| behavioral |
| Psychoses | MS-DRG | 885 | 26 | — | $14,651 | $6,740.69 | $19,047 | 1.5× | $26,548 |
| emergency |
| ED visit level 1 | CPT | 99281 | 34 | $600 | $107 | $21.77 | $128 | 0.91× | $215.84 |
| ED visit level 2 | CPT | 99282 | 34 | $1,200 | $196 | $30 | $196.51 | 0.83× | $393.02 |
| ED visit level 3 | CPT | 99283 | 34 | $1,800 | $349 | $30 | $349.37 | 0.86× | $698.74 |
| ED visit level 4 | CPT | 99284 | 34 | $2,600 | $534 | $30 | $534.03 | 0.80× | $1,068.06 |
| ED visit level 5 | CPT | 99285 | 34 | $3,800 | $762 | $30 | $762.2 | 0.73× | $1,524.4 |
| Critical care, first hour | CPT | 99291 | 34 | $5,000 | $1,057 | $30 | $1,057.2 | 0.99× | $2,114.4 |
| imaging |
| CT head without contrast | CPT | 70450 | 35 | $2,628 | $133 | $30 | $133.8 | 0.65× | $296.47 |
| CT head with contrast | CPT | 70460 | 33 | $2,979 | $224 | $137.27 | $224.48 | 0.96× | $448.96 |
| CT head with and without contrast | CPT | 70470 | 33 | $3,242 | $224 | $163.9 | $224.48 | 0.84× | $448.96 |
| CT neck with contrast | CPT | 70491 | 33 | $2,979 | $224 | $184.4 | $224.48 | 0.82× | $448.96 |
| MRI brain without contrast | CPT | 70551 | 34 | $2,444 | $305 | $30 | $305.38 | 0.76× | $767.79 |
| MRI brain with contrast | CPT | 70552 | 33 | $2,444 | $446 | $276.68 | $446.5 | 0.93× | $926.42 |
| MRI brain with and without contrast | CPT | 70553 | 34 | $3,370 | $446 | $30 | $446.5 | 0.76× | $1,435.35 |
| Chest X-ray single view | CPT | 71045 | 34 | $600 | $111 | $9.71 | $111.37 | 1.2× | $222.74 |
| Chest X-ray 2 views | CPT | 71046 | 34 | $656 | $111 | $18.13 | $111.37 | 1.1× | $222.74 |
| Chest X-ray 3 views | CPT | 71047 | 33 | $787 | $111 | $22.92 | $111.37 | 1.2× | $222.74 |
| CT chest without contrast | CPT | 71250 | 34 | $2,628 | $133 | $30 | $133.8 | 0.62× | $350.49 |
| CT chest with contrast | CPT | 71260 | 34 | $2,979 | $224 | $30 | $224.48 | 0.80× | $448.96 |
| CT chest with and without contrast | CPT | 71270 | 34 | $3,242 | $224 | $30 | $224.48 | 0.77× | $448.96 |
| MRI chest without contrast | CPT | 71550 | 33 | $2,444 | $305 | $305.38 | $402.29 | 0.93× | $867.15 |
| Lumbosacral spine X-ray | CPT | 72100 | 34 | $714 | $133 | $29.98 | $133.8 | 1.3× | $267.6 |
| CT cervical spine without contrast | CPT | 72125 | 33 | $2,628 | $133 | $129.09 | $133.8 | 0.66× | $350.49 |
| CT thoracic spine without contrast | CPT | 72128 | 33 | $2,628 | $133 | $132.34 | $133.8 | 0.67× | $350.49 |
| CT lumbar spine without contrast | CPT | 72131 | 34 | $2,628 | $133 | $30 | $133.8 | 0.66× | $350.49 |
| MRI cervical spine without contrast | CPT | 72141 | 34 | $2,444 | $305 | $30 | $305.38 | 0.77× | $867.15 |
| MRI thoracic spine without contrast | CPT | 72146 | 33 | $2,444 | $305 | $183.45 | $305.38 | 0.82× | $867.15 |
| MRI lumbar spine without contrast | CPT | 72148 | 34 | $2,444 | $305 | $30 | $305.38 | 0.81× | $867.15 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 33 | $2,760 | $446 | $281.85 | $446.5 | 0.98× | $1,027.55 |
| MRI cervical spine with and without contrast | CPT | 72156 | 34 | $3,036 | $446 | $30 | $446.5 | 0.83× | $1,462.81 |
| MRI lumbar spine with contrast | CPT | 72158 | 34 | $3,036 | $446 | $30 | $446.5 | 0.82× | $1,461.3 |
| CT pelvis without contrast | CPT | 72192 | 33 | $2,628 | $133 | $117.13 | $133.8 | 0.67× | $350.49 |
| CT pelvis with contrast | CPT | 72193 | 33 | $2,979 | $224 | $222.88 | $224.48 | 0.80× | $448.96 |
| Shoulder X-ray | CPT | 73030 | 34 | $623 | $111 | $25.59 | $111.37 | 1.2× | $222.74 |
| Humerus X-ray | CPT | 73060 | 33 | $596 | $111 | $21.46 | $111.37 | 1.2× | $222.74 |
| Hand X-ray 3 views | CPT | 73130 | 34 | $572 | $111 | $26.32 | $111.37 | 1.2× | $222.74 |
| MRI upper extremity joint without contrast | CPT | 73221 | 34 | $2,444 | $305 | $30 | $305.38 | 0.73× | $610.76 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 33 | $2,125 | $446 | $301.18 | $446.5 | 0.73× | $893 |
| Knee X-ray 1-2 views | CPT | 73560 | 34 | $623 | $111 | $20.19 | $111.37 | 1.2× | $222.74 |
| Ankle X-ray 3 views | CPT | 73610 | 34 | $522 | $111 | $26.32 | $111.37 | 1.2× | $222.74 |
| MRI lower extremity joint without contrast | CPT | 73721 | 34 | $2,444 | $305 | $30 | $305.38 | 0.65× | $610.76 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 33 | $2,350 | $446 | $300.2 | $446.5 | 0.70× | $893 |
| CT abdomen without contrast | CPT | 74150 | 33 | $2,628 | $133 | $116.66 | $133.8 | 0.71× | $350.49 |
| CT abdomen with contrast | CPT | 74160 | 33 | $2,979 | $224 | $221.59 | $224.48 | 0.78× | $448.96 |
| CT abdomen with and without contrast | CPT | 74170 | 33 | $3,242 | $224 | $224.48 | $255.65 | 0.76× | $448.96 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 34 | $5,900 | $305 | $30 | $305.38 | 0.84× | $610.76 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 33 | $6,900 | $446 | $202.9 | $446.5 | 0.81× | $893 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 34 | $2,622.41 | $446 | $30 | $446.5 | 0.78× | $893 |
| MRI abdomen without contrast | CPT | 74181 | 34 | $2,444 | $305 | $30 | $305.38 | 0.78× | $846.78 |
| MRI abdomen with and without contrast | CPT | 74183 | 34 | $2,350 | $446 | $30 | $446.5 | 0.79× | $893 |
| Abdominal ultrasound complete | CPT | 76700 | 34 | $1,307 | $133 | $30 | $133.8 | 0.90× | $267.6 |
| Abdominal ultrasound limited | CPT | 76705 | 33 | $1,100 | $133 | $60.12 | $133.8 | 0.91× | $267.6 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 34 | $1,301 | $133 | $30 | $133.8 | 0.93× | $267.6 |
| Obstetric ultrasound first trimester | CPT | 76801 | 34 | $475 | $133 | $30 | $133.8 | 0.95× | $267.6 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 34 | $1,301 | $133 | $30 | $133.8 | 0.88× | $267.6 |
| Transvaginal ultrasound | CPT | 76830 | 34 | $580 | $133 | $30 | $133.8 | 0.91× | $267.6 |
| Pelvic ultrasound complete | CPT | 76856 | 33 | $1,301 | $133 | $67.93 | $133.8 | 0.93× | $267.6 |
| Scrotal ultrasound | CPT | 76870 | 34 | $930 | $133 | $30 | $133.8 | 1.0× | $267.6 |
| Diagnostic mammography unilateral | CPT | 77065 | 34 | $599 | $101 | $30 | $80.15 | 0.54× | $203.54 |
| Diagnostic mammography bilateral | CPT | 77066 | 34 | $1,111 | $130 | $30 | $130.44 | 0.68× | $260.88 |
| Screening mammography bilateral | CPT | 77067 | 34 | $363 | $107 | $30 | $107.7 | 0.68× | $215.4 |
| EKG tracing only | CPT | 93005 | 34 | $500 | $75 | $23.52 | $37 | 0.31× | $151 |
| Transthoracic echocardiogram complete | CPT | 93306 | 34 | $3,219.18 | $699 | $30 | $699.34 | 1.2× | $1,398.68 |
| Transthoracic echocardiogram | CPT | 93307 | 33 | $1,460.07 | $305 | $129.18 | $305.38 | 1.2× | $610.76 |
| Stress echocardiogram | CPT | 93350 | 34 | $2,326.8 | $699 | $30 | $699.34 | 1.4× | $1,398.68 |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 27 | — | $20,923 | $19,851 | $27,202 | 1.3× | $37,913 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 26 | — | $10,704 | $10,166 | $13,916 | 1.3× | $19,396 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 26 | — | $7,376 | $7,011.36 | $10,371 | 1.4× | $13,366 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 26 | — | $16,345 | $15,512 | $21,249 | 1.4× | $29,618 |
| COPD w MCC | MS-DRG | 190 | 27 | — | $11,698 | $11,108 | $15,254 | 1.4× | $21,199 |
| COPD w CC | MS-DRG | 191 | 26 | — | $8,995 | $8,546.43 | $11,695 | 1.3× | $16,301 |
| COPD w/o CC/MCC | MS-DRG | 192 | 26 | — | $6,943 | $6,344.1 | $9,026.24 | 1.3× | $12,581 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 26 | — | $8,617 | $8,187.34 | $11,202 | 1.3× | $15,614 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 26 | — | $6,805 | $6,470.32 | $8,847.02 | 1.3× | $12,331 |
| AMI discharged alive w MCC | MS-DRG | 280 | 26 | — | $16,768 | $15,913 | $21,799 | 1.4× | $30,384 |
| AMI discharged alive w CC | MS-DRG | 281 | 26 | — | $9,772 | $9,282.98 | $13,013 | 1.3× | $17,709 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 26 | — | $7,771 | $7,385.93 | $10,927 | 1.4× | $14,082 |
| Heart failure & shock w MCC | MS-DRG | 291 | 26 | — | $13,497 | $12,813 | $17,546 | 1.4× | $24,457 |
| Heart failure & shock w CC | MS-DRG | 292 | 26 | — | $9,057 | $8,604.5 | $11,774 | 1.3× | $16,412 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 26 | — | $6,167 | $5,865.39 | $8,017.3 | 1.3× | $11,175 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 26 | — | $12,682 | $12,041 | $16,487 | 1.4× | $22,980 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 26 | — | $7,900 | $6,726.75 | $10,270 | 1.3× | $14,315 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 26 | — | $6,168 | $5,714.38 | $8,018.62 | 1.3× | $11,177 |
| GI hemorrhage w CC | MS-DRG | 378 | 27 | — | $10,402 | $9,879.2 | $13,286 | 1.3× | $18,849 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 26 | — | $6,824 | $6,488.71 | $8,872.24 | 1.3× | $12,367 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 27 | — | $8,348 | $7,932.79 | $11,051 | 1.4× | $15,127 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 26 | — | $16,396 | $15,561 | $21,446 | 1.4× | $29,710 |
| Kidney/UTI w MCC | MS-DRG | 689 | 26 | — | $12,236 | $11,618 | $15,907 | 1.4× | $22,172 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 27 | — | $8,653 | $7,967.19 | $11,709 | 1.4× | $15,681 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 27 | — | $20,223 | $19,188 | $24,171 | 1.3× | $36,646 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 27 | — | $10,837 | $9,533.26 | $14,663 | 1.4× | $19,637 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 34 | $137 | $8 | $8.34 | $8.46 | 0.26× | $30 |
| Electrolyte panel | CPT | 80051 | 33 | $495 | $7 | $7.01 | $7.15 | 0.30× | $14.02 |
| Comprehensive metabolic panel | CPT | 80053 | 33 | $273 | $10 | $10.55 | $10.56 | 0.24× | $21.12 |
| Lipid panel | CPT | 80061 | 33 | $130 | $13 | $13.24 | $13.39 | 0.35× | $26.78 |
| Renal function panel | CPT | 80069 | 33 | $557 | $8 | $8.68 | $8.72 | 0.32× | $17.36 |
| Hepatic function panel | CPT | 80076 | 34 | $137 | $8 | $7.32 | $8.17 | 0.31× | $30 |
| Urinalysis non-automated | CPT | 81002 | 33 | $31 | $3 | $2.47 | $3.48 | 0.50× | $6.96 |
| Urinalysis automated | CPT | 81003 | 34 | $58 | $2 | $2.25 | $2.25 | 0.16× | $30 |
| Glucose quantitative | CPT | 82947 | 33 | $332 | $3 | $3.79 | $3.93 | 0.22× | $7.86 |
| Hemoglobin A1c | CPT | 83036 | 34 | $233 | $9 | $7.21 | $9.71 | 0.36× | $30 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 33 | $473 | $16 | $5.53 | $14.5 | 0.31× | $33.6 |
| Complete blood count with automated differential | CPT | 85025 | 34 | $53.05 | $7 | $7.75 | $7.77 | 0.29× | $30 |
| Complete blood count without differential | CPT | 85027 | 33 | $116 | $6 | $6.47 | $6.55 | 0.30× | $12.94 |
| Urine culture bacterial | CPT | 87086 | 34 | $299 | $8 | $6.48 | $8.39 | 0.36× | $30 |
| Tissue exam by pathologist level IV | CPT | 88305 | 33 | $1,075 | $66 | $11.76 | $69.23 | 0.68× | $133.38 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 33 | $482.1 | $258 | $19.62 | $258.75 | 1.4× | $482.1 |
| Vaginal delivery only | CPT | 59409 | 33 | $6,818.31 | $4,143 | $780.72 | $4,143.08 | 1.9× | $6,818.31 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 10 | $462.4 | — | $49.2 | $49.2 | 0.57× | $54.12 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 10 | $782.25 | — | $82.05 | $82.05 | 0.67× | $90.26 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 10 | $1,274.5 | — | $98.83 | $98.83 | 0.57× | $108.71 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 10 | $1,731.05 | — | $118.62 | $118.62 | 0.54× | $130.48 |
| Office visit, established patient, 5 min | CPT | 99211 | 10 | $110 | — | $9.85 | $17.21 | 0.27× | $18.93 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 10 | $336.75 | — | $16.37 | $16.37 | 0.20× | $39.61 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 10 | $631.35 | — | $34.43 | $34.43 | 0.30× | $73.75 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 10 | $932.85 | — | $53.79 | $53.79 | 0.35× | $109.05 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 10 | $1,373.5 | — | $82.05 | $82.05 | 0.44× | $160.36 |
| surgery |
| Shoulder arthroscopy with decompression | CPT | 29826 | 10 | $7,861.13 | — | $605.06 | $605.06 | 1.9× | $665.57 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 33 | $7,861.13 | $9,286 | $493.96 | $7,861.13 | 2.4× | $7,861.13 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 33 | $12,500 | $4,187 | $790.35 | $4,187.71 | 2.0× | $8,375.42 |
| ACL reconstruction | CPT | 29888 | 33 | $3,500 | $9,286 | $967.66 | $3,500 | 1.0× | $3,500 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 26 | — | $47,326 | $44,876 | $61,524 | 1.4× | $85,756 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 26 | — | $24,867 | $23,589 | $32,327 | 1.4× | $45,060 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 26 | — | $17,572 | $16,676 | $24,521 | 1.5× | $31,842 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 26 | — | $17,661 | $16,760 | $23,478 | 1.4× | $32,003 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 26 | — | $14,334 | $13,607 | $19,822 | 1.5× | $25,974 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 26 | — | $35,180 | $33,364 | $49,464 | 1.5× | $72,555 |
| Laparoscopic appendectomy | CPT | 44970 | 33 | $15,500 | $7,737 | $391.98 | $7,737.45 | 5.0× | $15,475 |
| Major joint replacement w MCC | MS-DRG | 469 | 26 | — | $31,362 | $29,745 | $43,100 | 1.5× | $57,732 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 27 | — | $20,085 | $7,650 | $26,798 | 1.4× | $36,394 |
| Laparoscopic cholecystectomy | CPT | 47562 | 33 | $15,375 | $7,737 | $668.6 | $7,737.45 | 4.4× | $15,375 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 26 | — | $30,127 | $28,575 | $42,359 | 1.5× | $54,591 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 26 | — | $21,776 | $20,660 | $30,617 | 1.5× | $39,458 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 26 | — | $17,042 | $16,173 | $23,962 | 1.5× | $30,882 |
| Lap inguinal hernia repair | CPT | 49650 | 33 | $20,000 | $7,737 | $379.7 | $7,737.45 | 6.9× | $15,475 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 26 | — | $29,873 | $28,334 | $42,002 | 1.5× | $54,130 |
| OR procedure for obesity w CC | MS-DRG | 620 | 26 | — | $16,729 | $15,876 | $21,748 | 1.3× | $30,314 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 26 | — | $15,790 | $14,987 | $22,107 | 1.5× | $28,613 |
| Complex cataract surgery | CPT | 66982 | 33 | $11,711 | $2,953 | $1,008.93 | $2,953.7 | 1.3× | $5,907.4 |
| Cataract surgery with lens implant | CPT | 66984 | 33 | $12,115 | $2,953 | $1,441.87 | $2,953.7 | 1.4× | $5,907.4 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 26 | — | $13,057 | $12,396 | $16,974 | 1.4× | $23,660 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 26 | — | $21,312 | $19,315 | $27,706 | 1.4× | $38,618 |
| PCI single major coronary artery | CPT | 92920 | 33 | $21,188 | $7,284 | $435.12 | $7,284.43 | 1.3× | $14,569 |
| PCI with drug-eluting stent | CPT | 92928 | 33 | $31,531 | $14,775 | $483.05 | $14,775 | 1.5× | $29,550 |
| PCI bypass graft | CPT | 92937 | 33 | $31,531 | $14,775 | $482.46 | $14,775 | 1.4× | $29,550 |
| Left heart catheterization | CPT | 93452 | 33 | $15,282 | $4,149 | $549.26 | $4,149.23 | 1.3× | $8,298.46 |
| Coronary angiography with cath | CPT | 93455 | 33 | $15,282 | $4,149 | $671.23 | $4,149.23 | 1.3× | $8,298.46 |
| Coronary angiography with bypass cath | CPT | 93458 | 33 | $18,884 | $4,149 | $693.51 | $4,149.23 | 1.3× | $8,298.46 |