| behavioral |
| Psychoses | MS-DRG | 885 | 1 | — | — | $95 | $95 | $95 |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 1 | — | — | $95 | $95 | $95 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 1 | — | — | $95 | $95 | $95 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 1 | — | — | $95 | $95 | $95 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 1 | — | — | $95 | $95 | $95 |
| COPD w MCC | MS-DRG | 190 | 1 | — | — | $95 | $95 | $95 |
| COPD w CC | MS-DRG | 191 | 1 | — | — | $95 | $95 | $95 |
| COPD w/o CC/MCC | MS-DRG | 192 | 1 | — | — | $95 | $95 | $95 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 1 | — | — | $95 | $95 | $95 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 1 | — | — | $95 | $95 | $95 |
| AMI discharged alive w MCC | MS-DRG | 280 | 1 | — | — | $95 | $95 | $95 |
| AMI discharged alive w CC | MS-DRG | 281 | 1 | — | — | $95 | $95 | $95 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 1 | — | — | $95 | $95 | $95 |
| Heart failure & shock w MCC | MS-DRG | 291 | 1 | — | — | $95 | $95 | $95 |
| Heart failure & shock w CC | MS-DRG | 292 | 1 | — | — | $95 | $95 | $95 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 1 | — | — | $95 | $95 | $95 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 1 | — | — | $95 | $95 | $95 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 1 | — | — | $95 | $95 | $95 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 1 | — | — | $95 | $95 | $95 |
| GI hemorrhage w CC | MS-DRG | 378 | 1 | — | — | $95 | $95 | $95 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 1 | — | — | $95 | $95 | $95 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 1 | — | — | $95 | $95 | $95 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 1 | — | — | $95 | $95 | $95 |
| Kidney/UTI w MCC | MS-DRG | 689 | 1 | — | — | $95 | $95 | $95 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 1 | — | — | $95 | $95 | $95 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 1 | — | — | $95 | $95 | $95 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 1 | — | — | $95 | $95 | $95 |
| maternity |
| Cesarean section w CC/MCC | MS-DRG | 765 | 1 | — | — | $95 | $95 | $95 |
| Cesarean section w/o CC/MCC | MS-DRG | 766 | 1 | — | — | $95 | $95 | $95 |
| Vaginal delivery w complicating dx | MS-DRG | 774 | 1 | — | — | $95 | $95 | $95 |
| Vaginal delivery w/o complicating dx | MS-DRG | 775 | 1 | — | — | $95 | $95 | $95 |
| surgery |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 1 | — | — | $95 | $95 | $95 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 1 | — | — | $95 | $95 | $95 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 1 | — | — | $95 | $95 | $95 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 1 | — | — | $95 | $95 | $95 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 1 | — | — | $95 | $95 | $95 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 1 | — | — | $95 | $95 | $95 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 1 | — | — | $95 | $95 | $95 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 1 | — | — | $95 | $95 | $95 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 1 | — | — | $95 | $95 | $95 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 1 | — | — | $95 | $95 | $95 |
| Major joint replacement w MCC | MS-DRG | 469 | 1 | — | — | $95 | $95 | $95 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 1 | — | — | $95 | $95 | $95 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 1 | — | — | $95 | $95 | $95 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 1 | — | — | $95 | $95 | $95 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 1 | — | — | $95 | $95 | $95 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 1 | — | — | $95 | $95 | $95 |
| OR procedure for obesity w CC | MS-DRG | 620 | 1 | — | — | $95 | $95 | $95 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 1 | — | — | $95 | $95 | $95 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 1 | — | — | $95 | $95 | $95 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 1 | — | — | $95 | $95 | $95 |
