| behavioral |
| Psychoses | MS-DRG | 885 | 1 | — | — | $3,553.21 | $3,553.21 | 0.28× | $3,553.21 |
| emergency |
| ED visit level 1 | CPT | 99281 | 10 | $331 | $331 | $69.51 | $158.88 | 1.1× | $287.97 |
| ED visit level 2 | CPT | 99282 | 10 | $693 | $693 | $145.53 | $332.64 | 1.4× | $602.91 |
| ED visit level 3 | CPT | 99283 | 10 | $1,082 | $1,082 | $227.22 | $519.36 | 1.3× | $941.34 |
| ED visit level 4 | CPT | 99284 | 10 | $1,722 | $1,722 | $361.62 | $826.56 | 1.2× | $1,498.14 |
| ED visit level 5 | CPT | 99285 | 10 | $2,457 | $2,457 | $515.97 | $1,179.36 | 1.1× | $2,137.59 |
| Critical care, first hour | CPT | 99291 | 10 | $3,885 | $3,885 | $82 | $923.38 | 0.86× | $3,379.95 |
| imaging |
| CT head without contrast | CPT | 70450 | 10 | $2,783 | $2,783 | $584.43 | $834.9 | 4.0× | $2,421.21 |
| CT head with contrast | CPT | 70460 | 10 | $4,106 | $4,106 | $600 | $1,231.8 | 5.3× | $3,572.22 |
| CT head with and without contrast | CPT | 70470 | 10 | $4,883 | $4,883 | $600 | $1,464.9 | 5.5× | $4,248.21 |
| CT neck with contrast | CPT | 70491 | 10 | $4,862 | $4,862 | $600 | $1,458.6 | 5.3× | $4,229.94 |
| MRI brain without contrast | CPT | 70551 | 10 | $4,368 | $4,368 | $917.28 | $1,310.4 | 3.2× | $3,800.16 |
| MRI brain with contrast | CPT | 70552 | 10 | $4,536 | $4,536 | $952.56 | $1,360.8 | 2.8× | $3,946.32 |
| MRI brain with and without contrast | CPT | 70553 | 10 | $5,891 | $5,891 | $1,200 | $1,767.3 | 3.0× | $5,125.17 |
| Chest X-ray single view | CPT | 71045 | 10 | $483 | $483 | $101.43 | $231.84 | 2.5× | $420.21 |
| Chest X-ray 2 views | CPT | 71046 | 10 | $567 | $567 | $119.07 | $272.16 | 2.8× | $493.29 |
| Chest X-ray 3 views | CPT | 71047 | 10 | $1,019 | $1,019 | $213.99 | $489.12 | 5.1× | $886.53 |
| CT chest without contrast | CPT | 71250 | 10 | $3,528 | $3,528 | $600 | $1,058.4 | 4.9× | $3,069.36 |
| CT chest with contrast | CPT | 71260 | 10 | $4,442 | $4,442 | $600 | $1,332.6 | 4.7× | $3,864.54 |
| CT chest with and without contrast | CPT | 71270 | 10 | $4,883 | $4,883 | $600 | $1,464.9 | 5.0× | $4,248.21 |
| MRI chest without contrast | CPT | 71550 | 10 | $3,560 | $3,560 | $747.6 | $1,200 | 2.8× | $3,097.2 |
| MRI chest with contrast | CPT | 71551 | 10 | $4,715 | $4,715 | $990.15 | $1,414.5 | 1.7× | $4,102.05 |
| MRI chest with and without contrast | CPT | 71552 | 10 | $4,851 | $4,851 | $1,018.71 | $1,455.3 | 2.4× | $4,220.37 |
| Lumbosacral spine X-ray | CPT | 72100 | 10 | $1,008 | $1,008 | $211.68 | $483.84 | 4.7× | $876.96 |
| CT cervical spine without contrast | CPT | 72125 | 10 | $4,484 | $4,484 | $600 | $1,345.2 | 6.7× | $3,901.08 |
| CT thoracic spine without contrast | CPT | 72128 | 10 | $3,749 | $3,749 | $600 | $1,124.7 | 5.6× | $3,261.63 |
| CT lumbar spine without contrast | CPT | 72131 | 10 | $2,520 | $2,520 | $529.2 | $756 | 3.7× | $2,192.4 |
| MRI cervical spine without contrast | CPT | 72141 | 10 | $5,219 | $5,219 | $1,095.99 | $1,565.7 | 3.9× | $4,540.53 |
| MRI thoracic spine without contrast | CPT | 72146 | 10 | $4,368 | $4,368 | $917.28 | $1,310.4 | 3.5× | $3,800.16 |
| MRI lumbar spine without contrast | CPT | 72148 | 10 | $5,219 | $5,219 | $1,095.99 | $1,565.7 | 4.2× | $4,540.53 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 10 | $5,597 | $5,597 | $1,175.37 | $1,679.1 | 3.7× | $4,869.39 |
| MRI cervical spine with and without contrast | CPT | 72156 | 10 | $6,983 | $6,983 | $1,200 | $2,094.9 | 3.9× | $6,075.21 |
| MRI lumbar spine with contrast | CPT | 72158 | 10 | $7,067 | $7,067 | $1,200 | $2,120.1 | 3.9× | $6,148.29 |
| CT pelvis without contrast | CPT | 72192 | 10 | $3,581 | $3,581 | $600 | $1,074.3 | 5.4× | $3,115.47 |
| CT pelvis with contrast | CPT | 72193 | 10 | $4,053 | $4,053 | $600 | $1,215.9 | 4.3× | $3,526.11 |
| Shoulder X-ray | CPT | 73030 | 10 | $945 | $945 | $198.45 | $453.6 | 4.9× | $822.15 |
| Humerus X-ray | CPT | 73060 | 10 | $893 | $893 | $187.53 | $428.64 | 4.8× | $776.91 |
| Hand X-ray 3 views | CPT | 73130 | 10 | $735 | $735 | $154.35 | $352.8 | 3.8× | $639.45 |
| MRI upper extremity joint without contrast | CPT | 73221 | 10 | $5,345 | $5,345 | $1,122.45 | $1,603.5 | 3.9× | $4,650.15 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 10 | $4,851 | $4,851 | $1,018.71 | $1,455.3 | 2.4× | $4,220.37 |
| Knee X-ray 1-2 views | CPT | 73560 | 10 | $735 | $735 | $154.35 | $352.8 | 3.8× | $639.45 |
| Ankle X-ray 3 views | CPT | 73610 | 10 | $672 | $672 | $141.12 | $322.56 | 3.5× | $584.64 |
| MRI lower extremity joint without contrast | CPT | 73721 | 10 | $3,560 | $3,560 | $747.6 | $1,200 | 2.6× | $3,097.2 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 10 | $4,400 | $4,400 | $924 | $1,320 | 2.1× | $3,828 |
| CT abdomen without contrast | CPT | 74150 | 10 | $3,791 | $3,791 | $600 | $1,137.3 | 6.0× | $3,298.17 |
| CT abdomen with contrast | CPT | 74160 | 10 | $4,883 | $4,883 | $600 | $1,464.9 | 5.1× | $4,248.21 |
| CT abdomen with and without contrast | CPT | 74170 | 10 | $5,345 | $5,345 | $600 | $1,603.5 | 4.8× | $4,650.15 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 10 | $5,586 | $5,586 | $600 | $1,675.8 | 4.6× | $4,859.82 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 10 | $9,030 | $9,030 | $600 | $2,709 | 4.9× | $7,856.1 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 10 | $9,923 | $9,923 | $600 | $2,976.9 | 5.2× | $8,633.01 |
| MRI abdomen without contrast | CPT | 74181 | 10 | $2,972 | $2,972 | $624.12 | $1,200 | 3.1× | $2,585.64 |
| MRI abdomen with and without contrast | CPT | 74183 | 10 | $4,547 | $4,547 | $954.87 | $1,364.1 | 2.4× | $3,955.89 |
| Abdominal ultrasound complete | CPT | 76700 | 10 | $2,352 | $2,352 | $493.92 | $1,128.96 | 7.6× | $2,046.24 |
| Abdominal ultrasound limited | CPT | 76705 | 10 | $1,481 | $1,481 | $308.7 | $705.6 | 4.8× | $1,288.47 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 10 | $1,544 | $1,544 | $324.24 | $741.12 | 5.2× | $1,343.28 |
| Obstetric ultrasound first trimester | CPT | 76801 | 10 | $1,680 | $1,680 | $352.8 | $806.4 | 5.7× | $1,461.6 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 10 | $1,680 | $1,680 | $352.8 | $806.4 | 5.3× | $1,461.6 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 10 | $1,680 | $1,680 | $352.8 | $806.4 | 3.4× | $1,461.6 |
| Transvaginal ultrasound | CPT | 76830 | 10 | $1,901 | $1,901 | $399.21 | $912.48 | 6.2× | $1,653.87 |
| Pelvic ultrasound complete | CPT | 76856 | 10 | $1,722 | $1,722 | $361.62 | $826.56 | 5.8× | $1,498.14 |
| Scrotal ultrasound | CPT | 76870 | 10 | $1,607 | $1,607 | $337.47 | $771.36 | 5.9× | $1,398.09 |
| Diagnostic mammography unilateral | CPT | 77065 | 10 | $609 | $609 | $127.89 | $292.32 | 2.0× | $529.83 |
| Diagnostic mammography bilateral | CPT | 77066 | 10 | $735 | $735 | $154.35 | $352.8 | 1.9× | $639.45 |
| Screening mammography bilateral | CPT | 77067 | 10 | $520 | $520 | $109.2 | $249.6 | 1.6× | $452.4 |
| EKG tracing only | CPT | 93005 | 10 | $478 | $478 | $100.38 | $229.44 | 1.9× | $415.86 |
| EKG interpretation only | CPT | 93010 | 10 | $105 | $105 | $22.05 | $50.4 | 2.8× | $91.35 |
| Transthoracic echocardiogram complete | CPT | 93306 | 10 | $4,043 | $4,043 | $82 | $849.03 | 1.4× | $3,517.41 |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 1 | — | — | $3,553.21 | $3,553.21 | 0.18× | $3,553.21 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 1 | — | — | $3,553.21 | $3,553.21 | 0.33× | $3,553.21 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 1 | — | — | $3,553.21 | $3,553.21 | 0.47× | $3,553.21 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 1 | — | — | $3,553.21 | $3,553.21 | 0.23× | $3,553.21 |
| COPD w MCC | MS-DRG | 190 | 1 | — | — | $3,553.21 | $3,553.21 | 0.32× | $3,553.21 |
| COPD w CC | MS-DRG | 191 | 1 | — | — | $3,553.21 | $3,553.21 | 0.40× | $3,553.21 |
| COPD w/o CC/MCC | MS-DRG | 192 | 1 | — | — | $3,553.21 | $3,553.21 | 0.51× | $3,553.21 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 1 | — | — | $3,553.21 | $3,553.21 | 0.42× | $3,553.21 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 1 | — | — | $3,553.21 | $3,553.21 | 0.53× | $3,553.21 |
| AMI discharged alive w MCC | MS-DRG | 280 | 1 | — | — | $3,553.21 | $3,553.21 | 0.23× | $3,553.21 |
| AMI discharged alive w CC | MS-DRG | 281 | 1 | — | — | $3,553.21 | $3,553.21 | 0.37× | $3,553.21 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 1 | — | — | $3,553.21 | $3,553.21 | 0.46× | $3,553.21 |
| Heart failure & shock w MCC | MS-DRG | 291 | 1 | — | — | $3,553.21 | $3,553.21 | 0.28× | $3,553.21 |
| Heart failure & shock w CC | MS-DRG | 292 | 1 | — | — | $3,553.21 | $3,553.21 | 0.40× | $3,553.21 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 1 | — | — | $3,553.21 | $3,553.21 | 0.57× | $3,553.21 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 1 | — | — | $3,553.21 | $3,553.21 | 0.29× | $3,553.21 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 1 | — | — | $3,553.21 | $3,553.21 | 0.46× | $3,553.21 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 1 | — | — | $3,553.21 | $3,553.21 | 0.57× | $3,553.21 |
| GI hemorrhage w CC | MS-DRG | 378 | 1 | — | — | $3,553.21 | $3,553.21 | 0.35× | $3,553.21 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 1 | — | — | $3,553.21 | $3,553.21 | 0.52× | $3,553.21 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 1 | — | — | $3,553.21 | $3,553.21 | 0.44× | $3,553.21 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 1 | — | — | $3,553.21 | $3,553.21 | 0.23× | $3,553.21 |
| Kidney/UTI w MCC | MS-DRG | 689 | 1 | — | — | $3,553.21 | $3,553.21 | 0.31× | $3,553.21 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 1 | — | — | $3,553.21 | $3,553.21 | 0.43× | $3,553.21 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 1 | — | — | $3,553.21 | $3,553.21 | 0.19× | $3,553.21 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 1 | — | — | $3,553.21 | $3,553.21 | 0.34× | $3,553.21 |
| Initial hospital care, low complexity | CPT | 99221 | 10 | $305 | $305 | $20.58 | $64.05 | 0.69× | $265.35 |
| Initial hospital care, moderate complexity | CPT | 99222 | 10 | $630 | $630 | $82 | $189 | 1.1× | $548.1 |
| Initial hospital care, high complexity | CPT | 99223 | 10 | $625 | $625 | $82 | $187.5 | 0.83× | $543.75 |
| Hospital discharge, <30 min | CPT | 99238 | 10 | $289 | $289 | $60.69 | $86.7 | 1.0× | $251.43 |
| Hospital discharge, >30 min | CPT | 99239 | 10 | $410 | $410 | $82 | $123 | 1.0× | $356.7 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 10 | $305 | $305 | $64.05 | $146.4 | 4.5× | $265.35 |
| General health panel | CPT | 80050 | 10 | $425 | $425 | $89.25 | $204 | 1.9× | $369.75 |
| Electrolyte panel | CPT | 80051 | 10 | $189 | $189 | $39.69 | $90.72 | 3.8× | $164.43 |
| Comprehensive metabolic panel | CPT | 80053 | 10 | $504 | $504 | $94.92 | $216.96 | 4.9× | $438.48 |
| Lipid panel | CPT | 80061 | 10 | $299 | $299 | $62.79 | $143.52 | 3.8× | $260.13 |
| Renal function panel | CPT | 80069 | 10 | $378 | $378 | $79.38 | $181.44 | 6.7× | $328.86 |
| Hepatic function panel | CPT | 80076 | 10 | $452 | $452 | $94.92 | $216.96 | 8.2× | $393.24 |
| Urinalysis non-automated | CPT | 81002 | 10 | $184 | $184 | $20.37 | $55.2 | 7.9× | $160.08 |
| Urinalysis automated | CPT | 81003 | 10 | $116 | $116 | $20.37 | $46.56 | 3.3× | $100.92 |
| Glucose quantitative | CPT | 82947 | 10 | $194 | $194 | $40.74 | $93.12 | 5.3× | $168.78 |
| Hemoglobin A1c | CPT | 83036 | 10 | $310 | $310 | $65.1 | $148.8 | 5.5× | $269.7 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 10 | $263 | $263 | $55.23 | $126.24 | 2.7× | $228.81 |
| Complete blood count with automated differential | CPT | 85025 | 10 | $168 | $168 | $35.28 | $80.64 | 3.0× | $146.16 |
| Complete blood count without differential | CPT | 85027 | 10 | $200 | $200 | $4.62 | $30.57 | 1.4× | $174 |
| Urine culture bacterial | CPT | 87086 | 10 | $263 | $263 | $55.23 | $126.24 | 5.4× | $228.81 |
| Urine culture identification | CPT | 87088 | 10 | $189 | $189 | $39.69 | $90.72 | 4.1× | $164.43 |
| Tissue exam by pathologist level IV | CPT | 88305 | 10 | $510 | $510 | $107.1 | $244.8 | 2.4× | $443.7 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 10 | $893 | $893 | $187.53 | $428.64 | 2.3× | $776.91 |
| Cesarean section w CC/MCC | MS-DRG | 765 | 1 | — | — | $3,553.21 | $3,553.21 | 39.4× | $3,553.21 |
| Cesarean section w/o CC/MCC | MS-DRG | 766 | 1 | — | — | $3,553.21 | $3,553.21 | 39.4× | $3,553.21 |
| Vaginal delivery w complicating dx | MS-DRG | 774 | 1 | — | — | $3,553.21 | $3,553.21 | 38.6× | $3,553.21 |
| Vaginal delivery w/o complicating dx | MS-DRG | 775 | 1 | — | — | $3,553.21 | $3,553.21 | 3.8× | $3,553.21 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 10 | $1,859 | $1,859 | $82 | $557.7 | 0.61× | $1,617.33 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 10 | $2,741 | $2,741 | $82 | $822.3 | 0.85× | $2,384.67 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 10 | $1,092 | $1,092 | $82 | $327.6 | 0.39× | $950.04 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 10 | $1,334 | $1,334 | $82 | $400.2 | 0.45× | $1,160.58 |
| Colonoscopy diagnostic | CPT | 45378 | 10 | $3,045 | $3,045 | $82 | $913.5 | 1.0× | $2,649.15 |
| Colonoscopy with biopsy | CPT | 45380 | 10 | $3,633 | $3,633 | $82 | $1,089.9 | 0.90× | $3,160.71 |
| Colonoscopy with polyp removal | CPT | 45385 | 10 | $4,095 | $4,095 | $82 | $1,228.5 | 1.0× | $3,562.65 |
| surgery |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 1 | — | — | $3,553.21 | $3,553.21 | 0.13× | $3,553.21 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 1 | — | — | $3,553.21 | $3,553.21 | 0.19× | $3,553.21 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 1 | — | — | $3,553.21 | $3,553.21 | 0.08× | $3,553.21 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 1 | — | — | $3,553.21 | $3,553.21 | 0.15× | $3,553.21 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 1 | — | — | $3,553.21 | $3,553.21 | 0.22× | $3,553.21 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 1 | — | — | $3,553.21 | $3,553.21 | 0.22× | $3,553.21 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 1 | — | — | $3,553.21 | $3,553.21 | 0.26× | $3,553.21 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 1 | — | — | $3,553.21 | $3,553.21 | 0.11× | $3,553.21 |
| Laparoscopic appendectomy | CPT | 44970 | 10 | $4,883 | $4,883 | $82 | $1,464.9 | 0.94× | $11,730 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 1 | — | — | $3,553.21 | $3,553.21 | 0.07× | $3,553.21 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 1 | — | — | $3,553.21 | $3,553.21 | 0.11× | $3,553.21 |
| Major joint replacement w MCC | MS-DRG | 469 | 1 | — | — | $3,553.21 | $3,553.21 | 0.12× | $3,553.21 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 1 | — | — | $3,553.21 | $3,553.21 | 0.19× | $3,553.21 |
| Laparoscopic cholecystectomy | CPT | 47562 | 10 | $5,817 | $5,817 | $82 | $1,745.1 | 0.98× | $11,730 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 1 | — | — | $9,970 | $10,850 | 5.8× | $11,730 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 1 | — | — | $3,553.21 | $3,553.21 | 0.13× | $3,553.21 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 1 | — | — | $3,553.21 | $3,553.21 | 0.17× | $3,553.21 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 1 | — | — | $3,553.21 | $3,553.21 | 0.22× | $3,553.21 |
| Lap inguinal hernia repair | CPT | 49650 | 10 | $4,494 | $4,494 | $82 | $1,348.2 | 1.2× | $11,730 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 1 | — | — | $9,970 | $10,850 | 7.3× | $11,730 |
| Lap salpingo-oophorectomy | CPT | 58661 | 1 | — | — | $9,970 | $10,850 | 5.3× | $11,730 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 1 | — | — | $3,553.21 | $3,553.21 | 0.13× | $3,553.21 |
| OR procedure for obesity w CC | MS-DRG | 620 | 1 | — | — | $3,553.21 | $3,553.21 | 0.22× | $3,553.21 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 1 | — | — | $3,553.21 | $3,553.21 | 0.23× | $3,553.21 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 2 | — | — | $3,553.21 | $10,337 | 0.84× | $11,830 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 1 | — | — | $3,553.21 | $3,553.21 | 0.19× | $3,553.21 |