hospital_name,last_updated_on,Version,hospital_location,hospital_address,license_number|CA,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",general_contract_provisions,,,,,,,,,,,,,,,,,,,,140%
Kentfield  Marin,8/1/2025,2.0.0,Marin,"1125 Sir Francis Drake Blvd Kentfield, CA 94909",1760424261,TRUE,,,,,,,,,,,,,,,,,,,,,
Description,code|1,code|1|type,code|2,code|2|type,modifiers,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,payer_name,plan_name,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,estimated_amount,standard_charge|methodology,standard_charge|min,standard_charge|max,additional_generic_notes,,,,,,,
R&B - MED/SURGE PRIVATE,110,RC,,,,inpatient,,,4568.2,,,,,,,,,,,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Aetna ,commercial,2016,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Aetna MR,commercial,2416,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Alameda Med Cal,medicare,2500,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Anthem Blue Cross ,commercial,2460,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Anthem Blue Cross Medicare advantage,medicare,,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Anthem Blue Cross Med Cal,medicare,2259,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Blue Shield CA,commercial,2215,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Blue Shield CA Tandem PPO,commercial,2016,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Blue Shield CA MR,commercial,2215,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Canopy Health,commercial,2234.26,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Central CA Alliance Health DR,Commercial,2300,,,,per diem,2122,7448,lesser of BC or 2300 per diem,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Cigna,Commercial,1900,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Contra Costa Medi Cal,medicare,2394.75,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Dignity Health,commercial,2215,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Health Net ,Medicare,2329,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Health Net Medi Cal,medicare,2171,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Health Plan of San Mateo,commercial,2300,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Health Smart Commercial,commercial,2460,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Health Smart Auto,commercial,2200,,,,case rate,2122,7448,80% BC,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Humana Med Adv,commercial,,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Kaiser ,commercial,2818,,,,per diem,2122,7448,Lesser of BC or Per Diem,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Kaiser MR,commercial,2818,,,,per diem,2122,7448,Lesser of BC or Per Diem,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Kaiser DR,commercial,2818,,,,per diem,2122,7448,Lesser of BC or Per Diem,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,John Muir Health MR,commercial,,,,,case rate,2122,7448,115% Medicare allowable for locality if no Medicare allowable exists then rate shall be 65% BC,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Meritage Health MR,commercial,,,,,case rate,2122,7448,100% Current Medicare Allowable,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Northbay Healthcare group HMO,commercial,2175,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Provider Network fo American Wrap/TPA,commercial,,,,,case rate,2122,7448,80% BC,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,SFHP,commercial,2800,,,,case rate,2122,7448,,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,Tricare West,commercial,,,,,case rate,2122,7448,Lesser of 75% BC or 100% DRG,,,,,,,
R&B Med/Surg Semi Private,120,RC,,,,inpatient,,,4568.2,,United Healthcare,commercial,,,,,per diem,2122,7448,Lesser of aggregare charges or $1997/diem,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Aetna,commercial,2440,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Antehm Blue Cross 288,commercial,2812,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Antehm Blue Cross Med Cal,medicare,2259,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Alameda Mcal,commercial,2900,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Kaiser 316,commercial,3100,,,,per diem,2122,7448,Lesser of BC or the per diem rate,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Kaiser MR 909,commercial,3100,,,,per diem,2122,7448,Lesser of BC or the per diem rate or whatever is appropriate,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Kaiser DR 209,commercial,3100,,,,case rate,2122,7448,Lesser of BC or the per diem rate,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Antehm Blue Cross Med Cal,commercial,2416,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Blue Shield CA Comm,commercial,2534,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Blue Shield CA tandem PPO,commercial,2307,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Blue Shield CA MR,commercial,2534,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Central CA Alliance for Health DR,commercial,,,,,per diem,2122,7448,Lesser if BC or 2448 per diem,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Canopy Health,commercial,2635.28,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Cigna,commercial,2100,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,CA Dept of Corrections,medicare,2100,,,,case rate,2122,7448,120% of Medicare DRG,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Dignity Health,commercial,2574,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Health New Commercial,commercial,2678,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Health Net Medi Cal,Medicare,2600,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Health Plan of San Matei Medi Cal,medicare,2600,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Health Smart Commercial,commercial,2520,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Marin General Scan MCR Adv,Medicare,,,,,case rate,2122,7448,DRG,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Health Smart Auto,commercial,,,,,case rate,2122,7448,80% BC,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Kaiser,commercial,3100,,,,per diem,2122,7448,Lesser of Bcor per diem rate,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Kaiser MR,commercial,3100,,,,per diem,2122,7448,Lesser of Bcor per diem rate,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Kaiser DR,commercial,3100,,,,per diem,2122,7448,Lesser of Bcor per diem rate,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Medi-Cal,medicaid,,,,,case rate,2122,7448,Medicaid DRG,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Meritage Health MR,Medicare,,,,,case rate,2122,7448,100% Medicare Allowable,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,MultiPlan,commercial,2750,,,,case rate,2122,7448,Lesser of 75% BC or per diem,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,MultiPlan Complimentary,Commercial,,,,,case rate,2122,7448,80% BC,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,MultiPlan WC,Commercial,,,,,case rate,2122,7448,98% State WC FS,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,MultiPlan Auto,Commercial,,,,,case rate,2122,7448,98% State WC FS,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Partnership Health plan of CA,commercial,3000,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Networks by Design,commercial,,,,,case rate,2122,7448,Lesser of 65% or $2700/per diem,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,SFHP,commercial,3200,,,,case rate,2122,7448,,,,,,,,
R&B - HI OBS PRIVATE,200,RC,,,,inpatient,,,7448,,Tricare Healthnet,commercial,,,,,case rate,2122,7448,Lesser of 75% BC or 100% DRG,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Aetna ,commercial,2122,,,,case rate,2122,7448,,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Alameda Mcal,Medicare,2800,,,,case rate,2122,7448,,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Anthem Blue Cross 288,commercial,2601,,,,case rate,2122,7448,,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Antehm Blue Cross Med Cal,Medicare,2259,,,,case rate,2122,7448,,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Blue Shield CA Comm,commercial,2330,,,,case rate,2122,7448,,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Blue Shield CA Tandem PPO,commercial,2122,,,,case rate,2122,7448,,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Blue Shield CA MR,commercial,2330,,,,case rate,2122,7448,,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Central CA Alliance for Health DR,commercial,,,,,per diem,2122,7448,lesser of BC or 2300 per diem,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Cigna,commercial,2100,,,,case rate,2122,7448,,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Canopy Health,commercial,2635.28,,,,case rate,2122,7448,,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,CA Dept of Corrections,medicare,2635.28,,,,case rate,2122,7448,120% of Medicare DRG,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Dignity Health,commercial,2426,,,,case rate,2122,7448,,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Health New Commercial,commercial,2445,,,,case rate,2122,7448,,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Health Net Medi Cal,Medicare,2400,,,,case rate,2122,7448,,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Health Plan of San Mateo Medi Cal,medicare,2400,,,,case rate,2122,7448,,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Health Smart Commercial,commercial,2370,,,,case rate,2122,7448,,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Health Smart Auto,commercial,,,,,case rate,2122,7448,80% BC,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Health Smart WC,commercial,,,,,case rate,2122,7448,98% State WC Fee,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Kaiser 316,commercial,2885,,,,per diem,2122,7448,Lesser of BC or Per Diem,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Kaiser MR 909,commercial,2885,,,,per diem,2122,7448,Lesser of BC or Per Diem,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Kaiser DR 209,commercial,2885,,,,per diem,2122,7448,Lesser of BC or Per Diem,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Medi-CalMedicaid,medicaid,,,,,case rate,2122,7448,Medicaid DRG,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Meritage Health MR,Medicare,,,,,case rate,2122,7448,100% Medicare Allowable,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,MultiPlan,commercial,3750,,,,case rate,2122,7448,Lesser of 75% BC or per diem,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,MultiPlan Complimentary,commercial,,,,,case rate,2122,7448,80% BC,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,MultiPlan WC,commercial,,,,,case rate,2122,7448,98% State WC FS,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,MultiPlan Auto,commercial,,,,,case rate,2122,7448,98% State WC FS,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Networks by Design,commercial,,,,,case rate,2122,7448,Lesser of 65% or $2500/per diem,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Partnership Health plan of CA,commercial,2600,,,,case rate,2122,7448,,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,SFHP,commercial,3000,,,,case rate,2122,7448,,,,,,,,
R&B - INTERMEDIATE PRIVATE,206,RC,,,,inpatient,,,5660.2,,Tricare Healthnet,commercial,,,,,case rate,2122,7448,Lesser of 75% BC or 100% DRG,,,,,,,
Insulin Lispro Protam/Lispro 75-25,250,RC,VB000004,LOCAL,,inpatient,10,ML,409.97,409.97,,,,,,,,,,,,,,,,,
"Insulin Regular, Human",250,RC,VB000008,LOCAL,,inpatient,3,ML,214.13,214.13,,,,,,,,,,,,,,,,,
Insulin Nph Hum/Reg Insulin 70-30,250,RC,VB000010,LOCAL,,inpatient,10,ML,214.13,214.13,,,,,,,,,,,,,,,,,
Insulin NPH Hum/Reg Insulin 70/30,250,RC,VB000011,LOCAL,,inpatient,3,ML,6,6,,,,,,,,,,,,,,,,,
Multivit-Min/Ferrous Gluconate,257,RC,VB000021,LOCAL,,inpatient,236,ML,35.96,35.96,,,,,,,,,,,,,,,,,
morphine SULFATE Oral (RX-UD),250,RC,VB000097,LOCAL,,inpatient,100,ML,6,6,,,,,,,,,,,,,,,,,
calcitrioL Oral Soln 1mcg/mL,250,RC,VB000106,LOCAL,,inpatient,15,ML,47.73,47.73,,,,,,,,,,,,,,,,,
Atropine Sulfate 1% Ophth,250,RC,VB000130,LOCAL,,inpatient,5,ML,276.34,276.34,,,,,,,,,,,,,,,,,
"Insulin Glargine,hum.rec.anlog",250,RC,VB000171,LOCAL,,inpatient,10,ML,308.45,308.45,,,,,,,,,,,,,,,,,
amantadine HCL Oral (Bulk),250,RC,VB000225,LOCAL,,inpatient,473,ML,73.8,73.8,,,,,,,,,,,,,,,,,
Ethosuximide Oral Soln,250,RC,VB000227,LOCAL,,inpatient,1,EA,6,6,,,,,,,,,,,,,,,,,
Valproic Acid Oral (120mL Bottle),250,RC,VB000228,LOCAL,,inpatient,473,ML,290,290,,,,,,,,,,,,,,,,,
Clindamycin Phosphate 1% Gel (30gm),250,RC,VB000267,LOCAL,,inpatient,30,GM,414.6,414.6,,,,,,,,,,,,,,,,,
Insulin NPH Human 100 UNIT/ML,250,RC,VB000271,LOCAL,,inpatient,10,ML,6,6,,,,,,,,,,,,,,,,,
Insulin NPH/Regular 70/30,250,RC,VB000272,LOCAL,,inpatient,10,ML,6,6,,,,,,,,,,,,,,,,,
Insulin Aspart Prot/Insuln Asp,250,RC,VB000273,LOCAL,,inpatient,1,EA,6,6,,,,,,,,,,,,,,,,,
Insulin Detemir (BULK Vial),250,RC,VB000274,LOCAL,,inpatient,10,ML,517.68,517.68,,,,,,,,,,,,,,,,,
Insulin Aspart,250,RC,VB000277,LOCAL,,inpatient,1,EA,138.88,138.88,,,,,,,,,,,,,,,,,
Umeclidinium Brm/Vilanterol Tr,250,RC,VB000299,LOCAL,,inpatient,1,EA,564.19,564.19,,,,,,,,,,,,,,,,,
Fluticasone/Vilanterol,250,RC,VB000301,LOCAL,,inpatient,1,EA,753.02,753.02,,,,,,,,,,,,,,,,,
Fat Emulsions 20% - 250mL,250,RC,VB000347,LOCAL,,inpatient,250,ML,129.36,129.36,,,,,,,,,,,,,,,,,
Amino Acids 5 %/Dextrose 20 %,250,RC,VB000402,LOCAL,,inpatient,2000,ML,391.34,391.34,,,,,,,,,,,,,,,,,
Aa 5 %/Calcium/Lytes/Dext 20 %,250,RC,VB000405,LOCAL,,inpatient,2000,ML,417.55,417.55,,,,,,,,,,,,,,,,,
methadone HCL Oral,250,RC,VB000453,LOCAL,,inpatient,1000,ML,5,5,,,,,,,,,,,,,,,,,
HYDROmorphone HCL,250,RC,VB000489,LOCAL,,inpatient,1,ML,7.53,7.53,,,,,,,,,,,,,,,,,
lidocaine HCL 1% Local Inj - 20mL,250,RC,VB000499,LOCAL,,inpatient,20,ML,15.22,15.22,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride (ADD-Vantage),250,RC,VB000545,LOCAL,,inpatient,100,ML,21.36,21.36,,,,,,,,,,,,,,,,,
Potas Phos (45mM Phos-66mEq K/15mL),250,RC,VB000551,LOCAL,,inpatient,15,ML,70.28,70.28,,,,,,,,,,,,,,,,,
sodium acetate,250,RC,VB000552,LOCAL,,inpatient,20,ML,53.71,53.71,,,,,,,,,,,,,,,,,
potassium acetate Inj,250,RC,VB000577,LOCAL,,inpatient,20,ML,25.87,25.87,,,,,,,,,,,,,,,,,
Phenylephrine-Mineral Oil-Petrolatu,257,RC,VB000674,LOCAL,,inpatient,57,GM,46.32,46.32,,,,,,,,,,,,,,,,,
Urea/Alpha Hydroxy Acids 10%-4%,250,RC,VB000943,LOCAL,,inpatient,57,GM,29.24,29.24,,,,,,,,,,,,,,,,,
Erythromycin Ethylsuccinate,250,RC,VB001032,LOCAL,,inpatient,1,EA,18.04,18.04,,,,,,,,,,,,,,,,,
Lidocaine 4% Cream - 30gm,250,RC,VB001034,LOCAL,,inpatient,30,GM,120,120,,,,,,,,,,,,,,,,,
Guar Gum,257,RC,VB001107,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Methyl Salicylate/Menthol 15%-10%,257,RC,VB001126,LOCAL,,inpatient,85,GM,13.97,13.97,,,,,,,,,,,,,,,,,
Vecuronium Bromide,250,RC,VB001145,LOCAL,,inpatient,1,ML,40.8,40.8,,,,,,,,,,,,,,,,,
Itraconazole Oral Soln,250,RC,VB001221,LOCAL,,inpatient,150,ML,10.96,10.96,,,,,,,,,,,,,,,,,
Epoetin Alfa 4000 unit/mL,250,RC,VB001430,LOCAL,,inpatient,1,ML,318.34,318.34,,,,,,,,,,,,,,,,,
Buprenorphine HCL,250,RC,VB001481,LOCAL,,inpatient,1,EA,53.78,53.78,,,,,,,,,,,,,,,,,
Doxepin HCL Oral Soln,250,RC,VB001510,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
opium tincture Oral (RX-UD),250,RC,VB001579,LOCAL,,inpatient,118,ML,25.08,25.08,,,,,,,,,,,,,,,,,
vancomycin HCL Oral,250,RC,VB001708,LOCAL,,inpatient,150,ML,5.23,5.23,,,,,,,,,,,,,,,,,
amiodarone HCL,250,RC,VB001735,LOCAL,,inpatient,18,ML,5,5,,,,,,,,,,,,,,,,,
Tramadol HCL/Acetaminophen - UD,250,RC,VB001771,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Olopatadine HCL 0.1%,250,RC,VB001810,LOCAL,,inpatient,5,ML,125,125,,,,,,,,,,,,,,,,,
Lanolin Alcohol/Mo/W.pet/Ceres(57g),257,RC,VB001820,LOCAL,,inpatient,57,GM,34.08,34.08,,,,,,,,,,,,,,,,,
lidocaine HCL 2% Uro-Jet - 5mL,250,RC,VB001831,LOCAL,,inpatient,5,ML,30.34,30.34,,,,,,,,,,,,,,,,,
Insulin Nph Human Isophane,250,RC,VB001887,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
Cholecalciferol (Vitamin D3) - UD,257,RC,VB001911,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Vits A and D/White Pet/Lanolin,250,RC,VB001985,LOCAL,,inpatient,113,GM,15.96,15.96,,,,,,,,,,,,,,,,,
"Heparin Sodium,porcine",250,RC,VB002002,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
Benzocaine 20% Spray,250,RC,VB002003,LOCAL,,inpatient,57,GM,27.24,27.24,,,,,,,,,,,,,,,,,
vancomycin HCL Oral (RX-UD),250,RC,VB002009,LOCAL,,inpatient,150,ML,5,5,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB002013,LOCAL,,inpatient,1,EA,115.78,115.78,,,,,,,,,,,,,,,,,
Fentanyl Citrate/Pf,250,RC,VB002052,LOCAL,,inpatient,2,ML,7.39,7.39,,,,,,,,,,,,,,,,,
Diphenhyd-Lido-Al-Mg-Sime(Cmpd Kit),250,RC,VB002064,LOCAL,,inpatient,119,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Lactobacillus Acidophilus/Pect,257,RC,VB002084,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Petrolatum,white",257,RC,VB002092,LOCAL,,inpatient,1,EA,52.08,52.08,,,,,,,,,,,,,,,,,
lidocaine HCL 2% Inj - 10mL,250,RC,VB002101,LOCAL,,inpatient,10,ML,16.56,16.56,,,,,,,,,,,,,,,,,
Albuterol Sulfate,250,RC,VB002107,LOCAL,,inpatient,8,GM,109.06,109.06,,,,,,,,,,,,,,,,,
Potassium Chloride In Water,250,RC,VB002175,LOCAL,,inpatient,50,ML,18.58,18.58,,,,,,,,,,,,,,,,,
"Heparin Sodium,porcine",250,RC,VB002186,LOCAL,,inpatient,30,ML,34.22,34.22,,,,,,,,,,,,,,,,,
Roflumilast,250,RC,VB002201,LOCAL,,inpatient,1,EA,70.99,70.99,,,,,,,,,,,,,,,,,
Multivitamin With Folic Acid - UD,227,RC,VB002220,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Acetylcysteine,250,RC,VB002237,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
ALPRAZolam ODT,250,RC,VB002257,LOCAL,,inpatient,1,EA,6.07,6.07,,,,,,,,,,,,,,,,,
Salmeterol Xinafoate,250,RC,VB002283,LOCAL,,inpatient,1,EA,2032.61,2032.61,,,,,,,,,,,,,,,,,
Glucose Gel Packet,250,RC,VB002327,LOCAL,,inpatient,32,ML,15.96,15.96,,,,,,,,,,,,,,,,,
Carbidopa/Levodopa 61.25MG/245MG,250,RC,VB002337,LOCAL,,inpatient,1,EA,25.06,25.06,,,,,,,,,,,,,,,,,
carBAMazepine,250,RC,VB002340,LOCAL,,inpatient,1,EA,7.86,7.86,,,,,,,,,,,,,,,,,
tacrolimus ER,250,RC,VB002344,LOCAL,,inpatient,1,EA,133.48,133.48,,,,,,,,,,,,,,,,,
hydrALAZINE HCL,250,RC,VB002366,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Cariprazine HCL - UD,250,RC,VB002407,LOCAL,,inpatient,1,EA,220.44,220.44,,,,,,,,,,,,,,,,,
Bictegrav/Emtricit/Tenofov Ala,250,RC,VB002408,LOCAL,,inpatient,1,EA,543,543,,,,,,,,,,,,,,,,,
Dulaglutide 0.75 mg/0.5mL,250,RC,VB002438,LOCAL,,inpatient,0.5,ML,1184.64,1184.64,,,,,,,,,,,,,,,,,
Dulaglutide 1.5 mg/0.5mL,250,RC,VB002439,LOCAL,,inpatient,0.5,ML,1117.04,1117.04,,,,,,,,,,,,,,,,,
DULoxetine HCL,250,RC,VB002440,LOCAL,,inpatient,1,EA,40.03,40.03,,,,,,,,,,,,,,,,,
Raloxifene HCL,250,RC,VB002441,LOCAL,,inpatient,1,EA,31.68,31.68,,,,,,,,,,,,,,,,,
OLANZapine ODT,250,RC,VB002442,LOCAL,,inpatient,1,EA,56,56,,,,,,,,,,,,,,,,,
OLANZapine,250,RC,VB002443,LOCAL,,inpatient,1,EA,118.61,118.61,,,,,,,,,,,,,,,,,
prasugrel HCL,250,RC,VB002444,LOCAL,,inpatient,1,EA,66.02,66.02,,,,,,,,,,,,,,,,,
prasugrel HCL,250,RC,VB002445,LOCAL,,inpatient,1,EA,73.44,73.44,,,,,,,,,,,,,,,,,
Insulin Lispro,250,RC,VB002446,LOCAL,,inpatient,10,ML,6,6,,,,,,,,,,,,,,,,,
Insulin Lispro Protam/Lispro 75-25,250,RC,VB002447,LOCAL,,inpatient,10,ML,6,6,,,,,,,,,,,,,,,,,
OLANZapine,250,RC,VB002448,LOCAL,,inpatient,1,EA,241.25,241.25,,,,,,,,,,,,,,,,,
"Insulin Regular, Human - 10mL VIAL",257,RC,VB002449,LOCAL,,inpatient,10,ML,6,6,,,,,,,,,,,,,,,,,
Insulin Nph Human Isophane,257,RC,VB002450,LOCAL,,inpatient,3,ML,6,6,,,,,,,,,,,,,,,,,
Insulin Nph Hum/Reg Insulin 70-30,257,RC,VB002451,LOCAL,,inpatient,10,ML,6,6,,,,,,,,,,,,,,,,,
Insulin Lispro Protam/Lispro 75-25,250,RC,VB002452,LOCAL,,inpatient,3,ML,152.74,152.74,,,,,,,,,,,,,,,,,
Insulin Lispro,250,RC,VB002453,LOCAL,,inpatient,3,ML,152.74,152.74,,,,,,,,,,,,,,,,,
"Insulin Regular, Human",250,RC,VB002454,LOCAL,,inpatient,3,ML,1378.08,1378.08,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide,250,RC,VB002455,LOCAL,,inpatient,1,ML,44.93,44.93,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide,250,RC,VB002456,LOCAL,,inpatient,5,ML,45.61,45.61,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide,250,RC,VB002457,LOCAL,,inpatient,5,ML,11.61,11.61,,,,,,,,,,,,,,,,,
Hydroxyurea,250,RC,VB002458,LOCAL,,inpatient,1,EA,6.55,6.55,,,,,,,,,,,,,,,,,
Apixaban,250,RC,VB002459,LOCAL,,inpatient,1,EA,48.51,48.51,,,,,,,,,,,,,,,,,
Apixaban,250,RC,VB002460,LOCAL,,inpatient,1,EA,48.51,48.51,,,,,,,,,,,,,,,,,
Dapagliflozin Propanediol,250,RC,VB002461,LOCAL,,inpatient,1,EA,95.96,95.96,,,,,,,,,,,,,,,,,
Entecavir,250,RC,VB002462,LOCAL,,inpatient,1,EA,219.6,219.6,,,,,,,,,,,,,,,,,
stavudine,250,RC,VB002463,LOCAL,,inpatient,1,EA,34.08,34.08,,,,,,,,,,,,,,,,,
stavudine,250,RC,VB002464,LOCAL,,inpatient,1,EA,36.21,36.21,,,,,,,,,,,,,,,,,
stavudine,250,RC,VB002465,LOCAL,,inpatient,1,EA,36.87,36.87,,,,,,,,,,,,,,,,,
Abatacept/Maltose,250,RC,VB002466,LOCAL,,inpatient,1,EA,5642.74,5642.74,,,,,,,,,,,,,,,,,
Aztreonam/Dextrose-Water,250,RC,VB002467,LOCAL,,inpatient,50,ML,159.7,159.7,,,,,,,,,,,,,,,,,
Aztreonam/Dextrose-Water,250,RC,VB002468,LOCAL,,inpatient,50,ML,319.82,319.82,,,,,,,,,,,,,,,,,
Atazanavir Sulfate,250,RC,VB002469,LOCAL,,inpatient,1,EA,117.06,117.06,,,,,,,,,,,,,,,,,
Atazanavir Sulfate,250,RC,VB002470,LOCAL,,inpatient,1,EA,117.06,117.06,,,,,,,,,,,,,,,,,
valGANciclovir HCL,250,RC,VB002471,LOCAL,,inpatient,1,EA,222.36,222.36,,,,,,,,,,,,,,,,,
Saquinavir Mesylate,250,RC,VB002472,LOCAL,,inpatient,1,EA,20.91,20.91,,,,,,,,,,,,,,,,,
mycophenolate mofetiL,250,RC,VB002473,LOCAL,,inpatient,1,EA,43.18,43.18,,,,,,,,,,,,,,,,,
mycophenolate mofetiL,250,RC,VB002474,LOCAL,,inpatient,160,ML,36.24,36.24,,,,,,,,,,,,,,,,,
Mycophenolate Mofetil HCL,250,RC,VB002475,LOCAL,,inpatient,1,EA,518.29,518.29,,,,,,,,,,,,,,,,,
Oseltamivir Phosphate,250,RC,VB002476,LOCAL,,inpatient,1,EA,72.9,72.9,,,,,,,,,,,,,,,,,
Oseltamivir Phosphate,250,RC,VB002477,LOCAL,,inpatient,1,EA,66.88,66.88,,,,,,,,,,,,,,,,,
Ganciclovir Sodium,250,RC,VB002478,LOCAL,,inpatient,1,EA,211.2,211.2,,,,,,,,,,,,,,,,,
Sitagliptin Phosphate,250,RC,VB002479,LOCAL,,inpatient,1,EA,52.8,52.8,,,,,,,,,,,,,,,,,
Sitagliptin Phosphate,250,RC,VB002480,LOCAL,,inpatient,1,EA,52.8,52.8,,,,,,,,,,,,,,,,,
Raltegravir Potassium,250,RC,VB002481,LOCAL,,inpatient,1,EA,166.66,166.66,,,,,,,,,,,,,,,,,
Sitagliptin Phosphate,250,RC,VB002482,LOCAL,,inpatient,1,EA,52.8,52.8,,,,,,,,,,,,,,,,,
Aprepitant,250,RC,VB002483,LOCAL,,inpatient,1,EA,1640.78,1640.78,,,,,,,,,,,,,,,,,
Aprepitant,250,RC,VB002484,LOCAL,,inpatient,1,EA,566.59,566.59,,,,,,,,,,,,,,,,,
Imipenem/Cilastatin Sodium,250,RC,VB002485,LOCAL,,inpatient,1,EA,131.28,131.28,,,,,,,,,,,,,,,,,
Ertapenem Sodium,250,RC,VB002486,LOCAL,,inpatient,1,EA,617.57,617.57,,,,,,,,,,,,,,,,,
"Measles,mumps,rubella Vacc/Pf",250,RC,VB002487,LOCAL,,inpatient,1,EA,446.16,446.16,,,,,,,,,,,,,,,,,
Hepatitis A Virus Vaccine/Pf,250,RC,VB002488,LOCAL,,inpatient,1,EA,182.88,182.88,,,,,,,,,,,,,,,,,
Hepatitis A Virus Vaccine/Pf,250,RC,VB002489,LOCAL,,inpatient,1,EA,386.72,386.72,,,,,,,,,,,,,,,,,
Pneumococcal 23-Val P-Sac Vac,250,RC,VB002490,LOCAL,,inpatient,1,EA,561.98,561.98,,,,,,,,,,,,,,,,,
Hepatitis B Virus Vaccine/Pf,250,RC,VB002491,LOCAL,,inpatient,0.5,ML,130.37,130.37,,,,,,,,,,,,,,,,,
Carvedilol Phosphate,250,RC,VB002492,LOCAL,,inpatient,1,EA,44.04,44.04,,,,,,,,,,,,,,,,,
Carvedilol Phosphate,250,RC,VB002493,LOCAL,,inpatient,1,EA,44.04,44.04,,,,,,,,,,,,,,,,,
Carvedilol Phosphate,250,RC,VB002494,LOCAL,,inpatient,1,EA,44.04,44.04,,,,,,,,,,,,,,,,,
pantoprazole SODIUM,250,RC,VB002495,LOCAL,,inpatient,1,EA,13.62,13.62,,,,,,,,,,,,,,,,,
pantoprazole SODIUM Inj,250,RC,VB002496,LOCAL,,inpatient,1,EA,34,34,,,,,,,,,,,,,,,,,
sirolimus,250,RC,VB002497,LOCAL,,inpatient,1,EA,164.99,164.99,,,,,,,,,,,,,,,,,
Desvenlafaxine Succinate,250,RC,VB002498,LOCAL,,inpatient,1,EA,55.8,55.8,,,,,,,,,,,,,,,,,
Tigecycline,250,RC,VB002499,LOCAL,,inpatient,1,EA,480,480,,,,,,,,,,,,,,,,,
Hydrocortisone Sodium Succ/Pf,250,RC,VB002500,LOCAL,,inpatient,1,EA,113.4,113.4,,,,,,,,,,,,,,,,,
Hydrocortisone,250,RC,VB002501,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Hydrocortisone Sodium Succ/Pf,250,RC,VB002502,LOCAL,,inpatient,1,EA,213.74,213.74,,,,,,,,,,,,,,,,,
Hydrocortisone Sodium Succ/Pf,250,RC,VB002503,LOCAL,,inpatient,1,EA,419.71,419.71,,,,,,,,,,,,,,,,,
methylPREDNISolone,250,RC,VB002504,LOCAL,,inpatient,1,EA,7.88,7.88,,,,,,,,,,,,,,,,,
Methylprednisolone Sod Succ/Pf,250,RC,VB002505,LOCAL,,inpatient,1,EA,31.05,31.05,,,,,,,,,,,,,,,,,
Methylprednisolone Sod Succ/Pf,250,RC,VB002506,LOCAL,,inpatient,1,EA,50,50,,,,,,,,,,,,,,,,,
methylPREDNISolone,250,RC,VB002507,LOCAL,,inpatient,1,EA,13.8,13.8,,,,,,,,,,,,,,,,,
Bacitracin Inj,250,RC,VB002508,LOCAL,,inpatient,1,EA,53.52,53.52,,,,,,,,,,,,,,,,,
Gelatin,250,RC,VB002509,LOCAL,,inpatient,1,EA,7140.96,7140.96,,,,,,,,,,,,,,,,,
"Gelatin Sponge,absorb/Porcine",250,RC,VB002510,LOCAL,,inpatient,1,EA,548.54,548.54,,,,,,,,,,,,,,,,,
"Gelatin Sponge,absorb/Porcine",250,RC,VB002511,LOCAL,,inpatient,1,EA,1329.31,1329.31,,,,,,,,,,,,,,,,,
Testosterone Cypionate,250,RC,VB002512,LOCAL,,inpatient,1,ML,114.19,114.19,,,,,,,,,,,,,,,,,
methylPREDNISolone SOD SUCC,250,RC,VB002513,LOCAL,,inpatient,1,EA,211.1,211.1,,,,,,,,,,,,,,,,,
methylPREDNISolone SOD SUCC,250,RC,VB002514,LOCAL,,inpatient,1,EA,116.54,116.54,,,,,,,,,,,,,,,,,
Clindamycin Phosphate/D5w,250,RC,VB002515,LOCAL,,inpatient,50,ML,83.71,83.71,,,,,,,,,,,,,,,,,
Clindamycin Phosphate/D5w,250,RC,VB002516,LOCAL,,inpatient,50,ML,102.29,102.29,,,,,,,,,,,,,,,,,
methylPREDNISolone ACETATE,250,RC,VB002517,LOCAL,,inpatient,1,ML,94.68,94.68,,,,,,,,,,,,,,,,,
Tolterodine Tartrate,250,RC,VB002518,LOCAL,,inpatient,1,EA,41.56,41.56,,,,,,,,,,,,,,,,,
Linezolid,250,RC,VB002519,LOCAL,,inpatient,150,ML,7.86,7.86,,,,,,,,,,,,,,,,,
Linezolid In Dextrose 5%,250,RC,VB002520,LOCAL,,inpatient,300,ML,6,6,,,,,,,,,,,,,,,,,
Tolterodine Tartrate,250,RC,VB002521,LOCAL,,inpatient,1,EA,58.99,58.99,,,,,,,,,,,,,,,,,
Tolterodine Tartrate,250,RC,VB002522,LOCAL,,inpatient,1,EA,58.99,58.99,,,,,,,,,,,,,,,,,
Estramustine Phosphate Sodium,250,RC,VB002523,LOCAL,,inpatient,1,EA,80.44,80.44,,,,,,,,,,,,,,,,,
Rifabutin,250,RC,VB002524,LOCAL,,inpatient,1,EA,69.98,69.98,,,,,,,,,,,,,,,,,
"Diatrizoate Meglumine, Sodium",250,RC,VB002525,LOCAL,,inpatient,30,ML,79.2,79.2,,,,,,,,,,,,,,,,,
Gentamicin Sulf/Prednisolone,250,RC,VB002526,LOCAL,,inpatient,3.5,GM,769.92,769.92,,,,,,,,,,,,,,,,,
Gentamicin Sulf/Prednisolone,250,RC,VB002527,LOCAL,,inpatient,5,ML,769.92,769.92,,,,,,,,,,,,,,,,,
"Mineral Oil/Petrolatum,white",257,RC,VB002528,LOCAL,,inpatient,3.5,GM,46.9,46.9,,,,,,,,,,,,,,,,,
Sulfacetamide/Prednisolone,250,RC,VB002529,LOCAL,,inpatient,3.5,GM,733.25,733.25,,,,,,,,,,,,,,,,,
Carboxymethylcellulose Sodium,250,RC,VB002530,LOCAL,,inpatient,1,EA,6,6,,,,,,,,,,,,,,,,,
Onabotulinumtoxina,250,RC,VB002531,LOCAL,,inpatient,1,EA,3100.8,3100.8,,,,,,,,,,,,,,,,,
Mesalamine,250,RC,VB002532,LOCAL,,inpatient,1,EA,18.62,18.62,,,,,,,,,,,,,,,,,
Iron Dextran Complex,250,RC,VB002533,LOCAL,,inpatient,2,ML,6,6,,,,,,,,,,,,,,,,,
cycloSPORINE 0.05% Ophthalmic,250,RC,VB002534,LOCAL,,inpatient,30,ML,51.65,51.65,,,,,,,,,,,,,,,,,
Primaquine Phosphate,250,RC,VB002535,LOCAL,,inpatient,1,EA,9.82,9.82,,,,,,,,,,,,,,,,,
Sodium Ferric Gluconat/Sucrose,250,RC,VB002536,LOCAL,,inpatient,5,ML,152.64,152.64,,,,,,,,,,,,,,,,,
Dronedarone HCL,250,RC,VB002537,LOCAL,,inpatient,1,EA,52.67,52.67,,,,,,,,,,,,,,,,,
Camphor/Phenol,257,RC,VB002538,LOCAL,,inpatient,45,ML,22.18,22.18,,,,,,,,,,,,,,,,,
Irbesartan,250,RC,VB002539,LOCAL,,inpatient,1,EA,34.91,34.91,,,,,,,,,,,,,,,,,
miSOPROStoL,250,RC,VB002540,LOCAL,,inpatient,1,EA,20.12,20.12,,,,,,,,,,,,,,,,,
miSOPROStoL,250,RC,VB002541,LOCAL,,inpatient,1,EA,5.72,5.72,,,,,,,,,,,,,,,,,
Celecoxib,250,RC,VB002542,LOCAL,,inpatient,1,EA,48.04,48.04,,,,,,,,,,,,,,,,,
Celecoxib,250,RC,VB002543,LOCAL,,inpatient,1,EA,78.8,78.8,,,,,,,,,,,,,,,,,
Celecoxib,250,RC,VB002544,LOCAL,,inpatient,1,EA,118.21,118.21,,,,,,,,,,,,,,,,,
Mupirocin Calcium,250,RC,VB002545,LOCAL,,inpatient,1,EA,81.94,81.94,,,,,,,,,,,,,,,,,
Lipase-Protease-Amylase 6K-19K-30K,250,RC,VB002546,LOCAL,,inpatient,1,EA,10.3,10.3,,,,,,,,,,,,,,,,,
Lipase-Protea-Amyl 36K-114K-180K,250,RC,VB002547,LOCAL,,inpatient,1,EA,61.98,61.98,,,,,,,,,,,,,,,,,
Hydrocortisone Acetate,250,RC,VB002548,LOCAL,,inpatient,15,GM,2210.54,2210.54,,,,,,,,,,,,,,,,,
cefoTAXime SODIUM,250,RC,VB002549,LOCAL,,inpatient,1,EA,7.92,7.92,,,,,,,,,,,,,,,,,
"Estrogens, Conjugated",250,RC,VB002550,LOCAL,,inpatient,1,EA,1809.02,1809.02,,,,,,,,,,,,,,,,,
"Estrogens, Conjugated",250,RC,VB002551,LOCAL,,inpatient,30,GM,2212.08,2212.08,,,,,,,,,,,,,,,,,
Echothiophate Iodide,250,RC,VB002552,LOCAL,,inpatient,5,ML,427.73,427.73,,,,,,,,,,,,,,,,,
"Estrogens, Conjugated",250,RC,VB002553,LOCAL,,inpatient,1,EA,33.94,33.94,,,,,,,,,,,,,,,,,
"Estrogens, Conjugated",250,RC,VB002554,LOCAL,,inpatient,1,EA,33.94,33.94,,,,,,,,,,,,,,,,,
"Estrogens, Conjugated",250,RC,VB002555,LOCAL,,inpatient,1,EA,33.94,33.94,,,,,,,,,,,,,,,,,
Anidulafungin,250,RC,VB002556,LOCAL,,inpatient,1,EA,916.27,916.27,,,,,,,,,,,,,,,,,
penicillin G POTASSIUM,250,RC,VB002557,LOCAL,,inpatient,1,EA,61.06,61.06,,,,,,,,,,,,,,,,,
Voriconazole,250,RC,VB002558,LOCAL,,inpatient,1,EA,17.87,17.87,,,,,,,,,,,,,,,,,
Voriconazole,250,RC,VB002559,LOCAL,,inpatient,1,EA,289.44,289.44,,,,,,,,,,,,,,,,,
Fluconazole,250,RC,VB002560,LOCAL,,inpatient,1,EA,5.46,5.46,,,,,,,,,,,,,,,,,
Ziprasidone Mesylate,250,RC,VB002561,LOCAL,,inpatient,1,EA,309.26,309.26,,,,,,,,,,,,,,,,,
ziprasidone HCL,250,RC,VB002562,LOCAL,,inpatient,1,EA,70.44,70.44,,,,,,,,,,,,,,,,,
ziprasidone HCL,250,RC,VB002563,LOCAL,,inpatient,1,EA,85.47,85.47,,,,,,,,,,,,,,,,,
Dronabinol,250,RC,VB002564,LOCAL,,inpatient,1,EA,52.41,52.41,,,,,,,,,,,,,,,,,
Albumin Human 5%,250,RC,VB002565,LOCAL,,inpatient,250,ML,432,432,,,,,,,,,,,,,,,,,
Albumin Human 25%,250,RC,VB002566,LOCAL,,inpatient,100,ML,864,864,,,,,,,,,,,,,,,,,
calcitrioL,250,RC,VB002567,LOCAL,,inpatient,1,EA,5.12,5.12,,,,,,,,,,,,,,,,,
Flecainide Acetate,250,RC,VB002568,LOCAL,,inpatient,1,EA,14.32,14.32,,,,,,,,,,,,,,,,,
predniSONE,250,RC,VB002569,LOCAL,,inpatient,1,EA,6,6,,,,,,,,,,,,,,,,,
predniSONE,250,RC,VB002570,LOCAL,,inpatient,1,EA,6,6,,,,,,,,,,,,,,,,,
lithium carbonate,250,RC,VB002571,LOCAL,,inpatient,1,EA,6,6,,,,,,,,,,,,,,,,,
Cilostazol,250,RC,VB002572,LOCAL,,inpatient,1,EA,7.3,7.3,,,,,,,,,,,,,,,,,
Clarithromycin,250,RC,VB002573,LOCAL,,inpatient,1,EA,24.06,24.06,,,,,,,,,,,,,,,,,
Ipratropium Bromide 0.06% Nasal,250,RC,VB002574,LOCAL,,inpatient,15,ML,382.84,382.84,,,,,,,,,,,,,,,,,
Digoxin,250,RC,VB002575,LOCAL,,inpatient,60,ML,11.2,11.2,,,,,,,,,,,,,,,,,
Exemestane,250,RC,VB002576,LOCAL,,inpatient,1,EA,80.93,80.93,,,,,,,,,,,,,,,,,
Calcium Acetate,250,RC,VB002577,LOCAL,,inpatient,1,EA,6,6,,,,,,,,,,,,,,,,,
OXcarbazepine,250,RC,VB002578,LOCAL,,inpatient,1,EA,6.11,6.11,,,,,,,,,,,,,,,,,
OXcarbazepine,250,RC,VB002579,LOCAL,,inpatient,1,EA,20.49,20.49,,,,,,,,,,,,,,,,,
ramipriL,250,RC,VB002580,LOCAL,,inpatient,1,EA,7.22,7.22,,,,,,,,,,,,,,,,,
ramipriL,250,RC,VB002581,LOCAL,,inpatient,1,EA,7.58,7.58,,,,,,,,,,,,,,,,,
rOPINIRole HCL,250,RC,VB002582,LOCAL,,inpatient,1,EA,10.02,10.02,,,,,,,,,,,,,,,,,
rOPINIRole HCL,250,RC,VB002583,LOCAL,,inpatient,1,EA,10.02,10.02,,,,,,,,,,,,,,,,,
rOPINIRole HCL,250,RC,VB002584,LOCAL,,inpatient,1,EA,10.02,10.02,,,,,,,,,,,,,,,,,
rOPINIRole HCL,250,RC,VB002585,LOCAL,,inpatient,1,EA,10.39,10.39,,,,,,,,,,,,,,,,,
Acarbose,250,RC,VB002586,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Acarbose,250,RC,VB002587,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Acarbose,250,RC,VB002588,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Buprenorphine HCL,250,RC,VB002589,LOCAL,,inpatient,1,EA,16.56,16.56,,,,,,,,,,,,,,,,,
QUEtiapine FUMARATE,250,RC,VB002590,LOCAL,,inpatient,1,EA,67.85,67.85,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB002591,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB002592,LOCAL,,inpatient,15,ML,5,5,,,,,,,,,,,,,,,,,
codeine SULFATE,250,RC,VB002593,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Montelukast Sodium,250,RC,VB002594,LOCAL,,inpatient,1,EA,22.63,22.63,,,,,,,,,,,,,,,,,
HYDROmorphone HCL,250,RC,VB002595,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB002596,LOCAL,,inpatient,30,ML,5,5,,,,,,,,,,,,,,,,,
Telmisartan,250,RC,VB002597,LOCAL,,inpatient,1,EA,22.08,22.08,,,,,,,,,,,,,,,,,
lithium carbonate,250,RC,VB002598,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Diphenoxylate HCL/Atropine,250,RC,VB002599,LOCAL,,inpatient,60,ML,5.6,5.6,,,,,,,,,,,,,,,,,
Fluticasone Propionate,250,RC,VB002600,LOCAL,,inpatient,16,GM,373.32,373.32,,,,,,,,,,,,,,,,,
Lactulose,250,RC,VB002601,LOCAL,,inpatient,500,ML,5,5,,,,,,,,,,,,,,,,,
lidocaine HCL 4% Topical,250,RC,VB002602,LOCAL,,inpatient,50,ML,192,192,,,,,,,,,,,,,,,,,
methadone HCL,250,RC,VB002603,LOCAL,,inpatient,500,ML,5,5,,,,,,,,,,,,,,,,,
propranolol HCL,250,RC,VB002604,LOCAL,,inpatient,500,ML,5,5,,,,,,,,,,,,,,,,,
leucovorin calcium,250,RC,VB002605,LOCAL,,inpatient,1,EA,8.2,8.2,,,,,,,,,,,,,,,,,
leucovorin calcium,250,RC,VB002606,LOCAL,,inpatient,1,EA,47.11,47.11,,,,,,,,,,,,,,,,,
Mercaptopurine,250,RC,VB002607,LOCAL,,inpatient,1,EA,32.74,32.74,,,,,,,,,,,,,,,,,
megestroL ACETATE,250,RC,VB002608,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Propantheline Bromide,250,RC,VB002609,LOCAL,,inpatient,1,EA,12,12,,,,,,,,,,,,,,,,,
Clotrimazole Troche,250,RC,VB002610,LOCAL,,inpatient,1,EA,13.74,13.74,,,,,,,,,,,,,,,,,
dexAMETHasone,250,RC,VB002611,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
dexAMETHasone,250,RC,VB002612,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
dexAMETHasone,250,RC,VB002613,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
dexAMETHasone,250,RC,VB002614,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Furosemide,250,RC,VB002615,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Furosemide,250,RC,VB002616,LOCAL,,inpatient,1,EA,6.29,6.29,,,,,,,,,,,,,,,,,
lithium carbonate,250,RC,VB002617,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
metHOTREXate SODIUM,250,RC,VB002618,LOCAL,,inpatient,1,EA,14.26,14.26,,,,,,,,,,,,,,,,,
methadone HCL,250,RC,VB002619,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
methadone HCL,250,RC,VB002620,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
megestroL ACETATE,250,RC,VB002621,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
predniSONE,250,RC,VB002622,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
predniSONE,250,RC,VB002623,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
predniSONE,250,RC,VB002624,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Warfarin Sodium,250,RC,VB002625,LOCAL,,inpatient,1,EA,9.9,9.9,,,,,,,,,,,,,,,,,
Warfarin Sodium,250,RC,VB002626,LOCAL,,inpatient,1,EA,10.33,10.33,,,,,,,,,,,,,,,,,
Warfarin Sodium,250,RC,VB002627,LOCAL,,inpatient,1,EA,11.1,11.1,,,,,,,,,,,,,,,,,
Warfarin Sodium,250,RC,VB002628,LOCAL,,inpatient,1,EA,14.8,14.8,,,,,,,,,,,,,,,,,
Warfarin Sodium,250,RC,VB002629,LOCAL,,inpatient,1,EA,15.35,15.35,,,,,,,,,,,,,,,,,
Warfarin Sodium,250,RC,VB002630,LOCAL,,inpatient,1,EA,10.65,10.65,,,,,,,,,,,,,,,,,
Efavirenz,250,RC,VB002631,LOCAL,,inpatient,1,EA,52.3,52.3,,,,,,,,,,,,,,,,,
Carbachol,250,RC,VB002632,LOCAL,,inpatient,1.5,ML,148.7,148.7,,,,,,,,,,,,,,,,,
Naphazoline HCL/Pheniramine,250,RC,VB002633,LOCAL,,inpatient,15,ML,37.63,37.63,,,,,,,,,,,,,,,,,
Betaxolol HCL 0.25% Ophth,250,RC,VB002634,LOCAL,,inpatient,10,ML,1565.09,1565.09,,,,,,,,,,,,,,,,,
Povidone-Iodine,250,RC,VB002635,LOCAL,,inpatient,30,ML,85.25,85.25,,,,,,,,,,,,,,,,,
Balanced Salt Soln Non-Surg 3,257,RC,VB002636,LOCAL,,inpatient,30,ML,95.71,95.71,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide/Pf,250,RC,VB002637,LOCAL,,inpatient,1,ML,4531.2,4531.2,,,,,,,,,,,,,,,,,
Tobramycin/Dexamethasone,250,RC,VB002638,LOCAL,,inpatient,3.5,GM,1095.41,1095.41,,,,,,,,,,,,,,,,,
Moxifloxacin HCL  0.5 %,250,RC,VB002639,LOCAL,,inpatient,3,ML,835.78,835.78,,,,,,,,,,,,,,,,,
Aspirin/Acetamin/Caffe 250/250/65mg,250,RC,VB002640,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Caffeine,250,RC,VB002641,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Nicotine,257,RC,VB002642,LOCAL,,inpatient,1,EA,8.53,8.53,,,,,,,,,,,,,,,,,
Nicotine,257,RC,VB002643,LOCAL,,inpatient,1,EA,8.53,8.53,,,,,,,,,,,,,,,,,
Nicotine,257,RC,VB002644,LOCAL,,inpatient,1,EA,8.53,8.53,,,,,,,,,,,,,,,,,
rifAMPin,250,RC,VB002645,LOCAL,,inpatient,1,EA,22.13,22.13,,,,,,,,,,,,,,,,,
rifAMPin,250,RC,VB002646,LOCAL,,inpatient,1,EA,857.09,857.09,,,,,,,,,,,,,,,,,
"Dalteparin Sodium,porcine",250,RC,VB002647,LOCAL,,inpatient,0.2,ML,5,5,,,,,,,,,,,,,,,,,
"Dalteparin Sodium,porcine",250,RC,VB002648,LOCAL,,inpatient,0.2,ML,5,5,,,,,,,,,,,,,,,,,
"Dalteparin Sodium,porcine",250,RC,VB002649,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
"Dalteparin Sodium,porcine",250,RC,VB002650,LOCAL,,inpatient,0.5,ML,5,5,,,,,,,,,,,,,,,,,
"Dalteparin Sodium,porcine",250,RC,VB002651,LOCAL,,inpatient,0.6,ML,5,5,,,,,,,,,,,,,,,,,
"Dalteparin Sodium,porcine",250,RC,VB002652,LOCAL,,inpatient,0.72,ML,5,5,,,,,,,,,,,,,,,,,
Varenicline Tartrate,250,RC,VB002653,LOCAL,,inpatient,1,EA,40.23,40.23,,,,,,,,,,,,,,,,,
Varenicline Tartrate,250,RC,VB002654,LOCAL,,inpatient,1,EA,40.23,40.23,,,,,,,,,,,,,,,,,
Doxycycline Monohydrate Oral Susp,250,RC,VB002655,LOCAL,,inpatient,60,ML,5,5,,,,,,,,,,,,,,,,,
"Epoetin Alfa-Epbx 2,000 units/mL",250,RC,VB002656,LOCAL,,inpatient,1,ML,105.89,105.89,,,,,,,,,,,,,,,,,
"Epoetin Alfa-Epbx 4,000 units/mL",250,RC,VB002657,LOCAL,,inpatient,1,ML,211.78,211.78,,,,,,,,,,,,,,,,,
"Epoetin Alfa-Epbx 10,000 units/mL",250,RC,VB002658,LOCAL,,inpatient,1,ML,529.44,529.44,,,,,,,,,,,,,,,,,
"Epoetin Alfa-Epbx 40,000 units/mL",250,RC,VB002659,LOCAL,,inpatient,1,ML,2117.76,2117.76,,,,,,,,,,,,,,,,,
sildenafiL CITRATE,250,RC,VB002660,LOCAL,,inpatient,1,EA,296.9,296.9,,,,,,,,,,,,,,,,,
Dofetilide,250,RC,VB002661,LOCAL,,inpatient,1,EA,53.19,53.19,,,,,,,,,,,,,,,,,
Dofetilide,250,RC,VB002662,LOCAL,,inpatient,1,EA,53.19,53.19,,,,,,,,,,,,,,,,,
Dofetilide,250,RC,VB002663,LOCAL,,inpatient,1,EA,53.19,53.19,,,,,,,,,,,,,,,,,
Phenytoin,250,RC,VB002664,LOCAL,,inpatient,1,EA,10.73,10.73,,,,,,,,,,,,,,,,,
Ethosuximide,250,RC,VB002665,LOCAL,,inpatient,1,EA,6.37,6.37,,,,,,,,,,,,,,,,,
Phenelzine Sulfate,250,RC,VB002666,LOCAL,,inpatient,1,EA,12.37,12.37,,,,,,,,,,,,,,,,,
Nitroglycerin,250,RC,VB002667,LOCAL,,inpatient,1,EA,7.76,7.76,,,,,,,,,,,,,,,,,
Pregabalin,250,RC,VB002668,LOCAL,,inpatient,1,EA,53.43,53.43,,,,,,,,,,,,,,,,,
Pregabalin,250,RC,VB002669,LOCAL,,inpatient,1,EA,53.43,53.43,,,,,,,,,,,,,,,,,
Pregabalin,250,RC,VB002670,LOCAL,,inpatient,1,EA,53.43,53.43,,,,,,,,,,,,,,,,,
Phenytoin Sodium Extended,250,RC,VB002671,LOCAL,,inpatient,1,EA,7.17,7.17,,,,,,,,,,,,,,,,,
Paricalcitol,250,RC,VB002672,LOCAL,,inpatient,1,ML,72.72,72.72,,,,,,,,,,,,,,,,,
levothyroxine SODIUM,250,RC,VB002673,LOCAL,,inpatient,1,EA,7.95,7.95,,,,,,,,,,,,,,,,,
Lopinavir/Ritonavir,250,RC,VB002674,LOCAL,,inpatient,160,ML,15.36,15.36,,,,,,,,,,,,,,,,,
Sevoflurane,250,RC,VB002675,LOCAL,,inpatient,250,ML,902.4,902.4,,,,,,,,,,,,,,,,,
levothyroxine SODIUM,250,RC,VB002676,LOCAL,,inpatient,1,EA,7.94,7.94,,,,,,,,,,,,,,,,,
levothyroxine SODIUM,250,RC,VB002677,LOCAL,,inpatient,1,EA,7.94,7.94,,,,,,,,,,,,,,,,,
Valproic Acid Oral,250,RC,VB002678,LOCAL,,inpatient,480,ML,5.09,5.09,,,,,,,,,,,,,,,,,
levothyroxine SODIUM,250,RC,VB002679,LOCAL,,inpatient,1,EA,7.95,7.95,,,,,,,,,,,,,,,,,
Lopinavir/Ritonavir,250,RC,VB002680,LOCAL,,inpatient,1,EA,40.97,40.97,,,,,,,,,,,,,,,,,
levothyroxine SODIUM,250,RC,VB002681,LOCAL,,inpatient,1,EA,7.95,7.95,,,,,,,,,,,,,,,,,
levothyroxine SODIUM,250,RC,VB002682,LOCAL,,inpatient,1,EA,7.95,7.95,,,,,,,,,,,,,,,,,
levothyroxine SODIUM,250,RC,VB002683,LOCAL,,inpatient,1,EA,7.94,7.94,,,,,,,,,,,,,,,,,
levothyroxine SODIUM,250,RC,VB002684,LOCAL,,inpatient,1,EA,7.95,7.95,,,,,,,,,,,,,,,,,
Enoxaparin Sodium,250,RC,VB002685,LOCAL,,inpatient,0.6,ML,71.52,71.52,,,,,,,,,,,,,,,,,
Enoxaparin Sodium,250,RC,VB002686,LOCAL,,inpatient,0.8,ML,95.38,95.38,,,,,,,,,,,,,,,,,
Enoxaparin Sodium,250,RC,VB002687,LOCAL,,inpatient,1,ML,119.21,119.21,,,,,,,,,,,,,,,,,
Enoxaparin Sodium,250,RC,VB002688,LOCAL,,inpatient,0.3,ML,35.71,35.71,,,,,,,,,,,,,,,,,
Enoxaparin Sodium,250,RC,VB002689,LOCAL,,inpatient,3,ML,357.22,357.22,,,,,,,,,,,,,,,,,
Enoxaparin Sodium 120 mg/0.8mL,250,RC,VB002690,LOCAL,,inpatient,0.8,ML,143.09,143.09,,,,,,,,,,,,,,,,,
Enoxaparin Sodium,250,RC,VB002691,LOCAL,,inpatient,1,ML,178.88,178.88,,,,,,,,,,,,,,,,,
cycloSPORINE,250,RC,VB002692,LOCAL,,inpatient,5,ML,334.99,334.99,,,,,,,,,,,,,,,,,
cycloSPORINE,250,RC,VB002693,LOCAL,,inpatient,50,ML,80.21,80.21,,,,,,,,,,,,,,,,,
cycloSPORINE,250,RC,VB002694,LOCAL,,inpatient,1,EA,85.93,85.93,,,,,,,,,,,,,,,,,
"Cyclosporine, Modified",250,RC,VB002695,LOCAL,,inpatient,1,EA,14.12,14.12,,,,,,,,,,,,,,,,,
"Cyclosporine, Modified",250,RC,VB002696,LOCAL,,inpatient,1,EA,56.44,56.44,,,,,,,,,,,,,,,,,
"Cyclosporine, Modified",250,RC,VB002697,LOCAL,,inpatient,50,ML,61.53,61.53,,,,,,,,,,,,,,,,,
Entacapone,250,RC,VB002698,LOCAL,,inpatient,1,EA,37.01,37.01,,,,,,,,,,,,,,,,,
Valsartan,250,RC,VB002699,LOCAL,,inpatient,1,EA,45.48,45.48,,,,,,,,,,,,,,,,,
Valsartan,250,RC,VB002700,LOCAL,,inpatient,1,EA,48.91,48.91,,,,,,,,,,,,,,,,,
Valsartan,250,RC,VB002701,LOCAL,,inpatient,1,EA,26,26,,,,,,,,,,,,,,,,,
Famciclovir,250,RC,VB002702,LOCAL,,inpatient,1,EA,52.32,52.32,,,,,,,,,,,,,,,,,
Mycophenolate Sodium,250,RC,VB002703,LOCAL,,inpatient,1,EA,35.8,35.8,,,,,,,,,,,,,,,,,
Mycophenolate Sodium,250,RC,VB002704,LOCAL,,inpatient,1,EA,71.59,71.59,,,,,,,,,,,,,,,,,
Zoledronic Acid,250,RC,VB002705,LOCAL,,inpatient,5,ML,4427.9,4427.9,,,,,,,,,,,,,,,,,
Imatinib Mesylate,250,RC,VB002706,LOCAL,,inpatient,1,EA,449.46,449.46,,,,,,,,,,,,,,,,,
Zoledronic Acid/Mannitol-Water,250,RC,VB002707,LOCAL,,inpatient,100,ML,6283.44,6283.44,,,,,,,,,,,,,,,,,
Deferoxamine Mesylate,250,RC,VB002708,LOCAL,,inpatient,1,EA,166.66,166.66,,,,,,,,,,,,,,,,,
Tobramycin In 0.225% Sod Chlor,250,RC,VB002709,LOCAL,,inpatient,1,ML,705.94,705.94,,,,,,,,,,,,,,,,,
Rivastigmine,250,RC,VB002710,LOCAL,,inpatient,1,EA,109.76,109.76,,,,,,,,,,,,,,,,,
Rivastigmine,250,RC,VB002711,LOCAL,,inpatient,1,EA,109.76,109.76,,,,,,,,,,,,,,,,,
Everolimus,250,RC,VB002712,LOCAL,,inpatient,1,EA,3280.32,3280.32,,,,,,,,,,,,,,,,,
Sacubitril/Valsartan 24mg-26mg,250,RC,VB002713,LOCAL,,inpatient,1,EA,56.42,56.42,,,,,,,,,,,,,,,,,
Sacubitril/Valsartan 97mg-103mg,250,RC,VB002714,LOCAL,,inpatient,1,EA,56.42,56.42,,,,,,,,,,,,,,,,,
Sacubitril/Valsartan 49mg-51mg,250,RC,VB002715,LOCAL,,inpatient,1,EA,56.42,56.42,,,,,,,,,,,,,,,,,
Ciprofloxacin/Dexameth 0.3 %/0.1%,250,RC,VB002716,LOCAL,,inpatient,1,EA,1195.63,1195.63,,,,,,,,,,,,,,,,,
Travoprost,250,RC,VB002717,LOCAL,,inpatient,1,EA,1180.8,1180.8,,,,,,,,,,,,,,,,,
Posaconazole,250,RC,VB002718,LOCAL,,inpatient,105,ML,65.81,65.81,,,,,,,,,,,,,,,,,
Moxifloxacin HCL,250,RC,VB002719,LOCAL,,inpatient,1,EA,133,133,,,,,,,,,,,,,,,,,
Moxifloxacin-Sod.chloride(Iso),250,RC,VB002720,LOCAL,,inpatient,250,ML,245.09,245.09,,,,,,,,,,,,,,,,,
Nitroglycerin,250,RC,VB002721,LOCAL,,inpatient,1,EA,26.69,26.69,,,,,,,,,,,,,,,,,
Mometasone/Formoterol 200/5MCG,250,RC,VB002722,LOCAL,,inpatient,8.8,GM,1113.22,1113.22,,,,,,,,,,,,,,,,,
Mometasone/Formoterol 100/5MCG,250,RC,VB002723,LOCAL,,inpatient,8.8,GM,1113.22,1113.22,,,,,,,,,,,,,,,,,
Didanosine,250,RC,VB002724,LOCAL,,inpatient,1,EA,68.78,68.78,,,,,,,,,,,,,,,,,
"Insulin Glargine,hum.rec.anlog",250,RC,VB002725,LOCAL,,inpatient,3,ML,92.54,92.54,,,,,,,,,,,,,,,,,
"Insulin Glargine,hum.rec.anlog",250,RC,VB002726,LOCAL,,inpatient,10,ML,1.36,1.36,,,,,,,,,,,,,,,,,
pantoprazole SODIUM,250,RC,VB002727,LOCAL,,inpatient,1,EA,16.37,16.37,,,,,,,,,,,,,,,,,
Moexipril HCL,250,RC,VB002728,LOCAL,,inpatient,1,EA,5.56,5.56,,,,,,,,,,,,,,,,,
Acetaminophen With Codeine,250,RC,VB002729,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Fluocinonide 0.05 % - 15GM,250,RC,VB002730,LOCAL,,inpatient,15,GM,182.2,182.2,,,,,,,,,,,,,,,,,
Fluocinonide,250,RC,VB002731,LOCAL,,inpatient,15,GM,283,283,,,,,,,,,,,,,,,,,
ketorolac TROMETHAMINE,250,RC,VB002732,LOCAL,,inpatient,1,EA,8.63,8.63,,,,,,,,,,,,,,,,,
diflunisaL,250,RC,VB002733,LOCAL,,inpatient,1,EA,8.27,8.27,,,,,,,,,,,,,,,,,
Nortriptyline HCL,250,RC,VB002734,LOCAL,,inpatient,1,EA,5.74,5.74,,,,,,,,,,,,,,,,,
lovastatin,250,RC,VB002735,LOCAL,,inpatient,1,EA,5.38,5.38,,,,,,,,,,,,,,,,,
nystatin,250,RC,VB002736,LOCAL,,inpatient,1,EA,5.68,5.68,,,,,,,,,,,,,,,,,
Nefazodone HCL,250,RC,VB002737,LOCAL,,inpatient,1,EA,19.2,19.2,,,,,,,,,,,,,,,,,
Nefazodone HCL,250,RC,VB002738,LOCAL,,inpatient,1,EA,19.93,19.93,,,,,,,,,,,,,,,,,
Nefazodone HCL,250,RC,VB002739,LOCAL,,inpatient,1,EA,20.3,20.3,,,,,,,,,,,,,,,,,
Neomycin Sulfate,250,RC,VB002740,LOCAL,,inpatient,1,EA,5.95,5.95,,,,,,,,,,,,,,,,,
Sucralfate,250,RC,VB002741,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Amoxicillin/Potassium Clav,250,RC,VB002742,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
Cyproheptadine HCL,250,RC,VB002743,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dicloxacillin Sodium,250,RC,VB002744,LOCAL,,inpatient,1,EA,6.01,6.01,,,,,,,,,,,,,,,,,
Dicloxacillin Sodium,250,RC,VB002745,LOCAL,,inpatient,1,EA,10.92,10.92,,,,,,,,,,,,,,,,,
disopyramide PHOSPHATE,250,RC,VB002746,LOCAL,,inpatient,1,EA,13.5,13.5,,,,,,,,,,,,,,,,,
penicillin V POTASSIUM,250,RC,VB002747,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
levalbuterol HCL,250,RC,VB002748,LOCAL,,inpatient,3,ML,26.84,26.84,,,,,,,,,,,,,,,,,
Amoxicillin,250,RC,VB002749,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
Bumetanide,250,RC,VB002750,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Alendronate Sodium,250,RC,VB002751,LOCAL,,inpatient,1,EA,11.71,11.71,,,,,,,,,,,,,,,,,
Moexipril HCL,250,RC,VB002752,LOCAL,,inpatient,1,EA,5.82,5.82,,,,,,,,,,,,,,,,,
Zaleplon,250,RC,VB002753,LOCAL,,inpatient,1,EA,14.75,14.75,,,,,,,,,,,,,,,,,
Buprenorphine/Naloxone 2 MG-0.5MG,250,RC,VB002754,LOCAL,,inpatient,1,EA,23.29,23.29,,,,,,,,,,,,,,,,,
esomeprazole MAGNESIUM,250,RC,VB002755,LOCAL,,inpatient,1,EA,34.09,34.09,,,,,,,,,,,,,,,,,
Nefazodone HCL,250,RC,VB002756,LOCAL,,inpatient,1,EA,19.56,19.56,,,,,,,,,,,,,,,,,
lansoprazole,250,RC,VB002757,LOCAL,,inpatient,1,EA,22.67,22.67,,,,,,,,,,,,,,,,,
Losartan Potassium,250,RC,VB002758,LOCAL,,inpatient,1,EA,6.73,6.73,,,,,,,,,,,,,,,,,
Losartan Potassium,250,RC,VB002759,LOCAL,,inpatient,1,EA,9.05,9.05,,,,,,,,,,,,,,,,,
Losartan Potassium,250,RC,VB002760,LOCAL,,inpatient,1,EA,12.33,12.33,,,,,,,,,,,,,,,,,
Venlafaxine HCL,250,RC,VB002761,LOCAL,,inpatient,1,EA,8.24,8.24,,,,,,,,,,,,,,,,,
Niacin,250,RC,VB002762,LOCAL,,inpatient,1,EA,16.95,16.95,,,,,,,,,,,,,,,,,
Linezolid,250,RC,VB002763,LOCAL,,inpatient,1,EA,29.71,29.71,,,,,,,,,,,,,,,,,
Famciclovir,250,RC,VB002764,LOCAL,,inpatient,1,EA,50.77,50.77,,,,,,,,,,,,,,,,,
Mexiletine HCL,250,RC,VB002765,LOCAL,,inpatient,1,EA,10.14,10.14,,,,,,,,,,,,,,,,,
Mexiletine HCL,250,RC,VB002766,LOCAL,,inpatient,1,EA,12.11,12.11,,,,,,,,,,,,,,,,,
Mexiletine HCL,250,RC,VB002767,LOCAL,,inpatient,1,EA,13.99,13.99,,,,,,,,,,,,,,,,,
Acyclovir,257,RC,VB002768,LOCAL,,inpatient,1,EA,14.67,14.67,,,,,,,,,,,,,,,,,
Nicotine Polacrilex,250,RC,VB002769,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Fenofibrate,micronized",250,RC,VB002770,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Fenofibrate,micronized",250,RC,VB002771,LOCAL,,inpatient,1,EA,12.6,12.6,,,,,,,,,,,,,,,,,
Lidocaine/Prilocaine 2.5 %-2.5% 5GM,250,RC,VB002772,LOCAL,,inpatient,5,EA,32.16,32.16,,,,,,,,,,,,,,,,,
midodrine HCL,250,RC,VB002773,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
midodrine HCL,250,RC,VB002774,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dantrolene Sodium,250,RC,VB002775,LOCAL,,inpatient,1,EA,6.91,6.91,,,,,,,,,,,,,,,,,
Dantrolene Sodium,250,RC,VB002776,LOCAL,,inpatient,1,EA,8.67,8.67,,,,,,,,,,,,,,,,,
Fenofibrate,250,RC,VB002777,LOCAL,,inpatient,1,EA,9.51,9.51,,,,,,,,,,,,,,,,,
Fludrocortisone Acetate,250,RC,VB002778,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Chlorhexidine Gluconate 0.12%,250,RC,VB002779,LOCAL,,inpatient,473,ML,48,48,,,,,,,,,,,,,,,,,
Magnesium Hydroxide 2400mg/30mL,257,RC,VB002780,LOCAL,,inpatient,30,ML,9.36,9.36,,,,,,,,,,,,,,,,,
diphenhydrAMINE HCL - UD,250,RC,VB002781,LOCAL,,inpatient,10,ML,7.32,7.32,,,,,,,,,,,,,,,,,
Ferrous Sulfate,257,RC,VB002782,LOCAL,,inpatient,5,ML,16.28,16.28,,,,,,,,,,,,,,,,,
Docusate Sodium,257,RC,VB002783,LOCAL,,inpatient,10,ML,5.32,5.32,,,,,,,,,,,,,,,,,
Metoclopramide HCL,257,RC,VB002784,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
haloperidoL LACTATE,250,RC,VB002785,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
Sodium Citrate-Citric Acid,250,RC,VB002786,LOCAL,,inpatient,30,ML,8.68,8.68,,,,,,,,,,,,,,,,,
amantadine HCL Oral,250,RC,VB002787,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Sod/Pot/K Cit/Sod Cit/Cit Acid,250,RC,VB002788,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Sucralfate,250,RC,VB002789,LOCAL,,inpatient,1,EA,43.44,43.44,,,,,,,,,,,,,,,,,
prednisoLONE SODIUM PHOSPHATE,250,RC,VB002790,LOCAL,,inpatient,237,ML,5,5,,,,,,,,,,,,,,,,,
Sulfamethox/Trimeth 800-160mg/20ml,250,RC,VB002791,LOCAL,,inpatient,20,ML,81.96,81.96,,,,,,,,,,,,,,,,,
Acetaminophen-Codeine 300-30mg/12.5,250,RC,VB002792,LOCAL,,inpatient,12.5,ML,13.28,13.28,,,,,,,,,,,,,,,,,
Guaifenesin/Dextromethorphan,257,RC,VB002793,LOCAL,,inpatient,10,ML,11.08,11.08,,,,,,,,,,,,,,,,,
Codeine Phosphate/Guaifenesin,257,RC,VB002794,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
guaiFENesin,257,RC,VB002795,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
Mag Hydrox/Aluminum Hyd/Simeth,250,RC,VB002796,LOCAL,,inpatient,30,ML,15.16,15.16,,,,,,,,,,,,,,,,,
Lactulose,250,RC,VB002797,LOCAL,,inpatient,30,ML,5,5,,,,,,,,,,,,,,,,,
Calcium Carbonate,257,RC,VB002798,LOCAL,,inpatient,5,ML,12.28,12.28,,,,,,,,,,,,,,,,,
Lacosamide,250,RC,VB002799,LOCAL,,inpatient,20,ML,464.02,464.02,,,,,,,,,,,,,,,,,
Lacosamide,250,RC,VB002800,LOCAL,,inpatient,1,EA,57.95,57.95,,,,,,,,,,,,,,,,,
Lacosamide,250,RC,VB002801,LOCAL,,inpatient,1,EA,95.97,95.97,,,,,,,,,,,,,,,,,
"Sodium Phosphate,mono-Dibasic Enema",257,RC,VB002802,LOCAL,,inpatient,133,ML,5,5,,,,,,,,,,,,,,,,,
Docosanol,257,RC,VB002803,LOCAL,,inpatient,2,GM,123.92,123.92,,,,,,,,,,,,,,,,,
captopriL,250,RC,VB002804,LOCAL,,inpatient,1,EA,11.59,11.59,,,,,,,,,,,,,,,,,
Chlorothiazide,250,RC,VB002805,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
methocarbamoL,250,RC,VB002806,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Butalb/Acetam/Caff  50/325/40mg,250,RC,VB002807,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Chloroprocaine HCL/Pf,250,RC,VB002808,LOCAL,,inpatient,20,ML,5,5,,,,,,,,,,,,,,,,,
Chloroprocaine HCL/Pf,250,RC,VB002809,LOCAL,,inpatient,20,ML,5,5,,,,,,,,,,,,,,,,,
Dihydroergotamine Mesylate,250,RC,VB002810,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
Etomidate,250,RC,VB002811,LOCAL,,inpatient,20,ML,5,5,,,,,,,,,,,,,,,,,
azaTHIOprine SODIUM,250,RC,VB002812,LOCAL,,inpatient,1,EA,1200,1200,,,,,,,,,,,,,,,,,
Flumazenil,250,RC,VB002813,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
Flumazenil,250,RC,VB002814,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
Cortisone Acetate,250,RC,VB002815,LOCAL,,inpatient,1,EA,12.5,12.5,,,,,,,,,,,,,,,,,
Enalaprilat Dihydrate,250,RC,VB002816,LOCAL,,inpatient,2,ML,5,5,,,,,,,,,,,,,,,,,
Enalaprilat Dihydrate,250,RC,VB002817,LOCAL,,inpatient,1,ML,25.48,25.48,,,,,,,,,,,,,,,,,
metoprolol tartrate Inj,250,RC,VB002818,LOCAL,,inpatient,5,ML,12.96,12.96,,,,,,,,,,,,,,,,,
amiodarone HCL,250,RC,VB002819,LOCAL,,inpatient,3,ML,5,5,,,,,,,,,,,,,,,,,
cefOXitin SODIUM,250,RC,VB002820,LOCAL,,inpatient,1,GM,47.52,47.52,,,,,,,,,,,,,,,,,
Amoxicillin Oral Susp,250,RC,VB002821,LOCAL,,inpatient,100,ML,24.36,24.36,,,,,,,,,,,,,,,,,
cephALEXin,250,RC,VB002822,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
cefoTAXime SODIUM,250,RC,VB002823,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
cefoTAXime SODIUM,250,RC,VB002824,LOCAL,,inpatient,1,GM,5,5,,,,,,,,,,,,,,,,,
cefaDROXiL,250,RC,VB002825,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide 0.5 %,250,RC,VB002826,LOCAL,,inpatient,15,GM,44.4,44.4,,,,,,,,,,,,,,,,,
nystatin 100000 Unit/GM - 15GM,250,RC,VB002827,LOCAL,,inpatient,15,GM,67.2,67.2,,,,,,,,,,,,,,,,,
Bacitracin Zinc,257,RC,VB002828,LOCAL,,inpatient,28.35,GM,21.22,21.22,,,,,,,,,,,,,,,,,
Neomycin/Bacitracin/Polymyxinb28.35,250,RC,VB002829,LOCAL,,inpatient,28.35,GM,28.22,28.22,,,,,,,,,,,,,,,,,
Hydrocortisone 0.5 %,250,RC,VB002830,LOCAL,,inpatient,28.35,GM,12.96,12.96,,,,,,,,,,,,,,,,,
Betamethasone Valerate,250,RC,VB002831,LOCAL,,inpatient,15,GM,81.36,81.36,,,,,,,,,,,,,,,,,
Betamethasone Valerate 0.1% - 15GM,250,RC,VB002832,LOCAL,,inpatient,15,GM,111.88,111.88,,,,,,,,,,,,,,,,,
Betamethasone Valerate,250,RC,VB002833,LOCAL,,inpatient,60,ML,288,288,,,,,,,,,,,,,,,,,
"Petrolatum,white 454GM",257,RC,VB002834,LOCAL,,inpatient,453.6,GM,96,96,,,,,,,,,,,,,,,,,
Betamethasone Dipropionate,250,RC,VB002835,LOCAL,,inpatient,60,ML,191.95,191.95,,,,,,,,,,,,,,,,,
Fluocinolone Acetonide,250,RC,VB002836,LOCAL,,inpatient,15,GM,135.07,135.07,,,,,,,,,,,,,,,,,
Fluocinolone Acetonide,250,RC,VB002837,LOCAL,,inpatient,15,GM,135.07,135.07,,,,,,,,,,,,,,,,,
Fluocinolone Acetonide,250,RC,VB002838,LOCAL,,inpatient,60,GM,405.07,405.07,,,,,,,,,,,,,,,,,
Bacitracin Zinc,257,RC,VB002839,LOCAL,,inpatient,144,GM,138.24,138.24,,,,,,,,,,,,,,,,,
Fluocinonide,250,RC,VB002840,LOCAL,,inpatient,15,GM,463.88,463.88,,,,,,,,,,,,,,,,,
Hydrocortisone 1% Oint,257,RC,VB002841,LOCAL,,inpatient,28.35,GM,19.2,19.2,,,,,,,,,,,,,,,,,
Lidocaine/Prilocaine,250,RC,VB002842,LOCAL,,inpatient,30,GM,72.38,72.38,,,,,,,,,,,,,,,,,
Repaglinide,250,RC,VB002843,LOCAL,,inpatient,1,EA,30.03,30.03,,,,,,,,,,,,,,,,,
Insulin Degludec,250,RC,VB002844,LOCAL,,inpatient,3,ML,976.18,976.18,,,,,,,,,,,,,,,,,
Insulin Detemir,250,RC,VB002845,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
Liraglutide,250,RC,VB002846,LOCAL,,inpatient,3,ML,1304.45,1304.45,,,,,,,,,,,,,,,,,
Insulin Aspart,250,RC,VB002847,LOCAL,,inpatient,3,ML,134.11,134.11,,,,,,,,,,,,,,,,,
Cromolyn Sodium,250,RC,VB002848,LOCAL,,inpatient,2,ML,27.2,27.2,,,,,,,,,,,,,,,,,
SUMAtriptan SUCCINATE,250,RC,VB002849,LOCAL,,inpatient,0.5,ML,969.79,969.79,,,,,,,,,,,,,,,,,
Epoprostenol Sodium (Glycine),250,RC,VB002850,LOCAL,,inpatient,1,EA,89.71,89.71,,,,,,,,,,,,,,,,,
Diluent for Epoprostenol(Glyc),250,RC,VB002851,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
Epoprostenol Sodium (Glycine),250,RC,VB002852,LOCAL,,inpatient,1,EA,216.67,216.67,,,,,,,,,,,,,,,,,
Salmeterol Xinafoate,250,RC,VB002853,LOCAL,,inpatient,28,EA,1165.01,1165.01,,,,,,,,,,,,,,,,,
Atovaquone,250,RC,VB002854,LOCAL,,inpatient,5,ML,159.17,159.17,,,,,,,,,,,,,,,,,
lamiVUDine,250,RC,VB002855,LOCAL,,inpatient,1,EA,78.05,78.05,,,,,,,,,,,,,,,,,
Zanamivir,250,RC,VB002856,LOCAL,,inpatient,1,EA,283.2,283.2,,,,,,,,,,,,,,,,,
Albuterol Sulfate,250,RC,VB002857,LOCAL,,inpatient,18,GM,273.7,273.7,,,,,,,,,,,,,,,,,
Fluticasone Propion/Salmeterol,250,RC,VB002858,LOCAL,,inpatient,1,EA,218.5,218.5,,,,,,,,,,,,,,,,,
Fluticasone Propion/Salmeterol,250,RC,VB002859,LOCAL,,inpatient,1,EA,939.74,939.74,,,,,,,,,,,,,,,,,
Dutasteride,250,RC,VB002860,LOCAL,,inpatient,1,EA,45.84,45.84,,,,,,,,,,,,,,,,,
Fluticasone Propion/Salmeterol,250,RC,VB002861,LOCAL,,inpatient,12,GM,1203.84,1203.84,,,,,,,,,,,,,,,,,
Fluticasone Propion/Salmeterol,250,RC,VB002862,LOCAL,,inpatient,12,GM,1530.82,1530.82,,,,,,,,,,,,,,,,,
Fluticasone Propion/Salmeterol,250,RC,VB002863,LOCAL,,inpatient,12,GM,2110.66,2110.66,,,,,,,,,,,,,,,,,
Fluticasone Propionate,250,RC,VB002864,LOCAL,,inpatient,10.6,GM,981.79,981.79,,,,,,,,,,,,,,,,,
Fluticasone Propionate,250,RC,VB002865,LOCAL,,inpatient,12,GM,1314.38,1314.38,,,,,,,,,,,,,,,,,
Fluticasone Propionate,250,RC,VB002866,LOCAL,,inpatient,12,GM,2041.58,2041.58,,,,,,,,,,,,,,,,,
SUMAtriptan SUCCINATE,250,RC,VB002867,LOCAL,,inpatient,1,EA,166.74,166.74,,,,,,,,,,,,,,,,,
Fluticasone/Vilanterol,250,RC,VB002868,LOCAL,,inpatient,1,EA,753.02,753.02,,,,,,,,,,,,,,,,,
Rosiglitazone Maleate,250,RC,VB002869,LOCAL,,inpatient,1,EA,18.27,18.27,,,,,,,,,,,,,,,,,
Rosiglitazone Maleate,250,RC,VB002870,LOCAL,,inpatient,1,EA,27.11,27.11,,,,,,,,,,,,,,,,,
Fluticasone/Vilanterol,250,RC,VB002871,LOCAL,,inpatient,1,EA,1954.66,1954.66,,,,,,,,,,,,,,,,,
Orphenadrine Citrate,250,RC,VB002872,LOCAL,,inpatient,1,EA,8.74,8.74,,,,,,,,,,,,,,,,,
benazepril HCL,250,RC,VB002873,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Indomethacin,250,RC,VB002874,LOCAL,,inpatient,1,EA,12.01,12.01,,,,,,,,,,,,,,,,,
Carisoprodol/Aspirin,250,RC,VB002875,LOCAL,,inpatient,1,EA,9.57,9.57,,,,,,,,,,,,,,,,,
sulfADIAZINE,250,RC,VB002876,LOCAL,,inpatient,1,EA,20.19,20.19,,,,,,,,,,,,,,,,,
quiNIDine SULFATE,250,RC,VB002877,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
quiNIDine SULFATE,250,RC,VB002878,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Candesartan Cilexetil,250,RC,VB002879,LOCAL,,inpatient,1,EA,17.05,17.05,,,,,,,,,,,,,,,,,
Candesartan Cilexetil,250,RC,VB002880,LOCAL,,inpatient,1,EA,17.05,17.05,,,,,,,,,,,,,,,,,
Budesonide/Formoterol Fumarate,250,RC,VB002881,LOCAL,,inpatient,6,GM,764.16,764.16,,,,,,,,,,,,,,,,,
Budesonide/Formoterol Fumarate,250,RC,VB002882,LOCAL,,inpatient,6.9,GM,664.32,664.32,,,,,,,,,,,,,,,,,
Ticagrelor,250,RC,VB002883,LOCAL,,inpatient,1,EA,37.18,37.18,,,,,,,,,,,,,,,,,
Budesonide,250,RC,VB002884,LOCAL,,inpatient,2,ML,49.25,49.25,,,,,,,,,,,,,,,,,
esomeprazole MAGNESIUM,250,RC,VB002885,LOCAL,,inpatient,1,EA,44.05,44.05,,,,,,,,,,,,,,,,,
methylTESTOSTERone,250,RC,VB002886,LOCAL,,inpatient,1,EA,711.53,711.53,,,,,,,,,,,,,,,,,
Phytonadione (Vit K1),250,RC,VB002887,LOCAL,,inpatient,1,EA,282.05,282.05,,,,,,,,,,,,,,,,,
Pyridostigmine Bromide,250,RC,VB002888,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pyridostigmine Bromide,250,RC,VB002889,LOCAL,,inpatient,1,EA,196.85,196.85,,,,,,,,,,,,,,,,,
Flucytosine,250,RC,VB002890,LOCAL,,inpatient,1,EA,713.73,713.73,,,,,,,,,,,,,,,,,
Pramoxine HCL/Calamine,250,RC,VB002891,LOCAL,,inpatient,1,EA,18.62,18.62,,,,,,,,,,,,,,,,,
Piperacillin Sodium/Tazobactam,250,RC,VB002892,LOCAL,,inpatient,1,EA,45.79,45.79,,,,,,,,,,,,,,,,,
Piperacillin Sodium/Tazobactam,250,RC,VB002893,LOCAL,,inpatient,1,EA,65.92,65.92,,,,,,,,,,,,,,,,,
Sodium Chloride,250,RC,VB002894,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Oxazepam,250,RC,VB002895,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
propylthiouraciL,250,RC,VB002896,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
NIFEdipine,250,RC,VB002897,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Buprenorphine HCL/Naloxone HCL,250,RC,VB002898,LOCAL,,inpatient,30,EA,41.73,41.73,,,,,,,,,,,,,,,,,
Hetastarch In 0.9 % Nacl,250,RC,VB002899,LOCAL,,inpatient,500,ML,126.43,126.43,,,,,,,,,,,,,,,,,
Dextrose 5 % In Water,250,RC,VB002900,LOCAL,,inpatient,500,ML,19.34,19.34,,,,,,,,,,,,,,,,,
Dextrose 5 % In Water,250,RC,VB002901,LOCAL,,inpatient,250,ML,17.76,17.76,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride,250,RC,VB002902,LOCAL,,inpatient,1000,ML,11.76,11.76,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride,250,RC,VB002903,LOCAL,,inpatient,500,ML,13.54,13.54,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride,250,RC,VB002904,LOCAL,,inpatient,250,ML,11.52,11.52,,,,,,,,,,,,,,,,,
"Heparin/D5W 25,000 Units/250mL",250,RC,VB002905,LOCAL,,inpatient,250,ML,75.12,75.12,,,,,,,,,,,,,,,,,
Histamine Phosphate,250,RC,VB002906,LOCAL,,inpatient,1,EA,363.84,363.84,,,,,,,,,,,,,,,,,
Nitroglycerin 1GM Packet  2 %,250,RC,VB002907,LOCAL,,inpatient,1,GM,12.12,12.12,,,,,,,,,,,,,,,,,
Nitroglycerin (30GM Tube) 2 %,250,RC,VB002908,LOCAL,,inpatient,30,GM,187.2,187.2,,,,,,,,,,,,,,,,,
Parab/Cet Alc/Stryl Alc/Pg/Sls,250,RC,VB002909,LOCAL,,inpatient,1,EA,17.52,17.52,,,,,,,,,,,,,,,,,
Roflumilast,250,RC,VB002910,LOCAL,,inpatient,1,EA,57.78,57.78,,,,,,,,,,,,,,,,,
Anastrozole,250,RC,VB002911,LOCAL,,inpatient,1,EA,83.94,83.94,,,,,,,,,,,,,,,,,
QUEtiapine FUMARATE,250,RC,VB002912,LOCAL,,inpatient,1,EA,39.42,39.42,,,,,,,,,,,,,,,,,
QUEtiapine FUMARATE,250,RC,VB002913,LOCAL,,inpatient,1,EA,77.9,77.9,,,,,,,,,,,,,,,,,
QUEtiapine FUMARATE,250,RC,VB002914,LOCAL,,inpatient,1,EA,91.93,91.93,,,,,,,,,,,,,,,,,
rosuvastatin CALCIUM,250,RC,VB002915,LOCAL,,inpatient,1,EA,41.74,41.74,,,,,,,,,,,,,,,,,
rosuvastatin CALCIUM,250,RC,VB002916,LOCAL,,inpatient,1,EA,5.92,5.92,,,,,,,,,,,,,,,,,
Dapagliflozin Propanediol,250,RC,VB002917,LOCAL,,inpatient,1,EA,95.96,95.96,,,,,,,,,,,,,,,,,
"Water for IRRIGATION,sterile",250,RC,VB002918,LOCAL,,inpatient,1000,ML,19.44,19.44,,,,,,,,,,,,,,,,,
"Water for Injection,sterile",250,RC,VB002919,LOCAL,,inpatient,1000,ML,46.32,46.32,,,,,,,,,,,,,,,,,
Dextrose 5 % In Water,250,RC,VB002920,LOCAL,,inpatient,150,ML,31.92,31.92,,,,,,,,,,,,,,,,,
Dextrose 5 % In Water,250,RC,VB002921,LOCAL,,inpatient,250,ML,20.69,20.69,,,,,,,,,,,,,,,,,
Dextrose 5 % In Water,250,RC,VB002922,LOCAL,,inpatient,500,ML,21.46,21.46,,,,,,,,,,,,,,,,,
Dextrose 5 % In Water,250,RC,VB002923,LOCAL,,inpatient,1000,ML,26.54,26.54,,,,,,,,,,,,,,,,,
Dextrose 5 % In Water,250,RC,VB002924,LOCAL,,inpatient,50,ML,12.34,12.34,,,,,,,,,,,,,,,,,
Dextrose 5 % In Water,250,RC,VB002925,LOCAL,,inpatient,100,ML,12.34,12.34,,,,,,,,,,,,,,,,,
Dextrose 10 % In Water,250,RC,VB002926,LOCAL,,inpatient,250,ML,30.48,30.48,,,,,,,,,,,,,,,,,
Dextrose 10 % In Water,250,RC,VB002927,LOCAL,,inpatient,500,ML,28.18,28.18,,,,,,,,,,,,,,,,,
Dextrose 10 % In Water,250,RC,VB002928,LOCAL,,inpatient,1000,ML,36.24,36.24,,,,,,,,,,,,,,,,,
Sodium Chloride 0.45 %,250,RC,VB002929,LOCAL,,inpatient,500,ML,22.61,22.61,,,,,,,,,,,,,,,,,
Sodium Chloride 0.45 %,250,RC,VB002930,LOCAL,,inpatient,1000,ML,30.05,30.05,,,,,,,,,,,,,,,,,
Sodium Chloride 0.45 %,250,RC,VB002930,LOCAL,,inpatient,1000,ML,30.05,30.05,,,,,,,,,,,,,,,,,
Sodium Chloride Irrig Solution,250,RC,VB002931,LOCAL,,inpatient,250,ML,23.04,23.04,,,,,,,,,,,,,,,,,
Sodium Chloride Irrig Solution,250,RC,VB002932,LOCAL,,inpatient,500,ML,21.12,21.12,,,,,,,,,,,,,,,,,
Sodium Chloride Irrig Solution,250,RC,VB002933,LOCAL,,inpatient,1000,ML,21.98,21.98,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride,250,RC,VB002934,LOCAL,,inpatient,150,ML,31.92,31.92,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride,250,RC,VB002935,LOCAL,,inpatient,250,ML,20.59,20.59,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride,250,RC,VB002936,LOCAL,,inpatient,500,ML,20.26,20.26,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride,250,RC,VB002937,LOCAL,,inpatient,1000,ML,23.62,23.62,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride,250,RC,VB002938,LOCAL,,inpatient,50,ML,12.34,12.34,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride,250,RC,VB002939,LOCAL,,inpatient,100,ML,13.44,13.44,,,,,,,,,,,,,,,,,
Sodium Chloride 3 %,250,RC,VB002940,LOCAL,,inpatient,500,ML,30.48,30.48,,,,,,,,,,,,,,,,,
Sodium Chloride 3 %,250,RC,VB002940,LOCAL,,inpatient,500,ML,30.48,30.48,,,,,,,,,,,,,,,,,
Dextrose 5 %-0.2 % Sod Chlorid,250,RC,VB002941,LOCAL,,inpatient,1000,ML,29.81,29.81,,,,,,,,,,,,,,,,,
Dextrose 5 %-0.45 % Sod Chlord,250,RC,VB002942,LOCAL,,inpatient,500,ML,22.61,22.61,,,,,,,,,,,,,,,,,
Dextrose 5 %-0.45 % Sod Chlord,250,RC,VB002943,LOCAL,,inpatient,1000,ML,29.81,29.81,,,,,,,,,,,,,,,,,
Dextrose 5 % and 0.9 % Nacl,250,RC,VB002944,LOCAL,,inpatient,500,ML,22.7,22.7,,,,,,,,,,,,,,,,,
Dextrose 5 % and 0.9 % Nacl,250,RC,VB002945,LOCAL,,inpatient,1000,ML,28.37,28.37,,,,,,,,,,,,,,,,,
"Ringer's Solution,lactated",250,RC,VB002946,LOCAL,,inpatient,1000,ML,24.77,24.77,,,,,,,,,,,,,,,,,
Dextrose 5%-Lactated Ringers,250,RC,VB002947,LOCAL,,inpatient,500,ML,28.75,28.75,,,,,,,,,,,,,,,,,
Dextrose 5%-Lactated Ringers,250,RC,VB002948,LOCAL,,inpatient,1000,ML,28.61,28.61,,,,,,,,,,,,,,,,,
mannitoL,250,RC,VB002949,LOCAL,,inpatient,500,ML,302.69,302.69,,,,,,,,,,,,,,,,,
Lidocaine HCL/Dextrose 5 %/Pf,250,RC,VB002950,LOCAL,,inpatient,250,ML,37.78,37.78,,,,,,,,,,,,,,,,,
"Gentamicin In Nacl, Iso-Osm",250,RC,VB002951,LOCAL,,inpatient,100,ML,19.15,19.15,,,,,,,,,,,,,,,,,
Dextrose 5 % In Water (MINIBAG+),250,RC,VB002952,LOCAL,,inpatient,50,ML,32.02,32.02,,,,,,,,,,,,,,,,,
Dextrose 5 % In Water (MINIBAG+),250,RC,VB002953,LOCAL,,inpatient,100,ML,34.9,34.9,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride (MINIBAG+),250,RC,VB002954,LOCAL,,inpatient,100,ML,34.9,34.9,,,,,,,,,,,,,,,,,
Potassium Chl 20mEq in D5-0.2%NaCl,250,RC,VB002955,LOCAL,,inpatient,1000,ML,44.78,44.78,,,,,,,,,,,,,,,,,
Potassium Chl 10mEq in D5-0.45%NaCl,250,RC,VB002956,LOCAL,,inpatient,1000,ML,46.61,46.61,,,,,,,,,,,,,,,,,
Potassium Chl 20mEq in D5-0.45%NaCl,250,RC,VB002957,LOCAL,,inpatient,1000,ML,28.37,28.37,,,,,,,,,,,,,,,,,
Potassium Chl 30mEq in D5-0.45%NaCl,250,RC,VB002958,LOCAL,,inpatient,1000,ML,45.65,45.65,,,,,,,,,,,,,,,,,
Potassium Chl 40mEq in D5-0.45%NaCl,250,RC,VB002959,LOCAL,,inpatient,1000,ML,46.9,46.9,,,,,,,,,,,,,,,,,
Potassium Chloride 20mEq In D5W,250,RC,VB002960,LOCAL,,inpatient,1000,ML,49.15,49.15,,,,,,,,,,,,,,,,,
Potassium Chloride 20mEq in NS,250,RC,VB002961,LOCAL,,inpatient,1000,ML,51.02,51.02,,,,,,,,,,,,,,,,,
Potassium Chloride 40 mEq in NS,250,RC,VB002962,LOCAL,,inpatient,1000,ML,57.5,57.5,,,,,,,,,,,,,,,,,
Potassium Chloride IVPB,250,RC,VB002963,LOCAL,,inpatient,100,ML,19.58,19.58,,,,,,,,,,,,,,,,,
Potassium Chl 20mEq in D5-0.9%NaCl,250,RC,VB002964,LOCAL,,inpatient,1000,ML,51.02,51.02,,,,,,,,,,,,,,,,,
Potassium Chloride 20mEq In LR-D5,250,RC,VB002965,LOCAL,,inpatient,1000,ML,53.9,53.9,,,,,,,,,,,,,,,,,
Pen G Pot/Dextrose-Water,250,RC,VB002966,LOCAL,,inpatient,50,ML,51.5,51.5,,,,,,,,,,,,,,,,,
Metronidazole/Sodium Chloride 0.79%,250,RC,VB002967,LOCAL,,inpatient,100,ML,10.99,10.99,,,,,,,,,,,,,,,,,
"Fluconazole In Nacl,iso-Osm",250,RC,VB002968,LOCAL,,inpatient,200,ML,99.89,99.89,,,,,,,,,,,,,,,,,
"Fluconazole In Nacl,iso-Osm",250,RC,VB002969,LOCAL,,inpatient,100,ML,89.57,89.57,,,,,,,,,,,,,,,,,
Fat Emulsion/Olive/Soy/Phospho,250,RC,VB002970,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Phenylephrine HCL,250,RC,VB002971,LOCAL,,inpatient,1,EA,31.96,31.96,,,,,,,,,,,,,,,,,
Mineral Oil,250,RC,VB002972,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Clorazepate Dipotassium,250,RC,VB002973,LOCAL,,inpatient,1,EA,8.12,8.12,,,,,,,,,,,,,,,,,
pindoloL,250,RC,VB002974,LOCAL,,inpatient,1,EA,5.28,5.28,,,,,,,,,,,,,,,,,
Maprotiline HCL,250,RC,VB002975,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
pindoloL,250,RC,VB002976,LOCAL,,inpatient,1,EA,7.19,7.19,,,,,,,,,,,,,,,,,
Chlorothiazide,250,RC,VB002977,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Methyclothiazide,250,RC,VB002978,LOCAL,,inpatient,1,EA,7.37,7.37,,,,,,,,,,,,,,,,,
chlorproPAMIDE,250,RC,VB002979,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
chlorproPAMIDE,250,RC,VB002980,LOCAL,,inpatient,1,EA,10.16,10.16,,,,,,,,,,,,,,,,,
TOLBUTamide,250,RC,VB002981,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
TOLAZamide,250,RC,VB002982,LOCAL,,inpatient,1,EA,9.24,9.24,,,,,,,,,,,,,,,,,
timoloL MALEATE,250,RC,VB002983,LOCAL,,inpatient,1,EA,6.81,6.81,,,,,,,,,,,,,,,,,
Perphenazine/Amitriptyline HCL,250,RC,VB002984,LOCAL,,inpatient,1,EA,6.14,6.14,,,,,,,,,,,,,,,,,
Diphenoxylate/Atropine 2.5-0.025MG,250,RC,VB002985,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Perphenazine/Amitriptyline HCL,250,RC,VB002986,LOCAL,,inpatient,1,EA,7.82,7.82,,,,,,,,,,,,,,,,,
Theophylline Anhydrous,250,RC,VB002987,LOCAL,,inpatient,1,EA,5.43,5.43,,,,,,,,,,,,,,,,,
Bisoprolol/HCTZ 5-6.25mg,250,RC,VB002988,LOCAL,,inpatient,1,EA,5.52,5.52,,,,,,,,,,,,,,,,,
Methyldopa/Hydrochlorothiazide,250,RC,VB002989,LOCAL,,inpatient,1,EA,7.32,7.32,,,,,,,,,,,,,,,,,
Perphenazine/Amitriptyline HCL,250,RC,VB002990,LOCAL,,inpatient,1,EA,8.52,8.52,,,,,,,,,,,,,,,,,
Methyldopa/Hydrochlorothiazide,250,RC,VB002991,LOCAL,,inpatient,1,EA,8.63,8.63,,,,,,,,,,,,,,,,,
tiZANidine HCL,250,RC,VB002992,LOCAL,,inpatient,1,EA,8.5,8.5,,,,,,,,,,,,,,,,,
cloNIDine,250,RC,VB002993,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
cloNIDine,250,RC,VB002994,LOCAL,,inpatient,1,EA,223.06,223.06,,,,,,,,,,,,,,,,,
cloNIDine,250,RC,VB002995,LOCAL,,inpatient,1,EA,309.44,309.44,,,,,,,,,,,,,,,,,
Buprenorphine HCL,250,RC,VB002996,LOCAL,,inpatient,1,EA,33.84,33.84,,,,,,,,,,,,,,,,,
Thiothixene,250,RC,VB002997,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
niCARdipine HCL,250,RC,VB002998,LOCAL,,inpatient,1,EA,8.92,8.92,,,,,,,,,,,,,,,,,
nadoloL,250,RC,VB002999,LOCAL,,inpatient,1,EA,21.52,21.52,,,,,,,,,,,,,,,,,
guanFACINE HCL,250,RC,VB003000,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
lithium carbonate,250,RC,VB003001,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
niCARdipine HCL,250,RC,VB003002,LOCAL,,inpatient,1,EA,12.77,12.77,,,,,,,,,,,,,,,,,
estradioL,250,RC,VB003003,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ciprofloxacin/Ciprofloxa HCL,250,RC,VB003004,LOCAL,,inpatient,1,EA,39.2,39.2,,,,,,,,,,,,,,,,,
Bromocriptine Mesylate,250,RC,VB003005,LOCAL,,inpatient,1,EA,25.07,25.07,,,,,,,,,,,,,,,,,
Fenofibrate Nanocrystallized,250,RC,VB003006,LOCAL,,inpatient,1,EA,22.91,22.91,,,,,,,,,,,,,,,,,
Temazepam,250,RC,VB003007,LOCAL,,inpatient,1,EA,39.76,39.76,,,,,,,,,,,,,,,,,
Etoposide,250,RC,VB003008,LOCAL,,inpatient,1,EA,415.45,415.45,,,,,,,,,,,,,,,,,
Etidronate Disodium,250,RC,VB003009,LOCAL,,inpatient,1,EA,17.28,17.28,,,,,,,,,,,,,,,,,
cetirizine HCL,250,RC,VB003010,LOCAL,,inpatient,1,EA,9.98,9.98,,,,,,,,,,,,,,,,,
valACYclovir HCL,250,RC,VB003011,LOCAL,,inpatient,1,EA,28.9,28.9,,,,,,,,,,,,,,,,,
"Fenofibrate,micronized",250,RC,VB003012,LOCAL,,inpatient,1,EA,27.67,27.67,,,,,,,,,,,,,,,,,
omeprazole,250,RC,VB003013,LOCAL,,inpatient,1,EA,16.61,16.61,,,,,,,,,,,,,,,,,
propranolol HCL,250,RC,VB003014,LOCAL,,inpatient,1,EA,5.32,5.32,,,,,,,,,,,,,,,,,
metOLazone,250,RC,VB003015,LOCAL,,inpatient,1,EA,14.03,14.03,,,,,,,,,,,,,,,,,
propranolol HCL ER,250,RC,VB003016,LOCAL,,inpatient,1,EA,6.2,6.2,,,,,,,,,,,,,,,,,
propranolol HCL,250,RC,VB003017,LOCAL,,inpatient,1,EA,7.68,7.68,,,,,,,,,,,,,,,,,
Doxepin HCL,250,RC,VB003018,LOCAL,,inpatient,1,EA,7.89,7.89,,,,,,,,,,,,,,,,,
Oxybutynin Chloride,250,RC,VB003019,LOCAL,,inpatient,1,EA,13.15,13.15,,,,,,,,,,,,,,,,,
Eprosartan Mesylate,250,RC,VB003020,LOCAL,,inpatient,1,EA,13.7,13.7,,,,,,,,,,,,,,,,,
Albuterol Sulfate,250,RC,VB003021,LOCAL,,inpatient,3,ML,6.64,6.64,,,,,,,,,,,,,,,,,
Sodium Chloride 3% Inhalation(15ML),250,RC,VB003022,LOCAL,,inpatient,15,ML,5,5,,,,,,,,,,,,,,,,,
lansoprazole,250,RC,VB003023,LOCAL,,inpatient,1,EA,23.59,23.59,,,,,,,,,,,,,,,,,
Nitroglycerin,250,RC,VB003024,LOCAL,,inpatient,1,EA,7.43,7.43,,,,,,,,,,,,,,,,,
Nitroglycerin,250,RC,VB003025,LOCAL,,inpatient,1,EA,9.58,9.58,,,,,,,,,,,,,,,,,
Penciclovir,250,RC,VB003026,LOCAL,,inpatient,5,GM,3897.55,3897.55,,,,,,,,,,,,,,,,,
Norflurane/Pentafluoropropane,250,RC,VB003027,LOCAL,,inpatient,1,ea,173.52,173.52,,,,,,,,,,,,,,,,,
Sodium Fluoride/Calcium Carb,250,RC,VB003028,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Glycerin,250,RC,VB003029,LOCAL,,inpatient,1,ea,105.96,105.96,,,,,,,,,,,,,,,,,
Methyl Salicylate,250,RC,VB003030,LOCAL,,inpatient,1,ea,36.91,36.91,,,,,,,,,,,,,,,,,
HYDROcodone/Acetaminophen 5-325MG,250,RC,VB003031,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Acetaminophen-Codeine 300mg-30mg,250,RC,VB003032,LOCAL,,inpatient,1,EA,5.09,5.09,,,,,,,,,,,,,,,,,
Acetaminophen-Codeine 300MG-60MG,250,RC,VB003033,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Oxycodone HCL/Acetaminophen 5/325MG,250,RC,VB003034,LOCAL,,inpatient,1,EA,7.61,7.61,,,,,,,,,,,,,,,,,
methadone HCL,250,RC,VB003035,LOCAL,,inpatient,1000,ML,5,5,,,,,,,,,,,,,,,,,
methadone HCL,250,RC,VB003036,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
oxyCODONE HCL,250,RC,VB003037,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB003038,LOCAL,,inpatient,1,EA,8.16,8.16,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB003039,LOCAL,,inpatient,1,EA,14.74,14.74,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB003040,LOCAL,,inpatient,1,EA,36.35,36.35,,,,,,,,,,,,,,,,,
argatroban Inj 250mg/2.5mL,250,RC,VB003041,LOCAL,,inpatient,2.5,ML,1304.11,1304.11,,,,,,,,,,,,,,,,,
Bupivacaine HCL/Pf 0.5% - 30mL,250,RC,VB003042,LOCAL,,inpatient,30,ML,12.86,12.86,,,,,,,,,,,,,,,,,
Bupivacaine HCL/Pf 0.75% - 10mL,250,RC,VB003043,LOCAL,,inpatient,10,ML,11.81,11.81,,,,,,,,,,,,,,,,,
dilTIAZem HCL,250,RC,VB003044,LOCAL,,inpatient,10,ML,15.31,15.31,,,,,,,,,,,,,,,,,
Meperidine HCL/Pf,250,RC,VB003045,LOCAL,,inpatient,1,ML,28.7,28.7,,,,,,,,,,,,,,,,,
Meperidine HCL/Pf,250,RC,VB003046,LOCAL,,inpatient,1,ML,29.67,29.67,,,,,,,,,,,,,,,,,
Meperidine HCL/Pf,250,RC,VB003047,LOCAL,,inpatient,1,ML,30.4,30.4,,,,,,,,,,,,,,,,,
Meperidine HCL/Pf,250,RC,VB003048,LOCAL,,inpatient,1,ML,30.4,30.4,,,,,,,,,,,,,,,,,
Droperidol,250,RC,VB003049,LOCAL,,inpatient,2,ML,5.81,5.81,,,,,,,,,,,,,,,,,
naloxone HCL Inj,250,RC,VB003050,LOCAL,,inpatient,1,ML,75.98,75.98,,,,,,,,,,,,,,,,,
diazePAM,250,RC,VB003051,LOCAL,,inpatient,2,ML,161.57,161.57,,,,,,,,,,,,,,,,,
HYDROmorphone HCL,250,RC,VB003052,LOCAL,,inpatient,1,ML,12.48,12.48,,,,,,,,,,,,,,,,,
HYDROmorphone HCL,250,RC,VB003053,LOCAL,,inpatient,1,ML,15.1,15.1,,,,,,,,,,,,,,,,,
HYDROmorphone HCL,250,RC,VB003054,LOCAL,,inpatient,1,ML,16.16,16.16,,,,,,,,,,,,,,,,,
Bumetanide,250,RC,VB003055,LOCAL,,inpatient,4,ML,5,5,,,,,,,,,,,,,,,,,
LORazepam,250,RC,VB003056,LOCAL,,inpatient,1,ML,17.26,17.26,,,,,,,,,,,,,,,,,
Bupivacaine HCL/Pf 0.75% - 10mL,250,RC,VB003057,LOCAL,,inpatient,10,ML,22.9,22.9,,,,,,,,,,,,,,,,,
Dextrose 25 % In Water,250,RC,VB003058,LOCAL,,inpatient,10,ML,98.83,98.83,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB003059,LOCAL,,inpatient,1,ML,10.22,10.22,,,,,,,,,,,,,,,,,
Bacteriostatic Sodium Chloride 0.9%,250,RC,VB003060,LOCAL,,inpatient,30,ML,11.04,11.04,,,,,,,,,,,,,,,,,
LORazepam Inj,250,RC,VB003061,LOCAL,,inpatient,1,ML,17.22,17.22,,,,,,,,,,,,,,,,,
Morphine Sulfate/Pf,250,RC,VB003062,LOCAL,,inpatient,30,ML,38.3,38.3,,,,,,,,,,,,,,,,,
Magnesium Sulfate,250,RC,VB003063,LOCAL,,inpatient,20,ML,5,5,,,,,,,,,,,,,,,,,
Desmopressin Acetate,250,RC,VB003064,LOCAL,,inpatient,1,ML,49.34,49.34,,,,,,,,,,,,,,,,,
labetalol HCL Inj,250,RC,VB003065,LOCAL,,inpatient,20,ML,19.01,19.01,,,,,,,,,,,,,,,,,
labetalol HCL,250,RC,VB003066,LOCAL,,inpatient,4,ML,43.58,43.58,,,,,,,,,,,,,,,,,
Hydromorphone HCL/Pf,250,RC,VB003067,LOCAL,,inpatient,5,ML,73.2,73.2,,,,,,,,,,,,,,,,,
potassium acetate,250,RC,VB003068,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
sodium acetate,250,RC,VB003069,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
Acetylcysteine 20% *30ml*,250,RC,VB003070,LOCAL,,inpatient,30,ML,122.26,122.26,,,,,,,,,,,,,,,,,
Metoclopramide HCL Inj,250,RC,VB003071,LOCAL,,inpatient,2,ML,5.95,5.95,,,,,,,,,,,,,,,,,
Meropenem,250,RC,VB003072,LOCAL,,inpatient,1,EA,27.84,27.84,,,,,,,,,,,,,,,,,
ketorolac TROMETHAMINE,250,RC,VB003073,LOCAL,,inpatient,1,ML,31.34,31.34,,,,,,,,,,,,,,,,,
"Water for Inj.,bacteriostatic",250,RC,VB003074,LOCAL,,inpatient,30,ML,30.1,30.1,,,,,,,,,,,,,,,,,
verapamil HCL,250,RC,VB003075,LOCAL,,inpatient,2,ML,43.92,43.92,,,,,,,,,,,,,,,,,
mannitoL 25%,250,RC,VB003076,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
Clindamycin Phosphate Inj,250,RC,VB003077,LOCAL,,inpatient,2,ML,11.8,11.8,,,,,,,,,,,,,,,,,
Clindamycin Phosphate,250,RC,VB003078,LOCAL,,inpatient,4,ML,14.12,14.12,,,,,,,,,,,,,,,,,
Clindamycin Phosphate,250,RC,VB003079,LOCAL,,inpatient,6,ML,20.24,20.24,,,,,,,,,,,,,,,,,
lidocaine HCL Local Inj (50ML),250,RC,VB003080,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
lidocaine HCL Local Inj 1% (50ML),250,RC,VB003081,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
lidocaine HCL Local Inj 2% - 20mL,250,RC,VB003082,LOCAL,,inpatient,20,ML,19.06,19.06,,,,,,,,,,,,,,,,,
Lidocaine HCL/Pf Inj 0.5% - 50mL,250,RC,VB003083,LOCAL,,inpatient,50,ML,20.74,20.74,,,,,,,,,,,,,,,,,
Lidocaine HCL/Pf Inj 1% - 30mL,250,RC,VB003084,LOCAL,,inpatient,30,ML,15.7,15.7,,,,,,,,,,,,,,,,,
Lidocaine HCL/Pf,250,RC,VB003085,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
Lidocaine HCL/Pf Inj 4% - 5mL,250,RC,VB003086,LOCAL,,inpatient,5,ML,23.18,23.18,,,,,,,,,,,,,,,,,
Lidocaine HCL/Pf 1% Inj - 5mL,250,RC,VB003087,LOCAL,,inpatient,5,ML,8.21,8.21,,,,,,,,,,,,,,,,,
Ciprofloxacin In 5 % Dextrose,250,RC,VB003088,LOCAL,,inpatient,200,ML,12.62,12.62,,,,,,,,,,,,,,,,,
"Water for Injection,sterile",250,RC,VB003089,LOCAL,,inpatient,10,ML,16.46,16.46,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride,250,RC,VB003090,LOCAL,,inpatient,50,ML,16.99,16.99,,,,,,,,,,,,,,,,,
Dextrose 50 % In Water,250,RC,VB003091,LOCAL,,inpatient,50,ML,87.98,87.98,,,,,,,,,,,,,,,,,
Lidocaine HCL/Pf 2%,250,RC,VB003092,LOCAL,,inpatient,5,ML,36.43,36.43,,,,,,,,,,,,,,,,,
Atropine Sulfate Inj,250,RC,VB003093,LOCAL,,inpatient,10,ML,88.61,88.61,,,,,,,,,,,,,,,,,
EPINEPHrine,250,RC,VB003094,LOCAL,,inpatient,10,ML,25.15,25.15,,,,,,,,,,,,,,,,,
Furosemide Injection,250,RC,VB003095,LOCAL,,inpatient,4,ML,14.06,14.06,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB003096,LOCAL,,inpatient,1,EA,12.96,12.96,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB003097,LOCAL,,inpatient,1,EA,17.66,17.66,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB003098,LOCAL,,inpatient,1,EA,40.24,40.24,,,,,,,,,,,,,,,,,
Sodium Bicarbonate Inj 8.4%,250,RC,VB003099,LOCAL,,inpatient,50,ML,46.75,46.75,,,,,,,,,,,,,,,,,
Sodium Bicarbonate 8.4% Inj,250,RC,VB003100,LOCAL,,inpatient,50,ML,101.28,101.28,,,,,,,,,,,,,,,,,
Dextrose 50 % In Water,250,RC,VB003101,LOCAL,,inpatient,50,ML,25.06,25.06,,,,,,,,,,,,,,,,,
Sodium Chloride,250,RC,VB003102,LOCAL,,inpatient,40,ML,5,5,,,,,,,,,,,,,,,,,
Etomidate,250,RC,VB003103,LOCAL,,inpatient,10,ML,27.07,27.07,,,,,,,,,,,,,,,,,
Magnesium Sulfate In Water,250,RC,VB003104,LOCAL,,inpatient,50,ML,77.76,77.76,,,,,,,,,,,,,,,,,
Magnesium Sulfate In Water,250,RC,VB003105,LOCAL,,inpatient,50,ML,35.9,35.9,,,,,,,,,,,,,,,,,
Potassium Chloride In Water,250,RC,VB003106,LOCAL,,inpatient,100,ML,23.38,23.38,,,,,,,,,,,,,,,,,
EPINEPHrine,250,RC,VB003107,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
cefTRIAXone SODIUM,250,RC,VB003108,LOCAL,,inpatient,1,EA,13.89,13.89,,,,,,,,,,,,,,,,,
Dextrose 20 % In Water,250,RC,VB003109,LOCAL,,inpatient,500,ML,55.87,55.87,,,,,,,,,,,,,,,,,
Phytonadione (Vit K1) Inj,250,RC,VB003110,LOCAL,,inpatient,0.5,ML,22.8,22.8,,,,,,,,,,,,,,,,,
Phytonadione (Vit K1) Inj,250,RC,VB003111,LOCAL,,inpatient,1,ML,235.04,235.04,,,,,,,,,,,,,,,,,
Risedronate Sodium,250,RC,VB003112,LOCAL,,inpatient,1,EA,390.06,390.06,,,,,,,,,,,,,,,,,
Risedronate Sodium,250,RC,VB003113,LOCAL,,inpatient,1,EA,58.49,58.49,,,,,,,,,,,,,,,,,
Risedronate Sodium,250,RC,VB003114,LOCAL,,inpatient,1,EA,409.18,409.18,,,,,,,,,,,,,,,,,
Sodium Hypochlorite 0.125 %,250,RC,VB003115,LOCAL,,inpatient,1,EA,68,68,,,,,,,,,,,,,,,,,
Sodium Hypochlorite 0.25 %,250,RC,VB003116,LOCAL,,inpatient,1,EA,68,68,,,,,,,,,,,,,,,,,
Ibuprofen,250,RC,VB003117,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Tetracycline HCL,250,RC,VB003118,LOCAL,,inpatient,1,EA,35.52,35.52,,,,,,,,,,,,,,,,,
fosinopriL SODIUM,250,RC,VB003119,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
cefaCLOR,250,RC,VB003120,LOCAL,,inpatient,1,EA,10.15,10.15,,,,,,,,,,,,,,,,,
Chlorzoxazone,250,RC,VB003121,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
fosinopriL SODIUM,250,RC,VB003122,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
lovastatin,250,RC,VB003123,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
lovastatin,250,RC,VB003124,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Meclizine HCL,250,RC,VB003125,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Phenazopyridine HCL,250,RC,VB003126,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Tetracycline HCL,250,RC,VB003127,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Trandolapril,250,RC,VB003128,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Liotrix,250,RC,VB003129,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ceftaroline Fosamil Acetate,250,RC,VB003130,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Thyroid,pork",250,RC,VB003131,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Thyroid,pork",250,RC,VB003132,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Thyroid,pork",250,RC,VB003133,LOCAL,,inpatient,1,EA,5.39,5.39,,,,,,,,,,,,,,,,,
"Thyroid,pork",250,RC,VB003134,LOCAL,,inpatient,1,EA,8.44,8.44,,,,,,,,,,,,,,,,,
"Thyroid,pork",250,RC,VB003135,LOCAL,,inpatient,1,EA,9.88,9.88,,,,,,,,,,,,,,,,,
"Thyroid,pork",250,RC,VB003136,LOCAL,,inpatient,1,EA,7.4,7.4,,,,,,,,,,,,,,,,,
Ceftaroline Fosamil Acetate,250,RC,VB003137,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ceftaroline Fosamil Acetate,250,RC,VB003138,LOCAL,,inpatient,1,EA,1176.96,1176.96,,,,,,,,,,,,,,,,,
Vilazodone HCL,250,RC,VB003139,LOCAL,,inpatient,1,EA,58.37,58.37,,,,,,,,,,,,,,,,,
Vilazodone HCL,250,RC,VB003140,LOCAL,,inpatient,1,EA,58.37,58.37,,,,,,,,,,,,,,,,,
Vilazodone HCL,250,RC,VB003141,LOCAL,,inpatient,1,EA,58.37,58.37,,,,,,,,,,,,,,,,,
Linaclotide,250,RC,VB003142,LOCAL,,inpatient,1,EA,90.88,90.88,,,,,,,,,,,,,,,,,
Nebivolol HCL,250,RC,VB003143,LOCAL,,inpatient,1,EA,29.25,29.25,,,,,,,,,,,,,,,,,
Nebivolol HCL,250,RC,VB003144,LOCAL,,inpatient,1,EA,29.25,29.25,,,,,,,,,,,,,,,,,
Asenapine Maleate,250,RC,VB003145,LOCAL,,inpatient,1,EA,100.87,100.87,,,,,,,,,,,,,,,,,
Asenapine Maleate,250,RC,VB003146,LOCAL,,inpatient,1,EA,100.87,100.87,,,,,,,,,,,,,,,,,
Ceftazidime/Avibactam,250,RC,VB003147,LOCAL,,inpatient,1,EA,1993.75,1993.75,,,,,,,,,,,,,,,,,
Memantine HCL,250,RC,VB003148,LOCAL,,inpatient,1,EA,35.58,35.58,,,,,,,,,,,,,,,,,
Memantine HCL,250,RC,VB003149,LOCAL,,inpatient,1,EA,74.36,74.36,,,,,,,,,,,,,,,,,
Memantine HCL,250,RC,VB003150,LOCAL,,inpatient,1,EA,74.36,74.36,,,,,,,,,,,,,,,,,
FOSFOMYCIN tromethamine,250,RC,VB003151,LOCAL,,inpatient,1,EA,438.1,438.1,,,,,,,,,,,,,,,,,
Isavuconazonium Sulfate,250,RC,VB003152,LOCAL,,inpatient,1,EA,555.59,555.59,,,,,,,,,,,,,,,,,
tacrolimus,250,RC,VB003153,LOCAL,,inpatient,1,EA,17.24,17.24,,,,,,,,,,,,,,,,,
tacrolimus,250,RC,VB003154,LOCAL,,inpatient,1,EA,28.96,28.96,,,,,,,,,,,,,,,,,
tacrolimus,250,RC,VB003155,LOCAL,,inpatient,1,EA,37.25,37.25,,,,,,,,,,,,,,,,,
Mirabegron,250,RC,VB003156,LOCAL,,inpatient,1,EA,73.65,73.65,,,,,,,,,,,,,,,,,
tacrolimus,250,RC,VB003157,LOCAL,,inpatient,1,ML,1224.13,1224.13,,,,,,,,,,,,,,,,,
Amphotericin B Liposome,250,RC,VB003158,LOCAL,,inpatient,1,EA,1527.89,1527.89,,,,,,,,,,,,,,,,,
Micafungin Sodium,250,RC,VB003159,LOCAL,,inpatient,1,EA,897.6,897.6,,,,,,,,,,,,,,,,,
Micafungin Sodium,250,RC,VB003160,LOCAL,,inpatient,1,EA,448.8,448.8,,,,,,,,,,,,,,,,,
Acyclovir,250,RC,VB003161,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Clotrimazole (Vaginal)1 %,250,RC,VB003162,LOCAL,,inpatient,45,GM,48,48,,,,,,,,,,,,,,,,,
Permethrin  5 %,250,RC,VB003163,LOCAL,,inpatient,60,GM,495,495,,,,,,,,,,,,,,,,,
Hydrocortisone/Aloe Vera,257,RC,VB003164,LOCAL,,inpatient,28,GM,13.92,13.92,,,,,,,,,,,,,,,,,
Betamethasone Diprop 0.05% - 15GM,250,RC,VB003165,LOCAL,,inpatient,15,GM,166.4,166.4,,,,,,,,,,,,,,,,,
Betamethasone Dipr 0.05% Oint-15gm,250,RC,VB003166,LOCAL,,inpatient,15,GM,201.8,201.8,,,,,,,,,,,,,,,,,
Miconazole Nitrate 2 % Vaginal,257,RC,VB003167,LOCAL,,inpatient,45,GM,43.92,43.92,,,,,,,,,,,,,,,,,
Hydrocortisone/Acetic Acid,250,RC,VB003168,LOCAL,,inpatient,10,ML,964.37,964.37,,,,,,,,,,,,,,,,,
Clindamycin Phosp 1% Topical Soln,250,RC,VB003169,LOCAL,,inpatient,30,ML,163.24,163.24,,,,,,,,,,,,,,,,,
Ipratropium-Albuterol 0.5-3mg/3mL,250,RC,VB003170,LOCAL,,inpatient,3,ML,8.84,8.84,,,,,,,,,,,,,,,,,
Racepinephrine HCL  2.25 %,257,RC,VB003171,LOCAL,,inpatient,1,ML,10,10,,,,,,,,,,,,,,,,,
Albuterol Sulfate,250,RC,VB003172,LOCAL,,inpatient,3,ML,5,5,,,,,,,,,,,,,,,,,
Ipratropium Bromide 0.02% Inhal,250,RC,VB003173,LOCAL,,inpatient,2.5,ML,5.28,5.28,,,,,,,,,,,,,,,,,
Cyanocobalamin (Vitamin B-12),250,RC,VB003174,LOCAL,,inpatient,1,ML,33.55,33.55,,,,,,,,,,,,,,,,,
Methylergonovine Maleate,250,RC,VB003175,LOCAL,,inpatient,1,ML,150.14,150.14,,,,,,,,,,,,,,,,,
Atropine Sulfate Inj,250,RC,VB003176,LOCAL,,inpatient,1,ML,60.29,60.29,,,,,,,,,,,,,,,,,
Iron Sucrose Complex,250,RC,VB003177,LOCAL,,inpatient,5,ML,302.69,302.69,,,,,,,,,,,,,,,,,
Calcium Chloride Inj 10%,250,RC,VB003178,LOCAL,,inpatient,10,ML,8.9,8.9,,,,,,,,,,,,,,,,,
"Sod Phosphate,monobasic-Dibas",250,RC,VB003179,LOCAL,,inpatient,15,ML,112.32,112.32,,,,,,,,,,,,,,,,,
Glycopyrrolate Inj,250,RC,VB003180,LOCAL,,inpatient,1,ML,62.4,62.4,,,,,,,,,,,,,,,,,
hydrOXYzine HCL,250,RC,VB003181,LOCAL,,inpatient,1,ML,154.85,154.85,,,,,,,,,,,,,,,,,
Acetylcysteine 20% *4ml*,250,RC,VB003182,LOCAL,,inpatient,4,ML,69.31,69.31,,,,,,,,,,,,,,,,,
Methyldopate HCL,250,RC,VB003183,LOCAL,,inpatient,5,ML,38.4,38.4,,,,,,,,,,,,,,,,,
Terbutaline Sulfate,250,RC,VB003184,LOCAL,,inpatient,1,EA,21.77,21.77,,,,,,,,,,,,,,,,,
Dipyridamole,250,RC,VB003185,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Butalbital/Aspirin/Caffeine,250,RC,VB003186,LOCAL,,inpatient,1,EA,6.8,6.8,,,,,,,,,,,,,,,,,
Ferrous Sulfate,250,RC,VB003187,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Benzoyl Peroxide,257,RC,VB003188,LOCAL,,inpatient,42.5,GM,17.28,17.28,,,,,,,,,,,,,,,,,
Capsaicin 0.025 %,257,RC,VB003189,LOCAL,,inpatient,60,GM,33.36,33.36,,,,,,,,,,,,,,,,,
Vitamin E,250,RC,VB003190,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Melatonin,257,RC,VB003191,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Enoxaparin Sodium,250,RC,VB003192,LOCAL,,inpatient,0.4,ML,28.8,28.8,,,,,,,,,,,,,,,,,
Cosyntropin,250,RC,VB003193,LOCAL,,inpatient,1,EA,511.58,511.58,,,,,,,,,,,,,,,,,
Isoniazid,250,RC,VB003194,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
chlordiazePOXIDE HCL,250,RC,VB003195,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Norethindrone Acetate,250,RC,VB003196,LOCAL,,inpatient,1,EA,10.59,10.59,,,,,,,,,,,,,,,,,
Amiloride/Hydrochlorothiazide,250,RC,VB003197,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
danazoL,250,RC,VB003198,LOCAL,,inpatient,1,EA,36.28,36.28,,,,,,,,,,,,,,,,,
tretinoin,250,RC,VB003199,LOCAL,,inpatient,1,EA,149.41,149.41,,,,,,,,,,,,,,,,,
Dextroamphetamine Sulfate,250,RC,VB003200,LOCAL,,inpatient,1,EA,11.6,11.6,,,,,,,,,,,,,,,,,
Phenyleph/Mineral Oil/Petrolat,257,RC,VB003201,LOCAL,,inpatient,28,GM,39.16,39.16,,,,,,,,,,,,,,,,,
flavoxATE HCL,250,RC,VB003202,LOCAL,,inpatient,1,EA,5.85,5.85,,,,,,,,,,,,,,,,,
Trospium Chloride,250,RC,VB003203,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Hydrocortisone,250,RC,VB003204,LOCAL,,inpatient,10,GM,177.6,177.6,,,,,,,,,,,,,,,,,
Podophyllum Resin,250,RC,VB003205,LOCAL,,inpatient,15,ML,490,490,,,,,,,,,,,,,,,,,
Acetylcysteine 20% INJECTION - 30mL,250,RC,VB003206,LOCAL,,inpatient,30,ML,528,528,,,,,,,,,,,,,,,,,
nystatin 100000 Unit/GM,250,RC,VB003207,LOCAL,,inpatient,15,GM,109.84,109.84,,,,,,,,,,,,,,,,,
Hydrocortisone,250,RC,VB003208,LOCAL,,inpatient,60,ML,48.48,48.48,,,,,,,,,,,,,,,,,
Aspirin,257,RC,VB003209,LOCAL,,inpatient,1,EA,5.83,5.83,,,,,,,,,,,,,,,,,
Opium/Belladonna Alkaloids,250,RC,VB003210,LOCAL,,inpatient,1,EA,133.81,133.81,,,,,,,,,,,,,,,,,
Loxapine Succinate,250,RC,VB003211,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pentazocine HCL/Naloxone HCL,250,RC,VB003212,LOCAL,,inpatient,1,EA,9.9,9.9,,,,,,,,,,,,,,,,,
sulfaSALAzine,250,RC,VB003213,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Promethazine HCL,250,RC,VB003214,LOCAL,,inpatient,1,EA,70.82,70.82,,,,,,,,,,,,,,,,,
Ramelteon,250,RC,VB003215,LOCAL,,inpatient,1,EA,59.13,59.13,,,,,,,,,,,,,,,,,
valGANciclovir HCL,250,RC,VB003216,LOCAL,,inpatient,88,ML,45.47,45.47,,,,,,,,,,,,,,,,,
Promethazine HCL,250,RC,VB003217,LOCAL,,inpatient,1,EA,70.82,70.82,,,,,,,,,,,,,,,,,
fentaNYL,250,RC,VB003218,LOCAL,,inpatient,1,EA,57.74,57.74,,,,,,,,,,,,,,,,,
fentaNYL,250,RC,VB003219,LOCAL,,inpatient,1,EA,105.54,105.54,,,,,,,,,,,,,,,,,
fentaNYL,250,RC,VB003220,LOCAL,,inpatient,1,EA,160.98,160.98,,,,,,,,,,,,,,,,,
fentaNYL,250,RC,VB003221,LOCAL,,inpatient,1,EA,213.66,213.66,,,,,,,,,,,,,,,,,
Telmisartan,250,RC,VB003222,LOCAL,,inpatient,1,EA,19.29,19.29,,,,,,,,,,,,,,,,,
Nateglinide,250,RC,VB003223,LOCAL,,inpatient,1,EA,6.65,6.65,,,,,,,,,,,,,,,,,
Lidocaine 5 %,250,RC,VB003224,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Valproic Acid,250,RC,VB003225,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Probenecid/Colchicine,250,RC,VB003226,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Trihexyphenidyl HCL,250,RC,VB003227,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Trihexyphenidyl HCL,250,RC,VB003228,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
probenecid,250,RC,VB003229,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
allopurinoL,250,RC,VB003230,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
minoxidiL,250,RC,VB003231,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Sulindac,250,RC,VB003232,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Nortriptyline HCL,250,RC,VB003233,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
methylphenidate HCL,250,RC,VB003234,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Aspirin/Dipyridamole 25mg/200mg,250,RC,VB003235,LOCAL,,inpatient,1,EA,45.11,45.11,,,,,,,,,,,,,,,,,
Tipranavir,250,RC,VB003236,LOCAL,,inpatient,1,EA,83.83,83.83,,,,,,,,,,,,,,,,,
Telmisartan,250,RC,VB003237,LOCAL,,inpatient,1,EA,22.44,22.44,,,,,,,,,,,,,,,,,
Nevirapine,250,RC,VB003238,LOCAL,,inpatient,1,EA,72.48,72.48,,,,,,,,,,,,,,,,,
Tiotropium Bromide,250,RC,VB003239,LOCAL,,inpatient,1,EA,58.42,58.42,,,,,,,,,,,,,,,,,
Tiotropium Bromide,250,RC,VB003240,LOCAL,,inpatient,4,EA,890.74,890.74,,,,,,,,,,,,,,,,,
Dabigatran Etexilate Mesylate,250,RC,VB003241,LOCAL,,inpatient,1,EA,32.05,32.05,,,,,,,,,,,,,,,,,
Linagliptin,250,RC,VB003242,LOCAL,,inpatient,1,EA,84.01,84.01,,,,,,,,,,,,,,,,,
Dabigatran Etexilate Mesylate,250,RC,VB003243,LOCAL,,inpatient,1,EA,32.05,32.05,,,,,,,,,,,,,,,,,
Empagliflozin,250,RC,VB003244,LOCAL,,inpatient,1,EA,100.71,100.71,,,,,,,,,,,,,,,,,
Empagliflozin,250,RC,VB003245,LOCAL,,inpatient,1,EA,100.71,100.71,,,,,,,,,,,,,,,,,
Tiotropium Br-Olodaterol 2.5-2.5MCG,250,RC,VB003246,LOCAL,,inpatient,4,EA,360,360,,,,,,,,,,,,,,,,,
Pramipexole Di-HCL,250,RC,VB003247,LOCAL,,inpatient,1,EA,35.38,35.38,,,,,,,,,,,,,,,,,
Pramipexole Di-HCL,250,RC,VB003248,LOCAL,,inpatient,1,EA,35.38,35.38,,,,,,,,,,,,,,,,,
Olodaterol HCL,250,RC,VB003249,LOCAL,,inpatient,4,GM,1286.26,1286.26,,,,,,,,,,,,,,,,,
"Glucagon,human Recombinant",250,RC,VB003250,LOCAL,,inpatient,1,EA,823.68,823.68,,,,,,,,,,,,,,,,,
Ferrous Sulfate,257,RC,VB003251,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Amitriptyline HCL,250,RC,VB003252,LOCAL,,inpatient,1,EA,10.16,10.16,,,,,,,,,,,,,,,,,
Benztropine Mesylate,250,RC,VB003253,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Potassium Bicarbonate/Cit Ac,250,RC,VB003254,LOCAL,,inpatient,1,EA,5.01,5.01,,,,,,,,,,,,,,,,,
PHENobarbitaL,250,RC,VB003255,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
PHENobarbitaL,250,RC,VB003256,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
PHENobarbitaL,250,RC,VB003257,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
diphenhydrAMINE HCL Inj,250,RC,VB003258,LOCAL,,inpatient,1,ML,5.62,5.62,,,,,,,,,,,,,,,,,
PHENobarbitaL SODIUM,250,RC,VB003259,LOCAL,,inpatient,1,ML,126.5,126.5,,,,,,,,,,,,,,,,,
PHENobarbitaL SODIUM,250,RC,VB003260,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
Phenytoin Sodium Inj,250,RC,VB003261,LOCAL,,inpatient,2,ML,5,5,,,,,,,,,,,,,,,,,
Promethazine HCL Inj,250,RC,VB003262,LOCAL,,inpatient,1,ML,8.87,8.87,,,,,,,,,,,,,,,,,
chlorproMAZINE HCL Inj,250,RC,VB003263,LOCAL,,inpatient,2,ML,158.88,158.88,,,,,,,,,,,,,,,,,
HYDROmorphone HCL,250,RC,VB003264,LOCAL,,inpatient,20,ML,5.14,5.14,,,,,,,,,,,,,,,,,
Phenytoin Sodium Inj,250,RC,VB003265,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
Bumetanide Inj,250,RC,VB003266,LOCAL,,inpatient,10,ML,15.74,15.74,,,,,,,,,,,,,,,,,
Bumetanide Inj,250,RC,VB003267,LOCAL,,inpatient,4,ML,14.5,14.5,,,,,,,,,,,,,,,,,
dilTIAZem HCL,250,RC,VB003268,LOCAL,,inpatient,5,ML,16.42,16.42,,,,,,,,,,,,,,,,,
Doxapram HCL,250,RC,VB003269,LOCAL,,inpatient,20,ML,12.77,12.77,,,,,,,,,,,,,,,,,
Famotidine/Pf,250,RC,VB003270,LOCAL,,inpatient,2,ML,5,5,,,,,,,,,,,,,,,,,
Fentanyl Citrate/Pf,250,RC,VB003271,LOCAL,,inpatient,2,ML,7.68,7.68,,,,,,,,,,,,,,,,,
Fentanyl Citrate/Pf 250mcg/5ml amp,250,RC,VB003272,LOCAL,,inpatient,5,ML,11.52,11.52,,,,,,,,,,,,,,,,,
Fentanyl Citrate/Pf 1000mcg/20ml,250,RC,VB003273,LOCAL,,inpatient,20,ML,5,5,,,,,,,,,,,,,,,,,
LORazepam Inj,250,RC,VB003274,LOCAL,,inpatient,10,ML,56.16,56.16,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB003275,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
methocarbamoL Inj,250,RC,VB003276,LOCAL,,inpatient,10,ML,134.4,134.4,,,,,,,,,,,,,,,,,
Ampicillin Sodium/Sulbactam Na,250,RC,VB003277,LOCAL,,inpatient,1,EA,20.16,20.16,,,,,,,,,,,,,,,,,
Ampicillin Sodium/Sulbactam Na,250,RC,VB003278,LOCAL,,inpatient,1,EA,36.58,36.58,,,,,,,,,,,,,,,,,
Dicyclomine HCL Inj,250,RC,VB003279,LOCAL,,inpatient,2,ML,5,5,,,,,,,,,,,,,,,,,
Octreotide Acetate,250,RC,VB003280,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
Orphenadrine Citrate,250,RC,VB003281,LOCAL,,inpatient,2,ML,5,5,,,,,,,,,,,,,,,,,
dilTIAZem HCL,250,RC,VB003282,LOCAL,,inpatient,25,ML,5,5,,,,,,,,,,,,,,,,,
methylPREDNISolone ACETATE,250,RC,VB003283,LOCAL,,inpatient,1,ML,41.76,41.76,,,,,,,,,,,,,,,,,
Methotrexate Sodium/Pf,250,RC,VB003284,LOCAL,,inpatient,2,ML,51.76,51.76,,,,,,,,,,,,,,,,,
leucovorin calcium,250,RC,VB003285,LOCAL,,inpatient,1,EA,75.8,75.8,,,,,,,,,,,,,,,,,
medroxyPROGESTERone ACETATE,250,RC,VB003286,LOCAL,,inpatient,1,ML,391.4,391.4,,,,,,,,,,,,,,,,,
amikacin SULFATE,250,RC,VB003287,LOCAL,,inpatient,2,ML,58.84,58.84,,,,,,,,,,,,,,,,,
Tobramycin Sulfate Inj (30 ML Vial),250,RC,VB003288,LOCAL,,inpatient,30,ML,115.2,115.2,,,,,,,,,,,,,,,,,
Sulfameth-Trimethoprim 400-80mg/5ml,250,RC,VB003289,LOCAL,,inpatient,5,ML,30.12,30.12,,,,,,,,,,,,,,,,,
bisacodyL,257,RC,VB003290,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Prochlorperazine,250,RC,VB003291,LOCAL,,inpatient,1,EA,49.03,49.03,,,,,,,,,,,,,,,,,
Acetaminophen Suppository,257,RC,VB003292,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ergotamine Tartrate/Caffeine,250,RC,VB003293,LOCAL,,inpatient,1,EA,1083.53,1083.53,,,,,,,,,,,,,,,,,
Miconazole Nitrate Vaginal Supp,257,RC,VB003294,LOCAL,,inpatient,1,EA,26.12,26.12,,,,,,,,,,,,,,,,,
Hydrocortisone Acetate,250,RC,VB003295,LOCAL,,inpatient,1,EA,90.59,90.59,,,,,,,,,,,,,,,,,
metroNIDAZOLE,250,RC,VB003296,LOCAL,,inpatient,45,GM,2199.48,2199.48,,,,,,,,,,,,,,,,,
gentamicin SULFATE 0.1 % - 15GM,250,RC,VB003297,LOCAL,,inpatient,15,GM,197.52,197.52,,,,,,,,,,,,,,,,,
Perphenazine,250,RC,VB003298,LOCAL,,inpatient,1,EA,7.86,7.86,,,,,,,,,,,,,,,,,
Perphenazine,250,RC,VB003299,LOCAL,,inpatient,1,EA,10.75,10.75,,,,,,,,,,,,,,,,,
Perphenazine,250,RC,VB003300,LOCAL,,inpatient,1,EA,13.04,13.04,,,,,,,,,,,,,,,,,
methazolAMIDE,250,RC,VB003301,LOCAL,,inpatient,1,EA,30.65,30.65,,,,,,,,,,,,,,,,,
haloperidoL,250,RC,VB003302,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
haloperidoL,250,RC,VB003303,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
haloperidoL,250,RC,VB003304,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
haloperidoL,250,RC,VB003305,LOCAL,,inpatient,1,EA,7.17,7.17,,,,,,,,,,,,,,,,,
Isosorbide Dinitrate,250,RC,VB003306,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Isosorbide Dinitrate,250,RC,VB003307,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
penicillin V POTASSIUM,250,RC,VB003308,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Imipramine HCL,250,RC,VB003309,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Imipramine HCL,250,RC,VB003310,LOCAL,,inpatient,1,EA,5.85,5.85,,,,,,,,,,,,,,,,,
Amoxicillin/Potas Clav 250mg/125mg,250,RC,VB003311,LOCAL,,inpatient,1,EA,23.67,23.67,,,,,,,,,,,,,,,,,
Clarithromycin,250,RC,VB003312,LOCAL,,inpatient,1,EA,24.06,24.06,,,,,,,,,,,,,,,,,
Amoxicillin,250,RC,VB003313,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
clomiPRAMINE HCL,250,RC,VB003314,LOCAL,,inpatient,1,EA,44.97,44.97,,,,,,,,,,,,,,,,,
Cefdinir,250,RC,VB003315,LOCAL,,inpatient,1,EA,20.46,20.46,,,,,,,,,,,,,,,,,
Amoxicillin,250,RC,VB003316,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ondansetron HCL/Pf Inj,250,RC,VB003317,LOCAL,,inpatient,2,ML,5,5,,,,,,,,,,,,,,,,,
Pyridostigmine Bromide,250,RC,VB003318,LOCAL,,inpatient,2,ML,76.8,76.8,,,,,,,,,,,,,,,,,
Digoxin Inj,250,RC,VB003319,LOCAL,,inpatient,2,ML,29.92,29.92,,,,,,,,,,,,,,,,,
Nafcillin Sodium,250,RC,VB003320,LOCAL,,inpatient,1,EA,60,60,,,,,,,,,,,,,,,,,
cefTAZidime,250,RC,VB003321,LOCAL,,inpatient,1,ML,1.5,1.5,,,,,,,,,,,,,,,,,
cefTRIAXone SODIUM,250,RC,VB003322,LOCAL,,inpatient,1,ML,59.33,59.33,,,,,,,,,,,,,,,,,
cefTRIAXone SODIUM,250,RC,VB003323,LOCAL,,inpatient,1,ML,184,184,,,,,,,,,,,,,,,,,
Ciprofloxacin In 5 % Dextrose,250,RC,VB003324,LOCAL,,inpatient,100,ML,58.52,58.52,,,,,,,,,,,,,,,,,
Ampicillin Sodium,250,RC,VB003325,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
Ampicillin Sodium (ADD-Vantage),250,RC,VB003326,LOCAL,,inpatient,1,ML,138.99,138.99,,,,,,,,,,,,,,,,,
ceFAZolin SODIUM,250,RC,VB003327,LOCAL,,inpatient,1,ML,38.94,38.94,,,,,,,,,,,,,,,,,
methylPREDNISolone,250,RC,VB003328,LOCAL,,inpatient,1,EA,5.72,5.72,,,,,,,,,,,,,,,,,
methylPREDNISolone,250,RC,VB003329,LOCAL,,inpatient,1,EA,5.72,5.72,,,,,,,,,,,,,,,,,
Amoxicillin,250,RC,VB003330,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
donepezil HCL,250,RC,VB003331,LOCAL,,inpatient,1,EA,31.15,31.15,,,,,,,,,,,,,,,,,
QUEtiapine FUMARATE,250,RC,VB003332,LOCAL,,inpatient,1,EA,79.74,79.74,,,,,,,,,,,,,,,,,
Bicalutamide,250,RC,VB003333,LOCAL,,inpatient,1,EA,74.24,74.24,,,,,,,,,,,,,,,,,
cefPODOXime proxetiL,250,RC,VB003334,LOCAL,,inpatient,1,EA,26.95,26.95,,,,,,,,,,,,,,,,,
cefPODOXime proxetiL,250,RC,VB003335,LOCAL,,inpatient,1,EA,33.83,33.83,,,,,,,,,,,,,,,,,
metroNIDAZOLE 0.75 % Vaginal,250,RC,VB003336,LOCAL,,inpatient,70,GM,611.32,611.32,,,,,,,,,,,,,,,,,
fentaNYL,250,RC,VB003337,LOCAL,,inpatient,1,EA,81.21,81.21,,,,,,,,,,,,,,,,,
chlorproMAZINE HCL,250,RC,VB003338,LOCAL,,inpatient,1,EA,30.56,30.56,,,,,,,,,,,,,,,,,
chlorproMAZINE HCL,250,RC,VB003339,LOCAL,,inpatient,1,EA,41.5,41.5,,,,,,,,,,,,,,,,,
Bethanechol Chloride,250,RC,VB003340,LOCAL,,inpatient,1,EA,10.68,10.68,,,,,,,,,,,,,,,,,
Benztropine Mesylate,250,RC,VB003341,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Benztropine Mesylate,250,RC,VB003342,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Magnesium Sulfate,250,RC,VB003343,LOCAL,,inpatient,1,EA,5.28,5.28,,,,,,,,,,,,,,,,,
Chlorpheniramine Maleate,257,RC,VB003344,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Amitriptyline HCL,250,RC,VB003345,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Amitriptyline HCL,250,RC,VB003346,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Vitamin E,257,RC,VB003347,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ascorbic Acid,257,RC,VB003348,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Multivitamin With Folic Acid,257,RC,VB003349,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Nitroglycerin,250,RC,VB003350,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Tolnaftate,257,RC,VB003351,LOCAL,,inpatient,45,GM,12.67,12.67,,,,,,,,,,,,,,,,,
metroNIDAZOLE,250,RC,VB003352,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Calcium Carbonate,257,RC,VB003353,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Acetaminophen,257,RC,VB003354,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
dimenhyDRINATE,257,RC,VB003355,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
diphenhydrAMINE HCL,257,RC,VB003356,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ferrous Gluconate,250,RC,VB003357,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Sulfamethoxazole-Trimeth 800-160MG,250,RC,VB003358,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Oxybutynin Chloride,250,RC,VB003359,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
verapamil HCL,250,RC,VB003360,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
verapamil HCL,250,RC,VB003361,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Sodium Chloride  0.65 %,257,RC,VB003362,LOCAL,,inpatient,44,ML,5,5,,,,,,,,,,,,,,,,,
captopriL,250,RC,VB003363,LOCAL,,inpatient,1,EA,6.78,6.78,,,,,,,,,,,,,,,,,
captopriL,250,RC,VB003364,LOCAL,,inpatient,1,EA,7.19,7.19,,,,,,,,,,,,,,,,,
Pseudoephedrine HCL,257,RC,VB003365,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Calcium Citrate,257,RC,VB003366,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Simethicone,257,RC,VB003367,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pseudoephedrine HCL,257,RC,VB003368,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Prenatal No.137/Iron/Folic Acd,250,RC,VB003369,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Iron Polysaccharide Complex,257,RC,VB003370,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Multivit,calc,mins/Iron/Folic",250,RC,VB003371,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Enalapril Maleate,250,RC,VB003372,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Doxazosin Mesylate,250,RC,VB003373,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
diphenhydrAMINE HCL,257,RC,VB003374,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Enalapril Maleate,250,RC,VB003375,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Gabapentin,250,RC,VB003376,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Oxymetazoline HCL  0.05 %,257,RC,VB003377,LOCAL,,inpatient,15,ML,5.14,5.14,,,,,,,,,,,,,,,,,
FLUoxetine HCL,250,RC,VB003378,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Acyclovir,250,RC,VB003379,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
metFORMIN HCL,250,RC,VB003380,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Furosemide,250,RC,VB003381,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
simvastatin,250,RC,VB003382,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pseudoephedrine HCL ER,257,RC,VB003383,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
lisinopriL,250,RC,VB003384,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Cholecalciferol (Vitamin D3),250,RC,VB003385,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ibuprofen,250,RC,VB003386,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
pravastatin SODIUM,250,RC,VB003387,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Digoxin,250,RC,VB003388,LOCAL,,inpatient,1,EA,6.47,6.47,,,,,,,,,,,,,,,,,
Cholecalciferol (Vitamin D3),250,RC,VB003389,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
LORazepam,250,RC,VB003390,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
levETIRAcetam,250,RC,VB003391,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
zolpidem TARTRATE,250,RC,VB003392,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Citalopram Hydrobromide,250,RC,VB003393,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Citalopram Hydrobromide,250,RC,VB003394,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Terazosin HCL,250,RC,VB003395,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
carBAMazepine,250,RC,VB003396,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Phenytoin Sodium Extended,250,RC,VB003397,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
OLANZapine,250,RC,VB003398,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
atorvastatin CALCIUM,250,RC,VB003399,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
atorvastatin CALCIUM,250,RC,VB003400,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
atorvastatin CALCIUM,250,RC,VB003401,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
atorvastatin CALCIUM,250,RC,VB003402,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Clopidogrel Bisulfate,250,RC,VB003403,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
carvediloL,250,RC,VB003404,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dextromethorphan Polistirex,257,RC,VB003405,LOCAL,,inpatient,89,ML,5,5,,,,,,,,,,,,,,,,,
metoprolol succinate,250,RC,VB003406,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
metoprolol succinate,250,RC,VB003407,LOCAL,,inpatient,1,EA,5.03,5.03,,,,,,,,,,,,,,,,,
metoprolol succinate,250,RC,VB003408,LOCAL,,inpatient,1,EA,5.84,5.84,,,,,,,,,,,,,,,,,
metFORMIN HCL,250,RC,VB003409,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
metFORMIN HCL,250,RC,VB003410,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
levoFLOXacin,250,RC,VB003411,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
levoFLOXacin,250,RC,VB003412,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
amLODIPine BESYLATE,250,RC,VB003413,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
amLODIPine BESYLATE,250,RC,VB003414,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
OLANZapine,250,RC,VB003415,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
tamsulosin HCL,250,RC,VB003416,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
bisacodyL,250,RC,VB003417,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
donepezil HCL,250,RC,VB003418,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
tiZANidine HCL,250,RC,VB003419,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Escitalopram Oxalate,250,RC,VB003420,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Escitalopram Oxalate,250,RC,VB003421,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Isosorbide Mononitrate,250,RC,VB003422,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Isosorbide Mononitrate,250,RC,VB003423,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
DULoxetine HCL,250,RC,VB003424,LOCAL,,inpatient,1,EA,6.89,6.89,,,,,,,,,,,,,,,,,
DULoxetine HCL,250,RC,VB003425,LOCAL,,inpatient,1,EA,6.89,6.89,,,,,,,,,,,,,,,,,
Docusate Sodium,250,RC,VB003426,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Promethazine HCL,250,RC,VB003427,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Venlafaxine HCL,250,RC,VB003428,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Venlafaxine HCL ER,250,RC,VB003429,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Venlafaxine HCL,250,RC,VB003430,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Baclofen,250,RC,VB003431,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
lisinopriL,250,RC,VB003432,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
ARIPiprazole,250,RC,VB003433,LOCAL,,inpatient,1,EA,40.17,40.17,,,,,,,,,,,,,,,,,
Meclizine HCL,250,RC,VB003434,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Sennosides,250,RC,VB003435,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
propranolol HCL,250,RC,VB003436,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
ondansetron HCL,250,RC,VB003437,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
ondansetron HCL,250,RC,VB003438,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
traZODone HCL,250,RC,VB003439,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Carbamide Peroxide 6.5 % - 15mL,250,RC,VB003440,LOCAL,,inpatient,15,ML,9.07,9.07,,,,,,,,,,,,,,,,,
QUEtiapine FUMARATE,250,RC,VB003441,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Gabapentin,250,RC,VB003442,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Glycopyrrolate,250,RC,VB003443,LOCAL,,inpatient,1,EA,5.2,5.2,,,,,,,,,,,,,,,,,
Simethicone,250,RC,VB003444,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
lisinopriL,250,RC,VB003445,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Acetaminophen 650 mg/20.3mL,250,RC,VB003446,LOCAL,,inpatient,20.3,ML,9.76,9.76,,,,,,,,,,,,,,,,,
Loperamide HCL,250,RC,VB003447,LOCAL,,inpatient,120,ML,5,5,,,,,,,,,,,,,,,,,
traZODone HCL,250,RC,VB003448,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Atazanavir Sulfate,250,RC,VB003449,LOCAL,,inpatient,1,EA,89.24,89.24,,,,,,,,,,,,,,,,,
levothyroxine SODIUM,250,RC,VB003450,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
levothyroxine SODIUM,250,RC,VB003451,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
methocarbamoL,250,RC,VB003452,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Mag Carb/Aluminum Hydrox/Algin,250,RC,VB003453,LOCAL,,inpatient,355,ML,5,5,,,,,,,,,,,,,,,,,
Ibuprofen,250,RC,VB003454,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Perit. Dialysis No.6-1.5 % Dex,250,RC,VB003455,LOCAL,,inpatient,6000,ML,332.74,332.74,,,,,,,,,,,,,,,,,
Periton. Dialysis 4-1.5 % Dext,250,RC,VB003456,LOCAL,,inpatient,2000,ML,161.42,161.42,,,,,,,,,,,,,,,,,
Periton. Dialysis 4-1.5 % Dext,250,RC,VB003457,LOCAL,,inpatient,6000,ML,341.33,341.33,,,,,,,,,,,,,,,,,
Periton. Dialysis 13-Dex 2.5 %,250,RC,VB003458,LOCAL,,inpatient,6000,ML,351.89,351.89,,,,,,,,,,,,,,,,,
Perit. Dialysis 3-4.25 % Dextr,250,RC,VB003459,LOCAL,,inpatient,6000,ML,299.38,299.38,,,,,,,,,,,,,,,,,
Periton. Dialysis 13-Dex 2.5 %,250,RC,VB003460,LOCAL,,inpatient,2000,ML,227.33,227.33,,,,,,,,,,,,,,,,,
Periton. Dialysis 13-Dex 2.5 %,250,RC,VB003461,LOCAL,,inpatient,2500,ML,232.13,232.13,,,,,,,,,,,,,,,,,
Perit. Dialysis 3-4.25 % Dextr,250,RC,VB003462,LOCAL,,inpatient,2000,ML,229.68,229.68,,,,,,,,,,,,,,,,,
Perit. Dialysis 3-4.25 % Dextr,250,RC,VB003463,LOCAL,,inpatient,2500,ML,237.46,237.46,,,,,,,,,,,,,,,,,
Periton.dialysis 7-2.5 % Dextr,250,RC,VB003464,LOCAL,,inpatient,6000,ML,339.89,339.89,,,,,,,,,,,,,,,,,
Anticoag Citrate Dextrose Soln A,250,RC,VB003465,LOCAL,,inpatient,500,ML,26.32,26.32,,,,,,,,,,,,,,,,,
Albumin Human,250,RC,VB003466,LOCAL,,inpatient,500,ML,1048.99,1048.99,,,,,,,,,,,,,,,,,
Immun Glob G/Gly/Gluc/Iga 0-50,250,RC,VB003467,LOCAL,,inpatient,1,GM,5462.88,5462.88,,,,,,,,,,,,,,,,,
Immun Glob G/Gly/Gluc/Iga 0-50,250,RC,VB003468,LOCAL,,inpatient,1,GM,10925.76,10925.76,,,,,,,,,,,,,,,,,
"Antihemophilic Factor, Hum Rec",250,RC,VB003469,LOCAL,,inpatient,1,EA,9.41,9.41,,,,,,,,,,,,,,,,,
Hypromellose,250,RC,VB003470,LOCAL,,inpatient,15,ML,136.46,136.46,,,,,,,,,,,,,,,,,
dexAMETHasone 0.1% Ophth,250,RC,VB003471,LOCAL,,inpatient,5,ML,380.06,380.06,,,,,,,,,,,,,,,,,
Chondr Sulf A Sod/Hyaluronate,250,RC,VB003472,LOCAL,,inpatient,0.5,ML,1903.39,1903.39,,,,,,,,,,,,,,,,,
Bismuth Tribromoph/Petrolatum,250,RC,VB003473,LOCAL,,inpatient,1,EA,92.26,92.26,,,,,,,,,,,,,,,,,
Sodium Chloride 0.9 % (Flush),250,RC,VB003474,LOCAL,,inpatient,10,ML,5.92,5.92,,,,,,,,,,,,,,,,,
Bismuth Tribromoph/Petrolatum,250,RC,VB003475,LOCAL,,inpatient,1,EA,680.84,680.84,,,,,,,,,,,,,,,,,
Bismuth Tribromoph/Petrolatum,250,RC,VB003476,LOCAL,,inpatient,1,EA,148.76,148.76,,,,,,,,,,,,,,,,,
Bismuth Tribromoph/Petrolatum,250,RC,VB003477,LOCAL,,inpatient,1,EA,218.56,218.56,,,,,,,,,,,,,,,,,
Magnesium Chloride,250,RC,VB003478,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Calcium Carb/Vit D3  500mg/200Unit,250,RC,VB003479,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Esmolol In NS 2500 mg/250mL,250,RC,VB003480,LOCAL,,inpatient,250,ML,622.08,622.08,,,,,,,,,,,,,,,,,
esmolol HCL,250,RC,VB003481,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
Scopolamine,250,RC,VB003482,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Poractant Alfa,250,RC,VB003483,LOCAL,,inpatient,1.5,ML,2370.64,2370.64,,,,,,,,,,,,,,,,,
Poractant Alfa,250,RC,VB003484,LOCAL,,inpatient,3,ML,4674.64,4674.64,,,,,,,,,,,,,,,,,
Aspirin,250,RC,VB003485,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pyridoxine HCL (Vitamin B6),250,RC,VB003486,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pyridoxine HCL (Vitamin B6),250,RC,VB003487,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Niacin,250,RC,VB003488,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
simvastatin,250,RC,VB003489,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Clotrimazole 1% Topical Soln,250,RC,VB003490,LOCAL,,inpatient,30,ML,160.52,160.52,,,,,,,,,,,,,,,,,
Urea 10% - 177gm,250,RC,VB003491,LOCAL,,inpatient,177,ML,75.55,75.55,,,,,,,,,,,,,,,,,
"Mineral Oil/Petrolatum,white",250,RC,VB003492,LOCAL,,inpatient,120,GM,24.48,24.48,,,,,,,,,,,,,,,,,
buPROPion HCL,250,RC,VB003493,LOCAL,,inpatient,1,EA,19.07,19.07,,,,,,,,,,,,,,,,,
Hydrocortisone 2.5 % Rectal Cream,250,RC,VB003494,LOCAL,,inpatient,28.35,GM,336,336,,,,,,,,,,,,,,,,,
oxyCODONE HCL,250,RC,VB003495,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Zinc Oxide,250,RC,VB003496,LOCAL,,inpatient,1,EA,85.84,85.84,,,,,,,,,,,,,,,,,
Benzocaine/Resorcinol,250,RC,VB003497,LOCAL,,inpatient,1,EA,12.77,12.77,,,,,,,,,,,,,,,,,
Loratadine/Pseudoephedrine,250,RC,VB003498,LOCAL,,inpatient,1,EA,5.79,5.79,,,,,,,,,,,,,,,,,
Acetaminophen,250,RC,VB003499,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Miconazole Nitrate  2 %,250,RC,VB003500,LOCAL,,inpatient,85,GM,32.88,32.88,,,,,,,,,,,,,,,,,
Miconazole Nitrate  2 % - 57GM,250,RC,VB003501,LOCAL,,inpatient,57,GM,29.2,29.2,,,,,,,,,,,,,,,,,
Glycerin,250,RC,VB003502,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ubidecarenone,250,RC,VB003503,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Sodium Phosphate,mono-Dibasic",250,RC,VB003504,LOCAL,,inpatient,1,EA,21.96,21.96,,,,,,,,,,,,,,,,,
prednisoLONE ACETATE,250,RC,VB003505,LOCAL,,inpatient,5,ML,769.92,769.92,,,,,,,,,,,,,,,,,
Perflutren Lipid Microspheres,250,RC,VB003506,LOCAL,,inpatient,2,ML,889.81,889.81,,,,,,,,,,,,,,,,,
Buprenorphine HCL,250,RC,VB003507,LOCAL,,inpatient,1,ML,72.82,72.82,,,,,,,,,,,,,,,,,
Buprenorphine HCL/Naloxone HCL,250,RC,VB003508,LOCAL,,inpatient,1,EA,24.05,24.05,,,,,,,,,,,,,,,,,
Buprenorphine HCL/Naloxone HCL,250,RC,VB003509,LOCAL,,inpatient,1,EA,43.1,43.1,,,,,,,,,,,,,,,,,
Silver Nitrate Applicator 75 %-25 %,250,RC,VB003510,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Tetanus Immune Globulin/Pf,250,RC,VB003511,LOCAL,,inpatient,1,ML,3116.02,3116.02,,,,,,,,,,,,,,,,,
Immune Globul G (Igg)/Glycine,250,RC,VB003512,LOCAL,,inpatient,2,ML,440.88,440.88,,,,,,,,,,,,,,,,,
Albumin Human 25% - 50mL,250,RC,VB003513,LOCAL,,inpatient,50,ML,236.69,236.69,,,,,,,,,,,,,,,,,
Albumin Human,250,RC,VB003514,LOCAL,,inpatient,50,ML,156.48,156.48,,,,,,,,,,,,,,,,,
cefaCLOR,250,RC,VB003515,LOCAL,,inpatient,150,ML,16.8,16.8,,,,,,,,,,,,,,,,,
fluorouraciL,250,RC,VB003516,LOCAL,,inpatient,1,EA,4454.16,4454.16,,,,,,,,,,,,,,,,,
Aspirin/Sod Bicarb/Citric Acid,250,RC,VB003517,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
simvastatin,250,RC,VB003518,LOCAL,,inpatient,1,EA,19.66,19.66,,,,,,,,,,,,,,,,,
Pioglitazone HCL,250,RC,VB003519,LOCAL,,inpatient,1,EA,28.03,28.03,,,,,,,,,,,,,,,,,
Pioglitazone HCL,250,RC,VB003520,LOCAL,,inpatient,1,EA,42.83,42.83,,,,,,,,,,,,,,,,,
Pioglitazone HCL,250,RC,VB003521,LOCAL,,inpatient,1,EA,46.47,46.47,,,,,,,,,,,,,,,,,
Naltrexone HCL,250,RC,VB003522,LOCAL,,inpatient,1,EA,17.08,17.08,,,,,,,,,,,,,,,,,
Polyvinyl Alcohol 1.4 % Ophth,250,RC,VB003523,LOCAL,,inpatient,15,ML,29.64,29.64,,,,,,,,,,,,,,,,,
Hypromellose,250,RC,VB003524,LOCAL,,inpatient,1,EA,96.8,96.8,,,,,,,,,,,,,,,,,
levoFLOXacin Inj,250,RC,VB003525,LOCAL,,inpatient,20,ML,8.95,8.95,,,,,,,,,,,,,,,,,
levoFLOXacin,250,RC,VB003526,LOCAL,,inpatient,30,ML,7.92,7.92,,,,,,,,,,,,,,,,,
Phenylephrine HCL,250,RC,VB003527,LOCAL,,inpatient,5,ML,200,200,,,,,,,,,,,,,,,,,
ketorolac TROMETHAMINE 0.5 % 3mL,250,RC,VB003528,LOCAL,,inpatient,3,ML,194.92,194.92,,,,,,,,,,,,,,,,,
Atropine Sulfate 1% Ophthalmic,250,RC,VB003529,LOCAL,,inpatient,2,ML,191.44,191.44,,,,,,,,,,,,,,,,,
Bacitracin/Polymyxin B Ophth Oint,250,RC,VB003530,LOCAL,,inpatient,3.5,GM,102.8,102.8,,,,,,,,,,,,,,,,,
gentamicin SULFATE 0.3% Ophth,250,RC,VB003531,LOCAL,,inpatient,3.5,GM,155.8,155.8,,,,,,,,,,,,,,,,,
Latanoprost 0.005% (2.5mL),250,RC,VB003532,LOCAL,,inpatient,2.5,ML,380,380,,,,,,,,,,,,,,,,,
lidocaine HCL 2% Jelly - 5mL,250,RC,VB003533,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
lidocaine HCL 2 % - 30mL,250,RC,VB003534,LOCAL,,inpatient,30,ML,513.4,513.4,,,,,,,,,,,,,,,,,
Aminocaproic Acid,250,RC,VB003535,LOCAL,,inpatient,1,EA,87.95,87.95,,,,,,,,,,,,,,,,,
Diclofenac Sodium 0.1 %,250,RC,VB003536,LOCAL,,inpatient,2.5,ML,179.08,179.08,,,,,,,,,,,,,,,,,
calcitrioL,250,RC,VB003537,LOCAL,,inpatient,1,EA,37.5,37.5,,,,,,,,,,,,,,,,,
Promethazine HCL/Codeine,250,RC,VB003538,LOCAL,,inpatient,1,EA,11.68,11.68,,,,,,,,,,,,,,,,,
PHENobarbitaL,250,RC,VB003539,LOCAL,,inpatient,1,EA,9.44,9.44,,,,,,,,,,,,,,,,,
propranolol HCL,250,RC,VB003540,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Prochlorperazine Edisylate Inj,250,RC,VB003541,LOCAL,,inpatient,2,ML,5,5,,,,,,,,,,,,,,,,,
prednisoLONE,250,RC,VB003542,LOCAL,,inpatient,1,EA,74.15,74.15,,,,,,,,,,,,,,,,,
Sodium Chloride 2% Ophth,250,RC,VB003543,LOCAL,,inpatient,15,ML,69,69,,,,,,,,,,,,,,,,,
Tobramycin 0.3 %,250,RC,VB003544,LOCAL,,inpatient,5,ML,56.4,56.4,,,,,,,,,,,,,,,,,
Tobramycin/Dexamethasone 0.3 %-0.1%,250,RC,VB003545,LOCAL,,inpatient,2.5,ML,261.04,261.04,,,,,,,,,,,,,,,,,
Polymyxin B Sulf/Trimeth Ophth,250,RC,VB003546,LOCAL,,inpatient,10,ML,53.76,53.76,,,,,,,,,,,,,,,,,
Sulfacetamide/Prednisolone Sp,250,RC,VB003547,LOCAL,,inpatient,5,ML,75,75,,,,,,,,,,,,,,,,,
Flunisolide,250,RC,VB003548,LOCAL,,inpatient,25,ML,275,275,,,,,,,,,,,,,,,,,
Sodium Chloride 5% Ophth Oint,250,RC,VB003549,LOCAL,,inpatient,3.5,GM,72.64,72.64,,,,,,,,,,,,,,,,,
Brimonidine Tart 0.2% - 5mL,250,RC,VB003550,LOCAL,,inpatient,5,ML,72.52,72.52,,,,,,,,,,,,,,,,,
Dorzolamide-Timolol 22.3-6.8MG/ML,250,RC,VB003551,LOCAL,,inpatient,10,ML,269.96,269.96,,,,,,,,,,,,,,,,,
Levobunolol HCL 0.5 %,250,RC,VB003552,LOCAL,,inpatient,5,ML,96.72,96.72,,,,,,,,,,,,,,,,,
Acetylcholine Chloride,250,RC,VB003553,LOCAL,,inpatient,1,EA,626.74,626.74,,,,,,,,,,,,,,,,,
Acetic Acid/Aluminum Acetate,250,RC,VB003554,LOCAL,,inpatient,60,ML,288,288,,,,,,,,,,,,,,,,,
Neomycin/Polymyxin B/HC 3.5-10K-1,250,RC,VB003555,LOCAL,,inpatient,10,ML,402.72,402.72,,,,,,,,,,,,,,,,,
Sulfacetamide Sodium  10 %,250,RC,VB003556,LOCAL,,inpatient,15,ML,244,244,,,,,,,,,,,,,,,,,
Neomycin-Bacitracin-Polymyxin Ophth,250,RC,VB003557,LOCAL,,inpatient,3.5,GM,227.8,227.8,,,,,,,,,,,,,,,,,
Neomycin/Bacit/P-Myx/Hydrocort 1%,250,RC,VB003558,LOCAL,,inpatient,3.5,GM,260.2,260.2,,,,,,,,,,,,,,,,,
Neomycin/Polymyxn B/Gramicidin Opht,250,RC,VB003559,LOCAL,,inpatient,10,ML,247.76,247.76,,,,,,,,,,,,,,,,,
Neomycin/Polymyxin B/Dexameth Ophth,250,RC,VB003560,LOCAL,,inpatient,3.5,GM,79.44,79.44,,,,,,,,,,,,,,,,,
Atropine Sulfate,250,RC,VB003561,LOCAL,,inpatient,3.5,GM,79.6,79.6,,,,,,,,,,,,,,,,,
Neomycin/Polymyx/Dexamet 0.1% Ophth,250,RC,VB003562,LOCAL,,inpatient,5,ML,79.44,79.44,,,,,,,,,,,,,,,,,
Erythromycin Base 5MG/GM - Ophthalm,250,RC,VB003563,LOCAL,,inpatient,1,GM,49.64,49.64,,,,,,,,,,,,,,,,,
Cromolyn Sodium,250,RC,VB003564,LOCAL,,inpatient,10,ML,108,108,,,,,,,,,,,,,,,,,
Erythromycin Ethylsuccinate,250,RC,VB003565,LOCAL,,inpatient,1,EA,58.43,58.43,,,,,,,,,,,,,,,,,
Erythromycin Base,250,RC,VB003566,LOCAL,,inpatient,1,EA,55.7,55.7,,,,,,,,,,,,,,,,,
Erythromycin Ethylsuccinate,250,RC,VB003567,LOCAL,,inpatient,100,ML,31.76,31.76,,,,,,,,,,,,,,,,,
Erythromycin Ethylsuccinate,250,RC,VB003568,LOCAL,,inpatient,100,ML,18.06,18.06,,,,,,,,,,,,,,,,,
niMODipine,250,RC,VB003569,LOCAL,,inpatient,1,EA,512.78,512.78,,,,,,,,,,,,,,,,,
Lidocaine,250,RC,VB003570,LOCAL,,inpatient,1,EA,76.8,76.8,,,,,,,,,,,,,,,,,
Digoxin,250,RC,VB003571,LOCAL,,inpatient,1,EA,50.11,50.11,,,,,,,,,,,,,,,,,
cefTAZidime,250,RC,VB003572,LOCAL,,inpatient,1,EA,31.68,31.68,,,,,,,,,,,,,,,,,
cefTAZidime,250,RC,VB003573,LOCAL,,inpatient,1,EA,56.93,56.93,,,,,,,,,,,,,,,,,
Tranylcypromine Sulfate,250,RC,VB003574,LOCAL,,inpatient,1,EA,30.62,30.62,,,,,,,,,,,,,,,,,
Ethacrynate Sodium,250,RC,VB003575,LOCAL,,inpatient,1,EA,24070.37,24070.37,,,,,,,,,,,,,,,,,
penicillAMINE,250,RC,VB003576,LOCAL,,inpatient,1,EA,1257.05,1257.05,,,,,,,,,,,,,,,,,
cefTAZidime,250,RC,VB003577,LOCAL,,inpatient,1,GM,52.8,52.8,,,,,,,,,,,,,,,,,
cefTAZidime,250,RC,VB003578,LOCAL,,inpatient,1,EA,28.82,28.82,,,,,,,,,,,,,,,,,
Levofloxacin In Dextrose 5 %,250,RC,VB003579,LOCAL,,inpatient,150,ML,52.8,52.8,,,,,,,,,,,,,,,,,
Heparin 5000 unit/mL,250,RC,VB003580,LOCAL,,inpatient,1,ML,7.2,7.2,,,,,,,,,,,,,,,,,
Solifenacin Succinate,250,RC,VB003581,LOCAL,,inpatient,1,EA,55.51,55.51,,,,,,,,,,,,,,,,,
Dantrolene Sodium,250,RC,VB003582,LOCAL,,inpatient,1,EA,336,336,,,,,,,,,,,,,,,,,
Lecithin,250,RC,VB003583,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
B-Complex With Vitamin C,250,RC,VB003584,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Omega-3s/Dha/Epa/Fish Oil,250,RC,VB003585,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Flu Vacc Qs2019-20 36mos Up/Pf,250,RC,VB003586,LOCAL,,inpatient,1,EA,82.66,82.66,,,,,,,,,,,,,,,,,
Magnesium Gluconate,250,RC,VB003587,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Indinavir Sulfate,250,RC,VB003588,LOCAL,,inpatient,1,EA,32.5,32.5,,,,,,,,,,,,,,,,,
Hydrocodone Bit/Homatrop Me-Br,250,RC,VB003589,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Aluminum Chloride,250,RC,VB003590,LOCAL,,inpatient,1,EA,138,138,,,,,,,,,,,,,,,,,
Carvedilol Phosphate,250,RC,VB003591,LOCAL,,inpatient,1,EA,31.51,31.51,,,,,,,,,,,,,,,,,
Perindopril Erbumine,250,RC,VB003592,LOCAL,,inpatient,1,EA,10.56,10.56,,,,,,,,,,,,,,,,,
Chlordiazepoxide/Clidinium Br,250,RC,VB003593,LOCAL,,inpatient,1,EA,9.89,9.89,,,,,,,,,,,,,,,,,
Ciprofloxacin Lactate,250,RC,VB003594,LOCAL,,inpatient,1,EA,15.02,15.02,,,,,,,,,,,,,,,,,
Psyllium Husk 3.4g/5.8g Packet,250,RC,VB003595,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Magnesium Citrate,250,RC,VB003596,LOCAL,,inpatient,296,ML,7.96,7.96,,,,,,,,,,,,,,,,,
Piperonyl Butoxide/Pyrethrins,250,RC,VB003597,LOCAL,,inpatient,118,ML,35.16,35.16,,,,,,,,,,,,,,,,,
Calcium Carbonate/Vitamin D3,250,RC,VB003598,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Thiamine Mononitrate (Vit B1),250,RC,VB003599,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
acetaZOLAMIDE SODIUM,250,RC,VB003600,LOCAL,,inpatient,1,EA,190.56,190.56,,,,,,,,,,,,,,,,,
Colistin (Colistimethate Na),250,RC,VB003601,LOCAL,,inpatient,1,EA,134.4,134.4,,,,,,,,,,,,,,,,,
amphotericin B,250,RC,VB003602,LOCAL,,inpatient,1,EA,240,240,,,,,,,,,,,,,,,,,
Magnesium Sulfate Inj 50%,250,RC,VB003603,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
Ammonia,250,RC,VB003604,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
EPINEPHrine HCL,250,RC,VB003605,LOCAL,,inpatient,30,ML,1202.74,1202.74,,,,,,,,,,,,,,,,,
disopyramide PHOSPHATE,250,RC,VB003606,LOCAL,,inpatient,1,EA,11.36,11.36,,,,,,,,,,,,,,,,,
metroNIDAZOLE,250,RC,VB003607,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Olmesartan Medoxomil,250,RC,VB003608,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
HYDROmorphone HCL,250,RC,VB003609,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
HYDROmorphone HCL ORAL,250,RC,VB003610,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Terbutaline Sulfate,250,RC,VB003611,LOCAL,,inpatient,1,EA,109.29,109.29,,,,,,,,,,,,,,,,,
Methenamine Hippurate,250,RC,VB003612,LOCAL,,inpatient,1,EA,8.36,8.36,,,,,,,,,,,,,,,,,
B-Complex With Vitamin C,250,RC,VB003613,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Aspirin/Calcium Carb/Magnesium,250,RC,VB003614,LOCAL,,inpatient,1,EA,1.5,1.5,,,,,,,,,,,,,,,,,
Calcium Citrate,250,RC,VB003615,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
rosuvastatin CALCIUM,250,RC,VB003616,LOCAL,,inpatient,1,EA,41.75,41.75,,,,,,,,,,,,,,,,,
Hydrocodone Bit/Homatrop Me-Br,250,RC,VB003617,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Amoxicillin/Pot Clav 250-62.5mg/5mL,250,RC,VB003618,LOCAL,,inpatient,75,ML,2935.68,2935.68,,,,,,,,,,,,,,,,,
Amoxicillin/Potassium Clav,250,RC,VB003619,LOCAL,,inpatient,75,ML,26.72,26.72,,,,,,,,,,,,,,,,,
Amoxicillin/Potassium Clav,250,RC,VB003620,LOCAL,,inpatient,1,EA,34.33,34.33,,,,,,,,,,,,,,,,,
Immun Globg(Igg)/Sucr/Iga Ov50,250,RC,VB003621,LOCAL,,inpatient,1,EA,2764.8,2764.8,,,,,,,,,,,,,,,,,
Immun Glob G(Igg)/Pro/Iga 0-50,250,RC,VB003622,LOCAL,,inpatient,1,EA,4518.72,4518.72,,,,,,,,,,,,,,,,,
Hydrocortisone 2.5% Cream,250,RC,VB003623,LOCAL,,inpatient,28,GM,43.2,43.2,,,,,,,,,,,,,,,,,
Dibucaine,250,RC,VB003624,LOCAL,,inpatient,28,GM,24,24,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide 0.025 %,250,RC,VB003625,LOCAL,,inpatient,15,GM,24.48,24.48,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide 0.1 %,250,RC,VB003626,LOCAL,,inpatient,15,GM,22.28,22.28,,,,,,,,,,,,,,,,,
gentamicin SULFATE 0.1 % - 15GM,250,RC,VB003627,LOCAL,,inpatient,15,GM,197.52,197.52,,,,,,,,,,,,,,,,,
Mesalamine,250,RC,VB003628,LOCAL,,inpatient,60,ML,92.32,92.32,,,,,,,,,,,,,,,,,
Mupirocin 2% Oint - 22GM,250,RC,VB003629,LOCAL,,inpatient,22,GM,45,45,,,,,,,,,,,,,,,,,
Diclofenac Sodium 1 %,250,RC,VB003630,LOCAL,,inpatient,100,GM,72,72,,,,,,,,,,,,,,,,,
Diphenhydramine HCL/Zinc 2 %/0.1%,250,RC,VB003631,LOCAL,,inpatient,28,GM,15.96,15.96,,,,,,,,,,,,,,,,,
Clotrimazole,250,RC,VB003632,LOCAL,,inpatient,15,GM,15.12,15.12,,,,,,,,,,,,,,,,,
Ketoconazole 2 %,250,RC,VB003633,LOCAL,,inpatient,120,ML,121,121,,,,,,,,,,,,,,,,,
Ammonium Lactate 12% Lotion,250,RC,VB003634,LOCAL,,inpatient,227,GM,72.96,72.96,,,,,,,,,,,,,,,,,
Hydrocortisone/Iodoquinol,250,RC,VB003635,LOCAL,,inpatient,28.4,GM,689.76,689.76,,,,,,,,,,,,,,,,,
Ibuprofen,250,RC,VB003636,LOCAL,,inpatient,120,ML,5,5,,,,,,,,,,,,,,,,,
desipramine HCL,250,RC,VB003637,LOCAL,,inpatient,1,EA,10.71,10.71,,,,,,,,,,,,,,,,,
Sodium Polystyrene Sulfon/Sorb,250,RC,VB003638,LOCAL,,inpatient,60,ML,124,124,,,,,,,,,,,,,,,,,
Sorbitol Solution  70 %,250,RC,VB003639,LOCAL,,inpatient,30,ML,16.2,16.2,,,,,,,,,,,,,,,,,
Nitroglycerin,250,RC,VB003640,LOCAL,,inpatient,1,EA,10.38,10.38,,,,,,,,,,,,,,,,,
Rivastigmine,250,RC,VB003641,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
ARIPiprazole,250,RC,VB003642,LOCAL,,inpatient,1,EA,8.3,8.3,,,,,,,,,,,,,,,,,
Saliva Substitute Combo No.9,250,RC,VB003643,LOCAL,,inpatient,1,EA,23.24,23.24,,,,,,,,,,,,,,,,,
Lactobacillus Rhamnosus Gg,250,RC,VB003644,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Benzylpenicilloyl Polylysine,250,RC,VB003652,LOCAL,,inpatient,0.25,EA,3244.8,3244.8,,,,,,,,,,,,,,,,,
Formoterol Fumarate,250,RC,VB003653,LOCAL,,inpatient,2,ML,98.35,98.35,,,,,,,,,,,,,,,,,
lamiVUDine,250,RC,VB003654,LOCAL,,inpatient,1,EA,33.26,33.26,,,,,,,,,,,,,,,,,
Fosamprenavir Calcium,250,RC,VB003655,LOCAL,,inpatient,1,EA,92.69,92.69,,,,,,,,,,,,,,,,,
Abacavir Sulfate,250,RC,VB003656,LOCAL,,inpatient,1,EA,44.69,44.69,,,,,,,,,,,,,,,,,
Theophylline Anhydrous,250,RC,VB003657,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Nitroglycerin,250,RC,VB003658,LOCAL,,inpatient,1,EA,7.51,7.51,,,,,,,,,,,,,,,,,
Imipramine HCL,250,RC,VB003659,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Calcitonin,salmon,synthetic",250,RC,VB003660,LOCAL,,inpatient,3.7,ML,474.16,474.16,,,,,,,,,,,,,,,,,
Doxepin HCL,250,RC,VB003661,LOCAL,,inpatient,1,EA,13.58,13.58,,,,,,,,,,,,,,,,,
minoxidiL,250,RC,VB003662,LOCAL,,inpatient,1,EA,6.75,6.75,,,,,,,,,,,,,,,,,
Cholestyramine (With Sugar),250,RC,VB003663,LOCAL,,inpatient,60,GM,13.48,13.48,,,,,,,,,,,,,,,,,
Budesonide DR,250,RC,VB003664,LOCAL,,inpatient,1,EA,99.43,99.43,,,,,,,,,,,,,,,,,
Dapsone,250,RC,VB003665,LOCAL,,inpatient,1,EA,13.44,13.44,,,,,,,,,,,,,,,,,
Dapsone,250,RC,VB003666,LOCAL,,inpatient,1,EA,10.95,10.95,,,,,,,,,,,,,,,,,
Desloratadine,250,RC,VB003667,LOCAL,,inpatient,1,EA,32.32,32.32,,,,,,,,,,,,,,,,,
Olmesartan Medoxomil,250,RC,VB003668,LOCAL,,inpatient,1,EA,31.11,31.11,,,,,,,,,,,,,,,,,
Fluticasone Propion/Salmeterol,250,RC,VB003669,LOCAL,,inpatient,1,EA,2486.88,2486.88,,,,,,,,,,,,,,,,,
Bethanechol Chloride,250,RC,VB003670,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
traZODone HCL,250,RC,VB003671,LOCAL,,inpatient,1,EA,11.17,11.17,,,,,,,,,,,,,,,,,
Theophylline Anhydrous,250,RC,VB003672,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Theophylline Anhydrous,250,RC,VB003673,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Alteplase,250,RC,VB003674,LOCAL,,inpatient,1,EA,888.82,888.82,,,,,,,,,,,,,,,,,
Rituximab,250,RC,VB003675,LOCAL,,inpatient,10,ML,4509.7,4509.7,,,,,,,,,,,,,,,,,
Rituximab,250,RC,VB003676,LOCAL,,inpatient,50,ML,450.97,450.97,,,,,,,,,,,,,,,,,
Dornase Alfa,250,RC,VB003677,LOCAL,,inpatient,2.5,ML,642.1,642.1,,,,,,,,,,,,,,,,,
Bethanechol Chloride,250,RC,VB003678,LOCAL,,inpatient,1,EA,10.9,10.9,,,,,,,,,,,,,,,,,
buPROPion HCL,250,RC,VB003679,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Docusate Calcium,250,RC,VB003680,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Famotidine,250,RC,VB003681,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Fenofibrate Nanocrystallized,250,RC,VB003682,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Finasteride,250,RC,VB003683,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Fluconazole,250,RC,VB003684,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Fluconazole,250,RC,VB003685,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Irbesartan,250,RC,VB003686,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
levETIRAcetam Oral - UD,250,RC,VB003687,LOCAL,,inpatient,5,ML,27.52,27.52,,,,,,,,,,,,,,,,,
Melatonin,250,RC,VB003688,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
NIFEdipine,250,RC,VB003689,LOCAL,,inpatient,1,EA,5.25,5.25,,,,,,,,,,,,,,,,,
QUEtiapine FUMARATE,250,RC,VB003690,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Primidone,250,RC,VB003691,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
simvastatin,250,RC,VB003692,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
simvastatin,250,RC,VB003693,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Torsemide,250,RC,VB003694,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Trimethoprim,250,RC,VB003695,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Venlafaxine HCL,250,RC,VB003696,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Venlafaxine HCL,250,RC,VB003697,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Cyanocobalamin (Vitamin B-12),250,RC,VB003698,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Cyanocobalamin (Vitamin B-12),250,RC,VB003699,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Glycerin/Witch Hazel,250,RC,VB003700,LOCAL,,inpatient,1,EA,13.96,13.96,,,,,,,,,,,,,,,,,
guaiFENesin - UD,250,RC,VB003701,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
Loperamide HCL,250,RC,VB003702,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
lidocaine HCL 2 %,250,RC,VB003703,LOCAL,,inpatient,15,ML,5,5,,,,,,,,,,,,,,,,,
estradioL 0.05 mg/24 hour Patch,250,RC,VB003704,LOCAL,,inpatient,1,EA,91.56,91.56,,,,,,,,,,,,,,,,,
estradioL,250,RC,VB003705,LOCAL,,inpatient,1,EA,91.56,91.56,,,,,,,,,,,,,,,,,
estradioL,250,RC,VB003706,LOCAL,,inpatient,1,EA,91.56,91.56,,,,,,,,,,,,,,,,,
estradioL,250,RC,VB003707,LOCAL,,inpatient,1,EA,91.56,91.56,,,,,,,,,,,,,,,,,
Ciprofloxacin/Ciprofloxa HCL,250,RC,VB003708,LOCAL,,inpatient,1,EA,47.66,47.66,,,,,,,,,,,,,,,,,
Docusate Sodium,250,RC,VB003709,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Selenium Sulfide/Menthol,250,RC,VB003710,LOCAL,,inpatient,1,EA,23.64,23.64,,,,,,,,,,,,,,,,,
Sennosides/Docusate Sod 8.6MG-50MG,250,RC,VB003711,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Canagliflozin,250,RC,VB003712,LOCAL,,inpatient,1,EA,95.77,95.77,,,,,,,,,,,,,,,,,
Canagliflozin,250,RC,VB003713,LOCAL,,inpatient,1,EA,95.77,95.77,,,,,,,,,,,,,,,,,
Almotriptan Malate,250,RC,VB003714,LOCAL,,inpatient,1,EA,204.98,204.98,,,,,,,,,,,,,,,,,
Itraconazole,250,RC,VB003715,LOCAL,,inpatient,1,EA,137.8,137.8,,,,,,,,,,,,,,,,,
Risperidone Microspheres,250,RC,VB003716,LOCAL,,inpatient,1,EA,3097.39,3097.39,,,,,,,,,,,,,,,,,
Risperidone Microspheres,250,RC,VB003717,LOCAL,,inpatient,1,EA,4646.26,4646.26,,,,,,,,,,,,,,,,,
Risperidone Microspheres,250,RC,VB003718,LOCAL,,inpatient,1,EA,6195.22,6195.22,,,,,,,,,,,,,,,,,
risperiDONE,250,RC,VB003719,LOCAL,,inpatient,1,EA,59.05,59.05,,,,,,,,,,,,,,,,,
risperiDONE,250,RC,VB003720,LOCAL,,inpatient,1,EA,46.4,46.4,,,,,,,,,,,,,,,,,
Galantamine Hbr,250,RC,VB003721,LOCAL,,inpatient,1,EA,25.61,25.61,,,,,,,,,,,,,,,,,
Galantamine Hbr,250,RC,VB003722,LOCAL,,inpatient,1,EA,25.61,25.61,,,,,,,,,,,,,,,,,
Galantamine Hbr,250,RC,VB003723,LOCAL,,inpatient,1,EA,25.61,25.61,,,,,,,,,,,,,,,,,
Paliperidone,250,RC,VB003724,LOCAL,,inpatient,1,EA,192.34,192.34,,,,,,,,,,,,,,,,,
Paliperidone,250,RC,VB003725,LOCAL,,inpatient,1,EA,192.34,192.34,,,,,,,,,,,,,,,,,
Paliperidone Palmitate,250,RC,VB003726,LOCAL,,inpatient,0.75,ML,8565.84,8565.84,,,,,,,,,,,,,,,,,
Paliperidone Palmitate,250,RC,VB003727,LOCAL,,inpatient,1,ML,11421.55,11421.55,,,,,,,,,,,,,,,,,
Paliperidone Palmitate,250,RC,VB003728,LOCAL,,inpatient,1.5,ML,17131.92,17131.92,,,,,,,,,,,,,,,,,
Rivaroxaban,250,RC,VB003729,LOCAL,,inpatient,1,EA,47.84,47.84,,,,,,,,,,,,,,,,,
Rivaroxaban,250,RC,VB003730,LOCAL,,inpatient,1,EA,95.69,95.69,,,,,,,,,,,,,,,,,
Rivaroxaban,250,RC,VB003731,LOCAL,,inpatient,1,EA,95.69,95.69,,,,,,,,,,,,,,,,,
Rivaroxaban,250,RC,VB003732,LOCAL,,inpatient,1,EA,95.69,95.69,,,,,,,,,,,,,,,,,
levETIRAcetam Injection,250,RC,VB003733,LOCAL,,inpatient,5,ML,327.5,327.5,,,,,,,,,,,,,,,,,
Rotigotine,250,RC,VB003734,LOCAL,,inpatient,1,EA,138.23,138.23,,,,,,,,,,,,,,,,,
Collagenase Clostridium Hist. Oint,250,RC,VB003735,LOCAL,,inpatient,30,GM,1523.86,1523.86,,,,,,,,,,,,,,,,,
Sodium Chloride,250,RC,VB003736,LOCAL,,inpatient,30,ML,10.04,10.04,,,,,,,,,,,,,,,,,
Acetaminophen,250,RC,VB003737,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
metOLazone,250,RC,VB003738,LOCAL,,inpatient,1,EA,13.14,13.14,,,,,,,,,,,,,,,,,
metOLazone,250,RC,VB003739,LOCAL,,inpatient,1,EA,14.93,14.93,,,,,,,,,,,,,,,,,
Chlorthalidone,250,RC,VB003740,LOCAL,,inpatient,1,EA,9.18,9.18,,,,,,,,,,,,,,,,,
hydrOXYzine PAMOATE,250,RC,VB003741,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
hydrOXYzine PAMOATE,250,RC,VB003742,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Isoniazid,250,RC,VB003743,LOCAL,,inpatient,1,EA,5.15,5.15,,,,,,,,,,,,,,,,,
Spironolactone,250,RC,VB003744,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Spironolact/Hydrochlorothiazid,250,RC,VB003745,LOCAL,,inpatient,1,EA,8.64,8.64,,,,,,,,,,,,,,,,,
folic acid,250,RC,VB003746,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dicyclomine HCL,250,RC,VB003747,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dicyclomine HCL,250,RC,VB003748,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Amitriptyline HCL,250,RC,VB003749,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
chlordiazePOXIDE HCL,250,RC,VB003750,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ciprofloxacin HCL,250,RC,VB003751,LOCAL,,inpatient,1,EA,20.4,20.4,,,,,,,,,,,,,,,,,
Indomethacin,250,RC,VB003752,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Indomethacin,250,RC,VB003753,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Methyldopa,250,RC,VB003754,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Methyldopa,250,RC,VB003755,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Loratadine,250,RC,VB003756,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
metoprolol tartrate,250,RC,VB003757,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
propranolol HCL,250,RC,VB003758,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
propranolol HCL,250,RC,VB003759,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
diazePAM,250,RC,VB003760,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
cloNIDine HCL,250,RC,VB003761,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
cloNIDine HCL,250,RC,VB003762,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
cloNIDine HCL,250,RC,VB003763,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
polyethylene glycoL 3350,250,RC,VB003764,LOCAL,,inpatient,1,EA,7.53,7.53,,,,,,,,,,,,,,,,,
ziprasidone HCL,250,RC,VB003765,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
ziprasidone HCL,250,RC,VB003766,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
chlordiazePOXIDE HCL,250,RC,VB003767,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
mycophenolate mofetiL,250,RC,VB003768,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
buPROPion HCL SR,250,RC,VB003769,LOCAL,,inpatient,1,EA,6.76,6.76,,,,,,,,,,,,,,,,,
LORazepam,250,RC,VB003770,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Temazepam,250,RC,VB003771,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Triamterene/Hydrochlorothiazid,250,RC,VB003772,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Doxepin HCL,250,RC,VB003773,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Doxepin HCL,250,RC,VB003774,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Doxepin HCL,250,RC,VB003775,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
levothyroxine SODIUM,250,RC,VB003776,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
amLODIPine BESYLATE,250,RC,VB003777,LOCAL,,inpatient,1,EA,6.92,6.92,,,,,,,,,,,,,,,,,
Meloxicam,250,RC,VB003778,LOCAL,,inpatient,1,EA,12.53,12.53,,,,,,,,,,,,,,,,,
Meloxicam,250,RC,VB003779,LOCAL,,inpatient,1,EA,19.16,19.16,,,,,,,,,,,,,,,,,
risperiDONE,250,RC,VB003780,LOCAL,,inpatient,1,EA,15.57,15.57,,,,,,,,,,,,,,,,,
risperiDONE,250,RC,VB003781,LOCAL,,inpatient,1,EA,18.17,18.17,,,,,,,,,,,,,,,,,
risperiDONE,250,RC,VB003782,LOCAL,,inpatient,1,EA,30.36,30.36,,,,,,,,,,,,,,,,,
risperiDONE,250,RC,VB003783,LOCAL,,inpatient,1,EA,35.66,35.66,,,,,,,,,,,,,,,,,
Felodipine,250,RC,VB003784,LOCAL,,inpatient,1,EA,10.86,10.86,,,,,,,,,,,,,,,,,
fluPHENAZine HCL,250,RC,VB003785,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
fluPHENAZine HCL,250,RC,VB003786,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
fluPHENAZine HCL,250,RC,VB003787,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
lamoTRIgine,250,RC,VB003788,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
lamoTRIgine,250,RC,VB003789,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
chlorproMAZINE HCL,250,RC,VB003790,LOCAL,,inpatient,1,EA,88.95,88.95,,,,,,,,,,,,,,,,,
chlorproMAZINE HCL,250,RC,VB003791,LOCAL,,inpatient,1,EA,26.52,26.52,,,,,,,,,,,,,,,,,
Prochlorperazine Maleate,250,RC,VB003792,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Prochlorperazine Maleate,250,RC,VB003793,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Fexofenadine HCL,250,RC,VB003794,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Acyclovir 5%,250,RC,VB003795,LOCAL,,inpatient,5,GM,5,5,,,,,,,,,,,,,,,,,
Thioridazine HCL,250,RC,VB003796,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Thioridazine HCL,250,RC,VB003797,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Thioridazine HCL,250,RC,VB003798,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Trifluoperazine HCL,250,RC,VB003799,LOCAL,,inpatient,1,EA,5.37,5.37,,,,,,,,,,,,,,,,,
Trifluoperazine HCL,250,RC,VB003800,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Thioridazine HCL,250,RC,VB003801,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Thiothixene,250,RC,VB003802,LOCAL,,inpatient,1,EA,9.56,9.56,,,,,,,,,,,,,,,,,
Thiothixene,250,RC,VB003803,LOCAL,,inpatient,1,EA,14.49,14.49,,,,,,,,,,,,,,,,,
Thiothixene,250,RC,VB003804,LOCAL,,inpatient,1,EA,20.43,20.43,,,,,,,,,,,,,,,,,
azaTHIOprine,250,RC,VB003805,LOCAL,,inpatient,1,EA,9.38,9.38,,,,,,,,,,,,,,,,,
Mafenide Acetate,250,RC,VB003806,LOCAL,,inpatient,56.7,GM,290.48,290.48,,,,,,,,,,,,,,,,,
Prazosin HCL,250,RC,VB003807,LOCAL,,inpatient,1,EA,7.25,7.25,,,,,,,,,,,,,,,,,
Prazosin HCL,250,RC,VB003808,LOCAL,,inpatient,1,EA,10.09,10.09,,,,,,,,,,,,,,,,,
Prazosin HCL,250,RC,VB003809,LOCAL,,inpatient,1,EA,17.23,17.23,,,,,,,,,,,,,,,,,
Cyclobenzaprine HCL,250,RC,VB003810,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Albuterol Sulfate,250,RC,VB003811,LOCAL,,inpatient,1,EA,28.2,28.2,,,,,,,,,,,,,,,,,
Albuterol Sulfate,250,RC,VB003812,LOCAL,,inpatient,1,EA,28.2,28.2,,,,,,,,,,,,,,,,,
atenoloL,250,RC,VB003813,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
atenoloL,250,RC,VB003814,LOCAL,,inpatient,1,EA,5.97,5.97,,,,,,,,,,,,,,,,,
Loperamide HCL,250,RC,VB003815,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Oxybutynin Cl ER,250,RC,VB003816,LOCAL,,inpatient,1,EA,13.14,13.14,,,,,,,,,,,,,,,,,
Topiramate,250,RC,VB003817,LOCAL,,inpatient,1,EA,10.22,10.22,,,,,,,,,,,,,,,,,
haloperidoL,250,RC,VB003818,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
dilTIAZem HCL,250,RC,VB003819,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
dilTIAZem HCL,250,RC,VB003820,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
cloZAPine,250,RC,VB003821,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Carbidopa/Levodopa 25/100mg,250,RC,VB003822,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
atenoloL,250,RC,VB003823,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Divalproex Sodium ER,250,RC,VB003824,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Zonisamide,250,RC,VB003825,LOCAL,,inpatient,1,EA,7.9,7.9,,,,,,,,,,,,,,,,,
ALPRAZolam,250,RC,VB003826,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
ALPRAZolam,250,RC,VB003827,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Naproxen,250,RC,VB003828,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
metoprolol tartrate,250,RC,VB003829,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
metoprolol tartrate,250,RC,VB003830,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
glipiZIDE,250,RC,VB003831,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
glipiZIDE,250,RC,VB003832,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
nadoloL,250,RC,VB003833,LOCAL,,inpatient,1,EA,24.76,24.76,,,,,,,,,,,,,,,,,
nadoloL,250,RC,VB003834,LOCAL,,inpatient,1,EA,28.91,28.91,,,,,,,,,,,,,,,,,
Indapamide,250,RC,VB003835,LOCAL,,inpatient,1,EA,6.2,6.2,,,,,,,,,,,,,,,,,
carBAMazepine,250,RC,VB003836,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
glyBURIDE,250,RC,VB003837,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
glyBURIDE,250,RC,VB003838,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
clonazePAM,250,RC,VB003839,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
clonazePAM,250,RC,VB003840,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pentoxifylline ER,250,RC,VB003841,LOCAL,,inpatient,1,EA,5.99,5.99,,,,,,,,,,,,,,,,,
NIFEdipine,250,RC,VB003842,LOCAL,,inpatient,1,EA,10.25,10.25,,,,,,,,,,,,,,,,,
verapamil HCL,250,RC,VB003843,LOCAL,,inpatient,1,EA,9.97,9.97,,,,,,,,,,,,,,,,,
Loxapine Succinate,250,RC,VB003844,LOCAL,,inpatient,1,EA,7.7,7.7,,,,,,,,,,,,,,,,,
amiodarone HCL,250,RC,VB003845,LOCAL,,inpatient,1,EA,13.16,13.16,,,,,,,,,,,,,,,,,
cloZAPine,250,RC,VB003846,LOCAL,,inpatient,1,EA,5.29,5.29,,,,,,,,,,,,,,,,,
cloZAPine,250,RC,VB003847,LOCAL,,inpatient,1,EA,13.71,13.71,,,,,,,,,,,,,,,,,
dilTIAZem HCL,250,RC,VB003848,LOCAL,,inpatient,1,EA,15.89,15.89,,,,,,,,,,,,,,,,,
dilTIAZem HCL,250,RC,VB003849,LOCAL,,inpatient,1,EA,18.69,18.69,,,,,,,,,,,,,,,,,
labetalol HCL,250,RC,VB003850,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
labetalol HCL,250,RC,VB003851,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
carvediloL,250,RC,VB003852,LOCAL,,inpatient,1,EA,8.54,8.54,,,,,,,,,,,,,,,,,
carvediloL,250,RC,VB003853,LOCAL,,inpatient,1,EA,8.54,8.54,,,,,,,,,,,,,,,,,
carvediloL,250,RC,VB003854,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Triamterene/Hydrochlorothiazid,250,RC,VB003855,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Terazosin HCL,250,RC,VB003856,LOCAL,,inpatient,1,EA,6.42,6.42,,,,,,,,,,,,,,,,,
Terazosin HCL,250,RC,VB003857,LOCAL,,inpatient,1,EA,6.42,6.42,,,,,,,,,,,,,,,,,
Alendronate Sodium,250,RC,VB003858,LOCAL,,inpatient,1,EA,81.85,81.85,,,,,,,,,,,,,,,,,
buPROPion HCL,250,RC,VB003859,LOCAL,,inpatient,1,EA,6.19,6.19,,,,,,,,,,,,,,,,,
Enalapril Maleate,250,RC,VB003860,LOCAL,,inpatient,1,EA,5.83,5.83,,,,,,,,,,,,,,,,,
Enalapril Maleate,250,RC,VB003861,LOCAL,,inpatient,1,EA,11.06,11.06,,,,,,,,,,,,,,,,,
Doxazosin Mesylate,250,RC,VB003862,LOCAL,,inpatient,1,EA,15.06,15.06,,,,,,,,,,,,,,,,,
Doxazosin Mesylate,250,RC,VB003863,LOCAL,,inpatient,1,EA,15.78,15.78,,,,,,,,,,,,,,,,,
Spironolactone,250,RC,VB003864,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
busPIRone HCL,250,RC,VB003865,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
busPIRone HCL 10 MG,250,RC,VB003866,LOCAL,,inpatient,1,EA,5.38,5.38,,,,,,,,,,,,,,,,,
traMADoL HCL,250,RC,VB003867,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
fluvoxaMINE MALEATE,250,RC,VB003868,LOCAL,,inpatient,1,EA,10.29,10.29,,,,,,,,,,,,,,,,,
fluvoxaMINE MALEATE,250,RC,VB003869,LOCAL,,inpatient,1,EA,10.56,10.56,,,,,,,,,,,,,,,,,
Phentolamine Mesylate,250,RC,VB003870,LOCAL,,inpatient,1,EA,2006.4,2006.4,,,,,,,,,,,,,,,,,
Disulfiram,250,RC,VB003871,LOCAL,,inpatient,1,EA,16.16,16.16,,,,,,,,,,,,,,,,,
acetaZOLAMIDE,250,RC,VB003872,LOCAL,,inpatient,1,EA,44.4,44.4,,,,,,,,,,,,,,,,,
metroNIDAZOLE,250,RC,VB003873,LOCAL,,inpatient,25,GM,254.92,254.92,,,,,,,,,,,,,,,,,
acetic acid,250,RC,VB003874,LOCAL,,inpatient,500,ML,268.56,268.56,,,,,,,,,,,,,,,,,
clobetasoL PROPIONATE 0.05 %,250,RC,VB003875,LOCAL,,inpatient,15,GM,512.92,512.92,,,,,,,,,,,,,,,,,
clobetasoL PROPIONATE 0.05% Oint,250,RC,VB003876,LOCAL,,inpatient,15,GM,621.8,621.8,,,,,,,,,,,,,,,,,
Clotrimazole,250,RC,VB003877,LOCAL,,inpatient,30,ML,298.92,298.92,,,,,,,,,,,,,,,,,
Nystatin-Triamcin 10000Unit/GM-0.1%,250,RC,VB003878,LOCAL,,inpatient,15,GM,447.76,447.76,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide 0.1 %,250,RC,VB003879,LOCAL,,inpatient,5,GM,322.36,322.36,,,,,,,,,,,,,,,,,
Desoximetasone,250,RC,VB003880,LOCAL,,inpatient,15,GM,405,405,,,,,,,,,,,,,,,,,
Desoximetasone,250,RC,VB003881,LOCAL,,inpatient,15,GM,249.72,249.72,,,,,,,,,,,,,,,,,
Nystatin/Triamcin,250,RC,VB003882,LOCAL,,inpatient,15,GM,447.76,447.76,,,,,,,,,,,,,,,,,
Desonide 0.05 %,250,RC,VB003883,LOCAL,,inpatient,15,GM,321.16,321.16,,,,,,,,,,,,,,,,,
Triamcinolone Acet 0.1% Cream 15gm,250,RC,VB003884,LOCAL,,inpatient,15,GM,22.04,22.04,,,,,,,,,,,,,,,,,
nystatin 100000 Unit/GM - 15GM,250,RC,VB003885,LOCAL,,inpatient,15,GM,70.2,70.2,,,,,,,,,,,,,,,,,
Ketoconazole 2 %,250,RC,VB003886,LOCAL,,inpatient,15,GM,525.32,525.32,,,,,,,,,,,,,,,,,
Ciclopirox Olamine,250,RC,VB003887,LOCAL,,inpatient,15,GM,114.4,114.4,,,,,,,,,,,,,,,,,
clomiPRAMINE HCL,250,RC,VB003888,LOCAL,,inpatient,1,EA,44.97,44.97,,,,,,,,,,,,,,,,,
acetaZOLAMIDE,250,RC,VB003889,LOCAL,,inpatient,1,EA,11.53,11.53,,,,,,,,,,,,,,,,,
Clorazepate Dipotassium,250,RC,VB003890,LOCAL,,inpatient,1,EA,20.07,20.07,,,,,,,,,,,,,,,,,
carBAMazepine,250,RC,VB003891,LOCAL,,inpatient,450,ML,5,5,,,,,,,,,,,,,,,,,
Clotrimazole/Betamethason 1 %-0.05%,250,RC,VB003892,LOCAL,,inpatient,15,GM,122.88,122.88,,,,,,,,,,,,,,,,,
Pramoxine HCL 1% Foam,250,RC,VB003893,LOCAL,,inpatient,15,ML,209.72,209.72,,,,,,,,,,,,,,,,,
Silver Nitrate,250,RC,VB003894,LOCAL,,inpatient,1,EA,137.68,137.68,,,,,,,,,,,,,,,,,
"Collodion, Flexible",250,RC,VB003895,LOCAL,,inpatient,1,EA,5.96,5.96,,,,,,,,,,,,,,,,,
Ammonium Sulfate,250,RC,VB003896,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Codeine/Butalbital/Asa/Caffein,250,RC,VB003897,LOCAL,,inpatient,1,EA,10.96,10.96,,,,,,,,,,,,,,,,,
Multivit-Mins No.7/Folic Acid,250,RC,VB003898,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Letrozole,250,RC,VB003899,LOCAL,,inpatient,1,EA,72.46,72.46,,,,,,,,,,,,,,,,,
Fidaxomicin,250,RC,VB003900,LOCAL,,inpatient,1,EA,1249.2,1249.2,,,,,,,,,,,,,,,,,
Pyrimethamine,250,RC,VB003901,LOCAL,,inpatient,1,EA,3600,3600,,,,,,,,,,,,,,,,,
Isosorbide Dinitrate,250,RC,VB003902,LOCAL,,inpatient,1,EA,22.36,22.36,,,,,,,,,,,,,,,,,
"Peg3350/Sod Sulf,bicarb,cl/Kcl",250,RC,VB003903,LOCAL,,inpatient,4000,ML,119.57,119.57,,,,,,,,,,,,,,,,,
Nitrofurantoin Monohyd/M-Cryst,250,RC,VB003904,LOCAL,,inpatient,1,EA,28.55,28.55,,,,,,,,,,,,,,,,,
raNITIdine HCL,250,RC,VB003905,LOCAL,,inpatient,6,ML,39.6,39.6,,,,,,,,,,,,,,,,,
Melphalan,250,RC,VB003906,LOCAL,,inpatient,1,EA,54.34,54.34,,,,,,,,,,,,,,,,,
Mineral Oil/Hydrophil Petrolat,250,RC,VB003907,LOCAL,,inpatient,1,EA,30,30,,,,,,,,,,,,,,,,,
Eszopiclone,250,RC,VB003908,LOCAL,,inpatient,1,EA,24.67,24.67,,,,,,,,,,,,,,,,,
Microfibrillar Collagen,250,RC,VB003909,LOCAL,,inpatient,1,EA,912,912,,,,,,,,,,,,,,,,,
Ergoloid Mesylates,250,RC,VB003910,LOCAL,,inpatient,1,EA,32.42,32.42,,,,,,,,,,,,,,,,,
Felodipine,250,RC,VB003911,LOCAL,,inpatient,1,EA,6.04,6.04,,,,,,,,,,,,,,,,,
Felodipine,250,RC,VB003912,LOCAL,,inpatient,1,EA,6.04,6.04,,,,,,,,,,,,,,,,,
Trimethobenzamide HCL,250,RC,VB003913,LOCAL,,inpatient,1,EA,6.55,6.55,,,,,,,,,,,,,,,,,
Sulindac,250,RC,VB003914,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Trypsin/Balsam Peru/Castor Oil,250,RC,VB003915,LOCAL,,inpatient,113.4,ML,73.4,73.4,,,,,,,,,,,,,,,,,
Sulfamethoxazole-Trimethop 400-80MG,250,RC,VB003916,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Calcium Citrate,250,RC,VB003917,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Mesalamine,250,RC,VB003918,LOCAL,,inpatient,1,EA,14.57,14.57,,,,,,,,,,,,,,,,,
lanthanum carbonate,250,RC,VB003919,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
lanthanum carbonate,250,RC,VB003920,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Mineral Oil,250,RC,VB003921,LOCAL,,inpatient,1,EA,8.96,8.96,,,,,,,,,,,,,,,,,
Hydrocortisone,250,RC,VB003922,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pseudoephedrine HCL,250,RC,VB003923,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Permethrin,250,RC,VB003924,LOCAL,,inpatient,1,EA,44.16,44.16,,,,,,,,,,,,,,,,,
"Tetanus, Diphtheria Tox,adult",250,RC,VB003925,LOCAL,,inpatient,0.5,EA,26.04,26.04,,,,,,,,,,,,,,,,,
Hepatitis A and B Vaccines,250,RC,VB003926,LOCAL,,inpatient,1,EA,402.14,402.14,,,,,,,,,,,,,,,,,
rosuvastatin CALCIUM,250,RC,VB003927,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Aliskiren Hemifumarate,250,RC,VB003928,LOCAL,,inpatient,1,EA,18.74,18.74,,,,,,,,,,,,,,,,,
Elviteg/Cob/Emtri/Tenofo Disop,250,RC,VB003929,LOCAL,,inpatient,1,EA,601.23,601.23,,,,,,,,,,,,,,,,,
Darunavir Ethanolate,250,RC,VB003930,LOCAL,,inpatient,1,EA,304.68,304.68,,,,,,,,,,,,,,,,,
"Multivitamin Inj, Adult",250,RC,VB003931,LOCAL,,inpatient,10,ML,73.82,73.82,,,,,,,,,,,,,,,,,
Homatropine Hbr,250,RC,VB003932,LOCAL,,inpatient,1,EA,177.4,177.4,,,,,,,,,,,,,,,,,
Vitamin E,250,RC,VB003933,LOCAL,,inpatient,30,ML,5.4,5.4,,,,,,,,,,,,,,,,,
Multivitamin,250,RC,VB003934,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
FLUoxetine HCL,250,RC,VB003935,LOCAL,,inpatient,120,ML,5,5,,,,,,,,,,,,,,,,,
raNITIdine HCL,250,RC,VB003936,LOCAL,,inpatient,1,EA,5.9,5.9,,,,,,,,,,,,,,,,,
FLUoxetine HCL,250,RC,VB003937,LOCAL,,inpatient,1,EA,10.39,10.39,,,,,,,,,,,,,,,,,
Fondaparinux Sodium,250,RC,VB003938,LOCAL,,inpatient,0.8,ML,543.2,543.2,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB003939,LOCAL,,inpatient,1,EA,28,28,,,,,,,,,,,,,,,,,
QUEtiapine FUMARATE,250,RC,VB003940,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Theophylline Anhydrous ER,250,RC,VB003941,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
quinapril HCL,250,RC,VB003942,LOCAL,,inpatient,1,EA,15.1,15.1,,,,,,,,,,,,,,,,,
Ethotoin,250,RC,VB003943,LOCAL,,inpatient,1,EA,10.94,10.94,,,,,,,,,,,,,,,,,
Darbepoetin Alfa In Polysorbat,250,RC,VB003944,LOCAL,,inpatient,1,ML,1486.08,1486.08,,,,,,,,,,,,,,,,,
Darbepoetin Alfa In Polysorbat,250,RC,VB003945,LOCAL,,inpatient,0.3,ML,2229.12,2229.12,,,,,,,,,,,,,,,,,
Darbepoetin Alfa In Polysorbat,250,RC,VB003946,LOCAL,,inpatient,0.5,ML,3715.2,3715.2,,,,,,,,,,,,,,,,,
Darbepoetin Alfa In Polysorbat,250,RC,VB003947,LOCAL,,inpatient,0.42,ML,928.8,928.8,,,,,,,,,,,,,,,,,
Cinacalcet HCL,250,RC,VB003948,LOCAL,,inpatient,1,EA,129.07,129.07,,,,,,,,,,,,,,,,,
Pegfilgrastim,250,RC,VB003949,LOCAL,,inpatient,0.6,ML,30806.35,30806.35,,,,,,,,,,,,,,,,,
Romiplostim,250,RC,VB003950,LOCAL,,inpatient,1,EA,13214.5,13214.5,,,,,,,,,,,,,,,,,
Filgrastim,250,RC,VB003951,LOCAL,,inpatient,1,ML,1511.2,1511.2,,,,,,,,,,,,,,,,,
Filgrastim,250,RC,VB003952,LOCAL,,inpatient,1.6,ML,2406.38,2406.38,,,,,,,,,,,,,,,,,
Desmopressin Acetate,250,RC,VB003953,LOCAL,,inpatient,2.5,ML,1324.08,1324.08,,,,,,,,,,,,,,,,,
Desmopressin (Nonrefrig) 0.01%,250,RC,VB003954,LOCAL,,inpatient,5,ML,2284.08,2284.08,,,,,,,,,,,,,,,,,
"Cellulose,oxidized",250,RC,VB003955,LOCAL,,inpatient,1,EA,4587.07,4587.07,,,,,,,,,,,,,,,,,
niMODipine,250,RC,VB003956,LOCAL,,inpatient,1,EA,24,24,,,,,,,,,,,,,,,,,
Amphotericin B Lipid Complex,250,RC,VB003957,LOCAL,,inpatient,20,ML,504,504,,,,,,,,,,,,,,,,,
Infliximab,250,RC,VB003958,LOCAL,,inpatient,1,EA,5605.54,5605.54,,,,,,,,,,,,,,,,,
Sennosides,250,RC,VB003959,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Diph,pertuss(Acell),tet Ped/Pf",250,RC,VB003960,LOCAL,,inpatient,0.5,EA,230.97,230.97,,,,,,,,,,,,,,,,,
Hep B Vaccine/Dp(A)t-Polio/Pf,250,RC,VB003961,LOCAL,,inpatient,0.5,EA,958.75,958.75,,,,,,,,,,,,,,,,,
Hepatitis B Virus Vaccine/Pf,250,RC,VB003962,LOCAL,,inpatient,0.5,EA,107.04,107.04,,,,,,,,,,,,,,,,,
Sevelamer Carbonate,250,RC,VB003963,LOCAL,,inpatient,1,EA,28.56,28.56,,,,,,,,,,,,,,,,,
Sevelamer Carbonate,250,RC,VB003964,LOCAL,,inpatient,1,EA,85.67,85.67,,,,,,,,,,,,,,,,,
Sevelamer Carbonate,250,RC,VB003965,LOCAL,,inpatient,1,EA,85.67,85.67,,,,,,,,,,,,,,,,,
Calcium Carbonate,250,RC,VB003966,LOCAL,,inpatient,1,EA,1.5,1.5,,,,,,,,,,,,,,,,,
quinapril HCL,250,RC,VB003967,LOCAL,,inpatient,1,EA,12.07,12.07,,,,,,,,,,,,,,,,,
Mesalamine,250,RC,VB003968,LOCAL,,inpatient,1,EA,185.88,185.88,,,,,,,,,,,,,,,,,
Balsam Peru/Castor Oil,250,RC,VB003969,LOCAL,,inpatient,1,EA,150,150,,,,,,,,,,,,,,,,,
oxyCODONE HCL ER,250,RC,VB003970,LOCAL,,inpatient,1,EA,27.92,27.92,,,,,,,,,,,,,,,,,
oxyCODONE HCL ER,250,RC,VB003971,LOCAL,,inpatient,1,EA,41.07,41.07,,,,,,,,,,,,,,,,,
oxyCODONE HCL ER,250,RC,VB003972,LOCAL,,inpatient,1,EA,52.02,52.02,,,,,,,,,,,,,,,,,
oxyCODONE HCL ER,250,RC,VB003973,LOCAL,,inpatient,1,EA,89.05,89.05,,,,,,,,,,,,,,,,,
oxyCODONE HCL ER,250,RC,VB003974,LOCAL,,inpatient,1,EA,151.56,151.56,,,,,,,,,,,,,,,,,
Buprenorphine,250,RC,VB003975,LOCAL,,inpatient,1,EA,245.46,245.46,,,,,,,,,,,,,,,,,
Buprenorphine,250,RC,VB003976,LOCAL,,inpatient,1,EA,369.82,369.82,,,,,,,,,,,,,,,,,
Buprenorphine Patch,250,RC,VB003977,LOCAL,,inpatient,1,EA,658.67,658.67,,,,,,,,,,,,,,,,,
Buprenorphine,250,RC,VB003978,LOCAL,,inpatient,1,EA,345.16,345.16,,,,,,,,,,,,,,,,,
Buprenorphine,250,RC,VB003979,LOCAL,,inpatient,1,EA,626.21,626.21,,,,,,,,,,,,,,,,,
ARIPiprazole,250,RC,VB003980,LOCAL,,inpatient,1,EA,93.41,93.41,,,,,,,,,,,,,,,,,
Tolvaptan,250,RC,VB003981,LOCAL,,inpatient,1,EA,2496.95,2496.95,,,,,,,,,,,,,,,,,
Tolvaptan,250,RC,VB003982,LOCAL,,inpatient,1,EA,2590.29,2590.29,,,,,,,,,,,,,,,,,
ARIPiprazole,250,RC,VB003983,LOCAL,,inpatient,1,EA,13941.31,13941.31,,,,,,,,,,,,,,,,,
Beclomethasone Dipropionate,250,RC,VB003984,LOCAL,,inpatient,8.7,GM,812.54,812.54,,,,,,,,,,,,,,,,,
Beclomethasone Dipropionate,250,RC,VB003985,LOCAL,,inpatient,8.7,GM,1087.97,1087.97,,,,,,,,,,,,,,,,,
Ferumoxytol,250,RC,VB003986,LOCAL,,inpatient,17,ML,5729.38,5729.38,,,,,,,,,,,,,,,,,
Buprenorphine HCL,250,RC,VB003987,LOCAL,,inpatient,1,EA,34.24,34.24,,,,,,,,,,,,,,,,,
Interferon Beta-1a/Albumin,250,RC,VB003988,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Epoetin Alfa 2,000 units/mL",250,RC,VB003989,LOCAL,,inpatient,1,ML,256.61,256.61,,,,,,,,,,,,,,,,,
"Epoetin Alfa 4,000 units/mL",250,RC,VB003990,LOCAL,,inpatient,1,ML,513.12,513.12,,,,,,,,,,,,,,,,,
"Epoetin Alfa 10,000 units/mL",250,RC,VB003991,LOCAL,,inpatient,1,ML,1282.8,1282.8,,,,,,,,,,,,,,,,,
"Epoetin Alfa 40,000 units/mL",250,RC,VB003992,LOCAL,,inpatient,1,ML,5131.2,5131.2,,,,,,,,,,,,,,,,,
Darunavir Ethanolate,250,RC,VB003993,LOCAL,,inpatient,1,EA,172.65,172.65,,,,,,,,,,,,,,,,,
Etravirine,250,RC,VB003994,LOCAL,,inpatient,1,EA,59.92,59.92,,,,,,,,,,,,,,,,,
Hepatitis B Immune Globulin,250,RC,VB003995,LOCAL,,inpatient,5,EA,3217.76,3217.76,,,,,,,,,,,,,,,,,
Eplerenone,250,RC,VB003996,LOCAL,,inpatient,1,EA,14.88,14.88,,,,,,,,,,,,,,,,,
Azithromycin,250,RC,VB003997,LOCAL,,inpatient,1,EA,116.51,116.51,,,,,,,,,,,,,,,,,
Azithromycin,250,RC,VB003998,LOCAL,,inpatient,1,EA,16.32,16.32,,,,,,,,,,,,,,,,,
Azithromycin,250,RC,VB003999,LOCAL,,inpatient,1,EA,22.11,22.11,,,,,,,,,,,,,,,,,
Azithromycin,250,RC,VB004000,LOCAL,,inpatient,30,ML,5,5,,,,,,,,,,,,,,,,,
medroxyPROGESTERone ACETATE,250,RC,VB004001,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
medroxyPROGESTERone ACETATE,250,RC,VB004002,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
sertraline HCL,250,RC,VB004003,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
sertraline HCL,250,RC,VB004004,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
NIFEdipine,250,RC,VB004005,LOCAL,,inpatient,1,EA,9.17,9.17,,,,,,,,,,,,,,,,,
Magnesium Gluconate,250,RC,VB004006,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Sodium Thiosulfate 25% Inj,250,RC,VB004007,LOCAL,,inpatient,50,ML,480,480,,,,,,,,,,,,,,,,,
RABEprazole SODIUM,250,RC,VB004008,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
dexAMETHasone,250,RC,VB004009,LOCAL,,inpatient,237,ML,5,5,,,,,,,,,,,,,,,,,
Selenium Sulfide,250,RC,VB004010,LOCAL,,inpatient,118,ML,79.2,79.2,,,,,,,,,,,,,,,,,
Promethazine HCL,250,RC,VB004011,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
acetic acid 2% Otic,250,RC,VB004012,LOCAL,,inpatient,15,ML,160,160,,,,,,,,,,,,,,,,,
selegiline HCL,250,RC,VB004013,LOCAL,,inpatient,1,EA,9.21,9.21,,,,,,,,,,,,,,,,,
sotalol HCL,250,RC,VB004014,LOCAL,,inpatient,1,EA,10.25,10.25,,,,,,,,,,,,,,,,,
Doxazosin Mesylate,250,RC,VB004015,LOCAL,,inpatient,1,EA,5.95,5.95,,,,,,,,,,,,,,,,,
omeprazole,250,RC,VB004016,LOCAL,,inpatient,1,EA,29.59,29.59,,,,,,,,,,,,,,,,,
Cefepime HCL,250,RC,VB004017,LOCAL,,inpatient,1,ML,47.04,47.04,,,,,,,,,,,,,,,,,
Piperacillin Sodium/Tazobactam,250,RC,VB004018,LOCAL,,inpatient,1,EA,68.7,68.7,,,,,,,,,,,,,,,,,
ceFAZolin SODIUM,250,RC,VB004019,LOCAL,,inpatient,1,ML,10.45,10.45,,,,,,,,,,,,,,,,,
Cefepime HCL,250,RC,VB004020,LOCAL,,inpatient,1,ML,81.34,81.34,,,,,,,,,,,,,,,,,
Leflunomide,250,RC,VB004021,LOCAL,,inpatient,1,EA,65.62,65.62,,,,,,,,,,,,,,,,,
Cilostazol,250,RC,VB004022,LOCAL,,inpatient,1,EA,7.3,7.3,,,,,,,,,,,,,,,,,
levETIRAcetam,250,RC,VB004023,LOCAL,,inpatient,1,EA,17.79,17.79,,,,,,,,,,,,,,,,,
Solifenacin Succinate,250,RC,VB004024,LOCAL,,inpatient,1,EA,55.51,55.51,,,,,,,,,,,,,,,,,
Fondaparinux Sodium,250,RC,VB004025,LOCAL,,inpatient,0.6,ML,514.44,514.44,,,,,,,,,,,,,,,,,
ceFAZolin SODIUM,250,RC,VB004026,LOCAL,,inpatient,1,EA,10.44,10.44,,,,,,,,,,,,,,,,,
ceFAZolin SODIUM,250,RC,VB004027,LOCAL,,inpatient,1,ML,10.45,10.45,,,,,,,,,,,,,,,,,
ursodioL,250,RC,VB004028,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Benzonatate,250,RC,VB004029,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Candesartan Cilexetil,250,RC,VB004030,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
dilTIAZem HCL,250,RC,VB004031,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
dilTIAZem HCL,250,RC,VB004032,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Divalproex Sodium DR,250,RC,VB004033,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
cefUROXime axetiL,250,RC,VB004034,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
ritonavir,250,RC,VB004035,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Potassium Chloride,250,RC,VB004036,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pregabalin,250,RC,VB004037,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pregabalin,250,RC,VB004038,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Fluorometholone 0.1 % Ophth,250,RC,VB004039,LOCAL,,inpatient,5,ML,371.72,371.72,,,,,,,,,,,,,,,,,
liothyronine SODIUM,250,RC,VB004040,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
liothyronine SODIUM,250,RC,VB004041,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
penicillin G PROCAINE,250,RC,VB004042,LOCAL,,inpatient,1,ML,220.56,220.56,,,,,,,,,,,,,,,,,
penicillin G PROCAINE,250,RC,VB004043,LOCAL,,inpatient,2,ML,370.8,370.8,,,,,,,,,,,,,,,,,
Thrombin (Bovine),250,RC,VB004044,LOCAL,,inpatient,1,EA,424.66,424.66,,,,,,,,,,,,,,,,,
Thrombin (Bovine),250,RC,VB004045,LOCAL,,inpatient,1,EA,363.74,363.74,,,,,,,,,,,,,,,,,
Thrombin (Bovine),250,RC,VB004046,LOCAL,,inpatient,1,EA,1641.84,1641.84,,,,,,,,,,,,,,,,,
Thrombin (Bovine),250,RC,VB004047,LOCAL,,inpatient,1,EA,1641.84,1641.84,,,,,,,,,,,,,,,,,
Pen G Benz/Pen G Procaine,250,RC,VB004048,LOCAL,,inpatient,2,ML,1166.98,1166.98,,,,,,,,,,,,,,,,,
Pen G Benz/Pen G Procaine,250,RC,VB004049,LOCAL,,inpatient,2,ML,1166.98,1166.98,,,,,,,,,,,,,,,,,
penicillin G BENZATHINE,250,RC,VB004050,LOCAL,,inpatient,1,ML,1022.76,1022.76,,,,,,,,,,,,,,,,,
penicillin G BENZATHINE,250,RC,VB004051,LOCAL,,inpatient,2,ML,1771.39,1771.39,,,,,,,,,,,,,,,,,
penicillin G BENZATHINE,250,RC,VB004052,LOCAL,,inpatient,4,ML,3629.86,3629.86,,,,,,,,,,,,,,,,,
"Thrombin/Cal/Cmc/Gel/Dress,hem",250,RC,VB004053,LOCAL,,inpatient,1,EA,2931.41,2931.41,,,,,,,,,,,,,,,,,
"Thrombin/Cal/Cmc/Gel/Dress,hem",250,RC,VB004054,LOCAL,,inpatient,1,EA,1957.87,1957.87,,,,,,,,,,,,,,,,,
"Thrombin/Cal/Cmc/Gel/Dress,hem",250,RC,VB004055,LOCAL,,inpatient,1,EA,3556.46,3556.46,,,,,,,,,,,,,,,,,
Ofloxacin 0.3% OTIC,250,RC,VB004056,LOCAL,,inpatient,5,ML,296,296,,,,,,,,,,,,,,,,,
Dorzolamide HCL 2 %,250,RC,VB004057,LOCAL,,inpatient,10,ML,267,267,,,,,,,,,,,,,,,,,
Brimonidine Tartrate 0.15 % - 5ML,250,RC,VB004058,LOCAL,,inpatient,5,ML,766.72,766.72,,,,,,,,,,,,,,,,,
Pilocarpine HCL,250,RC,VB004059,LOCAL,,inpatient,15,ML,394.24,394.24,,,,,,,,,,,,,,,,,
Pilocarpine HCL,250,RC,VB004060,LOCAL,,inpatient,15,ML,403.24,403.24,,,,,,,,,,,,,,,,,
timoloL MALEATE 0.25 % - 5mL,250,RC,VB004061,LOCAL,,inpatient,5,ML,60,60,,,,,,,,,,,,,,,,,
timoloL MALEATE 0.5 %,250,RC,VB004062,LOCAL,,inpatient,5,ML,68,68,,,,,,,,,,,,,,,,,
Phenylephrine HCL,250,RC,VB004063,LOCAL,,inpatient,3,ML,93.36,93.36,,,,,,,,,,,,,,,,,
gentamicin SULFATE 0.3 % Ophth,250,RC,VB004064,LOCAL,,inpatient,5,ML,86.8,86.8,,,,,,,,,,,,,,,,,
prednisoLONE ACETATE  1 % - 5mL,250,RC,VB004065,LOCAL,,inpatient,5,ML,221.28,221.28,,,,,,,,,,,,,,,,,
Neomycin/Polymyxin B/HC Ophth 7.5mL,250,RC,VB004066,LOCAL,,inpatient,7.5,ML,748.4,748.4,,,,,,,,,,,,,,,,,
Ciprofloxacin HCL 0.3 % - 2.5mL,250,RC,VB004067,LOCAL,,inpatient,2.5,ML,100.12,100.12,,,,,,,,,,,,,,,,,
Neomyc/Bacit/Polymyx/Hydrocort  1 %,250,RC,VB004068,LOCAL,,inpatient,15,GM,766.7,766.7,,,,,,,,,,,,,,,,,
Neomycin/Polymyxin B/Hydrocort,250,RC,VB004069,LOCAL,,inpatient,7.5,GM,560.59,560.59,,,,,,,,,,,,,,,,,
Trifluridine,250,RC,VB004070,LOCAL,,inpatient,7.5,ML,1789.78,1789.78,,,,,,,,,,,,,,,,,
SILVER sulfADIAZINE (25 gm),250,RC,VB004071,LOCAL,,inpatient,25,GM,37.39,37.39,,,,,,,,,,,,,,,,,
ethambutoL HCL,250,RC,VB004072,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pyrazinamide,250,RC,VB004073,LOCAL,,inpatient,1,EA,25.98,25.98,,,,,,,,,,,,,,,,,
Mineral Oil/Hydrophil Petrolat,250,RC,VB004074,LOCAL,,inpatient,454,GM,44.08,44.08,,,,,,,,,,,,,,,,,
Tenofovir Disoproxil Fumarate,250,RC,VB004075,LOCAL,,inpatient,1,EA,200.56,200.56,,,,,,,,,,,,,,,,,
Emtricitabine,250,RC,VB004076,LOCAL,,inpatient,1,EA,85.84,85.84,,,,,,,,,,,,,,,,,
Ranolazine,250,RC,VB004077,LOCAL,,inpatient,1,EA,32.89,32.89,,,,,,,,,,,,,,,,,
Tenofovir Alafenamide,250,RC,VB004078,LOCAL,,inpatient,1,EA,244.26,244.26,,,,,,,,,,,,,,,,,
modafiniL,250,RC,VB004079,LOCAL,,inpatient,1,EA,88.26,88.26,,,,,,,,,,,,,,,,,
quiNIDine GLUCONATE,250,RC,VB004080,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
fluvoxaMINE MALEATE,250,RC,VB004081,LOCAL,,inpatient,1,EA,9.2,9.2,,,,,,,,,,,,,,,,,
Demeclocycline HCL,250,RC,VB004082,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
allopurinoL,250,RC,VB004083,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
hydrALAZINE HCL,250,RC,VB004084,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
hydrALAZINE HCL,250,RC,VB004085,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Oxazepam,250,RC,VB004086,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Rivastigmine Tartrate,250,RC,VB004087,LOCAL,,inpatient,1,EA,10,10,,,,,,,,,,,,,,,,,
Rivastigmine Tartrate,250,RC,VB004088,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Rivastigmine Tartrate,250,RC,VB004089,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Rivastigmine Tartrate,250,RC,VB004090,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
cephALEXin,250,RC,VB004091,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Telavancin HCL,250,RC,VB004092,LOCAL,,inpatient,1,EA,2337.52,2337.52,,,,,,,,,,,,,,,,,
Zonisamide,250,RC,VB004093,LOCAL,,inpatient,1,EA,52.77,52.77,,,,,,,,,,,,,,,,,
Nelfinavir Mesylate,250,RC,VB004094,LOCAL,,inpatient,1,EA,19.42,19.42,,,,,,,,,,,,,,,,,
Benzocaine/Menthol,250,RC,VB004095,LOCAL,,inpatient,1,EA,18.12,18.12,,,,,,,,,,,,,,,,,
Ferrous Fum/Vit C/B12/Stomc,250,RC,VB004096,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Talc,250,RC,VB004097,LOCAL,,inpatient,1,EA,504,504,,,,,,,,,,,,,,,,,
SUMAtriptan SUCCINATE,250,RC,VB004098,LOCAL,,inpatient,1,EA,100.56,100.56,,,,,,,,,,,,,,,,,
SUMAtriptan SUCCINATE,250,RC,VB004099,LOCAL,,inpatient,1,EA,100.56,100.56,,,,,,,,,,,,,,,,,
hydrOXYchloroQUINE SULFATE,250,RC,VB004100,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
clindamycin HCL,250,RC,VB004101,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Minocycline HCL,250,RC,VB004102,LOCAL,,inpatient,1,EA,13.59,13.59,,,,,,,,,,,,,,,,,
gentamicin SULFATE,250,RC,VB004103,LOCAL,,inpatient,2,ML,22.27,22.27,,,,,,,,,,,,,,,,,
gentamicin SULFATE Inj,250,RC,VB004104,LOCAL,,inpatient,20,ML,7.99,7.99,,,,,,,,,,,,,,,,,
Chloramphenicol Sod Succinate,250,RC,VB004105,LOCAL,,inpatient,1,EA,233.52,233.52,,,,,,,,,,,,,,,,,
thiamine HCL,250,RC,VB004106,LOCAL,,inpatient,2,ML,47.76,47.76,,,,,,,,,,,,,,,,,
Magnesium Sulfate Inj 50%,250,RC,VB004107,LOCAL,,inpatient,2,ML,7.58,7.58,,,,,,,,,,,,,,,,,
Sodium Bicarbonate 4.2%,250,RC,VB004108,LOCAL,,inpatient,5,ML,112.94,112.94,,,,,,,,,,,,,,,,,
"Potassium Phos,m-Basic-D-Basic",250,RC,VB004109,LOCAL,,inpatient,15,ML,9.69,9.69,,,,,,,,,,,,,,,,,
Magnesium Sulfate In Water,250,RC,VB004110,LOCAL,,inpatient,100,ML,43.49,43.49,,,,,,,,,,,,,,,,,
Pentamidine Isethionate,250,RC,VB004111,LOCAL,,inpatient,1,EA,801.07,801.07,,,,,,,,,,,,,,,,,
Doxycycline Hyclate,250,RC,VB004112,LOCAL,,inpatient,1,EA,126.38,126.38,,,,,,,,,,,,,,,,,
Ifosfamide,250,RC,VB004113,LOCAL,,inpatient,1,EA,278.64,278.64,,,,,,,,,,,,,,,,,
ketorolac TROMETHAMINE,250,RC,VB004114,LOCAL,,inpatient,1,ML,18,18,,,,,,,,,,,,,,,,,
dexAMETHasone SODIUM PHOSPHATE,250,RC,VB004115,LOCAL,,inpatient,1,ML,13.82,13.82,,,,,,,,,,,,,,,,,
Pyridoxine HCL (Vitamin B6),250,RC,VB004116,LOCAL,,inpatient,1,ML,104.3,104.3,,,,,,,,,,,,,,,,,
folic acid Inj,250,RC,VB004117,LOCAL,,inpatient,10,ML,30.68,30.68,,,,,,,,,,,,,,,,,
"Water for Injection,sterile",250,RC,VB004118,LOCAL,,inpatient,100,ML,36.86,36.86,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride,250,RC,VB004119,LOCAL,,inpatient,10,ML,5.57,5.57,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride,250,RC,VB004120,LOCAL,,inpatient,20,ML,10.03,10.03,,,,,,,,,,,,,,,,,
Sodium Chloride 4mEq/mL (23.4%),250,RC,VB004121,LOCAL,,inpatient,30,ML,5,5,,,,,,,,,,,,,,,,,
lidocaine HCL Local Inj 1% - 10mL,250,RC,VB004122,LOCAL,,inpatient,10,ML,12.77,12.77,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB004123,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
protamine SULFATE,250,RC,VB004124,LOCAL,,inpatient,5,ML,74.3,74.3,,,,,,,,,,,,,,,,,
protamine SULFATE,250,RC,VB004125,LOCAL,,inpatient,25,ML,10.16,10.16,,,,,,,,,,,,,,,,,
"Mineral Oil, Light Sterile",250,RC,VB004126,LOCAL,,inpatient,10,ML,109.34,109.34,,,,,,,,,,,,,,,,,
proGESTerone,250,RC,VB004127,LOCAL,,inpatient,10,ML,14.35,14.35,,,,,,,,,,,,,,,,,
fluPHENAZine DECANOATE,250,RC,VB004128,LOCAL,,inpatient,5,ML,148.77,148.77,,,,,,,,,,,,,,,,,
"Heparin Sodium,porcine/Pf",250,RC,VB004129,LOCAL,,inpatient,2,ML,31.66,31.66,,,,,,,,,,,,,,,,,
fluPHENAZine HCL,250,RC,VB004130,LOCAL,,inpatient,10,ML,92.19,92.19,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB004131,LOCAL,,inpatient,1,EA,62.4,62.4,,,,,,,,,,,,,,,,,
Tobramycin Sulfate,250,RC,VB004132,LOCAL,,inpatient,2,ML,16.27,16.27,,,,,,,,,,,,,,,,,
Acyclovir Sodium Inj,250,RC,VB004133,LOCAL,,inpatient,10,ML,90.24,90.24,,,,,,,,,,,,,,,,,
Nafcillin Sodium,250,RC,VB004134,LOCAL,,inpatient,1,EA,71.46,71.46,,,,,,,,,,,,,,,,,
cefOXitin SODIUM,250,RC,VB004135,LOCAL,,inpatient,1,EA,67.01,67.01,,,,,,,,,,,,,,,,,
Neostigmine Methylsulfate,250,RC,VB004136,LOCAL,,inpatient,10,ML,6.82,6.82,,,,,,,,,,,,,,,,,
Cefotetan Disodium,250,RC,VB004137,LOCAL,,inpatient,1,EA,116.26,116.26,,,,,,,,,,,,,,,,,
Cefotetan Disodium,250,RC,VB004138,LOCAL,,inpatient,1,EA,232.51,232.51,,,,,,,,,,,,,,,,,
Azithromycin,250,RC,VB004139,LOCAL,,inpatient,1,EA,35.66,35.66,,,,,,,,,,,,,,,,,
Aztreonam,250,RC,VB004140,LOCAL,,inpatient,1,EA,173.18,173.18,,,,,,,,,,,,,,,,,
Aztreonam,250,RC,VB004141,LOCAL,,inpatient,1,EA,351.89,351.89,,,,,,,,,,,,,,,,,
Bupivacaine HCL/Pf 0.25%,250,RC,VB004142,LOCAL,,inpatient,30,ML,33.17,33.17,,,,,,,,,,,,,,,,,
haloperidoL DECANOATE,250,RC,VB004143,LOCAL,,inpatient,1,ML,134.78,134.78,,,,,,,,,,,,,,,,,
haloperidoL LACTATE,250,RC,VB004144,LOCAL,,inpatient,1,ML,28.75,28.75,,,,,,,,,,,,,,,,,
Lidocaine HCL/Pf,250,RC,VB004145,LOCAL,,inpatient,20,ML,5,5,,,,,,,,,,,,,,,,,
Valproic Acid Inj,250,RC,VB004146,LOCAL,,inpatient,5,ML,32.16,32.16,,,,,,,,,,,,,,,,,
Meropenem,250,RC,VB004147,LOCAL,,inpatient,1,EA,28.32,28.32,,,,,,,,,,,,,,,,,
Heparin 1000 units/mL,250,RC,VB004148,LOCAL,,inpatient,1,ML,18.58,18.58,,,,,,,,,,,,,,,,,
Heparin 10000 Unit/10mL,250,RC,VB004149,LOCAL,,inpatient,10,ML,34.9,34.9,,,,,,,,,,,,,,,,,
"Heparin 10,000 unit/mL",250,RC,VB004150,LOCAL,,inpatient,1,ML,36.62,36.62,,,,,,,,,,,,,,,,,
propranolol HCL,250,RC,VB004151,LOCAL,,inpatient,1,ML,55.1,55.1,,,,,,,,,,,,,,,,,
hydrALAZINE HCL,250,RC,VB004152,LOCAL,,inpatient,1,ML,68.74,68.74,,,,,,,,,,,,,,,,,
amiodarone HCL,250,RC,VB004153,LOCAL,,inpatient,9,ML,5,5,,,,,,,,,,,,,,,,,
Magnesium Sulfate,250,RC,VB004154,LOCAL,,inpatient,20,ML,5,5,,,,,,,,,,,,,,,,,
levothyroxine SODIUM Inj,250,RC,VB004155,LOCAL,,inpatient,1,EA,1155.46,1155.46,,,,,,,,,,,,,,,,,
Chlorothiazide Sodium,250,RC,VB004156,LOCAL,,inpatient,1,EA,134.06,134.06,,,,,,,,,,,,,,,,,
diphenhydrAMINE HCL,250,RC,VB004157,LOCAL,,inpatient,1,ML,13.2,13.2,,,,,,,,,,,,,,,,,
Ampicillin Sodium,250,RC,VB004158,LOCAL,,inpatient,1,EA,28.32,28.32,,,,,,,,,,,,,,,,,
"Heparin Sodium,porcine",250,RC,VB004159,LOCAL,,inpatient,1,ML,80.45,80.45,,,,,,,,,,,,,,,,,
Potassium Chloride Inj,250,RC,VB004160,LOCAL,,inpatient,20,ML,12.58,12.58,,,,,,,,,,,,,,,,,
modafiniL,250,RC,VB004161,LOCAL,,inpatient,1,EA,369.95,369.95,,,,,,,,,,,,,,,,,
tiaGABine HCL,250,RC,VB004162,LOCAL,,inpatient,1,EA,57.17,57.17,,,,,,,,,,,,,,,,,
Tbo-Filgrastim,250,RC,VB004163,LOCAL,,inpatient,0.8,ML,1919.44,1919.44,,,,,,,,,,,,,,,,,
Neomyc/Colist/Hydrocort/Thonzn,250,RC,VB004164,LOCAL,,inpatient,10,ML,1111.92,1111.92,,,,,,,,,,,,,,,,,
Clopidogrel Bisulfate,250,RC,VB004165,LOCAL,,inpatient,1,EA,123.75,123.75,,,,,,,,,,,,,,,,,
Benzocaine,250,RC,VB004166,LOCAL,,inpatient,1,EA,27.24,27.24,,,,,,,,,,,,,,,,,
Phenol,250,RC,VB004167,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Carbidopa/Levodopa 25/250mg,250,RC,VB004168,LOCAL,,inpatient,1,EA,6.46,6.46,,,,,,,,,,,,,,,,,
carisoprodoL,250,RC,VB004169,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
diazePAM,250,RC,VB004170,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Carbidopa/Levodopa 10/100mg,250,RC,VB004171,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
hydroCHLOROthiazide,250,RC,VB004172,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Tamoxifen Citrate,250,RC,VB004173,LOCAL,,inpatient,1,EA,9.47,9.47,,,,,,,,,,,,,,,,,
Naproxen,250,RC,VB004174,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Aspirin (Chewable),250,RC,VB004175,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Metoclopramide HCL,250,RC,VB004176,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
predniSONE,250,RC,VB004177,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Aspirin EC,250,RC,VB004178,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Famotidine,250,RC,VB004179,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Sodium Chloride 0.9 % (Flush) 10mL,250,RC,VB004180,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
guaiFENesin,250,RC,VB004181,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Guaifenesin/Dextromethorphan,250,RC,VB004182,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Immun Glob G/Sorb/Gly/Iga 0-50,250,RC,VB004183,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
Heparin Lock Flush 500 unit/5mL,250,RC,VB004184,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
Methacholine Chloride,250,RC,VB004185,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
busPIRone HCL,250,RC,VB004186,LOCAL,,inpatient,1,EA,6.32,6.32,,,,,,,,,,,,,,,,,
cefUROXime axetiL,250,RC,VB004187,LOCAL,,inpatient,1,EA,32.06,32.06,,,,,,,,,,,,,,,,,
colchicine,250,RC,VB004188,LOCAL,,inpatient,1,EA,34.52,34.52,,,,,,,,,,,,,,,,,
Febuxostat,250,RC,VB004189,LOCAL,,inpatient,1,EA,52.8,52.8,,,,,,,,,,,,,,,,,
Vortioxetine Hydrobromide,250,RC,VB004190,LOCAL,,inpatient,1,EA,82.26,82.26,,,,,,,,,,,,,,,,,
Febuxostat,250,RC,VB004191,LOCAL,,inpatient,1,EA,52.8,52.8,,,,,,,,,,,,,,,,,
"Sod Phos Di, Mono/K Phos Mono",250,RC,VB004192,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dipyridamole,250,RC,VB004193,LOCAL,,inpatient,1,EA,5.68,5.68,,,,,,,,,,,,,,,,,
Dipyridamole,250,RC,VB004194,LOCAL,,inpatient,1,EA,12.25,12.25,,,,,,,,,,,,,,,,,
Ferrous Sulfate/Vit C/Folic Ac,250,RC,VB004195,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Paliperidone,250,RC,VB004196,LOCAL,,inpatient,1,EA,183.58,183.58,,,,,,,,,,,,,,,,,
Nitrofurantoin,250,RC,VB004197,LOCAL,,inpatient,230,ML,12.7,12.7,,,,,,,,,,,,,,,,,
ARIPiprazole,250,RC,VB004198,LOCAL,,inpatient,1,EA,128.3,128.3,,,,,,,,,,,,,,,,,
Phenoxybenzamine HCL,250,RC,VB004199,LOCAL,,inpatient,1,EA,1151.9,1151.9,,,,,,,,,,,,,,,,,
Triamterene,250,RC,VB004200,LOCAL,,inpatient,1,EA,45.98,45.98,,,,,,,,,,,,,,,,,
Famotidine,250,RC,VB004201,LOCAL,,inpatient,50,ML,18.84,18.84,,,,,,,,,,,,,,,,,
rifAXIMin,250,RC,VB004202,LOCAL,,inpatient,1,EA,53.88,53.88,,,,,,,,,,,,,,,,,
rifAXIMin,250,RC,VB004203,LOCAL,,inpatient,1,EA,277.06,277.06,,,,,,,,,,,,,,,,,
Zidovudine,250,RC,VB004204,LOCAL,,inpatient,240,ML,5,5,,,,,,,,,,,,,,,,,
Zidovudine,250,RC,VB004205,LOCAL,,inpatient,1,EA,8.08,8.08,,,,,,,,,,,,,,,,,
Perindopril Erbumine,250,RC,VB004206,LOCAL,,inpatient,1,EA,11.19,11.19,,,,,,,,,,,,,,,,,
Phenobarb/Hyoscy/Atropine/Scop,250,RC,VB004207,LOCAL,,inpatient,480,ML,8.63,8.63,,,,,,,,,,,,,,,,,
Phenobarb/Hyoscy/Atropine/Scop,250,RC,VB004208,LOCAL,,inpatient,1,EA,41.51,41.51,,,,,,,,,,,,,,,,,
tadalafiL,250,RC,VB004209,LOCAL,,inpatient,1,EA,333.6,333.6,,,,,,,,,,,,,,,,,
Primidone,250,RC,VB004210,LOCAL,,inpatient,1,EA,328.59,328.59,,,,,,,,,,,,,,,,,
Aspirin,250,RC,VB004211,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Calcium Carbonate,250,RC,VB004212,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Sodium Bicarbonate,250,RC,VB004213,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ezetimibe,250,RC,VB004214,LOCAL,,inpatient,1,EA,41.13,41.13,,,,,,,,,,,,,,,,,
Amoxicillin/Potas Clav 875mg/125mg,250,RC,VB004215,LOCAL,,inpatient,1,EA,20.21,20.21,,,,,,,,,,,,,,,,,
Amoxicillin/Potas Clav 500mg/125mg,250,RC,VB004216,LOCAL,,inpatient,1,EA,15.14,15.14,,,,,,,,,,,,,,,,,
megestroL ACETATE,250,RC,VB004217,LOCAL,,inpatient,10,ML,28.12,28.12,,,,,,,,,,,,,,,,,
Phenytoin,250,RC,VB004218,LOCAL,,inpatient,4,ML,34.56,34.56,,,,,,,,,,,,,,,,,
nystatin oral suspension,250,RC,VB004219,LOCAL,,inpatient,5,ML,6.16,6.16,,,,,,,,,,,,,,,,,
Albuterol Sulfate,250,RC,VB004220,LOCAL,,inpatient,18,GM,249.76,249.76,,,,,,,,,,,,,,,,,
Ampicillin Trihydrate,250,RC,VB004221,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ampicillin Trihydrate,250,RC,VB004222,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ampicillin Trihydrate,250,RC,VB004223,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
penicillin V POTASSIUM,250,RC,VB004224,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
penicillin V POTASSIUM,250,RC,VB004225,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB004226,LOCAL,,inpatient,1,EA,38.59,38.59,,,,,,,,,,,,,,,,,
Pamidronate Disodium,250,RC,VB004227,LOCAL,,inpatient,10,ML,129.6,129.6,,,,,,,,,,,,,,,,,
Fondaparinux Sodium,250,RC,VB004228,LOCAL,,inpatient,1,EA,266.96,266.96,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB004229,LOCAL,,inpatient,1,EA,1.5,1.5,,,,,,,,,,,,,,,,,
"Calcitonin,salmon,synthetic Inj",250,RC,VB004230,LOCAL,,inpatient,2,ML,4800,4800,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB004231,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Nitazoxanide,250,RC,VB004232,LOCAL,,inpatient,1,EA,695.6,695.6,,,,,,,,,,,,,,,,,
Nitazoxanide,250,RC,VB004233,LOCAL,,inpatient,60,ML,41.76,41.76,,,,,,,,,,,,,,,,,
DAPTOmycin,250,RC,VB004234,LOCAL,,inpatient,1,EA,2138.35,2138.35,,,,,,,,,,,,,,,,,
Alvimopan,250,RC,VB004235,LOCAL,,inpatient,1,EA,872.83,872.83,,,,,,,,,,,,,,,,,
Ceftolozane/Tazobactam,250,RC,VB004236,LOCAL,,inpatient,1,EA,836.93,836.93,,,,,,,,,,,,,,,,,
leucovorin calcium,250,RC,VB004237,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
PARoxetine HCL,250,RC,VB004238,LOCAL,,inpatient,1,EA,11.16,11.16,,,,,,,,,,,,,,,,,
dilTIAZem HCL,250,RC,VB004239,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
dilTIAZem HCL,250,RC,VB004240,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ciprofloxacin HCL,250,RC,VB004241,LOCAL,,inpatient,1,EA,21.84,21.84,,,,,,,,,,,,,,,,,
Ciprofloxacin HCL,250,RC,VB004242,LOCAL,,inpatient,1,EA,30.64,30.64,,,,,,,,,,,,,,,,,
Isosorbide Dinitrate,250,RC,VB004243,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
glipiZIDE,250,RC,VB004244,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Mirtazapine,250,RC,VB004245,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
hydrOXYzine HCL,250,RC,VB004246,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
ramipriL,250,RC,VB004247,LOCAL,,inpatient,1,EA,9.48,9.48,,,,,,,,,,,,,,,,,
methIMAzole,250,RC,VB004248,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Carbidopa/Levodopa ER 50/200mg,250,RC,VB004249,LOCAL,,inpatient,1,EA,6.33,6.33,,,,,,,,,,,,,,,,,
ramipriL,250,RC,VB004250,LOCAL,,inpatient,1,EA,7.59,7.59,,,,,,,,,,,,,,,,,
glipiZIDE,250,RC,VB004251,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dantrolene Sodium,250,RC,VB004252,LOCAL,,inpatient,1,EA,7.75,7.75,,,,,,,,,,,,,,,,,
Divalproex Sodium Sprinkle Cap DR,250,RC,VB004253,LOCAL,,inpatient,1,EA,5.67,5.67,,,,,,,,,,,,,,,,,
Glimepiride,250,RC,VB004254,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Glimepiride,250,RC,VB004255,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
rifAMPin,250,RC,VB004256,LOCAL,,inpatient,1,EA,7.95,7.95,,,,,,,,,,,,,,,,,
Propafenone HCL,250,RC,VB004257,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Divalproex Sodium ER,250,RC,VB004258,LOCAL,,inpatient,1,EA,15.33,15.33,,,,,,,,,,,,,,,,,
Oxandrolone,250,RC,VB004259,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Oxandrolone,250,RC,VB004260,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
hydrALAZINE HCL,250,RC,VB004261,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ergocalciferol (Vitamin D2),250,RC,VB004262,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Hydrocortisone,250,RC,VB004263,LOCAL,,inpatient,1,EA,6.96,6.96,,,,,,,,,,,,,,,,,
gemfibroziL,250,RC,VB004264,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
pravastatin SODIUM,250,RC,VB004265,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
pravastatin SODIUM,250,RC,VB004266,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Torsemide,250,RC,VB004267,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ketoconazole,250,RC,VB004268,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Desmopressin Acetate,250,RC,VB004269,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
amantadine HCL,250,RC,VB004270,LOCAL,,inpatient,1,EA,7.75,7.75,,,,,,,,,,,,,,,,,
OLANZapine,250,RC,VB004271,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Gabapentin,250,RC,VB004272,LOCAL,,inpatient,1,EA,5.35,5.35,,,,,,,,,,,,,,,,,
Divalproex Sodium DR,250,RC,VB004273,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Divalproex Sodium DR,250,RC,VB004274,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
cycloSPORINE,250,RC,VB004275,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
zolpidem TARTRATE,250,RC,VB004276,LOCAL,,inpatient,1,EA,16.75,16.75,,,,,,,,,,,,,,,,,
Repaglinide,250,RC,VB004277,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Repaglinide,250,RC,VB004278,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
desipramine HCL,250,RC,VB004279,LOCAL,,inpatient,1,EA,10.35,10.35,,,,,,,,,,,,,,,,,
lithium CITRATE,250,RC,VB004280,LOCAL,,inpatient,5,ML,5.76,5.76,,,,,,,,,,,,,,,,,
Furosemide,250,RC,VB004281,LOCAL,,inpatient,5,ML,9.84,9.84,,,,,,,,,,,,,,,,,
cephALEXin,250,RC,VB004282,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
"Fenofibrate,micronized",250,RC,VB004283,LOCAL,,inpatient,1,EA,9.41,9.41,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB004284,LOCAL,,inpatient,1,EA,125.22,125.22,,,,,,,,,,,,,,,,,
Imipramine Pamoate,250,RC,VB004285,LOCAL,,inpatient,1,EA,67.43,67.43,,,,,,,,,,,,,,,,,
ceFIXime,250,RC,VB004286,LOCAL,,inpatient,10,GM,99.63,99.63,,,,,,,,,,,,,,,,,
Bimatoprost 0.03% - 2.5mL,250,RC,VB004287,LOCAL,,inpatient,2.5,ML,538.52,538.52,,,,,,,,,,,,,,,,,
Doxycycline Monohydrate,250,RC,VB004288,LOCAL,,inpatient,1,EA,9.48,9.48,,,,,,,,,,,,,,,,,
Hyoscyamine Sulfate,250,RC,VB004289,LOCAL,,inpatient,1,ML,263,263,,,,,,,,,,,,,,,,,
Topiramate,250,RC,VB004290,LOCAL,,inpatient,1,EA,27.85,27.85,,,,,,,,,,,,,,,,,
lansoprazole Solutab,250,RC,VB004291,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Naproxen,250,RC,VB004292,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
pravastatin SODIUM,250,RC,VB004293,LOCAL,,inpatient,1,EA,19.18,19.18,,,,,,,,,,,,,,,,,
verapamil HCL,250,RC,VB004294,LOCAL,,inpatient,1,EA,6.54,6.54,,,,,,,,,,,,,,,,,
oxyCODONE HCL,250,RC,VB004295,LOCAL,,inpatient,30,ML,49.31,49.31,,,,,,,,,,,,,,,,,
Nizatidine,250,RC,VB004296,LOCAL,,inpatient,1,EA,9.55,9.55,,,,,,,,,,,,,,,,,
Glatiramer Acetate,250,RC,VB004297,LOCAL,,inpatient,1,ML,1138.24,1138.24,,,,,,,,,,,,,,,,,
Glatiramer Acetate,250,RC,VB004298,LOCAL,,inpatient,1,ML,2332.8,2332.8,,,,,,,,,,,,,,,,,
Magnesium Oxide,250,RC,VB004299,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Albuterol Sulfate,250,RC,VB004300,LOCAL,,inpatient,1,EA,9.31,9.31,,,,,,,,,,,,,,,,,
ethambutoL HCL,250,RC,VB004301,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
desipramine HCL,250,RC,VB004302,LOCAL,,inpatient,1,EA,6.74,6.74,,,,,,,,,,,,,,,,,
Bumetanide,250,RC,VB004303,LOCAL,,inpatient,1,EA,10.79,10.79,,,,,,,,,,,,,,,,,
B Complex W-C No.20/Folic Acid,250,RC,VB004304,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Flu Vac Qs 18-19(4yr Up)cel/Pf,250,RC,VB004305,LOCAL,,inpatient,1,EA,98.26,98.26,,,,,,,,,,,,,,,,,
Digoxin,250,RC,VB004306,LOCAL,,inpatient,1,ML,661.1,661.1,,,,,,,,,,,,,,,,,
Minocycline HCL,250,RC,VB004307,LOCAL,,inpatient,1,EA,1240.8,1240.8,,,,,,,,,,,,,,,,,
Potassium Iodide,250,RC,VB004308,LOCAL,,inpatient,1,EA,76.16,76.16,,,,,,,,,,,,,,,,,
Methyl Salicylate/Menthol 15%-10%,250,RC,VB004309,LOCAL,,inpatient,1,EA,15.79,15.79,,,,,,,,,,,,,,,,,
Tetrahydrozoline HCL 0.05 %,250,RC,VB004310,LOCAL,,inpatient,1,EA,15.46,15.46,,,,,,,,,,,,,,,,,
Cholecalciferol (Vitamin D3),250,RC,VB004311,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB004312,LOCAL,,inpatient,1,ML,13.78,13.78,,,,,,,,,,,,,,,,,
lidocaine HCL 2% Uro-Jet,250,RC,VB004313,LOCAL,,inpatient,10,ML,33.79,33.79,,,,,,,,,,,,,,,,,
Calcium Chloride Inj 10%,250,RC,VB004314,LOCAL,,inpatient,10,ML,50.4,50.4,,,,,,,,,,,,,,,,,
naloxone HCL,250,RC,VB004315,LOCAL,,inpatient,2,ML,158.4,158.4,,,,,,,,,,,,,,,,,
Potassium Chloride Packet,250,RC,VB004316,LOCAL,,inpatient,1,EA,24.18,24.18,,,,,,,,,,,,,,,,,
Benztropine Mesylate,250,RC,VB004317,LOCAL,,inpatient,1,EA,671.72,671.72,,,,,,,,,,,,,,,,,
Zinc Sulfate,250,RC,VB004318,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Phenol  1.4 %,250,RC,VB004319,LOCAL,,inpatient,1,EA,13.44,13.44,,,,,,,,,,,,,,,,,
diphenhydrAMINE HCL Oral (RX-UD),250,RC,VB004342,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
Melatonin CR,250,RC,VB004345,LOCAL,,inpatient,1,ea,1.5,1.5,,,,,,,,,,,,,,,,,
Melatonin,250,RC,VB004346,LOCAL,,inpatient,1,ea,8,8,,,,,,,,,,,,,,,,,
modafiniL,250,RC,VB004370,LOCAL,,inpatient,1,EA,159.62,159.62,,,,,,,,,,,,,,,,,
Omeprazole Oral Susp (Bulk),250,RC,VB004385,LOCAL,,inpatient,90,ML,406.8,406.8,,,,,,,,,,,,,,,,,
Dextromethorphan Polistirex,250,RC,VB004389,LOCAL,,inpatient,89,ML,45.6,45.6,,,,,,,,,,,,,,,,,
Dexlansoprazole,250,RC,VB004399,LOCAL,,inpatient,1,EA,49.36,49.36,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide 0.1% - 80gm,250,RC,VB004417,LOCAL,,inpatient,80,GM,37.92,37.92,,,,,,,,,,,,,,,,,
"Insulin Regular, Human",250,RC,VB004428,LOCAL,,inpatient,3,ML,5,5,,,,,,,,,,,,,,,,,
Brivaracetam,250,RC,VB004457,LOCAL,,inpatient,1,EA,117.84,117.84,,,,,,,,,,,,,,,,,
Fluticasone/Salmeterol 230-21MCG,250,RC,VB004484,LOCAL,,inpatient,8,GM,1227.6,1227.6,,,,,,,,,,,,,,,,,
Sodium Chloride for Inhal *15ml*,250,RC,VB004487,LOCAL,,inpatient,15,ML,5,5,,,,,,,,,,,,,,,,,
"Multivitamin With Iron,minerals",250,RC,VB004500,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Hydromorphone HCL/Pf Inj,250,RC,VB004564,LOCAL,,inpatient,1,ML,19.92,19.92,,,,,,,,,,,,,,,,,
BAZA AND VENELEX MIX 1:1 CREAM,250,RC,VB004574,LOCAL,,inpatient,120,GM,340,340,,,,,,,,,,,,,,,,,
tadalafiL,250,RC,VB004621,LOCAL,,inpatient,1,EA,270.25,270.25,,,,,,,,,,,,,,,,,
Insulin Regular 500 UNIT/ML,250,RC,VB004622,LOCAL,,inpatient,20,ML,7137.6,7137.6,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide,250,RC,VB004623,LOCAL,,inpatient,1,ML,89.86,89.86,,,,,,,,,,,,,,,,,
Multivit-Min/Ferrous Gluconate,250,RC,VB004624,LOCAL,,inpatient,236,ML,5,5,,,,,,,,,,,,,,,,,
Clindamycin Phosphate/D5w,250,RC,VB004625,LOCAL,,inpatient,50,ML,54.67,54.67,,,,,,,,,,,,,,,,,
Bimatoprost 0.01% - 2.5mL,250,RC,VB004626,LOCAL,,inpatient,2.5,ML,1267.01,1267.01,,,,,,,,,,,,,,,,,
Lipase/Protease/Amylase 10K-32K-42K,250,RC,VB004627,LOCAL,,inpatient,1,EA,18.07,18.07,,,,,,,,,,,,,,,,,
Lipase/Protease/Amylase 15K-47K-63K,250,RC,VB004628,LOCAL,,inpatient,1,EA,26.09,26.09,,,,,,,,,,,,,,,,,
Lipase/Protease/Amylase 5K-17K-24K,250,RC,VB004629,LOCAL,,inpatient,1,EA,9.14,9.14,,,,,,,,,,,,,,,,,
Lipase/Protease/Amylase 3K-9.5K-15K,250,RC,VB004630,LOCAL,,inpatient,1,EA,8.7,8.7,,,,,,,,,,,,,,,,,
Lipase-Protea-Amyl 24K-76K-120K,250,RC,VB004631,LOCAL,,inpatient,1,EA,40.82,40.82,,,,,,,,,,,,,,,,,
Hydrocortisone/Pramoxine 1%-1%,250,RC,VB004632,LOCAL,,inpatient,10,GM,933.02,933.02,,,,,,,,,,,,,,,,,
penicillin G POTASSIUM,250,RC,VB004633,LOCAL,,inpatient,1,EA,244.22,244.22,,,,,,,,,,,,,,,,,
dronabinoL,250,RC,VB004634,LOCAL,,inpatient,1,EA,54.18,54.18,,,,,,,,,,,,,,,,,
Flecainide Acetate,250,RC,VB004635,LOCAL,,inpatient,1,EA,8.08,8.08,,,,,,,,,,,,,,,,,
codeine SULFATE,250,RC,VB004636,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Calcium Gluconate,250,RC,VB004637,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Efavirenz,250,RC,VB004638,LOCAL,,inpatient,1,EA,156.9,156.9,,,,,,,,,,,,,,,,,
Olopatadine HCL  0.1 %,250,RC,VB004639,LOCAL,,inpatient,5,ML,1394.93,1394.93,,,,,,,,,,,,,,,,,
Brinzolamide 1% - 10mL,250,RC,VB004640,LOCAL,,inpatient,10,ML,1647.5,1647.5,,,,,,,,,,,,,,,,,
Tobramycin,250,RC,VB004641,LOCAL,,inpatient,3.5,GM,1028.93,1028.93,,,,,,,,,,,,,,,,,
Ciprofloxacin HCL 0.3 % Ophth,250,RC,VB004642,LOCAL,,inpatient,3.5,GM,1028.93,1028.93,,,,,,,,,,,,,,,,,
Apraclonidine HCL,250,RC,VB004643,LOCAL,,inpatient,5,ML,800.83,800.83,,,,,,,,,,,,,,,,,
Balanced Salt Irrig Soln No.2,250,RC,VB004644,LOCAL,,inpatient,15,ML,60.72,60.72,,,,,,,,,,,,,,,,,
Ciprofloxacin/Hydrocortisone,250,RC,VB004645,LOCAL,,inpatient,10,ML,1516.18,1516.18,,,,,,,,,,,,,,,,,
Axitinib,250,RC,VB004646,LOCAL,,inpatient,1,EA,1692.96,1692.96,,,,,,,,,,,,,,,,,
Fesoterodine Fumarate,250,RC,VB004647,LOCAL,,inpatient,1,EA,46.39,46.39,,,,,,,,,,,,,,,,,
Tofacitinib Citrate,250,RC,VB004648,LOCAL,,inpatient,1,EA,971.7,971.7,,,,,,,,,,,,,,,,,
sildenafiL CITRATE,250,RC,VB004649,LOCAL,,inpatient,1,EA,419.66,419.66,,,,,,,,,,,,,,,,,
Fosphenytoin Sodium,250,RC,VB004650,LOCAL,,inpatient,2,ML,194.06,194.06,,,,,,,,,,,,,,,,,
Pregabalin,250,RC,VB004651,LOCAL,,inpatient,1,EA,48.57,48.57,,,,,,,,,,,,,,,,,
Glecaprevir/Pibrentasvir,250,RC,VB004652,LOCAL,,inpatient,1,EA,754.29,754.29,,,,,,,,,,,,,,,,,
paricalcitoL,250,RC,VB004653,LOCAL,,inpatient,1,EA,62.45,62.45,,,,,,,,,,,,,,,,,
paricalcitoL Inj,250,RC,VB004654,LOCAL,,inpatient,1,ML,29.09,29.09,,,,,,,,,,,,,,,,,
ritonavir,250,RC,VB004655,LOCAL,,inpatient,1,EA,41.15,41.15,,,,,,,,,,,,,,,,,
Octreotide Acetate,250,RC,VB004656,LOCAL,,inpatient,1,ML,67.76,67.76,,,,,,,,,,,,,,,,,
Mometasone Furoate,250,RC,VB004657,LOCAL,,inpatient,1,GM,355.01,355.01,,,,,,,,,,,,,,,,,
Temozolomide,250,RC,VB004658,LOCAL,,inpatient,1,EA,2186.88,2186.88,,,,,,,,,,,,,,,,,
Posaconazole,250,RC,VB004659,LOCAL,,inpatient,1,EA,328.94,328.94,,,,,,,,,,,,,,,,,
Insulin Glulisine,250,RC,VB004660,LOCAL,,inpatient,3,ML,157.97,157.97,,,,,,,,,,,,,,,,,
Etodolac,250,RC,VB004661,LOCAL,,inpatient,1,EA,5.87,5.87,,,,,,,,,,,,,,,,,
"Cyclosporine, Modified",250,RC,VB004662,LOCAL,,inpatient,1,EA,10.95,10.95,,,,,,,,,,,,,,,,,
"Glyburide,micronized",250,RC,VB004663,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Magnesium, Aluminum Hydroxide",250,RC,VB004664,LOCAL,,inpatient,30,ML,22.68,22.68,,,,,,,,,,,,,,,,,
Codeine Phos/Guaifen 10/100mg/5ml,250,RC,VB004665,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
Valproic Acid Oral,250,RC,VB004666,LOCAL,,inpatient,5,ML,10.8,10.8,,,,,,,,,,,,,,,,,
Theophylline Anhydrous,250,RC,VB004667,LOCAL,,inpatient,15,ML,50.08,50.08,,,,,,,,,,,,,,,,,
Lacosamide,250,RC,VB004668,LOCAL,,inpatient,1,EA,99.66,99.66,,,,,,,,,,,,,,,,,
Lacosamide,250,RC,VB004669,LOCAL,,inpatient,1,EA,105.54,105.54,,,,,,,,,,,,,,,,,
colchicine,250,RC,VB004670,LOCAL,,inpatient,1,EA,29.99,29.99,,,,,,,,,,,,,,,,,
"Nicardipine In Nacl, Iso-Osm",250,RC,VB004671,LOCAL,,inpatient,200,ML,390.34,390.34,,,,,,,,,,,,,,,,,
niCARdipine HCL,250,RC,VB004672,LOCAL,,inpatient,10,ML,122.5,122.5,,,,,,,,,,,,,,,,,
Amoxicillin,250,RC,VB004673,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide 0.025 %,250,RC,VB004674,LOCAL,,inpatient,15,GM,17.86,17.86,,,,,,,,,,,,,,,,,
Insulin Aspart Prot/Aspart 70-30,250,RC,VB004675,LOCAL,,inpatient,10,ML,347.23,347.23,,,,,,,,,,,,,,,,,
Insulin Aspart (BULK Vial),250,RC,VB004676,LOCAL,,inpatient,10,ML,347.23,347.23,,,,,,,,,,,,,,,,,
diazePAM,250,RC,VB004677,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Baclofen,250,RC,VB004678,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Umeclidinium/Vilanterol 62.5-25MCG,250,RC,VB004679,LOCAL,,inpatient,1,EA,2347.63,2347.63,,,,,,,,,,,,,,,,,
Umeclidinium Bromide,250,RC,VB004680,LOCAL,,inpatient,1,EA,1699.68,1699.68,,,,,,,,,,,,,,,,,
Fluticasone/Umeclidin/Vilanter,250,RC,VB004681,LOCAL,,inpatient,1,EA,1515.36,1515.36,,,,,,,,,,,,,,,,,
Dextroamphetamine/Amphetamine,250,RC,VB004682,LOCAL,,inpatient,1,EA,6.86,6.86,,,,,,,,,,,,,,,,,
Dextroamphetamine/Amphetamine,250,RC,VB004683,LOCAL,,inpatient,1,EA,6.86,6.86,,,,,,,,,,,,,,,,,
Cholestyramine/Aspartame,250,RC,VB004684,LOCAL,,inpatient,60,GM,13.4,13.4,,,,,,,,,,,,,,,,,
esomeprazole SODIUM,250,RC,VB004685,LOCAL,,inpatient,1,EA,214.32,214.32,,,,,,,,,,,,,,,,,
Acyclovir,250,RC,VB004686,LOCAL,,inpatient,5,GM,960,960,,,,,,,,,,,,,,,,,
Nitroprusside Sodium,250,RC,VB004687,LOCAL,,inpatient,2,ML,720,720,,,,,,,,,,,,,,,,,
"Piperacillin-Tazo-Dextrose,iso",250,RC,VB004688,LOCAL,,inpatient,1,EA,97.44,97.44,,,,,,,,,,,,,,,,,
Isosorbide Mononitrate,250,RC,VB004689,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dextroamphetamine/Amphetamine,250,RC,VB004690,LOCAL,,inpatient,1,EA,28.2,28.2,,,,,,,,,,,,,,,,,
dilTIAZem HCL,250,RC,VB004691,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Cefazolin Sodium/Dextrose,iso",250,RC,VB004692,LOCAL,,inpatient,1,ML,54.48,54.48,,,,,,,,,,,,,,,,,
"Cefazolin Sodium/Dextrose,iso",250,RC,VB004693,LOCAL,,inpatient,1,ML,70.85,70.85,,,,,,,,,,,,,,,,,
Meropenem-0.9% Sodium Chloride,250,RC,VB004694,LOCAL,,inpatient,1,ML,85.12,85.12,,,,,,,,,,,,,,,,,
Meropenem-0.9% Sodium Chloride,250,RC,VB004695,LOCAL,,inpatient,1,ML,119.16,119.16,,,,,,,,,,,,,,,,,
Cefepime HCL In Dextrose 5 %,250,RC,VB004696,LOCAL,,inpatient,1,ML,81.72,81.72,,,,,,,,,,,,,,,,,
Cefepime HCL In Dextrose 5 %,250,RC,VB004697,LOCAL,,inpatient,1,ML,116.6,116.6,,,,,,,,,,,,,,,,,
Dextrose 10 % In Water,250,RC,VB004698,LOCAL,,inpatient,1000,ML,28.94,28.94,,,,,,,,,,,,,,,,,
Benzocaine,250,RC,VB004699,LOCAL,,inpatient,1,EA,188.52,188.52,,,,,,,,,,,,,,,,,
Benzocaine,250,RC,VB004700,LOCAL,,inpatient,1,EA,188.52,188.52,,,,,,,,,,,,,,,,,
Sodium Zirconium Cyclosilicate,250,RC,VB004701,LOCAL,,inpatient,1,EA,137.84,137.84,,,,,,,,,,,,,,,,,
Oxychlorosene Sodium,250,RC,VB004702,LOCAL,,inpatient,2,GM,13.78,13.78,,,,,,,,,,,,,,,,,
Lidocaine HCL/D5W 4 mg/mL IV,250,RC,VB004703,LOCAL,,inpatient,500,ML,29.71,29.71,,,,,,,,,,,,,,,,,
Fat Emulsions 20%,250,RC,VB004704,LOCAL,,inpatient,250,ML,226.18,226.18,,,,,,,,,,,,,,,,,
acetic acid 0.25% Irrigation,250,RC,VB004705,LOCAL,,inpatient,1000,ML,42.19,42.19,,,,,,,,,,,,,,,,,
Nitroglycerin In 5 % Dextrose,250,RC,VB004706,LOCAL,,inpatient,250,ML,108.19,108.19,,,,,,,,,,,,,,,,,
Dobutamine HCL In D5W 500 mg/250mL,250,RC,VB004707,LOCAL,,inpatient,250,ML,191.76,191.76,,,,,,,,,,,,,,,,,
Amino Acids 4.25 %/Dextrose 5%,250,RC,VB004708,LOCAL,,inpatient,2000,ML,356.26,356.26,,,,,,,,,,,,,,,,,
Amino Acids 4.25%/Dextrose 10%,250,RC,VB004709,LOCAL,,inpatient,2000,ML,362.11,362.11,,,,,,,,,,,,,,,,,
Amino Acids 5 %/Dextrose 15 %,250,RC,VB004710,LOCAL,,inpatient,2000,ML,385.97,385.97,,,,,,,,,,,,,,,,,
Aa 4.25 %/Calcium/Lytes/D5w,250,RC,VB004711,LOCAL,,inpatient,2000,ML,383.57,383.57,,,,,,,,,,,,,,,,,
Aa 4.25%/Calcium/Lytes/Dex 10%,250,RC,VB004712,LOCAL,,inpatient,2000,ML,389.66,389.66,,,,,,,,,,,,,,,,,
Aa 5%/D15w/Electrolytes,250,RC,VB004713,LOCAL,,inpatient,2000,ML,411.22,411.22,,,,,,,,,,,,,,,,,
Amino Acids 2.75 %/D5w,250,RC,VB004714,LOCAL,,inpatient,1000,ML,167.09,167.09,,,,,,,,,,,,,,,,,
AA 4.25 %/Dextrose 5%,250,RC,VB004715,LOCAL,,inpatient,1000,ML,185.18,185.18,,,,,,,,,,,,,,,,,
Amino Acids 4.25%/Dextrose 10%,250,RC,VB004716,LOCAL,,inpatient,1000,ML,187.06,187.06,,,,,,,,,,,,,,,,,
Amino Acids 5 %/Dextrose 15 %,250,RC,VB004717,LOCAL,,inpatient,1000,ML,211.15,211.15,,,,,,,,,,,,,,,,,
Amino Acids 5 %/Dextrose 20 %,250,RC,VB004718,LOCAL,,inpatient,1000,ML,215.33,215.33,,,,,,,,,,,,,,,,,
Aa 4.25 %/Calcium/Lytes/D5w,250,RC,VB004719,LOCAL,,inpatient,1000,ML,206.64,206.64,,,,,,,,,,,,,,,,,
Aa 4.25%/Calcium/Lytes/Dex 10%,250,RC,VB004720,LOCAL,,inpatient,1000,ML,228.29,228.29,,,,,,,,,,,,,,,,,
Aa 5%/D15w/Electrolytes,250,RC,VB004721,LOCAL,,inpatient,1000,ML,215.62,215.62,,,,,,,,,,,,,,,,,
Aa 5 %/Calcium/Lytes/Dext 20 %,250,RC,VB004722,LOCAL,,inpatient,1000,ML,217.34,217.34,,,,,,,,,,,,,,,,,
Cefepime In Iso-Osm Dextrose,250,RC,VB004723,LOCAL,,inpatient,50,ML,129.5,129.5,,,,,,,,,,,,,,,,,
Cefepime In Iso-Osm Dextrose,250,RC,VB004724,LOCAL,,inpatient,100,ML,204.38,204.38,,,,,,,,,,,,,,,,,
"Famotidine In Nacl,iso-Osm/Pf",250,RC,VB004725,LOCAL,,inpatient,50,ML,26.88,26.88,,,,,,,,,,,,,,,,,
buPROPion HCL,250,RC,VB004726,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Sodium Chloride Inhalation (15ML),250,RC,VB004727,LOCAL,,inpatient,15,ML,5,5,,,,,,,,,,,,,,,,,
Fenofibrate,250,RC,VB004728,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
estradioL,250,RC,VB004729,LOCAL,,inpatient,42.5,GM,1240.84,1240.84,,,,,,,,,,,,,,,,,
Ethyl Chloride,250,RC,VB004730,LOCAL,,inpatient,116,ML,167.14,167.14,,,,,,,,,,,,,,,,,
Oxycodone/Acetaminophen 10/325MG,250,RC,VB004731,LOCAL,,inpatient,1,EA,14.2,14.2,,,,,,,,,,,,,,,,,
methylphenidate HCL,250,RC,VB004732,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB004733,LOCAL,,inpatient,1,EA,23.21,23.21,,,,,,,,,,,,,,,,,
oxyCODONE HCL,250,RC,VB004734,LOCAL,,inpatient,1,EA,14.36,14.36,,,,,,,,,,,,,,,,,
Iohexol,250,RC,VB004735,LOCAL,,inpatient,50,ML,226.56,226.56,,,,,,,,,,,,,,,,,
morphine SULFATE Inj,250,RC,VB004736,LOCAL,,inpatient,20,ML,5,5,,,,,,,,,,,,,,,,,
Dexmedetomidine In 0.9 % Nacl,250,RC,VB004737,LOCAL,,inpatient,100,ML,240,240,,,,,,,,,,,,,,,,,
Bupivacaine HCL/Epinephrine,250,RC,VB004738,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB004739,LOCAL,,inpatient,1,ML,9.34,9.34,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB004740,LOCAL,,inpatient,1,ML,11.08,11.08,,,,,,,,,,,,,,,,,
Procainamide HCL,250,RC,VB004741,LOCAL,,inpatient,10,ML,196.72,196.72,,,,,,,,,,,,,,,,,
metoprolol tartrate,250,RC,VB004742,LOCAL,,inpatient,5,ML,10.42,10.42,,,,,,,,,,,,,,,,,
Midazolam HCL/Pf,250,RC,VB004743,LOCAL,,inpatient,5,ML,5.47,5.47,,,,,,,,,,,,,,,,,
HYDROmorphone HCL,250,RC,VB004744,LOCAL,,inpatient,1,ML,10.08,10.08,,,,,,,,,,,,,,,,,
HYDROmorphone HCL,250,RC,VB004745,LOCAL,,inpatient,1,ML,12.99,12.99,,,,,,,,,,,,,,,,,
Midazolam HCL,250,RC,VB004746,LOCAL,,inpatient,10,ML,10.9,10.9,,,,,,,,,,,,,,,,,
Milrinone Lactate/D5w,250,RC,VB004747,LOCAL,,inpatient,100,ML,76.94,76.94,,,,,,,,,,,,,,,,,
Lidocaine HCL/Epi 2 %-1:100K,250,RC,VB004748,LOCAL,,inpatient,20,ML,16.03,16.03,,,,,,,,,,,,,,,,,
Acetylcysteine 10% *30ml*,250,RC,VB004749,LOCAL,,inpatient,30,ML,96.53,96.53,,,,,,,,,,,,,,,,,
Hydromorphone HCL/Pf,250,RC,VB004750,LOCAL,,inpatient,1,EA,7.24,7.24,,,,,,,,,,,,,,,,,
Morphine Sulfate/Pf Inj,250,RC,VB004751,LOCAL,,inpatient,10,ML,43.58,43.58,,,,,,,,,,,,,,,,,
Zinc Chloride,250,RC,VB004752,LOCAL,,inpatient,10,ML,11.37,11.37,,,,,,,,,,,,,,,,,
"Fluconazole In Dextrose,iso-Os",250,RC,VB004753,LOCAL,,inpatient,200,ML,64.56,64.56,,,,,,,,,,,,,,,,,
"Fluconazole In Dextrose,iso-Os",250,RC,VB004754,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
Fosphenytoin Sodium 500 mg PE/10mL,250,RC,VB004755,LOCAL,,inpatient,10,ML,16.56,16.56,,,,,,,,,,,,,,,,,
Morphine Sulfate/Pf,250,RC,VB004756,LOCAL,,inpatient,30,ML,47.71,47.71,,,,,,,,,,,,,,,,,
Magnesium Sulfate/D5w,250,RC,VB004757,LOCAL,,inpatient,100,ML,39.46,39.46,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride (ADD-VANTAGE),250,RC,VB004758,LOCAL,,inpatient,250,ML,28.13,28.13,,,,,,,,,,,,,,,,,
Dextrose 70 % In Water,250,RC,VB004759,LOCAL,,inpatient,2000,ML,90.96,90.96,,,,,,,,,,,,,,,,,
Heparin in 1/2NS 25000 Unit/250ml,250,RC,VB004760,LOCAL,,inpatient,250,ML,68.3,68.3,,,,,,,,,,,,,,,,,
Dopamine HCL In D5W 400 mg/250mL,250,RC,VB004761,LOCAL,,inpatient,250,ML,76.18,76.18,,,,,,,,,,,,,,,,,
Dopamine HCL In D5W 800 mg/250mL,250,RC,VB004762,LOCAL,,inpatient,250,ML,108.72,108.72,,,,,,,,,,,,,,,,,
Fentanyl Citrate/Pf 250MCG/5ML VIAL,250,RC,VB004763,LOCAL,,inpatient,5,ML,16.42,16.42,,,,,,,,,,,,,,,,,
Fentanyl Citrate/Pf,250,RC,VB004764,LOCAL,,inpatient,10,ML,32.64,32.64,,,,,,,,,,,,,,,,,
Fentanyl Citrate/Pf 1000mcg/20ml,250,RC,VB004765,LOCAL,,inpatient,20,ML,50.3,50.3,,,,,,,,,,,,,,,,,
Linaclotide,250,RC,VB004766,LOCAL,,inpatient,1,EA,90.88,90.88,,,,,,,,,,,,,,,,,
Memantine HCL/Donepezil HCL,250,RC,VB004767,LOCAL,,inpatient,1,EA,99.2,99.2,,,,,,,,,,,,,,,,,
Memantine HCL,250,RC,VB004768,LOCAL,,inpatient,1,EA,35.58,35.58,,,,,,,,,,,,,,,,,
Isavuconazonium Sulfate,250,RC,VB004769,LOCAL,,inpatient,1,EA,1750.37,1750.37,,,,,,,,,,,,,,,,,
tacrolimus,250,RC,VB004770,LOCAL,,inpatient,1,EA,177.59,177.59,,,,,,,,,,,,,,,,,
Hydrocortisone 1% Cream,250,RC,VB004771,LOCAL,,inpatient,28.4,GM,25.88,25.88,,,,,,,,,,,,,,,,,
Hydrocortisone 1 %,250,RC,VB004772,LOCAL,,inpatient,28,GM,13.92,13.92,,,,,,,,,,,,,,,,,
Sodium Chloride 7% for Inhal (4ML),250,RC,VB004773,LOCAL,,inpatient,4,ML,5,5,,,,,,,,,,,,,,,,,
Sodium Chloride 0.9% Inhalation 3mL,250,RC,VB004774,LOCAL,,inpatient,3,ML,5,5,,,,,,,,,,,,,,,,,
Albuterol Sulfate,250,RC,VB004775,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Sodium Chloride,250,RC,VB004776,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Loxapine Succinate,250,RC,VB004777,LOCAL,,inpatient,1,EA,5.09,5.09,,,,,,,,,,,,,,,,,
Pilocarpine HCL,250,RC,VB004778,LOCAL,,inpatient,1,EA,8.9,8.9,,,,,,,,,,,,,,,,,
Propylene Glycol/Peg 400 0.3 %-0.4%,250,RC,VB004779,LOCAL,,inpatient,15,ML,29.57,29.57,,,,,,,,,,,,,,,,,
Simethicone (Bulk 30mL bottle),250,RC,VB004780,LOCAL,,inpatient,30,ML,21.41,21.41,,,,,,,,,,,,,,,,,
Nicotine Polacrilex,250,RC,VB004781,LOCAL,,inpatient,20,EA,5,5,,,,,,,,,,,,,,,,,
Calcium Polycarbophil,250,RC,VB004782,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
thiamine HCL,250,RC,VB004783,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Mineral Oil/Petrolatum,white",250,RC,VB004784,LOCAL,,inpatient,3.5,GM,14.8,14.8,,,,,,,,,,,,,,,,,
Folic Acid/Vit B Complex and C Tab,250,RC,VB004785,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dextroamphetamine/Amphetamine,250,RC,VB004786,LOCAL,,inpatient,1,EA,6.86,6.86,,,,,,,,,,,,,,,,,
Phenylephrine HCL/Cocoa Butter,250,RC,VB004787,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ferrous Sulfate,250,RC,VB004788,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Opium/Belladonna Alkaloids,250,RC,VB004789,LOCAL,,inpatient,1,EA,110.07,110.07,,,,,,,,,,,,,,,,,
Tamoxifen Citrate,250,RC,VB004790,LOCAL,,inpatient,1,EA,15.15,15.15,,,,,,,,,,,,,,,,,
tiZANidine HCL,250,RC,VB004791,LOCAL,,inpatient,1,EA,13.75,13.75,,,,,,,,,,,,,,,,,
verapamil HCL,250,RC,VB004792,LOCAL,,inpatient,1,EA,6.98,6.98,,,,,,,,,,,,,,,,,
Atenolol/Chlorthalidone,250,RC,VB004793,LOCAL,,inpatient,1,EA,7.53,7.53,,,,,,,,,,,,,,,,,
Ipratropium/Albuterol Sulfate,250,RC,VB004794,LOCAL,,inpatient,14.7,GM,1038.29,1038.29,,,,,,,,,,,,,,,,,
Ipratropium/Albuterol Sul 20-100MCG,250,RC,VB004795,LOCAL,,inpatient,4,GM,2419.3,2419.3,,,,,,,,,,,,,,,,,
Ipratropium Bromide,250,RC,VB004796,LOCAL,,inpatient,12.9,GM,1472.83,1472.83,,,,,,,,,,,,,,,,,
Empagliflozin/Metformin  25-1000mg,250,RC,VB004797,LOCAL,,inpatient,1,EA,100.71,100.71,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide,250,RC,VB004798,LOCAL,,inpatient,80,GM,44.6,44.6,,,,,,,,,,,,,,,,,
Promethazine HCL,250,RC,VB004799,LOCAL,,inpatient,1,ML,8.87,8.87,,,,,,,,,,,,,,,,,
Meperidine HCL/Pf,250,RC,VB004800,LOCAL,,inpatient,1,ML,12.17,12.17,,,,,,,,,,,,,,,,,
Meperidine HCL/Pf,250,RC,VB004801,LOCAL,,inpatient,1,ML,13.9,13.9,,,,,,,,,,,,,,,,,
Midazolam HCL Inj,250,RC,VB004802,LOCAL,,inpatient,10,ML,33.12,33.12,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB004803,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB004804,LOCAL,,inpatient,1,ML,12.23,12.23,,,,,,,,,,,,,,,,,
Phenylephrine HCL,250,RC,VB004805,LOCAL,,inpatient,1,ML,19.2,19.2,,,,,,,,,,,,,,,,,
Norepinephrine Bitartrate,250,RC,VB004806,LOCAL,,inpatient,4,ML,5,5,,,,,,,,,,,,,,,,,
amikacin SULFATE,250,RC,VB004807,LOCAL,,inpatient,4,ML,35.04,35.04,,,,,,,,,,,,,,,,,
Ampicillin Sodium (ADD-Vantage),250,RC,VB004808,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
Ondansetron ODT,250,RC,VB004809,LOCAL,,inpatient,1,EA,89.17,89.17,,,,,,,,,,,,,,,,,
Clarithromycin,250,RC,VB004810,LOCAL,,inpatient,100,ML,8.73,8.73,,,,,,,,,,,,,,,,,
Compounding Vehicle Syrup No15,250,RC,VB004811,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
cloBAZam,250,RC,VB004812,LOCAL,,inpatient,1,EA,73.22,73.22,,,,,,,,,,,,,,,,,
Warfarin Sodium,250,RC,VB004813,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Warfarin Sodium,250,RC,VB004814,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Urea 20% - 113.4gm,250,RC,VB004815,LOCAL,,inpatient,113.4,GM,79.58,79.58,,,,,,,,,,,,,,,,,
Povidone-Iodine,250,RC,VB004816,LOCAL,,inpatient,28.35,GM,7.2,7.2,,,,,,,,,,,,,,,,,
Bismuth Subsalicylate,250,RC,VB004817,LOCAL,,inpatient,236,ML,5,5,,,,,,,,,,,,,,,,,
Vitamin A,250,RC,VB004818,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lanolin/Mineral Oil,250,RC,VB004819,LOCAL,,inpatient,236,ML,9.6,9.6,,,,,,,,,,,,,,,,,
Niacin ER,250,RC,VB004820,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
witch hazeL,250,RC,VB004821,LOCAL,,inpatient,1,EA,12,12,,,,,,,,,,,,,,,,,
diphenhydrAMINE HCL,250,RC,VB004822,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Miconazole Nitrate,250,RC,VB004823,LOCAL,,inpatient,1,EA,36.91,36.91,,,,,,,,,,,,,,,,,
Acyclovir,250,RC,VB004824,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ibuprofen,250,RC,VB004825,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
LORazepam,250,RC,VB004826,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Potassium Chloride ER,250,RC,VB004827,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Potassium Chloride ER,250,RC,VB004827,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Citalopram Hydrobromide,250,RC,VB004828,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
HYDROcodone/acetaminophen,250,RC,VB004829,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Sodium Citrate,250,RC,VB004830,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Saccharomyces Boulardii,250,RC,VB004831,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Nicardipine In Nacl, Iso-Osm",250,RC,VB004832,LOCAL,,inpatient,200,ML,5,5,,,,,,,,,,,,,,,,,
haloperidoL LACTATE,250,RC,VB004833,LOCAL,,inpatient,1,ML,29.47,29.47,,,,,,,,,,,,,,,,,
haloperidoL DECANOATE,250,RC,VB004834,LOCAL,,inpatient,1,ML,236.88,236.88,,,,,,,,,,,,,,,,,
Oxybenzone/Octinox/Petrolatum,250,RC,VB004835,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Benzocaine/Resorcin/Aloe/E,a,d",250,RC,VB004836,LOCAL,,inpatient,1,EA,16.61,16.61,,,,,,,,,,,,,,,,,
Menthol/Cetylpyrd Cl,250,RC,VB004837,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Acetylcysteine,250,RC,VB004838,LOCAL,,inpatient,1,EA,1.5,1.5,,,,,,,,,,,,,,,,,
Dextroamphetamine/Amphetamine,250,RC,VB004839,LOCAL,,inpatient,1,EA,6.86,6.86,,,,,,,,,,,,,,,,,
Dextroamphetamine/Amphetamine,250,RC,VB004840,LOCAL,,inpatient,1,EA,6.86,6.86,,,,,,,,,,,,,,,,,
Mineral Oil/Petrolatum Ophth Oint,250,RC,VB004841,LOCAL,,inpatient,305,GM,34.96,34.96,,,,,,,,,,,,,,,,,
levalbuterol HCL,250,RC,VB004842,LOCAL,,inpatient,1,EA,34.15,34.15,,,,,,,,,,,,,,,,,
Ofloxacin 0.3 % Ophthalmic,250,RC,VB004843,LOCAL,,inpatient,5,ML,83.76,83.76,,,,,,,,,,,,,,,,,
Ketotifen Fumarate 0.025 %,250,RC,VB004844,LOCAL,,inpatient,5,ML,49.92,49.92,,,,,,,,,,,,,,,,,
Sodium Chloride  5 %,250,RC,VB004845,LOCAL,,inpatient,15,ML,72.64,72.64,,,,,,,,,,,,,,,,,
Desmopressin Acetate 0.01%,250,RC,VB004846,LOCAL,,inpatient,5,ML,985.04,985.04,,,,,,,,,,,,,,,,,
dexAMETHasone SOD PHOS 0.1% - 5mL,250,RC,VB004847,LOCAL,,inpatient,5,ML,258.72,258.72,,,,,,,,,,,,,,,,,
Levofloxacin In Dextrose 5 %,250,RC,VB004848,LOCAL,,inpatient,100,ML,27.98,27.98,,,,,,,,,,,,,,,,,
Torsemide,250,RC,VB004849,LOCAL,,inpatient,100,EA,5,5,,,,,,,,,,,,,,,,,
Levofloxacin In Dextrose 5 %,250,RC,VB004850,LOCAL,,inpatient,50,ML,19.2,19.2,,,,,,,,,,,,,,,,,
"Fluconazole In Nacl,iso-Osm",250,RC,VB004851,LOCAL,,inpatient,50,ML,44.2,44.2,,,,,,,,,,,,,,,,,
Psyllium Husk (With Sugar),250,RC,VB004852,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Sodium Hypochlorite,250,RC,VB004853,LOCAL,,inpatient,1,EA,74,74,,,,,,,,,,,,,,,,,
Ergocalciferol (Vitamin D2),250,RC,VB004854,LOCAL,,inpatient,1,EA,399.12,399.12,,,,,,,,,,,,,,,,,
Methyl Salicylate/Menthol,250,RC,VB004855,LOCAL,,inpatient,1,EA,19.63,19.63,,,,,,,,,,,,,,,,,
Trolamine Salicylate/Aloe Vera,250,RC,VB004856,LOCAL,,inpatient,1,EA,19.63,19.63,,,,,,,,,,,,,,,,,
"Tuberculin,purif.prot.deriv.",250,RC,VB004857,LOCAL,,inpatient,1,ML,42.64,42.64,,,,,,,,,,,,,,,,,
Vasopressin,250,RC,VB004858,LOCAL,,inpatient,1,ML,388.8,388.8,,,,,,,,,,,,,,,,,
levothyroxine SODIUM Inj,250,RC,VB004859,LOCAL,,inpatient,1,EA,506.78,506.78,,,,,,,,,,,,,,,,,
Gabapentin Oral 250mg/5mL (RX-UD),250,RC,VB004860,LOCAL,,inpatient,470,ML,5,5,,,,,,,,,,,,,,,,,
Cabozantinib S-Malate,250,RC,VB004861,LOCAL,,inpatient,1,EA,4208.19,4208.19,,,,,,,,,,,,,,,,,
dilTIAZem HCL,250,RC,VB004862,LOCAL,,inpatient,1,EA,8.57,8.57,,,,,,,,,,,,,,,,,
opium tincture,250,RC,VB004863,LOCAL,,inpatient,118,ML,25.12,25.12,,,,,,,,,,,,,,,,,
"Amiodarone In Dextrose,iso-Osm",250,RC,VB004864,LOCAL,,inpatient,100,ML,166.51,166.51,,,,,,,,,,,,,,,,,
"Amiodarone In Dextrose,iso-Osm",250,RC,VB004865,LOCAL,,inpatient,200,ML,221.47,221.47,,,,,,,,,,,,,,,,,
Hyoscyamine Sulfate,250,RC,VB004866,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Hyoscyamine Sulfate,250,RC,VB004867,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Interferon Beta-1a/Albumin,250,RC,VB004868,LOCAL,,inpatient,0.5,EA,4395.31,4395.31,,,,,,,,,,,,,,,,,
Dexmedetomidine/D5W 400 mcg/100mL,250,RC,VB004869,LOCAL,,inpatient,1,EA,172.8,172.8,,,,,,,,,,,,,,,,,
Hydrocortisone/Pramoxine,250,RC,VB004870,LOCAL,,inpatient,30,GM,583.52,583.52,,,,,,,,,,,,,,,,,
Hydrocortisone/Pramoxine,250,RC,VB004871,LOCAL,,inpatient,30,GM,628.84,628.84,,,,,,,,,,,,,,,,,
Hydrocortisone 2.5 % Lotion,250,RC,VB004872,LOCAL,,inpatient,59,ML,213.88,213.88,,,,,,,,,,,,,,,,,
Carbidopa/Levodopa/Entacapone,250,RC,VB004873,LOCAL,,inpatient,1,EA,14.84,14.84,,,,,,,,,,,,,,,,,
Vecuronium Bromide,250,RC,VB004874,LOCAL,,inpatient,1,EA,81.6,81.6,,,,,,,,,,,,,,,,,
Omega-3/Dha/Epa/Fish Oil,250,RC,VB004875,LOCAL,,inpatient,150,ML,5,5,,,,,,,,,,,,,,,,,
Clindamycin Phosphate,250,RC,VB004876,LOCAL,,inpatient,6,ML,20.6,20.6,,,,,,,,,,,,,,,,,
"Tuberculin,purif.prot.deriv. (PPD)",250,RC,VB004879,LOCAL,,inpatient,1,EA,555.55,555.55,,,,,,,,,,,,,,,,,
Dolutegravir Sodium,250,RC,VB004880,LOCAL,,inpatient,1,EA,372.03,372.03,,,,,,,,,,,,,,,,,
Abacavir/Doluteg/Lamiv 600/50/300mg,250,RC,VB004881,LOCAL,,inpatient,1,EA,623.59,623.59,,,,,,,,,,,,,,,,,
Dolutegravir/Rilpivirine,250,RC,VB004882,LOCAL,,inpatient,1,EA,584.44,584.44,,,,,,,,,,,,,,,,,
Isosorbide Dinitrate,250,RC,VB004883,LOCAL,,inpatient,1,EA,5.24,5.24,,,,,,,,,,,,,,,,,
Hydrocodone/Chlorphen P-Stirex,250,RC,VB004884,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
clomiPHENE CITRATE,250,RC,VB004885,LOCAL,,inpatient,1,EA,27.42,27.42,,,,,,,,,,,,,,,,,
Pirfenidone,250,RC,VB004886,LOCAL,,inpatient,1,EA,557.3,557.3,,,,,,,,,,,,,,,,,
aMILoride HCL,250,RC,VB004887,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Doxycycline Hyclate,250,RC,VB004888,LOCAL,,inpatient,1,EA,21.38,21.38,,,,,,,,,,,,,,,,,
midodrine HCL,250,RC,VB004889,LOCAL,,inpatient,1,EA,19.91,19.91,,,,,,,,,,,,,,,,,
prednisoLONE SODIUM PHOSPHATE,250,RC,VB004890,LOCAL,,inpatient,120,ML,5,5,,,,,,,,,,,,,,,,,
risperiDONE,250,RC,VB004891,LOCAL,,inpatient,1,EA,22.12,22.12,,,,,,,,,,,,,,,,,
Brivaracetam,250,RC,VB004892,LOCAL,,inpatient,1,EA,117.84,117.84,,,,,,,,,,,,,,,,,
benazepril HCL,250,RC,VB004893,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
buPROPion HCL SR,250,RC,VB004894,LOCAL,,inpatient,1,EA,7.24,7.24,,,,,,,,,,,,,,,,,
Nitrofurantoin Macrocrystal,250,RC,VB004895,LOCAL,,inpatient,1,EA,11.06,11.06,,,,,,,,,,,,,,,,,
ALPRAZolam,250,RC,VB004896,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
hydrOXYzine HCL,250,RC,VB004897,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
lamoTRIgine,250,RC,VB004898,LOCAL,,inpatient,1,EA,23.91,23.91,,,,,,,,,,,,,,,,,
Loxapine Succinate,250,RC,VB004899,LOCAL,,inpatient,1,EA,5.09,5.09,,,,,,,,,,,,,,,,,
Carbidopa/Levodopa ER 25/100mg,250,RC,VB004900,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
clobetasoL PROPIONATE,250,RC,VB004901,LOCAL,,inpatient,15,GM,665.36,665.36,,,,,,,,,,,,,,,,,
Betamethasone/Propylene Glyc,250,RC,VB004902,LOCAL,,inpatient,15,GM,151.8,151.8,,,,,,,,,,,,,,,,,
Tolnaftate 1% Cream,250,RC,VB004903,LOCAL,,inpatient,30,GM,34.8,34.8,,,,,,,,,,,,,,,,,
terbinafine HCL  1 %,250,RC,VB004904,LOCAL,,inpatient,15,GM,32.16,32.16,,,,,,,,,,,,,,,,,
Nortriptyline HCL,250,RC,VB004905,LOCAL,,inpatient,100,EA,11.06,11.06,,,,,,,,,,,,,,,,,
Potassium Bicarbonate/Cit Ac,250,RC,VB004906,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Theophylline Anhydrous,250,RC,VB004907,LOCAL,,inpatient,1,EA,18.57,18.57,,,,,,,,,,,,,,,,,
Povidone-Iodine,250,RC,VB004908,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
raNITIdine HCL,250,RC,VB004909,LOCAL,,inpatient,2,ML,79.2,79.2,,,,,,,,,,,,,,,,,
icosapent ethyL,250,RC,VB004910,LOCAL,,inpatient,1,EA,14.18,14.18,,,,,,,,,,,,,,,,,
Anagrelide HCL,250,RC,VB004911,LOCAL,,inpatient,1,EA,39.69,39.69,,,,,,,,,,,,,,,,,
Dextroamphetamine/Amphetamine,250,RC,VB004912,LOCAL,,inpatient,1,EA,34.19,34.19,,,,,,,,,,,,,,,,,
Dextroamphetamine/Amphetamine,250,RC,VB004913,LOCAL,,inpatient,1,EA,34.19,34.19,,,,,,,,,,,,,,,,,
Vits A and D/White Pet/Lanolin,250,RC,VB004914,LOCAL,,inpatient,1,EA,7.68,7.68,,,,,,,,,,,,,,,,,
Methyl Salicylate/Menthol,250,RC,VB004915,LOCAL,,inpatient,28,GM,7.08,7.08,,,,,,,,,,,,,,,,,
Acetylcysteine,250,RC,VB004916,LOCAL,,inpatient,1,EA,1.5,1.5,,,,,,,,,,,,,,,,,
lamiVUDine Oral,250,RC,VB004917,LOCAL,,inpatient,240,ML,5,5,,,,,,,,,,,,,,,,,
Potassium Chloride Oral,250,RC,VB004918,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lidocaine HCL/Pf Inj 2% - 2mL,250,RC,VB004919,LOCAL,,inpatient,2,ML,18,18,,,,,,,,,,,,,,,,,
Lidocaine HCL/Pf Inj 2% - 5mL,250,RC,VB004920,LOCAL,,inpatient,5,ML,14.4,14.4,,,,,,,,,,,,,,,,,
Acyclovir Sodium,250,RC,VB004921,LOCAL,,inpatient,1,EA,21.6,21.6,,,,,,,,,,,,,,,,,
Darbepoetin Alfa In Polysorbat,250,RC,VB004922,LOCAL,,inpatient,1,ML,928.8,928.8,,,,,,,,,,,,,,,,,
Darbepoetin Alfa In Polysorbat,250,RC,VB004923,LOCAL,,inpatient,1,ML,3715.2,3715.2,,,,,,,,,,,,,,,,,
Darbepoetin Alfa In Polysorbat,250,RC,VB004924,LOCAL,,inpatient,0.4,ML,1486.08,1486.08,,,,,,,,,,,,,,,,,
Darbepoetin Alfa In Polysorbat,250,RC,VB004925,LOCAL,,inpatient,0.4,ML,7430.4,7430.4,,,,,,,,,,,,,,,,,
Cinacalcet HCL,250,RC,VB004926,LOCAL,,inpatient,1,EA,258.14,258.14,,,,,,,,,,,,,,,,,
Apremilast,250,RC,VB004927,LOCAL,,inpatient,1,EA,425.9,425.9,,,,,,,,,,,,,,,,,
"Epoetin Alfa 20,000 units/mL",250,RC,VB004928,LOCAL,,inpatient,1,ML,1591.68,1591.68,,,,,,,,,,,,,,,,,
lamiVUDine,250,RC,VB004929,LOCAL,,inpatient,240,ML,5,5,,,,,,,,,,,,,,,,,
HYDROcodone/acetaminophen,250,RC,VB004930,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Minocycline HCL,250,RC,VB004931,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Hepatitis B Virus Vaccine/Pf,250,RC,VB004932,LOCAL,,inpatient,1,EA,343.15,343.15,,,,,,,,,,,,,,,,,
Carboxymethylcellulose Sodium,250,RC,VB004933,LOCAL,,inpatient,32,EA,35.28,35.28,,,,,,,,,,,,,,,,,
oxyCODONE HCL ER,250,RC,VB004934,LOCAL,,inpatient,1,EA,45.29,45.29,,,,,,,,,,,,,,,,,
oxyCODONE HCL ER,250,RC,VB004935,LOCAL,,inpatient,1,EA,72.36,72.36,,,,,,,,,,,,,,,,,
oxyCODONE HCL ER,250,RC,VB004936,LOCAL,,inpatient,1,EA,126.15,126.15,,,,,,,,,,,,,,,,,
Fluoride (Sodium),250,RC,VB004937,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Calcium Acetate,250,RC,VB004938,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Rilpivirine HCL,250,RC,VB004939,LOCAL,,inpatient,1,EA,237.34,237.34,,,,,,,,,,,,,,,,,
Darunavir/Cobicistat,250,RC,VB004940,LOCAL,,inpatient,1,EA,394.68,394.68,,,,,,,,,,,,,,,,,
Fluconazole,250,RC,VB004941,LOCAL,,inpatient,35,ML,5,5,,,,,,,,,,,,,,,,,
Ferric Citrate,250,RC,VB004942,LOCAL,,inpatient,1,EA,37.15,37.15,,,,,,,,,,,,,,,,,
Pamidronate Disodium,250,RC,VB004943,LOCAL,,inpatient,1,EA,270.58,270.58,,,,,,,,,,,,,,,,,
"Sodium,potassium Phosphates Oral",250,RC,VB004944,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Phenytoin,250,RC,VB004945,LOCAL,,inpatient,237,ML,5,5,,,,,,,,,,,,,,,,,
Doxycycline Hyclate,250,RC,VB004946,LOCAL,,inpatient,1,EA,15.99,15.99,,,,,,,,,,,,,,,,,
Mesalamine,250,RC,VB004947,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
methIMAzole,250,RC,VB004948,LOCAL,,inpatient,1,EA,17.05,17.05,,,,,,,,,,,,,,,,,
Betaxolol HCL 0.5%,250,RC,VB004949,LOCAL,,inpatient,5,ML,265.08,265.08,,,,,,,,,,,,,,,,,
Neomycin/Polymyxin B/Hydrocort,250,RC,VB004950,LOCAL,,inpatient,10,ML,41.95,41.95,,,,,,,,,,,,,,,,,
Emtricitabine/Tenofovir (Tdf),250,RC,VB004951,LOCAL,,inpatient,1,EA,294.76,294.76,,,,,,,,,,,,,,,,,
Ledipasvir/Sofosbuvir,250,RC,VB004952,LOCAL,,inpatient,1,EA,5400,5400,,,,,,,,,,,,,,,,,
Emtricitabine/Tenofov Alafenam,250,RC,VB004953,LOCAL,,inpatient,1,EA,352.37,352.37,,,,,,,,,,,,,,,,,
Bictegrav/Emtric/Tenofo 50/200/25mg,250,RC,VB004954,LOCAL,,inpatient,1,EA,674.58,674.58,,,,,,,,,,,,,,,,,
rOPINIRole HCL,250,RC,VB004955,LOCAL,,inpatient,1,EA,10,10,,,,,,,,,,,,,,,,,
Urea,250,RC,VB004956,LOCAL,,inpatient,1,EA,17.4,17.4,,,,,,,,,,,,,,,,,
Phenytoin Sodium Extended,250,RC,VB004957,LOCAL,,inpatient,1,EA,5.78,5.78,,,,,,,,,,,,,,,,,
Riluzole,250,RC,VB004958,LOCAL,,inpatient,1,EA,6.34,6.34,,,,,,,,,,,,,,,,,
calcitrioL,250,RC,VB004959,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
clindamycin HCL,250,RC,VB004960,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
propofoL 10mg/mL,250,RC,VB004961,LOCAL,,inpatient,50,ML,72,72,,,,,,,,,,,,,,,,,
propofoL 10mg/mL,250,RC,VB004962,LOCAL,,inpatient,20,ML,11.52,11.52,,,,,,,,,,,,,,,,,
propofoL 10mg/mL,250,RC,VB004963,LOCAL,,inpatient,100,ML,57.6,57.6,,,,,,,,,,,,,,,,,
Calcium Gluconate 10% Inj,250,RC,VB004964,LOCAL,,inpatient,10,ML,33.7,33.7,,,,,,,,,,,,,,,,,
Octreotide Acetate,250,RC,VB004965,LOCAL,,inpatient,5,ML,477.02,477.02,,,,,,,,,,,,,,,,,
Ampicillin Sodium,250,RC,VB004966,LOCAL,,inpatient,1,EA,38.11,38.11,,,,,,,,,,,,,,,,,
Midazolam HCL,250,RC,VB004967,LOCAL,,inpatient,2,ML,6.24,6.24,,,,,,,,,,,,,,,,,
Midazolam HCL Inj,250,RC,VB004968,LOCAL,,inpatient,5,ML,13.36,13.36,,,,,,,,,,,,,,,,,
Midazolam HCL Inj,250,RC,VB004969,LOCAL,,inpatient,1,ML,15.65,15.65,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB004970,LOCAL,,inpatient,1,ML,13.78,13.78,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB004971,LOCAL,,inpatient,1,ML,13.78,13.78,,,,,,,,,,,,,,,,,
Lidocaine HCL/Epineph 1%-1:100K,250,RC,VB004972,LOCAL,,inpatient,20,ML,26.88,26.88,,,,,,,,,,,,,,,,,
Adenosine,250,RC,VB004973,LOCAL,,inpatient,2,ML,52.56,52.56,,,,,,,,,,,,,,,,,
Pentamidine Isethionate,250,RC,VB004974,LOCAL,,inpatient,1,EA,801.07,801.07,,,,,,,,,,,,,,,,,
Arformoterol Tartrate,250,RC,VB004975,LOCAL,,inpatient,2,ML,90.04,90.04,,,,,,,,,,,,,,,,,
armodafiniL,250,RC,VB004976,LOCAL,,inpatient,1,EA,58.14,58.14,,,,,,,,,,,,,,,,,
Tbo-Filgrastim,250,RC,VB004977,LOCAL,,inpatient,0.5,ML,1438.08,1438.08,,,,,,,,,,,,,,,,,
Calcium Acetate,250,RC,VB004978,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Benzocaine/Menthol,250,RC,VB004979,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
HYDROcodone/APAP 7.5-325mg/15mL,250,RC,VB004980,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
Dimethyl Fumarate,250,RC,VB004981,LOCAL,,inpatient,1,EA,789.59,789.59,,,,,,,,,,,,,,,,,
Dextromethorphan Hbr/Quinidine,250,RC,VB004982,LOCAL,,inpatient,1,EA,125.9,125.9,,,,,,,,,,,,,,,,,
Carbidopa/Levodopa 48.75MG/195MG,250,RC,VB004983,LOCAL,,inpatient,1,EA,19.94,19.94,,,,,,,,,,,,,,,,,
"L.acid,para/B.bifidum/S.therm",250,RC,VB004984,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Flucytosine,250,RC,VB004985,LOCAL,,inpatient,1,EA,328.28,328.28,,,,,,,,,,,,,,,,,
Glycopyrrolate,250,RC,VB004986,LOCAL,,inpatient,1,EA,8.8,8.8,,,,,,,,,,,,,,,,,
vancomycin HCL Oral,250,RC,VB004987,LOCAL,,inpatient,150,ML,784.08,784.08,,,,,,,,,,,,,,,,,
Bosentan,250,RC,VB004988,LOCAL,,inpatient,1,EA,1073.1,1073.1,,,,,,,,,,,,,,,,,
Epoprostenol Sodium,250,RC,VB004989,LOCAL,,inpatient,1,EA,182.02,182.02,,,,,,,,,,,,,,,,,
HYDROcodone-APAP 7.5-325MG/15ML,250,RC,VB004990,LOCAL,,inpatient,15,ML,21.28,21.28,,,,,,,,,,,,,,,,,
sirolimus Oral Soln,250,RC,VB004991,LOCAL,,inpatient,1,EA,126.31,126.31,,,,,,,,,,,,,,,,,
Propafenone HCL,250,RC,VB004992,LOCAL,,inpatient,1,EA,31.54,31.54,,,,,,,,,,,,,,,,,
Droxidopa,250,RC,VB004993,LOCAL,,inpatient,1,EA,143.86,143.86,,,,,,,,,,,,,,,,,
Droxidopa,250,RC,VB004994,LOCAL,,inpatient,1,EA,409.36,409.36,,,,,,,,,,,,,,,,,
Droxidopa,250,RC,VB004995,LOCAL,,inpatient,1,EA,614.04,614.04,,,,,,,,,,,,,,,,,
Octreotide Acetate,250,RC,VB004996,LOCAL,,inpatient,1,EA,190.56,190.56,,,,,,,,,,,,,,,,,
Levetiracetam In Nacl (Iso-Os),250,RC,VB004997,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
Levetiracetam In Nacl (Iso-Os),250,RC,VB004998,LOCAL,,inpatient,1,EA,238.12,238.12,,,,,,,,,,,,,,,,,
Levetiracetam In Nacl (Iso-Os),250,RC,VB004999,LOCAL,,inpatient,1,EA,356.36,356.36,,,,,,,,,,,,,,,,,
Ampicillin Sodium,250,RC,VB005000,LOCAL,,inpatient,1,EA,63.68,63.68,,,,,,,,,,,,,,,,,
Metaxalone,250,RC,VB005001,LOCAL,,inpatient,1,EA,23.96,23.96,,,,,,,,,,,,,,,,,
Promethazine HCL,250,RC,VB005002,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ribavirin,250,RC,VB005003,LOCAL,,inpatient,1,EA,39.68,39.68,,,,,,,,,,,,,,,,,
valACYclovir HCL,250,RC,VB005004,LOCAL,,inpatient,1,EA,24.78,24.78,,,,,,,,,,,,,,,,,
Potassium Chloride,250,RC,VB005005,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
levoFLOXacin,250,RC,VB005006,LOCAL,,inpatient,1,EA,65.97,65.97,,,,,,,,,,,,,,,,,
bisoproloL FUMARATE,250,RC,VB005007,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
QUEtiapine FUMARATE,250,RC,VB005008,LOCAL,,inpatient,1,EA,48.87,48.87,,,,,,,,,,,,,,,,,
Triamterene-HCTZ 37.5-25 MG,250,RC,VB005009,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Cyclobenzaprine HCL,250,RC,VB005010,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Gabapentin,250,RC,VB005011,LOCAL,,inpatient,1,EA,11.62,11.62,,,,,,,,,,,,,,,,,
Potassium Citrate,250,RC,VB005012,LOCAL,,inpatient,1,EA,11.58,11.58,,,,,,,,,,,,,,,,,
OXcarbazepine,250,RC,VB005013,LOCAL,,inpatient,1,EA,11.02,11.02,,,,,,,,,,,,,,,,,
levETIRAcetam,250,RC,VB005014,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
HYDROcodone-acetaminophen 10-325MG,250,RC,VB005015,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
ursodioL,250,RC,VB005016,LOCAL,,inpatient,1,EA,16.32,16.32,,,,,,,,,,,,,,,,,
Venlafaxine HCL,250,RC,VB005017,LOCAL,,inpatient,1,EA,8.27,8.27,,,,,,,,,,,,,,,,,
oxyCODONE HCL,250,RC,VB005018,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Omega-3/Dha/Epa/Fish Oil,250,RC,VB005019,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Furosemide *Oral*,250,RC,VB005020,LOCAL,,inpatient,4,ML,9.84,9.84,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB005021,LOCAL,,inpatient,1,EA,230.86,230.86,,,,,,,,,,,,,,,,,
Imipramine Pamoate,250,RC,VB005022,LOCAL,,inpatient,1,EA,67.43,67.43,,,,,,,,,,,,,,,,,
lamiVUDine,250,RC,VB005023,LOCAL,,inpatient,1,EA,57.29,57.29,,,,,,,,,,,,,,,,,
Amlodipine/Valsartan 10mg-320mg,250,RC,VB005024,LOCAL,,inpatient,1,EA,31.49,31.49,,,,,,,,,,,,,,,,,
Erythromycin Base,250,RC,VB005025,LOCAL,,inpatient,1,EA,36.79,36.79,,,,,,,,,,,,,,,,,
Gabapentin,250,RC,VB005026,LOCAL,,inpatient,1,EA,10.1,10.1,,,,,,,,,,,,,,,,,
oxyCODONE HCL,250,RC,VB005027,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
dilTIAZem HCL,250,RC,VB005028,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
tacrolimus,250,RC,VB005029,LOCAL,,inpatient,1,EA,33.37,33.37,,,,,,,,,,,,,,,,,
tacrolimus,250,RC,VB005030,LOCAL,,inpatient,1,EA,25.03,25.03,,,,,,,,,,,,,,,,,
Alendronate Sodium,250,RC,VB005031,LOCAL,,inpatient,1,EA,81.95,81.95,,,,,,,,,,,,,,,,,
Pregabalin,250,RC,VB005032,LOCAL,,inpatient,1,EA,29.15,29.15,,,,,,,,,,,,,,,,,
terbinafine HCL,250,RC,VB005033,LOCAL,,inpatient,1,EA,52.09,52.09,,,,,,,,,,,,,,,,,
Multivit-Min/Ferrous Gluconate,250,RC,VB005034,LOCAL,,inpatient,236,ML,5,5,,,,,,,,,,,,,,,,,
Aminocaproic Acid,250,RC,VB005035,LOCAL,,inpatient,1,EA,54.2,54.2,,,,,,,,,,,,,,,,,
Lidocaine 5 % Oint,250,RC,VB005036,LOCAL,,inpatient,35.44,GM,104.16,104.16,,,,,,,,,,,,,,,,,
Plecanatide,250,RC,VB005037,LOCAL,,inpatient,1,EA,81.31,81.31,,,,,,,,,,,,,,,,,
Vorapaxar Sulfate,250,RC,VB005038,LOCAL,,inpatient,1,EA,59.18,59.18,,,,,,,,,,,,,,,,,
Flu Vacc Ts2019(65up)/Mf59c/Pf,250,RC,VB005039,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Flu Vac Qs 19-20(4yr Up)cel/Pf,250,RC,VB005040,LOCAL,,inpatient,1,EA,115.44,115.44,,,,,,,,,,,,,,,,,
Vancomycin/Water for Inj (PREMIXED),250,RC,VB005041,LOCAL,,inpatient,200,ML,76.8,76.8,,,,,,,,,,,,,,,,,
Vancomycin/Water for Inj (PREMIXED),250,RC,VB005042,LOCAL,,inpatient,300,ML,110.4,110.4,,,,,,,,,,,,,,,,,
Vancomycin/Water for Inj (PREMIXED),250,RC,VB005043,LOCAL,,inpatient,400,ML,5,5,,,,,,,,,,,,,,,,,
DAPTOmycin,250,RC,VB005044,LOCAL,,inpatient,1,EA,192,192,,,,,,,,,,,,,,,,,
Vancomycin/Water for Inj (PREMIXED),250,RC,VB005045,LOCAL,,inpatient,150,ML,57.2,57.2,,,,,,,,,,,,,,,,,
Vancomycin/Water for Inj (PREMIXED),250,RC,VB005046,LOCAL,,inpatient,1,EA,91.2,91.2,,,,,,,,,,,,,,,,,
Vancomycin/Water for Inj (PREMIXED),250,RC,VB005047,LOCAL,,inpatient,350,ML,124.8,124.8,,,,,,,,,,,,,,,,,
Polymyxin B Sulfate,250,RC,VB005048,LOCAL,,inpatient,1,EA,43.2,43.2,,,,,,,,,,,,,,,,,
Eravacycline Di-Hydrochloride,250,RC,VB005049,LOCAL,,inpatient,1,EA,322,322,,,,,,,,,,,,,,,,,
Aclidinium Bromide,250,RC,VB005050,LOCAL,,inpatient,1,EA,1371.55,1371.55,,,,,,,,,,,,,,,,,
Lanolin Alcohol/Mo/W.pet/Ceres,250,RC,VB005051,LOCAL,,inpatient,113,GM,51.68,51.68,,,,,,,,,,,,,,,,,
"Petrolatum,white",250,RC,VB005052,LOCAL,,inpatient,1,EA,34.32,34.32,,,,,,,,,,,,,,,,,
"Petrolatum,white 41%",250,RC,VB005053,LOCAL,,inpatient,1,EA,34.36,34.36,,,,,,,,,,,,,,,,,
"Petrolatum,white",250,RC,VB005054,LOCAL,,inpatient,1,EA,103.68,103.68,,,,,,,,,,,,,,,,,
Zinc Oxide 20 %,250,RC,VB005055,LOCAL,,inpatient,1,EA,36.24,36.24,,,,,,,,,,,,,,,,,
Morphine Sulfate,250,RC,VB005056,LOCAL,,inpatient,1,ML,5.74,5.74,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB005057,LOCAL,,inpatient,1,ML,13.78,13.78,,,,,,,,,,,,,,,,,
Hydromorphone HCL/Pf 0.5mg/0.5mL,250,RC,VB005058,LOCAL,,inpatient,0.5,ML,17.28,17.28,,,,,,,,,,,,,,,,,
Metoclopramide HCL Inj,250,RC,VB005059,LOCAL,,inpatient,2,ML,12.77,12.77,,,,,,,,,,,,,,,,,
levalbuterol HCL,250,RC,VB005060,LOCAL,,inpatient,3,ML,12.52,12.52,,,,,,,,,,,,,,,,,
Omega-3/Dha/Epa/Fish Oil,250,RC,VB005062,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
CAMERA,250,RC,VB005067,LOCAL,,inpatient,1,EA,1.5,1.5,,,,,,,,,,,,,,,,,
CLOUD CREAM,250,RC,VB005068,LOCAL,,inpatient,240,GM,1.5,1.5,,,,,,,,,,,,,,,,,
MIRACLE MOUTHWASH 120ML,250,RC,VB005073,LOCAL,,inpatient,120,ML,16,16,,,,,,,,,,,,,,,,,
"Fenofibrate,micronized",250,RC,VB005078,LOCAL,,inpatient,1,EA,7.84,7.84,,,,,,,,,,,,,,,,,
TPN 1000ML W/ELECTROLYTES,250,RC,VB005081,LOCAL,,inpatient,1000,ML,1.5,1.5,,,,,,,,,,,,,,,,,
TPN 2000ML W/ELECTROLYTES,250,RC,VB005082,LOCAL,,inpatient,2000,ML,1.5,1.5,,,,,,,,,,,,,,,,,
TPN 3000ML W/ELECTROLYTES,250,RC,VB005083,LOCAL,,inpatient,3000,ML,1.5,1.5,,,,,,,,,,,,,,,,,
TPN 4000ML W/ELECTROLYTES,250,RC,VB005084,LOCAL,,inpatient,4000,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Lanolin Alcohol/Mo/W.pet/Cere(16oz),250,RC,VB005087,LOCAL,,inpatient,454,GM,88.96,88.96,,,,,,,,,,,,,,,,,
Vancomycin Oral,250,RC,VB005088,LOCAL,,inpatient,5,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Vancomycin Oral,250,RC,VB005088,LOCAL,,inpatient,5,ML,1.5,1.5,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride (MINIBAG+),250,RC,VB005125,LOCAL,,inpatient,50,ML,34.9,34.9,,,,,,,,,,,,,,,,,
Sodium Bicarbonate Inj 8.4%,250,RC,VB005127,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
Furosemide Injection,250,RC,VB005128,LOCAL,,inpatient,10,ML,8.54,8.54,,,,,,,,,,,,,,,,,
Tobramycin Sulfate (30ML VIAL),250,RC,VB005129,LOCAL,,inpatient,30,ML,105.6,105.6,,,,,,,,,,,,,,,,,
OMEPRAZOLE 20MG/10ML ORAL,250,RC,VB005130,LOCAL,,inpatient,200,ML,1.92,1.92,,,,,,,,,,,,,,,,,
SILVER sulfADIAZINE (50gm),250,RC,VB005136,LOCAL,,inpatient,50,GM,83,83,,,,,,,,,,,,,,,,,
SILVER sulfADIAZINE (400gm Jar),250,RC,VB005137,LOCAL,,inpatient,400,GM,333.2,333.2,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride 500ML (HD),250,RC,VB005140,LOCAL,,inpatient,500,ML,16.22,16.22,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride 1000ML (HD),250,RC,VB005141,LOCAL,,inpatient,1000,ML,13.1,13.1,,,,,,,,,,,,,,,,,
Albumin Human 25% (HD USE ONLY),250,RC,VB005142,LOCAL,,inpatient,100,ML,551.04,551.04,,,,,,,,,,,,,,,,,
MIDAZOLAM IN NS (FLOOR STOCK),250,RC,VB005145,LOCAL,,inpatient,100,ML,1.5,1.5,,,,,,,,,,,,,,,,,
FENTANYL/NS 1000MCG/100ML (FLR STK),250,RC,VB005146,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
"Diatrizoate Meglumine, Sodium",250,RC,VB005148,LOCAL,,inpatient,30,ML,110.8,110.8,,,,,,,,,,,,,,,,,
Furosemide Injection,250,RC,VB005150,LOCAL,,inpatient,2,ML,5,5,,,,,,,,,,,,,,,,,
dexAMETHasone SODIUM PHOSPHATE,250,RC,VB005151,LOCAL,,inpatient,5,ML,33.17,33.17,,,,,,,,,,,,,,,,,
Potassium Chloride Packet,250,RC,VB005156,LOCAL,,inpatient,1,EA,42.96,42.96,,,,,,,,,,,,,,,,,
Dalbavancin HCL,250,RC,VB005226,LOCAL,,inpatient,1,EA,8539.82,8539.82,,,,,,,,,,,,,,,,,
guaiFENesin - UD,250,RC,VB005251,LOCAL,,inpatient,10,ML,7.72,7.72,,,,,,,,,,,,,,,,,
Sterile Water For IRRIG (RT USE),250,RC,VB005252,LOCAL,,inpatient,3000,ML,56.78,56.78,,,,,,,,,,,,,,,,,
lisinopriL,250,RC,VB005253,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Benzonatate,250,RC,VB005255,LOCAL,,inpatient,1,EA,19.07,19.07,,,,,,,,,,,,,,,,,
Hydromorphone HCL (PF),250,RC,VB005258,LOCAL,,inpatient,1,ML,20.74,20.74,,,,,,,,,,,,,,,,,
Ceftriaxone In is-Osm Dextrose,250,RC,VB005287,LOCAL,,inpatient,1,ML,116.84,116.84,,,,,,,,,,,,,,,,,
Fluticasone/Umeclidin/Vilanter,250,RC,VB005305,LOCAL,,inpatient,1,EA,1515.36,1515.36,,,,,,,,,,,,,,,,,
Lidocaine HCL/Pf 1% Inj - 5mL,250,RC,VB005314,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
Acetylcysteine 20% - 10mL,250,RC,VB005316,LOCAL,,inpatient,10,ML,72.77,72.77,,,,,,,,,,,,,,,,,
Capecitabine,250,RC,VB005320,LOCAL,,inpatient,1,EA,216.89,216.89,,,,,,,,,,,,,,,,,
Pneumoc 13-Val Conj-Dip Crm/Pf,250,RC,VB005321,LOCAL,,inpatient,0.5,ML,1117.25,1117.25,,,,,,,,,,,,,,,,,
Ertugliflozin Pidolate,250,RC,VB005322,LOCAL,,inpatient,1,EA,57.12,57.12,,,,,,,,,,,,,,,,,
Polyvinyl Alcohol/Povidone/Pf,250,RC,VB005323,LOCAL,,inpatient,50,ML,67.15,67.15,,,,,,,,,,,,,,,,,
Carboxymethylcellu Sod 0.5 % 15mL,250,RC,VB005324,LOCAL,,inpatient,15,ML,29.66,29.66,,,,,,,,,,,,,,,,,
Lipase/Protease/Amylase 20K-63K-84K,250,RC,VB005325,LOCAL,,inpatient,1,EA,35.45,35.45,,,,,,,,,,,,,,,,,
Lipase/Protease/Amylase 12K-38K-60K,250,RC,VB005326,LOCAL,,inpatient,1,EA,20.59,20.59,,,,,,,,,,,,,,,,,
"Estrogens, Conjugated",250,RC,VB005327,LOCAL,,inpatient,1,EA,33.94,33.94,,,,,,,,,,,,,,,,,
Ipratropium Bromide 0.03% Nasal,250,RC,VB005328,LOCAL,,inpatient,30,ML,446.68,446.68,,,,,,,,,,,,,,,,,
Triazolam,250,RC,VB005329,LOCAL,,inpatient,1,EA,24.15,24.15,,,,,,,,,,,,,,,,,
lithium carbonate,250,RC,VB005330,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Nepafenac  0.1 %,250,RC,VB005331,LOCAL,,inpatient,3,ML,1504.56,1504.56,,,,,,,,,,,,,,,,,
Octreotide Acetate,250,RC,VB005332,LOCAL,,inpatient,1,ML,131.43,131.43,,,,,,,,,,,,,,,,,
fluvastatin SODIUM,250,RC,VB005333,LOCAL,,inpatient,1,EA,65.53,65.53,,,,,,,,,,,,,,,,,
Eltrombopag Olamine,250,RC,VB005334,LOCAL,,inpatient,1,EA,1252.22,1252.22,,,,,,,,,,,,,,,,,
"Octreotide Acetate,mi-Spheres",250,RC,VB005335,LOCAL,,inpatient,1,EA,16912.46,16912.46,,,,,,,,,,,,,,,,,
Mometasone Furoate,250,RC,VB005336,LOCAL,,inpatient,17,GM,1206.86,1206.86,,,,,,,,,,,,,,,,,
Zaleplon,250,RC,VB005337,LOCAL,,inpatient,1,EA,15.15,15.15,,,,,,,,,,,,,,,,,
Influenza Vaccine Adult 2021-2022,250,RC,VB005338,LOCAL,,inpatient,1,EA,88.13,88.13,,,,,,,,,,,,,,,,,
Flu vaccine Adult (egg-free) 21-22,250,RC,VB005339,LOCAL,,inpatient,1,EA,123.07,123.07,,,,,,,,,,,,,,,,,
Flu vaccine >65 yr 2021-2022,250,RC,VB005340,LOCAL,,inpatient,1,EA,276.67,276.67,,,,,,,,,,,,,,,,,
Ticagrelor,250,RC,VB005341,LOCAL,,inpatient,1,EA,37.18,37.18,,,,,,,,,,,,,,,,,
Budesonide,250,RC,VB005342,LOCAL,,inpatient,2,ML,41.86,41.86,,,,,,,,,,,,,,,,,
Budesonide,250,RC,VB005343,LOCAL,,inpatient,2,ML,98.5,98.5,,,,,,,,,,,,,,,,,
esomeprazole MAGNESIUM,250,RC,VB005344,LOCAL,,inpatient,1,EA,45.96,45.96,,,,,,,,,,,,,,,,,
Dextrose/Dextrin/Malt 24 gm/31gm,250,RC,VB005345,LOCAL,,inpatient,31,GM,5,5,,,,,,,,,,,,,,,,,
Sodium Bicarbonate,250,RC,VB005346,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Psyllium Husk,250,RC,VB005347,LOCAL,,inpatient,30,GM,5,5,,,,,,,,,,,,,,,,,
Phenylephrine HCL  0.5 %,250,RC,VB005348,LOCAL,,inpatient,1,EA,16.66,16.66,,,,,,,,,,,,,,,,,
Isosorbide Mononitrate,250,RC,VB005349,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lubiprostone,250,RC,VB005350,LOCAL,,inpatient,1,EA,26.72,26.72,,,,,,,,,,,,,,,,,
"B1,b2,b3,b6,b12/Dexpan/Zn/Mang",250,RC,VB005351,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
QUEtiapine FUMARATE,250,RC,VB005352,LOCAL,,inpatient,1,EA,120.04,120.04,,,,,,,,,,,,,,,,,
Parenteral Amino Acid 10% No.6,250,RC,VB005353,LOCAL,,inpatient,2000,ML,273.46,273.46,,,,,,,,,,,,,,,,,
Potassium Chloride-0.45% Nacl,250,RC,VB005354,LOCAL,,inpatient,1000,ML,34.7,34.7,,,,,,,,,,,,,,,,,
Clindamycin In 0.9 % Sod Chlor,250,RC,VB005355,LOCAL,,inpatient,50,ML,51.26,51.26,,,,,,,,,,,,,,,,,
Clindamycin In 0.9 % Sod Chlor,250,RC,VB005356,LOCAL,,inpatient,50,ML,62.64,62.64,,,,,,,,,,,,,,,,,
Rasagiline Mesylate,250,RC,VB005357,LOCAL,,inpatient,1,EA,99.99,99.99,,,,,,,,,,,,,,,,,
tretinoin  0.01 %,250,RC,VB005358,LOCAL,,inpatient,15,GM,405.24,405.24,,,,,,,,,,,,,,,,,
Cefepime HCL,250,RC,VB005359,LOCAL,,inpatient,1,EA,27.79,27.79,,,,,,,,,,,,,,,,,
verapamil HCL Inj,250,RC,VB005360,LOCAL,,inpatient,4,ML,155.18,155.18,,,,,,,,,,,,,,,,,
Ampicillin Sodium/Sulbactam Na,250,RC,VB005361,LOCAL,,inpatient,1,EA,25.82,25.82,,,,,,,,,,,,,,,,,
Potassium Chloride In Water,250,RC,VB005362,LOCAL,,inpatient,50,ML,12.77,12.77,,,,,,,,,,,,,,,,,
Dextrose 5 % In Water,250,RC,VB005363,LOCAL,,inpatient,250,ML,27.94,27.94,,,,,,,,,,,,,,,,,
Dextrose 5 % In Water,250,RC,VB005364,LOCAL,,inpatient,100,ML,21.07,21.07,,,,,,,,,,,,,,,,,
Potassium Chloride/D5-NS,250,RC,VB005365,LOCAL,,inpatient,1000,ML,38.3,38.3,,,,,,,,,,,,,,,,,
Parenteral Amino Acid 15% No.2,250,RC,VB005366,LOCAL,,inpatient,2000,ML,202.75,202.75,,,,,,,,,,,,,,,,,
Nebivolol HCL,250,RC,VB005367,LOCAL,,inpatient,1,EA,27.86,27.86,,,,,,,,,,,,,,,,,
Zinc/Copper/Mangan/Chromic Chl,250,RC,VB005368,LOCAL,,inpatient,1,ML,58.8,58.8,,,,,,,,,,,,,,,,,
Trace Elements Inj,250,RC,VB005369,LOCAL,,inpatient,1,ML,129.5,129.5,,,,,,,,,,,,,,,,,
Aluminum Hydroxide,250,RC,VB005370,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Ascorbic Acid,250,RC,VB005371,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
Ubidecarenone,250,RC,VB005372,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
folic acid,250,RC,VB005373,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Vitamin B Complex,250,RC,VB005374,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Bacitracin 500 UNIT/G Ophth Oint,250,RC,VB005375,LOCAL,,inpatient,3.5,GM,518.76,518.76,,,,,,,,,,,,,,,,,
Dextroamphetamine/Amphetamine,250,RC,VB005376,LOCAL,,inpatient,1,EA,6.84,6.84,,,,,,,,,,,,,,,,,
Dextroamphetamine/Amphetamine,250,RC,VB005377,LOCAL,,inpatient,1,EA,24.53,24.53,,,,,,,,,,,,,,,,,
Levalbuterol Tartrate,250,RC,VB005378,LOCAL,,inpatient,15,GM,294.8,294.8,,,,,,,,,,,,,,,,,
Dabigatran Etexilate Mesylate,250,RC,VB005379,LOCAL,,inpatient,1,EA,15.87,15.87,,,,,,,,,,,,,,,,,
Ampicillin Sodium/Sulbactam Na,250,RC,VB005380,LOCAL,,inpatient,1,ML,307.4,307.4,,,,,,,,,,,,,,,,,
Nafcillin Sodium,250,RC,VB005381,LOCAL,,inpatient,1,EA,555.09,555.09,,,,,,,,,,,,,,,,,
penicillin G SODIUM,250,RC,VB005382,LOCAL,,inpatient,1,ML,230.39,230.39,,,,,,,,,,,,,,,,,
Menthol/Zinc Oxide 0.44-20.6%,250,RC,VB005383,LOCAL,,inpatient,1,EA,18.4,18.4,,,,,,,,,,,,,,,,,
Vitamin E,250,RC,VB005384,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Nitroglycerin,250,RC,VB005385,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
diphenhydrAMINE HCL ORAL,250,RC,VB005386,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
Calcium Carbonate,250,RC,VB005387,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Omega-3 Fatty Acids/Fish Oil,250,RC,VB005388,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ubidecarenone,250,RC,VB005389,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
zolpidem TARTRATE,250,RC,VB005390,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
OLANZapine,250,RC,VB005391,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Docusate Sodium,250,RC,VB005392,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Phenylephrine HCL  0.25 %,250,RC,VB005393,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Sodium Chloride/Sodium Bicarb,250,RC,VB005394,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
L. Acidophilus/L.bulgaricus,250,RC,VB005395,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Silver,250,RC,VB005396,LOCAL,,inpatient,1,EA,122.24,122.24,,,,,,,,,,,,,,,,,
Riboflavin (Vitamin B2),250,RC,VB005397,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Ferrous Sulfate, Dried",250,RC,VB005398,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Tetanus, Diphtheria Tox,adult",250,RC,VB005399,LOCAL,,inpatient,1,EA,134.35,134.35,,,,,,,,,,,,,,,,,
Docusate Sodium,250,RC,VB005400,LOCAL,,inpatient,5,ML,15.68,15.68,,,,,,,,,,,,,,,,,
Docusate/Benzocaine 283-20MG/5ML,250,RC,VB005401,LOCAL,,inpatient,5,ML,15.68,15.68,,,,,,,,,,,,,,,,,
Eye Cup,250,RC,VB005402,LOCAL,,inpatient,1,EA,5.08,5.08,,,,,,,,,,,,,,,,,
Eucalyptus Oil/Menthol/Camphor,250,RC,VB005403,LOCAL,,inpatient,1,EA,18.19,18.19,,,,,,,,,,,,,,,,,
Vit A/Vit C/Vit E/Zinc/Copper,250,RC,VB005404,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Vit A/Vit C/Vit E/Zinc/Copper,250,RC,VB005405,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
tadalafiL,250,RC,VB005406,LOCAL,,inpatient,1,EA,51.98,51.98,,,,,,,,,,,,,,,,,
Irbesartan,250,RC,VB005407,LOCAL,,inpatient,1,EA,12.28,12.28,,,,,,,,,,,,,,,,,
Flu Vacc Qs2020-21 36mos Up/Pf,250,RC,VB005408,LOCAL,,inpatient,1,EA,85.97,85.97,,,,,,,,,,,,,,,,,
"M-Vit,tx,iron,mins/Calc/Folic",250,RC,VB005409,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Cold Cream,250,RC,VB005410,LOCAL,,inpatient,1,EA,22.08,22.08,,,,,,,,,,,,,,,,,
Cadexomer Iodine 0.9%,250,RC,VB005411,LOCAL,,inpatient,1,EA,410.4,410.4,,,,,,,,,,,,,,,,,
"Nut.tx.gluc Intol,lf,soy/Fiber",250,RC,VB005412,LOCAL,,inpatient,1,EA,8.98,8.98,,,,,,,,,,,,,,,,,
Ivermectin,250,RC,VB005413,LOCAL,,inpatient,1,EA,19.88,19.88,,,,,,,,,,,,,,,,,
Buprenorphine/Naloxone 8mg/2mg,250,RC,VB005414,LOCAL,,inpatient,30,EA,35.2,35.2,,,,,,,,,,,,,,,,,
"Calcium Gluc In Nacl, Iso-Osm",250,RC,VB005415,LOCAL,,inpatient,50,ML,94.8,94.8,,,,,,,,,,,,,,,,,
Bacitracin 500 UNIT/G - 28GM,250,RC,VB005416,LOCAL,,inpatient,28,GM,21,21,,,,,,,,,,,,,,,,,
Neomycin/Bacitracin/Polymyxinb 144g,250,RC,VB005417,LOCAL,,inpatient,144,GM,5,5,,,,,,,,,,,,,,,,,
Mometasone Furoate  0.1 %,250,RC,VB005418,LOCAL,,inpatient,15,GM,116.64,116.64,,,,,,,,,,,,,,,,,
Clindamycin Phosphate 1 %,250,RC,VB005419,LOCAL,,inpatient,60,ML,5,5,,,,,,,,,,,,,,,,,
Calcium Carb/Vit D3 600 MG/200 Unit,250,RC,VB005420,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Flu Vacc Qs2020-21(65yr Up)/Pf,250,RC,VB005421,LOCAL,,inpatient,1,EA,253.78,253.78,,,,,,,,,,,,,,,,,
Ipecac,250,RC,VB005422,LOCAL,,inpatient,30,ML,5,5,,,,,,,,,,,,,,,,,
EPINEPHrine,250,RC,VB005423,LOCAL,,inpatient,1,EA,720,720,,,,,,,,,,,,,,,,,
Doxycycline Monohydrate,250,RC,VB005424,LOCAL,,inpatient,1,EA,5.8,5.8,,,,,,,,,,,,,,,,,
Calamine - 180mL,250,RC,VB005425,LOCAL,,inpatient,1,EA,33.48,33.48,,,,,,,,,,,,,,,,,
Mupirocin 2% - 1GM,250,RC,VB005426,LOCAL,,inpatient,1,GM,20.52,20.52,,,,,,,,,,,,,,,,,
Cyanocobalamin (Vitamin B-12),250,RC,VB005427,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Cholecalciferol (Vitamin D3),250,RC,VB005428,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lipase-Prote-Amyl 10.5K-35.5K-61.5K,250,RC,VB005429,LOCAL,,inpatient,1,EA,14.41,14.41,,,,,,,,,,,,,,,,,
benazepril HCL,250,RC,VB005430,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
cetirizine HCL,250,RC,VB005431,LOCAL,,inpatient,1,EA,9.98,9.98,,,,,,,,,,,,,,,,,
raNITIdine HCL,250,RC,VB005432,LOCAL,,inpatient,1,EA,6.34,6.34,,,,,,,,,,,,,,,,,
fluorouraciL 5 % - 40GM,250,RC,VB005433,LOCAL,,inpatient,40,GM,1539.76,1539.76,,,,,,,,,,,,,,,,,
estradioL,250,RC,VB005434,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Theophylline Anhydrous,250,RC,VB005435,LOCAL,,inpatient,1,EA,27.6,27.6,,,,,,,,,,,,,,,,,
Chlorhexidine Gluconate 4 %,250,RC,VB005436,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Patiromer Calcium Sorbitex,250,RC,VB005437,LOCAL,,inpatient,1,EA,227.71,227.71,,,,,,,,,,,,,,,,,
Ubidecarenone,250,RC,VB005438,LOCAL,,inpatient,30,EA,5,5,,,,,,,,,,,,,,,,,
carBAMazepine,250,RC,VB005439,LOCAL,,inpatient,1,EA,8.51,8.51,,,,,,,,,,,,,,,,,
carBAMazepine,250,RC,VB005440,LOCAL,,inpatient,1,EA,8.51,8.51,,,,,,,,,,,,,,,,,
Benzoin/Aloe Vera/Storax/Tolu,250,RC,VB005441,LOCAL,,inpatient,58,ML,21.44,21.44,,,,,,,,,,,,,,,,,
Mineral Oil,250,RC,VB005442,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ivabradine HCL,250,RC,VB005443,LOCAL,,inpatient,1,EA,50.07,50.07,,,,,,,,,,,,,,,,,
Fluconazole Oral Susp (BULK),250,RC,VB005444,LOCAL,,inpatient,35,ML,521.6,521.6,,,,,,,,,,,,,,,,,
Hepatitis B Virus Vaccine/Pf,250,RC,VB005445,LOCAL,,inpatient,1,EA,343.15,343.15,,,,,,,,,,,,,,,,,
Hepatitis A Virus Vaccine/Pf,250,RC,VB005446,LOCAL,,inpatient,1,EA,158.88,158.88,,,,,,,,,,,,,,,,,
Etanercept,250,RC,VB005447,LOCAL,,inpatient,1,EA,4229.63,4229.63,,,,,,,,,,,,,,,,,
Brexpiprazole,250,RC,VB005448,LOCAL,,inpatient,1,EA,242.51,242.51,,,,,,,,,,,,,,,,,
"Covid-19 Vacc, Mrna(Pfizer)/Pf",250,RC,VB005449,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Beclomethasone Dipropionate,250,RC,VB005450,LOCAL,,inpatient,10.6,GM,1025.76,1025.76,,,,,,,,,,,,,,,,,
Menthol 4 % Gel - 89mL,250,RC,VB005451,LOCAL,,inpatient,1,EA,36.52,36.52,,,,,,,,,,,,,,,,,
"Covid-19 Vac,ad26(Janssen)/Pf",250,RC,VB005452,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Hepatitis B Immune Globulin,250,RC,VB005453,LOCAL,,inpatient,1,EA,734.76,734.76,,,,,,,,,,,,,,,,,
Azelastine HCL 0.05 %,250,RC,VB005454,LOCAL,,inpatient,6,ML,416.28,416.28,,,,,,,,,,,,,,,,,
liothyronine SODIUM,250,RC,VB005455,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
timoloL MALEATE 0.25 % Gel Forming,250,RC,VB005456,LOCAL,,inpatient,5,ML,793,793,,,,,,,,,,,,,,,,,
Cyclopentolate HCL 1 % - 15mL,250,RC,VB005457,LOCAL,,inpatient,15,ML,162,162,,,,,,,,,,,,,,,,,
"Multivit Infusn,adult 1,vit K",250,RC,VB005458,LOCAL,,inpatient,10,ML,55.06,55.06,,,,,,,,,,,,,,,,,
Potassium Chloride,250,RC,VB005459,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lipase-Protea-Amyl 4.2K-14.2K-24.6K,250,RC,VB005460,LOCAL,,inpatient,1,EA,6.36,6.36,,,,,,,,,,,,,,,,,
Terbutaline Sulfate,250,RC,VB005461,LOCAL,,inpatient,1,ML,94.56,94.56,,,,,,,,,,,,,,,,,
Lurasidone HCL,250,RC,VB005462,LOCAL,,inpatient,1,EA,226.99,226.99,,,,,,,,,,,,,,,,,
Lubiprostone,250,RC,VB005463,LOCAL,,inpatient,1,EA,26.72,26.72,,,,,,,,,,,,,,,,,
L. Acidophilus/L.bulgaricus,250,RC,VB005464,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Azelastine HCL,250,RC,VB005465,LOCAL,,inpatient,30,ML,582.28,582.28,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB005466,LOCAL,,inpatient,150,ML,592.03,592.03,,,,,,,,,,,,,,,,,
Finasteride,250,RC,VB005467,LOCAL,,inpatient,1,EA,10.85,10.85,,,,,,,,,,,,,,,,,
Potassium Chloride,250,RC,VB005468,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
prednisoLONE SODIUM PHOSPHATE,250,RC,VB005469,LOCAL,,inpatient,1,EA,57.54,57.54,,,,,,,,,,,,,,,,,
Famotidine,250,RC,VB005470,LOCAL,,inpatient,4,ML,8.56,8.56,,,,,,,,,,,,,,,,,
Venlafaxine HCL,250,RC,VB005471,LOCAL,,inpatient,1,EA,9.26,9.26,,,,,,,,,,,,,,,,,
Nabumetone,250,RC,VB005472,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Nitrofurantoin Macrocrystal,250,RC,VB005473,LOCAL,,inpatient,1,EA,27.6,27.6,,,,,,,,,,,,,,,,,
Zidovudine,250,RC,VB005474,LOCAL,,inpatient,1,EA,23.33,23.33,,,,,,,,,,,,,,,,,
lanthanum carbonate,250,RC,VB005475,LOCAL,,inpatient,1,EA,51.87,51.87,,,,,,,,,,,,,,,,,
sirolimus,250,RC,VB005476,LOCAL,,inpatient,1,EA,34.62,34.62,,,,,,,,,,,,,,,,,
tacrolimus  0.1 %,250,RC,VB005477,LOCAL,,inpatient,30,GM,1041.8,1041.8,,,,,,,,,,,,,,,,,
Pimecrolimus  1 %,250,RC,VB005478,LOCAL,,inpatient,30,GM,1217.42,1217.42,,,,,,,,,,,,,,,,,
naloxone HCL Nasal Spray,250,RC,VB005479,LOCAL,,inpatient,2,EA,518.4,518.4,,,,,,,,,,,,,,,,,
haloperidoL DECANOATE,250,RC,VB005480,LOCAL,,inpatient,1,ML,125,125,,,,,,,,,,,,,,,,,
Flu Vac Ts 2016-17(4 Yr Up)/Pf,250,RC,VB005481,LOCAL,,inpatient,1,EA,71.62,71.62,,,,,,,,,,,,,,,,,
Ciclesonide,250,RC,VB005482,LOCAL,,inpatient,6.1,GM,1316.21,1316.21,,,,,,,,,,,,,,,,,
Ciclesonide,250,RC,VB005483,LOCAL,,inpatient,6.1,GM,1316.21,1316.21,,,,,,,,,,,,,,,,,
Biotin,250,RC,VB005484,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Levomefolate Calcium,250,RC,VB005485,LOCAL,,inpatient,1,EA,11.85,11.85,,,,,,,,,,,,,,,,,
Benzocaine/Menthol,250,RC,VB005486,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Banana Flakes/T-Galactooligos.,250,RC,VB005487,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Bacitracin Zinc/Polymyxin B,250,RC,VB005488,LOCAL,,inpatient,28.35,GM,43.2,43.2,,,,,,,,,,,,,,,,,
"Petrolatum,white",250,RC,VB005489,LOCAL,,inpatient,5,GM,5,5,,,,,,,,,,,,,,,,,
"Glucagon,human Recombinant",250,RC,VB005490,LOCAL,,inpatient,1,ML,1476.96,1476.96,,,,,,,,,,,,,,,,,
guanFACINE HCL,250,RC,VB005491,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Propafenone HCL,250,RC,VB005492,LOCAL,,inpatient,1,EA,9.32,9.32,,,,,,,,,,,,,,,,,
Guaifenesin/Dextromethorphan - UD,250,RC,VB005494,LOCAL,,inpatient,1,EA,1.5,1.5,,,,,,,,,,,,,,,,,
Hydromorphone 50MG in NS 50ML,250,RC,VB005499,LOCAL,,inpatient,50,ML,27.56,27.56,,,,,,,,,,,,,,,,,
Povidone-Iodine 10% Swab,250,RC,VB005501,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Carmex Classic Lip Balm,250,RC,VB005502,LOCAL,,inpatient,8,GM,5,5,,,,,,,,,,,,,,,,,
Wound Dressings-Gel***,250,RC,VB005504,LOCAL,,inpatient,42.5,GM,1.5,1.5,,,,,,,,,,,,,,,,,
Clotrimazole Topical 1% (10ML),250,RC,VB005505,LOCAL,,inpatient,10,ML,180.52,180.52,,,,,,,,,,,,,,,,,
SILVER sulfADIAZINE (20GM) 1%,250,RC,VB005531,LOCAL,,inpatient,20,GM,43.63,43.63,,,,,,,,,,,,,,,,,
"Water for Injection,sterile (50ML)",250,RC,VB005532,LOCAL,,inpatient,50,ML,40.66,40.66,,,,,,,,,,,,,,,,,
Mineral Oil (30ML),250,RC,VB005533,LOCAL,,inpatient,30,ML,7.87,7.87,,,,,,,,,,,,,,,,,
Sodium Chloride 0.9 % Flush (3ML),250,RC,VB005534,LOCAL,,inpatient,3,ML,5,5,,,,,,,,,,,,,,,,,
Sodium Chloride 0.9 % Flush (2.5ML),250,RC,VB005535,LOCAL,,inpatient,2.5,ML,5,5,,,,,,,,,,,,,,,,,
Miconazole Nitrate (71gm)  2 %,250,RC,VB005537,LOCAL,,inpatient,71,GM,33.96,33.96,,,,,,,,,,,,,,,,,
Miconazole Nitrate 2 % - 30GM,250,RC,VB005538,LOCAL,,inpatient,30,GM,28.8,28.8,,,,,,,,,,,,,,,,,
Clotrimazole (30GM) 1 %,250,RC,VB005539,LOCAL,,inpatient,30,GM,139.4,139.4,,,,,,,,,,,,,,,,,
Plurogel,250,RC,VB005540,LOCAL,,inpatient,1,EA,196,196,,,,,,,,,,,,,,,,,
Potassium Chloride,250,RC,VB005541,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
metroNIDAZOLE 0.75 % Topical 45GM,250,RC,VB005542,LOCAL,,inpatient,45,GM,656.06,656.06,,,,,,,,,,,,,,,,,
Dalfampridine,250,RC,VB005543,LOCAL,,inpatient,1,EA,193.79,193.79,,,,,,,,,,,,,,,,,
ursodioL,250,RC,VB005544,LOCAL,,inpatient,1,EA,19.01,19.01,,,,,,,,,,,,,,,,,
Bismuth Subsalicylate,250,RC,VB005545,LOCAL,,inpatient,236,ML,18.34,18.34,,,,,,,,,,,,,,,,,
Melatonin,250,RC,VB005546,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
CRANBERRY SUPPLEMENT,250,RC,VB005547,LOCAL,,inpatient,1,EA,1.5,1.5,,,,,,,,,,,,,,,,,
Cranberry Fruit,250,RC,VB005548,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
ACTIVE LIQUID PROTEIN,250,RC,VB005551,LOCAL,,inpatient,887,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Permethrin  1 %,250,RC,VB005565,LOCAL,,inpatient,1,EA,62.32,62.32,,,,,,,,,,,,,,,,,
Selenium,250,RC,VB005566,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Phytonadione (Vit K1),250,RC,VB005567,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Flu Vacc Qs2021-22(6mos Up)/Pf,250,RC,VB005579,LOCAL,,inpatient,1,EA,83.42,83.42,,,,,,,,,,,,,,,,,
Darunavir/Cob/Emtri/Tenof Alaf,250,RC,VB005584,LOCAL,,inpatient,1,EA,754.71,754.71,,,,,,,,,,,,,,,,,
Brimonidine Tartrate 0.1%,250,RC,VB005587,LOCAL,,inpatient,5,ML,186.66,186.66,,,,,,,,,,,,,,,,,
paricalcitoL,250,RC,VB005588,LOCAL,,inpatient,1,EA,124.9,124.9,,,,,,,,,,,,,,,,,
carBAMazepine,250,RC,VB005589,LOCAL,,inpatient,1,EA,7.66,7.66,,,,,,,,,,,,,,,,,
Codeine Phosphate/Guaifenesin,250,RC,VB005590,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
Milrinone Lactate/D5w,250,RC,VB005591,LOCAL,,inpatient,200,ML,153.12,153.12,,,,,,,,,,,,,,,,,
"Gentamicin In Nacl, Iso-Osm",250,RC,VB005592,LOCAL,,inpatient,50,ML,19.54,19.54,,,,,,,,,,,,,,,,,
Dobutamine HCL In D5W 1000 mg/250mL,250,RC,VB005593,LOCAL,,inpatient,250,ML,140.3,140.3,,,,,,,,,,,,,,,,,
Erythromycin Lactobionate,250,RC,VB005594,LOCAL,,inpatient,1,EA,526.76,526.76,,,,,,,,,,,,,,,,,
Meclizine HCL,250,RC,VB005595,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dextrose Oral Gel 40%,250,RC,VB005596,LOCAL,,inpatient,37.5,GM,5,5,,,,,,,,,,,,,,,,,
Tranexamic Acid,250,RC,VB005597,LOCAL,,inpatient,1,EA,20.88,20.88,,,,,,,,,,,,,,,,,
PHENobarbitaL Elixir,250,RC,VB005598,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Desmopressin Acetate,250,RC,VB005599,LOCAL,,inpatient,1,ML,285.7,285.7,,,,,,,,,,,,,,,,,
Niacin ER,250,RC,VB005600,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Calamine/Zinc Oxide,250,RC,VB005601,LOCAL,,inpatient,177,ML,7.2,7.2,,,,,,,,,,,,,,,,,
Glucosamine HCL/Chondroitin Su,250,RC,VB005602,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Cranberry Fruit Extract,250,RC,VB005603,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Fexofenadine HCL,250,RC,VB005604,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dextrose Chew Tab,250,RC,VB005605,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
A/C/E/Zinc/Sod Selenate/Copper,250,RC,VB005606,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Glycerin/Witch Hazel Leaf,250,RC,VB005607,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Benzocaine 20% Oral gel,250,RC,VB005608,LOCAL,,inpatient,1,EA,23.96,23.96,,,,,,,,,,,,,,,,,
Leflunomide,250,RC,VB005609,LOCAL,,inpatient,1,EA,25.26,25.26,,,,,,,,,,,,,,,,,
"Progesterone, Micronized",250,RC,VB005610,LOCAL,,inpatient,1,EA,8.4,8.4,,,,,,,,,,,,,,,,,
Tapentadol HCL,250,RC,VB005611,LOCAL,,inpatient,1,EA,68.27,68.27,,,,,,,,,,,,,,,,,
Barium Sulfate,250,RC,VB005612,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Barium Sulfate,250,RC,VB005613,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Cadexomer Iodine,250,RC,VB005615,LOCAL,,inpatient,1,EA,77.05,77.05,,,,,,,,,,,,,,,,,
Trolamine Salicylate,250,RC,VB005616,LOCAL,,inpatient,85,GM,5,5,,,,,,,,,,,,,,,,,
Saliva Stimulant Comb. No.3,250,RC,VB005617,LOCAL,,inpatient,1,EA,39.36,39.36,,,,,,,,,,,,,,,,,
metFORMIN HCL,250,RC,VB005618,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Cyanocobalamin (Vitamin B-12),250,RC,VB005619,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Vitamin B Complex/Folic Acid,250,RC,VB005620,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ferrous Sulfate,250,RC,VB005621,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
verapamil HCL,250,RC,VB005622,LOCAL,,inpatient,1,EA,9.27,9.27,,,,,,,,,,,,,,,,,
Sodium Polystyrene Sulfonate,250,RC,VB005623,LOCAL,,inpatient,453.6,GM,5,5,,,,,,,,,,,,,,,,,
Epinephrine HCL/Pf,250,RC,VB005624,LOCAL,,inpatient,1,EA,70,70,,,,,,,,,,,,,,,,,
Turmeric/Turmeric Root Extract,250,RC,VB005625,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Darbepoetin Alfa In Polysorbat,250,RC,VB005626,LOCAL,,inpatient,1,ML,2229.12,2229.12,,,,,,,,,,,,,,,,,
Potassium Citrate/Citric Acid,250,RC,VB005627,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide,250,RC,VB005628,LOCAL,,inpatient,60,ML,169.68,169.68,,,,,,,,,,,,,,,,,
Remdesivir,250,RC,VB005629,LOCAL,,inpatient,1,EA,3047.28,3047.28,,,,,,,,,,,,,,,,,
Benztropine Mesylate,250,RC,VB005630,LOCAL,,inpatient,2,ML,264,264,,,,,,,,,,,,,,,,,
Tbo-Filgrastim,250,RC,VB005631,LOCAL,,inpatient,1,ML,1199.34,1199.34,,,,,,,,,,,,,,,,,
Heparin Sodium 300 unit/3mL,250,RC,VB005632,LOCAL,,inpatient,3,ML,5,5,,,,,,,,,,,,,,,,,
Ascorbic Acid Inj,250,RC,VB005633,LOCAL,,inpatient,50,ML,8.69,8.69,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB005634,LOCAL,,inpatient,1,EA,426.88,426.88,,,,,,,,,,,,,,,,,
levETIRAcetam Oral (BULK),250,RC,VB005635,LOCAL,,inpatient,473,ML,1211.68,1211.68,,,,,,,,,,,,,,,,,
Eszopiclone,250,RC,VB005636,LOCAL,,inpatient,1,EA,48.59,48.59,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide,250,RC,VB005637,LOCAL,,inpatient,15,GM,5,5,,,,,,,,,,,,,,,,,
Electrolytes/Dextrose,250,RC,VB005638,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lactobacil 2-S.thermo-Bifido 1,250,RC,VB005639,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lactobacillus Acidophilus,250,RC,VB005640,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lanolin,250,RC,VB005641,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Clorazepate Dipotassium,250,RC,VB005644,LOCAL,,inpatient,1,EA,18.7,18.7,,,,,,,,,,,,,,,,,
Mesalamine,250,RC,VB005646,LOCAL,,inpatient,1,EA,49.92,49.92,,,,,,,,,,,,,,,,,
Simethicone,250,RC,VB005650,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Acetylcysteine 10% *4mL*,250,RC,VB005663,LOCAL,,inpatient,4,ML,69.89,69.89,,,,,,,,,,,,,,,,,
Diphen-Lido-Al Hydr-Mg Hydrox-Simet,250,RC,VB005664,LOCAL,,inpatient,237,ML,383.92,383.92,,,,,,,,,,,,,,,,,
Guaifenesin/Dextromethorphan - UD,250,RC,VB005665,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
Benzocaine/Menthol,250,RC,VB005668,LOCAL,,inpatient,1,EA,1.5,1.5,,,,,,,,,,,,,,,,,
Chlorhexidine Glucon 0.12% - 15mL,250,RC,VB005670,LOCAL,,inpatient,15,ML,5,5,,,,,,,,,,,,,,,,,
Vancomycin HCl Oral (Compound Kit),250,RC,VB005671,LOCAL,,inpatient,150,ML,434.9,434.9,,,,,,,,,,,,,,,,,
Mupirocin - UD,250,RC,VB005684,LOCAL,,inpatient,1,GM,20.5,20.5,,,,,,,,,,,,,,,,,
Carboxymethylcellulose Sodium 1%,250,RC,VB005687,LOCAL,,inpatient,30,ML,5,5,,,,,,,,,,,,,,,,,
dexAMETHasone,250,RC,VB005688,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Glyburide,micronized",250,RC,VB005689,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Diluent for Epoprostenol(Glyc),250,RC,VB005690,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pilocarpine HCL,250,RC,VB005691,LOCAL,,inpatient,1,EA,6.08,6.08,,,,,,,,,,,,,,,,,
Sodium Zirconium Cyclosilicate,250,RC,VB005692,LOCAL,,inpatient,11,EA,137.84,137.84,,,,,,,,,,,,,,,,,
Dobutamine HCL In D5W 250 mg/250mL,250,RC,VB005693,LOCAL,,inpatient,250,ML,107.76,107.76,,,,,,,,,,,,,,,,,
Midazolam HCL/Pf,250,RC,VB005694,LOCAL,,inpatient,2,ML,5.66,5.66,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB005695,LOCAL,,inpatient,1,EA,32.07,32.07,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB005696,LOCAL,,inpatient,1,EA,26.04,26.04,,,,,,,,,,,,,,,,,
Selenium,250,RC,VB005697,LOCAL,,inpatient,10,ML,8.51,8.51,,,,,,,,,,,,,,,,,
Zinc/Copper/Mangan/Chrom/Selen,250,RC,VB005698,LOCAL,,inpatient,1,ML,60,60,,,,,,,,,,,,,,,,,
fluPHENAZine HCL,250,RC,VB005699,LOCAL,,inpatient,1,EA,46.4,46.4,,,,,,,,,,,,,,,,,
Selenium Sulfide,250,RC,VB005700,LOCAL,,inpatient,207,ML,13.87,13.87,,,,,,,,,,,,,,,,,
medroxyPROGESTERone ACETATE,250,RC,VB005701,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Sodium Polystyrene Sulfon/Sorb,250,RC,VB005702,LOCAL,,inpatient,60,ML,45,45,,,,,,,,,,,,,,,,,
L. Acidophilus/Citrus Pectin,250,RC,VB005703,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Mineral Oil/Petrolatum,white",250,RC,VB005704,LOCAL,,inpatient,1,EA,32.74,32.74,,,,,,,,,,,,,,,,,
Immune Globul G/Gly/Iga Avg 46,250,RC,VB005705,LOCAL,,inpatient,100,ML,7139.52,7139.52,,,,,,,,,,,,,,,,,
Pramipexole Di-HCL,250,RC,VB005706,LOCAL,,inpatient,1,EA,11.8,11.8,,,,,,,,,,,,,,,,,
Theophylline Anhydrous,250,RC,VB005707,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Barium Sulfate,250,RC,VB005708,LOCAL,,inpatient,1,EA,274.08,274.08,,,,,,,,,,,,,,,,,
Neomycin Sulf/Polymyxin B Sulf,250,RC,VB005709,LOCAL,,inpatient,1,EA,52.44,52.44,,,,,,,,,,,,,,,,,
Treprostinil Sodium,250,RC,VB005710,LOCAL,,inpatient,20,ML,290.32,290.32,,,,,,,,,,,,,,,,,
Omega-3/Dha/Epa/Fish Oil,250,RC,VB005711,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Cholecalciferol (Vitamin D3),250,RC,VB005712,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pentosan Polysulfate Sodium,250,RC,VB005713,LOCAL,,inpatient,1,EA,57.48,57.48,,,,,,,,,,,,,,,,,
Metoclopramide HCL,250,RC,VB005714,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lanolin,250,RC,VB005715,LOCAL,,inpatient,1,EA,9.16,9.16,,,,,,,,,,,,,,,,,
Sod Chlord/Lanolin/Min.oil/Pet,250,RC,VB005716,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Tranexamic Acid,250,RC,VB005717,LOCAL,,inpatient,10,ML,28.8,28.8,,,,,,,,,,,,,,,,,
Desmopressin Acetate,250,RC,VB005718,LOCAL,,inpatient,1,EA,17.41,17.41,,,,,,,,,,,,,,,,,
Octreotide Acetate,250,RC,VB005719,LOCAL,,inpatient,1,ML,24.29,24.29,,,,,,,,,,,,,,,,,
Octreotide Acetate,250,RC,VB005720,LOCAL,,inpatient,1,ML,238.51,238.51,,,,,,,,,,,,,,,,,
Milrinone Lactate,250,RC,VB005721,LOCAL,,inpatient,20,ML,5,5,,,,,,,,,,,,,,,,,
Colesevelam HCL,250,RC,VB005722,LOCAL,,inpatient,1,EA,17.86,17.86,,,,,,,,,,,,,,,,,
Methylnaltrexone Bromide,250,RC,VB005723,LOCAL,,inpatient,0.6,EA,815.66,815.66,,,,,,,,,,,,,,,,,
Zonisamide,250,RC,VB005724,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
dexmedeTOMIDine HCL,250,RC,VB005725,LOCAL,,inpatient,2,ML,86.4,86.4,,,,,,,,,,,,,,,,,
EPINEPHrine,250,RC,VB005726,LOCAL,,inpatient,30,ML,283.2,283.2,,,,,,,,,,,,,,,,,
sotalol HCL,250,RC,VB005727,LOCAL,,inpatient,1,EA,13.67,13.67,,,,,,,,,,,,,,,,,
Cyanocobalamin/Folic Ac/Vit B6,250,RC,VB005728,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Docusate Sodium,250,RC,VB005734,LOCAL,,inpatient,473,ML,26.8,26.8,,,,,,,,,,,,,,,,,
clonazePAM,250,RC,VB005739,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Casirivimab/Imdevimab,250,RC,VB005743,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
Menthol/Zinc Oxide,250,RC,VB005749,LOCAL,,inpatient,113,GM,35,35,,,,,,,,,,,,,,,,,
Bismuth Subsalicylate Tablet,250,RC,VB005761,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Baclofen,250,RC,VB005762,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
nystatin OINT (30 GM Tube),250,RC,VB005765,LOCAL,,inpatient,30,GM,105,105,,,,,,,,,,,,,,,,,
Fluticasone Propion/Salmeterol,250,RC,VB005777,LOCAL,,inpatient,1,EA,1796.32,1796.32,,,,,,,,,,,,,,,,,
Fluticasone Propion/Salmeterol,250,RC,VB005778,LOCAL,,inpatient,1,EA,2362.52,2362.52,,,,,,,,,,,,,,,,,
Octreotide Acetate Inj,250,RC,VB005782,LOCAL,,inpatient,1,ML,37.92,37.92,,,,,,,,,,,,,,,,,
Acetaminophen,250,RC,VB005784,LOCAL,,inpatient,118,ML,12.1,12.1,,,,,,,,,,,,,,,,,
Amphotericin B/Sterile Water,250,RC,VB005796,LOCAL,,inpatient,500,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Midazolam in 0.9% Sodium Chloride,250,RC,VB005797,LOCAL,,inpatient,50,ML,33.12,33.12,,,,,,,,,,,,,,,,,
Morphine Sulfate in 0.9% Sodium Chl,250,RC,VB005798,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
Tolterodine Tartrate,250,RC,VB005800,LOCAL,,inpatient,1,EA,13.23,13.23,,,,,,,,,,,,,,,,,
Miconazole Nitrate 2% - 71gm,250,RC,VB005802,LOCAL,,inpatient,71,GM,390,390,,,,,,,,,,,,,,,,,
Sodium Polystyrene Sulfonate,250,RC,VB005806,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Docusate Sodium,250,RC,VB005807,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
PHENobarbitaL,250,RC,VB005811,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Gabapentin,250,RC,VB005813,LOCAL,,inpatient,6,ML,5,5,,,,,,,,,,,,,,,,,
Midazolam HCL In NS 50mg/50mL,250,RC,VB005814,LOCAL,,inpatient,50,ML,105.56,105.56,,,,,,,,,,,,,,,,,
Simethicone Chewable,250,RC,VB005820,LOCAL,,inpatient,1,EA,1.5,1.5,,,,,,,,,,,,,,,,,
Lacosamide in Sodium Chloride 0.9%,250,RC,VB005822,LOCAL,,inpatient,50,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Bimatoprost,250,RC,VB005828,LOCAL,,inpatient,5,ML,2532.96,2532.96,,,,,,,,,,,,,,,,,
Guaifenesin/Dextromethorphan,250,RC,VB005829,LOCAL,,inpatient,120,ML,5,5,,,,,,,,,,,,,,,,,
Fluocinonide (30gm),250,RC,VB005830,LOCAL,,inpatient,30,GM,364.4,364.4,,,,,,,,,,,,,,,,,
Imatinib Mesylate,250,RC,VB005831,LOCAL,,inpatient,1,EA,404.07,404.07,,,,,,,,,,,,,,,,,
guaiFENesin *118ml bottle*,250,RC,VB005832,LOCAL,,inpatient,118,ML,11.56,11.56,,,,,,,,,,,,,,,,,
ketorolac TROMETHAMINE 0.5% Ophth,250,RC,VB005833,LOCAL,,inpatient,5,ML,427.48,427.48,,,,,,,,,,,,,,,,,
Neomycin/Bacitracin/Polymyxinb 14gm,250,RC,VB005834,LOCAL,,inpatient,14.2,GM,21.16,21.16,,,,,,,,,,,,,,,,,
Nystatin/Triamcinolone *30gm*,250,RC,VB005835,LOCAL,,inpatient,30,GM,638.08,638.08,,,,,,,,,,,,,,,,,
"Potassium Phos,m-Basic-D-Basic",250,RC,VB005837,LOCAL,,inpatient,5,ML,71.09,71.09,,,,,,,,,,,,,,,,,
Tobramycin/Dexamethasone,250,RC,VB005838,LOCAL,,inpatient,5,ML,799.49,799.49,,,,,,,,,,,,,,,,,
Urea 20% - 85gm,250,RC,VB005839,LOCAL,,inpatient,85,GM,34.8,34.8,,,,,,,,,,,,,,,,,
"Water for Irrigation,sterile",250,RC,VB005840,LOCAL,,inpatient,250,ML,24.62,24.62,,,,,,,,,,,,,,,,,
Eravacycline Di-Hydrochloride,250,RC,VB005844,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
EPINEPHrine PROFESSIONAL KIT,250,RC,VB005845,LOCAL,,inpatient,1,EA,336,336,,,,,,,,,,,,,,,,,
Pneumococcal 23-Val P-Sac Vac,250,RC,VB005847,LOCAL,,inpatient,0.5,ea,5,5,,,,,,,,,,,,,,,,,
Albuterol Sulfate,250,RC,VB005853,LOCAL,,inpatient,8.5,GM,351.84,351.84,,,,,,,,,,,,,,,,,
Potassium Chloride Inj,250,RC,VB005854,LOCAL,,inpatient,10,ML,18.29,18.29,,,,,,,,,,,,,,,,,
Vitamin A & D Ointment,250,RC,VB005856,LOCAL,,inpatient,5,GM,1.5,1.5,,,,,,,,,,,,,,,,,
atomoxetine HCL,250,RC,VB005860,LOCAL,,inpatient,1,EA,63.26,63.26,,,,,,,,,,,,,,,,,
Glucagon,250,RC,VB005861,LOCAL,,inpatient,1,EA,1347.84,1347.84,,,,,,,,,,,,,,,,,
Insulin Lispro Protam/Lispro 50-50,250,RC,VB005862,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
Dasatinib,250,RC,VB005863,LOCAL,,inpatient,1,EA,2919.41,2919.41,,,,,,,,,,,,,,,,,
Entecavir,250,RC,VB005864,LOCAL,,inpatient,1,EA,219.6,219.6,,,,,,,,,,,,,,,,,
Entecavir,250,RC,VB005865,LOCAL,,inpatient,210,ML,21.96,21.96,,,,,,,,,,,,,,,,,
Oseltamivir Phosphate,250,RC,VB005866,LOCAL,,inpatient,60,ML,12.15,12.15,,,,,,,,,,,,,,,,,
"N.meningitidis B,lipid Fhbp Rc",250,RC,VB005867,LOCAL,,inpatient,0.5,ML,991.54,991.54,,,,,,,,,,,,,,,,,
Raltegravir Potassium,250,RC,VB005868,LOCAL,,inpatient,1,EA,41.66,41.66,,,,,,,,,,,,,,,,,
Indinavir Sulfate,250,RC,VB005869,LOCAL,,inpatient,1,EA,6.09,6.09,,,,,,,,,,,,,,,,,
Caspofungin Acetate,250,RC,VB005870,LOCAL,,inpatient,1,ea,1621.01,1621.01,,,,,,,,,,,,,,,,,
Pneumococcal 23-Val P-Sac Vac,250,RC,VB005871,LOCAL,,inpatient,0.5,ea,561.98,561.98,,,,,,,,,,,,,,,,,
Hepatitis B Virus Vaccine/Pf,250,RC,VB005872,LOCAL,,inpatient,1,ea,892.99,892.99,,,,,,,,,,,,,,,,,
Hepatitis B Virus Vaccine/Pf,250,RC,VB005873,LOCAL,,inpatient,1,ea,313.39,313.39,,,,,,,,,,,,,,,,,
pantoprazole SODIUM,250,RC,VB005874,LOCAL,,inpatient,1,EA,69.16,69.16,,,,,,,,,,,,,,,,,
Clindamycin Phosphate,250,RC,VB005875,LOCAL,,inpatient,40,GM,8.77,8.77,,,,,,,,,,,,,,,,,
Fluorometholone,250,RC,VB005876,LOCAL,,inpatient,3.5,GM,219.98,219.98,,,,,,,,,,,,,,,,,
Testosterone,250,RC,VB005877,LOCAL,,inpatient,1,EA,49.27,49.27,,,,,,,,,,,,,,,,,
Testosterone 4 mg/24 hour Patch,250,RC,VB005878,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lipase/Protease/Amylase 25-79-105K,250,RC,VB005879,LOCAL,,inpatient,1,EA,43.86,43.86,,,,,,,,,,,,,,,,,
Carboxymethylcellulose Sodium 1%,250,RC,VB005880,LOCAL,,inpatient,15,ML,41.66,41.66,,,,,,,,,,,,,,,,,
Brimonidine Tartrate/Timolol,250,RC,VB005881,LOCAL,,inpatient,5,ML,979.82,979.82,,,,,,,,,,,,,,,,,
Lipase/Protease/Amylase,250,RC,VB005882,LOCAL,,inpatient,1,EA,5.74,5.74,,,,,,,,,,,,,,,,,
Testosterone Gel 25mg/2.5gm (1%),250,RC,VB005883,LOCAL,,inpatient,2.5,GM,99.7,99.7,,,,,,,,,,,,,,,,,
Testosterone 50mg/5GM (1%) Gel,250,RC,VB005884,LOCAL,,inpatient,5,GM,20.49,20.49,,,,,,,,,,,,,,,,,
Flecainide Acetate,250,RC,VB005885,LOCAL,,inpatient,1,EA,17.37,17.37,,,,,,,,,,,,,,,,,
Citalopram Hydrobromide Oral Soln,250,RC,VB005886,LOCAL,,inpatient,240,ML,5,5,,,,,,,,,,,,,,,,,
Balsalazide Disodium,250,RC,VB005887,LOCAL,,inpatient,1,EA,6.4,6.4,,,,,,,,,,,,,,,,,
OXcarbazepine Oral,250,RC,VB005888,LOCAL,,inpatient,250,ML,5,5,,,,,,,,,,,,,,,,,
cyclophosphamide,250,RC,VB005889,LOCAL,,inpatient,1,EA,37.45,37.45,,,,,,,,,,,,,,,,,
Ethacrynic Acid,250,RC,VB005890,LOCAL,,inpatient,1,EA,95.8,95.8,,,,,,,,,,,,,,,,,
dexAMETHasone Oral,250,RC,VB005891,LOCAL,,inpatient,240,ML,5,5,,,,,,,,,,,,,,,,,
lithium CITRATE,250,RC,VB005892,LOCAL,,inpatient,500,ML,5,5,,,,,,,,,,,,,,,,,
methadone HCL Oral,250,RC,VB005893,LOCAL,,inpatient,500,ML,5,5,,,,,,,,,,,,,,,,,
leucovorin calcium,250,RC,VB005894,LOCAL,,inpatient,1,EA,98.94,98.94,,,,,,,,,,,,,,,,,
Dextran/Hypromellose/Glycerin,250,RC,VB005895,LOCAL,,inpatient,15,ML,31.73,31.73,,,,,,,,,,,,,,,,,
"Mineral Oil/Petrolatum,white Oint",250,RC,VB005896,LOCAL,,inpatient,3.5,GM,43.92,43.92,,,,,,,,,,,,,,,,,
Difluprednate,250,RC,VB005897,LOCAL,,inpatient,5,ML,1046.4,1046.4,,,,,,,,,,,,,,,,,
"Epoetin Alfa-Epbx 3,000 units/mL",250,RC,VB005898,LOCAL,,inpatient,1,ML,158.83,158.83,,,,,,,,,,,,,,,,,
sildenafiL CITRATE,250,RC,VB005899,LOCAL,,inpatient,1,EA,419.66,419.66,,,,,,,,,,,,,,,,,
Pregabalin,250,RC,VB005900,LOCAL,,inpatient,1,EA,48.57,48.57,,,,,,,,,,,,,,,,,
ritonavir,250,RC,VB005901,LOCAL,,inpatient,240,ML,28.8,28.8,,,,,,,,,,,,,,,,,
Leuprolide Acetate,250,RC,VB005902,LOCAL,,inpatient,1,EA,10302.29,10302.29,,,,,,,,,,,,,,,,,
Adalimumab,250,RC,VB005903,LOCAL,,inpatient,2,EA,16614.29,16614.29,,,,,,,,,,,,,,,,,
carBAMazepine ER,250,RC,VB005904,LOCAL,,inpatient,1,EA,7.93,7.93,,,,,,,,,,,,,,,,,
Imatinib Mesylate,250,RC,VB005905,LOCAL,,inpatient,1,EA,1619.59,1619.59,,,,,,,,,,,,,,,,,
Eltrombopag Olamine,250,RC,VB005906,LOCAL,,inpatient,1,EA,2266.12,2266.12,,,,,,,,,,,,,,,,,
Mometasone Furoate,250,RC,VB005907,LOCAL,,inpatient,1,GM,1078.94,1078.94,,,,,,,,,,,,,,,,,
Mometasone Furoate,250,RC,VB005908,LOCAL,,inpatient,13,GM,918.53,918.53,,,,,,,,,,,,,,,,,
Mometasone Furoate,250,RC,VB005909,LOCAL,,inpatient,13,GM,1079.52,1079.52,,,,,,,,,,,,,,,,,
cloZAPine,250,RC,VB005910,LOCAL,,inpatient,1,EA,32.7,32.7,,,,,,,,,,,,,,,,,
cloZAPine,250,RC,VB005911,LOCAL,,inpatient,1,EA,11.99,11.99,,,,,,,,,,,,,,,,,
atomoxetine HCL,250,RC,VB005912,LOCAL,,inpatient,1,EA,66.74,66.74,,,,,,,,,,,,,,,,,
cloZAPine,250,RC,VB005913,LOCAL,,inpatient,1,EA,6.68,6.68,,,,,,,,,,,,,,,,,
Lamivudine/Zidovudine,250,RC,VB005914,LOCAL,,inpatient,1,EA,62.11,62.11,,,,,,,,,,,,,,,,,
Cabergoline,250,RC,VB005915,LOCAL,,inpatient,1,EA,146.64,146.64,,,,,,,,,,,,,,,,,
Nefazodone HCL,250,RC,VB005916,LOCAL,,inpatient,1,EA,18.74,18.74,,,,,,,,,,,,,,,,,
colestipol HCL,250,RC,VB005917,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
fluPHENAZine HCL,250,RC,VB005918,LOCAL,,inpatient,120,ML,12.55,12.55,,,,,,,,,,,,,,,,,
fluPHENAZine HCL,250,RC,VB005919,LOCAL,,inpatient,60,ML,5,5,,,,,,,,,,,,,,,,,
Acetaminophen Oral 325mg/10.15mL,250,RC,VB005920,LOCAL,,inpatient,10.15,ML,5.72,5.72,,,,,,,,,,,,,,,,,
Sulfameth-Trimeth 800-160mg/20mL,250,RC,VB005921,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Mag Hydrox/Aluminum Hyd/Simeth,250,RC,VB005922,LOCAL,,inpatient,30,ML,18.16,18.16,,,,,,,,,,,,,,,,,
Senna Leaf Extract,250,RC,VB005923,LOCAL,,inpatient,15,ML,19.32,19.32,,,,,,,,,,,,,,,,,
Hydrocodone Bit/Homatrop Me-Br,250,RC,VB005924,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
Fluoride (Sodium),250,RC,VB005925,LOCAL,,inpatient,100,ML,91.78,91.78,,,,,,,,,,,,,,,,,
Lacosamide Oral Soln,250,RC,VB005926,LOCAL,,inpatient,465,ML,7.6,7.6,,,,,,,,,,,,,,,,,
bisacodyL,250,RC,VB005927,LOCAL,,inpatient,37,ML,16.72,16.72,,,,,,,,,,,,,,,,,
cefaDROXiL,250,RC,VB005928,LOCAL,,inpatient,1,EA,18.72,18.72,,,,,,,,,,,,,,,,,
Menthol/Camphor,250,RC,VB005929,LOCAL,,inpatient,222,ML,32.45,32.45,,,,,,,,,,,,,,,,,
Pramoxine HCL,250,RC,VB005930,LOCAL,,inpatient,222,ML,32.45,32.45,,,,,,,,,,,,,,,,,
Fluocinolone Acetonide 0.01%,250,RC,VB005931,LOCAL,,inpatient,60,ML,160.32,160.32,,,,,,,,,,,,,,,,,
Fluocinonide,250,RC,VB005932,LOCAL,,inpatient,60,ML,192,192,,,,,,,,,,,,,,,,,
Alclometasone Dipropionate,250,RC,VB005933,LOCAL,,inpatient,45,GM,390.04,390.04,,,,,,,,,,,,,,,,,
Betamethasone/Propylene Glyc,250,RC,VB005934,LOCAL,,inpatient,30,ML,381.84,381.84,,,,,,,,,,,,,,,,,
Desonide,250,RC,VB005935,LOCAL,,inpatient,60,GM,961.6,961.6,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide,250,RC,VB005936,LOCAL,,inpatient,60,ML,300,300,,,,,,,,,,,,,,,,,
Clotrimazole/Betamethasone Dip,250,RC,VB005937,LOCAL,,inpatient,30,ML,594.24,594.24,,,,,,,,,,,,,,,,,
Anagrelide HCL,250,RC,VB005938,LOCAL,,inpatient,1,EA,96.27,96.27,,,,,,,,,,,,,,,,,
Pyridostigmine Bromide,250,RC,VB005939,LOCAL,,inpatient,473,ML,17.82,17.82,,,,,,,,,,,,,,,,,
tretinoin,250,RC,VB005940,LOCAL,,inpatient,20,GM,72,72,,,,,,,,,,,,,,,,,
Pramoxine HCL/Zinc Acetate,250,RC,VB005941,LOCAL,,inpatient,1,EA,18.62,18.62,,,,,,,,,,,,,,,,,
"Piperacillin-Tazo-Dextrose,iso",250,RC,VB005942,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
Sodium Chloride/Aloe Vera,250,RC,VB005943,LOCAL,,inpatient,14.1,GM,5,5,,,,,,,,,,,,,,,,,
NIFEdipine,250,RC,VB005944,LOCAL,,inpatient,1,EA,9.21,9.21,,,,,,,,,,,,,,,,,
Sodium/Pot/Mag/Calc/Chlor/Acet,250,RC,VB005945,LOCAL,,inpatient,250,ML,5,5,,,,,,,,,,,,,,,,,
"Gly/Dimeth/Petrolat,wht/Water",250,RC,VB005946,LOCAL,,inpatient,85,GM,28.8,28.8,,,,,,,,,,,,,,,,,
Vit E Acet/Gly/Dimeth/Water,250,RC,VB005947,LOCAL,,inpatient,1,ea,46.08,46.08,,,,,,,,,,,,,,,,,
Skin Cleanser,250,RC,VB005948,LOCAL,,inpatient,1,ea,27.84,27.84,,,,,,,,,,,,,,,,,
QUEtiapine FUMARATE,250,RC,VB005949,LOCAL,,inpatient,1,EA,70.78,70.78,,,,,,,,,,,,,,,,,
Glycopyrrolate/Formoterol Fum,250,RC,VB005950,LOCAL,,inpatient,5.9,GM,1045.78,1045.78,,,,,,,,,,,,,,,,,
Dapagliflozin/Metformin HCL,250,RC,VB005951,LOCAL,,inpatient,1,EA,95.96,95.96,,,,,,,,,,,,,,,,,
Exenatide 10mcg/0.04mL,250,RC,VB005952,LOCAL,,inpatient,2.4,ML,4079.76,4079.76,,,,,,,,,,,,,,,,,
Fulvestrant,250,RC,VB005953,LOCAL,,inpatient,5,ML,3840,3840,,,,,,,,,,,,,,,,,
"Ringer's Solution,lactated IRRIG",250,RC,VB005954,LOCAL,,inpatient,1000,ML,44.06,44.06,,,,,,,,,,,,,,,,,
"Gentamicin In Nacl, Iso-Osm",250,RC,VB005955,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
Gentamicin In NS 120mg/100mL,250,RC,VB005956,LOCAL,,inpatient,100,ML,19.97,19.97,,,,,,,,,,,,,,,,,
"Cefazolin Sodium/Dextrose,iso",250,RC,VB005957,LOCAL,,inpatient,50,ML,25.25,25.25,,,,,,,,,,,,,,,,,
Vancomycin HCL In 5 % Dextrose,250,RC,VB005958,LOCAL,,inpatient,100,ML,37.25,37.25,,,,,,,,,,,,,,,,,
Vancomycin HCL In 5 % Dextrose,250,RC,VB005959,LOCAL,,inpatient,150,ML,57.98,57.98,,,,,,,,,,,,,,,,,
estradioL,250,RC,VB005960,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Etidronate Disodium,250,RC,VB005961,LOCAL,,inpatient,1,EA,34.56,34.56,,,,,,,,,,,,,,,,,
Desvenlafaxine Succinate,250,RC,VB005962,LOCAL,,inpatient,1,EA,45.84,45.84,,,,,,,,,,,,,,,,,
Glucosamine Sulfate,250,RC,VB005963,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Benzoin,250,RC,VB005964,LOCAL,,inpatient,1,ea,50.48,50.48,,,,,,,,,,,,,,,,,
oxyCODONE HCL,250,RC,VB005965,LOCAL,,inpatient,500,ML,5,5,,,,,,,,,,,,,,,,,
naloxone HCL,250,RC,VB005966,LOCAL,,inpatient,1,ML,16.46,16.46,,,,,,,,,,,,,,,,,
Norepinephrine Bitartrate,250,RC,VB005967,LOCAL,,inpatient,4,ML,24.28,24.28,,,,,,,,,,,,,,,,,
Furosemide,250,RC,VB005968,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
Magnesium Sulfate 4mEq/mL - 10mL,250,RC,VB005969,LOCAL,,inpatient,10,ML,195.6,195.6,,,,,,,,,,,,,,,,,
Imipenem/Cilastatin Sodium,250,RC,VB005970,LOCAL,,inpatient,1,EA,23.95,23.95,,,,,,,,,,,,,,,,,
ketorolac TROMETHAMINE,250,RC,VB005971,LOCAL,,inpatient,2,ML,15.7,15.7,,,,,,,,,,,,,,,,,
Aminocaproic Acid,250,RC,VB005972,LOCAL,,inpatient,20,ML,5,5,,,,,,,,,,,,,,,,,
morphine SULFATE IV,250,RC,VB005973,LOCAL,,inpatient,10,ML,52.8,52.8,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB005974,LOCAL,,inpatient,1,EA,104.24,104.24,,,,,,,,,,,,,,,,,
Linaclotide,250,RC,VB005975,LOCAL,,inpatient,1,EA,90.88,90.88,,,,,,,,,,,,,,,,,
Adenosine Inj,250,RC,VB005976,LOCAL,,inpatient,4,ML,328.03,328.03,,,,,,,,,,,,,,,,,
Betamethasone/Propylene Glyc,250,RC,VB005977,LOCAL,,inpatient,15,GM,253.72,253.72,,,,,,,,,,,,,,,,,
clobetasoL PROPIONATE 0.05% Soln,250,RC,VB005978,LOCAL,,inpatient,25,ML,412.64,412.64,,,,,,,,,,,,,,,,,
Cyproheptadine HCL Oral,250,RC,VB005979,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Miconazole Nitrate Vaginal Supp,250,RC,VB005980,LOCAL,,inpatient,1,EA,229.2,229.2,,,,,,,,,,,,,,,,,
"Potassium Phosphate,monobasic",250,RC,VB005981,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Betamethasone Acetate,sod Phos Inj",250,RC,VB005982,LOCAL,,inpatient,5,ML,52.83,52.83,,,,,,,,,,,,,,,,,
Vasopressin,250,RC,VB005983,LOCAL,,inpatient,1,ML,240,240,,,,,,,,,,,,,,,,,
Iron Sucrose Complex Inj,250,RC,VB005984,LOCAL,,inpatient,2.5,ML,151.34,151.34,,,,,,,,,,,,,,,,,
Zinc Sulfate Inj,250,RC,VB005985,LOCAL,,inpatient,5,ML,225.02,225.02,,,,,,,,,,,,,,,,,
Loxapine Succinate,250,RC,VB005986,LOCAL,,inpatient,1,EA,10.29,10.29,,,,,,,,,,,,,,,,,
Bismuth Subsalicylate,250,RC,VB005987,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Calcium Citrate/Vitamin D3,250,RC,VB005988,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pedi Multivit 158/Iron/Vit K1,250,RC,VB005989,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Niacin ER,250,RC,VB005990,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Niacin,250,RC,VB005991,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
L. Acidophilus/Lactobac Spor,250,RC,VB005992,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
danazoL,250,RC,VB005993,LOCAL,,inpatient,1,EA,21.77,21.77,,,,,,,,,,,,,,,,,
Norgestimate-Ethinyl Estradiol,250,RC,VB005994,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Benzocaine 10% Gel,250,RC,VB005995,LOCAL,,inpatient,9,GM,26.76,26.76,,,,,,,,,,,,,,,,,
Phenyleph/Pramoxin/Glycr/W.pet,250,RC,VB005996,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Ferrous Gluconate,250,RC,VB005998,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
estradioL VALERATE,250,RC,VB005999,LOCAL,,inpatient,5,ML,115.45,115.45,,,,,,,,,,,,,,,,,
verapamil HCL,250,RC,VB006000,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
verapamil HCL,250,RC,VB006001,LOCAL,,inpatient,1,EA,7.31,7.31,,,,,,,,,,,,,,,,,
Podofilox,250,RC,VB006002,LOCAL,,inpatient,3.5,ML,397.92,397.92,,,,,,,,,,,,,,,,,
Nintedanib Esylate,250,RC,VB006003,LOCAL,,inpatient,1,EA,1081.31,1081.31,,,,,,,,,,,,,,,,,
Tiotropium Bromide,250,RC,VB006004,LOCAL,,inpatient,4,GM,2531.47,2531.47,,,,,,,,,,,,,,,,,
Promethazine/Codeine 6.25-10mg/5mL,250,RC,VB006005,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
Promethazine HCL,250,RC,VB006006,LOCAL,,inpatient,1,ML,18.46,18.46,,,,,,,,,,,,,,,,,
LORazepam,250,RC,VB006007,LOCAL,,inpatient,1,ML,14.91,14.91,,,,,,,,,,,,,,,,,
Midazolam HCL Inj,250,RC,VB006008,LOCAL,,inpatient,5,ML,6.67,6.67,,,,,,,,,,,,,,,,,
Oxacillin Sodium,250,RC,VB006009,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
Oxacillin Sodium,250,RC,VB006010,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
Nafcillin Sodium,250,RC,VB006011,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
Diclofenac Potassium,250,RC,VB006012,LOCAL,,inpatient,1,EA,6.21,6.21,,,,,,,,,,,,,,,,,
Warfarin Sodium,250,RC,VB006013,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Vitamin E,250,RC,VB006014,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Selenium,250,RC,VB006015,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lactase,250,RC,VB006016,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
PARoxetine HCL,250,RC,VB006017,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
guaiFENesin,250,RC,VB006018,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
risperiDONE,250,RC,VB006019,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
ARIPiprazole,250,RC,VB006020,LOCAL,,inpatient,1,EA,129.6,129.6,,,,,,,,,,,,,,,,,
Acetaminophen Oral Soln,250,RC,VB006021,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
Immun Glob G(Igg)/Gly/Iga Ov50,250,RC,VB006022,LOCAL,,inpatient,200,ML,16762.56,16762.56,,,,,,,,,,,,,,,,,
Naphazoline HCL/Pheniramine,250,RC,VB006025,LOCAL,,inpatient,15,ML,23.18,23.18,,,,,,,,,,,,,,,,,
Tolnaftate,250,RC,VB006026,LOCAL,,inpatient,1,ea,27.6,27.6,,,,,,,,,,,,,,,,,
Benzocaine/Glycerin,250,RC,VB006027,LOCAL,,inpatient,1,ea,13.1,13.1,,,,,,,,,,,,,,,,,
Sodium Fluoride/Potassium Nit,250,RC,VB006028,LOCAL,,inpatient,100,ML,63.2,63.2,,,,,,,,,,,,,,,,,
"Petrolatum,white",250,RC,VB006029,LOCAL,,inpatient,368,GM,27.96,27.96,,,,,,,,,,,,,,,,,
Folic Acid/Vit B Complex and C,250,RC,VB006030,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Sulfacetamide/Prednisolone,250,RC,VB006031,LOCAL,,inpatient,5,ML,769.92,769.92,,,,,,,,,,,,,,,,,
Coal Tar,250,RC,VB006032,LOCAL,,inpatient,107,GM,39.96,39.96,,,,,,,,,,,,,,,,,
Diphenhydramine HCL/Zinc Acet,250,RC,VB006033,LOCAL,,inpatient,1,ea,16.9,16.9,,,,,,,,,,,,,,,,,
Dextroamphetamine Sulfate,250,RC,VB006034,LOCAL,,inpatient,1,EA,12.6,12.6,,,,,,,,,,,,,,,,,
Alpha-1-Proteinase Inhibitor,250,RC,VB006035,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pramipexole Di-HCL,250,RC,VB006036,LOCAL,,inpatient,1,EA,11.8,11.8,,,,,,,,,,,,,,,,,
Efavirenz/Emtricit/Tenofovr Df,250,RC,VB006037,LOCAL,,inpatient,1,EA,479.15,479.15,,,,,,,,,,,,,,,,,
Diclofenac Sodium,250,RC,VB006038,LOCAL,,inpatient,1,EA,5.89,5.89,,,,,,,,,,,,,,,,,
Famotidine/Ca Carb/Mag Hydrox,250,RC,VB006039,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ubidecarenone,250,RC,VB006040,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Dextran 70/Hypromellose,250,RC,VB006041,LOCAL,,inpatient,15,ML,24.72,24.72,,,,,,,,,,,,,,,,,
Tafluprost/Pf,250,RC,VB006042,LOCAL,,inpatient,30,ML,1104.24,1104.24,,,,,,,,,,,,,,,,,
Ascorbic Acid,250,RC,VB006043,LOCAL,,inpatient,100,EA,5,5,,,,,,,,,,,,,,,,,
"Vits A,c,e/Lutein/Minerals",250,RC,VB006044,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
prednisoLONE SOD PHOS Ophth (10mL),250,RC,VB006045,LOCAL,,inpatient,10,ML,239.84,239.84,,,,,,,,,,,,,,,,,
Erythromycin Base,250,RC,VB006046,LOCAL,,inpatient,1,EA,35.32,35.32,,,,,,,,,,,,,,,,,
Doxylamine Succinate,250,RC,VB006047,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Castor Oil,250,RC,VB006048,LOCAL,,inpatient,59,ML,19.96,19.96,,,,,,,,,,,,,,,,,
Octreotide Acetate,250,RC,VB006049,LOCAL,,inpatient,5,ML,230.4,230.4,,,,,,,,,,,,,,,,,
Multivit-Min/Folic Acid/Biotin,250,RC,VB006050,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Zinc Gluconate,250,RC,VB006051,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Torsemide,250,RC,VB006052,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
methylphenidate HCL,250,RC,VB006053,LOCAL,,inpatient,1,EA,52.84,52.84,,,,,,,,,,,,,,,,,
methylphenidate HCL,250,RC,VB006054,LOCAL,,inpatient,1,EA,55.87,55.87,,,,,,,,,,,,,,,,,
Barium Sulfate,250,RC,VB006055,LOCAL,,inpatient,450,ML,18.96,18.96,,,,,,,,,,,,,,,,,
Famciclovir,250,RC,VB006058,LOCAL,,inpatient,1,EA,25.28,25.28,,,,,,,,,,,,,,,,,
Pramipexole Di-HCL,250,RC,VB006059,LOCAL,,inpatient,1,EA,64.55,64.55,,,,,,,,,,,,,,,,,
Tobramycin Sulfate,250,RC,VB006061,LOCAL,,inpatient,1,EA,384,384,,,,,,,,,,,,,,,,,
Streptomycin Sulfate,250,RC,VB006062,LOCAL,,inpatient,1,EA,360,360,,,,,,,,,,,,,,,,,
Selenium,250,RC,VB006063,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Prasterone (Dhea),250,RC,VB006064,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Calcium Citrate/Vitamin D3,250,RC,VB006065,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Argatroban In Nacl,iso-Osmotic",250,RC,VB006066,LOCAL,,inpatient,1,ea,21.79,21.79,,,,,,,,,,,,,,,,,
Methenamine Mandelate,250,RC,VB006067,LOCAL,,inpatient,100,EA,7.2,7.2,,,,,,,,,,,,,,,,,
Vitamin B Complex,250,RC,VB006068,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Cranberry Fruit Extract,250,RC,VB006069,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Peg3350/Sod Sulf,bicarb,cl/Kcl",250,RC,VB006070,LOCAL,,inpatient,4000,ML,117.72,117.72,,,,,,,,,,,,,,,,,
Hepatitis B Vaccine/Cpg1018/Pf,250,RC,VB006071,LOCAL,,inpatient,0.5,ML,747.6,747.6,,,,,,,,,,,,,,,,,
Hydrocortisone 2.5% Oint,250,RC,VB006072,LOCAL,,inpatient,20,GM,12.48,12.48,,,,,,,,,,,,,,,,,
Alogliptin Benzoate,250,RC,VB006073,LOCAL,,inpatient,1,EA,31.2,31.2,,,,,,,,,,,,,,,,,
Mometasone Furoate,250,RC,VB006074,LOCAL,,inpatient,30,ML,119.4,119.4,,,,,,,,,,,,,,,,,
Alogliptin Benzoate,250,RC,VB006075,LOCAL,,inpatient,1,EA,31.2,31.2,,,,,,,,,,,,,,,,,
Salicylic Acid,250,RC,VB006076,LOCAL,,inpatient,177,ML,274.6,274.6,,,,,,,,,,,,,,,,,
Benzoyl Peroxide,250,RC,VB006077,LOCAL,,inpatient,60,GM,83.08,83.08,,,,,,,,,,,,,,,,,
guaiFENesin,250,RC,VB006078,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Clindamycin Phos/Benzoyl Perox,250,RC,VB006079,LOCAL,,inpatient,50,GM,624,624,,,,,,,,,,,,,,,,,
Nicotine Polacrilex,250,RC,VB006080,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Alfuzosin HCL ER,250,RC,VB006081,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
L. Rhamnosus Gg/Inulin,250,RC,VB006082,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Calcium Acetate Oral,250,RC,VB006083,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
"Diph,pertuss(Acell),tet Vac/Pf",250,RC,VB006084,LOCAL,,inpatient,0.5,EA,201.55,201.55,,,,,,,,,,,,,,,,,
"Meningococ Vac A,c,y,w-135/Pf",250,RC,VB006085,LOCAL,,inpatient,1,ML,587.62,587.62,,,,,,,,,,,,,,,,,
"Inhaler, Assist Devices",250,RC,VB006086,LOCAL,,inpatient,1,EA,186.38,186.38,,,,,,,,,,,,,,,,,
Revefenacin,250,RC,VB006087,LOCAL,,inpatient,3,ML,252.24,252.24,,,,,,,,,,,,,,,,,
Selegiline,250,RC,VB006088,LOCAL,,inpatient,1,EA,360.36,360.36,,,,,,,,,,,,,,,,,
Selegiline,250,RC,VB006089,LOCAL,,inpatient,1,EA,360.36,360.36,,,,,,,,,,,,,,,,,
Abacavir Sulfate/Lamivudine,250,RC,VB006090,LOCAL,,inpatient,1,EA,206.67,206.67,,,,,,,,,,,,,,,,,
Abacavir Sulfate,250,RC,VB006091,LOCAL,,inpatient,240,ML,5,5,,,,,,,,,,,,,,,,,
Maraviroc,250,RC,VB006092,LOCAL,,inpatient,1,EA,138.41,138.41,,,,,,,,,,,,,,,,,
risperiDONE,250,RC,VB006093,LOCAL,,inpatient,1,EA,17.92,17.92,,,,,,,,,,,,,,,,,
FLUoxetine HCL,250,RC,VB006094,LOCAL,,inpatient,1,EA,11.47,11.47,,,,,,,,,,,,,,,,,
Pimozide,250,RC,VB006095,LOCAL,,inpatient,1,EA,7.32,7.32,,,,,,,,,,,,,,,,,
tacrolimus,250,RC,VB006096,LOCAL,,inpatient,60,GM,2782.51,2782.51,,,,,,,,,,,,,,,,,
Erlotinib HCL,250,RC,VB006097,LOCAL,,inpatient,1,EA,1352.22,1352.22,,,,,,,,,,,,,,,,,
Isradipine,250,RC,VB006098,LOCAL,,inpatient,1,EA,9.53,9.53,,,,,,,,,,,,,,,,,
Levocarnitine (With Sugar),250,RC,VB006099,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
levOCARNitine,250,RC,VB006100,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Gatifloxacin,250,RC,VB006101,LOCAL,,inpatient,2.5,ML,472.64,472.64,,,,,,,,,,,,,,,,,
Itraconazole Oral Soln(Bulk bottle),250,RC,VB006102,LOCAL,,inpatient,150,ML,1645.2,1645.2,,,,,,,,,,,,,,,,,
Risperidone Microspheres,250,RC,VB006103,LOCAL,,inpatient,1,ML,1548.86,1548.86,,,,,,,,,,,,,,,,,
risperiDONE,250,RC,VB006104,LOCAL,,inpatient,1,EA,95.99,95.99,,,,,,,,,,,,,,,,,
risperiDONE,250,RC,VB006105,LOCAL,,inpatient,1,EA,121.1,121.1,,,,,,,,,,,,,,,,,
Lipase/Protease/Amylase,250,RC,VB006106,LOCAL,,inpatient,1,EA,28.83,28.83,,,,,,,,,,,,,,,,,
Paliperidone,250,RC,VB006107,LOCAL,,inpatient,1,EA,58.86,58.86,,,,,,,,,,,,,,,,,
Paliperidone Palmitate,250,RC,VB006108,LOCAL,,inpatient,0.25,ML,11420.35,11420.35,,,,,,,,,,,,,,,,,
Paliperidone Palmitate,250,RC,VB006109,LOCAL,,inpatient,0.5,ML,11420.93,11420.93,,,,,,,,,,,,,,,,,
risperiDONE,250,RC,VB006110,LOCAL,,inpatient,30,ML,19.48,19.48,,,,,,,,,,,,,,,,,
risperiDONE,250,RC,VB006111,LOCAL,,inpatient,1,EA,60.64,60.64,,,,,,,,,,,,,,,,,
Paliperidone Palmitate,250,RC,VB006112,LOCAL,,inpatient,2.63,ML,19046.87,19046.87,,,,,,,,,,,,,,,,,
Rotigotine,250,RC,VB006113,LOCAL,,inpatient,1,EA,138.23,138.23,,,,,,,,,,,,,,,,,
Rotigotine,250,RC,VB006114,LOCAL,,inpatient,1,EA,138.23,138.23,,,,,,,,,,,,,,,,,
Rotigotine,250,RC,VB006115,LOCAL,,inpatient,1,EA,138.23,138.23,,,,,,,,,,,,,,,,,
Electrolytes/Yerba Santa,250,RC,VB006116,LOCAL,,inpatient,236,ML,54,54,,,,,,,,,,,,,,,,,
Trifluoperazine HCL,250,RC,VB006117,LOCAL,,inpatient,1,EA,8,8,,,,,,,,,,,,,,,,,
Trifluoperazine HCL,250,RC,VB006118,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
hydroCHLOROthiazide,250,RC,VB006119,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Calcium Acetate/Aluminum Sulf,250,RC,VB006120,LOCAL,,inpatient,1,EA,54.4,54.4,,,,,,,,,,,,,,,,,
Ammonium Lactate,250,RC,VB006121,LOCAL,,inpatient,140,GM,89.76,89.76,,,,,,,,,,,,,,,,,
Imiquimod,250,RC,VB006122,LOCAL,,inpatient,24,GM,1000,1000,,,,,,,,,,,,,,,,,
Calcipotriene,250,RC,VB006123,LOCAL,,inpatient,60,GM,1447.56,1447.56,,,,,,,,,,,,,,,,,
metroNIDAZOLE 1% Gel,250,RC,VB006124,LOCAL,,inpatient,60,GM,1109.04,1109.04,,,,,,,,,,,,,,,,,
Rizatriptan Benzoate,250,RC,VB006125,LOCAL,,inpatient,1,EA,132.95,132.95,,,,,,,,,,,,,,,,,
Sodium Chloride/Nahco3/Kcl/Peg,250,RC,VB006126,LOCAL,,inpatient,4000,ML,128.11,128.11,,,,,,,,,,,,,,,,,
Econazole Nitrate,250,RC,VB006127,LOCAL,,inpatient,30,GM,869.4,869.4,,,,,,,,,,,,,,,,,
Mesalamine ER,250,RC,VB006128,LOCAL,,inpatient,1,EA,29.15,29.15,,,,,,,,,,,,,,,,,
Prucalopride Succinate,250,RC,VB006129,LOCAL,,inpatient,1,EA,89.15,89.15,,,,,,,,,,,,,,,,,
Coal Tar,250,RC,VB006130,LOCAL,,inpatient,118,ML,15.32,15.32,,,,,,,,,,,,,,,,,
"Petrolatum,white (454gm)",250,RC,VB006131,LOCAL,,inpatient,454,GM,48.16,48.16,,,,,,,,,,,,,,,,,
etravirine,250,RC,VB006132,LOCAL,,inpatient,1,EA,105.06,105.06,,,,,,,,,,,,,,,,,
Melatonin,250,RC,VB006133,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Hyoscyamine Sulfate,250,RC,VB006134,LOCAL,,inpatient,15,ML,159.96,159.96,,,,,,,,,,,,,,,,,
ARIPiprazole,250,RC,VB006135,LOCAL,,inpatient,150,ML,28.27,28.27,,,,,,,,,,,,,,,,,
atomoxetine HCL,250,RC,VB006136,LOCAL,,inpatient,1,EA,61.86,61.86,,,,,,,,,,,,,,,,,
atomoxetine HCL,250,RC,VB006137,LOCAL,,inpatient,1,EA,66.74,66.74,,,,,,,,,,,,,,,,,
lamoTRIgine,250,RC,VB006138,LOCAL,,inpatient,1,EA,56.1,56.1,,,,,,,,,,,,,,,,,
Oxacillin Sodium,250,RC,VB006139,LOCAL,,inpatient,1,EA,58,58,,,,,,,,,,,,,,,,,
Oxacillin Sodium,250,RC,VB006140,LOCAL,,inpatient,1,EA,113.1,113.1,,,,,,,,,,,,,,,,,
Salsalate,250,RC,VB006141,LOCAL,,inpatient,1,EA,38.69,38.69,,,,,,,,,,,,,,,,,
Darbepoetin Alfa In Polysorbat,250,RC,VB006142,LOCAL,,inpatient,0.3,ML,5572.8,5572.8,,,,,,,,,,,,,,,,,
Cinacalcet HCL,250,RC,VB006143,LOCAL,,inpatient,1,EA,387.22,387.22,,,,,,,,,,,,,,,,,
Darbepoetin Alfa In Polysorbat,250,RC,VB006144,LOCAL,,inpatient,1,ML,11145.6,11145.6,,,,,,,,,,,,,,,,,
Denosumab,250,RC,VB006145,LOCAL,,inpatient,1,ML,9002.06,9002.06,,,,,,,,,,,,,,,,,
Filgrastim,250,RC,VB006146,LOCAL,,inpatient,0.5,ML,1601.76,1601.76,,,,,,,,,,,,,,,,,
Naloxegol Oxalate,250,RC,VB006147,LOCAL,,inpatient,1,EA,59.06,59.06,,,,,,,,,,,,,,,,,
Cromolyn Sodium,250,RC,VB006148,LOCAL,,inpatient,26,ML,51.6,51.6,,,,,,,,,,,,,,,,,
Peg 400/Hypromellose/Glycerin,250,RC,VB006149,LOCAL,,inpatient,1,EA,8.16,8.16,,,,,,,,,,,,,,,,,
"Meningococcal B Vaccine,4-Comp",250,RC,VB006150,LOCAL,,inpatient,0.5,ML,856.8,856.8,,,,,,,,,,,,,,,,,
Etanercept,250,RC,VB006151,LOCAL,,inpatient,0.51,ML,7021.36,7021.36,,,,,,,,,,,,,,,,,
Sevelamer HCL,250,RC,VB006152,LOCAL,,inpatient,1,EA,35.7,35.7,,,,,,,,,,,,,,,,,
Lipase/Protease/Amylase,250,RC,VB006153,LOCAL,,inpatient,1,EA,30.47,30.47,,,,,,,,,,,,,,,,,
ARIPiprazole,250,RC,VB006154,LOCAL,,inpatient,1,EA,201.82,201.82,,,,,,,,,,,,,,,,,
ARIPiprazole,250,RC,VB006155,LOCAL,,inpatient,1,EA,13941.31,13941.31,,,,,,,,,,,,,,,,,
ARIPiprazole,250,RC,VB006156,LOCAL,,inpatient,1,EA,10455.98,10455.98,,,,,,,,,,,,,,,,,
Interferon Beta-1a,250,RC,VB006157,LOCAL,,inpatient,1,EA,41461.44,41461.44,,,,,,,,,,,,,,,,,
Clindamycin Phosphate 1% Gel,250,RC,VB006158,LOCAL,,inpatient,60,GM,622.36,622.36,,,,,,,,,,,,,,,,,
quinapril HCL,250,RC,VB006159,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Vit B Comp No.3/Folic/C/Biotin,250,RC,VB006160,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lindane,250,RC,VB006161,LOCAL,,inpatient,60,ML,547.44,547.44,,,,,,,,,,,,,,,,,
Cevimeline HCL,250,RC,VB006162,LOCAL,,inpatient,1,EA,13.95,13.95,,,,,,,,,,,,,,,,,
OLANZapine,250,RC,VB006163,LOCAL,,inpatient,1,EA,123.72,123.72,,,,,,,,,,,,,,,,,
OLANZapine ODT,250,RC,VB006164,LOCAL,,inpatient,1,EA,163.55,163.55,,,,,,,,,,,,,,,,,
ketorolac TROMETHAMINE,250,RC,VB006165,LOCAL,,inpatient,5,ML,320.56,320.56,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB006166,LOCAL,,inpatient,1,EA,73.53,73.53,,,,,,,,,,,,,,,,,
Pilocarpine HCL,250,RC,VB006167,LOCAL,,inpatient,15,ML,422.76,422.76,,,,,,,,,,,,,,,,,
metHOTREXate SODIUM Inj,250,RC,VB006168,LOCAL,,inpatient,2,ML,34.9,34.9,,,,,,,,,,,,,,,,,
Vitamin A Palmitate,250,RC,VB006169,LOCAL,,inpatient,2,ML,288,288,,,,,,,,,,,,,,,,,
Cariprazine HCL,250,RC,VB006170,LOCAL,,inpatient,1,EA,243.02,243.02,,,,,,,,,,,,,,,,,
Cariprazine HCL,250,RC,VB006171,LOCAL,,inpatient,1,EA,243.02,243.02,,,,,,,,,,,,,,,,,
Sofosbuvir,250,RC,VB006172,LOCAL,,inpatient,1,EA,4800,4800,,,,,,,,,,,,,,,,,
Elviteg/Cob/Emtri/Tenof Alafen,250,RC,VB006173,LOCAL,,inpatient,1,EA,674.58,674.58,,,,,,,,,,,,,,,,,
Emtricitab/Rilpiviri/Tenof Ala,250,RC,VB006174,LOCAL,,inpatient,1,EA,613.92,613.92,,,,,,,,,,,,,,,,,
verapamil HCL,250,RC,VB006175,LOCAL,,inpatient,1,EA,41.89,41.89,,,,,,,,,,,,,,,,,
rOPINIRole HCL,250,RC,VB006176,LOCAL,,inpatient,1,EA,10,10,,,,,,,,,,,,,,,,,
Perampanel,250,RC,VB006177,LOCAL,,inpatient,1,EA,196.32,196.32,,,,,,,,,,,,,,,,,
Rufinamide,250,RC,VB006178,LOCAL,,inpatient,1,EA,63.36,63.36,,,,,,,,,,,,,,,,,
haloperidoL DECANOATE,250,RC,VB006179,LOCAL,,inpatient,5,ML,247.1,247.1,,,,,,,,,,,,,,,,,
levothyroxine SODIUM Inj,250,RC,VB006180,LOCAL,,inpatient,1,EA,2533.97,2533.97,,,,,,,,,,,,,,,,,
Pamidronate Disodium IV,250,RC,VB006181,LOCAL,,inpatient,10,ML,506.88,506.88,,,,,,,,,,,,,,,,,
Fat Emul/Soy/Mct/Oliv/Fish Oil,250,RC,VB006182,LOCAL,,inpatient,250,ML,124.8,124.8,,,,,,,,,,,,,,,,,
Lurasidone HCL,250,RC,VB006183,LOCAL,,inpatient,1,EA,226.99,226.99,,,,,,,,,,,,,,,,,
Lurasidone HCL,250,RC,VB006184,LOCAL,,inpatient,1,EA,204.13,204.13,,,,,,,,,,,,,,,,,
Lurasidone HCL,250,RC,VB006185,LOCAL,,inpatient,1,EA,226.99,226.99,,,,,,,,,,,,,,,,,
Lurasidone HCL,250,RC,VB006186,LOCAL,,inpatient,1,EA,338.83,338.83,,,,,,,,,,,,,,,,,
Urea 40% - 85gm,250,RC,VB006187,LOCAL,,inpatient,85,GM,644.08,644.08,,,,,,,,,,,,,,,,,
Benzocaine 20%,250,RC,VB006188,LOCAL,,inpatient,57,GM,27.24,27.24,,,,,,,,,,,,,,,,,
PHENobarbitaL,250,RC,VB006189,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Magnesium Oxide,250,RC,VB006190,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dextromethorphan/Benzocaine,250,RC,VB006191,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Riboflavin (Vitamin B2),250,RC,VB006192,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Heparin Sodium,porcine 50 unit/5mL",250,RC,VB006193,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
lansoprazole,250,RC,VB006194,LOCAL,,inpatient,1,EA,66.42,66.42,,,,,,,,,,,,,,,,,
Vortioxetine Hydrobromide,250,RC,VB006195,LOCAL,,inpatient,1,EA,82.26,82.26,,,,,,,,,,,,,,,,,
calcitrioL 0.25 mcg/0.25mL,250,RC,VB006196,LOCAL,,inpatient,15,ML,126.93,126.93,,,,,,,,,,,,,,,,,
Colesevelam HCL,250,RC,VB006197,LOCAL,,inpatient,1,EA,107.14,107.14,,,,,,,,,,,,,,,,,
Mesalamine,250,RC,VB006198,LOCAL,,inpatient,1,EA,20.41,20.41,,,,,,,,,,,,,,,,,
Methylnaltrexone Bromide,250,RC,VB006199,LOCAL,,inpatient,1,EA,134.61,134.61,,,,,,,,,,,,,,,,,
Methylnaltrexone Bromide,250,RC,VB006200,LOCAL,,inpatient,0.6,EA,815.66,815.66,,,,,,,,,,,,,,,,,
Methylnaltrexone Bromide,250,RC,VB006201,LOCAL,,inpatient,0.4,EA,815.66,815.66,,,,,,,,,,,,,,,,,
Naltrexone Microspheres,250,RC,VB006202,LOCAL,,inpatient,1,EA,8113.63,8113.63,,,,,,,,,,,,,,,,,
Aripiprazole Lauroxil,250,RC,VB006203,LOCAL,,inpatient,1.6,ML,7636.8,7636.8,,,,,,,,,,,,,,,,,
Aripiprazole Lauroxil,250,RC,VB006204,LOCAL,,inpatient,2.4,ML,11463.89,11463.89,,,,,,,,,,,,,,,,,
Aripiprazole Lauroxil,250,RC,VB006205,LOCAL,,inpatient,3.2,ML,15273.55,15273.55,,,,,,,,,,,,,,,,,
Aripiprazole Lauroxil,250,RC,VB006206,LOCAL,,inpatient,3.9,ML,18425.33,18425.33,,,,,,,,,,,,,,,,,
sertraline HCL,250,RC,VB006207,LOCAL,,inpatient,1,EA,11.39,11.39,,,,,,,,,,,,,,,,,
Mirtazapine Orally Disintegrating,250,RC,VB006208,LOCAL,,inpatient,1,EA,9.42,9.42,,,,,,,,,,,,,,,,,
Treprostinil Sodium,250,RC,VB006209,LOCAL,,inpatient,20,ML,1527.98,1527.98,,,,,,,,,,,,,,,,,
Amoxicillin/Potassium Clav,250,RC,VB006212,LOCAL,,inpatient,75,ML,5,5,,,,,,,,,,,,,,,,,
Benzoyl Peroxide,250,RC,VB006213,LOCAL,,inpatient,148,GM,37.2,37.2,,,,,,,,,,,,,,,,,
Octreotide Acetate,250,RC,VB006214,LOCAL,,inpatient,1,EA,19.2,19.2,,,,,,,,,,,,,,,,,
Fondaparinux Sodium,250,RC,VB006215,LOCAL,,inpatient,0.4,ML,628.2,628.2,,,,,,,,,,,,,,,,,
levETIRAcetam,250,RC,VB006216,LOCAL,,inpatient,1,EA,19.04,19.04,,,,,,,,,,,,,,,,,
Diclofenac Sodium,250,RC,VB006217,LOCAL,,inpatient,1,EA,7.1,7.1,,,,,,,,,,,,,,,,,
lisinopriL,250,RC,VB006218,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
labetalol HCL,250,RC,VB006219,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Venlafaxine HCL ER,250,RC,VB006220,LOCAL,,inpatient,1,EA,39.88,39.88,,,,,,,,,,,,,,,,,
Zafirlukast,250,RC,VB006221,LOCAL,,inpatient,1,EA,13.78,13.78,,,,,,,,,,,,,,,,,
glipiZIDE,250,RC,VB006222,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
OLANZapine,250,RC,VB006223,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
carBAMazepine ER,250,RC,VB006224,LOCAL,,inpatient,1,EA,16.14,16.14,,,,,,,,,,,,,,,,,
Glimepiride,250,RC,VB006225,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
morphine SULFATE Oral,250,RC,VB006226,LOCAL,,inpatient,1,EA,14.21,14.21,,,,,,,,,,,,,,,,,
carBAMazepine Oral Susp,250,RC,VB006227,LOCAL,,inpatient,10,ML,18.2,18.2,,,,,,,,,,,,,,,,,
diazePAM Oral,250,RC,VB006228,LOCAL,,inpatient,5,ML,18.4,18.4,,,,,,,,,,,,,,,,,
Norethindrone,250,RC,VB006229,LOCAL,,inpatient,1,EA,5.27,5.27,,,,,,,,,,,,,,,,,
PARoxetine HCL,250,RC,VB006230,LOCAL,,inpatient,1,EA,11.5,11.5,,,,,,,,,,,,,,,,,
Ribavirin,250,RC,VB006231,LOCAL,,inpatient,1,EA,33.1,33.1,,,,,,,,,,,,,,,,,
haloperidoL,250,RC,VB006232,LOCAL,,inpatient,1,EA,11.03,11.03,,,,,,,,,,,,,,,,,
Acamprosate Calcium,250,RC,VB006233,LOCAL,,inpatient,1,EA,7.03,7.03,,,,,,,,,,,,,,,,,
Voriconazole,250,RC,VB006234,LOCAL,,inpatient,1,EA,79.51,79.51,,,,,,,,,,,,,,,,,
Rasagiline Mesylate,250,RC,VB006235,LOCAL,,inpatient,1,EA,182.98,182.98,,,,,,,,,,,,,,,,,
Loteprednol Etabonate,250,RC,VB006236,LOCAL,,inpatient,5,ML,1025.81,1025.81,,,,,,,,,,,,,,,,,
Methylphenidate,250,RC,VB006237,LOCAL,,inpatient,1,EA,28.89,28.89,,,,,,,,,,,,,,,,,
Immun Globg(Igg)/Malt/Iga Ov50 IV,250,RC,VB006238,LOCAL,,inpatient,100,ML,9324,9324,,,,,,,,,,,,,,,,,
esomeprazole MAGNESIUM,250,RC,VB006239,LOCAL,,inpatient,30,EA,39.02,39.02,,,,,,,,,,,,,,,,,
Testosterone 1.62% (20.25mg/ACT)Gel,250,RC,VB006240,LOCAL,,inpatient,75,GM,2682.88,2682.88,,,,,,,,,,,,,,,,,
methylphenidate HCL,250,RC,VB006241,LOCAL,,inpatient,1,EA,51.91,51.91,,,,,,,,,,,,,,,,,
methylphenidate HCL,250,RC,VB006242,LOCAL,,inpatient,1,EA,32,32,,,,,,,,,,,,,,,,,
Edaravone,250,RC,VB006244,LOCAL,,inpatient,100,ML,3114.91,3114.91,,,,,,,,,,,,,,,,,
Delafloxacin Meglumine,250,RC,VB006245,LOCAL,,inpatient,1,EA,382.56,382.56,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB006246,LOCAL,,inpatient,1,ML,12.62,12.62,,,,,,,,,,,,,,,,,
Hyoscyamine Sulfate,250,RC,VB006247,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Levomefolate Calcium,250,RC,VB006248,LOCAL,,inpatient,1,EA,11.85,11.85,,,,,,,,,,,,,,,,,
Zinc Gluconate,250,RC,VB006249,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Wheat Dextrin,250,RC,VB006250,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
gentamicin 0.1% Cream,250,RC,VB006253,LOCAL,,inpatient,30,GM,395,395,,,,,,,,,,,,,,,,,
Iohexol,250,RC,VB006254,LOCAL,,inpatient,100,ML,452.92,452.92,,,,,,,,,,,,,,,,,
LORazepam Inj,250,RC,VB006256,LOCAL,,inpatient,1,ML,7.5,7.5,,,,,,,,,,,,,,,,,
Miconazole Nitrate (28 GM Tube),250,RC,VB006257,LOCAL,,inpatient,28,GM,5,5,,,,,,,,,,,,,,,,,
morphine SULFATE Oral,250,RC,VB006258,LOCAL,,inpatient,5,ML,6.52,6.52,,,,,,,,,,,,,,,,,
nystatin Cream (30 GM Tube),250,RC,VB006259,LOCAL,,inpatient,30,GM,105,105,,,,,,,,,,,,,,,,,
phenoL 1.4% Spray,250,RC,VB006260,LOCAL,,inpatient,177,ML,13.54,13.54,,,,,,,,,,,,,,,,,
Sulfameth-Trimethopr 800-160mg/10mL,250,RC,VB006261,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
verapamil HCL Inj,250,RC,VB006262,LOCAL,,inpatient,2,ML,141.02,141.02,,,,,,,,,,,,,,,,,
Cholestyramine in Aquaphor 99GM,250,RC,VB006263,LOCAL,,inpatient,99,GM,10,10,,,,,,,,,,,,,,,,,
Testosterone Enanthate 100 MG/0.5ML,250,RC,VB006264,LOCAL,,inpatient,0.5,ML,771.74,771.74,,,,,,,,,,,,,,,,,
busPIRone HCL,250,RC,VB006265,LOCAL,,inpatient,1,EA,8.08,8.08,,,,,,,,,,,,,,,,,
Maalox/Benadryl/Lidocaine Visc,250,RC,VB006266,LOCAL,,inpatient,120,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Maalox/Benadryl/Lidocaine Visc,250,RC,VB006266,LOCAL,,inpatient,120,ML,1.5,1.5,,,,,,,,,,,,,,,,,
DAKINS 0.25% HALF STRENGTH 1000ML,250,RC,VB006267,LOCAL,,inpatient,1000,ML,12,12,,,,,,,,,,,,,,,,,
DAKINS 0.5% FULL STRENGTH 1000ML,250,RC,VB006268,LOCAL,,inpatient,1000,ML,12,12,,,,,,,,,,,,,,,,,
DAKINS 0.125% QTR STRENGTH 1000ML,250,RC,VB006269,LOCAL,,inpatient,1000,ML,43,43,,,,,,,,,,,,,,,,,
TUBE FEED DECLOGGER SOLN 15 ML,250,RC,VB006271,LOCAL,,inpatient,15,ML,1.5,1.5,,,,,,,,,,,,,,,,,
GENTAMICIN IRRIG 80MG/1000ML NS,250,RC,VB006272,LOCAL,,inpatient,1000,ML,1.5,1.5,,,,,,,,,,,,,,,,,
ACETIC ACID 3%/STERILE WATER 1000ML,250,RC,VB006284,LOCAL,,inpatient,1000,ML,1.5,1.5,,,,,,,,,,,,,,,,,
DAKINS 0.06% EIGHTH STRENGTH 1000ML,250,RC,VB006287,LOCAL,,inpatient,1000,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Omeprazole Oral (100mL Bottle),250,RC,VB006289,LOCAL,,inpatient,100,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Omeprazole Oral (120mL Bottle),250,RC,VB006293,LOCAL,,inpatient,120,ML,48,48,,,,,,,,,,,,,,,,,
Vancomycin Oral (200mL Bottle),250,RC,VB006294,LOCAL,,inpatient,200,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Cholestyramine in Aquaphor (120 GM),250,RC,VB006295,LOCAL,,inpatient,120,GM,1.5,1.5,,,,,,,,,,,,,,,,,
"Nystatin, Benadryl, Maalox (120ML)",250,RC,VB006296,LOCAL,,inpatient,120,ML,1.5,1.5,,,,,,,,,,,,,,,,,
levothyroxine SODIUM Inj,250,RC,VB006299,LOCAL,,inpatient,5,ML,425.71,425.71,,,,,,,,,,,,,,,,,
RAPID SEQUENCE INTUBATION KIT,250,RC,VB006304,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
FLUoxetine HCL Oral - UD,250,RC,VB006310,LOCAL,,inpatient,5,ML,27.36,27.36,,,,,,,,,,,,,,,,,
Olopatadine HCL 0.2%,250,RC,VB006311,LOCAL,,inpatient,2.5,ML,67.96,67.96,,,,,,,,,,,,,,,,,
Insulin Degludec,250,RC,VB006316,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
diphenhydrAMINE HCL - UD,250,RC,VB006317,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
Gentamicin Topical 200mg/250mL,250,RC,VB006321,LOCAL,,inpatient,250,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Albumin Human Inj 25%,250,RC,VB006328,LOCAL,,inpatient,50,ML,432,432,,,,,,,,,,,,,,,,,
Albumin Human 25% (HD USE ONLY),250,RC,VB006329,LOCAL,,inpatient,50,ML,432,432,,,,,,,,,,,,,,,,,
FENTANYL 1000 MCG IN NS 100ML IV,250,RC,VB006373,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
MIDAZOLAM 100MG IN NS 100ML IV,250,RC,VB006374,LOCAL,,inpatient,100,ML,1.5,1.5,,,,,,,,,,,,,,,,,
MIDAZOLAM 100MG IN NS 100ML IV,250,RC,VB006374,LOCAL,,inpatient,100,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Multivitamin/Iron/Folic Acid,250,RC,VB006375,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Multivit-Min/Iron/Folic/Vit K1,250,RC,VB006376,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Eplerenone,250,RC,VB006377,LOCAL,,inpatient,1,EA,70.97,70.97,,,,,,,,,,,,,,,,,
Lactase,250,RC,VB006378,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Voriconazole,250,RC,VB006379,LOCAL,,inpatient,75,ML,35.9,35.9,,,,,,,,,,,,,,,,,
Desvenlafaxine Succinate,250,RC,VB006380,LOCAL,,inpatient,1,EA,47.81,47.81,,,,,,,,,,,,,,,,,
Hypromellose,250,RC,VB006381,LOCAL,,inpatient,10,GM,34.32,34.32,,,,,,,,,,,,,,,,,
Wheat Dextrin,250,RC,VB006382,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Bacitracin/Polymyxin B Sulfate,250,RC,VB006383,LOCAL,,inpatient,28.3,GM,28.56,28.56,,,,,,,,,,,,,,,,,
Pyrithione Zinc,250,RC,VB006384,LOCAL,,inpatient,240,ML,38.88,38.88,,,,,,,,,,,,,,,,,
Bacitracin/Polymyxin B Sulfate,250,RC,VB006385,LOCAL,,inpatient,144,GM,5,5,,,,,,,,,,,,,,,,,
Vits A and D/White Pet/Lanolin,250,RC,VB006386,LOCAL,,inpatient,5,GM,5,5,,,,,,,,,,,,,,,,,
Chlorhexidine/Glycerin/He-Cell,250,RC,VB006387,LOCAL,,inpatient,1,EA,10.56,10.56,,,,,,,,,,,,,,,,,
Budesonide,250,RC,VB006388,LOCAL,,inpatient,1,EA,1270.08,1270.08,,,,,,,,,,,,,,,,,
Heparin-D5W 25000 Unit/500 mL,250,RC,VB006389,LOCAL,,inpatient,500,ML,78.82,78.82,,,,,,,,,,,,,,,,,
Parenteral Amino Acid 15% No.5,250,RC,VB006390,LOCAL,,inpatient,500,ML,477.79,477.79,,,,,,,,,,,,,,,,,
Dexmedetomidine In 0.9 % Nacl,250,RC,VB006391,LOCAL,,inpatient,100,ML,95.04,95.04,,,,,,,,,,,,,,,,,
Clove Oil,250,RC,VB006392,LOCAL,,inpatient,1,EA,25.96,25.96,,,,,,,,,,,,,,,,,
Simple Syrup,250,RC,VB006393,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Potassium Iodide/Iodine,250,RC,VB006394,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Iodixanol,250,RC,VB006395,LOCAL,,inpatient,50,ML,314.93,314.93,,,,,,,,,,,,,,,,,
nalbuphine HCL,250,RC,VB006396,LOCAL,,inpatient,1,ML,36.8,36.8,,,,,,,,,,,,,,,,,
Bupivacaine HCL/Epinephrine/Pf,250,RC,VB006397,LOCAL,,inpatient,10,ML,24.05,24.05,,,,,,,,,,,,,,,,,
Ketamine HCL Inj,250,RC,VB006398,LOCAL,,inpatient,10,ML,17.38,17.38,,,,,,,,,,,,,,,,,
ceFAZolin SODIUM (ADD-Vantage),250,RC,VB006399,LOCAL,,inpatient,1,EA,13.11,13.11,,,,,,,,,,,,,,,,,
dilTIAZem HCL,250,RC,VB006400,LOCAL,,inpatient,1,EA,54.77,54.77,,,,,,,,,,,,,,,,,
DOPamine HCL,250,RC,VB006401,LOCAL,,inpatient,5,ML,19.25,19.25,,,,,,,,,,,,,,,,,
Physiological Irrig Soln No.1,250,RC,VB006402,LOCAL,,inpatient,250,ML,27.17,27.17,,,,,,,,,,,,,,,,,
Pramipexole Di-HCL,250,RC,VB006403,LOCAL,,inpatient,1,EA,35.38,35.38,,,,,,,,,,,,,,,,,
Atropine Sulfate 0.4mg/mL - 20mL,250,RC,VB006404,LOCAL,,inpatient,20,ML,168.48,168.48,,,,,,,,,,,,,,,,,
Arginine,250,RC,VB006405,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
guaiFENesin,250,RC,VB006406,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Zinc/Petrolatum,white",250,RC,VB006407,LOCAL,,inpatient,1,EA,28.8,28.8,,,,,,,,,,,,,,,,,
"Syringe With Needle, 1 ML",250,RC,VB006408,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Honey,250,RC,VB006409,LOCAL,,inpatient,44,ML,69.22,69.22,,,,,,,,,,,,,,,,,
morphine SULFATE Inj,250,RC,VB006410,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
Dimethicone/Oxybenzone/Padim O,250,RC,VB006411,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Benzocaine/Menthol/Zinc Chlor,250,RC,VB006412,LOCAL,,inpatient,1,EA,28.22,28.22,,,,,,,,,,,,,,,,,
Menthol/Cetylpyrd Cl,250,RC,VB006413,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
lidocaine HCL 3% Cream - 28.35gm,250,RC,VB006414,LOCAL,,inpatient,28.35,GM,233.4,233.4,,,,,,,,,,,,,,,,,
levoFLOXacin 0.5% Ophthalmic,250,RC,VB006415,LOCAL,,inpatient,5,ML,60,60,,,,,,,,,,,,,,,,,
paricalcitoL,250,RC,VB006416,LOCAL,,inpatient,1,ML,20.16,20.16,,,,,,,,,,,,,,,,,
Tropicamide 0.5% Ophth,250,RC,VB006417,LOCAL,,inpatient,15,ML,40,40,,,,,,,,,,,,,,,,,
Hydromorphone HCL/Pf,250,RC,VB006418,LOCAL,,inpatient,1,ML,11.98,11.98,,,,,,,,,,,,,,,,,
Alpha Lipoic Acid,250,RC,VB006419,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
amphotericin B,250,RC,VB006420,LOCAL,,inpatient,5,GM,479.3,479.3,,,,,,,,,,,,,,,,,
Rocuronium Bromide,250,RC,VB006421,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
Methyl Salicylate/Menthol,250,RC,VB006422,LOCAL,,inpatient,1,EA,36.88,36.88,,,,,,,,,,,,,,,,,
Emollient Combination No.41,250,RC,VB006423,LOCAL,,inpatient,1,EA,38.16,38.16,,,,,,,,,,,,,,,,,
diphenhydrAMINE HCL,250,RC,VB006424,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Whey Protein Isolate 6 G-25/7 G,250,RC,VB006425,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Bacitracin,250,RC,VB006426,LOCAL,,inpatient,144,GM,5,5,,,,,,,,,,,,,,,,,
Tetanus-Diphtheria Toxoids/Pf,250,RC,VB006427,LOCAL,,inpatient,0.5,EA,195.6,195.6,,,,,,,,,,,,,,,,,
Glycerin/Witch Hazel,250,RC,VB006428,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Potassium Bicarbonate/Cit Ac,250,RC,VB006429,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Menthol/Zinc Oxide,250,RC,VB006430,LOCAL,,inpatient,113,ML,37.2,37.2,,,,,,,,,,,,,,,,,
levOCARNitine Inj,250,RC,VB006431,LOCAL,,inpatient,5,ML,186.58,186.58,,,,,,,,,,,,,,,,,
Pegfilgrastim,250,RC,VB006432,LOCAL,,inpatient,0.6,ML,30806.35,30806.35,,,,,,,,,,,,,,,,,
Filgrastim,250,RC,VB006433,LOCAL,,inpatient,0.8,ML,2550.86,2550.86,,,,,,,,,,,,,,,,,
Nasal Airflow Strips,250,RC,VB006434,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
clonazePAM ODT,250,RC,VB006435,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Hepatitis A Virus Vaccine/Pf,250,RC,VB006436,LOCAL,,inpatient,1,EA,409.92,409.92,,,,,,,,,,,,,,,,,
Lipase/Protease/Amylase,250,RC,VB006437,LOCAL,,inpatient,1,EA,15.45,15.45,,,,,,,,,,,,,,,,,
Beclomethasone Dipropionate,250,RC,VB006438,LOCAL,,inpatient,10.6,GM,1373.36,1373.36,,,,,,,,,,,,,,,,,
Buprenorphine HCL,250,RC,VB006439,LOCAL,,inpatient,1,EA,81.99,81.99,,,,,,,,,,,,,,,,,
Argin/Glut/Cahmb/Collag/Mv-Min,250,RC,VB006440,LOCAL,,inpatient,1,ea,11.33,11.33,,,,,,,,,,,,,,,,,
selegiline HCL,250,RC,VB006441,LOCAL,,inpatient,1,EA,8.41,8.41,,,,,,,,,,,,,,,,,
Pamidronate Disodium,250,RC,VB006442,LOCAL,,inpatient,10,ML,198.05,198.05,,,,,,,,,,,,,,,,,
Emtricita/Rilpivirine/Tenof Df,250,RC,VB006443,LOCAL,,inpatient,1,EA,579.71,579.71,,,,,,,,,,,,,,,,,
Lipase/Protease/Amylase,250,RC,VB006444,LOCAL,,inpatient,1,EA,24.3,24.3,,,,,,,,,,,,,,,,,
Gentamicin Sulfate/Pf,250,RC,VB006445,LOCAL,,inpatient,2,ML,29.62,29.62,,,,,,,,,,,,,,,,,
methylPREDNISolone SOD SUCC,250,RC,VB006446,LOCAL,,inpatient,1,EA,29.18,29.18,,,,,,,,,,,,,,,,,
"Fluconazole In Nacl,iso-Osm",250,RC,VB006447,LOCAL,,inpatient,1,EA,240,240,,,,,,,,,,,,,,,,,
"Heparin Sodium,porcine",250,RC,VB006448,LOCAL,,inpatient,1,ML,7.73,7.73,,,,,,,,,,,,,,,,,
Eszopiclone,250,RC,VB006449,LOCAL,,inpatient,1,EA,95.56,95.56,,,,,,,,,,,,,,,,,
L.acidoph/L.bulg/B.bif/S.therm,250,RC,VB006450,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Anakinra,250,RC,VB006451,LOCAL,,inpatient,0.67,ML,1011.26,1011.26,,,,,,,,,,,,,,,,,
Calcipotriene,250,RC,VB006452,LOCAL,,inpatient,60,GM,1694.76,1694.76,,,,,,,,,,,,,,,,,
Albumin Human 25%,250,RC,VB006453,LOCAL,,inpatient,50,ML,275.52,275.52,,,,,,,,,,,,,,,,,
Succinylcholine Chloride,250,RC,VB006455,LOCAL,,inpatient,10,ML,92.08,92.08,,,,,,,,,,,,,,,,,
Cholecalciferol (Vitamin D3),250,RC,VB006456,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Albuterol Sulfate,250,RC,VB006459,LOCAL,,inpatient,1,ea,351.84,351.84,,,,,,,,,,,,,,,,,
diphenhydrAMINE HCL 2% Gel,250,RC,VB006460,LOCAL,,inpatient,1,ea,17.72,17.72,,,,,,,,,,,,,,,,,
SILVER sulfADIAZINE,250,RC,VB006461,LOCAL,,inpatient,400,GM,284.02,284.02,,,,,,,,,,,,,,,,,
"Nut.tx.gluc Intol,lf,soy/Fiber",250,RC,VB006462,LOCAL,,inpatient,1,EA,13.25,13.25,,,,,,,,,,,,,,,,,
Chlorhexidine Gluconate 0.12% 118mL,250,RC,VB006467,LOCAL,,inpatient,118,ML,30,30,,,,,,,,,,,,,,,,,
Albumin Human 25%,250,RC,VB006470,LOCAL,,inpatient,100,ML,864,864,,,,,,,,,,,,,,,,,
Baricitinib,250,RC,VB006471,LOCAL,,inpatient,1,EA,442.78,442.78,,,,,,,,,,,,,,,,,
Teriparatide,250,RC,VB006472,LOCAL,,inpatient,2.24,ML,20591.47,20591.47,,,,,,,,,,,,,,,,,
Caspofungin Acetate,250,RC,VB006473,LOCAL,,inpatient,1,EA,1684.22,1684.22,,,,,,,,,,,,,,,,,
sirolimus,250,RC,VB006474,LOCAL,,inpatient,1,EA,329.98,329.98,,,,,,,,,,,,,,,,,
Nicotine,250,RC,VB006475,LOCAL,,inpatient,1,EA,2430.38,2430.38,,,,,,,,,,,,,,,,,
medroxyPROGESTERone ACETATE,250,RC,VB006476,LOCAL,,inpatient,1,ML,263.76,263.76,,,,,,,,,,,,,,,,,
Somatropin,250,RC,VB006477,LOCAL,,inpatient,1,EA,145.71,145.71,,,,,,,,,,,,,,,,,
Somatropin,250,RC,VB006478,LOCAL,,inpatient,1,EA,291.47,291.47,,,,,,,,,,,,,,,,,
silodosin,250,RC,VB006479,LOCAL,,inpatient,1,EA,41.84,41.84,,,,,,,,,,,,,,,,,
Oxybutynin,250,RC,VB006480,LOCAL,,inpatient,1,EA,407.91,407.91,,,,,,,,,,,,,,,,,
Lactase,250,RC,VB006481,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
"Estrogens, Conjugated",250,RC,VB006482,LOCAL,,inpatient,1,EA,33.94,33.94,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB006483,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Propylene Glycol/Peg 400/Pf,250,RC,VB006484,LOCAL,,inpatient,24,ML,5,5,,,,,,,,,,,,,,,,,
Bosutinib,250,RC,VB006485,LOCAL,,inpatient,1,EA,826.76,826.76,,,,,,,,,,,,,,,,,
Cisatracurium Besylate,250,RC,VB006486,LOCAL,,inpatient,20,ML,1425.6,1425.6,,,,,,,,,,,,,,,,,
dexmethylphenidate HCL,250,RC,VB006487,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Risedronate Sodium,250,RC,VB006488,LOCAL,,inpatient,1,EA,209.21,209.21,,,,,,,,,,,,,,,,,
Methylcellulose (With Sugar),250,RC,VB006489,LOCAL,,inpatient,454,GM,36.19,36.19,,,,,,,,,,,,,,,,,
Methylcellulose,250,RC,VB006490,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Clindamycin Phosphate 1% Lotion,250,RC,VB006491,LOCAL,,inpatient,60,ML,576.92,576.92,,,,,,,,,,,,,,,,,
Insulin Degludec,250,RC,VB006492,LOCAL,,inpatient,10,ML,1626.96,1626.96,,,,,,,,,,,,,,,,,
Fluticasone Propionate,250,RC,VB006493,LOCAL,,inpatient,1,EA,1314.38,1314.38,,,,,,,,,,,,,,,,,
Ezogabine,250,RC,VB006494,LOCAL,,inpatient,1,EA,28.96,28.96,,,,,,,,,,,,,,,,,
Methyl Salicylate/Menthol,250,RC,VB006495,LOCAL,,inpatient,142,GM,18.86,18.86,,,,,,,,,,,,,,,,,
Iopamidol IV Soln 76%,250,RC,VB006496,LOCAL,,inpatient,1,EA,243.98,243.98,,,,,,,,,,,,,,,,,
Insulin Regular In NS 100unit/100mL,250,RC,VB006497,LOCAL,,inpatient,100,ML,168,168,,,,,,,,,,,,,,,,,
Maprotiline HCL,250,RC,VB006498,LOCAL,,inpatient,1,EA,6.83,6.83,,,,,,,,,,,,,,,,,
estradioL 0.0375mg/24hr Patch,250,RC,VB006499,LOCAL,,inpatient,1,EA,92.83,92.83,,,,,,,,,,,,,,,,,
estradioL 0.05mg/24hr Patch,250,RC,VB006500,LOCAL,,inpatient,1,EA,45.35,45.35,,,,,,,,,,,,,,,,,
Dextroamphetamine Sulfate,250,RC,VB006502,LOCAL,,inpatient,1,EA,20.24,20.24,,,,,,,,,,,,,,,,,
Dexmedetomidine/NS 200 mcg/50mL,250,RC,VB006503,LOCAL,,inpatient,50,ML,134.4,134.4,,,,,,,,,,,,,,,,,
Procainamide HCL Inj,250,RC,VB006504,LOCAL,,inpatient,2,ML,349.25,349.25,,,,,,,,,,,,,,,,,
Darifenacin Hydrobromide,250,RC,VB006505,LOCAL,,inpatient,1,EA,60.97,60.97,,,,,,,,,,,,,,,,,
Levomilnacipran HCL,250,RC,VB006506,LOCAL,,inpatient,1,EA,84.22,84.22,,,,,,,,,,,,,,,,,
hydrOXYzine HCL,250,RC,VB006507,LOCAL,,inpatient,1,ML,140.45,140.45,,,,,,,,,,,,,,,,,
Zinc Sulfate Inj,250,RC,VB006508,LOCAL,,inpatient,10,ML,12.25,12.25,,,,,,,,,,,,,,,,,
cloBAZam Oral Susp,250,RC,VB006509,LOCAL,,inpatient,120,ML,34.62,34.62,,,,,,,,,,,,,,,,,
"Mineral Oil/Petrolatum,white",250,RC,VB006510,LOCAL,,inpatient,1,GM,5,5,,,,,,,,,,,,,,,,,
"Mineral Oil/Petrolatum,white",250,RC,VB006511,LOCAL,,inpatient,3.5,GM,28.72,28.72,,,,,,,,,,,,,,,,,
Diclofenac Sodium ER,250,RC,VB006512,LOCAL,,inpatient,1,EA,11.26,11.26,,,,,,,,,,,,,,,,,
Ciclopirox 1% Shampoo,250,RC,VB006513,LOCAL,,inpatient,120,ML,589.4,589.4,,,,,,,,,,,,,,,,,
Midazolam HCL Inj,250,RC,VB006514,LOCAL,,inpatient,2,ML,6,6,,,,,,,,,,,,,,,,,
Vitamin E,250,RC,VB006515,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Argatroban In 0.9 % Sod Chlor,250,RC,VB006516,LOCAL,,inpatient,125,ML,2837.16,2837.16,,,,,,,,,,,,,,,,,
Testosterone,250,RC,VB006517,LOCAL,,inpatient,5,GM,55.08,55.08,,,,,,,,,,,,,,,,,
Galantamine Hbr,250,RC,VB006518,LOCAL,,inpatient,1,EA,24.42,24.42,,,,,,,,,,,,,,,,,
Barium Sulfate,250,RC,VB006519,LOCAL,,inpatient,1,EA,13.09,13.09,,,,,,,,,,,,,,,,,
zolpidem TARTRATE,250,RC,VB006520,LOCAL,,inpatient,1,EA,24.47,24.47,,,,,,,,,,,,,,,,,
Docusate Sodium 283mg/5mL Enema,250,RC,VB006522,LOCAL,,inpatient,5,ML,86,86,,,,,,,,,,,,,,,,,
Proparacaine HCL,250,RC,VB006523,LOCAL,,inpatient,15,ML,175.48,175.48,,,,,,,,,,,,,,,,,
Azithromycin 1% Ophth,250,RC,VB006524,LOCAL,,inpatient,2.5,ML,1069,1069,,,,,,,,,,,,,,,,,
Nicotine Polacrilex,250,RC,VB006525,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ganciclovir Sodium,250,RC,VB006526,LOCAL,,inpatient,10,ML,288,288,,,,,,,,,,,,,,,,,
bisoproloL FUMARATE,250,RC,VB006527,LOCAL,,inpatient,1,EA,5.61,5.61,,,,,,,,,,,,,,,,,
Barium Sulfate,250,RC,VB006528,LOCAL,,inpatient,148,GM,5,5,,,,,,,,,,,,,,,,,
Barium Sulfate 40% (W/V),250,RC,VB006529,LOCAL,,inpatient,240,ml,67.06,67.06,,,,,,,,,,,,,,,,,
Barium Sulfate Oral,250,RC,VB006530,LOCAL,,inpatient,1,ea,28.88,28.88,,,,,,,,,,,,,,,,,
Ciprofloxacin HCL,250,RC,VB006531,LOCAL,,inpatient,1,EA,48.64,48.64,,,,,,,,,,,,,,,,,
Acitretin,250,RC,VB006532,LOCAL,,inpatient,1,EA,153.84,153.84,,,,,,,,,,,,,,,,,
Bumetanide,250,RC,VB006533,LOCAL,,inpatient,1,EA,11.75,11.75,,,,,,,,,,,,,,,,,
Acetaminophen IV 1000 mg/100mL,250,RC,VB006534,LOCAL,,inpatient,100,ML,177.64,177.64,,,,,,,,,,,,,,,,,
Terconazole,250,RC,VB006535,LOCAL,,inpatient,1,EA,130.51,130.51,,,,,,,,,,,,,,,,,
DULoxetine HCL,250,RC,VB006536,LOCAL,,inpatient,1,EA,35.81,35.81,,,,,,,,,,,,,,,,,
Lactobacillus Rhamnosus Gg,250,RC,VB006537,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Lactobacillus Rhamnosus Gg,250,RC,VB006538,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
prednisoLONE,250,RC,VB006539,LOCAL,,inpatient,480,ML,5,5,,,,,,,,,,,,,,,,,
Rotigotine,250,RC,VB006540,LOCAL,,inpatient,1,EA,138.23,138.23,,,,,,,,,,,,,,,,,
Rotigotine Patch,250,RC,VB006541,LOCAL,,inpatient,1,EA,138.23,138.23,,,,,,,,,,,,,,,,,
NIFEdipine,250,RC,VB006542,LOCAL,,inpatient,1,EA,5.58,5.58,,,,,,,,,,,,,,,,,
clobetasoL PROPIONATE,250,RC,VB006543,LOCAL,,inpatient,125,ML,2842.36,2842.36,,,,,,,,,,,,,,,,,
clomiPRAMINE HCL,250,RC,VB006544,LOCAL,,inpatient,1,EA,44.97,44.97,,,,,,,,,,,,,,,,,
"Peg3350/Sod Sulf,bicarb,cl/Kcl",250,RC,VB006545,LOCAL,,inpatient,1,EA,60.86,60.86,,,,,,,,,,,,,,,,,
Erythromycin Base,250,RC,VB006546,LOCAL,,inpatient,1,EA,75.15,75.15,,,,,,,,,,,,,,,,,
Oxacillin Sodium,250,RC,VB006547,LOCAL,,inpatient,1,EA,552,552,,,,,,,,,,,,,,,,,
Darbepoetin Alfa In Polysorbat,250,RC,VB006548,LOCAL,,inpatient,1,ML,7430.4,7430.4,,,,,,,,,,,,,,,,,
Darbepoetin Alfa In Polysorbat,250,RC,VB006549,LOCAL,,inpatient,1,ML,18576,18576,,,,,,,,,,,,,,,,,
Darbepoetin Alfa In Polysorbat,250,RC,VB006550,LOCAL,,inpatient,0.6,ML,11145.6,11145.6,,,,,,,,,,,,,,,,,
Etanercept,250,RC,VB006551,LOCAL,,inpatient,0.98,ML,7848.73,7848.73,,,,,,,,,,,,,,,,,
Brexpiprazole,250,RC,VB006552,LOCAL,,inpatient,1,EA,242.51,242.51,,,,,,,,,,,,,,,,,
Brexpiprazole,250,RC,VB006553,LOCAL,,inpatient,1,EA,242.51,242.51,,,,,,,,,,,,,,,,,
Brexpiprazole,250,RC,VB006554,LOCAL,,inpatient,1,EA,242.51,242.51,,,,,,,,,,,,,,,,,
Buprenorphine HCL,250,RC,VB006555,LOCAL,,inpatient,1,EA,77.97,77.97,,,,,,,,,,,,,,,,,
Lisdexamfetamine Dimesylate,250,RC,VB006556,LOCAL,,inpatient,1,EA,62.05,62.05,,,,,,,,,,,,,,,,,
Fentanyl Citrate-NS 1000mcg/100mL,250,RC,VB006557,LOCAL,,inpatient,100,ml,68.88,68.88,,,,,,,,,,,,,,,,,
Morphine Sulfate in NS 100mg/100mL,250,RC,VB006558,LOCAL,,inpatient,100,ml,67.1,67.1,,,,,,,,,,,,,,,,,
Hydromorphone HCL In 0.9% Nacl,250,RC,VB006559,LOCAL,,inpatient,50,ML,76.27,76.27,,,,,,,,,,,,,,,,,
Morphine Sulfate In 0.9 % Nacl,250,RC,VB006560,LOCAL,,inpatient,1,EA,43.58,43.58,,,,,,,,,,,,,,,,,
Sodium Phosphate In 0.9 % Nacl,250,RC,VB006561,LOCAL,,inpatient,1,EA,57.26,57.26,,,,,,,,,,,,,,,,,
Perampanel,250,RC,VB006562,LOCAL,,inpatient,1,EA,99.36,99.36,,,,,,,,,,,,,,,,,
Rufinamide,250,RC,VB006563,LOCAL,,inpatient,1,EA,126.72,126.72,,,,,,,,,,,,,,,,,
ceFAZolin SODIUM,250,RC,VB006564,LOCAL,,inpatient,1,EA,60.19,60.19,,,,,,,,,,,,,,,,,
Sodium Chloride 0.9 % (Flush) -10mL,250,RC,VB006565,LOCAL,,inpatient,10,ML,6,6,,,,,,,,,,,,,,,,,
Benzocaine/Menthol,250,RC,VB006566,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Carbidopa/Levodopa 23.75-95MG,250,RC,VB006567,LOCAL,,inpatient,1,EA,19.94,19.94,,,,,,,,,,,,,,,,,
oxyMORphone HCL,250,RC,VB006568,LOCAL,,inpatient,1,EA,36.96,36.96,,,,,,,,,,,,,,,,,
Demeclocycline HCL,250,RC,VB006569,LOCAL,,inpatient,1,EA,68.27,68.27,,,,,,,,,,,,,,,,,
Felbamate,250,RC,VB006570,LOCAL,,inpatient,1,EA,23.93,23.93,,,,,,,,,,,,,,,,,
Rizatriptan Benzoate,250,RC,VB006571,LOCAL,,inpatient,1,EA,133.25,133.25,,,,,,,,,,,,,,,,,
carBAMazepine,250,RC,VB006572,LOCAL,,inpatient,1,EA,27.86,27.86,,,,,,,,,,,,,,,,,
quiNINE SULFATE,250,RC,VB006573,LOCAL,,inpatient,1,EA,21.18,21.18,,,,,,,,,,,,,,,,,
Topiramate,250,RC,VB006574,LOCAL,,inpatient,1,EA,11.68,11.68,,,,,,,,,,,,,,,,,
Topiramate,250,RC,VB006575,LOCAL,,inpatient,1,EA,20.4,20.4,,,,,,,,,,,,,,,,,
ZOLMitriptan,250,RC,VB006576,LOCAL,,inpatient,1,EA,202.76,202.76,,,,,,,,,,,,,,,,,
Carbidopa,250,RC,VB006577,LOCAL,,inpatient,1,EA,7.01,7.01,,,,,,,,,,,,,,,,,
Norepinephrine Bit/NS,250,RC,VB006578,LOCAL,,inpatient,250,ML,106.56,106.56,,,,,,,,,,,,,,,,,
Fentanyl Citrate-NS 2500mcg/250mL,250,RC,VB006579,LOCAL,,inpatient,250,ml,207.36,207.36,,,,,,,,,,,,,,,,,
Sodium Citrate 4 % (5 ML),250,RC,VB006580,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Abaloparatide,250,RC,VB006581,LOCAL,,inpatient,1.56,ML,13569.7,13569.7,,,,,,,,,,,,,,,,,
Aliskiren Hemifumarate,250,RC,VB006582,LOCAL,,inpatient,1,EA,69.7,69.7,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB006583,LOCAL,,inpatient,30,ML,57.6,57.6,,,,,,,,,,,,,,,,,
Glycerin,250,RC,VB006584,LOCAL,,inpatient,1,EA,22.56,22.56,,,,,,,,,,,,,,,,,
Aloe Vera 99.5% Gel,250,RC,VB006586,LOCAL,,inpatient,237,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Omeprazole Oral (Compound Kit),250,RC,VB006587,LOCAL,,inpatient,300,ML,21.6,21.6,,,,,,,,,,,,,,,,,
Vancomycin Hcl Oral,250,RC,VB006588,LOCAL,,inpatient,300,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Perphenazine,250,RC,VB006598,LOCAL,,inpatient,1,EA,10.4,10.4,,,,,,,,,,,,,,,,,
Hydromorphone HCL/Pf Inj,250,RC,VB006622,LOCAL,,inpatient,1,ML,20.74,20.74,,,,,,,,,,,,,,,,,
morphine SULFATE Oral Soln (RX-UD),250,RC,VB006624,LOCAL,,inpatient,30,ML,5,5,,,,,,,,,,,,,,,,,
Adenosine,250,RC,VB006625,LOCAL,,inpatient,2,ML,29.76,29.76,,,,,,,,,,,,,,,,,
Atropine Sulfate 1% Ophthalmic 15mL,250,RC,VB006626,LOCAL,,inpatient,15,ML,660.24,660.24,,,,,,,,,,,,,,,,,
Chlorhexidine Gluconate 4%,250,RC,VB006627,LOCAL,,inpatient,236,ML,21.12,21.12,,,,,,,,,,,,,,,,,
clobetasoL PROPIONATE 0.05% - 30gm,250,RC,VB006628,LOCAL,,inpatient,30,GM,1025.84,1025.84,,,,,,,,,,,,,,,,,
Fat Emul/Soy/Mct/Oliv/Fish Oil,250,RC,VB006629,LOCAL,,inpatient,100,ML,105.6,105.6,,,,,,,,,,,,,,,,,
Hydromorphone HCL/Pf Inj,250,RC,VB006630,LOCAL,,inpatient,50,ML,587.95,587.95,,,,,,,,,,,,,,,,,
Ketoconazole 2% Cream - 30gm,250,RC,VB006631,LOCAL,,inpatient,30,GM,208.44,208.44,,,,,,,,,,,,,,,,,
Lidocaine HCL/Pf Inj 1% - 2mL,250,RC,VB006632,LOCAL,,inpatient,2,ML,11.33,11.33,,,,,,,,,,,,,,,,,
lidocaine HCL 2% Viscous,250,RC,VB006633,LOCAL,,inpatient,100,ML,52.8,52.8,,,,,,,,,,,,,,,,,
LORazepam,250,RC,VB006634,LOCAL,,inpatient,10,ML,69.5,69.5,,,,,,,,,,,,,,,,,
Nystatin-Triamcin 10000Unit/GM-0.1%,250,RC,VB006635,LOCAL,,inpatient,60,GM,209.68,209.68,,,,,,,,,,,,,,,,,
oxyCODONE HCL - UD,250,RC,VB006636,LOCAL,,inpatient,5,ML,28.32,28.32,,,,,,,,,,,,,,,,,
Parab/Cet Alc/Stryl Alc/Pg/Sls,250,RC,VB006637,LOCAL,,inpatient,473,ML,46.08,46.08,,,,,,,,,,,,,,,,,
Hydromorphone HCL/Pf Inj,250,RC,VB006638,LOCAL,,inpatient,1,ML,19.92,19.92,,,,,,,,,,,,,,,,,
terbinafine HCL 1% Cream 30gm,250,RC,VB006639,LOCAL,,inpatient,30,GM,48.16,48.16,,,,,,,,,,,,,,,,,
timoloL MALEATE 0.25% - 10mL,250,RC,VB006640,LOCAL,,inpatient,10,ML,111,111,,,,,,,,,,,,,,,,,
Zinc Oxide 20% Oint 1oz,250,RC,VB006641,LOCAL,,inpatient,28.4,GM,26.24,26.24,,,,,,,,,,,,,,,,,
Clear Eyes Contact Relief - 15mL,250,RC,VB006642,LOCAL,,inpatient,15,ML,1.5,1.5,,,,,,,,,,,,,,,,,
levETIRAcetam Oral (RX-UD),250,RC,VB006644,LOCAL,,inpatient,473,ML,9.37,9.37,,,,,,,,,,,,,,,,,
Magnesium Chloride,250,RC,VB006645,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Levorphanol Tartrate,250,RC,VB006646,LOCAL,,inpatient,1,EA,213.6,213.6,,,,,,,,,,,,,,,,,
AA/DEX (TPN - CENTRAL LINE),250,RC,VB006647,LOCAL,,inpatient,2000,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Menthol/Camphor/Dimeth/Phenol,250,RC,VB006649,LOCAL,,inpatient,10,GM,6.4,6.4,,,,,,,,,,,,,,,,,
Ketamine HCl Oral Soln,250,RC,VB006653,LOCAL,,inpatient,0.4,ML,1.5,1.5,,,,,,,,,,,,,,,,,
NAIL CLEAR (FUNGICURE) LACQUER 15ML,250,RC,VB006654,LOCAL,,inpatient,15,ML,1.5,1.5,,,,,,,,,,,,,,,,,
OXYBUTYNIN CHLORIDE IRRIG,250,RC,VB006656,LOCAL,,inpatient,90,ML,1.5,1.5,,,,,,,,,,,,,,,,,
THERAWORK RELIEF SPRAY,250,RC,VB006665,LOCAL,,inpatient,1,EA,1.5,1.5,,,,,,,,,,,,,,,,,
Guaifenesin/Dextrometh 100-10mg/5ml,250,RC,VB006666,LOCAL,,inpatient,118,ML,20.96,20.96,,,,,,,,,,,,,,,,,
CERAVE (OIL FREE) LOTION,250,RC,VB006670,LOCAL,,inpatient,355,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Magic Mouthwash w/Nystatin - 120mL,250,RC,VB006674,LOCAL,,inpatient,120,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Magic Mouthwash Modified - 90mL,250,RC,VB006675,LOCAL,,inpatient,90,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Oxybutynin Chloride ER,250,RC,VB006685,LOCAL,,inpatient,1,EA,12.63,12.63,,,,,,,,,,,,,,,,,
Oxymetazoline HCL 0.05% - 30mL,250,RC,VB006686,LOCAL,,inpatient,30,ML,10.75,10.75,,,,,,,,,,,,,,,,,
morphine SULFATE Oral (RX-UD),250,RC,VB006690,LOCAL,,inpatient,500,ML,5,5,,,,,,,,,,,,,,,,,
Vitamin K Oral Soln,250,RC,VB006691,LOCAL,,inpatient,1,ML,1.5,1.5,,,,,,,,,,,,,,,,,
LIDEX UNG/AQUAPHOR 1:4 RATIO,250,RC,VB006700,LOCAL,,inpatient,300,GM,1.5,1.5,,,,,,,,,,,,,,,,,
MAGIC MOUTHWASH #3 - 120mL,250,RC,VB006701,LOCAL,,inpatient,120,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Miconazole Nitrate 2% Powder,250,RC,VB006702,LOCAL,,inpatient,43,GM,22.56,22.56,,,,,,,,,,,,,,,,,
MAGIC MOUTH WASH 1 BOTTLE,250,RC,VB006703,LOCAL,,inpatient,120,ML,1.5,1.5,,,,,,,,,,,,,,,,,
MAGIC MOUTHWASH 2-NYST-LIDO-BE,250,RC,VB006704,LOCAL,,inpatient,120,ML,1.5,1.5,,,,,,,,,,,,,,,,,
TACROLIMUS ORAL 3mg/6mL,250,RC,VB006708,LOCAL,,inpatient,6,ML,31.44,31.44,,,,,,,,,,,,,,,,,
TACROLIMUS ORAL 1mg/mL,250,RC,VB006710,LOCAL,,inpatient,1,ML,1.5,1.5,,,,,,,,,,,,,,,,,
HYDROMORPHONE 50mg/50mL INFUSION,250,RC,VB006714,LOCAL,,inpatient,50,ML,1.5,1.5,,,,,,,,,,,,,,,,,
"Insulin Glargine,hum.rec.anlog",250,RC,VB006718,LOCAL,,inpatient,10,ML,473.52,473.52,,,,,,,,,,,,,,,,,
Insulin Nph Human Isophane,250,RC,VB006719,LOCAL,,inpatient,10,ML,214.13,214.13,,,,,,,,,,,,,,,,,
Melatonin,250,RC,VB006721,LOCAL,,inpatient,1,EA,1.88,1.88,,,,,,,,,,,,,,,,,
Omeprazole Oral,250,RC,VB006722,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Omeprazole Oral,250,RC,VB006722,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
morphine SULFATE Inj (Nexject),250,RC,VB006725,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
SODIUM CITRATE 4% SOLN - 3mL,250,RC,VB006726,LOCAL,,inpatient,3,ML,5,5,,,,,,,,,,,,,,,,,
Nystatin/Benadryl/Lidocai 2%- 120mL,250,RC,VB006728,LOCAL,,inpatient,120,ML,5,5,,,,,,,,,,,,,,,,,
Custom TPN,250,RC,VB006729,LOCAL,,inpatient,2000,ML,520,520,,,,,,,,,,,,,,,,,
Perampanel,250,RC,VB006739,LOCAL,,inpatient,1,EA,196.32,196.32,,,,,,,,,,,,,,,,,
Sod Phos (45mM Phos-60meQ Na/15ml),250,RC,VB006740,LOCAL,,inpatient,15,ML,72.4,72.4,,,,,,,,,,,,,,,,,
Calcium Gluconate Inj(4.65mEq/10mL),250,RC,VB006741,LOCAL,,inpatient,10,ML,48.08,48.08,,,,,,,,,,,,,,,,,
"Insulin Regular, Human",250,RC,VB006743,LOCAL,,inpatient,10,ML,660.96,660.96,,,,,,,,,,,,,,,,,
Adenosine Inj,250,RC,VB006744,LOCAL,,inpatient,2,ML,76.8,76.8,,,,,,,,,,,,,,,,,
Albumin Human 25% - 100mL,250,RC,VB006745,LOCAL,,inpatient,100,ML,555.46,555.46,,,,,,,,,,,,,,,,,
Ciprofloxacin HCL 0.3% Ophth - 5mL,250,RC,VB006746,LOCAL,,inpatient,5,ML,44.36,44.36,,,,,,,,,,,,,,,,,
Clotrimazole/Betam 1 %-0.05 % Cream,250,RC,VB006747,LOCAL,,inpatient,45,GM,174.24,174.24,,,,,,,,,,,,,,,,,
Cyclopentolate HCL 1% Ophth - 2mL,250,RC,VB006748,LOCAL,,inpatient,2,ML,59.08,59.08,,,,,,,,,,,,,,,,,
Bacitracin Zinc/Polymyx Oint 14.2g,250,RC,VB006749,LOCAL,,inpatient,14.2,GM,17.4,17.4,,,,,,,,,,,,,,,,,
Erythromycin Base Ophth Oint 3.5gm,250,RC,VB006750,LOCAL,,inpatient,3.5,GM,71.86,71.86,,,,,,,,,,,,,,,,,
Fentanyl Cit/Pf Inj 2500mcg/50mL,250,RC,VB006751,LOCAL,,inpatient,50,ML,120,120,,,,,,,,,,,,,,,,,
Lacosamide Oral Soln,250,RC,VB006752,LOCAL,,inpatient,200,ML,11.24,11.24,,,,,,,,,,,,,,,,,
BOSTON BUTT CREAM 4 OZ CREAM,250,RC,VB006756,LOCAL,,inpatient,120,GM,1.5,1.5,,,,,,,,,,,,,,,,,
Vancomycin Oral Soln,250,RC,VB006771,LOCAL,,inpatient,80,ML,78.84,78.84,,,,,,,,,,,,,,,,,
levothyroxine SODIUM Oral Soln,250,RC,VB006774,LOCAL,,inpatient,100,ML,6.36,6.36,,,,,,,,,,,,,,,,,
Parenteral Amino Acid 15% No.6,250,RC,VB006778,LOCAL,,inpatient,1000,ML,193.49,193.49,,,,,,,,,,,,,,,,,
Amino Ac 8 %/D10w/Electrolytes,250,RC,VB006822,LOCAL,,inpatient,2000,ML,5,5,,,,,,,,,,,,,,,,,
Fluocinonide 0.05% Gel - 60gm,250,RC,VB006823,LOCAL,,inpatient,60,GM,952.84,952.84,,,,,,,,,,,,,,,,,
clonazePAM Orally Disintegrating,250,RC,VB006824,LOCAL,,inpatient,1,EA,5.93,5.93,,,,,,,,,,,,,,,,,
Hydrocortisone Sod Succinate,250,RC,VB006829,LOCAL,,inpatient,1,EA,91.92,91.92,,,,,,,,,,,,,,,,,
"Epoetin Alfa-Epbx 20,000 units/mL",250,RC,VB006830,LOCAL,,inpatient,1,ML,1058.88,1058.88,,,,,,,,,,,,,,,,,
Cisatracurium Besylate (2mg/ml),250,RC,VB006831,LOCAL,,inpatient,10,ML,132,132,,,,,,,,,,,,,,,,,
Benzocaine,250,RC,VB006832,LOCAL,,inpatient,1,EA,53.2,53.2,,,,,,,,,,,,,,,,,
Lidocaine HCL/Epinephrine/Pf,250,RC,VB006833,LOCAL,,inpatient,5,ML,26.06,26.06,,,,,,,,,,,,,,,,,
Hydromorphone HCL,250,RC,VB006834,LOCAL,,inpatient,0.5,ML,16.56,16.56,,,,,,,,,,,,,,,,,
Lidocaine HCL/Epinephrine/Pf,250,RC,VB006835,LOCAL,,inpatient,20,ML,24.24,24.24,,,,,,,,,,,,,,,,,
Erythromycin Lactobionate,250,RC,VB006836,LOCAL,,inpatient,1,EA,405.77,405.77,,,,,,,,,,,,,,,,,
Hydrophilic Cream - 454gm,250,RC,VB006837,LOCAL,,inpatient,1,EA,22.08,22.08,,,,,,,,,,,,,,,,,
ePHEDrine SULFATE,250,RC,VB006838,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
Flu Vacc Qs2019-20 36mos Up/Pf,250,RC,VB006839,LOCAL,,inpatient,1,ea,82.66,82.66,,,,,,,,,,,,,,,,,
Melatonin,250,RC,VB006840,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Lactobacillus Rhamnosus Gg,250,RC,VB006841,LOCAL,,inpatient,1,ea,6.17,6.17,,,,,,,,,,,,,,,,,
clonazePAM,250,RC,VB006842,LOCAL,,inpatient,1,ea,5.2,5.2,,,,,,,,,,,,,,,,,
Lactulose,250,RC,VB006843,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Clotrimazole 2% Vag Cream,250,RC,VB006844,LOCAL,,inpatient,21,GM,42.4,42.4,,,,,,,,,,,,,,,,,
rOPINIRole HCL,250,RC,VB006845,LOCAL,,inpatient,1,ea,10,10,,,,,,,,,,,,,,,,,
Lidocaine HCL/Pf 2% Inj - 5mL,250,RC,VB006846,LOCAL,,inpatient,5,ML,18,18,,,,,,,,,,,,,,,,,
cloBAZam,250,RC,VB006847,LOCAL,,inpatient,1,ea,77.7,77.7,,,,,,,,,,,,,,,,,
Methyl Salicylate/Menth/Camph,250,RC,VB006848,LOCAL,,inpatient,1,ea,27.89,27.89,,,,,,,,,,,,,,,,,
methylPREDNISolone ACETATE Inj,250,RC,VB006849,LOCAL,,inpatient,5,ML,236.59,236.59,,,,,,,,,,,,,,,,,
Bacitracin Zinc/Polymyxin B,250,RC,VB006850,LOCAL,,inpatient,14.2,GM,24.1,24.1,,,,,,,,,,,,,,,,,
Mometasone/Formoterol,250,RC,VB006851,LOCAL,,inpatient,13,GM,1494.48,1494.48,,,,,,,,,,,,,,,,,
Mometasone/Formoterol,250,RC,VB006852,LOCAL,,inpatient,13,GM,1494.48,1494.48,,,,,,,,,,,,,,,,,
amantadine HCL Oral Soln UD,250,RC,VB006853,LOCAL,,inpatient,10,ML,19.76,19.76,,,,,,,,,,,,,,,,,
lidocaine HCL Local Inj 2%,250,RC,VB006854,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
clobetasoL PROP 0.05% - 50mL,250,RC,VB006855,LOCAL,,inpatient,50,ML,825.24,825.24,,,,,,,,,,,,,,,,,
Acyclovir 5% Oint - 15gm,250,RC,VB006856,LOCAL,,inpatient,15,GM,1595.2,1595.2,,,,,,,,,,,,,,,,,
"Water for Irrigation,sterile",250,RC,VB006857,LOCAL,,inpatient,3000,ML,51.41,51.41,,,,,,,,,,,,,,,,,
Glycopyrrolate,250,RC,VB006858,LOCAL,,inpatient,2,ML,55.2,55.2,,,,,,,,,,,,,,,,,
Perit. Dialysis No.6-1.5 % Dex,250,RC,VB006859,LOCAL,,inpatient,2500,ML,273.26,273.26,,,,,,,,,,,,,,,,,
Periton.dialysis 7-2.5 % Dextr,250,RC,VB006860,LOCAL,,inpatient,2500,ML,232.03,232.03,,,,,,,,,,,,,,,,,
Periton.dialysis 8-4.25 % Dext,250,RC,VB006861,LOCAL,,inpatient,2500,ML,237.6,237.6,,,,,,,,,,,,,,,,,
Sodium Citrate 4% - 250mL,250,RC,VB006862,LOCAL,,inpatient,250,ml,27.8,27.8,,,,,,,,,,,,,,,,,
timoloL MALEATE 0.5% - 10mL,250,RC,VB006863,LOCAL,,inpatient,10,ML,129.4,129.4,,,,,,,,,,,,,,,,,
Triamcinolone Acet 0.1% Cream 454gm,250,RC,VB006864,LOCAL,,inpatient,454,GM,93.32,93.32,,,,,,,,,,,,,,,,,
tacrolimus 0.1% Oint - 60gm,250,RC,VB006865,LOCAL,,inpatient,60,GM,960.04,960.04,,,,,,,,,,,,,,,,,
guaiFENesin,250,RC,VB006866,LOCAL,,inpatient,15,ML,5,5,,,,,,,,,,,,,,,,,
Potassium Chloride Oral,250,RC,VB006867,LOCAL,,inpatient,15,ML,66.8,66.8,,,,,,,,,,,,,,,,,
Povidone-Iodine,250,RC,VB006868,LOCAL,,inpatient,473,ML,23.96,23.96,,,,,,,,,,,,,,,,,
Coal Tar,250,RC,VB006869,LOCAL,,inpatient,1,ea,36.77,36.77,,,,,,,,,,,,,,,,,
Witch Hazel Topical Solution,250,RC,VB006872,LOCAL,,inpatient,480,ML,17.56,17.56,,,,,,,,,,,,,,,,,
methylPREDNISolone ACETATE,250,RC,VB006873,LOCAL,,inpatient,5,ML,170.69,170.69,,,,,,,,,,,,,,,,,
Magnesium Hydroxide,250,RC,VB006874,LOCAL,,inpatient,10,ML,13.88,13.88,,,,,,,,,,,,,,,,,
nebivolol HCL,250,RC,VB006875,LOCAL,,inpatient,1,EA,30.71,30.71,,,,,,,,,,,,,,,,,
Tapentadol HCL,250,RC,VB006876,LOCAL,,inpatient,1,EA,50.81,50.81,,,,,,,,,,,,,,,,,
Tapentadol HCL,250,RC,VB006877,LOCAL,,inpatient,1,EA,61.15,61.15,,,,,,,,,,,,,,,,,
Alpha Lipoic Acid,250,RC,VB006878,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lactobacillus Rhamnosus Gg,250,RC,VB006879,LOCAL,,inpatient,1,EA,8.23,8.23,,,,,,,,,,,,,,,,,
Flu Vacc Qs2020-21(6mos Up)/Pf,250,RC,VB006880,LOCAL,,inpatient,1,EA,83.47,83.47,,,,,,,,,,,,,,,,,
Ivabradine HCL,250,RC,VB006881,LOCAL,,inpatient,1,EA,50.07,50.07,,,,,,,,,,,,,,,,,
megestroL ACETATE,250,RC,VB006882,LOCAL,,inpatient,240,ML,5,5,,,,,,,,,,,,,,,,,
Flu Vac Qs 19-20 (4yr Up) Cell,250,RC,VB006883,LOCAL,,inpatient,1,ea,218.48,218.48,,,,,,,,,,,,,,,,,
Multivit/Iron Sulf/Folic Acid,250,RC,VB006884,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
"Diatrizoate Meglumine, Sodium",250,RC,VB006885,LOCAL,,inpatient,1,ea,110.78,110.78,,,,,,,,,,,,,,,,,
Miconazole Nitrate 2% Cream,250,RC,VB006886,LOCAL,,inpatient,14,GM,9.44,9.44,,,,,,,,,,,,,,,,,
timoloL MALEATE 0.5% 10mL,250,RC,VB006887,LOCAL,,inpatient,10,ML,129.4,129.4,,,,,,,,,,,,,,,,,
Ofloxacin 0.3% Ophth 10mL,250,RC,VB006888,LOCAL,,inpatient,10,ML,161.52,161.52,,,,,,,,,,,,,,,,,
Brimonidine Tart 0.2% - 10mL,250,RC,VB006889,LOCAL,,inpatient,10,ML,136.24,136.24,,,,,,,,,,,,,,,,,
Trolamine Salicylate/Aloe Vera,250,RC,VB006890,LOCAL,,inpatient,1,EA,27.41,27.41,,,,,,,,,,,,,,,,,
Potassium Chloride Oral,250,RC,VB006891,LOCAL,,inpatient,30,ML,127.92,127.92,,,,,,,,,,,,,,,,,
"Sod Phosphate,monobasic-Dibas",250,RC,VB006892,LOCAL,,inpatient,5,ML,77.47,77.47,,,,,,,,,,,,,,,,,
Acyclovir 5% Oint,250,RC,VB006893,LOCAL,,inpatient,15,GM,1595.2,1595.2,,,,,,,,,,,,,,,,,
Amoxicillin Chewable,250,RC,VB006895,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Amino Ac 8 %/D14w/Electrolytes,250,RC,VB006896,LOCAL,,inpatient,2000,ML,580.42,580.42,,,,,,,,,,,,,,,,,
Amino Acid 8 % In D14w,250,RC,VB006897,LOCAL,,inpatient,2000,ML,543.98,543.98,,,,,,,,,,,,,,,,,
Amino Acid 8 % In D10w,250,RC,VB006898,LOCAL,,inpatient,2000,ML,503.38,503.38,,,,,,,,,,,,,,,,,
Trolamine Salicylate Cream,250,RC,VB006913,LOCAL,,inpatient,141,GM,52.16,52.16,,,,,,,,,,,,,,,,,
Fluticasone Propion/Salmeterol,250,RC,VB006920,LOCAL,,inpatient,1,EA,1445.76,1445.76,,,,,,,,,,,,,,,,,
Dextrose Chew Tab,250,RC,VB006921,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Mesalamine,250,RC,VB006922,LOCAL,,inpatient,1,ea,167.28,167.28,,,,,,,,,,,,,,,,,
ALPRAZolam ODT,250,RC,VB006938,LOCAL,,inpatient,1,EA,7.56,7.56,,,,,,,,,,,,,,,,,
Ceftriaxone In is-Osm Dextrose,250,RC,VB006942,LOCAL,,inpatient,1,ML,81.72,81.72,,,,,,,,,,,,,,,,,
ALPRAZolam ODT,250,RC,VB006943,LOCAL,,inpatient,1,EA,10.09,10.09,,,,,,,,,,,,,,,,,
clonazePAM ODT,250,RC,VB006944,LOCAL,,inpatient,1,ea,5.19,5.19,,,,,,,,,,,,,,,,,
Diclofenac Epolamine 1.3%,250,RC,VB006945,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lacosamide Oral Soln,250,RC,VB006947,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
metFORMIN HCL,250,RC,VB006960,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Spironolactone,250,RC,VB006961,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Mederma Scar Cream,250,RC,VB006962,LOCAL,,inpatient,1,EA,1.5,1.5,,,,,,,,,,,,,,,,,
"Epoetin Alfa-Epbx 20,000 units/2 mL",250,RC,VB006969,LOCAL,,inpatient,2,ML,1058.88,1058.88,,,,,,,,,,,,,,,,,
Menthol/Zinc Oxide Powder,250,RC,VB006971,LOCAL,,inpatient,1,EA,11.42,11.42,,,,,,,,,,,,,,,,,
CYCLIC TPN 2000ML,250,RC,VB006972,LOCAL,,inpatient,2000,ML,1.5,1.5,,,,,,,,,,,,,,,,,
CYCLIC TPN W/LATEX ALLG 2000ML,250,RC,VB006973,LOCAL,,inpatient,2000,ML,1.5,1.5,,,,,,,,,,,,,,,,,
MAALOX/LOTRIMIN/HYDROCORT CREAM,250,RC,VB006975,LOCAL,,inpatient,180,GM,9.52,9.52,,,,,,,,,,,,,,,,,
MAALOX-LOTRIMIN-HYDROC-LIDO 240 ML,250,RC,VB006976,LOCAL,,inpatient,240,ML,9.52,9.52,,,,,,,,,,,,,,,,,
NYSTATIN-HYDROCORTISONE CREAM 60 GM,250,RC,VB006978,LOCAL,,inpatient,60,GM,1.5,1.5,,,,,,,,,,,,,,,,,
TACROLIMUS 0.5mg/mL - 60mL,250,RC,VB006979,LOCAL,,inpatient,60,ML,5,5,,,,,,,,,,,,,,,,,
SELSUN BLUE 11 OZ SHAMPOO,250,RC,VB006980,LOCAL,,inpatient,1,EA,1.5,1.5,,,,,,,,,,,,,,,,,
TPN - 3000mL,250,RC,VB006981,LOCAL,,inpatient,3000,ML,1.5,1.5,,,,,,,,,,,,,,,,,
TPN W/LATEX ALLERGY 2000ML,250,RC,VB006982,LOCAL,,inpatient,2000,ML,1.5,1.5,,,,,,,,,,,,,,,,,
TPN W/LATEX ALLERGY 3000ML,250,RC,VB006983,LOCAL,,inpatient,3000,ML,1.5,1.5,,,,,,,,,,,,,,,,,
TUBERCULIN TEST SITE READ,250,RC,VB006984,LOCAL,,inpatient,1,ea,1.5,1.5,,,,,,,,,,,,,,,,,
ZINC OX 20%/LIDOCAINE JEL 2% 240 ML,250,RC,VB006985,LOCAL,,inpatient,1,ea,27.56,27.56,,,,,,,,,,,,,,,,,
Vibegron,250,RC,VB006992,LOCAL,,inpatient,1,ea,80.14,80.14,,,,,,,,,,,,,,,,,
L. Acidophilus/L.bulgaricus,250,RC,VB006994,LOCAL,,inpatient,1,EA,8.13,8.13,,,,,,,,,,,,,,,,,
Acitretin,250,RC,VB006997,LOCAL,,inpatient,1,EA,124.81,124.81,,,,,,,,,,,,,,,,,
Norepinephrine/D5W - 8mg/250mL,250,RC,VB007000,LOCAL,,inpatient,250,ML,160.08,160.08,,,,,,,,,,,,,,,,,
TPN 1000ML,250,RC,VB007007,LOCAL,,inpatient,1000,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Biotin,250,RC,VB007009,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Bethanechol Chloride,250,RC,VB007013,LOCAL,,inpatient,1,EA,17.09,17.09,,,,,,,,,,,,,,,,,
metoprolol tartrate,250,RC,VB007014,LOCAL,,inpatient,1,EA,5.84,5.84,,,,,,,,,,,,,,,,,
Guaifenesin/DM 400MG-20MG,250,RC,VB007015,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Polyvinyl Alc/Povidone 0.5%-0.6%,250,RC,VB007016,LOCAL,,inpatient,15,ML,29.96,29.96,,,,,,,,,,,,,,,,,
Carboxymethylcel/Glycerin 0.5%-0.9%,250,RC,VB007017,LOCAL,,inpatient,15,ML,32.74,32.74,,,,,,,,,,,,,,,,,
Insulin Glargine-Yfgn 100 unit/mL,250,RC,VB007018,LOCAL,,inpatient,10,ML,302.26,302.26,,,,,,,,,,,,,,,,,
mycophenolate mofetiL 1500mg/7.5mL,250,RC,VB007019,LOCAL,,inpatient,160,ML,36.24,36.24,,,,,,,,,,,,,,,,,
Abatacept,250,RC,VB007020,LOCAL,,inpatient,1,ML,7141.87,7141.87,,,,,,,,,,,,,,,,,
colestipol HCL,250,RC,VB007021,LOCAL,,inpatient,30,GM,34.03,34.03,,,,,,,,,,,,,,,,,
estradioL CYPIONATE,250,RC,VB007022,LOCAL,,inpatient,5,ML,1179.17,1179.17,,,,,,,,,,,,,,,,,
Insulin Glargine Pen 300 unit/mL,250,RC,VB007023,LOCAL,,inpatient,1.5,ML,685.73,685.73,,,,,,,,,,,,,,,,,
Testosterone 1.62% (40.5mg/2.5gm),250,RC,VB007024,LOCAL,,inpatient,2.5,GM,40.98,40.98,,,,,,,,,,,,,,,,,
Testosterone 1.62% (20.25mg/1.25gm),250,RC,VB007025,LOCAL,,inpatient,1.25,GM,79.75,79.75,,,,,,,,,,,,,,,,,
HYDROmorphone HCL,250,RC,VB007026,LOCAL,,inpatient,1,EA,5.28,5.28,,,,,,,,,,,,,,,,,
LORazepam Oral,250,RC,VB007027,LOCAL,,inpatient,30,ML,6.4,6.4,,,,,,,,,,,,,,,,,
predniSONE Oral,250,RC,VB007028,LOCAL,,inpatient,120,ML,5,5,,,,,,,,,,,,,,,,,
Cyclopentolate HCL 2% Ophth,250,RC,VB007029,LOCAL,,inpatient,5,ML,367.92,367.92,,,,,,,,,,,,,,,,,
Nepafenac 0.3% Ophth,250,RC,VB007030,LOCAL,,inpatient,1.7,ML,1393.01,1393.01,,,,,,,,,,,,,,,,,
Epoetin Alfa-Epbx,250,RC,VB007031,LOCAL,,inpatient,1,ML,1058.88,1058.88,,,,,,,,,,,,,,,,,
Secukinumab,250,RC,VB007032,LOCAL,,inpatient,1,ML,18314.95,18314.95,,,,,,,,,,,,,,,,,
Mometasone Furoate Inh,250,RC,VB007033,LOCAL,,inpatient,1,GM,851.47,851.47,,,,,,,,,,,,,,,,,
armodafiniL,250,RC,VB007034,LOCAL,,inpatient,1,EA,87.55,87.55,,,,,,,,,,,,,,,,,
Escitalopram Oxalate,250,RC,VB007035,LOCAL,,inpatient,1,EA,16.55,16.55,,,,,,,,,,,,,,,,,
Cimetidine,250,RC,VB007036,LOCAL,,inpatient,1,EA,8.21,8.21,,,,,,,,,,,,,,,,,
Hydrogen Peroxide 1.5%,250,RC,VB007037,LOCAL,,inpatient,236,ML,19.15,19.15,,,,,,,,,,,,,,,,,
Doxycycline Hyclate,250,RC,VB007038,LOCAL,,inpatient,1,EA,9.01,9.01,,,,,,,,,,,,,,,,,
estradioL Vaginal,250,RC,VB007039,LOCAL,,inpatient,1,EA,102.1,102.1,,,,,,,,,,,,,,,,,
Insulin Detemir Pen 100 Unit/mL,250,RC,VB007040,LOCAL,,inpatient,3,ML,155.28,155.28,,,,,,,,,,,,,,,,,
SUMAtriptan Spray,250,RC,VB007041,LOCAL,,inpatient,6,EA,2693.76,2693.76,,,,,,,,,,,,,,,,,
Budesonide Inh,250,RC,VB007042,LOCAL,,inpatient,1,EA,948.48,948.48,,,,,,,,,,,,,,,,,
diazePAM Rectal Gel,250,RC,VB007043,LOCAL,,inpatient,1,EA,1683.6,1683.6,,,,,,,,,,,,,,,,,
Magnesium Carbonate,250,RC,VB007044,LOCAL,,inpatient,355,ML,5,5,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB007045,LOCAL,,inpatient,1,EA,75.95,75.95,,,,,,,,,,,,,,,,,
"Cefoxitin Sodium/Dextrose,iso",250,RC,VB007046,LOCAL,,inpatient,1,ML,140.28,140.28,,,,,,,,,,,,,,,,,
Ceftriaxone In is-Osm Dextrose,250,RC,VB007047,LOCAL,,inpatient,1,ML,81.72,81.72,,,,,,,,,,,,,,,,,
Ceftriaxone In is-Osm Dextrose,250,RC,VB007048,LOCAL,,inpatient,1,ML,125.95,125.95,,,,,,,,,,,,,,,,,
Roflumilast,250,RC,VB007049,LOCAL,,inpatient,1,EA,70.99,70.99,,,,,,,,,,,,,,,,,
Citric Ac/Gluconolact/Mag Carb,250,RC,VB007050,LOCAL,,inpatient,30,ML,28.42,28.42,,,,,,,,,,,,,,,,,
Amino Acid 8 % In D14w,250,RC,VB007051,LOCAL,,inpatient,2000,ML,543.98,543.98,,,,,,,,,,,,,,,,,
Amino Acids 5 %/Dextrose 25 %,250,RC,VB007052,LOCAL,,inpatient,2000,ML,349.87,349.87,,,,,,,,,,,,,,,,,
Amino Ac 2.75%/Dex 10%/Lyte 29,250,RC,VB007053,LOCAL,,inpatient,2000,ML,224.98,224.98,,,,,,,,,,,,,,,,,
"Cefazolin Sodium/Dextrose,iso",250,RC,VB007054,LOCAL,,inpatient,100,ML,44.4,44.4,,,,,,,,,,,,,,,,,
Vancomycin HCL In 5 % Dextrose,250,RC,VB007055,LOCAL,,inpatient,200,ML,129.94,129.94,,,,,,,,,,,,,,,,,
estradioL,250,RC,VB007056,LOCAL,,inpatient,1,EA,45.4,45.4,,,,,,,,,,,,,,,,,
Doxepin HCL,250,RC,VB007057,LOCAL,,inpatient,1,EA,65.3,65.3,,,,,,,,,,,,,,,,,
Valsartan,250,RC,VB007058,LOCAL,,inpatient,1,EA,16.22,16.22,,,,,,,,,,,,,,,,,
Talc,250,RC,VB007059,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Bupivacaine HCL Inj 0.5% - 50mL,250,RC,VB007060,LOCAL,,inpatient,50,ML,14.26,14.26,,,,,,,,,,,,,,,,,
morphine SULFATE Inj,250,RC,VB007061,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
Sodium Bicarbonate Inj 8.4% - 10mL,250,RC,VB007062,LOCAL,,inpatient,10,ML,67.44,67.44,,,,,,,,,,,,,,,,,
Zinc/Copper/Mangan/Chromic Chl,250,RC,VB007063,LOCAL,,inpatient,10,ML,164.5,164.5,,,,,,,,,,,,,,,,,
Zinc/Copper/Mangan/Chrom/Selen,250,RC,VB007064,LOCAL,,inpatient,10,ML,63.7,63.7,,,,,,,,,,,,,,,,,
Capsaicin Cream 0.075%,250,RC,VB007065,LOCAL,,inpatient,57,GM,22.51,22.51,,,,,,,,,,,,,,,,,
Sod Borate/Boric Ac/Water/Nacl,250,RC,VB007066,LOCAL,,inpatient,118,ML,14.78,14.78,,,,,,,,,,,,,,,,,
Pyridoxine HCL (Vitamin B6),250,RC,VB007067,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Aspirin,250,RC,VB007068,LOCAL,,inpatient,1,EA,6.03,6.03,,,,,,,,,,,,,,,,,
Trospium Chloride ER,250,RC,VB007069,LOCAL,,inpatient,1,EA,26.95,26.95,,,,,,,,,,,,,,,,,
Meperidine HCL/Pf Inj,250,RC,VB007070,LOCAL,,inpatient,1,ML,12.68,12.68,,,,,,,,,,,,,,,,,
Halobetasol Prop 0.05% Cream,250,RC,VB007071,LOCAL,,inpatient,15,GM,318.32,318.32,,,,,,,,,,,,,,,,,
Clindamycin/Benzoyl Perox 1.2%-5%,250,RC,VB007072,LOCAL,,inpatient,45,GM,813.76,813.76,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide Spray,250,RC,VB007073,LOCAL,,inpatient,16.5,GM,490.13,490.13,,,,,,,,,,,,,,,,,
Silver/Calcium Alginate,250,RC,VB007074,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Tetracaine/Benzocaine/Butamben,250,RC,VB007075,LOCAL,,inpatient,1,ea,864.8,864.8,,,,,,,,,,,,,,,,,
Crotamiton 10% Cream,250,RC,VB007076,LOCAL,,inpatient,60,GM,2428.42,2428.42,,,,,,,,,,,,,,,,,
Ammonium Lactate 5% Lotion,250,RC,VB007077,LOCAL,,inpatient,226,ML,53.04,53.04,,,,,,,,,,,,,,,,,
Cyanocobalamin (Vitamin B-12),250,RC,VB007078,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Lanreotide Acetate ER Inj,250,RC,VB007079,LOCAL,,inpatient,0.5,ML,42028.8,42028.8,,,,,,,,,,,,,,,,,
Physostigmine Salicylate Inj,250,RC,VB007080,LOCAL,,inpatient,2,ML,187.89,187.89,,,,,,,,,,,,,,,,,
Hydrocodone/Chlorphen P-Stirex,250,RC,VB007081,LOCAL,,inpatient,5,ML,28,28,,,,,,,,,,,,,,,,,
Sulfamethox/Trimeth 200-40mg/5ml UD,250,RC,VB007082,LOCAL,,inpatient,5,ML,15.56,15.56,,,,,,,,,,,,,,,,,
Tobramycin/Lotepred Etab 0.3%-0.5%,250,RC,VB007083,LOCAL,,inpatient,5,ML,1612.99,1612.99,,,,,,,,,,,,,,,,,
Besifloxacin HCL 0.6 % Ophth,250,RC,VB007084,LOCAL,,inpatient,5,ML,1104.19,1104.19,,,,,,,,,,,,,,,,,
Bromfenac Sodium 0.07 % Ophth,250,RC,VB007085,LOCAL,,inpatient,3,ML,1712.98,1712.98,,,,,,,,,,,,,,,,,
Vit C/E/Zn/Coppr/Lutein/Zeaxan,250,RC,VB007086,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Methyl Salicylate/Menth/Camph,250,RC,VB007087,LOCAL,,inpatient,113,ML,24.36,24.36,,,,,,,,,,,,,,,,,
Barium Sulfate 60%,250,RC,VB007088,LOCAL,,inpatient,355,ml,5,5,,,,,,,,,,,,,,,,,
Ferrous Fumarate/Ascorbic Acid,250,RC,VB007089,LOCAL,,inpatient,100,ml,5,5,,,,,,,,,,,,,,,,,
Psyllium Husk (With Sugar) Wafer,250,RC,VB007090,LOCAL,,inpatient,24,gm,5,5,,,,,,,,,,,,,,,,,
Menthol/Camphor Cream,250,RC,VB007091,LOCAL,,inpatient,56,gm,31,31,,,,,,,,,,,,,,,,,
Medium Chain Triglycerides,250,RC,VB007092,LOCAL,,inpatient,946,ML,5,5,,,,,,,,,,,,,,,,,
Doxepin HCL,250,RC,VB007093,LOCAL,,inpatient,1,EA,86.21,86.21,,,,,,,,,,,,,,,,,
Naproxen Sodium,250,RC,VB007094,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Thrombin (Recombinant),250,RC,VB007095,LOCAL,,inpatient,1,ea,412.8,412.8,,,,,,,,,,,,,,,,,
Dextroamphetamine/Amphetamine,250,RC,VB007096,LOCAL,,inpatient,1,EA,6.67,6.67,,,,,,,,,,,,,,,,,
Alogliptin Benzoate,250,RC,VB007097,LOCAL,,inpatient,1,EA,31.2,31.2,,,,,,,,,,,,,,,,,
Alpha Lipoic Acid,250,RC,VB007098,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Sucroferric Oxyhydroxide,250,RC,VB007099,LOCAL,,inpatient,1,EA,85.75,85.75,,,,,,,,,,,,,,,,,
Cholecalciferol (Vitamin D3),250,RC,VB007100,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
megestroL ACETATE Oral Susp,250,RC,VB007101,LOCAL,,inpatient,240,ML,5,5,,,,,,,,,,,,,,,,,
Glucosamine Sulfate,250,RC,VB007102,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Bromfenac Sodium 0.09 % Ophth,250,RC,VB007103,LOCAL,,inpatient,1.7,ML,854.76,854.76,,,,,,,,,,,,,,,,,
Tapentadol HCL,250,RC,VB007104,LOCAL,,inpatient,1,EA,36.88,36.88,,,,,,,,,,,,,,,,,
Digoxin Immune Fab,250,RC,VB007105,LOCAL,,inpatient,1,ea,23875.2,23875.2,,,,,,,,,,,,,,,,,
Mirtazapine,250,RC,VB007106,LOCAL,,inpatient,1,EA,11.18,11.18,,,,,,,,,,,,,,,,,
Spironolactone,250,RC,VB007107,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
amiodarone HCL,250,RC,VB007108,LOCAL,,inpatient,1,EA,29.72,29.72,,,,,,,,,,,,,,,,,
Levomefolate/Algal Oil 15-90.314mg,250,RC,VB007109,LOCAL,,inpatient,1,ea,16.46,16.46,,,,,,,,,,,,,,,,,
Emollient Combination No.92,250,RC,VB007110,LOCAL,,inpatient,1,ea,11.28,11.28,,,,,,,,,,,,,,,,,
Gel Dressing,250,RC,VB007111,LOCAL,,inpatient,1,ea,10,10,,,,,,,,,,,,,,,,,
A/C/E/Zinc/Sod Selenite/Copper,250,RC,VB007112,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ibandronate Sodium,250,RC,VB007113,LOCAL,,inpatient,1,EA,554.91,554.91,,,,,,,,,,,,,,,,,
Dibucaine 1% Oint,250,RC,VB007114,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Naloxegol Oxalate,250,RC,VB007115,LOCAL,,inpatient,1,EA,63.33,63.33,,,,,,,,,,,,,,,,,
Abiraterone Acetate,250,RC,VB007116,LOCAL,,inpatient,1,EA,21.46,21.46,,,,,,,,,,,,,,,,,
Hepatitis A Virus Vaccine/Pf,250,RC,VB007117,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Rabies Vaccine (Pcec)/Pf,250,RC,VB007118,LOCAL,,inpatient,1,ea,1819.39,1819.39,,,,,,,,,,,,,,,,,
Bacillus Coagulan/Calcium Carb,250,RC,VB007119,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Brexpiprazole,250,RC,VB007120,LOCAL,,inpatient,1,EA,242.51,242.51,,,,,,,,,,,,,,,,,
PARoxetine HCL Oral Susp,250,RC,VB007121,LOCAL,,inpatient,250,ML,8.51,8.51,,,,,,,,,,,,,,,,,
PARoxetine HCL Oral Susp,250,RC,VB007121,LOCAL,,inpatient,250,ML,8.51,8.51,,,,,,,,,,,,,,,,,
Doripenem,250,RC,VB007122,LOCAL,,inpatient,1,ea,180.32,180.32,,,,,,,,,,,,,,,,,
Diclofenac Epolamine 1.3%,250,RC,VB007123,LOCAL,,inpatient,1,EA,59.68,59.68,,,,,,,,,,,,,,,,,
Filgrastim-Sndz,250,RC,VB007124,LOCAL,,inpatient,0.8,ML,2107.1,2107.1,,,,,,,,,,,,,,,,,
Casirivimab/Imdevimab,250,RC,VB007125,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Eluxadoline,250,RC,VB007126,LOCAL,,inpatient,1,EA,134.51,134.51,,,,,,,,,,,,,,,,,
Phenytoin Sodium Extended,250,RC,VB007127,LOCAL,,inpatient,1,EA,8.66,8.66,,,,,,,,,,,,,,,,,
Moxifloxacin HCl IV 400mg/250mL,250,RC,VB007128,LOCAL,,inpatient,250,ML,220.8,220.8,,,,,,,,,,,,,,,,,
Glycopyrrol/Nebulizer/Accessor,250,RC,VB007129,LOCAL,,inpatient,1,ML,100.8,100.8,,,,,,,,,,,,,,,,,
Dexlansoprazole,250,RC,VB007130,LOCAL,,inpatient,1,EA,49.34,49.34,,,,,,,,,,,,,,,,,
Vortioxetine Hydrobromide,250,RC,VB007131,LOCAL,,inpatient,1,EA,82.26,82.26,,,,,,,,,,,,,,,,,
Edoxaban Tosylate,250,RC,VB007132,LOCAL,,inpatient,1,EA,69.31,69.31,,,,,,,,,,,,,,,,,
Galantamine Hbr,250,RC,VB007133,LOCAL,,inpatient,1,EA,25.46,25.46,,,,,,,,,,,,,,,,,
Deferasirox,250,RC,VB007134,LOCAL,,inpatient,1,EA,751.65,751.65,,,,,,,,,,,,,,,,,
Darifenacin Hydrobromide,250,RC,VB007135,LOCAL,,inpatient,1,EA,44.23,44.23,,,,,,,,,,,,,,,,,
Ephedrine Sulf/Guaifenesin 25-400MG,250,RC,VB007136,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Sod Bicarb 150mEq/1L,250,RC,VB007137,LOCAL,,inpatient,1000,ml,168,168,,,,,,,,,,,,,,,,,
Norepinephrine Bit/0.9 % Nacl,250,RC,VB007138,LOCAL,,inpatient,250,ML,144,144,,,,,,,,,,,,,,,,,
Emollient Combination No.72,250,RC,VB007139,LOCAL,,inpatient,250,ml,51.68,51.68,,,,,,,,,,,,,,,,,
Evolocumab,250,RC,VB007140,LOCAL,,inpatient,1,ML,1374.48,1374.48,,,,,,,,,,,,,,,,,
chlorambuciL,250,RC,VB007141,LOCAL,,inpatient,1,EA,127.28,127.28,,,,,,,,,,,,,,,,,
Phytonadione (Vit K1),250,RC,VB007142,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Prenatal Vit No.130/Iron/Folic,250,RC,VB007143,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ascorbic Acid,250,RC,VB007144,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Biotin,250,RC,VB007145,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Naphazoline/Pheniramine 0.025-0.3%,250,RC,VB007146,LOCAL,,inpatient,5,ML,14.02,14.02,,,,,,,,,,,,,,,,,
"Petrolatum,white - 28.35gm",250,RC,VB007147,LOCAL,,inpatient,28.35,GM,10.27,10.27,,,,,,,,,,,,,,,,,
Betamethasone Dip 0.05% Oint,250,RC,VB007148,LOCAL,,inpatient,45,GM,491.88,491.88,,,,,,,,,,,,,,,,,
clobetasoL PROPIONATE 0.05% Cream,250,RC,VB007149,LOCAL,,inpatient,60,GM,1835.84,1835.84,,,,,,,,,,,,,,,,,
clobetasoL PROPIONATE 0.05% Soln,250,RC,VB007150,LOCAL,,inpatient,50,ML,825.24,825.24,,,,,,,,,,,,,,,,,
Insulin Nph Human Isophane,250,RC,VB007151,LOCAL,,inpatient,10,ML,231.36,231.36,,,,,,,,,,,,,,,,,
Fluticasone Propion/Salmeterol,250,RC,VB007152,LOCAL,,inpatient,1,EA,218.5,218.5,,,,,,,,,,,,,,,,,
Fluticasone Propion/Salmeterol,250,RC,VB007153,LOCAL,,inpatient,1,EA,356.11,356.11,,,,,,,,,,,,,,,,,
Dextrose 70 % In Water,250,RC,VB007154,LOCAL,,inpatient,1000,ML,42.38,42.38,,,,,,,,,,,,,,,,,
"Diatrizoate Meglumine, Sodium",250,RC,VB007155,LOCAL,,inpatient,120,ML,319.3,319.3,,,,,,,,,,,,,,,,,
Urea 40% - 28.3gm,250,RC,VB007156,LOCAL,,inpatient,28.3,GM,273.5,273.5,,,,,,,,,,,,,,,,,
Sodium Chloride 0.9% Irrig Solution,250,RC,VB007157,LOCAL,,inpatient,2000,ML,55.1,55.1,,,,,,,,,,,,,,,,,
Parenteral Amino Acid 10% No.6,250,RC,VB007158,LOCAL,,inpatient,1000,ML,150.38,150.38,,,,,,,,,,,,,,,,,
Fat Emulsion/Olive/Soy/Phospho,250,RC,VB007159,LOCAL,,inpatient,500,ml,5,5,,,,,,,,,,,,,,,,,
Fat Emulsion/Olive/Soy/Phospho,250,RC,VB007160,LOCAL,,inpatient,250,ML,226.18,226.18,,,,,,,,,,,,,,,,,
Lidocaine HCL/Pf 1% Inj - 2mL,250,RC,VB007161,LOCAL,,inpatient,2,ML,6.14,6.14,,,,,,,,,,,,,,,,,
"Water for Injection,sterile",250,RC,VB007162,LOCAL,,inpatient,20,ML,23.23,23.23,,,,,,,,,,,,,,,,,
Phenytoin Oral Susp,250,RC,VB007163,LOCAL,,inpatient,237,ML,5,5,,,,,,,,,,,,,,,,,
Sulfameth-Trimethopr 400-80mg/5mL,250,RC,VB007164,LOCAL,,inpatient,30,ML,180.56,180.56,,,,,,,,,,,,,,,,,
Phenylephrine HCL 2.5 % Ophth,250,RC,VB007165,LOCAL,,inpatient,15,ML,450,450,,,,,,,,,,,,,,,,,
Promethazine HCL,250,RC,VB007166,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
gentamicin SULFATE 0.3 % Ophth,250,RC,VB007167,LOCAL,,inpatient,15,ML,437.14,437.14,,,,,,,,,,,,,,,,,
Erythromycin Ethylsuccinate,250,RC,VB007168,LOCAL,,inpatient,200,ML,15.88,15.88,,,,,,,,,,,,,,,,,
Trolamine Salicylate/Aloe Vera,250,RC,VB007169,LOCAL,,inpatient,1,ea,10.56,10.56,,,,,,,,,,,,,,,,,
Amoxicillin/Potas Clav 250-62.5mg/5,250,RC,VB007170,LOCAL,,inpatient,100,ML,580.64,580.64,,,,,,,,,,,,,,,,,
Immun Glob G(Igg)/Pro/Iga 0-50,250,RC,VB007171,LOCAL,,inpatient,200,ML,18074.88,18074.88,,,,,,,,,,,,,,,,,
Betamethasone Dip Aug 0.05% Cream,250,RC,VB007172,LOCAL,,inpatient,50,GM,339.48,339.48,,,,,,,,,,,,,,,,,
Coal Tar 0.5% Shampoo,250,RC,VB007173,LOCAL,,inpatient,1,ea,21.76,21.76,,,,,,,,,,,,,,,,,
Neomycin/Bacitracin/Polymyxinb,250,RC,VB007174,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Acyclovir Sodium Inj,250,RC,VB007175,LOCAL,,inpatient,10,ML,64,64,,,,,,,,,,,,,,,,,
Heparin Sodium 5000 unit/ml -10mL,250,RC,VB007176,LOCAL,,inpatient,10,ML,8.35,8.35,,,,,,,,,,,,,,,,,
Rocuronium Bromide,250,RC,VB007177,LOCAL,,inpatient,5,ML,31.2,31.2,,,,,,,,,,,,,,,,,
Fat Emul/Soy/Mct/Oliv/Fish Oil,250,RC,VB007178,LOCAL,,inpatient,500,ML,179.42,179.42,,,,,,,,,,,,,,,,,
Povidone-Iodine 10%,250,RC,VB007179,LOCAL,,inpatient,237,ML,14.88,14.88,,,,,,,,,,,,,,,,,
Maalox/Carafate/Diphenhyd/Lidocaine,250,RC,VB007186,LOCAL,,inpatient,120,ML,6,1.5,,,,,,,,,,,,,,,,,
Norgestimate-Ethinyl Estradiol,250,RC,VB007187,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Acetylcysteine,250,RC,VB007194,LOCAL,,inpatient,1,ea,6,6,,,,,,,,,,,,,,,,,
mycophenolate mofetiL 500mg/2.5mL,250,RC,VB007203,LOCAL,,inpatient,1,ea,36.24,36.24,,,,,,,,,,,,,,,,,
Nabumetone,250,RC,VB007208,LOCAL,,inpatient,1,EA,6.31,6.31,,,,,,,,,,,,,,,,,
Urea/Allantoin/Vit E Acetate 56gm,250,RC,VB007212,LOCAL,,inpatient,56,GM,20.6,20.6,,,,,,,,,,,,,,,,,
ALPRAZolam,250,RC,VB007213,LOCAL,,inpatient,1,EA,7.86,7.86,,,,,,,,,,,,,,,,,
Milnacipran HCL,250,RC,VB007214,LOCAL,,inpatient,1,EA,40.95,40.95,,,,,,,,,,,,,,,,,
ceFAZolin SODIUM,250,RC,VB007215,LOCAL,,inpatient,1,EA,29.25,29.25,,,,,,,,,,,,,,,,,
oxyMORphone HCL,250,RC,VB007216,LOCAL,,inpatient,1,ea,14.28,14.28,,,,,,,,,,,,,,,,,
FENTANYL CADD 50MCG/ML - 50ML,250,RC,VB007220,LOCAL,,inpatient,50,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Lacosamide,250,RC,VB007222,LOCAL,,inpatient,1,EA,67.24,67.24,,,,,,,,,,,,,,,,,
DAPTOmycin,250,RC,VB007229,LOCAL,,inpatient,1,EA,144,144,,,,,,,,,,,,,,,,,
LACOSAMIDE IV 200MG/100ML,250,RC,VB007260,LOCAL,,inpatient,100,ML,314.44,314.44,,,,,,,,,,,,,,,,,
sulfaSALAzine,250,RC,VB007262,LOCAL,,inpatient,1,EA,10.19,10.19,,,,,,,,,,,,,,,,,
"Estrogen,con/M-Progest Acet",250,RC,VB007263,LOCAL,,inpatient,1,EA,42.45,42.45,,,,,,,,,,,,,,,,,
Olopatadine HCL 0.7% Ophth,250,RC,VB007264,LOCAL,,inpatient,2.5,ML,986.02,986.02,,,,,,,,,,,,,,,,,
Brinzolamide/Brimonidine Tart,250,RC,VB007265,LOCAL,,inpatient,8,ML,993.94,993.94,,,,,,,,,,,,,,,,,
Omega-3 Acid Ethyl Esters,250,RC,VB007266,LOCAL,,inpatient,1,EA,8.27,8.27,,,,,,,,,,,,,,,,,
Erythromycin Base In Ethanol 2%,250,RC,VB007267,LOCAL,,inpatient,30,GM,621.68,621.68,,,,,,,,,,,,,,,,,
Fluticasone Propionate 0.05% Cream,250,RC,VB007268,LOCAL,,inpatient,30,GM,117.31,117.31,,,,,,,,,,,,,,,,,
rOPINIRole HCL,250,RC,VB007269,LOCAL,,inpatient,1,EA,10.94,10.94,,,,,,,,,,,,,,,,,
rOPINIRole HCL,250,RC,VB007270,LOCAL,,inpatient,1,EA,21.88,21.88,,,,,,,,,,,,,,,,,
rOPINIRole HCL,250,RC,VB007271,LOCAL,,inpatient,1,EA,32.82,32.82,,,,,,,,,,,,,,,,,
Diazoxide Oral,250,RC,VB007272,LOCAL,,inpatient,30,ML,49.59,49.59,,,,,,,,,,,,,,,,,
Ceftriaxone In is-Osm Dextrose,250,RC,VB007273,LOCAL,,inpatient,1,ML,81.72,81.72,,,,,,,,,,,,,,,,,
Ceftriaxone In is-Osm Dextrose,250,RC,VB007274,LOCAL,,inpatient,1,ML,116.84,116.84,,,,,,,,,,,,,,,,,
Brimonidine Tartrate 0.33% Gel,250,RC,VB007275,LOCAL,,inpatient,30,GM,3213.12,3213.12,,,,,,,,,,,,,,,,,
diazePAM Inj,250,RC,VB007276,LOCAL,,inpatient,10,ML,277.78,277.78,,,,,,,,,,,,,,,,,
Memantine HCL,250,RC,VB007277,LOCAL,,inpatient,1,EA,74.36,74.36,,,,,,,,,,,,,,,,,
Mirabegron,250,RC,VB007278,LOCAL,,inpatient,1,EA,73.65,73.65,,,,,,,,,,,,,,,,,
Trospium Chloride ER,250,RC,VB007279,LOCAL,,inpatient,1,EA,25.87,25.87,,,,,,,,,,,,,,,,,
Estazolam,250,RC,VB007280,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Valsartan-HCTZ 320mg-25mg,250,RC,VB007281,LOCAL,,inpatient,1,EA,24.57,24.57,,,,,,,,,,,,,,,,,
Budesonide,250,RC,VB007282,LOCAL,,inpatient,1,EA,272.51,272.51,,,,,,,,,,,,,,,,,
Promethazine/Dextromethorphan,250,RC,VB007283,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
SUMAtriptan,250,RC,VB007284,LOCAL,,inpatient,1,EA,1476.04,1476.04,,,,,,,,,,,,,,,,,
armodafiniL,250,RC,VB007285,LOCAL,,inpatient,1,EA,87.45,87.45,,,,,,,,,,,,,,,,,
Menthol/Zinc Oxide Ointment,250,RC,VB007286,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Omega-3/Dha/Epa/Fish Oil,250,RC,VB007287,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Loratadine/Pseudoephedrine 10-240mg,250,RC,VB007288,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
oxyMORphone HCL,250,RC,VB007289,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Miconazole Nitrate 2% Oint,250,RC,VB007290,LOCAL,,inpatient,57,GM,31.64,31.64,,,,,,,,,,,,,,,,,
Gluc Su/Chondro Su A/Vit C/Mn,250,RC,VB007291,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Potassium Gluconate,250,RC,VB007292,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Riboflavin (Vitamin B2),250,RC,VB007293,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
ALPRAZolam,250,RC,VB007294,LOCAL,,inpatient,1,EA,6.07,6.07,,,,,,,,,,,,,,,,,
ALPRAZolam,250,RC,VB007295,LOCAL,,inpatient,1,EA,7.56,7.56,,,,,,,,,,,,,,,,,
Lactulose,250,RC,VB007296,LOCAL,,inpatient,15,ML,10.04,10.04,,,,,,,,,,,,,,,,,
Fluocinolone Acetonide 0.01% Cream,250,RC,VB007297,LOCAL,,inpatient,15,GM,178.08,178.08,,,,,,,,,,,,,,,,,
donepezil HCL,250,RC,VB007298,LOCAL,,inpatient,1,EA,45.43,45.43,,,,,,,,,,,,,,,,,
Isosorbide Dinitrate,250,RC,VB007299,LOCAL,,inpatient,1,EA,9.5,9.5,,,,,,,,,,,,,,,,,
clonazePAM,250,RC,VB007300,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Balsam Peru/Castor Oil,250,RC,VB007301,LOCAL,,inpatient,1,EA,7.52,7.52,,,,,,,,,,,,,,,,,
Magnesium L-Lactate,250,RC,VB007302,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lenalidomide,250,RC,VB007303,LOCAL,,inpatient,1,EA,4279.44,4279.44,,,,,,,,,,,,,,,,,
Fenofibric Acid (Choline),250,RC,VB007304,LOCAL,,inpatient,1,EA,8,8,,,,,,,,,,,,,,,,,
Ranolazine,250,RC,VB007305,LOCAL,,inpatient,1,EA,54,54,,,,,,,,,,,,,,,,,
Cobicistat,250,RC,VB007306,LOCAL,,inpatient,1,EA,50.36,50.36,,,,,,,,,,,,,,,,,
verapamil HCL,250,RC,VB007307,LOCAL,,inpatient,1,EA,22.37,22.37,,,,,,,,,,,,,,,,,
Olmesartan Medoxomil,250,RC,VB007308,LOCAL,,inpatient,1,EA,20.54,20.54,,,,,,,,,,,,,,,,,
Acetaminophen IV,250,RC,VB007309,LOCAL,,inpatient,100,ML,46.08,46.08,,,,,,,,,,,,,,,,,
dexAMETHasone SOD PHOS Inj,250,RC,VB007310,LOCAL,,inpatient,10,ML,74.35,74.35,,,,,,,,,,,,,,,,,
Vortioxetine Hydrobromide,250,RC,VB007311,LOCAL,,inpatient,1,EA,71.06,71.06,,,,,,,,,,,,,,,,,
Carbidopa/Levodopa 36.25-145mg,250,RC,VB007312,LOCAL,,inpatient,1,EA,19.94,19.94,,,,,,,,,,,,,,,,,
oxyMORphone HCL,250,RC,VB007313,LOCAL,,inpatient,1,EA,161.96,161.96,,,,,,,,,,,,,,,,,
levETIRAcetam,250,RC,VB007314,LOCAL,,inpatient,1,EA,6.72,6.72,,,,,,,,,,,,,,,,,
hydroCHLOROthiazide,250,RC,VB007315,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Opicapone,250,RC,VB007316,LOCAL,,inpatient,1,EA,107.26,107.26,,,,,,,,,,,,,,,,,
Vancomycin/Water for Inj (PREMIXED),250,RC,VB007317,LOCAL,,inpatient,1,EA,43.2,43.2,,,,,,,,,,,,,,,,,
Pot Sor/He-Cellulos/Pov/Hyalur,250,RC,VB007318,LOCAL,,inpatient,1,EA,10.74,10.74,,,,,,,,,,,,,,,,,
Albuterol Sulfate,250,RC,VB007319,LOCAL,,inpatient,6.7,GM,179.92,179.92,,,,,,,,,,,,,,,,,
Sod Citra-Citric Acid 500-334mg/5ml,250,RC,VB007320,LOCAL,,inpatient,15,ML,5,5,,,,,,,,,,,,,,,,,
Umeclidinium Bromide,250,RC,VB007321,LOCAL,,inpatient,1,EA,360.24,360.24,,,,,,,,,,,,,,,,,
Miconazole Nitrate 2% Cream,250,RC,VB007322,LOCAL,,inpatient,14,GM,9.44,9.44,,,,,,,,,,,,,,,,,
Phenyleph/Pramoxin/Glycr/W.pet,250,RC,VB007323,LOCAL,,inpatient,51,GM,69.4,69.4,,,,,,,,,,,,,,,,,
Diclofenac Sodium 0.1% Ophth,250,RC,VB007324,LOCAL,,inpatient,5,ML,292.12,292.12,,,,,,,,,,,,,,,,,
lidocaine HCL 2% Gel,250,RC,VB007325,LOCAL,,inpatient,11,ML,30.48,30.48,,,,,,,,,,,,,,,,,
Hydrocortisone 2.5% Cream,250,RC,VB007326,LOCAL,,inpatient,20,GM,12.48,12.48,,,,,,,,,,,,,,,,,
Bacitracin Ointment  (14gm),250,RC,VB007327,LOCAL,,inpatient,14,GM,14.4,14.4,,,,,,,,,,,,,,,,,
Lidocaine 4% Cream,250,RC,VB007328,LOCAL,,inpatient,30,GM,134.4,134.4,,,,,,,,,,,,,,,,,
Balsam Peru/Castor Oil,250,RC,VB007332,LOCAL,,inpatient,28.35,gm,119,119,,,,,,,,,,,,,,,,,
Potassium Chloride Oral,250,RC,VB007333,LOCAL,,inpatient,15,ML,66.8,66.8,,,,,,,,,,,,,,,,,
Acyclovir Sodium IV,250,RC,VB007334,LOCAL,,inpatient,20,ML,22.7,22.7,,,,,,,,,,,,,,,,,
Potassium Chloride Inj,250,RC,VB007335,LOCAL,,inpatient,30,ML,16.56,16.56,,,,,,,,,,,,,,,,,
Desoximetasone 0.25% Cream,250,RC,VB007336,LOCAL,,inpatient,60,GM,796.96,796.96,,,,,,,,,,,,,,,,,
Desonide 0.05% Ointment,250,RC,VB007337,LOCAL,,inpatient,15,GM,240.4,240.4,,,,,,,,,,,,,,,,,
Eslicarbazepine Acetate,250,RC,VB007339,LOCAL,,inpatient,1,EA,215.53,215.53,,,,,,,,,,,,,,,,,
METAXOLONE 400MG,250,RC,VB007340,LOCAL,,inpatient,1,EA,1.5,1.5,,,,,,,,,,,,,,,,,
SPIRONOLACTONE 12.5MG,250,RC,VB007341,LOCAL,,inpatient,1,EA,1.5,1.5,,,,,,,,,,,,,,,,,
traMADOL 25MG (RX-UD),250,RC,VB007342,LOCAL,,inpatient,1,EA,3.2,3.2,,,,,,,,,,,,,,,,,
Benzocaine 20% Dental Gel (5.25gm),250,RC,VB007345,LOCAL,,inpatient,5.25,GM,38.48,38.48,,,,,,,,,,,,,,,,,
clobetasoL PROPIONATE 0.05% (50mL),250,RC,VB007346,LOCAL,,inpatient,1,EA,825.24,825.24,,,,,,,,,,,,,,,,,
Clindamycin Phosphate 1% Soln,250,RC,VB007347,LOCAL,,inpatient,60,ML,231.52,231.52,,,,,,,,,,,,,,,,,
Amoxapine,250,RC,VB007348,LOCAL,,inpatient,1,EA,8.63,8.63,,,,,,,,,,,,,,,,,
Amoxapine,250,RC,VB007349,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
ZITTEL BALM 240gm OINT,250,RC,VB007351,LOCAL,,inpatient,240,GM,1.5,1.5,,,,,,,,,,,,,,,,,
Zinc Oxide 40% Oint,250,RC,VB007352,LOCAL,,inpatient,57,GM,26.32,26.32,,,,,,,,,,,,,,,,,
Isoniazid Syrup,250,RC,VB007353,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Semaglutide (0.25 or 0.5mg/Dose),250,RC,VB007354,LOCAL,,inpatient,1.5,ML,4788.38,4788.38,,,,,,,,,,,,,,,,,
methylphenidate HCL ER,250,RC,VB007359,LOCAL,,inpatient,1,EA,31,31,,,,,,,,,,,,,,,,,
"L.acidoph,saliva/B.bif/S.therm",250,RC,VB007362,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
B Complex W-C No.20/Folic Acid 1mg,250,RC,VB007363,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Insulin Glargine-Yfgn,250,RC,VB007365,LOCAL,,inpatient,10,ML,0.44,0.44,,,,,,,,,,,,,,,,,
prednisoLONE SODIUM PHOSPHATE,250,RC,VB007366,LOCAL,,inpatient,120,ML,392.6,392.6,,,,,,,,,,,,,,,,,
propranolol HCL Oral Soln,250,RC,VB007367,LOCAL,,inpatient,500,ML,5,5,,,,,,,,,,,,,,,,,
Midazolam HCL In NS 100mg/100mL,250,RC,VB007368,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
Atovaquone Oral 1500mg/10ml,250,RC,VB007369,LOCAL,,inpatient,210,ML,26.25,26.25,,,,,,,,,,,,,,,,,
Edoxaban Tosylate,250,RC,VB007370,LOCAL,,inpatient,1,EA,69.31,69.31,,,,,,,,,,,,,,,,,
Calcium Carb/Magnesium Hydrox Chew,250,RC,VB007371,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Multivit-Minerals/Folic Acid Chew,250,RC,VB007372,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Sugammadex Sodium,250,RC,VB007373,LOCAL,,inpatient,5,ML,1196.88,1196.88,,,,,,,,,,,,,,,,,
Mineral Oil/Petrolatum Ophth Oint,250,RC,VB007374,LOCAL,,inpatient,3.5,GM,41.18,41.18,,,,,,,,,,,,,,,,,
Testosterone Gel 20.25mg/1.25gm,250,RC,VB007375,LOCAL,,inpatient,1.25,GM,79.75,79.75,,,,,,,,,,,,,,,,,
Lopinavir/Ritonavir 100MG-25MG,250,RC,VB007376,LOCAL,,inpatient,1,EA,20.48,20.48,,,,,,,,,,,,,,,,,
Posaconazole,250,RC,VB007377,LOCAL,,inpatient,16.7,ML,2546.16,2546.16,,,,,,,,,,,,,,,,,
Diclofenac Epolamine 1.3%,250,RC,VB007378,LOCAL,,inpatient,1,EA,56.69,56.69,,,,,,,,,,,,,,,,,
Iopamidol IV Soln 61%,250,RC,VB007379,LOCAL,,inpatient,100,ML,219.84,219.84,,,,,,,,,,,,,,,,,
Exenatide,250,RC,VB007380,LOCAL,,inpatient,1.2,ML,4079.76,4079.76,,,,,,,,,,,,,,,,,
Exenatide Microspheres,250,RC,VB007381,LOCAL,,inpatient,1,EA,908.68,908.68,,,,,,,,,,,,,,,,,
Citric Ac/Gluconolact/Mag Carb,250,RC,VB007382,LOCAL,,inpatient,30,ML,29.14,29.14,,,,,,,,,,,,,,,,,
Nitroglycerin In 5 % Dextrose,250,RC,VB007383,LOCAL,,inpatient,250,ML,118.03,118.03,,,,,,,,,,,,,,,,,
Doxycycline Monohydrate,250,RC,VB007384,LOCAL,,inpatient,1,EA,21.82,21.82,,,,,,,,,,,,,,,,,
Hydrocortisone 1% Lotion,250,RC,VB007385,LOCAL,,inpatient,1,EA,24.52,24.52,,,,,,,,,,,,,,,,,
Iohexol,250,RC,VB007386,LOCAL,,inpatient,100,ML,435.32,435.32,,,,,,,,,,,,,,,,,
morphine SULFATE Inj,250,RC,VB007387,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
cefTRIAXone SODIUM,250,RC,VB007388,LOCAL,,inpatient,1,EA,38.27,38.27,,,,,,,,,,,,,,,,,
Mirabegron,250,RC,VB007389,LOCAL,,inpatient,1,EA,73.65,73.65,,,,,,,,,,,,,,,,,
Doxycycline Monohydrate,250,RC,VB007390,LOCAL,,inpatient,1,EA,11.55,11.55,,,,,,,,,,,,,,,,,
dexAMETHasone SODIUM PHOSPHATE,250,RC,VB007391,LOCAL,,inpatient,1,ML,6.86,6.86,,,,,,,,,,,,,,,,,
Acetaminophen Suppository,250,RC,VB007392,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Diclofenac Sodium DR,250,RC,VB007393,LOCAL,,inpatient,1,EA,5.69,5.69,,,,,,,,,,,,,,,,,
Lysine,250,RC,VB007394,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Niacinamide,250,RC,VB007395,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Phenylephrine HCL,250,RC,VB007396,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Loteprednol Etabonate 0.2%,250,RC,VB007397,LOCAL,,inpatient,5,ML,1457.04,1457.04,,,,,,,,,,,,,,,,,
Ganciclovir Ophth Gel 0.15%,250,RC,VB007398,LOCAL,,inpatient,5,GM,2290.18,2290.18,,,,,,,,,,,,,,,,,
Bromfenac Sodium 0.07% Ophth,250,RC,VB007399,LOCAL,,inpatient,3,ML,1738.66,1738.66,,,,,,,,,,,,,,,,,
Amino Acids/Protein Hydrolys,250,RC,VB007400,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Fat Emulsion Plant Based - Oral 50%,250,RC,VB007401,LOCAL,,inpatient,1,ea,14.74,14.74,,,,,,,,,,,,,,,,,
Adefovir Dipivoxil,250,RC,VB007402,LOCAL,,inpatient,1,EA,151.58,151.58,,,,,,,,,,,,,,,,,
Triamcinolone Acet Topical,250,RC,VB007403,LOCAL,,inpatient,63,GM,980.88,980.88,,,,,,,,,,,,,,,,,
Oxycodone HCL/APAP 7.5-325 MG,250,RC,VB007404,LOCAL,,inpatient,1,EA,10.86,10.86,,,,,,,,,,,,,,,,,
clonazePAM ODT,250,RC,VB007405,LOCAL,,inpatient,1,EA,5.2,5.2,,,,,,,,,,,,,,,,,
lamoTRIgine ER,250,RC,VB007406,LOCAL,,inpatient,1,EA,81.58,81.58,,,,,,,,,,,,,,,,,
Spironolactone,250,RC,VB007407,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
L.acid/L.casei/B.bif/B.lon/Fos,250,RC,VB007408,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Naloxegol Oxalate,250,RC,VB007409,LOCAL,,inpatient,1,EA,63.33,63.33,,,,,,,,,,,,,,,,,
"Meningococcal Vaccine (A,c,y,w-135)",250,RC,VB007410,LOCAL,,inpatient,1,EA,751.68,751.68,,,,,,,,,,,,,,,,,
Nitroglycerin 0.4% Rectal Oint - 30,250,RC,VB007411,LOCAL,,inpatient,30,GM,3075.55,3075.55,,,,,,,,,,,,,,,,,
Arginine/Glutamine/Calcium Bmb,250,RC,VB007412,LOCAL,,inpatient,1,ea,9.84,9.84,,,,,,,,,,,,,,,,,
Carteolol HCL 1% Ophth,250,RC,VB007413,LOCAL,,inpatient,5,ML,85.12,85.12,,,,,,,,,,,,,,,,,
Filgrastim-Sndz,250,RC,VB007414,LOCAL,,inpatient,0.8,ML,2107.1,2107.1,,,,,,,,,,,,,,,,,
Cobicistat,250,RC,VB007415,LOCAL,,inpatient,1,EA,47.55,47.55,,,,,,,,,,,,,,,,,
methylPREDNISolone SOD SUCC,250,RC,VB007416,LOCAL,,inpatient,1,EA,55.92,55.92,,,,,,,,,,,,,,,,,
Baclofen Intrathecal Inj,250,RC,VB007417,LOCAL,,inpatient,20,ML,4944.96,4944.96,,,,,,,,,,,,,,,,,
Ketamine HCL,250,RC,VB007418,LOCAL,,inpatient,20,ML,5,5,,,,,,,,,,,,,,,,,
Mirtazapine,250,RC,VB007419,LOCAL,,inpatient,1,EA,5.15,5.15,,,,,,,,,,,,,,,,,
Abacavir/Lamivudine/Zidovudine,250,RC,VB007420,LOCAL,,inpatient,1,EA,115.9,115.9,,,,,,,,,,,,,,,,,
Topiramate,250,RC,VB007421,LOCAL,,inpatient,1,EA,32.61,32.61,,,,,,,,,,,,,,,,,
diazePAM Inj,250,RC,VB007422,LOCAL,,inpatient,2,ML,5,5,,,,,,,,,,,,,,,,,
Phenylephrine HCL 0.25% Nasal,250,RC,VB007423,LOCAL,,inpatient,1,ea,15.22,15.22,,,,,,,,,,,,,,,,,
Tapentadol HCL,250,RC,VB007424,LOCAL,,inpatient,1,EA,36.88,36.88,,,,,,,,,,,,,,,,,
Meropenem/Vaborbactam,250,RC,VB007425,LOCAL,,inpatient,1,EA,1068,1068,,,,,,,,,,,,,,,,,
Chromium Picolinate,250,RC,VB007426,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
terbinafine HCL 1% Cream,250,RC,VB007427,LOCAL,,inpatient,12,GM,35.71,35.71,,,,,,,,,,,,,,,,,
Hydrocortisone 2.5% Oint,250,RC,VB007428,LOCAL,,inpatient,28.35,GM,15.84,15.84,,,,,,,,,,,,,,,,,
Sodium Chloride 4mEq/mL (23.4%),250,RC,VB007429,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
Sodium Chloride for Inhalation 3%,250,RC,VB007430,LOCAL,,inpatient,4,ML,5,5,,,,,,,,,,,,,,,,,
Hydromorphone HCL/Pf Inj,250,RC,VB007431,LOCAL,,inpatient,5,ML,34.44,34.44,,,,,,,,,,,,,,,,,
"nystatin 100,000 Unit/gm Powder",250,RC,VB007432,LOCAL,,inpatient,30,GM,215.32,215.32,,,,,,,,,,,,,,,,,
Menthol 4% Gel,250,RC,VB007433,LOCAL,,inpatient,1,EA,38.96,38.96,,,,,,,,,,,,,,,,,
Menthol/Zinc Oxide 0.44-20.6% Oint,250,RC,VB007434,LOCAL,,inpatient,1,EA,17.8,17.8,,,,,,,,,,,,,,,,,
Loperamide HCL Oral Soln,250,RC,VB007435,LOCAL,,inpatient,15,ML,12.68,12.68,,,,,,,,,,,,,,,,,
Ibuprofen Oral Susp,250,RC,VB007436,LOCAL,,inpatient,10,ML,6.32,6.32,,,,,,,,,,,,,,,,,
Phenylephrine HCL Inj,250,RC,VB007437,LOCAL,,inpatient,5,ML,97.16,97.16,,,,,,,,,,,,,,,,,
Covid-19 Vaccine/Pf 30mcg/0.3ml,250,RC,VB007440,LOCAL,,inpatient,1.8,ML,5,5,,,,,,,,,,,,,,,,,
valGANciclovir HCL Oral Soln,250,RC,VB007442,LOCAL,,inpatient,88,ML,809.32,809.32,,,,,,,,,,,,,,,,,
Alcoholic Beverage,250,RC,VB007443,LOCAL,,inpatient,1,ea,15.12,15.12,,,,,,,,,,,,,,,,,
amikacin (neb) 125 MG/ML,250,RC,VB007444,LOCAL,,inpatient,1,ea,15.12,15.12,,,,,,,,,,,,,,,,,
Compounded Topical Medication,250,RC,VB007445,LOCAL,,inpatient,1,ea,302.76,302.76,,,,,,,,,,,,,,,,,
dakins (for theraflo) 0.125% 480 ML,250,RC,VB007446,LOCAL,,inpatient,1,ea,302.76,302.76,,,,,,,,,,,,,,,,,
Lacosamide,250,RC,VB007447,LOCAL,,inpatient,1,EA,43.01,43.01,,,,,,,,,,,,,,,,,
dakins (for theraflo) 0.25% 480 ML,250,RC,VB007448,LOCAL,,inpatient,480,ML,1.5,1.5,,,,,,,,,,,,,,,,,
enoxaparin (pharm compound),250,RC,VB007449,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
fortified tobramycin 13.6mg/mL,250,RC,VB007453,LOCAL,,inpatient,1,ea,1.5,1.5,,,,,,,,,,,,,,,,,
GI cocktail 15mL,250,RC,VB007454,LOCAL,,inpatient,15,ML,1.5,1.5,,,,,,,,,,,,,,,,,
HD-Albumin 25% 100mL,250,RC,VB007455,LOCAL,,inpatient,100,ML,1.5,1.5,,,,,,,,,,,,,,,,,
HYDROmorphone PCA 50 MG/100 ML,250,RC,VB007456,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
magic mouthwash 15 ML,250,RC,VB007457,LOCAL,,inpatient,15,ML,1.5,1.5,,,,,,,,,,,,,,,,,
morphine sulfate PCA 100mg/100mL,250,RC,VB007458,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
pantoprazole sodium (oral),250,RC,VB007459,LOCAL,,inpatient,20,ML,1.5,1.5,,,,,,,,,,,,,,,,,
sodium bicarbonate mouth rinse,250,RC,VB007460,LOCAL,,inpatient,1000,ML,1.5,1.5,,,,,,,,,,,,,,,,,
sodium chloride (oral) solution,250,RC,VB007461,LOCAL,,inpatient,10,ML,1.5,1.5,,,,,,,,,,,,,,,,,
tobramycin (inhalation),250,RC,VB007462,LOCAL,,inpatient,7.5,ML,1.5,1.5,,,,,,,,,,,,,,,,,
mycophenolate mofetiL Oral (Bulk),250,RC,VB007464,LOCAL,,inpatient,160,ML,6628.18,6628.18,,,,,,,,,,,,,,,,,
silodosin,250,RC,VB007476,LOCAL,,inpatient,1,EA,41.84,41.84,,,,,,,,,,,,,,,,,
Brimonidine Tartrate 0.1 %,250,RC,VB007477,LOCAL,,inpatient,10,ML,1865.76,1865.76,,,,,,,,,,,,,,,,,
Eletriptan Hydrobromide,250,RC,VB007478,LOCAL,,inpatient,1,EA,387.69,387.69,,,,,,,,,,,,,,,,,
Meperidine HCL,250,RC,VB007479,LOCAL,,inpatient,1,EA,12.08,12.08,,,,,,,,,,,,,,,,,
Lodoxamide Tromethamine 0.1 %,250,RC,VB007480,LOCAL,,inpatient,10,ML,947.52,947.52,,,,,,,,,,,,,,,,,
Cyclopentolate HCL 1%,250,RC,VB007481,LOCAL,,inpatient,5,ML,305.76,305.76,,,,,,,,,,,,,,,,,
Fesoterodine Fumarate,250,RC,VB007482,LOCAL,,inpatient,1,EA,46.39,46.39,,,,,,,,,,,,,,,,,
Formoterol Fumarate,250,RC,VB007483,LOCAL,,inpatient,1,EA,288.14,288.14,,,,,,,,,,,,,,,,,
armodafiniL,250,RC,VB007484,LOCAL,,inpatient,1,EA,87.55,87.55,,,,,,,,,,,,,,,,,
Trihexyphenidyl HCL,250,RC,VB007485,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
cefUROXime SODIUM,250,RC,VB007486,LOCAL,,inpatient,1,EA,14.03,14.03,,,,,,,,,,,,,,,,,
Fluticasone Furoate,250,RC,VB007487,LOCAL,,inpatient,1,EA,466.99,466.99,,,,,,,,,,,,,,,,,
Vit E Acet/Gly/Dimeth/Water Lotion,250,RC,VB007488,LOCAL,,inpatient,1,ea,27.84,27.84,,,,,,,,,,,,,,,,,
Saxagliptin HCL,250,RC,VB007489,LOCAL,,inpatient,1,EA,77.61,77.61,,,,,,,,,,,,,,,,,
Saxagliptin HCL,250,RC,VB007490,LOCAL,,inpatient,1,EA,77.61,77.61,,,,,,,,,,,,,,,,,
Glycerin 99.5% Topical,250,RC,VB007491,LOCAL,,inpatient,1,EA,36.1,36.1,,,,,,,,,,,,,,,,,
Oxycodone HCL/APAP 7.5-325 MG,250,RC,VB007492,LOCAL,,inpatient,1,EA,10.86,10.86,,,,,,,,,,,,,,,,,
Butorphanol Tartrate Inj,250,RC,VB007493,LOCAL,,inpatient,1,ML,54.44,54.44,,,,,,,,,,,,,,,,,
mannitoL 20%,250,RC,VB007494,LOCAL,,inpatient,250,ML,106.08,106.08,,,,,,,,,,,,,,,,,
Milnacipran HCL,250,RC,VB007495,LOCAL,,inpatient,1,EA,40.95,40.95,,,,,,,,,,,,,,,,,
Milnacipran HCL,250,RC,VB007496,LOCAL,,inpatient,1,EA,40.95,40.95,,,,,,,,,,,,,,,,,
Levomilnacipran HCL,250,RC,VB007497,LOCAL,,inpatient,1,EA,84.22,84.22,,,,,,,,,,,,,,,,,
clobetasoL PROPIONATE 0.05 % Lotion,250,RC,VB007498,LOCAL,,inpatient,59,ML,1157.12,1157.12,,,,,,,,,,,,,,,,,
Penlac nail Lacquer,250,RC,VB007499,LOCAL,,inpatient,6.6,ML,240.72,240.72,,,,,,,,,,,,,,,,,
clobetasoL PROPIONATE 0.05 % Oint,250,RC,VB007500,LOCAL,,inpatient,30,GM,1039,1039,,,,,,,,,,,,,,,,,
Menthol/Zinc Oxide Oint,250,RC,VB007501,LOCAL,,inpatient,1,EA,23,23,,,,,,,,,,,,,,,,,
amantadine HCL,250,RC,VB007502,LOCAL,,inpatient,1,EA,9.13,9.13,,,,,,,,,,,,,,,,,
Honey 80% Gel,250,RC,VB007503,LOCAL,,inpatient,1,EA,69.22,69.22,,,,,,,,,,,,,,,,,
"Zinc Oxide/Petrolatum, Yellow",250,RC,VB007504,LOCAL,,inpatient,170,GM,58.6,58.6,,,,,,,,,,,,,,,,,
Erythromycin Ethylsuccinate Oral,250,RC,VB007505,LOCAL,,inpatient,100,ML,1805.86,1805.86,,,,,,,,,,,,,,,,,
Bisoprolol/HCTZ 2.5-6.25MG,250,RC,VB007506,LOCAL,,inpatient,1,EA,13.48,13.48,,,,,,,,,,,,,,,,,
Bisoprolol/HCTZ 10-6.25MG,250,RC,VB007507,LOCAL,,inpatient,1,EA,13.48,13.48,,,,,,,,,,,,,,,,,
Polyethylene Glycol 400,250,RC,VB007508,LOCAL,,inpatient,1,EA,38.59,38.59,,,,,,,,,,,,,,,,,
Cadexomer Iodine 0.9%,250,RC,VB007509,LOCAL,,inpatient,1,EA,115.1,115.1,,,,,,,,,,,,,,,,,
Tinidazole,250,RC,VB007510,LOCAL,,inpatient,1,EA,50.74,50.74,,,,,,,,,,,,,,,,,
levETIRAcetam,250,RC,VB007511,LOCAL,,inpatient,1,EA,26.67,26.67,,,,,,,,,,,,,,,,,
Indapamide,250,RC,VB007512,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Psyllium Husk,250,RC,VB007513,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Clindamycin Phosphate Inj,250,RC,VB007514,LOCAL,,inpatient,4,ML,27.84,27.84,,,,,,,,,,,,,,,,,
Travoprost (Benzalkonium) 0.004 %,250,RC,VB007515,LOCAL,,inpatient,2.5,ML,416.2,416.2,,,,,,,,,,,,,,,,,
Acebutolol HCL,250,RC,VB007516,LOCAL,,inpatient,1,EA,7.11,7.11,,,,,,,,,,,,,,,,,
Acetaminophen,250,RC,VB007517,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Montelukast Sodium,250,RC,VB007518,LOCAL,,inpatient,1,EA,14.64,14.64,,,,,,,,,,,,,,,,,
Benzocaine 10% Dental Gel,250,RC,VB007519,LOCAL,,inpatient,1,EA,42.8,42.8,,,,,,,,,,,,,,,,,
Levomefolate/B6/B12/Algal Oil,250,RC,VB007520,LOCAL,,inpatient,1,EA,8.23,8.23,,,,,,,,,,,,,,,,,
Theophylline Anhydrous,250,RC,VB007521,LOCAL,,inpatient,1,EA,33.92,33.92,,,,,,,,,,,,,,,,,
Econazole Nitrate 1% Cream,250,RC,VB007522,LOCAL,,inpatient,15,GM,435,435,,,,,,,,,,,,,,,,,
icosapent ethyL,250,RC,VB007523,LOCAL,,inpatient,1,EA,8.3,8.3,,,,,,,,,,,,,,,,,
Lifitegrast 5%,250,RC,VB007524,LOCAL,,inpatient,1,EA,57.53,57.53,,,,,,,,,,,,,,,,,
Sod Chlord/Lanolin/Min.oil/Pet,250,RC,VB007525,LOCAL,,inpatient,237,ML,7.92,7.92,,,,,,,,,,,,,,,,,
cyclophosphamide,250,RC,VB007526,LOCAL,,inpatient,1,EA,33.6,33.6,,,,,,,,,,,,,,,,,
Hyoscyamine Sulfate,250,RC,VB007527,LOCAL,,inpatient,1,EA,6.24,6.24,,,,,,,,,,,,,,,,,
Triazolam,250,RC,VB007528,LOCAL,,inpatient,1,EA,14.08,14.08,,,,,,,,,,,,,,,,,
Olopatadine HCL 0.6% Nasal,250,RC,VB007529,LOCAL,,inpatient,1,EA,1083.44,1083.44,,,,,,,,,,,,,,,,,
Dextroamphetamine Sulfate ER,250,RC,VB007530,LOCAL,,inpatient,1,EA,24.76,24.76,,,,,,,,,,,,,,,,,
Zinc Oxide 16% Oint,250,RC,VB007531,LOCAL,,inpatient,57,GM,22.84,22.84,,,,,,,,,,,,,,,,,
Meprobamate,250,RC,VB007532,LOCAL,,inpatient,1,EA,27.5,27.5,,,,,,,,,,,,,,,,,
"Thyroid,pork",250,RC,VB007533,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
atomoxetine HCL,250,RC,VB007534,LOCAL,,inpatient,1,EA,61.86,61.86,,,,,,,,,,,,,,,,,
Alosetron HCL,250,RC,VB007535,LOCAL,,inpatient,1,EA,137.81,137.81,,,,,,,,,,,,,,,,,
Diclofenac/Misoprostol 50-0.2 MG,250,RC,VB007536,LOCAL,,inpatient,1,EA,32.36,32.36,,,,,,,,,,,,,,,,,
Rizatriptan Benzoate,250,RC,VB007537,LOCAL,,inpatient,1,EA,133,133,,,,,,,,,,,,,,,,,
Magnesium Chloride Inj,250,RC,VB007538,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
FLUoxetine HCL,250,RC,VB007539,LOCAL,,inpatient,1,EA,14.51,14.51,,,,,,,,,,,,,,,,,
Nateglinide,250,RC,VB007540,LOCAL,,inpatient,1,EA,8.27,8.27,,,,,,,,,,,,,,,,,
Fluconazole,250,RC,VB007541,LOCAL,,inpatient,1,EA,56.04,56.04,,,,,,,,,,,,,,,,,
Tetrabenazine,250,RC,VB007542,LOCAL,,inpatient,1,EA,314.9,314.9,,,,,,,,,,,,,,,,,
Netarsudil Mesylate 0.02%,250,RC,VB007543,LOCAL,,inpatient,2.5,ML,1557.31,1557.31,,,,,,,,,,,,,,,,,
Cupric Chloride,250,RC,VB007547,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
Mary's Mouthwash 240mL,250,RC,VB007552,LOCAL,,inpatient,240,ML,40,40,,,,,,,,,,,,,,,,,
DOMEBORO 1:40 ASTRINGENT 360 ML,250,RC,VB007553,LOCAL,,inpatient,360,ML,1.5,1.5,,,,,,,,,,,,,,,,,
DOMEBORO 1:20 ASTRINGENT 360 ML,250,RC,VB007554,LOCAL,,inpatient,360,ML,1.5,1.5,,,,,,,,,,,,,,,,,
DOMEBORO 1:10 ASTRINGENT 360 ML,250,RC,VB007555,LOCAL,,inpatient,360,ML,1.5,1.5,,,,,,,,,,,,,,,,,
SMOG ENEMA 400mL,250,RC,VB007558,LOCAL,,inpatient,400,ML,1.5,1.5,,,,,,,,,,,,,,,,,
Dimethicone 1.3% Cream,250,RC,VB007561,LOCAL,,inpatient,92,GM,23.52,23.52,,,,,,,,,,,,,,,,,
hydrOXYchloroQUINE SULFATE,250,RC,VB007563,LOCAL,,inpatient,1,EA,8.96,8.96,,,,,,,,,,,,,,,,,
Simethicone Susp,250,RC,VB007564,LOCAL,,inpatient,30,ML,5,5,,,,,,,,,,,,,,,,,
amantadine HCL Oral Soln,250,RC,VB007565,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Erythromycin Ethylsuccinate,250,RC,VB007566,LOCAL,,inpatient,100,ML,31.76,31.76,,,,,,,,,,,,,,,,,
Ketamine HCL Inj,250,RC,VB007567,LOCAL,,inpatient,20,ML,5,5,,,,,,,,,,,,,,,,,
Posaconazole Oral Susp,250,RC,VB007568,LOCAL,,inpatient,105,ML,65.81,65.81,,,,,,,,,,,,,,,,,
Sulfamethox/Trimeth 200-40mg/5ml,250,RC,VB007569,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Voriconazole Oral Susp,250,RC,VB007570,LOCAL,,inpatient,75,ML,56.28,56.28,,,,,,,,,,,,,,,,,
Alteplase,250,RC,VB007571,LOCAL,,inpatient,1,EA,846.48,846.48,,,,,,,,,,,,,,,,,
Octreotide Acetate Inj 100mcg/0.1mL,250,RC,VB007572,LOCAL,,inpatient,5,ML,230.4,230.4,,,,,,,,,,,,,,,,,
Sennosides - UD,250,RC,VB007573,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
Insulin Glargine-Yfgn,250,RC,VB007574,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
Menthol drops,250,RC,VB007576,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pitavastatin Magnesium,250,RC,VB007577,LOCAL,,inpatient,1,EA,37.2,37.2,,,,,,,,,,,,,,,,,
OLANZapine,250,RC,VB007579,LOCAL,,inpatient,1,EA,91.97,91.97,,,,,,,,,,,,,,,,,
Dasatinib,250,RC,VB007580,LOCAL,,inpatient,1,EA,1619.8,1619.8,,,,,,,,,,,,,,,,,
Calcium Carbonate/Vitamin D3,250,RC,VB007581,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Elbasvir/Grazoprevir 50MG-100MG,250,RC,VB007582,LOCAL,,inpatient,1,EA,1248,1248,,,,,,,,,,,,,,,,,
Letermovir,250,RC,VB007583,LOCAL,,inpatient,1,EA,1317.07,1317.07,,,,,,,,,,,,,,,,,
Ibutilide Fumarate Inj,250,RC,VB007584,LOCAL,,inpatient,10,ML,2687.18,2687.18,,,,,,,,,,,,,,,,,
Azelastine HCL,250,RC,VB007585,LOCAL,,inpatient,30,ML,775.58,775.58,,,,,,,,,,,,,,,,,
SUNItinib MALATE,250,RC,VB007586,LOCAL,,inpatient,1,EA,3853.62,3853.62,,,,,,,,,,,,,,,,,
Niacin,250,RC,VB007587,LOCAL,,inpatient,1,EA,43.88,43.88,,,,,,,,,,,,,,,,,
Leuprolide Acetate,250,RC,VB007588,LOCAL,,inpatient,1,EA,41208.96,41208.96,,,,,,,,,,,,,,,,,
Cisatracurium Besylate,250,RC,VB007589,LOCAL,,inpatient,1,ML,75.26,75.26,,,,,,,,,,,,,,,,,
Pazopanib HCL,250,RC,VB007590,LOCAL,,inpatient,1,EA,614.29,614.29,,,,,,,,,,,,,,,,,
Eltrombopag Olamine,250,RC,VB007591,LOCAL,,inpatient,1,EA,3399.18,3399.18,,,,,,,,,,,,,,,,,
Rifapentine,250,RC,VB007592,LOCAL,,inpatient,1,EA,19.22,19.22,,,,,,,,,,,,,,,,,
Fluocinonide 0.05% Cream,250,RC,VB007593,LOCAL,,inpatient,60,GM,728.76,728.76,,,,,,,,,,,,,,,,,
Nortriptyline HCL,250,RC,VB007594,LOCAL,,inpatient,1,EA,16.87,16.87,,,,,,,,,,,,,,,,,
tiaGABine HCL,250,RC,VB007595,LOCAL,,inpatient,1,EA,31.74,31.74,,,,,,,,,,,,,,,,,
hydrOXYzine HCL,250,RC,VB007596,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
glyBURIDE,250,RC,VB007597,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
haloperidoL LACTATE Oral,250,RC,VB007598,LOCAL,,inpatient,120,ML,5,5,,,,,,,,,,,,,,,,,
Lacosamide Oral,250,RC,VB007599,LOCAL,,inpatient,200,ML,1767.84,1767.84,,,,,,,,,,,,,,,,,
Mag Carb/Aluminum Hydrox/Algin,257,RC,VB007600,LOCAL,,inpatient,355,ML,5,5,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide 0.025% Oint,250,RC,VB007601,LOCAL,,inpatient,80,GM,44.59,44.59,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide 0.1% Oint,250,RC,VB007602,LOCAL,,inpatient,80,GM,55.78,55.78,,,,,,,,,,,,,,,,,
Desonide 0.05% Lotion,250,RC,VB007603,LOCAL,,inpatient,118,ML,1753.64,1753.64,,,,,,,,,,,,,,,,,
Beclomethasone Dipropionate,250,RC,VB007604,LOCAL,,inpatient,25,GM,1408.13,1408.13,,,,,,,,,,,,,,,,,
lamoTRIgine,250,RC,VB007605,LOCAL,,inpatient,1,EA,60.6,60.6,,,,,,,,,,,,,,,,,
Fluticasone/Umeclidin/Vilanter,250,RC,VB007606,LOCAL,,inpatient,1,EA,3251.57,3251.57,,,,,,,,,,,,,,,,,
Iopamidol 51%,250,RC,VB007607,LOCAL,,inpatient,1,ea,192.05,192.05,,,,,,,,,,,,,,,,,
Nitroglycerin 2% Oint (60gm),250,RC,VB007608,LOCAL,,inpatient,60,GM,6.24,6.24,,,,,,,,,,,,,,,,,
Benzocaine 20% Spray,250,RC,VB007609,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Emollient Combination No.40,250,RC,VB007610,LOCAL,,inpatient,1,ea,53.76,53.76,,,,,,,,,,,,,,,,,
Exenatide Microspheres,250,RC,VB007611,LOCAL,,inpatient,0.85,ML,992.93,992.93,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride,250,RC,VB007612,LOCAL,,inpatient,25,ML,13.44,13.44,,,,,,,,,,,,,,,,,
Fat Emulsions,250,RC,VB007613,LOCAL,,inpatient,500,ML,199.92,199.92,,,,,,,,,,,,,,,,,
metoprolol tartrate,250,RC,VB007614,LOCAL,,inpatient,1,EA,9.75,9.75,,,,,,,,,,,,,,,,,
Salicylic Acid,250,RC,VB007615,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,VB007616,LOCAL,,inpatient,25,GM,42.44,42.44,,,,,,,,,,,,,,,,,
Dextroamphetamine Sulfate,250,RC,VB007617,LOCAL,,inpatient,1,EA,26.16,26.16,,,,,,,,,,,,,,,,,
Iohexol,250,RC,VB007618,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
Meperidine HCL/Pf,250,RC,VB007619,LOCAL,,inpatient,1,ML,19.22,19.22,,,,,,,,,,,,,,,,,
nalbuphine HCL,250,RC,VB007620,LOCAL,,inpatient,1,ML,21.4,21.4,,,,,,,,,,,,,,,,,
Bupivacaine HCL/Epinephrine,250,RC,VB007621,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
Hydromorphone HCL/Pf,250,RC,VB007622,LOCAL,,inpatient,1,ML,78.55,78.55,,,,,,,,,,,,,,,,,
Parent Amino Ac 5.2 % (Renal),250,RC,VB007623,LOCAL,,inpatient,500,ML,110.54,110.54,,,,,,,,,,,,,,,,,
Aminophylline,250,RC,VB007624,LOCAL,,inpatient,10,ML,95.95,95.95,,,,,,,,,,,,,,,,,
Electrolyte-R (Ph 7.4),250,RC,VB007625,LOCAL,,inpatient,1000,ML,25.2,25.2,,,,,,,,,,,,,,,,,
Dextrose 50 % In Water (500mL),250,RC,VB007626,LOCAL,,inpatient,500,ML,59.28,59.28,,,,,,,,,,,,,,,,,
Enzalutamide,250,RC,VB007627,LOCAL,,inpatient,1,EA,596.23,596.23,,,,,,,,,,,,,,,,,
Betamethasone Valerate 0.1% Oint,250,RC,VB007628,LOCAL,,inpatient,45,GM,170.64,170.64,,,,,,,,,,,,,,,,,
Glycopyrrolate,250,RC,VB007629,LOCAL,,inpatient,5,ML,42.24,42.24,,,,,,,,,,,,,,,,,
Nitroglycerin IV,250,RC,VB007630,LOCAL,,inpatient,10,ML,74.64,74.64,,,,,,,,,,,,,,,,,
hydrOXYzine HCL,250,RC,VB007631,LOCAL,,inpatient,2,ML,106.63,106.63,,,,,,,,,,,,,,,,,
Calcium Carbonate Chew,250,RC,VB007632,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Benzoyl Peroxide 10%,250,RC,VB007633,LOCAL,,inpatient,42.5,GM,18.29,18.29,,,,,,,,,,,,,,,,,
Inositol,257,RC,VB007634,LOCAL,,inpatient,100,EA,5,5,,,,,,,,,,,,,,,,,
Norgestrel-Ethinyl Estradiol,250,RC,VB007635,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Desog-E.estradiol/E.estradiol,250,RC,VB007636,LOCAL,,inpatient,1,EA,8.57,8.57,,,,,,,,,,,,,,,,,
clobetasoL PROPIONATE 0.05% Lotion,250,RC,VB007637,LOCAL,,inpatient,118,ML,2116.6,2116.6,,,,,,,,,,,,,,,,,
Hydrocortisone Acetate Suppository,250,RC,VB007638,LOCAL,,inpatient,1,EA,68.82,68.82,,,,,,,,,,,,,,,,,
Estropipate,250,RC,VB007639,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Nateglinide,250,RC,VB007640,LOCAL,,inpatient,1,EA,6.91,6.91,,,,,,,,,,,,,,,,,
methylphenidate HCL,250,RC,VB007641,LOCAL,,inpatient,1,EA,6.06,6.06,,,,,,,,,,,,,,,,,
Afatinib Dimaleate,250,RC,VB007642,LOCAL,,inpatient,1,EA,1886.68,1886.68,,,,,,,,,,,,,,,,,
chlorproMAZINE HCL Inj,250,RC,VB007643,LOCAL,,inpatient,1,ML,138.67,138.67,,,,,,,,,,,,,,,,,
Terazosin HCL,250,RC,VB007644,LOCAL,,inpatient,1,EA,6.42,6.42,,,,,,,,,,,,,,,,,
amantadine HCL,250,RC,VB007645,LOCAL,,inpatient,1,EA,9.13,9.13,,,,,,,,,,,,,,,,,
Multivitamin With Iron Chew,257,RC,VB007646,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Magnesium Carb/Aluminum Hydrox,257,RC,VB007647,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Biotin,250,RC,VB007648,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
PARoxetine HCL,250,RC,VB007649,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Perit. Dialysis No.6-1.5 % Dex,250,RC,VB007650,LOCAL,,inpatient,2000,ML,156.29,156.29,,,,,,,,,,,,,,,,,
Periton.dialysis 8-4.25 % Dext,250,RC,VB007651,LOCAL,,inpatient,2000,ML,229.73,229.73,,,,,,,,,,,,,,,,,
Periton.dialysis 8-4.25 % Dext,250,RC,VB007652,LOCAL,,inpatient,6000,ML,299.86,299.86,,,,,,,,,,,,,,,,,
Immun Glob G(Igg)/Gly/Iga Ov50,250,RC,VB007653,LOCAL,,inpatient,100,GM,8381.28,8381.28,,,,,,,,,,,,,,,,,
Bismuth Tribromoph/Petrolatum,250,RC,VB007654,LOCAL,,inpatient,1,EA,5.27,5.27,,,,,,,,,,,,,,,,,
Colloidal Oatmeal,250,RC,VB007655,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
L. Acidophilus/L.bulgaricus,250,RC,VB007656,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Protectives, O.u.",250,RC,VB007657,LOCAL,,inpatient,1,EA,9.64,9.64,,,,,,,,,,,,,,,,,
thiamine HCL,250,RC,VB007658,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Nicardipine In Dextrose,iso-Os",250,RC,VB007659,LOCAL,,inpatient,200,ML,487.92,487.92,,,,,,,,,,,,,,,,,
"Nicardipine In Dextrose,iso-Os",250,RC,VB007660,LOCAL,,inpatient,200,ML,975.84,975.84,,,,,,,,,,,,,,,,,
Iodine/Potassium Iodide 5 %-10 %,250,RC,VB007661,LOCAL,,inpatient,1,EA,43.76,43.76,,,,,,,,,,,,,,,,,
Hydrophilic Cream,250,RC,VB007662,LOCAL,,inpatient,170,GM,99.4,99.4,,,,,,,,,,,,,,,,,
"Zinc Oxide/Petrolatum, Yellow",250,RC,VB007663,LOCAL,,inpatient,170,GM,58.6,58.6,,,,,,,,,,,,,,,,,
"Petrolatum,white",250,RC,VB007664,LOCAL,,inpatient,1,EA,15.96,15.96,,,,,,,,,,,,,,,,,
Cranberry Conc/Ascorbic Acid,250,RC,VB007665,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
isoproterenol HCL Inj,250,RC,VB007666,LOCAL,,inpatient,1,ML,2160,2160,,,,,,,,,,,,,,,,,
Glutamine,250,RC,VB007667,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Alendronate Sodium,250,RC,VB007668,LOCAL,,inpatient,1,EA,360,360,,,,,,,,,,,,,,,,,
ketorolac TROMETHAMINE 0.5% Ophth,250,RC,VB007669,LOCAL,,inpatient,10,ML,854.92,854.92,,,,,,,,,,,,,,,,,
Erythromycin Stearate,250,RC,VB007670,LOCAL,,inpatient,1,EA,52.5,52.5,,,,,,,,,,,,,,,,,
niMODipine,250,RC,VB007671,LOCAL,,inpatient,20,ML,392.35,392.35,,,,,,,,,,,,,,,,,
Oxycodone Myristate ER,250,RC,VB007672,LOCAL,,inpatient,1,EA,46.83,46.83,,,,,,,,,,,,,,,,,
Psyllium Husk/Calcium Carb,250,RC,VB007673,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Glutathione,250,RC,VB007674,LOCAL,,inpatient,5,GM,110.39,110.39,,,,,,,,,,,,,,,,,
Hyoscyamine Sulfate,250,RC,VB007675,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Arginine HCL,250,RC,VB007676,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Trimethobenzamide HCL,250,RC,VB007677,LOCAL,,inpatient,2,ML,145.5,145.5,,,,,,,,,,,,,,,,,
Isoxsuprine HCL,250,RC,VB007678,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Hyoscyamine Sulfate,250,RC,VB007679,LOCAL,,inpatient,1,EA,6.4,6.4,,,,,,,,,,,,,,,,,
Albumin Human 5%,250,RC,VB007680,LOCAL,,inpatient,500,ML,864,864,,,,,,,,,,,,,,,,,
gentamicin SULFATE 0.1% Oint,250,RC,VB007681,LOCAL,,inpatient,30,GM,395,395,,,,,,,,,,,,,,,,,
Benzoyl Peroxide 10%,257,RC,VB007682,LOCAL,,inpatient,227,GM,56.64,56.64,,,,,,,,,,,,,,,,,
Nicotine Polacrilex,257,RC,VB007683,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Hydrogen Peroxide 3%,257,RC,VB007684,LOCAL,,inpatient,473,ML,13.76,13.76,,,,,,,,,,,,,,,,,
Famotidine,257,RC,VB007685,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Galantamine Hbr,250,RC,VB007686,LOCAL,,inpatient,1,EA,22,22,,,,,,,,,,,,,,,,,
Saw Palmetto,250,RC,VB007687,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Saliva Substitute Combo No.9,250,RC,VB007688,LOCAL,,inpatient,1,ea,39.36,39.36,,,,,,,,,,,,,,,,,
Permethrin 1%,250,RC,VB007689,LOCAL,,inpatient,240,ML,34.37,34.37,,,,,,,,,,,,,,,,,
Calcipotriene/Betamethasone,250,RC,VB007690,LOCAL,,inpatient,60,GM,5706.34,5706.34,,,,,,,,,,,,,,,,,
Cobimetinib Fumarate,250,RC,VB007691,LOCAL,,inpatient,1,EA,621.28,621.28,,,,,,,,,,,,,,,,,
Naproxen Sodium,250,RC,VB007692,LOCAL,,inpatient,1,EA,17.5,17.5,,,,,,,,,,,,,,,,,
paregoric,250,RC,VB007693,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Riociguat,250,RC,VB007694,LOCAL,,inpatient,1,EA,752.54,752.54,,,,,,,,,,,,,,,,,
Interferon Beta-1b,250,RC,VB007695,LOCAL,,inpatient,1,EA,3410.69,3410.69,,,,,,,,,,,,,,,,,
Brivaracetam,250,RC,VB007696,LOCAL,,inpatient,300,ML,22.99,22.99,,,,,,,,,,,,,,,,,
Brivaracetam,250,RC,VB007697,LOCAL,,inpatient,5,ML,303.02,303.02,,,,,,,,,,,,,,,,,
Temazepam,250,RC,VB007698,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Felbamate,250,RC,VB007699,LOCAL,,inpatient,1,EA,20.67,20.67,,,,,,,,,,,,,,,,,
Diflorasone Diacetate 0.05% Oint,250,RC,VB007700,LOCAL,,inpatient,30,GM,1677.4,1677.4,,,,,,,,,,,,,,,,,
Diflorasone Diacetate 0.05% Cream,250,RC,VB007701,LOCAL,,inpatient,30,GM,1677.4,1677.4,,,,,,,,,,,,,,,,,
Hydrocortisone Butyrate 0.1%,250,RC,VB007702,LOCAL,,inpatient,60,ML,956.16,956.16,,,,,,,,,,,,,,,,,
Fremanezumab-Vfrm,250,RC,VB007703,LOCAL,,inpatient,1.5,ML,3624.72,3624.72,,,,,,,,,,,,,,,,,
"Collagen, Hydrolysate (Bovine)",250,RC,VB007704,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Everolimus,250,RC,VB007705,LOCAL,,inpatient,1,EA,2422.24,2422.24,,,,,,,,,,,,,,,,,
Albendazole,250,RC,VB007706,LOCAL,,inpatient,1,EA,1164.82,1164.82,,,,,,,,,,,,,,,,,
Emollient Combination No.92,250,RC,VB007707,LOCAL,,inpatient,1,EA,27.46,27.46,,,,,,,,,,,,,,,,,
Menthol/Zinc Oxide,250,RC,VB007708,LOCAL,,inpatient,113,ML,41.24,41.24,,,,,,,,,,,,,,,,,
Dimethicone 1.5% Cream,250,RC,VB007709,LOCAL,,inpatient,118,ML,28.2,28.2,,,,,,,,,,,,,,,,,
"Petrolatum,white (100gm)",250,RC,VB007710,LOCAL,,inpatient,100,GM,21.8,21.8,,,,,,,,,,,,,,,,,
Urea 40% - 226.8gm,250,RC,VB007711,LOCAL,,inpatient,226.8,GM,743.04,743.04,,,,,,,,,,,,,,,,,
Inulin/Sorbitol,250,RC,VB007712,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Mirtazapine,250,RC,VB007713,LOCAL,,inpatient,1,EA,10.53,10.53,,,,,,,,,,,,,,,,,
Ibrutinib,250,RC,VB007714,LOCAL,,inpatient,1,EA,967.57,967.57,,,,,,,,,,,,,,,,,
sevelamer HCL,250,RC,VB007715,LOCAL,,inpatient,1,EA,16.93,16.93,,,,,,,,,,,,,,,,,
Aluminum Chloride 15%,250,RC,VB007716,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Emollient Combination No.10,250,RC,VB007717,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Thalidomide,250,RC,VB007718,LOCAL,,inpatient,1,EA,1331.56,1331.56,,,,,,,,,,,,,,,,,
Candida Albicans Skin Test,250,RC,VB007719,LOCAL,,inpatient,1,EA,1420,1420,,,,,,,,,,,,,,,,,
Cefiderocol Sulfate Tosylate,250,RC,VB007720,LOCAL,,inpatient,1,EA,1117.63,1117.63,,,,,,,,,,,,,,,,,
Pnv No.118/Iron Fumarate/Fa,250,RC,VB007721,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
hydrOXYzine HCL,250,RC,VB007722,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
Apraclonidine HCL 0.5% Ophth,250,RC,VB007723,LOCAL,,inpatient,10,ML,689.32,689.32,,,,,,,,,,,,,,,,,
Ambrisentan,250,RC,VB007724,LOCAL,,inpatient,1,EA,2199.43,2199.43,,,,,,,,,,,,,,,,,
Remdesivir,250,RC,VB007725,LOCAL,,inpatient,20,ML,2496,2496,,,,,,,,,,,,,,,,,
Perampanel,250,RC,VB007726,LOCAL,,inpatient,1,EA,196.32,196.32,,,,,,,,,,,,,,,,,
Perampanel,250,RC,VB007727,LOCAL,,inpatient,1,EA,196.32,196.32,,,,,,,,,,,,,,,,,
Pimavanserin Tartrate,250,RC,VB007728,LOCAL,,inpatient,1,EA,819.2,819.2,,,,,,,,,,,,,,,,,
sodium acetate Inj,250,RC,VB007729,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
"Potassium Phos,m-Basic-D-Basic Inj",250,RC,VB007730,LOCAL,,inpatient,50,ML,6.46,6.46,,,,,,,,,,,,,,,,,
Eslicarbazepine Acetate,250,RC,VB007731,LOCAL,,inpatient,1,EA,215.53,215.53,,,,,,,,,,,,,,,,,
Zinc Oxide/Corn Starch,250,RC,VB007732,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Magnesium Chloride,250,RC,VB007733,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
Tedizolid Phosphate,250,RC,VB007734,LOCAL,,inpatient,1,EA,1854.38,1854.38,,,,,,,,,,,,,,,,,
Diclofenac Sodium/Misoprostol,250,RC,VB007735,LOCAL,,inpatient,1,EA,13.41,13.41,,,,,,,,,,,,,,,,,
Azithromycin,250,RC,VB007736,LOCAL,,inpatient,1,EA,27.48,27.48,,,,,,,,,,,,,,,,,
megestroL ACETATE,250,RC,VB007737,LOCAL,,inpatient,20,ML,33.4,33.4,,,,,,,,,,,,,,,,,
Imipramine Pamoate,250,RC,VB007738,LOCAL,,inpatient,1,EA,67.43,67.43,,,,,,,,,,,,,,,,,
Isradipine,250,RC,VB007739,LOCAL,,inpatient,1,EA,7.98,7.98,,,,,,,,,,,,,,,,,
dilTIAZem HCL,250,RC,VB007740,LOCAL,,inpatient,1,EA,6.62,6.62,,,,,,,,,,,,,,,,,
Valbenazine Tosylate,250,RC,VB007741,LOCAL,,inpatient,1,EA,1365.6,1365.6,,,,,,,,,,,,,,,,,
Netarsudil Mesylate 0.02% Ophth,250,RC,VB007742,LOCAL,,inpatient,2.5,ML,1604.02,1604.02,,,,,,,,,,,,,,,,,
Levocarnitine Oral Solution,250,RC,VB007743,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
Sodium Citrate 4% IV,250,RC,VB007744,LOCAL,,inpatient,1,ea,15.84,15.84,,,,,,,,,,,,,,,,,
Menthol 5% Patch,250,RC,VB007745,LOCAL,,inpatient,1,ea,7.15,7.15,,,,,,,,,,,,,,,,,
lidocaine HCL 2%  Gel (20mL),250,RC,VB007746,LOCAL,,inpatient,20,ML,48.82,48.82,,,,,,,,,,,,,,,,,
Cranberry Fruit Extract,250,RC,VB007747,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Iodixanol,250,RC,VB007749,LOCAL,,inpatient,100,ML,5.25,5.25,,,,,,,,,,,,,,,,,
"Cyclosporine,Modified(375mg/3.75mL)",250,RC,VB007750,LOCAL,,inpatient,50,ML,23.96,23.96,,,,,,,,,,,,,,,,,
"Cyclosporine,Modified(125mg/1.25mL)",250,RC,VB007751,LOCAL,,inpatient,1,ea,23.96,23.96,,,,,,,,,,,,,,,,,
Everolimus - UD,250,RC,VB007752,LOCAL,,inpatient,1,ea,206.41,206.41,,,,,,,,,,,,,,,,,
calcitrioL Oral 0.5 mcg/0.5mL,250,RC,VB007758,LOCAL,,inpatient,15,ML,47.73,47.73,,,,,,,,,,,,,,,,,
Hydromorphone IVPB 15mg in 30mL NS,250,RC,VB007765,LOCAL,,inpatient,30,ML,5,5,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide 0.1% Oint,250,RC,VB007771,LOCAL,,inpatient,30,GM,28.8,28.8,,,,,,,,,,,,,,,,,
Pneumoc 20-Val Conj-Dip Crm/Pf,250,RC,VB007772,LOCAL,,inpatient,0.5,ML,2628.97,2628.97,,,,,,,,,,,,,,,,,
HYDROMORPHONE 10MG/NS 50ML IV,250,RC,VB007787,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
Semaglutide,250,RC,VB007788,LOCAL,,inpatient,1,ea,159.61,159.61,,,,,,,,,,,,,,,,,
HydroMORPHONE 100mg/100mL NS DRIP,250,RC,VB007789,LOCAL,,inpatient,100,ML,96,96,,,,,,,,,,,,,,,,,
Lansoprazole Oral Suspension,250,RC,VB007790,LOCAL,,inpatient,1,EA,15.2,15.2,,,,,,,,,,,,,,,,,
TPN DELIVERED FROM CAPS,250,RC,VB007791,LOCAL,,inpatient,2000,ML,5,5,,,,,,,,,,,,,,,,,
HEMODIALYSIS SALINE FLUSH,250,RC,VB007793,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
TPN PERIPHERAL Clinimix 4.25%/5%,257,RC,VB007809,LOCAL,,inpatient,1000,ML,5,5,,,,,,,,,,,,,,,,,
TPN PERIPHERAL LINE RxMade 2L,257,RC,VB007810,LOCAL,,inpatient,2000,ML,5,5,,,,,,,,,,,,,,,,,
BIOTENE mouth oral Spray,257,RC,VB007817,LOCAL,,inpatient,44.3,ML,5,5,,,,,,,,,,,,,,,,,
Sodium CITrate Injection 4% - 5mL,250,RC,VB007818,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
sertraline HCL,250,RC,VB007819,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
METHIMAZOLE 2.5 MG**,250,RC,VB007820,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
METHYLPHENIDATE 2.5 MG**,250,RC,VB007821,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
NICARDIPINE 40MG/200ML NS,250,RC,VB007822,LOCAL,,inpatient,200,ML,5,5,,,,,,,,,,,,,,,,,
Brivaracetam Oral Soln,250,RC,VB007825,LOCAL,,inpatient,300,ML,20.76,20.76,,,,,,,,,,,,,,,,,
Diphen-Lido-Al Hydrox-Mg Hydr-Simet,250,RC,VB007826,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
methadone HCL Oral Conc 120mg/12ml,250,RC,VB007827,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
oxyCODONE HCL 7.5mg/7.5 mL,250,RC,VB007828,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
propranolol HCL Oral Soln,250,RC,VB007829,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dulaglutide,250,RC,VB007831,LOCAL,,inpatient,0.5,ML,1172.93,1172.93,,,,,,,,,,,,,,,,,
Suvorexant,250,RC,VB007832,LOCAL,,inpatient,1,EA,74.5,74.5,,,,,,,,,,,,,,,,,
Zoster Vaccine Live/Pf,250,RC,VB007833,LOCAL,,inpatient,1,EA,1070.98,1070.98,,,,,,,,,,,,,,,,,
Testosterone Cypionate,250,RC,VB007834,LOCAL,,inpatient,10,ML,663.22,663.22,,,,,,,,,,,,,,,,,
Onabotulinumtoxina,250,RC,VB007835,LOCAL,,inpatient,1,EA,1737.6,1737.6,,,,,,,,,,,,,,,,,
Ubrogepant,250,RC,VB007836,LOCAL,,inpatient,1,EA,520.73,520.73,,,,,,,,,,,,,,,,,
Onabotulinumtoxina,250,RC,VB007837,LOCAL,,inpatient,1,EA,3148.8,3148.8,,,,,,,,,,,,,,,,,
Insulin Glargine/Lixisenatide,250,RC,VB007838,LOCAL,,inpatient,3,ML,855.22,855.22,,,,,,,,,,,,,,,,,
Dupilumab,250,RC,VB007839,LOCAL,,inpatient,2,ML,9584.06,9584.06,,,,,,,,,,,,,,,,,
"Estrogen,con/M-Progest Acet",250,RC,VB007840,LOCAL,,inpatient,1,EA,42.45,42.45,,,,,,,,,,,,,,,,,
Naratriptan HCL,250,RC,VB007841,LOCAL,,inpatient,1,EA,117.96,117.96,,,,,,,,,,,,,,,,,
doxercalciferoL,250,RC,VB007842,LOCAL,,inpatient,1,EA,130.81,130.81,,,,,,,,,,,,,,,,,
Butorphanol Tartrate Nasal,250,RC,VB007843,LOCAL,,inpatient,2.5,ML,385.28,385.28,,,,,,,,,,,,,,,,,
Furosemide Oral,250,RC,VB007844,LOCAL,,inpatient,120,ML,5,5,,,,,,,,,,,,,,,,,
Sennosides,257,RC,VB007845,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Tofacitinib Citrate,250,RC,VB007846,LOCAL,,inpatient,1,EA,485.85,485.85,,,,,,,,,,,,,,,,,
Tafamidis Meglumine,250,RC,VB007847,LOCAL,,inpatient,1,EA,893.29,893.29,,,,,,,,,,,,,,,,,
Adalimumab,250,RC,VB007848,LOCAL,,inpatient,1,EA,33228.58,33228.58,,,,,,,,,,,,,,,,,
Fluocinonide 0.05% Oint,250,RC,VB007849,LOCAL,,inpatient,30,GM,566,566,,,,,,,,,,,,,,,,,
Clemastine Fumarate,250,RC,VB007850,LOCAL,,inpatient,1,EA,10.34,10.34,,,,,,,,,,,,,,,,,
Fluticasone Propion/Salmeterol,250,RC,VB007851,LOCAL,,inpatient,1,GM,613.68,613.68,,,,,,,,,,,,,,,,,
Temozolomide,250,RC,VB007852,LOCAL,,inpatient,1,EA,1745.8,1745.8,,,,,,,,,,,,,,,,,
Valproic Acid Oral,250,RC,VB007853,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
Insulin Degludec,250,RC,VB007854,LOCAL,,inpatient,3,ML,488.11,488.11,,,,,,,,,,,,,,,,,
Albiglutide,250,RC,VB007855,LOCAL,,inpatient,1,EA,626.4,626.4,,,,,,,,,,,,,,,,,
Budesonide/Glycopyr/Formoterol,250,RC,VB007856,LOCAL,,inpatient,5.9,GM,1758.82,1758.82,,,,,,,,,,,,,,,,,
Urea 40% - 198.4gm,250,RC,VB007857,LOCAL,,inpatient,198.4,GM,454.03,454.03,,,,,,,,,,,,,,,,,
Risedronate Sodium,250,RC,VB007858,LOCAL,,inpatient,1,EA,932.56,932.56,,,,,,,,,,,,,,,,,
metFORMIN HCL,250,RC,VB007859,LOCAL,,inpatient,1,EA,68.98,68.98,,,,,,,,,,,,,,,,,
Norethindrone-E.estradiol-Iron,250,RC,VB007860,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
fluvastatin SODIUM,250,RC,VB007861,LOCAL,,inpatient,1,EA,20.03,20.03,,,,,,,,,,,,,,,,,
Cod Liver Oil,250,RC,VB007862,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Memantine HCL/Donepezil 7MG-10MG,250,RC,VB007863,LOCAL,,inpatient,1,EA,99.2,99.2,,,,,,,,,,,,,,,,,
Levomilnacipran HCL,250,RC,VB007864,LOCAL,,inpatient,1,EA,84.22,84.22,,,,,,,,,,,,,,,,,
Enzalutamide,250,RC,VB007865,LOCAL,,inpatient,1,EA,596.23,596.23,,,,,,,,,,,,,,,,,
tacrolimus,250,RC,VB007866,LOCAL,,inpatient,1,EA,27.73,27.73,,,,,,,,,,,,,,,,,
Ferric Carboxymaltose IV,250,RC,VB007867,LOCAL,,inpatient,15,ML,7068.43,7068.43,,,,,,,,,,,,,,,,,
Ferrous Sulfate,250,RC,VB007868,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
propranolol HCL,250,RC,VB007869,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Carbidopa/Levodopa/Entacapone,250,RC,VB007870,LOCAL,,inpatient,1,EA,15,15,,,,,,,,,,,,,,,,,
captopriL,250,RC,VB007871,LOCAL,,inpatient,1,EA,12.37,12.37,,,,,,,,,,,,,,,,,
chlorproMAZINE HCL,250,RC,VB007872,LOCAL,,inpatient,1,EA,91.37,91.37,,,,,,,,,,,,,,,,,
Guaifenesin/Dextromethorphan,257,RC,VB007873,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
Peri.dialysis Soln28-Ico 7.5 %,250,RC,VB007874,LOCAL,,inpatient,2000,ML,567.02,567.02,,,,,,,,,,,,,,,,,
Phentermine HCL,250,RC,VB007875,LOCAL,,inpatient,1,EA,6.28,6.28,,,,,,,,,,,,,,,,,
Urea/Alpha Hydroxy Acids 10 %-4 %,250,RC,VB007876,LOCAL,,inpatient,142,GM,46.84,46.84,,,,,,,,,,,,,,,,,
Lutein,250,RC,VB007877,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Salicylic Acid 3% Cream,250,RC,VB007878,LOCAL,,inpatient,1,EA,43.96,43.96,,,,,,,,,,,,,,,,,
Diclofenac Potassium,250,RC,VB007879,LOCAL,,inpatient,1,EA,473.05,473.05,,,,,,,,,,,,,,,,,
Cromolyn Sodium Nasal,250,RC,VB007880,LOCAL,,inpatient,1,ea,39.96,39.96,,,,,,,,,,,,,,,,,
Temozolomide,250,RC,VB007881,LOCAL,,inpatient,1,EA,230.25,230.25,,,,,,,,,,,,,,,,,
Temozolomide,250,RC,VB007882,LOCAL,,inpatient,1,EA,1611.46,1611.46,,,,,,,,,,,,,,,,,
Loteprednol Etabonate 0.5%,250,RC,VB007883,LOCAL,,inpatient,5,GM,1243.54,1243.54,,,,,,,,,,,,,,,,,
Latanoprostene Bunod 0.024 %,250,RC,VB007884,LOCAL,,inpatient,2.5,ML,1244.02,1244.02,,,,,,,,,,,,,,,,,
Bepotastine Besilate 1.5%,250,RC,VB007885,LOCAL,,inpatient,5,ML,1402.03,1402.03,,,,,,,,,,,,,,,,,
Spinosad 0.9%,250,RC,VB007886,LOCAL,,inpatient,120,ML,1269.16,1269.16,,,,,,,,,,,,,,,,,
Bifidobacterium Infantis,250,RC,VB007887,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Salicylic Acid 3% Shampoo,250,RC,VB007888,LOCAL,,inpatient,1,ea,28.42,28.42,,,,,,,,,,,,,,,,,
Fexofenadine/Pseudoephedrine,250,RC,VB007889,LOCAL,,inpatient,1,ea,8.09,8.09,,,,,,,,,,,,,,,,,
EPINEPHrine,250,RC,VB007890,LOCAL,,inpatient,1,ML,71.81,71.81,,,,,,,,,,,,,,,,,
Flaxseed Oil,250,RC,VB007891,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Deferasirox,250,RC,VB007892,LOCAL,,inpatient,1,EA,450.58,450.58,,,,,,,,,,,,,,,,,
Deferasirox,250,RC,VB007893,LOCAL,,inpatient,1,EA,225.29,225.29,,,,,,,,,,,,,,,,,
Lidocaine 4% Patch,250,RC,VB007894,LOCAL,,inpatient,1,ea,8.39,8.39,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide 0.1% Oint,250,RC,VB007895,LOCAL,,inpatient,454,GM,165.36,165.36,,,,,,,,,,,,,,,,,
Phenylephrine HCL 1% Nasal,257,RC,VB007896,LOCAL,,inpatient,30,ML,27.56,27.56,,,,,,,,,,,,,,,,,
Mag Hydrox/Aluminum Hyd/Simeth,257,RC,VB007897,LOCAL,,inpatient,355,ML,5,5,,,,,,,,,,,,,,,,,
Spironolactone,250,RC,VB007898,LOCAL,,inpatient,118,ML,2074.56,2074.56,,,,,,,,,,,,,,,,,
Saliva Stimulant Comb. No.7,250,RC,VB007899,LOCAL,,inpatient,1,ea,39.36,39.36,,,,,,,,,,,,,,,,,
clonazePAM,250,RC,VB007900,LOCAL,,inpatient,1,EA,8.21,8.21,,,,,,,,,,,,,,,,,
levoFLOXacin Oral,250,RC,VB007901,LOCAL,,inpatient,200,ML,1116.6,1116.6,,,,,,,,,,,,,,,,,
Brivaracetam,250,RC,VB007902,LOCAL,,inpatient,1,EA,117.84,117.84,,,,,,,,,,,,,,,,,
Certolizumab Pegol,250,RC,VB007903,LOCAL,,inpatient,1,EA,12239.24,12239.24,,,,,,,,,,,,,,,,,
Estradiol/Norethindrone Acet,250,RC,VB007904,LOCAL,,inpatient,1,EA,25.93,25.93,,,,,,,,,,,,,,,,,
Mafenide Acetate 8.5% Cream,250,RC,VB007905,LOCAL,,inpatient,113.4,GM,558.44,558.44,,,,,,,,,,,,,,,,,
Fluocinonide/Emollient Base 0.05%,250,RC,VB007906,LOCAL,,inpatient,15,GM,192.64,192.64,,,,,,,,,,,,,,,,,
Iron/C/B12/Calciu/Stomach Conc,250,RC,VB007907,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Acebutolol HCL,250,RC,VB007908,LOCAL,,inpatient,1,EA,7.51,7.51,,,,,,,,,,,,,,,,,
Mineral Oil/I-Prop Myr/Water,257,RC,VB007909,LOCAL,,inpatient,236,ML,15.24,15.24,,,,,,,,,,,,,,,,,
Alpha Lipoic Acid,250,RC,VB007910,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Calcium/Magnesium/Zinc,250,RC,VB007911,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Crisaborole 2% Oint,250,RC,VB007912,LOCAL,,inpatient,60,GM,3808.37,3808.37,,,,,,,,,,,,,,,,,
Etanercept,250,RC,VB007913,LOCAL,,inpatient,1,ML,9789.12,9789.12,,,,,,,,,,,,,,,,,
doxercalciferoL,250,RC,VB007914,LOCAL,,inpatient,2,ML,33.41,33.41,,,,,,,,,,,,,,,,,
Meth/Meblue/Sod Phos/Psal/Hyos,250,RC,VB007915,LOCAL,,inpatient,1,EA,10.34,10.34,,,,,,,,,,,,,,,,,
Bismuth/Metronid/Tetracycline,250,RC,VB007916,LOCAL,,inpatient,1,EA,12.16,12.16,,,,,,,,,,,,,,,,,
Brexpiprazole,250,RC,VB007917,LOCAL,,inpatient,1,EA,242.51,242.51,,,,,,,,,,,,,,,,,
Buprenorphine HCL,250,RC,VB007918,LOCAL,,inpatient,1,EA,34.24,34.24,,,,,,,,,,,,,,,,,
Lisdexamfetamine Dimesylate,250,RC,VB007919,LOCAL,,inpatient,1,EA,62.05,62.05,,,,,,,,,,,,,,,,,
"Hyaluronate Sodium, Stabilized",250,RC,VB007920,LOCAL,,inpatient,1,EA,7200,7200,,,,,,,,,,,,,,,,,
Eluxadoline,250,RC,VB007921,LOCAL,,inpatient,1,EA,134.51,134.51,,,,,,,,,,,,,,,,,
Cariprazine HCL,250,RC,VB007922,LOCAL,,inpatient,1,EA,243.02,243.02,,,,,,,,,,,,,,,,,
Perampanel,250,RC,VB007923,LOCAL,,inpatient,1,EA,196.32,196.32,,,,,,,,,,,,,,,,,
Cholecalciferol (Vitamin D3),257,RC,VB007924,LOCAL,,inpatient,1,EA,7.33,7.33,,,,,,,,,,,,,,,,,
Bromocriptine Mesylate,250,RC,VB007925,LOCAL,,inpatient,1,EA,17.82,17.82,,,,,,,,,,,,,,,,,
Glycopyrrolate,250,RC,VB007926,LOCAL,,inpatient,1,EA,189.22,189.22,,,,,,,,,,,,,,,,,
Erythromycin/Benzoyl Peroxide,250,RC,VB007927,LOCAL,,inpatient,46.6,GM,1659.16,1659.16,,,,,,,,,,,,,,,,,
Leucovorin/Pyridox/Mecobalamin,250,RC,VB007928,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Pitavastatin Calcium,250,RC,VB007929,LOCAL,,inpatient,1,EA,51.16,51.16,,,,,,,,,,,,,,,,,
Omeprazole/Sodium Bicarb 40MG-1.1G,250,RC,VB007930,LOCAL,,inpatient,1,EA,436.82,436.82,,,,,,,,,,,,,,,,,
Potassium Chloride Oral,250,RC,VB007931,LOCAL,,inpatient,473,ML,6.5,6.5,,,,,,,,,,,,,,,,,
Flurbiprofen Sodium 0.03%,250,RC,VB007932,LOCAL,,inpatient,2.5,ML,172.8,172.8,,,,,,,,,,,,,,,,,
Tetrabenazine,250,RC,VB007933,LOCAL,,inpatient,1,EA,629.81,629.81,,,,,,,,,,,,,,,,,
Naproxen,250,RC,VB007934,LOCAL,,inpatient,1,EA,25.22,25.22,,,,,,,,,,,,,,,,,
Tapentadol HCL,250,RC,VB007935,LOCAL,,inpatient,1,EA,57.43,57.43,,,,,,,,,,,,,,,,,
Coal Tar 0.5% Shampoo,250,RC,VB007936,LOCAL,,inpatient,1,ea,59.95,59.95,,,,,,,,,,,,,,,,,
Netarsudil Mesylat/Latanoprost,250,RC,VB007937,LOCAL,,inpatient,2.5,ML,1697.28,1697.28,,,,,,,,,,,,,,,,,
Loteprednol Etabonate 1%,250,RC,VB007938,LOCAL,,inpatient,2.8,ML,1448.06,1448.06,,,,,,,,,,,,,,,,,
Cenobamate,250,RC,VB007939,LOCAL,,inpatient,1,EA,194.47,194.47,,,,,,,,,,,,,,,,,
Bempedoic Acid/Ezetimibe 180MG-10MG,250,RC,VB007940,LOCAL,,inpatient,1,EA,67.21,67.21,,,,,,,,,,,,,,,,,
Rimegepant Sulfate,250,RC,VB007941,LOCAL,,inpatient,1,EA,617.39,617.39,,,,,,,,,,,,,,,,,
methylphenidate HCL,250,RC,VB007942,LOCAL,,inpatient,1,EA,55.33,55.33,,,,,,,,,,,,,,,,,
Menthol 2.5% Gel,250,RC,VB007943,LOCAL,,inpatient,1,EA,17.62,17.62,,,,,,,,,,,,,,,,,
Calcium Carbonate/Vitamin D3,250,RC,VB007944,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Wheat Dextrin,250,RC,VB007945,LOCAL,,inpatient,1,EA,59.24,59.24,,,,,,,,,,,,,,,,,
Psyllium Husk/Aspartame,250,RC,VB007946,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
valGANciclovir HCL Oral Soln,250,RC,VB007948,LOCAL,,inpatient,88,ML,818.64,818.64,,,,,,,,,,,,,,,,,
Semaglutide,250,RC,VB007950,LOCAL,,inpatient,1,ea,159.61,159.61,,,,,,,,,,,,,,,,,
Menthol Aerosol 10% Topical,250,RC,VB007960,LOCAL,,inpatient,118,ML,32.3,32.3,,,,,,,,,,,,,,,,,
Primidone,250,RC,VB007961,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB007963,LOCAL,,inpatient,150,ML,5,5,,,,,,,,,,,,,,,,,
Ergocalciferol 8000 unit/mL,250,RC,VB007964,LOCAL,,inpatient,60,ML,6.65,6.65,,,,,,,,,,,,,,,,,
Cenobamate,250,RC,VB007966,LOCAL,,inpatient,1,EA,194.47,194.47,,,,,,,,,,,,,,,,,
Cranberry Capsule,257,RC,VB007967,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Cyclosporine,Modified (150mg/1.5mL)",250,RC,VB007968,LOCAL,,inpatient,50,ML,35.92,35.92,,,,,,,,,,,,,,,,,
"Cyclosporine,Modified(225mg/2.25mL)",250,RC,VB007969,LOCAL,,inpatient,50,ML,53.88,53.88,,,,,,,,,,,,,,,,,
Dolutegravir Sodium/Lamivudine,250,RC,VB007970,LOCAL,,inpatient,1,EA,495.31,495.31,,,,,,,,,,,,,,,,,
Bempedoic Acid,250,RC,VB007971,LOCAL,,inpatient,1,EA,67.21,67.21,,,,,,,,,,,,,,,,,
Atovaquone (Bulk bottle),250,RC,VB007972,LOCAL,,inpatient,210,ML,6307.16,6307.16,,,,,,,,,,,,,,,,,
Heparin/0.45% NaCl 25000 Unit/500mL,250,RC,VB007979,LOCAL,,inpatient,500,ML,5,5,,,,,,,,,,,,,,,,,
Amoxicillin/Potassium Clav 400-57mg,250,RC,VB007988,LOCAL,,inpatient,1,EA,23.5,23.5,,,,,,,,,,,,,,,,,
Patient Own Med - Respiratory,250,RC,VB007989,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
"Cyclosporine, Modified (RX-UD)",250,RC,VB007992,LOCAL,,inpatient,50,ML,94.24,94.24,,,,,,,,,,,,,,,,,
Acetaminophen - UD 650mg/20.3mL,250,RC,VB007993,LOCAL,,inpatient,20.3,ML,5,5,,,,,,,,,,,,,,,,,
Sodium Citrate Dextrose Soln 2.2%,250,RC,VB007995,LOCAL,,inpatient,1000,ML,5,5,,,,,,,,,,,,,,,,,
Lisdexamfetamine Dimesylate,250,RC,VB007996,LOCAL,,inpatient,1,EA,62.05,62.05,,,,,,,,,,,,,,,,,
Phendimetrazine Tartrate,250,RC,VB007997,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Gabapentin Oral 100mg/2mL (RX-UD),250,RC,VB007998,LOCAL,,inpatient,470,ML,5,5,,,,,,,,,,,,,,,,,
Betamethasone Diprop 0.05% - 45gm,250,RC,VB008002,LOCAL,,inpatient,45,GM,422.6,422.6,,,,,,,,,,,,,,,,,
"Gly/Dimeth/Petrolat,wht/Water",250,RC,VB008003,LOCAL,,inpatient,1,ea,53.76,53.76,,,,,,,,,,,,,,,,,
Acetylcysteine 20% - 30mL vial,250,RC,VB008004,LOCAL,,inpatient,30,ML,5,5,,,,,,,,,,,,,,,,,
Lidocaine 5% Cream - 30gm,250,RC,VB008005,LOCAL,,inpatient,1,ea,110.84,110.84,,,,,,,,,,,,,,,,,
Beta-Carotene,257,RC,VB008006,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
verapamil HCL,250,RC,VB008007,LOCAL,,inpatient,1,EA,8.25,8.25,,,,,,,,,,,,,,,,,
Neomycn/Bacitrc/Polymyx/Pramox Oint,257,RC,VB008008,LOCAL,,inpatient,28.4,GM,17.28,17.28,,,,,,,,,,,,,,,,,
Mometasone Furoate 0.1% Cream 45gm,250,RC,VB008009,LOCAL,,inpatient,45,GM,211.68,211.68,,,,,,,,,,,,,,,,,
Coal Tar 0.5% Shampoo,250,RC,VB008010,LOCAL,,inpatient,251,ML,11.09,11.09,,,,,,,,,,,,,,,,,
Benzocaine/Menthol/Zinc Chlor Gel,250,RC,VB008011,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Miconazole Nitrate 2% Cream 142gm,250,RC,VB008012,LOCAL,,inpatient,142,GM,52.56,52.56,,,,,,,,,,,,,,,,,
Lutein,250,RC,VB008013,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Menthol Lozenge,250,RC,VB008014,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Lidocaine 4%/Transparent Dressing,250,RC,VB008015,LOCAL,,inpatient,1,ea,96,96,,,,,,,,,,,,,,,,,
Psyllium Husk,250,RC,VB008016,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Ferrous Sulfate,250,RC,VB008017,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Benzoyl Peroxide 2.5% Gel,257,RC,VB008018,LOCAL,,inpatient,60,GM,79.16,79.16,,,,,,,,,,,,,,,,,
Hydrocortisone 2.5% Lotion 118mL,250,RC,VB008019,LOCAL,,inpatient,118,ML,305.96,305.96,,,,,,,,,,,,,,,,,
Calcium Carbonate Chew,250,RC,VB008020,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Glucosamine/Chondroitin/C/Mang,250,RC,VB008021,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Niacin,257,RC,VB008022,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
E-Lytes/Carboxymethylcellulose,250,RC,VB008023,LOCAL,,inpatient,1,ea,42.48,42.48,,,,,,,,,,,,,,,,,
Griseofulvin Ultramicrosize,250,RC,VB008024,LOCAL,,inpatient,1,EA,24.47,24.47,,,,,,,,,,,,,,,,,
Neostigmine Methylsulfate (1 mg/mL),250,RC,VB008025,LOCAL,,inpatient,10,ML,134.4,134.4,,,,,,,,,,,,,,,,,
estradioL Gel,250,RC,VB008026,LOCAL,,inpatient,1,EA,24.01,24.01,,,,,,,,,,,,,,,,,
omeprazole MAGNESIUM,250,RC,VB008027,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Biotin,250,RC,VB008028,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Lutein,250,RC,VB008029,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
"Estrogen,con/M-Progest Acet",250,RC,VB008030,LOCAL,,inpatient,1,EA,42.45,42.45,,,,,,,,,,,,,,,,,
"Estrogen,con/M-Progest Acet",250,RC,VB008031,LOCAL,,inpatient,1,EA,42.45,42.45,,,,,,,,,,,,,,,,,
lithium carbonate,250,RC,VB008032,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
PHENobarbitaL,250,RC,VB008033,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
tretinoin 0.025% Cream - 45gm,250,RC,VB008034,LOCAL,,inpatient,45,GM,162,162,,,,,,,,,,,,,,,,,
Parab/Cet Alc/Stryl Alc/Pg/Sls,250,RC,VB008035,LOCAL,,inpatient,1,ea,27.84,27.84,,,,,,,,,,,,,,,,,
Amino Acid 8 % In D14%,250,RC,VB008036,LOCAL,,inpatient,1000,ML,299.33,299.33,,,,,,,,,,,,,,,,,
Potassium Chloride In Water IV,250,RC,VB008037,LOCAL,,inpatient,100,ML,19.44,19.44,,,,,,,,,,,,,,,,,
estradioL Patch 0.1mg/24hr,250,RC,VB008038,LOCAL,,inpatient,1,EA,45.42,45.42,,,,,,,,,,,,,,,,,
Valsartan/Hydrochlorothia 80-12.5MG,250,RC,VB008039,LOCAL,,inpatient,1,EA,15.71,15.71,,,,,,,,,,,,,,,,,
Levomilnacipran HCL,250,RC,VB008040,LOCAL,,inpatient,1,EA,84.22,84.22,,,,,,,,,,,,,,,,,
Zinc/Copper/Mangan/Chrom/Selen,250,RC,VB008041,LOCAL,,inpatient,10,ML,10.68,10.68,,,,,,,,,,,,,,,,,
Clotrimazole 1% Cream - 28gm,257,RC,VB008042,LOCAL,,inpatient,28,GM,9.7,9.7,,,,,,,,,,,,,,,,,
Salicylic Acid/Sulfur Shampoo,257,RC,VB008043,LOCAL,,inpatient,118,ML,13.44,13.44,,,,,,,,,,,,,,,,,
Estropipate,250,RC,VB008044,LOCAL,,inpatient,1,EA,10.24,10.24,,,,,,,,,,,,,,,,,
Neomycin/Bacitracin/Polymyxinb 28gm,257,RC,VB008045,LOCAL,,inpatient,28,GM,10.13,10.13,,,,,,,,,,,,,,,,,
Multivit-Min/Fa/Lycopen/Lutein,257,RC,VB008046,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Itraconazole Oral,250,RC,VB008047,LOCAL,,inpatient,150,ML,9.26,9.26,,,,,,,,,,,,,,,,,
Phentermine HCL,250,RC,VB008048,LOCAL,,inpatient,1,EA,6.17,6.17,,,,,,,,,,,,,,,,,
Lanolin 50% Cream,250,RC,VB008049,LOCAL,,inpatient,1,EA,15.46,15.46,,,,,,,,,,,,,,,,,
Zoledronic Ac/Mannitol/0.9nacl,250,RC,VB008050,LOCAL,,inpatient,100,ML,864,864,,,,,,,,,,,,,,,,,
Doxepin HCL,250,RC,VB008051,LOCAL,,inpatient,1,EA,7.24,7.24,,,,,,,,,,,,,,,,,
Bevacizumab,250,RC,VB008052,LOCAL,,inpatient,4,ML,956.33,956.33,,,,,,,,,,,,,,,,,
folic acid,250,RC,VB008053,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Calamine/Menthol/Petrolat/Zinc,250,RC,VB008054,LOCAL,,inpatient,1,ea,67.73,67.73,,,,,,,,,,,,,,,,,
Cholecalciferol (Vitamin D3),250,RC,VB008055,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Bupivacaine HCL/Pf 0.5%,250,RC,VB008056,LOCAL,,inpatient,10,ML,14.4,14.4,,,,,,,,,,,,,,,,,
doxercalciferoL,250,RC,VB008057,LOCAL,,inpatient,1,EA,69.77,69.77,,,,,,,,,,,,,,,,,
doxercalciferoL,250,RC,VB008058,LOCAL,,inpatient,1,ML,16.7,16.7,,,,,,,,,,,,,,,,,
B Comp No3/Folic/C/Biotin/Zinc,250,RC,VB008059,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dextrose 10 % In Water,250,RC,VB008060,LOCAL,,inpatient,500,ML,5,5,,,,,,,,,,,,,,,,,
"Mineral Oil/Petrolatum,white",250,RC,VB008061,LOCAL,,inpatient,1,ea,43.84,43.84,,,,,,,,,,,,,,,,,
Felbamate Oral Susp,250,RC,VB008062,LOCAL,,inpatient,473,ML,10.45,10.45,,,,,,,,,,,,,,,,,
Vit E/Lidocaine/Aloe/Collagen,250,RC,VB008063,LOCAL,,inpatient,85,GM,83.04,83.04,,,,,,,,,,,,,,,,,
Cefdinir Susp,250,RC,VB008064,LOCAL,,inpatient,100,ML,6.3,6.3,,,,,,,,,,,,,,,,,
Levocetirizine Dihydrochloride,250,RC,VB008065,LOCAL,,inpatient,1,EA,12.31,12.31,,,,,,,,,,,,,,,,,
Mupirocin Calcium 2% Cream - 15gm,250,RC,VB008066,LOCAL,,inpatient,15,GM,980.64,980.64,,,,,,,,,,,,,,,,,
Hydrocortisone 2.5% Perianal Cream,250,RC,VB008067,LOCAL,,inpatient,28,GM,336,336,,,,,,,,,,,,,,,,,
levOCARNitine Oral Soln,250,RC,VB008068,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
levothyroxine SODIUM Oral Soln,250,RC,VB008069,LOCAL,,inpatient,1,ML,23.04,23.04,,,,,,,,,,,,,,,,,
B Complx/C/Folic/Zinc/Cup Su/E,250,RC,VB008070,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Gentamicin in NS 100 mg/100 mL,250,RC,VB008072,LOCAL,,inpatient,100,ML,20.5,20.5,,,,,,,,,,,,,,,,,
Buprenorphine,250,RC,VB008076,LOCAL,,inpatient,60,EA,84.4,84.4,,,,,,,,,,,,,,,,,
Acetylcysteine 20% - 3mL (RX-UD),250,RC,VB008079,LOCAL,,inpatient,4,ML,43.2,43.2,,,,,,,,,,,,,,,,,
"Cyclosporine,Modified(275mg/2.75mL)",250,RC,VB008080,LOCAL,,inpatient,50,ML,65.88,65.88,,,,,,,,,,,,,,,,,
Enoxaparin Sodium,250,RC,VB008081,LOCAL,,inpatient,0.6,ML,43.2,43.2,,,,,,,,,,,,,,,,,
Romiplostim,250,RC,VB008082,LOCAL,,inpatient,1,EA,6607.34,6607.34,,,,,,,,,,,,,,,,,
Gabapentin Oral 300mg/6mL (RX-UD),250,RC,VB008097,LOCAL,,inpatient,470,ML,5,5,,,,,,,,,,,,,,,,,
Vancomycin Oral Soln,250,RC,VB008098,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Ertapenem 0.5 GM/100mL IVPB,250,RC,VB008100,LOCAL,,inpatient,100,ML,48,48,,,,,,,,,,,,,,,,,
Propylene Glycol/Peg 400 Ophth,250,RC,VB008101,LOCAL,,inpatient,15,ML,46.32,46.32,,,,,,,,,,,,,,,,,
Theophylline Anhydrous - UD,250,RC,VB008102,LOCAL,,inpatient,15,ML,5,5,,,,,,,,,,,,,,,,,
Gabapentin Oral 400mg/8mL (RX-UD),250,RC,VB008103,LOCAL,,inpatient,470,ML,5,5,,,,,,,,,,,,,,,,,
Ampicillin Sodium,250,RC,VB008109,LOCAL,,inpatient,1,EA,31.2,31.2,,,,,,,,,,,,,,,,,
Valbenazine Tosylate,250,RC,VB008110,LOCAL,,inpatient,1,EA,1365.6,1365.6,,,,,,,,,,,,,,,,,
Oseltamivir Phosphate Oral (Bulk),250,RC,VB008111,LOCAL,,inpatient,60,ML,656.12,656.12,,,,,,,,,,,,,,,,,
Benzocaine/menthol 20%/0.5%,257,RC,VB008112,LOCAL,,inpatient,7,GM,28.22,28.22,,,,,,,,,,,,,,,,,
SODIUM CHLORIDE 3% IRRIGATION,250,RC,VB008117,LOCAL,,inpatient,500,ML,30.48,30.48,,,,,,,,,,,,,,,,,
Paliperidone ER,250,RC,VB008122,LOCAL,,inpatient,1,EA,122.25,122.25,,,,,,,,,,,,,,,,,
levETIRAcetam Oral 1000mg/10mL,250,RC,VB008123,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
levETIRAcetam Oral 750 mg/7.5mL,250,RC,VB008124,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
levETIRAcetam Oral 250mg/2.5mL,250,RC,VB008125,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
diazePAM Rectal Gel Kit,250,RC,VB008136,LOCAL,,inpatient,1,EA,1683.6,1683.6,,,,,,,,,,,,,,,,,
methadone HCL 125mg/12.5mL (RX-UD),250,RC,VB008137,LOCAL,,inpatient,1000,ML,5,5,,,,,,,,,,,,,,,,,
lamoTRIgine ER,250,RC,VB008138,LOCAL,,inpatient,1,EA,59.83,59.83,,,,,,,,,,,,,,,,,
MODAFINIL 50 MG** (RX-UD),250,RC,VB008139,LOCAL,,inpatient,1,EA,44.12,44.12,,,,,,,,,,,,,,,,,
MORPHINE SULFATE IN NS 100mg/100mL,250,RC,VB008141,LOCAL,,inpatient,100,ML,122.28,122.28,,,,,,,,,,,,,,,,,
atomoxetine HCL,250,RC,VB008142,LOCAL,,inpatient,1,EA,63.26,63.26,,,,,,,,,,,,,,,,,
Insulin Lispro Protamin/Lispro,250,RC,VB008143,LOCAL,,inpatient,10,ML,409.97,409.97,,,,,,,,,,,,,,,,,
Vericiguat,250,RC,VB008144,LOCAL,,inpatient,1,EA,110.93,110.93,,,,,,,,,,,,,,,,,
Ertugliflozin Pidolate,250,RC,VB008145,LOCAL,,inpatient,1,EA,57.12,57.12,,,,,,,,,,,,,,,,,
Clindamycin Phosphate Vaginal Supp,257,RC,VB008146,LOCAL,,inpatient,1,EA,294,294,,,,,,,,,,,,,,,,,
Carboxymethyl/Gly/Poly80/Pf,250,RC,VB008147,LOCAL,,inpatient,30,ML,5,5,,,,,,,,,,,,,,,,,
disopyramide PHOSPHATE,250,RC,VB008148,LOCAL,,inpatient,1,EA,24.5,24.5,,,,,,,,,,,,,,,,,
Anidulafungin,250,RC,VB008149,LOCAL,,inpatient,1,EA,458.16,458.16,,,,,,,,,,,,,,,,,
Propylene Glycol/Peg 400 Gel Ophth,257,RC,VB008150,LOCAL,,inpatient,10,ML,49.73,49.73,,,,,,,,,,,,,,,,,
Vit A/Vit C/Vit E/Zinc/Copper,250,RC,VB008151,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Venetoclax,250,RC,VB008152,LOCAL,,inpatient,1,EA,624.72,624.72,,,,,,,,,,,,,,,,,
Fingolimod HCL,250,RC,VB008153,LOCAL,,inpatient,1,EA,1869.43,1869.43,,,,,,,,,,,,,,,,,
Insulin Glulisine,250,RC,VB008154,LOCAL,,inpatient,10,ML,408.91,408.91,,,,,,,,,,,,,,,,,
Silver Nitrate,250,RC,VB008155,LOCAL,,inpatient,960,ML,366.6,366.6,,,,,,,,,,,,,,,,,
Phosphorated Carbo(Dext-Fruct),257,RC,VB008156,LOCAL,,inpatient,118,ML,9.4,9.4,,,,,,,,,,,,,,,,,
Desonide 0.05% Lotion,250,RC,VB008157,LOCAL,,inpatient,59,ML,1184.4,1184.4,,,,,,,,,,,,,,,,,
Sulfacetamide Sodium 10% Lotion,250,RC,VB008158,LOCAL,,inpatient,118,ML,377.47,377.47,,,,,,,,,,,,,,,,,
Semaglutide,250,RC,VB008159,LOCAL,,inpatient,1.5,ML,2324.45,2324.45,,,,,,,,,,,,,,,,,
lamoTRIgine,250,RC,VB008160,LOCAL,,inpatient,1,EA,158.11,158.11,,,,,,,,,,,,,,,,,
Fluticasone Furoate,250,RC,VB008161,LOCAL,,inpatient,14,EA,625.25,625.25,,,,,,,,,,,,,,,,,
Hydrocodone/Chlorphen P-Stirex,250,RC,VB008162,LOCAL,,inpatient,1,EA,174.79,174.79,,,,,,,,,,,,,,,,,
Ceftazidime In Dextrose5%water,250,RC,VB008163,LOCAL,,inpatient,1,ML,82.46,82.46,,,,,,,,,,,,,,,,,
Exenatide Microspheres,250,RC,VB008164,LOCAL,,inpatient,1,EA,792.19,792.19,,,,,,,,,,,,,,,,,
PARoxetine HCL ER,250,RC,VB008165,LOCAL,,inpatient,1,EA,22.3,22.3,,,,,,,,,,,,,,,,,
Nisoldipine,250,RC,VB008166,LOCAL,,inpatient,1,EA,24.57,24.57,,,,,,,,,,,,,,,,,
Olive Oil,250,RC,VB008167,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Piperacillin Sodium/Tazobactam,250,RC,VB008168,LOCAL,,inpatient,1,EA,41.42,41.42,,,,,,,,,,,,,,,,,
Piperacillin Sodium/Tazobactam,250,RC,VB008169,LOCAL,,inpatient,1,EA,58.16,58.16,,,,,,,,,,,,,,,,,
cefTAZidime,250,RC,VB008170,LOCAL,,inpatient,1,EA,28.57,28.57,,,,,,,,,,,,,,,,,
"Water for Irrigation,sterile",250,RC,VB008171,LOCAL,,inpatient,500,ML,25.2,25.2,,,,,,,,,,,,,,,,,
acetic acid 0.25% Irrigation,250,RC,VB008172,LOCAL,,inpatient,250,ML,25.2,25.2,,,,,,,,,,,,,,,,,
Potassium Chloride In Water,250,RC,VB008173,LOCAL,,inpatient,50,ML,15.36,15.36,,,,,,,,,,,,,,,,,
cefTRIAXone SODIUM,250,RC,VB008174,LOCAL,,inpatient,1,EA,19.88,19.88,,,,,,,,,,,,,,,,,
Ibuprofen,257,RC,VB008175,LOCAL,,inpatient,237,ML,5,5,,,,,,,,,,,,,,,,,
Atropine Sulfate,250,RC,VB008176,LOCAL,,inpatient,1,ML,38.4,38.4,,,,,,,,,,,,,,,,,
danazoL,250,RC,VB008177,LOCAL,,inpatient,1,EA,14.51,14.51,,,,,,,,,,,,,,,,,
polyethylene glycoL 3350 (Bulk),250,RC,VB008178,LOCAL,,inpatient,255,GM,87.4,87.4,,,,,,,,,,,,,,,,,
activated charcoaL,257,RC,VB008179,LOCAL,,inpatient,240,ML,94.6,94.6,,,,,,,,,,,,,,,,,
HYDROmorphone HCL,250,RC,VB008180,LOCAL,,inpatient,1,EA,82.15,82.15,,,,,,,,,,,,,,,,,
Enoxaparin Sodium,250,RC,VB008181,LOCAL,,inpatient,0.3,ML,21.6,21.6,,,,,,,,,,,,,,,,,
Enoxaparin Sodium,250,RC,VB008182,LOCAL,,inpatient,0.4,ML,129.88,129.88,,,,,,,,,,,,,,,,,
Enoxaparin Sodium,250,RC,VB008183,LOCAL,,inpatient,0.6,ML,5,5,,,,,,,,,,,,,,,,,
Enoxaparin Sodium,250,RC,VB008184,LOCAL,,inpatient,0.8,ML,260.12,260.12,,,,,,,,,,,,,,,,,
Enoxaparin Sodium,250,RC,VB008185,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
Enoxaparin Sodium 120 mg/0.8mL,250,RC,VB008186,LOCAL,,inpatient,0.8,ML,5,5,,,,,,,,,,,,,,,,,
Enoxaparin Sodium,250,RC,VB008187,LOCAL,,inpatient,1,ML,5,5,,,,,,,,,,,,,,,,,
Fluoxymesterone,250,RC,VB008188,LOCAL,,inpatient,1,EA,23.11,23.11,,,,,,,,,,,,,,,,,
Acetaminophen/Diphenhydramine,257,RC,VB008189,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dimethicone/Colloid Oatmeal Lotion,250,RC,VB008190,LOCAL,,inpatient,354,GM,37.2,37.2,,,,,,,,,,,,,,,,,
Aloe/Oxyben/Octinox/Cham/Hrb57,250,RC,VB008191,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Benzocaine/Resorcinol 5 %-2 %,250,RC,VB008192,LOCAL,,inpatient,60,GM,20.74,20.74,,,,,,,,,,,,,,,,,
Magnesium Hydroxide,250,RC,VB008193,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dorzolamide/Timolol/Pf 2 %-0.5 %,250,RC,VB008194,LOCAL,,inpatient,60,ML,858.4,858.4,,,,,,,,,,,,,,,,,
Isosorbide Dinit/Hydralazine,250,RC,VB008195,LOCAL,,inpatient,1,EA,18.4,18.4,,,,,,,,,,,,,,,,,
Guaifenesin/DM/Phenylephrine,257,RC,VB008196,LOCAL,,inpatient,118,ML,29.96,29.96,,,,,,,,,,,,,,,,,
Nitroglycerin Spray,250,RC,VB008197,LOCAL,,inpatient,4.9,GM,1320.48,1320.48,,,,,,,,,,,,,,,,,
Glucosam/Chon-Msm1/C/Mang/Bosw,250,RC,VB008198,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dimethyl Fumarate,250,RC,VB008199,LOCAL,,inpatient,1,EA,595.82,595.82,,,,,,,,,,,,,,,,,
Iloperidone,250,RC,VB008200,LOCAL,,inpatient,1,EA,147.39,147.39,,,,,,,,,,,,,,,,,
Magnesium Oxide,250,RC,VB008201,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Progesterone, Micronized",250,RC,VB008202,LOCAL,,inpatient,1,EA,16,16,,,,,,,,,,,,,,,,,
Albumin Human 5% - 250mL,250,RC,VB008203,LOCAL,,inpatient,250,ML,432,432,,,,,,,,,,,,,,,,,
Dextromethorphan Polistirex (Bulk),257,RC,VB008204,LOCAL,,inpatient,89,ML,29.38,29.38,,,,,,,,,,,,,,,,,
Eucalyptus/Menthol,250,RC,VB008205,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Saliva Substitute Combo No.9,250,RC,VB008206,LOCAL,,inpatient,1000,ml,60.96,60.96,,,,,,,,,,,,,,,,,
Propafenone HCL,250,RC,VB008207,LOCAL,,inpatient,1,EA,40,40,,,,,,,,,,,,,,,,,
Dorzolamide HCL 2% Ophth,250,RC,VB008208,LOCAL,,inpatient,10,ML,267.2,267.2,,,,,,,,,,,,,,,,,
Sulfamethoxazole/Trimethoprim(Bulk),250,RC,VB008209,LOCAL,,inpatient,473,ML,861.6,861.6,,,,,,,,,,,,,,,,,
clobetasoL PROPIONATE 0.05%,250,RC,VB008210,LOCAL,,inpatient,118,ML,3619.08,3619.08,,,,,,,,,,,,,,,,,
Becaplermin 0.01% Gel,250,RC,VB008211,LOCAL,,inpatient,15,GM,6526.56,6526.56,,,,,,,,,,,,,,,,,
Mafenide Acetate For Topical Soln,250,RC,VB008212,LOCAL,,inpatient,5,GM,4661.36,4661.36,,,,,,,,,,,,,,,,,
"Iron Aspgly,ps/C/Succinic Acid",250,RC,VB008213,LOCAL,,inpatient,1,EA,5.08,5.08,,,,,,,,,,,,,,,,,
Nitrofurantoin Macrocrystal,250,RC,VB008214,LOCAL,,inpatient,1,EA,56.26,56.26,,,,,,,,,,,,,,,,,
cefaCLOR,250,RC,VB008215,LOCAL,,inpatient,1,EA,15.58,15.58,,,,,,,,,,,,,,,,,
Fondaparinux Sodium 2.5 mg/0.5mL,250,RC,VB008216,LOCAL,,inpatient,0.5,ML,230.8,230.8,,,,,,,,,,,,,,,,,
Fondaparinux Sodium,250,RC,VB008217,LOCAL,,inpatient,0.4,ML,543.2,543.2,,,,,,,,,,,,,,,,,
Bupivacaine HCL/Pf 0.25%,250,RC,VB008218,LOCAL,,inpatient,10,ML,12.48,12.48,,,,,,,,,,,,,,,,,
Etelcalcetide Hydrochloride,250,RC,VB008219,LOCAL,,inpatient,1,ML,990.97,990.97,,,,,,,,,,,,,,,,,
Copper Gluconate,250,RC,VB008220,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
"Iron,carbonyl/Ascorbic Acid",250,RC,VB008221,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Amoxicillin/Pot Clav 250-62.5mg/5ml,250,RC,VB008222,LOCAL,,inpatient,150,ML,508,508,,,,,,,,,,,,,,,,,
Pimavanserin Tartrate,250,RC,VB008223,LOCAL,,inpatient,1,EA,222.24,222.24,,,,,,,,,,,,,,,,,
lidocaine HCL 1% Inj,250,RC,VB008224,LOCAL,,inpatient,2,ML,13.58,13.58,,,,,,,,,,,,,,,,,
haloperidoL DECANOATE,250,RC,VB008225,LOCAL,,inpatient,1,ML,247.1,247.1,,,,,,,,,,,,,,,,,
tiaGABine HCL,250,RC,VB008226,LOCAL,,inpatient,1,EA,73.9,73.9,,,,,,,,,,,,,,,,,
Methscopolamine Bromide,250,RC,VB008227,LOCAL,,inpatient,1,EA,10.82,10.82,,,,,,,,,,,,,,,,,
"Thyroid,pork",250,RC,VB008228,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
"Thyroid,pork",250,RC,VB008229,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Hydrocortisone 2.5% Rectal Cream,250,RC,VB008230,LOCAL,,inpatient,30,GM,349.32,349.32,,,,,,,,,,,,,,,,,
Atovaquone Oral Susp,250,RC,VB008231,LOCAL,,inpatient,210,ML,26.25,26.25,,,,,,,,,,,,,,,,,
Propafenone HCL,250,RC,VB008232,LOCAL,,inpatient,1,EA,39.95,39.95,,,,,,,,,,,,,,,,,
traMADoL HCL,250,RC,VB008233,LOCAL,,inpatient,1,EA,14.55,14.55,,,,,,,,,,,,,,,,,
lidocaine HCL 3% Cream,250,RC,VB008234,LOCAL,,inpatient,85,GM,698.76,698.76,,,,,,,,,,,,,,,,,
Chlorhexidine/Glycerin/He-Cell,250,RC,VB008235,LOCAL,,inpatient,1,ea,9.8,9.8,,,,,,,,,,,,,,,,,
Polyethylene Glycol 400 Ophth,250,RC,VB008236,LOCAL,,inpatient,15,ML,30.38,30.38,,,,,,,,,,,,,,,,,
Balsam Peru/Castor Oil Oint,250,RC,VB008237,LOCAL,,inpatient,60,GM,150,150,,,,,,,,,,,,,,,,,
OLANZapine ODT,250,RC,VB008256,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
OLANZapine UD,250,RC,VB008257,LOCAL,,inpatient,1,ea,60.64,60.64,,,,,,,,,,,,,,,,,
Ixekizumab,250,RC,VB008268,LOCAL,,inpatient,1,ML,34855.25,34855.25,,,,,,,,,,,,,,,,,
Alcaftadine 0.25% Ophthalmic,250,RC,VB008269,LOCAL,,inpatient,3,ML,1135.97,1135.97,,,,,,,,,,,,,,,,,
Deferasirox,250,RC,VB008270,LOCAL,,inpatient,1,EA,246.94,246.94,,,,,,,,,,,,,,,,,
cloZAPine ODT,250,RC,VB008271,LOCAL,,inpatient,1,EA,8.91,8.91,,,,,,,,,,,,,,,,,
cephALEXin Oral Susp,250,RC,VB008272,LOCAL,,inpatient,100,ML,95,95,,,,,,,,,,,,,,,,,
Calcium Carbonate,257,RC,VB008273,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Povidone-Iodine 0.3%,250,RC,VB008274,LOCAL,,inpatient,274,ML,5,5,,,,,,,,,,,,,,,,,
Bacitracin Zinc Packet,257,RC,VB008275,LOCAL,,inpatient,144,EA,5,5,,,,,,,,,,,,,,,,,
Terconazole 0.4% Vaginal Cream,250,RC,VB008276,LOCAL,,inpatient,45,GM,171.98,171.98,,,,,,,,,,,,,,,,,
Albiglutide,250,RC,VB008277,LOCAL,,inpatient,1,EA,626.41,626.41,,,,,,,,,,,,,,,,,
Parenteral Amino Acid 15% No.5,250,RC,VB008278,LOCAL,,inpatient,2000,ML,628.99,628.99,,,,,,,,,,,,,,,,,
Azelastine/Fluticasone 137-50 MCG,250,RC,VB008279,LOCAL,,inpatient,23,GM,911.16,911.16,,,,,,,,,,,,,,,,,
Bupivacaine HCL/Epinephrine/Pf,250,RC,VB008280,LOCAL,,inpatient,30,ML,28.37,28.37,,,,,,,,,,,,,,,,,
ketorolac TROMETHAMINE Inj,250,RC,VB008281,LOCAL,,inpatient,1,ML,17.56,17.56,,,,,,,,,,,,,,,,,
Piperacillin Sodium/Tazobactam,250,RC,VB008282,LOCAL,,inpatient,1,EA,58.16,58.16,,,,,,,,,,,,,,,,,
Aminophylline Inj,250,RC,VB008283,LOCAL,,inpatient,20,ML,61.78,61.78,,,,,,,,,,,,,,,,,
Parenteral Amino Acid 10% No.1,250,RC,VB008284,LOCAL,,inpatient,2000,ML,155.04,155.04,,,,,,,,,,,,,,,,,
Betamethasone Valerate 0.1% Cream,250,RC,VB008285,LOCAL,,inpatient,45,GM,228.4,228.4,,,,,,,,,,,,,,,,,
Niacin ER,257,RC,VB008286,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Hydrophilic Ointment,257,RC,VB008287,LOCAL,,inpatient,454,GM,76.8,76.8,,,,,,,,,,,,,,,,,
methazolAMIDE,250,RC,VB008288,LOCAL,,inpatient,1,EA,11.04,11.04,,,,,,,,,,,,,,,,,
Terconazole 0.8% Vaginal Cream,250,RC,VB008289,LOCAL,,inpatient,20,GM,163.72,163.72,,,,,,,,,,,,,,,,,
Orphenadrine Citrate Inj,250,RC,VB008290,LOCAL,,inpatient,2,ML,45,45,,,,,,,,,,,,,,,,,
Promethazine HCL Syrup,250,RC,VB008291,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
Somatropin for Inj,250,RC,VB008292,LOCAL,,inpatient,1,EA,1635.46,1635.46,,,,,,,,,,,,,,,,,
Amoxicillin/Pot Clav 600-42.9mg/5mL,250,RC,VB008293,LOCAL,,inpatient,200,ML,521.48,521.48,,,,,,,,,,,,,,,,,
"Multivitamin,stress Formula",257,RC,VB008294,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ammonium Lactate 12% Lotion,257,RC,VB008295,LOCAL,,inpatient,226,GM,18.58,18.58,,,,,,,,,,,,,,,,,
"Mineral Oil/Petrolatum,white",250,RC,VB008296,LOCAL,,inpatient,3.5,GM,25.87,25.87,,,,,,,,,,,,,,,,,
Lanolin Alcohol/Mo/W.pet/Ceres,250,RC,VB008297,LOCAL,,inpatient,454,GM,20.26,20.26,,,,,,,,,,,,,,,,,
Isosorbide Dinit/Hydralazine,250,RC,VB008298,LOCAL,,inpatient,1,EA,18.4,18.4,,,,,,,,,,,,,,,,,
cefUROXime SODIUM,250,RC,VB008299,LOCAL,,inpatient,1,EA,26.05,26.05,,,,,,,,,,,,,,,,,
"Pnv,calcium 72/Iron/Folic Acid",250,RC,VB008300,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Naftifine HCL 1% Cream,250,RC,VB008301,LOCAL,,inpatient,60,GM,1501.54,1501.54,,,,,,,,,,,,,,,,,
Phenazopyridine HCL,250,RC,VB008302,LOCAL,,inpatient,1,EA,7.92,7.92,,,,,,,,,,,,,,,,,
"Progesterone, Micronized",250,RC,VB008303,LOCAL,,inpatient,1,EA,16,16,,,,,,,,,,,,,,,,,
Interferon Beta-1a/Albumin,250,RC,VB008304,LOCAL,,inpatient,0.5,ML,4395.31,4395.31,,,,,,,,,,,,,,,,,
Desonide 0.05% Cream,250,RC,VB008305,LOCAL,,inpatient,60,GM,345.6,345.6,,,,,,,,,,,,,,,,,
Melatonin,250,RC,VB008306,LOCAL,,inpatient,60,ML,26.68,26.68,,,,,,,,,,,,,,,,,
Phenol/Sodium Phenolate Spray,257,RC,VB008307,LOCAL,,inpatient,177,ML,8.64,8.64,,,,,,,,,,,,,,,,,
Pimozide,250,RC,VB008308,LOCAL,,inpatient,1,EA,9.76,9.76,,,,,,,,,,,,,,,,,
Flutamide,250,RC,VB008309,LOCAL,,inpatient,1,EA,8.37,8.37,,,,,,,,,,,,,,,,,
Erlotinib HCL,250,RC,VB008310,LOCAL,,inpatient,1,EA,1195.52,1195.52,,,,,,,,,,,,,,,,,
Protriptyline HCL,250,RC,VB008311,LOCAL,,inpatient,1,EA,7.25,7.25,,,,,,,,,,,,,,,,,
Ciprofloxacin Oral Susp,250,RC,VB008312,LOCAL,,inpatient,100,ML,731.14,731.14,,,,,,,,,,,,,,,,,
Econazole Nitrate 1% Cream,250,RC,VB008313,LOCAL,,inpatient,85,GM,1738.8,1738.8,,,,,,,,,,,,,,,,,
Desoximetasone 0.05% Ointment,250,RC,VB008314,LOCAL,,inpatient,60,GM,1468.72,1468.72,,,,,,,,,,,,,,,,,
Loratadine,250,RC,VB008315,LOCAL,,inpatient,120,ML,5,5,,,,,,,,,,,,,,,,,
Etodolac,250,RC,VB008316,LOCAL,,inpatient,1,EA,5.75,5.75,,,,,,,,,,,,,,,,,
Glycopyrrolate/Pf,250,RC,VB008317,LOCAL,,inpatient,1,ML,18.24,18.24,,,,,,,,,,,,,,,,,
Butalbit/Acetamin/Caff/Codeine,250,RC,VB008318,LOCAL,,inpatient,1,EA,6,6,,,,,,,,,,,,,,,,,
"Sodium, Potassium,mag Sulfates",250,RC,VB008319,LOCAL,,inpatient,1,EA,571.92,571.92,,,,,,,,,,,,,,,,,
Erythromycin Base DR,250,RC,VB008320,LOCAL,,inpatient,1,EA,52.02,52.02,,,,,,,,,,,,,,,,,
dilTIAZem HCL ER,250,RC,VB008321,LOCAL,,inpatient,1,EA,17.35,17.35,,,,,,,,,,,,,,,,,
Miconazole Nitrate 2% Powder,250,RC,VB008322,LOCAL,,inpatient,85,GM,33.68,33.68,,,,,,,,,,,,,,,,,
Balsam Peru/Zinc Oxide,250,RC,VB008323,LOCAL,,inpatient,113,GM,45.96,45.96,,,,,,,,,,,,,,,,,
Cranberry Fruit Extract,250,RC,VB008324,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
oxaprozin,250,RC,VB008325,LOCAL,,inpatient,1,EA,14.66,14.66,,,,,,,,,,,,,,,,,
Meprobamate,250,RC,VB008326,LOCAL,,inpatient,1,EA,33,33,,,,,,,,,,,,,,,,,
Hepatitis B Virus Vaccine/Pf,250,RC,VB008327,LOCAL,,inpatient,0.5,ML,132.82,132.82,,,,,,,,,,,,,,,,,
Dicyclomine HCL Inj,250,RC,VB008328,LOCAL,,inpatient,2,ML,201.74,201.74,,,,,,,,,,,,,,,,,
Naldemedine Tosylate,250,RC,VB008329,LOCAL,,inpatient,1,EA,77.74,77.74,,,,,,,,,,,,,,,,,
Lenalidomide,250,RC,VB008330,LOCAL,,inpatient,1,EA,4279.44,4279.44,,,,,,,,,,,,,,,,,
methylphenidate HCL,250,RC,VB008331,LOCAL,,inpatient,500,ML,5,5,,,,,,,,,,,,,,,,,
Epinastine HCL 0.05% Ophthalmic,250,RC,VB008332,LOCAL,,inpatient,5,ML,450.76,450.76,,,,,,,,,,,,,,,,,
Fluorometholone 0.1% Ophth - 10mL,250,RC,VB008333,LOCAL,,inpatient,10,ML,743.36,743.36,,,,,,,,,,,,,,,,,
timoloL MALEATE 0.5% Gel Forming,250,RC,VB008334,LOCAL,,inpatient,5,ML,869.08,869.08,,,,,,,,,,,,,,,,,
Carteolol HCL 1% Ophthalmic,250,RC,VB008335,LOCAL,,inpatient,15,ML,229,229,,,,,,,,,,,,,,,,,
cefaCLOR,250,RC,VB008336,LOCAL,,inpatient,1,EA,20.25,20.25,,,,,,,,,,,,,,,,,
Alirocumab,250,RC,VB008337,LOCAL,,inpatient,1,ML,1251.77,1251.77,,,,,,,,,,,,,,,,,
Enteral Pump Access.hydrolysis,250,RC,VB008338,LOCAL,,inpatient,1,EA,660.59,660.59,,,,,,,,,,,,,,,,,
Eslicarbazepine Acetate,250,RC,VB008339,LOCAL,,inpatient,1,EA,215.53,215.53,,,,,,,,,,,,,,,,,
Hydrocortisone 2.5% Rectal Cream,250,RC,VB008340,LOCAL,,inpatient,30,GM,349.32,349.32,,,,,,,,,,,,,,,,,
sertraline HCL,250,RC,VB008341,LOCAL,,inpatient,60,ML,5,5,,,,,,,,,,,,,,,,,
Balsam Peru/Castor Oil Ointment,250,RC,VB008342,LOCAL,,inpatient,60,GM,150,150,,,,,,,,,,,,,,,,,
Timolol 0.5% Ophthalmic,250,RC,VB008343,LOCAL,,inpatient,5,ML,731.32,731.32,,,,,,,,,,,,,,,,,
Glucosamine/Chondroitin 1500mg,250,RC,VB008344,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
FULL STRENGTH DAKINS SOLUTION 0.1%,250,RC,VB008346,LOCAL,,inpatient,500,ML,6,6,,,,,,,,,,,,,,,,,
GPC SOLUTION 1/2.1M/1 G/UN/G,250,RC,VB008347,LOCAL,,inpatient,500,ML,40,40,,,,,,,,,,,,,,,,,
LICE COMB,250,RC,VB008348,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
MAGIC BUTT CREAM,250,RC,VB008349,LOCAL,,inpatient,30,GM,30,30,,,,,,,,,,,,,,,,,
Mylanta/Lidocaine/Donnatal,250,RC,VB008354,LOCAL,,inpatient,60,ML,8,8,,,,,,,,,,,,,,,,,
Propafenone HCL,250,RC,VB008356,LOCAL,,inpatient,1,EA,11.88,11.88,,,,,,,,,,,,,,,,,
Insulin Lispro 100 Unit/mL,250,RC,VB008360,LOCAL,,inpatient,3,ML,5,5,,,,,,,,,,,,,,,,,
Insulin Glargine Pen 300 unit/mL,250,RC,VB008364,LOCAL,,inpatient,3,ML,1371.46,1371.46,,,,,,,,,,,,,,,,,
SODIUM CHLORIDE 3% INHALATION 4mL,250,RC,VB008365,LOCAL,,inpatient,4,ML,5,5,,,,,,,,,,,,,,,,,
Flu Vacc Qs2022-23(6mos Up)/Pf,250,RC,VB008373,LOCAL,,inpatient,0.5,ML,89.42,89.42,,,,,,,,,,,,,,,,,
Sodium Hypochlorite 0.0125%,250,RC,VB008376,LOCAL,,inpatient,473,ML,68,68,,,,,,,,,,,,,,,,,
CALCIUM GLUCONATE 1GM DRIP KIT,250,RC,VB008378,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
CARDIZEM DRIP KIT 100 MG/100ML,250,RC,VB008379,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Flu Vacc Qs 2022-23 (6 Mos Up),250,RC,VB008381,LOCAL,,inpatient,5,ML,170.53,170.53,,,,,,,,,,,,,,,,,
MENTHOL 4% GEL - 89ML,257,RC,VB008382,LOCAL,,inpatient,89,ML,5,5,,,,,,,,,,,,,,,,,
FISH OIL LIQUID 1000 MG/5ML,250,RC,VB008385,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
HYDROMORPHONE PCA 0.2 MG/ML,250,RC,VB008386,LOCAL,,inpatient,30,ML,5,5,,,,,,,,,,,,,,,,,
LEVOPHED DRIP 8 MG/250ML KIT,250,RC,VB008388,LOCAL,,inpatient,250,ML,5,5,,,,,,,,,,,,,,,,,
THERAHONEY 15 GM TUBE,250,RC,VB008390,LOCAL,,inpatient,15,GM,13.6,13.6,,,,,,,,,,,,,,,,,
MORPHINE DRIP KIT 100 MG/100ML KIT,250,RC,VB008391,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
POTASSIUM PHOS KIT 20 MMOL/250ML,250,RC,VB008392,LOCAL,,inpatient,250,ML,5,5,,,,,,,,,,,,,,,,,
STOMATITIS COCKTAIL,250,RC,VB008393,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
SURGICEL 2X14IN HEMOSTAT,250,RC,VB008394,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
VANCOMYCIN RECTAL SOLN 500 MG/100ML,250,RC,VB008395,LOCAL,,inpatient,100,ML,10.16,10.16,,,,,,,,,,,,,,,,,
TACROLIMUS 0.5mg/mL - 240mL Bottle,250,RC,VB008396,LOCAL,,inpatient,240,ML,2140.8,2140.8,,,,,,,,,,,,,,,,,
Atogepant,250,RC,VB008398,LOCAL,,inpatient,1,EA,183.55,183.55,,,,,,,,,,,,,,,,,
COVID-19 Vacc Moderna Bival Booster,250,RC,VB008399,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Cyclosporine Oral Soln (BULK),250,RC,VB008403,LOCAL,,inpatient,50,ML,1198.2,1198.2,,,,,,,,,,,,,,,,,
lidocaine HCL 1% Gel (8 oz),250,RC,VB008405,LOCAL,,inpatient,226,GM,27.96,27.96,,,,,,,,,,,,,,,,,
Influenza Vaccine Quad 2022-2023,250,RC,VB008408,LOCAL,,inpatient,0.5,ML,132.91,132.91,,,,,,,,,,,,,,,,,
MARY'S MAGIC MOUTHWASH - 240mL,250,RC,VB008410,LOCAL,,inpatient,240,ML,5,5,,,,,,,,,,,,,,,,,
VALACYCLOVIR SUSPENSION 50 MG/ML,250,RC,VB008411,LOCAL,,inpatient,240,ML,678.72,678.72,,,,,,,,,,,,,,,,,
Flu Vacc Qs2022-23(65yr Up)/Pf,250,RC,VB008412,LOCAL,,inpatient,0.7,ML,291.5,291.5,,,,,,,,,,,,,,,,,
Varicella-Zoster Ge/As01b/Pf,250,RC,VB008422,LOCAL,,inpatient,1,EA,1034.44,1034.44,,,,,,,,,,,,,,,,,
methylphenidate HCL ER,250,RC,VB008423,LOCAL,,inpatient,1,EA,30.74,30.74,,,,,,,,,,,,,,,,,
Insulin Nph Human Isophane,257,RC,VB008429,LOCAL,,inpatient,3,ML,135.74,135.74,,,,,,,,,,,,,,,,,
Suvorexant,250,RC,VB008430,LOCAL,,inpatient,1,EA,74.5,74.5,,,,,,,,,,,,,,,,,
Suvorexant,250,RC,VB008431,LOCAL,,inpatient,1,EA,74.5,74.5,,,,,,,,,,,,,,,,,
Imipenem/Cilastatin/Relebactam,250,RC,VB008432,LOCAL,,inpatient,1,EA,1517.47,1517.47,,,,,,,,,,,,,,,,,
methylPREDNISolone,250,RC,VB008433,LOCAL,,inpatient,1,EA,8.57,8.57,,,,,,,,,,,,,,,,,
Clindamycin Palmitate HCL Oral,250,RC,VB008434,LOCAL,,inpatient,100,ML,156.14,156.14,,,,,,,,,,,,,,,,,
Emollient Base,250,RC,VB008435,LOCAL,,inpatient,1,ea,25.44,25.44,,,,,,,,,,,,,,,,,
Amino Acid 6 % In 5 % Dextrose,250,RC,VB008436,LOCAL,,inpatient,1000,ML,252.67,252.67,,,,,,,,,,,,,,,,,
morphine SULFATE Oral (CONCENTRATE),250,RC,VB008437,LOCAL,,inpatient,120,ML,5,5,,,,,,,,,,,,,,,,,
Iohexol Inj 300 mg/mL - 50mL,250,RC,VB008438,LOCAL,,inpatient,50,ML,228.84,228.84,,,,,,,,,,,,,,,,,
Fluticasone Propionate Nasal,257,RC,VB008439,LOCAL,,inpatient,15.8,ML,81.31,81.31,,,,,,,,,,,,,,,,,
Butalb/Acetaminophen/Caffeine,250,RC,VB008440,LOCAL,,inpatient,1,EA,11.75,11.75,,,,,,,,,,,,,,,,,
"Multivitamin,ther and Minerals",250,RC,VB008441,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Phenylephrine HCL/Hard Fat Supp,257,RC,VB008442,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Benzocaine 10% Dental Gel,250,RC,VB008443,LOCAL,,inpatient,7,GM,14.24,14.24,,,,,,,,,,,,,,,,,
Barium Sulfate 2% - 450mL,250,RC,VB008444,LOCAL,,inpatient,450,ML,5,5,,,,,,,,,,,,,,,,,
Hydrocortisone Acetate 1% Rectal,250,RC,VB008445,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
dexmedeTOMIDine HCL,250,RC,VB008446,LOCAL,,inpatient,4,ML,378.96,378.96,,,,,,,,,,,,,,,,,
Ciclopirox Olamine 0.77% - 30mL,250,RC,VB008447,LOCAL,,inpatient,30,ML,291.24,291.24,,,,,,,,,,,,,,,,,
Sodium Chlor/Hypochlorous Acid,250,RC,VB008448,LOCAL,,inpatient,1,ea,149.18,149.18,,,,,,,,,,,,,,,,,
propranolol HCL ER,250,RC,VB008449,LOCAL,,inpatient,1,EA,15.62,15.62,,,,,,,,,,,,,,,,,
Patiromer Calcium Sorbitex,250,RC,VB008450,LOCAL,,inpatient,1,EA,170.41,170.41,,,,,,,,,,,,,,,,,
Milrinone Lactate IV,250,RC,VB008451,LOCAL,,inpatient,10,ML,38.98,38.98,,,,,,,,,,,,,,,,,
Erythromycin Base DR,250,RC,VB008452,LOCAL,,inpatient,1,EA,42.25,42.25,,,,,,,,,,,,,,,,,
Bamlanivimab,250,RC,VB008461,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Insulin Nph Hum/Reg Insulin 70-30,257,RC,VB008462,LOCAL,,inpatient,3,ML,64.22,64.22,,,,,,,,,,,,,,,,,
Suvorexant,250,RC,VB008463,LOCAL,,inpatient,1,EA,71.09,71.09,,,,,,,,,,,,,,,,,
Methylprednisolone Sod Succ/Pf,250,RC,VB008464,LOCAL,,inpatient,1,EA,330.82,330.82,,,,,,,,,,,,,,,,,
miglitoL,250,RC,VB008465,LOCAL,,inpatient,1,EA,14.5,14.5,,,,,,,,,,,,,,,,,
Onabotulinumtoxina,250,RC,VB008466,LOCAL,,inpatient,1,EA,6201.6,6201.6,,,,,,,,,,,,,,,,,
Camphor/Phenol Gel,257,RC,VB008467,LOCAL,,inpatient,6.5,GM,13.25,13.25,,,,,,,,,,,,,,,,,
Alirocumab Auto-Injector,250,RC,VB008468,LOCAL,,inpatient,1,ML,2688,2688,,,,,,,,,,,,,,,,,
Doxazosin Mesylate ER,250,RC,VB008469,LOCAL,,inpatient,1,EA,31.74,31.74,,,,,,,,,,,,,,,,,
Palbociclib,250,RC,VB008470,LOCAL,,inpatient,1,EA,3762.74,3762.74,,,,,,,,,,,,,,,,,
Niacin ER,250,RC,VB008471,LOCAL,,inpatient,1,EA,35.39,35.39,,,,,,,,,,,,,,,,,
Everolimus,250,RC,VB008472,LOCAL,,inpatient,1,EA,51.6,51.6,,,,,,,,,,,,,,,,,
Guanidine HCL,250,RC,VB008473,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Glyburide/Metformin HCL 5/500MG,250,RC,VB008474,LOCAL,,inpatient,1,EA,6.23,6.23,,,,,,,,,,,,,,,,,
Alendronate Sodium,250,RC,VB008475,LOCAL,,inpatient,1,EA,11.71,11.71,,,,,,,,,,,,,,,,,
oxyMORphone HCL ER,250,RC,VB008476,LOCAL,,inpatient,1,EA,19.14,19.14,,,,,,,,,,,,,,,,,
Metoclopramide HCL Oral,250,RC,VB008477,LOCAL,,inpatient,473,ML,141.6,141.6,,,,,,,,,,,,,,,,,
Estradiol/Norethindrone Ace 1-0.5MG,250,RC,VB008478,LOCAL,,inpatient,1,EA,1064.4,1064.4,,,,,,,,,,,,,,,,,
cefUROXime axetiL Oral Susp,250,RC,VB008479,LOCAL,,inpatient,1,EA,1186.51,1186.51,,,,,,,,,,,,,,,,,
Budesonide Nasal Spray,250,RC,VB008480,LOCAL,,inpatient,8.6,GM,713.47,713.47,,,,,,,,,,,,,,,,,
selegiline HCL ODT,250,RC,VB008481,LOCAL,,inpatient,1,EA,458.23,458.23,,,,,,,,,,,,,,,,,
propranolol HCL ER,250,RC,VB008482,LOCAL,,inpatient,1,EA,15.62,15.62,,,,,,,,,,,,,,,,,
fluvoxaMINE MALEATE ER,250,RC,VB008483,LOCAL,,inpatient,1,EA,40.73,40.73,,,,,,,,,,,,,,,,,
oxyMORphone HCL ER,250,RC,VB008484,LOCAL,,inpatient,1,EA,24.69,24.69,,,,,,,,,,,,,,,,,
morphine SULFATE ER,250,RC,VB008485,LOCAL,,inpatient,1,EA,45.44,45.44,,,,,,,,,,,,,,,,,
Amino Ac 3%/Electrolyte/Glycer,250,RC,VB008486,LOCAL,,inpatient,1000,ML,164.35,164.35,,,,,,,,,,,,,,,,,
Cimetidine,250,RC,VB008487,LOCAL,,inpatient,1,EA,10.45,10.45,,,,,,,,,,,,,,,,,
Nisoldipine ER,250,RC,VB008488,LOCAL,,inpatient,1,EA,65.81,65.81,,,,,,,,,,,,,,,,,
Flurazepam HCL,250,RC,VB008489,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
estradioL 0.025mg/24HR Patch,250,RC,VB008490,LOCAL,,inpatient,1,EA,45.31,45.31,,,,,,,,,,,,,,,,,
Sodium Chloride 0.9% for Inhalation,250,RC,VB008491,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Norethindrone-Ethin Estradiol,250,RC,VB008492,LOCAL,,inpatient,1,EA,5.62,5.62,,,,,,,,,,,,,,,,,
Meperidine HCL,250,RC,VB008493,LOCAL,,inpatient,1,EA,11.07,11.07,,,,,,,,,,,,,,,,,
Aprepitant,250,RC,VB008494,LOCAL,,inpatient,1,EA,815.14,815.14,,,,,,,,,,,,,,,,,
Triamterene/Hydrochlorothiazide,250,RC,VB008495,LOCAL,,inpatient,1,EA,8.31,8.31,,,,,,,,,,,,,,,,,
Aspirin/Calcium Carb/Magnesium,250,RC,VB008496,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Immun Glob G(Igg)/Gly/Iga Ov50,250,RC,VB008497,LOCAL,,inpatient,50,GM,4190.64,4190.64,,,,,,,,,,,,,,,,,
Levocarnitine Tartrate,250,RC,VB008498,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Zileuton,250,RC,VB008499,LOCAL,,inpatient,1,EA,150.36,150.36,,,,,,,,,,,,,,,,,
Lidocaine/Hydrocortisone Ac 3%-0.5%,250,RC,VB008500,LOCAL,,inpatient,7,GM,71.4,71.4,,,,,,,,,,,,,,,,,
Aspirin/Sod Bicarb/Citric Acid,250,RC,VB008501,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Cefdinir Oral Susp (Bulk),250,RC,VB008502,LOCAL,,inpatient,100,ML,323.04,323.04,,,,,,,,,,,,,,,,,
estradioL Gel,250,RC,VB008503,LOCAL,,inpatient,1,EA,768,768,,,,,,,,,,,,,,,,,
HYDROmorphone HCL ER,250,RC,VB008504,LOCAL,,inpatient,1,EA,66.94,66.94,,,,,,,,,,,,,,,,,
Latanoprostene Bunod 0.024% Ophth,250,RC,VB008505,LOCAL,,inpatient,5,ML,2487.94,2487.94,,,,,,,,,,,,,,,,,
Antipyrine/Benzocaine OTIC,250,RC,VB008506,LOCAL,,inpatient,10,ML,47.8,47.8,,,,,,,,,,,,,,,,,
S-Adenosylmethionine Sul Tosyl,250,RC,VB008507,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Calcium Glycerophosphate,250,RC,VB008508,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Cabozantinib S-Malate,250,RC,VB008509,LOCAL,,inpatient,1,EA,4208.19,4208.19,,,,,,,,,,,,,,,,,
Cabozantinib S-Malate,250,RC,VB008510,LOCAL,,inpatient,1,EA,4208.19,4208.19,,,,,,,,,,,,,,,,,
Immun Glob G(Igg)/Pro/Iga 0-50,250,RC,VB008511,LOCAL,,inpatient,1,EA,9037.44,9037.44,,,,,,,,,,,,,,,,,
Fluticasone Propionate 0.005% Oint,250,RC,VB008512,LOCAL,,inpatient,30,GM,137.2,137.2,,,,,,,,,,,,,,,,,
Hydrocortisone 1% Cream,257,RC,VB008513,LOCAL,,inpatient,454,GM,192,192,,,,,,,,,,,,,,,,,
desipramine HCL,250,RC,VB008514,LOCAL,,inpatient,1,EA,25.96,25.96,,,,,,,,,,,,,,,,,
Methyl Salicylate/Menth/Camph,250,RC,VB008515,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Magnesium Sulfate (Epsom Salt),257,RC,VB008516,LOCAL,,inpatient,454,GM,6.36,6.36,,,,,,,,,,,,,,,,,
Pirfenidone,250,RC,VB008517,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Gabapentin Enacarbil ER,250,RC,VB008518,LOCAL,,inpatient,1,EA,89.94,89.94,,,,,,,,,,,,,,,,,
Cyanocobalamin (Vitamin B-12) SL,250,RC,VB008519,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Minocycline HCL,250,RC,VB008520,LOCAL,,inpatient,1,EA,17.41,17.41,,,,,,,,,,,,,,,,,
Evolocumab,250,RC,VB008521,LOCAL,,inpatient,1,ML,2681.18,2681.18,,,,,,,,,,,,,,,,,
Degarelix Acetate Inj,250,RC,VB008522,LOCAL,,inpatient,1,EA,2344.56,2344.56,,,,,,,,,,,,,,,,,
Abiraterone Acetate,250,RC,VB008523,LOCAL,,inpatient,1,EA,957.49,957.49,,,,,,,,,,,,,,,,,
Ibrutinib,250,RC,VB008524,LOCAL,,inpatient,1,EA,2902.72,2902.72,,,,,,,,,,,,,,,,,
doxercalciferoL,250,RC,VB008525,LOCAL,,inpatient,1,EA,161.63,161.63,,,,,,,,,,,,,,,,,
Estrogen/Me-Testosterone 1.25-2.5MG,250,RC,VB008526,LOCAL,,inpatient,1,EA,19.16,19.16,,,,,,,,,,,,,,,,,
Trypsin/Balsam Peru/Castor Oil,250,RC,VB008527,LOCAL,,inpatient,30,GM,112.6,112.6,,,,,,,,,,,,,,,,,
Vit B Comp C No.24/Iron/Folic,250,RC,VB008528,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lenalidomide,250,RC,VB008529,LOCAL,,inpatient,1,EA,4279.44,4279.44,,,,,,,,,,,,,,,,,
Ticlopidine HCL,250,RC,VB008530,LOCAL,,inpatient,1,EA,7.69,7.69,,,,,,,,,,,,,,,,,
PARoxetine HCL ER,250,RC,VB008531,LOCAL,,inpatient,1,EA,36.38,36.38,,,,,,,,,,,,,,,,,
Azilsartan Medoxomil,250,RC,VB008532,LOCAL,,inpatient,1,EA,41.45,41.45,,,,,,,,,,,,,,,,,
Nizatidine Oral Soln,250,RC,VB008533,LOCAL,,inpatient,480,ML,2940.43,2940.43,,,,,,,,,,,,,,,,,
Carteolol HCL 1% Ophth,250,RC,VB008534,LOCAL,,inpatient,10,ML,160.4,160.4,,,,,,,,,,,,,,,,,
Sofosbuvir/Velpatasvir 400-100 MG,250,RC,VB008535,LOCAL,,inpatient,1,EA,4272,4272,,,,,,,,,,,,,,,,,
verapamil HCL ER,250,RC,VB008536,LOCAL,,inpatient,1,EA,28.81,28.81,,,,,,,,,,,,,,,,,
Lenvatinib Mesylate,250,RC,VB008537,LOCAL,,inpatient,1,EA,3997.28,3997.28,,,,,,,,,,,,,,,,,
Lenvatinib Mesylate,250,RC,VB008538,LOCAL,,inpatient,1,EA,1332.43,1332.43,,,,,,,,,,,,,,,,,
fentaNYL CITRATE,250,RC,VB008539,LOCAL,,inpatient,1,EA,377.5,377.5,,,,,,,,,,,,,,,,,
Cyclobenzaprine HCL ER,250,RC,VB008540,LOCAL,,inpatient,1,EA,278.59,278.59,,,,,,,,,,,,,,,,,
oxyMORphone HCL ER,250,RC,VB008541,LOCAL,,inpatient,1,EA,12.54,12.54,,,,,,,,,,,,,,,,,
Permethrin,250,RC,VB008542,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
vancomycin HCL Oral,250,RC,VB008543,LOCAL,,inpatient,300,ML,1248.62,1248.62,,,,,,,,,,,,,,,,,
Pitavastatin Calcium,250,RC,VB008544,LOCAL,,inpatient,1,EA,51.16,51.16,,,,,,,,,,,,,,,,,
Pitavastatin Calcium,250,RC,VB008545,LOCAL,,inpatient,1,EA,51.16,51.16,,,,,,,,,,,,,,,,,
Omeprazole/Sodium Bicarb 20-1680MG,250,RC,VB008546,LOCAL,,inpatient,1,EA,529.09,529.09,,,,,,,,,,,,,,,,,
lamoTRIgine Chewable Tab,250,RC,VB008547,LOCAL,,inpatient,1,EA,17.58,17.58,,,,,,,,,,,,,,,,,
Trandolapril,250,RC,VB008548,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Iron,carbonyl",257,RC,VB008549,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Teduglutide,250,RC,VB008550,LOCAL,,inpatient,1,EA,99999.99,99999.99,,,,,,,,,,,,,,,,,
Obeticholic Acid,250,RC,VB008551,LOCAL,,inpatient,1,EA,1618.84,1618.84,,,,,,,,,,,,,,,,,
Niraparib Tosylate,250,RC,VB008552,LOCAL,,inpatient,1,EA,1383.14,1383.14,,,,,,,,,,,,,,,,,
Calcifediol ER,250,RC,VB008553,LOCAL,,inpatient,1,EA,200.52,200.52,,,,,,,,,,,,,,,,,
Valbenazine Tosylate,250,RC,VB008554,LOCAL,,inpatient,1,EA,1243.2,1243.2,,,,,,,,,,,,,,,,,
Lactobacillus Acidophilus,250,RC,VB008555,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Hyaluronate Sodium Inj,250,RC,VB008557,LOCAL,,inpatient,2,ML,912,912,,,,,,,,,,,,,,,,,
Alpha Lipoic Acid/Biotin,250,RC,VB008562,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
oxyCODONE HCL 1 mg/mL (RX-UD),250,RC,VB008566,LOCAL,,inpatient,500,ML,5,5,,,,,,,,,,,,,,,,,
Atovaquone - UD,250,RC,VB008568,LOCAL,,inpatient,5,ML,77.47,77.47,,,,,,,,,,,,,,,,,
dronabinoL,250,RC,VB008569,LOCAL,,inpatient,1,ea,26.04,26.04,,,,,,,,,,,,,,,,,
Nirmatrelvir/Ritonavir 300-100 MG,250,RC,VB008570,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
ARIPiprazole,250,RC,VB008571,LOCAL,,inpatient,1,EA,128.3,128.3,,,,,,,,,,,,,,,,,
Suvorexant,250,RC,VB008575,LOCAL,,inpatient,1,EA,74.5,74.5,,,,,,,,,,,,,,,,,
Lipase/Protease/Amylase 3K-10K-14K,250,RC,VB008576,LOCAL,,inpatient,1,EA,9.58,9.58,,,,,,,,,,,,,,,,,
penicillAMINE,250,RC,VB008577,LOCAL,,inpatient,1,EA,363.02,363.02,,,,,,,,,,,,,,,,,
dexAMETHasone,250,RC,VB008578,LOCAL,,inpatient,1,EA,7.14,7.14,,,,,,,,,,,,,,,,,
Rituximab-Pvvr,250,RC,VB008579,LOCAL,,inpatient,50,ML,344.06,344.06,,,,,,,,,,,,,,,,,
Ketamine HCL,250,RC,VB008580,LOCAL,,inpatient,5,ML,12.23,12.23,,,,,,,,,,,,,,,,,
Benzocaine 20% Gel,250,RC,VB008581,LOCAL,,inpatient,30,GM,55.4,55.4,,,,,,,,,,,,,,,,,
tacrolimus,250,RC,VB008582,LOCAL,,inpatient,1,EA,24.96,24.96,,,,,,,,,,,,,,,,,
Neostigmine Methylsulfate,250,RC,VB008583,LOCAL,,inpatient,10,ML,15.36,15.36,,,,,,,,,,,,,,,,,
Morphine Sulfate/Pf Inj,250,RC,VB008584,LOCAL,,inpatient,20,ML,84.88,84.88,,,,,,,,,,,,,,,,,
levothyroxine SODIUM,250,RC,VB008585,LOCAL,,inpatient,90,EA,5,5,,,,,,,,,,,,,,,,,
terbinafine HCL 1% Cream (28.4 GM),257,RC,VB008586,LOCAL,,inpatient,28.4,GM,43.96,43.96,,,,,,,,,,,,,,,,,
dronabinoL,250,RC,VB008587,LOCAL,,inpatient,1,EA,29.8,29.8,,,,,,,,,,,,,,,,,
Patiromer Calcium Sorbitex,250,RC,VB008588,LOCAL,,inpatient,1,EA,163.96,163.96,,,,,,,,,,,,,,,,,
Epoetin Alfa 3000 Units/mL,250,RC,VB008589,LOCAL,,inpatient,1,ML,384.86,384.86,,,,,,,,,,,,,,,,,
dilTIAZem HCL ER,250,RC,VB008590,LOCAL,,inpatient,1,EA,5.73,5.73,,,,,,,,,,,,,,,,,
Rituximab-Abbs,250,RC,VB008591,LOCAL,,inpatient,50,ML,405.86,405.86,,,,,,,,,,,,,,,,,
Morphine Sulfate/Pf,250,RC,VB008592,LOCAL,,inpatient,20,ML,54.45,54.45,,,,,,,,,,,,,,,,,
Lipase/Protease/Amylase 40-126-168K,250,RC,VB008593,LOCAL,,inpatient,1,EA,78.18,78.18,,,,,,,,,,,,,,,,,
Midazolam HCL/Pf Inj,250,RC,VB008594,LOCAL,,inpatient,2,ML,15.07,15.07,,,,,,,,,,,,,,,,,
Sodium Chloride 3.5% for Inhalation,250,RC,VB008595,LOCAL,,inpatient,4,ML,5,5,,,,,,,,,,,,,,,,,
Cranberry Conc/C/Bacill Coag,250,RC,VB008596,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Amino Ac 8 %/D14w/Electrolytes,250,RC,VB008598,LOCAL,,inpatient,1000,ML,5,5,,,,,,,,,,,,,,,,,
Ranolazine ER,250,RC,VB008599,LOCAL,,inpatient,1,EA,25.69,25.69,,,,,,,,,,,,,,,,,
Theophylline 100mg/18.75mL (RX-UD),250,RC,VB008600,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
VANCOMYCIN FLUSH 50 mg/10mL,250,RC,VB008603,LOCAL,,inpatient,10,ML,24,24,,,,,,,,,,,,,,,,,
Pregabalin - UD,250,RC,VB008605,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
ANASEPT WOUND CLEANSER SPRAY,250,RC,VB008606,LOCAL,,inpatient,355,ML,54.28,54.28,,,,,,,,,,,,,,,,,
CLOG ZAPPER,250,RC,VB008608,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
FENTANYL HOU DRIP 2500 MCG/50 ML,250,RC,VB008621,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
HEMODIALYSIS ABX LOCK 3 ML,250,RC,VB008623,LOCAL,,inpatient,1,ea,16,16,,,,,,,,,,,,,,,,,
SODIUM CHLORIDE 0.9% FOR TKO 250 ML,250,RC,VB008625,LOCAL,,inpatient,250,ML,5,5,,,,,,,,,,,,,,,,,
methadone HCL 135 mg/13.5mL (RX-UD),250,RC,VB008626,LOCAL,,inpatient,1000,ML,5.4,5.4,,,,,,,,,,,,,,,,,
diphenhydrAMINE HCL Oral (BULK),250,RC,VB008627,LOCAL,,inpatient,118,ML,11.47,11.47,,,,,,,,,,,,,,,,,
Bismuth Subsalicylate (BULK-237ml),250,RC,VB008628,LOCAL,,inpatient,237,ML,14.26,14.26,,,,,,,,,,,,,,,,,
Erythromycin Ethylsuccinate,250,RC,VB008629,LOCAL,,inpatient,100,ML,3175.78,3175.78,,,,,,,,,,,,,,,,,
Potassium Citrate/Citric Acid(BULK),250,RC,VB008630,LOCAL,,inpatient,473,ML,299.04,299.04,,,,,,,,,,,,,,,,,
predniSONE Oral (BULK),250,RC,VB008631,LOCAL,,inpatient,120,ML,384,384,,,,,,,,,,,,,,,,,
Voriconazole Oral Susp (BULK),250,RC,VB008632,LOCAL,,inpatient,75,ML,6753.68,6753.68,,,,,,,,,,,,,,,,,
pyRIDostigmine BROMIDE,250,RC,VB008634,LOCAL,,inpatient,1,EA,34.81,34.81,,,,,,,,,,,,,,,,,
Alendronate Sodium Oral,250,RC,VB008635,LOCAL,,inpatient,75,ML,344.96,344.96,,,,,,,,,,,,,,,,,
morphine SULFATE Inj Carpuject,250,RC,VB008636,LOCAL,,inpatient,1,EA,11.08,11.08,,,,,,,,,,,,,,,,,
NOZIN NASAL SANITIZER,250,RC,VB008637,LOCAL,,inpatient,1,EA,60,60,,,,,,,,,,,,,,,,,
BIOFREEZE 4% GEL,250,RC,VB008638,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Lacosamide Injection,250,RC,VB008644,LOCAL,,inpatient,20,ML,314.45,314.45,,,,,,,,,,,,,,,,,
TPN,250,RC,VB008647,LOCAL,,inpatient,1,ea,600,600,,,,,,,,,,,,,,,,,
CHLOROPHYLL,250,RC,VB008648,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Tobramycin In 0.225% Sod Chlor - UD,250,RC,VB008655,LOCAL,,inpatient,5,ML,515.08,515.08,,,,,,,,,,,,,,,,,
Pregabalin - UD,250,RC,VB008656,LOCAL,,inpatient,1,EA,6.47,6.47,,,,,,,,,,,,,,,,,
Pregabalin - UD,250,RC,VB008657,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Multivit-Min/Folic Acid/Hrb293,250,RC,VB008658,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Tobramycin Sulfate 300 mg/7.5mL,250,RC,VB008661,LOCAL,,inpatient,30,ML,25.8,25.8,,,,,,,,,,,,,,,,,
Abacavir Sulfate 300 mg/15mL(RX-UD),250,RC,VB008669,LOCAL,,inpatient,240,ML,39,39,,,,,,,,,,,,,,,,,
vancomycin HCL Oral 125mg/2.5mL,250,RC,VB008670,LOCAL,,inpatient,150,ML,11.4,11.4,,,,,,,,,,,,,,,,,
Ibuprofen Oral Susp - UD,257,RC,VB008671,LOCAL,,inpatient,5,ML,11.68,11.68,,,,,,,,,,,,,,,,,
Biotin,257,RC,VB008677,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
opium tincture (RX-UD),250,RC,VB008678,LOCAL,,inpatient,118,ML,25.12,25.12,,,,,,,,,,,,,,,,,
Eletriptan Hydrobromide,250,RC,VB008679,LOCAL,,inpatient,1,EA,387.69,387.69,,,,,,,,,,,,,,,,,
Nilotinib HCL,250,RC,VB008680,LOCAL,,inpatient,1,EA,927.63,927.63,,,,,,,,,,,,,,,,,
"Octreotide Acetate,mi-Spheres",250,RC,VB008681,LOCAL,,inpatient,1,EA,22158.24,22158.24,,,,,,,,,,,,,,,,,
Fluocinonide 0.05% Oint,250,RC,VB008682,LOCAL,,inpatient,60,GM,1132,1132,,,,,,,,,,,,,,,,,
piroxicam,250,RC,VB008683,LOCAL,,inpatient,1,EA,17.95,17.95,,,,,,,,,,,,,,,,,
Hydrocortisone 0.5% Oint,257,RC,VB008684,LOCAL,,inpatient,28.35,GM,15.84,15.84,,,,,,,,,,,,,,,,,
Hydrocortisone 2.5% Cream,250,RC,VB008685,LOCAL,,inpatient,30,GM,15.84,15.84,,,,,,,,,,,,,,,,,
Liraglutide Pen-Inj,250,RC,VB008686,LOCAL,,inpatient,3,ML,1295.04,1295.04,,,,,,,,,,,,,,,,,
hydroCHLOROthiazide,250,RC,VB008687,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Fluticasone Propion/Salmeterol,250,RC,VB008688,LOCAL,,inpatient,60,EA,748.75,748.75,,,,,,,,,,,,,,,,,
isoproterenol HCL,250,RC,VB008689,LOCAL,,inpatient,1,ML,7067.78,7067.78,,,,,,,,,,,,,,,,,
"Sod Chlor,bicarb/Squeez Bottle",257,RC,VB008690,LOCAL,,inpatient,1,EA,33.17,33.17,,,,,,,,,,,,,,,,,
acetic acid 0.25% Irrigation,250,RC,VB008691,LOCAL,,inpatient,500,ML,35.95,35.95,,,,,,,,,,,,,,,,,
"Heparin PF 5,000 unit/0.5mL Syringe",250,RC,VB008692,LOCAL,,inpatient,0.5,ML,10.56,10.56,,,,,,,,,,,,,,,,,
Lidocaine/D5W 1000 mg/250mL,250,RC,VB008693,LOCAL,,inpatient,250,ML,37.92,37.92,,,,,,,,,,,,,,,,,
Sincalide,250,RC,VB008694,LOCAL,,inpatient,1,EA,626.22,626.22,,,,,,,,,,,,,,,,,
Parenteral Amino Acid 10% No.6,250,RC,VB008695,LOCAL,,inpatient,500,ML,96.53,96.53,,,,,,,,,,,,,,,,,
piroxicam,250,RC,VB008696,LOCAL,,inpatient,1,EA,10.42,10.42,,,,,,,,,,,,,,,,,
Ethinyl Estradiol/Drospirenone,250,RC,VB008697,LOCAL,,inpatient,1,EA,10.95,10.95,,,,,,,,,,,,,,,,,
Ammonium Alum,250,RC,VB008698,LOCAL,,inpatient,340,ML,5,5,,,,,,,,,,,,,,,,,
Hydrogen Peroxide 3%,250,RC,VB008699,LOCAL,,inpatient,3840,ML,111.44,111.44,,,,,,,,,,,,,,,,,
Bupivacaine HCL 0.25%,250,RC,VB008700,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
DOBUTamine HCL,250,RC,VB008701,LOCAL,,inpatient,20,ML,37.1,37.1,,,,,,,,,,,,,,,,,
Dextrose 70 % In Water,250,RC,VB008702,LOCAL,,inpatient,500,ML,61.25,61.25,,,,,,,,,,,,,,,,,
Lidocaine HCL/Pf,250,RC,VB008703,LOCAL,,inpatient,5,ML,71.95,71.95,,,,,,,,,,,,,,,,,
Glycopyrrolate Inj,250,RC,VB008704,LOCAL,,inpatient,20,ML,613.54,613.54,,,,,,,,,,,,,,,,,
Zinc/Copper/Mangan/Chromic Chl,250,RC,VB008705,LOCAL,,inpatient,10,ML,205.63,205.63,,,,,,,,,,,,,,,,,
Droperidol Inj,250,RC,VB008706,LOCAL,,inpatient,2,ML,51.02,51.02,,,,,,,,,,,,,,,,,
Niacin ER,257,RC,VB008707,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ubidecarenone,257,RC,VB008708,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Isoflurane,250,RC,VB008709,LOCAL,,inpatient,100,ML,115.1,115.1,,,,,,,,,,,,,,,,,
ePHEDrine SULFATE,250,RC,VB008710,LOCAL,,inpatient,1,ML,211.1,211.1,,,,,,,,,,,,,,,,,
"Hyaluronidase, Human 150 unit/mL",250,RC,VB008711,LOCAL,,inpatient,1,ML,267.84,267.84,,,,,,,,,,,,,,,,,
"Hyaluronidase,ovine 200 unit/mL",250,RC,VB008712,LOCAL,,inpatient,1.2,ML,483.3,483.3,,,,,,,,,,,,,,,,,
Castor Oil,257,RC,VB008713,LOCAL,,inpatient,177,ML,5,5,,,,,,,,,,,,,,,,,
Oxycodone Myristate ER,250,RC,VB008714,LOCAL,,inpatient,1,EA,82.61,82.61,,,,,,,,,,,,,,,,,
Eculizumab,250,RC,VB008715,LOCAL,,inpatient,1,EA,31310.4,31310.4,,,,,,,,,,,,,,,,,
Sod.chlorid/Potassium Chloride,250,RC,VB008716,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide Nasal,250,RC,VB008717,LOCAL,,inpatient,10.8,ML,84.64,84.64,,,,,,,,,,,,,,,,,
Nitroglycerin Lingual Spray,250,RC,VB008718,LOCAL,,inpatient,4.1,GM,897.6,897.6,,,,,,,,,,,,,,,,,
Somatropin,250,RC,VB008719,LOCAL,,inpatient,1,EA,5518.27,5518.27,,,,,,,,,,,,,,,,,
Capsaicin 0.025% Patch,250,RC,VB008720,LOCAL,,inpatient,1,EA,7.35,7.35,,,,,,,,,,,,,,,,,
Prasterone (Dhea)/Calcium Carb,250,RC,VB008721,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Alectinib HCL,250,RC,VB008722,LOCAL,,inpatient,1,EA,389.32,389.32,,,,,,,,,,,,,,,,,
Albuterol Sulfate 0.5% Inh Soln,250,RC,VB008723,LOCAL,,inpatient,20,ML,11.59,11.59,,,,,,,,,,,,,,,,,
Norgestimate-Ethinyl Estradiol,250,RC,VB008724,LOCAL,,inpatient,1,EA,8.56,8.56,,,,,,,,,,,,,,,,,
NIFEdipine ER,250,RC,VB008725,LOCAL,,inpatient,1,EA,12.13,12.13,,,,,,,,,,,,,,,,,
dilTIAZem HCL ER,250,RC,VB008726,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lumacaftor/Ivacaftor,250,RC,VB008727,LOCAL,,inpatient,1,EA,995.96,995.96,,,,,,,,,,,,,,,,,
Naltrexone HCL/Bupropion HCL ER,250,RC,VB008728,LOCAL,,inpatient,1,EA,25.01,25.01,,,,,,,,,,,,,,,,,
Desoximetasone 0.05% Gel,250,RC,VB008729,LOCAL,,inpatient,15,GM,367.52,367.52,,,,,,,,,,,,,,,,,
Fremanezumab-Vfrm 225 mg/1.5mL,250,RC,VB008730,LOCAL,,inpatient,1.5,ML,3519.16,3519.16,,,,,,,,,,,,,,,,,
metHOTREXate Oral Soln,250,RC,VB008731,LOCAL,,inpatient,120,ML,100.02,100.02,,,,,,,,,,,,,,,,,
Methotrexate/Pf Inj,250,RC,VB008732,LOCAL,,inpatient,0.4,ML,952.85,952.85,,,,,,,,,,,,,,,,,
Mv-Min 51/Folic Acid/Vit K/Ubi,250,RC,VB008733,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Tolvaptan,250,RC,VB008734,LOCAL,,inpatient,1,EA,1727.98,1727.98,,,,,,,,,,,,,,,,,
Interferon Beta-1a 30 mcg/0.5mL,250,RC,VB008735,LOCAL,,inpatient,1,EA,41461.44,41461.44,,,,,,,,,,,,,,,,,
Pamidronate Disodium,250,RC,VB008736,LOCAL,,inpatient,1,EA,90.19,90.19,,,,,,,,,,,,,,,,,
Oxybutynin Chloride,250,RC,VB008737,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Ofloxacin 0.3% OTIC,250,RC,VB008738,LOCAL,,inpatient,10,ML,1234.24,1234.24,,,,,,,,,,,,,,,,,
guanFACINE HCL ER,250,RC,VB008739,LOCAL,,inpatient,1,EA,41.96,41.96,,,,,,,,,,,,,,,,,
prednisoLONE ACETATE 1% Ophth,250,RC,VB008740,LOCAL,,inpatient,10,ML,442.16,442.16,,,,,,,,,,,,,,,,,
Imm Glob G (Igg)/Sorb/Iga 0-50,250,RC,VB008741,LOCAL,,inpatient,100,ML,2541.12,2541.12,,,,,,,,,,,,,,,,,
Imm Glob G (Igg)/Sorb/Iga 0-50,250,RC,VB008742,LOCAL,,inpatient,400,ML,10164.48,10164.48,,,,,,,,,,,,,,,,,
Calcium Gluconate 10%,250,RC,VB008743,LOCAL,,inpatient,50,ML,5,5,,,,,,,,,,,,,,,,,
"Bupivacaine/Epi 0.25%/1:200,000",250,RC,VB008744,LOCAL,,inpatient,10,ML,32.21,32.21,,,,,,,,,,,,,,,,,
Acetylcysteine 20% Inhal Soln,250,RC,VB008745,LOCAL,,inpatient,30,ML,124.85,124.85,,,,,,,,,,,,,,,,,
oxyMORphone HCL ER,250,RC,VB008746,LOCAL,,inpatient,1,EA,67.41,67.41,,,,,,,,,,,,,,,,,
Protriptyline HCL,250,RC,VB008747,LOCAL,,inpatient,1,EA,13.21,13.21,,,,,,,,,,,,,,,,,
Chlorthalidone,250,RC,VB008748,LOCAL,,inpatient,1,EA,5.95,5.95,,,,,,,,,,,,,,,,,
Peg3350/Sod Sul/Nacl/Kcl/Asb/C,250,RC,VB008749,LOCAL,,inpatient,1,EA,604.22,604.22,,,,,,,,,,,,,,,,,
Nesiritide,250,RC,VB008750,LOCAL,,inpatient,1,EA,5080.85,5080.85,,,,,,,,,,,,,,,,,
Bosentan,250,RC,VB008751,LOCAL,,inpatient,1,EA,1073.1,1073.1,,,,,,,,,,,,,,,,,
Treprostinil Diolamine ER,250,RC,VB008752,LOCAL,,inpatient,1,EA,71.26,71.26,,,,,,,,,,,,,,,,,
Granisetron HCL/Pf,250,RC,VB008753,LOCAL,,inpatient,1,ML,48,48,,,,,,,,,,,,,,,,,
Acetaminophen 325mg/10.15mL,257,RC,VB008754,LOCAL,,inpatient,10.15,ML,5,5,,,,,,,,,,,,,,,,,
L-Norgest/E.estradiol-E.estrad,250,RC,VB008755,LOCAL,,inpatient,1,EA,13.4,13.4,,,,,,,,,,,,,,,,,
Immune Globulin(Human) IV,250,RC,VB008756,LOCAL,,inpatient,20,ML,1864.8,1864.8,,,,,,,,,,,,,,,,,
Immune Globulin(Human) IV,250,RC,VB008757,LOCAL,,inpatient,50,ML,4662,4662,,,,,,,,,,,,,,,,,
Immune Globulin(Human) IV,250,RC,VB008758,LOCAL,,inpatient,200,ML,18648,18648,,,,,,,,,,,,,,,,,
Immune Globulin(Human) IV,250,RC,VB008759,LOCAL,,inpatient,300,ML,27972,27972,,,,,,,,,,,,,,,,,
Crofelemer DR,250,RC,VB008760,LOCAL,,inpatient,1,EA,207.44,207.44,,,,,,,,,,,,,,,,,
levOCARNitine,250,RC,VB008761,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Black Cohosh,250,RC,VB008762,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Benzocaine/Benzethon Cl Spray,250,RC,VB008763,LOCAL,,inpatient,78,ML,5,5,,,,,,,,,,,,,,,,,
haloperidoL LACTATE,250,RC,VB008764,LOCAL,,inpatient,1,ML,19.2,19.2,,,,,,,,,,,,,,,,,
Multivit-Min/Iron/Folic/Hrb186,250,RC,VB008765,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
tacrolimus - UD,250,RC,VB008767,LOCAL,,inpatient,1,EA,5.04,5.04,,,,,,,,,,,,,,,,,
tacrolimus - UD,250,RC,VB008768,LOCAL,,inpatient,1,EA,6.56,6.56,,,,,,,,,,,,,,,,,
PROCEDURE KIT,250,RC,VB008771,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
TACROLIMUS 2 MG/4ML ORAL SOLN,250,RC,VB008772,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Testosterone Cypionate Inj,250,RC,VB008773,LOCAL,,inpatient,1,ML,105.55,105.55,,,,,,,,,,,,,,,,,
Tacrolimus 1 mg/2mL Oral,250,RC,VB008777,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
levOCARNitine 330 mg/3.3mL (RX-UD),250,RC,VB008780,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
Lisdexamfetamine Dimesylate,250,RC,VB008782,LOCAL,,inpatient,1,EA,62.05,62.05,,,,,,,,,,,,,,,,,
Vitamin K Oral Soln 5 mg/5mL,250,RC,VB008784,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
Pantoprazole Slurry,250,RC,VB008788,LOCAL,,inpatient,20,ML,13.64,13.64,,,,,,,,,,,,,,,,,
Potassium Citrate ER,250,RC,VB008791,LOCAL,,inpatient,1,EA,10.65,10.65,,,,,,,,,,,,,,,,,
levothyroxine SODIUM,250,RC,VB008793,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
LACTULOSE IN NS ENEMA 200 GM/1000ML,250,RC,VB008794,LOCAL,,inpatient,1000,ML,6.4,6.4,,,,,,,,,,,,,,,,,
mycophenolate mofetiL - UD,250,RC,VB008796,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ertapenem Sodium,250,RC,VB008797,LOCAL,,inpatient,1,ea,561.94,561.94,,,,,,,,,,,,,,,,,
Calcium Alginate/Honey,250,RC,VB008801,LOCAL,,inpatient,1,EA,22.84,22.84,,,,,,,,,,,,,,,,,
Glutamine,250,RC,VB008802,LOCAL,,inpatient,1,EA,98.4,98.4,,,,,,,,,,,,,,,,,
"Calcitonin,salmon Inj 400 units/2mL",250,RC,VB008803,LOCAL,,inpatient,2,ML,3840,3840,,,,,,,,,,,,,,,,,
Glutamine,250,RC,VB008804,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ferrous Sulfate Enteric-Coated,250,RC,VB008805,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Nortriptyline HCL Oral Soln,250,RC,VB008807,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Mometasone Furoate,250,RC,VB008808,LOCAL,,inpatient,1,EA,186.24,186.24,,,,,,,,,,,,,,,,,
methylphenidate 20mg/9HR patch,250,RC,VB008810,LOCAL,,inpatient,30,EA,67.03,67.03,,,,,,,,,,,,,,,,,
Vitamin A/Vit C/Zinc/Propolis,250,RC,VB008811,LOCAL,,inpatient,100,EA,5,5,,,,,,,,,,,,,,,,,
propranolol HCL Oral Soln,250,RC,VB008812,LOCAL,,inpatient,500,ML,5,5,,,,,,,,,,,,,,,,,
Dopamine/D5W 800mg/500mL,250,RC,VB008813,LOCAL,,inpatient,500,ML,110.69,110.69,,,,,,,,,,,,,,,,,
dilTIAZem HCL ER 12HR,250,RC,VB008814,LOCAL,,inpatient,1,EA,18.9,18.9,,,,,,,,,,,,,,,,,
fentaNYL 37.5 MCG/HR PATCH,250,RC,VB008815,LOCAL,,inpatient,1,EA,261.26,261.26,,,,,,,,,,,,,,,,,
Iohexol 350mg/mL - 125mL,250,RC,VB008816,LOCAL,,inpatient,125,ML,5,5,,,,,,,,,,,,,,,,,
HYDROmorphone HCL Inj,250,RC,VB008817,LOCAL,,inpatient,1,ML,12.29,12.29,,,,,,,,,,,,,,,,,
Vasopressin,250,RC,VB008818,LOCAL,,inpatient,10,ML,7.75,7.75,,,,,,,,,,,,,,,,,
Pot Chloride/Pot Bicarb/Cit Ac,250,RC,VB008819,LOCAL,,inpatient,1,EA,5.71,5.71,,,,,,,,,,,,,,,,,
Vit C/E/Zn/Coppr/Lutein/Zeaxan,250,RC,VB008820,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Hydrocortisone Valerate 0.2% - 15GM,250,RC,VB008821,LOCAL,,inpatient,15,GM,171.94,171.94,,,,,,,,,,,,,,,,,
Omega-3 Fatty Acids,250,RC,VB008822,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
B Complex C No.10/Folic Acid,257,RC,VB008823,LOCAL,,inpatient,237,ML,5,5,,,,,,,,,,,,,,,,,
AMIKACIN INHALATION,250,RC,VB008825,LOCAL,,inpatient,4,ML,28,28,,,,,,,,,,,,,,,,,
COLISTIMETHATE INHALATION,250,RC,VB008826,LOCAL,,inpatient,1,ea,37,37,,,,,,,,,,,,,,,,,
GENTAMICIN INHALATION,250,RC,VB008827,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
mycophenolate mofetiL 250mg/1.25mL,250,RC,VB008828,LOCAL,,inpatient,160,ML,36.24,36.24,,,,,,,,,,,,,,,,,
NO WARFARIN TODAY,250,RC,VB008829,LOCAL,,inpatient,1,ea,36.24,36.24,,,,,,,,,,,,,,,,,
TOBRAMYCIN INHALATION,250,RC,VB008831,LOCAL,,inpatient,1,ea,12.96,12.96,,,,,,,,,,,,,,,,,
Lumateperone Tosylate,250,RC,VB008832,LOCAL,,inpatient,1,EA,273.59,273.59,,,,,,,,,,,,,,,,,
Custom TPN,250,RC,VB008833,LOCAL,,inpatient,1000,ML,520,520,,,,,,,,,,,,,,,,,
Cosyntropin,250,RC,VB008836,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Leuprolide Acetate,250,RC,VB008837,LOCAL,,inpatient,1,EA,6504.34,6504.34,,,,,,,,,,,,,,,,,
Cyanocobalamin ER,250,RC,VB008838,LOCAL,,inpatient,110,EA,5,5,,,,,,,,,,,,,,,,,
Lacosamide Oral 75mg/7.5mL (RX-UD),250,RC,VB008844,LOCAL,,inpatient,200,ML,74.4,74.4,,,,,,,,,,,,,,,,,
Brivaracetam Oral (RX-UD),250,RC,VB008845,LOCAL,,inpatient,300,ML,103.8,103.8,,,,,,,,,,,,,,,,,
PHENobarbitaL 30mg/7.5mL (RX-UD),250,RC,VB008849,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
cloBAZam 10 mg/4mL (RX-UD),250,RC,VB008850,LOCAL,,inpatient,120,ML,13.28,13.28,,,,,,,,,,,,,,,,,
cloBAZam 7.5 mg/3mL (RX-UD),250,RC,VB008851,LOCAL,,inpatient,120,ML,9.96,9.96,,,,,,,,,,,,,,,,,
Celecoxib - UD,250,RC,VB008853,LOCAL,,inpatient,1,EA,5.79,5.79,,,,,,,,,,,,,,,,,
AMANTADINE 50 MG**,250,RC,VB008856,LOCAL,,inpatient,1,EA,9.12,9.12,,,,,,,,,,,,,,,,,
Multivitamin w/Extra C,257,RC,VB008857,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"nystatin 100,000 unit/GM Powder",250,RC,VB008858,LOCAL,,inpatient,60,GM,383.52,383.52,,,,,,,,,,,,,,,,,
Triamcinolone Acet 0.1% Cream 30GM,250,RC,VB008863,LOCAL,,inpatient,30,GM,33.6,33.6,,,,,,,,,,,,,,,,,
Diclofenac 1% Gel - 50 GM,250,RC,VB008865,LOCAL,,inpatient,50,GM,39.96,39.96,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB008866,LOCAL,,inpatient,1,EA,102.72,102.72,,,,,,,,,,,,,,,,,
Sevelamer Carbonate,250,RC,VB008867,LOCAL,,inpatient,1,EA,8.17,8.17,,,,,,,,,,,,,,,,,
tacrolimus (SL USE ONLY),250,RC,VB008868,LOCAL,,inpatient,1,EA,6.56,6.56,,,,,,,,,,,,,,,,,
Insulin Glargine-Yfgn PEN,250,RC,VB008869,LOCAL,,inpatient,3,ML,5,5,,,,,,,,,,,,,,,,,
Insulin Glargine-Yfgn PEN,250,RC,VB008870,LOCAL,,inpatient,3,ML,88.32,88.32,,,,,,,,,,,,,,,,,
Roflumilast,250,RC,VB008873,LOCAL,,inpatient,1,EA,49.53,49.53,,,,,,,,,,,,,,,,,
Rufinamide Oral 400mg/10mL (RX-UD),250,RC,VB008876,LOCAL,,inpatient,460,ML,160.48,160.48,,,,,,,,,,,,,,,,,
Prucalopride Succinate,250,RC,VB008877,LOCAL,,inpatient,30,EA,84.91,84.91,,,,,,,,,,,,,,,,,
Triamcinolone Acet Nasal Spray,250,RC,VB008883,LOCAL,,inpatient,16.9,ML,67.4,67.4,,,,,,,,,,,,,,,,,
docosanoL 10% Cream,257,RC,VB008884,LOCAL,,inpatient,2,GM,60.48,60.48,,,,,,,,,,,,,,,,,
Asenapine Maleate SL,250,RC,VB008885,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Omeprazole/Amoxicill/Rifabutin,250,RC,VB008886,LOCAL,,inpatient,1,ea,23.88,23.88,,,,,,,,,,,,,,,,,
Methsuximide,250,RC,VB008887,LOCAL,,inpatient,1,EA,22.04,22.04,,,,,,,,,,,,,,,,,
Vit A/Vit C/Vit E/Zinc/Copper,250,RC,VB008892,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ioversol Inj 68%,250,RC,VB008896,LOCAL,,inpatient,100,ML,417.6,417.6,,,,,,,,,,,,,,,,,
Ioversol Inj 64%,250,RC,VB008897,LOCAL,,inpatient,100,ML,432,432,,,,,,,,,,,,,,,,,
Filgrastim-Aafi,250,RC,VB008898,LOCAL,,inpatient,0.5,ML,1051.2,1051.2,,,,,,,,,,,,,,,,,
Filgrastim-Aafi,250,RC,VB008899,LOCAL,,inpatient,0.8,ML,1681.92,1681.92,,,,,,,,,,,,,,,,,
Acetaminophen-Codeine 120-12 MG/5ML,250,RC,VB008900,LOCAL,,inpatient,5,ML,11.28,11.28,,,,,,,,,,,,,,,,,
Phenylephrine HCL 1% Nasal Spray,257,RC,VB008901,LOCAL,,inpatient,15,ML,18.67,18.67,,,,,,,,,,,,,,,,,
Dextrose 2.5%/NaCl 0.45% 1000mL,250,RC,VB008902,LOCAL,,inpatient,1000,ML,19,19,,,,,,,,,,,,,,,,,
Lactated Ringers 250mL,250,RC,VB008903,LOCAL,,inpatient,250,ML,22.13,22.13,,,,,,,,,,,,,,,,,
TPN Electrolytes,250,RC,VB008904,LOCAL,,inpatient,20,ML,49.54,49.54,,,,,,,,,,,,,,,,,
Lactated Ringers 500mL,250,RC,VB008905,LOCAL,,inpatient,500,ML,27.98,27.98,,,,,,,,,,,,,,,,,
Benzocaine 20% Oral Gel,250,RC,VB008906,LOCAL,,inpatient,1,EA,25.01,25.01,,,,,,,,,,,,,,,,,
lidocaine HCL 2% Jelly Syringe,250,RC,VB008907,LOCAL,,inpatient,6,ML,28.56,28.56,,,,,,,,,,,,,,,,,
Vasopressin 20 unit/100mL,250,RC,VB008908,LOCAL,,inpatient,100,ML,240,240,,,,,,,,,,,,,,,,,
Dantrolene Sodium,250,RC,VB008909,LOCAL,,inpatient,1,ea,13257.44,13257.44,,,,,,,,,,,,,,,,,
Esmolol/Sterile Water 2500mg/250mL,250,RC,VB008910,LOCAL,,inpatient,250,ML,573.6,573.6,,,,,,,,,,,,,,,,,
Menthol 1.25% Patch,250,RC,VB008911,LOCAL,,inpatient,1,ea,5,5,,,,,,,,,,,,,,,,,
Sodium Chl/Hypochlorous Acid Irrig,250,RC,VB008912,LOCAL,,inpatient,250,ML,83.18,83.18,,,,,,,,,,,,,,,,,
Sodium Chl/Hypochlorous Acid Irrig,250,RC,VB008913,LOCAL,,inpatient,1000,ML,288.58,288.58,,,,,,,,,,,,,,,,,
"Iron Fum/Folic Acid/Mv,min 15",250,RC,VB008914,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Minocycline HCL,250,RC,VB008915,LOCAL,,inpatient,1,EA,24.08,24.08,,,,,,,,,,,,,,,,,
Hydrocodone/Chlorphen Suspension,250,RC,VB008916,LOCAL,,inpatient,118,ML,5,5,,,,,,,,,,,,,,,,,
Lidocaine HCL/Epinephrine 1%-1:100K,250,RC,VB008917,LOCAL,,inpatient,10,ML,19.01,19.01,,,,,,,,,,,,,,,,,
Fentanyl Citrate/Pf Inj,250,RC,VB008918,LOCAL,,inpatient,1,ML,10.61,10.61,,,,,,,,,,,,,,,,,
sodium acetate Inj,250,RC,VB008919,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
Phenobarb/Hyoscy/Atropine/Scop,250,RC,VB008920,LOCAL,,inpatient,120,ML,10.67,10.67,,,,,,,,,,,,,,,,,
Zinc Oxide/Cod Liver Oil 40%% Paste,250,RC,VB008921,LOCAL,,inpatient,57,GM,5,5,,,,,,,,,,,,,,,,,
Hydrocortisone Acetate 0.5% Cream,250,RC,VB008922,LOCAL,,inpatient,28.4,GM,5,5,,,,,,,,,,,,,,,,,
PRIMIDONE 25MG**,250,RC,VB008926,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
SOTALOL 40 MG**,250,RC,VB008927,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lidocaine 4% Cream 77 GM,257,RC,VB008930,LOCAL,,inpatient,77,GM,63.48,63.48,,,,,,,,,,,,,,,,,
sildenafiL CITRATE - UD,250,RC,VB008932,LOCAL,,inpatient,1,EA,80.91,80.91,,,,,,,,,,,,,,,,,
Pramipexole Dihydrochloride,250,RC,VB008933,LOCAL,,inpatient,1,EA,11.8,11.8,,,,,,,,,,,,,,,,,
Pramipexole Dihydrochloride - UD,250,RC,VB008934,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
norethindrone-e.estradioL-iron,250,RC,VB008935,LOCAL,,inpatient,1,EA,115.76,115.76,,,,,,,,,,,,,,,,,
CHOLECALCIFEROL 250 MCG,257,RC,VB008936,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
FORTIFIED VANCOMYCIN OPHTHALMIC,250,RC,VB008938,LOCAL,,inpatient,15,ML,93.6,93.6,,,,,,,,,,,,,,,,,
Multivit-Min/Fa/Lycopen/Lutein,257,RC,VB008939,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Erenumab-Aooe,250,RC,VB008943,LOCAL,,inpatient,1,ML,3684.82,3684.82,,,,,,,,,,,,,,,,,
Insulin Regular 500 UNIT/ML,250,RC,VB008945,LOCAL,,inpatient,20,ML,7.12,7.12,,,,,,,,,,,,,,,,,
Gabapentin Oral Soln - UD,250,RC,VB008946,LOCAL,,inpatient,5,ML,28.84,28.84,,,,,,,,,,,,,,,,,
Semaglutide Injection,250,RC,VB008947,LOCAL,,inpatient,3,ML,4788.38,4788.38,,,,,,,,,,,,,,,,,
diazePAM Nasal Spray,250,RC,VB008965,LOCAL,,inpatient,1,EA,1756.49,1756.49,,,,,,,,,,,,,,,,,
Sirolimus Oral Soln (RX-UD),250,RC,VB008966,LOCAL,,inpatient,60,ML,505.28,505.28,,,,,,,,,,,,,,,,,
Midazolam Nasal Spray,636,RC,VB008967,LOCAL,,inpatient,2,ML,1600.63,1600.63,,,,,,,,,,,,,,,,,
Filgrastim-Aafi 300MCG/0.5ML,250,RC,VB008977,LOCAL,,inpatient,0.5,ML,1051.2,1051.2,,,,,,,,,,,,,,,,,
Filgrastim-Aafi 480MCG/0.8ML,250,RC,VB008978,LOCAL,,inpatient,0.8,ML,1681.92,1681.92,,,,,,,,,,,,,,,,,
Argatroban In NS 50 mg/50mL,250,RC,VB008979,LOCAL,,inpatient,50,ML,950.4,950.4,,,,,,,,,,,,,,,,,
Sucralfate Oral Susp,250,RC,VB008980,LOCAL,,inpatient,420,ML,5,5,,,,,,,,,,,,,,,,,
Aa 2.75 %/Calcium/Lytes/D5w,250,RC,VB008981,LOCAL,,inpatient,2000,ML,253.2,253.2,,,,,,,,,,,,,,,,,
Amitriptyline/Chlordiazep 25mg-10mg,250,RC,VB008982,LOCAL,,inpatient,1,EA,8.65,8.65,,,,,,,,,,,,,,,,,
Ampicillin Sod/Sulbactam Sod,250,RC,VB008983,LOCAL,,inpatient,1,EA,44.34,44.34,,,,,,,,,,,,,,,,,
Piperacillin Sodium/Tazobactam,250,RC,VB008984,LOCAL,,inpatient,1,EA,315.17,315.17,,,,,,,,,,,,,,,,,
Phenylephrine HCL Inj,250,RC,VB008985,LOCAL,,inpatient,10,ML,19.2,19.2,,,,,,,,,,,,,,,,,
Sodium Chlor/Sodium Bicarb Powder,250,RC,VB008986,LOCAL,,inpatient,1,EA,72.19,72.19,,,,,,,,,,,,,,,,,
Magnesium Hydroxide,257,RC,VB008987,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Neomycin/Polym B 40mg/200K Units/mL,250,RC,VB008988,LOCAL,,inpatient,20,ML,680,680,,,,,,,,,,,,,,,,,
Hydrocortisone 1% Ointment - 28GM,250,RC,VB008989,LOCAL,,inpatient,28,GM,15.96,15.96,,,,,,,,,,,,,,,,,
"Mineral,lanolin Oils/Prop Gl Lotion",250,RC,VB008990,LOCAL,,inpatient,1,ea,49.36,49.36,,,,,,,,,,,,,,,,,
Emollient Combination No.71 Lotion,250,RC,VB008991,LOCAL,,inpatient,1,ea,12.86,12.86,,,,,,,,,,,,,,,,,
Urea Cream 10% - 85 GM,250,RC,VB008992,LOCAL,,inpatient,1,ea,36,36,,,,,,,,,,,,,,,,,
raNITIdine HCL Syrup,250,RC,VB008993,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
diphenhydrAMINE HCL Oral Liquid,257,RC,VB008994,LOCAL,,inpatient,10,ML,9.6,9.6,,,,,,,,,,,,,,,,,
Glucagon HCL,250,RC,VB008995,LOCAL,,inpatient,1,EA,720,720,,,,,,,,,,,,,,,,,
Miconazole Nitrate 2% Powder,250,RC,VB008996,LOCAL,,inpatient,1,EA,15.4,15.4,,,,,,,,,,,,,,,,,
HYDROcodone/APAP 2.5-108 MG/5 ML,250,RC,VB008997,LOCAL,,inpatient,5,ML,18.44,18.44,,,,,,,,,,,,,,,,,
Hydrocortisone 1% Cream (30 GM),257,RC,VB008998,LOCAL,,inpatient,30,GM,15.96,15.96,,,,,,,,,,,,,,,,,
Zinc Oxide 20% Oint (30 GM),257,RC,VB008999,LOCAL,,inpatient,30,GM,26.24,26.24,,,,,,,,,,,,,,,,,
Phytonadione (Vit K1) Inj,250,RC,VB009000,LOCAL,,inpatient,1,ML,205.3,205.3,,,,,,,,,,,,,,,,,
Desmopressin Acetate Inj,250,RC,VB009001,LOCAL,,inpatient,10,ML,189.6,189.6,,,,,,,,,,,,,,,,,
Fluorometholone Acetate 0.1% Ophth,250,RC,VB009002,LOCAL,,inpatient,5,ML,600.1,600.1,,,,,,,,,,,,,,,,,
Benzocaine/Menthol Lozenge,250,RC,VB009003,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Acetaminophen Oral Soln,250,RC,VB009004,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
Sodium Chloride 0.65% Nasal Spray,250,RC,VB009005,LOCAL,,inpatient,1,EA,17.56,17.56,,,,,,,,,,,,,,,,,
Fluocinolone Acet 0.01% OTIC,250,RC,VB009012,LOCAL,,inpatient,20,ML,356.16,356.16,,,,,,,,,,,,,,,,,
Everolimus - UD,250,RC,VB009013,LOCAL,,inpatient,1,EA,80.28,80.28,,,,,,,,,,,,,,,,,
Lacosamide Oral - UD,250,RC,VB009014,LOCAL,,inpatient,10,ML,196.12,196.12,,,,,,,,,,,,,,,,,
BLACK ELDERBERRY SYRUP*,257,RC,VB009015,LOCAL,,inpatient,120,ML,5,5,,,,,,,,,,,,,,,,,
Escitalopram Oral Soln (RX-UD),250,RC,VB009016,LOCAL,,inpatient,240,ML,5,5,,,,,,,,,,,,,,,,,
GATHE MAGIC PASTE,250,RC,VB009017,LOCAL,,inpatient,1,EA,20,20,,,,,,,,,,,,,,,,,
NON-FORMULARY IVPB - 100 ML,250,RC,VB009020,LOCAL,,inpatient,100,ML,5,5,,,,,,,,,,,,,,,,,
Lipase/Protease/Amylase DR,250,RC,VB009021,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lurasidone HCL,250,RC,VB009022,LOCAL,,inpatient,1,EA,204.13,204.13,,,,,,,,,,,,,,,,,
Lurasidone HCL,250,RC,VB009023,LOCAL,,inpatient,1,EA,204.13,204.13,,,,,,,,,,,,,,,,,
Cariprazine HCL,250,RC,VB009024,LOCAL,,inpatient,1,EA,243.02,243.02,,,,,,,,,,,,,,,,,
Cenobamate,250,RC,VB009026,LOCAL,,inpatient,1,EA,194.47,194.47,,,,,,,,,,,,,,,,,
Magnesium Carbonate (RX-UD),257,RC,VB009027,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Varenicline Tartrate - UD,250,RC,VB009030,LOCAL,,inpatient,1,EA,62.49,62.49,,,,,,,,,,,,,,,,,
Iopamidol Injection 61%,250,RC,VB009032,LOCAL,,inpatient,30,ML,105.84,105.84,,,,,,,,,,,,,,,,,
Insulin Aspart 100 UNIT/ML,250,RC,VB009033,LOCAL,,inpatient,10,ML,1.36,1.36,,,,,,,,,,,,,,,,,
Insulin Regular 100 UNIT/ML,250,RC,VB009034,LOCAL,,inpatient,10,ML,0.64,0.64,,,,,,,,,,,,,,,,,
Norgestimate-Ethinyl Estradiol,250,RC,VB009035,LOCAL,,inpatient,1,EA,20.95,20.95,,,,,,,,,,,,,,,,,
Phenylephrine HCL Injection,250,RC,VB009037,LOCAL,,inpatient,5,ML,24,24,,,,,,,,,,,,,,,,,
Lacosamide Oral Soln (RX-UD),250,RC,VB009043,LOCAL,,inpatient,200,ML,209.6,209.6,,,,,,,,,,,,,,,,,
Potassium Iodide/Iodine Soln,250,RC,VB009044,LOCAL,,inpatient,14,ML,154.8,154.8,,,,,,,,,,,,,,,,,
Lacosamide,250,RC,VB009047,LOCAL,,inpatient,20,ML,464,464,,,,,,,,,,,,,,,,,
LACOSAMIDE IV 150 MG/100ML NS,250,RC,VB009048,LOCAL,,inpatient,100,ML,444.24,444.24,,,,,,,,,,,,,,,,,
TACROLIMUS ORAL 2.5 mg/5mL,250,RC,VB009052,LOCAL,,inpatient,5,ML,17.4,17.4,,,,,,,,,,,,,,,,,
TACROLIMUS 3.5 mg/7mL ORAL SOLN,250,RC,VB009054,LOCAL,,inpatient,7,ML,24.36,24.36,,,,,,,,,,,,,,,,,
TACROLIMUS 4 mg/8mL ORAL SOLN,250,RC,VB009055,LOCAL,,inpatient,8,ML,27.84,27.84,,,,,,,,,,,,,,,,,
Fentanyl Cit in NS 1000 mcg/100mL,250,RC,VB009056,LOCAL,,inpatient,100,ML,108,108,,,,,,,,,,,,,,,,,
cefPODOXime proxetiL,250,RC,VB009064,LOCAL,,inpatient,100,ML,6.56,6.56,,,,,,,,,,,,,,,,,
Albuterol Sulfate Oral Soln,250,RC,VB009067,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
EMPTY IV CONTAINER - 50 ML,250,RC,VB009069,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Mag Carb/Aluminum Hydrox/Algin,257,RC,VB009070,LOCAL,,inpatient,355,ML,21.07,21.07,,,,,,,,,,,,,,,,,
levETIRAcetam Oral,250,RC,VB009071,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
SODIUM PHOSPHATE 15mmol/NS 100ml IV,250,RC,VB009072,LOCAL,,inpatient,100,ML,31.68,31.68,,,,,,,,,,,,,,,,,
SODIUM PHOSPHATE 30mmol/NS 250mL IV,250,RC,VB009073,LOCAL,,inpatient,250,ML,31.68,31.68,,,,,,,,,,,,,,,,,
Calcium Gluconate/Sod Chloride IV,250,RC,VB009075,LOCAL,,inpatient,100,ML,60.86,60.86,,,,,,,,,,,,,,,,,
Potassium Chloride Inj,250,RC,VB009076,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
Venlafaxine HCL ER Tab,250,RC,VB009081,LOCAL,,inpatient,1,EA,24.7,24.7,,,,,,,,,,,,,,,,,
buprenorphine HCL Film,250,RC,VB009082,LOCAL,,inpatient,1,EA,77.09,77.09,,,,,,,,,,,,,,,,,
Ceftazidime/Avibactam 0.94 GM/100ML,250,RC,VB009083,LOCAL,,inpatient,100,ML,679.92,679.92,,,,,,,,,,,,,,,,,
Ceftazidime/Avibactam 1.25 GM/100mL,250,RC,VB009084,LOCAL,,inpatient,100,ML,904.2,904.2,,,,,,,,,,,,,,,,,
CHOLESTYRAMINE 4 GM/BOUDREAUXS,250,RC,VB009085,LOCAL,,inpatient,60,GM,39.8,39.8,,,,,,,,,,,,,,,,,
Daridorexant HCL,250,RC,VB009087,LOCAL,,inpatient,1,EA,81.45,81.45,,,,,,,,,,,,,,,,,
Vitamin E Acet./Safflower Oil,250,RC,VB009088,LOCAL,,inpatient,52,ML,31.56,31.56,,,,,,,,,,,,,,,,,
Epoetin Alfa 3000 unit/mL,250,RC,VB009089,LOCAL,,inpatient,1,ML,238.75,238.75,,,,,,,,,,,,,,,,,
Venlafaxine HCL ER,250,RC,VB009090,LOCAL,,inpatient,1,EA,30.15,30.15,,,,,,,,,,,,,,,,,
CHOLECALCIFEROL,257,RC,VB009091,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
methadone HCL Oral 36 mg/3.6mL,250,RC,VB009095,LOCAL,,inpatient,30,ML,12.24,12.24,,,,,,,,,,,,,,,,,
Morphine Sulfate/Pf Inj (Mitigo),250,RC,VB009096,LOCAL,,inpatient,20,ML,84.95,84.95,,,,,,,,,,,,,,,,,
CARBIDOPA/LEVODOPA CR 12.5/50 MG,250,RC,VB009097,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Ferric Subsulfate Soln 20-22%,250,RC,VB009099,LOCAL,,inpatient,8,ML,5,5,,,,,,,,,,,,,,,,,
Mupirocin 2% Oint - 15 GM,250,RC,VB009101,LOCAL,,inpatient,15,GM,68.2,68.2,,,,,,,,,,,,,,,,,
Phenobarbital in NS IVPB,250,RC,VB009103,LOCAL,,inpatient,50,ML,126.48,126.48,,,,,,,,,,,,,,,,,
Lidocaine 4%/Menthol 1% Spray,257,RC,VB009105,LOCAL,,inpatient,1,EA,54.68,54.68,,,,,,,,,,,,,,,,,
BIOTIN TAB,257,RC,VB009107,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Omadacycline Tosylate - UD,250,RC,VB009109,LOCAL,,inpatient,1,EA,1263.14,1263.14,,,,,,,,,,,,,,,,,
granisetron HCL - UD,250,RC,VB009110,LOCAL,,inpatient,1,EA,236.22,236.22,,,,,,,,,,,,,,,,,
Carbidopa/Levodopa ODT,250,RC,VB009111,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
MORPHINE IV 250 MG/250ML NS,250,RC,VB009114,LOCAL,,inpatient,250,ML,18.6,18.6,,,,,,,,,,,,,,,,,
Hemin for Injection,250,RC,VB009118,LOCAL,,inpatient,1,EA,52514.35,52514.35,,,,,,,,,,,,,,,,,
OXYCODONE 5 MG (RX-UD),250,RC,VB009120,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
levETIRAcetam In Nacl (Iso-Os),250,RC,VB009121,LOCAL,,inpatient,50,ML,37.24,37.24,,,,,,,,,,,,,,,,,
oxyCODONE HCL,250,RC,VB009122,LOCAL,,inpatient,1,EA,7.36,7.36,,,,,,,,,,,,,,,,,
MEROPENEM 2 GM/100ML NS IVPB,250,RC,VB009123,LOCAL,,inpatient,100,ML,192,192,,,,,,,,,,,,,,,,,
Albumin 5% Human (250 mL),250,RC,VB009126,LOCAL,,inpatient,250,ML,223.49,223.49,,,,,,,,,,,,,,,,,
Lidocaine 2%/Hyaluronic/Collagen,250,RC,VB009129,LOCAL,,inpatient,85,GM,83.04,83.04,,,,,,,,,,,,,,,,,
methadone HCL Oral 45 mg/4.5mL,250,RC,VB009131,LOCAL,,inpatient,30,ML,5,5,,,,,,,,,,,,,,,,,
"Epoetin Alfa 10,000 unit/mL",250,RC,VB009132,LOCAL,,inpatient,1,ML,795.84,795.84,,,,,,,,,,,,,,,,,
Sulfuric Acid/Sulfonat. Phenol Swab,250,RC,VB009133,LOCAL,,inpatient,1,EA,23.07,23.07,,,,,,,,,,,,,,,,,
Albumin Human 25%,250,RC,VB009135,LOCAL,,inpatient,100,ML,551.04,551.04,,,,,,,,,,,,,,,,,
niMODipine Oral,250,RC,VB009136,LOCAL,,inpatient,5,ML,256.37,256.37,,,,,,,,,,,,,,,,,
methadone HCL Oral 40 mg/4mL,250,RC,VB009137,LOCAL,,inpatient,30,ML,13.6,13.6,,,,,,,,,,,,,,,,,
Baclofen Oral Soln,250,RC,VB009138,LOCAL,,inpatient,473,ML,5.24,5.24,,,,,,,,,,,,,,,,,
NON-FORMULARY C-2 CONTROLLED SUBS,250,RC,VB009139,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
methadone HCL Oral 35 mg/3.5mL,250,RC,VB009140,LOCAL,,inpatient,30,ML,10.2,10.2,,,,,,,,,,,,,,,,,
NON-FORMULARY C-3 CONTROLLED SUBS,250,RC,VB009141,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Peg3350/Sod Sulf,bicarb,cl/Kcl",250,RC,VB009143,LOCAL,,inpatient,4000,ML,126.68,126.68,,,,,,,,,,,,,,,,,
diphenhydrAMINE HCL - UD,250,RC,VB009144,LOCAL,,inpatient,5,ML,10.24,10.24,,,,,,,,,,,,,,,,,
Galcanezumab-Gnlm Pen,250,RC,VB009159,LOCAL,,inpatient,1,ML,3560.11,3560.11,,,,,,,,,,,,,,,,,
"Epoetin Alfa-Epbx 20,000 units/2mL",250,RC,VB009160,LOCAL,,inpatient,2,ML,52.92,52.92,,,,,,,,,,,,,,,,,
CARBIDOPA/LEVODOPA 12.5/50 MG,250,RC,VB009161,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
PHENobarbitaL,250,RC,VB009164,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
labetalol HCL Inj,250,RC,VB009165,LOCAL,,inpatient,2,ML,28.85,28.85,,,,,,,,,,,,,,,,,
Vasopressin 40 units/100mL,250,RC,VB009166,LOCAL,,inpatient,100,ML,480,480,,,,,,,,,,,,,,,,,
Multivitamin with DHA,250,RC,VB009169,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Flu Vacc Qs2023-24 36mos Up/Pf,250,RC,VB009170,LOCAL,,inpatient,0.5,ML,96.19,96.19,,,,,,,,,,,,,,,,,
"Petrolatum,white 41% (85 GM)",250,RC,VB009171,LOCAL,,inpatient,85,GM,25.96,25.96,,,,,,,,,,,,,,,,,
Drospirenone,250,RC,VB009173,LOCAL,,inpatient,1,EA,931.2,931.2,,,,,,,,,,,,,,,,,
CHLORPROMAZINE HCL,250,RC,VB009174,LOCAL,,inpatient,1,EA,5.84,5.84,,,,,,,,,,,,,,,,,
EMOLLIENT/SKIN CLEANSER,257,RC,VB009178,LOCAL,,inpatient,340,GM,39.56,39.56,,,,,,,,,,,,,,,,,
Budesonide/Glycopyr/Formoterol,250,RC,VB009187,LOCAL,,inpatient,10.7,GM,3096.67,3096.67,,,,,,,,,,,,,,,,,
oxyCODONE HCL Oral Conc (RX-UD),250,RC,VB009191,LOCAL,,inpatient,30,ML,29.17,29.17,,,,,,,,,,,,,,,,,
Eye Vitamin/Mineral AREDS2 Capsule,257,RC,VB009192,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Cholecalciferol (Vitamin D3),257,RC,VB009193,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Flu Vacc Qs2023(65up)/Mf59c/Pf,250,RC,VB009196,LOCAL,,inpatient,0.5,ML,322.7,322.7,,,,,,,,,,,,,,,,,
EARACHE DROPS - HYLANDS,257,RC,VB009197,LOCAL,,inpatient,10,ML,28.76,28.76,,,,,,,,,,,,,,,,,
Flu Vac Qs 23-24(6ms Up)cel/Pf,250,RC,VB009198,LOCAL,,inpatient,0.5,ML,140.88,140.88,,,,,,,,,,,,,,,,,
Ergocalciferol 1250 mcg/6.25mL,250,RC,VB009199,LOCAL,,inpatient,60,ML,41.48,41.48,,,,,,,,,,,,,,,,,
Pegfilgrastim-Jmdb,250,RC,VB009202,LOCAL,,inpatient,0.6,ML,10020,10020,,,,,,,,,,,,,,,,,
Ibuprofen Oral Susp (BULK),257,RC,VB009203,LOCAL,,inpatient,120,ML,32.16,32.16,,,,,,,,,,,,,,,,,
AZATHIOPRINE SUSPENSION,250,RC,VB009204,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Dicyclomine Oral Soln,250,RC,VB009206,LOCAL,,inpatient,473,ML,5,5,,,,,,,,,,,,,,,,,
Letermovir,250,RC,VB009207,LOCAL,,inpatient,1,EA,1317.07,1317.07,,,,,,,,,,,,,,,,,
Loteprednol Etabonate 0.25% Ophth,250,RC,VB009208,LOCAL,,inpatient,8.3,ML,2487.26,2487.26,,,,,,,,,,,,,,,,,
D-Mannose Nutritional Supplement,250,RC,VB009211,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Amino Acid 8 % In D10W,250,RC,VB009214,LOCAL,,inpatient,1000,ML,255.22,255.22,,,,,,,,,,,,,,,,,
LIDOCAINE HCL GEL 4%,257,RC,VB009215,LOCAL,,inpatient,75,ML,35.96,35.96,,,,,,,,,,,,,,,,,
Semaglutide,250,RC,VB009216,LOCAL,,inpatient,3,ML,4788.38,4788.38,,,,,,,,,,,,,,,,,
Formoterol Fumarate - UD,250,RC,VB009217,LOCAL,,inpatient,2,ML,84.76,84.76,,,,,,,,,,,,,,,,,
Decitabine/Cedazuridine 35/100MG,250,RC,VB009218,LOCAL,,inpatient,1,EA,8327.86,8327.86,,,,,,,,,,,,,,,,,
Semaglutide,250,RC,VB009219,LOCAL,,inpatient,1,EA,159.61,159.61,,,,,,,,,,,,,,,,,
L. Rhamnosus Gg/Inulin,250,RC,VB009220,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Levonorgestrel/Ethinyl estradiol,250,RC,VB009221,LOCAL,,inpatient,1,EA,140.64,140.64,,,,,,,,,,,,,,,,,
methadone Oral Conc 180 mg/18mL,250,RC,VB009222,LOCAL,,inpatient,1000,ML,5,5,,,,,,,,,,,,,,,,,
Flu Vacc Qs2023-24(6mos Up)/Pf,250,RC,VB009223,LOCAL,,inpatient,0.5,ML,91.1,91.1,,,,,,,,,,,,,,,,,
Daptomycin In NS,250,RC,VB009224,LOCAL,,inpatient,50,ML,187.2,187.2,,,,,,,,,,,,,,,,,
HYDROMORPHONE PCA 0.4 MG/ML IN NS,250,RC,VB009225,LOCAL,,inpatient,25,ML,5,5,,,,,,,,,,,,,,,,,
Acetaminophen/Caffeine 500/65 MG,250,RC,VB009226,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Sodium Oxybate - UD,250,RC,VB009227,LOCAL,,inpatient,180,ML,1516.68,1516.68,,,,,,,,,,,,,,,,,
EPINEPHrine Pen 0.15 mg/0.3mL,250,RC,VB009228,LOCAL,,inpatient,1,EA,720,720,,,,,,,,,,,,,,,,,
Nirmatrelvir/Ritonavir 150/100 MG,250,RC,VB009229,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Opicapone,250,RC,VB009230,LOCAL,,inpatient,1,EA,107.26,107.26,,,,,,,,,,,,,,,,,
Adalimumab-Bwwd,250,RC,VB009231,LOCAL,,inpatient,0.8,ML,2491.2,2491.2,,,,,,,,,,,,,,,,,
Flu Vacc Qs2023-24(65yr Up)/Pf,250,RC,VB009232,LOCAL,,inpatient,0.7,ML,306.05,306.05,,,,,,,,,,,,,,,,,
Canagliflozin/Metformin HCL,250,RC,VB009233,LOCAL,,inpatient,1,EA,47.88,47.88,,,,,,,,,,,,,,,,,
Darunavir Ethanolate,250,RC,VB009234,LOCAL,,inpatient,1,EA,150.86,150.86,,,,,,,,,,,,,,,,,
"Gentamicin In Nacl, Iso-Osm",250,RC,VB009235,LOCAL,,inpatient,50,ML,19.92,19.92,,,,,,,,,,,,,,,,,
Loteprednol Etabonate 0.38% Ophth,250,RC,VB009236,LOCAL,,inpatient,5,ML,1243.54,1243.54,,,,,,,,,,,,,,,,,
Abemaciclib,250,RC,VB009237,LOCAL,,inpatient,1,EA,1399.72,1399.72,,,,,,,,,,,,,,,,,
Methoxy Peg-Epoetin 100 mcg/0.3mL,250,RC,VB009238,LOCAL,,inpatient,0.3,ML,1384.7,1384.7,,,,,,,,,,,,,,,,,
MICAFUNGIN 150 MG/100ML NS,250,RC,VB009239,LOCAL,,inpatient,100,ML,1112,1112,,,,,,,,,,,,,,,,,
Clevidipine Butyrate IV,250,RC,VB009240,LOCAL,,inpatient,50,ML,410.72,410.72,,,,,,,,,,,,,,,,,
EMPTY IV CONTAINER 500ML,250,RC,VB009241,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Daptomycin In 0.9 % Sod Chlor,250,RC,VB009242,LOCAL,,inpatient,50,ML,158.4,158.4,,,,,,,,,,,,,,,,,
Daptomycin In NS 1000 mg/100mL,250,RC,VB009243,LOCAL,,inpatient,100,ML,316.8,316.8,,,,,,,,,,,,,,,,,
Daptomycin In NS 700 mg/100mL,250,RC,VB009244,LOCAL,,inpatient,100,ML,273.6,273.6,,,,,,,,,,,,,,,,,
CLONIDINE 0.05 MG (RX-UD),250,RC,VB009245,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Insulin Nph/Regular 70/30 (BULK),250,RC,VB009246,LOCAL,,inpatient,10,ML,231.36,231.36,,,,,,,,,,,,,,,,,
Bacitracin Oint (425 GM),250,RC,VB009247,LOCAL,,inpatient,425,GM,95.8,95.8,,,,,,,,,,,,,,,,,
Dextromethorphan Hbr/Bupropion,250,RC,VB009248,LOCAL,,inpatient,1,EA,94.2,94.2,,,,,,,,,,,,,,,,,
minoxidiL Topical Foam 5%,250,RC,VB009250,LOCAL,,inpatient,1,EA,93.04,93.04,,,,,,,,,,,,,,,,,
Hydroquinone 4% Topical Cream,250,RC,VB009251,LOCAL,,inpatient,28.35,GM,427.52,427.52,,,,,,,,,,,,,,,,,
Omega-3/Dha/Epa/Fish Oil - UD,257,RC,VB009252,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Eplerenone,250,RC,VB009254,LOCAL,,inpatient,1,EA,16.66,16.66,,,,,,,,,,,,,,,,,
Gentamicin Bladder Irrigation 0.05%,250,RC,VB009255,LOCAL,,inpatient,60,ML,28,28,,,,,,,,,,,,,,,,,
Menthol 4% Gel,257,RC,VB009256,LOCAL,,inpatient,74,ML,36.52,36.52,,,,,,,,,,,,,,,,,
Ferrous Sulfate ER,257,RC,VB009257,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
EGYPTIAN MAGIC CREAM (4 OZ),257,RC,VB009258,LOCAL,,inpatient,120,GM,5,5,,,,,,,,,,,,,,,,,
0.9% Sodium Chloride (FOR KVO),250,RC,VB009259,LOCAL,,inpatient,250,ML,23.47,23.47,,,,,,,,,,,,,,,,,
Peginterferon Alfa-2a,250,RC,VB009260,LOCAL,,inpatient,1,EA,5344.42,5344.42,,,,,,,,,,,,,,,,,
Flu Vacc Qs2023-24(6mos Up)/Pf,250,RC,VB009261,LOCAL,,inpatient,0.5,ML,91.25,91.25,,,,,,,,,,,,,,,,,
RESTA MOISTURIZING CREME,250,RC,VB009262,LOCAL,,inpatient,107,GM,48.4,48.4,,,,,,,,,,,,,,,,,
Methylprednisolone Sod Succ/Pf,250,RC,VB009263,LOCAL,,inpatient,1,EA,227.42,227.42,,,,,,,,,,,,,,,,,
BENZOCAINE/MENTHOL GEL 20/0.26%,257,RC,VB009264,LOCAL,,inpatient,7,GM,18.67,18.67,,,,,,,,,,,,,,,,,
Vasopressin Pf,250,RC,VB009265,LOCAL,,inpatient,1,ML,504.5,504.5,,,,,,,,,,,,,,,,,
Flu Vacc Qs 2023-24 (6 Mos Up),250,RC,VB009266,LOCAL,,inpatient,5,ML,177.35,177.35,,,,,,,,,,,,,,,,,
valGANciclovir HCL Oral Soln,250,RC,VB009267,LOCAL,,inpatient,88,ML,90.96,90.96,,,,,,,,,,,,,,,,,
Covid Vac 23-24(12up)(Andu)/Pf,250,RC,VB009268,LOCAL,,inpatient,0.5,ML,614.4,614.4,,,,,,,,,,,,,,,,,
Selenium,250,RC,VB009269,LOCAL,,inpatient,10,ML,187.89,187.89,,,,,,,,,,,,,,,,,
tacrolimus,250,RC,VB009270,LOCAL,,inpatient,1,EA,17.76,17.76,,,,,,,,,,,,,,,,,
Insulin Lispro,250,RC,VB009271,LOCAL,,inpatient,10,ML,0.12,0.12,,,,,,,,,,,,,,,,,
"Cyclosporine,Modified(175mg/1.75mL)",250,RC,VB009272,LOCAL,,inpatient,50,ML,41.92,41.92,,,,,,,,,,,,,,,,,
dilTIAZem HCL ER (LA),250,RC,VB009273,LOCAL,,inpatient,1,EA,16.41,16.41,,,,,,,,,,,,,,,,,
levETIRAcetam Oral 1000 mg/10mL,250,RC,VB009274,LOCAL,,inpatient,10,ML,5,5,,,,,,,,,,,,,,,,,
Pyrithione Zinc 1% Shampoo,257,RC,VB009275,LOCAL,,inpatient,325,ML,47.4,47.4,,,,,,,,,,,,,,,,,
ceFAZolin SODIUM,250,RC,VB009276,LOCAL,,inpatient,1,EA,42.12,42.12,,,,,,,,,,,,,,,,,
Methoxy Peg-Epoetin 30 mcg/0.3mL,250,RC,VB009277,LOCAL,,inpatient,0.3,ML,415.39,415.39,,,,,,,,,,,,,,,,,
Pirfenidone,250,RC,VB009278,LOCAL,,inpatient,1,EA,518.35,518.35,,,,,,,,,,,,,,,,,
Vilazodone HCL,250,RC,VB009279,LOCAL,,inpatient,1,EA,33.62,33.62,,,,,,,,,,,,,,,,,
Micafungin Sodium,250,RC,VB009280,LOCAL,,inpatient,1,EA,254.74,254.74,,,,,,,,,,,,,,,,,
Micafungin Sodium,250,RC,VB009281,LOCAL,,inpatient,1,EA,359.04,359.04,,,,,,,,,,,,,,,,,
Methoxy Peg-Epoetin 50 mcg/0.3mL,250,RC,VB009282,LOCAL,,inpatient,0.3,ML,692.35,692.35,,,,,,,,,,,,,,,,,
Methoxy Peg-Epoetin 75 mcg/0.3mL,250,RC,VB009283,LOCAL,,inpatient,0.3,ML,1038.53,1038.53,,,,,,,,,,,,,,,,,
Methoxy Peg-Epoetin 150 mcg/0.3mL,250,RC,VB009284,LOCAL,,inpatient,0.3,ML,2077.01,2077.01,,,,,,,,,,,,,,,,,
Methoxy Peg-Epoetin 200 mcg/0.3mL,250,RC,VB009285,LOCAL,,inpatient,0.3,ML,2769.36,2769.36,,,,,,,,,,,,,,,,,
Methoxy Peg-Epoetin 120 mcg/0.3mL,250,RC,VB009286,LOCAL,,inpatient,0.3,ML,1661.62,1661.62,,,,,,,,,,,,,,,,,
Nirmatrelvir/Ritonavir,250,RC,VB009287,LOCAL,,inpatient,1,EA,348.61,348.61,,,,,,,,,,,,,,,,,
Lurasidone HCL,250,RC,VB009288,LOCAL,,inpatient,1,EA,204.13,204.13,,,,,,,,,,,,,,,,,
Finerenone,250,RC,VB009289,LOCAL,,inpatient,1,EA,109.87,109.87,,,,,,,,,,,,,,,,,
Nirmatrelvir/Ritonavir 300-100 MG,250,RC,VB009290,LOCAL,,inpatient,1,EA,239.38,239.38,,,,,,,,,,,,,,,,,
VALSARTAN 20 MG,250,RC,VB009291,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
EMPAGLIFLOZIN 5 MG,250,RC,VB009292,LOCAL,,inpatient,1,EA,288.64,288.64,,,,,,,,,,,,,,,,,
"L.acid,casei/B.animal/S.thermo",250,RC,VB009293,LOCAL,,inpatient,1,EA,5.19,5.19,,,,,,,,,,,,,,,,,
Benzoyl Peroxide 5% Wash - 148mL,250,RC,VB009294,LOCAL,,inpatient,148,ML,25.39,25.39,,,,,,,,,,,,,,,,,
Salicylic Acid 6% Gel,250,RC,VB009295,LOCAL,,inpatient,100,ml,249.55,249.55,,,,,,,,,,,,,,,,,
Sodium Chloride/Aloe Vera Spray,250,RC,VB009296,LOCAL,,inpatient,22,ML,21.84,21.84,,,,,,,,,,,,,,,,,
Mineral Oil/Petrolatum Ophth Oint,250,RC,VB009297,LOCAL,,inpatient,3.5,GM,34.32,34.32,,,,,,,,,,,,,,,,,
Lactulose (Bulk - 237mL),250,RC,VB009298,LOCAL,,inpatient,237,ML,81.8,81.8,,,,,,,,,,,,,,,,,
Loperamide HCL,257,RC,VB009299,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Insulin Aspart 100 unit/mL Flexpen,250,RC,VB009300,LOCAL,,inpatient,3,ML,134.11,134.11,,,,,,,,,,,,,,,,,
Valsartan,250,RC,VB009301,LOCAL,,inpatient,1,EA,20.64,20.64,,,,,,,,,,,,,,,,,
HYDROMORPHONE ORAL (RX-UD),250,RC,VB009302,LOCAL,,inpatient,3,ML,5,5,,,,,,,,,,,,,,,,,
Calcium Carbonate Chew,257,RC,VB009303,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Iron Sucrose Complex Inj,250,RC,VB009304,LOCAL,,inpatient,10,ML,605.28,605.28,,,,,,,,,,,,,,,,,
Semaglutide (2 mg/dose),250,RC,VB009305,LOCAL,,inpatient,3,ML,4788.38,4788.38,,,,,,,,,,,,,,,,,
Acetaminophen,257,RC,VB009306,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Denosumab,250,RC,VB009307,LOCAL,,inpatient,1.7,ML,16558.75,16558.75,,,,,,,,,,,,,,,,,
Calcium Acetate,250,RC,VB009308,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Multivit-Min/Ferrous Gluconate - UD,250,RC,VB009309,LOCAL,,inpatient,15,ML,10.32,10.32,,,,,,,,,,,,,,,,,
"Vitamin E (Dl,tocopheryl Acet)",257,RC,VB009310,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
carBAMazepine ER,250,RC,VB009311,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Pen Needle, Diabetic",250,RC,VB009312,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
ceFAZolin SODIUM,250,RC,VB009313,LOCAL,,inpatient,1,EA,23.42,23.42,,,,,,,,,,,,,,,,,
Diphenhydr/Lidoca/Mag-Al Plus 1:1:1,250,RC,VB009314,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
treprostiniL,250,RC,VB009315,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
treprostiniL,250,RC,VB009316,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Cholecalciferol (VitD3) Softgel Cap,250,RC,VB009317,LOCAL,,inpatient,1,EA,6.13,6.13,,,,,,,,,,,,,,,,,
Temozolomide,250,RC,VB009318,LOCAL,,inpatient,1,EA,57.85,57.85,,,,,,,,,,,,,,,,,
Lumateperone Tosylate,250,RC,VB009319,LOCAL,,inpatient,1,EA,273.59,273.59,,,,,,,,,,,,,,,,,
FLUDROCORTISONE 0.05 MG*,250,RC,VB009320,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Iloperidone,250,RC,VB009321,LOCAL,,inpatient,1,EA,181.35,181.35,,,,,,,,,,,,,,,,,
Dulaglutide 4.5 mg/0.5mL,250,RC,VB009322,LOCAL,,inpatient,0.5,ML,1184.64,1184.64,,,,,,,,,,,,,,,,,
acetaminophen Oral Susp - UD,257,RC,VB009323,LOCAL,,inpatient,5,ML,5,5,,,,,,,,,,,,,,,,,
Carboxymethylcellulose 0.25% Ophth,257,RC,VB009324,LOCAL,,inpatient,15,ML,61.48,61.48,,,,,,,,,,,,,,,,,
Meropenem,250,RC,VB009325,LOCAL,,inpatient,1,EA,157.92,157.92,,,,,,,,,,,,,,,,,
Buprenorphine/Naloxone 12mg/3mg,250,RC,VB009326,LOCAL,,inpatient,1,EA,70.4,70.4,,,,,,,,,,,,,,,,,
Dextrose 10 % In Water (IVPB),250,RC,VB009327,LOCAL,,inpatient,250,ML,30.48,30.48,,,,,,,,,,,,,,,,,
Lanolin Alcohol/Mo/W.pet/Ceres,257,RC,VB009328,LOCAL,,inpatient,113,GM,13.1,13.1,,,,,,,,,,,,,,,,,
Lemborexant,250,RC,VB009329,LOCAL,,inpatient,1,EA,56.4,56.4,,,,,,,,,,,,,,,,,
amLODIPine 0.5mg/0.5ml,250,RC,VB009330,LOCAL,,inpatient,1,EA,10,10,,,,,,,,,,,,,,,,,
Teriflunomide,250,RC,VB009331,LOCAL,,inpatient,1,EA,1372.52,1372.52,,,,,,,,,,,,,,,,,
0.9 % Sodium Chloride 250ML (HD),250,RC,VB009332,LOCAL,,inpatient,250,ML,20.59,20.59,,,,,,,,,,,,,,,,,
Omega-3/Dha/Epa/Fish Oil,250,RC,VB009333,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
EMPTY SYRINGE 50ML,250,RC,VB009334,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Lipase/Protea/Amyl 20-63-84K Unit,250,RC,VB009335,LOCAL,,inpatient,1,EA,3846.24,3846.24,,,,,,,,,,,,,,,,,
Glucagon,250,RC,VB009336,LOCAL,,inpatient,1,EA,1344,1344,,,,,,,,,,,,,,,,,
Insulin Glargine-Aglr 100 unit/mL,250,RC,VB009337,LOCAL,,inpatient,3,ML,88.32,88.32,,,,,,,,,,,,,,,,,
HYOSCYAMINE SULFATE ODT,250,RC,VB009338,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
minoxidiL 2% Topical,250,RC,VB009339,LOCAL,,inpatient,60,ML,30,30,,,,,,,,,,,,,,,,,
Red Yeast Rice,257,RC,VB009340,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Mepivacaine HCL/Pf 2% Inj,250,RC,VB009341,LOCAL,,inpatient,20,ML,59.33,59.33,,,,,,,,,,,,,,,,,
Darunavir,250,RC,VB009342,LOCAL,,inpatient,1,EA,301.72,301.72,,,,,,,,,,,,,,,,,
methadone HCL INJ,250,RC,VB009343,LOCAL,,inpatient,1,EA,93.35,93.35,,,,,,,,,,,,,,,,,
methadone HCL INJ 7.5 mg/0.75mL,250,RC,VB009344,LOCAL,,inpatient,1,EA,93.35,93.35,,,,,,,,,,,,,,,,,
phenoL 1.4% Spray,257,RC,VB009345,LOCAL,,inpatient,1,EA,11.57,11.57,,,,,,,,,,,,,,,,,
Glycerin/Propyl Glycol 0.3%-1% Opht,257,RC,VB009346,LOCAL,,inpatient,15,ML,20.11,20.11,,,,,,,,,,,,,,,,,
Covid Vac 23-24(12up)(Raxt)/Pf,250,RC,VB009347,LOCAL,,inpatient,0.3,ML,619.2,619.2,,,,,,,,,,,,,,,,,
DAPTOMYCIN KEY,250,RC,VB009348,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
TACROLIMUS 5 mg/10mL ORAL SUSP,250,RC,VB009349,LOCAL,,inpatient,10,ML,34.8,34.8,,,,,,,,,,,,,,,,,
NOZIN NASAL SANITIZER SWAB 62%,257,RC,VB009350,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
TACROLIMUS 7 mg/14mL ORAL SUSP,250,RC,VB009351,LOCAL,,inpatient,1,ML,48.72,48.72,,,,,,,,,,,,,,,,,
Fluticasone/Vilanterol 50-25 MCG,250,RC,VB009352,LOCAL,,inpatient,1,EA,1954.66,1954.66,,,,,,,,,,,,,,,,,
Methenam/Sod Phos/Mblue/Hyoscy,250,RC,VB009353,LOCAL,,inpatient,1,EA,21.3,21.3,,,,,,,,,,,,,,,,,
carisoprodoL,250,RC,VB009354,LOCAL,,inpatient,1,EA,10.82,10.82,,,,,,,,,,,,,,,,,
Mepolizumab Injection,250,RC,VB009355,LOCAL,,inpatient,1,EA,18237.55,18237.55,,,,,,,,,,,,,,,,,
Gilteritinib Fumarate,250,RC,VB009356,LOCAL,,inpatient,1,EA,1545.55,1545.55,,,,,,,,,,,,,,,,,
nebivolol HCL,250,RC,VB009357,LOCAL,,inpatient,1,EA,29.25,29.25,,,,,,,,,,,,,,,,,
buPROPion HCL SR,250,RC,VB009358,LOCAL,,inpatient,1,EA,37.79,37.79,,,,,,,,,,,,,,,,,
MICRO DAILY EMF,250,RC,VB009359,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
BRAIN BOOST DAILY WITH TURMERIC,250,RC,VB009360,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Vitamins A and D Oint Packet,250,RC,VB009361,LOCAL,,inpatient,5,GM,5,5,,,,,,,,,,,,,,,,,
NIVEA COCOA BUTTER BODY CREAM,257,RC,VB009362,LOCAL,,inpatient,439,GM,33.44,33.44,,,,,,,,,,,,,,,,,
Cenobamate,250,RC,VB009363,LOCAL,,inpatient,1,EA,194.47,194.47,,,,,,,,,,,,,,,,,
methadone HCL Oral Conc 100mg/10mL,250,RC,VB009364,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
TPN CENTRAL - 5%/20% RxMade 1L #1,250,RC,VB009365,LOCAL,,inpatient,1000,ML,240,240,,,,,,,,,,,,,,,,,
TPN CENTRAL - 5%/20% RxMade 1L #2,250,RC,VB009366,LOCAL,,inpatient,1000,ML,240,240,,,,,,,,,,,,,,,,,
TPN CENTRAL 5%/20% RxMade 2L #1,250,RC,VB009367,LOCAL,,inpatient,2000,ML,280,280,,,,,,,,,,,,,,,,,
TPN CENTRAL 5%/20% RxMade 2L #2,250,RC,VB009368,LOCAL,,inpatient,2000,ML,280,280,,,,,,,,,,,,,,,,,
estradioL 0.0375 mg/24hr Patch,250,RC,VB009369,LOCAL,,inpatient,1,EA,97.84,97.84,,,,,,,,,,,,,,,,,
Polyvinyl Alcohol 1.4% Ophth,250,RC,VB009370,LOCAL,,inpatient,15,ML,25.73,25.73,,,,,,,,,,,,,,,,,
lithium CITRATE 4 mEq/2.5mL (RX-UD),250,RC,VB009371,LOCAL,,inpatient,500,ML,5,5,,,,,,,,,,,,,,,,,
Tetracaine HCL 0.5% Ophth,250,RC,VB009372,LOCAL,,inpatient,5,ML,144,144,,,,,,,,,,,,,,,,,
propylene glycoL 0.6% Ophth - 10mL,257,RC,VB009373,LOCAL,,inpatient,10,ML,52.22,52.22,,,,,,,,,,,,,,,,,
Evolocumab 420 mg/3.5mL,250,RC,VB009374,LOCAL,,inpatient,3.5,ML,2978.16,2978.16,,,,,,,,,,,,,,,,,
Ivermectin 0.5% Lotion 117 GM,250,RC,VB009375,LOCAL,,inpatient,117,GM,785.96,785.96,,,,,,,,,,,,,,,,,
Dexmedetomidine/NS 1000 mcg/250mL,250,RC,VB009376,LOCAL,,inpatient,250,ML,1018.08,1018.08,,,,,,,,,,,,,,,,,
MAGNESIUM GLYCINATE,257,RC,VB009377,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Tirzepatide 7.5 mg/0.5mL,250,RC,VB009378,LOCAL,,inpatient,0.5,ML,1295.71,1295.71,,,,,,,,,,,,,,,,,
Pyrimethamine,250,RC,VB009379,LOCAL,,inpatient,1,EA,3420,3420,,,,,,,,,,,,,,,,,
traMADoL HCL Oral Soln - UD,250,RC,VB009380,LOCAL,,inpatient,5,ML,47.56,47.56,,,,,,,,,,,,,,,,,
leucovorin calcium,250,RC,VB009381,LOCAL,,inpatient,1,EA,33.64,33.64,,,,,,,,,,,,,,,,,
Zoledronic Acid/Mannitol-Water,250,RC,PH009382,LOCAL,,inpatient,100,ML,1680,1680,,,,,,,,,,,,,,,,,
Flu Vacc Ts2024-25(6mos Up)/Pf,250,RC,PH009383,LOCAL,,inpatient,0.5,ML,95.68,95.68,,,,,,,,,,,,,,,,,
Flu Vacc Ts2024-25(6mos Up)/Pf,250,RC,PH009384,LOCAL,,inpatient,0.5,ML,91.1,91.1,,,,,,,,,,,,,,,,,
Flu Vacc Ts2024-25(65yr Up)/Pf,250,RC,PH009385,LOCAL,,inpatient,0.5,ML,348.53,348.53,,,,,,,,,,,,,,,,,
Ergocalciferol (Vitamin D2),250,RC,PH009386,LOCAL,,inpatient,1,EA,7.68,7.68,,,,,,,,,,,,,,,,,
Fat Emul/Soy/Mct/Oliv/Fish Oil,250,RC,PH009387,LOCAL,,inpatient,250,ML,137.18,137.18,,,,,,,,,,,,,,,,,
Lidocaine/Prilocaine 2.5%-2.5%,250,RC,PH009388,LOCAL,,inpatient,30,GM,72.4,72.4,,,,,,,,,,,,,,,,,
Ethacrynic Acid,250,RC,PH009389,LOCAL,,inpatient,1,EA,95.8,95.8,,,,,,,,,,,,,,,,,
Triamcinolone Acetonide,250,RC,PH009390,LOCAL,,inpatient,30,GM,33.6,33.6,,,,,,,,,,,,,,,,,
tramadoL HCL,250,RC,PH009391,LOCAL,,inpatient,1,EA,19.56,19.56,,,,,,,,,,,,,,,,,
Hydromorphone HCL/Pf,250,RC,PH009392,LOCAL,,inpatient,1,ML,19.92,19.92,,,,,,,,,,,,,,,,,
morphine SULFATE,250,RC,PH009393,LOCAL,,inpatient,1,ML,11.08,11.08,,,,,,,,,,,,,,,,,
morphine SULFATE - UD,250,RC,PH009394,LOCAL,,inpatient,1,EA,14.4,14.4,,,,,,,,,,,,,,,,,
"Nicardipine In Nacl, Iso-Osm",250,RC,PH009395,LOCAL,,inpatient,200,ML,780.67,780.67,,,,,,,,,,,,,,,,,
LORazepam,250,RC,VB009396,LOCAL,,inpatient,1,ML,17.22,17.22,,,,,,,,,,,,,,,,,
Cyanocobalamin/Coenzyme B-12,250,RC,VB009397,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Molnupiravir,250,RC,VB009398,LOCAL,,inpatient,1,EA,119.66,119.66,,,,,,,,,,,,,,,,,
Epoetin Alfa,250,RC,VB009399,LOCAL,,inpatient,1,EA,1591.68,1591.68,,,,,,,,,,,,,,,,,
Amino Acid 8 % In D14%,250,RC,VB009400,LOCAL,,inpatient,2000,ML,543.98,543.98,,,,,,,,,,,,,,,,,
vancomycin HCL - UD,250,RC,VB009401,LOCAL,,inpatient,20,ML,125.22,125.22,,,,,,,,,,,,,,,,,
vancomycin HCL,250,RC,VB009402,LOCAL,,inpatient,1,EA,96.48,96.48,,,,,,,,,,,,,,,,,
Zinc Sulfate,250,RC,VB009403,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Miconazole Nitrate,250,RC,VB009404,LOCAL,,inpatient,85,GM,32.88,32.88,,,,,,,,,,,,,,,,,
verapamil HCL,250,RC,VB009405,LOCAL,,inpatient,1,EA,6.98,6.98,,,,,,,,,,,,,,,,,
nystatin - UD,250,RC,VB009406,LOCAL,,inpatient,5,ML,9.08,9.08,,,,,,,,,,,,,,,,,
Calcium Carbonate,257,RC,VB009407,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
Voriconazole,636,RC,VB009408,LOCAL,,inpatient,75,ML,90.05,90.05,,Alter-Net,,,,,,,,all RC 636 40% BC when billed charges collectively exceed $500.oo Per patient,,,,,,,
Ganciclovir Sodium,636,RC,VB009409,LOCAL,,inpatient,10,ML,288,288,,Cigna,,,,,,,,all RC 636 Threshold for each RC $200.00,,,,,,,
Itraconazole,636,RC,VB009410,LOCAL,,inpatient,150,ML,9.87,9.87,,Health Net commercial,,,,,,,,RC 636 40%BC,,,,,,,
Voriconazole,636,RC,VB009408,LOCAL,,inpatient,75,ML,90.05,90.05,,Canopy Health,,,,,,,,all RC 636 40% BC ,,,,,,,
Ganciclovir Sodium,636,RC,VB009409,LOCAL,,inpatient,10,ML,288,288,,Canopy Health,,,,,,,,all RC 636 40% BC ,,,,,,,
Itraconazole,636,RC,VB009410,LOCAL,,inpatient,150,ML,9.87,9.87,,canopy Health,,,,,,,,all RC 636 40% BC ,,,,,,,
Zinc Sulfate - UD,250,RC,VB009411,LOCAL,,inpatient,1,EA,5,5,,,,,,,,,,,,,,,,,
"Insulin Regular, Human",250,RC,VB009412,LOCAL,,inpatient,3,ML,87.46,87.46,,,,,,,,,,,,,,,,,
Lidocaine/Menthol,250,RC,VB009413,LOCAL,,inpatient,1,EA,52.16,52.16,,,,,,,,,,,,,,,,,
XR JAW >4 VIEWS,320,RC,40000004,LOCAL,,inpatient,,,252.224,252.224,,,,,,,,,,,,,,,,,
XR Facial bones <3 views,320,RC,40000008,LOCAL,,inpatient,,,187.488,187.488,,,,,,,,,,,,,,,,,
XR Facial bones >3 views,320,RC,40000009,LOCAL,,inpatient,,,264.544,264.544,,,,,,,,,,,,,,,,,
XR Nasal bones,320,RC,40000010,LOCAL,,inpatient,,,204.008,204.008,,,,,,,,,,,,,,,,,
XR EYE Orbits 4 views,301,RC,40000013,LOCAL,,inpatient,,,378,378,,,,,,,,,,,,,,,,,
XR Sinuses <3 views,320,RC,40000014,LOCAL,,inpatient,,,191.52,191.52,,,,,,,,,,,,,,,,,
XR Sinuses >3 views,320,RC,40000015,LOCAL,,inpatient,,,239.568,239.568,,,,,,,,,,,,,,,,,
XR Skull<4 views,320,RC,40000017,LOCAL,,inpatient,,,229.152,229.152,,,,,,,,,,,,,,,,,
XR Skull >4 views,320,RC,40000018,LOCAL,,inpatient,,,291.816,291.816,,,,,,,,,,,,,,,,,
XR TEETH - partial mouth,320,RC,40000020,LOCAL,,inpatient,,,238.28,238.28,,,,,,,,,,,,,,,,,
XR Jaw joint -Unilateral,320,RC,40000022,LOCAL,,inpatient,,,378,378,,,,,,,,,,,,,,,,,
XR Jaw joints - bilateral,320,RC,40000023,LOCAL,,inpatient,,,378,378,,,,,,,,,,,,,,,,,
XR Neck,320,RC,40000027,LOCAL,,inpatient,,,170.744,170.744,,,,,,,,,,,,,,,,,
XR Chest 1 view,320,RC,40000032,LOCAL,,inpatient,,,145.824,145.824,,,,,,,,,,,,,,,,,
XR Chest 2 views,320,RC,40000033,LOCAL,,inpatient,,,190.904,190.904,,,,,,,,,,,,,,,,,
RF Chest 4+ views,320,RC,40000035,LOCAL,,inpatient,,,285.488,285.488,,,,,,,,,,,,,,,,,
XR Ribs 3 views BILATERAL,320,RC,40000038,LOCAL,,inpatient,,,252.056,252.056,,,,,,,,,,,,,,,,,
XR Breastbone >2 VIEWS,320,RC,40000040,LOCAL,,inpatient,,,378,378,,,,,,,,,,,,,,,,,
XR Neck Spine 2-3 views,320,RC,40000043,LOCAL,,inpatient,,,241.528,241.528,,,,,,,,,,,,,,,,,
XR Neck spine >6 views,320,RC,40000045,LOCAL,,inpatient,,,414.4,414.4,,,,,,,,,,,,,,,,,
XR Thorac spine 2 views,320,RC,40000046,LOCAL,,inpatient,,,210.392,210.392,,,,,,,,,,,,,,,,,
XR Thorac spine 3 views,320,RC,40000047,LOCAL,,inpatient,,,233.24,233.24,,,,,,,,,,,,,,,,,
XR Thoracolmbar >2 views,320,RC,40000049,LOCAL,,inpatient,,,189.448,189.448,,,,,,,,,,,,,,,,,
XR Lumbar Spine 2/3 views,320,RC,40000054,LOCAL,,inpatient,,,251.888,251.888,,,,,,,,,,,,,,,,,
XR Lumbar Sprine 4 views,320,RC,40000055,LOCAL,,inpatient,,,343.56,343.56,,,,,,,,,,,,,,,,,
XR Lumbar Spine Bending,320,RC,40000056,LOCAL,,inpatient,,,460.152,460.152,,,,,,,,,,,,,,,,,
XR Pelvis 1-2 views,320,RC,40000058,LOCAL,,inpatient,,,168.56,168.56,,,,,,,,,,,,,,,,,
XR Pelvis 3 views,320,RC,40000059,LOCAL,,inpatient,,,260.176,260.176,,,,,,,,,,,,,,,,,
XR Sacroiliac joints <3 views,320,RC,40000060,LOCAL,,inpatient,,,183.232,183.232,,,,,,,,,,,,,,,,,
XR Sacroiliac joints >3 views,320,RC,40000061,LOCAL,,inpatient,,,378,378,,,,,,,,,,,,,,,,,
XR Sacrum tailbone,320,RC,40000062,LOCAL,,inpatient,,,181.16,181.16,,,,,,,,,,,,,,,,,
XR Myelography neck spine,320,RC,40000063,LOCAL,,inpatient,,,891.688,891.688,,,,,,,,,,,,,,,,,
XR Myelogphy >2 spine regions,320,RC,40000066,LOCAL,,inpatient,,,1322.944,1322.944,,,,,,,,,,,,,,,,,
XR Collar bone,320,RC,40000070,LOCAL,,inpatient,,,176.96,176.96,,,,,,,,,,,,,,,,,
XR Shoulder blade,320,RC,40000071,LOCAL,,inpatient,,,189.336,189.336,,,,,,,,,,,,,,,,,
XR Shoulder 1 View - LT,320,RC,40000072,LOCAL,,inpatient,,,145.824,145.824,,,,,,,,,,,,,,,,,
XR Shoulder 1 View - RT,320,RC,40000073,LOCAL,,inpatient,,,145.824,145.824,,,,,,,,,,,,,,,,,
XR Shoulder 1 View - BI,320,RC,40000074,LOCAL,,inpatient,,,291.648,291.648,,,,,,,,,,,,,,,,,
XR Shoulder 2 views - LT,320,RC,40000075,LOCAL,,inpatient,,,191.464,191.464,,,,,,,,,,,,,,,,,
XR Shoulder 2 views - RT,320,RC,40000076,LOCAL,,inpatient,,,191.464,191.464,,,,,,,,,,,,,,,,,
XR Shoulder 2 views - BI,320,RC,40000077,LOCAL,,inpatient,,,382.928,382.928,,,,,,,,,,,,,,,,,
XR Shoulder Acromioclavicular,320,RC,40000081,LOCAL,,inpatient,,,378,378,,,,,,,,,,,,,,,,,
XR Humerus - LT,320,RC,40000082,LOCAL,,inpatient,,,181.16,181.16,,,,,,,,,,,,,,,,,
XR Humerus - RT,320,RC,40000083,LOCAL,,inpatient,,,181.16,181.16,,,,,,,,,,,,,,,,,
XR Humerus - BI,320,RC,40000084,LOCAL,,inpatient,,,362.32,362.32,,,,,,,,,,,,,,,,,
XR Elbow - 2 views LT,320,RC,40000085,LOCAL,,inpatient,,,174.888,174.888,,,,,,,,,,,,,,,,,
XR Elbow - 2 views RT,320,RC,40000086,LOCAL,,inpatient,,,174.888,174.888,,,,,,,,,,,,,,,,,
XR Elbow - 2 views BI,320,RC,40000087,LOCAL,,inpatient,,,345.576,345.576,,,,,,,,,,,,,,,,,
XR Elbow - 3 views LT,320,RC,40000088,LOCAL,,inpatient,,,210.28,210.28,,,,,,,,,,,,,,,,,
XR Elbow - 3 views RT,320,RC,40000089,LOCAL,,inpatient,,,210.28,210.28,,,,,,,,,,,,,,,,,
XR Elbow - 3 views BI,320,RC,40000090,LOCAL,,inpatient,,,420.56,420.56,,,,,,,,,,,,,,,,,
XR Forearm - LT,320,RC,40000094,LOCAL,,inpatient,,,172.872,172.872,,,,,,,,,,,,,,,,,
XR Forearm - RT,320,RC,40000095,LOCAL,,inpatient,,,172.872,172.872,,,,,,,,,,,,,,,,,
XR Forearm - BI,320,RC,40000096,LOCAL,,inpatient,,,345.744,345.744,,,,,,,,,,,,,,,,,
XR Wrist - 2 Views - LT,320,RC,40000097,LOCAL,,inpatient,,,191.464,191.464,,,,,,,,,,,,,,,,,
XR Wrist - 2 Views - RT,320,RC,40000098,LOCAL,,inpatient,,,191.464,191.464,,,,,,,,,,,,,,,,,
XR Wrist - 2 Views - BI,320,RC,40000099,LOCAL,,inpatient,,,382.942,382.942,,,,,,,,,,,,,,,,,
XR Wrist - 3 views - LT,320,RC,40000100,LOCAL,,inpatient,,,224.896,224.896,,,,,,,,,,,,,,,,,
XR Wrist - 3 views - RT,320,RC,40000101,LOCAL,,inpatient,,,224.896,224.896,,,,,,,,,,,,,,,,,
XR Wrist - 3 views - BI,320,RC,40000102,LOCAL,,inpatient,,,449.792,449.792,,,,,,,,,,,,,,,,,
XR Hand - 2 views - LT,320,RC,40000106,LOCAL,,inpatient,,,170.744,170.744,,,,,,,,,,,,,,,,,
XR Hand - 2 views - RT,320,RC,40000107,LOCAL,,inpatient,,,170.744,170.744,,,,,,,,,,,,,,,,,
XR Hand - 2 views - BI,320,RC,40000108,LOCAL,,inpatient,,,341.488,341.488,,,,,,,,,,,,,,,,,
XR Hand - 3 views - LT,320,RC,40000109,LOCAL,,inpatient,,,197.792,197.792,,,,,,,,,,,,,,,,,
XR Hand - 3 views - RT,320,RC,40000110,LOCAL,,inpatient,,,197.792,197.792,,,,,,,,,,,,,,,,,
XR Hand - 3 views - BI,320,RC,40000111,LOCAL,,inpatient,,,395.584,395.584,,,,,,,,,,,,,,,,,
XR Thumb - LT,320,RC,40000112,LOCAL,,inpatient,,,193.592,193.592,,,,,,,,,,,,,,,,,
XR Finger - 2ND - LT,320,RC,40000113,LOCAL,,inpatient,,,193.592,193.592,,,,,,,,,,,,,,,,,
XR Finger - 3RD - LT,320,RC,40000114,LOCAL,,inpatient,,,193.592,193.592,,,,,,,,,,,,,,,,,
XR Finger - 4TH - LT,320,RC,40000115,LOCAL,,inpatient,,,193.592,193.592,,,,,,,,,,,,,,,,,
XR Finger - 5TH - LT,320,RC,40000116,LOCAL,,inpatient,,,193.592,193.592,,,,,,,,,,,,,,,,,
XR THUMB - RT,320,RC,40000117,LOCAL,,inpatient,,,193.592,193.592,,,,,,,,,,,,,,,,,
XR Finger - 2nd - RT,320,RC,40000118,LOCAL,,inpatient,,,193.592,193.592,,,,,,,,,,,,,,,,,
XR Finger - 3rd - RT,320,RC,40000119,LOCAL,,inpatient,,,193.592,193.592,,,,,,,,,,,,,,,,,
XR Finger - 4th - RT,320,RC,40000120,LOCAL,,inpatient,,,193.592,193.592,,,,,,,,,,,,,,,,,
XR Finger - 5th - RT,320,RC,40000121,LOCAL,,inpatient,,,193.592,193.592,,,,,,,,,,,,,,,,,
XR Femur 1 view - LT,320,RC,40000132,LOCAL,,inpatient,,,171.696,171.696,,,,,,,,,,,,,,,,,
XR Femur 1 view - RT,320,RC,40000133,LOCAL,,inpatient,,,171.696,171.696,,,,,,,,,,,,,,,,,
XR Femur 1 view - BI,320,RC,40000134,LOCAL,,inpatient,,,343.392,343.392,,,,,,,,,,,,,,,,,
XR Femur >2 views - LT,320,RC,40000135,LOCAL,,inpatient,,,238.392,238.392,,,,,,,,,,,,,,,,,
XR Femur >2 views - RT,320,RC,40000136,LOCAL,,inpatient,,,238.392,238.392,,,,,,,,,,,,,,,,,
XR Femur >2 views - BI,320,RC,40000137,LOCAL,,inpatient,,,476.784,476.784,,,,,,,,,,,,,,,,,
XR Knee 1 or 2 views - LT,320,RC,40000138,LOCAL,,inpatient,,,131.04,131.04,,,,,,,,,,,,,,,,,
XR Knee 1 or 2 views - RT,320,RC,40000139,LOCAL,,inpatient,,,131.04,131.04,,,,,,,,,,,,,,,,,
XR Knee 1 or 2 views - BI,320,RC,40000140,LOCAL,,inpatient,,,262.08,262.08,,,,,,,,,,,,,,,,,
XR Knee 3 views - LT,320,RC,40000141,LOCAL,,inpatient,,,164.36,164.36,,,,,,,,,,,,,,,,,
XR Knee 3 views - RT,320,RC,40000142,LOCAL,,inpatient,,,164.36,164.36,,,,,,,,,,,,,,,,,
XR Knee 3 views - BI,320,RC,40000143,LOCAL,,inpatient,,,328.72,328.72,,,,,,,,,,,,,,,,,
XR Knee 4+ views - LT,320,RC,40000144,LOCAL,,inpatient,,,260.176,260.176,,,,,,,,,,,,,,,,,
XR Knee 4+ views - RT,320,RC,40000145,LOCAL,,inpatient,,,260.176,260.176,,,,,,,,,,,,,,,,,
XR Knee 4+ views - BI,320,RC,40000146,LOCAL,,inpatient,,,520.352,520.352,,,,,,,,,,,,,,,,,
XR Knees - standing bilateral,320,RC,40000147,LOCAL,,inpatient,,,210.112,210.112,,,,,,,,,,,,,,,,,
XR Knee joint w/contrast - LT,320,RC,40000148,LOCAL,,inpatient,,,811.944,811.944,,,,,,,,,,,,,,,,,
XR Knee joint w/contrast - RT,320,RC,40000149,LOCAL,,inpatient,,,811.944,811.944,,,,,,,,,,,,,,,,,
XR Knee joint w/contrast - BI,320,RC,40000150,LOCAL,,inpatient,,,1623.888,1623.888,,,,,,,,,,,,,,,,,
XR Lower leg - LT,320,RC,40000151,LOCAL,,inpatient,,,170.744,170.744,,,,,,,,,,,,,,,,,
XR Lower leg - RT,320,RC,40000152,LOCAL,,inpatient,,,170.744,170.744,,,,,,,,,,,,,,,,,
XR Lower leg - BI,320,RC,40000153,LOCAL,,inpatient,,,341.488,341.488,,,,,,,,,,,,,,,,,
XR Ankle - 2 views - LT,320,RC,40000154,LOCAL,,inpatient,,,174.888,174.888,,,,,,,,,,,,,,,,,
XR Ankle - 2 views - RT,320,RC,40000155,LOCAL,,inpatient,,,174.888,174.888,,,,,,,,,,,,,,,,,
XR Ankle - 2 views - BI,320,RC,40000156,LOCAL,,inpatient,,,345.576,345.576,,,,,,,,,,,,,,,,,
XR Ankle - 3 views - LT,320,RC,40000157,LOCAL,,inpatient,,,199.92,199.92,,,,,,,,,,,,,,,,,
XR Ankle - 3 views - RT,320,RC,40000158,LOCAL,,inpatient,,,199.92,199.92,,,,,,,,,,,,,,,,,
XR Ankle - 3 views - BI,320,RC,40000159,LOCAL,,inpatient,,,399.854,399.854,,,,,,,,,,,,,,,,,
XR Foot - 2 views - LT,320,RC,40000163,LOCAL,,inpatient,,,390.6,390.6,,,,,,,,,,,,,,,,,
XR Foot - 2 views - RT,320,RC,40000164,LOCAL,,inpatient,,,390.6,390.6,,,,,,,,,,,,,,,,,
XR Foot - 2 views - BI,320,RC,40000165,LOCAL,,inpatient,,,781.2,781.2,,,,,,,,,,,,,,,,,
XR Foot 3 views - LT,320,RC,40000166,LOCAL,,inpatient,,,390.6,390.6,,,,,,,,,,,,,,,,,
XR Foot 3 views - RT,320,RC,40000167,LOCAL,,inpatient,,,390.6,390.6,,,,,,,,,,,,,,,,,
XR Foot 3 views - BI,320,RC,40000168,LOCAL,,inpatient,,,781.2,781.2,,,,,,,,,,,,,,,,,
XR Heel - LT,320,RC,40000169,LOCAL,,inpatient,,,172.872,172.872,,,,,,,,,,,,,,,,,
XR Heel - RT,320,RC,40000170,LOCAL,,inpatient,,,172.872,172.872,,,,,,,,,,,,,,,,,
XR Heel - BI,320,RC,40000171,LOCAL,,inpatient,,,345.758,345.758,,,,,,,,,,,,,,,,,
XR Toe Great - LT,320,RC,40000172,LOCAL,,inpatient,,,181.104,181.104,,,,,,,,,,,,,,,,,
XR Toe  2ND  - LT,320,RC,40000173,LOCAL,,inpatient,,,181.104,181.104,,,,,,,,,,,,,,,,,
XR Toe  3RD  - LT,320,RC,40000174,LOCAL,,inpatient,,,181.104,181.104,,,,,,,,,,,,,,,,,
XR Toe  4TH  - LT,320,RC,40000175,LOCAL,,inpatient,,,181.104,181.104,,,,,,,,,,,,,,,,,
XR Toe  5TH  - LT,320,RC,40000176,LOCAL,,inpatient,,,181.104,181.104,,,,,,,,,,,,,,,,,
XR Toe - Great - RT,320,RC,40000177,LOCAL,,inpatient,,,181.104,181.104,,,,,,,,,,,,,,,,,
XR Toe 2nd - RT,320,RC,40000178,LOCAL,,inpatient,,,181.104,181.104,,,,,,,,,,,,,,,,,
XR Toe 3rd - RT,320,RC,40000179,LOCAL,,inpatient,,,181.104,181.104,,,,,,,,,,,,,,,,,
XR Toe 4th - RT,320,RC,40000180,LOCAL,,inpatient,,,181.104,181.104,,,,,,,,,,,,,,,,,
XR Toe 5th - RT,320,RC,40000181,LOCAL,,inpatient,,,181.104,181.104,,,,,,,,,,,,,,,,,
XR Abdomen 1 view,320,RC,40000182,LOCAL,,inpatient,,,177.408,177.408,,,,,,,,,,,,,,,,,
XR - Abdomen Complete,320,RC,40000185,LOCAL,,inpatient,,,297.976,297.976,,,,,,,,,,,,,,,,,
XR Esophagus w/cont 1 view,320,RC,40000188,LOCAL,,inpatient,,,556.08,556.08,,,,,,,,,,,,,,,,,
XR Esophagus w/cont 2 views,320,RC,40000189,LOCAL,,inpatient,,,893.2,893.2,,,,,,,,,,,,,,,,,
RF BARIUM SWALLOW - MODIFIED,320,RC,40000190,LOCAL,,inpatient,,,564.536,564.536,,,,,,,,,,,,,,,,,
XR Esophagus obstruction,320,RC,40000191,LOCAL,,inpatient,,,418.6,418.6,,,,,,,,,,,,,,,,,
XR Upper GI w/contr 1 view,320,RC,40000192,LOCAL,,inpatient,,,689.528,689.528,,,,,,,,,,,,,,,,,
XR Upper GI w/contr 2 views,320,RC,40000193,LOCAL,,inpatient,,,855.512,855.512,,,,,,,,,,,,,,,,,
XR SMALL INTESTINE,320,RC,40000194,LOCAL,,inpatient,,,168.84,168.84,,,,,,,,,,,,,,,,,
XR SM BOW VIA ENTERO,320,RC,40000195,LOCAL,,inpatient,,,893.2,893.2,,,,,,,,,,,,,,,,,
XR COLON W/C W/WO K,320,RC,40000196,LOCAL,,inpatient,,,893.2,893.2,,,,,,,,,,,,,,,,,
XR COLON W BARIUM,320,RC,40000197,LOCAL,,inpatient,,,893.2,893.2,,,,,,,,,,,,,,,,,
XR Gallbladder w/contr,320,RC,40000198,LOCAL,,inpatient,,,893.2,893.2,,,,,,,,,,,,,,,,,
XR Bile ducts/pancreas,320,RC,40000199,LOCAL,,inpatient,,,263.2,263.2,,,,,,,,,,,,,,,,,
XR Bile duct endoscopy,320,RC,40000200,LOCAL,,inpatient,,,79.8,79.8,,,,,,,,,,,,,,,,,
XR Pancreas endoscopy,320,RC,40000201,LOCAL,,inpatient,,,158.2,158.2,,,,,,,,,,,,,,,,,
XR Bile/panc endoscopy,320,RC,40000202,LOCAL,,inpatient,,,158.2,158.2,,,,,,,,,,,,,,,,,
XR GI Tube w/Guide,320,RC,40000203,LOCAL,,inpatient,,,868.056,868.056,,,,,,,,,,,,,,,,,
XR Peg Tube w/Guide,320,RC,40000204,LOCAL,,inpatient,,,203,203,,,,,,,,,,,,,,,,,
XR GI dilation w/Guide,320,RC,40000205,LOCAL,,inpatient,,,123.2,123.2,,,,,,,,,,,,,,,,,
XR Bile duct dilation,320,RC,40000206,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
XR PYELO W/WO KUB,320,RC,40000207,LOCAL,,inpatient,,,689.248,689.248,,,,,,,,,,,,,,,,,
XR Urography drip &/bolus,320,RC,40000208,LOCAL,,inpatient,,,893.2,893.2,,,,,,,,,,,,,,,,,
XR Urography w/nephroto,320,RC,40000209,LOCAL,,inpatient,,,893.2,893.2,,,,,,,,,,,,,,,,,
XR Urography retro w/w/o KUB,320,RC,40000210,LOCAL,,inpatient,,,1870.4,1870.4,,,,,,,,,,,,,,,,,
XR Urography antegrade,320,RC,40000211,LOCAL,,inpatient,,,1870.4,1870.4,,,,,,,,,,,,,,,,,
XR Bladder 3 views,402,RC,40000212,LOCAL,,inpatient,,,374.92,374.92,,,,,,,,,,,,,,,,,
XR Urethra/bladder,320,RC,40000213,LOCAL,,inpatient,,,1142.4,1142.4,,,,,,,,,,,,,,,,,
XR Urethra/bladder Voiding,320,RC,40000214,LOCAL,,inpatient,,,1142.4,1142.4,,,,,,,,,,,,,,,,,
XR Kidney lesion,320,RC,40000215,LOCAL,,inpatient,,,2360.4,2360.4,,,,,,,,,,,,,,,,,
XR Dilation urtr/urt rs&i,320,RC,40000216,LOCAL,,inpatient,,,8680,8680,,,,,,,,,,,,,,,,,
XR KSF EMPLOYEE Chest 1V,320,RC,40000224,LOCAL,,inpatient,,,145.824,145.824,,,,,,,,,,,,,,,,,
XR CLAVICLE LEFT,320,RC,40000333,LOCAL,,inpatient,,,155.47,155.47,,,,,,,,,,,,,,,,,
XR CLAVICLE RIGHT,320,RC,40000334,LOCAL,,inpatient,,,155.47,155.47,,,,,,,,,,,,,,,,,
XR BONE SURVEY COMPLETE,320,RC,40000353,LOCAL,,inpatient,,,548.8,548.8,,,,,,,,,,,,,,,,,
XR HIP 2 VIEW BILATERAL,320,RC,40000355,LOCAL,,inpatient,,,255.892,255.892,,,,,,,,,,,,,,,,,
XR HIP 2 VIEW LEFT,320,RC,40000356,LOCAL,,inpatient,,,255.892,255.892,,,,,,,,,,,,,,,,,
XR HIP 2 VIEW RIGHT,320,RC,40000357,LOCAL,,inpatient,,,255.892,255.892,,,,,,,,,,,,,,,,,
XR HIP COMPLETE BILATERAL,320,RC,40000358,LOCAL,,inpatient,,,548.8,548.8,,,,,,,,,,,,,,,,,
XR HIP COMPLETE LEFT,320,RC,40000359,LOCAL,,inpatient,,,548.8,548.8,,,,,,,,,,,,,,,,,
XR HIP COMPLETE RIGHT,320,RC,40000360,LOCAL,,inpatient,,,548.8,548.8,,,,,,,,,,,,,,,,,
XR HIP UNILAT 1 VIEW LEFT,320,RC,40000361,LOCAL,,inpatient,,,183.904,183.904,,,,,,,,,,,,,,,,,
XR HIP UNILAT 1 VIEW RIGHT,320,RC,40000362,LOCAL,,inpatient,,,183.904,183.904,,,,,,,,,,,,,,,,,
XR MANDIBLE <4 VIEWS,320,RC,40000363,LOCAL,,inpatient,,,390.6,390.6,,,,,,,,,,,,,,,,,
XR RIBS 3 VIEW LEFT,320,RC,40000364,LOCAL,,inpatient,,,504.112,504.112,,,,,,,,,,,,,,,,,
XR RIBS 3 VIEW RIGHT,320,RC,40000365,LOCAL,,inpatient,,,504.112,504.112,,,,,,,,,,,,,,,,,
US CHEST,402,RC,40100004,LOCAL,,inpatient,,,541.632,541.632,,,,,,,,,,,,,,,,,
US ABDOMEN COMPLETE,402,RC,40100007,LOCAL,,inpatient,,,835.408,835.408,,,,,,,,,,,,,,,,,
US KIDNEY COMPLETE,402,RC,40100009,LOCAL,,inpatient,,,814.464,814.464,,,,,,,,,,,,,,,,,
US ABDOMEN LIMITED,402,RC,40100038,LOCAL,,inpatient,,,658.224,658.224,,,,,,,,,,,,,,,,,
US KIDNEY LIMITED LEFT  ,402,RC,40100112,LOCAL,,inpatient,,,185.584,185.584,,,,,,,,,,,,,,,,,
US KIDNEY LIMITED RIGHT,402,RC,40100113,LOCAL,,inpatient,,,185.584,185.584,,,,,,,,,,,,,,,,,
US VENOUS-BILATERAL UPPER EXTR,402,RC,40100135,LOCAL,,inpatient,,,534.8,534.8,,,,,,,,,,,,,,,,,
US ECHO COMPLETE,402,RC,40100150,LOCAL,,inpatient,,,116.2,116.2,,,,,,,,,,,,,,,,,
US VENOUS UNILATERAL UPPER EXT,321,RC,40100151,LOCAL,,inpatient,,,534.8,534.8,,,,,,,,,,,,,,,,,
US KIDNEY LIMITED,321,RC,40100152,LOCAL,,inpatient,,,814.464,814.464,,,,,,,,,,,,,,,,,
US LEG/ARM NON(VASE TO RO ABS),321,RC,40100153,LOCAL,,inpatient,,,705.6,705.6,,,,,,,,,,,,,,,,,
NM Thyroid uptake measurement,341,RC,40200000,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Thyroid imaging w/blood flo,341,RC,40200001,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Thyroid imaging w/blood flo,341,RC,40200002,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Thyroid met imaging,341,RC,40200003,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Thyroid met imaging/studies,341,RC,40200004,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Thyroid met imaging body,341,RC,40200005,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Thyroid met uptake,341,RC,40200006,LOCAL,,inpatient,,,256.662,256.662,,,,,,,,,,,,,,,,,
NM Parathyroid planar imaging,341,RC,40200007,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Parathyrd planar w/wo subtr,341,RC,40200008,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Parathyrd planar w/spect&ct,341,RC,40200009,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Adrenal cortex & medulla im,341,RC,40200010,LOCAL,,inpatient,,,6234.2,6234.2,,,,,,,,,,,,,,,,,
NM Endocrine nuclear procedure,341,RC,40200011,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Bone marrow imaging ltd,341,RC,40200012,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Bone marrow imaging mult,341,RC,40200013,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Bone marrow imaging body,341,RC,40200014,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Plasma volume single,341,RC,40200015,LOCAL,,inpatient,,,6234.2,6234.2,,,,,,,,,,,,,,,,,
NM Plasma volume multiple,341,RC,40200016,LOCAL,,inpatient,,,6234.2,6234.2,,,,,,,,,,,,,,,,,
NM Red cell mass single,341,RC,40200017,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Red cell mass multiple,341,RC,40200018,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Blood volume,341,RC,40200019,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Red cell survival study,341,RC,40200020,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Red cell survival kinetics,341,RC,40200021,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Red cell sequestration,341,RC,40200022,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Spleen imaging,341,RC,40200023,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Platelet survival,341,RC,40200024,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Lymph system imaging,341,RC,40200025,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Blood/lymph nuclear exam,341,RC,40200026,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Liver imaging,341,RC,40200027,LOCAL,,inpatient,,,6234.2,6234.2,,,,,,,,,,,,,,,,,
NM Liver imaging with flow,341,RC,40200028,LOCAL,,inpatient,,,6234.2,6234.2,,,,,,,,,,,,,,,,,
NM Liver and spleen imaging,341,RC,40200029,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Liver & spleen image/flow,341,RC,40200030,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Hepatobiliary system imagin,341,RC,40200031,LOCAL,,inpatient,,,1784.832,1784.832,,,,,,,,,,,,,,,,,
NM Hepatobil syst image w/drug,341,RC,40200032,LOCAL,,inpatient,,,2443.98,2443.98,,,,,,,,,,,,,,,,,
NM Salivary gland imaging,341,RC,40200033,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Serial salivary imaging,341,RC,40200034,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Salivary gland function exa,341,RC,40200035,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Esophageal motility study,341,RC,40200036,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Gastric mucosa imaging,341,RC,40200037,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Gastroesophageal reflux exa,341,RC,40200038,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Gastric emptying imag study,341,RC,40200039,LOCAL,,inpatient,,,1700.832,1700.832,,,,,,,,,,,,,,,,,
NM Gastric emptying imag study,341,RC,40200040,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Gastric emptying imag study,341,RC,40200041,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Breath tst attain/anal c-14,341,RC,40200042,LOCAL,,inpatient,,,46.452,46.452,,,,,,,,,,,,,,,,,
NM Breath test analysis c-14,341,RC,40200043,LOCAL,,inpatient,,,396.522,396.522,,,,,,,,,,,,,,,,,
NM Acute gi blood loss imaging,341,RC,40200044,LOCAL,,inpatient,,,300.944,300.944,,,,,,,,,,,,,,,,,
NM Gi protein loss exam,341,RC,40200045,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Meckels divert exam,341,RC,40200046,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Leveen/shunt patency exam,341,RC,40200047,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Gi nuclear procedure,341,RC,40200048,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Bone imaging limited area,341,RC,40200049,LOCAL,,inpatient,,,1080.576,1080.576,,,,,,,,,,,,,,,,,
NM Bone imaging multiple areas,341,RC,40200050,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Bone imaging 3 phase,341,RC,40200052,LOCAL,,inpatient,,,1807.344,1807.344,,,,,,,,,,,,,,,,,
NM Bone mineral single photon,341,RC,40200053,LOCAL,,inpatient,,,213.276,213.276,,,,,,,,,,,,,,,,,
NM Bone mineral dual photon,341,RC,40200054,LOCAL,,inpatient,,,403.2,403.2,,,,,,,,,,,,,,,,,
NM Musculoskeletal nuclear exa,341,RC,40200055,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Non-imaging heart function,341,RC,40200056,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Cardiac shunt imaging,341,RC,40200057,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Vascular flow imaging,341,RC,40200058,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Ht muscle image spect sing,341,RC,40200059,LOCAL,,inpatient,,,2090.816,2090.816,,,,,,,,,,,,,,,,,
NM Ht muscle image spect mult,341,RC,40200060,LOCAL,,inpatient,,,2927.624,2927.624,,,,,,,,,,,,,,,,,
NM Ht muscle image planar sing,341,RC,40200061,LOCAL,,inpatient,,,6234.2,6234.2,,,,,,,,,,,,,,,,,
NM Ht musc image planar mult,341,RC,40200062,LOCAL,,inpatient,,,6234.2,6234.2,,,,,,,,,,,,,,,,,
NM Acute venous thrombus image,341,RC,40200063,LOCAL,,inpatient,,,6234.2,6234.2,,,,,,,,,,,,,,,,,
NM Venous thrombosis imaging,341,RC,40200064,LOCAL,,inpatient,,,6234.2,6234.2,,,,,,,,,,,,,,,,,
NM Ven thrombosis images bilat,341,RC,40200065,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Heart infarct image,341,RC,40200066,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Heart infarct image (ef),341,RC,40200067,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Heart infarct image (3d),341,RC,40200068,LOCAL,,inpatient,,,6234.2,6234.2,,,,,,,,,,,,,,,,,
NM Gated heart planar single,341,RC,40200069,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Gated heart multiple,341,RC,40200070,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Heart first pass single,341,RC,40200071,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Heart first pass multiple,341,RC,40200072,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Heart image spect,341,RC,40200073,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Heart first pass add-on,341,RC,40200074,LOCAL,,inpatient,,,298.2,298.2,,,,,,,,,,,,,,,,,
NM Cardiovascular nuclear exam,341,RC,40200075,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Lung ventilation imaging,341,RC,40200076,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Lung ventilat&perfus imagin,341,RC,40200078,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Lung perfusion differential,341,RC,40200079,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Lung perf&ventilat diferent,341,RC,40200080,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Respiratory nuclear exam,341,RC,40200081,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Brain image < 4 views,341,RC,40200082,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Brain image w/flow < 4 view,341,RC,40200083,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Brain image 4+ views,341,RC,40200084,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Brain image w/flow 4 + view,341,RC,40200085,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Brain flow imaging only,341,RC,40200086,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Cerebrospinal fluid scan,341,RC,40200087,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Csf ventriculography,341,RC,40200088,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Csf shunt evaluation,341,RC,40200089,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM Csf leakage imaging,341,RC,40200090,LOCAL,,inpatient,,,6234.2,6234.2,,,,,,,,,,,,,,,,,
NM Nuclear exam of tear flow,341,RC,40200091,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Nervous system nuclear exam,341,RC,40200092,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Kidney imaging morphol,341,RC,40200093,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Kidney imaging with flow,341,RC,40200094,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM K flow/funct image w/o drug,341,RC,40200095,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM K flow/funct image w/drug,341,RC,40200096,LOCAL,,inpatient,,,2312.8,2312.8,,,,,,,,,,,,,,,,,
NM K flow/funct image multiple,341,RC,40200097,LOCAL,,inpatient,,,2246.832,2246.832,,,,,,,,,,,,,,,,,
NM Kidney function study,341,RC,40200098,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Urinary bladder retention,341,RC,40200099,LOCAL,,inpatient,,,387.786,387.786,,,,,,,,,,,,,,,,,
NM Ureteral reflux study,341,RC,40200100,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Testicular imaging w/flow,341,RC,40200101,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Genitourinary nuclear exam,341,RC,40200102,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Rp loclzj tum 1 area 1 d im,341,RC,40200103,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Rp loclzj tum 2+area 1+d im,341,RC,40200104,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Rp loclzj tum whbdy 1 d img,341,RC,40200105,LOCAL,,inpatient,,,6234.2,6234.2,,,,,,,,,,,,,,,,,
NM Rp loclzj tum spect 1 area,341,RC,40200106,LOCAL,,inpatient,,,6234.2,6234.2,,,,,,,,,,,,,,,,,
NM Rp loclzj tum whbdy 2+d img,341,RC,40200107,LOCAL,,inpatient,,,6234.2,6234.2,,,,,,,,,,,,,,,,,
NM Nuclear diagnostic exam,341,RC,40200108,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Infuse radioactive material,342,RC,40200109,LOCAL,,inpatient,,,1157.8,1157.8,,,,,,,,,,,,,,,,,
NM Apply intrcav radiat simple,342,RC,40200110,LOCAL,,inpatient,,,2640.4,2640.4,,,,,,,,,,,,,,,,,
NM Apply intrcav radiat interm,342,RC,40200111,LOCAL,,inpatient,,,2640.4,2640.4,,,,,,,,,,,,,,,,,
NM Apply intrcav radiat compl,342,RC,40200112,LOCAL,,inpatient,,,3628.8,3628.8,,,,,,,,,,,,,,,,,
NM Hdr rdncl skn surf brachytx,342,RC,40200113,LOCAL,,inpatient,,,1157.8,1157.8,,,,,,,,,,,,,,,,,
NM Hdr rdncl skn surf brachytx,342,RC,40200114,LOCAL,,inpatient,,,1157.8,1157.8,,,,,,,,,,,,,,,,,
NM Hdr rdncl ntrstl/icav brcht,342,RC,40200115,LOCAL,,inpatient,,,3628.8,3628.8,,,,,,,,,,,,,,,,,
NM Hdr rdncl ntrstl/icav brcht,342,RC,40200116,LOCAL,,inpatient,,,3628.8,3628.8,,,,,,,,,,,,,,,,,
NM Hdr rdncl ntrstl/icav brcht,342,RC,40200117,LOCAL,,inpatient,,,3628.8,3628.8,,,,,,,,,,,,,,,,,
NM Apply interstit radiat comp,342,RC,40200118,LOCAL,,inpatient,,,3628.8,3628.8,,,,,,,,,,,,,,,,,
NM Apply surf ldr radionuclide,342,RC,40200119,LOCAL,,inpatient,,,600.6,600.6,,,,,,,,,,,,,,,,,
NM Radiation handling,342,RC,40200120,LOCAL,,inpatient,,,117.572,117.572,,,,,,,,,,,,,,,,,
NM Radium/radioisotope therapy,342,RC,40200121,LOCAL,,inpatient,,,600.6,600.6,,,,,,,,,,,,,,,,,
NM Iv inj ra drug dx study,342,RC,40200122,LOCAL,,inpatient,,,1803.2,1803.2,,,,,,,,,,,,,,,,,
NM Nuclear rx oral admin,342,RC,40200123,LOCAL,,inpatient,,,1163.4,1163.4,,,,,,,,,,,,,,,,,
NM Nuclear rx iv admin,342,RC,40200124,LOCAL,,inpatient,,,1163.4,1163.4,,,,,,,,,,,,,,,,,
NM Nuclear rx intracav admin,342,RC,40200125,LOCAL,,inpatient,,,1163.4,1163.4,,,,,,,,,,,,,,,,,
NM Nuclr rx interstit colloid,342,RC,40200126,LOCAL,,inpatient,,,1163.4,1163.4,,,,,,,,,,,,,,,,,
NM Hematopoietic nuclear tx,342,RC,40200127,LOCAL,,inpatient,,,1163.4,1163.4,,,,,,,,,,,,,,,,,
NM Nuclear rx intra-articular,342,RC,40200128,LOCAL,,inpatient,,,1163.4,1163.4,,,,,,,,,,,,,,,,,
NM Nuclear rx intra-arterial,342,RC,40200129,LOCAL,,inpatient,,,1163.4,1163.4,,,,,,,,,,,,,,,,,
NM Nuclear medicine therapy,342,RC,40200130,LOCAL,,inpatient,,,1163.4,1163.4,,,,,,,,,,,,,,,,,
CT HEAD WO,351,RC,40300000,LOCAL,,inpatient,,,1209.992,1209.992,,,,,,,,,,,,,,,,,
CT HEAD W,351,RC,40300001,LOCAL,,inpatient,,,1576.624,1576.624,,,,,,,,,,,,,,,,,
CT HEAD W/WO,351,RC,40300002,LOCAL,,inpatient,,,1907.528,1907.528,,,,,,,,,,,,,,,,,
CT orbit/ear/fossa w/o dye,351,RC,40300003,LOCAL,,inpatient,,,1580.88,1580.88,,,,,,,,,,,,,,,,,
CT orbit/ear/fossa w/dye,351,RC,40300004,LOCAL,,inpatient,,,2248.904,2248.904,,,,,,,,,,,,,,,,,
CT orbits w/o&w/dye,351,RC,40300005,LOCAL,,inpatient,,,2504.432,2504.432,,,,,,,,,,,,,,,,,
CT maxillofacial w/o dye,351,RC,40300006,LOCAL,,inpatient,,,1537.088,1537.088,,,,,,,,,,,,,,,,,
CT maxillofacial w/dye,351,RC,40300007,LOCAL,,inpatient,,,1045.576,1045.576,,,,,,,,,,,,,,,,,
CT maxill w/o & w/dye,351,RC,40300008,LOCAL,,inpatient,,,1272.096,1272.096,,,,,,,,,,,,,,,,,
CT soft tissue neck w/o dye,351,RC,40300009,LOCAL,,inpatient,,,1580.88,1580.88,,,,,,,,,,,,,,,,,
CT soft tissue neck w/dye,351,RC,40300010,LOCAL,,inpatient,,,1905.68,1905.68,,,,,,,,,,,,,,,,,
CTA Head/Brain w/o & w/dye,351,RC,40300012,LOCAL,,inpatient,,,2613.52,2613.52,,,,,,,,,,,,,,,,,
CTA Neck w/o & w/dye,351,RC,40300013,LOCAL,,inpatient,,,2613.52,2613.52,,,,,,,,,,,,,,,,,
CT thorax w/o dye,352,RC,40300014,LOCAL,,inpatient,,,993.832,993.832,,,,,,,,,,,,,,,,,
CT thorax w/dye,352,RC,40300015,LOCAL,,inpatient,,,1913.8,1913.8,,,,,,,,,,,,,,,,,
CT thorax w/o & w/dye,352,RC,40300016,LOCAL,,inpatient,,,1724.52,1724.52,,,,,,,,,,,,,,,,,
CTA Chest w/o & w/dye,352,RC,40300017,LOCAL,,inpatient,,,1879.08,1879.08,,,,,,,,,,,,,,,,,
CT neck spine w/o dye,352,RC,40300018,LOCAL,,inpatient,,,1501.472,1501.472,,,,,,,,,,,,,,,,,
CT neck spine w/dye,352,RC,40300019,LOCAL,,inpatient,,,1422.344,1422.344,,,,,,,,,,,,,,,,,
CT neck spine w/o & w/dye,352,RC,40300020,LOCAL,,inpatient,,,1678.096,1678.096,,,,,,,,,,,,,,,,,
CT chest spine w/o dye,352,RC,40300021,LOCAL,,inpatient,,,1501.472,1501.472,,,,,,,,,,,,,,,,,
CT chest spine w/o & w/dye,352,RC,40300023,LOCAL,,inpatient,,,1680.28,1680.28,,,,,,,,,,,,,,,,,
CT lumbar spine w/o dye,352,RC,40300024,LOCAL,,inpatient,,,1501.472,1501.472,,,,,,,,,,,,,,,,,
CT lumbar spine w/dye,352,RC,40300025,LOCAL,,inpatient,,,1909.544,1909.544,,,,,,,,,,,,,,,,,
CT lumb spine w/o&w/dye,352,RC,40300026,LOCAL,,inpatient,,,1336.188,1336.188,,,,,,,,,,,,,,,,,
CTA Pelvis w/o & w/dye,352,RC,40300027,LOCAL,,inpatient,,,893.2,893.2,,,,,,,,,,,,,,,,,
CT pelvis w/o dye,352,RC,40300028,LOCAL,,inpatient,,,1495.41,1495.41,,,,,,,,,,,,,,,,,
CT pelvis w/dye,352,RC,40300029,LOCAL,,inpatient,,,1811.656,1811.656,,,,,,,,,,,,,,,,,
CT R upper extremity w/o dye,352,RC,40300032,LOCAL,,inpatient,,,1501.36,1501.36,,,,,,,,,,,,,,,,,
CT upper extremity w/dye,352,RC,40300033,LOCAL,,inpatient,,,1842.848,1842.848,,,,,,,,,,,,,,,,,
CT upper extremity w/dye,352,RC,40300034,LOCAL,,inpatient,,,1842.848,1842.848,,,,,,,,,,,,,,,,,
CT uppr extrem w/o&w/dye,352,RC,40300035,LOCAL,,inpatient,,,2356.928,2356.928,,,,,,,,,,,,,,,,,
CT uppr extrem w/o&w/dye,352,RC,40300036,LOCAL,,inpatient,,,2356.928,2356.928,,,,,,,,,,,,,,,,,
CTA UP Extr w/o & w/dye,352,RC,40300037,LOCAL,,inpatient,,,2659.552,2659.552,,,,,,,,,,,,,,,,,
CTA UP Extr w/o & w/dye,352,RC,40300038,LOCAL,,inpatient,,,893.2,893.2,,,,,,,,,,,,,,,,,
CT lower extremity w/o dye,352,RC,40300040,LOCAL,,inpatient,,,1501.36,1501.36,,,,,,,,,,,,,,,,,
CT lower extremity w/dye,352,RC,40300041,LOCAL,,inpatient,,,1859.48,1859.48,,,,,,,,,,,,,,,,,
CT lower extremity w/dye,352,RC,40300042,LOCAL,,inpatient,,,1859.48,1859.48,,,,,,,,,,,,,,,,,
CT lwr extremity w/o&w/dye,352,RC,40300043,LOCAL,,inpatient,,,2369.416,2369.416,,,,,,,,,,,,,,,,,
CT lwr extremity w/o&w/dye,352,RC,40300044,LOCAL,,inpatient,,,2369.416,2369.416,,,,,,,,,,,,,,,,,
CTA Lower extr w/o&w/dye,352,RC,40300045,LOCAL,,inpatient,,,2659.552,2659.552,,,,,,,,,,,,,,,,,
CTA Lower ext w/o&w/dye,352,RC,40300046,LOCAL,,inpatient,,,2659.552,2659.552,,,,,,,,,,,,,,,,,
CT abdomen w/o dye,352,RC,40300047,LOCAL,,inpatient,,,1520.344,1520.344,,,,,,,,,,,,,,,,,
CT abdomen w/dye,352,RC,40300048,LOCAL,,inpatient,,,2055.256,2055.256,,,,,,,,,,,,,,,,,
CT abdomen w/o & w/dye,352,RC,40300049,LOCAL,,inpatient,,,2477.832,2477.832,,,,,,,,,,,,,,,,,
CTA Abd & pelvis w/o&w/dye,352,RC,40300050,LOCAL,,inpatient,,,2131.304,2131.304,,,,,,,,,,,,,,,,,
CTA Abdomen w/o & w/dye,352,RC,40300051,LOCAL,,inpatient,,,2661.512,2661.512,,,,,,,,,,,,,,,,,
CT abd & pelvis w/o contrast,352,RC,40300052,LOCAL,,inpatient,,,1233.288,1233.288,,,,,,,,,,,,,,,,,
CT abd & pelv w/contrast,352,RC,40300053,LOCAL,,inpatient,,,2085.16,2085.16,,,,,,,,,,,,,,,,,
CT abd & pelv 1/> regns,352,RC,40300054,LOCAL,,inpatient,,,1908.06,1908.06,,,,,,,,,,,,,,,,,
CT colonography dx,352,RC,40300055,LOCAL,,inpatient,,,1900.92,1900.92,,,,,,,,,,,,,,,,,
CT colonography dx w/dye,352,RC,40300056,LOCAL,,inpatient,,,2585.408,2585.408,,,,,,,,,,,,,,,,,
CT colonography screening,350,RC,40300057,LOCAL,,inpatient,,,470.4,470.4,,,,,,,,,,,,,,,,,
CT hrt w/o dye w/ca test,350,RC,40300058,LOCAL,,inpatient,,,454.496,454.496,,,,,,,,,,,,,,,,,
CT hrt w/3d image,352,RC,40300059,LOCAL,,inpatient,,,893.2,893.2,,,,,,,,,,,,,,,,,
CT hrt w/3d image congen,352,RC,40300060,LOCAL,,inpatient,,,893.2,893.2,,,,,,,,,,,,,,,,,
CTA Heart w/3d image,352,RC,40300061,LOCAL,,inpatient,,,3364.9,3364.9,,,,,,,,,,,,,,,,,
CTA Abdominal arteries,352,RC,40300062,LOCAL,,inpatient,,,2814.168,2814.168,,,,,,,,,,,,,,,,,
CT scan follow-up study,350,RC,40300063,LOCAL,,inpatient,,,993.832,993.832,,,,,,,,,,,,,,,,,
CT scan for localization,350,RC,40300064,LOCAL,,inpatient,,,777,777,,,,,,,,,,,,,,,,,
CT scan for needle biopsy,350,RC,40300065,LOCAL,,inpatient,,,1004.528,1004.528,,,,,,,,,,,,,,,,,
CT guide for tissue ablation,350,RC,40300066,LOCAL,,inpatient,,,842.8,842.8,,,,,,,,,,,,,,,,,
CT scan for therapy guide,350,RC,40300067,LOCAL,,inpatient,,,354.2,354.2,,,,,,,,,,,,,,,,,
CT bone density axial,352,RC,40300068,LOCAL,,inpatient,,,390.6,390.6,,,,,,,,,,,,,,,,,
CT SINUS W      ,350,RC,40300087,LOCAL,,inpatient,,,1045.576,1045.576,,,,,,,,,,,,,,,,,
CT SPINE THORACIC W          ,350,RC,40300089,LOCAL,,inpatient,,,1336.188,1336.188,,,,,,,,,,,,,,,,,
MRI orbit/face/neck w/o dye,614,RC,40400000,LOCAL,,inpatient,,,1693.86,1693.86,,,,,,,,,,,,,,,,,
MRI orbit/face/neck w/dye,614,RC,40400001,LOCAL,,inpatient,,,2501.8,2501.8,,,,,,,,,,,,,,,,,
MRI angiogram head w/o dye,615,RC,40400003,LOCAL,,inpatient,,,2469.208,2469.208,,,,,,,,,,,,,,,,,
MRI angiography neck w/o dye,615,RC,40400006,LOCAL,,inpatient,,,2447.648,2447.648,,,,,,,,,,,,,,,,,
MRI angiography neck w/dye,615,RC,40400007,LOCAL,,inpatient,,,3043.544,3043.544,,,,,,,,,,,,,,,,,
MRI BRAIN/STEM WO,611,RC,40400009,LOCAL,,inpatient,,,2554.944,2554.944,,,,,,,,,,,,,,,,,
MRI BRAIN/STEM W/DYE,611,RC,40400010,LOCAL,,inpatient,,,3225.208,3225.208,,,,,,,,,,,,,,,,,
MRI BRAIN/STEM WO/W,611,RC,40400011,LOCAL,,inpatient,,,3993.808,3993.808,,,,,,,,,,,,,,,,,
MRI - BRAIN W/O DYE,611,RC,40400013,LOCAL,,inpatient,,,2360.4,2360.4,,,,,,,,,,,,,,,,,
MRI - BRAIN W/DYE,611,RC,40400015,LOCAL,,inpatient,,,893.2,893.2,,,,,,,,,,,,,,,,,
MRI - BRAIN W/O & W/DYE,611,RC,40400016,LOCAL,,inpatient,,,893.2,893.2,,,,,,,,,,,,,,,,,
MR CHEST W,610,RC,40400018,LOCAL,,inpatient,,,2824.92,2824.92,,,,,,,,,,,,,,,,,
MRI cervical spine w/o dye,612,RC,40400021,LOCAL,,inpatient,,,2592.408,2592.408,,,,,,,,,,,,,,,,,
MRI cervical spine w/dye,612,RC,40400022,LOCAL,,inpatient,,,3265.024,3265.024,,,,,,,,,,,,,,,,,
MRI Thoracic spine w/o dye,612,RC,40400023,LOCAL,,inpatient,,,2592.408,2592.408,,,,,,,,,,,,,,,,,
MRI thoracic spine w/dye,612,RC,40400024,LOCAL,,inpatient,,,3240.048,3240.048,,,,,,,,,,,,,,,,,
MRI lumbar spine w/o dye,612,RC,40400025,LOCAL,,inpatient,,,2556.848,2556.848,,,,,,,,,,,,,,,,,
MRI cervical spine w/o & w/dye,612,RC,40400027,LOCAL,,inpatient,,,4060.616,4060.616,,,,,,,,,,,,,,,,,
MRI Thoracic spine w/o & w/dye,612,RC,40400028,LOCAL,,inpatient,,,4060.616,4060.616,,,,,,,,,,,,,,,,,
MRI lumbar spine w/o & w/dye,612,RC,40400029,LOCAL,,inpatient,,,3997.896,3997.896,,,,,,,,,,,,,,,,,
MRI angio spine w/o&w/dye,618,RC,40400030,LOCAL,,inpatient,,,3770.704,3770.704,,,,,,,,,,,,,,,,,
MRI pelvis w/o dye,614,RC,40400031,LOCAL,,inpatient,,,2552.704,2552.704,,,,,,,,,,,,,,,,,
MRI pelvis w/dye,614,RC,40400032,LOCAL,,inpatient,,,3208.576,3208.576,,,,,,,,,,,,,,,,,
MRI pelvis w/o & w/dye,614,RC,40400033,LOCAL,,inpatient,,,3960.488,3960.488,,,,,,,,,,,,,,,,,
MRI upper extremity w/o dye,614,RC,40400035,LOCAL,,inpatient,,,2261.112,2261.112,,,,,,,,,,,,,,,,,
MRI upper extremity w/o dye,614,RC,40400036,LOCAL,,inpatient,,,2261.112,2261.112,,,,,,,,,,,,,,,,,
MRI upper extremity w/dye,614,RC,40400037,LOCAL,,inpatient,,,2507.4,2507.4,,,,,,,,,,,,,,,,,
MRI upper extremity w/dye,614,RC,40400038,LOCAL,,inpatient,,,2507.4,2507.4,,,,,,,,,,,,,,,,,
MRI uppr extremity w/o&w/dye,614,RC,40400039,LOCAL,,inpatient,,,3102.456,3102.456,,,,,,,,,,,,,,,,,
MRI uppr extremity w/o&w/dye,614,RC,40400040,LOCAL,,inpatient,,,3102.456,3102.456,,,,,,,,,,,,,,,,,
MRI joint upr extrem w/o dye,614,RC,40400041,LOCAL,,inpatient,,,2523.36,2523.36,,,,,,,,,,,,,,,,,
MRI joint upr extrem w/o dye,614,RC,40400042,LOCAL,,inpatient,,,2523.36,2523.36,,,,,,,,,,,,,,,,,
MRI joint upr extrem w/dye,614,RC,40400043,LOCAL,,inpatient,,,2351.496,2351.496,,,,,,,,,,,,,,,,,
MRI joint upr extrem w/dye,614,RC,40400044,LOCAL,,inpatient,,,2351.496,2351.496,,,,,,,,,,,,,,,,,
MRI joint upr extr w/o&w/dye,614,RC,40400045,LOCAL,,inpatient,,,2913.904,2913.904,,,,,,,,,,,,,,,,,
MRI joint upr extr w/o&w/dye,614,RC,40400046,LOCAL,,inpatient,,,2913.904,2913.904,,,,,,,,,,,,,,,,,
MRI lower extremity w/o dye,614,RC,40400049,LOCAL,,inpatient,,,2515.128,2515.128,,,,,,,,,,,,,,,,,
MRI lower extremity w/o dye,614,RC,40400050,LOCAL,,inpatient,,,2515.128,2515.128,,,,,,,,,,,,,,,,,
MRI lower extremity w/dye,614,RC,40400051,LOCAL,,inpatient,,,2512.888,2512.888,,,,,,,,,,,,,,,,,
MRI lower extremity w/dye,614,RC,40400052,LOCAL,,inpatient,,,2512.888,2512.888,,,,,,,,,,,,,,,,,
MRI lwr extremity w/o&w/dye,614,RC,40400053,LOCAL,,inpatient,,,3122.392,3122.392,,,,,,,,,,,,,,,,,
MRI lwr extremity w/o&w/dye,614,RC,40400054,LOCAL,,inpatient,,,3122.392,3122.392,,,,,,,,,,,,,,,,,
MRI jnt of lwr extre w/o dye,614,RC,40400055,LOCAL,,inpatient,,,2521.288,2521.288,,,,,,,,,,,,,,,,,
MRI jnt of lwr extre w/o dye,614,RC,40400056,LOCAL,,inpatient,,,2521.288,2521.288,,,,,,,,,,,,,,,,,
MRI joint of lwr extr w/dye,614,RC,40400057,LOCAL,,inpatient,,,2370.928,2370.928,,,,,,,,,,,,,,,,,
MRI joint of lwr extr w/dye,614,RC,40400058,LOCAL,,inpatient,,,2370.928,2370.928,,,,,,,,,,,,,,,,,
MRI joint lwr extr RT W/WO,614,RC,40400059,LOCAL,,inpatient,,,3927.056,3927.056,,,,,,,,,,,,,,,,,
MRI joint lwr extr w/o&w/dye,614,RC,40400060,LOCAL,,inpatient,,,3927.056,3927.056,,,,,,,,,,,,,,,,,
MRI ang lwr ext w or w/o dye,616,RC,40400061,LOCAL,,inpatient,,,3406.368,3406.368,,,,,,,,,,,,,,,,,
MRI ang lwr ext w or w/o dye,616,RC,40400062,LOCAL,,inpatient,,,3406.368,3406.368,,,,,,,,,,,,,,,,,
MRI abdomen w/o dye,614,RC,40400063,LOCAL,,inpatient,,,6746.656,6746.656,,,,,,,,,,,,,,,,,
MRI abdomen w/dye,614,RC,40400064,LOCAL,,inpatient,,,3206.504,3206.504,,,,,,,,,,,,,,,,,
MRI abdomen w/o & w/dye,614,RC,40400065,LOCAL,,inpatient,,,3958.416,3958.416,,,,,,,,,,,,,,,,,
MRI angio abdom w orw/o dye,618,RC,40400066,LOCAL,,inpatient,,,3391.808,3391.808,,,,,,,,,,,,,,,,,
MRI Cardiac for morph,614,RC,40400067,LOCAL,,inpatient,,,1142.4,1142.4,,,,,,,,,,,,,,,,,
MRI Cardiac w/stress img,614,RC,40400068,LOCAL,,inpatient,,,2360.4,2360.4,,,,,,,,,,,,,,,,,
MRI Cardiac for morph w/dye,614,RC,40400069,LOCAL,,inpatient,,,1870.4,1870.4,,,,,,,,,,,,,,,,,
MRI Cardiac w/stress img & dye,614,RC,40400070,LOCAL,,inpatient,,,3336.2,3336.2,,,,,,,,,,,,,,,,,
MRI Cardiac veloc flow mapping,614,RC,40400071,LOCAL,,inpatient,,,455.952,455.952,,,,,,,,,,,,,,,,,
MRI spectroscopy,614,RC,40400072,LOCAL,,inpatient,,,285.6,285.6,,,,,,,,,,,,,,,,,
MRI elastography,614,RC,40400073,LOCAL,,inpatient,,,1142.4,1142.4,,,,,,,,,,,,,,,,,
MRI procedure,610,RC,40400074,LOCAL,,inpatient,,,390.6,390.6,,,,,,,,,,,,,,,,,
MRI guidance ndl plmt rs&i,614,RC,40400075,LOCAL,,inpatient,,,1800.4,1800.4,,,,,,,,,,,,,,,,,
MRI gdn parnchyma tiss abltj,614,RC,40400076,LOCAL,,inpatient,,,957.6,957.6,,,,,,,,,,,,,,,,,
MRI breast c- unilateral,614,RC,40400077,LOCAL,,inpatient,,,1142.4,1142.4,,,,,,,,,,,,,,,,,
MRI breast c- bilateral,614,RC,40400078,LOCAL,,inpatient,,,1142.4,1142.4,,,,,,,,,,,,,,,,,
MRI breast c-+ w/cad uni,614,RC,40400079,LOCAL,,inpatient,,,1299.2,1299.2,,,,,,,,,,,,,,,,,
MRI breast c-+ w/cad bi,614,RC,40400080,LOCAL,,inpatient,,,1293.6,1293.6,,,,,,,,,,,,,,,,,
MRI - Bone marrow,614,RC,40400081,LOCAL,,inpatient,,,1142.4,1142.4,,,,,,,,,,,,,,,,,
Magnetic image jaw joint,614,RC,40400082,LOCAL,,inpatient,,,1988.504,1988.504,,,,,,,,,,,,,,,,,
EKG,730,RC,40600000,LOCAL,,inpatient,,,624.82,624.82,,,,,,,,,,,,,,,,,
EKG TRACING ONLY W/O INTER/REP,730,RC,40600001,LOCAL,,inpatient,,,128.744,128.744,,,,,,,,,,,,,,,,,
EKG,730,RC,40600002,LOCAL,,inpatient,,,128.744,128.744,,,,,,,,,,,,,,,,,
ECG MONIT/REPRT UP TO 48 HRS,730,RC,40600003,LOCAL,,inpatient,,,567.112,567.112,,,,,,,,,,,,,,,,,
"ECG, TRANSTHORACIC,2D;COMPLETE",730,RC,40600004,LOCAL,,inpatient,,,1070.104,1070.104,,,,,,,,,,,,,,,,,
TELEMETRY MONITORING DAILY CHG,732,RC,40600005,LOCAL,,inpatient,,,777,777,,,,,,,,,,,,,,,,,
TELEMETRY MONITOR DAILY CHARGE,732,RC,40600006,LOCAL,,inpatient,,,560,560,,,,,,,,,,,,,,,,,
HOLTER RECORD,739,RC,40600007,LOCAL,,inpatient,,,235.704,235.704,,,,,,,,,,,,,,,,,
HOLTER W/SCANNING REPORT,739,RC,40600008,LOCAL,,inpatient,,,381.976,381.976,,,,,,,,,,,,,,,,,
US ECHO LIMITED,402,RC,40600017,LOCAL,,inpatient,,,575.33,575.33,,,,,,,,,,,,,,,,,
"EXTREM ART STUDY, SINGLE LEVEL",921,RC,40700001,LOCAL,,inpatient,,,948.36,948.36,,,,,,,,,,,,,,,,,
"EXTREM ART STUDY, MULTI LEVEL",921,RC,40700002,LOCAL,,inpatient,,,1053.192,1053.192,,,,,,,,,,,,,,,,,
DOPPLER EXTREMITY WITH MANEUVE,921,RC,40700007,LOCAL,,inpatient,,,704.536,704.536,,,,,,,,,,,,,,,,,
US VENOUS-BILATERAL LOWER EXTR,921,RC,40700008,LOCAL,,inpatient,,,1431.472,1431.472,,,,,,,,,,,,,,,,,
US VENOUS-UNILATERAL LOWER EXT,921,RC,40700009,LOCAL,,inpatient,,,954.856,954.856,,,,,,,,,,,,,,,,,
VASCULAR STUDY,921,RC,40700010,LOCAL,,inpatient,,,1194.76,1194.76,,,,,,,,,,,,,,,,,
HYPERBARIC OXYGEN THERAPY,940,RC,40700012,LOCAL,,inpatient,,,2240,2240,,,,,,,,,,,,,,,,,
EMG 1 Extremity,922,RC,40700013,LOCAL,,inpatient,,,470.19,470.19,,,,,,,,,,,,,,,,,
EMG 2 Extremities,922,RC,40700014,LOCAL,,inpatient,,,470.19,470.19,,,,,,,,,,,,,,,,,
EMG 3 Extremities,922,RC,40700016,LOCAL,,inpatient,,,586.11,586.11,,,,,,,,,,,,,,,,,
EMG 4 Extremities,922,RC,40700017,LOCAL,,inpatient,,,586.11,586.11,,,,,,,,,,,,,,,,,
PET BRAIN METABOLIC,340,RC,40700020,LOCAL,,inpatient,,,6264.44,6264.44,,,,,,,,,,,,,,,,,
PET MYOCARD REST/STR,340,RC,40700021,LOCAL,,inpatient,,,7433.02,7433.02,,,,,,,,,,,,,,,,,
PET BRAIN PERFUSION,340,RC,40700024,LOCAL,,inpatient,,,5276.39,5276.39,,,,,,,,,,,,,,,,,
PET SCAN-SKULL TO THIGH,340,RC,40700026,LOCAL,,inpatient,,,6394.92,6394.92,,,,,,,,,,,,,,,,,
EMG,922,RC,99990922,LOCAL,,inpatient,,,469,469,,,,,,,,,,,,,,,,,
CLINIMIX E 8/14 INJECT 2000ML,270,RC,IMS-0143,LOCAL,,inpatient,,,161.35,161.35,,,,,,,,,,,,,,,,,
MASK VENTURI ADULT W/7IN,270,RC,IMS-3206,LOCAL,,inpatient,,,0.084,0.084,,,,,,,,,,,,,,,,,
OXYMIZER NASAL CANNULA PENDANT,270,RC,IRT-0082,LOCAL,,inpatient,,,170.17,170.17,,,,,,,,,,,,,,,,,
MITSY MAX 10 SM NEB MOUTH PIEC,270,RC,IRT-0152,LOCAL,,inpatient,,,8.148,8.148,,,,,,,,,,,,,,,,,
SPIROLOG FLOW SENSOR,270,RC,IRT-0153,LOCAL,,inpatient,,,170.17,170.17,,,,,,,,,,,,,,,,,
HUDSON RCI DRAFT OPTI NEBULIZE,270,RC,IRT-0449,LOCAL,,inpatient,,,13.776,13.776,,,,,,,,,,,,,,,,,
MRSA SCREEN RAPID,306,RC,MRSAS,LOCAL,,inpatient,,,1.4,1.4,,,,,,,,,,,,,,,,,
Type & Crossmatch,309,RC,XM,LOCAL,,inpatient,,,1.4,1.4,,,,,,,,,,,,,,,,,
Metabolic panel BMP ion Ca,300,RC,41000000,LOCAL,,inpatient,,,90.104,90.104,,,,,,,,,,,,,,,,,
BASIC METABOLIC PANEL (BMP),300,RC,41000001,LOCAL,,inpatient,,,112.63,112.63,,,,,,,,,,,,,,,,,
COMPLETE METABOLIC PANEL (CMP),300,RC,41000003,LOCAL,,inpatient,,,140.742,140.742,,,,,,,,,,,,,,,,,
Obstetric panel,300,RC,41000004,LOCAL,,inpatient,,,701.4,701.4,,,,,,,,,,,,,,,,,
LIPID PANEL,300,RC,41000005,LOCAL,,inpatient,,,109.592,109.592,,,,,,,,,,,,,,,,,
RENAL FUNCTION PANEL,300,RC,41000006,LOCAL,,inpatient,,,115.57,115.57,,,,,,,,,,,,,,,,,
ACUTE HEPATITIS PANEL,300,RC,41000007,LOCAL,,inpatient,,,373.744,373.744,,,,,,,,,,,,,,,,,
HEPATIC FUNCTION PANEL,300,RC,41000008,LOCAL,,inpatient,,,108.71,108.71,,,,,,,,,,,,,,,,,
Obstetric panel,300,RC,41000009,LOCAL,,inpatient,,,1100.4,1100.4,,,,,,,,,,,,,,,,,
Drug assay adalimumab,300,RC,41000010,LOCAL,,inpatient,,,567,567,,,,,,,,,,,,,,,,,
Assay of amikacin,300,RC,41000011,LOCAL,,inpatient,,,200.62,200.62,,,,,,,,,,,,,,,,,
Drug assay caffeine,300,RC,41000012,LOCAL,,inpatient,,,567,567,,,,,,,,,,,,,,,,,
TEGRETOL LEVEL (CARBAMZAPINE),300,RC,41000013,LOCAL,,inpatient,,,193.83,193.83,,,,,,,,,,,,,,,,,
Assay carbamazepine free,300,RC,41000014,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
CYCLOSPORIN,300,RC,41000015,LOCAL,,inpatient,,,240.31,240.31,,,,,,,,,,,,,,,,,
Drug assay clozapine,300,RC,41000016,LOCAL,,inpatient,,,298.2,298.2,,,,,,,,,,,,,,,,,
DIGOXIN,300,RC,41000017,LOCAL,,inpatient,,,176.75,176.75,,,,,,,,,,,,,,,,,
Assay of digoxin free,300,RC,41000018,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
VALPROIC ACID,300,RC,41000019,LOCAL,,inpatient,,,180.32,180.32,,,,,,,,,,,,,,,,,
Dipropylacetic acid free,300,RC,41000020,LOCAL,,inpatient,,,197.4,197.4,,,,,,,,,,,,,,,,,
Assay of ethosuximide,300,RC,41000021,LOCAL,,inpatient,,,174.048,174.048,,,,,,,,,,,,,,,,,
Drug assay everolimus,300,RC,41000022,LOCAL,,inpatient,,,104.888,104.888,,,,,,,,,,,,,,,,,
Assay of gentamicin,300,RC,41000023,LOCAL,,inpatient,,,218.19,218.19,,,,,,,,,,,,,,,,,
Drug screen quant gabapentin,300,RC,41000024,LOCAL,,inpatient,,,269.92,269.92,,,,,,,,,,,,,,,,,
Assay of haloperidol,300,RC,41000025,LOCAL,,inpatient,,,231,231,,,,,,,,,,,,,,,,,
Drug screen quan lamotrigine,300,RC,41000026,LOCAL,,inpatient,,,156.408,156.408,,,,,,,,,,,,,,,,,
Assay of lidocaine,300,RC,41000027,LOCAL,,inpatient,,,156.408,156.408,,,,,,,,,,,,,,,,,
LEVETRIRACETAM,300,RC,41000028,LOCAL,,inpatient,,,450.24,450.24,,,,,,,,,,,,,,,,,
LITHIUM,300,RC,41000029,LOCAL,,inpatient,,,87.99,87.99,,,,,,,,,,,,,,,,,
Mycophenolic Acid,300,RC,41000030,LOCAL,,inpatient,,,170.576,170.576,,,,,,,,,,,,,,,,,
Drug scrn quant oxcarbazepin,300,RC,41000031,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
PHENOBARBITAL,300,RC,41000032,LOCAL,,inpatient,,,152.46,152.46,,,,,,,,,,,,,,,,,
PHENYTOIN (DILANTIN),300,RC,41000033,LOCAL,,inpatient,,,176.47,176.47,,,,,,,,,,,,,,,,,
Drug assay posaconazole,300,RC,41000035,LOCAL,,inpatient,,,399,399,,,,,,,,,,,,,,,,,
Assay of primidone,300,RC,41000036,LOCAL,,inpatient,,,220.92,220.92,,,,,,,,,,,,,,,,,
Assay of procainamide,300,RC,41000037,LOCAL,,inpatient,,,882,882,,,,,,,,,,,,,,,,,
Assay of procainamide,300,RC,41000038,LOCAL,,inpatient,,,222.95,222.95,,,,,,,,,,,,,,,,,
Assay of sirolimus,300,RC,41000040,LOCAL,,inpatient,,,182.77,182.77,,,,,,,,,,,,,,,,,
TACROLIMUS,300,RC,41000041,LOCAL,,inpatient,,,182.77,182.77,,,,,,,,,,,,,,,,,
THEOPHYLLINE,300,RC,41000042,LOCAL,,inpatient,,,188.37,188.37,,,,,,,,,,,,,,,,,
Drug screen quant tiagabine,300,RC,41000043,LOCAL,,inpatient,,,399,399,,,,,,,,,,,,,,,,,
TOBRAMYCIN RANDOM,300,RC,41000044,LOCAL,,inpatient,,,214.55,214.55,,,,,,,,,,,,,,,,,
Assay of topiramate,300,RC,41000045,LOCAL,,inpatient,,,158.69,158.69,,,,,,,,,,,,,,,,,
VANCOMYCIN RANDOM,300,RC,41000046,LOCAL,,inpatient,,,180.32,180.32,,,,,,,,,,,,,,,,,
Drug screen quant zonisamide,300,RC,41000047,LOCAL,,inpatient,,,137.592,137.592,,,,,,,,,,,,,,,,,
Drug assay infliximab,300,RC,41000048,LOCAL,,inpatient,,,567,567,,,,,,,,,,,,,,,,,
Drug assay lacosamide,300,RC,41000049,LOCAL,,inpatient,,,399,399,,,,,,,,,,,,,,,,,
Drug assay vedolizumab,300,RC,41000050,LOCAL,,inpatient,,,567,567,,,,,,,,,,,,,,,,,
Drug assay voriconazole,301,RC,41000051,LOCAL,,inpatient,,,151.816,151.816,,,,,,,,,,,,,,,,,
Quantitative assay drug,300,RC,41000052,LOCAL,,inpatient,,,182.28,182.28,,,,,,,,,,,,,,,,,
Drug test prsmv dir opt obs,300,RC,41000053,LOCAL,,inpatient,,,184.8,184.8,,,,,,,,,,,,,,,,,
Drug test prsmv instrmnt,300,RC,41000054,LOCAL,,inpatient,,,252,252,,,,,,,,,,,,,,,,,
Drug test prsmv chem anlyzr,300,RC,41000055,LOCAL,,inpatient,,,105.28,105.28,,,,,,,,,,,,,,,,,
Acth stimulation panel,300,RC,41000056,LOCAL,,inpatient,,,261.8,261.8,,,,,,,,,,,,,,,,,
Acth stimulation panel,300,RC,41000057,LOCAL,,inpatient,,,1276.8,1276.8,,,,,,,,,,,,,,,,,
Acth stimulation panel,300,RC,41000058,LOCAL,,inpatient,,,1150.8,1150.8,,,,,,,,,,,,,,,,,
Aldosterone suppression eval,300,RC,41000059,LOCAL,,inpatient,,,1843.8,1843.8,,,,,,,,,,,,,,,,,
Calcitonin stimul panel,300,RC,41000060,LOCAL,,inpatient,,,1180.2,1180.2,,,,,,,,,,,,,,,,,
Crh stimulation panel,300,RC,41000061,LOCAL,,inpatient,,,11785.2,11785.2,,,,,,,,,,,,,,,,,
Testosterone response,300,RC,41000062,LOCAL,,inpatient,,,760.2,760.2,,,,,,,,,,,,,,,,,
Estradiol response panel,300,RC,41000063,LOCAL,,inpatient,,,823.2,823.2,,,,,,,,,,,,,,,,,
Renin stimulation panel,300,RC,41000064,LOCAL,,inpatient,,,3078.6,3078.6,,,,,,,,,,,,,,,,,
Renin stimulation panel,300,RC,41000065,LOCAL,,inpatient,,,646.8,646.8,,,,,,,,,,,,,,,,,
Pituitary evaluation panel,300,RC,41000066,LOCAL,,inpatient,,,8517.6,8517.6,,,,,,,,,,,,,,,,,
Dexamethasone panel,300,RC,41000067,LOCAL,,inpatient,,,2381.4,2381.4,,,,,,,,,,,,,,,,,
Glucagon tolerance panel,300,RC,41000068,LOCAL,,inpatient,,,676.2,676.2,,,,,,,,,,,,,,,,,
Glucagon tolerance panel,300,RC,41000069,LOCAL,,inpatient,,,743.4,743.4,,,,,,,,,,,,,,,,,
Gonadotropin hormone panel,300,RC,41000070,LOCAL,,inpatient,,,2179.8,2179.8,,,,,,,,,,,,,,,,,
Growth hormone panel,300,RC,41000071,LOCAL,,inpatient,,,978.6,978.6,,,,,,,,,,,,,,,,,
Growth hormone panel,300,RC,41000072,LOCAL,,inpatient,,,1902.6,1902.6,,,,,,,,,,,,,,,,,
Insulin suppression panel,300,RC,41000073,LOCAL,,inpatient,,,2436,2436,,,,,,,,,,,,,,,,,
Insulin tolerance panel,300,RC,41000074,LOCAL,,inpatient,,,4191.6,4191.6,,,,,,,,,,,,,,,,,
Insulin tolerance panel,300,RC,41000075,LOCAL,,inpatient,,,1516.2,1516.2,,,,,,,,,,,,,,,,,
Metyrapone panel,300,RC,41000076,LOCAL,,inpatient,,,1339.8,1339.8,,,,,,,,,,,,,,,,,
Trh stimulation panel,300,RC,41000077,LOCAL,,inpatient,,,739.2,739.2,,,,,,,,,,,,,,,,,
Trh stimulation panel,300,RC,41000078,LOCAL,,inpatient,,,987,987,,,,,,,,,,,,,,,,,
Urinalysis nonauto w/scope,300,RC,41000079,LOCAL,,inpatient,,,42.14,42.14,,,,,,,,,,,,,,,,,
COMPLETE URINALYSIS (UA),307,RC,41000080,LOCAL,,inpatient,,,42.14,42.14,,,,,,,,,,,,,,,,,
Urinalysis nonauto w/o scope,300,RC,41000081,LOCAL,,inpatient,,,50.4,50.4,,,,,,,,,,,,,,,,,
Urinalysis auto w/o scope,307,RC,41000082,LOCAL,,inpatient,,,29.89,29.89,,,,,,,,,,,,,,,,,
Urinalysis,300,RC,41000083,LOCAL,,inpatient,,,23.072,23.072,,,,,,,,,,,,,,,,,
Urine screen for bacteria,300,RC,41000084,LOCAL,,inpatient,,,441,441,,,,,,,,,,,,,,,,,
Microscopic exam of urine,307,RC,41000085,LOCAL,,inpatient,,,40.46,40.46,,,,,,,,,,,,,,,,,
Urinalysis glass test,300,RC,41000086,LOCAL,,inpatient,,,67.2,67.2,,,,,,,,,,,,,,,,,
Urine pregnancy test,300,RC,41000087,LOCAL,,inpatient,,,84.21,84.21,,,,,,,,,,,,,,,,,
Urinalysis volume measure,300,RC,41000088,LOCAL,,inpatient,,,54.6,54.6,,,,,,,,,,,,,,,,,
Hpa-1 genotyping,300,RC,41000089,LOCAL,,inpatient,,,1797.6,1797.6,,,,,,,,,,,,,,,,,
Hpa-2 genotyping,300,RC,41000090,LOCAL,,inpatient,,,1797.6,1797.6,,,,,,,,,,,,,,,,,
Hpa-3 genotyping,300,RC,41000091,LOCAL,,inpatient,,,1797.6,1797.6,,,,,,,,,,,,,,,,,
Hpa-4 genotyping,300,RC,41000092,LOCAL,,inpatient,,,1797.6,1797.6,,,,,,,,,,,,,,,,,
Hpa-5 genotyping,300,RC,41000093,LOCAL,,inpatient,,,1797.6,1797.6,,,,,,,,,,,,,,,,,
Hpa-6 genotyping,300,RC,41000094,LOCAL,,inpatient,,,1797.6,1797.6,,,,,,,,,,,,,,,,,
Hpa-9 genotyping,300,RC,41000095,LOCAL,,inpatient,,,1797.6,1797.6,,,,,,,,,,,,,,,,,
Hpa-15 genotyping,300,RC,41000096,LOCAL,,inpatient,,,1797.6,1797.6,,,,,,,,,,,,,,,,,
Idh1 common variants,300,RC,41000097,LOCAL,,inpatient,,,2839.2,2839.2,,,,,,,,,,,,,,,,,
Idh2 common variants,300,RC,41000098,LOCAL,,inpatient,,,4347,4347,,,,,,,,,,,,,,,,,
Dmd dup/delet analysis,300,RC,41000099,LOCAL,,inpatient,,,4103.4,4103.4,,,,,,,,,,,,,,,,,
Brca1&2 gen full seq dup/del,300,RC,41000100,LOCAL,,inpatient,,,26825.4,26825.4,,,,,,,,,,,,,,,,,
Brca1&2 gene full seq alys,300,RC,41000101,LOCAL,,inpatient,,,6879.6,6879.6,,,,,,,,,,,,,,,,,
Brca1&2 gen ful dup/del alys,300,RC,41000102,LOCAL,,inpatient,,,8589,8589,,,,,,,,,,,,,,,,,
Brca1 gene full seq alys,300,RC,41000103,LOCAL,,inpatient,,,4158,4158,,,,,,,,,,,,,,,,,
Brca1 gene full dup/del alys,300,RC,41000104,LOCAL,,inpatient,,,4431,4431,,,,,,,,,,,,,,,,,
Brca2 gene full dup/del alys,300,RC,41000105,LOCAL,,inpatient,,,4158,4158,,,,,,,,,,,,,,,,,
Abl1 gene,300,RC,41000106,LOCAL,,inpatient,,,4410,4410,,,,,,,,,,,,,,,,,
Aff2 gene detc abnor alleles,300,RC,41000107,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Aff2 gene charac alleles,300,RC,41000108,LOCAL,,inpatient,,,4040.4,4040.4,,,,,,,,,,,,,,,,,
Ar gene full gene sequence,300,RC,41000109,LOCAL,,inpatient,,,4431,4431,,,,,,,,,,,,,,,,,
Ar gene known famil variant,300,RC,41000110,LOCAL,,inpatient,,,2721.6,2721.6,,,,,,,,,,,,,,,,,
Asxl1 full gene sequence,300,RC,41000111,LOCAL,,inpatient,,,9945.6,9945.6,,,,,,,,,,,,,,,,,
Asxl1 gene target seq alys,300,RC,41000112,LOCAL,,inpatient,,,3557.4,3557.4,,,,,,,,,,,,,,,,,
Atn1 gene detc abnor alleles,300,RC,41000113,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Atxn1 gene detc abnor allele,300,RC,41000114,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Atxn2 gene detc abnor allele,300,RC,41000115,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Atxn3 gene detc abnor allele,300,RC,41000116,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Atxn7 gene detc abnor allele,300,RC,41000117,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Atxn8os gen detc abnor allel,300,RC,41000118,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Atxn10 gene detc abnor allel,300,RC,41000119,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Cacna1a gen detc abnor allel,300,RC,41000120,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Cacna1a gene full gene seq,300,RC,41000121,LOCAL,,inpatient,,,12440.4,12440.4,,,,,,,,,,,,,,,,,
Cacna1a gen known famil vrnt,300,RC,41000122,LOCAL,,inpatient,,,2721.6,2721.6,,,,,,,,,,,,,,,,,
Cnbp gene detc abnor allele,300,RC,41000123,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Cstb gene detc abnor allele,300,RC,41000124,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Cstb gene full gene sequence,300,RC,41000125,LOCAL,,inpatient,,,4040.4,4040.4,,,,,,,,,,,,,,,,,
Cstb gene known famil vrnt,300,RC,41000126,LOCAL,,inpatient,,,2721.6,2721.6,,,,,,,,,,,,,,,,,
Aspa gene,300,RC,41000127,LOCAL,,inpatient,,,693,693,,,,,,,,,,,,,,,,,
Apc gene full sequence,300,RC,41000128,LOCAL,,inpatient,,,11466,11466,,,,,,,,,,,,,,,,,
Apc gene known fam variants,300,RC,41000129,LOCAL,,inpatient,,,4116,4116,,,,,,,,,,,,,,,,,
Apc gene dup/delet variants,300,RC,41000130,LOCAL,,inpatient,,,2940,2940,,,,,,,,,,,,,,,,,
Ar gene charac alleles,300,RC,41000131,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Bckdhb gene,300,RC,41000132,LOCAL,,inpatient,,,1394.4,1394.4,,,,,,,,,,,,,,,,,
Bcr/abl1 gene major bp,300,RC,41000133,LOCAL,,inpatient,,,1374.464,1374.464,,,,,,,,,,,,,,,,,
Bcr/abl1 gene minor bp,300,RC,41000134,LOCAL,,inpatient,,,1214.136,1214.136,,,,,,,,,,,,,,,,,
Bcr/abl1 gene other bp,300,RC,41000135,LOCAL,,inpatient,,,1347.976,1347.976,,,,,,,,,,,,,,,,,
Blm gene,300,RC,41000136,LOCAL,,inpatient,,,579.6,579.6,,,,,,,,,,,,,,,,,
Braf gene,300,RC,41000137,LOCAL,,inpatient,,,2578.8,2578.8,,,,,,,,,,,,,,,,,
Brca1&2 185&5385&6174 vrnt,300,RC,41000138,LOCAL,,inpatient,,,6468,6468,,,,,,,,,,,,,,,,,
Brca1 gene known famil vrnt,300,RC,41000139,LOCAL,,inpatient,,,5514.6,5514.6,,,,,,,,,,,,,,,,,
Brca2 gene full seq alys,300,RC,41000140,LOCAL,,inpatient,,,2721.6,2721.6,,,,,,,,,,,,,,,,,
Brca2 gene known famil vrnt,300,RC,41000141,LOCAL,,inpatient,,,5514.6,5514.6,,,,,,,,,,,,,,,,,
Cebpa gene full sequence,300,RC,41000142,LOCAL,,inpatient,,,3557.4,3557.4,,,,,,,,,,,,,,,,,
Calr gene com variants,300,RC,41000143,LOCAL,,inpatient,,,1789.2,1789.2,,,,,,,,,,,,,,,,,
Cftr gene com variants,300,RC,41000144,LOCAL,,inpatient,,,420,420,,,,,,,,,,,,,,,,,
Cftr gene known fam variants,300,RC,41000145,LOCAL,,inpatient,,,1428,1428,,,,,,,,,,,,,,,,,
Cftr gene dup/delet variants,300,RC,41000146,LOCAL,,inpatient,,,6396.6,6396.6,,,,,,,,,,,,,,,,,
Cftr gene full sequence,300,RC,41000147,LOCAL,,inpatient,,,7337.4,7337.4,,,,,,,,,,,,,,,,,
Cftr gene intron poly t,300,RC,41000148,LOCAL,,inpatient,,,2482.2,2482.2,,,,,,,,,,,,,,,,,
Cyp2c19 gene com variants,300,RC,41000149,LOCAL,,inpatient,,,4284,4284,,,,,,,,,,,,,,,,,
Cyp2d6 gene com variants,300,RC,41000150,LOCAL,,inpatient,,,6627.6,6627.6,,,,,,,,,,,,,,,,,
Cyp2c9 gene com variants,300,RC,41000151,LOCAL,,inpatient,,,2570.4,2570.4,,,,,,,,,,,,,,,,,
Cytogen micrarray copy nmbr,300,RC,41000152,LOCAL,,inpatient,,,13230,13230,,,,,,,,,,,,,,,,,
Cytogen m array copy no&snp,300,RC,41000153,LOCAL,,inpatient,,,17052,17052,,,,,,,,,,,,,,,,,
Cyp3a4 gene common variants,300,RC,41000154,LOCAL,,inpatient,,,2570.4,2570.4,,,,,,,,,,,,,,,,,
Cyp3a5 gene common variants,300,RC,41000155,LOCAL,,inpatient,,,2570.4,2570.4,,,,,,,,,,,,,,,,,
Dpyd gene common variants,300,RC,41000156,LOCAL,,inpatient,,,2570.4,2570.4,,,,,,,,,,,,,,,,,
Btk gene common variants,300,RC,41000157,LOCAL,,inpatient,,,2578.8,2578.8,,,,,,,,,,,,,,,,,
Dmpk gene detc abnor allele,300,RC,41000158,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Egfr gene com variants,300,RC,41000159,LOCAL,,inpatient,,,4771.2,4771.2,,,,,,,,,,,,,,,,,
Ezh2 gene full gene sequence,300,RC,41000160,LOCAL,,inpatient,,,4158,4158,,,,,,,,,,,,,,,,,
Ezh2 gene common variants,300,RC,41000161,LOCAL,,inpatient,,,2578.8,2578.8,,,,,,,,,,,,,,,,,
F9 full gene sequence,300,RC,41000162,LOCAL,,inpatient,,,8820,8820,,,,,,,,,,,,,,,,,
Dmpk gene charac alleles,300,RC,41000163,LOCAL,,inpatient,,,4040.4,4040.4,,,,,,,,,,,,,,,,,
F5 gene,300,RC,41000165,LOCAL,,inpatient,,,458.304,458.304,,,,,,,,,,,,,,,,,
Fancc gene,300,RC,41000166,LOCAL,,inpatient,,,537.6,537.6,,,,,,,,,,,,,,,,,
Fmr1 gene detection,300,RC,41000167,LOCAL,,inpatient,,,840,840,,,,,,,,,,,,,,,,,
Fmr1 gene charac alleles,300,RC,41000168,LOCAL,,inpatient,,,659.4,659.4,,,,,,,,,,,,,,,,,
Flt3 gene,300,RC,41000169,LOCAL,,inpatient,,,2431.8,2431.8,,,,,,,,,,,,,,,,,
Flt3 gene analysis,300,RC,41000170,LOCAL,,inpatient,,,1222.2,1222.2,,,,,,,,,,,,,,,,,
G6pd gene alys cmn variant,300,RC,41000171,LOCAL,,inpatient,,,2570.4,2570.4,,,,,,,,,,,,,,,,,
G6pd known familial variant,300,RC,41000172,LOCAL,,inpatient,,,5514.6,5514.6,,,,,,,,,,,,,,,,,
G6pd full gene sequence,300,RC,41000173,LOCAL,,inpatient,,,8820,8820,,,,,,,,,,,,,,,,,
G6pc gene,300,RC,41000174,LOCAL,,inpatient,,,861,861,,,,,,,,,,,,,,,,,
Gba gene,300,RC,41000175,LOCAL,,inpatient,,,693,693,,,,,,,,,,,,,,,,,
Gjb2 gene full sequence,300,RC,41000176,LOCAL,,inpatient,,,1486.8,1486.8,,,,,,,,,,,,,,,,,
Gjb2 gene known fam variants,300,RC,41000177,LOCAL,,inpatient,,,903,903,,,,,,,,,,,,,,,,,
Gjb6 gene com variants,300,RC,41000178,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Hexa gene,300,RC,41000179,LOCAL,,inpatient,,,756,756,,,,,,,,,,,,,,,,,
Hfe gene,300,RC,41000180,LOCAL,,inpatient,,,498.4,498.4,,,,,,,,,,,,,,,,,
Hba1/hba2 gene,300,RC,41000181,LOCAL,,inpatient,,,1503.6,1503.6,,,,,,,,,,,,,,,,,
Hba1/hba2 gene fam vrnt,300,RC,41000182,LOCAL,,inpatient,,,5514.6,5514.6,,,,,,,,,,,,,,,,,
Hba1/hba2 full gene sequence,300,RC,41000183,LOCAL,,inpatient,,,8820,8820,,,,,,,,,,,,,,,,,
Ikbkap gene,300,RC,41000184,LOCAL,,inpatient,,,579.6,579.6,,,,,,,,,,,,,,,,,
Igh gene rearrange amp meth,300,RC,41000185,LOCAL,,inpatient,,,2910.6,2910.6,,,,,,,,,,,,,,,,,
Igh gene rearrang dir probe,300,RC,41000186,LOCAL,,inpatient,,,1008,1008,,,,,,,,,,,,,,,,,
Igh vari regional mutation,300,RC,41000187,LOCAL,,inpatient,,,4330.2,4330.2,,,,,,,,,,,,,,,,,
Igk rearrangeabn clonal pop,300,RC,41000188,LOCAL,,inpatient,,,2541,2541,,,,,,,,,,,,,,,,,
Str markers specimen anal,300,RC,41000189,LOCAL,,inpatient,,,3427.2,3427.2,,,,,,,,,,,,,,,,,
Str markers spec anal addl,300,RC,41000190,LOCAL,,inpatient,,,4481.4,4481.4,,,,,,,,,,,,,,,,,
Chimerism anal no cell selec,300,RC,41000191,LOCAL,,inpatient,,,3049.2,3049.2,,,,,,,,,,,,,,,,,
Chimerism anal w/cell select,300,RC,41000192,LOCAL,,inpatient,,,3834.6,3834.6,,,,,,,,,,,,,,,,,
Hba1/hba2 gene dup/del vrnts,300,RC,41000193,LOCAL,,inpatient,,,2973.6,2973.6,,,,,,,,,,,,,,,,,
Jak2 gene,300,RC,41000194,LOCAL,,inpatient,,,449.61,449.61,,,,,,,,,,,,,,,,,
Htt gene detc abnor alleles,300,RC,41000195,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Kit gene targeted seq analys,300,RC,41000196,LOCAL,,inpatient,,,4842.6,4842.6,,,,,,,,,,,,,,,,,
Kit gene analys d816 variant,300,RC,41000197,LOCAL,,inpatient,,,1835.4,1835.4,,,,,,,,,,,,,,,,,
Htt gene charac alleles,300,RC,41000198,LOCAL,,inpatient,,,4040.4,4040.4,,,,,,,,,,,,,,,,,
Kras gene variants exon 2,300,RC,41000199,LOCAL,,inpatient,,,1202.32,1202.32,,,,,,,,,,,,,,,,,
Kras gene addl variants,300,RC,41000200,LOCAL,,inpatient,,,2839.2,2839.2,,,,,,,,,,,,,,,,,
Cytogenomic neo microra alys,300,RC,41000201,LOCAL,,inpatient,,,17052,17052,,,,,,,,,,,,,,,,,
Ifnl3 gene,300,RC,41000202,LOCAL,,inpatient,,,1079.4,1079.4,,,,,,,,,,,,,,,,,
Fxn gene detc abnor alleles,300,RC,41000203,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Fxn gene charac alleles,300,RC,41000204,LOCAL,,inpatient,,,4040.4,4040.4,,,,,,,,,,,,,,,,,
Fxn gene full gene sequence,300,RC,41000205,LOCAL,,inpatient,,,4040.4,4040.4,,,,,,,,,,,,,,,,,
Mgmt gene prmtr mthyltn alys,300,RC,41000206,LOCAL,,inpatient,,,1831.2,1831.2,,,,,,,,,,,,,,,,,
Mlh1 gene,300,RC,41000207,LOCAL,,inpatient,,,2826.6,2826.6,,,,,,,,,,,,,,,,,
Fxn gene known famil variant,300,RC,41000208,LOCAL,,inpatient,,,2721.6,2721.6,,,,,,,,,,,,,,,,,
Mcoln1 gene,300,RC,41000209,LOCAL,,inpatient,,,579.6,579.6,,,,,,,,,,,,,,,,,
Mthfr gene,300,RC,41000210,LOCAL,,inpatient,,,961.8,961.8,,,,,,,,,,,,,,,,,
Mlh1 gene full seq,300,RC,41000211,LOCAL,,inpatient,,,9928.8,9928.8,,,,,,,,,,,,,,,,,
Mlh1 gene known variants,300,RC,41000212,LOCAL,,inpatient,,,4867.8,4867.8,,,,,,,,,,,,,,,,,
Mlh1 gene dup/delete variant,300,RC,41000213,LOCAL,,inpatient,,,2973.6,2973.6,,,,,,,,,,,,,,,,,
Msh2 gene full seq,300,RC,41000214,LOCAL,,inpatient,,,5611.2,5611.2,,,,,,,,,,,,,,,,,
Msh2 gene known variants,300,RC,41000215,LOCAL,,inpatient,,,4964.4,4964.4,,,,,,,,,,,,,,,,,
Msh2 gene dup/delete variant,300,RC,41000216,LOCAL,,inpatient,,,3137.4,3137.4,,,,,,,,,,,,,,,,,
Msh6 gene full seq,300,RC,41000217,LOCAL,,inpatient,,,9433.2,9433.2,,,,,,,,,,,,,,,,,
Msh6 gene known variants,300,RC,41000218,LOCAL,,inpatient,,,4527.6,4527.6,,,,,,,,,,,,,,,,,
Msh6 gene dup/delete variant,300,RC,41000219,LOCAL,,inpatient,,,3498.6,3498.6,,,,,,,,,,,,,,,,,
Microsatellite instability,300,RC,41000220,LOCAL,,inpatient,,,5124,5124,,,,,,,,,,,,,,,,,
Mecp2 gene full seq,300,RC,41000221,LOCAL,,inpatient,,,7761.6,7761.6,,,,,,,,,,,,,,,,,
Mecp2 gene known variant,300,RC,41000222,LOCAL,,inpatient,,,1764,1764,,,,,,,,,,,,,,,,,
Mecp2 gene dup/delet variant,300,RC,41000223,LOCAL,,inpatient,,,2205,2205,,,,,,,,,,,,,,,,,
Myd88 gene p.leu265pro vrnt,300,RC,41000224,LOCAL,,inpatient,,,2578.8,2578.8,,,,,,,,,,,,,,,,,
Nudt15 gene common variants,300,RC,41000225,LOCAL,,inpatient,,,4284,4284,,,,,,,,,,,,,,,,,
Palb2 gene full gene seq,300,RC,41000226,LOCAL,,inpatient,,,4158,4158,,,,,,,,,,,,,,,,,
Palb2 gene known famil vrnt,300,RC,41000227,LOCAL,,inpatient,,,4431,4431,,,,,,,,,,,,,,,,,
Pik3ca gene trgt seq alys,300,RC,41000228,LOCAL,,inpatient,,,4040.4,4040.4,,,,,,,,,,,,,,,,,
Npm1 gene,300,RC,41000229,LOCAL,,inpatient,,,3624.6,3624.6,,,,,,,,,,,,,,,,,
Nras gene variants exon 2&3,300,RC,41000230,LOCAL,,inpatient,,,4347,4347,,,,,,,,,,,,,,,,,
Pabpn1 gene detc abnor allel,300,RC,41000231,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Pca3/klk3 antigen,300,RC,41000232,LOCAL,,inpatient,,,3750.6,3750.6,,,,,,,,,,,,,,,,,
Pdgfra gene,300,RC,41000233,LOCAL,,inpatient,,,4842.6,4842.6,,,,,,,,,,,,,,,,,
Pml/raralpha com breakpoints,300,RC,41000234,LOCAL,,inpatient,,,3049.2,3049.2,,,,,,,,,,,,,,,,,
Pml/raralpha 1 breakpoint,300,RC,41000235,LOCAL,,inpatient,,,3049.2,3049.2,,,,,,,,,,,,,,,,,
Pms2 gene full seq analysis,300,RC,41000236,LOCAL,,inpatient,,,9945.6,9945.6,,,,,,,,,,,,,,,,,
Pms2 known familial variants,300,RC,41000237,LOCAL,,inpatient,,,4867.8,4867.8,,,,,,,,,,,,,,,,,
Pms2 gene dup/delet variants,300,RC,41000238,LOCAL,,inpatient,,,2990.4,2990.4,,,,,,,,,,,,,,,,,
Plcg2 gene common variants,300,RC,41000239,LOCAL,,inpatient,,,4284,4284,,,,,,,,,,,,,,,,,
Pten gene full sequence,300,RC,41000240,LOCAL,,inpatient,,,8820,8820,,,,,,,,,,,,,,,,,
Pten gene known fam variant,300,RC,41000241,LOCAL,,inpatient,,,684.6,684.6,,,,,,,,,,,,,,,,,
Pten gene dup/delet variant,300,RC,41000242,LOCAL,,inpatient,,,4410,4410,,,,,,,,,,,,,,,,,
Pmp22 gene dup/delet,300,RC,41000243,LOCAL,,inpatient,,,11146.8,11146.8,,,,,,,,,,,,,,,,,
Pmp22 gene full sequence,300,RC,41000244,LOCAL,,inpatient,,,11314.8,11314.8,,,,,,,,,,,,,,,,,
Pmp22 gene known fam variant,300,RC,41000245,LOCAL,,inpatient,,,684.6,684.6,,,,,,,,,,,,,,,,,
Sept9 gen prmtr mthyltn alys,300,RC,41000246,LOCAL,,inpatient,,,2822.4,2822.4,,,,,,,,,,,,,,,,,
Slco1b1 gene com variants,300,RC,41000247,LOCAL,,inpatient,,,2570.4,2570.4,,,,,,,,,,,,,,,,,
Smn1 gene dos/deletion alys,300,RC,41000248,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Smpd1 gene common variants,300,RC,41000249,LOCAL,,inpatient,,,693,693,,,,,,,,,,,,,,,,,
Snrpn/ube3a gene,300,RC,41000250,LOCAL,,inpatient,,,751.8,751.8,,,,,,,,,,,,,,,,,
Serpina1 gene,300,RC,41000251,LOCAL,,inpatient,,,642.6,642.6,,,,,,,,,,,,,,,,,
Tgfbi gene common variants,300,RC,41000252,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Runx1 gene targeted seq alys,300,RC,41000253,LOCAL,,inpatient,,,4842.6,4842.6,,,,,,,,,,,,,,,,,
Tpmt gene com variants,300,RC,41000254,LOCAL,,inpatient,,,2570.4,2570.4,,,,,,,,,,,,,,,,,
Smn1 gene full gene sequence,300,RC,41000255,LOCAL,,inpatient,,,4431,4431,,,,,,,,,,,,,,,,,
Smn1 gen nown famil seq vrnt,300,RC,41000256,LOCAL,,inpatient,,,2721.6,2721.6,,,,,,,,,,,,,,,,,
Trb@ gene rearrange amplify,300,RC,41000257,LOCAL,,inpatient,,,3070.2,3070.2,,,,,,,,,,,,,,,,,
Trb@ gene rearrange dirprobe,300,RC,41000258,LOCAL,,inpatient,,,730.8,730.8,,,,,,,,,,,,,,,,,
Trg gene rearrangement anal,300,RC,41000259,LOCAL,,inpatient,,,2961,2961,,,,,,,,,,,,,,,,,
Ppp2r2b gen detc abnor allel,300,RC,41000260,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Tbp gene detc abnor alleles,300,RC,41000261,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Tert gene targeted seq alys,300,RC,41000262,LOCAL,,inpatient,,,2721.6,2721.6,,,,,,,,,,,,,,,,,
Tyms gene com variants,300,RC,41000263,LOCAL,,inpatient,,,2570.4,2570.4,,,,,,,,,,,,,,,,,
Ugt1a1 gene common variants,300,RC,41000264,LOCAL,,inpatient,,,3439.8,3439.8,,,,,,,,,,,,,,,,,
Vkorc1 gene,300,RC,41000265,LOCAL,,inpatient,,,1297.8,1297.8,,,,,,,,,,,,,,,,,
Hbb gene com variants,300,RC,41000266,LOCAL,,inpatient,,,2570.4,2570.4,,,,,,,,,,,,,,,,,
Hbb gene known fam variant,300,RC,41000267,LOCAL,,inpatient,,,5514.6,5514.6,,,,,,,,,,,,,,,,,
Hbb gene dup/del variants,300,RC,41000268,LOCAL,,inpatient,,,2973.6,2973.6,,,,,,,,,,,,,,,,,
Hbb full gene sequence,300,RC,41000269,LOCAL,,inpatient,,,4771.2,4771.2,,,,,,,,,,,,,,,,,
Hla i & ii typing lr,300,RC,41000270,LOCAL,,inpatient,,,5909.4,5909.4,,,,,,,,,,,,,,,,,
Hla i & ii type verify lr,300,RC,41000271,LOCAL,,inpatient,,,5947.2,5947.2,,,,,,,,,,,,,,,,,
Hla i typing complete lr,300,RC,41000272,LOCAL,,inpatient,,,5934.6,5934.6,,,,,,,,,,,,,,,,,
Hla i typing 1 locus lr,300,RC,41000273,LOCAL,,inpatient,,,1873.2,1873.2,,,,,,,,,,,,,,,,,
Hla i typing 1 antigen lr,300,RC,41000274,LOCAL,,inpatient,,,1092,1092,,,,,,,,,,,,,,,,,
Hla ii typing ag equiv lr,300,RC,41000275,LOCAL,,inpatient,,,3246.6,3246.6,,,,,,,,,,,,,,,,,
Hla ii typing 1 locus lr,300,RC,41000276,LOCAL,,inpatient,,,1797.6,1797.6,,,,,,,,,,,,,,,,,
Hla ii type 1 ag equiv lr,300,RC,41000277,LOCAL,,inpatient,,,1394.4,1394.4,,,,,,,,,,,,,,,,,
Hla i & ii typing hr,300,RC,41000278,LOCAL,,inpatient,,,5077.8,5077.8,,,,,,,,,,,,,,,,,
Hla i typing complete hr,300,RC,41000279,LOCAL,,inpatient,,,4930.8,4930.8,,,,,,,,,,,,,,,,,
Hla i typing 1 locus hr,300,RC,41000280,LOCAL,,inpatient,,,2604,2604,,,,,,,,,,,,,,,,,
Hla i typing 1 allele hr,300,RC,41000281,LOCAL,,inpatient,,,2499,2499,,,,,,,,,,,,,,,,,
Hla ii typing 1 loc hr,300,RC,41000282,LOCAL,,inpatient,,,1818.6,1818.6,,,,,,,,,,,,,,,,,
Hla ii typing 1 allele hr,300,RC,41000283,LOCAL,,inpatient,,,1604.4,1604.4,,,,,,,,,,,,,,,,,
Mopath procedure level 1,300,RC,41000284,LOCAL,,inpatient,,,940.8,940.8,,,,,,,,,,,,,,,,,
Mopath procedure level 2,300,RC,41000285,LOCAL,,inpatient,,,2016,2016,,,,,,,,,,,,,,,,,
Mopath procedure level 3,300,RC,41000286,LOCAL,,inpatient,,,2209.2,2209.2,,,,,,,,,,,,,,,,,
Mopath procedure level 4,300,RC,41000287,LOCAL,,inpatient,,,2721.6,2721.6,,,,,,,,,,,,,,,,,
Mopath procedure level 5,300,RC,41000288,LOCAL,,inpatient,,,4040.4,4040.4,,,,,,,,,,,,,,,,,
Mopath procedure level 6,300,RC,41000289,LOCAL,,inpatient,,,4431,4431,,,,,,,,,,,,,,,,,
Mopath procedure level 7,300,RC,41000290,LOCAL,,inpatient,,,4158,4158,,,,,,,,,,,,,,,,,
Mopath procedure level 8,300,RC,41000291,LOCAL,,inpatient,,,12440.4,12440.4,,,,,,,,,,,,,,,,,
Mopath procedure level 9,300,RC,41000292,LOCAL,,inpatient,,,29400,29400,,,,,,,,,,,,,,,,,
Aortic dysfunction/dilation,300,RC,41000293,LOCAL,,inpatient,,,7408.8,7408.8,,,,,,,,,,,,,,,,,
Aortic dysfunction/dilation,300,RC,41000294,LOCAL,,inpatient,,,19849.2,19849.2,,,,,,,,,,,,,,,,,
Ashkenazi jewish assoc dis,300,RC,41000295,LOCAL,,inpatient,,,35994,35994,,,,,,,,,,,,,,,,,
Car ion chnnlpath inc 10 gns,300,RC,41000296,LOCAL,,inpatient,,,8597.4,8597.4,,,,,,,,,,,,,,,,,
Car ion chnnlpath inc 2 gns,300,RC,41000297,LOCAL,,inpatient,,,8597.4,8597.4,,,,,,,,,,,,,,,,,
Exome sequence analysis,300,RC,41000298,LOCAL,,inpatient,,,70266,70266,,,,,,,,,,,,,,,,,
Exome re-evaluation,300,RC,41000300,LOCAL,,inpatient,,,4704,4704,,,,,,,,,,,,,,,,,
Fetal chrmoml aneuploidy,300,RC,41000301,LOCAL,,inpatient,,,11159.4,11159.4,,,,,,,,,,,,,,,,,
Fetal chrmoml microdeltj,300,RC,41000302,LOCAL,,inpatient,,,11159.4,11159.4,,,,,,,,,,,,,,,,,
Genome sequence analysis,300,RC,41000303,LOCAL,,inpatient,,,73957.8,73957.8,,,,,,,,,,,,,,,,,
Genome sequence analysis,300,RC,41000304,LOCAL,,inpatient,,,39837,39837,,,,,,,,,,,,,,,,,
Genome re-evaluation,300,RC,41000305,LOCAL,,inpatient,,,34364.4,34364.4,,,,,,,,,,,,,,,,,
Hearing loss sequence analys,300,RC,41000306,LOCAL,,inpatient,,,23889.6,23889.6,,,,,,,,,,,,,,,,,
Hearing loss dup/del analys,300,RC,41000307,LOCAL,,inpatient,,,9987.6,9987.6,,,,,,,,,,,,,,,,,
Hrdtry brst ca-rlatd dsordrs,300,RC,41000308,LOCAL,,inpatient,,,9983.4,9983.4,,,,,,,,,,,,,,,,,
Hrdtry brst ca-rlatd dsordrs,300,RC,41000309,LOCAL,,inpatient,,,6451.2,6451.2,,,,,,,,,,,,,,,,,
Hereditary retinal disorders,300,RC,41000310,LOCAL,,inpatient,,,8790.6,8790.6,,,,,,,,,,,,,,,,,
Hereditary colon ca dsordrs,300,RC,41000311,LOCAL,,inpatient,,,8597.4,8597.4,,,,,,,,,,,,,,,,,
Hereditary colon ca dsordrs,300,RC,41000312,LOCAL,,inpatient,,,8597.4,8597.4,,,,,,,,,,,,,,,,,
Heredtry nurondcrn tum dsrdr,300,RC,41000313,LOCAL,,inpatient,,,6451.2,6451.2,,,,,,,,,,,,,,,,,
Heredtry nurondcrn tum dsrdr,300,RC,41000314,LOCAL,,inpatient,,,6451.2,6451.2,,,,,,,,,,,,,,,,,
Hrdtry cardmypy gene panel,300,RC,41000315,LOCAL,,inpatient,,,8597.4,8597.4,,,,,,,,,,,,,,,,,
Mitochondrial gene,300,RC,41000316,LOCAL,,inpatient,,,48862.8,48862.8,,,,,,,,,,,,,,,,,
Noonan spectrum disorders,300,RC,41000317,LOCAL,,inpatient,,,31512.6,31512.6,,,,,,,,,,,,,,,,,
Genetic tstg severe inh cond,300,RC,41000318,LOCAL,,inpatient,,,35994,35994,,,,,,,,,,,,,,,,,
Targeted genomic seq analys,300,RC,41000319,LOCAL,,inpatient,,,8790.6,8790.6,,,,,,,,,,,,,,,,,
Hrdtry perph neurphy panel,300,RC,41000320,LOCAL,,inpatient,,,8597.4,8597.4,,,,,,,,,,,,,,,,,
Targeted genomic seq analys,300,RC,41000321,LOCAL,,inpatient,,,11163.6,11163.6,,,,,,,,,,,,,,,,,
Targeted genomic seq analys,300,RC,41000322,LOCAL,,inpatient,,,42919.8,42919.8,,,,,,,,,,,,,,,,,
Whole mitochondrial genome,300,RC,41000323,LOCAL,,inpatient,,,18921,18921,,,,,,,,,,,,,,,,,
Whole mitochondrial genome,300,RC,41000324,LOCAL,,inpatient,,,13759.2,13759.2,,,,,,,,,,,,,,,,,
X-linked intellectual dblt,300,RC,41000325,LOCAL,,inpatient,,,13435.8,13435.8,,,,,,,,,,,,,,,,,
X-linked intellectual dblt,300,RC,41000326,LOCAL,,inpatient,,,13435.8,13435.8,,,,,,,,,,,,,,,,,
Autoimmune rheumatoid arthr,300,RC,41000327,LOCAL,,inpatient,,,12356.4,12356.4,,,,,,,,,,,,,,,,,
Cor artery disease mrna,300,RC,41000328,LOCAL,,inpatient,,,15435,15435,,,,,,,,,,,,,,,,,
Onco (ovar) two proteins,300,RC,41000329,LOCAL,,inpatient,,,3830.4,3830.4,,,,,,,,,,,,,,,,,
Onco (ovar) five proteins,300,RC,41000330,LOCAL,,inpatient,,,13188,13188,,,,,,,,,,,,,,,,,
Oncology tissue of origin,300,RC,41000331,LOCAL,,inpatient,,,7644,7644,,,,,,,,,,,,,,,,,
Endo assay seven anal,300,RC,41000332,LOCAL,,inpatient,,,1012.2,1012.2,,,,,,,,,,,,,,,,,
Fetal aneuploidy trisom risk,300,RC,41000333,LOCAL,,inpatient,,,11688.6,11688.6,,,,,,,,,,,,,,,,,
Ftl cgen abnor two proteins,300,RC,41000334,LOCAL,,inpatient,,,798,798,,,,,,,,,,,,,,,,,
Ftl cgen abnor 3 proteins,300,RC,41000335,LOCAL,,inpatient,,,21865.2,21865.2,,,,,,,,,,,,,,,,,
Ftl cgen abnor three anal,300,RC,41000336,LOCAL,,inpatient,,,814.8,814.8,,,,,,,,,,,,,,,,,
Ftl cgen abnor four anal,300,RC,41000337,LOCAL,,inpatient,,,2255.4,2255.4,,,,,,,,,,,,,,,,,
Ftl cgen abnor five anal,300,RC,41000338,LOCAL,,inpatient,,,1020.6,1020.6,,,,,,,,,,,,,,,,,
Onc brst mrna 11 genes,300,RC,41000339,LOCAL,,inpatient,,,56935.2,56935.2,,,,,,,,,,,,,,,,,
Oncology breast mrna,300,RC,41000340,LOCAL,,inpatient,,,56935.2,56935.2,,,,,,,,,,,,,,,,,
Onc breast mrna 58 genes,300,RC,41000341,LOCAL,,inpatient,,,36901.2,36901.2,,,,,,,,,,,,,,,,,
Onc breast mrna 70 genes,300,RC,41000342,LOCAL,,inpatient,,,56935.2,56935.2,,,,,,,,,,,,,,,,,
Onc breast mrna 12 genes,300,RC,41000343,LOCAL,,inpatient,,,56935.2,56935.2,,,,,,,,,,,,,,,,,
Oncology colon mrna,300,RC,41000344,LOCAL,,inpatient,,,45805.2,45805.2,,,,,,,,,,,,,,,,,
Oncology colorectal scr,300,RC,41000345,LOCAL,,inpatient,,,7480.2,7480.2,,,,,,,,,,,,,,,,,
Oncology gynecologic,300,RC,41000346,LOCAL,,inpatient,,,8517.6,8517.6,,,,,,,,,,,,,,,,,
Oncology gynecologic,300,RC,41000347,LOCAL,,inpatient,,,2608.2,2608.2,,,,,,,,,,,,,,,,,
Oncology lung,300,RC,41000348,LOCAL,,inpatient,,,42205.8,42205.8,,,,,,,,,,,,,,,,,
Oncology prostate prob score,300,RC,41000349,LOCAL,,inpatient,,,11172,11172,,,,,,,,,,,,,,,,,
Oncology tum unknown origin,300,RC,41000350,LOCAL,,inpatient,,,55125,55125,,,,,,,,,,,,,,,,,
Onc prostate mrna 46 genes,300,RC,41000351,LOCAL,,inpatient,,,56935.2,56935.2,,,,,,,,,,,,,,,,,
Onc prostate mrna 22 cnt gen,300,RC,41000352,LOCAL,,inpatient,,,210,210,,,,,,,,,,,,,,,,,
Onc prostate 3 genes,300,RC,41000354,LOCAL,,inpatient,,,29841,29841,,,,,,,,,,,,,,,,,
Cardiology hrt trnspl mrna,300,RC,41000355,LOCAL,,inpatient,,,47628,47628,,,,,,,,,,,,,,,,,
Nfct ds chrnc hcv 6 assays,300,RC,41000356,LOCAL,,inpatient,,,1062.6,1062.6,,,,,,,,,,,,,,,,,
"KETONE BODIES,QUANT SER",300,RC,41000357,LOCAL,,inpatient,,,60.13,60.13,,,,,,,,,,,,,,,,,
Acetone assay,300,RC,41000358,LOCAL,,inpatient,,,108.78,108.78,,,,,,,,,,,,,,,,,
Acetylcholinesterase assay,300,RC,41000359,LOCAL,,inpatient,,,180.6,180.6,,,,,,,,,,,,,,,,,
Acylcarnitines qual,300,RC,41000360,LOCAL,,inpatient,,,243.6,243.6,,,,,,,,,,,,,,,,,
Acylcarnitines quant,300,RC,41000361,LOCAL,,inpatient,,,247.8,247.8,,,,,,,,,,,,,,,,,
Assay of adp & amp,300,RC,41000363,LOCAL,,inpatient,,,378,378,,,,,,,,,,,,,,,,,
Ur albumin semiquantitative,300,RC,41000367,LOCAL,,inpatient,,,92.4,92.4,,,,,,,,,,,,,,,,,
Albumin ischemia modified,300,RC,41000368,LOCAL,,inpatient,,,499.8,499.8,,,,,,,,,,,,,,,,,
Assay of breath ethanol,300,RC,41000369,LOCAL,,inpatient,,,441,441,,,,,,,,,,,,,,,,,
ALPHA-1 ANTI-TRYPSIN,300,RC,41000372,LOCAL,,inpatient,,,178.85,178.85,,,,,,,,,,,,,,,,,
Alpha-1-antitrypsin pheno,300,RC,41000373,LOCAL,,inpatient,,,192.5,192.5,,,,,,,,,,,,,,,,,
Alpha-fetoprotein amniotic,300,RC,41000375,LOCAL,,inpatient,,,223.3,223.3,,,,,,,,,,,,,,,,,
Alpha-fetoprotein l3,300,RC,41000376,LOCAL,,inpatient,,,857.43,857.43,,,,,,,,,,,,,,,,,
Assay of aluminum,300,RC,41000377,LOCAL,,inpatient,,,339.15,339.15,,,,,,,,,,,,,,,,,
Amines vaginal fluid qual,300,RC,41000378,LOCAL,,inpatient,,,88.2,88.2,,,,,,,,,,,,,,,,,
Amino acid single qual,300,RC,41000379,LOCAL,,inpatient,,,210,210,,,,,,,,,,,,,,,,,
Amino acids mult qual,300,RC,41000380,LOCAL,,inpatient,,,205.8,205.8,,,,,,,,,,,,,,,,,
Amino acids single quant,300,RC,41000381,LOCAL,,inpatient,,,336,336,,,,,,,,,,,,,,,,,
Assay aminolevulinic acid,300,RC,41000382,LOCAL,,inpatient,,,219.1,219.1,,,,,,,,,,,,,,,,,
Amino acids quant 2-5,300,RC,41000383,LOCAL,,inpatient,,,289.8,289.8,,,,,,,,,,,,,,,,,
Amino acids quan 6 or more,300,RC,41000384,LOCAL,,inpatient,,,247.8,247.8,,,,,,,,,,,,,,,,,
AMMONIA,300,RC,41000385,LOCAL,,inpatient,,,193.97,193.97,,,,,,,,,,,,,,,,,
Amniotic fluid scan,300,RC,41000386,LOCAL,,inpatient,,,138.6,138.6,,,,,,,,,,,,,,,,,
AMYLASE,300,RC,41000387,LOCAL,,inpatient,,,86.31,86.31,,,,,,,,,,,,,,,,,
Androstanediol glucuronide,300,RC,41000388,LOCAL,,inpatient,,,424.2,424.2,,,,,,,,,,,,,,,,,
Assay of androstenedione,300,RC,41000389,LOCAL,,inpatient,,,428.4,428.4,,,,,,,,,,,,,,,,,
Assay of androsterone,300,RC,41000390,LOCAL,,inpatient,,,373.8,373.8,,,,,,,,,,,,,,,,,
Assay of angiotensin ii,300,RC,41000391,LOCAL,,inpatient,,,302.4,302.4,,,,,,,,,,,,,,,,,
Assay of apolipoprotein,300,RC,41000393,LOCAL,,inpatient,,,206.29,206.29,,,,,,,,,,,,,,,,,
Assay of arsenic,300,RC,41000394,LOCAL,,inpatient,,,252.56,252.56,,,,,,,,,,,,,,,,,
Assay of ascorbic acid,300,RC,41000395,LOCAL,,inpatient,,,131.6,131.6,,,,,,,,,,,,,,,,,
Atomic absorption,300,RC,41000396,LOCAL,,inpatient,,,235.2,235.2,,,,,,,,,,,,,,,,,
Bile acids total,300,RC,41000398,LOCAL,,inpatient,,,182.448,182.448,,,,,,,,,,,,,,,,,
Bile acids cholylglycine,300,RC,41000399,LOCAL,,inpatient,,,390.6,390.6,,,,,,,,,,,,,,,,,
"BILIRUBIN, TOTAL",300,RC,41000400,LOCAL,,inpatient,,,66.78,66.78,,,,,,,,,,,,,,,,,
"BILIRUBIN, DIRECT",300,RC,41000401,LOCAL,,inpatient,,,66.78,66.78,,,,,,,,,,,,,,,,,
Fecal bilirubin test,300,RC,41000402,LOCAL,,inpatient,,,67.2,67.2,,,,,,,,,,,,,,,,,
Assay of biotinidase,300,RC,41000403,LOCAL,,inpatient,,,247.8,247.8,,,,,,,,,,,,,,,,,
"FECAL OCCULT,STOOL",300,RC,41000404,LOCAL,,inpatient,,,43.33,43.33,,,,,,,,,,,,,,,,,
Assay test for blood fecal,300,RC,41000407,LOCAL,,inpatient,,,211.68,211.68,,,,,,,,,,,,,,,,,
Assay of bradykinin,300,RC,41000408,LOCAL,,inpatient,,,75.6,75.6,,,,,,,,,,,,,,,,,
Assay of cadmium,300,RC,41000409,LOCAL,,inpatient,,,308.07,308.07,,,,,,,,,,,,,,,,,
"VITAMIN D 25-OH, TOTAL",300,RC,41000410,LOCAL,,inpatient,,,394.1,394.1,,,,,,,,,,,,,,,,,
Assay of calcitonin,300,RC,41000411,LOCAL,,inpatient,,,356.51,356.51,,,,,,,,,,,,,,,,,
CALCIUM,300,RC,41000412,LOCAL,,inpatient,,,68.67,68.67,,,,,,,,,,,,,,,,,
"CALCIUM, IONIZED",300,RC,41000413,LOCAL,,inpatient,,,181.93,181.93,,,,,,,,,,,,,,,,,
Calcium infusion test,300,RC,41000414,LOCAL,,inpatient,,,68.88,68.88,,,,,,,,,,,,,,,,,
Calculus analysis qual,300,RC,41000416,LOCAL,,inpatient,,,172.2,172.2,,,,,,,,,,,,,,,,,
Calculus assay quant,300,RC,41000417,LOCAL,,inpatient,,,189,189,,,,,,,,,,,,,,,,,
Calculus spectroscopy,300,RC,41000418,LOCAL,,inpatient,,,171.64,171.64,,,,,,,,,,,,,,,,,
X-ray assay calculus,300,RC,41000419,LOCAL,,inpatient,,,184.8,184.8,,,,,,,,,,,,,,,,,
Assay c-d transfer measure,300,RC,41000420,LOCAL,,inpatient,,,264.6,264.6,,,,,,,,,,,,,,,,,
Assay carboxyhb quant,300,RC,41000422,LOCAL,,inpatient,,,180.6,180.6,,,,,,,,,,,,,,,,,
Assay carboxyhb qual,300,RC,41000423,LOCAL,,inpatient,,,205.8,205.8,,,,,,,,,,,,,,,,,
Assay of carnitine,300,RC,41000425,LOCAL,,inpatient,,,224.56,224.56,,,,,,,,,,,,,,,,,
Assay of carotene,300,RC,41000426,LOCAL,,inpatient,,,134.4,134.4,,,,,,,,,,,,,,,,,
Assay urine catecholamines,300,RC,41000427,LOCAL,,inpatient,,,403.2,403.2,,,,,,,,,,,,,,,,,
Assay blood catecholamines,300,RC,41000428,LOCAL,,inpatient,,,428.4,428.4,,,,,,,,,,,,,,,,,
"CATECHOLAMINES FRAC,PLASMA",300,RC,41000429,LOCAL,,inpatient,,,336.14,336.14,,,,,,,,,,,,,,,,,
Assay of cathepsin-d,300,RC,41000430,LOCAL,,inpatient,,,264.6,264.6,,,,,,,,,,,,,,,,,
CERULOPLASMIN,300,RC,41000431,LOCAL,,inpatient,,,143.01,143.01,,,,,,,,,,,,,,,,,
Chemiluminescent assay,300,RC,41000432,LOCAL,,inpatient,,,188.09,188.09,,,,,,,,,,,,,,,,,
Assay of chloramphenicol,300,RC,41000433,LOCAL,,inpatient,,,184.8,184.8,,,,,,,,,,,,,,,,,
CHLORIDE,305,RC,41000434,LOCAL,,inpatient,,,61.18,61.18,,,,,,,,,,,,,,,,,
Assay of urine chloride,305,RC,41000435,LOCAL,,inpatient,,,66.92,66.92,,,,,,,,,,,,,,,,,
Assay other fluid chlorides,300,RC,41000436,LOCAL,,inpatient,,,75.6,75.6,,,,,,,,,,,,,,,,,
Test for chlorohydrocarbons,300,RC,41000437,LOCAL,,inpatient,,,88.2,88.2,,,,,,,,,,,,,,,,,
CHOLESTEROL,300,RC,41000438,LOCAL,,inpatient,,,57.96,57.96,,,,,,,,,,,,,,,,,
Assay serum cholinesterase,300,RC,41000439,LOCAL,,inpatient,,,117.6,117.6,,,,,,,,,,,,,,,,,
Assay rbc cholinesterase,300,RC,41000440,LOCAL,,inpatient,,,142.8,142.8,,,,,,,,,,,,,,,,,
Assay chondroitin sulfate,300,RC,41000441,LOCAL,,inpatient,,,302.4,302.4,,,,,,,,,,,,,,,,,
Assay of chromium,300,RC,41000442,LOCAL,,inpatient,,,298.2,298.2,,,,,,,,,,,,,,,,,
Assay of citrate,300,RC,41000443,LOCAL,,inpatient,,,370.16,370.16,,,,,,,,,,,,,,,,,
Collagen crosslinks,300,RC,41000444,LOCAL,,inpatient,,,273,273,,,,,,,,,,,,,,,,,
Assay of corticosterone,300,RC,41000446,LOCAL,,inpatient,,,299.67,299.67,,,,,,,,,,,,,,,,,
Cortisol free,300,RC,41000447,LOCAL,,inpatient,,,222.46,222.46,,,,,,,,,,,,,,,,,
CORTISOL,300,RC,41000448,LOCAL,,inpatient,,,217.07,217.07,,,,,,,,,,,,,,,,,
"CREATININE, SERUM",300,RC,41000449,LOCAL,,inpatient,,,49.336,49.336,,,,,,,,,,,,,,,,,
CK (CPK),300,RC,41000451,LOCAL,,inpatient,,,86.73,86.73,,,,,,,,,,,,,,,,,
Assay of cpk in blood,300,RC,41000452,LOCAL,,inpatient,,,178.36,178.36,,,,,,,,,,,,,,,,,
CKMB SCREEN (FRACTIONATION),300,RC,41000453,LOCAL,,inpatient,,,153.72,153.72,,,,,,,,,,,,,,,,,
Creatine isoforms,300,RC,41000454,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
"CREATININE, UR RANDOM",300,RC,41000456,LOCAL,,inpatient,,,68.88,68.88,,,,,,,,,,,,,,,,,
Assay of cryofibrinogen,300,RC,41000458,LOCAL,,inpatient,,,205.8,205.8,,,,,,,,,,,,,,,,,
Assay of cryoglobulin,300,RC,41000459,LOCAL,,inpatient,,,200.62,200.62,,,,,,,,,,,,,,,,,
Assay of cyanide,300,RC,41000460,LOCAL,,inpatient,,,285.6,285.6,,,,,,,,,,,,,,,,,
VITAMIN B12,300,RC,41000461,LOCAL,,inpatient,,,200.62,200.62,,,,,,,,,,,,,,,,,
B-12 binding capacity,300,RC,41000462,LOCAL,,inpatient,,,210,210,,,,,,,,,,,,,,,,,
Cystatin c,300,RC,41000463,LOCAL,,inpatient,,,144.76,144.76,,,,,,,,,,,,,,,,,
Test for urine cystines,300,RC,41000464,LOCAL,,inpatient,,,138.6,138.6,,,,,,,,,,,,,,,,,
Dehydroepiandrosterone,300,RC,41000466,LOCAL,,inpatient,,,296.03,296.03,,,,,,,,,,,,,,,,,
Desoxycorticosterone,300,RC,41000467,LOCAL,,inpatient,,,453.6,453.6,,,,,,,,,,,,,,,,,
Deoxycortisol,300,RC,41000468,LOCAL,,inpatient,,,428.4,428.4,,,,,,,,,,,,,,,,,
Assay of dibucaine number,300,RC,41000469,LOCAL,,inpatient,,,180.6,180.6,,,,,,,,,,,,,,,,,
Dihydrotestosterone,300,RC,41000470,LOCAL,,inpatient,,,428.4,428.4,,,,,,,,,,,,,,,,,
"VIT D, 1,25-DIHYDROXY",300,RC,41000471,LOCAL,,inpatient,,,512.47,512.47,,,,,,,,,,,,,,,,,
Pancreatic elastase fecal,300,RC,41000472,LOCAL,,inpatient,,,168,168,,,,,,,,,,,,,,,,,
Enzyme cell activity,300,RC,41000473,LOCAL,,inpatient,,,327.6,327.6,,,,,,,,,,,,,,,,,
Enzyme cell activity ra,300,RC,41000474,LOCAL,,inpatient,,,646.8,646.8,,,,,,,,,,,,,,,,,
URINE PROTEIN ELECTROPH,301,RC,41000475,LOCAL,,inpatient,,,387.45,387.45,,,,,,,,,,,,,,,,,
Assay of erythropoietin,300,RC,41000476,LOCAL,,inpatient,,,250.25,250.25,,,,,,,,,,,,,,,,,
Assay of estradiol,300,RC,41000477,LOCAL,,inpatient,,,371.91,371.91,,,,,,,,,,,,,,,,,
Assay of estrogens,300,RC,41000478,LOCAL,,inpatient,,,474.6,474.6,,,,,,,,,,,,,,,,,
Assay of estrogen,300,RC,41000479,LOCAL,,inpatient,,,231,231,,,,,,,,,,,,,,,,,
Assay of estriol,300,RC,41000480,LOCAL,,inpatient,,,357,357,,,,,,,,,,,,,,,,,
Assay of estrone,300,RC,41000481,LOCAL,,inpatient,,,365.4,365.4,,,,,,,,,,,,,,,,,
Assay of ethylene glycol,300,RC,41000482,LOCAL,,inpatient,,,161.42,161.42,,,,,,,,,,,,,,,,,
Assay of etiocholanolone,300,RC,41000483,LOCAL,,inpatient,,,386.4,386.4,,,,,,,,,,,,,,,,,
Fats/lipids feces qual,300,RC,41000484,LOCAL,,inpatient,,,54.208,54.208,,,,,,,,,,,,,,,,,
Fats/lipids feces quant,300,RC,41000485,LOCAL,,inpatient,,,223.65,223.65,,,,,,,,,,,,,,,,,
Assay of fecal fat,300,RC,41000486,LOCAL,,inpatient,,,336,336,,,,,,,,,,,,,,,,,
Assay of blood fatty acids,300,RC,41000487,LOCAL,,inpatient,,,277.2,277.2,,,,,,,,,,,,,,,,,
Long chain fatty acids,300,RC,41000488,LOCAL,,inpatient,,,289.8,289.8,,,,,,,,,,,,,,,,,
FERRITIN,300,RC,41000489,LOCAL,,inpatient,,,181.37,181.37,,,,,,,,,,,,,,,,,
Assay of fetal fibronectin,300,RC,41000490,LOCAL,,inpatient,,,945,945,,,,,,,,,,,,,,,,,
Assay of fluoride,300,RC,41000491,LOCAL,,inpatient,,,273,273,,,,,,,,,,,,,,,,,
FOLIC ACID (FOLATE),300,RC,41000492,LOCAL,,inpatient,,,195.72,195.72,,,,,,,,,,,,,,,,,
Assay of semen fructose,300,RC,41000494,LOCAL,,inpatient,,,256.2,256.2,,,,,,,,,,,,,,,,,
Assay of rbc galactokinase,300,RC,41000495,LOCAL,,inpatient,,,315,315,,,,,,,,,,,,,,,,,
Assay of galactose,300,RC,41000496,LOCAL,,inpatient,,,163.8,163.8,,,,,,,,,,,,,,,,,
Assay galactose transferase,300,RC,41000497,LOCAL,,inpatient,,,310.8,310.8,,,,,,,,,,,,,,,,,
Galactose transferase test,300,RC,41000498,LOCAL,,inpatient,,,172.2,172.2,,,,,,,,,,,,,,,,,
Galectin-3,300,RC,41000499,LOCAL,,inpatient,,,651,651,,,,,,,,,,,,,,,,,
Assay iga/igd/igg/igm each,300,RC,41000500,LOCAL,,inpatient,,,123.83,123.83,,,,,,,,,,,,,,,,,
Assay of ige,300,RC,41000501,LOCAL,,inpatient,,,219.24,219.24,,,,,,,,,,,,,,,,,
Igg 1 2 3 or 4 each,300,RC,41000502,LOCAL,,inpatient,,,117.6,117.6,,,,,,,,,,,,,,,,,
Blood ph,300,RC,41000503,LOCAL,,inpatient,,,112.7,112.7,,,,,,,,,,,,,,,,,
ARTERIAL BLOOD GASES (ABG),300,RC,41000505,LOCAL,,inpatient,,,377.79,377.79,,,,,,,,,,,,,,,,,
Blood gases o2 sat only,300,RC,41000506,LOCAL,,inpatient,,,142.8,142.8,,,,,,,,,,,,,,,,,
Hemoglobin-oxygen affinity,300,RC,41000507,LOCAL,,inpatient,,,133.07,133.07,,,,,,,,,,,,,,,,,
Gastric analy w/ph ea spec,300,RC,41000508,LOCAL,,inpatient,,,96.6,96.6,,,,,,,,,,,,,,,,,
Gastrin test,300,RC,41000509,LOCAL,,inpatient,,,260.4,260.4,,,,,,,,,,,,,,,,,
Assay of gastrin,300,RC,41000510,LOCAL,,inpatient,,,234.78,234.78,,,,,,,,,,,,,,,,,
GLUCAGON,300,RC,41000511,LOCAL,,inpatient,,,210,210,,,,,,,,,,,,,,,,,
GLUCOSE,300,RC,41000512,LOCAL,,inpatient,,,52.22,52.22,,,,,,,,,,,,,,,,,
Glucagon tolerance test,300,RC,41000513,LOCAL,,inpatient,,,260.4,260.4,,,,,,,,,,,,,,,,,
Reagent strip/blood glucose,300,RC,41000515,LOCAL,,inpatient,,,75.6,75.6,,,,,,,,,,,,,,,,,
Glucose test,300,RC,41000516,LOCAL,,inpatient,,,63.21,63.21,,,,,,,,,,,,,,,,,
Glucose tolerance test (gtt),300,RC,41000517,LOCAL,,inpatient,,,171.36,171.36,,,,,,,,,,,,,,,,,
Gtt-added samples,300,RC,41000518,LOCAL,,inpatient,,,52.15,52.15,,,,,,,,,,,,,,,,,
Assay of g6pd enzyme,300,RC,41000519,LOCAL,,inpatient,,,142.8,142.8,,,,,,,,,,,,,,,,,
Test for g6pd enzyme,300,RC,41000520,LOCAL,,inpatient,,,88.2,88.2,,,,,,,,,,,,,,,,,
Fingerstick Blood Sugar,300,RC,41000521,LOCAL,,inpatient,,,46.2,46.2,,,,,,,,,,,,,,,,,
Assay of glucosidase,300,RC,41000522,LOCAL,,inpatient,,,315,315,,,,,,,,,,,,,,,,,
Assay of gdh enzyme,300,RC,41000523,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
GGT,300,RC,41000524,LOCAL,,inpatient,,,95.83,95.83,,,,,,,,,,,,,,,,,
Assay of glutathione,300,RC,41000525,LOCAL,,inpatient,,,226.8,226.8,,,,,,,,,,,,,,,,,
Assay rbc glutathione,300,RC,41000526,LOCAL,,inpatient,,,138.6,138.6,,,,,,,,,,,,,,,,,
Assay of glycated protein,300,RC,41000527,LOCAL,,inpatient,,,200.62,200.62,,,,,,,,,,,,,,,,,
Assay of gonadotropin (fsh),300,RC,41000528,LOCAL,,inpatient,,,247.38,247.38,,,,,,,,,,,,,,,,,
Assay of gonadotropin (lh),300,RC,41000529,LOCAL,,inpatient,,,246.54,246.54,,,,,,,,,,,,,,,,,
Assay growth hormone (hgh),300,RC,41000530,LOCAL,,inpatient,,,221.97,221.97,,,,,,,,,,,,,,,,,
H pylori (c-13) blood,300,RC,41000532,LOCAL,,inpatient,,,896.63,896.63,,,,,,,,,,,,,,,,,
HAPTOGLOBIN,300,RC,41000533,LOCAL,,inpatient,,,167.44,167.44,,,,,,,,,,,,,,,,,
Assay of haptoglobins,300,RC,41000534,LOCAL,,inpatient,,,394.8,394.8,,,,,,,,,,,,,,,,,
H pylori (c-13) breath,300,RC,41000535,LOCAL,,inpatient,,,991.2,991.2,,,,,,,,,,,,,,,,,
H pylori drug admin,300,RC,41000536,LOCAL,,inpatient,,,117.6,117.6,,,,,,,,,,,,,,,,,
Heavy metal qual any anal,300,RC,41000537,LOCAL,,inpatient,,,306.6,306.6,,,,,,,,,,,,,,,,,
Heavy metal quant each nes,300,RC,41000538,LOCAL,,inpatient,,,323.4,323.4,,,,,,,,,,,,,,,,,
Hemoglobin electrophoresis,300,RC,41000539,LOCAL,,inpatient,,,189,189,,,,,,,,,,,,,,,,,
Hemoglobin chromotography,300,RC,41000540,LOCAL,,inpatient,,,264.6,264.6,,,,,,,,,,,,,,,,,
Hemoglobin copper sulfate,300,RC,41000541,LOCAL,,inpatient,,,58.8,58.8,,,,,,,,,,,,,,,,,
Fetal hemoglobin chemical,300,RC,41000542,LOCAL,,inpatient,,,159.6,159.6,,,,,,,,,,,,,,,,,
Fetal hemoglobin assay qual,300,RC,41000543,LOCAL,,inpatient,,,117.6,117.6,,,,,,,,,,,,,,,,,
HEMAGLOBIN A1C,305,RC,41000544,LOCAL,,inpatient,,,129.22,129.22,,,,,,,,,,,,,,,,,
Glycosylated hb home device,300,RC,41000545,LOCAL,,inpatient,,,142.8,142.8,,,,,,,,,,,,,,,,,
Blood methemoglobin test,300,RC,41000546,LOCAL,,inpatient,,,96.6,96.6,,,,,,,,,,,,,,,,,
Blood methemoglobin assay,300,RC,41000547,LOCAL,,inpatient,,,121.8,121.8,,,,,,,,,,,,,,,,,
Assay of plasma hemoglobin,300,RC,41000548,LOCAL,,inpatient,,,97.3,97.3,,,,,,,,,,,,,,,,,
Blood sulfhemoglobin assay,300,RC,41000549,LOCAL,,inpatient,,,130.2,130.2,,,,,,,,,,,,,,,,,
Assay of hemoglobin heat,300,RC,41000550,LOCAL,,inpatient,,,134.4,134.4,,,,,,,,,,,,,,,,,
Hemoglobin stability screen,300,RC,41000551,LOCAL,,inpatient,,,138.6,138.6,,,,,,,,,,,,,,,,,
Assay of urine hemoglobin,300,RC,41000552,LOCAL,,inpatient,,,58.8,58.8,,,,,,,,,,,,,,,,,
Assay of hemosiderin qual,300,RC,41000553,LOCAL,,inpatient,,,212.352,212.352,,,,,,,,,,,,,,,,,
Assay of b hexosaminidase,300,RC,41000554,LOCAL,,inpatient,,,247.8,247.8,,,,,,,,,,,,,,,,,
Assay of histamine,300,RC,41000555,LOCAL,,inpatient,,,393.12,393.12,,,,,,,,,,,,,,,,,
HOMOCYSTEINE (SERUM OR PLASMA),300,RC,41000556,LOCAL,,inpatient,,,224.56,224.56,,,,,,,,,,,,,,,,,
Assay of homovanillic acid,300,RC,41000557,LOCAL,,inpatient,,,327.6,327.6,,,,,,,,,,,,,,,,,
Assay of corticosteroids 17,300,RC,41000558,LOCAL,,inpatient,,,264.6,264.6,,,,,,,,,,,,,,,,,
5-Hydroxyindoleacetic Acd-HIAA,300,RC,41000559,LOCAL,,inpatient,,,171.64,171.64,,,,,,,,,,,,,,,,,
Assay of progesterone 17-d,300,RC,41000560,LOCAL,,inpatient,,,399,399,,,,,,,,,,,,,,,,,
Assay free hydroxyproline,300,RC,41000561,LOCAL,,inpatient,,,331.8,331.8,,,,,,,,,,,,,,,,,
Assay total hydroxyproline,300,RC,41000562,LOCAL,,inpatient,,,357,357,,,,,,,,,,,,,,,,,
Immunoassay nonantibody,300,RC,41000563,LOCAL,,inpatient,,,153.58,153.58,,,,,,,,,,,,,,,,,
Immunoassay dipstick,300,RC,41000564,LOCAL,,inpatient,,,142.8,142.8,,,,,,,,,,,,,,,,,
Ria nonantibody,300,RC,41000565,LOCAL,,inpatient,,,179.83,179.83,,,,,,,,,,,,,,,,,
Assay of insulin,300,RC,41000567,LOCAL,,inpatient,,,152.18,152.18,,,,,,,,,,,,,,,,,
Assay of intrinsic factor,300,RC,41000569,LOCAL,,inpatient,,,289.8,289.8,,,,,,,,,,,,,,,,,
IRON,300,RC,41000570,LOCAL,,inpatient,,,86.24,86.24,,,,,,,,,,,,,,,,,
IRON AND TIBC (IRON PANEL),300,RC,41000571,LOCAL,,inpatient,,,116.34,116.34,,,,,,,,,,,,,,,,,
Assay of idh enzyme,300,RC,41000572,LOCAL,,inpatient,,,130.2,130.2,,,,,,,,,,,,,,,,,
Assay of ketogenic steroids,300,RC,41000573,LOCAL,,inpatient,,,226.8,226.8,,,,,,,,,,,,,,,,,
Assay 17- ketosteroids,300,RC,41000574,LOCAL,,inpatient,,,189,189,,,,,,,,,,,,,,,,,
Fractionation ketosteroids,300,RC,41000575,LOCAL,,inpatient,,,420,420,,,,,,,,,,,,,,,,,
LACTIC ACID,300,RC,41000576,LOCAL,,inpatient,,,142.17,142.17,,,,,,,,,,,,,,,,,
Assay of ldh enzymes,300,RC,41000578,LOCAL,,inpatient,,,170.38,170.38,,,,,,,,,,,,,,,,,
Lactoferrin fecal (qual),300,RC,41000579,LOCAL,,inpatient,,,261.31,261.31,,,,,,,,,,,,,,,,,
Lactoferrin fecal (quant),300,RC,41000580,LOCAL,,inpatient,,,289.8,289.8,,,,,,,,,,,,,,,,,
Placental lactogen,300,RC,41000581,LOCAL,,inpatient,,,298.2,298.2,,,,,,,,,,,,,,,,,
Test urine for lactose,300,RC,41000582,LOCAL,,inpatient,,,163.8,163.8,,,,,,,,,,,,,,,,,
Assay of lead,300,RC,41000583,LOCAL,,inpatient,,,161.14,161.14,,,,,,,,,,,,,,,,,
L/s ratio fetal lung,300,RC,41000584,LOCAL,,inpatient,,,323.4,323.4,,,,,,,,,,,,,,,,,
Foam stability fetal lung,300,RC,41000585,LOCAL,,inpatient,,,277.2,277.2,,,,,,,,,,,,,,,,,
Fluoro polarize fetal lung,300,RC,41000586,LOCAL,,inpatient,,,277.2,277.2,,,,,,,,,,,,,,,,,
Lamellar bdy fetal lung,300,RC,41000587,LOCAL,,inpatient,,,285.6,285.6,,,,,,,,,,,,,,,,,
Assay of lap enzyme,300,RC,41000588,LOCAL,,inpatient,,,97.608,97.608,,,,,,,,,,,,,,,,,
LIPASE,300,RC,41000589,LOCAL,,inpatient,,,91.7,91.7,,,,,,,,,,,,,,,,,
Assay of lipoprotein(a),301,RC,41000590,LOCAL,,inpatient,,,100.24,100.24,,,,,,,,,,,,,,,,,
Assay lipoprotein pla2,300,RC,41000591,LOCAL,,inpatient,,,680.4,680.4,,,,,,,,,,,,,,,,,
Lipopro bld electrophoretic,300,RC,41000592,LOCAL,,inpatient,,,163.8,163.8,,,,,,,,,,,,,,,,,
Lipoprotein bld hr fraction,300,RC,41000593,LOCAL,,inpatient,,,499.8,499.8,,,,,,,,,,,,,,,,,
Lipoprotein bld quan part,300,RC,41000594,LOCAL,,inpatient,,,504,504,,,,,,,,,,,,,,,,,
Assay of lipoprotein,300,RC,41000595,LOCAL,,inpatient,,,108.99,108.99,,,,,,,,,,,,,,,,,
Assay of blood lipoprotein,300,RC,41000596,LOCAL,,inpatient,,,189,189,,,,,,,,,,,,,,,,,
LDH,300,RC,41000597,LOCAL,,inpatient,,,105,105,,,,,,,,,,,,,,,,,
Lipoprtn dir meas sd ldl chl,300,RC,41000598,LOCAL,,inpatient,,,504,504,,,,,,,,,,,,,,,,,
Assay of lrh hormone,300,RC,41000599,LOCAL,,inpatient,,,252,252,,,,,,,,,,,,,,,,,
MAGNESIUM,300,RC,41000600,LOCAL,,inpatient,,,89.18,89.18,,,,,,,,,,,,,,,,,
Assay malate dehydrogenase,300,RC,41000601,LOCAL,,inpatient,,,109.2,109.2,,,,,,,,,,,,,,,,,
Assay of manganese,300,RC,41000602,LOCAL,,inpatient,,,390.6,390.6,,,,,,,,,,,,,,,,,
Mass spectrometry qual/quan,300,RC,41000603,LOCAL,,inpatient,,,240.38,240.38,,,,,,,,,,,,,,,,,
Assay of mercury,300,RC,41000604,LOCAL,,inpatient,,,216.44,216.44,,,,,,,,,,,,,,,,,
Assay of metanephrines,300,RC,41000605,LOCAL,,inpatient,,,225.54,225.54,,,,,,,,,,,,,,,,,
Assay of methemalbumin,300,RC,41000606,LOCAL,,inpatient,,,159.6,159.6,,,,,,,,,,,,,,,,,
Microfluid analy tears,300,RC,41000607,LOCAL,,inpatient,,,331.8,331.8,,,,,,,,,,,,,,,,,
Mucopolysaccharides,300,RC,41000608,LOCAL,,inpatient,,,420,420,,,,,,,,,,,,,,,,,
Assay synovial fluid mucin,300,RC,41000609,LOCAL,,inpatient,,,88.2,88.2,,,,,,,,,,,,,,,,,
Assay of csf protein,300,RC,41000610,LOCAL,,inpatient,,,229.04,229.04,,,,,,,,,,,,,,,,,
"MYOGLOBIN, SERUM",300,RC,41000611,LOCAL,,inpatient,,,171.92,171.92,,,,,,,,,,,,,,,,,
Assay myeloperoxidase,300,RC,41000612,LOCAL,,inpatient,,,747.6,747.6,,,,,,,,,,,,,,,,,
BNP B Type Natriuetic Peptide,300,RC,41000613,LOCAL,,inpatient,,,451.85,451.85,,,,,,,,,,,,,,,,,
Assay nephelometry not spec,300,RC,41000614,LOCAL,,inpatient,,,180.95,180.95,,,,,,,,,,,,,,,,,
Assay of nickel,300,RC,41000615,LOCAL,,inpatient,,,361.2,361.2,,,,,,,,,,,,,,,,,
Assay of nucleotidase,300,RC,41000616,LOCAL,,inpatient,,,163.8,163.8,,,,,,,,,,,,,,,,,
Oligoclonal bands,300,RC,41000617,LOCAL,,inpatient,,,267.68,267.68,,,,,,,,,,,,,,,,,
Organic acids total quant,300,RC,41000618,LOCAL,,inpatient,,,219.1,219.1,,,,,,,,,,,,,,,,,
Organic acids qual each,300,RC,41000619,LOCAL,,inpatient,,,243.6,243.6,,,,,,,,,,,,,,,,,
"OSMOLALITY,SERUM",300,RC,41000621,LOCAL,,inpatient,,,87.99,87.99,,,,,,,,,,,,,,,,,
"OSMOLALITY,URINE",300,RC,41000622,LOCAL,,inpatient,,,90.72,90.72,,,,,,,,,,,,,,,,,
Assay of osteocalcin,300,RC,41000623,LOCAL,,inpatient,,,436.8,436.8,,,,,,,,,,,,,,,,,
Assay of oxalate,300,RC,41000624,LOCAL,,inpatient,,,171.36,171.36,,,,,,,,,,,,,,,,,
Oncoprotein her-2/neu,300,RC,41000625,LOCAL,,inpatient,,,945,945,,,,,,,,,,,,,,,,,
Oncoprotein dcp,300,RC,41000626,LOCAL,,inpatient,,,945,945,,,,,,,,,,,,,,,,,
"PARATHYROID HORMONE (PTH), INT",300,RC,41000627,LOCAL,,inpatient,,,549.43,549.43,,,,,,,,,,,,,,,,,
Exhaled breath condensate,300,RC,41000629,LOCAL,,inpatient,,,54.6,54.6,,,,,,,,,,,,,,,,,
Assay for calprotectin fecal,300,RC,41000630,LOCAL,,inpatient,,,289.8,289.8,,,,,,,,,,,,,,,,,
Assay of blood pku,300,RC,41000631,LOCAL,,inpatient,,,79.8,79.8,,,,,,,,,,,,,,,,,
Assay of phenylketones,300,RC,41000632,LOCAL,,inpatient,,,58.8,58.8,,,,,,,,,,,,,,,,,
Assay acid phosphatase,300,RC,41000633,LOCAL,,inpatient,,,98.28,98.28,,,,,,,,,,,,,,,,,
Assay prostate phosphatase,300,RC,41000634,LOCAL,,inpatient,,,142.8,142.8,,,,,,,,,,,,,,,,,
Assay alkaline phosphatase,300,RC,41000636,LOCAL,,inpatient,,,121.8,121.8,,,,,,,,,,,,,,,,,
Assay alkaline phosphatases,300,RC,41000637,LOCAL,,inpatient,,,196.91,196.91,,,,,,,,,,,,,,,,,
Assay phosphatidylglycerol,300,RC,41000638,LOCAL,,inpatient,,,243.6,243.6,,,,,,,,,,,,,,,,,
Assay of rbc pg6d enzyme,300,RC,41000639,LOCAL,,inpatient,,,138.6,138.6,,,,,,,,,,,,,,,,,
Assay phosphohexose enzymes,300,RC,41000640,LOCAL,,inpatient,,,159.6,159.6,,,,,,,,,,,,,,,,,
PHOSPHORUS,300,RC,41000641,LOCAL,,inpatient,,,63.14,63.14,,,,,,,,,,,,,,,,,
Assay of urine phosphorus,300,RC,41000642,LOCAL,,inpatient,,,68.88,68.88,,,,,,,,,,,,,,,,,
Test for porphobilinogen,300,RC,41000643,LOCAL,,inpatient,,,84,84,,,,,,,,,,,,,,,,,
Assay of porphobilinogen,300,RC,41000644,LOCAL,,inpatient,,,112.42,112.42,,,,,,,,,,,,,,,,,
Eval amniotic fluid protein,300,RC,41000645,LOCAL,,inpatient,,,1440.6,1440.6,,,,,,,,,,,,,,,,,
Test urine for porphyrins,300,RC,41000646,LOCAL,,inpatient,,,197.4,197.4,,,,,,,,,,,,,,,,,
Assay of urine porphyrins,300,RC,41000647,LOCAL,,inpatient,,,195.79,195.79,,,,,,,,,,,,,,,,,
Assay of feces porphyrins,300,RC,41000648,LOCAL,,inpatient,,,575.4,575.4,,,,,,,,,,,,,,,,,
POTASSIUM LEVEL,300,RC,41000649,LOCAL,,inpatient,,,61.18,61.18,,,,,,,,,,,,,,,,,
"POTASSIUM, UR RANDOM",300,RC,41000650,LOCAL,,inpatient,,,57.26,57.26,,,,,,,,,,,,,,,,,
PREALBUMIN,300,RC,41000651,LOCAL,,inpatient,,,194.11,194.11,,,,,,,,,,,,,,,,,
Assay of pregnanediol,300,RC,41000652,LOCAL,,inpatient,,,310.8,310.8,,,,,,,,,,,,,,,,,
Assay of pregnanetriol,300,RC,41000653,LOCAL,,inpatient,,,310.8,310.8,,,,,,,,,,,,,,,,,
Assay of pregnenolone,300,RC,41000654,LOCAL,,inpatient,,,302.4,302.4,,,,,,,,,,,,,,,,,
Assay of 17-hydroxypregneno,300,RC,41000655,LOCAL,,inpatient,,,336,336,,,,,,,,,,,,,,,,,
Assay of progesterone,300,RC,41000656,LOCAL,,inpatient,,,277.69,277.69,,,,,,,,,,,,,,,,,
PROCALCITONIN  (PCT),300,RC,41000657,LOCAL,,inpatient,,,285.208,285.208,,,,,,,,,,,,,,,,,
Assay of prostaglandin,300,RC,41000659,LOCAL,,inpatient,,,265.776,265.776,,,,,,,,,,,,,,,,,
Assay of psa free,300,RC,41000662,LOCAL,,inpatient,,,195.888,195.888,,,,,,,,,,,,,,,,,
TOTAL PROTEIN,300,RC,41000663,LOCAL,,inpatient,,,48.79,48.79,,,,,,,,,,,,,,,,,
Assay of protein any source,300,RC,41000666,LOCAL,,inpatient,,,84,84,,,,,,,,,,,,,,,,,
Pappa serum,300,RC,41000667,LOCAL,,inpatient,,,222.6,222.6,,,,,,,,,,,,,,,,,
"PROTEIN ELECTROPHORESIS, SERUM",300,RC,41000668,LOCAL,,inpatient,,,143.01,143.01,,,,,,,,,,,,,,,,,
Protein e-phoresis/urine/csf,300,RC,41000669,LOCAL,,inpatient,,,237.37,237.37,,,,,,,,,,,,,,,,,
Protein western blot test,300,RC,41000671,LOCAL,,inpatient,,,239.61,239.61,,,,,,,,,,,,,,,,,
Assay rbc protoporphyrin,300,RC,41000672,LOCAL,,inpatient,,,210,210,,,,,,,,,,,,,,,,,
Test rbc protoporphyrin,300,RC,41000673,LOCAL,,inpatient,,,142.8,142.8,,,,,,,,,,,,,,,,,
Assay of proinsulin,300,RC,41000674,LOCAL,,inpatient,,,390.6,390.6,,,,,,,,,,,,,,,,,
Assay of pyruvate,300,RC,41000676,LOCAL,,inpatient,,,214.2,214.2,,,,,,,,,,,,,,,,,
Assay of pyruvate kinase,300,RC,41000677,LOCAL,,inpatient,,,138.6,138.6,,,,,,,,,,,,,,,,,
Assay of quinine,300,RC,41000678,LOCAL,,inpatient,,,172.2,172.2,,,,,,,,,,,,,,,,,
Assay of estrogen,300,RC,41000679,LOCAL,,inpatient,,,1293.6,1293.6,,,,,,,,,,,,,,,,,
Assay of progesterone,300,RC,41000680,LOCAL,,inpatient,,,953.4,953.4,,,,,,,,,,,,,,,,,
Assay of endocrine hormone,300,RC,41000681,LOCAL,,inpatient,,,1045.8,1045.8,,,,,,,,,,,,,,,,,
Assay nonendocrine receptor,300,RC,41000682,LOCAL,,inpatient,,,486.78,486.78,,,,,,,,,,,,,,,,,
RENIN ACTIVITY,300,RC,41000683,LOCAL,,inpatient,,,292.81,292.81,,,,,,,,,,,,,,,,,
Assay of vitamin b-2,300,RC,41000684,LOCAL,,inpatient,,,269.36,269.36,,,,,,,,,,,,,,,,,
Assay of selenium,300,RC,41000685,LOCAL,,inpatient,,,373.8,373.8,,,,,,,,,,,,,,,,,
Assay of serotonin,300,RC,41000686,LOCAL,,inpatient,,,412.37,412.37,,,,,,,,,,,,,,,,,
Assay of sex hormone globul,300,RC,41000687,LOCAL,,inpatient,,,208.67,208.67,,,,,,,,,,,,,,,,,
Assay of sialic acid,300,RC,41000688,LOCAL,,inpatient,,,197.4,197.4,,,,,,,,,,,,,,,,,
Assay of silica,300,RC,41000689,LOCAL,,inpatient,,,369.6,369.6,,,,,,,,,,,,,,,,,
SODIUM,300,RC,41000690,LOCAL,,inpatient,,,64.05,64.05,,,,,,,,,,,,,,,,,
Assay of sweat sodium,300,RC,41000692,LOCAL,,inpatient,,,71.4,71.4,,,,,,,,,,,,,,,,,
Assay of somatomedin,300,RC,41000693,LOCAL,,inpatient,,,283.01,283.01,,,,,,,,,,,,,,,,,
Assay of somatostatin,300,RC,41000694,LOCAL,,inpatient,,,268.8,268.8,,,,,,,,,,,,,,,,,
Spectrophotometry,300,RC,41000695,LOCAL,,inpatient,,,93.03,93.03,,,,,,,,,,,,,,,,,
Body fluid specific gravity,300,RC,41000696,LOCAL,,inpatient,,,33.39,33.39,,,,,,,,,,,,,,,,,
Chromatogram assay sugars,300,RC,41000697,LOCAL,,inpatient,,,575.4,575.4,,,,,,,,,,,,,,,,,
Sugars single qual,300,RC,41000698,LOCAL,,inpatient,,,58.576,58.576,,,,,,,,,,,,,,,,,
Sugars multiple qual,300,RC,41000699,LOCAL,,inpatient,,,79.8,79.8,,,,,,,,,,,,,,,,,
Sugars single quant,300,RC,41000700,LOCAL,,inpatient,,,168,168,,,,,,,,,,,,,,,,,
Sugars multiple quant,300,RC,41000701,LOCAL,,inpatient,,,168,168,,,,,,,,,,,,,,,,,
Assay of urine sulfate,300,RC,41000702,LOCAL,,inpatient,,,63.21,63.21,,,,,,,,,,,,,,,,,
Assay of free testosterone,300,RC,41000703,LOCAL,,inpatient,,,339.01,339.01,,,,,,,,,,,,,,,,,
Assay of total testosterone,300,RC,41000704,LOCAL,,inpatient,,,343.7,343.7,,,,,,,,,,,,,,,,,
Testosterone bioavailable,300,RC,41000705,LOCAL,,inpatient,,,751.8,751.8,,,,,,,,,,,,,,,,,
VITAMIM B1 (THIAMINE),300,RC,41000706,LOCAL,,inpatient,,,282.66,282.66,,,,,,,,,,,,,,,,,
Assay of thiocyanate,300,RC,41000707,LOCAL,,inpatient,,,172.2,172.2,,,,,,,,,,,,,,,,,
Thromboxane urine,300,RC,41000708,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Assay of thyroglobulin,300,RC,41000709,LOCAL,,inpatient,,,235.2,235.2,,,,,,,,,,,,,,,,,
"T4,THYROXINE",300,RC,41000710,LOCAL,,inpatient,,,91.49,91.49,,,,,,,,,,,,,,,,,
Assay of neonatal thyroxine,300,RC,41000711,LOCAL,,inpatient,,,96.6,96.6,,,,,,,,,,,,,,,,,
FREE THYROXINE (T4),300,RC,41000712,LOCAL,,inpatient,,,120.05,120.05,,,,,,,,,,,,,,,,,
Assay of thyroid activity,300,RC,41000713,LOCAL,,inpatient,,,218.4,218.4,,,,,,,,,,,,,,,,,
THYROID STIM. HORMONE (TSH),300,RC,41000714,LOCAL,,inpatient,,,223.65,223.65,,,,,,,,,,,,,,,,,
Assay of tsi globulin,300,RC,41000715,LOCAL,,inpatient,,,676.9,676.9,,,,,,,,,,,,,,,,,
Assay of vitamin e,300,RC,41000716,LOCAL,,inpatient,,,188.72,188.72,,,,,,,,,,,,,,,,,
Assay of transcortin,300,RC,41000717,LOCAL,,inpatient,,,264.6,264.6,,,,,,,,,,,,,,,,,
AST (SGOT),300,RC,41000718,LOCAL,,inpatient,,,68.88,68.88,,,,,,,,,,,,,,,,,
TRANSFERRIN,300,RC,41000720,LOCAL,,inpatient,,,169.96,169.96,,,,,,,,,,,,,,,,,
TRIGLYCERIDE,300,RC,41000721,LOCAL,,inpatient,,,76.58,76.58,,,,,,,,,,,,,,,,,
Assay of thyroid (t3 or t4),300,RC,41000722,LOCAL,,inpatient,,,86.17,86.17,,,,,,,,,,,,,,,,,
TRIIODOTHYRONINE (T3 TOTAL),300,RC,41000723,LOCAL,,inpatient,,,188.72,188.72,,,,,,,,,,,,,,,,,
"T3, FREE",300,RC,41000724,LOCAL,,inpatient,,,225.54,225.54,,,,,,,,,,,,,,,,,
TROPONIN I,300,RC,41000726,LOCAL,,inpatient,,,131.04,131.04,,,,,,,,,,,,,,,,,
Assay duodenal fluid trypsin,300,RC,41000727,LOCAL,,inpatient,,,105,105,,,,,,,,,,,,,,,,,
Test feces for trypsin,300,RC,41000728,LOCAL,,inpatient,,,109.2,109.2,,,,,,,,,,,,,,,,,
Assay of feces for trypsin,300,RC,41000729,LOCAL,,inpatient,,,147,147,,,,,,,,,,,,,,,,,
Assay of tyrosine,300,RC,41000730,LOCAL,,inpatient,,,138.46,138.46,,,,,,,,,,,,,,,,,
Assay of troponin qual,300,RC,41000731,LOCAL,,inpatient,,,147,147,,,,,,,,,,,,,,,,,
BUN - BLOOD UREA NITROGEN,300,RC,41000733,LOCAL,,inpatient,,,75.6,75.6,,,,,,,,,,,,,,,,,
Assay of urine/urea-n,300,RC,41000734,LOCAL,,inpatient,,,63.21,63.21,,,,,,,,,,,,,,,,,
Urea-n clearance test,300,RC,41000735,LOCAL,,inpatient,,,87.92,87.92,,,,,,,,,,,,,,,,,
URIC ACID,300,RC,41000737,LOCAL,,inpatient,,,63.21,63.21,,,,,,,,,,,,,,,,,
Assay of feces/urobilinogen,300,RC,41000738,LOCAL,,inpatient,,,247.8,247.8,,,,,,,,,,,,,,,,,
Test urine urobilinogen,300,RC,41000739,LOCAL,,inpatient,,,67.2,67.2,,,,,,,,,,,,,,,,,
Assay of urine urobilinogen,300,RC,41000740,LOCAL,,inpatient,,,138.6,138.6,,,,,,,,,,,,,,,,,
Assay of urine urobilinogen,300,RC,41000741,LOCAL,,inpatient,,,88.2,88.2,,,,,,,,,,,,,,,,,
Assay of urine vma,300,RC,41000742,LOCAL,,inpatient,,,207.76,207.76,,,,,,,,,,,,,,,,,
Assay of vip,300,RC,41000743,LOCAL,,inpatient,,,376.264,376.264,,,,,,,,,,,,,,,,,
Assay of vasopressin,300,RC,41000744,LOCAL,,inpatient,,,451.85,451.85,,,,,,,,,,,,,,,,,
Assay of vitamin a,300,RC,41000745,LOCAL,,inpatient,,,154.42,154.42,,,,,,,,,,,,,,,,,
Assay of nos vitamin,300,RC,41000746,LOCAL,,inpatient,,,252,252,,,,,,,,,,,,,,,,,
Assay of vitamin k,300,RC,41000747,LOCAL,,inpatient,,,201.6,201.6,,,,,,,,,,,,,,,,,
Assay of volatiles,300,RC,41000748,LOCAL,,inpatient,,,171.192,171.192,,,,,,,,,,,,,,,,,
Xylose tolerance test,300,RC,41000749,LOCAL,,inpatient,,,189,189,,,,,,,,,,,,,,,,,
"ZINC, SERUM",300,RC,41000750,LOCAL,,inpatient,,,151.55,151.55,,,,,,,,,,,,,,,,,
Chorionic gonadotropin test,300,RC,41000752,LOCAL,,inpatient,,,200.41,200.41,,,,,,,,,,,,,,,,,
"HCG , URINE QUAL",300,RC,41000753,LOCAL,,inpatient,,,100.03,100.03,,,,,,,,,,,,,,,,,
Hcg free betachain test,300,RC,41000754,LOCAL,,inpatient,,,226.8,226.8,,,,,,,,,,,,,,,,,
Ovulation tests,300,RC,41000755,LOCAL,,inpatient,,,184.8,184.8,,,,,,,,,,,,,,,,,
Bleeding time test,305,RC,41000756,LOCAL,,inpatient,,,59.92,59.92,,,,,,,,,,,,,,,,,
Automated diff wbc count,300,RC,41000757,LOCAL,,inpatient,,,96.6,96.6,,,,,,,,,,,,,,,,,
MANUAL DIFFERENTIAL,305,RC,41000758,LOCAL,,inpatient,,,45.78,45.78,,,,,,,,,,,,,,,,,
Bl smear w/o diff wbc count,300,RC,41000759,LOCAL,,inpatient,,,45.78,45.78,,,,,,,,,,,,,,,,,
Manual diff wbc count b-coat,300,RC,41000760,LOCAL,,inpatient,,,75.6,75.6,,,,,,,,,,,,,,,,,
Spun microhematocrit,300,RC,41000761,LOCAL,,inpatient,,,105,105,,,,,,,,,,,,,,,,,
HEMATOCRIT (HCT),307,RC,41000762,LOCAL,,inpatient,,,99.554,99.554,,,,,,,,,,,,,,,,,
HEMAGLOBIN (HGB),305,RC,41000763,LOCAL,,inpatient,,,31.5,31.5,,,,,,,,,,,,,,,,,
CBC W/ AUTODIFF,305,RC,41000764,LOCAL,,inpatient,,,103.53,103.53,,,,,,,,,,,,,,,,,
CBC AUTOMATED (HEMOGRAM),305,RC,41000765,LOCAL,,inpatient,,,86.17,86.17,,,,,,,,,,,,,,,,,
Automated rbc count,305,RC,41000767,LOCAL,,inpatient,,,40.11,40.11,,,,,,,,,,,,,,,,,
Manual reticulocyte count,305,RC,41000768,LOCAL,,inpatient,,,57.26,57.26,,,,,,,,,,,,,,,,,
RETIC COUNT,305,RC,41000769,LOCAL,,inpatient,,,53.27,53.27,,,,,,,,,,,,,,,,,
Reticyte/hgb concentrate,300,RC,41000770,LOCAL,,inpatient,,,74.27,74.27,,,,,,,,,,,,,,,,,
"WBC COUNT,AUTO",305,RC,41000771,LOCAL,,inpatient,,,33.81,33.81,,,,,,,,,,,,,,,,,
PLATELET COUNT (PLT),305,RC,41000772,LOCAL,,inpatient,,,59.5,59.5,,,,,,,,,,,,,,,,,
Reticulated platelet assay,300,RC,41000773,LOCAL,,inpatient,,,525,525,,,,,,,,,,,,,,,,,
Chromogenic substrate assay,300,RC,41000774,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
Blood clot lysis time,300,RC,41000776,LOCAL,,inpatient,,,298.2,298.2,,,,,,,,,,,,,,,,,
Clot factor ii prothrom spec,300,RC,41000777,LOCAL,,inpatient,,,138.264,138.264,,,,,,,,,,,,,,,,,
Blooc clot factor v test,300,RC,41000778,LOCAL,,inpatient,,,234.92,234.92,,,,,,,,,,,,,,,,,
Clot factor vii proconvertin,300,RC,41000779,LOCAL,,inpatient,,,264.6,264.6,,,,,,,,,,,,,,,,,
Clot factor viii reltd antgn,300,RC,41000781,LOCAL,,inpatient,,,298.2,298.2,,,,,,,,,,,,,,,,,
Clot factor viii vw ristoctn,300,RC,41000782,LOCAL,,inpatient,,,305.48,305.48,,,,,,,,,,,,,,,,,
Clot factor viii vw antigen,300,RC,41000783,LOCAL,,inpatient,,,305.48,305.48,,,,,,,,,,,,,,,,,
Clot factor viii multimetric,300,RC,41000784,LOCAL,,inpatient,,,336,336,,,,,,,,,,,,,,,,,
Clot factor ix ptc/chrstmas,300,RC,41000785,LOCAL,,inpatient,,,109.074,109.074,,,,,,,,,,,,,,,,,
Clot factor x stuart-power,300,RC,41000786,LOCAL,,inpatient,,,238.35,238.35,,,,,,,,,,,,,,,,,
Clot factor xi pta,300,RC,41000787,LOCAL,,inpatient,,,264.6,264.6,,,,,,,,,,,,,,,,,
Clot factor xii hageman,300,RC,41000788,LOCAL,,inpatient,,,257.53,257.53,,,,,,,,,,,,,,,,,
Clot factor xiii fibrin stab,300,RC,41000789,LOCAL,,inpatient,,,239.4,239.4,,,,,,,,,,,,,,,,,
Clot factor xiii fibrin scrn,300,RC,41000790,LOCAL,,inpatient,,,134.4,134.4,,,,,,,,,,,,,,,,,
Clot factor fletcher fact,300,RC,41000791,LOCAL,,inpatient,,,277.2,277.2,,,,,,,,,,,,,,,,,
Clot factor wght kininogen,300,RC,41000792,LOCAL,,inpatient,,,277.2,277.2,,,,,,,,,,,,,,,,,
Antithrombin iii activity,300,RC,41000793,LOCAL,,inpatient,,,157.78,157.78,,,,,,,,,,,,,,,,,
Antithrombin iii antigen,300,RC,41000794,LOCAL,,inpatient,,,115.136,115.136,,,,,,,,,,,,,,,,,
Clot inhibit prot c antigen,300,RC,41000795,LOCAL,,inpatient,,,160.02,160.02,,,,,,,,,,,,,,,,,
Clot inhibit prot c activity,300,RC,41000796,LOCAL,,inpatient,,,184.1,184.1,,,,,,,,,,,,,,,,,
Clot inhibit prot s total,300,RC,41000797,LOCAL,,inpatient,,,154.42,154.42,,,,,,,,,,,,,,,,,
Clot inhibit prot s free,300,RC,41000798,LOCAL,,inpatient,,,203.98,203.98,,,,,,,,,,,,,,,,,
Assay activated protein c,300,RC,41000799,LOCAL,,inpatient,,,163.184,163.184,,,,,,,,,,,,,,,,,
Factor inhibitor test,300,RC,41000800,LOCAL,,inpatient,,,171.36,171.36,,,,,,,,,,,,,,,,,
Thrombomodulin,300,RC,41000801,LOCAL,,inpatient,,,252,252,,,,,,,,,,,,,,,,,
Coagulation time lee & white,300,RC,41000802,LOCAL,,inpatient,,,67.2,67.2,,,,,,,,,,,,,,,,,
Coagulation time activated,300,RC,41000803,LOCAL,,inpatient,,,56.7,56.7,,,,,,,,,,,,,,,,,
Coagulation time otr method,300,RC,41000804,LOCAL,,inpatient,,,49.56,49.56,,,,,,,,,,,,,,,,,
Euglobulin lysis,300,RC,41000805,LOCAL,,inpatient,,,121.8,121.8,,,,,,,,,,,,,,,,,
Fibrin degradation products,305,RC,41000806,LOCAL,,inpatient,,,91.7,91.7,,,,,,,,,,,,,,,,,
Fibrinogen test,300,RC,41000807,LOCAL,,inpatient,,,1184.4,1184.4,,,,,,,,,,,,,,,,,
D-DIMER,300,RC,41000810,LOCAL,,inpatient,,,244.384,244.384,,,,,,,,,,,,,,,,,
Fibrin degradj d-dimer,300,RC,41000811,LOCAL,,inpatient,,,151.2,151.2,,,,,,,,,,,,,,,,,
FIBRINOGEN,301,RC,41000812,LOCAL,,inpatient,,,113.05,113.05,,,,,,,,,,,,,,,,,
Fibrinogen antigen,300,RC,41000813,LOCAL,,inpatient,,,214.2,214.2,,,,,,,,,,,,,,,,,
Fibrinolysins screen i&r,300,RC,41000814,LOCAL,,inpatient,,,226.8,226.8,,,,,,,,,,,,,,,,,
Clotting funct activity,301,RC,41000815,LOCAL,,inpatient,,,244.384,244.384,,,,,,,,,,,,,,,,,
Fibrinolytic plasmin,300,RC,41000816,LOCAL,,inpatient,,,113.4,113.4,,,,,,,,,,,,,,,,,
Fibrinolytic antiplasmin,300,RC,41000817,LOCAL,,inpatient,,,113.4,113.4,,,,,,,,,,,,,,,,,
Fibrinolytic plasminogen,300,RC,41000818,LOCAL,,inpatient,,,252,252,,,,,,,,,,,,,,,,,
Fibrinolytic plasminogen,300,RC,41000819,LOCAL,,inpatient,,,69.608,69.608,,,,,,,,,,,,,,,,,
Fibrinolytic plasminogen,300,RC,41000820,LOCAL,,inpatient,,,151.2,151.2,,,,,,,,,,,,,,,,,
Heinz bodies direct,300,RC,41000821,LOCAL,,inpatient,,,63,63,,,,,,,,,,,,,,,,,
Heinz bodies induced,300,RC,41000822,LOCAL,,inpatient,,,100.8,100.8,,,,,,,,,,,,,,,,,
Hemoglobin fetal,300,RC,41000823,LOCAL,,inpatient,,,113.4,113.4,,,,,,,,,,,,,,,,,
Hemoglobin fetal,300,RC,41000824,LOCAL,,inpatient,,,138.6,138.6,,,,,,,,,,,,,,,,,
Hemolysin acid,300,RC,41000825,LOCAL,,inpatient,,,130.2,130.2,,,,,,,,,,,,,,,,,
Heparin assay Anti-XA,300,RC,41000826,LOCAL,,inpatient,,,398.216,398.216,,,,,,,,,,,,,,,,,
Heparin neutralization,300,RC,41000827,LOCAL,,inpatient,,,172.2,172.2,,,,,,,,,,,,,,,,,
Heparin-protamine tolerance,300,RC,41000828,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
Iron stain peripheral blood,300,RC,41000829,LOCAL,,inpatient,,,100.8,100.8,,,,,,,,,,,,,,,,,
Wbc alkaline phosphatase,300,RC,41000830,LOCAL,,inpatient,,,114.52,114.52,,,,,,,,,,,,,,,,,
Rbc mechanical fragility,300,RC,41000831,LOCAL,,inpatient,,,126,126,,,,,,,,,,,,,,,,,
Muramidase,300,RC,41000832,LOCAL,,inpatient,,,277.2,277.2,,,,,,,,,,,,,,,,,
Rbc osmotic fragility,300,RC,41000833,LOCAL,,inpatient,,,109.2,109.2,,,,,,,,,,,,,,,,,
Rbc osmotic fragility,300,RC,41000834,LOCAL,,inpatient,,,197.4,197.4,,,,,,,,,,,,,,,,,
Blood platelet aggregation,300,RC,41000835,LOCAL,,inpatient,,,285.95,285.95,,,,,,,,,,,,,,,,,
Phospholipid pltlt neutraliz,300,RC,41000836,LOCAL,,inpatient,,,239.33,239.33,,,,,,,,,,,,,,,,,
Hexagnal phosph pltlt neutrl,300,RC,41000837,LOCAL,,inpatient,,,191.464,191.464,,,,,,,,,,,,,,,,,
PT/INR,305,RC,41000838,LOCAL,,inpatient,,,52.29,52.29,,,,,,,,,,,,,,,,,
Prothrombin test,300,RC,41000839,LOCAL,,inpatient,,,52.43,52.43,,,,,,,,,,,,,,,,,
Viper venom prothrombin time,300,RC,41000840,LOCAL,,inpatient,,,86.24,86.24,,,,,,,,,,,,,,,,,
Russell viper venom diluted,305,RC,41000841,LOCAL,,inpatient,,,127.4,127.4,,,,,,,,,,,,,,,,,
Reptilase test,300,RC,41000842,LOCAL,,inpatient,,,131.11,131.11,,,,,,,,,,,,,,,,,
SED RATE  (ESR),300,RC,41000844,LOCAL,,inpatient,,,35.98,35.98,,,,,,,,,,,,,,,,,
Rbc sickle cell test,301,RC,41000845,LOCAL,,inpatient,,,73.43,73.43,,,,,,,,,,,,,,,,,
Thrombin time plasma,305,RC,41000846,LOCAL,,inpatient,,,76.86,76.86,,,,,,,,,,,,,,,,,
Thrombin time titer,300,RC,41000847,LOCAL,,inpatient,,,100.8,100.8,,,,,,,,,,,,,,,,,
Thromboplastin inhibition,300,RC,41000848,LOCAL,,inpatient,,,128.17,128.17,,,,,,,,,,,,,,,,,
THROMBOPLASTIN TIME PART-APTT,305,RC,41000849,LOCAL,,inpatient,,,79.94,79.94,,,,,,,,,,,,,,,,,
Thromboplastin time partial,305,RC,41000850,LOCAL,,inpatient,,,86.17,86.17,,,,,,,,,,,,,,,,,
Blood viscosity examination,300,RC,41000851,LOCAL,,inpatient,,,172.2,172.2,,,,,,,,,,,,,,,,,
Agglutinins febrile antigen,300,RC,41000852,LOCAL,,inpatient,,,100.8,100.8,,,,,,,,,,,,,,,,,
Allergen specific igg,300,RC,41000853,LOCAL,,inpatient,,,69.3,69.3,,,,,,,,,,,,,,,,,
Allg spec ige crude xtrc ea,300,RC,41000854,LOCAL,,inpatient,,,69.44,69.44,,,,,,,,,,,,,,,,,
Allg spec ige multiallg scr,300,RC,41000855,LOCAL,,inpatient,,,117.6,117.6,,,,,,,,,,,,,,,,,
Allg spec ige recomb ea,300,RC,41000856,LOCAL,,inpatient,,,264.6,264.6,,,,,,,,,,,,,,,,,
HEPARIN-INDUCED PLT AB (HIT),300,RC,41000858,LOCAL,,inpatient,,,264.95,264.95,,,,,,,,,,,,,,,,,
Immunoglobulin assay,300,RC,41000859,LOCAL,,inpatient,,,184.8,184.8,,,,,,,,,,,,,,,,,
ANTI-NUCLEAR ANTIBODY (ANA),305,RC,41000860,LOCAL,,inpatient,,,160.93,160.93,,,,,,,,,,,,,,,,,
Antinuclear antibodies (ana),300,RC,41000861,LOCAL,,inpatient,,,148.61,148.61,,,,,,,,,,,,,,,,,
ANTI-STREPTOLYSIN O,300,RC,41000862,LOCAL,,inpatient,,,97.16,97.16,,,,,,,,,,,,,,,,,
Antistreptolysin o screen,300,RC,41000863,LOCAL,,inpatient,,,84,84,,,,,,,,,,,,,,,,,
C-REACTIVE PROTEIN,305,RC,41000864,LOCAL,,inpatient,,,68.88,68.88,,,,,,,,,,,,,,,,,
C-reactive protein hs,300,RC,41000865,LOCAL,,inpatient,,,172.34,172.34,,,,,,,,,,,,,,,,,
Beta-2 glycoprotein antibody,300,RC,41000866,LOCAL,,inpatient,,,338.66,338.66,,,,,,,,,,,,,,,,,
Anti-phospholipid antibody,300,RC,41000868,LOCAL,,inpatient,,,213.85,213.85,,,,,,,,,,,,,,,,,
Cell enumeration & id,300,RC,41000869,LOCAL,,inpatient,,,3687.6,3687.6,,,,,,,,,,,,,,,,,
Chemotaxis assay,300,RC,41000870,LOCAL,,inpatient,,,235.2,235.2,,,,,,,,,,,,,,,,,
Cold agglutinin titer,300,RC,41000872,LOCAL,,inpatient,,,85.904,85.904,,,,,,,,,,,,,,,,,
Complement antigen,300,RC,41000873,LOCAL,,inpatient,,,159.81,159.81,,,,,,,,,,,,,,,,,
Complement/function activity,300,RC,41000874,LOCAL,,inpatient,,,159.81,159.81,,,,,,,,,,,,,,,,,
Complement fixation each,300,RC,41000876,LOCAL,,inpatient,,,147,147,,,,,,,,,,,,,,,,,
CYCLIC CITRULLINATED PEP(CCP),302,RC,41000877,LOCAL,,inpatient,,,172.34,172.34,,,,,,,,,,,,,,,,,
Deoxyribonuclease antibody,302,RC,41000878,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
ANTI-DNA ANTIBODY,302,RC,41000879,LOCAL,,inpatient,,,182.84,182.84,,,,,,,,,,,,,,,,,
Dna antibody single strand,302,RC,41000880,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
Nuclear antigen antibody,302,RC,41000881,LOCAL,,inpatient,,,238.7,238.7,,,,,,,,,,,,,,,,,
Fluorescent antibody screen,302,RC,41000882,LOCAL,,inpatient,,,160.44,160.44,,,,,,,,,,,,,,,,,
Growth hormone antibody,302,RC,41000884,LOCAL,,inpatient,,,231,231,,,,,,,,,,,,,,,,,
Hemagglutination inhibition,302,RC,41000885,LOCAL,,inpatient,,,121.8,121.8,,,,,,,,,,,,,,,,,
Immunoassay tumor qual,302,RC,41000886,LOCAL,,inpatient,,,373.8,373.8,,,,,,,,,,,,,,,,,
Immunoassay tumor ca 15-3,302,RC,41000887,LOCAL,,inpatient,,,277.06,277.06,,,,,,,,,,,,,,,,,
Immunoassay tumor ca 19-9,305,RC,41000888,LOCAL,,inpatient,,,277.06,277.06,,,,,,,,,,,,,,,,,
Immunoassay tumor ca 125,302,RC,41000889,LOCAL,,inpatient,,,277.06,277.06,,,,,,,,,,,,,,,,,
Human epididymis protein 4,302,RC,41000890,LOCAL,,inpatient,,,306.6,306.6,,,,,,,,,,,,,,,,,
Heterophile antibody screen,302,RC,41000891,LOCAL,,inpatient,,,68.88,68.88,,,,,,,,,,,,,,,,,
Heterophile antibody titer,302,RC,41000892,LOCAL,,inpatient,,,96.6,96.6,,,,,,,,,,,,,,,,,
Heterophile antibody absrbj,302,RC,41000893,LOCAL,,inpatient,,,109.2,109.2,,,,,,,,,,,,,,,,,
Immunoassay tumor other,305,RC,41000894,LOCAL,,inpatient,,,277.06,277.06,,,,,,,,,,,,,,,,,
Immunoassay infectious agent,302,RC,41000895,LOCAL,,inpatient,,,159.656,159.656,,,,,,,,,,,,,,,,,
Immunoassay infectious agent,302,RC,41000896,LOCAL,,inpatient,,,101.304,101.304,,,,,,,,,,,,,,,,,
Serum immunoelectrophoresis,302,RC,41000897,LOCAL,,inpatient,,,441,441,,,,,,,,,,,,,,,,,
Other immunoelectrophoresis,302,RC,41000898,LOCAL,,inpatient,,,340.2,340.2,,,,,,,,,,,,,,,,,
Immunoelectrophoresis assay,302,RC,41000899,LOCAL,,inpatient,,,441,441,,,,,,,,,,,,,,,,,
Immunodiffusion nes,305,RC,41000900,LOCAL,,inpatient,,,186.97,186.97,,,,,,,,,,,,,,,,,
Immunodiffusion ouchterlony,302,RC,41000901,LOCAL,,inpatient,,,155.4,155.4,,,,,,,,,,,,,,,,,
Immune complex assay,302,RC,41000902,LOCAL,,inpatient,,,357,357,,,,,,,,,,,,,,,,,
Immunfix e-phorsis/urine/csf,302,RC,41000904,LOCAL,,inpatient,,,390.67,390.67,,,,,,,,,,,,,,,,,
Inhibin a,302,RC,41000905,LOCAL,,inpatient,,,231,231,,,,,,,,,,,,,,,,,
Insulin antibodies,302,RC,41000906,LOCAL,,inpatient,,,315,315,,,,,,,,,,,,,,,,,
Intrinsic factor antibody,302,RC,41000907,LOCAL,,inpatient,,,200.62,200.62,,,,,,,,,,,,,,,,,
Islet cell antibody,305,RC,41000908,LOCAL,,inpatient,,,75.53,75.53,,,,,,,,,,,,,,,,,
Leukocyte histamine release,302,RC,41000909,LOCAL,,inpatient,,,184.8,184.8,,,,,,,,,,,,,,,,,
Leukocyte phagocytosis,302,RC,41000910,LOCAL,,inpatient,,,151.2,151.2,,,,,,,,,,,,,,,,,
Cell function assay w/stim,302,RC,41000911,LOCAL,,inpatient,,,1999.2,1999.2,,,,,,,,,,,,,,,,,
Lymphocyte transformation,302,RC,41000912,LOCAL,,inpatient,,,652.61,652.61,,,,,,,,,,,,,,,,,
B cells total count,302,RC,41000913,LOCAL,,inpatient,,,401.688,401.688,,,,,,,,,,,,,,,,,
Mononuclear cell antigen,302,RC,41000914,LOCAL,,inpatient,,,394.8,394.8,,,,,,,,,,,,,,,,,
Nk cells total count,302,RC,41000915,LOCAL,,inpatient,,,401.688,401.688,,,,,,,,,,,,,,,,,
T cells total count,302,RC,41000916,LOCAL,,inpatient,,,401.688,401.688,,,,,,,,,,,,,,,,,
CD4 PROFILE,302,RC,41000917,LOCAL,,inpatient,,,502.11,502.11,,,,,,,,,,,,,,,,,
T cell absolute count,302,RC,41000918,LOCAL,,inpatient,,,394.8,394.8,,,,,,,,,,,,,,,,,
Stem cells total count,302,RC,41000919,LOCAL,,inpatient,,,1142.4,1142.4,,,,,,,,,,,,,,,,,
Microsomal antibody each,302,RC,41000920,LOCAL,,inpatient,,,193.69,193.69,,,,,,,,,,,,,,,,,
Neutralization test viral,302,RC,41000921,LOCAL,,inpatient,,,247.8,247.8,,,,,,,,,,,,,,,,,
Nitroblue tetrazolium dye,302,RC,41000922,LOCAL,,inpatient,,,201.6,201.6,,,,,,,,,,,,,,,,,
Nuclear matrix protein 22,302,RC,41000923,LOCAL,,inpatient,,,319.2,319.2,,,,,,,,,,,,,,,,,
Particle agglut antbdy scrn,302,RC,41000924,LOCAL,,inpatient,,,135.66,135.66,,,,,,,,,,,,,,,,,
Particle agglut antbdy titr,302,RC,41000925,LOCAL,,inpatient,,,141.61,141.61,,,,,,,,,,,,,,,,,
Rheumatoid factor quant,305,RC,41000927,LOCAL,,inpatient,,,75.53,75.53,,,,,,,,,,,,,,,,,
Tb test cell immun measure,302,RC,41000928,LOCAL,,inpatient,,,660.016,660.016,,,,,,,,,,,,,,,,,
Tb ag response t-cell susp,302,RC,41000929,LOCAL,,inpatient,,,660.016,660.016,,,,,,,,,,,,,,,,,
Streptokinase antibody,302,RC,41000930,LOCAL,,inpatient,,,184.8,184.8,,,,,,,,,,,,,,,,,
Antinomyces antibody,300,RC,41000933,LOCAL,,inpatient,,,57.008,57.008,,,,,,,,,,,,,,,,,
Adenovirus antibody,302,RC,41000934,LOCAL,,inpatient,,,171.29,171.29,,,,,,,,,,,,,,,,,
Bacterium antibody,302,RC,41000936,LOCAL,,inpatient,,,137.424,137.424,,,,,,,,,,,,,,,,,
Bartonella antibody,302,RC,41000937,LOCAL,,inpatient,,,135.45,135.45,,,,,,,,,,,,,,,,,
Blastomyces antibody,302,RC,41000938,LOCAL,,inpatient,,,171.78,171.78,,,,,,,,,,,,,,,,,
Bordetella antibody,302,RC,41000939,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
Borrelia antibody,302,RC,41000942,LOCAL,,inpatient,,,197.4,197.4,,,,,,,,,,,,,,,,,
Brucella antibody,302,RC,41000943,LOCAL,,inpatient,,,118.93,118.93,,,,,,,,,,,,,,,,,
Campylobacter antibody,302,RC,41000944,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
Candida antibody,302,RC,41000945,LOCAL,,inpatient,,,159.88,159.88,,,,,,,,,,,,,,,,,
Chlamydia igm antibody,302,RC,41000947,LOCAL,,inpatient,,,168.98,168.98,,,,,,,,,,,,,,,,,
Coccidioides antibody,302,RC,41000948,LOCAL,,inpatient,,,152.74,152.74,,,,,,,,,,,,,,,,,
Q fever antibody,302,RC,41000949,LOCAL,,inpatient,,,119.728,119.728,,,,,,,,,,,,,,,,,
Cryptococcus antibody,302,RC,41000950,LOCAL,,inpatient,,,210,210,,,,,,,,,,,,,,,,,
Cmv antibody,302,RC,41000951,LOCAL,,inpatient,,,191.59,191.59,,,,,,,,,,,,,,,,,
Diphtheria antibody,302,RC,41000953,LOCAL,,inpatient,,,222.6,222.6,,,,,,,,,,,,,,,,,
Encephalitis californ antbdy,302,RC,41000954,LOCAL,,inpatient,,,175.56,175.56,,,,,,,,,,,,,,,,,
Encephaltis east eqne anbdy,302,RC,41000955,LOCAL,,inpatient,,,175.56,175.56,,,,,,,,,,,,,,,,,
Encephaltis st louis antbody,302,RC,41000956,LOCAL,,inpatient,,,175.56,175.56,,,,,,,,,,,,,,,,,
Encephaltis west eqne antbdy,302,RC,41000957,LOCAL,,inpatient,,,175.56,175.56,,,,,,,,,,,,,,,,,
Enterovirus antibody,302,RC,41000958,LOCAL,,inpatient,,,173.46,173.46,,,,,,,,,,,,,,,,,
Epstein-barr antibody,302,RC,41000959,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
Epstein-barr nuclear antigen,302,RC,41000960,LOCAL,,inpatient,,,226.8,226.8,,,,,,,,,,,,,,,,,
Ehrlichia antibody,302,RC,41000962,LOCAL,,inpatient,,,151.2,151.2,,,,,,,,,,,,,,,,,
Francisella tularensis,302,RC,41000963,LOCAL,,inpatient,,,210,210,,,,,,,,,,,,,,,,,
Giardia lamblia antibody,302,RC,41000965,LOCAL,,inpatient,,,196,196,,,,,,,,,,,,,,,,,
Helminth antibody,302,RC,41000967,LOCAL,,inpatient,,,138.544,138.544,,,,,,,,,,,,,,,,,
Hemophilus influenza antibdy,302,RC,41000968,LOCAL,,inpatient,,,231,231,,,,,,,,,,,,,,,,,
Htlv-i antibody,302,RC,41000969,LOCAL,,inpatient,,,111.72,111.72,,,,,,,,,,,,,,,,,
Htlv-ii antibody,302,RC,41000970,LOCAL,,inpatient,,,186.48,186.48,,,,,,,,,,,,,,,,,
Htlv/hiv confirmj antibody,301,RC,41000971,LOCAL,,inpatient,,,257.6,257.6,,,,,,,,,,,,,,,,,
Hepatitis delta agent antbdy,302,RC,41000972,LOCAL,,inpatient,,,252,252,,,,,,,,,,,,,,,,,
Herpes simplex nes antbdy,302,RC,41000973,LOCAL,,inpatient,,,257.6,257.6,,,,,,,,,,,,,,,,,
Herpes simplex type 1 test,302,RC,41000974,LOCAL,,inpatient,,,28.35,28.35,,,,,,,,,,,,,,,,,
Herpes simplex type 2 test,302,RC,41000975,LOCAL,,inpatient,,,140.448,140.448,,,,,,,,,,,,,,,,,
Histoplasma antibody,302,RC,41000976,LOCAL,,inpatient,,,206.08,206.08,,,,,,,,,,,,,,,,,
Hiv-2 antibody,302,RC,41000978,LOCAL,,inpatient,,,197.4,197.4,,,,,,,,,,,,,,,,,
HEP B SURFACE AB,302,RC,41000982,LOCAL,,inpatient,,,143.01,143.01,,,,,,,,,,,,,,,,,
Influenza virus antibody,302,RC,41000986,LOCAL,,inpatient,,,197.4,197.4,,,,,,,,,,,,,,,,,
John cunningham antibody,302,RC,41000987,LOCAL,,inpatient,,,247.8,247.8,,,,,,,,,,,,,,,,,
Legionella antibody,302,RC,41000988,LOCAL,,inpatient,,,164.92,164.92,,,,,,,,,,,,,,,,,
Leishmania antibody,302,RC,41000989,LOCAL,,inpatient,,,180.6,180.6,,,,,,,,,,,,,,,,,
Leptospira antibody,302,RC,41000990,LOCAL,,inpatient,,,239.4,239.4,,,,,,,,,,,,,,,,,
Listeria monocytogenes,302,RC,41000991,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
Lymph choriomeningitis ab,302,RC,41000992,LOCAL,,inpatient,,,189,189,,,,,,,,,,,,,,,,,
Mucormycosis antibody,302,RC,41000993,LOCAL,,inpatient,,,222.6,222.6,,,,,,,,,,,,,,,,,
Mumps antibody,302,RC,41000994,LOCAL,,inpatient,,,173.74,173.74,,,,,,,,,,,,,,,,,
Mycoplasma antibody,302,RC,41000995,LOCAL,,inpatient,,,203.7,203.7,,,,,,,,,,,,,,,,,
Neisseria meningitidis,302,RC,41000996,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
Nocardia antibody,302,RC,41000997,LOCAL,,inpatient,,,235.2,235.2,,,,,,,,,,,,,,,,,
Parvovirus antibody,302,RC,41000998,LOCAL,,inpatient,,,176.33,176.33,,,,,,,,,,,,,,,,,
Malaria antibody,302,RC,41000999,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
Protozoa antibody nos,302,RC,41001000,LOCAL,,inpatient,,,180.6,180.6,,,,,,,,,,,,,,,,,
Respiratory virus antibody,302,RC,41001001,LOCAL,,inpatient,,,235.2,235.2,,,,,,,,,,,,,,,,,
Rickettsia antibody,302,RC,41001002,LOCAL,,inpatient,,,206.08,206.08,,,,,,,,,,,,,,,,,
Rotavirus antibody,302,RC,41001003,LOCAL,,inpatient,,,268.8,268.8,,,,,,,,,,,,,,,,,
Rubella antibody,302,RC,41001004,LOCAL,,inpatient,,,191.59,191.59,,,,,,,,,,,,,,,,,
Rubeola antibody,302,RC,41001005,LOCAL,,inpatient,,,171.5,171.5,,,,,,,,,,,,,,,,,
Salmonella antibody,302,RC,41001006,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
Shigella antibody,302,RC,41001007,LOCAL,,inpatient,,,361.2,361.2,,,,,,,,,,,,,,,,,
Tetanus antibody,302,RC,41001008,LOCAL,,inpatient,,,218.4,218.4,,,,,,,,,,,,,,,,,
Toxoplasma antibody,302,RC,41001009,LOCAL,,inpatient,,,210,210,,,,,,,,,,,,,,,,,
Toxoplasma antibody igm,302,RC,41001010,LOCAL,,inpatient,,,210,210,,,,,,,,,,,,,,,,,
Treponema pallidum (Syphilis),302,RC,41001011,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
Trichinella antibody,302,RC,41001012,LOCAL,,inpatient,,,184.8,184.8,,,,,,,,,,,,,,,,,
Varicella-zoster antibody,302,RC,41001013,LOCAL,,inpatient,,,171.5,171.5,,,,,,,,,,,,,,,,,
West nile virus ab igm,302,RC,41001014,LOCAL,,inpatient,,,224.21,224.21,,,,,,,,,,,,,,,,,
West nile virus antibody,302,RC,41001015,LOCAL,,inpatient,,,191.59,191.59,,,,,,,,,,,,,,,,,
Virus antibody nos,302,RC,41001016,LOCAL,,inpatient,,,171.5,171.5,,,,,,,,,,,,,,,,,
Yersinia antibody,302,RC,41001017,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
Zika virus igm antibody,302,RC,41001018,LOCAL,,inpatient,,,247.8,247.8,,,,,,,,,,,,,,,,,
Thyroglobulin antibody,302,RC,41001019,LOCAL,,inpatient,,,235.2,235.2,,,,,,,,,,,,,,,,,
HEPATITIS C ANTIBOTY,302,RC,41001020,LOCAL,,inpatient,,,189.98,189.98,,,,,,,,,,,,,,,,,
Hep c ab test confirm,300,RC,41001021,LOCAL,,inpatient,,,88.746,88.746,,,,,,,,,,,,,,,,,
Lymphocytotoxicity assay,300,RC,41001022,LOCAL,,inpatient,,,2784.6,2784.6,,,,,,,,,,,,,,,,,
Lymphocytotoxicity assay,300,RC,41001023,LOCAL,,inpatient,,,701.4,701.4,,,,,,,,,,,,,,,,,
Cytotoxic antibody screening,300,RC,41001024,LOCAL,,inpatient,,,1155,1155,,,,,,,,,,,,,,,,,
Cytotoxic antibody screening,300,RC,41001025,LOCAL,,inpatient,,,436.8,436.8,,,,,,,,,,,,,,,,,
Hla typing a b or c,300,RC,41001026,LOCAL,,inpatient,,,343.56,343.56,,,,,,,,,,,,,,,,,
Hla typing a b or c,300,RC,41001027,LOCAL,,inpatient,,,852.6,852.6,,,,,,,,,,,,,,,,,
Hla typing dr/dq,300,RC,41001028,LOCAL,,inpatient,,,445.2,445.2,,,,,,,,,,,,,,,,,
Hla typing dr/dq,300,RC,41001029,LOCAL,,inpatient,,,1558.2,1558.2,,,,,,,,,,,,,,,,,
Lymphocyte culture mixed,300,RC,41001030,LOCAL,,inpatient,,,537.6,537.6,,,,,,,,,,,,,,,,,
Hla x-math non-cytotoxic,300,RC,41001031,LOCAL,,inpatient,,,1608.6,1608.6,,,,,,,,,,,,,,,,,
Hla x-match noncytotoxc addl,300,RC,41001032,LOCAL,,inpatient,,,537.6,537.6,,,,,,,,,,,,,,,,,
Hla class i&ii antibody qual,300,RC,41001033,LOCAL,,inpatient,,,945,945,,,,,,,,,,,,,,,,,
Hla class i/ii antibody qual,300,RC,41001034,LOCAL,,inpatient,,,945,945,,,,,,,,,,,,,,,,,
Hla class i phenotype qual,300,RC,41001035,LOCAL,,inpatient,,,1402.8,1402.8,,,,,,,,,,,,,,,,,
Hla class ii phenotype qual,300,RC,41001036,LOCAL,,inpatient,,,1205.4,1205.4,,,,,,,,,,,,,,,,,
Hla class i high defin qual,300,RC,41001037,LOCAL,,inpatient,,,4758.6,4758.6,,,,,,,,,,,,,,,,,
Hla class ii high defin qual,300,RC,41001038,LOCAL,,inpatient,,,4788,4788,,,,,,,,,,,,,,,,,
Hla class i semiquant panel,300,RC,41001039,LOCAL,,inpatient,,,5254.2,5254.2,,,,,,,,,,,,,,,,,
Hla class ii semiquant panel,300,RC,41001040,LOCAL,,inpatient,,,4746,4746,,,,,,,,,,,,,,,,,
Rbc antibody elution,300,RC,41001042,LOCAL,,inpatient,,,155.12,155.12,,,,,,,,,,,,,,,,,
Rbc antibody identification,302,RC,41001043,LOCAL,,inpatient,,,319.2,319.2,,,,,,,,,,,,,,,,,
Coombs test indirect qual,300,RC,41001045,LOCAL,,inpatient,,,76.23,76.23,,,,,,,,,,,,,,,,,
Coombs test indirect titer,302,RC,41001046,LOCAL,,inpatient,,,68.88,68.88,,,,,,,,,,,,,,,,,
Autologous blood process,300,RC,41001047,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Autologous blood op salvage,300,RC,41001048,LOCAL,,inpatient,,,9235.8,9235.8,,,,,,,,,,,,,,,,,
ABO / RH,305,RC,41001049,LOCAL,,inpatient,,,39.69,39.69,,,,,,,,,,,,,,,,,
Bld typing serologic rh phnt,305,RC,41001054,LOCAL,,inpatient,,,103.18,103.18,,,,,,,,,,,,,,,,,
Compatibility test incubate,300,RC,41001056,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Compatibility test electric,300,RC,41001058,LOCAL,,inpatient,,,290.584,290.584,,,,,,,,,,,,,,,,,
Small animal inoculation,300,RC,41001059,LOCAL,,inpatient,,,247.8,247.8,,,,,,,,,,,,,,,,,
Specimen infect agnt concntj,306,RC,41001060,LOCAL,,inpatient,,,88.9,88.9,,,,,,,,,,,,,,,,,
CULTURE BLOOD,300,RC,41001061,LOCAL,,inpatient,,,151.2,151.2,,,,,,,,,,,,,,,,,
CULTURE STOOL,306,RC,41001062,LOCAL,,inpatient,,,125.58,125.58,,,,,,,,,,,,,,,,,
Stool cultr aerobic bact ea,300,RC,41001063,LOCAL,,inpatient,,,125.58,125.58,,,,,,,,,,,,,,,,,
Culture aerobic quant other,306,RC,41001065,LOCAL,,inpatient,,,125.58,125.58,,,,,,,,,,,,,,,,,
Culture bacteria anaerobic,306,RC,41001066,LOCAL,,inpatient,,,125.58,125.58,,,,,,,,,,,,,,,,,
CULTURE ANAEROBE,306,RC,41001067,LOCAL,,inpatient,,,125.93,125.93,,,,,,,,,,,,,,,,,
Culture screen only,306,RC,41001070,LOCAL,,inpatient,,,88.27,88.27,,,,,,,,,,,,,,,,,
Culture of specimen by kit,300,RC,41001071,LOCAL,,inpatient,,,399,399,,,,,,,,,,,,,,,,,
CULTURE URINE,306,RC,41001072,LOCAL,,inpatient,,,107.45,107.45,,,,,,,,,,,,,,,,,
Urine bacteria culture,300,RC,41001073,LOCAL,,inpatient,,,107.8,107.8,,,,,,,,,,,,,,,,,
Skin fungi culture,300,RC,41001074,LOCAL,,inpatient,,,102.69,102.69,,,,,,,,,,,,,,,,,
CULTURE FUNGUS,300,RC,41001075,LOCAL,,inpatient,,,111.86,111.86,,,,,,,,,,,,,,,,,
Fungi identification yeast,300,RC,41001077,LOCAL,,inpatient,,,137.41,137.41,,,,,,,,,,,,,,,,,
Fungi identification mold,300,RC,41001078,LOCAL,,inpatient,,,109.928,109.928,,,,,,,,,,,,,,,,,
Mycoplasma,300,RC,41001079,LOCAL,,inpatient,,,226.8,226.8,,,,,,,,,,,,,,,,,
Mycobacteria culture,307,RC,41001081,LOCAL,,inpatient,,,143.85,143.85,,,,,,,,,,,,,,,,,
Mycobacteric identification,300,RC,41001082,LOCAL,,inpatient,,,214.2,214.2,,,,,,,,,,,,,,,,,
Culture type immunofluoresc,300,RC,41001083,LOCAL,,inpatient,,,74.2,74.2,,,,,,,,,,,,,,,,,
Culture typing glc/hplc,307,RC,41001084,LOCAL,,inpatient,,,166.81,166.81,,,,,,,,,,,,,,,,,
Culture type immunologic,300,RC,41001085,LOCAL,,inpatient,,,68.88,68.88,,,,,,,,,,,,,,,,,
Dna/rna direct probe,300,RC,41001086,LOCAL,,inpatient,,,266.91,266.91,,,,,,,,,,,,,,,,,
Dna/rna amplified probe,300,RC,41001087,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Macroscopic exam arthropod,300,RC,41001093,LOCAL,,inpatient,,,56.84,56.84,,,,,,,,,,,,,,,,,
Macroscopic exam parasite,300,RC,41001094,LOCAL,,inpatient,,,56.84,56.84,,,,,,,,,,,,,,,,,
Pinworm exam,300,RC,41001095,LOCAL,,inpatient,,,63,63,,,,,,,,,,,,,,,,,
Tissue homogenization cultr,300,RC,41001096,LOCAL,,inpatient,,,88.2,88.2,,,,,,,,,,,,,,,,,
Ova and parasites smears,306,RC,41001097,LOCAL,,inpatient,,,118.44,118.44,,,,,,,,,,,,,,,,,
Microbe susceptible diffuse,300,RC,41001098,LOCAL,,inpatient,,,50.568,50.568,,,,,,,,,,,,,,,,,
Microbe susceptible disk,300,RC,41001099,LOCAL,,inpatient,,,91.84,91.84,,,,,,,,,,,,,,,,,
Microbe susceptible enzyme,300,RC,41001100,LOCAL,,inpatient,,,71.4,71.4,,,,,,,,,,,,,,,,,
Microbe susceptible mlc,300,RC,41001102,LOCAL,,inpatient,,,592.2,592.2,,,,,,,,,,,,,,,,,
Microbe suscept macrobroth,300,RC,41001103,LOCAL,,inpatient,,,88.34,88.34,,,,,,,,,,,,,,,,,
Microbe suscept mycobacteri,300,RC,41001104,LOCAL,,inpatient,,,75.25,75.25,,,,,,,,,,,,,,,,,
Bactericidal level serum,300,RC,41001105,LOCAL,,inpatient,,,222.6,222.6,,,,,,,,,,,,,,,,,
GRAM STAIN smear,306,RC,41001106,LOCAL,,inpatient,,,56.84,56.84,,,,,,,,,,,,,,,,,
Smear special stain,300,RC,41001108,LOCAL,,inpatient,,,63,63,,,,,,,,,,,,,,,,,
Smear complex stain,300,RC,41001109,LOCAL,,inpatient,,,239.26,239.26,,,,,,,,,,,,,,,,,
Tissue exam for fungi,300,RC,41001111,LOCAL,,inpatient,,,56.84,56.84,,,,,,,,,,,,,,,,,
Assay toxin or antitoxin,300,RC,41001112,LOCAL,,inpatient,,,262.85,262.85,,,,,,,,,,,,,,,,,
Virus inoculate eggs/animal,300,RC,41001113,LOCAL,,inpatient,,,285.6,285.6,,,,,,,,,,,,,,,,,
CULTURE VIRAL,300,RC,41001114,LOCAL,,inpatient,,,346.99,346.99,,,,,,,,,,,,,,,,,
Virus inoculate tissue addl,300,RC,41001115,LOCAL,,inpatient,,,298.2,298.2,,,,,,,,,,,,,,,,,
Virus inoculation shell via,300,RC,41001116,LOCAL,,inpatient,,,260.33,260.33,,,,,,,,,,,,,,,,,
Genet virus isolate hsv,300,RC,41001117,LOCAL,,inpatient,,,450.8,450.8,,,,,,,,,,,,,,,,,
Adenovirus ag if,300,RC,41001118,LOCAL,,inpatient,,,214.2,214.2,,,,,,,,,,,,,,,,,
Pertussis ag if,300,RC,41001119,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
Enterovirus antibody dfa,300,RC,41001120,LOCAL,,inpatient,,,197.4,197.4,,,,,,,,,,,,,,,,,
Giardia ag if,300,RC,41001121,LOCAL,,inpatient,,,159.67,159.67,,,,,,,,,,,,,,,,,
Chlamydia trachomatis ag if,300,RC,41001122,LOCAL,,inpatient,,,82.88,82.88,,,,,,,,,,,,,,,,,
Cytomegalovirus dfa,300,RC,41001123,LOCAL,,inpatient,,,197.4,197.4,,,,,,,,,,,,,,,,,
Cryptosporidium ag if,300,RC,41001124,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
Herpes simplex 2 ag if,300,RC,41001125,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
Herpes simplex 1 ag if,300,RC,41001126,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
Influenza b ag if,300,RC,41001127,LOCAL,,inpatient,,,180.6,180.6,,,,,,,,,,,,,,,,,
Influenza a ag if,300,RC,41001128,LOCAL,,inpatient,,,235.2,235.2,,,,,,,,,,,,,,,,,
Legion pneumophilia ag if,300,RC,41001129,LOCAL,,inpatient,,,231,231,,,,,,,,,,,,,,,,,
Parainfluenza ag if,300,RC,41001130,LOCAL,,inpatient,,,243.6,243.6,,,,,,,,,,,,,,,,,
Pneumocystis carinii ag if,300,RC,41001132,LOCAL,,inpatient,,,159.67,159.67,,,,,,,,,,,,,,,,,
Rubeola ag if,300,RC,41001133,LOCAL,,inpatient,,,894.6,894.6,,,,,,,,,,,,,,,,,
Treponema pallidum ag if,300,RC,41001134,LOCAL,,inpatient,,,180.6,180.6,,,,,,,,,,,,,,,,,
Varicella zoster ag if,300,RC,41001135,LOCAL,,inpatient,,,197.4,197.4,,,,,,,,,,,,,,,,,
Antibody detection nos if,300,RC,41001136,LOCAL,,inpatient,,,235.2,235.2,,,,,,,,,,,,,,,,,
Ag detection polyval if,300,RC,41001137,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
Adenovirus ag ia,300,RC,41001138,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
Aspergillus ag ia,300,RC,41001139,LOCAL,,inpatient,,,127.736,127.736,,,,,,,,,,,,,,,,,
Chylmd trach ag ia,300,RC,41001140,LOCAL,,inpatient,,,222.6,222.6,,,,,,,,,,,,,,,,,
C. DIFFICILE ANTIGEN (EIA),306,RC,41001141,LOCAL,,inpatient,,,159.67,159.67,,,,,,,,,,,,,,,,,
Cryptococcus neoform ag ia,300,RC,41001142,LOCAL,,inpatient,,,159.67,159.67,,,,,,,,,,,,,,,,,
Cytomegalovirus ag ia,300,RC,41001145,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
E coli 0157 ag ia,300,RC,41001146,LOCAL,,inpatient,,,184.8,184.8,,,,,,,,,,,,,,,,,
Entamoeb hist dispr ag ia,300,RC,41001147,LOCAL,,inpatient,,,235.2,235.2,,,,,,,,,,,,,,,,,
Entamoeb hist group ag ia,300,RC,41001148,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
H. PYLORI ANTIGEN,300,RC,41001149,LOCAL,,inpatient,,,258.216,258.216,,,,,,,,,,,,,,,,,
H pylori ag ia,300,RC,41001150,LOCAL,,inpatient,,,235.2,235.2,,,,,,,,,,,,,,,,,
HEP B SURFACE AG,306,RC,41001151,LOCAL,,inpatient,,,137.48,137.48,,,,,,,,,,,,,,,,,
Hepatitis b surface ag ia,300,RC,41001152,LOCAL,,inpatient,,,151.2,151.2,,,,,,,,,,,,,,,,,
Hepatitis be ag ia,300,RC,41001153,LOCAL,,inpatient,,,153.44,153.44,,,,,,,,,,,,,,,,,
Hepatitis delta ag ia,300,RC,41001154,LOCAL,,inpatient,,,268.8,268.8,,,,,,,,,,,,,,,,,
"HIV 1,2 AB; P24 AG",300,RC,41001156,LOCAL,,inpatient,,,182.56,182.56,,,,,,,,,,,,,,,,,
Hiv-1 ag ia,300,RC,41001157,LOCAL,,inpatient,,,352.8,352.8,,,,,,,,,,,,,,,,,
Hiv-2 ag ia,300,RC,41001158,LOCAL,,inpatient,,,323.4,323.4,,,,,,,,,,,,,,,,,
Influenza a/b ag ia,300,RC,41001159,LOCAL,,inpatient,,,159.67,159.67,,,,,,,,,,,,,,,,,
Resp syncytial ag ia,300,RC,41001160,LOCAL,,inpatient,,,205.8,205.8,,,,,,,,,,,,,,,,,
Rotavirus ag ia,300,RC,41001161,LOCAL,,inpatient,,,159.67,159.67,,,,,,,,,,,,,,,,,
Shiga-like toxin ag ia,300,RC,41001162,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
Strep a ag ia,300,RC,41001163,LOCAL,,inpatient,,,159.67,159.67,,,,,,,,,,,,,,,,,
Ag detect nos ia single,300,RC,41001165,LOCAL,,inpatient,,,142.8,142.8,,,,,,,,,,,,,,,,,
Ag detect polyval ia mult,300,RC,41001166,LOCAL,,inpatient,,,155.4,155.4,,,,,,,,,,,,,,,,,
Bartonella dna amp probe,300,RC,41001167,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Bartonella dna quant,300,RC,41001168,LOCAL,,inpatient,,,630,630,,,,,,,,,,,,,,,,,
Lyme dis dna dir probe,300,RC,41001169,LOCAL,,inpatient,,,294,294,,,,,,,,,,,,,,,,,
Lyme dis dna amp probe,300,RC,41001170,LOCAL,,inpatient,,,242.018,242.018,,,,,,,,,,,,,,,,,
Candida dna dir probe,300,RC,41001171,LOCAL,,inpatient,,,294,294,,,,,,,,,,,,,,,,,
Candida dna amp probe,300,RC,41001172,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Candida dna quant,300,RC,41001173,LOCAL,,inpatient,,,819,819,,,,,,,,,,,,,,,,,
Cns dna amp probe type 12-25,300,RC,41001174,LOCAL,,inpatient,,,6127.8,6127.8,,,,,,,,,,,,,,,,,
Chylmd pneum dna dir probe,300,RC,41001175,LOCAL,,inpatient,,,294,294,,,,,,,,,,,,,,,,,
Chylmd pneum dna amp probe,300,RC,41001176,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Chylmd pneum dna quant,300,RC,41001177,LOCAL,,inpatient,,,630,630,,,,,,,,,,,,,,,,,
Chylmd trach dna dir probe,300,RC,41001178,LOCAL,,inpatient,,,266.91,266.91,,,,,,,,,,,,,,,,,
Chylmd trach dna quant,300,RC,41001180,LOCAL,,inpatient,,,372.288,372.288,,,,,,,,,,,,,,,,,
Cytomeg dna dir probe,300,RC,41001182,LOCAL,,inpatient,,,441,441,,,,,,,,,,,,,,,,,
"CMV PCR, QUALITATIVE",300,RC,41001183,LOCAL,,inpatient,,,373.744,373.744,,,,,,,,,,,,,,,,,
Enterovirus probe&revrs trns,300,RC,41001185,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Vanomycin dna amp probe,300,RC,41001186,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Influenza dna amp prob 1+,300,RC,41001187,LOCAL,,inpatient,,,756,756,,,,,,,,,,,,,,,,,
INFLUENZA BY PCR,300,RC,41001188,LOCAL,,inpatient,,,1407,1407,,,,,,,,,,,,,,,,,
Influenza dna amp prob addl,300,RC,41001189,LOCAL,,inpatient,,,428.4,428.4,,,,,,,,,,,,,,,,,
Nfct agent detection gi,300,RC,41001190,LOCAL,,inpatient,,,1885.8,1885.8,,,,,,,,,,,,,,,,,
Iadna-dna/rna probe tq 6-11,300,RC,41001191,LOCAL,,inpatient,,,1106.658,1106.658,,,,,,,,,,,,,,,,,
Iadna-dna/rna probe tq 12-25,300,RC,41001192,LOCAL,,inpatient,,,6127.8,6127.8,,,,,,,,,,,,,,,,,
Gardner vag dna dir probe,300,RC,41001193,LOCAL,,inpatient,,,294,294,,,,,,,,,,,,,,,,,
Gardner vag dna amp probe,300,RC,41001194,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Gardner vag dna quant,300,RC,41001195,LOCAL,,inpatient,,,613.2,613.2,,,,,,,,,,,,,,,,,
Hepatitis b dna amp probe,300,RC,41001196,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
HEPATITIS C RNA QUANT,300,RC,41001198,LOCAL,,inpatient,,,457.8,457.8,,,,,,,,,,,,,,,,,
Hepatitis c probe&rvrs trnsc,300,RC,41001199,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
"HEPATITIS C VIRAL RNA, QUAL",300,RC,41001200,LOCAL,,inpatient,,,570.22,570.22,,,,,,,,,,,,,,,,,
Hepatitis g dna dir probe,300,RC,41001201,LOCAL,,inpatient,,,436.8,436.8,,,,,,,,,,,,,,,,,
Hepatitis g dna amp probe,300,RC,41001202,LOCAL,,inpatient,,,575.4,575.4,,,,,,,,,,,,,,,,,
Hepatitis g dna quant,300,RC,41001203,LOCAL,,inpatient,,,613.2,613.2,,,,,,,,,,,,,,,,,
Hsv dna dir probe,300,RC,41001204,LOCAL,,inpatient,,,294,294,,,,,,,,,,,,,,,,,
Hsv dna amp probe,300,RC,41001205,LOCAL,,inpatient,,,373.744,373.744,,,,,,,,,,,,,,,,,
Hsv dna quant,300,RC,41001206,LOCAL,,inpatient,,,630,630,,,,,,,,,,,,,,,,,
Hhv-6 dna dir probe,300,RC,41001207,LOCAL,,inpatient,,,852.6,852.6,,,,,,,,,,,,,,,,,
Hhv-6 dna amp probe,300,RC,41001208,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Hhv-6 dna quant,300,RC,41001209,LOCAL,,inpatient,,,613.2,613.2,,,,,,,,,,,,,,,,,
Hiv-1 dna dir probe,300,RC,41001210,LOCAL,,inpatient,,,323.4,323.4,,,,,,,,,,,,,,,,,
Hiv-1 probe&reverse trnscrpj,300,RC,41001211,LOCAL,,inpatient,,,467.18,467.18,,,,,,,,,,,,,,,,,
Hiv-1 quant&revrse trnscrpj,300,RC,41001212,LOCAL,,inpatient,,,1132.74,1132.74,,,,,,,,,,,,,,,,,
Hiv-2 dna dir probe,300,RC,41001213,LOCAL,,inpatient,,,323.4,323.4,,,,,,,,,,,,,,,,,
Hiv-2 probe&revrse trnscripj,300,RC,41001214,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Hiv-2 quant&revrse trnscripj,300,RC,41001215,LOCAL,,inpatient,,,861,861,,,,,,,,,,,,,,,,,
Legion pneumo dna dir prob,300,RC,41001216,LOCAL,,inpatient,,,294,294,,,,,,,,,,,,,,,,,
Legion pneumo dna amp prob,300,RC,41001217,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Legion pneumo dna quant,300,RC,41001218,LOCAL,,inpatient,,,613.2,613.2,,,,,,,,,,,,,,,,,
Mycobacteria dna dir probe,300,RC,41001219,LOCAL,,inpatient,,,266.91,266.91,,,,,,,,,,,,,,,,,
Mycobacteria dna amp probe,300,RC,41001220,LOCAL,,inpatient,,,709.8,709.8,,,,,,,,,,,,,,,,,
Mycobacteria dna quant,300,RC,41001221,LOCAL,,inpatient,,,630,630,,,,,,,,,,,,,,,,,
M.tuberculo dna dir probe,300,RC,41001222,LOCAL,,inpatient,,,266.91,266.91,,,,,,,,,,,,,,,,,
M.tuberculo dna amp probe,300,RC,41001223,LOCAL,,inpatient,,,467.18,467.18,,,,,,,,,,,,,,,,,
M.tuberculo dna quant,300,RC,41001224,LOCAL,,inpatient,,,630,630,,,,,,,,,,,,,,,,,
M.avium-intra dna dir prob,300,RC,41001225,LOCAL,,inpatient,,,266.91,266.91,,,,,,,,,,,,,,,,,
M.avium-intra dna amp prob,300,RC,41001226,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
M.avium-intra dna quant,300,RC,41001227,LOCAL,,inpatient,,,630,630,,,,,,,,,,,,,,,,,
M. genitalium amp probe,300,RC,41001228,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
M.pneumon dna dir probe,300,RC,41001229,LOCAL,,inpatient,,,294,294,,,,,,,,,,,,,,,,,
M.pneumon dna amp probe,300,RC,41001230,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
M.pneumon dna quant,300,RC,41001231,LOCAL,,inpatient,,,4447.8,4447.8,,,,,,,,,,,,,,,,,
N.gonorrhoeae dna dir prob,300,RC,41001232,LOCAL,,inpatient,,,266.91,266.91,,,,,,,,,,,,,,,,,
N.gonorrhoeae dna amp prob,300,RC,41001233,LOCAL,,inpatient,,,467.18,467.18,,,,,,,,,,,,,,,,,
N.gonorrhoeae dna quant,300,RC,41001234,LOCAL,,inpatient,,,456.176,456.176,,,,,,,,,,,,,,,,,
Hpv low-risk types,300,RC,41001235,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Hpv high-risk types,300,RC,41001236,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Hpv types 16 & 18 only,300,RC,41001237,LOCAL,,inpatient,,,596.4,596.4,,,,,,,,,,,,,,,,,
Resp virus 3-5 targets,300,RC,41001238,LOCAL,,inpatient,,,246.372,246.372,,,,,,,,,,,,,,,,,
Resp virus 6-11 targets,300,RC,41001239,LOCAL,,inpatient,,,1081.64,1081.64,,,,,,,,,,,,,,,,,
Resp virus 12-25 targets,300,RC,41001240,LOCAL,,inpatient,,,1081.64,1081.64,,,,,,,,,,,,,,,,,
Sars-cov-2 covid-19 amp prb,300,RC,41001242,LOCAL,,inpatient,,,210,210,,,,,,,,,,,,,,,,,
Staph a dna amp probe,300,RC,41001243,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
"Group A Streptococcus,DNA Prob",300,RC,41001245,LOCAL,,inpatient,,,294,294,,,,,,,,,,,,,,,,,
Strep a dna amp probe,300,RC,41001246,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Strep a dna quant,300,RC,41001247,LOCAL,,inpatient,,,613.2,613.2,,,,,,,,,,,,,,,,,
Strep b dna amp probe,300,RC,41001248,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Trichomonas vagin dir probe,300,RC,41001249,LOCAL,,inpatient,,,294,294,,,,,,,,,,,,,,,,,
Trichomonas vaginalis amplif,300,RC,41001250,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Zika virus dna/rna amp probe,300,RC,41001251,LOCAL,,inpatient,,,756,756,,,,,,,,,,,,,,,,,
Detect agent nos dna dir,300,RC,41001252,LOCAL,,inpatient,,,441,441,,,,,,,,,,,,,,,,,
Detect agent nos dna amp,300,RC,41001253,LOCAL,,inpatient,,,467.18,467.18,,,,,,,,,,,,,,,,,
Detect agent nos dna quant,300,RC,41001254,LOCAL,,inpatient,,,456.176,456.176,,,,,,,,,,,,,,,,,
Detect agnt mult dna direc,300,RC,41001255,LOCAL,,inpatient,,,642.6,642.6,,,,,,,,,,,,,,,,,
Detect agnt mult dna ampli,300,RC,41001256,LOCAL,,inpatient,,,1033.2,1033.2,,,,,,,,,,,,,,,,,
Strep b assay w/optic,306,RC,41001257,LOCAL,,inpatient,,,159.67,159.67,,,,,,,,,,,,,,,,,
Clostridium toxin a w/optic,300,RC,41001258,LOCAL,,inpatient,,,159.67,159.67,,,,,,,,,,,,,,,,,
Influenza assay w/optic,300,RC,41001259,LOCAL,,inpatient,,,159.67,159.67,,,,,,,,,,,,,,,,,
Hiv antigen w/hiv antibodies,300,RC,41001260,LOCAL,,inpatient,,,483,483,,,,,,,,,,,,,,,,,
Rsv assay w/optic,300,RC,41001261,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
Trichomonas assay w/optic,300,RC,41001262,LOCAL,,inpatient,,,226.8,226.8,,,,,,,,,,,,,,,,,
Adenovirus assay w/optic,300,RC,41001263,LOCAL,,inpatient,,,319.2,319.2,,,,,,,,,,,,,,,,,
Chylmd trach assay w/optic,300,RC,41001264,LOCAL,,inpatient,,,520.8,520.8,,,,,,,,,,,,,,,,,
N. gonorrhoeae assay w/optic,300,RC,41001265,LOCAL,,inpatient,,,361.2,361.2,,,,,,,,,,,,,,,,,
Strep a assay w/optic,300,RC,41001266,LOCAL,,inpatient,,,159.67,159.67,,,,,,,,,,,,,,,,,
Agent nos assay w/optic,300,RC,41001267,LOCAL,,inpatient,,,80.556,80.556,,,,,,,,,,,,,,,,,
Phenotype infect agent drug,300,RC,41001268,LOCAL,,inpatient,,,1915.2,1915.2,,,,,,,,,,,,,,,,,
Genotype dna hiv reverse t,300,RC,41001269,LOCAL,,inpatient,,,3784.2,3784.2,,,,,,,,,,,,,,,,,
Genotype dna/rna hep c,300,RC,41001270,LOCAL,,inpatient,,,2741.592,2741.592,,,,,,,,,,,,,,,,,
Phenotype dna hiv w/culture,300,RC,41001271,LOCAL,,inpatient,,,7182,7182,,,,,,,,,,,,,,,,,
Phenotype dna hiv w/clt add,300,RC,41001272,LOCAL,,inpatient,,,382.2,382.2,,,,,,,,,,,,,,,,,
Sialidase enzyme assay,300,RC,41001273,LOCAL,,inpatient,,,180.6,180.6,,,,,,,,,,,,,,,,,
Genotype dna/rna hiv,300,RC,41001274,LOCAL,,inpatient,,,1894.2,1894.2,,,,,,,,,,,,,,,,,
Genotype cytomegalovirus,300,RC,41001275,LOCAL,,inpatient,,,3784.2,3784.2,,,,,,,,,,,,,,,,,
Genotype dna hepatitis b,300,RC,41001276,LOCAL,,inpatient,,,3784.2,3784.2,,,,,,,,,,,,,,,,,
Cytopath fl nongyn smears,300,RC,41001277,LOCAL,,inpatient,,,254.8,254.8,,,,,,,,,,,,,,,,,
Cytopath fl nongyn filter,300,RC,41001278,LOCAL,,inpatient,,,336,336,,,,,,,,,,,,,,,,,
Cytopath concentrate tech,300,RC,41001279,LOCAL,,inpatient,,,196,196,,,,,,,,,,,,,,,,,
Cytopath cell enhance tech,300,RC,41001280,LOCAL,,inpatient,,,392,392,,,,,,,,,,,,,,,,,
Cytp urne 3-5 probes ea spec,300,RC,41001281,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Cytp urine 3-5 probes cmptr,300,RC,41001282,LOCAL,,inpatient,,,4166.4,4166.4,,,,,,,,,,,,,,,,,
Forensic cytopathology,300,RC,41001283,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Sex chromatin identification,300,RC,41001284,LOCAL,,inpatient,,,264.6,264.6,,,,,,,,,,,,,,,,,
Sex chromatin identification,300,RC,41001285,LOCAL,,inpatient,,,106.4,106.4,,,,,,,,,,,,,,,,,
Cytopath c/v thin layer,300,RC,41001286,LOCAL,,inpatient,,,199.57,199.57,,,,,,,,,,,,,,,,,
Cytopath c/v thin layer redo,300,RC,41001287,LOCAL,,inpatient,,,340.2,340.2,,,,,,,,,,,,,,,,,
Cytopath c/v automated,300,RC,41001288,LOCAL,,inpatient,,,743.4,743.4,,,,,,,,,,,,,,,,,
Cytopath c/v auto rescreen,300,RC,41001289,LOCAL,,inpatient,,,235.2,235.2,,,,,,,,,,,,,,,,,
Cytopath c/v manual,300,RC,41001290,LOCAL,,inpatient,,,222.6,222.6,,,,,,,,,,,,,,,,,
Cytopath c/v auto redo,300,RC,41001291,LOCAL,,inpatient,,,407.4,407.4,,,,,,,,,,,,,,,,,
Cytopath c/v redo,300,RC,41001292,LOCAL,,inpatient,,,352.8,352.8,,,,,,,,,,,,,,,,,
Cytopath c/v index add-on,300,RC,41001293,LOCAL,,inpatient,,,214.2,214.2,,,,,,,,,,,,,,,,,
Cytopath smear other source,300,RC,41001294,LOCAL,,inpatient,,,336,336,,,,,,,,,,,,,,,,,
Cytopath smear other source,300,RC,41001295,LOCAL,,inpatient,,,336,336,,,,,,,,,,,,,,,,,
Cytopath smear other source,300,RC,41001296,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Cytopath tbs c/v manual,300,RC,41001297,LOCAL,,inpatient,,,222.6,222.6,,,,,,,,,,,,,,,,,
Cytopath tbs c/v redo,300,RC,41001298,LOCAL,,inpatient,,,621.6,621.6,,,,,,,,,,,,,,,,,
Cytopath tbs c/v auto redo,300,RC,41001299,LOCAL,,inpatient,,,222.6,222.6,,,,,,,,,,,,,,,,,
Cytopath tbs c/v select,300,RC,41001300,LOCAL,,inpatient,,,222.6,222.6,,,,,,,,,,,,,,,,,
Cytp dx eval fna 1st ea site,300,RC,41001301,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Cytopath eval fna report,300,RC,41001302,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Cytopath c/v auto in fluid,300,RC,41001303,LOCAL,,inpatient,,,373.8,373.8,,,,,,,,,,,,,,,,,
Cytopath c/v auto fluid redo,300,RC,41001304,LOCAL,,inpatient,,,390.6,390.6,,,,,,,,,,,,,,,,,
Cell marker study,300,RC,41001305,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Flowcytometry/ tc 1 marker,300,RC,41001306,LOCAL,,inpatient,,,299.67,299.67,,,,,,,,,,,,,,,,,
Cytopathology procedure,300,RC,41001307,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Tissue culture lymphocyte,300,RC,41001308,LOCAL,,inpatient,,,1713.6,1713.6,,,,,,,,,,,,,,,,,
Tissue culture placenta,300,RC,41001310,LOCAL,,inpatient,,,2209.2,2209.2,,,,,,,,,,,,,,,,,
Tissue culture bone marrow,300,RC,41001311,LOCAL,,inpatient,,,1681.33,1681.33,,,,,,,,,,,,,,,,,
Tissue culture tumor,300,RC,41001312,LOCAL,,inpatient,,,2167.2,2167.2,,,,,,,,,,,,,,,,,
Cell cryopreserve/storage,300,RC,41001313,LOCAL,,inpatient,,,193.2,193.2,,,,,,,,,,,,,,,,,
Frozen cell preparation,300,RC,41001314,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
Chromosome analysis 20-25,300,RC,41001315,LOCAL,,inpatient,,,2545.2,2545.2,,,,,,,,,,,,,,,,,
Chromosome analysis 50-100,300,RC,41001316,LOCAL,,inpatient,,,2545.2,2545.2,,,,,,,,,,,,,,,,,
Chromosome analysis 100,300,RC,41001317,LOCAL,,inpatient,,,2545.2,2545.2,,,,,,,,,,,,,,,,,
Chromosome analysis 5,300,RC,41001318,LOCAL,,inpatient,,,3885,3885,,,,,,,,,,,,,,,,,
Chromosome analysis 15-20,300,RC,41001319,LOCAL,,inpatient,,,1843.8,1843.8,,,,,,,,,,,,,,,,,
Chromosome analysis 45,300,RC,41001320,LOCAL,,inpatient,,,2209.2,2209.2,,,,,,,,,,,,,,,,,
Chromosome analysis 20-25,300,RC,41001321,LOCAL,,inpatient,,,1659.21,1659.21,,,,,,,,,,,,,,,,,
Chromosome analys placenta,300,RC,41001322,LOCAL,,inpatient,,,2772,2772,,,,,,,,,,,,,,,,,
Chromosome analys amniotic,300,RC,41001323,LOCAL,,inpatient,,,2553.6,2553.6,,,,,,,,,,,,,,,,,
Cytogenetics dna probe,300,RC,41001324,LOCAL,,inpatient,,,285.11,285.11,,,,,,,,,,,,,,,,,
Cytogenetics 3-5,300,RC,41001325,LOCAL,,inpatient,,,596.4,596.4,,,,,,,,,,,,,,,,,
Cytogenetics 10-30,300,RC,41001326,LOCAL,,inpatient,,,512.4,512.4,,,,,,,,,,,,,,,,,
Cytogenetics 25-99,300,RC,41001327,LOCAL,,inpatient,,,621.6,621.6,,,,,,,,,,,,,,,,,
Cytogenetics 100-300,300,RC,41001328,LOCAL,,inpatient,,,534.59,534.59,,,,,,,,,,,,,,,,,
Chromosome karyotype study,300,RC,41001329,LOCAL,,inpatient,,,334.11,334.11,,,,,,,,,,,,,,,,,
Chromosome banding study,300,RC,41001330,LOCAL,,inpatient,,,1008,1008,,,,,,,,,,,,,,,,,
Chromosome count additional,300,RC,41001331,LOCAL,,inpatient,,,394.8,394.8,,,,,,,,,,,,,,,,,
Chromosome study additional,300,RC,41001332,LOCAL,,inpatient,,,508.2,508.2,,,,,,,,,,,,,,,,,
Cytogenetic study,300,RC,41001333,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Cultr oocyte/embryo <4 days,300,RC,41001334,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Cultr oocyte/embryo <4 days,300,RC,41001335,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Embryo hatching,300,RC,41001336,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Oocyte identification,300,RC,41001337,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Prepare embryo for transfer,300,RC,41001338,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Sperm identification,300,RC,41001339,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Cryopreservation embryo(s),300,RC,41001340,LOCAL,,inpatient,,,9235.8,9235.8,,,,,,,,,,,,,,,,,
Cryopreservation sperm,300,RC,41001341,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Sperm isolation simple,300,RC,41001342,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Sperm isolation complex,300,RC,41001343,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Identify sperm tissue,300,RC,41001344,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Insemination of oocytes,300,RC,41001345,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Extended culture of oocytes,300,RC,41001346,LOCAL,,inpatient,,,9235.8,9235.8,,,,,,,,,,,,,,,,,
Assist oocyte fertilization,300,RC,41001347,LOCAL,,inpatient,,,9235.8,9235.8,,,,,,,,,,,,,,,,,
Assist oocyte fertilization,300,RC,41001348,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Biopsy oocyte polar body,300,RC,41001349,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Biopsy oocyte polar body,300,RC,41001350,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Semen analysis w/huhner,300,RC,41001351,LOCAL,,inpatient,,,133,133,,,,,,,,,,,,,,,,,
Semen analysis w/count,300,RC,41001352,LOCAL,,inpatient,,,126,126,,,,,,,,,,,,,,,,,
Semen anal vol/count/mot,300,RC,41001353,LOCAL,,inpatient,,,180.6,180.6,,,,,,,,,,,,,,,,,
Semen anal sperm detection,300,RC,41001354,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
Semen anal strict criteria,300,RC,41001355,LOCAL,,inpatient,,,226.8,226.8,,,,,,,,,,,,,,,,,
Sperm antibody test,300,RC,41001356,LOCAL,,inpatient,,,155.4,155.4,,,,,,,,,,,,,,,,,
Sperm evaluation test,300,RC,41001357,LOCAL,,inpatient,,,289.8,289.8,,,,,,,,,,,,,,,,,
Evaluation cervical mucus,300,RC,41001358,LOCAL,,inpatient,,,151.2,151.2,,,,,,,,,,,,,,,,,
Retrograde ejaculation anal,300,RC,41001359,LOCAL,,inpatient,,,289.8,289.8,,,,,,,,,,,,,,,,,
Cryopreserve testicular tiss,300,RC,41001360,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Cryopreservation oocyte(s),300,RC,41001361,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Storage/year embryo(s),300,RC,41001362,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Storage/year sperm/semen,300,RC,41001363,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Storage/year reprod tissue,300,RC,41001364,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Storage/year oocyte(s),300,RC,41001365,LOCAL,,inpatient,,,4166.4,4166.4,,,,,,,,,,,,,,,,,
Thawing cryopresrved embryo,300,RC,41001366,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Thawing cryopresrved sperm,300,RC,41001367,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Thaw cryoprsvrd reprod tiss,300,RC,41001368,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Thawing cryopresrved oocyte,300,RC,41001369,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Unlisted reprod med lab proc,300,RC,41001370,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
INF DISEASE 22 TGTS,300,RC,41001371,LOCAL,,inpatient,,,630,630,,,,,,,,,,,,,,,,,
OP SPEC COLL COVID19,300,RC,41001372,LOCAL,,inpatient,,,340.2,340.2,,,,,,,,,,,,,,,,,
Semen analysis,300,RC,41001373,LOCAL,,inpatient,,,96.6,96.6,,,,,,,,,,,,,,,,,
Screen cerv/vag thin layer,300,RC,41001375,LOCAL,,inpatient,,,298.2,298.2,,,,,,,,,,,,,,,,,
"Scr c/v cyto,thinlayer,rescr",300,RC,41001376,LOCAL,,inpatient,,,399,399,,,,,,,,,,,,,,,,,
"Scr c/v cyto,thinlayer,rescr",300,RC,41001377,LOCAL,,inpatient,,,646.8,646.8,,,,,,,,,,,,,,,,,
AB COVID 19 SGL STEP,302,RC,41001378,LOCAL,,inpatient,,,136.472,136.472,,,,,,,,,,,,,,,,,
"Scr c/v cyto,thinlayer,rescr",300,RC,41001379,LOCAL,,inpatient,,,390.6,390.6,,,,,,,,,,,,,,,,,
"Scr c/v cyto, automated sys",300,RC,41001381,LOCAL,,inpatient,,,222.6,222.6,,,,,,,,,,,,,,,,,
"Scr c/v cyto, autosys, rescr",300,RC,41001382,LOCAL,,inpatient,,,470.4,470.4,,,,,,,,,,,,,,,,,
Lab pathology consultation,300,RC,41001384,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Lab pathology consultation,300,RC,41001386,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Fecal blood scrn immunoassay,300,RC,41001387,LOCAL,,inpatient,,,264.6,264.6,,,,,,,,,,,,,,,,,
Bone marrow interpretation,300,RC,41001388,LOCAL,,inpatient,,,532.952,532.952,,,,,,,,,,,,,,,,,
Eia hiv-1/hiv-2 screen,300,RC,41001389,LOCAL,,inpatient,,,285.6,285.6,,,,,,,,,,,,,,,,,
Phys blood bank serv xmatch,300,RC,41001390,LOCAL,,inpatient,,,336,336,,,,,,,,,,,,,,,,,
Elisa hiv-1/hiv-2 screen,300,RC,41001391,LOCAL,,inpatient,,,268.8,268.8,,,,,,,,,,,,,,,,,
Phys blood bank serv reactj,300,RC,41001392,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Oral hiv-1/hiv-2 screen,300,RC,41001393,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
Phys blood bank serv authrj,300,RC,41001394,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Ven blood coll snf/hha,300,RC,41001395,LOCAL,,inpatient,,,75.6,75.6,,,,,,,,,,,,,,,,,
Skin test candida,302,RC,41001396,LOCAL,,inpatient,,,336,336,,,,,,,,,,,,,,,,,
Hep c screen high risk/other,300,RC,41001397,LOCAL,,inpatient,,,680.4,680.4,,,,,,,,,,,,,,,,,
Skin test nos antigen,302,RC,41001398,LOCAL,,inpatient,,,336,336,,,,,,,,,,,,,,,,,
Hiv combination assay,300,RC,41001399,LOCAL,,inpatient,,,352.8,352.8,,,,,,,,,,,,,,,,,
Coccidioidomycosis skin test,302,RC,41001400,LOCAL,,inpatient,,,810.6,810.6,,,,,,,,,,,,,,,,,
Hpv combo assay ca screen,300,RC,41001401,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
Histoplasmosis skin test,302,RC,41001402,LOCAL,,inpatient,,,810.6,810.6,,,,,,,,,,,,,,,,,
Drug test def 1-7 classes,300,RC,41001403,LOCAL,,inpatient,,,1684.2,1684.2,,,,,,,,,,,,,,,,,
Drug test def 8-14 classes,300,RC,41001405,LOCAL,,inpatient,,,2301.6,2301.6,,,,,,,,,,,,,,,,,
Drug test def 15-21 classes,300,RC,41001406,LOCAL,,inpatient,,,2923.2,2923.2,,,,,,,,,,,,,,,,,
Drug test def 22+ classes,300,RC,41001407,LOCAL,,inpatient,,,3628.8,3628.8,,,,,,,,,,,,,,,,,
Hepb screen high risk indiv,300,RC,41001408,LOCAL,,inpatient,,,415.8,415.8,,,,,,,,,,,,,,,,,
Drug test def simple all cl,300,RC,41001409,LOCAL,,inpatient,,,911.4,911.4,,,,,,,,,,,,,,,,,
Specimen collect COVID-19,300,RC,41001410,LOCAL,,inpatient,,,344.4,344.4,,,,,,,,,,,,,,,,,
Spec coll SNF/Lab COVID-19,300,RC,41001411,LOCAL,,inpatient,,,373.8,373.8,,,,,,,,,,,,,,,,,
Warfarin respon genetic test,300,RC,41001412,LOCAL,,inpatient,,,1776.6,1776.6,,,,,,,,,,,,,,,,,
Cephalin floculation test,300,RC,41001413,LOCAL,,inpatient,,,71.4,71.4,,,,,,,,,,,,,,,,,
Congo red blood test,300,RC,41001414,LOCAL,,inpatient,,,71.4,71.4,,,,,,,,,,,,,,,,,
Hair analysis,300,RC,41001415,LOCAL,,inpatient,,,71.4,71.4,,,,,,,,,,,,,,,,,
Blood thymol turbidity,300,RC,41001416,LOCAL,,inpatient,,,71.4,71.4,,,,,,,,,,,,,,,,,
Blood mucoprotein,300,RC,41001417,LOCAL,,inpatient,,,71.4,71.4,,,,,,,,,,,,,,,,,
Screen pap by tech w md supv,300,RC,41001418,LOCAL,,inpatient,,,222.6,222.6,,,,,,,,,,,,,,,,,
Catheterize for urine spec,300,RC,41001419,LOCAL,,inpatient,,,46.2,46.2,,,,,,,,,,,,,,,,,
Urine specimen collect mult,300,RC,41001420,LOCAL,,inpatient,,,46.2,46.2,,,,,,,,,,,,,,,,,
Wet mounts/ w preparations,300,RC,41001421,LOCAL,,inpatient,,,222.6,222.6,,,,,,,,,,,,,,,,,
Potassium hydroxide preps,300,RC,41001422,LOCAL,,inpatient,,,84,84,,,,,,,,,,,,,,,,,
Pinworm examinations,300,RC,41001423,LOCAL,,inpatient,,,63,63,,,,,,,,,,,,,,,,,
Fern test,300,RC,41001424,LOCAL,,inpatient,,,142.8,142.8,,,,,,,,,,,,,,,,,
Post-coital mucous exam,300,RC,41001425,LOCAL,,inpatient,,,369.6,369.6,,,,,,,,,,,,,,,,,
2019-ncov diagnostic p,300,RC,41001426,LOCAL,,inpatient,,,527.898,527.898,,,,,,,,,,,,,,,,,
Covid-19 lab test non-cdc,300,RC,41001427,LOCAL,,inpatient,,,754.278,754.278,,,,,,,,,,,,,,,,,
COVID19 AMP 2020-01R,305,RC,41001428,LOCAL,,inpatient,,,420,420,,,,,,,,,,,,,,,,,
COVID 19 ANY 2020-01,305,RC,41001429,LOCAL,,inpatient,,,420,420,,,,,,,,,,,,,,,,,
Wound Culture,301,RC,41001442,LOCAL,,inpatient,,,114.66,114.66,,,,,,,,,,,,,,,,,
Tox Screen - PCP,307,RC,41001447,LOCAL,,inpatient,,,390.6,390.6,,,,,,,,,,,,,,,,,
NEUTRALIZ AB SAR SCR,300,RC,41001451,LOCAL,,inpatient,,,44.688,44.688,,,,,,,,,,,,,,,,,
NEUTRAL AB SAR TITER,300,RC,41001452,LOCAL,,inpatient,,,44.688,44.688,,,,,,,,,,,,,,,,,
INF DNA/RN 21TGT SAR,300,RC,41001453,LOCAL,,inpatient,,,420,420,,,,,,,,,,,,,,,,,
"SVN SAR,ELISA,PL SER",300,RC,41001454,LOCAL,,inpatient,,,420,420,,,,,,,,,,,,,,,,,
SAR COV/COVID AB QUA,300,RC,41001455,LOCAL,,inpatient,,,72.534,72.534,,,,,,,,,,,,,,,,,
INF AG DNA/RNA MLPLX,300,RC,41001456,LOCAL,,inpatient,,,599.046,599.046,,,,,,,,,,,,,,,,,
INF AG DNA/RNA SYNC,300,RC,41001457,LOCAL,,inpatient,,,599.046,599.046,,,,,,,,,,,,,,,,,
INF AG ANT IMM W/VIS,300,RC,41001458,LOCAL,,inpatient,,,599.046,599.046,,,,,,,,,,,,,,,,,
INF DIS PATH RNA 3TG,300,RC,41001459,LOCAL,,inpatient,,,538.818,538.818,,,,,,,,,,,,,,,,,
INF DIS PATH RNA 4TG,300,RC,41001460,LOCAL,,inpatient,,,538.818,538.818,,,,,,,,,,,,,,,,,
CULTURE-CATH TIP,300,RC,41001484,LOCAL,,inpatient,,,114.66,114.66,,,,,,,,,,,,,,,,,
ADMISSION PROFILE,300,RC,41001492,LOCAL,,inpatient,,,1.4,1.4,,,,,,,,,,,,,,,,,
CARDIAC PANEL (ENZYMES),301,RC,41001493,LOCAL,,inpatient,,,1.4,1.4,,,,,,,,,,,,,,,,,
Candida auris Scr (inc CarbaR),306,RC,41001504,LOCAL,,inpatient,,,516.6,516.6,,,,,,,,,,,,,,,,,
VANCOMYCIN PEAK,300,RC,41001548,LOCAL,,inpatient,,,180.32,180.32,,,,,,,,,,,,,,,,,
VANCOMYCIN TROUGH,300,RC,41001549,LOCAL,,inpatient,,,180.32,180.32,,,,,,,,,,,,,,,,,
ANTI-MITOCHONDIAL AB,300,RC,41001550,LOCAL,,inpatient,,,160.44,160.44,,,,,,,,,,,,,,,,,
C3 COMPLEMENT,300,RC,41001556,LOCAL,,inpatient,,,159.81,159.81,,,,,,,,,,,,,,,,,
C4 COMPLEMENT,300,RC,41001557,LOCAL,,inpatient,,,159.81,159.81,,,,,,,,,,,,,,,,,
"CHLORIDE, UR RANDOM",300,RC,41001560,LOCAL,,inpatient,,,66.92,66.92,,,,,,,,,,,,,,,,,
"CREATININE, UR 24HR",300,RC,41001561,LOCAL,,inpatient,,,68.88,68.88,,,,,,,,,,,,,,,,,
CULTURE SPUTUM,300,RC,41001565,LOCAL,,inpatient,,,114.66,114.66,,,,,,,,,,,,,,,,,
GENTAMICIN RANDOM LEVEL,300,RC,41001571,LOCAL,,inpatient,,,218.19,218.19,,,,,,,,,,,,,,,,,
"GENTAMICIN, PEAK LEVEL",300,RC,41001572,LOCAL,,inpatient,,,218.19,218.19,,,,,,,,,,,,,,,,,
"GENTAMICIN, TROUGH LEVEL",300,RC,41001573,LOCAL,,inpatient,,,218.19,218.19,,,,,,,,,,,,,,,,,
"IMMUNOFIXATION,UR 24HR",300,RC,41001574,LOCAL,,inpatient,,,48.79,48.79,,,,,,,,,,,,,,,,,
TOTAL PROTEIN UR 24 HR,300,RC,41001585,LOCAL,,inpatient,,,48.79,48.79,,,,,,,,,,,,,,,,,
"TOTAL PROTEIN,URINE",300,RC,41001588,LOCAL,,inpatient,,,48.79,48.79,,,,,,,,,,,,,,,,,
Direct Antiglobulin Test (DAT),300,RC,41001594,LOCAL,,inpatient,,,68.88,68.88,,,,,,,,,,,,,,,,,
Vancomycin-Resistant Ent (VRE),306,RC,41001600,LOCAL,,inpatient,,,1.4,1.4,,,,,,,,,,,,,,,,,
"AMIKACIN LEVEL, PEAK",301,RC,41001604,LOCAL,,inpatient,,,200.62,200.62,,,,,,,,,,,,,,,,,
"AMIKACIN LEVEL, TROUGH",301,RC,41001605,LOCAL,,inpatient,,,200.62,200.62,,,,,,,,,,,,,,,,,
CBC W/ MANUAL DIFF,305,RC,41001608,LOCAL,,inpatient,,,57.26,57.26,,,,,,,,,,,,,,,,,
COVID19 RAPID ANTIGEN TEST,300,RC,41001613,LOCAL,,inpatient,,,420,420,,,,,,,,,,,,,,,,,
CULTURE AFB AND SMEAR,300,RC,41001620,LOCAL,,inpatient,,,143.85,143.85,,,,,,,,,,,,,,,,,
CULTURE GENITAL,300,RC,41001623,LOCAL,,inpatient,,,114.66,114.66,,,,,,,,,,,,,,,,,
"CYCLOSPORINE A, PEAK (2 HOUR)",300,RC,41001626,LOCAL,,inpatient,,,240.31,240.31,,,,,,,,,,,,,,,,,
"CYCLOSPORINE A, TROUGH",300,RC,41001627,LOCAL,,inpatient,,,240.31,240.31,,,,,,,,,,,,,,,,,
Drug Abuse Panel 10 w/ Oxy,300,RC,41001628,LOCAL,,inpatient,,,105.28,105.28,,,,,,,,,,,,,,,,,
"EOSINOPHILS, URINE",300,RC,41001629,LOCAL,,inpatient,,,74.55,74.55,,,,,,,,,,,,,,,,,
Erythropoietin (EPO)      ,300,RC,41001630,LOCAL,,inpatient,,,250.25,250.25,,,,,,,,,,,,,,,,,
Fungitell (1-3)-ß-D-Glucan As,300,RC,41001632,LOCAL,,inpatient,,,159.67,159.67,,,,,,,,,,,,,,,,,
"Hepatitis B Core Antibody, IgM",302,RC,41001640,LOCAL,,inpatient,,,156.66,156.66,,,,,,,,,,,,,,,,,
Immunoglobulin A (IGA)    ,302,RC,41001644,LOCAL,,inpatient,,,123.83,123.83,,,,,,,,,,,,,,,,,
Immunoglobulin E (IGE)  ,302,RC,41001645,LOCAL,,inpatient,,,219.24,219.24,,,,,,,,,,,,,,,,,
Immunoglobulin G (IGG)       ,302,RC,41001646,LOCAL,,inpatient,,,123.83,123.83,,,,,,,,,,,,,,,,,
MRSA Screen by Culture,302,RC,41001653,LOCAL,,inpatient,,,467.18,467.18,,,,,,,,,,,,,,,,,
OVA AND PARASITE,300,RC,41001655,LOCAL,,inpatient,,,118.44,118.44,,,,,,,,,,,,,,,,,
QUANTIFERON TB GOLD,300,RC,41001658,LOCAL,,inpatient,,,660.016,660.016,,,,,,,,,,,,,,,,,
TESTOSTERONE FREE AND TOTAL,300,RC,41001660,LOCAL,,inpatient,,,682.71,682.71,,,,,,,,,,,,,,,,,
"TOBRAMYCIN LEVEL, PEAK   ",300,RC,41001664,LOCAL,,inpatient,,,214.55,214.55,,,,,,,,,,,,,,,,,
"TOBRAMYCIN LEVEL, TROUGH",300,RC,41001665,LOCAL,,inpatient,,,214.55,214.55,,,,,,,,,,,,,,,,,
VARICELLA ZOSTER ANTIBODY IGM,302,RC,41001669,LOCAL,,inpatient,,,171.5,171.5,,,,,,,,,,,,,,,,,
VITAMIN C,300,RC,41001671,LOCAL,,inpatient,,,131.6,131.6,,,,,,,,,,,,,,,,,
CULTURE MRSA,306,RC,41001675,LOCAL,,inpatient,,,88.27,88.27,,,,,,,,,,,,,,,,,
HEMAGLOBIN and HEMATOCRIT,305,RC,41001676,LOCAL,,inpatient,,,99.554,99.554,,,,,,,,,,,,,,,,,
Amiodarone (Cordarone),301,RC,41001677,LOCAL,,inpatient,,,1.4,1.4,,,,,,,,,,,,,,,,,
"AMYLASE, BODY FLUID",309,RC,41001678,LOCAL,,inpatient,,,1.4,1.4,,,,,,,,,,,,,,,,,
ANTI-JO ANTIBODIES,301,RC,41001679,LOCAL,,inpatient,,,1.4,1.4,,,,,,,,,,,,,,,,,
"ANTISKIN AUTOANTIBODIES, QUANT",301,RC,41001680,LOCAL,,inpatient,,,1.4,1.4,,,,,,,,,,,,,,,,,
CD4:CD8 RATIO,302,RC,41001683,LOCAL,,inpatient,,,1.4,1.4,,,,,,,,,,,,,,,,,
CULTURE AEROBIC,306,RC,41001684,LOCAL,,inpatient,,,114.66,114.66,,,,,,,,,,,,,,,,,
CULTURE THROAT,306,RC,41001685,LOCAL,,inpatient,,,114.66,114.66,,,,,,,,,,,,,,,,,
GLUTAMIC ACID DECARBOXYLASE,301,RC,41001686,LOCAL,,inpatient,,,75.53,75.53,,,,,,,,,,,,,,,,,
LUPUS ANTICOAGULANT COMP,309,RC,41001687,LOCAL,,inpatient,,,1.4,1.4,,,,,,,,,,,,,,,,,
Hepatitis Screen,302,RC,41001688,LOCAL,,inpatient,,,14,14,,,,,,,,,,,,,,,,,
MEASLES/MUMPS/RUBELLA IMMUNITY,302,RC,41001689,LOCAL,,inpatient,,,140,140,,,,,,,,,,,,,,,,,
STREPTOZYME,306,RC,41001690,LOCAL,,inpatient,,,97.16,97.16,,,,,,,,,,,,,,,,,
Fingerstick PT/INR,300,RC,41001691,LOCAL,,inpatient,,,1.4,1.4,,,,,,,,,,,,,,,,,
SEND-OUT : AMMONIA,301,RC,41001692,LOCAL,,inpatient,,,193.97,193.97,,,,,,,,,,,,,,,,,
SEND-OUT : BMP,301,RC,41001693,LOCAL,,inpatient,,,112.63,112.63,,,,,,,,,,,,,,,,,
SEND-OUT : CBC,301,RC,41001694,LOCAL,,inpatient,,,103.53,103.53,,,,,,,,,,,,,,,,,
VENIPUNCTURE,300,RC,41001695,LOCAL,,inpatient,,,49.49,49.49,,,,,,,,,,,,,,,,,
SEND-OUT : CMP,301,RC,41001696,LOCAL,,inpatient,,,140.742,140.742,,,,,,,,,,,,,,,,,
SEND-OUT : CRP,301,RC,41001697,LOCAL,,inpatient,,,68.88,68.88,,,,,,,,,,,,,,,,,
SEND-OUT : ESR,305,RC,41001698,LOCAL,,inpatient,,,35.98,35.98,,,,,,,,,,,,,,,,,
SEND-OUT : POTASSIUM,301,RC,41001699,LOCAL,,inpatient,,,61.18,61.18,,,,,,,,,,,,,,,,,
SEND-OUT : PTT,309,RC,41001700,LOCAL,,inpatient,,,79.94,79.94,,,,,,,,,,,,,,,,,
SEND-OUT : LIVER FUNCTION PNL,301,RC,41001701,LOCAL,,inpatient,,,108.71,108.71,,,,,,,,,,,,,,,,,
SEND-OUT : VANCYMYCIN RANDOM,301,RC,41001702,LOCAL,,inpatient,,,180.32,180.32,,,,,,,,,,,,,,,,,
SEND-OUT : PT/INR,309,RC,41001703,LOCAL,,inpatient,,,52.29,52.29,,,,,,,,,,,,,,,,,
SEND-OUT : COVID PCR,300,RC,41001704,LOCAL,,inpatient,,,210,210,,,,,,,,,,,,,,,,,
LabCorp CMP,301,RC,41001705,LOCAL,,inpatient,,,140.742,140.742,,,,,,,,,,,,,,,,,
LabCorp CBC,305,RC,41001706,LOCAL,,inpatient,,,103.53,103.53,,,,,,,,,,,,,,,,,
LabCorp BMP,301,RC,41001707,LOCAL,,inpatient,,,112.63,112.63,,,,,,,,,,,,,,,,,
Total Iron-binding Capacity,301,RC,41001708,LOCAL,,inpatient,,,114.94,114.94,,,,,,,,,,,,,,,,,
Type & Screen,390,RC,41001709,LOCAL,,inpatient,,,1.4,1.4,,,,,,,,,,,,,,,,,
Fecal Occult Blood 2nd Spec.,300,RC,41001711,LOCAL,,inpatient,,,43.33,43.33,,,,,,,,,,,,,,,,,
Fecal Occult Blood 3rd Spec.,300,RC,41001712,LOCAL,,inpatient,,,43.33,43.33,,,,,,,,,,,,,,,,,
HIV - 1 Viral Load,300,RC,41001748,LOCAL,,inpatient,,,1132.74,1132.74,,,,,,,,,,,,,,,,,
Send-Out: Ferritin,300,RC,41001768,LOCAL,,inpatient,,,181.3,181.3,,,,,,,,,,,,,,,,,
Send-Out: D-Dimer,300,RC,41001769,LOCAL,,inpatient,,,244.384,244.384,,,,,,,,,,,,,,,,,
Send-Out: Folate,300,RC,41001770,LOCAL,,inpatient,,,145.6,145.6,,,,,,,,,,,,,,,,,
Send-Out: Procal,300,RC,41001771,LOCAL,,inpatient,,,285.18,285.18,,,,,,,,,,,,,,,,,
Send-Out: Vitamin B12,300,RC,41001772,LOCAL,,inpatient,,,200.62,200.62,,,,,,,,,,,,,,,,,
Send-Out: Free (FT-4),300,RC,41001773,LOCAL,,inpatient,,,19.082,19.082,,,,,,,,,,,,,,,,,
Send-Out: TSH,300,RC,41001774,LOCAL,,inpatient,,,223.58,223.58,,,,,,,,,,,,,,,,,
Send-Out: Cultures Blood,300,RC,41001775,LOCAL,,inpatient,,,151.2,151.2,,,,,,,,,,,,,,,,,
CPO Rectal Screening,300,RC,41001780,LOCAL,,inpatient,,,42,42,,,,,,,,,,,,,,,,,
Plasma fresh frozen,300,RC,41200000,LOCAL,,inpatient,,,1071,1071,,,,,,,,,,,,,,,,,
Blood product/irradiation,300,RC,41200006,LOCAL,,inpatient,,,532,532,,,,,,,,,,,,,,,,,
Pooling blood platelets,300,RC,41200009,LOCAL,,inpatient,,,1344,1344,,,,,,,,,,,,,,,,,
Enzyme ID Panel,300,RC,41200011,LOCAL,,inpatient,,,4166.4,4166.4,,,,,,,,,,,,,,,,,
Rbc serum pretx incubj/inhib,300,RC,41200015,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
BL BLOOD-ADMINISTRATION,391,RC,41200018,LOCAL,,inpatient,,,1737.162,1737.162,,,,,,,,,,,,,,,,,
BL PROCESSING/STORAGE EA P9016,390,RC,41200027,LOCAL,,inpatient,,,35,35,,,,,,,,,,,,,,,,,
BL PROCESSING/STORAGE EA P9019,390,RC,41200031,LOCAL,,inpatient,,,35,35,,,,,,,,,,,,,,,,,
BL PROCESSING/STORAGE EA P9021,390,RC,41200035,LOCAL,,inpatient,,,35,35,,,,,,,,,,,,,,,,,
BL PROCESSING/STORAGE EA P9022,390,RC,41200037,LOCAL,,inpatient,,,35,35,,,,,,,,,,,,,,,,,
BL PROCESSING/STORAGE EA P9023,390,RC,41200039,LOCAL,,inpatient,,,35,35,,,,,,,,,,,,,,,,,
BL PROCESSING/STORAGE EA P9031,390,RC,41200041,LOCAL,,inpatient,,,35,35,,,,,,,,,,,,,,,,,
BL PROCESSING/STORAGE EA P9032,390,RC,41200043,LOCAL,,inpatient,,,35,35,,,,,,,,,,,,,,,,,
BL PROCESSING/STORAGE EA P9033,390,RC,41200045,LOCAL,,inpatient,,,35,35,,,,,,,,,,,,,,,,,
BL PROCESSING/STORAGE EA P9034,390,RC,41200047,LOCAL,,inpatient,,,35,35,,,,,,,,,,,,,,,,,
BL PROCESSING/STORAGE EA P9038,390,RC,41200055,LOCAL,,inpatient,,,35,35,,,,,,,,,,,,,,,,,
BL PROCESSING/STORAGE EA P9039,390,RC,41200057,LOCAL,,inpatient,,,35,35,,,,,,,,,,,,,,,,,
BL PROCESSING/STORAGE EA P9040,390,RC,41200059,LOCAL,,inpatient,,,35,35,,,,,,,,,,,,,,,,,
RT Suctioning,410,RC,44000131,LOCAL,,inpatient,,,175,175,,,,,,,,,,,,,,,,,
RT Eval/Assessment,410,RC,44000132,LOCAL,,inpatient,,,452.2,452.2,,,,,,,,,,,,,,,,,
Blood - Packed Cells,381,RC,99990381,LOCAL,,inpatient,,,715.4,715.4,,,,,,,,,,,,,,,,,
Tissue exam by pathologist,300,RC,41100000,LOCAL,,inpatient,,,273,273,,,,,,,,,,,,,,,,,
Tissue exam by pathologist,300,RC,41100001,LOCAL,,inpatient,,,343,343,,,,,,,,,,,,,,,,,
Tissue exam by pathologist,300,RC,41100002,LOCAL,,inpatient,,,572.6,572.6,,,,,,,,,,,,,,,,,
Tissue exam by pathologist,300,RC,41100003,LOCAL,,inpatient,,,1173.2,1173.2,,,,,,,,,,,,,,,,,
Tissue exam by pathologist,300,RC,41100004,LOCAL,,inpatient,,,1783.6,1783.6,,,,,,,,,,,,,,,,,
Special stains group 1,300,RC,41100005,LOCAL,,inpatient,,,90.216,90.216,,,,,,,,,,,,,,,,,
Special stains group 2,300,RC,41100006,LOCAL,,inpatient,,,491.4,491.4,,,,,,,,,,,,,,,,,
Enzyme histochemistry,300,RC,41100007,LOCAL,,inpatient,,,9235.8,9235.8,,,,,,,,,,,,,,,,,
Microslide consultation,300,RC,41100008,LOCAL,,inpatient,,,491.4,491.4,,,,,,,,,,,,,,,,,
Microslide consultation,300,RC,41100009,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Comprehensive review of data,300,RC,41100010,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Path consult introp,300,RC,41100011,LOCAL,,inpatient,,,491.4,491.4,,,,,,,,,,,,,,,,,
Path consult intraop 1 bloc,300,RC,41100012,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Intraop cyto path consult 1,300,RC,41100013,LOCAL,,inpatient,,,9235.8,9235.8,,,,,,,,,,,,,,,,,
Immunohisto antb 1st stain,300,RC,41100014,LOCAL,,inpatient,,,414.4,414.4,,,,,,,,,,,,,,,,,
Immunohisto antibody slide,300,RC,41100015,LOCAL,,inpatient,,,4166.4,4166.4,,,,,,,,,,,,,,,,,
Immunofluor antb 1st stain,300,RC,41100016,LOCAL,,inpatient,,,4166.4,4166.4,,,,,,,,,,,,,,,,,
Electron microscopy,300,RC,41100017,LOCAL,,inpatient,,,9235.8,9235.8,,,,,,,,,,,,,,,,,
Analysis skeletal muscle,300,RC,41100018,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Analysis nerve,300,RC,41100019,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Analysis tumor,300,RC,41100020,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Tumor immunohistochem/manual,300,RC,41100021,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Tumor immunohistochem/comput,300,RC,41100022,LOCAL,,inpatient,,,4166.4,4166.4,,,,,,,,,,,,,,,,,
Nerve teasing preparations,300,RC,41100023,LOCAL,,inpatient,,,9235.8,9235.8,,,,,,,,,,,,,,,,,
Xm archive tissue molec anal,300,RC,41100024,LOCAL,,inpatient,,,336,336,,,,,,,,,,,,,,,,,
Insitu hybridization (fish),300,RC,41100025,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Insitu hybridization (fish),300,RC,41100026,LOCAL,,inpatient,,,4166.4,4166.4,,,,,,,,,,,,,,,,,
Insitu hybridization auto,300,RC,41100027,LOCAL,,inpatient,,,4166.4,4166.4,,,,,,,,,,,,,,,,,
Insitu hybridization manual,300,RC,41100028,LOCAL,,inpatient,,,672,672,,,,,,,,,,,,,,,,,
Protein western blot tissue,300,RC,41100029,LOCAL,,inpatient,,,327.6,327.6,,,,,,,,,,,,,,,,,
Protein analysis w/probe,300,RC,41100030,LOCAL,,inpatient,,,386.4,386.4,,,,,,,,,,,,,,,,,
M/phmtrc alys ishquant/semiq,300,RC,41100031,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
M/phmtrc alys ishquant/semiq,300,RC,41100032,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Surgical pathology procedure,300,RC,41100033,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Bilirubin total transcut,300,RC,41100034,LOCAL,,inpatient,,,75.6,75.6,,,,,,,,,,,,,,,,,
Hgb quant transcutaneous,300,RC,41100035,LOCAL,,inpatient,,,75.6,75.6,,,,,,,,,,,,,,,,,
Transcutaneous carboxyhb,300,RC,41100036,LOCAL,,inpatient,,,138.6,138.6,,,,,,,,,,,,,,,,,
Transcutaneous methb,300,RC,41100037,LOCAL,,inpatient,,,138.6,138.6,,,,,,,,,,,,,,,,,
Chct for mal hyperthermia,300,RC,41100038,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Body fluid cell count,300,RC,41100039,LOCAL,,inpatient,,,62.93,62.93,,,,,,,,,,,,,,,,,
Body fluid cell count,300,RC,41100040,LOCAL,,inpatient,,,73.29,73.29,,,,,,,,,,,,,,,,,
Exam synovial fluid crystals,300,RC,41100042,LOCAL,,inpatient,,,95.2,95.2,,,,,,,,,,,,,,,,,
Specimen fat stain,306,RC,41100043,LOCAL,,inpatient,,,57.47,57.47,,,,,,,,,,,,,,,,,
Exam feces for meat fibers,300,RC,41100044,LOCAL,,inpatient,,,71.4,71.4,,,,,,,,,,,,,,,,,
Nasal smear for eosinophils,300,RC,41100045,LOCAL,,inpatient,,,63.21,63.21,,,,,,,,,,,,,,,,,
Sputum specimen collection,300,RC,41100046,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Collect sweat for test,300,RC,41100047,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Pathology lab procedure,300,RC,41100048,LOCAL,,inpatient,,,726.6,726.6,,,,,,,,,,,,,,,,,
Frozen blood prep,300,RC,41200001,LOCAL,,inpatient,,,1470.924,1470.924,,,,,,,,,,,,,,,,,
Frozen blood thaw,300,RC,41200002,LOCAL,,inpatient,,,4166.4,4166.4,,,,,,,,,,,,,,,,,
Frozen blood freeze/thaw,300,RC,41200003,LOCAL,,inpatient,,,491.4,491.4,,,,,,,,,,,,,,,,,
Hemolysins/agglutinins auto,300,RC,41200004,LOCAL,,inpatient,,,130.2,130.2,,,,,,,,,,,,,,,,,
Hemolysins/agglutinins,300,RC,41200005,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
Leukacyte transfusion,300,RC,41200007,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Vol reduction of blood/prod,300,RC,41200008,LOCAL,,inpatient,,,88.2,88.2,,,,,,,,,,,,,,,,,
Rbc pretx incubatj w/chemicl,300,RC,41200010,LOCAL,,inpatient,,,252,252,,,,,,,,,,,,,,,,,
Cell Separation,300,RC,41200012,LOCAL,,inpatient,,,828.8,828.8,,,,,,,,,,,,,,,,,
Rbc serum pretx incubj drugs,300,RC,41200013,LOCAL,,inpatient,,,1604.4,1604.4,,,,,,,,,,,,,,,,,
Rbc serum pretx id dilution,300,RC,41200014,LOCAL,,inpatient,,,336,336,,,,,,,,,,,,,,,,,
Rbc pretreatment (Absorption),300,RC,41200016,LOCAL,,inpatient,,,491.4,491.4,,,,,,,,,,,,,,,,,
Split blood or products,300,RC,41200017,LOCAL,,inpatient,,,2108.4,2108.4,,,,,,,,,,,,,,,,,
Paracentesis,361,RC,42000000,LOCAL,,inpatient,,,3400.32,3400.32,,,,,,,,,,,,,,,,,
Percutaneous Tracheostomy,361,RC,42000001,LOCAL,,inpatient,,,15432.06,15432.06,,,,,,,,,,,,,,,,,
PEG,361,RC,42000002,LOCAL,,inpatient,,,6825,6825,,,,,,,,,,,,,,,,,
Intubation,361,RC,42000003,LOCAL,,inpatient,,,1258.32,1258.32,,,,,,,,,,,,,,,,,
Upper Gastro/Endoscopy,750,RC,42000004,LOCAL,,inpatient,,,4969.51,4969.51,,,,,,,,,,,,,,,,,
PICC Line Insertion,360,RC,42000032,LOCAL,,inpatient,,,6031.76,6031.76,,,,,,,,,,,,,,,,,
BRONCH EBUS 1 OR 2 STAT,360,RC,42000042,LOCAL,,inpatient,,,17261.3,17261.3,,,,,,,,,,,,,,,,,
BRONCH EBUS 3 OR > STAT,360,RC,42000043,LOCAL,,inpatient,,,17261.3,17261.3,,,,,,,,,,,,,,,,,
ESO FLX W/DIL BALLOON 30MM DIA,360,RC,42000044,LOCAL,,inpatient,,,9476.53,9476.53,,,,,,,,,,,,,,,,,
ESO FLX W/END US EXM,360,RC,42000045,LOCAL,,inpatient,,,9476.53,9476.53,,,,,,,,,,,,,,,,,
SIGMOIDOSCOPY FLX DIAG,360,RC,42000046,LOCAL,,inpatient,,,4740.33,4740.33,,,,,,,,,,,,,,,,,
NEEDLE BIOPSY W US 1ST LESION,361,RC,42000109,LOCAL,,inpatient,,,3451.56,3451.56,,,,,,,,,,,,,,,,,
NEEDLE BIOP W/US EACH ADDL,361,RC,42000110,LOCAL,,inpatient,,,277.83,277.83,,,,,,,,,,,,,,,,,
INCISIONAL BIOPSY SKIN SINGLE,361,RC,42000111,LOCAL,,inpatient,,,2080.4,2080.4,,,,,,,,,,,,,,,,,
SMPL REP SUP WOUND 12.6 TO 20C,361,RC,42000112,LOCAL,,inpatient,,,2078.58,2078.58,,,,,,,,,,,,,,,,,
"INCISION, BONE CORTEX, FOOT",360,RC,42000113,LOCAL,,inpatient,,,11887.4,11887.4,,,,,,,,,,,,,,,,,
LARYNGSCPY DIR W/WO TRACH DIAG,360,RC,42000114,LOCAL,,inpatient,,,6309.24,6309.24,,,,,,,,,,,,,,,,,
LARYNGOSCOPY FLEX; DIAGNOSTIC,360,RC,42000115,LOCAL,,inpatient,,,1039.29,1039.29,,,,,,,,,,,,,,,,,
UNLISTED PROCEDURE LARYNX,361,RC,42000116,LOCAL,,inpatient,,,907.2,907.2,,,,,,,,,,,,,,,,,
BRONCH W/BRUSHING,360,RC,42000117,LOCAL,,inpatient,,,9015.51,9015.51,,,,,,,,,,,,,,,,,
BRONCH W/ALVEOLAR LAVAGE,360,RC,42000118,LOCAL,,inpatient,,,9015.51,9015.51,,,,,,,,,,,,,,,,,
BRONCH BIOP LUNG END,360,RC,42000119,LOCAL,,inpatient,,,6038.76,6038.76,,,,,,,,,,,,,,,,,
BRONCH INS RAD MARK,360,RC,42000120,LOCAL,,inpatient,,,22701.21,22701.21,,,,,,,,,,,,,,,,,
ELECTROMAG NAV BRONCH,360,RC,42000121,LOCAL,,inpatient,,,10855.81,10855.81,,,,,,,,,,,,,,,,,
TRANSBRONCH LUNG BIOPSY SGL,360,RC,42000122,LOCAL,,inpatient,,,17261.3,17261.3,,,,,,,,,,,,,,,,,
BRONCH TRNSBRONCH NDL ASP,360,RC,42000123,LOCAL,,inpatient,,,17261.3,17261.3,,,,,,,,,,,,,,,,,
BRONCH  LUNG BX EA ADD,360,RC,42000124,LOCAL,,inpatient,,,296.94,296.94,,,,,,,,,,,,,,,,,
BRONCH W/FOR BODY REMOVAL,360,RC,42000125,LOCAL,,inpatient,,,6284.6,6284.6,,,,,,,,,,,,,,,,,
BRONCH  DEST GRTH LUNG,360,RC,42000126,LOCAL,,inpatient,,,12086.34,12086.34,,,,,,,,,,,,,,,,,
Replcmt G tube wo im/w revisio,750,RC,42000138,LOCAL,,inpatient,,,902.454,902.454,,,,,,,,,,,,,,,,,
"Laparosc, surg colectomy, part",361,RC,42000139,LOCAL,,inpatient,,,7817.754,7817.754,,,,,,,,,,,,,,,,,
Colec part w colopros w/colost,360,RC,42000140,LOCAL,,inpatient,,,8307.852,8307.852,,,,,,,,,,,,,,,,,
EEG OVER 1 HOUR,740,RC,40500001,LOCAL,,inpatient,,,3126.536,3126.536,,,,,,,,,,,,,,,,,
"EEG, AWAKE AND DROWSY",740,RC,40500002,LOCAL,,inpatient,,,1187.312,1187.312,,,,,,,,,,,,,,,,,
EEG; AWAKE AND ASLEEP,740,RC,40500003,LOCAL,,inpatient,,,2505.776,2505.776,,,,,,,,,,,,,,,,,
EEG COMA OR SLEEP ONLY,740,RC,40500004,LOCAL,,inpatient,,,2311.568,2311.568,,,,,,,,,,,,,,,,,
RT NASAL ENDOSC DIAG UN,412,RC,44000000,LOCAL,,inpatient,,,770,770,,,,,,,,,,,,,,,,,
RT INTUBATION,412,RC,44000001,LOCAL,,inpatient,,,670.488,670.488,,,,,,,,,,,,,,,,,
RT TRACH TUBE CHNG,410,RC,44000002,LOCAL,,inpatient,,,198.8,198.8,,,,,,,,,,,,,,,,,
RT BRONCHOSCOPY,460,RC,44000003,LOCAL,,inpatient,,,3924.536,3924.536,,,,,,,,,,,,,,,,,
RT ARTERIAL PUNCTURE,300,RC,44000004,LOCAL,,inpatient,,,171.248,171.248,,,,,,,,,,,,,,,,,
RT INSERTION CATH ARTERY,460,RC,44000005,LOCAL,,inpatient,,,248.038,248.038,,,,,,,,,,,,,,,,,
RT SPUTUM COLLECT,410,RC,44000006,LOCAL,,inpatient,,,900.2,900.2,,,,,,,,,,,,,,,,,
RT CARDIAC RESUSCITATION,480,RC,44000007,LOCAL,,inpatient,,,1649.704,1649.704,,,,,,,,,,,,,,,,,
RT CARDIAC DOPPLER LIMITED,483,RC,44000008,LOCAL,,inpatient,,,182,182,,,,,,,,,,,,,,,,,
RT VENT INIT SETUP,410,RC,44000009,LOCAL,,inpatient,,,218.54,218.54,,,,,,,,,,,,,,,,,
RT VENT INIT DAY,410,RC,44000010,LOCAL,,inpatient,,,2574.39,2574.39,,,,,,,,,,,,,,,,,
RT VENT  ASSIST SUBSEQ,460,RC,44000011,LOCAL,,inpatient,,,361.984,361.984,,,,,,,,,,,,,,,,,
RT VENT SUBSEQ DAILY,410,RC,44000012,LOCAL,,inpatient,,,2206.4,2206.4,,,,,,,,,,,,,,,,,
RT SPIROMETRY TRT,410,RC,44000013,LOCAL,,inpatient,,,275.52,275.52,,,,,,,,,,,,,,,,,
RT BRONCHOSPASM EVAL W/DILA,460,RC,44000014,LOCAL,,inpatient,,,163.52,163.52,,,,,,,,,,,,,,,,,
RT PULM FUNC PRE/POS,460,RC,44000015,LOCAL,,inpatient,,,325.304,325.304,,,,,,,,,,,,,,,,,
RT BRONCH PROV EVAL,460,RC,44000016,LOCAL,,inpatient,,,499.8,499.8,,,,,,,,,,,,,,,,,
RT FVC MANEUVER,460,RC,44000017,LOCAL,,inpatient,,,72.464,72.464,,,,,,,,,,,,,,,,,
RT LUNG FUNC (MBC/MVV),460,RC,44000018,LOCAL,,inpatient,,,74.256,74.256,,,,,,,,,,,,,,,,,
RT MAX BREATHING CAP,460,RC,44000019,LOCAL,,inpatient,,,220.528,220.528,,,,,,,,,,,,,,,,,
RT RESIDUAL LUNG CAPACITY,460,RC,44000020,LOCAL,,inpatient,,,220.528,220.528,,,,,,,,,,,,,,,,,
RT THORASIC GAS VOLUME,460,RC,44000022,LOCAL,,inpatient,,,173.712,173.712,,,,,,,,,,,,,,,,,
RT LUNG NITRO WASHOUT CURVE,460,RC,44000023,LOCAL,,inpatient,,,207.872,207.872,,,,,,,,,,,,,,,,,
RT MEASURE AIRFLOW RESISTANCE,460,RC,44000024,LOCAL,,inpatient,,,239.4,239.4,,,,,,,,,,,,,,,,,
RT BREATH AIRWAY CLOSING VOL,460,RC,44000025,LOCAL,,inpatient,,,197.064,197.064,,,,,,,,,,,,,,,,,
RT RESPIRATORY FLOW LOOP,460,RC,44000026,LOCAL,,inpatient,,,206.416,206.416,,,,,,,,,,,,,,,,,
RT BREATHING RESP TO CO,460,RC,44000027,LOCAL,,inpatient,,,296.8,296.8,,,,,,,,,,,,,,,,,
RT BREATH RESP HYPOXIA,460,RC,44000028,LOCAL,,inpatient,,,281.12,281.12,,,,,,,,,,,,,,,,,
RT HIGH ALT SIMULAT TST,460,RC,44000029,LOCAL,,inpatient,,,789.6,789.6,,,,,,,,,,,,,,,,,
RT HI ALT SIMTEST WO2 T,460,RC,44000030,LOCAL,,inpatient,,,789.6,789.6,,,,,,,,,,,,,,,,,
RT PULM STRESS TEST COMPLEX,460,RC,44000031,LOCAL,,inpatient,,,884.744,884.744,,,,,,,,,,,,,,,,,
RT PULM STRESS TEST SIMPLE,460,RC,44000032,LOCAL,,inpatient,,,499.8,499.8,,,,,,,,,,,,,,,,,
RT PULM STRESS T CMPLX,460,RC,44000033,LOCAL,,inpatient,,,1160.6,1160.6,,,,,,,,,,,,,,,,,
RT COUGH ASSIST,410,RC,44000034,LOCAL,,inpatient,,,74.984,74.984,,,,,,,,,,,,,,,,,
RT AEROSOL INHALATION TRMT,410,RC,44000035,LOCAL,,inpatient,,,74.984,74.984,,,,,,,,,,,,,,,,,
RT INH TRMT ACUTE AIRWY OBST/S,410,RC,44000036,LOCAL,,inpatient,,,74.984,74.984,,,,,,,,,,,,,,,,,
RT AERO/VAP INH 59 MIN,410,RC,44000037,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT IPPB TRMT 15MI,410,RC,44000038,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT LRG VOL NEB SETUP,410,RC,44000039,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT NEBULIZER TX 15 MINS,410,RC,44000040,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT NEBULIZER CG 15M,410,RC,44000041,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT EZPAP INITIAL,410,RC,44000042,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT HELIX INITIAL,410,RC,44000043,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT INHALER CHARGE 15,410,RC,44000044,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT MDI TREATMENT 15M,410,RC,44000045,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT PN SUBSEQ 20,410,RC,44000046,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT PENTAMADINE TX,410,RC,44000047,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT AEROSOL,410,RC,44000048,LOCAL,,inpatient,,,645.4,645.4,,,,,,,,,,,,,,,,,
RT BLD AERO INIT,410,RC,44000049,LOCAL,,inpatient,,,645.4,645.4,,,,,,,,,,,,,,,,,
RT EZPAP SUB 60 MIN,410,RC,44000050,LOCAL,,inpatient,,,645.4,645.4,,,,,,,,,,,,,,,,,
RT PN CONT INITIAL,410,RC,44000051,LOCAL,,inpatient,,,645.4,645.4,,,,,,,,,,,,,,,,,
RT SUBSQ NEB/MDI/EZPAP/IPPB,410,RC,44000052,LOCAL,,inpatient,,,74.984,74.984,,,,,,,,,,,,,,,,,
RT AEROSOL CONT,410,RC,44000053,LOCAL,,inpatient,,,74.984,74.984,,,,,,,,,,,,,,,,,
RT BLAND AER EA AD HR,410,RC,44000054,LOCAL,,inpatient,,,74.984,74.984,,,,,,,,,,,,,,,,,
RT EZPAP SUB 120MIN,410,RC,44000055,LOCAL,,inpatient,,,74.984,74.984,,,,,,,,,,,,,,,,,
RT HELIX IN EA AD HR,410,RC,44000056,LOCAL,,inpatient,,,74.984,74.984,,,,,,,,,,,,,,,,,
RT PN CONT SUBSEQ,410,RC,44000057,LOCAL,,inpatient,,,74.984,74.984,,,,,,,,,,,,,,,,,
RT CPAP TREATMENT,410,RC,44000058,LOCAL,,inpatient,,,316.4,316.4,,,,,,,,,,,,,,,,,
RT CPAP/BIPAP DAILY,410,RC,44000059,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT NEG PRESSURE VENT,410,RC,44000060,LOCAL,,inpatient,,,206.472,206.472,,,,,,,,,,,,,,,,,
RT CNP INIT/MGMT,410,RC,44000061,LOCAL,,inpatient,,,1834,1834,,,,,,,,,,,,,,,,,
RT DEMO/EVAL AEROSOL GEN,410,RC,44000062,LOCAL,,inpatient,,,83.72,83.72,,,,,,,,,,,,,,,,,
RT AEROSOL MONITOR,410,RC,44000063,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT AEROSOL SET-UP,410,RC,44000064,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT SPIRO SETUP/INST,410,RC,44000065,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT IPPB INIT SETUP,410,RC,44000066,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT NEBULIZER/SETUP,410,RC,44000067,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT NEB INIT CG,410,RC,44000068,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT SM VOL NEB INITIAL,410,RC,44000069,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT PU-DEM/EV PT ULT,460,RC,44000070,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT CHEST WALL MANIP  INITI,410,RC,44000071,LOCAL,,inpatient,,,121.184,121.184,,,,,,,,,,,,,,,,,
RT ACAPEL DH IN W/EV,410,RC,44000072,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT CHEST PHYSIO INIT,410,RC,44000073,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT FLUTTER INITIAL,410,RC,44000074,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT CPT INIT 30 MIN,410,RC,44000075,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT CHEST WALL MANIP SUBSE,410,RC,44000076,LOCAL,,inpatient,,,103.936,103.936,,,,,,,,,,,,,,,,,
RT ACAPEL DH SBQW/EV,410,RC,44000077,LOCAL,,inpatient,,,256.2,256.2,,,,,,,,,,,,,,,,,
RT CHEST PHYSIO SBSQ,410,RC,44000078,LOCAL,,inpatient,,,256.2,256.2,,,,,,,,,,,,,,,,,
RT FLUTTER SUB 10MIN,410,RC,44000079,LOCAL,,inpatient,,,256.2,256.2,,,,,,,,,,,,,,,,,
RT CPT SUB 20 MIN,410,RC,44000080,LOCAL,,inpatient,,,256.2,256.2,,,,,,,,,,,,,,,,,
RT IPV SUBSEQ  MOD,410,RC,44000081,LOCAL,,inpatient,,,256.2,256.2,,,,,,,,,,,,,,,,,
RT MECH CHEST OSCIL/SES,410,RC,44000082,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT O2 UPTAKE EXP GAS ANALY,460,RC,44000083,LOCAL,,inpatient,,,147.896,147.896,,,,,,,,,,,,,,,,,
RT O2 UPTAKE CO2 PRODUCTION,460,RC,44000084,LOCAL,,inpatient,,,210.112,210.112,,,,,,,,,,,,,,,,,
RT DIFFUSION CAPACITY STUDIES,460,RC,44000085,LOCAL,,inpatient,,,484.96,484.96,,,,,,,,,,,,,,,,,
RT MEMBRANE DIFFUSION STUDY,460,RC,44000086,LOCAL,,inpatient,,,484.96,484.96,,,,,,,,,,,,,,,,,
RT PULM FUNCT TST PLETH,460,RC,44000087,LOCAL,,inpatient,,,789.6,789.6,,,,,,,,,,,,,,,,,
RT BREATH AIRWAY CLOSIN,460,RC,44000088,LOCAL,,inpatient,,,197.064,197.064,,,,,,,,,,,,,,,,,
RT PULM FUNCT TST BY GA,460,RC,44000089,LOCAL,,inpatient,,,789.6,789.6,,,,,,,,,,,,,,,,,
RT LUNG NITRO WASHOUT,460,RC,44000090,LOCAL,,inpatient,,,207.872,207.872,,,,,,,,,,,,,,,,,
RT AIRWAY RESIST IMP OS,460,RC,44000091,LOCAL,,inpatient,,,789.6,789.6,,,,,,,,,,,,,,,,,
RT MEMBRANE DIFFUS STDY,460,RC,44000092,LOCAL,,inpatient,,,484.96,484.96,,,,,,,,,,,,,,,,,
RT PULSE OXI SINGLE CHECK,410,RC,44000094,LOCAL,,inpatient,,,14.952,14.952,,,,,,,,,,,,,,,,,
RT PULSE OX W/EX MULTIDET,410,RC,44000095,LOCAL,,inpatient,,,32.424,32.424,,,,,,,,,,,,,,,,,
RT PULSE OX CONT OVERNIGHT,410,RC,44000096,LOCAL,,inpatient,,,459.76,459.76,,,,,,,,,,,,,,,,,
RT EXHALED CO2,460,RC,44000097,LOCAL,,inpatient,,,210.112,210.112,,,,,,,,,,,,,,,,,
RT END TIDAL CO2,460,RC,44000098,LOCAL,,inpatient,,,210.112,210.112,,,,,,,,,,,,,,,,,
RT CO2 PER EVENT,460,RC,44000099,LOCAL,,inpatient,,,1160.6,1160.6,,,,,,,,,,,,,,,,,
RT OX SLEEP STUDY,410,RC,44000100,LOCAL,,inpatient,,,4186,4186,,,,,,,,,,,,,,,,,
RT EDUCATION EA30M,410,RC,44000101,LOCAL,,inpatient,,,116.718,116.718,,,,,,,,,,,,,,,,,
RT THPY TO INCREASE RESP. MUCS,410,RC,44000104,LOCAL,,inpatient,,,123.76,123.76,,,,,,,,,,,,,,,,,
RT INSP MSCL TRN EA15M,410,RC,44000105,LOCAL,,inpatient,,,256.2,256.2,,,,,,,,,,,,,,,,,
RT PURSE LIP TRAINING,410,RC,44000106,LOCAL,,inpatient,,,256.2,256.2,,,,,,,,,,,,,,,,,
RT THPY TO INCREASE RESP FUNC,410,RC,44000107,LOCAL,,inpatient,,,128.856,128.856,,,,,,,,,,,,,,,,,
RT THPY TO INC RESP FUNC 2 +,410,RC,44000108,LOCAL,,inpatient,,,88.48,88.48,,,,,,,,,,,,,,,,,
RT HYPERBARIC O2 THERPY,413,RC,44000109,LOCAL,,inpatient,,,527.8,527.8,,,,,,,,,,,,,,,,,
RT BREATHING EXER,410,RC,44000110,LOCAL,,inpatient,,,256.2,256.2,,,,,,,,,,,,,,,,,
RT RESP MUSCLE EX INS,410,RC,44000111,LOCAL,,inpatient,,,256.2,256.2,,,,,,,,,,,,,,,,,
RT PULM REHAB COPD,460,RC,44000112,LOCAL,,inpatient,,,256.2,256.2,,,,,,,,,,,,,,,,,
RT PULM-REHAB 1HR/SES,460,RC,44000113,LOCAL,,inpatient,,,256.2,256.2,,,,,,,,,,,,,,,,,
RT PU-SMOK/TOB CONS,410,RC,44000114,LOCAL,,inpatient,,,127.4,127.4,,,,,,,,,,,,,,,,,
RT PU-SMOK/TOB>10MI,410,RC,44000115,LOCAL,,inpatient,,,246.4,246.4,,,,,,,,,,,,,,,,,
RT CIRCUITS IPPB,410,RC,44000116,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT HYPERINFL TX,410,RC,44000117,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT CPPV INTL SET UP EA,410,RC,44000118,LOCAL,,inpatient,,,806.4,806.4,,,,,,,,,,,,,,,,,
RT PASS MUIR VLV INTL,410,RC,44000119,LOCAL,,inpatient,,,613.2,613.2,,,,,,,,,,,,,,,,,
RT PASS MUIR VLV SUBS,410,RC,44000120,LOCAL,,inpatient,,,263.2,263.2,,,,,,,,,,,,,,,,,
RT ECG TRACING ONLY,410,RC,44000121,LOCAL,,inpatient,,,274.4,274.4,,,,,,,,,,,,,,,,,
RT Trach Care,410,RC,44000122,LOCAL,,inpatient,,,452.2,452.2,,,,,,,,,,,,,,,,,
EEG,740,RC,99990740,LOCAL,,inpatient,,,1680,1680,,,,,,,,,,,,,,,,,
PT ADL SLF CARE TRN 15,420,RC,44100000,LOCAL,,inpatient,,,310.87,310.87,,,,,,,,,,,,,,,,,
PT APP SHT LEG CAST,420,RC,44100001,LOCAL,,inpatient,,,303.8,303.8,,,,,,,,,,,,,,,,,
PT APPL FINGER SPLN;DYN,420,RC,44100002,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
PT APPLIC/SURFCE NEUROSTM,420,RC,44100003,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
PT AQUA  THY 15 MIN,420,RC,44100004,LOCAL,,inpatient,,,310.87,310.87,,,,,,,,,,,,,,,,,
PT ASST TCH ASSES15,420,RC,44100005,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
PT BIOFEED PERI/RECTAL EA 15M,420,RC,44100006,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
PT BIOFEED PERI/RECTAL INT 15M,420,RC,44100007,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
PT BIOFEEDBACK 1UNIT,420,RC,44100008,LOCAL,,inpatient,,,182,182,,,,,,,,,,,,,,,,,
PT CANALITH REPOSITION 1UNIT,420,RC,44100009,LOCAL,,inpatient,,,182,182,,,,,,,,,,,,,,,,,
PT COG FUNC EA AD 15,420,RC,44100010,LOCAL,,inpatient,,,335.16,335.16,,,,,,,,,,,,,,,,,
PT COG FUNC INIT 15M,420,RC,44100011,LOCAL,,inpatient,,,159.6,159.6,,,,,,,,,,,,,,,,,
PT COMM REINT 15MIN,420,RC,44100012,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
PT CONT  BATH 15M,420,RC,44100013,LOCAL,,inpatient,,,266.14,266.14,,,,,,,,,,,,,,,,,
PT DEVELOP SCREEN,420,RC,44100014,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
PT DIATHERMY,420,RC,44100016,LOCAL,,inpatient,,,144.2,144.2,,,,,,,,,,,,,,,,,
PT DYN SHT ARM SPL,420,RC,44100017,LOCAL,,inpatient,,,245,245,,,,,,,,,,,,,,,,,
PT ESTIM UNATT/NONWOUND 1UNIT,420,RC,44100018,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
PT MCR ESTIM UNATTENDED 1UNIT,420,RC,44100019,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
PT E-STIM/UNATT WOUND,420,RC,44100020,LOCAL,,inpatient,,,133,133,,,,,,,,,,,,,,,,,
PT E-STIM/UNATT WOUND ULCER,420,RC,44100021,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
PT E-STM MAN 15MIN,420,RC,44100022,LOCAL,,inpatient,,,310.87,310.87,,,,,,,,,,,,,,,,,
PT EVAL HIGH COMPLEX 1UNIT,424,RC,44100023,LOCAL,,inpatient,,,452.62,452.62,,,,,,,,,,,,,,,,,
PT EVAL LOW COMPLEX 1UNIT,424,RC,44100024,LOCAL,,inpatient,,,452.62,452.62,,,,,,,,,,,,,,,,,
PT EVAL MOD COMPLEX 1UNIT,424,RC,44100025,LOCAL,,inpatient,,,452.62,452.62,,,,,,,,,,,,,,,,,
PT GAIT TRN  15  MIN,420,RC,44100026,LOCAL,,inpatient,,,310.87,310.87,,,,,,,,,,,,,,,,,
PT GROUP EXERCISE,420,RC,44100027,LOCAL,,inpatient,,,316.26,316.26,,,,,,,,,,,,,,,,,
PT HOT/COLD PACK,420,RC,44100028,LOCAL,,inpatient,,,105,105,,,,,,,,,,,,,,,,,
PT HYDROTH 15 MIN,420,RC,44100029,LOCAL,,inpatient,,,165.2,165.2,,,,,,,,,,,,,,,,,
PT HCPRO PHNE CALL 5-10,420,RC,44100030,LOCAL,,inpatient,,,47.6,47.6,,,,,,,,,,,,,,,,,
PT INFRARED,420,RC,44100031,LOCAL,,inpatient,,,148.4,148.4,,,,,,,,,,,,,,,,,
PT IONTOPHORESIS 15MIN,420,RC,44100032,LOCAL,,inpatient,,,435.89,435.89,,,,,,,,,,,,,,,,,
PT JOB ST VST W/RPT,420,RC,44100033,LOCAL,,inpatient,,,153.93,153.93,,,,,,,,,,,,,,,,,
PT KNEE STRAPPING,420,RC,44100034,LOCAL,,inpatient,,,142.8,142.8,,,,,,,,,,,,,,,,,
PT JT MOB/MANUAL THERAPY 15M,420,RC,44100035,LOCAL,,inpatient,,,310.87,310.87,,,,,,,,,,,,,,,,,
PT MASSAGE 15 MIN,420,RC,44100036,LOCAL,,inpatient,,,398.44,398.44,,,,,,,,,,,,,,,,,
PT DRY NDL 3+ MUSCLES 1UNIT,420,RC,44100037,LOCAL,,inpatient,,,182,182,,,,,,,,,,,,,,,,,
PT DRY NDL 1OR2 MUSCLES 1UNIT,420,RC,44100038,LOCAL,,inpatient,,,182,182,,,,,,,,,,,,,,,,,
PT NEU RE-ED 15MIN,420,RC,44100039,LOCAL,,inpatient,,,310.87,310.87,,,,,,,,,,,,,,,,,
PT ASST TCH ASSES 15 MIN,420,RC,44100040,LOCAL,,inpatient,,,564.62,564.62,,,,,,,,,,,,,,,,,
PT ORTH MGM/TRN SUB 15M,420,RC,44100041,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
PT PARAFFIN BATH 15 MIN,420,RC,44100042,LOCAL,,inpatient,,,142.94,142.94,,,,,,,,,,,,,,,,,
PT PHY PRFM TEST 1UNIT,420,RC,44100043,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
PT INIT PROS TRN 15MIN,420,RC,44100044,LOCAL,,inpatient,,,245.42,245.42,,,,,,,,,,,,,,,,,
PT REM DEV AD20CM,420,RC,44100045,LOCAL,,inpatient,,,57.4,57.4,,,,,,,,,,,,,,,,,
PT RNGE MOTN TRNK/EX,420,RC,44100046,LOCAL,,inpatient,,,36.4,36.4,,,,,,,,,,,,,,,,,
PT SENS INTG 15MIN,420,RC,44100047,LOCAL,,inpatient,,,144.2,144.2,,,,,,,,,,,,,,,,,
PT ST SPLINT SHT LEG,420,RC,44100048,LOCAL,,inpatient,,,249.2,249.2,,,,,,,,,,,,,,,,,
PT STAT SPLT SH ARM,420,RC,44100049,LOCAL,,inpatient,,,250.6,250.6,,,,,,,,,,,,,,,,,
PT STRAP SHOULDER 15,420,RC,44100050,LOCAL,,inpatient,,,180.6,180.6,,,,,,,,,,,,,,,,,
PT TAPING 30MIN,420,RC,44100051,LOCAL,,inpatient,,,126.294,126.294,,,,,,,,,,,,,,,,,
PT THER  ACT 15MN,420,RC,44100052,LOCAL,,inpatient,,,310.87,310.87,,,,,,,,,,,,,,,,,
PT THPY EXER  15MIN,420,RC,44100053,LOCAL,,inpatient,,,310.87,310.87,,,,,,,,,,,,,,,,,
PT TRACTION MECH,420,RC,44100054,LOCAL,,inpatient,,,32.2,32.2,,,,,,,,,,,,,,,,,
PT TX SPLINT LNG LEG,420,RC,44100055,LOCAL,,inpatient,,,196,196,,,,,,,,,,,,,,,,,
PT ULTRASOUND 15M,420,RC,44100056,LOCAL,,inpatient,,,310.87,310.87,,,,,,,,,,,,,,,,,
PT ULTRAVIOLET,420,RC,44100057,LOCAL,,inpatient,,,36.4,36.4,,,,,,,,,,,,,,,,,
PT UNNA BOOT STRP,420,RC,44100058,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
PT US BONE STIM,420,RC,44100059,LOCAL,,inpatient,,,161,161,,,,,,,,,,,,,,,,,
PT VASOPNEUMATIC,420,RC,44100060,LOCAL,,inpatient,,,32.2,32.2,,,,,,,,,,,,,,,,,
PT WHEEL CHAIR MGT 15M,420,RC,44100061,LOCAL,,inpatient,,,310.87,310.87,,,,,,,,,,,,,,,,,
PT FLUIDTHERAPY 15M,420,RC,44100062,LOCAL,,inpatient,,,316.26,316.26,,,,,,,,,,,,,,,,,
PT WND NEG PR<50,420,RC,44100063,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
PT WND NEG PR>50,420,RC,44100064,LOCAL,,inpatient,,,119,119,,,,,,,,,,,,,,,,,
PT WND NO SEL DBR,420,RC,44100065,LOCAL,,inpatient,,,715.4,715.4,,,,,,,,,,,,,,,,,
PT WND SEL DBR 20,420,RC,44100066,LOCAL,,inpatient,,,137.2,137.2,,,,,,,,,,,,,,,,,
PT WORK HARD ADH,420,RC,44100067,LOCAL,,inpatient,,,294,294,,,,,,,,,,,,,,,,,
PT WORK HARD IN2H,420,RC,44100068,LOCAL,,inpatient,,,588,588,,,,,,,,,,,,,,,,,
PT TeleHealth SVC 11-20 MIN,420,RC,44100069,LOCAL,,inpatient,,,169.4,169.4,,,,,,,,,,,,,,,,,
PT TeleHealth SVC 21+MIN,420,RC,44100070,LOCAL,,inpatient,,,383.6,383.6,,,,,,,,,,,,,,,,,
PT TeleHealth SVC 5-10 MIN,420,RC,44100071,LOCAL,,inpatient,,,109.2,109.2,,,,,,,,,,,,,,,,,
PT RE EVAL 1 UNIT,420,RC,44100072,LOCAL,,inpatient,,,251.79,251.79,,,,,,,,,,,,,,,,,
PT CANCELLATION FEE,420,RC,44100077,LOCAL,,inpatient,,,105,105,,,,,,,,,,,,,,,,,
PT PHY PRFM TEST 15,420,RC,44100134,LOCAL,,inpatient,,,238,238,,,,,,,,,,,,,,,,,
PT TECH ASSIST 15 MIN,420,RC,44100135,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
PT HCPRO PHN CALL 11-20,420,RC,44100147,LOCAL,,inpatient,,,67.2,67.2,,,,,,,,,,,,,,,,,
PT HC PRO PHN CAL 21-30,420,RC,44100148,LOCAL,,inpatient,,,198.8,198.8,,,,,,,,,,,,,,,,,
PT TELEHEALTH 5-10 M,420,RC,44100149,LOCAL,,inpatient,,,63,63,,,,,,,,,,,,,,,,,
PT E-STIM/UNATT WND,420,RC,44100153,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
PT REMOT IMAGE SUB  PAT,420,RC,44100154,LOCAL,,inpatient,,,109.2,109.2,,,,,,,,,,,,,,,,,
PT RIEF CHK IN MD/QHP,420,RC,44100155,LOCAL,,inpatient,,,169.4,169.4,,,,,,,,,,,,,,,,,
PT BRIEF CK IN 5-10M,420,RC,44100157,LOCAL,,inpatient,,,61.6,61.6,,,,,,,,,,,,,,,,,
PT RMT MONITOR SET UP/TRAINING,420,RC,44100172,LOCAL,,inpatient,,,594.622,594.622,,,,,,,,,,,,,,,,,
PT RMT MONITOR RT EACH 30 DAYS,420,RC,44100173,LOCAL,,inpatient,,,186.354,186.354,,,,,,,,,,,,,,,,,
PT RMT MONITOR MUSC EA 30 DAYS,420,RC,44100174,LOCAL,,inpatient,,,186.354,186.354,,,,,,,,,,,,,,,,,
PT RMT MONITOR TRMT 1ST 20 MIN,420,RC,44100175,LOCAL,,inpatient,,,172.97,172.97,,,,,,,,,,,,,,,,,
PT MULTILAY COMP ENTIRE ARM,420,RC,44100176,LOCAL,,inpatient,,,77,77,,,,,,,,,,,,,,,,,
PT MULTI LAY COMP BELOW KNEE,420,RC,44100177,LOCAL,,inpatient,,,134.4,134.4,,,,,,,,,,,,,,,,,
PT RMT MON TRMT EA ADD 20 MIN,420,RC,44100181,LOCAL,,inpatient,,,172.046,172.046,,,,,,,,,,,,,,,,,
PT VIRTUAL GAIT TRN EA 15 MIN,420,RC,44100206,LOCAL,,inpatient,,,147,147,,,,,,,,,,,,,,,,,
*PT PARAFFIN,420,RC,44109917,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
ST ACOUSTIC REFLEX,471,RC,44200000,LOCAL,,inpatient,,,75.6,75.6,,,,,,,,,,,,,,,,,
ST APHASIA ASSESS,444,RC,44200001,LOCAL,,inpatient,,,364,364,,,,,,,,,,,,,,,,,
ST AS TECH ASSES15M,440,RC,44200002,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
ST AUD EVOKED POT,471,RC,44200003,LOCAL,,inpatient,,,667.8,667.8,,,,,,,,,,,,,,,,,
ST AUDIO AIR/BONE,471,RC,44200004,LOCAL,,inpatient,,,182,182,,,,,,,,,,,,,,,,,
ST AUDIO SCRN PURE,471,RC,44200005,LOCAL,,inpatient,,,44.086,44.086,,,,,,,,,,,,,,,,,
ST EVAL OF VOICE,440,RC,44200006,LOCAL,,inpatient,,,185.78,185.78,,,,,,,,,,,,,,,,,
ST COG FUNC EA AD 15,440,RC,44200007,LOCAL,,inpatient,,,335.16,335.16,,,,,,,,,,,,,,,,,
ST COG FUNC INIT 15M,440,RC,44200008,LOCAL,,inpatient,,,167.58,167.58,,,,,,,,,,,,,,,,,
ST COG SKIL EV AD 30,440,RC,44200009,LOCAL,,inpatient,,,182,182,,,,,,,,,,,,,,,,,
ST COG SKILL EVAL 1H,440,RC,44200010,LOCAL,,inpatient,,,364,364,,,,,,,,,,,,,,,,,
ST COG TRN GRP,440,RC,44200011,LOCAL,,inpatient,,,85.4,85.4,,,,,,,,,,,,,,,,,
ST COMP AUDIOMET,471,RC,44200012,LOCAL,,inpatient,,,159.6,159.6,,,,,,,,,,,,,,,,,
ST DEVELOPMENT SCRN,444,RC,44200013,LOCAL,,inpatient,,,364,364,,,,,,,,,,,,,,,,,
ST DEVELOPMENTAL TEST,440,RC,44200014,LOCAL,,inpatient,,,364,364,,,,,,,,,,,,,,,,,
ST ELECTRIC STIM,440,RC,44200015,LOCAL,,inpatient,,,68.6,68.6,,,,,,,,,,,,,,,,,
ST ENT PROC/SVC,444,RC,44200016,LOCAL,,inpatient,,,197.4,197.4,,,,,,,,,,,,,,,,,
ST EV AUD REH AD 15M,440,RC,44200017,LOCAL,,inpatient,,,86.8,86.8,,,,,,,,,,,,,,,,,
ST EV DIST PR 12FREQ,444,RC,44200018,LOCAL,,inpatient,,,162.4,162.4,,,,,,,,,,,,,,,,,
ST EV NO SP AG D 1H,440,RC,44200019,LOCAL,,inpatient,,,302.4,302.4,,,,,,,,,,,,,,,,,
ST EV NO SP AG D+30,440,RC,44200020,LOCAL,,inpatient,,,140,140,,,,,,,,,,,,,,,,,
ST EV OTOAC 3-6 FRQ,471,RC,44200021,LOCAL,,inpatient,,,106.4,106.4,,,,,,,,,,,,,,,,,
ST EVAL AUD REHAB 1H,440,RC,44200022,LOCAL,,inpatient,,,366.8,366.8,,,,,,,,,,,,,,,,,
ST EVAL LANG/SPEECH,440,RC,44200023,LOCAL,,inpatient,,,998.76,998.76,,,,,,,,,,,,,,,,,
ST AAC GEN DEVICE EVAL 1 UNIT,444,RC,44200024,LOCAL,,inpatient,,,613.2,613.2,,,,,,,,,,,,,,,,,
ST EVAL SP PRODUCTION,440,RC,44200025,LOCAL,,inpatient,,,480.494,480.494,,,,,,,,,,,,,,,,,
ST EVAL SPEECH FLUENCY 1UNIT,444,RC,44200026,LOCAL,,inpatient,,,455,455,,,,,,,,,,,,,,,,,
ST FEES SWALLOW INT/REP,440,RC,44200027,LOCAL,,inpatient,,,364,364,,,,,,,,,,,,,,,,,
ST FEES W/LARY SEN,440,RC,44200028,LOCAL,,inpatient,,,60.2,60.2,,,,,,,,,,,,,,,,,
ST FLEX FIBERENDO SW,440,RC,44200029,LOCAL,,inpatient,,,954.03,954.03,,,,,,,,,,,,,,,,,
ST GROUP THERAPY 1UNIT,440,RC,44200030,LOCAL,,inpatient,,,77,77,,,,,,,,,,,,,,,,,
ST TX SP/LANG INDV,440,RC,44200031,LOCAL,,inpatient,,,367.99,367.99,,,,,,,,,,,,,,,,,
ST LARYNG SENS TST,440,RC,44200032,LOCAL,,inpatient,,,334.6,334.6,,,,,,,,,,,,,,,,,
ST LARYNGEAL FUN STD,444,RC,44200033,LOCAL,,inpatient,,,364,364,,,,,,,,,,,,,,,,,
ST MC SP/LNG THER GRPEA,440,RC,44200034,LOCAL,,inpatient,,,37.198,37.198,,,,,,,,,,,,,,,,,
ST MOD BARIUM SWALLOW STUDY,440,RC,44200035,LOCAL,,inpatient,,,427,427,,,,,,,,,,,,,,,,,
ST NON SPEECH DEV,440,RC,44200036,LOCAL,,inpatient,,,57.4,57.4,,,,,,,,,,,,,,,,,
ST ORTH MGM/TRN SUB 15 MIN,440,RC,44200037,LOCAL,,inpatient,,,246.96,246.96,,,,,,,,,,,,,,,,,
ST PURE TONE SCRN,471,RC,44200038,LOCAL,,inpatient,,,154,154,,,,,,,,,,,,,,,,,
ST Telehealth SVC 11-20 M,440,RC,44200039,LOCAL,,inpatient,,,109.2,109.2,,,,,,,,,,,,,,,,,
ST TeleHealth SVC 21+ M,440,RC,44200040,LOCAL,,inpatient,,,169.4,169.4,,,,,,,,,,,,,,,,,
ST TeleHealth  SVC 5-10 M,440,RC,44200041,LOCAL,,inpatient,,,63,63,,,,,,,,,,,,,,,,,
ST REHAB AUDIT POST-,440,RC,44200042,LOCAL,,inpatient,,,182,182,,,,,,,,,,,,,,,,,
ST REHAB PRE LINGUAL,440,RC,44200043,LOCAL,,inpatient,,,182,182,,,,,,,,,,,,,,,,,
ST REMOVE CERUM,440,RC,44200044,LOCAL,,inpatient,,,169.4,169.4,,,,,,,,,,,,,,,,,
ST SELECT PICT AUDIO,471,RC,44200045,LOCAL,,inpatient,,,250.6,250.6,,,,,,,,,,,,,,,,,
ST SELF MG/TR EA 15,440,RC,44200046,LOCAL,,inpatient,,,172.2,172.2,,,,,,,,,,,,,,,,,
ST SPCH AUDIOMTRY,471,RC,44200047,LOCAL,,inpatient,,,113.4,113.4,,,,,,,,,,,,,,,,,
ST STD COG PERF TST,440,RC,44200048,LOCAL,,inpatient,,,1189.93,1189.93,,,,,,,,,,,,,,,,,
ST STENGER TST PURE,471,RC,44200049,LOCAL,,inpatient,,,77,77,,,,,,,,,,,,,,,,,
ST TX SWALLOW DYSFUN,440,RC,44200050,LOCAL,,inpatient,,,671.79,671.79,,,,,,,,,,,,,,,,,
ST EVAL SWALLOW,440,RC,44200051,LOCAL,,inpatient,,,1189.93,1189.93,,,,,,,,,,,,,,,,,
ST THER ACT EACH 15M,440,RC,44200052,LOCAL,,inpatient,,,172.2,172.2,,,,,,,,,,,,,,,,,
ST TONE DECAY TEST,471,RC,44200053,LOCAL,,inpatient,,,152.6,152.6,,,,,,,,,,,,,,,,,
ST TX COM/WK RE15,440,RC,44200054,LOCAL,,inpatient,,,148.4,148.4,,,,,,,,,,,,,,,,,
ST TX SENS INT EA15,440,RC,44200055,LOCAL,,inpatient,,,144.2,144.2,,,,,,,,,,,,,,,,,
ST TYPANOMETRY,440,RC,44200056,LOCAL,,inpatient,,,54.6,54.6,,,,,,,,,,,,,,,,,
ST USE  SPEECH DEV,440,RC,44200057,LOCAL,,inpatient,,,546,546,,,,,,,,,,,,,,,,,
ST VESTIB EVAL 4 POS,471,RC,44200058,LOCAL,,inpatient,,,502.6,502.6,,,,,,,,,,,,,,,,,
ST VISUAL REINFOR,471,RC,44200059,LOCAL,,inpatient,,,187.6,187.6,,,,,,,,,,,,,,,,,
ST VOICE PROS TRAIN,440,RC,44200060,LOCAL,,inpatient,,,355.6,355.6,,,,,,,,,,,,,,,,,
ST AAC GEN DEVICE EA ADD 30M,444,RC,44200061,LOCAL,,inpatient,,,263.2,263.2,,,,,,,,,,,,,,,,,
ST BIOFEEDBACK 1UNIT,440,RC,44200062,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
ST CANCELLATION FEE,440,RC,44200066,LOCAL,,inpatient,,,105,105,,,,,,,,,,,,,,,,,
ST HC PRO PNE CALL 5-10,440,RC,44200088,LOCAL,,inpatient,,,98,98,,,,,,,,,,,,,,,,,
ST HC PRO PHN CAL 11-20,440,RC,44200089,LOCAL,,inpatient,,,133,133,,,,,,,,,,,,,,,,,
ST HC PRO PNE CAL 21-30,440,RC,44200090,LOCAL,,inpatient,,,198.8,198.8,,,,,,,,,,,,,,,,,
ST REMIT IMGE SUB BY PT,440,RC,44200093,LOCAL,,inpatient,,,47.6,47.6,,,,,,,,,,,,,,,,,
ST BRIEF CK IN MD/QHP,440,RC,44200094,LOCAL,,inpatient,,,67.2,67.2,,,,,,,,,,,,,,,,,
ST REM IMG PT NO E/M,440,RC,44200095,LOCAL,,inpatient,,,44.8,44.8,,,,,,,,,,,,,,,,,
ST BRIEF CK IN 5-10M,440,RC,44200096,LOCAL,,inpatient,,,61.6,61.6,,,,,,,,,,,,,,,,,
ST GROUP CAREGIVER TRAINING,440,RC,44200120,LOCAL,,inpatient,,,116.718,116.718,,,,,,,,,,,,,,,,,
ST VIRTUAL GAIT TRN EA 15 MIN,440,RC,44200121,LOCAL,,inpatient,,,147,147,,,,,,,,,,,,,,,,,
*ST PASSY MUIR VALVE EVAL,444,RC,44209906,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
OT ADL 15 MIN,430,RC,44300000,LOCAL,,inpatient,,,172.2,172.2,,,,,,,,,,,,,,,,,
OT APP FINGER SPLINT STATIC,430,RC,44300001,LOCAL,,inpatient,,,182,182,,,,,,,,,,,,,,,,,
OT APP LONG ARM SPLINT STATIC,430,RC,44300002,LOCAL,,inpatient,,,273,273,,,,,,,,,,,,,,,,,
OT APP FINGER SPLINT DYNAMIC,430,RC,44300003,LOCAL,,inpatient,,,182,182,,,,,,,,,,,,,,,,,
OT APP RIGD LEG CST,430,RC,44300004,LOCAL,,inpatient,,,529.2,529.2,,,,,,,,,,,,,,,,,
OT APPL CAST SHL-HAND,430,RC,44300005,LOCAL,,inpatient,,,273,273,,,,,,,,,,,,,,,,,
OT APPLIC/SURFCE NERUOSTM,430,RC,44300006,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
OT AQUA THY  15MIN,430,RC,44300007,LOCAL,,inpatient,,,211.4,211.4,,,,,,,,,,,,,,,,,
OT AQUATIC THERAPY IND,430,RC,44300008,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
OT ASSIST TECH ASSESS 15M,430,RC,44300009,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
OT BIOFEEDBACK,430,RC,44300010,LOCAL,,inpatient,,,182,182,,,,,,,,,,,,,,,,,
OT CANALITH REPOSITION 1UNIT,430,RC,44300011,LOCAL,,inpatient,,,182,182,,,,,,,,,,,,,,,,,
OT CAST ELBOW TO FNG,430,RC,44300012,LOCAL,,inpatient,,,315,315,,,,,,,,,,,,,,,,,
OT COG FUNC EA AD 15,430,RC,44300013,LOCAL,,inpatient,,,335.16,335.16,,,,,,,,,,,,,,,,,
OT COG FUNC INIT 15M,430,RC,44300014,LOCAL,,inpatient,,,167.58,167.58,,,,,,,,,,,,,,,,,
OT COG SKILL 15 MIN,430,RC,44300015,LOCAL,,inpatient,,,131.6,131.6,,,,,,,,,,,,,,,,,
OT COMM REINT 15MIN,430,RC,44300016,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
OT CONTR BATH 15M,430,RC,44300017,LOCAL,,inpatient,,,266.14,266.14,,,,,,,,,,,,,,,,,
OT DEVELOP SCREEN W/RPT,430,RC,44300018,LOCAL,,inpatient,,,364,364,,,,,,,,,,,,,,,,,
OT DEVELOPMENT SCRN,430,RC,44300019,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
OT DRY NDL 1OR2 MUSCLES 1UNIT,430,RC,44300020,LOCAL,,inpatient,,,182,182,,,,,,,,,,,,,,,,,
OT DRY NDL 3+ MUSCLES 1UNIT,430,RC,44300021,LOCAL,,inpatient,,,182,182,,,,,,,,,,,,,,,,,
OT APP SHORT ARM SPLINT DYNC,430,RC,44300022,LOCAL,,inpatient,,,273,273,,,,,,,,,,,,,,,,,
OT ELEC STIM UNATD NONWOUND MC,430,RC,44300023,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
OT ELEC STIM (UNATD) WOUND,430,RC,44300024,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
OT ESTIM UNATT/NONWOUND 1UNIT,430,RC,44300025,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
OT E-STIM MAN 15M,430,RC,44300026,LOCAL,,inpatient,,,310.87,310.87,,,,,,,,,,,,,,,,,
OT EVAL HIGH COMPLEX,434,RC,44300027,LOCAL,,inpatient,,,508.83,508.83,,,,,,,,,,,,,,,,,
OT EVAL LOW COMPLX,434,RC,44300028,LOCAL,,inpatient,,,508.83,508.83,,,,,,,,,,,,,,,,,
OT EVAL MOD COMPLX,434,RC,44300029,LOCAL,,inpatient,,,508.83,508.83,,,,,,,,,,,,,,,,,
ST FLEX FIBERENDO SW,430,RC,44300030,LOCAL,,inpatient,,,289.8,289.8,,,,,,,,,,,,,,,,,
OT PHYSICAL PERM TEST 15M,430,RC,44300031,LOCAL,,inpatient,,,162.4,162.4,,,,,,,,,,,,,,,,,
OT GAIT TRAIN 15 MIN,430,RC,44300032,LOCAL,,inpatient,,,140,140,,,,,,,,,,,,,,,,,
OT GROUP THERAPY,430,RC,44300033,LOCAL,,inpatient,,,86.8,86.8,,,,,,,,,,,,,,,,,
OT HOT/COLD PK,430,RC,44300034,LOCAL,,inpatient,,,105,105,,,,,,,,,,,,,,,,,
OT HYDROTHER 15M,430,RC,44300035,LOCAL,,inpatient,,,165.2,165.2,,,,,,,,,,,,,,,,,
OT INITIAL EVAL,434,RC,44300036,LOCAL,,inpatient,,,364,364,,,,,,,,,,,,,,,,,
OT IONTOPHORESIS 15MIN,430,RC,44300037,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
OT JT MOB/MANUAL THERAPY,430,RC,44300038,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
OT KNEE STRAPPING,430,RC,44300039,LOCAL,,inpatient,,,142.8,142.8,,,,,,,,,,,,,,,,,
OT LOW FRQ US WOUND,430,RC,44300040,LOCAL,,inpatient,,,93.8,93.8,,,,,,,,,,,,,,,,,
OT MASSAGE  15 MIN,430,RC,44300041,LOCAL,,inpatient,,,131.6,131.6,,,,,,,,,,,,,,,,,
OT MC OT TREATM INIT 30,431,RC,44300042,LOCAL,,inpatient,,,29.666,29.666,,,,,,,,,,,,,,,,,
OT MUSCL TST EXCL HAND,430,RC,44300043,LOCAL,,inpatient,,,124.6,124.6,,,,,,,,,,,,,,,,,
OT NEGPRES WD<50,430,RC,44300044,LOCAL,,inpatient,,,137.2,137.2,,,,,,,,,,,,,,,,,
OT NEGPRES WD>50,430,RC,44300045,LOCAL,,inpatient,,,151.2,151.2,,,,,,,,,,,,,,,,,
OT NEUR RE-ED 15M,430,RC,44300046,LOCAL,,inpatient,,,165.2,165.2,,,,,,,,,,,,,,,,,
OT NON SPEECH DEV,430,RC,44300047,LOCAL,,inpatient,,,149.8,149.8,,,,,,,,,,,,,,,,,
OT ORTH MGM/TRN INITIAL 15M,430,RC,44300048,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
OT ORTH MGM/TRN SUB 15 MIN,430,RC,44300049,LOCAL,,inpatient,,,245.42,245.42,,,,,,,,,,,,,,,,,
OT PARAFF BTH 15 MIN,430,RC,44300050,LOCAL,,inpatient,,,54.6,54.6,,,,,,,,,,,,,,,,,
OT PAT-FAM TRN 30 MIN,430,RC,44300051,LOCAL,,inpatient,,,116.718,116.718,,,,,,,,,,,,,,,,,
OT PROS TRN  15 MIN,430,RC,44300052,LOCAL,,inpatient,,,162.4,162.4,,,,,,,,,,,,,,,,,
OT TeleHealth SVC 11-20 M,430,RC,44300053,LOCAL,,inpatient,,,109.2,109.2,,,,,,,,,,,,,,,,,
OT TeleHealth SVC 21+ MIN,430,RC,44300054,LOCAL,,inpatient,,,169.4,169.4,,,,,,,,,,,,,,,,,
OT TeleHealth SVC 5-10 M,430,RC,44300055,LOCAL,,inpatient,,,63,63,,,,,,,,,,,,,,,,,
OT RE EVAL,430,RC,44300056,LOCAL,,inpatient,,,314.79,314.79,,,,,,,,,,,,,,,,,
OT WOUND DEBRIDEMENT <20CM SQ,430,RC,44300058,LOCAL,,inpatient,,,119,119,,,,,,,,,,,,,,,,,
OT REM DEV TIS ADL,430,RC,44300059,LOCAL,,inpatient,,,57.4,57.4,,,,,,,,,,,,,,,,,
OT REM FULL ARM/LEG CST,430,RC,44300060,LOCAL,,inpatient,,,248.99,248.99,,,,,,,,,,,,,,,,,
"OT REM GAUNT,BOOT, CAST",430,RC,44300061,LOCAL,,inpatient,,,181.09,181.09,,,,,,,,,,,,,,,,,
OT ROM TESTING HAND,430,RC,44300062,LOCAL,,inpatient,,,29.4,29.4,,,,,,,,,,,,,,,,,
OT SENS INT 15 MIN,430,RC,44300063,LOCAL,,inpatient,,,144.2,144.2,,,,,,,,,,,,,,,,,
OT APP SHORT ARM SPLINT STATIC,430,RC,44300064,LOCAL,,inpatient,,,182,182,,,,,,,,,,,,,,,,,
OT STRAP ANKLE/FOOT,430,RC,44300065,LOCAL,,inpatient,,,89.6,89.6,,,,,,,,,,,,,,,,,
OT STRAP ELBOW/WRIST,430,RC,44300066,LOCAL,,inpatient,,,96.6,96.6,,,,,,,,,,,,,,,,,
OT STRAP HAND/FINGER,430,RC,44300067,LOCAL,,inpatient,,,99.4,99.4,,,,,,,,,,,,,,,,,
OT STRAP UNNA BOOT,430,RC,44300068,LOCAL,,inpatient,,,176.4,176.4,,,,,,,,,,,,,,,,,
OT STRAPPING SHLDR,430,RC,44300069,LOCAL,,inpatient,,,92.4,92.4,,,,,,,,,,,,,,,,,
OT TAPING,430,RC,44300070,LOCAL,,inpatient,,,100.8,100.8,,,,,,,,,,,,,,,,,
OT THER  ACT 15MN,430,RC,44300071,LOCAL,,inpatient,,,172.2,172.2,,,,,,,,,,,,,,,,,
OT THER EXER  15MIN,430,RC,44300072,LOCAL,,inpatient,,,159.6,159.6,,,,,,,,,,,,,,,,,
OT TX DIATHERMY,430,RC,44300073,LOCAL,,inpatient,,,32.2,32.2,,,,,,,,,,,,,,,,,
OT TX INFRARED,430,RC,44300074,LOCAL,,inpatient,,,29.4,29.4,,,,,,,,,,,,,,,,,
OT TX MECH TRACTN,430,RC,44300075,LOCAL,,inpatient,,,78.4,78.4,,,,,,,,,,,,,,,,,
OT TX VASOPN DEV,430,RC,44300076,LOCAL,,inpatient,,,95.2,95.2,,,,,,,,,,,,,,,,,
OT ULTRASOUND 15,430,RC,44300077,LOCAL,,inpatient,,,310.87,310.87,,,,,,,,,,,,,,,,,
OT ULTRAVIOLET,430,RC,44300078,LOCAL,,inpatient,,,36.4,36.4,,,,,,,,,,,,,,,,,
OT WD CARE NO-SEL,430,RC,44300079,LOCAL,,inpatient,,,715.4,715.4,,,,,,,,,,,,,,,,,
OT WHEELCHAIR MGT 15M,430,RC,44300080,LOCAL,,inpatient,,,310.87,310.87,,,,,,,,,,,,,,,,,
OT FLUIDOTHERAPY,430,RC,44300081,LOCAL,,inpatient,,,316.26,316.26,,,,,,,,,,,,,,,,,
OT WINDOWING OF CAST,430,RC,44300082,LOCAL,,inpatient,,,239.33,239.33,,,,,,,,,,,,,,,,,
OT WORK HARD ADD,430,RC,44300083,LOCAL,,inpatient,,,294,294,,,,,,,,,,,,,,,,,
OT WORK HARD IN 2H,430,RC,44300084,LOCAL,,inpatient,,,588,588,,,,,,,,,,,,,,,,,
OT MCR Telehealth 5-10 min,430,RC,44300085,LOCAL,,inpatient,,,63,63,,,,,,,,,,,,,,,,,
OT MCR Telehealth 11-20 min,430,RC,44300086,LOCAL,,inpatient,,,109.2,109.2,,,,,,,,,,,,,,,,,
OT HC PRO PHN CALL 5-10,430,RC,44300141,LOCAL,,inpatient,,,98,98,,,,,,,,,,,,,,,,,
OT HC PRO PHN CAL 11-20,430,RC,44300142,LOCAL,,inpatient,,,133,133,,,,,,,,,,,,,,,,,
OT HC PRO PHN CAL 21-30,430,RC,44300143,LOCAL,,inpatient,,,198.8,198.8,,,,,,,,,,,,,,,,,
OT DRIVER SCREENING,430,RC,44300144,LOCAL,,inpatient,,,1241.8,1241.8,,,,,,,,,,,,,,,,,
OT REMIT IM SUBMI BY PT,430,RC,44300146,LOCAL,,inpatient,,,47.6,47.6,,,,,,,,,,,,,,,,,
OT BRIEF CK IN MD/QHP,430,RC,44300147,LOCAL,,inpatient,,,67.2,67.2,,,,,,,,,,,,,,,,,
OT IMG PT NON E/M,430,RC,44300148,LOCAL,,inpatient,,,44.8,44.8,,,,,,,,,,,,,,,,,
OT BRIEF CK IN 5-10M,430,RC,44300149,LOCAL,,inpatient,,,61.6,61.6,,,,,,,,,,,,,,,,,
OT CANCELLATION FEE,430,RC,44300150,LOCAL,,inpatient,,,105,105,,,,,,,,,,,,,,,,,
OT MC INITL EVAL 30 MIN,434,RC,44300163,LOCAL,,inpatient,,,376.32,376.32,,,,,,,,,,,,,,,,,
OT EO w/o joints CF,430,RC,44300170,LOCAL,,inpatient,,,798,798,,,,,,,,,,,,,,,,,
OT EWHO rigid w/o jnts CF,430,RC,44300171,LOCAL,,inpatient,,,1958.6,1958.6,,,,,,,,,,,,,,,,,
OT EWHO w/joint(s) CF,430,RC,44300172,LOCAL,,inpatient,,,2252.6,2252.6,,,,,,,,,,,,,,,,,
OT EWHFO rigid w/o jnts CF,430,RC,44300173,LOCAL,,inpatient,,,2977.8,2977.8,,,,,,,,,,,,,,,,,
OT EWHFO w/joints CF,430,RC,44300174,LOCAL,,inpatient,,,31535,31535,,,,,,,,,,,,,,,,,
OT FO w/o joints CF,430,RC,44300175,LOCAL,,inpatient,,,495.6,495.6,,,,,,,,,,,,,,,,,
OT FO nontorsion joint CF,430,RC,44300176,LOCAL,,inpatient,,,512.4,512.4,,,,,,,,,,,,,,,,,
OT HO w/o joints CF,430,RC,44300177,LOCAL,,inpatient,,,628.6,628.6,,,,,,,,,,,,,,,,,
OT HFO w/o joints CF,274,RC,44300178,LOCAL,,inpatient,,,628.6,628.6,,,,,,,,,,,,,,,,,
OT HFO w/joints(s) CF,430,RC,44300179,LOCAL,,inpatient,,,746.2,746.2,,,,,,,,,,,,,,,,,
"OT WHFO, rigid w/o joints",274,RC,44300180,LOCAL,,inpatient,,,1055.6,1055.6,,,,,,,,,,,,,,,,,
OT WHFO w/joint(s) custom fab,430,RC,44300181,LOCAL,,inpatient,,,1054.2,1054.2,,,,,,,,,,,,,,,,,
OT WHO w/nontorsion jnt(s) CF,430,RC,44300182,LOCAL,,inpatient,,,2303,2303,,,,,,,,,,,,,,,,,
OT WHO custom fab/no joints,430,RC,44300183,LOCAL,,inpatient,,,1551.2,1551.2,,,,,,,,,,,,,,,,,
*OT PROSTHETCI TRAINING,430,RC,44309910,LOCAL,,inpatient,,,91,91,,,,,,,,,,,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Aetna,Commercial,584,,,,other,584,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Alameda Mcal,Medicare,450,,,,other,540,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Anthem Blue Cross,Commercial,628,,,,per diem,628,1350,per diem,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Blue Shield CA MR,Medicare,670,,,,other,670,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Blue Shield CA Tandem,Commercial,610,,,,other,670,1350,per diem,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Blue Shield CA MR,Medicare,670,,,,other,670,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,CA Health & Wellness,Commercial,460,,,,per diem,460,1350,per diem,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Cigna,Commercial,675,,,,other,550,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,CA Health & Wellness DR, DR,460,,,,per diem,460,1350,per diem,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Canopy Health,Commercial,567,,,,other,550,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Contra Costa,Commercial,592.25,,,,other,550,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Contra Costa Medi -Cal,medicare,592.25,,,,other,550,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Dignity Health,Commercial,659,,,,other,659,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Healthnet Commercial,Commercial,481,,,,per diem,481,1350,per diem,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Healthnet Comm medi-Cal,Medicare,460,,,,per diem,460,1350,per diem,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Health Plan of San Matei,Commercial,500,,,,other,500,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Kaiser,commercial,670,,,,other,433,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Kaiser MR,commercial,670,,,,other,433,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Kaiser DR,commercial,670,,,,other,433,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Health Smart Commercial,Commercial,480,,,,other,480,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Networks by design,Commercial,500,,,,other,650,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Northbay Helathcare group,HMO,433,,,,other,433,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,SFHP,Commercial,650,,,,other,650,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Partnership Health Plan of CA DR,Commercial,575,,,,other,650,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Sutter Bay Health,Commercial,500,,,,other,500,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Sutter Bay Health MR,Commercial,500,,,,other,500,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,United Healthcare,Commercial,604,,,,other,604,1350,per unit,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,Aetna,Commercial,584,,,,other,584,1650,per unit,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,Alameda Mcal,Medicare,540,,,,other,540,1650,per unit,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,Anthem Blue Cross,Commercial,628,,,,per diem,628,1650,per diem,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,Blue Shield CA,Commercial,670,,,,other,670,1650,per diem,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,Blue Shield CA MR,Medicare,670,,,,other,670,1650,per unit,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,CA Health & Wellness,Commercial,460,,,,per diem,460,1650,per diem,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,CA Health & Wellness DR, DR,460,,,,per diem,460,1650,per diem,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Contra Costa,Commercial,592.25,,,,other,550,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Contra Costa Medi -Cal,medicare,592.25,,,,other,550,1350,per unit,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,Canopy Health,Commercial,550,,,,other,550,1650,per unit,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,Dignity Health,Commercial,659,,,,other,659,1650,per unit,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,Healthnet Commercial,Commercial,481,,,,per diem,481,1650,per diem,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,Healthnet Comm medi-Cal,Medicare,460,,,,per diem,460,1650,per diem,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,Health Plan of San Matei,Commercial,500,,,,other,500,1650,per unit,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,Health Smart Commercial,Commercial,480,,,,other,480,1650,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Kaiser,commercial,670,,,,other,433,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Kaiser MR,commercial,670,,,,other,433,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Kaiser DR,commercial,670,,,,other,433,1350,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,1890,1890,Networks by design,Commercial,500,,,,other,650,1350,per unit,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,Northbay Helathcare group,HMO,433,,,,other,433,1650,per unit,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,SFHP,Commercial,650,,,,other,650,1650,per unit,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,Sutter Bay Health,Commercial,500,,,,other,500,1650,per unit,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,Sutter Bay Health MR,Medicare,500,,,,other,500,1650,per unit,,,,,,,
Hemodialysis,801,RC,44700000,LOCAL,,inpatient,,,2228.07,2228.07,Partnership Health Plan of CA DR,Commercial,575,,,,other,650,1350,per unit,,,,,,,
Peritoneal Dialysis,801,RC,44700002,LOCAL,,inpatient,,,2228.07,2228.07,United Healthcare,Commercial,604,,,,other,604,1650,per unit,,,,,,,
WC I&D of Abscess Simple,361,RC,44800001,LOCAL,,inpatient,,,494.2,494.2,,,,,,,,,,,,,,,,,
WC I&D Abcess Complex,361,RC,44800002,LOCAL,,inpatient,,,494.2,494.2,,,,,,,,,,,,,,,,,
WC DEBR SUBQ TIS 1ST 20,761,RC,44800005,LOCAL,,inpatient,,,2080.4,2080.4,,,,,,,,,,,,,,,,,
WC DEBRID MUSCLE 20SQCM,761,RC,44800006,LOCAL,,inpatient,,,3200.4,3200.4,,,,,,,,,,,,,,,,,
WC DEBRID BONE 20SQCM,361,RC,44800007,LOCAL,,inpatient,,,8586.2,8586.2,,,,,,,,,,,,,,,,,
WC DEBR SUBQ TIS ADD 20,761,RC,44800008,LOCAL,,inpatient,,,201.6,201.6,,,,,,,,,,,,,,,,,
WC DEBRID MUSCLE ADD 20,761,RC,44800009,LOCAL,,inpatient,,,351.4,351.4,,,,,,,,,,,,,,,,,
WC DEBRID BONE ADD 20,361,RC,44800010,LOCAL,,inpatient,,,593.6,593.6,,,,,,,,,,,,,,,,,
WC WOUND VAC DSG <50 CM,761,RC,44800022,LOCAL,,inpatient,,,1169,1169,,,,,,,,,,,,,,,,,
WC WOUND VAC DSG <50 CM BS,761,RC,44800023,LOCAL,,inpatient,,,4384.1,4384.1,,,,,,,,,,,,,,,,,
WC WOUND VAC DSG >50 CM,761,RC,44800024,LOCAL,,inpatient,,,3131.5,3131.5,,,,,,,,,,,,,,,,,
WC PUNCH BIOPSY,761,RC,44800026,LOCAL,,inpatient,,,116.615,116.615,,,,,,,,,,,,,,,,,
WC INCISION BIOPSY,761,RC,44800027,LOCAL,,inpatient,,,1486,1486,,,,,,,,,,,,,,,,,
WC DEBRIDEMENT NAILS 1-5,761,RC,44800028,LOCAL,,inpatient,,,278.6,278.6,,,,,,,,,,,,,,,,,
WC DEBRIDEMENT NAILS 6+,761,RC,44800029,LOCAL,,inpatient,,,278.6,278.6,,,,,,,,,,,,,,,,,
WC AVULSION NAIL,761,RC,44800030,LOCAL,,inpatient,,,278.6,278.6,,,,,,,,,,,,,,,,,
WC AVULSION NAIL EA ADDITIONAL,761,RC,44800031,LOCAL,,inpatient,,,278.6,278.6,,,,,,,,,,,,,,,,,
WC EXCSN NAIL MTRX PERMANENT,761,RC,44800032,LOCAL,,inpatient,,,1514.8,1514.8,,,,,,,,,,,,,,,,,
WC BURN DEBRIDE <5% BSA,761,RC,44800033,LOCAL,,inpatient,,,1169,1169,,,,,,,,,,,,,,,,,
WC BURN DEBRIDE 5-10% BSA,761,RC,44800034,LOCAL,,inpatient,,,1169,1169,,,,,,,,,,,,,,,,,
WC BURN DEBRIDE >10% BSA,761,RC,44800035,LOCAL,,inpatient,,,2080.4,2080.4,,,,,,,,,,,,,,,,,
WC ESCHAROTOMY BURN INITIAL,761,RC,44800036,LOCAL,,inpatient,,,2080.4,2080.4,,,,,,,,,,,,,,,,,
WC ESCHAROTOMY BURN EACH >1,761,RC,44800037,LOCAL,,inpatient,,,449.4,449.4,,,,,,,,,,,,,,,,,
WC SCALP/TRUNK/LEG/ARM <2.5CM,761,RC,44800038,LOCAL,,inpatient,,,2080.4,2080.4,,,,,,,,,,,,,,,,,
WC SCALP/TRUNK/LEG/ARM 2.6-7.5,761,RC,44800039,LOCAL,,inpatient,,,2080.4,2080.4,,,,,,,,,,,,,,,,,
WC SCALP/TRUNK/LEG/AR 7.6-12.5,761,RC,44800040,LOCAL,,inpatient,,,2080.4,2080.4,,,,,,,,,,,,,,,,,
WC NECK/HANDS/FEET <2.5CM,761,RC,44800041,LOCAL,,inpatient,,,2080.4,2080.4,,,,,,,,,,,,,,,,,
WC NECK/HANDS/FEET 2.6-7.5CM,761,RC,44800042,LOCAL,,inpatient,,,2080.4,2080.4,,,,,,,,,,,,,,,,,
WC NECK/HANDS/FEET 7.6-12.5CM,761,RC,44800043,LOCAL,,inpatient,,,3200.4,3200.4,,,,,,,,,,,,,,,,,
WC FACE < 2.5CM,761,RC,44800044,LOCAL,,inpatient,,,2080.4,2080.4,,,,,,,,,,,,,,,,,
WC FACE 2.5-5.0 CM,761,RC,44800045,LOCAL,,inpatient,,,2080.4,2080.4,,,,,,,,,,,,,,,,,
WC FACE 5.1-7.5 CM,761,RC,44800046,LOCAL,,inpatient,,,2080.4,2080.4,,,,,,,,,,,,,,,,,
WC FACE 7.6-12.5 CM,761,RC,44800047,LOCAL,,inpatient,,,2080.4,2080.4,,,,,,,,,,,,,,,,,
WC UNNA BOOT,761,RC,44800048,LOCAL,,inpatient,,,383.6,383.6,,,,,,,,,,,,,,,,,
WC FOUR LAYER COMPR LEG BEL KN,761,RC,44800049,LOCAL,,inpatient,,,604.8,604.8,,,,,,,,,,,,,,,,,
WC LEG CAST TOTAL CONTACT,761,RC,44800050,LOCAL,,inpatient,,,1561,1561,,,,,,,,,,,,,,,,,
WC APPLY LOW COST SS LEG,761,RC,44800051,LOCAL,,inpatient,,,3200.4,3200.4,,,,,,,,,,,,,,,,,
WC APPLY LC SS LEG EA >25CM,761,RC,44800052,LOCAL,,inpatient,,,3200.4,3200.4,,,,,,,,,,,,,,,,,
WC APPLY LOW COST SS FOOT,761,RC,44800053,LOCAL,,inpatient,,,3200.4,3200.4,,,,,,,,,,,,,,,,,
WC APPLY LC SS FOOT EA > 25CM,761,RC,44800054,LOCAL,,inpatient,,,3200.4,3200.4,,,,,,,,,,,,,,,,,
WC APPLY HIGH COST SS LEG,761,RC,44800055,LOCAL,,inpatient,,,10264.8,10264.8,,,,,,,,,,,,,,,,,
WC APPLY HC SS LEG EA>25CM,761,RC,44800056,LOCAL,,inpatient,,,1139.6,1139.6,,,,,,,,,,,,,,,,,
WC APPLY HIGH COST SS FOOT,761,RC,44800057,LOCAL,,inpatient,,,10264.8,10264.8,,,,,,,,,,,,,,,,,
WC APPLY HC SS FOOT EA >25 CM,761,RC,44800058,LOCAL,,inpatient,,,512.4,512.4,,,,,,,,,,,,,,,,,
WC EPDRML AUTOGRFT LEG 1ST 100,761,RC,44800059,LOCAL,,inpatient,,,10264.8,10264.8,,,,,,,,,,,,,,,,,
WC EPDRML AUTOGRFT FT 1ST 100,761,RC,44800060,LOCAL,,inpatient,,,10264.8,10264.8,,,,,,,,,,,,,,,,,
"WC GRAFIX, PER SQUARE CM",636,RC,44800061,LOCAL,,inpatient,,,1422.4,1422.4,,,,,,,,,,,,,,,,,
WC EPICORD PER SQ CM,636,RC,44800062,LOCAL,,inpatient,,,1083.6,1083.6,,,,,,,,,,,,,,,,,
WC EPIFIX PER SQUARE CM,636,RC,44800063,LOCAL,,inpatient,,,840,840,,,,,,,,,,,,,,,,,
NEW PATIENT 15-29 MIN,761,RC,44800064,LOCAL,,inpatient,,,406,406,,,,,,,,,,,,,,,,,
NEW PATIENT INTERMED 30-44 MIN,761,RC,44800065,LOCAL,,inpatient,,,421.4,421.4,,,,,,,,,,,,,,,,,
NEW PATIENT EXTENDED 45-59 MIN,761,RC,44800066,LOCAL,,inpatient,,,714,714,,,,,,,,,,,,,,,,,
NEW PATIENT  COMPLEX 60-74MIN,761,RC,44800067,LOCAL,,inpatient,,,917,917,,,,,,,,,,,,,,,,,
ESTABLISHED PATIENT BRIEF,761,RC,44800068,LOCAL,,inpatient,,,121.8,121.8,,,,,,,,,,,,,,,,,
ESTABLISHED PATIENT LIMITED,761,RC,44800069,LOCAL,,inpatient,,,141.4,141.4,,,,,,,,,,,,,,,,,
ESTABLISHED PATIENT INTERMED,761,RC,44800070,LOCAL,,inpatient,,,278.6,278.6,,,,,,,,,,,,,,,,,
ESTABLISHED PATIENT EXTENDED,761,RC,44800071,LOCAL,,inpatient,,,431.2,431.2,,,,,,,,,,,,,,,,,
ESTABLISHED PATIENT COMPLEX,761,RC,44800072,LOCAL,,inpatient,,,609,609,,,,,,,,,,,,,,,,,
WC DEBRIDE SUBQ BX/BS,761,RC,44800073,LOCAL,,inpatient,,,2080.4,2080.4,,,,,,,,,,,,,,,,,
WC DEBRIDE SUBQ/MUSC BX/BS,761,RC,44800074,LOCAL,,inpatient,,,2286,2286,,,,,,,,,,,,,,,,,
WC DEBRIDE SUBQ/MUSC/BONE BX/B,761,RC,44800075,LOCAL,,inpatient,,,9115.4,9115.4,,,,,,,,,,,,,,,,,
WC NPWT </+ 50 SQ CM BX/AETNA,761,RC,44800076,LOCAL,,inpatient,,,1169,1169,,,,,,,,,,,,,,,,,
WC NPWT </= 50 SQ CM BS,761,RC,44800077,LOCAL,,inpatient,,,1169,1169,,,,,,,,,,,,,,,,,
WC MC OUTPATIENT CLNIC VISIT,761,RC,44800078,LOCAL,,inpatient,,,507.612,507.612,,,,,,,,,,,,,,,,,
WC New Patient visit 15-29 min,761,RC,44800079,LOCAL,,inpatient,,,406,406,,,,,,,,,,,,,,,,,
WC New Pat visit Intermd 30-44,761,RC,44800080,LOCAL,,inpatient,,,421.4,421.4,,,,,,,,,,,,,,,,,
WC New Pat visit extend 45-59m,761,RC,44800081,LOCAL,,inpatient,,,714,714,,,,,,,,,,,,,,,,,
WC New Pat visit complx 60-74m,761,RC,44800082,LOCAL,,inpatient,,,917,917,,,,,,,,,,,,,,,,,
WC Est Pat visit no QHP requir,761,RC,44800083,LOCAL,,inpatient,,,121.8,121.8,,,,,,,,,,,,,,,,,
WC Est Pat visit LTD 10-19 min,761,RC,44800084,LOCAL,,inpatient,,,141.4,141.4,,,,,,,,,,,,,,,,,
WC Est Pat Visit Interm 20-29m,761,RC,44800085,LOCAL,,inpatient,,,278.6,278.6,,,,,,,,,,,,,,,,,
WC Est Pat visit Extend 30-39m,761,RC,44800086,LOCAL,,inpatient,,,431.2,431.2,,,,,,,,,,,,,,,,,
WC Est Pat visit Complx 40-54m,761,RC,44800087,LOCAL,,inpatient,,,609,609,,,,,,,,,,,,,,,,,
WC Cancellation Fee,761,RC,44800088,LOCAL,,inpatient,,,105,105,,,,,,,,,,,,,,,,,
AMB Non EMR BLS RND Trip,540,RC,45000000,LOCAL,,inpatient,,,3080,3080,,,,,,,,,,,,,,,,,
AMB Non EMR ALS RND Trip,540,RC,45000001,LOCAL,,inpatient,,,3640,3640,,,,,,,,,,,,,,,,,
AMB Non EMR STRETCH/WC RND TRP,540,RC,45000002,LOCAL,,inpatient,,,140,140,,,,,,,,,,,,,,,,,
AMB EMR ALS ADV One Way,540,RC,45000003,LOCAL,,inpatient,,,4200,4200,,,,,,,,,,,,,,,,,
AMB EMR ALS One Way,540,RC,45000004,LOCAL,,inpatient,,,2940,2940,,,,,,,,,,,,,,,,,
AMBULANCE SPEC LONG DIST ALS,540,RC,45000005,LOCAL,,inpatient,,,3500,3500,,,,,,,,,,,,,,,,,
AMB EMR BLS One Way,540,RC,45000007,LOCAL,,inpatient,,,2520,2520,,,,,,,,,,,,,,,,,
Banatrol Plus,270,RC,IDT-0002,LOCAL,,inpatient,,,25.92,25.92,,,,,,,,,,,,,,,,,
FORMULA NEPRO CS 1L RTH BTL 8C,270,RC,IDT-0031,LOCAL,,inpatient,,,1.62,1.62,,,,,,,,,,,,,,,,,
FORMULA VITAL 1.5 CAL 1 L RTH,270,RC,IDT-0043,LOCAL,,inpatient,,,237.45,237.45,,,,,,,,,,,,,,,,,
FORMULA SPLMT ORNG PWDR LAC FR,270,RC,IDT-0210,LOCAL,,inpatient,,,29.98,29.98,,,,,,,,,,,,,,,,,
Sip-Thru Lid for 10 oz. to 20,270,RC,IES-0092,LOCAL,,inpatient,,,102.91,102.91,,,,,,,,,,,,,,,,,
POST MORTEM KIT,270,RC,IES-0099,LOCAL,,inpatient,,,55.44,55.44,,,,,,,,,,,,,,,,,
CLEANSER WND PROPHASE PHMB SPR,270,RC,IES-0109,LOCAL,,inpatient,,,62.43,62.43,,,,,,,,,,,,,,,,,
Therahoney Gel,270,RC,IES-0145,LOCAL,,inpatient,,,18.66,18.66,,,,,,,,,,,,,,,,,
PROPHASE WOUND CLEANER,270,RC,IES-0146,LOCAL,,inpatient,,,6,6,,,,,,,,,,,,,,,,,
ENSURE MILK CHOCOLATE,270,RC,IES-0189,LOCAL,,inpatient,,,8.58,8.58,,,,,,,,,,,,,,,,,
3M DURAPREP SOLUTION WITH APPL,270,RC,IES-0195,LOCAL,,inpatient,,,22.26,22.26,,,,,,,,,,,,,,,,,
KANGAROO E PUMP ENTERAL FEEDIN,270,RC,IMC-0071,LOCAL,,inpatient,,,1.86,1.86,,,,,,,,,,,,,,,,,
POWER PICC SOLO 2 LUM,270,RC,IMC-0101,LOCAL,,inpatient,,,3387.02,3387.02,,,,,,,,,,,,,,,,,
FEMALE PUREWICK,270,RC,IMC-0137,LOCAL,,inpatient,,,43.45,43.45,,,,,,,,,,,,,,,,,
HILLROM EVELLA BED DAY RENTAL,270,RC,IMC-0156,LOCAL,,inpatient,,,445.14,445.14,,,,,,,,,,,,,,,,,
Medline Mattress Bubble Overla,270,RC,IMC-0157,LOCAL,,inpatient,,,215.8,215.8,,,,,,,,,,,,,,,,,
CYSTOSCOPE IRRIGATION SET,270,RC,IMC-0173,LOCAL,,inpatient,,,25.32,25.32,,,,,,,,,,,,,,,,,
HIP ABDUCTOR SMALL,270,RC,IMC-0187,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
GLOVE EDEMA TAN LEFT LARGE,270,RC,IMC-0203,LOCAL,,inpatient,,,84.54,84.54,,,,,,,,,,,,,,,,,
EXCHANGER HME ESTC BCTR VIR PR,270,RC,IMC-0224,LOCAL,,inpatient,,,0.12,0.12,,,,,,,,,,,,,,,,,
BED BLUECHIP 9800 POWER ELITE,270,RC,IMC-0278,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
ENDO TRACH WITH MURPHY EYE 6 M,270,RC,IMC-0380,LOCAL,,inpatient,,,106.95,106.95,,,,,,,,,,,,,,,,,
TRACH TUBE TAPER GUARD 8.5MM,270,RC,IMC-0381,LOCAL,,inpatient,,,297.09,297.09,,,,,,,,,,,,,,,,,
TRACH TUBE TAPER GUARD 8.5MM,270,RC,IMC-0382,LOCAL,,inpatient,,,55,55,,,,,,,,,,,,,,,,,
KANGAROO ENTERAL FEEDING PUMP,270,RC,IMC-0383,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
NP100 84X35X.5X6 BY HILL-ROM M,270,RC,IMC-0384,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
EXCHANGER BYPASS,270,RC,IMC-0385,LOCAL,,inpatient,,,1.02,1.02,,,,,,,,,,,,,,,,,
TUBE LIHEP PLS 3ML,270,RC,IMC-0386,LOCAL,,inpatient,,,2.46,2.46,,,,,,,,,,,,,,,,,
HILL-ROM Medical Bed Specialty,270,RC,IMC-0483,LOCAL,,inpatient,,,225,225,,,,,,,,,,,,,,,,,
ADAPT SKIN BARRIER STRIPS N,270,RC,IMC-0484,LOCAL,,inpatient,,,0.84,0.84,,,,,,,,,,,,,,,,,
1 PIECE CUT TO FIT FLEX POUCHE,270,RC,IMC-0667,LOCAL,,inpatient,,,1.26,1.26,,,,,,,,,,,,,,,,,
THERMOMETER ORL SRTMP + LNG CR,270,RC,IMC-0682,LOCAL,,inpatient,,,710.73,710.73,,,,,,,,,,,,,,,,,
EXCHANGER BYPASS HEAT AND MOIS,270,RC,IMC-0749,LOCAL,,inpatient,,,1.02,1.02,,,,,,,,,,,,,,,,,
PURE IMAGE ULTRA SOUND GEL,270,RC,IMS-0002,LOCAL,,inpatient,,,11.34,11.34,,,,,,,,,,,,,,,,,
Spur Adult Resuscitator Bags M,270,RC,IMS-0036,LOCAL,,inpatient,,,17.34,17.34,,,,,,,,,,,,,,,,,
NASO AIRWAY 8MM INNER 5 MM,270,RC,IMS-0060,LOCAL,,inpatient,,,56.54,56.54,,,,,,,,,,,,,,,,,
"EDEMA GLOVE, OVER WRIST TAN LE",270,RC,IMS-0067,LOCAL,,inpatient,,,84.54,84.54,,,,,,,,,,,,,,,,,
ASCOPE 4 BRONCHO REGULAR,270,RC,IMS-0072,LOCAL,,inpatient,,,225.9,225.9,,,,,,,,,,,,,,,,,
Airlife valved Tee Adapters,270,RC,IMS-0076,LOCAL,,inpatient,,,10.86,10.86,,,,,,,,,,,,,,,,,
MIC Gastrotomy Feeding Tube 20,270,RC,IMS-0116,LOCAL,,inpatient,,,0.66,0.66,,,,,,,,,,,,,,,,,
SHDR IMMOBILIZER ABD MEDIUM,270,RC,IMS-0125,LOCAL,,inpatient,,,135,135,,,,,,,,,,,,,,,,,
SHD IMMOBILIZER ABD LARGE,270,RC,IMS-0127,LOCAL,,inpatient,,,135,135,,,,,,,,,,,,,,,,,
TUBE 24FR SIL RADPQ MED PORT R,270,RC,IMS-0154,LOCAL,,inpatient,,,103.2,103.2,,,,,,,,,,,,,,,,,
EDEMA GLOVE FF TAN RIGHT LARGE,270,RC,IMS-0158,LOCAL,,inpatient,,,84.54,84.54,,,,,,,,,,,,,,,,,
CLINIMIX E 5 /20% SOL 2000 ML,270,RC,IMS-0183,LOCAL,,inpatient,,,154.7,154.7,,,,,,,,,,,,,,,,,
Citric Acid 50% Liquid Concent,270,RC,IMS-0205,LOCAL,,inpatient,,,36.3,36.3,,,,,,,,,,,,,,,,,
CLINIMIX 4.25/5% SOL 2000 ML,270,RC,IMS-0222,LOCAL,,inpatient,,,78.98,78.98,,,,,,,,,,,,,,,,,
CLINIMIX 5% AA 15% DEX 2000ML,270,RC,IMS-0223,LOCAL,,inpatient,,,90.31,90.31,,,,,,,,,,,,,,,,,
SOLUTION IV CLNMX 5% AA 20% DE,270,RC,IMS-0224,LOCAL,,inpatient,,,94.11,94.11,,,,,,,,,,,,,,,,,
CLINIMIX E 5% AA 15% DEX 2000M,270,RC,IMS-0227,LOCAL,,inpatient,,,98.67,98.67,,,,,,,,,,,,,,,,,
SET .195IN 81IN REGULATE CLMP,270,RC,IMS-0259,LOCAL,,inpatient,,,0.72,0.72,,,,,,,,,,,,,,,,,
DIANEAL LOW CALCIUM,270,RC,IMS-0269,LOCAL,,inpatient,,,233,233,,,,,,,,,,,,,,,,,
CLINIMIX 5% AA 15% DEX 1000ML,270,RC,IMS-0278,LOCAL,,inpatient,,,32.12,32.12,,,,,,,,,,,,,,,,,
CLINIMIX 5% AA 20% DEX 1000ML,270,RC,IMS-0279,LOCAL,,inpatient,,,34.43,34.43,,,,,,,,,,,,,,,,,
ULTRA MIST SINGLE USE APPLICAT,270,RC,IMS-0302,LOCAL,,inpatient,,,175,175,,,,,,,,,,,,,,,,,
TRAY CATH 4FR P PICC SHRLK 1 L,270,RC,IMS-0334,LOCAL,,inpatient,,,266.76,266.76,,,,,,,,,,,,,,,,,
TRAY CATH 5FR 18GA P PICC 2 LU,270,RC,IMS-0335,LOCAL,,inpatient,,,283.91,283.91,,,,,,,,,,,,,,,,,
CONNECTOR TBG 4FR 1 LUM PICC R,270,RC,IMS-0336,LOCAL,,inpatient,,,55,55,,,,,,,,,,,,,,,,,
TRAY CATH 4FR 20CM POWERMIDLIN,270,RC,IMS-0364,LOCAL,,inpatient,,,221.65,221.65,,,,,,,,,,,,,,,,,
TRAY CATH 5FR POWERMIDLINE 2 L,270,RC,IMS-0365,LOCAL,,inpatient,,,243,243,,,,,,,,,,,,,,,,,
TRAY CATH 4FR POWERMIDLINE 2 L,270,RC,IMS-0367,LOCAL,,inpatient,,,243,243,,,,,,,,,,,,,,,,,
CATHETER 10CM 20GA IV POWERGLI,270,RC,IMS-0369,LOCAL,,inpatient,,,149.1,149.1,,,,,,,,,,,,,,,,,
KIT CATH 4FR 55CM P PICC PLC S,270,RC,IMS-0371,LOCAL,,inpatient,,,359.73,359.73,,,,,,,,,,,,,,,,,
PPICC PROV 4FR DL MB+ BP W/3CG,270,RC,IMS-0374,LOCAL,,inpatient,,,411.44,411.44,,,,,,,,,,,,,,,,,
"DRESSING, HYDRFRA, BL, NO BORD",270,RC,IMS-0396,LOCAL,,inpatient,,,36.52,36.52,,,,,,,,,,,,,,,,,
EXUDERM Satin Hydrocolloid Wou,270,RC,IMS-0406,LOCAL,,inpatient,,,19.2,19.2,,,,,,,,,,,,,,,,,
SQU83925,270,RC,IMS-0414,LOCAL,,inpatient,,,20.88,20.88,,,,,,,,,,,,,,,,,
"OptiView Clear Dressing, Multi",270,RC,IMS-0415,LOCAL,,inpatient,,,55.55,55.55,,,,,,,,,,,,,,,,,
TRACH PRELOADED STYLET 8.5 14f,270,RC,IMS-0431,LOCAL,,inpatient,,,16.32,16.32,,,,,,,,,,,,,,,,,
KIT PEG 20FR PUL EVV ENFIT DIS,270,RC,IMS-0443,LOCAL,,inpatient,,,286.79,286.79,,,,,,,,,,,,,,,,,
ENDOVIVE STD PEG PULL W/ENFIT,270,RC,IMS-0444,LOCAL,,inpatient,,,186.7,186.7,,,,,,,,,,,,,,,,,
AG CUFF MANOMETER,270,RC,IMS-0532,LOCAL,,inpatient,,,9,9,,,,,,,,,,,,,,,,,
METAL SUCTION CANISTER WALL PL,270,RC,IMS-0581,LOCAL,,inpatient,,,33.61,33.61,,,,,,,,,,,,,,,,,
KANGAROO FEEDING TUBE  10FR,270,RC,IMS-0590,LOCAL,,inpatient,,,27.6,27.6,,,,,,,,,,,,,,,,,
BOOT MPO 2000 MEDIUM,270,RC,IMS-0625,LOCAL,,inpatient,,,427.46,427.46,,,,,,,,,,,,,,,,,
HEMOSTAT FLOOR GRADE KELLY STR,270,RC,IMS-0639,LOCAL,,inpatient,,,55,55,,,,,,,,,,,,,,,,,
FEEDING ADAPTER  ENFIT LF STER,270,RC,IMS-0645,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
"Kangaroo EnFit Feeding Tube, 2",270,RC,IMS-0673,LOCAL,,inpatient,,,95.1,95.1,,,,,,,,,,,,,,,,,
Kangaroo Feeding Tube with 5 g,270,RC,IMS-0675,LOCAL,,inpatient,,,47.14,47.14,,,,,,,,,,,,,,,,,
PowerPICC SOLO 2 5FR,270,RC,IMS-0696,LOCAL,,inpatient,,,2030.99,2030.99,,,,,,,,,,,,,,,,,
CATHETER DRN 14FR 25CM MCLC 6,270,RC,IMS-0701,LOCAL,,inpatient,,,458.96,458.96,,,,,,,,,,,,,,,,,
CATHETER DRN 10.2FR 25CM MCLC,270,RC,IMS-0711,LOCAL,,inpatient,,,427.46,427.46,,,,,,,,,,,,,,,,,
CANNULA INNR VERSATUBE 6MM 7MM,270,RC,IMS-0727,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
CANNULA INNR VERSATUBE 7MM 8MM,270,RC,IMS-0728,LOCAL,,inpatient,,,23.52,23.52,,,,,,,,,,,,,,,,,
CATHETER DRN 24FR 15.75IN ARGY,270,RC,IMS-0733,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 7.5MM SHLY L,270,RC,IMS-0741,LOCAL,,inpatient,,,1.68,1.68,,,,,,,,,,,,,,,,,
SHILEY INNER CANNULA 8MM,270,RC,IMS-0742,LOCAL,,inpatient,,,267.08,267.08,,,,,,,,,,,,,,,,,
HILLROM  ENVELLA BED DAY RENTA,270,RC,IMS-0832,LOCAL,,inpatient,,,445.14,445.14,,,,,,,,,,,,,,,,,
NEW CANNULA OPTIFLOW 20 BX,270,RC,IMS-0835,LOCAL,,inpatient,,,6.54,6.54,,,,,,,,,,,,,,,,,
NEW CANNULA OPTIFLOW 20 BX,270,RC,IMS-0836,LOCAL,,inpatient,,,6.36,6.36,,,,,,,,,,,,,,,,,
NEW CANNULA OPTIFLOW 20 BX,270,RC,IMS-0837,LOCAL,,inpatient,,,6.36,6.36,,,,,,,,,,,,,,,,,
POUCH UROS STD 2.75IN N IMG BL,270,RC,IMS-0853,LOCAL,,inpatient,,,3.54,3.54,,,,,,,,,,,,,,,,,
"Dextrose 4.25%, 3,000 mL",270,RC,IMS-0888,LOCAL,,inpatient,,,109.67,109.67,,,,,,,,,,,,,,,,,
"Dextrose 1.5%, 2,000 mL",270,RC,IMS-0922,LOCAL,,inpatient,,,107.03,107.03,,,,,,,,,,,,,,,,,
BOOT MPO 2000 LARGE,270,RC,IMS-0927,LOCAL,,inpatient,,,427.46,427.46,,,,,,,,,,,,,,,,,
SILCONE WOUND 3X4,270,RC,IMS-0943,LOCAL,,inpatient,,,28.8,28.8,,,,,,,,,,,,,,,,,
Hillrom Vest System  -RT,270,RC,IMS-1002,LOCAL,,inpatient,,,60.72,60.72,,,,,,,,,,,,,,,,,
BLU SELECT 8MM TRACH TUBE,270,RC,IMS-1047,LOCAL,,inpatient,,,310.32,310.32,,,,,,,,,,,,,,,,,
PORTEX 7 UNCUFF FENES TRACH,270,RC,IMS-1088,LOCAL,,inpatient,,,310.32,310.32,,,,,,,,,,,,,,,,,
DRESSING VAC FOAM SMALL,270,RC,IMS-1094,LOCAL,,inpatient,,,37.13,37.13,,,,,,,,,,,,,,,,,
VAC GRANUFOAM DRESSING MEDIUM,270,RC,IMS-1116,LOCAL,,inpatient,,,199.45,199.45,,,,,,,,,,,,,,,,,
PAD WND DRN SENSATRAC VAC TUBE,270,RC,IMS-1130,LOCAL,,inpatient,,,93.56,93.56,,,,,,,,,,,,,,,,,
DRESSING VAC FOAM MEDIUM,270,RC,IMS-1141,LOCAL,,inpatient,,,37.13,37.13,,,,,,,,,,,,,,,,,
V.A.C  FREEDOM GRANUFOAM DRESS,270,RC,IMS-1145,LOCAL,,inpatient,,,37.13,37.13,,,,,,,,,,,,,,,,,
V.A.C GRANUFOAM DRESSING MEDIU,270,RC,IMS-1147,LOCAL,,inpatient,,,37.13,37.13,,,,,,,,,,,,,,,,,
Wound VAC Rental NPWT,270,RC,IMS-1154,LOCAL,,inpatient,,,54.39,54.39,,,,,,,,,,,,,,,,,
V.A.C GRANUFOAN DRESSING LARGE,270,RC,IMS-1158,LOCAL,,inpatient,,,74.25,74.25,,,,,,,,,,,,,,,,,
WOUND VAC RENTAL PER DAY,270,RC,IMS-1188,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
FOLEY CATH COUDE 18FE 30ML,270,RC,IMS-1190,LOCAL,,inpatient,,,34.05,34.05,,,,,,,,,,,,,,,,,
HIP ABDUCTOR SMALL,270,RC,IMS-1216,LOCAL,,inpatient,,,7.92,7.92,,,,,,,,,,,,,,,,,
BRACE WRIST WITH D RING LEFT M,270,RC,IMS-1323,LOCAL,,inpatient,,,109.73,109.73,,,,,,,,,,,,,,,,,
Debridement Kit,270,RC,IMS-1338,LOCAL,,inpatient,,,10.74,10.74,,,,,,,,,,,,,,,,,
"Freedom Arm Splint, Size M, 6""",270,RC,IMS-1372,LOCAL,,inpatient,,,52.53,52.53,,,,,,,,,,,,,,,,,
"Rolyan Hemi Arm Sling II, Left",270,RC,IMS-1384,LOCAL,,inpatient,,,228.42,228.42,,,,,,,,,,,,,,,,,
BOVIE EYE BUBBLES,270,RC,IMS-1415,LOCAL,,inpatient,,,47.63,47.63,,,,,,,,,,,,,,,,,
CATHETER  BRD 12FR,270,RC,IMS-1420,LOCAL,,inpatient,,,3.3,3.3,,,,,,,,,,,,,,,,,
"Freedom Arm Splint, Size M, 6""",270,RC,IMS-1428,LOCAL,,inpatient,,,52.53,52.53,,,,,,,,,,,,,,,,,
CATHETER BRD 16FR 2W,270,RC,IMS-1507,LOCAL,,inpatient,,,3.48,3.48,,,,,,,,,,,,,,,,,
CATHETER BRD 18FR 2W,270,RC,IMS-1508,LOCAL,,inpatient,,,3.48,3.48,,,,,,,,,,,,,,,,,
CATHETER BRD 18 FR 2W,270,RC,IMS-1509,LOCAL,,inpatient,,,3.48,3.48,,,,,,,,,,,,,,,,,
CATHETER BRD 22FR 2W,270,RC,IMS-1510,LOCAL,,inpatient,,,3.48,3.48,,,,,,,,,,,,,,,,,
"Bridle Pro Systems, 16-18 Fr,",270,RC,IMS-1524,LOCAL,,inpatient,,,989.15,989.15,,,,,,,,,,,,,,,,,
STOCKING CMPR 15-18 MMHG LG RE,270,RC,IMS-1576,LOCAL,,inpatient,,,47.3,47.3,,,,,,,,,,,,,,,,,
"SLING UNIVERSAL 19X33""",270,RC,IMS-1577,LOCAL,,inpatient,,,26.22,26.22,,,,,,,,,,,,,,,,,
QUAD BREATHE CALL BUTTON,270,RC,IMS-1606,LOCAL,,inpatient,,,771.62,771.62,,,,,,,,,,,,,,,,,
Matrix Elastic Bandage  Nonste,270,RC,IMS-1686,LOCAL,,inpatient,,,1.02,1.02,,,,,,,,,,,,,,,,,
ARM ELEVATOR,270,RC,IMS-1894,LOCAL,,inpatient,,,115.5,115.5,,,,,,,,,,,,,,,,,
"Posey Freedom Arm Splint, Size",270,RC,IMS-1908,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
"Nasal Tube Bridle Pro System,",270,RC,IMS-1919,LOCAL,,inpatient,,,1317.11,1317.11,,,,,,,,,,,,,,,,,
DEVICE SCR AMT BRIDLE 12FR STD,270,RC,IMS-2224,LOCAL,,inpatient,,,1336.86,1336.86,,,,,,,,,,,,,,,,,
"Nasal Tube Bridle Pro System,",270,RC,IMS-2255,LOCAL,,inpatient,,,1340.1,1340.1,,,,,,,,,,,,,,,,,
Splints: Dynapro Flex Finger H,270,RC,IMS-2307,LOCAL,,inpatient,,,61.71,61.71,,,,,,,,,,,,,,,,,
Dynapro Flex Finger Hand Split,270,RC,IMS-2308,LOCAL,,inpatient,,,61.71,61.71,,,,,,,,,,,,,,,,,
PUMP NASO TUBE DBL LUMEN  6FR,270,RC,IMS-2316,LOCAL,,inpatient,,,43.34,43.34,,,,,,,,,,,,,,,,,
PEEK A BOO HAND CONTROL MITTS,270,RC,IMS-2414,LOCAL,,inpatient,,,60.72,60.72,,,,,,,,,,,,,,,,,
MIDLINE DUAL LUMEN CATHETER 5,270,RC,IMS-2546,LOCAL,,inpatient,,,810,810,,,,,,,,,,,,,,,,,
"Rolyan Hemi Arm Sling II, Left",270,RC,IMS-2644,LOCAL,,inpatient,,,228.42,228.42,,,,,,,,,,,,,,,,,
CATHETER URTH BRD 18FR 2W FOL,270,RC,IMS-2658,LOCAL,,inpatient,,,1.38,1.38,,,,,,,,,,,,,,,,,
"Iodosorb Gel Dressing Tube, 10",270,RC,IMS-2829,LOCAL,,inpatient,,,4.08,4.08,,,,,,,,,,,,,,,,,
DISPOSABLE BIOPSY PUNCH 1 MM,270,RC,IMS-2838,LOCAL,,inpatient,,,11.52,11.52,,,,,,,,,,,,,,,,,
MSK NIV FULL FACE,270,RC,IMS-2851,LOCAL,,inpatient,,,9.18,9.18,,,,,,,,,,,,,,,,,
ENFIT H20 FEEDING SET 1000 ML,270,RC,IMS-2853,LOCAL,,inpatient,,,31.41,31.41,,,,,,,,,,,,,,,,,
KIT HMDIAL CATH 3 LUM 13CM 12F,270,RC,IMS-2883,LOCAL,,inpatient,,,95.7,95.7,,,,,,,,,,,,,,,,,
KIT HMDIAL CATH 3 LUM 16CM 12F,270,RC,IMS-2884,LOCAL,,inpatient,,,95.7,95.7,,,,,,,,,,,,,,,,,
KIT HMDIAL CATH 3 LUM 20CM 12F,270,RC,IMS-2885,LOCAL,,inpatient,,,95.7,95.7,,,,,,,,,,,,,,,,,
KIT HMDIAL CATH 3 LUM 16CM 12F,270,RC,IMS-2886,LOCAL,,inpatient,,,540,540,,,,,,,,,,,,,,,,,
KIT HMDIAL CATH 3 LUM 20CM 12F,270,RC,IMS-2887,LOCAL,,inpatient,,,540,540,,,,,,,,,,,,,,,,,
KIT HMDIAL CATH 3 LUM 24CM 12F,270,RC,IMS-2888,LOCAL,,inpatient,,,78.1,78.1,,,,,,,,,,,,,,,,,
LECTRODE DEFIB CMPLT 1STP X SE,270,RC,IMS-2905,LOCAL,,inpatient,,,392.04,392.04,,,,,,,,,,,,,,,,,
WAFFLE Pre-Inflated Cushion,270,RC,IMS-2944,LOCAL,,inpatient,,,82.5,82.5,,,,,,,,,,,,,,,,,
PROTECTANT SKIN MARATHON LIQUI,270,RC,IMS-2946,LOCAL,,inpatient,,,58.03,58.03,,,,,,,,,,,,,,,,,
HYDRO TRACH HME,270,RC,IMS-2990,LOCAL,,inpatient,,,24.48,24.48,,,,,,,,,,,,,,,,,
TAPE RETENTION 2 X 11 YD,270,RC,IMS-3008,LOCAL,,inpatient,,,29.4,29.4,,,,,,,,,,,,,,,,,
POUCH UROS 2.25IN CTF 2.5IN FL,270,RC,IMS-3009,LOCAL,,inpatient,,,0.48,0.48,,,,,,,,,,,,,,,,,
WOUND CLEANER VASHE 8OZ,270,RC,IMS-3020,LOCAL,,inpatient,,,82.5,82.5,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB 24IN EDG QCMB,270,RC,IMS-3057,LOCAL,,inpatient,,,107.35,107.35,,,,,,,,,,,,,,,,,
Truclose Suction Drainage Syst,270,RC,IMS-3091,LOCAL,,inpatient,,,55,55,,,,,,,,,,,,,,,,,
MASK PROFOMA MAX SMALL,270,RC,IMS-3118,LOCAL,,inpatient,,,1400.49,1400.49,,,,,,,,,,,,,,,,,
HUDSON MANUAL RESUSITATOR\,270,RC,IMS-3217,LOCAL,,inpatient,,,189.05,189.05,,,,,,,,,,,,,,,,,
GAUZE BORDER 6X6 PAD STERILE,270,RC,IMS-3263,LOCAL,,inpatient,,,58.47,58.47,,,,,,,,,,,,,,,,,
BOOT MPO 2000 SMALL,270,RC,IMS-3271,LOCAL,,inpatient,,,599.49,599.49,,,,,,,,,,,,,,,,,
UNIVERSAL WRIST CUFFS LARGE,270,RC,IMS-3273,LOCAL,,inpatient,,,206.6,206.6,,,,,,,,,,,,,,,,,
WOUND DRAIN COLLECTOR,270,RC,IMS-3276,LOCAL,,inpatient,,,1.26,1.26,,,,,,,,,,,,,,,,,
"SUPERSET CATHETER MOUNTS, STRA",270,RC,IMS-3294,LOCAL,,inpatient,,,20.76,20.76,,,,,,,,,,,,,,,,,
PLURA EVAC DRAIN CHST,270,RC,IMS-3317,LOCAL,,inpatient,,,675,675,,,,,,,,,,,,,,,,,
Surgifoam Absorbable Gelatin S,270,RC,IMS-3326,LOCAL,,inpatient,,,1.44,1.44,,,,,,,,,,,,,,,,,
Surgifoam Absorbable Gelatin S,270,RC,IMS-3343,LOCAL,,inpatient,,,1.44,1.44,,,,,,,,,,,,,,,,,
Blu Select Trach Tube 6MM,270,RC,IMS-3351,LOCAL,,inpatient,,,310.32,310.32,,,,,,,,,,,,,,,,,
"Arterial Line Catheter Kit, Si",270,RC,IMS-3357,LOCAL,,inpatient,,,214.5,214.5,,,,,,,,,,,,,,,,,
Trachs inner cannula 7.5  mm,270,RC,IMS-3377,LOCAL,,inpatient,,,17.04,17.04,,,,,,,,,,,,,,,,,
TUBE ET 8.5MM ORL/NSL CUF MRPH,270,RC,IMS-3378,LOCAL,,inpatient,,,8.46,8.46,,,,,,,,,,,,,,,,,
NASOPHAYNGEAL AIRWAY PORTEX 7.,270,RC,IMS-3389,LOCAL,,inpatient,,,56.6,56.6,,,,,,,,,,,,,,,,,
OXIMETER PENDANT NASAL CANNULA,270,RC,IMS-3404,LOCAL,,inpatient,,,113.3,113.3,,,,,,,,,,,,,,,,,
Ethicon Nylon Sutures 4.0,270,RC,IMS-3438,LOCAL,,inpatient,,,2.64,2.64,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB PED 10.2X8.9CM,270,RC,IMS-3451,LOCAL,,inpatient,,,394.52,394.52,,,,,,,,,,,,,,,,,
BREATHING CIRCUIT COAXIAL RENT,270,RC,IMS-3460,LOCAL,,inpatient,,,344.79,344.79,,,,,,,,,,,,,,,,,
AIRLIFE NEB KIT 500 ML,270,RC,IMS-3462,LOCAL,,inpatient,,,25.92,25.92,,,,,,,,,,,,,,,,,
OPTIFLOW NASAL CANNULA,270,RC,IMS-3463,LOCAL,,inpatient,,,108,108,,,,,,,,,,,,,,,,,
OPTIFLOW TRACH CONNECTOR,270,RC,IMS-3464,LOCAL,,inpatient,,,108,108,,,,,,,,,,,,,,,,,
"Edema Full-Finger Glove, Tan L",270,RC,IMS-3476,LOCAL,,inpatient,,,2.76,2.76,,,,,,,,,,,,,,,,,
CLINIMIX 5% AA 15% DEX IV,270,RC,IMS-3517,LOCAL,,inpatient,,,90.31,90.31,,,,,,,,,,,,,,,,,
SOLUTION IV CLNMX 5% AA 20%,270,RC,IMS-3518,LOCAL,,inpatient,,,94.11,94.11,,,,,,,,,,,,,,,,,
CLINIMIX E 5% AA 15% DEX IV,270,RC,IMS-3519,LOCAL,,inpatient,,,98.67,98.67,,,,,,,,,,,,,,,,,
CLINIMIX 5% AA 15% DEX IV,270,RC,IMS-3520,LOCAL,,inpatient,,,32.12,32.12,,,,,,,,,,,,,,,,,
CLINIMIX 5% AA 20% DEX IV,270,RC,IMS-3521,LOCAL,,inpatient,,,34.43,34.43,,,,,,,,,,,,,,,,,
METAL SUCTION CANISTER,270,RC,IMS-3522,LOCAL,,inpatient,,,33.61,33.61,,,,,,,,,,,,,,,,,
HEMOSTAT FLOOR GRADE,270,RC,IMS-3523,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
CANNULA INNR VERSATUBE,270,RC,IMS-3525,LOCAL,,inpatient,,,6,6,,,,,,,,,,,,,,,,,
CANNULA INNR VERSATUBE,270,RC,IMS-3526,LOCAL,,inpatient,,,6,6,,,,,,,,,,,,,,,,,
VEST SPU 43-53+ IN LG WRP DISP,270,RC,IMS-3527,LOCAL,,inpatient,,,60.72,60.72,,,,,,,,,,,,,,,,,
TRAY SURGICAL,270,RC,IMS-3528,LOCAL,,inpatient,,,25.02,25.02,,,,,,,,,,,,,,,,,
BINDER ABD 30-45INX9IN 3 PNL,270,RC,IMS-3529,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
CANNULA NSL CMFRT FLO + HEAT,270,RC,IMS-3530,LOCAL,,inpatient,,,4.86,4.86,,,,,,,,,,,,,,,,,
TRAY SURG BPTCH PICC LN,270,RC,IMS-3531,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
GLOVE EXM MED,270,RC,IMS-3532,LOCAL,,inpatient,,,0.3,0.3,,,,,,,,,,,,,,,,,
CPAP Boomerang Gel Pad,270,RC,IMS-3533,LOCAL,,inpatient,,,21.39,21.39,,,,,,,,,,,,,,,,,
HOLDER URINE DRAIN BAG/VINYL,270,RC,IMS-3534,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
PUMP ENTRAFLO H20 FEEDING PUMP,270,RC,IMS-3535,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
TRAY BARDEX ID FOLEY 18FR,270,RC,IMS-3536,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
TRAY BARDEX ID FOLEY 18FR,270,RC,IMS-3537,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
PICC DRSNG CHNG KT W/GUARDIVA2,270,RC,IMS-3538,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
DRESSING CHANGE KIT(PICC),270,RC,IMS-3539,LOCAL,,inpatient,,,1.8,1.8,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB CMPLT 1STP,270,RC,IMS-3541,LOCAL,,inpatient,,,392.04,392.04,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB CPR-D PADZ,270,RC,IMS-3542,LOCAL,,inpatient,,,622.08,622.08,,,,,,,,,,,,,,,,,
ELECTRODE TRN CPR 1STP,270,RC,IMS-3543,LOCAL,,inpatient,,,534.6,534.6,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB STAT PADZ,270,RC,IMS-3544,LOCAL,,inpatient,,,16.32,16.32,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB 2PC,270,RC,IMS-3545,LOCAL,,inpatient,,,230.4,230.4,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB 1 PC,270,RC,IMS-3546,LOCAL,,inpatient,,,622.08,622.08,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB CPR,270,RC,IMS-3547,LOCAL,,inpatient,,,1804.68,1804.68,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB 1STP,270,RC,IMS-3548,LOCAL,,inpatient,,,50.05,50.05,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB CPR AA,270,RC,IMS-3549,LOCAL,,inpatient,,,44.17,44.17,,,,,,,,,,,,,,,,,
ELECTRODE TRN CPR-D PADZ,270,RC,IMS-3550,LOCAL,,inpatient,,,317.52,317.52,,,,,,,,,,,,,,,,,
SET XTN STAY-SAFE PRTNL,270,RC,IMS-3551,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
DIALYZER OPTIFLUX HI FLUX,270,RC,IMS-3552,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
DEVICE SCR AMT BRIDLE STD NSL,270,RC,IMS-3553,LOCAL,,inpatient,,,162.45,162.45,,,,,,,,,,,,,,,,,
DEVICE SCR AMT BRIDLE STD,270,RC,IMS-3554,LOCAL,,inpatient,,,247.77,247.77,,,,,,,,,,,,,,,,,
TUBE 22FR CONN GSTRM MIC ENFIT,270,RC,IMS-3555,LOCAL,,inpatient,,,113.95,113.95,,,,,,,,,,,,,,,,,
CATHETER URTH BRD LBRSL IC 12,270,RC,IMS-3556,LOCAL,,inpatient,,,36.8,36.8,,,,,,,,,,,,,,,,,
CATHETER URTH BRD LBRSL IC 16,270,RC,IMS-3557,LOCAL,,inpatient,,,36.8,36.8,,,,,,,,,,,,,,,,,
CATHETER URTH BRD LBRSL IC 18,270,RC,IMS-3558,LOCAL,,inpatient,,,36.8,36.8,,,,,,,,,,,,,,,,,
CATHETER URTH BRD LBRSL IC 22,270,RC,IMS-3559,LOCAL,,inpatient,,,36.8,36.8,,,,,,,,,,,,,,,,,
CATHETER URTH LBRSL IC 20FR,270,RC,IMS-3560,LOCAL,,inpatient,,,36.8,36.8,,,,,,,,,,,,,,,,,
TRAY CATH ADV CMP CR LBRSL IC,270,RC,IMS-3561,LOCAL,,inpatient,,,36.8,36.8,,,,,,,,,,,,,,,,,
PUREWICK MALE EXTERNAL CATH,270,RC,IMS-3562,LOCAL,,inpatient,,,81.35,81.35,,,,,,,,,,,,,,,,,
TRAY CATH 5FR 18GA P PICC 2 LU,270,RC,IMS-3563,LOCAL,,inpatient,,,283.91,283.91,,,,,,,,,,,,,,,,,
PPICC PROV 4FR DL MB+ BP W/3CG,270,RC,IMS-3564,LOCAL,,inpatient,,,2440.71,2440.71,,,,,,,,,,,,,,,,,
"Edema Over-Wrist Glove, Tan, R",270,RC,IMS-3565,LOCAL,,inpatient,,,0.36,0.36,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 6.5MM,270,RC,IMS-3566,LOCAL,,inpatient,,,16.92,16.92,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 7MM,270,RC,IMS-3567,LOCAL,,inpatient,,,16.92,16.92,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 7.5MM,270,RC,IMS-3568,LOCAL,,inpatient,,,16.92,16.92,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 8MM,270,RC,IMS-3569,LOCAL,,inpatient,,,16.92,16.92,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 8.5MM,270,RC,IMS-3570,LOCAL,,inpatient,,,16.92,16.92,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 9MM,270,RC,IMS-3571,LOCAL,,inpatient,,,16.92,16.92,,,,,,,,,,,,,,,,,
HME BYPASS CLEARPATH 1EA,270,RC,IMS-3572,LOCAL,,inpatient,,,48.4,48.4,,,,,,,,,,,,,,,,,
NEW CANNULA OPTIFLOW 20 BX,270,RC,IMS-3573,LOCAL,,inpatient,,,108.15,108.15,,,,,,,,,,,,,,,,,
Snap Style ECG Electrode,270,RC,IMS-3574,LOCAL,,inpatient,,,0.72,0.72,,,,,,,,,,,,,,,,,
DRAIN PLURX KIT 1000 ML,270,RC,IMS-3575,LOCAL,,inpatient,,,268.11,268.11,,,,,,,,,,,,,,,,,
Fecal: Flexi Seal Odor Control,270,RC,IMS-3576,LOCAL,,inpatient,,,71.01,71.01,,,,,,,,,,,,,,,,,
Elastic Retention Netting  9 x,270,RC,IMS-3580,LOCAL,,inpatient,,,35.04,35.04,,,,,,,,,,,,,,,,,
"TRACHEOSTOMY TUBE, 7.0mm",270,RC,IMS-3582,LOCAL,,inpatient,,,310.72,310.72,,,,,,,,,,,,,,,,,
3M DuraPrep,270,RC,IMS-3583,LOCAL,,inpatient,,,22.5,22.5,,,,,,,,,,,,,,,,,
Elastic Retention Netting Fixa,270,RC,IMS-3584,LOCAL,,inpatient,,,46.04,46.04,,,,,,,,,,,,,,,,,
Antiseptic Non-Sterile Sol,270,RC,IMS-3585,LOCAL,,inpatient,,,52.25,52.25,,,,,,,,,,,,,,,,,
"SYSTEM,FMS,FLEXI SEAL,ODOR CON",270,RC,IMS-3599,LOCAL,,inpatient,,,463.5,463.5,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB CPR-D PADZ 1 P,270,RC,IMS-3623,LOCAL,,inpatient,,,622.08,622.08,,,,,,,,,,,,,,,,,
INDICATOR STRL 4 SD WSHR HLDR,270,RC,IMS-3696,LOCAL,,inpatient,,,253.85,253.85,,,,,,,,,,,,,,,,,
CATHETER 20FR 2W FOL,270,RC,IMS-3755,LOCAL,,inpatient,,,9.48,9.48,,,,,,,,,,,,,,,,,
TRAY CATH ADV CMP CR LBRSL IC,270,RC,IMS-3810,LOCAL,,inpatient,,,9.48,9.48,,,,,,,,,,,,,,,,,
AEGIS DISK DRESSING .75 DIA,270,RC,IMS-3994,LOCAL,,inpatient,,,0.36,0.36,,,,,,,,,,,,,,,,,
TRAY SURG LBR DLV,270,RC,IMS-4219,LOCAL,,inpatient,,,25.02,25.02,,,,,,,,,,,,,,,,,
BINDER ABD 30-45INX9IN 3 PNL F,270,RC,IMS-4547,LOCAL,,inpatient,,,380.79,380.79,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 6.5MM SHLY S,270,RC,IMS-4644,LOCAL,,inpatient,,,1.68,1.68,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 7MM SHLY STR,270,RC,IMS-4647,LOCAL,,inpatient,,,1.68,1.68,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 7.5MM SHLY L,270,RC,IMS-4650,LOCAL,,inpatient,,,2.04,2.04,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 8MM SHLY STR,270,RC,IMS-4653,LOCAL,,inpatient,,,1.68,1.68,,,,,,,,,,,,,,,,,
TUBE TRCH 79MM 8.5MM CUF ADLT,270,RC,IMS-4654,LOCAL,,inpatient,,,182.05,182.05,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 8.5MM SHLY S,270,RC,IMS-4655,LOCAL,,inpatient,,,1.68,1.68,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 9MM 9 SHLY,270,RC,IMS-4658,LOCAL,,inpatient,,,1.68,1.68,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 5MM PRTX BLU,270,RC,IMS-4672,LOCAL,,inpatient,,,16.56,16.56,,,,,,,,,,,,,,,,,
NEW CANNULA OPTIFLOW 20 BX,270,RC,IMS-4703,LOCAL,,inpatient,,,6.36,6.36,,,,,,,,,,,,,,,,,
NEW CANNULA OPTIFLOW 20 BX,270,RC,IMS-4704,LOCAL,,inpatient,,,6.36,6.36,,,,,,,,,,,,,,,,,
NEW CANNULA OPTIFLOW 20 BX,270,RC,IMS-4705,LOCAL,,inpatient,,,6.36,6.36,,,,,,,,,,,,,,,,,
NEW CANNULA OPTIFLOW 20 BX,270,RC,IMS-4706,LOCAL,,inpatient,,,6.36,6.36,,,,,,,,,,,,,,,,,
CANNULA NSL CMFRT FLO + SM HEA,270,RC,IMS-4746,LOCAL,,inpatient,,,4.86,4.86,,,,,,,,,,,,,,,,,
CANNULA NSL CMFRT FLO + MED,270,RC,IMS-4747,LOCAL,,inpatient,,,4.86,4.86,,,,,,,,,,,,,,,,,
ADULT HIGH FLOW CANNULAS (UP T,270,RC,IMS-4798,LOCAL,,inpatient,,,0.72,0.72,,,,,,,,,,,,,,,,,
MARATHON LIQUID NO STING PROTE,270,RC,IMS-4800,LOCAL,,inpatient,,,0.24,0.24,,,,,,,,,,,,,,,,,
EntraFlo H2O Feeding Sets,270,RC,IMS-4933,LOCAL,,inpatient,,,41.25,41.25,,,,,,,,,,,,,,,,,
TRAY SURG BPTCH PICC LN,270,RC,IMS-4956,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
TUBE 22FR CONN GSTRM MIC ENFIT,270,RC,IMS-4968,LOCAL,,inpatient,,,104.15,104.15,,,,,,,,,,,,,,,,,
OPTIFOAM GENTLE EX 4X4,270,RC,IMS-5016,LOCAL,,inpatient,,,0.36,0.36,,,,,,,,,,,,,,,,,
OPTIFOAM GENTLE EX 8X7,270,RC,IMS-5020,LOCAL,,inpatient,,,1.8,1.8,,,,,,,,,,,,,,,,,
FORCEPS SURG HLSTD-MSQTO STR 5,270,RC,IMS-5068,LOCAL,,inpatient,,,56.76,56.76,,,,,,,,,,,,,,,,,
PUREWICK FEMALE EXTERNAL,270,RC,IMS-5097,LOCAL,,inpatient,,,36.47,36.47,,,,,,,,,,,,,,,,,
FORMULA PEP 1.5 PEA PRTN ENZML,270,RC,IMS-5139,LOCAL,,inpatient,,,71.5,71.5,,,,,,,,,,,,,,,,,
BLUSELECT TRACH BLU CUF 7.0MM,270,RC,IMS-5260,LOCAL,,inpatient,,,170.7,170.7,,,,,,,,,,,,,,,,,
BLUSELECT TRACH BLU CUF 6MM,270,RC,IMS-5261,LOCAL,,inpatient,,,170.7,170.7,,,,,,,,,,,,,,,,,
BLUSELECT TRACH BLU CUF 6MM,270,RC,IMS-5262,LOCAL,,inpatient,,,6.84,6.84,,,,,,,,,,,,,,,,,
ELASTIC NETTING FIXAXTION SIZE,270,RC,IMS-5333,LOCAL,,inpatient,,,57.15,57.15,,,,,,,,,,,,,,,,,
ELASTIC NETTING  SIZE 4,270,RC,IMS-5334,LOCAL,,inpatient,,,63.25,63.25,,,,,,,,,,,,,,,,,
FLTR CPAP NON INVSV VNT VSN LF,270,RC,IMS-5401,LOCAL,,inpatient,,,230.2,230.2,,,,,,,,,,,,,,,,,
HOLDER URINE DRAIN BAG/VINYL,270,RC,IMS-5415,LOCAL,,inpatient,,,58.25,58.25,,,,,,,,,,,,,,,,,
PUMP ENTRAFLO H20 FEEDING PUMP,270,RC,IMS-5427,LOCAL,,inpatient,,,49.5,49.5,,,,,,,,,,,,,,,,,
PUREWICK MALE EXTERNAL CATHETE,270,RC,IMS-5452,LOCAL,,inpatient,,,81.35,81.35,,,,,,,,,,,,,,,,,
PUREWICK MALE EXTERNAL CATHETE,270,RC,IMS-5453,LOCAL,,inpatient,,,82.17,82.17,,,,,,,,,,,,,,,,,
TRAY BARDEX ID FOLEY 18FR,270,RC,IMS-5508,LOCAL,,inpatient,,,95.76,95.76,,,,,,,,,,,,,,,,,
TRAY BARDEX ID FOLEY 18FR,270,RC,IMS-5509,LOCAL,,inpatient,,,95.76,95.76,,,,,,,,,,,,,,,,,
PICC DRSNG CHNG KT W/GUARDIVA2,270,RC,IMS-5517,LOCAL,,inpatient,,,134.8,134.8,,,,,,,,,,,,,,,,,
PICC DRESSING CHANGE KIT,270,RC,IMS-5532,LOCAL,,inpatient,,,83.33,83.33,,,,,,,,,,,,,,,,,
CLOSED SUCTION CATH W/DOUBLE S,270,RC,IMS-5541,LOCAL,,inpatient,,,3.48,3.48,,,,,,,,,,,,,,,,,
"Edema Full-Finger Glove, Tan,",270,RC,IMS-5610,LOCAL,,inpatient,,,75.9,75.9,,,,,,,,,,,,,,,,,
"Edema Over-Wrist Glove, Tan, R",270,RC,IMS-5611,LOCAL,,inpatient,,,75.9,75.9,,,,,,,,,,,,,,,,,
WAND FEEDING TUBE CLOG REMOVER,270,RC,IMS-5665,LOCAL,,inpatient,,,6,6,,,,,,,,,,,,,,,,,
CABLE EKG 3/5 LD 12 PIN SM STA,270,RC,IMS-5733,LOCAL,,inpatient,,,237.95,237.95,,,,,,,,,,,,,,,,,
ELECTRODE ESURG 105CM 2MM COAG,270,RC,IMS-5804,LOCAL,,inpatient,,,683.64,683.64,,,,,,,,,,,,,,,,,
STOPCOCK IV MEDEX HFL MEDFUSIO,270,RC,IMS-6009,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
EZ PAP WITH MOUTHPIECE,270,RC,IMS-6035,LOCAL,,inpatient,,,8.4,8.4,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB ADLT 5.95X5.24,270,RC,IMS-6104,LOCAL,,inpatient,,,121.5,121.5,,,,,,,,,,,,,,,,,
CANNULA CPAP INT NSL SEAL NK S,270,RC,IMS-6243,LOCAL,,inpatient,,,1.8,1.8,,,,,,,,,,,,,,,,,
HME BYPASS CLEARPATH 1EA 25EA/,270,RC,IMS-6255,LOCAL,,inpatient,,,0.18,0.18,,,,,,,,,,,,,,,,,
SUCTION CANISTER ROLLSTAND HOL,270,RC,IMS-6287,LOCAL,,inpatient,,,233.91,233.91,,,,,,,,,,,,,,,,,
ELECTRODE TRN 1STP CBL CPR SNS,270,RC,IMS-6340,LOCAL,,inpatient,,,534.6,534.6,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB WHT 24IN STAT,270,RC,IMS-6342,LOCAL,,inpatient,,,16.32,16.32,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB STPDZ 2 2 PC M,270,RC,IMS-6345,LOCAL,,inpatient,,,230.4,230.4,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB CPR-D PADZ 1 P,270,RC,IMS-6347,LOCAL,,inpatient,,,622.08,622.08,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB SMLTR SETHR CP,270,RC,IMS-6349,LOCAL,,inpatient,,,1804.68,1804.68,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB 1STP CODE-RDY,270,RC,IMS-6352,LOCAL,,inpatient,,,50.05,50.05,,,,,,,,,,,,,,,,,
ELECTRODE DEFIB CPR AA BTRY RS,270,RC,IMS-6353,LOCAL,,inpatient,,,44.17,44.17,,,,,,,,,,,,,,,,,
ELECTRODE TRN CPR-D PADZ Z DSG,270,RC,IMS-6357,LOCAL,,inpatient,,,317.52,317.52,,,,,,,,,,,,,,,,,
3M Coban Self-Adherent Wraps,270,RC,IMS-6408,LOCAL,,inpatient,,,26.1,26.1,,,,,,,,,,,,,,,,,
MIDLINE KIT,270,RC,IMS-6425,LOCAL,,inpatient,,,133.6,133.6,,,,,,,,,,,,,,,,,
PICC LINE KIT,270,RC,IMS-6426,LOCAL,,inpatient,,,1298.66,1298.66,,,,,,,,,,,,,,,,,
ENTRAFLO H2O ENFIT 1000ML BAG,270,RC,IMS-6438,LOCAL,,inpatient,,,50.22,50.22,,,,,,,,,,,,,,,,,
AIRWAY LRYNG 3 YLW 18FR ADLT D,270,RC,IRT-0001,LOCAL,,inpatient,,,39.82,39.82,,,,,,,,,,,,,,,,,
"Cannula, Extra-Long, Disposabl",270,RC,IRT-0002,LOCAL,,inpatient,,,25.98,25.98,,,,,,,,,,,,,,,,,
Oxymeter Pendant Nasal Cannula,270,RC,IRT-0003,LOCAL,,inpatient,,,79.04,79.04,,,,,,,,,,,,,,,,,
AIRWAY LRYNG 5 PUR 18FR ADLT D,270,RC,IRT-0004,LOCAL,,inpatient,,,143,143,,,,,,,,,,,,,,,,,
Gastric Acc Laryngeal tb sz 4,270,RC,IRT-0016,LOCAL,,inpatient,,,48.4,48.4,,,,,,,,,,,,,,,,,
Gastric Access Laryngeal Tube,270,RC,IRT-0017,LOCAL,,inpatient,,,143,143,,,,,,,,,,,,,,,,,
Shiley Cuffless Flxbl Tube 6.5,270,RC,IRT-0021,LOCAL,,inpatient,,,153.1,153.1,,,,,,,,,,,,,,,,,
POLE IV CLMP FX,270,RC,IRT-0039,LOCAL,,inpatient,,,240.05,240.05,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT ADLT ME,270,RC,IRT-0042,LOCAL,,inpatient,,,12.78,12.78,,,,,,,,,,,,,,,,,
Easy Cap 11 CO2 Detector,270,RC,IRT-0045,LOCAL,,inpatient,,,146.3,146.3,,,,,,,,,,,,,,,,,
DEVICE PEP MTHPC ACPL DH,270,RC,IRT-0052,LOCAL,,inpatient,,,20.7,20.7,,,,,,,,,,,,,,,,,
TUBING O2 AIR COIL DISS MXTC,270,RC,IRT-0055,LOCAL,,inpatient,,,607.5,607.5,,,,,,,,,,,,,,,,,
UNIVERSAL TRACH CAPS,270,RC,IRT-0059,LOCAL,,inpatient,,,37.24,37.24,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 6MM SHLY XLT,270,RC,IRT-0063,LOCAL,,inpatient,,,2.58,2.58,,,,,,,,,,,,,,,,,
CANNULA NSL 25FT SFT CRSH RS O,270,RC,IRT-0069,LOCAL,,inpatient,,,0.3,0.3,,,,,,,,,,,,,,,,,
CATHETER SUC 14FR CLS TRCH LGT,270,RC,IRT-0070,LOCAL,,inpatient,,,4.68,4.68,,,,,,,,,,,,,,,,,
REAGENT .85% NACL 4L BLD BNK,270,RC,IRT-0072,LOCAL,,inpatient,,,18.24,18.24,,,,,,,,,,,,,,,,,
HUMIDIFIER RESP AIRLFE HCH M T,270,RC,IRT-0073,LOCAL,,inpatient,,,10.92,10.92,,,,,,,,,,,,,,,,,
LCD Disposable Nebulizer,270,RC,IRT-0076,LOCAL,,inpatient,,,42.35,42.35,,,,,,,,,,,,,,,,,
Gastric Acces Laryngeal Tube 5,270,RC,IRT-0077,LOCAL,,inpatient,,,143.85,143.85,,,,,,,,,,,,,,,,,
MASK AERSL CLR RCI VNYL ELONGA,270,RC,IRT-0097,LOCAL,,inpatient,,,1.8,1.8,,,,,,,,,,,,,,,,,
NIV ADULT FACE MASK MEDIUM,270,RC,IRT-0098,LOCAL,,inpatient,,,115.75,115.75,,,,,,,,,,,,,,,,,
VENTURI ADULT MASK,270,RC,IRT-0136,LOCAL,,inpatient,,,7.62,7.62,,,,,,,,,,,,,,,,,
ADAPTER 22MM SILCONE FEMALE AD,270,RC,IRT-0138,LOCAL,,inpatient,,,0.54,0.54,,,,,,,,,,,,,,,,,
Valved Tee Adapter 22 MM,270,RC,IRT-0158,LOCAL,,inpatient,,,0.3,0.3,,,,,,,,,,,,,,,,,
UNIT OXM PLS DCI DC3 SNSR HNDH,270,RC,IRT-0164,LOCAL,,inpatient,,,2115,2115,,,,,,,,,,,,,,,,,
UNIT OXM PLS DCI DC3 SNSR HNDH,270,RC,IRT-0165,LOCAL,,inpatient,,,2115,2115,,,,,,,,,,,,,,,,,
TESTER OXM RAD-57 RNBW ST,270,RC,IRT-0168,LOCAL,,inpatient,,,1462.5,1462.5,,,,,,,,,,,,,,,,,
HVLP Cuffed O/N Entr 7.5 w/mur,270,RC,IRT-0169,LOCAL,,inpatient,,,616.5,616.5,,,,,,,,,,,,,,,,,
CABLE OXM 10FT LNCS SPO2 2 KEY,270,RC,IRT-0170,LOCAL,,inpatient,,,810,810,,,,,,,,,,,,,,,,,
SENSOR ADLT RED DCI-DC3 3FT OX,270,RC,IRT-0171,LOCAL,,inpatient,,,630,630,,,,,,,,,,,,,,,,,
CABLE OXM RED 4FT LNCS SPO2 20,270,RC,IRT-0172,LOCAL,,inpatient,,,630,630,,,,,,,,,,,,,,,,,
PLUREX DRAINAGE KIT CHEST,270,RC,IRT-0186,LOCAL,,inpatient,,,7.32,7.32,,,,,,,,,,,,,,,,,
KIT HMDF PLS H2O 540ML STRL AQ,270,RC,IRT-0188,LOCAL,,inpatient,,,6.48,6.48,,,,,,,,,,,,,,,,,
TUBE TRCH 70MM 6MM CUF ADLT PR,270,RC,IRT-0198,LOCAL,,inpatient,,,428.36,428.36,,,,,,,,,,,,,,,,,
ADAPTER HMDF 850 HTR WRE SRG P,270,RC,IRT-0200,LOCAL,,inpatient,,,631.26,631.26,,,,,,,,,,,,,,,,,
FILTER BCTR/VIR 22MM 1.5MM D/X,270,RC,IRT-0203,LOCAL,,inpatient,,,4.14,4.14,,,,,,,,,,,,,,,,,
SYSTEM SUC 14FR CLS CATH 2 SWV,270,RC,IRT-0204,LOCAL,,inpatient,,,4.38,4.38,,,,,,,,,,,,,,,,,
SYSTEM SUC 14FR CLS CATH 2 SWV,270,RC,IRT-0205,LOCAL,,inpatient,,,4.38,4.38,,,,,,,,,,,,,,,,,
BLOOD GAS SAMPLER FULL KIT PUL,270,RC,IRT-0208,LOCAL,,inpatient,,,4.14,4.14,,,,,,,,,,,,,,,,,
CABLE OXM 10FT INTRFC SNSR XTN,270,RC,IRT-0215,LOCAL,,inpatient,,,493.79,493.79,,,,,,,,,,,,,,,,,
SENSOR ADLT MXFST NLCR OXMX C1,270,RC,IRT-0218,LOCAL,,inpatient,,,5.76,5.76,,,,,,,,,,,,,,,,,
SENSOR NLCR OXMX LOSAT 18IN AS,270,RC,IRT-0219,LOCAL,,inpatient,,,4.08,4.08,,,,,,,,,,,,,,,,,
HUMIDIFIER RESP STRL CMFRT FLO,270,RC,IRT-0221,LOCAL,,inpatient,,,6.12,6.12,,,,,,,,,,,,,,,,,
HOLDER TUBE ANCHORFAST GRD FST,270,RC,IRT-0225,LOCAL,,inpatient,,,3.72,3.72,,,,,,,,,,,,,,,,,
TUBE ET 8MM ORL/NSL CUF MRPH E,270,RC,IRT-0227,LOCAL,,inpatient,,,14.16,14.16,,,,,,,,,,,,,,,,,
SOLUTION INHL 0.9% NACL 15ML S,270,RC,IRT-0231,LOCAL,,inpatient,,,0.18,0.18,,,,,,,,,,,,,,,,,
Nelcore Adult C02 Detector,270,RC,IRT-0234,LOCAL,,inpatient,,,23.6,23.6,,,,,,,,,,,,,,,,,
PROBE 88IN 2 ARWY HMDF HEAT FL,270,RC,IRT-0238,LOCAL,,inpatient,,,513,513,,,,,,,,,,,,,,,,,
TUBE ET 7MM ORL/NSL CUF MRPH E,270,RC,IRT-0256,LOCAL,,inpatient,,,24,24,,,,,,,,,,,,,,,,,
HME PROVOX LIFE,270,RC,IRT-0260,LOCAL,,inpatient,,,23.34,23.34,,,,,,,,,,,,,,,,,
SHILEY CUFFED TRACH TUBE,270,RC,IRT-0264,LOCAL,,inpatient,,,50,50,,,,,,,,,,,,,,,,,
LTV 1200 Vent Circuit W/O PEEP,270,RC,IRT-0282,LOCAL,,inpatient,,,24,24,,,,,,,,,,,,,,,,,
FILTER BCTR/VIR 14.6CM 8.9CM E,270,RC,IRT-0294,LOCAL,,inpatient,,,3.9,3.9,,,,,,,,,,,,,,,,,
HUDSON TRACH MASK PEDIACTRIC,270,RC,IRT-0295,LOCAL,,inpatient,,,4.92,4.92,,,,,,,,,,,,,,,,,
HEATER NEB AQTH AQPK 26.6-32.2,270,RC,IRT-0305,LOCAL,,inpatient,,,675,675,,,,,,,,,,,,,,,,,
HEATER NEB AQTH 3 AQPK XTRN AD,270,RC,IRT-0306,LOCAL,,inpatient,,,1296,1296,,,,,,,,,,,,,,,,,
"TRACH TIES LARGE 9"" TO 17""",270,RC,IRT-0307,LOCAL,,inpatient,,,39.77,39.77,,,,,,,,,,,,,,,,,
"TRACH TIES MEDIUM 9"" TO 17""",270,RC,IRT-0308,LOCAL,,inpatient,,,3.6,3.6,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT ADLT LG,270,RC,IRT-0310,LOCAL,,inpatient,,,12.78,12.78,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT ADLT LG,270,RC,IRT-0312,LOCAL,,inpatient,,,9.24,9.24,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT ADLT,270,RC,IRT-0313,LOCAL,,inpatient,,,9.24,9.24,,,,,,,,,,,,,,,,,
SENSOR ADLT NLCR 24IN FNGR OXM,270,RC,IRT-0316,LOCAL,,inpatient,,,519.75,519.75,,,,,,,,,,,,,,,,,
DETECTOR CO2 END TDL CONN PORT,270,RC,IRT-0317,LOCAL,,inpatient,,,7.74,7.74,,,,,,,,,,,,,,,,,
SENSOR ADLT OXMX OXM FRHD STRP,270,RC,IRT-0319,LOCAL,,inpatient,,,28.02,28.02,,,,,,,,,,,,,,,,,
VALVE TRCH SPK 15MM PHONATE HN,270,RC,IRT-0323,LOCAL,,inpatient,,,116.45,116.45,,,,,,,,,,,,,,,,,
VALVE TRCH SPK 15MM SHLY PHONA,270,RC,IRT-0324,LOCAL,,inpatient,,,116.45,116.45,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT ADLT LG,270,RC,IRT-0325,LOCAL,,inpatient,,,18.3,18.3,,,,,,,,,,,,,,,,,
PROBE PROX 64IN ADLT 2 THRMSTR,270,RC,IRT-0330,LOCAL,,inpatient,,,531,531,,,,,,,,,,,,,,,,,
CATHETER SUC 14FR 21.3IN CLS F,270,RC,IRT-0332,LOCAL,,inpatient,,,2.22,2.22,,,,,,,,,,,,,,,,,
HANDLE LRNSCP HPX 2.5V C MED 2,270,RC,IRT-0336,LOCAL,,inpatient,,,213.9,213.9,,,,,,,,,,,,,,,,,
BLADE LRNSCP 172MM MLLR 3 SS F,270,RC,IRT-0337,LOCAL,,inpatient,,,244,244,,,,,,,,,,,,,,,,,
BLADE LRNSCP 182MM MLLR 4 SS H,270,RC,IRT-0338,LOCAL,,inpatient,,,244,244,,,,,,,,,,,,,,,,,
BLADE LRNSCP 126MM MCNTSH 3 SS,270,RC,IRT-0339,LOCAL,,inpatient,,,246.8,246.8,,,,,,,,,,,,,,,,,
BLADE LRNSCP 160MM MCNTSH 4 SS,270,RC,IRT-0340,LOCAL,,inpatient,,,246.8,246.8,,,,,,,,,,,,,,,,,
Blueselect Inner Trach 6.0,270,RC,IRT-0341,LOCAL,,inpatient,,,5.94,5.94,,,,,,,,,,,,,,,,,
HUDSON RCI AIR ENTRAPMENT,270,RC,IRT-0360,LOCAL,,inpatient,,,6,6,,,,,,,,,,,,,,,,,
HUDSON TRACH MASK,270,RC,IRT-0362,LOCAL,,inpatient,,,3.36,3.36,,,,,,,,,,,,,,,,,
HUDSON RCA TUBING,270,RC,IRT-0373,LOCAL,,inpatient,,,1.92,1.92,,,,,,,,,,,,,,,,,
Mask with Nebulizer,270,RC,IRT-0379,LOCAL,,inpatient,,,0.42,0.42,,,,,,,,,,,,,,,,,
TUBING AERSL 100FT 22MM CRRAFL,270,RC,IRT-0388,LOCAL,,inpatient,,,38.5,38.5,,,,,,,,,,,,,,,,,
MASK PERFOMA MAX XL,270,RC,IRT-0404,LOCAL,,inpatient,,,1358.91,1358.91,,,,,,,,,,,,,,,,,
Trach tube Blue Select 8 .0 mm,270,RC,IRT-0415,LOCAL,,inpatient,,,14.4,14.4,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 6MM SHLY LTX,270,RC,IRT-0418,LOCAL,,inpatient,,,3.66,3.66,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 8 SHLY STRL,270,RC,IRT-0419,LOCAL,,inpatient,,,3.66,3.66,,,,,,,,,,,,,,,,,
SENSOR FLW SPRLOG DISINFECTABL,270,RC,IRT-0422,LOCAL,,inpatient,,,98.12,98.12,,,,,,,,,,,,,,,,,
Nelcore Adult C02 Detector,270,RC,IRT-0423,LOCAL,,inpatient,,,11.34,11.34,,,,,,,,,,,,,,,,,
TUBE TRCH 65MM 5MM CUF SHLY PV,270,RC,IRT-0426,LOCAL,,inpatient,,,190.1,190.1,,,,,,,,,,,,,,,,,
TUBE TRCH 65MM 5MM CUFLS SHLY,270,RC,IRT-0430,LOCAL,,inpatient,,,142.5,142.5,,,,,,,,,,,,,,,,,
TUBE TRCH 76MM 6MM CUFLS SHLY,270,RC,IRT-0431,LOCAL,,inpatient,,,142.5,142.5,,,,,,,,,,,,,,,,,
TUBE TRCH 81MM 7.6MM CUFLS ADL,270,RC,IRT-0432,LOCAL,,inpatient,,,142.5,142.5,,,,,,,,,,,,,,,,,
TUBE TRCH 62MM 5MM CUF SHLY LF,270,RC,IRT-0438,LOCAL,,inpatient,,,146.3,146.3,,,,,,,,,,,,,,,,,
TUBE TRCH 74MM 6.4MM CUF ADLT,270,RC,IRT-0439,LOCAL,,inpatient,,,146.3,146.3,,,,,,,,,,,,,,,,,
TUBE TRCH 79MM 7.6MM CUF ADLT,270,RC,IRT-0440,LOCAL,,inpatient,,,146.3,146.3,,,,,,,,,,,,,,,,,
TUBE TRCH 79MM 8.9MM CUF SHLY,270,RC,IRT-0441,LOCAL,,inpatient,,,146.3,146.3,,,,,,,,,,,,,,,,,
Shiley Cuffless Flxbl Tube 7mm,270,RC,IRT-0442,LOCAL,,inpatient,,,3.66,3.66,,,,,,,,,,,,,,,,,
SHILEY CUFFLLESS INNER CANNUAL,270,RC,IRT-0443,LOCAL,,inpatient,,,3.66,3.66,,,,,,,,,,,,,,,,,
AMSURE Sterile Water,270,RC,IRT-0450,LOCAL,,inpatient,,,10.86,10.86,,,,,,,,,,,,,,,,,
"Laryngeal Tube Kit, Size 3",270,RC,IRT-0453,LOCAL,,inpatient,,,180.7,180.7,,,,,,,,,,,,,,,,,
TUBE TRCH 74MM 6.4MM CUFLS ADL,270,RC,IRT-0454,LOCAL,,inpatient,,,127.2,127.2,,,,,,,,,,,,,,,,,
TUBE TRCH 79MM 7.6MM CUFLS ADL,270,RC,IRT-0455,LOCAL,,inpatient,,,127.2,127.2,,,,,,,,,,,,,,,,,
TUBE TRCH 79MM 9MM CUFLS ADLT,270,RC,IRT-0456,LOCAL,,inpatient,,,127.2,127.2,,,,,,,,,,,,,,,,,
TUBE TRCH 76MM 6.4MM CUF ADLT,270,RC,IRT-0457,LOCAL,,inpatient,,,189.25,189.25,,,,,,,,,,,,,,,,,
TUBE TRCH 76MM 6.4MM CUF ADLT,270,RC,IRT-0458,LOCAL,,inpatient,,,189.25,189.25,,,,,,,,,,,,,,,,,
TUBE TRCH 81MM 7.6MM CUF ADLT,270,RC,IRT-0459,LOCAL,,inpatient,,,189.25,189.25,,,,,,,,,,,,,,,,,
REAGENT .85% NACL 4L BLD BNK,270,RC,IRT-0460,LOCAL,,inpatient,,,18.24,18.24,,,,,,,,,,,,,,,,,
DRAIN WND FLAT 20CMX10MM JP,270,RC,IRT-0461,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
HOLDER TUBE ANCHORFAST FSTNR,270,RC,IRT-0462,LOCAL,,inpatient,,,3.72,3.72,,,,,,,,,,,,,,,,,
HOLDER TUBE ANCHORFAST FSTNR,270,RC,IRT-0463,LOCAL,,inpatient,,,4.98,4.98,,,,,,,,,,,,,,,,,
UNIT OXM PLS DCI DC3 SNSR HAND,270,RC,IRT-0464,LOCAL,,inpatient,,,2115,2115,,,,,,,,,,,,,,,,,
TESTER OXM RAD-57 RNBW ST,270,RC,IRT-0465,LOCAL,,inpatient,,,1462.5,1462.5,,,,,,,,,,,,,,,,,
CABLE OXM 12FT 20 PIN RNBW,270,RC,IRT-0466,LOCAL,,inpatient,,,616.5,616.5,,,,,,,,,,,,,,,,,
CABLE OXM 10FT LNCS SPO2 2 KEY,270,RC,IRT-0467,LOCAL,,inpatient,,,810,810,,,,,,,,,,,,,,,,,
SENSOR ADLT RED DCI-DC3 3FT,270,RC,IRT-0468,LOCAL,,inpatient,,,630,630,,,,,,,,,,,,,,,,,
CABLE OXM RED 4FT LNCS SPO2,270,RC,IRT-0469,LOCAL,,inpatient,,,630,630,,,,,,,,,,,,,,,,,
CABLE OXM 10FT LNCS SPO2 2 KEY,270,RC,IRT-0470,LOCAL,,inpatient,,,810,810,,,,,,,,,,,,,,,,,
BOOT OXM ORNG HNDHLD PROT,270,RC,IRT-0471,LOCAL,,inpatient,,,175,175,,,,,,,,,,,,,,,,,
SENSOR ADLT LNCS DCI 3FT FNGR,270,RC,IRT-0472,LOCAL,,inpatient,,,562.5,562.5,,,,,,,,,,,,,,,,,
SENSOR ADLT LNCS TC-1 3FT EAR,270,RC,IRT-0473,LOCAL,,inpatient,,,517.5,517.5,,,,,,,,,,,,,,,,,
CABLE OXM 14FT LNCS,270,RC,IRT-0474,LOCAL,,inpatient,,,832.5,832.5,,,,,,,,,,,,,,,,,
CABLE OXM 4FT LNCS XTN LNC 4,270,RC,IRT-0475,LOCAL,,inpatient,,,576,576,,,,,,,,,,,,,,,,,
SENSOR ADLT RED DCI-DC3 3FT,270,RC,IRT-0476,LOCAL,,inpatient,,,630,630,,,,,,,,,,,,,,,,,
CABLE OXM RED 4FT LNCS SPO2 20,270,RC,IRT-0477,LOCAL,,inpatient,,,630,630,,,,,,,,,,,,,,,,,
CABLE OXM RED 10FT LNC MSM PT,270,RC,IRT-0478,LOCAL,,inpatient,,,720,720,,,,,,,,,,,,,,,,,
CABLE OXM RED 14FT LNCS LF,270,RC,IRT-0479,LOCAL,,inpatient,,,832.5,832.5,,,,,,,,,,,,,,,,,
SENSOR ADLT RNBW OXM SPO2 DBI,270,RC,IRT-0480,LOCAL,,inpatient,,,810,810,,,,,,,,,,,,,,,,,
SENSOR ADLT LNCS 3FT OXM SPO2,270,RC,IRT-0481,LOCAL,,inpatient,,,693,693,,,,,,,,,,,,,,,,,
SENSOR LNCS TFA-1 FRHD OXM,270,RC,IRT-0482,LOCAL,,inpatient,,,14.4,14.4,,,,,,,,,,,,,,,,,
KIT HMDF PLS H2O 540ML AQPK,270,RC,IRT-0485,LOCAL,,inpatient,,,0.6,0.6,,,,,,,,,,,,,,,,,
HUMIDIFIER RESP STRL CMFRT FLO,270,RC,IRT-0486,LOCAL,,inpatient,,,6.12,6.12,,,,,,,,,,,,,,,,,
HEATER NEB AQTH AQPK 26.6-32.2,270,RC,IRT-0487,LOCAL,,inpatient,,,675,675,,,,,,,,,,,,,,,,,
HEATER NEB AQTH 3 AQPK XTRN,270,RC,IRT-0488,LOCAL,,inpatient,,,1296,1296,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT M/L CN,270,RC,IRT-0489,LOCAL,,inpatient,,,12.9,12.9,,,,,,,,,,,,,,,,,
TUBING AERSL 100FT 22MM CRRAFL,270,RC,IRT-0490,LOCAL,,inpatient,,,38.5,38.5,,,,,,,,,,,,,,,,,
CANNULA NSL 7FT OTE TIP TBG,270,RC,IRT-0491,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
BRACKET HMDF RSRV HFLO CNCH,270,RC,IRT-0492,LOCAL,,inpatient,,,125,125,,,,,,,,,,,,,,,,,
TUBING AERSL 100FT 1IN CRRAFLX,270,RC,IRT-0493,LOCAL,,inpatient,,,82.23,82.23,,,,,,,,,,,,,,,,,
OXIMETER PLS FINGERSAT SM,270,RC,IRT-0494,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
REGULATOR SUC 3.15X6.3IN 2.5IN,270,RC,IRT-0495,LOCAL,,inpatient,,,753.39,753.39,,,,,,,,,,,,,,,,,
REGULATOR SUC 3.15X6.3IN 2.5IN,270,RC,IRT-0496,LOCAL,,inpatient,,,686.97,686.97,,,,,,,,,,,,,,,,,
ADAPTER VAC 1/8IN GENTEC,270,RC,IRT-0497,LOCAL,,inpatient,,,29.7,29.7,,,,,,,,,,,,,,,,,
COUPLER TBG GENTEC FLWMTR LF,270,RC,IRT-0498,LOCAL,,inpatient,,,720.9,720.9,,,,,,,,,,,,,,,,,
BRACKET VNT NPTN CNCHTHRM MNT,270,RC,IRT-0499,LOCAL,,inpatient,,,180,180,,,,,,,,,,,,,,,,,
KIT HDSN RCI ISGRD CONCHASMART,270,RC,IRT-0500,LOCAL,,inpatient,,,15.6,15.6,,,,,,,,,,,,,,,,,
CANNULA NSL 7FT OTE TIP STD TB,270,RC,IRT-0501,LOCAL,,inpatient,,,0.36,0.36,,,,,,,,,,,,,,,,,
HUMIDIFIER - HEAT,270,RC,IRT-0502,LOCAL,,inpatient,,,2880,2880,,,,,,,,,,,,,,,,,
KIT CRCT CONCHASMART 1 LMB,270,RC,IRT-0503,LOCAL,,inpatient,,,8.16,8.16,,,,,,,,,,,,,,,,,
KIT CRCT CONCHASMART 2 LMB,270,RC,IRT-0504,LOCAL,,inpatient,,,13.5,13.5,,,,,,,,,,,,,,,,,
KIT CRCT CONCHASMART NINVS VNT,270,RC,IRT-0505,LOCAL,,inpatient,,,12,12,,,,,,,,,,,,,,,,,
VALVE TRCH SPK 15MM PASSY-MUIR,270,RC,IRT-0506,LOCAL,,inpatient,,,349.43,349.43,,,,,,,,,,,,,,,,,
BAG PRSS INFS 500ML INFSRG 3W,270,RC,IRT-0507,LOCAL,,inpatient,,,6.6,6.6,,,,,,,,,,,,,,,,,
CABLE OXM 10FT LNCS SPO2 2 KEY,270,RC,IRT-0508,LOCAL,,inpatient,,,810,810,,,,,,,,,,,,,,,,,
SENSOR ADLT DR-Y EAR OXM CLIP,270,RC,IRT-0509,LOCAL,,inpatient,,,118.15,118.15,,,,,,,,,,,,,,,,,
CABLE OXM 8FT INTRFC SNSR XTN,270,RC,IRT-0510,LOCAL,,inpatient,,,199.5,199.5,,,,,,,,,,,,,,,,,
KIT KNEE CPM PADDING 6/CS,270,RC,IRT-0511,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
SOLUTION INHL H2O 2000ML FLX,270,RC,IRT-0513,LOCAL,,inpatient,,,4.98,4.98,,,,,,,,,,,,,,,,,
TUBING AERSL BLU 100FT 7/8IN,270,RC,IRT-0514,LOCAL,,inpatient,,,64.02,64.02,,,,,,,,,,,,,,,,,
ABSORBENT CO2 MDSRB PREFL 0.8,270,RC,IRT-0515,LOCAL,,inpatient,,,14.28,14.28,,,,,,,,,,,,,,,,,
TUBING AERSL BLU 100FT 7/8IN,270,RC,IRT-0516,LOCAL,,inpatient,,,62.1,62.1,,,,,,,,,,,,,,,,,
SENSOR FLW NICO STD TDL VOL,270,RC,IRT-0517,LOCAL,,inpatient,,,29.88,29.88,,,,,,,,,,,,,,,,,
TUBING AERSL 7/8IN 100FT SEG,270,RC,IRT-0518,LOCAL,,inpatient,,,63.09,63.09,,,,,,,,,,,,,,,,,
BOOT OXM ORNG HNDHLD PROT,270,RC,IRT-0519,LOCAL,,inpatient,,,175,175,,,,,,,,,,,,,,,,,
SENSOR ADLT LNCS DCI 3FT FNGR,270,RC,IRT-0520,LOCAL,,inpatient,,,562.5,562.5,,,,,,,,,,,,,,,,,
CABLE VNT AVEA RN CALL INTRFC,270,RC,IRT-0521,LOCAL,,inpatient,,,312.57,312.57,,,,,,,,,,,,,,,,,
KITVELAPREVENTIVE MAINTENANCE,270,RC,IRT-0522,LOCAL,,inpatient,,,1045.04,1045.04,,,,,,,,,,,,,,,,,
UPGRADE KIT INTERNAL BATTERY,270,RC,IRT-0523,LOCAL,,inpatient,,,2990.34,2990.34,,,,,,,,,,,,,,,,,
CABLE LNG TRM VNT LTV,270,RC,IRT-0524,LOCAL,,inpatient,,,280.49,280.49,,,,,,,,,,,,,,,,,
CIRCUIT VNT LTRM 5.5FT ADLT,270,RC,IRT-0525,LOCAL,,inpatient,,,1029.56,1029.56,,,,,,,,,,,,,,,,,
CABLE LNG TRM VNT LTV,270,RC,IRT-0526,LOCAL,,inpatient,,,264.02,264.02,,,,,,,,,,,,,,,,,
ASPIRATOR SUC 14X8X11IN 115V,270,RC,IRT-0527,LOCAL,,inpatient,,,1467.05,1467.05,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 6MM SHLY XLT,270,RC,IRT-0528,LOCAL,,inpatient,,,26.04,26.04,,,,,,,,,,,,,,,,,
SOLUTION INHL H2O 2000ML FLX B,270,RC,IRT-0529,LOCAL,,inpatient,,,4.98,4.98,,,,,,,,,,,,,,,,,
DEVICE PEP MTHPC ACPL DH,270,RC,IRT-0530,LOCAL,,inpatient,,,172.5,172.5,,,,,,,,,,,,,,,,,
SENSOR MXFST NLCR OXMX C10+ KG,270,RC,IRT-0531,LOCAL,,inpatient,,,117.8,117.8,,,,,,,,,,,,,,,,,
FILTER BCTR/VIR 14.6CM 8.9CM,270,RC,IRT-0532,LOCAL,,inpatient,,,43.89,43.89,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT SM CN D,270,RC,IRT-0533,LOCAL,,inpatient,,,12.9,12.9,,,,,,,,,,,,,,,,,
DETECTOR CO2 END TDL CONN PORT,270,RC,IRT-0534,LOCAL,,inpatient,,,43.56,43.56,,,,,,,,,,,,,,,,,
SENSOR OXMX OXM FRHD STRP HD,270,RC,IRT-0535,LOCAL,,inpatient,,,142.8,142.8,,,,,,,,,,,,,,,,,
VALVE TRCH SPK 15MM PHONATE,270,RC,IRT-0536,LOCAL,,inpatient,,,118.8,118.8,,,,,,,,,,,,,,,,,
VALVE TRCH SPK 15MM SHLY PHONA,270,RC,IRT-0537,LOCAL,,inpatient,,,118.8,118.8,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 6MM SHLY LTX,270,RC,IRT-0538,LOCAL,,inpatient,,,34.16,34.16,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 8 SHLY STRL,270,RC,IRT-0539,LOCAL,,inpatient,,,34.16,34.16,,,,,,,,,,,,,,,,,
TUBE TRCH 65MM 5MM CUF SHLY,270,RC,IRT-0540,LOCAL,,inpatient,,,193.9,193.9,,,,,,,,,,,,,,,,,
VALVE TRCH SPK 15MM PMV LF DIS,270,RC,IRT-0541,LOCAL,,inpatient,,,501.26,501.26,,,,,,,,,,,,,,,,,
TUBE TRCH 76MM 6MM CUFLS SHLY,270,RC,IRT-0542,LOCAL,,inpatient,,,145.35,145.35,,,,,,,,,,,,,,,,,
TUBE TRCH 81MM 7.6MM CUFLS,270,RC,IRT-0543,LOCAL,,inpatient,,,145.35,145.35,,,,,,,,,,,,,,,,,
BRACKET HMDF RSRV HFLO CNCH,270,RC,IRT-0544,LOCAL,,inpatient,,,125,125,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT ADLT LG,270,RC,IRT-0545,LOCAL,,inpatient,,,12.48,12.48,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT ADLT ME,270,RC,IRT-0546,LOCAL,,inpatient,,,12.48,12.48,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT ADLT SM,270,RC,IRT-0547,LOCAL,,inpatient,,,12.48,12.48,,,,,,,,,,,,,,,,,
Optiflow Trach Connector,270,RC,IRT-0548,LOCAL,,inpatient,,,82.23,82.23,,,,,,,,,,,,,,,,,
TUBE TRCH 79MM 7.6MM CUFLS,270,RC,IRT-0549,LOCAL,,inpatient,,,129.75,129.75,,,,,,,,,,,,,,,,,
TUBE TRCH 79MM 9MM CUFLS SHLY,270,RC,IRT-0550,LOCAL,,inpatient,,,129.75,129.75,,,,,,,,,,,,,,,,,
TUBE TRCH 76MM 6.4MM CUF SHLY,270,RC,IRT-0551,LOCAL,,inpatient,,,193.05,193.05,,,,,,,,,,,,,,,,,
TUBE TRCH 76MM 6.4MM CUF SHLY,270,RC,IRT-0552,LOCAL,,inpatient,,,193.05,193.05,,,,,,,,,,,,,,,,,
TUBE TRCH 81MM 7.6MM CUF SHLY,270,RC,IRT-0553,LOCAL,,inpatient,,,193.05,193.05,,,,,,,,,,,,,,,,,
TUBE TRCH 95MM 6MM CUF SHLY,270,RC,IRT-0554,LOCAL,,inpatient,,,237.56,237.56,,,,,,,,,,,,,,,,,
TUBE TRCH 6MM CUF SHLY PROX,270,RC,IRT-0555,LOCAL,,inpatient,,,242.33,242.33,,,,,,,,,,,,,,,,,
TUBE TRCH 95MM 6MM CUFLS SHLY,270,RC,IRT-0556,LOCAL,,inpatient,,,242.33,242.33,,,,,,,,,,,,,,,,,
TUBE TRCH 95MM 6MM CUFLS SHLY,270,RC,IRT-0557,LOCAL,,inpatient,,,276.62,276.62,,,,,,,,,,,,,,,,,
Shiley Tube ET 7MM CUF Dista,270,RC,IRT-0558,LOCAL,,inpatient,,,8.04,8.04,,,,,,,,,,,,,,,,,
TUBE ET 7MM ORL CUF MRPH EYE S,270,RC,IRT-0559,LOCAL,,inpatient,,,8.04,8.04,,,,,,,,,,,,,,,,,
TUBE ET 7.5MM ORL CUF MRPH EYE,270,RC,IRT-0560,LOCAL,,inpatient,,,8.04,8.04,,,,,,,,,,,,,,,,,
TUBE ET 8MM ORL CUF MRPH EYE S,270,RC,IRT-0561,LOCAL,,inpatient,,,8.04,8.04,,,,,,,,,,,,,,,,,
TUBE ET 8.5MM ORL CUF MRPH EYE,270,RC,IRT-0562,LOCAL,,inpatient,,,8.04,8.04,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 8MM SHLY XLT,270,RC,IRT-0563,LOCAL,,inpatient,,,242.33,242.33,,,,,,,,,,,,,,,,,
TUBE TRCH 105MM 8MM CUFLS SHLY,270,RC,IRT-0564,LOCAL,,inpatient,,,242.33,242.33,,,,,,,,,,,,,,,,,
TUBE TRCH 105MM 8MM CUFLS SHLY,270,RC,IRT-0565,LOCAL,,inpatient,,,242.33,242.33,,,,,,,,,,,,,,,,,
TUBE TRCH 90MM 5MM CUFLS SHLY,270,RC,IRT-0566,LOCAL,,inpatient,,,231.62,231.62,,,,,,,,,,,,,,,,,
TUBE TRCH 90MM 5MM CUF SHLY,270,RC,IRT-0567,LOCAL,,inpatient,,,228.06,228.06,,,,,,,,,,,,,,,,,
ADAPTER HMDF AIRLFE 1 LMB HTR,270,RC,IRT-0568,LOCAL,,inpatient,,,553.32,553.32,,,,,,,,,,,,,,,,,
Performax Mask Small,270,RC,IRT-0569,LOCAL,,inpatient,,,517.5,517.5,,,,,,,,,,,,,,,,,
FILTER BCTR/VIR EXPIR BNT SER,270,RC,IRT-0570,LOCAL,,inpatient,,,80.19,80.19,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT - LARGE,270,RC,IRT-0571,LOCAL,,inpatient,,,106.25,106.25,,,,,,,,,,,,,,,,,
Fisher Paykel B Level CPAP Hea,270,RC,IRT-0572,LOCAL,,inpatient,,,160.35,160.35,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT - MED,270,RC,IRT-0573,LOCAL,,inpatient,,,106.25,106.25,,,,,,,,,,,,,,,,,
KIT O2 5FT 1 LMB THRPY HEAT WR,270,RC,IRT-0574,LOCAL,,inpatient,,,176.8,176.8,,,,,,,,,,,,,,,,,
HUMIDIFIER RESP CARE CONTIN,270,RC,IRT-0575,LOCAL,,inpatient,,,4016.25,4016.25,,,,,,,,,,,,,,,,,
ADAPTER MSK OPTFL 22MM TPR LTW,270,RC,IRT-0576,LOCAL,,inpatient,,,100.75,100.75,,,,,,,,,,,,,,,,,
Suction Adapter - Endoscope,270,RC,IRT-0577,LOCAL,,inpatient,,,315.72,315.72,,,,,,,,,,,,,,,,,
VALVE TRCH SPK 15MM PMV LF,270,RC,IRT-0578,LOCAL,,inpatient,,,510.35,510.35,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT M/L CN,270,RC,IRT-0579,LOCAL,,inpatient,,,6.48,6.48,,,,,,,,,,,,,,,,,
TUBE TRCH 70MM 6MM CUF PRTX,270,RC,IRT-0580,LOCAL,,inpatient,,,449.78,449.78,,,,,,,,,,,,,,,,,
DEVICE PEP 22MM PRSS PORT MTHP,270,RC,IRT-0581,LOCAL,,inpatient,,,76.45,76.45,,,,,,,,,,,,,,,,,
SYSTEM CPAP 1 PORT CAP O2 TUBE,270,RC,IRT-0582,LOCAL,,inpatient,,,76.45,76.45,,,,,,,,,,,,,,,,,
MASMIO CENTROID POSTION TRACKE,270,RC,IRT-0583,LOCAL,,inpatient,,,200,200,,,,,,,,,,,,,,,,,
Masimo Radius PPG Unit,270,RC,IRT-0584,LOCAL,,inpatient,,,125,125,,,,,,,,,,,,,,,,,
"Cannula, XL, Disposable, 5mm",270,RC,IRT-0585,LOCAL,,inpatient,,,26.04,26.04,,,,,,,,,,,,,,,,,
"Oximask Adult, Size 7",270,RC,IRT-0586,LOCAL,,inpatient,,,64.02,64.02,,,,,,,,,,,,,,,,,
DEVICE PEP 22MM PRSS PORT MTHP,270,RC,IRT-0587,LOCAL,,inpatient,,,8.16,8.16,,,,,,,,,,,,,,,,,
SNSR FLW NON INVSV VNT ADLT NI,270,RC,IRT-0590,LOCAL,,inpatient,,,16.02,16.02,,,,,,,,,,,,,,,,,
ABSORBENT CO2 MDSRB PREFL 0.8K,270,RC,IRT-0593,LOCAL,,inpatient,,,14.28,14.28,,,,,,,,,,,,,,,,,
KIT O2 5FT 1 LMB THRPY HEAT WR,270,RC,IRT-0602,LOCAL,,inpatient,,,20.82,20.82,,,,,,,,,,,,,,,,,
TUBE TRCH 95MM 6MM CUF ADLT SH,270,RC,IRT-0610,LOCAL,,inpatient,,,237.56,237.56,,,,,,,,,,,,,,,,,
TUBE TRCH 95MM 6MM CUF ADLT SH,270,RC,IRT-0611,LOCAL,,inpatient,,,237.56,237.56,,,,,,,,,,,,,,,,,
TUBE TRCH 95MM 6MM CUFLS ADLT,270,RC,IRT-0613,LOCAL,,inpatient,,,227.07,227.07,,,,,,,,,,,,,,,,,
TUBE TRCH 95MM 6MM CUFLS ADLT,270,RC,IRT-0614,LOCAL,,inpatient,,,227.07,227.07,,,,,,,,,,,,,,,,,
TUBE TRCH 95MM 6MM CUFLS ADLT,270,RC,IRT-0615,LOCAL,,inpatient,,,227.07,227.07,,,,,,,,,,,,,,,,,
TUBE TRCH 100MM 7MM CUF ADLT S,270,RC,IRT-0616,LOCAL,,inpatient,,,237.56,237.56,,,,,,,,,,,,,,,,,
TUBE TRCH 100MM 7MM CUF ADLT S,270,RC,IRT-0617,LOCAL,,inpatient,,,237.56,237.56,,,,,,,,,,,,,,,,,
TUBE TRCH 100MM 7MM CUFLS ADLT,270,RC,IRT-0619,LOCAL,,inpatient,,,227.07,227.07,,,,,,,,,,,,,,,,,
TUBE TRCH 105MM 8MM CUF ADLT S,270,RC,IRT-0620,LOCAL,,inpatient,,,237.56,237.56,,,,,,,,,,,,,,,,,
TUBE TRCH 105MM 8MM CUF ADLT S,270,RC,IRT-0621,LOCAL,,inpatient,,,237.56,237.56,,,,,,,,,,,,,,,,,
CANNULA INNR TRCH 8MM SHLY XLT,270,RC,IRT-0622,LOCAL,,inpatient,,,2.58,2.58,,,,,,,,,,,,,,,,,
TUBE TRCH 105MM 8MM CUFLS ADLT,270,RC,IRT-0623,LOCAL,,inpatient,,,227.07,227.07,,,,,,,,,,,,,,,,,
TUBE TRCH 105MM 8MM CUFLS ADLT,270,RC,IRT-0624,LOCAL,,inpatient,,,227.07,227.07,,,,,,,,,,,,,,,,,
SYSTEM CPAP 1 PORT CAP O2 TUBE,270,RC,IRT-0626,LOCAL,,inpatient,,,12.3,12.3,,,,,,,,,,,,,,,,,
CIRCUIT BRTHG 2 HEAT LMB DRY G,270,RC,IRT-0627,LOCAL,,inpatient,,,14.4,14.4,,,,,,,,,,,,,,,,,
TUBE TRCH 90MM 5MM CUFLS ADLT,270,RC,IRT-0628,LOCAL,,inpatient,,,227.07,227.07,,,,,,,,,,,,,,,,,
CABLE OXM 14FT LNCS,270,RC,IRT-0632,LOCAL,,inpatient,,,832.5,832.5,,,,,,,,,,,,,,,,,
CABLE OXM 4FT LNCS XTN LNC 4 L,270,RC,IRT-0633,LOCAL,,inpatient,,,576,576,,,,,,,,,,,,,,,,,
SENSOR ADLT RED DCI-DC3 3FT OX,270,RC,IRT-0635,LOCAL,,inpatient,,,630,630,,,,,,,,,,,,,,,,,
CABLE OXM RED 4FT LNCS SPO2 20,270,RC,IRT-0636,LOCAL,,inpatient,,,630,630,,,,,,,,,,,,,,,,,
CABLE OXM RED 10FT LNC MSM PT,270,RC,IRT-0637,LOCAL,,inpatient,,,720,720,,,,,,,,,,,,,,,,,
CABLE OXM RED 14FT LNCS LF REU,270,RC,IRT-0638,LOCAL,,inpatient,,,832.5,832.5,,,,,,,,,,,,,,,,,
TUBE TRCH 90MM 5MM CUF ADLT SH,270,RC,IRT-0646,LOCAL,,inpatient,,,228.06,228.06,,,,,,,,,,,,,,,,,
TUBE TRCH 90MM 5MM CUF ADLT SH,270,RC,IRT-0647,LOCAL,,inpatient,,,237.56,237.56,,,,,,,,,,,,,,,,,
TUBE TRCH 90MM 5MM CUFLS ADLT,270,RC,IRT-0650,LOCAL,,inpatient,,,228.06,228.06,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT SM PRFM,270,RC,IRT-0653,LOCAL,,inpatient,,,12.54,12.54,,,,,,,,,,,,,,,,,
MASK CPAP MED PRFMTRK DISP,270,RC,IRT-0654,LOCAL,,inpatient,,,12.54,12.54,,,,,,,,,,,,,,,,,
BLADE LRNSCP 36MM MLLR 00 SS 1,270,RC,IRT-0658,LOCAL,,inpatient,,,244,244,,,,,,,,,,,,,,,,,
BAG RSC MNL ADLT W MSK MED O2,270,RC,IRT-0662,LOCAL,,inpatient,,,4.08,4.08,,,,,,,,,,,,,,,,,
BAG RSC MNL ADLT W MSK O2 RSRV,270,RC,IRT-0663,LOCAL,,inpatient,,,6.18,6.18,,,,,,,,,,,,,,,,,
BAG RSC MNL ADLT W MSK MED C,270,RC,IRT-0664,LOCAL,,inpatient,,,7.74,7.74,,,,,,,,,,,,,,,,,
MASK PROT O2 INLT VLV HRD CA H,270,RC,IRT-0665,LOCAL,,inpatient,,,18.54,18.54,,,,,,,,,,,,,,,,,
KIT CPAP NON INVSV VNT ADLT 5F,270,RC,IRT-0669,LOCAL,,inpatient,,,16.2,16.2,,,,,,,,,,,,,,,,,
TUBING AERSL BLU 100FT 7/8IN A,270,RC,IRT-0676,LOCAL,,inpatient,,,62.1,62.1,,,,,,,,,,,,,,,,,
TUBING AERSL CLR 100FT AIRLFE,270,RC,IRT-0682,LOCAL,,inpatient,,,64.02,64.02,,,,,,,,,,,,,,,,,
TUBING AERSL 7/8IN 100FT SEG C,270,RC,IRT-0686,LOCAL,,inpatient,,,63.09,63.09,,,,,,,,,,,,,,,,,
DEVICE PEP 22MM LO FLW INSPR V,270,RC,IRT-0689,LOCAL,,inpatient,,,20.7,20.7,,,,,,,,,,,,,,,,,
SENSOR ADLT RNBW OXM SPO2 DBI-,270,RC,IRT-0694,LOCAL,,inpatient,,,810,810,,,,,,,,,,,,,,,,,
SENSOR ADLT LNCS 3FT OXM SPO2,270,RC,IRT-0695,LOCAL,,inpatient,,,693,693,,,,,,,,,,,,,,,,,
KIT ARWY NSL EMER RND TIP 22-3,270,RC,IRT-0699,LOCAL,,inpatient,,,77.83,77.83,,,,,,,,,,,,,,,,,
AIRLFE H2O SPK CAP,270,RC,IRT-0717,LOCAL,,inpatient,,,4.26,4.26,,,,,,,,,,,,,,,,,
OXIMETER PLS FINGERSAT SM SIL,270,RC,IRT-0720,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
REGULATOR SUC 3.15X6.3IN 2.5IN,270,RC,IRT-0726,LOCAL,,inpatient,,,753.39,753.39,,,,,,,,,,,,,,,,,
REGULATOR SUC 3.15X6.3IN 2.5IN,270,RC,IRT-0727,LOCAL,,inpatient,,,686.97,686.97,,,,,,,,,,,,,,,,,
DAPTER VAC 1/8IN GENTEC DISS M,270,RC,IRT-0728,LOCAL,,inpatient,,,29.7,29.7,,,,,,,,,,,,,,,,,
COUPLER TBG GENTEC OH Y FLWMTR,270,RC,IRT-0729,LOCAL,,inpatient,,,720.9,720.9,,,,,,,,,,,,,,,,,
ASPIRATOR SUC 14X8X11IN SCHUCO,270,RC,IRT-0730,LOCAL,,inpatient,,,1438.29,1438.29,,,,,,,,,,,,,,,,,
BRACKET VNT NPTN CNCHTHRM MNT,270,RC,IRT-0735,LOCAL,,inpatient,,,180,180,,,,,,,,,,,,,,,,,
KIT CRCT HDSN RCI ISGRD CONCHA,270,RC,IRT-0736,LOCAL,,inpatient,,,15.6,15.6,,,,,,,,,,,,,,,,,
KIT CRCT 1 HEAT INSPR LMB ISGR,270,RC,IRT-0737,LOCAL,,inpatient,,,11.52,11.52,,,,,,,,,,,,,,,,,
HUMIDIFIER RESP CNCHTHRM NPTN,270,RC,IRT-0738,LOCAL,,inpatient,,,2880,2880,,,,,,,,,,,,,,,,,
HOLDER TUBE ANCHORFAST GRD FST,270,RC,IRT-0742,LOCAL,,inpatient,,,4.98,4.98,,,,,,,,,,,,,,,,,
KIT CRCT EVAQUA 2 2 LMB NO FLT,270,RC,IRT-0745,LOCAL,,inpatient,,,18.3,18.3,,,,,,,,,,,,,,,,,
FILTER BCTR/VIR EXPIR PR BNT S,270,RC,IRT-0746,LOCAL,,inpatient,,,7.14,7.14,,,,,,,,,,,,,,,,,
KIT CRCT CONCHASMART 1 LMB ADL,270,RC,IRT-0757,LOCAL,,inpatient,,,8.16,8.16,,,,,,,,,,,,,,,,,
KIT CRCT CONCHASMART 2 LMB ADL,270,RC,IRT-0758,LOCAL,,inpatient,,,13.5,13.5,,,,,,,,,,,,,,,,,
KIT CRCT CONCHASMART NINVS VNT,270,RC,IRT-0759,LOCAL,,inpatient,,,12,12,,,,,,,,,,,,,,,,,
VALVE TRCH SPK 15MM PASSY-MUIR,270,RC,IRT-0768,LOCAL,,inpatient,,,349.43,349.43,,,,,,,,,,,,,,,,,
SENSOR LNCS TFA-1 FRHD OXM HDB,270,RC,IRT-0778,LOCAL,,inpatient,,,14.4,14.4,,,,,,,,,,,,,,,,,
HUMIDIFIER RESP CARE CONTIN 1,270,RC,IRT-0779,LOCAL,,inpatient,,,4016.25,4016.25,,,,,,,,,,,,,,,,,
ADAPTER MSK OPTFL 22MM STD TPR,270,RC,IRT-0780,LOCAL,,inpatient,,,5.94,5.94,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT ADLT LG,270,RC,IRT-0782,LOCAL,,inpatient,,,15.72,15.72,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT ADLT ME,270,RC,IRT-0783,LOCAL,,inpatient,,,15.72,15.72,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT ADLT SM,270,RC,IRT-0784,LOCAL,,inpatient,,,15.72,15.72,,,,,,,,,,,,,,,,,
UNDERPAD INCNT 36X30IN PLMR DR,270,RC,IRT-0790,LOCAL,,inpatient,,,2.94,2.94,,,,,,,,,,,,,,,,,
COMPRILAN STRETCH BANDAGE  8CM,270,RC,IRT-0791,LOCAL,,inpatient,,,17.58,17.58,,,,,,,,,,,,,,,,,
LOTION HND BDY 700ML REFILL FR,270,RC,IRT-0796,LOCAL,,inpatient,,,3.78,3.78,,,,,,,,,,,,,,,,,
REGULATOR SUCTION CONT/INT NO,270,RC,IRT-0807,LOCAL,,inpatient,,,1011.11,1011.11,,,,,,,,,,,,,,,,,
TTL1LYR 16FR10ML 100%SILI DB T,270,RC,IRT-0808,LOCAL,,inpatient,,,8.58,8.58,,,,,,,,,,,,,,,,,
SPIROMETER VOLDYNE 4000 VOLUME,270,RC,IRT-0842,LOCAL,,inpatient,,,11.52,11.52,,,,,,,,,,,,,,,,,
GEL ELCTRD NUPRP SKNPRP TUBE M,270,RC,IRT-0845,LOCAL,,inpatient,,,17.58,17.58,,,,,,,,,,,,,,,,,
FORCEP FOERSTER SPONGE COATED,270,RC,IRT-0856,LOCAL,,inpatient,,,633.65,633.65,,,,,,,,,,,,,,,,,
KIT KNEE CPM PADDING 6/CS,270,RC,IRT-0859,LOCAL,,inpatient,,,59.95,59.95,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT ADLT LG,270,RC,IRT-0861,LOCAL,,inpatient,,,15.72,15.72,,,,,,,,,,,,,,,,,
MSK CPAP NON INVSV VNT ADLT ME,270,RC,IRT-0862,LOCAL,,inpatient,,,15.72,15.72,,,,,,,,,,,,,,,,,
KIT SUC 14IN MOBLVAC CARE-EVC,270,RC,IRT-0886,LOCAL,,inpatient,,,133,133,,,,,,,,,,,,,,,,,
ADAPTER ESCP SUC CLN BSCP,270,RC,IRT-0888,LOCAL,,inpatient,,,141.75,141.75,,,,,,,,,,,,,,,,,
BALLOON ENDO STRL LTX BFUC160F,270,RC,IRT-0889,LOCAL,,inpatient,,,6.48,6.48,,,,,,,,,,,,,,,,,
SNSR FLW NON INVSV VNT ADLT NI,270,RC,IRT-0897,LOCAL,,inpatient,,,16.02,16.02,,,,,,,,,,,,,,,,,
UNIT MNTR NON INVSV VNT CAPNOS,270,RC,IRT-0898,LOCAL,,inpatient,,,7271.51,7271.51,,,,,,,,,,,,,,,,,
FLTR INLT NON INVSV VNT V60 DI,270,RC,IRT-0899,LOCAL,,inpatient,,,9.66,9.66,,,,,,,,,,,,,,,,,
SHILEY CUFFLESS TRACH 8mm,270,RC,IRT-0916,LOCAL,,inpatient,,,153.1,153.1,,,,,,,,,,,,,,,,,
SYSTEM CPAP 1 PORT CAP O2 TUBE,270,RC,IRT-0971,LOCAL,,inpatient,,,12.3,12.3,,,,,,,,,,,,,,,,,
BAG RSC MNL 1500ML ADLT W ARFL,270,RC,IRT-1165,LOCAL,,inpatient,,,4.62,4.62,,,,,,,,,,,,,,,,,
BAG RSC MNL ADLT W ARFLW MSK O,270,RC,IRT-1166,LOCAL,,inpatient,,,5.52,5.52,,,,,,,,,,,,,,,,,
STANDARD NASAL CANNULAE,270,RC,IRT-1299,LOCAL,,inpatient,,,2.52,2.52,,,,,,,,,,,,,,,,,
CIRCUIT VNT LTRM 6FT ADLT LF D,270,RC,IRT-1302,LOCAL,,inpatient,,,7.56,7.56,,,,,,,,,,,,,,,,,
CABLE VNT AVEA RN CALL INTRFC,270,RC,IRT-1317,LOCAL,,inpatient,,,312.57,312.57,,,,,,,,,,,,,,,,,
KITVELAPREVENTIVE MAINTENANCE,270,RC,IRT-1318,LOCAL,,inpatient,,,1045.04,1045.04,,,,,,,,,,,,,,,,,
UPGRADE KIT INTERNAL BATTERY,270,RC,IRT-1319,LOCAL,,inpatient,,,2990.34,2990.34,,,,,,,,,,,,,,,,,
CABLE LNG TRM VNT LTV,270,RC,IRT-1320,LOCAL,,inpatient,,,280.49,280.49,,,,,,,,,,,,,,,,,
CIRCUIT VNT LTRM 5.5FT ADLT DI,270,RC,IRT-1321,LOCAL,,inpatient,,,1029.56,1029.56,,,,,,,,,,,,,,,,,
CABLE LNG TRM VNT LTV,270,RC,IRT-1323,LOCAL,,inpatient,,,264.02,264.02,,,,,,,,,,,,,,,,,
MASK O2 OXYMASK ADLT 7 UC,270,RC,IRT-1324,LOCAL,,inpatient,,,28.02,28.02,,,,,,,,,,,,,,,,,
AirSpriral Chamber Kit  Neb,270,RC,IRT-1326,LOCAL,,inpatient,,,337.41,337.41,,,,,,,,,,,,,,,,,
HILL ROM EVELLA BED PER DAY,270,RC,ISM-0156,LOCAL,,inpatient,,,445.14,445.14,,,,,,,,,,,,,,,,,
Laryngeal Tube Kit - Size 4,270,RC,ISR-0005,LOCAL,,inpatient,,,3.24,3.24,,,,,,,,,,,,,,,,,
CURETTE DERMAL STERILE DISP 7M,270,RC,ISR-0197,LOCAL,,inpatient,,,13.08,13.08,,,,,,,,,,,,,,,,,
Wound Vac Dressing - Medium,270,RC,ISS-1145,LOCAL,,inpatient,,,37.13,37.13,,,,,,,,,,,,,,,,,
BREATHING CIRCUIT COAXIAL RENT,270,RC,ISS-3460,LOCAL,,inpatient,,,344.79,344.79,,,,,,,,,,,,,,,,,
Optifoam Gentle Foam - 3x3,270,RC,ISW-0095,LOCAL,,inpatient,,,14.28,14.28,,,,,,,,,,,,,,,,,
SHOULDER IMMOBILZER XL,270,RC,ITH-0001,LOCAL,,inpatient,,,37.13,37.13,,,,,,,,,,,,,,,,,
Sling with Head Support - S,270,RC,ITH-0005,LOCAL,,inpatient,,,1477.98,1477.98,,,,,,,,,,,,,,,,,
"SPLINT, ULNA BOOSTER SMALL",270,RC,ITH-0006,LOCAL,,inpatient,,,249.9,249.9,,,,,,,,,,,,,,,,,
"SPLINT, ULNA BOOSTER LEFT LARG",270,RC,ITH-0007,LOCAL,,inpatient,,,249.9,249.9,,,,,,,,,,,,,,,,,
SLING PT C450LB LG U 6 PNT CRD,270,RC,ITH-0008,LOCAL,,inpatient,,,158.5,158.5,,,,,,,,,,,,,,,,,
"BRACE, WRIST D RING LEFT MEDIU",270,RC,ITH-0009,LOCAL,,inpatient,,,109.73,109.73,,,,,,,,,,,,,,,,,
FORMFIT THUMB SPICA RIGHT LARG,270,RC,ITH-0010,LOCAL,,inpatient,,,119,119,,,,,,,,,,,,,,,,,
SLING PT C250LB MED U 6 PNT CR,270,RC,ITH-0011,LOCAL,,inpatient,,,190.85,190.85,,,,,,,,,,,,,,,,,
"BRACE,WRIST,D-RING ,LEFT LARGE",270,RC,ITH-0012,LOCAL,,inpatient,,,109.73,109.73,,,,,,,,,,,,,,,,,
"BRACE, WRIST WITH D RING LEFT",270,RC,ITH-0013,LOCAL,,inpatient,,,109.84,109.84,,,,,,,,,,,,,,,,,
RING WRIST BRACE LONG BEIGE,270,RC,ITH-0014,LOCAL,,inpatient,,,109.73,109.73,,,,,,,,,,,,,,,,,
BRACE WITH D RING LEFT SMALL,270,RC,ITH-0016,LOCAL,,inpatient,,,109.73,109.73,,,,,,,,,,,,,,,,,
"RING,LONG,BEIGE,BRACE,WRIST",270,RC,ITH-0021,LOCAL,,inpatient,,,109.73,109.73,,,,,,,,,,,,,,,,,
ROYLAN SLING RIGHT SMALL,270,RC,ITH-0023,LOCAL,,inpatient,,,228.42,228.42,,,,,,,,,,,,,,,,,
ROYLAN HEMI SLING LEFT MEDIUM,270,RC,ITH-0024,LOCAL,,inpatient,,,228.42,228.42,,,,,,,,,,,,,,,,,
ROYLAN HEMI SLING LEFT LARGE,270,RC,ITH-0025,LOCAL,,inpatient,,,228.42,228.42,,,,,,,,,,,,,,,,,
FOAM WEDGE 21x7x7,270,RC,ITH-0026,LOCAL,,inpatient,,,1.98,1.98,,,,,,,,,,,,,,,,,
SLING PT C500LB XL U LTX DISP,270,RC,ITH-0027,LOCAL,,inpatient,,,209.95,209.95,,,,,,,,,,,,,,,,,
SPLINT ADULT FINGER RIGHT LARG,270,RC,ITH-0028,LOCAL,,inpatient,,,504.9,504.9,,,,,,,,,,,,,,,,,
SPLINT ADULT FINGER MEDIUM,270,RC,ITH-0029,LOCAL,,inpatient,,,504.9,504.9,,,,,,,,,,,,,,,,,
ROYLAN HEMI SLING LEFT XL,270,RC,ITH-0030,LOCAL,,inpatient,,,228.42,228.42,,,,,,,,,,,,,,,,,
OSSUR ANKLE BRACE LARGE,270,RC,ITH-0031,LOCAL,,inpatient,,,83.05,83.05,,,,,,,,,,,,,,,,,
SPLINT FREEDOM ARM MEDIUM,270,RC,ITH-0032,LOCAL,,inpatient,,,52.53,52.53,,,,,,,,,,,,,,,,,
SLING PT C400LB LG U HD,270,RC,ITH-0034,LOCAL,,inpatient,,,166.65,166.65,,,,,,,,,,,,,,,,,
OSSUR ANKLE BRACE MEDIUM,270,RC,ITH-0037,LOCAL,,inpatient,,,83.05,83.05,,,,,,,,,,,,,,,,,
SCISSORS 8.75IN SS ESMK CAST C,270,RC,ITH-0038,LOCAL,,inpatient,,,219.95,219.95,,,,,,,,,,,,,,,,,
OSSUR ANKLE BRACE SMALL,270,RC,ITH-0039,LOCAL,,inpatient,,,83.05,83.05,,,,,,,,,,,,,,,,,
Sling with Head Support - LRG,270,RC,ITH-0040,LOCAL,,inpatient,,,182.8,182.8,,,,,,,,,,,,,,,,,
SPLINT FREEDOM ARM SMALL,270,RC,ITH-0041,LOCAL,,inpatient,,,52.53,52.53,,,,,,,,,,,,,,,,,
ARM SPLINT LARGE 8/21 CIRCUM,270,RC,ITH-0042,LOCAL,,inpatient,,,52.53,52.53,,,,,,,,,,,,,,,,,
DJO GLOBAL STIRRUP ANKLE BRACE,270,RC,ITH-0043,LOCAL,,inpatient,,,86.9,86.9,,,,,,,,,,,,,,,,,
SPLINT FINGER ADULT SMALL,270,RC,ITH-0047,LOCAL,,inpatient,,,504.9,504.9,,,,,,,,,,,,,,,,,
POSITIONER 8' HIGH 11X22 BASE,270,RC,ITH-0062,LOCAL,,inpatient,,,66.99,66.99,,,,,,,,,,,,,,,,,
UNIVERSAL WRIST CUFFES MEDIUM,270,RC,ITH-0064,LOCAL,,inpatient,,,206.6,206.6,,,,,,,,,,,,,,,,,
WRIST ORTHOSIS-LARGE RIGHT,270,RC,ITH-0065,LOCAL,,inpatient,,,204.25,204.25,,,,,,,,,,,,,,,,,
WRIST ORTHOSIS-LARGE LEFT,270,RC,ITH-0066,LOCAL,,inpatient,,,200.35,200.35,,,,,,,,,,,,,,,,,
WRIST ORTHOSIS-XLARGE LEFT,270,RC,ITH-0067,LOCAL,,inpatient,,,202.3,202.3,,,,,,,,,,,,,,,,,
UNIVERSAL WRIST CUFF SMALL,270,RC,ITH-0068,LOCAL,,inpatient,,,206.6,206.6,,,,,,,,,,,,,,,,,
MULTI-PODUS SYSTEM-ADULT LAR.,270,RC,ITH-0069,LOCAL,,inpatient,,,764.91,764.91,,,,,,,,,,,,,,,,,
"RESTING HAND ORTHOSIS, MED  R.",270,RC,ITH-0070,LOCAL,,inpatient,,,422.01,422.01,,,,,,,,,,,,,,,,,
"Flex Cuff Elbow Orthosis, Medi",270,RC,ITH-0071,LOCAL,,inpatient,,,446.31,446.31,,,,,,,,,,,,,,,,,
"Flex Cuff Elbow Orthosis, X-La",270,RC,ITH-0072,LOCAL,,inpatient,,,455.18,455.18,,,,,,,,,,,,,,,,,
"Resting Hand Orthosis, Left, X",270,RC,ITH-0073,LOCAL,,inpatient,,,422.01,422.01,,,,,,,,,,,,,,,,,
"Resting Hand Orthosis, Right,",270,RC,ITH-0074,LOCAL,,inpatient,,,422.01,422.01,,,,,,,,,,,,,,,,,
"Resting Hand Orthosis, Left, S",270,RC,ITH-0075,LOCAL,,inpatient,,,267.03,267.03,,,,,,,,,,,,,,,,,
"Resting Hand Orthosis, Left, M",270,RC,ITH-0076,LOCAL,,inpatient,,,422.01,422.01,,,,,,,,,,,,,,,,,
"Resting Hand Orthosis, Right,",270,RC,ITH-0077,LOCAL,,inpatient,,,422.01,422.01,,,,,,,,,,,,,,,,,
"Resting Hand Orthosis, Left, L",270,RC,ITH-0078,LOCAL,,inpatient,,,422.01,422.01,,,,,,,,,,,,,,,,,
The Original Multi Podus Syste,270,RC,ITH-0079,LOCAL,,inpatient,,,764.91,764.91,,,,,,,,,,,,,,,,,
POSITION WEDGE 2XL,270,RC,ITH-0083,LOCAL,,inpatient,,,110.25,110.25,,,,,,,,,,,,,,,,,
SLING PT C500LB XL U LTX DISP,270,RC,ITH-0084,LOCAL,,inpatient,,,209.95,209.95,,,,,,,,,,,,,,,,,
SCISSORS 8.75IN,270,RC,ITH-0086,LOCAL,,inpatient,,,219.95,219.95,,,,,,,,,,,,,,,,,
"AIR PUTTY, MEDIUM PINK 5LB",270,RC,ITH-0087,LOCAL,,inpatient,,,372.02,372.02,,,,,,,,,,,,,,,,,
"Air-Putty, 5 lb., Soft",270,RC,ITH-0088,LOCAL,,inpatient,,,360.72,360.72,,,,,,,,,,,,,,,,,
"FLEX CUFF ELBOW SPLINT, LARGE",270,RC,ITH-0089,LOCAL,,inpatient,,,446.31,446.31,,,,,,,,,,,,,,,,,
MULTI-PODUS SYSTEM-ADULT MED.,270,RC,ITH-0090,LOCAL,,inpatient,,,472.91,472.91,,,,,,,,,,,,,,,,,
"RESTING HAND ORTHOSIS, SMALL R",270,RC,ITH-0091,LOCAL,,inpatient,,,267.89,267.89,,,,,,,,,,,,,,,,,
MPO 2000 Shortback - Small,270,RC,ITH-0092,LOCAL,,inpatient,,,715.19,715.19,,,,,,,,,,,,,,,,,
SHOULDER ABDUCTION LADDER,270,RC,ITH-0093,LOCAL,,inpatient,,,280.98,280.98,,,,,,,,,,,,,,,,,
MPO 2000 Shortback - Large,270,RC,ITH-0094,LOCAL,,inpatient,,,715.19,715.19,,,,,,,,,,,,,,,,,
MPO 2000 Shortback - XLarge,270,RC,ITH-0095,LOCAL,,inpatient,,,715.19,715.19,,,,,,,,,,,,,,,,,
MPO 2000 Active Attach - Med,270,RC,ITH-0096,LOCAL,,inpatient,,,789.75,789.75,,,,,,,,,,,,,,,,,
MPO 2000 Active Attach - Large,270,RC,ITH-0097,LOCAL,,inpatient,,,789.75,789.75,,,,,,,,,,,,,,,,,
MPO 2000 Active Attach - XL,270,RC,ITH-0098,LOCAL,,inpatient,,,789.75,789.75,,,,,,,,,,,,,,,,,
Flex Cuff Elbow Orthosis - S,270,RC,ITH-0099,LOCAL,,inpatient,,,446.31,446.31,,,,,,,,,,,,,,,,,
SPEECH-TEACH PORT. MIRR.12X16,270,RC,ITH-0100,LOCAL,,inpatient,,,311.22,311.22,,,,,,,,,,,,,,,,,
"15"" TRANSFER DISC",270,RC,ITH-0101,LOCAL,,inpatient,,,304.7,304.7,,,,,,,,,,,,,,,,,
Rolyan Hook: Self-Adhesive,270,RC,ITH-0102,LOCAL,,inpatient,,,250.7,250.7,,,,,,,,,,,,,,,,,
Rolyan Loop: Non-Adhesive,270,RC,ITH-0103,LOCAL,,inpatient,,,220.75,220.75,,,,,,,,,,,,,,,,,
Rolyan Shoulder Immobile - XL,270,RC,ITH-0104,LOCAL,,inpatient,,,56.32,56.32,,,,,,,,,,,,,,,,,
HARD SHELL HELMET -  SMALL,270,RC,ITH-0105,LOCAL,,inpatient,,,612.45,612.45,,,,,,,,,,,,,,,,,
HARD SHELL HELMET - MED,270,RC,ITH-0106,LOCAL,,inpatient,,,612.45,612.45,,,,,,,,,,,,,,,,,
HARD SHELL HELMET - LGE,270,RC,ITH-0107,LOCAL,,inpatient,,,612.45,612.45,,,,,,,,,,,,,,,,,
"REACTION WEB Knee Brace, M/L",270,RC,ITH-0108,LOCAL,,inpatient,,,88.44,88.44,,,,,,,,,,,,,,,,,
EZ-CALL SWITCH W/CORD,270,RC,ITH-0109,LOCAL,,inpatient,,,260.28,260.28,,,,,,,,,,,,,,,,,
THERABAND CLX BULK - YELLOW,270,RC,ITH-0110,LOCAL,,inpatient,,,1033.07,1033.07,,,,,,,,,,,,,,,,,
THERABAND CLX BULK - RED,270,RC,ITH-0111,LOCAL,,inpatient,,,1033.07,1033.07,,,,,,,,,,,,,,,,,
THERABAND CLX BULK - GREEN,270,RC,ITH-0112,LOCAL,,inpatient,,,1033.07,1033.07,,,,,,,,,,,,,,,,,
BOTTOM BUDDY,270,RC,ITH-0113,LOCAL,,inpatient,,,457.65,457.65,,,,,,,,,,,,,,,,,
Gait Belt,270,RC,ITH-0114,LOCAL,,inpatient,,,31.41,31.41,,,,,,,,,,,,,,,,,
COMFY ELBOW ORTHO ADULT,270,RC,ITH-0115,LOCAL,,inpatient,,,1011.74,1011.74,,,,,,,,,,,,,,,,,
"Comfy Rest Hand, Right, Large",270,RC,ITH-0116,LOCAL,,inpatient,,,313.7,313.7,,,,,,,,,,,,,,,,,
EZ-CALL SWITCH W/CORD,270,RC,ITH-0117,LOCAL,,inpatient,,,401.27,401.27,,,,,,,,,,,,,,,,,
E-Z Call  SWITCH - Universal,270,RC,ITH-0118,LOCAL,,inpatient,,,353.12,353.12,,,,,,,,,,,,,,,,,
SP GELFOAM BARI CUSHION,270,RC,ITH-0119,LOCAL,,inpatient,,,227.55,227.55,,,,,,,,,,,,,,,,,
ANKLE/WRIST WEIGHT DUMBBELL ST,270,RC,ITH-0120,LOCAL,,inpatient,,,1318.64,1318.64,,,,,,,,,,,,,,,,,
MIAMI J COLLAR 250 XS,270,RC,ITH-0121,LOCAL,,inpatient,,,351.27,351.27,,,,,,,,,,,,,,,,,
Aquasonic Ultrasound Gel,270,RC,ITH-0122,LOCAL,,inpatient,,,17.4,17.4,,,,,,,,,,,,,,,,,
LEMA STRAP,270,RC,ITH-0123,LOCAL,,inpatient,,,642.02,642.02,,,,,,,,,,,,,,,,,
Roho High Profile Cushion,270,RC,ITH-0124,LOCAL,,inpatient,,,2744.19,2744.19,,,,,,,,,,,,,,,,,
SHOULDER EXERCISE LADDER,270,RC,ITH-0125,LOCAL,,inpatient,,,490.64,490.64,,,,,,,,,,,,,,,,,
"Therapy Wrap 6"" x 24""",270,RC,ITH-0126,LOCAL,,inpatient,,,155.15,155.15,,,,,,,,,,,,,,,,,
SP COMBO PACK - SHOULDER W/ RO,270,RC,ITH-0127,LOCAL,,inpatient,,,104.9,104.9,,,,,,,,,,,,,,,,,
"Rolyan Ankle Brace, XXL",270,RC,ITH-0128,LOCAL,,inpatient,,,69.85,69.85,,,,,,,,,,,,,,,,,
MANIPULATION BOARD,270,RC,ITH-0129,LOCAL,,inpatient,,,427.77,427.77,,,,,,,,,,,,,,,,,
Balance Pad,270,RC,ITH-0130,LOCAL,,inpatient,,,216.15,216.15,,,,,,,,,,,,,,,,,
"Rolyan Wrist Braces, Right, S",270,RC,ITH-0131,LOCAL,,inpatient,,,108.08,108.08,,,,,,,,,,,,,,,,,
SHOULDER - ROTATOR COMPRESSION,270,RC,ITH-0132,LOCAL,,inpatient,,,104.9,104.9,,,,,,,,,,,,,,,,,
E-Z RELEASE BELT ALARM,270,RC,ITH-0133,LOCAL,,inpatient,,,230.99,230.99,,,,,,,,,,,,,,,,,
COCCYX CUSHION,270,RC,ITH-0134,LOCAL,,inpatient,,,108.35,108.35,,,,,,,,,,,,,,,,,
ADVANCED FUNC. SPLINT RIGHT-SM,270,RC,ITH-0135,LOCAL,,inpatient,,,104.78,104.78,,,,,,,,,,,,,,,,,
"TRANSFER BOARD W/SLOTS, 30""",270,RC,ITH-0136,LOCAL,,inpatient,,,171.9,171.9,,,,,,,,,,,,,,,,,
"Rolyan Kydex Orthosis, Left, S",270,RC,ITH-0137,LOCAL,,inpatient,,,1246.23,1246.23,,,,,,,,,,,,,,,,,
HI-D TRANSFER BOARD 10X26,270,RC,ITH-0138,LOCAL,,inpatient,,,316.71,316.71,,,,,,,,,,,,,,,,,
"HEAVY DUTY 35"" TRANSFER BOARD",270,RC,ITH-0139,LOCAL,,inpatient,,,228.96,228.96,,,,,,,,,,,,,,,,,
HEMI-SLING,270,RC,ITH-0140,LOCAL,,inpatient,,,85.42,85.42,,,,,,,,,,,,,,,,,
LEMA STRAP,270,RC,ITH-0141,LOCAL,,inpatient,,,496.62,496.62,,,,,,,,,,,,,,,,,
CLINIC/SELF-CATH MIRROR,270,RC,ITH-0145,LOCAL,,inpatient,,,220.4,220.4,,,,,,,,,,,,,,,,,
BARIATRIC OFFSET ADJ CANE,270,RC,ITH-0150,LOCAL,,inpatient,,,193.55,193.55,,,,,,,,,,,,,,,,,
SP VINYL WEDGE KNEE ABD CUSHIO,270,RC,ITH-0154,LOCAL,,inpatient,,,383.58,383.58,,,,,,,,,,,,,,,,,
ACU-SPRING FINGER EXT ASIST,270,RC,ITH-0156,LOCAL,,inpatient,,,100.43,100.43,,,,,,,,,,,,,,,,,
ECONOMY HEAT GUN,270,RC,ITH-0157,LOCAL,,inpatient,,,161.6,161.6,,,,,,,,,,,,,,,,,
Jamar Stainless Steel Finger G,270,RC,ITH-0160,LOCAL,,inpatient,,,101.85,101.85,,,,,,,,,,,,,,,,,
ROLYAN CERVICAL SUPPORT PILLOW,270,RC,ITH-0167,LOCAL,,inpatient,,,179.35,179.35,,,,,,,,,,,,,,,,,
DEPTH PERCEPTION PEGBOARD,270,RC,ITH-0168,LOCAL,,inpatient,,,247.5,247.5,,,,,,,,,,,,,,,,,
MUELLER SOFT ANKLE W/STRAP MED,270,RC,ITH-0171,LOCAL,,inpatient,,,178.45,178.45,,,,,,,,,,,,,,,,,
"ECONOMY WRIST SUPPORT, REG, R",270,RC,ITH-0176,LOCAL,,inpatient,,,100.21,100.21,,,,,,,,,,,,,,,,,
"FOLDING MOBILITY CANE 52""",270,RC,ITH-0188,LOCAL,,inpatient,,,278.24,278.24,,,,,,,,,,,,,,,,,
"AIR PUTTY, MEDIUM PINK 5LB",270,RC,ITH-0192,LOCAL,,inpatient,,,372.02,372.02,,,,,,,,,,,,,,,,,
"ROLYAN THERAPY PUTTY SOFT, YEL",270,RC,ITH-0194,LOCAL,,inpatient,,,166.25,166.25,,,,,,,,,,,,,,,,,
"ROLYAN THERAPY PUTTY MEDIUM, G",270,RC,ITH-0197,LOCAL,,inpatient,,,166.25,166.25,,,,,,,,,,,,,,,,,
"ROLYAN THERAPY PUTTY FIRM, BLU",270,RC,ITH-0199,LOCAL,,inpatient,,,161.75,161.75,,,,,,,,,,,,,,,,,
THERABAND CLX BULK 25YD YELLOW,270,RC,ITH-0201,LOCAL,,inpatient,,,240.62,240.62,,,,,,,,,,,,,,,,,
THERABAND CLX BULK 25YD RED,270,RC,ITH-0202,LOCAL,,inpatient,,,254.12,254.12,,,,,,,,,,,,,,,,,
THERABAND CLX BULK 25YD GREEN,270,RC,ITH-0203,LOCAL,,inpatient,,,260.42,260.42,,,,,,,,,,,,,,,,,
"STRAIGHT WAND MOUTHSTICK, 16""",270,RC,ITH-0215,LOCAL,,inpatient,,,105.66,105.66,,,,,,,,,,,,,,,,,
"REHAB WT BAR,1 LB, WHITE",270,RC,ITH-0217,LOCAL,,inpatient,,,116.05,116.05,,,,,,,,,,,,,,,,,
"REHAB WT BAR, 2 LB, ORANGE",270,RC,ITH-0218,LOCAL,,inpatient,,,116.05,116.05,,,,,,,,,,,,,,,,,
"REHAB WT BAR,3 LB, RED",270,RC,ITH-0219,LOCAL,,inpatient,,,122.8,122.8,,,,,,,,,,,,,,,,,
BED BODY BOLSTER,270,RC,ITH-0224,LOCAL,,inpatient,,,437.22,437.22,,,,,,,,,,,,,,,,,
"ROLYAN WATERCOLORS 1/16""X18""X2",270,RC,ITH-0228,LOCAL,,inpatient,,,233.8,233.8,,,,,,,,,,,,,,,,,
LARK-2 LANG. ACT. RESRCE KIT,270,RC,ITH-0231,LOCAL,,inpatient,,,873.99,873.99,,,,,,,,,,,,,,,,,
PROVALE CUP 5CC,270,RC,ITH-0232,LOCAL,,inpatient,,,157.15,157.15,,,,,,,,,,,,,,,,,
HIGH PROFILE CUSHION 20X16X4,270,RC,ITH-0243,LOCAL,,inpatient,,,2295.86,2295.86,,,,,,,,,,,,,,,,,
THERABAND STANDARD EXERCISE BA,270,RC,ITH-0251,LOCAL,,inpatient,,,109.34,109.34,,,,,,,,,,,,,,,,,
Wedge,270,RC,ITH-0255,LOCAL,,inpatient,,,562.5,562.5,,,,,,,,,,,,,,,,,
"RECLINING SHOWER CHAIR 600LB,",270,RC,ITH-0265,LOCAL,,inpatient,,,2498.58,2498.58,,,,,,,,,,,,,,,,,
BOTTOM BUDDY,270,RC,ITH-0266,LOCAL,,inpatient,,,224.45,224.45,,,,,,,,,,,,,,,,,
PICCOLIGHT POCKET OTOSCOPE,270,RC,ITH-0267,LOCAL,,inpatient,,,408.06,408.06,,,,,,,,,,,,,,,,,
50YD LEVEL 3 NO LATEX ROLYAN B,270,RC,ITH-0298,LOCAL,,inpatient,,,251.73,251.73,,,,,,,,,,,,,,,,,
CONTOUR SELECT CUSHION 18X16,270,RC,ITH-0313,LOCAL,,inpatient,,,2225.07,2225.07,,,,,,,,,,,,,,,,,
LOW PROFILE CUSHION 24X18X2,270,RC,ITH-0314,LOCAL,,inpatient,,,2757.42,2757.42,,,,,,,,,,,,,,,,,
HIGH PROFILE CUSHION 24X18X4,270,RC,ITH-0315,LOCAL,,inpatient,,,2911.23,2911.23,,,,,,,,,,,,,,,,,
LOW PROFILE CUSHION 26X18X2,270,RC,ITH-0316,LOCAL,,inpatient,,,2824.92,2824.92,,,,,,,,,,,,,,,,,
"2 POINT 72"" W/C BELT W/ PLSTIC",270,RC,ITH-0318,LOCAL,,inpatient,,,131.8,131.8,,,,,,,,,,,,,,,,,
E-Z RELEASE BELT ALARM,270,RC,ITH-0319,LOCAL,,inpatient,,,670.41,670.41,,,,,,,,,,,,,,,,,
BARIATRIC RELEASE WALKER,270,RC,ITH-0320,LOCAL,,inpatient,,,1326.38,1326.38,,,,,,,,,,,,,,,,,
"HOYER FULL BACK PADDED, LARGE",270,RC,ITH-0321,LOCAL,,inpatient,,,2037.11,2037.11,,,,,,,,,,,,,,,,,
COMFY ELBOW ORTHO ADULT,270,RC,ITH-0325,LOCAL,,inpatient,,,725.22,725.22,,,,,,,,,,,,,,,,,
COMFY AIR HAND ROLL ADULT,270,RC,ITH-0326,LOCAL,,inpatient,,,272.97,272.97,,,,,,,,,,,,,,,,,
MATRIX AURA SERIES FUNCTIONAL,270,RC,ITH-0379,LOCAL,,inpatient,,,22852.26,22852.26,,,,,,,,,,,,,,,,,
CVA SLINGS,270,RC,ITH-0389,LOCAL,,inpatient,,,104.65,104.65,,,,,,,,,,,,,,,,,
Spring Finger Extension Splint,270,RC,ITH-0411,LOCAL,,inpatient,,,71.56,71.56,,,,,,,,,,,,,,,,,
Spring Finger Extension Splint,270,RC,ITH-0412,LOCAL,,inpatient,,,70.4,70.4,,,,,,,,,,,,,,,,,
Spring Finger Extension Splint,270,RC,ITH-0413,LOCAL,,inpatient,,,70.4,70.4,,,,,,,,,,,,,,,,,
Spring Finger Extension Splint,270,RC,ITH-0414,LOCAL,,inpatient,,,72.49,72.49,,,,,,,,,,,,,,,,,
HIGH PROFILE CUSHION 16X16X4,270,RC,ITH-0416,LOCAL,,inpatient,,,2295.86,2295.86,,,,,,,,,,,,,,,,,
HIGH PROFILE CUSHION 18X16X4,270,RC,ITH-0417,LOCAL,,inpatient,,,1320.62,1320.62,,,,,,,,,,,,,,,,,
"48"" BROWN 6 LB. WEIGHTED BAR",270,RC,ITH-0451,LOCAL,,inpatient,,,107.35,107.35,,,,,,,,,,,,,,,,,
HARD SHELL HELMET - BLUE SMALL,270,RC,ITH-0479,LOCAL,,inpatient,,,451.35,451.35,,,,,,,,,,,,,,,,,
HARD SHELL HELMET - BLUE MED,270,RC,ITH-0480,LOCAL,,inpatient,,,452.25,452.25,,,,,,,,,,,,,,,,,
HARD SHELL HELMET - BLUE LGE,270,RC,ITH-0481,LOCAL,,inpatient,,,452.25,452.25,,,,,,,,,,,,,,,,,
HARD SHELL HELMET - BLUE X-LGE,270,RC,ITH-0482,LOCAL,,inpatient,,,455.63,455.63,,,,,,,,,,,,,,,,,
GRANDSTAND III STANDER,270,RC,ITH-0483,LOCAL,,inpatient,,,9817.02,9817.02,,,,,,,,,,,,,,,,,
COMFY GONIOMETER ELBOW ADULT,270,RC,ITH-0499,LOCAL,,inpatient,,,899.15,899.15,,,,,,,,,,,,,,,,,
MIAMI J COLLAR 250 XS,270,RC,ITH-0507,LOCAL,,inpatient,,,461.88,461.88,,,,,,,,,,,,,,,,,
DELUXE CUFF WEIGHT 32 PC SET,270,RC,ITH-0513,LOCAL,,inpatient,,,1341.5,1341.5,,,,,,,,,,,,,,,,,
"Horeshoe Table 72"" x 48"" Dove/",270,RC,ITH-0514,LOCAL,,inpatient,,,3462.21,3462.21,,,,,,,,,,,,,,,,,
"Juditta Wheelchair 20"" w 22"" r",270,RC,ITH-0516,LOCAL,,inpatient,,,22932.99,22932.99,,,,,,,,,,,,,,,,,
Days Steerable Knee Walker,270,RC,ITH-0523,LOCAL,,inpatient,,,2206.71,2206.71,,,,,,,,,,,,,,,,,
"VISTA 464 TLSO, ADJUSTABLE TLS",270,RC,ITH-0528,LOCAL,,inpatient,,,3451.86,3451.86,,,,,,,,,,,,,,,,,
"HYDRATHERM, DELUXE DIVIDER RAC",270,RC,ITH-0530,LOCAL,,inpatient,,,9155.97,9155.97,,,,,,,,,,,,,,,,,
COMFY GONIOMETER ELBOW S ADULT,270,RC,ITH-0545,LOCAL,,inpatient,,,899.15,899.15,,,,,,,,,,,,,,,,,
FLEX CUFF ELBOW SPLINT,270,RC,ITH-0550,LOCAL,,inpatient,,,446.31,446.31,,,,,,,,,,,,,,,,,
Sammons Preston Tri-Panel Knee,270,RC,ITH-0551,LOCAL,,inpatient,,,227,227,,,,,,,,,,,,,,,,,
MULPODUS SYSTEM-ADULT,270,RC,ITH-0560,LOCAL,,inpatient,,,472.91,472.91,,,,,,,,,,,,,,,,,
RESTING HAND ORTHOSIS,270,RC,ITH-0566,LOCAL,,inpatient,,,267.89,267.89,,,,,,,,,,,,,,,,,
AIR-SOFT RESTING HAND,270,RC,ITH-0568,LOCAL,,inpatient,,,660.6,660.6,,,,,,,,,,,,,,,,,
FIGURE-8 ANKLE SUPPORT,270,RC,ITH-0575,LOCAL,,inpatient,,,101.81,101.81,,,,,,,,,,,,,,,,,
EPX BACK SUPPORT,270,RC,ITH-0593,LOCAL,,inpatient,,,187.4,187.4,,,,,,,,,,,,,,,,,
SOFT PLANTAR FASCIITIS,270,RC,ITH-0599,LOCAL,,inpatient,,,273.65,273.65,,,,,,,,,,,,,,,,,
COMFY ADULT ELBOW ORTHOSIS,270,RC,ITH-0600,LOCAL,,inpatient,,,725.22,725.22,,,,,,,,,,,,,,,,,
ADVANCED FUNC. SPLINT,270,RC,ITH-0603,LOCAL,,inpatient,,,344.75,344.75,,,,,,,,,,,,,,,,,
D3 PULL-ON KNEE W/HINGES MED,270,RC,ITH-0607,LOCAL,,inpatient,,,248.22,248.22,,,,,,,,,,,,,,,,,
MPO 2000 Shortback w/o Transfe,270,RC,ITH-0625,LOCAL,,inpatient,,,715.19,715.19,,,,,,,,,,,,,,,,,
MPO 2000 Shortback w/o Transfe,270,RC,ITH-0626,LOCAL,,inpatient,,,715.19,715.19,,,,,,,,,,,,,,,,,
MPO 2000 Shortback w/o Transfe,270,RC,ITH-0627,LOCAL,,inpatient,,,715.19,715.19,,,,,,,,,,,,,,,,,
MPO 2000 Shortback w/o Transfe,270,RC,ITH-0628,LOCAL,,inpatient,,,715.19,715.19,,,,,,,,,,,,,,,,,
AMBIFLEX WRIST SUPPORT,270,RC,ITH-0637,LOCAL,,inpatient,,,106.37,106.37,,,,,,,,,,,,,,,,,
THERMOSKIN ELBOW SLEEVE,270,RC,ITH-0640,LOCAL,,inpatient,,,159.95,159.95,,,,,,,,,,,,,,,,,
EPX WRIST CONTROL,270,RC,ITH-0642,LOCAL,,inpatient,,,107.86,107.86,,,,,,,,,,,,,,,,,
"SFTSHLL HLMT,LG,RBL 23-23 3/4""",270,RC,ITH-0666,LOCAL,,inpatient,,,348.26,348.26,,,,,,,,,,,,,,,,,
DELUXE SQUARE REBOUNDER PACKAG,270,RC,ITH-0672,LOCAL,,inpatient,,,2620.44,2620.44,,,,,,,,,,,,,,,,,
ROLL-IN SHOWER BUDDY W/TILT,270,RC,ITH-0679,LOCAL,,inpatient,,,4926.33,4926.33,,,,,,,,,,,,,,,,,
ADJUSTABLE CONE HAND ORTH. ADU,270,RC,ITH-0685,LOCAL,,inpatient,,,382.41,382.41,,,,,,,,,,,,,,,,,
COMFY FINGER EXTENDER ADULT,270,RC,ITH-0687,LOCAL,,inpatient,,,322.7,322.7,,,,,,,,,,,,,,,,,
BESTMOVE 400 STANDING TRANSFER,270,RC,ITH-0690,LOCAL,,inpatient,,,3696.66,3696.66,,,,,,,,,,,,,,,,,
I-SERIES CONVERTIBLE CHAIR - 4,270,RC,ITH-0705,LOCAL,,inpatient,,,21142.26,21142.26,,,,,,,,,,,,,,,,,
I-SERIES CONVERTIBLE CHAIR - 7,270,RC,ITH-0706,LOCAL,,inpatient,,,25541.96,25541.96,,,,,,,,,,,,,,,,,
KNEE SLING,270,RC,ITH-0707,LOCAL,,inpatient,,,581.13,581.13,,,,,,,,,,,,,,,,,
"Gait Belt, 72"", Metal Buckle",270,RC,ITH-0724,LOCAL,,inpatient,,,108.65,108.65,,,,,,,,,,,,,,,,,
PROCARE THUMB SPLINT,270,RC,ITH-0732,LOCAL,,inpatient,,,104.65,104.65,,,,,,,,,,,,,,,,,
LACURA MOLDED FOOTREST,270,RC,ITH-0735,LOCAL,,inpatient,,,337.5,337.5,,,,,,,,,,,,,,,,,
ROLYAN KNEE SLEEVES,270,RC,ITH-0740,LOCAL,,inpatient,,,98.73,98.73,,,,,,,,,,,,,,,,,
ROLYANFIT HINGED KNEE SUPPORT,270,RC,ITH-0745,LOCAL,,inpatient,,,200.55,200.55,,,,,,,,,,,,,,,,,
PROTEC X FACTOR KNEE BRACE XL,270,RC,ITH-0751,LOCAL,,inpatient,,,165.3,165.3,,,,,,,,,,,,,,,,,
"TEST OF MEMORY AND LEARNING, S",270,RC,ITH-0780,LOCAL,,inpatient,,,2619.9,2619.9,,,,,,,,,,,,,,,,,
"EVA WALKER, PNEUMATIC W/DIRECT",270,RC,ITH-0792,LOCAL,,inpatient,,,5310.81,5310.81,,,,,,,,,,,,,,,,,
KINESIO GOLD FP BLUE,270,RC,ITH-0807,LOCAL,,inpatient,,,239.55,239.55,,,,,,,,,,,,,,,,,
FULL COVERAGE SOFT SHELL HELME,270,RC,ITH-0837,LOCAL,,inpatient,,,818.19,818.19,,,,,,,,,,,,,,,,,
FULL COVERAGE SOFT SHELL HELME,270,RC,ITH-0838,LOCAL,,inpatient,,,834.53,834.53,,,,,,,,,,,,,,,,,
"HARD SHELL HELMET, MED, TAN",270,RC,ITH-0839,LOCAL,,inpatient,,,918.77,918.77,,,,,,,,,,,,,,,,,
SCIFIT PRO2 WITH PREMIUM SEAT,270,RC,ITH-0851,LOCAL,,inpatient,,,17887.32,17887.32,,,,,,,,,,,,,,,,,
EXOSTRONG ARM SLEEVE S SHORT B,270,RC,ITH-0860,LOCAL,,inpatient,,,268.34,268.34,,,,,,,,,,,,,,,,,
VITALSTIM PLUS ELECTROTHERAPY,270,RC,ITH-0868,LOCAL,,inpatient,,,11265.66,11265.66,,,,,,,,,,,,,,,,,
SP GELFOAM BARI CUSHION 24X18X,270,RC,ITH-0895,LOCAL,,inpatient,,,465.44,465.44,,,,,,,,,,,,,,,,,
"ORTHOWEDGE, X-SMALL",270,RC,ITH-0915,LOCAL,,inpatient,,,192.95,192.95,,,,,,,,,,,,,,,,,
"ORTHOWEDGE, SMALL",270,RC,ITH-0916,LOCAL,,inpatient,,,192.95,192.95,,,,,,,,,,,,,,,,,
"ORTHOWEDGE, MEDIUM",270,RC,ITH-0917,LOCAL,,inpatient,,,90.37,90.37,,,,,,,,,,,,,,,,,
"HEELWEDGE SHOE, SMALL",270,RC,ITH-0919,LOCAL,,inpatient,,,220.6,220.6,,,,,,,,,,,,,,,,,
"HEELWEDGE SHOE, MEDIUM",270,RC,ITH-0920,LOCAL,,inpatient,,,220.6,220.6,,,,,,,,,,,,,,,,,
"HEELWEDGE SHOE, LARGE",270,RC,ITH-0921,LOCAL,,inpatient,,,220.6,220.6,,,,,,,,,,,,,,,,,
MPO 2000 Active w/Ambulatory A,270,RC,ITH-0925,LOCAL,,inpatient,,,789.75,789.75,,,,,,,,,,,,,,,,,
MPO 2000 Active w/Ambulatory A,270,RC,ITH-0926,LOCAL,,inpatient,,,789.75,789.75,,,,,,,,,,,,,,,,,
MPO 2000 Active w/Ambulatory A,270,RC,ITH-0927,LOCAL,,inpatient,,,789.75,789.75,,,,,,,,,,,,,,,,,
"DENSIFOAM MAT,5 X 7 FT",270,RC,ITH-0929,LOCAL,,inpatient,,,866.25,866.25,,,,,,,,,,,,,,,,,
"8X24X28"" VALU-FORM WEDGE",270,RC,ITH-0930,LOCAL,,inpatient,,,497.48,497.48,,,,,,,,,,,,,,,,,
"6 X 24"" VALU-FORM ROL",270,RC,ITH-0932,LOCAL,,inpatient,,,246.42,246.42,,,,,,,,,,,,,,,,,
"8 X 24"" VALU-FORM ROLL",270,RC,ITH-0933,LOCAL,,inpatient,,,304.56,304.56,,,,,,,,,,,,,,,,,
"T/F WEDGE,20""W X 22""L X 6""H -",270,RC,ITH-0939,LOCAL,,inpatient,,,390.38,390.38,,,,,,,,,,,,,,,,,
CARE CLINER XL - HUNTER GREEN,270,RC,ITH-0945,LOCAL,,inpatient,,,5508.95,5508.95,,,,,,,,,,,,,,,,,
2-CHANNEL INTELECT XT COMBO +,270,RC,ITH-0946,LOCAL,,inpatient,,,12368.43,12368.43,,,,,,,,,,,,,,,,,
Rolyan Functional Position Han,270,RC,ITH-0953,LOCAL,,inpatient,,,85.03,85.03,,,,,,,,,,,,,,,,,
Rolyan Functional Position Han,270,RC,ITH-0955,LOCAL,,inpatient,,,85.03,85.03,,,,,,,,,,,,,,,,,
Rolyan Functional Position Han,270,RC,ITH-0956,LOCAL,,inpatient,,,85.03,85.03,,,,,,,,,,,,,,,,,
Rolyan Functional Position Spl,270,RC,ITH-0957,LOCAL,,inpatient,,,103.4,103.4,,,,,,,,,,,,,,,,,
Rolyan Position Splint w/Strap,270,RC,ITH-0958,LOCAL,,inpatient,,,103.4,103.4,,,,,,,,,,,,,,,,,
Rolyan Functional Position Spl,270,RC,ITH-0959,LOCAL,,inpatient,,,103.4,103.4,,,,,,,,,,,,,,,,,
ROLYAN DLX HINGD KNEE WRAP XLG,270,RC,ITH-0974,LOCAL,,inpatient,,,480.15,480.15,,,,,,,,,,,,,,,,,
ROLYAN HORIZONTAL RING TREE (1,270,RC,ITH-0977,LOCAL,,inpatient,,,784.26,784.26,,,,,,,,,,,,,,,,,
AFO RIGHT LARGE (1),270,RC,ITH-0988,LOCAL,,inpatient,,,227,227,,,,,,,,,,,,,,,,,
ROLYAN KNEE SEPARATOR (1),270,RC,ITH-0991,LOCAL,,inpatient,,,102.9,102.9,,,,,,,,,,,,,,,,,
ELBOW RANGER MEDIUM (1),270,RC,ITH-0993,LOCAL,,inpatient,,,584.24,584.24,,,,,,,,,,,,,,,,,
ROLYAN FIGRE OF 8 SLING,270,RC,ITH-0995,LOCAL,,inpatient,,,195.35,195.35,,,,,,,,,,,,,,,,,
UNIVERSAL ARM SLING (1),270,RC,ITH-1000,LOCAL,,inpatient,,,182.3,182.3,,,,,,,,,,,,,,,,,
ROLYAN PROGR. PALM PROTECTOR S,270,RC,ITH-1069,LOCAL,,inpatient,,,237.45,237.45,,,,,,,,,,,,,,,,,
SFOAM PALM SHIELD,270,RC,ITH-1072,LOCAL,,inpatient,,,168.95,168.95,,,,,,,,,,,,,,,,,
KWIK-FORM FUNCTIONAL RESTING S,270,RC,ITH-1073,LOCAL,,inpatient,,,408.83,408.83,,,,,,,,,,,,,,,,,
ROLYAN THUMB LOOP ADULT (1),270,RC,ITH-1078,LOCAL,,inpatient,,,86.85,86.85,,,,,,,,,,,,,,,,,
"15"" TRANSFER DISC",270,RC,ITH-1114,LOCAL,,inpatient,,,415.4,415.4,,,,,,,,,,,,,,,,,
"PT2000 6'W x 8'L, Imp Blue, Ba",270,RC,ITH-1117,LOCAL,,inpatient,,,44662.5,44662.5,,,,,,,,,,,,,,,,,
CUBII TOTAL BODY+,270,RC,ITH-1125,LOCAL,,inpatient,,,2020.5,2020.5,,,,,,,,,,,,,,,,,
HT100 HAND THERAPY 60 X 30 REC,270,RC,ITH-1130,LOCAL,,inpatient,,,7258.5,7258.5,,,,,,,,,,,,,,,,,
"PT2000 5'W x 7'L, Imp Blue Bar",270,RC,ITH-1133,LOCAL,,inpatient,,,39995.19,39995.19,,,,,,,,,,,,,,,,,
"VISTA 637 LSO, Adjustable LSO",270,RC,ITH-1153,LOCAL,,inpatient,,,2730.69,2730.69,,,,,,,,,,,,,,,,,
HydraTherm DT,270,RC,ITH-1161,LOCAL,,inpatient,,,9155.97,9155.97,,,,,,,,,,,,,,,,,
HYDRATHERM STANDARD NO RACK NO,270,RC,ITH-1162,LOCAL,,inpatient,,,7932.47,7932.47,,,,,,,,,,,,,,,,,
HYDRATHERM STANDARD W PACKS,270,RC,ITH-1163,LOCAL,,inpatient,,,7650,7650,,,,,,,,,,,,,,,,,
"HYDRATHERM, DELUXE, NO RACK, N",270,RC,ITH-1164,LOCAL,,inpatient,,,9920.57,9920.57,,,,,,,,,,,,,,,,,
GAME READY ANKLE WRAP W / ATX,270,RC,ITH-1168,LOCAL,,inpatient,,,1332,1332,,,,,,,,,,,,,,,,,
GAME READY ANKLE WRAP W / ATX,270,RC,ITH-1169,LOCAL,,inpatient,,,1332,1332,,,,,,,,,,,,,,,,,
GAME READY STRAIGHT KNEE WRAP,270,RC,ITH-1170,LOCAL,,inpatient,,,1368,1368,,,,,,,,,,,,,,,,,
Game Ready Accelerated Recover,270,RC,ITH-1181,LOCAL,,inpatient,,,2467.89,2467.89,,,,,,,,,,,,,,,,,
Medium GAME READY FULL LEG BOO,270,RC,ITH-1182,LOCAL,,inpatient,,,3098.21,3098.21,,,,,,,,,,,,,,,,,
LRG  - GAME READY FULL LEG BOO,270,RC,ITH-1183,LOCAL,,inpatient,,,2979.14,2979.14,,,,,,,,,,,,,,,,,
LACURA GELFOAM KNEE ABD RND BT,270,RC,ITH-1201,LOCAL,,inpatient,,,574.88,574.88,,,,,,,,,,,,,,,,,
C-Gel Wheelchair Cushion,270,RC,ITH-1236,LOCAL,,inpatient,,,220.6,220.6,,,,,,,,,,,,,,,,,
COCCYX CUSHION 16X16X2,270,RC,ITH-1240,LOCAL,,inpatient,,,392.31,392.31,,,,,,,,,,,,,,,,,
FormFit LOW TOP WALKER,270,RC,ITH-1305,LOCAL,,inpatient,,,394.11,394.11,,,,,,,,,,,,,,,,,
"Comfy Deviation Hand Orthosis,",270,RC,ITH-1334,LOCAL,,inpatient,,,352.71,352.71,,,,,,,,,,,,,,,,,
BESTMOVE 450 STANDING TRANSFER,270,RC,ITH-1347,LOCAL,,inpatient,,,6910.92,6910.92,,,,,,,,,,,,,,,,,
Rolyan Progressive Palm Protec,270,RC,ITH-1352,LOCAL,,inpatient,,,243,243,,,,,,,,,,,,,,,,,
Rolyan Black Wrist Braces,270,RC,ITH-1353,LOCAL,,inpatient,,,113.8,113.8,,,,,,,,,,,,,,,,,
"REACTION WEB Knee Brace, M/L",270,RC,ITH-1391,LOCAL,,inpatient,,,506.43,506.43,,,,,,,,,,,,,,,,,
REACTION WEB Knee Brace,270,RC,ITH-1392,LOCAL,,inpatient,,,506.43,506.43,,,,,,,,,,,,,,,,,
"TheraBite, TheraBite",270,RC,ITH-1400,LOCAL,,inpatient,,,2469.92,2469.92,,,,,,,,,,,,,,,,,
ShowerBuddy,270,RC,ITH-1436,LOCAL,,inpatient,,,8072.64,8072.64,,,,,,,,,,,,,,,,,
"TubBuddy, TubBuddy",270,RC,ITH-1437,LOCAL,,inpatient,,,8808.21,8808.21,,,,,,,,,,,,,,,,,
"TubBuddy, TubBuddy + Tilt",270,RC,ITH-1438,LOCAL,,inpatient,,,11014.79,11014.79,,,,,,,,,,,,,,,,,
"Drop Arm Care Cliner, XL, CA 1",270,RC,ITH-1452,LOCAL,,inpatient,,,5508.95,5508.95,,,,,,,,,,,,,,,,,
Comfy Rest Hand Orthosis,270,RC,ITH-1454,LOCAL,,inpatient,,,345.78,345.78,,,,,,,,,,,,,,,,,
FREEZ GEL-GREEN 8 OZ PUMP,270,RC,ITH-1499,LOCAL,,inpatient,,,420.44,420.44,,,,,,,,,,,,,,,,,
"Aquasonic Ultrasound Gel, Aqua",270,RC,ITH-1583,LOCAL,,inpatient,,,102.52,102.52,,,,,,,,,,,,,,,,,
"Aquasonic Ultrasound Gel, Aqua",270,RC,ITH-1584,LOCAL,,inpatient,,,160.45,160.45,,,,,,,,,,,,,,,,,
E-Z Call Universal / Quadriple,270,RC,ITH-1606,LOCAL,,inpatient,,,244,244,,,,,,,,,,,,,,,,,
"Folding Mobility Cane, 50""",270,RC,ITH-1608,LOCAL,,inpatient,,,278.24,278.24,,,,,,,,,,,,,,,,,
SCIFIT PRO Series Total and Up,270,RC,ITH-1609,LOCAL,,inpatient,,,307.13,307.13,,,,,,,,,,,,,,,,,
SCIFIT PRO Series Total and Up,270,RC,ITH-1611,LOCAL,,inpatient,,,16399.67,16399.67,,,,,,,,,,,,,,,,,
"Air-Putty, 5 lb., Soft",270,RC,ITH-1612,LOCAL,,inpatient,,,360.72,360.72,,,,,,,,,,,,,,,,,
Comfy Hand Flex,270,RC,ITH-1683,LOCAL,,inpatient,,,471.69,471.69,,,,,,,,,,,,,,,,,
Flex Cuff Elbow Orthosis,270,RC,ITH-1684,LOCAL,,inpatient,,,446.31,446.31,,,,,,,,,,,,,,,,,
Intelect Legend XT Electrother,270,RC,ITH-1795,LOCAL,,inpatient,,,7704.68,7704.68,,,,,,,,,,,,,,,,,
Intelect Legend XT Electrother,270,RC,ITH-1796,LOCAL,,inpatient,,,9065.66,9065.66,,,,,,,,,,,,,,,,,
Intelect Legend XT Electrother,270,RC,ITH-1797,LOCAL,,inpatient,,,9760.28,9760.28,,,,,,,,,,,,,,,,,
Intelect Legend XT Electrother,270,RC,ITH-1798,LOCAL,,inpatient,,,10013.04,10013.04,,,,,,,,,,,,,,,,,
INTELECT LEGEND XT 2-CHANNEL C,270,RC,ITH-1799,LOCAL,,inpatient,,,11528.19,11528.19,,,,,,,,,,,,,,,,,
Intelect Legend XT Electrother,270,RC,ITH-1800,LOCAL,,inpatient,,,11638.49,11638.49,,,,,,,,,,,,,,,,,
Intelect Legend XT Electrother,270,RC,ITH-1801,LOCAL,,inpatient,,,14205.15,14205.15,,,,,,,,,,,,,,,,,
Air Soft Resting Hand Splints,270,RC,ITH-1813,LOCAL,,inpatient,,,660.6,660.6,,,,,,,,,,,,,,,,,
Ankle Contracture Boots,270,RC,ITH-1817,LOCAL,,inpatient,,,561.2,561.2,,,,,,,,,,,,,,,,,
Rolyan Ankle Braces,270,RC,ITH-1820,LOCAL,,inpatient,,,99.83,99.83,,,,,,,,,,,,,,,,,
Bariatric Reclining Shower/Com,270,RC,ITH-1827,LOCAL,,inpatient,,,2443.01,2443.01,,,,,,,,,,,,,,,,,
Forearm Support with Offset Sw,270,RC,ITH-1829,LOCAL,,inpatient,,,687.24,687.24,,,,,,,,,,,,,,,,,
Forearm Support with Offset Sw,270,RC,ITH-1830,LOCAL,,inpatient,,,618.53,618.53,,,,,,,,,,,,,,,,,
"ROLYAN TAILORSPLINT 3/32""X18""X",270,RC,ITH-1833,LOCAL,,inpatient,,,202.3,202.3,,,,,,,,,,,,,,,,,
R-Soft Plantar Fasciitis Stret,270,RC,ITH-1909,LOCAL,,inpatient,,,273.65,273.65,,,,,,,,,,,,,,,,,
"Rolyan Advanced Orthosis, Mitt",270,RC,ITH-1919,LOCAL,,inpatient,,,344.75,344.75,,,,,,,,,,,,,,,,,
"Rolyan Kydex Orthosis, Left, S",270,RC,ITH-1922,LOCAL,,inpatient,,,243.35,243.35,,,,,,,,,,,,,,,,,
"Rolyan Kydex Orthosis, Right,",270,RC,ITH-1923,LOCAL,,inpatient,,,243.35,243.35,,,,,,,,,,,,,,,,,
"Rolyan Kydex Orthosis, Right,",270,RC,ITH-1924,LOCAL,,inpatient,,,243.35,243.35,,,,,,,,,,,,,,,,,
"Rolyan Kydex Orthosis, Right,",270,RC,ITH-1925,LOCAL,,inpatient,,,228.02,228.02,,,,,,,,,,,,,,,,,
"Rolyan Kydex Orthosis, Left, M",270,RC,ITH-1926,LOCAL,,inpatient,,,228.02,228.02,,,,,,,,,,,,,,,,,
"Rolyan Kydex Orthosis, Left, L",270,RC,ITH-1927,LOCAL,,inpatient,,,228.02,228.02,,,,,,,,,,,,,,,,,
"Rolyan Kydex Orthosis, Right,",270,RC,ITH-1928,LOCAL,,inpatient,,,228.02,228.02,,,,,,,,,,,,,,,,,
"Rolyan Kydex Orthosis, Left, L",270,RC,ITH-1929,LOCAL,,inpatient,,,248.2,248.2,,,,,,,,,,,,,,,,,
"Rolyan Kydex Orthosis, Left, X",270,RC,ITH-1930,LOCAL,,inpatient,,,248.45,248.45,,,,,,,,,,,,,,,,,
"Foot-Up, Medium",270,RC,ITH-1933,LOCAL,,inpatient,,,700.43,700.43,,,,,,,,,,,,,,,,,
CONTOUR SELECT CUSHION 16X16,270,RC,ITH-1939,LOCAL,,inpatient,,,2198.7,2198.7,,,,,,,,,,,,,,,,,
LOW PROFILE CUSHION 24X18X2,270,RC,ITH-1940,LOCAL,,inpatient,,,2807.46,2807.46,,,,,,,,,,,,,,,,,
HIGH PROFILE CUSHION 22X18X4,270,RC,ITH-1941,LOCAL,,inpatient,,,2915.73,2915.73,,,,,,,,,,,,,,,,,
HIGH PROFILE CUSHION 26X18X4,270,RC,ITH-1942,LOCAL,,inpatient,,,3026.07,3026.07,,,,,,,,,,,,,,,,,
"Hoyer 6-Point Full Back Sling,",270,RC,ITH-1943,LOCAL,,inpatient,,,2037.11,2037.11,,,,,,,,,,,,,,,,,
"Hoyer 6-Point Full Back Sling,",270,RC,ITH-1944,LOCAL,,inpatient,,,2037.11,2037.11,,,,,,,,,,,,,,,,,
"Hoyer 6-Point Full Back Sling,",270,RC,ITH-1945,LOCAL,,inpatient,,,2037.11,2037.11,,,,,,,,,,,,,,,,,
"Hoyer 6-Point Full Back Sling,",270,RC,ITH-1946,LOCAL,,inpatient,,,2037.11,2037.11,,,,,,,,,,,,,,,,,
"Sammons Preston Gait Belts, 36",270,RC,ITH-1983,LOCAL,,inpatient,,,108.13,108.13,,,,,,,,,,,,,,,,,
"Rolyan Hook: Self-Adhesive, Bl",270,RC,ITH-2007,LOCAL,,inpatient,,,187.35,187.35,,,,,,,,,,,,,,,,,
"LMB Extension Finger Splint, S",270,RC,ITH-2016,LOCAL,,inpatient,,,85.25,85.25,,,,,,,,,,,,,,,,,
INCONTINENT RESISTANT COVER 20,270,RC,ITH-2025,LOCAL,,inpatient,,,633.33,633.33,,,,,,,,,,,,,,,,,
LOW PROFILE CUSHION 1516X2,270,RC,ITH-2027,LOCAL,,inpatient,,,2209.59,2209.59,,,,,,,,,,,,,,,,,
LOW PROFILE CUSHION 16X16X2,270,RC,ITH-2028,LOCAL,,inpatient,,,2243.16,2243.16,,,,,,,,,,,,,,,,,
LOW PROFILE CUSHION 18X16X2,270,RC,ITH-2029,LOCAL,,inpatient,,,1318.5,1318.5,,,,,,,,,,,,,,,,,
HIGH PROFILE CUSHION 15X16X4,270,RC,ITH-2030,LOCAL,,inpatient,,,2295.86,2295.86,,,,,,,,,,,,,,,,,
LOW PROFILE CUSHION 20X16X2,270,RC,ITH-2031,LOCAL,,inpatient,,,2243.16,2243.16,,,,,,,,,,,,,,,,,
"Rolyan Loop: Non-Adhesive, Lig",270,RC,ITH-2065,LOCAL,,inpatient,,,122.6,122.6,,,,,,,,,,,,,,,,,
"Rolyan Loop: Non-Adhesive, Roy",270,RC,ITH-2066,LOCAL,,inpatient,,,122.6,122.6,,,,,,,,,,,,,,,,,
"Rolyan Loop: Non-Adhesive, Bla",270,RC,ITH-2070,LOCAL,,inpatient,,,122.6,122.6,,,,,,,,,,,,,,,,,
"Rolyan Loop: Non-Adhesive, Yel",270,RC,ITH-2072,LOCAL,,inpatient,,,122.6,122.6,,,,,,,,,,,,,,,,,
"Rolyan Loop: Non-Adhesive, Red",270,RC,ITH-2073,LOCAL,,inpatient,,,122.6,122.6,,,,,,,,,,,,,,,,,
"Rolyan Loop: Non-Adhesive, Pur",270,RC,ITH-2074,LOCAL,,inpatient,,,122.6,122.6,,,,,,,,,,,,,,,,,
"Coban NL Tan 2"" x 2 yd, Per Ro",270,RC,ITH-2075,LOCAL,,inpatient,,,469.04,469.04,,,,,,,,,,,,,,,,,
"Coban NL Tan 3"" x2 yd, Per Rol",270,RC,ITH-2076,LOCAL,,inpatient,,,469.04,469.04,,,,,,,,,,,,,,,,,
"Rolyan Post-op Shoe, S, Women",270,RC,ITH-2103,LOCAL,,inpatient,,,75.41,75.41,,,,,,,,,,,,,,,,,
Comfy Elbow Orthosis,270,RC,ITH-2105,LOCAL,,inpatient,,,711.09,711.09,,,,,,,,,,,,,,,,,
"Comfy Elbow Orthosis, Navy, Br",270,RC,ITH-2107,LOCAL,,inpatient,,,874.35,874.35,,,,,,,,,,,,,,,,,
"Terry Tropic Pac Covers, Overs",270,RC,ITH-2130,LOCAL,,inpatient,,,70.02,70.02,,,,,,,,,,,,,,,,,
Full Coverage Soft Shell Helme,270,RC,ITH-2131,LOCAL,,inpatient,,,834.53,834.53,,,,,,,,,,,,,,,,,
Full Coverage Soft Shell Helme,270,RC,ITH-2132,LOCAL,,inpatient,,,834.53,834.53,,,,,,,,,,,,,,,,,
Full Coverage Soft Shell Helme,270,RC,ITH-2133,LOCAL,,inpatient,,,412.43,412.43,,,,,,,,,,,,,,,,,
Full Coverage Soft Shell Helme,270,RC,ITH-2134,LOCAL,,inpatient,,,818.19,818.19,,,,,,,,,,,,,,,,,
Full Coverage Soft Shell Helme,270,RC,ITH-2135,LOCAL,,inpatient,,,412.43,412.43,,,,,,,,,,,,,,,,,
"Hard Shell Helmet, Tan, Small",270,RC,ITH-2137,LOCAL,,inpatient,,,557.42,557.42,,,,,,,,,,,,,,,,,
"Hard Shell Helmet, Tan, Large",270,RC,ITH-2138,LOCAL,,inpatient,,,900.81,900.81,,,,,,,,,,,,,,,,,
"Hard Shell Helmet, Tan, X-Larg",270,RC,ITH-2139,LOCAL,,inpatient,,,918.77,918.77,,,,,,,,,,,,,,,,,
herafin Commode Transfer Board,270,RC,ITH-2141,LOCAL,,inpatient,,,417.11,417.11,,,,,,,,,,,,,,,,,
"Darco HeelWedge Healing Shoe,",270,RC,ITH-2208,LOCAL,,inpatient,,,220.6,220.6,,,,,,,,,,,,,,,,,
MPO 2000 Active w/Ambulatory A,270,RC,ITH-2213,LOCAL,,inpatient,,,789.75,789.75,,,,,,,,,,,,,,,,,
Rolyan Functional Position Han,270,RC,ITH-2248,LOCAL,,inpatient,,,85.03,85.03,,,,,,,,,,,,,,,,,
A. Rolyan Posterior Leaf Splin,270,RC,ITH-2258,LOCAL,,inpatient,,,211.1,211.1,,,,,,,,,,,,,,,,,
A. Rolyan Posterior Leaf Splin,270,RC,ITH-2260,LOCAL,,inpatient,,,211.1,211.1,,,,,,,,,,,,,,,,,
A. Rolyan Posterior Leaf Splin,270,RC,ITH-2261,LOCAL,,inpatient,,,211.1,211.1,,,,,,,,,,,,,,,,,
A. Rolyan Posterior Leaf Splin,270,RC,ITH-2263,LOCAL,,inpatient,,,211.1,211.1,,,,,,,,,,,,,,,,,
Rolyan Hinged Knee Wrap,270,RC,ITH-2264,LOCAL,,inpatient,,,480.15,480.15,,,,,,,,,,,,,,,,,
"Rolyan Hinged Knee Wrap, L, 1/",270,RC,ITH-2267,LOCAL,,inpatient,,,480.15,480.15,,,,,,,,,,,,,,,,,
"Rolyan Hinged Knee Wrap, L, 3/",270,RC,ITH-2268,LOCAL,,inpatient,,,480.15,480.15,,,,,,,,,,,,,,,,,
"B. Rolyan Ankle Foot Orthosis,",270,RC,ITH-2277,LOCAL,,inpatient,,,227,227,,,,,,,,,,,,,,,,,
"Rolyan Shoulder Immobilizer, X",270,RC,ITH-2286,LOCAL,,inpatient,,,75.3,75.3,,,,,,,,,,,,,,,,,
Rolyan Hemi Arm Slings Fits al,270,RC,ITH-2290,LOCAL,,inpatient,,,96.03,96.03,,,,,,,,,,,,,,,,,
Philadelphia Tracheotomy Colla,270,RC,ITH-2338,LOCAL,,inpatient,,,171.05,171.05,,,,,,,,,,,,,,,,,
Therapy Wrist Wrap,270,RC,ITH-2357,LOCAL,,inpatient,,,109.95,109.95,,,,,,,,,,,,,,,,,
Therapy  Wrap Cervical Collar,270,RC,ITH-2358,LOCAL,,inpatient,,,155.15,155.15,,,,,,,,,,,,,,,,,
Therapy Foot/Ankle Wrap,270,RC,ITH-2359,LOCAL,,inpatient,,,163.4,163.4,,,,,,,,,,,,,,,,,
"Therapy Lumbar Wrap, 36""-52"" W",270,RC,ITH-2362,LOCAL,,inpatient,,,249.4,249.4,,,,,,,,,,,,,,,,,
Therapy Shoulder Wrap,270,RC,ITH-2363,LOCAL,,inpatient,,,324.99,324.99,,,,,,,,,,,,,,,,,
"Sammons Preston Transfer Disc,",270,RC,ITH-2371,LOCAL,,inpatient,,,353.57,353.57,,,,,,,,,,,,,,,,,
"Adult Posture Mirrors, Triple",270,RC,ITH-2402,LOCAL,,inpatient,,,3109.77,3109.77,,,,,,,,,,,,,,,,,
"EVA Support Walkers, EVA Pneum",270,RC,ITH-2452,LOCAL,,inpatient,,,7918.29,7918.29,,,,,,,,,,,,,,,,,
EVA Support Walkers,270,RC,ITH-2453,LOCAL,,inpatient,,,5588.33,5588.33,,,,,,,,,,,,,,,,,
"EVA Support Walkers, EVA Pneum",270,RC,ITH-2454,LOCAL,,inpatient,,,8794.76,8794.76,,,,,,,,,,,,,,,,,
"EVA Support Walkers, EVA Small",270,RC,ITH-2455,LOCAL,,inpatient,,,7585.61,7585.61,,,,,,,,,,,,,,,,,
"EVA Support Walkers, EVA Pneum",270,RC,ITH-2456,LOCAL,,inpatient,,,10667.07,10667.07,,,,,,,,,,,,,,,,,
"EVA Support Walkers, Pneumatic",270,RC,ITH-2457,LOCAL,,inpatient,,,10880.42,10880.42,,,,,,,,,,,,,,,,,
Therapy Rehab Weighted Bars,270,RC,ITH-2469,LOCAL,,inpatient,,,113.3,113.3,,,,,,,,,,,,,,,,,
Rolyan Beige D-Ring Wrist Brac,270,RC,ITH-2485,LOCAL,,inpatient,,,129.5,129.5,,,,,,,,,,,,,,,,,
"Rolyan D-Ring Wrist Braces, Be",270,RC,ITH-2486,LOCAL,,inpatient,,,129.5,129.5,,,,,,,,,,,,,,,,,
Rolyan Beige D-Ring Wrist Brac,270,RC,ITH-2487,LOCAL,,inpatient,,,129.5,129.5,,,,,,,,,,,,,,,,,
"Rolyan D-Ring Wrist Braces, Be",270,RC,ITH-2488,LOCAL,,inpatient,,,129.5,129.5,,,,,,,,,,,,,,,,,
"Rolyan D-Ring Wrist Braces, Be",270,RC,ITH-2489,LOCAL,,inpatient,,,129.5,129.5,,,,,,,,,,,,,,,,,
Rolyan Beige D-Ring Wrist Brac,270,RC,ITH-2490,LOCAL,,inpatient,,,129.5,129.5,,,,,,,,,,,,,,,,,
EXTRA HEAVY THERAPY BAND - BLU,270,RC,ITH-2495,LOCAL,,inpatient,,,354.29,354.29,,,,,,,,,,,,,,,,,
SPECIAL HEAVY THERAPY BAND - B,270,RC,ITH-2496,LOCAL,,inpatient,,,603.45,603.45,,,,,,,,,,,,,,,,,
SOFT THERAPY PUTTY - ORANGE,270,RC,ITH-2499,LOCAL,,inpatient,,,273.83,273.83,,,,,,,,,,,,,,,,,
ULTRA MIST SINGLE USE APPLICAT,270,RC,IWC-0001,LOCAL,,inpatient,,,55,55,,,,,,,,,,,,,,,,,
UltraMist CloraPrep Skin Prep,270,RC,IWC-0002,LOCAL,,inpatient,,,55,55,,,,,,,,,,,,,,,,,
Pure image ultra sound gel,270,RC,IWC-0003,LOCAL,,inpatient,,,7.08,7.08,,,,,,,,,,,,,,,,,
CURAD XEROFOAM PETROLIUM 2.2,270,RC,IWC-0004,LOCAL,,inpatient,,,8.28,8.28,,,,,,,,,,,,,,,,,
CURAD COLD PACKS,270,RC,IWC-0005,LOCAL,,inpatient,,,12,12,,,,,,,,,,,,,,,,,
TAPE-MICROPORE HYPOALLERGEENIC,270,RC,IWC-0006,LOCAL,,inpatient,,,0.84,0.84,,,,,,,,,,,,,,,,,
MASKS-PERFORMA SIZE SMALL,270,RC,IWC-0007,LOCAL,,inpatient,,,157.4,157.4,,,,,,,,,,,,,,,,,
HOLLISTER FLANGE 1.75  - 1INCH,270,RC,IWC-0008,LOCAL,,inpatient,,,4.14,4.14,,,,,,,,,,,,,,,,,
HOLLISTER 2 PIECE CUT TO FIT S,270,RC,IWC-0010,LOCAL,,inpatient,,,4.14,4.14,,,,,,,,,,,,,,,,,
"DRESSING, HYDRFRA, BL, NO BORD",270,RC,IWC-0011,LOCAL,,inpatient,,,40.76,40.76,,,,,,,,,,,,,,,,,
GRAFT ST TIS 8X8CM PRMTRX AG F,270,RC,IWC-0014,LOCAL,,inpatient,,,15594.08,15594.08,,,,,,,,,,,,,,,,,
Wound VAC Dressing -LARGE,270,RC,IWC-0019,LOCAL,,inpatient,,,37.13,37.13,,,,,,,,,,,,,,,,,
CANISTER WND DRN ACTIVAC KCI G,270,RC,IWC-0022,LOCAL,,inpatient,,,15.66,15.66,,,,,,,,,,,,,,,,,
DRESSING WND 7.1X4.9IN MED VAC,270,RC,IWC-0023,LOCAL,,inpatient,,,126.6,126.6,,,,,,,,,,,,,,,,,
HOLLISTER 2 PICE CUT TO FIT BA,270,RC,IWC-0032,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
TAPE DRSG MDFX 11YDX2IN RTNT S,270,RC,IWC-0037,LOCAL,,inpatient,,,18,18,,,,,,,,,,,,,,,,,
BANDAGE TBGRP 10MR NTRL CMPR L,270,RC,IWC-0040,LOCAL,,inpatient,,,83.11,83.11,,,,,,,,,,,,,,,,,
BANDAGE TBGRP 10MR CMPR LTX RE,270,RC,IWC-0041,LOCAL,,inpatient,,,109.67,109.67,,,,,,,,,,,,,,,,,
BANDAGE TBGRP 10MR NS CMPR LTX,270,RC,IWC-0042,LOCAL,,inpatient,,,153.4,153.4,,,,,,,,,,,,,,,,,
BANDAGE TBGRP 10MR NTRL CMPR R,270,RC,IWC-0043,LOCAL,,inpatient,,,232.7,232.7,,,,,,,,,,,,,,,,,
BANDAGE TBGRP 10MR NTRL CMPR L,270,RC,IWC-0045,LOCAL,,inpatient,,,107.58,107.58,,,,,,,,,,,,,,,,,
BANDAGE 11YDX6IN MDFX GZE WTPR,270,RC,IWC-0060,LOCAL,,inpatient,,,59.35,59.35,,,,,,,,,,,,,,,,,
DRESSING WND 5X4IN MEDIHONEY C,270,RC,IWC-0071,LOCAL,,inpatient,,,47.69,47.69,,,,,,,,,,,,,,,,,
DRESSING WND MEDIHONEY TUBE AP,270,RC,IWC-0084,LOCAL,,inpatient,,,13.02,13.02,,,,,,,,,,,,,,,,,
DRESSING 6X6IN HI ABS COR ANMC,270,RC,IWC-0095,LOCAL,,inpatient,,,8.46,8.46,,,,,,,,,,,,,,,,,
CAVILON SKIN PROTECTANT,270,RC,IWC-0105,LOCAL,,inpatient,,,29.15,29.15,,,,,,,,,,,,,,,,,
BANDAGE 10YDX3IN ELAS PST UNFL,270,RC,IWC-0108,LOCAL,,inpatient,,,22.86,22.86,,,,,,,,,,,,,,,,,
DRESSING HDRCLD 25X9CM AQCL AG,270,RC,IWC-0112,LOCAL,,inpatient,,,16.08,16.08,,,,,,,,,,,,,,,,,
RESSING HDRCLD 35X9CM AQCL AG,270,RC,IWC-0113,LOCAL,,inpatient,,,17.94,17.94,,,,,,,,,,,,,,,,,
BANDAGE SPANDAGRIP 11YDX2.75IN,270,RC,IWC-0115,LOCAL,,inpatient,,,74.31,74.31,,,,,,,,,,,,,,,,,
BANDAGE SPANDAGRIP 11YDX3IN NT,270,RC,IWC-0116,LOCAL,,inpatient,,,82.12,82.12,,,,,,,,,,,,,,,,,
BANDAGE SPANDAGRIP 11YDX3.5IN,270,RC,IWC-0117,LOCAL,,inpatient,,,84.43,84.43,,,,,,,,,,,,,,,,,
BANDAGE SPANDAGRIP 11YDX4IN NT,270,RC,IWC-0118,LOCAL,,inpatient,,,105.99,105.99,,,,,,,,,,,,,,,,,
BANDAGE SPANDAGRIP 11YDX4.5IN,270,RC,IWC-0119,LOCAL,,inpatient,,,113.1,113.1,,,,,,,,,,,,,,,,,
SYSTEM CMPR THRPY 2.9YDX4IN TH,270,RC,IWC-0120,LOCAL,,inpatient,,,7.92,7.92,,,,,,,,,,,,,,,,,
DRESSING WND 4X4IN PURACOL + C,270,RC,IWC-0122,LOCAL,,inpatient,,,8.76,8.76,,,,,,,,,,,,,,,,,
TAPE DRSG MDFX 11YDX4IN RTNT S,270,RC,IWC-0123,LOCAL,,inpatient,,,29.4,29.4,,,,,,,,,,,,,,,,,
MESALT  4X4 DRESSING,270,RC,IWC-0126,LOCAL,,inpatient,,,2.1,2.1,,,,,,,,,,,,,,,,,
DRESSING STD 6X6IN ADHES ANBCT,270,RC,IWC-0130,LOCAL,,inpatient,,,7.92,7.92,,,,,,,,,,,,,,,,,
MEPILEX ADHESIVE FOAM DRESSING,270,RC,IWC-0132,LOCAL,,inpatient,,,26.52,26.52,,,,,,,,,,,,,,,,,
SILVASORB WND GEL 1.5 OZ,270,RC,IWC-0133,LOCAL,,inpatient,,,6.36,6.36,,,,,,,,,,,,,,,,,
DRESSING HDRCLD MEDIHONEY TUBE,270,RC,IWC-0138,LOCAL,,inpatient,,,5.58,5.58,,,,,,,,,,,,,,,,,
BANDAGE FOURFLEX 10YDX4IN NS C,270,RC,IWC-0147,LOCAL,,inpatient,,,6.3,6.3,,,,,,,,,,,,,,,,,
DRESSING WND 7.1X4.9IN MED VAC,270,RC,IWC-0148,LOCAL,,inpatient,,,126.6,126.6,,,,,,,,,,,,,,,,,
TAPE DRSG MDFX 11YDX2IN RTNT,270,RC,IWC-0149,LOCAL,,inpatient,,,18,18,,,,,,,,,,,,,,,,,
BANDAGE 11YDX6IN MDFX GZE,270,RC,IWC-0150,LOCAL,,inpatient,,,59.35,59.35,,,,,,,,,,,,,,,,,
DRESSING 6X6IN HI ABS COR ANMC,270,RC,IWC-0151,LOCAL,,inpatient,,,8.46,8.46,,,,,,,,,,,,,,,,,
WOUND DRESSING PURACOL/CLGN,270,RC,IWC-0152,LOCAL,,inpatient,,,8.76,8.76,,,,,,,,,,,,,,,,,
TAPE DRSG MDFX,270,RC,IWC-0153,LOCAL,,inpatient,,,29.4,29.4,,,,,,,,,,,,,,,,,
BANDAGE 3M CBN 5.1YDX4IN TAN C,270,RC,IWC-0154,LOCAL,,inpatient,,,7.92,7.92,,,,,,,,,,,,,,,,,
BANDAGE FOURFLEX,270,RC,IWC-0155,LOCAL,,inpatient,,,6.3,6.3,,,,,,,,,,,,,,,,,
BANDAGE TBGRP 10MRX7.5CM LG TU,270,RC,IWC-0156,LOCAL,,inpatient,,,42.63,42.63,,,,,,,,,,,,,,,,,
DRESSING 10X3.5IN ADHES ANMC,270,RC,IWC-0157,LOCAL,,inpatient,,,11.7,11.7,,,,,,,,,,,,,,,,,
DRESSING 7X7IN HI ABS WTPRF,270,RC,IWC-0158,LOCAL,,inpatient,,,6.48,6.48,,,,,,,,,,,,,,,,,
MWPILEX ADHESIVE FOAM DRESSING,270,RC,IWC-0159,LOCAL,,inpatient,,,1.26,1.26,,,,,,,,,,,,,,,,,
DRESSING HDRCLD 6.4X6.5IN,270,RC,IWC-0160,LOCAL,,inpatient,,,6.72,6.72,,,,,,,,,,,,,,,,,
DRESSING ALG 4X4IN MXRB X ABS,270,RC,IWC-0161,LOCAL,,inpatient,,,14.7,14.7,,,,,,,,,,,,,,,,,
DRESSING PRIM H2O SOL NIONC NS,270,RC,IWC-0162,LOCAL,,inpatient,,,22.5,22.5,,,,,,,,,,,,,,,,,
DRESSING 10X4IN SUPR ABS COR,270,RC,IWC-0163,LOCAL,,inpatient,,,13.56,13.56,,,,,,,,,,,,,,,,,
DRESSING CLGN NO WTPRF OUTR,270,RC,IWC-0164,LOCAL,,inpatient,,,10.44,10.44,,,,,,,,,,,,,,,,,
DRESSING HDRCLD 6X6IN AQCL X H,270,RC,IWC-0165,LOCAL,,inpatient,,,6.24,6.24,,,,,,,,,,,,,,,,,
DRESSING PLUROGEL H2O SOL NION,270,RC,IWC-0166,LOCAL,,inpatient,,,405,405,,,,,,,,,,,,,,,,,
DRESSING -PLUROGEL- 20G- TUBE,270,RC,IWC-0167,LOCAL,,inpatient,,,8.4,8.4,,,,,,,,,,,,,,,,,
DRESSING TUBE H2O SOL NIONC,270,RC,IWC-0168,LOCAL,,inpatient,,,245,245,,,,,,,,,,,,,,,,,
GEL DRSG MEDIHONEY TUBE,270,RC,IWC-0169,LOCAL,,inpatient,,,1.08,1.08,,,,,,,,,,,,,,,,,
OPTIFOAM GENTLE EX BORDERED,270,RC,IWC-0170,LOCAL,,inpatient,,,0.12,0.12,,,,,,,,,,,,,,,,,
CLEANSER WOUND EQUOS 8OZ SPRAY,270,RC,IWC-0171,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
OPTIFOAM GENTLE SACRUM DRESS,270,RC,IWC-0172,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
AEGIS 1 DISK 4MM HOLE,270,RC,IWC-0173,LOCAL,,inpatient,,,28.86,28.86,,,,,,,,,,,,,,,,,
OPTIFOAM AG GENTLE BORDER 4X4,270,RC,IWC-0174,LOCAL,,inpatient,,,0.06,0.06,,,,,,,,,,,,,,,,,
DRESSING 10X3.5IN ADHES ANMC P,270,RC,IWC-0175,LOCAL,,inpatient,,,11.7,11.7,,,,,,,,,,,,,,,,,
DRESSING 8X8IN WO BRDR HYDFERA,270,RC,IWC-0176,LOCAL,,inpatient,,,75.96,75.96,,,,,,,,,,,,,,,,,
BANDAGE TBGRP 10MR NTRL CMPR,270,RC,IWC-0177,LOCAL,,inpatient,,,10.26,10.26,,,,,,,,,,,,,,,,,
SOLUTION WND CLNSG VASHE,270,RC,IWC-0178,LOCAL,,inpatient,,,82.72,82.72,,,,,,,,,,,,,,,,,
# 15 Disp Scalpel Stain blade,270,RC,IWC-0180,LOCAL,,inpatient,,,11.7,11.7,,,,,,,,,,,,,,,,,
Dermal Curette 7mm Disp,270,RC,IWC-0181,LOCAL,,inpatient,,,13.08,13.08,,,,,,,,,,,,,,,,,
DRESSING 7X7IN HI ABS WTPRF LF,270,RC,IWC-0182,LOCAL,,inpatient,,,6.48,6.48,,,,,,,,,,,,,,,,,
"PASTE,HYDROPHILIC,DRESSING,WOU",270,RC,IWC-0183,LOCAL,,inpatient,,,85.14,85.14,,,,,,,,,,,,,,,,,
V.A.C. GRANUFOAM SMALL,270,RC,IWC-0184,LOCAL,,inpatient,,,841.5,841.5,,,,,,,,,,,,,,,,,
KIT UNBT CFLX DRSG CMFRT CMPR,270,RC,IWC-0188,LOCAL,,inpatient,,,6.48,6.48,,,,,,,,,,,,,,,,,
SOLUTION WND CLNSG VASHE,270,RC,IWC-0191,LOCAL,,inpatient,,,7.38,7.38,,,,,,,,,,,,,,,,,
DRESSING BIO 2X2IN ENDOFORM CL,270,RC,IWC-0194,LOCAL,,inpatient,,,6.18,6.18,,,,,,,,,,,,,,,,,
DRESSING BIO 2X2IN ENDOFORM CL,270,RC,IWC-0195,LOCAL,,inpatient,,,6.18,6.18,,,,,,,,,,,,,,,,,
DRESSING BIO 5X4IN ENDOFORM CL,270,RC,IWC-0196,LOCAL,,inpatient,,,21.54,21.54,,,,,,,,,,,,,,,,,
KIT CMPR 3.4YDX4IN CFLX TLC FO,270,RC,IWC-0197,LOCAL,,inpatient,,,7.56,7.56,,,,,,,,,,,,,,,,,
KIT CMPR 3.4YDX4IN CFLX TLC FO,270,RC,IWC-0198,LOCAL,,inpatient,,,7.56,7.56,,,,,,,,,,,,,,,,,
DRESSING HDRCLD 6.4X6.5IN EXDR,270,RC,IWC-0202,LOCAL,,inpatient,,,6.72,6.72,,,,,,,,,,,,,,,,,
DRESSING 8X8IN WO BRDR HYDFERA,270,RC,IWC-0208,LOCAL,,inpatient,,,7.92,7.92,,,,,,,,,,,,,,,,,
DRESSING GRMCDL 12.5X4.25IN PL,270,RC,IWC-0220,LOCAL,,inpatient,,,9.48,9.48,,,,,,,,,,,,,,,,,
SOLUTION WND CLNSG VASHE,270,RC,IWC-0221,LOCAL,,inpatient,,,13.2,13.2,,,,,,,,,,,,,,,,,
DRESSING WND 2.5X2.5CM HYALOMA,270,RC,IWC-0226,LOCAL,,inpatient,,,674.6,674.6,,,,,,,,,,,,,,,,,
DRESSING PRIM H2O SOL NIONC NS,270,RC,IWC-0232,LOCAL,,inpatient,,,22.5,22.5,,,,,,,,,,,,,,,,,
DRESSING 10X4IN SUPR ABS COR A,270,RC,IWC-0234,LOCAL,,inpatient,,,13.56,13.56,,,,,,,,,,,,,,,,,
DRESSING WND 10X1.5IN THERABON,270,RC,IWC-0238,LOCAL,,inpatient,,,16.92,16.92,,,,,,,,,,,,,,,,,
DRESSING CLGN NO WTPRF OUTR LY,270,RC,IWC-0247,LOCAL,,inpatient,,,10.44,10.44,,,,,,,,,,,,,,,,,
DRESSING PRIM H2O SOL NIONC BC,270,RC,IWC-0248,LOCAL,,inpatient,,,41.25,41.25,,,,,,,,,,,,,,,,,
DRESSING PLUROGEL H2O SOL NION,270,RC,IWC-0249,LOCAL,,inpatient,,,405,405,,,,,,,,,,,,,,,,,
SILICON WOUND DRESSING 4X5,270,RC,IWC-0250,LOCAL,,inpatient,,,7.92,7.92,,,,,,,,,,,,,,,,,
DRESSING -PLUROGEL- 20G- TUBE,270,RC,IWC-0251,LOCAL,,inpatient,,,8.4,8.4,,,,,,,,,,,,,,,,,
DRESSING TUBE H2O SOL NIONC BC,270,RC,IWC-0252,LOCAL,,inpatient,,,245,245,,,,,,,,,,,,,,,,,
OPTIFOAM GENTLE BORDER HEEL 9X,270,RC,IWC-0260,LOCAL,,inpatient,,,4.14,4.14,,,,,,,,,,,,,,,,,
OPTIFOAM GENTLE EX BORDERED 5X,270,RC,IWC-0261,LOCAL,,inpatient,,,0.12,0.12,,,,,,,,,,,,,,,,,
CLEANSER WOUND EQUOS 8OZ SPRAY,270,RC,IWC-0269,LOCAL,,inpatient,,,17.76,17.76,,,,,,,,,,,,,,,,,
SURGICEL ORIGINAL HEMOSTAT 2IN,270,RC,IWC-0277,LOCAL,,inpatient,,,15.24,15.24,,,,,,,,,,,,,,,,,
OPTIFOAM GENTLE EX SACRUM 7X7,270,RC,IWC-0280,LOCAL,,inpatient,,,63.69,63.69,,,,,,,,,,,,,,,,,
OPTIFOAM GENTLE EX BORDERED 4X,270,RC,IWC-0286,LOCAL,,inpatient,,,55,55,,,,,,,,,,,,,,,,,
AEGIS 1 DISK 4MM HOLE PEEL OPE,270,RC,IWC-0289,LOCAL,,inpatient,,,28.86,28.86,,,,,,,,,,,,,,,,,
OPTIFOAM AG GENTLE BORDER 4X4,270,RC,IWC-0290,LOCAL,,inpatient,,,37.95,37.95,,,,,,,,,,,,,,,,,
DOULOCK CURVED TAIL CLOSURE,270,RC,IWC-0297,LOCAL,,inpatient,,,2.64,2.64,,,,,,,,,,,,,,,,,
MAXORB II SILVER ALGINATE,270,RC,IWC-0304,LOCAL,,inpatient,,,28.16,28.16,,,,,,,,,,,,,,,,,
OPTICELL AG,270,RC,IWC-0305,LOCAL,,inpatient,,,31.85,31.85,,,,,,,,,,,,,,,,,
V.A.C. LARGE DRESSING,270,RC,IWC-0306,LOCAL,,inpatient,,,643.14,643.14,,,,,,,,,,,,,,,,,
"ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck with major O.R. procedures",3,MS-DRG,3,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,310277.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck without major O.R. procedures",4,MS-DRG,4,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,229767.96,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCC",11,MS-DRG,11,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CC",12,MS-DRG,12,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy without CC/MCC",13,MS-DRG,13,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Chimeric antigen receptor (CAR) T-cell and other immunotherapies,18,MS-DRG,18,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with MCC,20,MS-DRG,20,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with CC,21,MS-DRG,21,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage without CC/MCC,22,MS-DRG,22,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC or chemotherapy implant or epilepsy with neurostimulator,23,MS-DRG,23,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis without MCC,24,MS-DRG,24,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Craniotomy and endovascular intracranial procedures with MCC,25,MS-DRG,25,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Craniotomy and endovascular intracranial procedures with CC,26,MS-DRG,26,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Craniotomy and endovascular intracranial procedures without CC/MCC,27,MS-DRG,27,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Spinal procedures with MCC,28,MS-DRG,28,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Spinal procedures with CC or spinal neurostimulators,29,MS-DRG,29,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Spinal procedures without CC/MCC,30,MS-DRG,30,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Ventricular shunt procedures with MCC,31,MS-DRG,31,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Ventricular shunt procedures with CC,32,MS-DRG,32,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Ventricular shunt procedures without CC/MCC,33,MS-DRG,33,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Carotid artery stent procedures with MCC,34,MS-DRG,34,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Carotid artery stent procedures with CC,35,MS-DRG,35,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Carotid artery stent procedures without CC/MCC,36,MS-DRG,36,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Extracranial procedures with MCC,37,MS-DRG,37,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Extracranial procedures with CC,38,MS-DRG,38,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Extracranial procedures without CC/MCC,39,MS-DRG,39,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with MCC",40,MS-DRG,40,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,95774.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurostimulator",41,MS-DRG,41,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures without CC/MCC",42,MS-DRG,42,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Spinal disorders and injuries with CC/MCC,52,MS-DRG,52,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,82942.79,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Spinal disorders and injuries without CC/MCC,53,MS-DRG,53,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,81228.84,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Nervous system neoplasms with MCC,54,MS-DRG,54,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Nervous system neoplasms without MCC,55,MS-DRG,55,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Degenerative nervous system disorders with MCC,56,MS-DRG,56,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,61411.33,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Degenerative nervous system disorders without MCC,57,MS-DRG,57,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,51678.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Multiple sclerosis and cerebellar ataxia with MCC,58,MS-DRG,58,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Multiple sclerosis and cerebellar ataxia with CC,59,MS-DRG,59,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,51678.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Multiple sclerosis and cerebellar ataxia without CC/MCC,60,MS-DRG,60,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,51678.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with MCC",61,MS-DRG,61,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,111192.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with CC",62,MS-DRG,62,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent without CC/MCC",63,MS-DRG,63,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Intracranial hemorrhage or cerebral infarction with MCC,64,MS-DRG,64,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,111192.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Intracranial hemorrhage or cerebral infarction with CC or tPA in 24 hours,65,MS-DRG,65,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Intracranial hemorrhage or cerebral infarction without CC/MCC,66,MS-DRG,66,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Nonspecific CVA and precerebral occlusion without infarction with MCC,67,MS-DRG,67,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,66767.42,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Nonspecific CVA and precerebral occlusion without infarction without MCC,68,MS-DRG,68,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Transient ischemia without thrombolytic,69,MS-DRG,69,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Nonspecific cerebrovascular disorders with MCC*,70,MS-DRG,70,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,66767.42,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Nonspecific cerebrovascular disorders with CC*,71,MS-DRG,71,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,45128.84,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Nonspecific cerebrovascular disorders without CC/MCC*,72,MS-DRG,72,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cranial and peripheral nerve disorders with MCC,73,MS-DRG,73,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cranial and peripheral nerve disorders without MCC,74,MS-DRG,74,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Viral meningitis with CC/MCC,75,MS-DRG,75,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Viral meningitis without CC/MCC,76,MS-DRG,76,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hypertensive encephalopathy with MCC,77,MS-DRG,77,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,68160,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hypertensive encephalopathy with CC,78,MS-DRG,78,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,537909.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hypertensive encephalopathy without CC/MCC,79,MS-DRG,79,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Nontraumatic stupor and coma with MCC,80,MS-DRG,80,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Nontraumatic stupor and coma without MCC,81,MS-DRG,81,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Traumatic stupor and coma >1 hour with MCC*,82,MS-DRG,82,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,82529.13,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Traumatic stupor and coma >1 hour with CC*,83,MS-DRG,83,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,62451.46,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Traumatic stupor and coma >1 hour without CC/MCC*,84,MS-DRG,84,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Traumatic stupor and coma <1 hour with MCC,85,MS-DRG,85,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,62451.46,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Traumatic stupor and coma <1 hour with CC,86,MS-DRG,86,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,62451.46,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Traumatic stupor and coma <1 hour without CC/MCC,87,MS-DRG,87,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Concussion with MCC,88,MS-DRG,88,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,68160,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Concussion with CC,89,MS-DRG,89,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,537909.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Concussion without CC/MCC,90,MS-DRG,90,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other disorders of nervous system with MCC,91,MS-DRG,91,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,68160,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other disorders of nervous system with CC,92,MS-DRG,92,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,537909.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other disorders of nervous system without CC/MCC,93,MS-DRG,93,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,51678.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Bacterial and tuberculous infections of nervous system with MCC*,94,MS-DRG,94,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34375.739,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Bacterial and tuberculous infections of nervous system with CC*,95,MS-DRG,95,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,62451.46,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Bacterial and tuberculous infections of nervous system without CC/MCC*,96,MS-DRG,96,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Non-bacterial infection of nervous system except viral meningitis with MCC,97,MS-DRG,97,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,75054.04,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Non-bacterial infection of nervous system except viral meningitis with CC,98,MS-DRG,98,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Non-bacterial infection of nervous system except viral meningitis without CC/MCC,99,MS-DRG,99,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Seizures with MCC,100,MS-DRG,100,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Seizures without MCC,101,MS-DRG,101,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Headaches with MCC,102,MS-DRG,102,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Headaches without MCC,103,MS-DRG,103,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Orbital procedures with CC/MCC,113,MS-DRG,113,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Orbital procedures without CC/MCC,114,MS-DRG,114,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Extraocular procedures except orbit,115,MS-DRG,115,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Intraocular procedures with CC/MCC,116,MS-DRG,116,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Intraocular procedures without CC/MCC,117,MS-DRG,117,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Acute major eye infections with CC/MCC,121,MS-DRG,121,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Acute major eye infections without CC/MCC,122,MS-DRG,122,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Neurological eye disorders,123,MS-DRG,123,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other disorders of the eye with MCC or thrombolytic agent,124,MS-DRG,124,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other disorders of the eye without MCC,125,MS-DRG,125,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Sinus and mastoid procedures with CC/MCC,135,MS-DRG,135,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Sinus and mastoid procedures without CC/MCC,136,MS-DRG,136,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Mouth procedures with CC/MCC,137,MS-DRG,137,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Mouth procedures without CC/MCC,138,MS-DRG,138,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Salivary gland procedures,139,MS-DRG,139,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major head and neck procedures with MCC,140,MS-DRG,140,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,177508.29,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major head and neck procedures with CC,141,MS-DRG,141,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major head and neck procedures without CC/MCC,142,MS-DRG,142,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with MCC",143,MS-DRG,143,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with CC",144,MS-DRG,144,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures without CC/MCC",145,MS-DRG,145,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Ear, nose, mouth and throat malignancy with MCC*",146,MS-DRG,146,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Ear, nose, mouth and throat malignancy with CC*",147,MS-DRG,147,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Ear, nose, mouth and throat malignancy without CC/MCC*",148,MS-DRG,148,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Dysequilibrium,149,MS-DRG,149,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Epistaxis with MCC,150,MS-DRG,150,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Epistaxis without MCC,151,MS-DRG,151,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Otitis media and URI with MCC,152,MS-DRG,152,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Otitis media and URI without MCC,153,MS-DRG,153,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Other ear, nose, mouth and throat diagnoses with MCC",154,MS-DRG,154,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Other ear, nose, mouth and throat diagnoses with CC",155,MS-DRG,155,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Other ear, nose, mouth and throat diagnoses without CC/MCC",156,MS-DRG,156,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Dental and oral diseases with MCC,157,MS-DRG,157,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Dental and oral diseases with CC,158,MS-DRG,158,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Dental and oral diseases without CC/MCC,159,MS-DRG,159,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major chest procedures with MCC,163,MS-DRG,163,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,202666.58,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major chest procedures with CC,164,MS-DRG,164,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,202666.58,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major chest procedures without CC/MCC,165,MS-DRG,165,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,202666.58,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other respiratory system O.R. procedures with MCC,166,MS-DRG,166,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,177508.29,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other respiratory system O.R. procedures with CC,167,MS-DRG,167,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other respiratory system O.R. procedures without CC/MCC,168,MS-DRG,168,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism,173,MS-DRG,173,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Pulmonary embolism with MCC or acute cor pulmonale,175,MS-DRG,175,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Pulmonary embolism without MCC,176,MS-DRG,176,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory infections and inflammations with MCC*,177,MS-DRG,177,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,62918.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory infections and inflammations with CC*,178,MS-DRG,178,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,43491.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory infections and inflammations without CC/MCC*,179,MS-DRG,179,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,42251.85,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory neoplasms with MCC*,180,MS-DRG,180,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory neoplasms with CC*,181,MS-DRG,181,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory neoplasms without CC/MCC*,182,MS-DRG,182,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major chest trauma with MCC,183,MS-DRG,183,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major chest trauma with CC,184,MS-DRG,184,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major chest trauma without CC/MCC,185,MS-DRG,185,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Pleural effusion with MCC*,186,MS-DRG,186,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,66071.13,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Pleural effusion with CC*,187,MS-DRG,187,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Pleural effusion without CC/MCC*,188,MS-DRG,188,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Pulmonary edema and respiratory failure,189,MS-DRG,189,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72046.99,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Chronic obstructive pulmonary disease with MCC*,190,MS-DRG,190,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,20971.383,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Chronic obstructive pulmonary disease with CC*,191,MS-DRG,191,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Chronic obstructive pulmonary disease without CC/MCC*,192,MS-DRG,192,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Simple pneumonia and pleurisy with MCC,193,MS-DRG,193,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,59421.93,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Simple pneumonia and pleurisy with CC,194,MS-DRG,194,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,39604.42,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Simple pneumonia and pleurisy without CC/MCC,195,MS-DRG,195,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Interstitial lung disease with MCC*,196,MS-DRG,196,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Interstitial lung disease with CC*,197,MS-DRG,197,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Interstitial lung disease without CC/MCC*,198,MS-DRG,198,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Pneumothorax with MCC,199,MS-DRG,199,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Pneumothorax with CC,200,MS-DRG,200,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,21869.927,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Pneumothorax without CC/MCC,201,MS-DRG,201,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,21869.927,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Bronchitis and asthma with CC/MCC,202,MS-DRG,202,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,40508.305,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Bronchitis and asthma without CC/MCC,203,MS-DRG,203,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,15339.435,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory signs and symptoms,204,MS-DRG,204,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other respiratory system diagnoses with MCC,205,MS-DRG,205,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,112102.84,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other respiratory system diagnoses without MCC,206,MS-DRG,206,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory system diagnosis with ventilator support >96 hours,207,MS-DRG,207,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,147720.8,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory system diagnosis with ventilator support <=96 hours,208,MS-DRG,208,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,81481.35,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Concomitant aortic and mitral valve procedures,212,MS-DRG,212,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other heart assist system implant,215,MS-DRG,215,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC,216,MS-DRG,216,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with CC,217,MS-DRG,217,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization without CC/MCC,218,MS-DRG,218,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with MCC,219,MS-DRG,219,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with CC,220,MS-DRG,220,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization without CC/MCC,221,MS-DRG,221,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other cardiothoracic procedures with MCC,228,MS-DRG,228,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other cardiothoracic procedures without MCC,229,MS-DRG,229,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Coronary bypass with PTCA with MCC,231,MS-DRG,231,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Coronary bypass with PTCA without MCC,232,MS-DRG,232,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Coronary bypass with cardiac catheterization or open ablation with MCC,233,MS-DRG,233,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Coronary bypass with cardiac catheterization or open ablation without MCC,234,MS-DRG,234,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Coronary bypass without cardiac catheterization with MCC,235,MS-DRG,235,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Coronary bypass without cardiac catheterization without MCC,236,MS-DRG,236,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Amputation for circulatory system disorders except upper limb and toe with MCC,239,MS-DRG,239,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Amputation for circulatory system disorders except upper limb and toe with CC,240,MS-DRG,240,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Amputation for circulatory system disorders except upper limb and toe without CC/MCC,241,MS-DRG,241,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Permanent cardiac pacemaker implant with MCC,242,MS-DRG,242,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Permanent cardiac pacemaker implant with CC,243,MS-DRG,243,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Permanent cardiac pacemaker implant without CC/MCC,244,MS-DRG,244,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
AICD generator procedures,245,MS-DRG,245,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,40774.659,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Percutaneous cardiovascular procedures without intraluminal device with MCC,250,MS-DRG,250,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Percutaneous cardiovascular procedures without intraluminal device without MCC,251,MS-DRG,251,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other vascular procedures with MCC,252,MS-DRG,252,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other vascular procedures with CC,253,MS-DRG,253,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other vascular procedures without CC/MCC,254,MS-DRG,254,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Upper limb and toe amputation for circulatory system disorders with MCC,255,MS-DRG,255,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Upper limb and toe amputation for circulatory system disorders with CC,256,MS-DRG,256,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Upper limb and toe amputation for circulatory system disorders without CC/MCC,257,MS-DRG,257,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac pacemaker device replacement with MCC,258,MS-DRG,258,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac pacemaker device replacement without MCC,259,MS-DRG,259,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac pacemaker revision except device replacement with MCC,260,MS-DRG,260,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac pacemaker revision except device replacement with CC,261,MS-DRG,261,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac pacemaker revision except device replacement without CC/MCC,262,MS-DRG,262,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Vein ligation and stripping,263,MS-DRG,263,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other circulatory system O.R. procedures,264,MS-DRG,264,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
AICD lead procedures,265,MS-DRG,265,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Endovascular cardiac valve replacement and supplement procedures with MCC,266,MS-DRG,266,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Endovascular cardiac valve replacement and supplement procedures without MCC,267,MS-DRG,267,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Aortic and heart assist procedures except pulsation balloon with MCC,268,MS-DRG,268,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Aortic and heart assist procedures except pulsation balloon without MCC,269,MS-DRG,269,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other major cardiovascular procedures with MCC,270,MS-DRG,270,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other major cardiovascular procedures with CC,271,MS-DRG,271,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other major cardiovascular procedures without CC/MCC,272,MS-DRG,272,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Percutaneous and other intracardiac procedures with MCC,273,MS-DRG,273,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Percutaneous and other intracardiac procedures without MCC,274,MS-DRG,274,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac defibrillator implant with cardiac catheterization and MCC,275,MS-DRG,275,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac defibrillator implant with MCC or carotid sinus neurostimulator,276,MS-DRG,276,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac defibrillator implant without MCC,277,MS-DRG,277,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures with MCC,278,MS-DRG,278,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures without MCC,279,MS-DRG,279,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Acute myocardial infarction, discharged alive with MCC",280,MS-DRG,280,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,63798.62,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Acute myocardial infarction, discharged alive with CC",281,MS-DRG,281,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Acute myocardial infarction, discharged alive without CC/MCC",282,MS-DRG,282,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Acute myocardial infarction, expired with MCC",283,MS-DRG,283,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Acute myocardial infarction, expired with CC",284,MS-DRG,284,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Acute myocardial infarction, expired without CC/MCC",285,MS-DRG,285,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization with MCC",286,MS-DRG,286,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization without MCC",287,MS-DRG,287,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Acute and subacute endocarditis with MCC,288,MS-DRG,288,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,79476.64,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Acute and subacute endocarditis with CC,289,MS-DRG,289,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,54456.07,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Acute and subacute endocarditis without CC/MCC,290,MS-DRG,290,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48748.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Heart failure and shock with MCC,291,MS-DRG,291,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,59345.41,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Heart failure and shock with CC,292,MS-DRG,292,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,42060.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Heart failure and shock without CC/MCC,293,MS-DRG,293,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,42060.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Deep vein thrombophlebitis with CC/MCC,294,MS-DRG,294,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Deep vein thrombophlebitis without CC/MCC,295,MS-DRG,295,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Cardiac arrest, unexplained with MCC",296,MS-DRG,296,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,59345.41,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Cardiac arrest, unexplained with CC",297,MS-DRG,297,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,42060.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Cardiac arrest, unexplained without CC/MCC",298,MS-DRG,298,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,42060.56,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Peripheral vascular disorders with MCC,299,MS-DRG,299,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,64808.62,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Peripheral vascular disorders with CC,300,MS-DRG,300,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Peripheral vascular disorders without CC/MCC,301,MS-DRG,301,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Atherosclerosis with MCC,302,MS-DRG,302,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Atherosclerosis without MCC,303,MS-DRG,303,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hypertension with MCC,304,MS-DRG,304,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hypertension without MCC,305,MS-DRG,305,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac congenital and valvular disorders with MCC,306,MS-DRG,306,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac congenital and valvular disorders without MCC,307,MS-DRG,307,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac arrhythmia and conduction disorders with MCC,308,MS-DRG,308,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac arrhythmia and conduction disorders with CC,309,MS-DRG,309,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac arrhythmia and conduction disorders without CC/MCC,310,MS-DRG,310,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Angina pectoris,311,MS-DRG,311,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Syncope and collapse,312,MS-DRG,312,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Chest pain,313,MS-DRG,313,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other circulatory system diagnoses with MCC,314,MS-DRG,314,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,67570.83,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other circulatory system diagnoses with CC,315,MS-DRG,315,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,47562.03,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other circulatory system diagnoses without CC/MCC,316,MS-DRG,316,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Concomitant left atrial appendage closure and cardiac ablation,317,MS-DRG,317,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other endovascular cardiac valve procedures with MCC,319,MS-DRG,319,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other endovascular cardiac valve procedures without MCC,320,MS-DRG,320,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/intraluminal devices,321,MS-DRG,321,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Percutaneous cardiovascular procedures with intraluminal device without MCC,322,MS-DRG,322,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Coronary intravascular lithotripsy with intraluminal device with MCC,323,MS-DRG,323,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Coronary intravascular lithotripsy with intraluminal device without MCC,324,MS-DRG,324,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Coronary intravascular lithotripsy without intraluminal device,325,MS-DRG,325,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Stomach, esophageal and duodenal procedures with MCC",326,MS-DRG,326,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Stomach, esophageal and duodenal procedures with CC",327,MS-DRG,327,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Stomach, esophageal and duodenal procedures without CC/MCC",328,MS-DRG,328,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major small and large bowel procedures with MCC,329,MS-DRG,329,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major small and large bowel procedures with CC,330,MS-DRG,330,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major small and large bowel procedures without CC/MCC,331,MS-DRG,331,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Rectal resection with MCC,332,MS-DRG,332,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Rectal resection with CC,333,MS-DRG,333,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Rectal resection without CC/MCC,334,MS-DRG,334,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Peritoneal adhesiolysis with MCC,335,MS-DRG,335,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Peritoneal adhesiolysis with CC,336,MS-DRG,336,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Peritoneal adhesiolysis without CC/MCC,337,MS-DRG,337,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Minor small and large bowel procedures with MCC,344,MS-DRG,344,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Minor small and large bowel procedures with CC,345,MS-DRG,345,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Minor small and large bowel procedures without CC/MCC,346,MS-DRG,346,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Anal and stomal procedures with MCC,347,MS-DRG,347,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,68366.59,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Anal and stomal procedures with CC,348,MS-DRG,348,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Anal and stomal procedures without CC/MCC,349,MS-DRG,349,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Inguinal and femoral hernia procedures with MCC,350,MS-DRG,350,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,68366.59,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Inguinal and femoral hernia procedures with CC,351,MS-DRG,351,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Inguinal and femoral hernia procedures without CC/MCC,352,MS-DRG,352,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hernia procedures except inguinal and femoral with MCC,353,MS-DRG,353,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hernia procedures except inguinal and femoral with CC,354,MS-DRG,354,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hernia procedures except inguinal and femoral without CC/MCC,355,MS-DRG,355,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other digestive system O.R. procedures with MCC,356,MS-DRG,356,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,106800.32,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other digestive system O.R. procedures with CC,357,MS-DRG,357,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other digestive system O.R. procedures without CC/MCC,358,MS-DRG,358,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major esophageal disorders with MCC*,368,MS-DRG,368,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major esophageal disorders with CC*,369,MS-DRG,369,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major esophageal disorders without CC/MCC*,370,MS-DRG,370,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major gastrointestinal disorders and peritoneal infections with MCC,371,MS-DRG,371,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,68366.59,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major gastrointestinal disorders and peritoneal infections with CC,372,MS-DRG,372,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major gastrointestinal disorders and peritoneal infections without CC/MCC,373,MS-DRG,373,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Digestive malignancy with MCC*,374,MS-DRG,374,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Digestive malignancy with CC*,375,MS-DRG,375,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Digestive malignancy without CC/MCC*,376,MS-DRG,376,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Gastrointestinal hemorrhage with MCC,377,MS-DRG,377,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,54425.47,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Gastrointestinal hemorrhage with CC,378,MS-DRG,378,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Gastrointestinal hemorrhage without CC/MCC,379,MS-DRG,379,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Complicated peptic ulcer with MCC,380,MS-DRG,380,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,73278.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Complicated peptic ulcer with CC,381,MS-DRG,381,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Complicated peptic ulcer without CC/MCC,382,MS-DRG,382,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Uncomplicated peptic ulcer with MCC,383,MS-DRG,383,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Uncomplicated peptic ulcer without MCC,384,MS-DRG,384,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Inflammatory bowel disease with MCC,385,MS-DRG,385,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Inflammatory bowel disease with CC,386,MS-DRG,386,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Inflammatory bowel disease without CC/MCC,387,MS-DRG,387,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Gastrointestinal obstruction with MCC,388,MS-DRG,388,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,75604.95,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Gastrointestinal obstruction with CC,389,MS-DRG,389,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Gastrointestinal obstruction without CC/MCC,390,MS-DRG,390,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC",391,MS-DRG,391,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,59253.6,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC",392,MS-DRG,392,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,47929.3,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other digestive system diagnoses with MCC,393,MS-DRG,393,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,77739.74,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other digestive system diagnoses with CC,394,MS-DRG,394,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other digestive system diagnoses without CC/MCC,395,MS-DRG,395,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Appendix procedures with MCC,397,MS-DRG,397,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,68366.59,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Appendix procedures with CC,398,MS-DRG,398,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Appendix procedures without CC/MCC,399,MS-DRG,399,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Single level combined anterior and posterior spinal fusion except cervical,402,MS-DRG,402,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Pancreas, liver and shunt procedures with MCC",405,MS-DRG,405,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,40508.305,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Pancreas, liver and shunt procedures with CC",406,MS-DRG,406,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Pancreas, liver and shunt procedures without CC/MCC",407,MS-DRG,407,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with MCC,408,MS-DRG,408,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with CC,409,MS-DRG,409,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. without CC/MCC,410,MS-DRG,410,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cholecystectomy with C.D.E. with MCC,411,MS-DRG,411,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,73278.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cholecystectomy with C.D.E. with CC,412,MS-DRG,412,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cholecystectomy with C.D.E. without CC/MCC,413,MS-DRG,413,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with MCC,414,MS-DRG,414,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,73278.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with CC,415,MS-DRG,415,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. without CC/MCC,416,MS-DRG,416,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Laparoscopic cholecystectomy without C.D.E. with MCC,417,MS-DRG,417,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,73278.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Laparoscopic cholecystectomy without C.D.E. with CC,418,MS-DRG,418,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Laparoscopic cholecystectomy without C.D.E. without CC/MCC,419,MS-DRG,419,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hepatobiliary diagnostic procedures with MCC,420,MS-DRG,420,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hepatobiliary diagnostic procedures with CC,421,MS-DRG,421,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hepatobiliary diagnostic procedures without CC/MCC,422,MS-DRG,422,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other hepatobiliary or pancreas O.R. procedures with MCC,423,MS-DRG,423,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other hepatobiliary or pancreas O.R. procedures with CC,424,MS-DRG,424,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other hepatobiliary or pancreas O.R. procedures without CC/MCC,425,MS-DRG,425,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,426,MS-DRG,426,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,81343.62,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical with CC,427,MS-DRG,427,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,81343.62,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical without CC/MCC,428,MS-DRG,428,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,67111.73,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Combined anterior and posterior cervical spinal fusion with MCC,429,MS-DRG,429,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,81343.62,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Combined anterior and posterior cervical spinal fusion without MCC,430,MS-DRG,430,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cirrhosis and alcoholic hepatitis with MCC,432,MS-DRG,432,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,56468.43,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cirrhosis and alcoholic hepatitis with CC,433,MS-DRG,433,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cirrhosis and alcoholic hepatitis without CC/MCC,434,MS-DRG,434,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Malignancy of hepatobiliary system or pancreas with MCC,435,MS-DRG,435,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Malignancy of hepatobiliary system or pancreas with CC,436,MS-DRG,436,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Malignancy of hepatobiliary system or pancreas without CC/MCC,437,MS-DRG,437,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Disorders of pancreas except malignancy with MCC,438,MS-DRG,438,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,80165.28,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Disorders of pancreas except malignancy with CC,439,MS-DRG,439,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Disorders of pancreas except malignancy without CC/MCC,440,MS-DRG,440,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCC",441,MS-DRG,441,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,71243.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CC",442,MS-DRG,442,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without CC/MCC",443,MS-DRG,443,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Disorders of the biliary tract with MCC*,444,MS-DRG,444,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,58190.03,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Disorders of the biliary tract with CC*,445,MS-DRG,445,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53147.66,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Disorders of the biliary tract without CC/MCC*,446,MS-DRG,446,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,447,MS-DRG,447,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,1.0631,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Multiple level spinal fusion except cervical without MCC,448,MS-DRG,448,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,1.0631,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,450,MS-DRG,450,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,67111.74,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Single Level Spinal Fusion Except Cervical without MCC,451,MS-DRG,451,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with MCC",456,MS-DRG,456,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with CC",457,MS-DRG,457,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions without CC/MCC",458,MS-DRG,458,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Bilateral or multiple major joint procedures of lower extremity with MCC,461,MS-DRG,461,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,67111.74,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Bilateral or multiple major joint procedures of lower extremity without MCC,462,MS-DRG,462,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with MCC*,463,MS-DRG,463,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with CC*,464,MS-DRG,464,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72972.82,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders without CC/MCC*,465,MS-DRG,465,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,70057.58,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Revision of hip or knee replacement with MCC,466,MS-DRG,466,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Revision of hip or knee replacement with CC,467,MS-DRG,467,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Revision of hip or knee replacement without CC/MCC,468,MS-DRG,468,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity with MCC or total ankle replacement,469,MS-DRG,469,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity without MCC,470,MS-DRG,470,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cervical spinal fusion with MCC,471,MS-DRG,471,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cervical spinal fusion with CC,472,MS-DRG,472,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cervical spinal fusion without CC/MCC,473,MS-DRG,473,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with MCC,474,MS-DRG,474,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with CC,475,MS-DRG,475,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders without CC/MCC,476,MS-DRG,476,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Biopsies of musculoskeletal system and connective tissue with MCC,477,MS-DRG,477,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Biopsies of musculoskeletal system and connective tissue with CC,478,MS-DRG,478,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,28146.902,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Biopsies of musculoskeletal system and connective tissue without CC/MCC,479,MS-DRG,479,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,28146.902,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hip and femur procedures except major joint with MCC,480,MS-DRG,480,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hip and femur procedures except major joint with CC,481,MS-DRG,481,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hip and femur procedures except major joint without CC/MCC,482,MS-DRG,482,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major joint or limb reattachment procedures of upper extremities,483,MS-DRG,483,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Knee procedures with principal diagnosis of infection with MCC,485,MS-DRG,485,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Knee procedures with principal diagnosis of infection with CC,486,MS-DRG,486,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Knee procedures with principal diagnosis of infection without CC/MCC,487,MS-DRG,487,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Knee procedures without principal diagnosis of infection with CC/MCC,488,MS-DRG,488,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Knee procedures without principal diagnosis of infection without CC/MCC,489,MS-DRG,489,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,51693.87,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with MCC",492,MS-DRG,492,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with CC",493,MS-DRG,493,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur without CC/MCC",494,MS-DRG,494,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Local excision and removal of internal fixation devices except hip and femur with MCC,495,MS-DRG,495,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Local excision and removal of internal fixation devices except hip and femur with CC,496,MS-DRG,496,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Local excision and removal of internal fixation devices except hip and femur without CC/MCC,497,MS-DRG,497,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Local excision and removal of internal fixation devices of hip and femur with CC/MCC,498,MS-DRG,498,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Local excision and removal of internal fixation devices of hip and femur without CC/MCC,499,MS-DRG,499,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Soft tissue procedures with MCC,500,MS-DRG,500,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,94244.13,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Soft tissue procedures with CC,501,MS-DRG,501,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Soft tissue procedures without CC/MCC,502,MS-DRG,502,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,67111.74,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Foot procedures with MCC,503,MS-DRG,503,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Foot procedures with CC,504,MS-DRG,504,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Foot procedures without CC/MCC,505,MS-DRG,505,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major thumb or joint procedures,506,MS-DRG,506,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major shoulder or elbow joint procedures with CC/MCC,507,MS-DRG,507,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major shoulder or elbow joint procedures without CC/MCC,508,MS-DRG,508,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Arthroscopy,509,MS-DRG,509,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with MCC",510,MS-DRG,510,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with CC",511,MS-DRG,511,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures without CC/MCC",512,MS-DRG,512,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures with CC/MCC",513,MS-DRG,513,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures without CC/MCC",514,MS-DRG,514,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with MCC,515,MS-DRG,515,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,91742.07,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with CC,516,MS-DRG,516,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures without CC/MCC,517,MS-DRG,517,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Back and neck procedures except spinal fusion with MCC or disc device or neurostimulator,518,MS-DRG,518,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Back and neck procedures except spinal fusion with CC,519,MS-DRG,519,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Back and neck procedures except spinal fusion without CC/MCC,520,MS-DRG,520,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hip replacement with principal diagnosis of hip fracture with MCC,521,MS-DRG,521,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hip replacement with principal diagnosis of hip fracture without MCC,522,MS-DRG,522,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Fractures of femur with MCC,533,MS-DRG,533,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Fractures of femur without MCC,534,MS-DRG,534,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Fractures of hip and pelvis with MCC,535,MS-DRG,535,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Fractures of hip and pelvis without MCC,536,MS-DRG,536,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh with CC/MCC",537,MS-DRG,537,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh without CC/MCC",538,MS-DRG,538,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Osteomyelitis with MCC*,539,MS-DRG,539,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,74166.46,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Osteomyelitis with CC*,540,MS-DRG,540,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,54425.47,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Osteomyelitis without CC/MCC*,541,MS-DRG,541,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,51693.86,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with MCC*,542,MS-DRG,542,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with CC*,543,MS-DRG,543,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy without CC/MCC*,544,MS-DRG,544,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Connective tissue disorders with MCC,545,MS-DRG,545,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Connective tissue disorders with CC,546,MS-DRG,546,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Connective tissue disorders without CC/MCC,547,MS-DRG,547,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46988.16,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Septic arthritis with MCC,548,MS-DRG,548,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,65145.29,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Septic arthritis with CC,549,MS-DRG,549,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Septic arthritis without CC/MCC,550,MS-DRG,550,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Medical back problems with MCC,551,MS-DRG,551,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,99921.58,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Medical back problems without MCC,552,MS-DRG,552,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Bone diseases and arthropathies with MCC,553,MS-DRG,553,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Bone diseases and arthropathies without MCC,554,MS-DRG,554,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue with MCC,555,MS-DRG,555,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue without MCC,556,MS-DRG,556,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Tendonitis, myositis and bursitis with MCC",557,MS-DRG,557,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,69284.76,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Tendonitis, myositis and bursitis without MCC",558,MS-DRG,558,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53645.01,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Aftercare, musculoskeletal system and connective tissue with MCC*",559,MS-DRG,559,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,61671.48,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Aftercare, musculoskeletal system and connective tissue with CC*",560,MS-DRG,560,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48082.33,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Aftercare, musculoskeletal system and connective tissue without CC/MCC*",561,MS-DRG,561,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46988.16,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCC",562,MS-DRG,562,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCC",563,MS-DRG,563,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46988.16,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other musculoskeletal system and connective tissue diagnoses with MCC,564,MS-DRG,564,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,67111.74,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other musculoskeletal system and connective tissue diagnoses with CC,565,MS-DRG,565,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other musculoskeletal system and connective tissue diagnoses without CC/MCC,566,MS-DRG,566,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Skin debridement with MCC*,570,MS-DRG,570,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,90081.68,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Skin debridement with CC*,571,MS-DRG,571,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,65336.58,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Skin debridement without CC/MCC*,572,MS-DRG,572,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,65336.58,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Skin graft for skin ulcer or cellulitis with MCC,573,MS-DRG,573,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,106394.79,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Skin graft for skin ulcer or cellulitis with CC,574,MS-DRG,574,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Skin graft for skin ulcer or cellulitis without CC/MCC,575,MS-DRG,575,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Skin graft except for skin ulcer or cellulitis with MCC*,576,MS-DRG,576,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Skin graft except for skin ulcer or cellulitis with CC*,577,MS-DRG,577,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Skin graft except for skin ulcer or cellulitis without CC/MCC*,578,MS-DRG,578,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Other skin, subcutaneous tissue and breast procedures with MCC",579,MS-DRG,579,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,103793.26,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Other skin, subcutaneous tissue and breast procedures with CC",580,MS-DRG,580,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,85299.47,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Other skin, subcutaneous tissue and breast procedures without CC/MCC",581,MS-DRG,581,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,85299.47,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Mastectomy for malignancy with CC/MCC,582,MS-DRG,582,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,103793.26,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Mastectomy for malignancy without CC/MCC,583,MS-DRG,583,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,85299.47,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Breast biopsy, local excision and other breast procedures with CC/MCC",584,MS-DRG,584,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,65336.58,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Breast biopsy, local excision and other breast procedures without CC/MCC",585,MS-DRG,585,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Skin ulcers with MCC,592,MS-DRG,592,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,67333.63,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Skin ulcers with CC,593,MS-DRG,593,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53667.96,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Skin ulcers without CC/MCC,594,MS-DRG,594,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major skin disorders with MCC,595,MS-DRG,595,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major skin disorders without MCC,596,MS-DRG,596,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Malignant breast disorders with MCC,597,MS-DRG,597,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Malignant breast disorders with CC,598,MS-DRG,598,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Malignant breast disorders without CC/MCC,599,MS-DRG,599,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Non-malignant breast disorders with CC/MCC*,600,MS-DRG,600,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Non-malignant breast disorders without CC/MCC*,601,MS-DRG,601,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cellulitis with MCC,602,MS-DRG,602,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,55068.2,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cellulitis without MCC,603,MS-DRG,603,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36842.21,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Trauma to the skin, subcutaneous tissue and breast with MCC",604,MS-DRG,604,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Trauma to the skin, subcutaneous tissue and breast without MCC",605,MS-DRG,605,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Minor skin disorders with MCC,606,MS-DRG,606,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Minor skin disorders without MCC,607,MS-DRG,607,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Adrenal and pituitary procedures with CC/MCC,614,MS-DRG,614,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Adrenal and pituitary procedures without CC/MCC,615,MS-DRG,615,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with MCC",616,MS-DRG,616,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with CC",617,MS-DRG,617,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders without CC/MCC",618,MS-DRG,618,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
O.R. procedures for obesity with MCC,619,MS-DRG,619,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,100051.65,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
O.R. procedures for obesity with CC,620,MS-DRG,620,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72590.25,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
O.R. procedures for obesity without CC/MCC,621,MS-DRG,621,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with MCC",622,MS-DRG,622,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,100051.65,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with CC",623,MS-DRG,623,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72590.25,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders without CC/MCC",624,MS-DRG,624,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with MCC",625,MS-DRG,625,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,30309.826,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with CC",626,MS-DRG,626,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures without CC/MCC",627,MS-DRG,627,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with MCC",628,MS-DRG,628,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,30309.826,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with CC",629,MS-DRG,629,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures without CC/MCC",630,MS-DRG,630,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Diabetes with MCC,637,MS-DRG,637,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,67654.99,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Diabetes with CC,638,MS-DRG,638,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53843.95,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Diabetes without CC/MCC,639,MS-DRG,639,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCC",640,MS-DRG,640,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,74862.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCC",641,MS-DRG,641,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,47049.37,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Inborn and other disorders of metabolism,642,MS-DRG,642,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Endocrine disorders with MCC*,643,MS-DRG,643,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Endocrine disorders with CC*,644,MS-DRG,644,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Endocrine disorders without CC/MCC*,645,MS-DRG,645,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major bladder procedures with MCC,653,MS-DRG,653,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,91596.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major bladder procedures with CC,654,MS-DRG,654,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,80073.46,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major bladder procedures without CC/MCC,655,MS-DRG,655,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and ureter procedures for neoplasm with MCC,656,MS-DRG,656,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and ureter procedures for neoplasm with CC,657,MS-DRG,657,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and ureter procedures for neoplasm without CC/MCC,658,MS-DRG,658,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and ureter procedures for non-neoplasm with MCC*,659,MS-DRG,659,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and ureter procedures for non-neoplasm with CC*,660,MS-DRG,660,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and ureter procedures for non-neoplasm without CC/MCC*,661,MS-DRG,661,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Minor bladder procedures with MCC,662,MS-DRG,662,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Minor bladder procedures with CC,663,MS-DRG,663,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Minor bladder procedures without CC/MCC,664,MS-DRG,664,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Prostatectomy with MCC,665,MS-DRG,665,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,91596.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Prostatectomy with CC,666,MS-DRG,666,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,80073.46,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Prostatectomy without CC/MCC,667,MS-DRG,667,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Transurethral procedures with MCC,668,MS-DRG,668,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Transurethral procedures with CC,669,MS-DRG,669,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Transurethral procedures without CC/MCC,670,MS-DRG,670,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Urethral procedures with CC/MCC,671,MS-DRG,671,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Urethral procedures without CC/MCC,672,MS-DRG,672,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other kidney and urinary tract procedures with MCC*,673,MS-DRG,673,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,91596.69,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other kidney and urinary tract procedures with CC*,674,MS-DRG,674,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,80073.46,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other kidney and urinary tract procedures without CC/MCC*,675,MS-DRG,675,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,80073.46,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Renal failure with MCC,682,MS-DRG,682,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,66775.07,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Renal failure with CC,683,MS-DRG,683,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,46314.82,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Renal failure without CC/MCC,684,MS-DRG,684,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and urinary tract neoplasms with MCC,686,MS-DRG,686,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and urinary tract neoplasms with CC,687,MS-DRG,687,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and urinary tract neoplasms without CC/MCC,688,MS-DRG,688,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and urinary tract infections with MCC,689,MS-DRG,689,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48342.49,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and urinary tract infections without MCC,690,MS-DRG,690,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,35962.28,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Urinary stones with MCC,693,MS-DRG,693,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Urinary stones without MCC,694,MS-DRG,694,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and urinary tract signs and symptoms with MCC,695,MS-DRG,695,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and urinary tract signs and symptoms without MCC,696,MS-DRG,696,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Urethral stricture,697,MS-DRG,697,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other kidney and urinary tract diagnoses with MCC,698,MS-DRG,698,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,67746.82,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other kidney and urinary tract diagnoses with CC,699,MS-DRG,699,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,47363.09,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other kidney and urinary tract diagnoses without CC/MCC,700,MS-DRG,700,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major male pelvic procedures with CC/MCC,707,MS-DRG,707,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major male pelvic procedures without CC/MCC,708,MS-DRG,708,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Penis procedures with CC/MCC,709,MS-DRG,709,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Penis procedures without CC/MCC,710,MS-DRG,710,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Testes procedures with CC/MCC,711,MS-DRG,711,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Testes procedures without CC/MCC,712,MS-DRG,712,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Transurethral prostatectomy with CC/MCC,713,MS-DRG,713,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,30309.826,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Transurethral prostatectomy without CC/MCC,714,MS-DRG,714,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other male reproductive system O.R. procedures for malignancy with CC/MCC,715,MS-DRG,715,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other male reproductive system O.R. procedures for malignancy without CC/MCC,716,MS-DRG,716,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other male reproductive system O.R. procedures except malignancy with CC/MCC,717,MS-DRG,717,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other male reproductive system O.R. procedures except malignancy without CC/MCC,718,MS-DRG,718,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Malignancy, male reproductive system with MCC",722,MS-DRG,722,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,61794.07,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Malignancy, male reproductive system with CC",723,MS-DRG,723,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Malignancy, male reproductive system without CC/MCC",724,MS-DRG,724,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,50278,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Benign prostatic hypertrophy with MCC,725,MS-DRG,725,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,50278.46,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Benign prostatic hypertrophy without MCC,726,MS-DRG,726,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Inflammation of the male reproductive system with MCC,727,MS-DRG,727,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,61794.07,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Inflammation of the male reproductive system without MCC,728,MS-DRG,728,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,50278,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other male reproductive system diagnoses with CC/MCC,729,MS-DRG,729,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other male reproductive system diagnoses without CC/MCC,730,MS-DRG,730,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC",734,MS-DRG,734,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC",735,MS-DRG,735,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with MCC,736,MS-DRG,736,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with CC,737,MS-DRG,737,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy without CC/MCC,738,MS-DRG,738,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with MCC,739,MS-DRG,739,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with CC,740,MS-DRG,740,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy without CC/MCC,741,MS-DRG,741,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Uterine and adnexa procedures for non-malignancy with CC/MCC,742,MS-DRG,742,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Uterine and adnexa procedures for non-malignancy without CC/MCC,743,MS-DRG,743,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"D&C, conization, laparoscopy and tubal interruption with CC/MCC",744,MS-DRG,744,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"D&C, conization, laparoscopy and tubal interruption without CC/MCC",745,MS-DRG,745,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Vagina, cervix and vulva procedures with CC/MCC",746,MS-DRG,746,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Vagina, cervix and vulva procedures without CC/MCC",747,MS-DRG,747,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Female reproductive system reconstructive procedures,748,MS-DRG,748,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other female reproductive system O.R. procedures with CC/MCC,749,MS-DRG,749,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other female reproductive system O.R. procedures without CC/MCC,750,MS-DRG,750,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Malignancy, female reproductive system with MCC",754,MS-DRG,754,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Malignancy, female reproductive system with CC",755,MS-DRG,755,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Malignancy, female reproductive system without CC/MCC",756,MS-DRG,756,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Infections, female reproductive system with MCC",757,MS-DRG,757,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,29854.136,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Infections, female reproductive system with CC",758,MS-DRG,758,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Infections, female reproductive system without CC/MCC",759,MS-DRG,759,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Menstrual and other female reproductive system disorders with CC/MCC,760,MS-DRG,760,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Menstrual and other female reproductive system disorders without CC/MCC,761,MS-DRG,761,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Vaginal delivery with O.R. procedures except sterilization and/or D&C,768,MS-DRG,768,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Postpartum and post abortion diagnoses with O.R. procedures,769,MS-DRG,769,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Abortion with D&C, aspiration curettage or hysterotomy",770,MS-DRG,770,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Postpartum and post abortion diagnoses without O.R. procedures,776,MS-DRG,776,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Abortion without D&C,779,MS-DRG,779,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cesarean section with sterilization with MCC,783,MS-DRG,783,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cesarean section with sterilization with CC,784,MS-DRG,784,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,90613.37,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cesarean section with sterilization without CC/MCC,785,MS-DRG,785,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cesarean section without sterilization with MCC,786,MS-DRG,786,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cesarean section without sterilization with CC,787,MS-DRG,787,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Cesarean section without sterilization without CC/MCC,788,MS-DRG,788,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Neonates, died or transferred to another acute care facility",789,MS-DRG,789,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Extreme immaturity or respiratory distress syndrome, neonate",790,MS-DRG,790,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Prematurity with major problems,791,MS-DRG,791,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Prematurity without major problems,792,MS-DRG,792,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48921.03,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Full term neonate with major problems,793,MS-DRG,793,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Neonate with other significant problems,794,MS-DRG,794,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48921.03,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Splenic procedures with MCC,799,MS-DRG,799,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,106800.6,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Splenic procedures with CC,800,MS-DRG,800,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48921.03,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Splenic procedures without CC/MCC,801,MS-DRG,801,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures of the blood and blood forming organs with MCC,802,MS-DRG,802,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures of the blood and blood forming organs with CC,803,MS-DRG,803,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures of the blood and blood forming organs without CC/MCC,804,MS-DRG,804,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with MCC,808,MS-DRG,808,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with CC,809,MS-DRG,809,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without CC/MCC,810,MS-DRG,810,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Red blood cell disorders with MCC,811,MS-DRG,811,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Red blood cell disorders without MCC,812,MS-DRG,812,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Coagulation disorders,813,MS-DRG,813,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Reticuloendothelial and immunity disorders with MCC*,814,MS-DRG,814,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Reticuloendothelial and immunity disorders with CC*,815,MS-DRG,815,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Reticuloendothelial and immunity disorders without CC/MCC*,816,MS-DRG,816,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other antepartum diagnoses with O.R. procedures with MCC,817,MS-DRG,817,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,40508.305,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other antepartum diagnoses with O.R. procedures with CC,818,MS-DRG,818,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other antepartum diagnoses with O.R. procedures without CC/MCC,819,MS-DRG,819,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and leukemia with major O.R. procedures with MCC,820,MS-DRG,820,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and leukemia with major O.R. procedures with CC,821,MS-DRG,821,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and leukemia with major O.R. procedures without CC/MCC,822,MS-DRG,822,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and non-acute leukemia with other procedures with MCC,823,MS-DRG,823,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and non-acute leukemia with other procedures with CC,824,MS-DRG,824,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and non-acute leukemia with other procedures without CC/MCC,825,MS-DRG,825,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with MCC,826,MS-DRG,826,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with CC,827,MS-DRG,827,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures without CC/MCC,828,MS-DRG,828,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures with CC/MCC,829,MS-DRG,829,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures without CC/MCC,830,MS-DRG,830,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other antepartum diagnoses without O.R. procedures with MCC,831,MS-DRG,831,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other antepartum diagnoses without O.R. procedures with CC,832,MS-DRG,832,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other antepartum diagnoses without O.R. procedures without CC/MCC,833,MS-DRG,833,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Acute leukemia with MCC,834,MS-DRG,834,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Acute leukemia with CC,835,MS-DRG,835,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Acute leukemia without CC/MCC,836,MS-DRG,836,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy agent with MCC,837,MS-DRG,837,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapy agent,838,MS-DRG,838,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis without CC/MCC,839,MS-DRG,839,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and non-acute leukemia with MCC,840,MS-DRG,840,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and non-acute leukemia with CC,841,MS-DRG,841,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and non-acute leukemia without CC/MCC,842,MS-DRG,842,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with MCC,843,MS-DRG,843,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with CC,844,MS-DRG,844,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses without CC/MCC,845,MS-DRG,845,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with MCC,846,MS-DRG,846,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with CC,847,MS-DRG,847,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis without CC/MCC,848,MS-DRG,848,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Radiotherapy,849,MS-DRG,849,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Acute leukemia with other procedures,850,MS-DRG,850,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Infectious and parasitic diseases with O.R. procedures with MCC,853,MS-DRG,853,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,116013.09,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Infectious and parasitic diseases with O.R. procedures with CC,854,MS-DRG,854,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.07,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Infectious and parasitic diseases with O.R. procedures without CC/MCC,855,MS-DRG,855,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with MCC,856,MS-DRG,856,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,103112.54,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with CC,857,MS-DRG,857,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures without CC/MCC,858,MS-DRG,858,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Postoperative and post-traumatic infections with MCC,862,MS-DRG,862,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,70501.55,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Postoperative and post-traumatic infections without MCC,863,MS-DRG,863,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,47554.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Fever and inflammatory conditions,864,MS-DRG,864,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Viral illness with MCC,865,MS-DRG,865,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Viral illness without MCC,866,MS-DRG,866,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other infectious and parasitic diseases diagnoses with MCC,867,MS-DRG,867,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,70118.98,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other infectious and parasitic diseases diagnoses with CC,868,MS-DRG,868,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other infectious and parasitic diseases diagnoses without CC/MCC,869,MS-DRG,869,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Septicemia or severe sepsis with MV >96 hours,870,MS-DRG,870,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,158548.16,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Septicemia or severe sepsis without MV >96 hours with MCC,871,MS-DRG,871,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,64954.17,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Septicemia or severe sepsis without MV >96 hours without MCC,872,MS-DRG,872,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,43522.12,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Wound debridements for injuries with MCC,901,MS-DRG,901,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,98177.28,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Wound debridements for injuries with CC,902,MS-DRG,902,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Wound debridements for injuries without CC/MCC,903,MS-DRG,903,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Skin grafts for injuries with CC/MCC,904,MS-DRG,904,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Skin grafts for injuries without CC/MCC,905,MS-DRG,905,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Hand procedures for injuries,906,MS-DRG,906,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures for injuries with MCC*,907,MS-DRG,907,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures for injuries with CC*,908,MS-DRG,908,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures for injuries without CC/MCC*,909,MS-DRG,909,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Traumatic injury with MCC,913,MS-DRG,913,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Traumatic injury without MCC,914,MS-DRG,914,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Allergic reactions with MCC,915,MS-DRG,915,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Allergic reactions without MCC,916,MS-DRG,916,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Poisoning and toxic effects of drugs with MCC,917,MS-DRG,917,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Poisoning and toxic effects of drugs without MCC,918,MS-DRG,918,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Complications of treatment with MCC,919,MS-DRG,919,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,82055.43,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Complications of treatment with CC,920,MS-DRG,920,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52581.58,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Complications of treatment without CC/MCC,921,MS-DRG,921,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Other injury, poisoning and toxic effect diagnoses with MCC",922,MS-DRG,922,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Other injury, poisoning and toxic effect diagnoses without MCC",923,MS-DRG,923,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Extensive burns or full thickness burns with MV >96 hours with skin graft,927,MS-DRG,927,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Full thickness burn with skin graft or inhalation injury with CC/MCC,928,MS-DRG,928,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Full thickness burn with skin graft or inhalation injury without CC/MCC,929,MS-DRG,929,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Extensive burns or full thickness burns with MV >96 hours without skin graft,933,MS-DRG,933,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Full thickness burn without skin graft or inhalation injury,934,MS-DRG,934,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Non-extensive burns,935,MS-DRG,935,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
O.R. procedures with diagnoses of other contact with health services with MCC,939,MS-DRG,939,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,90701.7,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
O.R. procedures with diagnoses of other contact with health services with CC,940,MS-DRG,940,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
O.R. procedures with diagnoses of other contact with health services without CC/MCC,941,MS-DRG,941,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Signs and symptoms with MCC,947,MS-DRG,947,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Signs and symptoms without MCC,948,MS-DRG,948,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Aftercare with CC/MCC,949,MS-DRG,949,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,53224.31,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Aftercare without CC/MCC,950,MS-DRG,950,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other factors influencing health status,951,MS-DRG,951,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Craniotomy for multiple significant trauma,955,MS-DRG,955,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"Limb reattachment, hip and femur procedures for multiple significant trauma",956,MS-DRG,956,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures for multiple significant trauma with MCC,957,MS-DRG,957,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures for multiple significant trauma with CC,958,MS-DRG,958,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures for multiple significant trauma without CC/MCC,959,MS-DRG,959,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other multiple significant trauma with MCC,963,MS-DRG,963,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other multiple significant trauma with CC,964,MS-DRG,964,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Other multiple significant trauma without CC/MCC,965,MS-DRG,965,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
HIV with extensive O.R. procedures with MCC,969,MS-DRG,969,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
HIV with extensive O.R. procedures without MCC,970,MS-DRG,970,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
HIV with major related condition with MCC*,974,MS-DRG,974,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,87197.28,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
HIV with major related condition with CC*,975,MS-DRG,975,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,68412.68,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
HIV with major related condition without CC/MCC*,976,MS-DRG,976,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,68412.68,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
HIV with or without other related condition,977,MS-DRG,977,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with MCC,981,MS-DRG,981,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,68449.825,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with CC,982,MS-DRG,982,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,96991.29,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,983,MS-DRG,983,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with MCC,987,MS-DRG,987,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,163207.97,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with CC,988,MS-DRG,988,LOCAL,,Inpatient,,,,,Anthem Blue Cross,Commercial,,,MS-DRG,72269.07,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
"ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck with major O.R. procedures",3,MS-DRG,3,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,310277.39,Fee schedule,22000,120000,,,,,,,,
"Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck without major O.R. procedures",4,MS-DRG,4,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,229767.96,Fee schedule,22000,120000,,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCC",11,MS-DRG,11,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CC",12,MS-DRG,12,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy without CC/MCC",13,MS-DRG,13,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
Chimeric antigen receptor (CAR) T-cell and other immunotherapies,18,MS-DRG,18,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46368.39,Fee schedule,22000,120000,,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with MCC,20,MS-DRG,20,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with CC,21,MS-DRG,21,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage without CC/MCC,22,MS-DRG,22,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC or chemotherapy implant or epilepsy with neurostimulator,23,MS-DRG,23,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis without MCC,24,MS-DRG,24,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
Craniotomy and endovascular intracranial procedures with MCC,25,MS-DRG,25,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
Craniotomy and endovascular intracranial procedures with CC,26,MS-DRG,26,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
Craniotomy and endovascular intracranial procedures without CC/MCC,27,MS-DRG,27,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
Spinal procedures with MCC,28,MS-DRG,28,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
Spinal procedures with CC or spinal neurostimulators,29,MS-DRG,29,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
Spinal procedures without CC/MCC,30,MS-DRG,30,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
Ventricular shunt procedures with MCC,31,MS-DRG,31,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
Ventricular shunt procedures with CC,32,MS-DRG,32,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
Ventricular shunt procedures without CC/MCC,33,MS-DRG,33,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
Carotid artery stent procedures with MCC,34,MS-DRG,34,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Carotid artery stent procedures with CC,35,MS-DRG,35,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Carotid artery stent procedures without CC/MCC,36,MS-DRG,36,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Extracranial procedures with MCC,37,MS-DRG,37,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Extracranial procedures with CC,38,MS-DRG,38,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Extracranial procedures without CC/MCC,39,MS-DRG,39,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with MCC",40,MS-DRG,40,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,95774.44,Fee schedule,22000,120000,,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurostimulator",41,MS-DRG,41,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46368.39,Fee schedule,22000,120000,,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures without CC/MCC",42,MS-DRG,42,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46368.39,Fee schedule,22000,120000,,,,,,,,
Spinal disorders and injuries with CC/MCC,52,MS-DRG,52,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,82942.79,Fee schedule,22000,120000,,,,,,,,
Spinal disorders and injuries without CC/MCC,53,MS-DRG,53,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,81228.84,Fee schedule,22000,120000,,,,,,,,
Nervous system neoplasms with MCC,54,MS-DRG,54,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46368.39,Fee schedule,22000,120000,,,,,,,,
Nervous system neoplasms without MCC,55,MS-DRG,55,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46368.39,Fee schedule,22000,120000,,,,,,,,
Degenerative nervous system disorders with MCC,56,MS-DRG,56,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,61411.33,Fee schedule,22000,120000,,,,,,,,
Degenerative nervous system disorders without MCC,57,MS-DRG,57,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,51678.56,Fee schedule,22000,120000,,,,,,,,
Multiple sclerosis and cerebellar ataxia with MCC,58,MS-DRG,58,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Multiple sclerosis and cerebellar ataxia with CC,59,MS-DRG,59,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,51678.56,Fee schedule,22000,120000,,,,,,,,
Multiple sclerosis and cerebellar ataxia without CC/MCC,60,MS-DRG,60,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,51678.56,Fee schedule,22000,120000,,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with MCC",61,MS-DRG,61,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,111192.31,Fee schedule,22000,120000,,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with CC",62,MS-DRG,62,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent without CC/MCC",63,MS-DRG,63,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Intracranial hemorrhage or cerebral infarction with MCC,64,MS-DRG,64,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,111192.31,Fee schedule,22000,120000,,,,,,,,
Intracranial hemorrhage or cerebral infarction with CC or tPA in 24 hours,65,MS-DRG,65,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Intracranial hemorrhage or cerebral infarction without CC/MCC,66,MS-DRG,66,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Nonspecific CVA and precerebral occlusion without infarction with MCC,67,MS-DRG,67,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,66767.42,Fee schedule,22000,120000,,,,,,,,
Nonspecific CVA and precerebral occlusion without infarction without MCC,68,MS-DRG,68,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Transient ischemia without thrombolytic,69,MS-DRG,69,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Nonspecific cerebrovascular disorders with MCC*,70,MS-DRG,70,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,66767.42,Fee schedule,22000,120000,,,,,,,,
Nonspecific cerebrovascular disorders with CC*,71,MS-DRG,71,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,45128.84,Fee schedule,22000,120000,,,,,,,,
Nonspecific cerebrovascular disorders without CC/MCC*,72,MS-DRG,72,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Cranial and peripheral nerve disorders with MCC,73,MS-DRG,73,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
Cranial and peripheral nerve disorders without MCC,74,MS-DRG,74,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Viral meningitis with CC/MCC,75,MS-DRG,75,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Viral meningitis without CC/MCC,76,MS-DRG,76,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Hypertensive encephalopathy with MCC,77,MS-DRG,77,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,68160,Fee schedule,22000,120000,,,,,,,,
Hypertensive encephalopathy with CC,78,MS-DRG,78,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,537909.39,Fee schedule,22000,120000,,,,,,,,
Hypertensive encephalopathy without CC/MCC,79,MS-DRG,79,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Nontraumatic stupor and coma with MCC,80,MS-DRG,80,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,,,,,,,,
Nontraumatic stupor and coma without MCC,81,MS-DRG,81,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Traumatic stupor and coma >1 hour with MCC*,82,MS-DRG,82,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,82529.13,Fee schedule,22000,120000,,,,,,,,
Traumatic stupor and coma >1 hour with CC*,83,MS-DRG,83,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,62451.46,Fee schedule,22000,120000,,,,,,,,
Traumatic stupor and coma >1 hour without CC/MCC*,84,MS-DRG,84,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Traumatic stupor and coma <1 hour with MCC,85,MS-DRG,85,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,62451.46,Fee schedule,22000,120000,,,,,,,,
Traumatic stupor and coma <1 hour with CC,86,MS-DRG,86,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,62451.46,Fee schedule,22000,120000,,,,,,,,
Traumatic stupor and coma <1 hour without CC/MCC,87,MS-DRG,87,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Concussion with MCC,88,MS-DRG,88,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,68160,Fee schedule,22000,120000,,,,,,,,
Concussion with CC,89,MS-DRG,89,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,537909.39,Fee schedule,22000,120000,,,,,,,,
Concussion without CC/MCC,90,MS-DRG,90,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Other disorders of nervous system with MCC,91,MS-DRG,91,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,68160,Fee schedule,22000,120000,,,,,,,,
Other disorders of nervous system with CC,92,MS-DRG,92,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,537909.39,Fee schedule,22000,120000,,,,,,,,
Other disorders of nervous system without CC/MCC,93,MS-DRG,93,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,51678.56,Fee schedule,22000,120000,,,,,,,,
Bacterial and tuberculous infections of nervous system with MCC*,94,MS-DRG,94,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34375.739,Fee schedule,22000,120000,,,,,,,,
Bacterial and tuberculous infections of nervous system with CC*,95,MS-DRG,95,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,62451.46,Fee schedule,22000,120000,,,,,,,,
Bacterial and tuberculous infections of nervous system without CC/MCC*,96,MS-DRG,96,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Non-bacterial infection of nervous system except viral meningitis with MCC,97,MS-DRG,97,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,75054.04,Fee schedule,22000,120000,,,,,,,,
Non-bacterial infection of nervous system except viral meningitis with CC,98,MS-DRG,98,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
Non-bacterial infection of nervous system except viral meningitis without CC/MCC,99,MS-DRG,99,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Seizures with MCC,100,MS-DRG,100,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Seizures without MCC,101,MS-DRG,101,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Headaches with MCC,102,MS-DRG,102,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Headaches without MCC,103,MS-DRG,103,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Orbital procedures with CC/MCC,113,MS-DRG,113,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,115767.94,Fee schedule,22000,120000,,,,,,,,
Orbital procedures without CC/MCC,114,MS-DRG,114,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Extraocular procedures except orbit,115,MS-DRG,115,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Intraocular procedures with CC/MCC,116,MS-DRG,116,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,115767.94,Fee schedule,22000,120000,,,,,,,,
Intraocular procedures without CC/MCC,117,MS-DRG,117,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Acute major eye infections with CC/MCC,121,MS-DRG,121,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Acute major eye infections without CC/MCC,122,MS-DRG,122,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Neurological eye disorders,123,MS-DRG,123,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Other disorders of the eye with MCC or thrombolytic agent,124,MS-DRG,124,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Other disorders of the eye without MCC,125,MS-DRG,125,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Sinus and mastoid procedures with CC/MCC,135,MS-DRG,135,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,115767.94,Fee schedule,22000,120000,,,,,,,,
Sinus and mastoid procedures without CC/MCC,136,MS-DRG,136,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Mouth procedures with CC/MCC,137,MS-DRG,137,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,115767.94,Fee schedule,22000,120000,,,,,,,,
Mouth procedures without CC/MCC,138,MS-DRG,138,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Salivary gland procedures,139,MS-DRG,139,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Major head and neck procedures with MCC,140,MS-DRG,140,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,177508.29,Fee schedule,22000,120000,,,,,,,,
Major head and neck procedures with CC,141,MS-DRG,141,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,115767.94,Fee schedule,22000,120000,,,,,,,,
Major head and neck procedures without CC/MCC,142,MS-DRG,142,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with MCC",143,MS-DRG,143,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,115767.94,Fee schedule,22000,120000,,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with CC",144,MS-DRG,144,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures without CC/MCC",145,MS-DRG,145,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
"Ear, nose, mouth and throat malignancy with MCC*",146,MS-DRG,146,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
"Ear, nose, mouth and throat malignancy with CC*",147,MS-DRG,147,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
"Ear, nose, mouth and throat malignancy without CC/MCC*",148,MS-DRG,148,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Dysequilibrium,149,MS-DRG,149,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Epistaxis with MCC,150,MS-DRG,150,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Epistaxis without MCC,151,MS-DRG,151,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Otitis media and URI with MCC,152,MS-DRG,152,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Otitis media and URI without MCC,153,MS-DRG,153,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
"Other ear, nose, mouth and throat diagnoses with MCC",154,MS-DRG,154,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
"Other ear, nose, mouth and throat diagnoses with CC",155,MS-DRG,155,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
"Other ear, nose, mouth and throat diagnoses without CC/MCC",156,MS-DRG,156,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Dental and oral diseases with MCC,157,MS-DRG,157,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Dental and oral diseases with CC,158,MS-DRG,158,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
Dental and oral diseases without CC/MCC,159,MS-DRG,159,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
Major chest procedures with MCC,163,MS-DRG,163,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,202666.58,Fee schedule,22000,120000,,,,,,,,
Major chest procedures with CC,164,MS-DRG,164,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,202666.58,Fee schedule,22000,120000,,,,,,,,
Major chest procedures without CC/MCC,165,MS-DRG,165,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,202666.58,Fee schedule,22000,120000,,,,,,,,
Other respiratory system O.R. procedures with MCC,166,MS-DRG,166,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,177508.29,Fee schedule,22000,120000,,,,,,,,
Other respiratory system O.R. procedures with CC,167,MS-DRG,167,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,115767.94,Fee schedule,22000,120000,,,,,,,,
Other respiratory system O.R. procedures without CC/MCC,168,MS-DRG,168,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism,173,MS-DRG,173,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Pulmonary embolism with MCC or acute cor pulmonale,175,MS-DRG,175,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
Pulmonary embolism without MCC,176,MS-DRG,176,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Respiratory infections and inflammations with MCC*,177,MS-DRG,177,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,62918.69,Fee schedule,22000,120000,,,,,,,,
Respiratory infections and inflammations with CC*,178,MS-DRG,178,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,43491.4,Fee schedule,22000,120000,,,,,,,,
Respiratory infections and inflammations without CC/MCC*,179,MS-DRG,179,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,42251.85,Fee schedule,22000,120000,,,,,,,,
Respiratory neoplasms with MCC*,180,MS-DRG,180,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
Respiratory neoplasms with CC*,181,MS-DRG,181,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Respiratory neoplasms without CC/MCC*,182,MS-DRG,182,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Major chest trauma with MCC,183,MS-DRG,183,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Major chest trauma with CC,184,MS-DRG,184,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Major chest trauma without CC/MCC,185,MS-DRG,185,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Pleural effusion with MCC*,186,MS-DRG,186,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,66071.13,Fee schedule,22000,120000,,,,,,,,
Pleural effusion with CC*,187,MS-DRG,187,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Pleural effusion without CC/MCC*,188,MS-DRG,188,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Pulmonary edema and respiratory failure,189,MS-DRG,189,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72046.99,Fee schedule,22000,120000,,,,,,,,
Chronic obstructive pulmonary disease with MCC*,190,MS-DRG,190,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,20971.383,Fee schedule,22000,120000,,,,,,,,
Chronic obstructive pulmonary disease with CC*,191,MS-DRG,191,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Chronic obstructive pulmonary disease without CC/MCC*,192,MS-DRG,192,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Simple pneumonia and pleurisy with MCC,193,MS-DRG,193,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,59421.93,Fee schedule,22000,120000,,,,,,,,
Simple pneumonia and pleurisy with CC,194,MS-DRG,194,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,39604.42,Fee schedule,22000,120000,,,,,,,,
Simple pneumonia and pleurisy without CC/MCC,195,MS-DRG,195,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Interstitial lung disease with MCC*,196,MS-DRG,196,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Interstitial lung disease with CC*,197,MS-DRG,197,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Interstitial lung disease without CC/MCC*,198,MS-DRG,198,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Pneumothorax with MCC,199,MS-DRG,199,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Pneumothorax with CC,200,MS-DRG,200,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,21869.927,Fee schedule,22000,120000,,,,,,,,
Pneumothorax without CC/MCC,201,MS-DRG,201,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,21869.927,Fee schedule,22000,120000,,,,,,,,
Bronchitis and asthma with CC/MCC,202,MS-DRG,202,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,40508.305,Fee schedule,22000,120000,,,,,,,,
Bronchitis and asthma without CC/MCC,203,MS-DRG,203,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,15339.435,Fee schedule,22000,120000,,,,,,,,
Respiratory signs and symptoms,204,MS-DRG,204,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Other respiratory system diagnoses with MCC,205,MS-DRG,205,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,112102.84,Fee schedule,22000,120000,,,,,,,,
Other respiratory system diagnoses without MCC,206,MS-DRG,206,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
Respiratory system diagnosis with ventilator support >96 hours,207,MS-DRG,207,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,147720.8,Fee schedule,22000,120000,,,,,,,,
Respiratory system diagnosis with ventilator support <=96 hours,208,MS-DRG,208,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,81481.35,Fee schedule,22000,120000,,,,,,,,
Concomitant aortic and mitral valve procedures,212,MS-DRG,212,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Other heart assist system implant,215,MS-DRG,215,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC,216,MS-DRG,216,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with CC,217,MS-DRG,217,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization without CC/MCC,218,MS-DRG,218,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with MCC,219,MS-DRG,219,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with CC,220,MS-DRG,220,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization without CC/MCC,221,MS-DRG,221,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Other cardiothoracic procedures with MCC,228,MS-DRG,228,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Other cardiothoracic procedures without MCC,229,MS-DRG,229,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Coronary bypass with PTCA with MCC,231,MS-DRG,231,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Coronary bypass with PTCA without MCC,232,MS-DRG,232,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Coronary bypass with cardiac catheterization or open ablation with MCC,233,MS-DRG,233,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Coronary bypass with cardiac catheterization or open ablation without MCC,234,MS-DRG,234,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Coronary bypass without cardiac catheterization with MCC,235,MS-DRG,235,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Coronary bypass without cardiac catheterization without MCC,236,MS-DRG,236,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Amputation for circulatory system disorders except upper limb and toe with MCC,239,MS-DRG,239,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Amputation for circulatory system disorders except upper limb and toe with CC,240,MS-DRG,240,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Amputation for circulatory system disorders except upper limb and toe without CC/MCC,241,MS-DRG,241,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Permanent cardiac pacemaker implant with MCC,242,MS-DRG,242,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Permanent cardiac pacemaker implant with CC,243,MS-DRG,243,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Permanent cardiac pacemaker implant without CC/MCC,244,MS-DRG,244,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
AICD generator procedures,245,MS-DRG,245,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,40774.659,Fee schedule,22000,120000,,,,,,,,
Percutaneous cardiovascular procedures without intraluminal device with MCC,250,MS-DRG,250,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Percutaneous cardiovascular procedures without intraluminal device without MCC,251,MS-DRG,251,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Other vascular procedures with MCC,252,MS-DRG,252,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Other vascular procedures with CC,253,MS-DRG,253,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Other vascular procedures without CC/MCC,254,MS-DRG,254,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Upper limb and toe amputation for circulatory system disorders with MCC,255,MS-DRG,255,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Upper limb and toe amputation for circulatory system disorders with CC,256,MS-DRG,256,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
Upper limb and toe amputation for circulatory system disorders without CC/MCC,257,MS-DRG,257,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
Cardiac pacemaker device replacement with MCC,258,MS-DRG,258,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Cardiac pacemaker device replacement without MCC,259,MS-DRG,259,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Cardiac pacemaker revision except device replacement with MCC,260,MS-DRG,260,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,92851.55,Fee schedule,22000,120000,,,,,,,,
Cardiac pacemaker revision except device replacement with CC,261,MS-DRG,261,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,92851.55,Fee schedule,22000,120000,,,,,,,,
Cardiac pacemaker revision except device replacement without CC/MCC,262,MS-DRG,262,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,92851.55,Fee schedule,22000,120000,,,,,,,,
Vein ligation and stripping,263,MS-DRG,263,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,92851.55,Fee schedule,22000,120000,,,,,,,,
Other circulatory system O.R. procedures,264,MS-DRG,264,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,92851.55,Fee schedule,22000,120000,,,,,,,,
AICD lead procedures,265,MS-DRG,265,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Endovascular cardiac valve replacement and supplement procedures with MCC,266,MS-DRG,266,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Endovascular cardiac valve replacement and supplement procedures without MCC,267,MS-DRG,267,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Aortic and heart assist procedures except pulsation balloon with MCC,268,MS-DRG,268,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Aortic and heart assist procedures except pulsation balloon without MCC,269,MS-DRG,269,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,,,,,,,,
Other major cardiovascular procedures with MCC,270,MS-DRG,270,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Other major cardiovascular procedures with CC,271,MS-DRG,271,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Other major cardiovascular procedures without CC/MCC,272,MS-DRG,272,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Percutaneous and other intracardiac procedures with MCC,273,MS-DRG,273,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
Percutaneous and other intracardiac procedures without MCC,274,MS-DRG,274,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
Cardiac defibrillator implant with cardiac catheterization and MCC,275,MS-DRG,275,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Cardiac defibrillator implant with MCC or carotid sinus neurostimulator,276,MS-DRG,276,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Cardiac defibrillator implant without MCC,277,MS-DRG,277,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures with MCC,278,MS-DRG,278,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,92851.55,Fee schedule,22000,120000,,,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures without MCC,279,MS-DRG,279,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,92851.55,Fee schedule,22000,120000,,,,,,,,
"Acute myocardial infarction, discharged alive with MCC",280,MS-DRG,280,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,63798.62,Fee schedule,22000,120000,,,,,,,,
"Acute myocardial infarction, discharged alive with CC",281,MS-DRG,281,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
"Acute myocardial infarction, discharged alive without CC/MCC",282,MS-DRG,282,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
"Acute myocardial infarction, expired with MCC",283,MS-DRG,283,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
"Acute myocardial infarction, expired with CC",284,MS-DRG,284,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
"Acute myocardial infarction, expired without CC/MCC",285,MS-DRG,285,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization with MCC",286,MS-DRG,286,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization without MCC",287,MS-DRG,287,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Acute and subacute endocarditis with MCC,288,MS-DRG,288,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,79476.64,Fee schedule,22000,120000,,,,,,,,
Acute and subacute endocarditis with CC,289,MS-DRG,289,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,54456.07,Fee schedule,22000,120000,,,,,,,,
Acute and subacute endocarditis without CC/MCC,290,MS-DRG,290,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48748.02,Fee schedule,22000,120000,,,,,,,,
Heart failure and shock with MCC,291,MS-DRG,291,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,59345.41,Fee schedule,22000,120000,,,,,,,,
Heart failure and shock with CC,292,MS-DRG,292,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,42060.56,Fee schedule,22000,120000,,,,,,,,
Heart failure and shock without CC/MCC,293,MS-DRG,293,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,42060.56,Fee schedule,22000,120000,,,,,,,,
Deep vein thrombophlebitis with CC/MCC,294,MS-DRG,294,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
Deep vein thrombophlebitis without CC/MCC,295,MS-DRG,295,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
"Cardiac arrest, unexplained with MCC",296,MS-DRG,296,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,59345.41,Fee schedule,22000,120000,,,,,,,,
"Cardiac arrest, unexplained with CC",297,MS-DRG,297,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,42060.56,Fee schedule,22000,120000,,,,,,,,
"Cardiac arrest, unexplained without CC/MCC",298,MS-DRG,298,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,42060.56,Fee schedule,22000,120000,,,,,,,,
Peripheral vascular disorders with MCC,299,MS-DRG,299,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,64808.62,Fee schedule,22000,120000,,,,,,,,
Peripheral vascular disorders with CC,300,MS-DRG,300,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Peripheral vascular disorders without CC/MCC,301,MS-DRG,301,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Atherosclerosis with MCC,302,MS-DRG,302,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Atherosclerosis without MCC,303,MS-DRG,303,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Hypertension with MCC,304,MS-DRG,304,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
Hypertension without MCC,305,MS-DRG,305,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Cardiac congenital and valvular disorders with MCC,306,MS-DRG,306,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Cardiac congenital and valvular disorders without MCC,307,MS-DRG,307,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Cardiac arrhythmia and conduction disorders with MCC,308,MS-DRG,308,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
Cardiac arrhythmia and conduction disorders with CC,309,MS-DRG,309,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,,,,,,,,
Cardiac arrhythmia and conduction disorders without CC/MCC,310,MS-DRG,310,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Angina pectoris,311,MS-DRG,311,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Syncope and collapse,312,MS-DRG,312,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,,,,,,,,
Chest pain,313,MS-DRG,313,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Other circulatory system diagnoses with MCC,314,MS-DRG,314,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,67570.83,Fee schedule,22000,120000,,,,,,,,
Other circulatory system diagnoses with CC,315,MS-DRG,315,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,47562.03,Fee schedule,22000,120000,,,,,,,,
Other circulatory system diagnoses without CC/MCC,316,MS-DRG,316,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Concomitant left atrial appendage closure and cardiac ablation,317,MS-DRG,317,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Other endovascular cardiac valve procedures with MCC,319,MS-DRG,319,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Other endovascular cardiac valve procedures without MCC,320,MS-DRG,320,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/intraluminal devices,321,MS-DRG,321,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Percutaneous cardiovascular procedures with intraluminal device without MCC,322,MS-DRG,322,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Coronary intravascular lithotripsy with intraluminal device with MCC,323,MS-DRG,323,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Coronary intravascular lithotripsy with intraluminal device without MCC,324,MS-DRG,324,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,,,,,,,,
Coronary intravascular lithotripsy without intraluminal device,325,MS-DRG,325,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
"Stomach, esophageal and duodenal procedures with MCC",326,MS-DRG,326,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
"Stomach, esophageal and duodenal procedures with CC",327,MS-DRG,327,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,,,,,,,,
"Stomach, esophageal and duodenal procedures without CC/MCC",328,MS-DRG,328,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Major small and large bowel procedures with MCC,329,MS-DRG,329,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Major small and large bowel procedures with CC,330,MS-DRG,330,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Major small and large bowel procedures without CC/MCC,331,MS-DRG,331,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Rectal resection with MCC,332,MS-DRG,332,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,,,,,,,,
Rectal resection with CC,333,MS-DRG,333,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,,,,,,,,
Rectal resection without CC/MCC,334,MS-DRG,334,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Peritoneal adhesiolysis with MCC,335,MS-DRG,335,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Peritoneal adhesiolysis with CC,336,MS-DRG,336,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Peritoneal adhesiolysis without CC/MCC,337,MS-DRG,337,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Minor small and large bowel procedures with MCC,344,MS-DRG,344,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Minor small and large bowel procedures with CC,345,MS-DRG,345,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,,,,,,,,
Minor small and large bowel procedures without CC/MCC,346,MS-DRG,346,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Anal and stomal procedures with MCC,347,MS-DRG,347,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,68366.59,Fee schedule,22000,120000,,,,,,,,
Anal and stomal procedures with CC,348,MS-DRG,348,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,,,,,,,,
Anal and stomal procedures without CC/MCC,349,MS-DRG,349,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Inguinal and femoral hernia procedures with MCC,350,MS-DRG,350,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,68366.59,Fee schedule,22000,120000,,,,,,,,
Inguinal and femoral hernia procedures with CC,351,MS-DRG,351,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,,,,,,,,
Inguinal and femoral hernia procedures without CC/MCC,352,MS-DRG,352,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Hernia procedures except inguinal and femoral with MCC,353,MS-DRG,353,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,,,,,,,,
Hernia procedures except inguinal and femoral with CC,354,MS-DRG,354,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,,,,,,,,
Hernia procedures except inguinal and femoral without CC/MCC,355,MS-DRG,355,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Other digestive system O.R. procedures with MCC,356,MS-DRG,356,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,106800.32,Fee schedule,22000,120000,,,,,,,,
Other digestive system O.R. procedures with CC,357,MS-DRG,357,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Other digestive system O.R. procedures without CC/MCC,358,MS-DRG,358,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Major esophageal disorders with MCC*,368,MS-DRG,368,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Major esophageal disorders with CC*,369,MS-DRG,369,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Major esophageal disorders without CC/MCC*,370,MS-DRG,370,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Major gastrointestinal disorders and peritoneal infections with MCC,371,MS-DRG,371,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,68366.59,Fee schedule,22000,120000,,,,,,,,
Major gastrointestinal disorders and peritoneal infections with CC,372,MS-DRG,372,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,,,,,,,,
Major gastrointestinal disorders and peritoneal infections without CC/MCC,373,MS-DRG,373,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Digestive malignancy with MCC*,374,MS-DRG,374,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Digestive malignancy with CC*,375,MS-DRG,375,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Digestive malignancy without CC/MCC*,376,MS-DRG,376,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Gastrointestinal hemorrhage with MCC,377,MS-DRG,377,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,54425.47,Fee schedule,22000,120000,,,,,,,,
Gastrointestinal hemorrhage with CC,378,MS-DRG,378,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Gastrointestinal hemorrhage without CC/MCC,379,MS-DRG,379,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Complicated peptic ulcer with MCC,380,MS-DRG,380,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,73278.88,Fee schedule,22000,120000,,,,,,,,
Complicated peptic ulcer with CC,381,MS-DRG,381,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Complicated peptic ulcer without CC/MCC,382,MS-DRG,382,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Uncomplicated peptic ulcer with MCC,383,MS-DRG,383,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Uncomplicated peptic ulcer without MCC,384,MS-DRG,384,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Inflammatory bowel disease with MCC,385,MS-DRG,385,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
Inflammatory bowel disease with CC,386,MS-DRG,386,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Inflammatory bowel disease without CC/MCC,387,MS-DRG,387,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Gastrointestinal obstruction with MCC,388,MS-DRG,388,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,75604.95,Fee schedule,22000,120000,,,,,,,,
Gastrointestinal obstruction with CC,389,MS-DRG,389,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Gastrointestinal obstruction without CC/MCC,390,MS-DRG,390,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC",391,MS-DRG,391,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,59253.6,Fee schedule,22000,120000,,,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC",392,MS-DRG,392,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,47929.3,Fee schedule,22000,120000,,,,,,,,
Other digestive system diagnoses with MCC,393,MS-DRG,393,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,77739.74,Fee schedule,22000,120000,,,,,,,,
Other digestive system diagnoses with CC,394,MS-DRG,394,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55022.29,Fee schedule,22000,120000,,,,,,,,
Other digestive system diagnoses without CC/MCC,395,MS-DRG,395,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Appendix procedures with MCC,397,MS-DRG,397,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,68366.59,Fee schedule,22000,120000,,,,,,,,
Appendix procedures with CC,398,MS-DRG,398,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,,,,,,,,
Appendix procedures without CC/MCC,399,MS-DRG,399,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Single level combined anterior and posterior spinal fusion except cervical,402,MS-DRG,402,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,,,,,,,,
"Pancreas, liver and shunt procedures with MCC",405,MS-DRG,405,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,40508.305,Fee schedule,22000,120000,,,,,,,,
"Pancreas, liver and shunt procedures with CC",406,MS-DRG,406,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
"Pancreas, liver and shunt procedures without CC/MCC",407,MS-DRG,407,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,4870.44,Fee schedule,22000,120000,,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with MCC,408,MS-DRG,408,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55022.29,Fee schedule,22000,120000,,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with CC,409,MS-DRG,409,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,4870.44,Fee schedule,22000,120000,,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. without CC/MCC,410,MS-DRG,410,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,4870.44,Fee schedule,22000,120000,,,,,,,,
Cholecystectomy with C.D.E. with MCC,411,MS-DRG,411,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,73278.88,Fee schedule,22000,120000,,,,,,,,
Cholecystectomy with C.D.E. with CC,412,MS-DRG,412,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Cholecystectomy with C.D.E. without CC/MCC,413,MS-DRG,413,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,4870.44,Fee schedule,22000,120000,,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with MCC,414,MS-DRG,414,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,73278.88,Fee schedule,22000,120000,,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with CC,415,MS-DRG,415,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55022.29,Fee schedule,22000,120000,,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. without CC/MCC,416,MS-DRG,416,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55022.29,Fee schedule,22000,120000,,,,,,,,
Laparoscopic cholecystectomy without C.D.E. with MCC,417,MS-DRG,417,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,73278.88,Fee schedule,22000,120000,,,,,,,,
Laparoscopic cholecystectomy without C.D.E. with CC,418,MS-DRG,418,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,,,,,,,,
Laparoscopic cholecystectomy without C.D.E. without CC/MCC,419,MS-DRG,419,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,,,,,,,,
Hepatobiliary diagnostic procedures with MCC,420,MS-DRG,420,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55022.29,Fee schedule,22000,120000,,,,,,,,
Hepatobiliary diagnostic procedures with CC,421,MS-DRG,421,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,4870.44,Fee schedule,22000,120000,,,,,,,,
Hepatobiliary diagnostic procedures without CC/MCC,422,MS-DRG,422,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,4870.44,Fee schedule,22000,120000,,,,,,,,
Other hepatobiliary or pancreas O.R. procedures with MCC,423,MS-DRG,423,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
Other hepatobiliary or pancreas O.R. procedures with CC,424,MS-DRG,424,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,4870.44,Fee schedule,22000,120000,,,,,,,,
Other hepatobiliary or pancreas O.R. procedures without CC/MCC,425,MS-DRG,425,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,4870.44,Fee schedule,22000,120000,,,,,,,,
Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,426,MS-DRG,426,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,81343.62,Fee schedule,22000,120000,,,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical with CC,427,MS-DRG,427,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,81343.62,Fee schedule,22000,120000,,,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical without CC/MCC,428,MS-DRG,428,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,67111.73,Fee schedule,22000,120000,,,,,,,,
Combined anterior and posterior cervical spinal fusion with MCC,429,MS-DRG,429,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,81343.62,Fee schedule,22000,120000,,,,,,,,
Combined anterior and posterior cervical spinal fusion without MCC,430,MS-DRG,430,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,,,,,,,,
Cirrhosis and alcoholic hepatitis with MCC,432,MS-DRG,432,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,56468.43,Fee schedule,22000,120000,,,,,,,,
Cirrhosis and alcoholic hepatitis with CC,433,MS-DRG,433,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Cirrhosis and alcoholic hepatitis without CC/MCC,434,MS-DRG,434,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Malignancy of hepatobiliary system or pancreas with MCC,435,MS-DRG,435,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Malignancy of hepatobiliary system or pancreas with CC,436,MS-DRG,436,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Malignancy of hepatobiliary system or pancreas without CC/MCC,437,MS-DRG,437,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Disorders of pancreas except malignancy with MCC,438,MS-DRG,438,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,80165.28,Fee schedule,22000,120000,,,,,,,,
Disorders of pancreas except malignancy with CC,439,MS-DRG,439,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Disorders of pancreas except malignancy without CC/MCC,440,MS-DRG,440,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCC",441,MS-DRG,441,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,71243.57,Fee schedule,22000,120000,,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CC",442,MS-DRG,442,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without CC/MCC",443,MS-DRG,443,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Disorders of the biliary tract with MCC*,444,MS-DRG,444,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,58190.03,Fee schedule,22000,120000,,,,,,,,
Disorders of the biliary tract with CC*,445,MS-DRG,445,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53147.66,Fee schedule,22000,120000,,,,,,,,
Disorders of the biliary tract without CC/MCC*,446,MS-DRG,446,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,447,MS-DRG,447,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,1.0631,Fee schedule,22000,120000,,,,,,,,
Multiple level spinal fusion except cervical without MCC,448,MS-DRG,448,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,1.0631,Fee schedule,22000,120000,,,,,,,,
Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,450,MS-DRG,450,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,67111.74,Fee schedule,22000,120000,,,,,,,,
Single Level Spinal Fusion Except Cervical without MCC,451,MS-DRG,451,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with MCC",456,MS-DRG,456,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with CC",457,MS-DRG,457,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions without CC/MCC",458,MS-DRG,458,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,,,,,,,,
Bilateral or multiple major joint procedures of lower extremity with MCC,461,MS-DRG,461,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,67111.74,Fee schedule,22000,120000,,,,,,,,
Bilateral or multiple major joint procedures of lower extremity without MCC,462,MS-DRG,462,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with MCC*,463,MS-DRG,463,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with CC*,464,MS-DRG,464,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72972.82,Fee schedule,22000,120000,,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders without CC/MCC*,465,MS-DRG,465,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,70057.58,Fee schedule,22000,120000,,,,,,,,
Revision of hip or knee replacement with MCC,466,MS-DRG,466,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
Revision of hip or knee replacement with CC,467,MS-DRG,467,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Revision of hip or knee replacement without CC/MCC,468,MS-DRG,468,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity with MCC or total ankle replacement,469,MS-DRG,469,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity without MCC,470,MS-DRG,470,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Cervical spinal fusion with MCC,471,MS-DRG,471,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,,,,,,,,
Cervical spinal fusion with CC,472,MS-DRG,472,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,,,,,,,,
Cervical spinal fusion without CC/MCC,473,MS-DRG,473,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with MCC,474,MS-DRG,474,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with CC,475,MS-DRG,475,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders without CC/MCC,476,MS-DRG,476,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Biopsies of musculoskeletal system and connective tissue with MCC,477,MS-DRG,477,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
Biopsies of musculoskeletal system and connective tissue with CC,478,MS-DRG,478,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,28146.902,Fee schedule,22000,120000,,,,,,,,
Biopsies of musculoskeletal system and connective tissue without CC/MCC,479,MS-DRG,479,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,28146.902,Fee schedule,22000,120000,,,,,,,,
Hip and femur procedures except major joint with MCC,480,MS-DRG,480,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Hip and femur procedures except major joint with CC,481,MS-DRG,481,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Hip and femur procedures except major joint without CC/MCC,482,MS-DRG,482,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Major joint or limb reattachment procedures of upper extremities,483,MS-DRG,483,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
Knee procedures with principal diagnosis of infection with MCC,485,MS-DRG,485,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
Knee procedures with principal diagnosis of infection with CC,486,MS-DRG,486,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Knee procedures with principal diagnosis of infection without CC/MCC,487,MS-DRG,487,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Knee procedures without principal diagnosis of infection with CC/MCC,488,MS-DRG,488,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Knee procedures without principal diagnosis of infection without CC/MCC,489,MS-DRG,489,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,51693.87,Fee schedule,22000,120000,,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with MCC",492,MS-DRG,492,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with CC",493,MS-DRG,493,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur without CC/MCC",494,MS-DRG,494,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Local excision and removal of internal fixation devices except hip and femur with MCC,495,MS-DRG,495,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
Local excision and removal of internal fixation devices except hip and femur with CC,496,MS-DRG,496,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Local excision and removal of internal fixation devices except hip and femur without CC/MCC,497,MS-DRG,497,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Local excision and removal of internal fixation devices of hip and femur with CC/MCC,498,MS-DRG,498,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
Local excision and removal of internal fixation devices of hip and femur without CC/MCC,499,MS-DRG,499,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
Soft tissue procedures with MCC,500,MS-DRG,500,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,94244.13,Fee schedule,22000,120000,,,,,,,,
Soft tissue procedures with CC,501,MS-DRG,501,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Soft tissue procedures without CC/MCC,502,MS-DRG,502,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,67111.74,Fee schedule,22000,120000,,,,,,,,
Foot procedures with MCC,503,MS-DRG,503,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Foot procedures with CC,504,MS-DRG,504,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Foot procedures without CC/MCC,505,MS-DRG,505,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Major thumb or joint procedures,506,MS-DRG,506,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Major shoulder or elbow joint procedures with CC/MCC,507,MS-DRG,507,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Major shoulder or elbow joint procedures without CC/MCC,508,MS-DRG,508,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Arthroscopy,509,MS-DRG,509,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with MCC",510,MS-DRG,510,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with CC",511,MS-DRG,511,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures without CC/MCC",512,MS-DRG,512,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures with CC/MCC",513,MS-DRG,513,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures without CC/MCC",514,MS-DRG,514,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with MCC,515,MS-DRG,515,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,91742.07,Fee schedule,22000,120000,,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with CC,516,MS-DRG,516,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures without CC/MCC,517,MS-DRG,517,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Back and neck procedures except spinal fusion with MCC or disc device or neurostimulator,518,MS-DRG,518,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
Back and neck procedures except spinal fusion with CC,519,MS-DRG,519,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
Back and neck procedures except spinal fusion without CC/MCC,520,MS-DRG,520,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,,,,,,,,
Hip replacement with principal diagnosis of hip fracture with MCC,521,MS-DRG,521,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,,,,,,,,
Hip replacement with principal diagnosis of hip fracture without MCC,522,MS-DRG,522,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Fractures of femur with MCC,533,MS-DRG,533,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,,,,,,,,
Fractures of femur without MCC,534,MS-DRG,534,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,,,,,,,,
Fractures of hip and pelvis with MCC,535,MS-DRG,535,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Fractures of hip and pelvis without MCC,536,MS-DRG,536,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh with CC/MCC",537,MS-DRG,537,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh without CC/MCC",538,MS-DRG,538,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Osteomyelitis with MCC*,539,MS-DRG,539,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,74166.46,Fee schedule,22000,120000,,,,,,,,
Osteomyelitis with CC*,540,MS-DRG,540,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,54425.47,Fee schedule,22000,120000,,,,,,,,
Osteomyelitis without CC/MCC*,541,MS-DRG,541,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,51693.86,Fee schedule,22000,120000,,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with MCC*,542,MS-DRG,542,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with CC*,543,MS-DRG,543,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy without CC/MCC*,544,MS-DRG,544,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Connective tissue disorders with MCC,545,MS-DRG,545,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Connective tissue disorders with CC,546,MS-DRG,546,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Connective tissue disorders without CC/MCC,547,MS-DRG,547,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46988.16,Fee schedule,22000,120000,,,,,,,,
Septic arthritis with MCC,548,MS-DRG,548,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,65145.29,Fee schedule,22000,120000,,,,,,,,
Septic arthritis with CC,549,MS-DRG,549,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Septic arthritis without CC/MCC,550,MS-DRG,550,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Medical back problems with MCC,551,MS-DRG,551,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,99921.58,Fee schedule,22000,120000,,,,,,,,
Medical back problems without MCC,552,MS-DRG,552,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Bone diseases and arthropathies with MCC,553,MS-DRG,553,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Bone diseases and arthropathies without MCC,554,MS-DRG,554,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue with MCC,555,MS-DRG,555,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue without MCC,556,MS-DRG,556,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
"Tendonitis, myositis and bursitis with MCC",557,MS-DRG,557,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,69284.76,Fee schedule,22000,120000,,,,,,,,
"Tendonitis, myositis and bursitis without MCC",558,MS-DRG,558,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53645.01,Fee schedule,22000,120000,,,,,,,,
"Aftercare, musculoskeletal system and connective tissue with MCC*",559,MS-DRG,559,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,61671.48,Fee schedule,22000,120000,,,,,,,,
"Aftercare, musculoskeletal system and connective tissue with CC*",560,MS-DRG,560,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48082.33,Fee schedule,22000,120000,,,,,,,,
"Aftercare, musculoskeletal system and connective tissue without CC/MCC*",561,MS-DRG,561,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46988.16,Fee schedule,22000,120000,,,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCC",562,MS-DRG,562,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCC",563,MS-DRG,563,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46988.16,Fee schedule,22000,120000,,,,,,,,
Other musculoskeletal system and connective tissue diagnoses with MCC,564,MS-DRG,564,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,67111.74,Fee schedule,22000,120000,,,,,,,,
Other musculoskeletal system and connective tissue diagnoses with CC,565,MS-DRG,565,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,,,,,,,,
Other musculoskeletal system and connective tissue diagnoses without CC/MCC,566,MS-DRG,566,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,,,,,,,,
Skin debridement with MCC*,570,MS-DRG,570,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,90081.68,Fee schedule,22000,120000,,,,,,,,
Skin debridement with CC*,571,MS-DRG,571,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,65336.58,Fee schedule,22000,120000,,,,,,,,
Skin debridement without CC/MCC*,572,MS-DRG,572,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,65336.58,Fee schedule,22000,120000,,,,,,,,
Skin graft for skin ulcer or cellulitis with MCC,573,MS-DRG,573,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,106394.79,Fee schedule,22000,120000,,,,,,,,
Skin graft for skin ulcer or cellulitis with CC,574,MS-DRG,574,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Skin graft for skin ulcer or cellulitis without CC/MCC,575,MS-DRG,575,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Skin graft except for skin ulcer or cellulitis with MCC*,576,MS-DRG,576,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Skin graft except for skin ulcer or cellulitis with CC*,577,MS-DRG,577,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Skin graft except for skin ulcer or cellulitis without CC/MCC*,578,MS-DRG,578,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
"Other skin, subcutaneous tissue and breast procedures with MCC",579,MS-DRG,579,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,103793.26,Fee schedule,22000,120000,,,,,,,,
"Other skin, subcutaneous tissue and breast procedures with CC",580,MS-DRG,580,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,85299.47,Fee schedule,22000,120000,,,,,,,,
"Other skin, subcutaneous tissue and breast procedures without CC/MCC",581,MS-DRG,581,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,85299.47,Fee schedule,22000,120000,,,,,,,,
Mastectomy for malignancy with CC/MCC,582,MS-DRG,582,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,103793.26,Fee schedule,22000,120000,,,,,,,,
Mastectomy for malignancy without CC/MCC,583,MS-DRG,583,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,85299.47,Fee schedule,22000,120000,,,,,,,,
"Breast biopsy, local excision and other breast procedures with CC/MCC",584,MS-DRG,584,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,65336.58,Fee schedule,22000,120000,,,,,,,,
"Breast biopsy, local excision and other breast procedures without CC/MCC",585,MS-DRG,585,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Skin ulcers with MCC,592,MS-DRG,592,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,67333.63,Fee schedule,22000,120000,,,,,,,,
Skin ulcers with CC,593,MS-DRG,593,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53667.96,Fee schedule,22000,120000,,,,,,,,
Skin ulcers without CC/MCC,594,MS-DRG,594,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Major skin disorders with MCC,595,MS-DRG,595,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Major skin disorders without MCC,596,MS-DRG,596,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Malignant breast disorders with MCC,597,MS-DRG,597,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Malignant breast disorders with CC,598,MS-DRG,598,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Malignant breast disorders without CC/MCC,599,MS-DRG,599,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Non-malignant breast disorders with CC/MCC*,600,MS-DRG,600,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Non-malignant breast disorders without CC/MCC*,601,MS-DRG,601,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Cellulitis with MCC,602,MS-DRG,602,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,55068.2,Fee schedule,22000,120000,,,,,,,,
Cellulitis without MCC,603,MS-DRG,603,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36842.21,Fee schedule,22000,120000,,,,,,,,
"Trauma to the skin, subcutaneous tissue and breast with MCC",604,MS-DRG,604,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
"Trauma to the skin, subcutaneous tissue and breast without MCC",605,MS-DRG,605,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Minor skin disorders with MCC,606,MS-DRG,606,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Minor skin disorders without MCC,607,MS-DRG,607,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Adrenal and pituitary procedures with CC/MCC,614,MS-DRG,614,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Adrenal and pituitary procedures without CC/MCC,615,MS-DRG,615,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with MCC",616,MS-DRG,616,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with CC",617,MS-DRG,617,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders without CC/MCC",618,MS-DRG,618,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
O.R. procedures for obesity with MCC,619,MS-DRG,619,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,100051.65,Fee schedule,22000,120000,,,,,,,,
O.R. procedures for obesity with CC,620,MS-DRG,620,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72590.25,Fee schedule,22000,120000,,,,,,,,
O.R. procedures for obesity without CC/MCC,621,MS-DRG,621,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with MCC",622,MS-DRG,622,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,100051.65,Fee schedule,22000,120000,,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with CC",623,MS-DRG,623,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72590.25,Fee schedule,22000,120000,,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders without CC/MCC",624,MS-DRG,624,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with MCC",625,MS-DRG,625,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,30309.826,Fee schedule,22000,120000,,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with CC",626,MS-DRG,626,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures without CC/MCC",627,MS-DRG,627,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with MCC",628,MS-DRG,628,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,30309.826,Fee schedule,22000,120000,,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with CC",629,MS-DRG,629,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures without CC/MCC",630,MS-DRG,630,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Diabetes with MCC,637,MS-DRG,637,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,67654.99,Fee schedule,22000,120000,,,,,,,,
Diabetes with CC,638,MS-DRG,638,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53843.95,Fee schedule,22000,120000,,,,,,,,
Diabetes without CC/MCC,639,MS-DRG,639,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCC",640,MS-DRG,640,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,74862.75,Fee schedule,22000,120000,,,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCC",641,MS-DRG,641,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,47049.37,Fee schedule,22000,120000,,,,,,,,
Inborn and other disorders of metabolism,642,MS-DRG,642,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Endocrine disorders with MCC*,643,MS-DRG,643,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
Endocrine disorders with CC*,644,MS-DRG,644,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Endocrine disorders without CC/MCC*,645,MS-DRG,645,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Major bladder procedures with MCC,653,MS-DRG,653,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,91596.69,Fee schedule,22000,120000,,,,,,,,
Major bladder procedures with CC,654,MS-DRG,654,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,80073.46,Fee schedule,22000,120000,,,,,,,,
Major bladder procedures without CC/MCC,655,MS-DRG,655,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Kidney and ureter procedures for neoplasm with MCC,656,MS-DRG,656,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Kidney and ureter procedures for neoplasm with CC,657,MS-DRG,657,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Kidney and ureter procedures for neoplasm without CC/MCC,658,MS-DRG,658,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Kidney and ureter procedures for non-neoplasm with MCC*,659,MS-DRG,659,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Kidney and ureter procedures for non-neoplasm with CC*,660,MS-DRG,660,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Kidney and ureter procedures for non-neoplasm without CC/MCC*,661,MS-DRG,661,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Minor bladder procedures with MCC,662,MS-DRG,662,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Minor bladder procedures with CC,663,MS-DRG,663,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Minor bladder procedures without CC/MCC,664,MS-DRG,664,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Prostatectomy with MCC,665,MS-DRG,665,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,91596.69,Fee schedule,22000,120000,,,,,,,,
Prostatectomy with CC,666,MS-DRG,666,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,80073.46,Fee schedule,22000,120000,,,,,,,,
Prostatectomy without CC/MCC,667,MS-DRG,667,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Transurethral procedures with MCC,668,MS-DRG,668,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Transurethral procedures with CC,669,MS-DRG,669,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Transurethral procedures without CC/MCC,670,MS-DRG,670,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Urethral procedures with CC/MCC,671,MS-DRG,671,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Urethral procedures without CC/MCC,672,MS-DRG,672,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,,,,,,,,
Other kidney and urinary tract procedures with MCC*,673,MS-DRG,673,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,91596.69,Fee schedule,22000,120000,,,,,,,,
Other kidney and urinary tract procedures with CC*,674,MS-DRG,674,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,80073.46,Fee schedule,22000,120000,,,,,,,,
Other kidney and urinary tract procedures without CC/MCC*,675,MS-DRG,675,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,80073.46,Fee schedule,22000,120000,,,,,,,,
Renal failure with MCC,682,MS-DRG,682,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,66775.07,Fee schedule,22000,120000,,,,,,,,
Renal failure with CC,683,MS-DRG,683,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,46314.82,Fee schedule,22000,120000,,,,,,,,
Renal failure without CC/MCC,684,MS-DRG,684,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Kidney and urinary tract neoplasms with MCC,686,MS-DRG,686,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Kidney and urinary tract neoplasms with CC,687,MS-DRG,687,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Kidney and urinary tract neoplasms without CC/MCC,688,MS-DRG,688,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,,,,,,,,
Kidney and urinary tract infections with MCC,689,MS-DRG,689,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48342.49,Fee schedule,22000,120000,,,,,,,,
Kidney and urinary tract infections without MCC,690,MS-DRG,690,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,35962.28,Fee schedule,22000,120000,,,,,,,,
Urinary stones with MCC,693,MS-DRG,693,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,,,,,,,,
Urinary stones without MCC,694,MS-DRG,694,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,,,,,,,,
Kidney and urinary tract signs and symptoms with MCC,695,MS-DRG,695,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Kidney and urinary tract signs and symptoms without MCC,696,MS-DRG,696,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Urethral stricture,697,MS-DRG,697,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,,,,,,,,
Other kidney and urinary tract diagnoses with MCC,698,MS-DRG,698,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,67746.82,Fee schedule,22000,120000,,,,,,,,
Other kidney and urinary tract diagnoses with CC,699,MS-DRG,699,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,47363.09,Fee schedule,22000,120000,,,,,,,,
Other kidney and urinary tract diagnoses without CC/MCC,700,MS-DRG,700,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Major male pelvic procedures with CC/MCC,707,MS-DRG,707,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
Major male pelvic procedures without CC/MCC,708,MS-DRG,708,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Penis procedures with CC/MCC,709,MS-DRG,709,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
Penis procedures without CC/MCC,710,MS-DRG,710,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Testes procedures with CC/MCC,711,MS-DRG,711,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
Testes procedures without CC/MCC,712,MS-DRG,712,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Transurethral prostatectomy with CC/MCC,713,MS-DRG,713,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,30309.826,Fee schedule,22000,120000,,,,,,,,
Transurethral prostatectomy without CC/MCC,714,MS-DRG,714,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Other male reproductive system O.R. procedures for malignancy with CC/MCC,715,MS-DRG,715,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
Other male reproductive system O.R. procedures for malignancy without CC/MCC,716,MS-DRG,716,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Other male reproductive system O.R. procedures except malignancy with CC/MCC,717,MS-DRG,717,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
Other male reproductive system O.R. procedures except malignancy without CC/MCC,718,MS-DRG,718,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
"Malignancy, male reproductive system with MCC",722,MS-DRG,722,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,61794.07,Fee schedule,22000,120000,,,,,,,,
"Malignancy, male reproductive system with CC",723,MS-DRG,723,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
"Malignancy, male reproductive system without CC/MCC",724,MS-DRG,724,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,50278,Fee schedule,22000,120000,,,,,,,,
Benign prostatic hypertrophy with MCC,725,MS-DRG,725,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,50278.46,Fee schedule,22000,120000,,,,,,,,
Benign prostatic hypertrophy without MCC,726,MS-DRG,726,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Inflammation of the male reproductive system with MCC,727,MS-DRG,727,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,61794.07,Fee schedule,22000,120000,,,,,,,,
Inflammation of the male reproductive system without MCC,728,MS-DRG,728,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,50278,Fee schedule,22000,120000,,,,,,,,
Other male reproductive system diagnoses with CC/MCC,729,MS-DRG,729,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Other male reproductive system diagnoses without CC/MCC,730,MS-DRG,730,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC",734,MS-DRG,734,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC",735,MS-DRG,735,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with MCC,736,MS-DRG,736,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with CC,737,MS-DRG,737,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy without CC/MCC,738,MS-DRG,738,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with MCC,739,MS-DRG,739,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with CC,740,MS-DRG,740,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy without CC/MCC,741,MS-DRG,741,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Uterine and adnexa procedures for non-malignancy with CC/MCC,742,MS-DRG,742,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Uterine and adnexa procedures for non-malignancy without CC/MCC,743,MS-DRG,743,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
"D&C, conization, laparoscopy and tubal interruption with CC/MCC",744,MS-DRG,744,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
"D&C, conization, laparoscopy and tubal interruption without CC/MCC",745,MS-DRG,745,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
"Vagina, cervix and vulva procedures with CC/MCC",746,MS-DRG,746,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
"Vagina, cervix and vulva procedures without CC/MCC",747,MS-DRG,747,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Female reproductive system reconstructive procedures,748,MS-DRG,748,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Other female reproductive system O.R. procedures with CC/MCC,749,MS-DRG,749,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Other female reproductive system O.R. procedures without CC/MCC,750,MS-DRG,750,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
"Malignancy, female reproductive system with MCC",754,MS-DRG,754,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
"Malignancy, female reproductive system with CC",755,MS-DRG,755,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
"Malignancy, female reproductive system without CC/MCC",756,MS-DRG,756,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
"Infections, female reproductive system with MCC",757,MS-DRG,757,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,29854.136,Fee schedule,22000,120000,,,,,,,,
"Infections, female reproductive system with CC",758,MS-DRG,758,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
"Infections, female reproductive system without CC/MCC",759,MS-DRG,759,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Menstrual and other female reproductive system disorders with CC/MCC,760,MS-DRG,760,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,71182.55,Fee schedule,22000,120000,,,,,,,,
Menstrual and other female reproductive system disorders without CC/MCC,761,MS-DRG,761,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Vaginal delivery with O.R. procedures except sterilization and/or D&C,768,MS-DRG,768,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Postpartum and post abortion diagnoses with O.R. procedures,769,MS-DRG,769,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,71182.55,Fee schedule,22000,120000,,,,,,,,
"Abortion with D&C, aspiration curettage or hysterotomy",770,MS-DRG,770,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,71182.55,Fee schedule,22000,120000,,,,,,,,
Postpartum and post abortion diagnoses without O.R. procedures,776,MS-DRG,776,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Abortion without D&C,779,MS-DRG,779,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Cesarean section with sterilization with MCC,783,MS-DRG,783,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Cesarean section with sterilization with CC,784,MS-DRG,784,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,90613.37,Fee schedule,22000,120000,,,,,,,,
Cesarean section with sterilization without CC/MCC,785,MS-DRG,785,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Cesarean section without sterilization with MCC,786,MS-DRG,786,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Cesarean section without sterilization with CC,787,MS-DRG,787,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Cesarean section without sterilization without CC/MCC,788,MS-DRG,788,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
"Neonates, died or transferred to another acute care facility",789,MS-DRG,789,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
"Extreme immaturity or respiratory distress syndrome, neonate",790,MS-DRG,790,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,71182.55,Fee schedule,22000,120000,,,,,,,,
Prematurity with major problems,791,MS-DRG,791,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,71182.55,Fee schedule,22000,120000,,,,,,,,
Prematurity without major problems,792,MS-DRG,792,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48921.03,Fee schedule,22000,120000,,,,,,,,
Full term neonate with major problems,793,MS-DRG,793,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,71182.55,Fee schedule,22000,120000,,,,,,,,
Neonate with other significant problems,794,MS-DRG,794,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48921.03,Fee schedule,22000,120000,,,,,,,,
Splenic procedures with MCC,799,MS-DRG,799,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,106800.6,Fee schedule,22000,120000,,,,,,,,
Splenic procedures with CC,800,MS-DRG,800,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48921.03,Fee schedule,22000,120000,,,,,,,,
Splenic procedures without CC/MCC,801,MS-DRG,801,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Other O.R. procedures of the blood and blood forming organs with MCC,802,MS-DRG,802,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Other O.R. procedures of the blood and blood forming organs with CC,803,MS-DRG,803,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Other O.R. procedures of the blood and blood forming organs without CC/MCC,804,MS-DRG,804,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with MCC,808,MS-DRG,808,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with CC,809,MS-DRG,809,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without CC/MCC,810,MS-DRG,810,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Red blood cell disorders with MCC,811,MS-DRG,811,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,71182.55,Fee schedule,22000,120000,,,,,,,,
Red blood cell disorders without MCC,812,MS-DRG,812,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Coagulation disorders,813,MS-DRG,813,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Reticuloendothelial and immunity disorders with MCC*,814,MS-DRG,814,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Reticuloendothelial and immunity disorders with CC*,815,MS-DRG,815,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Reticuloendothelial and immunity disorders without CC/MCC*,816,MS-DRG,816,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Other antepartum diagnoses with O.R. procedures with MCC,817,MS-DRG,817,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,40508.305,Fee schedule,22000,120000,,,,,,,,
Other antepartum diagnoses with O.R. procedures with CC,818,MS-DRG,818,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
Other antepartum diagnoses with O.R. procedures without CC/MCC,819,MS-DRG,819,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Lymphoma and leukemia with major O.R. procedures with MCC,820,MS-DRG,820,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Lymphoma and leukemia with major O.R. procedures with CC,821,MS-DRG,821,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Lymphoma and leukemia with major O.R. procedures without CC/MCC,822,MS-DRG,822,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96210.83,Fee schedule,22000,120000,,,,,,,,
Lymphoma and non-acute leukemia with other procedures with MCC,823,MS-DRG,823,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Lymphoma and non-acute leukemia with other procedures with CC,824,MS-DRG,824,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Lymphoma and non-acute leukemia with other procedures without CC/MCC,825,MS-DRG,825,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with MCC,826,MS-DRG,826,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with CC,827,MS-DRG,827,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures without CC/MCC,828,MS-DRG,828,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96210.83,Fee schedule,22000,120000,,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures with CC/MCC,829,MS-DRG,829,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures without CC/MCC,830,MS-DRG,830,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Other antepartum diagnoses without O.R. procedures with MCC,831,MS-DRG,831,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,71182.55,Fee schedule,22000,120000,,,,,,,,
Other antepartum diagnoses without O.R. procedures with CC,832,MS-DRG,832,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Other antepartum diagnoses without O.R. procedures without CC/MCC,833,MS-DRG,833,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Acute leukemia with MCC,834,MS-DRG,834,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Acute leukemia with CC,835,MS-DRG,835,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Acute leukemia without CC/MCC,836,MS-DRG,836,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy agent with MCC,837,MS-DRG,837,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapy agent,838,MS-DRG,838,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis without CC/MCC,839,MS-DRG,839,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Lymphoma and non-acute leukemia with MCC,840,MS-DRG,840,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Lymphoma and non-acute leukemia with CC,841,MS-DRG,841,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Lymphoma and non-acute leukemia without CC/MCC,842,MS-DRG,842,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with MCC,843,MS-DRG,843,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with CC,844,MS-DRG,844,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses without CC/MCC,845,MS-DRG,845,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with MCC,846,MS-DRG,846,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with CC,847,MS-DRG,847,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis without CC/MCC,848,MS-DRG,848,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Radiotherapy,849,MS-DRG,849,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Acute leukemia with other procedures,850,MS-DRG,850,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Infectious and parasitic diseases with O.R. procedures with MCC,853,MS-DRG,853,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,116013.09,Fee schedule,22000,120000,,,,,,,,
Infectious and parasitic diseases with O.R. procedures with CC,854,MS-DRG,854,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.07,Fee schedule,22000,120000,,,,,,,,
Infectious and parasitic diseases with O.R. procedures without CC/MCC,855,MS-DRG,855,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with MCC,856,MS-DRG,856,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,103112.54,Fee schedule,22000,120000,,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with CC,857,MS-DRG,857,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures without CC/MCC,858,MS-DRG,858,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Postoperative and post-traumatic infections with MCC,862,MS-DRG,862,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,70501.55,Fee schedule,22000,120000,,,,,,,,
Postoperative and post-traumatic infections without MCC,863,MS-DRG,863,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,47554.5,Fee schedule,22000,120000,,,,,,,,
Fever and inflammatory conditions,864,MS-DRG,864,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Viral illness with MCC,865,MS-DRG,865,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Viral illness without MCC,866,MS-DRG,866,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Other infectious and parasitic diseases diagnoses with MCC,867,MS-DRG,867,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,70118.98,Fee schedule,22000,120000,,,,,,,,
Other infectious and parasitic diseases diagnoses with CC,868,MS-DRG,868,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Other infectious and parasitic diseases diagnoses without CC/MCC,869,MS-DRG,869,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Septicemia or severe sepsis with MV >96 hours,870,MS-DRG,870,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,158548.16,Fee schedule,22000,120000,,,,,,,,
Septicemia or severe sepsis without MV >96 hours with MCC,871,MS-DRG,871,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,64954.17,Fee schedule,22000,120000,,,,,,,,
Septicemia or severe sepsis without MV >96 hours without MCC,872,MS-DRG,872,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,43522.12,Fee schedule,22000,120000,,,,,,,,
Wound debridements for injuries with MCC,901,MS-DRG,901,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,98177.28,Fee schedule,22000,120000,,,,,,,,
Wound debridements for injuries with CC,902,MS-DRG,902,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
Wound debridements for injuries without CC/MCC,903,MS-DRG,903,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
Skin grafts for injuries with CC/MCC,904,MS-DRG,904,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
Skin grafts for injuries without CC/MCC,905,MS-DRG,905,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
Hand procedures for injuries,906,MS-DRG,906,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Other O.R. procedures for injuries with MCC*,907,MS-DRG,907,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96210.83,Fee schedule,22000,120000,,,,,,,,
Other O.R. procedures for injuries with CC*,908,MS-DRG,908,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96210.83,Fee schedule,22000,120000,,,,,,,,
Other O.R. procedures for injuries without CC/MCC*,909,MS-DRG,909,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Traumatic injury with MCC,913,MS-DRG,913,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Traumatic injury without MCC,914,MS-DRG,914,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Allergic reactions with MCC,915,MS-DRG,915,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Allergic reactions without MCC,916,MS-DRG,916,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Poisoning and toxic effects of drugs with MCC,917,MS-DRG,917,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Poisoning and toxic effects of drugs without MCC,918,MS-DRG,918,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Complications of treatment with MCC,919,MS-DRG,919,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,82055.43,Fee schedule,22000,120000,,,,,,,,
Complications of treatment with CC,920,MS-DRG,920,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52581.58,Fee schedule,22000,120000,,,,,,,,
Complications of treatment without CC/MCC,921,MS-DRG,921,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
"Other injury, poisoning and toxic effect diagnoses with MCC",922,MS-DRG,922,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
"Other injury, poisoning and toxic effect diagnoses without MCC",923,MS-DRG,923,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Extensive burns or full thickness burns with MV >96 hours with skin graft,927,MS-DRG,927,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
Full thickness burn with skin graft or inhalation injury with CC/MCC,928,MS-DRG,928,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
Full thickness burn with skin graft or inhalation injury without CC/MCC,929,MS-DRG,929,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
Extensive burns or full thickness burns with MV >96 hours without skin graft,933,MS-DRG,933,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Full thickness burn without skin graft or inhalation injury,934,MS-DRG,934,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
Non-extensive burns,935,MS-DRG,935,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
O.R. procedures with diagnoses of other contact with health services with MCC,939,MS-DRG,939,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,90701.7,Fee schedule,22000,120000,,,,,,,,
O.R. procedures with diagnoses of other contact with health services with CC,940,MS-DRG,940,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
O.R. procedures with diagnoses of other contact with health services without CC/MCC,941,MS-DRG,941,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,,,,,,,,
Signs and symptoms with MCC,947,MS-DRG,947,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Signs and symptoms without MCC,948,MS-DRG,948,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Aftercare with CC/MCC,949,MS-DRG,949,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,53224.31,Fee schedule,22000,120000,,,,,,,,
Aftercare without CC/MCC,950,MS-DRG,950,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Other factors influencing health status,951,MS-DRG,951,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Craniotomy for multiple significant trauma,955,MS-DRG,955,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96210.83,Fee schedule,22000,120000,,,,,,,,
"Limb reattachment, hip and femur procedures for multiple significant trauma",956,MS-DRG,956,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96210.83,Fee schedule,22000,120000,,,,,,,,
Other O.R. procedures for multiple significant trauma with MCC,957,MS-DRG,957,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96210.83,Fee schedule,22000,120000,,,,,,,,
Other O.R. procedures for multiple significant trauma with CC,958,MS-DRG,958,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96210.83,Fee schedule,22000,120000,,,,,,,,
Other O.R. procedures for multiple significant trauma without CC/MCC,959,MS-DRG,959,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,,,,,,,,
Other multiple significant trauma with MCC,963,MS-DRG,963,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
Other multiple significant trauma with CC,964,MS-DRG,964,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
Other multiple significant trauma without CC/MCC,965,MS-DRG,965,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,,,,,,,,
HIV with extensive O.R. procedures with MCC,969,MS-DRG,969,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
HIV with extensive O.R. procedures without MCC,970,MS-DRG,970,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,,,,,,,,
HIV with major related condition with MCC*,974,MS-DRG,974,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,87197.28,Fee schedule,22000,120000,,,,,,,,
HIV with major related condition with CC*,975,MS-DRG,975,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,68412.68,Fee schedule,22000,120000,,,,,,,,
HIV with major related condition without CC/MCC*,976,MS-DRG,976,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,68412.68,Fee schedule,22000,120000,,,,,,,,
HIV with or without other related condition,977,MS-DRG,977,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with MCC,981,MS-DRG,981,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,68449.825,Fee schedule,22000,120000,,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with CC,982,MS-DRG,982,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,96991.29,Fee schedule,22000,120000,,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,983,MS-DRG,983,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with MCC,987,MS-DRG,987,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,163207.97,Fee schedule,22000,120000,,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with CC,988,MS-DRG,988,LOCAL,,Inpatient,,,,,Anthem Blue Cross Medi-cal,Medicaid,,,MS-DRG,72269.07,Fee schedule,22000,120000,,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,989,MS-DRG,989,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.07,Per Diem,22000,120000,,,,,,,,
"ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck with major O.R. procedures",3,MS-DRG,3,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,310277.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck without major O.R. procedures",4,MS-DRG,4,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,229767.96,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCC",11,MS-DRG,11,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CC",12,MS-DRG,12,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy without CC/MCC",13,MS-DRG,13,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chimeric antigen receptor (CAR) T-cell and other immunotherapies,18,MS-DRG,18,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with MCC,20,MS-DRG,20,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with CC,21,MS-DRG,21,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage without CC/MCC,22,MS-DRG,22,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC or chemotherapy implant or epilepsy with neurostimulator,23,MS-DRG,23,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis without MCC,24,MS-DRG,24,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Craniotomy and endovascular intracranial procedures with MCC,25,MS-DRG,25,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Craniotomy and endovascular intracranial procedures with CC,26,MS-DRG,26,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Craniotomy and endovascular intracranial procedures without CC/MCC,27,MS-DRG,27,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Spinal procedures with MCC,28,MS-DRG,28,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Spinal procedures with CC or spinal neurostimulators,29,MS-DRG,29,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Spinal procedures without CC/MCC,30,MS-DRG,30,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Ventricular shunt procedures with MCC,31,MS-DRG,31,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Ventricular shunt procedures with CC,32,MS-DRG,32,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Ventricular shunt procedures without CC/MCC,33,MS-DRG,33,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Carotid artery stent procedures with MCC,34,MS-DRG,34,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Carotid artery stent procedures with CC,35,MS-DRG,35,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Carotid artery stent procedures without CC/MCC,36,MS-DRG,36,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extracranial procedures with MCC,37,MS-DRG,37,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extracranial procedures with CC,38,MS-DRG,38,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extracranial procedures without CC/MCC,39,MS-DRG,39,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with MCC",40,MS-DRG,40,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,95774.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurostimulator",41,MS-DRG,41,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures without CC/MCC",42,MS-DRG,42,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Spinal disorders and injuries with CC/MCC,52,MS-DRG,52,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,82942.79,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Spinal disorders and injuries without CC/MCC,53,MS-DRG,53,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,81228.84,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nervous system neoplasms with MCC,54,MS-DRG,54,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nervous system neoplasms without MCC,55,MS-DRG,55,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Degenerative nervous system disorders with MCC,56,MS-DRG,56,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,61411.33,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Degenerative nervous system disorders without MCC,57,MS-DRG,57,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,51678.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Multiple sclerosis and cerebellar ataxia with MCC,58,MS-DRG,58,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Multiple sclerosis and cerebellar ataxia with CC,59,MS-DRG,59,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,51678.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Multiple sclerosis and cerebellar ataxia without CC/MCC,60,MS-DRG,60,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,51678.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with MCC",61,MS-DRG,61,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,111192.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with CC",62,MS-DRG,62,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent without CC/MCC",63,MS-DRG,63,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Intracranial hemorrhage or cerebral infarction with MCC,64,MS-DRG,64,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,111192.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Intracranial hemorrhage or cerebral infarction with CC or tPA in 24 hours,65,MS-DRG,65,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Intracranial hemorrhage or cerebral infarction without CC/MCC,66,MS-DRG,66,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nonspecific CVA and precerebral occlusion without infarction with MCC,67,MS-DRG,67,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,66767.42,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nonspecific CVA and precerebral occlusion without infarction without MCC,68,MS-DRG,68,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Transient ischemia without thrombolytic,69,MS-DRG,69,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nonspecific cerebrovascular disorders with MCC*,70,MS-DRG,70,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,66767.42,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nonspecific cerebrovascular disorders with CC*,71,MS-DRG,71,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,45128.84,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nonspecific cerebrovascular disorders without CC/MCC*,72,MS-DRG,72,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cranial and peripheral nerve disorders with MCC,73,MS-DRG,73,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cranial and peripheral nerve disorders without MCC,74,MS-DRG,74,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Viral meningitis with CC/MCC,75,MS-DRG,75,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Viral meningitis without CC/MCC,76,MS-DRG,76,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hypertensive encephalopathy with MCC,77,MS-DRG,77,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,68160,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hypertensive encephalopathy with CC,78,MS-DRG,78,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,537909.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hypertensive encephalopathy without CC/MCC,79,MS-DRG,79,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nontraumatic stupor and coma with MCC,80,MS-DRG,80,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nontraumatic stupor and coma without MCC,81,MS-DRG,81,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Traumatic stupor and coma >1 hour with MCC*,82,MS-DRG,82,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,82529.13,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Traumatic stupor and coma >1 hour with CC*,83,MS-DRG,83,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,62451.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Traumatic stupor and coma >1 hour without CC/MCC*,84,MS-DRG,84,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Traumatic stupor and coma <1 hour with MCC,85,MS-DRG,85,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,62451.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Traumatic stupor and coma <1 hour with CC,86,MS-DRG,86,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,62451.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Traumatic stupor and coma <1 hour without CC/MCC,87,MS-DRG,87,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Concussion with MCC,88,MS-DRG,88,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,68160,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Concussion with CC,89,MS-DRG,89,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,537909.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Concussion without CC/MCC,90,MS-DRG,90,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other disorders of nervous system with MCC,91,MS-DRG,91,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,68160,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other disorders of nervous system with CC,92,MS-DRG,92,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,537909.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other disorders of nervous system without CC/MCC,93,MS-DRG,93,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,51678.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bacterial and tuberculous infections of nervous system with MCC*,94,MS-DRG,94,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34375.739,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bacterial and tuberculous infections of nervous system with CC*,95,MS-DRG,95,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,62451.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bacterial and tuberculous infections of nervous system without CC/MCC*,96,MS-DRG,96,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Non-bacterial infection of nervous system except viral meningitis with MCC,97,MS-DRG,97,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,75054.04,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Non-bacterial infection of nervous system except viral meningitis with CC,98,MS-DRG,98,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Non-bacterial infection of nervous system except viral meningitis without CC/MCC,99,MS-DRG,99,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Seizures with MCC,100,MS-DRG,100,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Seizures without MCC,101,MS-DRG,101,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Headaches with MCC,102,MS-DRG,102,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Headaches without MCC,103,MS-DRG,103,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Orbital procedures with CC/MCC,113,MS-DRG,113,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Orbital procedures without CC/MCC,114,MS-DRG,114,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extraocular procedures except orbit,115,MS-DRG,115,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Intraocular procedures with CC/MCC,116,MS-DRG,116,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Intraocular procedures without CC/MCC,117,MS-DRG,117,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute major eye infections with CC/MCC,121,MS-DRG,121,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute major eye infections without CC/MCC,122,MS-DRG,122,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Neurological eye disorders,123,MS-DRG,123,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other disorders of the eye with MCC or thrombolytic agent,124,MS-DRG,124,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other disorders of the eye without MCC,125,MS-DRG,125,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Sinus and mastoid procedures with CC/MCC,135,MS-DRG,135,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Sinus and mastoid procedures without CC/MCC,136,MS-DRG,136,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Mouth procedures with CC/MCC,137,MS-DRG,137,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Mouth procedures without CC/MCC,138,MS-DRG,138,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Salivary gland procedures,139,MS-DRG,139,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major head and neck procedures with MCC,140,MS-DRG,140,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,177508.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major head and neck procedures with CC,141,MS-DRG,141,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major head and neck procedures without CC/MCC,142,MS-DRG,142,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with MCC",143,MS-DRG,143,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with CC",144,MS-DRG,144,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures without CC/MCC",145,MS-DRG,145,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Ear, nose, mouth and throat malignancy with MCC*",146,MS-DRG,146,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Ear, nose, mouth and throat malignancy with CC*",147,MS-DRG,147,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Ear, nose, mouth and throat malignancy without CC/MCC*",148,MS-DRG,148,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Dysequilibrium,149,MS-DRG,149,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Epistaxis with MCC,150,MS-DRG,150,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Epistaxis without MCC,151,MS-DRG,151,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Otitis media and URI with MCC,152,MS-DRG,152,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Otitis media and URI without MCC,153,MS-DRG,153,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other ear, nose, mouth and throat diagnoses with MCC",154,MS-DRG,154,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other ear, nose, mouth and throat diagnoses with CC",155,MS-DRG,155,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other ear, nose, mouth and throat diagnoses without CC/MCC",156,MS-DRG,156,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Dental and oral diseases with MCC,157,MS-DRG,157,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Dental and oral diseases with CC,158,MS-DRG,158,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Dental and oral diseases without CC/MCC,159,MS-DRG,159,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major chest procedures with MCC,163,MS-DRG,163,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,202666.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major chest procedures with CC,164,MS-DRG,164,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,202666.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major chest procedures without CC/MCC,165,MS-DRG,165,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,202666.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other respiratory system O.R. procedures with MCC,166,MS-DRG,166,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,177508.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other respiratory system O.R. procedures with CC,167,MS-DRG,167,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other respiratory system O.R. procedures without CC/MCC,168,MS-DRG,168,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism,173,MS-DRG,173,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pulmonary embolism with MCC or acute cor pulmonale,175,MS-DRG,175,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pulmonary embolism without MCC,176,MS-DRG,176,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory infections and inflammations with MCC*,177,MS-DRG,177,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,62918.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory infections and inflammations with CC*,178,MS-DRG,178,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,43491.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory infections and inflammations without CC/MCC*,179,MS-DRG,179,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,42251.85,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory neoplasms with MCC*,180,MS-DRG,180,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory neoplasms with CC*,181,MS-DRG,181,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory neoplasms without CC/MCC*,182,MS-DRG,182,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major chest trauma with MCC,183,MS-DRG,183,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major chest trauma with CC,184,MS-DRG,184,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major chest trauma without CC/MCC,185,MS-DRG,185,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pleural effusion with MCC*,186,MS-DRG,186,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,66071.13,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pleural effusion with CC*,187,MS-DRG,187,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pleural effusion without CC/MCC*,188,MS-DRG,188,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pulmonary edema and respiratory failure,189,MS-DRG,189,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72046.99,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chronic obstructive pulmonary disease with MCC*,190,MS-DRG,190,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,20971.383,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chronic obstructive pulmonary disease with CC*,191,MS-DRG,191,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chronic obstructive pulmonary disease without CC/MCC*,192,MS-DRG,192,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Simple pneumonia and pleurisy with MCC,193,MS-DRG,193,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,59421.93,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Simple pneumonia and pleurisy with CC,194,MS-DRG,194,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,39604.42,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Simple pneumonia and pleurisy without CC/MCC,195,MS-DRG,195,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Interstitial lung disease with MCC*,196,MS-DRG,196,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Interstitial lung disease with CC*,197,MS-DRG,197,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Interstitial lung disease without CC/MCC*,198,MS-DRG,198,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pneumothorax with MCC,199,MS-DRG,199,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pneumothorax with CC,200,MS-DRG,200,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,21869.927,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pneumothorax without CC/MCC,201,MS-DRG,201,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,21869.927,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bronchitis and asthma with CC/MCC,202,MS-DRG,202,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,40508.305,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bronchitis and asthma without CC/MCC,203,MS-DRG,203,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,15339.435,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory signs and symptoms,204,MS-DRG,204,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other respiratory system diagnoses with MCC,205,MS-DRG,205,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,112102.84,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other respiratory system diagnoses without MCC,206,MS-DRG,206,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory system diagnosis with ventilator support >96 hours,207,MS-DRG,207,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,147720.8,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory system diagnosis with ventilator support <=96 hours,208,MS-DRG,208,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,81481.35,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Concomitant aortic and mitral valve procedures,212,MS-DRG,212,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other heart assist system implant,215,MS-DRG,215,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC,216,MS-DRG,216,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with CC,217,MS-DRG,217,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization without CC/MCC,218,MS-DRG,218,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with MCC,219,MS-DRG,219,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with CC,220,MS-DRG,220,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization without CC/MCC,221,MS-DRG,221,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other cardiothoracic procedures with MCC,228,MS-DRG,228,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other cardiothoracic procedures without MCC,229,MS-DRG,229,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary bypass with PTCA with MCC,231,MS-DRG,231,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary bypass with PTCA without MCC,232,MS-DRG,232,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary bypass with cardiac catheterization or open ablation with MCC,233,MS-DRG,233,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary bypass with cardiac catheterization or open ablation without MCC,234,MS-DRG,234,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary bypass without cardiac catheterization with MCC,235,MS-DRG,235,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary bypass without cardiac catheterization without MCC,236,MS-DRG,236,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Amputation for circulatory system disorders except upper limb and toe with MCC,239,MS-DRG,239,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Amputation for circulatory system disorders except upper limb and toe with CC,240,MS-DRG,240,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Amputation for circulatory system disorders except upper limb and toe without CC/MCC,241,MS-DRG,241,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Permanent cardiac pacemaker implant with MCC,242,MS-DRG,242,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Permanent cardiac pacemaker implant with CC,243,MS-DRG,243,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Permanent cardiac pacemaker implant without CC/MCC,244,MS-DRG,244,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
AICD generator procedures,245,MS-DRG,245,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,40774.659,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Percutaneous cardiovascular procedures without intraluminal device with MCC,250,MS-DRG,250,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Percutaneous cardiovascular procedures without intraluminal device without MCC,251,MS-DRG,251,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other vascular procedures with MCC,252,MS-DRG,252,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other vascular procedures with CC,253,MS-DRG,253,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other vascular procedures without CC/MCC,254,MS-DRG,254,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Upper limb and toe amputation for circulatory system disorders with MCC,255,MS-DRG,255,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Upper limb and toe amputation for circulatory system disorders with CC,256,MS-DRG,256,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Upper limb and toe amputation for circulatory system disorders without CC/MCC,257,MS-DRG,257,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac pacemaker device replacement with MCC,258,MS-DRG,258,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac pacemaker device replacement without MCC,259,MS-DRG,259,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac pacemaker revision except device replacement with MCC,260,MS-DRG,260,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac pacemaker revision except device replacement with CC,261,MS-DRG,261,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac pacemaker revision except device replacement without CC/MCC,262,MS-DRG,262,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Vein ligation and stripping,263,MS-DRG,263,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other circulatory system O.R. procedures,264,MS-DRG,264,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
AICD lead procedures,265,MS-DRG,265,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Endovascular cardiac valve replacement and supplement procedures with MCC,266,MS-DRG,266,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Endovascular cardiac valve replacement and supplement procedures without MCC,267,MS-DRG,267,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Aortic and heart assist procedures except pulsation balloon with MCC,268,MS-DRG,268,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Aortic and heart assist procedures except pulsation balloon without MCC,269,MS-DRG,269,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other major cardiovascular procedures with MCC,270,MS-DRG,270,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other major cardiovascular procedures with CC,271,MS-DRG,271,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other major cardiovascular procedures without CC/MCC,272,MS-DRG,272,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Percutaneous and other intracardiac procedures with MCC,273,MS-DRG,273,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Percutaneous and other intracardiac procedures without MCC,274,MS-DRG,274,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac defibrillator implant with cardiac catheterization and MCC,275,MS-DRG,275,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac defibrillator implant with MCC or carotid sinus neurostimulator,276,MS-DRG,276,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac defibrillator implant without MCC,277,MS-DRG,277,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures with MCC,278,MS-DRG,278,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures without MCC,279,MS-DRG,279,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Acute myocardial infarction, discharged alive with MCC",280,MS-DRG,280,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,63798.62,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Acute myocardial infarction, discharged alive with CC",281,MS-DRG,281,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Acute myocardial infarction, discharged alive without CC/MCC",282,MS-DRG,282,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Acute myocardial infarction, expired with MCC",283,MS-DRG,283,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Acute myocardial infarction, expired with CC",284,MS-DRG,284,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Acute myocardial infarction, expired without CC/MCC",285,MS-DRG,285,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization with MCC",286,MS-DRG,286,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization without MCC",287,MS-DRG,287,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute and subacute endocarditis with MCC,288,MS-DRG,288,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,79476.64,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute and subacute endocarditis with CC,289,MS-DRG,289,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,54456.07,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute and subacute endocarditis without CC/MCC,290,MS-DRG,290,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48748.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Heart failure and shock with MCC,291,MS-DRG,291,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,59345.41,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Heart failure and shock with CC,292,MS-DRG,292,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,42060.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Heart failure and shock without CC/MCC,293,MS-DRG,293,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,42060.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Deep vein thrombophlebitis with CC/MCC,294,MS-DRG,294,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Deep vein thrombophlebitis without CC/MCC,295,MS-DRG,295,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Cardiac arrest, unexplained with MCC",296,MS-DRG,296,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,59345.41,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Cardiac arrest, unexplained with CC",297,MS-DRG,297,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,42060.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Cardiac arrest, unexplained without CC/MCC",298,MS-DRG,298,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,42060.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Peripheral vascular disorders with MCC,299,MS-DRG,299,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,64808.62,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Peripheral vascular disorders with CC,300,MS-DRG,300,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Peripheral vascular disorders without CC/MCC,301,MS-DRG,301,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Atherosclerosis with MCC,302,MS-DRG,302,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Atherosclerosis without MCC,303,MS-DRG,303,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hypertension with MCC,304,MS-DRG,304,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hypertension without MCC,305,MS-DRG,305,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac congenital and valvular disorders with MCC,306,MS-DRG,306,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac congenital and valvular disorders without MCC,307,MS-DRG,307,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac arrhythmia and conduction disorders with MCC,308,MS-DRG,308,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac arrhythmia and conduction disorders with CC,309,MS-DRG,309,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac arrhythmia and conduction disorders without CC/MCC,310,MS-DRG,310,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Angina pectoris,311,MS-DRG,311,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Syncope and collapse,312,MS-DRG,312,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chest pain,313,MS-DRG,313,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other circulatory system diagnoses with MCC,314,MS-DRG,314,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,67570.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other circulatory system diagnoses with CC,315,MS-DRG,315,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,47562.03,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other circulatory system diagnoses without CC/MCC,316,MS-DRG,316,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Concomitant left atrial appendage closure and cardiac ablation,317,MS-DRG,317,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other endovascular cardiac valve procedures with MCC,319,MS-DRG,319,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other endovascular cardiac valve procedures without MCC,320,MS-DRG,320,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/intraluminal devices,321,MS-DRG,321,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Percutaneous cardiovascular procedures with intraluminal device without MCC,322,MS-DRG,322,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary intravascular lithotripsy with intraluminal device with MCC,323,MS-DRG,323,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary intravascular lithotripsy with intraluminal device without MCC,324,MS-DRG,324,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary intravascular lithotripsy without intraluminal device,325,MS-DRG,325,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Stomach, esophageal and duodenal procedures with MCC",326,MS-DRG,326,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Stomach, esophageal and duodenal procedures with CC",327,MS-DRG,327,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Stomach, esophageal and duodenal procedures without CC/MCC",328,MS-DRG,328,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major small and large bowel procedures with MCC,329,MS-DRG,329,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major small and large bowel procedures with CC,330,MS-DRG,330,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major small and large bowel procedures without CC/MCC,331,MS-DRG,331,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Rectal resection with MCC,332,MS-DRG,332,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Rectal resection with CC,333,MS-DRG,333,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Rectal resection without CC/MCC,334,MS-DRG,334,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Peritoneal adhesiolysis with MCC,335,MS-DRG,335,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Peritoneal adhesiolysis with CC,336,MS-DRG,336,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Peritoneal adhesiolysis without CC/MCC,337,MS-DRG,337,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Minor small and large bowel procedures with MCC,344,MS-DRG,344,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Minor small and large bowel procedures with CC,345,MS-DRG,345,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Minor small and large bowel procedures without CC/MCC,346,MS-DRG,346,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Anal and stomal procedures with MCC,347,MS-DRG,347,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,68366.59,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Anal and stomal procedures with CC,348,MS-DRG,348,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Anal and stomal procedures without CC/MCC,349,MS-DRG,349,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inguinal and femoral hernia procedures with MCC,350,MS-DRG,350,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,68366.59,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inguinal and femoral hernia procedures with CC,351,MS-DRG,351,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inguinal and femoral hernia procedures without CC/MCC,352,MS-DRG,352,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hernia procedures except inguinal and femoral with MCC,353,MS-DRG,353,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hernia procedures except inguinal and femoral with CC,354,MS-DRG,354,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hernia procedures except inguinal and femoral without CC/MCC,355,MS-DRG,355,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other digestive system O.R. procedures with MCC,356,MS-DRG,356,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,106800.32,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other digestive system O.R. procedures with CC,357,MS-DRG,357,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other digestive system O.R. procedures without CC/MCC,358,MS-DRG,358,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major esophageal disorders with MCC*,368,MS-DRG,368,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major esophageal disorders with CC*,369,MS-DRG,369,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major esophageal disorders without CC/MCC*,370,MS-DRG,370,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major gastrointestinal disorders and peritoneal infections with MCC,371,MS-DRG,371,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,68366.59,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major gastrointestinal disorders and peritoneal infections with CC,372,MS-DRG,372,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major gastrointestinal disorders and peritoneal infections without CC/MCC,373,MS-DRG,373,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Digestive malignancy with MCC*,374,MS-DRG,374,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Digestive malignancy with CC*,375,MS-DRG,375,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Digestive malignancy without CC/MCC*,376,MS-DRG,376,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Gastrointestinal hemorrhage with MCC,377,MS-DRG,377,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,54425.47,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Gastrointestinal hemorrhage with CC,378,MS-DRG,378,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Gastrointestinal hemorrhage without CC/MCC,379,MS-DRG,379,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Complicated peptic ulcer with MCC,380,MS-DRG,380,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,73278.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Complicated peptic ulcer with CC,381,MS-DRG,381,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Complicated peptic ulcer without CC/MCC,382,MS-DRG,382,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uncomplicated peptic ulcer with MCC,383,MS-DRG,383,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uncomplicated peptic ulcer without MCC,384,MS-DRG,384,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inflammatory bowel disease with MCC,385,MS-DRG,385,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inflammatory bowel disease with CC,386,MS-DRG,386,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inflammatory bowel disease without CC/MCC,387,MS-DRG,387,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Gastrointestinal obstruction with MCC,388,MS-DRG,388,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,75604.95,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Gastrointestinal obstruction with CC,389,MS-DRG,389,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Gastrointestinal obstruction without CC/MCC,390,MS-DRG,390,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC",391,MS-DRG,391,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,59253.6,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC",392,MS-DRG,392,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,47929.3,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other digestive system diagnoses with MCC,393,MS-DRG,393,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,77739.74,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other digestive system diagnoses with CC,394,MS-DRG,394,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other digestive system diagnoses without CC/MCC,395,MS-DRG,395,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Appendix procedures with MCC,397,MS-DRG,397,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,68366.59,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Appendix procedures with CC,398,MS-DRG,398,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Appendix procedures without CC/MCC,399,MS-DRG,399,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Single level combined anterior and posterior spinal fusion except cervical,402,MS-DRG,402,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Pancreas, liver and shunt procedures with MCC",405,MS-DRG,405,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,40508.305,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Pancreas, liver and shunt procedures with CC",406,MS-DRG,406,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Pancreas, liver and shunt procedures without CC/MCC",407,MS-DRG,407,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with MCC,408,MS-DRG,408,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with CC,409,MS-DRG,409,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. without CC/MCC,410,MS-DRG,410,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cholecystectomy with C.D.E. with MCC,411,MS-DRG,411,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,73278.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cholecystectomy with C.D.E. with CC,412,MS-DRG,412,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cholecystectomy with C.D.E. without CC/MCC,413,MS-DRG,413,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with MCC,414,MS-DRG,414,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,73278.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with CC,415,MS-DRG,415,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. without CC/MCC,416,MS-DRG,416,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Laparoscopic cholecystectomy without C.D.E. with MCC,417,MS-DRG,417,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,73278.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Laparoscopic cholecystectomy without C.D.E. with CC,418,MS-DRG,418,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Laparoscopic cholecystectomy without C.D.E. without CC/MCC,419,MS-DRG,419,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hepatobiliary diagnostic procedures with MCC,420,MS-DRG,420,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hepatobiliary diagnostic procedures with CC,421,MS-DRG,421,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hepatobiliary diagnostic procedures without CC/MCC,422,MS-DRG,422,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other hepatobiliary or pancreas O.R. procedures with MCC,423,MS-DRG,423,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other hepatobiliary or pancreas O.R. procedures with CC,424,MS-DRG,424,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other hepatobiliary or pancreas O.R. procedures without CC/MCC,425,MS-DRG,425,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,426,MS-DRG,426,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,81343.62,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical with CC,427,MS-DRG,427,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,81343.62,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical without CC/MCC,428,MS-DRG,428,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,67111.73,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Combined anterior and posterior cervical spinal fusion with MCC,429,MS-DRG,429,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,81343.62,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Combined anterior and posterior cervical spinal fusion without MCC,430,MS-DRG,430,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cirrhosis and alcoholic hepatitis with MCC,432,MS-DRG,432,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,56468.43,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cirrhosis and alcoholic hepatitis with CC,433,MS-DRG,433,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cirrhosis and alcoholic hepatitis without CC/MCC,434,MS-DRG,434,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Malignancy of hepatobiliary system or pancreas with MCC,435,MS-DRG,435,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Malignancy of hepatobiliary system or pancreas with CC,436,MS-DRG,436,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Malignancy of hepatobiliary system or pancreas without CC/MCC,437,MS-DRG,437,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Disorders of pancreas except malignancy with MCC,438,MS-DRG,438,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,80165.28,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Disorders of pancreas except malignancy with CC,439,MS-DRG,439,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Disorders of pancreas except malignancy without CC/MCC,440,MS-DRG,440,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCC",441,MS-DRG,441,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,71243.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CC",442,MS-DRG,442,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without CC/MCC",443,MS-DRG,443,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Disorders of the biliary tract with MCC*,444,MS-DRG,444,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,58190.03,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Disorders of the biliary tract with CC*,445,MS-DRG,445,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53147.66,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Disorders of the biliary tract without CC/MCC*,446,MS-DRG,446,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,447,MS-DRG,447,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,1.0631,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Multiple level spinal fusion except cervical without MCC,448,MS-DRG,448,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,1.0631,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,450,MS-DRG,450,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,67111.74,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Single Level Spinal Fusion Except Cervical without MCC,451,MS-DRG,451,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with MCC",456,MS-DRG,456,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with CC",457,MS-DRG,457,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions without CC/MCC",458,MS-DRG,458,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bilateral or multiple major joint procedures of lower extremity with MCC,461,MS-DRG,461,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,67111.74,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bilateral or multiple major joint procedures of lower extremity without MCC,462,MS-DRG,462,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with MCC*,463,MS-DRG,463,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with CC*,464,MS-DRG,464,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72972.82,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders without CC/MCC*,465,MS-DRG,465,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,70057.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Revision of hip or knee replacement with MCC,466,MS-DRG,466,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Revision of hip or knee replacement with CC,467,MS-DRG,467,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Revision of hip or knee replacement without CC/MCC,468,MS-DRG,468,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity with MCC or total ankle replacement,469,MS-DRG,469,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity without MCC,470,MS-DRG,470,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cervical spinal fusion with MCC,471,MS-DRG,471,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cervical spinal fusion with CC,472,MS-DRG,472,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cervical spinal fusion without CC/MCC,473,MS-DRG,473,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with MCC,474,MS-DRG,474,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with CC,475,MS-DRG,475,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders without CC/MCC,476,MS-DRG,476,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Biopsies of musculoskeletal system and connective tissue with MCC,477,MS-DRG,477,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Biopsies of musculoskeletal system and connective tissue with CC,478,MS-DRG,478,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,28146.902,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Biopsies of musculoskeletal system and connective tissue without CC/MCC,479,MS-DRG,479,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,28146.902,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hip and femur procedures except major joint with MCC,480,MS-DRG,480,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hip and femur procedures except major joint with CC,481,MS-DRG,481,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hip and femur procedures except major joint without CC/MCC,482,MS-DRG,482,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major joint or limb reattachment procedures of upper extremities,483,MS-DRG,483,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Knee procedures with principal diagnosis of infection with MCC,485,MS-DRG,485,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Knee procedures with principal diagnosis of infection with CC,486,MS-DRG,486,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Knee procedures with principal diagnosis of infection without CC/MCC,487,MS-DRG,487,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Knee procedures without principal diagnosis of infection with CC/MCC,488,MS-DRG,488,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Knee procedures without principal diagnosis of infection without CC/MCC,489,MS-DRG,489,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,51693.87,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with MCC",492,MS-DRG,492,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with CC",493,MS-DRG,493,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur without CC/MCC",494,MS-DRG,494,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Local excision and removal of internal fixation devices except hip and femur with MCC,495,MS-DRG,495,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Local excision and removal of internal fixation devices except hip and femur with CC,496,MS-DRG,496,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Local excision and removal of internal fixation devices except hip and femur without CC/MCC,497,MS-DRG,497,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Local excision and removal of internal fixation devices of hip and femur with CC/MCC,498,MS-DRG,498,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Local excision and removal of internal fixation devices of hip and femur without CC/MCC,499,MS-DRG,499,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Soft tissue procedures with MCC,500,MS-DRG,500,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,94244.13,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Soft tissue procedures with CC,501,MS-DRG,501,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Soft tissue procedures without CC/MCC,502,MS-DRG,502,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,67111.74,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Foot procedures with MCC,503,MS-DRG,503,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Foot procedures with CC,504,MS-DRG,504,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Foot procedures without CC/MCC,505,MS-DRG,505,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major thumb or joint procedures,506,MS-DRG,506,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major shoulder or elbow joint procedures with CC/MCC,507,MS-DRG,507,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major shoulder or elbow joint procedures without CC/MCC,508,MS-DRG,508,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Arthroscopy,509,MS-DRG,509,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with MCC",510,MS-DRG,510,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with CC",511,MS-DRG,511,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures without CC/MCC",512,MS-DRG,512,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures with CC/MCC",513,MS-DRG,513,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures without CC/MCC",514,MS-DRG,514,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with MCC,515,MS-DRG,515,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,91742.07,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with CC,516,MS-DRG,516,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures without CC/MCC,517,MS-DRG,517,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Back and neck procedures except spinal fusion with MCC or disc device or neurostimulator,518,MS-DRG,518,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Back and neck procedures except spinal fusion with CC,519,MS-DRG,519,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Back and neck procedures except spinal fusion without CC/MCC,520,MS-DRG,520,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hip replacement with principal diagnosis of hip fracture with MCC,521,MS-DRG,521,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hip replacement with principal diagnosis of hip fracture without MCC,522,MS-DRG,522,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Fractures of femur with MCC,533,MS-DRG,533,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Fractures of femur without MCC,534,MS-DRG,534,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Fractures of hip and pelvis with MCC,535,MS-DRG,535,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Fractures of hip and pelvis without MCC,536,MS-DRG,536,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh with CC/MCC",537,MS-DRG,537,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh without CC/MCC",538,MS-DRG,538,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Osteomyelitis with MCC*,539,MS-DRG,539,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,74166.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Osteomyelitis with CC*,540,MS-DRG,540,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,54425.47,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Osteomyelitis without CC/MCC*,541,MS-DRG,541,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,51693.86,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with MCC*,542,MS-DRG,542,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with CC*,543,MS-DRG,543,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy without CC/MCC*,544,MS-DRG,544,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Connective tissue disorders with MCC,545,MS-DRG,545,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Connective tissue disorders with CC,546,MS-DRG,546,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Connective tissue disorders without CC/MCC,547,MS-DRG,547,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46988.16,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Septic arthritis with MCC,548,MS-DRG,548,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,65145.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Septic arthritis with CC,549,MS-DRG,549,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Septic arthritis without CC/MCC,550,MS-DRG,550,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Medical back problems with MCC,551,MS-DRG,551,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,99921.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Medical back problems without MCC,552,MS-DRG,552,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bone diseases and arthropathies with MCC,553,MS-DRG,553,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bone diseases and arthropathies without MCC,554,MS-DRG,554,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue with MCC,555,MS-DRG,555,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue without MCC,556,MS-DRG,556,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Tendonitis, myositis and bursitis with MCC",557,MS-DRG,557,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,69284.76,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Tendonitis, myositis and bursitis without MCC",558,MS-DRG,558,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53645.01,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Aftercare, musculoskeletal system and connective tissue with MCC*",559,MS-DRG,559,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,61671.48,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Aftercare, musculoskeletal system and connective tissue with CC*",560,MS-DRG,560,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48082.33,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Aftercare, musculoskeletal system and connective tissue without CC/MCC*",561,MS-DRG,561,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46988.16,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCC",562,MS-DRG,562,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCC",563,MS-DRG,563,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46988.16,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other musculoskeletal system and connective tissue diagnoses with MCC,564,MS-DRG,564,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,67111.74,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other musculoskeletal system and connective tissue diagnoses with CC,565,MS-DRG,565,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other musculoskeletal system and connective tissue diagnoses without CC/MCC,566,MS-DRG,566,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin debridement with MCC*,570,MS-DRG,570,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,90081.68,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin debridement with CC*,571,MS-DRG,571,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,65336.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin debridement without CC/MCC*,572,MS-DRG,572,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,65336.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin graft for skin ulcer or cellulitis with MCC,573,MS-DRG,573,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,106394.79,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin graft for skin ulcer or cellulitis with CC,574,MS-DRG,574,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin graft for skin ulcer or cellulitis without CC/MCC,575,MS-DRG,575,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin graft except for skin ulcer or cellulitis with MCC*,576,MS-DRG,576,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin graft except for skin ulcer or cellulitis with CC*,577,MS-DRG,577,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin graft except for skin ulcer or cellulitis without CC/MCC*,578,MS-DRG,578,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other skin, subcutaneous tissue and breast procedures with MCC",579,MS-DRG,579,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,103793.26,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other skin, subcutaneous tissue and breast procedures with CC",580,MS-DRG,580,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,85299.47,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other skin, subcutaneous tissue and breast procedures without CC/MCC",581,MS-DRG,581,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,85299.47,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Mastectomy for malignancy with CC/MCC,582,MS-DRG,582,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,103793.26,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Mastectomy for malignancy without CC/MCC,583,MS-DRG,583,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,85299.47,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Breast biopsy, local excision and other breast procedures with CC/MCC",584,MS-DRG,584,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,65336.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Breast biopsy, local excision and other breast procedures without CC/MCC",585,MS-DRG,585,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin ulcers with MCC,592,MS-DRG,592,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,67333.63,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin ulcers with CC,593,MS-DRG,593,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53667.96,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin ulcers without CC/MCC,594,MS-DRG,594,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major skin disorders with MCC,595,MS-DRG,595,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major skin disorders without MCC,596,MS-DRG,596,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Malignant breast disorders with MCC,597,MS-DRG,597,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Malignant breast disorders with CC,598,MS-DRG,598,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Malignant breast disorders without CC/MCC,599,MS-DRG,599,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Non-malignant breast disorders with CC/MCC*,600,MS-DRG,600,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Non-malignant breast disorders without CC/MCC*,601,MS-DRG,601,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cellulitis with MCC,602,MS-DRG,602,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,55068.2,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cellulitis without MCC,603,MS-DRG,603,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36842.21,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Trauma to the skin, subcutaneous tissue and breast with MCC",604,MS-DRG,604,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Trauma to the skin, subcutaneous tissue and breast without MCC",605,MS-DRG,605,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Minor skin disorders with MCC,606,MS-DRG,606,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Minor skin disorders without MCC,607,MS-DRG,607,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Adrenal and pituitary procedures with CC/MCC,614,MS-DRG,614,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Adrenal and pituitary procedures without CC/MCC,615,MS-DRG,615,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with MCC",616,MS-DRG,616,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with CC",617,MS-DRG,617,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders without CC/MCC",618,MS-DRG,618,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
O.R. procedures for obesity with MCC,619,MS-DRG,619,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,100051.65,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
O.R. procedures for obesity with CC,620,MS-DRG,620,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72590.25,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
O.R. procedures for obesity without CC/MCC,621,MS-DRG,621,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with MCC",622,MS-DRG,622,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,100051.65,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with CC",623,MS-DRG,623,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72590.25,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders without CC/MCC",624,MS-DRG,624,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with MCC",625,MS-DRG,625,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,30309.826,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with CC",626,MS-DRG,626,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures without CC/MCC",627,MS-DRG,627,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with MCC",628,MS-DRG,628,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,30309.826,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with CC",629,MS-DRG,629,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures without CC/MCC",630,MS-DRG,630,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Diabetes with MCC,637,MS-DRG,637,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,67654.99,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Diabetes with CC,638,MS-DRG,638,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53843.95,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Diabetes without CC/MCC,639,MS-DRG,639,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCC",640,MS-DRG,640,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,74862.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCC",641,MS-DRG,641,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,47049.37,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inborn and other disorders of metabolism,642,MS-DRG,642,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Endocrine disorders with MCC*,643,MS-DRG,643,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Endocrine disorders with CC*,644,MS-DRG,644,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Endocrine disorders without CC/MCC*,645,MS-DRG,645,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major bladder procedures with MCC,653,MS-DRG,653,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,91596.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major bladder procedures with CC,654,MS-DRG,654,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,80073.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major bladder procedures without CC/MCC,655,MS-DRG,655,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and ureter procedures for neoplasm with MCC,656,MS-DRG,656,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and ureter procedures for neoplasm with CC,657,MS-DRG,657,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and ureter procedures for neoplasm without CC/MCC,658,MS-DRG,658,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and ureter procedures for non-neoplasm with MCC*,659,MS-DRG,659,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and ureter procedures for non-neoplasm with CC*,660,MS-DRG,660,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and ureter procedures for non-neoplasm without CC/MCC*,661,MS-DRG,661,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Minor bladder procedures with MCC,662,MS-DRG,662,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Minor bladder procedures with CC,663,MS-DRG,663,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Minor bladder procedures without CC/MCC,664,MS-DRG,664,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Prostatectomy with MCC,665,MS-DRG,665,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,91596.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Prostatectomy with CC,666,MS-DRG,666,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,80073.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Prostatectomy without CC/MCC,667,MS-DRG,667,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Transurethral procedures with MCC,668,MS-DRG,668,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Transurethral procedures with CC,669,MS-DRG,669,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Transurethral procedures without CC/MCC,670,MS-DRG,670,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Urethral procedures with CC/MCC,671,MS-DRG,671,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Urethral procedures without CC/MCC,672,MS-DRG,672,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other kidney and urinary tract procedures with MCC*,673,MS-DRG,673,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,91596.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other kidney and urinary tract procedures with CC*,674,MS-DRG,674,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,80073.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other kidney and urinary tract procedures without CC/MCC*,675,MS-DRG,675,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,80073.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Renal failure with MCC,682,MS-DRG,682,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,66775.07,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Renal failure with CC,683,MS-DRG,683,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,46314.82,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Renal failure without CC/MCC,684,MS-DRG,684,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and urinary tract neoplasms with MCC,686,MS-DRG,686,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and urinary tract neoplasms with CC,687,MS-DRG,687,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and urinary tract neoplasms without CC/MCC,688,MS-DRG,688,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and urinary tract infections with MCC,689,MS-DRG,689,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48342.49,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and urinary tract infections without MCC,690,MS-DRG,690,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,35962.28,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Urinary stones with MCC,693,MS-DRG,693,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Urinary stones without MCC,694,MS-DRG,694,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and urinary tract signs and symptoms with MCC,695,MS-DRG,695,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and urinary tract signs and symptoms without MCC,696,MS-DRG,696,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Urethral stricture,697,MS-DRG,697,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other kidney and urinary tract diagnoses with MCC,698,MS-DRG,698,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,67746.82,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other kidney and urinary tract diagnoses with CC,699,MS-DRG,699,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,47363.09,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other kidney and urinary tract diagnoses without CC/MCC,700,MS-DRG,700,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major male pelvic procedures with CC/MCC,707,MS-DRG,707,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major male pelvic procedures without CC/MCC,708,MS-DRG,708,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Penis procedures with CC/MCC,709,MS-DRG,709,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Penis procedures without CC/MCC,710,MS-DRG,710,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Testes procedures with CC/MCC,711,MS-DRG,711,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Testes procedures without CC/MCC,712,MS-DRG,712,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Transurethral prostatectomy with CC/MCC,713,MS-DRG,713,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,30309.826,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Transurethral prostatectomy without CC/MCC,714,MS-DRG,714,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other male reproductive system O.R. procedures for malignancy with CC/MCC,715,MS-DRG,715,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other male reproductive system O.R. procedures for malignancy without CC/MCC,716,MS-DRG,716,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other male reproductive system O.R. procedures except malignancy with CC/MCC,717,MS-DRG,717,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other male reproductive system O.R. procedures except malignancy without CC/MCC,718,MS-DRG,718,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Malignancy, male reproductive system with MCC",722,MS-DRG,722,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,61794.07,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Malignancy, male reproductive system with CC",723,MS-DRG,723,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Malignancy, male reproductive system without CC/MCC",724,MS-DRG,724,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,50278,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Benign prostatic hypertrophy with MCC,725,MS-DRG,725,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,50278.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Benign prostatic hypertrophy without MCC,726,MS-DRG,726,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inflammation of the male reproductive system with MCC,727,MS-DRG,727,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,61794.07,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inflammation of the male reproductive system without MCC,728,MS-DRG,728,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,50278,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other male reproductive system diagnoses with CC/MCC,729,MS-DRG,729,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other male reproductive system diagnoses without CC/MCC,730,MS-DRG,730,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC",734,MS-DRG,734,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC",735,MS-DRG,735,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with MCC,736,MS-DRG,736,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with CC,737,MS-DRG,737,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy without CC/MCC,738,MS-DRG,738,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with MCC,739,MS-DRG,739,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with CC,740,MS-DRG,740,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy without CC/MCC,741,MS-DRG,741,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uterine and adnexa procedures for non-malignancy with CC/MCC,742,MS-DRG,742,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uterine and adnexa procedures for non-malignancy without CC/MCC,743,MS-DRG,743,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"D&C, conization, laparoscopy and tubal interruption with CC/MCC",744,MS-DRG,744,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"D&C, conization, laparoscopy and tubal interruption without CC/MCC",745,MS-DRG,745,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Vagina, cervix and vulva procedures with CC/MCC",746,MS-DRG,746,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Vagina, cervix and vulva procedures without CC/MCC",747,MS-DRG,747,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Female reproductive system reconstructive procedures,748,MS-DRG,748,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other female reproductive system O.R. procedures with CC/MCC,749,MS-DRG,749,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other female reproductive system O.R. procedures without CC/MCC,750,MS-DRG,750,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Malignancy, female reproductive system with MCC",754,MS-DRG,754,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Malignancy, female reproductive system with CC",755,MS-DRG,755,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Malignancy, female reproductive system without CC/MCC",756,MS-DRG,756,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Infections, female reproductive system with MCC",757,MS-DRG,757,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,29854.136,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Infections, female reproductive system with CC",758,MS-DRG,758,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Infections, female reproductive system without CC/MCC",759,MS-DRG,759,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Menstrual and other female reproductive system disorders with CC/MCC,760,MS-DRG,760,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Menstrual and other female reproductive system disorders without CC/MCC,761,MS-DRG,761,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Vaginal delivery with O.R. procedures except sterilization and/or D&C,768,MS-DRG,768,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Postpartum and post abortion diagnoses with O.R. procedures,769,MS-DRG,769,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Abortion with D&C, aspiration curettage or hysterotomy",770,MS-DRG,770,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Postpartum and post abortion diagnoses without O.R. procedures,776,MS-DRG,776,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Abortion without D&C,779,MS-DRG,779,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cesarean section with sterilization with MCC,783,MS-DRG,783,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cesarean section with sterilization with CC,784,MS-DRG,784,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,90613.37,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cesarean section with sterilization without CC/MCC,785,MS-DRG,785,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cesarean section without sterilization with MCC,786,MS-DRG,786,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cesarean section without sterilization with CC,787,MS-DRG,787,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cesarean section without sterilization without CC/MCC,788,MS-DRG,788,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Neonates, died or transferred to another acute care facility",789,MS-DRG,789,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Extreme immaturity or respiratory distress syndrome, neonate",790,MS-DRG,790,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Prematurity with major problems,791,MS-DRG,791,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Prematurity without major problems,792,MS-DRG,792,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48921.03,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Full term neonate with major problems,793,MS-DRG,793,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Neonate with other significant problems,794,MS-DRG,794,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48921.03,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Splenic procedures with MCC,799,MS-DRG,799,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,106800.6,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Splenic procedures with CC,800,MS-DRG,800,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48921.03,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Splenic procedures without CC/MCC,801,MS-DRG,801,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures of the blood and blood forming organs with MCC,802,MS-DRG,802,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures of the blood and blood forming organs with CC,803,MS-DRG,803,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures of the blood and blood forming organs without CC/MCC,804,MS-DRG,804,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with MCC,808,MS-DRG,808,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with CC,809,MS-DRG,809,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without CC/MCC,810,MS-DRG,810,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Red blood cell disorders with MCC,811,MS-DRG,811,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Red blood cell disorders without MCC,812,MS-DRG,812,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coagulation disorders,813,MS-DRG,813,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Reticuloendothelial and immunity disorders with MCC*,814,MS-DRG,814,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Reticuloendothelial and immunity disorders with CC*,815,MS-DRG,815,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Reticuloendothelial and immunity disorders without CC/MCC*,816,MS-DRG,816,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other antepartum diagnoses with O.R. procedures with MCC,817,MS-DRG,817,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,40508.305,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other antepartum diagnoses with O.R. procedures with CC,818,MS-DRG,818,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other antepartum diagnoses with O.R. procedures without CC/MCC,819,MS-DRG,819,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and leukemia with major O.R. procedures with MCC,820,MS-DRG,820,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and leukemia with major O.R. procedures with CC,821,MS-DRG,821,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and leukemia with major O.R. procedures without CC/MCC,822,MS-DRG,822,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and non-acute leukemia with other procedures with MCC,823,MS-DRG,823,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and non-acute leukemia with other procedures with CC,824,MS-DRG,824,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and non-acute leukemia with other procedures without CC/MCC,825,MS-DRG,825,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with MCC,826,MS-DRG,826,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with CC,827,MS-DRG,827,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures without CC/MCC,828,MS-DRG,828,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures with CC/MCC,829,MS-DRG,829,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures without CC/MCC,830,MS-DRG,830,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other antepartum diagnoses without O.R. procedures with MCC,831,MS-DRG,831,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other antepartum diagnoses without O.R. procedures with CC,832,MS-DRG,832,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other antepartum diagnoses without O.R. procedures without CC/MCC,833,MS-DRG,833,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute leukemia with MCC,834,MS-DRG,834,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute leukemia with CC,835,MS-DRG,835,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute leukemia without CC/MCC,836,MS-DRG,836,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy agent with MCC,837,MS-DRG,837,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapy agent,838,MS-DRG,838,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis without CC/MCC,839,MS-DRG,839,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and non-acute leukemia with MCC,840,MS-DRG,840,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and non-acute leukemia with CC,841,MS-DRG,841,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and non-acute leukemia without CC/MCC,842,MS-DRG,842,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with MCC,843,MS-DRG,843,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with CC,844,MS-DRG,844,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses without CC/MCC,845,MS-DRG,845,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with MCC,846,MS-DRG,846,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with CC,847,MS-DRG,847,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis without CC/MCC,848,MS-DRG,848,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Radiotherapy,849,MS-DRG,849,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute leukemia with other procedures,850,MS-DRG,850,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Infectious and parasitic diseases with O.R. procedures with MCC,853,MS-DRG,853,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,116013.09,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Infectious and parasitic diseases with O.R. procedures with CC,854,MS-DRG,854,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.07,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Infectious and parasitic diseases with O.R. procedures without CC/MCC,855,MS-DRG,855,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with MCC,856,MS-DRG,856,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,103112.54,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with CC,857,MS-DRG,857,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures without CC/MCC,858,MS-DRG,858,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Postoperative and post-traumatic infections with MCC,862,MS-DRG,862,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,70501.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Postoperative and post-traumatic infections without MCC,863,MS-DRG,863,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,47554.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Fever and inflammatory conditions,864,MS-DRG,864,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Viral illness with MCC,865,MS-DRG,865,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Viral illness without MCC,866,MS-DRG,866,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other infectious and parasitic diseases diagnoses with MCC,867,MS-DRG,867,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,70118.98,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other infectious and parasitic diseases diagnoses with CC,868,MS-DRG,868,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other infectious and parasitic diseases diagnoses without CC/MCC,869,MS-DRG,869,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Septicemia or severe sepsis with MV >96 hours,870,MS-DRG,870,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,158548.16,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Septicemia or severe sepsis without MV >96 hours with MCC,871,MS-DRG,871,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,64954.17,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Septicemia or severe sepsis without MV >96 hours without MCC,872,MS-DRG,872,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,43522.12,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Wound debridements for injuries with MCC,901,MS-DRG,901,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,98177.28,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Wound debridements for injuries with CC,902,MS-DRG,902,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Wound debridements for injuries without CC/MCC,903,MS-DRG,903,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin grafts for injuries with CC/MCC,904,MS-DRG,904,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin grafts for injuries without CC/MCC,905,MS-DRG,905,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hand procedures for injuries,906,MS-DRG,906,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures for injuries with MCC*,907,MS-DRG,907,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures for injuries with CC*,908,MS-DRG,908,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures for injuries without CC/MCC*,909,MS-DRG,909,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Traumatic injury with MCC,913,MS-DRG,913,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Traumatic injury without MCC,914,MS-DRG,914,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Allergic reactions with MCC,915,MS-DRG,915,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Allergic reactions without MCC,916,MS-DRG,916,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Poisoning and toxic effects of drugs with MCC,917,MS-DRG,917,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Poisoning and toxic effects of drugs without MCC,918,MS-DRG,918,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Complications of treatment with MCC,919,MS-DRG,919,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,82055.43,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Complications of treatment with CC,920,MS-DRG,920,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52581.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Complications of treatment without CC/MCC,921,MS-DRG,921,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other injury, poisoning and toxic effect diagnoses with MCC",922,MS-DRG,922,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other injury, poisoning and toxic effect diagnoses without MCC",923,MS-DRG,923,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extensive burns or full thickness burns with MV >96 hours with skin graft,927,MS-DRG,927,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Full thickness burn with skin graft or inhalation injury with CC/MCC,928,MS-DRG,928,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Full thickness burn with skin graft or inhalation injury without CC/MCC,929,MS-DRG,929,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extensive burns or full thickness burns with MV >96 hours without skin graft,933,MS-DRG,933,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Full thickness burn without skin graft or inhalation injury,934,MS-DRG,934,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Non-extensive burns,935,MS-DRG,935,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
O.R. procedures with diagnoses of other contact with health services with MCC,939,MS-DRG,939,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,90701.7,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
O.R. procedures with diagnoses of other contact with health services with CC,940,MS-DRG,940,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
O.R. procedures with diagnoses of other contact with health services without CC/MCC,941,MS-DRG,941,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Signs and symptoms with MCC,947,MS-DRG,947,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Signs and symptoms without MCC,948,MS-DRG,948,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Aftercare with CC/MCC,949,MS-DRG,949,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,53224.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Aftercare without CC/MCC,950,MS-DRG,950,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other factors influencing health status,951,MS-DRG,951,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Craniotomy for multiple significant trauma,955,MS-DRG,955,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Limb reattachment, hip and femur procedures for multiple significant trauma",956,MS-DRG,956,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures for multiple significant trauma with MCC,957,MS-DRG,957,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures for multiple significant trauma with CC,958,MS-DRG,958,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures for multiple significant trauma without CC/MCC,959,MS-DRG,959,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other multiple significant trauma with MCC,963,MS-DRG,963,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other multiple significant trauma with CC,964,MS-DRG,964,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other multiple significant trauma without CC/MCC,965,MS-DRG,965,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
HIV with extensive O.R. procedures with MCC,969,MS-DRG,969,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
HIV with extensive O.R. procedures without MCC,970,MS-DRG,970,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
HIV with major related condition with MCC*,974,MS-DRG,974,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,87197.28,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
HIV with major related condition with CC*,975,MS-DRG,975,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,68412.68,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
HIV with major related condition without CC/MCC*,976,MS-DRG,976,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,68412.68,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
HIV with or without other related condition,977,MS-DRG,977,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with MCC,981,MS-DRG,981,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,68449.825,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with CC,982,MS-DRG,982,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,96991.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,983,MS-DRG,983,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with CC,988,MS-DRG,988,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.07,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,989,MS-DRG,989,LOCAL,,Inpatient,,,,,Blue Shield CA ,Commercial,,,MS-DRG,72269.07,Per Diem,22000,120000,Lesser of BC or rate,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with MCC,987,MS-DRG,987,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,163207.97,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck with major O.R. procedures",3,MS-DRG,3,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,310277.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck without major O.R. procedures",4,MS-DRG,4,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,229767.96,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCC",11,MS-DRG,11,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CC",12,MS-DRG,12,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy without CC/MCC",13,MS-DRG,13,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chimeric antigen receptor (CAR) T-cell and other immunotherapies,18,MS-DRG,18,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with MCC,20,MS-DRG,20,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with CC,21,MS-DRG,21,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage without CC/MCC,22,MS-DRG,22,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC or chemotherapy implant or epilepsy with neurostimulator,23,MS-DRG,23,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis without MCC,24,MS-DRG,24,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Craniotomy and endovascular intracranial procedures with MCC,25,MS-DRG,25,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Craniotomy and endovascular intracranial procedures with CC,26,MS-DRG,26,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Craniotomy and endovascular intracranial procedures without CC/MCC,27,MS-DRG,27,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Spinal procedures with MCC,28,MS-DRG,28,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Spinal procedures with CC or spinal neurostimulators,29,MS-DRG,29,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Spinal procedures without CC/MCC,30,MS-DRG,30,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Ventricular shunt procedures with MCC,31,MS-DRG,31,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Ventricular shunt procedures with CC,32,MS-DRG,32,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Ventricular shunt procedures without CC/MCC,33,MS-DRG,33,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Carotid artery stent procedures with MCC,34,MS-DRG,34,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Carotid artery stent procedures with CC,35,MS-DRG,35,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Carotid artery stent procedures without CC/MCC,36,MS-DRG,36,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extracranial procedures with MCC,37,MS-DRG,37,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extracranial procedures with CC,38,MS-DRG,38,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extracranial procedures without CC/MCC,39,MS-DRG,39,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with MCC",40,MS-DRG,40,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,95774.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurostimulator",41,MS-DRG,41,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures without CC/MCC",42,MS-DRG,42,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Spinal disorders and injuries with CC/MCC,52,MS-DRG,52,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,82942.79,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Spinal disorders and injuries without CC/MCC,53,MS-DRG,53,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,81228.84,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nervous system neoplasms with MCC,54,MS-DRG,54,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nervous system neoplasms without MCC,55,MS-DRG,55,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Degenerative nervous system disorders with MCC,56,MS-DRG,56,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,61411.33,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Degenerative nervous system disorders without MCC,57,MS-DRG,57,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,51678.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Multiple sclerosis and cerebellar ataxia with MCC,58,MS-DRG,58,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Multiple sclerosis and cerebellar ataxia with CC,59,MS-DRG,59,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,51678.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Multiple sclerosis and cerebellar ataxia without CC/MCC,60,MS-DRG,60,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,51678.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with MCC",61,MS-DRG,61,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,111192.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with CC",62,MS-DRG,62,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent without CC/MCC",63,MS-DRG,63,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Intracranial hemorrhage or cerebral infarction with MCC,64,MS-DRG,64,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,111192.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Intracranial hemorrhage or cerebral infarction with CC or tPA in 24 hours,65,MS-DRG,65,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Intracranial hemorrhage or cerebral infarction without CC/MCC,66,MS-DRG,66,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nonspecific CVA and precerebral occlusion without infarction with MCC,67,MS-DRG,67,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,66767.42,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nonspecific CVA and precerebral occlusion without infarction without MCC,68,MS-DRG,68,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Transient ischemia without thrombolytic,69,MS-DRG,69,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nonspecific cerebrovascular disorders with MCC*,70,MS-DRG,70,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,66767.42,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nonspecific cerebrovascular disorders with CC*,71,MS-DRG,71,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,45128.84,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nonspecific cerebrovascular disorders without CC/MCC*,72,MS-DRG,72,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cranial and peripheral nerve disorders with MCC,73,MS-DRG,73,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cranial and peripheral nerve disorders without MCC,74,MS-DRG,74,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Viral meningitis with CC/MCC,75,MS-DRG,75,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Viral meningitis without CC/MCC,76,MS-DRG,76,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hypertensive encephalopathy with MCC,77,MS-DRG,77,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,68160,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hypertensive encephalopathy with CC,78,MS-DRG,78,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,537909.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hypertensive encephalopathy without CC/MCC,79,MS-DRG,79,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nontraumatic stupor and coma with MCC,80,MS-DRG,80,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Nontraumatic stupor and coma without MCC,81,MS-DRG,81,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Traumatic stupor and coma >1 hour with MCC*,82,MS-DRG,82,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,82529.13,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Traumatic stupor and coma >1 hour with CC*,83,MS-DRG,83,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,62451.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Traumatic stupor and coma >1 hour without CC/MCC*,84,MS-DRG,84,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Traumatic stupor and coma <1 hour with MCC,85,MS-DRG,85,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,62451.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Traumatic stupor and coma <1 hour with CC,86,MS-DRG,86,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,62451.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Traumatic stupor and coma <1 hour without CC/MCC,87,MS-DRG,87,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Concussion with MCC,88,MS-DRG,88,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,68160,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Concussion with CC,89,MS-DRG,89,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,537909.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Concussion without CC/MCC,90,MS-DRG,90,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other disorders of nervous system with MCC,91,MS-DRG,91,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,68160,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other disorders of nervous system with CC,92,MS-DRG,92,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,537909.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other disorders of nervous system without CC/MCC,93,MS-DRG,93,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,51678.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bacterial and tuberculous infections of nervous system with MCC*,94,MS-DRG,94,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34375.739,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bacterial and tuberculous infections of nervous system with CC*,95,MS-DRG,95,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,62451.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bacterial and tuberculous infections of nervous system without CC/MCC*,96,MS-DRG,96,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Non-bacterial infection of nervous system except viral meningitis with MCC,97,MS-DRG,97,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,75054.04,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Non-bacterial infection of nervous system except viral meningitis with CC,98,MS-DRG,98,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Non-bacterial infection of nervous system except viral meningitis without CC/MCC,99,MS-DRG,99,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Seizures with MCC,100,MS-DRG,100,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Seizures without MCC,101,MS-DRG,101,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Headaches with MCC,102,MS-DRG,102,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Headaches without MCC,103,MS-DRG,103,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Orbital procedures with CC/MCC,113,MS-DRG,113,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Orbital procedures without CC/MCC,114,MS-DRG,114,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extraocular procedures except orbit,115,MS-DRG,115,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Intraocular procedures with CC/MCC,116,MS-DRG,116,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Intraocular procedures without CC/MCC,117,MS-DRG,117,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute major eye infections with CC/MCC,121,MS-DRG,121,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute major eye infections without CC/MCC,122,MS-DRG,122,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Neurological eye disorders,123,MS-DRG,123,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other disorders of the eye with MCC or thrombolytic agent,124,MS-DRG,124,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other disorders of the eye without MCC,125,MS-DRG,125,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Sinus and mastoid procedures with CC/MCC,135,MS-DRG,135,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Sinus and mastoid procedures without CC/MCC,136,MS-DRG,136,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Mouth procedures with CC/MCC,137,MS-DRG,137,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Mouth procedures without CC/MCC,138,MS-DRG,138,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Salivary gland procedures,139,MS-DRG,139,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major head and neck procedures with MCC,140,MS-DRG,140,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,177508.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major head and neck procedures with CC,141,MS-DRG,141,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major head and neck procedures without CC/MCC,142,MS-DRG,142,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with MCC",143,MS-DRG,143,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with CC",144,MS-DRG,144,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures without CC/MCC",145,MS-DRG,145,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Ear, nose, mouth and throat malignancy with MCC*",146,MS-DRG,146,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Ear, nose, mouth and throat malignancy with CC*",147,MS-DRG,147,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Ear, nose, mouth and throat malignancy without CC/MCC*",148,MS-DRG,148,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Dysequilibrium,149,MS-DRG,149,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Epistaxis with MCC,150,MS-DRG,150,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Epistaxis without MCC,151,MS-DRG,151,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Otitis media and URI with MCC,152,MS-DRG,152,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Otitis media and URI without MCC,153,MS-DRG,153,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other ear, nose, mouth and throat diagnoses with MCC",154,MS-DRG,154,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other ear, nose, mouth and throat diagnoses with CC",155,MS-DRG,155,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other ear, nose, mouth and throat diagnoses without CC/MCC",156,MS-DRG,156,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Dental and oral diseases with MCC,157,MS-DRG,157,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Dental and oral diseases with CC,158,MS-DRG,158,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Dental and oral diseases without CC/MCC,159,MS-DRG,159,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major chest procedures with MCC,163,MS-DRG,163,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,202666.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major chest procedures with CC,164,MS-DRG,164,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,202666.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major chest procedures without CC/MCC,165,MS-DRG,165,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,202666.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other respiratory system O.R. procedures with MCC,166,MS-DRG,166,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,177508.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other respiratory system O.R. procedures with CC,167,MS-DRG,167,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other respiratory system O.R. procedures without CC/MCC,168,MS-DRG,168,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism,173,MS-DRG,173,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pulmonary embolism with MCC or acute cor pulmonale,175,MS-DRG,175,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pulmonary embolism without MCC,176,MS-DRG,176,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory infections and inflammations with MCC*,177,MS-DRG,177,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,62918.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory infections and inflammations with CC*,178,MS-DRG,178,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,43491.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory infections and inflammations without CC/MCC*,179,MS-DRG,179,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,42251.85,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory neoplasms with MCC*,180,MS-DRG,180,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory neoplasms with CC*,181,MS-DRG,181,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory neoplasms without CC/MCC*,182,MS-DRG,182,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major chest trauma with MCC,183,MS-DRG,183,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major chest trauma with CC,184,MS-DRG,184,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major chest trauma without CC/MCC,185,MS-DRG,185,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pleural effusion with MCC*,186,MS-DRG,186,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,66071.13,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pleural effusion with CC*,187,MS-DRG,187,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pleural effusion without CC/MCC*,188,MS-DRG,188,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pulmonary edema and respiratory failure,189,MS-DRG,189,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72046.99,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chronic obstructive pulmonary disease with MCC*,190,MS-DRG,190,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,20971.383,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chronic obstructive pulmonary disease with CC*,191,MS-DRG,191,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chronic obstructive pulmonary disease without CC/MCC*,192,MS-DRG,192,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Simple pneumonia and pleurisy with MCC,193,MS-DRG,193,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,59421.93,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Simple pneumonia and pleurisy with CC,194,MS-DRG,194,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,39604.42,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Simple pneumonia and pleurisy without CC/MCC,195,MS-DRG,195,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Interstitial lung disease with MCC*,196,MS-DRG,196,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Interstitial lung disease with CC*,197,MS-DRG,197,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Interstitial lung disease without CC/MCC*,198,MS-DRG,198,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pneumothorax with MCC,199,MS-DRG,199,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pneumothorax with CC,200,MS-DRG,200,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,21869.927,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pneumothorax without CC/MCC,201,MS-DRG,201,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,21869.927,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bronchitis and asthma with CC/MCC,202,MS-DRG,202,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,40508.305,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bronchitis and asthma without CC/MCC,203,MS-DRG,203,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,15339.435,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory signs and symptoms,204,MS-DRG,204,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other respiratory system diagnoses with MCC,205,MS-DRG,205,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,112102.84,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other respiratory system diagnoses without MCC,206,MS-DRG,206,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory system diagnosis with ventilator support >96 hours,207,MS-DRG,207,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,147720.8,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Respiratory system diagnosis with ventilator support <=96 hours,208,MS-DRG,208,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,81481.35,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Concomitant aortic and mitral valve procedures,212,MS-DRG,212,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other heart assist system implant,215,MS-DRG,215,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC,216,MS-DRG,216,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with CC,217,MS-DRG,217,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization without CC/MCC,218,MS-DRG,218,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with MCC,219,MS-DRG,219,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with CC,220,MS-DRG,220,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization without CC/MCC,221,MS-DRG,221,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other cardiothoracic procedures with MCC,228,MS-DRG,228,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other cardiothoracic procedures without MCC,229,MS-DRG,229,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary bypass with PTCA with MCC,231,MS-DRG,231,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary bypass with PTCA without MCC,232,MS-DRG,232,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary bypass with cardiac catheterization or open ablation with MCC,233,MS-DRG,233,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary bypass with cardiac catheterization or open ablation without MCC,234,MS-DRG,234,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary bypass without cardiac catheterization with MCC,235,MS-DRG,235,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary bypass without cardiac catheterization without MCC,236,MS-DRG,236,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Amputation for circulatory system disorders except upper limb and toe with MCC,239,MS-DRG,239,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Amputation for circulatory system disorders except upper limb and toe with CC,240,MS-DRG,240,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Amputation for circulatory system disorders except upper limb and toe without CC/MCC,241,MS-DRG,241,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Permanent cardiac pacemaker implant with MCC,242,MS-DRG,242,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Permanent cardiac pacemaker implant with CC,243,MS-DRG,243,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Permanent cardiac pacemaker implant without CC/MCC,244,MS-DRG,244,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
AICD generator procedures,245,MS-DRG,245,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,40774.659,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Percutaneous cardiovascular procedures without intraluminal device with MCC,250,MS-DRG,250,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Percutaneous cardiovascular procedures without intraluminal device without MCC,251,MS-DRG,251,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other vascular procedures with MCC,252,MS-DRG,252,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other vascular procedures with CC,253,MS-DRG,253,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other vascular procedures without CC/MCC,254,MS-DRG,254,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Upper limb and toe amputation for circulatory system disorders with MCC,255,MS-DRG,255,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Upper limb and toe amputation for circulatory system disorders with CC,256,MS-DRG,256,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Upper limb and toe amputation for circulatory system disorders without CC/MCC,257,MS-DRG,257,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac pacemaker device replacement with MCC,258,MS-DRG,258,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac pacemaker device replacement without MCC,259,MS-DRG,259,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac pacemaker revision except device replacement with MCC,260,MS-DRG,260,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac pacemaker revision except device replacement with CC,261,MS-DRG,261,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac pacemaker revision except device replacement without CC/MCC,262,MS-DRG,262,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Vein ligation and stripping,263,MS-DRG,263,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other circulatory system O.R. procedures,264,MS-DRG,264,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
AICD lead procedures,265,MS-DRG,265,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Endovascular cardiac valve replacement and supplement procedures with MCC,266,MS-DRG,266,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Endovascular cardiac valve replacement and supplement procedures without MCC,267,MS-DRG,267,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Aortic and heart assist procedures except pulsation balloon with MCC,268,MS-DRG,268,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Aortic and heart assist procedures except pulsation balloon without MCC,269,MS-DRG,269,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other major cardiovascular procedures with MCC,270,MS-DRG,270,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other major cardiovascular procedures with CC,271,MS-DRG,271,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other major cardiovascular procedures without CC/MCC,272,MS-DRG,272,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Percutaneous and other intracardiac procedures with MCC,273,MS-DRG,273,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Percutaneous and other intracardiac procedures without MCC,274,MS-DRG,274,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac defibrillator implant with cardiac catheterization and MCC,275,MS-DRG,275,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac defibrillator implant with MCC or carotid sinus neurostimulator,276,MS-DRG,276,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac defibrillator implant without MCC,277,MS-DRG,277,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures with MCC,278,MS-DRG,278,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures without MCC,279,MS-DRG,279,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Acute myocardial infarction, discharged alive with MCC",280,MS-DRG,280,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,63798.62,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Acute myocardial infarction, discharged alive with CC",281,MS-DRG,281,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Acute myocardial infarction, discharged alive without CC/MCC",282,MS-DRG,282,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Acute myocardial infarction, expired with MCC",283,MS-DRG,283,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Acute myocardial infarction, expired with CC",284,MS-DRG,284,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Acute myocardial infarction, expired without CC/MCC",285,MS-DRG,285,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization with MCC",286,MS-DRG,286,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization without MCC",287,MS-DRG,287,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute and subacute endocarditis with MCC,288,MS-DRG,288,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,79476.64,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute and subacute endocarditis with CC,289,MS-DRG,289,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,54456.07,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute and subacute endocarditis without CC/MCC,290,MS-DRG,290,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48748.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Heart failure and shock with MCC,291,MS-DRG,291,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,59345.41,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Heart failure and shock with CC,292,MS-DRG,292,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,42060.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Heart failure and shock without CC/MCC,293,MS-DRG,293,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,42060.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Deep vein thrombophlebitis with CC/MCC,294,MS-DRG,294,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Deep vein thrombophlebitis without CC/MCC,295,MS-DRG,295,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Cardiac arrest, unexplained with MCC",296,MS-DRG,296,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,59345.41,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Cardiac arrest, unexplained with CC",297,MS-DRG,297,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,42060.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Cardiac arrest, unexplained without CC/MCC",298,MS-DRG,298,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,42060.56,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Peripheral vascular disorders with MCC,299,MS-DRG,299,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,64808.62,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Peripheral vascular disorders with CC,300,MS-DRG,300,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Peripheral vascular disorders without CC/MCC,301,MS-DRG,301,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Atherosclerosis with MCC,302,MS-DRG,302,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Atherosclerosis without MCC,303,MS-DRG,303,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hypertension with MCC,304,MS-DRG,304,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hypertension without MCC,305,MS-DRG,305,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac congenital and valvular disorders with MCC,306,MS-DRG,306,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac congenital and valvular disorders without MCC,307,MS-DRG,307,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac arrhythmia and conduction disorders with MCC,308,MS-DRG,308,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac arrhythmia and conduction disorders with CC,309,MS-DRG,309,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cardiac arrhythmia and conduction disorders without CC/MCC,310,MS-DRG,310,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Angina pectoris,311,MS-DRG,311,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Syncope and collapse,312,MS-DRG,312,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chest pain,313,MS-DRG,313,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other circulatory system diagnoses with MCC,314,MS-DRG,314,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,67570.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other circulatory system diagnoses with CC,315,MS-DRG,315,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,47562.03,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other circulatory system diagnoses without CC/MCC,316,MS-DRG,316,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Concomitant left atrial appendage closure and cardiac ablation,317,MS-DRG,317,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other endovascular cardiac valve procedures with MCC,319,MS-DRG,319,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other endovascular cardiac valve procedures without MCC,320,MS-DRG,320,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/intraluminal devices,321,MS-DRG,321,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Percutaneous cardiovascular procedures with intraluminal device without MCC,322,MS-DRG,322,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary intravascular lithotripsy with intraluminal device with MCC,323,MS-DRG,323,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary intravascular lithotripsy with intraluminal device without MCC,324,MS-DRG,324,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coronary intravascular lithotripsy without intraluminal device,325,MS-DRG,325,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Stomach, esophageal and duodenal procedures with MCC",326,MS-DRG,326,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Stomach, esophageal and duodenal procedures with CC",327,MS-DRG,327,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Stomach, esophageal and duodenal procedures without CC/MCC",328,MS-DRG,328,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major small and large bowel procedures with MCC,329,MS-DRG,329,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major small and large bowel procedures with CC,330,MS-DRG,330,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major small and large bowel procedures without CC/MCC,331,MS-DRG,331,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Rectal resection with MCC,332,MS-DRG,332,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Rectal resection with CC,333,MS-DRG,333,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Rectal resection without CC/MCC,334,MS-DRG,334,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Peritoneal adhesiolysis with MCC,335,MS-DRG,335,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Peritoneal adhesiolysis with CC,336,MS-DRG,336,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Peritoneal adhesiolysis without CC/MCC,337,MS-DRG,337,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Minor small and large bowel procedures with MCC,344,MS-DRG,344,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Minor small and large bowel procedures with CC,345,MS-DRG,345,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Minor small and large bowel procedures without CC/MCC,346,MS-DRG,346,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Anal and stomal procedures with MCC,347,MS-DRG,347,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,68366.59,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Anal and stomal procedures with CC,348,MS-DRG,348,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Anal and stomal procedures without CC/MCC,349,MS-DRG,349,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inguinal and femoral hernia procedures with MCC,350,MS-DRG,350,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,68366.59,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inguinal and femoral hernia procedures with CC,351,MS-DRG,351,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inguinal and femoral hernia procedures without CC/MCC,352,MS-DRG,352,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hernia procedures except inguinal and femoral with MCC,353,MS-DRG,353,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hernia procedures except inguinal and femoral with CC,354,MS-DRG,354,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hernia procedures except inguinal and femoral without CC/MCC,355,MS-DRG,355,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other digestive system O.R. procedures with MCC,356,MS-DRG,356,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,106800.32,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other digestive system O.R. procedures with CC,357,MS-DRG,357,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other digestive system O.R. procedures without CC/MCC,358,MS-DRG,358,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major esophageal disorders with MCC*,368,MS-DRG,368,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major esophageal disorders with CC*,369,MS-DRG,369,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major esophageal disorders without CC/MCC*,370,MS-DRG,370,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major gastrointestinal disorders and peritoneal infections with MCC,371,MS-DRG,371,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,68366.59,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major gastrointestinal disorders and peritoneal infections with CC,372,MS-DRG,372,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major gastrointestinal disorders and peritoneal infections without CC/MCC,373,MS-DRG,373,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Digestive malignancy with MCC*,374,MS-DRG,374,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Digestive malignancy with CC*,375,MS-DRG,375,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Digestive malignancy without CC/MCC*,376,MS-DRG,376,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Gastrointestinal hemorrhage with MCC,377,MS-DRG,377,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,54425.47,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Gastrointestinal hemorrhage with CC,378,MS-DRG,378,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Gastrointestinal hemorrhage without CC/MCC,379,MS-DRG,379,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Complicated peptic ulcer with MCC,380,MS-DRG,380,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,73278.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Complicated peptic ulcer with CC,381,MS-DRG,381,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Complicated peptic ulcer without CC/MCC,382,MS-DRG,382,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uncomplicated peptic ulcer with MCC,383,MS-DRG,383,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uncomplicated peptic ulcer without MCC,384,MS-DRG,384,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inflammatory bowel disease with MCC,385,MS-DRG,385,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inflammatory bowel disease with CC,386,MS-DRG,386,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inflammatory bowel disease without CC/MCC,387,MS-DRG,387,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Gastrointestinal obstruction with MCC,388,MS-DRG,388,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,75604.95,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Gastrointestinal obstruction with CC,389,MS-DRG,389,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Gastrointestinal obstruction without CC/MCC,390,MS-DRG,390,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC",391,MS-DRG,391,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,59253.6,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC",392,MS-DRG,392,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,47929.3,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other digestive system diagnoses with MCC,393,MS-DRG,393,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,77739.74,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other digestive system diagnoses with CC,394,MS-DRG,394,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other digestive system diagnoses without CC/MCC,395,MS-DRG,395,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Appendix procedures with MCC,397,MS-DRG,397,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,68366.59,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Appendix procedures with CC,398,MS-DRG,398,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Appendix procedures without CC/MCC,399,MS-DRG,399,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Single level combined anterior and posterior spinal fusion except cervical,402,MS-DRG,402,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Pancreas, liver and shunt procedures with MCC",405,MS-DRG,405,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,40508.305,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Pancreas, liver and shunt procedures with CC",406,MS-DRG,406,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Pancreas, liver and shunt procedures without CC/MCC",407,MS-DRG,407,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with MCC,408,MS-DRG,408,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with CC,409,MS-DRG,409,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. without CC/MCC,410,MS-DRG,410,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cholecystectomy with C.D.E. with MCC,411,MS-DRG,411,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,73278.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cholecystectomy with C.D.E. with CC,412,MS-DRG,412,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cholecystectomy with C.D.E. without CC/MCC,413,MS-DRG,413,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with MCC,414,MS-DRG,414,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,73278.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with CC,415,MS-DRG,415,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. without CC/MCC,416,MS-DRG,416,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Laparoscopic cholecystectomy without C.D.E. with MCC,417,MS-DRG,417,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,73278.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Laparoscopic cholecystectomy without C.D.E. with CC,418,MS-DRG,418,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Laparoscopic cholecystectomy without C.D.E. without CC/MCC,419,MS-DRG,419,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hepatobiliary diagnostic procedures with MCC,420,MS-DRG,420,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hepatobiliary diagnostic procedures with CC,421,MS-DRG,421,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hepatobiliary diagnostic procedures without CC/MCC,422,MS-DRG,422,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other hepatobiliary or pancreas O.R. procedures with MCC,423,MS-DRG,423,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other hepatobiliary or pancreas O.R. procedures with CC,424,MS-DRG,424,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other hepatobiliary or pancreas O.R. procedures without CC/MCC,425,MS-DRG,425,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,426,MS-DRG,426,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,81343.62,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical with CC,427,MS-DRG,427,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,81343.62,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical without CC/MCC,428,MS-DRG,428,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,67111.73,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Combined anterior and posterior cervical spinal fusion with MCC,429,MS-DRG,429,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,81343.62,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Combined anterior and posterior cervical spinal fusion without MCC,430,MS-DRG,430,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cirrhosis and alcoholic hepatitis with MCC,432,MS-DRG,432,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,56468.43,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cirrhosis and alcoholic hepatitis with CC,433,MS-DRG,433,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cirrhosis and alcoholic hepatitis without CC/MCC,434,MS-DRG,434,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Malignancy of hepatobiliary system or pancreas with MCC,435,MS-DRG,435,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Malignancy of hepatobiliary system or pancreas with CC,436,MS-DRG,436,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Malignancy of hepatobiliary system or pancreas without CC/MCC,437,MS-DRG,437,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Disorders of pancreas except malignancy with MCC,438,MS-DRG,438,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,80165.28,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Disorders of pancreas except malignancy with CC,439,MS-DRG,439,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Disorders of pancreas except malignancy without CC/MCC,440,MS-DRG,440,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCC",441,MS-DRG,441,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,71243.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CC",442,MS-DRG,442,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without CC/MCC",443,MS-DRG,443,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Disorders of the biliary tract with MCC*,444,MS-DRG,444,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,58190.03,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Disorders of the biliary tract with CC*,445,MS-DRG,445,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53147.66,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Disorders of the biliary tract without CC/MCC*,446,MS-DRG,446,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,447,MS-DRG,447,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,1.0631,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Multiple level spinal fusion except cervical without MCC,448,MS-DRG,448,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,1.0631,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,450,MS-DRG,450,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,67111.74,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Single Level Spinal Fusion Except Cervical without MCC,451,MS-DRG,451,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with MCC",456,MS-DRG,456,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with CC",457,MS-DRG,457,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions without CC/MCC",458,MS-DRG,458,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bilateral or multiple major joint procedures of lower extremity with MCC,461,MS-DRG,461,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,67111.74,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bilateral or multiple major joint procedures of lower extremity without MCC,462,MS-DRG,462,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with MCC*,463,MS-DRG,463,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with CC*,464,MS-DRG,464,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72972.82,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders without CC/MCC*,465,MS-DRG,465,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,70057.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Revision of hip or knee replacement with MCC,466,MS-DRG,466,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Revision of hip or knee replacement with CC,467,MS-DRG,467,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Revision of hip or knee replacement without CC/MCC,468,MS-DRG,468,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity with MCC or total ankle replacement,469,MS-DRG,469,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity without MCC,470,MS-DRG,470,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cervical spinal fusion with MCC,471,MS-DRG,471,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cervical spinal fusion with CC,472,MS-DRG,472,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cervical spinal fusion without CC/MCC,473,MS-DRG,473,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with MCC,474,MS-DRG,474,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with CC,475,MS-DRG,475,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders without CC/MCC,476,MS-DRG,476,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Biopsies of musculoskeletal system and connective tissue with MCC,477,MS-DRG,477,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Biopsies of musculoskeletal system and connective tissue with CC,478,MS-DRG,478,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,28146.902,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Biopsies of musculoskeletal system and connective tissue without CC/MCC,479,MS-DRG,479,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,28146.902,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hip and femur procedures except major joint with MCC,480,MS-DRG,480,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hip and femur procedures except major joint with CC,481,MS-DRG,481,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hip and femur procedures except major joint without CC/MCC,482,MS-DRG,482,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major joint or limb reattachment procedures of upper extremities,483,MS-DRG,483,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Knee procedures with principal diagnosis of infection with MCC,485,MS-DRG,485,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Knee procedures with principal diagnosis of infection with CC,486,MS-DRG,486,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Knee procedures with principal diagnosis of infection without CC/MCC,487,MS-DRG,487,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Knee procedures without principal diagnosis of infection with CC/MCC,488,MS-DRG,488,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Knee procedures without principal diagnosis of infection without CC/MCC,489,MS-DRG,489,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,51693.87,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with MCC",492,MS-DRG,492,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with CC",493,MS-DRG,493,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur without CC/MCC",494,MS-DRG,494,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Local excision and removal of internal fixation devices except hip and femur with MCC,495,MS-DRG,495,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Local excision and removal of internal fixation devices except hip and femur with CC,496,MS-DRG,496,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Local excision and removal of internal fixation devices except hip and femur without CC/MCC,497,MS-DRG,497,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Local excision and removal of internal fixation devices of hip and femur with CC/MCC,498,MS-DRG,498,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Local excision and removal of internal fixation devices of hip and femur without CC/MCC,499,MS-DRG,499,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Soft tissue procedures with MCC,500,MS-DRG,500,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,94244.13,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Soft tissue procedures with CC,501,MS-DRG,501,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Soft tissue procedures without CC/MCC,502,MS-DRG,502,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,67111.74,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Foot procedures with MCC,503,MS-DRG,503,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Foot procedures with CC,504,MS-DRG,504,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Foot procedures without CC/MCC,505,MS-DRG,505,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major thumb or joint procedures,506,MS-DRG,506,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major shoulder or elbow joint procedures with CC/MCC,507,MS-DRG,507,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major shoulder or elbow joint procedures without CC/MCC,508,MS-DRG,508,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Arthroscopy,509,MS-DRG,509,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with MCC",510,MS-DRG,510,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with CC",511,MS-DRG,511,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures without CC/MCC",512,MS-DRG,512,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures with CC/MCC",513,MS-DRG,513,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures without CC/MCC",514,MS-DRG,514,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with MCC,515,MS-DRG,515,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,91742.07,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with CC,516,MS-DRG,516,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures without CC/MCC,517,MS-DRG,517,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Back and neck procedures except spinal fusion with MCC or disc device or neurostimulator,518,MS-DRG,518,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Back and neck procedures except spinal fusion with CC,519,MS-DRG,519,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Back and neck procedures except spinal fusion without CC/MCC,520,MS-DRG,520,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hip replacement with principal diagnosis of hip fracture with MCC,521,MS-DRG,521,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hip replacement with principal diagnosis of hip fracture without MCC,522,MS-DRG,522,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Fractures of femur with MCC,533,MS-DRG,533,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Fractures of femur without MCC,534,MS-DRG,534,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Fractures of hip and pelvis with MCC,535,MS-DRG,535,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Fractures of hip and pelvis without MCC,536,MS-DRG,536,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh with CC/MCC",537,MS-DRG,537,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh without CC/MCC",538,MS-DRG,538,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Osteomyelitis with MCC*,539,MS-DRG,539,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,74166.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Osteomyelitis with CC*,540,MS-DRG,540,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,54425.47,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Osteomyelitis without CC/MCC*,541,MS-DRG,541,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,51693.86,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with MCC*,542,MS-DRG,542,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with CC*,543,MS-DRG,543,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy without CC/MCC*,544,MS-DRG,544,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Connective tissue disorders with MCC,545,MS-DRG,545,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Connective tissue disorders with CC,546,MS-DRG,546,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Connective tissue disorders without CC/MCC,547,MS-DRG,547,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46988.16,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Septic arthritis with MCC,548,MS-DRG,548,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,65145.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Septic arthritis with CC,549,MS-DRG,549,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Septic arthritis without CC/MCC,550,MS-DRG,550,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Medical back problems with MCC,551,MS-DRG,551,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,99921.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Medical back problems without MCC,552,MS-DRG,552,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bone diseases and arthropathies with MCC,553,MS-DRG,553,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Bone diseases and arthropathies without MCC,554,MS-DRG,554,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue with MCC,555,MS-DRG,555,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue without MCC,556,MS-DRG,556,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Tendonitis, myositis and bursitis with MCC",557,MS-DRG,557,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,69284.76,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Tendonitis, myositis and bursitis without MCC",558,MS-DRG,558,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53645.01,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Aftercare, musculoskeletal system and connective tissue with MCC*",559,MS-DRG,559,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,61671.48,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Aftercare, musculoskeletal system and connective tissue with CC*",560,MS-DRG,560,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48082.33,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Aftercare, musculoskeletal system and connective tissue without CC/MCC*",561,MS-DRG,561,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46988.16,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCC",562,MS-DRG,562,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCC",563,MS-DRG,563,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46988.16,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other musculoskeletal system and connective tissue diagnoses with MCC,564,MS-DRG,564,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,67111.74,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other musculoskeletal system and connective tissue diagnoses with CC,565,MS-DRG,565,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other musculoskeletal system and connective tissue diagnoses without CC/MCC,566,MS-DRG,566,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin debridement with MCC*,570,MS-DRG,570,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,90081.68,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin debridement with CC*,571,MS-DRG,571,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,65336.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin debridement without CC/MCC*,572,MS-DRG,572,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,65336.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin graft for skin ulcer or cellulitis with MCC,573,MS-DRG,573,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,106394.79,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin graft for skin ulcer or cellulitis with CC,574,MS-DRG,574,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin graft for skin ulcer or cellulitis without CC/MCC,575,MS-DRG,575,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin graft except for skin ulcer or cellulitis with MCC*,576,MS-DRG,576,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin graft except for skin ulcer or cellulitis with CC*,577,MS-DRG,577,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin graft except for skin ulcer or cellulitis without CC/MCC*,578,MS-DRG,578,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other skin, subcutaneous tissue and breast procedures with MCC",579,MS-DRG,579,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,103793.26,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other skin, subcutaneous tissue and breast procedures with CC",580,MS-DRG,580,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,85299.47,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other skin, subcutaneous tissue and breast procedures without CC/MCC",581,MS-DRG,581,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,85299.47,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Mastectomy for malignancy with CC/MCC,582,MS-DRG,582,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,103793.26,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Mastectomy for malignancy without CC/MCC,583,MS-DRG,583,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,85299.47,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Breast biopsy, local excision and other breast procedures with CC/MCC",584,MS-DRG,584,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,65336.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Breast biopsy, local excision and other breast procedures without CC/MCC",585,MS-DRG,585,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin ulcers with MCC,592,MS-DRG,592,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,67333.63,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin ulcers with CC,593,MS-DRG,593,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53667.96,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin ulcers without CC/MCC,594,MS-DRG,594,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major skin disorders with MCC,595,MS-DRG,595,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major skin disorders without MCC,596,MS-DRG,596,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Malignant breast disorders with MCC,597,MS-DRG,597,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Malignant breast disorders with CC,598,MS-DRG,598,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Malignant breast disorders without CC/MCC,599,MS-DRG,599,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Non-malignant breast disorders with CC/MCC*,600,MS-DRG,600,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Non-malignant breast disorders without CC/MCC*,601,MS-DRG,601,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cellulitis with MCC,602,MS-DRG,602,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,55068.2,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cellulitis without MCC,603,MS-DRG,603,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36842.21,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Trauma to the skin, subcutaneous tissue and breast with MCC",604,MS-DRG,604,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Trauma to the skin, subcutaneous tissue and breast without MCC",605,MS-DRG,605,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Minor skin disorders with MCC,606,MS-DRG,606,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Minor skin disorders without MCC,607,MS-DRG,607,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Adrenal and pituitary procedures with CC/MCC,614,MS-DRG,614,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Adrenal and pituitary procedures without CC/MCC,615,MS-DRG,615,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with MCC",616,MS-DRG,616,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with CC",617,MS-DRG,617,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders without CC/MCC",618,MS-DRG,618,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
O.R. procedures for obesity with MCC,619,MS-DRG,619,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,100051.65,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
O.R. procedures for obesity with CC,620,MS-DRG,620,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72590.25,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
O.R. procedures for obesity without CC/MCC,621,MS-DRG,621,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with MCC",622,MS-DRG,622,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,100051.65,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with CC",623,MS-DRG,623,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72590.25,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders without CC/MCC",624,MS-DRG,624,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with MCC",625,MS-DRG,625,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,30309.826,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with CC",626,MS-DRG,626,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures without CC/MCC",627,MS-DRG,627,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with MCC",628,MS-DRG,628,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,30309.826,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with CC",629,MS-DRG,629,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures without CC/MCC",630,MS-DRG,630,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Diabetes with MCC,637,MS-DRG,637,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,67654.99,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Diabetes with CC,638,MS-DRG,638,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53843.95,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Diabetes without CC/MCC,639,MS-DRG,639,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCC",640,MS-DRG,640,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,74862.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCC",641,MS-DRG,641,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,47049.37,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inborn and other disorders of metabolism,642,MS-DRG,642,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Endocrine disorders with MCC*,643,MS-DRG,643,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Endocrine disorders with CC*,644,MS-DRG,644,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Endocrine disorders without CC/MCC*,645,MS-DRG,645,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major bladder procedures with MCC,653,MS-DRG,653,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,91596.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major bladder procedures with CC,654,MS-DRG,654,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,80073.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major bladder procedures without CC/MCC,655,MS-DRG,655,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and ureter procedures for neoplasm with MCC,656,MS-DRG,656,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and ureter procedures for neoplasm with CC,657,MS-DRG,657,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and ureter procedures for neoplasm without CC/MCC,658,MS-DRG,658,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and ureter procedures for non-neoplasm with MCC*,659,MS-DRG,659,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and ureter procedures for non-neoplasm with CC*,660,MS-DRG,660,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and ureter procedures for non-neoplasm without CC/MCC*,661,MS-DRG,661,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Minor bladder procedures with MCC,662,MS-DRG,662,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Minor bladder procedures with CC,663,MS-DRG,663,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Minor bladder procedures without CC/MCC,664,MS-DRG,664,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Prostatectomy with MCC,665,MS-DRG,665,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,91596.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Prostatectomy with CC,666,MS-DRG,666,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,80073.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Prostatectomy without CC/MCC,667,MS-DRG,667,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Transurethral procedures with MCC,668,MS-DRG,668,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Transurethral procedures with CC,669,MS-DRG,669,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Transurethral procedures without CC/MCC,670,MS-DRG,670,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Urethral procedures with CC/MCC,671,MS-DRG,671,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Urethral procedures without CC/MCC,672,MS-DRG,672,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other kidney and urinary tract procedures with MCC*,673,MS-DRG,673,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,91596.69,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other kidney and urinary tract procedures with CC*,674,MS-DRG,674,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,80073.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other kidney and urinary tract procedures without CC/MCC*,675,MS-DRG,675,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,80073.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Renal failure with MCC,682,MS-DRG,682,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,66775.07,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Renal failure with CC,683,MS-DRG,683,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,46314.82,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Renal failure without CC/MCC,684,MS-DRG,684,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and urinary tract neoplasms with MCC,686,MS-DRG,686,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and urinary tract neoplasms with CC,687,MS-DRG,687,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and urinary tract neoplasms without CC/MCC,688,MS-DRG,688,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and urinary tract infections with MCC,689,MS-DRG,689,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48342.49,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and urinary tract infections without MCC,690,MS-DRG,690,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,35962.28,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Urinary stones with MCC,693,MS-DRG,693,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Urinary stones without MCC,694,MS-DRG,694,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and urinary tract signs and symptoms with MCC,695,MS-DRG,695,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Kidney and urinary tract signs and symptoms without MCC,696,MS-DRG,696,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Urethral stricture,697,MS-DRG,697,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other kidney and urinary tract diagnoses with MCC,698,MS-DRG,698,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,67746.82,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other kidney and urinary tract diagnoses with CC,699,MS-DRG,699,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,47363.09,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other kidney and urinary tract diagnoses without CC/MCC,700,MS-DRG,700,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major male pelvic procedures with CC/MCC,707,MS-DRG,707,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major male pelvic procedures without CC/MCC,708,MS-DRG,708,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Penis procedures with CC/MCC,709,MS-DRG,709,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Penis procedures without CC/MCC,710,MS-DRG,710,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Testes procedures with CC/MCC,711,MS-DRG,711,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Testes procedures without CC/MCC,712,MS-DRG,712,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Transurethral prostatectomy with CC/MCC,713,MS-DRG,713,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,30309.826,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Transurethral prostatectomy without CC/MCC,714,MS-DRG,714,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other male reproductive system O.R. procedures for malignancy with CC/MCC,715,MS-DRG,715,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other male reproductive system O.R. procedures for malignancy without CC/MCC,716,MS-DRG,716,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other male reproductive system O.R. procedures except malignancy with CC/MCC,717,MS-DRG,717,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other male reproductive system O.R. procedures except malignancy without CC/MCC,718,MS-DRG,718,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Malignancy, male reproductive system with MCC",722,MS-DRG,722,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,61794.07,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Malignancy, male reproductive system with CC",723,MS-DRG,723,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Malignancy, male reproductive system without CC/MCC",724,MS-DRG,724,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,50278,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Benign prostatic hypertrophy with MCC,725,MS-DRG,725,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,50278.46,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Benign prostatic hypertrophy without MCC,726,MS-DRG,726,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inflammation of the male reproductive system with MCC,727,MS-DRG,727,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,61794.07,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Inflammation of the male reproductive system without MCC,728,MS-DRG,728,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,50278,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other male reproductive system diagnoses with CC/MCC,729,MS-DRG,729,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other male reproductive system diagnoses without CC/MCC,730,MS-DRG,730,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC",734,MS-DRG,734,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC",735,MS-DRG,735,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with MCC,736,MS-DRG,736,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with CC,737,MS-DRG,737,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy without CC/MCC,738,MS-DRG,738,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with MCC,739,MS-DRG,739,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with CC,740,MS-DRG,740,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy without CC/MCC,741,MS-DRG,741,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uterine and adnexa procedures for non-malignancy with CC/MCC,742,MS-DRG,742,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Uterine and adnexa procedures for non-malignancy without CC/MCC,743,MS-DRG,743,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"D&C, conization, laparoscopy and tubal interruption with CC/MCC",744,MS-DRG,744,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"D&C, conization, laparoscopy and tubal interruption without CC/MCC",745,MS-DRG,745,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Vagina, cervix and vulva procedures with CC/MCC",746,MS-DRG,746,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Vagina, cervix and vulva procedures without CC/MCC",747,MS-DRG,747,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Female reproductive system reconstructive procedures,748,MS-DRG,748,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other female reproductive system O.R. procedures with CC/MCC,749,MS-DRG,749,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other female reproductive system O.R. procedures without CC/MCC,750,MS-DRG,750,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Malignancy, female reproductive system with MCC",754,MS-DRG,754,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Malignancy, female reproductive system with CC",755,MS-DRG,755,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Malignancy, female reproductive system without CC/MCC",756,MS-DRG,756,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Infections, female reproductive system with MCC",757,MS-DRG,757,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,29854.136,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Infections, female reproductive system with CC",758,MS-DRG,758,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Infections, female reproductive system without CC/MCC",759,MS-DRG,759,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Menstrual and other female reproductive system disorders with CC/MCC,760,MS-DRG,760,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Menstrual and other female reproductive system disorders without CC/MCC,761,MS-DRG,761,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Vaginal delivery with O.R. procedures except sterilization and/or D&C,768,MS-DRG,768,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Postpartum and post abortion diagnoses with O.R. procedures,769,MS-DRG,769,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Abortion with D&C, aspiration curettage or hysterotomy",770,MS-DRG,770,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Postpartum and post abortion diagnoses without O.R. procedures,776,MS-DRG,776,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Abortion without D&C,779,MS-DRG,779,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cesarean section with sterilization with MCC,783,MS-DRG,783,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cesarean section with sterilization with CC,784,MS-DRG,784,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,90613.37,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cesarean section with sterilization without CC/MCC,785,MS-DRG,785,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cesarean section without sterilization with MCC,786,MS-DRG,786,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cesarean section without sterilization with CC,787,MS-DRG,787,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Cesarean section without sterilization without CC/MCC,788,MS-DRG,788,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Neonates, died or transferred to another acute care facility",789,MS-DRG,789,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Extreme immaturity or respiratory distress syndrome, neonate",790,MS-DRG,790,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Prematurity with major problems,791,MS-DRG,791,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Prematurity without major problems,792,MS-DRG,792,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48921.03,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Full term neonate with major problems,793,MS-DRG,793,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Neonate with other significant problems,794,MS-DRG,794,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48921.03,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Splenic procedures with MCC,799,MS-DRG,799,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,106800.6,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Splenic procedures with CC,800,MS-DRG,800,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48921.03,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Splenic procedures without CC/MCC,801,MS-DRG,801,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures of the blood and blood forming organs with MCC,802,MS-DRG,802,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures of the blood and blood forming organs with CC,803,MS-DRG,803,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures of the blood and blood forming organs without CC/MCC,804,MS-DRG,804,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with MCC,808,MS-DRG,808,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with CC,809,MS-DRG,809,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without CC/MCC,810,MS-DRG,810,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Red blood cell disorders with MCC,811,MS-DRG,811,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Red blood cell disorders without MCC,812,MS-DRG,812,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Coagulation disorders,813,MS-DRG,813,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Reticuloendothelial and immunity disorders with MCC*,814,MS-DRG,814,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Reticuloendothelial and immunity disorders with CC*,815,MS-DRG,815,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Reticuloendothelial and immunity disorders without CC/MCC*,816,MS-DRG,816,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other antepartum diagnoses with O.R. procedures with MCC,817,MS-DRG,817,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,40508.305,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other antepartum diagnoses with O.R. procedures with CC,818,MS-DRG,818,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other antepartum diagnoses with O.R. procedures without CC/MCC,819,MS-DRG,819,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and leukemia with major O.R. procedures with MCC,820,MS-DRG,820,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and leukemia with major O.R. procedures with CC,821,MS-DRG,821,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and leukemia with major O.R. procedures without CC/MCC,822,MS-DRG,822,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and non-acute leukemia with other procedures with MCC,823,MS-DRG,823,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and non-acute leukemia with other procedures with CC,824,MS-DRG,824,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and non-acute leukemia with other procedures without CC/MCC,825,MS-DRG,825,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with MCC,826,MS-DRG,826,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with CC,827,MS-DRG,827,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures without CC/MCC,828,MS-DRG,828,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures with CC/MCC,829,MS-DRG,829,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures without CC/MCC,830,MS-DRG,830,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other antepartum diagnoses without O.R. procedures with MCC,831,MS-DRG,831,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other antepartum diagnoses without O.R. procedures with CC,832,MS-DRG,832,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other antepartum diagnoses without O.R. procedures without CC/MCC,833,MS-DRG,833,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute leukemia with MCC,834,MS-DRG,834,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute leukemia with CC,835,MS-DRG,835,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute leukemia without CC/MCC,836,MS-DRG,836,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy agent with MCC,837,MS-DRG,837,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapy agent,838,MS-DRG,838,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis without CC/MCC,839,MS-DRG,839,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and non-acute leukemia with MCC,840,MS-DRG,840,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and non-acute leukemia with CC,841,MS-DRG,841,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Lymphoma and non-acute leukemia without CC/MCC,842,MS-DRG,842,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with MCC,843,MS-DRG,843,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with CC,844,MS-DRG,844,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses without CC/MCC,845,MS-DRG,845,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with MCC,846,MS-DRG,846,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with CC,847,MS-DRG,847,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis without CC/MCC,848,MS-DRG,848,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Radiotherapy,849,MS-DRG,849,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Acute leukemia with other procedures,850,MS-DRG,850,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Infectious and parasitic diseases with O.R. procedures with MCC,853,MS-DRG,853,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,116013.09,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Infectious and parasitic diseases with O.R. procedures with CC,854,MS-DRG,854,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.07,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Infectious and parasitic diseases with O.R. procedures without CC/MCC,855,MS-DRG,855,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with MCC,856,MS-DRG,856,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,103112.54,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with CC,857,MS-DRG,857,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures without CC/MCC,858,MS-DRG,858,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Postoperative and post-traumatic infections with MCC,862,MS-DRG,862,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,70501.55,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Postoperative and post-traumatic infections without MCC,863,MS-DRG,863,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,47554.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Fever and inflammatory conditions,864,MS-DRG,864,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Viral illness with MCC,865,MS-DRG,865,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Viral illness without MCC,866,MS-DRG,866,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other infectious and parasitic diseases diagnoses with MCC,867,MS-DRG,867,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,70118.98,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other infectious and parasitic diseases diagnoses with CC,868,MS-DRG,868,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other infectious and parasitic diseases diagnoses without CC/MCC,869,MS-DRG,869,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Septicemia or severe sepsis with MV >96 hours,870,MS-DRG,870,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,158548.16,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Septicemia or severe sepsis without MV >96 hours with MCC,871,MS-DRG,871,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,64954.17,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Septicemia or severe sepsis without MV >96 hours without MCC,872,MS-DRG,872,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,43522.12,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Wound debridements for injuries with MCC,901,MS-DRG,901,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,98177.28,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Wound debridements for injuries with CC,902,MS-DRG,902,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Wound debridements for injuries without CC/MCC,903,MS-DRG,903,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin grafts for injuries with CC/MCC,904,MS-DRG,904,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Skin grafts for injuries without CC/MCC,905,MS-DRG,905,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Hand procedures for injuries,906,MS-DRG,906,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures for injuries with MCC*,907,MS-DRG,907,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures for injuries with CC*,908,MS-DRG,908,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures for injuries without CC/MCC*,909,MS-DRG,909,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Traumatic injury with MCC,913,MS-DRG,913,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Traumatic injury without MCC,914,MS-DRG,914,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Allergic reactions with MCC,915,MS-DRG,915,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Allergic reactions without MCC,916,MS-DRG,916,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Poisoning and toxic effects of drugs with MCC,917,MS-DRG,917,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Poisoning and toxic effects of drugs without MCC,918,MS-DRG,918,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Complications of treatment with MCC,919,MS-DRG,919,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,82055.43,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Complications of treatment with CC,920,MS-DRG,920,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52581.58,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Complications of treatment without CC/MCC,921,MS-DRG,921,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other injury, poisoning and toxic effect diagnoses with MCC",922,MS-DRG,922,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Other injury, poisoning and toxic effect diagnoses without MCC",923,MS-DRG,923,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extensive burns or full thickness burns with MV >96 hours with skin graft,927,MS-DRG,927,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Full thickness burn with skin graft or inhalation injury with CC/MCC,928,MS-DRG,928,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Full thickness burn with skin graft or inhalation injury without CC/MCC,929,MS-DRG,929,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extensive burns or full thickness burns with MV >96 hours without skin graft,933,MS-DRG,933,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Full thickness burn without skin graft or inhalation injury,934,MS-DRG,934,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Non-extensive burns,935,MS-DRG,935,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
O.R. procedures with diagnoses of other contact with health services with MCC,939,MS-DRG,939,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,90701.7,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
O.R. procedures with diagnoses of other contact with health services with CC,940,MS-DRG,940,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
O.R. procedures with diagnoses of other contact with health services without CC/MCC,941,MS-DRG,941,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Signs and symptoms with MCC,947,MS-DRG,947,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Signs and symptoms without MCC,948,MS-DRG,948,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Aftercare with CC/MCC,949,MS-DRG,949,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,53224.31,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Aftercare without CC/MCC,950,MS-DRG,950,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other factors influencing health status,951,MS-DRG,951,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Craniotomy for multiple significant trauma,955,MS-DRG,955,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"Limb reattachment, hip and femur procedures for multiple significant trauma",956,MS-DRG,956,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures for multiple significant trauma with MCC,957,MS-DRG,957,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures for multiple significant trauma with CC,958,MS-DRG,958,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other O.R. procedures for multiple significant trauma without CC/MCC,959,MS-DRG,959,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other multiple significant trauma with MCC,963,MS-DRG,963,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other multiple significant trauma with CC,964,MS-DRG,964,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Other multiple significant trauma without CC/MCC,965,MS-DRG,965,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
HIV with extensive O.R. procedures with MCC,969,MS-DRG,969,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
HIV with extensive O.R. procedures without MCC,970,MS-DRG,970,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
HIV with major related condition with MCC*,974,MS-DRG,974,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,87197.28,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
HIV with major related condition with CC*,975,MS-DRG,975,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,68412.68,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
HIV with major related condition without CC/MCC*,976,MS-DRG,976,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,68412.68,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
HIV with or without other related condition,977,MS-DRG,977,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with MCC,981,MS-DRG,981,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,68449.825,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with CC,982,MS-DRG,982,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,96991.29,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,983,MS-DRG,983,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with CC,988,MS-DRG,988,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,72269.07,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with MCC,987,MS-DRG,987,LOCAL,,Inpatient,,,,,Blue Shield CA MR,Commercial,,,MS-DRG,163207.97,Per Diem,22000,120000,If TBC exceeds  $307088; apply 39.8% if akkiwed charges after the stop loss is reached Per diem rate ends when stop loss is met.,,,,,,,
"ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck with major O.R. procedures",3,MS-DRG,3,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,310277.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck without major O.R. procedures",4,MS-DRG,4,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,229767.96,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCC",11,MS-DRG,11,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CC",12,MS-DRG,12,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy without CC/MCC",13,MS-DRG,13,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Chimeric antigen receptor (CAR) T-cell and other immunotherapies,18,MS-DRG,18,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with MCC,20,MS-DRG,20,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with CC,21,MS-DRG,21,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage without CC/MCC,22,MS-DRG,22,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC or chemotherapy implant or epilepsy with neurostimulator,23,MS-DRG,23,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis without MCC,24,MS-DRG,24,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Craniotomy and endovascular intracranial procedures with MCC,25,MS-DRG,25,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Craniotomy and endovascular intracranial procedures with CC,26,MS-DRG,26,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Craniotomy and endovascular intracranial procedures without CC/MCC,27,MS-DRG,27,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Spinal procedures with MCC,28,MS-DRG,28,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Spinal procedures with CC or spinal neurostimulators,29,MS-DRG,29,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Spinal procedures without CC/MCC,30,MS-DRG,30,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Ventricular shunt procedures with MCC,31,MS-DRG,31,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Ventricular shunt procedures with CC,32,MS-DRG,32,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Ventricular shunt procedures without CC/MCC,33,MS-DRG,33,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Carotid artery stent procedures with MCC,34,MS-DRG,34,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Carotid artery stent procedures with CC,35,MS-DRG,35,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Carotid artery stent procedures without CC/MCC,36,MS-DRG,36,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Extracranial procedures with MCC,37,MS-DRG,37,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Extracranial procedures with CC,38,MS-DRG,38,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Extracranial procedures without CC/MCC,39,MS-DRG,39,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with MCC",40,MS-DRG,40,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,95774.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurostimulator",41,MS-DRG,41,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures without CC/MCC",42,MS-DRG,42,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Spinal disorders and injuries with CC/MCC,52,MS-DRG,52,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,82942.79,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Spinal disorders and injuries without CC/MCC,53,MS-DRG,53,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,81228.84,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Nervous system neoplasms with MCC,54,MS-DRG,54,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Nervous system neoplasms without MCC,55,MS-DRG,55,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46368.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Degenerative nervous system disorders with MCC,56,MS-DRG,56,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,61411.33,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Degenerative nervous system disorders without MCC,57,MS-DRG,57,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,51678.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Multiple sclerosis and cerebellar ataxia with MCC,58,MS-DRG,58,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Multiple sclerosis and cerebellar ataxia with CC,59,MS-DRG,59,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,51678.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Multiple sclerosis and cerebellar ataxia without CC/MCC,60,MS-DRG,60,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,51678.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with MCC",61,MS-DRG,61,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,111192.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with CC",62,MS-DRG,62,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent without CC/MCC",63,MS-DRG,63,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Intracranial hemorrhage or cerebral infarction with MCC,64,MS-DRG,64,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,111192.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Intracranial hemorrhage or cerebral infarction with CC or tPA in 24 hours,65,MS-DRG,65,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Intracranial hemorrhage or cerebral infarction without CC/MCC,66,MS-DRG,66,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Nonspecific CVA and precerebral occlusion without infarction with MCC,67,MS-DRG,67,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,66767.42,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Nonspecific CVA and precerebral occlusion without infarction without MCC,68,MS-DRG,68,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Transient ischemia without thrombolytic,69,MS-DRG,69,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Nonspecific cerebrovascular disorders with MCC*,70,MS-DRG,70,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,66767.42,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Nonspecific cerebrovascular disorders with CC*,71,MS-DRG,71,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,45128.84,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Nonspecific cerebrovascular disorders without CC/MCC*,72,MS-DRG,72,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cranial and peripheral nerve disorders with MCC,73,MS-DRG,73,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cranial and peripheral nerve disorders without MCC,74,MS-DRG,74,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Viral meningitis with CC/MCC,75,MS-DRG,75,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Viral meningitis without CC/MCC,76,MS-DRG,76,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hypertensive encephalopathy with MCC,77,MS-DRG,77,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,68160,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hypertensive encephalopathy with CC,78,MS-DRG,78,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,537909.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hypertensive encephalopathy without CC/MCC,79,MS-DRG,79,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Nontraumatic stupor and coma with MCC,80,MS-DRG,80,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Nontraumatic stupor and coma without MCC,81,MS-DRG,81,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Traumatic stupor and coma >1 hour with MCC*,82,MS-DRG,82,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,82529.13,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Traumatic stupor and coma >1 hour with CC*,83,MS-DRG,83,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,62451.46,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Traumatic stupor and coma >1 hour without CC/MCC*,84,MS-DRG,84,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Traumatic stupor and coma <1 hour with MCC,85,MS-DRG,85,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,62451.46,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Traumatic stupor and coma <1 hour with CC,86,MS-DRG,86,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,62451.46,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Traumatic stupor and coma <1 hour without CC/MCC,87,MS-DRG,87,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Concussion with MCC,88,MS-DRG,88,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,68160,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Concussion with CC,89,MS-DRG,89,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,537909.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Concussion without CC/MCC,90,MS-DRG,90,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other disorders of nervous system with MCC,91,MS-DRG,91,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,68160,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other disorders of nervous system with CC,92,MS-DRG,92,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,537909.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other disorders of nervous system without CC/MCC,93,MS-DRG,93,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,51678.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Bacterial and tuberculous infections of nervous system with MCC*,94,MS-DRG,94,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34375.739,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Bacterial and tuberculous infections of nervous system with CC*,95,MS-DRG,95,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,62451.46,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Bacterial and tuberculous infections of nervous system without CC/MCC*,96,MS-DRG,96,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Non-bacterial infection of nervous system except viral meningitis with MCC,97,MS-DRG,97,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,75054.04,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Non-bacterial infection of nervous system except viral meningitis with CC,98,MS-DRG,98,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Non-bacterial infection of nervous system except viral meningitis without CC/MCC,99,MS-DRG,99,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Seizures with MCC,100,MS-DRG,100,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Seizures without MCC,101,MS-DRG,101,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Headaches with MCC,102,MS-DRG,102,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Headaches without MCC,103,MS-DRG,103,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Orbital procedures with CC/MCC,113,MS-DRG,113,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Orbital procedures without CC/MCC,114,MS-DRG,114,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Extraocular procedures except orbit,115,MS-DRG,115,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Intraocular procedures with CC/MCC,116,MS-DRG,116,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Intraocular procedures without CC/MCC,117,MS-DRG,117,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Acute major eye infections with CC/MCC,121,MS-DRG,121,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Acute major eye infections without CC/MCC,122,MS-DRG,122,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Neurological eye disorders,123,MS-DRG,123,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other disorders of the eye with MCC or thrombolytic agent,124,MS-DRG,124,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other disorders of the eye without MCC,125,MS-DRG,125,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Sinus and mastoid procedures with CC/MCC,135,MS-DRG,135,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Sinus and mastoid procedures without CC/MCC,136,MS-DRG,136,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Mouth procedures with CC/MCC,137,MS-DRG,137,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Mouth procedures without CC/MCC,138,MS-DRG,138,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Salivary gland procedures,139,MS-DRG,139,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major head and neck procedures with MCC,140,MS-DRG,140,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,177508.29,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major head and neck procedures with CC,141,MS-DRG,141,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major head and neck procedures without CC/MCC,142,MS-DRG,142,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with MCC",143,MS-DRG,143,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with CC",144,MS-DRG,144,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures without CC/MCC",145,MS-DRG,145,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Ear, nose, mouth and throat malignancy with MCC*",146,MS-DRG,146,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Ear, nose, mouth and throat malignancy with CC*",147,MS-DRG,147,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Ear, nose, mouth and throat malignancy without CC/MCC*",148,MS-DRG,148,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Dysequilibrium,149,MS-DRG,149,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Epistaxis with MCC,150,MS-DRG,150,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Epistaxis without MCC,151,MS-DRG,151,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Otitis media and URI with MCC,152,MS-DRG,152,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Otitis media and URI without MCC,153,MS-DRG,153,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Other ear, nose, mouth and throat diagnoses with MCC",154,MS-DRG,154,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Other ear, nose, mouth and throat diagnoses with CC",155,MS-DRG,155,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Other ear, nose, mouth and throat diagnoses without CC/MCC",156,MS-DRG,156,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Dental and oral diseases with MCC,157,MS-DRG,157,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Dental and oral diseases with CC,158,MS-DRG,158,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Dental and oral diseases without CC/MCC,159,MS-DRG,159,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major chest procedures with MCC,163,MS-DRG,163,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,202666.58,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major chest procedures with CC,164,MS-DRG,164,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,202666.58,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major chest procedures without CC/MCC,165,MS-DRG,165,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,202666.58,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other respiratory system O.R. procedures with MCC,166,MS-DRG,166,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,177508.29,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other respiratory system O.R. procedures with CC,167,MS-DRG,167,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,115767.94,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other respiratory system O.R. procedures without CC/MCC,168,MS-DRG,168,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism,173,MS-DRG,173,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Pulmonary embolism with MCC or acute cor pulmonale,175,MS-DRG,175,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Pulmonary embolism without MCC,176,MS-DRG,176,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Respiratory infections and inflammations with MCC*,177,MS-DRG,177,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,62918.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Respiratory infections and inflammations with CC*,178,MS-DRG,178,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,43491.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Respiratory infections and inflammations without CC/MCC*,179,MS-DRG,179,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,42251.85,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Respiratory neoplasms with MCC*,180,MS-DRG,180,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Respiratory neoplasms with CC*,181,MS-DRG,181,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Respiratory neoplasms without CC/MCC*,182,MS-DRG,182,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major chest trauma with MCC,183,MS-DRG,183,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major chest trauma with CC,184,MS-DRG,184,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major chest trauma without CC/MCC,185,MS-DRG,185,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Pleural effusion with MCC*,186,MS-DRG,186,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,66071.13,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Pleural effusion with CC*,187,MS-DRG,187,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Pleural effusion without CC/MCC*,188,MS-DRG,188,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Pulmonary edema and respiratory failure,189,MS-DRG,189,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72046.99,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Chronic obstructive pulmonary disease with MCC*,190,MS-DRG,190,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,20971.383,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Chronic obstructive pulmonary disease with CC*,191,MS-DRG,191,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Chronic obstructive pulmonary disease without CC/MCC*,192,MS-DRG,192,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Simple pneumonia and pleurisy with MCC,193,MS-DRG,193,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,59421.93,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Simple pneumonia and pleurisy with CC,194,MS-DRG,194,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,39604.42,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Simple pneumonia and pleurisy without CC/MCC,195,MS-DRG,195,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Interstitial lung disease with MCC*,196,MS-DRG,196,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Interstitial lung disease with CC*,197,MS-DRG,197,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Interstitial lung disease without CC/MCC*,198,MS-DRG,198,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Pneumothorax with MCC,199,MS-DRG,199,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Pneumothorax with CC,200,MS-DRG,200,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,21869.927,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Pneumothorax without CC/MCC,201,MS-DRG,201,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,21869.927,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Bronchitis and asthma with CC/MCC,202,MS-DRG,202,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,40508.305,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Bronchitis and asthma without CC/MCC,203,MS-DRG,203,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,15339.435,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Respiratory signs and symptoms,204,MS-DRG,204,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other respiratory system diagnoses with MCC,205,MS-DRG,205,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,112102.84,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other respiratory system diagnoses without MCC,206,MS-DRG,206,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Respiratory system diagnosis with ventilator support >96 hours,207,MS-DRG,207,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,147720.8,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Respiratory system diagnosis with ventilator support <=96 hours,208,MS-DRG,208,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,81481.35,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Concomitant aortic and mitral valve procedures,212,MS-DRG,212,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other heart assist system implant,215,MS-DRG,215,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC,216,MS-DRG,216,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with CC,217,MS-DRG,217,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization without CC/MCC,218,MS-DRG,218,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with MCC,219,MS-DRG,219,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with CC,220,MS-DRG,220,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization without CC/MCC,221,MS-DRG,221,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other cardiothoracic procedures with MCC,228,MS-DRG,228,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other cardiothoracic procedures without MCC,229,MS-DRG,229,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Coronary bypass with PTCA with MCC,231,MS-DRG,231,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Coronary bypass with PTCA without MCC,232,MS-DRG,232,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Coronary bypass with cardiac catheterization or open ablation with MCC,233,MS-DRG,233,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Coronary bypass with cardiac catheterization or open ablation without MCC,234,MS-DRG,234,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Coronary bypass without cardiac catheterization with MCC,235,MS-DRG,235,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Coronary bypass without cardiac catheterization without MCC,236,MS-DRG,236,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Amputation for circulatory system disorders except upper limb and toe with MCC,239,MS-DRG,239,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Amputation for circulatory system disorders except upper limb and toe with CC,240,MS-DRG,240,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Amputation for circulatory system disorders except upper limb and toe without CC/MCC,241,MS-DRG,241,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Permanent cardiac pacemaker implant with MCC,242,MS-DRG,242,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Permanent cardiac pacemaker implant with CC,243,MS-DRG,243,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Permanent cardiac pacemaker implant without CC/MCC,244,MS-DRG,244,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
AICD generator procedures,245,MS-DRG,245,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,40774.659,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Percutaneous cardiovascular procedures without intraluminal device with MCC,250,MS-DRG,250,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Percutaneous cardiovascular procedures without intraluminal device without MCC,251,MS-DRG,251,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other vascular procedures with MCC,252,MS-DRG,252,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other vascular procedures with CC,253,MS-DRG,253,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other vascular procedures without CC/MCC,254,MS-DRG,254,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Upper limb and toe amputation for circulatory system disorders with MCC,255,MS-DRG,255,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Upper limb and toe amputation for circulatory system disorders with CC,256,MS-DRG,256,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Upper limb and toe amputation for circulatory system disorders without CC/MCC,257,MS-DRG,257,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac pacemaker device replacement with MCC,258,MS-DRG,258,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac pacemaker device replacement without MCC,259,MS-DRG,259,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac pacemaker revision except device replacement with MCC,260,MS-DRG,260,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac pacemaker revision except device replacement with CC,261,MS-DRG,261,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac pacemaker revision except device replacement without CC/MCC,262,MS-DRG,262,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Vein ligation and stripping,263,MS-DRG,263,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other circulatory system O.R. procedures,264,MS-DRG,264,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
AICD lead procedures,265,MS-DRG,265,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Endovascular cardiac valve replacement and supplement procedures with MCC,266,MS-DRG,266,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Endovascular cardiac valve replacement and supplement procedures without MCC,267,MS-DRG,267,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Aortic and heart assist procedures except pulsation balloon with MCC,268,MS-DRG,268,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Aortic and heart assist procedures except pulsation balloon without MCC,269,MS-DRG,269,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79522.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other major cardiovascular procedures with MCC,270,MS-DRG,270,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other major cardiovascular procedures with CC,271,MS-DRG,271,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other major cardiovascular procedures without CC/MCC,272,MS-DRG,272,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Percutaneous and other intracardiac procedures with MCC,273,MS-DRG,273,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Percutaneous and other intracardiac procedures without MCC,274,MS-DRG,274,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac defibrillator implant with cardiac catheterization and MCC,275,MS-DRG,275,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac defibrillator implant with MCC or carotid sinus neurostimulator,276,MS-DRG,276,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac defibrillator implant without MCC,277,MS-DRG,277,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures with MCC,278,MS-DRG,278,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures without MCC,279,MS-DRG,279,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,92851.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Acute myocardial infarction, discharged alive with MCC",280,MS-DRG,280,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,63798.62,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Acute myocardial infarction, discharged alive with CC",281,MS-DRG,281,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Acute myocardial infarction, discharged alive without CC/MCC",282,MS-DRG,282,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Acute myocardial infarction, expired with MCC",283,MS-DRG,283,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Acute myocardial infarction, expired with CC",284,MS-DRG,284,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Acute myocardial infarction, expired without CC/MCC",285,MS-DRG,285,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization with MCC",286,MS-DRG,286,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization without MCC",287,MS-DRG,287,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Acute and subacute endocarditis with MCC,288,MS-DRG,288,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,79476.64,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Acute and subacute endocarditis with CC,289,MS-DRG,289,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,54456.07,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Acute and subacute endocarditis without CC/MCC,290,MS-DRG,290,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48748.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Heart failure and shock with MCC,291,MS-DRG,291,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,59345.41,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Heart failure and shock with CC,292,MS-DRG,292,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,42060.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Heart failure and shock without CC/MCC,293,MS-DRG,293,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,42060.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Deep vein thrombophlebitis with CC/MCC,294,MS-DRG,294,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Deep vein thrombophlebitis without CC/MCC,295,MS-DRG,295,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Cardiac arrest, unexplained with MCC",296,MS-DRG,296,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,59345.41,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Cardiac arrest, unexplained with CC",297,MS-DRG,297,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,42060.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Cardiac arrest, unexplained without CC/MCC",298,MS-DRG,298,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,42060.56,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Peripheral vascular disorders with MCC,299,MS-DRG,299,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,64808.62,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Peripheral vascular disorders with CC,300,MS-DRG,300,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Peripheral vascular disorders without CC/MCC,301,MS-DRG,301,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Atherosclerosis with MCC,302,MS-DRG,302,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Atherosclerosis without MCC,303,MS-DRG,303,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hypertension with MCC,304,MS-DRG,304,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hypertension without MCC,305,MS-DRG,305,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac congenital and valvular disorders with MCC,306,MS-DRG,306,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac congenital and valvular disorders without MCC,307,MS-DRG,307,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac arrhythmia and conduction disorders with MCC,308,MS-DRG,308,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac arrhythmia and conduction disorders with CC,309,MS-DRG,309,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,60095.27,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cardiac arrhythmia and conduction disorders without CC/MCC,310,MS-DRG,310,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Angina pectoris,311,MS-DRG,311,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Syncope and collapse,312,MS-DRG,312,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46383.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Chest pain,313,MS-DRG,313,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other circulatory system diagnoses with MCC,314,MS-DRG,314,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,67570.83,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other circulatory system diagnoses with CC,315,MS-DRG,315,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,47562.03,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other circulatory system diagnoses without CC/MCC,316,MS-DRG,316,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Concomitant left atrial appendage closure and cardiac ablation,317,MS-DRG,317,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other endovascular cardiac valve procedures with MCC,319,MS-DRG,319,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other endovascular cardiac valve procedures without MCC,320,MS-DRG,320,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/intraluminal devices,321,MS-DRG,321,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Percutaneous cardiovascular procedures with intraluminal device without MCC,322,MS-DRG,322,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Coronary intravascular lithotripsy with intraluminal device with MCC,323,MS-DRG,323,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Coronary intravascular lithotripsy with intraluminal device without MCC,324,MS-DRG,324,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,34914.02,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Coronary intravascular lithotripsy without intraluminal device,325,MS-DRG,325,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Stomach, esophageal and duodenal procedures with MCC",326,MS-DRG,326,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Stomach, esophageal and duodenal procedures with CC",327,MS-DRG,327,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Stomach, esophageal and duodenal procedures without CC/MCC",328,MS-DRG,328,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major small and large bowel procedures with MCC,329,MS-DRG,329,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major small and large bowel procedures with CC,330,MS-DRG,330,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major small and large bowel procedures without CC/MCC,331,MS-DRG,331,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Rectal resection with MCC,332,MS-DRG,332,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Rectal resection with CC,333,MS-DRG,333,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Rectal resection without CC/MCC,334,MS-DRG,334,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Peritoneal adhesiolysis with MCC,335,MS-DRG,335,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Peritoneal adhesiolysis with CC,336,MS-DRG,336,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Peritoneal adhesiolysis without CC/MCC,337,MS-DRG,337,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Minor small and large bowel procedures with MCC,344,MS-DRG,344,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Minor small and large bowel procedures with CC,345,MS-DRG,345,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Minor small and large bowel procedures without CC/MCC,346,MS-DRG,346,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Anal and stomal procedures with MCC,347,MS-DRG,347,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,68366.59,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Anal and stomal procedures with CC,348,MS-DRG,348,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Anal and stomal procedures without CC/MCC,349,MS-DRG,349,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Inguinal and femoral hernia procedures with MCC,350,MS-DRG,350,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,68366.59,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Inguinal and femoral hernia procedures with CC,351,MS-DRG,351,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Inguinal and femoral hernia procedures without CC/MCC,352,MS-DRG,352,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hernia procedures except inguinal and femoral with MCC,353,MS-DRG,353,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,118828.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hernia procedures except inguinal and femoral with CC,354,MS-DRG,354,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hernia procedures except inguinal and femoral without CC/MCC,355,MS-DRG,355,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other digestive system O.R. procedures with MCC,356,MS-DRG,356,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,106800.32,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other digestive system O.R. procedures with CC,357,MS-DRG,357,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other digestive system O.R. procedures without CC/MCC,358,MS-DRG,358,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major esophageal disorders with MCC*,368,MS-DRG,368,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major esophageal disorders with CC*,369,MS-DRG,369,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major esophageal disorders without CC/MCC*,370,MS-DRG,370,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major gastrointestinal disorders and peritoneal infections with MCC,371,MS-DRG,371,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,68366.59,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major gastrointestinal disorders and peritoneal infections with CC,372,MS-DRG,372,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major gastrointestinal disorders and peritoneal infections without CC/MCC,373,MS-DRG,373,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Digestive malignancy with MCC*,374,MS-DRG,374,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Digestive malignancy with CC*,375,MS-DRG,375,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Digestive malignancy without CC/MCC*,376,MS-DRG,376,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Gastrointestinal hemorrhage with MCC,377,MS-DRG,377,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,54425.47,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Gastrointestinal hemorrhage with CC,378,MS-DRG,378,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Gastrointestinal hemorrhage without CC/MCC,379,MS-DRG,379,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Complicated peptic ulcer with MCC,380,MS-DRG,380,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,73278.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Complicated peptic ulcer with CC,381,MS-DRG,381,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Complicated peptic ulcer without CC/MCC,382,MS-DRG,382,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Uncomplicated peptic ulcer with MCC,383,MS-DRG,383,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Uncomplicated peptic ulcer without MCC,384,MS-DRG,384,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Inflammatory bowel disease with MCC,385,MS-DRG,385,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Inflammatory bowel disease with CC,386,MS-DRG,386,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Inflammatory bowel disease without CC/MCC,387,MS-DRG,387,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Gastrointestinal obstruction with MCC,388,MS-DRG,388,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,75604.95,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Gastrointestinal obstruction with CC,389,MS-DRG,389,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Gastrointestinal obstruction without CC/MCC,390,MS-DRG,390,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC",391,MS-DRG,391,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,59253.6,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC",392,MS-DRG,392,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,47929.3,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other digestive system diagnoses with MCC,393,MS-DRG,393,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,77739.74,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other digestive system diagnoses with CC,394,MS-DRG,394,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other digestive system diagnoses without CC/MCC,395,MS-DRG,395,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Appendix procedures with MCC,397,MS-DRG,397,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,68366.59,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Appendix procedures with CC,398,MS-DRG,398,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Appendix procedures without CC/MCC,399,MS-DRG,399,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Single level combined anterior and posterior spinal fusion except cervical,402,MS-DRG,402,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Pancreas, liver and shunt procedures with MCC",405,MS-DRG,405,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,40508.305,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Pancreas, liver and shunt procedures with CC",406,MS-DRG,406,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Pancreas, liver and shunt procedures without CC/MCC",407,MS-DRG,407,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with MCC,408,MS-DRG,408,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with CC,409,MS-DRG,409,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. without CC/MCC,410,MS-DRG,410,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cholecystectomy with C.D.E. with MCC,411,MS-DRG,411,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,73278.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cholecystectomy with C.D.E. with CC,412,MS-DRG,412,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cholecystectomy with C.D.E. without CC/MCC,413,MS-DRG,413,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with MCC,414,MS-DRG,414,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,73278.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with CC,415,MS-DRG,415,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. without CC/MCC,416,MS-DRG,416,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Laparoscopic cholecystectomy without C.D.E. with MCC,417,MS-DRG,417,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,73278.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Laparoscopic cholecystectomy without C.D.E. with CC,418,MS-DRG,418,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Laparoscopic cholecystectomy without C.D.E. without CC/MCC,419,MS-DRG,419,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hepatobiliary diagnostic procedures with MCC,420,MS-DRG,420,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55022.29,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hepatobiliary diagnostic procedures with CC,421,MS-DRG,421,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hepatobiliary diagnostic procedures without CC/MCC,422,MS-DRG,422,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other hepatobiliary or pancreas O.R. procedures with MCC,423,MS-DRG,423,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other hepatobiliary or pancreas O.R. procedures with CC,424,MS-DRG,424,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other hepatobiliary or pancreas O.R. procedures without CC/MCC,425,MS-DRG,425,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,4870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,426,MS-DRG,426,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,81343.62,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical with CC,427,MS-DRG,427,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,81343.62,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical without CC/MCC,428,MS-DRG,428,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,67111.73,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Combined anterior and posterior cervical spinal fusion with MCC,429,MS-DRG,429,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,81343.62,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Combined anterior and posterior cervical spinal fusion without MCC,430,MS-DRG,430,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cirrhosis and alcoholic hepatitis with MCC,432,MS-DRG,432,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,56468.43,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cirrhosis and alcoholic hepatitis with CC,433,MS-DRG,433,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cirrhosis and alcoholic hepatitis without CC/MCC,434,MS-DRG,434,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Malignancy of hepatobiliary system or pancreas with MCC,435,MS-DRG,435,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Malignancy of hepatobiliary system or pancreas with CC,436,MS-DRG,436,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Malignancy of hepatobiliary system or pancreas without CC/MCC,437,MS-DRG,437,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Disorders of pancreas except malignancy with MCC,438,MS-DRG,438,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,80165.28,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Disorders of pancreas except malignancy with CC,439,MS-DRG,439,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Disorders of pancreas except malignancy without CC/MCC,440,MS-DRG,440,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCC",441,MS-DRG,441,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,71243.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CC",442,MS-DRG,442,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without CC/MCC",443,MS-DRG,443,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Disorders of the biliary tract with MCC*,444,MS-DRG,444,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,58190.03,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Disorders of the biliary tract with CC*,445,MS-DRG,445,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53147.66,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Disorders of the biliary tract without CC/MCC*,446,MS-DRG,446,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,447,MS-DRG,447,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,1.0631,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Multiple level spinal fusion except cervical without MCC,448,MS-DRG,448,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,1.0631,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,450,MS-DRG,450,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,67111.74,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Single Level Spinal Fusion Except Cervical without MCC,451,MS-DRG,451,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with MCC",456,MS-DRG,456,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with CC",457,MS-DRG,457,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions without CC/MCC",458,MS-DRG,458,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Bilateral or multiple major joint procedures of lower extremity with MCC,461,MS-DRG,461,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,67111.74,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Bilateral or multiple major joint procedures of lower extremity without MCC,462,MS-DRG,462,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with MCC*,463,MS-DRG,463,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with CC*,464,MS-DRG,464,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72972.82,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders without CC/MCC*,465,MS-DRG,465,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,70057.58,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Revision of hip or knee replacement with MCC,466,MS-DRG,466,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Revision of hip or knee replacement with CC,467,MS-DRG,467,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Revision of hip or knee replacement without CC/MCC,468,MS-DRG,468,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity with MCC or total ankle replacement,469,MS-DRG,469,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity without MCC,470,MS-DRG,470,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cervical spinal fusion with MCC,471,MS-DRG,471,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cervical spinal fusion with CC,472,MS-DRG,472,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cervical spinal fusion without CC/MCC,473,MS-DRG,473,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with MCC,474,MS-DRG,474,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with CC,475,MS-DRG,475,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders without CC/MCC,476,MS-DRG,476,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Biopsies of musculoskeletal system and connective tissue with MCC,477,MS-DRG,477,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Biopsies of musculoskeletal system and connective tissue with CC,478,MS-DRG,478,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,28146.902,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Biopsies of musculoskeletal system and connective tissue without CC/MCC,479,MS-DRG,479,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,28146.902,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hip and femur procedures except major joint with MCC,480,MS-DRG,480,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hip and femur procedures except major joint with CC,481,MS-DRG,481,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hip and femur procedures except major joint without CC/MCC,482,MS-DRG,482,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major joint or limb reattachment procedures of upper extremities,483,MS-DRG,483,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Knee procedures with principal diagnosis of infection with MCC,485,MS-DRG,485,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Knee procedures with principal diagnosis of infection with CC,486,MS-DRG,486,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Knee procedures with principal diagnosis of infection without CC/MCC,487,MS-DRG,487,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Knee procedures without principal diagnosis of infection with CC/MCC,488,MS-DRG,488,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Knee procedures without principal diagnosis of infection without CC/MCC,489,MS-DRG,489,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,51693.87,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with MCC",492,MS-DRG,492,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with CC",493,MS-DRG,493,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur without CC/MCC",494,MS-DRG,494,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Local excision and removal of internal fixation devices except hip and femur with MCC,495,MS-DRG,495,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Local excision and removal of internal fixation devices except hip and femur with CC,496,MS-DRG,496,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Local excision and removal of internal fixation devices except hip and femur without CC/MCC,497,MS-DRG,497,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Local excision and removal of internal fixation devices of hip and femur with CC/MCC,498,MS-DRG,498,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Local excision and removal of internal fixation devices of hip and femur without CC/MCC,499,MS-DRG,499,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Soft tissue procedures with MCC,500,MS-DRG,500,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,94244.13,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Soft tissue procedures with CC,501,MS-DRG,501,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Soft tissue procedures without CC/MCC,502,MS-DRG,502,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,67111.74,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Foot procedures with MCC,503,MS-DRG,503,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Foot procedures with CC,504,MS-DRG,504,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Foot procedures without CC/MCC,505,MS-DRG,505,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major thumb or joint procedures,506,MS-DRG,506,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major shoulder or elbow joint procedures with CC/MCC,507,MS-DRG,507,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major shoulder or elbow joint procedures without CC/MCC,508,MS-DRG,508,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Arthroscopy,509,MS-DRG,509,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with MCC",510,MS-DRG,510,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with CC",511,MS-DRG,511,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures without CC/MCC",512,MS-DRG,512,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures with CC/MCC",513,MS-DRG,513,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures without CC/MCC",514,MS-DRG,514,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with MCC,515,MS-DRG,515,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,91742.07,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with CC,516,MS-DRG,516,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures without CC/MCC,517,MS-DRG,517,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Back and neck procedures except spinal fusion with MCC or disc device or neurostimulator,518,MS-DRG,518,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Back and neck procedures except spinal fusion with CC,519,MS-DRG,519,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Back and neck procedures except spinal fusion without CC/MCC,520,MS-DRG,520,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hip replacement with principal diagnosis of hip fracture with MCC,521,MS-DRG,521,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hip replacement with principal diagnosis of hip fracture without MCC,522,MS-DRG,522,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Fractures of femur with MCC,533,MS-DRG,533,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Fractures of femur without MCC,534,MS-DRG,534,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55504.34,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Fractures of hip and pelvis with MCC,535,MS-DRG,535,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Fractures of hip and pelvis without MCC,536,MS-DRG,536,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh with CC/MCC",537,MS-DRG,537,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh without CC/MCC",538,MS-DRG,538,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Osteomyelitis with MCC*,539,MS-DRG,539,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,74166.46,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Osteomyelitis with CC*,540,MS-DRG,540,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,54425.47,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Osteomyelitis without CC/MCC*,541,MS-DRG,541,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,51693.86,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with MCC*,542,MS-DRG,542,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with CC*,543,MS-DRG,543,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy without CC/MCC*,544,MS-DRG,544,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Connective tissue disorders with MCC,545,MS-DRG,545,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Connective tissue disorders with CC,546,MS-DRG,546,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Connective tissue disorders without CC/MCC,547,MS-DRG,547,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46988.16,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Septic arthritis with MCC,548,MS-DRG,548,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,65145.29,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Septic arthritis with CC,549,MS-DRG,549,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Septic arthritis without CC/MCC,550,MS-DRG,550,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Medical back problems with MCC,551,MS-DRG,551,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,99921.58,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Medical back problems without MCC,552,MS-DRG,552,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Bone diseases and arthropathies with MCC,553,MS-DRG,553,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Bone diseases and arthropathies without MCC,554,MS-DRG,554,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue with MCC,555,MS-DRG,555,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue without MCC,556,MS-DRG,556,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Tendonitis, myositis and bursitis with MCC",557,MS-DRG,557,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,69284.76,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Tendonitis, myositis and bursitis without MCC",558,MS-DRG,558,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53645.01,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Aftercare, musculoskeletal system and connective tissue with MCC*",559,MS-DRG,559,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,61671.48,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Aftercare, musculoskeletal system and connective tissue with CC*",560,MS-DRG,560,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48082.33,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Aftercare, musculoskeletal system and connective tissue without CC/MCC*",561,MS-DRG,561,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46988.16,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCC",562,MS-DRG,562,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCC",563,MS-DRG,563,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46988.16,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other musculoskeletal system and connective tissue diagnoses with MCC,564,MS-DRG,564,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,67111.74,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other musculoskeletal system and connective tissue diagnoses with CC,565,MS-DRG,565,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other musculoskeletal system and connective tissue diagnoses without CC/MCC,566,MS-DRG,566,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53790.39,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Skin debridement with MCC*,570,MS-DRG,570,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,90081.68,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Skin debridement with CC*,571,MS-DRG,571,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,65336.58,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Skin debridement without CC/MCC*,572,MS-DRG,572,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,65336.58,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Skin graft for skin ulcer or cellulitis with MCC,573,MS-DRG,573,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,106394.79,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Skin graft for skin ulcer or cellulitis with CC,574,MS-DRG,574,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Skin graft for skin ulcer or cellulitis without CC/MCC,575,MS-DRG,575,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Skin graft except for skin ulcer or cellulitis with MCC*,576,MS-DRG,576,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Skin graft except for skin ulcer or cellulitis with CC*,577,MS-DRG,577,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Skin graft except for skin ulcer or cellulitis without CC/MCC*,578,MS-DRG,578,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Other skin, subcutaneous tissue and breast procedures with MCC",579,MS-DRG,579,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,103793.26,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Other skin, subcutaneous tissue and breast procedures with CC",580,MS-DRG,580,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,85299.47,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Other skin, subcutaneous tissue and breast procedures without CC/MCC",581,MS-DRG,581,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,85299.47,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Mastectomy for malignancy with CC/MCC,582,MS-DRG,582,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,103793.26,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Mastectomy for malignancy without CC/MCC,583,MS-DRG,583,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,85299.47,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Breast biopsy, local excision and other breast procedures with CC/MCC",584,MS-DRG,584,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,65336.58,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Breast biopsy, local excision and other breast procedures without CC/MCC",585,MS-DRG,585,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Skin ulcers with MCC,592,MS-DRG,592,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,67333.63,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Skin ulcers with CC,593,MS-DRG,593,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53667.96,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Skin ulcers without CC/MCC,594,MS-DRG,594,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major skin disorders with MCC,595,MS-DRG,595,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major skin disorders without MCC,596,MS-DRG,596,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Malignant breast disorders with MCC,597,MS-DRG,597,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Malignant breast disorders with CC,598,MS-DRG,598,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Malignant breast disorders without CC/MCC,599,MS-DRG,599,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Non-malignant breast disorders with CC/MCC*,600,MS-DRG,600,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Non-malignant breast disorders without CC/MCC*,601,MS-DRG,601,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cellulitis with MCC,602,MS-DRG,602,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,55068.2,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cellulitis without MCC,603,MS-DRG,603,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36842.21,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Trauma to the skin, subcutaneous tissue and breast with MCC",604,MS-DRG,604,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Trauma to the skin, subcutaneous tissue and breast without MCC",605,MS-DRG,605,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Minor skin disorders with MCC,606,MS-DRG,606,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Minor skin disorders without MCC,607,MS-DRG,607,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Adrenal and pituitary procedures with CC/MCC,614,MS-DRG,614,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Adrenal and pituitary procedures without CC/MCC,615,MS-DRG,615,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with MCC",616,MS-DRG,616,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with CC",617,MS-DRG,617,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders without CC/MCC",618,MS-DRG,618,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
O.R. procedures for obesity with MCC,619,MS-DRG,619,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,100051.65,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
O.R. procedures for obesity with CC,620,MS-DRG,620,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72590.25,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
O.R. procedures for obesity without CC/MCC,621,MS-DRG,621,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with MCC",622,MS-DRG,622,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,100051.65,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with CC",623,MS-DRG,623,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72590.25,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders without CC/MCC",624,MS-DRG,624,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with MCC",625,MS-DRG,625,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,30309.826,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with CC",626,MS-DRG,626,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures without CC/MCC",627,MS-DRG,627,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with MCC",628,MS-DRG,628,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,30309.826,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with CC",629,MS-DRG,629,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures without CC/MCC",630,MS-DRG,630,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Diabetes with MCC,637,MS-DRG,637,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,67654.99,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Diabetes with CC,638,MS-DRG,638,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53843.95,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Diabetes without CC/MCC,639,MS-DRG,639,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCC",640,MS-DRG,640,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,74862.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCC",641,MS-DRG,641,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,47049.37,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Inborn and other disorders of metabolism,642,MS-DRG,642,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Endocrine disorders with MCC*,643,MS-DRG,643,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Endocrine disorders with CC*,644,MS-DRG,644,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Endocrine disorders without CC/MCC*,645,MS-DRG,645,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major bladder procedures with MCC,653,MS-DRG,653,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,91596.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major bladder procedures with CC,654,MS-DRG,654,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,80073.46,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major bladder procedures without CC/MCC,655,MS-DRG,655,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Kidney and ureter procedures for neoplasm with MCC,656,MS-DRG,656,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Kidney and ureter procedures for neoplasm with CC,657,MS-DRG,657,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Kidney and ureter procedures for neoplasm without CC/MCC,658,MS-DRG,658,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Kidney and ureter procedures for non-neoplasm with MCC*,659,MS-DRG,659,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Kidney and ureter procedures for non-neoplasm with CC*,660,MS-DRG,660,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Kidney and ureter procedures for non-neoplasm without CC/MCC*,661,MS-DRG,661,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Minor bladder procedures with MCC,662,MS-DRG,662,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Minor bladder procedures with CC,663,MS-DRG,663,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Minor bladder procedures without CC/MCC,664,MS-DRG,664,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Prostatectomy with MCC,665,MS-DRG,665,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,91596.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Prostatectomy with CC,666,MS-DRG,666,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,80073.46,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Prostatectomy without CC/MCC,667,MS-DRG,667,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Transurethral procedures with MCC,668,MS-DRG,668,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Transurethral procedures with CC,669,MS-DRG,669,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Transurethral procedures without CC/MCC,670,MS-DRG,670,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Urethral procedures with CC/MCC,671,MS-DRG,671,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Urethral procedures without CC/MCC,672,MS-DRG,672,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72268.88,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other kidney and urinary tract procedures with MCC*,673,MS-DRG,673,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,91596.69,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other kidney and urinary tract procedures with CC*,674,MS-DRG,674,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,80073.46,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other kidney and urinary tract procedures without CC/MCC*,675,MS-DRG,675,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,80073.46,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Renal failure with MCC,682,MS-DRG,682,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,66775.07,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Renal failure with CC,683,MS-DRG,683,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,46314.82,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Renal failure without CC/MCC,684,MS-DRG,684,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Kidney and urinary tract neoplasms with MCC,686,MS-DRG,686,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Kidney and urinary tract neoplasms with CC,687,MS-DRG,687,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Kidney and urinary tract neoplasms without CC/MCC,688,MS-DRG,688,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.4,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Kidney and urinary tract infections with MCC,689,MS-DRG,689,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48342.49,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Kidney and urinary tract infections without MCC,690,MS-DRG,690,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,35962.28,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Urinary stones with MCC,693,MS-DRG,693,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Urinary stones without MCC,694,MS-DRG,694,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Kidney and urinary tract signs and symptoms with MCC,695,MS-DRG,695,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Kidney and urinary tract signs and symptoms without MCC,696,MS-DRG,696,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Urethral stricture,697,MS-DRG,697,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other kidney and urinary tract diagnoses with MCC,698,MS-DRG,698,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,67746.82,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other kidney and urinary tract diagnoses with CC,699,MS-DRG,699,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,47363.09,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other kidney and urinary tract diagnoses without CC/MCC,700,MS-DRG,700,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major male pelvic procedures with CC/MCC,707,MS-DRG,707,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major male pelvic procedures without CC/MCC,708,MS-DRG,708,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Penis procedures with CC/MCC,709,MS-DRG,709,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Penis procedures without CC/MCC,710,MS-DRG,710,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Testes procedures with CC/MCC,711,MS-DRG,711,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Testes procedures without CC/MCC,712,MS-DRG,712,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Transurethral prostatectomy with CC/MCC,713,MS-DRG,713,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,30309.826,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Transurethral prostatectomy without CC/MCC,714,MS-DRG,714,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other male reproductive system O.R. procedures for malignancy with CC/MCC,715,MS-DRG,715,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other male reproductive system O.R. procedures for malignancy without CC/MCC,716,MS-DRG,716,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other male reproductive system O.R. procedures except malignancy with CC/MCC,717,MS-DRG,717,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other male reproductive system O.R. procedures except malignancy without CC/MCC,718,MS-DRG,718,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Malignancy, male reproductive system with MCC",722,MS-DRG,722,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,61794.07,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Malignancy, male reproductive system with CC",723,MS-DRG,723,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Malignancy, male reproductive system without CC/MCC",724,MS-DRG,724,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,50278,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Benign prostatic hypertrophy with MCC,725,MS-DRG,725,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,50278.46,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Benign prostatic hypertrophy without MCC,726,MS-DRG,726,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Inflammation of the male reproductive system with MCC,727,MS-DRG,727,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,61794.07,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Inflammation of the male reproductive system without MCC,728,MS-DRG,728,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,50278,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other male reproductive system diagnoses with CC/MCC,729,MS-DRG,729,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other male reproductive system diagnoses without CC/MCC,730,MS-DRG,730,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC",734,MS-DRG,734,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC",735,MS-DRG,735,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with MCC,736,MS-DRG,736,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with CC,737,MS-DRG,737,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy without CC/MCC,738,MS-DRG,738,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with MCC,739,MS-DRG,739,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with CC,740,MS-DRG,740,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy without CC/MCC,741,MS-DRG,741,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Uterine and adnexa procedures for non-malignancy with CC/MCC,742,MS-DRG,742,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Uterine and adnexa procedures for non-malignancy without CC/MCC,743,MS-DRG,743,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"D&C, conization, laparoscopy and tubal interruption with CC/MCC",744,MS-DRG,744,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"D&C, conization, laparoscopy and tubal interruption without CC/MCC",745,MS-DRG,745,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Vagina, cervix and vulva procedures with CC/MCC",746,MS-DRG,746,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Vagina, cervix and vulva procedures without CC/MCC",747,MS-DRG,747,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Female reproductive system reconstructive procedures,748,MS-DRG,748,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other female reproductive system O.R. procedures with CC/MCC,749,MS-DRG,749,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other female reproductive system O.R. procedures without CC/MCC,750,MS-DRG,750,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Malignancy, female reproductive system with MCC",754,MS-DRG,754,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Malignancy, female reproductive system with CC",755,MS-DRG,755,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Malignancy, female reproductive system without CC/MCC",756,MS-DRG,756,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Infections, female reproductive system with MCC",757,MS-DRG,757,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,29854.136,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Infections, female reproductive system with CC",758,MS-DRG,758,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Infections, female reproductive system without CC/MCC",759,MS-DRG,759,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Menstrual and other female reproductive system disorders with CC/MCC,760,MS-DRG,760,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Menstrual and other female reproductive system disorders without CC/MCC,761,MS-DRG,761,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Vaginal delivery with O.R. procedures except sterilization and/or D&C,768,MS-DRG,768,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Postpartum and post abortion diagnoses with O.R. procedures,769,MS-DRG,769,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Abortion with D&C, aspiration curettage or hysterotomy",770,MS-DRG,770,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Postpartum and post abortion diagnoses without O.R. procedures,776,MS-DRG,776,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Abortion without D&C,779,MS-DRG,779,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cesarean section with sterilization with MCC,783,MS-DRG,783,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cesarean section with sterilization with CC,784,MS-DRG,784,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,90613.37,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cesarean section with sterilization without CC/MCC,785,MS-DRG,785,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cesarean section without sterilization with MCC,786,MS-DRG,786,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cesarean section without sterilization with CC,787,MS-DRG,787,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Cesarean section without sterilization without CC/MCC,788,MS-DRG,788,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Neonates, died or transferred to another acute care facility",789,MS-DRG,789,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Extreme immaturity or respiratory distress syndrome, neonate",790,MS-DRG,790,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Prematurity with major problems,791,MS-DRG,791,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Prematurity without major problems,792,MS-DRG,792,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48921.03,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Full term neonate with major problems,793,MS-DRG,793,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Neonate with other significant problems,794,MS-DRG,794,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48921.03,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Splenic procedures with MCC,799,MS-DRG,799,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,106800.6,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Splenic procedures with CC,800,MS-DRG,800,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48921.03,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Splenic procedures without CC/MCC,801,MS-DRG,801,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other O.R. procedures of the blood and blood forming organs with MCC,802,MS-DRG,802,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other O.R. procedures of the blood and blood forming organs with CC,803,MS-DRG,803,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other O.R. procedures of the blood and blood forming organs without CC/MCC,804,MS-DRG,804,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with MCC,808,MS-DRG,808,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with CC,809,MS-DRG,809,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without CC/MCC,810,MS-DRG,810,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Red blood cell disorders with MCC,811,MS-DRG,811,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Red blood cell disorders without MCC,812,MS-DRG,812,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Coagulation disorders,813,MS-DRG,813,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Reticuloendothelial and immunity disorders with MCC*,814,MS-DRG,814,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Reticuloendothelial and immunity disorders with CC*,815,MS-DRG,815,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Reticuloendothelial and immunity disorders without CC/MCC*,816,MS-DRG,816,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other antepartum diagnoses with O.R. procedures with MCC,817,MS-DRG,817,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,40508.305,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other antepartum diagnoses with O.R. procedures with CC,818,MS-DRG,818,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other antepartum diagnoses with O.R. procedures without CC/MCC,819,MS-DRG,819,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Lymphoma and leukemia with major O.R. procedures with MCC,820,MS-DRG,820,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Lymphoma and leukemia with major O.R. procedures with CC,821,MS-DRG,821,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Lymphoma and leukemia with major O.R. procedures without CC/MCC,822,MS-DRG,822,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Lymphoma and non-acute leukemia with other procedures with MCC,823,MS-DRG,823,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Lymphoma and non-acute leukemia with other procedures with CC,824,MS-DRG,824,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Lymphoma and non-acute leukemia with other procedures without CC/MCC,825,MS-DRG,825,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with MCC,826,MS-DRG,826,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with CC,827,MS-DRG,827,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures without CC/MCC,828,MS-DRG,828,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures with CC/MCC,829,MS-DRG,829,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures without CC/MCC,830,MS-DRG,830,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other antepartum diagnoses without O.R. procedures with MCC,831,MS-DRG,831,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,71182.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other antepartum diagnoses without O.R. procedures with CC,832,MS-DRG,832,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other antepartum diagnoses without O.R. procedures without CC/MCC,833,MS-DRG,833,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Acute leukemia with MCC,834,MS-DRG,834,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Acute leukemia with CC,835,MS-DRG,835,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Acute leukemia without CC/MCC,836,MS-DRG,836,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy agent with MCC,837,MS-DRG,837,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapy agent,838,MS-DRG,838,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis without CC/MCC,839,MS-DRG,839,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Lymphoma and non-acute leukemia with MCC,840,MS-DRG,840,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Lymphoma and non-acute leukemia with CC,841,MS-DRG,841,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Lymphoma and non-acute leukemia without CC/MCC,842,MS-DRG,842,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with MCC,843,MS-DRG,843,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with CC,844,MS-DRG,844,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses without CC/MCC,845,MS-DRG,845,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with MCC,846,MS-DRG,846,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with CC,847,MS-DRG,847,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis without CC/MCC,848,MS-DRG,848,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Radiotherapy,849,MS-DRG,849,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Acute leukemia with other procedures,850,MS-DRG,850,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Infectious and parasitic diseases with O.R. procedures with MCC,853,MS-DRG,853,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,116013.09,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Infectious and parasitic diseases with O.R. procedures with CC,854,MS-DRG,854,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.07,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Infectious and parasitic diseases with O.R. procedures without CC/MCC,855,MS-DRG,855,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with MCC,856,MS-DRG,856,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,103112.54,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with CC,857,MS-DRG,857,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures without CC/MCC,858,MS-DRG,858,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Postoperative and post-traumatic infections with MCC,862,MS-DRG,862,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,70501.55,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Postoperative and post-traumatic infections without MCC,863,MS-DRG,863,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,47554.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Fever and inflammatory conditions,864,MS-DRG,864,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Viral illness with MCC,865,MS-DRG,865,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Viral illness without MCC,866,MS-DRG,866,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other infectious and parasitic diseases diagnoses with MCC,867,MS-DRG,867,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,70118.98,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other infectious and parasitic diseases diagnoses with CC,868,MS-DRG,868,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other infectious and parasitic diseases diagnoses without CC/MCC,869,MS-DRG,869,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Septicemia or severe sepsis with MV >96 hours,870,MS-DRG,870,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,158548.16,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Septicemia or severe sepsis without MV >96 hours with MCC,871,MS-DRG,871,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,64954.17,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Septicemia or severe sepsis without MV >96 hours without MCC,872,MS-DRG,872,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,43522.12,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Wound debridements for injuries with MCC,901,MS-DRG,901,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,98177.28,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Wound debridements for injuries with CC,902,MS-DRG,902,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Wound debridements for injuries without CC/MCC,903,MS-DRG,903,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Skin grafts for injuries with CC/MCC,904,MS-DRG,904,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Skin grafts for injuries without CC/MCC,905,MS-DRG,905,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Hand procedures for injuries,906,MS-DRG,906,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other O.R. procedures for injuries with MCC*,907,MS-DRG,907,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other O.R. procedures for injuries with CC*,908,MS-DRG,908,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other O.R. procedures for injuries without CC/MCC*,909,MS-DRG,909,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Traumatic injury with MCC,913,MS-DRG,913,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Traumatic injury without MCC,914,MS-DRG,914,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Allergic reactions with MCC,915,MS-DRG,915,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Allergic reactions without MCC,916,MS-DRG,916,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Poisoning and toxic effects of drugs with MCC,917,MS-DRG,917,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Poisoning and toxic effects of drugs without MCC,918,MS-DRG,918,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Complications of treatment with MCC,919,MS-DRG,919,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,82055.43,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Complications of treatment with CC,920,MS-DRG,920,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52581.58,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Complications of treatment without CC/MCC,921,MS-DRG,921,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Other injury, poisoning and toxic effect diagnoses with MCC",922,MS-DRG,922,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Other injury, poisoning and toxic effect diagnoses without MCC",923,MS-DRG,923,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Extensive burns or full thickness burns with MV >96 hours with skin graft,927,MS-DRG,927,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Full thickness burn with skin graft or inhalation injury with CC/MCC,928,MS-DRG,928,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Full thickness burn with skin graft or inhalation injury without CC/MCC,929,MS-DRG,929,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Extensive burns or full thickness burns with MV >96 hours without skin graft,933,MS-DRG,933,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Full thickness burn without skin graft or inhalation injury,934,MS-DRG,934,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Non-extensive burns,935,MS-DRG,935,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
O.R. procedures with diagnoses of other contact with health services with MCC,939,MS-DRG,939,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,90701.7,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
O.R. procedures with diagnoses of other contact with health services with CC,940,MS-DRG,940,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
O.R. procedures with diagnoses of other contact with health services without CC/MCC,941,MS-DRG,941,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.06,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Signs and symptoms with MCC,947,MS-DRG,947,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Signs and symptoms without MCC,948,MS-DRG,948,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Aftercare with CC/MCC,949,MS-DRG,949,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,53224.31,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Aftercare without CC/MCC,950,MS-DRG,950,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other factors influencing health status,951,MS-DRG,951,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Craniotomy for multiple significant trauma,955,MS-DRG,955,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"Limb reattachment, hip and femur procedures for multiple significant trauma",956,MS-DRG,956,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other O.R. procedures for multiple significant trauma with MCC,957,MS-DRG,957,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other O.R. procedures for multiple significant trauma with CC,958,MS-DRG,958,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96210.83,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other O.R. procedures for multiple significant trauma without CC/MCC,959,MS-DRG,959,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,36574.5,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other multiple significant trauma with MCC,963,MS-DRG,963,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other multiple significant trauma with CC,964,MS-DRG,964,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Other multiple significant trauma without CC/MCC,965,MS-DRG,965,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,48870.57,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
HIV with extensive O.R. procedures with MCC,969,MS-DRG,969,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
HIV with extensive O.R. procedures without MCC,970,MS-DRG,970,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96585.75,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
HIV with major related condition with MCC*,974,MS-DRG,974,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,87197.28,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
HIV with major related condition with CC*,975,MS-DRG,975,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,68412.68,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
HIV with major related condition without CC/MCC*,976,MS-DRG,976,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,68412.68,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
HIV with or without other related condition,977,MS-DRG,977,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,983,MS-DRG,983,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,52145.44,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with MCC,981,MS-DRG,981,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,68449.825,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with CC,982,MS-DRG,982,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,96991.29,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with CC,988,MS-DRG,988,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,72269.07,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with MCC,987,MS-DRG,987,LOCAL,,Inpatient,,,,,Blue Shield CA Tandem,Commercial,,,MS-DRG,163207.97,Per Diem,22000,120000,"If TBC exceeds $270,400, 41.2% of allowed charges.",,,,,,,
"ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck with major O.R. procedures",3,MS-DRG,3,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,310277.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck without major O.R. procedures",4,MS-DRG,4,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,229767.96,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCC",11,MS-DRG,11,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CC",12,MS-DRG,12,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy without CC/MCC",13,MS-DRG,13,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Chimeric antigen receptor (CAR) T-cell and other immunotherapies,18,MS-DRG,18,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46368.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with MCC,20,MS-DRG,20,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with CC,21,MS-DRG,21,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage without CC/MCC,22,MS-DRG,22,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC or chemotherapy implant or epilepsy with neurostimulator,23,MS-DRG,23,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis without MCC,24,MS-DRG,24,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Craniotomy and endovascular intracranial procedures with MCC,25,MS-DRG,25,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Craniotomy and endovascular intracranial procedures with CC,26,MS-DRG,26,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Craniotomy and endovascular intracranial procedures without CC/MCC,27,MS-DRG,27,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Spinal procedures with MCC,28,MS-DRG,28,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Spinal procedures with CC or spinal neurostimulators,29,MS-DRG,29,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Spinal procedures without CC/MCC,30,MS-DRG,30,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Ventricular shunt procedures with MCC,31,MS-DRG,31,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Ventricular shunt procedures with CC,32,MS-DRG,32,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Ventricular shunt procedures without CC/MCC,33,MS-DRG,33,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Carotid artery stent procedures with MCC,34,MS-DRG,34,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Carotid artery stent procedures with CC,35,MS-DRG,35,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Carotid artery stent procedures without CC/MCC,36,MS-DRG,36,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Extracranial procedures with MCC,37,MS-DRG,37,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Extracranial procedures with CC,38,MS-DRG,38,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Extracranial procedures without CC/MCC,39,MS-DRG,39,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with MCC",40,MS-DRG,40,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,95774.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurostimulator",41,MS-DRG,41,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46368.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures without CC/MCC",42,MS-DRG,42,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46368.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Spinal disorders and injuries with CC/MCC,52,MS-DRG,52,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,82942.79,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Spinal disorders and injuries without CC/MCC,53,MS-DRG,53,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,81228.84,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Nervous system neoplasms with MCC,54,MS-DRG,54,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46368.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Nervous system neoplasms without MCC,55,MS-DRG,55,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46368.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Degenerative nervous system disorders with MCC,56,MS-DRG,56,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,61411.33,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Degenerative nervous system disorders without MCC,57,MS-DRG,57,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,51678.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Multiple sclerosis and cerebellar ataxia with MCC,58,MS-DRG,58,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Multiple sclerosis and cerebellar ataxia with CC,59,MS-DRG,59,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,51678.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Multiple sclerosis and cerebellar ataxia without CC/MCC,60,MS-DRG,60,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,51678.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with MCC",61,MS-DRG,61,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,111192.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with CC",62,MS-DRG,62,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent without CC/MCC",63,MS-DRG,63,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Intracranial hemorrhage or cerebral infarction with MCC,64,MS-DRG,64,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,111192.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Intracranial hemorrhage or cerebral infarction with CC or tPA in 24 hours,65,MS-DRG,65,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Intracranial hemorrhage or cerebral infarction without CC/MCC,66,MS-DRG,66,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Nonspecific CVA and precerebral occlusion without infarction with MCC,67,MS-DRG,67,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,66767.42,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Nonspecific CVA and precerebral occlusion without infarction without MCC,68,MS-DRG,68,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Transient ischemia without thrombolytic,69,MS-DRG,69,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Nonspecific cerebrovascular disorders with MCC*,70,MS-DRG,70,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,66767.42,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Nonspecific cerebrovascular disorders with CC*,71,MS-DRG,71,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,45128.84,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Nonspecific cerebrovascular disorders without CC/MCC*,72,MS-DRG,72,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cranial and peripheral nerve disorders with MCC,73,MS-DRG,73,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cranial and peripheral nerve disorders without MCC,74,MS-DRG,74,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Viral meningitis with CC/MCC,75,MS-DRG,75,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Viral meningitis without CC/MCC,76,MS-DRG,76,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hypertensive encephalopathy with MCC,77,MS-DRG,77,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,68160,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hypertensive encephalopathy with CC,78,MS-DRG,78,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,537909.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hypertensive encephalopathy without CC/MCC,79,MS-DRG,79,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Nontraumatic stupor and coma with MCC,80,MS-DRG,80,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Nontraumatic stupor and coma without MCC,81,MS-DRG,81,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Traumatic stupor and coma >1 hour with MCC*,82,MS-DRG,82,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,82529.13,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Traumatic stupor and coma >1 hour with CC*,83,MS-DRG,83,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,62451.46,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Traumatic stupor and coma >1 hour without CC/MCC*,84,MS-DRG,84,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Traumatic stupor and coma <1 hour with MCC,85,MS-DRG,85,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,62451.46,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Traumatic stupor and coma <1 hour with CC,86,MS-DRG,86,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,62451.46,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Traumatic stupor and coma <1 hour without CC/MCC,87,MS-DRG,87,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Concussion with MCC,88,MS-DRG,88,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,68160,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Concussion with CC,89,MS-DRG,89,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,537909.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Concussion without CC/MCC,90,MS-DRG,90,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other disorders of nervous system with MCC,91,MS-DRG,91,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,68160,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other disorders of nervous system with CC,92,MS-DRG,92,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,537909.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other disorders of nervous system without CC/MCC,93,MS-DRG,93,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,51678.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Bacterial and tuberculous infections of nervous system with MCC*,94,MS-DRG,94,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34375.739,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Bacterial and tuberculous infections of nervous system with CC*,95,MS-DRG,95,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,62451.46,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Bacterial and tuberculous infections of nervous system without CC/MCC*,96,MS-DRG,96,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Non-bacterial infection of nervous system except viral meningitis with MCC,97,MS-DRG,97,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,75054.04,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Non-bacterial infection of nervous system except viral meningitis with CC,98,MS-DRG,98,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Non-bacterial infection of nervous system except viral meningitis without CC/MCC,99,MS-DRG,99,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Seizures with MCC,100,MS-DRG,100,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Seizures without MCC,101,MS-DRG,101,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Headaches with MCC,102,MS-DRG,102,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Headaches without MCC,103,MS-DRG,103,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Orbital procedures with CC/MCC,113,MS-DRG,113,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,115767.94,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Orbital procedures without CC/MCC,114,MS-DRG,114,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Extraocular procedures except orbit,115,MS-DRG,115,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Intraocular procedures with CC/MCC,116,MS-DRG,116,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,115767.94,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Intraocular procedures without CC/MCC,117,MS-DRG,117,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Acute major eye infections with CC/MCC,121,MS-DRG,121,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Acute major eye infections without CC/MCC,122,MS-DRG,122,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Neurological eye disorders,123,MS-DRG,123,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other disorders of the eye with MCC or thrombolytic agent,124,MS-DRG,124,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other disorders of the eye without MCC,125,MS-DRG,125,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Sinus and mastoid procedures with CC/MCC,135,MS-DRG,135,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,115767.94,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Sinus and mastoid procedures without CC/MCC,136,MS-DRG,136,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Mouth procedures with CC/MCC,137,MS-DRG,137,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,115767.94,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Mouth procedures without CC/MCC,138,MS-DRG,138,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Salivary gland procedures,139,MS-DRG,139,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major head and neck procedures with MCC,140,MS-DRG,140,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,177508.29,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major head and neck procedures with CC,141,MS-DRG,141,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,115767.94,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major head and neck procedures without CC/MCC,142,MS-DRG,142,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with MCC",143,MS-DRG,143,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,115767.94,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with CC",144,MS-DRG,144,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures without CC/MCC",145,MS-DRG,145,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Ear, nose, mouth and throat malignancy with MCC*",146,MS-DRG,146,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Ear, nose, mouth and throat malignancy with CC*",147,MS-DRG,147,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Ear, nose, mouth and throat malignancy without CC/MCC*",148,MS-DRG,148,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Dysequilibrium,149,MS-DRG,149,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Epistaxis with MCC,150,MS-DRG,150,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Epistaxis without MCC,151,MS-DRG,151,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Otitis media and URI with MCC,152,MS-DRG,152,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Otitis media and URI without MCC,153,MS-DRG,153,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Other ear, nose, mouth and throat diagnoses with MCC",154,MS-DRG,154,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Other ear, nose, mouth and throat diagnoses with CC",155,MS-DRG,155,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Other ear, nose, mouth and throat diagnoses without CC/MCC",156,MS-DRG,156,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Dental and oral diseases with MCC,157,MS-DRG,157,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Dental and oral diseases with CC,158,MS-DRG,158,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Dental and oral diseases without CC/MCC,159,MS-DRG,159,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major chest procedures with MCC,163,MS-DRG,163,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,202666.58,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major chest procedures with CC,164,MS-DRG,164,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,202666.58,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major chest procedures without CC/MCC,165,MS-DRG,165,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,202666.58,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other respiratory system O.R. procedures with MCC,166,MS-DRG,166,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,177508.29,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other respiratory system O.R. procedures with CC,167,MS-DRG,167,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,115767.94,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other respiratory system O.R. procedures without CC/MCC,168,MS-DRG,168,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism,173,MS-DRG,173,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Pulmonary embolism with MCC or acute cor pulmonale,175,MS-DRG,175,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Pulmonary embolism without MCC,176,MS-DRG,176,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Respiratory infections and inflammations with MCC*,177,MS-DRG,177,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,62918.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Respiratory infections and inflammations with CC*,178,MS-DRG,178,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,43491.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Respiratory infections and inflammations without CC/MCC*,179,MS-DRG,179,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,42251.85,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Respiratory neoplasms with MCC*,180,MS-DRG,180,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Respiratory neoplasms with CC*,181,MS-DRG,181,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Respiratory neoplasms without CC/MCC*,182,MS-DRG,182,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major chest trauma with MCC,183,MS-DRG,183,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major chest trauma with CC,184,MS-DRG,184,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major chest trauma without CC/MCC,185,MS-DRG,185,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Pleural effusion with MCC*,186,MS-DRG,186,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,66071.13,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Pleural effusion with CC*,187,MS-DRG,187,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Pleural effusion without CC/MCC*,188,MS-DRG,188,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Pulmonary edema and respiratory failure,189,MS-DRG,189,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72046.99,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Chronic obstructive pulmonary disease with MCC*,190,MS-DRG,190,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,20971.383,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Chronic obstructive pulmonary disease with CC*,191,MS-DRG,191,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Chronic obstructive pulmonary disease without CC/MCC*,192,MS-DRG,192,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Simple pneumonia and pleurisy with MCC,193,MS-DRG,193,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,59421.93,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Simple pneumonia and pleurisy with CC,194,MS-DRG,194,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,39604.42,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Simple pneumonia and pleurisy without CC/MCC,195,MS-DRG,195,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Interstitial lung disease with MCC*,196,MS-DRG,196,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Interstitial lung disease with CC*,197,MS-DRG,197,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Interstitial lung disease without CC/MCC*,198,MS-DRG,198,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Pneumothorax with MCC,199,MS-DRG,199,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Pneumothorax with CC,200,MS-DRG,200,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,21869.927,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Pneumothorax without CC/MCC,201,MS-DRG,201,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,21869.927,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Bronchitis and asthma with CC/MCC,202,MS-DRG,202,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,40508.305,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Bronchitis and asthma without CC/MCC,203,MS-DRG,203,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,15339.435,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Respiratory signs and symptoms,204,MS-DRG,204,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other respiratory system diagnoses with MCC,205,MS-DRG,205,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,112102.84,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other respiratory system diagnoses without MCC,206,MS-DRG,206,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Respiratory system diagnosis with ventilator support >96 hours,207,MS-DRG,207,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,147720.8,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Respiratory system diagnosis with ventilator support <=96 hours,208,MS-DRG,208,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,81481.35,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Concomitant aortic and mitral valve procedures,212,MS-DRG,212,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other heart assist system implant,215,MS-DRG,215,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC,216,MS-DRG,216,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with CC,217,MS-DRG,217,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization without CC/MCC,218,MS-DRG,218,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with MCC,219,MS-DRG,219,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with CC,220,MS-DRG,220,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization without CC/MCC,221,MS-DRG,221,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other cardiothoracic procedures with MCC,228,MS-DRG,228,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other cardiothoracic procedures without MCC,229,MS-DRG,229,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Coronary bypass with PTCA with MCC,231,MS-DRG,231,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Coronary bypass with PTCA without MCC,232,MS-DRG,232,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Coronary bypass with cardiac catheterization or open ablation with MCC,233,MS-DRG,233,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Coronary bypass with cardiac catheterization or open ablation without MCC,234,MS-DRG,234,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Coronary bypass without cardiac catheterization with MCC,235,MS-DRG,235,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Coronary bypass without cardiac catheterization without MCC,236,MS-DRG,236,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Amputation for circulatory system disorders except upper limb and toe with MCC,239,MS-DRG,239,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Amputation for circulatory system disorders except upper limb and toe with CC,240,MS-DRG,240,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Amputation for circulatory system disorders except upper limb and toe without CC/MCC,241,MS-DRG,241,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Permanent cardiac pacemaker implant with MCC,242,MS-DRG,242,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Permanent cardiac pacemaker implant with CC,243,MS-DRG,243,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Permanent cardiac pacemaker implant without CC/MCC,244,MS-DRG,244,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
AICD generator procedures,245,MS-DRG,245,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,40774.659,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Percutaneous cardiovascular procedures without intraluminal device with MCC,250,MS-DRG,250,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Percutaneous cardiovascular procedures without intraluminal device without MCC,251,MS-DRG,251,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other vascular procedures with MCC,252,MS-DRG,252,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other vascular procedures with CC,253,MS-DRG,253,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other vascular procedures without CC/MCC,254,MS-DRG,254,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Upper limb and toe amputation for circulatory system disorders with MCC,255,MS-DRG,255,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Upper limb and toe amputation for circulatory system disorders with CC,256,MS-DRG,256,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Upper limb and toe amputation for circulatory system disorders without CC/MCC,257,MS-DRG,257,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac pacemaker device replacement with MCC,258,MS-DRG,258,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac pacemaker device replacement without MCC,259,MS-DRG,259,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac pacemaker revision except device replacement with MCC,260,MS-DRG,260,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,92851.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac pacemaker revision except device replacement with CC,261,MS-DRG,261,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,92851.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac pacemaker revision except device replacement without CC/MCC,262,MS-DRG,262,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,92851.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Vein ligation and stripping,263,MS-DRG,263,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,92851.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other circulatory system O.R. procedures,264,MS-DRG,264,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,92851.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
AICD lead procedures,265,MS-DRG,265,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Endovascular cardiac valve replacement and supplement procedures with MCC,266,MS-DRG,266,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Endovascular cardiac valve replacement and supplement procedures without MCC,267,MS-DRG,267,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Aortic and heart assist procedures except pulsation balloon with MCC,268,MS-DRG,268,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Aortic and heart assist procedures except pulsation balloon without MCC,269,MS-DRG,269,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79522.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other major cardiovascular procedures with MCC,270,MS-DRG,270,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other major cardiovascular procedures with CC,271,MS-DRG,271,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other major cardiovascular procedures without CC/MCC,272,MS-DRG,272,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Percutaneous and other intracardiac procedures with MCC,273,MS-DRG,273,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Percutaneous and other intracardiac procedures without MCC,274,MS-DRG,274,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac defibrillator implant with cardiac catheterization and MCC,275,MS-DRG,275,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac defibrillator implant with MCC or carotid sinus neurostimulator,276,MS-DRG,276,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac defibrillator implant without MCC,277,MS-DRG,277,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures with MCC,278,MS-DRG,278,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,92851.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures without MCC,279,MS-DRG,279,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,92851.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Acute myocardial infarction, discharged alive with MCC",280,MS-DRG,280,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,63798.62,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Acute myocardial infarction, discharged alive with CC",281,MS-DRG,281,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Acute myocardial infarction, discharged alive without CC/MCC",282,MS-DRG,282,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Acute myocardial infarction, expired with MCC",283,MS-DRG,283,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Acute myocardial infarction, expired with CC",284,MS-DRG,284,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Acute myocardial infarction, expired without CC/MCC",285,MS-DRG,285,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization with MCC",286,MS-DRG,286,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization without MCC",287,MS-DRG,287,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Acute and subacute endocarditis with MCC,288,MS-DRG,288,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,79476.64,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Acute and subacute endocarditis with CC,289,MS-DRG,289,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,54456.07,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Acute and subacute endocarditis without CC/MCC,290,MS-DRG,290,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48748.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Heart failure and shock with MCC,291,MS-DRG,291,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,59345.41,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Heart failure and shock with CC,292,MS-DRG,292,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,42060.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Heart failure and shock without CC/MCC,293,MS-DRG,293,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,42060.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Deep vein thrombophlebitis with CC/MCC,294,MS-DRG,294,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Deep vein thrombophlebitis without CC/MCC,295,MS-DRG,295,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Cardiac arrest, unexplained with MCC",296,MS-DRG,296,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,59345.41,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Cardiac arrest, unexplained with CC",297,MS-DRG,297,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,42060.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Cardiac arrest, unexplained without CC/MCC",298,MS-DRG,298,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,42060.56,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Peripheral vascular disorders with MCC,299,MS-DRG,299,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,64808.62,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Peripheral vascular disorders with CC,300,MS-DRG,300,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Peripheral vascular disorders without CC/MCC,301,MS-DRG,301,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Atherosclerosis with MCC,302,MS-DRG,302,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Atherosclerosis without MCC,303,MS-DRG,303,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hypertension with MCC,304,MS-DRG,304,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hypertension without MCC,305,MS-DRG,305,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac congenital and valvular disorders with MCC,306,MS-DRG,306,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac congenital and valvular disorders without MCC,307,MS-DRG,307,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac arrhythmia and conduction disorders with MCC,308,MS-DRG,308,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac arrhythmia and conduction disorders with CC,309,MS-DRG,309,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,60095.27,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cardiac arrhythmia and conduction disorders without CC/MCC,310,MS-DRG,310,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Angina pectoris,311,MS-DRG,311,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Syncope and collapse,312,MS-DRG,312,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46383.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Chest pain,313,MS-DRG,313,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other circulatory system diagnoses with MCC,314,MS-DRG,314,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,67570.83,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other circulatory system diagnoses with CC,315,MS-DRG,315,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,47562.03,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other circulatory system diagnoses without CC/MCC,316,MS-DRG,316,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Concomitant left atrial appendage closure and cardiac ablation,317,MS-DRG,317,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other endovascular cardiac valve procedures with MCC,319,MS-DRG,319,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other endovascular cardiac valve procedures without MCC,320,MS-DRG,320,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/intraluminal devices,321,MS-DRG,321,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Percutaneous cardiovascular procedures with intraluminal device without MCC,322,MS-DRG,322,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Coronary intravascular lithotripsy with intraluminal device with MCC,323,MS-DRG,323,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Coronary intravascular lithotripsy with intraluminal device without MCC,324,MS-DRG,324,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,34914.02,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Coronary intravascular lithotripsy without intraluminal device,325,MS-DRG,325,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Stomach, esophageal and duodenal procedures with MCC",326,MS-DRG,326,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Stomach, esophageal and duodenal procedures with CC",327,MS-DRG,327,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Stomach, esophageal and duodenal procedures without CC/MCC",328,MS-DRG,328,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major small and large bowel procedures with MCC,329,MS-DRG,329,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major small and large bowel procedures with CC,330,MS-DRG,330,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major small and large bowel procedures without CC/MCC,331,MS-DRG,331,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Rectal resection with MCC,332,MS-DRG,332,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Rectal resection with CC,333,MS-DRG,333,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Rectal resection without CC/MCC,334,MS-DRG,334,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Peritoneal adhesiolysis with MCC,335,MS-DRG,335,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Peritoneal adhesiolysis with CC,336,MS-DRG,336,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Peritoneal adhesiolysis without CC/MCC,337,MS-DRG,337,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Minor small and large bowel procedures with MCC,344,MS-DRG,344,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Minor small and large bowel procedures with CC,345,MS-DRG,345,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Minor small and large bowel procedures without CC/MCC,346,MS-DRG,346,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Anal and stomal procedures with MCC,347,MS-DRG,347,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,68366.59,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Anal and stomal procedures with CC,348,MS-DRG,348,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Anal and stomal procedures without CC/MCC,349,MS-DRG,349,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Inguinal and femoral hernia procedures with MCC,350,MS-DRG,350,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,68366.59,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Inguinal and femoral hernia procedures with CC,351,MS-DRG,351,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Inguinal and femoral hernia procedures without CC/MCC,352,MS-DRG,352,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hernia procedures except inguinal and femoral with MCC,353,MS-DRG,353,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,118828.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hernia procedures except inguinal and femoral with CC,354,MS-DRG,354,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hernia procedures except inguinal and femoral without CC/MCC,355,MS-DRG,355,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other digestive system O.R. procedures with MCC,356,MS-DRG,356,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,106800.32,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other digestive system O.R. procedures with CC,357,MS-DRG,357,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other digestive system O.R. procedures without CC/MCC,358,MS-DRG,358,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major esophageal disorders with MCC*,368,MS-DRG,368,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major esophageal disorders with CC*,369,MS-DRG,369,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major esophageal disorders without CC/MCC*,370,MS-DRG,370,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major gastrointestinal disorders and peritoneal infections with MCC,371,MS-DRG,371,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,68366.59,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major gastrointestinal disorders and peritoneal infections with CC,372,MS-DRG,372,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major gastrointestinal disorders and peritoneal infections without CC/MCC,373,MS-DRG,373,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Digestive malignancy with MCC*,374,MS-DRG,374,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Digestive malignancy with CC*,375,MS-DRG,375,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Digestive malignancy without CC/MCC*,376,MS-DRG,376,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Gastrointestinal hemorrhage with MCC,377,MS-DRG,377,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,54425.47,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Gastrointestinal hemorrhage with CC,378,MS-DRG,378,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Gastrointestinal hemorrhage without CC/MCC,379,MS-DRG,379,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Complicated peptic ulcer with MCC,380,MS-DRG,380,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,73278.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Complicated peptic ulcer with CC,381,MS-DRG,381,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Complicated peptic ulcer without CC/MCC,382,MS-DRG,382,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Uncomplicated peptic ulcer with MCC,383,MS-DRG,383,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Uncomplicated peptic ulcer without MCC,384,MS-DRG,384,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Inflammatory bowel disease with MCC,385,MS-DRG,385,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Inflammatory bowel disease with CC,386,MS-DRG,386,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Inflammatory bowel disease without CC/MCC,387,MS-DRG,387,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Gastrointestinal obstruction with MCC,388,MS-DRG,388,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,75604.95,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Gastrointestinal obstruction with CC,389,MS-DRG,389,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Gastrointestinal obstruction without CC/MCC,390,MS-DRG,390,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC",391,MS-DRG,391,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,59253.6,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC",392,MS-DRG,392,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,47929.3,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other digestive system diagnoses with MCC,393,MS-DRG,393,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,77739.74,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other digestive system diagnoses with CC,394,MS-DRG,394,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55022.29,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other digestive system diagnoses without CC/MCC,395,MS-DRG,395,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Appendix procedures with MCC,397,MS-DRG,397,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,68366.59,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Appendix procedures with CC,398,MS-DRG,398,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Appendix procedures without CC/MCC,399,MS-DRG,399,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Single level combined anterior and posterior spinal fusion except cervical,402,MS-DRG,402,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Pancreas, liver and shunt procedures with MCC",405,MS-DRG,405,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,40508.305,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Pancreas, liver and shunt procedures with CC",406,MS-DRG,406,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Pancreas, liver and shunt procedures without CC/MCC",407,MS-DRG,407,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,4870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with MCC,408,MS-DRG,408,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55022.29,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with CC,409,MS-DRG,409,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,4870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. without CC/MCC,410,MS-DRG,410,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,4870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cholecystectomy with C.D.E. with MCC,411,MS-DRG,411,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,73278.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cholecystectomy with C.D.E. with CC,412,MS-DRG,412,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cholecystectomy with C.D.E. without CC/MCC,413,MS-DRG,413,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,4870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with MCC,414,MS-DRG,414,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,73278.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with CC,415,MS-DRG,415,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55022.29,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. without CC/MCC,416,MS-DRG,416,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55022.29,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Laparoscopic cholecystectomy without C.D.E. with MCC,417,MS-DRG,417,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,73278.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Laparoscopic cholecystectomy without C.D.E. with CC,418,MS-DRG,418,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Laparoscopic cholecystectomy without C.D.E. without CC/MCC,419,MS-DRG,419,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hepatobiliary diagnostic procedures with MCC,420,MS-DRG,420,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55022.29,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hepatobiliary diagnostic procedures with CC,421,MS-DRG,421,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,4870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hepatobiliary diagnostic procedures without CC/MCC,422,MS-DRG,422,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,4870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other hepatobiliary or pancreas O.R. procedures with MCC,423,MS-DRG,423,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other hepatobiliary or pancreas O.R. procedures with CC,424,MS-DRG,424,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,4870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other hepatobiliary or pancreas O.R. procedures without CC/MCC,425,MS-DRG,425,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,4870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,426,MS-DRG,426,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,81343.62,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical with CC,427,MS-DRG,427,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,81343.62,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical without CC/MCC,428,MS-DRG,428,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,67111.73,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Combined anterior and posterior cervical spinal fusion with MCC,429,MS-DRG,429,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,81343.62,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Combined anterior and posterior cervical spinal fusion without MCC,430,MS-DRG,430,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cirrhosis and alcoholic hepatitis with MCC,432,MS-DRG,432,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,56468.43,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cirrhosis and alcoholic hepatitis with CC,433,MS-DRG,433,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cirrhosis and alcoholic hepatitis without CC/MCC,434,MS-DRG,434,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Malignancy of hepatobiliary system or pancreas with MCC,435,MS-DRG,435,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Malignancy of hepatobiliary system or pancreas with CC,436,MS-DRG,436,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Malignancy of hepatobiliary system or pancreas without CC/MCC,437,MS-DRG,437,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Disorders of pancreas except malignancy with MCC,438,MS-DRG,438,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,80165.28,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Disorders of pancreas except malignancy with CC,439,MS-DRG,439,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Disorders of pancreas except malignancy without CC/MCC,440,MS-DRG,440,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCC",441,MS-DRG,441,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,71243.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CC",442,MS-DRG,442,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without CC/MCC",443,MS-DRG,443,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Disorders of the biliary tract with MCC*,444,MS-DRG,444,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,58190.03,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Disorders of the biliary tract with CC*,445,MS-DRG,445,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53147.66,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Disorders of the biliary tract without CC/MCC*,446,MS-DRG,446,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,447,MS-DRG,447,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,1.0631,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Multiple level spinal fusion except cervical without MCC,448,MS-DRG,448,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,1.0631,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,450,MS-DRG,450,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,67111.74,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Single Level Spinal Fusion Except Cervical without MCC,451,MS-DRG,451,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with MCC",456,MS-DRG,456,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with CC",457,MS-DRG,457,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions without CC/MCC",458,MS-DRG,458,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Bilateral or multiple major joint procedures of lower extremity with MCC,461,MS-DRG,461,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,67111.74,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Bilateral or multiple major joint procedures of lower extremity without MCC,462,MS-DRG,462,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with MCC*,463,MS-DRG,463,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with CC*,464,MS-DRG,464,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72972.82,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders without CC/MCC*,465,MS-DRG,465,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,70057.58,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Revision of hip or knee replacement with MCC,466,MS-DRG,466,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Revision of hip or knee replacement with CC,467,MS-DRG,467,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Revision of hip or knee replacement without CC/MCC,468,MS-DRG,468,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity with MCC or total ankle replacement,469,MS-DRG,469,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity without MCC,470,MS-DRG,470,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cervical spinal fusion with MCC,471,MS-DRG,471,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cervical spinal fusion with CC,472,MS-DRG,472,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cervical spinal fusion without CC/MCC,473,MS-DRG,473,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with MCC,474,MS-DRG,474,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with CC,475,MS-DRG,475,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders without CC/MCC,476,MS-DRG,476,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Biopsies of musculoskeletal system and connective tissue with MCC,477,MS-DRG,477,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Biopsies of musculoskeletal system and connective tissue with CC,478,MS-DRG,478,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,28146.902,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Biopsies of musculoskeletal system and connective tissue without CC/MCC,479,MS-DRG,479,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,28146.902,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hip and femur procedures except major joint with MCC,480,MS-DRG,480,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hip and femur procedures except major joint with CC,481,MS-DRG,481,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hip and femur procedures except major joint without CC/MCC,482,MS-DRG,482,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major joint or limb reattachment procedures of upper extremities,483,MS-DRG,483,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Knee procedures with principal diagnosis of infection with MCC,485,MS-DRG,485,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Knee procedures with principal diagnosis of infection with CC,486,MS-DRG,486,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Knee procedures with principal diagnosis of infection without CC/MCC,487,MS-DRG,487,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Knee procedures without principal diagnosis of infection with CC/MCC,488,MS-DRG,488,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Knee procedures without principal diagnosis of infection without CC/MCC,489,MS-DRG,489,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,51693.87,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with MCC",492,MS-DRG,492,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with CC",493,MS-DRG,493,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur without CC/MCC",494,MS-DRG,494,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Local excision and removal of internal fixation devices except hip and femur with MCC,495,MS-DRG,495,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Local excision and removal of internal fixation devices except hip and femur with CC,496,MS-DRG,496,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Local excision and removal of internal fixation devices except hip and femur without CC/MCC,497,MS-DRG,497,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Local excision and removal of internal fixation devices of hip and femur with CC/MCC,498,MS-DRG,498,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Local excision and removal of internal fixation devices of hip and femur without CC/MCC,499,MS-DRG,499,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Soft tissue procedures with MCC,500,MS-DRG,500,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,94244.13,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Soft tissue procedures with CC,501,MS-DRG,501,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Soft tissue procedures without CC/MCC,502,MS-DRG,502,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,67111.74,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Foot procedures with MCC,503,MS-DRG,503,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Foot procedures with CC,504,MS-DRG,504,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Foot procedures without CC/MCC,505,MS-DRG,505,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major thumb or joint procedures,506,MS-DRG,506,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major shoulder or elbow joint procedures with CC/MCC,507,MS-DRG,507,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major shoulder or elbow joint procedures without CC/MCC,508,MS-DRG,508,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Arthroscopy,509,MS-DRG,509,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with MCC",510,MS-DRG,510,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with CC",511,MS-DRG,511,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures without CC/MCC",512,MS-DRG,512,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures with CC/MCC",513,MS-DRG,513,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures without CC/MCC",514,MS-DRG,514,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with MCC,515,MS-DRG,515,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,91742.07,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with CC,516,MS-DRG,516,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures without CC/MCC,517,MS-DRG,517,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Back and neck procedures except spinal fusion with MCC or disc device or neurostimulator,518,MS-DRG,518,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Back and neck procedures except spinal fusion with CC,519,MS-DRG,519,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Back and neck procedures except spinal fusion without CC/MCC,520,MS-DRG,520,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hip replacement with principal diagnosis of hip fracture with MCC,521,MS-DRG,521,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hip replacement with principal diagnosis of hip fracture without MCC,522,MS-DRG,522,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Fractures of femur with MCC,533,MS-DRG,533,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Fractures of femur without MCC,534,MS-DRG,534,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55504.34,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Fractures of hip and pelvis with MCC,535,MS-DRG,535,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Fractures of hip and pelvis without MCC,536,MS-DRG,536,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh with CC/MCC",537,MS-DRG,537,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh without CC/MCC",538,MS-DRG,538,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Osteomyelitis with MCC*,539,MS-DRG,539,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,74166.46,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Osteomyelitis with CC*,540,MS-DRG,540,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,54425.47,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Osteomyelitis without CC/MCC*,541,MS-DRG,541,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,51693.86,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with MCC*,542,MS-DRG,542,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with CC*,543,MS-DRG,543,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy without CC/MCC*,544,MS-DRG,544,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Connective tissue disorders with MCC,545,MS-DRG,545,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Connective tissue disorders with CC,546,MS-DRG,546,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Connective tissue disorders without CC/MCC,547,MS-DRG,547,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46988.16,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Septic arthritis with MCC,548,MS-DRG,548,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,65145.29,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Septic arthritis with CC,549,MS-DRG,549,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Septic arthritis without CC/MCC,550,MS-DRG,550,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Medical back problems with MCC,551,MS-DRG,551,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,99921.58,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Medical back problems without MCC,552,MS-DRG,552,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Bone diseases and arthropathies with MCC,553,MS-DRG,553,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Bone diseases and arthropathies without MCC,554,MS-DRG,554,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue with MCC,555,MS-DRG,555,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue without MCC,556,MS-DRG,556,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Tendonitis, myositis and bursitis with MCC",557,MS-DRG,557,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,69284.76,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Tendonitis, myositis and bursitis without MCC",558,MS-DRG,558,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53645.01,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Aftercare, musculoskeletal system and connective tissue with MCC*",559,MS-DRG,559,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,61671.48,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Aftercare, musculoskeletal system and connective tissue with CC*",560,MS-DRG,560,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48082.33,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Aftercare, musculoskeletal system and connective tissue without CC/MCC*",561,MS-DRG,561,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46988.16,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCC",562,MS-DRG,562,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCC",563,MS-DRG,563,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46988.16,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other musculoskeletal system and connective tissue diagnoses with MCC,564,MS-DRG,564,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,67111.74,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other musculoskeletal system and connective tissue diagnoses with CC,565,MS-DRG,565,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other musculoskeletal system and connective tissue diagnoses without CC/MCC,566,MS-DRG,566,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53790.39,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Skin debridement with MCC*,570,MS-DRG,570,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,90081.68,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Skin debridement with CC*,571,MS-DRG,571,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,65336.58,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Skin debridement without CC/MCC*,572,MS-DRG,572,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,65336.58,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Skin graft for skin ulcer or cellulitis with MCC,573,MS-DRG,573,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,106394.79,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Skin graft for skin ulcer or cellulitis with CC,574,MS-DRG,574,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Skin graft for skin ulcer or cellulitis without CC/MCC,575,MS-DRG,575,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Skin graft except for skin ulcer or cellulitis with MCC*,576,MS-DRG,576,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Skin graft except for skin ulcer or cellulitis with CC*,577,MS-DRG,577,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Skin graft except for skin ulcer or cellulitis without CC/MCC*,578,MS-DRG,578,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Other skin, subcutaneous tissue and breast procedures with MCC",579,MS-DRG,579,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,103793.26,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Other skin, subcutaneous tissue and breast procedures with CC",580,MS-DRG,580,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,85299.47,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Other skin, subcutaneous tissue and breast procedures without CC/MCC",581,MS-DRG,581,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,85299.47,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Mastectomy for malignancy with CC/MCC,582,MS-DRG,582,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,103793.26,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Mastectomy for malignancy without CC/MCC,583,MS-DRG,583,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,85299.47,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Breast biopsy, local excision and other breast procedures with CC/MCC",584,MS-DRG,584,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,65336.58,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Breast biopsy, local excision and other breast procedures without CC/MCC",585,MS-DRG,585,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Skin ulcers with MCC,592,MS-DRG,592,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,67333.63,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Skin ulcers with CC,593,MS-DRG,593,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53667.96,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Skin ulcers without CC/MCC,594,MS-DRG,594,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major skin disorders with MCC,595,MS-DRG,595,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major skin disorders without MCC,596,MS-DRG,596,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Malignant breast disorders with MCC,597,MS-DRG,597,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Malignant breast disorders with CC,598,MS-DRG,598,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Malignant breast disorders without CC/MCC,599,MS-DRG,599,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Non-malignant breast disorders with CC/MCC*,600,MS-DRG,600,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Non-malignant breast disorders without CC/MCC*,601,MS-DRG,601,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cellulitis with MCC,602,MS-DRG,602,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,55068.2,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cellulitis without MCC,603,MS-DRG,603,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36842.21,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Trauma to the skin, subcutaneous tissue and breast with MCC",604,MS-DRG,604,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Trauma to the skin, subcutaneous tissue and breast without MCC",605,MS-DRG,605,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Minor skin disorders with MCC,606,MS-DRG,606,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Minor skin disorders without MCC,607,MS-DRG,607,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Adrenal and pituitary procedures with CC/MCC,614,MS-DRG,614,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Adrenal and pituitary procedures without CC/MCC,615,MS-DRG,615,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with MCC",616,MS-DRG,616,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with CC",617,MS-DRG,617,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders without CC/MCC",618,MS-DRG,618,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
O.R. procedures for obesity with MCC,619,MS-DRG,619,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,100051.65,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
O.R. procedures for obesity with CC,620,MS-DRG,620,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72590.25,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
O.R. procedures for obesity without CC/MCC,621,MS-DRG,621,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with MCC",622,MS-DRG,622,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,100051.65,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with CC",623,MS-DRG,623,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72590.25,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders without CC/MCC",624,MS-DRG,624,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with MCC",625,MS-DRG,625,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,30309.826,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with CC",626,MS-DRG,626,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures without CC/MCC",627,MS-DRG,627,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with MCC",628,MS-DRG,628,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,30309.826,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with CC",629,MS-DRG,629,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures without CC/MCC",630,MS-DRG,630,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Diabetes with MCC,637,MS-DRG,637,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,67654.99,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Diabetes with CC,638,MS-DRG,638,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53843.95,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Diabetes without CC/MCC,639,MS-DRG,639,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCC",640,MS-DRG,640,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,74862.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCC",641,MS-DRG,641,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,47049.37,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Inborn and other disorders of metabolism,642,MS-DRG,642,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Endocrine disorders with MCC*,643,MS-DRG,643,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Endocrine disorders with CC*,644,MS-DRG,644,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Endocrine disorders without CC/MCC*,645,MS-DRG,645,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major bladder procedures with MCC,653,MS-DRG,653,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,91596.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major bladder procedures with CC,654,MS-DRG,654,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,80073.46,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major bladder procedures without CC/MCC,655,MS-DRG,655,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Kidney and ureter procedures for neoplasm with MCC,656,MS-DRG,656,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Kidney and ureter procedures for neoplasm with CC,657,MS-DRG,657,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Kidney and ureter procedures for neoplasm without CC/MCC,658,MS-DRG,658,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Kidney and ureter procedures for non-neoplasm with MCC*,659,MS-DRG,659,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Kidney and ureter procedures for non-neoplasm with CC*,660,MS-DRG,660,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Kidney and ureter procedures for non-neoplasm without CC/MCC*,661,MS-DRG,661,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Minor bladder procedures with MCC,662,MS-DRG,662,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Minor bladder procedures with CC,663,MS-DRG,663,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Minor bladder procedures without CC/MCC,664,MS-DRG,664,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Prostatectomy with MCC,665,MS-DRG,665,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,91596.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Prostatectomy with CC,666,MS-DRG,666,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,80073.46,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Prostatectomy without CC/MCC,667,MS-DRG,667,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Transurethral procedures with MCC,668,MS-DRG,668,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Transurethral procedures with CC,669,MS-DRG,669,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Transurethral procedures without CC/MCC,670,MS-DRG,670,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Urethral procedures with CC/MCC,671,MS-DRG,671,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Urethral procedures without CC/MCC,672,MS-DRG,672,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72268.88,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other kidney and urinary tract procedures with MCC*,673,MS-DRG,673,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,91596.69,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other kidney and urinary tract procedures with CC*,674,MS-DRG,674,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,80073.46,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other kidney and urinary tract procedures without CC/MCC*,675,MS-DRG,675,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,80073.46,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Renal failure with MCC,682,MS-DRG,682,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,66775.07,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Renal failure with CC,683,MS-DRG,683,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,46314.82,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Renal failure without CC/MCC,684,MS-DRG,684,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Kidney and urinary tract neoplasms with MCC,686,MS-DRG,686,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Kidney and urinary tract neoplasms with CC,687,MS-DRG,687,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Kidney and urinary tract neoplasms without CC/MCC,688,MS-DRG,688,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.4,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Kidney and urinary tract infections with MCC,689,MS-DRG,689,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48342.49,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Kidney and urinary tract infections without MCC,690,MS-DRG,690,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,35962.28,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Urinary stones with MCC,693,MS-DRG,693,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Urinary stones without MCC,694,MS-DRG,694,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Kidney and urinary tract signs and symptoms with MCC,695,MS-DRG,695,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Kidney and urinary tract signs and symptoms without MCC,696,MS-DRG,696,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Urethral stricture,697,MS-DRG,697,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other kidney and urinary tract diagnoses with MCC,698,MS-DRG,698,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,67746.82,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other kidney and urinary tract diagnoses with CC,699,MS-DRG,699,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,47363.09,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other kidney and urinary tract diagnoses without CC/MCC,700,MS-DRG,700,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major male pelvic procedures with CC/MCC,707,MS-DRG,707,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major male pelvic procedures without CC/MCC,708,MS-DRG,708,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Penis procedures with CC/MCC,709,MS-DRG,709,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Penis procedures without CC/MCC,710,MS-DRG,710,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Testes procedures with CC/MCC,711,MS-DRG,711,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Testes procedures without CC/MCC,712,MS-DRG,712,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Transurethral prostatectomy with CC/MCC,713,MS-DRG,713,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,30309.826,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Transurethral prostatectomy without CC/MCC,714,MS-DRG,714,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other male reproductive system O.R. procedures for malignancy with CC/MCC,715,MS-DRG,715,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other male reproductive system O.R. procedures for malignancy without CC/MCC,716,MS-DRG,716,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other male reproductive system O.R. procedures except malignancy with CC/MCC,717,MS-DRG,717,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other male reproductive system O.R. procedures except malignancy without CC/MCC,718,MS-DRG,718,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Malignancy, male reproductive system with MCC",722,MS-DRG,722,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,61794.07,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Malignancy, male reproductive system with CC",723,MS-DRG,723,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Malignancy, male reproductive system without CC/MCC",724,MS-DRG,724,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,50278,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Benign prostatic hypertrophy with MCC,725,MS-DRG,725,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,50278.46,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Benign prostatic hypertrophy without MCC,726,MS-DRG,726,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Inflammation of the male reproductive system with MCC,727,MS-DRG,727,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,61794.07,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Inflammation of the male reproductive system without MCC,728,MS-DRG,728,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,50278,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other male reproductive system diagnoses with CC/MCC,729,MS-DRG,729,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other male reproductive system diagnoses without CC/MCC,730,MS-DRG,730,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC",734,MS-DRG,734,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC",735,MS-DRG,735,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with MCC,736,MS-DRG,736,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with CC,737,MS-DRG,737,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy without CC/MCC,738,MS-DRG,738,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with MCC,739,MS-DRG,739,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with CC,740,MS-DRG,740,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy without CC/MCC,741,MS-DRG,741,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Uterine and adnexa procedures for non-malignancy with CC/MCC,742,MS-DRG,742,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Uterine and adnexa procedures for non-malignancy without CC/MCC,743,MS-DRG,743,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"D&C, conization, laparoscopy and tubal interruption with CC/MCC",744,MS-DRG,744,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"D&C, conization, laparoscopy and tubal interruption without CC/MCC",745,MS-DRG,745,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Vagina, cervix and vulva procedures with CC/MCC",746,MS-DRG,746,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Vagina, cervix and vulva procedures without CC/MCC",747,MS-DRG,747,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Female reproductive system reconstructive procedures,748,MS-DRG,748,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other female reproductive system O.R. procedures with CC/MCC,749,MS-DRG,749,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other female reproductive system O.R. procedures without CC/MCC,750,MS-DRG,750,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Malignancy, female reproductive system with MCC",754,MS-DRG,754,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Malignancy, female reproductive system with CC",755,MS-DRG,755,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Malignancy, female reproductive system without CC/MCC",756,MS-DRG,756,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Infections, female reproductive system with MCC",757,MS-DRG,757,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,29854.136,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Infections, female reproductive system with CC",758,MS-DRG,758,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Infections, female reproductive system without CC/MCC",759,MS-DRG,759,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Menstrual and other female reproductive system disorders with CC/MCC,760,MS-DRG,760,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,71182.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Menstrual and other female reproductive system disorders without CC/MCC,761,MS-DRG,761,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Vaginal delivery with O.R. procedures except sterilization and/or D&C,768,MS-DRG,768,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Postpartum and post abortion diagnoses with O.R. procedures,769,MS-DRG,769,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,71182.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Abortion with D&C, aspiration curettage or hysterotomy",770,MS-DRG,770,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,71182.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Postpartum and post abortion diagnoses without O.R. procedures,776,MS-DRG,776,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Abortion without D&C,779,MS-DRG,779,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cesarean section with sterilization with MCC,783,MS-DRG,783,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cesarean section with sterilization with CC,784,MS-DRG,784,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,90613.37,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cesarean section with sterilization without CC/MCC,785,MS-DRG,785,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cesarean section without sterilization with MCC,786,MS-DRG,786,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cesarean section without sterilization with CC,787,MS-DRG,787,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Cesarean section without sterilization without CC/MCC,788,MS-DRG,788,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Neonates, died or transferred to another acute care facility",789,MS-DRG,789,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Extreme immaturity or respiratory distress syndrome, neonate",790,MS-DRG,790,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,71182.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Prematurity with major problems,791,MS-DRG,791,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,71182.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Prematurity without major problems,792,MS-DRG,792,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48921.03,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Full term neonate with major problems,793,MS-DRG,793,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,71182.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Neonate with other significant problems,794,MS-DRG,794,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48921.03,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Splenic procedures with MCC,799,MS-DRG,799,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,106800.6,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Splenic procedures with CC,800,MS-DRG,800,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48921.03,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Splenic procedures without CC/MCC,801,MS-DRG,801,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other O.R. procedures of the blood and blood forming organs with MCC,802,MS-DRG,802,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other O.R. procedures of the blood and blood forming organs with CC,803,MS-DRG,803,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other O.R. procedures of the blood and blood forming organs without CC/MCC,804,MS-DRG,804,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with MCC,808,MS-DRG,808,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with CC,809,MS-DRG,809,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without CC/MCC,810,MS-DRG,810,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Red blood cell disorders with MCC,811,MS-DRG,811,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,71182.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Red blood cell disorders without MCC,812,MS-DRG,812,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Coagulation disorders,813,MS-DRG,813,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Reticuloendothelial and immunity disorders with MCC*,814,MS-DRG,814,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Reticuloendothelial and immunity disorders with CC*,815,MS-DRG,815,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Reticuloendothelial and immunity disorders without CC/MCC*,816,MS-DRG,816,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other antepartum diagnoses with O.R. procedures with MCC,817,MS-DRG,817,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,40508.305,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other antepartum diagnoses with O.R. procedures with CC,818,MS-DRG,818,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other antepartum diagnoses with O.R. procedures without CC/MCC,819,MS-DRG,819,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Lymphoma and leukemia with major O.R. procedures with MCC,820,MS-DRG,820,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Lymphoma and leukemia with major O.R. procedures with CC,821,MS-DRG,821,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Lymphoma and leukemia with major O.R. procedures without CC/MCC,822,MS-DRG,822,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96210.83,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Lymphoma and non-acute leukemia with other procedures with MCC,823,MS-DRG,823,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Lymphoma and non-acute leukemia with other procedures with CC,824,MS-DRG,824,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Lymphoma and non-acute leukemia with other procedures without CC/MCC,825,MS-DRG,825,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with MCC,826,MS-DRG,826,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with CC,827,MS-DRG,827,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures without CC/MCC,828,MS-DRG,828,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96210.83,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures with CC/MCC,829,MS-DRG,829,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures without CC/MCC,830,MS-DRG,830,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other antepartum diagnoses without O.R. procedures with MCC,831,MS-DRG,831,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,71182.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other antepartum diagnoses without O.R. procedures with CC,832,MS-DRG,832,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other antepartum diagnoses without O.R. procedures without CC/MCC,833,MS-DRG,833,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Acute leukemia with MCC,834,MS-DRG,834,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Acute leukemia with CC,835,MS-DRG,835,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Acute leukemia without CC/MCC,836,MS-DRG,836,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy agent with MCC,837,MS-DRG,837,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapy agent,838,MS-DRG,838,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis without CC/MCC,839,MS-DRG,839,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Lymphoma and non-acute leukemia with MCC,840,MS-DRG,840,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Lymphoma and non-acute leukemia with CC,841,MS-DRG,841,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Lymphoma and non-acute leukemia without CC/MCC,842,MS-DRG,842,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with MCC,843,MS-DRG,843,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with CC,844,MS-DRG,844,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses without CC/MCC,845,MS-DRG,845,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with MCC,846,MS-DRG,846,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with CC,847,MS-DRG,847,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis without CC/MCC,848,MS-DRG,848,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Radiotherapy,849,MS-DRG,849,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Acute leukemia with other procedures,850,MS-DRG,850,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Infectious and parasitic diseases with O.R. procedures with MCC,853,MS-DRG,853,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,116013.09,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Infectious and parasitic diseases with O.R. procedures with CC,854,MS-DRG,854,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.07,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Infectious and parasitic diseases with O.R. procedures without CC/MCC,855,MS-DRG,855,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with MCC,856,MS-DRG,856,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,103112.54,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with CC,857,MS-DRG,857,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures without CC/MCC,858,MS-DRG,858,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Postoperative and post-traumatic infections with MCC,862,MS-DRG,862,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,70501.55,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Postoperative and post-traumatic infections without MCC,863,MS-DRG,863,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,47554.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Fever and inflammatory conditions,864,MS-DRG,864,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Viral illness with MCC,865,MS-DRG,865,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Viral illness without MCC,866,MS-DRG,866,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other infectious and parasitic diseases diagnoses with MCC,867,MS-DRG,867,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,70118.98,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other infectious and parasitic diseases diagnoses with CC,868,MS-DRG,868,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other infectious and parasitic diseases diagnoses without CC/MCC,869,MS-DRG,869,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Septicemia or severe sepsis with MV >96 hours,870,MS-DRG,870,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,158548.16,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Septicemia or severe sepsis without MV >96 hours with MCC,871,MS-DRG,871,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,64954.17,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Septicemia or severe sepsis without MV >96 hours without MCC,872,MS-DRG,872,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,43522.12,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Wound debridements for injuries with MCC,901,MS-DRG,901,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,98177.28,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Wound debridements for injuries with CC,902,MS-DRG,902,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Wound debridements for injuries without CC/MCC,903,MS-DRG,903,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Skin grafts for injuries with CC/MCC,904,MS-DRG,904,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Skin grafts for injuries without CC/MCC,905,MS-DRG,905,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Hand procedures for injuries,906,MS-DRG,906,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other O.R. procedures for injuries with MCC*,907,MS-DRG,907,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96210.83,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other O.R. procedures for injuries with CC*,908,MS-DRG,908,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96210.83,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other O.R. procedures for injuries without CC/MCC*,909,MS-DRG,909,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Traumatic injury with MCC,913,MS-DRG,913,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Traumatic injury without MCC,914,MS-DRG,914,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Allergic reactions with MCC,915,MS-DRG,915,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Allergic reactions without MCC,916,MS-DRG,916,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Poisoning and toxic effects of drugs with MCC,917,MS-DRG,917,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Poisoning and toxic effects of drugs without MCC,918,MS-DRG,918,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Complications of treatment with MCC,919,MS-DRG,919,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,82055.43,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Complications of treatment with CC,920,MS-DRG,920,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52581.58,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Complications of treatment without CC/MCC,921,MS-DRG,921,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Other injury, poisoning and toxic effect diagnoses with MCC",922,MS-DRG,922,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Other injury, poisoning and toxic effect diagnoses without MCC",923,MS-DRG,923,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Extensive burns or full thickness burns with MV >96 hours with skin graft,927,MS-DRG,927,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Full thickness burn with skin graft or inhalation injury with CC/MCC,928,MS-DRG,928,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Full thickness burn with skin graft or inhalation injury without CC/MCC,929,MS-DRG,929,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Extensive burns or full thickness burns with MV >96 hours without skin graft,933,MS-DRG,933,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Full thickness burn without skin graft or inhalation injury,934,MS-DRG,934,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Non-extensive burns,935,MS-DRG,935,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
O.R. procedures with diagnoses of other contact with health services with MCC,939,MS-DRG,939,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,90701.7,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
O.R. procedures with diagnoses of other contact with health services with CC,940,MS-DRG,940,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
O.R. procedures with diagnoses of other contact with health services without CC/MCC,941,MS-DRG,941,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.06,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Signs and symptoms with MCC,947,MS-DRG,947,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Signs and symptoms without MCC,948,MS-DRG,948,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Aftercare with CC/MCC,949,MS-DRG,949,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,53224.31,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Aftercare without CC/MCC,950,MS-DRG,950,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other factors influencing health status,951,MS-DRG,951,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Craniotomy for multiple significant trauma,955,MS-DRG,955,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96210.83,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"Limb reattachment, hip and femur procedures for multiple significant trauma",956,MS-DRG,956,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96210.83,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other O.R. procedures for multiple significant trauma with MCC,957,MS-DRG,957,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96210.83,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other O.R. procedures for multiple significant trauma with CC,958,MS-DRG,958,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96210.83,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other O.R. procedures for multiple significant trauma without CC/MCC,959,MS-DRG,959,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,36574.5,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other multiple significant trauma with MCC,963,MS-DRG,963,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other multiple significant trauma with CC,964,MS-DRG,964,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Other multiple significant trauma without CC/MCC,965,MS-DRG,965,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,48870.57,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
HIV with extensive O.R. procedures with MCC,969,MS-DRG,969,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
HIV with extensive O.R. procedures without MCC,970,MS-DRG,970,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96585.75,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
HIV with major related condition with MCC*,974,MS-DRG,974,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,87197.28,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
HIV with major related condition with CC*,975,MS-DRG,975,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,68412.68,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
HIV with major related condition without CC/MCC*,976,MS-DRG,976,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,68412.68,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
HIV with or without other related condition,977,MS-DRG,977,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with MCC,981,MS-DRG,981,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,68449.825,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with CC,982,MS-DRG,982,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,96991.29,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,983,MS-DRG,983,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,52145.44,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with MCC,987,MS-DRG,987,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,163207.97,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with CC,988,MS-DRG,988,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.07,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,989,MS-DRG,989,LOCAL,,Inpatient,,,,,Brown & Toland Medi cal MR,Medicaid,,,MS-DRG,72269.07,Fee schedule,22000,120000,lessor of BC or 100% Medicare rate for Marin County,,,,,,,
"ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck with major O.R. procedures",3,MS-DRG,3,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,310277.39,Fee schedule,22000,120000,,,,,,,,
"Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck without major O.R. procedures",4,MS-DRG,4,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,229767.96,Fee Schedule,22000,120000,,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCC",11,MS-DRG,11,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CC",12,MS-DRG,12,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy without CC/MCC",13,MS-DRG,13,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
Chimeric antigen receptor (CAR) T-cell and other immunotherapies,18,MS-DRG,18,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46368.39,Fee Schedule,22000,120000,,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with MCC,20,MS-DRG,20,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with CC,21,MS-DRG,21,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage without CC/MCC,22,MS-DRG,22,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC or chemotherapy implant or epilepsy with neurostimulator,23,MS-DRG,23,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis without MCC,24,MS-DRG,24,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
Craniotomy and endovascular intracranial procedures with MCC,25,MS-DRG,25,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
Craniotomy and endovascular intracranial procedures with CC,26,MS-DRG,26,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
Craniotomy and endovascular intracranial procedures without CC/MCC,27,MS-DRG,27,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
Spinal procedures with MCC,28,MS-DRG,28,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
Spinal procedures with CC or spinal neurostimulators,29,MS-DRG,29,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
Spinal procedures without CC/MCC,30,MS-DRG,30,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
Ventricular shunt procedures with MCC,31,MS-DRG,31,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
Ventricular shunt procedures with CC,32,MS-DRG,32,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
Ventricular shunt procedures without CC/MCC,33,MS-DRG,33,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
Carotid artery stent procedures with MCC,34,MS-DRG,34,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Carotid artery stent procedures with CC,35,MS-DRG,35,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Carotid artery stent procedures without CC/MCC,36,MS-DRG,36,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Extracranial procedures with MCC,37,MS-DRG,37,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Extracranial procedures with CC,38,MS-DRG,38,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Extracranial procedures without CC/MCC,39,MS-DRG,39,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with MCC",40,MS-DRG,40,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,95774.44,Fee Schedule,22000,120000,,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurostimulator",41,MS-DRG,41,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46368.39,Fee Schedule,22000,120000,,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures without CC/MCC",42,MS-DRG,42,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46368.39,Fee Schedule,22000,120000,,,,,,,,
Spinal disorders and injuries with CC/MCC,52,MS-DRG,52,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,82942.79,Fee Schedule,22000,120000,,,,,,,,
Spinal disorders and injuries without CC/MCC,53,MS-DRG,53,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,81228.84,Fee Schedule,22000,120000,,,,,,,,
Nervous system neoplasms with MCC,54,MS-DRG,54,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46368.39,Fee Schedule,22000,120000,,,,,,,,
Nervous system neoplasms without MCC,55,MS-DRG,55,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46368.39,Fee Schedule,22000,120000,,,,,,,,
Degenerative nervous system disorders with MCC,56,MS-DRG,56,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,61411.33,Fee Schedule,22000,120000,,,,,,,,
Degenerative nervous system disorders without MCC,57,MS-DRG,57,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,51678.56,Fee Schedule,22000,120000,,,,,,,,
Multiple sclerosis and cerebellar ataxia with MCC,58,MS-DRG,58,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Multiple sclerosis and cerebellar ataxia with CC,59,MS-DRG,59,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,51678.56,Fee Schedule,22000,120000,,,,,,,,
Multiple sclerosis and cerebellar ataxia without CC/MCC,60,MS-DRG,60,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,51678.56,Fee Schedule,22000,120000,,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with MCC",61,MS-DRG,61,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,111192.31,Fee Schedule,22000,120000,,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with CC",62,MS-DRG,62,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent without CC/MCC",63,MS-DRG,63,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Intracranial hemorrhage or cerebral infarction with MCC,64,MS-DRG,64,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,111192.31,Fee Schedule,22000,120000,,,,,,,,
Intracranial hemorrhage or cerebral infarction with CC or tPA in 24 hours,65,MS-DRG,65,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Intracranial hemorrhage or cerebral infarction without CC/MCC,66,MS-DRG,66,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Nonspecific CVA and precerebral occlusion without infarction with MCC,67,MS-DRG,67,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,66767.42,Fee Schedule,22000,120000,,,,,,,,
Nonspecific CVA and precerebral occlusion without infarction without MCC,68,MS-DRG,68,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Transient ischemia without thrombolytic,69,MS-DRG,69,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Nonspecific cerebrovascular disorders with MCC*,70,MS-DRG,70,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,66767.42,Fee Schedule,22000,120000,,,,,,,,
Nonspecific cerebrovascular disorders with CC*,71,MS-DRG,71,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,45128.84,Fee Schedule,22000,120000,,,,,,,,
Nonspecific cerebrovascular disorders without CC/MCC*,72,MS-DRG,72,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Cranial and peripheral nerve disorders with MCC,73,MS-DRG,73,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
Cranial and peripheral nerve disorders without MCC,74,MS-DRG,74,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Viral meningitis with CC/MCC,75,MS-DRG,75,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Viral meningitis without CC/MCC,76,MS-DRG,76,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Hypertensive encephalopathy with MCC,77,MS-DRG,77,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,68160,Fee Schedule,22000,120000,,,,,,,,
Hypertensive encephalopathy with CC,78,MS-DRG,78,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,537909.39,Fee Schedule,22000,120000,,,,,,,,
Hypertensive encephalopathy without CC/MCC,79,MS-DRG,79,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Nontraumatic stupor and coma with MCC,80,MS-DRG,80,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.56,Fee Schedule,22000,120000,,,,,,,,
Nontraumatic stupor and coma without MCC,81,MS-DRG,81,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Traumatic stupor and coma >1 hour with MCC*,82,MS-DRG,82,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,82529.13,Fee Schedule,22000,120000,,,,,,,,
Traumatic stupor and coma >1 hour with CC*,83,MS-DRG,83,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,62451.46,Fee Schedule,22000,120000,,,,,,,,
Traumatic stupor and coma >1 hour without CC/MCC*,84,MS-DRG,84,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Traumatic stupor and coma <1 hour with MCC,85,MS-DRG,85,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,62451.46,Fee Schedule,22000,120000,,,,,,,,
Traumatic stupor and coma <1 hour with CC,86,MS-DRG,86,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,62451.46,Fee Schedule,22000,120000,,,,,,,,
Traumatic stupor and coma <1 hour without CC/MCC,87,MS-DRG,87,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Concussion with MCC,88,MS-DRG,88,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,68160,Fee Schedule,22000,120000,,,,,,,,
Concussion with CC,89,MS-DRG,89,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,537909.39,Fee Schedule,22000,120000,,,,,,,,
Concussion without CC/MCC,90,MS-DRG,90,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Other disorders of nervous system with MCC,91,MS-DRG,91,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,68160,Fee Schedule,22000,120000,,,,,,,,
Other disorders of nervous system with CC,92,MS-DRG,92,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,537909.39,Fee Schedule,22000,120000,,,,,,,,
Other disorders of nervous system without CC/MCC,93,MS-DRG,93,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,51678.56,Fee Schedule,22000,120000,,,,,,,,
Bacterial and tuberculous infections of nervous system with MCC*,94,MS-DRG,94,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34375.739,Fee Schedule,22000,120000,,,,,,,,
Bacterial and tuberculous infections of nervous system with CC*,95,MS-DRG,95,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,62451.46,Fee Schedule,22000,120000,,,,,,,,
Bacterial and tuberculous infections of nervous system without CC/MCC*,96,MS-DRG,96,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Non-bacterial infection of nervous system except viral meningitis with MCC,97,MS-DRG,97,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,75054.04,Fee Schedule,22000,120000,,,,,,,,
Non-bacterial infection of nervous system except viral meningitis with CC,98,MS-DRG,98,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
Non-bacterial infection of nervous system except viral meningitis without CC/MCC,99,MS-DRG,99,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Seizures with MCC,100,MS-DRG,100,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Seizures without MCC,101,MS-DRG,101,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Headaches with MCC,102,MS-DRG,102,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Headaches without MCC,103,MS-DRG,103,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Orbital procedures with CC/MCC,113,MS-DRG,113,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,115767.94,Fee Schedule,22000,120000,,,,,,,,
Orbital procedures without CC/MCC,114,MS-DRG,114,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Extraocular procedures except orbit,115,MS-DRG,115,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Intraocular procedures with CC/MCC,116,MS-DRG,116,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,115767.94,Fee Schedule,22000,120000,,,,,,,,
Intraocular procedures without CC/MCC,117,MS-DRG,117,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Acute major eye infections with CC/MCC,121,MS-DRG,121,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Acute major eye infections without CC/MCC,122,MS-DRG,122,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Neurological eye disorders,123,MS-DRG,123,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Other disorders of the eye with MCC or thrombolytic agent,124,MS-DRG,124,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Other disorders of the eye without MCC,125,MS-DRG,125,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Sinus and mastoid procedures with CC/MCC,135,MS-DRG,135,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,115767.94,Fee Schedule,22000,120000,,,,,,,,
Sinus and mastoid procedures without CC/MCC,136,MS-DRG,136,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Mouth procedures with CC/MCC,137,MS-DRG,137,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,115767.94,Fee Schedule,22000,120000,,,,,,,,
Mouth procedures without CC/MCC,138,MS-DRG,138,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Salivary gland procedures,139,MS-DRG,139,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Major head and neck procedures with MCC,140,MS-DRG,140,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,177508.29,Fee Schedule,22000,120000,,,,,,,,
Major head and neck procedures with CC,141,MS-DRG,141,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,115767.94,Fee Schedule,22000,120000,,,,,,,,
Major head and neck procedures without CC/MCC,142,MS-DRG,142,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with MCC",143,MS-DRG,143,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,115767.94,Fee Schedule,22000,120000,,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with CC",144,MS-DRG,144,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures without CC/MCC",145,MS-DRG,145,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
"Ear, nose, mouth and throat malignancy with MCC*",146,MS-DRG,146,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
"Ear, nose, mouth and throat malignancy with CC*",147,MS-DRG,147,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
"Ear, nose, mouth and throat malignancy without CC/MCC*",148,MS-DRG,148,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Dysequilibrium,149,MS-DRG,149,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Epistaxis with MCC,150,MS-DRG,150,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Epistaxis without MCC,151,MS-DRG,151,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Otitis media and URI with MCC,152,MS-DRG,152,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Otitis media and URI without MCC,153,MS-DRG,153,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
"Other ear, nose, mouth and throat diagnoses with MCC",154,MS-DRG,154,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
"Other ear, nose, mouth and throat diagnoses with CC",155,MS-DRG,155,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
"Other ear, nose, mouth and throat diagnoses without CC/MCC",156,MS-DRG,156,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Dental and oral diseases with MCC,157,MS-DRG,157,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Dental and oral diseases with CC,158,MS-DRG,158,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
Dental and oral diseases without CC/MCC,159,MS-DRG,159,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
Major chest procedures with MCC,163,MS-DRG,163,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,202666.58,Fee Schedule,22000,120000,,,,,,,,
Major chest procedures with CC,164,MS-DRG,164,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,202666.58,Fee Schedule,22000,120000,,,,,,,,
Major chest procedures without CC/MCC,165,MS-DRG,165,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,202666.58,Fee Schedule,22000,120000,,,,,,,,
Other respiratory system O.R. procedures with MCC,166,MS-DRG,166,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,177508.29,Fee Schedule,22000,120000,,,,,,,,
Other respiratory system O.R. procedures with CC,167,MS-DRG,167,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,115767.94,Fee Schedule,22000,120000,,,,,,,,
Other respiratory system O.R. procedures without CC/MCC,168,MS-DRG,168,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism,173,MS-DRG,173,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Pulmonary embolism with MCC or acute cor pulmonale,175,MS-DRG,175,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
Pulmonary embolism without MCC,176,MS-DRG,176,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Respiratory infections and inflammations with MCC*,177,MS-DRG,177,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,62918.69,Fee Schedule,22000,120000,,,,,,,,
Respiratory infections and inflammations with CC*,178,MS-DRG,178,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,43491.4,Fee Schedule,22000,120000,,,,,,,,
Respiratory infections and inflammations without CC/MCC*,179,MS-DRG,179,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,42251.85,Fee Schedule,22000,120000,,,,,,,,
Respiratory neoplasms with MCC*,180,MS-DRG,180,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
Respiratory neoplasms with CC*,181,MS-DRG,181,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Respiratory neoplasms without CC/MCC*,182,MS-DRG,182,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Major chest trauma with MCC,183,MS-DRG,183,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Major chest trauma with CC,184,MS-DRG,184,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Major chest trauma without CC/MCC,185,MS-DRG,185,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Pleural effusion with MCC*,186,MS-DRG,186,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,66071.13,Fee Schedule,22000,120000,,,,,,,,
Pleural effusion with CC*,187,MS-DRG,187,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Pleural effusion without CC/MCC*,188,MS-DRG,188,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Pulmonary edema and respiratory failure,189,MS-DRG,189,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72046.99,Fee Schedule,22000,120000,,,,,,,,
Chronic obstructive pulmonary disease with MCC*,190,MS-DRG,190,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,20971.383,Fee Schedule,22000,120000,,,,,,,,
Chronic obstructive pulmonary disease with CC*,191,MS-DRG,191,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Chronic obstructive pulmonary disease without CC/MCC*,192,MS-DRG,192,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Simple pneumonia and pleurisy with MCC,193,MS-DRG,193,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,59421.93,Fee Schedule,22000,120000,,,,,,,,
Simple pneumonia and pleurisy with CC,194,MS-DRG,194,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,39604.42,Fee Schedule,22000,120000,,,,,,,,
Simple pneumonia and pleurisy without CC/MCC,195,MS-DRG,195,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Interstitial lung disease with MCC*,196,MS-DRG,196,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Interstitial lung disease with CC*,197,MS-DRG,197,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Interstitial lung disease without CC/MCC*,198,MS-DRG,198,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Pneumothorax with MCC,199,MS-DRG,199,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Pneumothorax with CC,200,MS-DRG,200,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,21869.927,Fee Schedule,22000,120000,,,,,,,,
Pneumothorax without CC/MCC,201,MS-DRG,201,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,21869.927,Fee Schedule,22000,120000,,,,,,,,
Bronchitis and asthma with CC/MCC,202,MS-DRG,202,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,40508.305,Fee Schedule,22000,120000,,,,,,,,
Bronchitis and asthma without CC/MCC,203,MS-DRG,203,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,15339.435,Fee Schedule,22000,120000,,,,,,,,
Respiratory signs and symptoms,204,MS-DRG,204,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Other respiratory system diagnoses with MCC,205,MS-DRG,205,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,112102.84,Fee Schedule,22000,120000,,,,,,,,
Other respiratory system diagnoses without MCC,206,MS-DRG,206,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
Respiratory system diagnosis with ventilator support >96 hours,207,MS-DRG,207,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,147720.8,Fee Schedule,22000,120000,,,,,,,,
Respiratory system diagnosis with ventilator support <=96 hours,208,MS-DRG,208,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,81481.35,Fee Schedule,22000,120000,,,,,,,,
Concomitant aortic and mitral valve procedures,212,MS-DRG,212,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Other heart assist system implant,215,MS-DRG,215,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC,216,MS-DRG,216,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with CC,217,MS-DRG,217,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization without CC/MCC,218,MS-DRG,218,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with MCC,219,MS-DRG,219,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with CC,220,MS-DRG,220,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization without CC/MCC,221,MS-DRG,221,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Other cardiothoracic procedures with MCC,228,MS-DRG,228,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Other cardiothoracic procedures without MCC,229,MS-DRG,229,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Coronary bypass with PTCA with MCC,231,MS-DRG,231,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Coronary bypass with PTCA without MCC,232,MS-DRG,232,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Coronary bypass with cardiac catheterization or open ablation with MCC,233,MS-DRG,233,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Coronary bypass with cardiac catheterization or open ablation without MCC,234,MS-DRG,234,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Coronary bypass without cardiac catheterization with MCC,235,MS-DRG,235,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Coronary bypass without cardiac catheterization without MCC,236,MS-DRG,236,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Amputation for circulatory system disorders except upper limb and toe with MCC,239,MS-DRG,239,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Amputation for circulatory system disorders except upper limb and toe with CC,240,MS-DRG,240,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Amputation for circulatory system disorders except upper limb and toe without CC/MCC,241,MS-DRG,241,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Permanent cardiac pacemaker implant with MCC,242,MS-DRG,242,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Permanent cardiac pacemaker implant with CC,243,MS-DRG,243,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Permanent cardiac pacemaker implant without CC/MCC,244,MS-DRG,244,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
AICD generator procedures,245,MS-DRG,245,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,40774.659,Fee Schedule,22000,120000,,,,,,,,
Percutaneous cardiovascular procedures without intraluminal device with MCC,250,MS-DRG,250,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Percutaneous cardiovascular procedures without intraluminal device without MCC,251,MS-DRG,251,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Other vascular procedures with MCC,252,MS-DRG,252,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Other vascular procedures with CC,253,MS-DRG,253,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Other vascular procedures without CC/MCC,254,MS-DRG,254,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Upper limb and toe amputation for circulatory system disorders with MCC,255,MS-DRG,255,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Upper limb and toe amputation for circulatory system disorders with CC,256,MS-DRG,256,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
Upper limb and toe amputation for circulatory system disorders without CC/MCC,257,MS-DRG,257,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
Cardiac pacemaker device replacement with MCC,258,MS-DRG,258,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Cardiac pacemaker device replacement without MCC,259,MS-DRG,259,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Cardiac pacemaker revision except device replacement with MCC,260,MS-DRG,260,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,92851.55,Fee Schedule,22000,120000,,,,,,,,
Cardiac pacemaker revision except device replacement with CC,261,MS-DRG,261,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,92851.55,Fee Schedule,22000,120000,,,,,,,,
Cardiac pacemaker revision except device replacement without CC/MCC,262,MS-DRG,262,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,92851.55,Fee Schedule,22000,120000,,,,,,,,
Vein ligation and stripping,263,MS-DRG,263,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,92851.55,Fee Schedule,22000,120000,,,,,,,,
Other circulatory system O.R. procedures,264,MS-DRG,264,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,92851.55,Fee Schedule,22000,120000,,,,,,,,
AICD lead procedures,265,MS-DRG,265,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Endovascular cardiac valve replacement and supplement procedures with MCC,266,MS-DRG,266,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Endovascular cardiac valve replacement and supplement procedures without MCC,267,MS-DRG,267,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Aortic and heart assist procedures except pulsation balloon with MCC,268,MS-DRG,268,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Aortic and heart assist procedures except pulsation balloon without MCC,269,MS-DRG,269,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79522.55,Fee Schedule,22000,120000,,,,,,,,
Other major cardiovascular procedures with MCC,270,MS-DRG,270,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Other major cardiovascular procedures with CC,271,MS-DRG,271,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Other major cardiovascular procedures without CC/MCC,272,MS-DRG,272,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Percutaneous and other intracardiac procedures with MCC,273,MS-DRG,273,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
Percutaneous and other intracardiac procedures without MCC,274,MS-DRG,274,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
Cardiac defibrillator implant with cardiac catheterization and MCC,275,MS-DRG,275,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Cardiac defibrillator implant with MCC or carotid sinus neurostimulator,276,MS-DRG,276,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Cardiac defibrillator implant without MCC,277,MS-DRG,277,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures with MCC,278,MS-DRG,278,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,92851.55,Fee Schedule,22000,120000,,,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures without MCC,279,MS-DRG,279,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,92851.55,Fee Schedule,22000,120000,,,,,,,,
"Acute myocardial infarction, discharged alive with MCC",280,MS-DRG,280,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,63798.62,Fee Schedule,22000,120000,,,,,,,,
"Acute myocardial infarction, discharged alive with CC",281,MS-DRG,281,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
"Acute myocardial infarction, discharged alive without CC/MCC",282,MS-DRG,282,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
"Acute myocardial infarction, expired with MCC",283,MS-DRG,283,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
"Acute myocardial infarction, expired with CC",284,MS-DRG,284,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
"Acute myocardial infarction, expired without CC/MCC",285,MS-DRG,285,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization with MCC",286,MS-DRG,286,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization without MCC",287,MS-DRG,287,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Acute and subacute endocarditis with MCC,288,MS-DRG,288,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,79476.64,Fee Schedule,22000,120000,,,,,,,,
Acute and subacute endocarditis with CC,289,MS-DRG,289,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,54456.07,Fee Schedule,22000,120000,,,,,,,,
Acute and subacute endocarditis without CC/MCC,290,MS-DRG,290,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48748.02,Fee Schedule,22000,120000,,,,,,,,
Heart failure and shock with MCC,291,MS-DRG,291,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,59345.41,Fee Schedule,22000,120000,,,,,,,,
Heart failure and shock with CC,292,MS-DRG,292,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,42060.56,Fee Schedule,22000,120000,,,,,,,,
Heart failure and shock without CC/MCC,293,MS-DRG,293,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,42060.56,Fee Schedule,22000,120000,,,,,,,,
Deep vein thrombophlebitis with CC/MCC,294,MS-DRG,294,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
Deep vein thrombophlebitis without CC/MCC,295,MS-DRG,295,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
"Cardiac arrest, unexplained with MCC",296,MS-DRG,296,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,59345.41,Fee Schedule,22000,120000,,,,,,,,
"Cardiac arrest, unexplained with CC",297,MS-DRG,297,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,42060.56,Fee Schedule,22000,120000,,,,,,,,
"Cardiac arrest, unexplained without CC/MCC",298,MS-DRG,298,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,42060.56,Fee Schedule,22000,120000,,,,,,,,
Peripheral vascular disorders with MCC,299,MS-DRG,299,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,64808.62,Fee Schedule,22000,120000,,,,,,,,
Peripheral vascular disorders with CC,300,MS-DRG,300,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Peripheral vascular disorders without CC/MCC,301,MS-DRG,301,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Atherosclerosis with MCC,302,MS-DRG,302,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Atherosclerosis without MCC,303,MS-DRG,303,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Hypertension with MCC,304,MS-DRG,304,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
Hypertension without MCC,305,MS-DRG,305,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Cardiac congenital and valvular disorders with MCC,306,MS-DRG,306,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Cardiac congenital and valvular disorders without MCC,307,MS-DRG,307,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Cardiac arrhythmia and conduction disorders with MCC,308,MS-DRG,308,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
Cardiac arrhythmia and conduction disorders with CC,309,MS-DRG,309,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,60095.27,Fee Schedule,22000,120000,,,,,,,,
Cardiac arrhythmia and conduction disorders without CC/MCC,310,MS-DRG,310,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Angina pectoris,311,MS-DRG,311,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Syncope and collapse,312,MS-DRG,312,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46383.69,Fee Schedule,22000,120000,,,,,,,,
Chest pain,313,MS-DRG,313,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Other circulatory system diagnoses with MCC,314,MS-DRG,314,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,67570.83,Fee Schedule,22000,120000,,,,,,,,
Other circulatory system diagnoses with CC,315,MS-DRG,315,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,47562.03,Fee Schedule,22000,120000,,,,,,,,
Other circulatory system diagnoses without CC/MCC,316,MS-DRG,316,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Concomitant left atrial appendage closure and cardiac ablation,317,MS-DRG,317,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Other endovascular cardiac valve procedures with MCC,319,MS-DRG,319,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Other endovascular cardiac valve procedures without MCC,320,MS-DRG,320,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/intraluminal devices,321,MS-DRG,321,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Percutaneous cardiovascular procedures with intraluminal device without MCC,322,MS-DRG,322,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Coronary intravascular lithotripsy with intraluminal device with MCC,323,MS-DRG,323,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Coronary intravascular lithotripsy with intraluminal device without MCC,324,MS-DRG,324,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,34914.02,Fee Schedule,22000,120000,,,,,,,,
Coronary intravascular lithotripsy without intraluminal device,325,MS-DRG,325,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
"Stomach, esophageal and duodenal procedures with MCC",326,MS-DRG,326,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
"Stomach, esophageal and duodenal procedures with CC",327,MS-DRG,327,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55504.34,Fee Schedule,22000,120000,,,,,,,,
"Stomach, esophageal and duodenal procedures without CC/MCC",328,MS-DRG,328,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Major small and large bowel procedures with MCC,329,MS-DRG,329,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Major small and large bowel procedures with CC,330,MS-DRG,330,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Major small and large bowel procedures without CC/MCC,331,MS-DRG,331,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Rectal resection with MCC,332,MS-DRG,332,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55504.34,Fee Schedule,22000,120000,,,,,,,,
Rectal resection with CC,333,MS-DRG,333,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55504.34,Fee Schedule,22000,120000,,,,,,,,
Rectal resection without CC/MCC,334,MS-DRG,334,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Peritoneal adhesiolysis with MCC,335,MS-DRG,335,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Peritoneal adhesiolysis with CC,336,MS-DRG,336,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Peritoneal adhesiolysis without CC/MCC,337,MS-DRG,337,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Minor small and large bowel procedures with MCC,344,MS-DRG,344,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Minor small and large bowel procedures with CC,345,MS-DRG,345,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55504.34,Fee Schedule,22000,120000,,,,,,,,
Minor small and large bowel procedures without CC/MCC,346,MS-DRG,346,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Anal and stomal procedures with MCC,347,MS-DRG,347,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,68366.59,Fee Schedule,22000,120000,,,,,,,,
Anal and stomal procedures with CC,348,MS-DRG,348,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55504.34,Fee Schedule,22000,120000,,,,,,,,
Anal and stomal procedures without CC/MCC,349,MS-DRG,349,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Inguinal and femoral hernia procedures with MCC,350,MS-DRG,350,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,68366.59,Fee Schedule,22000,120000,,,,,,,,
Inguinal and femoral hernia procedures with CC,351,MS-DRG,351,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55504.34,Fee Schedule,22000,120000,,,,,,,,
Inguinal and femoral hernia procedures without CC/MCC,352,MS-DRG,352,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Hernia procedures except inguinal and femoral with MCC,353,MS-DRG,353,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,118828.55,Fee Schedule,22000,120000,,,,,,,,
Hernia procedures except inguinal and femoral with CC,354,MS-DRG,354,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55504.34,Fee Schedule,22000,120000,,,,,,,,
Hernia procedures except inguinal and femoral without CC/MCC,355,MS-DRG,355,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Other digestive system O.R. procedures with MCC,356,MS-DRG,356,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,106800.32,Fee Schedule,22000,120000,,,,,,,,
Other digestive system O.R. procedures with CC,357,MS-DRG,357,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Other digestive system O.R. procedures without CC/MCC,358,MS-DRG,358,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Major esophageal disorders with MCC*,368,MS-DRG,368,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Major esophageal disorders with CC*,369,MS-DRG,369,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Major esophageal disorders without CC/MCC*,370,MS-DRG,370,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Major gastrointestinal disorders and peritoneal infections with MCC,371,MS-DRG,371,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,68366.59,Fee Schedule,22000,120000,,,,,,,,
Major gastrointestinal disorders and peritoneal infections with CC,372,MS-DRG,372,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55504.34,Fee Schedule,22000,120000,,,,,,,,
Major gastrointestinal disorders and peritoneal infections without CC/MCC,373,MS-DRG,373,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Digestive malignancy with MCC*,374,MS-DRG,374,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Digestive malignancy with CC*,375,MS-DRG,375,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Digestive malignancy without CC/MCC*,376,MS-DRG,376,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Gastrointestinal hemorrhage with MCC,377,MS-DRG,377,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,54425.47,Fee Schedule,22000,120000,,,,,,,,
Gastrointestinal hemorrhage with CC,378,MS-DRG,378,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Gastrointestinal hemorrhage without CC/MCC,379,MS-DRG,379,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Complicated peptic ulcer with MCC,380,MS-DRG,380,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,73278.88,Fee Schedule,22000,120000,,,,,,,,
Complicated peptic ulcer with CC,381,MS-DRG,381,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Complicated peptic ulcer without CC/MCC,382,MS-DRG,382,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Uncomplicated peptic ulcer with MCC,383,MS-DRG,383,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Uncomplicated peptic ulcer without MCC,384,MS-DRG,384,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Inflammatory bowel disease with MCC,385,MS-DRG,385,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
Inflammatory bowel disease with CC,386,MS-DRG,386,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Inflammatory bowel disease without CC/MCC,387,MS-DRG,387,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Gastrointestinal obstruction with MCC,388,MS-DRG,388,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,75604.95,Fee Schedule,22000,120000,,,,,,,,
Gastrointestinal obstruction with CC,389,MS-DRG,389,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Gastrointestinal obstruction without CC/MCC,390,MS-DRG,390,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC",391,MS-DRG,391,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,59253.6,Fee Schedule,22000,120000,,,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC",392,MS-DRG,392,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,47929.3,Fee Schedule,22000,120000,,,,,,,,
Other digestive system diagnoses with MCC,393,MS-DRG,393,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,77739.74,Fee Schedule,22000,120000,,,,,,,,
Other digestive system diagnoses with CC,394,MS-DRG,394,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55022.29,Fee Schedule,22000,120000,,,,,,,,
Other digestive system diagnoses without CC/MCC,395,MS-DRG,395,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Appendix procedures with MCC,397,MS-DRG,397,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,68366.59,Fee Schedule,22000,120000,,,,,,,,
Appendix procedures with CC,398,MS-DRG,398,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55504.34,Fee Schedule,22000,120000,,,,,,,,
Appendix procedures without CC/MCC,399,MS-DRG,399,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Single level combined anterior and posterior spinal fusion except cervical,402,MS-DRG,402,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53790.39,Fee Schedule,22000,120000,,,,,,,,
"Pancreas, liver and shunt procedures with MCC",405,MS-DRG,405,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,40508.305,Fee Schedule,22000,120000,,,,,,,,
"Pancreas, liver and shunt procedures with CC",406,MS-DRG,406,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
"Pancreas, liver and shunt procedures without CC/MCC",407,MS-DRG,407,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,4870.44,Fee Schedule,22000,120000,,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with MCC,408,MS-DRG,408,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55022.29,Fee Schedule,22000,120000,,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with CC,409,MS-DRG,409,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,4870.44,Fee Schedule,22000,120000,,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. without CC/MCC,410,MS-DRG,410,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,4870.44,Fee Schedule,22000,120000,,,,,,,,
Cholecystectomy with C.D.E. with MCC,411,MS-DRG,411,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,73278.88,Fee Schedule,22000,120000,,,,,,,,
Cholecystectomy with C.D.E. with CC,412,MS-DRG,412,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Cholecystectomy with C.D.E. without CC/MCC,413,MS-DRG,413,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,4870.44,Fee Schedule,22000,120000,,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with MCC,414,MS-DRG,414,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,73278.88,Fee Schedule,22000,120000,,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with CC,415,MS-DRG,415,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55022.29,Fee Schedule,22000,120000,,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. without CC/MCC,416,MS-DRG,416,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55022.29,Fee Schedule,22000,120000,,,,,,,,
Laparoscopic cholecystectomy without C.D.E. with MCC,417,MS-DRG,417,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,73278.88,Fee Schedule,22000,120000,,,,,,,,
Laparoscopic cholecystectomy without C.D.E. with CC,418,MS-DRG,418,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55504.34,Fee Schedule,22000,120000,,,,,,,,
Laparoscopic cholecystectomy without C.D.E. without CC/MCC,419,MS-DRG,419,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55504.34,Fee Schedule,22000,120000,,,,,,,,
Hepatobiliary diagnostic procedures with MCC,420,MS-DRG,420,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55022.29,Fee Schedule,22000,120000,,,,,,,,
Hepatobiliary diagnostic procedures with CC,421,MS-DRG,421,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,4870.44,Fee Schedule,22000,120000,,,,,,,,
Hepatobiliary diagnostic procedures without CC/MCC,422,MS-DRG,422,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,4870.44,Fee Schedule,22000,120000,,,,,,,,
Other hepatobiliary or pancreas O.R. procedures with MCC,423,MS-DRG,423,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
Other hepatobiliary or pancreas O.R. procedures with CC,424,MS-DRG,424,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,4870.44,Fee Schedule,22000,120000,,,,,,,,
Other hepatobiliary or pancreas O.R. procedures without CC/MCC,425,MS-DRG,425,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,4870.44,Fee Schedule,22000,120000,,,,,,,,
Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,426,MS-DRG,426,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,81343.62,Fee Schedule,22000,120000,,,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical with CC,427,MS-DRG,427,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,81343.62,Fee Schedule,22000,120000,,,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical without CC/MCC,428,MS-DRG,428,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,67111.73,Fee Schedule,22000,120000,,,,,,,,
Combined anterior and posterior cervical spinal fusion with MCC,429,MS-DRG,429,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,81343.62,Fee Schedule,22000,120000,,,,,,,,
Combined anterior and posterior cervical spinal fusion without MCC,430,MS-DRG,430,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53790.39,Fee Schedule,22000,120000,,,,,,,,
Cirrhosis and alcoholic hepatitis with MCC,432,MS-DRG,432,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,56468.43,Fee Schedule,22000,120000,,,,,,,,
Cirrhosis and alcoholic hepatitis with CC,433,MS-DRG,433,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Cirrhosis and alcoholic hepatitis without CC/MCC,434,MS-DRG,434,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Malignancy of hepatobiliary system or pancreas with MCC,435,MS-DRG,435,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Malignancy of hepatobiliary system or pancreas with CC,436,MS-DRG,436,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Malignancy of hepatobiliary system or pancreas without CC/MCC,437,MS-DRG,437,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Disorders of pancreas except malignancy with MCC,438,MS-DRG,438,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,80165.28,Fee Schedule,22000,120000,,,,,,,,
Disorders of pancreas except malignancy with CC,439,MS-DRG,439,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Disorders of pancreas except malignancy without CC/MCC,440,MS-DRG,440,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCC",441,MS-DRG,441,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,71243.57,Fee Schedule,22000,120000,,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CC",442,MS-DRG,442,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without CC/MCC",443,MS-DRG,443,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Disorders of the biliary tract with MCC*,444,MS-DRG,444,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,58190.03,Fee Schedule,22000,120000,,,,,,,,
Disorders of the biliary tract with CC*,445,MS-DRG,445,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53147.66,Fee Schedule,22000,120000,,,,,,,,
Disorders of the biliary tract without CC/MCC*,446,MS-DRG,446,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,447,MS-DRG,447,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,1.0631,Fee Schedule,22000,120000,,,,,,,,
Multiple level spinal fusion except cervical without MCC,448,MS-DRG,448,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,1.0631,Fee Schedule,22000,120000,,,,,,,,
Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,450,MS-DRG,450,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,67111.74,Fee Schedule,22000,120000,,,,,,,,
Single Level Spinal Fusion Except Cervical without MCC,451,MS-DRG,451,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53790.39,Fee Schedule,22000,120000,,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with MCC",456,MS-DRG,456,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53790.39,Fee Schedule,22000,120000,,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with CC",457,MS-DRG,457,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53790.39,Fee Schedule,22000,120000,,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions without CC/MCC",458,MS-DRG,458,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53790.39,Fee Schedule,22000,120000,,,,,,,,
Bilateral or multiple major joint procedures of lower extremity with MCC,461,MS-DRG,461,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,67111.74,Fee Schedule,22000,120000,,,,,,,,
Bilateral or multiple major joint procedures of lower extremity without MCC,462,MS-DRG,462,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53790.39,Fee Schedule,22000,120000,,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with MCC*,463,MS-DRG,463,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with CC*,464,MS-DRG,464,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72972.82,Fee Schedule,22000,120000,,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders without CC/MCC*,465,MS-DRG,465,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,70057.58,Fee Schedule,22000,120000,,,,,,,,
Revision of hip or knee replacement with MCC,466,MS-DRG,466,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
Revision of hip or knee replacement with CC,467,MS-DRG,467,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Revision of hip or knee replacement without CC/MCC,468,MS-DRG,468,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity with MCC or total ankle replacement,469,MS-DRG,469,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity without MCC,470,MS-DRG,470,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Cervical spinal fusion with MCC,471,MS-DRG,471,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53790.39,Fee Schedule,22000,120000,,,,,,,,
Cervical spinal fusion with CC,472,MS-DRG,472,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53790.39,Fee Schedule,22000,120000,,,,,,,,
Cervical spinal fusion without CC/MCC,473,MS-DRG,473,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53790.39,Fee Schedule,22000,120000,,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with MCC,474,MS-DRG,474,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with CC,475,MS-DRG,475,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders without CC/MCC,476,MS-DRG,476,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Biopsies of musculoskeletal system and connective tissue with MCC,477,MS-DRG,477,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
Biopsies of musculoskeletal system and connective tissue with CC,478,MS-DRG,478,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,28146.902,Fee Schedule,22000,120000,,,,,,,,
Biopsies of musculoskeletal system and connective tissue without CC/MCC,479,MS-DRG,479,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,28146.902,Fee Schedule,22000,120000,,,,,,,,
Hip and femur procedures except major joint with MCC,480,MS-DRG,480,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Hip and femur procedures except major joint with CC,481,MS-DRG,481,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Hip and femur procedures except major joint without CC/MCC,482,MS-DRG,482,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Major joint or limb reattachment procedures of upper extremities,483,MS-DRG,483,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
Knee procedures with principal diagnosis of infection with MCC,485,MS-DRG,485,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
Knee procedures with principal diagnosis of infection with CC,486,MS-DRG,486,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Knee procedures with principal diagnosis of infection without CC/MCC,487,MS-DRG,487,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Knee procedures without principal diagnosis of infection with CC/MCC,488,MS-DRG,488,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Knee procedures without principal diagnosis of infection without CC/MCC,489,MS-DRG,489,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,51693.87,Fee Schedule,22000,120000,,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with MCC",492,MS-DRG,492,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with CC",493,MS-DRG,493,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur without CC/MCC",494,MS-DRG,494,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Local excision and removal of internal fixation devices except hip and femur with MCC,495,MS-DRG,495,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
Local excision and removal of internal fixation devices except hip and femur with CC,496,MS-DRG,496,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Local excision and removal of internal fixation devices except hip and femur without CC/MCC,497,MS-DRG,497,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Local excision and removal of internal fixation devices of hip and femur with CC/MCC,498,MS-DRG,498,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
Local excision and removal of internal fixation devices of hip and femur without CC/MCC,499,MS-DRG,499,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
Soft tissue procedures with MCC,500,MS-DRG,500,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,94244.13,Fee Schedule,22000,120000,,,,,,,,
Soft tissue procedures with CC,501,MS-DRG,501,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Soft tissue procedures without CC/MCC,502,MS-DRG,502,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,67111.74,Fee Schedule,22000,120000,,,,,,,,
Foot procedures with MCC,503,MS-DRG,503,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Foot procedures with CC,504,MS-DRG,504,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Foot procedures without CC/MCC,505,MS-DRG,505,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Major thumb or joint procedures,506,MS-DRG,506,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Major shoulder or elbow joint procedures with CC/MCC,507,MS-DRG,507,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Major shoulder or elbow joint procedures without CC/MCC,508,MS-DRG,508,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Arthroscopy,509,MS-DRG,509,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with MCC",510,MS-DRG,510,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53790.39,Fee Schedule,22000,120000,,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with CC",511,MS-DRG,511,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures without CC/MCC",512,MS-DRG,512,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures with CC/MCC",513,MS-DRG,513,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures without CC/MCC",514,MS-DRG,514,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with MCC,515,MS-DRG,515,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,91742.07,Fee Schedule,22000,120000,,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with CC,516,MS-DRG,516,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures without CC/MCC,517,MS-DRG,517,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Back and neck procedures except spinal fusion with MCC or disc device or neurostimulator,518,MS-DRG,518,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
Back and neck procedures except spinal fusion with CC,519,MS-DRG,519,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
Back and neck procedures except spinal fusion without CC/MCC,520,MS-DRG,520,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55504.34,Fee Schedule,22000,120000,,,,,,,,
Hip replacement with principal diagnosis of hip fracture with MCC,521,MS-DRG,521,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53790.39,Fee Schedule,22000,120000,,,,,,,,
Hip replacement with principal diagnosis of hip fracture without MCC,522,MS-DRG,522,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Fractures of femur with MCC,533,MS-DRG,533,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55504.34,Fee Schedule,22000,120000,,,,,,,,
Fractures of femur without MCC,534,MS-DRG,534,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55504.34,Fee Schedule,22000,120000,,,,,,,,
Fractures of hip and pelvis with MCC,535,MS-DRG,535,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Fractures of hip and pelvis without MCC,536,MS-DRG,536,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh with CC/MCC",537,MS-DRG,537,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh without CC/MCC",538,MS-DRG,538,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Osteomyelitis with MCC*,539,MS-DRG,539,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,74166.46,Fee Schedule,22000,120000,,,,,,,,
Osteomyelitis with CC*,540,MS-DRG,540,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,54425.47,Fee Schedule,22000,120000,,,,,,,,
Osteomyelitis without CC/MCC*,541,MS-DRG,541,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,51693.86,Fee Schedule,22000,120000,,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with MCC*,542,MS-DRG,542,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with CC*,543,MS-DRG,543,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy without CC/MCC*,544,MS-DRG,544,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Connective tissue disorders with MCC,545,MS-DRG,545,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Connective tissue disorders with CC,546,MS-DRG,546,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Connective tissue disorders without CC/MCC,547,MS-DRG,547,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46988.16,Fee Schedule,22000,120000,,,,,,,,
Septic arthritis with MCC,548,MS-DRG,548,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,65145.29,Fee Schedule,22000,120000,,,,,,,,
Septic arthritis with CC,549,MS-DRG,549,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Septic arthritis without CC/MCC,550,MS-DRG,550,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Medical back problems with MCC,551,MS-DRG,551,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,99921.58,Fee Schedule,22000,120000,,,,,,,,
Medical back problems without MCC,552,MS-DRG,552,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Bone diseases and arthropathies with MCC,553,MS-DRG,553,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Bone diseases and arthropathies without MCC,554,MS-DRG,554,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue with MCC,555,MS-DRG,555,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue without MCC,556,MS-DRG,556,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
"Tendonitis, myositis and bursitis with MCC",557,MS-DRG,557,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,69284.76,Fee Schedule,22000,120000,,,,,,,,
"Tendonitis, myositis and bursitis without MCC",558,MS-DRG,558,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53645.01,Fee Schedule,22000,120000,,,,,,,,
"Aftercare, musculoskeletal system and connective tissue with MCC*",559,MS-DRG,559,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,61671.48,Fee Schedule,22000,120000,,,,,,,,
"Aftercare, musculoskeletal system and connective tissue with CC*",560,MS-DRG,560,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48082.33,Fee Schedule,22000,120000,,,,,,,,
"Aftercare, musculoskeletal system and connective tissue without CC/MCC*",561,MS-DRG,561,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46988.16,Fee Schedule,22000,120000,,,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCC",562,MS-DRG,562,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCC",563,MS-DRG,563,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,46988.16,Fee Schedule,22000,120000,,,,,,,,
Other musculoskeletal system and connective tissue diagnoses with MCC,564,MS-DRG,564,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,67111.74,Fee Schedule,22000,120000,,,,,,,,
Other musculoskeletal system and connective tissue diagnoses with CC,565,MS-DRG,565,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53790.39,Fee Schedule,22000,120000,,,,,,,,
Other musculoskeletal system and connective tissue diagnoses without CC/MCC,566,MS-DRG,566,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53790.39,Fee Schedule,22000,120000,,,,,,,,
Skin debridement with MCC*,570,MS-DRG,570,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,90081.68,Fee Schedule,22000,120000,,,,,,,,
Skin debridement with CC*,571,MS-DRG,571,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,65336.58,Fee Schedule,22000,120000,,,,,,,,
Skin debridement without CC/MCC*,572,MS-DRG,572,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,65336.58,Fee Schedule,22000,120000,,,,,,,,
Skin graft for skin ulcer or cellulitis with MCC,573,MS-DRG,573,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,106394.79,Fee Schedule,22000,120000,,,,,,,,
Skin graft for skin ulcer or cellulitis with CC,574,MS-DRG,574,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Skin graft for skin ulcer or cellulitis without CC/MCC,575,MS-DRG,575,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Skin graft except for skin ulcer or cellulitis with MCC*,576,MS-DRG,576,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Skin graft except for skin ulcer or cellulitis with CC*,577,MS-DRG,577,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Skin graft except for skin ulcer or cellulitis without CC/MCC*,578,MS-DRG,578,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
"Other skin, subcutaneous tissue and breast procedures with MCC",579,MS-DRG,579,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,103793.26,Fee Schedule,22000,120000,,,,,,,,
"Other skin, subcutaneous tissue and breast procedures with CC",580,MS-DRG,580,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,85299.47,Fee Schedule,22000,120000,,,,,,,,
"Other skin, subcutaneous tissue and breast procedures without CC/MCC",581,MS-DRG,581,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,85299.47,Fee Schedule,22000,120000,,,,,,,,
Mastectomy for malignancy with CC/MCC,582,MS-DRG,582,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,103793.26,Fee Schedule,22000,120000,,,,,,,,
Mastectomy for malignancy without CC/MCC,583,MS-DRG,583,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,85299.47,Fee Schedule,22000,120000,,,,,,,,
"Breast biopsy, local excision and other breast procedures with CC/MCC",584,MS-DRG,584,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,65336.58,Fee Schedule,22000,120000,,,,,,,,
"Breast biopsy, local excision and other breast procedures without CC/MCC",585,MS-DRG,585,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Skin ulcers with MCC,592,MS-DRG,592,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,67333.63,Fee Schedule,22000,120000,,,,,,,,
Skin ulcers with CC,593,MS-DRG,593,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53667.96,Fee Schedule,22000,120000,,,,,,,,
Skin ulcers without CC/MCC,594,MS-DRG,594,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Major skin disorders with MCC,595,MS-DRG,595,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Major skin disorders without MCC,596,MS-DRG,596,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Malignant breast disorders with MCC,597,MS-DRG,597,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Malignant breast disorders with CC,598,MS-DRG,598,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Malignant breast disorders without CC/MCC,599,MS-DRG,599,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Non-malignant breast disorders with CC/MCC*,600,MS-DRG,600,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Non-malignant breast disorders without CC/MCC*,601,MS-DRG,601,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Cellulitis with MCC,602,MS-DRG,602,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,55068.2,Fee Schedule,22000,120000,,,,,,,,
Cellulitis without MCC,603,MS-DRG,603,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36842.21,Fee Schedule,22000,120000,,,,,,,,
"Trauma to the skin, subcutaneous tissue and breast with MCC",604,MS-DRG,604,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
"Trauma to the skin, subcutaneous tissue and breast without MCC",605,MS-DRG,605,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Minor skin disorders with MCC,606,MS-DRG,606,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Minor skin disorders without MCC,607,MS-DRG,607,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Adrenal and pituitary procedures with CC/MCC,614,MS-DRG,614,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Adrenal and pituitary procedures without CC/MCC,615,MS-DRG,615,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with MCC",616,MS-DRG,616,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with CC",617,MS-DRG,617,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders without CC/MCC",618,MS-DRG,618,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
O.R. procedures for obesity with MCC,619,MS-DRG,619,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,100051.65,Fee Schedule,22000,120000,,,,,,,,
O.R. procedures for obesity with CC,620,MS-DRG,620,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72590.25,Fee Schedule,22000,120000,,,,,,,,
O.R. procedures for obesity without CC/MCC,621,MS-DRG,621,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with MCC",622,MS-DRG,622,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,100051.65,Fee Schedule,22000,120000,,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with CC",623,MS-DRG,623,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72590.25,Fee Schedule,22000,120000,,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders without CC/MCC",624,MS-DRG,624,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with MCC",625,MS-DRG,625,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,30309.826,Fee Schedule,22000,120000,,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with CC",626,MS-DRG,626,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures without CC/MCC",627,MS-DRG,627,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with MCC",628,MS-DRG,628,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,30309.826,Fee Schedule,22000,120000,,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with CC",629,MS-DRG,629,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures without CC/MCC",630,MS-DRG,630,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.31,Fee Schedule,22000,120000,,,,,,,,
Diabetes with MCC,637,MS-DRG,637,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,67654.99,Fee Schedule,22000,120000,,,,,,,,
Diabetes with CC,638,MS-DRG,638,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53843.95,Fee Schedule,22000,120000,,,,,,,,
Diabetes without CC/MCC,639,MS-DRG,639,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCC",640,MS-DRG,640,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,74862.75,Fee Schedule,22000,120000,,,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCC",641,MS-DRG,641,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,47049.37,Fee Schedule,22000,120000,,,,,,,,
Inborn and other disorders of metabolism,642,MS-DRG,642,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.4,Fee Schedule,22000,120000,,,,,,,,
Endocrine disorders with MCC*,643,MS-DRG,643,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.5,Fee Schedule,22000,120000,,,,,,,,
Endocrine disorders with CC*,644,MS-DRG,644,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Endocrine disorders without CC/MCC*,645,MS-DRG,645,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Major bladder procedures with MCC,653,MS-DRG,653,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,91596.69,Fee Schedule,22000,120000,,,,,,,,
Major bladder procedures with CC,654,MS-DRG,654,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,80073.46,Fee Schedule,22000,120000,,,,,,,,
Major bladder procedures without CC/MCC,655,MS-DRG,655,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Kidney and ureter procedures for neoplasm with MCC,656,MS-DRG,656,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Kidney and ureter procedures for neoplasm with CC,657,MS-DRG,657,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Kidney and ureter procedures for neoplasm without CC/MCC,658,MS-DRG,658,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Kidney and ureter procedures for non-neoplasm with MCC*,659,MS-DRG,659,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Kidney and ureter procedures for non-neoplasm with CC*,660,MS-DRG,660,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Kidney and ureter procedures for non-neoplasm without CC/MCC*,661,MS-DRG,661,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Minor bladder procedures with MCC,662,MS-DRG,662,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Minor bladder procedures with CC,663,MS-DRG,663,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Minor bladder procedures without CC/MCC,664,MS-DRG,664,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72268.88,Fee Schedule,22000,120000,,,,,,,,
Prostatectomy with MCC,665,MS-DRG,665,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,91596.69,Fee Schedule,22000,120000,,,,,,,,
Prostatectomy with CC,666,MS-DRG,666,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,80073.46,Fee Schedule,22000,120000,,,,,,,,
Urethral stricture,697,MS-DRG,697,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.44,Fee Schedule,22000,120000,,,,,,,,
Other kidney and urinary tract diagnoses with MCC,698,MS-DRG,698,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,67746.82,Fee Schedule,22000,120000,,,,,,,,
Other kidney and urinary tract diagnoses with CC,699,MS-DRG,699,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,47363.09,Fee Schedule,22000,120000,,,,,,,,
Other kidney and urinary tract diagnoses without CC/MCC,700,MS-DRG,700,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Major male pelvic procedures with CC/MCC,707,MS-DRG,707,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
Major male pelvic procedures without CC/MCC,708,MS-DRG,708,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Penis procedures with CC/MCC,709,MS-DRG,709,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
Penis procedures without CC/MCC,710,MS-DRG,710,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Testes procedures with CC/MCC,711,MS-DRG,711,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
Testes procedures without CC/MCC,712,MS-DRG,712,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Transurethral prostatectomy with CC/MCC,713,MS-DRG,713,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,30309.826,Fee Schedule,22000,120000,,,,,,,,
Transurethral prostatectomy without CC/MCC,714,MS-DRG,714,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Other male reproductive system O.R. procedures for malignancy with CC/MCC,715,MS-DRG,715,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
Other male reproductive system O.R. procedures for malignancy without CC/MCC,716,MS-DRG,716,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Other male reproductive system O.R. procedures except malignancy with CC/MCC,717,MS-DRG,717,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
Other male reproductive system O.R. procedures except malignancy without CC/MCC,718,MS-DRG,718,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
"Malignancy, male reproductive system with MCC",722,MS-DRG,722,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,61794.07,Fee Schedule,22000,120000,,,,,,,,
"Malignancy, male reproductive system with CC",723,MS-DRG,723,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
"Malignancy, male reproductive system without CC/MCC",724,MS-DRG,724,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,50278,Fee Schedule,22000,120000,,,,,,,,
Benign prostatic hypertrophy with MCC,725,MS-DRG,725,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,50278.46,Fee Schedule,22000,120000,,,,,,,,
Benign prostatic hypertrophy without MCC,726,MS-DRG,726,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Inflammation of the male reproductive system with MCC,727,MS-DRG,727,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,61794.07,Fee Schedule,22000,120000,,,,,,,,
Inflammation of the male reproductive system without MCC,728,MS-DRG,728,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,50278,Fee Schedule,22000,120000,,,,,,,,
Other male reproductive system diagnoses with CC/MCC,729,MS-DRG,729,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Other male reproductive system diagnoses without CC/MCC,730,MS-DRG,730,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC",734,MS-DRG,734,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC",735,MS-DRG,735,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with MCC,736,MS-DRG,736,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with CC,737,MS-DRG,737,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy without CC/MCC,738,MS-DRG,738,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with MCC,739,MS-DRG,739,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with CC,740,MS-DRG,740,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy without CC/MCC,741,MS-DRG,741,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Uterine and adnexa procedures for non-malignancy with CC/MCC,742,MS-DRG,742,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Uterine and adnexa procedures for non-malignancy without CC/MCC,743,MS-DRG,743,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
"D&C, conization, laparoscopy and tubal interruption with CC/MCC",744,MS-DRG,744,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
"D&C, conization, laparoscopy and tubal interruption without CC/MCC",745,MS-DRG,745,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
"Vagina, cervix and vulva procedures with CC/MCC",746,MS-DRG,746,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
"Vagina, cervix and vulva procedures without CC/MCC",747,MS-DRG,747,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Female reproductive system reconstructive procedures,748,MS-DRG,748,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Other female reproductive system O.R. procedures with CC/MCC,749,MS-DRG,749,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Other female reproductive system O.R. procedures without CC/MCC,750,MS-DRG,750,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
"Malignancy, female reproductive system with MCC",754,MS-DRG,754,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
"Malignancy, female reproductive system with CC",755,MS-DRG,755,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
"Malignancy, female reproductive system without CC/MCC",756,MS-DRG,756,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
"Infections, female reproductive system with MCC",757,MS-DRG,757,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,29854.136,Fee Schedule,22000,120000,,,,,,,,
"Infections, female reproductive system with CC",758,MS-DRG,758,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
"Infections, female reproductive system without CC/MCC",759,MS-DRG,759,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Menstrual and other female reproductive system disorders with CC/MCC,760,MS-DRG,760,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,71182.55,Fee Schedule,22000,120000,,,,,,,,
Menstrual and other female reproductive system disorders without CC/MCC,761,MS-DRG,761,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Vaginal delivery with O.R. procedures except sterilization and/or D&C,768,MS-DRG,768,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Postpartum and post abortion diagnoses with O.R. procedures,769,MS-DRG,769,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,71182.55,Fee Schedule,22000,120000,,,,,,,,
"Abortion with D&C, aspiration curettage or hysterotomy",770,MS-DRG,770,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,71182.55,Fee Schedule,22000,120000,,,,,,,,
Postpartum and post abortion diagnoses without O.R. procedures,776,MS-DRG,776,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Abortion without D&C,779,MS-DRG,779,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Cesarean section with sterilization with MCC,783,MS-DRG,783,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Cesarean section with sterilization with CC,784,MS-DRG,784,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,90613.37,Fee Schedule,22000,120000,,,,,,,,
Cesarean section with sterilization without CC/MCC,785,MS-DRG,785,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Cesarean section without sterilization with MCC,786,MS-DRG,786,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Cesarean section without sterilization with CC,787,MS-DRG,787,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Cesarean section without sterilization without CC/MCC,788,MS-DRG,788,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
"Neonates, died or transferred to another acute care facility",789,MS-DRG,789,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
"Extreme immaturity or respiratory distress syndrome, neonate",790,MS-DRG,790,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,71182.55,Fee Schedule,22000,120000,,,,,,,,
Prematurity with major problems,791,MS-DRG,791,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,71182.55,Fee Schedule,22000,120000,,,,,,,,
Prematurity without major problems,792,MS-DRG,792,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48921.03,Fee Schedule,22000,120000,,,,,,,,
Full term neonate with major problems,793,MS-DRG,793,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,71182.55,Fee Schedule,22000,120000,,,,,,,,
Neonate with other significant problems,794,MS-DRG,794,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48921.03,Fee Schedule,22000,120000,,,,,,,,
Splenic procedures with MCC,799,MS-DRG,799,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,106800.6,Fee Schedule,22000,120000,,,,,,,,
Splenic procedures with CC,800,MS-DRG,800,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48921.03,Fee Schedule,22000,120000,,,,,,,,
Splenic procedures without CC/MCC,801,MS-DRG,801,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Other O.R. procedures of the blood and blood forming organs with MCC,802,MS-DRG,802,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Other O.R. procedures of the blood and blood forming organs with CC,803,MS-DRG,803,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Other O.R. procedures of the blood and blood forming organs without CC/MCC,804,MS-DRG,804,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with MCC,808,MS-DRG,808,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with CC,809,MS-DRG,809,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without CC/MCC,810,MS-DRG,810,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Red blood cell disorders with MCC,811,MS-DRG,811,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,71182.55,Fee Schedule,22000,120000,,,,,,,,
Red blood cell disorders without MCC,812,MS-DRG,812,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Coagulation disorders,813,MS-DRG,813,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Reticuloendothelial and immunity disorders with MCC*,814,MS-DRG,814,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Reticuloendothelial and immunity disorders with CC*,815,MS-DRG,815,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Reticuloendothelial and immunity disorders without CC/MCC*,816,MS-DRG,816,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Other antepartum diagnoses with O.R. procedures with MCC,817,MS-DRG,817,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,40508.305,Fee Schedule,22000,120000,,,,,,,,
Other antepartum diagnoses with O.R. procedures with CC,818,MS-DRG,818,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
Other antepartum diagnoses with O.R. procedures without CC/MCC,819,MS-DRG,819,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Lymphoma and leukemia with major O.R. procedures with MCC,820,MS-DRG,820,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Lymphoma and leukemia with major O.R. procedures with CC,821,MS-DRG,821,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Lymphoma and leukemia with major O.R. procedures without CC/MCC,822,MS-DRG,822,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96210.83,Fee Schedule,22000,120000,,,,,,,,
Lymphoma and non-acute leukemia with other procedures with MCC,823,MS-DRG,823,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Lymphoma and non-acute leukemia with other procedures with CC,824,MS-DRG,824,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Lymphoma and non-acute leukemia with other procedures without CC/MCC,825,MS-DRG,825,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with MCC,826,MS-DRG,826,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with CC,827,MS-DRG,827,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures without CC/MCC,828,MS-DRG,828,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96210.83,Fee Schedule,22000,120000,,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures with CC/MCC,829,MS-DRG,829,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures without CC/MCC,830,MS-DRG,830,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Other antepartum diagnoses without O.R. procedures with MCC,831,MS-DRG,831,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,71182.55,Fee Schedule,22000,120000,,,,,,,,
Other antepartum diagnoses without O.R. procedures with CC,832,MS-DRG,832,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Other antepartum diagnoses without O.R. procedures without CC/MCC,833,MS-DRG,833,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Acute leukemia with MCC,834,MS-DRG,834,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Acute leukemia with CC,835,MS-DRG,835,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Acute leukemia without CC/MCC,836,MS-DRG,836,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy agent with MCC,837,MS-DRG,837,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapy agent,838,MS-DRG,838,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis without CC/MCC,839,MS-DRG,839,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Lymphoma and non-acute leukemia with MCC,840,MS-DRG,840,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Lymphoma and non-acute leukemia with CC,841,MS-DRG,841,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Lymphoma and non-acute leukemia without CC/MCC,842,MS-DRG,842,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with MCC,843,MS-DRG,843,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with CC,844,MS-DRG,844,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses without CC/MCC,845,MS-DRG,845,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with MCC,846,MS-DRG,846,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with CC,847,MS-DRG,847,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis without CC/MCC,848,MS-DRG,848,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Radiotherapy,849,MS-DRG,849,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Acute leukemia with other procedures,850,MS-DRG,850,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Infectious and parasitic diseases with O.R. procedures with MCC,853,MS-DRG,853,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,116013.09,Fee Schedule,22000,120000,,,,,,,,
Infectious and parasitic diseases with O.R. procedures with CC,854,MS-DRG,854,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.07,Fee Schedule,22000,120000,,,,,,,,
Infectious and parasitic diseases with O.R. procedures without CC/MCC,855,MS-DRG,855,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with MCC,856,MS-DRG,856,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,103112.54,Fee Schedule,22000,120000,,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with CC,857,MS-DRG,857,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures without CC/MCC,858,MS-DRG,858,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Postoperative and post-traumatic infections with MCC,862,MS-DRG,862,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,70501.55,Fee Schedule,22000,120000,,,,,,,,
Postoperative and post-traumatic infections without MCC,863,MS-DRG,863,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,47554.5,Fee Schedule,22000,120000,,,,,,,,
Fever and inflammatory conditions,864,MS-DRG,864,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Viral illness with MCC,865,MS-DRG,865,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Viral illness without MCC,866,MS-DRG,866,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Other infectious and parasitic diseases diagnoses with MCC,867,MS-DRG,867,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,70118.98,Fee Schedule,22000,120000,,,,,,,,
Other infectious and parasitic diseases diagnoses with CC,868,MS-DRG,868,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Other infectious and parasitic diseases diagnoses without CC/MCC,869,MS-DRG,869,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Septicemia or severe sepsis with MV >96 hours,870,MS-DRG,870,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,158548.16,Fee Schedule,22000,120000,,,,,,,,
Septicemia or severe sepsis without MV >96 hours with MCC,871,MS-DRG,871,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,64954.17,Fee Schedule,22000,120000,,,,,,,,
Septicemia or severe sepsis without MV >96 hours without MCC,872,MS-DRG,872,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,43522.12,Fee Schedule,22000,120000,,,,,,,,
Wound debridements for injuries with MCC,901,MS-DRG,901,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,98177.28,Fee Schedule,22000,120000,,,,,,,,
Wound debridements for injuries with CC,902,MS-DRG,902,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
Wound debridements for injuries without CC/MCC,903,MS-DRG,903,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
Skin grafts for injuries with CC/MCC,904,MS-DRG,904,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
Skin grafts for injuries without CC/MCC,905,MS-DRG,905,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
Hand procedures for injuries,906,MS-DRG,906,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Other O.R. procedures for injuries with MCC*,907,MS-DRG,907,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96210.83,Fee Schedule,22000,120000,,,,,,,,
Other O.R. procedures for injuries with CC*,908,MS-DRG,908,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96210.83,Fee Schedule,22000,120000,,,,,,,,
Other O.R. procedures for injuries without CC/MCC*,909,MS-DRG,909,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Traumatic injury with MCC,913,MS-DRG,913,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Traumatic injury without MCC,914,MS-DRG,914,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Allergic reactions with MCC,915,MS-DRG,915,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Allergic reactions without MCC,916,MS-DRG,916,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Poisoning and toxic effects of drugs with MCC,917,MS-DRG,917,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Poisoning and toxic effects of drugs without MCC,918,MS-DRG,918,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Complications of treatment with MCC,919,MS-DRG,919,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,82055.43,Fee Schedule,22000,120000,,,,,,,,
Complications of treatment with CC,920,MS-DRG,920,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52581.58,Fee Schedule,22000,120000,,,,,,,,
Complications of treatment without CC/MCC,921,MS-DRG,921,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
"Other injury, poisoning and toxic effect diagnoses with MCC",922,MS-DRG,922,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
"Other injury, poisoning and toxic effect diagnoses without MCC",923,MS-DRG,923,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Extensive burns or full thickness burns with MV >96 hours with skin graft,927,MS-DRG,927,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
Full thickness burn with skin graft or inhalation injury with CC/MCC,928,MS-DRG,928,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
Full thickness burn with skin graft or inhalation injury without CC/MCC,929,MS-DRG,929,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
Extensive burns or full thickness burns with MV >96 hours without skin graft,933,MS-DRG,933,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Full thickness burn without skin graft or inhalation injury,934,MS-DRG,934,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
Non-extensive burns,935,MS-DRG,935,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
O.R. procedures with diagnoses of other contact with health services with MCC,939,MS-DRG,939,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,90701.7,Fee Schedule,22000,120000,,,,,,,,
O.R. procedures with diagnoses of other contact with health services with CC,940,MS-DRG,940,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
O.R. procedures with diagnoses of other contact with health services without CC/MCC,941,MS-DRG,941,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.06,Fee Schedule,22000,120000,,,,,,,,
Signs and symptoms with MCC,947,MS-DRG,947,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Signs and symptoms without MCC,948,MS-DRG,948,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Aftercare with CC/MCC,949,MS-DRG,949,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,53224.31,Fee Schedule,22000,120000,,,,,,,,
Aftercare without CC/MCC,950,MS-DRG,950,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Other factors influencing health status,951,MS-DRG,951,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Craniotomy for multiple significant trauma,955,MS-DRG,955,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96210.83,Fee Schedule,22000,120000,,,,,,,,
"Limb reattachment, hip and femur procedures for multiple significant trauma",956,MS-DRG,956,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96210.83,Fee Schedule,22000,120000,,,,,,,,
Other O.R. procedures for multiple significant trauma with MCC,957,MS-DRG,957,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96210.83,Fee Schedule,22000,120000,,,,,,,,
Other O.R. procedures for multiple significant trauma with CC,958,MS-DRG,958,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96210.83,Fee Schedule,22000,120000,,,,,,,,
Other O.R. procedures for multiple significant trauma without CC/MCC,959,MS-DRG,959,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,36574.5,Fee Schedule,22000,120000,,,,,,,,
Other multiple significant trauma with MCC,963,MS-DRG,963,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
Other multiple significant trauma with CC,964,MS-DRG,964,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
Other multiple significant trauma without CC/MCC,965,MS-DRG,965,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,48870.57,Fee Schedule,22000,120000,,,,,,,,
HIV with extensive O.R. procedures with MCC,969,MS-DRG,969,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
HIV with extensive O.R. procedures without MCC,970,MS-DRG,970,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96585.75,Fee Schedule,22000,120000,,,,,,,,
HIV with major related condition with MCC*,974,MS-DRG,974,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,87197.28,Fee Schedule,22000,120000,,,,,,,,
HIV with major related condition with CC*,975,MS-DRG,975,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,68412.68,Fee Schedule,22000,120000,,,,,,,,
HIV with major related condition without CC/MCC*,976,MS-DRG,976,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,68412.68,Fee Schedule,22000,120000,,,,,,,,
HIV with or without other related condition,977,MS-DRG,977,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with MCC,981,MS-DRG,981,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,68449.825,Fee Schedule,22000,120000,,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with CC,982,MS-DRG,982,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,96991.29,Fee Schedule,22000,120000,,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,983,MS-DRG,983,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,52145.44,Fee Schedule,22000,120000,,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with MCC,987,MS-DRG,987,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,163207.97,Fee Schedule,22000,120000,,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with CC,988,MS-DRG,988,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.07,Fee Schedule,22000,120000,,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,989,MS-DRG,989,LOCAL,,Inpatient,,,,,VA Community Care Network,VA,,,MS-DRG,72269.07,Fee Schedule,22000,120000,,,,,,,,
"ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck with major O.R. procedures",3,MS-DRG,3,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,310277.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck without major O.R. procedures",4,MS-DRG,4,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,229767.96,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCC",11,MS-DRG,11,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CC",12,MS-DRG,12,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy without CC/MCC",13,MS-DRG,13,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chimeric antigen receptor (CAR) T-cell and other immunotherapies,18,MS-DRG,18,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46368.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with MCC,20,MS-DRG,20,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with CC,21,MS-DRG,21,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage without CC/MCC,22,MS-DRG,22,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC or chemotherapy implant or epilepsy with neurostimulator,23,MS-DRG,23,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis without MCC,24,MS-DRG,24,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy and endovascular intracranial procedures with MCC,25,MS-DRG,25,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy and endovascular intracranial procedures with CC,26,MS-DRG,26,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy and endovascular intracranial procedures without CC/MCC,27,MS-DRG,27,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Spinal procedures with MCC,28,MS-DRG,28,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Spinal procedures with CC or spinal neurostimulators,29,MS-DRG,29,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Spinal procedures without CC/MCC,30,MS-DRG,30,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ventricular shunt procedures with MCC,31,MS-DRG,31,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ventricular shunt procedures with CC,32,MS-DRG,32,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ventricular shunt procedures without CC/MCC,33,MS-DRG,33,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Carotid artery stent procedures with MCC,34,MS-DRG,34,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Carotid artery stent procedures with CC,35,MS-DRG,35,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Carotid artery stent procedures without CC/MCC,36,MS-DRG,36,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extracranial procedures with MCC,37,MS-DRG,37,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extracranial procedures with CC,38,MS-DRG,38,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extracranial procedures without CC/MCC,39,MS-DRG,39,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with MCC",40,MS-DRG,40,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,95774.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurostimulator",41,MS-DRG,41,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46368.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures without CC/MCC",42,MS-DRG,42,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46368.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Spinal disorders and injuries with CC/MCC,52,MS-DRG,52,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,82942.79,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Spinal disorders and injuries without CC/MCC,53,MS-DRG,53,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,81228.84,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nervous system neoplasms with MCC,54,MS-DRG,54,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46368.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nervous system neoplasms without MCC,55,MS-DRG,55,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46368.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Degenerative nervous system disorders with MCC,56,MS-DRG,56,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,61411.33,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Degenerative nervous system disorders without MCC,57,MS-DRG,57,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,51678.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple sclerosis and cerebellar ataxia with MCC,58,MS-DRG,58,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple sclerosis and cerebellar ataxia with CC,59,MS-DRG,59,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,51678.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple sclerosis and cerebellar ataxia without CC/MCC,60,MS-DRG,60,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,51678.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with MCC",61,MS-DRG,61,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,111192.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with CC",62,MS-DRG,62,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent without CC/MCC",63,MS-DRG,63,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial hemorrhage or cerebral infarction with MCC,64,MS-DRG,64,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,111192.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial hemorrhage or cerebral infarction with CC or tPA in 24 hours,65,MS-DRG,65,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial hemorrhage or cerebral infarction without CC/MCC,66,MS-DRG,66,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nonspecific CVA and precerebral occlusion without infarction with MCC,67,MS-DRG,67,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,66767.42,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nonspecific CVA and precerebral occlusion without infarction without MCC,68,MS-DRG,68,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Transient ischemia without thrombolytic,69,MS-DRG,69,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nonspecific cerebrovascular disorders with MCC*,70,MS-DRG,70,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,66767.42,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nonspecific cerebrovascular disorders with CC*,71,MS-DRG,71,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,45128.84,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nonspecific cerebrovascular disorders without CC/MCC*,72,MS-DRG,72,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cranial and peripheral nerve disorders with MCC,73,MS-DRG,73,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cranial and peripheral nerve disorders without MCC,74,MS-DRG,74,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Viral meningitis with CC/MCC,75,MS-DRG,75,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Viral meningitis without CC/MCC,76,MS-DRG,76,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hypertensive encephalopathy with MCC,77,MS-DRG,77,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,68160,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hypertensive encephalopathy with CC,78,MS-DRG,78,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,537909.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hypertensive encephalopathy without CC/MCC,79,MS-DRG,79,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nontraumatic stupor and coma with MCC,80,MS-DRG,80,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nontraumatic stupor and coma without MCC,81,MS-DRG,81,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma >1 hour with MCC*,82,MS-DRG,82,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,82529.13,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma >1 hour with CC*,83,MS-DRG,83,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,62451.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma >1 hour without CC/MCC*,84,MS-DRG,84,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma <1 hour with MCC,85,MS-DRG,85,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,62451.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma <1 hour with CC,86,MS-DRG,86,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,62451.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma <1 hour without CC/MCC,87,MS-DRG,87,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Concussion with MCC,88,MS-DRG,88,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,68160,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Concussion with CC,89,MS-DRG,89,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,537909.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Concussion without CC/MCC,90,MS-DRG,90,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other disorders of nervous system with MCC,91,MS-DRG,91,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,68160,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other disorders of nervous system with CC,92,MS-DRG,92,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,537909.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other disorders of nervous system without CC/MCC,93,MS-DRG,93,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,51678.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bacterial and tuberculous infections of nervous system with MCC*,94,MS-DRG,94,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34375.739,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bacterial and tuberculous infections of nervous system with CC*,95,MS-DRG,95,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,62451.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bacterial and tuberculous infections of nervous system without CC/MCC*,96,MS-DRG,96,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-bacterial infection of nervous system except viral meningitis with MCC,97,MS-DRG,97,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,75054.04,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-bacterial infection of nervous system except viral meningitis with CC,98,MS-DRG,98,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-bacterial infection of nervous system except viral meningitis without CC/MCC,99,MS-DRG,99,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Seizures with MCC,100,MS-DRG,100,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Seizures without MCC,101,MS-DRG,101,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Headaches with MCC,102,MS-DRG,102,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Headaches without MCC,103,MS-DRG,103,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Orbital procedures with CC/MCC,113,MS-DRG,113,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Orbital procedures without CC/MCC,114,MS-DRG,114,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extraocular procedures except orbit,115,MS-DRG,115,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intraocular procedures with CC/MCC,116,MS-DRG,116,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intraocular procedures without CC/MCC,117,MS-DRG,117,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute major eye infections with CC/MCC,121,MS-DRG,121,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute major eye infections without CC/MCC,122,MS-DRG,122,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Neurological eye disorders,123,MS-DRG,123,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other disorders of the eye with MCC or thrombolytic agent,124,MS-DRG,124,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other disorders of the eye without MCC,125,MS-DRG,125,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Sinus and mastoid procedures with CC/MCC,135,MS-DRG,135,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Sinus and mastoid procedures without CC/MCC,136,MS-DRG,136,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Mouth procedures with CC/MCC,137,MS-DRG,137,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Mouth procedures without CC/MCC,138,MS-DRG,138,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Salivary gland procedures,139,MS-DRG,139,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major head and neck procedures with MCC,140,MS-DRG,140,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,177508.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major head and neck procedures with CC,141,MS-DRG,141,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major head and neck procedures without CC/MCC,142,MS-DRG,142,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with MCC",143,MS-DRG,143,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with CC",144,MS-DRG,144,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures without CC/MCC",145,MS-DRG,145,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ear, nose, mouth and throat malignancy with MCC*",146,MS-DRG,146,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ear, nose, mouth and throat malignancy with CC*",147,MS-DRG,147,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ear, nose, mouth and throat malignancy without CC/MCC*",148,MS-DRG,148,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Dysequilibrium,149,MS-DRG,149,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Epistaxis with MCC,150,MS-DRG,150,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Epistaxis without MCC,151,MS-DRG,151,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Otitis media and URI with MCC,152,MS-DRG,152,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Otitis media and URI without MCC,153,MS-DRG,153,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat diagnoses with MCC",154,MS-DRG,154,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat diagnoses with CC",155,MS-DRG,155,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat diagnoses without CC/MCC",156,MS-DRG,156,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Dental and oral diseases with MCC,157,MS-DRG,157,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Dental and oral diseases with CC,158,MS-DRG,158,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Dental and oral diseases without CC/MCC,159,MS-DRG,159,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest procedures with MCC,163,MS-DRG,163,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,202666.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest procedures with CC,164,MS-DRG,164,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,202666.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest procedures without CC/MCC,165,MS-DRG,165,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,202666.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other respiratory system O.R. procedures with MCC,166,MS-DRG,166,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,177508.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other respiratory system O.R. procedures with CC,167,MS-DRG,167,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other respiratory system O.R. procedures without CC/MCC,168,MS-DRG,168,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism,173,MS-DRG,173,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pulmonary embolism with MCC or acute cor pulmonale,175,MS-DRG,175,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pulmonary embolism without MCC,176,MS-DRG,176,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory infections and inflammations with MCC*,177,MS-DRG,177,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,62918.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory infections and inflammations with CC*,178,MS-DRG,178,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,43491.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory infections and inflammations without CC/MCC*,179,MS-DRG,179,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,42251.85,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory neoplasms with MCC*,180,MS-DRG,180,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory neoplasms with CC*,181,MS-DRG,181,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory neoplasms without CC/MCC*,182,MS-DRG,182,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest trauma with MCC,183,MS-DRG,183,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest trauma with CC,184,MS-DRG,184,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest trauma without CC/MCC,185,MS-DRG,185,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pleural effusion with MCC*,186,MS-DRG,186,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,66071.13,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pleural effusion with CC*,187,MS-DRG,187,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pleural effusion without CC/MCC*,188,MS-DRG,188,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pulmonary edema and respiratory failure,189,MS-DRG,189,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72046.99,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chronic obstructive pulmonary disease with MCC*,190,MS-DRG,190,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,20971.383,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chronic obstructive pulmonary disease with CC*,191,MS-DRG,191,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chronic obstructive pulmonary disease without CC/MCC*,192,MS-DRG,192,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Simple pneumonia and pleurisy with MCC,193,MS-DRG,193,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,59421.93,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Simple pneumonia and pleurisy with CC,194,MS-DRG,194,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,39604.42,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Simple pneumonia and pleurisy without CC/MCC,195,MS-DRG,195,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Interstitial lung disease with MCC*,196,MS-DRG,196,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Interstitial lung disease with CC*,197,MS-DRG,197,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Interstitial lung disease without CC/MCC*,198,MS-DRG,198,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pneumothorax with MCC,199,MS-DRG,199,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pneumothorax with CC,200,MS-DRG,200,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,21869.927,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pneumothorax without CC/MCC,201,MS-DRG,201,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,21869.927,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bronchitis and asthma with CC/MCC,202,MS-DRG,202,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,40508.305,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bronchitis and asthma without CC/MCC,203,MS-DRG,203,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,15339.435,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory signs and symptoms,204,MS-DRG,204,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other respiratory system diagnoses with MCC,205,MS-DRG,205,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,112102.84,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other respiratory system diagnoses without MCC,206,MS-DRG,206,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory system diagnosis with ventilator support >96 hours,207,MS-DRG,207,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,147720.8,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory system diagnosis with ventilator support <=96 hours,208,MS-DRG,208,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,81481.35,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Concomitant aortic and mitral valve procedures,212,MS-DRG,212,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other heart assist system implant,215,MS-DRG,215,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC,216,MS-DRG,216,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with CC,217,MS-DRG,217,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization without CC/MCC,218,MS-DRG,218,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with MCC,219,MS-DRG,219,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with CC,220,MS-DRG,220,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization without CC/MCC,221,MS-DRG,221,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other cardiothoracic procedures with MCC,228,MS-DRG,228,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other cardiothoracic procedures without MCC,229,MS-DRG,229,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass with PTCA with MCC,231,MS-DRG,231,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass with PTCA without MCC,232,MS-DRG,232,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass with cardiac catheterization or open ablation with MCC,233,MS-DRG,233,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass with cardiac catheterization or open ablation without MCC,234,MS-DRG,234,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass without cardiac catheterization with MCC,235,MS-DRG,235,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass without cardiac catheterization without MCC,236,MS-DRG,236,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for circulatory system disorders except upper limb and toe with MCC,239,MS-DRG,239,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for circulatory system disorders except upper limb and toe with CC,240,MS-DRG,240,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for circulatory system disorders except upper limb and toe without CC/MCC,241,MS-DRG,241,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Permanent cardiac pacemaker implant with MCC,242,MS-DRG,242,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Permanent cardiac pacemaker implant with CC,243,MS-DRG,243,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Permanent cardiac pacemaker implant without CC/MCC,244,MS-DRG,244,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
AICD generator procedures,245,MS-DRG,245,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,40774.659,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous cardiovascular procedures without intraluminal device with MCC,250,MS-DRG,250,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous cardiovascular procedures without intraluminal device without MCC,251,MS-DRG,251,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other vascular procedures with MCC,252,MS-DRG,252,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other vascular procedures with CC,253,MS-DRG,253,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other vascular procedures without CC/MCC,254,MS-DRG,254,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Upper limb and toe amputation for circulatory system disorders with MCC,255,MS-DRG,255,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Upper limb and toe amputation for circulatory system disorders with CC,256,MS-DRG,256,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Upper limb and toe amputation for circulatory system disorders without CC/MCC,257,MS-DRG,257,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac pacemaker device replacement with MCC,258,MS-DRG,258,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac pacemaker device replacement without MCC,259,MS-DRG,259,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac pacemaker revision except device replacement with MCC,260,MS-DRG,260,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac pacemaker revision except device replacement with CC,261,MS-DRG,261,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac pacemaker revision except device replacement without CC/MCC,262,MS-DRG,262,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Vein ligation and stripping,263,MS-DRG,263,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other circulatory system O.R. procedures,264,MS-DRG,264,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
AICD lead procedures,265,MS-DRG,265,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Endovascular cardiac valve replacement and supplement procedures with MCC,266,MS-DRG,266,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Endovascular cardiac valve replacement and supplement procedures without MCC,267,MS-DRG,267,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Aortic and heart assist procedures except pulsation balloon with MCC,268,MS-DRG,268,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Aortic and heart assist procedures except pulsation balloon without MCC,269,MS-DRG,269,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other major cardiovascular procedures with MCC,270,MS-DRG,270,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other major cardiovascular procedures with CC,271,MS-DRG,271,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other major cardiovascular procedures without CC/MCC,272,MS-DRG,272,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous and other intracardiac procedures with MCC,273,MS-DRG,273,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous and other intracardiac procedures without MCC,274,MS-DRG,274,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac defibrillator implant with cardiac catheterization and MCC,275,MS-DRG,275,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac defibrillator implant with MCC or carotid sinus neurostimulator,276,MS-DRG,276,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac defibrillator implant without MCC,277,MS-DRG,277,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures with MCC,278,MS-DRG,278,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures without MCC,279,MS-DRG,279,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, discharged alive with MCC",280,MS-DRG,280,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,63798.62,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, discharged alive with CC",281,MS-DRG,281,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, discharged alive without CC/MCC",282,MS-DRG,282,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, expired with MCC",283,MS-DRG,283,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, expired with CC",284,MS-DRG,284,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, expired without CC/MCC",285,MS-DRG,285,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization with MCC",286,MS-DRG,286,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization without MCC",287,MS-DRG,287,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute and subacute endocarditis with MCC,288,MS-DRG,288,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,79476.64,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute and subacute endocarditis with CC,289,MS-DRG,289,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,54456.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute and subacute endocarditis without CC/MCC,290,MS-DRG,290,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48748.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Heart failure and shock with MCC,291,MS-DRG,291,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,59345.41,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Heart failure and shock with CC,292,MS-DRG,292,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,42060.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Heart failure and shock without CC/MCC,293,MS-DRG,293,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,42060.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Deep vein thrombophlebitis with CC/MCC,294,MS-DRG,294,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Deep vein thrombophlebitis without CC/MCC,295,MS-DRG,295,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Cardiac arrest, unexplained with MCC",296,MS-DRG,296,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,59345.41,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Cardiac arrest, unexplained with CC",297,MS-DRG,297,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,42060.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Cardiac arrest, unexplained without CC/MCC",298,MS-DRG,298,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,42060.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peripheral vascular disorders with MCC,299,MS-DRG,299,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,64808.62,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peripheral vascular disorders with CC,300,MS-DRG,300,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peripheral vascular disorders without CC/MCC,301,MS-DRG,301,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Atherosclerosis with MCC,302,MS-DRG,302,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Atherosclerosis without MCC,303,MS-DRG,303,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hypertension with MCC,304,MS-DRG,304,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hypertension without MCC,305,MS-DRG,305,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac congenital and valvular disorders with MCC,306,MS-DRG,306,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac congenital and valvular disorders without MCC,307,MS-DRG,307,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac arrhythmia and conduction disorders with MCC,308,MS-DRG,308,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac arrhythmia and conduction disorders with CC,309,MS-DRG,309,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac arrhythmia and conduction disorders without CC/MCC,310,MS-DRG,310,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Angina pectoris,311,MS-DRG,311,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Syncope and collapse,312,MS-DRG,312,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chest pain,313,MS-DRG,313,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other circulatory system diagnoses with MCC,314,MS-DRG,314,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,67570.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other circulatory system diagnoses with CC,315,MS-DRG,315,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,47562.03,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other circulatory system diagnoses without CC/MCC,316,MS-DRG,316,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Concomitant left atrial appendage closure and cardiac ablation,317,MS-DRG,317,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other endovascular cardiac valve procedures with MCC,319,MS-DRG,319,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other endovascular cardiac valve procedures without MCC,320,MS-DRG,320,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/intraluminal devices,321,MS-DRG,321,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous cardiovascular procedures with intraluminal device without MCC,322,MS-DRG,322,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary intravascular lithotripsy with intraluminal device with MCC,323,MS-DRG,323,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary intravascular lithotripsy with intraluminal device without MCC,324,MS-DRG,324,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary intravascular lithotripsy without intraluminal device,325,MS-DRG,325,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Stomach, esophageal and duodenal procedures with MCC",326,MS-DRG,326,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Stomach, esophageal and duodenal procedures with CC",327,MS-DRG,327,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Stomach, esophageal and duodenal procedures without CC/MCC",328,MS-DRG,328,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major small and large bowel procedures with MCC,329,MS-DRG,329,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major small and large bowel procedures with CC,330,MS-DRG,330,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major small and large bowel procedures without CC/MCC,331,MS-DRG,331,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Rectal resection with MCC,332,MS-DRG,332,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Rectal resection with CC,333,MS-DRG,333,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Rectal resection without CC/MCC,334,MS-DRG,334,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peritoneal adhesiolysis with MCC,335,MS-DRG,335,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peritoneal adhesiolysis with CC,336,MS-DRG,336,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peritoneal adhesiolysis without CC/MCC,337,MS-DRG,337,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor small and large bowel procedures with MCC,344,MS-DRG,344,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor small and large bowel procedures with CC,345,MS-DRG,345,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor small and large bowel procedures without CC/MCC,346,MS-DRG,346,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Anal and stomal procedures with MCC,347,MS-DRG,347,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,68366.59,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Anal and stomal procedures with CC,348,MS-DRG,348,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Anal and stomal procedures without CC/MCC,349,MS-DRG,349,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inguinal and femoral hernia procedures with MCC,350,MS-DRG,350,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,68366.59,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inguinal and femoral hernia procedures with CC,351,MS-DRG,351,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inguinal and femoral hernia procedures without CC/MCC,352,MS-DRG,352,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hernia procedures except inguinal and femoral with MCC,353,MS-DRG,353,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hernia procedures except inguinal and femoral with CC,354,MS-DRG,354,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hernia procedures except inguinal and femoral without CC/MCC,355,MS-DRG,355,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system O.R. procedures with MCC,356,MS-DRG,356,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,106800.32,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system O.R. procedures with CC,357,MS-DRG,357,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system O.R. procedures without CC/MCC,358,MS-DRG,358,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major esophageal disorders with MCC*,368,MS-DRG,368,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major esophageal disorders with CC*,369,MS-DRG,369,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major esophageal disorders without CC/MCC*,370,MS-DRG,370,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major gastrointestinal disorders and peritoneal infections with MCC,371,MS-DRG,371,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,68366.59,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major gastrointestinal disorders and peritoneal infections with CC,372,MS-DRG,372,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major gastrointestinal disorders and peritoneal infections without CC/MCC,373,MS-DRG,373,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Digestive malignancy with MCC*,374,MS-DRG,374,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Digestive malignancy with CC*,375,MS-DRG,375,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Digestive malignancy without CC/MCC*,376,MS-DRG,376,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal hemorrhage with MCC,377,MS-DRG,377,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,54425.47,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal hemorrhage with CC,378,MS-DRG,378,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal hemorrhage without CC/MCC,379,MS-DRG,379,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complicated peptic ulcer with MCC,380,MS-DRG,380,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,73278.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complicated peptic ulcer with CC,381,MS-DRG,381,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complicated peptic ulcer without CC/MCC,382,MS-DRG,382,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uncomplicated peptic ulcer with MCC,383,MS-DRG,383,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uncomplicated peptic ulcer without MCC,384,MS-DRG,384,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inflammatory bowel disease with MCC,385,MS-DRG,385,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inflammatory bowel disease with CC,386,MS-DRG,386,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inflammatory bowel disease without CC/MCC,387,MS-DRG,387,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal obstruction with MCC,388,MS-DRG,388,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,75604.95,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal obstruction with CC,389,MS-DRG,389,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal obstruction without CC/MCC,390,MS-DRG,390,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC",391,MS-DRG,391,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,59253.6,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC",392,MS-DRG,392,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,47929.3,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system diagnoses with MCC,393,MS-DRG,393,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,77739.74,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system diagnoses with CC,394,MS-DRG,394,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55022.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system diagnoses without CC/MCC,395,MS-DRG,395,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Appendix procedures with MCC,397,MS-DRG,397,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,68366.59,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Appendix procedures with CC,398,MS-DRG,398,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Appendix procedures without CC/MCC,399,MS-DRG,399,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Single level combined anterior and posterior spinal fusion except cervical,402,MS-DRG,402,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Pancreas, liver and shunt procedures with MCC",405,MS-DRG,405,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,40508.305,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Pancreas, liver and shunt procedures with CC",406,MS-DRG,406,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Pancreas, liver and shunt procedures without CC/MCC",407,MS-DRG,407,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with MCC,408,MS-DRG,408,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55022.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with CC,409,MS-DRG,409,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. without CC/MCC,410,MS-DRG,410,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy with C.D.E. with MCC,411,MS-DRG,411,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,73278.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy with C.D.E. with CC,412,MS-DRG,412,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy with C.D.E. without CC/MCC,413,MS-DRG,413,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with MCC,414,MS-DRG,414,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,73278.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with CC,415,MS-DRG,415,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55022.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. without CC/MCC,416,MS-DRG,416,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55022.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Laparoscopic cholecystectomy without C.D.E. with MCC,417,MS-DRG,417,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,73278.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Laparoscopic cholecystectomy without C.D.E. with CC,418,MS-DRG,418,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Laparoscopic cholecystectomy without C.D.E. without CC/MCC,419,MS-DRG,419,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hepatobiliary diagnostic procedures with MCC,420,MS-DRG,420,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55022.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hepatobiliary diagnostic procedures with CC,421,MS-DRG,421,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hepatobiliary diagnostic procedures without CC/MCC,422,MS-DRG,422,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other hepatobiliary or pancreas O.R. procedures with MCC,423,MS-DRG,423,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other hepatobiliary or pancreas O.R. procedures with CC,424,MS-DRG,424,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other hepatobiliary or pancreas O.R. procedures without CC/MCC,425,MS-DRG,425,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,426,MS-DRG,426,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,81343.62,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical with CC,427,MS-DRG,427,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,81343.62,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical without CC/MCC,428,MS-DRG,428,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,67111.73,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Combined anterior and posterior cervical spinal fusion with MCC,429,MS-DRG,429,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,81343.62,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Combined anterior and posterior cervical spinal fusion without MCC,430,MS-DRG,430,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cirrhosis and alcoholic hepatitis with MCC,432,MS-DRG,432,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,56468.43,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cirrhosis and alcoholic hepatitis with CC,433,MS-DRG,433,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cirrhosis and alcoholic hepatitis without CC/MCC,434,MS-DRG,434,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignancy of hepatobiliary system or pancreas with MCC,435,MS-DRG,435,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignancy of hepatobiliary system or pancreas with CC,436,MS-DRG,436,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignancy of hepatobiliary system or pancreas without CC/MCC,437,MS-DRG,437,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of pancreas except malignancy with MCC,438,MS-DRG,438,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,80165.28,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of pancreas except malignancy with CC,439,MS-DRG,439,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of pancreas except malignancy without CC/MCC,440,MS-DRG,440,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCC",441,MS-DRG,441,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,71243.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CC",442,MS-DRG,442,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without CC/MCC",443,MS-DRG,443,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of the biliary tract with MCC*,444,MS-DRG,444,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,58190.03,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of the biliary tract with CC*,445,MS-DRG,445,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53147.66,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of the biliary tract without CC/MCC*,446,MS-DRG,446,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,447,MS-DRG,447,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,1.0631,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple level spinal fusion except cervical without MCC,448,MS-DRG,448,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,1.0631,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,450,MS-DRG,450,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,67111.74,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Single Level Spinal Fusion Except Cervical without MCC,451,MS-DRG,451,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with MCC",456,MS-DRG,456,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with CC",457,MS-DRG,457,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions without CC/MCC",458,MS-DRG,458,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bilateral or multiple major joint procedures of lower extremity with MCC,461,MS-DRG,461,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,67111.74,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bilateral or multiple major joint procedures of lower extremity without MCC,462,MS-DRG,462,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with MCC*,463,MS-DRG,463,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with CC*,464,MS-DRG,464,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72972.82,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders without CC/MCC*,465,MS-DRG,465,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,70057.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Revision of hip or knee replacement with MCC,466,MS-DRG,466,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Revision of hip or knee replacement with CC,467,MS-DRG,467,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Revision of hip or knee replacement without CC/MCC,468,MS-DRG,468,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity with MCC or total ankle replacement,469,MS-DRG,469,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity without MCC,470,MS-DRG,470,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cervical spinal fusion with MCC,471,MS-DRG,471,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cervical spinal fusion with CC,472,MS-DRG,472,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cervical spinal fusion without CC/MCC,473,MS-DRG,473,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with MCC,474,MS-DRG,474,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with CC,475,MS-DRG,475,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders without CC/MCC,476,MS-DRG,476,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biopsies of musculoskeletal system and connective tissue with MCC,477,MS-DRG,477,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biopsies of musculoskeletal system and connective tissue with CC,478,MS-DRG,478,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,28146.902,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biopsies of musculoskeletal system and connective tissue without CC/MCC,479,MS-DRG,479,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,28146.902,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hip and femur procedures except major joint with MCC,480,MS-DRG,480,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hip and femur procedures except major joint with CC,481,MS-DRG,481,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hip and femur procedures except major joint without CC/MCC,482,MS-DRG,482,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major joint or limb reattachment procedures of upper extremities,483,MS-DRG,483,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Knee procedures with principal diagnosis of infection with MCC,485,MS-DRG,485,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Knee procedures with principal diagnosis of infection with CC,486,MS-DRG,486,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Knee procedures with principal diagnosis of infection without CC/MCC,487,MS-DRG,487,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Knee procedures without principal diagnosis of infection with CC/MCC,488,MS-DRG,488,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Knee procedures without principal diagnosis of infection without CC/MCC,489,MS-DRG,489,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,51693.87,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with MCC",492,MS-DRG,492,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with CC",493,MS-DRG,493,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur without CC/MCC",494,MS-DRG,494,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Local excision and removal of internal fixation devices except hip and femur with MCC,495,MS-DRG,495,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Local excision and removal of internal fixation devices except hip and femur with CC,496,MS-DRG,496,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Local excision and removal of internal fixation devices except hip and femur without CC/MCC,497,MS-DRG,497,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Local excision and removal of internal fixation devices of hip and femur with CC/MCC,498,MS-DRG,498,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Local excision and removal of internal fixation devices of hip and femur without CC/MCC,499,MS-DRG,499,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Soft tissue procedures with MCC,500,MS-DRG,500,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,94244.13,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Soft tissue procedures with CC,501,MS-DRG,501,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Soft tissue procedures without CC/MCC,502,MS-DRG,502,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,67111.74,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Foot procedures with MCC,503,MS-DRG,503,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Foot procedures with CC,504,MS-DRG,504,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Foot procedures without CC/MCC,505,MS-DRG,505,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major thumb or joint procedures,506,MS-DRG,506,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major shoulder or elbow joint procedures with CC/MCC,507,MS-DRG,507,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major shoulder or elbow joint procedures without CC/MCC,508,MS-DRG,508,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Arthroscopy,509,MS-DRG,509,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with MCC",510,MS-DRG,510,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with CC",511,MS-DRG,511,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures without CC/MCC",512,MS-DRG,512,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures with CC/MCC",513,MS-DRG,513,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures without CC/MCC",514,MS-DRG,514,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with MCC,515,MS-DRG,515,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,91742.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with CC,516,MS-DRG,516,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures without CC/MCC,517,MS-DRG,517,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Back and neck procedures except spinal fusion with MCC or disc device or neurostimulator,518,MS-DRG,518,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Back and neck procedures except spinal fusion with CC,519,MS-DRG,519,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Back and neck procedures except spinal fusion without CC/MCC,520,MS-DRG,520,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hip replacement with principal diagnosis of hip fracture with MCC,521,MS-DRG,521,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hip replacement with principal diagnosis of hip fracture without MCC,522,MS-DRG,522,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Fractures of femur with MCC,533,MS-DRG,533,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Fractures of femur without MCC,534,MS-DRG,534,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Fractures of hip and pelvis with MCC,535,MS-DRG,535,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Fractures of hip and pelvis without MCC,536,MS-DRG,536,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh with CC/MCC",537,MS-DRG,537,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh without CC/MCC",538,MS-DRG,538,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Osteomyelitis with MCC*,539,MS-DRG,539,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,74166.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Osteomyelitis with CC*,540,MS-DRG,540,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,54425.47,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Osteomyelitis without CC/MCC*,541,MS-DRG,541,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,51693.86,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with MCC*,542,MS-DRG,542,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with CC*,543,MS-DRG,543,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy without CC/MCC*,544,MS-DRG,544,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Connective tissue disorders with MCC,545,MS-DRG,545,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Connective tissue disorders with CC,546,MS-DRG,546,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Connective tissue disorders without CC/MCC,547,MS-DRG,547,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46988.16,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septic arthritis with MCC,548,MS-DRG,548,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,65145.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septic arthritis with CC,549,MS-DRG,549,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septic arthritis without CC/MCC,550,MS-DRG,550,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Medical back problems with MCC,551,MS-DRG,551,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,99921.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Medical back problems without MCC,552,MS-DRG,552,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bone diseases and arthropathies with MCC,553,MS-DRG,553,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bone diseases and arthropathies without MCC,554,MS-DRG,554,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue with MCC,555,MS-DRG,555,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue without MCC,556,MS-DRG,556,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tendonitis, myositis and bursitis with MCC",557,MS-DRG,557,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,69284.76,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tendonitis, myositis and bursitis without MCC",558,MS-DRG,558,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53645.01,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Aftercare, musculoskeletal system and connective tissue with MCC*",559,MS-DRG,559,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,61671.48,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Aftercare, musculoskeletal system and connective tissue with CC*",560,MS-DRG,560,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48082.33,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Aftercare, musculoskeletal system and connective tissue without CC/MCC*",561,MS-DRG,561,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46988.16,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCC",562,MS-DRG,562,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCC",563,MS-DRG,563,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,46988.16,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue diagnoses with MCC,564,MS-DRG,564,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,67111.74,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue diagnoses with CC,565,MS-DRG,565,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue diagnoses without CC/MCC,566,MS-DRG,566,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin debridement with MCC*,570,MS-DRG,570,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,90081.68,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin debridement with CC*,571,MS-DRG,571,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,65336.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin debridement without CC/MCC*,572,MS-DRG,572,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,65336.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft for skin ulcer or cellulitis with MCC,573,MS-DRG,573,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,106394.79,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft for skin ulcer or cellulitis with CC,574,MS-DRG,574,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft for skin ulcer or cellulitis without CC/MCC,575,MS-DRG,575,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft except for skin ulcer or cellulitis with MCC*,576,MS-DRG,576,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft except for skin ulcer or cellulitis with CC*,577,MS-DRG,577,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft except for skin ulcer or cellulitis without CC/MCC*,578,MS-DRG,578,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other skin, subcutaneous tissue and breast procedures with MCC",579,MS-DRG,579,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,103793.26,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other skin, subcutaneous tissue and breast procedures with CC",580,MS-DRG,580,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,85299.47,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other skin, subcutaneous tissue and breast procedures without CC/MCC",581,MS-DRG,581,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,85299.47,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Mastectomy for malignancy with CC/MCC,582,MS-DRG,582,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,103793.26,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Mastectomy for malignancy without CC/MCC,583,MS-DRG,583,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,85299.47,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Breast biopsy, local excision and other breast procedures with CC/MCC",584,MS-DRG,584,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,65336.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Breast biopsy, local excision and other breast procedures without CC/MCC",585,MS-DRG,585,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin ulcers with MCC,592,MS-DRG,592,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,67333.63,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin ulcers with CC,593,MS-DRG,593,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53667.96,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin ulcers without CC/MCC,594,MS-DRG,594,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major skin disorders with MCC,595,MS-DRG,595,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major skin disorders without MCC,596,MS-DRG,596,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignant breast disorders with MCC,597,MS-DRG,597,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignant breast disorders with CC,598,MS-DRG,598,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignant breast disorders without CC/MCC,599,MS-DRG,599,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-malignant breast disorders with CC/MCC*,600,MS-DRG,600,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-malignant breast disorders without CC/MCC*,601,MS-DRG,601,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cellulitis with MCC,602,MS-DRG,602,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,55068.2,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cellulitis without MCC,603,MS-DRG,603,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36842.21,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Trauma to the skin, subcutaneous tissue and breast with MCC",604,MS-DRG,604,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Trauma to the skin, subcutaneous tissue and breast without MCC",605,MS-DRG,605,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor skin disorders with MCC,606,MS-DRG,606,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor skin disorders without MCC,607,MS-DRG,607,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Adrenal and pituitary procedures with CC/MCC,614,MS-DRG,614,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Adrenal and pituitary procedures without CC/MCC,615,MS-DRG,615,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with MCC",616,MS-DRG,616,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with CC",617,MS-DRG,617,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders without CC/MCC",618,MS-DRG,618,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures for obesity with MCC,619,MS-DRG,619,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,100051.65,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures for obesity with CC,620,MS-DRG,620,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72590.25,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures for obesity without CC/MCC,621,MS-DRG,621,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with MCC",622,MS-DRG,622,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,100051.65,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with CC",623,MS-DRG,623,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72590.25,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders without CC/MCC",624,MS-DRG,624,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with MCC",625,MS-DRG,625,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,30309.826,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with CC",626,MS-DRG,626,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures without CC/MCC",627,MS-DRG,627,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with MCC",628,MS-DRG,628,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,30309.826,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with CC",629,MS-DRG,629,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures without CC/MCC",630,MS-DRG,630,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Diabetes with MCC,637,MS-DRG,637,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,67654.99,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Diabetes with CC,638,MS-DRG,638,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53843.95,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Diabetes without CC/MCC,639,MS-DRG,639,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCC",640,MS-DRG,640,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,74862.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCC",641,MS-DRG,641,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,47049.37,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inborn and other disorders of metabolism,642,MS-DRG,642,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Endocrine disorders with MCC*,643,MS-DRG,643,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Endocrine disorders with CC*,644,MS-DRG,644,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Endocrine disorders without CC/MCC*,645,MS-DRG,645,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major bladder procedures with MCC,653,MS-DRG,653,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,91596.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major bladder procedures with CC,654,MS-DRG,654,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,80073.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major bladder procedures without CC/MCC,655,MS-DRG,655,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for neoplasm with MCC,656,MS-DRG,656,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for neoplasm with CC,657,MS-DRG,657,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for neoplasm without CC/MCC,658,MS-DRG,658,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for non-neoplasm with MCC*,659,MS-DRG,659,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for non-neoplasm with CC*,660,MS-DRG,660,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for non-neoplasm without CC/MCC*,661,MS-DRG,661,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor bladder procedures with MCC,662,MS-DRG,662,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor bladder procedures with CC,663,MS-DRG,663,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor bladder procedures without CC/MCC,664,MS-DRG,664,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Prostatectomy with MCC,665,MS-DRG,665,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,91596.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Prostatectomy with CC,666,MS-DRG,666,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,80073.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Urethral stricture,697,MS-DRG,697,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other kidney and urinary tract diagnoses with MCC,698,MS-DRG,698,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,67746.82,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other kidney and urinary tract diagnoses with CC,699,MS-DRG,699,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,47363.09,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other kidney and urinary tract diagnoses without CC/MCC,700,MS-DRG,700,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major male pelvic procedures with CC/MCC,707,MS-DRG,707,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major male pelvic procedures without CC/MCC,708,MS-DRG,708,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Penis procedures with CC/MCC,709,MS-DRG,709,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Penis procedures without CC/MCC,710,MS-DRG,710,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Testes procedures with CC/MCC,711,MS-DRG,711,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Testes procedures without CC/MCC,712,MS-DRG,712,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Transurethral prostatectomy with CC/MCC,713,MS-DRG,713,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,30309.826,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Transurethral prostatectomy without CC/MCC,714,MS-DRG,714,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system O.R. procedures for malignancy with CC/MCC,715,MS-DRG,715,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system O.R. procedures for malignancy without CC/MCC,716,MS-DRG,716,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system O.R. procedures except malignancy with CC/MCC,717,MS-DRG,717,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system O.R. procedures except malignancy without CC/MCC,718,MS-DRG,718,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, male reproductive system with MCC",722,MS-DRG,722,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,61794.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, male reproductive system with CC",723,MS-DRG,723,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, male reproductive system without CC/MCC",724,MS-DRG,724,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,50278,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Benign prostatic hypertrophy with MCC,725,MS-DRG,725,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,50278.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Benign prostatic hypertrophy without MCC,726,MS-DRG,726,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inflammation of the male reproductive system with MCC,727,MS-DRG,727,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,61794.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inflammation of the male reproductive system without MCC,728,MS-DRG,728,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,50278,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system diagnoses with CC/MCC,729,MS-DRG,729,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system diagnoses without CC/MCC,730,MS-DRG,730,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC",734,MS-DRG,734,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC",735,MS-DRG,735,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with MCC,736,MS-DRG,736,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with CC,737,MS-DRG,737,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy without CC/MCC,738,MS-DRG,738,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with MCC,739,MS-DRG,739,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with CC,740,MS-DRG,740,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy without CC/MCC,741,MS-DRG,741,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for non-malignancy with CC/MCC,742,MS-DRG,742,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for non-malignancy without CC/MCC,743,MS-DRG,743,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"D&C, conization, laparoscopy and tubal interruption with CC/MCC",744,MS-DRG,744,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"D&C, conization, laparoscopy and tubal interruption without CC/MCC",745,MS-DRG,745,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Vagina, cervix and vulva procedures with CC/MCC",746,MS-DRG,746,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Vagina, cervix and vulva procedures without CC/MCC",747,MS-DRG,747,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Female reproductive system reconstructive procedures,748,MS-DRG,748,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other female reproductive system O.R. procedures with CC/MCC,749,MS-DRG,749,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other female reproductive system O.R. procedures without CC/MCC,750,MS-DRG,750,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, female reproductive system with MCC",754,MS-DRG,754,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, female reproductive system with CC",755,MS-DRG,755,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, female reproductive system without CC/MCC",756,MS-DRG,756,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Infections, female reproductive system with MCC",757,MS-DRG,757,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,29854.136,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Infections, female reproductive system with CC",758,MS-DRG,758,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Infections, female reproductive system without CC/MCC",759,MS-DRG,759,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Menstrual and other female reproductive system disorders with CC/MCC,760,MS-DRG,760,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Menstrual and other female reproductive system disorders without CC/MCC,761,MS-DRG,761,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Vaginal delivery with O.R. procedures except sterilization and/or D&C,768,MS-DRG,768,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postpartum and post abortion diagnoses with O.R. procedures,769,MS-DRG,769,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Abortion with D&C, aspiration curettage or hysterotomy",770,MS-DRG,770,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postpartum and post abortion diagnoses without O.R. procedures,776,MS-DRG,776,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Abortion without D&C,779,MS-DRG,779,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section with sterilization with MCC,783,MS-DRG,783,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section with sterilization with CC,784,MS-DRG,784,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,90613.37,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section with sterilization without CC/MCC,785,MS-DRG,785,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section without sterilization with MCC,786,MS-DRG,786,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section without sterilization with CC,787,MS-DRG,787,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section without sterilization without CC/MCC,788,MS-DRG,788,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Neonates, died or transferred to another acute care facility",789,MS-DRG,789,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Extreme immaturity or respiratory distress syndrome, neonate",790,MS-DRG,790,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Prematurity with major problems,791,MS-DRG,791,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Prematurity without major problems,792,MS-DRG,792,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48921.03,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Full term neonate with major problems,793,MS-DRG,793,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Neonate with other significant problems,794,MS-DRG,794,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48921.03,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Splenic procedures with MCC,799,MS-DRG,799,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,106800.6,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Splenic procedures with CC,800,MS-DRG,800,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48921.03,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Splenic procedures without CC/MCC,801,MS-DRG,801,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures of the blood and blood forming organs with MCC,802,MS-DRG,802,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures of the blood and blood forming organs with CC,803,MS-DRG,803,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures of the blood and blood forming organs without CC/MCC,804,MS-DRG,804,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with MCC,808,MS-DRG,808,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with CC,809,MS-DRG,809,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without CC/MCC,810,MS-DRG,810,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Red blood cell disorders with MCC,811,MS-DRG,811,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Red blood cell disorders without MCC,812,MS-DRG,812,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coagulation disorders,813,MS-DRG,813,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Reticuloendothelial and immunity disorders with MCC*,814,MS-DRG,814,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Reticuloendothelial and immunity disorders with CC*,815,MS-DRG,815,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Reticuloendothelial and immunity disorders without CC/MCC*,816,MS-DRG,816,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses with O.R. procedures with MCC,817,MS-DRG,817,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,40508.305,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses with O.R. procedures with CC,818,MS-DRG,818,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses with O.R. procedures without CC/MCC,819,MS-DRG,819,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and leukemia with major O.R. procedures with MCC,820,MS-DRG,820,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and leukemia with major O.R. procedures with CC,821,MS-DRG,821,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and leukemia with major O.R. procedures without CC/MCC,822,MS-DRG,822,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia with other procedures with MCC,823,MS-DRG,823,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia with other procedures with CC,824,MS-DRG,824,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia with other procedures without CC/MCC,825,MS-DRG,825,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with MCC,826,MS-DRG,826,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with CC,827,MS-DRG,827,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures without CC/MCC,828,MS-DRG,828,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures with CC/MCC,829,MS-DRG,829,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures without CC/MCC,830,MS-DRG,830,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses without O.R. procedures with MCC,831,MS-DRG,831,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses without O.R. procedures with CC,832,MS-DRG,832,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses without O.R. procedures without CC/MCC,833,MS-DRG,833,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute leukemia with MCC,834,MS-DRG,834,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute leukemia with CC,835,MS-DRG,835,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute leukemia without CC/MCC,836,MS-DRG,836,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy agent with MCC,837,MS-DRG,837,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapy agent,838,MS-DRG,838,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis without CC/MCC,839,MS-DRG,839,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia with MCC,840,MS-DRG,840,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia with CC,841,MS-DRG,841,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia without CC/MCC,842,MS-DRG,842,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with MCC,843,MS-DRG,843,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with CC,844,MS-DRG,844,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses without CC/MCC,845,MS-DRG,845,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with MCC,846,MS-DRG,846,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with CC,847,MS-DRG,847,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis without CC/MCC,848,MS-DRG,848,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Radiotherapy,849,MS-DRG,849,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute leukemia with other procedures,850,MS-DRG,850,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Infectious and parasitic diseases with O.R. procedures with MCC,853,MS-DRG,853,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,116013.09,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Infectious and parasitic diseases with O.R. procedures with CC,854,MS-DRG,854,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Infectious and parasitic diseases with O.R. procedures without CC/MCC,855,MS-DRG,855,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with MCC,856,MS-DRG,856,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,103112.54,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with CC,857,MS-DRG,857,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures without CC/MCC,858,MS-DRG,858,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postoperative and post-traumatic infections with MCC,862,MS-DRG,862,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,70501.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postoperative and post-traumatic infections without MCC,863,MS-DRG,863,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,47554.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Fever and inflammatory conditions,864,MS-DRG,864,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Viral illness with MCC,865,MS-DRG,865,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Viral illness without MCC,866,MS-DRG,866,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other infectious and parasitic diseases diagnoses with MCC,867,MS-DRG,867,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,70118.98,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other infectious and parasitic diseases diagnoses with CC,868,MS-DRG,868,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other infectious and parasitic diseases diagnoses without CC/MCC,869,MS-DRG,869,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septicemia or severe sepsis with MV >96 hours,870,MS-DRG,870,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,158548.16,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septicemia or severe sepsis without MV >96 hours with MCC,871,MS-DRG,871,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,64954.17,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septicemia or severe sepsis without MV >96 hours without MCC,872,MS-DRG,872,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,43522.12,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridements for injuries with MCC,901,MS-DRG,901,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,98177.28,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridements for injuries with CC,902,MS-DRG,902,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridements for injuries without CC/MCC,903,MS-DRG,903,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin grafts for injuries with CC/MCC,904,MS-DRG,904,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin grafts for injuries without CC/MCC,905,MS-DRG,905,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hand procedures for injuries,906,MS-DRG,906,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for injuries with MCC*,907,MS-DRG,907,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for injuries with CC*,908,MS-DRG,908,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for injuries without CC/MCC*,909,MS-DRG,909,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic injury with MCC,913,MS-DRG,913,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic injury without MCC,914,MS-DRG,914,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Allergic reactions with MCC,915,MS-DRG,915,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Allergic reactions without MCC,916,MS-DRG,916,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Poisoning and toxic effects of drugs with MCC,917,MS-DRG,917,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Poisoning and toxic effects of drugs without MCC,918,MS-DRG,918,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complications of treatment with MCC,919,MS-DRG,919,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,82055.43,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complications of treatment with CC,920,MS-DRG,920,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52581.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complications of treatment without CC/MCC,921,MS-DRG,921,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other injury, poisoning and toxic effect diagnoses with MCC",922,MS-DRG,922,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other injury, poisoning and toxic effect diagnoses without MCC",923,MS-DRG,923,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extensive burns or full thickness burns with MV >96 hours with skin graft,927,MS-DRG,927,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Full thickness burn with skin graft or inhalation injury with CC/MCC,928,MS-DRG,928,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Full thickness burn with skin graft or inhalation injury without CC/MCC,929,MS-DRG,929,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extensive burns or full thickness burns with MV >96 hours without skin graft,933,MS-DRG,933,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Full thickness burn without skin graft or inhalation injury,934,MS-DRG,934,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-extensive burns,935,MS-DRG,935,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures with diagnoses of other contact with health services with MCC,939,MS-DRG,939,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,90701.7,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures with diagnoses of other contact with health services with CC,940,MS-DRG,940,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures with diagnoses of other contact with health services without CC/MCC,941,MS-DRG,941,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Signs and symptoms with MCC,947,MS-DRG,947,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Signs and symptoms without MCC,948,MS-DRG,948,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Aftercare with CC/MCC,949,MS-DRG,949,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,53224.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Aftercare without CC/MCC,950,MS-DRG,950,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other factors influencing health status,951,MS-DRG,951,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy for multiple significant trauma,955,MS-DRG,955,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Limb reattachment, hip and femur procedures for multiple significant trauma",956,MS-DRG,956,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for multiple significant trauma with MCC,957,MS-DRG,957,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for multiple significant trauma with CC,958,MS-DRG,958,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for multiple significant trauma without CC/MCC,959,MS-DRG,959,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other multiple significant trauma with MCC,963,MS-DRG,963,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other multiple significant trauma with CC,964,MS-DRG,964,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other multiple significant trauma without CC/MCC,965,MS-DRG,965,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with extensive O.R. procedures with MCC,969,MS-DRG,969,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with extensive O.R. procedures without MCC,970,MS-DRG,970,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with major related condition with MCC*,974,MS-DRG,974,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,87197.28,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with major related condition with CC*,975,MS-DRG,975,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,68412.68,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with major related condition without CC/MCC*,976,MS-DRG,976,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,68412.68,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with or without other related condition,977,MS-DRG,977,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with MCC,981,MS-DRG,981,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,68449.825,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with CC,982,MS-DRG,982,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,96991.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,983,MS-DRG,983,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with MCC,987,MS-DRG,987,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,163207.97,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with CC,988,MS-DRG,988,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,989,MS-DRG,989,LOCAL,,Inpatient,,,,,Kaiser,commercial,,,MS-DRG,72269.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck with major O.R. procedures",3,MS-DRG,3,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,310277.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck without major O.R. procedures",4,MS-DRG,4,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,229767.96,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCC",11,MS-DRG,11,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CC",12,MS-DRG,12,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy without CC/MCC",13,MS-DRG,13,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chimeric antigen receptor (CAR) T-cell and other immunotherapies,18,MS-DRG,18,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46368.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with MCC,20,MS-DRG,20,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with CC,21,MS-DRG,21,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage without CC/MCC,22,MS-DRG,22,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC or chemotherapy implant or epilepsy with neurostimulator,23,MS-DRG,23,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis without MCC,24,MS-DRG,24,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy and endovascular intracranial procedures with MCC,25,MS-DRG,25,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy and endovascular intracranial procedures with CC,26,MS-DRG,26,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy and endovascular intracranial procedures without CC/MCC,27,MS-DRG,27,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Spinal procedures with MCC,28,MS-DRG,28,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Spinal procedures with CC or spinal neurostimulators,29,MS-DRG,29,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Spinal procedures without CC/MCC,30,MS-DRG,30,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ventricular shunt procedures with MCC,31,MS-DRG,31,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ventricular shunt procedures with CC,32,MS-DRG,32,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ventricular shunt procedures without CC/MCC,33,MS-DRG,33,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Carotid artery stent procedures with MCC,34,MS-DRG,34,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Carotid artery stent procedures with CC,35,MS-DRG,35,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Carotid artery stent procedures without CC/MCC,36,MS-DRG,36,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extracranial procedures with MCC,37,MS-DRG,37,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extracranial procedures with CC,38,MS-DRG,38,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extracranial procedures without CC/MCC,39,MS-DRG,39,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with MCC",40,MS-DRG,40,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,95774.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurostimulator",41,MS-DRG,41,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46368.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures without CC/MCC",42,MS-DRG,42,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46368.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Spinal disorders and injuries with CC/MCC,52,MS-DRG,52,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,82942.79,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Spinal disorders and injuries without CC/MCC,53,MS-DRG,53,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,81228.84,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nervous system neoplasms with MCC,54,MS-DRG,54,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46368.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nervous system neoplasms without MCC,55,MS-DRG,55,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46368.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Degenerative nervous system disorders with MCC,56,MS-DRG,56,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,61411.33,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Degenerative nervous system disorders without MCC,57,MS-DRG,57,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,51678.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple sclerosis and cerebellar ataxia with MCC,58,MS-DRG,58,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple sclerosis and cerebellar ataxia with CC,59,MS-DRG,59,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,51678.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple sclerosis and cerebellar ataxia without CC/MCC,60,MS-DRG,60,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,51678.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with MCC",61,MS-DRG,61,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,111192.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with CC",62,MS-DRG,62,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent without CC/MCC",63,MS-DRG,63,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial hemorrhage or cerebral infarction with MCC,64,MS-DRG,64,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,111192.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial hemorrhage or cerebral infarction with CC or tPA in 24 hours,65,MS-DRG,65,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial hemorrhage or cerebral infarction without CC/MCC,66,MS-DRG,66,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nonspecific CVA and precerebral occlusion without infarction with MCC,67,MS-DRG,67,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,66767.42,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nonspecific CVA and precerebral occlusion without infarction without MCC,68,MS-DRG,68,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Transient ischemia without thrombolytic,69,MS-DRG,69,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nonspecific cerebrovascular disorders with MCC*,70,MS-DRG,70,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,66767.42,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nonspecific cerebrovascular disorders with CC*,71,MS-DRG,71,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,45128.84,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nonspecific cerebrovascular disorders without CC/MCC*,72,MS-DRG,72,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cranial and peripheral nerve disorders with MCC,73,MS-DRG,73,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cranial and peripheral nerve disorders without MCC,74,MS-DRG,74,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Viral meningitis with CC/MCC,75,MS-DRG,75,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Viral meningitis without CC/MCC,76,MS-DRG,76,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hypertensive encephalopathy with MCC,77,MS-DRG,77,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,68160,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hypertensive encephalopathy with CC,78,MS-DRG,78,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,537909.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hypertensive encephalopathy without CC/MCC,79,MS-DRG,79,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nontraumatic stupor and coma with MCC,80,MS-DRG,80,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nontraumatic stupor and coma without MCC,81,MS-DRG,81,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma >1 hour with MCC*,82,MS-DRG,82,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,82529.13,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma >1 hour with CC*,83,MS-DRG,83,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,62451.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma >1 hour without CC/MCC*,84,MS-DRG,84,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma <1 hour with MCC,85,MS-DRG,85,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,62451.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma <1 hour with CC,86,MS-DRG,86,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,62451.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma <1 hour without CC/MCC,87,MS-DRG,87,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Concussion with MCC,88,MS-DRG,88,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,68160,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Concussion with CC,89,MS-DRG,89,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,537909.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Concussion without CC/MCC,90,MS-DRG,90,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other disorders of nervous system with MCC,91,MS-DRG,91,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,68160,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other disorders of nervous system with CC,92,MS-DRG,92,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,537909.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other disorders of nervous system without CC/MCC,93,MS-DRG,93,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,51678.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bacterial and tuberculous infections of nervous system with MCC*,94,MS-DRG,94,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34375.739,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bacterial and tuberculous infections of nervous system with CC*,95,MS-DRG,95,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,62451.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bacterial and tuberculous infections of nervous system without CC/MCC*,96,MS-DRG,96,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-bacterial infection of nervous system except viral meningitis with MCC,97,MS-DRG,97,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,75054.04,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-bacterial infection of nervous system except viral meningitis with CC,98,MS-DRG,98,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-bacterial infection of nervous system except viral meningitis without CC/MCC,99,MS-DRG,99,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Seizures with MCC,100,MS-DRG,100,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Seizures without MCC,101,MS-DRG,101,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Headaches with MCC,102,MS-DRG,102,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Headaches without MCC,103,MS-DRG,103,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Orbital procedures with CC/MCC,113,MS-DRG,113,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Orbital procedures without CC/MCC,114,MS-DRG,114,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extraocular procedures except orbit,115,MS-DRG,115,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intraocular procedures with CC/MCC,116,MS-DRG,116,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intraocular procedures without CC/MCC,117,MS-DRG,117,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute major eye infections with CC/MCC,121,MS-DRG,121,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute major eye infections without CC/MCC,122,MS-DRG,122,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Neurological eye disorders,123,MS-DRG,123,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other disorders of the eye with MCC or thrombolytic agent,124,MS-DRG,124,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other disorders of the eye without MCC,125,MS-DRG,125,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Sinus and mastoid procedures with CC/MCC,135,MS-DRG,135,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Sinus and mastoid procedures without CC/MCC,136,MS-DRG,136,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Mouth procedures with CC/MCC,137,MS-DRG,137,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Mouth procedures without CC/MCC,138,MS-DRG,138,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Salivary gland procedures,139,MS-DRG,139,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major head and neck procedures with MCC,140,MS-DRG,140,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,177508.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major head and neck procedures with CC,141,MS-DRG,141,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major head and neck procedures without CC/MCC,142,MS-DRG,142,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with MCC",143,MS-DRG,143,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with CC",144,MS-DRG,144,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures without CC/MCC",145,MS-DRG,145,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ear, nose, mouth and throat malignancy with MCC*",146,MS-DRG,146,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ear, nose, mouth and throat malignancy with CC*",147,MS-DRG,147,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ear, nose, mouth and throat malignancy without CC/MCC*",148,MS-DRG,148,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Dysequilibrium,149,MS-DRG,149,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Epistaxis with MCC,150,MS-DRG,150,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Epistaxis without MCC,151,MS-DRG,151,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Otitis media and URI with MCC,152,MS-DRG,152,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Otitis media and URI without MCC,153,MS-DRG,153,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat diagnoses with MCC",154,MS-DRG,154,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat diagnoses with CC",155,MS-DRG,155,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat diagnoses without CC/MCC",156,MS-DRG,156,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Dental and oral diseases with MCC,157,MS-DRG,157,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Dental and oral diseases with CC,158,MS-DRG,158,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Dental and oral diseases without CC/MCC,159,MS-DRG,159,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest procedures with MCC,163,MS-DRG,163,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,202666.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest procedures with CC,164,MS-DRG,164,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,202666.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest procedures without CC/MCC,165,MS-DRG,165,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,202666.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other respiratory system O.R. procedures with MCC,166,MS-DRG,166,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,177508.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other respiratory system O.R. procedures with CC,167,MS-DRG,167,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other respiratory system O.R. procedures without CC/MCC,168,MS-DRG,168,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism,173,MS-DRG,173,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pulmonary embolism with MCC or acute cor pulmonale,175,MS-DRG,175,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pulmonary embolism without MCC,176,MS-DRG,176,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory infections and inflammations with MCC*,177,MS-DRG,177,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,62918.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory infections and inflammations with CC*,178,MS-DRG,178,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,43491.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory infections and inflammations without CC/MCC*,179,MS-DRG,179,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,42251.85,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory neoplasms with MCC*,180,MS-DRG,180,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory neoplasms with CC*,181,MS-DRG,181,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory neoplasms without CC/MCC*,182,MS-DRG,182,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest trauma with MCC,183,MS-DRG,183,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest trauma with CC,184,MS-DRG,184,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest trauma without CC/MCC,185,MS-DRG,185,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pleural effusion with MCC*,186,MS-DRG,186,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,66071.13,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pleural effusion with CC*,187,MS-DRG,187,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pleural effusion without CC/MCC*,188,MS-DRG,188,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pulmonary edema and respiratory failure,189,MS-DRG,189,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72046.99,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chronic obstructive pulmonary disease with MCC*,190,MS-DRG,190,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,20971.383,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chronic obstructive pulmonary disease with CC*,191,MS-DRG,191,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chronic obstructive pulmonary disease without CC/MCC*,192,MS-DRG,192,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Simple pneumonia and pleurisy with MCC,193,MS-DRG,193,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,59421.93,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Simple pneumonia and pleurisy with CC,194,MS-DRG,194,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,39604.42,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Simple pneumonia and pleurisy without CC/MCC,195,MS-DRG,195,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Interstitial lung disease with MCC*,196,MS-DRG,196,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Interstitial lung disease with CC*,197,MS-DRG,197,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Interstitial lung disease without CC/MCC*,198,MS-DRG,198,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pneumothorax with MCC,199,MS-DRG,199,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pneumothorax with CC,200,MS-DRG,200,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,21869.927,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pneumothorax without CC/MCC,201,MS-DRG,201,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,21869.927,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bronchitis and asthma with CC/MCC,202,MS-DRG,202,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,40508.305,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bronchitis and asthma without CC/MCC,203,MS-DRG,203,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,15339.435,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory signs and symptoms,204,MS-DRG,204,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other respiratory system diagnoses with MCC,205,MS-DRG,205,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,112102.84,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other respiratory system diagnoses without MCC,206,MS-DRG,206,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory system diagnosis with ventilator support >96 hours,207,MS-DRG,207,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,147720.8,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory system diagnosis with ventilator support <=96 hours,208,MS-DRG,208,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,81481.35,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Concomitant aortic and mitral valve procedures,212,MS-DRG,212,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other heart assist system implant,215,MS-DRG,215,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC,216,MS-DRG,216,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with CC,217,MS-DRG,217,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization without CC/MCC,218,MS-DRG,218,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with MCC,219,MS-DRG,219,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with CC,220,MS-DRG,220,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization without CC/MCC,221,MS-DRG,221,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other cardiothoracic procedures with MCC,228,MS-DRG,228,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other cardiothoracic procedures without MCC,229,MS-DRG,229,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass with PTCA with MCC,231,MS-DRG,231,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass with PTCA without MCC,232,MS-DRG,232,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass with cardiac catheterization or open ablation with MCC,233,MS-DRG,233,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass with cardiac catheterization or open ablation without MCC,234,MS-DRG,234,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass without cardiac catheterization with MCC,235,MS-DRG,235,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass without cardiac catheterization without MCC,236,MS-DRG,236,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for circulatory system disorders except upper limb and toe with MCC,239,MS-DRG,239,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for circulatory system disorders except upper limb and toe with CC,240,MS-DRG,240,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for circulatory system disorders except upper limb and toe without CC/MCC,241,MS-DRG,241,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Permanent cardiac pacemaker implant with MCC,242,MS-DRG,242,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Permanent cardiac pacemaker implant with CC,243,MS-DRG,243,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Permanent cardiac pacemaker implant without CC/MCC,244,MS-DRG,244,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
AICD generator procedures,245,MS-DRG,245,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,40774.659,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous cardiovascular procedures without intraluminal device with MCC,250,MS-DRG,250,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous cardiovascular procedures without intraluminal device without MCC,251,MS-DRG,251,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other vascular procedures with MCC,252,MS-DRG,252,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other vascular procedures with CC,253,MS-DRG,253,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other vascular procedures without CC/MCC,254,MS-DRG,254,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Upper limb and toe amputation for circulatory system disorders with MCC,255,MS-DRG,255,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Upper limb and toe amputation for circulatory system disorders with CC,256,MS-DRG,256,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Upper limb and toe amputation for circulatory system disorders without CC/MCC,257,MS-DRG,257,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac pacemaker device replacement with MCC,258,MS-DRG,258,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac pacemaker device replacement without MCC,259,MS-DRG,259,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac pacemaker revision except device replacement with MCC,260,MS-DRG,260,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac pacemaker revision except device replacement with CC,261,MS-DRG,261,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac pacemaker revision except device replacement without CC/MCC,262,MS-DRG,262,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Vein ligation and stripping,263,MS-DRG,263,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other circulatory system O.R. procedures,264,MS-DRG,264,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
AICD lead procedures,265,MS-DRG,265,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Endovascular cardiac valve replacement and supplement procedures with MCC,266,MS-DRG,266,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Endovascular cardiac valve replacement and supplement procedures without MCC,267,MS-DRG,267,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Aortic and heart assist procedures except pulsation balloon with MCC,268,MS-DRG,268,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Aortic and heart assist procedures except pulsation balloon without MCC,269,MS-DRG,269,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other major cardiovascular procedures with MCC,270,MS-DRG,270,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other major cardiovascular procedures with CC,271,MS-DRG,271,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other major cardiovascular procedures without CC/MCC,272,MS-DRG,272,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous and other intracardiac procedures with MCC,273,MS-DRG,273,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous and other intracardiac procedures without MCC,274,MS-DRG,274,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac defibrillator implant with cardiac catheterization and MCC,275,MS-DRG,275,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac defibrillator implant with MCC or carotid sinus neurostimulator,276,MS-DRG,276,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac defibrillator implant without MCC,277,MS-DRG,277,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures with MCC,278,MS-DRG,278,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures without MCC,279,MS-DRG,279,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, discharged alive with MCC",280,MS-DRG,280,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,63798.62,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, discharged alive with CC",281,MS-DRG,281,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, discharged alive without CC/MCC",282,MS-DRG,282,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, expired with MCC",283,MS-DRG,283,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, expired with CC",284,MS-DRG,284,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, expired without CC/MCC",285,MS-DRG,285,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization with MCC",286,MS-DRG,286,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization without MCC",287,MS-DRG,287,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute and subacute endocarditis with MCC,288,MS-DRG,288,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,79476.64,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute and subacute endocarditis with CC,289,MS-DRG,289,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,54456.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute and subacute endocarditis without CC/MCC,290,MS-DRG,290,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48748.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Heart failure and shock with MCC,291,MS-DRG,291,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,59345.41,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Heart failure and shock with CC,292,MS-DRG,292,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,42060.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Heart failure and shock without CC/MCC,293,MS-DRG,293,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,42060.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Deep vein thrombophlebitis with CC/MCC,294,MS-DRG,294,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Deep vein thrombophlebitis without CC/MCC,295,MS-DRG,295,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Cardiac arrest, unexplained with MCC",296,MS-DRG,296,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,59345.41,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Cardiac arrest, unexplained with CC",297,MS-DRG,297,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,42060.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Cardiac arrest, unexplained without CC/MCC",298,MS-DRG,298,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,42060.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peripheral vascular disorders with MCC,299,MS-DRG,299,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,64808.62,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peripheral vascular disorders with CC,300,MS-DRG,300,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peripheral vascular disorders without CC/MCC,301,MS-DRG,301,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Atherosclerosis with MCC,302,MS-DRG,302,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Atherosclerosis without MCC,303,MS-DRG,303,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hypertension with MCC,304,MS-DRG,304,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hypertension without MCC,305,MS-DRG,305,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac congenital and valvular disorders with MCC,306,MS-DRG,306,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac congenital and valvular disorders without MCC,307,MS-DRG,307,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac arrhythmia and conduction disorders with MCC,308,MS-DRG,308,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac arrhythmia and conduction disorders with CC,309,MS-DRG,309,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac arrhythmia and conduction disorders without CC/MCC,310,MS-DRG,310,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Angina pectoris,311,MS-DRG,311,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Syncope and collapse,312,MS-DRG,312,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chest pain,313,MS-DRG,313,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other circulatory system diagnoses with MCC,314,MS-DRG,314,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,67570.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other circulatory system diagnoses with CC,315,MS-DRG,315,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,47562.03,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other circulatory system diagnoses without CC/MCC,316,MS-DRG,316,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Concomitant left atrial appendage closure and cardiac ablation,317,MS-DRG,317,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other endovascular cardiac valve procedures with MCC,319,MS-DRG,319,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other endovascular cardiac valve procedures without MCC,320,MS-DRG,320,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/intraluminal devices,321,MS-DRG,321,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous cardiovascular procedures with intraluminal device without MCC,322,MS-DRG,322,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary intravascular lithotripsy with intraluminal device with MCC,323,MS-DRG,323,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary intravascular lithotripsy with intraluminal device without MCC,324,MS-DRG,324,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary intravascular lithotripsy without intraluminal device,325,MS-DRG,325,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Stomach, esophageal and duodenal procedures with MCC",326,MS-DRG,326,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Stomach, esophageal and duodenal procedures with CC",327,MS-DRG,327,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Stomach, esophageal and duodenal procedures without CC/MCC",328,MS-DRG,328,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major small and large bowel procedures with MCC,329,MS-DRG,329,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major small and large bowel procedures with CC,330,MS-DRG,330,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major small and large bowel procedures without CC/MCC,331,MS-DRG,331,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Rectal resection with MCC,332,MS-DRG,332,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Rectal resection with CC,333,MS-DRG,333,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Rectal resection without CC/MCC,334,MS-DRG,334,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peritoneal adhesiolysis with MCC,335,MS-DRG,335,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peritoneal adhesiolysis with CC,336,MS-DRG,336,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peritoneal adhesiolysis without CC/MCC,337,MS-DRG,337,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor small and large bowel procedures with MCC,344,MS-DRG,344,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor small and large bowel procedures with CC,345,MS-DRG,345,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor small and large bowel procedures without CC/MCC,346,MS-DRG,346,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Anal and stomal procedures with MCC,347,MS-DRG,347,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,68366.59,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Anal and stomal procedures with CC,348,MS-DRG,348,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Anal and stomal procedures without CC/MCC,349,MS-DRG,349,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inguinal and femoral hernia procedures with MCC,350,MS-DRG,350,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,68366.59,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inguinal and femoral hernia procedures with CC,351,MS-DRG,351,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inguinal and femoral hernia procedures without CC/MCC,352,MS-DRG,352,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hernia procedures except inguinal and femoral with MCC,353,MS-DRG,353,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hernia procedures except inguinal and femoral with CC,354,MS-DRG,354,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hernia procedures except inguinal and femoral without CC/MCC,355,MS-DRG,355,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system O.R. procedures with MCC,356,MS-DRG,356,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,106800.32,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system O.R. procedures with CC,357,MS-DRG,357,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system O.R. procedures without CC/MCC,358,MS-DRG,358,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major esophageal disorders with MCC*,368,MS-DRG,368,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major esophageal disorders with CC*,369,MS-DRG,369,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major esophageal disorders without CC/MCC*,370,MS-DRG,370,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major gastrointestinal disorders and peritoneal infections with MCC,371,MS-DRG,371,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,68366.59,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major gastrointestinal disorders and peritoneal infections with CC,372,MS-DRG,372,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major gastrointestinal disorders and peritoneal infections without CC/MCC,373,MS-DRG,373,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Digestive malignancy with MCC*,374,MS-DRG,374,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Digestive malignancy with CC*,375,MS-DRG,375,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Digestive malignancy without CC/MCC*,376,MS-DRG,376,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal hemorrhage with MCC,377,MS-DRG,377,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,54425.47,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal hemorrhage with CC,378,MS-DRG,378,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal hemorrhage without CC/MCC,379,MS-DRG,379,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complicated peptic ulcer with MCC,380,MS-DRG,380,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,73278.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complicated peptic ulcer with CC,381,MS-DRG,381,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complicated peptic ulcer without CC/MCC,382,MS-DRG,382,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uncomplicated peptic ulcer with MCC,383,MS-DRG,383,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uncomplicated peptic ulcer without MCC,384,MS-DRG,384,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inflammatory bowel disease with MCC,385,MS-DRG,385,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inflammatory bowel disease with CC,386,MS-DRG,386,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inflammatory bowel disease without CC/MCC,387,MS-DRG,387,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal obstruction with MCC,388,MS-DRG,388,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,75604.95,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal obstruction with CC,389,MS-DRG,389,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal obstruction without CC/MCC,390,MS-DRG,390,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC",391,MS-DRG,391,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,59253.6,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC",392,MS-DRG,392,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,47929.3,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system diagnoses with MCC,393,MS-DRG,393,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,77739.74,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system diagnoses with CC,394,MS-DRG,394,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55022.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system diagnoses without CC/MCC,395,MS-DRG,395,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Appendix procedures with MCC,397,MS-DRG,397,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,68366.59,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Appendix procedures with CC,398,MS-DRG,398,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Appendix procedures without CC/MCC,399,MS-DRG,399,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Single level combined anterior and posterior spinal fusion except cervical,402,MS-DRG,402,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Pancreas, liver and shunt procedures with MCC",405,MS-DRG,405,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,40508.305,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Pancreas, liver and shunt procedures with CC",406,MS-DRG,406,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Pancreas, liver and shunt procedures without CC/MCC",407,MS-DRG,407,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with MCC,408,MS-DRG,408,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55022.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with CC,409,MS-DRG,409,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. without CC/MCC,410,MS-DRG,410,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy with C.D.E. with MCC,411,MS-DRG,411,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,73278.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy with C.D.E. with CC,412,MS-DRG,412,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy with C.D.E. without CC/MCC,413,MS-DRG,413,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with MCC,414,MS-DRG,414,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,73278.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with CC,415,MS-DRG,415,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55022.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. without CC/MCC,416,MS-DRG,416,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55022.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Laparoscopic cholecystectomy without C.D.E. with MCC,417,MS-DRG,417,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,73278.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Laparoscopic cholecystectomy without C.D.E. with CC,418,MS-DRG,418,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Laparoscopic cholecystectomy without C.D.E. without CC/MCC,419,MS-DRG,419,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hepatobiliary diagnostic procedures with MCC,420,MS-DRG,420,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55022.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hepatobiliary diagnostic procedures with CC,421,MS-DRG,421,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hepatobiliary diagnostic procedures without CC/MCC,422,MS-DRG,422,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other hepatobiliary or pancreas O.R. procedures with MCC,423,MS-DRG,423,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other hepatobiliary or pancreas O.R. procedures with CC,424,MS-DRG,424,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other hepatobiliary or pancreas O.R. procedures without CC/MCC,425,MS-DRG,425,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,426,MS-DRG,426,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,81343.62,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical with CC,427,MS-DRG,427,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,81343.62,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical without CC/MCC,428,MS-DRG,428,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,67111.73,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Combined anterior and posterior cervical spinal fusion with MCC,429,MS-DRG,429,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,81343.62,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Combined anterior and posterior cervical spinal fusion without MCC,430,MS-DRG,430,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cirrhosis and alcoholic hepatitis with MCC,432,MS-DRG,432,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,56468.43,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cirrhosis and alcoholic hepatitis with CC,433,MS-DRG,433,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cirrhosis and alcoholic hepatitis without CC/MCC,434,MS-DRG,434,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignancy of hepatobiliary system or pancreas with MCC,435,MS-DRG,435,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignancy of hepatobiliary system or pancreas with CC,436,MS-DRG,436,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignancy of hepatobiliary system or pancreas without CC/MCC,437,MS-DRG,437,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of pancreas except malignancy with MCC,438,MS-DRG,438,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,80165.28,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of pancreas except malignancy with CC,439,MS-DRG,439,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of pancreas except malignancy without CC/MCC,440,MS-DRG,440,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCC",441,MS-DRG,441,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,71243.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CC",442,MS-DRG,442,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without CC/MCC",443,MS-DRG,443,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of the biliary tract with MCC*,444,MS-DRG,444,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,58190.03,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of the biliary tract with CC*,445,MS-DRG,445,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53147.66,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of the biliary tract without CC/MCC*,446,MS-DRG,446,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,447,MS-DRG,447,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,1.0631,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple level spinal fusion except cervical without MCC,448,MS-DRG,448,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,1.0631,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,450,MS-DRG,450,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,67111.74,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Single Level Spinal Fusion Except Cervical without MCC,451,MS-DRG,451,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with MCC",456,MS-DRG,456,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with CC",457,MS-DRG,457,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions without CC/MCC",458,MS-DRG,458,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bilateral or multiple major joint procedures of lower extremity with MCC,461,MS-DRG,461,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,67111.74,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bilateral or multiple major joint procedures of lower extremity without MCC,462,MS-DRG,462,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with MCC*,463,MS-DRG,463,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with CC*,464,MS-DRG,464,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72972.82,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders without CC/MCC*,465,MS-DRG,465,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,70057.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Revision of hip or knee replacement with MCC,466,MS-DRG,466,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Revision of hip or knee replacement with CC,467,MS-DRG,467,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Revision of hip or knee replacement without CC/MCC,468,MS-DRG,468,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity with MCC or total ankle replacement,469,MS-DRG,469,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity without MCC,470,MS-DRG,470,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cervical spinal fusion with MCC,471,MS-DRG,471,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cervical spinal fusion with CC,472,MS-DRG,472,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cervical spinal fusion without CC/MCC,473,MS-DRG,473,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with MCC,474,MS-DRG,474,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with CC,475,MS-DRG,475,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders without CC/MCC,476,MS-DRG,476,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biopsies of musculoskeletal system and connective tissue with MCC,477,MS-DRG,477,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biopsies of musculoskeletal system and connective tissue with CC,478,MS-DRG,478,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,28146.902,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biopsies of musculoskeletal system and connective tissue without CC/MCC,479,MS-DRG,479,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,28146.902,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hip and femur procedures except major joint with MCC,480,MS-DRG,480,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hip and femur procedures except major joint with CC,481,MS-DRG,481,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hip and femur procedures except major joint without CC/MCC,482,MS-DRG,482,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major joint or limb reattachment procedures of upper extremities,483,MS-DRG,483,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Knee procedures with principal diagnosis of infection with MCC,485,MS-DRG,485,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Knee procedures with principal diagnosis of infection with CC,486,MS-DRG,486,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Knee procedures with principal diagnosis of infection without CC/MCC,487,MS-DRG,487,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Knee procedures without principal diagnosis of infection with CC/MCC,488,MS-DRG,488,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Knee procedures without principal diagnosis of infection without CC/MCC,489,MS-DRG,489,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,51693.87,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with MCC",492,MS-DRG,492,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with CC",493,MS-DRG,493,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur without CC/MCC",494,MS-DRG,494,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Local excision and removal of internal fixation devices except hip and femur with MCC,495,MS-DRG,495,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Local excision and removal of internal fixation devices except hip and femur with CC,496,MS-DRG,496,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Local excision and removal of internal fixation devices except hip and femur without CC/MCC,497,MS-DRG,497,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Local excision and removal of internal fixation devices of hip and femur with CC/MCC,498,MS-DRG,498,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Local excision and removal of internal fixation devices of hip and femur without CC/MCC,499,MS-DRG,499,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Soft tissue procedures with MCC,500,MS-DRG,500,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,94244.13,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Soft tissue procedures with CC,501,MS-DRG,501,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Soft tissue procedures without CC/MCC,502,MS-DRG,502,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,67111.74,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Foot procedures with MCC,503,MS-DRG,503,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Foot procedures with CC,504,MS-DRG,504,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Foot procedures without CC/MCC,505,MS-DRG,505,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major thumb or joint procedures,506,MS-DRG,506,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major shoulder or elbow joint procedures with CC/MCC,507,MS-DRG,507,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major shoulder or elbow joint procedures without CC/MCC,508,MS-DRG,508,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Arthroscopy,509,MS-DRG,509,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with MCC",510,MS-DRG,510,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with CC",511,MS-DRG,511,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures without CC/MCC",512,MS-DRG,512,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures with CC/MCC",513,MS-DRG,513,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures without CC/MCC",514,MS-DRG,514,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with MCC,515,MS-DRG,515,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,91742.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with CC,516,MS-DRG,516,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures without CC/MCC,517,MS-DRG,517,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Back and neck procedures except spinal fusion with MCC or disc device or neurostimulator,518,MS-DRG,518,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Back and neck procedures except spinal fusion with CC,519,MS-DRG,519,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Back and neck procedures except spinal fusion without CC/MCC,520,MS-DRG,520,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hip replacement with principal diagnosis of hip fracture with MCC,521,MS-DRG,521,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hip replacement with principal diagnosis of hip fracture without MCC,522,MS-DRG,522,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Fractures of femur with MCC,533,MS-DRG,533,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Fractures of femur without MCC,534,MS-DRG,534,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Fractures of hip and pelvis with MCC,535,MS-DRG,535,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Fractures of hip and pelvis without MCC,536,MS-DRG,536,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh with CC/MCC",537,MS-DRG,537,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh without CC/MCC",538,MS-DRG,538,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Osteomyelitis with MCC*,539,MS-DRG,539,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,74166.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Osteomyelitis with CC*,540,MS-DRG,540,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,54425.47,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Osteomyelitis without CC/MCC*,541,MS-DRG,541,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,51693.86,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with MCC*,542,MS-DRG,542,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with CC*,543,MS-DRG,543,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy without CC/MCC*,544,MS-DRG,544,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Connective tissue disorders with MCC,545,MS-DRG,545,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Connective tissue disorders with CC,546,MS-DRG,546,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Connective tissue disorders without CC/MCC,547,MS-DRG,547,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46988.16,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septic arthritis with MCC,548,MS-DRG,548,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,65145.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septic arthritis with CC,549,MS-DRG,549,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septic arthritis without CC/MCC,550,MS-DRG,550,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Medical back problems with MCC,551,MS-DRG,551,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,99921.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Medical back problems without MCC,552,MS-DRG,552,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bone diseases and arthropathies with MCC,553,MS-DRG,553,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bone diseases and arthropathies without MCC,554,MS-DRG,554,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue with MCC,555,MS-DRG,555,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue without MCC,556,MS-DRG,556,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tendonitis, myositis and bursitis with MCC",557,MS-DRG,557,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,69284.76,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tendonitis, myositis and bursitis without MCC",558,MS-DRG,558,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53645.01,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Aftercare, musculoskeletal system and connective tissue with MCC*",559,MS-DRG,559,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,61671.48,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Aftercare, musculoskeletal system and connective tissue with CC*",560,MS-DRG,560,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48082.33,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Aftercare, musculoskeletal system and connective tissue without CC/MCC*",561,MS-DRG,561,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46988.16,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCC",562,MS-DRG,562,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCC",563,MS-DRG,563,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,46988.16,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue diagnoses with MCC,564,MS-DRG,564,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,67111.74,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue diagnoses with CC,565,MS-DRG,565,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue diagnoses without CC/MCC,566,MS-DRG,566,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin debridement with MCC*,570,MS-DRG,570,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,90081.68,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin debridement with CC*,571,MS-DRG,571,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,65336.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin debridement without CC/MCC*,572,MS-DRG,572,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,65336.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft for skin ulcer or cellulitis with MCC,573,MS-DRG,573,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,106394.79,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft for skin ulcer or cellulitis with CC,574,MS-DRG,574,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft for skin ulcer or cellulitis without CC/MCC,575,MS-DRG,575,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft except for skin ulcer or cellulitis with MCC*,576,MS-DRG,576,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft except for skin ulcer or cellulitis with CC*,577,MS-DRG,577,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft except for skin ulcer or cellulitis without CC/MCC*,578,MS-DRG,578,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other skin, subcutaneous tissue and breast procedures with MCC",579,MS-DRG,579,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,103793.26,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other skin, subcutaneous tissue and breast procedures with CC",580,MS-DRG,580,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,85299.47,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other skin, subcutaneous tissue and breast procedures without CC/MCC",581,MS-DRG,581,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,85299.47,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Mastectomy for malignancy with CC/MCC,582,MS-DRG,582,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,103793.26,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Mastectomy for malignancy without CC/MCC,583,MS-DRG,583,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,85299.47,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Breast biopsy, local excision and other breast procedures with CC/MCC",584,MS-DRG,584,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,65336.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Breast biopsy, local excision and other breast procedures without CC/MCC",585,MS-DRG,585,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin ulcers with MCC,592,MS-DRG,592,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,67333.63,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin ulcers with CC,593,MS-DRG,593,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53667.96,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin ulcers without CC/MCC,594,MS-DRG,594,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major skin disorders with MCC,595,MS-DRG,595,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major skin disorders without MCC,596,MS-DRG,596,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignant breast disorders with MCC,597,MS-DRG,597,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignant breast disorders with CC,598,MS-DRG,598,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignant breast disorders without CC/MCC,599,MS-DRG,599,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-malignant breast disorders with CC/MCC*,600,MS-DRG,600,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-malignant breast disorders without CC/MCC*,601,MS-DRG,601,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cellulitis with MCC,602,MS-DRG,602,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,55068.2,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cellulitis without MCC,603,MS-DRG,603,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36842.21,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Trauma to the skin, subcutaneous tissue and breast with MCC",604,MS-DRG,604,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Trauma to the skin, subcutaneous tissue and breast without MCC",605,MS-DRG,605,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor skin disorders with MCC,606,MS-DRG,606,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor skin disorders without MCC,607,MS-DRG,607,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Adrenal and pituitary procedures with CC/MCC,614,MS-DRG,614,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Adrenal and pituitary procedures without CC/MCC,615,MS-DRG,615,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with MCC",616,MS-DRG,616,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with CC",617,MS-DRG,617,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders without CC/MCC",618,MS-DRG,618,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures for obesity with MCC,619,MS-DRG,619,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,100051.65,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures for obesity with CC,620,MS-DRG,620,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72590.25,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures for obesity without CC/MCC,621,MS-DRG,621,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with MCC",622,MS-DRG,622,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,100051.65,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with CC",623,MS-DRG,623,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72590.25,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders without CC/MCC",624,MS-DRG,624,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with MCC",625,MS-DRG,625,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,30309.826,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with CC",626,MS-DRG,626,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures without CC/MCC",627,MS-DRG,627,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with MCC",628,MS-DRG,628,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,30309.826,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with CC",629,MS-DRG,629,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures without CC/MCC",630,MS-DRG,630,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Diabetes with MCC,637,MS-DRG,637,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,67654.99,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Diabetes with CC,638,MS-DRG,638,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53843.95,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Diabetes without CC/MCC,639,MS-DRG,639,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCC",640,MS-DRG,640,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,74862.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCC",641,MS-DRG,641,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,47049.37,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inborn and other disorders of metabolism,642,MS-DRG,642,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Endocrine disorders with MCC*,643,MS-DRG,643,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Endocrine disorders with CC*,644,MS-DRG,644,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Endocrine disorders without CC/MCC*,645,MS-DRG,645,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major bladder procedures with MCC,653,MS-DRG,653,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,91596.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major bladder procedures with CC,654,MS-DRG,654,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,80073.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major bladder procedures without CC/MCC,655,MS-DRG,655,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for neoplasm with MCC,656,MS-DRG,656,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for neoplasm with CC,657,MS-DRG,657,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for neoplasm without CC/MCC,658,MS-DRG,658,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for non-neoplasm with MCC*,659,MS-DRG,659,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for non-neoplasm with CC*,660,MS-DRG,660,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for non-neoplasm without CC/MCC*,661,MS-DRG,661,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor bladder procedures with MCC,662,MS-DRG,662,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor bladder procedures with CC,663,MS-DRG,663,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor bladder procedures without CC/MCC,664,MS-DRG,664,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Prostatectomy with MCC,665,MS-DRG,665,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,91596.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Prostatectomy with CC,666,MS-DRG,666,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,80073.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Urethral stricture,697,MS-DRG,697,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other kidney and urinary tract diagnoses with MCC,698,MS-DRG,698,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,67746.82,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other kidney and urinary tract diagnoses with CC,699,MS-DRG,699,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,47363.09,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other kidney and urinary tract diagnoses without CC/MCC,700,MS-DRG,700,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major male pelvic procedures with CC/MCC,707,MS-DRG,707,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major male pelvic procedures without CC/MCC,708,MS-DRG,708,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Penis procedures with CC/MCC,709,MS-DRG,709,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Penis procedures without CC/MCC,710,MS-DRG,710,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Testes procedures with CC/MCC,711,MS-DRG,711,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Testes procedures without CC/MCC,712,MS-DRG,712,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Transurethral prostatectomy with CC/MCC,713,MS-DRG,713,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,30309.826,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Transurethral prostatectomy without CC/MCC,714,MS-DRG,714,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system O.R. procedures for malignancy with CC/MCC,715,MS-DRG,715,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system O.R. procedures for malignancy without CC/MCC,716,MS-DRG,716,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system O.R. procedures except malignancy with CC/MCC,717,MS-DRG,717,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system O.R. procedures except malignancy without CC/MCC,718,MS-DRG,718,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, male reproductive system with MCC",722,MS-DRG,722,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,61794.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, male reproductive system with CC",723,MS-DRG,723,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, male reproductive system without CC/MCC",724,MS-DRG,724,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,50278,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Benign prostatic hypertrophy with MCC,725,MS-DRG,725,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,50278.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Benign prostatic hypertrophy without MCC,726,MS-DRG,726,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inflammation of the male reproductive system with MCC,727,MS-DRG,727,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,61794.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inflammation of the male reproductive system without MCC,728,MS-DRG,728,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,50278,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system diagnoses with CC/MCC,729,MS-DRG,729,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system diagnoses without CC/MCC,730,MS-DRG,730,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC",734,MS-DRG,734,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC",735,MS-DRG,735,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with MCC,736,MS-DRG,736,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with CC,737,MS-DRG,737,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy without CC/MCC,738,MS-DRG,738,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with MCC,739,MS-DRG,739,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with CC,740,MS-DRG,740,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy without CC/MCC,741,MS-DRG,741,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for non-malignancy with CC/MCC,742,MS-DRG,742,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for non-malignancy without CC/MCC,743,MS-DRG,743,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"D&C, conization, laparoscopy and tubal interruption with CC/MCC",744,MS-DRG,744,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"D&C, conization, laparoscopy and tubal interruption without CC/MCC",745,MS-DRG,745,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Vagina, cervix and vulva procedures with CC/MCC",746,MS-DRG,746,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Vagina, cervix and vulva procedures without CC/MCC",747,MS-DRG,747,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Female reproductive system reconstructive procedures,748,MS-DRG,748,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other female reproductive system O.R. procedures with CC/MCC,749,MS-DRG,749,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other female reproductive system O.R. procedures without CC/MCC,750,MS-DRG,750,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, female reproductive system with MCC",754,MS-DRG,754,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, female reproductive system with CC",755,MS-DRG,755,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, female reproductive system without CC/MCC",756,MS-DRG,756,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Infections, female reproductive system with MCC",757,MS-DRG,757,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,29854.136,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Infections, female reproductive system with CC",758,MS-DRG,758,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Infections, female reproductive system without CC/MCC",759,MS-DRG,759,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Menstrual and other female reproductive system disorders with CC/MCC,760,MS-DRG,760,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Menstrual and other female reproductive system disorders without CC/MCC,761,MS-DRG,761,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Vaginal delivery with O.R. procedures except sterilization and/or D&C,768,MS-DRG,768,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postpartum and post abortion diagnoses with O.R. procedures,769,MS-DRG,769,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Abortion with D&C, aspiration curettage or hysterotomy",770,MS-DRG,770,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postpartum and post abortion diagnoses without O.R. procedures,776,MS-DRG,776,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Abortion without D&C,779,MS-DRG,779,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section with sterilization with MCC,783,MS-DRG,783,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section with sterilization with CC,784,MS-DRG,784,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,90613.37,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section with sterilization without CC/MCC,785,MS-DRG,785,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section without sterilization with MCC,786,MS-DRG,786,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section without sterilization with CC,787,MS-DRG,787,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section without sterilization without CC/MCC,788,MS-DRG,788,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Neonates, died or transferred to another acute care facility",789,MS-DRG,789,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Extreme immaturity or respiratory distress syndrome, neonate",790,MS-DRG,790,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Prematurity with major problems,791,MS-DRG,791,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Prematurity without major problems,792,MS-DRG,792,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48921.03,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Full term neonate with major problems,793,MS-DRG,793,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Neonate with other significant problems,794,MS-DRG,794,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48921.03,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Splenic procedures with MCC,799,MS-DRG,799,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,106800.6,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Splenic procedures with CC,800,MS-DRG,800,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48921.03,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Splenic procedures without CC/MCC,801,MS-DRG,801,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures of the blood and blood forming organs with MCC,802,MS-DRG,802,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures of the blood and blood forming organs with CC,803,MS-DRG,803,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures of the blood and blood forming organs without CC/MCC,804,MS-DRG,804,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with MCC,808,MS-DRG,808,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with CC,809,MS-DRG,809,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without CC/MCC,810,MS-DRG,810,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Red blood cell disorders with MCC,811,MS-DRG,811,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Red blood cell disorders without MCC,812,MS-DRG,812,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coagulation disorders,813,MS-DRG,813,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Reticuloendothelial and immunity disorders with MCC*,814,MS-DRG,814,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Reticuloendothelial and immunity disorders with CC*,815,MS-DRG,815,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Reticuloendothelial and immunity disorders without CC/MCC*,816,MS-DRG,816,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses with O.R. procedures with MCC,817,MS-DRG,817,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,40508.305,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses with O.R. procedures with CC,818,MS-DRG,818,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses with O.R. procedures without CC/MCC,819,MS-DRG,819,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and leukemia with major O.R. procedures with MCC,820,MS-DRG,820,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and leukemia with major O.R. procedures with CC,821,MS-DRG,821,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and leukemia with major O.R. procedures without CC/MCC,822,MS-DRG,822,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia with other procedures with MCC,823,MS-DRG,823,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia with other procedures with CC,824,MS-DRG,824,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia with other procedures without CC/MCC,825,MS-DRG,825,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with MCC,826,MS-DRG,826,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with CC,827,MS-DRG,827,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures without CC/MCC,828,MS-DRG,828,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures with CC/MCC,829,MS-DRG,829,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures without CC/MCC,830,MS-DRG,830,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses without O.R. procedures with MCC,831,MS-DRG,831,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses without O.R. procedures with CC,832,MS-DRG,832,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses without O.R. procedures without CC/MCC,833,MS-DRG,833,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute leukemia with MCC,834,MS-DRG,834,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute leukemia with CC,835,MS-DRG,835,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute leukemia without CC/MCC,836,MS-DRG,836,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy agent with MCC,837,MS-DRG,837,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapy agent,838,MS-DRG,838,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis without CC/MCC,839,MS-DRG,839,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia with MCC,840,MS-DRG,840,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia with CC,841,MS-DRG,841,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia without CC/MCC,842,MS-DRG,842,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with MCC,843,MS-DRG,843,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with CC,844,MS-DRG,844,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses without CC/MCC,845,MS-DRG,845,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with MCC,846,MS-DRG,846,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with CC,847,MS-DRG,847,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis without CC/MCC,848,MS-DRG,848,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Radiotherapy,849,MS-DRG,849,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute leukemia with other procedures,850,MS-DRG,850,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Infectious and parasitic diseases with O.R. procedures with MCC,853,MS-DRG,853,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,116013.09,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Infectious and parasitic diseases with O.R. procedures with CC,854,MS-DRG,854,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Infectious and parasitic diseases with O.R. procedures without CC/MCC,855,MS-DRG,855,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with MCC,856,MS-DRG,856,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,103112.54,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with CC,857,MS-DRG,857,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures without CC/MCC,858,MS-DRG,858,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postoperative and post-traumatic infections with MCC,862,MS-DRG,862,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,70501.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postoperative and post-traumatic infections without MCC,863,MS-DRG,863,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,47554.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Fever and inflammatory conditions,864,MS-DRG,864,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Viral illness with MCC,865,MS-DRG,865,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Viral illness without MCC,866,MS-DRG,866,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other infectious and parasitic diseases diagnoses with MCC,867,MS-DRG,867,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,70118.98,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other infectious and parasitic diseases diagnoses with CC,868,MS-DRG,868,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other infectious and parasitic diseases diagnoses without CC/MCC,869,MS-DRG,869,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septicemia or severe sepsis with MV >96 hours,870,MS-DRG,870,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,158548.16,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septicemia or severe sepsis without MV >96 hours with MCC,871,MS-DRG,871,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,64954.17,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septicemia or severe sepsis without MV >96 hours without MCC,872,MS-DRG,872,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,43522.12,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridements for injuries with MCC,901,MS-DRG,901,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,98177.28,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridements for injuries with CC,902,MS-DRG,902,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridements for injuries without CC/MCC,903,MS-DRG,903,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin grafts for injuries with CC/MCC,904,MS-DRG,904,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin grafts for injuries without CC/MCC,905,MS-DRG,905,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hand procedures for injuries,906,MS-DRG,906,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for injuries with MCC*,907,MS-DRG,907,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for injuries with CC*,908,MS-DRG,908,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for injuries without CC/MCC*,909,MS-DRG,909,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic injury with MCC,913,MS-DRG,913,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic injury without MCC,914,MS-DRG,914,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Allergic reactions with MCC,915,MS-DRG,915,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Allergic reactions without MCC,916,MS-DRG,916,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Poisoning and toxic effects of drugs with MCC,917,MS-DRG,917,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Poisoning and toxic effects of drugs without MCC,918,MS-DRG,918,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complications of treatment with MCC,919,MS-DRG,919,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,82055.43,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complications of treatment with CC,920,MS-DRG,920,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52581.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complications of treatment without CC/MCC,921,MS-DRG,921,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other injury, poisoning and toxic effect diagnoses with MCC",922,MS-DRG,922,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other injury, poisoning and toxic effect diagnoses without MCC",923,MS-DRG,923,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extensive burns or full thickness burns with MV >96 hours with skin graft,927,MS-DRG,927,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Full thickness burn with skin graft or inhalation injury with CC/MCC,928,MS-DRG,928,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Full thickness burn with skin graft or inhalation injury without CC/MCC,929,MS-DRG,929,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extensive burns or full thickness burns with MV >96 hours without skin graft,933,MS-DRG,933,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Full thickness burn without skin graft or inhalation injury,934,MS-DRG,934,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-extensive burns,935,MS-DRG,935,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures with diagnoses of other contact with health services with MCC,939,MS-DRG,939,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,90701.7,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures with diagnoses of other contact with health services with CC,940,MS-DRG,940,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures with diagnoses of other contact with health services without CC/MCC,941,MS-DRG,941,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Signs and symptoms with MCC,947,MS-DRG,947,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Signs and symptoms without MCC,948,MS-DRG,948,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Aftercare with CC/MCC,949,MS-DRG,949,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,53224.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Aftercare without CC/MCC,950,MS-DRG,950,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other factors influencing health status,951,MS-DRG,951,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy for multiple significant trauma,955,MS-DRG,955,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Limb reattachment, hip and femur procedures for multiple significant trauma",956,MS-DRG,956,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for multiple significant trauma with MCC,957,MS-DRG,957,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for multiple significant trauma with CC,958,MS-DRG,958,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for multiple significant trauma without CC/MCC,959,MS-DRG,959,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other multiple significant trauma with MCC,963,MS-DRG,963,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other multiple significant trauma with CC,964,MS-DRG,964,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other multiple significant trauma without CC/MCC,965,MS-DRG,965,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with extensive O.R. procedures with MCC,969,MS-DRG,969,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with extensive O.R. procedures without MCC,970,MS-DRG,970,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with major related condition with MCC*,974,MS-DRG,974,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,87197.28,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with major related condition with CC*,975,MS-DRG,975,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,68412.68,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with major related condition without CC/MCC*,976,MS-DRG,976,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,68412.68,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with or without other related condition,977,MS-DRG,977,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with MCC,981,MS-DRG,981,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,68449.825,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with CC,982,MS-DRG,982,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,96991.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,983,MS-DRG,983,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with MCC,987,MS-DRG,987,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,163207.97,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with CC,988,MS-DRG,988,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,989,MS-DRG,989,LOCAL,,Inpatient,,,,,Kaiser MR,commercial,,,MS-DRG,72269.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck with major O.R. procedures",3,MS-DRG,3,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,310277.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck without major O.R. procedures",4,MS-DRG,4,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,229767.96,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCC",11,MS-DRG,11,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CC",12,MS-DRG,12,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy without CC/MCC",13,MS-DRG,13,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chimeric antigen receptor (CAR) T-cell and other immunotherapies,18,MS-DRG,18,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46368.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with MCC,20,MS-DRG,20,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with CC,21,MS-DRG,21,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage without CC/MCC,22,MS-DRG,22,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC or chemotherapy implant or epilepsy with neurostimulator,23,MS-DRG,23,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis without MCC,24,MS-DRG,24,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy and endovascular intracranial procedures with MCC,25,MS-DRG,25,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy and endovascular intracranial procedures with CC,26,MS-DRG,26,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy and endovascular intracranial procedures without CC/MCC,27,MS-DRG,27,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Spinal procedures with MCC,28,MS-DRG,28,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Spinal procedures with CC or spinal neurostimulators,29,MS-DRG,29,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Spinal procedures without CC/MCC,30,MS-DRG,30,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ventricular shunt procedures with MCC,31,MS-DRG,31,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ventricular shunt procedures with CC,32,MS-DRG,32,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ventricular shunt procedures without CC/MCC,33,MS-DRG,33,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Carotid artery stent procedures with MCC,34,MS-DRG,34,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Carotid artery stent procedures with CC,35,MS-DRG,35,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Carotid artery stent procedures without CC/MCC,36,MS-DRG,36,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extracranial procedures with MCC,37,MS-DRG,37,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extracranial procedures with CC,38,MS-DRG,38,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extracranial procedures without CC/MCC,39,MS-DRG,39,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with MCC",40,MS-DRG,40,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,95774.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurostimulator",41,MS-DRG,41,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46368.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures without CC/MCC",42,MS-DRG,42,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46368.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Spinal disorders and injuries with CC/MCC,52,MS-DRG,52,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,82942.79,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Spinal disorders and injuries without CC/MCC,53,MS-DRG,53,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,81228.84,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nervous system neoplasms with MCC,54,MS-DRG,54,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46368.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nervous system neoplasms without MCC,55,MS-DRG,55,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46368.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Degenerative nervous system disorders with MCC,56,MS-DRG,56,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,61411.33,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Degenerative nervous system disorders without MCC,57,MS-DRG,57,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,51678.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple sclerosis and cerebellar ataxia with MCC,58,MS-DRG,58,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple sclerosis and cerebellar ataxia with CC,59,MS-DRG,59,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,51678.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple sclerosis and cerebellar ataxia without CC/MCC,60,MS-DRG,60,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,51678.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with MCC",61,MS-DRG,61,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,111192.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with CC",62,MS-DRG,62,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent without CC/MCC",63,MS-DRG,63,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial hemorrhage or cerebral infarction with MCC,64,MS-DRG,64,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,111192.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial hemorrhage or cerebral infarction with CC or tPA in 24 hours,65,MS-DRG,65,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intracranial hemorrhage or cerebral infarction without CC/MCC,66,MS-DRG,66,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nonspecific CVA and precerebral occlusion without infarction with MCC,67,MS-DRG,67,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,66767.42,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nonspecific CVA and precerebral occlusion without infarction without MCC,68,MS-DRG,68,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Transient ischemia without thrombolytic,69,MS-DRG,69,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nonspecific cerebrovascular disorders with MCC*,70,MS-DRG,70,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,66767.42,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nonspecific cerebrovascular disorders with CC*,71,MS-DRG,71,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,45128.84,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nonspecific cerebrovascular disorders without CC/MCC*,72,MS-DRG,72,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cranial and peripheral nerve disorders with MCC,73,MS-DRG,73,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cranial and peripheral nerve disorders without MCC,74,MS-DRG,74,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Viral meningitis with CC/MCC,75,MS-DRG,75,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Viral meningitis without CC/MCC,76,MS-DRG,76,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hypertensive encephalopathy with MCC,77,MS-DRG,77,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,68160,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hypertensive encephalopathy with CC,78,MS-DRG,78,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,537909.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hypertensive encephalopathy without CC/MCC,79,MS-DRG,79,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nontraumatic stupor and coma with MCC,80,MS-DRG,80,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Nontraumatic stupor and coma without MCC,81,MS-DRG,81,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma >1 hour with MCC*,82,MS-DRG,82,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,82529.13,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma >1 hour with CC*,83,MS-DRG,83,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,62451.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma >1 hour without CC/MCC*,84,MS-DRG,84,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma <1 hour with MCC,85,MS-DRG,85,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,62451.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma <1 hour with CC,86,MS-DRG,86,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,62451.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic stupor and coma <1 hour without CC/MCC,87,MS-DRG,87,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Concussion with MCC,88,MS-DRG,88,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,68160,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Concussion with CC,89,MS-DRG,89,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,537909.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Concussion without CC/MCC,90,MS-DRG,90,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other disorders of nervous system with MCC,91,MS-DRG,91,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,68160,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other disorders of nervous system with CC,92,MS-DRG,92,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,537909.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other disorders of nervous system without CC/MCC,93,MS-DRG,93,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,51678.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bacterial and tuberculous infections of nervous system with MCC*,94,MS-DRG,94,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34375.739,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bacterial and tuberculous infections of nervous system with CC*,95,MS-DRG,95,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,62451.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bacterial and tuberculous infections of nervous system without CC/MCC*,96,MS-DRG,96,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-bacterial infection of nervous system except viral meningitis with MCC,97,MS-DRG,97,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,75054.04,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-bacterial infection of nervous system except viral meningitis with CC,98,MS-DRG,98,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-bacterial infection of nervous system except viral meningitis without CC/MCC,99,MS-DRG,99,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Seizures with MCC,100,MS-DRG,100,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Seizures without MCC,101,MS-DRG,101,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Headaches with MCC,102,MS-DRG,102,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Headaches without MCC,103,MS-DRG,103,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Orbital procedures with CC/MCC,113,MS-DRG,113,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Orbital procedures without CC/MCC,114,MS-DRG,114,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extraocular procedures except orbit,115,MS-DRG,115,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intraocular procedures with CC/MCC,116,MS-DRG,116,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Intraocular procedures without CC/MCC,117,MS-DRG,117,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute major eye infections with CC/MCC,121,MS-DRG,121,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute major eye infections without CC/MCC,122,MS-DRG,122,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Neurological eye disorders,123,MS-DRG,123,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other disorders of the eye with MCC or thrombolytic agent,124,MS-DRG,124,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other disorders of the eye without MCC,125,MS-DRG,125,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Sinus and mastoid procedures with CC/MCC,135,MS-DRG,135,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Sinus and mastoid procedures without CC/MCC,136,MS-DRG,136,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Mouth procedures with CC/MCC,137,MS-DRG,137,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Mouth procedures without CC/MCC,138,MS-DRG,138,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Salivary gland procedures,139,MS-DRG,139,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major head and neck procedures with MCC,140,MS-DRG,140,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,177508.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major head and neck procedures with CC,141,MS-DRG,141,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major head and neck procedures without CC/MCC,142,MS-DRG,142,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with MCC",143,MS-DRG,143,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with CC",144,MS-DRG,144,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures without CC/MCC",145,MS-DRG,145,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ear, nose, mouth and throat malignancy with MCC*",146,MS-DRG,146,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ear, nose, mouth and throat malignancy with CC*",147,MS-DRG,147,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Ear, nose, mouth and throat malignancy without CC/MCC*",148,MS-DRG,148,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Dysequilibrium,149,MS-DRG,149,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Epistaxis with MCC,150,MS-DRG,150,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Epistaxis without MCC,151,MS-DRG,151,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Otitis media and URI with MCC,152,MS-DRG,152,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Otitis media and URI without MCC,153,MS-DRG,153,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat diagnoses with MCC",154,MS-DRG,154,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat diagnoses with CC",155,MS-DRG,155,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other ear, nose, mouth and throat diagnoses without CC/MCC",156,MS-DRG,156,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Dental and oral diseases with MCC,157,MS-DRG,157,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Dental and oral diseases with CC,158,MS-DRG,158,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Dental and oral diseases without CC/MCC,159,MS-DRG,159,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest procedures with MCC,163,MS-DRG,163,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,202666.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest procedures with CC,164,MS-DRG,164,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,202666.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest procedures without CC/MCC,165,MS-DRG,165,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,202666.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other respiratory system O.R. procedures with MCC,166,MS-DRG,166,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,177508.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other respiratory system O.R. procedures with CC,167,MS-DRG,167,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,115767.94,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other respiratory system O.R. procedures without CC/MCC,168,MS-DRG,168,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism,173,MS-DRG,173,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pulmonary embolism with MCC or acute cor pulmonale,175,MS-DRG,175,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pulmonary embolism without MCC,176,MS-DRG,176,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory infections and inflammations with MCC*,177,MS-DRG,177,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,62918.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory infections and inflammations with CC*,178,MS-DRG,178,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,43491.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory infections and inflammations without CC/MCC*,179,MS-DRG,179,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,42251.85,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory neoplasms with MCC*,180,MS-DRG,180,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory neoplasms with CC*,181,MS-DRG,181,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory neoplasms without CC/MCC*,182,MS-DRG,182,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest trauma with MCC,183,MS-DRG,183,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest trauma with CC,184,MS-DRG,184,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major chest trauma without CC/MCC,185,MS-DRG,185,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pleural effusion with MCC*,186,MS-DRG,186,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,66071.13,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pleural effusion with CC*,187,MS-DRG,187,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pleural effusion without CC/MCC*,188,MS-DRG,188,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pulmonary edema and respiratory failure,189,MS-DRG,189,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72046.99,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chronic obstructive pulmonary disease with MCC*,190,MS-DRG,190,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,20971.383,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chronic obstructive pulmonary disease with CC*,191,MS-DRG,191,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chronic obstructive pulmonary disease without CC/MCC*,192,MS-DRG,192,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Simple pneumonia and pleurisy with MCC,193,MS-DRG,193,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,59421.93,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Simple pneumonia and pleurisy with CC,194,MS-DRG,194,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,39604.42,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Simple pneumonia and pleurisy without CC/MCC,195,MS-DRG,195,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Interstitial lung disease with MCC*,196,MS-DRG,196,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Interstitial lung disease with CC*,197,MS-DRG,197,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Interstitial lung disease without CC/MCC*,198,MS-DRG,198,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pneumothorax with MCC,199,MS-DRG,199,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pneumothorax with CC,200,MS-DRG,200,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,21869.927,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pneumothorax without CC/MCC,201,MS-DRG,201,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,21869.927,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bronchitis and asthma with CC/MCC,202,MS-DRG,202,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,40508.305,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bronchitis and asthma without CC/MCC,203,MS-DRG,203,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,15339.435,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory signs and symptoms,204,MS-DRG,204,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other respiratory system diagnoses with MCC,205,MS-DRG,205,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,112102.84,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other respiratory system diagnoses without MCC,206,MS-DRG,206,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory system diagnosis with ventilator support >96 hours,207,MS-DRG,207,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,147720.8,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Respiratory system diagnosis with ventilator support <=96 hours,208,MS-DRG,208,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,81481.35,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Concomitant aortic and mitral valve procedures,212,MS-DRG,212,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other heart assist system implant,215,MS-DRG,215,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC,216,MS-DRG,216,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with CC,217,MS-DRG,217,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization without CC/MCC,218,MS-DRG,218,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with MCC,219,MS-DRG,219,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with CC,220,MS-DRG,220,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization without CC/MCC,221,MS-DRG,221,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other cardiothoracic procedures with MCC,228,MS-DRG,228,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other cardiothoracic procedures without MCC,229,MS-DRG,229,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass with PTCA with MCC,231,MS-DRG,231,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass with PTCA without MCC,232,MS-DRG,232,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass with cardiac catheterization or open ablation with MCC,233,MS-DRG,233,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass with cardiac catheterization or open ablation without MCC,234,MS-DRG,234,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass without cardiac catheterization with MCC,235,MS-DRG,235,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary bypass without cardiac catheterization without MCC,236,MS-DRG,236,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for circulatory system disorders except upper limb and toe with MCC,239,MS-DRG,239,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for circulatory system disorders except upper limb and toe with CC,240,MS-DRG,240,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for circulatory system disorders except upper limb and toe without CC/MCC,241,MS-DRG,241,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Permanent cardiac pacemaker implant with MCC,242,MS-DRG,242,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Permanent cardiac pacemaker implant with CC,243,MS-DRG,243,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Permanent cardiac pacemaker implant without CC/MCC,244,MS-DRG,244,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
AICD generator procedures,245,MS-DRG,245,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,40774.659,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous cardiovascular procedures without intraluminal device with MCC,250,MS-DRG,250,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous cardiovascular procedures without intraluminal device without MCC,251,MS-DRG,251,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other vascular procedures with MCC,252,MS-DRG,252,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other vascular procedures with CC,253,MS-DRG,253,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other vascular procedures without CC/MCC,254,MS-DRG,254,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Upper limb and toe amputation for circulatory system disorders with MCC,255,MS-DRG,255,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Upper limb and toe amputation for circulatory system disorders with CC,256,MS-DRG,256,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Upper limb and toe amputation for circulatory system disorders without CC/MCC,257,MS-DRG,257,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac pacemaker device replacement with MCC,258,MS-DRG,258,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac pacemaker device replacement without MCC,259,MS-DRG,259,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac pacemaker revision except device replacement with MCC,260,MS-DRG,260,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac pacemaker revision except device replacement with CC,261,MS-DRG,261,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac pacemaker revision except device replacement without CC/MCC,262,MS-DRG,262,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Vein ligation and stripping,263,MS-DRG,263,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other circulatory system O.R. procedures,264,MS-DRG,264,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
AICD lead procedures,265,MS-DRG,265,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Endovascular cardiac valve replacement and supplement procedures with MCC,266,MS-DRG,266,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Endovascular cardiac valve replacement and supplement procedures without MCC,267,MS-DRG,267,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Aortic and heart assist procedures except pulsation balloon with MCC,268,MS-DRG,268,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Aortic and heart assist procedures except pulsation balloon without MCC,269,MS-DRG,269,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79522.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other major cardiovascular procedures with MCC,270,MS-DRG,270,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other major cardiovascular procedures with CC,271,MS-DRG,271,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other major cardiovascular procedures without CC/MCC,272,MS-DRG,272,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous and other intracardiac procedures with MCC,273,MS-DRG,273,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous and other intracardiac procedures without MCC,274,MS-DRG,274,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac defibrillator implant with cardiac catheterization and MCC,275,MS-DRG,275,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac defibrillator implant with MCC or carotid sinus neurostimulator,276,MS-DRG,276,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac defibrillator implant without MCC,277,MS-DRG,277,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures with MCC,278,MS-DRG,278,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures without MCC,279,MS-DRG,279,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,92851.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, discharged alive with MCC",280,MS-DRG,280,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,63798.62,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, discharged alive with CC",281,MS-DRG,281,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, discharged alive without CC/MCC",282,MS-DRG,282,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, expired with MCC",283,MS-DRG,283,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, expired with CC",284,MS-DRG,284,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Acute myocardial infarction, expired without CC/MCC",285,MS-DRG,285,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization with MCC",286,MS-DRG,286,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization without MCC",287,MS-DRG,287,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute and subacute endocarditis with MCC,288,MS-DRG,288,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,79476.64,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute and subacute endocarditis with CC,289,MS-DRG,289,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,54456.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute and subacute endocarditis without CC/MCC,290,MS-DRG,290,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48748.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Heart failure and shock with MCC,291,MS-DRG,291,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,59345.41,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Heart failure and shock with CC,292,MS-DRG,292,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,42060.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Heart failure and shock without CC/MCC,293,MS-DRG,293,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,42060.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Deep vein thrombophlebitis with CC/MCC,294,MS-DRG,294,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Deep vein thrombophlebitis without CC/MCC,295,MS-DRG,295,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Cardiac arrest, unexplained with MCC",296,MS-DRG,296,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,59345.41,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Cardiac arrest, unexplained with CC",297,MS-DRG,297,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,42060.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Cardiac arrest, unexplained without CC/MCC",298,MS-DRG,298,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,42060.56,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peripheral vascular disorders with MCC,299,MS-DRG,299,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,64808.62,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peripheral vascular disorders with CC,300,MS-DRG,300,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peripheral vascular disorders without CC/MCC,301,MS-DRG,301,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Atherosclerosis with MCC,302,MS-DRG,302,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Atherosclerosis without MCC,303,MS-DRG,303,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hypertension with MCC,304,MS-DRG,304,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hypertension without MCC,305,MS-DRG,305,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac congenital and valvular disorders with MCC,306,MS-DRG,306,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac congenital and valvular disorders without MCC,307,MS-DRG,307,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac arrhythmia and conduction disorders with MCC,308,MS-DRG,308,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac arrhythmia and conduction disorders with CC,309,MS-DRG,309,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,60095.27,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cardiac arrhythmia and conduction disorders without CC/MCC,310,MS-DRG,310,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Angina pectoris,311,MS-DRG,311,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Syncope and collapse,312,MS-DRG,312,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46383.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chest pain,313,MS-DRG,313,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other circulatory system diagnoses with MCC,314,MS-DRG,314,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,67570.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other circulatory system diagnoses with CC,315,MS-DRG,315,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,47562.03,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other circulatory system diagnoses without CC/MCC,316,MS-DRG,316,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Concomitant left atrial appendage closure and cardiac ablation,317,MS-DRG,317,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other endovascular cardiac valve procedures with MCC,319,MS-DRG,319,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other endovascular cardiac valve procedures without MCC,320,MS-DRG,320,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/intraluminal devices,321,MS-DRG,321,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Percutaneous cardiovascular procedures with intraluminal device without MCC,322,MS-DRG,322,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary intravascular lithotripsy with intraluminal device with MCC,323,MS-DRG,323,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary intravascular lithotripsy with intraluminal device without MCC,324,MS-DRG,324,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,34914.02,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coronary intravascular lithotripsy without intraluminal device,325,MS-DRG,325,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Stomach, esophageal and duodenal procedures with MCC",326,MS-DRG,326,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Stomach, esophageal and duodenal procedures with CC",327,MS-DRG,327,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Stomach, esophageal and duodenal procedures without CC/MCC",328,MS-DRG,328,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major small and large bowel procedures with MCC,329,MS-DRG,329,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major small and large bowel procedures with CC,330,MS-DRG,330,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major small and large bowel procedures without CC/MCC,331,MS-DRG,331,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Rectal resection with MCC,332,MS-DRG,332,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Rectal resection with CC,333,MS-DRG,333,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Rectal resection without CC/MCC,334,MS-DRG,334,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peritoneal adhesiolysis with MCC,335,MS-DRG,335,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peritoneal adhesiolysis with CC,336,MS-DRG,336,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Peritoneal adhesiolysis without CC/MCC,337,MS-DRG,337,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor small and large bowel procedures with MCC,344,MS-DRG,344,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor small and large bowel procedures with CC,345,MS-DRG,345,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor small and large bowel procedures without CC/MCC,346,MS-DRG,346,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Anal and stomal procedures with MCC,347,MS-DRG,347,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,68366.59,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Anal and stomal procedures with CC,348,MS-DRG,348,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Anal and stomal procedures without CC/MCC,349,MS-DRG,349,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inguinal and femoral hernia procedures with MCC,350,MS-DRG,350,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,68366.59,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inguinal and femoral hernia procedures with CC,351,MS-DRG,351,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inguinal and femoral hernia procedures without CC/MCC,352,MS-DRG,352,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hernia procedures except inguinal and femoral with MCC,353,MS-DRG,353,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,118828.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hernia procedures except inguinal and femoral with CC,354,MS-DRG,354,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hernia procedures except inguinal and femoral without CC/MCC,355,MS-DRG,355,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system O.R. procedures with MCC,356,MS-DRG,356,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,106800.32,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system O.R. procedures with CC,357,MS-DRG,357,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system O.R. procedures without CC/MCC,358,MS-DRG,358,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major esophageal disorders with MCC*,368,MS-DRG,368,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major esophageal disorders with CC*,369,MS-DRG,369,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major esophageal disorders without CC/MCC*,370,MS-DRG,370,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major gastrointestinal disorders and peritoneal infections with MCC,371,MS-DRG,371,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,68366.59,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major gastrointestinal disorders and peritoneal infections with CC,372,MS-DRG,372,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major gastrointestinal disorders and peritoneal infections without CC/MCC,373,MS-DRG,373,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Digestive malignancy with MCC*,374,MS-DRG,374,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Digestive malignancy with CC*,375,MS-DRG,375,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Digestive malignancy without CC/MCC*,376,MS-DRG,376,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal hemorrhage with MCC,377,MS-DRG,377,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,54425.47,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal hemorrhage with CC,378,MS-DRG,378,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal hemorrhage without CC/MCC,379,MS-DRG,379,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complicated peptic ulcer with MCC,380,MS-DRG,380,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,73278.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complicated peptic ulcer with CC,381,MS-DRG,381,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complicated peptic ulcer without CC/MCC,382,MS-DRG,382,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uncomplicated peptic ulcer with MCC,383,MS-DRG,383,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uncomplicated peptic ulcer without MCC,384,MS-DRG,384,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inflammatory bowel disease with MCC,385,MS-DRG,385,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inflammatory bowel disease with CC,386,MS-DRG,386,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inflammatory bowel disease without CC/MCC,387,MS-DRG,387,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal obstruction with MCC,388,MS-DRG,388,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,75604.95,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal obstruction with CC,389,MS-DRG,389,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Gastrointestinal obstruction without CC/MCC,390,MS-DRG,390,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC",391,MS-DRG,391,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,59253.6,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC",392,MS-DRG,392,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,47929.3,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system diagnoses with MCC,393,MS-DRG,393,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,77739.74,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system diagnoses with CC,394,MS-DRG,394,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55022.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other digestive system diagnoses without CC/MCC,395,MS-DRG,395,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Appendix procedures with MCC,397,MS-DRG,397,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,68366.59,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Appendix procedures with CC,398,MS-DRG,398,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Appendix procedures without CC/MCC,399,MS-DRG,399,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Single level combined anterior and posterior spinal fusion except cervical,402,MS-DRG,402,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Pancreas, liver and shunt procedures with MCC",405,MS-DRG,405,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,40508.305,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Pancreas, liver and shunt procedures with CC",406,MS-DRG,406,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Pancreas, liver and shunt procedures without CC/MCC",407,MS-DRG,407,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with MCC,408,MS-DRG,408,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55022.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with CC,409,MS-DRG,409,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. without CC/MCC,410,MS-DRG,410,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy with C.D.E. with MCC,411,MS-DRG,411,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,73278.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy with C.D.E. with CC,412,MS-DRG,412,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy with C.D.E. without CC/MCC,413,MS-DRG,413,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with MCC,414,MS-DRG,414,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,73278.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with CC,415,MS-DRG,415,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55022.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. without CC/MCC,416,MS-DRG,416,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55022.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Laparoscopic cholecystectomy without C.D.E. with MCC,417,MS-DRG,417,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,73278.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Laparoscopic cholecystectomy without C.D.E. with CC,418,MS-DRG,418,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Laparoscopic cholecystectomy without C.D.E. without CC/MCC,419,MS-DRG,419,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hepatobiliary diagnostic procedures with MCC,420,MS-DRG,420,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55022.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hepatobiliary diagnostic procedures with CC,421,MS-DRG,421,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hepatobiliary diagnostic procedures without CC/MCC,422,MS-DRG,422,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other hepatobiliary or pancreas O.R. procedures with MCC,423,MS-DRG,423,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other hepatobiliary or pancreas O.R. procedures with CC,424,MS-DRG,424,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other hepatobiliary or pancreas O.R. procedures without CC/MCC,425,MS-DRG,425,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,4870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,426,MS-DRG,426,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,81343.62,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical with CC,427,MS-DRG,427,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,81343.62,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical without CC/MCC,428,MS-DRG,428,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,67111.73,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Combined anterior and posterior cervical spinal fusion with MCC,429,MS-DRG,429,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,81343.62,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Combined anterior and posterior cervical spinal fusion without MCC,430,MS-DRG,430,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cirrhosis and alcoholic hepatitis with MCC,432,MS-DRG,432,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,56468.43,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cirrhosis and alcoholic hepatitis with CC,433,MS-DRG,433,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cirrhosis and alcoholic hepatitis without CC/MCC,434,MS-DRG,434,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignancy of hepatobiliary system or pancreas with MCC,435,MS-DRG,435,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignancy of hepatobiliary system or pancreas with CC,436,MS-DRG,436,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignancy of hepatobiliary system or pancreas without CC/MCC,437,MS-DRG,437,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of pancreas except malignancy with MCC,438,MS-DRG,438,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,80165.28,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of pancreas except malignancy with CC,439,MS-DRG,439,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of pancreas except malignancy without CC/MCC,440,MS-DRG,440,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCC",441,MS-DRG,441,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,71243.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CC",442,MS-DRG,442,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without CC/MCC",443,MS-DRG,443,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of the biliary tract with MCC*,444,MS-DRG,444,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,58190.03,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of the biliary tract with CC*,445,MS-DRG,445,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53147.66,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Disorders of the biliary tract without CC/MCC*,446,MS-DRG,446,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,447,MS-DRG,447,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,1.0631,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Multiple level spinal fusion except cervical without MCC,448,MS-DRG,448,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,1.0631,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,450,MS-DRG,450,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,67111.74,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Single Level Spinal Fusion Except Cervical without MCC,451,MS-DRG,451,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with MCC",456,MS-DRG,456,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with CC",457,MS-DRG,457,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions without CC/MCC",458,MS-DRG,458,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bilateral or multiple major joint procedures of lower extremity with MCC,461,MS-DRG,461,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,67111.74,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bilateral or multiple major joint procedures of lower extremity without MCC,462,MS-DRG,462,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with MCC*,463,MS-DRG,463,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with CC*,464,MS-DRG,464,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72972.82,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders without CC/MCC*,465,MS-DRG,465,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,70057.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Revision of hip or knee replacement with MCC,466,MS-DRG,466,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Revision of hip or knee replacement with CC,467,MS-DRG,467,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Revision of hip or knee replacement without CC/MCC,468,MS-DRG,468,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity with MCC or total ankle replacement,469,MS-DRG,469,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity without MCC,470,MS-DRG,470,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cervical spinal fusion with MCC,471,MS-DRG,471,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cervical spinal fusion with CC,472,MS-DRG,472,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cervical spinal fusion without CC/MCC,473,MS-DRG,473,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with MCC,474,MS-DRG,474,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with CC,475,MS-DRG,475,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders without CC/MCC,476,MS-DRG,476,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biopsies of musculoskeletal system and connective tissue with MCC,477,MS-DRG,477,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biopsies of musculoskeletal system and connective tissue with CC,478,MS-DRG,478,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,28146.902,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Biopsies of musculoskeletal system and connective tissue without CC/MCC,479,MS-DRG,479,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,28146.902,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hip and femur procedures except major joint with MCC,480,MS-DRG,480,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hip and femur procedures except major joint with CC,481,MS-DRG,481,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hip and femur procedures except major joint without CC/MCC,482,MS-DRG,482,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major joint or limb reattachment procedures of upper extremities,483,MS-DRG,483,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Knee procedures with principal diagnosis of infection with MCC,485,MS-DRG,485,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Knee procedures with principal diagnosis of infection with CC,486,MS-DRG,486,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Knee procedures with principal diagnosis of infection without CC/MCC,487,MS-DRG,487,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Knee procedures without principal diagnosis of infection with CC/MCC,488,MS-DRG,488,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Knee procedures without principal diagnosis of infection without CC/MCC,489,MS-DRG,489,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,51693.87,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with MCC",492,MS-DRG,492,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with CC",493,MS-DRG,493,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur without CC/MCC",494,MS-DRG,494,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Local excision and removal of internal fixation devices except hip and femur with MCC,495,MS-DRG,495,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Local excision and removal of internal fixation devices except hip and femur with CC,496,MS-DRG,496,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Local excision and removal of internal fixation devices except hip and femur without CC/MCC,497,MS-DRG,497,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Local excision and removal of internal fixation devices of hip and femur with CC/MCC,498,MS-DRG,498,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Local excision and removal of internal fixation devices of hip and femur without CC/MCC,499,MS-DRG,499,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Soft tissue procedures with MCC,500,MS-DRG,500,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,94244.13,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Soft tissue procedures with CC,501,MS-DRG,501,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Soft tissue procedures without CC/MCC,502,MS-DRG,502,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,67111.74,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Foot procedures with MCC,503,MS-DRG,503,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Foot procedures with CC,504,MS-DRG,504,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Foot procedures without CC/MCC,505,MS-DRG,505,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major thumb or joint procedures,506,MS-DRG,506,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major shoulder or elbow joint procedures with CC/MCC,507,MS-DRG,507,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major shoulder or elbow joint procedures without CC/MCC,508,MS-DRG,508,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Arthroscopy,509,MS-DRG,509,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with MCC",510,MS-DRG,510,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with CC",511,MS-DRG,511,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures without CC/MCC",512,MS-DRG,512,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures with CC/MCC",513,MS-DRG,513,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures without CC/MCC",514,MS-DRG,514,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with MCC,515,MS-DRG,515,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,91742.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with CC,516,MS-DRG,516,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures without CC/MCC,517,MS-DRG,517,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Back and neck procedures except spinal fusion with MCC or disc device or neurostimulator,518,MS-DRG,518,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Back and neck procedures except spinal fusion with CC,519,MS-DRG,519,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Back and neck procedures except spinal fusion without CC/MCC,520,MS-DRG,520,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hip replacement with principal diagnosis of hip fracture with MCC,521,MS-DRG,521,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hip replacement with principal diagnosis of hip fracture without MCC,522,MS-DRG,522,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Fractures of femur with MCC,533,MS-DRG,533,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Fractures of femur without MCC,534,MS-DRG,534,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55504.34,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Fractures of hip and pelvis with MCC,535,MS-DRG,535,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Fractures of hip and pelvis without MCC,536,MS-DRG,536,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh with CC/MCC",537,MS-DRG,537,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh without CC/MCC",538,MS-DRG,538,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Osteomyelitis with MCC*,539,MS-DRG,539,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,74166.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Osteomyelitis with CC*,540,MS-DRG,540,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,54425.47,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Osteomyelitis without CC/MCC*,541,MS-DRG,541,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,51693.86,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with MCC*,542,MS-DRG,542,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with CC*,543,MS-DRG,543,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy without CC/MCC*,544,MS-DRG,544,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Connective tissue disorders with MCC,545,MS-DRG,545,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Connective tissue disorders with CC,546,MS-DRG,546,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Connective tissue disorders without CC/MCC,547,MS-DRG,547,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46988.16,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septic arthritis with MCC,548,MS-DRG,548,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,65145.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septic arthritis with CC,549,MS-DRG,549,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septic arthritis without CC/MCC,550,MS-DRG,550,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Medical back problems with MCC,551,MS-DRG,551,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,99921.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Medical back problems without MCC,552,MS-DRG,552,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bone diseases and arthropathies with MCC,553,MS-DRG,553,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Bone diseases and arthropathies without MCC,554,MS-DRG,554,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue with MCC,555,MS-DRG,555,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue without MCC,556,MS-DRG,556,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tendonitis, myositis and bursitis with MCC",557,MS-DRG,557,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,69284.76,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Tendonitis, myositis and bursitis without MCC",558,MS-DRG,558,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53645.01,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Aftercare, musculoskeletal system and connective tissue with MCC*",559,MS-DRG,559,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,61671.48,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Aftercare, musculoskeletal system and connective tissue with CC*",560,MS-DRG,560,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48082.33,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Aftercare, musculoskeletal system and connective tissue without CC/MCC*",561,MS-DRG,561,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46988.16,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCC",562,MS-DRG,562,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCC",563,MS-DRG,563,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,46988.16,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue diagnoses with MCC,564,MS-DRG,564,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,67111.74,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue diagnoses with CC,565,MS-DRG,565,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other musculoskeletal system and connective tissue diagnoses without CC/MCC,566,MS-DRG,566,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53790.39,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin debridement with MCC*,570,MS-DRG,570,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,90081.68,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin debridement with CC*,571,MS-DRG,571,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,65336.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin debridement without CC/MCC*,572,MS-DRG,572,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,65336.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft for skin ulcer or cellulitis with MCC,573,MS-DRG,573,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,106394.79,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft for skin ulcer or cellulitis with CC,574,MS-DRG,574,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft for skin ulcer or cellulitis without CC/MCC,575,MS-DRG,575,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft except for skin ulcer or cellulitis with MCC*,576,MS-DRG,576,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft except for skin ulcer or cellulitis with CC*,577,MS-DRG,577,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin graft except for skin ulcer or cellulitis without CC/MCC*,578,MS-DRG,578,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other skin, subcutaneous tissue and breast procedures with MCC",579,MS-DRG,579,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,103793.26,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other skin, subcutaneous tissue and breast procedures with CC",580,MS-DRG,580,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,85299.47,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other skin, subcutaneous tissue and breast procedures without CC/MCC",581,MS-DRG,581,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,85299.47,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Mastectomy for malignancy with CC/MCC,582,MS-DRG,582,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,103793.26,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Mastectomy for malignancy without CC/MCC,583,MS-DRG,583,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,85299.47,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Breast biopsy, local excision and other breast procedures with CC/MCC",584,MS-DRG,584,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,65336.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Breast biopsy, local excision and other breast procedures without CC/MCC",585,MS-DRG,585,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin ulcers with MCC,592,MS-DRG,592,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,67333.63,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin ulcers with CC,593,MS-DRG,593,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53667.96,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin ulcers without CC/MCC,594,MS-DRG,594,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major skin disorders with MCC,595,MS-DRG,595,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major skin disorders without MCC,596,MS-DRG,596,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignant breast disorders with MCC,597,MS-DRG,597,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignant breast disorders with CC,598,MS-DRG,598,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Malignant breast disorders without CC/MCC,599,MS-DRG,599,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-malignant breast disorders with CC/MCC*,600,MS-DRG,600,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-malignant breast disorders without CC/MCC*,601,MS-DRG,601,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cellulitis with MCC,602,MS-DRG,602,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,55068.2,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cellulitis without MCC,603,MS-DRG,603,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36842.21,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Trauma to the skin, subcutaneous tissue and breast with MCC",604,MS-DRG,604,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Trauma to the skin, subcutaneous tissue and breast without MCC",605,MS-DRG,605,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor skin disorders with MCC,606,MS-DRG,606,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor skin disorders without MCC,607,MS-DRG,607,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Adrenal and pituitary procedures with CC/MCC,614,MS-DRG,614,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Adrenal and pituitary procedures without CC/MCC,615,MS-DRG,615,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with MCC",616,MS-DRG,616,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with CC",617,MS-DRG,617,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders without CC/MCC",618,MS-DRG,618,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures for obesity with MCC,619,MS-DRG,619,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,100051.65,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures for obesity with CC,620,MS-DRG,620,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72590.25,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures for obesity without CC/MCC,621,MS-DRG,621,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with MCC",622,MS-DRG,622,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,100051.65,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with CC",623,MS-DRG,623,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72590.25,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders without CC/MCC",624,MS-DRG,624,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with MCC",625,MS-DRG,625,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,30309.826,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with CC",626,MS-DRG,626,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures without CC/MCC",627,MS-DRG,627,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with MCC",628,MS-DRG,628,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,30309.826,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with CC",629,MS-DRG,629,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures without CC/MCC",630,MS-DRG,630,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Diabetes with MCC,637,MS-DRG,637,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,67654.99,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Diabetes with CC,638,MS-DRG,638,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53843.95,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Diabetes without CC/MCC,639,MS-DRG,639,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCC",640,MS-DRG,640,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,74862.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCC",641,MS-DRG,641,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,47049.37,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inborn and other disorders of metabolism,642,MS-DRG,642,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.4,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Endocrine disorders with MCC*,643,MS-DRG,643,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Endocrine disorders with CC*,644,MS-DRG,644,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Endocrine disorders without CC/MCC*,645,MS-DRG,645,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major bladder procedures with MCC,653,MS-DRG,653,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,91596.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major bladder procedures with CC,654,MS-DRG,654,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,80073.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major bladder procedures without CC/MCC,655,MS-DRG,655,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for neoplasm with MCC,656,MS-DRG,656,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for neoplasm with CC,657,MS-DRG,657,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for neoplasm without CC/MCC,658,MS-DRG,658,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for non-neoplasm with MCC*,659,MS-DRG,659,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for non-neoplasm with CC*,660,MS-DRG,660,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Kidney and ureter procedures for non-neoplasm without CC/MCC*,661,MS-DRG,661,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor bladder procedures with MCC,662,MS-DRG,662,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor bladder procedures with CC,663,MS-DRG,663,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Minor bladder procedures without CC/MCC,664,MS-DRG,664,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72268.88,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Prostatectomy with MCC,665,MS-DRG,665,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,91596.69,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Prostatectomy with CC,666,MS-DRG,666,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,80073.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Urethral stricture,697,MS-DRG,697,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other kidney and urinary tract diagnoses with MCC,698,MS-DRG,698,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,67746.82,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other kidney and urinary tract diagnoses with CC,699,MS-DRG,699,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,47363.09,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other kidney and urinary tract diagnoses without CC/MCC,700,MS-DRG,700,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major male pelvic procedures with CC/MCC,707,MS-DRG,707,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major male pelvic procedures without CC/MCC,708,MS-DRG,708,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Penis procedures with CC/MCC,709,MS-DRG,709,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Penis procedures without CC/MCC,710,MS-DRG,710,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Testes procedures with CC/MCC,711,MS-DRG,711,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Testes procedures without CC/MCC,712,MS-DRG,712,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Transurethral prostatectomy with CC/MCC,713,MS-DRG,713,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,30309.826,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Transurethral prostatectomy without CC/MCC,714,MS-DRG,714,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system O.R. procedures for malignancy with CC/MCC,715,MS-DRG,715,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system O.R. procedures for malignancy without CC/MCC,716,MS-DRG,716,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system O.R. procedures except malignancy with CC/MCC,717,MS-DRG,717,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system O.R. procedures except malignancy without CC/MCC,718,MS-DRG,718,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, male reproductive system with MCC",722,MS-DRG,722,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,61794.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, male reproductive system with CC",723,MS-DRG,723,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, male reproductive system without CC/MCC",724,MS-DRG,724,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,50278,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Benign prostatic hypertrophy with MCC,725,MS-DRG,725,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,50278.46,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Benign prostatic hypertrophy without MCC,726,MS-DRG,726,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inflammation of the male reproductive system with MCC,727,MS-DRG,727,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,61794.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Inflammation of the male reproductive system without MCC,728,MS-DRG,728,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,50278,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system diagnoses with CC/MCC,729,MS-DRG,729,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other male reproductive system diagnoses without CC/MCC,730,MS-DRG,730,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC",734,MS-DRG,734,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC",735,MS-DRG,735,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with MCC,736,MS-DRG,736,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with CC,737,MS-DRG,737,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy without CC/MCC,738,MS-DRG,738,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with MCC,739,MS-DRG,739,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with CC,740,MS-DRG,740,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy without CC/MCC,741,MS-DRG,741,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for non-malignancy with CC/MCC,742,MS-DRG,742,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Uterine and adnexa procedures for non-malignancy without CC/MCC,743,MS-DRG,743,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"D&C, conization, laparoscopy and tubal interruption with CC/MCC",744,MS-DRG,744,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"D&C, conization, laparoscopy and tubal interruption without CC/MCC",745,MS-DRG,745,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Vagina, cervix and vulva procedures with CC/MCC",746,MS-DRG,746,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Vagina, cervix and vulva procedures without CC/MCC",747,MS-DRG,747,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Female reproductive system reconstructive procedures,748,MS-DRG,748,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other female reproductive system O.R. procedures with CC/MCC,749,MS-DRG,749,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other female reproductive system O.R. procedures without CC/MCC,750,MS-DRG,750,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, female reproductive system with MCC",754,MS-DRG,754,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, female reproductive system with CC",755,MS-DRG,755,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Malignancy, female reproductive system without CC/MCC",756,MS-DRG,756,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Infections, female reproductive system with MCC",757,MS-DRG,757,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,29854.136,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Infections, female reproductive system with CC",758,MS-DRG,758,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Infections, female reproductive system without CC/MCC",759,MS-DRG,759,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Menstrual and other female reproductive system disorders with CC/MCC,760,MS-DRG,760,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Menstrual and other female reproductive system disorders without CC/MCC,761,MS-DRG,761,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Vaginal delivery with O.R. procedures except sterilization and/or D&C,768,MS-DRG,768,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postpartum and post abortion diagnoses with O.R. procedures,769,MS-DRG,769,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Abortion with D&C, aspiration curettage or hysterotomy",770,MS-DRG,770,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postpartum and post abortion diagnoses without O.R. procedures,776,MS-DRG,776,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Abortion without D&C,779,MS-DRG,779,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section with sterilization with MCC,783,MS-DRG,783,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section with sterilization with CC,784,MS-DRG,784,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,90613.37,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section with sterilization without CC/MCC,785,MS-DRG,785,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section without sterilization with MCC,786,MS-DRG,786,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section without sterilization with CC,787,MS-DRG,787,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Cesarean section without sterilization without CC/MCC,788,MS-DRG,788,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Neonates, died or transferred to another acute care facility",789,MS-DRG,789,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Extreme immaturity or respiratory distress syndrome, neonate",790,MS-DRG,790,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Prematurity with major problems,791,MS-DRG,791,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Prematurity without major problems,792,MS-DRG,792,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48921.03,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Full term neonate with major problems,793,MS-DRG,793,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Neonate with other significant problems,794,MS-DRG,794,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48921.03,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Splenic procedures with MCC,799,MS-DRG,799,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,106800.6,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Splenic procedures with CC,800,MS-DRG,800,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48921.03,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Splenic procedures without CC/MCC,801,MS-DRG,801,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures of the blood and blood forming organs with MCC,802,MS-DRG,802,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures of the blood and blood forming organs with CC,803,MS-DRG,803,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures of the blood and blood forming organs without CC/MCC,804,MS-DRG,804,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with MCC,808,MS-DRG,808,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with CC,809,MS-DRG,809,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without CC/MCC,810,MS-DRG,810,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Red blood cell disorders with MCC,811,MS-DRG,811,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Red blood cell disorders without MCC,812,MS-DRG,812,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Coagulation disorders,813,MS-DRG,813,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Reticuloendothelial and immunity disorders with MCC*,814,MS-DRG,814,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Reticuloendothelial and immunity disorders with CC*,815,MS-DRG,815,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Reticuloendothelial and immunity disorders without CC/MCC*,816,MS-DRG,816,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses with O.R. procedures with MCC,817,MS-DRG,817,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,40508.305,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses with O.R. procedures with CC,818,MS-DRG,818,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses with O.R. procedures without CC/MCC,819,MS-DRG,819,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and leukemia with major O.R. procedures with MCC,820,MS-DRG,820,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and leukemia with major O.R. procedures with CC,821,MS-DRG,821,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and leukemia with major O.R. procedures without CC/MCC,822,MS-DRG,822,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia with other procedures with MCC,823,MS-DRG,823,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia with other procedures with CC,824,MS-DRG,824,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia with other procedures without CC/MCC,825,MS-DRG,825,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with MCC,826,MS-DRG,826,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with CC,827,MS-DRG,827,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures without CC/MCC,828,MS-DRG,828,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures with CC/MCC,829,MS-DRG,829,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures without CC/MCC,830,MS-DRG,830,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses without O.R. procedures with MCC,831,MS-DRG,831,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,71182.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses without O.R. procedures with CC,832,MS-DRG,832,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other antepartum diagnoses without O.R. procedures without CC/MCC,833,MS-DRG,833,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute leukemia with MCC,834,MS-DRG,834,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute leukemia with CC,835,MS-DRG,835,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute leukemia without CC/MCC,836,MS-DRG,836,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy agent with MCC,837,MS-DRG,837,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapy agent,838,MS-DRG,838,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis without CC/MCC,839,MS-DRG,839,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia with MCC,840,MS-DRG,840,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia with CC,841,MS-DRG,841,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Lymphoma and non-acute leukemia without CC/MCC,842,MS-DRG,842,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with MCC,843,MS-DRG,843,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with CC,844,MS-DRG,844,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses without CC/MCC,845,MS-DRG,845,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with MCC,846,MS-DRG,846,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with CC,847,MS-DRG,847,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis without CC/MCC,848,MS-DRG,848,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Radiotherapy,849,MS-DRG,849,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Acute leukemia with other procedures,850,MS-DRG,850,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Infectious and parasitic diseases with O.R. procedures with MCC,853,MS-DRG,853,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,116013.09,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Infectious and parasitic diseases with O.R. procedures with CC,854,MS-DRG,854,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Infectious and parasitic diseases with O.R. procedures without CC/MCC,855,MS-DRG,855,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with MCC,856,MS-DRG,856,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,103112.54,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with CC,857,MS-DRG,857,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures without CC/MCC,858,MS-DRG,858,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postoperative and post-traumatic infections with MCC,862,MS-DRG,862,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,70501.55,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Postoperative and post-traumatic infections without MCC,863,MS-DRG,863,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,47554.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Fever and inflammatory conditions,864,MS-DRG,864,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Viral illness with MCC,865,MS-DRG,865,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Viral illness without MCC,866,MS-DRG,866,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other infectious and parasitic diseases diagnoses with MCC,867,MS-DRG,867,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,70118.98,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other infectious and parasitic diseases diagnoses with CC,868,MS-DRG,868,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other infectious and parasitic diseases diagnoses without CC/MCC,869,MS-DRG,869,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septicemia or severe sepsis with MV >96 hours,870,MS-DRG,870,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,158548.16,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septicemia or severe sepsis without MV >96 hours with MCC,871,MS-DRG,871,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,64954.17,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Septicemia or severe sepsis without MV >96 hours without MCC,872,MS-DRG,872,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,43522.12,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridements for injuries with MCC,901,MS-DRG,901,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,98177.28,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridements for injuries with CC,902,MS-DRG,902,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Wound debridements for injuries without CC/MCC,903,MS-DRG,903,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin grafts for injuries with CC/MCC,904,MS-DRG,904,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Skin grafts for injuries without CC/MCC,905,MS-DRG,905,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Hand procedures for injuries,906,MS-DRG,906,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for injuries with MCC*,907,MS-DRG,907,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for injuries with CC*,908,MS-DRG,908,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for injuries without CC/MCC*,909,MS-DRG,909,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic injury with MCC,913,MS-DRG,913,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Traumatic injury without MCC,914,MS-DRG,914,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Allergic reactions with MCC,915,MS-DRG,915,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Allergic reactions without MCC,916,MS-DRG,916,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Poisoning and toxic effects of drugs with MCC,917,MS-DRG,917,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Poisoning and toxic effects of drugs without MCC,918,MS-DRG,918,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complications of treatment with MCC,919,MS-DRG,919,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,82055.43,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complications of treatment with CC,920,MS-DRG,920,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52581.58,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Complications of treatment without CC/MCC,921,MS-DRG,921,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other injury, poisoning and toxic effect diagnoses with MCC",922,MS-DRG,922,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Other injury, poisoning and toxic effect diagnoses without MCC",923,MS-DRG,923,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extensive burns or full thickness burns with MV >96 hours with skin graft,927,MS-DRG,927,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Full thickness burn with skin graft or inhalation injury with CC/MCC,928,MS-DRG,928,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Full thickness burn with skin graft or inhalation injury without CC/MCC,929,MS-DRG,929,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extensive burns or full thickness burns with MV >96 hours without skin graft,933,MS-DRG,933,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Full thickness burn without skin graft or inhalation injury,934,MS-DRG,934,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-extensive burns,935,MS-DRG,935,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures with diagnoses of other contact with health services with MCC,939,MS-DRG,939,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,90701.7,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures with diagnoses of other contact with health services with CC,940,MS-DRG,940,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
O.R. procedures with diagnoses of other contact with health services without CC/MCC,941,MS-DRG,941,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.06,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Signs and symptoms with MCC,947,MS-DRG,947,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Signs and symptoms without MCC,948,MS-DRG,948,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Aftercare with CC/MCC,949,MS-DRG,949,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,53224.31,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Aftercare without CC/MCC,950,MS-DRG,950,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other factors influencing health status,951,MS-DRG,951,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Craniotomy for multiple significant trauma,955,MS-DRG,955,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"Limb reattachment, hip and femur procedures for multiple significant trauma",956,MS-DRG,956,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for multiple significant trauma with MCC,957,MS-DRG,957,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for multiple significant trauma with CC,958,MS-DRG,958,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96210.83,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other O.R. procedures for multiple significant trauma without CC/MCC,959,MS-DRG,959,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,36574.5,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other multiple significant trauma with MCC,963,MS-DRG,963,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other multiple significant trauma with CC,964,MS-DRG,964,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Other multiple significant trauma without CC/MCC,965,MS-DRG,965,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,48870.57,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with extensive O.R. procedures with MCC,969,MS-DRG,969,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with extensive O.R. procedures without MCC,970,MS-DRG,970,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96585.75,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with major related condition with MCC*,974,MS-DRG,974,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,87197.28,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with major related condition with CC*,975,MS-DRG,975,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,68412.68,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with major related condition without CC/MCC*,976,MS-DRG,976,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,68412.68,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
HIV with or without other related condition,977,MS-DRG,977,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with MCC,981,MS-DRG,981,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,68449.825,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with CC,982,MS-DRG,982,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,96991.29,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,983,MS-DRG,983,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,52145.44,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with MCC,987,MS-DRG,987,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,163207.97,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with CC,988,MS-DRG,988,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,989,MS-DRG,989,LOCAL,,Inpatient,,,,,Kaiser DR,commercial,,,MS-DRG,72269.07,case rate,22000,120000,"Threshold:$450,000 Stop loss rate: 45% BC. All other services not described in exhibit 3:2 45% of billed charges",,,,,,,
"ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck with major O.R. procedures",3,MS-DRG,3,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,310277.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck without major O.R. procedures",4,MS-DRG,4,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,229767.96,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCC",11,MS-DRG,11,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CC",12,MS-DRG,12,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy without CC/MCC",13,MS-DRG,13,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Chimeric antigen receptor (CAR) T-cell and other immunotherapies,18,MS-DRG,18,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with MCC,20,MS-DRG,20,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with CC,21,MS-DRG,21,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage without CC/MCC,22,MS-DRG,22,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC or chemotherapy implant or epilepsy with neurostimulator,23,MS-DRG,23,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis without MCC,24,MS-DRG,24,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Craniotomy and endovascular intracranial procedures with MCC,25,MS-DRG,25,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Craniotomy and endovascular intracranial procedures with CC,26,MS-DRG,26,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Craniotomy and endovascular intracranial procedures without CC/MCC,27,MS-DRG,27,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Spinal procedures with MCC,28,MS-DRG,28,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Spinal procedures with CC or spinal neurostimulators,29,MS-DRG,29,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Spinal procedures without CC/MCC,30,MS-DRG,30,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Ventricular shunt procedures with MCC,31,MS-DRG,31,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Ventricular shunt procedures with CC,32,MS-DRG,32,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Ventricular shunt procedures without CC/MCC,33,MS-DRG,33,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Carotid artery stent procedures with MCC,34,MS-DRG,34,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Carotid artery stent procedures with CC,35,MS-DRG,35,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Carotid artery stent procedures without CC/MCC,36,MS-DRG,36,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Extracranial procedures with MCC,37,MS-DRG,37,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Extracranial procedures with CC,38,MS-DRG,38,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Extracranial procedures without CC/MCC,39,MS-DRG,39,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with MCC",40,MS-DRG,40,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,95774.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurostimulator",41,MS-DRG,41,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures without CC/MCC",42,MS-DRG,42,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Spinal disorders and injuries with CC/MCC,52,MS-DRG,52,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,82942.79,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Spinal disorders and injuries without CC/MCC,53,MS-DRG,53,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,81228.84,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Nervous system neoplasms with MCC,54,MS-DRG,54,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Nervous system neoplasms without MCC,55,MS-DRG,55,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Degenerative nervous system disorders with MCC,56,MS-DRG,56,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,61411.33,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Degenerative nervous system disorders without MCC,57,MS-DRG,57,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,51678.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Multiple sclerosis and cerebellar ataxia with MCC,58,MS-DRG,58,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Multiple sclerosis and cerebellar ataxia with CC,59,MS-DRG,59,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,51678.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Multiple sclerosis and cerebellar ataxia without CC/MCC,60,MS-DRG,60,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,51678.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with MCC",61,MS-DRG,61,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,111192.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with CC",62,MS-DRG,62,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent without CC/MCC",63,MS-DRG,63,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Intracranial hemorrhage or cerebral infarction with MCC,64,MS-DRG,64,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,111192.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Intracranial hemorrhage or cerebral infarction with CC or tPA in 24 hours,65,MS-DRG,65,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Intracranial hemorrhage or cerebral infarction without CC/MCC,66,MS-DRG,66,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Nonspecific CVA and precerebral occlusion without infarction with MCC,67,MS-DRG,67,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,66767.42,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Nonspecific CVA and precerebral occlusion without infarction without MCC,68,MS-DRG,68,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Transient ischemia without thrombolytic,69,MS-DRG,69,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Nonspecific cerebrovascular disorders with MCC*,70,MS-DRG,70,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,66767.42,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Nonspecific cerebrovascular disorders with CC*,71,MS-DRG,71,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,45128.84,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Nonspecific cerebrovascular disorders without CC/MCC*,72,MS-DRG,72,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cranial and peripheral nerve disorders with MCC,73,MS-DRG,73,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cranial and peripheral nerve disorders without MCC,74,MS-DRG,74,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Viral meningitis with CC/MCC,75,MS-DRG,75,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Viral meningitis without CC/MCC,76,MS-DRG,76,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hypertensive encephalopathy with MCC,77,MS-DRG,77,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,68160,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hypertensive encephalopathy with CC,78,MS-DRG,78,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,537909.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hypertensive encephalopathy without CC/MCC,79,MS-DRG,79,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Nontraumatic stupor and coma with MCC,80,MS-DRG,80,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Nontraumatic stupor and coma without MCC,81,MS-DRG,81,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Traumatic stupor and coma >1 hour with MCC*,82,MS-DRG,82,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,82529.13,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Traumatic stupor and coma >1 hour with CC*,83,MS-DRG,83,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,62451.46,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Traumatic stupor and coma >1 hour without CC/MCC*,84,MS-DRG,84,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Traumatic stupor and coma <1 hour with MCC,85,MS-DRG,85,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,62451.46,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Traumatic stupor and coma <1 hour with CC,86,MS-DRG,86,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,62451.46,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Traumatic stupor and coma <1 hour without CC/MCC,87,MS-DRG,87,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Concussion with MCC,88,MS-DRG,88,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,68160,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Concussion with CC,89,MS-DRG,89,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,537909.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Concussion without CC/MCC,90,MS-DRG,90,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other disorders of nervous system with MCC,91,MS-DRG,91,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,68160,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other disorders of nervous system with CC,92,MS-DRG,92,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,537909.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other disorders of nervous system without CC/MCC,93,MS-DRG,93,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,51678.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Bacterial and tuberculous infections of nervous system with MCC*,94,MS-DRG,94,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34375.739,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Bacterial and tuberculous infections of nervous system with CC*,95,MS-DRG,95,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,62451.46,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Bacterial and tuberculous infections of nervous system without CC/MCC*,96,MS-DRG,96,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Non-bacterial infection of nervous system except viral meningitis with MCC,97,MS-DRG,97,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,75054.04,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Non-bacterial infection of nervous system except viral meningitis with CC,98,MS-DRG,98,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Non-bacterial infection of nervous system except viral meningitis without CC/MCC,99,MS-DRG,99,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Seizures with MCC,100,MS-DRG,100,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Seizures without MCC,101,MS-DRG,101,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Headaches with MCC,102,MS-DRG,102,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Headaches without MCC,103,MS-DRG,103,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Orbital procedures with CC/MCC,113,MS-DRG,113,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Orbital procedures without CC/MCC,114,MS-DRG,114,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Extraocular procedures except orbit,115,MS-DRG,115,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Intraocular procedures with CC/MCC,116,MS-DRG,116,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Intraocular procedures without CC/MCC,117,MS-DRG,117,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Acute major eye infections with CC/MCC,121,MS-DRG,121,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Acute major eye infections without CC/MCC,122,MS-DRG,122,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Neurological eye disorders,123,MS-DRG,123,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other disorders of the eye with MCC or thrombolytic agent,124,MS-DRG,124,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other disorders of the eye without MCC,125,MS-DRG,125,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Sinus and mastoid procedures with CC/MCC,135,MS-DRG,135,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Sinus and mastoid procedures without CC/MCC,136,MS-DRG,136,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Mouth procedures with CC/MCC,137,MS-DRG,137,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Mouth procedures without CC/MCC,138,MS-DRG,138,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Salivary gland procedures,139,MS-DRG,139,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major head and neck procedures with MCC,140,MS-DRG,140,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,177508.29,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major head and neck procedures with CC,141,MS-DRG,141,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major head and neck procedures without CC/MCC,142,MS-DRG,142,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with MCC",143,MS-DRG,143,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with CC",144,MS-DRG,144,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures without CC/MCC",145,MS-DRG,145,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Ear, nose, mouth and throat malignancy with MCC*",146,MS-DRG,146,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Ear, nose, mouth and throat malignancy with CC*",147,MS-DRG,147,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Ear, nose, mouth and throat malignancy without CC/MCC*",148,MS-DRG,148,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Dysequilibrium,149,MS-DRG,149,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Epistaxis with MCC,150,MS-DRG,150,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Epistaxis without MCC,151,MS-DRG,151,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Otitis media and URI with MCC,152,MS-DRG,152,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Otitis media and URI without MCC,153,MS-DRG,153,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Other ear, nose, mouth and throat diagnoses with MCC",154,MS-DRG,154,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Other ear, nose, mouth and throat diagnoses with CC",155,MS-DRG,155,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Other ear, nose, mouth and throat diagnoses without CC/MCC",156,MS-DRG,156,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Dental and oral diseases with MCC,157,MS-DRG,157,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Dental and oral diseases with CC,158,MS-DRG,158,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Dental and oral diseases without CC/MCC,159,MS-DRG,159,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major chest procedures with MCC,163,MS-DRG,163,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,202666.58,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major chest procedures with CC,164,MS-DRG,164,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,202666.58,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major chest procedures without CC/MCC,165,MS-DRG,165,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,202666.58,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other respiratory system O.R. procedures with MCC,166,MS-DRG,166,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,177508.29,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other respiratory system O.R. procedures with CC,167,MS-DRG,167,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other respiratory system O.R. procedures without CC/MCC,168,MS-DRG,168,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism,173,MS-DRG,173,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Pulmonary embolism with MCC or acute cor pulmonale,175,MS-DRG,175,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Pulmonary embolism without MCC,176,MS-DRG,176,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory infections and inflammations with MCC*,177,MS-DRG,177,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,62918.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory infections and inflammations with CC*,178,MS-DRG,178,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,43491.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory infections and inflammations without CC/MCC*,179,MS-DRG,179,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,42251.85,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory neoplasms with MCC*,180,MS-DRG,180,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory neoplasms with CC*,181,MS-DRG,181,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory neoplasms without CC/MCC*,182,MS-DRG,182,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major chest trauma with MCC,183,MS-DRG,183,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major chest trauma with CC,184,MS-DRG,184,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major chest trauma without CC/MCC,185,MS-DRG,185,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Pleural effusion with MCC*,186,MS-DRG,186,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,66071.13,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Pleural effusion with CC*,187,MS-DRG,187,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Pleural effusion without CC/MCC*,188,MS-DRG,188,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Pulmonary edema and respiratory failure,189,MS-DRG,189,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72046.99,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Chronic obstructive pulmonary disease with MCC*,190,MS-DRG,190,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,20971.383,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Chronic obstructive pulmonary disease with CC*,191,MS-DRG,191,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Chronic obstructive pulmonary disease without CC/MCC*,192,MS-DRG,192,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Simple pneumonia and pleurisy with MCC,193,MS-DRG,193,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,59421.93,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Simple pneumonia and pleurisy with CC,194,MS-DRG,194,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,39604.42,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Simple pneumonia and pleurisy without CC/MCC,195,MS-DRG,195,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Interstitial lung disease with MCC*,196,MS-DRG,196,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Interstitial lung disease with CC*,197,MS-DRG,197,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Interstitial lung disease without CC/MCC*,198,MS-DRG,198,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Pneumothorax with MCC,199,MS-DRG,199,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Pneumothorax with CC,200,MS-DRG,200,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,21869.927,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Pneumothorax without CC/MCC,201,MS-DRG,201,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,21869.927,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Bronchitis and asthma with CC/MCC,202,MS-DRG,202,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,40508.305,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Bronchitis and asthma without CC/MCC,203,MS-DRG,203,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,15339.435,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory signs and symptoms,204,MS-DRG,204,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other respiratory system diagnoses with MCC,205,MS-DRG,205,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,112102.84,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other respiratory system diagnoses without MCC,206,MS-DRG,206,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory system diagnosis with ventilator support >96 hours,207,MS-DRG,207,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,147720.8,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Respiratory system diagnosis with ventilator support <=96 hours,208,MS-DRG,208,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,81481.35,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Concomitant aortic and mitral valve procedures,212,MS-DRG,212,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other heart assist system implant,215,MS-DRG,215,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC,216,MS-DRG,216,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with CC,217,MS-DRG,217,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization without CC/MCC,218,MS-DRG,218,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with MCC,219,MS-DRG,219,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with CC,220,MS-DRG,220,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization without CC/MCC,221,MS-DRG,221,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other cardiothoracic procedures with MCC,228,MS-DRG,228,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other cardiothoracic procedures without MCC,229,MS-DRG,229,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Coronary bypass with PTCA with MCC,231,MS-DRG,231,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Coronary bypass with PTCA without MCC,232,MS-DRG,232,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Coronary bypass with cardiac catheterization or open ablation with MCC,233,MS-DRG,233,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Coronary bypass with cardiac catheterization or open ablation without MCC,234,MS-DRG,234,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Coronary bypass without cardiac catheterization with MCC,235,MS-DRG,235,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Coronary bypass without cardiac catheterization without MCC,236,MS-DRG,236,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Amputation for circulatory system disorders except upper limb and toe with MCC,239,MS-DRG,239,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Amputation for circulatory system disorders except upper limb and toe with CC,240,MS-DRG,240,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Amputation for circulatory system disorders except upper limb and toe without CC/MCC,241,MS-DRG,241,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Permanent cardiac pacemaker implant with MCC,242,MS-DRG,242,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Permanent cardiac pacemaker implant with CC,243,MS-DRG,243,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Permanent cardiac pacemaker implant without CC/MCC,244,MS-DRG,244,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
AICD generator procedures,245,MS-DRG,245,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,40774.659,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Percutaneous cardiovascular procedures without intraluminal device with MCC,250,MS-DRG,250,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Percutaneous cardiovascular procedures without intraluminal device without MCC,251,MS-DRG,251,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other vascular procedures with MCC,252,MS-DRG,252,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other vascular procedures with CC,253,MS-DRG,253,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other vascular procedures without CC/MCC,254,MS-DRG,254,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Upper limb and toe amputation for circulatory system disorders with MCC,255,MS-DRG,255,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Upper limb and toe amputation for circulatory system disorders with CC,256,MS-DRG,256,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Upper limb and toe amputation for circulatory system disorders without CC/MCC,257,MS-DRG,257,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac pacemaker device replacement with MCC,258,MS-DRG,258,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac pacemaker device replacement without MCC,259,MS-DRG,259,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac pacemaker revision except device replacement with MCC,260,MS-DRG,260,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac pacemaker revision except device replacement with CC,261,MS-DRG,261,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac pacemaker revision except device replacement without CC/MCC,262,MS-DRG,262,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Vein ligation and stripping,263,MS-DRG,263,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other circulatory system O.R. procedures,264,MS-DRG,264,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
AICD lead procedures,265,MS-DRG,265,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Endovascular cardiac valve replacement and supplement procedures with MCC,266,MS-DRG,266,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Endovascular cardiac valve replacement and supplement procedures without MCC,267,MS-DRG,267,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Aortic and heart assist procedures except pulsation balloon with MCC,268,MS-DRG,268,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Aortic and heart assist procedures except pulsation balloon without MCC,269,MS-DRG,269,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other major cardiovascular procedures with MCC,270,MS-DRG,270,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other major cardiovascular procedures with CC,271,MS-DRG,271,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other major cardiovascular procedures without CC/MCC,272,MS-DRG,272,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Percutaneous and other intracardiac procedures with MCC,273,MS-DRG,273,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Percutaneous and other intracardiac procedures without MCC,274,MS-DRG,274,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac defibrillator implant with cardiac catheterization and MCC,275,MS-DRG,275,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac defibrillator implant with MCC or carotid sinus neurostimulator,276,MS-DRG,276,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac defibrillator implant without MCC,277,MS-DRG,277,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures with MCC,278,MS-DRG,278,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures without MCC,279,MS-DRG,279,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Acute myocardial infarction, discharged alive with MCC",280,MS-DRG,280,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,63798.62,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Acute myocardial infarction, discharged alive with CC",281,MS-DRG,281,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Acute myocardial infarction, discharged alive without CC/MCC",282,MS-DRG,282,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Acute myocardial infarction, expired with MCC",283,MS-DRG,283,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Acute myocardial infarction, expired with CC",284,MS-DRG,284,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Acute myocardial infarction, expired without CC/MCC",285,MS-DRG,285,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization with MCC",286,MS-DRG,286,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization without MCC",287,MS-DRG,287,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Acute and subacute endocarditis with MCC,288,MS-DRG,288,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,79476.64,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Acute and subacute endocarditis with CC,289,MS-DRG,289,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,54456.07,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Acute and subacute endocarditis without CC/MCC,290,MS-DRG,290,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48748.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Heart failure and shock with MCC,291,MS-DRG,291,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,59345.41,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Heart failure and shock with CC,292,MS-DRG,292,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,42060.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Heart failure and shock without CC/MCC,293,MS-DRG,293,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,42060.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Deep vein thrombophlebitis with CC/MCC,294,MS-DRG,294,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Deep vein thrombophlebitis without CC/MCC,295,MS-DRG,295,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Cardiac arrest, unexplained with MCC",296,MS-DRG,296,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,59345.41,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Cardiac arrest, unexplained with CC",297,MS-DRG,297,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,42060.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Cardiac arrest, unexplained without CC/MCC",298,MS-DRG,298,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,42060.56,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Peripheral vascular disorders with MCC,299,MS-DRG,299,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,64808.62,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Peripheral vascular disorders with CC,300,MS-DRG,300,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Peripheral vascular disorders without CC/MCC,301,MS-DRG,301,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Atherosclerosis with MCC,302,MS-DRG,302,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Atherosclerosis without MCC,303,MS-DRG,303,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hypertension with MCC,304,MS-DRG,304,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hypertension without MCC,305,MS-DRG,305,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac congenital and valvular disorders with MCC,306,MS-DRG,306,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac congenital and valvular disorders without MCC,307,MS-DRG,307,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac arrhythmia and conduction disorders with MCC,308,MS-DRG,308,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac arrhythmia and conduction disorders with CC,309,MS-DRG,309,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cardiac arrhythmia and conduction disorders without CC/MCC,310,MS-DRG,310,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Angina pectoris,311,MS-DRG,311,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Syncope and collapse,312,MS-DRG,312,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Chest pain,313,MS-DRG,313,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other circulatory system diagnoses with MCC,314,MS-DRG,314,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,67570.83,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other circulatory system diagnoses with CC,315,MS-DRG,315,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,47562.03,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other circulatory system diagnoses without CC/MCC,316,MS-DRG,316,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Concomitant left atrial appendage closure and cardiac ablation,317,MS-DRG,317,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other endovascular cardiac valve procedures with MCC,319,MS-DRG,319,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other endovascular cardiac valve procedures without MCC,320,MS-DRG,320,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/intraluminal devices,321,MS-DRG,321,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Percutaneous cardiovascular procedures with intraluminal device without MCC,322,MS-DRG,322,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Coronary intravascular lithotripsy with intraluminal device with MCC,323,MS-DRG,323,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Coronary intravascular lithotripsy with intraluminal device without MCC,324,MS-DRG,324,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Coronary intravascular lithotripsy without intraluminal device,325,MS-DRG,325,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Stomach, esophageal and duodenal procedures with MCC",326,MS-DRG,326,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Stomach, esophageal and duodenal procedures with CC",327,MS-DRG,327,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Stomach, esophageal and duodenal procedures without CC/MCC",328,MS-DRG,328,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major small and large bowel procedures with MCC,329,MS-DRG,329,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major small and large bowel procedures with CC,330,MS-DRG,330,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major small and large bowel procedures without CC/MCC,331,MS-DRG,331,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Rectal resection with MCC,332,MS-DRG,332,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Rectal resection with CC,333,MS-DRG,333,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Rectal resection without CC/MCC,334,MS-DRG,334,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Peritoneal adhesiolysis with MCC,335,MS-DRG,335,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Peritoneal adhesiolysis with CC,336,MS-DRG,336,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Peritoneal adhesiolysis without CC/MCC,337,MS-DRG,337,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Minor small and large bowel procedures with MCC,344,MS-DRG,344,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Minor small and large bowel procedures with CC,345,MS-DRG,345,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Minor small and large bowel procedures without CC/MCC,346,MS-DRG,346,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Anal and stomal procedures with MCC,347,MS-DRG,347,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,68366.59,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Anal and stomal procedures with CC,348,MS-DRG,348,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Anal and stomal procedures without CC/MCC,349,MS-DRG,349,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Inguinal and femoral hernia procedures with MCC,350,MS-DRG,350,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,68366.59,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Inguinal and femoral hernia procedures with CC,351,MS-DRG,351,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Inguinal and femoral hernia procedures without CC/MCC,352,MS-DRG,352,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hernia procedures except inguinal and femoral with MCC,353,MS-DRG,353,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hernia procedures except inguinal and femoral with CC,354,MS-DRG,354,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hernia procedures except inguinal and femoral without CC/MCC,355,MS-DRG,355,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other digestive system O.R. procedures with MCC,356,MS-DRG,356,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,106800.32,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other digestive system O.R. procedures with CC,357,MS-DRG,357,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other digestive system O.R. procedures without CC/MCC,358,MS-DRG,358,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major esophageal disorders with MCC*,368,MS-DRG,368,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major esophageal disorders with CC*,369,MS-DRG,369,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major esophageal disorders without CC/MCC*,370,MS-DRG,370,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major gastrointestinal disorders and peritoneal infections with MCC,371,MS-DRG,371,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,68366.59,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major gastrointestinal disorders and peritoneal infections with CC,372,MS-DRG,372,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major gastrointestinal disorders and peritoneal infections without CC/MCC,373,MS-DRG,373,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Digestive malignancy with MCC*,374,MS-DRG,374,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Digestive malignancy with CC*,375,MS-DRG,375,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Digestive malignancy without CC/MCC*,376,MS-DRG,376,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Gastrointestinal hemorrhage with MCC,377,MS-DRG,377,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,54425.47,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Gastrointestinal hemorrhage with CC,378,MS-DRG,378,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Gastrointestinal hemorrhage without CC/MCC,379,MS-DRG,379,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Complicated peptic ulcer with MCC,380,MS-DRG,380,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,73278.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Complicated peptic ulcer with CC,381,MS-DRG,381,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Complicated peptic ulcer without CC/MCC,382,MS-DRG,382,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Uncomplicated peptic ulcer with MCC,383,MS-DRG,383,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Uncomplicated peptic ulcer without MCC,384,MS-DRG,384,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Inflammatory bowel disease with MCC,385,MS-DRG,385,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Inflammatory bowel disease with CC,386,MS-DRG,386,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Inflammatory bowel disease without CC/MCC,387,MS-DRG,387,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Gastrointestinal obstruction with MCC,388,MS-DRG,388,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,75604.95,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Gastrointestinal obstruction with CC,389,MS-DRG,389,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Gastrointestinal obstruction without CC/MCC,390,MS-DRG,390,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC",391,MS-DRG,391,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,59253.6,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC",392,MS-DRG,392,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,47929.3,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other digestive system diagnoses with MCC,393,MS-DRG,393,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,77739.74,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other digestive system diagnoses with CC,394,MS-DRG,394,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other digestive system diagnoses without CC/MCC,395,MS-DRG,395,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Appendix procedures with MCC,397,MS-DRG,397,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,68366.59,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Appendix procedures with CC,398,MS-DRG,398,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Appendix procedures without CC/MCC,399,MS-DRG,399,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Single level combined anterior and posterior spinal fusion except cervical,402,MS-DRG,402,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Pancreas, liver and shunt procedures with MCC",405,MS-DRG,405,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,40508.305,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Pancreas, liver and shunt procedures with CC",406,MS-DRG,406,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Pancreas, liver and shunt procedures without CC/MCC",407,MS-DRG,407,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with MCC,408,MS-DRG,408,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with CC,409,MS-DRG,409,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. without CC/MCC,410,MS-DRG,410,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cholecystectomy with C.D.E. with MCC,411,MS-DRG,411,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,73278.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cholecystectomy with C.D.E. with CC,412,MS-DRG,412,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cholecystectomy with C.D.E. without CC/MCC,413,MS-DRG,413,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with MCC,414,MS-DRG,414,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,73278.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with CC,415,MS-DRG,415,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. without CC/MCC,416,MS-DRG,416,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Laparoscopic cholecystectomy without C.D.E. with MCC,417,MS-DRG,417,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,73278.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Laparoscopic cholecystectomy without C.D.E. with CC,418,MS-DRG,418,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Laparoscopic cholecystectomy without C.D.E. without CC/MCC,419,MS-DRG,419,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hepatobiliary diagnostic procedures with MCC,420,MS-DRG,420,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hepatobiliary diagnostic procedures with CC,421,MS-DRG,421,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hepatobiliary diagnostic procedures without CC/MCC,422,MS-DRG,422,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other hepatobiliary or pancreas O.R. procedures with MCC,423,MS-DRG,423,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other hepatobiliary or pancreas O.R. procedures with CC,424,MS-DRG,424,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other hepatobiliary or pancreas O.R. procedures without CC/MCC,425,MS-DRG,425,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,426,MS-DRG,426,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,81343.62,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical with CC,427,MS-DRG,427,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,81343.62,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical without CC/MCC,428,MS-DRG,428,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,67111.73,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Combined anterior and posterior cervical spinal fusion with MCC,429,MS-DRG,429,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,81343.62,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Combined anterior and posterior cervical spinal fusion without MCC,430,MS-DRG,430,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cirrhosis and alcoholic hepatitis with MCC,432,MS-DRG,432,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,56468.43,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cirrhosis and alcoholic hepatitis with CC,433,MS-DRG,433,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cirrhosis and alcoholic hepatitis without CC/MCC,434,MS-DRG,434,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Malignancy of hepatobiliary system or pancreas with MCC,435,MS-DRG,435,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Malignancy of hepatobiliary system or pancreas with CC,436,MS-DRG,436,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Malignancy of hepatobiliary system or pancreas without CC/MCC,437,MS-DRG,437,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Disorders of pancreas except malignancy with MCC,438,MS-DRG,438,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,80165.28,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Disorders of pancreas except malignancy with CC,439,MS-DRG,439,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Disorders of pancreas except malignancy without CC/MCC,440,MS-DRG,440,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCC",441,MS-DRG,441,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,71243.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CC",442,MS-DRG,442,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without CC/MCC",443,MS-DRG,443,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Disorders of the biliary tract with MCC*,444,MS-DRG,444,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,58190.03,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Disorders of the biliary tract with CC*,445,MS-DRG,445,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53147.66,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Disorders of the biliary tract without CC/MCC*,446,MS-DRG,446,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,447,MS-DRG,447,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,1.0631,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Multiple level spinal fusion except cervical without MCC,448,MS-DRG,448,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,1.0631,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,450,MS-DRG,450,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,67111.74,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Single Level Spinal Fusion Except Cervical without MCC,451,MS-DRG,451,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with MCC",456,MS-DRG,456,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with CC",457,MS-DRG,457,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions without CC/MCC",458,MS-DRG,458,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Bilateral or multiple major joint procedures of lower extremity with MCC,461,MS-DRG,461,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,67111.74,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Bilateral or multiple major joint procedures of lower extremity without MCC,462,MS-DRG,462,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with MCC*,463,MS-DRG,463,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with CC*,464,MS-DRG,464,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72972.82,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders without CC/MCC*,465,MS-DRG,465,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,70057.58,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Revision of hip or knee replacement with MCC,466,MS-DRG,466,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Revision of hip or knee replacement with CC,467,MS-DRG,467,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Revision of hip or knee replacement without CC/MCC,468,MS-DRG,468,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity with MCC or total ankle replacement,469,MS-DRG,469,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity without MCC,470,MS-DRG,470,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cervical spinal fusion with MCC,471,MS-DRG,471,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cervical spinal fusion with CC,472,MS-DRG,472,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cervical spinal fusion without CC/MCC,473,MS-DRG,473,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with MCC,474,MS-DRG,474,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with CC,475,MS-DRG,475,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders without CC/MCC,476,MS-DRG,476,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Biopsies of musculoskeletal system and connective tissue with MCC,477,MS-DRG,477,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Biopsies of musculoskeletal system and connective tissue with CC,478,MS-DRG,478,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,28146.902,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Biopsies of musculoskeletal system and connective tissue without CC/MCC,479,MS-DRG,479,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,28146.902,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hip and femur procedures except major joint with MCC,480,MS-DRG,480,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hip and femur procedures except major joint with CC,481,MS-DRG,481,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hip and femur procedures except major joint without CC/MCC,482,MS-DRG,482,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major joint or limb reattachment procedures of upper extremities,483,MS-DRG,483,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Knee procedures with principal diagnosis of infection with MCC,485,MS-DRG,485,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Knee procedures with principal diagnosis of infection with CC,486,MS-DRG,486,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Knee procedures with principal diagnosis of infection without CC/MCC,487,MS-DRG,487,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Knee procedures without principal diagnosis of infection with CC/MCC,488,MS-DRG,488,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Knee procedures without principal diagnosis of infection without CC/MCC,489,MS-DRG,489,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,51693.87,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with MCC",492,MS-DRG,492,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with CC",493,MS-DRG,493,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur without CC/MCC",494,MS-DRG,494,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Local excision and removal of internal fixation devices except hip and femur with MCC,495,MS-DRG,495,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Local excision and removal of internal fixation devices except hip and femur with CC,496,MS-DRG,496,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Local excision and removal of internal fixation devices except hip and femur without CC/MCC,497,MS-DRG,497,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Local excision and removal of internal fixation devices of hip and femur with CC/MCC,498,MS-DRG,498,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Local excision and removal of internal fixation devices of hip and femur without CC/MCC,499,MS-DRG,499,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Soft tissue procedures with MCC,500,MS-DRG,500,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,94244.13,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Soft tissue procedures with CC,501,MS-DRG,501,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Soft tissue procedures without CC/MCC,502,MS-DRG,502,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,67111.74,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Foot procedures with MCC,503,MS-DRG,503,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Foot procedures with CC,504,MS-DRG,504,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Foot procedures without CC/MCC,505,MS-DRG,505,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major thumb or joint procedures,506,MS-DRG,506,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major shoulder or elbow joint procedures with CC/MCC,507,MS-DRG,507,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major shoulder or elbow joint procedures without CC/MCC,508,MS-DRG,508,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Arthroscopy,509,MS-DRG,509,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with MCC",510,MS-DRG,510,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with CC",511,MS-DRG,511,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures without CC/MCC",512,MS-DRG,512,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures with CC/MCC",513,MS-DRG,513,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures without CC/MCC",514,MS-DRG,514,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with MCC,515,MS-DRG,515,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,91742.07,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with CC,516,MS-DRG,516,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures without CC/MCC,517,MS-DRG,517,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Back and neck procedures except spinal fusion with MCC or disc device or neurostimulator,518,MS-DRG,518,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Back and neck procedures except spinal fusion with CC,519,MS-DRG,519,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Back and neck procedures except spinal fusion without CC/MCC,520,MS-DRG,520,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hip replacement with principal diagnosis of hip fracture with MCC,521,MS-DRG,521,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hip replacement with principal diagnosis of hip fracture without MCC,522,MS-DRG,522,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Fractures of femur with MCC,533,MS-DRG,533,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Fractures of femur without MCC,534,MS-DRG,534,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Fractures of hip and pelvis with MCC,535,MS-DRG,535,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Fractures of hip and pelvis without MCC,536,MS-DRG,536,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh with CC/MCC",537,MS-DRG,537,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh without CC/MCC",538,MS-DRG,538,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Osteomyelitis with MCC*,539,MS-DRG,539,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,74166.46,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Osteomyelitis with CC*,540,MS-DRG,540,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,54425.47,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Osteomyelitis without CC/MCC*,541,MS-DRG,541,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,51693.86,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with MCC*,542,MS-DRG,542,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with CC*,543,MS-DRG,543,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy without CC/MCC*,544,MS-DRG,544,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Connective tissue disorders with MCC,545,MS-DRG,545,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Connective tissue disorders with CC,546,MS-DRG,546,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Connective tissue disorders without CC/MCC,547,MS-DRG,547,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46988.16,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Septic arthritis with MCC,548,MS-DRG,548,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,65145.29,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Septic arthritis with CC,549,MS-DRG,549,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Septic arthritis without CC/MCC,550,MS-DRG,550,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Medical back problems with MCC,551,MS-DRG,551,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,99921.58,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Medical back problems without MCC,552,MS-DRG,552,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Bone diseases and arthropathies with MCC,553,MS-DRG,553,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Bone diseases and arthropathies without MCC,554,MS-DRG,554,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue with MCC,555,MS-DRG,555,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue without MCC,556,MS-DRG,556,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Tendonitis, myositis and bursitis with MCC",557,MS-DRG,557,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,69284.76,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Tendonitis, myositis and bursitis without MCC",558,MS-DRG,558,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53645.01,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Aftercare, musculoskeletal system and connective tissue with MCC*",559,MS-DRG,559,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,61671.48,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Aftercare, musculoskeletal system and connective tissue with CC*",560,MS-DRG,560,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48082.33,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Aftercare, musculoskeletal system and connective tissue without CC/MCC*",561,MS-DRG,561,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46988.16,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCC",562,MS-DRG,562,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCC",563,MS-DRG,563,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46988.16,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other musculoskeletal system and connective tissue diagnoses with MCC,564,MS-DRG,564,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,67111.74,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other musculoskeletal system and connective tissue diagnoses with CC,565,MS-DRG,565,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other musculoskeletal system and connective tissue diagnoses without CC/MCC,566,MS-DRG,566,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Skin debridement with MCC*,570,MS-DRG,570,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,90081.68,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Skin debridement with CC*,571,MS-DRG,571,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,65336.58,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Skin debridement without CC/MCC*,572,MS-DRG,572,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,65336.58,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Skin graft for skin ulcer or cellulitis with MCC,573,MS-DRG,573,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,106394.79,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Skin graft for skin ulcer or cellulitis with CC,574,MS-DRG,574,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Skin graft for skin ulcer or cellulitis without CC/MCC,575,MS-DRG,575,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Skin graft except for skin ulcer or cellulitis with MCC*,576,MS-DRG,576,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Skin graft except for skin ulcer or cellulitis with CC*,577,MS-DRG,577,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Skin graft except for skin ulcer or cellulitis without CC/MCC*,578,MS-DRG,578,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Other skin, subcutaneous tissue and breast procedures with MCC",579,MS-DRG,579,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,103793.26,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Other skin, subcutaneous tissue and breast procedures with CC",580,MS-DRG,580,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,85299.47,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Other skin, subcutaneous tissue and breast procedures without CC/MCC",581,MS-DRG,581,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,85299.47,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Mastectomy for malignancy with CC/MCC,582,MS-DRG,582,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,103793.26,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Mastectomy for malignancy without CC/MCC,583,MS-DRG,583,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,85299.47,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Breast biopsy, local excision and other breast procedures with CC/MCC",584,MS-DRG,584,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,65336.58,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Breast biopsy, local excision and other breast procedures without CC/MCC",585,MS-DRG,585,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Skin ulcers with MCC,592,MS-DRG,592,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,67333.63,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Skin ulcers with CC,593,MS-DRG,593,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53667.96,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Skin ulcers without CC/MCC,594,MS-DRG,594,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major skin disorders with MCC,595,MS-DRG,595,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major skin disorders without MCC,596,MS-DRG,596,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Malignant breast disorders with MCC,597,MS-DRG,597,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Malignant breast disorders with CC,598,MS-DRG,598,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Malignant breast disorders without CC/MCC,599,MS-DRG,599,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Non-malignant breast disorders with CC/MCC*,600,MS-DRG,600,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Non-malignant breast disorders without CC/MCC*,601,MS-DRG,601,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cellulitis with MCC,602,MS-DRG,602,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,55068.2,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cellulitis without MCC,603,MS-DRG,603,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36842.21,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Trauma to the skin, subcutaneous tissue and breast with MCC",604,MS-DRG,604,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Trauma to the skin, subcutaneous tissue and breast without MCC",605,MS-DRG,605,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Minor skin disorders with MCC,606,MS-DRG,606,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Minor skin disorders without MCC,607,MS-DRG,607,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Adrenal and pituitary procedures with CC/MCC,614,MS-DRG,614,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Adrenal and pituitary procedures without CC/MCC,615,MS-DRG,615,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with MCC",616,MS-DRG,616,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with CC",617,MS-DRG,617,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders without CC/MCC",618,MS-DRG,618,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
O.R. procedures for obesity with MCC,619,MS-DRG,619,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,100051.65,case rate,22000,120000,Lesser of BC or rate,,,,,,,
O.R. procedures for obesity with CC,620,MS-DRG,620,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72590.25,case rate,22000,120000,Lesser of BC or rate,,,,,,,
O.R. procedures for obesity without CC/MCC,621,MS-DRG,621,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with MCC",622,MS-DRG,622,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,100051.65,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with CC",623,MS-DRG,623,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72590.25,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders without CC/MCC",624,MS-DRG,624,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with MCC",625,MS-DRG,625,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,30309.826,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with CC",626,MS-DRG,626,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures without CC/MCC",627,MS-DRG,627,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with MCC",628,MS-DRG,628,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,30309.826,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with CC",629,MS-DRG,629,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures without CC/MCC",630,MS-DRG,630,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Diabetes with MCC,637,MS-DRG,637,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,67654.99,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Diabetes with CC,638,MS-DRG,638,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53843.95,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Diabetes without CC/MCC,639,MS-DRG,639,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCC",640,MS-DRG,640,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,74862.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCC",641,MS-DRG,641,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,47049.37,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Inborn and other disorders of metabolism,642,MS-DRG,642,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Endocrine disorders with MCC*,643,MS-DRG,643,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Endocrine disorders with CC*,644,MS-DRG,644,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Endocrine disorders without CC/MCC*,645,MS-DRG,645,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major bladder procedures with MCC,653,MS-DRG,653,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,91596.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major bladder procedures with CC,654,MS-DRG,654,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,80073.46,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major bladder procedures without CC/MCC,655,MS-DRG,655,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and ureter procedures for neoplasm with MCC,656,MS-DRG,656,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and ureter procedures for neoplasm with CC,657,MS-DRG,657,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and ureter procedures for neoplasm without CC/MCC,658,MS-DRG,658,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and ureter procedures for non-neoplasm with MCC*,659,MS-DRG,659,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and ureter procedures for non-neoplasm with CC*,660,MS-DRG,660,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and ureter procedures for non-neoplasm without CC/MCC*,661,MS-DRG,661,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Minor bladder procedures with MCC,662,MS-DRG,662,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Minor bladder procedures with CC,663,MS-DRG,663,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Minor bladder procedures without CC/MCC,664,MS-DRG,664,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Prostatectomy with MCC,665,MS-DRG,665,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,91596.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Prostatectomy with CC,666,MS-DRG,666,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,80073.46,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Prostatectomy without CC/MCC,667,MS-DRG,667,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Transurethral procedures with MCC,668,MS-DRG,668,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Transurethral procedures with CC,669,MS-DRG,669,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Transurethral procedures without CC/MCC,670,MS-DRG,670,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Urethral procedures with CC/MCC,671,MS-DRG,671,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Urethral procedures without CC/MCC,672,MS-DRG,672,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other kidney and urinary tract procedures with MCC*,673,MS-DRG,673,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,91596.69,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other kidney and urinary tract procedures with CC*,674,MS-DRG,674,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,80073.46,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other kidney and urinary tract procedures without CC/MCC*,675,MS-DRG,675,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,80073.46,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Renal failure with MCC,682,MS-DRG,682,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,66775.07,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Renal failure with CC,683,MS-DRG,683,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,46314.82,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Renal failure without CC/MCC,684,MS-DRG,684,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and urinary tract neoplasms with MCC,686,MS-DRG,686,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and urinary tract neoplasms with CC,687,MS-DRG,687,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and urinary tract neoplasms without CC/MCC,688,MS-DRG,688,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and urinary tract infections with MCC,689,MS-DRG,689,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48342.49,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and urinary tract infections without MCC,690,MS-DRG,690,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,35962.28,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Urinary stones with MCC,693,MS-DRG,693,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Urinary stones without MCC,694,MS-DRG,694,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and urinary tract signs and symptoms with MCC,695,MS-DRG,695,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Kidney and urinary tract signs and symptoms without MCC,696,MS-DRG,696,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Urethral stricture,697,MS-DRG,697,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other kidney and urinary tract diagnoses with MCC,698,MS-DRG,698,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,67746.82,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other kidney and urinary tract diagnoses with CC,699,MS-DRG,699,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,47363.09,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other kidney and urinary tract diagnoses without CC/MCC,700,MS-DRG,700,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major male pelvic procedures with CC/MCC,707,MS-DRG,707,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major male pelvic procedures without CC/MCC,708,MS-DRG,708,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Penis procedures with CC/MCC,709,MS-DRG,709,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Penis procedures without CC/MCC,710,MS-DRG,710,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Testes procedures with CC/MCC,711,MS-DRG,711,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Testes procedures without CC/MCC,712,MS-DRG,712,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Transurethral prostatectomy with CC/MCC,713,MS-DRG,713,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,30309.826,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Transurethral prostatectomy without CC/MCC,714,MS-DRG,714,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other male reproductive system O.R. procedures for malignancy with CC/MCC,715,MS-DRG,715,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other male reproductive system O.R. procedures for malignancy without CC/MCC,716,MS-DRG,716,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other male reproductive system O.R. procedures except malignancy with CC/MCC,717,MS-DRG,717,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other male reproductive system O.R. procedures except malignancy without CC/MCC,718,MS-DRG,718,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Malignancy, male reproductive system with MCC",722,MS-DRG,722,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,61794.07,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Malignancy, male reproductive system with CC",723,MS-DRG,723,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Malignancy, male reproductive system without CC/MCC",724,MS-DRG,724,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,50278,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Benign prostatic hypertrophy with MCC,725,MS-DRG,725,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,50278.46,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Benign prostatic hypertrophy without MCC,726,MS-DRG,726,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Inflammation of the male reproductive system with MCC,727,MS-DRG,727,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,61794.07,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Inflammation of the male reproductive system without MCC,728,MS-DRG,728,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,50278,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other male reproductive system diagnoses with CC/MCC,729,MS-DRG,729,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other male reproductive system diagnoses without CC/MCC,730,MS-DRG,730,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC",734,MS-DRG,734,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC",735,MS-DRG,735,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with MCC,736,MS-DRG,736,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with CC,737,MS-DRG,737,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy without CC/MCC,738,MS-DRG,738,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with MCC,739,MS-DRG,739,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with CC,740,MS-DRG,740,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy without CC/MCC,741,MS-DRG,741,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Uterine and adnexa procedures for non-malignancy with CC/MCC,742,MS-DRG,742,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Uterine and adnexa procedures for non-malignancy without CC/MCC,743,MS-DRG,743,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"D&C, conization, laparoscopy and tubal interruption with CC/MCC",744,MS-DRG,744,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"D&C, conization, laparoscopy and tubal interruption without CC/MCC",745,MS-DRG,745,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Vagina, cervix and vulva procedures with CC/MCC",746,MS-DRG,746,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Vagina, cervix and vulva procedures without CC/MCC",747,MS-DRG,747,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Female reproductive system reconstructive procedures,748,MS-DRG,748,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other female reproductive system O.R. procedures with CC/MCC,749,MS-DRG,749,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other female reproductive system O.R. procedures without CC/MCC,750,MS-DRG,750,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Malignancy, female reproductive system with MCC",754,MS-DRG,754,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Malignancy, female reproductive system with CC",755,MS-DRG,755,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Malignancy, female reproductive system without CC/MCC",756,MS-DRG,756,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Infections, female reproductive system with MCC",757,MS-DRG,757,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,29854.136,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Infections, female reproductive system with CC",758,MS-DRG,758,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Infections, female reproductive system without CC/MCC",759,MS-DRG,759,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Menstrual and other female reproductive system disorders with CC/MCC,760,MS-DRG,760,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Menstrual and other female reproductive system disorders without CC/MCC,761,MS-DRG,761,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Vaginal delivery with O.R. procedures except sterilization and/or D&C,768,MS-DRG,768,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Postpartum and post abortion diagnoses with O.R. procedures,769,MS-DRG,769,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Abortion with D&C, aspiration curettage or hysterotomy",770,MS-DRG,770,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Postpartum and post abortion diagnoses without O.R. procedures,776,MS-DRG,776,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Abortion without D&C,779,MS-DRG,779,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cesarean section with sterilization with MCC,783,MS-DRG,783,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cesarean section with sterilization with CC,784,MS-DRG,784,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,90613.37,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cesarean section with sterilization without CC/MCC,785,MS-DRG,785,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cesarean section without sterilization with MCC,786,MS-DRG,786,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cesarean section without sterilization with CC,787,MS-DRG,787,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Cesarean section without sterilization without CC/MCC,788,MS-DRG,788,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Neonates, died or transferred to another acute care facility",789,MS-DRG,789,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Extreme immaturity or respiratory distress syndrome, neonate",790,MS-DRG,790,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Prematurity with major problems,791,MS-DRG,791,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Prematurity without major problems,792,MS-DRG,792,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48921.03,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Full term neonate with major problems,793,MS-DRG,793,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Neonate with other significant problems,794,MS-DRG,794,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48921.03,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Splenic procedures with MCC,799,MS-DRG,799,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,106800.6,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Splenic procedures with CC,800,MS-DRG,800,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48921.03,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Splenic procedures without CC/MCC,801,MS-DRG,801,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures of the blood and blood forming organs with MCC,802,MS-DRG,802,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures of the blood and blood forming organs with CC,803,MS-DRG,803,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures of the blood and blood forming organs without CC/MCC,804,MS-DRG,804,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with MCC,808,MS-DRG,808,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with CC,809,MS-DRG,809,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without CC/MCC,810,MS-DRG,810,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Red blood cell disorders with MCC,811,MS-DRG,811,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Red blood cell disorders without MCC,812,MS-DRG,812,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Coagulation disorders,813,MS-DRG,813,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Reticuloendothelial and immunity disorders with MCC*,814,MS-DRG,814,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Reticuloendothelial and immunity disorders with CC*,815,MS-DRG,815,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Reticuloendothelial and immunity disorders without CC/MCC*,816,MS-DRG,816,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other antepartum diagnoses with O.R. procedures with MCC,817,MS-DRG,817,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,40508.305,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other antepartum diagnoses with O.R. procedures with CC,818,MS-DRG,818,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other antepartum diagnoses with O.R. procedures without CC/MCC,819,MS-DRG,819,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and leukemia with major O.R. procedures with MCC,820,MS-DRG,820,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and leukemia with major O.R. procedures with CC,821,MS-DRG,821,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and leukemia with major O.R. procedures without CC/MCC,822,MS-DRG,822,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and non-acute leukemia with other procedures with MCC,823,MS-DRG,823,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and non-acute leukemia with other procedures with CC,824,MS-DRG,824,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and non-acute leukemia with other procedures without CC/MCC,825,MS-DRG,825,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with MCC,826,MS-DRG,826,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with CC,827,MS-DRG,827,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures without CC/MCC,828,MS-DRG,828,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures with CC/MCC,829,MS-DRG,829,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures without CC/MCC,830,MS-DRG,830,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other antepartum diagnoses without O.R. procedures with MCC,831,MS-DRG,831,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other antepartum diagnoses without O.R. procedures with CC,832,MS-DRG,832,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other antepartum diagnoses without O.R. procedures without CC/MCC,833,MS-DRG,833,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Acute leukemia with MCC,834,MS-DRG,834,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Acute leukemia with CC,835,MS-DRG,835,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Acute leukemia without CC/MCC,836,MS-DRG,836,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy agent with MCC,837,MS-DRG,837,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapy agent,838,MS-DRG,838,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis without CC/MCC,839,MS-DRG,839,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and non-acute leukemia with MCC,840,MS-DRG,840,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and non-acute leukemia with CC,841,MS-DRG,841,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Lymphoma and non-acute leukemia without CC/MCC,842,MS-DRG,842,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with MCC,843,MS-DRG,843,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with CC,844,MS-DRG,844,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses without CC/MCC,845,MS-DRG,845,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with MCC,846,MS-DRG,846,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with CC,847,MS-DRG,847,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis without CC/MCC,848,MS-DRG,848,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Radiotherapy,849,MS-DRG,849,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Acute leukemia with other procedures,850,MS-DRG,850,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Infectious and parasitic diseases with O.R. procedures with MCC,853,MS-DRG,853,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,116013.09,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Infectious and parasitic diseases with O.R. procedures with CC,854,MS-DRG,854,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.07,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Infectious and parasitic diseases with O.R. procedures without CC/MCC,855,MS-DRG,855,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with MCC,856,MS-DRG,856,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,103112.54,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with CC,857,MS-DRG,857,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures without CC/MCC,858,MS-DRG,858,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Postoperative and post-traumatic infections with MCC,862,MS-DRG,862,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,70501.55,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Postoperative and post-traumatic infections without MCC,863,MS-DRG,863,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,47554.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Fever and inflammatory conditions,864,MS-DRG,864,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Viral illness with MCC,865,MS-DRG,865,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Viral illness without MCC,866,MS-DRG,866,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other infectious and parasitic diseases diagnoses with MCC,867,MS-DRG,867,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,70118.98,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other infectious and parasitic diseases diagnoses with CC,868,MS-DRG,868,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other infectious and parasitic diseases diagnoses without CC/MCC,869,MS-DRG,869,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Septicemia or severe sepsis with MV >96 hours,870,MS-DRG,870,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,158548.16,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Septicemia or severe sepsis without MV >96 hours with MCC,871,MS-DRG,871,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,64954.17,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Septicemia or severe sepsis without MV >96 hours without MCC,872,MS-DRG,872,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,43522.12,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Wound debridements for injuries with MCC,901,MS-DRG,901,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,98177.28,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Wound debridements for injuries with CC,902,MS-DRG,902,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Wound debridements for injuries without CC/MCC,903,MS-DRG,903,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Skin grafts for injuries with CC/MCC,904,MS-DRG,904,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Skin grafts for injuries without CC/MCC,905,MS-DRG,905,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Hand procedures for injuries,906,MS-DRG,906,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures for injuries with MCC*,907,MS-DRG,907,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures for injuries with CC*,908,MS-DRG,908,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures for injuries without CC/MCC*,909,MS-DRG,909,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Traumatic injury with MCC,913,MS-DRG,913,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Traumatic injury without MCC,914,MS-DRG,914,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Allergic reactions with MCC,915,MS-DRG,915,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Allergic reactions without MCC,916,MS-DRG,916,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Poisoning and toxic effects of drugs with MCC,917,MS-DRG,917,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Poisoning and toxic effects of drugs without MCC,918,MS-DRG,918,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Complications of treatment with MCC,919,MS-DRG,919,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,82055.43,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Complications of treatment with CC,920,MS-DRG,920,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52581.58,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Complications of treatment without CC/MCC,921,MS-DRG,921,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Other injury, poisoning and toxic effect diagnoses with MCC",922,MS-DRG,922,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Other injury, poisoning and toxic effect diagnoses without MCC",923,MS-DRG,923,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Extensive burns or full thickness burns with MV >96 hours with skin graft,927,MS-DRG,927,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Full thickness burn with skin graft or inhalation injury with CC/MCC,928,MS-DRG,928,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Full thickness burn with skin graft or inhalation injury without CC/MCC,929,MS-DRG,929,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Extensive burns or full thickness burns with MV >96 hours without skin graft,933,MS-DRG,933,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Full thickness burn without skin graft or inhalation injury,934,MS-DRG,934,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Non-extensive burns,935,MS-DRG,935,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
O.R. procedures with diagnoses of other contact with health services with MCC,939,MS-DRG,939,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,90701.7,case rate,22000,120000,Lesser of BC or rate,,,,,,,
O.R. procedures with diagnoses of other contact with health services with CC,940,MS-DRG,940,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
O.R. procedures with diagnoses of other contact with health services without CC/MCC,941,MS-DRG,941,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Signs and symptoms with MCC,947,MS-DRG,947,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Signs and symptoms without MCC,948,MS-DRG,948,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Aftercare with CC/MCC,949,MS-DRG,949,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,53224.31,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Aftercare without CC/MCC,950,MS-DRG,950,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other factors influencing health status,951,MS-DRG,951,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Craniotomy for multiple significant trauma,955,MS-DRG,955,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"Limb reattachment, hip and femur procedures for multiple significant trauma",956,MS-DRG,956,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures for multiple significant trauma with MCC,957,MS-DRG,957,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures for multiple significant trauma with CC,958,MS-DRG,958,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other O.R. procedures for multiple significant trauma without CC/MCC,959,MS-DRG,959,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other multiple significant trauma with MCC,963,MS-DRG,963,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other multiple significant trauma with CC,964,MS-DRG,964,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Other multiple significant trauma without CC/MCC,965,MS-DRG,965,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of BC or rate,,,,,,,
HIV with extensive O.R. procedures with MCC,969,MS-DRG,969,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
HIV with extensive O.R. procedures without MCC,970,MS-DRG,970,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of BC or rate,,,,,,,
HIV with major related condition with MCC*,974,MS-DRG,974,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,87197.28,case rate,22000,120000,Lesser of BC or rate,,,,,,,
HIV with major related condition with CC*,975,MS-DRG,975,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,68412.68,case rate,22000,120000,Lesser of BC or rate,,,,,,,
HIV with major related condition without CC/MCC*,976,MS-DRG,976,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,68412.68,case rate,22000,120000,Lesser of BC or rate,,,,,,,
HIV with or without other related condition,977,MS-DRG,977,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with MCC,981,MS-DRG,981,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,68449.825,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with CC,982,MS-DRG,982,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,96991.29,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,983,MS-DRG,983,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with MCC,987,MS-DRG,987,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,163207.97,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with CC,988,MS-DRG,988,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.07,case rate,22000,120000,Lesser of BC or rate,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,989,MS-DRG,989,LOCAL,,Inpatient,,,,,Physicians Plus ACO,Commercial,,,MS-DRG,72269.07,case rate,22000,120000,Lesser of BC or rate,,,,,,,
"ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck with major O.R. procedures",3,MS-DRG,3,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,310277.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck without major O.R. procedures",4,MS-DRG,4,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,229767.96,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCC",11,MS-DRG,11,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CC",12,MS-DRG,12,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy without CC/MCC",13,MS-DRG,13,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Chimeric antigen receptor (CAR) T-cell and other immunotherapies,18,MS-DRG,18,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with MCC,20,MS-DRG,20,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with CC,21,MS-DRG,21,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage without CC/MCC,22,MS-DRG,22,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC or chemotherapy implant or epilepsy with neurostimulator,23,MS-DRG,23,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis without MCC,24,MS-DRG,24,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Craniotomy and endovascular intracranial procedures with MCC,25,MS-DRG,25,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Craniotomy and endovascular intracranial procedures with CC,26,MS-DRG,26,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Craniotomy and endovascular intracranial procedures without CC/MCC,27,MS-DRG,27,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Spinal procedures with MCC,28,MS-DRG,28,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Spinal procedures with CC or spinal neurostimulators,29,MS-DRG,29,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Spinal procedures without CC/MCC,30,MS-DRG,30,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Ventricular shunt procedures with MCC,31,MS-DRG,31,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Ventricular shunt procedures with CC,32,MS-DRG,32,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Ventricular shunt procedures without CC/MCC,33,MS-DRG,33,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Carotid artery stent procedures with MCC,34,MS-DRG,34,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Carotid artery stent procedures with CC,35,MS-DRG,35,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Carotid artery stent procedures without CC/MCC,36,MS-DRG,36,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Extracranial procedures with MCC,37,MS-DRG,37,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Extracranial procedures with CC,38,MS-DRG,38,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Extracranial procedures without CC/MCC,39,MS-DRG,39,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with MCC",40,MS-DRG,40,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,95774.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurostimulator",41,MS-DRG,41,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures without CC/MCC",42,MS-DRG,42,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Spinal disorders and injuries with CC/MCC,52,MS-DRG,52,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,82942.79,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Spinal disorders and injuries without CC/MCC,53,MS-DRG,53,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,81228.84,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Nervous system neoplasms with MCC,54,MS-DRG,54,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Nervous system neoplasms without MCC,55,MS-DRG,55,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Degenerative nervous system disorders with MCC,56,MS-DRG,56,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,61411.33,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Degenerative nervous system disorders without MCC,57,MS-DRG,57,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,51678.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Multiple sclerosis and cerebellar ataxia with MCC,58,MS-DRG,58,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Multiple sclerosis and cerebellar ataxia with CC,59,MS-DRG,59,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,51678.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Multiple sclerosis and cerebellar ataxia without CC/MCC,60,MS-DRG,60,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,51678.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with MCC",61,MS-DRG,61,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,111192.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with CC",62,MS-DRG,62,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent without CC/MCC",63,MS-DRG,63,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Intracranial hemorrhage or cerebral infarction with MCC,64,MS-DRG,64,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,111192.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Intracranial hemorrhage or cerebral infarction with CC or tPA in 24 hours,65,MS-DRG,65,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Intracranial hemorrhage or cerebral infarction without CC/MCC,66,MS-DRG,66,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Nonspecific CVA and precerebral occlusion without infarction with MCC,67,MS-DRG,67,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,66767.42,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Nonspecific CVA and precerebral occlusion without infarction without MCC,68,MS-DRG,68,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Transient ischemia without thrombolytic,69,MS-DRG,69,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Nonspecific cerebrovascular disorders with MCC*,70,MS-DRG,70,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,66767.42,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Nonspecific cerebrovascular disorders with CC*,71,MS-DRG,71,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,45128.84,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Nonspecific cerebrovascular disorders without CC/MCC*,72,MS-DRG,72,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cranial and peripheral nerve disorders with MCC,73,MS-DRG,73,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cranial and peripheral nerve disorders without MCC,74,MS-DRG,74,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Viral meningitis with CC/MCC,75,MS-DRG,75,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Viral meningitis without CC/MCC,76,MS-DRG,76,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hypertensive encephalopathy with MCC,77,MS-DRG,77,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,68160,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hypertensive encephalopathy with CC,78,MS-DRG,78,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,537909.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hypertensive encephalopathy without CC/MCC,79,MS-DRG,79,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Nontraumatic stupor and coma with MCC,80,MS-DRG,80,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Nontraumatic stupor and coma without MCC,81,MS-DRG,81,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Traumatic stupor and coma >1 hour with MCC*,82,MS-DRG,82,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,82529.13,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Traumatic stupor and coma >1 hour with CC*,83,MS-DRG,83,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,62451.46,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Traumatic stupor and coma >1 hour without CC/MCC*,84,MS-DRG,84,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Traumatic stupor and coma <1 hour with MCC,85,MS-DRG,85,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,62451.46,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Traumatic stupor and coma <1 hour with CC,86,MS-DRG,86,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,62451.46,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Traumatic stupor and coma <1 hour without CC/MCC,87,MS-DRG,87,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Concussion with MCC,88,MS-DRG,88,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,68160,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Concussion with CC,89,MS-DRG,89,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,537909.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Concussion without CC/MCC,90,MS-DRG,90,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other disorders of nervous system with MCC,91,MS-DRG,91,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,68160,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other disorders of nervous system with CC,92,MS-DRG,92,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,537909.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other disorders of nervous system without CC/MCC,93,MS-DRG,93,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,51678.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Bacterial and tuberculous infections of nervous system with MCC*,94,MS-DRG,94,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34375.739,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Bacterial and tuberculous infections of nervous system with CC*,95,MS-DRG,95,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,62451.46,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Bacterial and tuberculous infections of nervous system without CC/MCC*,96,MS-DRG,96,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Non-bacterial infection of nervous system except viral meningitis with MCC,97,MS-DRG,97,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,75054.04,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Non-bacterial infection of nervous system except viral meningitis with CC,98,MS-DRG,98,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Non-bacterial infection of nervous system except viral meningitis without CC/MCC,99,MS-DRG,99,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Seizures with MCC,100,MS-DRG,100,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Seizures without MCC,101,MS-DRG,101,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Headaches with MCC,102,MS-DRG,102,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Headaches without MCC,103,MS-DRG,103,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Orbital procedures with CC/MCC,113,MS-DRG,113,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Orbital procedures without CC/MCC,114,MS-DRG,114,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Extraocular procedures except orbit,115,MS-DRG,115,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Intraocular procedures with CC/MCC,116,MS-DRG,116,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Intraocular procedures without CC/MCC,117,MS-DRG,117,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Acute major eye infections with CC/MCC,121,MS-DRG,121,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Acute major eye infections without CC/MCC,122,MS-DRG,122,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Neurological eye disorders,123,MS-DRG,123,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other disorders of the eye with MCC or thrombolytic agent,124,MS-DRG,124,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other disorders of the eye without MCC,125,MS-DRG,125,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Sinus and mastoid procedures with CC/MCC,135,MS-DRG,135,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Sinus and mastoid procedures without CC/MCC,136,MS-DRG,136,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Mouth procedures with CC/MCC,137,MS-DRG,137,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Mouth procedures without CC/MCC,138,MS-DRG,138,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Salivary gland procedures,139,MS-DRG,139,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major head and neck procedures with MCC,140,MS-DRG,140,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,177508.29,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major head and neck procedures with CC,141,MS-DRG,141,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major head and neck procedures without CC/MCC,142,MS-DRG,142,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with MCC",143,MS-DRG,143,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with CC",144,MS-DRG,144,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures without CC/MCC",145,MS-DRG,145,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Ear, nose, mouth and throat malignancy with MCC*",146,MS-DRG,146,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Ear, nose, mouth and throat malignancy with CC*",147,MS-DRG,147,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Ear, nose, mouth and throat malignancy without CC/MCC*",148,MS-DRG,148,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Dysequilibrium,149,MS-DRG,149,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Epistaxis with MCC,150,MS-DRG,150,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Epistaxis without MCC,151,MS-DRG,151,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Otitis media and URI with MCC,152,MS-DRG,152,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Otitis media and URI without MCC,153,MS-DRG,153,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Other ear, nose, mouth and throat diagnoses with MCC",154,MS-DRG,154,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Other ear, nose, mouth and throat diagnoses with CC",155,MS-DRG,155,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Other ear, nose, mouth and throat diagnoses without CC/MCC",156,MS-DRG,156,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Dental and oral diseases with MCC,157,MS-DRG,157,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Dental and oral diseases with CC,158,MS-DRG,158,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Dental and oral diseases without CC/MCC,159,MS-DRG,159,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major chest procedures with MCC,163,MS-DRG,163,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,202666.58,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major chest procedures with CC,164,MS-DRG,164,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,202666.58,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major chest procedures without CC/MCC,165,MS-DRG,165,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,202666.58,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other respiratory system O.R. procedures with MCC,166,MS-DRG,166,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,177508.29,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other respiratory system O.R. procedures with CC,167,MS-DRG,167,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other respiratory system O.R. procedures without CC/MCC,168,MS-DRG,168,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism,173,MS-DRG,173,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Pulmonary embolism with MCC or acute cor pulmonale,175,MS-DRG,175,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Pulmonary embolism without MCC,176,MS-DRG,176,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Respiratory infections and inflammations with MCC*,177,MS-DRG,177,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,62918.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Respiratory infections and inflammations with CC*,178,MS-DRG,178,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,43491.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Respiratory infections and inflammations without CC/MCC*,179,MS-DRG,179,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,42251.85,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Respiratory neoplasms with MCC*,180,MS-DRG,180,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Respiratory neoplasms with CC*,181,MS-DRG,181,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Respiratory neoplasms without CC/MCC*,182,MS-DRG,182,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major chest trauma with MCC,183,MS-DRG,183,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major chest trauma with CC,184,MS-DRG,184,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major chest trauma without CC/MCC,185,MS-DRG,185,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Pleural effusion with MCC*,186,MS-DRG,186,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,66071.13,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Pleural effusion with CC*,187,MS-DRG,187,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Pleural effusion without CC/MCC*,188,MS-DRG,188,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Pulmonary edema and respiratory failure,189,MS-DRG,189,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72046.99,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Chronic obstructive pulmonary disease with MCC*,190,MS-DRG,190,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,20971.383,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Chronic obstructive pulmonary disease with CC*,191,MS-DRG,191,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Chronic obstructive pulmonary disease without CC/MCC*,192,MS-DRG,192,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Simple pneumonia and pleurisy with MCC,193,MS-DRG,193,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,59421.93,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Simple pneumonia and pleurisy with CC,194,MS-DRG,194,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,39604.42,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Simple pneumonia and pleurisy without CC/MCC,195,MS-DRG,195,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Interstitial lung disease with MCC*,196,MS-DRG,196,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Interstitial lung disease with CC*,197,MS-DRG,197,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Interstitial lung disease without CC/MCC*,198,MS-DRG,198,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Pneumothorax with MCC,199,MS-DRG,199,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Pneumothorax with CC,200,MS-DRG,200,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,21869.927,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Pneumothorax without CC/MCC,201,MS-DRG,201,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,21869.927,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Bronchitis and asthma with CC/MCC,202,MS-DRG,202,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,40508.305,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Bronchitis and asthma without CC/MCC,203,MS-DRG,203,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,15339.435,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Respiratory signs and symptoms,204,MS-DRG,204,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other respiratory system diagnoses with MCC,205,MS-DRG,205,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,112102.84,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other respiratory system diagnoses without MCC,206,MS-DRG,206,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Respiratory system diagnosis with ventilator support >96 hours,207,MS-DRG,207,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,147720.8,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Respiratory system diagnosis with ventilator support <=96 hours,208,MS-DRG,208,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,81481.35,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Concomitant aortic and mitral valve procedures,212,MS-DRG,212,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other heart assist system implant,215,MS-DRG,215,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC,216,MS-DRG,216,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with CC,217,MS-DRG,217,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization without CC/MCC,218,MS-DRG,218,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with MCC,219,MS-DRG,219,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with CC,220,MS-DRG,220,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization without CC/MCC,221,MS-DRG,221,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other cardiothoracic procedures with MCC,228,MS-DRG,228,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other cardiothoracic procedures without MCC,229,MS-DRG,229,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Coronary bypass with PTCA with MCC,231,MS-DRG,231,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Coronary bypass with PTCA without MCC,232,MS-DRG,232,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Coronary bypass with cardiac catheterization or open ablation with MCC,233,MS-DRG,233,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Coronary bypass with cardiac catheterization or open ablation without MCC,234,MS-DRG,234,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Coronary bypass without cardiac catheterization with MCC,235,MS-DRG,235,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Coronary bypass without cardiac catheterization without MCC,236,MS-DRG,236,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Amputation for circulatory system disorders except upper limb and toe with MCC,239,MS-DRG,239,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Amputation for circulatory system disorders except upper limb and toe with CC,240,MS-DRG,240,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Amputation for circulatory system disorders except upper limb and toe without CC/MCC,241,MS-DRG,241,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Permanent cardiac pacemaker implant with MCC,242,MS-DRG,242,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Permanent cardiac pacemaker implant with CC,243,MS-DRG,243,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Permanent cardiac pacemaker implant without CC/MCC,244,MS-DRG,244,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
AICD generator procedures,245,MS-DRG,245,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,40774.659,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Percutaneous cardiovascular procedures without intraluminal device with MCC,250,MS-DRG,250,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Percutaneous cardiovascular procedures without intraluminal device without MCC,251,MS-DRG,251,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other vascular procedures with MCC,252,MS-DRG,252,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other vascular procedures with CC,253,MS-DRG,253,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other vascular procedures without CC/MCC,254,MS-DRG,254,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Upper limb and toe amputation for circulatory system disorders with MCC,255,MS-DRG,255,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Upper limb and toe amputation for circulatory system disorders with CC,256,MS-DRG,256,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Upper limb and toe amputation for circulatory system disorders without CC/MCC,257,MS-DRG,257,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac pacemaker device replacement with MCC,258,MS-DRG,258,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac pacemaker device replacement without MCC,259,MS-DRG,259,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac pacemaker revision except device replacement with MCC,260,MS-DRG,260,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac pacemaker revision except device replacement with CC,261,MS-DRG,261,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac pacemaker revision except device replacement without CC/MCC,262,MS-DRG,262,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Vein ligation and stripping,263,MS-DRG,263,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other circulatory system O.R. procedures,264,MS-DRG,264,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
AICD lead procedures,265,MS-DRG,265,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Endovascular cardiac valve replacement and supplement procedures with MCC,266,MS-DRG,266,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Endovascular cardiac valve replacement and supplement procedures without MCC,267,MS-DRG,267,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Aortic and heart assist procedures except pulsation balloon with MCC,268,MS-DRG,268,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Aortic and heart assist procedures except pulsation balloon without MCC,269,MS-DRG,269,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other major cardiovascular procedures with MCC,270,MS-DRG,270,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other major cardiovascular procedures with CC,271,MS-DRG,271,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other major cardiovascular procedures without CC/MCC,272,MS-DRG,272,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Percutaneous and other intracardiac procedures with MCC,273,MS-DRG,273,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Percutaneous and other intracardiac procedures without MCC,274,MS-DRG,274,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac defibrillator implant with cardiac catheterization and MCC,275,MS-DRG,275,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac defibrillator implant with MCC or carotid sinus neurostimulator,276,MS-DRG,276,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac defibrillator implant without MCC,277,MS-DRG,277,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures with MCC,278,MS-DRG,278,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures without MCC,279,MS-DRG,279,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Acute myocardial infarction, discharged alive with MCC",280,MS-DRG,280,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,63798.62,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Acute myocardial infarction, discharged alive with CC",281,MS-DRG,281,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Acute myocardial infarction, discharged alive without CC/MCC",282,MS-DRG,282,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Acute myocardial infarction, expired with MCC",283,MS-DRG,283,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Acute myocardial infarction, expired with CC",284,MS-DRG,284,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Acute myocardial infarction, expired without CC/MCC",285,MS-DRG,285,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization with MCC",286,MS-DRG,286,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization without MCC",287,MS-DRG,287,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Acute and subacute endocarditis with MCC,288,MS-DRG,288,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,79476.64,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Acute and subacute endocarditis with CC,289,MS-DRG,289,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,54456.07,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Acute and subacute endocarditis without CC/MCC,290,MS-DRG,290,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48748.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Heart failure and shock with MCC,291,MS-DRG,291,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,59345.41,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Heart failure and shock with CC,292,MS-DRG,292,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,42060.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Heart failure and shock without CC/MCC,293,MS-DRG,293,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,42060.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Deep vein thrombophlebitis with CC/MCC,294,MS-DRG,294,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Deep vein thrombophlebitis without CC/MCC,295,MS-DRG,295,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Cardiac arrest, unexplained with MCC",296,MS-DRG,296,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,59345.41,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Cardiac arrest, unexplained with CC",297,MS-DRG,297,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,42060.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Cardiac arrest, unexplained without CC/MCC",298,MS-DRG,298,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,42060.56,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Peripheral vascular disorders with MCC,299,MS-DRG,299,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,64808.62,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Peripheral vascular disorders with CC,300,MS-DRG,300,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Peripheral vascular disorders without CC/MCC,301,MS-DRG,301,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Atherosclerosis with MCC,302,MS-DRG,302,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Atherosclerosis without MCC,303,MS-DRG,303,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hypertension with MCC,304,MS-DRG,304,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hypertension without MCC,305,MS-DRG,305,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac congenital and valvular disorders with MCC,306,MS-DRG,306,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac congenital and valvular disorders without MCC,307,MS-DRG,307,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac arrhythmia and conduction disorders with MCC,308,MS-DRG,308,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac arrhythmia and conduction disorders with CC,309,MS-DRG,309,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cardiac arrhythmia and conduction disorders without CC/MCC,310,MS-DRG,310,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Angina pectoris,311,MS-DRG,311,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Syncope and collapse,312,MS-DRG,312,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Chest pain,313,MS-DRG,313,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other circulatory system diagnoses with MCC,314,MS-DRG,314,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,67570.83,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other circulatory system diagnoses with CC,315,MS-DRG,315,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,47562.03,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other circulatory system diagnoses without CC/MCC,316,MS-DRG,316,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Concomitant left atrial appendage closure and cardiac ablation,317,MS-DRG,317,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other endovascular cardiac valve procedures with MCC,319,MS-DRG,319,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other endovascular cardiac valve procedures without MCC,320,MS-DRG,320,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/intraluminal devices,321,MS-DRG,321,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Percutaneous cardiovascular procedures with intraluminal device without MCC,322,MS-DRG,322,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Coronary intravascular lithotripsy with intraluminal device with MCC,323,MS-DRG,323,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Coronary intravascular lithotripsy with intraluminal device without MCC,324,MS-DRG,324,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Coronary intravascular lithotripsy without intraluminal device,325,MS-DRG,325,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Stomach, esophageal and duodenal procedures with MCC",326,MS-DRG,326,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Stomach, esophageal and duodenal procedures with CC",327,MS-DRG,327,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Stomach, esophageal and duodenal procedures without CC/MCC",328,MS-DRG,328,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major small and large bowel procedures with MCC,329,MS-DRG,329,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major small and large bowel procedures with CC,330,MS-DRG,330,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major small and large bowel procedures without CC/MCC,331,MS-DRG,331,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Rectal resection with MCC,332,MS-DRG,332,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Rectal resection with CC,333,MS-DRG,333,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Rectal resection without CC/MCC,334,MS-DRG,334,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Peritoneal adhesiolysis with MCC,335,MS-DRG,335,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Peritoneal adhesiolysis with CC,336,MS-DRG,336,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Peritoneal adhesiolysis without CC/MCC,337,MS-DRG,337,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Minor small and large bowel procedures with MCC,344,MS-DRG,344,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Minor small and large bowel procedures with CC,345,MS-DRG,345,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Minor small and large bowel procedures without CC/MCC,346,MS-DRG,346,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Anal and stomal procedures with MCC,347,MS-DRG,347,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,68366.59,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Anal and stomal procedures with CC,348,MS-DRG,348,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Anal and stomal procedures without CC/MCC,349,MS-DRG,349,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Inguinal and femoral hernia procedures with MCC,350,MS-DRG,350,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,68366.59,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Inguinal and femoral hernia procedures with CC,351,MS-DRG,351,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Inguinal and femoral hernia procedures without CC/MCC,352,MS-DRG,352,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hernia procedures except inguinal and femoral with MCC,353,MS-DRG,353,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hernia procedures except inguinal and femoral with CC,354,MS-DRG,354,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hernia procedures except inguinal and femoral without CC/MCC,355,MS-DRG,355,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other digestive system O.R. procedures with MCC,356,MS-DRG,356,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,106800.32,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other digestive system O.R. procedures with CC,357,MS-DRG,357,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other digestive system O.R. procedures without CC/MCC,358,MS-DRG,358,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major esophageal disorders with MCC*,368,MS-DRG,368,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major esophageal disorders with CC*,369,MS-DRG,369,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major esophageal disorders without CC/MCC*,370,MS-DRG,370,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major gastrointestinal disorders and peritoneal infections with MCC,371,MS-DRG,371,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,68366.59,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major gastrointestinal disorders and peritoneal infections with CC,372,MS-DRG,372,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major gastrointestinal disorders and peritoneal infections without CC/MCC,373,MS-DRG,373,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Digestive malignancy with MCC*,374,MS-DRG,374,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Digestive malignancy with CC*,375,MS-DRG,375,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Digestive malignancy without CC/MCC*,376,MS-DRG,376,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Gastrointestinal hemorrhage with MCC,377,MS-DRG,377,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,54425.47,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Gastrointestinal hemorrhage with CC,378,MS-DRG,378,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Gastrointestinal hemorrhage without CC/MCC,379,MS-DRG,379,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Complicated peptic ulcer with MCC,380,MS-DRG,380,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,73278.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Complicated peptic ulcer with CC,381,MS-DRG,381,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Complicated peptic ulcer without CC/MCC,382,MS-DRG,382,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Uncomplicated peptic ulcer with MCC,383,MS-DRG,383,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Uncomplicated peptic ulcer without MCC,384,MS-DRG,384,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Inflammatory bowel disease with MCC,385,MS-DRG,385,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Inflammatory bowel disease with CC,386,MS-DRG,386,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Inflammatory bowel disease without CC/MCC,387,MS-DRG,387,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Gastrointestinal obstruction with MCC,388,MS-DRG,388,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,75604.95,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Gastrointestinal obstruction with CC,389,MS-DRG,389,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Gastrointestinal obstruction without CC/MCC,390,MS-DRG,390,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC",391,MS-DRG,391,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,59253.6,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC",392,MS-DRG,392,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,47929.3,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other digestive system diagnoses with MCC,393,MS-DRG,393,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,77739.74,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other digestive system diagnoses with CC,394,MS-DRG,394,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other digestive system diagnoses without CC/MCC,395,MS-DRG,395,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Appendix procedures with MCC,397,MS-DRG,397,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,68366.59,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Appendix procedures with CC,398,MS-DRG,398,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Appendix procedures without CC/MCC,399,MS-DRG,399,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Single level combined anterior and posterior spinal fusion except cervical,402,MS-DRG,402,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Pancreas, liver and shunt procedures with MCC",405,MS-DRG,405,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,40508.305,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Pancreas, liver and shunt procedures with CC",406,MS-DRG,406,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Pancreas, liver and shunt procedures without CC/MCC",407,MS-DRG,407,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with MCC,408,MS-DRG,408,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with CC,409,MS-DRG,409,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. without CC/MCC,410,MS-DRG,410,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cholecystectomy with C.D.E. with MCC,411,MS-DRG,411,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,73278.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cholecystectomy with C.D.E. with CC,412,MS-DRG,412,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cholecystectomy with C.D.E. without CC/MCC,413,MS-DRG,413,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with MCC,414,MS-DRG,414,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,73278.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with CC,415,MS-DRG,415,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. without CC/MCC,416,MS-DRG,416,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Laparoscopic cholecystectomy without C.D.E. with MCC,417,MS-DRG,417,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,73278.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Laparoscopic cholecystectomy without C.D.E. with CC,418,MS-DRG,418,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Laparoscopic cholecystectomy without C.D.E. without CC/MCC,419,MS-DRG,419,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hepatobiliary diagnostic procedures with MCC,420,MS-DRG,420,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hepatobiliary diagnostic procedures with CC,421,MS-DRG,421,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hepatobiliary diagnostic procedures without CC/MCC,422,MS-DRG,422,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other hepatobiliary or pancreas O.R. procedures with MCC,423,MS-DRG,423,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other hepatobiliary or pancreas O.R. procedures with CC,424,MS-DRG,424,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other hepatobiliary or pancreas O.R. procedures without CC/MCC,425,MS-DRG,425,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,426,MS-DRG,426,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,81343.62,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical with CC,427,MS-DRG,427,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,81343.62,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical without CC/MCC,428,MS-DRG,428,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,67111.73,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Combined anterior and posterior cervical spinal fusion with MCC,429,MS-DRG,429,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,81343.62,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Combined anterior and posterior cervical spinal fusion without MCC,430,MS-DRG,430,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cirrhosis and alcoholic hepatitis with MCC,432,MS-DRG,432,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,56468.43,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cirrhosis and alcoholic hepatitis with CC,433,MS-DRG,433,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cirrhosis and alcoholic hepatitis without CC/MCC,434,MS-DRG,434,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Malignancy of hepatobiliary system or pancreas with MCC,435,MS-DRG,435,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Malignancy of hepatobiliary system or pancreas with CC,436,MS-DRG,436,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Malignancy of hepatobiliary system or pancreas without CC/MCC,437,MS-DRG,437,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Disorders of pancreas except malignancy with MCC,438,MS-DRG,438,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,80165.28,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Disorders of pancreas except malignancy with CC,439,MS-DRG,439,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Disorders of pancreas except malignancy without CC/MCC,440,MS-DRG,440,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCC",441,MS-DRG,441,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,71243.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CC",442,MS-DRG,442,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without CC/MCC",443,MS-DRG,443,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Disorders of the biliary tract with MCC*,444,MS-DRG,444,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,58190.03,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Disorders of the biliary tract with CC*,445,MS-DRG,445,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53147.66,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Disorders of the biliary tract without CC/MCC*,446,MS-DRG,446,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,447,MS-DRG,447,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,1.0631,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Multiple level spinal fusion except cervical without MCC,448,MS-DRG,448,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,1.0631,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,450,MS-DRG,450,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,67111.74,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Single Level Spinal Fusion Except Cervical without MCC,451,MS-DRG,451,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with MCC",456,MS-DRG,456,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with CC",457,MS-DRG,457,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions without CC/MCC",458,MS-DRG,458,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Bilateral or multiple major joint procedures of lower extremity with MCC,461,MS-DRG,461,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,67111.74,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Bilateral or multiple major joint procedures of lower extremity without MCC,462,MS-DRG,462,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with MCC*,463,MS-DRG,463,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with CC*,464,MS-DRG,464,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72972.82,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders without CC/MCC*,465,MS-DRG,465,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,70057.58,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Revision of hip or knee replacement with MCC,466,MS-DRG,466,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Revision of hip or knee replacement with CC,467,MS-DRG,467,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Revision of hip or knee replacement without CC/MCC,468,MS-DRG,468,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity with MCC or total ankle replacement,469,MS-DRG,469,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity without MCC,470,MS-DRG,470,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cervical spinal fusion with MCC,471,MS-DRG,471,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cervical spinal fusion with CC,472,MS-DRG,472,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cervical spinal fusion without CC/MCC,473,MS-DRG,473,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with MCC,474,MS-DRG,474,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with CC,475,MS-DRG,475,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders without CC/MCC,476,MS-DRG,476,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Biopsies of musculoskeletal system and connective tissue with MCC,477,MS-DRG,477,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Biopsies of musculoskeletal system and connective tissue with CC,478,MS-DRG,478,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,28146.902,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Biopsies of musculoskeletal system and connective tissue without CC/MCC,479,MS-DRG,479,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,28146.902,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hip and femur procedures except major joint with MCC,480,MS-DRG,480,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hip and femur procedures except major joint with CC,481,MS-DRG,481,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hip and femur procedures except major joint without CC/MCC,482,MS-DRG,482,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major joint or limb reattachment procedures of upper extremities,483,MS-DRG,483,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Knee procedures with principal diagnosis of infection with MCC,485,MS-DRG,485,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Knee procedures with principal diagnosis of infection with CC,486,MS-DRG,486,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Knee procedures with principal diagnosis of infection without CC/MCC,487,MS-DRG,487,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Knee procedures without principal diagnosis of infection with CC/MCC,488,MS-DRG,488,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Knee procedures without principal diagnosis of infection without CC/MCC,489,MS-DRG,489,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,51693.87,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with MCC",492,MS-DRG,492,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with CC",493,MS-DRG,493,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur without CC/MCC",494,MS-DRG,494,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Local excision and removal of internal fixation devices except hip and femur with MCC,495,MS-DRG,495,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Local excision and removal of internal fixation devices except hip and femur with CC,496,MS-DRG,496,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Local excision and removal of internal fixation devices except hip and femur without CC/MCC,497,MS-DRG,497,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Local excision and removal of internal fixation devices of hip and femur with CC/MCC,498,MS-DRG,498,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Local excision and removal of internal fixation devices of hip and femur without CC/MCC,499,MS-DRG,499,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Soft tissue procedures with MCC,500,MS-DRG,500,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,94244.13,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Soft tissue procedures with CC,501,MS-DRG,501,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Soft tissue procedures without CC/MCC,502,MS-DRG,502,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,67111.74,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Foot procedures with MCC,503,MS-DRG,503,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Foot procedures with CC,504,MS-DRG,504,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Foot procedures without CC/MCC,505,MS-DRG,505,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major thumb or joint procedures,506,MS-DRG,506,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major shoulder or elbow joint procedures with CC/MCC,507,MS-DRG,507,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major shoulder or elbow joint procedures without CC/MCC,508,MS-DRG,508,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Arthroscopy,509,MS-DRG,509,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with MCC",510,MS-DRG,510,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with CC",511,MS-DRG,511,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures without CC/MCC",512,MS-DRG,512,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures with CC/MCC",513,MS-DRG,513,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures without CC/MCC",514,MS-DRG,514,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with MCC,515,MS-DRG,515,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,91742.07,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with CC,516,MS-DRG,516,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures without CC/MCC,517,MS-DRG,517,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Back and neck procedures except spinal fusion with MCC or disc device or neurostimulator,518,MS-DRG,518,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Back and neck procedures except spinal fusion with CC,519,MS-DRG,519,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Back and neck procedures except spinal fusion without CC/MCC,520,MS-DRG,520,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hip replacement with principal diagnosis of hip fracture with MCC,521,MS-DRG,521,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hip replacement with principal diagnosis of hip fracture without MCC,522,MS-DRG,522,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Fractures of femur with MCC,533,MS-DRG,533,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Fractures of femur without MCC,534,MS-DRG,534,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Fractures of hip and pelvis with MCC,535,MS-DRG,535,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Fractures of hip and pelvis without MCC,536,MS-DRG,536,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh with CC/MCC",537,MS-DRG,537,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh without CC/MCC",538,MS-DRG,538,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Osteomyelitis with MCC*,539,MS-DRG,539,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,74166.46,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Osteomyelitis with CC*,540,MS-DRG,540,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,54425.47,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Osteomyelitis without CC/MCC*,541,MS-DRG,541,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,51693.86,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with MCC*,542,MS-DRG,542,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with CC*,543,MS-DRG,543,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy without CC/MCC*,544,MS-DRG,544,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Connective tissue disorders with MCC,545,MS-DRG,545,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Connective tissue disorders with CC,546,MS-DRG,546,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Connective tissue disorders without CC/MCC,547,MS-DRG,547,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46988.16,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Septic arthritis with MCC,548,MS-DRG,548,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,65145.29,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Septic arthritis with CC,549,MS-DRG,549,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Septic arthritis without CC/MCC,550,MS-DRG,550,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Medical back problems with MCC,551,MS-DRG,551,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,99921.58,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Medical back problems without MCC,552,MS-DRG,552,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Bone diseases and arthropathies with MCC,553,MS-DRG,553,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Bone diseases and arthropathies without MCC,554,MS-DRG,554,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue with MCC,555,MS-DRG,555,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue without MCC,556,MS-DRG,556,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Tendonitis, myositis and bursitis with MCC",557,MS-DRG,557,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,69284.76,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Tendonitis, myositis and bursitis without MCC",558,MS-DRG,558,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53645.01,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Aftercare, musculoskeletal system and connective tissue with MCC*",559,MS-DRG,559,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,61671.48,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Aftercare, musculoskeletal system and connective tissue with CC*",560,MS-DRG,560,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48082.33,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Aftercare, musculoskeletal system and connective tissue without CC/MCC*",561,MS-DRG,561,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46988.16,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCC",562,MS-DRG,562,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCC",563,MS-DRG,563,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46988.16,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other musculoskeletal system and connective tissue diagnoses with MCC,564,MS-DRG,564,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,67111.74,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other musculoskeletal system and connective tissue diagnoses with CC,565,MS-DRG,565,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other musculoskeletal system and connective tissue diagnoses without CC/MCC,566,MS-DRG,566,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Skin debridement with MCC*,570,MS-DRG,570,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,90081.68,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Skin debridement with CC*,571,MS-DRG,571,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,65336.58,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Skin debridement without CC/MCC*,572,MS-DRG,572,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,65336.58,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Skin graft for skin ulcer or cellulitis with MCC,573,MS-DRG,573,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,106394.79,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Skin graft for skin ulcer or cellulitis with CC,574,MS-DRG,574,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Skin graft for skin ulcer or cellulitis without CC/MCC,575,MS-DRG,575,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Skin graft except for skin ulcer or cellulitis with MCC*,576,MS-DRG,576,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Skin graft except for skin ulcer or cellulitis with CC*,577,MS-DRG,577,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Skin graft except for skin ulcer or cellulitis without CC/MCC*,578,MS-DRG,578,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Other skin, subcutaneous tissue and breast procedures with MCC",579,MS-DRG,579,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,103793.26,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Other skin, subcutaneous tissue and breast procedures with CC",580,MS-DRG,580,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,85299.47,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Other skin, subcutaneous tissue and breast procedures without CC/MCC",581,MS-DRG,581,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,85299.47,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Mastectomy for malignancy with CC/MCC,582,MS-DRG,582,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,103793.26,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Mastectomy for malignancy without CC/MCC,583,MS-DRG,583,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,85299.47,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Breast biopsy, local excision and other breast procedures with CC/MCC",584,MS-DRG,584,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,65336.58,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Breast biopsy, local excision and other breast procedures without CC/MCC",585,MS-DRG,585,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Skin ulcers with MCC,592,MS-DRG,592,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,67333.63,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Skin ulcers with CC,593,MS-DRG,593,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53667.96,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Skin ulcers without CC/MCC,594,MS-DRG,594,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major skin disorders with MCC,595,MS-DRG,595,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major skin disorders without MCC,596,MS-DRG,596,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Malignant breast disorders with MCC,597,MS-DRG,597,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Malignant breast disorders with CC,598,MS-DRG,598,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Malignant breast disorders without CC/MCC,599,MS-DRG,599,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Non-malignant breast disorders with CC/MCC*,600,MS-DRG,600,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Non-malignant breast disorders without CC/MCC*,601,MS-DRG,601,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cellulitis with MCC,602,MS-DRG,602,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,55068.2,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cellulitis without MCC,603,MS-DRG,603,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36842.21,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Trauma to the skin, subcutaneous tissue and breast with MCC",604,MS-DRG,604,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Trauma to the skin, subcutaneous tissue and breast without MCC",605,MS-DRG,605,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Minor skin disorders with MCC,606,MS-DRG,606,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Minor skin disorders without MCC,607,MS-DRG,607,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Adrenal and pituitary procedures with CC/MCC,614,MS-DRG,614,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Adrenal and pituitary procedures without CC/MCC,615,MS-DRG,615,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with MCC",616,MS-DRG,616,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with CC",617,MS-DRG,617,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders without CC/MCC",618,MS-DRG,618,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
O.R. procedures for obesity with MCC,619,MS-DRG,619,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,100051.65,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
O.R. procedures for obesity with CC,620,MS-DRG,620,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72590.25,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
O.R. procedures for obesity without CC/MCC,621,MS-DRG,621,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with MCC",622,MS-DRG,622,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,100051.65,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with CC",623,MS-DRG,623,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72590.25,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders without CC/MCC",624,MS-DRG,624,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with MCC",625,MS-DRG,625,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,30309.826,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with CC",626,MS-DRG,626,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures without CC/MCC",627,MS-DRG,627,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with MCC",628,MS-DRG,628,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,30309.826,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with CC",629,MS-DRG,629,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures without CC/MCC",630,MS-DRG,630,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Diabetes with MCC,637,MS-DRG,637,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,67654.99,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Diabetes with CC,638,MS-DRG,638,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53843.95,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Diabetes without CC/MCC,639,MS-DRG,639,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCC",640,MS-DRG,640,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,74862.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCC",641,MS-DRG,641,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,47049.37,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Inborn and other disorders of metabolism,642,MS-DRG,642,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Endocrine disorders with MCC*,643,MS-DRG,643,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Endocrine disorders with CC*,644,MS-DRG,644,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Endocrine disorders without CC/MCC*,645,MS-DRG,645,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major bladder procedures with MCC,653,MS-DRG,653,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,91596.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major bladder procedures with CC,654,MS-DRG,654,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,80073.46,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major bladder procedures without CC/MCC,655,MS-DRG,655,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Kidney and ureter procedures for neoplasm with MCC,656,MS-DRG,656,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Kidney and ureter procedures for neoplasm with CC,657,MS-DRG,657,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Kidney and ureter procedures for neoplasm without CC/MCC,658,MS-DRG,658,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Kidney and ureter procedures for non-neoplasm with MCC*,659,MS-DRG,659,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Kidney and ureter procedures for non-neoplasm with CC*,660,MS-DRG,660,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Kidney and ureter procedures for non-neoplasm without CC/MCC*,661,MS-DRG,661,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Minor bladder procedures with MCC,662,MS-DRG,662,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Minor bladder procedures with CC,663,MS-DRG,663,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Minor bladder procedures without CC/MCC,664,MS-DRG,664,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Prostatectomy with MCC,665,MS-DRG,665,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,91596.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Prostatectomy with CC,666,MS-DRG,666,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,80073.46,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Prostatectomy without CC/MCC,667,MS-DRG,667,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Transurethral procedures with MCC,668,MS-DRG,668,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Transurethral procedures with CC,669,MS-DRG,669,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Transurethral procedures without CC/MCC,670,MS-DRG,670,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Urethral procedures with CC/MCC,671,MS-DRG,671,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Urethral procedures without CC/MCC,672,MS-DRG,672,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other kidney and urinary tract procedures with MCC*,673,MS-DRG,673,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,91596.69,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other kidney and urinary tract procedures with CC*,674,MS-DRG,674,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,80073.46,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other kidney and urinary tract procedures without CC/MCC*,675,MS-DRG,675,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,80073.46,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Renal failure with MCC,682,MS-DRG,682,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,66775.07,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Renal failure with CC,683,MS-DRG,683,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,46314.82,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Renal failure without CC/MCC,684,MS-DRG,684,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Kidney and urinary tract neoplasms with MCC,686,MS-DRG,686,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Kidney and urinary tract neoplasms with CC,687,MS-DRG,687,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Kidney and urinary tract neoplasms without CC/MCC,688,MS-DRG,688,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Kidney and urinary tract infections with MCC,689,MS-DRG,689,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48342.49,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Kidney and urinary tract infections without MCC,690,MS-DRG,690,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,35962.28,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Urinary stones with MCC,693,MS-DRG,693,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Urinary stones without MCC,694,MS-DRG,694,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Kidney and urinary tract signs and symptoms with MCC,695,MS-DRG,695,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Kidney and urinary tract signs and symptoms without MCC,696,MS-DRG,696,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Urethral stricture,697,MS-DRG,697,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other kidney and urinary tract diagnoses with MCC,698,MS-DRG,698,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,67746.82,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other kidney and urinary tract diagnoses with CC,699,MS-DRG,699,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,47363.09,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other kidney and urinary tract diagnoses without CC/MCC,700,MS-DRG,700,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major male pelvic procedures with CC/MCC,707,MS-DRG,707,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major male pelvic procedures without CC/MCC,708,MS-DRG,708,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Penis procedures with CC/MCC,709,MS-DRG,709,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Penis procedures without CC/MCC,710,MS-DRG,710,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Testes procedures with CC/MCC,711,MS-DRG,711,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Testes procedures without CC/MCC,712,MS-DRG,712,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Transurethral prostatectomy with CC/MCC,713,MS-DRG,713,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,30309.826,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Transurethral prostatectomy without CC/MCC,714,MS-DRG,714,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other male reproductive system O.R. procedures for malignancy with CC/MCC,715,MS-DRG,715,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other male reproductive system O.R. procedures for malignancy without CC/MCC,716,MS-DRG,716,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other male reproductive system O.R. procedures except malignancy with CC/MCC,717,MS-DRG,717,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other male reproductive system O.R. procedures except malignancy without CC/MCC,718,MS-DRG,718,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Malignancy, male reproductive system with MCC",722,MS-DRG,722,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,61794.07,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Malignancy, male reproductive system with CC",723,MS-DRG,723,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Malignancy, male reproductive system without CC/MCC",724,MS-DRG,724,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,50278,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Benign prostatic hypertrophy with MCC,725,MS-DRG,725,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,50278.46,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Benign prostatic hypertrophy without MCC,726,MS-DRG,726,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Inflammation of the male reproductive system with MCC,727,MS-DRG,727,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,61794.07,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Inflammation of the male reproductive system without MCC,728,MS-DRG,728,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,50278,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other male reproductive system diagnoses with CC/MCC,729,MS-DRG,729,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other male reproductive system diagnoses without CC/MCC,730,MS-DRG,730,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC",734,MS-DRG,734,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC",735,MS-DRG,735,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with MCC,736,MS-DRG,736,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with CC,737,MS-DRG,737,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy without CC/MCC,738,MS-DRG,738,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with MCC,739,MS-DRG,739,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with CC,740,MS-DRG,740,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy without CC/MCC,741,MS-DRG,741,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Uterine and adnexa procedures for non-malignancy with CC/MCC,742,MS-DRG,742,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Uterine and adnexa procedures for non-malignancy without CC/MCC,743,MS-DRG,743,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"D&C, conization, laparoscopy and tubal interruption with CC/MCC",744,MS-DRG,744,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"D&C, conization, laparoscopy and tubal interruption without CC/MCC",745,MS-DRG,745,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Vagina, cervix and vulva procedures with CC/MCC",746,MS-DRG,746,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Vagina, cervix and vulva procedures without CC/MCC",747,MS-DRG,747,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Female reproductive system reconstructive procedures,748,MS-DRG,748,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other female reproductive system O.R. procedures with CC/MCC,749,MS-DRG,749,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other female reproductive system O.R. procedures without CC/MCC,750,MS-DRG,750,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Malignancy, female reproductive system with MCC",754,MS-DRG,754,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Malignancy, female reproductive system with CC",755,MS-DRG,755,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Malignancy, female reproductive system without CC/MCC",756,MS-DRG,756,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Infections, female reproductive system with MCC",757,MS-DRG,757,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,29854.136,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Infections, female reproductive system with CC",758,MS-DRG,758,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Infections, female reproductive system without CC/MCC",759,MS-DRG,759,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Menstrual and other female reproductive system disorders with CC/MCC,760,MS-DRG,760,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Menstrual and other female reproductive system disorders without CC/MCC,761,MS-DRG,761,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Vaginal delivery with O.R. procedures except sterilization and/or D&C,768,MS-DRG,768,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Postpartum and post abortion diagnoses with O.R. procedures,769,MS-DRG,769,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Abortion with D&C, aspiration curettage or hysterotomy",770,MS-DRG,770,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Postpartum and post abortion diagnoses without O.R. procedures,776,MS-DRG,776,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Abortion without D&C,779,MS-DRG,779,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cesarean section with sterilization with MCC,783,MS-DRG,783,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cesarean section with sterilization with CC,784,MS-DRG,784,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,90613.37,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cesarean section with sterilization without CC/MCC,785,MS-DRG,785,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cesarean section without sterilization with MCC,786,MS-DRG,786,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cesarean section without sterilization with CC,787,MS-DRG,787,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Cesarean section without sterilization without CC/MCC,788,MS-DRG,788,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Neonates, died or transferred to another acute care facility",789,MS-DRG,789,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Extreme immaturity or respiratory distress syndrome, neonate",790,MS-DRG,790,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Prematurity with major problems,791,MS-DRG,791,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Prematurity without major problems,792,MS-DRG,792,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48921.03,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Full term neonate with major problems,793,MS-DRG,793,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Neonate with other significant problems,794,MS-DRG,794,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48921.03,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Splenic procedures with MCC,799,MS-DRG,799,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,106800.6,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Splenic procedures with CC,800,MS-DRG,800,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48921.03,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Splenic procedures without CC/MCC,801,MS-DRG,801,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other O.R. procedures of the blood and blood forming organs with MCC,802,MS-DRG,802,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other O.R. procedures of the blood and blood forming organs with CC,803,MS-DRG,803,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other O.R. procedures of the blood and blood forming organs without CC/MCC,804,MS-DRG,804,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with MCC,808,MS-DRG,808,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with CC,809,MS-DRG,809,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without CC/MCC,810,MS-DRG,810,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Red blood cell disorders with MCC,811,MS-DRG,811,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Red blood cell disorders without MCC,812,MS-DRG,812,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Coagulation disorders,813,MS-DRG,813,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Reticuloendothelial and immunity disorders with MCC*,814,MS-DRG,814,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Reticuloendothelial and immunity disorders with CC*,815,MS-DRG,815,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Reticuloendothelial and immunity disorders without CC/MCC*,816,MS-DRG,816,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other antepartum diagnoses with O.R. procedures with MCC,817,MS-DRG,817,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,40508.305,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other antepartum diagnoses with O.R. procedures with CC,818,MS-DRG,818,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other antepartum diagnoses with O.R. procedures without CC/MCC,819,MS-DRG,819,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Lymphoma and leukemia with major O.R. procedures with MCC,820,MS-DRG,820,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Lymphoma and leukemia with major O.R. procedures with CC,821,MS-DRG,821,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Lymphoma and leukemia with major O.R. procedures without CC/MCC,822,MS-DRG,822,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Lymphoma and non-acute leukemia with other procedures with MCC,823,MS-DRG,823,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Lymphoma and non-acute leukemia with other procedures with CC,824,MS-DRG,824,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Lymphoma and non-acute leukemia with other procedures without CC/MCC,825,MS-DRG,825,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with MCC,826,MS-DRG,826,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with CC,827,MS-DRG,827,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures without CC/MCC,828,MS-DRG,828,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures with CC/MCC,829,MS-DRG,829,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures without CC/MCC,830,MS-DRG,830,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other antepartum diagnoses without O.R. procedures with MCC,831,MS-DRG,831,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other antepartum diagnoses without O.R. procedures with CC,832,MS-DRG,832,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other antepartum diagnoses without O.R. procedures without CC/MCC,833,MS-DRG,833,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Acute leukemia with MCC,834,MS-DRG,834,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Acute leukemia with CC,835,MS-DRG,835,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Acute leukemia without CC/MCC,836,MS-DRG,836,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy agent with MCC,837,MS-DRG,837,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapy agent,838,MS-DRG,838,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis without CC/MCC,839,MS-DRG,839,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Lymphoma and non-acute leukemia with MCC,840,MS-DRG,840,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Lymphoma and non-acute leukemia with CC,841,MS-DRG,841,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Lymphoma and non-acute leukemia without CC/MCC,842,MS-DRG,842,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with MCC,843,MS-DRG,843,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with CC,844,MS-DRG,844,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses without CC/MCC,845,MS-DRG,845,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with MCC,846,MS-DRG,846,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with CC,847,MS-DRG,847,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis without CC/MCC,848,MS-DRG,848,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Radiotherapy,849,MS-DRG,849,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Acute leukemia with other procedures,850,MS-DRG,850,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Infectious and parasitic diseases with O.R. procedures with MCC,853,MS-DRG,853,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,116013.09,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Infectious and parasitic diseases with O.R. procedures with CC,854,MS-DRG,854,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.07,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Infectious and parasitic diseases with O.R. procedures without CC/MCC,855,MS-DRG,855,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with MCC,856,MS-DRG,856,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,103112.54,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with CC,857,MS-DRG,857,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures without CC/MCC,858,MS-DRG,858,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Postoperative and post-traumatic infections with MCC,862,MS-DRG,862,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,70501.55,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Postoperative and post-traumatic infections without MCC,863,MS-DRG,863,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,47554.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Fever and inflammatory conditions,864,MS-DRG,864,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Viral illness with MCC,865,MS-DRG,865,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Viral illness without MCC,866,MS-DRG,866,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other infectious and parasitic diseases diagnoses with MCC,867,MS-DRG,867,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,70118.98,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other infectious and parasitic diseases diagnoses with CC,868,MS-DRG,868,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other infectious and parasitic diseases diagnoses without CC/MCC,869,MS-DRG,869,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Septicemia or severe sepsis with MV >96 hours,870,MS-DRG,870,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,158548.16,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Septicemia or severe sepsis without MV >96 hours with MCC,871,MS-DRG,871,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,64954.17,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Septicemia or severe sepsis without MV >96 hours without MCC,872,MS-DRG,872,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,43522.12,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Wound debridements for injuries with MCC,901,MS-DRG,901,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,98177.28,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Wound debridements for injuries with CC,902,MS-DRG,902,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Wound debridements for injuries without CC/MCC,903,MS-DRG,903,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Skin grafts for injuries with CC/MCC,904,MS-DRG,904,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Skin grafts for injuries without CC/MCC,905,MS-DRG,905,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Hand procedures for injuries,906,MS-DRG,906,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other O.R. procedures for injuries with MCC*,907,MS-DRG,907,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other O.R. procedures for injuries with CC*,908,MS-DRG,908,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other O.R. procedures for injuries without CC/MCC*,909,MS-DRG,909,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Traumatic injury with MCC,913,MS-DRG,913,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Traumatic injury without MCC,914,MS-DRG,914,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Allergic reactions with MCC,915,MS-DRG,915,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Allergic reactions without MCC,916,MS-DRG,916,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Poisoning and toxic effects of drugs with MCC,917,MS-DRG,917,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Poisoning and toxic effects of drugs without MCC,918,MS-DRG,918,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Complications of treatment with MCC,919,MS-DRG,919,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,82055.43,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Complications of treatment with CC,920,MS-DRG,920,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52581.58,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Complications of treatment without CC/MCC,921,MS-DRG,921,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Other injury, poisoning and toxic effect diagnoses with MCC",922,MS-DRG,922,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Other injury, poisoning and toxic effect diagnoses without MCC",923,MS-DRG,923,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Extensive burns or full thickness burns with MV >96 hours with skin graft,927,MS-DRG,927,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Full thickness burn with skin graft or inhalation injury with CC/MCC,928,MS-DRG,928,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Full thickness burn with skin graft or inhalation injury without CC/MCC,929,MS-DRG,929,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Extensive burns or full thickness burns with MV >96 hours without skin graft,933,MS-DRG,933,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Full thickness burn without skin graft or inhalation injury,934,MS-DRG,934,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Non-extensive burns,935,MS-DRG,935,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
O.R. procedures with diagnoses of other contact with health services with MCC,939,MS-DRG,939,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,90701.7,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
O.R. procedures with diagnoses of other contact with health services with CC,940,MS-DRG,940,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
O.R. procedures with diagnoses of other contact with health services without CC/MCC,941,MS-DRG,941,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Signs and symptoms with MCC,947,MS-DRG,947,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Signs and symptoms without MCC,948,MS-DRG,948,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Aftercare with CC/MCC,949,MS-DRG,949,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,53224.31,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Aftercare without CC/MCC,950,MS-DRG,950,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other factors influencing health status,951,MS-DRG,951,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Craniotomy for multiple significant trauma,955,MS-DRG,955,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"Limb reattachment, hip and femur procedures for multiple significant trauma",956,MS-DRG,956,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other O.R. procedures for multiple significant trauma with MCC,957,MS-DRG,957,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other O.R. procedures for multiple significant trauma with CC,958,MS-DRG,958,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other O.R. procedures for multiple significant trauma without CC/MCC,959,MS-DRG,959,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other multiple significant trauma with MCC,963,MS-DRG,963,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other multiple significant trauma with CC,964,MS-DRG,964,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Other multiple significant trauma without CC/MCC,965,MS-DRG,965,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
HIV with extensive O.R. procedures with MCC,969,MS-DRG,969,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
HIV with extensive O.R. procedures without MCC,970,MS-DRG,970,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
HIV with major related condition with MCC*,974,MS-DRG,974,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,87197.28,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
HIV with major related condition with CC*,975,MS-DRG,975,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,68412.68,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
HIV with major related condition without CC/MCC*,976,MS-DRG,976,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,68412.68,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
HIV with or without other related condition,977,MS-DRG,977,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with MCC,981,MS-DRG,981,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,68449.825,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with CC,982,MS-DRG,982,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,96991.29,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,983,MS-DRG,983,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with MCC,987,MS-DRG,987,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,163207.97,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with CC,988,MS-DRG,988,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.07,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,989,MS-DRG,989,LOCAL,,Inpatient,,,,,Health Smart,Commercial,,,MS-DRG,72269.07,case rate,22000,120000,"If TBC exceeds $200,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC",,,,,,,
"ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck with major O.R. procedures",3,MS-DRG,3,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,310277.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck without major O.R. procedures",4,MS-DRG,4,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,229767.96,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCC",11,MS-DRG,11,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CC",12,MS-DRG,12,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy without CC/MCC",13,MS-DRG,13,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Chimeric antigen receptor (CAR) T-cell and other immunotherapies,18,MS-DRG,18,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with MCC,20,MS-DRG,20,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with CC,21,MS-DRG,21,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage without CC/MCC,22,MS-DRG,22,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC or chemotherapy implant or epilepsy with neurostimulator,23,MS-DRG,23,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis without MCC,24,MS-DRG,24,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Craniotomy and endovascular intracranial procedures with MCC,25,MS-DRG,25,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Craniotomy and endovascular intracranial procedures with CC,26,MS-DRG,26,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Craniotomy and endovascular intracranial procedures without CC/MCC,27,MS-DRG,27,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Spinal procedures with MCC,28,MS-DRG,28,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Spinal procedures with CC or spinal neurostimulators,29,MS-DRG,29,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Spinal procedures without CC/MCC,30,MS-DRG,30,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Ventricular shunt procedures with MCC,31,MS-DRG,31,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Ventricular shunt procedures with CC,32,MS-DRG,32,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Ventricular shunt procedures without CC/MCC,33,MS-DRG,33,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Carotid artery stent procedures with MCC,34,MS-DRG,34,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Carotid artery stent procedures with CC,35,MS-DRG,35,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Carotid artery stent procedures without CC/MCC,36,MS-DRG,36,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Extracranial procedures with MCC,37,MS-DRG,37,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Extracranial procedures with CC,38,MS-DRG,38,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Extracranial procedures without CC/MCC,39,MS-DRG,39,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with MCC",40,MS-DRG,40,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,95774.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurostimulator",41,MS-DRG,41,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Peripheral, cranial nerve and other nervous system procedures without CC/MCC",42,MS-DRG,42,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Spinal disorders and injuries with CC/MCC,52,MS-DRG,52,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,82942.79,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Spinal disorders and injuries without CC/MCC,53,MS-DRG,53,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,81228.84,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Nervous system neoplasms with MCC,54,MS-DRG,54,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Nervous system neoplasms without MCC,55,MS-DRG,55,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Degenerative nervous system disorders with MCC,56,MS-DRG,56,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,61411.33,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Degenerative nervous system disorders without MCC,57,MS-DRG,57,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,51678.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Multiple sclerosis and cerebellar ataxia with MCC,58,MS-DRG,58,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Multiple sclerosis and cerebellar ataxia with CC,59,MS-DRG,59,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,51678.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Multiple sclerosis and cerebellar ataxia without CC/MCC,60,MS-DRG,60,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,51678.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with MCC",61,MS-DRG,61,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,111192.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with CC",62,MS-DRG,62,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent without CC/MCC",63,MS-DRG,63,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Intracranial hemorrhage or cerebral infarction with MCC,64,MS-DRG,64,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,111192.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Intracranial hemorrhage or cerebral infarction with CC or tPA in 24 hours,65,MS-DRG,65,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Intracranial hemorrhage or cerebral infarction without CC/MCC,66,MS-DRG,66,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Nonspecific CVA and precerebral occlusion without infarction with MCC,67,MS-DRG,67,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,66767.42,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Nonspecific CVA and precerebral occlusion without infarction without MCC,68,MS-DRG,68,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Transient ischemia without thrombolytic,69,MS-DRG,69,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Nonspecific cerebrovascular disorders with MCC*,70,MS-DRG,70,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,66767.42,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Nonspecific cerebrovascular disorders with CC*,71,MS-DRG,71,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,45128.84,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Nonspecific cerebrovascular disorders without CC/MCC*,72,MS-DRG,72,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cranial and peripheral nerve disorders with MCC,73,MS-DRG,73,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cranial and peripheral nerve disorders without MCC,74,MS-DRG,74,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Viral meningitis with CC/MCC,75,MS-DRG,75,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Viral meningitis without CC/MCC,76,MS-DRG,76,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hypertensive encephalopathy with MCC,77,MS-DRG,77,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,68160,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hypertensive encephalopathy with CC,78,MS-DRG,78,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,537909.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hypertensive encephalopathy without CC/MCC,79,MS-DRG,79,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Nontraumatic stupor and coma with MCC,80,MS-DRG,80,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Nontraumatic stupor and coma without MCC,81,MS-DRG,81,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Traumatic stupor and coma >1 hour with MCC*,82,MS-DRG,82,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,82529.13,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Traumatic stupor and coma >1 hour with CC*,83,MS-DRG,83,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,62451.46,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Traumatic stupor and coma >1 hour without CC/MCC*,84,MS-DRG,84,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Traumatic stupor and coma <1 hour with MCC,85,MS-DRG,85,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,62451.46,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Traumatic stupor and coma <1 hour with CC,86,MS-DRG,86,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,62451.46,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Traumatic stupor and coma <1 hour without CC/MCC,87,MS-DRG,87,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Concussion with MCC,88,MS-DRG,88,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,68160,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Concussion with CC,89,MS-DRG,89,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,537909.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Concussion without CC/MCC,90,MS-DRG,90,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other disorders of nervous system with MCC,91,MS-DRG,91,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,68160,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other disorders of nervous system with CC,92,MS-DRG,92,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,537909.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other disorders of nervous system without CC/MCC,93,MS-DRG,93,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,51678.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Bacterial and tuberculous infections of nervous system with MCC*,94,MS-DRG,94,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34375.739,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Bacterial and tuberculous infections of nervous system with CC*,95,MS-DRG,95,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,62451.46,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Bacterial and tuberculous infections of nervous system without CC/MCC*,96,MS-DRG,96,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Non-bacterial infection of nervous system except viral meningitis with MCC,97,MS-DRG,97,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,75054.04,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Non-bacterial infection of nervous system except viral meningitis with CC,98,MS-DRG,98,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Non-bacterial infection of nervous system except viral meningitis without CC/MCC,99,MS-DRG,99,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Seizures with MCC,100,MS-DRG,100,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Seizures without MCC,101,MS-DRG,101,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Headaches with MCC,102,MS-DRG,102,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Headaches without MCC,103,MS-DRG,103,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Orbital procedures with CC/MCC,113,MS-DRG,113,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Orbital procedures without CC/MCC,114,MS-DRG,114,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Extraocular procedures except orbit,115,MS-DRG,115,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Intraocular procedures with CC/MCC,116,MS-DRG,116,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Intraocular procedures without CC/MCC,117,MS-DRG,117,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Acute major eye infections with CC/MCC,121,MS-DRG,121,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Acute major eye infections without CC/MCC,122,MS-DRG,122,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Neurological eye disorders,123,MS-DRG,123,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other disorders of the eye with MCC or thrombolytic agent,124,MS-DRG,124,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other disorders of the eye without MCC,125,MS-DRG,125,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Sinus and mastoid procedures with CC/MCC,135,MS-DRG,135,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Sinus and mastoid procedures without CC/MCC,136,MS-DRG,136,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Mouth procedures with CC/MCC,137,MS-DRG,137,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Mouth procedures without CC/MCC,138,MS-DRG,138,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Salivary gland procedures,139,MS-DRG,139,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major head and neck procedures with MCC,140,MS-DRG,140,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,177508.29,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major head and neck procedures with CC,141,MS-DRG,141,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major head and neck procedures without CC/MCC,142,MS-DRG,142,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with MCC",143,MS-DRG,143,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with CC",144,MS-DRG,144,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Other ear, nose, mouth and throat O.R. procedures without CC/MCC",145,MS-DRG,145,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Ear, nose, mouth and throat malignancy with MCC*",146,MS-DRG,146,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Ear, nose, mouth and throat malignancy with CC*",147,MS-DRG,147,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Ear, nose, mouth and throat malignancy without CC/MCC*",148,MS-DRG,148,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Dysequilibrium,149,MS-DRG,149,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Epistaxis with MCC,150,MS-DRG,150,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Epistaxis without MCC,151,MS-DRG,151,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Otitis media and URI with MCC,152,MS-DRG,152,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Otitis media and URI without MCC,153,MS-DRG,153,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Other ear, nose, mouth and throat diagnoses with MCC",154,MS-DRG,154,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Other ear, nose, mouth and throat diagnoses with CC",155,MS-DRG,155,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Other ear, nose, mouth and throat diagnoses without CC/MCC",156,MS-DRG,156,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Dental and oral diseases with MCC,157,MS-DRG,157,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Dental and oral diseases with CC,158,MS-DRG,158,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Dental and oral diseases without CC/MCC,159,MS-DRG,159,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major chest procedures with MCC,163,MS-DRG,163,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,202666.58,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major chest procedures with CC,164,MS-DRG,164,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,202666.58,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major chest procedures without CC/MCC,165,MS-DRG,165,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,202666.58,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other respiratory system O.R. procedures with MCC,166,MS-DRG,166,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,177508.29,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other respiratory system O.R. procedures with CC,167,MS-DRG,167,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other respiratory system O.R. procedures without CC/MCC,168,MS-DRG,168,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism,173,MS-DRG,173,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Pulmonary embolism with MCC or acute cor pulmonale,175,MS-DRG,175,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Pulmonary embolism without MCC,176,MS-DRG,176,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Respiratory infections and inflammations with MCC*,177,MS-DRG,177,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,62918.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Respiratory infections and inflammations with CC*,178,MS-DRG,178,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,43491.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Respiratory infections and inflammations without CC/MCC*,179,MS-DRG,179,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,42251.85,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Respiratory neoplasms with MCC*,180,MS-DRG,180,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Respiratory neoplasms with CC*,181,MS-DRG,181,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Respiratory neoplasms without CC/MCC*,182,MS-DRG,182,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major chest trauma with MCC,183,MS-DRG,183,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major chest trauma with CC,184,MS-DRG,184,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major chest trauma without CC/MCC,185,MS-DRG,185,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Pleural effusion with MCC*,186,MS-DRG,186,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,66071.13,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Pleural effusion with CC*,187,MS-DRG,187,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Pleural effusion without CC/MCC*,188,MS-DRG,188,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Pulmonary edema and respiratory failure,189,MS-DRG,189,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72046.99,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Chronic obstructive pulmonary disease with MCC*,190,MS-DRG,190,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,20971.383,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Chronic obstructive pulmonary disease with CC*,191,MS-DRG,191,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Chronic obstructive pulmonary disease without CC/MCC*,192,MS-DRG,192,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Simple pneumonia and pleurisy with MCC,193,MS-DRG,193,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,59421.93,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Simple pneumonia and pleurisy with CC,194,MS-DRG,194,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,39604.42,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Simple pneumonia and pleurisy without CC/MCC,195,MS-DRG,195,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Interstitial lung disease with MCC*,196,MS-DRG,196,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Interstitial lung disease with CC*,197,MS-DRG,197,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Interstitial lung disease without CC/MCC*,198,MS-DRG,198,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Pneumothorax with MCC,199,MS-DRG,199,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Pneumothorax with CC,200,MS-DRG,200,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,21869.927,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Pneumothorax without CC/MCC,201,MS-DRG,201,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,21869.927,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Bronchitis and asthma with CC/MCC,202,MS-DRG,202,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,40508.305,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Bronchitis and asthma without CC/MCC,203,MS-DRG,203,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,15339.435,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Respiratory signs and symptoms,204,MS-DRG,204,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other respiratory system diagnoses with MCC,205,MS-DRG,205,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,112102.84,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other respiratory system diagnoses without MCC,206,MS-DRG,206,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Respiratory system diagnosis with ventilator support >96 hours,207,MS-DRG,207,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,147720.8,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Respiratory system diagnosis with ventilator support <=96 hours,208,MS-DRG,208,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,81481.35,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Concomitant aortic and mitral valve procedures,212,MS-DRG,212,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other heart assist system implant,215,MS-DRG,215,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC,216,MS-DRG,216,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with CC,217,MS-DRG,217,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization without CC/MCC,218,MS-DRG,218,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with MCC,219,MS-DRG,219,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with CC,220,MS-DRG,220,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization without CC/MCC,221,MS-DRG,221,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other cardiothoracic procedures with MCC,228,MS-DRG,228,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other cardiothoracic procedures without MCC,229,MS-DRG,229,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Coronary bypass with PTCA with MCC,231,MS-DRG,231,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Coronary bypass with PTCA without MCC,232,MS-DRG,232,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Coronary bypass with cardiac catheterization or open ablation with MCC,233,MS-DRG,233,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Coronary bypass with cardiac catheterization or open ablation without MCC,234,MS-DRG,234,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Coronary bypass without cardiac catheterization with MCC,235,MS-DRG,235,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Coronary bypass without cardiac catheterization without MCC,236,MS-DRG,236,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Amputation for circulatory system disorders except upper limb and toe with MCC,239,MS-DRG,239,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Amputation for circulatory system disorders except upper limb and toe with CC,240,MS-DRG,240,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Amputation for circulatory system disorders except upper limb and toe without CC/MCC,241,MS-DRG,241,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Permanent cardiac pacemaker implant with MCC,242,MS-DRG,242,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Permanent cardiac pacemaker implant with CC,243,MS-DRG,243,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Permanent cardiac pacemaker implant without CC/MCC,244,MS-DRG,244,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
AICD generator procedures,245,MS-DRG,245,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,40774.659,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Percutaneous cardiovascular procedures without intraluminal device with MCC,250,MS-DRG,250,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Percutaneous cardiovascular procedures without intraluminal device without MCC,251,MS-DRG,251,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other vascular procedures with MCC,252,MS-DRG,252,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other vascular procedures with CC,253,MS-DRG,253,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other vascular procedures without CC/MCC,254,MS-DRG,254,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Upper limb and toe amputation for circulatory system disorders with MCC,255,MS-DRG,255,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Upper limb and toe amputation for circulatory system disorders with CC,256,MS-DRG,256,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Upper limb and toe amputation for circulatory system disorders without CC/MCC,257,MS-DRG,257,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac pacemaker device replacement with MCC,258,MS-DRG,258,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac pacemaker device replacement without MCC,259,MS-DRG,259,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac pacemaker revision except device replacement with MCC,260,MS-DRG,260,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac pacemaker revision except device replacement with CC,261,MS-DRG,261,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac pacemaker revision except device replacement without CC/MCC,262,MS-DRG,262,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Vein ligation and stripping,263,MS-DRG,263,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other circulatory system O.R. procedures,264,MS-DRG,264,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
AICD lead procedures,265,MS-DRG,265,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Endovascular cardiac valve replacement and supplement procedures with MCC,266,MS-DRG,266,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Endovascular cardiac valve replacement and supplement procedures without MCC,267,MS-DRG,267,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Aortic and heart assist procedures except pulsation balloon with MCC,268,MS-DRG,268,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Aortic and heart assist procedures except pulsation balloon without MCC,269,MS-DRG,269,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other major cardiovascular procedures with MCC,270,MS-DRG,270,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other major cardiovascular procedures with CC,271,MS-DRG,271,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other major cardiovascular procedures without CC/MCC,272,MS-DRG,272,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Percutaneous and other intracardiac procedures with MCC,273,MS-DRG,273,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Percutaneous and other intracardiac procedures without MCC,274,MS-DRG,274,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac defibrillator implant with cardiac catheterization and MCC,275,MS-DRG,275,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac defibrillator implant with MCC or carotid sinus neurostimulator,276,MS-DRG,276,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac defibrillator implant without MCC,277,MS-DRG,277,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures with MCC,278,MS-DRG,278,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures without MCC,279,MS-DRG,279,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Acute myocardial infarction, discharged alive with MCC",280,MS-DRG,280,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,63798.62,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Acute myocardial infarction, discharged alive with CC",281,MS-DRG,281,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Acute myocardial infarction, discharged alive without CC/MCC",282,MS-DRG,282,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Acute myocardial infarction, expired with MCC",283,MS-DRG,283,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Acute myocardial infarction, expired with CC",284,MS-DRG,284,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Acute myocardial infarction, expired without CC/MCC",285,MS-DRG,285,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization with MCC",286,MS-DRG,286,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization without MCC",287,MS-DRG,287,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Acute and subacute endocarditis with MCC,288,MS-DRG,288,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,79476.64,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Acute and subacute endocarditis with CC,289,MS-DRG,289,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,54456.07,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Acute and subacute endocarditis without CC/MCC,290,MS-DRG,290,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48748.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Heart failure and shock with MCC,291,MS-DRG,291,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,59345.41,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Heart failure and shock with CC,292,MS-DRG,292,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,42060.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Heart failure and shock without CC/MCC,293,MS-DRG,293,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,42060.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Deep vein thrombophlebitis with CC/MCC,294,MS-DRG,294,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Deep vein thrombophlebitis without CC/MCC,295,MS-DRG,295,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Cardiac arrest, unexplained with MCC",296,MS-DRG,296,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,59345.41,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Cardiac arrest, unexplained with CC",297,MS-DRG,297,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,42060.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Cardiac arrest, unexplained without CC/MCC",298,MS-DRG,298,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,42060.56,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Peripheral vascular disorders with MCC,299,MS-DRG,299,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,64808.62,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Peripheral vascular disorders with CC,300,MS-DRG,300,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Peripheral vascular disorders without CC/MCC,301,MS-DRG,301,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Atherosclerosis with MCC,302,MS-DRG,302,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Atherosclerosis without MCC,303,MS-DRG,303,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hypertension with MCC,304,MS-DRG,304,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hypertension without MCC,305,MS-DRG,305,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac congenital and valvular disorders with MCC,306,MS-DRG,306,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac congenital and valvular disorders without MCC,307,MS-DRG,307,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac arrhythmia and conduction disorders with MCC,308,MS-DRG,308,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac arrhythmia and conduction disorders with CC,309,MS-DRG,309,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cardiac arrhythmia and conduction disorders without CC/MCC,310,MS-DRG,310,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Angina pectoris,311,MS-DRG,311,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Syncope and collapse,312,MS-DRG,312,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Chest pain,313,MS-DRG,313,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other circulatory system diagnoses with MCC,314,MS-DRG,314,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,67570.83,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other circulatory system diagnoses with CC,315,MS-DRG,315,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,47562.03,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other circulatory system diagnoses without CC/MCC,316,MS-DRG,316,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Concomitant left atrial appendage closure and cardiac ablation,317,MS-DRG,317,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other endovascular cardiac valve procedures with MCC,319,MS-DRG,319,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other endovascular cardiac valve procedures without MCC,320,MS-DRG,320,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/intraluminal devices,321,MS-DRG,321,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Percutaneous cardiovascular procedures with intraluminal device without MCC,322,MS-DRG,322,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Coronary intravascular lithotripsy with intraluminal device with MCC,323,MS-DRG,323,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Coronary intravascular lithotripsy with intraluminal device without MCC,324,MS-DRG,324,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Coronary intravascular lithotripsy without intraluminal device,325,MS-DRG,325,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Stomach, esophageal and duodenal procedures with MCC",326,MS-DRG,326,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Stomach, esophageal and duodenal procedures with CC",327,MS-DRG,327,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Stomach, esophageal and duodenal procedures without CC/MCC",328,MS-DRG,328,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major small and large bowel procedures with MCC,329,MS-DRG,329,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major small and large bowel procedures with CC,330,MS-DRG,330,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major small and large bowel procedures without CC/MCC,331,MS-DRG,331,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Rectal resection with MCC,332,MS-DRG,332,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Rectal resection with CC,333,MS-DRG,333,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Rectal resection without CC/MCC,334,MS-DRG,334,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Peritoneal adhesiolysis with MCC,335,MS-DRG,335,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Peritoneal adhesiolysis with CC,336,MS-DRG,336,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Peritoneal adhesiolysis without CC/MCC,337,MS-DRG,337,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Minor small and large bowel procedures with MCC,344,MS-DRG,344,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Minor small and large bowel procedures with CC,345,MS-DRG,345,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Minor small and large bowel procedures without CC/MCC,346,MS-DRG,346,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Anal and stomal procedures with MCC,347,MS-DRG,347,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,68366.59,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Anal and stomal procedures with CC,348,MS-DRG,348,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Anal and stomal procedures without CC/MCC,349,MS-DRG,349,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Inguinal and femoral hernia procedures with MCC,350,MS-DRG,350,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,68366.59,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Inguinal and femoral hernia procedures with CC,351,MS-DRG,351,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Inguinal and femoral hernia procedures without CC/MCC,352,MS-DRG,352,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hernia procedures except inguinal and femoral with MCC,353,MS-DRG,353,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hernia procedures except inguinal and femoral with CC,354,MS-DRG,354,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hernia procedures except inguinal and femoral without CC/MCC,355,MS-DRG,355,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other digestive system O.R. procedures with MCC,356,MS-DRG,356,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,106800.32,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other digestive system O.R. procedures with CC,357,MS-DRG,357,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other digestive system O.R. procedures without CC/MCC,358,MS-DRG,358,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major esophageal disorders with MCC*,368,MS-DRG,368,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major esophageal disorders with CC*,369,MS-DRG,369,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major esophageal disorders without CC/MCC*,370,MS-DRG,370,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major gastrointestinal disorders and peritoneal infections with MCC,371,MS-DRG,371,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,68366.59,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major gastrointestinal disorders and peritoneal infections with CC,372,MS-DRG,372,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major gastrointestinal disorders and peritoneal infections without CC/MCC,373,MS-DRG,373,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Digestive malignancy with MCC*,374,MS-DRG,374,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Digestive malignancy with CC*,375,MS-DRG,375,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Digestive malignancy without CC/MCC*,376,MS-DRG,376,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Gastrointestinal hemorrhage with MCC,377,MS-DRG,377,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,54425.47,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Gastrointestinal hemorrhage with CC,378,MS-DRG,378,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Gastrointestinal hemorrhage without CC/MCC,379,MS-DRG,379,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Complicated peptic ulcer with MCC,380,MS-DRG,380,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,73278.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Complicated peptic ulcer with CC,381,MS-DRG,381,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Complicated peptic ulcer without CC/MCC,382,MS-DRG,382,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Uncomplicated peptic ulcer with MCC,383,MS-DRG,383,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Uncomplicated peptic ulcer without MCC,384,MS-DRG,384,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Inflammatory bowel disease with MCC,385,MS-DRG,385,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Inflammatory bowel disease with CC,386,MS-DRG,386,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Inflammatory bowel disease without CC/MCC,387,MS-DRG,387,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Gastrointestinal obstruction with MCC,388,MS-DRG,388,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,75604.95,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Gastrointestinal obstruction with CC,389,MS-DRG,389,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Gastrointestinal obstruction without CC/MCC,390,MS-DRG,390,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC",391,MS-DRG,391,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,59253.6,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC",392,MS-DRG,392,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,47929.3,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other digestive system diagnoses with MCC,393,MS-DRG,393,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,77739.74,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other digestive system diagnoses with CC,394,MS-DRG,394,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other digestive system diagnoses without CC/MCC,395,MS-DRG,395,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Appendix procedures with MCC,397,MS-DRG,397,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,68366.59,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Appendix procedures with CC,398,MS-DRG,398,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Appendix procedures without CC/MCC,399,MS-DRG,399,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Single level combined anterior and posterior spinal fusion except cervical,402,MS-DRG,402,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Pancreas, liver and shunt procedures with MCC",405,MS-DRG,405,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,40508.305,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Pancreas, liver and shunt procedures with CC",406,MS-DRG,406,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Pancreas, liver and shunt procedures without CC/MCC",407,MS-DRG,407,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with MCC,408,MS-DRG,408,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with CC,409,MS-DRG,409,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. without CC/MCC,410,MS-DRG,410,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cholecystectomy with C.D.E. with MCC,411,MS-DRG,411,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,73278.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cholecystectomy with C.D.E. with CC,412,MS-DRG,412,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cholecystectomy with C.D.E. without CC/MCC,413,MS-DRG,413,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with MCC,414,MS-DRG,414,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,73278.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with CC,415,MS-DRG,415,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cholecystectomy except by laparoscope without C.D.E. without CC/MCC,416,MS-DRG,416,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Laparoscopic cholecystectomy without C.D.E. with MCC,417,MS-DRG,417,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,73278.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Laparoscopic cholecystectomy without C.D.E. with CC,418,MS-DRG,418,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Laparoscopic cholecystectomy without C.D.E. without CC/MCC,419,MS-DRG,419,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hepatobiliary diagnostic procedures with MCC,420,MS-DRG,420,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hepatobiliary diagnostic procedures with CC,421,MS-DRG,421,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hepatobiliary diagnostic procedures without CC/MCC,422,MS-DRG,422,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other hepatobiliary or pancreas O.R. procedures with MCC,423,MS-DRG,423,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other hepatobiliary or pancreas O.R. procedures with CC,424,MS-DRG,424,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other hepatobiliary or pancreas O.R. procedures without CC/MCC,425,MS-DRG,425,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,426,MS-DRG,426,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,81343.62,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical with CC,427,MS-DRG,427,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,81343.62,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical without CC/MCC,428,MS-DRG,428,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,67111.73,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Combined anterior and posterior cervical spinal fusion with MCC,429,MS-DRG,429,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,81343.62,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Combined anterior and posterior cervical spinal fusion without MCC,430,MS-DRG,430,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cirrhosis and alcoholic hepatitis with MCC,432,MS-DRG,432,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,56468.43,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cirrhosis and alcoholic hepatitis with CC,433,MS-DRG,433,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cirrhosis and alcoholic hepatitis without CC/MCC,434,MS-DRG,434,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Malignancy of hepatobiliary system or pancreas with MCC,435,MS-DRG,435,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Malignancy of hepatobiliary system or pancreas with CC,436,MS-DRG,436,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Malignancy of hepatobiliary system or pancreas without CC/MCC,437,MS-DRG,437,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Disorders of pancreas except malignancy with MCC,438,MS-DRG,438,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,80165.28,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Disorders of pancreas except malignancy with CC,439,MS-DRG,439,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Disorders of pancreas except malignancy without CC/MCC,440,MS-DRG,440,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCC",441,MS-DRG,441,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,71243.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CC",442,MS-DRG,442,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without CC/MCC",443,MS-DRG,443,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Disorders of the biliary tract with MCC*,444,MS-DRG,444,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,58190.03,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Disorders of the biliary tract with CC*,445,MS-DRG,445,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53147.66,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Disorders of the biliary tract without CC/MCC*,446,MS-DRG,446,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,447,MS-DRG,447,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,1.0631,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Multiple level spinal fusion except cervical without MCC,448,MS-DRG,448,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,1.0631,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,450,MS-DRG,450,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,67111.74,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Single Level Spinal Fusion Except Cervical without MCC,451,MS-DRG,451,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with MCC",456,MS-DRG,456,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with CC",457,MS-DRG,457,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions without CC/MCC",458,MS-DRG,458,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Bilateral or multiple major joint procedures of lower extremity with MCC,461,MS-DRG,461,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,67111.74,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Bilateral or multiple major joint procedures of lower extremity without MCC,462,MS-DRG,462,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with MCC*,463,MS-DRG,463,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with CC*,464,MS-DRG,464,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72972.82,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders without CC/MCC*,465,MS-DRG,465,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,70057.58,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Revision of hip or knee replacement with MCC,466,MS-DRG,466,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Revision of hip or knee replacement with CC,467,MS-DRG,467,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Revision of hip or knee replacement without CC/MCC,468,MS-DRG,468,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity with MCC or total ankle replacement,469,MS-DRG,469,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity without MCC,470,MS-DRG,470,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cervical spinal fusion with MCC,471,MS-DRG,471,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cervical spinal fusion with CC,472,MS-DRG,472,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cervical spinal fusion without CC/MCC,473,MS-DRG,473,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with MCC,474,MS-DRG,474,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with CC,475,MS-DRG,475,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Amputation for musculoskeletal system and connective tissue disorders without CC/MCC,476,MS-DRG,476,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Biopsies of musculoskeletal system and connective tissue with MCC,477,MS-DRG,477,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Biopsies of musculoskeletal system and connective tissue with CC,478,MS-DRG,478,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,28146.902,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Biopsies of musculoskeletal system and connective tissue without CC/MCC,479,MS-DRG,479,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,28146.902,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hip and femur procedures except major joint with MCC,480,MS-DRG,480,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hip and femur procedures except major joint with CC,481,MS-DRG,481,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hip and femur procedures except major joint without CC/MCC,482,MS-DRG,482,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major joint or limb reattachment procedures of upper extremities,483,MS-DRG,483,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Knee procedures with principal diagnosis of infection with MCC,485,MS-DRG,485,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Knee procedures with principal diagnosis of infection with CC,486,MS-DRG,486,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Knee procedures with principal diagnosis of infection without CC/MCC,487,MS-DRG,487,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Knee procedures without principal diagnosis of infection with CC/MCC,488,MS-DRG,488,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Knee procedures without principal diagnosis of infection without CC/MCC,489,MS-DRG,489,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,51693.87,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with MCC",492,MS-DRG,492,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with CC",493,MS-DRG,493,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur without CC/MCC",494,MS-DRG,494,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Local excision and removal of internal fixation devices except hip and femur with MCC,495,MS-DRG,495,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Local excision and removal of internal fixation devices except hip and femur with CC,496,MS-DRG,496,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Local excision and removal of internal fixation devices except hip and femur without CC/MCC,497,MS-DRG,497,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Local excision and removal of internal fixation devices of hip and femur with CC/MCC,498,MS-DRG,498,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Local excision and removal of internal fixation devices of hip and femur without CC/MCC,499,MS-DRG,499,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Soft tissue procedures with MCC,500,MS-DRG,500,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,94244.13,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Soft tissue procedures with CC,501,MS-DRG,501,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Soft tissue procedures without CC/MCC,502,MS-DRG,502,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,67111.74,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Foot procedures with MCC,503,MS-DRG,503,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Foot procedures with CC,504,MS-DRG,504,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Foot procedures without CC/MCC,505,MS-DRG,505,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major thumb or joint procedures,506,MS-DRG,506,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major shoulder or elbow joint procedures with CC/MCC,507,MS-DRG,507,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major shoulder or elbow joint procedures without CC/MCC,508,MS-DRG,508,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Arthroscopy,509,MS-DRG,509,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with MCC",510,MS-DRG,510,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with CC",511,MS-DRG,511,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures without CC/MCC",512,MS-DRG,512,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures with CC/MCC",513,MS-DRG,513,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures without CC/MCC",514,MS-DRG,514,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with MCC,515,MS-DRG,515,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,91742.07,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with CC,516,MS-DRG,516,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures without CC/MCC,517,MS-DRG,517,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Back and neck procedures except spinal fusion with MCC or disc device or neurostimulator,518,MS-DRG,518,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Back and neck procedures except spinal fusion with CC,519,MS-DRG,519,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Back and neck procedures except spinal fusion without CC/MCC,520,MS-DRG,520,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hip replacement with principal diagnosis of hip fracture with MCC,521,MS-DRG,521,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hip replacement with principal diagnosis of hip fracture without MCC,522,MS-DRG,522,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Fractures of femur with MCC,533,MS-DRG,533,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Fractures of femur without MCC,534,MS-DRG,534,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Fractures of hip and pelvis with MCC,535,MS-DRG,535,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Fractures of hip and pelvis without MCC,536,MS-DRG,536,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh with CC/MCC",537,MS-DRG,537,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh without CC/MCC",538,MS-DRG,538,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Osteomyelitis with MCC*,539,MS-DRG,539,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,74166.46,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Osteomyelitis with CC*,540,MS-DRG,540,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,54425.47,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Osteomyelitis without CC/MCC*,541,MS-DRG,541,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,51693.86,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with MCC*,542,MS-DRG,542,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with CC*,543,MS-DRG,543,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy without CC/MCC*,544,MS-DRG,544,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Connective tissue disorders with MCC,545,MS-DRG,545,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Connective tissue disorders with CC,546,MS-DRG,546,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Connective tissue disorders without CC/MCC,547,MS-DRG,547,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46988.16,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Septic arthritis with MCC,548,MS-DRG,548,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,65145.29,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Septic arthritis with CC,549,MS-DRG,549,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Septic arthritis without CC/MCC,550,MS-DRG,550,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Medical back problems with MCC,551,MS-DRG,551,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,99921.58,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Medical back problems without MCC,552,MS-DRG,552,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Bone diseases and arthropathies with MCC,553,MS-DRG,553,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Bone diseases and arthropathies without MCC,554,MS-DRG,554,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue with MCC,555,MS-DRG,555,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue without MCC,556,MS-DRG,556,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Tendonitis, myositis and bursitis with MCC",557,MS-DRG,557,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,69284.76,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Tendonitis, myositis and bursitis without MCC",558,MS-DRG,558,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53645.01,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Aftercare, musculoskeletal system and connective tissue with MCC*",559,MS-DRG,559,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,61671.48,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Aftercare, musculoskeletal system and connective tissue with CC*",560,MS-DRG,560,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48082.33,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Aftercare, musculoskeletal system and connective tissue without CC/MCC*",561,MS-DRG,561,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46988.16,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCC",562,MS-DRG,562,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCC",563,MS-DRG,563,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46988.16,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other musculoskeletal system and connective tissue diagnoses with MCC,564,MS-DRG,564,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,67111.74,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other musculoskeletal system and connective tissue diagnoses with CC,565,MS-DRG,565,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other musculoskeletal system and connective tissue diagnoses without CC/MCC,566,MS-DRG,566,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Skin debridement with MCC*,570,MS-DRG,570,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,90081.68,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Skin debridement with CC*,571,MS-DRG,571,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,65336.58,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Skin debridement without CC/MCC*,572,MS-DRG,572,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,65336.58,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Skin graft for skin ulcer or cellulitis with MCC,573,MS-DRG,573,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,106394.79,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Skin graft for skin ulcer or cellulitis with CC,574,MS-DRG,574,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Skin graft for skin ulcer or cellulitis without CC/MCC,575,MS-DRG,575,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Skin graft except for skin ulcer or cellulitis with MCC*,576,MS-DRG,576,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Skin graft except for skin ulcer or cellulitis with CC*,577,MS-DRG,577,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Skin graft except for skin ulcer or cellulitis without CC/MCC*,578,MS-DRG,578,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Other skin, subcutaneous tissue and breast procedures with MCC",579,MS-DRG,579,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,103793.26,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Other skin, subcutaneous tissue and breast procedures with CC",580,MS-DRG,580,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,85299.47,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Other skin, subcutaneous tissue and breast procedures without CC/MCC",581,MS-DRG,581,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,85299.47,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Mastectomy for malignancy with CC/MCC,582,MS-DRG,582,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,103793.26,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Mastectomy for malignancy without CC/MCC,583,MS-DRG,583,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,85299.47,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Breast biopsy, local excision and other breast procedures with CC/MCC",584,MS-DRG,584,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,65336.58,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Breast biopsy, local excision and other breast procedures without CC/MCC",585,MS-DRG,585,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Skin ulcers with MCC,592,MS-DRG,592,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,67333.63,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Skin ulcers with CC,593,MS-DRG,593,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53667.96,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Skin ulcers without CC/MCC,594,MS-DRG,594,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major skin disorders with MCC,595,MS-DRG,595,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major skin disorders without MCC,596,MS-DRG,596,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Malignant breast disorders with MCC,597,MS-DRG,597,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Malignant breast disorders with CC,598,MS-DRG,598,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Malignant breast disorders without CC/MCC,599,MS-DRG,599,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Non-malignant breast disorders with CC/MCC*,600,MS-DRG,600,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Non-malignant breast disorders without CC/MCC*,601,MS-DRG,601,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cellulitis with MCC,602,MS-DRG,602,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,55068.2,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cellulitis without MCC,603,MS-DRG,603,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36842.21,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Trauma to the skin, subcutaneous tissue and breast with MCC",604,MS-DRG,604,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Trauma to the skin, subcutaneous tissue and breast without MCC",605,MS-DRG,605,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Minor skin disorders with MCC,606,MS-DRG,606,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Minor skin disorders without MCC,607,MS-DRG,607,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Adrenal and pituitary procedures with CC/MCC,614,MS-DRG,614,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Adrenal and pituitary procedures without CC/MCC,615,MS-DRG,615,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with MCC",616,MS-DRG,616,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with CC",617,MS-DRG,617,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders without CC/MCC",618,MS-DRG,618,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
O.R. procedures for obesity with MCC,619,MS-DRG,619,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,100051.65,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
O.R. procedures for obesity with CC,620,MS-DRG,620,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72590.25,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
O.R. procedures for obesity without CC/MCC,621,MS-DRG,621,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with MCC",622,MS-DRG,622,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,100051.65,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with CC",623,MS-DRG,623,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72590.25,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders without CC/MCC",624,MS-DRG,624,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with MCC",625,MS-DRG,625,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,30309.826,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with CC",626,MS-DRG,626,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Thyroid, parathyroid and thyroglossal procedures without CC/MCC",627,MS-DRG,627,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with MCC",628,MS-DRG,628,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,30309.826,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with CC",629,MS-DRG,629,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures without CC/MCC",630,MS-DRG,630,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Diabetes with MCC,637,MS-DRG,637,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,67654.99,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Diabetes with CC,638,MS-DRG,638,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53843.95,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Diabetes without CC/MCC,639,MS-DRG,639,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCC",640,MS-DRG,640,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,74862.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCC",641,MS-DRG,641,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,47049.37,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Inborn and other disorders of metabolism,642,MS-DRG,642,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Endocrine disorders with MCC*,643,MS-DRG,643,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Endocrine disorders with CC*,644,MS-DRG,644,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Endocrine disorders without CC/MCC*,645,MS-DRG,645,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major bladder procedures with MCC,653,MS-DRG,653,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,91596.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major bladder procedures with CC,654,MS-DRG,654,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,80073.46,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major bladder procedures without CC/MCC,655,MS-DRG,655,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Kidney and ureter procedures for neoplasm with MCC,656,MS-DRG,656,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Kidney and ureter procedures for neoplasm with CC,657,MS-DRG,657,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Kidney and ureter procedures for neoplasm without CC/MCC,658,MS-DRG,658,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Kidney and ureter procedures for non-neoplasm with MCC*,659,MS-DRG,659,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Kidney and ureter procedures for non-neoplasm with CC*,660,MS-DRG,660,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Kidney and ureter procedures for non-neoplasm without CC/MCC*,661,MS-DRG,661,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Minor bladder procedures with MCC,662,MS-DRG,662,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Minor bladder procedures with CC,663,MS-DRG,663,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Minor bladder procedures without CC/MCC,664,MS-DRG,664,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Prostatectomy with MCC,665,MS-DRG,665,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,91596.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Prostatectomy with CC,666,MS-DRG,666,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,80073.46,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Prostatectomy without CC/MCC,667,MS-DRG,667,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Transurethral procedures with MCC,668,MS-DRG,668,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Transurethral procedures with CC,669,MS-DRG,669,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Transurethral procedures without CC/MCC,670,MS-DRG,670,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Urethral procedures with CC/MCC,671,MS-DRG,671,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Urethral procedures without CC/MCC,672,MS-DRG,672,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other kidney and urinary tract procedures with MCC*,673,MS-DRG,673,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,91596.69,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other kidney and urinary tract procedures with CC*,674,MS-DRG,674,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,80073.46,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other kidney and urinary tract procedures without CC/MCC*,675,MS-DRG,675,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,80073.46,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Renal failure with MCC,682,MS-DRG,682,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,66775.07,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Renal failure with CC,683,MS-DRG,683,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,46314.82,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Renal failure without CC/MCC,684,MS-DRG,684,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Kidney and urinary tract neoplasms with MCC,686,MS-DRG,686,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Kidney and urinary tract neoplasms with CC,687,MS-DRG,687,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Kidney and urinary tract neoplasms without CC/MCC,688,MS-DRG,688,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Kidney and urinary tract infections with MCC,689,MS-DRG,689,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48342.49,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Kidney and urinary tract infections without MCC,690,MS-DRG,690,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,35962.28,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Urinary stones with MCC,693,MS-DRG,693,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Urinary stones without MCC,694,MS-DRG,694,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Kidney and urinary tract signs and symptoms with MCC,695,MS-DRG,695,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Kidney and urinary tract signs and symptoms without MCC,696,MS-DRG,696,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Urethral stricture,697,MS-DRG,697,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other kidney and urinary tract diagnoses with MCC,698,MS-DRG,698,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,67746.82,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other kidney and urinary tract diagnoses with CC,699,MS-DRG,699,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,47363.09,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other kidney and urinary tract diagnoses without CC/MCC,700,MS-DRG,700,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major male pelvic procedures with CC/MCC,707,MS-DRG,707,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major male pelvic procedures without CC/MCC,708,MS-DRG,708,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Penis procedures with CC/MCC,709,MS-DRG,709,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Penis procedures without CC/MCC,710,MS-DRG,710,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Testes procedures with CC/MCC,711,MS-DRG,711,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Testes procedures without CC/MCC,712,MS-DRG,712,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Transurethral prostatectomy with CC/MCC,713,MS-DRG,713,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,30309.826,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Transurethral prostatectomy without CC/MCC,714,MS-DRG,714,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other male reproductive system O.R. procedures for malignancy with CC/MCC,715,MS-DRG,715,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other male reproductive system O.R. procedures for malignancy without CC/MCC,716,MS-DRG,716,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other male reproductive system O.R. procedures except malignancy with CC/MCC,717,MS-DRG,717,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other male reproductive system O.R. procedures except malignancy without CC/MCC,718,MS-DRG,718,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Malignancy, male reproductive system with MCC",722,MS-DRG,722,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,61794.07,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Malignancy, male reproductive system with CC",723,MS-DRG,723,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Malignancy, male reproductive system without CC/MCC",724,MS-DRG,724,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,50278,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Benign prostatic hypertrophy with MCC,725,MS-DRG,725,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,50278.46,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Benign prostatic hypertrophy without MCC,726,MS-DRG,726,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Inflammation of the male reproductive system with MCC,727,MS-DRG,727,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,61794.07,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Inflammation of the male reproductive system without MCC,728,MS-DRG,728,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,50278,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other male reproductive system diagnoses with CC/MCC,729,MS-DRG,729,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other male reproductive system diagnoses without CC/MCC,730,MS-DRG,730,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC",734,MS-DRG,734,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC",735,MS-DRG,735,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with MCC,736,MS-DRG,736,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with CC,737,MS-DRG,737,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy without CC/MCC,738,MS-DRG,738,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with MCC,739,MS-DRG,739,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with CC,740,MS-DRG,740,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy without CC/MCC,741,MS-DRG,741,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Uterine and adnexa procedures for non-malignancy with CC/MCC,742,MS-DRG,742,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Uterine and adnexa procedures for non-malignancy without CC/MCC,743,MS-DRG,743,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"D&C, conization, laparoscopy and tubal interruption with CC/MCC",744,MS-DRG,744,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"D&C, conization, laparoscopy and tubal interruption without CC/MCC",745,MS-DRG,745,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Vagina, cervix and vulva procedures with CC/MCC",746,MS-DRG,746,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Vagina, cervix and vulva procedures without CC/MCC",747,MS-DRG,747,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Female reproductive system reconstructive procedures,748,MS-DRG,748,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other female reproductive system O.R. procedures with CC/MCC,749,MS-DRG,749,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other female reproductive system O.R. procedures without CC/MCC,750,MS-DRG,750,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Malignancy, female reproductive system with MCC",754,MS-DRG,754,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Malignancy, female reproductive system with CC",755,MS-DRG,755,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Malignancy, female reproductive system without CC/MCC",756,MS-DRG,756,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Infections, female reproductive system with MCC",757,MS-DRG,757,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,29854.136,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Infections, female reproductive system with CC",758,MS-DRG,758,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Infections, female reproductive system without CC/MCC",759,MS-DRG,759,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Menstrual and other female reproductive system disorders with CC/MCC,760,MS-DRG,760,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Menstrual and other female reproductive system disorders without CC/MCC,761,MS-DRG,761,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Vaginal delivery with O.R. procedures except sterilization and/or D&C,768,MS-DRG,768,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Postpartum and post abortion diagnoses with O.R. procedures,769,MS-DRG,769,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Abortion with D&C, aspiration curettage or hysterotomy",770,MS-DRG,770,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Postpartum and post abortion diagnoses without O.R. procedures,776,MS-DRG,776,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Abortion without D&C,779,MS-DRG,779,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cesarean section with sterilization with MCC,783,MS-DRG,783,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cesarean section with sterilization with CC,784,MS-DRG,784,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,90613.37,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cesarean section with sterilization without CC/MCC,785,MS-DRG,785,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cesarean section without sterilization with MCC,786,MS-DRG,786,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cesarean section without sterilization with CC,787,MS-DRG,787,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Cesarean section without sterilization without CC/MCC,788,MS-DRG,788,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Neonates, died or transferred to another acute care facility",789,MS-DRG,789,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Extreme immaturity or respiratory distress syndrome, neonate",790,MS-DRG,790,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Prematurity with major problems,791,MS-DRG,791,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Prematurity without major problems,792,MS-DRG,792,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48921.03,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Full term neonate with major problems,793,MS-DRG,793,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Neonate with other significant problems,794,MS-DRG,794,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48921.03,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Splenic procedures with MCC,799,MS-DRG,799,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,106800.6,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Splenic procedures with CC,800,MS-DRG,800,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48921.03,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Splenic procedures without CC/MCC,801,MS-DRG,801,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other O.R. procedures of the blood and blood forming organs with MCC,802,MS-DRG,802,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other O.R. procedures of the blood and blood forming organs with CC,803,MS-DRG,803,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other O.R. procedures of the blood and blood forming organs without CC/MCC,804,MS-DRG,804,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with MCC,808,MS-DRG,808,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with CC,809,MS-DRG,809,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without CC/MCC,810,MS-DRG,810,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Red blood cell disorders with MCC,811,MS-DRG,811,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Red blood cell disorders without MCC,812,MS-DRG,812,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Coagulation disorders,813,MS-DRG,813,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Reticuloendothelial and immunity disorders with MCC*,814,MS-DRG,814,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Reticuloendothelial and immunity disorders with CC*,815,MS-DRG,815,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Reticuloendothelial and immunity disorders without CC/MCC*,816,MS-DRG,816,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other antepartum diagnoses with O.R. procedures with MCC,817,MS-DRG,817,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,40508.305,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other antepartum diagnoses with O.R. procedures with CC,818,MS-DRG,818,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other antepartum diagnoses with O.R. procedures without CC/MCC,819,MS-DRG,819,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Lymphoma and leukemia with major O.R. procedures with MCC,820,MS-DRG,820,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Lymphoma and leukemia with major O.R. procedures with CC,821,MS-DRG,821,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Lymphoma and leukemia with major O.R. procedures without CC/MCC,822,MS-DRG,822,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Lymphoma and non-acute leukemia with other procedures with MCC,823,MS-DRG,823,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Lymphoma and non-acute leukemia with other procedures with CC,824,MS-DRG,824,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Lymphoma and non-acute leukemia with other procedures without CC/MCC,825,MS-DRG,825,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with MCC,826,MS-DRG,826,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with CC,827,MS-DRG,827,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures without CC/MCC,828,MS-DRG,828,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures with CC/MCC,829,MS-DRG,829,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures without CC/MCC,830,MS-DRG,830,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other antepartum diagnoses without O.R. procedures with MCC,831,MS-DRG,831,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other antepartum diagnoses without O.R. procedures with CC,832,MS-DRG,832,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other antepartum diagnoses without O.R. procedures without CC/MCC,833,MS-DRG,833,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Acute leukemia with MCC,834,MS-DRG,834,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Acute leukemia with CC,835,MS-DRG,835,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Acute leukemia without CC/MCC,836,MS-DRG,836,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy agent with MCC,837,MS-DRG,837,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapy agent,838,MS-DRG,838,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis without CC/MCC,839,MS-DRG,839,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Lymphoma and non-acute leukemia with MCC,840,MS-DRG,840,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Lymphoma and non-acute leukemia with CC,841,MS-DRG,841,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Lymphoma and non-acute leukemia without CC/MCC,842,MS-DRG,842,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with MCC,843,MS-DRG,843,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with CC,844,MS-DRG,844,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses without CC/MCC,845,MS-DRG,845,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with MCC,846,MS-DRG,846,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with CC,847,MS-DRG,847,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis without CC/MCC,848,MS-DRG,848,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Radiotherapy,849,MS-DRG,849,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Acute leukemia with other procedures,850,MS-DRG,850,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Infectious and parasitic diseases with O.R. procedures with MCC,853,MS-DRG,853,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,116013.09,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Infectious and parasitic diseases with O.R. procedures with CC,854,MS-DRG,854,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.07,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Infectious and parasitic diseases with O.R. procedures without CC/MCC,855,MS-DRG,855,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with MCC,856,MS-DRG,856,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,103112.54,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with CC,857,MS-DRG,857,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Postoperative or post-traumatic infections with O.R. procedures without CC/MCC,858,MS-DRG,858,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Postoperative and post-traumatic infections with MCC,862,MS-DRG,862,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,70501.55,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Postoperative and post-traumatic infections without MCC,863,MS-DRG,863,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,47554.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Fever and inflammatory conditions,864,MS-DRG,864,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Viral illness with MCC,865,MS-DRG,865,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Viral illness without MCC,866,MS-DRG,866,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other infectious and parasitic diseases diagnoses with MCC,867,MS-DRG,867,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,70118.98,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other infectious and parasitic diseases diagnoses with CC,868,MS-DRG,868,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other infectious and parasitic diseases diagnoses without CC/MCC,869,MS-DRG,869,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Septicemia or severe sepsis with MV >96 hours,870,MS-DRG,870,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,158548.16,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Septicemia or severe sepsis without MV >96 hours with MCC,871,MS-DRG,871,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,64954.17,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Septicemia or severe sepsis without MV >96 hours without MCC,872,MS-DRG,872,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,43522.12,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Wound debridements for injuries with MCC,901,MS-DRG,901,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,98177.28,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Wound debridements for injuries with CC,902,MS-DRG,902,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Wound debridements for injuries without CC/MCC,903,MS-DRG,903,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Skin grafts for injuries with CC/MCC,904,MS-DRG,904,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Skin grafts for injuries without CC/MCC,905,MS-DRG,905,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Hand procedures for injuries,906,MS-DRG,906,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other O.R. procedures for injuries with MCC*,907,MS-DRG,907,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other O.R. procedures for injuries with CC*,908,MS-DRG,908,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other O.R. procedures for injuries without CC/MCC*,909,MS-DRG,909,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Traumatic injury with MCC,913,MS-DRG,913,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Traumatic injury without MCC,914,MS-DRG,914,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Allergic reactions with MCC,915,MS-DRG,915,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Allergic reactions without MCC,916,MS-DRG,916,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Poisoning and toxic effects of drugs with MCC,917,MS-DRG,917,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Poisoning and toxic effects of drugs without MCC,918,MS-DRG,918,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Complications of treatment with MCC,919,MS-DRG,919,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,82055.43,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Complications of treatment with CC,920,MS-DRG,920,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52581.58,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Complications of treatment without CC/MCC,921,MS-DRG,921,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Other injury, poisoning and toxic effect diagnoses with MCC",922,MS-DRG,922,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Other injury, poisoning and toxic effect diagnoses without MCC",923,MS-DRG,923,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Extensive burns or full thickness burns with MV >96 hours with skin graft,927,MS-DRG,927,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Full thickness burn with skin graft or inhalation injury with CC/MCC,928,MS-DRG,928,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Full thickness burn with skin graft or inhalation injury without CC/MCC,929,MS-DRG,929,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Extensive burns or full thickness burns with MV >96 hours without skin graft,933,MS-DRG,933,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Full thickness burn without skin graft or inhalation injury,934,MS-DRG,934,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Non-extensive burns,935,MS-DRG,935,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
O.R. procedures with diagnoses of other contact with health services with MCC,939,MS-DRG,939,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,90701.7,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
O.R. procedures with diagnoses of other contact with health services with CC,940,MS-DRG,940,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
O.R. procedures with diagnoses of other contact with health services without CC/MCC,941,MS-DRG,941,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Signs and symptoms with MCC,947,MS-DRG,947,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Signs and symptoms without MCC,948,MS-DRG,948,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Aftercare with CC/MCC,949,MS-DRG,949,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,53224.31,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Aftercare without CC/MCC,950,MS-DRG,950,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other factors influencing health status,951,MS-DRG,951,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Craniotomy for multiple significant trauma,955,MS-DRG,955,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"Limb reattachment, hip and femur procedures for multiple significant trauma",956,MS-DRG,956,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other O.R. procedures for multiple significant trauma with MCC,957,MS-DRG,957,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other O.R. procedures for multiple significant trauma with CC,958,MS-DRG,958,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other O.R. procedures for multiple significant trauma without CC/MCC,959,MS-DRG,959,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other multiple significant trauma with MCC,963,MS-DRG,963,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other multiple significant trauma with CC,964,MS-DRG,964,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Other multiple significant trauma without CC/MCC,965,MS-DRG,965,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
HIV with extensive O.R. procedures with MCC,969,MS-DRG,969,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
HIV with extensive O.R. procedures without MCC,970,MS-DRG,970,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
HIV with major related condition with MCC*,974,MS-DRG,974,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,87197.28,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
HIV with major related condition with CC*,975,MS-DRG,975,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,68412.68,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
HIV with major related condition without CC/MCC*,976,MS-DRG,976,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,68412.68,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
HIV with or without other related condition,977,MS-DRG,977,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with MCC,981,MS-DRG,981,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,68449.825,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with CC,982,MS-DRG,982,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,96991.29,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,983,MS-DRG,983,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with MCC,987,MS-DRG,987,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,163207.97,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with CC,988,MS-DRG,988,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.07,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,989,MS-DRG,989,LOCAL,,Inpatient,,,,,Health Net ,Commercial,,,MS-DRG,72269.07,case rate,22000,120000,"If TBC exceeds $300,00, will pay per diem up to date threshhold met, remaining charges in excess of threshold at $65% of BC not to exceed $3000/per diem for each remaining day of that admission",,,,,,,
"ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck with major O.R. procedures",3,MS-DRG,3,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,310277.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck without major O.R. procedures",4,MS-DRG,4,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,229767.96,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCC",11,MS-DRG,11,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CC",12,MS-DRG,12,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Tracheostomy for face, mouth and neck diagnoses or laryngectomy without CC/MCC",13,MS-DRG,13,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Chimeric antigen receptor (CAR) T-cell and other immunotherapies,18,MS-DRG,18,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with MCC,20,MS-DRG,20,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage with CC,21,MS-DRG,21,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Intracranial vascular procedures with principal diagnosis hemorrhage without CC/MCC,22,MS-DRG,22,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC or chemotherapy implant or epilepsy with neurostimulator,23,MS-DRG,23,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Craniotomy with major device implant or acute complex CNS principal diagnosis without MCC,24,MS-DRG,24,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Craniotomy and endovascular intracranial procedures with MCC,25,MS-DRG,25,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Craniotomy and endovascular intracranial procedures with CC,26,MS-DRG,26,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Craniotomy and endovascular intracranial procedures without CC/MCC,27,MS-DRG,27,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Spinal procedures with MCC,28,MS-DRG,28,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Spinal procedures with CC or spinal neurostimulators,29,MS-DRG,29,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Spinal procedures without CC/MCC,30,MS-DRG,30,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Ventricular shunt procedures with MCC,31,MS-DRG,31,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Ventricular shunt procedures with CC,32,MS-DRG,32,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Ventricular shunt procedures without CC/MCC,33,MS-DRG,33,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Carotid artery stent procedures with MCC,34,MS-DRG,34,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Carotid artery stent procedures with CC,35,MS-DRG,35,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Carotid artery stent procedures without CC/MCC,36,MS-DRG,36,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Extracranial procedures with MCC,37,MS-DRG,37,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Extracranial procedures with CC,38,MS-DRG,38,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Extracranial procedures without CC/MCC,39,MS-DRG,39,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with MCC",40,MS-DRG,40,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,95774.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurostimulator",41,MS-DRG,41,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Peripheral, cranial nerve and other nervous system procedures without CC/MCC",42,MS-DRG,42,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Spinal disorders and injuries with CC/MCC,52,MS-DRG,52,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,82942.79,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Spinal disorders and injuries without CC/MCC,53,MS-DRG,53,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,81228.84,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Nervous system neoplasms with MCC,54,MS-DRG,54,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Nervous system neoplasms without MCC,55,MS-DRG,55,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46368.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Degenerative nervous system disorders with MCC,56,MS-DRG,56,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,61411.33,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Degenerative nervous system disorders without MCC,57,MS-DRG,57,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,51678.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Multiple sclerosis and cerebellar ataxia with MCC,58,MS-DRG,58,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Multiple sclerosis and cerebellar ataxia with CC,59,MS-DRG,59,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,51678.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Multiple sclerosis and cerebellar ataxia without CC/MCC,60,MS-DRG,60,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,51678.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with MCC",61,MS-DRG,61,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,111192.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with CC",62,MS-DRG,62,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent without CC/MCC",63,MS-DRG,63,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Intracranial hemorrhage or cerebral infarction with MCC,64,MS-DRG,64,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,111192.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Intracranial hemorrhage or cerebral infarction with CC or tPA in 24 hours,65,MS-DRG,65,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Intracranial hemorrhage or cerebral infarction without CC/MCC,66,MS-DRG,66,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Nonspecific CVA and precerebral occlusion without infarction with MCC,67,MS-DRG,67,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,66767.42,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Nonspecific CVA and precerebral occlusion without infarction without MCC,68,MS-DRG,68,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Transient ischemia without thrombolytic,69,MS-DRG,69,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Nonspecific cerebrovascular disorders with MCC*,70,MS-DRG,70,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,66767.42,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Nonspecific cerebrovascular disorders with CC*,71,MS-DRG,71,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,45128.84,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Nonspecific cerebrovascular disorders without CC/MCC*,72,MS-DRG,72,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cranial and peripheral nerve disorders with MCC,73,MS-DRG,73,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cranial and peripheral nerve disorders without MCC,74,MS-DRG,74,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Viral meningitis with CC/MCC,75,MS-DRG,75,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Viral meningitis without CC/MCC,76,MS-DRG,76,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hypertensive encephalopathy with MCC,77,MS-DRG,77,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,68160,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hypertensive encephalopathy with CC,78,MS-DRG,78,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,537909.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hypertensive encephalopathy without CC/MCC,79,MS-DRG,79,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Nontraumatic stupor and coma with MCC,80,MS-DRG,80,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Nontraumatic stupor and coma without MCC,81,MS-DRG,81,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Traumatic stupor and coma >1 hour with MCC*,82,MS-DRG,82,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,82529.13,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Traumatic stupor and coma >1 hour with CC*,83,MS-DRG,83,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,62451.46,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Traumatic stupor and coma >1 hour without CC/MCC*,84,MS-DRG,84,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Traumatic stupor and coma <1 hour with MCC,85,MS-DRG,85,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,62451.46,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Traumatic stupor and coma <1 hour with CC,86,MS-DRG,86,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,62451.46,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Traumatic stupor and coma <1 hour without CC/MCC,87,MS-DRG,87,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Concussion with MCC,88,MS-DRG,88,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,68160,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Concussion with CC,89,MS-DRG,89,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,537909.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Concussion without CC/MCC,90,MS-DRG,90,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other disorders of nervous system with MCC,91,MS-DRG,91,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,68160,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other disorders of nervous system with CC,92,MS-DRG,92,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,537909.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other disorders of nervous system without CC/MCC,93,MS-DRG,93,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,51678.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Bacterial and tuberculous infections of nervous system with MCC*,94,MS-DRG,94,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34375.739,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Bacterial and tuberculous infections of nervous system with CC*,95,MS-DRG,95,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,62451.46,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Bacterial and tuberculous infections of nervous system without CC/MCC*,96,MS-DRG,96,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Non-bacterial infection of nervous system except viral meningitis with MCC,97,MS-DRG,97,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,75054.04,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Non-bacterial infection of nervous system except viral meningitis with CC,98,MS-DRG,98,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Non-bacterial infection of nervous system except viral meningitis without CC/MCC,99,MS-DRG,99,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Seizures with MCC,100,MS-DRG,100,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Seizures without MCC,101,MS-DRG,101,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Headaches with MCC,102,MS-DRG,102,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Headaches without MCC,103,MS-DRG,103,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Orbital procedures with CC/MCC,113,MS-DRG,113,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Orbital procedures without CC/MCC,114,MS-DRG,114,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Extraocular procedures except orbit,115,MS-DRG,115,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Intraocular procedures with CC/MCC,116,MS-DRG,116,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Intraocular procedures without CC/MCC,117,MS-DRG,117,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Acute major eye infections with CC/MCC,121,MS-DRG,121,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Acute major eye infections without CC/MCC,122,MS-DRG,122,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Neurological eye disorders,123,MS-DRG,123,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other disorders of the eye with MCC or thrombolytic agent,124,MS-DRG,124,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other disorders of the eye without MCC,125,MS-DRG,125,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Sinus and mastoid procedures with CC/MCC,135,MS-DRG,135,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Sinus and mastoid procedures without CC/MCC,136,MS-DRG,136,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Mouth procedures with CC/MCC,137,MS-DRG,137,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Mouth procedures without CC/MCC,138,MS-DRG,138,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Salivary gland procedures,139,MS-DRG,139,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major head and neck procedures with MCC,140,MS-DRG,140,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,177508.29,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major head and neck procedures with CC,141,MS-DRG,141,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major head and neck procedures without CC/MCC,142,MS-DRG,142,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with MCC",143,MS-DRG,143,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures with CC",144,MS-DRG,144,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Other ear, nose, mouth and throat O.R. procedures without CC/MCC",145,MS-DRG,145,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Ear, nose, mouth and throat malignancy with MCC*",146,MS-DRG,146,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Ear, nose, mouth and throat malignancy with CC*",147,MS-DRG,147,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Ear, nose, mouth and throat malignancy without CC/MCC*",148,MS-DRG,148,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Dysequilibrium,149,MS-DRG,149,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Epistaxis with MCC,150,MS-DRG,150,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Epistaxis without MCC,151,MS-DRG,151,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Otitis media and URI with MCC,152,MS-DRG,152,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Otitis media and URI without MCC,153,MS-DRG,153,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Other ear, nose, mouth and throat diagnoses with MCC",154,MS-DRG,154,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Other ear, nose, mouth and throat diagnoses with CC",155,MS-DRG,155,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Other ear, nose, mouth and throat diagnoses without CC/MCC",156,MS-DRG,156,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Dental and oral diseases with MCC,157,MS-DRG,157,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Dental and oral diseases with CC,158,MS-DRG,158,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Dental and oral diseases without CC/MCC,159,MS-DRG,159,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major chest procedures with MCC,163,MS-DRG,163,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,202666.58,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major chest procedures with CC,164,MS-DRG,164,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,202666.58,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major chest procedures without CC/MCC,165,MS-DRG,165,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,202666.58,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other respiratory system O.R. procedures with MCC,166,MS-DRG,166,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,177508.29,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other respiratory system O.R. procedures with CC,167,MS-DRG,167,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,115767.94,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other respiratory system O.R. procedures without CC/MCC,168,MS-DRG,168,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism,173,MS-DRG,173,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Pulmonary embolism with MCC or acute cor pulmonale,175,MS-DRG,175,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Pulmonary embolism without MCC,176,MS-DRG,176,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Respiratory infections and inflammations with MCC*,177,MS-DRG,177,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,62918.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Respiratory infections and inflammations with CC*,178,MS-DRG,178,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,43491.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Respiratory infections and inflammations without CC/MCC*,179,MS-DRG,179,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,42251.85,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Respiratory neoplasms with MCC*,180,MS-DRG,180,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Respiratory neoplasms with CC*,181,MS-DRG,181,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Respiratory neoplasms without CC/MCC*,182,MS-DRG,182,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major chest trauma with MCC,183,MS-DRG,183,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major chest trauma with CC,184,MS-DRG,184,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major chest trauma without CC/MCC,185,MS-DRG,185,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Pleural effusion with MCC*,186,MS-DRG,186,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,66071.13,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Pleural effusion with CC*,187,MS-DRG,187,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Pleural effusion without CC/MCC*,188,MS-DRG,188,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Pulmonary edema and respiratory failure,189,MS-DRG,189,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72046.99,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Chronic obstructive pulmonary disease with MCC*,190,MS-DRG,190,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,20971.383,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Chronic obstructive pulmonary disease with CC*,191,MS-DRG,191,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Chronic obstructive pulmonary disease without CC/MCC*,192,MS-DRG,192,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Simple pneumonia and pleurisy with MCC,193,MS-DRG,193,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,59421.93,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Simple pneumonia and pleurisy with CC,194,MS-DRG,194,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,39604.42,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Simple pneumonia and pleurisy without CC/MCC,195,MS-DRG,195,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Interstitial lung disease with MCC*,196,MS-DRG,196,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Interstitial lung disease with CC*,197,MS-DRG,197,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Interstitial lung disease without CC/MCC*,198,MS-DRG,198,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Pneumothorax with MCC,199,MS-DRG,199,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Pneumothorax with CC,200,MS-DRG,200,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,21869.927,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Pneumothorax without CC/MCC,201,MS-DRG,201,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,21869.927,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Bronchitis and asthma with CC/MCC,202,MS-DRG,202,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,40508.305,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Bronchitis and asthma without CC/MCC,203,MS-DRG,203,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,15339.435,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Respiratory signs and symptoms,204,MS-DRG,204,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other respiratory system diagnoses with MCC,205,MS-DRG,205,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,112102.84,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other respiratory system diagnoses without MCC,206,MS-DRG,206,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Respiratory system diagnosis with ventilator support >96 hours,207,MS-DRG,207,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,147720.8,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Respiratory system diagnosis with ventilator support <=96 hours,208,MS-DRG,208,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,81481.35,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Concomitant aortic and mitral valve procedures,212,MS-DRG,212,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other heart assist system implant,215,MS-DRG,215,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC,216,MS-DRG,216,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with CC,217,MS-DRG,217,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization without CC/MCC,218,MS-DRG,218,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with MCC,219,MS-DRG,219,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization with CC,220,MS-DRG,220,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac valve and other major cardiothoracic procedures without cardiac catheterization without CC/MCC,221,MS-DRG,221,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other cardiothoracic procedures with MCC,228,MS-DRG,228,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other cardiothoracic procedures without MCC,229,MS-DRG,229,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Coronary bypass with PTCA with MCC,231,MS-DRG,231,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Coronary bypass with PTCA without MCC,232,MS-DRG,232,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Coronary bypass with cardiac catheterization or open ablation with MCC,233,MS-DRG,233,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Coronary bypass with cardiac catheterization or open ablation without MCC,234,MS-DRG,234,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Coronary bypass without cardiac catheterization with MCC,235,MS-DRG,235,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Coronary bypass without cardiac catheterization without MCC,236,MS-DRG,236,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Amputation for circulatory system disorders except upper limb and toe with MCC,239,MS-DRG,239,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Amputation for circulatory system disorders except upper limb and toe with CC,240,MS-DRG,240,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Amputation for circulatory system disorders except upper limb and toe without CC/MCC,241,MS-DRG,241,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Permanent cardiac pacemaker implant with MCC,242,MS-DRG,242,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Permanent cardiac pacemaker implant with CC,243,MS-DRG,243,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Permanent cardiac pacemaker implant without CC/MCC,244,MS-DRG,244,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
AICD generator procedures,245,MS-DRG,245,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,40774.659,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Percutaneous cardiovascular procedures without intraluminal device with MCC,250,MS-DRG,250,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Percutaneous cardiovascular procedures without intraluminal device without MCC,251,MS-DRG,251,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other vascular procedures with MCC,252,MS-DRG,252,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other vascular procedures with CC,253,MS-DRG,253,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other vascular procedures without CC/MCC,254,MS-DRG,254,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Upper limb and toe amputation for circulatory system disorders with MCC,255,MS-DRG,255,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Upper limb and toe amputation for circulatory system disorders with CC,256,MS-DRG,256,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Upper limb and toe amputation for circulatory system disorders without CC/MCC,257,MS-DRG,257,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac pacemaker device replacement with MCC,258,MS-DRG,258,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac pacemaker device replacement without MCC,259,MS-DRG,259,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac pacemaker revision except device replacement with MCC,260,MS-DRG,260,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac pacemaker revision except device replacement with CC,261,MS-DRG,261,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac pacemaker revision except device replacement without CC/MCC,262,MS-DRG,262,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Vein ligation and stripping,263,MS-DRG,263,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other circulatory system O.R. procedures,264,MS-DRG,264,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
AICD lead procedures,265,MS-DRG,265,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Endovascular cardiac valve replacement and supplement procedures with MCC,266,MS-DRG,266,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Endovascular cardiac valve replacement and supplement procedures without MCC,267,MS-DRG,267,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Aortic and heart assist procedures except pulsation balloon with MCC,268,MS-DRG,268,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Aortic and heart assist procedures except pulsation balloon without MCC,269,MS-DRG,269,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79522.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other major cardiovascular procedures with MCC,270,MS-DRG,270,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other major cardiovascular procedures with CC,271,MS-DRG,271,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other major cardiovascular procedures without CC/MCC,272,MS-DRG,272,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Percutaneous and other intracardiac procedures with MCC,273,MS-DRG,273,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Percutaneous and other intracardiac procedures without MCC,274,MS-DRG,274,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac defibrillator implant with cardiac catheterization and MCC,275,MS-DRG,275,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac defibrillator implant with MCC or carotid sinus neurostimulator,276,MS-DRG,276,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac defibrillator implant without MCC,277,MS-DRG,277,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures with MCC,278,MS-DRG,278,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Ultrasound accelerated and other thrombolysis of peripheral vascular structures without MCC,279,MS-DRG,279,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,92851.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Acute myocardial infarction, discharged alive with MCC",280,MS-DRG,280,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,63798.62,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Acute myocardial infarction, discharged alive with CC",281,MS-DRG,281,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Acute myocardial infarction, discharged alive without CC/MCC",282,MS-DRG,282,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Acute myocardial infarction, expired with MCC",283,MS-DRG,283,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Acute myocardial infarction, expired with CC",284,MS-DRG,284,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Acute myocardial infarction, expired without CC/MCC",285,MS-DRG,285,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization with MCC",286,MS-DRG,286,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Circulatory disorders except AMI, with cardiac catheterization without MCC",287,MS-DRG,287,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Acute and subacute endocarditis with MCC,288,MS-DRG,288,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,79476.64,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Acute and subacute endocarditis with CC,289,MS-DRG,289,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,54456.07,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Acute and subacute endocarditis without CC/MCC,290,MS-DRG,290,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48748.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Heart failure and shock with MCC,291,MS-DRG,291,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,59345.41,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Heart failure and shock with CC,292,MS-DRG,292,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,42060.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Heart failure and shock without CC/MCC,293,MS-DRG,293,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,42060.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Deep vein thrombophlebitis with CC/MCC,294,MS-DRG,294,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Deep vein thrombophlebitis without CC/MCC,295,MS-DRG,295,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Cardiac arrest, unexplained with MCC",296,MS-DRG,296,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,59345.41,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Cardiac arrest, unexplained with CC",297,MS-DRG,297,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,42060.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Cardiac arrest, unexplained without CC/MCC",298,MS-DRG,298,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,42060.56,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Peripheral vascular disorders with MCC,299,MS-DRG,299,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,64808.62,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Peripheral vascular disorders with CC,300,MS-DRG,300,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Peripheral vascular disorders without CC/MCC,301,MS-DRG,301,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Atherosclerosis with MCC,302,MS-DRG,302,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Atherosclerosis without MCC,303,MS-DRG,303,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hypertension with MCC,304,MS-DRG,304,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hypertension without MCC,305,MS-DRG,305,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac congenital and valvular disorders with MCC,306,MS-DRG,306,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac congenital and valvular disorders without MCC,307,MS-DRG,307,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac arrhythmia and conduction disorders with MCC,308,MS-DRG,308,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac arrhythmia and conduction disorders with CC,309,MS-DRG,309,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,60095.27,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cardiac arrhythmia and conduction disorders without CC/MCC,310,MS-DRG,310,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Angina pectoris,311,MS-DRG,311,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Syncope and collapse,312,MS-DRG,312,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46383.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Chest pain,313,MS-DRG,313,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other circulatory system diagnoses with MCC,314,MS-DRG,314,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,67570.83,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other circulatory system diagnoses with CC,315,MS-DRG,315,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,47562.03,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other circulatory system diagnoses without CC/MCC,316,MS-DRG,316,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Concomitant left atrial appendage closure and cardiac ablation,317,MS-DRG,317,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other endovascular cardiac valve procedures with MCC,319,MS-DRG,319,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other endovascular cardiac valve procedures without MCC,320,MS-DRG,320,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/intraluminal devices,321,MS-DRG,321,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Percutaneous cardiovascular procedures with intraluminal device without MCC,322,MS-DRG,322,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Coronary intravascular lithotripsy with intraluminal device with MCC,323,MS-DRG,323,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Coronary intravascular lithotripsy with intraluminal device without MCC,324,MS-DRG,324,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,34914.02,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Coronary intravascular lithotripsy without intraluminal device,325,MS-DRG,325,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Stomach, esophageal and duodenal procedures with MCC",326,MS-DRG,326,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Stomach, esophageal and duodenal procedures with CC",327,MS-DRG,327,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Stomach, esophageal and duodenal procedures without CC/MCC",328,MS-DRG,328,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major small and large bowel procedures with MCC,329,MS-DRG,329,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major small and large bowel procedures with CC,330,MS-DRG,330,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major small and large bowel procedures without CC/MCC,331,MS-DRG,331,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Rectal resection with MCC,332,MS-DRG,332,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Rectal resection with CC,333,MS-DRG,333,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Rectal resection without CC/MCC,334,MS-DRG,334,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Peritoneal adhesiolysis with MCC,335,MS-DRG,335,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Peritoneal adhesiolysis with CC,336,MS-DRG,336,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Peritoneal adhesiolysis without CC/MCC,337,MS-DRG,337,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Minor small and large bowel procedures with MCC,344,MS-DRG,344,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Minor small and large bowel procedures with CC,345,MS-DRG,345,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Minor small and large bowel procedures without CC/MCC,346,MS-DRG,346,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Anal and stomal procedures with MCC,347,MS-DRG,347,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,68366.59,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Anal and stomal procedures with CC,348,MS-DRG,348,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Anal and stomal procedures without CC/MCC,349,MS-DRG,349,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Inguinal and femoral hernia procedures with MCC,350,MS-DRG,350,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,68366.59,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Inguinal and femoral hernia procedures with CC,351,MS-DRG,351,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Inguinal and femoral hernia procedures without CC/MCC,352,MS-DRG,352,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hernia procedures except inguinal and femoral with MCC,353,MS-DRG,353,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,118828.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hernia procedures except inguinal and femoral with CC,354,MS-DRG,354,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hernia procedures except inguinal and femoral without CC/MCC,355,MS-DRG,355,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other digestive system O.R. procedures with MCC,356,MS-DRG,356,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,106800.32,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other digestive system O.R. procedures with CC,357,MS-DRG,357,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other digestive system O.R. procedures without CC/MCC,358,MS-DRG,358,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major esophageal disorders with MCC*,368,MS-DRG,368,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major esophageal disorders with CC*,369,MS-DRG,369,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major esophageal disorders without CC/MCC*,370,MS-DRG,370,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major gastrointestinal disorders and peritoneal infections with MCC,371,MS-DRG,371,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,68366.59,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major gastrointestinal disorders and peritoneal infections with CC,372,MS-DRG,372,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major gastrointestinal disorders and peritoneal infections without CC/MCC,373,MS-DRG,373,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Digestive malignancy with MCC*,374,MS-DRG,374,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Digestive malignancy with CC*,375,MS-DRG,375,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Digestive malignancy without CC/MCC*,376,MS-DRG,376,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Gastrointestinal hemorrhage with MCC,377,MS-DRG,377,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,54425.47,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Gastrointestinal hemorrhage with CC,378,MS-DRG,378,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Gastrointestinal hemorrhage without CC/MCC,379,MS-DRG,379,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Complicated peptic ulcer with MCC,380,MS-DRG,380,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,73278.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Complicated peptic ulcer with CC,381,MS-DRG,381,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Complicated peptic ulcer without CC/MCC,382,MS-DRG,382,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Uncomplicated peptic ulcer with MCC,383,MS-DRG,383,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Uncomplicated peptic ulcer without MCC,384,MS-DRG,384,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Inflammatory bowel disease with MCC,385,MS-DRG,385,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Inflammatory bowel disease with CC,386,MS-DRG,386,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Inflammatory bowel disease without CC/MCC,387,MS-DRG,387,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Gastrointestinal obstruction with MCC,388,MS-DRG,388,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,75604.95,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Gastrointestinal obstruction with CC,389,MS-DRG,389,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Gastrointestinal obstruction without CC/MCC,390,MS-DRG,390,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC",391,MS-DRG,391,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,59253.6,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC",392,MS-DRG,392,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,47929.3,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other digestive system diagnoses with MCC,393,MS-DRG,393,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,77739.74,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other digestive system diagnoses with CC,394,MS-DRG,394,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other digestive system diagnoses without CC/MCC,395,MS-DRG,395,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Appendix procedures with MCC,397,MS-DRG,397,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,68366.59,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Appendix procedures with CC,398,MS-DRG,398,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Appendix procedures without CC/MCC,399,MS-DRG,399,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Single level combined anterior and posterior spinal fusion except cervical,402,MS-DRG,402,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Pancreas, liver and shunt procedures with MCC",405,MS-DRG,405,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,40508.305,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Pancreas, liver and shunt procedures with CC",406,MS-DRG,406,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Pancreas, liver and shunt procedures without CC/MCC",407,MS-DRG,407,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with MCC,408,MS-DRG,408,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. with CC,409,MS-DRG,409,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Biliary tract procedures except only cholecystectomy with or without C.D.E. without CC/MCC,410,MS-DRG,410,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cholecystectomy with C.D.E. with MCC,411,MS-DRG,411,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,73278.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cholecystectomy with C.D.E. with CC,412,MS-DRG,412,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cholecystectomy with C.D.E. without CC/MCC,413,MS-DRG,413,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with MCC,414,MS-DRG,414,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,73278.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. with CC,415,MS-DRG,415,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cholecystectomy except by laparoscope without C.D.E. without CC/MCC,416,MS-DRG,416,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Laparoscopic cholecystectomy without C.D.E. with MCC,417,MS-DRG,417,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,73278.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Laparoscopic cholecystectomy without C.D.E. with CC,418,MS-DRG,418,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Laparoscopic cholecystectomy without C.D.E. without CC/MCC,419,MS-DRG,419,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hepatobiliary diagnostic procedures with MCC,420,MS-DRG,420,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55022.29,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hepatobiliary diagnostic procedures with CC,421,MS-DRG,421,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hepatobiliary diagnostic procedures without CC/MCC,422,MS-DRG,422,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other hepatobiliary or pancreas O.R. procedures with MCC,423,MS-DRG,423,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other hepatobiliary or pancreas O.R. procedures with CC,424,MS-DRG,424,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other hepatobiliary or pancreas O.R. procedures without CC/MCC,425,MS-DRG,425,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,4870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,426,MS-DRG,426,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,81343.62,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical with CC,427,MS-DRG,427,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,81343.62,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Multiple level combined anterior and posterior spinal fusion except cervical without CC/MCC,428,MS-DRG,428,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,67111.73,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Combined anterior and posterior cervical spinal fusion with MCC,429,MS-DRG,429,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,81343.62,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Combined anterior and posterior cervical spinal fusion without MCC,430,MS-DRG,430,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cirrhosis and alcoholic hepatitis with MCC,432,MS-DRG,432,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,56468.43,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cirrhosis and alcoholic hepatitis with CC,433,MS-DRG,433,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cirrhosis and alcoholic hepatitis without CC/MCC,434,MS-DRG,434,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Malignancy of hepatobiliary system or pancreas with MCC,435,MS-DRG,435,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Malignancy of hepatobiliary system or pancreas with CC,436,MS-DRG,436,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Malignancy of hepatobiliary system or pancreas without CC/MCC,437,MS-DRG,437,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Disorders of pancreas except malignancy with MCC,438,MS-DRG,438,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,80165.28,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Disorders of pancreas except malignancy with CC,439,MS-DRG,439,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Disorders of pancreas except malignancy without CC/MCC,440,MS-DRG,440,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCC",441,MS-DRG,441,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,71243.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CC",442,MS-DRG,442,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without CC/MCC",443,MS-DRG,443,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Disorders of the biliary tract with MCC*,444,MS-DRG,444,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,58190.03,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Disorders of the biliary tract with CC*,445,MS-DRG,445,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53147.66,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Disorders of the biliary tract without CC/MCC*,446,MS-DRG,446,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,447,MS-DRG,447,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,1.0631,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Multiple level spinal fusion except cervical without MCC,448,MS-DRG,448,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,1.0631,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device,450,MS-DRG,450,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,67111.74,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Single Level Spinal Fusion Except Cervical without MCC,451,MS-DRG,451,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with MCC",456,MS-DRG,456,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions with CC",457,MS-DRG,457,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusions without CC/MCC",458,MS-DRG,458,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Bilateral or multiple major joint procedures of lower extremity with MCC,461,MS-DRG,461,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,67111.74,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Bilateral or multiple major joint procedures of lower extremity without MCC,462,MS-DRG,462,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with MCC*,463,MS-DRG,463,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with CC*,464,MS-DRG,464,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72972.82,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders without CC/MCC*,465,MS-DRG,465,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,70057.58,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Revision of hip or knee replacement with MCC,466,MS-DRG,466,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Revision of hip or knee replacement with CC,467,MS-DRG,467,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Revision of hip or knee replacement without CC/MCC,468,MS-DRG,468,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity with MCC or total ankle replacement,469,MS-DRG,469,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major hip and knee joint replacement or reattachment of lower extremity without MCC,470,MS-DRG,470,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cervical spinal fusion with MCC,471,MS-DRG,471,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cervical spinal fusion with CC,472,MS-DRG,472,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cervical spinal fusion without CC/MCC,473,MS-DRG,473,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with MCC,474,MS-DRG,474,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders with CC,475,MS-DRG,475,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Amputation for musculoskeletal system and connective tissue disorders without CC/MCC,476,MS-DRG,476,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Biopsies of musculoskeletal system and connective tissue with MCC,477,MS-DRG,477,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Biopsies of musculoskeletal system and connective tissue with CC,478,MS-DRG,478,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,28146.902,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Biopsies of musculoskeletal system and connective tissue without CC/MCC,479,MS-DRG,479,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,28146.902,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hip and femur procedures except major joint with MCC,480,MS-DRG,480,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hip and femur procedures except major joint with CC,481,MS-DRG,481,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hip and femur procedures except major joint without CC/MCC,482,MS-DRG,482,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major joint or limb reattachment procedures of upper extremities,483,MS-DRG,483,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Knee procedures with principal diagnosis of infection with MCC,485,MS-DRG,485,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Knee procedures with principal diagnosis of infection with CC,486,MS-DRG,486,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Knee procedures with principal diagnosis of infection without CC/MCC,487,MS-DRG,487,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Knee procedures without principal diagnosis of infection with CC/MCC,488,MS-DRG,488,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Knee procedures without principal diagnosis of infection without CC/MCC,489,MS-DRG,489,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,51693.87,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with MCC",492,MS-DRG,492,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur with CC",493,MS-DRG,493,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Lower extremity and humerus procedures except hip, foot and femur without CC/MCC",494,MS-DRG,494,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Local excision and removal of internal fixation devices except hip and femur with MCC,495,MS-DRG,495,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Local excision and removal of internal fixation devices except hip and femur with CC,496,MS-DRG,496,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Local excision and removal of internal fixation devices except hip and femur without CC/MCC,497,MS-DRG,497,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Local excision and removal of internal fixation devices of hip and femur with CC/MCC,498,MS-DRG,498,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Local excision and removal of internal fixation devices of hip and femur without CC/MCC,499,MS-DRG,499,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Soft tissue procedures with MCC,500,MS-DRG,500,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,94244.13,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Soft tissue procedures with CC,501,MS-DRG,501,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Soft tissue procedures without CC/MCC,502,MS-DRG,502,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,67111.74,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Foot procedures with MCC,503,MS-DRG,503,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Foot procedures with CC,504,MS-DRG,504,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Foot procedures without CC/MCC,505,MS-DRG,505,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major thumb or joint procedures,506,MS-DRG,506,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major shoulder or elbow joint procedures with CC/MCC,507,MS-DRG,507,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major shoulder or elbow joint procedures without CC/MCC,508,MS-DRG,508,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Arthroscopy,509,MS-DRG,509,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with MCC",510,MS-DRG,510,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures with CC",511,MS-DRG,511,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Shoulder, elbow or forearm procedures, except major joint procedures without CC/MCC",512,MS-DRG,512,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures with CC/MCC",513,MS-DRG,513,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Hand or wrist procedures, except major thumb or joint procedures without CC/MCC",514,MS-DRG,514,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with MCC,515,MS-DRG,515,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,91742.07,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures with CC,516,MS-DRG,516,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other musculoskeletal system and connective tissue O.R. procedures without CC/MCC,517,MS-DRG,517,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Back and neck procedures except spinal fusion with MCC or disc device or neurostimulator,518,MS-DRG,518,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Back and neck procedures except spinal fusion with CC,519,MS-DRG,519,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Back and neck procedures except spinal fusion without CC/MCC,520,MS-DRG,520,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hip replacement with principal diagnosis of hip fracture with MCC,521,MS-DRG,521,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hip replacement with principal diagnosis of hip fracture without MCC,522,MS-DRG,522,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Fractures of femur with MCC,533,MS-DRG,533,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Fractures of femur without MCC,534,MS-DRG,534,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55504.34,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Fractures of hip and pelvis with MCC,535,MS-DRG,535,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Fractures of hip and pelvis without MCC,536,MS-DRG,536,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh with CC/MCC",537,MS-DRG,537,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Sprains, strains, and dislocations of hip, pelvis and thigh without CC/MCC",538,MS-DRG,538,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Osteomyelitis with MCC*,539,MS-DRG,539,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,74166.46,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Osteomyelitis with CC*,540,MS-DRG,540,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,54425.47,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Osteomyelitis without CC/MCC*,541,MS-DRG,541,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,51693.86,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with MCC*,542,MS-DRG,542,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy with CC*,543,MS-DRG,543,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Pathological fractures and musculoskeletal and connective tissue malignancy without CC/MCC*,544,MS-DRG,544,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Connective tissue disorders with MCC,545,MS-DRG,545,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Connective tissue disorders with CC,546,MS-DRG,546,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Connective tissue disorders without CC/MCC,547,MS-DRG,547,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46988.16,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Septic arthritis with MCC,548,MS-DRG,548,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,65145.29,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Septic arthritis with CC,549,MS-DRG,549,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Septic arthritis without CC/MCC,550,MS-DRG,550,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Medical back problems with MCC,551,MS-DRG,551,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,99921.58,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Medical back problems without MCC,552,MS-DRG,552,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Bone diseases and arthropathies with MCC,553,MS-DRG,553,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Bone diseases and arthropathies without MCC,554,MS-DRG,554,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue with MCC,555,MS-DRG,555,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Signs and symptoms of musculoskeletal system and connective tissue without MCC,556,MS-DRG,556,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Tendonitis, myositis and bursitis with MCC",557,MS-DRG,557,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,69284.76,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Tendonitis, myositis and bursitis without MCC",558,MS-DRG,558,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53645.01,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Aftercare, musculoskeletal system and connective tissue with MCC*",559,MS-DRG,559,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,61671.48,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Aftercare, musculoskeletal system and connective tissue with CC*",560,MS-DRG,560,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48082.33,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Aftercare, musculoskeletal system and connective tissue without CC/MCC*",561,MS-DRG,561,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46988.16,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCC",562,MS-DRG,562,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCC",563,MS-DRG,563,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46988.16,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other musculoskeletal system and connective tissue diagnoses with MCC,564,MS-DRG,564,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,67111.74,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other musculoskeletal system and connective tissue diagnoses with CC,565,MS-DRG,565,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other musculoskeletal system and connective tissue diagnoses without CC/MCC,566,MS-DRG,566,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53790.39,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Skin debridement with MCC*,570,MS-DRG,570,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,90081.68,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Skin debridement with CC*,571,MS-DRG,571,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,65336.58,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Skin debridement without CC/MCC*,572,MS-DRG,572,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,65336.58,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Skin graft for skin ulcer or cellulitis with MCC,573,MS-DRG,573,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,106394.79,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Skin graft for skin ulcer or cellulitis with CC,574,MS-DRG,574,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Skin graft for skin ulcer or cellulitis without CC/MCC,575,MS-DRG,575,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Skin graft except for skin ulcer or cellulitis with MCC*,576,MS-DRG,576,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Skin graft except for skin ulcer or cellulitis with CC*,577,MS-DRG,577,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Skin graft except for skin ulcer or cellulitis without CC/MCC*,578,MS-DRG,578,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Other skin, subcutaneous tissue and breast procedures with MCC",579,MS-DRG,579,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,103793.26,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Other skin, subcutaneous tissue and breast procedures with CC",580,MS-DRG,580,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,85299.47,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Other skin, subcutaneous tissue and breast procedures without CC/MCC",581,MS-DRG,581,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,85299.47,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Mastectomy for malignancy with CC/MCC,582,MS-DRG,582,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,103793.26,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Mastectomy for malignancy without CC/MCC,583,MS-DRG,583,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,85299.47,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Breast biopsy, local excision and other breast procedures with CC/MCC",584,MS-DRG,584,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,65336.58,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Breast biopsy, local excision and other breast procedures without CC/MCC",585,MS-DRG,585,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Skin ulcers with MCC,592,MS-DRG,592,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,67333.63,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Skin ulcers with CC,593,MS-DRG,593,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53667.96,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Skin ulcers without CC/MCC,594,MS-DRG,594,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major skin disorders with MCC,595,MS-DRG,595,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major skin disorders without MCC,596,MS-DRG,596,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Malignant breast disorders with MCC,597,MS-DRG,597,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Malignant breast disorders with CC,598,MS-DRG,598,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Malignant breast disorders without CC/MCC,599,MS-DRG,599,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Non-malignant breast disorders with CC/MCC*,600,MS-DRG,600,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Non-malignant breast disorders without CC/MCC*,601,MS-DRG,601,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cellulitis with MCC,602,MS-DRG,602,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,55068.2,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cellulitis without MCC,603,MS-DRG,603,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36842.21,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Trauma to the skin, subcutaneous tissue and breast with MCC",604,MS-DRG,604,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Trauma to the skin, subcutaneous tissue and breast without MCC",605,MS-DRG,605,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Minor skin disorders with MCC,606,MS-DRG,606,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Minor skin disorders without MCC,607,MS-DRG,607,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Adrenal and pituitary procedures with CC/MCC,614,MS-DRG,614,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Adrenal and pituitary procedures without CC/MCC,615,MS-DRG,615,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with MCC",616,MS-DRG,616,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders with CC",617,MS-DRG,617,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Amputation of lower limb for endocrine, nutritional and metabolic disorders without CC/MCC",618,MS-DRG,618,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
O.R. procedures for obesity with MCC,619,MS-DRG,619,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,100051.65,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
O.R. procedures for obesity with CC,620,MS-DRG,620,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72590.25,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
O.R. procedures for obesity without CC/MCC,621,MS-DRG,621,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with MCC",622,MS-DRG,622,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,100051.65,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with CC",623,MS-DRG,623,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72590.25,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders without CC/MCC",624,MS-DRG,624,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with MCC",625,MS-DRG,625,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,30309.826,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures with CC",626,MS-DRG,626,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Thyroid, parathyroid and thyroglossal procedures without CC/MCC",627,MS-DRG,627,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with MCC",628,MS-DRG,628,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,30309.826,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures with CC",629,MS-DRG,629,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Other endocrine, nutritional and metabolic O.R. procedures without CC/MCC",630,MS-DRG,630,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Diabetes with MCC,637,MS-DRG,637,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,67654.99,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Diabetes with CC,638,MS-DRG,638,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53843.95,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Diabetes without CC/MCC,639,MS-DRG,639,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCC",640,MS-DRG,640,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,74862.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCC",641,MS-DRG,641,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,47049.37,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Inborn and other disorders of metabolism,642,MS-DRG,642,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Endocrine disorders with MCC*,643,MS-DRG,643,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Endocrine disorders with CC*,644,MS-DRG,644,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Endocrine disorders without CC/MCC*,645,MS-DRG,645,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major bladder procedures with MCC,653,MS-DRG,653,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,91596.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major bladder procedures with CC,654,MS-DRG,654,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,80073.46,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major bladder procedures without CC/MCC,655,MS-DRG,655,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Kidney and ureter procedures for neoplasm with MCC,656,MS-DRG,656,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Kidney and ureter procedures for neoplasm with CC,657,MS-DRG,657,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Kidney and ureter procedures for neoplasm without CC/MCC,658,MS-DRG,658,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Kidney and ureter procedures for non-neoplasm with MCC*,659,MS-DRG,659,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Kidney and ureter procedures for non-neoplasm with CC*,660,MS-DRG,660,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Kidney and ureter procedures for non-neoplasm without CC/MCC*,661,MS-DRG,661,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Minor bladder procedures with MCC,662,MS-DRG,662,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Minor bladder procedures with CC,663,MS-DRG,663,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Minor bladder procedures without CC/MCC,664,MS-DRG,664,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Prostatectomy with MCC,665,MS-DRG,665,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,91596.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Prostatectomy with CC,666,MS-DRG,666,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,80073.46,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Prostatectomy without CC/MCC,667,MS-DRG,667,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Transurethral procedures with MCC,668,MS-DRG,668,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Transurethral procedures with CC,669,MS-DRG,669,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Transurethral procedures without CC/MCC,670,MS-DRG,670,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Urethral procedures with CC/MCC,671,MS-DRG,671,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Urethral procedures without CC/MCC,672,MS-DRG,672,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72268.88,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other kidney and urinary tract procedures with MCC*,673,MS-DRG,673,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,91596.69,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other kidney and urinary tract procedures with CC*,674,MS-DRG,674,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,80073.46,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other kidney and urinary tract procedures without CC/MCC*,675,MS-DRG,675,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,80073.46,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Renal failure with MCC,682,MS-DRG,682,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,66775.07,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Renal failure with CC,683,MS-DRG,683,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,46314.82,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Renal failure without CC/MCC,684,MS-DRG,684,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Kidney and urinary tract neoplasms with MCC,686,MS-DRG,686,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Kidney and urinary tract neoplasms with CC,687,MS-DRG,687,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Kidney and urinary tract neoplasms without CC/MCC,688,MS-DRG,688,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.4,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Kidney and urinary tract infections with MCC,689,MS-DRG,689,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48342.49,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Kidney and urinary tract infections without MCC,690,MS-DRG,690,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,35962.28,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Urinary stones with MCC,693,MS-DRG,693,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Urinary stones without MCC,694,MS-DRG,694,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Kidney and urinary tract signs and symptoms with MCC,695,MS-DRG,695,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Kidney and urinary tract signs and symptoms without MCC,696,MS-DRG,696,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Urethral stricture,697,MS-DRG,697,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other kidney and urinary tract diagnoses with MCC,698,MS-DRG,698,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,67746.82,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other kidney and urinary tract diagnoses with CC,699,MS-DRG,699,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,47363.09,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other kidney and urinary tract diagnoses without CC/MCC,700,MS-DRG,700,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major male pelvic procedures with CC/MCC,707,MS-DRG,707,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major male pelvic procedures without CC/MCC,708,MS-DRG,708,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Penis procedures with CC/MCC,709,MS-DRG,709,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Penis procedures without CC/MCC,710,MS-DRG,710,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Testes procedures with CC/MCC,711,MS-DRG,711,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Testes procedures without CC/MCC,712,MS-DRG,712,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Transurethral prostatectomy with CC/MCC,713,MS-DRG,713,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,30309.826,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Transurethral prostatectomy without CC/MCC,714,MS-DRG,714,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other male reproductive system O.R. procedures for malignancy with CC/MCC,715,MS-DRG,715,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other male reproductive system O.R. procedures for malignancy without CC/MCC,716,MS-DRG,716,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other male reproductive system O.R. procedures except malignancy with CC/MCC,717,MS-DRG,717,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other male reproductive system O.R. procedures except malignancy without CC/MCC,718,MS-DRG,718,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Malignancy, male reproductive system with MCC",722,MS-DRG,722,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,61794.07,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Malignancy, male reproductive system with CC",723,MS-DRG,723,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Malignancy, male reproductive system without CC/MCC",724,MS-DRG,724,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,50278,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Benign prostatic hypertrophy with MCC,725,MS-DRG,725,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,50278.46,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Benign prostatic hypertrophy without MCC,726,MS-DRG,726,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Inflammation of the male reproductive system with MCC,727,MS-DRG,727,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,61794.07,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Inflammation of the male reproductive system without MCC,728,MS-DRG,728,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,50278,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other male reproductive system diagnoses with CC/MCC,729,MS-DRG,729,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other male reproductive system diagnoses without CC/MCC,730,MS-DRG,730,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC",734,MS-DRG,734,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC",735,MS-DRG,735,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with MCC,736,MS-DRG,736,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy with CC,737,MS-DRG,737,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Uterine and adnexa procedures for ovarian or adnexal malignancy without CC/MCC,738,MS-DRG,738,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with MCC,739,MS-DRG,739,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy with CC,740,MS-DRG,740,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Uterine and adnexa procedures for non-ovarian and non-adnexal malignancy without CC/MCC,741,MS-DRG,741,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Uterine and adnexa procedures for non-malignancy with CC/MCC,742,MS-DRG,742,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Uterine and adnexa procedures for non-malignancy without CC/MCC,743,MS-DRG,743,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"D&C, conization, laparoscopy and tubal interruption with CC/MCC",744,MS-DRG,744,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"D&C, conization, laparoscopy and tubal interruption without CC/MCC",745,MS-DRG,745,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Vagina, cervix and vulva procedures with CC/MCC",746,MS-DRG,746,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Vagina, cervix and vulva procedures without CC/MCC",747,MS-DRG,747,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Female reproductive system reconstructive procedures,748,MS-DRG,748,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other female reproductive system O.R. procedures with CC/MCC,749,MS-DRG,749,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other female reproductive system O.R. procedures without CC/MCC,750,MS-DRG,750,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Malignancy, female reproductive system with MCC",754,MS-DRG,754,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Malignancy, female reproductive system with CC",755,MS-DRG,755,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Malignancy, female reproductive system without CC/MCC",756,MS-DRG,756,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Infections, female reproductive system with MCC",757,MS-DRG,757,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,29854.136,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Infections, female reproductive system with CC",758,MS-DRG,758,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Infections, female reproductive system without CC/MCC",759,MS-DRG,759,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Menstrual and other female reproductive system disorders with CC/MCC,760,MS-DRG,760,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Menstrual and other female reproductive system disorders without CC/MCC,761,MS-DRG,761,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Vaginal delivery with O.R. procedures except sterilization and/or D&C,768,MS-DRG,768,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Postpartum and post abortion diagnoses with O.R. procedures,769,MS-DRG,769,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Abortion with D&C, aspiration curettage or hysterotomy",770,MS-DRG,770,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Postpartum and post abortion diagnoses without O.R. procedures,776,MS-DRG,776,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Abortion without D&C,779,MS-DRG,779,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cesarean section with sterilization with MCC,783,MS-DRG,783,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cesarean section with sterilization with CC,784,MS-DRG,784,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,90613.37,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cesarean section with sterilization without CC/MCC,785,MS-DRG,785,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cesarean section without sterilization with MCC,786,MS-DRG,786,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cesarean section without sterilization with CC,787,MS-DRG,787,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Cesarean section without sterilization without CC/MCC,788,MS-DRG,788,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Neonates, died or transferred to another acute care facility",789,MS-DRG,789,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Extreme immaturity or respiratory distress syndrome, neonate",790,MS-DRG,790,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Prematurity with major problems,791,MS-DRG,791,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Prematurity without major problems,792,MS-DRG,792,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48921.03,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Full term neonate with major problems,793,MS-DRG,793,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Neonate with other significant problems,794,MS-DRG,794,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48921.03,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Splenic procedures with MCC,799,MS-DRG,799,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,106800.6,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Splenic procedures with CC,800,MS-DRG,800,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48921.03,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Splenic procedures without CC/MCC,801,MS-DRG,801,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other O.R. procedures of the blood and blood forming organs with MCC,802,MS-DRG,802,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other O.R. procedures of the blood and blood forming organs with CC,803,MS-DRG,803,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other O.R. procedures of the blood and blood forming organs without CC/MCC,804,MS-DRG,804,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with MCC,808,MS-DRG,808,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with CC,809,MS-DRG,809,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without CC/MCC,810,MS-DRG,810,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Red blood cell disorders with MCC,811,MS-DRG,811,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Red blood cell disorders without MCC,812,MS-DRG,812,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Coagulation disorders,813,MS-DRG,813,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Reticuloendothelial and immunity disorders with MCC*,814,MS-DRG,814,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Reticuloendothelial and immunity disorders with CC*,815,MS-DRG,815,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Reticuloendothelial and immunity disorders without CC/MCC*,816,MS-DRG,816,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other antepartum diagnoses with O.R. procedures with MCC,817,MS-DRG,817,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,40508.305,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other antepartum diagnoses with O.R. procedures with CC,818,MS-DRG,818,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other antepartum diagnoses with O.R. procedures without CC/MCC,819,MS-DRG,819,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Lymphoma and leukemia with major O.R. procedures with MCC,820,MS-DRG,820,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Lymphoma and leukemia with major O.R. procedures with CC,821,MS-DRG,821,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Lymphoma and leukemia with major O.R. procedures without CC/MCC,822,MS-DRG,822,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Lymphoma and non-acute leukemia with other procedures with MCC,823,MS-DRG,823,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Lymphoma and non-acute leukemia with other procedures with CC,824,MS-DRG,824,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Lymphoma and non-acute leukemia with other procedures without CC/MCC,825,MS-DRG,825,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with MCC,826,MS-DRG,826,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures with CC,827,MS-DRG,827,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with major O.R. procedures without CC/MCC,828,MS-DRG,828,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures with CC/MCC,829,MS-DRG,829,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Myeloproliferative disorders or poorly differentiated neoplasms with other procedures without CC/MCC,830,MS-DRG,830,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other antepartum diagnoses without O.R. procedures with MCC,831,MS-DRG,831,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,71182.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other antepartum diagnoses without O.R. procedures with CC,832,MS-DRG,832,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other antepartum diagnoses without O.R. procedures without CC/MCC,833,MS-DRG,833,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Acute leukemia with MCC,834,MS-DRG,834,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Acute leukemia with CC,835,MS-DRG,835,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Acute leukemia without CC/MCC,836,MS-DRG,836,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy agent with MCC,837,MS-DRG,837,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapy agent,838,MS-DRG,838,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Chemotherapy with acute leukemia as secondary diagnosis without CC/MCC,839,MS-DRG,839,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Lymphoma and non-acute leukemia with MCC,840,MS-DRG,840,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Lymphoma and non-acute leukemia with CC,841,MS-DRG,841,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Lymphoma and non-acute leukemia without CC/MCC,842,MS-DRG,842,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with MCC,843,MS-DRG,843,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with CC,844,MS-DRG,844,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses without CC/MCC,845,MS-DRG,845,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with MCC,846,MS-DRG,846,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis with CC,847,MS-DRG,847,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Chemotherapy without acute leukemia as secondary diagnosis without CC/MCC,848,MS-DRG,848,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Radiotherapy,849,MS-DRG,849,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Acute leukemia with other procedures,850,MS-DRG,850,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Infectious and parasitic diseases with O.R. procedures with MCC,853,MS-DRG,853,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,116013.09,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Infectious and parasitic diseases with O.R. procedures with CC,854,MS-DRG,854,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.07,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Infectious and parasitic diseases with O.R. procedures without CC/MCC,855,MS-DRG,855,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with MCC,856,MS-DRG,856,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,103112.54,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures with CC,857,MS-DRG,857,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Postoperative or post-traumatic infections with O.R. procedures without CC/MCC,858,MS-DRG,858,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Postoperative and post-traumatic infections with MCC,862,MS-DRG,862,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,70501.55,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Postoperative and post-traumatic infections without MCC,863,MS-DRG,863,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,47554.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Fever and inflammatory conditions,864,MS-DRG,864,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Viral illness with MCC,865,MS-DRG,865,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Viral illness without MCC,866,MS-DRG,866,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other infectious and parasitic diseases diagnoses with MCC,867,MS-DRG,867,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,70118.98,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other infectious and parasitic diseases diagnoses with CC,868,MS-DRG,868,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other infectious and parasitic diseases diagnoses without CC/MCC,869,MS-DRG,869,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Septicemia or severe sepsis with MV >96 hours,870,MS-DRG,870,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,158548.16,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Septicemia or severe sepsis without MV >96 hours with MCC,871,MS-DRG,871,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,64954.17,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Septicemia or severe sepsis without MV >96 hours without MCC,872,MS-DRG,872,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,43522.12,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Wound debridements for injuries with MCC,901,MS-DRG,901,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,98177.28,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Wound debridements for injuries with CC,902,MS-DRG,902,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Wound debridements for injuries without CC/MCC,903,MS-DRG,903,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Skin grafts for injuries with CC/MCC,904,MS-DRG,904,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Skin grafts for injuries without CC/MCC,905,MS-DRG,905,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Hand procedures for injuries,906,MS-DRG,906,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other O.R. procedures for injuries with MCC*,907,MS-DRG,907,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other O.R. procedures for injuries with CC*,908,MS-DRG,908,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other O.R. procedures for injuries without CC/MCC*,909,MS-DRG,909,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Traumatic injury with MCC,913,MS-DRG,913,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Traumatic injury without MCC,914,MS-DRG,914,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Allergic reactions with MCC,915,MS-DRG,915,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Allergic reactions without MCC,916,MS-DRG,916,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Poisoning and toxic effects of drugs with MCC,917,MS-DRG,917,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Poisoning and toxic effects of drugs without MCC,918,MS-DRG,918,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Complications of treatment with MCC,919,MS-DRG,919,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,82055.43,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Complications of treatment with CC,920,MS-DRG,920,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52581.58,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Complications of treatment without CC/MCC,921,MS-DRG,921,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Other injury, poisoning and toxic effect diagnoses with MCC",922,MS-DRG,922,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Other injury, poisoning and toxic effect diagnoses without MCC",923,MS-DRG,923,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Extensive burns or full thickness burns with MV >96 hours with skin graft,927,MS-DRG,927,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Full thickness burn with skin graft or inhalation injury with CC/MCC,928,MS-DRG,928,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Full thickness burn with skin graft or inhalation injury without CC/MCC,929,MS-DRG,929,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Extensive burns or full thickness burns with MV >96 hours without skin graft,933,MS-DRG,933,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Full thickness burn without skin graft or inhalation injury,934,MS-DRG,934,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Non-extensive burns,935,MS-DRG,935,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
O.R. procedures with diagnoses of other contact with health services with MCC,939,MS-DRG,939,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,90701.7,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
O.R. procedures with diagnoses of other contact with health services with CC,940,MS-DRG,940,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
O.R. procedures with diagnoses of other contact with health services without CC/MCC,941,MS-DRG,941,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.06,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Signs and symptoms with MCC,947,MS-DRG,947,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Signs and symptoms without MCC,948,MS-DRG,948,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Aftercare with CC/MCC,949,MS-DRG,949,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,53224.31,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Aftercare without CC/MCC,950,MS-DRG,950,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other factors influencing health status,951,MS-DRG,951,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Craniotomy for multiple significant trauma,955,MS-DRG,955,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
"Limb reattachment, hip and femur procedures for multiple significant trauma",956,MS-DRG,956,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other O.R. procedures for multiple significant trauma with MCC,957,MS-DRG,957,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other O.R. procedures for multiple significant trauma with CC,958,MS-DRG,958,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96210.83,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other O.R. procedures for multiple significant trauma without CC/MCC,959,MS-DRG,959,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,36574.5,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other multiple significant trauma with MCC,963,MS-DRG,963,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other multiple significant trauma with CC,964,MS-DRG,964,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Other multiple significant trauma without CC/MCC,965,MS-DRG,965,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,48870.57,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
HIV with extensive O.R. procedures with MCC,969,MS-DRG,969,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
HIV with extensive O.R. procedures without MCC,970,MS-DRG,970,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96585.75,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
HIV with major related condition with MCC*,974,MS-DRG,974,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,87197.28,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
HIV with major related condition with CC*,975,MS-DRG,975,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,68412.68,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
HIV with major related condition without CC/MCC*,976,MS-DRG,976,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,68412.68,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
HIV with or without other related condition,977,MS-DRG,977,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with MCC,981,MS-DRG,981,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,68449.825,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis with CC,982,MS-DRG,982,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,96991.29,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,983,MS-DRG,983,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,52145.44,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with MCC,987,MS-DRG,987,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,163207.97,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis with CC,988,MS-DRG,988,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.07,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,
Non-extensive O.R. procedures unrelated to principal diagnosis without CC/MCC,989,MS-DRG,989,LOCAL,,Inpatient,,,,,Cigna,Commercial,,,MS-DRG,72269.07,case rate,22000,120000,Lesser of 50% BC or rate,,,,,,,