| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 9 | $189 | $113.4 | $26.99 | $101.15 | 0.57× | $165.24 |
| Psychiatric eval with medical services | CPT | 90792 | 9 | $213 | $127.8 | $30.42 | $101.15 | 0.58× | $186.23 |
| emergency |
| ED visit level 1 | CPT | 99281 | 9 | $111 | $66.6 | $15.85 | $55.43 | 0.40× | $97.05 |
| ED visit level 2 | CPT | 99282 | 9 | $254 | $152.4 | $36.27 | $99.69 | 0.42× | $222.07 |
| ED visit level 3 | CPT | 99283 | 9 | $488 | $292.8 | $69.69 | $174.31 | 0.43× | $426.66 |
| ED visit level 4 | CPT | 99284 | 9 | $3,079 | $1,847.4 | $268.07 | $439.68 | 0.66× | $2,691.97 |
| ED visit level 5 | CPT | 99285 | 9 | $5,248 | $3,148.8 | $279.6 | $749.41 | 0.72× | $4,588.33 |
| Critical care, first hour | CPT | 99291 | 5 | $467 | $280.2 | $157.68 | $195.02 | 0.18× | $222.29 |
| imaging |
| CT head without contrast | CPT | 70450 | 9 | $2,821 | $1,692.6 | $66.94 | $402.84 | 1.9× | $2,115.75 |
| CT head with contrast | CPT | 70460 | 9 | $3,088 | $1,852.8 | $112.07 | $440.97 | 1.9× | $2,316 |
| CT head with and without contrast | CPT | 70470 | 9 | $4,386 | $2,631.6 | $112.07 | $542 | 2.0× | $3,289.5 |
| CT neck with contrast | CPT | 70491 | 9 | $3,936 | $2,361.6 | $112.07 | $542 | 2.0× | $2,952 |
| MRI brain without contrast | CPT | 70551 | 9 | $6,272 | $3,763.2 | $152.17 | $760 | 1.9× | $4,704 |
| MRI brain with contrast | CPT | 70552 | 9 | $7,065 | $4,239 | $224.83 | $760 | 1.6× | $5,298.75 |
| MRI brain with and without contrast | CPT | 70553 | 9 | $9,015 | $5,409 | $224.83 | $760 | 1.3× | $6,761.25 |
| Chest X-ray single view | CPT | 71045 | 9 | $431 | $258.6 | $55.43 | $61.55 | 0.65× | $376.82 |
| Chest X-ray 2 views | CPT | 71046 | 9 | $504 | $302.4 | $55.43 | $71.97 | 0.73× | $440.65 |
| CT chest without contrast | CPT | 71250 | 9 | $3,467 | $2,080.2 | $66.94 | $495.09 | 2.3× | $2,600.25 |
| CT chest with contrast | CPT | 71260 | 9 | $4,746 | $2,847.6 | $112.07 | $542 | 1.9× | $3,559.5 |
| CT chest with and without contrast | CPT | 71270 | 9 | $5,674 | $3,404.4 | $112.07 | $542 | 1.9× | $4,255.5 |
| MRI chest with and without contrast | CPT | 71552 | 9 | $6,272 | $3,763.2 | $224.83 | $760 | 1.3× | $4,704 |
| Lumbosacral spine X-ray | CPT | 72100 | 9 | $583 | $349.8 | $66.94 | $83.25 | 0.80× | $509.72 |
| CT cervical spine without contrast | CPT | 72125 | 9 | $4,203 | $2,521.8 | $66.94 | $542 | 2.7× | $3,152.25 |
| CT thoracic spine without contrast | CPT | 72128 | 9 | $4,278 | $2,566.8 | $66.94 | $542 | 2.7× | $3,208.5 |
| CT lumbar spine without contrast | CPT | 72131 | 9 | $3,982 | $2,389.2 | $66.94 | $542 | 2.7× | $2,986.5 |
| MRI cervical spine without contrast | CPT | 72141 | 9 | $5,862 | $3,517.2 | $152.17 | $760 | 1.9× | $4,396.5 |
| MRI thoracic spine without contrast | CPT | 72146 | 9 | $6,272 | $3,763.2 | $152.17 | $760 | 2.0× | $4,704 |
| MRI lumbar spine without contrast | CPT | 72148 | 9 | $5,849 | $3,509.4 | $152.17 | $760 | 2.0× | $4,386.75 |
| MRI cervical spine with and without contrast | CPT | 72156 | 9 | $9,528 | $5,716.8 | $224.83 | $760 | 1.4× | $7,146 |
| MRI lumbar spine with contrast | CPT | 72158 | 9 | $7,193 | $4,315.8 | $224.83 | $760 | 1.4× | $5,394.75 |
| CT pelvis without contrast | CPT | 72192 | 9 | $3,329 | $1,997.4 | $66.94 | $475.38 | 2.4× | $2,496.75 |
| CT pelvis with contrast | CPT | 72193 | 9 | $4,613 | $2,767.8 | $112.07 | $542 | 1.9× | $3,459.75 |
| Shoulder X-ray | CPT | 73030 | 9 | $1,008 | $604.8 | $55.43 | $143.94 | 1.5× | $881.29 |
| Humerus X-ray | CPT | 73060 | 9 | $1,008 | $604.8 | $55.43 | $143.94 | 1.6× | $881.29 |
| Hand X-ray 3 views | CPT | 73130 | 9 | $1,010 | $606 | $55.43 | $144.23 | 1.6× | $883.04 |
| MRI upper extremity joint without contrast | CPT | 73221 | 9 | $5,862 | $3,517.2 | $152.17 | $760 | 1.8× | $4,396.5 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 9 | $6,272 | $3,763.2 | $224.83 | $760 | 1.2× | $4,704 |
| Knee X-ray 1-2 views | CPT | 73560 | 9 | $940 | $564 | $55.43 | $134.23 | 1.4× | $821.84 |
| Ankle X-ray 3 views | CPT | 73610 | 9 | $1,070 | $642 | $55.43 | $152.8 | 1.7× | $935.5 |
| MRI lower extremity joint without contrast | CPT | 73721 | 9 | $5,862 | $3,517.2 | $152.17 | $760 | 1.6× | $4,396.5 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 9 | $6,272 | $3,763.2 | $224.83 | $760 | 1.2× | $4,704 |
| CT abdomen without contrast | CPT | 74150 | 9 | $3,003 | $1,801.8 | $66.94 | $428.83 | 2.3× | $2,252.25 |
| CT abdomen with contrast | CPT | 74160 | 9 | $3,701 | $2,220.6 | $112.07 | $528.5 | 1.8× | $2,775.75 |
| CT abdomen with and without contrast | CPT | 74170 | 9 | $4,418 | $2,650.8 | $112.07 | $542 | 1.6× | $3,313.5 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 9 | $6,328 | $3,796.8 | $152.17 | $542 | 1.5× | $4,746 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 9 | $8,312 | $4,987.2 | $224.83 | $542 | 0.99× | $6,234 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 9 | $10,155 | $6,093 | $224.83 | $542 | 0.94× | $7,616.25 |
| MRI abdomen without contrast | CPT | 74181 | 9 | $4,883 | $2,929.8 | $152.17 | $697.29 | 1.8× | $3,662.25 |
| MRI abdomen with and without contrast | CPT | 74183 | 9 | $5,225 | $3,135 | $224.83 | $746.13 | 1.3× | $3,918.75 |
| Abdominal ultrasound complete | CPT | 76700 | 9 | $1,687 | $1,012.2 | $66.94 | $240.9 | 1.6× | $1,474.94 |
| Abdominal ultrasound limited | CPT | 76705 | 9 | $1,027 | $616.2 | $66.94 | $146.66 | 1.0× | $897.91 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 9 | $897 | $538.2 | $66.94 | $128.09 | 0.89× | $784.25 |
| Obstetric ultrasound first trimester | CPT | 76801 | 9 | $1,465 | $879 | $66.94 | $209.2 | 1.5× | $1,280.85 |
| Transvaginal ultrasound | CPT | 76830 | 9 | $1,604 | $962.4 | $66.94 | $229.05 | 1.6× | $1,402.38 |
| Pelvic ultrasound complete | CPT | 76856 | 9 | $1,408 | $844.8 | $66.94 | $201.06 | 1.4× | $1,231.01 |
| Scrotal ultrasound | CPT | 76870 | 9 | $1,604 | $962.4 | $66.94 | $229.05 | 1.7× | $1,402.38 |
| Diagnostic mammography unilateral | CPT | 77065 | 9 | $482 | $289.2 | $68.83 | $76.62 | 0.51× | $361.5 |
| Diagnostic mammography bilateral | CPT | 77066 | 9 | $964 | $578.4 | $98.3 | $120 | 0.63× | $723 |
| Screening mammography bilateral | CPT | 77067 | 9 | $398 | $238.8 | $56.83 | $81.07 | 0.51× | $298.5 |
| EKG complete | CPT | 93000 | 6 | $228 | $136.8 | $32.56 | $76.24 | 3.1× | $199.34 |
| EKG tracing only | CPT | 93005 | 9 | $391 | $234.6 | $15.28 | $55.83 | 0.47× | $341.85 |
| EKG interpretation only | CPT | 93010 | 5 | $72 | $43.2 | $8.1 | $8.1 | 0.45× | $9.93 |
| Transthoracic echocardiogram complete | CPT | 93306 | 9 | $3,393 | $2,035.8 | $65.61 | $345.17 | 0.58× | $2,966.5 |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 8 | — | — | $12,147 | $13,497 | 0.87× | $21,924 |
| COPD w MCC | MS-DRG | 190 | 8 | — | — | $8,610.23 | $9,566.92 | 0.85× | $15,541 |
| COPD w CC | MS-DRG | 191 | 8 | — | — | $6,552.69 | $7,280.77 | 0.83× | $11,827 |
| COPD w/o CC/MCC | MS-DRG | 192 | 8 | — | — | $4,990.31 | $5,544.79 | 0.79× | $9,007.07 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 8 | — | — | $6,264.31 | $6,960.35 | 0.82× | $11,307 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 8 | — | — | $4,885.37 | $5,428.19 | 0.81× | $8,817.67 |
| AMI discharged alive w MCC | MS-DRG | 280 | 8 | — | — | $12,469 | $13,854 | 0.88× | $22,505 |
| AMI discharged alive w CC | MS-DRG | 281 | 8 | — | — | $7,144.22 | $7,938.03 | 0.82× | $12,895 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 8 | — | — | $5,620.7 | $6,245.23 | 0.80× | $10,145 |
| Heart failure & shock w MCC | MS-DRG | 291 | 8 | — | — | $9,979.06 | $11,088 | 0.87× | $18,011 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 8 | — | — | $9,358.77 | $10,399 | 0.86× | $16,892 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 8 | — | — | $5,718.64 | $6,354.05 | 0.82× | $10,322 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 8 | — | — | $4,400.33 | $4,889.26 | 0.79× | $7,942.22 |
| GI hemorrhage w CC | MS-DRG | 378 | 8 | — | — | $7,623.05 | $8,470.05 | 0.85× | $13,759 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 8 | — | — | $4,900.14 | $5,444.6 | 0.80× | $8,844.33 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 8 | — | — | $6,059.88 | $6,733.2 | 0.84× | $10,938 |
| Kidney/UTI w MCC | MS-DRG | 689 | 8 | — | — | $9,019.09 | $10,021 | 0.86× | $16,279 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 8 | — | — | $6,292.3 | $6,991.44 | 0.84× | $11,357 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 8 | — | — | $15,099 | $16,777 | 0.90× | $27,253 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 8 | — | — | $7,954.18 | $8,837.98 | 0.85× | $14,357 |
| Initial hospital care, low complexity | CPT | 99221 | 5 | $162 | $97.2 | $51.66 | $72.79 | 0.78× | $100.2 |
| Initial hospital care, moderate complexity | CPT | 99222 | 5 | $222 | $133.2 | $85.6 | $114.33 | 0.68× | $135.34 |
| Initial hospital care, high complexity | CPT | 99223 | 5 | $321 | $192.6 | $119.25 | $152.94 | 0.68× | $200.4 |
| Hospital discharge, <30 min | CPT | 99238 | 5 | $152 | $91.2 | $53.44 | $72.54 | 0.85× | $72.54 |
| Hospital discharge, >30 min | CPT | 99239 | 5 | $198 | $118.8 | $72.89 | $103.34 | 0.85× | $105.42 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 9 | $240 | $144 | $5.69 | $8.46 | 0.26× | $209.83 |
| Electrolyte panel | CPT | 80051 | 9 | $192 | $115.2 | $4.75 | $7.01 | 0.29× | $167.87 |
| Comprehensive metabolic panel | CPT | 80053 | 9 | $248 | $148.8 | $7.15 | $10.56 | 0.24× | $216.83 |
| Lipid panel | CPT | 80061 | 9 | $351 | $210.6 | $9.68 | $13.39 | 0.35× | $306.88 |
| Renal function panel | CPT | 80069 | 9 | $338 | $202.8 | $5.69 | $8.68 | 0.32× | $295.51 |
| Hepatic function panel | CPT | 80076 | 9 | $298 | $178.8 | $5.69 | $8.17 | 0.31× | $260.54 |
| Urinalysis non-automated | CPT | 81002 | 9 | $60 | $36 | $2.05 | $3.48 | 0.50× | $52.46 |
| Urinalysis automated | CPT | 81003 | 9 | $90 | $54 | $1.91 | $2.25 | 0.16× | $78.69 |
| Glucose quantitative | CPT | 82947 | 9 | $194 | $116.4 | $3.34 | $3.93 | 0.22× | $169.61 |
| Hemoglobin A1c | CPT | 83036 | 9 | $118 | $70.8 | $8.25 | $9.71 | 0.36× | $103.17 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 9 | $265 | $159 | $14.28 | $16.8 | 0.36× | $231.69 |
| Complete blood count with automated differential | CPT | 85025 | 9 | $120 | $72 | $6.61 | $7.77 | 0.29× | $104.92 |
| Complete blood count without differential | CPT | 85027 | 9 | $92 | $55.2 | $5.5 | $6.47 | 0.30× | $80.44 |
| Urine culture bacterial | CPT | 87086 | 9 | $202 | $121.2 | $6.86 | $8.07 | 0.35× | $176.61 |
| Tissue exam by pathologist level IV | CPT | 88305 | 9 | $184 | $110.4 | $33.64 | $36.09 | 0.35× | $160.87 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 9 | $646 | $387.6 | $10.57 | $40.23 | 0.47× | $564.8 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 9 | $857 | $514.2 | $15.28 | $69.96 | 0.57× | $749.28 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 9 | $1,104 | $662.4 | $25.99 | $114.34 | 0.66× | $965.23 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 9 | $1,454 | $872.4 | $33.42 | $166.51 | 0.75× | $1,271.23 |
| Office visit, established patient, 5 min | CPT | 99211 | 6 | $453 | $271.8 | $8.14 | $57.26 | 0.89× | $396.06 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 9 | $646 | $387.6 | $10.57 | $30.41 | 0.38× | $564.8 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 9 | $857 | $514.2 | $10.57 | $56.25 | 0.49× | $749.28 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 9 | $1,104 | $662.4 | $15.57 | $82.78 | 0.54× | $965.23 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 9 | $1,454 | $872.4 | $21.99 | $122.82 | 0.65× | $1,271.23 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 5 | $5,821 | $3,492.6 | $1,143.49 | $1,245.94 | 0.30× | $1,688.91 |
| Total hip replacement | CPT | 27130 | 5 | $6,679 | $4,007.4 | $1,112.92 | $1,112.92 | 0.26× | $1,573.95 |
| Total knee replacement | CPT | 27447 | 5 | $6,291 | $3,774.6 | $1,110.51 | $1,110.51 | 0.27× | $1,573.57 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 5 | $3,158 | $1,894.8 | $143.32 | $143.32 | 0.44× | $610.22 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 5 | $3,440 | $2,064 | $787.23 | $931.56 | 0.28× | $1,218.18 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 5 | $3,268 | $1,960.8 | $487.5 | $487.5 | 0.24× | $620.42 |
| ACL reconstruction | CPT | 29888 | 5 | $5,479 | $3,287.4 | $849.01 | $849.01 | 0.25× | $1,137.77 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 8 | — | — | $35,729 | $39,699 | 0.92× | $64,488 |
| Major joint replacement w MCC | MS-DRG | 469 | 8 | — | — | $23,577 | $26,197 | 0.89× | $42,555 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 8 | — | — | $22,638 | $25,153 | 0.90× | $40,859 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 8 | — | — | $16,281 | $18,090 | 0.89× | $29,385 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 8 | — | — | $12,678 | $14,087 | 0.88× | $22,882 |