| behavioral |
| Psychoses | MS-DRG | 885 | 34 | — | — | $934.82 | $9,442.7 | 0.74× | $9,538.09 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 102 | $550 | $165 | $114.4 | $522.5 | 2.9× | $550 |
| emergency |
| ED visit level 1 | CPT | 99281 | 102 | $660 | $198 | $22.88 | $180 | 1.3× | $660 |
| ED visit level 2 | CPT | 99282 | 102 | $715 | $214.5 | $46.95 | $679.25 | 2.9× | $715 |
| ED visit level 3 | CPT | 99283 | 102 | $770 | $231 | $70.3 | $731.5 | 1.8× | $770 |
| ED visit level 4 | CPT | 99284 | 102 | $1,100 | $330 | $129.55 | $1,045 | 1.6× | $1,100 |
| ED visit level 5 | CPT | 99285 | 102 | $1,540 | $462 | $188.42 | $1,463 | 1.4× | $1,540 |
| Critical care, first hour | CPT | 99291 | 102 | $2,200 | $660 | $237.72 | $2,090 | 1.9× | $2,200 |
| imaging |
| CT head without contrast | CPT | 70450 | 102 | $3,450.5 | $1,035.15 | $175.58 | $3,277.98 | 15.8× | $3,450.5 |
| CT head with contrast | CPT | 70460 | 102 | $2,630.5 | $789.15 | $285.47 | $2,498.98 | 10.7× | $2,630.5 |
| CT head with and without contrast | CPT | 70470 | 102 | $4,083 | $1,224.9 | $285.47 | $3,878.85 | 14.5× | $4,083 |
| CT neck with contrast | CPT | 70491 | 102 | $2,337.5 | $701.25 | $285.47 | $2,220.63 | 8.1× | $2,337.5 |
| MRI brain without contrast | CPT | 70551 | 102 | $2,591 | $777.3 | $365.08 | $2,461.45 | 6.1× | $2,591 |
| MRI brain with contrast | CPT | 70552 | 102 | $2,310 | $693 | $480.48 | $2,194.5 | 4.6× | $2,310 |
| MRI brain with and without contrast | CPT | 70553 | 102 | $3,327.5 | $998.25 | $598.21 | $3,161.13 | 5.4× | $3,327.5 |
| Chest X-ray single view | CPT | 71045 | 102 | $103 | $30.9 | $21.42 | $103 | 1.1× | $125.03 |
| Chest X-ray 2 views | CPT | 71046 | 102 | $300 | $90 | $32.19 | $258 | 2.6× | $300 |
| Chest X-ray 3 views | CPT | 71047 | 102 | $434 | $130.2 | $40.57 | $412.3 | 4.3× | $434 |
| CT chest without contrast | CPT | 71250 | 102 | $3,067 | $920.1 | $175.58 | $2,913.65 | 13.6× | $3,067 |
| CT chest with contrast | CPT | 71260 | 102 | $3,221.5 | $966.45 | $285.47 | $3,060.43 | 10.9× | $3,221.5 |
| CT chest with and without contrast | CPT | 71270 | 102 | $4,377.5 | $1,313.25 | $285.47 | $4,158.63 | 14.3× | $4,377.5 |
| MRI chest without contrast | CPT | 71550 | 102 | $2,591 | $777.3 | $365.08 | $2,461.45 | 5.7× | $2,591 |
| MRI chest with contrast | CPT | 71551 | 102 | $2,310 | $693 | $480.48 | $2,194.5 | 2.7× | $2,310 |
| MRI chest with and without contrast | CPT | 71552 | 102 | $3,327.5 | $998.25 | $598.21 | $3,161.13 | 5.3× | $3,327.5 |
| Lumbosacral spine X-ray | CPT | 72100 | 102 | $430 | $129 | $39.52 | $408.5 | 3.9× | $430 |
| CT cervical spine without contrast | CPT | 72125 | 102 | $2,665.5 | $799.65 | $175.58 | $2,532.23 | 12.6× | $2,665.5 |
| CT thoracic spine without contrast | CPT | 72128 | 102 | $2,847.5 | $854.25 | $175.58 | $2,705.13 | 13.6× | $2,847.5 |
| CT lumbar spine without contrast | CPT | 72131 | 102 | $3,156 | $946.8 | $175.58 | $2,998.2 | 14.8× | $3,156 |
| MRI cervical spine without contrast | CPT | 72141 | 102 | $2,591 | $777.3 | $365.08 | $2,461.45 | 6.2× | $2,591 |
| MRI thoracic spine without contrast | CPT | 72146 | 102 | $2,591 | $777.3 | $365.08 | $2,461.45 | 6.6× | $2,591 |
| MRI lumbar spine without contrast | CPT | 72148 | 102 | $2,591 | $777.3 | $365.08 | $2,461.45 | 6.5× | $2,591 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 102 | $2,310 | $693 | $480.48 | $2,194.5 | 4.8× | $2,310 |
| MRI cervical spine with and without contrast | CPT | 72156 | 102 | $3,327.5 | $998.25 | $598.21 | $3,161.13 | 5.9× | $3,327.5 |
| MRI lumbar spine with contrast | CPT | 72158 | 102 | $3,327.5 | $998.25 | $598.21 | $3,161.13 | 5.8× | $3,327.5 |
| CT pelvis without contrast | CPT | 72192 | 102 | $3,279.5 | $983.85 | $175.58 | $3,115.53 | 15.6× | $3,279.5 |
| CT pelvis with contrast | CPT | 72193 | 102 | $3,735 | $1,120.5 | $285.47 | $3,548.25 | 12.6× | $3,735 |
| Shoulder X-ray | CPT | 73030 | 102 | $945 | $283.5 | $34.8 | $472.5 | 5.1× | $945 |
| Humerus X-ray | CPT | 73060 | 102 | $717 | $215.1 | $33.77 | $358.5 | 4.0× | $717 |
| Hand X-ray 3 views | CPT | 73130 | 102 | $706 | $211.8 | $38.49 | $317.7 | 3.4× | $706 |
| MRI upper extremity joint without contrast | CPT | 73221 | 102 | $1,787.5 | $536.25 | $365.08 | $1,698.13 | 4.1× | $1,787.5 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 102 | $2,574 | $772.2 | $535.39 | $2,445.3 | 4.0× | $2,574 |
| Knee X-ray 1-2 views | CPT | 73560 | 102 | $710 | $213 | $36.9 | $319.95 | 3.4× | $710 |
| Ankle X-ray 3 views | CPT | 73610 | 102 | $755 | $226.5 | $38.49 | $377.5 | 4.1× | $755 |
| MRI lower extremity joint without contrast | CPT | 73721 | 102 | $2,574 | $772.2 | $365.08 | $1,787.5 | 3.8× | $2,574 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 102 | $2,574 | $772.2 | $535.39 | $2,445.3 | 3.9× | $2,574 |
| CT abdomen without contrast | CPT | 74150 | 102 | $3,017 | $905.1 | $175.58 | $2,866.15 | 15.2× | $3,017 |
| CT abdomen with contrast | CPT | 74160 | 102 | $2,944.5 | $883.35 | $285.47 | $2,797.28 | 9.8× | $2,944.5 |
| CT abdomen with and without contrast | CPT | 74170 | 102 | $4,465 | $1,339.5 | $285.47 | $4,241.75 | 12.7× | $4,465 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 102 | $5,113.5 | $1,534.05 | $336 | $4,857.83 | 13.3× | $5,113.5 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 102 | $5,628 | $1,688.4 | $336 | $5,346.6 | 9.7× | $5,628 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 102 | $5,445 | $1,633.5 | $336 | $5,172.75 | 9.0× | $5,445 |
| MRI abdomen without contrast | CPT | 74181 | 102 | $2,591 | $777.3 | $365.08 | $2,461.45 | 6.3× | $2,591 |
| MRI abdomen with and without contrast | CPT | 74183 | 102 | $3,327.5 | $998.25 | $598.21 | $3,161.13 | 5.6× | $3,327.5 |
| Abdominal ultrasound complete | CPT | 76700 | 102 | $1,411.5 | $423.45 | $121.28 | $1,340.93 | 9.0× | $1,411.5 |
| Abdominal ultrasound limited | CPT | 76705 | 102 | $658.5 | $197.55 | $91.41 | $625.58 | 4.3× | $658.5 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 102 | $658.5 | $197.55 | $112.9 | $625.58 | 4.4× | $658.5 |
| Obstetric ultrasound first trimester | CPT | 76801 | 102 | $959 | $287.7 | $107.13 | $911.05 | 6.4× | $959 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 102 | $959 | $287.7 | $133.34 | $911.05 | 6.0× | $959 |
| Transvaginal ultrasound | CPT | 76830 | 102 | $1,157 | $347.1 | $130.72 | $1,099.15 | 7.4× | $1,157 |
| Pelvic ultrasound complete | CPT | 76856 | 102 | $1,157 | $347.1 | $111.33 | $550 | 3.8× | $1,157 |
| Scrotal ultrasound | CPT | 76870 | 102 | $783 | $234.9 | $108.18 | $743.85 | 5.7× | $783 |
| Diagnostic mammography unilateral | CPT | 77065 | 122 | $467.5 | $140.25 | $72.84 | $420.75 | 2.8× | $467.5 |
| Diagnostic mammography bilateral | CPT | 77066 | 122 | $467.5 | $140.25 | $93.46 | $420.75 | 2.2× | $467.5 |
| Screening mammography bilateral | CPT | 77067 | 125 | $412.5 | $123.75 | $77.07 | $371.25 | 2.4× | $412.5 |
| EKG tracing only | CPT | 93005 | 102 | $400 | $120 | $11.63 | $380 | 3.2× | $400 |
| Transthoracic echocardiogram complete | CPT | 93306 | 102 | $2,075 | $622.5 | $180.28 | $1,971.25 | 3.3× | $2,075 |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 34 | — | — | $934.82 | $13,595 | 0.67× | $13,732 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 34 | — | — | $934.82 | $6,829.87 | 0.64× | $6,898.86 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 34 | — | — | $934.82 | $4,626.7 | 0.61× | $4,673.44 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 34 | — | — | $934.82 | $10,564 | 0.68× | $10,671 |
| COPD w MCC | MS-DRG | 190 | 34 | — | — | $934.82 | $7,488.32 | 0.67× | $7,563.96 |
| COPD w CC | MS-DRG | 191 | 34 | — | — | $934.82 | $5,698.88 | 0.65× | $5,756.45 |
| COPD w/o CC/MCC | MS-DRG | 192 | 34 | — | — | $934.82 | $4,340.07 | 0.62× | $4,383.91 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 34 | — | — | $934.82 | $5,448.07 | 0.64× | $5,503.11 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 34 | — | — | $934.82 | $4,248.81 | 0.64× | $4,291.73 |
| AMI discharged alive w MCC | MS-DRG | 280 | 34 | — | — | $934.82 | $10,844 | 0.69× | $10,954 |
| AMI discharged alive w CC | MS-DRG | 281 | 34 | — | — | $934.82 | $6,213.33 | 0.64× | $6,276.1 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 34 | — | — | $934.82 | $4,888.33 | 0.63× | $4,937.71 |
| Heart failure & shock w MCC | MS-DRG | 291 | 34 | — | — | $934.82 | $8,678.79 | 0.68× | $8,766.46 |
| Heart failure & shock w CC | MS-DRG | 292 | 34 | — | — | $934.82 | $5,739.44 | 0.64× | $5,797.42 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 34 | — | — | $934.82 | $3,826.29 | 0.62× | $3,864.94 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 34 | — | — | $934.82 | $8,139.33 | 0.67× | $8,221.55 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 34 | — | — | $934.82 | $4,973.5 | 0.64× | $5,023.74 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 34 | — | — | $934.82 | $3,826.97 | 0.62× | $3,865.63 |
| GI hemorrhage w CC | MS-DRG | 378 | 34 | — | — | $934.82 | $6,629.76 | 0.66× | $6,696.73 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 34 | — | — | $934.82 | $4,261.65 | 0.62× | $4,304.7 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 34 | — | — | $934.82 | $5,270.28 | 0.66× | $5,323.52 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 34 | — | — | $934.82 | $10,598 | 0.70× | $10,705 |
| Kidney/UTI w MCC | MS-DRG | 689 | 34 | — | — | $934.82 | $7,843.9 | 0.68× | $7,923.14 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 34 | — | — | $934.82 | $5,472.41 | 0.66× | $5,527.69 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 34 | — | — | $934.82 | $13,132 | 0.70× | $13,264 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 34 | — | — | $934.82 | $6,917.75 | 0.67× | $6,987.63 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 125 | $256.5 | $76.95 | $8.04 | $153.9 | 4.8× | $256.5 |
| Electrolyte panel | CPT | 80051 | 125 | $271 | $81.3 | $6.66 | $162.6 | 6.8× | $271 |
| Comprehensive metabolic panel | CPT | 80053 | 125 | $262.5 | $78.75 | $10.03 | $157.5 | 3.5× | $262.5 |
| Lipid panel | CPT | 80061 | 125 | $129.5 | $38.85 | $12.05 | $73.03 | 1.9× | $129.5 |
| Renal function panel | CPT | 80069 | 125 | $305.5 | $91.65 | $8.25 | $183.3 | 6.7× | $305.5 |
| Hepatic function panel | CPT | 80076 | 125 | $380 | $114 | $7.76 | $228 | 8.6× | $380 |
| Urinalysis non-automated | CPT | 81002 | 125 | $129.5 | $38.85 | $3.21 | $77.7 | 11.2× | $129.5 |
| Urinalysis automated | CPT | 81003 | 125 | $129.5 | $38.85 | $2.14 | $14.5 | 1.0× | $129.5 |
| Glucose quantitative | CPT | 82947 | 125 | $124 | $37.2 | $3.73 | $74.4 | 4.2× | $124 |
| Hemoglobin A1c | CPT | 83036 | 125 | $192.5 | $57.75 | $9.22 | $115.5 | 4.3× | $192.5 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 125 | $115 | $34.5 | $15.96 | $69 | 1.5× | $115 |
| Complete blood count with automated differential | CPT | 85025 | 125 | $129.5 | $38.85 | $7.38 | $77.7 | 2.9× | $129.5 |
| Complete blood count without differential | CPT | 85027 | 125 | $129.5 | $38.85 | $6.15 | $77.7 | 3.6× | $129.5 |
| Urine culture bacterial | CPT | 87086 | 125 | $294.5 | $88.35 | $7.67 | $176.7 | 7.6× | $294.5 |
| Tissue exam by pathologist level IV | CPT | 88305 | 105 | $80 | $24 | $16.64 | $72 | 0.70× | $80 |
| maternity |
| Vaginal delivery only | CPT | 59409 | 102 | $5,895 | $1,768.5 | $1,097.78 | $5,305.5 | 2.4× | $5,895 |
| Cesarean section w CC/MCC | MS-DRG | 765 | 27 | — | — | $934.82 | $8,037.17 | 89.1× | $8,037.17 |
| Cesarean section w/o CC/MCC | MS-DRG | 766 | 27 | — | — | $934.82 | $5,716.16 | 63.4× | $5,716.16 |
| Vaginal delivery w complicating dx | MS-DRG | 774 | 27 | — | — | $934.82 | $5,670.41 | 61.6× | $5,670.41 |
| Vaginal delivery w/o complicating dx | MS-DRG | 775 | 27 | — | — | $934.82 | $4,407.13 | 4.7× | $4,407.13 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 16 | $2,207.5 | $662.25 | $187.4 | $349.65 | 0.38× | $1,300 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 16 | $2,207.5 | $662.25 | $211.18 | $468.3 | 0.49× | $1,520 |
| Colonoscopy diagnostic | CPT | 45378 | 16 | $2,857.5 | $857.25 | $284.23 | $468.3 | 0.53× | $1,520 |
| Colonoscopy with biopsy | CPT | 45380 | 16 | $2,857.5 | $857.25 | $307.13 | $468.3 | 0.39× | $1,573.21 |
| Colonoscopy with polyp removal | CPT | 45385 | 16 | $2,857.5 | $857.25 | $390.21 | $468.3 | 0.39× | $1,573.21 |
| surgery |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 27 | — | — | $934.82 | $20,454 | 0.74× | $20,454 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 27 | — | — | $934.82 | $13,039 | 0.71× | $13,039 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 34 | — | — | $934.82 | $31,073 | 0.72× | $31,387 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 34 | — | — | $934.82 | $16,206 | 0.70× | $16,369 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 34 | — | — | $934.82 | $11,377 | 0.69× | $11,492 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 34 | — | — | $934.82 | $11,436 | 0.69× | $11,551 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 34 | — | — | $934.82 | $9,233.13 | 0.68× | $9,326.4 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 34 | — | — | $934.82 | $23,033 | 0.71× | $23,265 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 27 | — | — | $934.82 | $45,289 | 0.92× | $45,289 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 27 | — | — | $934.82 | $24,978 | 0.74× | $24,978 |
| Major joint replacement w MCC | MS-DRG | 469 | 34 | — | — | $934.82 | $20,505 | 0.69× | $20,712 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 34 | — | — | $934.82 | $13,040 | 0.69× | $13,172 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 34 | — | — | $934.82 | $19,688 | 0.70× | $19,887 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 34 | — | — | $934.82 | $14,159 | 0.70× | $14,302 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 34 | — | — | $934.82 | $11,026 | 0.69× | $11,137 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 34 | — | — | $934.82 | $19,520 | 0.72× | $19,717 |
| OR procedure for obesity w CC | MS-DRG | 620 | 34 | — | — | $934.82 | $10,818 | 0.67× | $10,928 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 34 | — | — | $934.82 | $10,197 | 0.67× | $10,300 |
| Cataract surgery with lens implant | CPT | 66984 | 15 | $4,235 | $1,270.5 | $864.15 | $947.57 | 0.43× | $4,600 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 34 | — | — | $934.82 | $8,387.42 | 0.68× | $8,472.15 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 34 | — | — | $934.82 | $13,852 | 0.72× | $13,992 |
| PCI single major coronary artery | CPT | 92920 | 102 | $51,454 | $15,436 | $740.54 | $48,882 | 8.6× | $51,454 |
| PCI with drug-eluting stent | CPT | 92928 | 102 | $70,764 | $21,229 | $823.84 | $34,853 | 3.5× | $70,764 |
| PCI bypass graft | CPT | 92937 | 102 | $17,512 | $5,253.6 | $822.94 | $16,636 | 1.5× | $17,512 |
| Left heart catheterization | CPT | 93452 | 102 | $13,983 | $4,194.75 | $726.37 | $12,584 | 4.1× | $13,983 |
| Coronary angiography with cath | CPT | 93455 | 102 | $4,599 | $1,379.7 | $816.97 | $4,301.92 | 1.4× | $4,599 |
| Coronary angiography with bypass cath | CPT | 93458 | 102 | $17,708 | $5,312.25 | $832.58 | $15,937 | 5.1× | $17,708 |