| behavioral |
| Psychoses | MS-DRG | 885 | 5 | — | — | $10,183 | $10,183 | 0.79× | $27,895 |
| emergency |
| ED visit level 1 | CPT | 99281 | 15 | $633 | $443.1 | $19.33 | $332.77 | 2.4× | $1,509 |
| ED visit level 2 | CPT | 99282 | 15 | $1,213 | $849.1 | $38.04 | $637.68 | 2.7× | $2,066 |
| ED visit level 3 | CPT | 99283 | 15 | $2,110 | $1,477 | $56.68 | $1,109.23 | 2.7× | $3,624 |
| ED visit level 4 | CPT | 99284 | 15 | $3,588 | $2,511.6 | $108.14 | $1,886.22 | 2.8× | $6,687 |
| ED visit level 5 | CPT | 99285 | 15 | $5,276 | $3,693.2 | $158.84 | $2,773.6 | 2.7× | $7,928 |
| Critical care, first hour | CPT | 99291 | 15 | $8,441 | $5,908.7 | $205.99 | $4,437.44 | 4.1× | $8,683 |
| imaging |
| CT head without contrast | CPT | 70450 | 15 | $5,659 | $3,961.3 | $100 | $1,085.5 | 5.2× | $3,802.85 |
| CT head with contrast | CPT | 70460 | 15 | $7,923 | $5,546.1 | $100 | $1,085.5 | 4.6× | $5,324.26 |
| CT head with and without contrast | CPT | 70470 | 15 | $9,337 | $6,535.9 | $100 | $1,085.5 | 4.1× | $6,274.47 |
| CT neck with contrast | CPT | 70491 | 15 | $7,277 | $5,093.9 | $100 | $1,085.5 | 4.0× | $4,890.15 |
| Chest X-ray single view | CPT | 71045 | 11 | $1,190 | $833 | $20.22 | $225.25 | 2.4× | $2,013 |
| Chest X-ray 2 views | CPT | 71046 | 11 | $1,476 | $1,033.2 | $31.13 | $276.61 | 2.8× | $2,013 |
| Chest X-ray 3 views | CPT | 71047 | 11 | $1,797 | $1,257.9 | $39.85 | $359.78 | 3.8× | $2,013 |
| CT chest without contrast | CPT | 71250 | 15 | $3,555 | $2,488.5 | $100 | $1,085.5 | 5.0× | $2,388.96 |
| CT chest with contrast | CPT | 71260 | 15 | $7,109 | $4,976.3 | $100 | $1,085.5 | 3.9× | $4,777.25 |
| CT chest with and without contrast | CPT | 71270 | 15 | $7,962 | $5,573.4 | $100 | $1,085.5 | 3.7× | $5,350.47 |
| Lumbosacral spine X-ray | CPT | 72100 | 11 | $1,429 | $1,000.3 | $38.58 | $120.7 | 1.2× | $2,013 |
| CT cervical spine without contrast | CPT | 72125 | 15 | $5,537 | $3,875.9 | $100 | $1,085.5 | 5.4× | $3,720.87 |
| CT thoracic spine without contrast | CPT | 72128 | 15 | $7,039 | $4,927.3 | $100 | $1,085.5 | 5.4× | $4,730.21 |
| CT lumbar spine without contrast | CPT | 72131 | 15 | $5,575 | $3,902.5 | $100 | $1,085.5 | 5.3× | $3,746.4 |
| CT pelvis without contrast | CPT | 72192 | 15 | $3,881 | $2,716.7 | $100 | $1,085.5 | 5.4× | $2,608.04 |
| CT pelvis with contrast | CPT | 72193 | 15 | $7,800 | $5,460 | $100 | $1,085.5 | 3.9× | $5,241.6 |
| Shoulder X-ray | CPT | 73030 | 11 | $2,082 | $1,457.4 | $33.36 | $607.25 | 6.5× | $2,013 |
| Humerus X-ray | CPT | 73060 | 11 | $1,309 | $916.3 | $31.08 | $272.39 | 3.0× | $2,013 |
| Hand X-ray 3 views | CPT | 73130 | 11 | $2,006 | $1,404.2 | $35.23 | $584.94 | 6.3× | $2,013 |
| Knee X-ray 1-2 views | CPT | 73560 | 11 | $1,625 | $1,137.5 | $33 | $473.82 | 5.1× | $2,013 |
| Ankle X-ray 3 views | CPT | 73610 | 11 | $2,441 | $1,708.7 | $35.99 | $711.82 | 7.7× | $2,013 |
| CT abdomen without contrast | CPT | 74150 | 15 | $4,434 | $3,103.8 | $100 | $1,085.5 | 5.8× | $2,979.65 |
| CT abdomen with contrast | CPT | 74160 | 15 | $8,061 | $5,642.7 | $100 | $1,085.5 | 3.8× | $5,417 |
| CT abdomen with and without contrast | CPT | 74170 | 15 | $9,539 | $6,677.3 | $100 | $1,085.5 | 3.2× | $6,410.21 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 15 | $8,598 | $6,018.6 | $100 | $1,085.5 | 3.0× | $5,777.86 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 15 | $13,435 | $9,404.5 | $100 | $1,085.5 | 2.0× | $9,028.32 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 15 | $15,182 | $10,627 | $100 | $1,085.5 | 1.9× | $10,202 |
| Abdominal ultrasound complete | CPT | 76700 | 11 | $2,900 | $2,030 | $100 | $1,087.5 | 7.3× | $2,630 |
| Abdominal ultrasound limited | CPT | 76705 | 11 | $2,377 | $1,663.9 | $100 | $822.33 | 5.6× | $2,630 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 11 | $3,587 | $2,510.9 | $100 | $1,021.62 | 7.1× | $2,630 |
| Obstetric ultrasound first trimester | CPT | 76801 | 11 | $2,015 | $1,410.5 | $100 | $755.63 | 5.3× | $2,630 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 11 | $2,317 | $1,621.9 | $100 | $868.88 | 5.7× | $2,630 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 11 | $921 | $644.7 | $100 | $300.14 | 1.3× | $2,630 |
| Transvaginal ultrasound | CPT | 76830 | 11 | $1,458 | $1,020.6 | $100 | $546.75 | 3.7× | $2,630 |
| Pelvic ultrasound complete | CPT | 76856 | 11 | $2,966 | $2,076.2 | $100 | $992.31 | 6.9× | $2,630 |
| Scrotal ultrasound | CPT | 76870 | 11 | $3,102 | $2,171.4 | $77.84 | $953.5 | 7.3× | $2,630 |
| Diagnostic mammography unilateral | CPT | 77065 | 11 | $550 | $385 | $91.54 | $206.25 | 1.4× | $550 |
| Diagnostic mammography bilateral | CPT | 77066 | 11 | $1,100 | $770 | $100 | $412.5 | 2.2× | $1,100 |
| Screening mammography bilateral | CPT | 77067 | 11 | $800 | $560 | $96.78 | $300 | 1.9× | $800 |
| EKG tracing only | CPT | 93005 | 8 | $1,262 | $883.4 | $7.4 | $61.05 | 0.52× | $1,083 |
| Transthoracic echocardiogram complete | CPT | 93306 | 8 | $7,744 | $5,420.8 | $203.54 | $529.6 | 0.88× | $5,203.97 |
| Transthoracic echocardiogram | CPT | 93307 | 8 | $2,739 | $1,917.3 | $117.41 | $252.39 | 1.0× | $1,840.61 |
| Stress echocardiogram | CPT | 93350 | 8 | $1,284 | $898.8 | $214.85 | $529.6 | 1.0× | $1,321 |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 5 | — | — | $14,429 | $14,429 | 0.93× | $41,610 |
| COPD w MCC | MS-DRG | 190 | 5 | — | — | $9,392.59 | $9,392.59 | 0.84× | $25,343 |
| COPD w CC | MS-DRG | 191 | 5 | — | — | $7,711.48 | $7,711.48 | 0.87× | $19,913 |
| COPD w/o CC/MCC | MS-DRG | 192 | 5 | — | — | $6,397.59 | $6,397.59 | 0.91× | $15,669 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 5 | — | — | $7,571.15 | $7,571.15 | 0.89× | $19,460 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 5 | — | — | $6,188.84 | $6,188.84 | 0.93× | $14,995 |
| AMI discharged alive w MCC | MS-DRG | 280 | 5 | — | — | $12,899 | $12,899 | 0.82× | $36,669 |
| AMI discharged alive w CC | MS-DRG | 281 | 5 | — | — | $8,053.56 | $8,053.56 | 0.83× | $21,018 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 5 | — | — | $6,611.22 | $6,611.22 | 0.85× | $16,359 |
| Heart failure & shock w MCC | MS-DRG | 291 | 5 | — | — | $10,908 | $10,908 | 0.85× | $30,236 |
| Heart failure & shock w CC | MS-DRG | 292 | 5 | — | — | $7,795.25 | $7,795.25 | 0.87× | $20,184 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 5 | — | — | $6,102.28 | $6,102.28 | 0.98× | $14,715 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 5 | — | — | $9,918.98 | $9,918.98 | 0.82× | $27,043 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 5 | — | — | $6,778.07 | $6,778.07 | 0.87× | $16,898 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 5 | — | — | $5,444.63 | $5,444.63 | 0.88× | $12,591 |
| GI hemorrhage w CC | MS-DRG | 378 | 5 | — | — | $8,480.12 | $8,480.12 | 0.85× | $22,396 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 5 | — | — | $5,994.06 | $5,994.06 | 0.88× | $14,366 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 5 | — | — | $6,882.79 | $6,882.79 | 0.86× | $17,236 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 5 | — | — | $11,408 | $11,408 | 0.75× | $31,853 |
| Kidney/UTI w MCC | MS-DRG | 689 | 5 | — | — | $9,304.62 | $9,304.62 | 0.80× | $25,059 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 5 | — | — | $7,076.87 | $7,076.87 | 0.85× | $17,863 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 5 | — | — | $14,589 | $14,589 | 0.78× | $42,126 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 5 | — | — | $8,678.39 | $8,678.39 | 0.84× | $23,036 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 11 | $818 | $572.6 | $5.77 | $14.3 | 0.44× | $549.7 |
| General health panel | CPT | 80050 | 7 | $140 | $98 | $24.31 | $69.75 | 0.65× | $94.08 |
| Electrolyte panel | CPT | 80051 | 11 | $644 | $450.8 | $4.79 | $11.84 | 0.50× | $432.77 |
| Comprehensive metabolic panel | CPT | 80053 | 11 | $1,234 | $863.8 | $7.21 | $24.57 | 0.55× | $829.25 |
| Lipid panel | CPT | 80061 | 11 | $462 | $323.4 | $9.14 | $26.91 | 0.71× | $310.47 |
| Renal function panel | CPT | 80069 | 11 | $416 | $291.2 | $5.93 | $14.67 | 0.54× | $279.56 |
| Hepatic function panel | CPT | 80076 | 11 | $1,359 | $951.3 | $5.57 | $13.81 | 0.52× | $913.25 |
| Urinalysis non-automated | CPT | 81002 | 11 | $35 | $24.5 | $1.75 | $5.29 | 0.76× | $23.52 |
| Urinalysis automated | CPT | 81003 | 11 | $386 | $270.2 | $1.53 | $3.79 | 0.27× | $259.4 |
| Glucose quantitative | CPT | 82947 | 11 | $330 | $231 | $2.68 | $6.65 | 0.38× | $221.76 |
| Hemoglobin A1c | CPT | 83036 | 11 | $431 | $301.7 | $6.62 | $23.25 | 0.86× | $289.64 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 11 | $951 | $665.7 | $11.47 | $40.24 | 0.85× | $639.08 |
| Complete blood count with automated differential | CPT | 85025 | 11 | $500 | $350 | $5.31 | $13.13 | 0.50× | $336 |
| Complete blood count without differential | CPT | 85027 | 11 | $241 | $168.7 | $4.42 | $10.93 | 0.51× | $161.96 |
| Urine culture bacterial | CPT | 87086 | 11 | $1,051 | $735.7 | $5.51 | $13.65 | 0.59× | $706.28 |
| Urine culture identification | CPT | 87088 | 11 | $602 | $421.4 | $5.53 | $13.67 | 0.61× | $404.55 |
| Tissue exam by pathologist level IV | CPT | 88305 | 11 | $1,845 | $1,291.5 | $27.3 | $64.87 | 0.63× | $1,239.84 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 10 | — | — | $62.13 | $188.64 | 1.0× | $1,083 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 3 | — | — | $2,023 | $2,031.86 | 0.89× | $3,793.41 |
| Vaginal delivery only | CPT | 59409 | 11 | — | — | $822.61 | $2,848.44 | 1.3× | $3,793.41 |
| Vaginal delivery with postpartum | CPT | 59410 | 4 | — | — | $1,014.4 | $2,023 | 1.9× | $3,793.41 |
| Routine obstetric care with C-section | CPT | 59510 | 3 | — | — | $2,023 | $2,247.1 | 0.90× | $3,793.41 |
| C-section delivery only | CPT | 59514 | 3 | — | — | $895.91 | $2,023 | 2.1× | $3,793.41 |
| C-section with postpartum | CPT | 59515 | 4 | — | — | $1,228.85 | $2,892 | 2.3× | $4,539 |
| office |
| Office visit, established patient, 5 min | CPT | 99211 | 9 | $399 | $279.3 | $8.55 | $226.24 | 3.5× | $268.13 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 12 | — | — | $329.44 | $1,315 | 1.4× | $4,552 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 12 | — | — | $329.44 | $1,729 | 1.8× | $5,125 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 11 | — | — | $60.11 | $1,097.02 | 1.3× | $4,552 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 12 | — | — | $217.65 | $1,315 | 1.5× | $4,552 |
| Colonoscopy diagnostic | CPT | 45378 | 12 | — | — | $332.71 | $1,729 | 2.0× | $5,125 |
| Colonoscopy with biopsy | CPT | 45380 | 12 | — | — | $332.71 | $1,729 | 1.4× | $5,125 |
| Colonoscopy with polyp removal | CPT | 45385 | 12 | — | — | $332.71 | $1,729 | 1.4× | $5,125 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 11 | — | — | $1,391.87 | $13,278 | 3.2× | $14,448 |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 7 | — | — | $11,054 | $23,368 | 0.84× | $70,481 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 7 | — | — | $11,054 | $15,427 | 0.84× | $66,233 |
| Hip hemiarthroplasty | CPT | 27125 | 11 | — | — | $1,079.36 | $2,980.71 | 2.4× | $13,640 |
| Total hip replacement | CPT | 27130 | 12 | — | — | $1,294.96 | $13,183 | 3.0× | $14,448 |
| Total knee replacement | CPT | 27447 | 12 | — | — | $1,294.26 | $13,183 | 3.2× | $14,448 |
| Knee revision arthroplasty single component | CPT | 27486 | 11 | — | — | $1,343.02 | $13,278 | 7.9× | $14,448 |
| Knee revision arthroplasty all components | CPT | 27487 | 11 | — | — | $1,679.74 | $13,278 | 6.6× | $14,448 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 9 | — | — | $168.17 | $1,872 | 5.7× | $11,780 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 12 | — | — | $1,965.14 | $6,802.86 | 2.1× | $8,696 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 12 | — | — | $1,058.82 | $3,073.42 | 1.5× | $11,780 |
| ACL reconstruction | CPT | 29888 | 12 | — | — | $1,638 | $6,802.86 | 2.0× | $8,696 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 5 | — | — | $35,408 | $35,408 | 0.82× | $109,369 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 5 | — | — | $19,272 | $19,272 | 0.83× | $57,252 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 5 | — | — | $13,485 | $13,485 | 0.82× | $38,561 |
| CABG single arterial graft | CPT | 33533 | 7 | — | — | $1,381 | $2,025 | 1.1× | $3,793.41 |
| CABG 2 arterial grafts | CPT | 33534 | 7 | — | — | $1,381 | $2,025 | 0.94× | $3,793.41 |
| CABG 3 arterial grafts | CPT | 33535 | 7 | — | — | $1,381 | $2,025 | 0.89× | $3,793.41 |
| CABG 4+ arterial grafts | CPT | 33536 | 7 | — | — | $1,381 | $2,025 | 0.83× | $3,793.41 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 5 | — | — | $10,688 | $13,331 | 0.81× | $38,065 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 5 | — | — | $10,688 | $10,728 | 0.79× | $29,656 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 5 | — | — | $26,079 | $26,079 | 0.81× | $79,239 |
| Open appendectomy | CPT | 44950 | 11 | — | — | $1,154.72 | $3,363.87 | 3.0× | $4,071 |
| Laparoscopic appendectomy | CPT | 44970 | 12 | — | — | $1,589.51 | $5,494.93 | 3.5× | $8,696 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 5 | — | — | $17,452 | $48,543 | 0.98× | $170,584 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 6 | — | — | $17,452 | $29,002 | 0.86× | $99,655 |
| Major joint replacement w MCC | MS-DRG | 469 | 6 | — | — | $23,080 | $23,080 | 0.78× | $69,550 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 6 | — | — | $14,810 | $14,810 | 0.78× | $54,619 |
| Laparoscopic cholecystectomy | CPT | 47562 | 12 | — | — | $1,589.51 | $5,494.93 | 3.1× | $15,372 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 12 | — | — | $1,589.51 | $5,494.93 | 2.9× | $15,372 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 6 | — | — | $17,452 | $22,661 | 0.81× | $68,199 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 6 | — | — | $16,176 | $16,499 | 0.81× | $54,619 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 6 | — | — | $13,043 | $13,304 | 0.83× | $54,619 |
| Open umbilical hernia repair | CPT | 49560 | 12 | — | — | $1,154.72 | $3,456.74 | 1.8× | $8,107 |
| Umbilical hernia repair age 5+ | CPT | 49585 | 12 | — | — | $1,154.72 | $3,456.74 | 2.6× | $8,107 |
| Lap inguinal hernia repair | CPT | 49650 | 12 | — | — | $1,589.51 | $5,494.93 | 4.9× | $8,696 |
| Lap incisional hernia repair | CPT | 49652 | 12 | — | — | $1,589.51 | $5,494.93 | 2.0× | $11,088 |
| Total abdominal hysterectomy | CPT | 58150 | 9 | — | — | $963.35 | $2,236.5 | 2.3× | $9,089 |
| Vaginal hysterectomy | CPT | 58260 | 12 | — | — | $1,430.56 | $4,321.01 | 2.4× | $11,088 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 12 | — | — | $1,589.51 | $5,494.93 | 3.7× | $11,088 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 12 | — | — | $2,590.67 | $7,934 | 3.6× | $9,865.92 |
| Lap salpingo-oophorectomy | CPT | 58661 | 12 | — | — | $1,589.51 | $5,494.93 | 2.7× | $8,696 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 11 | — | — | $11,512 | $23,146 | 0.85× | $69,025 |
| OR procedure for obesity w CC | MS-DRG | 620 | 11 | — | — | $11,512 | $19,722 | 1.2× | $58,741 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 11 | — | — | $11,512 | $19,722 | 1.3× | $58,741 |
| Complex cataract surgery | CPT | 66982 | 12 | — | — | $771.57 | $2,978 | 1.3× | $10,422 |
| Cataract surgery with lens implant | CPT | 66984 | 12 | — | — | $771.57 | $2,978 | 1.4× | $10,422 |
| Intravitreal injection | CPT | 67028 | 11 | — | — | $97.47 | $629.5 | 1.8× | $4,552 |
| Vitrectomy mechanical | CPT | 67042 | 12 | — | — | $1,417.92 | $4,321.01 | 1.7× | $11,088 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 5 | — | — | $9,451.23 | $9,451.23 | 0.77× | $25,532 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 5 | — | — | $14,071 | $14,071 | 0.74× | $40,453 |