| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 10 | $260 | $156 | $44.2 | $44.86 | 0.25× | $228.8 |
| Psychiatric eval with medical services | CPT | 90792 | 10 | $270 | $162 | $45.9 | $46.59 | 0.27× | $237.6 |
| Psychotherapy 30 minutes | CPT | 90832 | 10 | $170 | $102 | $28.9 | $29.34 | 0.20× | $149.6 |
| Psychotherapy 45 minutes | CPT | 90834 | 10 | $230 | $138 | $39.1 | $39.69 | 0.25× | $202.4 |
| Psychotherapy 60 minutes | CPT | 90837 | 10 | $310 | $186 | $52.7 | $53.49 | 0.28× | $272.8 |
| emergency |
| ED visit level 1 | CPT | 99281 | 10 | $236 | $141.6 | $40.12 | $40.72 | 0.29× | $207.68 |
| ED visit level 2 | CPT | 99282 | 10 | $465 | $279 | $79.05 | $80.24 | 0.34× | $409.2 |
| ED visit level 3 | CPT | 99283 | 10 | $630 | $378 | $107.1 | $108.71 | 0.27× | $554.4 |
| ED visit level 4 | CPT | 99284 | 10 | $2,909 | $1,745.4 | $494.53 | $501.95 | 0.75× | $2,559.92 |
| ED visit level 5 | CPT | 99285 | 10 | $4,960 | $2,976 | $314.33 | $847.42 | 0.81× | $4,364.8 |
| imaging |
| CT head without contrast | CPT | 70450 | 10 | $3,011 | $1,806.6 | $511.87 | $516.99 | 2.5× | $2,649.68 |
| CT head with contrast | CPT | 70460 | 10 | $2,629 | $1,577.4 | $446.93 | $451.4 | 1.9× | $2,313.52 |
| CT head with and without contrast | CPT | 70470 | 10 | $3,734 | $2,240.4 | $542 | $641.13 | 2.4× | $3,285.92 |
| CT neck with contrast | CPT | 70491 | 10 | $3,446 | $2,067.6 | $542 | $591.68 | 2.2× | $3,032.48 |
| MRI brain without contrast | CPT | 70551 | 10 | $5,342 | $3,205.2 | $760 | $917.22 | 2.3× | $4,700.96 |
| MRI brain with contrast | CPT | 70552 | 10 | $6,005 | $3,603 | $760 | $1,031.06 | 2.2× | $5,284.4 |
| MRI brain with and without contrast | CPT | 70553 | 10 | $7,671 | $4,602.6 | $760 | $1,317.11 | 2.2× | $6,750.48 |
| Chest X-ray single view | CPT | 71045 | 10 | $356 | $213.6 | $60.52 | $61.43 | 0.65× | $313.28 |
| Chest X-ray 2 views | CPT | 71046 | 10 | $421 | $252.6 | $71.57 | $72.65 | 0.74× | $370.48 |
| Chest X-ray 3 views | CPT | 71047 | 10 | $648 | $388.8 | $110.16 | $111.81 | 1.2× | $570.24 |
| CT chest without contrast | CPT | 71250 | 10 | $3,353 | $2,011.8 | $542 | $575.71 | 2.7× | $2,950.64 |
| CT chest with contrast | CPT | 71260 | 10 | $4,038 | $2,422.8 | $542 | $693.32 | 2.5× | $3,553.44 |
| CT chest with and without contrast | CPT | 71270 | 10 | $4,833 | $2,899.8 | $542 | $829.83 | 2.8× | $4,253.04 |
| Lumbosacral spine X-ray | CPT | 72100 | 10 | $580 | $348 | $98.6 | $100.08 | 0.97× | $510.4 |
| CT cervical spine without contrast | CPT | 72125 | 10 | $4,229 | $2,537.4 | $542 | $726.12 | 3.6× | $3,721.52 |
| CT thoracic spine without contrast | CPT | 72128 | 10 | $3,745 | $2,247 | $542 | $643.02 | 3.2× | $3,295.6 |
| CT lumbar spine without contrast | CPT | 72131 | 10 | $3,481 | $2,088.6 | $45.18 | $597.69 | 2.9× | $3,063.28 |
| MRI cervical spine without contrast | CPT | 72141 | 10 | $5,087 | $3,052.2 | $760 | $873.44 | 2.2× | $4,476.56 |
| MRI thoracic spine without contrast | CPT | 72146 | 10 | $5,342 | $3,205.2 | $760 | $917.22 | 2.5× | $4,700.96 |
| MRI lumbar spine without contrast | CPT | 72148 | 10 | $5,089 | $3,053.4 | $760 | $873.78 | 2.3× | $4,478.32 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 10 | $5,231 | $3,138.6 | $760 | $898.16 | 2.0× | $4,603.28 |
| MRI cervical spine with and without contrast | CPT | 72156 | 10 | $8,108 | $4,864.8 | $760 | $1,392.14 | 2.6× | $7,135.04 |
| MRI lumbar spine with contrast | CPT | 72158 | 10 | $6,258 | $3,754.8 | $760 | $1,074.5 | 2.0× | $5,507.04 |
| CT pelvis without contrast | CPT | 72192 | 10 | $2,834 | $1,700.4 | $481.78 | $486.6 | 2.4× | $2,493.92 |
| CT pelvis with contrast | CPT | 72193 | 10 | $3,929 | $2,357.4 | $542 | $674.61 | 2.4× | $3,457.52 |
| Shoulder X-ray | CPT | 73030 | 10 | $986 | $591.6 | $83.47 | $169.3 | 1.8× | $867.68 |
| Humerus X-ray | CPT | 73060 | 10 | $491 | $294.6 | $83.47 | $84.72 | 0.95× | $432.08 |
| Hand X-ray 3 views | CPT | 73130 | 10 | $1,000 | $600 | $85.17 | $171.7 | 1.8× | $880 |
| MRI upper extremity joint without contrast | CPT | 73221 | 10 | $5,122 | $3,073.2 | $760 | $879.45 | 2.1× | $4,507.36 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 10 | $4,753 | $2,851.8 | $760 | $816.09 | 1.3× | $4,182.64 |
| Knee X-ray 1-2 views | CPT | 73560 | 10 | $985 | $591 | $83.47 | $169.12 | 1.8× | $866.8 |
| Ankle X-ray 3 views | CPT | 73610 | 10 | $1,058 | $634.8 | $89.93 | $181.66 | 2.0× | $931.04 |
| MRI lower extremity joint without contrast | CPT | 73721 | 10 | $5,122 | $3,073.2 | $760 | $879.45 | 1.9× | $4,507.36 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 10 | $4,820 | $2,892 | $760 | $827.59 | 1.3× | $4,241.6 |
| CT abdomen without contrast | CPT | 74150 | 10 | $2,555 | $1,533 | $434.35 | $438.69 | 2.3× | $2,248.4 |
| CT abdomen with contrast | CPT | 74160 | 10 | $3,154 | $1,892.4 | $536.18 | $541.54 | 1.9× | $2,775.52 |
| CT abdomen with and without contrast | CPT | 74170 | 10 | $3,761 | $2,256.6 | $542 | $645.76 | 1.9× | $3,309.68 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 10 | $5,488 | $3,292.8 | $542 | $942.29 | 2.6× | $4,829.44 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 10 | $7,079 | $4,247.4 | $542 | $1,215.46 | 2.2× | $6,229.52 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 10 | $8,784 | $5,270.4 | $542 | $1,508.21 | 2.6× | $7,729.92 |
| MRI abdomen without contrast | CPT | 74181 | 10 | $4,233 | $2,539.8 | $719.61 | $726.81 | 1.9× | $3,725.04 |
| MRI abdomen with and without contrast | CPT | 74183 | 10 | $4,445 | $2,667 | $755.65 | $763.21 | 1.3× | $3,911.6 |
| Abdominal ultrasound complete | CPT | 76700 | 10 | $1,546 | $927.6 | $262.82 | $266.77 | 1.8× | $1,360.48 |
| Abdominal ultrasound limited | CPT | 76705 | 10 | $1,107 | $664.2 | $188.19 | $191.01 | 1.3× | $974.16 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 10 | $969 | $581.4 | $164.73 | $167.2 | 1.2× | $852.72 |
| Obstetric ultrasound first trimester | CPT | 76801 | 10 | $1,349 | $809.4 | $229.33 | $232.77 | 1.6× | $1,187.12 |
| Transvaginal ultrasound | CPT | 76830 | 10 | $1,464 | $878.4 | $248.88 | $252.62 | 1.7× | $1,288.32 |
| Pelvic ultrasound complete | CPT | 76856 | 10 | $1,531 | $918.6 | $260.27 | $264.18 | 1.8× | $1,347.28 |
| Scrotal ultrasound | CPT | 76870 | 10 | $1,512 | $907.2 | $257.04 | $260.9 | 2.0× | $1,330.56 |
| Diagnostic mammography unilateral | CPT | 77065 | 10 | $471 | $282.6 | $80.07 | $80.87 | 0.54× | $414.48 |
| Diagnostic mammography bilateral | CPT | 77066 | 10 | $946 | $567.6 | $120 | $162.43 | 0.85× | $832.48 |
| Screening mammography bilateral | CPT | 77067 | 10 | $634 | $380.4 | $8.5 | $54.43 | 0.35× | $557.92 |
| EKG tracing only | CPT | 93005 | 10 | $397 | $238.2 | $67.49 | $68.5 | 0.58× | $349.36 |
| Transthoracic echocardiogram complete | CPT | 93306 | 10 | $3,961 | $2,376.6 | $673.37 | $683.47 | 1.1× | $3,485.68 |
| Transthoracic echocardiogram | CPT | 93307 | 10 | $736 | $441.6 | $125.12 | $127 | 0.51× | $647.68 |
| Stress echocardiogram | CPT | 93350 | 10 | $4,115 | $2,469 | $699.55 | $710.05 | 1.4× | $3,621.2 |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 1 | — | — | $20,828 | $21,376 | 1.4× | $21,924 |
| COPD w MCC | MS-DRG | 190 | 1 | — | — | $14,764 | $15,152 | 1.3× | $15,541 |
| COPD w CC | MS-DRG | 191 | 1 | — | — | $11,236 | $11,531 | 1.3× | $11,827 |
| COPD w/o CC/MCC | MS-DRG | 192 | 1 | — | — | $8,556.72 | $8,781.9 | 1.3× | $9,007.07 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 1 | — | — | $10,741 | $11,024 | 1.3× | $11,307 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 1 | — | — | $8,376.79 | $8,597.23 | 1.3× | $8,817.67 |
| AMI discharged alive w MCC | MS-DRG | 280 | 1 | — | — | $21,380 | $21,942 | 1.4× | $22,505 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 1 | — | — | $9,637.64 | $9,891.26 | 1.3× | $10,145 |
| Heart failure & shock w MCC | MS-DRG | 291 | 1 | — | — | $17,111 | $17,561 | 1.4× | $18,011 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 1 | — | — | $7,543.77 | $7,742.3 | 1.2× | $7,940.82 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 1 | — | — | $16,047 | $16,469 | 1.4× | $16,892 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 1 | — | — | $9,805.57 | $10,064 | 1.3× | $10,322 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 1 | — | — | $7,545.11 | $7,743.67 | 1.2× | $7,942.22 |
| GI hemorrhage w CC | MS-DRG | 378 | 1 | — | — | $13,071 | $13,415 | 1.3× | $13,759 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 1 | — | — | $8,402.11 | $8,623.22 | 1.3× | $8,844.33 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 1 | — | — | $10,391 | $10,664 | 1.3× | $10,938 |
| Kidney/UTI w MCC | MS-DRG | 689 | 1 | — | — | $15,465 | $15,872 | 1.4× | $16,279 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 1 | — | — | $10,789 | $11,073 | 1.3× | $11,357 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 1 | — | — | $25,890 | $26,571 | 1.4× | $27,253 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 1 | — | — | $13,639 | $13,998 | 1.3× | $14,357 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 10 | $175 | $105 | $8.46 | $30.05 | 0.93× | $154 |
| Electrolyte panel | CPT | 80051 | 10 | $139 | $83.4 | $7.01 | $23.87 | 1.0× | $122.32 |
| Comprehensive metabolic panel | CPT | 80053 | 10 | $205 | $123 | $10.56 | $35.2 | 0.79× | $180.4 |
| Lipid panel | CPT | 80061 | 10 | $292 | $175.2 | $13.39 | $50.14 | 1.3× | $256.96 |
| Renal function panel | CPT | 80069 | 10 | $254 | $152.4 | $8.68 | $43.61 | 1.6× | $223.52 |
| Hepatic function panel | CPT | 80076 | 10 | $226 | $135.6 | $8.17 | $38.8 | 1.5× | $198.88 |
| Urinalysis non-automated | CPT | 81002 | 10 | $23 | $13.8 | $3.48 | $3.95 | 0.57× | $20.24 |
| Urinalysis automated | CPT | 81003 | 10 | $41 | $24.6 | $2.25 | $7.04 | 0.51× | $36.08 |
| Glucose quantitative | CPT | 82947 | 10 | $163 | $97.8 | $3.93 | $27.99 | 1.6× | $143.44 |
| Hemoglobin A1c | CPT | 83036 | 10 | $95 | $57 | $4.29 | $16.25 | 0.60× | $83.6 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 10 | $218 | $130.8 | $16.8 | $37.43 | 0.79× | $191.84 |
| Complete blood count with automated differential | CPT | 85025 | 10 | $96 | $57.6 | $7.77 | $16.48 | 0.62× | $84.48 |
| Complete blood count without differential | CPT | 85027 | 10 | $76 | $45.6 | $6.47 | $13.05 | 0.60× | $66.88 |
| Urine culture bacterial | CPT | 87086 | 10 | $151 | $90.6 | $8.07 | $25.93 | 1.1× | $132.88 |
| Tissue exam by pathologist level IV | CPT | 88305 | 10 | $169 | $101.4 | $28.73 | $29.16 | 0.28× | $148.72 |
| maternity |
| Vaginal delivery only | CPT | 59409 | 10 | $5,641 | $3,384.6 | $958.97 | $973.36 | 0.44× | $4,964.08 |
| office |
| Office visit, established patient, 5 min | CPT | 99211 | 10 | $689 | $413.4 | $80.92 | $118.3 | 1.8× | $606.32 |