| Knee arthroscopy with meniscectomy | CPT | 29881 | 21 | $67.75 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 21 | $67.75 |
| Total hip replacement | CPT | 27130 | 21 | $67.75 |
| Total knee replacement | CPT | 27447 | 21 | $67.75 |
| CABG single arterial graft | CPT | 33533 | 21 | $67.75 |
| CABG 2 arterial grafts | CPT | 33534 | 21 | $67.75 |
| Total shoulder arthroplasty | CPT | 23472 | 21 | $67.75 |
| Hip hemiarthroplasty | CPT | 27125 | 21 | $67.75 |
| Knee revision arthroplasty single component | CPT | 27486 | 21 | $67.75 |
| Knee revision arthroplasty all components | CPT | 27487 | 21 | $67.75 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 21 | $67.75 |
| ACL reconstruction | CPT | 29888 | 21 | $67.75 |
| Heart failure & shock w MCC | MS-DRG | 291 | 21 | $67.75 |
| Heart failure & shock w CC | MS-DRG | 292 | 21 | $67.75 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 21 | $67.75 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 21 | $67.75 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 21 | $67.75 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 21 | $67.75 |
| AMI discharged alive w MCC | MS-DRG | 280 | 21 | $67.75 |
| AMI discharged alive w CC | MS-DRG | 281 | 21 | $67.75 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 21 | $67.75 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 21 | $67.75 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 21 | $67.75 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 21 | $67.75 |
| COPD w MCC | MS-DRG | 190 | 21 | $67.75 |
| COPD w CC | MS-DRG | 191 | 21 | $67.75 |
| COPD w/o CC/MCC | MS-DRG | 192 | 21 | $67.75 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 21 | $67.75 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 21 | $67.75 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 21 | $67.75 |