Final Cost Outlier Thresholds Effective December 1, 2009
Also available as an Excel Spreadsheet (XLS)
| APR–DRG | APR–DRG Description | 2009 Cost Outlier Thresholds |
|---|---|---|
| 001 | Liver Transplant | $ 632,417 |
| 002 | Heart &/or Lung Transplant | $ 1,328,568 |
| 003 | Bone Marrow Transplant | $ 531,628 |
| 004 | Tracheostomy W Long Term Mechanical Ventilation W Extensive Procedure | $ 965,288 |
| 005 | Tracheostomy W Long Term Mechanical Ventilation W/O Extensive Procedure | $ 649,358 |
| 006 | Pancreas Transplant | $ 325,730 |
| 020 | Craniotomy for Trauma | $ 164,112 |
| 021 | Craniotomy Except for Trauma | $ 181,388 |
| 022 | Ventricular Shunt Procedures | $ 95,683 |
| 023 | Spinal Procedures | $ 120,713 |
| 024 | Extracranial Vascular Procedures | $ 90,435 |
| 026 | Other Nervous System & Related Procedures | $ 102,040 |
| 040 | Spinal Disorders & Injuries | $ 72,211 |
| 041 | Nervous System Malignancy | $ 76,357 |
| 042 | Degenerative Nervous System Disorders Exc Mult Sclerosis | $ 67,799 |
| 043 | Multiple Sclerosis & Other Demyelinating Diseases | $ 42,221 |
| 044 | Intracranial Hemorrhage | $ 103,759 |
| 045 | CVA & Precerebral Occulusion w/ Infarct | $ 55,435 |
| 046 | Nonspecific CVA & Precerebral Occlusion w/o Infarct | $ 42,630 |
| 047 | Transient Ischemia | $ 23,797 |
| 048 | Peripheral, Cranial & Autonomic Nerve Disorders | $ 40,095 |
| 049 | Bacterial & Tuberculous Infections of Nervous System | $ 126,954 |
| 050 | Non-bacterial Infections of Nervous System Exc Viral Meningitis | $ 99,215 |
| 051 | Viral Meningitis | $ 31,949 |
| 052 | Nontraumatic Stupor & Coma | $ 48,171 |
| 053 | Seizure | $ 31,048 |
| 054 | Migraine & Other Headaches | $ 24,485 |
| 055 | Head Trauma w/ Coma > 1 Hr or Hemorrhage | $ 54,351 |
| 056 | Brain Contusion/Laceration & Compliated Skull FX, COMA < 1 HR OR No Coma | $ 46,345 |
| 057 | Concussion, Closed Skull FX Nos, Uncomplicated Intracranial Injury, Coma <1 Hr or No Coma | $ 20,296 |
| 058 | Other Disorders of Nervous System | $ 39,041 |
| 070 | Orbital Procedures | $ 46,429 |
| 073 | Eye Procedures Except Orbit | $ 36,133 |
| 080 | Acute Major Eye Infections | $ 28,610 |
| 082 | Eye Disorders Except Major Infections | $ 28,515 |
| 089 | Major Cranial/Facial Bone Procedures | $ 103,812 |
| 090 | Major Larynx & Trachea Procedures | $ 159,811 |
| 091 | Other Major Head & Neck Procedures | $ 184,507 |
| 092 | Facial Bone Procedures Except Major Cranial/Facial Bone Procedures | $ 51,207 |
| 093 | Sinus & Mastoid Procedures | $ 45,034 |
| 095 | Cleft Lip & Palate Repair | $ 34,657 |
| 097 | Tonsill & Adenoid Procedures | $ 28,234 |
| 098 | Other Ear, Nose, Mouth & Throat Procedures | $ 37,361 |
| 110 | Ear, Nose, Mouth Throat, Cranial/Facial Malignancies | $ 73,550 |
| 111 | Vertigo & Other Labyrinth Disorders | $ 21,525 |
| 113 | Infections Of The Upper Respiratory Tract | $ 19,824 |
| 114 | Dental & Oral Diseases & Injuries | $ 30,574 |
| 115 | Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses | $ 26,755 |
| 120 | Major Respiratory & Chest Procedures | $ 111,067 |
| 121 | Other Respiratory & Chest Procedures | $ 95,174 |
| 130 | Respiratory System Diagnosis w/ Ventilator Support 96+ Hours | $ 243,053 |
| 131 | Cystic Fibrosis - Pulmonary Disease | $ 92,839 |
| 132 | BPD & Oth Chronic Respiratory Dis Arising In Perinatal Period | $ 89,709 |
| 133 | Pulmonary Edema & Respiratory Failure | $ 78,887 |
| 134 | Pulmonary Embolism | $ 51,842 |
| 135 | Major Chest & Respiratory Trauma | $ 37,685 |
| 136 | Respiratory Malignancy | $ 84,922 |
| 137 | Major Respiratory Infections & Inflammations | $ 79,872 |
| 138 | Bronchiolitis & RSV Pneumonia | $ 25,704 |
| 139 | Other Pneumonia | $ 32,873 |
| 140 | Chronic Obstructive Pulmonary Disease | $ 34,154 |
| 141 | Asthma | $ 23,474 |
| 142 | Interstitial Lung Disease | $ 56,614 |
| 143 | Other Respiratory Diagnosis Except Signs, Symptoms & Minor Diagnoses | $ 45,725 |
| 144 | Respiratory System Signs, Symptoms & Other Diagnoses | $ 25,740 |
| 160 | Major Cardiothoracic Repair of Heart Anomaly | $ 270,150 |
| 161 | Cardiac Defibrillator & Heart Assist Anomaly | $ 238,407 |
| 162 | Cardiac Valve Procedures w/ Cardiac Catheterization | $ 266,063 |
| 163 | Cardiac Valve Procedures w/o Cardiac Catheterization | $ 176,411 |
| 165 | Coronary Bypass w/ Cardiac Cath Or Percutaneous Cardiac Procedure | $ 180,517 |
| 166 | Coronary Bypass w/o Cardiac Cath Or Percutaneous Cardiac Procedure | $ 133,055 |
| 167 | Other Cardiothoracic Procedures | $ 163,863 |
| 169 | Major Thoracic & Abdominal Vascular Procedures | $ 180,372 |
| 170 | Permanent Cardiac Pacemaker Implant w/ AMI, Heart Failure or Shock | $ 174,349 |
| 171 | Perm Cardiac Pacemaker Implant w/o AMI, Heart Failure or Shock | $ 91,012 |
| 173 | Other Vascular Procedures | $ 117,406 |
| 174 | Percutaneous Cardiovascular Procedures w/ AMI | $ 85,886 |
| 175 | Percutaneous Cardiovascular Procedures w/o AMI | $ 62,795 |
| 176 | Cardiac Pacemaker & Defibrillator Device Replacement | $ 145,243 |
| 177 | Cardiac Pacemaker & Defibrillator Revision Except Device Replacement | $ 109,839 |
| 180 | Other Circulatory System Procedures | $ 143,747 |
| 190 | Acute Myocardial Infarction | $ 62,189 |
| 191 | Cardiac Catheterization w/ Circ Disord Exc Ischemic Heart Disease | $ 63,184 |
| 192 | Cardiac Catheterization for Ischemic Heart Disease | $ 33,064 |
| 193 | Acute & Subacute Endocarditis | $ 131,145 |
| 194 | Heart Failure | $ 45,833 |
| 196 | Cardiac Arrest | $ 69,077 |
| 197 | Peripheral & Other Vascular Disorders | $ 45,486 |
| 198 | Angina Pectoris & Coronary Atherosclerosis | $ 20,584 |
| 199 | Hypertension | $ 23,750 |
| 200 | Cardiac Congenital & Valvular Disorders | $ 43,152 |
| 201 | Cardiac Arrhythmia & Conduction Disorders | $ 26,444 |
| 203 | Chest Pain | $ 16,243 |
| 204 | Syncope & Collapse | $ 23,198 |
| 205 | Cardiomyopathy | $ 33,763 |
| 206 | Malfunction, Reaction & Comp of Cardiac or Vasc Device or Proc | $ 83,814 |
| 207 | Other Circulatory System Diagnoses | $ 36,459 |
| 220 | Major Stomach, Esophageal & Duodenal Procedures | $ 139,311 |
| 221 | Major Small & Large Bowel Procedures | $ 87,113 |
| 222 | Minor Stomach, Esophageal & Duodenal Procedures | $ 37,985 |
| 223 | Minor Small & Large Bowel Procedures | $ 61,759 |
| 224 | Peritoneal Adhesiolysis | $ 67,875 |
| 225 | Appendectomy | $ 28,500 |
| 226 | Anal Procedures | $ 28,415 |
| 227 | Hernia Procedures Except Inguinal, Femoral & Umbilical | $ 44,118 |
| 228 | Inguinal, Femoral & Umbilical Hernia Procedures | $ 29,930 |
| 229 | Other Digestive System & Abdominal Procedures | $ 93,949 |
| 240 | Digestive Malignancy | $ 78,562 |
| 241 | Peptic Ulcer & Gastritis | $ 32,054 |
| 242 | Major Esophageal Disorders | $ 47,974 |
| 243 | Other Esophageal Disorders | $ 25,735 |
| 244 | Diverticulitis & Diverticulosis | $ 24,716 |
| 245 | Inflammatory Bowel Disease | $ 41,673 |
| 246 | Gastrointestinal Vascular Insufficiency | $ 35,537 |
| 247 | Intestinal Obstruction | $ 27,451 |
| 248 | Major Gastrointestinal & Peritoneal Infections | $ 47,875 |
| 249 | Non-Bacterial Gastroenteritis, Nausea & Vomiting | $ 19,937 |
| 251 | Abdominal Pain | $ 20,970 |
| 252 | Malfunction, Reaction & Complication Of G.I. Device Or Procedure | $ 46,786 |
| 253 | Other & Unspecified Gastrointestinal Hemorrhage | $ 43,178 |
| 254 | Other Digestive System Diagnoses | $ 30,427 |
| 260 | Major Pancreas, Liver & Shunt Procedures | $ 155,997 |
| 261 | Major Biliary Tract Procedures | $ 123,946 |
| 262 | Cholecystectomy Except Laparoscopic | $ 67,556 |
| 263 | Laparoscopic Cholecystectomy | $ 40,184 |
| 264 | Other Hepatobiliary, Pancreas & Abdominal Procedures | $ 138,160 |
| 279 | Hepatic Coma & Other Major Acute Liver Disorders | $ 72,230 |
| 280 | Alcoholic Liver Disease | $ 68,779 |
| 281 | Malignancy of Hepatobiliary System & Pancreas | $ 71,024 |
| 282 | Disorders of Pancreas Except Malignancy | $ 35,933 |
| 283 | Other Disorders Of The Liver | $ 51,508 |
| 284 | Disorders of the Gallbladder & Biliary Tract | $ 39,286 |
| 301 | Hip Joint Replacement | $ 65,799 |
| 302 | Knee Joint Replacement | $ 61,532 |
| 303 | Dorsal & Lumbar Fusion Proc for Curvature of Back | $ 210,600 |
| 304 | Dorsal & Lumbar Fusion Proc Except for Curvature of Back | $ 148,526 |
| 305 | Amputation of Lower Limb Except Toes | $ 159,903 |
| 308 | Hip & Femur Procedures for Trauma Except Joint Replacement | $ 72,819 |
| 309 | Hip & Femur Procedures for Non-Trauma Except Joint Replacement | $ 77,944 |
| 310 | Intervertebral Disc Excision & Decompression | $ 35,260 |
| 312 | Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses | $ 190,600 |
| 313 | Knee & Lower Leg Procedures Except Foot | $ 54,541 |
| 314 | Foot & Toe Procedures | $ 68,279 |
| 315 | Shoulder, Upper Arm & Forearm Procedures | $ 47,153 |
| 316 | Hand & Wrist Procedures | $ 31,669 |
| 317 | Tendon, Muscle & Other Soft Tissue Procedures | $ 47,614 |
| 320 | Other Musculoskeletel System & Connective Tissue Procedures | $ 76,348 |
| 321 | Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp | $ 66,129 |
| 340 | Fractures of Femur | $ 44,693 |
| 341 | Fracture of Pelvis or Dislocation of Hip | $ 36,852 |
| 342 | Fracture or Dislocation Except Femur, Pelvis & Back | $ 24,417 |
| 343 | Musculoskeletal Malignancy & Pathol Fractures D/T Muscskel Malig | $ 104,066 |
| 344 | Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections | $ 79,002 |
| 346 | Connective Tissue Disorders | $ 57,593 |
| 347 | Other Back & Neck Disorders, Fractures & Injuries | $ 30,329 |
| 349 | Malfunction, Reaction & Comp of Orthopedic Device or Procedure | $ 53,457 |
| 351 | Other Musculoskeletal System & Connective Tissue Diagnoses | $ 30,848 |
| 361 | Skin Graft for Skin & Subcutaneous Tissue Diagnoses | $ 81,686 |
| 362 | Mastectomy Procedures | $ 62,823 |
| 363 | Breast Procedures Except Mastectomy | $ 42,171 |
| 364 | Other Skin, Subcutaneous Tissue & Related Procedures | $ 49,079 |
| 380 | Skin Ulcers | $ 49,330 |
| 381 | Major Skin Disorders | $ 45,976 |
| 382 | Malignant Breast Disorders | $ 61,360 |
| 383 | Cellulitis & Other Bacterial Skin Infections | $ 29,279 |
| 384 | Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue | $ 21,878 |
| 385 | Other Skin, Subcutaneous Tissue & Breast Disorders | $ 28,214 |
| 401 | Pituitary & Adrenal Procedures | $ 73,925 |
| 403 | Procedures for Obesity | $ 39,053 |
| 404 | Thyroid, Parathyroid & Thyroglossal Procedures | $ 25,521 |
| 405 | Other Procedures for Endocrine, Nutrititional & Metabolic Disorders | $ 163,409 |
| 420 | Diabetes | $ 29,772 |
| 421 | Malnutrition, Failure To Thrive & Other Nutritional Disorders | $ 56,254 |
| 422 | Hypovolemia & Related Electrolyte Disorders | $ 28,052 |
| 423 | Inborn Errors of Metabolism | $ 51,648 |
| 424 | Other Endocrine Disorders | $ 37,211 |
| 425 | Electrolyte Disorders Except Hypovolemia Related | $ 34,544 |
| 440 | Kidney Transplant | $ 313,242 |
| 441 | Major Bladder Procedures | $ 124,443 |
| 442 | Kidney & Urinary Tract Procedures for Malignancy | $ 59,855 |
| 443 | Kidney & Urinary Tract Procedures for Nonmalignancy | $ 61,205 |
| 444 | Renal Dialysis Access Device Procedure Only | $ 119,850 |
| 445 | Other Bladder Procedures | $ 51,919 |
| 446 | Urethral & Transurethral Procedures | $ 29,257 |
| 447 | Other Kidney, Urinary Tract & Related Procedures | $ 103,333 |
| 460 | Renal Failure | $ 62,686 |
| 461 | Kidney & Urinary Tract Malignancy | $ 70,653 |
| 462 | Nephritis & Nephrosis | $ 41,825 |
| 463 | Kidney & Urinary Tract Infections | $ 28,608 |
| 465 | Urinary Stones & Acquired Upper Urinary Tract Obstruction | $ 23,172 |
| 466 | Malfunction, Reaction & Complic of Genitourinary Device Or Proc | $ 62,665 |
| 468 | Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms | $ 37,806 |
| 480 | Major Male Pelvic Procedures | $ 40,983 |
| 481 | Penis Procedures | $ 58,138 |
| 482 | Transurethral Prostatectomy | $ 26,302 |
| 483 | Testes & Scrotal Procedures | $ 29,318 |
| 484 | Other Male Reproductive System & Related Procedures | $ 69,585 |
| 500 | Malignancy, Male Reproductive System | $ 67,508 |
| 501 | Male Reproductive System Diagnoses Except Malignancy | $ 28,213 |
| 510 | Pelvic Evisceration, Radical Hysterectectomy & Radical GYN Procs | $ 57,674 |
| 511 | Uterine & Adnexa Procedures for Ovarian & Adnexal Malignancy | $ 76,630 |
| 512 | Uterine & Adnexa Procedures for Non-ovarian & Non-adnexal Malig | $ 41,521 |
| 513 | Uterine & Adnexa Procedures for Non-Malignancy Except Leiomyoma | $ 27,241 |
| 514 | Female Reproductive System Reconstructive Procedures | $ 25,454 |
| 517 | Dilation & Curettage For Non-Obstetric Procedures | $ 25,931 |
| 518 | Other Female Reproductive System & Related Procedures | $ 35,512 |
| 519 | Uterine & Adnexa Procedures For Leiomyoma | $ 30,112 |
| 530 | Female Reproductive System Malignancy | $ 71,738 |
| 531 | Female Reproductive System Infections | $ 25,936 |
| 532 | Menstrual & Other Female Reproductive System Disorders | $ 23,556 |
| 540 | Cesarean Delivery | $ 26,613 |
| 541 | Vaginal Delivery w/ Sterilization &/or D&C | $ 23,722 |
| 542 | Vaginal Delivery w/ Complicating Procedures Exc Sterilization &/or D&C | $ 18,206 |
| 544 | D&C, Aspiration Curettage or Hysterotomy For Obstetric Diagnoses | $ 20,065 |
| 545 | Ectopic Pregnancy Procedure | $ 26,481 |
| 546 | Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses | $ 30,101 |
| 560 | Vaginal Delivery | $ 16,387 |
| 561 | Postpartum & Post Abortion Diagnoses w/o Procedure | $ 23,430 |
| 563 | Threatened Abortion | $ 18,955 |
| 564 | Abortion w/o D&C, Aspiration Curettage or Hysterotomy | $ 15,869 |
| 565 | False Labor | $ 8,099 |
| 566 | Other Antepartum Diagnoses | $ 21,557 |
| 580 | Neonate, Transferred <5 Days Old, Not Born Here | $ 37,407 |
| 581 | Neonate, Transferred <5 Days Old, Born Here | $ 7,269 |
| 583 | Neonate, w/ ECMO | $ 1,812,166 |
| 588 | Neonate BWT <1500G W Major Procedure | $ 1,365,643 |
| 589 | Neonate BWT < 500G | $ 17,645 |
| 591 | Neonate, Birthwt 500-749G w/o Major Procedure | $ 1,202,483 |
| 593 | Neonate, Birthwt 750-999G w/o Major Procedure | $ 643,591 |
| 602 | Neonate, Birthwt 1000-1249G w/ Resp Dist Synd/Oth Maj Resp Or Maj Anom | $ 467,269 |
| 603 | Neonate, Birthwt 1000-1249G W OR W/O Other Significant Condition | $ 380,905 |
| 607 | Neonate, BWT 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom | $ 350,137 |
| 608 | Neonate, Birthwt 1250-1499G W OR W/O Other Significant Condition | $ 204,074 |
| 609 | Neonate, BWT 1500-2499G W Major Procedure | $ 549,565 |
| 611 | Neonate, Birthwt 1500-1999G W Major Anomaly | $ 261,139 |
| 612 | Neonate, BWT 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond | $ 228,389 |
| 613 | Neonate, Birthwt 1500-1999G W Congenital/Perinatal Infection | $ 176,654 |
| 614 | Neonate, Birthwt 1500-1999G W OR W/O Other Significant Condition | $ 123,799 |
| 621 | Neonate, BWT 2000-2499G W Major Anomaly | $ 154,340 |
| 622 | Neonate, BWT 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond | $ 108,530 |
| 623 | Neonate, Birthwt 2000-2499G W Congenital/Perinatal Infection | $ 91,827 |
| 625 | Neonate, Birthwt 2000-2499G W Other Significant Condition | $ 102,563 |
| 626 | Neonate, BWT 2000-2499G, Normal Newborn Or Neonate W Other Problem | $ 37,043 |
| 630 | Neonate, Birthwt > 2499g w/ Major Cardiovasc Procedure | $ 417,996 |
| 631 | Neonate, Birthwt > 2499g w/ Other Major Procedure | $ 520,799 |
| 633 | Neonate, Birthwt > 2499g w/ Major Anomaly | $ 52,864 |
| 634 | Neonate, Birthwt > 2499g W Resp Dist Synd/Oth Maj Resp Cond | $ 76,755 |
| 636 | Neonate, Birthwt > 2499g W Congenital/Perinatal Infection | $ 51,248 |
| 639 | Neonate, Birthwt > 2499g W Other Significant Condition | $ 38,908 |
| 640 | Neonate, Bwt > 2499g, Normal Newborn Or Neonate W Other Problem | $ 6,835 |
| 650 | Splenectomy | $ 76,562 |
| 651 | Other Procedures of Blood & Blood Forming Organs | $ 64,011 |
| 660 | Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul | $ 65,791 |
| 661 | Coagulation & Platelet Disorders | $ 67,194 |
| 662 | Sickle Cell Anemia Crisis | $ 48,262 |
| 663 | Other Anemia & Disorders Of Blood & Blood Forming Organs | $ 33,178 |
| 680 | Major O.R. Procedures For Lymphatic/Hematopietic/Other Neoplasms | $ 180,596 |
| 681 | Other O.R. Procedures For Lymphatic/Hematopietic/Other Neoplasms | $ 96,573 |
| 690 | Acute Leukemia | $ 449,551 |
| 691 | Lymphoma & Non-acute Leukemia | $ 130,970 |
| 692 | Radiotherapy | $ 55,851 |
| 693 | Chemotherapy | $ 52,347 |
| 694 | Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior | $ 78,355 |
| 710 | Infectious & Parasitic Diseases Including HIV W O.R. Procedure | $ 293,318 |
| 711 | Post-Op,Post-Trauma, Other Device Infections W O.R. Procedure | $ 115,396 |
| 720 | Septicemia & Disseminated Infections | $ 105,463 |
| 721 | Post-Operative, Post-Traumatic, Other Device Infections | $ 47,266 |
| 722 | Fever | $ 26,738 |
| 723 | Viral Illness | $ 23,249 |
| 724 | Other Infectious & Parasitic Diseases | $ 50,565 |
| 740 | Mental Illness Diagnosis W O.R. Procedure | $ 127,079 |
| 750 | Schizophrenia | $ 38,518 |
| 751 | Major Depressive Disorders & Other/Unspecified Psychoses | $ 52,044 |
| 752 | Disorders of Personality & Impulse Control | $ 7,567 |
| 753 | Bipolar Disorders | $ 21,720 |
| 754 | Depression Except Major Depressive Disorder | $ 12,561 |
| 755 | Adjustment Disorders & Neuroses Except Depressive Diagnoses | $ 14,262 |
| 756 | Acute Anxiety & Delirium States | $ 19,250 |
| 757 | Organic Mental Health Disturbances | $ 55,407 |
| 758 | Childhood Behavioral Disorders | $ 21,778 |
| 759 | Eating Disorders | $ 80,589 |
| 760 | Other Mental Health Disorders | $ 30,769 |
| 770 | Drug & Alcohol Abuse or Dependence, Left Against Medical Advice | $ 17,247 |
| 772 | Alcohol & Drug Dependence w/ Rehab/Detox Therapy | $ 33,014 |
| 773 | Opioid Abuse & Dependence | $ 30,541 |
| 774 | Cocaine Abuse & Dependence | $ 31,363 |
| 775 | Alcohol Abuse & Dependence | $ 28,419 |
| 776 | Other Drug Abuse & Dependence | $ 35,151 |
| 791 | O.R. Procedure For Other Complications Of Treatment | $ 71,659 |
| 811 | Allergic Reactions | $ 16,328 |
| 812 | Poisoning Of Medicinal Agents | $ 26,303 |
| 813 | Other Complications of Treatment | $ 34,142 |
| 815 | Other Injury, Poisoning & Toxic Effect Diagnoses | $ 28,341 |
| 816 | Toxic Effects Of Non-Medicinal Substances | $ 30,189 |
| 841 | Extensive 3rd Degree Burns W Skin Graft | $ 1,216,922 |
| 842 | Full Thickness Burns W Skin Graft | $ 232,033 |
| 843 | Extensive 3rd Degree Or Full Thickness Burns W/O Skin Graft | $ 96,967 |
| 844 | Partial Thickness Burns W Or W/O Skin Graft | $ 97,005 |
| 850 | Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service | $ 76,084 |
| 860 | Rehabilitation | $ 65,810 |
| 861 | Signs, Symptoms & Other Factors Influencing Health Status | $ 29,809 |
| 862 | Other Aftercare & Convalescence | $ 67,325 |
| 863 | Neonatal Aftercare | $ 123,793 |
| 890 | HIV W Multiple Major HIV Related Conditions | $ 213,372 |
| 892 | HIV W Major HIV Related Condition | $ 85,989 |
| 893 | HIV W Multiple Significant HIV Related Conditions | $ 73,871 |
| 894 | HIV W One Signif HIV Cond Or W/O Signif Related Cond | $ 43,109 |
| 910 | Craniotomy For Multiple Significant Trauma | $ 231,236 |
| 911 | Extensive Abdominal/Thoraic Procedures For Mult Significant Trauma | $ 290,996 |
| 912 | Musculoskeletal & Other Procedures For Multiple Significant Trauma | $ 285,639 |
| 930 | Multiple Significant Trauma W/O O.R. Procedure | $ 72,064 |
| 950 | Extensive Procedure Unrelated To Principal Diagnosis | $ 209,195 |
| 951 | Moderately Extensive Procedure Unrelated To Principal Diagnosis | $ 112,237 |
| 952 | Nonextensive Procedure Unrelated To Principal Diagnosis | $ 67,746 |
