| behavioral |
| Psychoses | MS-DRG | 885 | 32 | $28,103 | $16,862 | $48.5 | $80 | 0.01× | $22,655 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 33 | $432 | $259.2 | $190 | $285 | 1.6× | $375.84 |
| Psychotherapy 30 minutes | CPT | 90832 | 33 | $309 | $185.4 | $139.05 | $229.59 | 1.5× | $299 |
| Psychotherapy 45 minutes | CPT | 90834 | 33 | $377 | $226.2 | $169.65 | $249.2 | 1.6× | $327.99 |
| Psychotherapy 60 minutes | CPT | 90837 | 33 | $418 | $250.8 | $188.1 | $285 | 1.5× | $363.66 |
| emergency |
| ED visit level 1 | CPT | 99281 | 36 | $948 | $568.8 | $90.36 | $616.2 | 4.4× | $1,727 |
| ED visit level 2 | CPT | 99282 | 23 | $1,683 | $1,009.8 | $888.62 | $1,009.8 | 4.3× | $1,727 |
| ED visit level 3 | CPT | 99283 | 36 | $2,674 | $1,604.4 | $292.53 | $1,665.7 | 4.1× | $2,326.38 |
| ED visit level 4 | CPT | 99284 | 23 | $3,765 | $2,259 | $1,011 | $2,187.47 | 3.3× | $3,275.55 |
| ED visit level 5 | CPT | 99285 | 36 | $5,551 | $3,330.6 | $638.18 | $3,469.38 | 3.3× | $4,829.37 |
| Critical care, first hour | CPT | 99291 | 36 | $6,853 | $4,111.8 | $885.19 | $4,111.8 | 3.8× | $5,962.11 |
| imaging |
| CT head without contrast | CPT | 70450 | 35 | $1,433 | $859.8 | $112.03 | $925.73 | 4.5× | $1,500 |
| CT head with contrast | CPT | 70460 | 35 | $1,705 | $1,023 | $187.96 | $1,108.25 | 4.7× | $1,500 |
| CT head with and without contrast | CPT | 70470 | 35 | $2,032 | $1,219.2 | $187.96 | $1,178.56 | 4.4× | $1,767.84 |
| CT neck with contrast | CPT | 70491 | 35 | $1,429 | $857.4 | $187.96 | $928.85 | 3.4× | $1,500 |
| MRI brain without contrast | CPT | 70551 | 35 | $2,303 | $1,381.8 | $255.69 | $1,496.95 | 3.7× | $2,250 |
| MRI brain with contrast | CPT | 70552 | 35 | $2,800 | $1,680 | $373.86 | $1,663 | 3.5× | $2,436 |
| MRI brain with and without contrast | CPT | 70553 | 35 | $3,367 | $2,020.2 | $373.86 | $1,851.85 | 3.1× | $2,929.29 |
| Chest X-ray single view | CPT | 71045 | 35 | $435 | $261 | $30.49 | $254.26 | 2.7× | $378.45 |
| Chest X-ray 2 views | CPT | 71046 | 35 | $457 | $274.2 | $43.02 | $267.12 | 2.7× | $397.59 |
| Chest X-ray 3 views | CPT | 71047 | 35 | $480 | $288 | $54.87 | $278.4 | 2.9× | $417.6 |
| CT chest without contrast | CPT | 71250 | 35 | $1,181 | $708.6 | $112.03 | $877.48 | 4.1× | $1,500 |
| CT chest with contrast | CPT | 71260 | 35 | $1,543 | $925.8 | $187.96 | $1,002.95 | 3.6× | $1,500 |
| CT chest with and without contrast | CPT | 71270 | 35 | $1,623 | $973.8 | $187.96 | $1,009 | 3.5× | $1,500 |
| MRI chest without contrast | CPT | 71550 | 35 | $2,631 | $1,578.6 | $255.69 | $1,614.23 | 3.8× | $2,288.97 |
| MRI chest with and without contrast | CPT | 71552 | 35 | $3,582 | $2,149.2 | $373.86 | $2,328.3 | 3.9× | $3,116.34 |
| Lumbosacral spine X-ray | CPT | 72100 | 35 | $308 | $184.8 | $67.96 | $181.41 | 1.8× | $296 |
| CT cervical spine without contrast | CPT | 72125 | 35 | $1,512 | $907.2 | $112.03 | $982.8 | 4.9× | $1,500 |
| CT thoracic spine without contrast | CPT | 72128 | 35 | $1,258 | $754.8 | $112.03 | $916 | 4.6× | $1,500 |
| CT lumbar spine without contrast | CPT | 72131 | 35 | $1,152 | $691.2 | $112.03 | $855.94 | 4.2× | $1,500 |
| MRI cervical spine without contrast | CPT | 72141 | 35 | $2,301 | $1,380.6 | $251.1 | $1,495.65 | 3.8× | $2,250 |
| MRI thoracic spine without contrast | CPT | 72146 | 35 | $1,921 | $1,152.6 | $251.1 | $1,248.65 | 3.3× | $2,250 |
| MRI lumbar spine without contrast | CPT | 72148 | 35 | $2,371 | $1,422.6 | $251.73 | $1,475.95 | 3.9× | $2,250 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 35 | $2,450 | $1,470 | $373.86 | $1,592.5 | 3.5× | $2,250 |
| MRI cervical spine with and without contrast | CPT | 72156 | 35 | $3,179 | $1,907.4 | $373.86 | $1,782 | 3.3× | $2,765.73 |
| MRI lumbar spine with contrast | CPT | 72158 | 35 | $2,781 | $1,668.6 | $373.86 | $1,663 | 3.0× | $2,419.47 |
| CT pelvis without contrast | CPT | 72192 | 35 | $1,175 | $705 | $112.03 | $873.03 | 4.4× | $1,500 |
| CT pelvis with contrast | CPT | 72193 | 35 | $1,540 | $924 | $187.96 | $1,009 | 3.6× | $1,500 |
| Shoulder X-ray | CPT | 73030 | 31 | $332 | $199.2 | $56.84 | $215.8 | 2.3× | $296 |
| Humerus X-ray | CPT | 73060 | 35 | $280 | $168 | $44.89 | $162.4 | 1.8× | $296 |
| Hand X-ray 3 views | CPT | 73130 | 31 | $296 | $177.6 | $61.68 | $192.4 | 2.1× | $296 |
| MRI upper extremity joint without contrast | CPT | 73221 | 31 | $2,110 | $1,266 | $284.68 | $1,567.73 | 3.8× | $2,250 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 31 | $6,318 | $3,790.8 | $601 | $4,106.7 | 6.7× | $5,496.66 |
| Knee X-ray 1-2 views | CPT | 73560 | 31 | $262 | $157.2 | $48.62 | $170.3 | 1.8× | $296 |
| Ankle X-ray 3 views | CPT | 73610 | 31 | $277 | $166.2 | $63.09 | $180.05 | 2.0× | $296 |
| MRI lower extremity joint without contrast | CPT | 73721 | 31 | $2,390 | $1,434 | $284.03 | $1,662.03 | 3.6× | $2,250 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 31 | $3,484 | $2,090.4 | $599.07 | $2,264.6 | 3.6× | $3,031.08 |
| CT abdomen without contrast | CPT | 74150 | 35 | $1,353 | $811.8 | $112.03 | $916 | 4.9× | $1,500 |
| CT abdomen with contrast | CPT | 74160 | 35 | $1,476 | $885.6 | $187.96 | $1,009 | 3.5× | $1,500 |
| CT abdomen with and without contrast | CPT | 74170 | 35 | $1,772 | $1,063.2 | $187.96 | $1,151.8 | 3.4× | $1,541.64 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 35 | $2,907 | $1,744.2 | $225.02 | $1,642.46 | 4.5× | $2,807 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 35 | $4,732 | $2,839.2 | $373.86 | $2,602.6 | 4.7× | $4,116.84 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 35 | $4,969 | $2,981.4 | $373.86 | $2,732.95 | 4.8× | $4,323.03 |
| MRI abdomen without contrast | CPT | 74181 | 35 | $2,404 | $1,442.4 | $255.69 | $1,496.49 | 3.8× | $2,250 |
| MRI abdomen with and without contrast | CPT | 74183 | 35 | $3,268 | $1,960.8 | $373.86 | $1,797.4 | 3.2× | $2,843.16 |
| Abdominal ultrasound complete | CPT | 76700 | 35 | $955 | $573 | $112.03 | $539.58 | 3.6× | $830.85 |
| Abdominal ultrasound limited | CPT | 76705 | 35 | $746 | $447.6 | $112.03 | $443.5 | 3.0× | $649.02 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 35 | $876 | $525.6 | $112.03 | $508.08 | 3.5× | $762.12 |
| Obstetric ultrasound first trimester | CPT | 76801 | 35 | $790 | $474 | $112.03 | $465.31 | 3.3× | $687.3 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 35 | $1,056 | $633.6 | $112.03 | $612.48 | 4.0× | $918.72 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 35 | $671 | $402.6 | $155.82 | $404.16 | 1.7× | $583.77 |
| Transvaginal ultrasound | CPT | 76830 | 35 | $641 | $384.6 | $112.03 | $377.55 | 2.6× | $557.67 |
| Pelvic ultrasound complete | CPT | 76856 | 35 | $1,024 | $614.4 | $112.03 | $563.2 | 3.9× | $890.88 |
| Scrotal ultrasound | CPT | 76870 | 35 | $1,367 | $820.2 | $103.43 | $792.86 | 6.0× | $1,189.29 |
| Diagnostic mammography unilateral | CPT | 77065 | 35 | $330 | $198 | $79.65 | $247.5 | 1.7× | $303.36 |
| Diagnostic mammography bilateral | CPT | 77066 | 35 | $488 | $292.8 | $102.44 | $358.24 | 1.9× | $424.56 |
| Screening mammography bilateral | CPT | 77067 | 35 | $349 | $209.4 | $42.13 | $259.31 | 1.6× | $319.51 |
| EKG tracing only | CPT | 93005 | 35 | $530 | $318 | $63.22 | $326 | 2.8× | $461.1 |
| Transthoracic echocardiogram complete | CPT | 93306 | 35 | $8,910 | $5,346 | $585.55 | $5,167.8 | 8.6× | $7,751.7 |
| Transthoracic echocardiogram | CPT | 93307 | 35 | $2,472 | $1,483.2 | $255.69 | $1,433.76 | 5.8× | $2,150.64 |
| Stress echocardiogram | CPT | 93350 | 35 | $6,677 | $4,006.2 | $585.55 | $3,872.66 | 7.6× | $5,808.99 |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 35 | $51,006 | $30,603 | $48.5 | $86 | 0.00× | $41,881 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 35 | $45,159 | $27,095 | $48.5 | $86 | 0.01× | $33,399 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 35 | $33,860 | $20,316 | $48.5 | $86 | 0.01× | $33,399 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 35 | $44,600 | $26,760 | $48.5 | $86 | 0.01× | $29,637 |
| COPD w MCC | MS-DRG | 190 | 35 | $38,300 | $22,980 | $48.5 | $86 | 0.01× | $22,842 |
| COPD w CC | MS-DRG | 191 | 35 | $30,853 | $18,512 | $48.5 | $86 | 0.01× | $22,842 |
| COPD w/o CC/MCC | MS-DRG | 192 | 35 | $15,006 | $9,003.39 | $48.5 | $86 | 0.01× | $22,842 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 35 | $29,324 | $17,594 | $48.5 | $86 | 0.01× | $16,457 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 35 | $22,958 | $13,775 | $48.5 | $86 | 0.01× | $16,457 |
| AMI discharged alive w MCC | MS-DRG | 280 | 32 | $58,829 | $35,297 | $48.5 | $80 | 0.01× | $30,308 |
| AMI discharged alive w CC | MS-DRG | 281 | 32 | $43,303 | $25,982 | $48.5 | $80 | 0.01× | $20,201 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 32 | $38,053 | $22,832 | $48.5 | $80 | 0.01× | $20,201 |
| Heart failure & shock w MCC | MS-DRG | 291 | 35 | $42,244 | $25,346 | $48.5 | $86 | 0.01× | $24,146 |
| Heart failure & shock w CC | MS-DRG | 292 | 35 | $27,788 | $16,673 | $48.5 | $86 | 0.01× | $19,137 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 35 | $29,289 | $17,573 | $48.5 | $85 | 0.01× | $19,137 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 35 | $41,885 | $25,131 | $48.5 | $86 | 0.01× | $22,123 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 35 | $33,515 | $20,109 | $48.5 | $86 | 0.01× | $16,704 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 35 | $26,264 | $15,758 | $48.5 | $85 | 0.01× | $16,704 |
| GI hemorrhage w CC | MS-DRG | 378 | 32 | $36,845 | $22,107 | $48.5 | $80 | 0.01× | $15,924 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 32 | $25,012 | $15,007 | $48.5 | $80 | 0.01× | $10,224 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 35 | $27,038 | $16,223 | $48.5 | $86 | 0.01× | $15,724 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 35 | $121,371 | $72,822 | $48.5 | $85 | 0.01× | $24,488 |
| Kidney/UTI w MCC | MS-DRG | 689 | 35 | $42,289 | $25,373 | $48.5 | $86 | 0.01× | $18,299 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 35 | $26,626 | $15,976 | $48.5 | $86 | 0.01× | $16,598 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 32 | $51,058 | $30,635 | $48.5 | $80 | 0.00× | $31,221 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 32 | $33,129 | $19,878 | $48.5 | $80 | 0.01× | $16,597 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 36 | $261 | $156.6 | $8.46 | $147.47 | 4.6× | $227.07 |
| General health panel | CPT | 80050 | 32 | $463 | $277.8 | $46.97 | $277.8 | 2.6× | $402.81 |
| Electrolyte panel | CPT | 80051 | 36 | $83 | $49.8 | $7.01 | $45.65 | 1.9× | $72.21 |
| Comprehensive metabolic panel | CPT | 80053 | 36 | $359 | $215.4 | $10.56 | $197.45 | 4.4× | $312.33 |
| Lipid panel | CPT | 80061 | 36 | $95 | $57 | $13.39 | $52.25 | 1.4× | $82.65 |
| Renal function panel | CPT | 80069 | 36 | $313 | $187.8 | $8.68 | $176.85 | 6.5× | $272.31 |
| Hepatic function panel | CPT | 80076 | 36 | $88 | $52.8 | $8.17 | $49.72 | 1.9× | $76.56 |
| Urinalysis non-automated | CPT | 81002 | 36 | $41 | $24.6 | $3.48 | $22.55 | 3.2× | $35.67 |
| Urinalysis automated | CPT | 81003 | 36 | $26 | $15.6 | $2.25 | $14.69 | 1.1× | $22.62 |
| Glucose quantitative | CPT | 82947 | 36 | $56 | $33.6 | $3.93 | $30.8 | 1.8× | $48.72 |
| Hemoglobin A1c | CPT | 83036 | 36 | $56 | $33.6 | $9.71 | $30.8 | 1.1× | $48.72 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 36 | $110 | $66 | $16.8 | $62.15 | 1.3× | $95.7 |
| Complete blood count with automated differential | CPT | 85025 | 36 | $154 | $92.4 | $7.77 | $84.7 | 3.2× | $133.98 |
| Complete blood count without differential | CPT | 85027 | 36 | $100 | $60 | $6.47 | $56.5 | 2.6× | $87 |
| Urine culture bacterial | CPT | 87086 | 36 | $54 | $32.4 | $8.07 | $30.51 | 1.3× | $46.98 |
| Urine culture identification | CPT | 87088 | 36 | $46 | $27.6 | $8.09 | $25.3 | 1.1× | $40.02 |
| Tissue exam by pathologist level IV | CPT | 88305 | 35 | $311 | $186.6 | $42.6 | $180.38 | 1.8× | $270.57 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 35 | $1,735 | $1,041 | $216.65 | $1,127.75 | 6.0× | $1,509.45 |
| Vaginal delivery only | CPT | 59409 | 36 | $3,004 | $1,802.4 | $25 | $75.5 | 0.03× | $7,952 |
| C-section delivery only | CPT | 59514 | 14 | $3,500 | $2,100 | $327 | $2,030 | 2.1× | $3,045 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 36 | $7,196.93 | $4,318.16 | $25 | $1,089 | 1.2× | $6,771 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 36 | $9,487.66 | $5,692.6 | $25 | $1,020.54 | 1.1× | $6,771 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 36 | $9,111.63 | $5,466.98 | $25 | $1,011.52 | 1.2× | $6,771 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 36 | $8,490.9 | $5,094.54 | $25 | $996.56 | 1.1× | $6,771 |
| Colonoscopy diagnostic | CPT | 45378 | 36 | $9,600.23 | $5,760.14 | $25 | $1,734.4 | 2.0× | $6,771 |
| Colonoscopy with biopsy | CPT | 45380 | 36 | $13,416 | $8,049.53 | $25 | $1,282.34 | 1.1× | $6,771 |
| Colonoscopy with polyp removal | CPT | 45385 | 36 | $9,942.71 | $5,965.63 | $25 | $1,634.05 | 1.4× | $6,771 |
| surgery |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 35 | $150,133 | $90,080 | $48.5 | $85 | 0.00× | $90,663 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 35 | $85,380 | $51,228 | $48.5 | $86 | 0.00× | $40,860 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 35 | $59,526 | $35,716 | $48.5 | $86 | 0.01× | $33,014 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 35 | $53,031 | $31,819 | $48.5 | $86 | 0.01× | $27,436 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 35 | $43,531 | $26,118 | $48.5 | $86 | 0.01× | $23,987 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 32 | $81,876 | $49,126 | $48.5 | $80 | 0.00× | $65,249 |
| Major joint replacement w MCC | MS-DRG | 469 | 35 | $86,770 | $52,062 | $48.5 | $86 | 0.00× | $55,480 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 35 | $63,301 | $37,980 | $48.5 | $86 | 0.00× | $37,912 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 35 | $73,646 | $44,187 | $48.5 | $86 | 0.00× | $50,923 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 35 | $65,905 | $39,543 | $48.5 | $86 | 0.00× | $40,696 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 35 | $56,492 | $33,895 | $48.5 | $86 | 0.01× | $40,696 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 35 | $93,873 | $56,324 | $48.5 | $86 | 0.00× | $56,810 |
| OR procedure for obesity w CC | MS-DRG | 620 | 35 | $59,102 | $35,461 | $48.5 | $86 | 0.01× | $43,439 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 35 | $37,091 | $22,254 | $48.5 | $75 | 0.00× | $43,439 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 35 | $52,487 | $31,492 | $48.5 | $86 | 0.01× | $20,123 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 35 | $58,914 | $35,349 | $48.5 | $86 | 0.00× | $33,234 |
| PCI single major coronary artery | CPT | 92920 | 36 | $63,806 | $38,283 | $25 | $5,639.69 | 0.99× | $31,216 |
| PCI with drug-eluting stent | CPT | 92928 | 36 | $75,179 | $45,107 | $25 | $7,780.59 | 0.78× | $31,216 |
| PCI bypass graft | CPT | 92937 | 36 | $79,512 | $47,707 | $25 | $7,987.68 | 0.73× | $31,216 |
| Left heart catheterization | CPT | 93452 | 32 | $43,773 | $26,264 | $25 | $77.75 | 0.03× | $23,604 |
| Coronary angiography with cath | CPT | 93455 | 36 | $15,624 | $9,374.57 | $25 | $82.5 | 0.03× | $13,389 |
| Coronary angiography with bypass cath | CPT | 93458 | 36 | $54,941 | $32,964 | $25 | $7,462 | 2.4× | $31,216 |