29 | $16,190.29 |
| 091 | OTHER DISORDERS OF NERVOUS SYSTEM W MCC | $7,238.24 | $32,017.72 |
| 092 | OTHER DISORDERS OF NERVOUS SYSTEM W CC | $2,082.71 | $45,057.93 |
| 093 | OTHER DISORDERS OF NERVOUS SYSTEM W/O CC/MCC | $9,346.91 | $20,088.21 |
| 097 | NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W MCC | $113,013.54 | $113,013.54 |
| 100 | SEIZURES W MCC | $15,908.69 | $86,855.09 |
| 101 | SEIZURES W/O MCC | $8,337.21 | $26,096.27 |
| 103 | HEADACHES W/O MCC | $30,254.53 | $34,779.41 |
| 125 | OTHER DISORDERS OF THE EYE W/O MCC | $30,202.11 | $30,202.11 |
| 134 | OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCC | $24,114.35 | $24,114.35 |
| 135 | SINUS & MASTOID PROCEDURES W CC/MCC | $19,855.19 | $19,855.19 |
| 150 | EPISTAXIS W MCC | $30,229.13 | $30,229.13 |
| 152 | OTITIS MEDIA & URI W MCC | $14,184.55 | $14,184.55 |
| 153 | OTITIS MEDIA & URI W/O MCC | $7,430.37 | $13,441.17 |
| 154 | OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W MCC | $10,445.71 | $11,776.62 |
| 156 | OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W/O CC/MCC | $4,984.42 | $4,984.42 |
| 163 | MAJOR CHEST PROCEDURES W MCC | $48,579.21 | $48,579.21 |
| 166 | OTHER RESP SYSTEM O.R. PROCEDURES W MCC | $31,559.72 | $194,694.77 |
| 167 | OTHER RESP SYSTEM O.R. PROCEDURES W CC | $56,764.03 | $59,043.55 |
| 168 | OTHER RESP SYSTEM O.R. PROCEDURES W/O CC/MCC | $26,581.78 | $26,581.78 |
| 175 | PULMONARY EMBOLISM W MCC | $12,270.44 | $74,275.33 |
| 176 | PULMONARY EMBOLISM W/O MCC | $5,573.89 | $25,379.04 |
| 177 | RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC | $4,681.84 | $117,973.28 |
| 178 | RESPIRATORY INFECTIONS & INFLAMMATIONS W CC | $9,721.70 | $52,865.95 |
| 179 | RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC | $11,631.82 | $19,748.30 |
| 180 | RESPIRATORY NEOPLASMS W MCC | $15,060.84 | $93,206.48 |
| 181 | RESPIRATORY NEOPLASMS W CC | $55,446.54 | $106,867.79 |
| 183 | MAJOR CHEST TRAUMA W MCC | $24,413.35 | $69,100.29 |
| 184 | MAJOR CHEST TRAUMA W CC | $10,501.72 | $64,815.28 |
| 186 | PLEURAL EFFUSION W MCC | $7,830.82 | $35,787.51 |
| 187 | PLEURAL EFFUSION W CC | $9,744.65 | $30,844.30 |
| 189 | PULMONARY EDEMA & RESPIRATORY FAILURE | $6,207.15 | $83,842.53 |
| 190 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC | $3,941.06 | $60,913.17 |
| 191 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC | $5,960.62 | $37,002.77 |
| 192 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC | $5,847.82 | $21,843.54 |
| 193 | SIMPLE PNEUMONIA & PLEURISY W MCC | $7,270.72 | $102,718.25 |
| 194 | SIMPLE PNEUMONIA & PLEURISY W CC | $7,386.57 | $165,623.08 |
| 195 | SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC | $7,570.99 | $21,694.75 |
| 196 | INTERSTITIAL LUNG DISEASE W MCC | $12,990.37 | $27,332.96 |
| 197 | INTERSTITIAL LUNG DISEASE W CC | $11,349.74 | $11,349.74 |
| 198 | INTERSTITIAL LUNG DISEASE W/O CC/MCC | $10,121.46 | $10,121.46 |
| 199 | PNEUMOTHORAX W MCC | $8,466.02 | $32,244.47 |
| 200 | PNEUMOTHORAX W CC | $9,484.12 | $33,197.06 |
| 202 | BRONCHITIS & ASTHMA W CC/MCC | $11,788.01 | $40,449.23 |
| 203 | BRONCHITIS & ASTHMA W/O CC/MCC | $20,019.59 | $20,699.67 |
| 204 | RESPIRATORY SIGNS & SYMPTOMS | $9,693.05 | $19,207.29 |
| 205 | OTHER RESPIRATORY SYSTEM DIAGNOSES W MCC | $8,463.09 | $46,045.58 |
| 206 | OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC | $31,083.64 | $31,083.64 |
| 207 | RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS OR PERIPHERAL EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) | $52,029.76 | $171,021.11 |
| 208 | RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS | $32,105.85 | $118,848.49 |
| 239 | AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W MCC | $51,587.16 | $51,587.16 |
| 240 | AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W CC | $16,026.33 | $33,908.03 |
| 242 | PERMANENT CARDIAC PACEMAKER IMPLANT W MCC | $49,775.81 | $66,828.23 |
| 243 | PERMANENT CARDIAC PACEMAKER IMPLANT W CC | $33,448.41 | $60,512.11 |
| 252 | OTHER VASCULAR PROCEDURES W MCC | $20,600.69 | $47,476.15 |
| 253 | OTHER VASCULAR PROCEDURES W CC | $28,821.73 | $64,482.06 |
| 254 | OTHER VASCULAR PROCEDURES W/O CC/MCC | $25,730.73 | $28,890.68 |
| 256 | UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W CC | $47,543.46 | $47,543.46 |
| 259 | CARDIAC PACEMAKER DEVICE REPLACEMENT W/O MCC | $28,822.41 | $28,822.41 |
| 262 | CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W/O CC/MCC | $8,434.05 | $8,434.05 |
| 264 | OTHER CIRCULATORY SYSTEM O.R. PROCEDURES | $35,771.21 | $148,258.46 |
| 268 | AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W MCC | $58,613.92 | $208,276.52 |
| 269 | AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W/O MCC | $48,202.84 | $48,202.84 |
| 271 | OTHER MAJOR CARDIOVASCULAR PROCEDURES W CC | $44,307.60 | $44,307.60 |
| 272 | OTHER MAJOR CARDIOVASCULAR PROCEDURES W/O CC/MCC | $30,440.95 | $30,440.95 |
| 280 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC | $4,783.48 | $57,467.97 |
| 281 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC | $8,732.92 | $41,302.40 |
| 282 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC | $7,906.36 | $23,834.31 |
| 283 | ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC | $13,903.84 | $198,988.82 |
| 286 | CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC | $19,440.79 | $66,400.27 |
| 287 | CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC | $14,573.06 | $33,579.24 |
| 291 | HEART FAILURE & SHOCK W MCC OR PERIPHERAL EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) | $6,754.87 | $146,309.58 |
| 292 | HEART FAILURE & SHOCK W CC | $6,837.66 | $35,297.65 |
| 293 | HEART FAILURE & SHOCK W/O CC/MCC | $7,410.42 | $27,560.18 |
| 299 | PERIPHERAL VASCULAR DISORDERS W MCC | $19,272.40 | $59,716.87 |
| 300 | PERIPHERAL VASCULAR DISORDERS W CC | $8,467.90 | $48,738.12 |
| 301 | PERIPHERAL VASCULAR DISORDERS W/O CC/MCC | $4,351.20 | $19,505.57 |
| 302 | ATHEROSCLEROSIS W MCC | $15,413.73 | $15,413.73 |
| 303 | ATHEROSCLEROSIS W/O MCC | $6,445.78 | $26,336.85 |
| 304 | HYPERTENSION W MCC | $5,746.07 | $43,646.37 |
| 305 | HYPERTENSION W/O MCC | $3,114.58 | $20,647.51 |
| 308 | CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC | $5,411.74 | $89,861.13 |
| 309 | CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC | $4,648.34 | $55,873.19 |
| 310 | CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC | $4,198.30 | $26,975.33 |
| 311 | ANGINA PECTORIS | $5,411.09 | $20,628.10 |
| 312 | SYNCOPE & COLLAPSE | $8,680.48 | $48,191.96 |
| 313 | CHEST PAIN | $7,311.26 | $30,876.78 |
| 314 | OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC | $11,343.51 | $93,540.69 |
| 315 | OTHER CIRCULATORY SYSTEM DIAGNOSES W CC | $6,981.86 | $35,642.05 |
| 316 | OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC | $16,551.89 | $16,551.89 |
| 326 | STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC | $33,005.38 | $97,924.74 |
| 327 | STOMACH, ESOPHAGEAL & DUODENAL PROC W CC | $31,894.50 | $31,894.50 |
| 328 | STOMACH, ESOPHAGEAL & DUODENAL PROC W/O CC/MCC | $10,847.48 | $10,847.48 |
| 329 | MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC | $26,803.65 | $215,245.37 |
| 330 | MAJOR SMALL & LARGE BOWEL PROCEDURES W CC | $13,121.96 | $62,286.36 |
| 331 | MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC | $11,050.55 | $42,555.68 |
| 334 | RECTAL RESECTION W/O CC/MCC | $21,561.72 | $21,561.72 |
| 335 | PERITONEAL ADHESIOLYSIS W MCC | $27,731.15 | $92,323.20 |
| 336 | PERITONEAL ADHESIOLYSIS W CC | $18,323.70 | $58,975.86 |
| 337 | PERITONEAL ADHESIOLYSIS W/O CC/MCC | $15,173.54 | $35,507.10 |
| 338 | APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W MCC | $28,098.52 | $30,605.31 |
| 339 | APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC | $20,328.93 | $33,281.08 |
| 340 | APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC | $17,766.78 | $45,291.31 |
| 345 | MINOR SMALL & LARGE BOWEL PROCEDURES W CC | $22,793.25 | $22,793.25 |
| 348 | ANAL & STOMAL PROCEDURES W CC | $18,876.52 | $29,834.60 |
| 349 | ANAL & STOMAL PROCEDURES W/O CC/MCC | $28,029.97 | $28,029.97 |
| 350 | INGUINAL & FEMORAL HERNIA PROCEDURES W MCC | $18,286.57 | $33,914.31 |
| 351 | INGUINAL & FEMORAL HERNIA PROCEDURES W CC | $17,143.18 | $29,967.67 |
| 352 | INGUINAL & FEMORAL HERNIA PROCEDURES W/O CC/MCC | $17,382.62 | $23,120.62 |
| 353 | HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W MCC | $38,256.00 | $117,439.98 |
| 354 | HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W CC | $33,019.85 | $33,019.85 |
| 355 | HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W/O CC/MCC | $20,861.58 | $20,861.58 |
| 356 | OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC | $38,300.48 | $58,756.26 |
| 357 | OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC | $34,786.93 | $40,419.93 |
| 368 | MAJOR ESOPHAGEAL DISORDERS W MCC | $27,985.90 | $54,585.95 |
| 369 | MAJOR ESOPHAGEAL DISORDERS W CC | $9,458.38 | $9,458.38 |
| 371 | MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC | $20,676.13 | $55,514.07 |
| 372 | MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC | $10,262.39 | $42,842.16 |
| 373 | MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W/O CC/MCC | $76,934.20 | $76,934.20 |
| 374 | DIGESTIVE MALIGNANCY W MCC | $26,677.21 | $174,877.65 |
| 375 | DIGESTIVE MALIGNANCY W CC | $4,750.58 | $43,542.70 |
| 376 | DIGESTIVE MALIGNANCY W/O CC/MCC | $32,676.88 | $32,676.88 |
| 377 | G.I. HEMORRHAGE W MCC | $5,662.29 | $125,579.12 |
| 378 | G.I. HEMORRHAGE W CC | $4,308.92 | $56,807.92 |
| 379 | G.I. HEMORRHAGE W/O CC/MCC | $1,878.51 | $14,768.25 |
| 380 | COMPLICATED PEPTIC ULCER W MCC | $25,730.75 | $25,730.75 |
| 381 | COMPLICATED PEPTIC ULCER W CC | $8,855.43 | $25,282.39 |
| 382 | COMPLICATED PEPTIC ULCER W/O CC/MCC | $20,623.10 | $20,623.10 |
| 384 | UNCOMPLICATED PEPTIC ULCER W/O MCC | $3,987.99 | $25,820.64 |
| 385 | INFLAMMATORY BOWEL DISEASE W MCC | $17,019.30 | $22,925.02 |
| 386 | INFLAMMATORY BOWEL DISEASE W CC | $9,323.78 | $46,863.57 |
| 387 | INFLAMMATORY BOWEL DISEASE W/O CC/MCC | $9,700.01 | $24,225.41 |
| 388 | G.I. OBSTRUCTION W MCC | $22,121.60 | $70,538.90 |
| 389 | G.I. OBSTRUCTION W CC | $9,941.11 | $27,997.25 |
| 390 | G.I. OBSTRUCTION W/O CC/MCC | $9,048.15 | $23,488.76 |
| 391 | ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC | $11,571.65 | $59,591.00 |
| 392 | ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC | $6,976.14 | $116,621.06 |
| 393 | OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC | $15,747.93 | $112,554.46 |
| 394 | OTHER DIGESTIVE SYSTEM DIAGNOSES W CC | $2,309.53 | $49,044.06 |
| 395 | OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC | $10,874.61 | $12,025.14 |
| 414 | CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W MCC | $60,928.31 | $60,928.31 |
| 415 | CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC | $24,256.67 | $44,015.69 |
| 416 | CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC/MCC | $36,575.97 | $46,343.78 |
| 417 | LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC | $20,637.76 | $92,773.08 |
| 418 | LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC | $22,728.71 | $38,238.25 |
| 419 | LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC | $22,088.71 | $54,062.27 |
| 432 | CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC | $8,443.86 | $124,857.22 |
| 433 | CIRRHOSIS & ALCOHOLIC HEPATITIS W CC | $11,982.53 | $23,088.45 |
| 435 | MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC | $24,090.78 | $118,452.89 |
| 436 | MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC | $82,450.10 | $82,450.10 |
| 438 | DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC | $16,768.19 | $84,543.43 |
| 439 | DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC | $7,206.03 | $31,112.08 |
| 440 | DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC | $9,920.33 | $22,858.20 |
| 441 | DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W MCC | $11,009.25 | $90,334.45 |
| 442 | DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC | $7,165.39 | $40,492.26 |
| 443 | DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC/MCC | $7,404.29 | $11,991.67 |
| 444 | DISORDERS OF THE BILIARY TRACT W MCC | $11,476.79 | $32,755.74 |
| 445 | DISORDERS OF THE BILIARY TRACT W CC | $9,591.40 | $61,855.23 |
| 446 | DISORDERS OF THE BILIARY TRACT W/O CC/MCC | $15,637.63 | $15,778.46 |
| 453 | COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W MCC | $143,344.16 | $143,344.16 |
| 454 | COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W CC | $55,309.25 | $233,741.64 |
| 455 | COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O CC/MCC | $58,810.64 | $101,118.66 |
| 456 | SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W MCC | $68,866.58 | $68,866.58 |
| 457 | SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W CC | $46,788.77 | $121,923.85 |
| 458 | SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W/O CC/MCC | $32,527.14 | $61,376.37 |
| 459 | SPINAL FUSION EXCEPT CERVICAL W MCC | $39,915.27 | $117,758.41 |
| 460 | SPINAL FUSION EXCEPT CERVICAL W/O MCC | $30,210.94 | $121,261.77 |
| 463 | WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC | $47,389.46 | $75,474.52 |
| 464 | WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W CC | $33,951.82 | $103,190.54 |
| 465 | WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W/O CC/MCC | $22,957.58 | $98,865.46 |
| 466 | REVISION OF HIP OR KNEE REPLACEMENT W MCC | $46,372.61 | $114,994.72 |
| 467 | REVISION OF HIP OR KNEE REPLACEMENT W CC | $22,910.29 | $100,377.89 |
| 468 | REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC | $32,156.26 | $80,386.26 |
| 469 | MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC OR TOTAL ANKLE REPLACEMENT | $28,403.29 | $191,820.37 |
| 470 | MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC | $22,507.77 | $106,208.72 |
| 471 | CERVICAL SPINAL FUSION W MCC | $119,980.91 | $119,980.91 |
| 472 | CERVICAL SPINAL FUSION W CC | $28,880.96 | $72,896.63 |
| 473 | CERVICAL SPINAL FUSION W/O CC/MCC | $19,847.88 | $48,328.89 |
| 474 | AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W MCC | $104,203.38 | $104,203.38 |
| 477 | BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC | $64,485.86 | $116,301.75 |
| 478 | BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC | $26,740.97 | $38,402.12 |
| 479 | BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC | $38,175.96 | $66,878.87 |
| 480 | HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC | $15,350.46 | $269,970.70 |
| 481 | HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC | $18,344.48 | $69,226.51 |
| 482 | HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC | $24,160.28 | $33,943.16 |
| 483 | MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES | $32,728.10 | $53,531.56 |
| 485 | KNEE PROCEDURES W PDX OF INFECTION W MCC | $40,248.68 | $63,408.81 |
| 486 | KNEE PROCEDURES W PDX OF INFECTION W CC | $31,363.64 | $50,557.00 |
| 488 | KNEE PROCEDURES W/O PDX OF INFECTION W CC/MCC | $14,670.71 | $20,672.94 |
| 489 | KNEE PROCEDURES W/O PDX OF INFECTION W/O CC/MCC | $19,491.82 | $32,640.23 |
| 492 | LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W MCC | $50,613.46 | $50,613.46 |
| 493 | LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC | $43,497.69 | $43,497.69 |
| 494 | LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC | $27,383.63 | $33,534.40 |
| 497 | LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W/O CC/MCC | $12,557.29 | $28,400.13 |
| 498 | LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W CC/MCC | $25,373.13 | $25,373.13 |
| 500 | SOFT TISSUE PROCEDURES W MCC | $18,960.39 | $144,220.90 |
| 501 | SOFT TISSUE PROCEDURES W CC | $19,478.05 | $28,350.45 |
| 502 | SOFT TISSUE PROCEDURES W/O CC/MCC | $26,892.83 | $30,196.58 |
| 504 | FOOT PROCEDURES W CC | $14,152.32 | $14,152.32 |
| 513 | HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W CC/MCC | $22,290.43 | $55,658.48 |
| 515 | OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W MCC | $56,429.55 | $117,656.29 |
| 516 | OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC | $271,508.70 | $271,508.70 |
| 517 | OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC/MCC | $11,811.25 | $16,359.67 |
| 518 | BACK & NECK PROC EXC SPINAL FUSION W MCC OR DISC DEVICE/NEUROSTIM | $42,975.72 | $61,731.31 |
| 519 | BACK & NECK PROC EXC SPINAL FUSION W CC | $15,537.67 | $16,918.07 |
| 520 | BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC | $16,073.30 | $29,601.20 |
| 533 | FRACTURES OF FEMUR W MCC | $14,214.15 | $18,162.41 |
| 535 | FRACTURES OF HIP & PELVIS W MCC | $10,875.62 | $24,302.97 |
| 536 | FRACTURES OF HIP & PELVIS W/O MCC | $8,162.13 | $22,039.05 |
| 540 | OSTEOMYELITIS W CC | $30,746.92 | $30,746.92 |
| 542 | PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W MCC | $18,145.49 | $172,256.09 |
| 543 | PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC | $18,748.52 | $18,748.52 |
| 545 | CONNECTIVE TISSUE DISORDERS W MCC | $90,661.95 | $90,661.95 |
| 546 | CONNECTIVE TISSUE DISORDERS W CC | $13,993.08 | $13,993.08 |
| 550 | SEPTIC ARTHRITIS W/O CC/MCC | $12,701.84 | $12,701.84 |
| 551 | MEDICAL BACK PROBLEMS W MCC | $36,598.92 | $36,598.92 |
| 552 | MEDICAL BACK PROBLEMS W/O MCC | $19,792.31 | $51,162.68 |
| 553 | BONE DISEASES & ARTHROPATHIES W MCC | $15,101.64 | $37,233.77 |
| 554 | BONE DISEASES & ARTHROPATHIES W/O MCC | $10,708.79 | $23,111.20 |
| 555 | SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W MCC | $12,428.42 | $12,428.42 |
| 556 | SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W/O MCC | $15,492.76 | $19,221.52 |
| 557 | TENDONITIS, MYOSITIS & BURSITIS W MCC | $14,483.56 | $51,758.84 |
| 558 | TENDONITIS, MYOSITIS & BURSITIS W/O MCC | $13,394.85 | $18,450.06 |
| 559 | AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC | $21,060.22 | $65,140.94 |
| 560 | AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC | $1,946.66 | $1,946.66 |
| 561 | AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC | $231.26 | $231.26 |
| 562 | FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W MCC | $31,841.56 | $31,841.56 |
| 563 | FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC | $11,931.10 | $34,231.39 |
| 564 | OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W MCC | $14,426.42 | $67,315.42 |
| 565 | OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC | $8,104.52 | $25,912.72 |
| 566 | OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W/O CC/MCC | $15,904.70 | $15,904.70 |
| 571 | SKIN DEBRIDEMENT W CC | $21,043.55 | $21,043.55 |
| 576 | SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W MCC | $32,720.50 | $32,720.50 |
| 579 | OTHER SKIN, SUBCUT TISS & BREAST PROC W MCC | $27,500.97 | $46,832.50 |
| 580 | OTHER SKIN, SUBCUT TISS & BREAST PROC W CC | $15,748.09 | $45,816.99 |
| 581 | OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC | $11,329.89 | $16,580.89 |
| 583 | MASTECTOMY FOR MALIGNANCY W/O CC/MCC | $22,939.04 | $22,939.04 |
| 584 | BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W CC/MCC | $36,809.24 | $36,809.24 |
| 585 | BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W/O CC/MCC | $24,006.19 | $33,884.85 |
| 592 | SKIN ULCERS W MCC | $13,507.93 | $75,032.46 |
| 593 | SKIN ULCERS W CC | $15,828.88 | $23,609.88 |
| 595 | MAJOR SKIN DISORDERS W MCC | $38,409.15 | $38,409.15 |
| 597 | MALIGNANT BREAST DISORDERS W MCC | $30,860.73 | $44,513.23 |
| 598 | MALIGNANT BREAST DISORDERS W CC | $13,961.74 | $13,961.74 |
| 602 | CELLULITIS W MCC | $10,042.07 | $52,491.90 |
| 603 | CELLULITIS W/O MCC | $5,987.76 | $40,208.31 |
| 604 | TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W MCC | $17,951.33 | $58,777.96 |
| 605 | TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC | $27,801.27 | $27,801.27 |
| 607 | MINOR SKIN DISORDERS W/O MCC | $45.07 | $45.07 |
| 616 | AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W MCC | $31,203.18 | $61,152.25 |
| 617 | AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W CC | $22,673.08 | $71,293.42 |
| 620 | O.R. PROCEDURES FOR OBESITY W CC | $23,267.89 | $23,267.89 |
| 622 | SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W MCC | $24,354.43 | $24,354.43 |
| 623 | SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC | $20,292.28 | $31,768.66 |
| 627 | THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W/O CC/MCC | $14,458.23 | $14,458.23 |
| 628 | OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W MCC | $26,511.85 | $30,936.08 |
| 637 | DIABETES W MCC | $8,846.36 | $147,566.83 |
| 638 | DIABETES W CC | $6,298.40 | $48,098.47 |
| 639 | DIABETES W/O CC/MCC | $8,996.52 | $19,564.88 |
| 640 | MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W MCC | $6,182.16 | $140,044.14 |
| 641 | MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W/O MCC | $4,978.98 | $52,078.09 |
| 643 | ENDOCRINE DISORDERS W MCC | $13,284.77 | $31,905.35 |
| 644 | ENDOCRINE DISORDERS W CC | $10,212.54 | $30,880.64 |
| 653 | MAJOR BLADDER PROCEDURES W MCC | $75,825.06 | $75,825.06 |
| 654 | MAJOR BLADDER PROCEDURES W CC | $53,477.78 | $53,477.78 |
| 655 | MAJOR BLADDER PROCEDURES W/O CC/MCC | $22,366.44 | $41,269.45 |
| 656 | KIDNEY & URETER PROCEDURES FOR NEOPLASM W MCC | $89,956.40 | $89,956.40 |
| 657 | KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC | $27,141.97 | $47,221.59 |
| 658 | KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC | $19,564.87 | $29,687.56 |
| 659 | KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W MCC | $71,795.65 | $71,795.65 |
| 660 | KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC | $31,586.08 | $36,275.58 |
| 661 | KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC | $25,962.13 | $38,827.08 |
| 665 | PROSTATECTOMY W MCC | $21,602.44 | $21,602.44 |
| 668 | TRANSURETHRAL PROCEDURES W MCC | $29,496.34 | $54,332.36 |
| 669 | TRANSURETHRAL PROCEDURES W CC | $10,788.14 | $35,010.88 |
| 670 | TRANSURETHRAL PROCEDURES W/O CC/MCC | $14,154.88 | $14,154.88 |
| 673 | OTHER KIDNEY & URINARY TRACT PROCEDURES W MCC | $52,170.99 | $174,595.11 |
| 674 | OTHER KIDNEY & URINARY TRACT PROCEDURES W CC | $61,493.42 | $154,387.31 |
| 682 | RENAL FAILURE W MCC | $6,521.42 | $124,927.63 |
| 683 | RENAL FAILURE W CC | $6,566.60 | $45,313.97 |
| 684 | RENAL FAILURE W/O CC/MCC | $5,221.53 | $13,254.85 |
| 686 | KIDNEY & URINARY TRACT NEOPLASMS W MCC | $18,077.28 | $29,536.28 |
| 687 | KIDNEY & URINARY TRACT NEOPLASMS W CC | $12,124.58 | $12,124.58 |
| 689 | KIDNEY & URINARY TRACT INFECTIONS W MCC | $5,436.93 | $128,243.67 |
| 690 | KIDNEY & URINARY TRACT INFECTIONS W/O MCC | $5,383.49 | $49,277.32 |
| 693 | URINARY STONES W/O ESW LITHOTRIPSY W MCC | $49,627.90 | $49,627.90 |
| 694 | URINARY STONES W/O ESW LITHOTRIPSY W/O MCC | $3,516.27 | $35,370.02 |
| 695 | KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W MCC | $15,794.05 | $15,794.05 |
| 696 | KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W/O MCC | $11,867.15 | $11,867.15 |
| 698 | OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC | $6,975.89 | $231,761.83 |
| 699 | OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC | $9,976.92 | $133,362.53 |
| 700 | OTHER KIDNEY & URINARY TRACT DIAGNOSES W/O CC/MCC | $8,552.49 | $10,162.96 |
| 707 | MAJOR MALE PELVIC PROCEDURES W CC/MCC | $38,633.99 | $44,858.70 |
| 708 | MAJOR MALE PELVIC PROCEDURES W/O CC/MCC | $22,069.27 | $32,250.16 |
| 713 | TRANSURETHRAL PROSTATECTOMY W CC/MCC | $24,027.99 | $24,027.99 |
| 722 | MALIGNANCY, MALE REPRODUCTIVE SYSTEM W MCC | $87,622.56 | $87,622.56 |
| 723 | MALIGNANCY, MALE REPRODUCTIVE SYSTEM W CC | $36,770.88 | $36,770.88 |
| 726 | BENIGN PROSTATIC HYPERTROPHY W/O MCC | $18,275.34 | $18,275.34 |
| 727 | INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W MCC | $12,599.69 | $12,599.69 |
| 728 | INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W/O MCC | $11,084.97 | $18,784.57 |
| 742 | UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC | $16,439.46 | $166,221.70 |
| 743 | UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC | $13,397.20 | $17,560.76 |
| 744 | D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W CC/MCC | $19,688.93 | $21,822.10 |
| 754 | MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W MCC | $11,090.74 | $81,257.03 |
| 757 | INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W MCC | $26,379.07 | $26,379.07 |
| 765 | CESAREAN SECTION W CC/MCC | $17,205.55 | $17,205.55 |
| 766 | CESAREAN SECTION W/O CC/MCC | $13,476.80 | $13,947.35 |
| 767 | VAGINAL DELIVERY W STERILIZATION &/OR D&C | $20,640.78 | $22,679.16 |
| 768 | VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C | $30,057.91 | $30,057.91 |
| 775 | VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES | $13,318.05 | $13,318.05 |
| 781 | OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS | $8,347.31 | $8,347.31 |
| 802 | OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W MCC | $29,680.10 | $39,973.15 |
| 803 | OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W CC | $65,231.60 | $65,231.60 |
| 808 | MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W MCC | $27,161.73 | $82,460.34 |
| 809 | MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC | $7,018.34 | $25,708.61 |
| 810 | MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W/O CC/MCC | $27,905.39 | $27,905.39 |
| 811 | RED BLOOD CELL DISORDERS W MCC | $7,488.55 | $57,044.42 |
| 812 | RED BLOOD CELL DISORDERS W/O MCC | $9,088.13 | $39,584.85 |
| 813 | COAGULATION DISORDERS | $8,406.88 | $80,548.79 |
| 815 | RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC | $24,944.39 | $31,034.24 |
| 821 | LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W CC | $14,052.55 | $14,052.55 |
| 823 | LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER PROC W MCC | $61,438.87 | $93,444.93 |
| 834 | ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W MCC | $13,073.00 | $297,647.40 |
| 837 | CHEMO W ACUTE LEUKEMIA AS SDX OR W HIGH DOSE CHEMO AGENT W MCC | $131,341.76 | $343,178.13 |
| 838 | CHEMO W ACUTE LEUKEMIA AS SDX W CC OR HIGH DOSE CHEMO AGENT | $38,226.65 | $38,226.65 |
| 839 | CHEMO W ACUTE LEUKEMIA AS SDX W/O CC/MCC | $10,927.59 | $15,554.12 |
| 840 | LYMPHOMA & NON-ACUTE LEUKEMIA W MCC | $13,789.14 | $136,285.96 |
| 841 | LYMPHOMA & NON-ACUTE LEUKEMIA W CC | $47,224.27 | $87,409.08 |
| 842 | LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC/MCC | $30,080.43 | $30,893.99 |
| 843 | OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W MCC | $40,959.64 | $56,970.27 |
| 846 | CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W MCC | $8,793.78 | $115,554.96 |
| 847 | CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W CC | $7,456.19 | $99,697.55 |
| 848 | CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W/O CC/MCC | $12,005.65 | $64,738.19 |
| 849 | RADIOTHERAPY | $15,878.84 | $74,950.49 |
| 853 | INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC | $11,313.12 | $432,461.42 |
| 854 | INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC | $19,577.51 | $60,807.32 |
| 856 | POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W MCC | $35,248.65 | $87,397.00 |
| 857 | POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC | $18,292.35 | $56,597.90 |
| 858 | POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W/O CC/MCC | $12,494.67 | $12,494.67 |
| 862 | POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W MCC | $13,365.74 | $108,769.84 |
| 863 | POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC | $6,553.86 | $26,627.22 |
| 864 | FEVER AND INFLAMMATORY CONDITIONS | $7,721.90 | $26,548.08 |
| 865 | VIRAL ILLNESS W MCC | $9,493.40 | $18,848.46 |
| 866 | VIRAL ILLNESS W/O MCC | $10,457.35 | $45,732.28 |
| 867 | OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W MCC | $9,489.57 | $57,453.20 |
| 868 | OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W CC | $8,698.49 | $43,277.92 |
| 869 | OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W/O CC/MCC | $9,817.37 | $17,767.46 |
| 870 | SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS OR PERIPHERAL EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) | $61,024.32 | $337,273.56 |
| 871 | SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC | $4,400.87 | $200,751.99 |
| 872 | SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC | $4,904.26 | $60,465.08 |
| 876 | O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF MENTAL ILLNESS | $26,911.08 | $26,911.08 |
| 880 | ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION | $11,434.09 | $14,127.60 |
| 881 | DEPRESSIVE NEUROSES | $5,500.55 | $20,846.66 |
| 882 | NEUROSES EXCEPT DEPRESSIVE | $10,545.32 | $10,545.32 |
| 883 | DISORDERS OF PERSONALITY & IMPULSE CONTROL | $16,668.13 | $16,668.13 |
| 884 | ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY | $26,630.09 | $88,564.29 |
| 885 | PSYCHOSES | $2,115.43 | $135,439.05 |
| 886 | BEHAVIORAL & DEVELOPMENTAL DISORDERS | $16,199.76 | $42,458.34 |
| 894 | ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA | $6,181.23 | $6,181.23 |
| 896 | ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC | $13,498.91 | $41,171.79 |
| 897 | ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC | $8,091.49 | $30,097.20 |
| 901 | WOUND DEBRIDEMENTS FOR INJURIES W MCC | $88,131.86 | $88,131.86 |
| 902 | WOUND DEBRIDEMENTS FOR INJURIES W CC | $14,090.80 | $26,632.10 |
| 907 | OTHER O.R. PROCEDURES FOR INJURIES W MCC | $33,369.11 | $142,379.91 |
| 908 | OTHER O.R. PROCEDURES FOR INJURIES W CC | $17,835.44 | $33,013.00 |
| 917 | POISONING & TOXIC EFFECTS OF DRUGS W MCC | $10,954.09 | $81,803.12 |
| 918 | POISONING & TOXIC EFFECTS OF DRUGS W/O MCC | $6,657.65 | $22,686.76 |
| 919 | COMPLICATIONS OF TREATMENT W MCC | $22,575.81 | $105,192.57 |
| 920 | COMPLICATIONS OF TREATMENT W CC | $12,712.96 | $22,656.29 |
| 922 | OTHER INJURY, POISONING & TOXIC EFFECT DIAG W MCC | $18,732.27 | $18,732.27 |
| 934 | FULL THICKNESS BURN W/O SKIN GRAFT OR INHAL INJ | $56,623.72 | $56,623.72 |
| 935 | NON-EXTENSIVE BURNS | $11,947.35 | $11,947.35 |
| 947 | SIGNS & SYMPTOMS W MCC | $16,100.57 | $48,944.21 |
| 948 | SIGNS & SYMPTOMS W/O MCC | $6,788.97 | $66,673.50 |
| 951 | OTHER FACTORS INFLUENCING HEALTH STATUS | $1,676.06 | $1,676.06 |
| 956 | LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA | $36,531.84 | $74,206.69 |
| 963 | OTHER MULTIPLE SIGNIFICANT TRAUMA W MCC | $21,733.69 | $32,048.77 |
| 964 | OTHER MULTIPLE SIGNIFICANT TRAUMA W CC | $46,287.42 | $46,287.42 |
| 974 | HIV W MAJOR RELATED CONDITION W MCC | $56,524.13 | $56,524.13 |
| 981 | EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC | $19,492.30 | $239,775.46 |
| 982 | EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC | $22,786.62 | $72,035.91 |
| 983 | EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC | $40,821.22 | $40,821.22 |
| 987 | NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC | $71,737.59 | $224,316.47 |
| 988 | NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC | $13,050.95 | $35,718.94 |