| Psychoses | MS-DRG 885 | $75.00 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | $75.00 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $75.00 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | $75.00 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $75.00 |
| COPD w MCC | MS-DRG 190 | $75.00 |
| COPD w CC | MS-DRG 191 | $75.00 |
| COPD w/o CC/MCC | MS-DRG 192 | $75.00 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $75.00 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $75.00 |
| AMI discharged alive w MCC | MS-DRG 280 | $75.00 |
| AMI discharged alive w CC | MS-DRG 281 | $75.00 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $75.00 |
| Heart failure & shock w MCC | MS-DRG 291 | $75.00 |
| Heart failure & shock w CC | MS-DRG 292 | $75.00 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $75.00 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $75.00 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $75.00 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $75.00 |
| GI hemorrhage w CC | MS-DRG 378 | $75.00 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $75.00 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $75.00 |
| Fractures of femur w/o MCC | MS-DRG 533 | $75.00 |
| Kidney/UTI w MCC | MS-DRG 689 | $75.00 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $75.00 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $75.00 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $75.00 |
| Cesarean section w CC/MCC | MS-DRG 765 | $75.00 |
| Cesarean section w/o CC/MCC | MS-DRG 766 | $75.00 |
| Vaginal delivery w complicating dx | MS-DRG 774 | $75.00 |
| Vaginal delivery w/o complicating dx | MS-DRG 775 | $75.00 |
| PCI w drug-eluting stent w MCC | MS-DRG 246 | $75.00 |
| PCI w drug-eluting stent w/o MCC | MS-DRG 247 | $75.00 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $75.00 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $75.00 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $75.00 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $75.00 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $75.00 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $75.00 |
| Spinal fusion (non-cervical) w MCC | MS-DRG 459 | $75.00 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG 460 | $75.00 |
| Major joint replacement w MCC | MS-DRG 469 | $75.00 |
| Major joint replacement w/o MCC | MS-DRG 470 | $75.00 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $75.00 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $75.00 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $75.00 |
| OR procedure for obesity w MCC | MS-DRG 619 | $75.00 |
| OR procedure for obesity w CC | MS-DRG 620 | $75.00 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $75.00 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $75.00 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $75.00 |
