| behavioral |
| Psychoses | MS-DRG | 885 | 18 | — | — | $1,458 | $13,712 | $30,024 |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 18 | — | — | $2,778 | $19,261 | $42,370 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 18 | — | — | $2,778 | $10,728 | $23,090 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 18 | — | — | $2,778 | $8,230.89 | $17,716 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 18 | — | — | $2,778 | $16,146 | $34,431 |
| COPD w MCC | MS-DRG | 190 | 18 | — | — | $2,778 | $11,534 | $24,826 |
| COPD w CC | MS-DRG | 191 | 18 | — | — | $2,778 | $9,528.75 | $20,510 |
| COPD w/o CC/MCC | MS-DRG | 192 | 18 | — | — | $2,778 | $7,918.59 | $17,044 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 18 | — | — | $2,778 | $9,231.63 | $19,870 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 18 | — | — | $2,778 | $7,732.4 | $16,643 |
| AMI discharged alive w MCC | MS-DRG | 280 | 19 | — | — | $12,261 | $16,480 | $34,962 |
| AMI discharged alive w CC | MS-DRG | 281 | 19 | — | — | $6,885.67 | $10,005 | $26,466 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 19 | — | — | $5,416.36 | $8,510.5 | $19,849 |
| Heart failure & shock w MCC | MS-DRG | 291 | 18 | — | — | $2,778 | $12,916 | $27,799 |
| Heart failure & shock w CC | MS-DRG | 292 | 18 | — | — | $2,778 | $9,544.71 | $20,544 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 18 | — | — | $2,778 | $7,170.08 | $15,433 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 18 | — | — | $2,778 | $12,164 | $26,182 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 18 | — | — | $2,778 | $8,618.42 | $18,550 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 18 | — | — | $2,778 | $7,252.16 | $15,609 |
| GI hemorrhage w CC | MS-DRG | 378 | 18 | — | — | $2,778 | $10,492 | $22,583 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 18 | — | — | $2,778 | $7,838.8 | $16,872 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 18 | — | — | $2,778 | $8,929.97 | $19,221 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 18 | — | — | $2,778 | $15,231 | $32,480 |
| Kidney/UTI w MCC | MS-DRG | 689 | 18 | — | — | $2,778 | $11,893 | $25,599 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 18 | — | — | $2,778 | $9,099.43 | $19,585 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 18 | — | — | $2,778 | $19,065 | $41,793 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 18 | — | — | $2,778 | $10,835 | $23,321 |
| lab |
| Tissue exam by pathologist level IV | CPT | 88305 | 14 | — | — | $47.08 | $52.04 | $241.91 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 16 | — | — | $334.95 | $994.82 | $4,042 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 16 | — | — | $334.95 | $994.82 | $5,016 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 15 | — | — | $130.67 | $877.65 | $4,042 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 15 | — | — | $328.5 | $982.14 | $4,042 |
| Colonoscopy diagnostic | CPT | 45378 | 16 | — | — | $328.5 | $1,003.03 | $5,016 |
| Colonoscopy with biopsy | CPT | 45380 | 16 | — | — | $429.26 | $1,295.08 | $5,016 |
| Colonoscopy with polyp removal | CPT | 45385 | 16 | — | — | $429.26 | $1,295.08 | $5,016 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 15 | — | — | $2,417.79 | $17,044 | $35,280 |
| Total hip replacement | CPT | 27130 | 15 | — | — | $6,546 | $13,240 | $40,224 |
| Total knee replacement | CPT | 27447 | 15 | — | — | $6,546 | $13,240 | $40,224 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 4 | — | — | $1,772 | $5,668 | $11,704 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 16 | — | — | $2,398.52 | $7,524.13 | $20,219 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 16 | — | — | $1,088.27 | $3,552.29 | $13,821 |
| ACL reconstruction | CPT | 29888 | 16 | — | — | $3,300.05 | $6,869.86 | $20,219 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 18 | — | — | $6,182 | $41,502 | $97,807 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 18 | — | — | $6,182 | $22,810 | $50,347 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 18 | — | — | $6,182 | $16,078 | $35,166 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 18 | — | — | $6,182 | $15,719 | $35,324 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 18 | — | — | $6,182 | $13,013 | $28,065 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 18 | — | — | $6,182 | $31,017 | $75,178 |
| Laparoscopic appendectomy | CPT | 44970 | 15 | — | — | $5,013.07 | $6,283.65 | $16,338 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 6 | — | — | $35,308 | $68,382 | $103,364 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 6 | — | — | $35,174 | $37,715 | $57,008 |
| Major joint replacement w MCC | MS-DRG | 469 | 19 | — | — | $24,417 | $32,647 | $69,623 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 19 | — | — | $14,084 | $19,726 | $40,161 |
| Laparoscopic cholecystectomy | CPT | 47562 | 15 | — | — | $1,888.85 | $6,200.38 | $16,338 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 15 | — | — | $1,888.85 | $6,200.38 | $16,338 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 19 | — | — | $9,144 | $26,804 | $62,643 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 19 | — | — | $9,144 | $19,360 | $44,195 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 19 | — | — | $9,144 | $15,165 | $33,790 |
| Lap inguinal hernia repair | CPT | 49650 | 16 | — | — | $1,888.85 | $6,235 | $16,338 |
| Total abdominal hysterectomy | CPT | 58150 | 4 | — | — | $1,677.98 | $5,369 | $16,163 |
| Vaginal hysterectomy | CPT | 58260 | 15 | — | — | $1,526.99 | $5,300.1 | $15,605 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 15 | — | — | $3,110.01 | $9,884.78 | $28,436 |
| Lap salpingo-oophorectomy | CPT | 58661 | 16 | — | — | $1,888.85 | $6,332.3 | $16,338 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 19 | — | — | $6,182 | $26,234 | $58,074 |
| OR procedure for obesity w CC | MS-DRG | 620 | 19 | — | — | $6,182 | $16,232 | $34,016 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 19 | — | — | $6,182 | $15,023 | $31,136 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 18 | — | — | $6,182 | $12,109 | $26,064 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 18 | — | — | $6,182 | $18,101 | $41,620 |