| behavioral |
| Psychoses | MS-DRG | 885 | 14 | $189,056 | — | $1,223 | $16,157 | 1.3× | $101,915 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 15 | $976 | $175 | $172 | $213.1 | 1.2× | $564.2 |
| Psychiatric eval with medical services | CPT | 90792 | 15 | $976 | $175 | $172 | $213.1 | 1.2× | $564.2 |
| Psychotherapy 30 minutes | CPT | 90832 | 15 | $590 | $175 | $78 | $175 | 1.2× | $338.8 |
| Psychotherapy 45 minutes | CPT | 90834 | 15 | $789 | $175 | $119 | $175 | 1.1× | $456.4 |
| Psychotherapy 60 minutes | CPT | 90837 | 15 | $824 | $175 | $80 | $175 | 0.92× | $476.7 |
| emergency |
| ED visit level 1 | CPT | 99281 | 15 | $1,293 | $90 | $90 | $205.09 | 1.5× | $1,014.6 |
| ED visit level 2 | CPT | 99282 | 15 | $1,817 | $168 | $168 | $216.37 | 0.91× | $1,426.9 |
| ED visit level 3 | CPT | 99283 | 15 | $2,226 | $294 | $226.66 | $294 | 0.73× | $1,435 |
| ED visit level 4 | CPT | 99284 | 15 | $3,727 | $458 | $383.73 | $458 | 0.69× | $1,435 |
| ED visit level 5 | CPT | 99285 | 15 | $5,785 | $658 | $568 | $658 | 0.63× | $1,435 |
| Critical care, first hour | CPT | 99291 | 15 | $8,050 | $921 | $568 | $1,076.47 | 1.0× | $2,422.05 |
| imaging |
| CT head without contrast | CPT | 70450 | 15 | $1,626 | $128 | $97.91 | $128 | 0.62× | $272.7 |
| CT head with contrast | CPT | 70460 | 15 | $933 | $216 | $140.3 | $216 | 0.92× | $368.4 |
| CT head with and without contrast | CPT | 70470 | 15 | $933 | $216 | $170.79 | $219.17 | 0.82× | $493.13 |
| CT neck with contrast | CPT | 70491 | 15 | $1,208 | $216 | $171.7 | $216 | 0.79× | $386.33 |
| MRI brain without contrast | CPT | 70551 | 15 | $3,991 | $280 | $280 | $504.03 | 1.2× | $1,249 |
| MRI brain with contrast | CPT | 70552 | 15 | $4,774 | $442 | $353.74 | $505 | 1.1× | $1,136.25 |
| MRI brain with and without contrast | CPT | 70553 | 15 | $4,582 | $442 | $442 | $505 | 0.86× | $1,268 |
| Chest X-ray single view | CPT | 71045 | 15 | $406 | $104.23 | $10.1 | $104.23 | 1.1× | $166.81 |
| Chest X-ray 2 views | CPT | 71046 | 15 | $435 | $104.23 | $15.15 | $104.23 | 1.1× | $166.81 |
| Chest X-ray 3 views | CPT | 71047 | 15 | $486 | $104.23 | $15.15 | $104.23 | 1.1× | $166.81 |
| CT chest without contrast | CPT | 71250 | 15 | $1,505 | $128 | $128 | $141.4 | 0.66× | $318.15 |
| CT chest with contrast | CPT | 71260 | 15 | $1,505 | $216 | $171.7 | $216 | 0.77× | $386.33 |
| CT chest with and without contrast | CPT | 71270 | 15 | $1,007 | $216 | $216 | $256.54 | 0.88× | $577.22 |
| CT cervical spine without contrast | CPT | 72125 | 15 | $1,208 | $128 | $128 | $141.4 | 0.70× | $318.15 |
| CT thoracic spine without contrast | CPT | 72128 | 15 | $1,208 | $128 | $128 | $141.4 | 0.71× | $318.15 |
| CT lumbar spine without contrast | CPT | 72131 | 15 | $1,505 | $128 | $128 | $141.4 | 0.70× | $318.15 |
| MRI cervical spine without contrast | CPT | 72141 | 15 | $3,548 | $280 | $280 | $503.05 | 1.3× | $1,136.25 |
| MRI thoracic spine without contrast | CPT | 72146 | 15 | $5,324 | $280 | $280 | $503.05 | 1.3× | $1,136.25 |
| MRI lumbar spine without contrast | CPT | 72148 | 15 | $5,324 | $280 | $280 | $503.05 | 1.3× | $1,136.25 |
| MRI cervical spine with and without contrast | CPT | 72156 | 15 | $3,450 | $442 | $442 | $505 | 0.93× | $1,268 |
| MRI lumbar spine with contrast | CPT | 72158 | 15 | $4,928 | $442 | $442 | $505 | 0.92× | $1,268 |
| CT pelvis without contrast | CPT | 72192 | 15 | $1,505 | $128 | $121.73 | $141.4 | 0.71× | $318.15 |
| CT pelvis with contrast | CPT | 72193 | 15 | $1,255 | $216 | $171.7 | $216 | 0.77× | $386.33 |
| Shoulder X-ray | CPT | 73030 | 15 | $285 | $104.23 | $15.15 | $104.23 | 1.1× | $166.81 |
| Humerus X-ray | CPT | 73060 | 15 | $228 | $104.23 | $10.1 | $104.23 | 1.2× | $166.81 |
| Hand X-ray 3 views | CPT | 73130 | 15 | $228 | $104.23 | $12.63 | $104.23 | 1.1× | $166.81 |
| MRI upper extremity joint without contrast | CPT | 73221 | 15 | $3,330 | $280 | $280 | $504.03 | 1.2× | $1,249 |
| Knee X-ray 1-2 views | CPT | 73560 | 15 | $228 | $104.23 | $10.1 | $104.23 | 1.1× | $166.81 |
| Ankle X-ray 3 views | CPT | 73610 | 15 | $228 | $104.23 | $12.63 | $104.23 | 1.1× | $166.81 |
| MRI lower extremity joint without contrast | CPT | 73721 | 15 | $3,330 | $283 | $283 | $504.03 | 1.1× | $1,249 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 15 | $3,450 | $442 | $442 | $505 | 0.80× | $1,323 |
| CT abdomen without contrast | CPT | 74150 | 15 | $1,505 | $128 | $119.82 | $141.4 | 0.75× | $318.15 |
| CT abdomen with contrast | CPT | 74160 | 15 | $1,505 | $216 | $171.7 | $216 | 0.75× | $432 |
| CT abdomen with and without contrast | CPT | 74170 | 15 | $1,255 | $216 | $216 | $256.54 | 0.77× | $577.22 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 15 | $3,015 | $128 | $69.38 | $128 | 0.35× | $688.38 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 15 | $3,015 | $442 | $109.01 | $442 | 0.81× | $759.46 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 15 | $3,015 | $442 | $138.11 | $442 | 0.77× | $759.46 |
| MRI abdomen without contrast | CPT | 74181 | 15 | $2,218 | $280 | $280 | $504.03 | 1.3× | $1,249 |
| MRI abdomen with and without contrast | CPT | 74183 | 15 | $3,253 | $442 | $442 | $505 | 0.89× | $1,327 |
| Abdominal ultrasound complete | CPT | 76700 | 15 | $908 | $128 | $60.6 | $128 | 0.86× | $224.53 |
| Abdominal ultrasound limited | CPT | 76705 | 15 | $532 | $128 | $40.4 | $128 | 0.87× | $224.53 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 15 | $532 | $128 | $60.6 | $128 | 0.89× | $224.53 |
| Obstetric ultrasound first trimester | CPT | 76801 | 15 | $532 | $128 | $54 | $128 | 0.90× | $224.53 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 15 | $532 | $128 | $55.55 | $128 | 0.84× | $224.53 |
| Transvaginal ultrasound | CPT | 76830 | 15 | $532 | $128 | $60.6 | $128 | 0.87× | $224.53 |
| Pelvic ultrasound complete | CPT | 76856 | 15 | $532 | $128 | $55.55 | $128 | 0.89× | $224.53 |
| Scrotal ultrasound | CPT | 76870 | 15 | $532 | $128 | $30.3 | $128 | 0.98× | $224.53 |
| Diagnostic mammography unilateral | CPT | 77065 | 15 | $988 | $107.98 | $95.49 | $107.98 | 0.72× | $331.62 |
| Diagnostic mammography bilateral | CPT | 77066 | 15 | $1,235 | $137.55 | $97.97 | $137.55 | 0.72× | $331.62 |
| Screening mammography bilateral | CPT | 77067 | 15 | $814 | $114.14 | $97.97 | $114.14 | 0.72× | $268 |
| EKG tracing only | CPT | 93005 | 15 | $330 | $69 | $7.58 | $69 | 0.59× | $226 |
| Transthoracic echocardiogram complete | CPT | 93306 | 15 | $1,689 | $604 | $188.77 | $604 | 1.0× | $996.54 |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 14 | $81,069 | — | $2,276 | $24,629 | 1.6× | $31,503 |
| COPD w MCC | MS-DRG | 190 | 14 | $101,661 | — | $2,276 | $13,971 | 1.2× | $21,684 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 14 | $55,331 | — | $2,276 | $11,418 | 1.3× | $27,461 |
| Heart failure & shock w MCC | MS-DRG | 291 | 14 | $49,413 | — | $2,276 | $16,993 | 1.3× | $34,964 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 14 | $34,605 | — | $2,276 | $14,878 | 1.2× | $29,564 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 14 | $31,100 | — | $2,276 | $9,270 | 1.4× | $39,609 |
| Kidney/UTI w MCC | MS-DRG | 689 | 14 | $36,790 | — | $2,276 | $14,612 | 1.3× | $32,994 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 14 | $48,678 | — | $2,276 | $10,954 | 1.3× | $30,910 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 14 | $76,468 | — | $2,276 | $23,044 | 1.2× | $38,740 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 14 | $44,895 | — | $2,276 | $13,373 | 1.3× | $45,822 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 15 | $161 | $8.46 | $6.07 | $8.46 | 0.26× | $16.47 |
| Electrolyte panel | CPT | 80051 | 15 | $65 | $7.01 | $5.07 | $7.01 | 0.29× | $13.73 |
| Comprehensive metabolic panel | CPT | 80053 | 15 | $226 | $10.56 | $9.09 | $10.56 | 0.24× | $22.73 |
| Lipid panel | CPT | 80061 | 15 | $147 | $13.39 | $10.51 | $13.39 | 0.35× | $23.65 |
| Hepatic function panel | CPT | 80076 | 15 | $255 | $8.17 | $6.07 | $8.17 | 0.31× | $16.47 |
| Urinalysis automated | CPT | 81003 | 15 | $29 | $2.25 | $2.02 | $2.25 | 0.16× | $4.55 |
| Glucose quantitative | CPT | 82947 | 15 | $61 | $3.93 | $3.74 | $3.93 | 0.22× | $8.84 |
| Hemoglobin A1c | CPT | 83036 | 15 | $103 | $9.71 | $9.22 | $9.71 | 0.36× | $21.85 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 15 | $245 | $16.8 | $9.09 | $16.8 | 0.36× | $28.14 |
| Complete blood count with automated differential | CPT | 85025 | 15 | $106 | $7.77 | $3.2 | $7.77 | 0.29× | $13.01 |
| Complete blood count without differential | CPT | 85027 | 15 | $94 | $6.47 | $3.2 | $6.47 | 0.30× | $10.84 |
| Urine culture identification | CPT | 87088 | 15 | $105 | $8.09 | $7.69 | $8.09 | 0.36× | $18.2 |
| Tissue exam by pathologist level IV | CPT | 88305 | 15 | $285 | $60.15 | $28 | $60.15 | 0.59× | $102.48 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 15 | $847 | $86 | $71.05 | $161.9 | 1.9× | $462 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 15 | $1,118 | $135 | $103.21 | $187.33 | 1.5× | $642.11 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 15 | $1,559 | $198 | $144.83 | $200.82 | 1.2× | $908 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 15 | $2,030 | $261 | $179.2 | $351.85 | 1.6× | $1,109.25 |
| Office visit, established patient, 5 min | CPT | 99211 | 15 | $381 | $28 | $18.98 | $105.18 | 1.6× | $339 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 15 | $847 | $68 | $41.37 | $205.84 | 2.6× | $491.12 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 15 | $847 | $107 | $72.96 | $217.42 | 1.9× | $524.74 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 15 | $1,118 | $151 | $96 | $304.28 | 2.0× | $761.28 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 15 | $1,485 | $211 | $136.14 | $313.32 | 1.7× | $809.82 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 15 | $4,565 | $990.36 | $990.36 | $1,451.45 | 1.6× | $5,536.01 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 15 | $5,162 | $990.36 | $990.36 | $1,546.45 | 1.6× | $5,536.01 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 15 | $6,300 | $997 | $997 | $1,004.13 | 1.1× | $3,957 |
| Colonoscopy diagnostic | CPT | 45378 | 15 | $4,275 | $997 | $997 | $1,004.13 | 1.1× | $3,303.1 |
| Colonoscopy with biopsy | CPT | 45380 | 15 | $4,914 | $1,299.17 | $1,004.13 | $1,299.17 | 1.1× | $3,796.95 |
| Colonoscopy with polyp removal | CPT | 45385 | 15 | $5,438 | $1,299.17 | $1,004.13 | $1,299.17 | 1.1× | $3,957 |
| surgery |
| Shoulder arthroscopy with decompression | CPT | 29826 | 15 | $9,664 | $3,571.1 | $1,290 | $3,571.1 | 10.9× | $7,467.25 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 15 | $11,366 | $7,935.57 | $2,150 | $7,935.57 | 2.4× | $12,830 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 15 | $6,126 | $3,571.1 | $1,301 | $3,571.1 | 1.7× | $5,773.48 |
| ACL reconstruction | CPT | 29888 | 15 | $11,738 | $7,935.57 | $1,716 | $7,935.57 | 2.4× | $12,830 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 14 | $56,986 | — | $2,276 | $22,572 | 1.2× | $63,349 |
| Laparoscopic cholecystectomy | CPT | 47562 | 15 | $7,975 | $6,253.02 | $1,301 | $6,253.02 | 3.5× | $10,109 |
| Lap inguinal hernia repair | CPT | 49650 | 15 | $9,633 | $6,253.02 | $2,121 | $6,067.36 | 5.4× | $10,109 |
| Cataract surgery with lens implant | CPT | 66984 | 15 | $4,782 | $2,590.68 | $1,999 | $2,590.68 | 1.2× | $5,525.24 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 14 | $31,734 | — | $2,276 | $14,850 | 1.2× | $76,554 |