| behavioral |
| Psychotherapy 30 minutes | CPT | 90832 | 6 | $484 | $179.08 | $2.33 | $217.35 | 1.5× | $435.6 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 6 | $507 | $187.59 | $4.36 | $285.91 | 1.8× | $456.3 |
| emergency |
| ED visit level 1 | CPT | 99281 | 7 | $344 | $127.28 | $19.18 | $92.53 | 0.66× | $709 |
| ED visit level 2 | CPT | 99282 | 7 | $654 | $241.98 | $1.18 | $164.84 | 0.70× | $709 |
| ED visit level 3 | CPT | 99283 | 7 | $996 | $368.52 | $2 | $283.42 | 0.70× | $970 |
| ED visit level 4 | CPT | 99284 | 7 | $1,718 | $635.66 | $3.4 | $435.86 | 0.65× | $1,546.2 |
| ED visit level 5 | CPT | 99285 | 7 | $3,285 | $1,215.45 | $4.93 | $638.19 | 0.61× | $2,956.5 |
| Critical care, first hour | CPT | 99291 | 7 | $4,218 | $1,560.66 | $7.97 | $877.09 | 0.82× | $3,796.2 |
| imaging |
| CT head without contrast | CPT | 70450 | 7 | $1,563 | $578.31 | $3.28 | $112.8 | 0.54× | $1,406.7 |
| CT head with contrast | CPT | 70460 | 7 | $2,024 | $748.88 | $107.39 | $286.37 | 1.2× | $1,821.6 |
| CT head with and without contrast | CPT | 70470 | 7 | $2,495 | $923.15 | $107.39 | $286.37 | 1.1× | $2,245.5 |
| CT neck with contrast | CPT | 70491 | 7 | $2,407 | $890.59 | $107.39 | $286.37 | 1.0× | $2,166.3 |
| MRI brain without contrast | CPT | 70551 | 7 | $3,657 | $1,353.09 | $143.22 | $381.92 | 0.95× | $3,291.3 |
| MRI brain with contrast | CPT | 70552 | 7 | $4,032 | $1,491.84 | $224.78 | $599.42 | 1.3× | $3,628.8 |
| MRI brain with and without contrast | CPT | 70553 | 7 | $5,187 | $1,919.19 | $224.78 | $599.42 | 1.0× | $4,668.3 |
| Chest X-ray single view | CPT | 71045 | 7 | $480 | $177.6 | $53.12 | $117.52 | 1.2× | $550 |
| Chest X-ray 2 views | CPT | 71046 | 7 | $515 | $190.55 | $1.01 | $93.4 | 0.95× | $550 |
| Chest X-ray 3 views | CPT | 71047 | 7 | $549 | $203.13 | $1.27 | $93.4 | 0.98× | $550 |
| CT chest without contrast | CPT | 71250 | 7 | $2,024 | $748.88 | $4.11 | $112.8 | 0.52× | $1,821.6 |
| CT chest with contrast | CPT | 71260 | 7 | $2,511 | $929.07 | $107.39 | $286.37 | 1.0× | $2,259.9 |
| CT chest with and without contrast | CPT | 71270 | 7 | $2,841 | $1,051.17 | $107.39 | $286.37 | 0.98× | $2,556.9 |
| MRI chest without contrast | CPT | 71550 | 7 | $4,053 | $1,499.61 | $143.22 | $381.92 | 0.89× | $3,647.7 |
| MRI chest with and without contrast | CPT | 71552 | 7 | $6,129 | $2,267.73 | $224.78 | $599.42 | 1.00× | $5,516.1 |
| Lumbosacral spine X-ray | CPT | 72100 | 7 | $761 | $281.57 | $1.2 | $112.8 | 1.1× | $684.9 |
| CT cervical spine without contrast | CPT | 72125 | 7 | $2,033 | $752.21 | $4.03 | $112.8 | 0.56× | $1,829.7 |
| CT thoracic spine without contrast | CPT | 72128 | 7 | $2,031 | $751.47 | $4.02 | $112.8 | 0.57× | $1,827.9 |
| CT lumbar spine without contrast | CPT | 72131 | 7 | $2,024 | $748.88 | $4 | $112.8 | 0.56× | $1,821.6 |
| MRI cervical spine without contrast | CPT | 72141 | 7 | $3,219 | $1,191.03 | $143.22 | $381.92 | 0.96× | $2,897.1 |
| MRI thoracic spine without contrast | CPT | 72146 | 7 | $3,298 | $1,220.26 | $143.22 | $381.92 | 1.0× | $2,968.2 |
| MRI lumbar spine without contrast | CPT | 72148 | 7 | $3,295 | $1,219.15 | $143.22 | $381.92 | 1.0× | $2,965.5 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 7 | $4,019 | $1,487.03 | $224.78 | $599.42 | 1.3× | $3,617.1 |
| MRI cervical spine with and without contrast | CPT | 72156 | 7 | $5,108 | $1,889.96 | $224.78 | $599.42 | 1.1× | $4,597.2 |
| MRI lumbar spine with contrast | CPT | 72158 | 7 | $5,101 | $1,887.37 | $224.78 | $599.42 | 1.1× | $4,590.9 |
| CT pelvis without contrast | CPT | 72192 | 7 | $1,919 | $710.03 | $4.11 | $112.8 | 0.56× | $1,727.1 |
| CT pelvis with contrast | CPT | 72193 | 7 | $2,265 | $838.05 | $107.39 | $286.37 | 1.0× | $2,038.5 |
| Shoulder X-ray | CPT | 73030 | 7 | $482 | $178.34 | $1.05 | $93.4 | 1.0× | $550 |
| Humerus X-ray | CPT | 73060 | 7 | $482 | $178.34 | $53.12 | $117.52 | 1.3× | $550 |
| Hand X-ray 3 views | CPT | 73130 | 7 | $546 | $202.02 | $1.12 | $93.4 | 1.0× | $550 |
| MRI upper extremity joint without contrast | CPT | 73221 | 7 | $3,469 | $1,283.53 | $143.22 | $381.92 | 0.92× | $3,122.1 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 7 | $3,758 | $1,390.46 | $224.78 | $599.42 | 0.98× | $3,382.2 |
| Knee X-ray 1-2 views | CPT | 73560 | 7 | $482 | $178.34 | $1.03 | $93.4 | 1.0× | $550 |
| Ankle X-ray 3 views | CPT | 73610 | 7 | $546 | $202.02 | $1.1 | $93.4 | 1.0× | $550 |
| MRI lower extremity joint without contrast | CPT | 73721 | 7 | $3,543 | $1,310.91 | $143.22 | $381.92 | 0.82× | $3,188.7 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 7 | $3,798 | $1,405.26 | $224.78 | $599.42 | 0.95× | $3,418.2 |
| CT abdomen without contrast | CPT | 74150 | 7 | $1,904 | $704.48 | $4.22 | $112.8 | 0.60× | $1,713.6 |
| CT abdomen with contrast | CPT | 74160 | 7 | $2,655 | $982.35 | $107.39 | $286.37 | 1.00× | $2,389.5 |
| CT abdomen with and without contrast | CPT | 74170 | 7 | $3,240 | $1,198.8 | $107.39 | $286.37 | 0.86× | $2,916 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 7 | $1,487 | $550.19 | $143.22 | $381.92 | 1.0× | $1,399 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 7 | $2,655 | $982.35 | $224.78 | $599.42 | 1.1× | $2,389.5 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 7 | $3,466 | $1,282.42 | $224.78 | $599.42 | 1.0× | $3,119.4 |
| MRI abdomen without contrast | CPT | 74181 | 7 | $3,227 | $1,193.99 | $143.22 | $381.92 | 0.98× | $2,904.3 |
| MRI abdomen with and without contrast | CPT | 74183 | 7 | $5,379 | $1,990.23 | $224.78 | $599.42 | 1.1× | $4,841.1 |
| Abdominal ultrasound complete | CPT | 76700 | 7 | $1,090 | $403.3 | $3.52 | $112.8 | 0.76× | $981 |
| Abdominal ultrasound limited | CPT | 76705 | 7 | $842 | $311.54 | $2.63 | $127.95 | 0.87× | $798 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 7 | $1,056 | $390.72 | $3.28 | $112.8 | 0.79× | $950.4 |
| Obstetric ultrasound first trimester | CPT | 76801 | 7 | $899 | $332.63 | $3.54 | $112.8 | 0.80× | $809.1 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 7 | $1,090 | $403.3 | $4.11 | $112.8 | 0.74× | $981 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 7 | $1,871 | $692.27 | $143.22 | $381.92 | 1.6× | $1,683.9 |
| Transvaginal ultrasound | CPT | 76830 | 7 | $978 | $361.86 | $3.62 | $112.8 | 0.76× | $880.2 |
| Pelvic ultrasound complete | CPT | 76856 | 7 | $978 | $361.86 | $3.19 | $112.8 | 0.79× | $880.2 |
| Scrotal ultrasound | CPT | 76870 | 7 | $992 | $367.04 | $3.03 | $112.8 | 0.86× | $892.8 |
| Diagnostic mammography unilateral | CPT | 77065 | 7 | $564 | $208.68 | $3.8 | $214.88 | 1.4× | $507.6 |
| Diagnostic mammography bilateral | CPT | 77066 | 7 | $778 | $287.86 | $4.8 | $225 | 1.2× | $700.2 |
| Screening mammography bilateral | CPT | 77067 | 7 | $747 | $276.39 | $3.88 | $225 | 1.4× | $672.3 |
| EKG tracing only | CPT | 93005 | 7 | $392 | $145.04 | $35.75 | $79.18 | 0.67× | $352.8 |
| EKG interpretation only | CPT | 93010 | 7 | $36 | $13.32 | $7.78 | $13.88 | 0.77× | $32.4 |
| Transthoracic echocardiogram complete | CPT | 93306 | 7 | $2,058 | $761.46 | $5.94 | $581.61 | 0.97× | $1,852.2 |
| Transthoracic echocardiogram | CPT | 93307 | 7 | $2,808 | $1,038.96 | $143.22 | $381.92 | 1.5× | $2,527.2 |
| Stress echocardiogram | CPT | 93350 | 7 | $1,405 | $519.85 | $5.61 | $576.17 | 1.1× | $1,264.5 |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 6 | $30,891 | $11,739 | $6,278.93 | $12,600 | 0.82× | $18,971 |
| COPD w MCC | MS-DRG | 190 | 6 | $36,604 | $13,910 | $4,450.74 | $8,931.27 | 0.80× | $13,447 |
| COPD w CC | MS-DRG | 191 | 6 | $20,802 | $7,904.87 | $3,387.17 | $6,797.02 | 0.77× | $10,234 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 6 | $21,682 | $8,239.01 | $3,238.11 | $6,497.9 | 0.77× | $9,783.63 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 6 | $14,928 | $5,672.77 | $2,525.31 | $5,067.54 | 0.76× | $7,629.99 |
| AMI discharged alive w MCC | MS-DRG | 280 | 6 | $46,091 | $17,515 | $6,445.27 | $12,934 | 0.83× | $19,474 |
| AMI discharged alive w CC | MS-DRG | 281 | 6 | $23,400 | $8,891.96 | $3,692.94 | $7,410.61 | 0.77× | $11,158 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 6 | $26,133 | $9,930.5 | $2,905.42 | $5,830.29 | 0.75× | $8,778.43 |
| Heart failure & shock w MCC | MS-DRG | 291 | 6 | $33,359 | $12,676 | $5,158.31 | $10,351 | 0.81× | $15,585 |
| Heart failure & shock w CC | MS-DRG | 292 | 6 | $20,347 | $7,731.82 | $3,411.28 | $6,845.42 | 0.77× | $10,307 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 6 | $33,728 | $12,817 | $8,891.03 | $17,842 | 1.5× | $26,863 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 6 | $30,335 | $11,527 | $2,956.04 | $5,931.88 | 0.76× | $8,931.4 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 6 | $19,333 | $7,346.39 | $2,274.59 | $4,564.4 | 0.74× | $6,872.45 |
| GI hemorrhage w CC | MS-DRG | 378 | 6 | $17,949 | $6,820.56 | $3,940.45 | $7,907.3 | 0.79× | $11,906 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 6 | $16,612 | $6,312.62 | $2,532.95 | $5,082.85 | 0.74× | $7,653.06 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 6 | $18,097 | $6,876.84 | $3,132.43 | $6,285.84 | 0.78× | $9,464.34 |
| Kidney/UTI w MCC | MS-DRG | 689 | 6 | $24,826 | $9,433.97 | $4,662.09 | $9,355.39 | 0.81× | $14,086 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 6 | $20,753 | $7,886.2 | $3,252.57 | $6,526.92 | 0.79× | $9,827.33 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 6 | $37,170 | $14,125 | $7,804.97 | $15,662 | 0.84× | $23,582 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 6 | $24,111 | $9,162.29 | $4,111.62 | $8,250.77 | 0.80× | $12,423 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 7 | $208 | $76.96 | $8.61 | $9.01 | 0.28× | $187.2 |
| General health panel | CPT | 80050 | 6 | $373 | $138.01 | $1.14 | $118.34 | 1.1× | $335.7 |
| Electrolyte panel | CPT | 80051 | 7 | $171 | $63.27 | $7.14 | $7.47 | 0.31× | $153.9 |
| Comprehensive metabolic panel | CPT | 80053 | 7 | $252 | $93.24 | $10.75 | $11.25 | 0.25× | $226.8 |
| Lipid panel | CPT | 80061 | 7 | $356 | $131.72 | $13.63 | $14.26 | 0.37× | $320.4 |
| Renal function panel | CPT | 80069 | 7 | $227 | $83.99 | $8.84 | $9.25 | 0.34× | $204.3 |
| Hepatic function panel | CPT | 80076 | 7 | $254 | $93.98 | $8.32 | $8.7 | 0.33× | $228.6 |
| Urinalysis non-automated | CPT | 81002 | 7 | $120 | $44.4 | $3.54 | $3.72 | 0.53× | $108 |
| Urinalysis automated | CPT | 81003 | 7 | $120 | $44.4 | $2.29 | $2.4 | 0.17× | $108 |
| Glucose quantitative | CPT | 82947 | 7 | $134 | $49.58 | $4 | $19.05 | 1.1× | $120.6 |
| Hemoglobin A1c | CPT | 83036 | 7 | $147 | $54.39 | $9.88 | $10.34 | 0.38× | $132.3 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 7 | $285 | $105.45 | $17.1 | $19.05 | 0.40× | $256.5 |
| Complete blood count with automated differential | CPT | 85025 | 7 | $318 | $117.66 | $7.91 | $8.28 | 0.31× | $286.2 |
| Complete blood count without differential | CPT | 85027 | 7 | $260 | $96.2 | $6.59 | $6.89 | 0.32× | $234 |
| Urine culture bacterial | CPT | 87086 | 7 | $296 | $109.52 | $8.22 | $8.59 | 0.37× | $266.4 |
| Urine culture identification | CPT | 87088 | 7 | $200 | $74 | $8.24 | $8.62 | 0.39× | $180 |
| Tissue exam by pathologist level IV | CPT | 88305 | 7 | $176 | $65.12 | $2.17 | $68.63 | 0.67× | $158.4 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 7 | $832 | $307.84 | $1.4 | $213.39 | 1.1× | $748.8 |
| office |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 6 | $153 | $56.61 | $3.28 | $81.51 | 0.67× | $425.88 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 6 | $213 | $78.81 | $4.9 | $133.28 | 0.77× | $636.22 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 6 | $282 | $104.34 | $6.46 | $181.08 | 0.82× | $838.77 |
| Office visit, established patient, 5 min | CPT | 99211 | 6 | $273 | $101.01 | $8.45 | $79.33 | 1.2× | $245.7 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 6 | $141 | $52.17 | $2.69 | $66.25 | 0.58× | $349.27 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 6 | $205 | $75.85 | $3.79 | $97.46 | 0.64× | $492.09 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 6 | $271 | $100.27 | $5.33 | $144.5 | 0.77× | $692.05 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 7 | $3,570 | $1,320.9 | $8.61 | $994.51 | 1.1× | $3,213 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 7 | $3,925 | $1,452.25 | $11.28 | $994.51 | 1.0× | $3,532.5 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 7 | $2,087 | $772.19 | $5.63 | $958.05 | 1.1× | $2,241 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 7 | $3,925 | $1,452.25 | $8.66 | $967.09 | 1.1× | $3,532.5 |
| Colonoscopy diagnostic | CPT | 45378 | 7 | $3,570 | $1,320.9 | $10.06 | $967.09 | 1.1× | $3,213 |
| Colonoscopy with biopsy | CPT | 45380 | 7 | $3,925 | $1,452.25 | $12.9 | $1,239.01 | 1.0× | $3,532.5 |
| Colonoscopy with polyp removal | CPT | 45385 | 7 | $3,925 | $1,452.25 | $13.42 | $1,239.01 | 1.0× | $3,532.5 |
| surgery |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 4 | $120,097 | $45,637 | $19,485 | $36,539 | 0.85× | $55,802 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 6 | $42,369 | $16,100 | $10,162 | $19,328 | 0.83× | $30,114 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 6 | $32,551 | $12,369 | $7,133.81 | $13,569 | 0.83× | $21,141 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 6 | $36,460 | $13,855 | $7,170.69 | $13,639 | 0.83× | $21,250 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 6 | $13,619 | $5,175.09 | $5,789.63 | $11,012 | 0.81× | $17,157 |
| Major joint replacement w MCC | MS-DRG | 469 | 6 | $42,522 | $16,158 | $11,515 | $24,112 | 0.82× | $38,103 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 6 | $39,372 | $14,962 | $8,176.61 | $15,333 | 0.81× | $24,231 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 6 | $54,422 | $20,681 | $12,345 | $23,482 | 0.84× | $36,584 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 6 | $39,943 | $15,179 | $8,878.59 | $16,888 | 0.83× | $26,311 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 6 | $33,743 | $12,822 | $6,913.81 | $13,151 | 0.82× | $20,489 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 6 | $21,187 | $8,050.95 | $5,259.33 | $10,004 | 0.81× | $15,586 |
| PCI single major coronary artery | CPT | 92920 | 7 | $13,803 | $5,107.11 | $13.97 | $5,878.28 | 1.0× | $12,423 |
| PCI with drug-eluting stent | CPT | 92928 | 7 | $23,092 | $8,544.04 | $15.54 | $11,692 | 1.2× | $21,158 |
| PCI bypass graft | CPT | 92937 | 7 | $30,601 | $11,322 | $15.54 | $11,692 | 1.1× | $27,541 |
| Left heart catheterization | CPT | 93452 | 7 | $10,990 | $4,066.3 | $26.42 | $3,411.78 | 1.1× | $9,891 |
| Coronary angiography with cath | CPT | 93455 | 7 | $10,990 | $4,066.3 | $29.64 | $3,411.78 | 1.1× | $9,891 |
| Coronary angiography with bypass cath | CPT | 93458 | 7 | $10,990 | $4,066.3 | $30.58 | $3,411.78 | 1.1× | $9,891 |