| behavioral |
| Psychoses | MS-DRG | 885 | 5 | — | — | $8,671.94 | $13,724 | 1.1× | $15,423 |
| emergency |
| ED visit level 1 | CPT | 99281 | 12 | $434 | $260.4 | $51.6 | $173.6 | 1.2× | $368.9 |
| ED visit level 2 | CPT | 99282 | 13 | $640 | $384 | $36.28 | $253.44 | 1.1× | $544 |
| ED visit level 3 | CPT | 99283 | 13 | $893 | $535.8 | $62.31 | $352.58 | 0.87× | $759.05 |
| ED visit level 4 | CPT | 99284 | 13 | $1,176 | $705.6 | $104.86 | $456.88 | 0.68× | $999.6 |
| ED visit level 5 | CPT | 99285 | 13 | $1,919 | $1,151.4 | $152.61 | $734.02 | 0.70× | $1,631.15 |
| Critical care, first hour | CPT | 99291 | 13 | $4,438 | $2,662.8 | $166.79 | $1,679.79 | 1.6× | $3,772.3 |
| imaging |
| CT head without contrast | CPT | 70450 | 13 | $3,017 | $1,810.2 | $93.97 | $1,146.46 | 5.5× | $2,564.45 |
| CT head with contrast | CPT | 70460 | 13 | $4,727 | $2,836.2 | $147.4 | $1,789.17 | 7.6× | $4,017.95 |
| CT head with and without contrast | CPT | 70470 | 13 | $5,257 | $3,154.2 | $157.31 | $1,989.78 | 7.5× | $4,468.45 |
| CT neck with contrast | CPT | 70491 | 13 | $4,727 | $2,836.2 | $151.25 | $1,789.17 | 6.5× | $4,017.95 |
| MRI brain without contrast | CPT | 70551 | 14 | $6,391 | $3,834.6 | $213.6 | $2,428.58 | 6.0× | $5,432.35 |
| MRI brain with contrast | CPT | 70552 | 14 | $8,227 | $4,936.2 | $315.59 | $3,126.26 | 6.5× | $6,992.95 |
| MRI brain with and without contrast | CPT | 70553 | 14 | $10,082 | $6,049.2 | $315.59 | $3,831.16 | 6.5× | $8,569.7 |
| Chest X-ray single view | CPT | 71045 | 13 | $707 | $424.2 | $6.49 | $267.6 | 2.8× | $600.95 |
| Chest X-ray 2 views | CPT | 71046 | 13 | $707 | $424.2 | $11.9 | $267.6 | 2.7× | $600.95 |
| Chest X-ray 3 views | CPT | 71047 | 13 | $707 | $424.2 | $15.12 | $267.6 | 2.8× | $600.95 |
| CT chest without contrast | CPT | 71250 | 13 | $3,017 | $1,810.2 | $93.97 | $1,154.01 | 5.4× | $2,564.45 |
| CT chest with contrast | CPT | 71260 | 13 | $4,727 | $2,836.2 | $157.31 | $1,796.26 | 6.4× | $4,017.95 |
| CT chest with and without contrast | CPT | 71270 | 13 | $5,257 | $3,154.2 | $157.31 | $1,997.66 | 6.9× | $4,468.45 |
| MRI chest without contrast | CPT | 71550 | 14 | $6,391 | $3,834.6 | $213.6 | $2,428.58 | 5.6× | $5,432.35 |
| MRI chest with and without contrast | CPT | 71552 | 14 | $10,082 | $6,049.2 | $315.59 | $3,831.16 | 6.4× | $8,569.7 |
| Lumbosacral spine X-ray | CPT | 72100 | 13 | $707 | $424.2 | $34.88 | $267.6 | 2.6× | $600.95 |
| CT cervical spine without contrast | CPT | 72125 | 13 | $3,017 | $1,810.2 | $93.97 | $1,154.01 | 5.7× | $2,564.45 |
| CT thoracic spine without contrast | CPT | 72128 | 13 | $3,017 | $1,810.2 | $93.97 | $1,154.01 | 5.8× | $2,564.45 |
| CT lumbar spine without contrast | CPT | 72131 | 13 | $3,017 | $1,810.2 | $93.97 | $1,154.01 | 5.7× | $2,564.45 |
| MRI cervical spine without contrast | CPT | 72141 | 14 | $6,391 | $3,834.6 | $213.6 | $2,428.58 | 6.1× | $5,432.35 |
| MRI thoracic spine without contrast | CPT | 72146 | 14 | $6,391 | $3,834.6 | $213.6 | $2,428.58 | 6.5× | $5,432.35 |
| MRI lumbar spine without contrast | CPT | 72148 | 14 | $6,391 | $3,834.6 | $213.6 | $2,428.58 | 6.5× | $5,432.35 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 14 | $8,227 | $4,936.2 | $315.59 | $3,126.26 | 6.9× | $6,992.95 |
| MRI cervical spine with and without contrast | CPT | 72156 | 14 | $10,082 | $6,049.2 | $315.59 | $3,834.32 | 7.1× | $8,569.7 |
| MRI lumbar spine with contrast | CPT | 72158 | 14 | $10,082 | $6,049.2 | $315.59 | $3,831.16 | 7.0× | $8,569.7 |
| CT pelvis without contrast | CPT | 72192 | 13 | $3,017 | $1,810.2 | $93.97 | $1,154.01 | 5.8× | $2,564.45 |
| CT pelvis with contrast | CPT | 72193 | 13 | $4,727 | $2,836.2 | $154.1 | $1,796.26 | 6.4× | $4,017.95 |
| Shoulder X-ray | CPT | 73030 | 12 | $707 | $424.2 | $29.08 | $272.19 | 2.9× | $600.95 |
| Humerus X-ray | CPT | 73060 | 12 | $707 | $424.2 | $28.5 | $272.19 | 3.0× | $600.95 |
| Hand X-ray 3 views | CPT | 73130 | 12 | $707 | $424.2 | $27.23 | $272.19 | 2.9× | $600.95 |
| MRI upper extremity joint without contrast | CPT | 73221 | 13 | $6,391 | $3,834.6 | $213.6 | $2,460.53 | 5.9× | $5,432.35 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 13 | $10,082 | $6,049.2 | $315.59 | $3,881.57 | 6.4× | $8,569.7 |
| Knee X-ray 1-2 views | CPT | 73560 | 12 | $707 | $424.2 | $30.69 | $272.19 | 2.9× | $600.95 |
| Ankle X-ray 3 views | CPT | 73610 | 12 | $707 | $424.2 | $26.71 | $272.19 | 3.0× | $600.95 |
| MRI lower extremity joint without contrast | CPT | 73721 | 13 | $6,391 | $3,834.6 | $213.6 | $2,460.53 | 5.3× | $5,432.35 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 13 | $10,082 | $6,049.2 | $315.59 | $3,881.57 | 6.1× | $8,569.7 |
| CT abdomen without contrast | CPT | 74150 | 13 | $3,017 | $1,810.2 | $93.97 | $1,154.01 | 6.1× | $2,564.45 |
| CT abdomen with contrast | CPT | 74160 | 13 | $4,727 | $2,836.2 | $157.31 | $1,796.26 | 6.3× | $4,017.95 |
| CT abdomen with and without contrast | CPT | 74170 | 13 | $5,257 | $3,154.2 | $157.31 | $1,997.66 | 6.0× | $4,468.45 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 13 | $6,374 | $3,824.4 | $185.12 | $2,422.12 | 6.6× | $5,417.9 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 13 | $9,132 | $5,479.2 | $289.48 | $3,470.16 | 6.3× | $7,762.2 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 13 | $9,132 | $5,479.2 | $315.59 | $3,470.16 | 6.0× | $7,762.2 |
| MRI abdomen without contrast | CPT | 74181 | 14 | $6,391 | $3,834.6 | $213.6 | $2,428.58 | 6.2× | $5,432.35 |
| MRI abdomen with and without contrast | CPT | 74183 | 14 | $10,082 | $6,049.2 | $315.59 | $3,831.16 | 6.8× | $8,569.7 |
| Abdominal ultrasound complete | CPT | 76700 | 13 | $1,582 | $949.2 | $93.97 | $601.16 | 4.0× | $1,344.7 |
| Abdominal ultrasound limited | CPT | 76705 | 13 | $2,663 | $1,597.8 | $68.75 | $1,007.95 | 6.9× | $2,263.55 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 13 | $2,272 | $1,363.2 | $89.65 | $859.95 | 6.0× | $1,931.2 |
| Obstetric ultrasound first trimester | CPT | 76801 | 13 | $1,046 | $627.6 | $92.5 | $402.71 | 2.8× | $889.1 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 13 | $2,272 | $1,363.2 | $85.25 | $859.95 | 5.6× | $1,931.2 |
| Transvaginal ultrasound | CPT | 76830 | 13 | $1,511 | $906.6 | $84.15 | $571.92 | 3.9× | $1,284.35 |
| Pelvic ultrasound complete | CPT | 76856 | 13 | $1,338 | $802.8 | $84.15 | $508.44 | 3.6× | $1,137.3 |
| Scrotal ultrasound | CPT | 76870 | 13 | $2,951 | $1,770.6 | $81.4 | $1,116.96 | 8.5× | $2,508.35 |
| EKG tracing only | CPT | 93005 | 13 | $799 | $479.4 | $11.51 | $302.42 | 2.6× | $679.15 |
| Transthoracic echocardiogram complete | CPT | 93306 | 13 | $3,151 | $1,890.6 | $155.12 | $1,213.13 | 2.0× | $2,678.35 |
| Stress echocardiogram | CPT | 93350 | 13 | $4,533 | $2,719.8 | $84.15 | $1,715.74 | 3.4× | $3,853.05 |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 6 | — | — | $10,293 | $20,005 | 0.99× | $34,687 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 6 | — | — | $9,590.03 | $10,623 | 0.99× | $21,791 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 6 | — | — | $6,831.72 | $7,567.65 | 0.99× | $17,022 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 6 | — | — | $10,293 | $15,802 | 1.0× | $26,732 |
| COPD w MCC | MS-DRG | 190 | 6 | — | — | $10,293 | $11,536 | 1.0× | $18,035 |
| COPD w CC | MS-DRG | 191 | 6 | — | — | $8,174.06 | $9,122.79 | 1.0× | $15,935 |
| COPD w/o CC/MCC | MS-DRG | 192 | 6 | — | — | $6,472.85 | $7,170.13 | 1.0× | $12,724 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 6 | — | — | $7,860.05 | $8,746.86 | 1.0× | $15,095 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 6 | — | — | $6,358.58 | $7,043.55 | 1.1× | $11,340 |
| AMI discharged alive w MCC | MS-DRG | 280 | 6 | — | — | $10,293 | $16,190 | 1.0× | $27,078 |
| AMI discharged alive w CC | MS-DRG | 281 | 6 | — | — | $8,818.13 | $9,893.88 | 1.0× | $18,678 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 6 | — | — | $7,159.27 | $7,930.49 | 1.0× | $16,849 |
| Heart failure & shock w MCC | MS-DRG | 291 | 6 | — | — | $10,293 | $13,187 | 1.0× | $20,926 |
| Heart failure & shock w CC | MS-DRG | 292 | 6 | — | — | $8,224.85 | $9,183.59 | 1.0× | $14,280 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 6 | — | — | $5,829.61 | $6,457.6 | 1.0× | $12,773 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 6 | — | — | $10,293 | $12,439 | 1.0× | $19,419 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 6 | — | — | $7,265.9 | $7,984.23 | 1.0× | $12,229 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 6 | — | — | $5,830.46 | $6,399.28 | 1.0× | $10,293 |
| GI hemorrhage w CC | MS-DRG | 378 | 6 | — | — | $9,339.52 | $10,367 | 1.0× | $19,024 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 6 | — | — | $6,374.69 | $7,061.39 | 1.0× | $13,415 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 6 | — | — | $7,637.45 | $8,402.75 | 1.0× | $12,822 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 5 | — | — | $14,308 | $15,994 | 1.1× | $37,751 |
| Kidney/UTI w MCC | MS-DRG | 689 | 5 | — | — | $10,860 | $12,140 | 1.0× | $22,532 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 5 | — | — | $7,890.53 | $8,660.34 | 1.0× | $12,328 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 5 | — | — | $17,480 | $19,541 | 1.0× | $34,638 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 5 | — | — | $9,700.06 | $10,844 | 1.0× | $17,689 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 14 | $376 | $225.6 | $7.84 | $141.75 | 4.4× | $319.6 |
| Electrolyte panel | CPT | 80051 | 14 | $199 | $119.4 | $6.5 | $75.62 | 3.2× | $169.15 |
| Comprehensive metabolic panel | CPT | 80053 | 14 | $1,109 | $665.4 | $9.79 | $418.09 | 9.4× | $942.65 |
| Lipid panel | CPT | 80061 | 14 | $828 | $496.8 | $12.41 | $312.16 | 8.2× | $703.8 |
| Renal function panel | CPT | 80069 | 14 | $408 | $244.8 | $8.05 | $153.82 | 5.6× | $346.8 |
| Hepatic function panel | CPT | 80076 | 14 | $576 | $345.6 | $7.57 | $217.15 | 8.2× | $489.6 |
| Urinalysis non-automated | CPT | 81002 | 14 | $42 | $25.2 | $3.1 | $16.17 | 2.3× | $35.7 |
| Urinalysis automated | CPT | 81003 | 14 | $89 | $53.4 | $2.09 | $33.55 | 2.4× | $75.65 |
| Glucose quantitative | CPT | 82947 | 14 | $191 | $114.6 | $3.64 | $72.01 | 4.1× | $162.35 |
| Hemoglobin A1c | CPT | 83036 | 14 | $258 | $154.8 | $7.7 | $98.04 | 3.6× | $219.3 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 14 | $428 | $256.8 | $15.57 | $162.64 | 3.4× | $363.8 |
| Complete blood count with automated differential | CPT | 85025 | 14 | $105 | $63 | $6.6 | $40.16 | 1.5× | $89.25 |
| Complete blood count without differential | CPT | 85027 | 14 | $118 | $70.8 | $5.76 | $44.84 | 2.1× | $100.3 |
| Urine culture bacterial | CPT | 87086 | 14 | $124 | $74.4 | $7.48 | $47.74 | 2.0× | $105.4 |
| Tissue exam by pathologist level IV | CPT | 88305 | 14 | $569 | $341.4 | $28.27 | $214.51 | 2.1× | $483.65 |
| maternity |
| Vaginal delivery only | CPT | 59409 | 12 | $7,193 | $4,315.8 | $605.56 | $3,146.68 | 1.4× | $7,503.77 |
| C-section delivery only | CPT | 59514 | 11 | $14,893 | $8,935.8 | $358.6 | $5,957.2 | 6.2× | $12,659 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 13 | $502 | $301.2 | $36.08 | $193.27 | 2.2× | $426.7 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 13 | $647 | $388.2 | $36.08 | $249.09 | 2.0× | $549.95 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 13 | $850 | $510 | $36.08 | $327.25 | 1.9× | $722.5 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 13 | $1,035 | $621 | $36.08 | $398.48 | 1.8× | $879.75 |
| Office visit, established patient, 5 min | CPT | 99211 | 13 | $224 | $134.4 | $19.03 | $86.24 | 1.3× | $190.4 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 13 | $270 | $162 | $28.6 | $105.48 | 1.3× | $229.5 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 13 | $306 | $183.6 | $36.08 | $122.4 | 1.1× | $260.1 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 13 | $404 | $242.4 | $36.08 | $161.6 | 1.1× | $343.4 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 13 | $689 | $413.4 | $36.08 | $261.82 | 1.4× | $585.65 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 13 | $3,768 | $2,260.8 | $137.74 | $1,463.87 | 1.6× | $3,202.8 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 13 | $5,056 | $3,033.6 | $163.44 | $1,964.26 | 2.0× | $4,297.6 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 13 | $997 | $598.2 | $58.47 | $498.5 | 0.59× | $1,705.45 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 13 | $3,768 | $2,260.8 | $70.04 | $1,463.87 | 1.6× | $3,202.8 |
| Colonoscopy diagnostic | CPT | 45378 | 13 | $2,500 | $1,500 | $198.55 | $990 | 1.1× | $3,719.96 |
| Colonoscopy with biopsy | CPT | 45380 | 13 | $5,056 | $3,033.6 | $247.96 | $1,964.26 | 1.6× | $4,297.6 |
| Colonoscopy with polyp removal | CPT | 45385 | 13 | $9,103 | $5,461.8 | $294.89 | $3,459.14 | 2.9× | $7,737.55 |
| surgery |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 1 | — | — | $10,293 | $10,293 | 0.37× | $10,293 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 1 | — | — | $10,293 | $10,293 | 0.56× | $10,293 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 6 | — | — | $1,274.16 | $6,312.83 | 1.9× | $7,491.76 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 7 | — | — | $597.85 | $2,892.29 | 1.4× | $5,255.05 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 6 | — | — | $10,293 | $44,245 | 1.0× | $71,153 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 6 | — | — | $10,293 | $23,626 | 1.0× | $43,754 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 6 | — | — | $10,293 | $16,929 | 1.0× | $32,884 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 6 | — | — | $10,293 | $17,011 | 1.0× | $31,525 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 6 | — | — | $10,293 | $13,956 | 1.0× | $26,213 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 6 | — | — | $10,293 | $33,094 | 1.0× | $82,567 |
| Laparoscopic appendectomy | CPT | 44970 | 6 | — | — | $1,067.82 | $5,705.87 | 3.7× | $8,315.75 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 1 | — | — | $10,293 | $10,293 | 0.21× | $10,293 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 1 | — | — | $10,293 | $10,293 | 0.31× | $10,293 |
| Major joint replacement w MCC | MS-DRG | 469 | 6 | — | — | $10,293 | $29,589 | 1.0× | $54,872 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 6 | — | — | $10,293 | $19,235 | 1.0× | $29,795 |
| Laparoscopic cholecystectomy | CPT | 47562 | 6 | — | — | $1,414.39 | $5,705.87 | 3.2× | $8,315.75 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 6 | — | — | $1,521.52 | $5,705.87 | 3.0× | $8,315.75 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 6 | — | — | $10,293 | $28,455 | 1.0× | $62,975 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 6 | — | — | $10,293 | $20,788 | 1.0× | $44,174 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 6 | — | — | $10,293 | $16,442 | 1.0× | $31,994 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 5 | — | — | $25,477 | $28,481 | 1.0× | $54,056 |
| OR procedure for obesity w CC | MS-DRG | 620 | 5 | — | — | $14,584 | $16,303 | 1.0× | $31,549 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 5 | — | — | $13,806 | $15,433 | 1.0× | $25,472 |
| Complex cataract surgery | CPT | 66982 | 6 | — | — | $1,071.14 | $2,348.35 | 1.1× | $7,361.94 |
| Cataract surgery with lens implant | CPT | 66984 | 7 | — | — | $662.78 | $2,315.74 | 1.1× | $7,361.94 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 5 | — | — | $11,540 | $12,900 | 1.1× | $21,568 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 5 | — | — | $16,456 | $20,175 | 1.1× | $25,175 |
| PCI single major coronary artery | CPT | 92920 | 11 | $25,937 | $15,562 | $556.41 | $10,375 | 1.8× | $22,046 |
| PCI with drug-eluting stent | CPT | 92928 | 11 | $39,395 | $23,637 | $619.1 | $15,758 | 1.6× | $33,486 |
| PCI bypass graft | CPT | 92937 | 11 | $39,395 | $23,637 | $517.93 | $15,758 | 1.4× | $33,486 |
| Left heart catheterization | CPT | 93452 | 12 | $11,460 | $6,876 | $1,056.32 | $4,538.16 | 1.5× | $9,741 |
| Coronary angiography with cath | CPT | 93455 | 12 | $12,688 | $7,612.8 | $1,289.74 | $5,024.45 | 1.6× | $10,785 |
| Coronary angiography with bypass cath | CPT | 93458 | 12 | $15,284 | $9,170.4 | $1,321.51 | $6,052.47 | 1.9× | $12,991 |