| behavioral |
| Psychoses | MS-DRG | 885 | 23 | — | — | $8,986.36 | $8,986.36 | 0.70× | $13,346 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 16 | $525 | — | $138.31 | $380.63 | 2.1× | $525 |
| Psychotherapy 45 minutes | CPT | 90834 | 16 | $364 | — | $138.31 | $263.9 | 1.6× | $364 |
| Psychotherapy 60 minutes | CPT | 90837 | 16 | $276.43 | — | $75 | $138.31 | 0.73× | $276.43 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 16 | $150 | — | $75 | $136.66 | 0.86× | $150 |
| emergency |
| ED visit level 1 | CPT | 99281 | 30 | $500 | — | $10.38 | $36.52 | 0.26× | $500 |
| ED visit level 2 | CPT | 99282 | 30 | $550 | — | $35 | $235.31 | 0.99× | $1,250 |
| ED visit level 3 | CPT | 99283 | 30 | $650 | — | $53.9 | $105.36 | 0.26× | $1,491 |
| ED visit level 4 | CPT | 99284 | 30 | $850 | — | $71.5 | $192.64 | 0.29× | $2,286 |
| ED visit level 5 | CPT | 99285 | 30 | $2,600 | — | $83.75 | $185.88 | 0.18× | $5,034 |
| Critical care, first hour | CPT | 99291 | 30 | $2,000 | — | $93.05 | $193.62 | 0.18× | $7,313 |
| imaging |
| CT head without contrast | CPT | 70450 | 18 | $2,348.4 | — | $107.6 | $1,473.62 | 7.1× | $2,348.4 |
| CT head with contrast | CPT | 70460 | 18 | $2,840.4 | — | $174.94 | $1,782.35 | 7.6× | $2,840.4 |
| CT head with and without contrast | CPT | 70470 | 18 | $2,937.6 | — | $174.94 | $1,843.34 | 6.9× | $2,937.6 |
| CT neck with contrast | CPT | 70491 | 18 | $2,925.6 | — | $174.94 | $1,835.81 | 6.7× | $2,925.6 |
| MRI brain without contrast | CPT | 70551 | 18 | $2,148 | — | $223.73 | $1,611 | 4.0× | $2,148 |
| MRI brain with contrast | CPT | 70552 | 18 | $2,295.6 | — | $366.59 | $1,440.49 | 3.0× | $2,295.6 |
| MRI brain with and without contrast | CPT | 70553 | 18 | $5,202 | — | $366.59 | $3,901.5 | 6.6× | $5,202 |
| Chest X-ray single view | CPT | 71045 | 18 | $250 | — | $11.86 | $169.38 | 1.8× | $250 |
| Chest X-ray 2 views | CPT | 71046 | 18 | $375 | — | $21.87 | $235.31 | 2.4× | $375 |
| Chest X-ray 3 views | CPT | 71047 | 18 | $190 | — | $27.87 | $128.73 | 1.3× | $190 |
| CT chest without contrast | CPT | 71250 | 18 | $2,348.4 | — | $107.6 | $1,473.62 | 6.9× | $2,348.4 |
| CT chest with contrast | CPT | 71260 | 18 | $2,800.8 | — | $174.94 | $1,757.5 | 6.2× | $2,800.8 |
| CT chest with and without contrast | CPT | 71270 | 18 | $3,201.6 | — | $174.94 | $2,009 | 6.9× | $3,201.6 |
| MRI chest with and without contrast | CPT | 71552 | 18 | $5,300 | — | $366.59 | $3,325.75 | 5.5× | $5,300 |
| Lumbosacral spine X-ray | CPT | 72100 | 18 | $350 | — | $28 | $237.13 | 2.3× | $350 |
| CT cervical spine without contrast | CPT | 72125 | 18 | $2,348.4 | — | $107.6 | $1,473.62 | 7.3× | $2,348.4 |
| CT thoracic spine without contrast | CPT | 72128 | 18 | $2,348.4 | — | $107.6 | $1,473.62 | 7.4× | $2,348.4 |
| CT lumbar spine without contrast | CPT | 72131 | 18 | $2,348.4 | — | $107.6 | $1,473.62 | 7.3× | $2,348.4 |
| MRI cervical spine without contrast | CPT | 72141 | 18 | $2,776.8 | — | $223.73 | $1,742.44 | 4.4× | $2,776.8 |
| MRI thoracic spine without contrast | CPT | 72146 | 18 | $2,904 | — | $223.73 | $1,410.48 | 3.8× | $2,904 |
| MRI lumbar spine without contrast | CPT | 72148 | 18 | $2,776.8 | — | $223.73 | $1,567.2 | 4.2× | $2,776.8 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 18 | $3,098.4 | — | $366.59 | $2,323.8 | 5.1× | $3,098.4 |
| MRI cervical spine with and without contrast | CPT | 72156 | 18 | $4,444.8 | — | $366.59 | $2,789.11 | 5.2× | $4,444.8 |
| MRI lumbar spine with contrast | CPT | 72158 | 18 | $4,444.8 | — | $366.59 | $3,333.6 | 6.1× | $4,444.8 |
| CT pelvis without contrast | CPT | 72192 | 18 | $2,348.4 | — | $107.6 | $1,473.62 | 7.4× | $2,348.4 |
| CT pelvis with contrast | CPT | 72193 | 18 | $2,925.6 | — | $174.94 | $1,835.81 | 6.5× | $2,925.6 |
| Shoulder X-ray | CPT | 73030 | 18 | $400 | — | $20 | $251 | 2.7× | $400 |
| Humerus X-ray | CPT | 73060 | 18 | $400 | — | $22 | $251 | 2.8× | $400 |
| Hand X-ray 3 views | CPT | 73130 | 18 | $300 | — | $25 | $189.27 | 2.0× | $300 |
| MRI upper extremity joint without contrast | CPT | 73221 | 18 | $2,526 | — | $223.73 | $1,585.07 | 3.8× | $2,526 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 18 | $3,500.4 | — | $366.59 | $2,227.98 | 3.6× | $3,500.4 |
| Knee X-ray 1-2 views | CPT | 73560 | 18 | $300 | — | $25 | $189.27 | 2.0× | $300 |
| Ankle X-ray 3 views | CPT | 73610 | 18 | $300 | — | $18 | $189.27 | 2.1× | $300 |
| MRI lower extremity joint without contrast | CPT | 73721 | 18 | $2,526 | — | $223.73 | $2,128.68 | 4.6× | $2,526 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 18 | $3,564 | — | $366.59 | $2,248.81 | 3.5× | $3,564 |
| CT abdomen without contrast | CPT | 74150 | 18 | $2,348.4 | — | $107.6 | $1,473.62 | 7.8× | $2,348.4 |
| CT abdomen with contrast | CPT | 74160 | 18 | $2,800.8 | — | $174.94 | $1,757.5 | 6.1× | $2,800.8 |
| CT abdomen with and without contrast | CPT | 74170 | 18 | $3,064.8 | — | $174.94 | $1,923.16 | 5.7× | $3,064.8 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 18 | $4,327.2 | — | $108.3 | $2,715.32 | 7.5× | $4,327.2 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 18 | $4,760.4 | — | $206.27 | $2,987.15 | 5.4× | $4,760.4 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 18 | $5,047.2 | — | $272.95 | $3,167.12 | 5.5× | $5,047.2 |
| MRI abdomen without contrast | CPT | 74181 | 18 | $3,714 | — | $223.73 | $2,785.5 | 7.1× | $3,714 |
| MRI abdomen with and without contrast | CPT | 74183 | 18 | $5,242.8 | — | $366.59 | $3,289.86 | 5.8× | $5,242.8 |
| Abdominal ultrasound complete | CPT | 76700 | 18 | $1,200 | — | $56 | $753 | 5.0× | $1,200 |
| Abdominal ultrasound limited | CPT | 76705 | 18 | $700 | — | $20 | $439.25 | 3.0× | $700 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 18 | $500 | — | $44 | $313.75 | 2.2× | $500 |
| Obstetric ultrasound first trimester | CPT | 76801 | 18 | $1,400 | — | $42.75 | $878.5 | 6.2× | $1,400 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 18 | $1,400 | — | $56 | $878.5 | 5.8× | $1,400 |
| Transvaginal ultrasound | CPT | 76830 | 18 | $1,400 | — | $68 | $878.5 | 5.9× | $1,400 |
| Pelvic ultrasound complete | CPT | 76856 | 18 | $1,400 | — | $40 | $878.5 | 6.1× | $1,400 |
| Scrotal ultrasound | CPT | 76870 | 18 | $1,400 | — | $31 | $878.5 | 6.7× | $1,400 |
| Diagnostic mammography unilateral | CPT | 77065 | 30 | $450 | — | $74.28 | $87.72 | 0.59× | $450 |
| Diagnostic mammography bilateral | CPT | 77066 | 30 | $500 | — | $95.21 | $111.86 | 0.59× | $500 |
| Screening mammography bilateral | CPT | 77067 | 30 | $500 | — | $78.6 | $220.92 | 1.4× | $500 |
| EKG tracing only | CPT | 93005 | 18 | $190 | — | $17 | $124.45 | 1.1× | $190 |
| EKG interpretation only | CPT | 93010 | 30 | $26 | — | $7.43 | $13 | 0.72× | $26 |
| Transthoracic echocardiogram complete | CPT | 93306 | 18 | $1,500 | — | $257.51 | $982.5 | 1.6× | $1,500 |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 23 | — | — | $10,054 | $10,054 | 0.65× | $14,932 |
| COPD w MCC | MS-DRG | 190 | 23 | — | — | $7,126.43 | $7,126.43 | 0.63× | $10,584 |
| COPD w CC | MS-DRG | 191 | 23 | — | — | $5,423.47 | $5,423.47 | 0.61× | $8,054.87 |
| COPD w/o CC/MCC | MS-DRG | 192 | 23 | — | — | $4,130.32 | $4,130.32 | 0.59× | $6,134.31 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 23 | — | — | $5,184.78 | $5,184.78 | 0.61× | $7,700.37 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 23 | — | — | $4,043.47 | $4,043.47 | 0.61× | $6,005.32 |
| AMI discharged alive w MCC | MS-DRG | 280 | 23 | — | — | $10,320 | $10,320 | 0.66× | $15,327 |
| AMI discharged alive w CC | MS-DRG | 281 | 23 | — | — | $5,913.06 | $5,913.06 | 0.61× | $8,782 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 23 | — | — | $4,652.08 | $4,652.08 | 0.60× | $6,909.22 |
| Heart failure & shock w MCC | MS-DRG | 291 | 23 | — | — | $8,259.38 | $8,259.38 | 0.65× | $12,267 |
| Heart failure & shock w CC | MS-DRG | 292 | 23 | — | — | $5,462.07 | $5,462.07 | 0.61× | $8,112.2 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 23 | — | — | $3,641.37 | $3,641.37 | 0.59× | $5,408.13 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 23 | — | — | $7,745.98 | $7,745.98 | 0.64× | $11,504 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 23 | — | — | $4,733.15 | $4,733.15 | 0.61× | $7,029.61 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 23 | — | — | $3,642.02 | $3,642.02 | 0.59× | $5,409.09 |
| GI hemorrhage w CC | MS-DRG | 378 | 23 | — | — | $6,309.36 | $6,309.36 | 0.63× | $9,370.59 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 23 | — | — | $4,055.7 | $4,055.7 | 0.59× | $6,023.47 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 23 | — | — | $5,015.58 | $5,015.58 | 0.62× | $7,449.08 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 23 | — | — | $10,086 | $10,086 | 0.66× | $14,979 |
| Kidney/UTI w MCC | MS-DRG | 689 | 23 | — | — | $7,464.83 | $7,464.83 | 0.64× | $11,087 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 23 | — | — | $5,207.95 | $5,207.95 | 0.63× | $7,734.77 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 23 | — | — | $12,497 | $12,497 | 0.67× | $18,561 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 23 | — | — | $6,583.44 | $6,583.44 | 0.63× | $9,777.63 |
| Initial hospital care, low complexity | CPT | 99221 | 30 | $289 | — | $74.73 | $113.49 | 1.2× | $289 |
| Initial hospital care, moderate complexity | CPT | 99222 | 30 | $390 | — | $92.4 | $151.48 | 0.90× | $390 |
| Initial hospital care, high complexity | CPT | 99223 | 30 | $579 | — | $42.8 | $157.88 | 0.70× | $579 |
| Hospital discharge, <30 min | CPT | 99238 | 30 | $207 | — | $52.8 | $99.97 | 1.2× | $207 |
| Hospital discharge, >30 min | CPT | 99239 | 30 | $307 | — | $9.89 | $103.92 | 0.86× | $307 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 31 | $296 | — | $8.46 | $9.64 | 0.30× | $296 |
| Electrolyte panel | CPT | 80051 | 31 | $255 | — | $7.01 | $7.99 | 0.34× | $255 |
| Comprehensive metabolic panel | CPT | 80053 | 31 | $339 | — | $10.56 | $12.04 | 0.27× | $339 |
| Lipid panel | CPT | 80061 | 31 | $112 | — | $13.39 | $15.26 | 0.40× | $112 |
| Renal function panel | CPT | 80069 | 31 | $290 | — | $8.68 | $15.67 | 0.57× | $290 |
| Hepatic function panel | CPT | 80076 | 31 | $151 | — | $8.17 | $13.09 | 0.49× | $151 |
| Glucose quantitative | CPT | 82947 | 31 | $76 | — | $3.93 | $4.48 | 0.25× | $76 |
| Hemoglobin A1c | CPT | 83036 | 31 | $120 | — | $9.71 | $11.07 | 0.41× | $120 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 31 | $146 | — | $14.5 | $19.15 | 0.41× | $146 |
| Complete blood count with automated differential | CPT | 85025 | 31 | $118 | — | $7.77 | $8.86 | 0.33× | $118 |
| Urine culture bacterial | CPT | 87086 | 31 | $125 | — | $8.07 | $9.2 | 0.39× | $125 |
| Urine culture identification | CPT | 87088 | 31 | $39 | — | $8.09 | $9.22 | 0.41× | $39 |
| Tissue exam by pathologist level IV | CPT | 88305 | 18 | $58 | — | $28 | $51.66 | 0.50× | $63.56 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 18 | $340 | — | $170 | $238 | 1.3× | $2,790 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 16 | $4,000 | — | $2,000 | $3,600 | 1.6× | $4,000 |
| Vaginal delivery only | CPT | 59409 | 29 | $10,000 | — | $363 | $765 | 0.35× | $10,000 |
| Vaginal delivery with postpartum | CPT | 59410 | 16 | $2,750 | — | $1,375 | $2,475 | 2.3× | $2,750 |
| Routine obstetric care with C-section | CPT | 59510 | 16 | $6,000 | — | $3,000 | $5,400 | 2.2× | $6,000 |
| C-section with postpartum | CPT | 59515 | 16 | $3,500 | — | $1,750 | $3,150 | 2.5× | $3,500 |
| Cesarean section w CC/MCC | MS-DRG | 765 | 23 | — | — | $7,572.27 | $7,572.27 | 84.0× | $11,246 |
| Cesarean section w/o CC/MCC | MS-DRG | 766 | 23 | — | — | $5,385.51 | $5,385.51 | 59.8× | $7,998.49 |
| Vaginal delivery w complicating dx | MS-DRG | 774 | 23 | — | — | $5,342.4 | $5,342.4 | 58.1× | $7,934.47 |
| Vaginal delivery w/o complicating dx | MS-DRG | 775 | 23 | — | — | $4,152.2 | $4,152.2 | 4.4× | $6,166.8 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 30 | $111.21 | — | $39.06 | $66.72 | 0.77× | $111.21 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 30 | $171.18 | — | $67.43 | $74.25 | 0.61× | $171.18 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 30 | $289.5 | — | $110.46 | $125.88 | 0.72× | $289.5 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 30 | $376.26 | — | $12 | $150.81 | 0.68× | $376.26 |
| Office visit, established patient, 5 min | CPT | 99211 | 30 | $115 | — | $7.37 | $30.81 | 0.48× | $115 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 30 | $125 | — | $29.44 | $44.45 | 0.56× | $125 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 30 | $112.8 | — | $54.71 | $74.12 | 0.65× | $112.8 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 30 | $200 | — | $80.42 | $108 | 0.71× | $200 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 28 | $250 | — | $119.25 | $125 | 0.66× | $250 |
| surgery |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 23 | — | — | $19,271 | $19,271 | 0.70× | $28,621 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 23 | — | — | $12,285 | $12,285 | 0.67× | $18,245 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 23 | — | — | $29,572 | $29,572 | 0.69× | $43,920 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 23 | — | — | $15,422 | $15,422 | 0.66× | $22,905 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 23 | — | — | $10,827 | $10,827 | 0.66× | $16,080 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 23 | — | — | $10,883 | $10,883 | 0.66× | $16,163 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 23 | — | — | $8,786.93 | $8,786.93 | 0.65× | $13,050 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 23 | — | — | $21,920 | $21,920 | 0.68× | $32,555 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 23 | — | — | $42,669 | $42,669 | 0.86× | $63,372 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 23 | — | — | $23,533 | $23,533 | 0.70× | $34,951 |
| Major joint replacement w MCC | MS-DRG | 469 | 23 | — | — | $19,514 | $19,514 | 0.66× | $28,982 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 23 | — | — | $12,410 | $12,410 | 0.66× | $18,431 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 23 | — | — | $18,736 | $18,736 | 0.67× | $27,827 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 23 | — | — | $13,475 | $13,475 | 0.66× | $20,013 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 23 | — | — | $10,493 | $10,493 | 0.66× | $15,584 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 23 | — | — | $18,576 | $18,576 | 0.68× | $27,589 |
| OR procedure for obesity w CC | MS-DRG | 620 | 23 | — | — | $10,296 | $10,296 | 0.64× | $15,291 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 23 | — | — | $9,704.35 | $9,704.35 | 0.64× | $14,413 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 23 | — | — | $7,982.09 | $7,982.09 | 0.65× | $11,855 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 23 | — | — | $13,183 | $13,183 | 0.69× | $19,579 |
| PCI single major coronary artery | CPT | 92920 | 18 | $9,121.12 | — | $320 | $6,384.78 | 1.1× | $14,407 |
| PCI with drug-eluting stent | CPT | 92928 | 18 | $15,584 | — | $320 | $10,909 | 1.1× | $15,584 |
| Coronary angiography with cath | CPT | 93455 | 18 | $6,600.7 | — | $156.71 | $4,620.49 | 1.5× | $11,858 |
| Coronary angiography with bypass cath | CPT | 93458 | 18 | $6,600.7 | — | $165.64 | $4,620.49 | 1.5× | $11,858 |