| Knee arthroscopy with meniscectomy | CPT | 29881 | 4 | $2,380 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 4 | $1,738 |
| Upper GI endoscopy diagnostic | CPT | 43235 | 4 | $813 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 4 | $1,381 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 4 | $813 |
| ACL reconstruction | CPT | 29888 | 4 | $1,738 |
| Heart failure & shock w MCC | MS-DRG | 291 | 4 | $9,410 |
| Heart failure & shock w CC | MS-DRG | 292 | 4 | $9,410 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 4 | $9,410 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 4 | $9,410 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 4 | $9,410 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 4 | $9,410 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 4 | $9,410 |
| AMI discharged alive w MCC | MS-DRG | 280 | 4 | $9,410 |
| AMI discharged alive w CC | MS-DRG | 281 | 4 | $9,410 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 4 | $9,410 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 4 | $9,410 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 4 | $9,410 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 4 | $9,410 |
| COPD w MCC | MS-DRG | 190 | 4 | $9,410 |
| COPD w CC | MS-DRG | 191 | 4 | $9,410 |
| COPD w/o CC/MCC | MS-DRG | 192 | 4 | $9,410 |
| GI hemorrhage w CC | MS-DRG | 378 | 4 | $9,410 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 4 | $9,410 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 4 | $9,410 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 4 | $9,410 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 4 | $9,410 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 4 | $9,410 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 4 | $9,410 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 4 | $9,410 |
