| Humerus X-ray | CPT | 73060 | 6 | $111.93 |
| Vaginal hysterectomy | CPT | 58260 | 6 | $6,433.99 |
| Vaginal delivery only | CPT | 59409 | 6 | $4,163.48 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 6 | $448.71 |
| Heart failure & shock w MCC | MS-DRG | 291 | 5 | $12,823 |
| Heart failure & shock w CC | MS-DRG | 292 | 5 | $8,576.16 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 5 | $5,812.17 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 5 | $7,898.34 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 5 | $12,043 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 5 | $7,469.59 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 5 | $5,813.15 |
| AMI discharged alive w MCC | MS-DRG | 280 | 5 | $15,951 |
| AMI discharged alive w CC | MS-DRG | 281 | 5 | $9,260.8 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 5 | $19,925 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 5 | $6,968.55 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 5 | $6,422.59 |
| COPD w MCC | MS-DRG | 190 | 5 | $11,103 |
| COPD w CC | MS-DRG | 191 | 5 | $8,517.56 |
| COPD w/o CC/MCC | MS-DRG | 192 | 5 | $6,554.44 |
| GI hemorrhage w CC | MS-DRG | 378 | 5 | $9,862.43 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 5 | $6,441.15 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 5 | $45,177 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 5 | $23,697 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 5 | $16,721 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 5 | $16,806 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 5 | $4,208.34 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 5 | $13,624 |
| Total shoulder arthroplasty | CPT | 23472 | 5 | $22,551 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 5 | $9,332.7 |
| ACL reconstruction | CPT | 29888 | 5 | $9,332.7 |
