| behavioral |
| Psychoses | MS-DRG | 885 | 12 | — | $3,629 | $60 | $7,863.5 | 0.61× | $29,394 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 12 | $858 | $187.73 | $177.84 | $504.59 | 2.8× | $829.77 |
| Psychiatric eval with medical services | CPT | 90792 | 12 | $965 | $211.14 | $177.84 | $567.52 | 3.3× | $933.25 |
| Psychotherapy 30 minutes | CPT | 90832 | 12 | $461 | $100.86 | $88.66 | $276.6 | 1.9× | $445.83 |
| Psychotherapy 45 minutes | CPT | 90834 | 12 | $518 | $113.33 | $100.17 | $310.8 | 1.9× | $500.95 |
| Psychotherapy 60 minutes | CPT | 90837 | 12 | $567 | $124.05 | $90.26 | $340.2 | 1.8× | $548.34 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 12 | $667 | $145.93 | $92.82 | $392.26 | 2.5× | $645.05 |
| emergency |
| ED visit level 1 | CPT | 99281 | 13 | $1,052 | $230.17 | $97.46 | $564.5 | 4.0× | $2,838 |
| ED visit level 2 | CPT | 99282 | 13 | $1,427 | $312.22 | $140 | $564.5 | 2.4× | $2,838 |
| ED visit level 3 | CPT | 99283 | 13 | $2,261 | $494.7 | $306.48 | $1,342.3 | 3.3× | $2,838 |
| ED visit level 4 | CPT | 99284 | 13 | $3,099 | $678.06 | $471.32 | $1,571.5 | 2.4× | $2,997.04 |
| ED visit level 5 | CPT | 99285 | 13 | $4,357 | $953.31 | $620 | $1,571.5 | 1.5× | $4,213.65 |
| Critical care, first hour | CPT | 99291 | 13 | $5,566 | $1,217.84 | $932.65 | $1,791.99 | 1.7× | $5,382.87 |
| imaging |
| CT head without contrast | CPT | 70450 | 13 | $2,085 | $456.19 | $57 | $234.22 | 1.1× | $2,016.4 |
| CT head with contrast | CPT | 70460 | 13 | $2,305 | $504.33 | $57 | $296 | 1.3× | $2,229.16 |
| CT head with and without contrast | CPT | 70470 | 13 | $2,934 | $641.95 | $57 | $307.08 | 1.2× | $2,837.47 |
| CT neck with contrast | CPT | 70491 | 13 | $3,005 | $657.49 | $57 | $322.04 | 1.2× | $2,906.13 |
| MRI brain without contrast | CPT | 70551 | 13 | $3,279 | $717.44 | $57 | $468.21 | 1.2× | $3,317 |
| MRI brain with contrast | CPT | 70552 | 13 | $3,615 | $790.96 | $57 | $603.32 | 1.3× | $3,496.06 |
| MRI brain with and without contrast | CPT | 70553 | 13 | $5,038 | $1,102.31 | $57 | $691.76 | 1.2× | $4,872.24 |
| Chest X-ray single view | CPT | 71045 | 13 | $494 | $108.08 | $20.09 | $97.46 | 1.0× | $477.74 |
| Chest X-ray 2 views | CPT | 71046 | 13 | $510 | $111.58 | $30.85 | $116.42 | 1.2× | $493.22 |
| Chest X-ray 3 views | CPT | 71047 | 13 | $541 | $118.37 | $39.46 | $116.42 | 1.2× | $523.2 |
| CT chest without contrast | CPT | 71250 | 13 | $2,195 | $480.26 | $57 | $239.39 | 1.1× | $2,122.78 |
| CT chest with contrast | CPT | 71260 | 13 | $2,983 | $652.68 | $57 | $302.68 | 1.1× | $2,884.85 |
| CT chest with and without contrast | CPT | 71270 | 13 | $3,652 | $799.05 | $57 | $370.45 | 1.3× | $3,531.84 |
| MRI chest without contrast | CPT | 71550 | 13 | $2,920 | $638.89 | $57 | $532.42 | 1.2× | $3,317 |
| MRI chest with contrast | CPT | 71551 | 13 | $3,808 | $833.19 | $57 | $964.56 | 1.2× | $3,682.71 |
| MRI chest with and without contrast | CPT | 71552 | 13 | $4,726 | $1,034.04 | $57 | $794.37 | 1.3× | $4,570.51 |
| Lumbosacral spine X-ray | CPT | 72100 | 13 | $533 | $116.62 | $36.08 | $118.54 | 1.1× | $515.46 |
| CT cervical spine without contrast | CPT | 72125 | 13 | $2,209 | $483.32 | $57 | $234.22 | 1.2× | $2,136.32 |
| CT thoracic spine without contrast | CPT | 72128 | 13 | $2,008 | $439.35 | $57 | $234.22 | 1.2× | $1,941.93 |
| CT lumbar spine without contrast | CPT | 72131 | 13 | $2,093 | $457.94 | $57 | $239.39 | 1.2× | $2,024.14 |
| MRI cervical spine without contrast | CPT | 72141 | 13 | $2,756 | $603.01 | $57 | $468.21 | 1.2× | $3,317 |
| MRI thoracic spine without contrast | CPT | 72146 | 13 | $2,996 | $655.52 | $57 | $468.21 | 1.3× | $3,317 |
| MRI lumbar spine without contrast | CPT | 72148 | 13 | $2,854 | $624.45 | $57 | $468.21 | 1.2× | $3,317 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 13 | $3,356 | $734.29 | $57 | $603.32 | 1.3× | $3,317 |
| MRI cervical spine with and without contrast | CPT | 72156 | 13 | $4,909 | $1,074.08 | $57 | $691.76 | 1.3× | $4,747.49 |
| MRI lumbar spine with contrast | CPT | 72158 | 13 | $4,859 | $1,063.14 | $57 | $691.76 | 1.3× | $4,699.13 |
| CT pelvis without contrast | CPT | 72192 | 13 | $2,020 | $441.97 | $57 | $235.57 | 1.2× | $1,953.54 |
| CT pelvis with contrast | CPT | 72193 | 13 | $2,563 | $560.78 | $57 | $392.11 | 1.4× | $2,478.67 |
| Shoulder X-ray | CPT | 73030 | 14 | $1,140 | — | $21.88 | $94.15 | 1.0× | $193.95 |
| Humerus X-ray | CPT | 73060 | 14 | $519 | — | $21.88 | $94.15 | 1.1× | $193.95 |
| Hand X-ray 3 views | CPT | 73130 | 14 | $1,074 | — | $21.88 | $94.15 | 1.0× | $193.95 |
| MRI upper extremity joint without contrast | CPT | 73221 | 14 | $3,173 | — | $21.88 | $326 | 0.78× | $3,317 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 14 | $4,658 | — | $21.88 | $436 | 0.71× | $3,317 |
| Knee X-ray 1-2 views | CPT | 73560 | 14 | $1,072 | — | $21.88 | $94.15 | 1.0× | $193.95 |
| Ankle X-ray 3 views | CPT | 73610 | 14 | $958 | — | $21.88 | $94.15 | 1.0× | $193.95 |
| MRI lower extremity joint without contrast | CPT | 73721 | 14 | $4,916 | — | $21.88 | $326 | 0.70× | $3,317 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 14 | $4,353 | — | $21.88 | $436 | 0.69× | $3,317 |
| CT abdomen without contrast | CPT | 74150 | 13 | $2,001 | $437.81 | $57 | $234.22 | 1.2× | $1,935.16 |
| CT abdomen with contrast | CPT | 74160 | 13 | $2,990 | $654.21 | $57 | $392.11 | 1.4× | $2,891.62 |
| CT abdomen with and without contrast | CPT | 74170 | 13 | $3,739 | $818.09 | $57 | $392.11 | 1.2× | $3,615.98 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 13 | $3,040 | $665.15 | $57 | $368.2 | 1.0× | $2,939.98 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 13 | $3,605 | $788.77 | $57 | $581.67 | 1.1× | $3,486.39 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 13 | $4,549 | $995.32 | $57 | $603.32 | 1.0× | $4,399.33 |
| MRI abdomen without contrast | CPT | 74181 | 13 | $3,098 | $677.84 | $57 | $468.21 | 1.2× | $3,317 |
| MRI abdomen with and without contrast | CPT | 74183 | 13 | $4,542 | $993.78 | $57 | $691.76 | 1.2× | $4,392.56 |
| Abdominal ultrasound complete | CPT | 76700 | 13 | $1,091 | $238.71 | $57 | $205.98 | 1.4× | $1,055.1 |
| Abdominal ultrasound limited | CPT | 76705 | 13 | $942 | $206.1 | $57 | $174.5 | 1.2× | $911 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 13 | $994 | $217.48 | $57 | $205.98 | 1.4× | $961.29 |
| Obstetric ultrasound first trimester | CPT | 76801 | 13 | $743 | $162.56 | $57 | $183.91 | 1.3× | $718.55 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 13 | $931 | $203.7 | $57 | $225.9 | 1.5× | $900.37 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 13 | $923 | $201.95 | $57 | $267.55 | 1.1× | $892.63 |
| Transvaginal ultrasound | CPT | 76830 | 13 | $1,069 | $233.89 | $57 | $202.86 | 1.4× | $1,033.82 |
| Pelvic ultrasound complete | CPT | 76856 | 13 | $1,138 | $248.99 | $57 | $190.92 | 1.3× | $1,100.55 |
| Scrotal ultrasound | CPT | 76870 | 13 | $908 | $198.67 | $57 | $183.89 | 1.4× | $878.12 |
| Diagnostic mammography unilateral | CPT | 77065 | 10 | $619 | — | $21.88 | $112.34 | 0.75× | $454.85 |
| Diagnostic mammography bilateral | CPT | 77066 | 9 | $783 | $171.32 | $57 | $196.45 | 1.0× | $757.23 |
| Screening mammography bilateral | CPT | 77067 | 9 | $634 | $138.71 | $57 | $159.27 | 1.0× | $613.14 |
| EKG complete | CPT | 93000 | 10 | — | — | $21.88 | $67.43 | 2.8× | $334 |
| EKG tracing only | CPT | 93005 | 13 | $359 | $78.54 | $65.75 | $215.4 | 1.8× | $347.18 |
| EKG interpretation only | CPT | 93010 | 10 | — | — | $18.04 | $60 | 3.3× | $96.71 |
| Transthoracic echocardiogram complete | CPT | 93306 | 13 | $4,118 | $901.01 | $413.8 | $1,977.73 | 3.3× | $3,982.51 |
| Transthoracic echocardiogram | CPT | 93307 | 13 | $2,033 | $444.82 | $258.7 | $1,023.75 | 4.1× | $1,966.11 |
| Stress echocardiogram | CPT | 93350 | 13 | $2,547 | $557.28 | $308.32 | $1,282.52 | 2.5× | $2,463.2 |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 13 | — | $3,629 | $60 | $26,717 | 1.7× | $43,143 |
| COPD w MCC | MS-DRG | 190 | 13 | — | $3,629 | $60 | $17,499 | 1.6× | $29,972 |
| COPD w CC | MS-DRG | 191 | 13 | — | $3,629 | $60 | $13,390 | 1.5× | $22,929 |
| COPD w/o CC/MCC | MS-DRG | 192 | 13 | — | $3,629 | $60 | $11,036 | 1.6× | $17,273 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 13 | — | $3,629 | $60 | $13,390 | 1.6× | $21,885 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 13 | — | $3,629 | $60 | $10,618 | 1.6× | $16,619 |
| AMI discharged alive w MCC | MS-DRG | 280 | 13 | — | $3,629 | $60 | $25,576 | 1.6× | $43,807 |
| AMI discharged alive w CC | MS-DRG | 281 | 13 | — | $3,629 | $60 | $15,697 | 1.6× | $24,602 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 13 | — | $3,629 | $60 | $12,364 | 1.6× | $19,352 |
| Heart failure & shock w MCC | MS-DRG | 291 | 13 | — | $3,629 | $60 | $20,331 | 1.6× | $34,824 |
| Heart failure & shock w CC | MS-DRG | 292 | 13 | — | $3,629 | $60 | $14,685 | 1.6× | $22,985 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 13 | — | $3,629 | $60 | $9,356 | 1.5× | $15,697 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 13 | — | $3,629 | $60 | $18,933 | 1.6× | $32,184 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 13 | — | $3,629 | $60 | $12,607 | 1.6× | $19,731 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 13 | — | $3,629 | $60 | $9,541 | 1.5× | $15,697 |
| GI hemorrhage w CC | MS-DRG | 378 | 13 | — | $3,629 | $60 | $15,494 | 1.5× | $26,313 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 13 | — | $3,629 | $60 | $10,857 | 1.6× | $16,993 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 13 | — | $3,629 | $60 | $13,306 | 1.7× | $20,825 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 13 | — | $3,629 | $60 | $25,693 | 1.7× | $40,698 |
| Kidney/UTI w MCC | MS-DRG | 689 | 13 | — | $3,629 | $60 | $18,496 | 1.6× | $31,234 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 13 | — | $3,629 | $60 | $13,390 | 1.6× | $21,421 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 13 | — | $3,629 | $60 | $31,224 | 1.7× | $52,366 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 13 | — | $3,629 | $60 | $16,220 | 1.6× | $27,516 |
| Initial hospital care, low complexity | CPT | 99221 | 10 | — | — | $21.88 | $95.43 | 1.0× | $11,042 |
| Initial hospital care, moderate complexity | CPT | 99222 | 11 | — | — | $21.88 | $3,317 | 19.6× | $11,042 |
| Initial hospital care, high complexity | CPT | 99223 | 11 | — | — | $21.88 | $3,317 | 14.7× | $11,042 |
| Hospital discharge, <30 min | CPT | 99238 | 11 | — | — | $21.88 | $3,317 | 38.7× | $11,042 |
| Hospital discharge, >30 min | CPT | 99239 | 11 | — | — | $21.88 | $3,317 | 27.3× | $11,042 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 13 | $164 | $9.31 | $3.98 | $10.41 | 0.32× | $158.6 |
| General health panel | CPT | 80050 | 10 | — | — | $19.11 | $58.02 | 0.54× | $161.56 |
| Electrolyte panel | CPT | 80051 | 13 | $133 | $7.71 | $3.29 | $8.62 | 0.36× | $128.62 |
| Comprehensive metabolic panel | CPT | 80053 | 13 | $328 | $11.62 | $4.96 | $12.99 | 0.29× | $317.2 |
| Lipid panel | CPT | 80061 | 13 | $247 | $14.73 | $6.29 | $16.47 | 0.43× | $238.87 |
| Renal function panel | CPT | 80069 | 13 | $210 | $9.55 | $4.08 | $8.85 | 0.32× | $203.09 |
| Hepatic function panel | CPT | 80076 | 13 | $180 | $8.99 | $3.84 | $10.05 | 0.38× | $174.07 |
| Urinalysis non-automated | CPT | 81002 | 13 | $43 | $3.83 | $1.64 | $3.55 | 0.51× | $57 |
| Urinalysis automated | CPT | 81003 | 13 | $77 | $2.48 | $1.06 | $2.46 | 0.18× | $74.46 |
| Glucose quantitative | CPT | 82947 | 13 | $46 | $4.32 | $1.85 | $3.93 | 0.22× | $57 |
| Hemoglobin A1c | CPT | 83036 | 13 | $115 | $10.68 | $4.56 | $10.82 | 0.40× | $111.21 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 13 | $275 | $18.48 | $7.9 | $20.66 | 0.44× | $265.95 |
| Complete blood count with automated differential | CPT | 85025 | 13 | $146 | $8.55 | $3.65 | $8.2 | 0.31× | $141.19 |
| Complete blood count without differential | CPT | 85027 | 13 | $102 | $7.12 | $3.04 | $7.87 | 0.36× | $98.64 |
| Urine culture bacterial | CPT | 87086 | 13 | $130 | $8.88 | $3.79 | $9.84 | 0.42× | $125.72 |
| Urine culture identification | CPT | 87088 | 13 | $78 | $8.9 | $3.8 | $8.25 | 0.37× | $75.43 |
| Tissue exam by pathologist level IV | CPT | 88305 | 13 | $429 | $93.86 | $23.57 | $62.03 | 0.61× | $414.88 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 13 | $1,064 | $5,419 | $57.62 | $481.7 | 2.6× | $4,294 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 9 | — | $5,419 | $24.85 | $65.47 | 0.03× | $4,294 |
| Vaginal delivery only | CPT | 59409 | 13 | — | $5,419 | $24.85 | $733.83 | 0.33× | $7,003.39 |
| Vaginal delivery with postpartum | CPT | 59410 | 9 | — | $5,419 | $24.85 | $65.44 | 0.06× | $4,294 |
| Routine obstetric care with C-section | CPT | 59510 | 9 | — | $5,419 | $24.85 | $65.47 | 0.03× | $4,294 |
| C-section delivery only | CPT | 59514 | 9 | — | $5,419 | $24.85 | $65.44 | 0.07× | $4,294 |
| C-section with postpartum | CPT | 59515 | 9 | — | $5,419 | $24.85 | $65.47 | 0.05× | $7,729 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 9 | $391 | $85.55 | $42.02 | $234.6 | 2.7× | $378.13 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 9 | $578 | $126.46 | $64.24 | $346.8 | 2.8× | $558.98 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 9 | $697 | $152.5 | $95.55 | $418.2 | 2.4× | $674.06 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 9 | $809 | $177 | $126.02 | $485.4 | 2.2× | $782.38 |
| Office visit, established patient, 5 min | CPT | 99211 | 9 | $305 | $66.73 | $16 | $183 | 2.8× | $294.96 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 9 | $465 | $101.74 | $49.06 | $279 | 3.5× | $449.7 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 9 | $513 | $112.24 | $81.6 | $307.8 | 2.7× | $496.12 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 9 | $564 | $123.4 | $119.85 | $338.4 | 2.2× | $545.44 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 9 | $665 | $145.5 | $161.06 | $399 | 2.1× | $643.12 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 13 | — | $5,419 | $24.85 | $1,037.75 | 1.1× | $4,523 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 13 | — | $5,419 | $24.85 | $1,037.75 | 1.1× | $5,153 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 13 | — | $5,419 | $24.85 | $1,009.14 | 1.2× | $4,294 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 13 | — | $5,419 | $24.85 | $1,009.14 | 1.1× | $4,294 |
| Colonoscopy diagnostic | CPT | 45378 | 13 | — | $5,419 | $24.85 | $1,009.14 | 1.1× | $5,153 |
| Colonoscopy with biopsy | CPT | 45380 | 13 | — | $5,419 | $24.85 | $1,305.08 | 1.1× | $5,153 |
| Colonoscopy with polyp removal | CPT | 45385 | 13 | — | $5,419 | $24.85 | $1,305.08 | 1.1× | $5,153 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 13 | — | $5,419 | $24.85 | $20,355 | 4.9× | $40,507 |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 3 | — | — | $6,640 | $49,781 | 1.8× | $72,676 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 3 | — | — | $6,640 | $20,137 | 1.1× | $46,228 |
| Hip hemiarthroplasty | CPT | 27125 | 9 | — | $5,419 | $24.85 | $3,266 | 2.6× | $26,990 |
| Total hip replacement | CPT | 27130 | 13 | — | $5,419 | $24.85 | $14,242 | 3.3× | $28,341 |
| Total knee replacement | CPT | 27447 | 13 | — | $5,419 | $24.85 | $14,242 | 3.4× | $28,341 |
| Knee revision arthroplasty single component | CPT | 27486 | 9 | — | $5,419 | $24.85 | $3,266 | 2.0× | $26,990 |
| Knee revision arthroplasty all components | CPT | 27487 | 9 | — | $5,419 | $24.85 | $3,266 | 1.6× | $26,990 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 9 | — | $5,419 | $24.85 | $96.71 | 0.30× | $21,314 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 13 | — | $5,419 | $24.85 | $7,414 | 2.3× | $21,314 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 13 | — | $5,419 | $24.85 | $3,591.33 | 1.8× | $21,314 |
| ACL reconstruction | CPT | 29888 | 13 | — | $5,419 | $24.85 | $6,012 | 1.8× | $21,314 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 13 | — | $3,629 | $60 | $78,301 | 1.8× | $122,553 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 13 | — | $3,629 | $60 | $40,306 | 1.7× | $63,085 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 13 | — | $3,629 | $60 | $28,153 | 1.7× | $44,064 |
| CABG single arterial graft | CPT | 33533 | 9 | — | $5,419 | $24.85 | $74.64 | 0.04× | $4,294 |
| CABG 2 arterial grafts | CPT | 33534 | 9 | — | $5,419 | $24.85 | $74.64 | 0.03× | $4,296.8 |
| CABG 3 arterial grafts | CPT | 33535 | 9 | — | $5,419 | $24.85 | $74.64 | 0.03× | $5,116.8 |
| CABG 4+ arterial grafts | CPT | 33536 | 9 | — | $5,419 | $24.85 | $74.64 | 0.03× | $5,116.8 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 13 | — | $3,629 | $60 | $28,279 | 1.7× | $44,261 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 13 | — | $3,629 | $60 | $22,468 | 1.7× | $35,165 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 13 | — | $3,629 | $60 | $58,856 | 1.8× | $94,199 |
| Open appendectomy | CPT | 44950 | 13 | — | $5,419 | $24.85 | $1,767.69 | 1.6× | $13,744 |
| Laparoscopic appendectomy | CPT | 44970 | 13 | — | $5,419 | $24.85 | $4,809.5 | 3.1× | $12,851 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 3 | — | — | $6,640 | $125,279 | 2.5× | $163,002 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 3 | — | — | $6,640 | $73,188 | 2.2× | $91,439 |
| Major joint replacement w MCC | MS-DRG | 469 | 13 | — | $3,629 | $60 | $55,738 | 1.9× | $87,238 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 13 | — | $3,629 | $60 | $29,790 | 1.6× | $39,258 |
| Laparoscopic cholecystectomy | CPT | 47562 | 13 | — | $5,419 | $24.85 | $6,457.82 | 3.6× | $12,851 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 13 | — | $5,419 | $24.85 | $6,457.82 | 3.4× | $12,851 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 13 | — | $3,629 | $60 | $50,150 | 1.8× | $78,492 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 13 | — | $3,629 | $60 | $35,381 | 1.7× | $55,377 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 13 | — | $3,629 | $60 | $27,051 | 1.7× | $42,339 |
| Lap inguinal hernia repair | CPT | 49650 | 13 | — | $5,419 | $24.85 | $4,809.5 | 4.3× | $12,851 |
| Total abdominal hysterectomy | CPT | 58150 | 9 | — | $5,419 | $24.85 | $70.04 | 0.07× | $9,446 |
| Vaginal hysterectomy | CPT | 58260 | 13 | — | $5,419 | $24.85 | $5,426.98 | 3.0× | $12,565 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 13 | — | $5,419 | $24.85 | $6,457.82 | 4.4× | $12,851 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 13 | — | $5,419 | $24.85 | $6,807.5 | 3.1× | $22,932 |
| Lap salpingo-oophorectomy | CPT | 58661 | 13 | — | $5,419 | $24.85 | $6,457.82 | 3.2× | $12,851 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 13 | — | $3,629 | $60 | $32,300 | 1.2× | $63,962 |
| OR procedure for obesity w CC | MS-DRG | 620 | 13 | — | $3,629 | $60 | $31,815 | 2.0× | $43,038 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 13 | — | $3,629 | $60 | $29,122 | 1.9× | $43,038 |
| Complex cataract surgery | CPT | 66982 | 13 | — | $5,419 | $24.85 | $2,524.45 | 1.1× | $11,172 |
| Cataract surgery with lens implant | CPT | 66984 | 13 | — | $5,419 | $24.85 | $2,524.45 | 1.2× | $11,172 |
| Intravitreal injection | CPT | 67028 | 13 | — | $5,419 | $24.85 | $367.13 | 1.1× | $4,294 |
| Vitrectomy mechanical | CPT | 67042 | 13 | — | $5,419 | $24.85 | $4,452.74 | 1.8× | $12,565 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 13 | — | $3,629 | $60 | $20,440 | 1.7× | $31,992 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 13 | — | $3,629 | $60 | $33,320 | 1.7× | $52,150 |
| PCI single major coronary artery | CPT | 92920 | 14 | $15,906 | — | $21.88 | $11,044 | 1.9× | $50,824 |
| PCI with drug-eluting stent | CPT | 92928 | 14 | $24,712 | — | $21.88 | $13,113 | 1.3× | $50,824 |
| PCI bypass graft | CPT | 92937 | 14 | $17,872 | — | $21.88 | $13,113 | 1.2× | $50,824 |
| Left heart catheterization | CPT | 93452 | 13 | $14,112 | $3,087.7 | $3,180 | $8,115.1 | 2.6× | $21,297 |
| Coronary angiography with cath | CPT | 93455 | 13 | $21,408 | $4,684.07 | $3,180 | $9,545 | 3.0× | $21,297 |
| Coronary angiography with bypass cath | CPT | 93458 | 13 | $21,894 | $4,790.4 | $3,180 | $9,545 | 3.1× | $21,297 |