Final Cost Outlier Thresholds Effective January 1, 2013
Also available as an Excel Spreadsheet XLS, 34KB
| APR-DRG | APR-DRG Description | Product Line | 2013 Cost Outlier Thresholds |
|---|---|---|---|
| 001 | Liver Transplant | Transplant Surgery | $1,124,797 |
| 002 | Heart &/or Lung Transplant | Transplant Surgery | $1,697,184 |
| 003 | Bone Marrow Transplant | Transplant Surgery | $774,489 |
| 004 | Tracheostomy W Long Term Mechanical Ventilation W Extensive Procedure | General Surgery | $1,036,343 |
| 005 | Tracheostomy W Long Term Mechanical Ventilation W/O Extensive Procedure | General Surgery | $695,051 |
| 006 | Pancreas Transplant | Transplant Surgery | $181,096 |
| 020 | Craniotomy for Trauma | Trauma | $160,434 |
| 021 | Craniotomy Except for Trauma | Neurological Surgery | $200,194 |
| 022 | Ventricular Shunt Procedures | Neurological Surgery | $269,127 |
| 023 | Spinal Procedures | Neurological Surgery | $156,428 |
| 024 | Extracranial Vascular Procedures | Neurological Surgery | $134,647 |
| 026 | Other Nervous System & Related Procedures | Neurological Surgery | $115,909 |
| 040 | Spinal Disorders & Injuries | Neurology | $71,163 |
| 041 | Nervous System Malignancy | Oncology | $89,093 |
| 042 | Degenerative Nervous System Disorders Exc Mult Sclerosis | Neurology | $51,421 |
| 043 | Multiple Sclerosis & Other Demyelinating Diseases | Neurology | $44,022 |
| 044 | Intracranial Hemorrhage | Neurology | $126,889 |
| 045 | CVA & Precerebral Occulusion w/ Infarct | Neurology | $65,140 |
| 046 | Nonspecific CVA & Precerebral Occlusion w/o Infarct | Neurology | $48,251 |
| 047 | Transient Ischemia | Neurology | $23,970 |
| 048 | Peripheral, Cranial & Autonomic Nerve Disorders | Neurology | $38,212 |
| 049 | Bacterial & Tuberculous Infections of Nervous System | Infectious Disease | $176,338 |
| 050 | Non-bacterial Infections of Nervous System Exc Viral Meningitis | Infectious Disease | $84,686 |
| 051 | Viral Meningitis | Infectious Disease | $40,223 |
| 052 | Nontraumatic Stupor & Coma | Neurology | $40,840 |
| 053 | Seizure | Neurology | $33,640 |
| 054 | Migraine & Other Headaches | Neurology | $25,103 |
| 055 | Head Trauma w/ Coma > 1 Hr or Hemorrhage | Trauma | $58,575 |
| 056 | Brain Contusion/Laceration & Compliated Skull FX, COMA < 1 HR OR No Coma | Neurology | $42,211 |
| 057 | Concussion, Closed Skull FX Nos, Uncomplicated Intracranial Injury, Coma <1 Hr or No Coma | Neurology | $21,395 |
| 058 | Other Disorders of Nervous System | Neurology | $40,762 |
| 070 | Orbital Procedures | Ophthalmology Surgery | $54,481 |
| 073 | Eye Procedures Except Orbit | Ophthalmology Surgery | $42,462 |
| 080 | Acute Major Eye Infections | Ophthalmology | $30,756 |
| 082 | Eye Disorders Except Major Infections | Ophthalmology | $30,559 |
| 089 | Major Cranial/Facial Bone Procedures | ENT Surgery | $113,197 |
| 090 | Major Larynx & Trachea Procedures | ENT Surgery | $187,534 |
| 091 | Other Major Head & Neck Procedures | ENT Surgery | $215,560 |
| 092 | Facial Bone Procedures Except Major Cranial/Facial Bone Procedures | ENT Surgery | $62,617 |
| 093 | Sinus & Mastoid Procedures | ENT Surgery | $57,226 |
| 095 | Cleft Lip & Palate Repair | ENT Surgery | $34,652 |
| 097 | Tonsill & Adenoid Procedures | ENT Surgery | $28,289 |
| 098 | Other Ear, Nose, Mouth & Throat Procedures | ENT Surgery | $48,554 |
| 110 | Ear, Nose, Mouth Throat, Cranial/Facial Malignancies | Oncology | $90,100 |
| 111 | Vertigo & Other Labyrinth Disorders | Otolaryngology | $22,658 |
| 113 | Infections Of The Upper Respiratory Tract | Otolaryngology | $24,183 |
| 114 | Dental & Oral Diseases & Injuries | Dental | $34,432 |
| 115 | Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses | Otolaryngology | $30,973 |
| 120 | Major Respiratory & Chest Procedures | General Surgery | $115,395 |
| 121 | Other Respiratory & Chest Procedures | General Surgery | $104,951 |
| 130 | Respiratory System Diagnosis w/ Ventilator Support 96+ Hours | Pulmonary | $261,151 |
| 131 | Cystic Fibrosis - Pulmonary Disease | Pulmonary | $132,416 |
| 132 | BPD & Oth Chronic Respiratory Dis Arising In Perinatal Period | Neonatology | $81,557 |
| 133 | Pulmonary Edema & Respiratory Failure | Pulmonary | $82,040 |
| 134 | Pulmonary Embolism | Pulmonary | $57,012 |
| 135 | Major Chest & Respiratory Trauma | Trauma | $39,835 |
| 136 | Respiratory Malignancy | Oncology | $84,941 |
| 137 | Major Respiratory Infections & Inflammations | Pulmonary | $85,596 |
| 138 | Bronchiolitis & RSV Pneumonia | Pulmonary | $31,534 |
| 139 | Other Pneumonia | Pulmonary | $37,058 |
| 140 | Chronic Obstructive Pulmonary Disease | Pulmonary | $37,309 |
| 141 | Asthma | Pulmonary | $27,233 |
| 142 | Interstitial Lung Disease | Pulmonary | $62,048 |
| 143 | Other Respiratory Diagnosis Except Signs, Symptoms & Minor Diagnoses | Pulmonary | $51,443 |
| 144 | Respiratory System Signs, Symptoms & Other Diagnoses | Pulmonary | $27,787 |
| 160 | Major Cardiothoracic Repair of Heart Anomaly | Open Heart Surgery | $263,693 |
| 161 | Cardiac Defibrillator & Heart Assist Anomaly | Open Heart Surgery | $278,850 |
| 162 | Cardiac Valve Procedures w/ Cardiac Catheterization | Open Heart Surgery | $233,149 |
| 163 | Cardiac Valve Procedures w/o Cardiac Catheterization | Open Heart Surgery | $198,883 |
| 165 | Coronary Bypass w/ Cardiac Cath Or Percutaneous Cardiac Procedure | Open Heart Surgery | $167,413 |
| 166 | Coronary Bypass w/o Cardiac Cath Or Percutaneous Cardiac Procedure | Open Heart Surgery | $141,179 |
| 167 | Other Cardiothoracic Procedures | Cardiovascular Surgery | $164,922 |
| 169 | Major Thoracic & Abdominal Vascular Procedures | Cardiovascular Surgery | $206,814 |
| 170 | Permanent Cardiac Pacemaker Implant w/ AMI, Heart Failure or Shock | Cardiovascular Surgery | $160,896 |
| 171 | Perm Cardiac Pacemaker Implant w/o AMI, Heart Failure or Shock | Cardiovascular Surgery | $92,627 |
| 173 | Other Vascular Procedures | Cardiovascular Surgery | $139,709 |
| 174 | Percutaneous Cardiovascular Procedures w/ AMI | Cardiovascular Surgery | $102,075 |
| 175 | Percutaneous Cardiovascular Procedures w/o AMI | Cardiovascular Surgery | $72,133 |
| 176 | Cardiac Pacemaker & Defibrillator Device Replacement | Cardiovascular Surgery | $162,250 |
| 177 | Cardiac Pacemaker & Defibrillator Revision Except Device Replacement | Cardiovascular Surgery | $163,605 |
| 180 | Other Circulatory System Procedures | Cardiovascular Surgery | $155,043 |
| 190 | Acute Myocardial Infarction | Cardiology | $73,180 |
| 191 | Cardiac Catheterization w/ Circ Disord Exc Ischemic Heart Disease | Cardiac Catheter | $81,744 |
| 192 | Cardiac Catheterization for Ischemic Heart Disease | Cardiac Catheter | $38,339 |
| 193 | Acute & Subacute Endocarditis | Cardiology | $141,104 |
| 194 | Heart Failure | Cardiology | $55,651 |
| 196 | Cardiac Arrest | Cardiology | $56,931 |
| 197 | Peripheral & Other Vascular Disorders | Cardiology | $49,095 |
| 198 | Angina Pectoris & Coronary Atherosclerosis | Cardiology | $24,124 |
| 199 | Hypertension | Cardiology | $26,357 |
| 200 | Cardiac Congenital & Valvular Disorders | Cardiology | $53,926 |
| 201 | Cardiac Arrhythmia & Conduction Disorders | Cardiology | $30,101 |
| 203 | Chest Pain | Cardiology | $19,518 |
| 204 | Syncope & Collapse | Cardiology | $24,955 |
| 205 | Cardiomyopathy | Cardiology | $41,545 |
| 206 | Malfunction, Reaction & Comp of Cardiac or Vasc Device or Proc | Cardiology | $71,804 |
| 207 | Other Circulatory System Diagnoses | Cardiology | $40,896 |
| 220 | Major Stomach, Esophageal & Duodenal Procedures | General Surgery | $144,099 |
| 221 | Major Small & Large Bowel Procedures | General Surgery | $100,270 |
| 222 | Minor Stomach, Esophageal & Duodenal Procedures | General Surgery | $49,095 |
| 223 | Minor Small & Large Bowel Procedures | General Surgery | $76,334 |
| 224 | Peritoneal Adhesiolysis | General Surgery | $79,143 |
| 225 | Appendectomy | General Surgery | $31,709 |
| 226 | Anal Procedures | General Surgery | $33,335 |
| 227 | Hernia Procedures Except Inguinal, Femoral & Umbilical | General Surgery | $55,240 |
| 228 | Inguinal, Femoral & Umbilical Hernia Procedures | General Surgery | $36,984 |
| 229 | Other Digestive System & Abdominal Procedures | General Surgery | $107,145 |
| 240 | Digestive Malignancy | Oncology | $95,993 |
| 241 | Peptic Ulcer & Gastritis | Gastroenterology | $35,309 |
| 242 | Major Esophageal Disorders | Gastroenterology | $56,731 |
| 243 | Other Esophageal Disorders | Gastroenterology | $29,394 |
| 244 | Diverticulitis & Diverticulosis | Gastroenterology | $26,340 |
| 245 | Inflammatory Bowel Disease | Gastroenterology | $43,863 |
| 246 | Gastrointestinal Vascular Insufficiency | Gastroenterology | $35,809 |
| 247 | Intestinal Obstruction | Gastroenterology | $28,739 |
| 248 | Major Gastrointestinal & Peritoneal Infections | Gastroenterology | $52,848 |
| 249 | Non-Bacterial Gastroenteritis, Nausea & Vomiting | Gastroenterology | $23,503 |
| 251 | Abdominal Pain | Gastroenterology | $23,887 |
| 252 | Malfunction, Reaction & Complication Of G.I. Device Or Procedure | Gastroenterology | $52,821 |
| 253 | Other & Unspecified Gastrointestinal Hemorrhage | Gastroenterology | $46,674 |
| 254 | Other Digestive System Diagnoses | Gastroenterology | $33,078 |
| 260 | Major Pancreas, Liver & Shunt Procedures | General Surgery | $162,432 |
| 261 | Major Biliary Tract Procedures | General Surgery | $136,527 |
| 262 | Cholecystectomy Except Laparoscopic | General Surgery | $82,147 |
| 263 | Laparoscopic Cholecystectomy | General Surgery | $43,675 |
| 264 | Other Hepatobiliary, Pancreas & Abdominal Procedures | General Surgery | $166,207 |
| 279 | Hepatic Coma & Other Major Acute Liver Disorders | Gastroenterology | $91,647 |
| 280 | Alcoholic Liver Disease | Gastroenterology | $72,155 |
| 281 | Malignancy of Hepatobiliary System & Pancreas | Oncology | $83,405 |
| 282 | Disorders of Pancreas Except Malignancy | Gastroenterology | $38,306 |
| 283 | Other Disorders Of The Liver | Gastroenterology | $56,403 |
| 284 | Disorders of the Gallbladder & Biliary Tract | Gastroenterology | $41,035 |
| 301 | Hip Joint Replacement | Orthopedic Surgery | $76,311 |
| 302 | Knee Joint Replacement | Orthopedic Surgery | $76,744 |
| 303 | Dorsal & Lumbar Fusion Proc for Curvature of Back | Orthopedic Surgery | $240,067 |
| 304 | Dorsal & Lumbar Fusion Proc Except for Curvature of Back | Orthopedic Surgery | $154,659 |
| 305 | Amputation of Lower Limb Except Toes | Orthopedic Surgery | $164,840 |
| 308 | Hip & Femur Procedures for Trauma Except Joint Replacement | Trauma | $86,785 |
| 309 | Hip & Femur Procedures for Non-Trauma Except Joint Replacement | Orthopedic Surgery | $96,707 |
| 310 | Intervertebral Disc Excision & Decompression | Orthopedic Surgery | $42,366 |
| 312 | Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses | Orthopedic Surgery | $181,118 |
| 313 | Knee & Lower Leg Procedures Except Foot | Orthopedic Surgery | $70,332 |
| 314 | Foot & Toe Procedures | Orthopedic Surgery | $81,740 |
| 315 | Shoulder, Upper Arm & Forearm Procedures | Orthopedic Surgery | $58,724 |
| 316 | Hand & Wrist Procedures | Orthopedic Surgery | $41,681 |
| 317 | Tendon, Muscle & Other Soft Tissue Procedures | Orthopedic Surgery | $51,233 |
| 320 | Other Musculoskeletel System & Connective Tissue Procedures | Orthopedic Surgery | $79,950 |
| 321 | Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp | Orthopedic Surgery | $78,566 |
| 340 | Fractures of Femur | Orthopedics | $37,813 |
| 341 | Fracture of Pelvis or Dislocation of Hip | Orthopedics | $36,383 |
| 342 | Fracture or Dislocation Except Femur, Pelvis & Back | Orthopedics | $30,478 |
| 343 | Musculoskeletal Malignancy & Pathol Fractures D/T Muscskel Malig | Oncology | $108,523 |
| 344 | Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections | Infectious Disease | $85,391 |
| 346 | Connective Tissue Disorders | Orthopedics | $64,010 |
| 347 | Other Back & Neck Disorders, Fractures & Injuries | Orthopedics | $34,055 |
| 349 | Malfunction, Reaction & Comp of Orthopedic Device or Procedure | Orthopedics | $58,842 |
| 351 | Other Musculoskeletal System & Connective Tissue Diagnoses | Rheumatology | $32,978 |
| 361 | Skin Graft for Skin & Subcutaneous Tissue Diagnoses | General Surgery | $96,998 |
| 362 | Mastectomy Procedures | General Surgery | $77,694 |
| 363 | Breast Procedures Except Mastectomy | General Surgery | $52,444 |
| 364 | Other Skin, Subcutaneous Tissue & Related Procedures | General Surgery | $50,592 |
| 380 | Skin Ulcers | Dermatology | $55,380 |
| 381 | Major Skin Disorders | Dermatology | $55,001 |
| 382 | Malignant Breast Disorders | Oncology | $81,411 |
| 383 | Cellulitis & Other Bacterial Skin Infections | Infectious Disease | $32,123 |
| 384 | Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue | Dermatology | $25,012 |
| 385 | Other Skin, Subcutaneous Tissue & Breast Disorders | Dermatology | $31,663 |
| 401 | Pituitary & Adrenal Procedures | General Surgery | $106,149 |
| 403 | Procedures for Obesity | General Surgery | $55,621 |
| 404 | Thyroid, Parathyroid & Thyroglossal Procedures | General Surgery | $26,087 |
| 405 | Other Procedures for Endocrine, Nutrititional & Metabolic Disorders | General Surgery | $178,401 |
| 420 | Diabetes | Endocrinology | $32,589 |
| 421 | Malnutrition, Failure To Thrive & Other Nutritional Disorders | Endocrinology | $73,888 |
| 422 | Hypovolemia & Related Electrolyte Disorders | Endocrinology | $30,597 |
| 423 | Inborn Errors of Metabolism | Endocrinology | $72,840 |
| 424 | Other Endocrine Disorders | Endocrinology | $40,322 |
| 425 | Electrolyte Disorders Except Hypovolemia Related | Endocrinology | $38,765 |
| 440 | Kidney Transplant | Transplant Surgery | $184,092 |
| 441 | Major Bladder Procedures | Urologic/Nephrologic Surgery | $147,121 |
| 442 | Kidney & Urinary Tract Procedures for Malignancy | Urologic/Nephrologic Surgery | $79,430 |
| 443 | Kidney & Urinary Tract Procedures for Nonmalignancy | Urologic/Nephrologic Surgery | $65,241 |
| 444 | Renal Dialysis Access Device Procedure Only | Urologic/Nephrologic Surgery | $147,566 |
| 445 | Other Bladder Procedures | Urologic/Nephrologic Surgery | $63,700 |
| 446 | Urethral & Transurethral Procedures | Urologic/Nephrologic Surgery | $29,350 |
| 447 | Other Kidney, Urinary Tract & Related Procedures | Urologic/Nephrologic Surgery | $104,933 |
| 460 | Renal Failure | Urology/Nephrology | $61,609 |
| 461 | Kidney & Urinary Tract Malignancy | Oncology | $69,819 |
| 462 | Nephritis & Nephrosis | Urology/Nephrology | $53,242 |
| 463 | Kidney & Urinary Tract Infections | Urology/Nephrology | $32,390 |
| 465 | Urinary Stones & Acquired Upper Urinary Tract Obstruction | Urology/Nephrology | $26,759 |
| 466 | Malfunction, Reaction & Complic of Genitourinary Device Or Proc | Urology/Nephrology | $72,190 |
| 468 | Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms | Urology/Nephrology | $44,175 |
| 480 | Major Male Pelvic Procedures | Urologic/Nephrologic Surgery | $36,886 |
| 481 | Penis Procedures | Urologic/Nephrologic Surgery | $65,768 |
| 482 | Transurethral Prostatectomy | Urologic/Nephrologic Surgery | $25,328 |
| 483 | Testes & Scrotal Procedures | Urologic/Nephrologic Surgery | $28,250 |
| 484 | Other Male Reproductive System & Related Procedures | Urologic/Nephrologic Surgery | $62,806 |
| 500 | Malignancy, Male Reproductive System | Oncology | $78,743 |
| 501 | Male Reproductive System Diagnoses Except Malignancy | Urology/Nephrology | $28,874 |
| 510 | Pelvic Evisceration, Radical Hysterectectomy & Radical GYN Procs | Gynecology Surgery | $84,811 |
| 511 | Uterine & Adnexa Procedures for Ovarian & Adnexal Malignancy | Gynecology Surgery | $80,844 |
| 512 | Uterine & Adnexa Procedures for Non-ovarian & Non-adnexal Malig | Gynecology Surgery | $52,420 |
| 513 | Uterine & Adnexa Procedures for Non-Malignancy Except Leiomyoma | Gynecology Surgery | $34,149 |
| 514 | Female Reproductive System Reconstructive Procedures | Gynecology Surgery | $35,571 |
| 517 | Dilation & Curettage For Non-Obstetric Procedures | Gynecology Surgery | $29,638 |
| 518 | Other Female Reproductive System & Related Procedures | Gynecology Surgery | $41,463 |
| 519 | Uterine & Adnexa Procedures For Leiomyoma | Gynecology Surgery | $34,535 |
| 530 | Female Reproductive System Malignancy | Oncology | $67,179 |
| 531 | Female Reproductive System Infections | Gynecology | $30,184 |
| 532 | Menstrual & Other Female Reproductive System Disorders | Gynecology | $21,693 |
| 540 | Cesarean Delivery | Obstetrics/Delivery | $30,061 |
| 541 | Vaginal Delivery w/ Sterilization &/or D&C | Obstetrics/Delivery | $26,708 |
| 542 | Vaginal Delivery w/ Complicating Procedures Exc Sterilization &/or D&C | Obstetrics/Delivery | $21,418 |
| 544 | D&C, Aspiration Curettage or Hysterotomy For Obstetric Diagnoses | Other Obstetrics | $23,447 |
| 545 | Ectopic Pregnancy Procedure | Gynecology Surgery | $30,613 |
| 546 | Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses | Other Obstetrics | $36,057 |
| 560 | Vaginal Delivery | Obstetrics/Delivery | $19,988 |
| 561 | Postpartum & Post Abortion Diagnoses w/o Procedure | Other Obstetrics | $20,099 |
| 563 | Threatened Abortion | Other Obstetrics | $20,280 |
| 564 | Abortion w/o D&C, Aspiration Curettage or Hysterotomy | Other Obstetrics | $18,409 |
| 565 | False Labor | Other Obstetrics | $10,366 |
| 566 | Other Antepartum Diagnoses | Other Obstetrics | $20,516 |
| 580 | Neonate, Transferred <5 Days Old, Not Born Here | Neonatology | $42,889 |
| 581 | Neonate, Transferred <5 Days Old, Born Here | Neonatology | $8,563 |
| 583 | Neonate, w/ ECMO | Neonatology | $1,156,666 |
| 588 | Neonate BWT <1500G W Major Procedure | Neonatology | $1,662,283 |
| 589 | Neonate BWT < 500G | Neonatology | $22,076 |
| 591 | Neonate, Birthwt 500-749G w/o Major Procedure | Neonatology | $1,594,593 |
| 593 | Neonate, Birthwt 750-999G w/o Major Procedure | Neonatology | $930,843 |
| 602 | Neonate, Birthwt 1000-1249G w/ Resp Dist Synd/Oth Maj Resp Or Maj Anom | Neonatology | $691,294 |
| 603 | Neonate, Birthwt 1000-1249G W OR W/O Other Significant Condition | Neonatology | $431,147 |
| 607 | Neonate, BWT 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom | Neonatology | $471,667 |
| 608 | Neonate, Birthwt 1250-1499G W OR W/O Other Significant Condition | Neonatology | $408,170 |
| 609 | Neonate, BWT 1500-2499G W Major Procedure | Neonatology | $1,040,778 |
| 611 | Neonate, Birthwt 1500-1999G W Major Anomaly | Neonatology | $390,076 |
| 612 | Neonate, BWT 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond | Neonatology | $275,789 |
| 613 | Neonate, Birthwt 1500-1999G W Congenital/Perinatal Infection | Neonatology | $188,659 |
| 614 | Neonate, Birthwt 1500-1999G W OR W/O Other Significant Condition | Neonatology | $194,977 |
| 621 | Neonate, BWT 2000-2499G W Major Anomaly | Neonatology | $176,294 |
| 622 | Neonate, BWT 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond | Neonatology | $143,295 |
| 623 | Neonate, Birthwt 2000-2499G W Congenital/Perinatal Infection | Neonatology | $104,476 |
| 625 | Neonate, Birthwt 2000-2499G W Other Significant Condition | Neonatology | $121,487 |
| 626 | Neonate, BWT 2000-2499G, Normal Newborn Or Neonate W Other Problem | Neonatology | $20,942 |
| 630 | Neonate, Birthwt > 2499g w/ Major Cardiovasc Procedure | Neonatology | $694,073 |
| 631 | Neonate, Birthwt > 2499g w/ Other Major Procedure | Neonatology | $391,656 |
| 633 | Neonate, Birthwt > 2499g w/ Major Anomaly | Neonatology | $46,986 |
| 634 | Neonate, Birthwt > 2499g W Resp Dist Synd/Oth Maj Resp Cond | Neonatology | $84,522 |
| 636 | Neonate, Birthwt > 2499g W Congenital/Perinatal Infection | Neonatology | $62,176 |
| 639 | Neonate, Birthwt > 2499g W Other Significant Condition | Neonatology | $45,914 |
| 640 | Neonate, Bwt > 2499g, Normal Newborn Or Neonate W Other Problem | Neonatology | $8,250 |
| 650 | Splenectomy | General Surgery | $100,360 |
| 651 | Other Procedures of Blood & Blood Forming Organs | General Surgery | $72,635 |
| 660 | Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul | Hematology | $72,517 |
| 661 | Coagulation & Platelet Disorders | Hematology | $73,555 |
| 662 | Sickle Cell Anemia Crisis | Hematology | $55,449 |
| 663 | Other Anemia & Disorders Of Blood & Blood Forming Organs | Hematology | $33,429 |
| 680 | Major O.R. Procedures For Lymphatic/Hematopietic/Other Neoplasms | General Surgery | $236,866 |
| 681 | Other O.R. Procedures For Lymphatic/Hematopietic/Other Neoplasms | General Surgery | $151,492 |
| 690 | Acute Leukemia | Oncology | $489,639 |
| 691 | Lymphoma & Non-acute Leukemia | Oncology | $179,420 |
| 692 | Radiotherapy | Oncology | $47,314 |
| 693 | Chemotherapy | Oncology | $64,780 |
| 694 | Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior | Oncology | $78,209 |
| 710 | Infectious & Parasitic Diseases Including HIV W O.R. Procedure | General Surgery | $285,815 |
| 711 | Post-Op,Post-Trauma, Other Device Infections W O.R. Procedure | General Surgery | $133,544 |
| 720 | Septicemia & Disseminated Infections | Infectious Disease | $111,569 |
| 721 | Post-Operative, Post-Traumatic, Other Device Infections | General Medicine | $66,452 |
| 722 | Fever | General Medicine | $31,676 |
| 723 | Viral Illness | Infectious Disease | $28,949 |
| 724 | Other Infectious & Parasitic Diseases | Infectious Disease | $55,345 |
| 740 | Mental Illness Diagnosis W O.R. Procedure | General Surgery | $124,733 |
| 750 | Schizophrenia | Mental Health | $40,980 |
| 751 | Major Depressive Disorders & Other/Unspecified Psychoses | Mental Health | $28,123 |
| 752 | Disorders of Personality & Impulse Control | Mental Health | $23,562 |
| 753 | Bipolar Disorders | Mental Health | $27,560 |
| 754 | Depression Except Major Depressive Disorder | Mental Health | $19,435 |
| 755 | Adjustment Disorders & Neuroses Except Depressive Diagnoses | Mental Health | $16,950 |
| 756 | Acute Anxiety & Delirium States | Mental Health | $18,313 |
| 757 | Organic Mental Health Disturbances | Mental Health | $41,643 |
| 758 | Childhood Behavioral Disorders | Mental Health | $9,333 |
| 759 | Eating Disorders | Mental Health | $27,439 |
| 760 | Other Mental Health Disorders | Mental Health | $17,750 |
| 770 | Drug & Alcohol Abuse or Dependence, Left Against Medical Advice | Substance Abuse | $14,772 |
| 772 | Alcohol & Drug Dependence w/ Rehab/Detox Therapy | Substance Abuse | $47,312 |
| 773 | Opioid Abuse & Dependence | Substance Abuse | $27,411 |
| 774 | Cocaine Abuse & Dependence | Substance Abuse | $21,454 |
| 775 | Alcohol Abuse & Dependence | Substance Abuse | $31,589 |
| 776 | Other Drug Abuse & Dependence | Substance Abuse | $29,873 |
| 791 | O.R. Procedure For Other Complications Of Treatment | General Surgery | $88,130 |
| 811 | Allergic Reactions | General Medicine | $16,893 |
| 812 | Poisoning Of Medicinal Agents | General Medicine | $31,314 |
| 813 | Other Complications of Treatment | General Medicine | $41,285 |
| 815 | Other Injury, Poisoning & Toxic Effect Diagnoses | General Medicine | $26,638 |
| 816 | Toxic Effects Of Non-Medicinal Substances | General Medicine | $37,838 |
| 841 | Extensive 3rd Degree Burns W Skin Graft | General Surgery | $966,458 |
| 842 | Full Thickness Burns W Skin Graft | General Surgery | $193,319 |
| 843 | Extensive 3rd Degree Or Full Thickness Burns W/O Skin Graft | General Medicine | $108,130 |
| 844 | Partial Thickness Burns W Or W/O Skin Graft | General Medicine | $85,449 |
| 850 | Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service | General Surgery | $89,261 |
| 860 | Rehabilitation | Rehabilitation | $77,774 |
| 861 | Signs, Symptoms & Other Factors Influencing Health Status | General Medicine | $32,254 |
| 862 | Other Aftercare & Convalescence | General Medicine | $55,769 |
| 863 | Neonatal Aftercare | Neonatology | $106,852 |
| 890 | HIV W Multiple Major HIV Related Conditions | HIV | $211,281 |
| 892 | HIV W Major HIV Related Condition | HIV | $77,367 |
| 893 | HIV W Multiple Significant HIV Related Conditions | HIV | $55,694 |
| 894 | HIV W One Signif HIV Cond Or W/O Signif Related Cond | HIV | $42,130 |
| 910 | Craniotomy For Multiple Significant Trauma | Trauma | $234,086 |
| 911 | Extensive Abdominal/Thoraic Procedures For Mult Significant Trauma | Trauma | $310,814 |
| 912 | Musculoskeletal & Other Procedures For Multiple Significant Trauma | Trauma | $295,913 |
| 930 | Multiple Significant Trauma W/O O.R. Procedure | Trauma | $96,568 |
| 950 | Extensive Procedure Unrelated To Principal Diagnosis | General Surgery | $231,074 |
| 951 | Moderately Extensive Procedure Unrelated To Principal Diagnosis | General Surgery | $135,085 |
| 952 | Nonextensive Procedure Unrelated To Principal Diagnosis | General Surgery | $82,707 |
