Version 3.19 - Inpatient Facility Charge Table,,,,,,,,
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Item Code,Code Type,Description,Charge Type Indicator,Standard Room and Board Per Diem,Standard Ancillary Charge Per Diem,ICU Room and Board Per Diem,ICU Ancillary Charge Per Diem,Start Date
001,DRG,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC,S,"$4,006.84 ","$26,973.29 ","$7,400.24 ","$26,973.29 ",20161001
002,DRG,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W/O MCC,S,"$3,338.92 ","$27,402.24 ","$6,227.78 ","$27,402.24 ",20161001
003,DRG,"ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R.",S,"$4,257.52 ","$16,408.50 ","$7,352.45 ","$16,408.50 ",20161001
004,DRG,"TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R.",S,"$3,856.32 ","$10,865.12 ","$6,490.02 ","$10,865.12 ",20161001
005,DRG,LIVER TRANSPLANT W MCC OR INTESTINAL TRANSPLANT,S,"$3,679.59 ","$26,691.26 ","$7,810.40 ","$26,691.26 ",20161001
006,DRG,LIVER TRANSPLANT W/O MCC,S,"$3,109.96 ","$32,821.55 ","$6,431.24 ","$32,821.55 ",20161001
007,DRG,LUNG TRANSPLANT,S,"$3,972.81 ","$31,070.59 ","$6,846.85 ","$31,070.59 ",20161001
008,DRG,SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT,S,"$3,280.66 ","$40,270.48 ","$6,477.75 ","$40,270.48 ",20161001
010,DRG,PANCREAS TRANSPLANT,S,"$3,423.08 ","$30,992.34 ","$6,190.85 ","$30,992.34 ",20161001
011,DRG,"TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W MCC",S,"$3,669.83 ","$12,356.03 ","$6,880.80 ","$12,356.03 ",20161001
012,DRG,"TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W CC",S,"$3,685.14 ","$13,441.51 ","$6,488.65 ","$13,441.51 ",20161001
013,DRG,"TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W/O CC/MCC",S,"$3,145.21 ","$12,055.36 ","$5,727.21 ","$12,055.36 ",20161001
014,DRG,ALLOGENEIC BONE MARROW TRANSPLANT,S,"$5,180.02 ","$14,240.60 ","$6,542.95 ","$14,240.60 ",20161001
016,DRG,AUTOLOGOUS BONE MARROW TRANSPLANT W CC/MCC,S,"$4,718.67 ","$9,569.93 ","$5,800.47 ","$9,569.93 ",20161001
017,DRG,AUTOLOGOUS BONE MARROW TRANSPLANT W/O CC/MCC,S,"$4,027.73 ","$8,947.85 ","$5,709.66 ","$8,947.85 ",20161001
020,DRG,INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W MCC,S,"$3,999.82 ","$20,372.65 ","$8,250.00 ","$20,372.65 ",20161001
021,DRG,INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W CC,S,"$3,811.18 ","$16,272.61 ","$7,513.68 ","$16,272.61 ",20161001
022,DRG,INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W/O CC/MCC,S,"$3,843.70 ","$20,093.68 ","$6,989.26 ","$20,093.68 ",20161001
023,DRG,CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W MCC OR CHEMO IMPLANT,S,"$3,520.98 ","$16,538.64 ","$7,315.92 ","$16,538.64 ",20161001
024,DRG,CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W/O MCC,S,"$4,137.72 ","$27,041.37 ","$8,035.19 ","$27,041.37 ",20161001
025,DRG,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCC,S,"$3,660.76 ","$16,281.76 ","$7,525.90 ","$16,281.76 ",20161001
026,DRG,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W CC,S,"$3,863.96 ","$19,886.37 ","$7,730.88 ","$19,886.37 ",20161001
027,DRG,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W/O CC/MCC,S,"$3,586.22 ","$31,981.62 ","$7,358.28 ","$31,981.62 ",20161001
028,DRG,SPINAL PROCEDURES W MCC,S,"$3,332.21 ","$15,861.34 ","$7,054.43 ","$15,861.34 ",20161001
029,DRG,SPINAL PROCEDURES W CC OR SPINAL NEUROSTIMULATORS,S,"$3,196.83 ","$17,463.80 ","$6,565.43 ","$17,463.80 ",20161001
030,DRG,SPINAL PROCEDURES W/O CC/MCC,S,"$3,138.49 ","$20,989.16 ","$6,472.34 ","$20,989.16 ",20161001
031,DRG,VENTRICULAR SHUNT PROCEDURES W MCC,S,"$3,635.32 ","$11,606.93 ","$6,799.96 ","$11,606.93 ",20161001
032,DRG,VENTRICULAR SHUNT PROCEDURES W CC,S,"$3,403.52 ","$15,707.26 ","$6,477.66 ","$15,707.26 ",20161001
033,DRG,VENTRICULAR SHUNT PROCEDURES W/O CC/MCC,S,"$3,068.62 ","$24,667.94 ","$5,882.72 ","$24,667.94 ",20161001
034,DRG,CAROTID ARTERY STENT PROCEDURE W MCC,S,"$3,312.73 ","$20,391.10 ","$6,739.84 ","$20,391.10 ",20161001
035,DRG,CAROTID ARTERY STENT PROCEDURE W CC,S,"$3,515.14 ","$30,173.96 ","$6,575.89 ","$30,173.96 ",20161001
036,DRG,CAROTID ARTERY STENT PROCEDURE W/O CC/MCC,S,"$2,833.29 ","$42,319.96 ","$5,267.11 ","$42,319.96 ",20161001
037,DRG,EXTRACRANIAL PROCEDURES W MCC,S,"$3,003.91 ","$14,228.15 ","$5,524.35 ","$14,228.15 ",20161001
038,DRG,EXTRACRANIAL PROCEDURES W CC,S,"$3,044.23 ","$19,610.04 ","$5,510.84 ","$19,610.04 ",20161001
039,DRG,EXTRACRANIAL PROCEDURES W/O CC/MCC,S,"$2,738.04 ","$28,246.67 ","$5,159.04 ","$28,246.67 ",20161001
040,DRG,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W MCC,S,"$3,150.28 ","$9,995.14 ","$6,034.81 ","$9,995.14 ",20161001
041,DRG,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W CC OR PERIPH NEUROSTIM,S,"$3,026.07 ","$11,317.10 ","$5,641.41 ","$11,317.10 ",20161001
042,DRG,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W/O CC/MCC,S,"$3,508.58 ","$23,242.50 ","$6,285.53 ","$23,242.50 ",20161001
052,DRG,SPINAL DISORDERS & INJURIES W CC/MCC,N,"$2,202.92 ","$4,455.32 ","$5,661.66 ","$4,455.32 ",20161001
053,DRG,SPINAL DISORDERS & INJURIES W/O CC/MCC,N,"$1,590.30 ","$3,841.66 ","$3,475.36 ","$3,841.66 ",20161001
054,DRG,NERVOUS SYSTEM NEOPLASMS W MCC,N,"$3,206.25 ","$7,329.55 ","$5,839.88 ","$7,329.55 ",20161001
055,DRG,NERVOUS SYSTEM NEOPLASMS W/O MCC,N,"$2,630.07 ","$6,552.05 ","$4,645.17 ","$6,552.05 ",20161001
056,DRG,DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC,N,"$2,841.03 ","$4,456.66 ","$5,617.77 ","$4,456.66 ",20161001
057,DRG,DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC,N,"$3,022.13 ","$2,551.90 ","$5,904.78 ","$2,551.90 ",20161001
058,DRG,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W MCC,N,"$2,989.82 ","$6,506.86 ","$5,174.33 ","$6,506.86 ",20161001
059,DRG,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W CC,N,"$2,997.72 ","$6,334.15 ","$4,628.45 ","$6,334.15 ",20161001
060,DRG,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W/O CC/MCC,N,"$2,870.82 ","$6,195.81 ","$4,346.68 ","$6,195.81 ",20161001
061,DRG,ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W MCC,N,"$3,623.55 ","$13,601.45 ","$6,851.80 ","$13,601.45 ",20161001
062,DRG,ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W CC,N,"$3,489.73 ","$15,911.67 ","$6,655.96 ","$15,911.67 ",20161001
063,DRG,ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W/O CC/MCC,N,"$3,546.28 ","$20,046.40 ","$6,583.78 ","$20,046.40 ",20161001
064,DRG,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC,N,"$3,128.47 ","$8,150.29 ","$6,097.98 ","$8,150.29 ",20161001
065,DRG,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS,N,"$2,874.53 ","$7,735.14 ","$5,316.00 ","$7,735.14 ",20161001
066,DRG,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC,N,"$2,628.05 ","$8,815.31 ","$4,767.89 ","$8,815.31 ",20161001
067,DRG,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W MCC,N,"$2,444.26 ","$7,655.75 ","$4,416.52 ","$7,655.75 ",20161001
068,DRG,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W/O MCC,N,"$2,189.97 ","$8,341.55 ","$3,892.51 ","$8,341.55 ",20161001
069,DRG,TRANSIENT ISCHEMIA,N,"$3,068.54 ","$11,314.09 ","$5,192.03 ","$11,314.09 ",20161001
070,DRG,NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC,N,"$2,829.60 ","$7,064.11 ","$5,247.03 ","$7,064.11 ",20161001
071,DRG,NONSPECIFIC CEREBROVASCULAR DISORDERS W CC,N,"$2,735.70 ","$5,788.96 ","$4,707.54 ","$5,788.96 ",20161001
072,DRG,NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC,N,"$2,867.10 ","$8,154.73 ","$4,999.31 ","$8,154.73 ",20161001
073,DRG,CRANIAL & PERIPHERAL NERVE DISORDERS W MCC,N,"$2,892.80 ","$6,790.03 ","$4,918.30 ","$6,790.03 ",20161001
074,DRG,CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC,N,"$2,694.17 ","$6,465.45 ","$4,736.76 ","$6,465.45 ",20161001
075,DRG,VIRAL MENINGITIS W CC/MCC,N,"$2,694.09 ","$7,326.10 ","$4,745.54 ","$7,326.10 ",20161001
076,DRG,VIRAL MENINGITIS W/O CC/MCC,N,"$2,607.86 ","$6,811.97 ","$4,367.80 ","$6,811.97 ",20161001
077,DRG,HYPERTENSIVE ENCEPHALOPATHY W MCC,N,"$2,803.40 ","$7,503.23 ","$5,329.48 ","$7,503.23 ",20161001
078,DRG,HYPERTENSIVE ENCEPHALOPATHY W CC,N,"$3,029.60 ","$7,954.85 ","$5,521.36 ","$7,954.85 ",20161001
079,DRG,HYPERTENSIVE ENCEPHALOPATHY W/O CC/MCC,N,"$2,851.02 ","$7,898.15 ","$4,691.84 ","$7,898.15 ",20161001
080,DRG,NONTRAUMATIC STUPOR & COMA W MCC,N,"$3,382.73 ","$6,995.54 ","$6,172.50 ","$6,995.54 ",20161001
081,DRG,NONTRAUMATIC STUPOR & COMA W/O MCC,N,"$2,867.05 ","$5,557.51 ","$5,121.71 ","$5,557.51 ",20161001
082,DRG,"TRAUMATIC STUPOR & COMA, COMA >1 HR W MCC",N,"$2,934.51 ","$8,972.18 ","$6,666.50 ","$8,972.18 ",20161001
083,DRG,"TRAUMATIC STUPOR & COMA, COMA >1 HR W CC",N,"$3,203.73 ","$7,871.40 ","$6,765.28 ","$7,871.40 ",20161001
084,DRG,"TRAUMATIC STUPOR & COMA, COMA >1 HR W/O CC/MCC",N,"$3,418.15 ","$10,089.24 ","$7,450.43 ","$10,089.24 ",20161001
085,DRG,"TRAUMATIC STUPOR & COMA, COMA <1 HR W MCC",N,"$3,000.19 ","$7,200.85 ","$6,201.42 ","$7,200.85 ",20161001
086,DRG,"TRAUMATIC STUPOR & COMA, COMA <1 HR W CC",N,"$3,041.60 ","$6,685.48 ","$6,147.51 ","$6,685.48 ",20161001
087,DRG,"TRAUMATIC STUPOR & COMA, COMA <1 HR W/O CC/MCC",N,"$2,703.48 ","$6,927.08 ","$5,644.29 ","$6,927.08 ",20161001
088,DRG,CONCUSSION W MCC,N,"$3,214.34 ","$10,034.41 ","$7,041.35 ","$10,034.41 ",20161001
089,DRG,CONCUSSION W CC,N,"$3,683.21 ","$10,733.21 ","$6,927.89 ","$10,733.21 ",20161001
090,DRG,CONCUSSION W/O CC/MCC,N,"$3,803.17 ","$12,892.39 ","$7,066.33 ","$12,892.39 ",20161001
091,DRG,OTHER DISORDERS OF NERVOUS SYSTEM W MCC,N,"$2,838.79 ","$6,851.09 ","$5,464.29 ","$6,851.09 ",20161001
092,DRG,OTHER DISORDERS OF NERVOUS SYSTEM W CC,N,"$2,972.52 ","$6,438.23 ","$5,051.87 ","$6,438.23 ",20161001
093,DRG,OTHER DISORDERS OF NERVOUS SYSTEM W/O CC/MCC,N,"$2,871.10 ","$7,718.52 ","$4,791.43 ","$7,718.52 ",20161001
094,DRG,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W MCC,N,"$3,130.76 ","$8,521.09 ","$5,875.26 ","$8,521.09 ",20161001
095,DRG,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W CC,N,"$3,174.03 ","$10,089.94 ","$5,652.47 ","$10,089.94 ",20161001
096,DRG,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W/O CC/MCC,N,"$2,682.69 ","$12,428.31 ","$4,746.64 ","$12,428.31 ",20161001
097,DRG,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W MCC,N,"$3,073.97 ","$8,508.77 ","$5,562.49 ","$8,508.77 ",20161001
098,DRG,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W CC,N,"$3,267.24 ","$7,779.06 ","$5,378.29 ","$7,779.06 ",20161001
099,DRG,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W/O CC/MCC,N,"$2,749.60 ","$7,446.62 ","$4,315.00 ","$7,446.62 ",20161001
100,DRG,SEIZURES W MCC,N,"$3,110.92 ","$8,021.07 ","$5,757.43 ","$8,021.07 ",20161001
101,DRG,SEIZURES W/O MCC,N,"$3,248.72 ","$7,418.79 ","$5,157.50 ","$7,418.79 ",20161001
102,DRG,HEADACHES W MCC,N,"$3,279.13 ","$9,036.59 ","$5,644.73 ","$9,036.59 ",20161001
103,DRG,HEADACHES W/O MCC,N,"$2,497.75 ","$7,566.36 ","$4,287.86 ","$7,566.36 ",20161001
113,DRG,ORBITAL PROCEDURES W CC/MCC,S,"$4,038.18 ","$14,905.25 ","$8,290.20 ","$14,905.25 ",20161001
114,DRG,ORBITAL PROCEDURES W/O CC/MCC,S,"$3,610.41 ","$18,712.78 ","$7,509.07 ","$18,712.78 ",20161001
115,DRG,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,S,"$3,377.57 ","$10,852.07 ","$6,013.65 ","$10,852.07 ",20161001
116,DRG,INTRAOCULAR PROCEDURES W CC/MCC,S,"$3,406.37 ","$9,867.23 ","$5,630.93 ","$9,867.23 ",20161001
117,DRG,INTRAOCULAR PROCEDURES W/O CC/MCC,S,"$3,175.94 ","$12,768.52 ","$6,365.92 ","$12,768.52 ",20161001
121,DRG,ACUTE MAJOR EYE INFECTIONS W CC/MCC,N,"$2,932.34 ","$4,514.26 ","$5,103.17 ","$4,514.26 ",20161001
122,DRG,ACUTE MAJOR EYE INFECTIONS W/O CC/MCC,N,"$2,642.58 ","$3,863.40 ","$5,146.72 ","$3,863.40 ",20161001
123,DRG,NEUROLOGICAL EYE DISORDERS,N,"$3,036.39 ","$10,192.22 ","$4,821.80 ","$10,192.22 ",20161001
124,DRG,OTHER DISORDERS OF THE EYE W MCC,N,"$3,372.97 ","$6,797.25 ","$5,441.99 ","$6,797.25 ",20161001
125,DRG,OTHER DISORDERS OF THE EYE W/O MCC,N,"$3,185.76 ","$6,151.94 ","$5,152.43 ","$6,151.94 ",20161001
129,DRG,MAJOR HEAD & NECK PROCEDURES W CC/MCC OR MAJOR DEVICE,S,"$3,859.61 ","$19,735.89 ","$7,027.06 ","$19,735.89 ",20161001
130,DRG,MAJOR HEAD & NECK PROCEDURES W/O CC/MCC,S,"$3,560.36 ","$23,819.60 ","$6,255.93 ","$23,819.60 ",20161001
131,DRG,CRANIAL/FACIAL PROCEDURES W CC/MCC,S,"$4,023.08 ","$18,969.11 ","$8,007.06 ","$18,969.11 ",20161001
132,DRG,CRANIAL/FACIAL PROCEDURES W/O CC/MCC,S,"$4,980.48 ","$31,332.60 ","$9,446.14 ","$31,332.60 ",20161001
133,DRG,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W CC/MCC",S,"$3,161.66 ","$12,203.34 ","$5,965.15 ","$12,203.34 ",20161001
134,DRG,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCC",S,"$3,291.95 ","$18,203.64 ","$6,003.20 ","$18,203.64 ",20161001
135,DRG,SINUS & MASTOID PROCEDURES W CC/MCC,S,"$3,139.90 ","$13,267.82 ","$5,810.52 ","$13,267.82 ",20161001
136,DRG,SINUS & MASTOID PROCEDURES W/O CC/MCC,S,"$3,629.73 ","$21,421.43 ","$6,093.96 ","$21,421.43 ",20161001
137,DRG,MOUTH PROCEDURES W CC/MCC,S,"$2,846.99 ","$8,606.37 ","$5,625.79 ","$8,606.37 ",20161001
138,DRG,MOUTH PROCEDURES W/O CC/MCC,S,"$3,115.39 ","$12,138.52 ","$5,066.08 ","$12,138.52 ",20161001
139,DRG,SALIVARY GLAND PROCEDURES,S,"$3,364.45 ","$21,682.92 ","$6,513.57 ","$21,682.92 ",20161001
146,DRG,"EAR, NOSE, MOUTH & THROAT MALIGNANCY W MCC",N,"$2,982.96 ","$5,793.99 ","$5,594.60 ","$5,793.99 ",20161001
147,DRG,"EAR, NOSE, MOUTH & THROAT MALIGNANCY W CC",N,"$2,909.15 ","$5,783.60 ","$4,810.38 ","$5,783.60 ",20161001
148,DRG,"EAR, NOSE, MOUTH & THROAT MALIGNANCY W/O CC/MCC",N,"$2,284.49 ","$6,081.92 ","$4,660.13 ","$6,081.92 ",20161001
149,DRG,DYSEQUILIBRIUM,N,"$3,258.27 ","$9,077.62 ","$5,127.45 ","$9,077.62 ",20161001
150,DRG,EPISTAXIS W MCC,N,"$3,219.42 ","$7,253.12 ","$5,503.98 ","$7,253.12 ",20161001
151,DRG,EPISTAXIS W/O MCC,N,"$3,106.39 ","$5,680.50 ","$5,344.35 ","$5,680.50 ",20161001
152,DRG,OTITIS MEDIA & URI W MCC,N,"$3,050.26 ","$5,972.14 ","$5,024.07 ","$5,972.14 ",20161001
153,DRG,OTITIS MEDIA & URI W/O MCC,N,"$2,654.90 ","$5,057.10 ","$4,332.75 ","$5,057.10 ",20161001
154,DRG,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W MCC",N,"$3,089.12 ","$7,173.19 ","$5,716.08 ","$7,173.19 ",20161001
155,DRG,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W CC",N,"$2,896.81 ","$6,197.84 ","$4,996.47 ","$6,197.84 ",20161001
156,DRG,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W/O CC/MCC",N,"$2,839.86 ","$6,167.67 ","$5,099.60 ","$6,167.67 ",20161001
157,DRG,DENTAL & ORAL DISEASES W MCC,N,"$3,317.53 ","$7,545.28 ","$5,956.99 ","$7,545.28 ",20161001
158,DRG,DENTAL & ORAL DISEASES W CC,N,"$2,947.93 ","$6,042.11 ","$4,845.47 ","$6,042.11 ",20161001
159,DRG,DENTAL & ORAL DISEASES W/O CC/MCC,N,"$3,256.41 ","$7,528.20 ","$5,694.10 ","$7,528.20 ",20161001
163,DRG,MAJOR CHEST PROCEDURES W MCC,S,"$3,116.83 ","$11,832.42 ","$5,591.02 ","$11,832.42 ",20161001
164,DRG,MAJOR CHEST PROCEDURES W CC,S,"$3,469.33 ","$14,014.90 ","$5,266.49 ","$14,014.90 ",20161001
165,DRG,MAJOR CHEST PROCEDURES W/O CC/MCC,S,"$3,081.30 ","$15,881.51 ","$4,557.93 ","$15,881.51 ",20161001
166,DRG,OTHER RESP SYSTEM O.R. PROCEDURES W MCC,S,"$2,939.09 ","$9,194.15 ","$5,129.84 ","$9,194.15 ",20161001
167,DRG,OTHER RESP SYSTEM O.R. PROCEDURES W CC,S,"$3,032.25 ","$10,125.12 ","$5,108.83 ","$10,125.12 ",20161001
168,DRG,OTHER RESP SYSTEM O.R. PROCEDURES W/O CC/MCC,S,"$2,736.48 ","$11,560.04 ","$4,493.20 ","$11,560.04 ",20161001
175,DRG,PULMONARY EMBOLISM W MCC,N,"$2,660.91 ","$6,651.26 ","$4,520.46 ","$6,651.26 ",20161001
176,DRG,PULMONARY EMBOLISM W/O MCC,N,"$2,668.73 ","$6,359.98 ","$4,400.51 ","$6,359.98 ",20161001
177,DRG,RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC,N,"$2,710.87 ","$6,203.71 ","$4,697.29 ","$6,203.71 ",20161001
178,DRG,RESPIRATORY INFECTIONS & INFLAMMATIONS W CC,N,"$2,788.52 ","$5,879.99 ","$4,736.06 ","$5,879.99 ",20161001
179,DRG,RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC,N,"$2,586.55 ","$5,448.49 ","$4,584.59 ","$5,448.49 ",20161001
180,DRG,RESPIRATORY NEOPLASMS W MCC,N,"$2,821.85 ","$7,102.46 ","$4,717.36 ","$7,102.46 ",20161001
181,DRG,RESPIRATORY NEOPLASMS W CC,N,"$2,912.13 ","$7,014.20 ","$4,765.29 ","$7,014.20 ",20161001
182,DRG,RESPIRATORY NEOPLASMS W/O CC/MCC,N,"$1,530.62 ","$4,488.69 ","$2,565.36 ","$4,488.69 ",20161001
183,DRG,MAJOR CHEST TRAUMA W MCC,N,"$3,327.32 ","$7,437.67 ","$6,641.13 ","$7,437.67 ",20161001
184,DRG,MAJOR CHEST TRAUMA W CC,N,"$3,310.69 ","$7,658.56 ","$6,709.70 ","$7,658.56 ",20161001
185,DRG,MAJOR CHEST TRAUMA W/O CC/MCC,N,"$3,472.80 ","$7,902.75 ","$6,980.88 ","$7,902.75 ",20161001
186,DRG,PLEURAL EFFUSION W MCC,N,"$2,621.33 ","$6,559.76 ","$4,415.94 ","$6,559.76 ",20161001
187,DRG,PLEURAL EFFUSION W CC,N,"$2,855.64 ","$6,722.46 ","$4,635.16 ","$6,722.46 ",20161001
188,DRG,PLEURAL EFFUSION W/O CC/MCC,N,"$2,589.76 ","$6,439.52 ","$4,181.36 ","$6,439.52 ",20161001
189,DRG,PULMONARY EDEMA & RESPIRATORY FAILURE,N,"$2,510.49 ","$5,716.63 ","$4,356.78 ","$5,716.63 ",20161001
190,DRG,CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC,N,"$2,404.12 ","$5,730.83 ","$4,170.21 ","$5,730.83 ",20161001
191,DRG,CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC,N,"$2,338.55 ","$5,433.49 ","$3,989.87 ","$5,433.49 ",20161001
192,DRG,CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC,N,"$2,112.40 ","$5,048.15 ","$3,791.86 ","$5,048.15 ",20161001
193,DRG,SIMPLE PNEUMONIA & PLEURISY W MCC,N,"$2,558.97 ","$6,323.01 ","$4,455.74 ","$6,323.01 ",20161001
194,DRG,SIMPLE PNEUMONIA & PLEURISY W CC,N,"$2,463.89 ","$5,463.42 ","$4,226.80 ","$5,463.42 ",20161001
195,DRG,SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC,N,"$2,150.75 ","$4,788.62 ","$3,858.61 ","$4,788.62 ",20161001
196,DRG,INTERSTITIAL LUNG DISEASE W MCC,N,"$2,869.97 ","$5,940.39 ","$4,894.34 ","$5,940.39 ",20161001
197,DRG,INTERSTITIAL LUNG DISEASE W CC,N,"$2,892.64 ","$6,144.68 ","$4,877.93 ","$6,144.68 ",20161001
198,DRG,INTERSTITIAL LUNG DISEASE W/O CC/MCC,N,"$2,862.15 ","$6,203.17 ","$4,663.59 ","$6,203.17 ",20161001
199,DRG,PNEUMOTHORAX W MCC,N,"$2,710.18 ","$5,951.19 ","$4,758.14 ","$5,951.19 ",20161001
200,DRG,PNEUMOTHORAX W CC,N,"$2,742.24 ","$5,932.97 ","$4,719.93 ","$5,932.97 ",20161001
201,DRG,PNEUMOTHORAX W/O CC/MCC,N,"$2,287.20 ","$4,920.06 ","$3,907.50 ","$4,920.06 ",20161001
202,DRG,BRONCHITIS & ASTHMA W CC/MCC,N,"$2,670.55 ","$5,758.23 ","$4,575.86 ","$5,758.23 ",20161001
203,DRG,BRONCHITIS & ASTHMA W/O CC/MCC,N,"$2,405.04 ","$5,018.11 ","$4,254.10 ","$5,018.11 ",20161001
204,DRG,RESPIRATORY SIGNS & SYMPTOMS,N,"$2,853.73 ","$7,669.35 ","$4,575.83 ","$7,669.35 ",20161001
205,DRG,OTHER RESPIRATORY SYSTEM DIAGNOSES W MCC,N,"$3,239.70 ","$7,976.28 ","$5,551.98 ","$7,976.28 ",20161001
206,DRG,OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC,N,"$3,130.44 ","$7,957.15 ","$5,241.26 ","$7,957.15 ",20161001
207,DRG,RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS,N,"$2,844.56 ","$8,246.25 ","$5,278.54 ","$8,246.25 ",20161001
208,DRG,RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS,N,"$2,788.27 ","$9,253.80 ","$5,391.26 ","$9,253.80 ",20161001
215,DRG,OTHER HEART ASSIST SYSTEM IMPLANT,S,"$3,384.81 ","$31,990.43 ","$7,223.89 ","$31,990.43 ",20161001
216,DRG,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W MCC,S,"$3,790.90 ","$22,355.30 ","$6,588.36 ","$22,355.30 ",20161001
217,DRG,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W CC,S,"$3,984.98 ","$25,347.71 ","$6,441.44 ","$25,347.71 ",20161001
218,DRG,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W/O CC/MCC,S,"$3,443.37 ","$29,875.82 ","$5,950.21 ","$29,875.82 ",20161001
219,DRG,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W MCC,S,"$3,986.76 ","$25,002.18 ","$7,014.55 ","$25,002.18 ",20161001
220,DRG,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W CC,S,"$3,790.85 ","$28,021.03 ","$6,404.26 ","$28,021.03 ",20161001
221,DRG,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W/O CC/MCC,S,"$3,526.57 ","$33,495.32 ","$6,064.83 ","$33,495.32 ",20161001
222,DRG,CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W MCC,S,"$3,614.53 ","$25,075.60 ","$6,015.98 ","$25,075.60 ",20161001
223,DRG,CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W/O MCC,S,"$3,387.15 ","$32,736.27 ","$4,827.30 ","$32,736.27 ",20161001
224,DRG,CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W MCC,S,"$3,412.35 ","$27,442.72 ","$5,873.99 ","$27,442.72 ",20161001
225,DRG,CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W/O MCC,S,"$3,326.44 ","$43,068.07 ","$5,047.37 ","$43,068.07 ",20161001
226,DRG,CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W MCC,S,"$3,249.85 ","$26,045.29 ","$5,336.72 ","$26,045.29 ",20161001
227,DRG,CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W/O MCC,S,"$3,350.24 ","$47,521.26 ","$4,983.33 ","$47,521.26 ",20161001
228,DRG,OTHER CARDIOTHORACIC PROCEDURES W MCC,S,"$3,313.89 ","$22,396.37 ","$6,332.16 ","$22,396.37 ",20161001
229,DRG,OTHER CARDIOTHORACIC PROCEDURES W/O MCC,S,"$3,088.41 ","$28,137.22 ","$5,723.50 ","$28,137.22 ",20161001
231,DRG,CORONARY BYPASS W PTCA W MCC,S,"$2,814.01 ","$24,589.07 ","$5,681.14 ","$24,589.07 ",20161001
232,DRG,CORONARY BYPASS W PTCA W/O MCC,S,"$2,826.36 ","$25,402.06 ","$5,241.26 ","$25,402.06 ",20161001
233,DRG,CORONARY BYPASS W CARDIAC CATH W MCC,S,"$3,100.47 ","$19,237.74 ","$5,642.70 ","$19,237.74 ",20161001
234,DRG,CORONARY BYPASS W CARDIAC CATH W/O MCC,S,"$2,926.33 ","$20,852.49 ","$5,072.83 ","$20,852.49 ",20161001
235,DRG,CORONARY BYPASS W/O CARDIAC CATH W MCC,S,"$3,275.15 ","$19,143.80 ","$5,911.20 ","$19,143.80 ",20161001
236,DRG,CORONARY BYPASS W/O CARDIAC CATH W/O MCC,S,"$3,074.68 ","$21,537.92 ","$5,325.36 ","$21,537.92 ",20161001
239,DRG,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W MCC,S,"$2,949.70 ","$9,295.73 ","$5,098.95 ","$9,295.73 ",20161001
240,DRG,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W CC,S,"$2,854.20 ","$8,516.15 ","$4,494.06 ","$8,516.15 ",20161001
241,DRG,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W/O CC/MCC,S,"$2,128.51 ","$7,160.92 ","$3,459.57 ","$7,160.92 ",20161001
242,DRG,PERMANENT CARDIAC PACEMAKER IMPLANT W MCC,S,"$3,398.80 ","$16,928.62 ","$5,810.19 ","$16,928.62 ",20161001
243,DRG,PERMANENT CARDIAC PACEMAKER IMPLANT W CC,S,"$3,486.40 ","$21,919.32 ","$5,547.91 ","$21,919.32 ",20161001
244,DRG,PERMANENT CARDIAC PACEMAKER IMPLANT W/O CC/MCC,S,"$3,114.95 ","$25,984.24 ","$4,885.58 ","$25,984.24 ",20161001
245,DRG,AICD GENERATOR PROCEDURES,S,"$3,348.53 ","$29,393.45 ","$4,938.78 ","$29,393.45 ",20161001
246,DRG,PERC CARDIOVASC PROC W DRUG-ELUTING STENT W MCC OR 4+ VESSELS/STENTS,S,"$3,404.30 ","$26,269.74 ","$5,818.45 ","$26,269.74 ",20161001
247,DRG,PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC,S,"$3,140.14 ","$37,178.27 ","$4,991.51 ","$37,178.27 ",20161001
248,DRG,PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W MCC OR 4+ VES/STENTS,S,"$3,052.86 ","$20,320.19 ","$5,611.47 ","$20,320.19 ",20161001
249,DRG,PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W/O MCC,S,"$2,974.18 ","$30,420.85 ","$5,098.24 ","$30,420.85 ",20161001
250,DRG,PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W MCC,S,"$3,252.31 ","$19,153.31 ","$5,772.14 ","$19,153.31 ",20161001
251,DRG,PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W/O MCC,S,"$3,182.37 ","$28,712.60 ","$5,231.29 ","$28,712.60 ",20161001
252,DRG,OTHER VASCULAR PROCEDURES W MCC,S,"$3,148.63 ","$13,672.38 ","$5,349.36 ","$13,672.38 ",20161001
253,DRG,OTHER VASCULAR PROCEDURES W CC,S,"$3,215.01 ","$16,797.13 ","$5,065.23 ","$16,797.13 ",20161001
254,DRG,OTHER VASCULAR PROCEDURES W/O CC/MCC,S,"$2,877.07 ","$22,766.63 ","$4,734.08 ","$22,766.63 ",20161001
255,DRG,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W MCC,S,"$2,847.16 ","$7,601.54 ","$4,579.82 ","$7,601.54 ",20161001
256,DRG,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W CC,S,"$2,777.59 ","$6,856.36 ","$4,157.60 ","$6,856.36 ",20161001
257,DRG,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W/O CC/MCC,S,"$2,506.68 ","$7,179.24 ","$3,647.37 ","$7,179.24 ",20161001
258,DRG,CARDIAC PACEMAKER DEVICE REPLACEMENT W MCC,S,"$3,627.20 ","$14,794.64 ","$5,736.67 ","$14,794.64 ",20161001
259,DRG,CARDIAC PACEMAKER DEVICE REPLACEMENT W/O MCC,S,"$3,319.74 ","$19,154.53 ","$4,902.07 ","$19,154.53 ",20161001
260,DRG,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W MCC,S,"$3,356.51 ","$11,759.81 ","$5,751.76 ","$11,759.81 ",20161001
261,DRG,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W CC,S,"$3,274.90 ","$15,207.17 ","$5,179.27 ","$15,207.17 ",20161001
262,DRG,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W/O CC/MCC,S,"$3,692.54 ","$22,248.83 ","$5,651.15 ","$22,248.83 ",20161001
263,DRG,VEIN LIGATION & STRIPPING,S,"$3,313.54 ","$10,922.55 ","$5,523.76 ","$10,922.55 ",20161001
264,DRG,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,S,"$3,139.62 ","$9,304.15 ","$5,312.47 ","$9,304.15 ",20161001
265,DRG,AICD LEAD PROCEDURES,S,"$2,979.15 ","$23,376.52 ","$5,046.29 ","$23,376.52 ",20161001
266,DRG,ENDOVASCULAR CARDIAC VALVE REPLACEMENT W MCC,S,"$5,378.08 ","$38,401.18 ","$9,156.72 ","$38,401.18 ",20161001
267,DRG,ENDOVASCULAR CARDIAC VALVE REPLACEMENT W/O MCC,S,"$4,211.79 ","$46,759.38 ","$7,508.39 ","$46,759.38 ",20161001
268,DRG,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W MCC,S,"$1,746.19 ","$22,755.51 ","$3,201.35 ","$22,755.51 ",20161001
269,DRG,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W/O MCC,S,"$1,512.38 ","$48,396.22 ","$2,617.88 ","$48,396.22 ",20161001
270,DRG,OTHER MAJOR CARDIOVASCULAR PROCEDURES W MCC,S,"$1,737.21 ","$17,869.13 ","$3,233.90 ","$17,869.13 ",20161001
271,DRG,OTHER MAJOR CARDIOVASCULAR PROCEDURES W CC,S,"$1,501.38 ","$17,483.45 ","$2,569.50 ","$17,483.45 ",20161001
272,DRG,OTHER MAJOR CARDIOVASCULAR PROCEDURES W/O CC/MCC,S,"$1,478.39 ","$25,869.86 ","$2,532.29 ","$25,869.86 ",20161001
273,DRG,PERCUTANEOUS INTRACARDIAC PROCEDURES W MCC,S,"$2,069.10 ","$18,448.19 ","$3,464.52 ","$18,448.19 ",20161001
274,DRG,PERCUTANEOUS INTRACARDIAC PROCEDURES W/O MCC,S,"$2,191.21 ","$37,176.24 ","$3,298.30 ","$37,176.24 ",20161001
280,DRG,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC",N,"$3,210.42 ","$8,409.86 ","$5,530.15 ","$8,409.86 ",20161001
281,DRG,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC",N,"$3,347.40 ","$9,962.49 ","$5,486.82 ","$9,962.49 ",20161001
282,DRG,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC",N,"$3,367.79 ","$12,959.82 ","$5,539.13 ","$12,959.82 ",20161001
283,DRG,"ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC",N,"$3,420.31 ","$12,037.46 ","$6,668.87 ","$12,037.46 ",20161001
284,DRG,"ACUTE MYOCARDIAL INFARCTION, EXPIRED W CC",N,"$2,835.28 ","$9,766.92 ","$5,435.71 ","$9,766.92 ",20161001
285,DRG,"ACUTE MYOCARDIAL INFARCTION, EXPIRED W/O CC/MCC",N,"$2,251.30 ","$9,506.17 ","$4,956.34 ","$9,506.17 ",20161001
286,DRG,"CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC",N,"$3,228.24 ","$10,157.75 ","$5,395.35 ","$10,157.75 ",20161001
287,DRG,"CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC",N,"$3,048.48 ","$13,754.32 ","$4,682.37 ","$13,754.32 ",20161001
288,DRG,ACUTE & SUBACUTE ENDOCARDITIS W MCC,N,"$2,920.42 ","$5,656.00 ","$4,957.75 ","$5,656.00 ",20161001
289,DRG,ACUTE & SUBACUTE ENDOCARDITIS W CC,N,"$2,876.66 ","$4,754.72 ","$4,253.48 ","$4,754.72 ",20161001
290,DRG,ACUTE & SUBACUTE ENDOCARDITIS W/O CC/MCC,N,"$2,606.98 ","$4,827.24 ","$4,331.07 ","$4,827.24 ",20161001
291,DRG,HEART FAILURE & SHOCK W MCC,N,"$2,691.32 ","$5,834.81 ","$4,590.94 ","$5,834.81 ",20161001
292,DRG,HEART FAILURE & SHOCK W CC,N,"$2,688.89 ","$4,834.26 ","$4,362.87 ","$4,834.26 ",20161001
293,DRG,HEART FAILURE & SHOCK W/O CC/MCC,N,"$2,517.30 ","$4,910.97 ","$4,282.89 ","$4,910.97 ",20161001
294,DRG,DEEP VEIN THROMBOPHLEBITIS W CC/MCC,N,"$2,707.29 ","$5,622.08 ","$5,435.11 ","$5,622.08 ",20161001
295,DRG,DEEP VEIN THROMBOPHLEBITIS W/O CC/MCC,N,"$1,891.73 ","$2,921.36 ","$3,430.31 ","$2,921.36 ",20161001
296,DRG,"CARDIAC ARREST, UNEXPLAINED W MCC",N,"$3,050.70 ","$14,152.71 ","$5,853.88 ","$14,152.71 ",20161001
297,DRG,"CARDIAC ARREST, UNEXPLAINED W CC",N,"$2,520.68 ","$10,167.61 ","$5,056.86 ","$10,167.61 ",20161001
298,DRG,"CARDIAC ARREST, UNEXPLAINED W/O CC/MCC",N,"$2,382.71 ","$8,308.36 ","$4,769.45 ","$8,308.36 ",20161001
299,DRG,PERIPHERAL VASCULAR DISORDERS W MCC,N,"$2,899.43 ","$6,174.78 ","$5,037.45 ","$6,174.78 ",20161001
300,DRG,PERIPHERAL VASCULAR DISORDERS W CC,N,"$2,891.77 ","$5,312.60 ","$4,882.36 ","$5,312.60 ",20161001
301,DRG,PERIPHERAL VASCULAR DISORDERS W/O CC/MCC,N,"$2,590.13 ","$5,056.13 ","$4,705.85 ","$5,056.13 ",20161001
302,DRG,ATHEROSCLEROSIS W MCC,N,"$2,938.81 ","$6,864.90 ","$5,073.01 ","$6,864.90 ",20161001
303,DRG,ATHEROSCLEROSIS W/O MCC,N,"$3,191.38 ","$8,106.35 ","$5,326.32 ","$8,106.35 ",20161001
304,DRG,HYPERTENSION W MCC,N,"$2,712.23 ","$6,433.46 ","$4,613.16 ","$6,433.46 ",20161001
305,DRG,HYPERTENSION W/O MCC,N,"$2,794.24 ","$6,926.88 ","$4,444.05 ","$6,926.88 ",20161001
306,DRG,CARDIAC CONGENITAL & VALVULAR DISORDERS W MCC,N,"$3,967.44 ","$7,089.67 ","$6,560.80 ","$7,089.67 ",20161001
307,DRG,CARDIAC CONGENITAL & VALVULAR DISORDERS W/O MCC,N,"$3,060.00 ","$5,994.26 ","$4,964.57 ","$5,994.26 ",20161001
308,DRG,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC,N,"$2,909.28 ","$6,175.81 ","$4,722.89 ","$6,175.81 ",20161001
309,DRG,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC,N,"$2,912.92 ","$6,045.80 ","$4,541.19 ","$6,045.80 ",20161001
310,DRG,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC,N,"$2,795.07 ","$6,309.10 ","$4,325.53 ","$6,309.10 ",20161001
311,DRG,ANGINA PECTORIS,N,"$3,071.45 ","$8,136.36 ","$4,711.68 ","$8,136.36 ",20161001
312,DRG,SYNCOPE & COLLAPSE,N,"$3,130.84 ","$7,882.48 ","$4,933.72 ","$7,882.48 ",20161001
313,DRG,CHEST PAIN,N,"$3,224.78 ","$10,256.85 ","$4,824.74 ","$10,256.85 ",20161001
314,DRG,OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC,N,"$2,945.22 ","$7,456.92 ","$5,217.95 ","$7,456.92 ",20161001
315,DRG,OTHER CIRCULATORY SYSTEM DIAGNOSES W CC,N,"$2,940.77 ","$6,794.50 ","$4,942.21 ","$6,794.50 ",20161001
316,DRG,OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC,N,"$2,975.57 ","$7,899.69 ","$5,002.50 ","$7,899.69 ",20161001
326,DRG,"STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC",S,"$2,968.15 ","$11,462.87 ","$5,714.35 ","$11,462.87 ",20161001
327,DRG,"STOMACH, ESOPHAGEAL & DUODENAL PROC W CC",S,"$3,297.97 ","$13,103.40 ","$5,970.80 ","$13,103.40 ",20161001
328,DRG,"STOMACH, ESOPHAGEAL & DUODENAL PROC W/O CC/MCC",S,"$3,031.13 ","$18,935.39 ","$5,533.61 ","$18,935.39 ",20161001
329,DRG,MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC,S,"$2,702.50 ","$10,112.78 ","$5,201.54 ","$10,112.78 ",20161001
330,DRG,MAJOR SMALL & LARGE BOWEL PROCEDURES W CC,S,"$2,849.30 ","$10,291.20 ","$4,991.42 ","$10,291.20 ",20161001
331,DRG,MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC,S,"$2,728.28 ","$12,924.41 ","$4,638.93 ","$12,924.41 ",20161001
332,DRG,RECTAL RESECTION W MCC,S,"$2,797.80 ","$10,951.38 ","$5,346.47 ","$10,951.38 ",20161001
333,DRG,RECTAL RESECTION W CC,S,"$2,925.20 ","$11,855.88 ","$5,099.29 ","$11,855.88 ",20161001
334,DRG,RECTAL RESECTION W/O CC/MCC,S,"$2,876.04 ","$14,527.71 ","$4,703.81 ","$14,527.71 ",20161001
335,DRG,PERITONEAL ADHESIOLYSIS W MCC,S,"$2,749.05 ","$9,577.10 ","$5,276.11 ","$9,577.10 ",20161001
336,DRG,PERITONEAL ADHESIOLYSIS W CC,S,"$2,797.35 ","$9,149.19 ","$4,963.91 ","$9,149.19 ",20161001
337,DRG,PERITONEAL ADHESIOLYSIS W/O CC/MCC,S,"$2,753.34 ","$11,206.31 ","$4,855.08 ","$11,206.31 ",20161001
338,DRG,APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W MCC,S,"$2,492.66 ","$9,644.51 ","$4,794.55 ","$9,644.51 ",20161001
339,DRG,APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC,S,"$2,672.30 ","$9,786.27 ","$4,568.71 ","$9,786.27 ",20161001
340,DRG,APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC,S,"$2,666.93 ","$12,511.83 ","$4,353.49 ","$12,511.83 ",20161001
341,DRG,APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W MCC,S,"$2,855.62 ","$13,010.66 ","$5,375.83 ","$13,010.66 ",20161001
342,DRG,APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC,S,"$2,862.10 ","$15,340.59 ","$4,878.87 ","$15,340.59 ",20161001
343,DRG,APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC,S,"$3,075.81 ","$22,591.64 ","$4,919.16 ","$22,591.64 ",20161001
344,DRG,MINOR SMALL & LARGE BOWEL PROCEDURES W MCC,S,"$2,763.16 ","$8,612.12 ","$5,138.81 ","$8,612.12 ",20161001
345,DRG,MINOR SMALL & LARGE BOWEL PROCEDURES W CC,S,"$2,884.80 ","$8,554.58 ","$4,871.71 ","$8,554.58 ",20161001
346,DRG,MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC,S,"$2,555.14 ","$9,645.62 ","$4,149.52 ","$9,645.62 ",20161001
347,DRG,ANAL & STOMAL PROCEDURES W MCC,S,"$2,720.08 ","$8,792.47 ","$5,062.54 ","$8,792.47 ",20161001
348,DRG,ANAL & STOMAL PROCEDURES W CC,S,"$2,851.79 ","$9,254.76 ","$4,761.61 ","$9,254.76 ",20161001
349,DRG,ANAL & STOMAL PROCEDURES W/O CC/MCC,S,"$2,521.08 ","$10,935.03 ","$4,628.59 ","$10,935.03 ",20161001
350,DRG,INGUINAL & FEMORAL HERNIA PROCEDURES W MCC,S,"$2,951.32 ","$10,701.04 ","$5,430.20 ","$10,701.04 ",20161001
351,DRG,INGUINAL & FEMORAL HERNIA PROCEDURES W CC,S,"$3,231.80 ","$12,555.53 ","$5,499.94 ","$12,555.53 ",20161001
352,DRG,INGUINAL & FEMORAL HERNIA PROCEDURES W/O CC/MCC,S,"$3,225.22 ","$16,240.93 ","$5,362.85 ","$16,240.93 ",20161001
353,DRG,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W MCC,S,"$2,721.51 ","$11,609.56 ","$5,282.07 ","$11,609.56 ",20161001
354,DRG,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W CC,S,"$2,780.64 ","$12,360.89 ","$4,932.65 ","$12,360.89 ",20161001
355,DRG,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W/O CC/MCC,S,"$2,801.14 ","$15,641.54 ","$4,705.41 ","$15,641.54 ",20161001
356,DRG,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC,S,"$2,963.38 ","$9,431.14 ","$5,227.24 ","$9,431.14 ",20161001
357,DRG,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC,S,"$2,889.43 ","$10,135.21 ","$4,994.27 ","$10,135.21 ",20161001
358,DRG,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC,S,"$2,647.16 ","$12,192.97 ","$4,464.84 ","$12,192.97 ",20161001
368,DRG,MAJOR ESOPHAGEAL DISORDERS W MCC,N,"$2,812.00 ","$7,973.90 ","$5,242.43 ","$7,973.90 ",20161001
369,DRG,MAJOR ESOPHAGEAL DISORDERS W CC,N,"$2,735.75 ","$7,237.30 ","$4,794.82 ","$7,237.30 ",20161001
370,DRG,MAJOR ESOPHAGEAL DISORDERS W/O CC/MCC,N,"$2,591.61 ","$7,362.33 ","$4,434.13 ","$7,362.33 ",20161001
371,DRG,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC,N,"$2,840.12 ","$5,590.51 ","$4,705.86 ","$5,590.51 ",20161001
372,DRG,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC,N,"$2,756.82 ","$4,782.70 ","$4,399.17 ","$4,782.70 ",20161001
373,DRG,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W/O CC/MCC,N,"$2,627.43 ","$4,643.43 ","$4,246.68 ","$4,643.43 ",20161001
374,DRG,DIGESTIVE MALIGNANCY W MCC,N,"$3,187.02 ","$6,674.28 ","$5,329.16 ","$6,674.28 ",20161001
375,DRG,DIGESTIVE MALIGNANCY W CC,N,"$3,133.46 ","$6,670.79 ","$4,944.05 ","$6,670.79 ",20161001
376,DRG,DIGESTIVE MALIGNANCY W/O CC/MCC,N,"$2,291.61 ","$6,242.71 ","$3,458.63 ","$6,242.71 ",20161001
377,DRG,G.I. HEMORRHAGE W MCC,N,"$2,880.39 ","$7,700.26 ","$5,178.53 ","$7,700.26 ",20161001
378,DRG,G.I. HEMORRHAGE W CC,N,"$2,799.98 ","$7,184.19 ","$4,916.03 ","$7,184.19 ",20161001
379,DRG,G.I. HEMORRHAGE W/O CC/MCC,N,"$2,751.69 ","$6,857.95 ","$4,718.78 ","$6,857.95 ",20161001
380,DRG,COMPLICATED PEPTIC ULCER W MCC,N,"$2,734.57 ","$7,359.58 ","$5,102.74 ","$7,359.58 ",20161001
381,DRG,COMPLICATED PEPTIC ULCER W CC,N,"$2,694.68 ","$6,923.52 ","$4,723.08 ","$6,923.52 ",20161001
382,DRG,COMPLICATED PEPTIC ULCER W/O CC/MCC,N,"$2,595.84 ","$7,301.68 ","$4,271.02 ","$7,301.68 ",20161001
383,DRG,UNCOMPLICATED PEPTIC ULCER W MCC,N,"$2,813.48 ","$8,008.95 ","$4,877.65 ","$8,008.95 ",20161001
384,DRG,UNCOMPLICATED PEPTIC ULCER W/O MCC,N,"$2,586.95 ","$8,103.75 ","$4,350.42 ","$8,103.75 ",20161001
385,DRG,INFLAMMATORY BOWEL DISEASE W MCC,N,"$2,822.60 ","$6,058.99 ","$5,004.38 ","$6,058.99 ",20161001
386,DRG,INFLAMMATORY BOWEL DISEASE W CC,N,"$2,681.43 ","$5,648.79 ","$4,508.05 ","$5,648.79 ",20161001
387,DRG,INFLAMMATORY BOWEL DISEASE W/O CC/MCC,N,"$2,621.36 ","$5,849.90 ","$4,290.80 ","$5,849.90 ",20161001
388,DRG,G.I. OBSTRUCTION W MCC,N,"$2,656.19 ","$5,876.46 ","$4,671.71 ","$5,876.46 ",20161001
389,DRG,G.I. OBSTRUCTION W CC,N,"$2,633.94 ","$5,177.31 ","$4,403.45 ","$5,177.31 ",20161001
390,DRG,G.I. OBSTRUCTION W/O CC/MCC,N,"$2,525.01 ","$5,008.08 ","$4,204.62 ","$5,008.08 ",20161001
391,DRG,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC",N,"$2,653.30 ","$6,280.94 ","$4,478.97 ","$6,280.94 ",20161001
392,DRG,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC",N,"$2,531.29 ","$6,174.70 ","$4,178.43 ","$6,174.70 ",20161001
393,DRG,OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC,N,"$2,892.41 ","$6,610.40 ","$5,030.77 ","$6,610.40 ",20161001
394,DRG,OTHER DIGESTIVE SYSTEM DIAGNOSES W CC,N,"$2,793.11 ","$6,067.81 ","$4,658.60 ","$6,067.81 ",20161001
395,DRG,OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC,N,"$3,038.50 ","$7,254.65 ","$4,937.97 ","$7,254.65 ",20161001
405,DRG,"PANCREAS, LIVER & SHUNT PROCEDURES W MCC",S,"$3,454.73 ","$13,190.47 ","$6,819.62 ","$13,190.47 ",20161001
406,DRG,"PANCREAS, LIVER & SHUNT PROCEDURES W CC",S,"$3,643.78 ","$14,480.23 ","$6,735.90 ","$14,480.23 ",20161001
407,DRG,"PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/MCC",S,"$3,510.45 ","$15,796.07 ","$6,217.91 ","$15,796.07 ",20161001
408,DRG,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W MCC,S,"$2,982.99 ","$10,877.42 ","$5,784.11 ","$10,877.42 ",20161001
409,DRG,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W CC,S,"$2,967.04 ","$10,477.69 ","$5,302.26 ","$10,477.69 ",20161001
410,DRG,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W/O CC/MCC,S,"$3,119.36 ","$12,068.77 ","$5,502.71 ","$12,068.77 ",20161001
411,DRG,CHOLECYSTECTOMY W C.D.E. W MCC,S,"$2,970.10 ","$12,390.94 ","$5,605.31 ","$12,390.94 ",20161001
412,DRG,CHOLECYSTECTOMY W C.D.E. W CC,S,"$2,646.65 ","$11,772.97 ","$5,267.04 ","$11,772.97 ",20161001
413,DRG,CHOLECYSTECTOMY W C.D.E. W/O CC/MCC,S,"$2,569.50 ","$13,202.77 ","$4,497.76 ","$13,202.77 ",20161001
414,DRG,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W MCC,S,"$2,747.69 ","$10,904.76 ","$5,278.00 ","$10,904.76 ",20161001
415,DRG,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC,S,"$2,703.53 ","$10,794.95 ","$4,729.63 ","$10,794.95 ",20161001
416,DRG,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC/MCC,S,"$2,675.80 ","$12,281.70 ","$4,557.51 ","$12,281.70 ",20161001
417,DRG,LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC,S,"$2,737.77 ","$12,247.57 ","$4,988.71 ","$12,247.57 ",20161001
418,DRG,LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC,S,"$2,814.27 ","$13,682.02 ","$4,690.90 ","$13,682.02 ",20161001
419,DRG,LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC,S,"$2,835.66 ","$17,133.52 ","$4,484.91 ","$17,133.52 ",20161001
420,DRG,HEPATOBILIARY DIAGNOSTIC PROCEDURES W MCC,S,"$2,970.57 ","$10,493.87 ","$5,775.78 ","$10,493.87 ",20161001
421,DRG,HEPATOBILIARY DIAGNOSTIC PROCEDURES W CC,S,"$3,027.17 ","$11,480.84 ","$5,603.91 ","$11,480.84 ",20161001
422,DRG,HEPATOBILIARY DIAGNOSTIC PROCEDURES W/O CC/MCC,S,"$3,242.64 ","$15,720.32 ","$5,628.94 ","$15,720.32 ",20161001
423,DRG,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W MCC,S,"$3,169.20 ","$9,660.88 ","$5,776.30 ","$9,660.88 ",20161001
424,DRG,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W CC,S,"$2,913.64 ","$8,834.00 ","$4,731.04 ","$8,834.00 ",20161001
425,DRG,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W/O CC/MCC,S,"$3,380.76 ","$13,870.08 ","$6,325.94 ","$13,870.08 ",20161001
432,DRG,CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC,N,"$2,893.83 ","$7,466.63 ","$5,257.41 ","$7,466.63 ",20161001
433,DRG,CIRRHOSIS & ALCOHOLIC HEPATITIS W CC,N,"$2,651.47 ","$6,393.24 ","$4,307.60 ","$6,393.24 ",20161001
434,DRG,CIRRHOSIS & ALCOHOLIC HEPATITIS W/O CC/MCC,N,"$3,369.91 ","$8,334.26 ","$5,711.73 ","$8,334.26 ",20161001
435,DRG,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC,N,"$3,137.34 ","$7,880.85 ","$5,354.41 ","$7,880.85 ",20161001
436,DRG,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC,N,"$2,896.13 ","$6,844.59 ","$4,557.47 ","$6,844.59 ",20161001
437,DRG,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W/O CC/MCC,N,"$2,112.82 ","$6,810.71 ","$3,182.58 ","$6,810.71 ",20161001
438,DRG,DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC,N,"$2,648.01 ","$6,966.21 ","$4,769.05 ","$6,966.21 ",20161001
439,DRG,DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC,N,"$2,434.92 ","$5,679.36 ","$4,093.24 ","$5,679.36 ",20161001
440,DRG,DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC,N,"$2,292.40 ","$5,767.06 ","$3,807.40 ","$5,767.06 ",20161001
441,DRG,"DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W MCC",N,"$3,091.11 ","$7,626.13 ","$5,669.85 ","$7,626.13 ",20161001
442,DRG,"DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC",N,"$2,854.22 ","$5,983.62 ","$4,736.82 ","$5,983.62 ",20161001
443,DRG,"DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC/MCC",N,"$2,965.06 ","$6,565.62 ","$4,846.87 ","$6,565.62 ",20161001
444,DRG,DISORDERS OF THE BILIARY TRACT W MCC,N,"$3,043.72 ","$8,027.25 ","$5,246.52 ","$8,027.25 ",20161001
445,DRG,DISORDERS OF THE BILIARY TRACT W CC,N,"$3,048.76 ","$8,550.97 ","$4,874.74 ","$8,550.97 ",20161001
446,DRG,DISORDERS OF THE BILIARY TRACT W/O CC/MCC,N,"$2,897.20 ","$9,045.61 ","$4,530.70 ","$9,045.61 ",20161001
453,DRG,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W MCC,S,"$3,481.31 ","$37,279.51 ","$7,374.64 ","$37,279.51 ",20161001
454,DRG,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W CC,S,"$3,349.49 ","$52,999.16 ","$6,688.39 ","$52,999.16 ",20161001
455,DRG,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O CC/MCC,S,"$2,924.76 ","$65,359.95 ","$5,529.88 ","$65,359.95 ",20161001
456,DRG,SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W MCC,S,"$3,520.79 ","$31,097.02 ","$7,038.05 ","$31,097.02 ",20161001
457,DRG,SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W CC,S,"$3,292.03 ","$39,802.66 ","$6,783.35 ","$39,802.66 ",20161001
458,DRG,SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W/O CC/MCC,S,"$2,795.73 ","$49,971.89 ","$5,801.65 ","$49,971.89 ",20161001
459,DRG,SPINAL FUSION EXCEPT CERVICAL W MCC,S,"$2,792.43 ","$25,083.59 ","$5,777.27 ","$25,083.59 ",20161001
460,DRG,SPINAL FUSION EXCEPT CERVICAL W/O MCC,S,"$2,704.59 ","$41,102.50 ","$5,287.60 ","$41,102.50 ",20161001
461,DRG,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W MCC,S,"$2,882.07 ","$21,133.64 ","$5,811.45 ","$21,133.64 ",20161001
462,DRG,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC,S,"$2,989.71 ","$32,341.18 ","$4,248.44 ","$32,341.18 ",20161001
463,DRG,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC",S,"$3,312.86 ","$8,982.00 ","$6,253.83 ","$8,982.00 ",20161001
464,DRG,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W CC",S,"$3,195.13 ","$12,235.37 ","$5,920.86 ","$12,235.37 ",20161001
465,DRG,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W/O CC/MCC",S,"$3,293.60 ","$16,511.66 ","$6,528.83 ","$16,511.66 ",20161001
466,DRG,REVISION OF HIP OR KNEE REPLACEMENT W MCC,S,"$2,898.85 ","$18,838.33 ","$5,687.36 ","$18,838.33 ",20161001
467,DRG,REVISION OF HIP OR KNEE REPLACEMENT W CC,S,"$2,883.60 ","$28,390.44 ","$5,085.79 ","$28,390.44 ",20161001
468,DRG,REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC,S,"$2,871.65 ","$34,274.35 ","$4,817.26 ","$34,274.35 ",20161001
469,DRG,MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC,S,"$3,004.29 ","$16,150.59 ","$5,796.46 ","$16,150.59 ",20161001
470,DRG,MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC,S,"$2,791.14 ","$24,968.57 ","$4,776.98 ","$24,968.57 ",20161001
471,DRG,CERVICAL SPINAL FUSION W MCC,S,"$3,227.50 ","$20,787.54 ","$6,733.27 ","$20,787.54 ",20161001
472,DRG,CERVICAL SPINAL FUSION W CC,S,"$3,455.13 ","$37,070.90 ","$6,883.85 ","$37,070.90 ",20161001
473,DRG,CERVICAL SPINAL FUSION W/O CC/MCC,S,"$2,715.42 ","$49,236.03 ","$5,528.39 ","$49,236.03 ",20161001
474,DRG,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W MCC,S,"$2,857.77 ","$8,771.81 ","$5,077.85 ","$8,771.81 ",20161001
475,DRG,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W CC,S,"$2,896.99 ","$8,461.84 ","$4,719.24 ","$8,461.84 ",20161001
476,DRG,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W/O CC/MCC,S,"$2,741.09 ","$10,547.91 ","$4,862.33 ","$10,547.91 ",20161001
477,DRG,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC,S,"$2,876.52 ","$8,740.91 ","$4,947.79 ","$8,740.91 ",20161001
478,DRG,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC,S,"$2,964.95 ","$11,447.21 ","$4,618.44 ","$11,447.21 ",20161001
479,DRG,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC,S,"$2,823.32 ","$15,343.46 ","$4,552.73 ","$15,343.46 ",20161001
480,DRG,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC,S,"$3,009.27 ","$12,585.91 ","$5,696.70 ","$12,585.91 ",20161001
481,DRG,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC,S,"$2,911.37 ","$13,514.32 ","$5,023.73 ","$13,514.32 ",20161001
482,DRG,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC,S,"$3,143.34 ","$15,308.87 ","$5,274.50 ","$15,308.87 ",20161001
483,DRG,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,S,"$2,801.77 ","$40,193.29 ","$5,146.03 ","$40,193.29 ",20161001
485,DRG,KNEE PROCEDURES W PDX OF INFECTION W MCC,S,"$2,667.38 ","$9,705.07 ","$5,049.72 ","$9,705.07 ",20161001
486,DRG,KNEE PROCEDURES W PDX OF INFECTION W CC,S,"$2,640.52 ","$10,390.62 ","$4,494.30 ","$10,390.62 ",20161001
487,DRG,KNEE PROCEDURES W PDX OF INFECTION W/O CC/MCC,S,"$2,469.27 ","$10,887.77 ","$3,967.84 ","$10,887.77 ",20161001
488,DRG,KNEE PROCEDURES W/O PDX OF INFECTION W CC/MCC,S,"$2,869.03 ","$15,463.83 ","$5,354.56 ","$15,463.83 ",20161001
489,DRG,KNEE PROCEDURES W/O PDX OF INFECTION W/O CC/MCC,S,"$3,075.20 ","$22,015.80 ","$5,321.95 ","$22,015.80 ",20161001
492,DRG,"LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W MCC",S,"$3,006.72 ","$14,426.20 ","$5,791.59 ","$14,426.20 ",20161001
493,DRG,"LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC",S,"$3,051.12 ","$16,803.09 ","$5,190.84 ","$16,803.09 ",20161001
494,DRG,"LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC",S,"$2,982.96 ","$19,327.75 ","$4,767.49 ","$19,327.75 ",20161001
495,DRG,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W MCC,S,"$3,211.26 ","$9,255.13 ","$6,035.29 ","$9,255.13 ",20161001
496,DRG,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W CC,S,"$3,166.39 ","$12,827.02 ","$5,292.46 ","$12,827.02 ",20161001
497,DRG,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W/O CC/MCC,S,"$3,184.21 ","$20,412.32 ","$5,600.14 ","$20,412.32 ",20161001
498,DRG,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W CC/MCC,S,"$2,860.37 ","$10,612.14 ","$5,455.00 ","$10,612.14 ",20161001
499,DRG,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W/O CC/MCC,S,"$3,276.06 ","$17,603.15 ","$4,818.12 ","$17,603.15 ",20161001
500,DRG,SOFT TISSUE PROCEDURES W MCC,S,"$3,033.85 ","$8,024.18 ","$5,607.80 ","$8,024.18 ",20161001
501,DRG,SOFT TISSUE PROCEDURES W CC,S,"$2,982.42 ","$9,593.93 ","$5,024.04 ","$9,593.93 ",20161001
502,DRG,SOFT TISSUE PROCEDURES W/O CC/MCC,S,"$3,281.77 ","$15,896.03 ","$5,448.57 ","$15,896.03 ",20161001
503,DRG,FOOT PROCEDURES W MCC,S,"$3,063.87 ","$8,391.54 ","$5,169.13 ","$8,391.54 ",20161001
504,DRG,FOOT PROCEDURES W CC,S,"$3,173.47 ","$9,362.04 ","$5,037.23 ","$9,362.04 ",20161001
505,DRG,FOOT PROCEDURES W/O CC/MCC,S,"$3,678.44 ","$17,117.27 ","$6,000.64 ","$17,117.27 ",20161001
506,DRG,MAJOR THUMB OR JOINT PROCEDURES,S,"$2,983.62 ","$10,215.02 ","$4,905.20 ","$10,215.02 ",20161001
507,DRG,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES W CC/MCC,S,"$3,128.93 ","$12,675.10 ","$5,162.96 ","$12,675.10 ",20161001
508,DRG,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES W/O CC/MCC,S,"$2,899.14 ","$23,348.10 ","$5,655.83 ","$23,348.10 ",20161001
509,DRG,ARTHROSCOPY,S,"$3,420.51 ","$13,262.95 ","$5,023.74 ","$13,262.95 ",20161001
510,DRG,"SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W MCC",S,"$3,288.17 ","$16,503.58 ","$6,621.17 ","$16,503.58 ",20161001
511,DRG,"SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W CC",S,"$3,349.07 ","$18,596.89 ","$5,831.97 ","$18,596.89 ",20161001
512,DRG,"SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W/O CC/MCC",S,"$3,072.90 ","$22,684.38 ","$5,216.66 ","$22,684.38 ",20161001
513,DRG,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W CC/MCC",S,"$2,997.68 ","$10,223.67 ","$5,325.02 ","$10,223.67 ",20161001
514,DRG,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W/O CC/MCC",S,"$3,103.16 ","$13,421.74 ","$5,506.51 ","$13,421.74 ",20161001
515,DRG,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W MCC,S,"$3,226.69 ","$12,247.38 ","$6,175.20 ","$12,247.38 ",20161001
516,DRG,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC,S,"$3,100.71 ","$15,027.91 ","$5,708.02 ","$15,027.91 ",20161001
517,DRG,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC/MCC,S,"$3,114.96 ","$23,254.72 ","$5,692.47 ","$23,254.72 ",20161001
518,DRG,BACK & NECK PROC EXC SPINAL FUSION W MCC OR DISC DEVICE/NEUROSTIM,S,"$3,403.40 ","$20,087.63 ","$6,702.81 ","$20,087.63 ",20161001
519,DRG,BACK & NECK PROC EXC SPINAL FUSION W CC,S,"$3,113.42 ","$16,416.50 ","$5,693.70 ","$16,416.50 ",20161001
520,DRG,BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC,S,"$3,076.93 ","$22,278.91 ","$5,251.85 ","$22,278.91 ",20161001
533,DRG,FRACTURES OF FEMUR W MCC,N,"$2,663.46 ","$5,978.34 ","$5,047.07 ","$5,978.34 ",20161001
534,DRG,FRACTURES OF FEMUR W/O MCC,N,"$3,079.12 ","$5,210.45 ","$5,450.63 ","$5,210.45 ",20161001
535,DRG,FRACTURES OF HIP & PELVIS W MCC,N,"$2,699.78 ","$5,711.41 ","$5,005.41 ","$5,711.41 ",20161001
536,DRG,FRACTURES OF HIP & PELVIS W/O MCC,N,"$2,612.01 ","$4,278.11 ","$4,989.71 ","$4,278.11 ",20161001
537,DRG,"SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH W CC/MCC",N,"$2,715.03 ","$5,567.41 ","$4,373.36 ","$5,567.41 ",20161001
538,DRG,"SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH W/O CC/MCC",N,"$2,868.58 ","$5,682.00 ","$5,022.85 ","$5,682.00 ",20161001
539,DRG,OSTEOMYELITIS W MCC,N,"$2,707.64 ","$3,722.41 ","$4,122.42 ","$3,722.41 ",20161001
540,DRG,OSTEOMYELITIS W CC,N,"$2,765.07 ","$4,028.50 ","$4,245.73 ","$4,028.50 ",20161001
541,DRG,OSTEOMYELITIS W/O CC/MCC,N,"$2,312.56 ","$3,492.32 ","$3,846.89 ","$3,492.32 ",20161001
542,DRG,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W MCC,N,"$3,346.79 ","$6,905.87 ","$5,667.59 ","$6,905.87 ",20161001
543,DRG,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC,N,"$3,345.30 ","$6,353.43 ","$5,220.58 ","$6,353.43 ",20161001
544,DRG,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W/O CC/MCC,N,"$3,518.32 ","$6,168.80 ","$5,908.30 ","$6,168.80 ",20161001
545,DRG,CONNECTIVE TISSUE DISORDERS W MCC,N,"$3,358.61 ","$8,207.30 ","$6,091.72 ","$8,207.30 ",20161001
546,DRG,CONNECTIVE TISSUE DISORDERS W CC,N,"$3,207.35 ","$6,939.70 ","$5,323.24 ","$6,939.70 ",20161001
547,DRG,CONNECTIVE TISSUE DISORDERS W/O CC/MCC,N,"$3,235.30 ","$7,149.43 ","$5,403.89 ","$7,149.43 ",20161001
548,DRG,SEPTIC ARTHRITIS W MCC,N,"$2,777.79 ","$4,596.31 ","$4,242.06 ","$4,596.31 ",20161001
549,DRG,SEPTIC ARTHRITIS W CC,N,"$2,706.01 ","$4,524.01 ","$4,340.28 ","$4,524.01 ",20161001
550,DRG,SEPTIC ARTHRITIS W/O CC/MCC,N,"$2,509.54 ","$4,427.55 ","$4,262.45 ","$4,427.55 ",20161001
551,DRG,MEDICAL BACK PROBLEMS W MCC,N,"$3,084.33 ","$7,092.66 ","$5,975.62 ","$7,092.66 ",20161001
552,DRG,MEDICAL BACK PROBLEMS W/O MCC,N,"$3,122.96 ","$6,664.00 ","$5,702.80 ","$6,664.00 ",20161001
553,DRG,BONE DISEASES & ARTHROPATHIES W MCC,N,"$2,889.55 ","$6,013.63 ","$4,831.27 ","$6,013.63 ",20161001
554,DRG,BONE DISEASES & ARTHROPATHIES W/O MCC,N,"$2,642.90 ","$3,794.29 ","$4,931.59 ","$3,794.29 ",20161001
555,DRG,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W MCC,N,"$2,731.31 ","$6,568.57 ","$4,665.33 ","$6,568.57 ",20161001
556,DRG,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W/O MCC,N,"$2,583.90 ","$5,688.46 ","$4,212.86 ","$5,688.46 ",20161001
557,DRG,"TENDONITIS, MYOSITIS & BURSITIS W MCC",N,"$2,603.70 ","$5,191.13 ","$4,413.42 ","$5,191.13 ",20161001
558,DRG,"TENDONITIS, MYOSITIS & BURSITIS W/O MCC",N,"$2,561.54 ","$4,736.76 ","$4,181.57 ","$4,736.76 ",20161001
559,DRG,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC",N,"$2,474.64 ","$3,948.88 ","$4,264.31 ","$3,948.88 ",20161001
560,DRG,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC",N,"$2,466.11 ","$3,797.71 ","$4,001.79 ","$3,797.71 ",20161001
561,DRG,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC",N,"$1,958.89 ","$3,837.14 ","$3,427.39 ","$3,837.14 ",20161001
562,DRG,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W MCC",N,"$3,071.32 ","$6,950.92 ","$5,589.25 ","$6,950.92 ",20161001
563,DRG,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC",N,"$3,074.70 ","$5,757.38 ","$5,199.40 ","$5,757.38 ",20161001
564,DRG,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W MCC,N,"$2,839.18 ","$5,251.44 ","$4,775.44 ","$5,251.44 ",20161001
565,DRG,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC,N,"$2,898.55 ","$5,247.44 ","$4,918.12 ","$5,247.44 ",20161001
566,DRG,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W/O CC/MCC,N,"$2,360.25 ","$4,645.42 ","$3,929.25 ","$4,645.42 ",20161001
570,DRG,SKIN DEBRIDEMENT W MCC,S,"$2,854.50 ","$4,880.61 ","$4,581.74 ","$4,880.61 ",20161001
571,DRG,SKIN DEBRIDEMENT W CC,S,"$2,730.72 ","$5,973.42 ","$4,446.14 ","$5,973.42 ",20161001
572,DRG,SKIN DEBRIDEMENT W/O CC/MCC,S,"$2,520.65 ","$6,776.07 ","$4,437.95 ","$6,776.07 ",20161001
573,DRG,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W MCC,S,"$2,658.57 ","$5,688.99 ","$4,771.38 ","$5,688.99 ",20161001
574,DRG,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W CC,S,"$3,157.24 ","$7,275.74 ","$5,596.33 ","$7,275.74 ",20161001
575,DRG,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W/O CC/MCC,S,"$2,859.82 ","$7,319.39 ","$4,750.61 ","$7,319.39 ",20161001
576,DRG,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W MCC,S,"$3,286.78 ","$10,865.91 ","$6,954.08 ","$10,865.91 ",20161001
577,DRG,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W CC,S,"$4,060.38 ","$15,930.86 ","$7,807.84 ","$15,930.86 ",20161001
578,DRG,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W/O CC/MCC,S,"$4,580.00 ","$22,418.69 ","$8,847.16 ","$22,418.69 ",20161001
579,DRG,"OTHER SKIN, SUBCUT TISS & BREAST PROC W MCC",S,"$3,028.90 ","$7,091.08 ","$5,466.40 ","$7,091.08 ",20161001
580,DRG,"OTHER SKIN, SUBCUT TISS & BREAST PROC W CC",S,"$3,699.84 ","$12,692.47 ","$6,454.56 ","$12,692.47 ",20161001
581,DRG,"OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC",S,"$4,280.10 ","$24,863.92 ","$7,959.26 ","$24,863.92 ",20161001
582,DRG,MASTECTOMY FOR MALIGNANCY W CC/MCC,S,"$3,886.59 ","$25,009.42 ","$7,202.05 ","$25,009.42 ",20161001
583,DRG,MASTECTOMY FOR MALIGNANCY W/O CC/MCC,S,"$3,659.62 ","$33,041.21 ","$6,971.75 ","$33,041.21 ",20161001
584,DRG,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W CC/MCC",S,"$3,429.86 ","$15,673.25 ","$6,331.32 ","$15,673.25 ",20161001
585,DRG,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W/O CC/MCC",S,"$3,470.03 ","$29,206.05 ","$7,487.66 ","$29,206.05 ",20161001
592,DRG,SKIN ULCERS W MCC,N,"$2,525.73 ","$3,238.85 ","$4,028.55 ","$3,238.85 ",20161001
593,DRG,SKIN ULCERS W CC,N,"$2,680.45 ","$3,777.81 ","$4,306.73 ","$3,777.81 ",20161001
594,DRG,SKIN ULCERS W/O CC/MCC,N,"$2,162.91 ","$3,024.24 ","$3,761.75 ","$3,024.24 ",20161001
595,DRG,MAJOR SKIN DISORDERS W MCC,N,"$3,087.23 ","$6,059.38 ","$6,445.30 ","$6,059.38 ",20161001
596,DRG,MAJOR SKIN DISORDERS W/O MCC,N,"$3,231.72 ","$4,927.47 ","$6,095.99 ","$4,927.47 ",20161001
597,DRG,MALIGNANT BREAST DISORDERS W MCC,N,"$3,012.71 ","$6,330.19 ","$5,271.98 ","$6,330.19 ",20161001
598,DRG,MALIGNANT BREAST DISORDERS W CC,N,"$2,988.10 ","$5,463.29 ","$5,027.95 ","$5,463.29 ",20161001
599,DRG,MALIGNANT BREAST DISORDERS W/O CC/MCC,N,"$4,139.50 ","$6,761.83 ","$5,171.91 ","$6,761.83 ",20161001
600,DRG,NON-MALIGNANT BREAST DISORDERS W CC/MCC,N,"$2,690.96 ","$5,067.44 ","$4,426.02 ","$5,067.44 ",20161001
601,DRG,NON-MALIGNANT BREAST DISORDERS W/O CC/MCC,N,"$2,903.57 ","$5,184.18 ","$4,904.01 ","$5,184.18 ",20161001
602,DRG,CELLULITIS W MCC,N,"$2,741.94 ","$5,294.60 ","$4,589.94 ","$5,294.60 ",20161001
603,DRG,CELLULITIS W/O MCC,N,"$2,556.89 ","$4,235.28 ","$4,116.73 ","$4,235.28 ",20161001
604,DRG,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W MCC",N,"$3,306.95 ","$7,780.50 ","$5,863.67 ","$7,780.50 ",20161001
605,DRG,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC",N,"$3,438.62 ","$7,799.51 ","$5,837.11 ","$7,799.51 ",20161001
606,DRG,MINOR SKIN DISORDERS W MCC,N,"$3,131.76 ","$5,607.28 ","$5,572.89 ","$5,607.28 ",20161001
607,DRG,MINOR SKIN DISORDERS W/O MCC,N,"$2,976.88 ","$4,546.13 ","$5,001.62 ","$4,546.13 ",20161001
614,DRG,ADRENAL & PITUITARY PROCEDURES W CC/MCC,S,"$3,623.25 ","$18,025.03 ","$7,002.58 ","$18,025.03 ",20161001
615,DRG,ADRENAL & PITUITARY PROCEDURES W/O CC/MCC,S,"$3,458.79 ","$26,751.56 ","$6,864.49 ","$26,751.56 ",20161001
616,DRG,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W MCC",S,"$2,686.50 ","$7,708.16 ","$4,674.44 ","$7,708.16 ",20161001
617,DRG,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W CC",S,"$2,615.58 ","$7,541.00 ","$4,143.02 ","$7,541.00 ",20161001
618,DRG,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W/O CC/MCC",S,"$2,515.76 ","$7,345.05 ","$3,858.89 ","$7,345.05 ",20161001
619,DRG,O.R. PROCEDURES FOR OBESITY W MCC,S,"$2,990.18 ","$18,936.71 ","$6,250.56 ","$18,936.71 ",20161001
620,DRG,O.R. PROCEDURES FOR OBESITY W CC,S,"$3,159.28 ","$27,018.81 ","$6,042.07 ","$27,018.81 ",20161001
621,DRG,O.R. PROCEDURES FOR OBESITY W/O CC/MCC,S,"$2,782.59 ","$32,884.76 ","$4,922.18 ","$32,884.76 ",20161001
622,DRG,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W MCC",S,"$3,056.19 ","$5,980.57 ","$4,940.40 ","$5,980.57 ",20161001
623,DRG,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC",S,"$3,215.66 ","$6,652.42 ","$5,335.34 ","$6,652.42 ",20161001
624,DRG,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W/O CC/MCC",S,"$4,517.92 ","$12,927.83 ","$10,407.72 ","$12,927.83 ",20161001
625,DRG,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W MCC",S,"$3,116.20 ","$13,146.92 ","$5,892.81 ","$13,146.92 ",20161001
626,DRG,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W CC",S,"$3,650.20 ","$20,946.15 ","$6,308.46 ","$20,946.15 ",20161001
627,DRG,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W/O CC/MCC",S,"$3,238.89 ","$27,835.26 ","$5,246.10 ","$27,835.26 ",20161001
628,DRG,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W MCC",S,"$2,702.39 ","$8,828.31 ","$4,824.06 ","$8,828.31 ",20161001
629,DRG,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC",S,"$2,921.18 ","$8,213.53 ","$4,563.35 ","$8,213.53 ",20161001
630,DRG,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W/O CC/MCC",S,"$2,866.43 ","$13,920.18 ","$4,628.66 ","$13,920.18 ",20161001
637,DRG,DIABETES W MCC,N,"$2,810.54 ","$6,141.74 ","$5,087.67 ","$6,141.74 ",20161001
638,DRG,DIABETES W CC,N,"$2,754.07 ","$5,034.65 ","$4,713.40 ","$5,034.65 ",20161001
639,DRG,DIABETES W/O CC/MCC,N,"$2,749.13 ","$5,210.56 ","$4,631.06 ","$5,210.56 ",20161001
640,DRG,"MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W MCC",N,"$2,876.44 ","$6,128.22 ","$4,901.49 ","$6,128.22 ",20161001
641,DRG,"MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W/O MCC",N,"$2,620.65 ","$5,013.84 ","$4,486.25 ","$5,013.84 ",20161001
642,DRG,INBORN AND OTHER DISORDERS OF METABOLISM,N,"$2,665.22 ","$8,394.35 ","$4,993.99 ","$8,394.35 ",20161001
643,DRG,ENDOCRINE DISORDERS W MCC,N,"$3,188.77 ","$6,221.65 ","$5,582.71 ","$6,221.65 ",20161001
644,DRG,ENDOCRINE DISORDERS W CC,N,"$3,006.13 ","$5,395.35 ","$4,974.08 ","$5,395.35 ",20161001
645,DRG,ENDOCRINE DISORDERS W/O CC/MCC,N,"$3,154.37 ","$5,925.59 ","$5,261.63 ","$5,925.59 ",20161001
652,DRG,KIDNEY TRANSPLANT,S,"$3,708.41 ","$40,728.47 ","$7,263.03 ","$40,728.47 ",20161001
653,DRG,MAJOR BLADDER PROCEDURES W MCC,S,"$3,250.90 ","$12,027.35 ","$6,065.17 ","$12,027.35 ",20161001
654,DRG,MAJOR BLADDER PROCEDURES W CC,S,"$3,250.54 ","$13,534.42 ","$5,691.96 ","$13,534.42 ",20161001
655,DRG,MAJOR BLADDER PROCEDURES W/O CC/MCC,S,"$3,292.28 ","$17,046.46 ","$5,894.56 ","$17,046.46 ",20161001
656,DRG,KIDNEY & URETER PROCEDURES FOR NEOPLASM W MCC,S,"$3,211.66 ","$14,180.98 ","$6,089.25 ","$14,180.98 ",20161001
657,DRG,KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC,S,"$3,202.88 ","$16,308.97 ","$5,788.79 ","$16,308.97 ",20161001
658,DRG,KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC,S,"$3,063.14 ","$22,349.58 ","$5,451.19 ","$22,349.58 ",20161001
659,DRG,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W MCC,S,"$3,436.62 ","$10,766.50 ","$6,274.58 ","$10,766.50 ",20161001
660,DRG,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC,S,"$3,739.44 ","$14,205.91 ","$6,291.34 ","$14,205.91 ",20161001
661,DRG,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC,S,"$3,212.30 ","$23,347.78 ","$5,432.54 ","$23,347.78 ",20161001
662,DRG,MINOR BLADDER PROCEDURES W MCC,S,"$3,004.50 ","$8,802.74 ","$5,372.60 ","$8,802.74 ",20161001
663,DRG,MINOR BLADDER PROCEDURES W CC,S,"$2,872.80 ","$10,350.18 ","$4,576.95 ","$10,350.18 ",20161001
664,DRG,MINOR BLADDER PROCEDURES W/O CC/MCC,S,"$2,686.58 ","$18,455.57 ","$4,266.37 ","$18,455.57 ",20161001
665,DRG,PROSTATECTOMY W MCC,S,"$3,096.25 ","$7,976.24 ","$4,961.75 ","$7,976.24 ",20161001
666,DRG,PROSTATECTOMY W CC,S,"$3,309.54 ","$9,688.91 ","$4,936.58 ","$9,688.91 ",20161001
667,DRG,PROSTATECTOMY W/O CC/MCC,S,"$2,931.96 ","$12,535.40 ","$4,281.04 ","$12,535.40 ",20161001
668,DRG,TRANSURETHRAL PROCEDURES W MCC,S,"$2,883.03 ","$8,701.78 ","$5,004.73 ","$8,701.78 ",20161001
669,DRG,TRANSURETHRAL PROCEDURES W CC,S,"$3,229.05 ","$12,339.16 ","$5,350.79 ","$12,339.16 ",20161001
670,DRG,TRANSURETHRAL PROCEDURES W/O CC/MCC,S,"$3,113.47 ","$13,468.79 ","$4,651.55 ","$13,468.79 ",20161001
671,DRG,URETHRAL PROCEDURES W CC/MCC,S,"$2,947.00 ","$10,273.43 ","$4,982.65 ","$10,273.43 ",20161001
672,DRG,URETHRAL PROCEDURES W/O CC/MCC,S,"$3,762.87 ","$19,183.90 ","$5,045.03 ","$19,183.90 ",20161001
673,DRG,OTHER KIDNEY & URINARY TRACT PROCEDURES W MCC,S,"$3,122.21 ","$9,360.39 ","$5,149.65 ","$9,360.39 ",20161001
674,DRG,OTHER KIDNEY & URINARY TRACT PROCEDURES W CC,S,"$2,975.82 ","$10,019.41 ","$4,839.27 ","$10,019.41 ",20161001
675,DRG,OTHER KIDNEY & URINARY TRACT PROCEDURES W/O CC/MCC,S,"$2,795.08 ","$17,315.86 ","$4,089.26 ","$17,315.86 ",20161001
682,DRG,RENAL FAILURE W MCC,N,"$2,748.31 ","$6,189.21 ","$4,742.64 ","$6,189.21 ",20161001
683,DRG,RENAL FAILURE W CC,N,"$2,653.60 ","$5,362.35 ","$4,412.26 ","$5,362.35 ",20161001
684,DRG,RENAL FAILURE W/O CC/MCC,N,"$2,402.10 ","$5,100.09 ","$4,068.18 ","$5,100.09 ",20161001
685,DRG,ADMIT FOR RENAL DIALYSIS,N,"$2,542.20 ","$6,726.31 ","$4,185.66 ","$6,726.31 ",20161001
686,DRG,KIDNEY & URINARY TRACT NEOPLASMS W MCC,N,"$2,975.64 ","$6,326.29 ","$5,343.48 ","$6,326.29 ",20161001
687,DRG,KIDNEY & URINARY TRACT NEOPLASMS W CC,N,"$3,341.59 ","$6,971.71 ","$5,161.37 ","$6,971.71 ",20161001
688,DRG,KIDNEY & URINARY TRACT NEOPLASMS W/O CC/MCC,N,"$3,160.40 ","$8,849.70 ","$5,301.98 ","$8,849.70 ",20161001
689,DRG,KIDNEY & URINARY TRACT INFECTIONS W MCC,N,"$2,665.34 ","$5,155.68 ","$4,480.84 ","$5,155.68 ",20161001
690,DRG,KIDNEY & URINARY TRACT INFECTIONS W/O MCC,N,"$2,618.52 ","$5,025.95 ","$4,387.22 ","$5,025.95 ",20161001
691,DRG,URINARY STONES W ESW LITHOTRIPSY W CC/MCC,N,"$2,608.64 ","$14,942.19 ","$4,658.60 ","$14,942.19 ",20161001
692,DRG,URINARY STONES W ESW LITHOTRIPSY W/O CC/MCC,N,"$2,201.98 ","$17,209.98 ","$4,312.70 ","$17,209.98 ",20161001
693,DRG,URINARY STONES W/O ESW LITHOTRIPSY W MCC,N,"$2,733.62 ","$8,156.33 ","$4,885.47 ","$8,156.33 ",20161001
694,DRG,URINARY STONES W/O ESW LITHOTRIPSY W/O MCC,N,"$2,738.54 ","$10,281.57 ","$4,583.72 ","$10,281.57 ",20161001
695,DRG,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W MCC,N,"$2,896.42 ","$5,719.62 ","$4,918.07 ","$5,719.62 ",20161001
696,DRG,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W/O MCC,N,"$2,953.28 ","$5,369.65 ","$4,644.41 ","$5,369.65 ",20161001
697,DRG,URETHRAL STRICTURE,N,"$3,073.48 ","$8,836.73 ","$5,484.05 ","$8,836.73 ",20161001
698,DRG,OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC,N,"$3,053.89 ","$6,115.21 ","$5,237.62 ","$6,115.21 ",20161001
699,DRG,OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC,N,"$3,112.09 ","$6,529.06 ","$5,043.41 ","$6,529.06 ",20161001
700,DRG,OTHER KIDNEY & URINARY TRACT DIAGNOSES W/O CC/MCC,N,"$3,233.52 ","$6,762.21 ","$5,129.48 ","$6,762.21 ",20161001
707,DRG,MAJOR MALE PELVIC PROCEDURES W CC/MCC,S,"$3,283.35 ","$22,394.89 ","$6,224.15 ","$22,394.89 ",20161001
708,DRG,MAJOR MALE PELVIC PROCEDURES W/O CC/MCC,S,"$2,924.37 ","$39,166.52 ","$4,889.60 ","$39,166.52 ",20161001
709,DRG,PENIS PROCEDURES W CC/MCC,S,"$2,921.00 ","$10,435.63 ","$5,779.20 ","$10,435.63 ",20161001
710,DRG,PENIS PROCEDURES W/O CC/MCC,S,"$2,962.21 ","$24,336.16 ","$4,442.95 ","$24,336.16 ",20161001
711,DRG,TESTES PROCEDURES W CC/MCC,S,"$3,054.11 ","$9,248.10 ","$5,795.41 ","$9,248.10 ",20161001
712,DRG,TESTES PROCEDURES W/O CC/MCC,S,"$3,515.89 ","$14,109.33 ","$5,343.79 ","$14,109.33 ",20161001
713,DRG,TRANSURETHRAL PROSTATECTOMY W CC/MCC,S,"$2,841.96 ","$10,145.73 ","$4,844.17 ","$10,145.73 ",20161001
714,DRG,TRANSURETHRAL PROSTATECTOMY W/O CC/MCC,S,"$3,228.61 ","$16,343.82 ","$4,998.84 ","$16,343.82 ",20161001
715,DRG,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC FOR MALIGNANCY W CC/MCC,S,"$3,202.97 ","$10,079.86 ","$5,230.58 ","$10,079.86 ",20161001
716,DRG,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC FOR MALIGNANCY W/O CC/MCC,S,"$3,345.87 ","$32,696.82 ","$5,402.46 ","$32,696.82 ",20161001
717,DRG,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W CC/MCC,S,"$2,826.53 ","$8,264.04 ","$5,032.86 ","$8,264.04 ",20161001
718,DRG,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W/O CC/MCC,S,"$2,919.31 ","$11,056.52 ","$4,420.76 ","$11,056.52 ",20161001
722,DRG,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM W MCC",N,"$3,154.47 ","$5,457.49 ","$4,936.44 ","$5,457.49 ",20161001
723,DRG,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM W CC",N,"$3,227.38 ","$5,859.53 ","$5,222.55 ","$5,859.53 ",20161001
724,DRG,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM W/O CC/MCC",N,"$3,280.41 ","$8,269.85 ","$4,618.77 ","$8,269.85 ",20161001
725,DRG,BENIGN PROSTATIC HYPERTROPHY W MCC,N,"$2,759.99 ","$4,996.23 ","$4,582.72 ","$4,996.23 ",20161001
726,DRG,BENIGN PROSTATIC HYPERTROPHY W/O MCC,N,"$3,169.68 ","$5,628.68 ","$4,947.82 ","$5,628.68 ",20161001
727,DRG,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W MCC,N,"$2,784.04 ","$5,679.13 ","$4,634.78 ","$5,679.13 ",20161001
728,DRG,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W/O MCC,N,"$2,675.58 ","$5,252.51 ","$4,538.04 ","$5,252.51 ",20161001
729,DRG,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES W CC/MCC,N,"$2,550.04 ","$4,753.71 ","$4,363.56 ","$4,753.71 ",20161001
730,DRG,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES W/O CC/MCC,N,"$3,184.18 ","$7,153.12 ","$5,418.53 ","$7,153.12 ",20161001
734,DRG,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY W CC/MCC",S,"$3,556.55 ","$14,976.10 ","$6,944.61 ","$14,976.10 ",20161001
735,DRG,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY W/O CC/MCC",S,"$3,376.93 ","$25,260.24 ","$5,381.66 ","$25,260.24 ",20161001
736,DRG,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W MCC,S,"$3,169.59 ","$11,717.04 ","$6,220.47 ","$11,717.04 ",20161001
737,DRG,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W CC,S,"$3,304.35 ","$13,242.02 ","$6,279.69 ","$13,242.02 ",20161001
738,DRG,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W/O CC/MCC,S,"$3,214.98 ","$17,068.49 ","$5,403.06 ","$17,068.49 ",20161001
739,DRG,"UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W MCC",S,"$3,332.22 ","$12,555.22 ","$6,356.41 ","$12,555.22 ",20161001
740,DRG,"UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W CC",S,"$3,442.74 ","$17,142.47 ","$6,308.96 ","$17,142.47 ",20161001
741,DRG,"UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC/MCC",S,"$3,212.73 ","$24,779.25 ","$5,360.73 ","$24,779.25 ",20161001
742,DRG,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC,S,"$2,893.23 ","$15,508.96 ","$5,669.86 ","$15,508.96 ",20161001
743,DRG,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC,S,"$2,630.20 ","$20,653.41 ","$4,907.21 ","$20,653.41 ",20161001
744,DRG,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W CC/MCC",S,"$3,437.65 ","$10,760.29 ","$5,950.65 ","$10,760.29 ",20161001
745,DRG,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W/O CC/MCC",S,"$3,124.98 ","$17,992.12 ","$5,147.75 ","$17,992.12 ",20161001
746,DRG,"VAGINA, CERVIX & VULVA PROCEDURES W CC/MCC",S,"$2,914.57 ","$10,920.53 ","$5,368.34 ","$10,920.53 ",20161001
747,DRG,"VAGINA, CERVIX & VULVA PROCEDURES W/O CC/MCC",S,"$2,809.31 ","$20,366.66 ","$4,853.34 ","$20,366.66 ",20161001
748,DRG,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,S,"$2,696.86 ","$23,638.10 ","$5,569.17 ","$23,638.10 ",20161001
749,DRG,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W CC/MCC,S,"$3,171.98 ","$11,029.49 ","$5,885.93 ","$11,029.49 ",20161001
750,DRG,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC,S,"$3,084.78 ","$18,759.96 ","$5,636.14 ","$18,759.96 ",20161001
754,DRG,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W MCC",N,"$2,983.46 ","$6,064.07 ","$5,066.30 ","$6,064.07 ",20161001
755,DRG,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC",N,"$2,998.73 ","$5,725.79 ","$4,939.15 ","$5,725.79 ",20161001
756,DRG,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC",N,"$2,251.29 ","$4,541.40 ","$3,720.96 ","$4,541.40 ",20161001
757,DRG,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W MCC",N,"$2,658.26 ","$5,597.65 ","$4,395.29 ","$5,597.65 ",20161001
758,DRG,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W CC",N,"$2,678.38 ","$5,259.50 ","$4,235.52 ","$5,259.50 ",20161001
759,DRG,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC",N,"$2,612.33 ","$5,319.28 ","$4,692.88 ","$5,319.28 ",20161001
760,DRG,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W CC/MCC,N,"$3,220.87 ","$7,024.38 ","$5,296.21 ","$7,024.38 ",20161001
761,DRG,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W/O CC/MCC,N,"$3,751.20 ","$8,718.25 ","$5,754.22 ","$8,718.25 ",20161001
765,DRG,CESAREAN SECTION W CC/MCC,S,"$2,736.09 ","$6,444.49 ","$5,237.16 ","$6,444.49 ",20161001
766,DRG,CESAREAN SECTION W/O CC/MCC,S,"$2,588.81 ","$7,149.17 ","$4,703.17 ","$7,149.17 ",20161001
767,DRG,VAGINAL DELIVERY W STERILIZATION &/OR D&C,S,"$2,533.63 ","$8,472.80 ","$3,947.85 ","$8,472.80 ",20161001
768,DRG,VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C,S,"$4,333.65 ","$8,787.45 ","$8,216.78 ","$8,787.45 ",20161001
769,DRG,POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE,S,"$2,576.91 ","$11,282.85 ","$5,248.46 ","$11,282.85 ",20161001
770,DRG,"ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",S,"$3,620.17 ","$12,943.81 ","$6,022.26 ","$12,943.81 ",20161001
774,DRG,VAGINAL DELIVERY W COMPLICATING DIAGNOSES,N,"$2,725.52 ","$5,634.48 ","$4,903.26 ","$5,634.48 ",20161001
775,DRG,VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES,N,"$2,654.10 ","$5,586.24 ","$5,065.16 ","$5,586.24 ",20161001
776,DRG,POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE,N,"$2,966.91 ","$4,588.56 ","$5,701.35 ","$4,588.56 ",20161001
777,DRG,ECTOPIC PREGNANCY,N,"$3,170.65 ","$17,230.10 ","$5,847.23 ","$17,230.10 ",20161001
778,DRG,THREATENED ABORTION,N,"$2,663.74 ","$3,092.40 ","$3,921.61 ","$3,092.40 ",20161001
779,DRG,ABORTION W/O D&C,N,"$3,385.97 ","$7,623.04 ","$5,370.51 ","$7,623.04 ",20161001
780,DRG,FALSE LABOR,N,"$2,154.45 ","$4,334.57 ","$4,021.65 ","$4,334.57 ",20161001
781,DRG,OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS,N,"$3,064.04 ","$3,598.41 ","$5,359.58 ","$3,598.41 ",20161001
782,DRG,OTHER ANTEPARTUM DIAGNOSES W/O MEDICAL COMPLICATIONS,N,"$2,672.26 ","$4,359.83 ","$4,464.09 ","$4,359.83 ",20161001
789,DRG,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",N,"$3,907.42 ","$8,212.81 ","$7,228.36 ","$8,212.81 ",20161001
790,DRG,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",N,"$3,279.16 ","$6,892.30 ","$6,066.13 ","$6,892.30 ",20161001
791,DRG,PREMATURITY W MAJOR PROBLEMS,N,"$2,555.83 ","$5,371.99 ","$4,728.06 ","$5,371.99 ",20161001
792,DRG,PREMATURITY W/O MAJOR PROBLEMS,N,"$1,853.44 ","$3,895.65 ","$3,428.69 ","$3,895.65 ",20161001
793,DRG,FULL TERM NEONATE W MAJOR PROBLEMS,N,"$2,113.39 ","$4,442.05 ","$3,909.59 ","$4,442.05 ",20161001
794,DRG,NEONATE W OTHER SIGNIFICANT PROBLEMS,N,"$1,141.45 ","$2,399.16 ","$2,111.58 ","$2,399.16 ",20161001
795,DRG,NORMAL NEWBORN,N,$831.12 ,"$1,746.88 ","$1,537.49 ","$1,746.88 ",20161001
799,DRG,SPLENECTOMY W MCC,S,"$2,760.72 ","$13,326.58 ","$5,695.30 ","$13,326.58 ",20161001
800,DRG,SPLENECTOMY W CC,S,"$3,151.39 ","$15,672.83 ","$5,868.67 ","$15,672.83 ",20161001
801,DRG,SPLENECTOMY W/O CC/MCC,S,"$2,681.81 ","$18,807.46 ","$4,475.63 ","$18,807.46 ",20161001
802,DRG,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W MCC,S,"$3,327.91 ","$9,962.91 ","$5,430.03 ","$9,962.91 ",20161001
803,DRG,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W CC,S,"$3,069.99 ","$11,277.33 ","$5,289.53 ","$11,277.33 ",20161001
804,DRG,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W/O CC/MCC,S,"$3,103.53 ","$15,654.99 ","$5,132.71 ","$15,654.99 ",20161001
808,DRG,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W MCC,N,"$3,456.07 ","$9,439.96 ","$5,783.11 ","$9,439.96 ",20161001
809,DRG,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC,N,"$2,959.57 ","$7,332.85 ","$4,669.71 ","$7,332.85 ",20161001
810,DRG,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W/O CC/MCC,N,"$3,053.55 ","$8,893.52 ","$4,975.88 ","$8,893.52 ",20161001
811,DRG,RED BLOOD CELL DISORDERS W MCC,N,"$2,862.84 ","$7,108.35 ","$4,770.23 ","$7,108.35 ",20161001
812,DRG,RED BLOOD CELL DISORDERS W/O MCC,N,"$2,629.22 ","$6,099.51 ","$4,271.94 ","$6,099.51 ",20161001
813,DRG,COAGULATION DISORDERS,N,"$3,238.77 ","$16,258.15 ","$5,514.93 ","$16,258.15 ",20161001
814,DRG,RETICULOENDOTHELIAL & IMMUNITY DISORDERS W MCC,N,"$3,292.45 ","$8,054.10 ","$6,064.52 ","$8,054.10 ",20161001
815,DRG,RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC,N,"$2,917.65 ","$6,842.41 ","$5,039.45 ","$6,842.41 ",20161001
816,DRG,RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC/MCC,N,"$2,532.91 ","$6,636.70 ","$4,639.75 ","$6,636.70 ",20161001
820,DRG,LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W MCC,S,"$3,670.90 ","$12,346.18 ","$6,429.87 ","$12,346.18 ",20161001
821,DRG,LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W CC,S,"$3,544.42 ","$14,559.03 ","$6,013.03 ","$14,559.03 ",20161001
822,DRG,LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W/O CC/MCC,S,"$3,489.21 ","$21,175.59 ","$5,712.15 ","$21,175.59 ",20161001
823,DRG,LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W MCC,S,"$3,942.06 ","$12,198.10 ","$6,621.94 ","$12,198.10 ",20161001
824,DRG,LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W CC,S,"$3,295.71 ","$11,124.81 ","$5,145.45 ","$11,124.81 ",20161001
825,DRG,LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W/O CC/MCC,S,"$3,207.79 ","$15,289.18 ","$5,221.38 ","$15,289.18 ",20161001
826,DRG,MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W MCC,S,"$3,356.86 ","$12,547.13 ","$6,658.23 ","$12,547.13 ",20161001
827,DRG,MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W CC,S,"$3,450.56 ","$13,462.78 ","$6,254.07 ","$13,462.78 ",20161001
828,DRG,MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W/O CC/MCC,S,"$3,357.59 ","$17,477.04 ","$6,005.63 ","$17,477.04 ",20161001
829,DRG,MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R. PROC W CC/MCC,S,"$3,690.13 ","$12,280.26 ","$6,166.72 ","$12,280.26 ",20161001
830,DRG,MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R. PROC W/O CC/MCC,S,"$4,213.49 ","$19,414.87 ","$7,005.15 ","$19,414.87 ",20161001
834,DRG,ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W MCC,N,"$3,989.70 ","$10,851.74 ","$6,176.76 ","$10,851.74 ",20161001
835,DRG,ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W CC,N,"$3,746.55 ","$9,440.71 ","$5,105.30 ","$9,440.71 ",20161001
836,DRG,ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W/O CC/MCC,N,"$3,629.52 ","$10,111.47 ","$5,076.71 ","$10,111.47 ",20161001
837,DRG,CHEMO W ACUTE LEUKEMIA AS SDX OR W HIGH DOSE CHEMO AGENT W MCC,N,"$3,741.59 ","$9,361.07 ","$5,198.39 ","$9,361.07 ",20161001
838,DRG,CHEMO W ACUTE LEUKEMIA AS SDX W CC OR HIGH DOSE CHEMO AGENT,N,"$3,768.66 ","$10,818.20 ","$5,221.30 ","$10,818.20 ",20161001
839,DRG,CHEMO W ACUTE LEUKEMIA AS SDX W/O CC/MCC,N,"$3,630.89 ","$7,506.37 ","$4,405.97 ","$7,506.37 ",20161001
840,DRG,LYMPHOMA & NON-ACUTE LEUKEMIA W MCC,N,"$3,714.53 ","$9,727.02 ","$5,955.26 ","$9,727.02 ",20161001
841,DRG,LYMPHOMA & NON-ACUTE LEUKEMIA W CC,N,"$3,442.14 ","$8,687.05 ","$5,242.81 ","$8,687.05 ",20161001
842,DRG,LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC/MCC,N,"$2,885.58 ","$9,086.28 ","$4,479.01 ","$9,086.28 ",20161001
843,DRG,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W MCC,N,"$2,985.88 ","$6,747.88 ","$4,986.78 ","$6,747.88 ",20161001
844,DRG,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC,N,"$2,916.07 ","$6,252.63 ","$4,744.72 ","$6,252.63 ",20161001
845,DRG,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC/MCC,N,"$2,417.80 ","$5,611.46 ","$3,663.90 ","$5,611.46 ",20161001
846,DRG,CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W MCC,N,"$3,727.95 ","$9,754.03 ","$5,254.60 ","$9,754.03 ",20161001
847,DRG,CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W CC,N,"$3,398.07 ","$10,826.08 ","$4,279.07 ","$10,826.08 ",20161001
848,DRG,CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W/O CC/MCC,N,"$3,061.93 ","$9,745.43 ","$5,038.77 ","$9,745.43 ",20161001
849,DRG,RADIOTHERAPY,N,"$3,846.30 ","$9,275.50 ","$5,810.13 ","$9,275.50 ",20161001
853,DRG,INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC,S,"$3,110.31 ","$10,524.72 ","$5,674.70 ","$10,524.72 ",20161001
854,DRG,INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC,S,"$2,786.74 ","$8,415.62 ","$4,660.60 ","$8,415.62 ",20161001
855,DRG,INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W/O CC/MCC,S,"$2,599.34 ","$10,486.45 ","$4,747.93 ","$10,486.45 ",20161001
856,DRG,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W MCC,S,"$2,933.29 ","$9,085.18 ","$5,627.13 ","$9,085.18 ",20161001
857,DRG,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC,S,"$2,911.24 ","$8,428.96 ","$4,809.21 ","$8,428.96 ",20161001
858,DRG,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W/O CC/MCC,S,"$2,702.86 ","$8,825.82 ","$4,332.86 ","$8,825.82 ",20161001
862,DRG,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W MCC,N,"$2,801.65 ","$5,835.68 ","$4,937.10 ","$5,835.68 ",20161001
863,DRG,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC,N,"$2,693.81 ","$5,041.24 ","$4,258.93 ","$5,041.24 ",20161001
864,DRG,FEVER,N,"$2,829.20 ","$6,519.54 ","$4,531.69 ","$6,519.54 ",20161001
865,DRG,VIRAL ILLNESS W MCC,N,"$3,205.87 ","$7,150.36 ","$5,622.84 ","$7,150.36 ",20161001
866,DRG,VIRAL ILLNESS W/O MCC,N,"$2,845.79 ","$5,727.73 ","$4,522.06 ","$5,727.73 ",20161001
867,DRG,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W MCC,N,"$3,261.89 ","$8,414.98 ","$5,687.02 ","$8,414.98 ",20161001
868,DRG,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W CC,N,"$2,932.44 ","$5,572.05 ","$4,577.33 ","$5,572.05 ",20161001
869,DRG,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W/O CC/MCC,N,"$2,517.03 ","$4,835.82 ","$4,669.43 ","$4,835.82 ",20161001
870,DRG,SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS,N,"$3,829.99 ","$10,942.83 ","$6,391.51 ","$10,942.83 ",20161001
871,DRG,SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC,N,"$3,038.26 ","$7,002.66 ","$5,232.98 ","$7,002.66 ",20161001
872,DRG,SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC,N,"$2,834.80 ","$5,313.37 ","$4,475.11 ","$5,313.37 ",20161001
876,DRG,O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,S,"$2,838.49 ","$4,154.22 ","$4,596.88 ","$4,154.22 ",20161001
880,DRG,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,N,"$2,110.92 ","$2,909.79 ","$3,670.30 ","$2,909.79 ",20161001
881,DRG,DEPRESSIVE NEUROSES,N,"$2,227.24 ",$828.82 ,"$3,268.42 ",$828.82 ,20161001
882,DRG,NEUROSES EXCEPT DEPRESSIVE,N,"$2,139.36 ",$724.76 ,"$3,213.32 ",$724.76 ,20161001
883,DRG,DISORDERS OF PERSONALITY & IMPULSE CONTROL,N,"$2,189.66 ",$755.68 ,"$3,189.23 ",$755.68 ,20161001
884,DRG,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,N,"$2,389.35 ","$1,418.32 ","$4,251.95 ","$1,418.32 ",20161001
885,DRG,PSYCHOSES,N,"$2,259.07 ",$664.74 ,"$3,306.68 ",$664.74 ,20161001
886,DRG,BEHAVIORAL & DEVELOPMENTAL DISORDERS,N,"$1,618.30 ",$652.81 ,"$2,837.57 ",$652.81 ,20161001
887,DRG,OTHER MENTAL DISORDER DIAGNOSES,N,"$1,247.60 ",$840.38 ,"$1,999.83 ",$840.38 ,20161001
894,DRG,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",N,"$1,827.55 ","$1,566.16 ","$3,791.42 ","$1,566.16 ",20161001
895,DRG,ALCOHOL/DRUG ABUSE OR DEPENDENCE W REHABILITATION THERAPY,N,"$1,648.61 ",$387.33 ,"$3,302.29 ",$387.33 ,20161001
896,DRG,ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC,N,"$2,648.22 ","$4,690.13 ","$4,938.44 ","$4,690.13 ",20161001
897,DRG,ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC,N,"$1,696.74 ","$1,183.83 ","$3,233.48 ","$1,183.83 ",20161001
901,DRG,WOUND DEBRIDEMENTS FOR INJURIES W MCC,S,"$3,203.85 ","$7,122.20 ","$5,822.80 ","$7,122.20 ",20161001
902,DRG,WOUND DEBRIDEMENTS FOR INJURIES W CC,S,"$3,138.24 ","$7,394.87 ","$5,196.09 ","$7,394.87 ",20161001
903,DRG,WOUND DEBRIDEMENTS FOR INJURIES W/O CC/MCC,S,"$3,036.45 ","$9,359.27 ","$5,335.05 ","$9,359.27 ",20161001
904,DRG,SKIN GRAFTS FOR INJURIES W CC/MCC,S,"$3,565.15 ","$10,501.93 ","$6,609.30 ","$10,501.93 ",20161001
905,DRG,SKIN GRAFTS FOR INJURIES W/O CC/MCC,S,"$3,244.55 ","$11,079.26 ","$6,588.08 ","$11,079.26 ",20161001
906,DRG,HAND PROCEDURES FOR INJURIES,S,"$2,950.53 ","$12,958.09 ","$6,400.56 ","$12,958.09 ",20161001
907,DRG,OTHER O.R. PROCEDURES FOR INJURIES W MCC,S,"$2,952.88 ","$11,415.58 ","$5,769.86 ","$11,415.58 ",20161001
908,DRG,OTHER O.R. PROCEDURES FOR INJURIES W CC,S,"$2,890.40 ","$11,243.38 ","$5,249.38 ","$11,243.38 ",20161001
909,DRG,OTHER O.R. PROCEDURES FOR INJURIES W/O CC/MCC,S,"$2,801.93 ","$14,430.22 ","$5,067.21 ","$14,430.22 ",20161001
913,DRG,TRAUMATIC INJURY W MCC,N,"$2,791.79 ","$6,093.36 ","$5,194.85 ","$6,093.36 ",20161001
914,DRG,TRAUMATIC INJURY W/O MCC,N,"$2,419.49 ","$5,353.75 ","$4,503.58 ","$5,353.75 ",20161001
915,DRG,ALLERGIC REACTIONS W MCC,N,"$2,868.90 ","$8,274.24 ","$5,817.78 ","$8,274.24 ",20161001
916,DRG,ALLERGIC REACTIONS W/O MCC,N,"$2,848.30 ","$5,457.41 ","$5,341.28 ","$5,457.41 ",20161001
917,DRG,POISONING & TOXIC EFFECTS OF DRUGS W MCC,N,"$2,897.33 ","$8,132.56 ","$5,426.37 ","$8,132.56 ",20161001
918,DRG,POISONING & TOXIC EFFECTS OF DRUGS W/O MCC,N,"$2,940.94 ","$5,857.83 ","$4,979.27 ","$5,857.83 ",20161001
919,DRG,COMPLICATIONS OF TREATMENT W MCC,N,"$2,892.88 ","$6,526.89 ","$5,095.16 ","$6,526.89 ",20161001
920,DRG,COMPLICATIONS OF TREATMENT W CC,N,"$2,925.11 ","$6,146.96 ","$4,947.36 ","$6,146.96 ",20161001
921,DRG,COMPLICATIONS OF TREATMENT W/O CC/MCC,N,"$2,713.00 ","$6,418.75 ","$4,612.36 ","$6,418.75 ",20161001
922,DRG,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG W MCC",N,"$3,886.15 ","$8,952.47 ","$7,177.82 ","$8,952.47 ",20161001
923,DRG,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O MCC",N,"$3,140.67 ","$5,446.40 ","$5,571.18 ","$5,446.40 ",20161001
927,DRG,EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV >96 HRS W SKIN GRAFT,S,"$3,501.42 ","$16,323.75 ","$9,211.29 ","$16,323.75 ",20161001
928,DRG,FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W CC/MCC,S,"$3,637.75 ","$8,818.49 ","$8,811.41 ","$8,818.49 ",20161001
929,DRG,FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W/O CC/MCC,S,"$3,382.59 ","$7,500.81 ","$8,609.02 ","$7,500.81 ",20161001
933,DRG,EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV >96 HRS W/O SKIN GRAFT,N,"$2,554.79 ","$11,119.50 ","$7,405.20 ","$11,119.50 ",20161001
934,DRG,FULL THICKNESS BURN W/O SKIN GRFT OR INHAL INJ,N,"$3,125.52 ","$5,372.67 ","$9,102.33 ","$5,372.67 ",20161001
935,DRG,NON-EXTENSIVE BURNS,N,"$3,271.71 ","$6,808.22 ","$9,155.57 ","$6,808.22 ",20161001
939,DRG,O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W MCC,S,"$2,694.54 ","$6,504.07 ","$5,485.84 ","$6,504.07 ",20161001
940,DRG,O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W CC,S,"$2,574.70 ","$6,635.16 ","$5,212.57 ","$6,635.16 ",20161001
941,DRG,O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W/O CC/MCC,S,"$2,585.46 ","$13,771.07 ","$5,714.78 ","$13,771.07 ",20161001
945,DRG,REHABILITATION W CC/MCC,N,"$1,971.05 ","$2,503.45 ","$3,519.43 ","$2,503.45 ",20161001
946,DRG,REHABILITATION W/O CC/MCC,N,"$1,774.66 ","$1,813.64 ","$2,626.35 ","$1,813.64 ",20161001
947,DRG,SIGNS & SYMPTOMS W MCC,N,"$2,668.89 ","$5,790.31 ","$4,526.47 ","$5,790.31 ",20161001
948,DRG,SIGNS & SYMPTOMS W/O MCC,N,"$2,598.53 ","$5,397.85 ","$4,207.31 ","$5,397.85 ",20161001
949,DRG,AFTERCARE W CC/MCC,N,"$2,483.09 ","$2,784.90 ","$3,907.76 ","$2,784.90 ",20161001
950,DRG,AFTERCARE W/O CC/MCC,N,"$1,520.29 ","$1,602.05 ","$2,491.42 ","$1,602.05 ",20161001
951,DRG,OTHER FACTORS INFLUENCING HEALTH STATUS,N,"$1,878.23 ","$2,426.03 ","$6,444.16 ","$2,426.03 ",20161001
955,DRG,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,S,"$3,826.45 ","$18,940.06 ","$8,261.27 ","$18,940.06 ",20161001
956,DRG,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",S,"$3,396.16 ","$17,041.66 ","$7,529.49 ","$17,041.66 ",20161001
957,DRG,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W MCC,S,"$3,077.33 ","$16,979.32 ","$7,255.41 ","$16,979.32 ",20161001
958,DRG,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W CC,S,"$3,263.19 ","$16,591.42 ","$7,175.63 ","$16,591.42 ",20161001
959,DRG,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC,S,"$2,996.19 ","$17,456.04 ","$6,548.73 ","$17,456.04 ",20161001
963,DRG,OTHER MULTIPLE SIGNIFICANT TRAUMA W MCC,N,"$2,673.67 ","$8,370.52 ","$6,117.81 ","$8,370.52 ",20161001
964,DRG,OTHER MULTIPLE SIGNIFICANT TRAUMA W CC,N,"$2,915.44 ","$7,531.61 ","$6,572.98 ","$7,531.61 ",20161001
965,DRG,OTHER MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC,N,"$2,991.71 ","$7,470.00 ","$7,027.97 ","$7,470.00 ",20161001
969,DRG,HIV W EXTENSIVE O.R. PROCEDURE W MCC,S,"$3,560.39 ","$11,615.30 ","$6,454.42 ","$11,615.30 ",20161001
970,DRG,HIV W EXTENSIVE O.R. PROCEDURE W/O MCC,S,"$2,784.29 ","$11,716.05 ","$5,065.24 ","$11,716.05 ",20161001
974,DRG,HIV W MAJOR RELATED CONDITION W MCC,N,"$3,332.70 ","$7,968.45 ","$5,743.96 ","$7,968.45 ",20161001
975,DRG,HIV W MAJOR RELATED CONDITION W CC,N,"$3,391.90 ","$6,069.61 ","$4,851.77 ","$6,069.61 ",20161001
976,DRG,HIV W MAJOR RELATED CONDITION W/O CC/MCC,N,"$3,014.13 ","$5,629.69 ","$4,538.14 ","$5,629.69 ",20161001
977,DRG,HIV W OR W/O OTHER RELATED CONDITION,N,"$3,306.65 ","$6,804.86 ","$4,785.45 ","$6,804.86 ",20161001
981,DRG,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC,S,"$2,909.88 ","$10,709.63 ","$5,337.13 ","$10,709.63 ",20161001
982,DRG,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC,S,"$2,688.37 ","$11,182.88 ","$4,646.20 ","$11,182.88 ",20161001
983,DRG,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC,S,"$2,493.44 ","$15,767.73 ","$4,347.54 ","$15,767.73 ",20161001
984,DRG,PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC,S,"$2,875.44 ","$7,427.42 ","$4,887.01 ","$7,427.42 ",20161001
985,DRG,PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC,S,"$2,807.85 ","$8,392.82 ","$4,467.06 ","$8,392.82 ",20161001
986,DRG,PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC,S,"$2,711.77 ","$11,261.69 ","$4,723.66 ","$11,261.69 ",20161001
987,DRG,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC,S,"$2,999.17 ","$8,056.54 ","$5,385.89 ","$8,056.54 ",20161001
988,DRG,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC,S,"$2,817.71 ","$8,407.96 ","$4,705.13 ","$8,407.96 ",20161001
989,DRG,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC,S,"$2,433.52 ","$11,118.78 ","$4,337.57 ","$11,118.78 ",20161001
000,SNF,SKILLED NURSING FACILITY PER DIEM,,$912.64 ,,,,20161001
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