| behavioral |
| Psychoses | MS-DRG | 885 | 12 | — | $2,486 | $60 | $9,148.45 | 0.71× | $34,888 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 12 | $914 | $154.46 | $135.82 | $533.95 | 3.0× | $836.12 |
| Psychiatric eval with medical services | CPT | 90792 | 12 | $915 | $154.63 | $135.96 | $549 | 3.2× | $837.04 |
| Psychotherapy 30 minutes | CPT | 90832 | 12 | $547 | $92.44 | $81.28 | $328.2 | 2.2× | $500.39 |
| Psychotherapy 45 minutes | CPT | 90834 | 12 | $606 | $102.41 | $90.05 | $354.02 | 2.2× | $554.36 |
| Psychotherapy 60 minutes | CPT | 90837 | 12 | $725 | $122.52 | $90.26 | $423.54 | 2.2× | $663.23 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 14 | — | — | $14.45 | $77.36 | 0.49× | $349.42 |
| emergency |
| ED visit level 1 | CPT | 99281 | 13 | $915 | $154.63 | $6.03 | $421 | 3.0× | $2,409 |
| ED visit level 2 | CPT | 99282 | 13 | $1,575 | $266.17 | $21.98 | $421 | 1.8× | $2,962 |
| ED visit level 3 | CPT | 99283 | 13 | $2,428 | $410.33 | $38.87 | $1,548 | 3.8× | $2,962 |
| ED visit level 4 | CPT | 99284 | 13 | $3,145 | $531.5 | $66.11 | $1,776 | 2.7× | $3,339 |
| ED visit level 5 | CPT | 99285 | 13 | $5,117 | $864.77 | $95.73 | $1,776 | 1.7× | $3,339 |
| Critical care, first hour | CPT | 99291 | 13 | $5,512 | $931.52 | $152.74 | $1,810 | 1.7× | $3,339 |
| imaging |
| CT head without contrast | CPT | 70450 | 13 | $2,085 | $352.36 | $59.63 | $225.5 | 1.1× | $1,907.35 |
| CT head with contrast | CPT | 70460 | 13 | $2,305 | $389.54 | $83.46 | $287.91 | 1.2× | $2,108.61 |
| CT head with and without contrast | CPT | 70470 | 13 | $2,934 | $495.84 | $97.79 | $316.01 | 1.2× | $2,684.02 |
| CT neck with contrast | CPT | 70491 | 13 | $3,096 | $523.22 | $103.8 | $331.4 | 1.2× | $2,832.22 |
| MRI brain without contrast | CPT | 70551 | 13 | $3,279 | $554.15 | $110.75 | $436 | 1.1× | $2,999.62 |
| MRI brain with contrast | CPT | 70552 | 13 | $3,615 | $610.93 | $152.96 | $537.18 | 1.1× | $3,307 |
| MRI brain with and without contrast | CPT | 70553 | 13 | $5,038 | $851.42 | $179.88 | $603.32 | 1.0× | $4,608.76 |
| Chest X-ray single view | CPT | 71045 | 13 | $426 | $71.99 | $14.1 | $96.23 | 1.0× | $389.7 |
| Chest X-ray 2 views | CPT | 71046 | 13 | $493 | $83.31 | $18.52 | $96.23 | 0.98× | $450.99 |
| Chest X-ray 3 views | CPT | 71047 | 13 | $629 | $106.3 | $23.3 | $96.23 | 1.0× | $575.4 |
| CT chest without contrast | CPT | 71250 | 13 | $3,358 | $567.5 | $74.78 | $231.28 | 1.1× | $3,071.89 |
| CT chest with contrast | CPT | 71260 | 13 | $4,261 | $720.1 | $94.2 | $311.46 | 1.1× | $3,897.96 |
| CT chest with and without contrast | CPT | 71270 | 13 | $4,620 | $780.78 | $110.82 | $340.46 | 1.2× | $4,226.37 |
| MRI chest without contrast | CPT | 71550 | 13 | $1,464 | $247.41 | $168.91 | $414 | 0.96× | $2,917 |
| MRI chest with contrast | CPT | 71551 | 13 | $3,550 | $599.95 | $212.27 | $863.44 | 1.1× | $3,247.54 |
| MRI chest with and without contrast | CPT | 71552 | 13 | $4,042 | $683.09 | $264.25 | $603.32 | 1.0× | $3,697.62 |
| Lumbosacral spine X-ray | CPT | 72100 | 13 | $533 | $90.07 | $22.04 | $116.22 | 1.1× | $487.58 |
| CT cervical spine without contrast | CPT | 72125 | 13 | $3,779 | $638.65 | $73.2 | $231.83 | 1.2× | $3,457.02 |
| CT thoracic spine without contrast | CPT | 72128 | 13 | $2,850 | $481.65 | $73.02 | $230.95 | 1.2× | $2,607.18 |
| CT lumbar spine without contrast | CPT | 72131 | 13 | $3,681 | $622.08 | $72.65 | $231.28 | 1.1× | $3,367.37 |
| MRI cervical spine without contrast | CPT | 72141 | 13 | $2,756 | $465.76 | $107.59 | $409.54 | 1.0× | $2,917 |
| MRI thoracic spine without contrast | CPT | 72146 | 13 | $2,996 | $506.32 | $107.41 | $432.92 | 1.2× | $2,917 |
| MRI lumbar spine without contrast | CPT | 72148 | 13 | $2,854 | $482.32 | $107.97 | $414 | 1.1× | $2,917 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 13 | $3,356 | $567.16 | $153.13 | $516.12 | 1.1× | $3,070.06 |
| MRI cervical spine with and without contrast | CPT | 72156 | 13 | $4,909 | $829.62 | $180.81 | $603.32 | 1.1× | $4,490.75 |
| MRI lumbar spine with contrast | CPT | 72158 | 13 | $4,859 | $821.17 | $180.45 | $603.32 | 1.1× | $4,445.01 |
| CT pelvis without contrast | CPT | 72192 | 13 | $2,020 | $341.38 | $74.77 | $231.28 | 1.2× | $1,847.89 |
| CT pelvis with contrast | CPT | 72193 | 13 | $2,563 | $433.14 | $128.38 | $340.46 | 1.2× | $2,344.63 |
| Shoulder X-ray | CPT | 73030 | 14 | $1,656 | — | $14.45 | $91.48 | 0.98× | $191.5 |
| Humerus X-ray | CPT | 73060 | 14 | $713 | — | $14.45 | $91.48 | 1.0× | $191.5 |
| Hand X-ray 3 views | CPT | 73130 | 14 | $1,732 | — | $14.45 | $91.48 | 0.98× | $191.5 |
| MRI upper extremity joint without contrast | CPT | 73221 | 14 | $5,654 | — | $14.45 | $319.46 | 0.77× | $2,917 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 14 | $6,234 | — | $14.45 | $425 | 0.70× | $2,917 |
| Knee X-ray 1-2 views | CPT | 73560 | 14 | $1,398 | — | $14.45 | $91.48 | 0.98× | $191.5 |
| Ankle X-ray 3 views | CPT | 73610 | 14 | $1,588 | — | $14.45 | $91.48 | 0.99× | $191.5 |
| MRI lower extremity joint without contrast | CPT | 73721 | 14 | $2,458 | — | $14.45 | $319.46 | 0.68× | $2,917 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 14 | $4,353 | — | $14.45 | $425 | 0.67× | $2,917 |
| CT abdomen without contrast | CPT | 74150 | 13 | $1,895 | $320.25 | $76.7 | $231.28 | 1.2× | $1,733.54 |
| CT abdomen with contrast | CPT | 74160 | 13 | $2,766 | $467.45 | $131.23 | $340.46 | 1.2× | $2,530.33 |
| CT abdomen with and without contrast | CPT | 74170 | 13 | $3,279 | $554.15 | $134.25 | $340.46 | 1.0× | $2,999.62 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 13 | $3,040 | $513.76 | $102.65 | $368.2 | 1.0× | $2,780.99 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 13 | $3,605 | $609.24 | $171.5 | $520.92 | 0.95× | $3,297.85 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 13 | $4,549 | $768.78 | $192.46 | $603.32 | 1.0× | $4,161.42 |
| MRI abdomen without contrast | CPT | 74181 | 13 | $3,177 | $536.91 | $110.58 | $436 | 1.1× | $2,917 |
| MRI abdomen with and without contrast | CPT | 74183 | 13 | $4,413 | $745.79 | $191.32 | $649.32 | 1.1× | $4,037.01 |
| Abdominal ultrasound complete | CPT | 76700 | 13 | $1,091 | $184.37 | $63.94 | $169.43 | 1.1× | $998.04 |
| Abdominal ultrasound limited | CPT | 76705 | 13 | $942 | $159.19 | $47.83 | $139.98 | 0.96× | $960 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 13 | $1,278 | $215.98 | $59.56 | $164.12 | 1.1× | $1,169.11 |
| Obstetric ultrasound first trimester | CPT | 76801 | 13 | $743 | $125.56 | $64.3 | $139.85 | 0.99× | $960 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 13 | $931 | $157.33 | $74.52 | $169.43 | 1.1× | $960 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 13 | $923 | $155.98 | $96.76 | $264.17 | 1.1× | $960 |
| Transvaginal ultrasound | CPT | 76830 | 13 | $1,069 | $180.66 | $65.74 | $152.15 | 1.0× | $977.92 |
| Pelvic ultrasound complete | CPT | 76856 | 13 | $1,331 | $224.93 | $57.94 | $152.15 | 1.1× | $1,217.59 |
| Scrotal ultrasound | CPT | 76870 | 13 | $1,376 | $232.54 | $55.03 | $154.14 | 1.2× | $1,258.76 |
| Diagnostic mammography unilateral | CPT | 77065 | 10 | $619 | — | $14.45 | $102.24 | 0.68× | $454.85 |
| Diagnostic mammography bilateral | CPT | 77066 | 9 | $783 | $132.32 | $87.32 | $151.66 | 0.80× | $716.28 |
| Screening mammography bilateral | CPT | 77067 | 9 | $634 | $107.14 | $70.49 | $125.79 | 0.80× | $579.98 |
| EKG complete | CPT | 93000 | 10 | — | — | $7.8 | $73.71 | 3.0× | $157 |
| EKG tracing only | CPT | 93005 | 13 | $359 | $60.67 | $3.53 | $138 | 1.2× | $328.41 |
| EKG interpretation only | CPT | 93010 | 10 | — | — | $4.27 | $60 | 3.3× | $91.48 |
| Transthoracic echocardiogram complete | CPT | 93306 | 13 | $4,616 | $780.1 | $107.81 | $1,048.65 | 1.8× | $4,222.71 |
| Transthoracic echocardiogram | CPT | 93307 | 13 | $1,291 | $218.17 | $74.96 | $569 | 2.3× | $1,181 |
| Stress echocardiogram | CPT | 93350 | 13 | $2,698 | $455.96 | $101.68 | $1,048.65 | 2.1× | $2,468.13 |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 13 | — | $2,486 | $60 | $29,896 | 1.9× | $57,567 |
| COPD w MCC | MS-DRG | 190 | 13 | — | $2,486 | $60 | $19,432 | 1.7× | $39,992 |
| COPD w CC | MS-DRG | 191 | 13 | — | $2,486 | $60 | $15,269 | 1.7× | $30,594 |
| COPD w/o CC/MCC | MS-DRG | 192 | 13 | — | $2,486 | $60 | $11,969 | 1.7× | $23,048 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 13 | — | $2,486 | $60 | $14,921 | 1.8× | $29,202 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 13 | — | $2,486 | $60 | $11,498 | 1.7× | $22,176 |
| AMI discharged alive w MCC | MS-DRG | 280 | 13 | — | $2,486 | $60 | $28,117 | 1.8× | $58,454 |
| AMI discharged alive w CC | MS-DRG | 281 | 13 | — | $2,486 | $60 | $16,116 | 1.7× | $32,827 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 13 | — | $2,486 | $60 | $12,544 | 1.6× | $25,822 |
| Heart failure & shock w MCC | MS-DRG | 291 | 13 | — | $2,486 | $60 | $23,184 | 1.8× | $46,467 |
| Heart failure & shock w CC | MS-DRG | 292 | 13 | — | $2,486 | $60 | $15,476 | 1.7× | $30,669 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 13 | — | $2,486 | $60 | $10,728 | 1.7× | $19,540 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 13 | — | $2,486 | $60 | $20,736 | 1.7× | $42,945 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 13 | — | $2,486 | $60 | $12,957 | 1.7× | $26,328 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 13 | — | $2,486 | $60 | $10,347 | 1.7× | $19,925 |
| GI hemorrhage w CC | MS-DRG | 378 | 13 | — | $2,486 | $60 | $17,172 | 1.7× | $35,110 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 13 | — | $2,486 | $60 | $11,015 | 1.6× | $22,674 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 13 | — | $2,486 | $60 | $13,216 | 1.6× | $27,788 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 13 | — | $2,486 | $60 | $25,157 | 1.7× | $54,305 |
| Kidney/UTI w MCC | MS-DRG | 689 | 13 | — | $2,486 | $60 | $19,307 | 1.7× | $41,677 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 13 | — | $2,486 | $60 | $13,697 | 1.6× | $28,582 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 13 | — | $2,486 | $60 | $32,370 | 1.7× | $69,874 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 13 | — | $2,486 | $60 | $17,663 | 1.7× | $36,716 |
| Initial hospital care, low complexity | CPT | 99221 | 10 | — | — | $14.45 | $91.48 | 0.98× | $11,330 |
| Initial hospital care, moderate complexity | CPT | 99222 | 11 | — | — | $14.45 | $3,527.5 | 20.9× | $11,330 |
| Initial hospital care, high complexity | CPT | 99223 | 11 | — | — | $14.45 | $3,527.5 | 15.7× | $11,330 |
| Hospital discharge, <30 min | CPT | 99238 | 11 | — | — | $14.45 | $3,527.5 | 41.2× | $11,330 |
| Hospital discharge, >30 min | CPT | 99239 | 11 | — | — | $14.45 | $3,527.5 | 29.1× | $11,330 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 13 | $164 | $9.31 | $3.98 | $8.46 | 0.26× | $150.02 |
| General health panel | CPT | 80050 | 10 | — | — | $15.82 | $46.44 | 0.43× | $161.56 |
| Electrolyte panel | CPT | 80051 | 13 | $133 | $7.71 | $3.29 | $7.01 | 0.29× | $121.66 |
| Comprehensive metabolic panel | CPT | 80053 | 13 | $328 | $11.62 | $4.96 | $10.56 | 0.24× | $300.05 |
| Lipid panel | CPT | 80061 | 13 | $247 | $14.73 | $6.29 | $13.39 | 0.35× | $225.95 |
| Renal function panel | CPT | 80069 | 13 | $210 | $9.55 | $4.08 | $8.68 | 0.32× | $192.1 |
| Hepatic function panel | CPT | 80076 | 13 | $180 | $8.99 | $3.84 | $8.17 | 0.31× | $164.66 |
| Urinalysis non-automated | CPT | 81002 | 13 | $43 | $3.83 | $1.64 | $3.48 | 0.50× | $39.33 |
| Urinalysis automated | CPT | 81003 | 13 | $77 | $2.48 | $1.06 | $2.25 | 0.16× | $70.43 |
| Glucose quantitative | CPT | 82947 | 13 | $64 | $4.32 | $1.85 | $3.93 | 0.22× | $58.54 |
| Hemoglobin A1c | CPT | 83036 | 13 | $242 | $10.68 | $4.56 | $9.71 | 0.36× | $221.38 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 13 | $275 | $18.48 | $7.9 | $16.8 | 0.36× | $251.57 |
| Complete blood count with automated differential | CPT | 85025 | 13 | $146 | $8.55 | $3.65 | $7.77 | 0.29× | $133.56 |
| Complete blood count without differential | CPT | 85027 | 13 | $102 | $7.12 | $3.04 | $6.47 | 0.30× | $93.3 |
| Urine culture bacterial | CPT | 87086 | 13 | $257 | $8.88 | $3.79 | $8.07 | 0.35× | $235.1 |
| Urine culture identification | CPT | 87088 | 13 | $123 | $8.9 | $3.8 | $8.09 | 0.36× | $112.52 |
| Tissue exam by pathologist level IV | CPT | 88305 | 13 | $819 | $138.41 | $23.57 | $62.61 | 0.61× | $749.22 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 13 | $1,455 | $6,311 | $26.84 | $392.6 | 2.1× | $9,057 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 9 | — | $6,311 | $14.45 | $67.19 | 0.03× | $9,057 |
| Vaginal delivery only | CPT | 59409 | 13 | — | $6,311 | $14.45 | $856.38 | 0.39× | $9,057 |
| Vaginal delivery with postpartum | CPT | 59410 | 9 | — | $6,311 | $14.45 | $67.19 | 0.06× | $9,057 |
| Routine obstetric care with C-section | CPT | 59510 | 9 | — | $6,311 | $14.45 | $67.19 | 0.03× | $9,057 |
| C-section delivery only | CPT | 59514 | 9 | — | $6,311 | $14.45 | $67.19 | 0.07× | $9,057 |
| C-section with postpartum | CPT | 59515 | 9 | — | $6,311 | $14.45 | $67.19 | 0.05× | $9,057 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 9 | $391 | $66.07 | $40.83 | $247.54 | 2.9× | $357.68 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 9 | $578 | $97.68 | $62.83 | $365.93 | 3.0× | $528.75 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 9 | $697 | $117.79 | $93.94 | $441.27 | 2.5× | $637.61 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 9 | $809 | $136.72 | $116.9 | $512.18 | 2.3× | $740.07 |
| Office visit, established patient, 5 min | CPT | 99211 | 9 | $305 | $51.54 | $12.81 | $193.1 | 3.0× | $279.01 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 9 | $465 | $78.58 | $32.03 | $294.39 | 3.7× | $425.38 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 9 | $513 | $86.69 | $51.22 | $324.78 | 2.8× | $469.29 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 9 | $564 | $95.31 | $72.14 | $357.07 | 2.3× | $515.94 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 9 | $665 | $112.38 | $96.09 | $421.01 | 2.2× | $608.34 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 13 | — | $6,311 | $14.45 | $1,024.64 | 1.1× | $9,057 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 13 | — | $6,311 | $14.45 | $1,024.64 | 1.1× | $9,057 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 13 | — | $6,311 | $14.45 | $996.39 | 1.2× | $9,057 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 13 | — | $6,311 | $14.45 | $996.39 | 1.1× | $9,057 |
| Colonoscopy diagnostic | CPT | 45378 | 13 | — | $6,311 | $14.45 | $996.39 | 1.1× | $9,057 |
| Colonoscopy with biopsy | CPT | 45380 | 13 | — | $6,311 | $14.45 | $1,288.59 | 1.1× | $9,057 |
| Colonoscopy with polyp removal | CPT | 45385 | 13 | — | $6,311 | $14.45 | $1,288.59 | 1.1× | $9,057 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 13 | — | $6,311 | $14.45 | $20,016 | 4.8× | $39,995 |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 3 | — | — | $20,731 | $50,166 | 1.8× | $67,732 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 3 | — | — | $13,295 | $38,729 | 2.1× | $46,288 |
| Hip hemiarthroplasty | CPT | 27125 | 9 | — | $6,311 | $14.45 | $8,222 | 6.6× | $26,240 |
| Total hip replacement | CPT | 27130 | 13 | — | $6,311 | $14.45 | $14,062 | 3.2× | $27,983 |
| Total knee replacement | CPT | 27447 | 13 | — | $6,311 | $14.45 | $14,062 | 3.4× | $27,983 |
| Knee revision arthroplasty single component | CPT | 27486 | 9 | — | $6,311 | $14.45 | $8,222 | 4.9× | $26,240 |
| Knee revision arthroplasty all components | CPT | 27487 | 9 | — | $6,311 | $14.45 | $8,222 | 4.1× | $26,240 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 9 | — | $6,311 | $14.45 | $92.3 | 0.28× | $22,013 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 13 | — | $6,311 | $14.45 | $7,807.24 | 2.4× | $22,013 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 13 | — | $6,311 | $14.45 | $3,545.97 | 1.7× | $22,013 |
| ACL reconstruction | CPT | 29888 | 13 | — | $6,311 | $14.45 | $7,807.24 | 2.3× | $22,013 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 13 | — | $2,486 | $60 | $83,861 | 1.9× | $163,527 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 13 | — | $2,486 | $60 | $43,714 | 1.9× | $84,176 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 13 | — | $2,486 | $60 | $29,568 | 1.8× | $58,795 |
| CABG single arterial graft | CPT | 33533 | 9 | — | $6,311 | $14.45 | $85.66 | 0.05× | $9,057 |
| CABG 2 arterial grafts | CPT | 33534 | 9 | — | $6,311 | $14.45 | $85.66 | 0.04× | $9,057 |
| CABG 3 arterial grafts | CPT | 33535 | 9 | — | $6,311 | $14.45 | $85.66 | 0.04× | $9,057 |
| CABG 4+ arterial grafts | CPT | 33536 | 9 | — | $6,311 | $14.45 | $85.66 | 0.04× | $9,057 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 13 | — | $2,486 | $60 | $29,187 | 1.8× | $59,059 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 13 | — | $2,486 | $60 | $22,740 | 1.7× | $46,922 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 13 | — | $2,486 | $60 | $60,759 | 1.9× | $125,693 |
| Open appendectomy | CPT | 44950 | 13 | — | $6,311 | $14.45 | $385.03 | 0.34× | $13,570 |
| Laparoscopic appendectomy | CPT | 44970 | 13 | — | $6,311 | $14.45 | $6,376.26 | 4.1× | $13,407 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 3 | — | — | $5,565 | $144,934 | 2.9× | $190,075 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 3 | — | — | $5,565 | $82,318 | 2.5× | $104,832 |
| Major joint replacement w MCC | MS-DRG | 469 | 13 | — | $2,486 | $60 | $53,926 | 1.8× | $116,405 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 13 | — | $2,486 | $60 | $27,209 | 1.4× | $71,289 |
| Laparoscopic cholecystectomy | CPT | 47562 | 13 | — | $6,311 | $14.45 | $6,376.26 | 3.6× | $13,407 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 13 | — | $6,311 | $14.45 | $6,376.26 | 3.4× | $13,407 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 13 | — | $2,486 | $60 | $52,293 | 1.9× | $104,735 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 13 | — | $2,486 | $60 | $36,231 | 1.8× | $73,891 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 13 | — | $2,486 | $60 | $28,473 | 1.8× | $56,495 |
| Lap inguinal hernia repair | CPT | 49650 | 13 | — | $6,311 | $14.45 | $6,376.26 | 5.7× | $13,407 |
| Total abdominal hysterectomy | CPT | 58150 | 9 | — | $6,311 | $14.45 | $85.86 | 0.09× | $10,973 |
| Vaginal hysterectomy | CPT | 58260 | 13 | — | $6,311 | $14.45 | $5,394.95 | 3.0× | $13,206 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 13 | — | $6,311 | $14.45 | $6,376.26 | 4.3× | $13,407 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 13 | — | $6,311 | $14.45 | $8,889 | 4.0× | $22,643 |
| Lap salpingo-oophorectomy | CPT | 58661 | 13 | — | $6,311 | $14.45 | $6,376.26 | 3.1× | $13,407 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 13 | — | $2,486 | $60 | $28,164 | 1.0× | $91,136 |
| OR procedure for obesity w CC | MS-DRG | 620 | 13 | — | $2,486 | $60 | $23,447 | 1.4× | $53,381 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 13 | — | $2,486 | $60 | $23,447 | 1.5× | $48,862 |
| Complex cataract surgery | CPT | 66982 | 13 | — | $6,311 | $14.45 | $2,492.56 | 1.1× | $12,048 |
| Cataract surgery with lens implant | CPT | 66984 | 13 | — | $6,311 | $14.45 | $2,492.56 | 1.1× | $12,048 |
| Intravitreal injection | CPT | 67028 | 13 | — | $6,311 | $14.45 | $362.5 | 1.1× | $9,057 |
| Vitrectomy mechanical | CPT | 67042 | 13 | — | $6,311 | $14.45 | $4,396.5 | 1.7× | $13,407 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 13 | — | $2,486 | $60 | $19,776 | 1.6× | $42,688 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 13 | — | $2,486 | $60 | $32,236 | 1.7× | $69,586 |
| PCI single major coronary artery | CPT | 92920 | 14 | $12,587 | — | $14.45 | $11,652 | 2.1× | $55,450 |
| PCI with drug-eluting stent | CPT | 92928 | 14 | $21,044 | — | $14.45 | $17,664 | 1.8× | $55,450 |
| PCI bypass graft | CPT | 92937 | 14 | $19,654 | — | $14.45 | $17,664 | 1.6× | $55,450 |
| Left heart catheterization | CPT | 93452 | 13 | $14,112 | $2,384.92 | $487.31 | $9,331 | 3.0× | $20,471 |
| Coronary angiography with cath | CPT | 93455 | 13 | $20,940 | $3,538.86 | $547.11 | $11,058 | 3.5× | $20,471 |
| Coronary angiography with bypass cath | CPT | 93458 | 13 | $21,415 | $3,619.13 | $564.75 | $11,074 | 3.6× | $20,471 |