Final Cost Outlier Thresholds Effective January 1, 2010 - December 31, 2010
Also available as an Excel Spreadsheet
| APR–DRG | APR–DRG Description | 2010 High Cost Outlier Thresholds Effective 1/1/10 |
|---|---|---|
| 001 | Liver Transplant | $ 643,168 |
| 002 | Heart &/or Lung Transplant | $ 1,351,154 |
| 003 | Bone Marrow Transplant | $ 540,666 |
| 004 | Tracheostomy W Long Term Mechanical Ventilation W Extensive Procedure | $ 981,698 |
| 005 | Tracheostomy W Long Term Mechanical Ventilation W/O Extensive Procedure | $ 660,397 |
| 006 | Pancreas Transplant | $ 331,267 |
| 020 | Craniotomy for Trauma | $ 166,902 |
| 021 | Craniotomy Except for Trauma | $ 184,472 |
| 022 | Ventricular Shunt Procedures | $ 97,310 |
| 023 | Spinal Procedures | $ 122,765 |
| 024 | Extracranial Vascular Procedures | $ 91,972 |
| 026 | Other Nervous System & Related Procedures | $ 103,775 |
| 040 | Spinal Disorders & Injuries | $ 73,439 |
| 041 | Nervous System Malignancy | $ 77,655 |
| 042 | Degenerative Nervous System Disorders Exc Mult Sclerosis | $ 68,952 |
| 043 | Multiple Sclerosis & Other Demyelinating Diseases | $ 42,939 |
| 044 | Intracranial Hemorrhage | $ 105,523 |
| 045 | CVA & Precerebral Occulusion w/ Infarct | $ 56,377 |
| 046 | Nonspecific CVA & Precerebral Occlusion w/o Infarct | $ 43,355 |
| 047 | Transient Ischemia | $ 24,202 |
| 048 | Peripheral, Cranial & Autonomic Nerve Disorders | $ 40,777 |
| 049 | Bacterial & Tuberculous Infections of Nervous System | $ 129,112 |
| 050 | Non-bacterial Infections of Nervous System Exc Viral Meningitis | $ 100,902 |
| 051 | Viral Meningitis | $ 32,492 |
| 052 | Nontraumatic Stupor & Coma | $ 48,990 |
| 053 | Seizure | $ 31,576 |
| 054 | Migraine & Other Headaches | $ 24,901 |
| 055 | Head Trauma w/ Coma > 1 Hr or Hemorrhage | $ 55,275 |
| 056 | Brain Contusion/Laceration & Compliated Skull FX, COMA < 1 HR OR No Coma | $ 47,133 |
| 057 | Concussion, Closed Skull FX Nos, Uncomplicated Intracranial Injury, Coma <1 Hr or No Coma | $ 20,641 |
| 058 | Other Disorders of Nervous System | $ 39,705 |
| 070 | Orbital Procedures | $ 47,218 |
| 073 | Eye Procedures Except Orbit | $ 36,747 |
| 080 | Acute Major Eye Infections | $ 29,096 |
| 082 | Eye Disorders Except Major Infections | $ 29,000 |
| 089 | Major Cranial/Facial Bone Procedures | $ 105,577 |
| 090 | Major Larynx & Trachea Procedures | $ 162,528 |
| 091 | Other Major Head & Neck Procedures | $ 187,644 |
| 092 | Facial Bone Procedures Except Major Cranial/Facial Bone Procedures | $ 52,078 |
| 093 | Sinus & Mastoid Procedures | $ 45,800 |
| 095 | Cleft Lip & Palate Repair | $ 35,246 |
| 097 | Tonsill & Adenoid Procedures | $ 28,714 |
| 098 | Other Ear, Nose, Mouth & Throat Procedures | $ 37,996 |
| 110 | Ear, Nose, Mouth Throat, Cranial/Facial Malignancies | $ 74,800 |
| 111 | Vertigo & Other Labyrinth Disorders | $ 21,891 |
| 113 | Infections Of The Upper Respiratory Tract | $ 20,161 |
| 114 | Dental & Oral Diseases & Injuries | $ 31,094 |
| 115 | Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses | $ 27,210 |
| 120 | Major Respiratory & Chest Procedures | $ 112,955 |
| 121 | Other Respiratory & Chest Procedures | $ 96,792 |
| 130 | Respiratory System Diagnosis w/ Ventilator Support 96+ Hours | $ 247,185 |
| 131 | Cystic Fibrosis - Pulmonary Disease | $ 94,417 |
| 132 | BPD & Oth Chronic Respiratory Dis Arising In Perinatal Period | $ 91,234 |
| 133 | Pulmonary Edema & Respiratory Failure | $ 80,228 |
| 134 | Pulmonary Embolism | $ 52,723 |
| 135 | Major Chest & Respiratory Trauma | $ 38,326 |
| 136 | Respiratory Malignancy | $ 86,366 |
| 137 | Major Respiratory Infections & Inflammations | $ 81,230 |
| 138 | Bronchiolitis & RSV Pneumonia | $ 26,141 |
| 139 | Other Pneumonia | $ 33,432 |
| 140 | Chronic Obstructive Pulmonary Disease | $ 34,735 |
| 141 | Asthma | $ 23,873 |
| 142 | Interstitial Lung Disease | $ 57,576 |
| 143 | Other Respiratory Diagnosis Except Signs, Symptoms & Minor Diagnoses | $ 46,502 |
| 144 | Respiratory System Signs, Symptoms & Other Diagnoses | $ 26,178 |
| 160 | Major Cardiothoracic Repair of Heart Anomaly | $ 274,743 |
| 161 | Cardiac Defibrillator & Heart Assist Anomaly | $ 242,460 |
| 162 | Cardiac Valve Procedures w/ Cardiac Catheterization | $ 270,586 |
| 163 | Cardiac Valve Procedures w/o Cardiac Catheterization | $ 179,410 |
| 165 | Coronary Bypass w/ Cardiac Cath Or Percutaneous Cardiac Procedure | $ 183,586 |
| 166 | Coronary Bypass w/o Cardiac Cath Or Percutaneous Cardiac Procedure | $ 135,317 |
| 167 | Other Cardiothoracic Procedures | $ 166,649 |
| 169 | Major Thoracic & Abdominal Vascular Procedures | $ 183,438 |
| 170 | Permanent Cardiac Pacemaker Implant w/ AMI, Heart Failure or Shock | $ 177,313 |
| 171 | Perm Cardiac Pacemaker Implant w/o AMI, Heart Failure or Shock | $ 92,559 |
| 173 | Other Vascular Procedures | $ 119,402 |
| 174 | Percutaneous Cardiovascular Procedures w/ AMI | $ 87,346 |
| 175 | Percutaneous Cardiovascular Procedures w/o AMI | $ 63,863 |
| 176 | Cardiac Pacemaker & Defibrillator Device Replacement | $ 147,712 |
| 177 | Cardiac Pacemaker & Defibrillator Revision Except Device Replacement | $ 111,706 |
| 180 | Other Circulatory System Procedures | $ 146,191 |
| 190 | Acute Myocardial Infarction | $ 63,246 |
| 191 | Cardiac Catheterization w/ Circ Disord Exc Ischemic Heart Disease | $ 64,258 |
| 192 | Cardiac Catheterization for Ischemic Heart Disease | $ 33,626 |
| 193 | Acute & Subacute Endocarditis | $ 133,374 |
| 194 | Heart Failure | $ 46,612 |
| 196 | Cardiac Arrest | $ 70,251 |
| 197 | Peripheral & Other Vascular Disorders | $ 46,259 |
| 198 | Angina Pectoris & Coronary Atherosclerosis | $ 20,934 |
| 199 | Hypertension | $ 24,154 |
| 200 | Cardiac Congenital & Valvular Disorders | $ 43,886 |
| 201 | Cardiac Arrhythmia & Conduction Disorders | $ 26,894 |
| 203 | Chest Pain | $ 16,519 |
| 204 | Syncope & Collapse | $ 23,592 |
| 205 | Cardiomyopathy | $ 34,337 |
| 206 | Malfunction, Reaction & Comp of Cardiac or Vasc Device or Proc | $ 85,239 |
| 207 | Other Circulatory System Diagnoses | $ 37,079 |
| 220 | Major Stomach, Esophageal & Duodenal Procedures | $ 141,679 |
| 221 | Major Small & Large Bowel Procedures | $ 88,594 |
| 222 | Minor Stomach, Esophageal & Duodenal Procedures | $ 38,631 |
| 223 | Minor Small & Large Bowel Procedures | $ 62,809 |
| 224 | Peritoneal Adhesiolysis | $ 69,029 |
| 225 | Appendectomy | $ 28,985 |
| 226 | Anal Procedures | $ 28,898 |
| 227 | Hernia Procedures Except Inguinal, Femoral & Umbilical | $ 44,868 |
| 228 | Inguinal, Femoral & Umbilical Hernia Procedures | $ 30,439 |
| 229 | Other Digestive System & Abdominal Procedures | $ 95,546 |
| 240 | Digestive Malignancy | $ 79,898 |
| 241 | Peptic Ulcer & Gastritis | $ 32,599 |
| 242 | Major Esophageal Disorders | $ 48,790 |
| 243 | Other Esophageal Disorders | $ 26,172 |
| 244 | Diverticulitis & Diverticulosis | $ 25,136 |
| 245 | Inflammatory Bowel Disease | $ 42,381 |
| 246 | Gastrointestinal Vascular Insufficiency | $ 36,141 |
| 247 | Intestinal Obstruction | $ 27,918 |
| 248 | Major Gastrointestinal & Peritoneal Infections | $ 48,689 |
| 249 | Non-Bacterial Gastroenteritis, Nausea & Vomiting | $ 20,276 |
| 251 | Abdominal Pain | $ 21,326 |
| 252 | Malfunction, Reaction & Complication Of G.I. Device Or Procedure | $ 47,581 |
| 253 | Other & Unspecified Gastrointestinal Hemorrhage | $ 43,912 |
| 254 | Other Digestive System Diagnoses | $ 30,944 |
| 260 | Major Pancreas, Liver & Shunt Procedures | $ 158,649 |
| 261 | Major Biliary Tract Procedures | $ 126,053 |
| 262 | Cholecystectomy Except Laparoscopic | $ 68,704 |
| 263 | Laparoscopic Cholecystectomy | $ 40,867 |
| 264 | Other Hepatobiliary, Pancreas & Abdominal Procedures | $ 140,509 |
| 279 | Hepatic Coma & Other Major Acute Liver Disorders | $ 73,458 |
| 280 | Alcoholic Liver Disease | $ 69,948 |
| 281 | Malignancy of Hepatobiliary System & Pancreas | $ 72,231 |
| 282 | Disorders of Pancreas Except Malignancy | $ 36,544 |
| 283 | Other Disorders Of The Liver | $ 52,384 |
| 284 | Disorders of the Gallbladder & Biliary Tract | $ 39,954 |
| 301 | Hip Joint Replacement | $ 66,918 |
| 302 | Knee Joint Replacement | $ 62,578 |
| 303 | Dorsal & Lumbar Fusion Proc for Curvature of Back | $ 214,180 |
| 304 | Dorsal & Lumbar Fusion Proc Except for Curvature of Back | $ 151,051 |
| 305 | Amputation of Lower Limb Except Toes | $ 162,621 |
| 308 | Hip & Femur Procedures for Trauma Except Joint Replacement | $ 74,057 |
| 309 | Hip & Femur Procedures for Non-Trauma Except Joint Replacement | $ 79,269 |
| 310 | Intervertebral Disc Excision & Decompression | $ 35,859 |
| 312 | Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses | $ 193,840 |
| 313 | Knee & Lower Leg Procedures Except Foot | $ 55,468 |
| 314 | Foot & Toe Procedures | $ 69,440 |
| 315 | Shoulder, Upper Arm & Forearm Procedures | $ 47,955 |
| 316 | Hand & Wrist Procedures | $ 32,207 |
| 317 | Tendon, Muscle & Other Soft Tissue Procedures | $ 48,423 |
| 320 | Other Musculoskeletel System & Connective Tissue Procedures | $ 77,646 |
| 321 | Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp | $ 67,253 |
| 340 | Fractures of Femur | $ 45,453 |
| 341 | Fracture of Pelvis or Dislocation of Hip | $ 37,478 |
| 342 | Fracture or Dislocation Except Femur, Pelvis & Back | $ 24,832 |
| 343 | Musculoskeletal Malignancy & Pathol Fractures D/T Muscskel Malig | $ 105,835 |
| 344 | Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections | $ 80,345 |
| 346 | Connective Tissue Disorders | $ 58,572 |
| 347 | Other Back & Neck Disorders, Fractures & Injuries | $ 30,845 |
| 349 | Malfunction, Reaction & Comp of Orthopedic Device or Procedure | $ 54,366 |
| 351 | Other Musculoskeletal System & Connective Tissue Diagnoses | $ 31,372 |
| 361 | Skin Graft for Skin & Subcutaneous Tissue Diagnoses | $ 83,075 |
| 362 | Mastectomy Procedures | $ 63,891 |
| 363 | Breast Procedures Except Mastectomy | $ 42,888 |
| 364 | Other Skin, Subcutaneous Tissue & Related Procedures | $ 49,913 |
| 380 | Skin Ulcers | $ 50,169 |
| 381 | Major Skin Disorders | $ 46,758 |
| 382 | Malignant Breast Disorders | $ 62,403 |
| 383 | Cellulitis & Other Bacterial Skin Infections | $ 29,777 |
| 384 | Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue | $ 22,250 |
| 385 | Other Skin, Subcutaneous Tissue & Breast Disorders | $ 28,694 |
| 401 | Pituitary & Adrenal Procedures | $ 75,182 |
| 403 | Procedures for Obesity | $ 39,717 |
| 404 | Thyroid, Parathyroid & Thyroglossal Procedures | $ 25,955 |
| 405 | Other Procedures for Endocrine, Nutrititional & Metabolic Disorders | $ 166,187 |
| 420 | Diabetes | $ 30,278 |
| 421 | Malnutrition, Failure To Thrive & Other Nutritional Disorders | $ 57,210 |
| 422 | Hypovolemia & Related Electrolyte Disorders | $ 28,529 |
| 423 | Inborn Errors of Metabolism | $ 52,526 |
| 424 | Other Endocrine Disorders | $ 37,844 |
| 425 | Electrolyte Disorders Except Hypovolemia Related | $ 35,131 |
| 440 | Kidney Transplant | $ 318,567 |
| 441 | Major Bladder Procedures | $ 126,559 |
| 442 | Kidney & Urinary Tract Procedures for Malignancy | $ 60,873 |
| 443 | Kidney & Urinary Tract Procedures for Nonmalignancy | $ 62,245 |
| 444 | Renal Dialysis Access Device Procedure Only | $ 121,887 |
| 445 | Other Bladder Procedures | $ 52,802 |
| 446 | Urethral & Transurethral Procedures | $ 29,754 |
| 447 | Other Kidney, Urinary Tract & Related Procedures | $ 105,090 |
| 460 | Renal Failure | $ 63,752 |
| 461 | Kidney & Urinary Tract Malignancy | $ 71,854 |
| 462 | Nephritis & Nephrosis | $ 42,536 |
| 463 | Kidney & Urinary Tract Infections | $ 29,094 |
| 465 | Urinary Stones & Acquired Upper Urinary Tract Obstruction | $ 23,566 |
| 466 | Malfunction, Reaction & Complic of Genitourinary Device Or Proc | $ 63,730 |
| 468 | Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms | $ 38,449 |
| 480 | Major Male Pelvic Procedures | $ 41,680 |
| 481 | Penis Procedures | $ 59,126 |
| 482 | Transurethral Prostatectomy | $ 26,749 |
| 483 | Testes & Scrotal Procedures | $ 29,816 |
| 484 | Other Male Reproductive System & Related Procedures | $ 70,768 |
| 500 | Malignancy, Male Reproductive System | $ 68,656 |
| 501 | Male Reproductive System Diagnoses Except Malignancy | $ 28,693 |
| 510 | Pelvic Evisceration, Radical Hysterectectomy & Radical GYN Procs | $ 58,654 |
| 511 | Uterine & Adnexa Procedures for Ovarian & Adnexal Malignancy | $ 77,933 |
| 512 | Uterine & Adnexa Procedures for Non-ovarian & Non-adnexal Malig | $ 42,227 |
| 513 | Uterine & Adnexa Procedures for Non-Malignancy Except Leiomyoma | $ 27,704 |
| 514 | Female Reproductive System Reconstructive Procedures | $ 25,887 |
| 517 | Dilation & Curettage For Non-Obstetric Procedures | $ 26,372 |
| 518 | Other Female Reproductive System & Related Procedures | $ 36,116 |
| 519 | Uterine & Adnexa Procedures For Leiomyoma | $ 30,624 |
| 530 | Female Reproductive System Malignancy | $ 72,958 |
| 531 | Female Reproductive System Infections | $ 26,377 |
| 532 | Menstrual & Other Female Reproductive System Disorders | $ 23,956 |
| 540 | Cesarean Delivery | $ 27,065 |
| 541 | Vaginal Delivery w/ Sterilization &/or D&C | $ 24,125 |
| 542 | Vaginal Delivery w/ Complicating Procedures Exc Sterilization &/or D&C | $ 18,516 |
| 544 | D&C, Aspiration Curettage or Hysterotomy For Obstetric Diagnoses | $ 20,406 |
| 545 | Ectopic Pregnancy Procedure | $ 26,931 |
| 546 | Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses | $ 30,613 |
| 560 | Vaginal Delivery | $ 16,666 |
| 561 | Postpartum & Post Abortion Diagnoses w/o Procedure | $ 23,828 |
| 563 | Threatened Abortion | $ 19,277 |
| 564 | Abortion w/o D&C, Aspiration Curettage or Hysterotomy | $ 16,139 |
| 565 | False Labor | $ 8,237 |
| 566 | Other Antepartum Diagnoses | $ 21,923 |
| 580 | Neonate, Transferred <5 Days Old, Not Born Here | $ 38,043 |
| 581 | Neonate, Transferred <5 Days Old, Born Here | $ 7,393 |
| 583 | Neonate, w/ ECMO | $ 1,842,973 |
| 588 | Neonate BWT <1500G W Major Procedure | $ 1,388,859 |
| 589 | Neonate BWT < 500G | $ 17,945 |
| 591 | Neonate, Birthwt 500-749G w/o Major Procedure | $ 1,222,925 |
| 593 | Neonate, Birthwt 750-999G w/o Major Procedure | $ 654,532 |
| 602 | Neonate, Birthwt 1000-1249G w/ Resp Dist Synd/Oth Maj Resp Or Maj Anom | $ 475,213 |
| 603 | Neonate, Birthwt 1000-1249G W OR W/O Other Significant Condition | $ 387,380 |
| 607 | Neonate, BWT 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom | $ 356,089 |
| 608 | Neonate, Birthwt 1250-1499G W OR W/O Other Significant Condition | $ 207,543 |
| 609 | Neonate, BWT 1500-2499G W Major Procedure | $ 558,908 |
| 611 | Neonate, Birthwt 1500-1999G W Major Anomaly | $ 265,578 |
| 612 | Neonate, BWT 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond | $ 232,272 |
| 613 | Neonate, Birthwt 1500-1999G W Congenital/Perinatal Infection | $ 179,657 |
| 614 | Neonate, Birthwt 1500-1999G W OR W/O Other Significant Condition | $ 125,904 |
| 621 | Neonate, BWT 2000-2499G W Major Anomaly | $ 156,964 |
| 622 | Neonate, BWT 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond | $ 110,375 |
| 623 | Neonate, Birthwt 2000-2499G W Congenital/Perinatal Infection | $ 93,388 |
| 625 | Neonate, Birthwt 2000-2499G W Other Significant Condition | $ 104,307 |
| 626 | Neonate, BWT 2000-2499G, Normal Newborn Or Neonate W Other Problem | $ 37,673 |
| 630 | Neonate, Birthwt > 2499g w/ Major Cardiovasc Procedure | $ 425,102 |
| 631 | Neonate, Birthwt > 2499g w/ Other Major Procedure | $ 529,653 |
| 633 | Neonate, Birthwt > 2499g w/ Major Anomaly | $ 53,763 |
| 634 | Neonate, Birthwt > 2499g W Resp Dist Synd/Oth Maj Resp Cond | $ 78,060 |
| 636 | Neonate, Birthwt > 2499g W Congenital/Perinatal Infection | $ 52,119 |
| 639 | Neonate, Birthwt > 2499g W Other Significant Condition | $ 39,569 |
| 640 | Neonate, Bwt > 2499g, Normal Newborn Or Neonate W Other Problem | $ 6,951 |
| 650 | Splenectomy | $ 77,864 |
| 651 | Other Procedures of Blood & Blood Forming Organs | $ 65,099 |
| 660 | Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul | $ 66,909 |
| 661 | Coagulation & Platelet Disorders | $ 68,336 |
| 662 | Sickle Cell Anemia Crisis | $ 49,082 |
| 663 | Other Anemia & Disorders Of Blood & Blood Forming Organs | $ 33,742 |
| 680 | Major O.R. Procedures For Lymphatic/Hematopietic/Other Neoplasms | $ 183,666 |
| 681 | Other O.R. Procedures For Lymphatic/Hematopietic/Other Neoplasms | $ 98,215 |
| 690 | Acute Leukemia | $ 457,193 |
| 691 | Lymphoma & Non-acute Leukemia | $ 133,196 |
| 692 | Radiotherapy | $ 56,800 |
| 693 | Chemotherapy | $ 53,237 |
| 694 | Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior | $ 79,687 |
| 710 | Infectious & Parasitic Diseases Including HIV W O.R. Procedure | $ 298,304 |
| 711 | Post-Op,Post-Trauma, Other Device Infections W O.R. Procedure | $ 117,358 |
| 720 | Septicemia & Disseminated Infections | $ 107,256 |
| 721 | Post-Operative, Post-Traumatic, Other Device Infections | $ 48,070 |
| 722 | Fever | $ 27,193 |
| 723 | Viral Illness | $ 23,644 |
| 724 | Other Infectious & Parasitic Diseases | $ 51,425 |
| 740 | Mental Illness Diagnosis W O.R. Procedure | $ 129,239 |
| 750 | Schizophrenia | $ 39,173 |
| 751 | Major Depressive Disorders & Other/Unspecified Psychoses | $ 52,929 |
| 752 | Disorders of Personality & Impulse Control | $ 7,696 |
| 753 | Bipolar Disorders | $ 22,089 |
| 754 | Depression Except Major Depressive Disorder | $ 12,775 |
| 755 | Adjustment Disorders & Neuroses Except Depressive Diagnoses | $ 14,504 |
| 756 | Acute Anxiety & Delirium States | $ 19,577 |
| 757 | Organic Mental Health Disturbances | $ 56,349 |
| 758 | Childhood Behavioral Disorders | $ 22,148 |
| 759 | Eating Disorders | $ 81,959 |
| 760 | Other Mental Health Disorders | $ 31,292 |
| 770 | Drug & Alcohol Abuse or Dependence, Left Against Medical Advice | $ 17,540 |
| 772 | Alcohol & Drug Dependence w/ Rehab/Detox Therapy | $ 33,575 |
| 773 | Opioid Abuse & Dependence | $ 31,060 |
| 774 | Cocaine Abuse & Dependence | $ 31,896 |
| 775 | Alcohol Abuse & Dependence | $ 28,902 |
| 776 | Other Drug Abuse & Dependence | $ 35,749 |
| 791 | O.R. Procedure For Other Complications Of Treatment | $ 72,877 |
| 811 | Allergic Reactions | $ 16,606 |
| 812 | Poisoning Of Medicinal Agents | $ 26,750 |
| 813 | Other Complications of Treatment | $ 34,722 |
| 815 | Other Injury, Poisoning & Toxic Effect Diagnoses | $ 28,823 |
| 816 | Toxic Effects Of Non-Medicinal Substances | $ 30,702 |
| 841 | Extensive 3rd Degree Burns W Skin Graft | $ 1,237,610 |
| 842 | Full Thickness Burns W Skin Graft | $ 235,978 |
| 843 | Extensive 3rd Degree Or Full Thickness Burns W/O Skin Graft | $ 98,615 |
| 844 | Partial Thickness Burns W Or W/O Skin Graft | $ 98,654 |
| 850 | Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service | $ 77,377 |
| 860 | Rehabilitation | $ 66,929 |
| 861 | Signs, Symptoms & Other Factors Influencing Health Status | $ 30,316 |
| 862 | Other Aftercare & Convalescence | $ 68,470 |
| 863 | Neonatal Aftercare | $ 125,897 |
| 890 | HIV W Multiple Major HIV Related Conditions | $ 216,999 |
| 892 | HIV W Major HIV Related Condition | $ 87,451 |
| 893 | HIV W Multiple Significant HIV Related Conditions | $ 75,127 |
| 894 | HIV W One Signif HIV Cond Or W/O Signif Related Cond | $ 43,842 |
| 910 | Craniotomy For Multiple Significant Trauma | $ 235,167 |
| 911 | Extensive Abdominal/Thoraic Procedures For Mult Significant Trauma | $ 295,943 |
| 912 | Musculoskeletal & Other Procedures For Multiple Significant Trauma | $ 290,495 |
| 930 | Multiple Significant Trauma W/O O.R. Procedure | $ 73,289 |
| 950 | Extensive Procedure Unrelated To Principal Diagnosis | $ 212,751 |
| 951 | Moderately Extensive Procedure Unrelated To Principal Diagnosis | $ 114,145 |
| 952 | Nonextensive Procedure Unrelated To Principal Diagnosis | $ 68,898 |
