| behavioral |
| Psychoses | MS-DRG | 885 | 9 | $28,872 | $4,619.49 | $9,939.39 | $9,939.39 | $21,701 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 19 | $305 | $48.8 | $122.11 | $169.86 | $305 |
| Psychiatric eval with medical services | CPT | 90792 | 19 | $462.55 | $74.01 | $118.7 | $200.27 | $462.55 |
| Psychotherapy 30 minutes | CPT | 90832 | 26 | $233 | $37.28 | $30.99 | $92.65 | $208.3 |
| Psychotherapy 45 minutes | CPT | 90834 | 26 | $476 | $76.16 | $63.31 | $150.81 | $425.54 |
| Psychotherapy 60 minutes | CPT | 90837 | 26 | $594 | $95.04 | $79 | $181.34 | $531.04 |
| emergency |
| ED visit level 1 | CPT | 99281 | 26 | $481 | $76.96 | $11.33 | $86.15 | $430.01 |
| ED visit level 2 | CPT | 99282 | 26 | $828 | $132.48 | $28.88 | $72.67 | $740.23 |
| ED visit level 3 | CPT | 99283 | 26 | $1,518 | $242.88 | $49.16 | $111.91 | $1,357.09 |
| ED visit level 4 | CPT | 99284 | 26 | $2,372 | $379.52 | $83.69 | $206.6 | $2,120.57 |
| ED visit level 5 | CPT | 99285 | 26 | $17,000 | $2,720 | $121.28 | $1,855.57 | $15,198 |
| Critical care, first hour | CPT | 99291 | 26 | $7,063 | $1,130.08 | $145.5 | $415.48 | $6,314.32 |
| imaging |
| CT head without contrast | CPT | 70450 | 22 | $3,077 | $492.32 | $53.41 | $106.81 | $2,750.84 |
| CT head with contrast | CPT | 70460 | 22 | $4,030 | $644.8 | $179.2 | $926.09 | $3,602.82 |
| CT head with and without contrast | CPT | 70470 | 22 | $3,859 | $617.44 | $179.2 | $886.8 | $3,449.95 |
| CT neck with contrast | CPT | 70491 | 22 | $3,464 | $554.24 | $179.2 | $796.03 | $3,096.82 |
| MRI brain without contrast | CPT | 70551 | 26 | $5,450 | $872 | $116.92 | $243.77 | $4,872.3 |
| MRI brain with contrast | CPT | 70552 | 22 | $4,923 | $787.68 | $356.43 | $1,189.89 | $4,401.16 |
| MRI brain with and without contrast | CPT | 70553 | 26 | $7,118 | $1,138.88 | $178.22 | $305.33 | $6,474.8 |
| Chest X-ray single view | CPT | 71045 | 26 | $746 | $119.36 | $10.98 | $35.56 | $666.92 |
| Chest X-ray 2 views | CPT | 71046 | 26 | $931 | $148.96 | $14.74 | $35.56 | $832.31 |
| CT chest without contrast | CPT | 71250 | 22 | $3,143 | $502.88 | $53.41 | $106.81 | $2,809.84 |
| CT chest with contrast | CPT | 71260 | 22 | $3,698 | $591.68 | $179.2 | $849.8 | $3,306.01 |
| MRI chest without contrast | CPT | 71550 | 22 | $5,800 | $928 | $243.77 | $1,401.86 | $5,185.2 |
| MRI chest with and without contrast | CPT | 71552 | 22 | $6,056 | $968.96 | $356.43 | $1,463.74 | $5,414.06 |
| Lumbosacral spine X-ray | CPT | 72100 | 26 | $1,080 | $172.8 | $14.35 | $42.72 | $965.52 |
| CT cervical spine without contrast | CPT | 72125 | 22 | $3,655 | $584.8 | $106.81 | $839.92 | $3,267.57 |
| CT thoracic spine without contrast | CPT | 72128 | 22 | $3,010 | $481.6 | $106.81 | $691.7 | $2,690.94 |
| CT lumbar spine without contrast | CPT | 72131 | 22 | $3,246 | $519.36 | $106.81 | $745.93 | $2,901.92 |
| MRI cervical spine without contrast | CPT | 72141 | 22 | $5,401 | $864.16 | $243.77 | $1,760.73 | $4,828.49 |
| MRI thoracic spine without contrast | CPT | 72146 | 22 | $4,848 | $775.68 | $121.89 | $1,071.9 | $4,334.11 |
| MRI lumbar spine without contrast | CPT | 72148 | 26 | $5,116 | $818.56 | $112.96 | $243.77 | $4,573.7 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 22 | $7,031 | $1,124.96 | $356.43 | $1,699.39 | $6,285.71 |
| MRI cervical spine with and without contrast | CPT | 72156 | 22 | $6,096 | $975.36 | $356.43 | $1,473.4 | $5,449.82 |
| MRI lumbar spine with contrast | CPT | 72158 | 22 | $6,647 | $1,063.52 | $356.43 | $1,606.58 | $5,942.42 |
| CT pelvis without contrast | CPT | 72192 | 22 | $2,850 | $456 | $106.81 | $654.93 | $2,547.9 |
| CT pelvis with contrast | CPT | 72193 | 22 | $3,852 | $616.32 | $179.2 | $885.19 | $3,443.69 |
| Shoulder X-ray | CPT | 73030 | 26 | $1,740 | $278.4 | $11.26 | $47.89 | $1,555.56 |
| Humerus X-ray | CPT | 73060 | 26 | $870 | $139.2 | $10.3 | $35.76 | $777.78 |
| Hand X-ray 3 views | CPT | 73130 | 26 | $1,598 | $255.68 | $11.98 | $58.41 | $1,428.61 |
| MRI upper extremity joint without contrast | CPT | 73221 | 22 | $4,919 | $787.04 | $121.89 | $243.77 | $4,397.59 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 22 | $8,497 | $1,359.52 | $356.43 | $2,053.72 | $7,596.32 |
| Knee X-ray 1-2 views | CPT | 73560 | 26 | $1,774 | $283.84 | $11.03 | $50.62 | $1,585.96 |
| Ankle X-ray 3 views | CPT | 73610 | 26 | $1,774 | $283.84 | $14.35 | $40.41 | $897.64 |
| MRI lower extremity joint without contrast | CPT | 73721 | 26 | $4,629 | $740.64 | $121.89 | $243.77 | $4,138.33 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 22 | $6,786 | $1,085.76 | $178.22 | $356.43 | $6,066.68 |
| CT abdomen without contrast | CPT | 74150 | 22 | $2,925 | $468 | $106.81 | $672.17 | $2,614.95 |
| CT abdomen with contrast | CPT | 74160 | 22 | $3,721 | $595.36 | $179.2 | $855.08 | $3,326.57 |
| CT abdomen with and without contrast | CPT | 74170 | 22 | $4,363 | $698.08 | $179.2 | $1,002.62 | $3,900.52 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 22 | $6,225 | $996 | $121.89 | $243.77 | $5,565.15 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 22 | $7,819 | $1,251.04 | $178.22 | $356.43 | $6,990.19 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 22 | $9,479 | $1,516.64 | $356.43 | $2,178.28 | $8,474.23 |
| MRI abdomen without contrast | CPT | 74181 | 22 | $4,499 | $719.84 | $121.89 | $243.77 | $4,022.11 |
| MRI abdomen with and without contrast | CPT | 74183 | 22 | $7,213 | $1,154.08 | $178.22 | $356.43 | $6,448.42 |
| Abdominal ultrasound complete | CPT | 76700 | 22 | $2,956 | $472.96 | $106.81 | $714.47 | $2,642.66 |
| Abdominal ultrasound limited | CPT | 76705 | 26 | $2,283 | $365.28 | $81.23 | $108.95 | $2,041 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 26 | $2,896 | $463.36 | $53.41 | $106.81 | $2,589.02 |
| Obstetric ultrasound first trimester | CPT | 76801 | 26 | $2,533 | $405.28 | $76.12 | $110.85 | $2,264.5 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 26 | $2,660 | $425.6 | $87.72 | $128.14 | $2,378.04 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 26 | $4,244 | $679.04 | $115.79 | $243.77 | $3,794.14 |
| Transvaginal ultrasound | CPT | 76830 | 26 | $1,384 | $221.44 | $38.38 | $110.59 | $1,237.3 |
| Pelvic ultrasound complete | CPT | 76856 | 26 | $1,982 | $317.12 | $35.95 | $102.47 | $1,771.91 |
| Scrotal ultrasound | CPT | 76870 | 22 | $1,625 | $260 | $106.81 | $392.77 | $1,452.75 |
| Diagnostic mammography unilateral | CPT | 77065 | 20 | $1,592 | $254.72 | $105.87 | $511.83 | $1,423.25 |
| Diagnostic mammography bilateral | CPT | 77066 | 20 | $1,986 | $317.76 | $132.07 | $499.48 | $1,290.9 |
| Screening mammography bilateral | CPT | 77067 | 26 | $832 | $133.12 | $66.3 | $162.31 | $743.81 |
| EKG complete | CPT | 93000 | 19 | $128.7 | $20.59 | $14.74 | $26.28 | $128.7 |
| EKG tracing only | CPT | 93005 | 26 | $581 | $92.96 | $6.62 | $24.11 | $519.41 |
| EKG interpretation only | CPT | 93010 | 19 | $85.3 | $13.65 | $8.33 | $13.87 | $85.3 |
| Transthoracic echocardiogram complete | CPT | 93306 | 26 | $4,849 | $775.84 | $126.93 | $558.25 | $4,335.01 |
| Transthoracic echocardiogram | CPT | 93307 | 26 | $2,145 | $343.2 | $91 | $243.77 | $1,917.63 |
| Stress echocardiogram | CPT | 93350 | 26 | $5,180 | $828.8 | $163.7 | $367.69 | $4,630.92 |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 12 | $93,936 | $15,030 | $14,310 | $14,310 | $40,447 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 12 | $72,471 | $11,595 | $7,189.12 | $7,189.12 | $20,320 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 12 | $60,813 | $9,730.11 | $4,870.07 | $4,870.07 | $13,765 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 12 | $90,653 | $14,504 | $11,120 | $11,120 | $31,431 |
| COPD w MCC | MS-DRG | 190 | 12 | $52,186 | $8,349.75 | $7,882.2 | $7,882.2 | $22,279 |
| COPD w CC | MS-DRG | 191 | 12 | $60,558 | $9,689.36 | $5,998.64 | $5,998.64 | $16,955 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 12 | $45,351 | $7,256.23 | $5,734.65 | $5,734.65 | $16,209 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 12 | $28,048 | $4,487.63 | $4,472.3 | $4,472.3 | $12,641 |
| AMI discharged alive w MCC | MS-DRG | 280 | 12 | $77,866 | $12,459 | $11,415 | $11,415 | $32,263 |
| AMI discharged alive w CC | MS-DRG | 281 | 12 | $61,105 | $9,776.85 | $6,540.16 | $6,540.16 | $18,486 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 12 | $54,865 | $8,778.33 | $5,145.46 | $5,145.46 | $14,544 |
| Heart failure & shock w MCC | MS-DRG | 291 | 12 | $63,025 | $10,084 | $9,135.3 | $9,135.3 | $25,821 |
| Heart failure & shock w CC | MS-DRG | 292 | 12 | $54,967 | $8,794.69 | $6,041.34 | $6,041.34 | $17,076 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 12 | $59,038 | $9,446.02 | $8,567.46 | $8,567.46 | $24,216 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 12 | $44,157 | $7,065.16 | $5,235.12 | $5,235.12 | $14,797 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 12 | $33,675 | $5,387.96 | $4,028.27 | $4,028.27 | $11,386 |
| GI hemorrhage w CC | MS-DRG | 378 | 12 | $61,864 | $9,898.24 | $6,978.49 | $6,978.49 | $19,725 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 12 | $42,557 | $6,809.2 | $5,547.5 | $5,547.5 | $15,680 |
| Kidney/UTI w MCC | MS-DRG | 689 | 12 | $53,654 | $8,584.65 | $8,256.5 | $8,256.5 | $23,337 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 12 | $49,845 | $7,975.27 | $5,760.26 | $5,760.26 | $16,281 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 12 | $100,917 | $16,147 | $13,822 | $13,822 | $39,070 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 12 | $54,540 | $8,726.39 | $7,281.63 | $7,281.63 | $20,582 |
| Initial hospital care, low complexity | CPT | 99221 | 19 | $305.8 | $48.93 | $61.76 | $76.86 | $305.8 |
| Initial hospital care, moderate complexity | CPT | 99222 | 19 | $414.15 | $66.26 | $88.82 | $119.28 | $414.15 |
| Initial hospital care, high complexity | CPT | 99223 | 19 | $606.55 | $97.05 | $121.97 | $158.96 | $606.55 |
| Hospital discharge, <30 min | CPT | 99238 | 19 | $228.1 | $36.5 | $54.59 | $75.27 | $228.1 |
| Hospital discharge, >30 min | CPT | 99239 | 19 | $313.45 | $50.15 | $77.02 | $107 | $313.45 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 22 | $334 | $53.44 | $8.46 | $11.84 | $298.6 |
| General health panel | CPT | 80050 | 20 | $913 | $146.08 | $67.98 | $417.97 | $816.22 |
| Electrolyte panel | CPT | 80051 | 22 | $360 | $57.6 | $7.01 | $80.28 | $321.84 |
| Comprehensive metabolic panel | CPT | 80053 | 22 | $433 | $69.28 | $10.56 | $134.78 | $387.1 |
| Lipid panel | CPT | 80061 | 22 | $424 | $67.84 | $13.39 | $138.22 | $379.06 |
| Renal function panel | CPT | 80069 | 22 | $405 | $64.8 | $8.68 | $12.15 | $362.07 |
| Hepatic function panel | CPT | 80076 | 22 | $575 | $92 | $8.17 | $11.44 | $514.05 |
| Urinalysis non-automated | CPT | 81002 | 22 | $141 | $22.56 | $3.48 | $43.22 | $126.05 |
| Urinalysis automated | CPT | 81003 | 22 | $109 | $17.44 | $2.25 | $31.21 | $97.45 |
| Glucose quantitative | CPT | 82947 | 22 | $170 | $27.2 | $3.93 | $54.68 | $151.98 |
| Hemoglobin A1c | CPT | 83036 | 22 | $225 | $36 | $3.88 | $9.71 | $201.15 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 22 | $344 | $55.04 | $16.8 | $99.22 | $307.54 |
| Complete blood count with automated differential | CPT | 85025 | 22 | $201 | $32.16 | $7.77 | $15.46 | $179.69 |
| Complete blood count without differential | CPT | 85027 | 22 | $143 | $22.88 | $6.47 | $11.6 | $127.84 |
| Urine culture bacterial | CPT | 87086 | 22 | $335 | $53.6 | $8.07 | $12.11 | $299.49 |
| Tissue exam by pathologist level IV | CPT | 88305 | 22 | $699 | $111.84 | $39.64 | $261.86 | $624.91 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 26 | $823 | $131.68 | $7.9 | $59.34 | $735.76 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 19 | $6,829.85 | $1,092.78 | $1,840.25 | $2,357.58 | $6,829.85 |
| Vaginal delivery only | CPT | 59409 | 26 | $6,552 | $1,048.32 | $788.01 | $1,650.96 | $5,857.49 |
| Vaginal delivery with postpartum | CPT | 59410 | 19 | $4,524.3 | $723.89 | $924.45 | $1,061.27 | $4,524.3 |
| Routine obstetric care with C-section | CPT | 59510 | 19 | $7,964.6 | $1,274.34 | $2,046.31 | $2,659.91 | $7,964.6 |
| C-section delivery only | CPT | 59514 | 19 | $3,997.65 | $639.62 | $906.58 | $906.58 | $3,997.65 |
| C-section with postpartum | CPT | 59515 | 19 | $5,030.25 | $804.84 | $1,070.45 | $1,342.06 | $5,030.25 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 19 | $189.15 | $30.26 | $32.21 | $72.83 | $140.88 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 19 | $275.2 | $44.03 | $55.95 | $115.46 | $192.64 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 19 | $387.35 | $61.98 | $90.81 | $174.69 | $312.42 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 19 | $531.3 | $85.01 | $123.49 | $234.19 | $394.34 |
| Office visit, established patient, 5 min | CPT | 99211 | 26 | $2,750 | $440 | $7.75 | $218.07 | $2,458.5 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 26 | $1,311 | $209.76 | $22.72 | $74.63 | $1,172.03 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 19 | $184.8 | $29.57 | $44.64 | $92.64 | $142.74 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 19 | $275.2 | $44.03 | $65.79 | $132.42 | $202.96 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 19 | $367 | $58.72 | $97.69 | $188.34 | $271.51 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 26 | $5,255 | $840.8 | $112.07 | $463.32 | $4,697.97 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 26 | $5,498 | $879.68 | $125.46 | $434.53 | $4,915.21 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 26 | $1,754 | $280.64 | $54.08 | $352.36 | $1,568.08 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 26 | $4,714 | $754.24 | $67.25 | $475.05 | $4,214.32 |
| Colonoscopy diagnostic | CPT | 45378 | 26 | $5,737 | $917.92 | $168.48 | $475.05 | $5,128.88 |
| Colonoscopy with biopsy | CPT | 45380 | 26 | $5,740 | $918.4 | $181.43 | $927.96 | $5,131.56 |
| Colonoscopy with polyp removal | CPT | 45385 | 26 | $7,990 | $1,278.4 | $228.04 | $611.28 | $7,143.06 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 19 | $8,535.6 | $1,365.7 | $1,344.5 | $1,344.5 | $8,535.6 |
| Hip hemiarthroplasty | CPT | 27125 | 19 | $7,502.65 | $1,200.42 | $1,026.65 | $1,066.7 | $7,502.65 |
| Total hip replacement | CPT | 27130 | 19 | $12,830 | $2,052.73 | $1,203.83 | $1,203.83 | $12,830 |
| Total knee replacement | CPT | 27447 | 19 | $11,117 | $1,778.77 | $1,201.56 | $1,201.56 | $11,117 |
| Knee revision arthroplasty single component | CPT | 27486 | 19 | $8,872.05 | $1,419.53 | $972.13 | $1,318.23 | $8,872.05 |
| Knee revision arthroplasty all components | CPT | 27487 | 19 | $10,122 | $1,619.55 | $1,473.3 | $1,636.09 | $10,122 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 19 | $5,541.45 | $886.63 | $155.89 | $155.89 | $5,541.45 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 19 | $6,644.85 | $1,063.18 | $738.81 | $1,001.73 | $6,644.85 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 19 | $5,427.5 | $868.4 | $521.43 | $521.43 | $5,427.5 |
| ACL reconstruction | CPT | 29888 | 19 | $9,979.75 | $1,596.76 | $673.62 | $912.05 | $9,979.75 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 12 | $307,993 | $49,279 | $32,708 | $32,708 | $92,449 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 12 | $184,965 | $29,594 | $17,058 | $17,058 | $48,215 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 12 | $180,845 | $28,935 | $11,975 | $11,975 | $33,848 |
| CABG single arterial graft | CPT | 33533 | 19 | $13,130 | $2,100.83 | $1,866.78 | $1,876.52 | $13,130 |
| CABG 2 arterial grafts | CPT | 33534 | 19 | $13,352 | $2,136.38 | $2,193.7 | $2,203.41 | $13,352 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 12 | $142,855 | $22,857 | $12,037 | $12,037 | $34,023 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 12 | $150,776 | $24,124 | $9,718.8 | $9,718.8 | $27,470 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 12 | $169,685 | $27,150 | $24,244 | $24,244 | $68,527 |
| Laparoscopic appendectomy | CPT | 44970 | 19 | $3,055.5 | $488.88 | $424.25 | $606.29 | $3,055.5 |
| Major joint replacement w MCC | MS-DRG | 469 | 12 | $232,142 | $37,143 | $21,584 | $21,584 | $61,007 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 12 | $215,837 | $34,534 | $13,726 | $13,726 | $38,796 |
| Laparoscopic cholecystectomy | CPT | 47562 | 19 | $3,576.85 | $572.3 | $628.59 | $664.06 | $3,576.85 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 19 | $3,519.25 | $563.08 | $263.17 | $721.14 | $3,519.25 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 12 | $231,486 | $37,038 | $20,723 | $20,723 | $58,575 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 12 | $215,756 | $34,521 | $14,904 | $14,904 | $42,127 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 12 | $182,343 | $29,175 | $11,606 | $11,606 | $32,804 |
| Lap inguinal hernia repair | CPT | 49650 | 19 | $2,619.55 | $419.13 | $387.05 | $440.68 | $2,619.55 |
| Total abdominal hysterectomy | CPT | 58150 | 19 | $6,084.3 | $973.49 | $772.7 | $975.09 | $6,084.3 |
| Vaginal hysterectomy | CPT | 58260 | 19 | $4,928.6 | $788.58 | $725.6 | $769.48 | $4,928.6 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 19 | $5,615.55 | $898.49 | $725.6 | $817.79 | $5,615.55 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 19 | $5,207 | $833.12 | $725 | $914.56 | $5,207 |
| Lap salpingo-oophorectomy | CPT | 58661 | 19 | $4,794.8 | $767.17 | $480 | $613.58 | $4,794.8 |
| OR procedure for obesity w CC | MS-DRG | 620 | 12 | $136,081 | $21,773 | $11,387 | $11,387 | $32,187 |
| Intravitreal injection | CPT | 67028 | 19 | $1,018.5 | $162.96 | $75.37 | $110.75 | $892.23 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 12 | $93,749 | $15,000 | $8,828.61 | $8,828.61 | $24,954 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 12 | $74,293 | $11,887 | $14,581 | $14,581 | $41,214 |
| PCI single major coronary artery | CPT | 92920 | 26 | $17,838 | $2,854.08 | $366.81 | $1,215.14 | $15,947 |
| PCI with drug-eluting stent | CPT | 92928 | 26 | $23,280 | $3,724.8 | $408.11 | $1,351.14 | $20,812 |
| PCI bypass graft | CPT | 92937 | 26 | $23,555 | $3,768.8 | $408.19 | $1,350.38 | $21,058 |
| Left heart catheterization | CPT | 93452 | 22 | $16,917 | $2,706.72 | $3,312.15 | $4,928.77 | $15,124 |
| Coronary angiography with cath | CPT | 93455 | 22 | $17,803 | $2,848.48 | $3,312.15 | $5,186.91 | $15,916 |
| Coronary angiography with bypass cath | CPT | 93458 | 22 | $20,416 | $3,266.56 | $3,312.15 | $5,948.2 | $18,252 |