| behavioral |
| Psychoses | MS-DRG | 885 | 8 | — | — | $970.66 | $12,064 | 0.94× | $12,064 |
| emergency |
| ED visit level 1 | CPT | 99281 | 10 | $111 | $66.6 | $32.19 | $65.72 | 0.47× | $825 |
| ED visit level 2 | CPT | 99282 | 10 | $254 | $152.4 | $73.66 | $118.2 | 0.50× | $825 |
| ED visit level 3 | CPT | 99283 | 10 | $488 | $292.8 | $141.52 | $206.66 | 0.51× | $825 |
| ED visit level 4 | CPT | 99284 | 10 | $3,079 | $1,847.4 | $74.05 | $317.82 | 0.48× | $2,691.97 |
| ED visit level 5 | CPT | 99285 | 10 | $5,248 | $3,148.8 | $457.6 | $1,178.17 | 1.1× | $4,588.33 |
| Critical care, first hour | CPT | 99291 | 6 | $467 | $280.2 | $195.02 | $195.02 | 0.18× | $321.78 |
| imaging |
| CT head without contrast | CPT | 70450 | 10 | $2,821 | $1,692.6 | $61.83 | $474 | 2.3× | $1,692.6 |
| CT head with contrast | CPT | 70460 | 10 | $3,088 | $1,852.8 | $88.45 | $474 | 2.0× | $1,852.8 |
| CT head with and without contrast | CPT | 70470 | 10 | $4,386 | $2,631.6 | $106.5 | $474 | 1.8× | $2,631.6 |
| CT neck with contrast | CPT | 70491 | 10 | $3,936 | $2,361.6 | $111.82 | $474 | 1.7× | $2,361.6 |
| MRI brain without contrast | CPT | 70551 | 10 | $6,272 | $3,763.2 | $118.63 | $663 | 1.6× | $3,763.2 |
| MRI brain with contrast | CPT | 70552 | 10 | $7,065 | $4,239 | $175.43 | $663 | 1.4× | $4,239 |
| MRI brain with and without contrast | CPT | 70553 | 10 | $9,015 | $5,409 | $198.8 | $663 | 1.1× | $5,409 |
| Chest X-ray single view | CPT | 71045 | 10 | $431 | $258.6 | $15.38 | $124.99 | 1.3× | $285.41 |
| Chest X-ray 2 views | CPT | 71046 | 10 | $504 | $302.4 | $20.71 | $146.16 | 1.5× | $333.75 |
| CT chest without contrast | CPT | 71250 | 10 | $3,467 | $2,080.2 | $76.92 | $474 | 2.2× | $2,080.2 |
| CT chest with contrast | CPT | 71260 | 10 | $4,746 | $2,847.6 | $104.43 | $474 | 1.7× | $2,847.6 |
| CT chest with and without contrast | CPT | 71270 | 10 | $5,674 | $3,404.4 | $128.69 | $474 | 1.6× | $3,404.4 |
| MRI chest without contrast | CPT | 71550 | 10 | $6,272 | $3,763.2 | $180.41 | $663 | 1.5× | $3,763.2 |
| Lumbosacral spine X-ray | CPT | 72100 | 10 | $583 | $349.8 | $26.03 | $169.07 | 1.6× | $386.06 |
| CT cervical spine without contrast | CPT | 72125 | 10 | $4,203 | $2,521.8 | $77.51 | $474 | 2.4× | $2,521.8 |
| CT thoracic spine without contrast | CPT | 72128 | 10 | $4,278 | $2,566.8 | $77.51 | $474 | 2.4× | $2,566.8 |
| CT lumbar spine without contrast | CPT | 72131 | 10 | $3,982 | $2,389.2 | $76.92 | $474 | 2.3× | $2,389.2 |
| MRI cervical spine without contrast | CPT | 72141 | 10 | $5,862 | $3,517.2 | $113.6 | $663 | 1.7× | $3,517.2 |
| MRI thoracic spine without contrast | CPT | 72146 | 10 | $6,272 | $3,763.2 | $113.6 | $663 | 1.8× | $3,763.2 |
| MRI lumbar spine without contrast | CPT | 72148 | 10 | $5,849 | $3,509.4 | $114.19 | $663 | 1.8× | $3,509.4 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 10 | $6,003 | $3,601.8 | $175.43 | $663 | 1.5× | $3,601.8 |
| MRI cervical spine with and without contrast | CPT | 72156 | 10 | $9,528 | $5,716.8 | $200.28 | $663 | 1.2× | $5,716.8 |
| MRI lumbar spine with contrast | CPT | 72158 | 10 | $7,193 | $4,315.8 | $199.68 | $663 | 1.2× | $4,315.8 |
| CT pelvis without contrast | CPT | 72192 | 10 | $3,329 | $1,997.4 | $76.62 | $474 | 2.4× | $1,997.4 |
| CT pelvis with contrast | CPT | 72193 | 10 | $4,613 | $2,767.8 | $132.87 | $474 | 1.7× | $2,767.8 |
| Shoulder X-ray | CPT | 73030 | 10 | $1,008 | $604.8 | $22.78 | $224.28 | 2.4× | $667.5 |
| Humerus X-ray | CPT | 73060 | 10 | $1,008 | $604.8 | $21.59 | $224.28 | 2.5× | $667.5 |
| Hand X-ray 3 views | CPT | 73130 | 10 | $1,010 | $606 | $25.44 | $224.73 | 2.4× | $668.82 |
| MRI upper extremity joint without contrast | CPT | 73221 | 10 | $5,862 | $3,517.2 | $129.87 | $663 | 1.6× | $3,517.2 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 10 | $6,272 | $3,763.2 | $266.55 | $663 | 1.1× | $3,763.2 |
| Knee X-ray 1-2 views | CPT | 73560 | 10 | $940 | $564 | $23.37 | $208.71 | 2.2× | $622.47 |
| Ankle X-ray 3 views | CPT | 73610 | 10 | $1,070 | $642 | $25.44 | $237.63 | 2.6× | $708.55 |
| MRI lower extremity joint without contrast | CPT | 73721 | 10 | $11,724 | $7,034.4 | $129.87 | $1,716.98 | 3.7× | $7,034.4 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 10 | $6,272 | $3,763.2 | $266.55 | $663 | 1.0× | $3,763.2 |
| CT abdomen without contrast | CPT | 74150 | 10 | $3,003 | $1,801.8 | $75.73 | $474 | 2.5× | $1,801.8 |
| CT abdomen with contrast | CPT | 74160 | 10 | $3,701 | $2,220.6 | $132.87 | $474 | 1.7× | $2,220.6 |
| CT abdomen with and without contrast | CPT | 74170 | 10 | $4,418 | $2,650.8 | $132.87 | $474 | 1.4× | $2,650.8 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 10 | $6,328 | $3,796.8 | $94.96 | $474 | 1.3× | $3,796.8 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 10 | $8,312 | $4,987.2 | $205.31 | $474 | 0.86× | $4,987.2 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 10 | $10,155 | $6,093 | $231.64 | $474 | 0.82× | $6,093 |
| MRI abdomen without contrast | CPT | 74181 | 10 | $4,883 | $2,929.8 | $120.11 | $663 | 1.7× | $2,929.8 |
| MRI abdomen with and without contrast | CPT | 74183 | 10 | $5,225 | $3,135 | $222.17 | $663 | 1.2× | $3,135 |
| Abdominal ultrasound complete | CPT | 76700 | 10 | $1,687 | $1,012.2 | $70.11 | $489.23 | 3.3× | $1,117.13 |
| Abdominal ultrasound limited | CPT | 76705 | 10 | $1,027 | $616.2 | $53.55 | $297.83 | 2.0× | $680.08 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 10 | $897 | $538.2 | $65.97 | $260.13 | 1.8× | $593.99 |
| Obstetric ultrasound first trimester | CPT | 76801 | 10 | $1,465 | $879 | $63.31 | $424.85 | 3.0× | $970.12 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 10 | $2,161 | $1,296.6 | $76.62 | $626.69 | 2.7× | $1,431.01 |
| Transvaginal ultrasound | CPT | 76830 | 10 | $1,604 | $962.4 | $77.51 | $465.16 | 3.1× | $1,062.17 |
| Pelvic ultrasound complete | CPT | 76856 | 10 | $1,408 | $844.8 | $65.08 | $408.32 | 2.9× | $932.38 |
| Scrotal ultrasound | CPT | 76870 | 10 | $1,604 | $962.4 | $63.01 | $465.16 | 3.5× | $1,062.17 |
| Diagnostic mammography unilateral | CPT | 77065 | 10 | $482 | $289.2 | $36.71 | $76.62 | 0.51× | $289.2 |
| Diagnostic mammography bilateral | CPT | 77066 | 10 | $964 | $578.4 | $98.3 | $104 | 0.55× | $578.4 |
| Screening mammography bilateral | CPT | 77067 | 10 | $398 | $238.8 | $81.07 | $104 | 0.66× | $238.8 |
| EKG complete | CPT | 93000 | 7 | $228 | $136.8 | $66.12 | $101.46 | 4.1× | $158 |
| EKG tracing only | CPT | 93005 | 10 | $391 | $234.6 | $31.03 | $63.77 | 0.54× | $270.96 |
| EKG interpretation only | CPT | 93010 | 10 | $83 | $49.8 | $8.1 | $11.44 | 0.63× | $57.52 |
| Transthoracic echocardiogram complete | CPT | 93306 | 10 | $3,393 | $2,035.8 | $65.61 | $409.24 | 0.68× | $2,351.35 |
| Transthoracic echocardiogram | CPT | 93307 | 6 | $236.5 | $141.9 | $41.88 | $41.88 | 0.17× | $157.16 |
| Stress echocardiogram | CPT | 93350 | 10 | $663 | $397.8 | $65.61 | $295.04 | 0.58× | $459.46 |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 8 | — | — | $10,729 | $13,497 | 0.87× | $19,609 |
| COPD w MCC | MS-DRG | 190 | 8 | — | — | $6,969.68 | $9,566.92 | 0.85× | $13,900 |
| COPD w CC | MS-DRG | 191 | 8 | — | — | $5,369.57 | $7,280.77 | 0.83× | $10,578 |
| COPD w/o CC/MCC | MS-DRG | 192 | 8 | — | — | $4,059.11 | $5,544.79 | 0.79× | $8,055.91 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 8 | — | — | $5,200.07 | $6,960.35 | 0.82× | $10,113 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 8 | — | — | $3,956.66 | $5,428.19 | 0.81× | $7,886.51 |
| AMI discharged alive w MCC | MS-DRG | 280 | 8 | — | — | $10,034 | $13,854 | 0.88× | $20,128 |
| AMI discharged alive w CC | MS-DRG | 281 | 8 | — | — | $5,774.34 | $7,938.03 | 0.82× | $11,533 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 8 | — | — | $4,541.68 | $6,245.23 | 0.80× | $9,073.56 |
| Heart failure & shock w MCC | MS-DRG | 291 | 8 | — | — | $8,120.13 | $11,088 | 0.87× | $16,109 |
| Heart failure & shock w CC | MS-DRG | 292 | 8 | — | — | $5,417 | $7,332.59 | 0.82× | $10,653 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 8 | — | — | $3,551.25 | $4,888.39 | 0.79× | $7,102.25 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 8 | — | — | $7,603.41 | $10,399 | 0.86× | $15,108 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 8 | — | — | $4,709.91 | $6,354.05 | 0.82× | $9,231.67 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 8 | — | — | $3,497.49 | $4,889.26 | 0.79× | $7,103.5 |
| GI hemorrhage w CC | MS-DRG | 378 | 8 | — | — | $6,222.12 | $8,470.05 | 0.85× | $12,306 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 8 | — | — | $4,004.72 | $5,444.6 | 0.80× | $7,910.35 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 8 | — | — | $4,968.59 | $6,733.2 | 0.84× | $9,782.53 |
| Kidney/UTI w MCC | MS-DRG | 689 | 8 | — | — | $7,427.58 | $10,021 | 0.86× | $14,560 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 8 | — | — | $5,103.3 | $6,991.44 | 0.84× | $10,158 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 8 | — | — | $12,539 | $16,777 | 0.90× | $24,375 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 8 | — | — | $6,513.68 | $8,837.98 | 0.85× | $12,841 |
| Initial hospital care, low complexity | CPT | 99221 | 6 | $162 | $97.2 | $51.66 | $72.79 | 0.78× | $120.1 |
| Initial hospital care, moderate complexity | CPT | 99222 | 6 | $222 | $133.2 | $85.6 | $114.33 | 0.68× | $188.64 |
| Initial hospital care, high complexity | CPT | 99223 | 6 | $321 | $192.6 | $119.25 | $152.94 | 0.68× | $252.35 |
| Hospital discharge, <30 min | CPT | 99238 | 6 | $152 | $91.2 | $53.44 | $72.54 | 0.85× | $119.69 |
| Hospital discharge, >30 min | CPT | 99239 | 6 | $198 | $118.8 | $72.89 | $103.34 | 0.85× | $170.51 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 10 | $240 | $144 | $5.69 | $8.46 | 0.26× | $158.93 |
| Electrolyte panel | CPT | 80051 | 10 | $192 | $115.2 | $4.75 | $7.01 | 0.29× | $127.14 |
| Comprehensive metabolic panel | CPT | 80053 | 10 | $248 | $148.8 | $7.15 | $10.56 | 0.24× | $164.23 |
| Lipid panel | CPT | 80061 | 10 | $351 | $210.6 | $9.68 | $13.39 | 0.35× | $232.43 |
| Renal function panel | CPT | 80069 | 10 | $338 | $202.8 | $5.69 | $8.68 | 0.32× | $223.82 |
| Hepatic function panel | CPT | 80076 | 10 | $298 | $178.8 | $5.69 | $8.17 | 0.31× | $197.34 |
| Urinalysis non-automated | CPT | 81002 | 10 | $60 | $36 | $2.05 | $3.48 | 0.50× | $39.73 |
| Urinalysis automated | CPT | 81003 | 10 | $90 | $54 | $1.91 | $2.25 | 0.16× | $59.6 |
| Glucose quantitative | CPT | 82947 | 10 | $194 | $116.4 | $3.34 | $3.93 | 0.22× | $128.47 |
| Hemoglobin A1c | CPT | 83036 | 10 | $118 | $70.8 | $8.25 | $9.71 | 0.36× | $78.14 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 10 | $265 | $159 | $14.28 | $16.8 | 0.36× | $175.48 |
| Complete blood count with automated differential | CPT | 85025 | 10 | $120 | $72 | $6.61 | $7.77 | 0.29× | $79.46 |
| Complete blood count without differential | CPT | 85027 | 10 | $92 | $55.2 | $5.5 | $6.47 | 0.30× | $60.92 |
| Urine culture bacterial | CPT | 87086 | 10 | $202 | $121.2 | $6.86 | $8.07 | 0.35× | $133.76 |
| Tissue exam by pathologist level IV | CPT | 88305 | 10 | $184 | $110.4 | $30.77 | $39.88 | 0.39× | $121.84 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 10 | $394 | $236.4 | $114.26 | $150.15 | 0.80× | $273.04 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 10 | $151 | $90.6 | $21.46 | $40.23 | 0.47× | $66.38 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 10 | $224 | $134.4 | $31.03 | $69.96 | 0.57× | $115.43 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 10 | $341 | $204.6 | $52.78 | $114.34 | 0.66× | $188.66 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 10 | $391 | $234.6 | $67.86 | $143.29 | 0.65× | $258.37 |
| Office visit, established patient, 5 min | CPT | 99211 | 10 | $689 | $413.4 | $7.54 | $33.97 | 0.53× | $477.48 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 10 | $123 | $73.8 | $21.46 | $30.41 | 0.38× | $51.28 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 10 | $857 | $514.2 | $21.46 | $56.25 | 0.49× | $593.9 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 10 | $226 | $135.6 | $31.61 | $79.16 | 0.52× | $136.59 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 10 | $257 | $154.2 | $44.66 | $98.39 | 0.52× | $202.65 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 6 | $1,039 | $623.4 | $106.59 | $106.59 | 0.12× | $175.87 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 6 | $983 | $589.8 | $119.33 | $119.33 | 0.12× | $196.89 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 6 | $315 | $189 | $51.2 | $51.2 | 0.06× | $84.48 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 6 | $436 | $261.6 | $63.94 | $63.94 | 0.07× | $105.5 |
| Colonoscopy diagnostic | CPT | 45378 | 6 | $1,242 | $745.2 | $159.33 | $159.33 | 0.18× | $324.55 |
| Colonoscopy with biopsy | CPT | 45380 | 6 | $1,412 | $847.2 | $172.05 | $172.05 | 0.14× | $415.51 |
| Colonoscopy with polyp removal | CPT | 45385 | 6 | $1,731 | $1,038.6 | $216.7 | $216.7 | 0.18× | $435.84 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 6 | $5,821 | $3,492.6 | $1,143.49 | $1,245.94 | 0.30× | $2,055.8 |
| Total hip replacement | CPT | 27130 | 6 | $6,679 | $4,007.4 | $1,112.92 | $1,112.92 | 0.26× | $1,836.32 |
| Total knee replacement | CPT | 27447 | 6 | $6,291 | $3,774.6 | $1,110.51 | $1,110.51 | 0.27× | $1,832.34 |
| Knee revision arthroplasty single component | CPT | 27486 | 6 | $5,639 | $3,383.4 | $1,162.27 | $1,219.57 | 0.73× | $2,012.29 |
| Knee revision arthroplasty all components | CPT | 27487 | 6 | $7,534 | $4,520.4 | $1,510.09 | $1,510.09 | 0.75× | $2,491.65 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 6 | $3,158 | $1,894.8 | $143.32 | $143.32 | 0.44× | $610.22 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 6 | $3,440 | $2,064 | $787.23 | $931.56 | 0.28× | $1,537.07 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 6 | $3,268 | $1,960.8 | $487.5 | $487.5 | 0.24× | $804.38 |
| ACL reconstruction | CPT | 29888 | 6 | $5,479 | $3,287.4 | $849.01 | $849.01 | 0.25× | $1,400.87 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 8 | — | — | $28,567 | $39,699 | 0.92× | $57,678 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 8 | — | — | $15,003 | $20,704 | 0.89× | $30,080 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 8 | — | — | $10,575 | $14,535 | 0.89× | $21,117 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 8 | — | — | $10,339 | $14,610 | 0.89× | $21,226 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 8 | — | — | $8,305.44 | $11,796 | 0.87× | $17,138 |
| Open appendectomy | CPT | 44950 | 6 | $1,775 | $1,065 | $443.78 | $581.83 | 0.51× | $960.02 |
| Laparoscopic appendectomy | CPT | 44970 | 6 | $2,331 | $1,398.6 | $395.19 | $552.95 | 0.35× | $912.37 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 8 | — | — | $11,901 | $16,659 | 0.88× | $24,204 |
| Laparoscopic cholecystectomy | CPT | 47562 | 6 | $3,046 | $1,827.6 | $522.64 | $604.97 | 0.34× | $998.2 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 6 | $3,367 | $2,020.2 | $562.24 | $655.67 | 0.35× | $1,081.86 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 8 | — | — | $18,651 | $25,153 | 0.90× | $36,544 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 8 | — | — | $13,123 | $18,090 | 0.89× | $26,282 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 8 | — | — | $10,046 | $14,087 | 0.88× | $20,466 |
| Lap inguinal hernia repair | CPT | 49650 | 6 | $1,872 | $1,123.2 | $302.13 | $403.51 | 0.36× | $665.79 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 8 | — | — | $7,349.16 | $10,716 | 0.87× | $15,568 |
| PCI single major coronary artery | CPT | 92920 | 10 | $15,289 | $9,173.4 | $377.86 | $4,255.45 | 0.75× | $10,595 |
| PCI with drug-eluting stent | CPT | 92928 | 10 | $23,213 | $13,928 | $452.83 | $8,464.28 | 0.84× | $16,087 |
| PCI bypass graft | CPT | 92937 | 10 | $23,213 | $13,928 | $482.77 | $8,464.28 | 0.78× | $16,087 |
| Coronary angiography with cath | CPT | 93455 | 10 | $16,517 | $9,910.2 | $263.03 | $2,400.64 | 0.77× | $10,938 |
| Coronary angiography with bypass cath | CPT | 93458 | 10 | $23,902 | $14,341 | $277.92 | $2,400.64 | 0.77× | $14,341 |