| behavioral |
| Psychoses | MS-DRG | 885 | 5 | — | — | $12,009 | $12,009 | 0.94× | $12,009 |
| emergency |
| ED visit level 1 | CPT | 99281 | 15 | $604 | $422.8 | $21.77 | $409.82 | 2.9× | $4,175 |
| ED visit level 2 | CPT | 99282 | 15 | $845 | $591.5 | $34.97 | $573.34 | 2.4× | $7,127 |
| ED visit level 3 | CPT | 99283 | 15 | $1,387 | $970.9 | $63.97 | $941.08 | 2.3× | $9,503 |
| ED visit level 4 | CPT | 99284 | 15 | $1,901 | $1,330.7 | $98.04 | $1,382.03 | 2.1× | $15,270 |
| ED visit level 5 | CPT | 99285 | 15 | $2,663 | $1,864.1 | $155.03 | $1,936.01 | 1.9× | $21,196 |
| Critical care, first hour | CPT | 99291 | 14 | $5,315 | $3,720.5 | $813.3 | $4,208.15 | 3.9× | $24,652 |
| imaging |
| CT head without contrast | CPT | 70450 | 11 | $4,593 | $3,215.1 | $136.73 | $1,984.33 | 9.6× | $4,593 |
| CT head with contrast | CPT | 70460 | 11 | $5,316 | $3,721.2 | $209.04 | $3,349.08 | 14.3× | $5,316 |
| CT head with and without contrast | CPT | 70470 | 11 | $5,795 | $4,056.5 | $222.3 | $3,650.85 | 13.7× | $5,795 |
| CT neck with contrast | CPT | 70491 | 11 | $5,123 | $3,586.1 | $222.3 | $3,208.13 | 11.7× | $5,123 |
| MRI brain without contrast | CPT | 70551 | 11 | $8,252 | $5,776.4 | $283.78 | $4,951.8 | 12.3× | $8,252 |
| MRI brain with contrast | CPT | 70552 | 11 | $8,829 | $6,180.3 | $396.44 | $5,562.27 | 11.6× | $8,829 |
| MRI brain with and without contrast | CPT | 70553 | 11 | $9,596 | $6,717.2 | $465.84 | $6,206.34 | 10.5× | $9,596 |
| Chest X-ray single view | CPT | 71045 | 12 | $626 | $438.2 | $17.67 | $372.65 | 3.9× | $626 |
| Chest X-ray 2 views | CPT | 71046 | 12 | $971 | $679.7 | $27.48 | $597.24 | 6.1× | $971 |
| Chest X-ray 3 views | CPT | 71047 | 12 | $1,198 | $838.6 | $35.27 | $736.47 | 7.7× | $1,198 |
| CT chest without contrast | CPT | 71250 | 11 | $5,115 | $3,580.5 | $136.73 | $3,144.07 | 14.6× | $5,115 |
| CT chest with contrast | CPT | 71260 | 11 | $5,123 | $3,586.1 | $222.3 | $3,163.97 | 11.2× | $5,123 |
| CT chest with and without contrast | CPT | 71270 | 11 | $5,738 | $4,016.6 | $222.3 | $3,614.94 | 12.4× | $5,738 |
| MRI chest without contrast | CPT | 71550 | 11 | $3,652 | $2,556.4 | $284.3 | $2,387 | 5.5× | $3,652 |
| MRI chest with contrast | CPT | 71551 | 11 | $5,373 | $3,761.1 | $395.33 | $3,384.99 | 4.2× | $5,373 |
| MRI chest with and without contrast | CPT | 71552 | 11 | $5,939 | $4,157.3 | $465.84 | $3,741.57 | 6.2× | $5,939 |
| Lumbosacral spine X-ray | CPT | 72100 | 12 | $1,036 | $725.2 | $43.45 | $489.77 | 4.7× | $1,036 |
| CT cervical spine without contrast | CPT | 72125 | 11 | $5,930 | $4,151 | $136.73 | $3,735.9 | 18.5× | $5,930 |
| CT thoracic spine without contrast | CPT | 72128 | 11 | $5,834 | $4,083.8 | $136.73 | $3,675.42 | 18.4× | $5,834 |
| CT lumbar spine without contrast | CPT | 72131 | 11 | $6,338 | $4,436.6 | $136.73 | $3,992.94 | 19.7× | $6,338 |
| MRI cervical spine without contrast | CPT | 72141 | 11 | $4,671 | $3,269.7 | $277.53 | $3,260.81 | 8.2× | $4,671 |
| MRI thoracic spine without contrast | CPT | 72146 | 11 | $4,671 | $3,269.7 | $277.53 | $3,260.81 | 8.7× | $4,671 |
| MRI lumbar spine without contrast | CPT | 72148 | 11 | $5,027 | $3,518.9 | $277.97 | $3,340.88 | 8.9× | $5,027 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 11 | $5,891 | $4,123.7 | $399.67 | $3,711.33 | 8.2× | $5,891 |
| MRI cervical spine with and without contrast | CPT | 72156 | 11 | $7,185 | $5,029.5 | $465.84 | $4,673.24 | 8.6× | $7,185 |
| MRI lumbar spine with contrast | CPT | 72158 | 11 | $6,984 | $4,888.8 | $465.84 | $4,588.37 | 8.4× | $6,984 |
| CT pelvis without contrast | CPT | 72192 | 11 | $3,931 | $2,751.7 | $136.73 | $2,476.53 | 12.4× | $3,931 |
| CT pelvis with contrast | CPT | 72193 | 11 | $5,123 | $3,586.1 | $222.3 | $2,860.13 | 10.2× | $5,123 |
| Shoulder X-ray | CPT | 73030 | 12 | $1,514 | $1,059.8 | $37.09 | $537.08 | 5.8× | $1,514 |
| Humerus X-ray | CPT | 73060 | 12 | $626 | $438.2 | $29.81 | $423.75 | 4.7× | $626 |
| Hand X-ray 3 views | CPT | 73130 | 12 | $1,068 | $747.6 | $36.06 | $634.41 | 6.8× | $1,068 |
| MRI upper extremity joint without contrast | CPT | 73221 | 11 | $6,289 | $4,402.3 | $284.3 | $3,774.12 | 9.1× | $6,289 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 11 | $8,670 | $6,069 | $408.36 | $5,326.8 | 8.7× | $8,670 |
| Knee X-ray 1-2 views | CPT | 73560 | 12 | $1,394 | $975.8 | $27.28 | $796.82 | 8.5× | $1,394 |
| Ankle X-ray 3 views | CPT | 73610 | 12 | $1,394 | $975.8 | $36.06 | $796.82 | 8.6× | $1,394 |
| MRI lower extremity joint without contrast | CPT | 73721 | 11 | $5,931 | $4,151.7 | $284.3 | $3,927.84 | 8.4× | $5,931 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 11 | $8,655 | $6,058.5 | $407.06 | $4,154.93 | 6.6× | $8,655 |
| CT abdomen without contrast | CPT | 74150 | 11 | $4,576 | $3,203.2 | $136.73 | $2,900.1 | 15.4× | $4,576 |
| CT abdomen with contrast | CPT | 74160 | 11 | $4,815 | $3,370.5 | $222.3 | $3,033.45 | 10.6× | $4,815 |
| CT abdomen with and without contrast | CPT | 74170 | 11 | $4,893 | $3,425.1 | $222.3 | $3,063.85 | 9.2× | $4,893 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 11 | $7,892 | $5,524.4 | $178.43 | $4,943.05 | 13.6× | $7,892 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 11 | $8,285 | $5,799.5 | $281.8 | $5,219.55 | 9.5× | $8,285 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 11 | $8,602 | $6,021.4 | $319.24 | $5,419.26 | 9.4× | $8,602 |
| MRI abdomen without contrast | CPT | 74181 | 11 | $4,671 | $3,269.7 | $284.3 | $2,942.73 | 7.5× | $4,671 |
| MRI abdomen with and without contrast | CPT | 74183 | 11 | $6,403 | $4,482.1 | $351.25 | $4,033.89 | 7.1× | $6,403 |
| Abdominal ultrasound complete | CPT | 76700 | 12 | $2,216 | $1,551.2 | $119.34 | $1,362.69 | 9.1× | $2,216 |
| Abdominal ultrasound limited | CPT | 76705 | 12 | $1,578 | $1,104.6 | $87.13 | $639.2 | 4.4× | $1,578 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 12 | $1,578 | $1,104.6 | $115.78 | $1,106.6 | 7.7× | $1,578 |
| Obstetric ultrasound first trimester | CPT | 76801 | 12 | $1,896 | $1,327.2 | $78.42 | $1,165.82 | 8.2× | $1,896 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 12 | $1,592 | $1,114.4 | $135.29 | $995.45 | 6.5× | $1,592 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 12 | $2,918 | $2,042.6 | $159.03 | $1,815.94 | 7.7× | $2,918 |
| Transvaginal ultrasound | CPT | 76830 | 12 | $1,578 | $1,104.6 | $97.04 | $970.52 | 6.6× | $1,578 |
| Pelvic ultrasound complete | CPT | 76856 | 12 | $1,635 | $1,144.5 | $97.04 | $1,005.8 | 7.0× | $1,635 |
| Scrotal ultrasound | CPT | 76870 | 12 | $1,683 | $1,178.1 | $85.75 | $1,035.09 | 7.9× | $1,683 |
| Diagnostic mammography unilateral | CPT | 77065 | 9 | $742 | $519.4 | $117.89 | $530 | 3.5× | $742 |
| Diagnostic mammography bilateral | CPT | 77066 | 9 | $929 | $650.3 | $149.36 | $666.14 | 3.5× | $929 |
| Screening mammography bilateral | CPT | 77067 | 9 | $868 | $607.6 | $120.94 | $623.32 | 4.0× | $868 |
| EKG tracing only | CPT | 93005 | 11 | $874 | $611.8 | $29.84 | $198.13 | 1.7× | $874 |
| Transthoracic echocardiogram complete | CPT | 93306 | 11 | $3,197 | $2,237.9 | $239.76 | $2,014.11 | 3.4× | $3,197 |
| Transthoracic echocardiogram | CPT | 93307 | 11 | $1,743 | $1,220.1 | $215.3 | $1,098.09 | 4.4× | $1,743 |
| Stress echocardiogram | CPT | 93350 | 11 | $2,407 | $1,684.9 | $137.87 | $795.49 | 1.6× | $2,407 |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 5 | — | — | $17,707 | $17,707 | 1.1× | $17,707 |
| COPD w MCC | MS-DRG | 190 | 5 | — | — | $10,940 | $10,940 | 0.97× | $10,940 |
| COPD w CC | MS-DRG | 191 | 5 | — | — | $8,689.82 | $8,689.82 | 0.98× | $8,689.82 |
| COPD w/o CC/MCC | MS-DRG | 192 | 5 | — | — | $6,926.22 | $6,926.22 | 0.99× | $6,926.22 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 5 | — | — | $8,499.16 | $8,499.16 | 1.0× | $8,499.16 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 5 | — | — | $6,647.71 | $6,647.71 | 0.99× | $6,647.71 |
| AMI discharged alive w MCC | MS-DRG | 280 | 5 | — | — | $15,443 | $15,443 | 0.99× | $15,443 |
| AMI discharged alive w CC | MS-DRG | 281 | 5 | — | — | $9,122.54 | $9,122.54 | 0.94× | $9,122.54 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 5 | — | — | $7,211.28 | $7,211.28 | 0.92× | $7,211.28 |
| Heart failure & shock w MCC | MS-DRG | 291 | 5 | — | — | $12,279 | $12,279 | 0.96× | $12,279 |
| Heart failure & shock w CC | MS-DRG | 292 | 5 | — | — | $8,495.42 | $8,495.42 | 0.95× | $8,495.42 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 5 | — | — | $5,938.35 | $5,938.35 | 0.96× | $5,938.35 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 5 | — | — | $11,649 | $11,649 | 0.96× | $11,649 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 5 | — | — | $7,439.32 | $7,439.32 | 0.96× | $7,439.32 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 5 | — | — | $5,651.42 | $5,651.42 | 0.91× | $5,651.42 |
| GI hemorrhage w CC | MS-DRG | 378 | 5 | — | — | $9,710.4 | $9,710.4 | 0.97× | $9,710.4 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 5 | — | — | $6,380.41 | $6,380.41 | 0.93× | $6,380.41 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 5 | — | — | $7,582.31 | $7,582.31 | 0.94× | $7,582.31 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 5 | — | — | $13,661 | $13,661 | 0.90× | $13,661 |
| Kidney/UTI w MCC | MS-DRG | 689 | 5 | — | — | $10,838 | $10,838 | 0.93× | $10,838 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 5 | — | — | $7,845.87 | $7,845.87 | 0.94× | $7,845.87 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 5 | — | — | $17,923 | $17,923 | 0.96× | $17,923 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 5 | — | — | $10,017 | $10,017 | 0.97× | $10,017 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 12 | $688 | $481.6 | $8.46 | $257.47 | 7.9× | $675.62 |
| General health panel | CPT | 80050 | 8 | $1,784 | $1,248.8 | $106.6 | $1,061.48 | 9.9× | $1,751.89 |
| Electrolyte panel | CPT | 80051 | 12 | $311 | $217.7 | $7.01 | $143.08 | 6.0× | $305.41 |
| Comprehensive metabolic panel | CPT | 80053 | 12 | $945 | $661.5 | $6.27 | $11.18 | 0.25× | $927.99 |
| Lipid panel | CPT | 80061 | 12 | $1,021 | $714.7 | $6.47 | $14.08 | 0.37× | $1,002.63 |
| Renal function panel | CPT | 80069 | 12 | $805 | $563.5 | $8.68 | $38.7 | 1.4× | $790.51 |
| Hepatic function panel | CPT | 80076 | 12 | $650 | $455 | $8.17 | $244.68 | 9.2× | $638.3 |
| Urinalysis non-automated | CPT | 81002 | 12 | $146 | $102.2 | $3.08 | $62.14 | 8.9× | $143.38 |
| Urinalysis automated | CPT | 81003 | 12 | $247 | $172.9 | $2.25 | $117.15 | 8.4× | $242.56 |
| Glucose quantitative | CPT | 82947 | 12 | $255 | $178.5 | $3.93 | $25.97 | 1.5× | $250.41 |
| Hemoglobin A1c | CPT | 83036 | 12 | $484 | $338.8 | $2.8 | $8.65 | 0.32× | $475.29 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 12 | $286 | $200.2 | $4.48 | $40.89 | 0.86× | $283.05 |
| Complete blood count with automated differential | CPT | 85025 | 12 | $403 | $282.1 | $7.77 | $34.65 | 1.3× | $395.75 |
| Complete blood count without differential | CPT | 85027 | 12 | $233 | $163.1 | $6.47 | $118.05 | 5.5× | $228.81 |
| Urine culture identification | CPT | 87088 | 12 | $193 | $135.1 | $8.09 | $119.52 | 5.4× | $189.53 |
| Tissue exam by pathologist level IV | CPT | 88305 | 12 | $346 | $242.2 | $21.04 | $64.09 | 0.63× | $346 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 14 | $737 | $515.9 | $32.7 | $596.43 | 3.2× | $14,083 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 4 | — | — | $1,994.02 | $7,139.82 | 3.1× | $14,083 |
| Vaginal delivery only | CPT | 59409 | 9 | — | — | $780.72 | $4,258 | 1.9× | $14,083 |
| Vaginal delivery with postpartum | CPT | 59410 | 4 | — | — | $4,849.17 | $7,685.41 | 7.2× | $14,083 |
| Routine obstetric care with C-section | CPT | 59510 | 4 | — | — | $1,995.21 | $8,159.8 | 3.3× | $14,083 |
| C-section delivery only | CPT | 59514 | 4 | — | — | $781.35 | $8,159.8 | 8.5× | $14,083 |
| C-section with postpartum | CPT | 59515 | 4 | — | — | $5,541.9 | $8,974 | 7.1× | $14,083 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 6 | $318 | $222.6 | $49.2 | $248.47 | 2.9× | $318 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 6 | $400 | $280 | $82.05 | $304.8 | 2.5× | $400 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 6 | $2,391 | $1,673.7 | $98.83 | $1,732.75 | 10.0× | $2,391 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 6 | $750 | $525 | $118.62 | $550.21 | 2.5× | $750 |
| Office visit, established patient, 5 min | CPT | 99211 | 6 | $308 | $215.6 | $17.21 | $219 | 3.4× | $308 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 6 | $318 | $222.6 | $16.37 | $238.22 | 3.0× | $318 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 6 | $369 | $258.3 | $34.43 | $276.42 | 2.4× | $369 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 6 | $2,391 | $1,673.7 | $53.79 | $495.5 | 3.2× | $2,391 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 6 | $625 | $437.5 | $82.05 | $457.17 | 2.4× | $625 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 10 | — | — | $405.42 | $3,137 | 3.4× | $9,264 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 10 | — | — | $423.61 | $3,137 | 3.2× | $9,264 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 10 | — | — | $99 | $2,802 | 3.3× | $8,271 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 10 | — | — | $130.65 | $2,802 | 3.1× | $8,271 |
| Colonoscopy diagnostic | CPT | 45378 | 10 | — | — | $534.04 | $3,137 | 3.6× | $9,264 |
| Colonoscopy with biopsy | CPT | 45380 | 10 | — | — | $597.36 | $3,137 | 2.6× | $9,264 |
| Colonoscopy with polyp removal | CPT | 45385 | 10 | — | — | $723.96 | $3,137 | 2.6× | $9,264 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 8 | — | — | $5,541.9 | $14,821 | 3.6× | $26,468 |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 5 | — | — | $29,625 | $29,625 | 1.1× | $29,625 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 5 | — | — | $18,867 | $18,867 | 1.0× | $18,867 |
| Hip hemiarthroplasty | CPT | 27125 | 6 | — | — | $1,885.66 | $7,491.91 | 6.0× | $19,190 |
| Total hip replacement | CPT | 27130 | 9 | — | — | $2,693.8 | $11,993 | 2.8× | $26,468 |
| Total knee replacement | CPT | 27447 | 9 | — | — | $2,693.8 | $14,994 | 3.6× | $26,468 |
| Knee revision arthroplasty single component | CPT | 27486 | 5 | — | — | $5,541.9 | $9,495 | 5.7× | $26,468 |
| Knee revision arthroplasty all components | CPT | 27487 | 6 | — | — | $2,584.03 | $9,495 | 4.7× | $26,468 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 6 | — | — | $605.06 | $6,617 | 20.2× | $12,268 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 9 | — | — | $623.03 | $8,078.96 | 2.5× | $23,160 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 9 | — | — | $790.35 | $5,537.5 | 2.7× | $15,880 |
| ACL reconstruction | CPT | 29888 | 9 | — | — | $1,220.29 | $8,078.96 | 2.4× | $23,160 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 5 | — | — | $46,092 | $46,092 | 1.1× | $46,092 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 5 | — | — | $24,251 | $24,251 | 1.0× | $24,251 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 5 | — | — | $16,412 | $16,412 | 1.00× | $16,412 |
| CABG single arterial graft | CPT | 33533 | 5 | — | — | $3,386.12 | $11,611 | 6.2× | $19,190 |
| CABG 2 arterial grafts | CPT | 33534 | 5 | — | — | $3,807.69 | $13,555 | 6.3× | $21,695 |
| CABG 3 arterial grafts | CPT | 33535 | 5 | — | — | $4,228.6 | $13,555 | 6.0× | $21,695 |
| CABG 4+ arterial grafts | CPT | 33536 | 5 | — | — | $4,650.86 | $13,555 | 5.5× | $21,695 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 5 | — | — | $16,211 | $16,211 | 0.98× | $16,211 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 5 | — | — | $12,718 | $12,718 | 0.94× | $12,718 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 5 | — | — | $33,290 | $33,290 | 1.0× | $33,290 |
| Open appendectomy | CPT | 44950 | 9 | — | — | $724.63 | $4,719.46 | 4.2× | $15,880 |
| Laparoscopic appendectomy | CPT | 44970 | 9 | — | — | $494.31 | $6,842.69 | 4.4× | $23,160 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 5 | — | — | $63,357 | $63,357 | 1.3× | $63,357 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 5 | — | — | $37,162 | $37,162 | 1.1× | $37,162 |
| Major joint replacement w MCC | MS-DRG | 469 | 5 | — | — | $29,266 | $29,266 | 0.99× | $29,266 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 5 | — | — | $18,185 | $18,185 | 0.96× | $18,185 |
| Laparoscopic cholecystectomy | CPT | 47562 | 9 | — | — | $843.15 | $8,076 | 4.6× | $23,160 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 9 | — | — | $970.44 | $8,076 | 4.3× | $23,160 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 5 | — | — | $28,704 | $28,704 | 1.0× | $28,704 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 5 | — | — | $20,015 | $20,015 | 0.99× | $20,015 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 5 | — | — | $15,807 | $15,807 | 0.99× | $15,807 |
| Open umbilical hernia repair | CPT | 49560 | 9 | — | — | $839.12 | $5,537.5 | 2.9× | $15,880 |
| Umbilical hernia repair age 5+ | CPT | 49585 | 9 | — | — | $534.04 | $5,537.5 | 4.2× | $15,880 |
| Lap inguinal hernia repair | CPT | 49650 | 9 | — | — | $379.7 | $7,348.39 | 6.5× | $23,160 |
| Lap incisional hernia repair | CPT | 49652 | 9 | — | — | $524.57 | $8,014.5 | 3.0× | $23,160 |
| Total abdominal hysterectomy | CPT | 58150 | 6 | — | — | $1,162.9 | $6,691 | 6.9× | $19,190 |
| Vaginal hysterectomy | CPT | 58260 | 9 | — | — | $1,162.9 | $5,687.55 | 3.1× | $15,880 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 9 | — | — | $838.74 | $8,076 | 5.5× | $23,160 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 9 | — | — | $616.65 | $11,488 | 5.2× | $23,160 |
| Lap salpingo-oophorectomy | CPT | 58661 | 9 | — | — | $701.38 | $7,817.32 | 3.8× | $23,160 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 5 | — | — | $29,040 | $29,040 | 1.1× | $29,040 |
| OR procedure for obesity w CC | MS-DRG | 620 | 5 | — | — | $16,899 | $16,899 | 1.0× | $16,899 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 5 | — | — | $15,352 | $15,352 | 1.0× | $15,352 |
| Complex cataract surgery | CPT | 66982 | 9 | — | — | $1,272.35 | $4,258 | 1.9× | $15,519 |
| Cataract surgery with lens implant | CPT | 66984 | 9 | — | — | $1,818.32 | $4,258 | 1.9× | $15,519 |
| Intravitreal injection | CPT | 67028 | 10 | — | — | $377.7 | $2,240 | 6.5× | $6,617 |
| Vitrectomy mechanical | CPT | 67042 | 9 | — | — | $1,186.9 | $6,020.45 | 2.4× | $19,190 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 5 | — | — | $11,012 | $11,012 | 0.90× | $11,012 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 5 | — | — | $17,205 | $17,205 | 0.90× | $17,205 |
| PCI single major coronary artery | CPT | 92920 | 12 | $16,600 | $11,620 | $435.12 | $8,719 | 1.5× | $23,160 |
| PCI with drug-eluting stent | CPT | 92928 | 12 | $25,352 | $17,746 | $483.05 | $12,956 | 1.3× | $24,896 |
| PCI bypass graft | CPT | 92937 | 12 | $24,748 | $17,324 | $482.46 | $12,956 | 1.2× | $24,303 |
| Left heart catheterization | CPT | 93452 | 12 | $16,814 | $11,770 | $967.53 | $9,920.26 | 3.2× | $19,190 |
| Coronary angiography with cath | CPT | 93455 | 12 | $19,645 | $13,752 | $1,166.18 | $10,811 | 3.5× | $21,695 |
| Coronary angiography with bypass cath | CPT | 93458 | 12 | $20,759 | $14,531 | $1,204.89 | $11,117 | 3.6× | $21,695 |