| Psychoses | MS-DRG 885 | $12,871 |
| Hand X-ray 3 views | CPT 73130 | $95.51 |
| Knee X-ray 1-2 views | CPT 73560 | $95.51 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | $19,198 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $9,814.43 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | $6,643.01 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $15,601 |
| COPD w MCC | MS-DRG 190 | $10,838 |
| COPD w CC | MS-DRG 191 | $8,291.47 |
| COPD w/o CC/MCC | MS-DRG 192 | $6,246.33 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $7,914.12 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $6,009.9 |
| AMI discharged alive w MCC | MS-DRG 280 | $15,921 |
| AMI discharged alive w CC | MS-DRG 281 | $8,940.96 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $7,033.06 |
| Heart failure & shock w MCC | MS-DRG 291 | $12,593 |
| Heart failure & shock w CC | MS-DRG 292 | $8,311.75 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $5,295.69 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $11,639 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $7,135.24 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $5,399.92 |
| GI hemorrhage w CC | MS-DRG 378 | $9,515.25 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $6,144.99 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $6,366.74 |
| Fractures of femur w/o MCC | MS-DRG 533 | $14,717 |
| Kidney/UTI w MCC | MS-DRG 689 | $11,295 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $7,746.16 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $18,937 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $9,950.51 |
| Tissue exam by pathologist level IV | CPT 88305 | $58.16 |
| Office visit, established patient, 5 min | CPT 99211 | $26.75 |
| Upper GI endoscopy diagnostic | CPT 43235 | $1,090.38 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,090.38 |
| Sigmoidoscopy diagnostic | CPT 45330 | $858.4 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,025.99 |
| Colonoscopy diagnostic | CPT 45378 | $1,078.27 |
| Colonoscopy with biopsy | CPT 45380 | $1,405.49 |
| Colonoscopy with polyp removal | CPT 45385 | $1,405.49 |
| Total shoulder arthroplasty | CPT 23472 | $16,878 |
| Total hip replacement | CPT 27130 | $14,030 |
| Total knee replacement | CPT 27447 | $14,030 |
| Knee revision arthroplasty single component | CPT 27486 | $2,629.85 |
| Knee revision arthroplasty all components | CPT 27487 | $3,290.87 |
| Shoulder arthroscopy with decompression | CPT 29826 | $5,460 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $7,813.39 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $3,842.51 |
| ACL reconstruction | CPT 29888 | $7,519.03 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $44,318 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $22,813 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $15,934 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $16,006 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $12,717 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $33,234 |
| Laparoscopic appendectomy | CPT 44970 | $6,301.76 |
| Spinal fusion (non-cervical) w MCC | MS-DRG 459 | $73,572 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG 460 | $40,577 |
| Major joint replacement w MCC | MS-DRG 469 | $31,870 |
| Major joint replacement w/o MCC | MS-DRG 470 | $18,384 |
| Laparoscopic cholecystectomy | CPT 47562 | $6,477.23 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $6,477.23 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $27,936 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $19,709 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $15,069 |
| Lap inguinal hernia repair | CPT 49650 | $6,301.76 |
| Total abdominal hysterectomy | CPT 58150 | $1,887.73 |
| Vaginal hysterectomy | CPT 58260 | $5,583.58 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $10,589 |
| Lap salpingo-oophorectomy | CPT 58661 | $6,443.69 |
| OR procedure for obesity w MCC | MS-DRG 619 | $26,314 |
| OR procedure for obesity w CC | MS-DRG 620 | $15,413 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $14,108 |
| Complex cataract surgery | CPT 66982 | $2,804.18 |
| Cataract surgery with lens implant | CPT 66984 | $2,804.18 |
| Vitrectomy mechanical | CPT 67042 | $4,564.21 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $11,569 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $18,859 |
