| behavioral |
| Psychoses | MS-DRG | 885 | 5 | — | — | $8,665 | $23,174 | 1.8× | $25,161 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 16 | $2,796 | — | $61.86 | $243.13 | 1.4× | $1,733.52 |
| Psychiatric eval with medical services | CPT | 90792 | 16 | $716 | — | $62.91 | $164.18 | 0.95× | $502.61 |
| Psychotherapy 30 minutes | CPT | 90832 | 16 | $866 | — | $54.79 | $176.33 | 1.2× | $536.92 |
| Psychotherapy 45 minutes | CPT | 90834 | 16 | $1,958 | — | $82.18 | $219.73 | 1.4× | $1,213.96 |
| Psychotherapy 60 minutes | CPT | 90837 | 16 | $1,958 | — | $90.57 | $222.47 | 1.2× | $1,213.96 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 16 | $1,958 | — | $169.17 | $247.69 | 1.6× | $1,213.96 |
| imaging |
| CT head without contrast | CPT | 70450 | 16 | $6,129 | — | $105.54 | $246.03 | 1.2× | $3,799.98 |
| CT head with contrast | CPT | 70460 | 16 | $6,805 | — | $165.27 | $286.84 | 1.2× | $4,219.1 |
| CT head with and without contrast | CPT | 70470 | 16 | $8,856 | — | $180.2 | $335.17 | 1.3× | $5,490.72 |
| CT neck with contrast | CPT | 70491 | 16 | $6,805 | — | $165.27 | $289.75 | 1.1× | $4,219.1 |
| MRI brain without contrast | CPT | 70551 | 16 | $10,444 | — | $186.13 | $711.45 | 1.8× | $6,475.28 |
| MRI brain with contrast | CPT | 70552 | 16 | $11,813 | — | $239.71 | $714.37 | 1.5× | $7,324.06 |
| MRI brain with and without contrast | CPT | 70553 | 16 | $20,881 | — | $293.72 | $714.37 | 1.2× | $12,946 |
| Chest X-ray single view | CPT | 71045 | 16 | $1,048 | — | $32.62 | $99.46 | 1.1× | $649.76 |
| Chest X-ray 2 views | CPT | 71046 | 16 | $1,535 | — | $36.23 | $99.46 | 1.0× | $951.7 |
| Chest X-ray 3 views | CPT | 71047 | 16 | $1,097 | — | $36.23 | $108.19 | 1.1× | $680.14 |
| CT chest without contrast | CPT | 71250 | 16 | $6,129 | — | $105.54 | $281.51 | 1.3× | $3,799.98 |
| CT chest with contrast | CPT | 71260 | 16 | $6,806 | — | $165.27 | $305.87 | 1.1× | $4,219.72 |
| CT chest with and without contrast | CPT | 71270 | 16 | $8,861 | — | $180.2 | $352.7 | 1.2× | $5,493.82 |
| MRI chest without contrast | CPT | 71550 | 16 | $10,444 | — | $186.13 | $708.5 | 1.6× | $6,475.28 |
| MRI chest with contrast | CPT | 71551 | 16 | $11,813 | — | $239.71 | $999.02 | 1.2× | $7,324.06 |
| MRI chest with and without contrast | CPT | 71552 | 16 | $20,881 | — | $293.72 | $1,216.97 | 2.0× | $12,946 |
| Lumbosacral spine X-ray | CPT | 72100 | 16 | $1,113 | — | $24.64 | $118.15 | 1.1× | $690.06 |
| CT cervical spine without contrast | CPT | 72125 | 16 | $6,129 | — | $105.54 | $281.51 | 1.4× | $3,799.98 |
| CT thoracic spine without contrast | CPT | 72128 | 16 | $6,129 | — | $105.54 | $297.32 | 1.5× | $3,799.98 |
| CT lumbar spine without contrast | CPT | 72131 | 16 | $6,129 | — | $105.54 | $292.05 | 1.4× | $3,799.98 |
| MRI cervical spine without contrast | CPT | 72141 | 16 | $10,444 | — | $186.13 | $714.37 | 1.8× | $6,475.28 |
| MRI thoracic spine without contrast | CPT | 72146 | 16 | $10,444 | — | $186.13 | $550.74 | 1.5× | $6,475.28 |
| MRI lumbar spine without contrast | CPT | 72148 | 16 | $10,444 | — | $186.13 | $539.78 | 1.4× | $6,475.28 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 16 | $11,813 | — | $239.71 | $714.37 | 1.6× | $7,324.06 |
| MRI cervical spine with and without contrast | CPT | 72156 | 16 | $20,881 | — | $293.72 | $714.37 | 1.3× | $12,946 |
| MRI lumbar spine with contrast | CPT | 72158 | 16 | $18,653 | — | $293.72 | $714.37 | 1.3× | $11,565 |
| CT pelvis without contrast | CPT | 72192 | 16 | $6,129 | — | $105.54 | $237.07 | 1.2× | $3,799.98 |
| CT pelvis with contrast | CPT | 72193 | 16 | $6,805 | — | $165.27 | $295.21 | 1.0× | $4,219.1 |
| Shoulder X-ray | CPT | 73030 | 16 | $1,929 | — | $24.64 | $111.32 | 1.2× | $1,195.98 |
| Humerus X-ray | CPT | 73060 | 16 | $967 | — | $24.64 | $107.29 | 1.2× | $599.54 |
| Hand X-ray 3 views | CPT | 73130 | 16 | $1,792 | — | $24.64 | $109.08 | 1.2× | $1,111.04 |
| MRI upper extremity joint without contrast | CPT | 73221 | 16 | $10,444 | — | $186.13 | $862.79 | 2.1× | $6,475.28 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 16 | $11,813 | — | $293.72 | $1,020.64 | 1.7× | $7,324.06 |
| Knee X-ray 1-2 views | CPT | 73560 | 16 | $872 | — | $24.64 | $107.29 | 1.2× | $540.64 |
| Ankle X-ray 3 views | CPT | 73610 | 16 | $1,792 | — | $24.64 | $109.08 | 1.2× | $1,111.04 |
| MRI lower extremity joint without contrast | CPT | 73721 | 16 | $20,881 | — | $186.13 | $862.79 | 1.8× | $12,946 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 16 | $10,444 | — | $293.72 | $902.36 | 1.4× | $6,475.28 |
| CT abdomen without contrast | CPT | 74150 | 16 | $6,129 | — | $105.54 | $271.84 | 1.4× | $3,799.98 |
| CT abdomen with contrast | CPT | 74160 | 16 | $6,805 | — | $165.27 | $314.09 | 1.1× | $4,219.1 |
| CT abdomen with and without contrast | CPT | 74170 | 16 | $8,861 | — | $180.2 | $371.88 | 1.1× | $5,493.82 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 16 | $6,129 | — | $222.84 | $371.92 | 1.0× | $3,799.98 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 16 | $6,805 | — | $319.3 | $570.53 | 1.0× | $4,219.1 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 16 | $8,861 | — | $319.3 | $697.5 | 1.2× | $5,493.82 |
| MRI abdomen without contrast | CPT | 74181 | 16 | $10,444 | — | $186.13 | $708.5 | 1.8× | $6,475.28 |
| MRI abdomen with and without contrast | CPT | 74183 | 16 | $20,881 | — | $293.72 | $1,215.64 | 2.1× | $12,946 |
| Abdominal ultrasound complete | CPT | 76700 | 16 | $3,240 | — | $52.97 | $200.76 | 1.3× | $2,008.8 |
| Abdominal ultrasound limited | CPT | 76705 | 16 | $2,335 | — | $52.97 | $150.76 | 1.0× | $1,447.7 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 16 | $3,240 | — | $52.97 | $171.74 | 1.2× | $2,008.8 |
| Obstetric ultrasound first trimester | CPT | 76801 | 16 | $3,468 | — | $52.97 | $177.2 | 1.3× | $2,150.16 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 16 | $2,919 | — | $52.97 | $170.98 | 1.1× | $1,809.78 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 16 | $4,175 | — | $83.67 | $367.69 | 1.6× | $2,588.5 |
| Transvaginal ultrasound | CPT | 76830 | 16 | $2,516 | — | $52.97 | $168.93 | 1.1× | $1,559.92 |
| Pelvic ultrasound complete | CPT | 76856 | 16 | $2,516 | — | $52.97 | $168.93 | 1.2× | $1,559.92 |
| Scrotal ultrasound | CPT | 76870 | 16 | $2,727 | — | $52.97 | $163.48 | 1.2× | $1,690.74 |
| Diagnostic mammography unilateral | CPT | 77065 | 10 | $1,081 | — | $80.12 | $181.37 | 1.2× | $670.22 |
| Diagnostic mammography bilateral | CPT | 77066 | 10 | $1,346 | — | $101.46 | $231.1 | 1.2× | $834.52 |
| Screening mammography bilateral | CPT | 77067 | 10 | $1,197 | — | $82.03 | $191.52 | 1.2× | $742.14 |
| EKG tracing only | CPT | 93005 | 16 | $1,293 | — | $14.71 | $68.77 | 0.58× | $801.66 |
| Transthoracic echocardiogram complete | CPT | 93306 | 16 | $10,200 | — | $162.17 | $682.07 | 1.1× | $6,324 |
| Transthoracic echocardiogram | CPT | 93307 | 16 | $6,454 | — | $245.13 | $326.83 | 1.3× | $4,001.48 |
| Stress echocardiogram | CPT | 93350 | 16 | $6,198 | — | $161.21 | $748.47 | 1.5× | $3,842.76 |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 5 | — | — | $8,665 | $34,600 | 1.7× | $35,756 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 5 | — | — | $8,665 | $18,152 | 1.7× | $20,429 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 5 | — | — | $5,899.53 | $12,286 | 1.6× | $20,429 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 5 | — | — | $8,665 | $27,073 | 1.8× | $33,994 |
| COPD w MCC | MS-DRG | 190 | 5 | — | — | $5,654 | $19,190 | 1.7× | $20,684 |
| COPD w CC | MS-DRG | 191 | 5 | — | — | $5,654 | $14,605 | 1.7× | $16,257 |
| COPD w/o CC/MCC | MS-DRG | 192 | 5 | — | — | $5,534.04 | $11,553 | 1.7× | $13,330 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 5 | — | — | $6,946.86 | $14,637 | 1.7× | $20,429 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 5 | — | — | $5,417.67 | $11,115 | 1.7× | $20,429 |
| AMI discharged alive w MCC | MS-DRG | 280 | 5 | — | — | $13,827 | $29,299 | 1.9× | $42,147 |
| AMI discharged alive w CC | MS-DRG | 281 | 5 | — | — | $7,922.64 | $16,454 | 1.7× | $42,147 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 5 | — | — | $6,233.12 | $12,943 | 1.7× | $42,147 |
| Heart failure & shock w MCC | MS-DRG | 291 | 5 | — | — | $8,665 | $22,241 | 1.7× | $23,317 |
| Heart failure & shock w CC | MS-DRG | 292 | 5 | — | — | $7,318.38 | $15,372 | 1.7× | $20,429 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 5 | — | — | $4,878.92 | $9,794.3 | 1.6× | $20,429 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 5 | — | — | $8,665 | $20,918 | 1.7× | $22,078 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 5 | — | — | $6,341.73 | $13,197 | 1.7× | $20,429 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 4 | — | — | $4,879.78 | $9,987.08 | 1.6× | $10,280 |
| GI hemorrhage w CC | MS-DRG | 378 | 5 | — | — | $8,453.63 | $17,598 | 1.8× | $20,429 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 5 | — | — | $5,434.05 | $11,365 | 1.7× | $36,557 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 5 | — | — | $5,654 | $13,596 | 1.7× | $14,079 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 4 | — | — | $13,514 | $27,219 | 1.8× | $27,874 |
| Kidney/UTI w MCC | MS-DRG | 689 | 5 | — | — | $5,654 | $20,028 | 1.7× | $20,890 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 5 | — | — | $5,654 | $13,991 | 1.7× | $14,597 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 5 | — | — | $8,665 | $33,593 | 1.8× | $35,023 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 5 | — | — | $8,665 | $18,403 | 1.8× | $20,429 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 16 | $173 | — | $8.46 | $19.72 | 0.61× | $107.26 |
| General health panel | CPT | 80050 | 9 | $1,182 | — | $42.13 | $155.58 | 1.4× | $732.84 |
| Electrolyte panel | CPT | 80051 | 16 | $554 | — | $7.01 | $14.75 | 0.62× | $343.48 |
| Comprehensive metabolic panel | CPT | 80053 | 16 | $763 | — | $10.56 | $24.63 | 0.55× | $473.06 |
| Lipid panel | CPT | 80061 | 16 | $470 | — | $13.39 | $29.5 | 0.77× | $291.4 |
| Renal function panel | CPT | 80069 | 16 | $292 | — | $8.68 | $16.68 | 0.61× | $181.04 |
| Hepatic function panel | CPT | 80076 | 16 | $173 | — | $8.17 | $19.03 | 0.72× | $107.26 |
| Urinalysis non-automated | CPT | 81002 | 16 | $8 | — | $1.28 | $4.28 | 0.61× | $14.63 |
| Urinalysis automated | CPT | 81003 | 16 | $372 | — | $2.25 | $8.63 | 0.62× | $230.64 |
| Glucose quantitative | CPT | 82947 | 16 | $441 | — | $2.17 | $10.08 | 0.57× | $273.42 |
| Hemoglobin A1c | CPT | 83036 | 16 | $205 | — | $9.71 | $15.47 | 0.57× | $127.1 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 16 | $126 | — | $16.8 | $26.74 | 0.57× | $84.75 |
| Complete blood count with automated differential | CPT | 85025 | 16 | $620 | — | $7.77 | $15.87 | 0.60× | $384.4 |
| Complete blood count without differential | CPT | 85027 | 16 | $457 | — | $6.47 | $14.73 | 0.68× | $283.34 |
| Urine culture bacterial | CPT | 87086 | 16 | $151 | — | $8.07 | $16.86 | 0.72× | $93.62 |
| Urine culture identification | CPT | 87088 | 16 | $1,452 | — | $8.09 | $16.86 | 0.76× | $900.24 |
| Tissue exam by pathologist level IV | CPT | 88305 | 16 | $3,062 | — | $53.54 | $135.6 | 1.3× | $1,898.44 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 16 | $933 | — | $36.88 | $213.94 | 1.1× | $4,398.03 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 10 | $310 | — | $39.22 | $65.72 | 0.76× | $1,670 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 10 | $440 | — | $52.32 | $92.84 | 0.76× | $272.8 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 10 | $716 | — | $68.18 | $129.17 | 0.74× | $443.92 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 10 | $891 | — | $97.08 | $188 | 0.85× | $552.42 |
| Office visit, established patient, 5 min | CPT | 99211 | 10 | $420 | — | $1.26 | $46.04 | 0.71× | $260.4 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 10 | $480 | — | $4.17 | $54.79 | 0.68× | $297.6 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 10 | $519 | — | $39.67 | $103.5 | 0.90× | $321.78 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 10 | $716 | — | $52.32 | $120.88 | 0.79× | $443.92 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 10 | $891 | — | $71.73 | $164.33 | 0.87× | $552.42 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 16 | $3,937 | — | $201.38 | $1,127.48 | 1.2× | $6,316 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 16 | $6,328 | — | $238.95 | $1,146.11 | 1.2× | $6,316 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 16 | $3,468 | — | $85.48 | $1,156.03 | 1.4× | $4,123 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 16 | $3,468 | — | $102.39 | $1,156.03 | 1.3× | $4,123 |
| Colonoscopy diagnostic | CPT | 45378 | 16 | $4,197 | — | $290.28 | $1,165.59 | 1.3× | $6,316 |
| Colonoscopy with biopsy | CPT | 45380 | 16 | $6,996 | — | $362.52 | $1,499.84 | 1.2× | $6,316 |
| Colonoscopy with polyp removal | CPT | 45385 | 16 | $6,691 | — | $431.13 | $1,499.84 | 1.2× | $6,316 |
| surgery |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 1 | — | — | $57,438 | $57,438 | 2.1× | $57,438 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 1 | — | — | $36,276 | $36,276 | 2.0× | $36,276 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 5 | — | — | $27,590 | $79,632 | 1.9× | $89,829 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 5 | — | — | $20,664 | $42,192 | 1.8× | $65,048 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 5 | — | — | $14,254 | $29,470 | 1.8× | $36,557 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 4 | — | — | $14,582 | $29,602 | 1.8× | $31,051 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 5 | — | — | $6,157 | $23,279 | 1.7× | $24,284 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 4 | — | — | $29,369 | $63,002 | 1.9× | $64,648 |
| Laparoscopic appendectomy | CPT | 44970 | 14 | — | — | $1,670 | $6,583.59 | 4.2× | $17,119 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 1 | — | — | $123,790 | $123,790 | 2.5× | $123,790 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 1 | — | — | $72,263 | $72,263 | 2.2× | $72,263 |
| Major joint replacement w MCC | MS-DRG | 469 | 5 | — | — | $15,505 | $52,549 | 1.8× | $58,346 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 5 | — | — | $15,505 | $33,656 | 1.8× | $36,557 |
| Laparoscopic cholecystectomy | CPT | 47562 | 14 | — | — | $1,670 | $7,453.12 | 4.2× | $17,119 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 14 | — | — | $1,670 | $7,453.12 | 4.0× | $17,119 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 4 | — | — | $25,104 | $52,497 | 1.9× | $55,627 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 4 | — | — | $18,055 | $37,037 | 1.8× | $38,535 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 5 | — | — | $14,059 | $28,317 | 1.8× | $36,557 |
| Lap inguinal hernia repair | CPT | 49650 | 14 | — | — | $1,670 | $7,453.12 | 6.6× | $17,119 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 14 | — | — | $1,670 | $11,576 | 5.2× | $30,101 |
| Lap salpingo-oophorectomy | CPT | 58661 | 14 | — | — | $1,670 | $7,453.12 | 3.7× | $17,119 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 5 | — | — | $15,505 | $48,668 | 1.8× | $56,287 |
| OR procedure for obesity w CC | MS-DRG | 620 | 5 | — | — | $13,795 | $28,506 | 1.8× | $36,557 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 5 | — | — | $13,002 | $26,093 | 1.7× | $36,557 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 5 | — | — | $6,157 | $14,516 | 1.2× | $22,060 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 5 | — | — | $6,157 | $33,787 | 1.8× | $36,433 |
| PCI single major coronary artery | CPT | 92920 | 16 | $14,095 | — | $1,217.81 | $5,964.24 | 1.1× | $16,117 |
| PCI with drug-eluting stent | CPT | 92928 | 16 | $21,404 | — | $1,849.31 | $11,860 | 1.2× | $32,690 |
| PCI bypass graft | CPT | 92937 | 16 | $21,404 | — | $1,849.31 | $11,860 | 1.1× | $32,690 |
| Left heart catheterization | CPT | 93452 | 16 | $30,821 | — | $1,670 | $4,080.02 | 1.3× | $19,109 |
| Coronary angiography with cath | CPT | 93455 | 16 | $28,479 | — | $1,670 | $4,296.88 | 1.4× | $17,657 |
| Coronary angiography with bypass cath | CPT | 93458 | 16 | $20,754 | — | $1,670 | $4,046.72 | 1.3× | $12,867 |