Service Type DRG CPT/HCPCS CPT / DRG Description Gross or Average Charge Self Pay Cash Price Min Negotiated Rate Max Negotiated Rate Aetna Better Health MA Aetna Comm Aetna Medicare Aetna Signature Administrators AmeriHealth MA AmeriHealth MC Adv CBC Comm CBC Medicare Cigna Gateway MA Gateway Medicare Geisinger Comm Geisinger MA Geisinger Medicare Highmark Comm Highmark Choice Blue Highmark Medicare Humana Medicare Medicare Multiplan PA Health & Wellness PAMA Tower Health UHC Comm UHC MA UHC MA CHIP UPMC Comm UPMC MA UPMC MA CHIP Vibra Medicare Outpatient 10060 Drainage of skin abscess 943.00 271.77 154.48 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 876.69 701.35 179.92 185.37 181.74 754.40 166.29 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 Outpatient 10061 Drainage of skin abscess " 1,816.00 " 523.37 297.33 " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,688.64 " " 1,350.91 " 346.30 356.80 349.80 " 1,452.80 " 320.07 " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 Outpatient 10120 Remove foreign body " 1,816.00 " 523.37 297.33 " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,688.64 " " 1,350.91 " 346.30 356.80 349.80 " 1,452.80 " 320.07 " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 Outpatient 11042 Deb subq tissue 20 sq cm/< " 1,816.00 " 523.37 297.33 " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,688.64 " " 1,350.91 " 346.30 356.80 349.80 " 1,452.80 " 320.07 " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 Outpatient 11043 Deb musc/fascia 20 sq cm/< " 2,752.00 " 793.13 450.53 " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,559.39 " " 2,047.50 " 524.74 540.64 530.04 " 2,201.60 " 484.99 " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 Outpatient 11402 Exc tr-ext b9+marg 1.1-2 cm " 3,265.00 " 940.97 535.31 " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 3,036.89 " " 2,429.50 " 623.48 642.38 629.78 " 2,612.00 " 576.25 " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 Outpatient 11406 Exc tr-ext b9+marg >4.0 cm " 7,387.00 " " 2,128.93 " " 1,210.37 " " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 6,869.97 " " 5,495.95 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " Outpatient 11423 Exc h-f-nk-sp b9+marg 2.1-3 " 7,387.00 " " 2,128.93 " " 1,210.37 " " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 6,869.97 " " 5,495.95 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " Outpatient 11642 Exc f/e/e/n/l mal+mrg 1.1-2 " 3,265.00 " 940.97 535.31 " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 3,036.89 " " 2,429.50 " 623.48 642.38 629.78 " 2,612.00 " 576.25 " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 Outpatient 12001 Rpr s/n/ax/gen/trnk 2.5cm/< 943.00 271.77 154.48 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 876.69 701.35 179.92 185.37 181.74 754.40 166.29 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 Outpatient 12002 Rpr s/n/ax/gen/trnk2.6-7.5cm 943.00 271.77 154.48 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 876.69 701.35 179.92 185.37 181.74 754.40 166.29 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 Outpatient 12004 Rpr s/n/ax/gen/trk7.6-12.5cm 943.00 271.77 154.48 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 876.69 701.35 179.92 185.37 181.74 754.40 166.29 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 Outpatient 12005 Rpr s/n/a/gen/trk12.6-20.0cm " 1,816.00 " 523.37 297.33 " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,688.64 " " 1,350.91 " 346.30 356.80 349.80 " 1,452.80 " 320.07 " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 Outpatient 12011 Rpr f/e/e/n/l/m 2.5 cm/< 943.00 271.77 154.48 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 876.69 701.35 179.92 185.37 181.74 754.40 166.29 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 Outpatient 12013 Rpr f/e/e/n/l/m 2.6-5.0 cm 943.00 271.77 154.48 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 876.69 701.35 179.92 185.37 181.74 754.40 166.29 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 Outpatient 12031 Intmd rpr s/a/t/ext 2.5 cm/< " 1,816.00 " 523.37 297.33 " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,688.64 " " 1,350.91 " 346.30 356.80 349.80 " 1,452.80 " 320.07 " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 Outpatient 12032 Intmd rpr s/a/t/ext 2.6-7.5 " 1,816.00 " 523.37 297.33 " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,688.64 " " 1,350.91 " 346.30 356.80 349.80 " 1,452.80 " 320.07 " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 Outpatient 12034 Intmd rpr s/tr/ext 7.6-12.5 " 1,816.00 " 523.37 297.33 " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,688.64 " " 1,350.91 " 346.30 356.80 349.80 " 1,452.80 " 320.07 " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 Outpatient 12042 Intmd rpr n-hf/genit2.6-7.5 " 1,816.00 " 523.37 297.33 " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,688.64 " " 1,350.91 " 346.30 356.80 349.80 " 1,452.80 " 320.07 " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 Outpatient 12052 Intmd rpr face/mm 2.6-5.0 cm " 1,816.00 " 523.37 297.33 " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,688.64 " " 1,350.91 " 346.30 356.80 349.80 " 1,452.80 " 320.07 " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 Outpatient 16020 Dress/debrid p-thick burn s 943.00 271.77 154.48 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 876.69 701.35 179.92 185.37 181.74 754.40 166.29 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 Outpatient 16025 Dress/debrid p-thick burn m 943.00 271.77 154.48 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 876.69 701.35 179.92 185.37 181.74 754.40 166.29 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 Outpatient 17250 Chem caut of granltj tissue 943.00 271.77 154.48 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 876.69 701.35 179.92 185.37 181.74 754.40 166.29 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 Outpatient 19081 Bx breast 1st lesion strtctc " 7,387.00 " " 2,128.93 " " 1,210.37 " " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 6,869.97 " " 5,495.95 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " Outpatient 19083 Bx breast 1st lesion us imag " 7,387.00 " " 2,128.93 " " 1,210.37 " " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 6,869.97 " " 5,495.95 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " Outpatient 19120 Removal of breast lesion " 16,578.00 " " 4,777.78 " " 2,716.41 " " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 15,418.35 " " 12,334.62 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " Outpatient 19125 Excision breast lesion " 16,578.00 " " 4,777.78 " " 2,716.41 " " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 15,418.35 " " 12,334.62 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " Outpatient 19283 Perq dev breast 1st strtctc " 3,265.00 " 940.97 535.31 " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 3,036.89 " " 2,429.50 " 623.48 642.38 629.78 " 2,612.00 " 576.25 " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 Outpatient 19301 Partial mastectomy " 16,578.00 " " 4,777.78 " " 2,716.41 " " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 15,418.35 " " 12,334.62 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " Outpatient 19303 Mast simple complete " 29,053.00 " " 8,373.07 " " 4,760.76 " " 27,020.64 " " 7,466.62 " " 25,994.29 " " 5,656.90 " " 26,884.27 " " 4,760.76 " " 5,600.89 " " 14,889.66 " " 5,600.89 " " 17,431.80 " " 4,760.76 " " 5,992.95 " " 19,230.18 " " 5,040.80 " " 5,600.89 " " 27,020.64 " " 21,616.40 " " 5,544.88 " " 5,712.91 " " 5,600.89 " " 23,242.40 " " 5,124.81 " " 17,141.27 " " 19,465.51 " " 4,928.78 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,712.91 " Outpatient 19318 Breast reduction " 29,053.00 " " 8,373.07 " " 4,760.76 " " 27,020.64 " " 7,466.62 " " 25,994.29 " " 5,656.90 " " 26,884.27 " " 4,760.76 " " 5,600.89 " " 14,889.66 " " 5,600.89 " " 17,431.80 " " 4,760.76 " " 5,992.95 " " 19,230.18 " " 5,040.80 " " 5,600.89 " " 27,020.64 " " 21,616.40 " " 5,544.88 " " 5,712.91 " " 5,600.89 " " 23,242.40 " " 5,124.81 " " 17,141.27 " " 19,465.51 " " 4,928.78 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,712.91 " Outpatient 20225 Bone biopsy trocar/needle " 7,387.00 " " 2,128.93 " " 1,210.37 " " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 6,869.97 " " 5,495.95 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " Outpatient 20550 Inj tendon sheath/ligament " 1,371.00 " 395.12 224.75 " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,275.21 " " 1,020.16 " 261.77 269.70 264.41 " 1,096.80 " 241.94 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 Outpatient 20600 Drain/inj joint/bursa w/o us " 1,371.00 " 395.12 224.75 " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,275.21 " " 1,020.16 " 261.77 269.70 264.41 " 1,096.80 " 241.94 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 Outpatient 20605 Drain/inj joint/bursa w/o us " 1,371.00 " 395.12 224.75 " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,275.21 " " 1,020.16 " 261.77 269.70 264.41 " 1,096.80 " 241.94 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 Outpatient 20610 Drain/inj joint/bursa w/o us " 1,371.00 " 395.12 224.75 " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,275.21 " " 1,020.16 " 261.77 269.70 264.41 " 1,096.80 " 241.94 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 Outpatient 20680 Removal of support implant " 12,443.00 " " 3,586.07 " " 2,039.67 " " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 11,572.10 " " 9,257.64 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " Outpatient 21552 Exc neck les sc 3 cm/> " 12,443.00 " " 3,586.07 " " 2,039.67 " " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 11,572.10 " " 9,257.64 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " Outpatient 21931 Exc back les sc 3 cm/> " 7,387.00 " " 2,128.93 " " 1,210.37 " " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 6,869.97 " " 5,495.95 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " Outpatient 22551 Arthrd ant ntrbdy cervical " 64,652.00 " " 18,632.71 " " 10,607.31 " " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 60,129.43 " " 48,103.30 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " Outpatient 23650 Treat shoulder dislocation " 1,082.00 " 311.83 177.30 " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 " 1,006.77 " 805.41 206.50 212.76 208.59 865.60 190.86 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 Outpatient 25111 Remove wrist tendon lesion " 7,310.00 " " 2,106.74 " " 1,198.18 " " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 6,798.45 " " 5,438.73 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " Outpatient 25605 Treat fracture radius/ulna " 7,310.00 " " 2,106.74 " " 1,198.18 " " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 6,798.45 " " 5,438.73 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " Outpatient 25607 Treat fx rad extra-articul " 32,891.00 " " 9,479.19 " " 5,388.23 " " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 30,589.97 " " 24,471.85 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " Outpatient 25608 Treat fx rad intra-articul " 32,891.00 " " 9,479.19 " " 5,388.23 " " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 30,589.97 " " 24,471.85 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " Outpatient 26055 Incise finger tendon sheath " 7,310.00 " " 2,106.74 " " 1,198.18 " " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 6,798.45 " " 5,438.73 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " Outpatient 27650 Repair achilles tendon " 32,891.00 " " 9,479.19 " " 5,388.23 " " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 30,589.97 " " 24,471.85 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " Outpatient 27695 Repair of ankle ligament " 32,891.00 " " 9,479.19 " " 5,388.23 " " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 30,589.97 " " 24,471.85 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " Outpatient 27792 Treatment of ankle fracture " 32,891.00 " " 9,479.19 " " 5,388.23 " " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 30,589.97 " " 24,471.85 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " Outpatient 27814 Treatment of ankle fracture " 32,891.00 " " 9,479.19 " " 5,388.23 " " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 30,589.97 " " 24,471.85 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " Outpatient 27829 Treat lower leg joint " 32,891.00 " " 9,479.19 " " 5,388.23 " " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 30,589.97 " " 24,471.85 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " Outpatient 28285 Repair of hammertoe " 14,860.00 " " 4,282.65 " " 2,436.17 " " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 13,820.05 " " 11,055.99 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " Outpatient 28297 Correction hallux valgus " 32,891.00 " " 9,479.19 " " 5,388.23 " " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 30,589.97 " " 24,471.85 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " Outpatient 28308 Incision of metatarsal " 14,860.00 " " 4,282.65 " " 2,436.17 " " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 13,820.05 " " 11,055.99 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " Outpatient 29105 Apply long arm splint 741.00 213.56 121.53 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 689.33 551.46 141.55 145.84 142.98 592.80 130.83 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 Outpatient 29125 Apply forearm splint 588.00 169.46 97.00 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 546.63 437.30 112.98 116.40 114.12 470.40 104.42 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 Outpatient 29130 Application of finger splint 588.00 169.46 97.00 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 546.63 437.30 112.98 116.40 114.12 470.40 104.42 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 Outpatient 29445 Apply rigid leg cast " 1,266.00 " 364.86 207.53 " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 " 1,177.56 " 942.04 241.71 249.03 244.15 " 1,012.80 " 223.40 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 Outpatient 29505 Application long leg splint 741.00 213.56 121.53 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 689.33 551.46 141.55 145.84 142.98 592.80 130.83 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 Outpatient 29515 Application lower leg splint 741.00 213.56 121.53 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 689.33 551.46 141.55 145.84 142.98 592.80 130.83 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 Outpatient 29580 Application of paste boot 741.00 213.56 121.53 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 689.33 551.46 141.55 145.84 142.98 592.80 130.83 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 Outpatient 29581 Apply multlay comprs lwr leg 741.00 213.56 121.53 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 689.33 551.46 141.55 145.84 142.98 592.80 130.83 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 Outpatient 29823 Sho arthrs srg xtnsv dbrdmt " 14,860.00 " " 4,282.65 " " 2,436.17 " " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 13,820.05 " " 11,055.99 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " Outpatient 29824 Sho arthrs srg dstl claviclc " 14,860.00 " " 4,282.65 " " 2,436.17 " " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 13,820.05 " " 11,055.99 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " Outpatient 29827 Sho arthrs srg rt8tr cuf rpr " 32,891.00 " " 9,479.19 " " 5,388.23 " " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 30,589.97 " " 24,471.85 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " Outpatient 29828 Sho arthrs srg bicp tenodsis " 32,891.00 " " 9,479.19 " " 5,388.23 " " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 30,589.97 " " 24,471.85 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " Outpatient 29881 Knee arthroscopy/surgery " 14,860.00 " " 4,282.65 " " 2,436.17 " " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 13,820.05 " " 11,055.99 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " Outpatient 29888 Knee arthroscopy/surgery " 32,891.00 " " 9,479.19 " " 5,388.23 " " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 30,589.97 " " 24,471.85 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " Outpatient 29891 Ankle arthroscopy/surgery " 14,860.00 " " 4,282.65 " " 2,436.17 " " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 13,820.05 " " 11,055.99 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " Outpatient 29895 Ankle arthroscopy/surgery " 14,860.00 " " 4,282.65 " " 2,436.17 " " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 13,820.05 " " 11,055.99 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " Outpatient 29898 Ankle arthroscopy/surgery " 14,860.00 " " 4,282.65 " " 2,436.17 " " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 13,820.05 " " 11,055.99 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " Outpatient 30901 Control of nosebleed 588.00 169.46 97.00 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 546.63 437.30 112.98 116.40 114.12 470.40 104.42 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 Outpatient 30903 Control of nosebleed 588.00 169.46 97.00 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 546.63 437.30 112.98 116.40 114.12 470.40 104.42 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 Outpatient 31500 Insert emergency airway " 1,111.00 " 320.19 181.99 " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 " 1,033.19 " 826.55 211.97 218.39 214.11 888.80 195.91 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 Outpatient 31624 Dx bronchoscope/lavage " 7,856.00 " " 2,264.10 " " 1,287.04 " " 7,306.42 " " 2,018.99 " " 7,027.37 " " 1,529.30 " " 7,267.97 " " 1,287.04 " " 1,514.16 " " 4,026.20 " " 1,514.16 " " 4,713.60 " " 1,287.04 " " 1,620.15 " " 5,199.89 " " 1,362.74 " " 1,514.16 " " 7,306.42 " " 5,845.11 " " 1,499.02 " " 1,544.44 " " 1,514.16 " " 6,284.80 " " 1,385.46 " " 4,635.04 " " 5,263.52 " " 1,332.46 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,544.44 " Outpatient 31653 Bronch ebus samplng 3/> node " 16,265.00 " " 4,687.57 " " 2,664.68 " " 15,126.76 " " 4,180.11 " " 14,549.48 " " 3,166.27 " " 15,047.62 " " 2,664.68 " " 3,134.92 " " 8,335.81 " " 3,134.92 " " 9,759.00 " " 2,664.68 " " 3,354.36 " " 10,765.80 " " 2,821.43 " " 3,134.92 " " 15,126.76 " " 12,101.34 " " 3,103.57 " " 3,197.62 " " 3,134.92 " " 13,012.00 " " 2,868.45 " " 9,596.35 " " 10,897.55 " " 2,758.73 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,197.62 " Outpatient 32408 Core ndl bx lng/med perq " 7,387.00 " " 2,128.93 " " 1,210.37 " " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 6,869.97 " " 5,495.95 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " Outpatient 32555 Aspirate pleura w/ imaging " 2,844.00 " 819.64 464.98 " 2,644.56 " 730.91 " 2,538.87 " 552.51 " 2,625.79 " 464.98 547.04 " 1,457.55 " 547.04 " 1,706.40 " 464.98 585.33 " 1,882.44 " 492.34 547.04 " 2,644.56 " " 2,115.64 " 541.57 557.98 547.04 " 2,275.20 " 500.54 " 1,677.96 " " 1,905.48 " 481.40 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 557.98 Outpatient 33208 Insrt heart pm atrial & vent " 54,601.00 " " 15,736.01 " " 8,944.64 " " 50,780.95 " " 14,032.46 " " 48,838.81 " " 10,628.34 " " 50,510.93 " " 8,944.64 " " 10,523.11 " " 27,983.01 " " 10,523.11 " " 32,760.60 " " 8,944.64 " " 11,259.73 " " 36,140.40 " " 9,470.80 " " 10,523.11 " " 50,780.95 " " 40,624.55 " " 10,417.88 " " 10,733.57 " " 10,523.11 " " 43,680.80 " " 9,628.65 " " 32,214.59 " " 36,582.67 " " 9,260.34 " " 22,331.81 " " 40,950.75 " " 20,753.84 " " 24,423.03 " " 10,733.57 " Outpatient 33227 Remove&replace pm gen singl " 42,801.00 " " 12,335.25 " " 7,018.35 " " 39,806.71 " " 10,999.86 " " 38,321.01 " " 8,339.45 " " 39,633.02 " " 7,018.35 " " 8,256.88 " " 21,935.51 " " 8,256.88 " " 25,680.60 " " 7,018.35 " " 8,834.86 " " 28,329.98 " " 7,431.19 " " 8,256.88 " " 39,806.71 " " 31,845.21 " " 8,174.31 " " 8,422.02 " " 8,256.88 " " 34,240.80 " " 7,555.05 " " 25,252.59 " " 28,676.67 " " 7,266.05 " " 17,505.61 " " 32,100.75 " " 16,268.66 " " 19,144.89 " " 8,422.02 " Outpatient 33228 Remv&replc pm gen dual lead " 54,601.00 " " 15,736.01 " " 8,944.64 " " 50,780.95 " " 14,032.46 " " 48,838.81 " " 10,628.34 " " 50,510.93 " " 8,944.64 " " 10,523.11 " " 27,983.01 " " 10,523.11 " " 32,760.60 " " 8,944.64 " " 11,259.73 " " 36,140.40 " " 9,470.80 " " 10,523.11 " " 50,780.95 " " 40,624.55 " " 10,417.88 " " 10,733.57 " " 10,523.11 " " 43,680.80 " " 9,628.65 " " 32,214.59 " " 36,582.67 " " 9,260.34 " " 22,331.81 " " 40,950.75 " " 20,753.84 " " 24,423.03 " " 10,733.57 " Outpatient 33249 Insj/rplcmt defib w/lead(s) " 172,404.00 " " 49,686.83 " " 28,256.63 " " 160,342.89 " " 44,307.83 " " 154,284.50 " " 33,575.52 " " 159,566.83 " " 28,256.63 " " 33,243.09 " " 88,357.05 " " 33,243.09 " " 103,442.40 " " 28,256.63 " " 35,570.11 " " 114,114.21 " " 29,918.78 " " 33,243.09 " " 160,342.89 " " 128,273.65 " " 32,910.66 " " 33,907.95 " " 33,243.09 " " 137,923.20 " " 30,417.43 " " 101,718.36 " " 115,510.68 " " 29,253.92 " " 70,513.24 " " 129,303.00 " " 65,530.76 " " 77,116.31 " " 33,907.95 " Outpatient 33263 Rmvl & rplcmt dfb gen 2 lead " 120,961.00 " " 34,860.96 " " 19,836.86 " " 112,498.49 " " 31,086.98 " " 108,311.58 " " 23,570.85 " " 112,019.90 " " 19,836.86 " " 23,337.48 " " 61,992.51 " " 23,337.48 " " 72,576.60 " " 19,836.86 " " 24,971.10 " " 80,064.09 " " 21,003.73 " " 23,337.48 " " 112,498.49 " " 89,998.33 " " 23,104.11 " " 23,804.23 " " 23,337.48 " " 96,768.80 " " 21,353.79 " " 71,366.99 " " 81,043.87 " " 20,536.98 " " 49,473.05 " " 90,720.75 " " 45,977.28 " " 54,105.86 " " 23,804.23 " Outpatient 33285 Insj subq car rhythm mntr " 42,801.00 " " 12,335.25 " " 7,018.35 " " 39,806.71 " " 10,999.86 " " 38,321.01 " " 8,339.45 " " 39,633.02 " " 7,018.35 " " 8,256.88 " " 21,935.51 " " 8,256.88 " " 25,680.60 " " 7,018.35 " " 8,834.86 " " 28,329.98 " " 7,431.19 " " 8,256.88 " " 39,806.71 " " 31,845.21 " " 8,174.31 " " 8,422.02 " " 8,256.88 " " 34,240.80 " " 7,555.05 " " 25,252.59 " " 28,676.67 " " 7,266.05 " " 17,505.61 " " 32,100.75 " " 16,268.66 " " 19,144.89 " " 8,422.02 " Outpatient 33286 Rmvl subq car rhythm mntr " 3,265.00 " 940.97 535.31 " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 3,036.89 " " 2,429.50 " 623.48 642.38 629.78 " 2,612.00 " 576.25 " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 Outpatient 36223 Place cath carotid/inom art " 25,044.00 " " 7,217.68 " " 4,102.21 " " 23,292.37 " " 6,436.31 " " 22,398.55 " " 4,874.39 " " 23,165.42 " " 4,102.21 " " 4,826.13 " " 12,835.05 " " 4,826.13 " " 15,026.40 " " 4,102.21 " " 5,163.96 " " 16,576.62 " " 4,343.52 " " 4,826.13 " " 23,292.37 " " 18,633.80 " " 4,777.87 " " 4,922.65 " " 4,826.13 " " 20,035.20 " " 4,415.91 " " 14,775.96 " " 16,779.48 " " 4,246.99 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,922.65 " Outpatient 36225 Place cath subclavian art " 15,024.00 " " 4,329.92 " " 2,462.57 " " 13,972.65 " " 3,861.17 " " 13,445.92 " " 2,926.11 " " 13,906.27 " " 2,462.57 " " 2,897.14 " " 7,699.80 " " 2,897.14 " " 9,014.40 " " 2,462.57 " " 3,099.94 " " 9,944.39 " " 2,607.43 " " 2,897.14 " " 13,972.65 " " 11,178.06 " " 2,868.17 " " 2,955.08 " " 2,897.14 " " 12,019.20 " " 2,650.88 " " 8,864.16 " " 10,066.08 " " 2,549.48 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,955.08 " Outpatient 36415 Routine venipuncture 16.00 4.61 2.55 14.40 4.11 13.92 3.03 14.40 2.55 3.00 8.20 3.00 7.68 2.55 3.21 10.59 2.70 3.00 10.17 8.13 2.97 3.06 3.00 12.80 2.75 9.44 7.86 2.64 6.54 12.00 6.08 7.16 3.06 Outpatient 36430 Blood transfusion service " 2,085.00 " 600.90 341.45 " 1,938.75 " 535.85 " 1,864.33 " 405.72 " 1,928.16 " 341.45 401.70 " 1,068.56 " 401.70 " 1,251.00 " 341.45 429.82 " 1,380.06 " 361.53 401.70 " 1,938.75 " " 1,550.99 " 397.68 409.73 401.70 " 1,668.00 " 367.56 " 1,230.15 " " 1,396.95 " 353.50 852.77 " 1,563.75 " 792.51 932.62 409.73 Outpatient 36475 Endovenous rf 1st vein " 15,024.00 " " 4,329.92 " " 2,462.57 " " 13,972.65 " " 3,861.17 " " 13,445.92 " " 2,926.11 " " 13,906.27 " " 2,462.57 " " 2,897.14 " " 7,699.80 " " 2,897.14 " " 9,014.40 " " 2,462.57 " " 3,099.94 " " 9,944.39 " " 2,607.43 " " 2,897.14 " " 13,972.65 " " 11,178.06 " " 2,868.17 " " 2,955.08 " " 2,897.14 " " 12,019.20 " " 2,650.88 " " 8,864.16 " " 10,066.08 " " 2,549.48 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,955.08 " Outpatient 36556 Insert non-tunnel cv cath " 15,024.00 " " 4,329.92 " " 2,462.57 " " 13,972.65 " " 3,861.17 " " 13,445.92 " " 2,926.11 " " 13,906.27 " " 2,462.57 " " 2,897.14 " " 7,699.80 " " 2,897.14 " " 9,014.40 " " 2,462.57 " " 3,099.94 " " 9,944.39 " " 2,607.43 " " 2,897.14 " " 13,972.65 " " 11,178.06 " " 2,868.17 " " 2,955.08 " " 2,897.14 " " 12,019.20 " " 2,650.88 " " 8,864.16 " " 10,066.08 " " 2,549.48 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,955.08 " Outpatient 36558 Insert tunneled cv cath " 15,024.00 " " 4,329.92 " " 2,462.57 " " 13,972.65 " " 3,861.17 " " 13,445.92 " " 2,926.11 " " 13,906.27 " " 2,462.57 " " 2,897.14 " " 7,699.80 " " 2,897.14 " " 9,014.40 " " 2,462.57 " " 3,099.94 " " 9,944.39 " " 2,607.43 " " 2,897.14 " " 13,972.65 " " 11,178.06 " " 2,868.17 " " 2,955.08 " " 2,897.14 " " 12,019.20 " " 2,650.88 " " 8,864.16 " " 10,066.08 " " 2,549.48 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,955.08 " Outpatient 36561 Insert tunneled cv cath " 15,024.00 " " 4,329.92 " " 2,462.57 " " 13,972.65 " " 3,861.17 " " 13,445.92 " " 2,926.11 " " 13,906.27 " " 2,462.57 " " 2,897.14 " " 7,699.80 " " 2,897.14 " " 9,014.40 " " 2,462.57 " " 3,099.94 " " 9,944.39 " " 2,607.43 " " 2,897.14 " " 13,972.65 " " 11,178.06 " " 2,868.17 " " 2,955.08 " " 2,897.14 " " 12,019.20 " " 2,650.88 " " 8,864.16 " " 10,066.08 " " 2,549.48 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,955.08 " Outpatient 36581 Replace tunneled cv cath " 15,024.00 " " 4,329.92 " " 2,462.57 " " 13,972.65 " " 3,861.17 " " 13,445.92 " " 2,926.11 " " 13,906.27 " " 2,462.57 " " 2,897.14 " " 7,699.80 " " 2,897.14 " " 9,014.40 " " 2,462.57 " " 3,099.94 " " 9,944.39 " " 2,607.43 " " 2,897.14 " " 13,972.65 " " 11,178.06 " " 2,868.17 " " 2,955.08 " " 2,897.14 " " 12,019.20 " " 2,650.88 " " 8,864.16 " " 10,066.08 " " 2,549.48 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,955.08 " Outpatient 36589 Removal tunneled cv cath " 2,844.00 " 819.64 464.98 " 2,644.56 " 730.91 " 2,538.87 " 552.51 " 2,625.79 " 464.98 547.04 " 1,457.55 " 547.04 " 1,706.40 " 464.98 585.33 " 1,882.44 " 492.34 547.04 " 2,644.56 " " 2,115.64 " 541.57 557.98 547.04 " 2,275.20 " 500.54 " 1,677.96 " " 1,905.48 " 481.40 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 557.98 Outpatient 36590 Removal tunneled cv cath " 7,382.00 " " 2,127.49 " " 1,209.68 " " 6,865.78 " " 1,897.17 " " 6,604.98 " " 1,437.38 " " 6,831.12 " " 1,209.68 " " 1,423.15 " " 3,783.28 " " 1,423.15 " " 4,429.20 " " 1,209.68 " " 1,522.77 " " 4,886.15 " " 1,280.84 " " 1,423.15 " " 6,865.78 " " 5,492.60 " " 1,408.92 " " 1,451.61 " " 1,423.15 " " 5,905.60 " " 1,302.18 " " 4,355.38 " " 4,945.94 " " 1,252.37 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,451.61 " Outpatient 36591 Draw blood off venous device 588.00 169.46 97.00 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 546.63 437.30 112.98 116.40 114.12 470.40 104.42 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 Outpatient 36592 Collect blood from picc 588.00 169.46 97.00 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 546.63 437.30 112.98 116.40 114.12 470.40 104.42 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 Outpatient 36593 Declot vascular device " 1,631.00 " 470.05 274.29 " 1,548.91 " 419.17 " 1,497.64 " 325.92 " 1,548.91 " 274.29 322.69 835.89 322.69 978.60 274.29 345.28 " 1,079.56 " 290.42 322.69 " 1,517.32 " " 1,213.85 " 319.46 329.14 322.69 " 1,304.80 " 295.26 962.29 " 1,092.77 " 283.97 667.08 " 1,223.25 " 619.94 729.55 329.14 Outpatient 36600 Withdrawal of arterial blood 588.00 169.46 97.00 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 546.63 437.30 112.98 116.40 114.12 470.40 104.42 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 Outpatient 36902 Intro cath dialysis circuit " 26,023.00 " " 7,499.83 " " 4,263.63 " " 24,202.85 " " 6,687.91 " " 23,279.90 " " 5,066.19 " " 24,076.94 " " 4,263.63 " " 5,016.03 " " 13,336.79 " " 5,016.03 " " 15,613.80 " " 4,263.63 " " 5,367.15 " " 17,224.62 " " 4,514.43 " " 5,016.03 " " 24,202.85 " " 19,362.18 " " 4,965.87 " " 5,116.35 " " 5,016.03 " " 20,818.40 " " 4,589.67 " " 15,353.57 " " 17,435.41 " " 4,414.11 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,116.35 " Outpatient 37221 Iliac revasc w/stent " 52,725.00 " " 15,195.35 " " 8,640.72 " " 49,036.77 " " 13,550.33 " " 47,179.33 " " 10,267.21 " " 48,794.64 " " 8,640.72 " " 10,165.55 " " 27,021.56 " " 10,165.55 " " 31,635.00 " " 8,640.72 " " 10,877.14 " " 34,898.68 " " 9,149.00 " " 10,165.55 " " 49,036.77 " " 39,229.22 " " 10,063.89 " " 10,368.86 " " 10,165.55 " " 42,180.00 " " 9,301.48 " " 31,107.75 " " 35,325.75 " " 8,945.68 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,368.86 " Outpatient 37224 Fem/popl revas w/tla " 26,023.00 " " 7,499.83 " " 4,263.63 " " 24,202.85 " " 6,687.91 " " 23,279.90 " " 5,066.19 " " 24,076.94 " " 4,263.63 " " 5,016.03 " " 13,336.79 " " 5,016.03 " " 15,613.80 " " 4,263.63 " " 5,367.15 " " 17,224.62 " " 4,514.43 " " 5,016.03 " " 24,202.85 " " 19,362.18 " " 4,965.87 " " 5,116.35 " " 5,016.03 " " 20,818.40 " " 4,589.67 " " 15,353.57 " " 17,435.41 " " 4,414.11 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,116.35 " Outpatient 37226 Fem/popl revasc w/stent " 52,725.00 " " 15,195.35 " " 8,640.72 " " 49,036.77 " " 13,550.33 " " 47,179.33 " " 10,267.21 " " 48,794.64 " " 8,640.72 " " 10,165.55 " " 27,021.56 " " 10,165.55 " " 31,635.00 " " 8,640.72 " " 10,877.14 " " 34,898.68 " " 9,149.00 " " 10,165.55 " " 49,036.77 " " 39,229.22 " " 10,063.89 " " 10,368.86 " " 10,165.55 " " 42,180.00 " " 9,301.48 " " 31,107.75 " " 35,325.75 " " 8,945.68 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,368.86 " Outpatient 37243 Vasc embolize/occlude organ " 52,725.00 " " 15,195.35 " " 8,640.72 " " 49,036.77 " " 13,550.33 " " 47,179.33 " " 10,267.21 " " 48,794.64 " " 8,640.72 " " 10,165.55 " " 27,021.56 " " 10,165.55 " " 31,635.00 " " 8,640.72 " " 10,877.14 " " 34,898.68 " " 9,149.00 " " 10,165.55 " " 49,036.77 " " 39,229.22 " " 10,063.89 " " 10,368.86 " " 10,165.55 " " 42,180.00 " " 9,301.48 " " 31,107.75 " " 35,325.75 " " 8,945.68 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,368.86 " Outpatient 37765 Stab phleb veins xtr 10-20 " 15,024.00 " " 4,329.92 " " 2,462.57 " " 13,972.65 " " 3,861.17 " " 13,445.92 " " 2,926.11 " " 13,906.27 " " 2,462.57 " " 2,897.14 " " 7,699.80 " " 2,897.14 " " 9,014.40 " " 2,462.57 " " 3,099.94 " " 9,944.39 " " 2,607.43 " " 2,897.14 " " 13,972.65 " " 11,178.06 " " 2,868.17 " " 2,955.08 " " 2,897.14 " " 12,019.20 " " 2,650.88 " " 8,864.16 " " 10,066.08 " " 2,549.48 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,955.08 " Outpatient 38222 Dx bone marrow bx & aspir " 12,443.00 " " 3,586.07 " " 2,039.67 " " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 11,572.10 " " 9,257.64 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " Outpatient 38505 Needle biopsy lymph nodes " 7,387.00 " " 2,128.93 " " 1,210.37 " " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 6,869.97 " " 5,495.95 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " Outpatient 38525 Biopsy/removal lymph nodes " 16,578.00 " " 4,777.78 " " 2,716.41 " " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 15,418.35 " " 12,334.62 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " Outpatient 43235 Egd diagnostic brush wash " 4,250.00 " " 1,224.85 " 696.07 " 3,953.02 " " 1,092.25 " " 3,800.60 " 827.09 " 3,930.72 " 696.07 818.90 " 2,178.13 " 818.90 " 2,550.00 " 696.07 876.22 " 2,813.08 " 737.01 818.90 " 3,953.02 " " 3,162.40 " 810.71 835.28 818.90 " 3,400.00 " 749.29 " 2,507.50 " " 2,847.50 " 720.63 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 835.28 Outpatient 43239 Egd biopsy single/multiple " 4,250.00 " " 1,224.85 " 696.07 " 3,953.02 " " 1,092.25 " " 3,800.60 " 827.09 " 3,930.72 " 696.07 818.90 " 2,178.13 " 818.90 " 2,550.00 " 696.07 876.22 " 2,813.08 " 737.01 818.90 " 3,953.02 " " 3,162.40 " 810.71 835.28 818.90 " 3,400.00 " 749.29 " 2,507.50 " " 2,847.50 " 720.63 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 835.28 Outpatient 43244 Egd varices ligation " 8,531.00 " " 2,458.63 " " 1,397.21 " " 7,934.52 " " 2,192.47 " " 7,628.95 " " 1,660.22 " " 7,890.14 " " 1,397.21 " " 1,643.78 " " 4,372.14 " " 1,643.78 " " 5,118.60 " " 1,397.21 " " 1,758.84 " " 5,646.67 " " 1,479.40 " " 1,643.78 " " 7,934.52 " " 6,347.58 " " 1,627.34 " " 1,676.66 " " 1,643.78 " " 6,824.80 " " 1,504.06 " " 5,033.29 " " 5,715.77 " " 1,446.53 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,676.66 " Outpatient 43247 Egd remove foreign body " 4,250.00 " " 1,224.85 " 696.07 " 3,953.02 " " 1,092.25 " " 3,800.60 " 827.09 " 3,930.72 " 696.07 818.90 " 2,178.13 " 818.90 " 2,550.00 " 696.07 876.22 " 2,813.08 " 737.01 818.90 " 3,953.02 " " 3,162.40 " 810.71 835.28 818.90 " 3,400.00 " 749.29 " 2,507.50 " " 2,847.50 " 720.63 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 835.28 Outpatient 43249 Esoph egd dilation <30 mm " 8,531.00 " " 2,458.63 " " 1,397.21 " " 7,934.52 " " 2,192.47 " " 7,628.95 " " 1,660.22 " " 7,890.14 " " 1,397.21 " " 1,643.78 " " 4,372.14 " " 1,643.78 " " 5,118.60 " " 1,397.21 " " 1,758.84 " " 5,646.67 " " 1,479.40 " " 1,643.78 " " 7,934.52 " " 6,347.58 " " 1,627.34 " " 1,676.66 " " 1,643.78 " " 6,824.80 " " 1,504.06 " " 5,033.29 " " 5,715.77 " " 1,446.53 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,676.66 " Outpatient 43255 Egd control bleeding any " 8,531.00 " " 2,458.63 " " 1,397.21 " " 7,934.52 " " 2,192.47 " " 7,628.95 " " 1,660.22 " " 7,890.14 " " 1,397.21 " " 1,643.78 " " 4,372.14 " " 1,643.78 " " 5,118.60 " " 1,397.21 " " 1,758.84 " " 5,646.67 " " 1,479.40 " " 1,643.78 " " 7,934.52 " " 6,347.58 " " 1,627.34 " " 1,676.66 " " 1,643.78 " " 6,824.80 " " 1,504.06 " " 5,033.29 " " 5,715.77 " " 1,446.53 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,676.66 " Outpatient 43262 Endo cholangiopancreatograph " 16,174.00 " " 4,661.35 " " 2,641.37 " " 15,042.61 " " 4,156.72 " " 14,422.17 " " 3,138.56 " " 14,915.95 " " 2,641.37 " " 3,107.49 " " 8,289.18 " " 3,107.49 " " 9,704.40 " " 2,641.37 " " 3,325.01 " " 10,705.57 " " 2,796.74 " " 3,107.49 " " 15,042.61 " " 12,034.02 " " 3,076.42 " " 3,169.64 " " 3,107.49 " " 12,939.20 " " 2,843.35 " " 9,542.66 " " 10,836.58 " " 2,734.59 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,169.64 " Outpatient 43264 Ercp remove duct calculi " 16,174.00 " " 4,661.35 " " 2,641.37 " " 15,042.61 " " 4,156.72 " " 14,422.17 " " 3,138.56 " " 14,915.95 " " 2,641.37 " " 3,107.49 " " 8,289.18 " " 3,107.49 " " 9,704.40 " " 2,641.37 " " 3,325.01 " " 10,705.57 " " 2,796.74 " " 3,107.49 " " 15,042.61 " " 12,034.02 " " 3,076.42 " " 3,169.64 " " 3,107.49 " " 12,939.20 " " 2,843.35 " " 9,542.66 " " 10,836.58 " " 2,734.59 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,169.64 " Outpatient 43762 Rplc gtube no revj trc " 1,397.00 " 402.62 228.91 " 1,299.49 " 359.03 " 1,249.89 " 272.00 " 1,292.69 " 228.91 269.31 715.96 269.31 838.20 228.91 288.16 924.67 242.38 269.31 " 1,299.49 " " 1,039.59 " 266.62 274.70 269.31 " 1,117.60 " 246.42 824.23 935.99 236.99 571.37 " 1,047.75 " 531.00 624.88 274.70 Outpatient 44970 Laparoscopy appendectomy " 26,567.00 " " 7,656.61 " " 4,352.74 " " 24,708.67 " " 6,827.72 " " 23,766.47 " " 5,172.08 " " 24,580.18 " " 4,352.74 " " 5,120.87 " " 13,615.59 " " 5,120.87 " " 15,940.20 " " 4,352.74 " " 5,479.33 " " 17,584.70 " " 4,608.78 " " 5,120.87 " " 24,708.67 " " 19,766.84 " " 5,069.66 " " 5,223.29 " " 5,120.87 " " 21,253.60 " " 4,685.60 " " 15,674.53 " " 17,799.89 " " 4,506.37 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,223.29 " Outpatient 45330 Diagnostic sigmoidoscopy " 4,167.00 " " 1,200.93 " 682.67 " 3,875.16 " " 1,070.92 " " 3,727.45 " 811.17 " 3,855.07 " 682.67 803.14 " 2,135.59 " 803.14 " 2,500.20 " 682.67 859.36 " 2,758.14 " 722.83 803.14 " 3,875.16 " " 3,100.11 " 795.11 819.20 803.14 " 3,333.60 " 734.87 " 2,458.53 " " 2,791.89 " 706.76 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 819.20 Outpatient 45378 Diagnostic colonoscopy " 4,167.00 " " 1,200.93 " 682.67 " 3,875.16 " " 1,070.92 " " 3,727.45 " 811.17 " 3,855.07 " 682.67 803.14 " 2,135.59 " 803.14 " 2,500.20 " 682.67 859.36 " 2,758.14 " 722.83 803.14 " 3,875.16 " " 3,100.11 " 795.11 819.20 803.14 " 3,333.60 " 734.87 " 2,458.53 " " 2,791.89 " 706.76 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 819.20 Outpatient 45380 Colonoscopy and biopsy " 5,444.00 " " 1,568.96 " 892.04 " 5,063.20 " " 1,399.11 " " 4,870.65 " " 1,059.95 " " 5,037.41 " 892.04 " 1,049.46 " " 2,790.05 " " 1,049.46 " " 3,266.40 " 892.04 " 1,122.92 " " 3,603.38 " 944.51 " 1,049.46 " " 5,063.20 " " 4,050.54 " " 1,038.97 " " 1,070.45 " " 1,049.46 " " 4,355.20 " 960.26 " 3,211.96 " " 3,647.48 " 923.52 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,070.45 " Outpatient 45385 Colonoscopy w/lesion removal " 5,444.00 " " 1,568.96 " 892.04 " 5,063.20 " " 1,399.11 " " 4,870.65 " " 1,059.95 " " 5,037.41 " 892.04 " 1,049.46 " " 2,790.05 " " 1,049.46 " " 3,266.40 " 892.04 " 1,122.92 " " 3,603.38 " 944.51 " 1,049.46 " " 5,063.20 " " 4,050.54 " " 1,038.97 " " 1,070.45 " " 1,049.46 " " 4,355.20 " 960.26 " 3,211.96 " " 3,647.48 " 923.52 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,070.45 " Outpatient 46260 Remove in/ex hem groups 2+ " 12,828.00 " " 3,697.03 " " 2,101.57 " " 11,930.40 " " 3,296.80 " " 11,474.79 " " 2,497.15 " " 11,867.66 " " 2,101.57 " " 2,472.43 " " 6,574.35 " " 2,472.43 " " 7,696.80 " " 2,101.57 " " 2,645.50 " " 8,490.85 " " 2,225.19 " " 2,472.43 " " 11,930.40 " " 9,544.27 " " 2,447.71 " " 2,521.88 " " 2,472.43 " " 10,262.40 " " 2,262.27 " " 7,568.52 " " 8,594.76 " " 2,175.74 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,521.88 " Outpatient 46505 Chemodenervation anal musc " 5,444.00 " " 1,568.96 " 892.04 " 5,063.20 " " 1,399.11 " " 4,870.65 " " 1,059.95 " " 5,037.41 " 892.04 " 1,049.46 " " 2,790.05 " " 1,049.46 " " 3,266.40 " 892.04 " 1,122.92 " " 3,603.38 " 944.51 " 1,049.46 " " 5,063.20 " " 4,050.54 " " 1,038.97 " " 1,070.45 " " 1,049.46 " " 4,355.20 " 960.26 " 3,211.96 " " 3,647.48 " 923.52 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,070.45 " Outpatient 46922 Excision of anal lesion(s) " 12,828.00 " " 3,697.03 " " 2,101.57 " " 11,930.40 " " 3,296.80 " " 11,474.79 " " 2,497.15 " " 11,867.66 " " 2,101.57 " " 2,472.43 " " 6,574.35 " " 2,472.43 " " 7,696.80 " " 2,101.57 " " 2,645.50 " " 8,490.85 " " 2,225.19 " " 2,472.43 " " 11,930.40 " " 9,544.27 " " 2,447.71 " " 2,521.88 " " 2,472.43 " " 10,262.40 " " 2,262.27 " " 7,568.52 " " 8,594.76 " " 2,175.74 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,521.88 " Outpatient 46947 Hemorrhoidopexy by stapling " 12,828.00 " " 3,697.03 " " 2,101.57 " " 11,930.40 " " 3,296.80 " " 11,474.79 " " 2,497.15 " " 11,867.66 " " 2,101.57 " " 2,472.43 " " 6,574.35 " " 2,472.43 " " 7,696.80 " " 2,101.57 " " 2,645.50 " " 8,490.85 " " 2,225.19 " " 2,472.43 " " 11,930.40 " " 9,544.27 " " 2,447.71 " " 2,521.88 " " 2,472.43 " " 10,262.40 " " 2,262.27 " " 7,568.52 " " 8,594.76 " " 2,175.74 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,521.88 " Outpatient 47000 Needle biopsy of liver " 7,387.00 " " 2,128.93 " " 1,210.37 " " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 6,869.97 " " 5,495.95 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " Outpatient 47531 Injection for cholangiogram " 16,713.00 " " 4,816.69 " " 2,736.92 " " 15,543.70 " " 4,295.24 " " 14,943.92 " " 3,252.11 " " 15,455.57 " " 2,736.92 " " 3,219.91 " " 8,565.41 " " 3,219.91 " " 10,027.80 " " 2,736.92 " " 3,445.30 " " 11,062.33 " " 2,897.92 " " 3,219.91 " " 15,543.70 " " 12,434.90 " " 3,187.71 " " 3,284.31 " " 3,219.91 " " 13,370.40 " " 2,946.22 " " 9,860.67 " " 11,197.71 " " 2,833.52 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,284.31 " Outpatient 47562 Laparoscopic cholecystectomy " 26,567.00 " " 7,656.61 " " 4,352.74 " " 24,708.67 " " 6,827.72 " " 23,766.47 " " 5,172.08 " " 24,580.18 " " 4,352.74 " " 5,120.87 " " 13,615.59 " " 5,120.87 " " 15,940.20 " " 4,352.74 " " 5,479.33 " " 17,584.70 " " 4,608.78 " " 5,120.87 " " 24,708.67 " " 19,766.84 " " 5,069.66 " " 5,223.29 " " 5,120.87 " " 21,253.60 " " 4,685.60 " " 15,674.53 " " 17,799.89 " " 4,506.37 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,223.29 " Outpatient 49083 Abd paracentesis w/imaging " 4,250.00 " " 1,224.85 " 696.07 " 3,953.02 " " 1,092.25 " " 3,800.60 " 827.09 " 3,930.72 " 696.07 818.90 " 2,178.13 " 818.90 " 2,550.00 " 696.07 876.22 " 2,813.08 " 737.01 818.90 " 3,953.02 " " 3,162.40 " 810.71 835.28 818.90 " 3,400.00 " 749.29 " 2,507.50 " " 2,847.50 " 720.63 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 835.28 Outpatient 49180 Biopsy abdominal mass " 7,387.00 " " 2,128.93 " " 1,210.37 " " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 6,869.97 " " 5,495.95 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " Outpatient 49505 Prp i/hern init reduc >5 yr " 16,713.00 " " 4,816.69 " " 2,736.92 " " 15,543.70 " " 4,295.24 " " 14,943.92 " " 3,252.11 " " 15,455.57 " " 2,736.92 " " 3,219.91 " " 8,565.41 " " 3,219.91 " " 10,027.80 " " 2,736.92 " " 3,445.30 " " 11,062.33 " " 2,897.92 " " 3,219.91 " " 15,543.70 " " 12,434.90 " " 3,187.71 " " 3,284.31 " " 3,219.91 " " 13,370.40 " " 2,946.22 " " 9,860.67 " " 11,197.71 " " 2,833.52 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,284.31 " Outpatient 49561 Rpr ventral hern init block " 16,713.00 " " 4,816.69 " " 2,736.92 " " 15,543.70 " " 4,295.24 " " 14,943.92 " " 3,252.11 " " 15,455.57 " " 2,736.92 " " 3,219.91 " " 8,565.41 " " 3,219.91 " " 10,027.80 " " 2,736.92 " " 3,445.30 " " 11,062.33 " " 2,897.92 " " 3,219.91 " " 15,543.70 " " 12,434.90 " " 3,187.71 " " 3,284.31 " " 3,219.91 " " 13,370.40 " " 2,946.22 " " 9,860.67 " " 11,197.71 " " 2,833.52 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,284.31 " Outpatient 49585 Rpr umbil hern reduc > 5 yr " 16,713.00 " " 4,816.69 " " 2,736.92 " " 15,543.70 " " 4,295.24 " " 14,943.92 " " 3,252.11 " " 15,455.57 " " 2,736.92 " " 3,219.91 " " 8,565.41 " " 3,219.91 " " 10,027.80 " " 2,736.92 " " 3,445.30 " " 11,062.33 " " 2,897.92 " " 3,219.91 " " 15,543.70 " " 12,434.90 " " 3,187.71 " " 3,284.31 " " 3,219.91 " " 13,370.40 " " 2,946.22 " " 9,860.67 " " 11,197.71 " " 2,833.52 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,284.31 " Outpatient 49650 Lap ing hernia repair init " 26,567.00 " " 7,656.61 " " 4,352.74 " " 24,708.67 " " 6,827.72 " " 23,766.47 " " 5,172.08 " " 24,580.18 " " 4,352.74 " " 5,120.87 " " 13,615.59 " " 5,120.87 " " 15,940.20 " " 4,352.74 " " 5,479.33 " " 17,584.70 " " 4,608.78 " " 5,120.87 " " 24,708.67 " " 19,766.84 " " 5,069.66 " " 5,223.29 " " 5,120.87 " " 21,253.60 " " 4,685.60 " " 15,674.53 " " 17,799.89 " " 4,506.37 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,223.29 " Outpatient 49652 Lap vent/abd hernia repair " 26,567.00 " " 7,656.61 " " 4,352.74 " " 24,708.67 " " 6,827.72 " " 23,766.47 " " 5,172.08 " " 24,580.18 " " 4,352.74 " " 5,120.87 " " 13,615.59 " " 5,120.87 " " 15,940.20 " " 4,352.74 " " 5,479.33 " " 17,584.70 " " 4,608.78 " " 5,120.87 " " 24,708.67 " " 19,766.84 " " 5,069.66 " " 5,223.29 " " 5,120.87 " " 21,253.60 " " 4,685.60 " " 15,674.53 " " 17,799.89 " " 4,506.37 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,223.29 " Outpatient 49653 Lap vent/abd hern proc comp " 26,567.00 " " 7,656.61 " " 4,352.74 " " 24,708.67 " " 6,827.72 " " 23,766.47 " " 5,172.08 " " 24,580.18 " " 4,352.74 " " 5,120.87 " " 13,615.59 " " 5,120.87 " " 15,940.20 " " 4,352.74 " " 5,479.33 " " 17,584.70 " " 4,608.78 " " 5,120.87 " " 24,708.67 " " 19,766.84 " " 5,069.66 " " 5,223.29 " " 5,120.87 " " 21,253.60 " " 4,685.60 " " 15,674.53 " " 17,799.89 " " 4,506.37 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,223.29 " Outpatient 49655 Lap inc hern repair comp " 46,765.00 " " 13,477.67 " " 7,661.94 " " 43,493.54 " " 12,018.61 " " 41,835.11 " " 9,104.19 " " 43,267.44 " " 7,661.94 " " 9,014.05 " " 23,967.06 " " 9,014.05 " " 28,059.00 " " 7,661.94 " " 9,645.03 " " 30,953.75 " " 8,112.65 " " 9,014.05 " " 43,493.54 " " 34,794.65 " " 8,923.91 " " 9,194.33 " " 9,014.05 " " 37,412.00 " " 8,247.86 " " 27,591.35 " " 31,332.55 " " 7,932.36 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,194.33 " Outpatient 50435 Exchange nephrostomy cath " 9,413.00 " " 2,712.83 " " 1,540.27 " " 8,754.66 " " 2,419.14 " " 8,410.04 " " 1,830.20 " " 8,697.98 " " 1,540.27 " " 1,812.08 " " 4,824.16 " " 1,812.08 " " 5,647.80 " " 1,540.27 " " 1,938.93 " " 6,230.46 " " 1,630.87 " " 1,812.08 " " 8,754.66 " " 7,003.69 " " 1,793.96 " " 1,848.32 " " 1,812.08 " " 7,530.40 " " 1,658.05 " " 5,553.67 " " 6,306.71 " " 1,594.63 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,848.32 " Outpatient 51702 Insert temp bladder cath 588.00 169.46 97.00 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 546.63 437.30 112.98 116.40 114.12 470.40 104.42 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 Outpatient 51798 Us urine capacity measure 292.00 84.15 47.88 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 271.75 217.40 55.77 57.46 56.33 233.60 51.54 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 Outpatient 52287 Cystoscopy chemodenervation " 9,413.00 " " 2,712.83 " " 1,540.27 " " 8,754.66 " " 2,419.14 " " 8,410.04 " " 1,830.20 " " 8,697.98 " " 1,540.27 " " 1,812.08 " " 4,824.16 " " 1,812.08 " " 5,647.80 " " 1,540.27 " " 1,938.93 " " 6,230.46 " " 1,630.87 " " 1,812.08 " " 8,754.66 " " 7,003.69 " " 1,793.96 " " 1,848.32 " " 1,812.08 " " 7,530.40 " " 1,658.05 " " 5,553.67 " " 6,306.71 " " 1,594.63 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,848.32 " Outpatient 52332 Cystoscopy and treatment " 16,151.00 " " 4,654.72 " " 2,644.85 " " 15,020.86 " " 4,150.81 " " 14,441.20 " " 3,142.71 " " 14,935.63 " " 2,644.85 " " 3,111.59 " " 8,277.39 " " 3,111.59 " " 9,690.60 " " 2,644.85 " " 3,329.40 " " 10,690.35 " " 2,800.43 " " 3,111.59 " " 15,020.86 " " 12,016.63 " " 3,080.47 " " 3,173.82 " " 3,111.59 " " 12,920.80 " " 2,847.10 " " 9,529.09 " " 10,821.17 " " 2,738.20 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,173.82 " Outpatient 52352 Cystouretero w/stone remove " 16,151.00 " " 4,654.72 " " 2,644.85 " " 15,020.86 " " 4,150.81 " " 14,441.20 " " 3,142.71 " " 14,935.63 " " 2,644.85 " " 3,111.59 " " 8,277.39 " " 3,111.59 " " 9,690.60 " " 2,644.85 " " 3,329.40 " " 10,690.35 " " 2,800.43 " " 3,111.59 " " 15,020.86 " " 12,016.63 " " 3,080.47 " " 3,173.82 " " 3,111.59 " " 12,920.80 " " 2,847.10 " " 9,529.09 " " 10,821.17 " " 2,738.20 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,173.82 " Outpatient 52356 Cysto/uretero w/lithotripsy " 23,173.00 " " 6,678.46 " " 3,795.31 " " 21,551.80 " " 5,955.46 " " 20,722.84 " " 4,509.72 " " 21,432.34 " " 3,795.31 " " 4,465.07 " " 11,876.16 " " 4,465.07 " " 13,903.80 " " 3,795.31 " " 4,777.62 " " 15,338.21 " " 4,018.56 " " 4,465.07 " " 21,551.80 " " 17,241.35 " " 4,420.42 " " 4,554.37 " " 4,465.07 " " 18,538.40 " " 4,085.54 " " 13,672.07 " " 15,525.91 " " 3,929.26 " " 9,477.76 " " 17,379.75 " " 8,808.06 " " 10,365.28 " " 4,554.37 " Outpatient 57240 Anterior colporrhaphy " 23,150.00 " " 6,671.83 " " 3,793.29 " " 21,530.50 " " 5,949.55 " " 20,711.79 " " 4,507.32 " " 21,420.91 " " 3,793.29 " " 4,462.69 " " 11,864.38 " " 4,462.69 " " 13,890.00 " " 3,793.29 " " 4,775.08 " " 15,322.99 " " 4,016.42 " " 4,462.69 " " 21,530.50 " " 17,224.31 " " 4,418.06 " " 4,551.94 " " 4,462.69 " " 18,520.00 " " 4,083.36 " " 13,658.50 " " 15,510.50 " " 3,927.17 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,551.94 " Outpatient 57260 Cmbn ant pst colprhy " 23,150.00 " " 6,671.83 " " 3,793.29 " " 21,530.50 " " 5,949.55 " " 20,711.79 " " 4,507.32 " " 21,420.91 " " 3,793.29 " " 4,462.69 " " 11,864.38 " " 4,462.69 " " 13,890.00 " " 3,793.29 " " 4,775.08 " " 15,322.99 " " 4,016.42 " " 4,462.69 " " 21,530.50 " " 17,224.31 " " 4,418.06 " " 4,551.94 " " 4,462.69 " " 18,520.00 " " 4,083.36 " " 13,658.50 " " 15,510.50 " " 3,927.17 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,551.94 " Outpatient 57283 Colpopexy intraperitoneal " 35,670.00 " " 10,280.09 " " 5,839.85 " " 33,174.66 " " 9,167.19 " " 31,886.26 " " 6,939.11 " " 32,977.97 " " 5,839.85 " " 6,870.41 " " 18,280.88 " " 6,870.41 " " 21,402.00 " " 5,839.85 " " 7,351.34 " " 23,609.97 " " 6,183.37 " " 6,870.41 " " 33,174.66 " " 26,539.59 " " 6,801.71 " " 7,007.82 " " 6,870.41 " " 28,536.00 " " 6,286.43 " " 21,045.30 " " 23,898.90 " " 6,045.96 " " 14,589.03 " " 26,752.50 " " 13,558.17 " " 15,955.19 " " 7,007.82 " Outpatient 57288 Repair bladder defect " 23,150.00 " " 6,671.83 " " 3,793.29 " " 21,530.50 " " 5,949.55 " " 20,711.79 " " 4,507.32 " " 21,420.91 " " 3,793.29 " " 4,462.69 " " 11,864.38 " " 4,462.69 " " 13,890.00 " " 3,793.29 " " 4,775.08 " " 15,322.99 " " 4,016.42 " " 4,462.69 " " 21,530.50 " " 17,224.31 " " 4,418.06 " " 4,551.94 " " 4,462.69 " " 18,520.00 " " 4,083.36 " " 13,658.50 " " 15,510.50 " " 3,927.17 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,551.94 " Outpatient 57522 Conization of cervix " 13,772.00 " " 3,969.09 " " 2,256.99 " " 12,808.36 " " 3,539.40 " " 12,323.42 " " 2,681.83 " " 12,745.34 " " 2,256.99 " " 2,655.28 " " 7,058.15 " " 2,655.28 " " 8,263.20 " " 2,256.99 " " 2,841.15 " " 9,115.69 " " 2,389.75 " " 2,655.28 " " 12,808.36 " " 10,246.63 " " 2,628.73 " " 2,708.39 " " 2,655.28 " " 11,017.60 " " 2,429.58 " " 8,125.48 " " 9,227.24 " " 2,336.65 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,708.39 " Outpatient 58262 Vag hyst including t/o " 23,150.00 " " 6,671.83 " " 3,793.29 " " 21,530.50 " " 5,949.55 " " 20,711.79 " " 4,507.32 " " 21,420.91 " " 3,793.29 " " 4,462.69 " " 11,864.38 " " 4,462.69 " " 13,890.00 " " 3,793.29 " " 4,775.08 " " 15,322.99 " " 4,016.42 " " 4,462.69 " " 21,530.50 " " 17,224.31 " " 4,418.06 " " 4,551.94 " " 4,462.69 " " 18,520.00 " " 4,083.36 " " 13,658.50 " " 15,510.50 " " 3,927.17 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,551.94 " Outpatient 58263 Vag hyst w/t/o & vag repair " 23,150.00 " " 6,671.83 " " 3,793.29 " " 21,530.50 " " 5,949.55 " " 20,711.79 " " 4,507.32 " " 21,420.91 " " 3,793.29 " " 4,462.69 " " 11,864.38 " " 4,462.69 " " 13,890.00 " " 3,793.29 " " 4,775.08 " " 15,322.99 " " 4,016.42 " " 4,462.69 " " 21,530.50 " " 17,224.31 " " 4,418.06 " " 4,551.94 " " 4,462.69 " " 18,520.00 " " 4,083.36 " " 13,658.50 " " 15,510.50 " " 3,927.17 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,551.94 " Outpatient 58300 Insert intrauterine device " 3,746.00 " " 1,079.60 " - " 2,996.80 " 962.72 - - - - - " 1,919.83 " - " 2,247.60 " - - " 2,479.48 " - - 978.00 782.40 - - " 2,996.80 " - " 2,210.14 " " 2,509.82 " - " 1,532.11 " " 2,809.50 " " 1,423.85 " " 1,675.59 " - Outpatient 58558 Hysteroscopy biopsy " 13,772.00 " " 3,969.09 " " 2,256.99 " " 12,808.36 " " 3,539.40 " " 12,323.42 " " 2,681.83 " " 12,745.34 " " 2,256.99 " " 2,655.28 " " 7,058.15 " " 2,655.28 " " 8,263.20 " " 2,256.99 " " 2,841.15 " " 9,115.69 " " 2,389.75 " " 2,655.28 " " 12,808.36 " " 10,246.63 " " 2,628.73 " " 2,708.39 " " 2,655.28 " " 11,017.60 " " 2,429.58 " " 8,125.48 " " 9,227.24 " " 2,336.65 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,708.39 " Outpatient 58563 Hysteroscopy ablation " 23,150.00 " " 6,671.83 " " 3,793.29 " " 21,530.50 " " 5,949.55 " " 20,711.79 " " 4,507.32 " " 21,420.91 " " 3,793.29 " " 4,462.69 " " 11,864.38 " " 4,462.69 " " 13,890.00 " " 3,793.29 " " 4,775.08 " " 15,322.99 " " 4,016.42 " " 4,462.69 " " 21,530.50 " " 17,224.31 " " 4,418.06 " " 4,551.94 " " 4,462.69 " " 18,520.00 " " 4,083.36 " " 13,658.50 " " 15,510.50 " " 3,927.17 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,551.94 " Outpatient 58571 Tlh w/t/o 250 g or less " 46,765.00 " " 13,477.67 " " 7,661.94 " " 43,493.54 " " 12,018.61 " " 41,835.11 " " 9,104.19 " " 43,267.44 " " 7,661.94 " " 9,014.05 " " 23,967.06 " " 9,014.05 " " 28,059.00 " " 7,661.94 " " 9,645.03 " " 30,953.75 " " 8,112.65 " " 9,014.05 " " 43,493.54 " " 34,794.65 " " 8,923.91 " " 9,194.33 " " 9,014.05 " " 37,412.00 " " 8,247.86 " " 27,591.35 " " 31,332.55 " " 7,932.36 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,194.33 " Outpatient 58573 Tlh w/t/o uterus over 250 g " 46,765.00 " " 13,477.67 " " 7,661.94 " " 43,493.54 " " 12,018.61 " " 41,835.11 " " 9,104.19 " " 43,267.44 " " 7,661.94 " " 9,014.05 " " 23,967.06 " " 9,014.05 " " 28,059.00 " " 7,661.94 " " 9,645.03 " " 30,953.75 " " 8,112.65 " " 9,014.05 " " 43,493.54 " " 34,794.65 " " 8,923.91 " " 9,194.33 " " 9,014.05 " " 37,412.00 " " 8,247.86 " " 27,591.35 " " 31,332.55 " " 7,932.36 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,194.33 " Outpatient 58661 Laparoscopy remove adnexa " 26,567.00 " " 7,656.61 " " 4,352.74 " " 24,708.67 " " 6,827.72 " " 23,766.47 " " 5,172.08 " " 24,580.18 " " 4,352.74 " " 5,120.87 " " 13,615.59 " " 5,120.87 " " 15,940.20 " " 4,352.74 " " 5,479.33 " " 17,584.70 " " 4,608.78 " " 5,120.87 " " 24,708.67 " " 19,766.84 " " 5,069.66 " " 5,223.29 " " 5,120.87 " " 21,253.60 " " 4,685.60 " " 15,674.53 " " 17,799.89 " " 4,506.37 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,223.29 " Outpatient 58662 Laparoscopy excise lesions " 26,567.00 " " 7,656.61 " " 4,352.74 " " 24,708.67 " " 6,827.72 " " 23,766.47 " " 5,172.08 " " 24,580.18 " " 4,352.74 " " 5,120.87 " " 13,615.59 " " 5,120.87 " " 15,940.20 " " 4,352.74 " " 5,479.33 " " 17,584.70 " " 4,608.78 " " 5,120.87 " " 24,708.67 " " 19,766.84 " " 5,069.66 " " 5,223.29 " " 5,120.87 " " 21,253.60 " " 4,685.60 " " 15,674.53 " " 17,799.89 " " 4,506.37 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,223.29 " Outpatient 59025 Fetal non-stress test 894.00 257.65 146.55 831.65 229.76 800.17 174.13 827.57 146.55 172.41 458.18 172.41 536.40 146.55 184.48 591.74 155.17 172.41 831.65 665.31 170.69 175.86 172.41 715.20 157.76 527.46 598.98 151.72 365.65 670.50 339.81 399.89 175.86 Outpatient 59151 Treat ectopic pregnancy " 26,567.00 " " 7,656.61 " " 4,352.74 " " 24,708.67 " " 6,827.72 " " 23,766.47 " " 5,172.08 " " 24,580.18 " " 4,352.74 " " 5,120.87 " " 13,615.59 " " 5,120.87 " " 15,940.20 " " 4,352.74 " " 5,479.33 " " 17,584.70 " " 4,608.78 " " 5,120.87 " " 24,708.67 " " 19,766.84 " " 5,069.66 " " 5,223.29 " " 5,120.87 " " 21,253.60 " " 4,685.60 " " 15,674.53 " " 17,799.89 " " 4,506.37 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,223.29 " Outpatient 59812 Treatment of miscarriage " 13,772.00 " " 3,969.09 " " 2,256.99 " " 12,808.36 " " 3,539.40 " " 12,323.42 " " 2,681.83 " " 12,745.34 " " 2,256.99 " " 2,655.28 " " 7,058.15 " " 2,655.28 " " 8,263.20 " " 2,256.99 " " 2,841.15 " " 9,115.69 " " 2,389.75 " " 2,655.28 " " 12,808.36 " " 10,246.63 " " 2,628.73 " " 2,708.39 " " 2,655.28 " " 11,017.60 " " 2,429.58 " " 8,125.48 " " 9,227.24 " " 2,336.65 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,708.39 " Outpatient 59820 Care of miscarriage " 13,772.00 " " 3,969.09 " " 2,256.99 " " 12,808.36 " " 3,539.40 " " 12,323.42 " " 2,681.83 " " 12,745.34 " " 2,256.99 " " 2,655.28 " " 7,058.15 " " 2,655.28 " " 8,263.20 " " 2,256.99 " " 2,841.15 " " 9,115.69 " " 2,389.75 " " 2,655.28 " " 12,808.36 " " 10,246.63 " " 2,628.73 " " 2,708.39 " " 2,655.28 " " 11,017.60 " " 2,429.58 " " 8,125.48 " " 9,227.24 " " 2,336.65 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,708.39 " Outpatient 62321 Njx interlaminar crv/thrc " 3,332.00 " 960.28 546.24 " 3,098.51 " 856.32 " 2,982.56 " 649.07 " 3,084.67 " 546.24 642.64 " 1,707.65 " 642.64 " 1,999.20 " 546.24 687.62 " 2,205.45 " 578.38 642.64 " 3,098.51 " " 2,478.80 " 636.21 655.49 642.64 " 2,665.60 " 588.02 " 1,965.88 " " 2,232.44 " 565.52 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 655.49 Outpatient 62323 Njx interlaminar lmbr/sac " 3,332.00 " 960.28 546.24 " 3,098.51 " 856.32 " 2,982.56 " 649.07 " 3,084.67 " 546.24 642.64 " 1,707.65 " 642.64 " 1,999.20 " 546.24 687.62 " 2,205.45 " 578.38 642.64 " 3,098.51 " " 2,478.80 " 636.21 655.49 642.64 " 2,665.60 " 588.02 " 1,965.88 " " 2,232.44 " 565.52 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 655.49 Outpatient 62328 Dx lmbr spi pnxr w/fluor/ct " 3,332.00 " 960.28 546.24 " 3,098.51 " 856.32 " 2,982.56 " 649.07 " 3,084.67 " 546.24 642.64 " 1,707.65 " 642.64 " 1,999.20 " 546.24 687.62 " 2,205.45 " 578.38 642.64 " 3,098.51 " " 2,478.80 " 636.21 655.49 642.64 " 2,665.60 " 588.02 " 1,965.88 " " 2,232.44 " 565.52 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 655.49 Outpatient 63030 Low back disk surgery " 32,891.00 " " 9,479.19 " " 5,388.23 " " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 30,589.97 " " 24,471.85 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " Outpatient 63042 Laminotomy single lumbar " 32,891.00 " " 9,479.19 " " 5,388.23 " " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 30,589.97 " " 24,471.85 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " Outpatient 63047 Lam facetec & foramot lumbar " 32,891.00 " " 9,479.19 " " 5,388.23 " " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 30,589.97 " " 24,471.85 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " Outpatient 63650 Implant neuroelectrodes " 32,344.00 " " 9,321.54 " " 5,302.65 " " 30,080.83 " " 8,312.41 " " 28,953.08 " " 6,300.79 " " 29,944.37 " " 5,302.65 " " 6,238.41 " " 16,576.30 " " 6,238.41 " " 19,406.40 " " 5,302.65 " " 6,675.10 " " 21,408.49 " " 5,614.57 " " 6,238.41 " " 30,080.83 " " 24,064.54 " " 6,176.03 " " 6,363.18 " " 6,238.41 " " 25,875.20 " " 5,708.15 " " 19,082.96 " " 21,670.48 " " 5,489.80 " " 13,228.70 " " 24,258.00 " " 12,293.95 " " 14,467.47 " " 6,363.18 " Outpatient 63655 Implant neuroelectrodes " 107,519.00 " " 30,986.98 " " 17,614.62 " " 99,996.89 " " 27,632.38 " " 96,177.89 " " 20,930.31 " " 99,470.78 " " 17,614.62 " " 20,723.08 " " 55,103.49 " " 20,723.08 " " 64,511.40 " " 17,614.62 " " 22,173.70 " " 71,166.83 " " 18,650.77 " " 20,723.08 " " 99,996.89 " " 79,997.10 " " 20,515.85 " " 21,137.54 " " 20,723.08 " " 86,015.20 " " 18,961.62 " " 63,436.21 " " 72,037.73 " " 18,236.31 " " 43,975.27 " " 80,639.25 " " 40,867.97 " " 48,093.25 " " 21,137.54 " Outpatient 63685 Insrt/redo spine n generator " 154,584.00 " " 44,551.11 " " 25,322.44 " " 143,769.16 " " 39,728.09 " " 138,263.47 " " 30,089.01 " " 142,997.28 " " 25,322.44 " " 29,791.10 " " 79,224.30 " " 29,791.10 " " 92,750.40 " " 25,322.44 " " 31,876.48 " " 102,319.15 " " 26,811.99 " " 29,791.10 " " 143,769.16 " " 115,014.74 " " 29,493.19 " " 30,386.92 " " 29,791.10 " " 123,667.20 " " 27,258.86 " " 91,204.56 " " 103,571.28 " " 26,216.17 " " 63,224.86 " " 115,938.00 " " 58,757.38 " " 69,145.42 " " 30,386.92 " Outpatient 64400 Njx aa&/strd trigeminal nrv " 1,371.00 " 395.12 224.75 " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,275.21 " " 1,020.16 " 261.77 269.70 264.41 " 1,096.80 " 241.94 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 Outpatient 64415 Njx aa&/strd brach plexus " 4,318.00 " " 1,244.45 " 708.14 " 4,015.82 " " 1,109.73 " " 3,866.55 " 841.44 " 3,998.93 " 708.14 833.11 " 2,212.98 " 833.11 " 2,590.80 " 708.14 891.43 " 2,858.08 " 749.80 833.11 " 4,015.82 " " 3,212.64 " 824.78 849.77 833.11 " 3,454.40 " 762.30 " 2,547.62 " " 2,893.06 " 733.14 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 849.77 Outpatient 64447 Njx aa&/strd femoral nerve " 3,332.00 " 960.28 546.24 " 3,098.51 " 856.32 " 2,982.56 " 649.07 " 3,084.67 " 546.24 642.64 " 1,707.65 " 642.64 " 1,999.20 " 546.24 687.62 " 2,205.45 " 578.38 642.64 " 3,098.51 " " 2,478.80 " 636.21 655.49 642.64 " 2,665.60 " 588.02 " 1,965.88 " " 2,232.44 " 565.52 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 655.49 Outpatient 64450 Njx aa&/strd other pn/branch " 3,332.00 " 960.28 546.24 " 3,098.51 " 856.32 " 2,982.56 " 649.07 " 3,084.67 " 546.24 642.64 " 1,707.65 " 642.64 " 1,999.20 " 546.24 687.62 " 2,205.45 " 578.38 642.64 " 3,098.51 " " 2,478.80 " 636.21 655.49 642.64 " 2,665.60 " 588.02 " 1,965.88 " " 2,232.44 " 565.52 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 655.49 Outpatient 64483 Njx aa&/strd tfrm epi l/s 1 " 4,318.00 " " 1,244.45 " 708.14 " 4,015.82 " " 1,109.73 " " 3,866.55 " 841.44 " 3,998.93 " 708.14 833.11 " 2,212.98 " 833.11 " 2,590.80 " 708.14 891.43 " 2,858.08 " 749.80 833.11 " 4,015.82 " " 3,212.64 " 824.78 849.77 833.11 " 3,454.40 " 762.30 " 2,547.62 " " 2,893.06 " 733.14 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 849.77 Outpatient 64490 Inj paravert f jnt c/t 1 lev " 4,318.00 " " 1,244.45 " 708.14 " 4,015.82 " " 1,109.73 " " 3,866.55 " 841.44 " 3,998.93 " 708.14 833.11 " 2,212.98 " 833.11 " 2,590.80 " 708.14 891.43 " 2,858.08 " 749.80 833.11 " 4,015.82 " " 3,212.64 " 824.78 849.77 833.11 " 3,454.40 " 762.30 " 2,547.62 " " 2,893.06 " 733.14 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 849.77 Outpatient 64493 Inj paravert f jnt l/s 1 lev " 4,318.00 " " 1,244.45 " 708.14 " 4,015.82 " " 1,109.73 " " 3,866.55 " 841.44 " 3,998.93 " 708.14 833.11 " 2,212.98 " 833.11 " 2,590.80 " 708.14 891.43 " 2,858.08 " 749.80 833.11 " 4,015.82 " " 3,212.64 " 824.78 849.77 833.11 " 3,454.40 " 762.30 " 2,547.62 " " 2,893.06 " 733.14 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 849.77 Outpatient 64635 Destroy lumb/sac facet jnt " 9,211.00 " " 2,654.61 " " 1,510.50 " " 8,566.18 " " 2,367.23 " " 8,247.51 " " 1,794.83 " " 8,529.89 " " 1,510.50 " " 1,777.06 " " 4,720.64 " " 1,777.06 " " 5,526.60 " " 1,510.50 " " 1,901.45 " " 6,096.76 " " 1,599.35 " " 1,777.06 " " 8,566.18 " " 6,852.91 " " 1,759.29 " " 1,812.60 " " 1,777.06 " " 7,368.80 " " 1,626.01 " " 5,434.49 " " 6,171.37 " " 1,563.81 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,812.60 " Outpatient 64718 Revise ulnar nerve at elbow " 9,211.00 " " 2,654.61 " " 1,510.50 " " 8,566.18 " " 2,367.23 " " 8,247.51 " " 1,794.83 " " 8,529.89 " " 1,510.50 " " 1,777.06 " " 4,720.64 " " 1,777.06 " " 5,526.60 " " 1,510.50 " " 1,901.45 " " 6,096.76 " " 1,599.35 " " 1,777.06 " " 8,566.18 " " 6,852.91 " " 1,759.29 " " 1,812.60 " " 1,777.06 " " 7,368.80 " " 1,626.01 " " 5,434.49 " " 6,171.37 " " 1,563.81 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,812.60 " Outpatient 64721 Carpal tunnel surgery " 9,211.00 " " 2,654.61 " " 1,510.50 " " 8,566.18 " " 2,367.23 " " 8,247.51 " " 1,794.83 " " 8,529.89 " " 1,510.50 " " 1,777.06 " " 4,720.64 " " 1,777.06 " " 5,526.60 " " 1,510.50 " " 1,901.45 " " 6,096.76 " " 1,599.35 " " 1,777.06 " " 8,566.18 " " 6,852.91 " " 1,759.29 " " 1,812.60 " " 1,777.06 " " 7,368.80 " " 1,626.01 " " 5,434.49 " " 6,171.37 " " 1,563.81 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,812.60 " Outpatient 67311 Revise eye muscle " 10,512.00 " " 3,029.56 " " 1,721.40 " " 9,776.88 " " 2,701.58 " " 9,399.06 " " 2,045.43 " " 9,720.86 " " 1,721.40 " " 2,025.18 " " 5,387.40 " " 2,025.18 " " 6,307.20 " " 1,721.40 " " 2,166.94 " " 6,957.89 " " 1,822.66 " " 2,025.18 " " 9,776.88 " " 7,821.47 " " 2,004.93 " " 2,065.68 " " 2,025.18 " " 8,409.60 " " 1,853.04 " " 6,202.08 " " 7,043.04 " " 1,782.16 " " 4,299.41 " " 7,884.00 " " 3,995.61 " " 4,702.02 " " 2,065.68 " Outpatient 69200 Clear outer ear canal 588.00 169.46 97.00 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 546.63 437.30 112.98 116.40 114.12 470.40 104.42 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 Outpatient 69209 Remove impacted ear wax uni 292.00 84.15 47.88 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 271.75 217.40 55.77 57.46 56.33 233.60 51.54 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 Outpatient 70110 X-ray exam of jaw 4/> views 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 70150 X-ray exam of facial bones 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 70160 X-ray exam of nasal bones 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 70170 X-ray exam of tear duct " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 602.94 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 70200 X-ray exam of eye sockets 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 70220 X-ray exam of sinuses 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 70250 X-ray exam of skull 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 70260 X-ray exam of skull 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 70360 X-ray exam of neck 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 70450 Ct head/brain w/o dye 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 70470 Ct head/brain w/o & w/dye 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 70480 Ct orbit/ear/fossa w/o dye 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 70482 Ct orbit/ear/fossa w/o&w/dye 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 70486 Ct maxillofacial w/o dye 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 70487 Ct maxillofacial w/dye 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 70490 Ct soft tissue neck w/o dye 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 70491 Ct soft tissue neck w/dye 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 70492 Ct sft tsue nck w/o & w/dye 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 70496 Ct angiography head 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 70498 Ct angiography neck 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 70543 Mri orbt/fac/nck w/o &w/dye " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 70544 Mr angiography head w/o dye " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 602.94 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 70547 Mr angiography neck w/o dye " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 602.94 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 70549 Mr angiograph neck w/o&w/dye " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 70551 Mri brain stem w/o dye " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 602.94 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 70553 Mri brain stem w/o & w/dye " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 71045 X-ray exam chest 1 view 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 71046 X-ray exam chest 2 views 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 71100 X-ray exam ribs uni 2 views 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 71101 X-ray exam unilat ribs/chest 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 71110 X-ray exam ribs bil 3 views 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 71111 X-ray exam ribs/chest4/> vws 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 71120 X-ray exam breastbone 2/>vws 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 71250 Ct thorax dx c- 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 71260 Ct thorax dx c+ 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 71270 Ct thorax dx c-/c+ 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 71271 Ct thorax lung cancer scr c- 425.00 122.49 93.65 528.86 109.23 511.36 111.28 528.86 93.65 110.18 217.81 110.18 207.10 93.65 117.89 281.31 99.16 110.18 395.00 316.00 109.08 112.38 110.18 340.00 100.81 250.75 211.96 96.96 173.83 318.75 161.54 190.10 112.38 Outpatient 71275 Ct angiography chest 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 72020 X-ray exam of spine 1 view 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 72040 X-ray exam neck spine 2-3 vw 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 72050 X-ray exam neck spine 4/5vws 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72052 X-ray exam neck spine 6/>vws 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72070 X-ray exam thorac spine 2vws 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72072 X-ray exam thorac spine 3vws 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72081 X-ray exam entire spi 1 vw 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 72082 X-ray exam entire spi 2/3 vw 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72100 X-ray exam l-s spine 2/3 vws 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72110 X-ray exam l-2 spine 4/>vws 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72114 X-ray exam l-s spine bending 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72120 X-ray bend only l-s spine 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72125 Ct neck spine w/o dye 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72128 Ct chest spine w/o dye 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72129 Ct chest spine w/dye 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 72131 Ct lumbar spine w/o dye 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72132 Ct lumbar spine w/dye " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 72141 Mri neck spine w/o dye " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 602.94 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 72146 Mri chest spine w/o dye " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 602.94 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 72148 Mri lumbar spine w/o dye " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 602.94 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 72156 Mri neck spine w/o & w/dye " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 72157 Mri chest spine w/o & w/dye " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 72158 Mri lumbar spine w/o & w/dye " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 72170 X-ray exam of pelvis 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72190 X-ray exam of pelvis 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72192 Ct pelvis w/o dye 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72193 Ct pelvis w/dye 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 72195 Mri pelvis w/o dye " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 602.94 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 72197 Mri pelvis w/o & w/dye " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 72200 X-ray exam si joints 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72202 X-ray exam si joints 3/> vws 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 72220 X-ray exam sacrum tailbone 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73000 X-ray exam of collar bone 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73010 X-ray exam of shoulder blade 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 73020 X-ray exam of shoulder 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73030 X-ray exam of shoulder 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73060 X-ray exam of humerus 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73070 X-ray exam of elbow 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73080 X-ray exam of elbow 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73090 X-ray exam of forearm 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73100 X-ray exam of wrist 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73110 X-ray exam of wrist 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73120 X-ray exam of hand 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 73130 X-ray exam of hand 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73140 X-ray exam of finger(s) 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73200 Ct upper extremity w/o dye 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 73201 Ct upper extremity w/dye " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 73218 Mri upper extremity w/o dye " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 602.94 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 73220 Mri uppr extremity w/o&w/dye " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 73221 Mri joint upr extrem w/o dye " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 602.94 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 73222 Mri joint upr extrem w/dye " 3,755.00 " " 1,082.19 " 615.44 " 3,492.01 " 965.04 " 3,360.39 " 731.29 " 3,475.44 " 615.44 724.05 " 1,924.44 " 724.05 " 1,830.86 " 615.44 774.73 " 2,485.43 " 651.65 724.05 " 3,492.01 " " 2,793.59 " 716.81 738.53 724.05 " 3,004.00 " 662.51 " 2,215.45 " " 1,873.77 " 637.16 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 738.53 Outpatient 73223 Mri joint upr extr w/o&w/dye " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 73501 X-ray exam hip uni 1 view 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73502 X-ray exam hip uni 2-3 views 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73503 X-ray exam hip uni 4/> views 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 73521 X-ray exam hips bi 2 views 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 73522 X-ray exam hips bi 3-4 views 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 73523 X-ray exam hips bi 5/> views 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 73552 X-ray exam of femur 2/> 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73560 X-ray exam of knee 1 or 2 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73562 X-ray exam of knee 3 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73564 X-ray exam knee 4 or more 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 73565 X-ray exam of knees 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73590 X-ray exam of lower leg 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73600 X-ray exam of ankle 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73610 X-ray exam of ankle 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73620 X-ray exam of foot 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73630 X-ray exam of foot 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73650 X-ray exam of heel 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73660 X-ray exam of toe(s) 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 73700 Ct lower extremity w/o dye 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 73701 Ct lower extremity w/dye 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 73718 Mri lower extremity w/o dye " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 602.94 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 73720 Mri lwr extremity w/o&w/dye " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 73721 Mri jnt of lwr extre w/o dye " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 602.94 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 73722 Mri joint of lwr extr w/dye " 3,755.00 " " 1,082.19 " 615.44 " 3,492.01 " 965.04 " 3,360.39 " 731.29 " 3,475.44 " 615.44 724.05 " 1,924.44 " 724.05 " 1,830.86 " 615.44 774.73 " 2,485.43 " 651.65 724.05 " 3,492.01 " " 2,793.59 " 716.81 738.53 724.05 " 3,004.00 " 662.51 " 2,215.45 " " 1,873.77 " 637.16 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 738.53 Outpatient 73723 Mri joint lwr extr w/o&w/dye " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 74018 X-ray exam abdomen 1 view 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 74019 X-ray exam abdomen 2 views 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 74021 X-ray exam abdomen 3+ views 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 74022 X-ray exam complete abdomen 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 74150 Ct abdomen w/o dye 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 74160 Ct abdomen w/dye 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 74170 Ct abdomen w/o & w/dye 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 74174 Ct angio abd&pelv w/o&w/dye " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 74176 Ct abd & pelvis w/o contrast " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 602.94 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 74177 Ct abd & pelv w/contrast " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 74178 Ct abd & pelv 1/> regns " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 74181 Mri abdomen w/o dye " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 602.94 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 74183 Mri abdomen w/o & w/dye " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 74220 X-ray xm esophagus 1cntrst 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 74221 X-ray xm esophagus 2cntrst 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 74230 X-ray xm swlng funcj c+ 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 74240 X-ray xm upr gi trc 1cntrst 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 74246 X-ray xm upr gi trc 2cntrst 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 74250 X-ray xm sm int 1cntrst std 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 74420 Urography rtrgr +-kub " 1,933.00 " 557.09 316.78 " 1,797.41 " 496.78 " 1,729.65 " 376.41 " 1,788.86 " 316.78 372.68 990.66 372.68 942.39 316.78 398.77 " 1,279.45 " 335.41 372.68 " 1,797.41 " " 1,437.92 " 368.95 380.13 372.68 " 1,546.40 " 341.00 " 1,140.47 " 964.47 327.96 790.60 " 1,449.75 " 734.73 864.63 380.13 Outpatient 74740 X-ray female genital tract " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 602.94 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 75571 Ct hrt w/o dye w/ca test 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 75572 Ct hrt w/3d image 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 75625 Contrast exam abdominl aorta " 15,024.00 " " 4,329.92 " " 2,462.57 " " 13,972.65 " " 3,861.17 " " 13,445.92 " " 2,926.11 " " 13,906.27 " " 2,462.57 " " 2,897.14 " " 7,699.80 " " 2,897.14 " " 7,325.85 " " 2,462.57 " " 3,099.94 " " 9,944.39 " " 2,607.43 " " 2,897.14 " " 13,972.65 " " 11,178.06 " " 2,868.17 " " 2,955.08 " " 2,897.14 " " 12,019.20 " " 2,650.88 " " 8,864.16 " " 7,497.55 " " 2,549.48 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,955.08 " Outpatient 75635 Ct angio abdominal arteries 937.00 270.04 153.66 871.82 240.81 839.02 182.59 867.74 153.66 180.78 480.21 180.78 457.09 153.66 193.43 620.20 162.70 180.78 871.82 697.45 178.97 184.40 180.78 749.60 165.41 552.83 467.80 159.09 383.23 702.75 356.15 419.12 184.40 Outpatient 75710 Artery x-rays arm/leg " 15,024.00 " " 4,329.92 " " 2,462.57 " " 13,972.65 " " 3,861.17 " " 13,445.92 " " 2,926.11 " " 13,906.27 " " 2,462.57 " " 2,897.14 " " 7,699.80 " " 2,897.14 " " 7,325.85 " " 2,462.57 " " 3,099.94 " " 9,944.39 " " 2,607.43 " " 2,897.14 " " 13,972.65 " " 11,178.06 " " 2,868.17 " " 2,955.08 " " 2,897.14 " " 12,019.20 " " 2,650.88 " " 8,864.16 " " 7,497.55 " " 2,549.48 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,955.08 " Outpatient 75716 Artery x-rays arms/legs " 15,024.00 " " 4,329.92 " " 2,462.57 " " 13,972.65 " " 3,861.17 " " 13,445.92 " " 2,926.11 " " 13,906.27 " " 2,462.57 " " 2,897.14 " " 7,699.80 " " 2,897.14 " " 7,325.85 " " 2,462.57 " " 3,099.94 " " 9,944.39 " " 2,607.43 " " 2,897.14 " " 13,972.65 " " 11,178.06 " " 2,868.17 " " 2,955.08 " " 2,897.14 " " 12,019.20 " " 2,650.88 " " 8,864.16 " " 7,497.55 " " 2,549.48 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,955.08 " Outpatient 75726 Artery x-rays abdomen " 25,044.00 " " 7,217.68 " " 4,102.21 " " 23,292.37 " " 6,436.31 " " 22,398.55 " " 4,874.39 " " 23,165.42 " " 4,102.21 " " 4,826.13 " " 12,835.05 " " 4,826.13 " " 12,212.15 " " 4,102.21 " " 5,163.96 " " 16,576.62 " " 4,343.52 " " 4,826.13 " " 23,292.37 " " 18,633.80 " " 4,777.87 " " 4,922.65 " " 4,826.13 " " 20,035.20 " " 4,415.91 " " 14,775.96 " " 12,498.37 " " 4,246.99 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,922.65 " Outpatient 76010 X-ray nose to rectum 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 76098 X-ray exam surgical specimen " 2,535.00 " 730.59 415.66 " 2,357.79 " 651.50 " 2,269.54 " 493.90 " 2,347.25 " 415.66 489.01 " 1,299.19 " 489.01 " 1,236.20 " 415.66 523.24 " 1,677.92 " 440.11 489.01 " 2,357.79 " " 1,886.22 " 484.12 498.79 489.01 " 2,028.00 " 447.44 " 1,495.65 " " 1,265.17 " 430.33 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 498.79 Outpatient 76506 Echo exam of head 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76536 Us exam of head and neck 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76604 Us exam chest 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76641 Ultrasound breast complete 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76642 Ultrasound breast limited 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 76700 Us exam abdom complete 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76705 Echo exam of abdomen 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76706 Us abdl aorta screen aaa 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76770 Us exam abdo back wall comp 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76775 Us exam abdo back wall lim 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76801 Ob us < 14 wks single fetus 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76805 Ob us >= 14 wks sngl fetus 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76815 Ob us limited fetus(s) 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76816 Ob us follow-up per fetus 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76817 Transvaginal us obstetric 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76818 Fetal biophys profile w/nst 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76819 Fetal biophys profil w/o nst 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76830 Transvaginal us non-ob 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76856 Us exam pelvic complete 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76857 Us exam pelvic limited 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76870 Us exam scrotum 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76881 Us compl joint r-t w/img 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76882 Us lmtd jt/nonvasc xtr strux 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 76885 Us exam infant hips dynamic 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 77061 Breast tomosynthesis uni 144.00 41.50 - 115.20 37.01 - - - - - 73.80 - 86.40 - - 95.31 - - 37.60 30.08 - - 115.20 - 84.96 96.48 - 58.90 108.00 54.73 64.41 - Outpatient 77063 Breast tomosynthesis bi 126.00 36.31 19.34 109.20 32.38 105.59 22.98 109.20 19.34 22.75 64.58 22.75 75.60 19.34 24.34 83.40 20.48 22.75 99.58 79.67 22.52 23.21 22.75 100.80 20.82 74.34 66.73 20.02 51.53 94.50 47.89 56.36 23.21 Outpatient 77065 Dx mammo incl cad uni 451.00 129.98 72.35 408.58 115.91 395.05 85.97 408.58 72.35 85.12 231.14 85.12 270.60 72.35 91.08 298.52 76.61 85.12 132.19 105.75 84.27 86.82 85.12 360.80 77.88 266.09 239.52 74.91 184.46 338.25 171.43 201.73 86.82 Outpatient 77066 Dx mammo incl cad bi 576.00 166.00 92.24 520.90 148.03 503.65 109.61 520.90 92.24 108.52 295.20 108.52 345.60 92.24 116.12 381.25 97.67 108.52 163.51 130.81 107.43 110.69 108.52 460.80 99.30 339.84 306.25 95.50 235.58 432.00 218.94 257.64 110.69 Outpatient 77067 Scr mammo bi incl cad 476.00 137.18 76.22 430.42 122.33 416.17 90.57 430.42 76.22 89.67 243.95 89.67 285.60 76.22 95.95 315.06 80.70 89.67 125.17 100.14 88.77 91.46 89.67 380.80 82.05 280.84 253.22 78.91 194.68 357.00 180.93 212.91 91.46 Outpatient 77072 X-rays for bone age 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 77075 X-rays bone survey complete 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 77080 Dxa bone density axial 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 77081 Dxa bone density/peripheral 425.00 122.49 69.58 395.00 109.23 379.92 82.68 392.93 69.58 81.86 217.81 81.86 207.10 69.58 87.59 281.31 73.67 81.86 395.00 316.00 81.04 83.50 81.86 340.00 74.90 250.75 211.96 72.04 173.83 318.75 161.54 190.10 83.50 Outpatient 77085 Dxa bone density study 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 285.50 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 77280 Set radiation therapy field 666.00 191.94 109.16 619.47 171.16 596.01 129.70 616.42 109.16 128.42 341.33 128.42 324.79 109.16 137.41 440.83 115.58 128.42 619.47 495.57 127.14 130.99 128.42 532.80 117.50 392.94 446.22 113.01 272.39 499.50 253.15 297.90 130.99 Outpatient 77290 Set radiation therapy field " 1,778.00 " 512.42 291.31 " 1,653.69 " 456.95 " 1,590.60 " 346.15 " 1,645.06 " 291.31 342.72 911.23 342.72 867.02 291.31 366.71 " 1,176.86 " 308.45 342.72 " 1,653.69 " " 1,322.94 " 339.29 349.57 342.72 " 1,422.40 " 313.59 " 1,049.02 " " 1,191.26 " 301.59 727.20 " 1,333.50 " 675.82 795.30 349.57 Outpatient 77295 3-d radiotherapy plan " 6,626.00 " " 1,909.61 " " 1,086.29 " " 6,162.85 " " 1,702.88 " " 5,931.28 " " 1,290.77 " " 6,134.35 " " 1,086.29 " " 1,277.99 " " 3,395.83 " " 1,277.99 " " 3,231.18 " " 1,086.29 " " 1,367.45 " " 4,385.75 " " 1,150.19 " " 1,277.99 " " 6,162.85 " " 4,930.25 " " 1,265.21 " " 1,303.55 " " 1,277.99 " " 5,300.80 " " 1,169.36 " " 3,909.34 " " 4,439.42 " " 1,124.63 " " 2,710.03 " " 4,969.50 " " 2,518.54 " " 2,963.81 " " 1,303.55 " Outpatient 77300 Radiation therapy dose plan 666.00 191.94 109.16 619.47 171.16 596.01 129.70 616.42 109.16 128.42 341.33 128.42 324.79 109.16 137.41 440.83 115.58 128.42 619.47 495.57 127.14 130.99 128.42 532.80 117.50 392.94 446.22 113.01 272.39 499.50 253.15 297.90 130.99 Outpatient 77301 Radiotherapy dose plan imrt " 6,626.00 " " 1,909.61 " " 1,086.29 " " 6,162.85 " " 1,702.88 " " 5,931.28 " " 1,290.77 " " 6,134.35 " " 1,086.29 " " 1,277.99 " " 3,395.83 " " 1,277.99 " " 3,231.18 " " 1,086.29 " " 1,367.45 " " 4,385.75 " " 1,150.19 " " 1,277.99 " " 6,162.85 " " 4,930.25 " " 1,265.21 " " 1,303.55 " " 1,277.99 " " 5,300.80 " " 1,169.36 " " 3,909.34 " " 4,439.42 " " 1,124.63 " " 2,710.03 " " 4,969.50 " " 2,518.54 " " 2,963.81 " " 1,303.55 " Outpatient 77307 Telethx isodose plan cplx " 1,778.00 " 512.42 291.31 " 1,653.69 " 456.95 " 1,590.60 " 346.15 " 1,645.06 " 291.31 342.72 911.23 342.72 867.02 291.31 366.71 " 1,176.86 " 308.45 342.72 " 1,653.69 " " 1,322.94 " 339.29 349.57 342.72 " 1,422.40 " 313.59 " 1,049.02 " " 1,191.26 " 301.59 727.20 " 1,333.50 " 675.82 795.30 349.57 Outpatient 77321 Special teletx port plan " 1,778.00 " 512.42 291.31 " 1,653.69 " 456.95 " 1,590.60 " 346.15 " 1,645.06 " 291.31 342.72 911.23 342.72 867.02 291.31 366.71 " 1,176.86 " 308.45 342.72 " 1,653.69 " " 1,322.94 " 339.29 349.57 342.72 " 1,422.40 " 313.59 " 1,049.02 " " 1,191.26 " 301.59 727.20 " 1,333.50 " 675.82 795.30 349.57 Outpatient 77332 Radiation treatment aid(s) 666.00 191.94 109.16 619.47 171.16 596.01 129.70 616.42 109.16 128.42 341.33 128.42 324.79 109.16 137.41 440.83 115.58 128.42 619.47 495.57 127.14 130.99 128.42 532.80 117.50 392.94 446.22 113.01 272.39 499.50 253.15 297.90 130.99 Outpatient 77333 Radiation treatment aid(s) 666.00 191.94 109.16 619.47 171.16 596.01 129.70 616.42 109.16 128.42 341.33 128.42 324.79 109.16 137.41 440.83 115.58 128.42 619.47 495.57 127.14 130.99 128.42 532.80 117.50 392.94 446.22 113.01 272.39 499.50 253.15 297.90 130.99 Outpatient 77334 Radiation treatment aid(s) " 1,778.00 " 512.42 291.31 " 1,653.69 " 456.95 " 1,590.60 " 346.15 " 1,645.06 " 291.31 342.72 911.23 342.72 867.02 291.31 366.71 " 1,176.86 " 308.45 342.72 " 1,653.69 " " 1,322.94 " 339.29 349.57 342.72 " 1,422.40 " 313.59 " 1,049.02 " " 1,191.26 " 301.59 727.20 " 1,333.50 " 675.82 795.30 349.57 Outpatient 77336 Radiation physics consult 666.00 191.94 109.16 619.47 171.16 596.01 129.70 616.42 109.16 128.42 341.33 128.42 324.79 109.16 137.41 440.83 115.58 128.42 619.47 495.57 127.14 130.99 128.42 532.80 117.50 392.94 446.22 113.01 272.39 499.50 253.15 297.90 130.99 Outpatient 77338 Design mlc device for imrt " 1,778.00 " 512.42 291.31 " 1,653.69 " 456.95 " 1,590.60 " 346.15 " 1,645.06 " 291.31 342.72 911.23 342.72 867.02 291.31 366.71 " 1,176.86 " 308.45 342.72 " 1,653.69 " " 1,322.94 " 339.29 349.57 342.72 " 1,422.40 " 313.59 " 1,049.02 " " 1,191.26 " 301.59 727.20 " 1,333.50 " 675.82 795.30 349.57 Outpatient 77370 Radiation physics consult 666.00 191.94 109.16 619.47 171.16 596.01 129.70 616.42 109.16 128.42 341.33 128.42 324.79 109.16 137.41 440.83 115.58 128.42 619.47 495.57 127.14 130.99 128.42 532.80 117.50 392.94 446.22 113.01 272.39 499.50 253.15 297.90 130.99 Outpatient 77373 Sbrt delivery " 9,102.00 " " 2,623.20 " " 1,491.95 " " 8,465.35 " " 2,339.21 " " 8,146.20 " " 1,772.78 " " 8,425.10 " " 1,491.95 " " 1,755.23 " " 4,664.78 " " 1,755.23 " " 4,438.37 " " 1,491.95 " " 1,878.10 " " 6,024.61 " " 1,579.71 " " 1,755.23 " " 8,465.35 " " 6,772.25 " " 1,737.68 " " 1,790.33 " " 1,755.23 " " 7,281.60 " " 1,606.04 " " 5,370.18 " " 6,098.34 " " 1,544.60 " " 3,722.72 " " 6,826.50 " " 3,459.67 " " 4,071.32 " " 1,790.33 " Outpatient 77385 Ntsty modul rad tx dlvr smpl " 2,848.00 " 820.79 466.74 " 2,649.10 " 731.94 " 2,548.43 " 554.59 " 2,635.68 " 466.74 549.10 " 1,459.60 " 549.10 " 1,388.93 " 466.74 587.54 " 1,885.09 " 494.19 549.10 " 2,649.10 " " 2,119.27 " 543.61 560.08 549.10 " 2,278.40 " 502.43 " 1,680.32 " " 1,908.16 " 483.21 " 1,164.83 " " 2,136.00 " " 1,082.52 " " 1,273.91 " 560.08 Outpatient 77386 Ntsty modul rad tx dlvr cplx " 2,848.00 " 820.79 466.74 " 2,649.10 " 731.94 " 2,548.43 " 554.59 " 2,635.68 " 466.74 549.10 " 1,459.60 " 549.10 " 1,388.93 " 466.74 587.54 " 1,885.09 " 494.19 549.10 " 2,649.10 " " 2,119.27 " 543.61 560.08 549.10 " 2,278.40 " 502.43 " 1,680.32 " " 1,908.16 " 483.21 " 1,164.83 " " 2,136.00 " " 1,082.52 " " 1,273.91 " 560.08 Outpatient 77402 Radiation treatment delivery 633.00 182.43 103.05 588.56 162.68 562.64 122.44 581.90 103.05 121.23 324.41 121.23 308.58 103.05 129.72 418.98 109.11 121.23 588.56 470.84 120.02 123.65 121.23 506.40 110.93 373.47 424.11 106.68 258.90 474.75 240.60 283.14 123.65 Outpatient 77412 Radiation treatment delivery " 1,269.00 " 365.73 207.94 " 1,180.04 " 326.13 " 1,135.35 " 247.08 " 1,174.22 " 207.94 244.63 650.36 244.63 618.70 207.94 261.75 839.95 220.17 244.63 " 1,180.04 " 944.03 242.18 249.52 244.63 " 1,015.20 " 223.84 748.71 850.23 215.27 519.02 951.75 482.35 567.62 249.52 Outpatient 77470 Special radiation treatment " 2,848.00 " 820.79 466.74 " 2,649.10 " 731.94 " 2,548.43 " 554.59 " 2,635.68 " 466.74 549.10 " 1,459.60 " 549.10 " 1,388.93 " 466.74 587.54 " 1,885.09 " 494.19 549.10 " 2,649.10 " " 2,119.27 " 543.61 560.08 549.10 " 2,278.40 " 502.43 " 1,680.32 " " 1,908.16 " 483.21 " 1,164.83 " " 2,136.00 " " 1,082.52 " " 1,273.91 " 560.08 Outpatient 77778 Apply interstit radiat compl " 3,719.00 " " 1,071.82 " 610.25 " 3,459.19 " 955.78 " 3,332.03 " 725.12 " 3,446.11 " 610.25 717.94 " 1,905.99 " 717.94 " 1,813.66 " 610.25 768.20 " 2,461.61 " 646.15 717.94 " 3,459.19 " " 2,767.34 " 710.76 732.30 717.94 " 2,975.20 " 656.92 " 2,194.21 " " 2,491.73 " 631.79 " 1,521.07 " " 2,789.25 " " 1,413.59 " " 1,663.51 " 732.30 Outpatient 78014 Thyroid imaging w/blood flow " 1,980.00 " 570.64 324.28 " 1,841.39 " 508.86 " 1,770.58 " 385.32 " 1,831.20 " 324.28 381.50 " 1,014.75 " 381.50 965.43 324.28 408.21 " 1,310.56 " 343.35 381.50 " 1,841.39 " " 1,473.10 " 377.69 389.13 381.50 " 1,584.00 " 349.07 " 1,168.20 " 988.05 335.72 809.82 " 1,485.00 " 752.60 885.65 389.13 Outpatient 78195 Lymph system imaging " 2,569.00 " 740.39 420.96 " 2,389.58 " 660.23 " 2,298.50 " 500.20 " 2,377.20 " 420.96 495.25 " 1,316.61 " 495.25 " 1,252.86 " 420.96 529.92 " 1,700.42 " 445.73 495.25 " 2,389.58 " " 1,911.65 " 490.30 505.16 495.25 " 2,055.20 " 453.15 " 1,515.71 " " 1,282.23 " 435.82 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 505.16 Outpatient 78201 Liver imaging " 2,569.00 " 740.39 420.96 " 2,389.58 " 660.23 " 2,298.50 " 500.20 " 2,377.20 " 420.96 495.25 " 1,316.61 " 495.25 " 1,252.86 " 420.96 529.92 " 1,700.42 " 445.73 495.25 " 2,389.58 " " 1,911.65 " 490.30 505.16 495.25 " 2,055.20 " 453.15 " 1,515.71 " " 1,282.23 " 435.82 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 505.16 Outpatient 78226 Hepatobiliary system imaging " 1,980.00 " 570.64 324.28 " 1,841.39 " 508.86 " 1,770.58 " 385.32 " 1,831.20 " 324.28 381.50 " 1,014.75 " 381.50 965.43 324.28 408.21 " 1,310.56 " 343.35 381.50 " 1,841.39 " " 1,473.10 " 377.69 389.13 381.50 " 1,584.00 " 349.07 " 1,168.20 " 988.05 335.72 809.82 " 1,485.00 " 752.60 885.65 389.13 Outpatient 78227 Hepatobil syst image w/drug " 1,980.00 " 570.64 420.96 " 2,389.58 " 508.86 " 2,298.50 " 500.20 " 2,377.20 " 420.96 495.25 " 1,014.75 " 495.25 " 1,252.86 " 420.96 529.92 " 1,310.56 " 445.73 495.25 " 2,389.58 " " 1,911.65 " 490.30 505.16 495.25 " 1,584.00 " 453.15 " 1,168.20 " " 1,282.23 " 435.82 809.82 " 1,485.00 " 752.60 885.65 505.16 Outpatient 78264 Gastric emptying imag study " 1,980.00 " 570.64 324.28 " 1,841.39 " 508.86 " 1,770.58 " 385.32 " 1,831.20 " 324.28 381.50 " 1,014.75 " 381.50 965.43 324.28 408.21 " 1,310.56 " 343.35 381.50 " 1,841.39 " " 1,473.10 " 377.69 389.13 381.50 " 1,584.00 " 349.07 " 1,168.20 " 988.05 335.72 809.82 " 1,485.00 " 752.60 885.65 389.13 Outpatient 78306 Bone imaging whole body " 1,980.00 " 570.64 324.28 " 1,841.39 " 508.86 " 1,770.58 " 385.32 " 1,831.20 " 324.28 381.50 " 1,014.75 " 381.50 965.43 324.28 408.21 " 1,310.56 " 343.35 381.50 " 1,841.39 " " 1,473.10 " 377.69 389.13 381.50 " 1,584.00 " 349.07 " 1,168.20 " 988.05 335.72 809.82 " 1,485.00 " 752.60 885.65 389.13 Outpatient 78315 Bone imaging 3 phase " 1,980.00 " 570.64 324.28 " 1,841.39 " 508.86 " 1,770.58 " 385.32 " 1,831.20 " 324.28 381.50 " 1,014.75 " 381.50 965.43 324.28 408.21 " 1,310.56 " 343.35 381.50 " 1,841.39 " " 1,473.10 " 377.69 389.13 381.50 " 1,584.00 " 349.07 " 1,168.20 " 988.05 335.72 809.82 " 1,485.00 " 752.60 885.65 389.13 Outpatient 78431 Myocrd img pet rst&strs ct " 11,815.00 " " 3,405.08 " " 1,895.59 " " 10,988.57 " " 3,036.46 " " 10,350.16 " " 2,252.41 " " 10,704.53 " " 1,895.59 " " 2,230.11 " " 6,055.19 " " 2,230.11 " " 5,761.28 " " 1,895.59 " " 2,386.22 " " 7,820.35 " " 2,007.10 " " 2,230.11 " " 10,988.57 " " 8,790.81 " " 2,207.81 " " 2,274.71 " " 2,230.11 " " 9,452.00 " " 2,040.55 " " 6,970.85 " " 5,896.31 " " 1,962.50 " " 4,832.34 " " 8,861.25 " " 4,490.88 " " 5,284.85 " " 2,274.71 " Outpatient 78452 Ht muscle image spect mult " 6,856.00 " " 1,975.90 " " 1,124.15 " " 6,376.54 " " 1,761.99 " " 6,137.99 " " 1,335.76 " " 6,348.14 " " 1,124.15 " " 1,322.53 " " 3,513.70 " " 1,322.53 " " 3,343.21 " " 1,124.15 " " 1,415.11 " " 4,537.99 " " 1,190.28 " " 1,322.53 " " 6,376.54 " " 5,101.20 " " 1,309.30 " " 1,348.98 " " 1,322.53 " " 5,484.80 " " 1,210.11 " " 4,045.04 " " 3,421.56 " " 1,163.83 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,348.98 " Outpatient 78472 Gated heart planar single " 1,980.00 " 570.64 324.28 " 1,841.39 " 508.86 " 1,770.58 " 385.32 " 1,831.20 " 324.28 381.50 " 1,014.75 " 381.50 965.43 324.28 408.21 " 1,310.56 " 343.35 381.50 " 1,841.39 " " 1,473.10 " 377.69 389.13 381.50 " 1,584.00 " 349.07 " 1,168.20 " 988.05 335.72 809.82 " 1,485.00 " 752.60 885.65 389.13 Outpatient 78492 Myocrd img pet mlt rst&strs " 7,772.00 " " 2,239.89 " " 1,273.19 " " 7,228.07 " " 1,997.40 " " 6,951.76 " " 1,512.85 " " 7,189.78 " " 1,273.19 " " 1,497.87 " " 3,983.15 " " 1,497.87 " " 3,789.67 " " 1,273.19 " " 1,602.72 " " 5,144.29 " " 1,348.08 " " 1,497.87 " " 7,228.07 " " 5,782.43 " " 1,482.89 " " 1,527.83 " " 1,497.87 " " 6,217.60 " " 1,370.55 " " 4,585.48 " " 3,878.49 " " 1,318.13 " " 3,178.75 " " 5,829.00 " " 2,954.14 " " 3,476.42 " " 1,527.83 " Outpatient 78580 Lung perfusion imaging " 1,980.00 " 570.64 324.28 " 1,841.39 " 508.86 " 1,770.58 " 385.32 " 1,831.20 " 324.28 381.50 " 1,014.75 " 381.50 965.43 324.28 408.21 " 1,310.56 " 343.35 381.50 " 1,841.39 " " 1,473.10 " 377.69 389.13 381.50 " 1,584.00 " 349.07 " 1,168.20 " 988.05 335.72 809.82 " 1,485.00 " 752.60 885.65 389.13 Outpatient 78708 K flow/funct image w/drug " 2,569.00 " 740.39 420.96 " 2,389.58 " 660.23 " 2,298.50 " 500.20 " 2,377.20 " 420.96 495.25 " 1,316.61 " 495.25 " 1,252.86 " 420.96 529.92 " 1,700.42 " 445.73 495.25 " 2,389.58 " " 1,911.65 " 490.30 505.16 495.25 " 2,055.20 " 453.15 " 1,515.71 " " 1,282.23 " 435.82 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 505.16 Outpatient 78815 Pet image w/ct skull-thigh " 7,772.00 " " 2,239.89 " " 1,273.19 " " 7,228.07 " " 1,997.40 " " 6,951.76 " " 1,512.85 " " 7,189.78 " " 1,273.19 " " 1,497.87 " " 3,983.15 " " 1,497.87 " " 3,789.67 " " 1,273.19 " " 1,602.72 " " 5,144.29 " " 1,348.08 " " 1,497.87 " " 7,228.07 " " 5,782.43 " " 1,482.89 " " 1,527.83 " " 1,497.87 " " 6,217.60 " " 1,370.55 " " 4,585.48 " " 3,878.49 " " 1,318.13 " " 3,178.75 " " 5,829.00 " " 2,954.14 " " 3,476.42 " " 1,527.83 " Outpatient 78816 Pet image w/ct full body " 7,772.00 " " 2,239.89 " " 1,273.19 " " 7,228.07 " " 1,997.40 " " 6,951.76 " " 1,512.85 " " 7,189.78 " " 1,273.19 " " 1,497.87 " " 3,983.15 " " 1,497.87 " " 3,789.67 " " 1,273.19 " " 1,602.72 " " 5,144.29 " " 1,348.08 " " 1,497.87 " " 7,228.07 " " 5,782.43 " " 1,482.89 " " 1,527.83 " " 1,497.87 " " 6,217.60 " " 1,370.55 " " 4,585.48 " " 3,878.49 " " 1,318.13 " " 3,178.75 " " 5,829.00 " " 2,954.14 " " 3,476.42 " " 1,527.83 " Outpatient 78830 Rp loclzj tum spect w/ct 1 " 6,856.00 " " 1,975.90 " " 1,124.15 " " 6,376.54 " " 1,761.99 " " 6,137.99 " " 1,335.76 " " 6,348.14 " " 1,124.15 " " 1,322.53 " " 3,513.70 " " 1,322.53 " " 3,343.21 " " 1,124.15 " " 1,415.11 " " 4,537.99 " " 1,190.28 " " 1,322.53 " " 6,376.54 " " 5,101.20 " " 1,309.30 " " 1,348.98 " " 1,322.53 " " 5,484.80 " " 1,210.11 " " 4,045.04 " " 3,421.56 " " 1,163.83 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,348.98 " Outpatient 80048 Metabolic panel total ca 44.00 12.68 7.19 40.61 11.31 39.26 8.54 40.61 7.19 8.46 22.55 8.46 21.66 7.19 9.05 29.12 7.61 8.46 28.68 22.94 8.38 8.63 8.46 35.20 7.74 25.96 22.17 7.44 18.00 33.00 16.72 19.68 8.63 Outpatient 80050 General health panel 383.00 110.38 - 306.40 98.43 - - - - - 196.29 - 229.80 - - 253.51 - - 99.99 79.99 - - 306.40 - 225.97 256.61 - 156.65 287.25 145.58 171.32 - Outpatient 80051 Electrolyte panel 37.00 10.66 5.96 33.65 9.51 32.53 7.08 33.65 5.96 7.01 18.96 7.01 17.95 5.96 7.50 24.49 6.31 7.01 23.76 19.01 6.94 7.15 7.01 29.60 6.41 21.83 18.37 6.17 15.13 27.75 14.06 16.55 7.15 Outpatient 80053 Comprehen metabolic panel 55.00 15.85 8.98 50.69 14.14 49.01 10.67 50.69 8.98 10.56 28.19 10.56 27.03 8.98 11.30 36.40 9.50 10.56 35.79 28.63 10.45 10.77 10.56 44.00 9.66 32.45 27.67 9.29 22.50 41.25 20.91 24.60 10.77 Outpatient 80055 Obstetric panel 251.00 72.34 40.64 229.49 64.51 221.89 48.29 229.49 40.64 47.81 128.64 47.81 122.39 40.64 51.16 166.14 43.03 47.81 162.05 129.64 47.33 48.77 47.81 200.80 43.75 148.09 125.26 42.07 102.66 188.25 95.41 112.27 48.77 Outpatient 80069 Renal function panel 46.00 13.26 7.38 41.66 11.82 40.28 8.77 41.66 7.38 8.68 23.58 8.68 22.22 7.38 9.29 30.45 7.81 8.68 29.42 23.54 8.59 8.85 8.68 36.80 7.94 27.14 22.74 7.64 18.81 34.50 17.48 20.58 8.85 Outpatient 80074 Acute hepatitis panel 250.00 72.05 40.49 228.62 64.25 221.06 48.11 228.62 40.49 47.63 128.13 47.63 121.93 40.49 50.96 165.48 42.87 47.63 161.44 129.15 47.15 48.58 47.63 200.00 43.58 147.50 124.79 41.91 102.25 187.50 95.03 111.83 48.58 Outpatient 80076 Hepatic function panel 43.00 12.39 6.94 39.22 11.05 37.92 8.25 39.22 6.94 8.17 22.04 8.17 20.92 6.94 8.74 28.46 7.35 8.17 27.69 22.15 8.09 8.33 8.17 34.40 7.48 25.37 21.41 7.19 17.59 32.25 16.34 19.23 8.33 Outpatient 80081 Obstetric panel 393.00 113.26 63.63 359.33 101.00 347.43 75.61 359.33 63.63 74.86 201.41 74.86 191.64 63.63 80.10 260.13 67.37 74.86 253.74 202.99 74.11 76.36 74.86 314.40 68.50 231.87 196.13 65.88 160.74 294.75 149.38 175.79 76.36 Outpatient 80143 Drug assay acetaminophen 98.00 28.24 15.84 89.47 25.19 86.51 18.83 89.47 15.84 18.64 50.23 18.64 47.72 15.84 19.94 64.87 16.78 18.64 63.18 50.54 18.45 19.01 18.64 78.40 17.06 57.82 48.84 16.40 40.08 73.50 37.25 43.84 19.01 Outpatient 80156 Assay carbamazepine total 76.00 21.90 12.38 69.94 19.53 67.62 14.72 69.94 12.38 14.57 38.95 14.57 37.30 12.38 15.59 50.30 13.11 14.57 49.39 39.51 14.42 14.86 14.57 60.80 13.33 44.84 38.17 12.82 31.08 57.00 28.89 33.99 14.86 Outpatient 80158 Drug assay cyclosporine 95.00 27.38 15.34 86.64 24.42 83.77 18.23 86.64 15.34 18.05 48.69 18.05 46.21 15.34 19.31 62.88 16.25 18.05 61.18 48.94 17.87 18.41 18.05 76.00 16.52 56.05 47.29 15.88 38.86 71.25 36.11 42.49 18.41 Outpatient 80159 Drug assay clozapine 106.00 30.55 17.13 96.72 27.24 93.52 20.35 96.72 17.13 20.15 54.33 20.15 51.58 17.13 21.56 70.16 18.14 20.15 68.30 54.64 19.95 20.55 20.15 84.80 18.44 62.54 52.79 17.73 43.35 79.50 40.29 47.41 20.55 Outpatient 80162 Assay of digoxin total 70.00 20.17 11.29 63.74 17.99 61.63 13.41 63.74 11.29 13.28 35.88 13.28 34.00 11.29 14.21 46.33 11.95 13.28 45.01 36.01 13.15 13.55 13.28 56.00 12.15 41.30 34.79 11.69 28.63 52.50 26.61 31.31 13.55 Outpatient 80164 Assay dipropylacetic acd tot 71.00 20.46 11.51 64.99 18.25 62.84 13.68 64.99 11.51 13.54 36.39 13.54 34.66 11.51 14.49 46.99 12.19 13.54 45.89 36.72 13.40 13.81 13.54 56.80 12.39 41.89 35.47 11.92 29.04 53.25 26.99 31.76 13.81 Outpatient 80175 Drug screen quan lamotrigine 70.00 20.17 11.26 63.60 17.99 61.49 13.38 63.60 11.26 13.25 35.88 13.25 33.92 11.26 14.18 46.33 11.93 13.25 44.91 35.93 13.12 13.52 13.25 56.00 12.12 41.30 34.72 11.66 28.63 52.50 26.61 31.31 13.52 Outpatient 80177 Drug scrn quan levetiracetam 70.00 20.17 11.26 63.60 17.99 61.49 13.38 63.60 11.26 13.25 35.88 13.25 33.92 11.26 14.18 46.33 11.93 13.25 44.91 35.93 13.12 13.52 13.25 56.00 12.12 41.30 34.72 11.66 28.63 52.50 26.61 31.31 13.52 Outpatient 80178 Assay of lithium 35.00 10.09 5.62 31.73 9.00 30.68 6.68 31.73 5.62 6.61 17.94 6.61 16.92 5.62 7.07 23.17 5.95 6.61 22.40 17.92 6.54 6.74 6.61 28.00 6.05 20.65 17.32 5.82 14.32 26.25 13.30 15.66 6.74 Outpatient 80183 Drug scrn quant oxcarbazepin 70.00 20.17 11.26 63.60 17.99 61.49 13.38 63.60 11.26 13.25 35.88 13.25 33.92 11.26 14.18 46.33 11.93 13.25 44.91 35.93 13.12 13.52 13.25 56.00 12.12 41.30 34.72 11.66 28.63 52.50 26.61 31.31 13.52 Outpatient 80184 Assay of phenobarbital 80.00 23.06 13.01 73.44 20.56 71.01 15.45 73.44 13.01 15.30 41.00 15.30 39.17 13.01 16.37 52.95 13.77 15.30 51.86 41.49 15.15 15.61 15.30 64.00 14.00 47.20 40.09 13.46 32.72 60.00 30.41 35.78 15.61 Outpatient 80185 Assay of phenytoin total 70.00 20.17 11.26 63.60 17.99 61.49 13.38 63.60 11.26 13.25 35.88 13.25 33.92 11.26 14.18 46.33 11.93 13.25 44.91 35.93 13.12 13.52 13.25 56.00 12.12 41.30 34.72 11.66 28.63 52.50 26.61 31.31 13.52 Outpatient 80195 Assay of sirolimus 72.00 20.75 11.67 65.90 18.50 63.72 13.87 65.90 11.67 13.73 36.90 13.73 35.15 11.67 14.69 47.66 12.36 13.73 46.54 37.23 13.59 14.00 13.73 57.60 12.56 42.48 35.97 12.08 29.45 54.00 27.37 32.21 14.00 Outpatient 80197 Assay of tacrolimus 72.00 20.75 11.67 65.90 18.50 63.72 13.87 65.90 11.67 13.73 36.90 13.73 35.15 11.67 14.69 47.66 12.36 13.73 46.54 37.23 13.59 14.00 13.73 57.60 12.56 42.48 35.97 12.08 29.45 54.00 27.37 32.21 14.00 Outpatient 80198 Assay of theophylline 74.00 21.33 12.02 67.87 19.02 65.63 14.28 67.87 12.02 14.14 37.93 14.14 36.20 12.02 15.13 48.98 12.73 14.14 47.93 38.34 14.00 14.42 14.14 59.20 12.94 43.66 37.05 12.44 30.27 55.50 28.13 33.10 14.42 Outpatient 80201 Assay of topiramate 63.00 18.16 10.13 57.22 16.19 55.32 12.04 57.22 10.13 11.92 32.29 11.92 30.52 10.13 12.75 41.70 10.73 11.92 40.40 32.32 11.80 12.16 11.92 50.40 10.91 37.17 31.23 10.49 25.77 47.25 23.95 28.18 12.16 Outpatient 80202 Assay of vancomycin 71.00 20.46 11.51 64.99 18.25 62.84 13.68 64.99 11.51 13.54 36.39 13.54 34.66 11.51 14.49 46.99 12.19 13.54 45.89 36.72 13.40 13.81 13.54 56.80 12.39 41.89 35.47 11.92 29.04 53.25 26.99 31.76 13.81 Outpatient 80299 Quantitative assay drug 98.00 28.24 15.84 89.47 25.19 86.51 18.83 89.47 15.84 18.64 50.23 18.64 47.72 15.84 19.94 64.87 16.78 18.64 63.18 50.54 18.45 19.01 18.64 78.40 17.06 57.82 48.84 16.40 40.08 73.50 37.25 43.84 19.01 Outpatient 80307 Drug test prsmv chem anlyzr 326.00 93.95 52.82 298.27 83.78 288.40 62.76 298.27 52.82 62.14 167.08 62.14 159.08 52.82 66.49 215.78 55.93 62.14 210.62 168.50 61.52 63.38 62.14 260.80 56.86 192.34 162.81 54.68 133.33 244.50 123.91 145.82 63.38 Outpatient 81001 Urinalysis auto w/scope 17.00 4.90 2.69 15.22 4.37 14.71 3.20 15.22 2.69 3.17 8.71 3.17 8.12 2.69 3.39 11.25 2.85 3.17 10.74 8.60 3.14 3.23 3.17 13.60 2.90 10.03 8.31 2.79 6.95 12.75 6.46 7.60 3.23 Outpatient 81025 Urine pregnancy test 45.00 12.97 7.32 41.33 11.57 39.96 8.70 41.33 7.32 8.61 23.06 8.61 22.04 7.32 9.21 29.79 7.75 8.61 29.18 23.35 8.52 8.78 8.61 36.00 7.88 26.55 22.56 7.58 18.41 33.75 17.10 20.13 8.78 Outpatient 81206 Bcr/abl1 gene major bp 861.00 248.14 139.37 787.01 221.28 760.95 165.60 787.01 139.37 163.96 441.26 163.96 419.74 139.37 175.44 569.90 147.56 163.96 555.74 444.59 162.32 167.24 163.96 688.80 150.02 507.99 429.58 144.28 352.15 645.75 327.27 385.13 167.24 Outpatient 81207 Bcr/abl1 gene minor bp 760.00 219.03 123.11 695.23 195.32 672.22 146.29 695.23 123.11 144.84 389.50 144.84 370.79 123.11 154.98 503.04 130.36 144.84 490.94 392.75 143.39 147.74 144.84 608.00 132.53 448.40 379.48 127.46 310.84 570.00 288.88 339.95 147.74 Outpatient 81240 F2 gene 345.00 99.43 55.84 315.31 88.67 304.87 66.35 315.31 55.84 65.69 176.81 65.69 168.17 55.84 70.29 228.36 59.12 65.69 222.66 178.13 65.03 67.00 65.69 276.00 60.11 203.55 172.11 57.81 141.11 258.75 131.13 154.32 67.00 Outpatient 81241 F5 gene 385.00 110.96 62.36 352.18 98.95 340.52 74.10 352.18 62.36 73.37 197.31 73.37 187.83 62.36 78.51 254.83 66.03 73.37 248.69 198.95 72.64 74.84 73.37 308.00 67.13 227.15 192.23 64.57 157.47 288.75 146.34 172.21 74.84 Outpatient 81256 Hfe gene 343.00 98.85 55.56 313.73 88.15 303.34 66.01 313.73 55.56 65.36 175.79 65.36 167.32 55.56 69.94 227.03 58.82 65.36 221.54 177.23 64.71 66.67 65.36 274.40 59.80 202.37 171.24 57.52 140.29 257.25 130.37 153.42 66.67 Outpatient 81291 Mthfr gene 343.00 98.85 55.54 313.63 88.15 303.25 65.99 313.63 55.54 65.34 175.79 65.34 167.27 55.54 69.91 227.03 58.81 65.34 221.47 177.18 64.69 66.65 65.34 274.40 59.79 202.37 171.19 57.50 140.29 257.25 130.37 153.42 66.65 Outpatient 81382 Hla ii typing 1 loc hr 649.00 187.04 105.13 593.66 166.79 574.01 124.92 593.66 105.13 123.68 332.61 123.68 316.62 105.13 132.34 429.57 111.31 123.68 419.21 335.37 122.44 126.15 123.68 519.20 113.17 382.91 324.04 108.84 265.44 486.75 246.68 290.30 126.15 Outpatient 81596 Nfct ds chrnc hcv 6 assays 379.00 109.23 61.36 346.51 97.40 335.04 72.91 346.51 61.36 72.19 194.24 72.19 184.81 61.36 77.24 250.86 64.97 72.19 244.69 195.75 71.47 73.63 72.19 303.20 66.05 223.61 189.14 63.53 155.01 284.25 144.06 169.53 73.63 Outpatient 82010 Acetone assay 43.00 12.39 6.94 39.22 11.05 37.92 8.25 39.22 6.94 8.17 22.04 8.17 20.92 6.94 8.74 28.46 7.35 8.17 27.69 22.15 8.09 8.33 8.17 34.40 7.48 25.37 21.41 7.19 17.59 32.25 16.34 19.23 8.33 Outpatient 82024 Assay of acth 203.00 58.50 32.83 185.38 52.17 179.24 39.01 185.38 32.83 38.62 104.04 38.62 98.87 32.83 41.32 134.37 34.76 38.62 130.90 104.72 38.23 39.39 38.62 162.40 35.34 119.77 101.18 33.99 83.03 152.25 77.16 90.80 39.39 Outpatient 82043 Ur albumin quantitative 30.00 8.65 4.91 27.74 7.71 26.83 5.84 27.74 4.91 5.78 15.38 5.78 14.80 4.91 6.18 19.86 5.20 5.78 19.59 15.67 5.72 5.90 5.78 24.00 5.29 17.70 15.14 5.09 12.27 22.50 11.40 13.42 5.90 Outpatient 82077 Assay spec xcp ur&breath ia 601.00 173.21 14.68 480.80 154.46 80.15 17.44 82.90 14.68 17.27 308.01 17.27 44.21 14.68 18.48 397.80 15.54 17.27 58.54 46.83 17.10 17.62 17.27 480.80 15.80 354.59 45.25 15.20 245.81 450.75 228.44 268.83 17.62 Outpatient 82085 Assay of aldolase 51.00 14.70 8.25 46.61 13.11 45.07 9.81 46.61 8.25 9.71 26.14 9.71 24.86 8.25 10.39 33.76 8.74 9.71 32.91 26.33 9.61 9.90 9.71 40.80 8.88 30.09 25.44 8.54 20.86 38.25 19.39 22.81 9.90 Outpatient 82088 Assay of aldosterone 214.00 61.67 34.64 195.60 55.00 189.12 41.16 195.60 34.64 40.75 109.68 40.75 104.32 34.64 43.60 141.65 36.68 40.75 138.12 110.50 40.34 41.57 40.75 171.20 37.29 126.26 106.77 35.86 87.53 160.50 81.34 95.72 41.57 Outpatient 82103 Alpha-1-antitrypsin total 71.00 20.46 11.42 64.51 18.25 62.38 13.57 64.51 11.42 13.44 36.39 13.44 34.41 11.42 14.38 46.99 12.10 13.44 45.55 36.44 13.31 13.71 13.44 56.80 12.30 41.89 35.21 11.83 29.04 53.25 26.99 31.76 13.71 Outpatient 82104 Alpha-1-antitrypsin pheno 76.00 21.90 12.29 69.41 19.53 67.11 14.60 69.41 12.29 14.46 38.95 14.46 37.02 12.29 15.47 50.30 13.01 14.46 49.01 39.21 14.32 14.75 14.46 60.80 13.23 44.84 37.89 12.72 31.08 57.00 28.89 33.99 14.75 Outpatient 82105 Alpha-fetoprotein serum 88.00 25.36 14.25 80.50 22.62 77.83 16.94 80.50 14.25 16.77 45.10 16.77 42.93 14.25 17.94 58.25 15.09 16.77 56.84 45.47 16.60 17.11 16.77 70.40 15.34 51.92 43.94 14.76 35.99 66.00 33.45 39.36 17.11 Outpatient 82107 Alpha-fetoprotein l3 338.00 97.41 54.75 309.17 86.87 298.93 65.05 309.17 54.75 64.41 173.23 64.41 164.89 54.75 68.92 223.72 57.97 64.41 218.32 174.65 63.77 65.70 64.41 270.40 58.94 199.42 168.75 56.68 138.24 253.50 128.47 151.19 65.70 Outpatient 82140 Assay of ammonia 76.00 21.90 12.38 69.94 19.53 67.62 14.72 69.94 12.38 14.57 38.95 14.57 37.30 12.38 15.59 50.30 13.11 14.57 49.39 39.51 14.42 14.86 14.57 60.80 13.33 44.84 38.17 12.82 31.08 57.00 28.89 33.99 14.86 Outpatient 82150 Assay of amylase 34.00 9.80 5.51 31.10 8.74 30.07 6.54 31.10 5.51 6.48 17.43 6.48 16.59 5.51 6.93 22.50 5.83 6.48 21.96 17.57 6.42 6.61 6.48 27.20 5.93 20.06 16.98 5.70 13.91 25.50 12.92 15.21 6.61 Outpatient 82157 Assay of androstenedione 154.00 44.38 24.89 140.54 39.58 135.89 29.57 140.54 24.89 29.28 78.93 29.28 74.96 24.89 31.33 101.93 26.35 29.28 99.24 79.40 28.99 29.87 29.28 123.20 26.79 90.86 76.71 25.77 62.99 115.50 58.54 68.88 29.87 Outpatient 82164 Angiotensin i enzyme test 77.00 22.19 12.41 70.08 19.79 67.76 14.75 70.08 12.41 14.60 39.46 14.60 37.38 12.41 15.62 50.97 13.14 14.60 49.49 39.59 14.45 14.89 14.60 61.60 13.36 45.43 38.25 12.85 31.49 57.75 29.27 34.44 14.89 Outpatient 82232 Assay of beta-2 protein 85.00 24.50 13.75 77.66 21.85 75.09 16.34 77.66 13.75 16.18 43.56 16.18 41.42 13.75 17.31 56.26 14.56 16.18 54.84 43.87 16.02 16.50 16.18 68.00 14.80 50.15 42.39 14.24 34.77 63.75 32.31 38.02 16.50 Outpatient 82239 Bile acids total 90.00 25.94 14.55 82.18 23.13 79.46 17.29 82.18 14.55 17.12 46.13 17.12 43.83 14.55 18.32 59.57 15.41 17.12 58.03 46.42 16.95 17.46 17.12 72.00 15.66 53.10 44.85 15.07 36.81 67.50 34.21 40.26 17.46 Outpatient 82247 Bilirubin total 26.00 7.49 4.27 24.10 6.68 23.30 5.07 24.10 4.27 5.02 13.33 5.02 12.85 4.27 5.37 17.21 4.52 5.02 17.02 13.61 4.97 5.12 5.02 20.80 4.59 15.34 13.15 4.42 10.63 19.50 9.88 11.63 5.12 Outpatient 82248 Bilirubin direct 26.00 7.49 4.27 24.10 6.68 23.30 5.07 24.10 4.27 5.02 13.33 5.02 12.85 4.27 5.37 17.21 4.52 5.02 17.02 13.61 4.97 5.12 5.02 20.80 4.59 15.34 13.15 4.42 10.63 19.50 9.88 11.63 5.12 Outpatient 82270 Occult blood feces 23.00 6.63 3.72 21.02 5.91 20.33 4.42 21.02 3.72 4.38 11.79 4.38 11.21 3.72 4.69 15.22 3.94 4.38 14.85 11.88 4.34 4.47 4.38 18.40 4.01 13.57 11.48 3.85 9.41 17.25 8.74 10.29 4.47 Outpatient 82272 Occult bld feces 1-3 tests 22.00 6.34 3.60 20.30 5.65 19.63 4.27 20.30 3.60 4.23 11.28 4.23 10.83 3.60 4.53 14.56 3.81 4.23 14.34 11.47 4.19 4.31 4.23 17.60 3.87 12.98 11.08 3.72 9.00 16.50 8.36 9.84 4.31 Outpatient 82306 Vitamin d 25 hydroxy 155.00 44.67 25.16 142.08 39.84 137.38 29.90 142.08 25.16 29.60 79.44 29.60 75.78 25.16 31.67 102.59 26.64 29.60 100.33 80.26 29.30 30.19 29.60 124.00 27.08 91.45 77.55 26.05 63.40 116.25 58.92 69.33 30.19 Outpatient 82310 Assay of calcium 27.00 7.78 4.39 24.77 6.94 23.95 5.21 24.77 4.39 5.16 13.84 5.16 13.21 4.39 5.52 17.87 4.64 5.16 17.49 13.99 5.11 5.26 5.16 21.60 4.72 15.93 13.52 4.54 11.04 20.25 10.26 12.08 5.26 Outpatient 82330 Assay of calcium 72.00 20.75 11.63 65.66 18.50 63.49 13.82 65.66 11.63 13.68 36.90 13.68 35.02 11.63 14.64 47.66 12.31 13.68 46.37 37.09 13.54 13.95 13.68 57.60 12.52 42.48 35.84 12.04 29.45 54.00 27.37 32.21 13.95 Outpatient 82340 Assay of calcium in urine 32.00 9.22 5.13 28.94 8.22 27.99 6.09 28.94 5.13 6.03 16.40 6.03 15.44 5.13 6.45 21.18 5.43 6.03 20.44 16.35 5.97 6.15 6.03 25.60 5.52 18.88 15.80 5.31 13.09 24.00 12.16 14.31 6.15 Outpatient 82365 Calculus spectroscopy 68.00 19.60 10.97 61.92 17.48 59.87 13.03 61.92 10.97 12.90 34.85 12.90 33.02 10.97 13.80 45.01 11.61 12.90 43.72 34.98 12.77 13.16 12.90 54.40 11.80 40.12 33.80 11.35 27.81 51.00 25.85 30.42 13.16 Outpatient 82378 Carcinoembryonic antigen 100.00 28.82 16.12 91.01 25.70 88.00 19.15 91.01 16.12 18.96 51.25 18.96 48.54 16.12 20.29 66.19 17.06 18.96 64.26 51.41 18.77 19.34 18.96 80.00 17.35 59.00 49.68 16.68 40.90 75.00 38.01 44.73 19.34 Outpatient 82384 Assay three catecholamines 133.00 38.33 21.46 121.20 34.18 117.19 25.50 121.20 21.46 25.25 68.16 25.25 64.64 21.46 27.02 88.03 22.73 25.25 85.58 68.47 25.00 25.76 25.25 106.40 23.10 78.47 66.16 22.22 54.40 99.75 50.55 59.49 25.76 Outpatient 82390 Assay of ceruloplasmin 56.00 16.14 9.13 51.55 14.39 49.85 10.85 51.55 9.13 10.74 28.70 10.74 27.49 9.13 11.49 37.07 9.67 10.74 36.40 29.12 10.63 10.95 10.74 44.80 9.83 33.04 28.14 9.45 22.90 42.00 21.29 25.05 10.95 Outpatient 82397 Chemiluminescent assay 74.00 21.33 12.00 67.78 19.02 65.53 14.26 67.78 12.00 14.12 37.93 14.12 36.15 12.00 15.11 48.98 12.71 14.12 47.86 38.29 13.98 14.40 14.12 59.20 12.92 43.66 36.99 12.43 30.27 55.50 28.13 33.10 14.40 Outpatient 82465 Assay bld/serum cholesterol 23.00 6.63 3.70 20.88 5.91 20.19 4.39 20.88 3.70 4.35 11.79 4.35 11.14 3.70 4.65 15.22 3.92 4.35 14.74 11.80 4.31 4.44 4.35 18.40 3.98 13.57 11.40 3.83 9.41 17.25 8.74 10.29 4.44 Outpatient 82507 Assay of citrate 146.00 42.08 23.63 133.44 37.52 129.02 28.08 133.44 23.63 27.80 74.83 27.80 71.17 23.63 29.75 96.64 25.02 27.80 94.23 75.38 27.52 28.36 27.80 116.80 25.44 86.14 72.84 24.46 59.71 109.50 55.49 65.31 28.36 Outpatient 82523 Collagen crosslinks 98.00 28.24 15.88 89.66 25.19 86.70 18.87 89.66 15.88 18.68 50.23 18.68 47.82 15.88 19.99 64.87 16.81 18.68 63.32 50.65 18.49 19.05 18.68 78.40 17.09 57.82 48.94 16.44 40.08 73.50 37.25 43.84 19.05 Outpatient 82525 Assay of copper 65.00 18.73 10.55 59.57 16.71 57.60 12.53 59.57 10.55 12.41 33.31 12.41 31.77 10.55 13.28 43.02 11.17 12.41 42.06 33.65 12.29 12.66 12.41 52.00 11.36 38.35 32.51 10.92 26.59 48.75 24.71 29.07 12.66 Outpatient 82530 Cortisol free 88.00 25.36 14.20 80.21 22.62 77.55 16.88 80.21 14.20 16.71 45.10 16.71 42.78 14.20 17.88 58.25 15.04 16.71 56.64 45.31 16.54 17.04 16.71 70.40 15.29 51.92 43.78 14.70 35.99 66.00 33.45 39.36 17.04 Outpatient 82533 Total cortisol 86.00 24.79 13.86 78.24 22.10 75.65 16.46 78.24 13.86 16.30 44.08 16.30 41.73 13.86 17.44 56.92 14.67 16.30 55.25 44.20 16.14 16.63 16.30 68.80 14.91 50.74 42.71 14.34 35.17 64.50 32.69 38.47 16.63 Outpatient 82542 Col chromotography qual/quan 126.00 36.31 20.48 115.63 32.38 111.80 24.33 115.63 20.48 24.09 64.58 24.09 61.67 20.48 25.78 83.40 21.68 24.09 81.65 65.32 23.85 24.57 24.09 100.80 22.04 74.34 63.12 21.20 51.53 94.50 47.89 56.36 24.57 Outpatient 82550 Assay of ck (cpk) 34.00 9.80 5.53 31.25 8.74 30.21 6.58 31.25 5.53 6.51 17.43 6.51 16.67 5.53 6.97 22.50 5.86 6.51 22.07 17.65 6.44 6.64 6.51 27.20 5.96 20.06 17.06 5.73 13.91 25.50 12.92 15.21 6.64 Outpatient 82553 Creatine mb fraction 61.00 17.58 9.82 55.44 15.68 53.60 11.67 55.44 9.82 11.55 31.26 11.55 29.57 9.82 12.36 40.38 10.40 11.55 39.15 31.32 11.43 11.78 11.55 48.80 10.57 35.99 30.26 10.16 24.95 45.75 23.19 27.29 11.78 Outpatient 82565 Assay of creatinine 27.00 7.78 4.35 24.58 6.94 23.76 5.17 24.58 4.35 5.12 13.84 5.12 13.11 4.35 5.48 17.87 4.61 5.12 17.35 13.88 5.07 5.22 5.12 21.60 4.68 15.93 13.41 4.51 11.04 20.25 10.26 12.08 5.22 Outpatient 82570 Assay of urine creatinine 27.00 7.78 4.40 24.86 6.94 24.04 5.23 24.86 4.40 5.18 13.84 5.18 13.26 4.40 5.54 17.87 4.66 5.18 17.56 14.05 5.13 5.28 5.18 21.60 4.74 15.93 13.57 4.56 11.04 20.25 10.26 12.08 5.28 Outpatient 82575 Creatinine clearance test 50.00 14.41 8.04 45.41 12.85 43.90 9.55 45.41 8.04 9.46 25.63 9.46 24.22 8.04 10.12 33.10 8.51 9.46 32.06 25.65 9.37 9.65 9.46 40.00 8.66 29.50 24.79 8.32 20.45 37.50 19.01 22.37 9.65 Outpatient 82607 Vitamin b-12 79.00 22.77 12.82 72.38 20.30 69.99 15.23 72.38 12.82 15.08 40.49 15.08 38.60 12.82 16.14 52.29 13.57 15.08 51.11 40.89 14.93 15.38 15.08 63.20 13.80 46.61 39.51 13.27 32.31 59.25 30.03 35.34 15.38 Outpatient 82626 Dehydroepiandrosterone 133.00 38.33 21.48 121.30 34.18 117.28 25.52 121.30 21.48 25.27 68.16 25.27 64.69 21.48 27.04 88.03 22.74 25.27 85.65 68.52 25.02 25.78 25.27 106.40 23.12 78.47 66.21 22.24 54.40 99.75 50.55 59.49 25.78 Outpatient 82627 Dehydroepiandrosterone 117.00 33.72 18.90 106.70 30.07 103.17 22.45 106.70 18.90 22.23 59.96 22.23 56.91 18.90 23.79 77.44 20.01 22.23 75.35 60.28 22.01 22.67 22.23 93.60 20.34 69.03 58.24 19.56 47.85 87.75 44.47 52.33 22.67 Outpatient 82652 Vit d 1 25-dihydroxy 202.00 58.22 32.73 184.80 51.91 178.68 38.89 184.80 32.73 38.50 103.53 38.50 98.56 32.73 41.20 133.70 34.65 38.50 130.50 104.40 38.12 39.27 38.50 161.60 35.23 119.18 100.87 33.88 82.62 151.50 76.78 90.35 39.27 Outpatient 82656 El-1 fecal qual/semiq 61.00 17.58 9.80 55.34 15.68 53.51 11.65 55.34 9.80 11.53 31.26 11.53 29.52 9.80 12.34 40.38 10.38 11.53 39.08 31.26 11.41 11.76 11.53 48.80 10.55 35.99 30.21 10.15 24.95 45.75 23.19 27.29 11.76 Outpatient 82668 Assay of erythropoietin 99.00 28.53 15.97 90.19 25.44 87.21 18.98 90.19 15.97 18.79 50.74 18.79 48.10 15.97 20.11 65.53 16.91 18.79 63.69 50.95 18.60 19.17 18.79 79.20 17.19 58.41 49.23 16.54 40.49 74.25 37.63 44.28 19.17 Outpatient 82670 Assay of total estradiol 147.00 42.37 23.75 134.11 37.78 129.67 28.22 134.11 23.75 27.94 75.34 27.94 71.53 23.75 29.90 97.30 25.15 27.94 94.70 75.76 27.66 28.50 27.94 117.60 25.57 86.73 73.20 24.59 60.12 110.25 55.87 65.75 28.50 Outpatient 82672 Assay of estrogen 114.00 32.85 18.45 104.16 29.30 100.71 21.92 104.16 18.45 21.70 58.43 21.70 55.55 18.45 23.22 75.46 19.53 21.70 73.55 58.84 21.48 22.13 21.70 91.20 19.86 67.26 56.85 19.10 46.63 85.50 43.33 50.99 22.13 Outpatient 82677 Assay of estriol 127.00 36.60 20.55 116.06 32.64 112.22 24.42 116.06 20.55 24.18 65.09 24.18 61.90 20.55 25.87 84.06 21.76 24.18 81.96 65.57 23.94 24.66 24.18 101.60 22.12 74.93 63.35 21.28 51.94 95.25 48.27 56.81 24.66 Outpatient 82705 Fats/lipids feces qual 45.00 12.97 4.34 36.00 11.57 23.67 5.15 24.48 4.34 5.10 23.06 5.10 13.06 4.34 5.46 29.79 4.59 5.10 17.29 13.83 5.05 5.20 5.10 36.00 4.67 26.55 13.36 4.49 18.41 33.75 17.10 20.13 5.20 Outpatient 82728 Assay of ferritin 72.00 20.75 11.59 65.42 18.50 63.26 13.77 65.42 11.59 13.63 36.90 13.63 34.89 11.59 14.58 47.66 12.27 13.63 46.20 36.96 13.49 13.90 13.63 57.60 12.47 42.48 35.71 11.99 29.45 54.00 27.37 32.21 13.90 Outpatient 82731 Assay of fetal fibronectin 338.00 97.41 54.75 309.17 86.87 298.93 65.05 309.17 54.75 64.41 173.23 64.41 164.89 54.75 68.92 223.72 57.97 64.41 218.32 174.65 63.77 65.70 64.41 270.40 58.94 199.42 168.75 56.68 138.24 253.50 128.47 151.19 65.70 Outpatient 82746 Assay of folic acid serum 77.00 22.19 12.50 70.56 19.79 68.22 14.85 70.56 12.50 14.70 39.46 14.70 37.63 12.50 15.73 50.97 13.23 14.70 49.83 39.86 14.55 14.99 14.70 61.60 13.45 45.43 38.51 12.94 31.49 57.75 29.27 34.44 14.99 Outpatient 82784 Assay iga/igd/igg/igm each 49.00 14.12 7.91 44.64 12.59 43.16 9.39 44.64 7.91 9.30 25.11 9.30 23.81 7.91 9.95 32.43 8.37 9.30 31.52 25.22 9.21 9.49 9.30 39.20 8.51 28.91 24.37 8.18 20.04 36.75 18.62 21.92 9.49 Outpatient 82785 Assay of ige 86.00 24.79 13.99 79.01 22.10 76.39 16.62 79.01 13.99 16.46 44.08 16.46 42.14 13.99 17.61 56.92 14.81 16.46 55.79 44.63 16.30 16.79 16.46 68.80 15.06 50.74 43.13 14.48 35.17 64.50 32.69 38.47 16.79 Outpatient 82787 Igg 1 2 3 or 4 each 42.00 12.10 6.82 38.50 10.79 37.22 8.10 38.50 6.82 8.02 21.53 8.02 20.53 6.82 8.58 27.80 7.22 8.02 27.18 21.75 7.94 8.18 8.02 33.60 7.34 24.78 21.01 7.06 17.18 31.50 15.96 18.79 8.18 Outpatient 82803 Blood gases any combination 137.00 39.48 22.16 125.14 35.21 120.99 26.33 125.14 22.16 26.07 70.21 26.07 66.74 22.16 27.89 90.68 23.46 26.07 88.36 70.69 25.81 26.59 26.07 109.60 23.85 80.83 68.30 22.94 56.03 102.75 52.07 61.28 26.59 Outpatient 82947 Assay glucose blood quant 21.00 6.05 3.34 18.86 5.40 18.24 3.97 18.86 3.34 3.93 10.76 3.93 10.06 3.34 4.21 13.90 3.54 3.93 13.32 10.66 3.89 4.01 3.93 16.80 3.60 12.39 10.30 3.46 8.59 15.75 7.98 9.39 4.01 Outpatient 82950 Glucose test 25.00 7.21 4.04 22.80 6.43 22.05 4.80 22.80 4.04 4.75 12.81 4.75 12.16 4.04 5.08 16.55 4.28 4.75 16.10 12.88 4.70 4.85 4.75 20.00 4.35 14.75 12.45 4.18 10.23 18.75 9.50 11.18 4.85 Outpatient 82951 Glucose tolerance test (gtt) 68.00 19.60 10.94 61.78 17.48 59.73 13.00 61.78 10.94 12.87 34.85 12.87 32.95 10.94 13.77 45.01 11.58 12.87 43.62 34.90 12.74 13.13 12.87 54.40 11.78 40.12 33.72 11.33 27.81 51.00 25.85 30.42 13.13 Outpatient 82952 Gtt-added samples 21.00 6.05 3.33 18.82 5.40 18.19 3.96 18.82 3.33 3.92 10.76 3.92 10.04 3.33 4.19 13.90 3.53 3.92 13.29 10.63 3.88 4.00 3.92 16.80 3.59 12.39 10.27 3.45 8.59 15.75 7.98 9.39 4.00 Outpatient 82955 Assay of g6pd enzyme 51.00 14.70 8.25 46.56 13.11 45.02 9.80 46.56 8.25 9.70 26.14 9.70 24.83 8.25 10.38 33.76 8.73 9.70 32.88 26.30 9.60 9.89 9.70 40.80 8.88 30.09 25.41 8.54 20.86 38.25 19.39 22.81 9.89 Outpatient 82962 Glucose blood test 17.00 4.90 2.79 15.74 4.37 15.22 3.31 15.74 2.79 3.28 8.71 3.28 8.40 2.79 3.51 11.25 2.95 3.28 11.12 8.89 3.25 3.35 3.28 13.60 3.00 10.03 8.59 2.89 6.95 12.75 6.46 7.60 3.35 Outpatient 82977 Assay of ggt 38.00 10.95 6.12 34.56 9.77 33.42 7.27 34.56 6.12 7.20 19.48 7.20 18.43 6.12 7.70 25.15 6.48 7.20 24.40 19.52 7.13 7.34 7.20 30.40 6.59 22.42 18.86 6.34 15.54 28.50 14.44 17.00 7.34 Outpatient 82985 Assay of glycated protein 88.00 25.36 14.25 80.45 22.62 77.78 16.93 80.45 14.25 16.76 45.10 16.76 42.91 14.25 17.93 58.25 15.08 16.76 56.81 45.45 16.59 17.10 16.76 70.40 15.34 51.92 43.91 14.75 35.99 66.00 33.45 39.36 17.10 Outpatient 83001 Assay of gonadotropin (fsh) 98.00 28.24 15.79 89.18 25.19 86.23 18.77 89.18 15.79 18.58 50.23 18.58 47.56 15.79 19.88 64.87 16.72 18.58 62.98 50.38 18.39 18.95 18.58 78.40 17.00 57.82 48.68 16.35 40.08 73.50 37.25 43.84 18.95 Outpatient 83002 Assay of gonadotropin (lh) 97.00 27.96 15.74 88.90 24.93 85.95 18.71 88.90 15.74 18.52 49.71 18.52 47.41 15.74 19.82 64.20 16.67 18.52 62.77 50.22 18.33 18.89 18.52 77.60 16.95 57.23 48.52 16.30 39.67 72.75 36.87 43.39 18.89 Outpatient 83010 Assay of haptoglobin quant 66.00 19.02 10.69 60.38 16.96 58.39 12.71 60.38 10.69 12.58 33.83 12.58 32.20 10.69 13.46 43.69 11.32 12.58 42.64 34.11 12.45 12.83 12.58 52.80 11.51 38.94 32.96 11.07 26.99 49.50 25.09 29.52 12.83 Outpatient 83020 Hemoglobin electrophoresis 95.00 27.38 10.94 76.00 24.42 59.73 13.00 61.78 10.94 12.87 48.69 12.87 32.95 10.94 13.77 62.88 11.58 12.87 43.62 34.90 12.74 13.13 12.87 76.00 11.78 56.05 33.72 11.33 38.86 71.25 36.11 42.49 13.13 Outpatient 83021 Hemoglobin chromotography 95.00 27.38 15.35 86.69 24.42 83.82 18.24 86.69 15.35 18.06 48.69 18.06 46.23 15.35 19.32 62.88 16.25 18.06 61.21 48.97 17.88 18.42 18.06 76.00 16.52 56.05 47.32 15.89 38.86 71.25 36.11 42.49 18.42 Outpatient 83036 Glycosylated hemoglobin test 51.00 14.70 8.25 46.61 13.11 45.07 9.81 46.61 8.25 9.71 26.14 9.71 24.86 8.25 10.39 33.76 8.74 9.71 32.91 26.33 9.61 9.90 9.71 40.80 8.88 30.09 25.44 8.54 20.86 38.25 19.39 22.81 9.90 Outpatient 83090 Assay of homocystine 94.00 27.09 15.23 86.02 24.16 83.17 18.10 86.02 15.23 17.92 48.18 17.92 45.88 15.23 19.17 62.22 16.13 17.92 60.74 48.59 17.74 18.28 17.92 75.20 16.40 55.46 46.95 15.77 38.45 70.50 35.73 42.05 18.28 Outpatient 83497 Assay of 5-hiaa 68.00 19.60 10.97 61.92 17.48 59.87 13.03 61.92 10.97 12.90 34.85 12.90 33.02 10.97 13.80 45.01 11.61 12.90 43.72 34.98 12.77 13.16 12.90 54.40 11.80 40.12 33.80 11.35 27.81 51.00 25.85 30.42 13.16 Outpatient 83498 Assay of progesterone 17-d 143.00 41.21 23.09 130.42 36.75 126.10 27.44 130.42 23.09 27.17 73.29 27.17 69.56 23.09 29.07 94.65 24.45 27.17 92.09 73.67 26.90 27.71 27.17 114.40 24.86 84.37 71.19 23.91 58.49 107.25 54.35 63.96 27.71 Outpatient 83516 Immunoassay nonantibody 61.00 17.58 9.80 55.34 15.68 53.51 11.65 55.34 9.80 11.53 31.26 11.53 29.52 9.80 12.34 40.38 10.38 11.53 39.08 31.26 11.41 11.76 11.53 48.80 10.55 35.99 30.21 10.15 24.95 45.75 23.19 27.29 11.76 Outpatient 83519 Ria nonantibody 97.00 27.96 15.64 88.32 24.93 85.40 18.58 88.32 15.64 18.40 49.71 18.40 47.10 15.64 19.69 64.20 16.56 18.40 62.37 49.89 18.22 18.77 18.40 77.60 16.84 57.23 48.21 16.19 39.67 72.75 36.87 43.39 18.77 Outpatient 83525 Assay of insulin 60.00 17.29 9.72 54.86 15.42 53.05 11.54 54.86 9.72 11.43 30.75 11.43 29.26 9.72 12.23 39.71 10.29 11.43 38.74 30.99 11.32 11.66 11.43 48.00 10.46 35.40 29.95 10.06 24.54 45.00 22.81 26.84 11.66 Outpatient 83540 Assay of iron 34.00 9.80 5.50 31.06 8.74 30.03 6.53 31.06 5.50 6.47 17.43 6.47 16.56 5.50 6.92 22.50 5.82 6.47 21.93 17.54 6.41 6.60 6.47 27.20 5.92 20.06 16.95 5.69 13.91 25.50 12.92 15.21 6.60 Outpatient 83605 Assay of lactic acid 61.00 17.58 9.83 55.54 15.68 53.70 11.69 55.54 9.83 11.57 31.26 11.57 29.62 9.83 12.38 40.38 10.41 11.57 39.22 31.37 11.45 11.80 11.57 48.80 10.59 35.99 30.31 10.18 24.95 45.75 23.19 27.29 11.80 Outpatient 83615 Lactate (ld) (ldh) enzyme 32.00 9.22 5.13 28.99 8.22 28.03 6.10 28.99 5.13 6.04 16.40 6.04 15.46 5.13 6.46 21.18 5.44 6.04 20.47 16.38 5.98 6.16 6.04 25.60 5.53 18.88 15.82 5.32 13.09 24.00 12.16 14.31 6.16 Outpatient 83655 Assay of lead 64.00 18.44 10.29 58.13 16.45 56.20 12.23 58.13 10.29 12.11 32.80 12.11 31.00 10.29 12.96 42.36 10.90 12.11 41.05 32.84 11.99 12.35 12.11 51.20 11.08 37.76 31.73 10.66 26.18 48.00 24.33 28.63 12.35 Outpatient 83690 Assay of lipase 36.00 10.38 5.86 33.07 9.25 31.98 6.96 33.07 5.86 6.89 18.45 6.89 17.64 5.86 7.37 23.83 6.20 6.89 23.35 18.68 6.82 7.03 6.89 28.80 6.30 21.24 18.05 6.06 14.72 27.00 13.68 16.10 7.03 Outpatient 83718 Assay of lipoprotein 43.00 12.39 6.96 39.31 11.05 38.01 8.27 39.31 6.96 8.19 22.04 8.19 20.97 6.96 8.76 28.46 7.37 8.19 27.76 22.21 8.11 8.35 8.19 34.40 7.49 25.37 21.46 7.21 17.59 32.25 16.34 19.23 8.35 Outpatient 83721 Assay of blood lipoprotein 55.00 15.85 8.93 50.40 14.14 48.73 10.61 50.40 8.93 10.50 28.19 10.50 26.88 8.93 11.24 36.40 9.45 10.50 35.59 28.47 10.40 10.71 10.50 44.00 9.61 32.45 27.51 9.24 22.50 41.25 20.91 24.60 10.71 Outpatient 83735 Assay of magnesium 35.00 10.09 5.70 32.16 9.00 31.10 6.77 32.16 5.70 6.70 17.94 6.70 17.15 5.70 7.17 23.17 6.03 6.70 22.71 18.17 6.63 6.83 6.70 28.00 6.13 20.65 17.55 5.90 14.32 26.25 13.30 15.66 6.83 Outpatient 83825 Assay of mercury 85.00 24.50 13.82 78.05 21.85 75.46 16.42 78.05 13.82 16.26 43.56 16.26 41.63 13.82 17.40 56.26 14.63 16.26 55.11 44.09 16.10 16.59 16.26 68.00 14.88 50.15 42.60 14.31 34.77 63.75 32.31 38.02 16.59 Outpatient 83835 Assay of metanephrines 89.00 25.65 14.40 81.31 22.87 78.62 17.11 81.31 14.40 16.94 45.61 16.94 43.37 14.40 18.13 58.91 15.25 16.94 57.42 45.93 16.77 17.28 16.94 71.20 15.50 52.51 44.38 14.91 36.40 66.75 33.83 39.81 17.28 Outpatient 83880 Assay of natriuretic peptide 206.00 59.37 33.37 188.45 52.94 182.21 39.65 188.45 33.37 39.26 105.58 39.26 100.51 33.37 42.01 136.35 35.33 39.26 133.07 106.46 38.87 40.05 39.26 164.80 35.92 121.54 102.86 34.55 84.25 154.50 78.30 92.14 40.05 Outpatient 83883 Assay nephelometry not spec 71.00 20.46 11.56 65.28 18.25 63.12 13.74 65.28 11.56 13.60 36.39 13.60 34.82 11.56 14.55 46.99 12.24 13.60 46.10 36.88 13.46 13.87 13.60 56.80 12.44 41.89 35.63 11.97 29.04 53.25 26.99 31.76 13.87 Outpatient 83921 Organic acid single quant 111.00 31.99 18.03 101.81 28.53 98.44 21.42 101.81 18.03 21.21 56.89 21.21 54.30 18.03 22.69 73.47 19.09 21.21 71.89 57.51 21.00 21.63 21.21 88.80 19.41 65.49 55.57 18.66 45.40 83.25 42.19 49.65 21.63 Outpatient 83930 Assay of blood osmolality 35.00 10.09 5.62 31.73 9.00 30.68 6.68 31.73 5.62 6.61 17.94 6.61 16.92 5.62 7.07 23.17 5.95 6.61 22.40 17.92 6.54 6.74 6.61 28.00 6.05 20.65 17.32 5.82 14.32 26.25 13.30 15.66 6.74 Outpatient 83935 Assay of urine osmolality 36.00 10.38 5.80 32.74 9.25 31.65 6.89 32.74 5.80 6.82 18.45 6.82 17.46 5.80 7.30 23.83 6.14 6.82 23.12 18.49 6.75 6.96 6.82 28.80 6.24 21.24 17.87 6.00 14.72 27.00 13.68 16.10 6.96 Outpatient 83945 Assay of oxalate 76.00 21.90 12.28 69.36 19.53 67.06 14.59 69.36 12.28 14.45 38.95 14.45 36.99 12.28 15.46 50.30 13.01 14.45 48.98 39.18 14.31 14.74 14.45 60.80 13.22 44.84 37.86 12.72 31.08 57.00 28.89 33.99 14.74 Outpatient 83970 Assay of parathormone 217.00 62.54 35.09 198.14 55.77 191.58 41.69 198.14 35.09 41.28 111.21 41.28 105.68 35.09 44.17 143.63 37.15 41.28 139.92 111.93 40.87 42.11 41.28 173.60 37.77 128.03 108.15 36.33 88.75 162.75 82.48 97.06 42.11 Outpatient 83986 Assay ph body fluid nos 19.00 5.48 3.04 17.18 4.88 16.62 3.62 17.18 3.04 3.58 9.74 3.58 9.16 3.04 3.83 12.58 3.22 3.58 12.13 9.71 3.54 3.65 3.58 15.20 3.28 11.21 9.38 3.15 7.77 14.25 7.22 8.50 3.65 Outpatient 83993 Assay for calprotectin fecal 103.00 29.68 16.69 94.22 26.47 91.10 19.83 94.22 16.69 19.63 52.79 19.63 50.25 16.69 21.00 68.18 17.67 19.63 66.54 53.23 19.43 20.02 19.63 82.40 17.96 60.77 51.43 17.27 42.13 77.25 39.15 46.07 20.02 Outpatient 84075 Assay alkaline phosphatase 27.00 7.78 4.40 24.86 6.94 24.04 5.23 24.86 4.40 5.18 13.84 5.18 13.26 4.40 5.54 17.87 4.66 5.18 17.56 14.05 5.13 5.28 5.18 21.60 4.74 15.93 13.57 4.56 11.04 20.25 10.26 12.08 5.28 Outpatient 84080 Assay alkaline phosphatases 78.00 22.48 12.56 70.94 20.05 68.60 14.93 70.94 12.56 14.78 39.98 14.78 37.84 12.56 15.81 51.63 13.30 14.78 50.10 40.08 14.63 15.08 14.78 62.40 13.52 46.02 38.72 13.01 31.90 58.50 29.65 34.89 15.08 Outpatient 84100 Assay of phosphorus 25.00 7.21 4.03 22.75 6.43 22.00 4.79 22.75 4.03 4.74 12.81 4.74 12.13 4.03 5.07 16.55 4.27 4.74 16.07 12.85 4.69 4.83 4.74 20.00 4.34 14.75 12.42 4.17 10.23 18.75 9.50 11.18 4.83 Outpatient 84112 Eval amniotic fluid protein 515.00 148.42 83.39 470.93 132.36 455.34 99.09 470.93 83.39 98.11 263.94 98.11 251.16 83.39 104.98 340.88 88.30 98.11 332.54 266.04 97.13 100.07 98.11 412.00 89.77 303.85 257.05 86.34 210.64 386.25 195.75 230.36 100.07 Outpatient 84132 Assay of serum potassium 25.00 7.21 4.05 22.85 6.43 22.09 4.81 22.85 4.05 4.76 12.81 4.76 12.19 4.05 5.09 16.55 4.28 4.76 16.13 12.91 4.71 4.86 4.76 20.00 4.36 14.75 12.47 4.19 10.23 18.75 9.50 11.18 4.86 Outpatient 84133 Assay of urine potassium 25.00 7.21 4.02 22.70 6.43 21.95 4.78 22.70 4.02 4.73 12.81 4.73 12.11 4.02 5.06 16.55 4.26 4.73 16.03 12.83 4.68 4.82 4.73 20.00 4.33 14.75 12.39 4.16 10.23 18.75 9.50 11.18 4.82 Outpatient 84134 Assay of prealbumin 77.00 22.19 12.40 70.03 19.79 67.71 14.74 70.03 12.40 14.59 39.46 14.59 37.35 12.40 15.61 50.97 13.13 14.59 49.45 39.56 14.44 14.88 14.59 61.60 13.35 45.43 38.23 12.84 31.49 57.75 29.27 34.44 14.88 Outpatient 84143 Assay of 17-hydroxypregneno 120.00 34.58 19.39 109.49 30.84 105.86 23.04 109.49 19.39 22.81 61.50 22.81 58.39 19.39 24.41 79.43 20.53 22.81 77.31 61.85 22.58 23.27 22.81 96.00 20.87 70.80 59.76 20.07 49.08 90.00 45.61 53.68 23.27 Outpatient 84144 Assay of progesterone 110.00 31.70 17.73 100.13 28.27 96.81 21.07 100.13 17.73 20.86 56.38 20.86 53.40 17.73 22.32 72.81 18.77 20.86 70.70 56.56 20.65 21.28 20.86 88.00 19.09 64.90 54.65 18.36 44.99 82.50 41.81 49.20 21.28 Outpatient 84145 Procalcitonin (pct) 143.00 41.21 23.14 130.66 36.75 126.33 27.49 130.66 23.14 27.22 73.29 27.22 69.68 23.14 29.13 94.65 24.50 27.22 92.26 73.81 26.95 27.76 27.22 114.40 24.91 84.37 71.32 23.95 58.49 107.25 54.35 63.96 27.76 Outpatient 84146 Assay of prolactin 102.00 29.40 16.47 93.02 26.21 89.94 19.57 93.02 16.47 19.38 52.28 19.38 49.61 16.47 20.74 67.51 17.44 19.38 65.69 52.55 19.19 19.77 19.38 81.60 17.73 60.18 50.78 17.05 41.72 76.50 38.77 45.62 19.77 Outpatient 84153 Assay of psa total 97.00 27.96 15.63 88.27 24.93 85.35 18.57 88.27 15.63 18.39 49.71 18.39 47.08 15.63 19.68 64.20 16.55 18.39 62.33 49.87 18.21 18.76 18.39 77.60 16.83 57.23 48.18 16.18 39.67 72.75 36.87 43.39 18.76 Outpatient 84154 Assay of psa free 97.00 27.96 15.63 88.27 24.93 85.35 18.57 88.27 15.63 18.39 49.71 18.39 47.08 15.63 19.68 64.20 16.55 18.39 62.33 49.87 18.21 18.76 18.39 77.60 16.83 57.23 48.18 16.18 39.67 72.75 36.87 43.39 18.76 Outpatient 84155 Assay of protein serum 19.00 5.48 3.12 17.62 4.88 17.03 3.71 17.62 3.12 3.67 9.74 3.67 9.40 3.12 3.93 12.58 3.30 3.67 12.44 9.95 3.63 3.74 3.67 15.20 3.36 11.21 9.62 3.23 7.77 14.25 7.22 8.50 3.74 Outpatient 84156 Assay of protein urine 19.00 5.48 3.12 17.62 4.88 17.03 3.71 17.62 3.12 3.67 9.74 3.67 9.40 3.12 3.93 12.58 3.30 3.67 12.44 9.95 3.63 3.74 3.67 15.20 3.36 11.21 9.62 3.23 7.77 14.25 7.22 8.50 3.74 Outpatient 84157 Assay of protein other 21.00 6.05 3.40 19.20 5.40 18.56 4.04 19.20 3.40 4.00 10.76 4.00 10.24 3.40 4.28 13.90 3.60 4.00 13.56 10.85 3.96 4.08 4.00 16.80 3.66 12.39 10.48 3.52 8.59 15.75 7.98 9.39 4.08 Outpatient 84165 Protein e-phoresis serum 95.00 27.38 9.13 76.00 24.42 49.85 10.85 51.55 9.13 10.74 48.69 10.74 27.49 9.13 11.49 62.88 9.67 10.74 36.40 29.12 10.63 10.95 10.74 76.00 9.83 56.05 28.14 9.45 38.86 71.25 36.11 42.49 10.95 Outpatient 84207 Assay of vitamin b-6 148.00 42.65 23.89 134.88 38.04 130.41 28.38 134.88 23.89 28.10 75.85 28.10 71.94 23.89 30.07 97.96 25.29 28.10 95.24 76.20 27.82 28.66 28.10 118.40 25.71 87.32 73.62 24.73 60.53 111.00 56.25 66.20 28.66 Outpatient 84244 Assay of renin 115.00 33.14 18.69 105.55 29.56 102.06 22.21 105.55 18.69 21.99 58.94 21.99 56.29 18.69 23.53 76.12 19.79 21.99 74.54 59.63 21.77 22.43 21.99 92.00 20.12 67.85 57.61 19.35 47.04 86.25 43.71 51.44 22.43 Outpatient 84252 Assay of vitamin b-2 106.00 30.55 17.20 97.15 27.24 93.94 20.44 97.15 17.20 20.24 54.33 20.24 51.81 17.20 21.66 70.16 18.22 20.24 68.60 54.88 20.04 20.64 20.24 84.80 18.52 62.54 53.03 17.81 43.35 79.50 40.29 47.41 20.64 Outpatient 84255 Assay of selenium 134.00 38.62 21.70 122.54 34.44 118.49 25.79 122.54 21.70 25.53 68.68 25.53 65.36 21.70 27.32 88.69 22.98 25.53 86.53 69.23 25.27 26.04 25.53 107.20 23.36 79.06 66.89 22.47 54.81 100.50 50.93 59.94 26.04 Outpatient 84260 Assay of serotonin 163.00 46.98 26.33 148.70 41.89 143.78 31.29 148.70 26.33 30.98 83.54 30.98 79.31 26.33 33.15 107.89 27.88 30.98 105.01 84.01 30.67 31.60 30.98 130.40 28.35 96.17 81.17 27.26 66.67 122.25 61.96 72.91 31.60 Outpatient 84270 Assay of sex hormone globul 114.00 32.85 18.47 104.30 29.30 100.85 21.95 104.30 18.47 21.73 58.43 21.73 55.63 18.47 23.25 75.46 19.56 21.73 73.65 58.92 21.51 22.16 21.73 91.20 19.88 67.26 56.93 19.12 46.63 85.50 43.33 50.99 22.16 Outpatient 84295 Assay of serum sodium 25.00 7.21 4.09 23.09 6.43 22.32 4.86 23.09 4.09 4.81 12.81 4.81 12.31 4.09 5.15 16.55 4.33 4.81 16.30 13.04 4.76 4.91 4.81 20.00 4.40 14.75 12.60 4.23 10.23 18.75 9.50 11.18 4.91 Outpatient 84300 Assay of urine sodium 27.00 7.78 4.30 24.29 6.94 23.48 5.11 24.29 4.30 5.06 13.84 5.06 12.95 4.30 5.41 17.87 4.55 5.06 17.15 13.72 5.01 5.16 5.06 21.60 4.63 15.93 13.26 4.45 11.04 20.25 10.26 12.08 5.16 Outpatient 84305 Assay of somatomedin 112.00 32.28 18.07 102.05 28.78 98.67 21.47 102.05 18.07 21.26 57.40 21.26 54.43 18.07 22.75 74.13 19.13 21.26 72.06 57.65 21.05 21.69 21.26 89.60 19.45 66.08 55.70 18.71 45.81 84.00 42.57 50.10 21.69 Outpatient 84392 Assay of urine sulfate 29.00 8.36 4.67 26.35 7.45 25.48 5.54 26.35 4.67 5.49 14.86 5.49 14.05 4.67 5.87 19.20 4.94 5.49 18.61 14.89 5.44 5.60 5.49 23.20 5.02 17.11 14.38 4.83 11.86 21.75 11.02 12.97 5.60 Outpatient 84402 Assay of free testosterone 134.00 38.62 21.65 122.26 34.44 118.21 25.72 122.26 21.65 25.47 68.68 25.47 65.20 21.65 27.25 88.69 22.92 25.47 86.33 69.06 25.22 25.98 25.47 107.20 23.31 79.06 66.73 22.41 54.81 100.50 50.93 59.94 25.98 Outpatient 84425 Assay of vitamin b-1 111.00 31.99 18.05 101.90 28.53 98.53 21.44 101.90 18.05 21.23 56.89 21.23 54.35 18.05 22.72 73.47 19.11 21.23 71.96 57.57 21.02 21.65 21.23 88.80 19.43 65.49 55.62 18.68 45.40 83.25 42.19 49.65 21.65 Outpatient 84432 Assay of thyroglobulin 84.00 24.21 13.65 77.09 21.59 74.54 16.22 77.09 13.65 16.06 43.05 16.06 41.11 13.65 17.18 55.60 14.45 16.06 54.44 43.55 15.90 16.38 16.06 67.20 14.69 49.56 42.08 14.13 34.36 63.00 31.93 37.57 16.38 Outpatient 84436 Assay of total thyroxine 36.00 10.38 5.84 32.98 9.25 31.88 6.94 32.98 5.84 6.87 18.45 6.87 17.59 5.84 7.35 23.83 6.18 6.87 23.29 18.63 6.80 7.01 6.87 28.80 6.29 21.24 18.00 6.05 14.72 27.00 13.68 16.10 7.01 Outpatient 84439 Assay of free thyroxine 47.00 13.55 7.67 43.30 12.08 41.86 9.11 43.30 7.67 9.02 24.09 9.02 23.09 7.67 9.65 31.11 8.12 9.02 30.57 24.46 8.93 9.20 9.02 37.60 8.25 27.73 23.63 7.94 19.22 35.25 17.86 21.02 9.20 Outpatient 84443 Assay thyroid stim hormone 88.00 25.36 14.28 80.64 22.62 77.97 16.97 80.64 14.28 16.80 45.10 16.80 43.01 14.28 17.98 58.25 15.12 16.80 56.94 45.55 16.63 17.14 16.80 70.40 15.37 51.92 44.02 14.78 35.99 66.00 33.45 39.36 17.14 Outpatient 84445 Assay of tsi globulin 267.00 76.95 43.23 244.13 68.62 236.05 51.37 244.13 43.23 50.86 136.84 50.86 130.20 43.23 54.42 176.73 45.77 50.86 172.39 137.91 50.35 51.88 50.86 213.60 46.54 157.53 133.25 44.76 109.20 200.25 101.49 119.43 51.88 Outpatient 84446 Assay of vitamin e 74.00 21.33 12.05 68.06 19.02 65.81 14.32 68.06 12.05 14.18 37.93 14.18 36.30 12.05 15.17 48.98 12.76 14.18 48.06 38.45 14.04 14.46 14.18 59.20 12.97 43.66 37.15 12.48 30.27 55.50 28.13 33.10 14.46 Outpatient 84450 Transferase (ast) (sgot) 27.00 7.78 4.40 24.86 6.94 24.04 5.23 24.86 4.40 5.18 13.84 5.18 13.26 4.40 5.54 17.87 4.66 5.18 17.56 14.05 5.13 5.28 5.18 21.60 4.74 15.93 13.57 4.56 11.04 20.25 10.26 12.08 5.28 Outpatient 84460 Alanine amino (alt) (sgpt) 28.00 8.07 4.51 25.44 7.20 24.60 5.35 25.44 4.51 5.30 14.35 5.30 13.57 4.51 5.67 18.53 4.77 5.30 17.96 14.37 5.25 5.41 5.30 22.40 4.85 16.52 13.89 4.66 11.45 21.00 10.64 12.52 5.41 Outpatient 84466 Assay of transferrin 67.00 19.31 10.85 61.25 17.22 59.22 12.89 61.25 10.85 12.76 34.34 12.76 32.67 10.85 13.65 44.35 11.48 12.76 43.25 34.60 12.63 13.02 12.76 53.60 11.68 39.53 33.43 11.23 27.40 50.25 25.47 29.97 13.02 Outpatient 84478 Assay of triglycerides 30.00 8.65 4.88 27.55 7.71 26.64 5.80 27.55 4.88 5.74 15.38 5.74 14.69 4.88 6.14 19.86 5.17 5.74 19.46 15.56 5.68 5.85 5.74 24.00 5.25 17.70 15.04 5.05 12.27 22.50 11.40 13.42 5.85 Outpatient 84479 Assay of thyroid (t3 or t4) 34.00 9.80 5.50 31.06 8.74 30.03 6.53 31.06 5.50 6.47 17.43 6.47 16.56 5.50 6.92 22.50 5.82 6.47 21.93 17.54 6.41 6.60 6.47 27.20 5.92 20.06 16.95 5.69 13.91 25.50 12.92 15.21 6.60 Outpatient 84480 Assay triiodothyronine (t3) 74.00 21.33 12.05 68.06 19.02 65.81 14.32 68.06 12.05 14.18 37.93 14.18 36.30 12.05 15.17 48.98 12.76 14.18 48.06 38.45 14.04 14.46 14.18 59.20 12.97 43.66 37.15 12.48 30.27 55.50 28.13 33.10 14.46 Outpatient 84481 Free assay (ft-3) 89.00 25.65 14.40 81.31 22.87 78.62 17.11 81.31 14.40 16.94 45.61 16.94 43.37 14.40 18.13 58.91 15.25 16.94 57.42 45.93 16.77 17.28 16.94 71.20 15.50 52.51 44.38 14.91 36.40 66.75 33.83 39.81 17.28 Outpatient 84482 T3 reverse 83.00 23.92 13.40 75.65 21.33 73.14 15.92 75.65 13.40 15.76 42.54 15.76 40.35 13.40 16.86 54.94 14.18 15.76 53.42 42.73 15.60 16.08 15.76 66.40 14.42 48.97 41.29 13.87 33.95 62.25 31.55 37.13 16.08 Outpatient 84484 Assay of troponin quant 65.00 18.73 10.60 59.86 16.71 57.87 12.59 59.86 10.60 12.47 33.31 12.47 31.92 10.60 13.34 43.02 11.22 12.47 42.27 33.81 12.35 12.72 12.47 52.00 11.41 38.35 32.67 10.97 26.59 48.75 24.71 29.07 12.72 Outpatient 84520 Assay of urea nitrogen 21.00 6.05 3.36 18.96 5.40 18.33 3.99 18.96 3.36 3.95 10.76 3.95 10.11 3.36 4.23 13.90 3.56 3.95 13.39 10.71 3.91 4.03 3.95 16.80 3.61 12.39 10.35 3.48 8.59 15.75 7.98 9.39 4.03 Outpatient 84550 Assay of blood/uric acid 24.00 6.92 3.84 21.70 6.17 20.98 4.57 21.70 3.84 4.52 12.30 4.52 11.57 3.84 4.84 15.89 4.07 4.52 15.32 12.26 4.47 4.61 4.52 19.20 4.14 14.16 11.84 3.98 9.82 18.00 9.12 10.74 4.61 Outpatient 84560 Assay of urine/uric acid 27.00 7.78 4.32 24.38 6.94 23.58 5.13 24.38 4.32 5.08 13.84 5.08 13.00 4.32 5.44 17.87 4.57 5.08 17.22 13.77 5.03 5.18 5.08 21.60 4.65 15.93 13.31 4.47 11.04 20.25 10.26 12.08 5.18 Outpatient 84590 Assay of vitamin a 61.00 17.58 9.87 55.73 15.68 53.88 11.73 55.73 9.87 11.61 31.26 11.61 29.72 9.87 12.42 40.38 10.45 11.61 39.35 31.48 11.49 11.84 11.61 48.80 10.62 35.99 30.42 10.22 24.95 45.75 23.19 27.29 11.84 Outpatient 84630 Assay of zinc 60.00 17.29 9.68 54.67 15.42 52.86 11.50 54.67 9.68 11.39 30.75 11.39 29.16 9.68 12.19 39.71 10.25 11.39 38.61 30.89 11.28 11.62 11.39 48.00 10.42 35.40 29.84 10.02 24.54 45.00 22.81 26.84 11.62 Outpatient 84681 Assay of c-peptide 109.00 31.41 17.69 99.89 28.01 96.58 21.02 99.89 17.69 20.81 55.86 20.81 53.27 17.69 22.27 72.15 18.73 20.81 70.54 56.43 20.60 21.23 20.81 87.20 19.04 64.31 54.52 18.31 44.58 81.75 41.43 48.76 21.23 Outpatient 84702 Chorionic gonadotropin test 79.00 22.77 12.79 72.24 20.30 69.85 15.20 72.24 12.79 15.05 40.49 15.05 38.53 12.79 16.10 52.29 13.55 15.05 51.01 40.81 14.90 15.35 15.05 63.20 13.77 46.61 39.43 13.24 32.31 59.25 30.03 35.34 15.35 Outpatient 85007 Bl smear w/diff wbc count 20.00 5.76 3.23 18.24 5.14 17.64 3.84 18.24 3.23 3.80 10.25 3.80 9.73 3.23 4.07 13.24 3.42 3.80 12.88 10.30 3.76 3.88 3.80 16.00 3.48 11.80 9.96 3.34 8.18 15.00 7.60 8.95 3.88 Outpatient 85014 Hematocrit 12.00 3.46 2.01 11.38 3.08 11.00 2.39 11.38 2.01 2.37 6.15 2.37 6.07 2.01 2.54 7.94 2.13 2.37 8.03 6.43 2.35 2.42 2.37 9.60 2.17 7.08 6.21 2.09 4.91 9.00 4.56 5.37 2.42 Outpatient 85018 Hemoglobin 12.00 3.46 2.01 11.38 3.08 11.00 2.39 11.38 2.01 2.37 6.15 2.37 6.07 2.01 2.54 7.94 2.13 2.37 8.03 6.43 2.35 2.42 2.37 9.60 2.17 7.08 6.21 2.09 4.91 9.00 4.56 5.37 2.42 Outpatient 85025 Complete cbc w/auto diff wbc 41.00 11.82 6.60 37.30 10.54 36.06 7.85 37.30 6.60 7.77 21.01 7.77 19.89 6.60 8.31 27.14 6.99 7.77 26.34 21.07 7.69 7.93 7.77 32.80 7.11 24.19 20.36 6.84 16.77 30.75 15.58 18.34 7.93 Outpatient 85027 Complete cbc automated 34.00 9.80 5.50 31.06 8.74 30.03 6.53 31.06 5.50 6.47 17.43 6.47 16.56 5.50 6.92 22.50 5.82 6.47 21.93 17.54 6.41 6.60 6.47 27.20 5.92 20.06 16.95 5.69 13.91 25.50 12.92 15.21 6.60 Outpatient 85046 Reticyte/hgb concentrate 29.00 8.36 4.73 26.74 7.45 25.85 5.63 26.74 4.73 5.57 14.86 5.57 14.26 4.73 5.96 19.20 5.01 5.57 18.88 15.10 5.51 5.68 5.57 23.20 5.10 17.11 14.59 4.90 11.86 21.75 11.02 12.97 5.68 Outpatient 85049 Automated platelet count 24.00 6.92 3.81 21.50 6.17 20.79 4.52 21.50 3.81 4.48 12.30 4.48 11.47 3.81 4.79 15.89 4.03 4.48 15.18 12.15 4.44 4.57 4.48 19.20 4.10 14.16 11.74 3.94 9.82 18.00 9.12 10.74 4.57 Outpatient 85245 Clot factor viii vw ristoctn 120.00 34.58 19.50 110.11 30.84 106.47 23.17 110.11 19.50 22.94 61.50 22.94 58.73 19.50 24.55 79.43 20.65 22.94 77.76 62.20 22.71 23.40 22.94 96.00 20.99 70.80 60.10 20.19 49.08 90.00 45.61 53.68 23.40 Outpatient 85246 Clot factor viii vw antigen 120.00 34.58 19.50 110.11 30.84 106.47 23.17 110.11 19.50 22.94 61.50 22.94 58.73 19.50 24.55 79.43 20.65 22.94 77.76 62.20 22.71 23.40 22.94 96.00 20.99 70.80 60.10 20.19 49.08 90.00 45.61 53.68 23.40 Outpatient 85247 Clot factor viii multimetric 120.00 34.58 19.50 110.11 30.84 106.47 23.17 110.11 19.50 22.94 61.50 22.94 58.73 19.50 24.55 79.43 20.65 22.94 77.76 62.20 22.71 23.40 22.94 96.00 20.99 70.80 60.10 20.19 49.08 90.00 45.61 53.68 23.40 Outpatient 85300 Antithrombin iii activity 62.00 17.87 10.07 56.88 15.93 55.00 11.97 56.88 10.07 11.85 31.78 11.85 30.34 10.07 12.68 41.04 10.67 11.85 40.17 32.13 11.73 12.09 11.85 49.60 10.84 36.58 31.05 10.43 25.36 46.50 23.57 27.73 12.09 Outpatient 85302 Clot inhibit prot c antigen 63.00 18.16 10.21 57.65 16.19 55.74 12.13 57.65 10.21 12.01 32.29 12.01 30.75 10.21 12.85 41.70 10.81 12.01 40.71 32.57 11.89 12.25 12.01 50.40 10.99 37.17 31.47 10.57 25.77 47.25 23.95 28.18 12.25 Outpatient 85303 Clot inhibit prot c activity 63.00 18.16 11.76 66.43 16.19 64.23 13.98 66.43 11.76 13.84 32.29 13.84 35.43 11.76 14.81 41.70 12.46 13.84 46.91 37.53 13.70 14.12 13.84 50.40 12.66 37.17 36.26 12.18 25.77 47.25 23.95 28.18 14.12 Outpatient 85305 Clot inhibit prot s total 61.00 17.58 9.87 55.73 15.68 53.88 11.73 55.73 9.87 11.61 31.26 11.61 29.72 9.87 12.42 40.38 10.45 11.61 39.35 31.48 11.49 11.84 11.61 48.80 10.62 35.99 30.42 10.22 24.95 45.75 23.19 27.29 11.84 Outpatient 85306 Clot inhibit prot s free 80.00 23.06 13.02 73.54 20.56 71.10 15.47 73.54 13.02 15.32 41.00 15.32 39.22 13.02 16.39 52.95 13.79 15.32 51.93 41.54 15.17 15.63 15.32 64.00 14.02 47.20 40.14 13.48 32.72 60.00 30.41 35.78 15.63 Outpatient 85347 Coagulation time activated 22.00 6.34 3.64 20.54 5.65 19.86 4.32 20.54 3.64 4.28 11.28 4.28 10.96 3.64 4.58 14.56 3.85 4.28 14.51 11.61 4.24 4.37 4.28 17.60 3.92 12.98 11.21 3.77 9.00 16.50 8.36 9.84 4.37 Outpatient 85379 Fibrin degradation quant 51.00 14.70 8.65 48.86 13.11 47.25 10.28 48.86 8.65 10.18 26.14 10.18 26.06 8.65 10.89 33.76 9.16 10.18 34.51 27.60 10.08 10.38 10.18 40.80 9.31 30.09 26.67 8.96 20.86 38.25 19.39 22.81 10.38 Outpatient 85384 Fibrinogen activity 51.00 14.70 8.26 46.66 13.11 45.11 9.82 46.66 8.26 9.72 26.14 9.72 24.88 8.26 10.40 33.76 8.75 9.72 32.95 26.36 9.62 9.91 9.72 40.80 8.89 30.09 25.47 8.55 20.86 38.25 19.39 22.81 9.91 Outpatient 85460 Hemoglobin fetal 41.00 11.82 6.57 37.10 10.54 35.88 7.81 37.10 6.57 7.73 21.01 7.73 19.79 6.57 8.27 27.14 6.96 7.73 26.20 20.96 7.65 7.88 7.73 32.80 7.07 24.19 20.25 6.80 16.77 30.75 15.58 18.34 7.88 Outpatient 85520 Heparin assay 69.00 19.89 11.13 62.83 17.73 60.75 13.22 62.83 11.13 13.09 35.36 13.09 33.51 11.13 14.01 45.67 11.78 13.09 44.37 35.49 12.96 13.35 13.09 55.20 11.98 40.71 34.30 11.52 28.22 51.75 26.23 30.86 13.35 Outpatient 85597 Phospholipid pltlt neutraliz 94.00 27.09 15.28 86.30 24.16 83.45 18.16 86.30 15.28 17.98 48.18 17.98 46.03 15.28 19.24 62.22 16.18 17.98 60.94 48.75 17.80 18.34 17.98 75.20 16.45 55.46 47.11 15.82 38.45 70.50 35.73 42.05 18.34 Outpatient 85610 Prothrombin time 23.00 6.63 3.65 20.59 5.91 19.91 4.33 20.59 3.65 4.29 11.79 4.29 10.98 3.65 4.59 15.22 3.86 4.29 14.54 11.63 4.25 4.38 4.29 18.40 3.93 13.57 11.24 3.78 9.41 17.25 8.74 10.29 4.38 Outpatient 85613 Russell viper venom diluted 50.00 14.41 8.14 45.98 12.85 44.46 9.68 45.98 8.14 9.58 25.63 9.58 24.52 8.14 10.25 33.10 8.62 9.58 32.47 25.98 9.48 9.77 9.58 40.00 8.77 29.50 25.10 8.43 20.45 37.50 19.01 22.37 9.77 Outpatient 85652 Rbc sed rate automated 14.00 4.03 2.30 12.96 3.60 12.53 2.73 12.96 2.30 2.70 7.18 2.70 6.91 2.30 2.89 9.27 2.43 2.70 9.15 7.32 2.67 2.75 2.70 11.20 2.47 8.26 7.07 2.38 5.73 10.50 5.32 6.26 2.75 Outpatient 85660 Rbc sickle cell test 29.00 8.36 4.68 26.45 7.45 25.57 5.57 26.45 4.68 5.51 14.86 5.51 14.11 4.68 5.90 19.20 4.96 5.51 18.68 14.94 5.45 5.62 5.51 23.20 5.04 17.11 14.44 4.85 11.86 21.75 11.02 12.97 5.62 Outpatient 86008 Allg spec ige recomb ea 94.00 27.09 15.24 86.06 24.16 83.21 18.11 86.06 15.24 17.93 48.18 17.93 45.90 15.24 19.19 62.22 16.14 17.93 60.77 48.62 17.75 18.29 17.93 75.20 16.41 55.46 46.98 15.78 38.45 70.50 35.73 42.05 18.29 Outpatient 86021 Wbc antibody identification 79.00 22.77 12.79 72.24 20.30 69.85 15.20 72.24 12.79 15.05 40.49 15.05 38.53 12.79 16.10 52.29 13.55 15.05 51.01 40.81 14.90 15.35 15.05 63.20 13.77 46.61 39.43 13.24 32.31 59.25 30.03 35.34 15.35 Outpatient 86038 Antinuclear antibodies 63.00 18.16 10.28 58.03 16.19 56.11 12.21 58.03 10.28 12.09 32.29 12.09 30.95 10.28 12.94 41.70 10.88 12.09 40.98 32.78 11.97 12.33 12.09 50.40 11.06 37.17 31.68 10.64 25.77 47.25 23.95 28.18 12.33 Outpatient 86039 Antinuclear antibodies (ana) 59.00 17.00 9.49 53.57 15.16 51.79 11.27 53.57 9.49 11.16 30.24 11.16 28.57 9.49 11.94 39.05 10.04 11.16 37.83 30.26 11.05 11.38 11.16 47.20 10.21 34.81 29.24 9.82 24.13 44.25 22.43 26.39 11.38 Outpatient 86140 C-reactive protein 27.00 7.78 4.40 24.86 6.94 24.04 5.23 24.86 4.40 5.18 13.84 5.18 13.26 4.40 5.54 17.87 4.66 5.18 17.56 14.05 5.13 5.28 5.18 21.60 4.74 15.93 13.57 4.56 11.04 20.25 10.26 12.08 5.28 Outpatient 86141 C-reactive protein hs 68.00 19.60 11.01 62.16 17.48 60.10 13.08 62.16 11.01 12.95 34.85 12.95 33.15 11.01 13.86 45.01 11.66 12.95 43.89 35.12 12.82 13.21 12.95 54.40 11.85 40.12 33.93 11.40 27.81 51.00 25.85 30.42 13.21 Outpatient 86146 Beta-2 glycoprotein antibody 134.00 38.62 21.63 122.16 34.44 118.12 25.70 122.16 21.63 25.45 68.68 25.45 65.15 21.63 27.23 88.69 22.91 25.45 86.26 69.01 25.20 25.96 25.45 107.20 23.29 79.06 66.68 22.40 54.81 100.50 50.93 59.94 25.96 Outpatient 86147 Cardiolipin antibody ea ig 134.00 38.62 21.63 122.16 34.44 118.12 25.70 122.16 21.63 25.45 68.68 25.45 65.15 21.63 27.23 88.69 22.91 25.45 86.26 69.01 25.20 25.96 25.45 107.20 23.29 79.06 66.68 22.40 54.81 100.50 50.93 59.94 25.96 Outpatient 86148 Anti-phospholipid antibody 84.00 24.21 13.66 77.14 21.59 74.58 16.23 77.14 13.66 16.07 43.05 16.07 41.14 13.66 17.19 55.60 14.46 16.07 54.47 43.58 15.91 16.39 16.07 67.20 14.70 49.56 42.10 14.14 34.36 63.00 31.93 37.57 16.39 Outpatient 86160 Complement antigen 63.00 18.16 10.20 57.60 16.19 55.69 12.12 57.60 10.20 12.00 32.29 12.00 30.72 10.20 12.84 41.70 10.80 12.00 40.67 32.54 11.88 12.24 12.00 50.40 10.98 37.17 31.44 10.56 25.77 47.25 23.95 28.18 12.24 Outpatient 86162 Complement total (ch50) 107.00 30.84 17.27 97.54 27.50 94.31 20.52 97.54 17.27 20.32 54.84 20.32 52.02 17.27 21.74 70.82 18.29 20.32 68.87 55.10 20.12 20.73 20.32 85.60 18.59 63.13 53.24 17.88 43.76 80.25 40.67 47.86 20.73 Outpatient 86200 Ccp antibody 68.00 19.60 11.01 62.16 17.48 60.10 13.08 62.16 11.01 12.95 34.85 12.95 33.15 11.01 13.86 45.01 11.66 12.95 43.89 35.12 12.82 13.21 12.95 54.40 11.85 40.12 33.93 11.40 27.81 51.00 25.85 30.42 13.21 Outpatient 86225 Dna antibody native 72.00 20.75 11.68 65.95 18.50 63.77 13.88 65.95 11.68 13.74 36.90 13.74 35.17 11.68 14.70 47.66 12.37 13.74 46.57 37.26 13.60 14.01 13.74 57.60 12.57 42.48 36.00 12.09 29.45 54.00 27.37 32.21 14.01 Outpatient 86300 Immunoassay tumor ca 15-3 109.00 31.41 17.69 99.89 28.01 96.58 21.02 99.89 17.69 20.81 55.86 20.81 53.27 17.69 22.27 72.15 18.73 20.81 70.54 56.43 20.60 21.23 20.81 87.20 19.04 64.31 54.52 18.31 44.58 81.75 41.43 48.76 21.23 Outpatient 86301 Immunoassay tumor ca 19-9 109.00 31.41 17.69 99.89 28.01 96.58 21.02 99.89 17.69 20.81 55.86 20.81 53.27 17.69 22.27 72.15 18.73 20.81 70.54 56.43 20.60 21.23 20.81 87.20 19.04 64.31 54.52 18.31 44.58 81.75 41.43 48.76 21.23 Outpatient 86304 Immunoassay tumor ca 125 109.00 31.41 17.69 99.89 28.01 96.58 21.02 99.89 17.69 20.81 55.86 20.81 53.27 17.69 22.27 72.15 18.73 20.81 70.54 56.43 20.60 21.23 20.81 87.20 19.04 64.31 54.52 18.31 44.58 81.75 41.43 48.76 21.23 Outpatient 86308 Heterophile antibody screen 27.00 7.78 4.40 24.86 6.94 24.04 5.23 24.86 4.40 5.18 13.84 5.18 13.26 4.40 5.54 17.87 4.66 5.18 17.56 14.05 5.13 5.28 5.18 21.60 4.74 15.93 13.57 4.56 11.04 20.25 10.26 12.08 5.28 Outpatient 86316 Immunoassay tumor other 109.00 31.41 17.69 99.89 28.01 96.58 21.02 99.89 17.69 20.81 55.86 20.81 53.27 17.69 22.27 72.15 18.73 20.81 70.54 56.43 20.60 21.23 20.81 87.20 19.04 64.31 54.52 18.31 44.58 81.75 41.43 48.76 21.23 Outpatient 86317 Immunoassay infectious agent 79.00 22.77 12.74 71.95 20.30 69.57 15.14 71.95 12.74 14.99 40.49 14.99 38.37 12.74 16.04 52.29 13.49 14.99 50.81 40.65 14.84 15.29 14.99 63.20 13.72 46.61 39.27 13.19 32.31 59.25 30.03 35.34 15.29 Outpatient 86325 Other immunoelectrophoresis 121.00 34.87 19.66 111.02 31.10 107.35 23.36 111.02 19.66 23.13 62.01 23.13 59.21 19.66 24.75 80.09 20.82 23.13 78.40 62.72 22.90 23.59 23.13 96.80 21.16 71.39 60.60 20.35 49.49 90.75 45.99 54.12 23.59 Outpatient 86334 Immunofix e-phoresis serum 117.00 33.72 18.99 107.23 30.07 103.68 22.56 107.23 18.99 22.34 59.96 22.34 57.19 18.99 23.90 77.44 20.11 22.34 75.72 60.58 22.12 22.79 22.34 93.60 20.44 69.03 58.53 19.66 47.85 87.75 44.47 52.33 22.79 Outpatient 86335 Immunfix e-phorsis/urine/csf 154.00 44.38 24.95 140.88 39.58 136.22 29.64 140.88 24.95 29.35 78.93 29.35 75.14 24.95 31.40 101.93 26.42 29.35 99.48 79.59 29.06 29.94 29.35 123.20 26.86 90.86 76.90 25.83 62.99 115.50 58.54 68.88 29.94 Outpatient 86336 Inhibin a 82.00 23.63 13.25 74.83 21.07 72.35 15.75 74.83 13.25 15.59 42.03 15.59 39.91 13.25 16.68 54.28 14.03 15.59 52.84 42.27 15.43 15.90 15.59 65.60 14.26 48.38 40.85 13.72 33.54 61.50 31.17 36.68 15.90 Outpatient 86337 Insulin antibodies 112.00 32.28 18.20 102.77 28.78 99.37 21.62 102.77 18.20 21.41 57.40 21.41 54.81 18.20 22.91 74.13 19.27 21.41 72.57 58.06 21.20 21.84 21.41 89.60 19.59 66.08 56.09 18.84 45.81 84.00 42.57 50.10 21.84 Outpatient 86340 Intrinsic factor antibody 79.00 22.77 12.82 72.38 20.30 69.99 15.23 72.38 12.82 15.08 40.49 15.08 38.60 12.82 16.14 52.29 13.57 15.08 51.11 40.89 14.93 15.38 15.08 63.20 13.80 46.61 39.51 13.27 32.31 59.25 30.03 35.34 15.38 Outpatient 86355 B cells total count 198.00 57.06 32.07 181.10 50.89 175.11 38.11 181.10 32.07 37.73 101.48 37.73 96.59 32.07 40.37 131.06 33.96 37.73 127.89 102.31 37.35 38.48 37.73 158.40 34.52 116.82 98.85 33.20 80.98 148.50 75.26 88.57 38.48 Outpatient 86357 Nk cells total count 198.00 57.06 32.07 181.10 50.89 175.11 38.11 181.10 32.07 37.73 101.48 37.73 96.59 32.07 40.37 131.06 33.96 37.73 127.89 102.31 37.35 38.48 37.73 158.40 34.52 116.82 98.85 33.20 80.98 148.50 75.26 88.57 38.48 Outpatient 86359 T cells total count 198.00 57.06 32.07 181.10 50.89 175.11 38.11 181.10 32.07 37.73 101.48 37.73 96.59 32.07 40.37 131.06 33.96 37.73 127.89 102.31 37.35 38.48 37.73 158.40 34.52 116.82 98.85 33.20 80.98 148.50 75.26 88.57 38.48 Outpatient 86360 T cell absolute count/ratio 247.00 71.19 39.93 225.50 63.48 218.04 47.45 225.50 39.93 46.98 126.59 46.98 120.27 39.93 50.27 163.49 42.28 46.98 159.24 127.39 46.51 47.92 46.98 197.60 42.99 145.73 123.09 41.34 101.02 185.25 93.88 110.48 47.92 Outpatient 86361 T cell absolute count 141.00 40.64 22.76 128.54 36.24 124.29 27.05 128.54 22.76 26.78 72.26 26.78 68.56 22.76 28.65 93.33 24.10 26.78 90.77 72.62 26.51 27.32 26.78 112.80 24.50 83.19 70.16 23.57 57.67 105.75 53.59 63.07 27.32 Outpatient 86376 Microsomal antibody each 76.00 21.90 12.37 69.84 19.53 67.53 14.70 69.84 12.37 14.55 38.95 14.55 37.25 12.37 15.57 50.30 13.10 14.55 49.32 39.45 14.40 14.84 14.55 60.80 13.31 44.84 38.12 12.80 31.08 57.00 28.89 33.99 14.84 Outpatient 86382 Neutralization test viral 89.00 25.65 14.37 81.17 22.87 78.48 17.08 81.17 14.37 16.91 45.61 16.91 43.29 14.37 18.09 58.91 15.22 16.91 57.32 45.85 16.74 17.25 16.91 71.20 15.47 52.51 44.30 14.88 36.40 66.75 33.83 39.81 17.25 Outpatient 86430 Rheumatoid factor test qual 32.00 9.22 5.22 29.47 8.22 28.50 6.20 29.47 5.22 6.14 16.40 6.14 15.72 5.22 6.57 21.18 5.53 6.14 20.81 16.65 6.08 6.26 6.14 25.60 5.62 18.88 16.09 5.40 13.09 24.00 12.16 14.31 6.26 Outpatient 86431 Rheumatoid factor quant 30.00 8.65 4.82 27.22 7.71 26.32 5.73 27.22 4.82 5.67 15.38 5.67 14.52 4.82 6.07 19.86 5.10 5.67 19.22 15.37 5.61 5.78 5.67 24.00 5.19 17.70 14.86 4.99 12.27 22.50 11.40 13.42 5.78 Outpatient 86480 Tb test cell immun measure 325.00 93.67 52.68 297.50 83.53 287.66 62.60 297.50 52.68 61.98 166.56 61.98 158.67 52.68 66.32 215.12 55.78 61.98 210.08 168.06 61.36 63.22 61.98 260.00 56.71 191.75 162.39 54.54 132.93 243.75 123.53 145.37 63.22 Outpatient 86592 Syphilis test non-trep qual 22.00 6.34 3.63 20.50 5.65 19.82 4.31 20.50 3.63 4.27 11.28 4.27 10.93 3.63 4.57 14.56 3.84 4.27 14.47 11.58 4.23 4.36 4.27 17.60 3.91 12.98 11.19 3.76 9.00 16.50 8.36 9.84 4.36 Outpatient 86593 Syphilis test non-trep quant 23.00 6.63 3.74 21.12 5.91 20.42 4.44 21.12 3.74 4.40 11.79 4.40 11.26 3.74 4.71 15.22 3.96 4.40 14.91 11.93 4.36 4.49 4.40 18.40 4.03 13.57 11.53 3.87 9.41 17.25 8.74 10.29 4.49 Outpatient 86606 Aspergillus antibody 79.00 22.77 12.79 72.24 20.30 69.85 15.20 72.24 12.79 15.05 40.49 15.05 38.53 12.79 16.10 52.29 13.55 15.05 51.01 40.81 14.90 15.35 15.05 63.20 13.77 46.61 39.43 13.24 32.31 59.25 30.03 35.34 15.35 Outpatient 86609 Bacterium antibody 68.00 19.60 10.95 61.82 17.48 59.78 13.01 61.82 10.95 12.88 34.85 12.88 32.97 10.95 13.78 45.01 11.59 12.88 43.66 34.93 12.75 13.14 12.88 54.40 11.79 40.12 33.75 11.33 27.81 51.00 25.85 30.42 13.14 Outpatient 86611 Bartonella antibody 53.00 15.27 8.65 48.86 13.62 47.25 10.28 48.86 8.65 10.18 27.16 10.18 26.06 8.65 10.89 35.08 9.16 10.18 34.51 27.60 10.08 10.38 10.18 42.40 9.31 31.27 26.67 8.96 21.68 39.75 20.15 23.71 10.38 Outpatient 86617 Lyme disease antibody 81.00 23.34 13.17 74.35 20.82 71.89 15.64 74.35 13.17 15.49 41.51 15.49 39.65 13.17 16.57 53.61 13.94 15.49 52.50 42.00 15.34 15.80 15.49 64.80 14.17 47.79 40.58 13.63 33.13 60.75 30.79 36.23 15.80 Outpatient 86618 Lyme disease antibody 89.00 25.65 14.48 81.74 22.87 79.04 17.20 81.74 14.48 17.03 45.61 17.03 43.60 14.48 18.22 58.91 15.33 17.03 57.72 46.18 16.86 17.37 17.03 71.20 15.58 52.51 44.62 14.99 36.40 66.75 33.83 39.81 17.37 Outpatient 86644 Cmv antibody 76.00 21.90 12.23 69.07 19.53 66.79 14.53 69.07 12.23 14.39 38.95 14.39 36.84 12.23 15.40 50.30 12.95 14.39 48.77 39.02 14.25 14.68 14.39 60.80 13.17 44.84 37.70 12.66 31.08 57.00 28.89 33.99 14.68 Outpatient 86645 Cmv antibody igm 88.00 25.36 14.32 80.88 22.62 78.20 17.02 80.88 14.32 16.85 45.10 16.85 43.14 14.32 18.03 58.25 15.17 16.85 57.11 45.69 16.68 17.19 16.85 70.40 15.42 51.92 44.15 14.83 35.99 66.00 33.45 39.36 17.19 Outpatient 86658 Enterovirus antibody 68.00 19.60 11.08 62.54 17.48 60.47 13.16 62.54 11.08 13.03 34.85 13.03 33.36 11.08 13.94 45.01 11.73 13.03 44.17 35.33 12.90 13.29 13.03 54.40 11.92 40.12 34.14 11.47 27.81 51.00 25.85 30.42 13.29 Outpatient 86664 Epstein-barr nuclear antigen 80.00 23.06 13.00 73.39 20.56 70.96 15.44 73.39 13.00 15.29 41.00 15.29 39.14 13.00 16.36 52.95 13.76 15.29 51.83 41.46 15.14 15.60 15.29 64.00 13.99 47.20 40.06 13.46 32.72 60.00 30.41 35.78 15.60 Outpatient 86665 Epstein-barr capsid vca 95.00 27.38 15.42 87.07 24.42 84.19 18.32 87.07 15.42 18.14 48.69 18.14 46.44 15.42 19.41 62.88 16.33 18.14 61.49 49.19 17.96 18.50 18.14 76.00 16.60 56.05 47.53 15.96 38.86 71.25 36.11 42.49 18.50 Outpatient 86666 Ehrlichia antibody 53.00 15.27 8.65 48.86 13.62 47.25 10.28 48.86 8.65 10.18 27.16 10.18 26.06 8.65 10.89 35.08 9.16 10.18 34.51 27.60 10.08 10.38 10.18 42.40 9.31 31.27 26.67 8.96 21.68 39.75 20.15 23.71 10.38 Outpatient 86682 Helminth antibody 68.00 19.60 11.06 62.45 17.48 60.38 13.14 62.45 11.06 13.01 34.85 13.01 33.31 11.06 13.92 45.01 11.71 13.01 44.10 35.28 12.88 13.27 13.01 54.40 11.90 40.12 34.09 11.45 27.81 51.00 25.85 30.42 13.27 Outpatient 86695 Herpes simplex type 1 test 69.00 19.89 11.21 63.31 17.73 61.22 13.32 63.31 11.21 13.19 35.36 13.19 33.77 11.21 14.11 45.67 11.87 13.19 44.71 35.77 13.06 13.45 13.19 55.20 12.07 40.71 34.56 11.61 28.22 51.75 26.23 30.86 13.45 Outpatient 86696 Herpes simplex type 2 test 102.00 29.40 16.45 92.88 26.21 89.81 19.54 92.88 16.45 19.35 52.28 19.35 49.54 16.45 20.70 67.51 17.42 19.35 65.59 52.47 19.16 19.74 19.35 81.60 17.71 60.18 50.70 17.03 41.72 76.50 38.77 45.62 19.74 Outpatient 86703 Hiv-1/hiv-2 1 result antbdy 72.00 20.75 11.65 65.81 18.50 63.63 13.85 65.81 11.65 13.71 36.90 13.71 35.10 11.65 14.67 47.66 12.34 13.71 46.47 37.18 13.57 13.98 13.71 57.60 12.54 42.48 35.92 12.06 29.45 54.00 27.37 32.21 13.98 Outpatient 86704 Hep b core antibody total 63.00 18.16 10.24 57.84 16.19 55.93 12.17 57.84 10.24 12.05 32.29 12.05 30.85 10.24 12.89 41.70 10.85 12.05 40.84 32.67 11.93 12.29 12.05 50.40 11.03 37.17 31.57 10.60 25.77 47.25 23.95 28.18 12.29 Outpatient 86705 Hep b core antibody igm 62.00 17.87 10.00 56.50 15.93 54.63 11.89 56.50 10.00 11.77 31.78 11.77 30.13 10.00 12.59 41.04 10.59 11.77 39.89 31.92 11.65 12.01 11.77 49.60 10.77 36.58 30.84 10.36 25.36 46.50 23.57 27.73 12.01 Outpatient 86706 Hep b surface antibody 56.00 16.14 9.13 51.55 14.39 49.85 10.85 51.55 9.13 10.74 28.70 10.74 27.49 9.13 11.49 37.07 9.67 10.74 36.40 29.12 10.63 10.95 10.74 44.80 9.83 33.04 28.14 9.45 22.90 42.00 21.29 25.05 10.95 Outpatient 86707 Hepatitis be antibody 61.00 17.58 9.83 55.54 15.68 53.70 11.69 55.54 9.83 11.57 31.26 11.57 29.62 9.83 12.38 40.38 10.41 11.57 39.22 31.37 11.45 11.80 11.57 48.80 10.59 35.99 30.31 10.18 24.95 45.75 23.19 27.29 11.80 Outpatient 86708 Hepatitis a antibody 65.00 18.73 10.53 59.47 16.71 57.50 12.51 59.47 10.53 12.39 33.31 12.39 31.72 10.53 13.26 43.02 11.15 12.39 42.00 33.60 12.27 12.64 12.39 52.00 11.34 38.35 32.46 10.90 26.59 48.75 24.71 29.07 12.64 Outpatient 86709 Hepatitis a igm antibody 59.00 17.00 9.57 54.05 15.16 52.26 11.37 54.05 9.57 11.26 30.24 11.26 28.83 9.57 12.05 39.05 10.13 11.26 38.17 30.53 11.15 11.49 11.26 47.20 10.30 34.81 29.50 9.91 24.13 44.25 22.43 26.39 11.49 Outpatient 86735 Mumps antibody 69.00 19.89 11.09 62.64 17.73 60.57 13.18 62.64 11.09 13.05 35.36 13.05 33.41 11.09 13.96 45.67 11.75 13.05 44.23 35.39 12.92 13.31 13.05 55.20 11.94 40.71 34.19 11.48 28.22 51.75 26.23 30.86 13.31 Outpatient 86747 Parvovirus antibody 79.00 22.77 12.78 72.14 20.30 69.76 15.18 72.14 12.78 15.03 40.49 15.03 38.48 12.78 16.08 52.29 13.53 15.03 50.94 40.76 14.88 15.33 15.03 63.20 13.75 46.61 39.38 13.23 32.31 59.25 30.03 35.34 15.33 Outpatient 86757 Rickettsia antibody 102.00 29.40 16.45 92.88 26.21 89.81 19.54 92.88 16.45 19.35 52.28 19.35 49.54 16.45 20.70 67.51 17.42 19.35 65.59 52.47 19.16 19.74 19.35 81.60 17.71 60.18 50.70 17.03 41.72 76.50 38.77 45.62 19.74 Outpatient 86762 Rubella antibody 76.00 21.90 12.23 69.07 19.53 66.79 14.53 69.07 12.23 14.39 38.95 14.39 36.84 12.23 15.40 50.30 12.95 14.39 48.77 39.02 14.25 14.68 14.39 60.80 13.17 44.84 37.70 12.66 31.08 57.00 28.89 33.99 14.68 Outpatient 86765 Rubeola antibody 68.00 19.60 10.95 61.82 17.48 59.78 13.01 61.82 10.95 12.88 34.85 12.88 32.97 10.95 13.78 45.01 11.59 12.88 43.66 34.93 12.75 13.14 12.88 54.40 11.79 40.12 33.75 11.33 27.81 51.00 25.85 30.42 13.14 Outpatient 86777 Toxoplasma antibody 76.00 21.90 12.23 69.07 19.53 66.79 14.53 69.07 12.23 14.39 38.95 14.39 36.84 12.23 15.40 50.30 12.95 14.39 48.77 39.02 14.25 14.68 14.39 60.80 13.17 44.84 37.70 12.66 31.08 57.00 28.89 33.99 14.68 Outpatient 86778 Toxoplasma antibody igm 76.00 21.90 12.25 69.17 19.53 66.88 14.55 69.17 12.25 14.41 38.95 14.41 36.89 12.25 15.42 50.30 12.97 14.41 48.84 39.07 14.27 14.70 14.41 60.80 13.19 44.84 37.75 12.68 31.08 57.00 28.89 33.99 14.70 Outpatient 86780 Treponema pallidum 70.00 20.17 11.25 63.55 17.99 61.45 13.37 63.55 11.25 13.24 35.88 13.24 33.89 11.25 14.17 46.33 11.92 13.24 44.88 35.90 13.11 13.50 13.24 56.00 12.11 41.30 34.69 11.65 28.63 52.50 26.61 31.31 13.50 Outpatient 86787 Varicella-zoster antibody 68.00 19.60 10.95 61.82 17.48 59.78 13.01 61.82 10.95 12.88 34.85 12.88 32.97 10.95 13.78 45.01 11.59 12.88 43.66 34.93 12.75 13.14 12.88 54.40 11.79 40.12 33.75 11.33 27.81 51.00 25.85 30.42 13.14 Outpatient 86800 Thyroglobulin antibody 84.00 24.21 13.52 76.37 21.59 73.84 16.07 76.37 13.52 15.91 43.05 15.91 40.73 13.52 17.02 55.60 14.32 15.91 53.93 43.14 15.75 16.23 15.91 67.20 14.56 49.56 41.68 14.00 34.36 63.00 31.93 37.57 16.23 Outpatient 86803 Hepatitis c ab test 75.00 21.62 12.13 68.50 19.28 66.23 14.41 68.50 12.13 14.27 38.44 14.27 36.53 12.13 15.27 49.64 12.84 14.27 48.37 38.69 14.13 14.56 14.27 60.00 13.06 44.25 37.39 12.56 30.68 56.25 28.51 33.55 14.56 Outpatient 86812 Hla typing a b or c 136.00 39.20 21.94 123.89 34.95 119.79 26.07 123.89 21.94 25.81 69.70 25.81 66.07 21.94 27.62 90.02 23.23 25.81 87.48 69.99 25.55 26.33 25.81 108.80 23.62 80.24 67.62 22.71 55.62 102.00 51.69 60.83 26.33 Outpatient 86850 Rbc antibody screen 261.00 75.22 25.60 242.94 67.08 233.40 50.79 241.39 42.75 50.29 133.76 50.29 127.39 42.75 53.81 172.76 45.26 50.29 242.94 194.35 49.79 51.30 50.29 208.80 46.02 153.99 25.60 44.26 106.75 195.75 99.21 116.75 51.30 Outpatient 86870 Rbc antibody identification " 1,529.00 " 440.66 250.55 " 1,422.15 " 392.95 " 1,368.01 " 297.71 " 1,414.85 " 250.55 294.76 783.61 294.76 745.63 250.55 315.39 " 1,012.05 " 265.28 294.76 " 1,422.15 " " 1,137.72 " 291.81 300.66 294.76 " 1,223.20 " 269.71 902.11 763.10 259.39 625.36 " 1,146.75 " 581.17 683.92 300.66 Outpatient 86880 Coombs test direct 292.00 84.15 14.12 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 142.49 47.88 60.27 193.27 50.70 56.33 271.75 217.40 55.77 57.46 56.33 233.60 51.54 172.28 14.12 49.57 119.43 219.00 110.99 130.61 57.46 Outpatient 86886 Coombs test indirect titer 783.00 225.66 13.57 728.29 201.23 700.53 152.45 724.51 128.30 150.94 401.29 150.94 381.85 128.30 161.51 518.27 135.85 150.94 728.29 582.63 149.43 153.96 150.94 626.40 138.11 461.97 13.57 132.83 320.25 587.25 297.62 350.24 153.96 Outpatient 86900 Blood typing serologic abo 588.00 169.46 7.83 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 286.59 97.00 122.11 389.20 102.71 114.12 546.63 437.30 112.98 116.40 114.12 470.40 104.42 346.92 7.83 100.43 240.49 441.00 223.50 263.01 116.40 Outpatient 86902 Blood type antigen donor ea " 1,529.00 " 440.66 16.64 " 1,422.15 " 392.95 " 1,368.01 " 297.71 " 1,414.85 " 250.55 294.76 783.61 294.76 745.63 250.55 315.39 " 1,012.05 " 265.28 294.76 " 1,422.15 " " 1,137.72 " 291.81 300.66 294.76 " 1,223.20 " 269.71 902.11 16.64 259.39 625.36 " 1,146.75 " 581.17 683.92 300.66 Outpatient 86905 Blood typing rbc antigens " 1,529.00 " 440.66 10.03 " 1,422.15 " 392.95 " 1,368.01 " 297.71 " 1,414.85 " 250.55 294.76 783.61 294.76 745.63 250.55 315.39 " 1,012.05 " 265.28 294.76 " 1,422.15 " " 1,137.72 " 291.81 300.66 294.76 " 1,223.20 " 269.71 902.11 10.03 259.39 625.36 " 1,146.75 " 581.17 683.92 300.66 Outpatient 86920 Compatibility test spin 783.00 225.66 128.30 728.29 201.23 700.53 152.45 724.51 128.30 150.94 401.29 150.94 381.85 128.30 161.51 518.27 135.85 150.94 728.29 582.63 149.43 153.96 150.94 626.40 138.11 461.97 390.80 132.83 320.25 587.25 297.62 350.24 153.96 Outpatient 86922 Compatibility test antiglob 783.00 225.66 128.30 728.29 201.23 700.53 152.45 724.51 128.30 150.94 401.29 150.94 381.85 128.30 161.51 518.27 135.85 150.94 728.29 582.63 149.43 153.96 150.94 626.40 138.11 461.97 390.80 132.83 320.25 587.25 297.62 350.24 153.96 Outpatient 87015 Specimen infect agnt concntj 35.00 10.09 5.68 32.06 9.00 31.00 6.75 32.06 5.68 6.68 17.94 6.68 17.10 5.68 7.15 23.17 6.01 6.68 22.64 18.11 6.61 6.81 6.68 28.00 6.11 20.65 17.50 5.88 14.32 26.25 13.30 15.66 6.81 Outpatient 87040 Blood culture for bacteria 54.00 15.56 8.77 49.54 13.88 47.90 10.42 49.54 8.77 10.32 27.68 10.32 26.42 8.77 11.04 35.74 9.29 10.32 34.98 27.98 10.22 10.53 10.32 43.20 9.44 31.86 27.04 9.08 22.09 40.50 20.53 24.15 10.53 Outpatient 87045 Feces culture aerobic bact 50.00 14.41 8.02 45.31 12.85 43.81 9.53 45.31 8.02 9.44 25.63 9.44 24.17 8.02 10.10 33.10 8.50 9.44 32.00 25.60 9.35 9.63 9.44 40.00 8.64 29.50 24.73 8.31 20.45 37.50 19.01 22.37 9.63 Outpatient 87046 Stool cultr aerobic bact ea 50.00 14.41 8.02 45.31 12.85 43.81 9.53 45.31 8.02 9.44 25.63 9.44 24.17 8.02 10.10 33.10 8.50 9.44 32.00 25.60 9.35 9.63 9.44 40.00 8.64 29.50 24.73 8.31 20.45 37.50 19.01 22.37 9.63 Outpatient 87070 Culture othr specimn aerobic 45.00 12.97 7.33 41.38 11.57 40.01 8.71 41.38 7.33 8.62 23.06 8.62 22.07 7.33 9.22 29.79 7.76 8.62 29.22 23.37 8.53 8.79 8.62 36.00 7.89 26.55 22.58 7.59 18.41 33.75 17.10 20.13 8.79 Outpatient 87075 Cultr bacteria except blood 50.00 14.41 8.05 45.46 12.85 43.95 9.56 45.46 8.05 9.47 25.63 9.47 24.24 8.05 10.13 33.10 8.52 9.47 32.10 25.68 9.38 9.66 9.47 40.00 8.67 29.50 24.81 8.33 20.45 37.50 19.01 22.37 9.66 Outpatient 87077 Culture aerobic identify 42.00 12.10 6.87 38.78 10.79 37.50 8.16 38.78 6.87 8.08 21.53 8.08 20.68 6.87 8.65 27.80 7.27 8.08 27.39 21.91 8.00 8.24 8.08 33.60 7.39 24.78 21.17 7.11 17.18 31.50 15.96 18.79 8.24 Outpatient 87086 Urine culture/colony count 42.00 12.10 6.86 38.74 10.79 37.45 8.15 38.74 6.86 8.07 21.53 8.07 20.66 6.86 8.63 27.80 7.26 8.07 27.35 21.88 7.99 8.23 8.07 33.60 7.38 24.78 21.14 7.10 17.18 31.50 15.96 18.79 8.23 Outpatient 87088 Urine bacteria culture 42.00 12.10 6.88 38.83 10.79 37.55 8.17 38.83 6.88 8.09 21.53 8.09 20.71 6.88 8.66 27.80 7.28 8.09 27.42 21.94 8.01 8.25 8.09 33.60 7.40 24.78 21.20 7.12 17.18 31.50 15.96 18.79 8.25 Outpatient 87106 Fungi identification yeast 54.00 15.56 8.77 49.54 13.88 47.90 10.42 49.54 8.77 10.32 27.68 10.32 26.42 8.77 11.04 35.74 9.29 10.32 34.98 27.98 10.22 10.53 10.32 43.20 9.44 31.86 27.04 9.08 22.09 40.50 20.53 24.15 10.53 Outpatient 87116 Mycobacteria culture 57.00 16.43 9.18 51.84 14.65 50.12 10.91 51.84 9.18 10.80 29.21 10.80 27.65 9.18 11.56 37.73 9.72 10.80 36.61 29.29 10.69 11.02 10.80 45.60 9.88 33.63 28.30 9.50 23.31 42.75 21.67 25.50 11.02 Outpatient 87147 Culture type immunologic 27.00 7.78 4.40 24.86 6.94 24.04 5.23 24.86 4.40 5.18 13.84 5.18 13.26 4.40 5.54 17.87 4.66 5.18 17.56 14.05 5.13 5.28 5.18 21.60 4.74 15.93 13.57 4.56 11.04 20.25 10.26 12.08 5.28 Outpatient 87181 Microbe susceptible diffuse 25.00 7.21 4.04 22.80 6.43 22.05 4.80 22.80 4.04 4.75 12.81 4.75 12.16 4.04 5.08 16.55 4.28 4.75 16.10 12.88 4.70 4.85 4.75 20.00 4.35 14.75 12.45 4.18 10.23 18.75 9.50 11.18 4.85 Outpatient 87184 Microbe susceptible disk 39.00 11.24 6.36 35.90 10.02 34.72 7.55 35.90 6.36 7.48 19.99 7.48 19.15 6.36 8.00 25.81 6.73 7.48 25.35 20.28 7.41 7.63 7.48 31.20 6.84 23.01 19.60 6.58 15.95 29.25 14.82 17.44 7.63 Outpatient 87205 Smear gram stain 22.00 6.34 3.63 20.50 5.65 19.82 4.31 20.50 3.63 4.27 11.28 4.27 10.93 3.63 4.57 14.56 3.84 4.27 14.47 11.58 4.23 4.36 4.27 17.60 3.91 12.98 11.19 3.76 9.00 16.50 8.36 9.84 4.36 Outpatient 87206 Smear fluorescent/acid stai 28.00 8.07 4.58 25.87 7.20 25.02 5.44 25.87 4.58 5.39 14.35 5.39 13.80 4.58 5.77 18.53 4.85 5.39 18.27 14.62 5.34 5.50 5.39 22.40 4.93 16.52 14.12 4.74 11.45 21.00 10.64 12.52 5.50 Outpatient 87209 Smear complex stain 94.00 27.09 15.28 86.30 24.16 83.45 18.16 86.30 15.28 17.98 48.18 17.98 46.03 15.28 19.24 62.22 16.18 17.98 60.94 48.75 17.80 18.34 17.98 75.20 16.45 55.46 47.11 15.82 38.45 70.50 35.73 42.05 18.34 Outpatient 87255 Genet virus isolate hsv 178.00 51.30 28.78 162.53 45.75 157.15 34.20 162.53 28.78 33.86 91.23 33.86 86.68 28.78 36.23 117.82 30.47 33.86 114.77 91.81 33.52 34.54 33.86 142.40 30.98 105.02 88.71 29.80 72.80 133.50 67.66 79.62 34.54 Outpatient 87324 Clostridium ag ia 63.00 18.16 10.18 57.50 16.19 55.60 12.10 57.50 10.18 11.98 32.29 11.98 30.67 10.18 12.82 41.70 10.78 11.98 40.61 32.48 11.86 12.22 11.98 50.40 10.96 37.17 31.39 10.54 25.77 47.25 23.95 28.18 12.22 Outpatient 87328 Cryptosporidium ag ia 73.00 21.04 11.75 66.34 18.76 64.14 13.96 66.34 11.75 13.82 37.41 13.82 35.38 11.75 14.79 48.32 12.44 13.82 46.84 37.47 13.68 14.10 13.82 58.40 12.65 43.07 36.21 12.16 29.86 54.75 27.75 32.65 14.10 Outpatient 87329 Giardia ag ia 63.00 18.16 10.18 57.50 16.19 55.60 12.10 57.50 10.18 11.98 32.29 11.98 30.67 10.18 12.82 41.70 10.78 11.98 40.61 32.48 11.86 12.22 11.98 50.40 10.96 37.17 31.39 10.54 25.77 47.25 23.95 28.18 12.22 Outpatient 87338 Hpylori stool ag ia 75.00 21.62 12.22 69.02 19.28 66.74 14.52 69.02 12.22 14.38 38.44 14.38 36.81 12.22 15.39 49.64 12.94 14.38 48.74 38.99 14.24 14.67 14.38 60.00 13.16 44.25 37.68 12.65 30.68 56.25 28.51 33.55 14.67 Outpatient 87340 Hepatitis b surface ag ia 54.00 15.56 8.78 49.58 13.88 47.94 10.43 49.58 8.78 10.33 27.68 10.33 26.44 8.78 11.05 35.74 9.30 10.33 35.01 28.01 10.23 10.54 10.33 43.20 9.45 31.86 27.06 9.09 22.09 40.50 20.53 24.15 10.54 Outpatient 87350 Hepatitis be ag ia 61.00 17.58 9.80 55.34 15.68 53.51 11.65 55.34 9.80 11.53 31.26 11.53 29.52 9.80 12.34 40.38 10.38 11.53 39.08 31.26 11.41 11.76 11.53 48.80 10.55 35.99 30.21 10.15 24.95 45.75 23.19 27.29 11.76 Outpatient 87425 Rotavirus ag ia 63.00 18.16 10.18 57.50 16.19 55.60 12.10 57.50 10.18 11.98 32.29 11.98 30.67 10.18 12.82 41.70 10.78 11.98 40.61 32.48 11.86 12.22 11.98 50.40 10.96 37.17 31.39 10.54 25.77 47.25 23.95 28.18 12.22 Outpatient 87426 Sarscov coronavirus ag ia 237.00 68.30 - 189.60 60.91 - - - - - 121.46 - 142.20 - - 156.87 - - - - - - - 189.60 - 139.83 158.79 - 96.93 177.75 90.08 106.01 - Outpatient 87427 Shiga-like toxin ag ia 63.00 18.16 10.18 57.50 16.19 55.60 12.10 57.50 10.18 11.98 32.29 11.98 30.67 10.18 12.82 41.70 10.78 11.98 40.61 32.48 11.86 12.22 11.98 50.40 10.96 37.17 31.39 10.54 25.77 47.25 23.95 28.18 12.22 Outpatient 87449 Nos each organism ag ia 63.00 18.16 10.18 57.50 16.19 55.60 12.10 57.50 10.18 11.98 32.29 11.98 30.67 10.18 12.82 41.70 10.78 11.98 40.61 32.48 11.86 12.22 11.98 50.40 10.96 37.17 31.39 10.54 25.77 47.25 23.95 28.18 12.22 Outpatient 87480 Candida dna dir probe 105.00 30.26 17.04 96.24 26.99 93.05 20.25 96.24 17.04 20.05 53.81 20.05 51.33 17.04 21.45 69.50 18.05 20.05 67.96 54.37 19.85 20.45 20.05 84.00 18.35 61.95 52.53 17.64 42.95 78.75 39.91 46.97 20.45 Outpatient 87490 Chlmyd trach dna dir probe 108.00 31.13 19.34 109.20 27.76 105.59 22.98 109.20 19.34 22.75 55.35 22.75 58.24 19.34 24.34 71.49 20.48 22.75 77.11 61.69 22.52 23.21 22.75 86.40 20.82 63.72 59.61 20.02 44.17 81.00 41.05 48.31 23.21 Outpatient 87493 C diff amplified probe 196.00 56.49 31.68 178.90 50.37 172.97 37.64 178.90 31.68 37.27 100.45 37.27 95.41 31.68 39.88 129.73 33.54 37.27 126.33 101.06 36.90 38.02 37.27 156.80 34.10 115.64 97.65 32.80 80.16 147.00 74.50 87.67 38.02 Outpatient 87496 Cytomeg dna amp probe 184.00 53.03 29.83 168.43 47.29 162.86 35.44 168.43 29.83 35.09 94.30 35.09 89.83 29.83 37.55 121.79 31.58 35.09 118.94 95.15 34.74 35.79 35.09 147.20 32.11 108.56 91.94 30.88 75.26 138.00 69.94 82.30 35.79 Outpatient 87497 Cytomeg dna quant 225.00 64.85 36.41 205.63 57.83 198.82 43.27 205.63 36.41 42.84 115.31 42.84 109.67 36.41 45.84 148.93 38.56 42.84 145.21 116.16 42.41 43.70 42.84 180.00 39.20 132.75 112.24 37.70 92.03 168.75 85.52 100.64 43.70 Outpatient 87510 Gardner vag dna dir probe 105.00 30.26 17.04 96.24 26.99 93.05 20.25 96.24 17.04 20.05 53.81 20.05 51.33 17.04 21.45 69.50 18.05 20.05 67.96 54.37 19.85 20.45 20.05 84.00 18.35 61.95 52.53 17.64 42.95 78.75 39.91 46.97 20.45 Outpatient 87517 Hepatitis b dna quant 225.00 64.85 36.41 205.63 57.83 198.82 43.27 205.63 36.41 42.84 115.31 42.84 109.67 36.41 45.84 148.93 38.56 42.84 145.21 116.16 42.41 43.70 42.84 180.00 39.20 132.75 112.24 37.70 92.03 168.75 85.52 100.64 43.70 Outpatient 87522 Hepatitis c revrs trnscrpj 225.00 64.85 36.41 205.63 57.83 198.82 43.27 205.63 36.41 42.84 115.31 42.84 109.67 36.41 45.84 148.93 38.56 42.84 145.21 116.16 42.41 43.70 42.84 180.00 39.20 132.75 112.24 37.70 92.03 168.75 85.52 100.64 43.70 Outpatient 87529 Hsv dna amp probe 184.00 53.03 29.83 168.43 47.29 162.86 35.44 168.43 29.83 35.09 94.30 35.09 89.83 29.83 37.55 121.79 31.58 35.09 118.94 95.15 34.74 35.79 35.09 147.20 32.11 108.56 91.94 30.88 75.26 138.00 69.94 82.30 35.79 Outpatient 87536 Hiv-1 quant&revrse trnscrpj 447.00 128.83 72.34 408.48 114.88 394.96 85.95 408.48 72.34 85.10 229.09 85.10 217.86 72.34 91.06 295.87 76.59 85.10 288.45 230.76 84.25 86.80 85.10 357.60 77.87 263.73 222.96 74.89 182.82 335.25 169.90 199.94 86.80 Outpatient 87624 Hpv high-risk types 184.00 53.03 29.83 168.43 47.29 162.86 35.44 168.43 29.83 35.09 94.30 35.09 89.83 29.83 37.55 121.79 31.58 35.09 118.94 95.15 34.74 35.79 35.09 147.20 32.11 108.56 91.94 30.88 75.26 138.00 69.94 82.30 35.79 Outpatient 87625 Hpv types 16 & 18 only 213.00 61.39 34.47 194.64 54.74 188.20 40.96 194.64 34.47 40.55 109.16 40.55 103.81 34.47 43.39 140.98 36.50 40.55 137.44 109.96 40.14 41.36 40.55 170.40 37.10 125.67 106.24 35.68 87.12 159.75 80.96 95.27 41.36 Outpatient 87631 Resp virus 3-5 targets 749.00 215.86 121.24 684.62 192.49 661.96 144.06 684.62 121.24 142.63 383.86 142.63 365.13 121.24 152.61 495.76 128.37 142.63 483.44 386.76 141.20 145.48 142.63 599.20 130.51 441.91 373.69 125.51 306.34 561.75 284.69 335.03 145.48 Outpatient 87641 Mr-staph dna amp probe 184.00 53.03 29.83 168.43 47.29 162.86 35.44 168.43 29.83 35.09 94.30 35.09 89.83 29.83 37.55 121.79 31.58 35.09 118.94 95.15 34.74 35.79 35.09 147.20 32.11 108.56 91.94 30.88 75.26 138.00 69.94 82.30 35.79 Outpatient 87660 Trichomonas vagin dir probe 105.00 30.26 17.04 96.24 26.99 93.05 20.25 96.24 17.04 20.05 53.81 20.05 51.33 17.04 21.45 69.50 18.05 20.05 67.96 54.37 19.85 20.45 20.05 84.00 18.35 61.95 52.53 17.64 42.95 78.75 39.91 46.97 20.45 Outpatient 87661 Trichomonas vaginalis amplif 184.00 53.03 29.83 168.43 47.29 162.86 35.44 168.43 29.83 35.09 94.30 35.09 89.83 29.83 37.55 121.79 31.58 35.09 118.94 95.15 34.74 35.79 35.09 147.20 32.11 108.56 91.94 30.88 75.26 138.00 69.94 82.30 35.79 Outpatient 87798 Detect agent nos dna amp 184.00 53.03 29.83 168.43 47.29 162.86 35.44 168.43 29.83 35.09 94.30 35.09 89.83 29.83 37.55 121.79 31.58 35.09 118.94 95.15 34.74 35.79 35.09 147.20 32.11 108.56 91.94 30.88 75.26 138.00 69.94 82.30 35.79 Outpatient 87801 Detect agnt mult dna ampli 369.00 106.35 59.67 336.96 94.83 325.81 70.90 336.96 59.67 70.20 189.11 70.20 179.71 59.67 75.11 244.24 63.18 70.20 237.94 190.35 69.50 71.60 70.20 295.20 64.23 217.71 183.92 61.78 150.92 276.75 140.26 165.05 71.60 Outpatient 87902 Genotype dna/rna hep c " 1,352.00 " 389.65 218.83 " 1,235.76 " 347.46 " 1,194.85 " 260.02 " 1,235.76 " 218.83 257.45 692.90 257.45 659.07 218.83 275.47 894.89 231.71 257.45 872.63 698.10 254.88 262.60 257.45 " 1,081.60 " 235.57 797.68 674.52 226.56 552.97 " 1,014.00 " 513.90 604.75 262.60 Outpatient 88112 Cytopath cell enhance tech 261.00 75.22 42.75 242.94 67.08 233.40 50.79 241.39 42.75 50.29 133.76 50.29 127.39 42.75 53.81 172.76 45.26 50.29 242.94 194.35 49.79 51.30 50.29 208.80 46.02 153.99 130.37 44.26 106.75 195.75 99.21 116.75 51.30 Outpatient 88142 Cytopath c/v thin layer 106.00 30.55 17.22 97.25 27.24 94.03 20.46 97.25 17.22 20.26 54.33 20.26 51.87 17.22 21.68 70.16 18.23 20.26 68.67 54.94 20.06 20.67 20.26 84.80 18.54 62.54 53.08 17.83 43.35 79.50 40.29 47.41 20.67 Outpatient 88172 Cytp dx eval fna 1st ea site 783.00 225.66 128.30 728.29 201.23 700.53 152.45 724.51 128.30 150.94 401.29 150.94 381.85 128.30 161.51 518.27 135.85 150.94 728.29 582.63 149.43 153.96 150.94 626.40 138.11 461.97 390.80 132.83 320.25 587.25 297.62 350.24 153.96 Outpatient 88173 Cytopath eval fna report 261.00 75.22 42.75 242.94 67.08 233.40 50.79 241.39 42.75 50.29 133.76 50.29 127.39 42.75 53.81 172.76 45.26 50.29 242.94 194.35 49.79 51.30 50.29 208.80 46.02 153.99 130.37 44.26 106.75 195.75 99.21 116.75 51.30 Outpatient 88230 Tissue culture lymphocyte 612.00 176.38 99.02 559.15 157.28 540.64 117.65 559.15 99.02 116.49 313.65 116.49 298.21 99.02 124.64 405.08 104.84 116.49 394.84 315.87 115.33 118.82 116.49 489.60 106.59 361.08 305.20 102.51 250.31 459.00 232.62 273.75 118.82 Outpatient 88237 Tissue culture bone marrow 755.00 217.59 122.19 690.00 194.04 667.16 145.19 690.00 122.19 143.75 386.94 143.75 368.00 122.19 153.81 499.73 129.38 143.75 487.24 389.79 142.31 146.63 143.75 604.00 131.53 445.45 376.63 126.50 308.80 566.25 286.98 337.71 146.63 Outpatient 88262 Chromosome analysis 15-20 659.00 189.92 106.67 602.35 169.36 582.41 126.74 602.35 106.67 125.49 337.74 125.49 321.25 106.67 134.27 436.19 112.94 125.49 425.35 340.28 124.24 128.00 125.49 527.20 114.82 388.81 328.78 110.43 269.53 494.25 250.49 294.77 128.00 Outpatient 88264 Chromosome analysis 20-25 759.00 218.74 122.92 694.13 195.06 671.15 146.06 694.13 122.92 144.61 388.99 144.61 370.20 122.92 154.73 502.38 130.15 144.61 490.16 392.12 143.16 147.50 144.61 607.20 132.32 447.81 378.88 127.26 310.43 569.25 288.50 339.50 147.50 Outpatient 88280 Chromosome karyotype study 176.00 50.72 28.45 160.66 45.23 155.34 33.80 160.66 28.45 33.47 90.20 33.47 85.68 28.45 35.81 116.49 30.12 33.47 113.45 90.76 33.14 34.14 33.47 140.80 30.63 103.84 87.69 29.45 71.98 132.00 66.90 78.72 34.14 Outpatient 88300 Surgical path gross 130.00 37.47 21.25 120.47 33.41 116.03 25.25 120.00 21.25 25.00 66.63 25.00 63.16 21.25 26.75 86.05 22.50 25.00 120.47 96.38 24.75 25.50 25.00 104.00 22.88 76.70 64.64 22.00 53.17 97.50 49.41 58.15 25.50 Outpatient 88302 Tissue exam by pathologist 130.00 37.47 21.25 120.47 33.41 116.03 25.25 120.00 21.25 25.00 66.63 25.00 63.16 21.25 26.75 86.05 22.50 25.00 120.47 96.38 24.75 25.50 25.00 104.00 22.88 76.70 64.64 22.00 53.17 97.50 49.41 58.15 25.50 Outpatient 88304 Tissue exam by pathologist 261.00 75.22 42.75 242.94 67.08 233.40 50.79 241.39 42.75 50.29 133.76 50.29 127.39 42.75 53.81 172.76 45.26 50.29 242.94 194.35 49.79 51.30 50.29 208.80 46.02 153.99 130.37 44.26 106.75 195.75 99.21 116.75 51.30 Outpatient 88305 Tissue exam by pathologist 261.00 75.22 42.75 242.94 67.08 233.40 50.79 241.39 42.75 50.29 133.76 50.29 127.39 42.75 53.81 172.76 45.26 50.29 242.94 194.35 49.79 51.30 50.29 208.80 46.02 153.99 130.37 44.26 106.75 195.75 99.21 116.75 51.30 Outpatient 88307 Tissue exam by pathologist " 1,529.00 " 440.66 250.55 " 1,422.15 " 392.95 " 1,368.01 " 297.71 " 1,414.85 " 250.55 294.76 783.61 294.76 745.63 250.55 315.39 " 1,012.05 " 265.28 294.76 " 1,422.15 " " 1,137.72 " 291.81 300.66 294.76 " 1,223.20 " 269.71 902.11 763.10 259.39 625.36 " 1,146.75 " 581.17 683.92 300.66 Outpatient 88309 Tissue exam by pathologist " 3,445.00 " 992.85 563.75 " 3,203.77 " 885.37 " 3,078.12 " 669.86 " 3,183.50 " 563.75 663.23 " 1,765.56 " 663.23 " 1,679.74 " 563.75 709.66 " 2,280.25 " 596.91 663.23 " 3,203.77 " " 2,563.00 " 656.60 676.49 663.23 " 2,756.00 " 606.86 " 2,032.55 " " 1,719.11 " 583.64 " 1,409.01 " " 2,583.75 " " 1,309.44 " " 1,540.95 " 676.49 Outpatient 88312 Special stains group 1 261.00 75.22 42.75 242.94 67.08 233.40 50.79 241.39 42.75 50.29 133.76 50.29 127.39 42.75 53.81 172.76 45.26 50.29 242.94 194.35 49.79 51.30 50.29 208.80 46.02 153.99 130.37 44.26 106.75 195.75 99.21 116.75 51.30 Outpatient 88313 Special stains group 2 178.00 51.30 29.12 165.23 45.75 159.00 34.60 164.45 29.12 34.26 91.23 34.26 86.63 29.12 36.66 117.82 30.83 34.26 165.23 132.18 33.92 34.95 34.26 142.40 31.35 105.02 88.66 30.15 72.80 133.50 67.66 79.62 34.95 Outpatient 88331 Path consult intraop 1 bloc 783.00 225.66 128.30 728.29 201.23 700.53 152.45 724.51 128.30 150.94 401.29 150.94 381.85 128.30 161.51 518.27 135.85 150.94 728.29 582.63 149.43 153.96 150.94 626.40 138.11 461.97 390.80 132.83 320.25 587.25 297.62 350.24 153.96 Outpatient 88342 Immunohisto antb 1st stain 783.00 225.66 128.30 728.29 201.23 700.53 152.45 724.51 128.30 150.94 401.29 150.94 381.85 128.30 161.51 518.27 135.85 150.94 728.29 582.63 149.43 153.96 150.94 626.40 138.11 461.97 390.80 132.83 320.25 587.25 297.62 350.24 153.96 Outpatient 88346 Immunofluor antb 1st stain " 1,529.00 " 440.66 250.55 " 1,422.15 " 392.95 " 1,368.01 " 297.71 " 1,414.85 " 250.55 294.76 783.61 294.76 745.63 250.55 315.39 " 1,012.05 " 265.28 294.76 " 1,422.15 " " 1,137.72 " 291.81 300.66 294.76 " 1,223.20 " 269.71 902.11 763.10 259.39 625.36 " 1,146.75 " 581.17 683.92 300.66 Outpatient 88360 Tumor immunohistochem/manual 783.00 225.66 128.30 728.29 201.23 700.53 152.45 724.51 128.30 150.94 401.29 150.94 381.85 128.30 161.51 518.27 135.85 150.94 728.29 582.63 149.43 153.96 150.94 626.40 138.11 461.97 390.80 132.83 320.25 587.25 297.62 350.24 153.96 Outpatient 88377 M/phmtrc alys ishquant/semiq 783.00 225.66 128.30 728.29 201.23 700.53 152.45 724.51 128.30 150.94 401.29 150.94 381.85 128.30 161.51 518.27 135.85 150.94 728.29 582.63 149.43 153.96 150.94 626.40 138.11 461.97 390.80 132.83 320.25 587.25 297.62 350.24 153.96 Outpatient 89051 Body fluid cell count 29.00 8.36 4.76 26.88 7.45 25.99 5.66 26.88 4.76 5.60 14.86 5.60 14.34 4.76 5.99 19.20 5.04 5.60 18.98 15.18 5.54 5.71 5.60 23.20 5.12 17.11 14.67 4.93 11.86 21.75 11.02 12.97 5.71 Outpatient 89055 Leukocyte assessment fecal 22.00 6.34 3.63 20.50 5.65 19.82 4.31 20.50 3.63 4.27 11.28 4.27 10.93 3.63 4.57 14.56 3.84 4.27 14.47 11.58 4.23 4.36 4.27 17.60 3.91 12.98 11.19 3.76 9.00 16.50 8.36 9.84 4.36 Outpatient 90471 Immunization admin 325.00 93.67 53.34 302.57 83.53 291.23 63.38 301.20 53.34 62.75 166.56 62.75 195.00 53.34 67.14 215.12 56.48 62.75 302.57 242.05 62.12 64.01 62.75 260.00 57.42 191.75 217.75 55.22 132.93 243.75 123.53 145.37 64.01 Outpatient 92507 Speech/hearing therapy 399.00 114.99 64.69 365.28 102.54 353.19 76.86 365.28 64.69 76.10 204.49 76.10 239.40 64.69 81.43 264.10 68.49 76.10 268.04 214.43 75.34 77.62 76.10 319.20 69.63 235.41 267.33 66.97 163.19 299.25 151.66 178.47 77.62 Outpatient 92523 Speech sound lang comprehen " 1,201.00 " 346.13 191.50 " 1,081.39 " 308.66 " 1,045.59 " 227.54 " 1,081.39 " 191.50 225.29 615.51 225.29 720.60 191.50 241.06 794.94 202.76 225.29 653.83 523.07 223.04 229.80 225.29 960.80 206.14 708.59 804.67 198.26 491.21 900.75 456.50 537.21 229.80 Outpatient 92524 Behavral qualit analys voice 573.00 165.14 92.80 524.06 147.26 506.72 110.27 524.06 92.80 109.18 293.66 109.18 343.80 92.80 116.82 379.27 98.26 109.18 305.22 244.18 108.09 111.36 109.18 458.40 99.90 338.07 383.91 96.08 234.36 429.75 217.80 256.30 111.36 Outpatient 92526 Oral function therapy 441.00 127.10 71.66 404.64 113.34 391.24 85.14 404.64 71.66 84.30 226.01 84.30 264.60 71.66 90.20 291.90 75.87 84.30 294.72 235.77 83.46 85.99 84.30 352.80 77.13 260.19 295.47 74.18 180.37 330.75 167.62 197.26 85.99 Outpatient 92610 Evaluate swallowing function 363.00 104.62 59.13 333.89 93.29 322.83 70.26 333.89 59.13 69.56 186.04 69.56 217.80 59.13 74.43 240.27 62.60 69.56 234.52 187.62 68.86 70.95 69.56 290.40 63.65 214.17 243.21 61.21 148.47 272.25 137.98 162.37 70.95 Outpatient 92611 Motion fluoroscopy/swallow 477.00 137.47 77.12 435.50 122.59 421.09 91.64 435.50 77.12 90.73 244.46 90.73 286.20 77.12 97.08 315.73 81.66 90.73 307.87 246.29 89.82 92.54 90.73 381.60 83.02 281.43 319.59 79.84 195.09 357.75 181.31 213.36 92.54 Outpatient 92920 Prq cardiac angioplast 1 art " 26,023.00 " " 7,499.83 " " 4,263.63 " " 24,202.85 " " 6,687.91 " " 23,279.90 " " 5,066.19 " " 24,076.94 " " 4,263.63 " " 5,016.03 " " 13,336.79 " " 5,016.03 " " 15,613.80 " " 4,263.63 " " 5,367.15 " " 17,224.62 " " 4,514.43 " " 5,016.03 " " 24,202.85 " " 19,362.18 " " 4,965.87 " " 5,116.35 " " 5,016.03 " " 20,818.40 " " 4,589.67 " " 15,353.57 " " 17,435.41 " " 4,414.11 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,116.35 " Outpatient 92950 Heart/lung resuscitation cpr " 1,388.00 " 400.02 227.66 " 1,291.25 " 356.72 " 1,243.07 " 270.52 " 1,285.63 " 227.66 267.84 711.35 267.84 832.80 227.66 286.59 918.72 241.06 267.84 " 1,291.25 " " 1,032.99 " 265.16 273.20 267.84 " 1,110.40 " 245.07 818.92 929.96 235.70 567.69 " 1,041.00 " 527.58 620.85 273.20 Outpatient 92960 Cardioversion electric ext " 2,950.00 " 850.19 483.25 " 2,743.63 " 758.15 " 2,638.60 " 574.22 " 2,728.94 " 483.25 568.53 " 1,511.88 " 568.53 " 1,770.00 " 483.25 608.33 " 1,952.61 " 511.68 568.53 " 2,743.63 " " 2,194.89 " 562.84 579.90 568.53 " 2,360.00 " 520.20 " 1,740.50 " " 1,976.50 " 500.31 " 1,206.55 " " 2,212.50 " " 1,121.30 " " 1,319.54 " 579.90 Outpatient 93005 Electrocardiogram tracing 292.00 84.15 47.88 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 271.75 217.40 55.77 57.46 56.33 233.60 51.54 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 Outpatient 93017 Cardiovascular stress test " 1,388.00 " 400.02 227.66 " 1,291.25 " 356.72 " 1,243.07 " 270.52 " 1,285.63 " 227.66 267.84 711.35 267.84 832.80 227.66 286.59 918.72 241.06 267.84 " 1,291.25 " " 1,032.99 " 265.16 273.20 267.84 " 1,110.40 " 245.07 818.92 929.96 235.70 567.69 " 1,041.00 " 527.58 620.85 273.20 Outpatient 93225 Ecg monit/reprt up to 48 hrs 588.00 169.46 97.00 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 546.63 437.30 112.98 116.40 114.12 470.40 104.42 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 Outpatient 93242 Ext ecg>48hr<7d recording 178.00 51.30 45.75 270.38 45.75 261.43 56.89 270.38 47.88 56.33 91.23 56.33 106.80 47.88 60.27 117.82 50.70 56.33 165.23 132.18 55.77 57.46 56.33 142.40 51.54 105.02 119.26 49.57 72.80 133.50 67.66 79.62 57.46 Outpatient 93246 Ext ecg>7d<15d recording 292.00 84.15 47.88 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 271.75 217.40 55.77 57.46 56.33 233.60 51.54 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 Outpatient 93270 Remote 30 day ecg rev/report 195.00 56.20 32.04 181.41 50.12 174.92 38.07 180.91 32.04 37.69 99.94 37.69 117.00 32.04 40.33 129.07 33.92 37.69 181.41 145.13 37.31 38.44 37.69 156.00 34.49 115.05 130.65 33.17 79.76 146.25 74.12 87.22 38.44 Outpatient 93306 Tte w/doppler complete " 2,535.00 " 730.59 415.66 " 2,357.79 " 651.50 " 2,269.54 " 493.90 " 2,347.25 " 415.66 489.01 " 1,299.19 " 489.01 " 1,521.00 " 415.66 523.24 " 1,677.92 " 440.11 489.01 " 2,357.79 " " 1,886.22 " 484.12 498.79 489.01 " 2,028.00 " 447.44 " 1,495.65 " " 1,698.45 " 430.33 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 498.79 Outpatient 93308 Tte f-up or lmtd " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 724.80 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 809.36 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 93312 Echo transesophageal " 2,535.00 " 730.59 415.66 " 2,357.79 " 651.50 " 2,269.54 " 493.90 " 2,347.25 " 415.66 489.01 " 1,299.19 " 489.01 " 1,521.00 " 415.66 523.24 " 1,677.92 " 440.11 489.01 " 2,357.79 " " 1,886.22 " 484.12 498.79 489.01 " 2,028.00 " 447.44 " 1,495.65 " " 1,698.45 " 430.33 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 498.79 Outpatient 93350 Stress tte only " 2,535.00 " 730.59 415.66 " 2,357.79 " 651.50 " 2,269.54 " 493.90 " 2,347.25 " 415.66 489.01 " 1,299.19 " 489.01 " 1,521.00 " 415.66 523.24 " 1,677.92 " 440.11 489.01 " 2,357.79 " " 1,886.22 " 484.12 498.79 489.01 " 2,028.00 " 447.44 " 1,495.65 " " 1,698.45 " 430.33 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 498.79 Outpatient 93451 Right heart cath " 15,220.00 " " 4,386.40 " " 2,494.49 " " 14,155.09 " " 3,911.54 " " 13,620.19 " " 2,964.04 " " 14,086.51 " " 2,494.49 " " 2,934.69 " " 7,800.25 " " 2,934.69 " " 9,132.00 " " 2,494.49 " " 3,140.12 " " 10,074.12 " " 2,641.22 " " 2,934.69 " " 14,155.09 " " 11,324.01 " " 2,905.34 " " 2,993.38 " " 2,934.69 " " 12,176.00 " " 2,685.24 " " 8,979.80 " " 10,197.40 " " 2,582.53 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,993.38 " Outpatient 93454 Coronary artery angio s&i " 15,220.00 " " 4,386.40 " " 2,494.49 " " 14,155.09 " " 3,911.54 " " 13,620.19 " " 2,964.04 " " 14,086.51 " " 2,494.49 " " 2,934.69 " " 7,800.25 " " 2,934.69 " " 9,132.00 " " 2,494.49 " " 3,140.12 " " 10,074.12 " " 2,641.22 " " 2,934.69 " " 14,155.09 " " 11,324.01 " " 2,905.34 " " 2,993.38 " " 2,934.69 " " 12,176.00 " " 2,685.24 " " 8,979.80 " " 10,197.40 " " 2,582.53 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,993.38 " Outpatient 93455 Coronary art/grft angio s&i " 15,220.00 " " 4,386.40 " " 2,494.49 " " 14,155.09 " " 3,911.54 " " 13,620.19 " " 2,964.04 " " 14,086.51 " " 2,494.49 " " 2,934.69 " " 7,800.25 " " 2,934.69 " " 9,132.00 " " 2,494.49 " " 3,140.12 " " 10,074.12 " " 2,641.22 " " 2,934.69 " " 14,155.09 " " 11,324.01 " " 2,905.34 " " 2,993.38 " " 2,934.69 " " 12,176.00 " " 2,685.24 " " 8,979.80 " " 10,197.40 " " 2,582.53 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,993.38 " Outpatient 93456 R hrt coronary artery angio " 15,220.00 " " 4,386.40 " " 2,494.49 " " 14,155.09 " " 3,911.54 " " 13,620.19 " " 2,964.04 " " 14,086.51 " " 2,494.49 " " 2,934.69 " " 7,800.25 " " 2,934.69 " " 9,132.00 " " 2,494.49 " " 3,140.12 " " 10,074.12 " " 2,641.22 " " 2,934.69 " " 14,155.09 " " 11,324.01 " " 2,905.34 " " 2,993.38 " " 2,934.69 " " 12,176.00 " " 2,685.24 " " 8,979.80 " " 10,197.40 " " 2,582.53 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,993.38 " Outpatient 93458 L hrt artery/ventricle angio " 15,220.00 " " 4,386.40 " " 2,494.49 " " 14,155.09 " " 3,911.54 " " 13,620.19 " " 2,964.04 " " 14,086.51 " " 2,494.49 " " 2,934.69 " " 7,800.25 " " 2,934.69 " " 9,132.00 " " 2,494.49 " " 3,140.12 " " 10,074.12 " " 2,641.22 " " 2,934.69 " " 14,155.09 " " 11,324.01 " " 2,905.34 " " 2,993.38 " " 2,934.69 " " 12,176.00 " " 2,685.24 " " 8,979.80 " " 10,197.40 " " 2,582.53 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,993.38 " Outpatient 93459 L hrt art/grft angio " 15,220.00 " " 4,386.40 " " 2,494.49 " " 14,155.09 " " 3,911.54 " " 13,620.19 " " 2,964.04 " " 14,086.51 " " 2,494.49 " " 2,934.69 " " 7,800.25 " " 2,934.69 " " 9,132.00 " " 2,494.49 " " 3,140.12 " " 10,074.12 " " 2,641.22 " " 2,934.69 " " 14,155.09 " " 11,324.01 " " 2,905.34 " " 2,993.38 " " 2,934.69 " " 12,176.00 " " 2,685.24 " " 8,979.80 " " 10,197.40 " " 2,582.53 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,993.38 " Outpatient 93460 R&l hrt art/ventricle angio " 15,220.00 " " 4,386.40 " " 2,494.49 " " 14,155.09 " " 3,911.54 " " 13,620.19 " " 2,964.04 " " 14,086.51 " " 2,494.49 " " 2,934.69 " " 7,800.25 " " 2,934.69 " " 9,132.00 " " 2,494.49 " " 3,140.12 " " 10,074.12 " " 2,641.22 " " 2,934.69 " " 14,155.09 " " 11,324.01 " " 2,905.34 " " 2,993.38 " " 2,934.69 " " 12,176.00 " " 2,685.24 " " 8,979.80 " " 10,197.40 " " 2,582.53 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,993.38 " Outpatient 93653 Compre ep eval tx svt " 112,688.00 " " 32,476.68 " " 18,459.47 " " 104,804.57 " " 28,960.82 " " 100,790.86 " " 21,934.19 " " 104,241.70 " " 18,459.47 " " 21,717.02 " " 57,752.60 " " 21,717.02 " " 67,612.80 " " 18,459.47 " " 23,237.21 " " 74,588.19 " " 19,545.32 " " 21,717.02 " " 104,804.57 " " 83,843.23 " " 21,499.85 " " 22,151.36 " " 21,717.02 " " 90,150.40 " " 19,871.07 " " 66,485.92 " " 75,500.96 " " 19,110.98 " " 46,089.39 " " 84,516.00 " " 42,832.71 " " 50,405.34 " " 22,151.36 " Outpatient 93656 Compre ep eval abltj atr fib " 112,688.00 " " 32,476.68 " " 18,459.47 " " 104,804.57 " " 28,960.82 " " 100,790.86 " " 21,934.19 " " 104,241.70 " " 18,459.47 " " 21,717.02 " " 57,752.60 " " 21,717.02 " " 67,612.80 " " 18,459.47 " " 23,237.21 " " 74,588.19 " " 19,545.32 " " 21,717.02 " " 104,804.57 " " 83,843.23 " " 21,499.85 " " 22,151.36 " " 21,717.02 " " 90,150.40 " " 19,871.07 " " 66,485.92 " " 75,500.96 " " 19,110.98 " " 46,089.39 " " 84,516.00 " " 42,832.71 " " 50,405.34 " " 22,151.36 " Outpatient 93660 Tilt table evaluation " 2,561.00 " 738.08 419.91 " 2,381.68 " 658.18 " 2,292.75 " 498.95 " 2,371.25 " 419.91 494.01 " 1,312.51 " 494.01 " 1,536.60 " 419.91 528.59 " 1,695.13 " 444.61 494.01 " 2,381.68 " " 1,905.34 " 489.07 503.89 494.01 " 2,048.80 " 452.02 " 1,510.99 " " 1,715.87 " 434.73 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 503.89 Outpatient 93668 Peripheral vascular rehab 292.00 84.15 47.88 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 271.75 217.40 55.77 57.46 56.33 233.60 51.54 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 Outpatient 93798 Cardiac rehab/monitor 609.00 175.51 99.86 566.67 156.51 545.24 118.65 563.90 99.86 117.48 312.11 117.48 365.40 99.86 125.70 403.10 105.73 117.48 566.67 453.33 116.31 119.83 117.48 487.20 107.49 359.31 408.03 103.38 249.08 456.75 231.48 272.41 119.83 Outpatient 93880 Extracranial bilat study " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 809.36 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 93882 Extracranial uni/ltd study 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 383.24 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 93922 Upr/l xtremity art 2 levels 588.00 169.46 97.00 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 286.59 97.00 122.11 389.20 102.71 114.12 546.63 437.30 112.98 116.40 114.12 470.40 104.42 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 Outpatient 93923 Upr/lxtr art stdy 3+ lvls 733.00 211.25 120.11 681.39 188.38 655.79 142.71 678.24 120.11 141.30 375.66 141.30 357.25 120.11 151.19 485.17 127.17 141.30 681.39 545.11 139.89 144.13 141.30 586.40 129.29 432.47 491.11 124.34 299.80 549.75 278.61 327.87 144.13 Outpatient 93924 Lwr xtr vasc stdy bilat " 1,388.00 " 400.02 227.66 " 1,291.25 " 356.72 " 1,243.07 " 270.52 " 1,285.63 " 227.66 267.84 711.35 267.84 676.99 227.66 286.59 918.72 241.06 267.84 " 1,291.25 " " 1,032.99 " 265.16 273.20 267.84 " 1,110.40 " 245.07 818.92 929.96 235.70 567.69 " 1,041.00 " 527.58 620.85 273.20 Outpatient 93925 Lower extremity study " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 809.36 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 93930 Upper extremity study " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 809.36 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 93931 Upper extremity study 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 383.24 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 93970 Extremity study " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 809.36 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 93971 Extremity study 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 383.24 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 93976 Vascular study 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 383.24 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 93978 Vascular study " 1,208.00 " 348.15 197.94 " 1,123.68 " 310.46 " 1,080.77 " 235.20 " 1,117.78 " 197.94 232.87 619.10 232.87 589.13 197.94 249.17 799.58 209.58 232.87 " 1,123.68 " 898.94 230.54 237.53 232.87 966.40 213.08 712.72 809.36 204.93 494.07 906.00 459.16 540.34 237.53 Outpatient 93990 Doppler flow testing 572.00 164.85 93.65 532.05 147.00 511.36 111.28 528.86 93.65 110.18 293.15 110.18 278.96 93.65 117.89 378.61 99.16 110.18 532.05 425.64 109.08 112.38 110.18 457.60 100.81 337.48 383.24 96.96 233.95 429.00 217.42 255.86 112.38 Outpatient 94010 Breathing capacity test 733.00 211.25 120.11 681.39 188.38 655.79 142.71 678.24 120.11 141.30 375.66 141.30 439.80 120.11 151.19 485.17 127.17 141.30 681.39 545.11 139.89 144.13 141.30 586.40 129.29 432.47 491.11 124.34 299.80 549.75 278.61 327.87 144.13 Outpatient 94060 Evaluation of wheezing " 1,388.00 " 400.02 227.66 " 1,291.25 " 356.72 " 1,243.07 " 270.52 " 1,285.63 " 227.66 267.84 711.35 267.84 832.80 227.66 286.59 918.72 241.06 267.84 " 1,291.25 " " 1,032.99 " 265.16 273.20 267.84 " 1,110.40 " 245.07 818.92 929.96 235.70 567.69 " 1,041.00 " 527.58 620.85 273.20 Outpatient 94070 Evaluation of wheezing " 1,388.00 " 400.02 227.66 " 1,291.25 " 356.72 " 1,243.07 " 270.52 " 1,285.63 " 227.66 267.84 711.35 267.84 832.80 227.66 286.59 918.72 241.06 267.84 " 1,291.25 " " 1,032.99 " 265.16 273.20 267.84 " 1,110.40 " 245.07 818.92 929.96 235.70 567.69 " 1,041.00 " 527.58 620.85 273.20 Outpatient 94644 Cbt 1st hour 588.00 169.46 97.00 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 546.63 437.30 112.98 116.40 114.12 470.40 104.42 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 Outpatient 94660 Pos airway pressure cpap 986.00 284.17 161.70 917.36 253.40 882.88 192.13 913.10 161.70 190.23 505.33 190.23 591.60 161.70 203.55 652.63 171.21 190.23 917.36 733.88 188.33 194.03 190.23 788.80 174.06 581.74 660.62 167.40 403.27 739.50 374.78 441.04 194.03 Outpatient 94726 Pulm funct tst plethysmograp " 1,388.00 " 400.02 227.66 " 1,291.25 " 356.72 " 1,243.07 " 270.52 " 1,285.63 " 227.66 267.84 711.35 267.84 832.80 227.66 286.59 918.72 241.06 267.84 " 1,291.25 " " 1,032.99 " 265.16 273.20 267.84 " 1,110.40 " 245.07 818.92 929.96 235.70 567.69 " 1,041.00 " 527.58 620.85 273.20 Outpatient 94727 Pulm function test by gas 733.00 211.25 120.11 681.39 188.38 655.79 142.71 678.24 120.11 141.30 375.66 141.30 439.80 120.11 151.19 485.17 127.17 141.30 681.39 545.11 139.89 144.13 141.30 586.40 129.29 432.47 491.11 124.34 299.80 549.75 278.61 327.87 144.13 Outpatient 95249 Cont gluc mntr pt prov eqp 292.00 84.15 47.88 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 271.75 217.40 55.77 57.46 56.33 233.60 51.54 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 Outpatient 95708 Eeg wo vid ea 12-26hr unmntr " 2,561.00 " 738.08 419.91 " 2,381.68 " 658.18 " 2,292.75 " 498.95 " 2,371.25 " 419.91 494.01 " 1,312.51 " 494.01 " 1,536.60 " 419.91 528.59 " 1,695.13 " 444.61 494.01 " 2,381.68 " " 1,905.34 " 489.07 503.89 494.01 " 2,048.80 " 452.02 " 1,510.99 " " 1,715.87 " 434.73 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 503.89 Outpatient 95819 Eeg awake and asleep " 1,388.00 " 400.02 227.66 " 1,291.25 " 356.72 " 1,243.07 " 270.52 " 1,285.63 " 227.66 267.84 711.35 267.84 832.80 227.66 286.59 918.72 241.06 267.84 " 1,291.25 " " 1,032.99 " 265.16 273.20 267.84 " 1,110.40 " 245.07 818.92 929.96 235.70 567.69 " 1,041.00 " 527.58 620.85 273.20 Outpatient 95861 Muscle test 2 limbs 588.00 169.46 97.00 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 546.63 437.30 112.98 116.40 114.12 470.40 104.42 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 Outpatient 95925 Somatosensory testing " 1,388.00 " 400.02 227.66 " 1,291.25 " 356.72 " 1,243.07 " 270.52 " 1,285.63 " 227.66 267.84 711.35 267.84 832.80 227.66 286.59 918.72 241.06 267.84 " 1,291.25 " " 1,032.99 " 265.16 273.20 267.84 " 1,110.40 " 245.07 818.92 929.96 235.70 567.69 " 1,041.00 " 527.58 620.85 273.20 Outpatient 95926 Somatosensory testing " 1,388.00 " 400.02 227.66 " 1,291.25 " 356.72 " 1,243.07 " 270.52 " 1,285.63 " 227.66 267.84 711.35 267.84 832.80 227.66 286.59 918.72 241.06 267.84 " 1,291.25 " " 1,032.99 " 265.16 273.20 267.84 " 1,110.40 " 245.07 818.92 929.96 235.70 567.69 " 1,041.00 " 527.58 620.85 273.20 Outpatient 95928 C motor evoked uppr limbs " 4,829.00 " " 1,391.72 " 791.44 " 4,491.22 " " 1,241.05 " " 4,321.33 " 940.41 " 4,469.28 " 791.44 931.10 " 2,474.86 " 931.10 " 2,897.40 " 791.44 996.28 " 3,196.32 " 837.99 931.10 " 4,491.22 " " 3,592.96 " 921.79 949.72 931.10 " 3,863.20 " 851.96 " 2,849.11 " " 3,235.43 " 819.37 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 949.72 Outpatient 95929 C motor evoked lwr limbs " 2,561.00 " 738.08 419.91 " 2,381.68 " 658.18 " 2,292.75 " 498.95 " 2,371.25 " 419.91 494.01 " 1,312.51 " 494.01 " 1,536.60 " 419.91 528.59 " 1,695.13 " 444.61 494.01 " 2,381.68 " " 1,905.34 " 489.07 503.89 494.01 " 2,048.80 " 452.02 " 1,510.99 " " 1,715.87 " 434.73 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 503.89 Outpatient 95937 Neuromuscular junction test 733.00 211.25 120.11 681.39 188.38 655.79 142.71 678.24 120.11 141.30 375.66 141.30 439.80 120.11 151.19 485.17 127.17 141.30 681.39 545.11 139.89 144.13 141.30 586.40 129.29 432.47 491.11 124.34 299.80 549.75 278.61 327.87 144.13 Outpatient 96360 Hydration iv infusion init " 1,068.00 " 307.80 175.98 993.79 274.48 960.89 209.11 993.79 175.98 207.04 547.35 207.04 640.80 175.98 221.53 706.91 186.34 207.04 993.66 794.92 204.97 211.18 207.04 854.40 189.44 630.12 715.56 182.20 436.81 801.00 405.95 477.72 211.18 Outpatient 96361 Hydrate iv infusion add-on 210.00 60.52 34.43 195.31 53.97 187.96 40.91 194.40 34.43 40.50 107.63 40.50 126.00 34.43 43.34 139.00 36.45 40.50 195.31 156.25 40.10 41.31 40.50 168.00 37.06 123.90 140.70 35.64 85.89 157.50 79.82 93.93 41.31 Outpatient 96365 Ther/proph/diag iv inf init " 1,068.00 " 307.80 175.98 993.79 274.48 960.89 209.11 993.79 175.98 207.04 547.35 207.04 640.80 175.98 221.53 706.91 186.34 207.04 993.66 794.92 204.97 211.18 207.04 854.40 189.44 630.12 715.56 182.20 436.81 801.00 405.95 477.72 211.18 Outpatient 96366 Ther/proph/diag iv inf addon 210.00 60.52 34.43 195.31 53.97 187.96 40.91 194.40 34.43 40.50 107.63 40.50 126.00 34.43 43.34 139.00 36.45 40.50 195.31 156.25 40.10 41.31 40.50 168.00 37.06 123.90 140.70 35.64 85.89 157.50 79.82 93.93 41.31 Outpatient 96367 Tx/proph/dg addl seq iv inf 325.00 93.67 53.34 302.57 83.53 291.23 63.38 301.20 53.34 62.75 166.56 62.75 195.00 53.34 67.14 215.12 56.48 62.75 302.57 242.05 62.12 64.01 62.75 260.00 57.42 191.75 217.75 55.22 132.93 243.75 123.53 145.37 64.01 Outpatient 96372 Ther/proph/diag inj sc/im 325.00 93.67 53.34 302.57 83.53 291.23 63.38 301.20 53.34 62.75 166.56 62.75 195.00 53.34 67.14 215.12 56.48 62.75 302.57 242.05 62.12 64.01 62.75 260.00 57.42 191.75 217.75 55.22 132.93 243.75 123.53 145.37 64.01 Outpatient 96374 Ther/proph/diag inj iv push " 1,068.00 " 307.80 175.98 993.79 274.48 960.89 209.11 993.79 175.98 207.04 547.35 207.04 640.80 175.98 221.53 706.91 186.34 207.04 993.66 794.92 204.97 211.18 207.04 854.40 189.44 630.12 715.56 182.20 436.81 801.00 405.95 477.72 211.18 Outpatient 96375 Tx/pro/dx inj new drug addon 210.00 60.52 34.43 195.31 53.97 187.96 40.91 194.40 34.43 40.50 107.63 40.50 126.00 34.43 43.34 139.00 36.45 40.50 195.31 156.25 40.10 41.31 40.50 168.00 37.06 123.90 140.70 35.64 85.89 157.50 79.82 93.93 41.31 Outpatient 96377 Applicaton on-body injector 210.00 60.52 34.43 195.31 53.97 187.96 40.91 194.40 34.43 40.50 107.63 40.50 126.00 34.43 43.34 139.00 36.45 40.50 195.31 156.25 40.10 41.31 40.50 168.00 37.06 123.90 140.70 35.64 85.89 157.50 79.82 93.93 41.31 Outpatient 96401 Chemo anti-neopl sq/im 325.00 93.67 53.34 302.57 83.53 291.23 63.38 301.20 53.34 62.75 166.56 62.75 195.00 53.34 67.14 215.12 56.48 62.75 302.57 242.05 62.12 64.01 62.75 260.00 57.42 191.75 217.75 55.22 132.93 243.75 123.53 145.37 64.01 Outpatient 96402 Chemo hormon antineopl sq/im 325.00 93.67 53.34 302.57 83.53 291.23 63.38 301.20 53.34 62.75 166.56 62.75 195.00 53.34 67.14 215.12 56.48 62.75 302.57 242.05 62.12 64.01 62.75 260.00 57.42 191.75 217.75 55.22 132.93 243.75 123.53 145.37 64.01 Outpatient 96409 Chemo iv push sngl drug " 1,068.00 " 307.80 175.98 993.79 274.48 960.89 209.11 993.79 175.98 207.04 547.35 207.04 640.80 175.98 221.53 706.91 186.34 207.04 993.66 794.92 204.97 211.18 207.04 854.40 189.44 630.12 715.56 182.20 436.81 801.00 405.95 477.72 211.18 Outpatient 96411 Chemo iv push addl drug 325.00 93.67 53.34 302.57 83.53 291.23 63.38 301.20 53.34 62.75 166.56 62.75 195.00 53.34 67.14 215.12 56.48 62.75 302.57 242.05 62.12 64.01 62.75 260.00 57.42 191.75 217.75 55.22 132.93 243.75 123.53 145.37 64.01 Outpatient 96413 Chemo iv infusion 1 hr " 1,631.00 " 470.05 274.29 " 1,548.91 " 419.17 " 1,497.64 " 325.92 " 1,548.91 " 274.29 322.69 835.89 322.69 978.60 274.29 345.28 " 1,079.56 " 290.42 322.69 " 1,517.32 " " 1,213.85 " 319.46 329.14 322.69 " 1,304.80 " 295.26 962.29 " 1,092.77 " 283.97 667.08 " 1,223.25 " 619.94 729.55 329.14 Outpatient 96415 Chemo iv infusion addl hr 325.00 93.67 53.34 302.57 83.53 291.23 63.38 301.20 53.34 62.75 166.56 62.75 195.00 53.34 67.14 215.12 56.48 62.75 302.57 242.05 62.12 64.01 62.75 260.00 57.42 191.75 217.75 55.22 132.93 243.75 123.53 145.37 64.01 Outpatient 96416 Chemo prolong infuse w/pump " 1,631.00 " 470.05 274.29 " 1,548.91 " 419.17 " 1,497.64 " 325.92 " 1,548.91 " 274.29 322.69 835.89 322.69 978.60 274.29 345.28 " 1,079.56 " 290.42 322.69 " 1,517.32 " " 1,213.85 " 319.46 329.14 322.69 " 1,304.80 " 295.26 962.29 " 1,092.77 " 283.97 667.08 " 1,223.25 " 619.94 729.55 329.14 Outpatient 96417 Chemo iv infus each addl seq 325.00 93.67 53.34 302.57 83.53 291.23 63.38 301.20 53.34 62.75 166.56 62.75 195.00 53.34 67.14 215.12 56.48 62.75 302.57 242.05 62.12 64.01 62.75 260.00 57.42 191.75 217.75 55.22 132.93 243.75 123.53 145.37 64.01 Outpatient 96523 Irrig drug delivery device 292.00 84.15 47.88 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 271.75 217.40 55.77 57.46 56.33 233.60 51.54 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 Outpatient 97012 Mechanical traction therapy 77.00 22.19 12.04 67.97 19.79 65.72 14.30 67.97 12.04 14.16 39.46 14.16 46.20 12.04 15.15 50.97 12.74 14.16 51.25 41.00 14.02 14.44 14.16 61.60 12.96 45.43 51.59 12.46 31.49 57.75 29.27 34.44 14.44 Outpatient 97016 Vasopneumatic device therapy 62.00 17.87 9.98 56.35 15.93 54.49 11.86 56.35 9.98 11.74 31.78 11.74 37.20 9.98 12.56 41.04 10.57 11.74 41.52 33.22 11.62 11.97 11.74 49.60 10.74 36.58 41.54 10.33 25.36 46.50 23.57 27.73 11.97 Outpatient 97018 Paraffin bath therapy 30.00 8.65 4.79 27.02 7.71 26.13 5.69 27.02 4.79 5.63 15.38 5.63 18.00 4.79 6.02 19.86 5.07 5.63 19.96 15.97 5.57 5.74 5.63 24.00 5.15 17.70 20.10 4.95 12.27 22.50 11.40 13.42 5.74 Outpatient 97022 Whirlpool therapy 91.00 26.23 14.37 81.17 23.39 78.48 17.08 81.17 14.37 16.91 46.64 16.91 54.60 14.37 18.09 60.23 15.22 16.91 59.79 47.83 16.74 17.25 16.91 72.80 15.47 53.69 60.97 14.88 37.22 68.25 34.59 40.70 17.25 Outpatient 97035 Ultrasound therapy 74.00 21.33 11.96 67.54 19.02 65.30 14.21 67.54 11.96 14.07 37.93 14.07 44.40 11.96 15.05 48.98 12.66 14.07 48.64 38.91 13.93 14.35 14.07 59.20 12.87 43.66 49.58 12.38 30.27 55.50 28.13 33.10 14.35 Outpatient 97110 Therapeutic exercises 155.00 44.67 24.81 140.11 39.84 135.47 29.48 140.11 24.81 29.19 79.44 29.19 93.00 24.81 31.23 102.59 26.27 29.19 103.24 82.60 28.90 29.77 29.19 124.00 26.71 91.45 103.85 25.69 63.40 116.25 58.92 69.33 29.77 Outpatient 97112 Neuromuscular reeducation 179.00 51.59 28.76 162.43 46.00 157.05 34.18 162.43 28.76 33.84 91.74 33.84 107.40 28.76 36.21 118.48 30.46 33.84 118.53 94.82 33.50 34.52 33.84 143.20 30.96 105.61 119.93 29.78 73.21 134.25 68.04 80.07 34.52 Outpatient 97116 Gait training therapy 155.00 44.67 24.81 140.11 39.84 135.47 29.48 140.11 24.81 29.19 79.44 29.19 93.00 24.81 31.23 102.59 26.27 29.19 102.09 81.67 28.90 29.77 29.19 124.00 26.71 91.45 103.85 25.69 63.40 116.25 58.92 69.33 29.77 Outpatient 97124 Massage therapy 150.00 43.23 24.92 140.74 38.55 136.08 29.61 140.74 24.92 29.32 76.88 29.32 90.00 24.92 31.37 99.29 26.39 29.32 97.85 78.28 29.03 29.91 29.32 120.00 26.83 88.50 100.50 25.80 61.35 112.50 57.02 67.10 29.91 Outpatient 97130 Ther ivntj ea addl 15 min 115.00 33.14 18.50 104.50 29.56 101.04 21.99 104.50 18.50 21.77 58.94 21.77 69.00 18.50 23.29 76.12 19.59 21.77 74.43 59.55 21.55 22.21 21.77 92.00 19.92 67.85 77.05 19.16 47.04 86.25 43.71 51.44 22.21 Outpatient 97140 Manual therapy 1/> regions 142.00 40.92 22.84 128.98 36.49 124.71 27.14 128.98 22.84 26.87 72.78 26.87 85.20 22.84 28.75 93.99 24.18 26.87 95.08 76.06 26.60 27.41 26.87 113.60 24.59 83.78 95.14 23.65 58.08 106.50 53.97 63.52 27.41 Outpatient 97161 Pt eval low complex 20 min 519.00 149.58 84.41 476.69 133.38 460.91 100.30 476.69 84.41 99.31 265.99 99.31 311.40 84.41 106.26 343.53 89.38 99.31 287.90 230.32 98.32 101.30 99.31 415.20 90.87 306.21 347.73 87.39 212.27 389.25 197.27 232.15 101.30 Outpatient 97162 Pt eval mod complex 30 min 519.00 149.58 84.41 476.69 133.38 460.91 100.30 476.69 84.41 99.31 265.99 99.31 311.40 84.41 106.26 343.53 89.38 99.31 287.90 230.32 98.32 101.30 99.31 415.20 90.87 306.21 347.73 87.39 212.27 389.25 197.27 232.15 101.30 Outpatient 97163 Pt eval high complex 45 min 519.00 149.58 84.41 476.69 133.38 460.91 100.30 476.69 84.41 99.31 265.99 99.31 311.40 84.41 106.26 343.53 89.38 99.31 287.90 230.32 98.32 101.30 99.31 415.20 90.87 306.21 347.73 87.39 212.27 389.25 197.27 232.15 101.30 Outpatient 97164 Pt re-eval est plan care 354.00 102.02 58.01 327.60 90.98 316.76 68.93 327.60 58.01 68.25 181.43 68.25 212.40 58.01 73.03 234.31 61.43 68.25 197.27 157.82 67.57 69.62 68.25 283.20 62.45 208.86 237.18 60.06 144.79 265.50 134.56 158.34 69.62 Outpatient 97165 Ot eval low complex 30 min 504.00 145.25 84.97 479.81 129.53 463.92 100.96 479.81 84.97 99.96 258.30 99.96 302.40 84.97 106.96 333.60 89.96 99.96 305.12 244.10 98.96 101.96 99.96 403.20 91.46 297.36 337.68 87.96 206.14 378.00 191.57 225.44 101.96 Outpatient 97168 Ot re-eval est plan care 339.00 97.70 58.28 329.14 87.12 318.24 69.26 329.14 58.28 68.57 173.74 68.57 203.40 58.28 73.37 224.38 61.71 68.57 209.88 167.90 67.88 69.94 68.57 271.20 62.74 200.01 227.13 60.34 138.65 254.25 128.85 151.63 69.94 Outpatient 97530 Therapeutic activities 199.00 57.35 31.14 175.87 51.14 170.05 37.01 175.87 31.14 36.64 101.99 36.64 119.40 31.14 39.20 131.72 32.98 36.64 131.82 105.45 36.27 37.37 36.64 159.20 33.53 117.41 133.33 32.24 81.39 149.25 75.64 89.01 37.37 Outpatient 97535 Self care mngment training 172.00 49.57 27.57 155.71 44.20 150.56 32.76 155.71 27.57 32.44 88.15 32.44 103.20 27.57 34.71 113.85 29.20 32.44 114.70 91.76 32.12 33.09 32.44 137.60 29.68 101.48 115.24 28.55 70.35 129.00 65.38 76.94 33.09 Outpatient 97597 Rmvl devital tis 20 cm/< 943.00 271.77 154.48 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 876.69 701.35 179.92 185.37 181.74 754.40 166.29 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 Outpatient 97605 Neg press wound tx <=50 cm 943.00 271.77 154.48 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 876.69 701.35 179.92 185.37 181.74 754.40 166.29 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 Outpatient 97610 Low frequency non-thermal us 943.00 271.77 154.48 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 876.69 701.35 179.92 185.37 181.74 754.40 166.29 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 Outpatient 97760 Orthotic mgmt&traing 1st enc 253.00 72.91 40.64 229.49 65.02 221.89 48.29 229.49 40.64 47.81 129.66 47.81 151.80 40.64 51.16 167.46 43.03 47.81 164.39 131.51 47.33 48.77 47.81 202.40 43.75 149.27 169.51 42.07 103.48 189.75 96.17 113.17 48.77 Outpatient 97802 Medical nutrition indiv in 169.00 48.71 27.16 153.36 43.43 148.28 32.27 153.36 27.16 31.95 86.61 31.95 101.40 27.16 34.19 111.86 28.76 31.95 109.21 87.37 31.63 32.59 31.95 135.20 29.23 99.71 113.23 28.12 69.12 126.75 64.24 75.59 32.59 Outpatient 97803 Med nutrition indiv subseq 144.00 41.50 23.15 130.75 37.01 126.42 27.51 130.75 23.15 27.24 73.80 27.24 86.40 23.15 29.15 95.31 24.52 27.24 93.08 74.46 26.97 27.78 27.24 115.20 24.92 84.96 96.48 23.97 58.90 108.00 54.73 64.41 27.78 Outpatient 99195 Phlebotomy 588.00 169.46 97.00 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 546.63 437.30 112.98 116.40 114.12 470.40 104.42 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 Outpatient 99281 Emergency dept visit 381.00 109.80 62.40 354.49 97.92 340.70 74.14 352.37 62.40 73.41 195.26 73.41 228.60 62.40 78.55 252.18 66.07 73.41 354.49 283.59 72.68 74.88 73.41 304.80 67.17 224.79 255.27 64.60 155.83 285.75 144.82 170.42 74.88 Outpatient 99282 Emergency dept visit 691.00 199.15 112.99 642.53 177.59 616.94 134.26 638.06 112.99 132.93 354.14 132.93 414.60 112.99 142.24 457.37 119.64 132.93 642.53 514.02 131.60 135.59 132.93 552.80 121.63 407.69 462.97 116.98 282.62 518.25 262.65 309.08 135.59 Outpatient 99283 Emergency dept visit " 1,216.00 " 350.45 199.08 " 1,130.85 " 312.51 " 1,086.99 " 236.55 " 1,124.21 " 199.08 234.21 623.20 234.21 729.60 199.08 250.60 804.87 210.79 234.21 " 1,130.85 " 904.67 231.87 238.89 234.21 972.80 214.30 717.44 814.72 206.10 497.34 912.00 462.20 543.92 238.89 Outpatient 99284 Emergency dept visit " 1,910.00 " 550.46 312.93 " 1,776.06 " 490.87 " 1,708.62 " 371.83 " 1,767.12 " 312.93 368.15 978.88 368.15 " 1,146.00 " 312.93 393.92 " 1,264.23 " 331.34 368.15 " 1,776.06 " " 1,420.84 " 364.47 375.51 368.15 " 1,528.00 " 336.86 " 1,126.90 " " 1,279.70 " 323.97 781.19 " 1,432.50 " 725.99 854.34 375.51 Outpatient 99285 Emergency dept visit " 2,741.00 " 789.96 449.17 " 2,549.35 " 704.44 " 2,452.54 " 533.72 " 2,536.51 " 449.17 528.44 " 1,404.76 " 528.44 " 1,644.60 " 449.17 565.43 " 1,814.27 " 475.60 528.44 " 2,549.35 " " 2,039.47 " 523.16 539.01 528.44 " 2,192.80 " 483.52 " 1,617.19 " " 1,836.47 " 465.03 " 1,121.07 " " 2,055.75 " " 1,041.85 " " 1,226.05 " 539.01 Outpatient 99291 Critical care first hour " 3,637.00 " " 1,048.18 " 640.77 " 3,618.48 " 934.71 " 3,498.69 " 761.39 " 3,618.48 " 640.77 753.85 " 1,863.96 " 753.85 " 2,182.20 " 640.77 806.62 " 2,407.33 " 678.47 753.85 " 3,382.16 " " 2,705.72 " 746.31 768.93 753.85 " 2,909.60 " 689.77 " 2,145.83 " " 2,436.79 " 663.39 " 1,487.53 " " 2,727.75 " " 1,382.42 " " 1,626.83 " 768.93 Outpatient 0001A Adm sarscov2 30mcg/0.3ml 1st 210.00 60.52 33.69 190.27 53.97 183.97 40.04 190.27 33.69 39.64 107.63 39.64 126.00 33.69 42.41 139.00 35.68 39.64 75.67 60.53 39.24 40.43 39.64 168.00 36.27 123.90 140.70 34.88 85.89 157.50 79.82 93.93 40.43 Outpatient 0002A Adm sarscov2 30mcg/0.3ml 2nd 210.00 60.52 33.69 190.27 53.97 183.97 40.04 190.27 33.69 39.64 107.63 39.64 126.00 33.69 42.41 139.00 35.68 39.64 124.52 99.61 39.24 40.43 39.64 168.00 36.27 123.90 140.70 34.88 85.89 157.50 79.82 93.93 40.43 Outpatient 0011A Adm sarscov2 100mcg/0.5ml1st 210.00 60.52 33.69 190.27 53.97 183.97 40.04 190.27 33.69 39.64 107.63 39.64 126.00 33.69 42.41 139.00 35.68 39.64 75.67 60.53 39.24 40.43 39.64 168.00 36.27 123.90 140.70 34.88 85.89 157.50 79.82 93.93 40.43 Outpatient C9803 Hopd covid-19 spec collect 130.00 37.47 21.25 120.47 33.41 116.03 25.25 120.00 21.25 25.00 66.63 25.00 78.00 21.25 26.75 86.05 22.50 25.00 120.47 96.38 24.75 25.50 25.00 104.00 22.88 76.70 64.64 22.00 53.17 97.50 49.41 58.15 25.50 Outpatient G0009 Admin pneumococcal vaccine 210.00 60.52 34.43 195.31 53.97 187.96 40.91 194.40 34.43 40.50 107.63 40.50 126.00 34.43 43.34 139.00 36.45 40.50 195.31 156.25 40.10 41.31 40.50 168.00 37.06 123.90 140.70 35.64 85.89 157.50 79.82 93.93 41.31 Outpatient G0103 Psa screening 101.00 29.11 16.41 92.69 25.96 89.62 19.50 92.69 16.41 19.31 51.76 19.31 60.60 16.41 20.66 66.85 17.38 19.31 65.45 52.36 19.12 19.70 19.31 80.80 17.67 59.59 50.59 16.99 41.31 75.75 38.39 45.18 19.70 Outpatient G0123 Screen cerv/vag thin layer 106.00 30.55 17.22 97.25 27.24 94.03 20.46 97.25 17.22 20.26 54.33 20.26 63.60 17.22 21.68 70.16 18.23 20.26 68.67 54.94 20.06 20.67 20.26 84.80 18.54 62.54 53.08 17.83 43.35 79.50 40.29 47.41 20.67 Outpatient G0238 "Oth resp proc, indiv" 130.00 37.47 21.25 120.47 33.41 116.03 25.25 120.00 21.25 25.00 66.63 25.00 78.00 21.25 26.75 86.05 22.50 25.00 120.47 96.38 24.75 25.50 25.00 104.00 22.88 76.70 87.10 22.00 53.17 97.50 49.41 58.15 25.50 Outpatient G0257 Unsched dialysis esrd pt hos " 3,435.00 " 989.97 563.42 " 3,194.95 " 882.80 " 3,076.35 " 669.48 " 3,181.68 " 563.42 662.85 " 1,760.44 " 662.85 " 2,061.00 " 563.42 709.25 " 2,273.63 " 596.57 662.85 " 3,194.95 " " 2,555.94 " 656.22 676.11 662.85 " 2,748.00 " 606.51 " 2,026.65 " " 2,301.45 " 583.31 " 1,404.92 " " 2,576.25 " " 1,305.64 " " 1,536.48 " 676.11 Outpatient G0260 Inj for sacroiliac jt anesth " 2,628.00 " 757.39 546.24 " 3,098.51 " 675.40 " 2,982.56 " 649.07 " 3,084.67 " 546.24 642.64 " 1,346.85 " 642.64 " 1,576.80 " 546.24 687.62 " 1,739.47 " 578.38 642.64 " 3,098.51 " " 2,478.80 " 636.21 655.49 642.64 " 2,102.40 " 588.02 " 1,550.52 " " 1,760.76 " 565.52 " 1,074.85 " " 1,971.00 " 998.90 " 1,175.50 " 655.49 Outpatient G0283 Elec stim other than wound 67.00 19.31 10.25 57.89 17.22 55.97 12.18 57.89 10.25 12.06 34.34 12.06 40.20 10.25 12.90 44.35 10.85 12.06 46.13 36.90 11.94 12.30 12.06 53.60 11.03 39.53 44.89 10.61 27.40 50.25 25.47 29.97 12.30 Outpatient G0463 Hospital outpt clinic visit 115.00 33.14 29.56 579.78 29.56 558.09 121.45 577.20 102.21 120.25 58.94 120.25 69.00 102.21 128.67 76.12 108.23 120.25 579.78 463.82 119.05 122.66 120.25 92.00 110.03 67.85 77.05 105.82 47.04 86.25 43.71 51.44 122.66 Outpatient P9016 Rbc leukocytes reduced 990.00 285.32 162.05 920.43 254.43 884.83 192.56 915.12 162.05 190.65 507.38 190.65 594.00 162.05 204.00 655.28 171.59 190.65 920.43 736.34 188.74 194.46 190.65 792.00 174.44 584.10 663.30 167.77 404.91 742.50 376.30 442.83 194.46 Outpatient P9035 Platelet pheres leukoreduced " 2,556.00 " 736.64 418.55 " 2,376.90 " 656.89 " 2,285.32 " 497.33 " 2,363.57 " 418.55 492.41 " 1,309.95 " 492.41 " 1,533.60 " 418.55 526.88 " 1,691.82 " 443.17 492.41 " 2,376.90 " " 1,901.51 " 487.49 502.26 492.41 " 2,044.80 " 450.56 " 1,508.04 " " 1,712.52 " 433.32 " 1,045.40 " " 1,917.00 " 971.54 " 1,143.30 " 502.26 Outpatient P9037 Plate pheres leukoredu irrad " 3,241.00 " 934.06 530.92 " 3,014.26 " 832.94 " 2,898.88 " 630.86 " 2,998.13 " 530.92 624.61 " 1,661.01 " 624.61 " 1,944.60 " 530.92 668.33 " 2,145.22 " 562.15 624.61 " 3,014.26 " " 2,411.40 " 618.36 637.10 624.61 " 2,592.80 " 571.52 " 1,912.19 " " 2,171.47 " 549.66 " 1,325.57 " " 2,430.75 " " 1,231.90 " " 1,449.70 " 637.10 Outpatient P9040 Rbc leukoreduced irradiated " 1,368.00 " 394.26 224.08 " 1,272.19 " 351.58 " 1,223.49 " 266.26 " 1,265.38 " 224.08 263.62 701.10 263.62 820.80 224.08 282.07 905.48 237.26 263.62 " 1,272.19 " " 1,017.74 " 260.98 268.89 263.62 " 1,094.40 " 241.21 807.12 916.56 231.99 559.51 " 1,026.00 " 519.98 611.91 268.89 Outpatient P9073 Platelets pheresis path redu " 3,065.00 " 883.33 502.12 " 2,850.89 " 787.71 " 2,741.64 " 596.64 " 2,835.50 " 502.12 590.73 " 1,570.81 " 590.73 " 1,839.00 " 502.12 632.08 " 2,028.72 " 531.66 590.73 " 2,850.89 " " 2,280.70 " 584.82 602.54 590.73 " 2,452.00 " 540.52 " 1,808.35 " " 2,053.55 " 519.84 " 1,253.59 " " 2,298.75 " " 1,165.01 " " 1,370.97 " 602.54 Outpatient U0005 Infec agen detec ampli probe 131.00 37.75 21.25 120.00 33.67 116.03 25.25 120.00 21.25 25.00 67.14 25.00 78.60 21.25 26.75 86.71 22.50 25.00 84.74 67.79 24.75 25.50 25.00 104.80 22.88 77.29 65.50 22.00 53.58 98.25 49.79 58.60 25.50 Inpatient 3 "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES" " 698,532.02 " " 177,846.25 " " 133,868.68 " " 558,825.62 " " 282,207.34 " " 135,220.89 " " 291,397.09 " " 135,220.89 " " 279,006.82 " " 135,220.89 " " 302,057.96 " " 144,686.35 " " 398,302.96 " " 135,220.89 " " 354,546.51 " " 283,637.21 " " 133,868.68 " " 137,925.31 " " 135,220.89 " " 558,825.62 " " 414,928.02 " " 334,346.25 " " 523,899.02 " " 137,925.31 " Inpatient 4 "TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES" " 452,515.92 " " 115,210.55 " " 83,733.62 " " 362,012.74 " " 176,107.25 " " 84,579.41 " " 181,841.97 " " 84,579.41 " " 175,100.98 " " 84,579.41 " " 188,494.73 " " 90,499.97 " " 258,024.58 " " 84,579.41 " " 239,920.42 " " 191,936.33 " " 83,733.62 " " 86,271.00 " " 84,579.41 " " 362,012.74 " " 268,794.46 " " 208,643.75 " " 339,386.94 " " 86,271.00 " Inpatient 25 CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC " 88,111.41 " " 22,433.16 " " 31,908.77 " " 82,264.98 " " 66,431.10 " " 32,231.08 " " 68,594.34 " " 32,231.08 " " 68,139.75 " " 32,231.08 " " 71,103.89 " " 34,487.26 " " 50,241.13 " " 32,231.08 " " 82,264.98 " " 65,811.98 " " 31,908.77 " " 32,875.70 " " 32,231.08 " " 70,489.13 " " 52,338.18 " " 78,704.50 " " 66,083.56 " " 32,875.70 " Inpatient 29 SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS " 183,075.74 " " 46,611.08 " " 23,528.96 " " 146,460.59 " " 48,697.03 " " 23,766.63 " " 50,282.79 " " 23,766.63 " " 51,801.03 " " 23,766.63 " " 52,122.41 " " 25,430.29 " " 104,389.79 " " 23,766.63 " " 56,192.76 " " 44,954.21 " " 23,528.96 " " 24,241.96 " " 23,766.63 " " 146,460.59 " " 108,746.99 " " 57,694.00 " " 137,306.81 " " 24,241.96 " Inpatient 35 CAROTID ARTERY STENT PROCEDURES WITH CC " 93,791.80 " " 23,879.39 " " 16,848.71 " " 75,033.44 " " 34,559.71 " " 17,018.90 " " 35,685.10 " " 17,018.90 " " 35,247.10 " " 17,018.90 " " 36,990.66 " " 18,210.22 " " 53,480.08 " " 17,018.90 " " 53,162.88 " " 42,530.30 " " 16,848.71 " " 17,359.28 " " 17,018.90 " " 75,033.44 " " 55,712.33 " " 40,944.75 " " 70,343.85 " " 17,359.28 " Inpatient 36 CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC " 50,900.63 " " 12,959.30 " " 13,446.81 " " 40,720.50 " " 27,360.32 " " 13,582.64 " " 28,251.28 " " 13,582.64 " " 27,908.44 " " 13,582.64 " " 29,284.86 " " 14,533.42 " " 29,023.54 " " 13,582.64 " " 34,203.33 " " 27,362.65 " " 13,446.81 " " 13,854.29 " " 13,582.64 " " 40,720.50 " " 30,234.97 " " 32,415.25 " " 38,175.47 " " 13,854.29 " Inpatient 38 EXTRACRANIAL PROCEDURES WITH CC " 46,880.90 " " 11,935.88 " " 12,096.25 " " 37,504.72 " " 24,502.13 " " 12,218.43 " " 25,300.02 " " 12,218.43 " " 24,807.15 " " 12,218.43 " " 26,225.63 " " 13,073.72 " " 26,731.49 " " 12,218.43 " " 36,843.67 " " 29,474.93 " " 12,096.25 " " 12,462.80 " " 12,218.43 " " 37,504.72 " " 27,847.25 " " 29,029.00 " " 35,160.68 " " 12,462.80 " Inpatient 39 EXTRACRANIAL PROCEDURES WITHOUT CC/MCC " 36,451.16 " " 9,280.47 " " 8,468.91 " " 29,160.93 " " 16,825.65 " " 8,554.45 " " 17,373.55 " " 8,554.45 " " 17,623.56 " " 8,554.45 " " 18,009.17 " " 9,153.26 " " 20,784.45 " " 8,554.45 " " 25,410.26 " " 20,328.20 " " 8,468.91 " " 8,725.54 " " 8,554.45 " " 29,160.93 " " 21,651.99 " " 19,934.25 " " 27,338.37 " " 8,725.54 " Inpatient 41 "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR" " 114,699.99 " " 29,202.62 " " 16,918.51 " " 91,759.99 " " 34,707.42 " " 17,089.40 " " 35,837.62 " " 17,089.40 " " 36,883.19 " " 17,089.40 " " 37,148.76 " " 18,285.66 " " 65,401.93 " " 17,089.40 " " 44,910.04 " " 35,928.02 " " 16,918.51 " " 17,431.19 " " 17,089.40 " " 91,759.99 " " 68,131.79 " " 41,119.75 " " 86,024.99 " " 17,431.19 " Inpatient 42 "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC" " 120,375.98 " " 30,647.72 " " 13,788.12 " " 96,300.78 " " 28,082.63 " " 13,927.39 " " 28,997.10 " " 13,927.39 " " 30,215.41 " " 13,927.39 " " 30,057.97 " " 14,902.31 " " 68,638.38 " " 13,927.39 " " 29,843.13 " " 23,874.50 " " 13,788.12 " " 14,205.94 " " 13,927.39 " " 96,300.78 " " 71,503.33 " " 33,271.00 " " 90,281.99 " " 14,205.94 " Inpatient 54 NERVOUS SYSTEM NEOPLASMS WITH MCC " 31,961.47 " " 8,137.39 " " 10,068.65 " " 25,569.18 " " 20,211.16 " " 10,170.35 " " 20,869.31 " " 10,170.35 " " 20,805.54 " " 10,170.35 " " 21,632.82 " " 10,882.27 " " 18,224.43 " " 10,170.35 " " 21,631.42 " " 17,305.13 " " 10,068.65 " " 10,373.76 " " 10,170.35 " " 25,569.18 " " 18,985.11 " " 23,945.25 " " 23,971.10 " " 10,373.76 " Inpatient 56 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC " 44,495.35 " " 11,328.52 " " 15,840.84 " " 41,349.21 " " 32,426.78 " " 16,000.85 " " 33,482.72 " " 16,000.85 " " 30,275.55 " " 16,000.85 " " 34,707.69 " " 17,120.91 " " 25,371.25 " " 16,000.85 " " 41,349.21 " " 33,079.36 " " 15,840.84 " " 16,320.87 " " 16,000.85 " " 35,596.28 " " 26,430.24 " " 38,417.75 " " 33,371.51 " " 16,320.87 " Inpatient 57 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC " 31,434.10 " " 8,003.12 " " 9,365.09 " " 25,168.03 " " 18,722.24 " " 9,459.69 " " 19,331.91 " " 9,459.69 " " 17,960.57 " " 9,459.69 " " 20,039.18 " " 10,121.87 " " 17,923.72 " " 9,459.69 " " 25,168.03 " " 20,134.42 " " 9,365.09 " " 9,648.88 " " 9,459.69 " " 25,147.28 " " 18,671.86 " " 22,181.25 " " 23,575.58 " " 9,648.88 " Inpatient 59 MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC " 40,107.38 " " 10,211.34 " " 8,386.54 " " 32,085.90 " " 16,651.35 " " 8,471.25 " " 17,193.58 " " 8,471.25 " " 16,970.07 " " 8,471.25 " " 17,822.61 " " 9,064.24 " " 22,869.23 " " 8,471.25 " " 20,323.37 " " 16,258.69 " " 8,386.54 " " 8,640.68 " " 8,471.25 " " 32,085.90 " " 23,823.78 " " 19,727.75 " " 30,080.54 " " 8,640.68 " Inpatient 60 MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC " 27,436.15 " " 6,985.24 " " 6,923.59 " " 21,948.92 " " 13,555.35 " " 6,993.53 " " 13,996.76 " " 6,993.53 " " 13,368.78 " " 6,993.53 " " 14,508.84 " " 7,483.08 " " 15,644.09 " " 6,993.53 " " 17,683.02 " " 14,146.41 " " 6,923.59 " " 7,133.40 " " 6,993.53 " " 21,948.92 " " 16,297.07 " " 16,059.75 " " 20,577.11 " " 7,133.40 " Inpatient 61 "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC" " 101,825.40 " " 25,924.75 " " 20,698.01 " " 81,460.32 " " 42,705.92 " " 20,907.08 " " 44,096.58 " " 20,907.08 " " 44,275.66 " " 20,907.08 " " 45,709.87 " " 22,370.58 " " 58,060.84 " " 20,907.08 " " 67,904.89 " " 54,323.91 " " 20,698.01 " " 21,325.22 " " 20,907.08 " " 81,460.32 " " 60,484.29 " " 50,596.00 " " 76,369.05 " " 21,325.22 " Inpatient 62 "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC" " 89,922.26 " " 22,894.21 " " 14,396.05 " " 71,937.81 " " 29,369.18 " " 14,541.46 " " 30,325.55 " " 14,541.46 " " 30,574.60 " " 14,541.46 " " 31,435.02 " " 15,559.36 " " 51,273.67 " " 14,541.46 " " 47,429.26 " " 37,943.40 " " 14,396.05 " " 14,832.29 " " 14,541.46 " " 71,937.81 " " 53,413.82 " " 34,795.25 " " 67,441.70 " " 14,832.29 " Inpatient 64 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC " 46,193.98 " " 11,760.99 " " 13,911.66 " " 37,957.94 " " 28,344.07 " " 14,052.18 " " 29,267.06 " " 14,052.18 " " 27,992.29 " " 14,052.18 " " 30,337.81 " " 15,035.83 " " 26,339.81 " " 14,052.18 " " 37,957.94 " " 30,366.34 " " 13,911.66 " " 14,333.22 " " 14,052.18 " " 36,955.18 " " 27,439.22 " " 33,580.75 " " 34,645.49 " " 14,333.22 " Inpatient 65 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS " 34,191.77 " " 8,705.22 " " 7,637.62 " " 27,353.42 " " 15,066.42 " " 7,714.77 " " 15,557.04 " " 7,714.77 " " 16,318.16 " " 7,714.77 " " 16,126.20 " " 8,254.80 " " 19,496.15 " " 7,714.77 " " 23,884.19 " " 19,107.35 " " 7,637.62 " " 7,869.07 " " 7,714.77 " " 27,353.42 " " 20,309.91 " " 17,850.00 " " 25,643.83 " " 7,869.07 " Inpatient 66 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC " 22,579.62 " " 5,748.77 " " 5,485.09 " " 19,524.00 " " 10,511.04 " " 5,540.49 " " 10,853.32 " " 5,540.49 " " 11,814.96 " " 5,540.49 " " 11,250.40 " " 5,928.32 " " 12,874.90 " " 5,540.49 " " 19,524.00 " " 15,619.19 " " 5,485.09 " " 5,651.30 " " 5,540.49 " " 18,063.70 " " 13,412.29 " " 12,453.00 " " 16,934.72 " " 5,651.30 " Inpatient 69 TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC " 21,478.42 " " 5,468.41 " " 6,012.05 " " 17,368.12 " " 11,626.25 " " 6,072.78 " " 12,004.85 " " 6,072.78 " " 11,901.99 " " 6,072.78 " " 12,444.05 " " 6,497.87 " " 12,247.00 " " 6,072.78 " " 17,368.12 " " 13,894.49 " " 6,012.05 " " 6,194.24 " " 6,072.78 " " 17,182.74 " " 12,758.18 " " 13,774.25 " " 16,108.82 " " 6,194.24 " Inpatient 70 NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC " 48,192.26 " " 12,269.75 " " 12,241.42 " " 38,553.81 " " 24,809.37 " " 12,365.07 " " 25,617.26 " " 12,365.07 " " 26,085.65 " " 12,365.07 " " 26,554.48 " " 13,230.62 " " 27,479.23 " " 12,365.07 " " 31,587.21 " " 25,269.76 " " 12,241.42 " " 12,612.37 " " 12,365.07 " " 38,553.81 " " 28,626.20 " " 29,393.00 " " 36,144.20 " " 12,612.37 " Inpatient 71 NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC " 35,941.90 " " 9,150.81 " " 7,580.39 " " 28,753.52 " " 14,945.30 " " 7,656.96 " " 15,431.97 " " 7,656.96 " " 15,659.92 " " 7,656.96 " " 15,996.56 " " 8,192.95 " " 20,494.07 " " 7,656.96 " " 21,389.19 " " 17,111.35 " " 7,580.39 " " 7,810.10 " " 7,656.96 " " 28,753.52 " " 21,349.49 " " 17,706.50 " " 26,956.43 " " 7,810.10 " Inpatient 72 NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC " 28,880.21 " " 7,352.90 " " 5,904.57 " " 23,104.17 " " 11,398.78 " " 5,964.21 " " 11,769.97 " " 5,964.21 " " 12,028.57 " " 5,964.21 " " 12,200.58 " " 6,381.70 " " 16,467.50 " " 5,964.21 " " 16,011.61 " " 12,809.29 " " 5,904.57 " " 6,083.49 " " 5,964.21 " " 23,104.17 " " 17,154.84 " " 13,504.75 " " 21,660.16 " " 6,083.49 " Inpatient 73 CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC " 33,815.11 " " 8,609.33 " " 10,659.12 " " 35,680.95 " " 21,460.79 " " 10,766.79 " " 22,159.63 " " 10,766.79 " " 22,212.19 " " 10,766.79 " " 22,970.35 " " 11,520.47 " " 19,281.38 " " 10,766.79 " " 35,680.95 " " 28,544.75 " " 10,659.12 " " 10,982.13 " " 10,766.79 " " 27,052.09 " " 20,086.18 " " 25,425.75 " " 25,361.33 " " 10,982.13 " Inpatient 74 CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC " 83,368.98 " " 21,225.74 " " 7,630.64 " " 66,695.18 " " 15,051.65 " " 7,707.72 " " 15,541.79 " " 7,707.72 " " 15,088.73 " " 7,707.72 " " 16,110.39 " " 8,247.26 " " 47,536.99 " " 7,707.72 " " 18,627.73 " " 14,902.18 " " 7,630.64 " " 7,861.87 " " 7,707.72 " " 66,695.18 " " 49,521.17 " " 17,832.50 " " 62,526.74 " " 7,861.87 " Inpatient 82 TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC " 192,916.43 " " 49,116.52 " " 16,319.65 " " 154,333.14 " " 33,440.07 " " 16,484.49 " " 34,529.00 " " 16,484.49 " " 34,155.32 " " 16,484.49 " " 35,792.26 " " 17,638.40 " " 110,000.95 " " 16,484.49 " " 46,460.33 " " 37,168.25 " " 16,319.65 " " 16,814.18 " " 16,484.49 " " 154,333.14 " " 114,592.36 " " 39,618.25 " " 144,687.32 " " 16,814.18 " Inpatient 84 TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC " 13,626.63 " " 3,469.34 " " 6,839.15 " " 18,288.61 " " 13,376.62 " " 6,908.23 " " 13,812.21 " " 6,908.23 " " 14,243.78 " " 6,908.23 " " 14,317.54 " " 7,391.81 " " 7,769.90 " " 6,908.23 " " 18,288.61 " " 14,630.88 " " 6,839.15 " " 7,046.39 " " 6,908.23 " " 10,901.30 " " 8,094.22 " " 15,848.00 " " 10,219.97 " " 7,046.39 " Inpatient 91 OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC " 51,553.33 " " 13,125.48 " " 12,040.41 " " 41,242.66 " " 24,383.97 " " 12,162.03 " " 25,178.00 " " 12,162.03 " " 24,372.01 " " 12,162.03 " " 26,099.15 " " 13,013.37 " " 29,395.71 " " 12,162.03 " " 30,908.96 " " 24,727.16 " " 12,040.41 " " 12,405.27 " " 12,162.03 " " 41,242.66 " " 30,622.68 " " 28,889.00 " " 38,665.00 " " 12,405.27 " Inpatient 92 OTHER DISORDERS OF NERVOUS SYSTEM WITH CC " 26,919.47 " " 6,853.70 " " 7,420.55 " " 22,164.34 " " 14,607.04 " " 7,495.51 " " 15,082.70 " " 7,495.51 " " 14,822.90 " " 7,495.51 " " 15,634.51 " " 8,020.20 " " 15,349.48 " " 7,495.51 " " 22,164.34 " " 17,731.46 " " 7,420.55 " " 7,645.42 " " 7,495.51 " " 21,535.58 " " 15,990.17 " " 17,305.75 " " 20,189.60 " " 7,645.42 " Inpatient 93 OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC " 43,865.65 " " 11,168.19 " " 5,977.85 " " 35,092.52 " " 11,553.88 " " 6,038.23 " " 11,930.11 " " 6,038.23 " " 11,541.24 " " 6,038.23 " " 12,366.58 " " 6,460.91 " " 25,012.19 " " 6,038.23 " " 17,150.11 " " 13,720.08 " " 5,977.85 " " 6,158.99 " " 6,038.23 " " 35,092.52 " " 26,056.20 " " 13,688.50 " " 32,899.24 " " 6,158.99 " Inpatient 97 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC " 291,454.87 " " 74,204.41 " " 26,764.75 " " 233,163.90 " " 55,544.87 " " 27,035.10 " " 57,353.62 " " 27,035.10 " " 53,853.25 " " 27,035.10 " " 59,451.92 " " 28,927.56 " " 166,187.57 " " 27,035.10 " " 87,993.73 " " 70,394.99 " " 26,764.75 " " 27,575.80 " " 27,035.10 " " 233,163.90 " " 173,124.19 " " 65,807.00 " " 218,591.15 " " 27,575.80 " Inpatient 98 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC " 54,669.41 " " 13,918.83 " " 15,262.93 " " 43,735.53 " " 31,203.74 " " 15,417.10 " " 32,219.85 " " 15,417.10 " " 29,647.38 " " 15,417.10 " " 33,398.63 " " 16,496.30 " " 31,172.50 " " 15,417.10 " " 31,296.53 " " 25,037.22 " " 15,262.93 " " 15,725.44 " " 15,417.10 " " 43,735.53 " " 32,473.63 " " 36,968.75 " " 41,002.06 " " 15,725.44 " Inpatient 100 SEIZURES WITH MCC " 35,208.48 " " 8,964.08 " " 13,615.02 " " 32,837.00 " " 27,716.30 " " 13,752.55 " " 28,618.85 " " 13,752.55 " " 26,087.22 " " 13,752.55 " " 29,665.88 " " 14,715.23 " " 20,075.88 " " 13,752.55 " " 31,514.54 " " 25,211.62 " " 13,615.02 " " 14,027.60 " " 13,752.55 " " 28,166.78 " " 20,913.84 " " 32,837.00 " " 26,406.36 " " 14,027.60 " Inpatient 101 SEIZURES WITHOUT MCC " 20,461.39 " " 5,209.47 " " 6,719.09 " " 16,369.11 " " 13,122.56 " " 6,786.96 " " 13,549.88 " " 6,786.96 " " 13,153.58 " " 6,786.96 " " 14,045.60 " " 7,262.05 " " 11,667.08 " " 6,786.96 " " 14,049.53 " " 11,239.62 " " 6,719.09 " " 6,922.70 " " 6,786.96 " " 16,369.11 " " 12,154.07 " " 15,547.00 " " 15,346.04 " " 6,922.70 " Inpatient 123 NEUROLOGICAL EYE DISORDERS " 18,390.87 " " 4,682.32 " " 5,870.36 " " 17,295.45 " " 11,326.40 " " 5,929.66 " " 11,695.23 " " 5,929.66 " " 11,851.35 " " 5,929.66 " " 12,123.11 " " 6,344.74 " " 10,486.47 " " 5,929.66 " " 17,295.45 " " 13,836.36 " " 5,870.36 " " 6,048.25 " " 5,929.66 " " 14,712.70 " " 10,924.18 " " 13,419.00 " " 13,793.15 " " 6,048.25 " Inpatient 149 DYSEQUILIBRIUM " 19,606.12 " " 4,991.72 " " 5,662.37 " " 15,684.90 " " 10,886.23 " " 5,719.57 " " 11,240.72 " " 5,719.57 " " 11,144.06 " " 5,719.57 " " 11,651.97 " " 6,119.94 " " 11,179.41 " " 5,719.57 " " 14,412.88 " " 11,530.30 " " 5,662.37 " " 5,833.96 " " 5,719.57 " " 15,684.90 " " 11,646.04 " " 12,897.50 " " 14,704.59 " " 5,833.96 " Inpatient 151 EPISTAXIS WITHOUT MCC " 20,965.58 " " 5,337.84 " " 5,672.15 " " 16,772.46 " " 10,906.91 " " 5,729.44 " " 11,262.08 " " 5,729.44 " " 11,582.36 " " 5,729.44 " " 11,674.10 " " 6,130.50 " " 11,954.57 " " 5,729.44 " " 13,661.95 " " 10,929.56 " " 5,672.15 " " 5,844.03 " " 5,729.44 " " 16,772.46 " " 12,453.55 " " 12,922.00 " " 15,724.19 " " 5,844.03 " Inpatient 153 OTITIS MEDIA AND URI WITHOUT MCC " 13,919.77 " " 3,543.97 " " 5,496.25 " " 12,481.00 " " 10,534.68 " " 5,551.77 " " 10,877.73 " " 5,551.77 " " 11,314.96 " " 5,551.77 " " 11,275.69 " " 5,940.39 " " 7,937.05 " " 5,551.77 " " 9,350.20 " " 7,480.16 " " 5,496.25 " " 5,662.81 " " 5,551.77 " " 11,135.82 " " 8,268.34 " " 12,481.00 " " 10,439.83 " " 5,662.81 " Inpatient 155 "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC" " 22,736.67 " " 5,788.76 " " 6,866.36 " " 18,189.34 " " 13,434.22 " " 6,935.72 " " 13,871.69 " " 6,935.72 " " 14,201.05 " " 6,935.72 " " 14,379.20 " " 7,421.22 " " 12,964.45 " " 6,935.72 " " 12,862.58 " " 10,290.06 " " 6,866.36 " " 7,074.43 " " 6,935.72 " " 18,189.34 " " 13,505.58 " " 15,916.25 " " 17,052.50 " " 7,074.43 " Inpatient 163 MAJOR CHEST PROCEDURES WITH MCC " 172,762.00 " " 43,985.21 " " 35,464.23 " " 138,209.60 " " 73,955.44 " " 35,822.45 " " 76,363.71 " " 35,822.45 " " 78,334.45 " " 35,822.45 " " 79,157.51 " " 38,330.02 " " 98,508.89 " " 35,822.45 " " 88,732.11 " " 70,985.69 " " 35,464.23 " " 36,538.90 " " 35,822.45 " " 138,209.60 " " 102,620.63 " " 87,619.00 " " 129,571.50 " " 36,538.90 " Inpatient 164 MAJOR CHEST PROCEDURES WITH CC " 116,650.38 " " 29,699.19 " " 19,053.59 " " 93,320.30 " " 39,225.87 " " 19,246.05 " " 40,503.21 " " 19,246.05 " " 40,800.94 " " 19,246.05 " " 41,985.04 " " 20,593.27 " " 66,514.05 " " 19,246.05 " " 47,453.48 " " 37,962.78 " " 19,053.59 " " 19,630.97 " " 19,246.05 " " 93,320.30 " " 69,290.33 " " 46,473.00 " " 87,487.79 " " 19,630.97 " Inpatient 165 MAJOR CHEST PROCEDURES WITHOUT CC/MCC " 85,121.48 " " 21,671.93 " " 13,895.60 " " 68,097.18 " " 28,310.10 " " 14,035.96 " " 29,231.98 " " 14,035.96 " " 29,281.87 " " 14,035.96 " " 30,301.45 " " 15,018.48 " " 48,536.27 " " 14,035.96 " " 36,625.66 " " 29,300.52 " " 13,895.60 " " 14,316.68 " " 14,035.96 " " 68,097.18 " " 50,562.16 " " 33,540.50 " " 63,841.11 " " 14,316.68 " Inpatient 166 OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC " 73,623.52 " " 18,744.55 " " 26,507.19 " " 66,402.68 " " 54,999.82 " " 26,774.94 " " 56,790.82 " " 26,774.94 " " 56,133.33 " " 26,774.94 " " 58,868.54 " " 28,649.19 " " 41,980.13 " " 26,774.94 " " 66,402.68 " " 53,122.14 " " 26,507.19 " " 27,310.44 " " 26,774.94 " " 58,898.82 " " 43,732.37 " " 65,161.25 " " 55,217.64 " " 27,310.44 " Inpatient 167 OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC " 59,969.87 " " 15,268.33 " " 13,212.29 " " 47,975.90 " " 26,864.02 " " 13,345.75 " " 27,738.81 " " 13,345.75 " " 29,266.04 " " 13,345.75 " " 28,753.65 " " 14,279.95 " " 34,194.82 " " 13,345.75 " " 35,729.40 " " 28,583.51 " " 13,212.29 " " 13,612.67 " " 13,345.75 " " 47,975.90 " " 35,622.10 " " 31,827.25 " " 44,977.40 " " 13,612.67 " Inpatient 168 OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC " 53,737.20 " " 13,681.49 " " 9,971.63 " " 42,989.76 " " 20,005.84 " " 10,072.35 " " 20,657.31 " " 10,072.35 " " 20,413.13 " " 10,072.35 " " 21,413.06 " " 10,777.41 " " 30,640.95 " " 10,072.35 " " 26,669.88 " " 21,335.89 " " 9,971.63 " " 10,273.80 " " 10,072.35 " " 42,989.76 " " 31,919.90 " " 23,702.00 " " 40,302.90 " " 10,273.80 " Inpatient 175 PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE " 37,195.67 " " 9,470.02 " " 11,308.94 " " 29,756.54 " " 22,835.97 " " 11,423.17 " " 23,579.59 " " 11,423.17 " " 23,228.02 " " 11,423.17 " " 24,442.26 " " 12,222.79 " " 21,208.97 " " 11,423.17 " " 26,548.76 " " 21,239.00 " " 11,308.94 " " 11,651.63 " " 11,423.17 " " 29,756.54 " " 22,094.23 " " 27,055.00 " " 27,896.75 " " 11,651.63 " Inpatient 176 PULMONARY EMBOLISM WITHOUT MCC " 28,837.16 " " 7,341.94 " " 6,714.90 " " 23,069.73 " " 13,113.69 " " 6,782.73 " " 13,540.73 " " 6,782.73 " " 14,166.24 " " 6,782.73 " " 14,036.12 " " 7,257.52 " " 16,442.95 " " 6,782.73 " " 15,696.71 " " 12,557.37 " " 6,714.90 " " 6,918.38 " " 6,782.73 " " 23,069.73 " " 17,129.27 " " 15,536.50 " " 21,627.87 " " 6,918.38 " Inpatient 177 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC " 40,070.44 " " 10,201.93 " " 13,424.48 " " 32,359.25 " " 27,313.06 " " 13,560.08 " " 28,202.47 " " 13,560.08 " " 29,286.61 " " 13,560.08 " " 29,234.27 " " 14,509.29 " " 22,848.16 " " 13,560.08 " " 31,126.97 " " 24,901.57 " " 13,424.48 " " 13,831.28 " " 13,560.08 " " 32,056.35 " " 23,801.84 " " 32,359.25 " " 30,052.83 " " 13,831.28 " Inpatient 178 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC " 24,248.47 " " 6,173.66 " " 8,948.40 " " 23,884.19 " " 17,840.41 " " 9,038.79 " " 18,421.37 " " 9,038.79 " " 20,498.57 " " 9,038.79 " " 19,095.32 " " 9,671.51 " " 13,826.48 " " 9,038.79 " " 23,884.19 " " 19,107.35 " " 8,948.40 " " 9,219.57 " " 9,038.79 " " 19,398.78 " " 14,403.59 " " 21,136.50 " " 18,186.35 " " 9,219.57 " Inpatient 179 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC " 19,666.88 " " 5,007.19 " " 6,609.52 " " 16,714.09 " " 12,890.65 " " 6,676.28 " " 13,310.42 " " 6,676.28 " " 14,716.88 " " 6,676.28 " " 13,797.39 " " 7,143.62 " " 11,214.05 " " 6,676.28 " " 16,714.09 " " 13,371.27 " " 6,609.52 " " 6,809.81 " " 6,676.28 " " 15,733.50 " " 11,682.13 " " 15,272.25 " " 14,750.16 " " 6,809.81 " Inpatient 180 RESPIRATORY NEOPLASMS WITH MCC " 63,487.20 " " 16,163.84 " " 12,662.30 " " 50,789.76 " " 25,700.06 " " 12,790.20 " " 26,536.95 " " 12,790.20 " " 26,731.22 " " 12,790.20 " " 27,507.82 " " 13,685.51 " " 36,200.40 " " 12,790.20 " " 32,677.26 " " 26,141.80 " " 12,662.30 " " 13,046.00 " " 12,790.20 " " 50,789.76 " " 37,711.40 " " 30,448.25 " " 47,615.40 " " 13,046.00 " Inpatient 186 PLEURAL EFFUSION WITH MCC " 56,747.50 " " 14,447.91 " " 11,293.58 " " 45,398.00 " " 22,803.47 " " 11,407.66 " " 23,546.04 " " 11,407.66 " " 24,125.17 " " 11,407.66 " " 24,407.48 " " 12,206.20 " " 32,357.42 " " 11,407.66 " " 26,209.63 " " 20,967.70 " " 11,293.58 " " 11,635.81 " " 11,407.66 " " 45,398.00 " " 33,708.02 " " 27,016.50 " " 42,560.63 " " 11,635.81 " Inpatient 187 PLEURAL EFFUSION WITH CC " 44,182.90 " " 11,248.97 " " 7,727.66 " " 35,346.32 " " 15,256.97 " " 7,805.72 " " 15,753.79 " " 7,805.72 " " 16,723.24 " " 7,805.72 " " 16,330.15 " " 8,352.12 " " 25,193.09 " " 7,805.72 " " 20,517.15 " " 16,413.72 " " 7,727.66 " " 7,961.83 " " 7,805.72 " " 35,346.32 " " 26,244.64 " " 18,075.75 " " 33,137.18 " " 7,961.83 " Inpatient 189 PULMONARY EDEMA AND RESPIRATORY FAILURE " 38,839.80 " " 9,888.61 " " 9,076.13 " " 31,071.84 " " 18,110.72 " " 9,167.81 " " 18,700.48 " " 9,167.81 " " 19,300.78 " " 9,167.81 " " 19,384.64 " " 9,809.56 " " 22,146.45 " " 9,167.81 " " 21,873.66 " " 17,498.92 " " 9,076.13 " " 9,351.17 " " 9,167.81 " " 31,071.84 " " 23,070.84 " " 21,456.75 " " 29,129.85 " " 9,351.17 " Inpatient 190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC " 32,998.69 " " 8,401.47 " " 8,371.18 " " 26,398.95 " " 16,618.85 " " 8,455.74 " " 17,160.03 " " 8,455.74 " " 18,240.64 " " 8,455.74 " " 17,787.83 " " 9,047.64 " " 18,815.85 " " 8,455.74 " " 19,257.54 " " 15,406.03 " " 8,371.18 " " 8,624.85 " " 8,455.74 " " 26,398.95 " " 19,601.22 " " 19,689.25 " " 24,749.02 " " 8,624.85 " Inpatient 191 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC " 25,709.48 " " 6,545.63 " " 6,690.48 " " 20,567.58 " " 13,062.00 " " 6,758.06 " " 13,487.34 " " 6,758.06 " " 14,522.26 " " 6,758.06 " " 13,980.78 " " 7,231.12 " " 14,659.55 " " 6,758.06 " " 16,205.40 " " 12,964.32 " " 6,690.48 " " 6,893.22 " " 6,758.06 " " 20,567.58 " " 15,271.43 " " 15,475.25 " " 19,282.11 " " 6,893.22 " Inpatient 192 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC " 13,251.50 " " 3,373.83 " " 5,373.41 " " 13,104.82 " " 10,274.71 " " 5,427.69 " " 10,609.29 " " 5,427.69 " " 11,496.93 " " 5,427.69 " " 10,997.44 " " 5,807.63 " " 7,556.01 " " 5,427.69 " " 13,104.82 " " 10,483.85 " " 5,373.41 " " 5,536.24 " " 5,427.69 " " 10,601.20 " " 7,871.39 " " 12,173.00 " " 9,938.63 " " 5,536.24 " Inpatient 193 SIMPLE PNEUMONIA AND PLEURISY WITH MCC " 42,027.29 " " 10,700.15 " " 9,675.69 " " 33,621.83 " " 19,379.55 " " 9,773.42 " " 20,010.62 " " 9,773.42 " " 21,729.60 " " 9,773.42 " " 20,742.72 " " 10,457.56 " " 23,963.96 " " 9,773.42 " " 23,351.28 " " 18,681.02 " " 9,675.69 " " 9,968.89 " " 9,773.42 " " 33,621.83 " " 24,964.21 " " 22,960.00 " " 31,520.47 " " 9,968.89 " Inpatient 194 SIMPLE PNEUMONIA AND PLEURISY WITH CC " 26,052.14 " " 6,632.87 " " 6,548.09 " " 20,841.71 " " 12,760.67 " " 6,614.23 " " 13,176.20 " " 6,614.23 " " 14,767.52 " " 6,614.23 " " 13,658.26 " " 7,077.23 " " 14,854.93 " " 6,614.23 " " 15,091.13 " " 12,072.90 " " 6,548.09 " " 6,746.51 " " 6,614.23 " " 20,841.71 " " 15,474.97 " " 15,118.25 " " 19,539.11 " " 6,746.51 " Inpatient 195 SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC " 11,717.21 " " 2,983.20 " " 5,165.41 " " 11,651.50 " " 9,834.53 " " 5,217.59 " " 10,154.78 " " 5,217.59 " " 11,234.26 " " 5,217.59 " " 10,526.30 " " 5,582.82 " " 6,681.15 " " 5,217.59 " " 11,094.28 " " 8,875.42 " " 5,165.41 " " 5,321.94 " " 5,217.59 " " 9,373.77 " " 6,960.02 " " 11,651.50 " " 8,787.91 " " 5,321.94 " Inpatient 196 INTERSTITIAL LUNG DISEASE WITH MCC " 37,917.00 " " 9,653.67 " " 12,653.22 " " 31,538.76 " " 25,680.86 " " 12,781.03 " " 26,517.13 " " 12,781.03 " " 25,259.68 " " 12,781.03 " " 27,487.27 " " 13,675.70 " " 21,620.27 " " 12,781.03 " " 31,538.76 " " 25,231.00 " " 12,653.22 " " 13,036.65 " " 12,781.03 " " 30,333.60 " " 22,522.70 " " 30,425.50 " " 28,437.75 " " 13,036.65 " Inpatient 199 PNEUMOTHORAX WITH MCC " 57,633.04 " " 14,673.37 " " 13,011.98 " " 46,106.43 " " 26,440.09 " " 13,143.41 " " 27,301.08 " " 13,143.41 " " 28,587.23 " " 13,143.41 " " 28,299.90 " " 14,063.45 " " 32,862.36 " " 13,143.41 " " 27,178.57 " " 21,742.85 " " 13,011.98 " " 13,406.28 " " 13,143.41 " " 46,106.43 " " 34,234.03 " " 31,325.00 " " 43,224.78 " " 13,406.28 " Inpatient 200 PNEUMOTHORAX WITH CC " 30,164.48 " " 7,679.88 " " 8,031.97 " " 24,131.58 " " 15,900.98 " " 8,113.10 " " 16,418.78 " " 8,113.10 " " 16,791.26 " " 8,113.10 " " 17,019.47 " " 8,681.02 " " 17,199.79 " " 8,113.10 " " 18,894.19 " " 15,115.35 " " 8,031.97 " " 8,275.36 " " 8,113.10 " " 24,131.58 " " 17,917.70 " " 18,838.75 " " 22,623.36 " " 8,275.36 " Inpatient 201 PNEUMOTHORAX WITHOUT CC/MCC " 30,236.50 " " 7,698.21 " " 5,471.13 " " 24,189.20 " " 10,481.50 " " 5,526.39 " " 10,822.82 " " 5,526.39 " " 12,026.99 " " 5,526.39 " " 11,218.78 " " 5,913.24 " " 17,240.85 " " 5,526.39 " " 11,045.83 " " 8,836.66 " " 5,471.13 " " 5,636.92 " " 5,526.39 " " 24,189.20 " " 17,960.48 " " 12,418.00 " " 22,677.38 " " 5,636.92 " Inpatient 202 BRONCHITIS AND ASTHMA WITH CC/MCC " 24,007.39 " " 6,112.28 " " 7,267.70 " " 19,205.91 " " 14,283.56 " " 7,341.11 " " 14,748.68 " " 7,341.11 " " 14,655.17 " " 7,341.11 " " 15,288.27 " " 7,854.99 " " 13,689.01 " " 7,341.11 " " 15,163.80 " " 12,131.03 " " 7,267.70 " " 7,487.93 " " 7,341.11 " " 19,205.91 " " 14,260.39 " " 16,922.50 " " 18,005.54 " " 7,487.93 " Inpatient 203 BRONCHITIS AND ASTHMA WITHOUT CC/MCC " 19,211.90 " " 4,891.35 " " 5,452.98 " " 15,369.52 " " 10,443.10 " " 5,508.06 " " 10,783.16 " " 5,508.06 " " 11,164.64 " " 5,508.06 " " 11,177.67 " " 5,893.62 " " 10,954.63 " " 5,508.06 " " 9,737.77 " " 7,790.22 " " 5,452.98 " " 5,618.22 " " 5,508.06 " " 15,369.52 " " 11,411.87 " " 12,372.50 " " 14,408.93 " " 5,618.22 " Inpatient 204 RESPIRATORY SIGNS AND SYMPTOMS " 48,331.89 " " 12,305.30 " " 6,057.42 " " 38,665.51 " " 11,722.27 " " 6,118.61 " " 12,103.99 " " 6,118.61 " " 12,123.51 " " 6,118.61 " " 12,546.82 " " 6,546.91 " " 27,558.84 " " 6,118.61 " " 15,139.58 " " 12,111.66 " " 6,057.42 " " 6,240.98 " " 6,118.61 " " 38,665.51 " " 28,709.14 " " 13,888.00 " " 36,248.92 " " 6,240.98 " Inpatient 205 OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC " 45,208.55 " " 11,510.10 " " 12,277.71 " " 36,166.84 " " 24,886.18 " " 12,401.73 " " 25,696.57 " " 12,401.73 " " 23,620.43 " " 12,401.73 " " 26,636.69 " " 13,269.85 " " 25,777.92 " " 12,401.73 " " 26,766.77 " " 21,413.41 " " 12,277.71 " " 12,649.76 " " 12,401.73 " " 36,166.84 " " 26,853.88 " " 29,484.00 " " 33,906.41 " " 12,649.76 " Inpatient 206 OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC " 26,266.25 " " 6,687.39 " " 6,702.34 " " 21,013.00 " " 13,087.11 " " 6,770.04 " " 13,513.27 " " 6,770.04 " " 13,477.95 " " 6,770.04 " " 14,007.66 " " 7,243.94 " " 14,977.02 " " 6,770.04 " " 15,163.80 " " 12,131.03 " " 6,702.34 " " 6,905.44 " " 6,770.04 " " 21,013.00 " " 15,602.15 " " 15,505.00 " " 19,699.69 " " 6,905.44 " Inpatient 207 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS " 245,395.03 " " 62,477.57 " " 40,554.51 " " 196,316.02 " " 84,727.93 " " 40,964.15 " " 87,487.00 " " 40,964.15 " " 86,810.77 " " 40,964.15 " " 90,687.74 " " 43,831.64 " " 139,924.25 " " 40,964.15 " " 122,264.44 " " 97,811.55 " " 40,554.51 " " 41,783.43 " " 40,964.15 " " 196,316.02 " " 145,764.65 " " 100,381.75 " " 184,046.27 " " 41,783.43 " Inpatient 208 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS " 78,184.89 " " 19,905.87 " " 18,280.24 " " 62,547.91 " " 37,589.24 " " 18,464.89 " " 38,813.29 " " 18,464.89 " " 37,471.80 " " 18,464.89 " " 40,233.29 " " 19,757.43 " " 44,581.02 " " 18,464.89 " " 44,788.92 " " 35,831.12 " " 18,280.24 " " 18,834.19 " " 18,464.89 " " 62,547.91 " " 46,441.82 " " 44,534.00 " " 58,638.67 " " 18,834.19 " Inpatient 215 OTHER HEART ASSIST SYSTEM IMPLANT " 225,944.83 " " 57,525.55 " " 74,212.63 " " 203,895.50 " " 155,958.13 " " 74,962.25 " " 161,036.72 " " 74,962.25 " " 203,895.50 " " 74,962.25 " " 166,928.30 " " 80,209.61 " " 128,833.74 " " 74,962.25 " " 192,053.45 " " 153,642.76 " " 74,212.63 " " 76,461.50 " " 74,962.25 " " 180,755.86 " " 134,211.23 " " 184,772.00 " " 169,458.62 " " 76,461.50 " Inpatient 219 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC " 257,136.30 " " 65,466.90 " " 56,757.84 " " 205,709.04 " " 119,018.81 " " 57,331.15 " " 122,894.52 " " 57,331.15 " " 120,326.85 " " 57,331.15 " " 127,390.66 " " 61,344.33 " " 146,619.12 " " 57,331.15 " " 132,881.74 " " 106,305.39 " " 56,757.84 " " 58,477.77 " " 57,331.15 " " 205,709.04 " " 152,738.96 " " 141,008.00 " " 192,852.23 " " 58,477.77 " Inpatient 220 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC " 170,347.01 " " 43,370.35 " " 38,245.63 " " 136,277.61 " " 79,841.69 " " 38,631.95 " " 82,441.64 " " 38,631.95 " " 81,315.48 " " 38,631.95 " " 85,457.79 " " 41,336.19 " " 97,131.87 " " 38,631.95 " " 102,455.67 " " 81,964.53 " " 38,245.63 " " 39,404.59 " " 38,631.95 " " 136,277.61 " " 101,186.12 " " 94,592.75 " " 127,760.26 " " 39,404.59 " Inpatient 222 "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK WITH MCC" " 320,501.55 " " 81,599.69 " " 56,013.80 " " 256,401.24 " " 117,444.22 " " 56,579.60 " " 121,268.65 " " 56,579.60 " " 134,276.33 " " 56,579.60 " " 125,705.31 " " 60,540.17 " " 182,749.98 " " 56,579.60 " " 197,680.37 " " 158,144.29 " " 56,013.80 " " 57,711.19 " " 56,579.60 " " 256,401.24 " " 190,377.92 " " 139,142.50 " " 240,376.16 " " 57,711.19 " Inpatient 225 "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITHOUT MCC" " 342,781.15 " " 87,272.08 " " 39,728.81 " " 274,224.92 " " 82,980.52 " " 40,130.11 " " 85,682.69 " " 40,130.11 " " 89,586.12 " " 40,130.11 " " 88,817.42 " " 42,939.22 " " 195,453.81 " " 40,130.11 " " 111,367.07 " " 89,093.66 " " 39,728.81 " " 40,932.71 " " 40,130.11 " " 274,224.92 " " 203,612.00 " " 98,311.50 " " 257,085.86 " " 40,932.71 " Inpatient 226 CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC " 300,195.92 " " 76,429.88 " " 46,339.97 " " 240,156.74 " " 96,971.62 " " 46,808.05 " " 100,129.38 " " 46,808.05 " " 107,545.11 " " 46,808.05 " " 103,792.65 " " 50,084.61 " " 171,171.71 " " 46,808.05 " " 143,448.12 " " 114,758.50 " " 46,339.97 " " 47,744.21 " " 46,808.05 " " 240,156.74 " " 178,316.38 " " 114,887.50 " " 225,146.94 " " 47,744.21 " Inpatient 227 CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC " 277,027.41 " " 70,531.18 " " 36,897.15 " " 221,621.93 " " 76,987.93 " " 37,269.85 " " 79,494.95 " " 37,269.85 " " 85,518.04 " " 37,269.85 " " 82,403.30 " " 39,878.74 " " 157,961.03 " " 37,269.85 " " 100,698.85 " " 80,559.08 " " 36,897.15 " " 38,015.25 " " 37,269.85 " " 221,621.93 " " 164,554.28 " " 91,211.75 " " 207,770.56 " " 38,015.25 " Inpatient 228 OTHER CARDIOTHORACIC PROCEDURES WITH MCC " 211,512.22 " " 53,851.01 " " 37,722.15 " " 169,209.78 " " 78,733.86 " " 38,103.18 " " 81,297.74 " " 38,103.18 " " 104,340.97 " " 38,103.18 " " 84,272.04 " " 40,770.40 " " 120,604.27 " " 38,103.18 " " 148,540.35 " " 118,832.28 " " 37,722.15 " " 38,865.24 " " 38,103.18 " " 169,209.78 " " 125,638.26 " " 93,280.25 " " 158,634.17 " " 38,865.24 " Inpatient 229 OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC " 131,632.83 " " 33,513.72 " " 24,536.83 " " 105,306.26 " " 50,829.97 " " 24,784.68 " " 52,485.18 " " 24,784.68 " " 72,498.96 " " 24,784.68 " " 54,405.37 " " 26,519.61 " " 75,057.04 " " 24,784.68 " " 89,292.25 " " 71,433.80 " " 24,536.83 " " 25,280.37 " " 24,784.68 " " 105,306.26 " " 78,189.90 " " 60,221.00 " " 98,724.62 " " 25,280.37 " Inpatient 233 CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC " 207,921.25 " " 52,936.75 " " 55,813.49 " " 166,337.00 " " 117,020.29 " " 56,377.26 " " 120,830.92 " " 56,377.26 " " 116,198.65 " " 56,377.26 " " 125,251.56 " " 60,323.67 " " 118,556.70 " " 56,377.26 " " 131,405.00 " " 105,124.00 " " 55,813.49 " " 57,504.81 " " 56,377.26 " " 166,337.00 " " 123,505.22 " " 138,640.25 " " 155,940.94 " " 57,504.81 " Inpatient 234 CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC " 149,542.44 " " 38,073.51 " " 37,761.94 " " 119,633.95 " " 78,818.06 " " 38,143.37 " " 81,384.67 " " 38,143.37 " " 80,014.84 " " 38,143.37 " " 84,362.16 " " 40,813.41 " " 85,269.10 " " 38,143.37 " " 102,608.43 " " 82,086.75 " " 37,761.94 " " 38,906.24 " " 38,143.37 " " 119,633.95 " " 88,828.21 " " 93,380.00 " " 112,156.83 " " 38,906.24 " Inpatient 235 CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC " 184,071.84 " " 46,864.69 " " 43,123.02 " " 147,257.47 " " 90,163.66 " " 43,558.61 " " 93,099.73 " " 43,558.61 " " 91,431.07 " " 43,558.61 " " 96,505.82 " " 46,607.71 " " 104,957.76 " " 43,558.61 " " 99,731.32 " " 79,785.06 " " 43,123.02 " " 44,429.78 " " 43,558.61 " " 147,257.47 " " 109,338.67 " " 106,821.75 " " 138,053.88 " " 44,429.78 " Inpatient 236 CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC " 124,044.97 " " 31,581.85 " " 29,114.11 " " 99,235.98 " " 60,516.79 " " 29,408.19 " " 62,487.44 " " 29,408.19 " " 61,449.83 " " 29,408.19 " " 64,773.57 " " 31,466.76 " " 70,730.44 " " 29,408.19 " " 77,300.05 " " 61,840.04 " " 29,114.11 " " 29,996.35 " " 29,408.19 " " 99,235.98 " " 73,682.71 " " 71,697.50 " " 93,033.73 " " 29,996.35 " Inpatient 239 AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC " 107,883.13 " " 27,467.04 " " 34,132.50 " " 89,572.33 " " 71,137.14 " " 34,477.27 " " 73,453.63 " " 34,477.27 " " 73,511.62 " " 34,477.27 " " 76,140.96 " " 36,890.68 " " 61,514.96 " " 34,477.27 " " 89,572.33 " " 71,657.86 " " 34,132.50 " " 35,166.82 " " 34,477.27 " " 86,306.50 " " 64,082.58 " " 84,280.00 " " 80,912.35 " " 35,166.82 " Inpatient 240 AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC " 91,746.74 " " 23,358.72 " " 19,983.29 " " 73,397.39 " " 41,193.36 " " 20,185.14 " " 42,534.78 " " 20,185.14 " " 42,201.26 " " 20,185.14 " " 44,090.93 " " 21,598.10 " " 52,313.99 " " 20,185.14 " " 47,816.83 " " 38,253.46 " " 19,983.29 " " 20,588.84 " " 20,185.14 " " 73,397.39 " " 54,497.56 " " 48,804.00 " " 68,810.06 " " 20,588.84 " Inpatient 242 PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC " 114,297.94 " " 29,100.26 " " 26,535.81 " " 91,438.35 " " 55,060.38 " " 26,803.85 " " 56,853.36 " " 26,803.85 " " 58,630.18 " " 26,803.85 " " 58,933.36 " " 28,680.12 " " 65,172.69 " " 26,803.85 " " 72,411.51 " " 57,929.21 " " 26,535.81 " " 27,339.93 " " 26,803.85 " " 91,438.35 " " 67,892.98 " " 65,233.00 " " 85,723.46 " " 27,339.93 " Inpatient 243 PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC " 108,332.88 " " 27,581.55 " " 18,096.68 " " 86,666.30 " " 37,200.76 " " 18,279.47 " " 38,412.16 " " 18,279.47 " " 41,280.37 " " 18,279.47 " " 39,817.49 " " 19,559.03 " " 61,771.41 " " 18,279.47 " " 52,602.74 " " 42,082.19 " " 18,096.68 " " 18,645.06 " " 18,279.47 " " 86,666.30 " " 64,349.73 " " 44,073.75 " " 81,249.66 " " 18,645.06 " Inpatient 244 PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC " 91,767.67 " " 23,364.05 " " 14,919.53 " " 73,414.14 " " 30,477.00 " " 15,070.23 " " 31,469.45 " " 15,070.23 " " 33,854.69 " " 15,070.23 " " 32,620.77 " " 16,125.15 " " 52,325.93 " " 15,070.23 " " 46,339.21 " " 37,071.36 " " 14,919.53 " " 15,371.63 " " 15,070.23 " " 73,414.14 " " 54,510.00 " " 36,107.75 " " 68,825.75 " " 15,371.63 " Inpatient 246 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS " 141,183.61 " " 35,945.35 " " 22,324.97 " " 112,946.89 " " 46,149.04 " " 22,550.47 " " 47,651.82 " " 22,550.47 " " 50,796.26 " " 22,550.47 " " 49,395.18 " " 24,129.00 " " 80,502.89 " " 22,550.47 " " 68,974.26 " " 55,179.40 " " 22,324.97 " " 23,001.48 " " 22,550.47 " " 112,946.89 " " 83,863.06 " " 54,675.25 " " 105,887.71 " " 23,001.48 " Inpatient 247 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC " 105,186.40 " " 26,780.46 " " 14,290.66 " " 84,149.12 " " 29,146.14 " " 14,435.01 " " 30,095.25 " " 14,435.01 " " 33,478.10 " " 14,435.01 " " 31,196.29 " " 15,445.46 " " 59,977.29 " " 14,435.01 " " 48,567.76 " " 38,854.19 " " 14,290.66 " " 14,723.71 " " 14,435.01 " " 84,149.12 " " 62,480.72 " " 34,531.00 " " 78,889.80 " " 14,723.71 " Inpatient 248 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS " 155,617.39 " " 39,620.19 " " 22,589.50 " " 124,493.91 " " 46,708.86 " " 22,817.68 " " 48,229.87 " " 22,817.68 " " 48,226.61 " " 22,817.68 " " 49,994.38 " " 24,414.92 " " 88,733.04 " " 22,817.68 " " 64,162.10 " " 51,329.68 " " 22,589.50 " " 23,274.03 " " 22,817.68 " " 124,493.91 " " 92,436.73 " " 55,338.50 " " 116,713.04 " " 23,274.03 " Inpatient 250 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC " 134,820.98 " " 34,325.42 " " 18,119.71 " " 107,856.78 " " 37,249.51 " " 18,302.74 " " 38,462.49 " " 18,302.74 " " 39,652.20 " " 18,302.74 " " 39,869.66 " " 19,583.93 " " 76,874.92 " " 18,302.74 " " 47,453.48 " " 37,962.78 " " 18,119.71 " " 18,668.79 " " 18,302.74 " " 107,856.78 " " 80,083.66 " " 44,131.50 " " 101,115.74 " " 18,668.79 " Inpatient 251 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC " 68,983.55 " " 17,563.21 " " 12,093.45 " " 55,186.84 " " 24,496.23 " " 12,215.61 " " 25,293.92 " " 12,215.61 " " 26,311.91 " " 12,215.61 " " 26,219.30 " " 13,070.70 " " 39,334.42 " " 12,215.61 " " 39,580.90 " " 31,664.71 " " 12,093.45 " " 12,459.92 " " 12,215.61 " " 55,186.84 " " 40,976.23 " " 29,022.00 " " 51,737.66 " " 12,459.92 " Inpatient 252 OTHER VASCULAR PROCEDURES WITH MCC " 149,503.61 " " 38,063.62 " " 23,730.68 " " 119,602.89 " " 49,123.91 " " 23,970.38 " " 50,723.58 " " 23,970.38 " " 51,163.35 " " 23,970.38 " " 52,579.32 " " 25,648.31 " " 85,246.96 " " 23,970.38 " " 81,475.68 " " 65,180.54 " " 23,730.68 " " 24,449.79 " " 23,970.38 " " 119,602.89 " " 88,805.14 " " 58,199.75 " " 112,127.71 " " 24,449.79 " Inpatient 253 OTHER VASCULAR PROCEDURES WITH CC " 98,553.41 " " 25,091.70 " " 19,039.63 " " 78,842.73 " " 39,196.33 " " 19,231.95 " " 40,472.71 " " 19,231.95 " " 40,109.49 " " 19,231.95 " " 41,953.42 " " 20,578.19 " " 56,195.15 " " 19,231.95 " " 56,829.29 " " 45,463.43 " " 19,039.63 " " 19,616.59 " " 19,231.95 " " 78,842.73 " " 58,540.73 " " 46,438.00 " " 73,915.06 " " 19,616.59 " Inpatient 254 OTHER VASCULAR PROCEDURES WITHOUT CC/MCC " 57,150.21 " " 14,550.44 " " 13,192.75 " " 45,720.17 " " 26,822.66 " " 13,326.01 " " 27,696.11 " " 13,326.01 " " 28,685.34 " " 13,326.01 " " 28,709.38 " " 14,258.83 " " 32,587.05 " " 13,326.01 " " 38,878.43 " " 31,102.73 " " 13,192.75 " " 13,592.53 " " 13,326.01 " " 45,720.17 " " 33,947.22 " " 31,778.25 " " 42,862.66 " " 13,592.53 " Inpatient 258 CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC " 129,479.15 " " 32,965.39 " " 22,630.68 " " 103,583.32 " " 46,796.01 " " 22,859.27 " " 48,319.86 " " 22,859.27 " " 48,764.60 " " 22,859.27 " " 50,087.66 " " 24,459.42 " " 73,829.01 " " 22,859.27 " " 79,438.79 " " 63,551.03 " " 22,630.68 " " 23,316.46 " " 22,859.27 " " 103,583.32 " " 76,910.62 " " 55,441.75 " " 97,109.36 " " 23,316.46 " Inpatient 261 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC " 71,719.04 " " 18,259.67 " " 14,435.13 " " 57,375.23 " " 29,451.90 " " 14,580.94 " " 30,410.96 " " 14,580.94 " " 30,655.30 " " 14,580.94 " " 31,523.56 " " 15,601.61 " " 40,894.20 " " 14,580.94 " " 37,279.69 " " 29,823.74 " " 14,435.13 " " 14,872.56 " " 14,580.94 " " 57,375.23 " " 42,601.11 " " 34,893.25 " " 53,789.28 " " 14,872.56 " Inpatient 264 OTHER CIRCULATORY SYSTEM O.R. PROCEDURES " 70,652.44 " " 17,988.11 " " 23,227.44 " " 56,938.00 " " 48,058.93 " " 23,462.06 " " 49,623.91 " " 23,462.06 " " 50,911.77 " " 23,462.06 " " 51,439.42 " " 25,104.40 " " 40,286.02 " " 23,462.06 " " 45,588.29 " " 36,470.62 " " 23,227.44 " " 23,931.30 " " 23,462.06 " " 56,521.95 " " 41,967.55 " " 56,938.00 " " 52,989.33 " " 23,931.30 " Inpatient 266 ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC " 197,130.07 " " 50,189.32 " " 49,710.45 " " 157,704.06 " " 104,104.53 " " 50,212.58 " " 107,494.57 " " 50,212.58 " " 122,652.80 " " 50,212.58 " " 111,427.30 " " 53,727.46 " " 112,403.57 " " 50,212.58 " " 139,221.57 " " 111,377.25 " " 49,710.45 " " 51,216.83 " " 50,212.58 " " 157,704.06 " " 117,095.26 " " 123,338.25 " " 147,847.55 " " 51,216.83 " Inpatient 267 ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC " 199,230.84 " " 50,724.17 " " 39,590.61 " " 159,384.67 " " 82,688.06 " " 39,990.52 " " 85,380.70 " " 39,990.52 " " 96,603.56 " " 39,990.52 " " 88,504.38 " " 42,789.86 " " 113,601.42 " " 39,990.52 " " 113,225.73 " " 90,580.59 " " 39,590.61 " " 40,790.33 " " 39,990.52 " " 159,384.67 " " 118,343.12 " " 97,965.00 " " 149,423.13 " " 40,790.33 " Inpatient 268 AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC " 124,402.72 " " 31,672.93 " " 49,119.97 " " 153,556.20 " " 102,854.90 " " 49,616.13 " " 106,204.25 " " 49,616.13 " " 103,227.03 " " 49,616.13 " " 110,089.77 " " 53,089.26 " " 70,934.43 " " 49,616.13 " " 153,556.20 " " 122,844.96 " " 49,119.97 " " 50,608.45 " " 49,616.13 " " 99,522.18 " " 73,895.22 " " 121,857.75 " " 93,302.04 " " 50,608.45 " Inpatient 269 AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC " 109,698.77 " " 27,929.31 " " 30,636.37 " " 87,759.02 " " 63,738.34 " " 30,945.83 " " 65,813.91 " " 30,945.83 " " 65,748.91 " " 30,945.83 " " 68,221.73 " " 33,112.04 " " 62,550.24 " " 30,945.83 " " 75,517.77 " " 60,414.22 " " 30,636.37 " " 31,564.75 " " 30,945.83 " " 87,759.02 " " 65,161.07 " " 75,514.25 " " 82,274.08 " " 31,564.75 " Inpatient 270 OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC " 206,141.97 " " 52,483.75 " " 36,721.96 " " 164,913.58 " " 76,617.18 " " 37,092.89 " " 79,112.12 " " 37,092.89 " " 78,174.63 " " 37,092.89 " " 82,006.47 " " 39,689.39 " " 117,542.15 " " 37,092.89 " " 93,416.96 " " 74,733.57 " " 36,721.96 " " 37,834.75 " " 37,092.89 " " 164,913.58 " " 122,448.33 " " 90,772.50 " " 154,606.48 " " 37,834.75 " Inpatient 271 OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC " 101,889.02 " " 25,940.94 " " 25,403.71 " " 81,511.22 " " 52,664.52 " " 25,660.31 " " 54,379.48 " " 25,660.31 " " 53,533.63 " " 25,660.31 " " 56,368.97 " " 27,456.53 " " 58,097.12 " " 25,660.31 " " 75,059.47 " " 60,047.58 " " 25,403.71 " " 26,173.52 " " 25,660.31 " " 81,511.22 " " 60,522.08 " " 62,394.50 " " 76,416.77 " " 26,173.52 " Inpatient 272 OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC " 91,156.47 " " 23,208.44 " " 19,281.82 " " 72,925.18 " " 39,708.88 " " 19,476.59 " " 41,001.95 " " 19,476.59 " " 38,826.24 " " 19,476.59 " " 42,502.02 " " 20,839.95 " " 51,977.42 " " 19,476.59 " " 58,815.26 " " 47,052.21 " " 19,281.82 " " 19,866.12 " " 19,476.59 " " 72,925.18 " " 54,146.94 " " 47,045.25 " " 68,367.35 " " 19,866.12 " Inpatient 273 PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC " 143,638.09 " " 36,570.26 " " 27,227.49 " " 114,910.47 " " 56,524.19 " " 27,502.52 " " 58,364.83 " " 27,502.52 " " 56,633.33 " " 27,502.52 " " 60,500.13 " " 29,427.70 " " 81,902.44 " " 27,502.52 " " 96,523.22 " " 77,218.58 " " 27,227.49 " " 28,052.57 " " 27,502.52 " " 114,910.47 " " 85,321.03 " " 66,967.25 " " 107,728.57 " " 28,052.57 " Inpatient 274 PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC " 138,618.95 " " 35,292.38 " " 23,457.77 " " 110,895.16 " " 48,546.37 " " 23,694.72 " " 50,127.22 " " 23,694.72 " " 43,805.70 " " 23,694.72 " " 51,961.15 " " 25,353.35 " " 79,040.53 " " 23,694.72 " " 69,432.56 " " 55,546.04 " " 23,457.77 " " 24,168.61 " " 23,694.72 " " 110,895.16 " " 82,339.66 " " 57,515.50 " " 103,964.21 " " 24,168.61 " Inpatient 280 "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC" " 51,902.98 " " 13,214.50 " " 11,733.99 " " 41,522.38 " " 23,735.52 " " 11,852.52 " " 24,508.44 " " 11,852.52 " " 26,232.79 " " 11,852.52 " " 25,405.09 " " 12,682.20 " " 29,595.08 " " 11,852.52 " " 30,036.92 " " 24,029.53 " " 11,733.99 " " 12,089.57 " " 11,852.52 " " 41,522.38 " " 30,830.37 " " 28,120.75 " " 38,927.24 " " 12,089.57 " Inpatient 281 "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC" " 27,931.61 " " 7,111.39 " " 7,013.64 " " 22,345.29 " " 13,745.89 " " 7,084.48 " " 14,193.51 " " 7,084.48 " " 15,582.39 " " 7,084.48 " " 14,712.79 " " 7,580.39 " " 15,926.60 " " 7,084.48 " " 19,887.35 " " 15,909.87 " " 7,013.64 " " 7,226.17 " " 7,084.48 " " 22,345.29 " " 16,591.38 " " 16,285.50 " " 20,948.71 " " 7,226.17 " Inpatient 282 "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC" " 38,801.38 " " 9,878.83 " " 5,586.29 " " 31,041.10 " " 10,725.22 " " 5,642.72 " " 11,074.48 " " 5,642.72 " " 12,004.83 " " 5,642.72 " " 11,479.64 " " 6,037.71 " " 22,124.55 " " 5,642.72 " " 18,119.04 " " 14,495.23 " " 5,586.29 " " 5,755.57 " " 5,642.72 " " 31,041.10 " " 23,048.02 " " 12,706.75 " " 29,101.04 " " 5,755.57 " Inpatient 283 "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC" " 46,974.76 " " 11,959.77 " " 13,533.36 " " 48,107.51 " " 27,543.48 " " 13,670.06 " " 28,440.40 " " 13,670.06 " " 27,805.59 " " 13,670.06 " " 29,480.91 " " 14,626.96 " " 26,785.01 " " 13,670.06 " " 48,107.51 " " 38,486.00 " " 13,533.36 " " 13,943.46 " " 13,670.06 " " 37,579.81 " " 27,903.01 " " 32,632.25 " " 35,231.07 " " 13,943.46 " Inpatient 286 "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC" " 63,533.61 " " 16,175.66 " " 15,429.04 " " 50,826.89 " " 31,555.29 " " 15,584.89 " " 32,582.85 " " 15,584.89 " " 35,255.01 " " 15,584.89 " " 33,774.90 " " 16,675.83 " " 36,226.86 " " 15,584.89 " " 36,649.88 " " 29,319.90 " " 15,429.04 " " 15,896.59 " " 15,584.89 " " 50,826.89 " " 37,738.96 " " 37,385.25 " " 47,650.21 " " 15,896.59 " Inpatient 287 "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC" " 39,685.32 " " 10,103.88 " " 8,301.39 " " 31,748.26 " " 16,471.14 " " 8,385.24 " " 17,007.51 " " 8,385.24 " " 18,593.50 " " 8,385.24 " " 17,629.73 " " 8,972.21 " " 22,628.57 " " 8,385.24 " " 22,842.59 " " 18,274.07 " " 8,301.39 " " 8,552.94 " " 8,385.24 " " 31,748.26 " " 23,573.08 " " 19,514.25 " " 29,763.99 " " 8,552.94 " Inpatient 288 ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC " 126,189.52 " " 32,127.85 " " 19,261.59 " " 100,951.62 " " 39,666.04 " " 19,456.15 " " 40,957.72 " " 19,456.15 " " 42,854.74 " " 19,456.15 " " 42,456.17 " " 20,818.08 " " 71,953.26 " " 19,456.15 " " 51,864.36 " " 41,491.49 " " 19,261.59 " " 19,845.27 " " 19,456.15 " " 100,951.62 " " 74,956.57 " " 46,994.50 " " 94,642.14 " " 19,845.27 " Inpatient 289 ACUTE AND SUBACUTE ENDOCARDITIS WITH CC " 62,373.16 " " 15,880.21 " " 11,990.15 " " 49,898.53 " " 24,277.62 " " 12,111.26 " " 25,068.19 " " 12,111.26 " " 26,815.06 " " 12,111.26 " " 25,985.32 " " 12,959.05 " " 35,565.18 " " 12,111.26 " " 30,933.18 " " 24,746.54 " " 11,990.15 " " 12,353.49 " " 12,111.26 " " 49,898.53 " " 37,049.66 " " 28,763.00 " " 46,779.87 " " 12,353.49 " Inpatient 291 HEART FAILURE AND SHOCK WITH MCC " 37,851.70 " " 9,637.04 " " 9,370.68 " " 30,281.36 " " 18,734.06 " " 9,465.33 " " 19,344.11 " " 9,465.33 " " 23,356.18 " " 9,465.33 " " 20,051.82 " " 10,127.90 " " 21,583.04 " " 9,465.33 " " 23,084.82 " " 18,467.85 " " 9,370.68 " " 9,654.64 " " 9,465.33 " " 30,281.36 " " 22,483.91 " " 22,195.25 " " 28,388.78 " " 9,654.64 " Inpatient 292 HEART FAILURE AND SHOCK WITH CC " 26,553.92 " " 6,760.63 " " 6,545.30 " " 21,243.14 " " 12,754.76 " " 6,611.41 " " 13,170.10 " " 6,611.41 " " 15,172.58 " " 6,611.41 " " 13,651.94 " " 7,074.21 " " 15,141.05 " " 6,611.41 " " 16,108.51 " " 12,886.80 " " 6,545.30 " " 6,743.64 " " 6,611.41 " " 21,243.14 " " 15,773.03 " " 15,111.25 " " 19,915.44 " " 6,743.64 " Inpatient 293 HEART FAILURE AND SHOCK WITHOUT CC/MCC " 18,826.41 " " 4,793.20 " " 4,635.66 " " 15,061.13 " " 8,713.41 " " 4,682.48 " " 8,997.15 " " 4,682.48 " " 10,659.90 " " 4,682.48 " " 9,326.32 " " 5,010.25 " " 10,734.82 " " 4,682.48 " " 12,596.13 " " 10,076.90 " " 4,635.66 " " 4,776.13 " " 4,682.48 " " 15,061.13 " " 11,182.89 " " 10,323.25 " " 14,119.81 " " 4,776.13 " Inpatient 299 PERIPHERAL VASCULAR DISORDERS WITH MCC " 38,778.11 " " 9,872.91 " " 11,215.40 " " 31,022.49 " " 22,638.03 " " 11,328.69 " " 23,375.22 " " 11,328.69 " " 22,329.29 " " 11,328.69 " " 24,230.41 " " 12,121.70 " " 22,111.28 " " 11,328.69 " " 22,115.89 " " 17,692.71 " " 11,215.40 " " 11,555.26 " " 11,328.69 " " 31,022.49 " " 23,034.20 " " 26,820.50 " " 29,083.58 " " 11,555.26 " Inpatient 300 PERIPHERAL VASCULAR DISORDERS WITH CC " 22,775.83 " " 5,798.73 " " 7,803.73 " " 18,266.50 " " 15,417.97 " " 7,882.56 " " 15,920.04 " " 7,882.56 " " 16,114.04 " " 7,882.56 " " 16,502.48 " " 8,434.34 " " 12,986.78 " " 7,882.56 " " 16,084.28 " " 12,867.42 " " 7,803.73 " " 8,040.21 " " 7,882.56 " " 18,220.66 " " 13,528.84 " " 18,266.50 " " 17,081.87 " " 8,040.21 " Inpatient 301 PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC " 24,907.29 " " 6,341.40 " " 5,704.94 " " 19,925.83 " " 10,976.33 " " 5,762.57 " " 11,333.76 " " 5,762.57 " " 11,473.19 " " 5,762.57 " " 11,748.41 " " 6,165.95 " " 14,202.14 " " 5,762.57 " " 11,845.20 " " 9,476.16 " " 5,704.94 " " 5,877.82 " " 5,762.57 " " 19,925.83 " " 14,794.93 " " 13,004.25 " " 18,680.47 " " 5,877.82 " Inpatient 304 HYPERTENSION WITH MCC " 46,322.90 " " 11,793.81 " " 8,175.05 " " 37,058.32 " " 16,203.79 " " 8,257.63 " " 16,731.44 " " 8,257.63 " " 16,590.32 " " 8,257.63 " " 17,343.57 " " 8,835.66 " " 26,413.32 " " 8,257.63 " " 21,486.08 " " 17,188.86 " " 8,175.05 " " 8,422.78 " " 8,257.63 " " 37,058.32 " " 27,515.80 " " 19,197.50 " " 34,742.18 " " 8,422.78 " Inpatient 305 HYPERTENSION WITHOUT MCC " 23,417.01 " " 5,961.97 " " 5,682.61 " " 18,733.61 " " 10,929.06 " " 5,740.01 " " 11,284.95 " " 5,740.01 " " 10,944.71 " " 5,740.01 " " 11,697.82 " " 6,141.81 " " 13,352.38 " " 5,740.01 " " 14,025.30 " " 11,220.24 " " 5,682.61 " " 5,854.81 " " 5,740.01 " " 18,733.61 " " 13,909.70 " " 12,948.25 " " 17,562.76 " " 5,854.81 " Inpatient 306 CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC " 30,996.82 " " 7,891.79 " " 11,039.52 " " 37,836.83 " " 22,265.81 " " 11,151.03 " " 22,990.86 " " 11,151.03 " " 21,550.79 " " 11,151.03 " " 23,831.99 " " 11,931.60 " " 17,674.39 " " 11,151.03 " " 37,836.83 " " 30,269.45 " " 11,039.52 " " 11,374.05 " " 11,151.03 " " 24,797.46 " " 18,412.11 " " 26,379.50 " " 23,247.62 " " 11,374.05 " Inpatient 308 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC " 32,465.93 " " 8,265.83 " " 8,900.25 " " 25,972.74 " " 17,738.49 " " 8,990.15 " " 18,316.13 " " 8,990.15 " " 18,805.52 " " 8,990.15 " " 18,986.23 " " 9,619.46 " " 18,512.07 " " 8,990.15 " " 20,226.47 " " 16,181.17 " " 8,900.25 " " 9,169.95 " " 8,990.15 " " 25,972.74 " " 19,284.76 " " 21,015.75 " " 24,349.45 " " 9,169.95 " Inpatient 309 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC " 21,162.48 " " 5,387.97 " " 5,756.59 " " 16,929.98 " " 11,085.64 " " 5,814.74 " " 11,446.63 " " 5,814.74 " " 12,216.86 " " 5,814.74 " " 11,865.41 " " 6,221.77 " " 12,066.85 " " 5,814.74 " " 12,765.69 " " 10,212.55 " " 5,756.59 " " 5,931.03 " " 5,814.74 " " 16,929.98 " " 12,570.51 " " 13,133.75 " " 15,871.86 " " 5,931.03 " Inpatient 310 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC " 19,512.49 " " 4,967.88 " " 4,421.38 " " 15,609.99 " " 8,259.94 " " 4,466.04 " " 8,528.92 " " 4,466.04 " " 8,901.97 " " 4,466.04 " " 8,840.95 " " 4,778.66 " " 11,126.02 " " 4,466.04 " " 10,319.13 " " 8,255.30 " " 4,421.38 " " 4,555.36 " " 4,466.04 " " 15,609.99 " " 11,590.42 " " 9,786.00 " " 14,634.37 " " 4,555.36 " Inpatient 312 SYNCOPE AND COLLAPSE " 28,111.88 " " 7,157.28 " " 6,372.20 " " 22,489.50 " " 12,388.44 " " 6,436.57 " " 12,791.85 " " 6,436.57 " " 12,602.95 " " 6,436.57 " " 13,259.85 " " 6,887.13 " " 16,029.39 " " 6,436.57 " " 14,485.55 " " 11,588.43 " " 6,372.20 " " 6,565.30 " " 6,436.57 " " 22,489.50 " " 16,698.46 " " 14,677.25 " " 21,083.91 " " 6,565.30 " Inpatient 313 CHEST PAIN " 24,798.25 " " 6,313.63 " " 5,553.48 " " 19,838.60 " " 10,655.80 " " 5,609.58 " " 11,002.79 " " 5,609.58 " " 11,115.60 " " 5,609.58 " " 11,405.33 " " 6,002.25 " " 14,139.96 " " 5,609.58 " " 13,516.61 " " 10,813.29 " " 5,553.48 " " 5,721.77 " " 5,609.58 " " 19,838.60 " " 14,730.16 " " 12,624.50 " " 18,598.69 " " 5,721.77 " Inpatient 314 OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC " 74,553.60 " " 18,981.35 " " 15,068.89 " " 59,642.88 " " 30,793.10 " " 15,221.10 " " 31,795.84 " " 15,221.10 " " 30,981.24 " " 15,221.10 " " 32,959.11 " " 16,286.58 " " 42,510.46 " " 15,221.10 " " 36,746.78 " " 29,397.41 " " 15,068.89 " " 15,525.52 " " 15,221.10 " " 59,642.88 " " 44,284.84 " " 36,482.25 " " 55,915.20 " " 15,525.52 " Inpatient 315 OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC " 22,197.92 " " 5,651.59 " " 7,312.37 " " 18,530.84 " " 14,378.09 " " 7,386.23 " " 14,846.30 " " 7,386.23 " " 15,281.77 " " 7,386.23 " " 15,389.45 " " 7,903.27 " " 12,657.25 " " 7,386.23 " " 18,530.84 " " 14,824.67 " " 7,312.37 " " 7,533.95 " " 7,386.23 " " 17,758.34 " " 13,185.56 " " 17,034.50 " " 16,648.44 " " 7,533.95 " Inpatient 326 "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC" " 87,939.78 " " 22,389.47 " " 37,624.44 " " 100,087.78 " " 78,527.07 " " 38,004.48 " " 81,084.21 " " 38,004.48 " " 71,949.90 " " 38,004.48 " " 84,050.70 " " 40,664.79 " " 50,143.26 " " 38,004.48 " " 100,087.78 " " 80,070.22 " " 37,624.44 " " 38,764.57 " " 38,004.48 " " 70,351.82 " " 52,236.23 " " 93,035.25 " " 65,954.84 " " 38,764.57 " Inpatient 327 "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC" " 53,888.77 " " 13,720.08 " " 18,419.14 " " 47,138.58 " " 37,883.18 " " 18,605.19 " " 39,116.80 " " 18,605.19 " " 33,479.68 " " 18,605.19 " " 40,547.91 " " 19,907.55 " " 30,727.38 " " 18,605.19 " " 47,138.58 " " 37,710.85 " " 18,419.14 " " 18,977.29 " " 18,605.19 " " 43,111.02 " " 32,009.93 " " 44,882.25 " " 40,416.58 " " 18,977.29 " Inpatient 328 "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC" " 68,649.67 " " 17,478.21 " " 12,152.77 " " 54,919.74 " " 24,621.78 " " 12,275.53 " " 25,423.56 " " 12,275.53 " " 23,800.81 " " 12,275.53 " " 26,353.69 " " 13,134.82 " " 39,144.04 " " 12,275.53 " " 28,801.53 " " 23,041.21 " " 12,152.77 " " 12,521.04 " " 12,275.53 " " 54,919.74 " " 40,777.90 " " 29,170.75 " " 51,487.25 " " 12,521.04 " Inpatient 329 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC " 104,218.77 " " 26,534.10 " " 34,622.47 " " 85,508.50 " " 72,174.06 " " 34,972.19 " " 74,524.32 " " 34,972.19 " " 77,736.34 " " 34,972.19 " " 77,250.82 " " 37,420.24 " " 59,425.54 " " 34,972.19 " " 80,202.62 " " 64,162.10 " " 34,622.47 " " 35,671.63 " " 34,972.19 " " 83,375.02 " " 61,905.95 " " 85,508.50 " " 78,164.08 " " 35,671.63 " Inpatient 330 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC " 79,615.54 " " 20,270.12 " " 18,311.65 " " 63,692.43 " " 37,655.71 " " 18,496.62 " " 38,881.92 " " 18,496.62 " " 39,058.84 " " 18,496.62 " " 40,304.43 " " 19,791.38 " " 45,396.78 " " 18,496.62 " " 44,425.57 " " 35,540.44 " " 18,311.65 " " 18,866.55 " " 18,496.62 " " 63,692.43 " " 47,291.63 " " 44,612.75 " " 59,711.66 " " 18,866.55 " Inpatient 331 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC " 60,845.85 " " 15,491.35 " " 12,457.09 " " 48,676.68 " " 25,265.80 " " 12,582.92 " " 26,088.55 " " 12,582.92 " " 26,514.44 " " 12,582.92 " " 27,043.01 " " 13,463.72 " " 34,694.30 " " 12,582.92 " " 33,089.06 " " 26,471.24 " " 12,457.09 " " 12,834.58 " " 12,582.92 " " 48,676.68 " " 36,142.43 " " 29,933.75 " " 45,634.39 " " 12,834.58 " Inpatient 335 PERITONEAL ADHESIOLYSIS WITH MCC " 99,035.90 " " 25,214.54 " " 27,833.34 " " 79,228.72 " " 57,806.31 " " 28,114.48 " " 59,688.70 " " 28,114.48 " " 64,777.38 " " 28,114.48 " " 61,872.44 " " 30,082.49 " " 56,470.27 " " 28,114.48 " " 60,495.69 " " 48,396.55 " " 27,833.34 " " 28,676.77 " " 28,114.48 " " 79,228.72 " " 58,827.32 " " 68,486.25 " " 74,276.93 " " 28,676.77 " Inpatient 336 PERITONEAL ADHESIOLYSIS WITH CC " 58,806.54 " " 14,972.15 " " 16,510.89 " " 47,045.23 " " 33,844.79 " " 16,677.67 " " 34,946.91 " " 16,677.67 " " 37,017.67 " " 16,677.67 " " 36,225.45 " " 17,845.11 " " 33,531.49 " " 16,677.67 " " 39,217.56 " " 31,374.03 " " 16,510.89 " " 17,011.22 " " 16,677.67 " " 47,045.23 " " 34,931.08 " " 40,097.75 " " 44,104.91 " " 17,011.22 " Inpatient 337 PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC " 52,241.19 " " 13,300.61 " " 11,946.18 " " 41,792.95 " " 24,184.56 " " 12,066.85 " " 24,972.10 " " 12,066.85 " " 25,604.63 " " 12,066.85 " " 25,885.71 " " 12,911.53 " " 29,787.93 " " 12,066.85 " " 29,697.79 " " 23,758.22 " " 11,946.18 " " 12,308.19 " " 12,066.85 " " 41,792.95 " " 31,031.27 " " 28,652.75 " " 39,180.89 " " 12,308.19 " Inpatient 340 APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC " 57,944.81 " " 14,752.75 " " 9,091.49 " " 46,355.85 " " 18,143.22 " " 9,183.32 " " 18,734.03 " " 9,183.32 " " 18,985.91 " " 9,183.32 " " 19,419.42 " " 9,826.15 " " 33,040.13 " " 9,183.32 " " 25,652.50 " " 20,521.99 " " 9,091.49 " " 9,366.99 " " 9,183.32 " " 46,355.85 " " 34,419.22 " " 21,495.25 " " 43,458.61 " " 9,366.99 " Inpatient 343 APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC " 48,563.47 " " 12,364.26 " " 8,256.03 " " 38,850.78 " " 16,375.13 " " 8,339.42 " " 16,908.37 " " 8,339.42 " " 16,707.39 " " 8,339.42 " " 17,526.97 " " 8,923.18 " " 27,690.89 " " 8,339.42 " " 21,219.63 " " 16,975.70 " " 8,256.03 " " 8,506.21 " " 8,339.42 " " 38,850.78 " " 28,846.70 " " 19,400.50 " " 36,422.60 " " 8,506.21 " Inpatient 346 MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC " 19,846.42 " " 5,052.90 " " 9,420.24 " " 24,174.87 " " 18,838.93 " " 9,515.39 " " 19,452.40 " " 9,515.39 " " 17,414.68 " " 9,515.39 " " 20,164.07 " " 10,181.47 " " 11,316.43 " " 9,515.39 " " 24,174.87 " " 19,339.89 " " 9,420.24 " " 9,705.70 " " 9,515.39 " " 15,877.14 " " 11,788.77 " " 22,319.50 " " 14,884.82 " " 9,705.70 " Inpatient 351 INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC " 55,890.78 " " 14,229.79 " " 10,936.92 " " 44,712.62 " " 22,048.67 " " 11,047.39 " " 22,766.66 " " 11,047.39 " " 23,565.05 " " 11,047.39 " " 23,599.59 " " 11,820.71 " " 31,868.92 " " 11,047.39 " " 31,708.33 " " 25,366.65 " " 10,936.92 " " 11,268.34 " " 11,047.39 " " 44,712.62 " " 33,199.12 " " 26,122.25 " " 41,918.09 " " 11,268.34 " Inpatient 355 HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC " 50,357.72 " " 12,821.08 " " 10,012.11 " " 40,286.18 " " 20,091.51 " " 10,113.24 " " 20,745.77 " " 10,113.24 " " 20,895.73 " " 10,113.24 " " 21,504.76 " " 10,821.17 " " 28,713.97 " " 10,113.24 " " 26,136.96 " " 20,909.56 " " 10,012.11 " " 10,315.50 " " 10,113.24 " " 40,286.18 " " 29,912.49 " " 23,803.50 " " 37,768.29 " " 10,315.50 " Inpatient 356 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC " 212,434.34 " " 54,085.78 " " 30,585.43 " " 169,947.47 " " 63,630.51 " " 30,894.37 " " 65,702.57 " " 30,894.37 " " 60,212.48 " " 30,894.37 " " 68,106.32 " " 33,056.98 " " 121,130.06 " " 30,894.37 " " 74,168.33 " " 59,334.66 " " 30,585.43 " " 31,512.26 " " 30,894.37 " " 169,947.47 " " 126,186.00 " " 75,386.50 " " 159,325.76 " " 31,512.26 " Inpatient 358 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC " 28,696.66 " " 7,306.17 " " 9,934.63 " " 26,960.56 " " 19,927.56 " " 10,034.98 " " 20,576.47 " " 10,034.98 " " 22,281.81 " " 10,034.98 " " 21,329.27 " " 10,737.43 " " 16,362.84 " " 10,034.98 " " 26,960.56 " " 21,568.44 " " 9,934.63 " " 10,235.68 " " 10,034.98 " " 22,957.33 " " 17,045.82 " " 23,609.25 " " 21,522.50 " " 10,235.68 " Inpatient 368 MAJOR ESOPHAGEAL DISORDERS WITH MCC " 43,038.86 " " 10,957.69 " " 14,122.45 " " 36,819.45 " " 28,790.16 " " 14,265.10 " " 29,727.67 " " 14,265.10 " " 29,073.00 " " 14,265.10 " " 30,815.27 " " 15,263.66 " " 24,540.76 " " 14,265.10 " " 36,819.45 " " 29,455.55 " " 14,122.45 " " 14,550.40 " " 14,265.10 " " 34,431.09 " " 25,565.08 " " 34,109.25 " " 32,279.15 " " 14,550.40 " Inpatient 369 MAJOR ESOPHAGEAL DISORDERS WITH CC " 35,983.08 " " 9,161.29 " " 8,036.86 " " 28,786.46 " " 15,911.32 " " 8,118.04 " " 16,429.45 " " 8,118.04 " " 17,213.73 " " 8,118.04 " " 17,030.53 " " 8,686.30 " " 20,517.55 " " 8,118.04 " " 19,960.02 " " 15,968.01 " " 8,036.86 " " 8,280.40 " " 8,118.04 " " 28,786.46 " " 21,373.95 " " 18,851.00 " " 26,987.31 " " 8,280.40 " Inpatient 371 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC " 35,395.75 " " 9,011.76 " " 12,601.57 " " 30,296.00 " " 25,571.56 " " 12,728.86 " " 26,404.26 " " 12,728.86 " " 27,288.18 " " 12,728.86 " " 27,370.27 " " 13,619.88 " " 20,182.66 " " 12,728.86 " " 29,043.76 " " 23,235.00 " " 12,601.57 " " 12,983.44 " " 12,728.86 " " 28,316.60 " " 21,025.08 " " 30,296.00 " " 26,546.81 " " 12,983.44 " Inpatient 372 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC " 32,838.64 " " 8,360.72 " " 7,702.54 " " 26,270.91 " " 15,203.79 " " 7,780.34 " " 15,698.88 " " 7,780.34 " " 16,756.46 " " 7,780.34 " " 16,273.23 " " 8,324.96 " " 18,724.59 " " 7,780.34 " " 16,738.31 " " 13,390.65 " " 7,702.54 " " 7,935.95 " " 7,780.34 " " 26,270.91 " " 19,506.15 " " 18,012.75 " " 24,628.98 " " 7,935.95 " Inpatient 373 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC " 9,597.13 " " 2,443.43 " " 5,472.28 " " 13,758.85 " " 10,998.49 " " 5,773.15 " " 11,356.64 " " 5,773.15 " " 12,061.79 " " 5,773.15 " " 11,772.13 " " 6,177.27 " " 5,472.28 " " 5,773.15 " " 13,758.85 " " 11,007.07 " " 5,715.42 " " 5,888.61 " " 5,773.15 " " 7,677.70 " " 5,700.70 " " 13,030.50 " " 7,197.85 " " 5,888.61 " Inpatient 374 DIGESTIVE MALIGNANCY WITH MCC " 62,536.92 " " 15,921.90 " " 14,992.11 " " 50,029.54 " " 30,630.62 " " 15,143.55 " " 31,628.07 " " 15,143.55 " " 31,669.54 " " 15,143.55 " " 32,785.20 " " 16,203.60 " " 35,658.55 " " 15,143.55 " " 35,026.92 " " 28,021.53 " " 14,992.11 " " 15,446.42 " " 15,143.55 " " 50,029.54 " " 37,146.93 " " 36,289.75 " " 46,902.69 " " 15,446.42 " Inpatient 375 DIGESTIVE MALIGNANCY WITH CC " 54,197.44 " " 13,798.67 " " 8,947.01 " " 43,357.95 " " 17,837.46 " " 9,037.38 " " 18,418.32 " " 9,037.38 " " 19,536.54 " " 9,037.38 " " 19,092.16 " " 9,670.00 " " 30,903.38 " " 9,037.38 " " 21,897.88 " " 17,518.30 " " 8,947.01 " " 9,218.13 " " 9,037.38 " " 43,357.95 " " 32,193.28 " " 21,133.00 " " 40,648.08 " " 9,218.13 " Inpatient 376 DIGESTIVE MALIGNANCY WITHOUT CC/MCC " 34,873.64 " " 8,878.83 " " 6,792.38 " " 27,898.91 " " 13,277.65 " " 6,860.99 " " 13,710.02 " " 6,860.99 " " 14,876.70 " " 6,860.99 " " 14,211.61 " " 7,341.26 " " 19,884.95 " " 6,860.99 " " 17,465.01 " " 13,972.01 " " 6,792.38 " " 6,998.21 " " 6,860.99 " " 27,898.91 " " 20,714.94 " " 15,730.75 " " 26,155.23 " " 6,998.21 " Inpatient 377 GASTROINTESTINAL HEMORRHAGE WITH MCC " 55,201.07 " " 14,054.19 " " 13,090.15 " " 44,160.86 " " 26,605.53 " " 13,222.37 " " 27,471.90 " " 13,222.37 " " 27,123.63 " " 13,222.37 " " 28,476.97 " " 14,147.94 " " 31,475.65 " " 13,222.37 " " 34,203.33 " " 27,362.65 " " 13,090.15 " " 13,486.82 " " 13,222.37 " " 44,160.86 " " 32,789.44 " " 31,521.00 " " 41,400.80 " " 13,486.82 " Inpatient 378 GASTROINTESTINAL HEMORRHAGE WITH CC " 42,398.23 " " 10,794.59 " " 7,452.66 " " 33,918.58 " " 14,674.99 " " 7,527.94 " " 15,152.86 " " 7,527.94 " " 15,354.54 " " 7,527.94 " " 15,707.24 " " 8,054.90 " " 24,175.47 " " 7,527.94 " " 18,942.64 " " 15,154.10 " " 7,452.66 " " 7,678.50 " " 7,527.94 " " 33,918.58 " " 25,184.55 " " 17,386.25 " " 31,798.67 " " 7,678.50 " Inpatient 379 GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC " 23,456.35 " " 5,971.99 " " 4,965.80 " " 18,765.08 " " 9,412.08 " " 5,015.96 " " 9,718.57 " " 5,015.96 " " 10,201.02 " " 5,015.96 " " 10,074.13 " " 5,367.08 " " 13,374.81 " " 5,015.96 " " 13,395.50 " " 10,716.39 " " 4,965.80 " " 5,116.28 " " 5,015.96 " " 18,765.08 " " 13,933.07 " " 11,151.00 " " 17,592.26 " " 5,116.28 " Inpatient 380 COMPLICATED PEPTIC ULCER WITH MCC " 43,136.24 " " 10,982.49 " " 13,686.22 " " 34,508.99 " " 27,866.97 " " 13,824.46 " " 28,774.42 " " 13,824.46 " " 30,014.47 " " 13,824.46 " " 29,827.15 " " 14,792.17 " " 24,596.28 " " 13,824.46 " " 34,082.21 " " 27,265.76 " " 13,686.22 " " 14,100.95 " " 13,824.46 " " 34,508.99 " " 25,622.93 " " 33,015.50 " " 32,352.18 " " 14,100.95 " Inpatient 381 COMPLICATED PEPTIC ULCER WITH CC " 35,314.30 " " 8,991.02 " " 7,911.92 " " 28,251.44 " " 15,646.92 " " 7,991.84 " " 16,156.44 " " 7,991.84 " " 17,060.26 " " 7,991.84 " " 16,747.53 " " 8,551.27 " " 20,136.21 " " 7,991.84 " " 18,918.41 " " 15,134.73 " " 7,911.92 " " 8,151.68 " " 7,991.84 " " 28,251.44 " " 20,976.69 " " 18,537.75 " " 26,485.73 " " 8,151.68 " Inpatient 382 COMPLICATED PEPTIC ULCER WITHOUT CC/MCC " 21,605.74 " " 5,500.82 " " 5,882.93 " " 17,284.59 " " 11,352.99 " " 5,942.35 " " 11,722.69 " " 5,942.35 " " 12,710.55 " " 5,942.35 " " 12,151.57 " " 6,358.31 " " 12,319.59 " " 5,942.35 " " 14,291.76 " " 11,433.40 " " 5,882.93 " " 6,061.20 " " 5,942.35 " " 17,284.59 " " 12,833.81 " " 13,450.50 " " 16,204.31 " " 6,061.20 " Inpatient 384 UNCOMPLICATED PEPTIC ULCER WITHOUT MCC " 27,166.63 " " 6,916.62 " " 6,749.81 " " 21,733.30 " " 13,187.55 " " 6,817.99 " " 13,616.99 " " 6,817.99 " " 13,871.93 " " 6,817.99 " " 14,115.17 " " 7,295.25 " " 15,490.41 " " 6,817.99 " " 15,963.17 " " 12,770.53 " " 6,749.81 " " 6,954.35 " " 6,817.99 " " 21,733.30 " " 16,136.98 " " 15,624.00 " " 20,374.97 " " 6,954.35 " Inpatient 385 INFLAMMATORY BOWEL DISEASE WITH MCC " 18,870.29 " " 4,804.38 " " 10,759.84 " " 28,390.25 " " 23,962.99 " " 11,961.10 " " 24,743.32 " " 11,961.10 " " 26,163.17 " " 11,961.10 " " 25,648.56 " " 12,798.38 " " 10,759.84 " " 11,961.10 " " 26,427.64 " " 21,142.11 " " 11,841.49 " " 12,200.32 " " 11,961.10 " " 15,096.23 " " 11,208.95 " " 28,390.25 " " 14,152.72 " " 12,200.32 " Inpatient 386 INFLAMMATORY BOWEL DISEASE WITH CC " 27,579.51 " " 7,021.74 " " 7,463.83 " " 22,063.61 " " 14,698.62 " " 7,539.22 " " 15,177.27 " " 7,539.22 " " 15,220.05 " " 7,539.22 " " 15,732.53 " " 8,066.97 " " 15,725.84 " " 7,539.22 " " 17,053.22 " " 13,642.57 " " 7,463.83 " " 7,690.00 " " 7,539.22 " " 22,063.61 " " 16,382.23 " " 17,414.25 " " 20,684.63 " " 7,690.00 " Inpatient 387 INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC " 20,181.91 " " 5,138.31 " " 5,506.73 " " 16,145.53 " " 10,556.83 " " 5,562.35 " " 10,900.60 " " 5,562.35 " " 11,628.25 " " 5,562.35 " " 11,299.41 " " 5,951.71 " " 11,507.73 " " 5,562.35 " " 13,007.92 " " 10,406.34 " " 5,506.73 " " 5,673.60 " " 5,562.35 " " 16,145.53 " " 11,988.05 " " 12,507.25 " " 15,136.43 " " 5,673.60 " Inpatient 388 GASTROINTESTINAL OBSTRUCTION WITH MCC " 22,802.39 " " 5,805.49 " " 11,089.77 " " 26,505.50 " " 22,372.16 " " 11,201.79 " " 23,100.68 " " 11,201.79 " " 24,114.10 " " 11,201.79 " " 23,945.83 " " 11,985.92 " " 13,001.92 " " 11,201.79 " " 22,455.02 " " 17,964.01 " " 11,089.77 " " 11,425.83 " " 11,201.79 " " 18,241.91 " " 13,544.62 " " 26,505.50 " " 17,101.79 " " 11,425.83 " Inpatient 389 GASTROINTESTINAL OBSTRUCTION WITH CC " 25,006.67 " " 6,366.70 " " 6,264.02 " " 20,005.34 " " 12,159.49 " " 6,327.29 " " 12,555.45 " " 6,327.29 " " 13,508.02 " " 6,327.29 " " 13,014.79 " " 6,770.20 " " 14,258.80 " " 6,327.29 " " 13,007.92 " " 10,406.34 " " 6,264.02 " " 6,453.84 " " 6,327.29 " " 20,005.34 " " 14,853.96 " " 14,406.00 " " 18,755.00 " " 6,453.84 " Inpatient 390 GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC " 17,065.42 " " 4,344.86 " " 4,588.19 " " 13,652.34 " " 8,612.97 " " 4,634.54 " " 8,893.44 " " 4,634.54 " " 9,439.95 " " 4,634.54 " " 9,218.81 " " 4,958.96 " " 9,730.70 " " 4,634.54 " " 10,294.91 " " 8,235.93 " " 4,588.19 " " 4,727.23 " " 4,634.54 " " 13,652.34 " " 10,136.86 " " 10,204.25 " " 12,799.07 " " 4,727.23 " Inpatient 391 "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC" " 34,411.32 " " 8,761.12 " " 9,237.36 " " 27,529.06 " " 18,451.93 " " 9,330.67 " " 19,052.80 " " 9,330.67 " " 19,542.86 " " 9,330.67 " " 19,749.85 " " 9,983.82 " " 19,621.33 " " 9,330.67 " " 21,292.30 " " 17,033.83 " " 9,237.36 " " 9,517.28 " " 9,330.67 " " 27,529.06 " " 20,440.32 " " 21,861.00 " " 25,808.49 " " 9,517.28 " Inpatient 392 "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC" " 23,929.85 " " 6,092.54 " " 5,863.38 " " 19,143.88 " " 11,311.63 " " 5,922.61 " " 11,679.98 " " 5,922.61 " " 12,015.92 " " 5,922.61 " " 12,107.30 " " 6,337.19 " " 13,644.80 " " 5,922.61 " " 13,080.59 " " 10,464.47 " " 5,863.38 " " 6,041.06 " " 5,922.61 " " 19,143.88 " " 14,214.33 " " 13,401.50 " " 17,947.39 " " 6,041.06 " Inpatient 393 OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC " 52,623.88 " " 13,398.04 " " 12,113.00 " " 42,099.10 " " 24,537.59 " " 12,235.35 " " 25,336.62 " " 12,235.35 " " 25,960.63 " " 12,235.35 " " 26,263.57 " " 13,091.82 " " 30,006.14 " " 12,235.35 " " 28,050.60 " " 22,440.48 " " 12,113.00 " " 12,480.06 " " 12,235.35 " " 42,099.10 " " 31,258.58 " " 29,071.00 " " 39,467.91 " " 12,480.06 " Inpatient 394 OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC " 28,573.17 " " 7,274.73 " " 7,085.53 " " 22,858.54 " " 13,898.03 " " 7,157.10 " " 14,350.61 " " 7,157.10 " " 14,921.00 " " 7,157.10 " " 14,875.63 " " 7,658.10 " " 16,292.42 " " 7,157.10 " " 17,053.22 " " 13,642.57 " " 7,085.53 " " 7,300.24 " " 7,157.10 " " 22,858.54 " " 16,972.46 " " 16,465.75 " " 21,429.88 " " 7,300.24 " Inpatient 395 OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC " 16,507.34 " " 4,202.77 " " 5,065.61 " " 14,485.55 " " 9,623.31 " " 5,116.78 " " 9,936.68 " " 5,116.78 " " 10,675.71 " " 5,116.78 " " 10,300.22 " " 5,474.95 " " 9,412.49 " " 5,116.78 " " 14,485.55 " " 11,588.43 " " 5,065.61 " " 5,219.12 " " 5,116.78 " " 13,205.87 " " 9,805.36 " " 11,401.25 " " 12,380.51 " " 5,219.12 " Inpatient 415 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC " 81,543.45 " " 20,760.96 " " 14,698.97 " " 65,234.76 " " 30,010.24 " " 14,847.44 " " 30,987.49 " " 14,847.44 " " 31,971.76 " " 14,847.44 " " 32,121.18 " " 15,886.76 " " 46,496.08 " " 14,847.44 " " 37,061.68 " " 29,649.33 " " 14,698.97 " " 15,144.39 " " 14,847.44 " " 65,234.76 " " 48,436.81 " " 35,554.75 " " 61,157.59 " " 15,144.39 " Inpatient 417 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC " 95,995.05 " " 24,440.34 " " 17,439.19 " " 76,796.04 " " 35,809.34 " " 17,615.34 " " 36,975.42 " " 17,615.34 " " 37,837.31 " " 17,615.34 " " 38,328.18 " " 18,848.41 " " 54,736.38 " " 17,615.34 " " 35,777.84 " " 28,622.27 " " 17,439.19 " " 17,967.65 " " 17,615.34 " " 76,796.04 " " 57,021.06 " " 42,425.25 " " 71,996.29 " " 17,967.65 " Inpatient 418 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC " 80,634.20 " " 20,529.47 " " 12,307.03 " " 64,507.36 " " 24,948.22 " " 12,431.34 " " 25,760.63 " " 12,431.34 " " 26,367.29 " " 12,431.34 " " 26,703.09 " " 13,301.53 " " 45,977.62 " " 12,431.34 " " 30,206.48 " " 24,165.18 " " 12,307.03 " " 12,679.97 " " 12,431.34 " " 64,507.36 " " 47,896.71 " " 29,557.50 " " 60,475.65 " " 12,679.97 " Inpatient 419 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC " 72,805.31 " " 18,536.23 " " 9,698.72 " " 58,244.25 " " 19,428.30 " " 9,796.69 " " 20,060.96 " " 9,796.69 " " 20,653.64 " " 9,796.69 " " 20,794.89 " " 10,482.46 " " 41,513.59 " " 9,796.69 " " 25,700.94 " " 20,560.75 " " 9,698.72 " " 9,992.62 " " 9,796.69 " " 58,244.25 " " 43,246.35 " " 23,017.75 " " 54,603.98 " " 9,992.62 " Inpatient 432 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC " 45,596.31 " " 11,608.82 " " 13,645.73 " " 36,477.05 " " 27,781.30 " " 13,783.57 " " 28,685.96 " " 13,783.57 " " 28,487.55 " " 13,783.57 " " 29,735.45 " " 14,748.42 " " 25,999.02 " " 13,783.57 " " 34,760.46 " " 27,808.36 " " 13,645.73 " " 14,059.24 " " 13,783.57 " " 36,477.05 " " 27,084.21 " " 32,914.00 " " 34,197.23 " " 14,059.24 " Inpatient 433 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC " 28,801.61 " " 7,332.89 " " 7,706.72 " " 23,041.29 " " 15,212.65 " " 7,784.57 " " 15,708.03 " " 7,784.57 " " 16,161.52 " " 7,784.57 " " 16,282.72 " " 8,329.49 " " 16,422.68 " " 7,784.57 " " 19,257.54 " " 15,406.03 " " 7,706.72 " " 7,940.26 " " 7,784.57 " " 23,041.29 " " 17,108.16 " " 18,023.25 " " 21,601.21 " " 7,940.26 " Inpatient 434 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC " 27,109.13 " " 6,901.98 " " 4,850.63 " " 21,687.30 " " 9,168.36 " " 4,899.63 " " 9,466.92 " " 4,899.63 " " 9,941.53 " " 4,899.63 " " 9,813.27 " " 5,242.60 " " 15,457.63 " " 4,899.63 " " 11,893.65 " " 9,514.92 " " 4,850.63 " " 4,997.62 " " 4,899.63 " " 21,687.30 " " 16,102.82 " " 10,862.25 " " 20,331.85 " " 4,997.62 " Inpatient 435 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC " 61,915.74 " " 15,763.75 " " 12,756.52 " " 49,532.59 " " 25,899.47 " " 12,885.37 " " 26,742.86 " " 12,885.37 " " 26,427.42 " " 12,885.37 " " 27,721.25 " " 13,787.35 " " 35,304.35 " " 12,885.37 " " 32,095.90 " " 25,676.71 " " 12,756.52 " " 13,143.08 " " 12,885.37 " " 49,532.59 " " 36,777.95 " " 30,684.50 " " 46,436.81 " " 13,143.08 " Inpatient 436 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC " 34,872.40 " " 8,878.51 " " 8,346.06 " " 27,897.92 " " 16,565.68 " " 8,430.36 " " 17,105.12 " " 8,430.36 " " 17,966.90 " " 8,430.36 " " 17,730.92 " " 9,020.49 " " 19,884.24 " " 8,430.36 " " 21,025.84 " " 16,820.67 " " 8,346.06 " " 8,598.97 " " 8,430.36 " " 27,897.92 " " 20,714.21 " " 19,626.25 " " 26,154.30 " " 8,598.97 " Inpatient 438 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC " 33,256.79 " " 8,467.18 " " 11,670.49 " " 33,379.73 " " 23,601.10 " " 11,788.37 " " 24,369.65 " " 11,788.37 " " 26,256.52 " " 11,788.37 " " 25,261.22 " " 12,613.56 " " 18,963.02 " " 11,788.37 " " 33,379.73 " " 26,703.78 " " 11,670.49 " " 12,024.14 " " 11,788.37 " " 26,605.43 " " 19,754.53 " " 27,961.50 " " 24,942.59 " " 12,024.14 " Inpatient 439 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC " 29,881.38 " " 7,607.80 " " 6,417.58 " " 23,905.10 " " 12,484.45 " " 6,482.40 " " 12,890.99 " " 6,482.40 " " 13,830.81 " " 6,482.40 " " 13,362.61 " " 6,936.17 " " 17,038.36 " " 6,482.40 " " 15,963.17 " " 12,770.53 " " 6,417.58 " " 6,612.05 " " 6,482.40 " " 23,905.10 " " 17,749.54 " " 14,791.00 " " 22,411.04 " " 6,612.05 " Inpatient 440 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC " 21,271.40 " " 5,415.70 " " 4,750.13 " " 17,017.12 " " 8,955.66 " " 4,798.11 " " 9,247.29 " " 4,798.11 " " 10,096.59 " " 4,798.11 " " 9,585.60 " " 5,133.98 " " 12,128.95 " " 4,798.11 " " 12,014.77 " " 9,611.81 " " 4,750.13 " " 4,894.07 " " 4,798.11 " " 17,017.12 " " 12,635.21 " " 10,610.25 " " 15,953.55 " " 4,894.07 " Inpatient 441 "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC" " 33,895.43 " " 8,629.78 " " 13,636.66 " " 36,746.78 " " 27,762.09 " " 13,774.40 " " 28,666.13 " " 13,774.40 " " 28,731.24 " " 13,774.40 " " 29,714.90 " " 14,738.61 " " 19,327.17 " " 13,774.40 " " 36,746.78 " " 29,397.41 " " 13,636.66 " " 14,049.89 " " 13,774.40 " " 27,116.34 " " 20,133.89 " " 32,891.25 " " 25,421.57 " " 14,049.89 " Inpatient 442 "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC" " 41,942.21 " " 10,678.49 " " 7,009.45 " " 33,553.77 " " 13,737.03 " " 7,080.25 " " 14,184.36 " " 7,080.25 " " 14,864.03 " " 7,080.25 " " 14,703.30 " " 7,575.87 " " 23,915.45 " " 7,080.25 " " 17,828.36 " " 14,262.69 " " 7,009.45 " " 7,221.86 " " 7,080.25 " " 33,553.77 " " 24,913.67 " " 16,275.00 " " 31,456.66 " " 7,221.86 " Inpatient 443 "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC" " 28,961.39 " " 7,373.57 " " 5,147.27 " " 23,169.11 " " 9,796.13 " " 5,199.26 " " 10,115.13 " " 5,199.26 " " 10,740.60 " " 5,199.26 " " 10,485.19 " " 5,563.21 " " 16,513.78 " " 5,199.26 " " 15,284.91 " " 12,227.93 " " 5,147.27 " " 5,303.25 " " 5,199.26 " " 23,169.11 " " 17,203.07 " " 11,606.00 " " 21,721.04 " " 5,303.25 " Inpatient 444 DISORDERS OF THE BILIARY TRACT WITH MCC " 74,357.44 " " 18,931.40 " " 12,185.58 " " 59,485.95 " " 24,691.20 " " 12,308.67 " " 25,495.24 " " 12,308.67 " " 25,311.90 " " 12,308.67 " " 26,428.00 " " 13,170.28 " " 42,398.61 " " 12,308.67 " " 28,026.38 " " 22,421.10 " " 12,185.58 " " 12,554.84 " " 12,308.67 " " 59,485.95 " " 44,168.32 " " 29,253.00 " " 55,768.08 " " 12,554.84 " Inpatient 445 DISORDERS OF THE BILIARY TRACT WITH CC " 51,158.71 " " 13,025.01 " " 8,038.95 " " 40,926.97 " " 15,915.75 " " 8,120.15 " " 16,434.03 " " 8,120.15 " " 16,742.21 " " 8,120.15 " " 17,035.28 " " 8,688.56 " " 29,170.70 " " 8,120.15 " " 20,904.73 " " 16,723.77 " " 8,038.95 " " 8,282.55 " " 8,120.15 " " 40,926.97 " " 30,388.27 " " 18,856.25 " " 38,369.03 " " 8,282.55 " Inpatient 446 DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC " 57,990.19 " " 14,764.30 " " 6,217.95 " " 46,392.15 " " 12,062.00 " " 6,280.76 " " 12,454.78 " " 6,280.76 " " 12,525.40 " " 6,280.76 " " 12,910.45 " " 6,720.41 " " 33,066.01 " " 6,280.76 " " 16,374.96 " " 13,099.97 " " 6,217.95 " " 6,406.38 " " 6,280.76 " " 46,392.15 " " 34,446.17 " " 14,290.50 " " 43,492.64 " " 6,406.38 " Inpatient 453 COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC " 229,066.76 " " 58,320.40 " " 64,647.67 " " 183,253.41 " " 135,715.95 " " 65,300.68 " " 140,135.38 " " 65,300.68 " " 154,124.57 " " 65,300.68 " " 145,262.28 " " 69,871.73 " " 130,613.87 " " 65,300.68 " " 179,297.42 " " 143,437.93 " " 64,647.67 " " 66,606.69 " " 65,300.68 " " 183,253.41 " " 136,065.66 " " 160,790.00 " " 171,800.07 " " 66,606.69 " Inpatient 454 COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC " 168,023.27 " " 42,778.72 " " 43,046.25 " " 134,418.62 " " 90,001.18 " " 43,481.06 " " 92,931.96 " " 43,481.06 " " 102,798.23 " " 43,481.06 " " 96,331.91 " " 46,524.73 " " 95,806.87 " " 43,481.06 " " 112,945.66 " " 90,356.53 " " 43,046.25 " " 44,350.68 " " 43,481.06 " " 134,418.62 " " 99,805.82 " " 106,629.25 " " 126,017.45 " " 44,350.68 " Inpatient 455 COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC " 152,078.57 " " 38,719.20 " " 33,890.30 " " 121,662.86 " " 70,624.58 " " 34,232.63 " " 72,924.39 " " 34,232.63 " " 80,356.61 " " 34,232.63 " " 75,592.35 " " 36,628.91 " " 86,715.20 " " 34,232.63 " " 92,729.51 " " 74,183.61 " " 33,890.30 " " 34,917.28 " " 34,232.63 " " 121,662.86 " " 90,334.67 " " 83,672.75 " " 114,058.93 " " 34,917.28 " Inpatient 459 SPINAL FUSION EXCEPT CERVICAL WITH MCC " 220,268.37 " " 56,080.33 " " 47,516.04 " " 176,214.70 " " 99,460.53 " " 47,996.00 " " 102,699.34 " " 47,996.00 " " 95,533.94 " " 47,996.00 " " 106,456.64 " " 51,355.72 " " 125,597.02 " " 47,996.00 " " 111,316.15 " " 89,052.92 " " 47,516.04 " " 48,955.92 " " 47,996.00 " " 176,214.70 " " 130,839.41 " " 117,836.25 " " 165,201.28 " " 48,955.92 " Inpatient 460 SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC " 132,615.73 " " 33,763.96 " " 27,953.38 " " 106,092.58 " " 58,060.37 " " 28,235.74 " " 59,951.04 " " 28,235.74 " " 63,533.70 " " 28,235.74 " " 62,144.37 " " 30,212.24 " " 75,617.49 " " 28,235.74 " " 61,055.84 " " 48,844.67 " " 27,953.38 " " 28,800.45 " " 28,235.74 " " 106,092.58 " " 78,773.74 " " 68,787.25 " " 99,461.80 " " 28,800.45 " Inpatient 464 WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC " 85,442.11 " " 21,753.56 " " 21,289.19 " " 68,353.69 " " 43,957.02 " " 21,504.23 " " 45,388.43 " " 21,504.23 " " 44,989.26 " " 21,504.23 " " 47,048.98 " " 23,009.53 " " 48,719.09 " " 21,504.23 " " 51,787.98 " " 41,430.38 " " 21,289.19 " " 21,934.31 " " 21,504.23 " " 68,353.69 " " 50,752.61 " " 52,078.25 " " 64,081.58 " " 21,934.31 " Inpatient 470 MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC " 88,277.39 " " 22,475.42 " " 13,781.84 " " 70,621.91 " " 28,069.33 " " 13,921.05 " " 28,983.38 " " 13,921.05 " " 32,506.58 " " 13,921.05 " " 30,043.74 " " 14,895.52 " " 50,335.77 " " 13,921.05 " " 32,653.04 " " 26,122.42 " " 13,781.84 " " 14,199.47 " " 13,921.05 " " 70,621.91 " " 52,436.77 " " 33,255.25 " " 66,208.04 " " 14,199.47 " Inpatient 472 CERVICAL SPINAL FUSION WITH CC " 129,894.81 " " 33,071.22 " " 21,832.20 " " 103,915.85 " " 45,106.20 " " 22,052.73 " " 46,575.03 " " 22,052.73 " " 45,152.23 " " 22,052.73 " " 48,279.00 " " 23,596.42 " " 74,066.02 " " 22,052.73 " " 51,940.75 " " 41,552.60 " " 21,832.20 " " 22,493.78 " " 22,052.73 " " 103,915.85 " " 77,157.52 " " 53,439.75 " " 97,421.11 " " 22,493.78 " Inpatient 473 CERVICAL SPINAL FUSION WITHOUT CC/MCC " 117,790.87 " " 29,989.56 " " 18,239.76 " " 94,232.70 " " 37,503.57 " " 18,424.00 " " 38,724.83 " " 18,424.00 " " 36,264.51 " " 18,424.00 " " 40,141.59 " " 19,713.68 " " 67,164.35 " " 18,424.00 " " 38,733.09 " " 30,986.46 " " 18,239.76 " " 18,792.48 " " 18,424.00 " " 94,232.70 " " 69,967.78 " " 44,432.50 " " 88,343.15 " " 18,792.48 " Inpatient 477 BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC " 96,045.77 " " 24,453.25 " " 23,962.41 " " 76,836.62 " " 49,614.31 " " 24,204.45 " " 51,229.94 " " 24,204.45 " " 51,158.62 " " 24,204.45 " " 53,104.21 " " 25,898.76 " " 54,765.30 " " 24,204.45 " " 62,456.20 " " 49,964.96 " " 23,962.41 " " 24,688.54 " " 24,204.45 " " 76,836.62 " " 57,051.19 " " 58,780.75 " " 72,034.33 " " 24,688.54 " Inpatient 478 BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC " 107,042.90 " " 27,253.12 " " 16,979.23 " " 85,634.32 " " 34,835.93 " " 17,150.74 " " 35,970.32 " " 17,150.74 " " 35,422.73 " " 17,150.74 " " 37,286.30 " " 18,351.29 " " 61,035.86 " " 17,150.74 " " 42,996.39 " " 34,397.10 " " 16,979.23 " " 17,493.75 " " 17,150.74 " " 85,634.32 " " 63,583.48 " " 41,272.00 " " 80,282.18 " " 17,493.75 " Inpatient 480 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC " 101,485.62 " " 25,838.24 " " 21,637.47 " " 81,188.50 " " 44,694.09 " " 21,856.03 " " 46,149.50 " " 21,856.03 " " 47,786.75 " " 21,856.03 " " 47,837.90 " " 23,385.95 " " 57,867.10 " " 21,856.03 " " 67,803.04 " " 54,242.43 " " 21,637.47 " " 22,293.15 " " 21,856.03 " " 81,188.50 " " 60,282.46 " " 52,951.50 " " 76,114.22 " " 22,293.15 " Inpatient 481 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC " 64,739.04 " " 16,482.56 " " 15,148.46 " " 51,791.23 " " 30,961.49 " " 15,301.47 " " 31,969.72 " " 15,301.47 " " 32,440.11 " " 15,301.47 " " 33,139.34 " " 16,372.57 " " 36,914.20 " " 15,301.47 " " 43,626.20 " " 34,900.95 " " 15,148.46 " " 15,607.50 " " 15,301.47 " " 51,791.23 " " 38,454.99 " " 36,681.75 " " 48,554.28 " " 15,607.50 " Inpatient 482 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC " 55,458.75 " " 14,119.80 " " 12,005.50 " " 44,367.00 " " 24,310.11 " " 12,126.77 " " 25,101.74 " " 12,126.77 " " 26,413.17 " " 12,126.77 " " 26,020.10 " " 12,975.64 " " 31,622.58 " " 12,126.77 " " 31,684.10 " " 25,347.27 " " 12,005.50 " " 12,369.31 " " 12,126.77 " " 44,367.00 " " 32,942.50 " " 28,801.50 " " 41,594.06 " " 12,369.31 " Inpatient 492 "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC" " 168,241.79 " " 42,834.36 " " 24,737.84 " " 134,593.43 " " 51,255.37 " " 24,987.72 " " 52,924.44 " " 24,987.72 " " 52,231.40 " " 24,987.72 " " 54,860.70 " " 26,736.86 " " 95,931.47 " " 24,987.72 " " 63,092.73 " " 50,474.18 " " 24,737.84 " " 25,487.47 " " 24,987.72 " " 134,593.43 " " 99,935.62 " " 60,725.00 " " 126,181.34 " " 25,487.47 " Inpatient 493 "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC" " 93,960.40 " " 23,922.32 " " 16,751.69 " " 75,168.32 " " 34,354.39 " " 16,920.90 " " 35,473.10 " " 16,920.90 " " 34,868.93 " " 16,920.90 " " 36,770.90 " " 18,105.36 " " 53,576.22 " " 16,920.90 " " 44,643.58 " " 35,714.85 " " 16,751.69 " " 17,259.32 " " 16,920.90 " " 75,168.32 " " 55,812.48 " " 40,701.50 " " 70,470.30 " " 17,259.32 " Inpatient 494 "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC" " 106,822.29 " " 27,196.96 " " 13,442.63 " " 85,457.83 " " 27,351.46 " " 13,578.41 " " 28,242.13 " " 13,578.41 " " 27,789.77 " " 13,578.41 " " 29,275.38 " " 14,528.90 " " 60,910.07 " " 13,578.41 " " 31,635.66 " " 25,308.52 " " 13,442.63 " " 13,849.98 " " 13,578.41 " " 85,457.83 " " 63,452.44 " " 32,404.75 " " 80,116.72 " " 13,849.98 " Inpatient 501 SOFT TISSUE PROCEDURES WITH CC " 37,163.25 " " 9,461.76 " " 12,761.41 " " 30,696.75 " " 25,909.81 " " 12,890.31 " " 26,753.53 " " 12,890.31 " " 26,721.72 " " 12,890.31 " " 27,732.32 " " 13,792.63 " " 21,190.49 " " 12,890.31 " " 30,618.28 " " 24,494.61 " " 12,761.41 " " 13,148.12 " " 12,890.31 " " 29,730.60 " " 22,074.97 " " 30,696.75 " " 27,872.44 " " 13,148.12 " Inpatient 504 FOOT PROCEDURES WITH CC " 131,862.31 " " 33,572.14 " " 12,907.28 " " 105,489.85 " " 26,218.53 " " 13,037.66 " " 27,072.30 " " 13,037.66 " " 27,283.43 " " 13,037.66 " " 28,062.75 " " 13,950.30 " " 75,187.89 " " 13,037.66 " " 33,064.83 " " 26,451.86 " " 12,907.28 " " 13,298.41 " " 13,037.66 " " 105,489.85 " " 78,326.21 " " 31,062.50 " " 98,896.73 " " 13,298.41 " Inpatient 515 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC " 70,973.49 " " 18,069.85 " " 22,438.74 " " 62,659.89 " " 46,389.80 " " 22,665.39 " " 47,900.43 " " 22,665.39 " " 46,196.55 " " 22,665.39 " " 49,652.89 " " 24,251.97 " " 40,469.08 " " 22,665.39 " " 62,659.89 " " 50,127.91 " " 22,438.74 " " 23,118.70 " " 22,665.39 " " 56,778.79 " " 42,158.25 " " 54,960.50 " " 53,230.12 " " 23,118.70 " Inpatient 516 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC " 65,135.53 " " 16,583.51 " " 14,218.06 " " 52,108.42 " " 28,992.52 " " 14,361.68 " " 29,936.63 " " 14,361.68 " " 29,778.70 " " 14,361.68 " " 31,031.87 " " 15,367.00 " " 37,140.28 " " 14,361.68 " " 40,138.04 " " 32,110.42 " " 14,218.06 " " 14,648.91 " " 14,361.68 " " 52,108.42 " " 38,690.50 " " 34,349.00 " " 48,851.65 " " 14,648.91 " Inpatient 517 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC " 68,857.10 " " 17,531.02 " " 10,277.34 " " 55,085.68 " " 20,652.81 " " 10,381.15 " " 21,325.35 " " 10,381.15 " " 22,723.28 " " 10,381.15 " " 22,105.54 " " 11,107.83 " " 39,262.32 " " 10,381.15 " " 25,289.15 " " 20,231.31 " " 10,277.34 " " 10,588.77 " " 10,381.15 " " 55,085.68 " " 40,901.12 " " 24,468.50 " " 51,642.83 " " 10,588.77 " Inpatient 518 BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR " 99,865.58 " " 25,425.78 " " 25,553.77 " " 79,892.46 " " 52,982.10 " " 25,811.89 " " 54,707.40 " " 25,811.89 " " 45,770.90 " " 25,811.89 " " 56,708.89 " " 27,618.72 " " 56,943.35 " " 25,811.89 " " 46,629.89 " " 37,303.90 " " 25,553.77 " " 26,328.13 " " 25,811.89 " " 79,892.46 " " 59,320.15 " " 62,770.75 " " 74,899.19 " " 26,328.13 " Inpatient 519 BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC " 81,445.37 " " 20,735.99 " " 14,198.52 " " 65,156.30 " " 28,951.16 " " 14,341.94 " " 29,893.92 " " 14,341.94 " " 28,535.04 " " 14,341.94 " " 30,987.60 " " 15,345.88 " " 46,440.15 " " 14,341.94 " " 31,562.99 " " 25,250.38 " " 14,198.52 " " 14,628.78 " " 14,341.94 " " 65,156.30 " " 48,378.55 " " 34,300.00 " " 61,084.03 " " 14,628.78 " Inpatient 520 BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC " 55,996.07 " " 14,256.60 " " 10,417.63 " " 44,796.86 " " 20,949.71 " " 10,522.86 " " 21,631.91 " " 10,522.86 " " 20,511.23 " " 10,522.86 " " 22,423.32 " " 11,259.46 " " 31,928.96 " " 10,522.86 " " 24,441.33 " " 19,553.06 " " 10,417.63 " " 10,733.32 " " 10,522.86 " " 44,796.86 " " 33,261.67 " " 24,820.25 " " 41,997.05 " " 10,733.32 " Inpatient 521 HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC " 75,753.69 " " 19,286.89 " " 21,919.45 " " 77,987.50 " " 45,290.84 " " 22,140.86 " " 46,765.68 " " 22,140.86 " " 48,471.13 " " 22,140.86 " " 48,476.62 " " 23,690.72 " " 43,194.75 " " 22,140.86 " " 77,987.50 " " 62,390.00 " " 21,919.45 " " 22,583.68 " " 22,140.86 " " 60,602.95 " " 44,997.69 " " 53,658.50 " " 56,815.27 " " 22,583.68 " Inpatient 522 HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC " 66,928.46 " " 17,039.99 " " 15,799.67 " " 53,542.77 " " 32,339.63 " " 15,959.26 " " 33,392.73 " " 15,959.26 " " 34,637.34 " " 15,959.26 " " 34,614.41 " " 17,076.41 " " 38,162.61 " " 15,959.26 " " 41,203.87 " " 32,963.08 " " 15,799.67 " " 16,278.45 " " 15,959.26 " " 53,542.77 " " 39,755.51 " " 38,314.50 " " 50,196.35 " " 16,278.45 " Inpatient 536 FRACTURES OF HIP AND PELVIS WITHOUT MCC " 16,646.74 " " 4,238.26 " " 5,904.57 " " 14,582.44 " " 11,398.78 " " 5,964.21 " " 11,769.97 " " 5,964.21 " " 11,938.38 " " 5,964.21 " " 12,200.58 " " 6,381.70 " " 9,491.97 " " 5,964.21 " " 14,582.44 " " 11,665.95 " " 5,904.57 " " 6,083.49 " " 5,964.21 " " 13,317.39 " " 9,888.16 " " 13,504.75 " " 12,485.06 " " 6,083.49 " Inpatient 540 OSTEOMYELITIS WITH CC " 32,344.04 " " 8,234.79 " " 9,603.10 " " 25,875.23 " " 19,225.93 " " 9,700.10 " " 19,852.00 " " 9,700.10 " " 20,436.87 " " 9,700.10 " " 20,578.30 " " 10,379.11 " " 18,442.57 " " 9,700.10 " " 20,541.38 " " 16,433.10 " " 9,603.10 " " 9,894.10 " " 9,700.10 " " 25,875.23 " " 19,212.36 " " 22,778.00 " " 24,258.03 " " 9,894.10 " Inpatient 542 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC " 68,839.26 " " 17,526.48 " " 13,145.98 " " 55,071.41 " " 26,723.69 " " 13,278.77 " " 27,593.92 " " 13,278.77 " " 28,645.78 " " 13,278.77 " " 28,603.45 " " 14,208.28 " " 39,252.15 " " 13,278.77 " " 39,120.66 " " 31,296.52 " " 13,145.98 " " 13,544.35 " " 13,278.77 " " 55,071.41 " " 40,890.52 " " 31,661.00 " " 51,629.45 " " 13,544.35 " Inpatient 543 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC " 36,441.51 " " 9,278.01 " " 7,813.51 " " 29,153.21 " " 15,438.65 " " 7,892.43 " " 15,941.39 " " 7,892.43 " " 17,083.98 " " 7,892.43 " " 16,524.61 " " 8,444.90 " " 20,778.95 " " 7,892.43 " " 23,375.50 " " 18,700.40 " " 7,813.51 " " 8,050.28 " " 7,892.43 " " 29,153.21 " " 21,646.26 " " 18,291.00 " " 27,331.13 " " 8,050.28 " Inpatient 549 SEPTIC ARTHRITIS WITH CC " 26,176.35 " " 6,664.50 " " 9,242.25 " " 23,205.94 " " 18,462.27 " " 9,335.61 " " 19,063.47 " " 9,335.61 " " 18,897.30 " " 9,335.61 " " 19,760.92 " " 9,989.10 " " 14,925.75 " " 9,335.61 " " 23,205.94 " " 18,564.75 " " 9,242.25 " " 9,522.32 " " 9,335.61 " " 20,941.08 " " 15,548.75 " " 21,873.25 " " 19,632.26 " " 9,522.32 " Inpatient 550 SEPTIC ARTHRITIS WITHOUT CC/MCC " 31,595.15 " " 8,044.13 " " 6,652.79 " " 25,276.12 " " 12,982.23 " " 6,719.99 " " 13,404.98 " " 6,719.99 " " 14,250.12 " " 6,719.99 " " 13,895.41 " " 7,190.39 " " 18,015.55 " " 6,719.99 " " 19,087.98 " " 15,270.38 " " 6,652.79 " " 6,854.39 " " 6,719.99 " " 25,276.12 " " 18,767.52 " " 15,380.75 " " 23,696.36 " " 6,854.39 " Inpatient 552 MEDICAL BACK PROBLEMS WITHOUT MCC " 23,186.18 " " 5,903.20 " " 7,102.97 " " 18,548.94 " " 13,934.96 " " 7,174.72 " " 14,388.74 " " 7,174.72 " " 14,142.52 " " 7,174.72 " " 14,915.15 " " 7,676.95 " " 13,220.76 " " 7,174.72 " " 17,295.45 " " 13,836.36 " " 7,102.97 " " 7,318.21 " " 7,174.72 " " 18,548.94 " " 13,772.59 " " 16,509.50 " " 17,389.64 " " 7,318.21 " Inpatient 554 BONE DISEASES AND ARTHROPATHIES WITHOUT MCC " 19,228.91 " " 4,895.68 " " 6,049.74 " " 18,119.04 " " 11,706.02 " " 6,110.85 " " 12,087.21 " " 6,110.85 " " 11,894.07 " " 6,110.85 " " 12,529.43 " " 6,538.61 " " 10,964.32 " " 6,110.85 " " 18,119.04 " " 14,495.23 " " 6,049.74 " " 6,233.07 " " 6,110.85 " " 15,383.13 " " 11,421.97 " " 13,868.75 " " 14,421.68 " " 6,233.07 " Inpatient 556 SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC " 28,422.01 " " 7,236.24 " " 6,162.81 " " 22,737.61 " " 11,945.31 " " 6,225.06 " " 12,334.29 " " 6,225.06 " " 12,324.46 " " 6,225.06 " " 12,785.55 " " 6,660.81 " " 16,206.23 " " 6,225.06 " " 17,150.11 " " 13,720.08 " " 6,162.81 " " 6,349.56 " " 6,225.06 " " 22,737.61 " " 16,882.67 " " 14,152.25 " " 21,316.51 " " 6,349.56 " Inpatient 558 "TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC" " 21,315.99 " " 5,427.05 " " 6,530.64 " " 17,052.79 " " 12,723.74 " " 6,596.61 " " 13,138.07 " " 6,596.61 " " 13,555.47 " " 6,596.61 " " 13,618.73 " " 7,058.37 " " 12,154.38 " " 6,596.61 " " 11,215.40 " " 8,972.31 " " 6,530.64 " " 6,728.54 " " 6,596.61 " " 17,052.79 " " 12,661.70 " " 15,074.50 " " 15,986.99 " " 6,728.54 " Inpatient 562 "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC" " 28,958.28 " " 7,372.78 " " 10,372.26 " " 29,189.10 " " 20,853.70 " " 10,477.03 " " 21,532.77 " " 10,477.03 " " 21,870.41 " " 10,477.03 " " 22,320.56 " " 11,210.42 " " 16,512.01 " " 10,477.03 " " 29,189.10 " " 23,351.27 " " 10,372.26 " " 10,686.57 " " 10,477.03 " " 23,166.62 " " 17,201.22 " " 24,706.50 " " 21,718.71 " " 10,686.57 " Inpatient 563 "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC" " 21,198.01 " " 5,397.01 " " 6,606.02 " " 16,958.41 " " 12,883.27 " " 6,672.75 " " 13,302.79 " " 6,672.75 " " 13,030.16 " " 6,672.75 " " 13,789.48 " " 7,139.84 " " 12,087.11 " " 6,672.75 " " 16,374.96 " " 13,099.97 " " 6,606.02 " " 6,806.21 " " 6,672.75 " " 16,958.41 " " 12,591.62 " " 15,263.50 " " 15,898.51 " " 6,806.21 " Inpatient 565 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC " 35,734.21 " " 9,097.93 " " 7,562.94 " " 28,587.37 " " 14,908.37 " " 7,639.33 " " 15,393.84 " " 7,639.33 " " 15,072.91 " " 7,639.33 " " 15,957.03 " " 8,174.08 " " 20,375.65 " " 7,639.33 " " 17,586.13 " " 14,068.90 " " 7,562.94 " " 7,792.12 " " 7,639.33 " " 28,587.37 " " 21,226.12 " " 17,662.75 " " 26,800.66 " " 7,792.12 " Inpatient 566 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC " 21,430.77 " " 5,456.27 " " 5,766.36 " " 17,144.62 " " 11,106.31 " " 5,824.61 " " 11,467.98 " " 5,824.61 " " 12,292.82 " " 5,824.61 " " 11,887.54 " " 6,232.33 " " 12,219.83 " " 5,824.61 " " 15,139.58 " " 12,111.66 " " 5,766.36 " " 5,941.10 " " 5,824.61 " " 17,144.62 " " 12,729.88 " " 13,158.25 " " 16,073.08 " " 5,941.10 " Inpatient 570 SKIN DEBRIDEMENT WITH MCC " 46,339.17 " " 11,797.95 " " 20,352.51 " " 49,729.75 " " 41,974.75 " " 20,558.09 " " 43,341.61 " " 20,558.09 " " 41,055.68 " " 20,558.09 " " 44,927.28 " " 21,997.16 " " 26,422.59 " " 20,558.09 " " 44,474.02 " " 35,579.20 " " 20,352.51 " " 20,969.25 " " 20,558.09 " " 37,071.34 " " 27,525.47 " " 49,729.75 " " 34,754.38 " " 20,969.25 " Inpatient 571 SKIN DEBRIDEMENT WITH CC " 52,605.45 " " 13,393.35 " " 11,932.92 " " 42,084.36 " " 24,156.49 " " 12,053.45 " " 24,943.12 " " 12,053.45 " " 25,770.76 " " 12,053.45 " " 25,855.67 " " 12,897.19 " " 29,995.63 " " 12,053.45 " " 26,645.65 " " 21,316.52 " " 11,932.92 " " 12,294.52 " " 12,053.45 " " 42,084.36 " " 31,247.64 " " 28,619.50 " " 39,454.09 " " 12,294.52 " Inpatient 579 "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC" " 140,804.40 " " 35,848.80 " " 22,468.75 " " 112,643.52 " " 46,453.32 " " 22,695.71 " " 47,966.01 " " 22,695.71 " " 42,096.83 " " 22,695.71 " " 49,720.87 " " 24,284.41 " " 80,286.67 " " 22,695.71 " " 52,042.59 " " 41,634.07 " " 22,468.75 " " 23,149.62 " " 22,695.71 " " 112,643.52 " " 83,637.81 " " 55,035.75 " " 105,603.30 " " 23,149.62 " Inpatient 580 "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC" " 105,276.44 " " 26,803.38 " " 12,584.82 " " 84,221.15 " " 25,536.10 " " 12,711.94 " " 26,367.66 " " 12,711.94 " " 24,618.86 " " 12,711.94 " " 27,332.33 " " 13,601.78 " " 60,028.63 " " 12,711.94 " " 27,154.34 " " 21,723.47 " " 12,584.82 " " 12,966.18 " " 12,711.94 " " 84,221.15 " " 62,534.21 " " 30,254.00 " " 78,957.33 " " 12,966.18 " Inpatient 581 "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC" " 124,373.08 " " 31,665.39 " " 10,127.97 " " 99,498.46 " " 20,336.71 " " 10,230.27 " " 20,998.95 " " 10,230.27 " " 19,367.24 " " 10,230.27 " " 21,767.21 " " 10,946.39 " " 70,917.53 " " 10,230.27 " " 21,873.66 " " 17,498.92 " " 10,127.97 " " 10,434.88 " " 10,230.27 " " 99,498.46 " " 73,877.61 " " 24,094.00 " " 93,279.81 " " 10,434.88 " Inpatient 583 MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC " 153,463.08 " " 39,071.70 " " 11,277.53 " " 122,770.46 " " 22,769.50 " " 11,391.44 " " 23,510.96 " " 11,391.44 " " 21,444.78 " " 11,391.44 " " 24,371.12 " " 12,188.84 " " 87,504.65 " " 11,391.44 " " 39,096.44 " " 31,277.14 " " 11,277.53 " " 11,619.27 " " 11,391.44 " " 122,770.46 " " 91,157.07 " " 26,976.25 " " 115,097.31 " " 11,619.27 " Inpatient 597 MALIGNANT BREAST DISORDERS WITH MCC " 47,765.05 " " 12,160.98 " " 11,992.94 " " 38,212.04 " " 24,283.52 " " 12,114.08 " " 25,074.29 " " 12,114.08 " " 28,535.04 " " 12,114.08 " " 25,991.64 " " 12,962.07 " " 27,235.63 " " 12,114.08 " " 36,383.43 " " 29,106.73 " " 11,992.94 " " 12,356.36 " " 12,114.08 " " 38,212.04 " " 28,372.44 " " 28,770.00 " " 35,823.79 " " 12,356.36 " Inpatient 602 CELLULITIS WITH MCC " 40,812.59 " " 10,390.89 " " 10,638.89 " " 32,650.07 " " 21,417.95 " " 10,746.35 " " 22,115.40 " " 10,746.35 " " 22,887.83 " " 10,746.35 " " 22,924.50 " " 11,498.59 " " 23,271.34 " " 10,746.35 " " 22,067.44 " " 17,653.95 " " 10,638.89 " " 10,961.28 " " 10,746.35 " " 32,650.07 " " 24,242.68 " " 25,375.00 " " 30,609.44 " " 10,961.28 " Inpatient 603 CELLULITIS WITHOUT MCC " 19,737.07 " " 5,025.06 " " 6,476.20 " " 15,789.66 " " 12,608.53 " " 6,541.62 " " 13,019.11 " " 6,541.62 " " 13,454.21 " " 6,541.62 " " 13,495.42 " " 6,999.53 " " 11,254.08 " " 6,541.62 " " 10,706.71 " " 8,565.36 " " 6,476.20 " " 6,672.45 " " 6,541.62 " " 15,789.66 " " 11,723.82 " " 14,938.00 " " 14,802.80 " " 6,672.45 " Inpatient 605 "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC" " 19,466.18 " " 4,956.09 " " 6,827.28 " " 15,818.25 " " 13,351.51 " " 6,896.24 " " 13,786.28 " " 6,896.24 " " 13,384.60 " " 6,896.24 " " 14,290.66 " " 7,378.98 " " 11,099.62 " " 6,896.24 " " 15,139.58 " " 12,111.66 " " 6,827.28 " " 7,034.16 " " 6,896.24 " " 15,572.94 " " 11,562.91 " " 15,818.25 " " 14,599.64 " " 7,034.16 " Inpatient 607 MINOR SKIN DISORDERS WITHOUT MCC " 21,526.57 " " 5,480.66 " " 6,298.91 " " 17,221.26 " " 12,233.34 " " 6,362.54 " " 12,631.71 " " 6,362.54 " " 12,495.36 " " 6,362.54 " " 13,093.84 " " 6,807.92 " " 12,274.45 " " 6,362.54 " " 10,924.72 " " 8,739.77 " " 6,298.91 " " 6,489.79 " " 6,362.54 " " 17,221.26 " " 12,786.78 " " 14,493.50 " " 16,144.93 " " 6,489.79 " Inpatient 617 "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC" " 56,323.43 " " 14,339.95 " " 14,685.71 " " 45,058.74 " " 29,982.18 " " 14,834.05 " " 30,958.51 " " 14,834.05 " " 33,199.63 " " 14,834.05 " " 32,091.14 " " 15,872.43 " " 32,115.62 " " 14,834.05 " " 30,957.40 " " 24,765.91 " " 14,685.71 " " 15,130.73 " " 14,834.05 " " 45,058.74 " " 33,456.12 " " 35,521.50 " " 42,242.57 " " 15,130.73 " Inpatient 620 O.R. PROCEDURES FOR OBESITY WITH CC " 62,438.73 " " 15,896.90 " " 12,821.43 " " 49,950.98 " " 26,036.84 " " 12,950.94 " " 26,884.70 " " 12,950.94 " " 29,036.61 " " 12,950.94 " " 27,868.29 " " 13,857.51 " " 35,602.56 " " 12,950.94 " " 30,715.17 " " 24,572.13 " " 12,821.43 " " 13,209.96 " " 12,950.94 " " 49,950.98 " " 37,088.61 " " 30,847.25 " " 46,829.05 " " 13,209.96 " Inpatient 621 O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC " 63,340.43 " " 16,126.47 " " 11,665.60 " " 50,672.34 " " 23,590.76 " " 11,783.43 " " 24,358.97 " " 11,783.43 " " 25,044.49 " " 11,783.43 " " 25,250.15 " " 12,608.27 " " 36,116.71 " " 11,783.43 " " 26,815.22 " " 21,452.17 " " 11,665.60 " " 12,019.10 " " 11,783.43 " " 50,672.34 " " 37,624.22 " " 27,949.25 " " 47,505.32 " " 12,019.10 " Inpatient 622 "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC" " 127,946.28 " " 32,575.12 " " 25,749.20 " " 102,357.02 " " 53,395.69 " " 26,009.29 " " 55,134.45 " " 26,009.29 " " 57,152.33 " " 26,009.29 " " 57,151.57 " " 27,829.94 " " 72,954.97 " " 26,009.29 " " 89,699.63 " " 71,759.71 " " 25,749.20 " " 26,529.48 " " 26,009.29 " " 102,357.02 " " 76,000.09 " " 63,260.75 " " 95,959.71 " " 26,529.48 " Inpatient 623 "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC" " 48,352.54 " " 12,310.56 " " 13,580.82 " " 38,682.03 " " 27,643.93 " " 13,718.00 " " 28,544.12 " " 13,718.00 " " 30,020.80 " " 13,718.00 " " 29,588.42 " " 14,678.26 " " 27,570.62 " " 13,718.00 " " 29,140.65 " " 23,312.52 " " 13,580.82 " " 13,992.36 " " 13,718.00 " " 38,682.03 " " 28,721.41 " " 32,751.25 " " 36,264.41 " " 13,992.36 " Inpatient 629 "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC" " 63,462.64 " " 16,157.59 " " 16,887.80 " " 50,770.11 " " 34,642.43 " " 17,058.38 " " 35,770.52 " " 17,058.38 " " 36,645.85 " " 17,058.38 " " 37,079.19 " " 18,252.47 " " 36,186.40 " " 17,058.38 " " 36,892.12 " " 29,513.68 " " 16,887.80 " " 17,399.55 " " 17,058.38 " " 50,770.11 " " 37,696.81 " " 41,042.75 " " 47,596.98 " " 17,399.55 " Inpatient 637 DIABETES WITH MCC " 43,669.02 " " 11,118.13 " " 10,126.57 " " 34,935.22 " " 20,333.76 " " 10,228.86 " " 20,995.90 " " 10,228.86 " " 21,122.00 " " 10,228.86 " " 21,764.05 " " 10,944.88 " " 24,900.08 " " 10,228.86 " " 24,199.10 " " 19,359.27 " " 10,126.57 " " 10,433.44 " " 10,228.86 " " 34,935.22 " " 25,939.40 " " 24,090.50 " " 32,751.77 " " 10,433.44 " Inpatient 638 DIABETES WITH CC " 19,356.38 " " 4,928.13 " " 6,656.27 " " 15,485.10 " " 12,989.62 " " 6,723.51 " " 13,412.61 " " 6,723.51 " " 13,470.04 " " 6,723.51 " " 13,903.31 " " 7,194.16 " " 11,037.01 " " 6,723.51 " " 13,565.06 " " 10,852.04 " " 6,656.27 " " 6,857.98 " " 6,723.51 " " 15,485.10 " " 11,497.69 " " 15,389.50 " " 14,517.29 " " 6,857.98 " Inpatient 639 DIABETES WITHOUT CC/MCC " 21,441.19 " " 5,458.93 " " 4,773.16 " " 17,152.95 " " 9,004.40 " " 4,821.37 " " 9,297.62 " " 4,821.37 " " 9,901.99 " " 4,821.37 " " 9,637.78 " " 5,158.87 " " 12,225.77 " " 4,821.37 " " 10,416.03 " " 8,332.82 " " 4,773.16 " " 4,917.80 " " 4,821.37 " " 17,152.95 " " 12,736.07 " " 10,668.00 " " 16,080.89 " " 4,917.80 " Inpatient 640 "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC" " 32,069.36 " " 8,164.86 " " 9,108.94 " " 25,655.49 " " 18,180.15 " " 9,200.95 " " 18,772.16 " " 9,200.95 " " 18,552.35 " " 9,200.95 " " 19,458.95 " " 9,845.02 " " 18,285.95 " " 9,200.95 " " 22,503.46 " " 18,002.77 " " 9,108.94 " " 9,384.97 " " 9,200.95 " " 25,655.49 " " 19,049.20 " " 21,539.00 " " 24,052.02 " " 9,384.97 " Inpatient 641 "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC" " 22,938.42 " " 5,840.12 " " 5,782.42 " " 18,350.74 " " 11,140.29 " " 5,840.83 " " 11,503.06 " " 5,840.83 " " 11,805.47 " " 5,840.83 " " 11,923.90 " " 6,249.69 " " 13,079.49 " " 5,840.83 " " 13,298.60 " " 10,638.88 " " 5,782.42 " " 5,957.65 " " 5,840.83 " " 18,350.74 " " 13,625.42 " " 13,198.50 " " 17,203.82 " " 5,957.65 " Inpatient 643 ENDOCRINE DISORDERS WITH MCC " 63,728.57 " " 16,225.29 " " 12,158.36 " " 50,982.86 " " 24,633.60 " " 12,281.17 " " 25,435.76 " " 12,281.17 " " 25,182.14 " " 12,281.17 " " 26,366.34 " " 13,140.85 " " 36,338.03 " " 12,281.17 " " 29,818.91 " " 23,855.12 " " 12,158.36 " " 12,526.79 " " 12,281.17 " " 50,982.86 " " 37,854.77 " " 29,184.75 " " 47,796.43 " " 12,526.79 " Inpatient 644 ENDOCRINE DISORDERS WITH CC " 26,343.90 " " 6,707.16 " " 7,636.23 " " 21,075.12 " " 15,063.47 " " 7,713.36 " " 15,553.99 " " 7,713.36 " " 15,859.30 " " 7,713.36 " " 16,123.04 " " 8,253.30 " " 15,021.29 " " 7,713.36 " " 18,240.16 " " 14,592.12 " " 7,636.23 " " 7,867.63 " " 7,713.36 " " 21,075.12 " " 15,648.28 " " 17,846.50 " " 19,757.93 " " 7,867.63 " Inpatient 645 ENDOCRINE DISORDERS WITHOUT CC/MCC " 18,472.55 " " 4,703.11 " " 5,882.93 " " 14,778.04 " " 11,352.99 " " 5,942.35 " " 11,722.69 " " 5,942.35 " " 11,691.55 " " 5,942.35 " " 12,151.57 " " 6,358.31 " " 10,533.05 " " 5,942.35 " " 11,651.42 " " 9,321.13 " " 5,882.93 " " 6,061.20 " " 5,942.35 " " 14,778.04 " " 10,972.69 " " 13,450.50 " " 13,854.41 " " 6,061.20 " Inpatient 654 MAJOR BLADDER PROCEDURES WITH CC " 54,464.00 " " 13,866.53 " " 20,778.97 " " 58,331.49 " " 42,877.26 " " 20,988.86 " " 44,273.51 " " 20,988.86 " " 43,848.44 " " 20,988.86 " " 45,893.27 " " 22,458.08 " " 31,055.37 " " 20,988.86 " " 58,331.49 " " 46,665.20 " " 20,778.97 " " 21,408.64 " " 20,988.86 " " 43,571.20 " " 32,351.62 " " 50,799.00 " " 40,848.00 " " 21,408.64 " Inpatient 657 KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC " 44,259.90 " " 11,268.57 " " 14,021.93 " " 35,407.92 " " 28,577.45 " " 14,163.57 " " 29,508.04 " " 14,163.57 " " 31,288.21 " " 14,163.57 " " 30,587.61 " " 15,155.02 " " 25,236.99 " " 14,163.57 " " 34,857.36 " " 27,885.88 " " 14,021.93 " " 14,446.84 " " 14,163.57 " " 35,407.92 " " 26,290.38 " " 33,857.25 " " 33,194.93 " " 14,446.84 " Inpatient 659 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC " 70,006.30 " " 17,823.60 " " 19,128.97 " " 56,005.04 " " 39,385.39 " " 19,322.19 " " 40,667.93 " " 19,322.19 " " 54,001.99 " " 19,322.19 " " 42,155.78 " " 20,674.74 " " 39,917.59 " " 19,322.19 " " 38,733.09 " " 30,986.46 " " 19,128.97 " " 19,708.63 " " 19,322.19 " " 56,005.04 " " 41,583.74 " " 46,662.00 " " 52,504.73 " " 19,708.63 " Inpatient 660 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC " 49,213.40 " " 12,529.73 " " 10,590.72 " " 39,370.72 " " 21,316.03 " " 10,697.70 " " 22,010.16 " " 10,697.70 " " 28,364.14 " " 10,697.70 " " 22,815.41 " " 11,446.54 " " 28,061.48 " " 10,697.70 " " 23,545.07 " " 18,836.05 " " 10,590.72 " " 10,911.65 " " 10,697.70 " " 39,370.72 " " 29,232.76 " " 25,254.25 " " 36,910.05 " " 10,911.65 " Inpatient 661 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC " 49,482.30 " " 12,598.19 " " 7,942.63 " " 39,585.84 " " 15,711.91 " " 8,022.86 " " 16,223.55 " " 8,022.86 " " 23,006.50 " " 8,022.86 " " 16,817.10 " " 8,584.46 " " 28,214.81 " " 8,022.86 " " 19,160.65 " " 15,328.51 " " 7,942.63 " " 8,183.32 " " 8,022.86 " " 39,585.84 " " 29,392.49 " " 18,614.75 " " 37,111.73 " " 8,183.32 " Inpatient 666 PROSTATECTOMY WITH CC " 85,566.66 " " 21,785.27 " " 12,660.90 " " 68,453.33 " " 25,697.11 " " 12,788.79 " " 26,533.90 " " 12,788.79 " " 27,527.11 " " 12,788.79 " " 27,504.66 " " 13,684.01 " " 48,790.11 " " 12,788.79 " " 42,415.03 " " 33,932.02 " " 12,660.90 " " 13,044.57 " " 12,788.79 " " 68,453.33 " " 50,826.60 " " 30,444.75 " " 64,175.00 " " 13,044.57 " Inpatient 669 TRANSURETHRAL PROCEDURES WITH CC " 50,189.23 " " 12,778.18 " " 11,431.07 " " 40,151.38 " " 23,094.46 " " 11,546.54 " " 23,846.50 " " 11,546.54 " " 21,883.08 " " 11,546.54 " " 24,718.94 " " 12,354.80 " " 28,617.90 " " 11,546.54 " " 23,181.72 " " 18,545.37 " " 11,431.07 " " 11,777.47 " " 11,546.54 " " 40,151.38 " " 29,812.40 " " 27,361.25 " " 37,641.92 " " 11,777.47 " Inpatient 670 TRANSURETHRAL PROCEDURES WITHOUT CC/MCC " 67,994.51 " " 17,311.40 " " 7,347.97 " " 54,395.61 " " 14,453.42 " " 7,422.19 " " 14,924.08 " " 7,422.19 " " 15,566.58 " " 7,422.19 " " 15,470.09 " " 7,941.74 " " 38,770.47 " " 7,422.19 " " 17,222.78 " " 13,778.22 " " 7,347.97 " " 7,570.63 " " 7,422.19 " " 54,395.61 " " 40,388.74 " " 17,123.75 " " 50,995.88 " " 7,570.63 " Inpatient 673 OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC " 104,384.79 " " 26,576.37 " " 24,725.98 " " 83,507.83 " " 51,230.26 " " 24,975.74 " " 52,898.51 " " 24,975.74 " " 55,767.83 " " 24,975.74 " " 54,833.82 " " 26,724.04 " " 59,520.21 " " 24,975.74 " " 62,379.82 " " 49,903.85 " " 24,725.98 " " 25,475.25 " " 24,975.74 " " 83,507.83 " " 62,004.57 " " 60,695.25 " " 78,288.59 " " 25,475.25 " Inpatient 674 OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC " 123,358.50 " " 31,407.07 " " 17,152.32 " " 98,686.80 " " 35,202.25 " " 17,325.58 " " 36,348.57 " " 17,325.58 " " 36,655.34 " " 17,325.58 " " 37,678.39 " " 18,538.37 " " 70,339.02 " " 17,325.58 " " 42,148.58 " " 33,718.85 " " 17,152.32 " " 17,672.09 " " 17,325.58 " " 98,686.80 " " 73,274.95 " " 41,706.00 " " 92,518.88 " " 17,672.09 " Inpatient 682 RENAL FAILURE WITH MCC " 38,525.91 " " 9,808.70 " " 10,797.33 " " 30,820.73 " " 21,753.25 " " 10,906.39 " " 22,461.62 " " 10,906.39 " " 23,489.10 " " 10,906.39 " " 23,283.39 " " 11,669.84 " " 21,967.47 " " 10,906.39 " " 26,161.19 " " 20,928.94 " " 10,797.33 " " 11,124.52 " " 10,906.39 " " 30,820.73 " " 22,884.39 " " 25,772.25 " " 28,894.43 " " 11,124.52 " Inpatient 683 RENAL FAILURE WITH CC " 26,656.30 " " 6,786.69 " " 6,655.58 " " 21,325.04 " " 12,988.14 " " 6,722.81 " " 13,411.08 " " 6,722.81 " " 14,704.23 " " 6,722.81 " " 13,901.73 " " 7,193.41 " " 15,199.42 " " 6,722.81 " " 14,461.32 " " 11,569.05 " " 6,655.58 " " 6,857.27 " " 6,722.81 " " 21,325.04 " " 15,833.84 " " 15,387.75 " " 19,992.23 " " 6,857.27 " Inpatient 684 RENAL FAILURE WITHOUT CC/MCC " 17,560.41 " " 4,470.88 " " 4,761.30 " " 14,048.33 " " 8,979.29 " " 4,809.39 " " 9,271.69 " " 4,809.39 " " 9,944.70 " " 4,809.39 " " 9,610.90 " " 5,146.05 " " 10,012.95 " " 4,809.39 " " 10,246.46 " " 8,197.17 " " 4,761.30 " " 4,905.58 " " 4,809.39 " " 14,048.33 " " 10,430.88 " " 10,638.25 " " 13,170.31 " " 4,905.58 " Inpatient 687 KIDNEY AND URINARY TRACT NEOPLASMS WITH CC " 45,959.20 " " 11,701.21 " " 7,847.71 " " 36,767.36 " " 15,511.03 " " 7,926.98 " " 16,016.13 " " 7,926.98 " " 17,384.62 " " 7,926.98 " " 16,602.08 " " 8,481.87 " " 26,205.94 " " 7,926.98 " " 22,721.47 " " 18,177.17 " " 7,847.71 " " 8,085.52 " " 7,926.98 " " 36,767.36 " " 27,299.76 " " 18,376.75 " " 34,469.40 " " 8,085.52 " Inpatient 689 KIDNEY AND URINARY TRACT INFECTIONS WITH MCC " 24,944.21 " " 6,350.80 " " 8,295.11 " " 20,832.06 " " 16,457.85 " " 8,378.90 " " 16,993.78 " " 8,378.90 " " 17,080.82 " " 8,378.90 " " 17,615.50 " " 8,965.42 " " 14,223.19 " " 8,378.90 " " 20,832.06 " " 16,665.64 " " 8,295.11 " " 8,546.48 " " 8,378.90 " " 19,955.37 " " 14,816.86 " " 19,498.50 " " 18,708.16 " " 8,546.48 " Inpatient 690 KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC " 24,923.58 " " 6,345.54 " " 6,060.22 " " 19,938.86 " " 11,728.17 " " 6,121.43 " " 12,110.09 " " 6,121.43 " " 12,572.89 " " 6,121.43 " " 12,553.14 " " 6,549.93 " " 14,211.43 " " 6,121.43 " " 11,627.19 " " 9,301.75 " " 6,060.22 " " 6,243.86 " " 6,121.43 " " 19,938.86 " " 14,804.61 " " 13,895.00 " " 18,692.69 " " 6,243.86 " Inpatient 696 KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC " 25,273.20 " " 6,434.56 " " 5,347.58 " " 20,218.56 " " 10,220.05 " " 5,401.60 " " 10,552.86 " " 5,401.60 " " 11,015.91 " " 5,401.60 " " 10,938.94 " " 5,779.71 " " 14,410.78 " " 5,401.60 " " 10,852.05 " " 8,681.64 " " 5,347.58 " " 5,509.63 " " 5,401.60 " " 20,218.56 " " 15,012.28 " " 12,108.25 " " 18,954.90 " " 5,509.63 " Inpatient 698 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC " 33,230.58 " " 8,460.51 " " 11,759.82 " " 28,438.18 " " 23,790.17 " " 11,878.61 " " 24,564.87 " " 11,878.61 " " 25,128.35 " " 11,878.61 " " 25,463.59 " " 12,710.11 " " 18,948.08 " " 11,878.61 " " 28,438.18 " " 22,750.54 " " 11,759.82 " " 12,116.18 " " 11,878.61 " " 26,584.46 " " 19,738.96 " " 28,185.50 " " 24,922.94 " " 12,116.18 " Inpatient 699 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC " 35,621.90 " " 9,069.34 " " 7,686.48 " " 28,497.52 " " 15,169.82 " " 7,764.12 " " 15,663.80 " " 7,764.12 " " 16,560.25 " " 7,764.12 " " 16,236.87 " " 8,307.61 " " 20,311.61 " " 7,764.12 " " 17,392.34 " " 13,913.87 " " 7,686.48 " " 7,919.40 " " 7,764.12 " " 28,497.52 " " 21,159.41 " " 17,972.50 " " 26,716.43 " " 7,919.40 " Inpatient 700 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC " 27,357.38 " " 6,965.19 " " 5,728.67 " " 21,885.90 " " 11,026.55 " " 5,786.54 " " 11,385.62 " " 5,786.54 " " 12,288.07 " " 5,786.54 " " 11,802.17 " " 6,191.60 " " 15,599.18 " " 5,786.54 " " 14,533.99 " " 11,627.19 " " 5,728.67 " " 5,902.27 " " 5,786.54 " " 21,885.90 " " 16,250.28 " " 13,063.75 " " 20,518.04 " " 5,902.27 " Inpatient 722 "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC" " 49,317.27 " " 12,556.18 " " 12,471.75 " " 41,833.67 " " 25,296.81 " " 12,597.73 " " 26,120.58 " " 12,597.73 " " 27,481.22 " " 12,597.73 " " 27,076.21 " " 13,479.57 " " 28,120.71 " " 12,597.73 " " 41,833.67 " " 33,466.93 " " 12,471.75 " " 12,849.68 " " 12,597.73 " " 39,453.82 " " 29,294.46 " " 29,970.50 " " 36,987.95 " " 12,849.68 " Inpatient 723 "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC" " 20,041.30 " " 5,102.51 " " 8,139.46 " " 26,621.43 " " 16,128.45 " " 8,221.68 " " 16,653.66 " " 8,221.68 " " 17,756.46 " " 8,221.68 " " 17,262.94 " " 8,797.20 " " 11,427.55 " " 8,221.68 " " 26,621.43 " " 21,297.14 " " 8,139.46 " " 8,386.11 " " 8,221.68 " " 16,033.04 " " 11,904.53 " " 19,108.25 " " 15,030.98 " " 8,386.11 " Inpatient 727 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC " 31,948.09 " " 8,133.98 " " 10,436.47 " " 34,397.11 " " 20,989.59 " " 10,541.89 " " 21,673.09 " " 10,541.89 " " 22,944.79 " " 10,541.89 " " 22,466.01 " " 11,279.82 " " 18,216.80 " " 10,541.89 " " 34,397.11 " " 27,517.68 " " 10,436.47 " " 10,752.73 " " 10,541.89 " " 25,558.47 " " 18,977.17 " " 24,867.50 " " 23,961.07 " " 10,752.73 " Inpatient 728 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC " 23,732.14 " " 6,042.20 " " 6,141.87 " " 18,985.71 " " 11,900.99 " " 6,203.91 " " 12,288.54 " " 6,203.91 " " 12,841.87 " " 6,203.91 " " 12,738.12 " " 6,638.18 " " 13,532.07 " " 6,203.91 " " 12,184.33 " " 9,747.46 " " 6,141.87 " " 6,327.99 " " 6,203.91 " " 18,985.71 " " 14,096.89 " " 14,099.75 " " 17,799.11 " " 6,327.99 " Inpatient 742 UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC " 50,211.37 " " 12,783.81 " " 12,510.14 " " 40,169.10 " " 25,378.06 " " 12,636.50 " " 26,204.46 " " 12,636.50 " " 25,925.82 " " 12,636.50 " " 27,163.16 " " 13,521.06 " " 28,630.52 " " 12,636.50 " " 29,722.01 " " 23,777.60 " " 12,510.14 " " 12,889.23 " " 12,636.50 " " 40,169.10 " " 29,825.55 " " 30,066.75 " " 37,658.53 " " 12,889.23 " Inpatient 743 UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC " 49,914.32 " " 12,708.19 " " 8,424.93 " " 39,931.46 " " 16,732.59 " " 8,510.03 " " 17,277.47 " " 8,510.03 " " 17,001.72 " " 8,510.03 " " 17,909.57 " " 9,105.73 " " 28,461.15 " " 8,510.03 " " 20,807.83 " " 16,646.26 " " 8,424.93 " " 8,680.23 " " 8,510.03 " " 39,931.46 " " 29,649.11 " " 19,824.00 " " 37,435.74 " " 8,680.23 " Inpatient 747 "VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC" " 43,517.17 " " 11,079.47 " " 7,072.97 " " 34,813.74 " " 13,871.45 " " 7,144.41 " " 14,323.15 " " 7,144.41 " " 14,590.30 " " 7,144.41 " " 14,847.17 " " 7,644.52 " " 24,813.49 " " 7,144.41 " " 18,894.19 " " 15,115.35 " " 7,072.97 " " 7,287.30 " " 7,144.41 " " 34,813.74 " " 25,849.20 " " 16,434.25 " " 32,637.88 " " 7,287.30 " Inpatient 748 FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES " 75,891.18 " " 19,321.89 " " 9,924.17 " " 60,712.94 " " 19,905.40 " " 10,024.41 " " 20,553.60 " " 10,024.41 " " 20,047.63 " " 10,024.41 " " 21,305.56 " " 10,726.12 " " 43,273.15 " " 10,024.41 " " 22,794.14 " " 18,235.31 " " 9,924.17 " " 10,224.90 " " 10,024.41 " " 60,712.94 " " 45,079.36 " " 23,583.00 " " 56,918.39 " " 10,224.90 " Inpatient 749 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC " 89,124.52 " " 22,691.10 " " 19,459.81 " " 71,299.62 " " 40,085.54 " " 19,656.37 " " 41,390.88 " " 19,656.37 " " 40,775.62 " " 19,656.37 " " 42,905.18 " " 21,032.32 " " 50,818.80 " " 19,656.37 " " 42,342.36 " " 33,873.88 " " 19,459.81 " " 20,049.50 " " 19,656.37 " " 71,299.62 " " 52,939.96 " " 47,491.50 " " 66,843.39 " " 20,049.50 " Inpatient 755 "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC" " 39,458.06 " " 10,046.02 " " 8,400.50 " " 31,566.45 " " 16,680.89 " " 8,485.35 " " 17,224.08 " " 8,485.35 " " 17,367.22 " " 8,485.35 " " 17,854.23 " " 9,079.32 " " 22,498.99 " " 8,485.35 " " 20,250.70 " " 16,200.55 " " 8,400.50 " " 8,655.06 " " 8,485.35 " " 31,566.45 " " 23,438.09 " " 19,762.75 " " 29,593.55 " " 8,655.06 " Inpatient 758 "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC" " 26,359.46 " " 6,711.12 " " 7,286.54 " " 21,087.57 " " 14,323.44 " " 7,360.14 " " 14,789.86 " " 7,360.14 " " 15,873.54 " " 7,360.14 " " 15,330.96 " " 7,875.35 " " 15,030.16 " " 7,360.14 " " 14,606.66 " " 11,685.33 " " 7,286.54 " " 7,507.34 " " 7,360.14 " " 21,087.57 " " 15,657.52 " " 16,969.75 " " 19,769.60 " " 7,507.34 " Inpatient 759 "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC" " 27,742.63 " " 7,063.27 " " 5,288.26 " " 22,194.10 " " 10,094.50 " " 5,341.68 " " 10,423.22 " " 5,341.68 " " 11,324.45 " " 5,341.68 " " 10,804.55 " " 5,715.60 " " 15,818.85 " " 5,341.68 " " 11,651.42 " " 9,321.13 " " 5,288.26 " " 5,448.51 " " 5,341.68 " " 22,194.10 " " 16,479.12 " " 11,959.50 " " 20,806.97 " " 5,448.51 " Inpatient 760 MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC " 26,259.03 " " 6,685.55 " " 6,940.36 " " 21,007.22 " " 13,590.80 " " 7,010.46 " " 14,033.37 " " 7,010.46 " " 13,585.55 " " 7,010.46 " " 14,546.78 " " 7,501.19 " " 14,972.90 " " 7,010.46 " " 14,388.65 " " 11,510.92 " " 6,940.36 " " 7,150.67 " " 7,010.46 " " 21,007.22 " " 15,597.86 " " 16,101.75 " " 19,694.27 " " 7,150.67 " Inpatient 768 VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C " 29,878.59 " " 7,607.09 " " 8,438.33 " " 23,902.87 " " 17,276.16 " " 8,769.48 " " 17,838.74 " " 8,769.48 " " 17,941.58 " " 8,769.48 " " 18,491.38 " " 9,383.34 " " 17,036.77 " " 8,769.48 " " 10,547.91 " " 8,438.33 " " 8,681.79 " " 8,944.87 " " 8,769.48 " " 23,902.87 " " 17,747.88 " " 20,468.00 " " 22,408.94 " " 8,944.87 " Inpatient 776 POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES " 9,985.45 " " 2,542.30 " " 5,693.70 " " 13,553.75 " " 11,440.14 " " 5,983.95 " " 11,812.67 " " 5,983.95 " " 12,775.42 " " 5,983.95 " " 12,244.85 " " 6,402.83 " " 5,693.70 " " 5,983.95 " " 9,592.43 " " 7,673.95 " " 5,924.11 " " 6,103.63 " " 5,983.95 " " 7,988.36 " " 5,931.36 " " 13,553.75 " " 7,489.09 " " 6,103.63 " Inpatient 785 CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC " 35,870.50 " " 9,132.63 " " 6,917.32 " " 28,696.40 " " 13,542.05 " " 6,987.19 " " 13,983.03 " " 6,987.19 " " 13,246.94 " " 6,987.19 " " 14,494.61 " " 7,476.29 " " 20,453.36 " " 6,987.19 " " 12,387.82 " " 9,910.26 " " 6,917.32 " " 7,126.93 " " 6,987.19 " " 28,696.40 " " 21,307.08 " " 16,044.00 " " 26,902.88 " " 7,126.93 " Inpatient 786 CESAREAN SECTION WITHOUT STERILIZATION WITH MCC " 30,780.32 " " 7,836.67 " " 11,646.76 " " 27,902.00 " " 23,550.88 " " 11,764.40 " " 24,317.79 " " 11,764.40 " " 18,625.14 " " 11,764.40 " " 25,207.46 " " 12,587.91 " " 17,550.94 " " 11,764.40 " " 17,136.82 " " 13,709.46 " " 11,646.76 " " 11,999.69 " " 11,764.40 " " 24,624.26 " " 18,283.51 " " 27,902.00 " " 23,085.24 " " 11,999.69 " Inpatient 787 CESAREAN SECTION WITHOUT STERILIZATION WITH CC " 23,454.57 " " 5,971.53 " " 7,947.52 " " 18,763.66 " " 15,722.25 " " 8,027.80 " " 16,234.23 " " 8,027.80 " " 18,625.14 " " 8,027.80 " " 16,828.16 " " 8,589.75 " " 13,373.80 " " 8,027.80 " " 15,075.56 " " 12,060.45 " " 7,947.52 " " 8,188.36 " " 8,027.80 " " 18,763.66 " " 13,932.01 " " 18,627.00 " " 17,590.93 " " 8,188.36 " Inpatient 788 CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC " 18,849.66 " " 4,799.12 " " 6,712.11 " " 15,529.50 " " 13,107.79 " " 6,779.91 " " 13,534.62 " " 6,779.91 " " 13,246.94 " " 6,779.91 " " 14,029.79 " " 7,254.50 " " 10,748.08 " " 6,779.91 " " 13,277.00 " " 10,621.60 " " 6,712.11 " " 6,915.51 " " 6,779.91 " " 15,079.73 " " 11,196.70 " " 15,529.50 " " 14,137.25 " " 6,915.51 " Inpatient 789 "NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY" " 11,321.06 " " 2,882.34 " " 6,455.27 " " 26,233.44 " " 25,406.12 " " 12,649.90 " " 26,233.44 " " 12,649.90 " " 25,968.54 " " 12,649.90 " " 6,474.51 " " 13,535.39 " " 6,455.27 " " 12,649.90 " " 16,827.80 " " 13,462.24 " " 12,523.40 " " 12,902.90 " " 12,649.90 " " 9,056.85 " " 6,724.71 " " 6,792.64 " " 8,490.80 " " 12,902.90 " Inpatient 790 "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE" " 125,550.04 " " 31,965.04 " " 40,107.80 " " 101,156.77 " " 83,782.59 " " 40,512.93 " " 86,510.87 " " 40,512.93 " " 85,635.13 " " 40,512.93 " " 71,802.07 " " 43,348.84 " " 71,588.63 " " 40,512.93 " " 101,156.77 " " 80,925.39 " " 40,107.80 " " 41,323.19 " " 40,512.93 " " 100,440.03 " " 74,576.72 " " 75,330.02 " " 94,162.53 " " 41,323.19 " Inpatient 791 PREMATURITY WITH MAJOR PROBLEMS " 93,038.73 " " 23,687.66 " " 27,556.24 " " 74,430.98 " " 57,219.90 " " 27,834.59 " " 59,083.20 " " 27,834.59 " " 58,486.19 " " 27,834.59 " " 53,208.85 " " 29,783.01 " " 53,050.68 " " 27,834.59 " " 35,539.43 " " 28,431.53 " " 27,556.24 " " 28,391.28 " " 27,834.59 " " 74,430.98 " " 55,265.01 " " 55,823.24 " " 69,779.05 " " 28,391.28 " Inpatient 792 PREMATURITY WITHOUT MAJOR PROBLEMS " 24,418.08 " " 6,216.84 " " 8,561.12 " " 35,650.02 " " 34,525.74 " " 17,002.68 " " 35,650.02 " " 17,002.68 " " 35,288.24 " " 17,002.68 " " 13,964.70 " " 18,192.87 " " 13,923.19 " " 17,002.68 " " 10,701.40 " " 8,561.12 " " 16,832.65 " " 17,342.73 " " 17,002.68 " " 19,534.46 " " 14,504.34 " " 14,650.85 " " 18,313.56 " " 17,342.73 " Inpatient 793 FULL TERM NEONATE WITH MAJOR PROBLEMS " 38,158.89 " " 9,715.25 " " 10,410.12 " " 60,690.76 " " 58,776.76 " " 28,577.68 " " 60,690.76 " " 28,577.68 " " 60,077.99 " " 28,577.68 " " 21,823.07 " " 30,578.12 " " 21,758.20 " " 28,577.68 " " 13,012.65 " " 10,410.12 " " 28,291.90 " " 29,149.23 " " 28,577.68 " " 30,527.11 " " 22,666.38 " " 22,895.33 " " 28,619.17 " " 29,149.23 " Inpatient 794 NEONATE WITH OTHER SIGNIFICANT PROBLEMS " 13,753.06 " " 3,501.53 " " 2,583.53 " " 21,480.92 " " 20,803.48 " " 10,453.06 " " 21,480.92 " " 10,453.06 " " 21,264.40 " " 10,453.06 " " 7,865.38 " " 11,184.77 " " 7,841.99 " " 10,453.06 " " 3,229.42 " " 2,583.53 " " 10,348.53 " " 10,662.12 " " 10,453.06 " " 11,002.45 " " 8,169.32 " " 8,251.84 " " 10,314.80 " " 10,662.12 " Inpatient 795 NORMAL NEWBORN " 11,634.20 " " 2,962.07 " " 1,697.54 " " 9,307.36 " " 2,816.83 " " 1,868.05 " " 2,908.56 " " 1,868.05 " " 2,878.19 " " 1,868.05 " " 3,014.97 " " 1,998.81 " " 6,633.82 " " 1,868.05 " " 2,121.93 " " 1,697.54 " " 1,849.37 " " 1,905.41 " " 1,868.05 " " 9,307.36 " " 6,910.71 " " 3,337.25 " " 8,725.65 " " 1,905.41 " Inpatient 805 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC " 25,554.65 " " 6,506.21 " " 7,706.72 " " 20,443.72 " " 15,212.65 " " 7,784.57 " " 15,708.03 " " 7,784.57 " " 13,140.92 " " 7,784.57 " " 16,282.72 " " 8,329.49 " " 14,571.26 " " 7,784.57 " " 11,308.12 " " 9,046.50 " " 7,706.72 " " 7,940.26 " " 7,784.57 " " 20,443.72 " " 15,179.46 " " 18,023.25 " " 19,165.99 " " 7,940.26 " Inpatient 806 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC " 25,525.21 " " 6,498.72 " " 5,645.62 " " 20,420.17 " " 10,850.78 " " 5,702.65 " " 11,204.12 " " 5,702.65 " " 13,140.92 " " 5,702.65 " " 11,614.03 " " 6,101.84 " " 14,554.47 " " 5,702.65 " " 9,426.60 " " 7,541.28 " " 5,645.62 " " 5,816.70 " " 5,702.65 " " 20,420.17 " " 15,161.97 " " 12,855.50 " " 19,143.91 " " 5,816.70 " Inpatient 807 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC " 24,384.74 " " 6,208.35 " " 5,001.39 " " 19,507.79 " " 9,487.41 " " 5,051.91 " " 9,796.36 " " 5,051.91 " " 10,213.69 " " 5,051.91 " " 10,154.76 " " 5,405.54 " " 13,904.18 " " 5,051.91 " " 8,362.31 " " 6,689.85 " " 5,001.39 " " 5,152.95 " " 5,051.91 " " 19,507.79 " " 14,484.54 " " 11,240.25 " " 18,288.56 " " 5,152.95 " Inpatient 808 MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC " 97,777.35 " " 24,894.11 " " 15,774.53 " " 78,221.88 " " 32,286.45 " " 15,933.87 " " 33,337.82 " " 15,933.87 " " 33,677.47 " " 15,933.87 " " 34,557.50 " " 17,049.24 " " 55,752.64 " " 15,933.87 " " 37,546.15 " " 30,036.91 " " 15,774.53 " " 16,252.55 " " 15,933.87 " " 78,221.88 " " 58,079.75 " " 38,251.50 " " 73,333.01 " " 16,252.55 " Inpatient 809 MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC " 34,990.24 " " 8,908.52 " " 9,057.29 " " 27,992.19 " " 18,070.84 " " 9,148.78 " " 18,659.30 " " 9,148.78 " " 18,928.94 " " 9,148.78 " " 19,341.95 " " 9,789.19 " " 19,951.43 " " 9,148.78 " " 21,486.08 " " 17,188.86 " " 9,057.29 " " 9,331.76 " " 9,148.78 " " 27,992.19 " " 20,784.20 " " 21,409.50 " " 26,242.68 " " 9,331.76 " Inpatient 811 RED BLOOD CELL DISORDERS WITH MCC " 42,399.15 " " 10,794.82 " " 10,145.42 " " 33,919.32 " " 20,373.64 " " 10,247.90 " " 21,037.08 " " 10,247.90 " " 21,166.30 " " 10,247.90 " " 21,806.73 " " 10,965.25 " " 24,176.00 " " 10,247.90 " " 26,088.52 " " 20,870.81 " " 10,145.42 " " 10,452.86 " " 10,247.90 " " 33,919.32 " " 25,185.10 " " 24,137.75 " " 31,799.36 " " 10,452.86 " Inpatient 812 RED BLOOD CELL DISORDERS WITHOUT MCC " 34,809.05 " " 8,862.38 " " 6,662.56 " " 27,847.24 " " 13,002.91 " " 6,729.86 " " 13,426.34 " " 6,729.86 " " 13,970.05 " " 6,729.86 " " 13,917.54 " " 7,200.95 " " 19,848.12 " " 6,729.86 " " 16,544.53 " " 13,235.62 " " 6,662.56 " " 6,864.46 " " 6,729.86 " " 27,847.24 " " 20,676.58 " " 15,405.25 " " 26,106.79 " " 6,864.46 " Inpatient 813 COAGULATION DISORDERS " 103,190.70 " " 26,272.35 " " 11,302.65 " " 82,552.56 " " 22,822.67 " " 11,416.82 " " 23,565.87 " " 11,416.82 " " 27,387.86 " " 11,416.82 " " 24,428.03 " " 12,216.00 " " 58,839.34 " " 11,416.82 " " 31,926.34 " " 25,541.06 " " 11,302.65 " " 11,645.16 " " 11,416.82 " " 82,552.56 " " 61,295.28 " " 27,039.25 " " 77,393.03 " " 11,645.16 " Inpatient 814 RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC " 36,569.17 " " 9,310.51 " " 13,721.82 " " 36,843.67 " " 27,942.30 " " 13,860.42 " " 28,852.21 " " 13,860.42 " " 27,769.19 " " 13,860.42 " " 29,907.78 " " 14,830.65 " " 20,851.74 " " 13,860.42 " " 36,843.67 " " 29,474.93 " " 13,721.82 " " 14,137.63 " " 13,860.42 " " 29,255.34 " " 21,722.09 " " 33,104.75 " " 27,426.88 " " 14,137.63 " Inpatient 815 RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC " 41,195.28 " " 10,488.32 " " 7,451.96 " " 32,956.22 " " 14,673.51 " " 7,527.23 " " 15,151.34 " " 7,527.23 " " 15,851.39 " " 7,527.23 " " 15,705.65 " " 8,054.14 " " 23,489.55 " " 7,527.23 " " 19,451.33 " " 15,561.06 " " 7,451.96 " " 7,677.77 " " 7,527.23 " " 32,956.22 " " 24,470.00 " " 17,384.50 " " 30,896.46 " " 7,677.77 " Inpatient 831 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC " 18,045.40 " " 4,594.36 " " 8,348.16 " " 19,631.50 " " 16,570.11 " " 8,432.48 " " 17,109.69 " " 8,432.48 " " 16,267.53 " " 8,432.48 " " 17,735.66 " " 9,022.75 " " 10,289.49 " " 8,432.48 " " 12,911.03 " " 10,328.82 " " 8,348.16 " " 8,601.13 " " 8,432.48 " " 14,436.32 " " 10,718.97 " " 19,631.50 " " 13,534.05 " " 8,601.13 " Inpatient 832 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC " 17,002.13 " " 4,328.74 " " 5,950.63 " " 13,620.25 " " 11,496.27 " " 6,010.74 " " 11,870.63 " " 6,010.74 " " 11,373.50 " " 6,010.74 " " 12,304.92 " " 6,431.49 " " 9,694.61 " " 6,010.74 " " 9,907.34 " " 7,925.87 " " 5,950.63 " " 6,130.95 " " 6,010.74 " " 13,601.70 " " 10,099.27 " " 13,620.25 " " 12,751.60 " " 6,130.95 " Inpatient 833 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC " 10,198.26 " " 2,596.48 " " 4,266.43 " " 9,397.50 " " 7,932.03 " " 4,309.53 " " 8,190.32 " " 4,309.53 " " 7,599.73 " " 4,309.53 " " 8,489.97 " " 4,611.20 " " 5,815.05 " " 4,309.53 " " 7,533.45 " " 6,026.76 " " 4,266.43 " " 4,395.72 " " 4,309.53 " " 8,158.61 " " 6,057.77 " " 9,397.50 " " 7,648.70 " " 4,395.72 " Inpatient 840 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC " 85,260.27 " " 21,707.26 " " 22,996.41 " " 76,816.29 " " 47,570.01 " " 23,228.70 " " 49,119.07 " " 23,228.70 " " 48,712.40 " " 23,228.70 " " 50,916.11 " " 24,854.71 " " 48,615.41 " " 23,228.70 " " 76,816.29 " " 61,453.03 " " 22,996.41 " " 23,693.27 " " 23,228.70 " " 68,208.22 " " 50,644.60 " " 56,358.75 " " 63,945.20 " " 23,693.27 " Inpatient 841 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC " 32,039.90 " " 8,157.36 " " 11,836.60 " " 36,407.65 " " 23,952.65 " " 11,956.16 " " 24,732.64 " " 11,956.16 " " 25,634.70 " " 11,956.16 " " 25,637.50 " " 12,793.09 " " 18,269.15 " " 11,956.16 " " 36,407.65 " " 29,126.11 " " 11,836.60 " " 12,195.28 " " 11,956.16 " " 25,631.92 " " 19,031.70 " " 28,378.00 " " 24,029.93 " " 12,195.28 " Inpatient 843 OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC " 106,442.17 " " 27,100.18 " " 13,832.78 " " 85,153.74 " " 28,177.16 " " 13,972.51 " " 29,094.72 " " 13,972.51 " " 28,302.42 " " 13,972.51 " " 30,159.16 " " 14,950.59 " " 60,693.33 " " 13,972.51 " " 36,383.43 " " 29,106.73 " " 13,832.78 " " 14,251.96 " " 13,972.51 " " 85,153.74 " " 63,226.65 " " 33,383.00 " " 79,831.63 " " 14,251.96 " Inpatient 844 OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC " 39,532.76 " " 10,065.04 " " 8,783.69 " " 31,626.21 " " 17,491.82 " " 8,872.41 " " 18,061.42 " " 8,872.41 " " 19,096.66 " " 8,872.41 " " 18,722.20 " " 9,493.48 " " 22,541.58 " " 8,872.41 " " 25,507.16 " " 20,405.72 " " 8,783.69 " " 9,049.86 " " 8,872.41 " " 31,626.21 " " 23,482.46 " " 20,723.50 " " 29,649.57 " " 9,049.86 " Inpatient 847 CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC " 26,426.17 " " 6,728.10 " " 9,843.90 " " 23,381.75 " " 19,735.53 " " 9,943.33 " " 20,378.20 " " 9,943.33 " " 19,938.45 " " 9,943.33 " " 21,123.74 " " 10,639.36 " " 15,068.20 " " 9,943.33 " " 19,693.56 " " 15,754.84 " " 9,843.90 " " 10,142.20 " " 9,943.33 " " 21,140.94 " " 15,697.14 " " 23,381.75 " " 19,819.63 " " 10,142.20 " Inpatient 853 INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC " 136,493.61 " " 34,751.27 " " 35,192.02 " " 109,194.89 " " 73,379.37 " " 35,547.49 " " 75,768.89 " " 35,547.49 " " 81,146.18 " " 35,547.49 " " 78,540.92 " " 38,035.81 " " 77,828.66 " " 35,547.49 " " 91,761.98 " " 73,409.59 " " 35,192.02 " " 36,258.44 " " 35,547.49 " " 109,194.89 " " 81,077.20 " " 86,936.50 " " 102,370.21 " " 36,258.44 " Inpatient 854 INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC " 83,519.55 " " 21,264.08 " " 15,330.63 " " 66,815.64 " " 31,347.02 " " 15,485.48 " " 32,367.79 " " 15,485.48 " " 37,837.31 " " 15,485.48 " " 33,551.98 " " 16,569.46 " " 47,622.85 " " 15,485.48 " " 36,068.52 " " 28,854.81 " " 15,330.63 " " 15,795.19 " " 15,485.48 " " 66,815.64 " " 49,610.61 " " 37,138.50 " " 62,639.66 " " 15,795.19 " Inpatient 856 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC " 72,298.31 " " 18,407.15 " " 33,070.89 " " 81,618.25 " " 68,890.47 " " 33,404.94 " " 71,133.80 " " 33,404.94 " " 70,410.33 " " 33,404.94 " " 73,736.26 " " 35,743.29 " " 41,224.50 " " 33,404.94 " " 69,712.63 " " 55,770.10 " " 33,070.89 " " 34,073.04 " " 33,404.94 " " 57,838.65 " " 42,945.20 " " 81,618.25 " " 54,223.73 " " 34,073.04 " Inpatient 857 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC " 79,454.00 " " 20,228.99 " " 15,192.43 " " 63,563.20 " " 31,054.55 " " 15,345.89 " " 32,065.80 " " 15,345.89 " " 31,452.78 " " 15,345.89 " " 33,238.94 " " 16,420.10 " " 45,304.67 " " 15,345.89 " " 32,386.58 " " 25,909.26 " " 15,192.43 " " 15,652.81 " " 15,345.89 " " 63,563.20 " " 47,195.68 " " 36,792.00 " " 59,590.50 " " 15,652.81 " Inpatient 862 POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC " 40,725.18 " " 10,368.63 " " 13,756.71 " " 33,192.25 " " 28,016.16 " " 13,895.67 " " 28,928.47 " " 13,895.67 " " 28,997.07 " " 13,895.67 " " 29,986.83 " " 14,868.37 " " 23,221.50 " " 13,895.67 " " 22,503.46 " " 18,002.77 " " 13,756.71 " " 14,173.58 " " 13,895.67 " " 32,580.14 " " 24,190.76 " " 33,192.25 " " 30,543.89 " " 14,173.58 " Inpatient 863 POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC " 20,490.11 " " 5,216.78 " " 7,577.60 " " 17,699.50 " " 14,939.39 " " 7,654.14 " " 15,425.87 " " 7,654.14 " " 15,935.25 " " 7,654.14 " " 15,990.23 " " 8,189.93 " " 11,683.46 " " 7,654.14 " " 15,066.91 " " 12,053.52 " " 7,577.60 " " 7,807.22 " " 7,654.14 " " 16,392.09 " " 12,171.13 " " 17,699.50 " " 15,367.58 " " 7,807.22 " Inpatient 864 FEVER AND INFLAMMATORY CONDITIONS " 27,021.91 " " 6,879.78 " " 6,636.04 " " 21,617.53 " " 12,946.78 " " 6,703.07 " " 13,368.38 " " 6,703.07 " " 13,767.51 " " 6,703.07 " " 13,857.47 " " 7,172.28 " " 15,407.89 " " 6,703.07 " " 14,340.21 " " 11,472.16 " " 6,636.04 " " 6,837.13 " " 6,703.07 " " 21,617.53 " " 16,051.01 " " 15,338.75 " " 20,266.43 " " 6,837.13 " Inpatient 866 VIRAL ILLNESS WITHOUT MCC " 24,321.02 " " 6,192.13 " " 6,374.30 " " 19,456.82 " " 12,392.87 " " 6,438.69 " " 12,796.43 " " 6,438.69 " " 12,666.24 " " 6,438.69 " " 13,264.59 " " 6,889.40 " " 13,867.85 " " 6,438.69 " " 12,789.91 " " 10,231.93 " " 6,374.30 " " 6,567.46 " " 6,438.69 " " 19,456.82 " " 14,446.69 " " 14,682.50 " " 18,240.77 " " 6,567.46 " Inpatient 868 OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC " 43,933.00 " " 11,185.34 " " 7,958.69 " " 35,146.40 " " 15,745.89 " " 8,039.08 " " 16,258.63 " " 8,039.08 " " 16,764.36 " " 8,039.08 " " 16,853.46 " " 8,601.82 " " 25,050.60 " " 8,039.08 " " 16,399.19 " " 13,119.35 " " 7,958.69 " " 8,199.86 " " 8,039.08 " " 35,146.40 " " 26,096.20 " " 18,655.00 " " 32,949.75 " " 8,199.86 " Inpatient 870 SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS " 239,276.88 " " 60,919.89 " " 45,460.52 " " 191,421.50 " " 95,110.47 " " 45,919.72 " " 98,207.63 " " 45,919.72 " " 96,372.55 " " 45,919.72 " " 101,800.59 " " 49,134.10 " " 136,435.68 " " 45,919.72 " " 136,369.92 " " 109,095.94 " " 45,460.52 " " 46,838.11 " " 45,919.72 " " 191,421.50 " " 142,130.47 " " 112,682.50 " " 179,457.66 " " 46,838.11 " Inpatient 871 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC " 57,161.97 " " 14,553.44 " " 13,585.71 " " 45,729.58 " " 27,654.27 " " 13,722.94 " " 28,554.79 " " 13,722.94 " " 28,846.73 " " 13,722.94 " " 29,599.48 " " 14,683.55 " " 32,593.76 " " 13,722.94 " " 32,410.80 " " 25,928.63 " " 13,585.71 " " 13,997.40 " " 13,722.94 " " 45,729.58 " " 33,954.21 " " 32,763.50 " " 42,871.48 " " 13,997.40 " Inpatient 872 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC " 30,687.91 " " 7,813.14 " " 7,681.59 " " 24,550.33 " " 15,159.48 " " 7,759.18 " " 15,653.13 " " 7,759.18 " " 16,688.41 " " 7,759.18 " " 16,225.80 " " 8,302.32 " " 17,498.25 " " 7,759.18 " " 17,125.89 " " 13,700.71 " " 7,681.59 " " 7,914.36 " " 7,759.18 " " 24,550.33 " " 18,228.62 " " 17,960.25 " " 23,015.93 " " 7,914.36 " Inpatient 880 ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION " 40,392.63 " " 10,283.96 " " 6,552.29 " " 32,314.10 " " 12,769.53 " " 6,618.47 " " 13,185.35 " " 6,618.47 " " 12,794.40 " " 6,618.47 " " 13,667.75 " " 7,081.76 " " 23,031.88 " " 6,618.47 " " 14,243.31 " " 11,394.65 " " 6,552.29 " " 6,750.84 " " 6,618.47 " " 32,314.10 " " 23,993.22 " " 15,128.75 " " 30,294.47 " " 6,750.84 " Inpatient 884 ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY " 51,618.16 " " 13,141.98 " " 10,620.04 " " 41,294.53 " " 21,378.07 " " 10,727.31 " " 22,074.22 " " 10,727.31 " " 19,530.20 " " 10,727.31 " " 22,881.81 " " 11,478.22 " " 29,432.67 " " 10,727.31 " " 13,516.61 " " 10,813.29 " " 10,620.04 " " 10,941.86 " " 10,727.31 " " 41,294.53 " " 30,661.19 " " 25,327.75 " " 38,713.62 " " 10,941.86 " Inpatient 885 PSYCHOSES " 20,051.82 " " 5,105.19 " " 8,952.94 " " 21,689.50 " " 18,307.18 " " 9,261.58 " " 18,903.33 " " 9,261.58 " " 18,569.75 " " 9,261.58 " " 19,594.91 " " 9,909.89 " " 11,433.55 " " 9,261.58 " " 11,191.17 " " 8,952.94 " " 9,168.96 " " 9,446.81 " " 9,261.58 " " 16,041.46 " " 11,910.78 " " 21,689.50 " " 15,038.87 " " 9,446.81 " Inpatient 894 "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA" " 14,206.89 " " 3,617.07 " " 4,350.19 " " 11,365.51 " " 8,109.28 " " 4,394.13 " " 8,373.35 " " 4,394.13 " " 8,297.53 " " 4,394.13 " " 8,679.69 " " 4,701.72 " " 8,100.77 " " 4,394.13 " " 8,599.28 " " 6,879.42 " " 4,350.19 " " 4,482.01 " " 4,394.13 " " 11,365.51 " " 8,438.89 " " 9,607.50 " " 10,655.17 " " 4,482.01 " Inpatient 896 "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC" " 42,643.92 " " 10,857.14 " " 12,944.27 " " 34,115.14 " " 26,296.81 " " 13,075.02 " " 27,153.14 " " 13,075.02 " " 25,881.52 " " 13,075.02 " " 28,146.54 " " 13,990.27 " " 24,315.56 " " 13,075.02 " " 31,223.86 " " 24,979.08 " " 12,944.27 " " 13,336.52 " " 13,075.02 " " 34,115.14 " " 25,330.49 " " 31,155.25 " " 31,982.94 " " 13,336.52 " Inpatient 897 "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC" " 23,094.54 " " 5,879.87 " " 6,290.54 " " 18,475.63 " " 12,215.62 " " 6,354.08 " " 12,613.40 " " 6,354.08 " " 12,495.36 " " 6,354.08 " " 13,074.87 " " 6,798.87 " " 13,168.51 " " 6,354.08 " " 11,627.19 " " 9,301.75 " " 6,290.54 " " 6,481.16 " " 6,354.08 " " 18,475.63 " " 13,718.16 " " 14,472.50 " " 17,320.91 " " 6,481.16 " Inpatient 901 WOUND DEBRIDEMENTS FOR INJURIES WITH MCC " 60,825.96 " " 15,486.29 " " 30,312.52 " " 106,911.37 " " 63,052.97 " " 30,618.71 " " 65,106.21 " " 30,618.71 " " 65,722.02 " " 30,618.71 " " 67,488.15 " " 32,762.02 " " 34,682.96 " " 30,618.71 " " 106,911.37 " " 85,529.10 " " 30,312.52 " " 31,231.08 " " 30,618.71 " " 48,660.77 " " 36,130.62 " " 74,702.25 " " 45,619.47 " " 31,231.08 " Inpatient 902 WOUND DEBRIDEMENTS FOR INJURIES WITH CC " 37,048.58 " " 9,432.57 " " 14,228.54 " " 34,375.25 " " 29,014.68 " " 14,372.26 " " 29,959.50 " " 14,372.26 " " 31,603.08 " " 14,372.26 " " 31,055.58 " " 15,378.32 " " 21,125.10 " " 14,372.26 " " 30,012.69 " " 24,010.15 " " 14,228.54 " " 14,659.71 " " 14,372.26 " " 29,638.86 " " 22,006.86 " " 34,375.25 " " 27,786.44 " " 14,659.71 " Inpatient 908 OTHER O.R. PROCEDURES FOR INJURIES WITH CC " 84,800.76 " " 21,590.27 " " 14,829.49 " " 67,840.61 " " 30,286.46 " " 14,979.28 " " 31,272.70 " " 14,979.28 " " 32,038.21 " " 14,979.28 " " 32,416.82 " " 16,027.83 " " 48,353.39 " " 14,979.28 " " 33,355.51 " " 26,684.40 " " 14,829.49 " " 15,278.87 " " 14,979.28 " " 67,840.61 " " 50,371.65 " " 35,882.00 " " 63,600.57 " " 15,278.87 " Inpatient 914 TRAUMATIC INJURY WITHOUT MCC " 14,740.63 " " 3,752.96 " " 6,708.63 " " 17,658.80 " " 13,100.40 " " 6,776.39 " " 13,527.00 " " 6,776.39 " " 13,137.76 " " 6,776.39 " " 14,021.89 " " 7,250.74 " " 8,405.11 " " 6,776.39 " " 17,658.80 " " 14,127.04 " " 6,708.63 " " 6,911.92 " " 6,776.39 " " 11,792.50 " " 8,755.93 " " 15,520.75 " " 11,055.47 " " 6,911.92 " Inpatient 915 ALLERGIC REACTIONS WITH MCC " 60,026.48 " " 15,282.74 " " 12,380.32 " " 48,021.18 " " 25,103.31 " " 12,505.37 " " 25,920.77 " " 12,505.37 " " 25,599.87 " " 12,505.37 " " 26,869.10 " " 13,380.75 " " 34,227.10 " " 12,505.37 " " 25,289.15 " " 20,231.31 " " 12,380.32 " " 12,755.48 " " 12,505.37 " " 48,021.18 " " 35,655.73 " " 29,741.25 " " 45,019.86 " " 12,755.48 " Inpatient 916 ALLERGIC REACTIONS WITHOUT MCC " 12,530.20 " " 3,190.19 " " 5,113.77 " " 11,522.00 " " 9,725.23 " " 5,165.42 " " 10,041.92 " " 5,165.42 " " 9,496.91 " " 5,165.42 " " 10,409.30 " " 5,527.00 " " 7,144.72 " " 5,165.42 " " 11,336.51 " " 9,069.21 " " 5,113.77 " " 5,268.73 " " 5,165.42 " " 10,024.16 " " 7,442.94 " " 11,522.00 " " 9,397.65 " " 5,268.73 " Inpatient 917 POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC " 29,104.51 " " 7,410.01 " " 10,837.81 " " 25,873.75 " " 21,838.92 " " 10,947.28 " " 22,550.08 " " 10,947.28 " " 22,191.63 " " 10,947.28 " " 23,375.09 " " 11,713.59 " " 16,595.39 " " 10,947.28 " " 24,489.78 " " 19,591.82 " " 10,837.81 " " 11,166.23 " " 10,947.28 " " 23,283.61 " " 17,288.08 " " 25,873.75 " " 21,828.38 " " 11,166.23 " Inpatient 918 POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC " 22,332.63 " " 5,685.89 " " 6,043.46 " " 17,866.10 " " 11,692.72 " " 6,104.51 " " 12,073.48 " " 6,104.51 " " 11,870.34 " " 6,104.51 " " 12,515.20 " " 6,531.83 " " 12,734.07 " " 6,104.51 " " 11,554.52 " " 9,243.62 " " 6,043.46 " " 6,226.60 " " 6,104.51 " " 17,866.10 " " 13,265.58 " " 13,853.00 " " 16,749.47 " " 6,226.60 " Inpatient 919 COMPLICATIONS OF TREATMENT WITH MCC " 55,524.29 " " 14,136.48 " " 13,389.58 " " 44,419.43 " " 27,239.20 " " 13,524.83 " " 28,126.21 " " 13,524.83 " " 27,694.83 " " 13,524.83 " " 29,155.22 " " 14,471.57 " " 31,659.95 " " 13,524.83 " " 29,261.77 " " 23,409.41 " " 13,389.58 " " 13,795.33 " " 13,524.83 " " 44,419.43 " " 32,981.43 " " 32,271.75 " " 41,643.22 " " 13,795.33 " Inpatient 920 COMPLICATIONS OF TREATMENT WITH CC " 58,905.95 " " 14,997.45 " " 7,669.73 " " 47,124.76 " " 15,134.37 " " 7,747.20 " " 15,627.20 " " 7,747.20 " " 15,808.66 " " 7,747.20 " " 16,198.93 " " 8,289.50 " " 33,588.17 " " 7,747.20 " " 17,949.48 " " 14,359.58 " " 7,669.73 " " 7,902.14 " " 7,747.20 " " 47,124.76 " " 34,990.13 " " 17,930.50 " " 44,179.46 " " 7,902.14 " Inpatient 922 "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC" " 32,869.13 " " 8,368.48 " " 11,603.47 " " 34,179.10 " " 23,459.30 " " 11,720.68 " " 24,223.23 " " 11,720.68 " " 23,446.38 " " 11,720.68 " " 25,109.44 " " 12,541.13 " " 18,741.98 " " 11,720.68 " " 34,179.10 " " 27,343.28 " " 11,603.47 " " 11,955.09 " " 11,720.68 " " 26,295.30 " " 19,524.26 " " 27,793.50 " " 24,651.85 " " 11,955.09 " Inpatient 941 O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC " 111,663.72 " " 28,429.58 " " 13,940.97 " " 89,330.98 " " 28,406.11 " " 14,081.79 " " 29,331.12 " " 14,081.79 " " 29,394.21 " " 14,081.79 " " 30,404.21 " " 15,067.52 " " 63,670.65 " " 14,081.79 " " 28,438.18 " " 22,750.54 " " 13,940.97 " " 14,363.43 " " 14,081.79 " " 89,330.98 " " 66,328.25 " " 33,654.25 " " 83,747.79 " " 14,363.43 " Inpatient 947 SIGNS AND SYMPTOMS WITH MCC " 41,423.49 " " 10,546.42 " " 8,852.09 " " 33,138.79 " " 17,636.57 " " 8,941.50 " " 18,210.89 " " 8,941.50 " " 18,572.93 " " 8,941.50 " " 18,877.14 " " 9,567.41 " " 23,619.67 " " 8,941.50 " " 21,195.41 " " 16,956.32 " " 8,852.09 " " 9,120.33 " " 8,941.50 " " 33,138.79 " " 24,605.55 " " 20,895.00 " " 31,067.62 " " 9,120.33 " Inpatient 948 SIGNS AND SYMPTOMS WITHOUT MCC " 22,949.46 " " 5,842.93 " " 6,012.05 " " 18,359.57 " " 11,626.25 " " 6,072.78 " " 12,004.85 " " 6,072.78 " " 12,224.78 " " 6,072.78 " " 12,444.05 " " 6,497.87 " " 13,085.78 " " 6,072.78 " " 15,188.02 " " 12,150.41 " " 6,012.05 " " 6,194.24 " " 6,072.78 " " 18,359.57 " " 13,631.98 " " 13,774.25 " " 17,212.10 " " 6,194.24 " Inpatient 951 OTHER FACTORS INFLUENCING HEALTH STATUS " 31,027.95 " " 7,899.72 " " 4,424.17 " " 24,822.36 " " 8,265.85 " " 4,468.86 " " 8,535.02 " " 4,468.86 " " 12,541.24 " " 4,468.86 " " 8,847.28 " " 4,781.68 " " 17,692.14 " " 4,468.86 " " 9,035.30 " " 7,228.24 " " 4,424.17 " " 4,558.24 " " 4,468.86 " " 24,822.36 " " 18,430.60 " " 9,793.00 " " 23,270.96 " " 4,558.24 " Inpatient 974 HIV WITH MAJOR RELATED CONDITION WITH MCC " 89,032.26 " " 22,667.61 " " 19,297.18 " " 71,225.81 " " 39,741.38 " " 19,492.10 " " 41,035.51 " " 19,492.10 " " 43,886.40 " " 19,492.10 " " 42,536.81 " " 20,856.55 " " 50,766.19 " " 19,492.10 " " 61,463.22 " " 49,170.57 " " 19,297.18 " " 19,881.94 " " 19,492.10 " " 71,225.81 " " 52,885.16 " " 47,083.75 " " 66,774.20 " " 19,881.94 " Inpatient 981 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC " 153,712.61 " " 39,135.23 " " 32,726.09 " " 122,970.09 " " 68,160.78 " " 33,056.66 " " 70,380.35 " " 33,056.66 " " 68,206.20 " " 33,056.66 " " 72,955.25 " " 35,370.63 " " 87,646.93 " " 33,056.66 " " 93,671.57 " " 74,937.26 " " 32,726.09 " " 33,717.79 " " 33,056.66 " " 122,970.09 " " 91,305.29 " " 80,753.75 " " 115,284.46 " " 33,717.79 " Inpatient 982 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC " 62,441.24 " " 15,897.54 " " 18,223.01 " " 49,952.99 " " 37,468.12 " " 18,407.08 " " 38,688.22 " " 18,407.08 " " 39,297.76 " " 18,407.08 " " 40,103.65 " " 19,695.58 " " 35,604.00 " " 18,407.08 " " 44,498.24 " " 35,598.58 " " 18,223.01 " " 18,775.22 " " 18,407.08 " " 49,952.99 " " 37,090.10 " " 44,390.50 " " 46,830.93 " " 18,775.22 " Inpatient 983 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC " 125,318.83 " " 31,906.17 " " 12,050.87 " " 100,255.06 " " 24,406.12 " " 12,172.60 " " 25,200.88 " " 12,172.60 " " 26,033.42 " " 12,172.60 " " 26,122.86 " " 13,024.68 " " 71,456.80 " " 12,172.60 " " 32,217.02 " " 25,773.60 " " 12,050.87 " " 12,416.05 " " 12,172.60 " " 100,255.06 " " 74,439.39 " " 28,915.25 " " 93,989.12 " " 12,416.05 " Inpatient 987 NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC " 140,498.38 " " 35,770.89 " " 23,383.09 " " 112,398.70 " " 48,388.32 " " 23,619.28 " " 49,964.03 " " 23,619.28 " " 51,206.08 " " 23,619.28 " " 51,791.98 " " 25,272.63 " " 80,112.18 " " 23,619.28 " " 63,856.56 " " 51,085.25 " " 23,383.09 " " 24,091.67 " " 23,619.28 " " 112,398.70 " " 83,456.04 " " 57,328.25 " " 105,373.79 " " 24,091.67 " Inpatient 988 NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC " 64,976.38 " " 16,542.99 " " 12,428.48 " " 51,981.10 " " 25,205.23 " " 12,554.02 " " 26,026.01 " " 12,554.02 " " 27,061.91 " " 12,554.02 " " 26,978.18 " " 13,432.80 " " 37,049.53 " " 12,554.02 " " 30,351.82 " " 24,281.45 " " 12,428.48 " " 12,805.10 " " 12,554.02 " " 51,981.10 " " 38,595.97 " " 29,862.00 " " 48,732.29 " " 12,805.10 " Inpatient 4.4 TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE " 986,110.80 " " 251,063.81 " " 129,833.48 " " 233,557.45 " " 136,325.15 " " 129,833.48 " " 129,833.48 " " 129,833.48 " " 138,272.66 " " 129,833.48 " " 129,833.48 " " 194,750.22 " " 233,557.45 " " 231,285.36 " Inpatient 5.4 TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE " 570,910.16 " " 145,353.73 " " 87,246.21 " " 156,947.21 " " 91,608.52 " " 87,246.21 " " 87,246.21 " " 87,246.21 " " 92,917.21 " " 87,246.21 " " 87,246.21 " " 130,869.32 " " 156,947.21 " " 155,420.40 " Inpatient 21.1 OPEN CRANIOTOMY EXCEPT TRAUMA " 70,636.05 " " 17,983.94 " " 18,463.13 " " 33,213.32 " " 19,386.29 " " 18,463.13 " " 18,463.13 " " 18,463.13 " " 19,663.23 " " 18,463.13 " " 18,463.13 " " 27,694.70 " " 33,213.32 " " 32,890.22 " Inpatient 24.2 OPEN EXTRACRANIAL VASCULAR PROCEDURES " 40,688.86 " " 10,359.38 " " 11,170.40 " " 20,094.43 " " 11,728.92 " " 11,170.40 " " 11,170.40 " " 11,170.40 " " 11,896.48 " " 11,170.40 " " 11,170.40 " " 16,755.60 " " 20,094.43 " " 19,898.95 " Inpatient 41.2 NERVOUS SYSTEM MALIGNANCY " 29,337.69 " " 7,469.37 " " 8,115.62 " " 14,599.19 " " 8,521.40 " " 8,115.62 " " 8,115.62 " " 8,115.62 " " 8,643.14 " " 8,115.62 " " 8,115.62 " " 12,173.43 " " 14,599.19 " " 14,457.17 " Inpatient 41.3 NERVOUS SYSTEM MALIGNANCY " 28,499.23 " " 7,255.90 " " 10,784.36 " " 19,399.99 " " 11,323.58 " " 10,784.36 " " 10,784.36 " " 10,784.36 " " 11,485.34 " " 10,784.36 " " 10,784.36 " " 16,176.54 " " 19,399.99 " " 19,211.26 " Inpatient 43.1 MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES " 21,412.13 " " 5,451.53 " " 7,237.24 " " 13,019.07 " " 7,599.10 " " 7,237.24 " " 7,237.24 " " 7,237.24 " " 7,707.66 " " 7,237.24 " " 7,237.24 " " 10,855.86 " " 13,019.07 " " 12,892.42 " Inpatient 44.3 INTRACRANIAL HEMORRHAGE " 35,606.92 " " 9,065.52 " " 12,377.00 " " 22,264.99 " " 12,995.85 " " 12,377.00 " " 12,377.00 " " 12,377.00 " " 13,181.51 " " 12,377.00 " " 12,377.00 " " 18,565.50 " " 22,264.99 " " 22,048.39 " Inpatient 45.2 CVA & PRECEREBRAL OCCLUSION W INFARCT " 37,623.56 " " 9,578.96 " " 8,188.30 " " 14,729.93 " " 8,597.72 " " 8,188.30 " " 8,188.30 " " 8,188.30 " " 8,720.54 " " 8,188.30 " " 8,188.30 " " 12,282.45 " " 14,729.93 " " 14,586.64 " Inpatient 45.3 CVA & PRECEREBRAL OCCLUSION W INFARCT " 57,025.18 " " 14,518.61 " " 11,935.47 " " 21,470.72 " " 12,532.24 " " 11,935.47 " " 11,935.47 " " 11,935.47 " " 12,711.28 " " 11,935.47 " " 11,935.47 " " 17,903.21 " " 21,470.72 " " 21,261.85 " Inpatient 47.3 TRANSIENT ISCHEMIA " 21,014.11 " " 5,350.19 " " 8,446.18 " " 15,193.83 " " 8,868.49 " " 8,446.18 " " 8,446.18 " " 8,446.18 " " 8,995.18 " " 8,446.18 " " 8,446.18 " " 12,669.27 " " 15,193.83 " " 15,046.03 " Inpatient 48.2 "PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS " " 39,821.11 " " 10,138.45 " " 6,539.38 " " 11,763.69 " " 6,866.35 " " 6,539.38 " " 6,539.38 " " 6,539.38 " " 6,964.44 " " 6,539.38 " " 6,539.38 " " 9,809.07 " " 11,763.69 " " 11,649.25 " Inpatient 49.2 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM " 32,231.56 " " 8,206.16 " " 17,332.33 " " 31,179.13 " " 18,198.95 " " 17,332.33 " " 17,332.33 " " 17,332.33 " " 18,458.93 " " 17,332.33 " " 17,332.33 " " 25,998.50 " " 31,179.13 " " 30,875.81 " Inpatient 52.3 ALTERATION IN CONSCIOUSNESS " 43,829.82 " " 11,159.07 " " 8,218.77 " " 14,784.75 " " 8,629.71 " " 8,218.77 " " 8,218.77 " " 8,218.77 " " 8,752.99 " " 8,218.77 " " 8,218.77 " " 12,328.16 " " 14,784.75 " " 14,640.92 " Inpatient 53.3 SEIZURE " 90,645.44 " " 23,078.33 " " 8,245.34 " " 14,832.54 " " 8,657.61 " " 8,245.34 " " 8,245.34 " " 8,245.34 " " 8,781.29 " " 8,245.34 " " 8,245.34 " " 12,368.01 " " 14,832.54 " " 14,688.25 " Inpatient 58.1 OTHER DISORDERS OF NERVOUS SYSTEM " 17,156.52 " " 4,368.05 " " 6,043.15 " " 10,871.02 " " 6,345.31 " " 6,043.15 " " 6,043.15 " " 6,043.15 " " 6,435.95 " " 6,043.15 " " 6,043.15 " " 9,064.73 " " 10,871.02 " " 10,765.27 " Inpatient 82.1 EYE INFECTIONS & OTHER EYE DISORDERS " 8,985.20 " " 2,287.63 " " 4,845.93 " " 8,717.34 " " 5,088.23 " " 4,845.93 " " 4,845.93 " " 4,845.93 " " 5,160.92 " " 4,845.93 " " 4,845.93 " " 7,268.90 " " 8,717.34 " " 8,632.54 " Inpatient 111.2 VERTIGO & OTHER LABYRINTH DISORDERS " 26,211.84 " " 6,673.53 " " 5,831.37 " " 10,490.05 " " 6,122.94 " " 5,831.37 " " 5,831.37 " " 5,831.37 " " 6,210.41 " " 5,831.37 " " 5,831.37 " " 8,747.06 " " 10,490.05 " " 10,388.00 " Inpatient 113.1 INFECTIONS OF UPPER RESPIRATORY TRACT " 8,755.46 " " 2,229.14 " " 3,161.85 " " 5,687.85 " " 3,319.94 " " 3,161.85 " " 3,161.85 " " 3,161.85 " " 3,367.37 " " 3,161.85 " " 3,161.85 " " 4,742.78 " " 5,687.85 " " 5,632.52 " Inpatient 113.2 INFECTIONS OF UPPER RESPIRATORY TRACT " 16,450.68 " " 4,188.34 " " 4,627.11 " " 8,323.71 " " 4,858.47 " " 4,627.11 " " 4,627.11 " " 4,627.11 " " 4,927.87 " " 4,627.11 " " 4,627.11 " " 6,940.67 " " 8,323.71 " " 8,242.73 " Inpatient 113.3 INFECTIONS OF UPPER RESPIRATORY TRACT " 9,135.26 " " 2,325.84 " " 7,449.02 " " 13,400.04 " " 7,821.47 " " 7,449.02 " " 7,449.02 " " 7,449.02 " " 7,933.21 " " 7,449.02 " " 7,449.02 " " 11,173.53 " " 13,400.04 " " 13,269.68 " Inpatient 121.2 OTHER RESPIRATORY & CHEST PROCEDURES " 60,910.38 " " 15,507.78 " " 15,520.09 " " 27,919.09 " " 16,296.09 " " 15,520.09 " " 15,520.09 " " 15,520.09 " " 16,528.90 " " 15,520.09 " " 15,520.09 " " 23,280.14 " " 27,919.09 " " 27,647.49 " Inpatient 130.4 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS " 279,561.62 " " 71,176.39 " " 51,371.82 " " 92,412.77 " " 53,940.41 " " 51,371.82 " " 51,371.82 " " 51,371.82 " " 54,710.99 " " 51,371.82 " " 51,371.82 " " 77,057.73 " " 92,412.77 " " 91,513.76 " Inpatient 133.2 RESPIRATORY FAILURE " 29,382.80 " " 7,480.86 " " 6,836.34 " " 12,297.89 " " 7,178.16 " " 6,836.34 " " 6,836.34 " " 6,836.34 " " 7,280.70 " " 6,836.34 " " 6,836.34 " " 10,254.51 " " 12,297.89 " " 12,178.26 " Inpatient 133.3 RESPIRATORY FAILURE " 52,953.08 " " 13,481.85 " " 10,109.94 " " 18,186.77 " " 10,615.44 " " 10,109.94 " " 10,109.94 " " 10,109.94 " " 10,767.09 " " 10,109.94 " " 10,109.94 " " 15,164.91 " " 18,186.77 " " 18,009.85 " Inpatient 134.1 PULMONARY EMBOLISM " 13,085.17 " " 3,331.48 " " 5,549.25 " " 9,982.55 " " 5,826.71 " " 5,549.25 " " 5,549.25 " " 5,549.25 " " 5,909.95 " " 5,549.25 " " 5,549.25 " " 8,323.88 " " 9,982.55 " " 9,885.43 " Inpatient 134.2 PULMONARY EMBOLISM " 22,887.45 " " 5,827.14 " " 7,336.49 " " 13,197.61 " " 7,703.31 " " 7,336.49 " " 7,336.49 " " 7,336.49 " " 7,813.36 " " 7,336.49 " " 7,336.49 " " 11,004.74 " " 13,197.61 " " 13,069.22 " Inpatient 134.3 PULMONARY EMBOLISM " 26,997.85 " " 6,873.65 " " 10,453.01 " " 18,803.92 " " 10,975.66 " " 10,453.01 " " 10,453.01 " " 10,453.01 " " 11,132.46 " " 10,453.01 " " 10,453.01 " " 15,679.52 " " 18,803.92 " " 18,620.99 " Inpatient 136.3 RESPIRATORY MALIGNANCY " 56,379.45 " " 14,354.21 " " 12,047.22 " " 21,671.74 " " 12,649.58 " " 12,047.22 " " 12,047.22 " " 12,047.22 " " 12,830.29 " " 12,047.22 " " 12,047.22 " " 18,070.83 " " 21,671.74 " " 21,460.92 " Inpatient 136.4 RESPIRATORY MALIGNANCY " 89,155.93 " " 22,699.10 " " 17,567.56 " " 31,602.28 " " 18,445.94 " " 17,567.56 " " 17,567.56 " " 17,567.56 " " 18,709.45 " " 17,567.56 " " 17,567.56 " " 26,351.34 " " 31,602.28 " " 31,294.85 " Inpatient 137.3 MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS " 37,781.48 " " 9,619.17 " " 10,871.88 " " 19,557.42 " " 11,415.47 " " 10,871.88 " " 10,871.88 " " 10,871.88 " " 11,578.55 " " 10,871.88 " " 10,871.88 " " 16,307.82 " " 19,557.42 " " 19,367.17 " Inpatient 137.4 MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS " 71,653.11 " " 18,242.88 " " 15,954.59 " " 28,700.71 " " 16,752.32 " " 15,954.59 " " 15,954.59 " " 15,954.59 " " 16,991.64 " " 15,954.59 " " 15,954.59 " " 23,931.89 " " 28,700.71 " " 28,421.51 " Inpatient 139.1 OTHER PNEUMONIA " 16,618.49 " " 4,231.07 " " 4,134.78 " " 7,438.06 " " 4,341.52 " " 4,134.78 " " 4,134.78 " " 4,134.78 " " 4,403.54 " " 4,134.78 " " 4,134.78 " " 6,202.17 " " 7,438.06 " " 7,365.70 " Inpatient 139.2 OTHER PNEUMONIA " 23,449.15 " " 5,970.15 " " 5,722.74 " " 10,294.64 " " 6,008.88 " " 5,722.74 " " 5,722.74 " " 5,722.74 " " 6,094.72 " " 5,722.74 " " 5,722.74 " " 8,584.11 " " 10,294.64 " " 10,194.49 " Inpatient 139.3 OTHER PNEUMONIA " 25,896.51 " " 6,593.25 " " 8,496.20 " " 15,283.81 " " 8,921.01 " " 8,496.20 " " 8,496.20 " " 8,496.20 " " 9,048.45 " " 8,496.20 " " 8,496.20 " " 12,744.30 " " 15,283.81 " " 15,135.13 " Inpatient 139.4 OTHER PNEUMONIA " 70,380.48 " " 17,918.87 " " 13,503.89 " " 24,292.15 " " 14,179.08 " " 13,503.89 " " 13,503.89 " " 13,503.89 " " 14,381.64 " " 13,503.89 " " 13,503.89 " " 20,255.84 " " 24,292.15 " " 24,055.83 " Inpatient 140.2 CHRONIC OBSTRUCTIVE PULMONARY DISEASE " 48,835.28 " " 12,433.46 " " 6,036.11 " " 10,858.36 " " 6,337.92 " " 6,036.11 " " 6,036.11 " " 6,036.11 " " 6,428.46 " " 6,036.11 " " 6,036.11 " " 9,054.17 " " 10,858.36 " " 10,752.73 " Inpatient 140.3 CHRONIC OBSTRUCTIVE PULMONARY DISEASE " 48,116.21 " " 12,250.39 " " 7,529.51 " " 13,544.84 " " 7,905.99 " " 7,529.51 " " 7,529.51 " " 7,529.51 " " 8,018.93 " " 7,529.51 " " 7,529.51 " " 11,294.27 " " 13,544.84 " " 13,413.07 " Inpatient 140.4 CHRONIC OBSTRUCTIVE PULMONARY DISEASE " 26,053.38 " " 6,633.19 " " 11,695.55 " " 21,039.12 " " 12,280.33 " " 11,695.55 " " 11,695.55 " " 11,695.55 " " 12,455.76 " " 11,695.55 " " 11,695.55 " " 17,543.33 " " 21,039.12 " " 20,834.45 " Inpatient 141.1 ASTHMA " 14,454.19 " " 3,680.04 " " 3,697.94 " " 6,652.22 " " 3,882.84 " " 3,697.94 " " 3,697.94 " " 3,697.94 " " 3,938.31 " " 3,697.94 " " 3,697.94 " " 5,546.91 " " 6,652.22 " " 6,587.51 " Inpatient 141.2 ASTHMA " 20,319.02 " " 5,173.22 " " 5,328.10 " " 9,584.72 " " 5,594.51 " " 5,328.10 " " 5,328.10 " " 5,328.10 " " 5,674.43 " " 5,328.10 " " 5,328.10 " " 7,992.15 " " 9,584.72 " " 9,491.48 " Inpatient 141.3 ASTHMA " 12,337.96 " " 3,141.24 " " 7,595.94 " " 13,664.34 " " 7,975.74 " " 7,595.94 " " 7,595.94 " " 7,595.94 " " 8,089.68 " " 7,595.94 " " 7,595.94 " " 11,393.91 " " 13,664.34 " " 13,531.41 " Inpatient 143.2 "OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DI " " 36,834.39 " " 9,378.04 " " 6,612.06 " " 11,894.43 " " 6,942.66 " " 6,612.06 " " 6,612.06 " " 6,612.06 " " 7,041.84 " " 6,612.06 " " 6,612.06 " " 9,918.09 " " 11,894.43 " " 11,778.72 " Inpatient 143.3 "OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DI " " 27,078.08 " " 6,894.08 " " 10,033.36 " " 18,049.01 " " 10,535.03 " " 10,033.36 " " 10,033.36 " " 10,033.36 " " 10,685.53 " " 10,033.36 " " 10,033.36 " " 15,050.04 " " 18,049.01 " " 17,873.43 " Inpatient 163.2 CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX " 87,964.42 " " 22,395.74 " " 37,653.03 " " 67,734.04 " " 39,535.68 " " 37,653.03 " " 37,653.03 " " 37,653.03 " " 40,100.48 " " 37,653.03 " " 37,653.03 " " 56,479.55 " " 67,734.04 " " 67,075.11 " Inpatient 165.2 CORONARY BYPASS W AMI OR COMPLEX PDX " 126,745.80 " " 32,269.48 " " 36,731.67 " " 66,076.60 " " 38,568.25 " " 36,731.67 " " 36,731.67 " " 36,731.67 " " 39,119.23 " " 36,731.67 " " 36,731.67 " " 55,097.51 " " 66,076.60 " " 65,433.80 " Inpatient 166.4 CORONARY BYPASS W/O AMI OR COMPLEX PDX " 225,369.62 " " 57,379.11 " " 62,667.26 " " 112,732.13 " " 65,800.62 " " 62,667.26 " " 62,667.26 " " 62,667.26 " " 66,740.63 " " 62,667.26 " " 62,667.26 " " 94,000.89 " " 112,732.13 " " 111,635.46 " Inpatient 167.1 OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES " 47,270.56 " " 12,035.08 " " 27,759.55 " " 49,936.65 " " 29,147.53 " " 27,759.55 " " 27,759.55 " " 27,759.55 " " 29,563.92 " " 27,759.55 " " 27,759.55 " " 41,639.33 " " 49,936.65 " " 49,450.86 " Inpatient 167.3 OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES " 96,892.55 " " 24,668.84 " " 39,430.10 " " 70,930.81 " " 41,401.61 " " 39,430.10 " " 39,430.10 " " 39,430.10 " " 41,993.06 " " 39,430.10 " " 39,430.10 " " 59,145.15 " " 70,930.81 " " 70,240.78 " Inpatient 169.1 MAJOR ABDOMINAL VASCULAR PROCEDURES " 32,160.59 " " 8,188.09 " " 17,439.40 " " 31,371.74 " " 18,311.37 " " 17,439.40 " " 17,439.40 " " 17,439.40 " " 18,572.96 " " 17,439.40 " " 17,439.40 " " 26,159.10 " " 31,371.74 " " 31,066.55 " Inpatient 170.4 "PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR " " 181,355.48 " " 46,173.11 " " 37,538.15 " " 67,527.38 " " 39,415.06 " " 37,538.15 " " 37,538.15 " " 37,538.15 " " 39,978.13 " " 37,538.15 " " 37,538.15 " " 56,307.23 " " 67,527.38 " " 66,870.46 " Inpatient 171.2 "PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHO " " 111,314.12 " " 28,340.57 " " 16,660.27 " " 29,970.16 " " 17,493.28 " " 16,660.27 " " 16,660.27 " " 16,660.27 " " 17,743.19 " " 16,660.27 " " 16,660.27 " " 24,990.41 " " 29,970.16 " " 29,678.60 " Inpatient 174.1 PERCUTANEOUS CARDIAC INTERVENTION W AMI " 93,395.89 " " 23,778.59 " " 16,750.92 " " 30,133.23 " " 17,588.47 " " 16,750.92 " " 16,750.92 " " 16,750.92 " " 17,839.73 " " 16,750.92 " " 16,750.92 " " 25,126.38 " " 30,133.23 " " 29,840.09 " Inpatient 174.2 PERCUTANEOUS CARDIAC INTERVENTION W AMI " 114,943.25 " " 29,264.55 " " 18,853.08 " " 33,914.81 " " 19,795.73 " " 18,853.08 " " 18,853.08 " " 18,853.08 " " 20,078.53 " " 18,853.08 " " 18,853.08 " " 28,279.62 " " 33,914.81 " " 33,584.88 " Inpatient 174.3 PERCUTANEOUS CARDIAC INTERVENTION W AMI " 125,867.16 " " 32,045.78 " " 24,289.81 " " 43,694.94 " " 25,504.30 " " 24,289.81 " " 24,289.81 " " 24,289.81 " " 25,868.65 " " 24,289.81 " " 24,289.81 " " 36,434.72 " " 43,694.94 " " 43,269.87 " Inpatient 175.2 PERCUTANEOUS CARDIAC INTERVENTION W/O AMI " 84,563.74 " " 21,529.93 " " 21,435.08 " " 38,559.57 " " 22,506.83 " " 21,435.08 " " 21,435.08 " " 21,435.08 " " 22,828.36 " " 21,435.08 " " 21,435.08 " " 32,152.62 " " 38,559.57 " " 38,184.45 " Inpatient 175.3 PERCUTANEOUS CARDIAC INTERVENTION W/O AMI " 146,490.50 " " 37,296.48 " " 26,432.61 " " 47,549.62 " " 27,754.24 " " 26,432.61 " " 26,432.61 " " 26,432.61 " " 28,150.73 " " 26,432.61 " " 26,432.61 " " 39,648.92 " " 47,549.62 " " 47,087.05 " Inpatient 178.3 EXTERNAL HEART ASSIST SYSTEMS " 163,989.40 " " 41,751.70 " " 55,349.53 " " 99,568.27 " " 58,117.01 " " 55,349.53 " " 55,349.53 " " 55,349.53 " " 58,947.25 " " 55,349.53 " " 55,349.53 " " 83,024.30 " " 99,568.27 " " 98,599.65 " Inpatient 182.2 OTHER PERIPHERAL VASCULAR PROCEDURES " 111,084.20 " " 28,282.04 " " 22,347.06 " " 40,200.13 " " 23,464.41 " " 22,347.06 " " 22,347.06 " " 22,347.06 " " 23,799.62 " " 22,347.06 " " 22,347.06 " " 33,520.59 " " 40,200.13 " " 39,809.05 " Inpatient 182.3 OTHER PERIPHERAL VASCULAR PROCEDURES " 70,674.10 " " 17,993.63 " " 25,313.54 " " 45,536.53 " " 26,579.22 " " 25,313.54 " " 25,313.54 " " 25,313.54 " " 26,958.92 " " 25,313.54 " " 25,313.54 " " 37,970.31 " " 45,536.53 " " 45,093.54 " Inpatient 182.4 OTHER PERIPHERAL VASCULAR PROCEDURES " 251,948.93 " " 64,146.20 " " 47,334.72 " " 85,150.43 " " 49,701.46 " " 47,334.72 " " 47,334.72 " " 47,334.72 " " 50,411.48 " " 47,334.72 " " 47,334.72 " " 71,002.08 " " 85,150.43 " " 84,322.07 " Inpatient 183.2 PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES " 253,899.82 " " 64,642.89 " " 42,313.75 " " 76,118.20 " " 44,429.44 " " 42,313.75 " " 42,313.75 " " 42,313.75 " " 45,064.14 " " 42,313.75 " " 42,313.75 " " 63,470.63 " " 76,118.20 " " 75,377.71 " Inpatient 190.1 ACUTE MYOCARDIAL INFARCTION " 25,405.00 " " 6,468.11 " " 6,149.43 " " 11,062.21 " " 6,456.90 " " 6,149.43 " " 6,149.43 " " 6,149.43 " " 6,549.14 " " 6,149.43 " " 6,149.43 " " 9,224.15 " " 11,062.21 " " 10,954.59 " Inpatient 190.2 ACUTE MYOCARDIAL INFARCTION " 33,788.90 " " 8,602.65 " " 7,473.25 " " 13,443.63 " " 7,846.91 " " 7,473.25 " " 7,473.25 " " 7,473.25 " " 7,959.01 " " 7,473.25 " " 7,473.25 " " 11,209.88 " " 13,443.63 " " 13,312.85 " Inpatient 190.3 ACUTE MYOCARDIAL INFARCTION " 50,270.54 " " 12,798.88 " " 10,306.87 " " 18,541.03 " " 10,822.21 " " 10,306.87 " " 10,306.87 " " 10,306.87 " " 10,976.82 " " 10,306.87 " " 10,306.87 " " 15,460.31 " " 18,541.03 " " 18,360.66 " Inpatient 191.1 CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE " 24,489.36 " " 6,234.99 " " 8,569.65 " " 15,415.94 " " 8,998.13 " " 8,569.65 " " 8,569.65 " " 8,569.65 " " 9,126.68 " " 8,569.65 " " 8,569.65 " " 12,854.48 " " 15,415.94 " " 15,265.97 " Inpatient 191.2 CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE " 56,311.48 " " 14,336.90 " " 9,959.90 " " 17,916.86 " " 10,457.90 " " 9,959.90 " " 9,959.90 " " 9,959.90 " " 10,607.29 " " 9,959.90 " " 9,959.90 " " 14,939.85 " " 17,916.86 " " 17,742.57 " Inpatient 192.2 CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS " 57,011.03 " " 14,515.01 " " 11,401.72 " " 20,510.55 " " 11,971.81 " " 11,401.72 " " 11,401.72 " " 11,401.72 " " 12,142.83 " " 11,401.72 " " 11,401.72 " " 17,102.58 " " 20,510.55 " " 20,311.02 " Inpatient 192.3 CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS " 121,323.06 " " 30,888.85 " " 16,664.95 " " 29,978.58 " " 17,498.20 " " 16,664.95 " " 16,664.95 " " 16,664.95 " " 17,748.17 " " 16,664.95 " " 16,664.95 " " 24,997.43 " " 29,978.58 " " 29,686.94 " Inpatient 194.1 HEART FAILURE " 19,296.16 " " 4,912.80 " " 4,648.99 " " 8,363.07 " " 4,881.44 " " 4,648.99 " " 4,648.99 " " 4,648.99 " " 4,951.17 " " 4,648.99 " " 4,648.99 " " 6,973.49 " " 8,363.07 " " 8,281.71 " Inpatient 194.2 HEART FAILURE " 29,186.22 " " 7,430.81 " " 6,144.74 " " 11,053.77 " " 6,451.98 " " 6,144.74 " " 6,144.74 " " 6,144.74 " " 6,544.15 " " 6,144.74 " " 6,144.74 " " 9,217.11 " " 11,053.77 " " 10,946.24 " Inpatient 194.3 HEART FAILURE " 51,645.24 " " 13,148.88 " " 8,888.50 " " 15,989.52 " " 9,332.93 " " 8,888.50 " " 8,888.50 " " 8,888.50 " " 9,466.25 " " 8,888.50 " " 8,888.50 " " 13,332.75 " " 15,989.52 " " 15,833.97 " Inpatient 194.4 HEART FAILURE " 51,632.26 " " 13,145.57 " " 14,539.34 " " 26,154.82 " " 15,266.31 " " 14,539.34 " " 14,539.34 " " 14,539.34 " " 15,484.40 " " 14,539.34 " " 14,539.34 " " 21,809.01 " " 26,154.82 " " 25,900.38 " Inpatient 197.1 PERIPHERAL & OTHER VASCULAR DISORDERS " 10,790.78 " " 2,747.33 " " 4,990.50 " " 8,977.41 " " 5,240.03 " " 4,990.50 " " 4,990.50 " " 4,990.50 " " 5,314.88 " " 4,990.50 " " 4,990.50 " " 7,485.75 " " 8,977.41 " " 8,890.08 " Inpatient 197.2 PERIPHERAL & OTHER VASCULAR DISORDERS " 13,877.89 " " 3,533.31 " " 6,515.16 " " 11,720.12 " " 6,840.92 " " 6,515.16 " " 6,515.16 " " 6,515.16 " " 6,938.65 " " 6,515.16 " " 6,515.16 " " 9,772.74 " " 11,720.12 " " 11,606.11 " Inpatient 199.1 HYPERTENSION " 12,455.64 " " 3,171.21 " " 4,745.90 " " 8,537.40 " " 4,983.20 " " 4,745.90 " " 4,745.90 " " 4,745.90 " " 5,054.38 " " 4,745.90 " " 4,745.90 " " 7,118.85 " " 8,537.40 " " 8,454.35 " Inpatient 199.2 HYPERTENSION " 24,078.01 " " 6,130.26 " " 5,492.21 " " 9,879.94 " " 5,766.82 " " 5,492.21 " " 5,492.21 " " 5,492.21 " " 5,849.20 " " 5,492.21 " " 5,492.21 " " 8,238.32 " " 9,879.94 " " 9,783.82 " Inpatient 199.3 HYPERTENSION " 48,072.25 " " 12,239.19 " " 7,288.04 " " 13,110.46 " " 7,652.44 " " 7,288.04 " " 7,288.04 " " 7,288.04 " " 7,761.76 " " 7,288.04 " " 7,288.04 " " 10,932.06 " " 13,110.46 " " 12,982.91 " Inpatient 201.1 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS " 17,957.12 " " 4,571.88 " " 4,191.83 " " 7,540.68 " " 4,401.42 " " 4,191.83 " " 4,191.83 " " 4,191.83 " " 4,464.30 " " 4,191.83 " " 4,191.83 " " 6,287.75 " " 7,540.68 " " 7,467.33 " Inpatient 201.2 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS " 21,725.77 " " 5,531.38 " " 5,489.86 " " 9,875.71 " " 5,764.35 " " 5,489.86 " " 5,489.86 " " 5,489.86 " " 5,846.70 " " 5,489.86 " " 5,489.86 " " 8,234.79 " " 9,875.71 " " 9,779.64 " Inpatient 201.3 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS " 40,401.12 " " 10,286.13 " " 8,099.99 " " 14,571.07 " " 8,504.99 " " 8,099.99 " " 8,099.99 " " 8,099.99 " " 8,626.49 " " 8,099.99 " " 8,099.99 " " 12,149.99 " " 14,571.07 " " 14,429.32 " Inpatient 220.1 "MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES " " 50,613.41 " " 12,886.17 " " 12,660.68 " " 22,775.30 " " 13,293.71 " " 12,660.68 " " 12,660.68 " " 12,660.68 " " 13,483.62 " " 12,660.68 " " 12,660.68 " " 18,991.02 " " 22,775.30 " " 22,553.74 " Inpatient 223.1 OTHER SMALL & LARGE BOWEL PROCEDURES " 19,148.96 " " 4,875.33 " " 9,390.20 " " 16,892.03 " " 9,859.71 " " 9,390.20 " " 9,390.20 " " 9,390.20 " " 10,000.56 " " 9,390.20 " " 9,390.20 " " 14,085.30 " " 16,892.03 " " 16,727.70 " Inpatient 229.3 OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES " 63,929.90 " " 16,276.55 " " 19,840.87 " " 35,691.74 " " 20,832.91 " " 19,840.87 " " 19,840.87 " " 19,840.87 " " 21,130.53 " " 19,840.87 " " 19,840.87 " " 29,761.31 " " 35,691.74 " " 35,344.53 " Inpatient 230.2 MAJOR SMALL BOWEL PROCEDURES " 105,948.02 " " 26,974.36 " " 17,038.50 " " 30,650.56 " " 17,890.43 " " 17,038.50 " " 17,038.50 " " 17,038.50 " " 18,146.00 " " 17,038.50 " " 17,038.50 " " 25,557.75 " " 30,650.56 " " 30,352.38 " Inpatient 230.3 MAJOR SMALL BOWEL PROCEDURES " 66,529.86 " " 16,938.50 " " 26,260.69 " " 47,240.36 " " 27,573.72 " " 26,260.69 " " 26,260.69 " " 26,260.69 " " 27,967.63 " " 26,260.69 " " 26,260.69 " " 39,391.04 " " 47,240.36 " " 46,780.79 " Inpatient 230.4 MAJOR SMALL BOWEL PROCEDURES " 267,843.21 " " 68,192.88 " " 50,262.91 " " 90,417.95 " " 52,776.06 " " 50,262.91 " " 50,262.91 " " 50,262.91 " " 53,530.00 " " 50,262.91 " " 50,262.91 " " 75,394.37 " " 90,417.95 " " 89,538.35 " Inpatient 231.1 MAJOR LARGE BOWEL PROCEDURES " 82,975.02 " " 21,125.44 " " 12,339.49 " " 22,197.51 " " 12,956.46 " " 12,339.49 " " 12,339.49 " " 12,339.49 " " 13,141.56 " " 12,339.49 " " 12,339.49 " " 18,509.24 " " 22,197.51 " " 21,981.57 " Inpatient 231.2 MAJOR LARGE BOWEL PROCEDURES " 76,018.90 " " 19,354.41 " " 16,120.27 " " 28,998.75 " " 16,926.28 " " 16,120.27 " " 16,120.27 " " 16,120.27 " " 17,168.09 " " 16,120.27 " " 16,120.27 " " 24,180.41 " " 28,998.75 " " 28,716.65 " Inpatient 240.2 DIGESTIVE MALIGNANCY " 66,706.57 " " 16,983.49 " " 8,182.82 " " 14,720.07 " " 8,591.96 " " 8,182.82 " " 8,182.82 " " 8,182.82 " " 8,714.70 " " 8,182.82 " " 8,182.82 " " 12,274.23 " " 14,720.07 " " 14,576.88 " Inpatient 241.2 PEPTIC ULCER & GASTRITIS " 25,384.69 " " 6,462.94 " " 7,175.50 " " 12,908.01 " " 7,534.28 " " 7,175.50 " " 7,175.50 " " 7,175.50 " " 7,641.91 " " 7,175.50 " " 7,175.50 " " 10,763.25 " " 12,908.01 " " 12,782.44 " Inpatient 241.4 PEPTIC ULCER & GASTRITIS " 54,178.08 " " 13,793.74 " " 22,610.42 " " 40,673.88 " " 23,740.94 " " 22,610.42 " " 22,610.42 " " 22,610.42 " " 24,080.10 " " 22,610.42 " " 22,610.42 " " 33,915.63 " " 40,673.88 " " 40,278.20 " Inpatient 242.3 MAJOR ESOPHAGEAL DISORDERS " 33,699.48 " " 8,579.89 " " 9,983.34 " " 17,959.03 " " 10,482.51 " " 9,983.34 " " 9,983.34 " " 9,983.34 " " 10,632.26 " " 9,983.34 " " 9,983.34 " " 14,975.01 " " 17,959.03 " " 17,784.32 " Inpatient 242.4 MAJOR ESOPHAGEAL DISORDERS " 57,891.37 " " 14,739.14 " " 21,887.55 " " 39,373.51 " " 22,981.93 " " 21,887.55 " " 21,887.55 " " 21,887.55 " " 23,310.24 " " 21,887.55 " " 21,887.55 " " 32,831.33 " " 39,373.51 " " 38,990.48 " Inpatient 243.2 OTHER ESOPHAGEAL DISORDERS " 21,200.89 " " 5,397.75 " " 6,404.19 " " 11,520.50 " " 6,724.40 " " 6,404.19 " " 6,404.19 " " 6,404.19 " " 6,820.46 " " 6,404.19 " " 6,404.19 " " 9,606.29 " " 11,520.50 " " 11,408.42 " Inpatient 244.1 DIVERTICULITIS & DIVERTICULOSIS " 17,531.87 " " 4,463.61 " " 4,626.33 " " 8,322.31 " " 4,857.65 " " 4,626.33 " " 4,626.33 " " 4,626.33 " " 4,927.04 " " 4,626.33 " " 4,626.33 " " 6,939.50 " " 8,322.31 " " 8,241.34 " Inpatient 244.2 DIVERTICULITIS & DIVERTICULOSIS " 30,648.44 " " 7,803.09 " " 6,247.11 " " 11,237.93 " " 6,559.47 " " 6,247.11 " " 6,247.11 " " 6,247.11 " " 6,653.17 " " 6,247.11 " " 6,247.11 " " 9,370.67 " " 11,237.93 " " 11,128.60 " Inpatient 245.2 INFLAMMATORY BOWEL DISEASE " 16,382.56 " " 4,171.00 " " 7,259.12 " " 13,058.43 " " 7,622.08 " " 7,259.12 " " 7,259.12 " " 7,259.12 " " 7,730.96 " " 7,259.12 " " 7,259.12 " " 10,888.68 " " 13,058.43 " " 12,931.40 " Inpatient 246.1 GASTROINTESTINAL VASCULAR INSUFFICIENCY " 8,309.83 " " 2,115.68 " " 5,569.57 " " 10,019.10 " " 5,848.05 " " 5,569.57 " " 5,569.57 " " 5,569.57 " " 5,931.59 " " 5,569.57 " " 5,569.57 " " 8,354.36 " " 10,019.10 " " 9,921.63 " Inpatient 247.1 INTESTINAL OBSTRUCTION " 16,366.51 " " 4,166.91 " " 4,346.56 " " 7,819.03 " " 4,563.89 " " 4,346.56 " " 4,346.56 " " 4,346.56 " " 4,629.09 " " 4,346.56 " " 4,346.56 " " 6,519.84 " " 7,819.03 " " 7,742.96 " Inpatient 247.2 INTESTINAL OBSTRUCTION " 16,247.16 " " 4,136.53 " " 5,857.16 " " 10,536.45 " " 6,150.02 " " 5,857.16 " " 5,857.16 " " 5,857.16 " " 6,237.88 " " 5,857.16 " " 5,857.16 " " 8,785.74 " " 10,536.45 " " 10,433.94 " Inpatient 247.3 INTESTINAL OBSTRUCTION " 30,606.46 " " 7,792.40 " " 9,449.60 " " 16,998.89 " " 9,922.08 " " 9,449.60 " " 9,449.60 " " 9,449.60 " " 10,063.82 " " 9,449.60 " " 9,449.60 " " 14,174.40 " " 16,998.89 " " 16,833.52 " Inpatient 248.2 MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS " 12,877.60 " " 3,278.64 " " 6,762.10 " " 12,164.34 " " 7,100.21 " " 6,762.10 " " 6,762.10 " " 6,762.10 " " 7,201.64 " " 6,762.10 " " 6,762.10 " " 10,143.15 " " 12,164.34 " " 12,046.00 " Inpatient 249.1 "OTHER GASTROENTERITIS, NAUSEA & VOMITING " " 15,683.95 " " 3,993.13 " " 4,211.37 " " 7,575.83 " " 4,421.94 " " 4,211.37 " " 4,211.37 " " 4,211.37 " " 4,485.11 " " 4,211.37 " " 4,211.37 " " 6,317.06 " " 7,575.83 " " 7,502.13 " Inpatient 249.2 "OTHER GASTROENTERITIS, NAUSEA & VOMITING " " 25,626.80 " " 6,524.58 " " 5,185.87 " " 9,328.86 " " 5,445.16 " " 5,185.87 " " 5,185.87 " " 5,185.87 " " 5,522.95 " " 5,185.87 " " 5,185.87 " " 7,778.81 " " 9,328.86 " " 9,238.11 " Inpatient 249.3 "OTHER GASTROENTERITIS, NAUSEA & VOMITING " " 37,588.72 " " 9,570.09 " " 7,885.86 " " 14,185.87 " " 8,280.15 " " 7,885.86 " " 7,885.86 " " 7,885.86 " " 8,398.44 " " 7,885.86 " " 7,885.86 " " 11,828.79 " " 14,185.87 " " 14,047.87 " Inpatient 251.2 ABDOMINAL PAIN " 20,872.96 " " 5,314.26 " " 5,957.97 " " 10,717.79 " " 6,255.87 " " 5,957.97 " " 5,957.97 " " 5,957.97 " " 6,345.24 " " 5,957.97 " " 5,957.97 " " 8,936.96 " " 10,717.79 " " 10,613.53 " Inpatient 252.2 "MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDUR " " 22,417.53 " " 5,707.50 " " 6,814.46 " " 12,258.53 " " 7,155.18 " " 6,814.46 " " 6,814.46 " " 6,814.46 " " 7,257.40 " " 6,814.46 " " 6,814.46 " " 10,221.69 " " 12,258.53 " " 12,139.28 " Inpatient 253.1 OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE " 32,034.91 " " 8,156.09 " " 5,322.63 " " 9,574.88 " " 5,588.76 " " 5,322.63 " " 5,322.63 " " 5,322.63 " " 5,668.60 " " 5,322.63 " " 5,322.63 " " 7,983.95 " " 9,574.88 " " 9,481.73 " Inpatient 253.2 OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE " 42,929.28 " " 10,929.79 " " 6,869.17 " " 12,356.95 " " 7,212.63 " " 6,869.17 " " 6,869.17 " " 6,869.17 " " 7,315.67 " " 6,869.17 " " 6,869.17 " " 10,303.76 " " 12,356.95 " " 12,236.74 " Inpatient 253.3 OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE " 34,116.39 " " 8,686.03 " " 10,131.04 " " 18,224.73 " " 10,637.59 " " 10,131.04 " " 10,131.04 " " 10,131.04 " " 10,789.56 " " 10,131.04 " " 10,131.04 " " 15,196.56 " " 18,224.73 " " 18,047.43 " Inpatient 253.4 OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE " 41,054.39 " " 10,452.45 " " 18,492.04 " " 33,265.33 " " 19,416.64 " " 18,492.04 " " 18,492.04 " " 18,492.04 " " 19,694.02 " " 18,492.04 " " 18,492.04 " " 27,738.06 " " 33,265.33 " " 32,941.72 " Inpatient 254.1 OTHER DIGESTIVE SYSTEM DIAGNOSES " 22,673.36 " " 5,772.64 " " 4,804.51 " " 8,642.83 " " 5,044.74 " " 4,804.51 " " 4,804.51 " " 4,804.51 " " 5,116.80 " " 4,804.51 " " 4,804.51 " " 7,206.77 " " 8,642.83 " " 8,558.75 " Inpatient 254.2 OTHER DIGESTIVE SYSTEM DIAGNOSES " 21,342.81 " " 5,433.88 " " 6,425.29 " " 11,558.45 " " 6,746.55 " " 6,425.29 " " 6,425.29 " " 6,425.29 " " 6,842.93 " " 6,425.29 " " 6,425.29 " " 9,637.94 " " 11,558.45 " " 11,446.01 " Inpatient 263.2 CHOLECYSTECTOMY " 86,784.98 " " 22,095.45 " " 12,411.39 " " 22,326.85 " " 13,031.96 " " 12,411.39 " " 12,411.39 " " 12,411.39 " " 13,218.13 " " 12,411.39 " " 12,411.39 " " 18,617.09 " " 22,326.85 " " 22,109.65 " Inpatient 263.3 CHOLECYSTECTOMY " 65,694.34 " " 16,725.78 " " 16,698.56 " " 30,039.04 " " 17,533.49 " " 16,698.56 " " 16,698.56 " " 16,698.56 " " 17,783.97 " " 16,698.56 " " 16,698.56 " " 25,047.84 " " 30,039.04 " " 29,746.81 " Inpatient 279.2 HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS " 62,343.37 " " 15,872.62 " " 6,122.86 " " 11,014.41 " " 6,429.00 " " 6,122.86 " " 6,122.86 " " 6,122.86 " " 6,520.85 " " 6,122.86 " " 6,122.86 " " 9,184.29 " " 11,014.41 " " 10,907.26 " Inpatient 279.3 HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS " 25,982.12 " " 6,615.05 " " 9,380.04 " " 16,873.75 " " 9,849.04 " " 9,380.04 " " 9,380.04 " " 9,380.04 " " 9,989.74 " " 9,380.04 " " 9,380.04 " " 14,070.06 " " 16,873.75 " " 16,709.60 " Inpatient 279.4 HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS " 84,391.25 " " 21,486.01 " " 22,298.61 " " 40,112.97 " " 23,413.54 " " 22,298.61 " " 22,298.61 " " 22,298.61 " " 23,748.02 " " 22,298.61 " " 22,298.61 " " 33,447.92 " " 40,112.97 " " 39,722.74 " Inpatient 280.1 ALCOHOLIC LIVER DISEASE " 43,257.72 " " 11,013.42 " " 4,537.24 " " 8,162.04 " " 4,764.10 " " 4,537.24 " " 4,537.24 " " 4,537.24 " " 4,832.16 " " 4,537.24 " " 4,537.24 " " 6,805.86 " " 8,162.04 " " 8,082.64 " Inpatient 280.2 ALCOHOLIC LIVER DISEASE " 23,406.56 " " 5,959.31 " " 5,843.09 " " 10,511.13 " " 6,135.24 " " 5,843.09 " " 5,843.09 " " 5,843.09 " " 6,222.89 " " 5,843.09 " " 5,843.09 " " 8,764.64 " " 10,511.13 " " 10,408.88 " Inpatient 280.3 ALCOHOLIC LIVER DISEASE " 35,524.14 " " 9,044.45 " " 8,999.47 " " 16,189.15 " " 9,449.44 " " 8,999.47 " " 8,999.47 " " 8,999.47 " " 9,584.44 " " 8,999.47 " " 8,999.47 " " 13,499.21 " " 16,189.15 " " 16,031.66 " Inpatient 280.4 ALCOHOLIC LIVER DISEASE " 27,216.59 " " 6,929.34 " " 20,273.81 " " 36,470.56 " " 21,287.50 " " 20,273.81 " " 20,273.81 " " 20,273.81 " " 21,591.61 " " 20,273.81 " " 20,273.81 " " 30,410.72 " " 36,470.56 " " 36,115.77 " Inpatient 281.2 MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS " 18,195.77 " " 4,632.64 " " 8,387.57 " " 15,088.40 " " 8,806.95 " " 8,387.57 " " 8,387.57 " " 8,387.57 " " 8,932.76 " " 8,387.57 " " 8,387.57 " " 12,581.36 " " 15,088.40 " " 14,941.62 " Inpatient 282.1 DISORDERS OF PANCREAS EXCEPT MALIGNANCY " 15,914.26 " " 4,051.77 " " 4,522.40 " " 8,135.35 " " 4,748.52 " " 4,522.40 " " 4,522.40 " " 4,522.40 " " 4,816.36 " " 4,522.40 " " 4,522.40 " " 6,783.60 " " 8,135.35 " " 8,056.20 " Inpatient 282.2 DISORDERS OF PANCREAS EXCEPT MALIGNANCY " 37,687.93 " " 9,595.35 " " 6,097.07 " " 10,968.02 " " 6,401.92 " " 6,097.07 " " 6,097.07 " " 6,097.07 " " 6,493.38 " " 6,097.07 " " 6,097.07 " " 9,145.61 " " 10,968.02 " " 10,861.32 " Inpatient 282.3 DISORDERS OF PANCREAS EXCEPT MALIGNANCY " 25,203.33 " " 6,416.77 " " 10,183.40 " " 18,318.92 " " 10,692.57 " " 10,183.40 " " 10,183.40 " " 10,183.40 " " 10,845.32 " " 10,183.40 " " 10,183.40 " " 15,275.10 " " 18,318.92 " " 18,140.71 " Inpatient 283.3 OTHER DISORDERS OF THE LIVER " 45,806.45 " " 11,662.32 " " 9,376.92 " " 16,868.14 " " 9,845.77 " " 9,376.92 " " 9,376.92 " " 9,376.92 " " 9,986.42 " " 9,376.92 " " 9,376.92 " " 14,065.38 " " 16,868.14 " " 16,704.05 " Inpatient 284.2 DISORDERS OF GALLBLADDER & BILIARY TRACT " 60,854.83 " " 15,493.64 " " 7,774.11 " " 13,984.85 " " 8,162.82 " " 7,774.11 " " 7,774.11 " " 7,774.11 " " 8,279.43 " " 7,774.11 " " 7,774.11 " " 11,661.17 " " 13,984.85 " " 13,848.80 " Inpatient 284.3 DISORDERS OF GALLBLADDER & BILIARY TRACT " 63,671.78 " " 16,210.84 " " 11,100.07 " " 19,967.92 " " 11,655.07 " " 11,100.07 " " 11,100.07 " " 11,100.07 " " 11,821.57 " " 11,100.07 " " 11,100.07 " " 16,650.11 " " 19,967.92 " " 19,773.66 " Inpatient 304.1 DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK " 142,705.63 " " 36,332.85 " " 23,948.30 " " 43,080.60 " " 25,145.72 " " 23,948.30 " " 23,948.30 " " 23,948.30 " " 25,504.94 " " 23,948.30 " " 23,948.30 " " 35,922.45 " " 43,080.60 " " 42,661.50 " Inpatient 304.2 DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK " 101,174.21 " " 25,758.95 " " 29,196.69 " " 52,521.93 " " 30,656.52 " " 29,196.69 " " 29,196.69 " " 29,196.69 " " 31,094.47 " " 29,196.69 " " 29,196.69 " " 43,795.04 " " 52,521.93 " " 52,010.98 " Inpatient 305.3 AMPUTATION OF LOWER LIMB EXCEPT TOES " 80,142.16 " " 20,404.19 " " 20,120.64 " " 36,195.02 " " 21,126.67 " " 20,120.64 " " 20,120.64 " " 20,120.64 " " 21,428.48 " " 20,120.64 " " 20,120.64 " " 30,180.96 " " 36,195.02 " " 35,842.91 " Inpatient 308.1 HIP & FEMUR FRACTURE REPAIR " 56,257.02 " " 14,323.04 " " 11,643.98 " " 20,946.36 " " 12,226.18 " " 11,643.98 " " 11,643.98 " " 11,643.98 " " 12,400.84 " " 11,643.98 " " 11,643.98 " " 17,465.97 " " 20,946.36 " " 20,742.59 " Inpatient 308.4 HIP & FEMUR FRACTURE REPAIR " 80,527.91 " " 20,502.41 " " 27,916.63 " " 50,219.23 " " 29,312.46 " " 27,916.63 " " 27,916.63 " " 27,916.63 " " 29,731.21 " " 27,916.63 " " 27,916.63 " " 41,874.95 " " 50,219.23 " " 49,730.68 " Inpatient 310.1 INTERVERTEBRAL DISC EXCISION & DECOMPRESSION " 84,607.79 " " 21,541.14 " " 9,990.38 " " 17,971.69 " " 10,489.90 " " 9,990.38 " " 9,990.38 " " 9,990.38 " " 10,639.75 " " 9,990.38 " " 9,990.38 " " 14,985.57 " " 17,971.69 " " 17,796.86 " Inpatient 313.1 KNEE & LOWER LEG PROCEDURES EXCEPT FOOT " 54,046.38 " " 13,760.21 " " 10,527.25 " " 18,937.47 " " 11,053.61 " " 10,527.25 " " 10,527.25 " " 10,527.25 " " 11,211.52 " " 10,527.25 " " 10,527.25 " " 15,790.88 " " 18,937.47 " " 18,753.24 " Inpatient 313.2 KNEE & LOWER LEG PROCEDURES EXCEPT FOOT " 83,692.74 " " 21,308.17 " " 14,187.68 " " 25,522.22 " " 14,897.06 " " 14,187.68 " " 14,187.68 " " 14,187.68 " " 15,109.88 " " 14,187.68 " " 14,187.68 " " 21,281.52 " " 25,522.22 " " 25,273.93 " Inpatient 313.4 KNEE & LOWER LEG PROCEDURES EXCEPT FOOT " 185,166.47 " " 47,143.38 " " 35,557.89 " " 63,965.09 " " 37,335.78 " " 35,557.89 " " 35,557.89 " " 35,557.89 " " 37,869.15 " " 35,557.89 " " 35,557.89 " " 53,336.84 " " 63,965.09 " " 63,342.83 " Inpatient 314.2 FOOT & TOE PROCEDURES " 70,185.83 " " 17,869.31 " " 10,258.42 " " 18,453.87 " " 10,771.34 " " 10,258.42 " " 10,258.42 " " 10,258.42 " " 10,925.22 " " 10,258.42 " " 10,258.42 " " 15,387.63 " " 18,453.87 " " 18,274.35 " Inpatient 317.2 "TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES " " 121,899.49 " " 31,035.61 " " 11,717.44 " " 21,078.50 " " 12,303.31 " " 11,717.44 " " 11,717.44 " " 11,717.44 " " 12,479.07 " " 11,717.44 " " 11,717.44 " " 17,576.16 " " 21,078.50 " " 20,873.45 " Inpatient 317.3 "TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES " " 108,669.80 " " 27,667.33 " " 18,717.11 " " 33,670.21 " " 19,652.97 " " 18,717.11 " " 18,717.11 " " 18,717.11 " " 19,933.72 " " 18,717.11 " " 18,717.11 " " 28,075.67 " " 33,670.21 " " 33,342.66 " Inpatient 320.1 OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES " 53,106.41 " " 13,520.89 " " 9,508.99 " " 17,105.72 " " 9,984.44 " " 9,508.99 " " 9,508.99 " " 9,508.99 " " 10,127.07 " " 9,508.99 " " 9,508.99 " " 14,263.49 " " 17,105.72 " " 16,939.31 " Inpatient 320.2 OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES " 44,543.64 " " 11,340.81 " " 13,374.94 " " 24,060.18 " " 14,043.69 " " 13,374.94 " " 13,374.94 " " 13,374.94 " " 14,244.31 " " 13,374.94 " " 13,374.94 " " 20,062.41 " " 24,060.18 " " 23,826.12 " Inpatient 320.4 OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES " 89,286.66 " " 22,732.38 " " 35,952.54 " " 64,675.02 " " 37,750.17 " " 35,952.54 " " 35,952.54 " " 35,952.54 " " 38,289.46 " " 35,952.54 " " 35,952.54 " " 53,928.81 " " 64,675.02 " " 64,045.85 " Inpatient 321.2 CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DEC " 156,989.16 " " 39,969.44 " " 18,710.07 " " 33,657.54 " " 19,645.57 " " 18,710.07 " " 18,710.07 " " 18,710.07 " " 19,926.22 " " 18,710.07 " " 18,710.07 " " 28,065.11 " " 33,657.54 " " 33,330.12 " Inpatient 340.1 FRACTURE OF FEMUR " 8,981.98 " " 2,286.81 " " 4,089.46 " " 7,356.53 " " 4,293.93 " " 4,089.46 " " 4,089.46 " " 4,089.46 " " 4,355.27 " " 4,089.46 " " 4,089.46 " " 6,134.19 " " 7,356.53 " " 7,284.96 " Inpatient 343.2 MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALI " 28,456.33 " " 7,244.98 " " 8,999.47 " " 16,189.15 " " 9,449.44 " " 8,999.47 " " 8,999.47 " " 8,999.47 " " 9,584.44 " " 8,999.47 " " 8,999.47 " " 13,499.21 " " 16,189.15 " " 16,031.66 " Inpatient 343.3 MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALI " 58,285.46 " " 14,839.48 " " 13,400.73 " " 24,106.57 " " 14,070.77 " " 13,400.73 " " 13,400.73 " " 13,400.73 " " 14,271.78 " " 13,400.73 " " 13,400.73 " " 20,101.10 " " 24,106.57 " " 23,872.06 " Inpatient 344.1 "OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIO " " 28,367.10 " " 7,222.26 " " 6,243.99 " " 11,232.31 " " 6,556.19 " " 6,243.99 " " 6,243.99 " " 6,243.99 " " 6,649.85 " " 6,243.99 " " 6,243.99 " " 9,365.99 " " 11,232.31 " " 11,123.04 " Inpatient 344.2 "OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIO " " 47,309.93 " " 12,045.11 " " 7,845.23 " " 14,112.78 " " 8,237.49 " " 7,845.23 " " 7,845.23 " " 7,845.23 " " 8,355.17 " " 7,845.23 " " 7,845.23 " " 11,767.85 " " 14,112.78 " " 13,975.49 " Inpatient 344.3 "OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIO " " 35,984.15 " " 9,161.57 " " 11,316.54 " " 20,357.32 " " 11,882.37 " " 11,316.54 " " 11,316.54 " " 11,316.54 " " 12,052.12 " " 11,316.54 " " 11,316.54 " " 16,974.81 " " 20,357.32 " " 20,159.28 " Inpatient 344.4 "OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIO " " 14,071.03 " " 3,582.48 " " 21,410.85 " " 38,515.98 " " 22,481.39 " " 21,410.85 " " 21,410.85 " " 21,410.85 " " 22,802.56 " " 21,410.85 " " 21,410.85 " " 32,116.28 " " 38,515.98 " " 38,141.29 " Inpatient 347.1 "OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES " " 17,706.61 " " 4,508.10 " " 5,868.88 " " 10,557.53 " " 6,162.32 " " 5,868.88 " " 5,868.88 " " 5,868.88 " " 6,250.36 " " 5,868.88 " " 5,868.88 " " 8,803.32 " " 10,557.53 " " 10,454.82 " Inpatient 347.2 "OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES " " 22,199.64 " " 5,652.03 " " 6,998.11 " " 12,588.90 " " 7,348.02 " " 6,998.11 " " 6,998.11 " " 6,998.11 " " 7,452.99 " " 6,998.11 " " 6,998.11 " " 10,497.17 " " 12,588.90 " " 12,466.43 " Inpatient 349.2 "MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCED " " 9,664.73 " " 2,460.64 " " 6,597.99 " " 11,869.12 " " 6,927.89 " " 6,597.99 " " 6,597.99 " " 6,597.99 " " 7,026.86 " " 6,597.99 " " 6,597.99 " " 9,896.99 " " 11,869.12 " " 11,753.66 " Inpatient 351.1 OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES " 15,370.17 " " 3,913.25 " " 4,857.65 " " 8,738.43 " " 5,100.53 " " 4,857.65 " " 4,857.65 " " 4,857.65 " " 5,173.40 " " 4,857.65 " " 4,857.65 " " 7,286.48 " " 8,738.43 " " 8,653.42 " Inpatient 351.2 OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES " 24,734.76 " " 6,297.47 " " 5,721.96 " " 10,293.23 " " 6,008.06 " " 5,721.96 " " 5,721.96 " " 5,721.96 " " 6,093.89 " " 5,721.96 " " 5,721.96 " " 8,582.94 " " 10,293.23 " " 10,193.10 " Inpatient 362.2 MASTECTOMY PROCEDURES " 247,261.53 " " 62,952.79 " " 12,309.01 " " 22,142.68 " " 12,924.46 " " 12,309.01 " " 12,309.01 " " 12,309.01 " " 13,109.10 " " 12,309.01 " " 12,309.01 " " 18,463.52 " " 22,142.68 " " 21,927.27 " Inpatient 364.1 "OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES " " 23,613.71 " " 6,012.05 " " 6,738.66 " " 12,122.18 " " 7,075.59 " " 6,738.66 " " 6,738.66 " " 6,738.66 " " 7,176.67 " " 6,738.66 " " 6,738.66 " " 10,107.99 " " 12,122.18 " " 12,004.25 " Inpatient 364.2 "OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES " " 23,762.69 " " 6,049.98 " " 10,012.26 " " 18,011.05 " " 10,512.87 " " 10,012.26 " " 10,012.26 " " 10,012.26 " " 10,663.06 " " 10,012.26 " " 10,012.26 " " 15,018.39 " " 18,011.05 " " 17,835.84 " Inpatient 364.3 "OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES " " 62,710.28 " " 15,966.04 " " 16,337.52 " " 29,389.56 " " 17,154.40 " " 16,337.52 " " 16,337.52 " " 16,337.52 " " 17,399.46 " " 16,337.52 " " 16,337.52 " " 24,506.28 " " 29,389.56 " " 29,103.66 " Inpatient 380.2 SKIN ULCERS " 8,223.95 " " 2,093.82 " " 6,433.88 " " 11,573.91 " " 6,755.57 " " 6,433.88 " " 6,433.88 " " 6,433.88 " " 6,852.08 " " 6,433.88 " " 6,433.88 " " 9,650.82 " " 11,573.91 " " 11,461.31 " Inpatient 380.3 SKIN ULCERS " 48,667.66 " " 12,390.78 " " 9,330.81 " " 16,785.19 " " 9,797.35 " " 9,330.81 " " 9,330.81 " " 9,330.81 " " 9,937.31 " " 9,330.81 " " 9,330.81 " " 13,996.22 " " 16,785.19 " " 16,621.90 " Inpatient 383.1 CELLULITIS & OTHER SKIN INFECTIONS " 15,676.79 " " 3,991.31 " " 3,947.23 " " 7,100.67 " " 4,144.59 " " 3,947.23 " " 3,947.23 " " 3,947.23 " " 4,203.80 " " 3,947.23 " " 3,947.23 " " 5,920.85 " " 7,100.67 " " 7,031.60 " Inpatient 383.2 CELLULITIS & OTHER SKIN INFECTIONS " 25,481.34 " " 6,487.55 " " 5,479.70 " " 9,857.43 " " 5,753.69 " " 5,479.70 " " 5,479.70 " " 5,479.70 " " 5,835.88 " " 5,479.70 " " 5,479.70 " " 8,219.55 " " 9,857.43 " " 9,761.54 " Inpatient 383.3 CELLULITIS & OTHER SKIN INFECTIONS " 19,780.18 " " 5,036.03 " " 8,398.51 " " 15,108.08 " " 8,818.44 " " 8,398.51 " " 8,398.51 " " 8,398.51 " " 8,944.41 " " 8,398.51 " " 8,398.51 " " 12,597.77 " " 15,108.08 " " 14,961.11 " Inpatient 383.4 CELLULITIS & OTHER SKIN INFECTIONS " 84,632.27 " " 21,547.37 " " 17,093.20 " " 30,748.96 " " 17,947.86 " " 17,093.20 " " 17,093.20 " " 17,093.20 " " 18,204.26 " " 17,093.20 " " 17,093.20 " " 25,639.80 " " 30,748.96 " " 30,449.83 " Inpatient 385.2 "OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS " " 17,044.06 " " 4,339.42 " " 5,484.39 " " 9,865.87 " " 5,758.61 " " 5,484.39 " " 5,484.39 " " 5,484.39 " " 5,840.88 " " 5,484.39 " " 5,484.39 " " 8,226.59 " " 9,865.87 " " 9,769.89 " Inpatient 403.1 PROCEDURES FOR OBESITY " 58,835.13 " " 14,979.42 " " 9,176.08 " " 16,506.85 " " 9,634.88 " " 9,176.08 " " 9,176.08 " " 9,176.08 " " 9,772.53 " " 9,176.08 " " 9,176.08 " " 13,764.12 " " 16,506.85 " " 16,346.27 " Inpatient 403.2 PROCEDURES FOR OBESITY " 41,168.61 " " 10,481.53 " " 11,197.76 " " 20,143.65 " " 11,757.65 " " 11,197.76 " " 11,197.76 " " 11,197.76 " " 11,925.61 " " 11,197.76 " " 11,197.76 " " 16,796.64 " " 20,143.65 " " 19,947.69 " Inpatient 420.1 DIABETES " 18,768.93 " " 4,778.57 " " 4,151.98 " " 7,469.00 " " 4,359.58 " " 4,151.98 " " 4,151.98 " " 4,151.98 " " 4,421.86 " " 4,151.98 " " 4,151.98 " " 6,227.97 " " 7,469.00 " " 7,396.34 " Inpatient 420.2 DIABETES " 26,323.95 " " 6,702.08 " " 5,006.91 " " 9,006.93 " " 5,257.26 " " 5,006.91 " " 5,006.91 " " 5,006.91 " " 5,332.36 " " 5,006.91 " " 5,006.91 " " 7,510.37 " " 9,006.93 " " 8,919.31 " Inpatient 420.3 DIABETES " 61,794.37 " " 15,732.85 " " 7,584.21 " " 13,643.24 " " 7,963.42 " " 7,584.21 " " 7,584.21 " " 7,584.21 " " 8,077.18 " " 7,584.21 " " 7,584.21 " " 11,376.32 " " 13,643.24 " " 13,510.51 " Inpatient 420.4 DIABETES " 67,634.04 " " 17,219.63 " " 16,392.22 " " 29,487.96 " " 17,211.83 " " 16,392.22 " " 16,392.22 " " 16,392.22 " " 17,457.71 " " 16,392.22 " " 16,392.22 " " 24,588.33 " " 29,487.96 " " 29,201.10 " Inpatient 425.2 OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS " 27,362.57 " " 6,966.51 " " 5,311.69 " " 9,555.20 " " 5,577.27 " " 5,311.69 " " 5,311.69 " " 5,311.69 " " 5,656.95 " " 5,311.69 " " 5,311.69 " " 7,967.54 " " 9,555.20 " " 9,462.24 " Inpatient 425.3 OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS " 22,154.35 " " 5,640.50 " " 7,404.48 " " 13,319.92 " " 7,774.70 " " 7,404.48 " " 7,404.48 " " 7,404.48 " " 7,885.77 " " 7,404.48 " " 7,404.48 " " 11,106.72 " " 13,319.92 " " 13,190.34 " Inpatient 426.1 NON-HYPOVOLEMIC SODIUM DISORDERS " 22,622.16 " " 5,759.60 " " 4,458.31 " " 8,020.05 " " 4,681.23 " " 4,458.31 " " 4,458.31 " " 4,458.31 " " 4,748.10 " " 4,458.31 " " 4,458.31 " " 6,687.47 " " 8,020.05 " " 7,942.03 " Inpatient 426.2 NON-HYPOVOLEMIC SODIUM DISORDERS " 17,853.89 " " 4,545.60 " " 5,767.29 " " 10,374.78 " " 6,055.65 " " 5,767.29 " " 5,767.29 " " 5,767.29 " " 6,142.16 " " 5,767.29 " " 5,767.29 " " 8,650.94 " " 10,374.78 " " 10,273.85 " Inpatient 426.3 NON-HYPOVOLEMIC SODIUM DISORDERS " 28,835.57 " " 7,341.54 " " 8,596.23 " " 15,463.76 " " 9,026.04 " " 8,596.23 " " 8,596.23 " " 8,596.23 " " 9,154.98 " " 8,596.23 " " 8,596.23 " " 12,894.35 " " 15,463.76 " " 15,313.32 " Inpatient 427.2 THYROID DISORDERS " 32,581.62 " " 8,295.28 " " 6,206.47 " " 11,164.82 " " 6,516.79 " " 6,206.47 " " 6,206.47 " " 6,206.47 " " 6,609.89 " " 6,206.47 " " 6,206.47 " " 9,309.71 " " 11,164.82 " " 11,056.21 " Inpatient 443.2 KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY " 43,343.16 " " 11,035.17 " " 12,650.52 " " 22,757.02 " " 13,283.05 " " 12,650.52 " " 12,650.52 " " 12,650.52 " " 13,472.80 " " 12,650.52 " " 12,650.52 " " 18,975.78 " " 22,757.02 " " 22,535.64 " Inpatient 462.3 NEPHRITIS & NEPHROSIS " 311,154.75 " " 79,220.00 " " 12,552.83 " " 22,581.29 " " 13,180.47 " " 12,552.83 " " 12,552.83 " " 12,552.83 " " 13,368.76 " " 12,552.83 " " 12,552.83 " " 18,829.25 " " 22,581.29 " " 22,361.61 " Inpatient 463.1 KIDNEY & URINARY TRACT INFECTIONS " 33,734.01 " " 8,588.68 " " 4,458.31 " " 8,020.05 " " 4,681.23 " " 4,458.31 " " 4,458.31 " " 4,458.31 " " 4,748.10 " " 4,458.31 " " 4,458.31 " " 6,687.47 " " 8,020.05 " " 7,942.03 " Inpatient 463.2 KIDNEY & URINARY TRACT INFECTIONS " 32,649.14 " " 8,312.47 " " 5,449.23 " " 9,802.62 " " 5,721.69 " " 5,449.23 " " 5,449.23 " " 5,449.23 " " 5,803.43 " " 5,449.23 " " 5,449.23 " " 8,173.85 " " 9,802.62 " " 9,707.26 " Inpatient 463.3 KIDNEY & URINARY TRACT INFECTIONS " 16,693.45 " " 4,250.15 " " 7,493.56 " " 13,480.17 " " 7,868.24 " " 7,493.56 " " 7,493.56 " " 7,493.56 " " 7,980.64 " " 7,493.56 " " 7,493.56 " " 11,240.34 " " 13,480.17 " " 13,349.03 " Inpatient 466.2 "MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PRO " " 23,887.44 " " 6,081.74 " " 5,992.35 " " 10,779.64 " " 6,291.97 " " 5,992.35 " " 5,992.35 " " 5,992.35 " " 6,381.85 " " 5,992.35 " " 5,992.35 " " 8,988.53 " " 10,779.64 " " 10,674.77 " Inpatient 466.3 "MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PRO " " 17,843.26 " " 4,542.90 " " 9,262.82 " " 16,662.89 " " 9,725.96 " " 9,262.82 " " 9,262.82 " " 9,262.82 " " 9,864.90 " " 9,262.82 " " 9,262.82 " " 13,894.23 " " 16,662.89 " " 16,500.79 " Inpatient 466.4 "MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PRO " " 29,932.27 " " 7,620.76 " " 15,558.39 " " 27,987.99 " " 16,336.31 " " 15,558.39 " " 15,558.39 " " 15,558.39 " " 16,569.69 " " 15,558.39 " " 15,558.39 " " 23,337.59 " " 27,987.99 " " 27,715.72 " Inpatient 468.2 "OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS " " 27,649.74 " " 7,039.62 " " 6,175.22 " " 11,108.60 " " 6,483.98 " " 6,175.22 " " 6,175.22 " " 6,175.22 " " 6,576.61 " " 6,175.22 " " 6,175.22 " " 9,262.83 " " 11,108.60 " " 11,000.54 " Inpatient 469.1 ACUTE KIDNEY INJURY " 20,344.93 " " 5,179.82 " " 4,355.94 " " 7,835.90 " " 4,573.74 " " 4,355.94 " " 4,355.94 " " 4,355.94 " " 4,639.08 " " 4,355.94 " " 4,355.94 " " 6,533.91 " " 7,835.90 " " 7,759.67 " Inpatient 469.2 ACUTE KIDNEY INJURY " 76,691.71 " " 19,525.71 " " 5,783.70 " " 10,404.30 " " 6,072.89 " " 5,783.70 " " 5,783.70 " " 5,783.70 " " 6,159.64 " " 5,783.70 " " 5,783.70 " " 8,675.55 " " 10,404.30 " " 10,303.08 " Inpatient 469.3 ACUTE KIDNEY INJURY " 89,126.16 " " 22,691.52 " " 9,194.05 " " 16,539.18 " " 9,653.75 " " 9,194.05 " " 9,194.05 " " 9,194.05 " " 9,791.66 " " 9,194.05 " " 9,194.05 " " 13,791.08 " " 16,539.18 " " 16,378.28 " Inpatient 469.4 ACUTE KIDNEY INJURY " 103,307.20 " " 26,302.01 " " 18,130.22 " " 32,614.45 " " 19,036.73 " " 18,130.22 " " 18,130.22 " " 18,130.22 " " 19,308.68 " " 18,130.22 " " 18,130.22 " " 27,195.33 " " 32,614.45 " " 32,297.17 " Inpatient 470.3 CHRONIC KIDNEY DISEASE " 74,046.93 " " 18,852.35 " " 8,519.64 " " 15,325.98 " " 8,945.62 " " 8,519.64 " " 8,519.64 " " 8,519.64 " " 9,073.42 " " 8,519.64 " " 8,519.64 " " 12,779.46 " " 15,325.98 " " 15,176.89 " Inpatient 501.1 MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY " 20,695.06 " " 5,268.96 " " 4,277.79 " " 7,695.32 " " 4,491.68 " " 4,277.79 " " 4,277.79 " " 4,277.79 " " 4,555.85 " " 4,277.79 " " 4,277.79 " " 6,416.69 " " 7,695.32 " " 7,620.46 " Inpatient 501.2 MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY " 15,293.31 " " 3,893.68 " " 5,613.33 " " 10,097.82 " " 5,894.00 " " 5,613.33 " " 5,613.33 " " 5,613.33 " " 5,978.20 " " 5,613.33 " " 5,613.33 " " 8,420.00 " " 10,097.82 " " 9,999.59 " Inpatient 513.1 UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMY " 37,093.42 " " 9,443.98 " " 7,925.72 " " 14,257.58 " " 8,322.01 " " 7,925.72 " " 7,925.72 " " 7,925.72 " " 8,440.89 " " 7,925.72 " " 7,925.72 " " 11,888.58 " " 14,257.58 " " 14,118.88 " Inpatient 513.2 UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMY " 48,560.65 " " 12,363.54 " " 9,328.47 " " 16,780.98 " " 9,794.89 " " 9,328.47 " " 9,328.47 " " 9,328.47 " " 9,934.82 " " 9,328.47 " " 9,328.47 " " 13,992.71 " " 16,780.98 " " 16,617.74 " Inpatient 513.3 UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMY " 77,677.66 " " 19,776.73 " " 16,209.35 " " 29,159.00 " " 17,019.82 " " 16,209.35 " " 16,209.35 " " 16,209.35 " " 17,262.96 " " 16,209.35 " " 16,209.35 " " 24,314.03 " " 29,159.00 " " 28,875.34 " Inpatient 518.2 OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES " 47,011.99 " " 11,969.25 " " 10,735.90 " " 19,312.81 " " 11,272.70 " " 10,735.90 " " 10,735.90 " " 10,735.90 " " 11,433.73 " " 10,735.90 " " 10,735.90 " " 16,103.85 " " 19,312.81 " " 19,124.93 " Inpatient 519.1 UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA " 29,805.57 " " 7,588.50 " " 5,446.88 " " 9,798.39 " " 5,719.22 " " 5,446.88 " " 5,446.88 " " 5,446.88 " " 5,800.93 " " 5,446.88 " " 5,446.88 " " 8,170.32 " " 9,798.39 " " 9,703.07 " Inpatient 531.1 FEMALE REPRODUCTIVE SYSTEM INFECTIONS " 21,697.52 " " 5,524.19 " " 3,904.25 " " 7,023.36 " " 4,099.46 " " 3,904.25 " " 3,904.25 " " 3,904.25 " " 4,158.03 " " 3,904.25 " " 3,904.25 " " 5,856.38 " " 7,023.36 " " 6,955.03 " Inpatient 532.3 MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS " 46,013.05 " " 11,714.92 " " 8,266.44 " " 14,870.50 " " 8,679.76 " " 8,266.44 " " 8,266.44 " " 8,266.44 " " 8,803.76 " " 8,266.44 " " 8,266.44 " " 12,399.66 " " 14,870.50 " " 14,725.84 " Inpatient 539.1 CESAREAN SECTION W STERILIZATION " 57,914.26 " " 14,744.97 " " 4,448.16 " " 8,001.80 " " 4,670.57 " " 4,448.16 " " 4,448.16 " " 4,448.16 " " 4,737.29 " " 4,448.16 " " 4,448.16 " " 6,672.24 " " 8,001.80 " " 7,923.95 " Inpatient 539.4 CESAREAN SECTION W STERILIZATION " 83,294.11 " " 21,206.68 " " 19,793.98 " " 35,607.39 " " 20,783.68 " " 19,793.98 " " 19,793.98 " " 19,793.98 " " 21,080.59 " " 19,793.98 " " 19,793.98 " " 29,690.97 " " 35,607.39 " " 35,261.00 " Inpatient 540.1 CESAREAN SECTION W/O STERILIZATION " 18,240.76 " " 4,644.10 " " 4,241.85 " " 7,630.66 " " 4,453.94 " " 4,241.85 " " 4,241.85 " " 4,241.85 " " 4,517.57 " " 4,241.85 " " 4,241.85 " " 6,362.78 " " 7,630.66 " " 7,556.43 " Inpatient 540.2 CESAREAN SECTION W/O STERILIZATION " 25,030.58 " " 6,372.79 " " 5,010.04 " " 9,012.56 " " 5,260.54 " " 5,010.04 " " 5,010.04 " " 5,010.04 " " 5,335.69 " " 5,010.04 " " 5,010.04 " " 7,515.06 " " 9,012.56 " " 8,924.89 " Inpatient 540.3 CESAREAN SECTION W/O STERILIZATION " 35,342.55 " " 8,998.21 " " 7,334.92 " " 13,194.79 " " 7,701.67 " " 7,334.92 " " 7,334.92 " " 7,334.92 " " 7,811.69 " " 7,334.92 " " 7,334.92 " " 11,002.38 " " 13,194.79 " " 13,066.43 " Inpatient 542.2 VAGINAL DELIVERY W O.R. PROCEDURE EXCEPT STERILIZATION &/OR D&C " 27,285.80 " " 6,946.96 " " 3,600.26 " " 6,476.51 " " 3,780.27 " " 3,600.26 " " 3,600.26 " " 3,600.26 " " 3,834.28 " " 3,600.26 " " 3,600.26 " " 5,400.39 " " 6,476.51 " " 6,413.50 " Inpatient 560.1 VAGINAL DELIVERY " 23,061.75 " " 5,871.52 " " 2,664.83 " " 4,793.76 " " 2,798.07 " " 2,664.83 " " 2,664.83 " " 2,664.83 " " 2,838.04 " " 2,664.83 " " 2,664.83 " " 3,997.25 " " 4,793.76 " " 4,747.13 " Inpatient 560.2 VAGINAL DELIVERY " 25,329.04 " " 6,448.77 " " 2,862.54 " " 5,149.42 " " 3,005.67 " " 2,862.54 " " 2,862.54 " " 2,862.54 " " 3,048.61 " " 2,862.54 " " 2,862.54 " " 4,293.81 " " 5,149.42 " " 5,099.33 " Inpatient 560.3 VAGINAL DELIVERY " 26,025.48 " " 6,626.09 " " 4,050.38 " " 7,286.23 " " 4,252.90 " " 4,050.38 " " 4,050.38 " " 4,050.38 " " 4,313.65 " " 4,050.38 " " 4,050.38 " " 6,075.57 " " 7,286.23 " " 7,215.35 " Inpatient 561.2 POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE " 10,122.10 " " 2,577.09 " " 3,163.41 " " 5,690.66 " " 3,321.58 " " 3,163.41 " " 3,163.41 " " 3,163.41 " " 3,369.03 " " 3,163.41 " " 3,163.41 " " 4,745.12 " " 5,690.66 " " 5,635.30 " Inpatient 561.4 POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE " 66,203.30 " " 16,855.36 " " 11,006.29 " " 19,799.22 " " 11,556.60 " " 11,006.29 " " 11,006.29 " " 11,006.29 " " 11,721.70 " " 11,006.29 " " 11,006.29 " " 16,509.44 " " 19,799.22 " " 19,606.61 " Inpatient 566.1 ANTEPARTUM W/O O.R. PROCEDURE " 3,271.83 " 833.01 " 2,591.37 " " 4,661.62 " " 2,720.94 " " 2,591.37 " " 2,591.37 " " 2,591.37 " " 2,759.81 " " 2,591.37 " " 2,591.37 " " 3,887.06 " " 4,661.62 " " 4,616.27 " Inpatient 566.2 ANTEPARTUM W/O O.R. PROCEDURE " 8,388.62 " " 2,135.74 " " 3,278.29 " " 5,897.32 " " 3,442.20 " " 3,278.29 " " 3,278.29 " " 3,278.29 " " 3,491.38 " " 3,278.29 " " 3,278.29 " " 4,917.44 " " 5,897.32 " " 5,839.95 " Inpatient 566.3 ANTEPARTUM W/O O.R. PROCEDURE " 21,751.13 " " 5,537.84 " " 4,902.97 " " 8,819.95 " " 5,148.12 " " 4,902.97 " " 4,902.97 " " 4,902.97 " " 5,221.66 " " 4,902.97 " " 4,902.97 " " 7,354.46 " " 8,819.95 " " 8,734.15 " Inpatient 566.4 ANTEPARTUM W/O O.R. PROCEDURE " 11,808.50 " " 3,006.44 " " 9,888.78 " " 17,788.93 " " 10,383.22 " " 9,888.78 " " 9,888.78 " " 9,888.78 " " 10,531.55 " " 9,888.78 " " 9,888.78 " " 14,833.17 " " 17,788.93 " " 17,615.87 " Inpatient 581.3 "NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE " " 14,306.06 " " 3,642.32 " " 2,508.53 " " 4,512.59 " " 2,633.96 " " 2,508.53 " " 2,508.53 " " 2,508.53 " " 2,671.58 " " 2,508.53 " " 2,508.53 " " 3,762.80 " " 4,512.59 " " 4,468.70 " Inpatient 614.1 NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION " 116,172.10 " " 29,577.42 " " 15,622.47 " " 28,103.26 " " 16,403.59 " " 15,622.47 " " 15,622.47 " " 15,622.47 " " 16,637.93 " " 15,622.47 " " 15,622.47 " " 23,433.71 " " 28,103.26 " " 27,829.87 " Inpatient 614.2 NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION " 169,771.76 " " 43,223.89 " " 26,400.57 " " 47,491.99 " " 27,720.60 " " 26,400.57 " " 26,400.57 " " 26,400.57 " " 28,116.61 " " 26,400.57 " " 26,400.57 " " 39,600.86 " " 47,491.99 " " 47,029.98 " Inpatient 625.1 NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION " 130,005.02 " " 33,099.28 " " 14,783.16 " " 26,593.43 " " 15,522.32 " " 14,783.16 " " 14,783.16 " " 14,783.16 " " 15,744.07 " " 14,783.16 " " 14,783.16 " " 22,174.74 " " 26,593.43 " " 26,334.72 " Inpatient 625.3 NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION " 87,989.96 " " 22,402.24 " " 30,936.25 " " 55,651.22 " " 32,483.06 " " 30,936.25 " " 30,936.25 " " 30,936.25 " " 32,947.11 " " 30,936.25 " " 30,936.25 " " 46,404.38 " " 55,651.22 " " 55,109.84 " Inpatient 626.1 "NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER " " 11,947.65 " " 3,041.87 " " 1,773.95 " " 3,191.16 " " 1,862.65 " " 1,773.95 " " 1,773.95 " " 1,773.95 " " 1,889.26 " " 1,773.95 " " 1,773.95 " " 2,660.93 " " 3,191.16 " " 3,160.11 " Inpatient 626.2 "NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER " " 10,807.65 " " 2,751.63 " " 3,197.01 " " 5,751.10 " " 3,356.86 " " 3,197.01 " " 3,197.01 " " 3,197.01 " " 3,404.82 " " 3,197.01 " " 3,197.01 " " 4,795.52 " " 5,751.10 " " 5,695.15 " Inpatient 626.3 "NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER " " 27,216.30 " " 6,929.27 " " 8,937.73 " " 16,078.08 " " 9,384.62 " " 8,937.73 " " 8,937.73 " " 8,937.73 " " 9,518.68 " " 8,937.73 " " 8,937.73 " " 13,406.60 " " 16,078.08 " " 15,921.67 " Inpatient 633.2 NEONATE BIRTHWT >2499G W MAJOR ANOMALY " 157,675.44 " " 40,144.17 " " 14,901.95 " " 26,807.12 " " 15,647.05 " " 14,901.95 " " 14,901.95 " " 14,901.95 " " 15,870.58 " " 14,901.95 " " 14,901.95 " " 22,352.93 " " 26,807.12 " " 26,546.33 " Inpatient 633.3 NEONATE BIRTHWT >2499G W MAJOR ANOMALY " 135,034.65 " " 34,379.82 " " 33,622.18 " " 60,482.94 " " 35,303.29 " " 33,622.18 " " 33,622.18 " " 33,622.18 " " 35,807.62 " " 33,622.18 " " 33,622.18 " " 50,433.27 " " 60,482.94 " " 59,894.55 " Inpatient 633.4 NEONATE BIRTHWT >2499G W MAJOR ANOMALY " 239,058.44 " " 60,864.28 " " 77,785.68 " " 139,928.66 " " 81,674.96 " " 77,785.68 " " 77,785.68 " " 77,785.68 " " 82,841.75 " " 77,785.68 " " 77,785.68 " " 116,678.52 " " 139,928.66 " " 138,567.41 " Inpatient 634.1 "NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND " " 28,766.45 " " 7,323.94 " " 7,814.75 " " 14,057.95 " " 8,205.49 " " 7,814.75 " " 7,814.75 " " 7,814.75 " " 8,322.71 " " 7,814.75 " " 7,814.75 " " 11,722.13 " " 14,057.95 " " 13,921.20 " Inpatient 634.2 "NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND " " 56,139.07 " " 14,293.01 " " 13,926.67 " " 25,052.69 " " 14,623.00 " " 13,926.67 " " 13,926.67 " " 13,926.67 " " 14,831.90 " " 13,926.67 " " 13,926.67 " " 20,890.01 " " 25,052.69 " " 24,808.97 " Inpatient 634.3 "NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND " " 183,412.90 " " 46,696.92 " " 20,800.52 " " 37,418.06 " " 21,840.55 " " 20,800.52 " " 20,800.52 " " 20,800.52 " " 22,152.55 " " 20,800.52 " " 20,800.52 " " 31,200.78 " " 37,418.06 " " 37,054.05 " Inpatient 636.1 NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION " 42,346.57 " " 10,781.44 " " 7,622.51 " " 13,712.13 " " 8,003.64 " " 7,622.51 " " 7,622.51 " " 7,622.51 " " 8,117.97 " " 7,622.51 " " 7,622.51 " " 11,433.77 " " 13,712.13 " " 13,578.74 " Inpatient 636.2 NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION " 139,093.05 " " 35,413.09 " " 11,568.17 " " 20,809.98 " " 12,146.58 " " 11,568.17 " " 11,568.17 " " 11,568.17 " " 12,320.10 " " 11,568.17 " " 11,568.17 " " 17,352.26 " " 20,809.98 " " 20,607.54 " Inpatient 639.1 NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION " 68,636.36 " " 17,474.82 " " 7,263.81 " " 13,066.87 " " 7,627.00 " " 7,263.81 " " 7,263.81 " " 7,263.81 " " 7,735.96 " " 7,263.81 " " 7,263.81 " " 10,895.72 " " 13,066.87 " " 12,939.75 " Inpatient 639.2 NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION " 59,042.66 " " 15,032.26 " " 12,913.87 " " 23,230.76 " " 13,559.56 " " 12,913.87 " " 12,913.87 " " 12,913.87 " " 13,753.27 " " 12,913.87 " " 12,913.87 " " 19,370.81 " " 23,230.76 " " 23,004.77 " Inpatient 639.3 NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION " 444,268.70 " " 113,110.81 " " 20,405.88 " " 36,708.14 " " 21,426.17 " " 20,405.88 " " 20,405.88 " " 20,405.88 " " 21,732.26 " " 20,405.88 " " 20,405.88 " " 30,608.82 " " 36,708.14 " " 36,351.03 " Inpatient 640.1 "NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER " " 11,463.35 " " 2,918.57 " 997.94 " 1,795.19 " " 1,047.84 " 997.94 997.94 997.94 " 1,062.81 " 997.94 997.94 " 1,496.91 " " 1,795.19 " " 1,777.73 " Inpatient 640.2 "NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER " " 13,962.85 " " 3,554.94 " " 1,577.80 " " 2,838.30 " " 1,656.69 " " 1,577.80 " " 1,577.80 " " 1,577.80 " " 1,680.36 " " 1,577.80 " " 1,577.80 " " 2,366.70 " " 2,838.30 " " 2,810.69 " Inpatient 640.3 "NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER " " 26,808.61 " " 6,825.47 " " 3,924.57 " " 7,059.91 " " 4,120.80 " " 3,924.57 " " 3,924.57 " " 3,924.57 " " 4,179.67 " " 3,924.57 " " 3,924.57 " " 5,886.86 " " 7,059.91 " " 6,991.23 " Inpatient 651.2 OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS " 25,417.23 " " 6,471.23 " " 13,427.30 " " 24,154.37 " " 14,098.67 " " 13,427.30 " " 13,427.30 " " 13,427.30 " " 14,300.07 " " 13,427.30 " " 13,427.30 " " 20,140.95 " " 24,154.37 " " 23,919.39 " Inpatient 660.1 MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & CO " 13,462.50 " " 3,427.55 " " 6,723.81 " " 12,095.46 " " 7,060.00 " " 6,723.81 " " 6,723.81 " " 6,723.81 " " 7,160.86 " " 6,723.81 " " 6,723.81 " " 10,085.72 " " 12,095.46 " " 11,977.80 " Inpatient 660.2 MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & CO " 95,357.05 " " 24,277.90 " " 7,969.48 " " 14,336.30 " " 8,367.95 " " 7,969.48 " " 7,969.48 " " 7,969.48 " " 8,487.50 " " 7,969.48 " " 7,969.48 " " 11,954.22 " " 14,336.30 " " 14,196.83 " Inpatient 662.1 SICKLE CELL ANEMIA CRISIS " 7,334.75 " " 1,867.43 " " 5,006.91 " " 9,006.93 " " 5,257.26 " " 5,006.91 " " 5,006.91 " " 5,006.91 " " 5,332.36 " " 5,006.91 " " 5,006.91 " " 7,510.37 " " 9,006.93 " " 8,919.31 " Inpatient 662.2 SICKLE CELL ANEMIA CRISIS " 58,096.95 " " 14,791.48 " " 6,755.85 " " 12,153.10 " " 7,093.64 " " 6,755.85 " " 6,755.85 " " 6,755.85 " " 7,194.98 " " 6,755.85 " " 6,755.85 " " 10,133.78 " " 12,153.10 " " 12,034.87 " Inpatient 662.3 SICKLE CELL ANEMIA CRISIS " 13,206.17 " " 3,362.29 " " 10,215.44 " " 18,376.56 " " 10,726.21 " " 10,215.44 " " 10,215.44 " " 10,215.44 " " 10,879.44 " " 10,215.44 " " 10,215.44 " " 15,323.16 " " 18,376.56 " " 18,197.78 " Inpatient 663.1 OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS " 36,802.57 " " 9,369.93 " " 4,933.45 " " 8,874.78 " " 5,180.12 " " 4,933.45 " " 4,933.45 " " 4,933.45 " " 5,254.12 " " 4,933.45 " " 4,933.45 " " 7,400.18 " " 8,874.78 " " 8,788.45 " Inpatient 663.2 OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS " 49,589.85 " " 12,625.58 " " 6,261.96 " " 11,264.64 " " 6,575.06 " " 6,261.96 " " 6,261.96 " " 6,261.96 " " 6,668.99 " " 6,261.96 " " 6,261.96 " " 9,392.94 " " 11,264.64 " " 11,155.06 " Inpatient 663.3 OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS " 21,524.26 " " 5,480.08 " " 8,938.51 " " 16,079.49 " " 9,385.44 " " 8,938.51 " " 8,938.51 " " 8,938.51 " " 9,519.51 " " 8,938.51 " " 8,938.51 " " 13,407.77 " " 16,079.49 " " 15,923.06 " Inpatient 680.3 MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEO " 50,386.85 " " 12,828.49 " " 32,608.61 " " 58,659.63 " " 34,239.04 " " 32,608.61 " " 32,608.61 " " 32,608.61 " " 34,728.17 " " 32,608.61 " " 32,608.61 " " 48,912.92 " " 58,659.63 " " 58,088.98 " Inpatient 710.2 INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE " 79,474.87 " " 20,234.30 " " 14,850.37 " " 26,714.33 " " 15,592.89 " " 14,850.37 " " 14,850.37 " " 14,850.37 " " 15,815.64 " " 14,850.37 " " 14,850.37 " " 22,275.56 " " 26,714.33 " " 26,454.45 " Inpatient 710.3 INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE " 145,617.62 " " 37,074.25 " " 23,724.02 " " 42,677.14 " " 24,910.22 " " 23,724.02 " " 23,724.02 " " 23,724.02 " " 25,266.08 " " 23,724.02 " " 23,724.02 " " 35,586.03 " " 42,677.14 " " 42,261.97 " Inpatient 710.4 INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE " 234,152.44 " " 59,615.21 " " 45,239.59 " " 81,381.50 " " 47,501.57 " " 45,239.59 " " 45,239.59 " " 45,239.59 " " 48,180.16 " " 45,239.59 " " 45,239.59 " " 67,859.39 " " 81,381.50 " " 80,589.81 " Inpatient 711.1 "POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE " " 68,878.86 " " 17,536.56 " " 9,548.06 " " 17,176.01 " " 10,025.46 " " 9,548.06 " " 9,548.06 " " 9,548.06 " " 10,168.68 " " 9,548.06 " " 9,548.06 " " 14,322.09 " " 17,176.01 " " 17,008.91 " Inpatient 711.2 "POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE " " 79,352.23 " " 20,203.08 " " 13,121.75 " " 23,604.72 " " 13,777.84 " " 13,121.75 " " 13,121.75 " " 13,121.75 " " 13,974.66 " " 13,121.75 " " 13,121.75 " " 19,682.63 " " 23,604.72 " " 23,375.09 " Inpatient 711.3 "POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE " " 84,376.64 " " 21,482.29 " " 23,323.12 " " 41,955.96 " " 24,489.28 " " 23,323.12 " " 23,323.12 " " 23,323.12 " " 24,839.12 " " 23,323.12 " " 23,323.12 " " 34,984.68 " " 41,955.96 " " 41,547.81 " Inpatient 720.1 SEPTICEMIA & DISSEMINATED INFECTIONS " 24,190.63 " " 6,158.93 " " 5,140.54 " " 9,247.32 " " 5,397.57 " " 5,140.54 " " 5,140.54 " " 5,140.54 " " 5,474.68 " " 5,140.54 " " 5,140.54 " " 7,710.81 " " 9,247.32 " " 9,157.36 " Inpatient 720.2 SEPTICEMIA & DISSEMINATED INFECTIONS " 32,406.68 " " 8,250.74 " " 6,874.64 " " 12,366.79 " " 7,218.37 " " 6,874.64 " " 6,874.64 " " 6,874.64 " " 7,321.49 " " 6,874.64 " " 6,874.64 " " 10,311.96 " " 12,366.79 " " 12,246.48 " Inpatient 720.3 SEPTICEMIA & DISSEMINATED INFECTIONS " 69,233.95 " " 17,626.96 " " 10,636.66 " " 19,134.29 " " 11,168.49 " " 10,636.66 " " 10,636.66 " " 10,636.66 " " 11,328.04 " " 10,636.66 " " 10,636.66 " " 15,954.99 " " 19,134.29 " " 18,948.15 " Inpatient 720.4 SEPTICEMIA & DISSEMINATED INFECTIONS " 116,031.94 " " 29,541.73 " " 20,025.30 " " 36,023.51 " " 21,026.57 " " 20,025.30 " " 20,025.30 " " 20,025.30 " " 21,326.94 " " 20,025.30 " " 20,025.30 " " 30,037.95 " " 36,023.51 " " 35,673.07 " Inpatient 721.1 "POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS " " 4,647.82 " " 1,183.33 " " 5,190.56 " " 9,337.30 " " 5,450.09 " " 5,190.56 " " 5,190.56 " " 5,190.56 " " 5,527.95 " " 5,190.56 " " 5,190.56 " " 7,785.84 " " 9,337.30 " " 9,246.46 " Inpatient 721.2 "POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS " " 25,638.93 " " 6,527.67 " " 7,185.66 " " 12,926.28 " " 7,544.94 " " 7,185.66 " " 7,185.66 " " 7,185.66 " " 7,652.73 " " 7,185.66 " " 7,185.66 " " 10,778.49 " " 12,926.28 " " 12,800.53 " Inpatient 721.4 "POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS " " 87,434.31 " " 22,260.78 " " 22,747.96 " " 40,921.31 " " 23,885.36 " " 22,747.96 " " 22,747.96 " " 22,747.96 " " 24,226.58 " " 22,747.96 " " 22,747.96 " " 34,121.94 " " 40,921.31 " " 40,523.22 " Inpatient 722.2 FEVER & INFLAMMATORY CONDITIONS " 15,793.62 " " 4,021.06 " " 5,453.13 " " 9,809.64 " " 5,725.79 " " 5,453.13 " " 5,453.13 " " 5,453.13 " " 5,807.58 " " 5,453.13 " " 5,453.13 " " 8,179.70 " " 9,809.64 " " 9,714.21 " Inpatient 724.1 OTHER INFECTIOUS & PARASITIC DISEASES " 12,556.58 " " 3,196.91 " " 5,568.01 " " 10,016.29 " " 5,846.41 " " 5,568.01 " " 5,568.01 " " 5,568.01 " " 5,929.93 " " 5,568.01 " " 5,568.01 " " 8,352.02 " " 10,016.29 " " 9,918.85 " Inpatient 724.2 OTHER INFECTIOUS & PARASITIC DISEASES " 8,841.09 " " 2,250.94 " " 6,602.68 " " 11,877.56 " " 6,932.81 " " 6,602.68 " " 6,602.68 " " 6,602.68 " " 7,031.85 " " 6,602.68 " " 6,602.68 " " 9,904.02 " " 11,877.56 " " 11,762.01 " Inpatient 770.1 "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVI " " 11,150.12 " " 2,838.82 " " 1,909.14 " " 3,434.35 " " 2,004.60 " " 1,909.14 " " 1,909.14 " " 1,909.14 " " 2,033.23 " " 1,909.14 " " 1,909.14 " " 2,863.71 " " 3,434.35 " " 3,400.94 " Inpatient 770.2 "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVI " " 14,971.08 " " 3,811.64 " " 2,993.05 " " 5,384.20 " " 3,142.70 " " 2,993.05 " " 2,993.05 " " 2,993.05 " " 3,187.60 " " 2,993.05 " " 2,993.05 " " 4,489.58 " " 5,384.20 " " 5,331.82 " Inpatient 775.2 ALCOHOL ABUSE & DEPENDENCE " 34,623.70 " " 8,815.19 " " 4,637.27 " " 8,341.99 " " 4,869.13 " " 4,637.27 " " 4,637.27 " " 4,637.27 " " 4,938.69 " " 4,637.27 " " 4,637.27 " " 6,955.91 " " 8,341.99 " " 8,260.83 " Inpatient 775.3 ALCOHOL ABUSE & DEPENDENCE " 20,109.57 " " 5,119.90 " " 7,955.42 " " 14,311.01 " " 8,353.19 " " 7,955.42 " " 7,955.42 " " 7,955.42 " " 8,472.52 " " 7,955.42 " " 7,955.42 " " 11,933.13 " " 14,311.01 " " 14,171.79 " Inpatient 776.3 OTHER DRUG ABUSE & DEPENDENCE " 37,838.12 " " 9,633.59 " " 8,646.24 " " 15,553.72 " " 9,078.55 " " 8,646.24 " " 8,646.24 " " 8,646.24 " " 9,208.25 " " 8,646.24 " " 8,646.24 " " 12,969.36 " " 15,553.72 " " 15,402.41 " Inpatient 811.2 ALLERGIC REACTIONS " 20,764.46 " " 5,286.63 " " 4,550.53 " " 8,185.95 " " 4,778.06 " " 4,550.53 " " 4,550.53 " " 4,550.53 " " 4,846.31 " " 4,550.53 " " 4,550.53 " " 6,825.80 " " 8,185.95 " " 8,106.31 " Inpatient 812.3 POISONING OF MEDICINAL AGENTS " 23,229.66 " " 5,914.27 " " 7,259.12 " " 13,058.43 " " 7,622.08 " " 7,259.12 " " 7,259.12 " " 7,259.12 " " 7,730.96 " " 7,259.12 " " 7,259.12 " " 10,888.68 " " 13,058.43 " " 12,931.40 " Inpatient 812.4 POISONING OF MEDICINAL AGENTS " 81,329.85 " " 20,706.58 " " 13,663.31 " " 24,578.93 " " 14,346.48 " " 13,663.31 " " 13,663.31 " " 13,663.31 " " 14,551.43 " " 13,663.31 " " 13,663.31 " " 20,494.97 " " 24,578.93 " " 24,339.82 " Inpatient 813.2 OTHER COMPLICATIONS OF TREATMENT " 41,828.49 " " 10,649.53 " " 6,607.37 " " 11,886.00 " " 6,937.74 " " 6,607.37 " " 6,607.37 " " 6,607.37 " " 7,036.85 " " 6,607.37 " " 6,607.37 " " 9,911.06 " " 11,886.00 " " 11,770.37 " Inpatient 816.4 TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES " 33,454.34 " " 8,517.47 " " 13,111.59 " " 23,586.44 " " 13,767.17 " " 13,111.59 " " 13,111.59 " " 13,111.59 " " 13,963.84 " " 13,111.59 " " 13,111.59 " " 19,667.39 " " 23,586.44 " " 23,356.99 " Inpatient 817.2 INTENTIONAL SELF-HARM & ATTEMPTED SUICIDE " 37,641.93 " " 9,583.64 " " 4,441.90 " " 7,990.53 " " 4,664.00 " " 4,441.90 " " 4,441.90 " " 4,441.90 " " 4,730.62 " " 4,441.90 " " 4,441.90 " " 6,662.85 " " 7,990.53 " " 7,912.80 " Inpatient 850.1 "PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH " " 41,104.46 " " 10,465.20 " " 16,415.66 " " 29,530.13 " " 17,236.44 " " 16,415.66 " " 16,415.66 " " 16,415.66 " " 17,482.68 " " 16,415.66 " " 16,415.66 " " 24,623.49 " " 29,530.13 " " 29,242.86 " Inpatient 850.2 "PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH " " 132,819.34 " " 33,815.80 " " 21,895.37 " " 39,387.58 " " 22,990.14 " " 21,895.37 " " 21,895.37 " " 21,895.37 " " 23,318.57 " " 21,895.37 " " 21,895.37 " " 32,843.06 " " 39,387.58 " " 39,004.41 " Inpatient 861.2 "SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS " " 11,071.55 " " 2,818.82 " " 5,596.14 " " 10,066.90 " " 5,875.95 " " 5,596.14 " " 5,596.14 " " 5,596.14 " " 5,959.89 " " 5,596.14 " " 5,596.14 " " 8,394.21 " " 10,066.90 " " 9,968.96 " Inpatient 861.3 "SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS " " 46,268.20 " " 11,779.88 " " 7,890.55 " " 14,194.31 " " 8,285.08 " " 7,890.55 " " 7,890.55 " " 7,890.55 " " 8,403.44 " " 7,890.55 " " 7,890.55 " " 11,835.83 " " 14,194.31 " " 14,056.23 " Inpatient 950.1 EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS " 251,919.93 " " 64,138.81 " " 13,195.21 " " 23,736.86 " " 13,854.97 " " 13,195.21 " " 13,195.21 " " 13,195.21 " " 14,052.90 " " 13,195.21 " " 13,195.21 " " 19,792.82 " " 23,736.86 " " 23,505.95 " Inpatient 952.1 NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS " 45,239.53 " " 11,517.98 " " 8,542.30 " " 15,366.74 " " 8,969.42 " " 8,542.30 " " 8,542.30 " " 8,542.30 " " 9,097.55 " " 8,542.30 " " 8,542.30 " " 12,813.45 " " 15,366.74 " " 15,217.25 " Inpatient 952.3 NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS " 80,183.69 " " 20,414.77 " " 19,519.68 " " 35,113.95 " " 20,495.66 " " 19,519.68 " " 19,519.68 " " 19,519.68 " " 20,788.46 " " 19,519.68 " " 19,519.68 " " 29,279.52 " " 35,113.95 " " 34,772.36 " Inpatient 952.4 NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS " 129,141.74 " " 32,879.49 " " 41,147.78 " " 74,020.74 " " 43,205.17 " " 41,147.78 " " 41,147.78 " " 41,147.78 " " 43,822.39 " " 41,147.78 " " 41,147.78 " " 61,721.67 " " 74,020.74 " " 73,300.66 "