| behavioral |
| Psychoses | MS-DRG | 885 | 14 | — | — | $17.8 | $10,311 | $46,269 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 14 | — | $347.82 | $19.84 | $165.08 | $472.56 |
| Psychiatric eval with medical services | CPT | 90792 | 14 | — | $347.82 | $19.84 | $165.08 | $472.56 |
| Psychotherapy 30 minutes | CPT | 90832 | 14 | — | $279.15 | $19.84 | $165.08 | $379.31 |
| Psychotherapy 45 minutes | CPT | 90834 | 14 | — | $347.82 | $19.84 | $165.08 | $472.56 |
| Psychotherapy 60 minutes | CPT | 90837 | 14 | — | $347.82 | $19.84 | $165.08 | $472.56 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 14 | — | $347.82 | $19.84 | $165.08 | $472.56 |
| emergency |
| ED visit level 1 | CPT | 99281 | 14 | — | $169.48 | $18.8 | $78.43 | $1,037 |
| ED visit level 2 | CPT | 99282 | 14 | — | $278.04 | $18.8 | $142.81 | $1,293 |
| ED visit level 3 | CPT | 99283 | 14 | — | $440.87 | $18.8 | $253.89 | $3,034 |
| ED visit level 4 | CPT | 99284 | 14 | — | $702.29 | $18.8 | $239.05 | $4,928 |
| ED visit level 5 | CPT | 99285 | 14 | — | $1,043.47 | $18.8 | $321.95 | $4,928 |
| Critical care, first hour | CPT | 99291 | 14 | — | $1,564.1 | $18.8 | $429.14 | $8,017 |
| imaging |
| CT head without contrast | CPT | 70450 | 14 | — | $421.37 | $36.9 | $100.65 | $946.9 |
| CT head with contrast | CPT | 70460 | 14 | — | $608.16 | $36.9 | $168.85 | $1,499.36 |
| CT head with and without contrast | CPT | 70470 | 14 | — | $597.3 | $36.9 | $168.85 | $1,660.91 |
| CT neck with contrast | CPT | 70491 | 14 | — | $454.98 | $36.9 | $168.85 | $1,499.36 |
| MRI brain without contrast | CPT | 70551 | 14 | — | $622.39 | $36.9 | $229.36 | $1,695.46 |
| MRI brain with contrast | CPT | 70552 | 14 | — | $905.29 | $36.9 | $335.84 | $1,873.78 |
| MRI brain with and without contrast | CPT | 70553 | 14 | — | $1,131.61 | $36.9 | $335.84 | $2,624.09 |
| Chest X-ray single view | CPT | 71045 | 14 | — | $109.66 | $7.78 | $80.94 | $217.73 |
| Chest X-ray 2 views | CPT | 71046 | 14 | — | $109.66 | $14.34 | $80.94 | $217.73 |
| Chest X-ray 3 views | CPT | 71047 | 14 | — | $109.66 | $18.28 | $80.94 | $195.96 |
| CT chest without contrast | CPT | 71250 | 14 | — | $474.58 | $36.9 | $100.65 | $946.9 |
| CT chest with contrast | CPT | 71260 | 14 | — | $591 | $36.9 | $168.85 | $1,499.36 |
| CT chest with and without contrast | CPT | 71270 | 14 | — | $684.18 | $36.9 | $168.85 | $1,660.91 |
| MRI chest without contrast | CPT | 71550 | 14 | — | $678.97 | $36.9 | $229.36 | $1,695.46 |
| MRI chest with contrast | CPT | 71551 | 14 | — | $623.46 | $36.9 | $729.11 | $1,873.78 |
| MRI chest with and without contrast | CPT | 71552 | 14 | — | $1,124.82 | $36.9 | $335.84 | $2,361.69 |
| Lumbosacral spine X-ray | CPT | 72100 | 14 | — | $67.34 | $32.1 | $97.24 | $217.73 |
| CT cervical spine without contrast | CPT | 72125 | 14 | — | $490.87 | $36.9 | $100.65 | $946.9 |
| CT thoracic spine without contrast | CPT | 72128 | 14 | — | $422.45 | $36.9 | $100.65 | $946.9 |
| CT lumbar spine without contrast | CPT | 72131 | 14 | — | $526.71 | $36.9 | $100.65 | $946.9 |
| MRI cervical spine without contrast | CPT | 72141 | 14 | — | $622.39 | $36.9 | $229.36 | $1,695.46 |
| MRI thoracic spine without contrast | CPT | 72146 | 14 | — | $678.97 | $36.9 | $229.36 | $1,695.46 |
| MRI lumbar spine without contrast | CPT | 72148 | 14 | — | $659.73 | $36.9 | $229.36 | $1,695.46 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 14 | — | $860.03 | $36.9 | $335.84 | $1,873.78 |
| MRI cervical spine with and without contrast | CPT | 72156 | 14 | — | $1,131.61 | $36.9 | $335.84 | $2,624.09 |
| MRI lumbar spine with contrast | CPT | 72158 | 14 | — | $1,131.61 | $36.9 | $335.84 | $2,624.09 |
| CT pelvis without contrast | CPT | 72192 | 14 | — | $491.96 | $36.9 | $100.65 | $946.9 |
| CT pelvis with contrast | CPT | 72193 | 14 | — | $527.8 | $36.9 | $168.85 | $1,499.36 |
| Shoulder X-ray | CPT | 73030 | 14 | — | $62.75 | $29.77 | $80.94 | $217.73 |
| Humerus X-ray | CPT | 73060 | 14 | — | $59.98 | $12.67 | $80.94 | $217.73 |
| Hand X-ray 3 views | CPT | 73130 | 14 | — | $62.71 | $27.91 | $80.94 | $217.73 |
| MRI upper extremity joint without contrast | CPT | 73221 | 14 | — | $622.39 | $36.9 | $229.36 | $1,695.46 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 14 | — | $1,118.04 | $36.9 | $335.84 | $2,361.69 |
| Knee X-ray 1-2 views | CPT | 73560 | 14 | — | $59.98 | $27.4 | $80.94 | $195.96 |
| Ankle X-ray 3 views | CPT | 73610 | 14 | — | $61.81 | $27.91 | $80.94 | $217.73 |
| MRI lower extremity joint without contrast | CPT | 73721 | 14 | — | $622.39 | $36.9 | $229.36 | $1,695.46 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 14 | — | $1,118.04 | $36.9 | $335.84 | $2,624.09 |
| CT abdomen without contrast | CPT | 74150 | 14 | — | $456.12 | $36.9 | $100.65 | $946.9 |
| CT abdomen with contrast | CPT | 74160 | 14 | — | $688.52 | $36.9 | $168.85 | $1,499.36 |
| CT abdomen with and without contrast | CPT | 74170 | 14 | — | $775.4 | $36.9 | $168.85 | $1,660.91 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 14 | — | $533.75 | $36.9 | $229.36 | $1,893.79 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 14 | — | $873.07 | $36.9 | $330.97 | $2,998.77 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 14 | — | $957.06 | $36.9 | $330.97 | $3,321.79 |
| MRI abdomen without contrast | CPT | 74181 | 14 | — | $678.97 | $36.9 | $229.36 | $1,695.46 |
| MRI abdomen with and without contrast | CPT | 74183 | 14 | — | $1,037.83 | $36.9 | $335.84 | $2,624.09 |
| Abdominal ultrasound complete | CPT | 76700 | 14 | — | $210.48 | $32.1 | $99.18 | $476.27 |
| Abdominal ultrasound limited | CPT | 76705 | 14 | — | $145.41 | $32.1 | $97.24 | $476.27 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 14 | — | $176.1 | $32.1 | $99.18 | $476.27 |
| Obstetric ultrasound first trimester | CPT | 76801 | 14 | — | $230.41 | $32.1 | $97.24 | $428.65 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 14 | — | $148.18 | $32.1 | $99.18 | $428.65 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 14 | — | $428.69 | $32.1 | $221.92 | $671.49 |
| Transvaginal ultrasound | CPT | 76830 | 14 | — | $263.9 | $32.1 | $97.24 | $476.27 |
| Pelvic ultrasound complete | CPT | 76856 | 14 | — | $150.05 | $32.1 | $97.24 | $476.27 |
| Scrotal ultrasound | CPT | 76870 | 14 | — | $215.01 | $32.1 | $97.24 | $476.27 |
| Diagnostic mammography unilateral | CPT | 77065 | 15 | — | — | $25 | $50 | $148.61 |
| Diagnostic mammography bilateral | CPT | 77066 | 15 | — | — | $25 | $50 | $275.83 |
| Screening mammography bilateral | CPT | 77067 | 14 | — | $148.42 | $25 | $58.27 | $159.41 |
| EKG complete | CPT | 93000 | 13 | — | — | $16.54 | $50 | $500 |
| EKG tracing only | CPT | 93005 | 14 | — | $84.19 | $19.84 | $56.8 | $500 |
| EKG interpretation only | CPT | 93010 | 14 | — | — | $8.55 | $33.7 | $90 |
| Transthoracic echocardiogram complete | CPT | 93306 | 14 | — | $963.72 | $19.84 | $508.21 | $2,101.27 |
| Transthoracic echocardiogram | CPT | 93307 | 14 | — | $347.99 | $19.84 | $221.92 | $1,242.43 |
| Stress echocardiogram | CPT | 93350 | 14 | — | $1,390.19 | $19.84 | $508.21 | $1,891.15 |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 14 | — | $16,091 | $36.9 | $11,824 | $51,764 |
| COPD w MCC | MS-DRG | 190 | 14 | — | $10,643 | $36.9 | $8,381.03 | $36,693 |
| COPD w CC | MS-DRG | 191 | 14 | — | $9,118.96 | $36.9 | $6,378.27 | $27,924 |
| COPD w/o CC/MCC | MS-DRG | 192 | 14 | — | $8,004.26 | $36.9 | $4,857.47 | $21,266 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 14 | — | $9,437.75 | $36.9 | $6,097.57 | $26,695 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 14 | — | $6,237.98 | $36.9 | $4,755.33 | $20,819 |
| AMI discharged alive w MCC | MS-DRG | 280 | 14 | — | $18,510 | $36.9 | $12,137 | $53,136 |
| AMI discharged alive w CC | MS-DRG | 281 | 14 | — | $13,668 | $36.9 | $6,954.05 | $30,445 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 14 | — | $12,128 | $36.9 | $5,471.08 | $23,953 |
| Heart failure & shock w MCC | MS-DRG | 291 | 14 | — | $11,509 | $36.9 | $9,713.43 | $42,526 |
| Heart failure & shock w CC | MS-DRG | 292 | 14 | — | $8,543.84 | $36.9 | $6,423.67 | $28,123 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 14 | — | $6,553.55 | $36.9 | $4,282.44 | $18,749 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 14 | — | $13,642 | $36.9 | $9,109.65 | $39,883 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 14 | — | $8,283.21 | $36.9 | $5,566.42 | $24,370 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 14 | — | $6,922.96 | $36.9 | $4,283.2 | $18,752 |
| GI hemorrhage w CC | MS-DRG | 378 | 14 | — | $11,871 | $36.9 | $7,420.12 | $32,486 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 14 | — | $8,711.85 | $36.9 | $4,769.71 | $20,882 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 14 | — | $8,746.32 | $36.9 | $5,898.57 | $25,824 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 14 | — | $28,287 | $36.9 | $11,861 | $51,930 |
| Kidney/UTI w MCC | MS-DRG | 689 | 14 | — | $12,165 | $36.9 | $8,779.01 | $38,435 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 14 | — | $8,569.69 | $36.9 | $6,124.8 | $26,815 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 14 | — | $16,579 | $36.9 | $14,697 | $64,345 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 14 | — | $10,249 | $36.9 | $7,742.44 | $33,897 |
| Initial hospital care, low complexity | CPT | 99221 | 15 | — | — | $18.72 | $36.9 | $96.66 |
| Initial hospital care, moderate complexity | CPT | 99222 | 15 | — | — | $18.72 | $36.9 | $131.11 |
| Initial hospital care, high complexity | CPT | 99223 | 15 | — | — | $18.72 | $36.9 | $194.01 |
| Hospital discharge, <30 min | CPT | 99238 | 15 | — | — | $18.72 | $36.9 | $90 |
| Hospital discharge, >30 min | CPT | 99239 | 15 | — | — | $18.72 | $36.9 | $102.7 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 14 | — | $31.25 | $8.46 | $10.91 | $90 |
| General health panel | CPT | 80050 | 14 | — | $52.72 | $19.84 | $47.68 | $217.07 |
| Electrolyte panel | CPT | 80051 | 14 | — | $26.78 | $7.01 | $9.05 | $117.15 |
| Comprehensive metabolic panel | CPT | 80053 | 14 | — | $35.71 | $10.56 | $12.34 | $150.75 |
| Lipid panel | CPT | 80061 | 14 | — | $41.9 | $12.64 | $14.66 | $90 |
| Renal function panel | CPT | 80069 | 14 | — | $35.68 | $8.68 | $11.19 | $90 |
| Hepatic function panel | CPT | 80076 | 14 | — | $38.3 | $8.17 | $10.53 | $90 |
| Urinalysis non-automated | CPT | 81002 | 14 | — | $9.81 | $2.99 | $3.64 | $90 |
| Urinalysis automated | CPT | 81003 | 14 | — | $10.69 | $2.25 | $2.9 | $90 |
| Glucose quantitative | CPT | 82947 | 14 | — | $14.29 | $3.93 | $5.06 | $90 |
| Hemoglobin A1c | CPT | 83036 | 14 | — | $37.48 | $9.71 | $12.51 | $90 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 14 | — | $59.85 | $16.8 | $21.65 | $90 |
| Complete blood count with automated differential | CPT | 85025 | 14 | — | $26.8 | $7.77 | $9.56 | $90 |
| Complete blood count without differential | CPT | 85027 | 14 | — | $21.44 | $6.47 | $7.68 | $90 |
| Urine culture bacterial | CPT | 87086 | 14 | — | $27.7 | $8.07 | $10.41 | $90 |
| Urine culture identification | CPT | 87088 | 14 | — | $30.35 | $8.09 | $10.44 | $90 |
| Tissue exam by pathologist level IV | CPT | 88305 | 14 | — | $107.45 | $27.63 | $50.21 | $168.29 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 14 | — | $271.03 | $36.9 | $188.97 | $1,094 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 15 | — | — | $18.8 | $50 | $7,646 |
| Vaginal delivery only | CPT | 59409 | 14 | — | $4,210.44 | $36.9 | $3,025.84 | $12,598 |
| Vaginal delivery with postpartum | CPT | 59410 | 15 | — | — | $18.8 | $50 | $7,646 |
| Routine obstetric care with C-section | CPT | 59510 | 15 | — | — | $18.8 | $50 | $7,646 |
| C-section delivery only | CPT | 59514 | 15 | — | — | $18.8 | $50 | $7,646 |
| C-section with postpartum | CPT | 59515 | 15 | — | — | $18.8 | $50 | $7,646 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 14 | — | $93.65 | $18.8 | $35.7 | $93.65 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 14 | — | $136.36 | $18.8 | $35.7 | $136.36 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 14 | — | $188.7 | $18.8 | $35.7 | $188.7 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 14 | — | $255.41 | $18.8 | $35.7 | $255.41 |
| Office visit, established patient, 5 min | CPT | 99211 | 14 | — | $47.77 | $8.9 | $34.1 | $90 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 14 | — | $81.66 | $18.8 | $34.1 | $90 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 14 | — | $108.5 | $18.8 | $35.7 | $108.5 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 14 | — | $145.87 | $18.8 | $35.7 | $145.87 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 14 | — | $198.55 | $18.8 | $35.7 | $198.55 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 14 | — | $759.47 | $36.9 | $847.79 | $8,579 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 14 | — | $832.93 | $36.9 | $864.66 | $8,579 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 14 | — | $1,104.9 | $36.9 | $864.93 | $2,843 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 14 | — | $795.91 | $36.9 | $864.93 | $2,843 |
| Colonoscopy diagnostic | CPT | 45378 | 14 | — | $832.93 | $36.9 | $864.93 | $8,579 |
| Colonoscopy with biopsy | CPT | 45380 | 14 | — | $832.93 | $36.9 | $1,112.97 | $8,579 |
| Colonoscopy with polyp removal | CPT | 45385 | 14 | — | $832.93 | $36.9 | $1,140.8 | $8,579 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 14 | — | $21,927 | $18.8 | $7,299.5 | $31,148 |
| Hip hemiarthroplasty | CPT | 27125 | 14 | — | $17,649 | $18.8 | $8,261.5 | $22,807 |
| Total hip replacement | CPT | 27130 | 14 | — | $27,052 | $18.8 | $8,738 | $27,052 |
| Total knee replacement | CPT | 27447 | 14 | — | $21,564 | $18.8 | $8,738 | $22,807 |
| Knee revision arthroplasty single component | CPT | 27486 | 14 | — | $23,346 | $18.8 | $8,738 | $23,346 |
| Knee revision arthroplasty all components | CPT | 27487 | 14 | — | $23,346 | $18.8 | $8,738 | $31,148 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 14 | — | — | $25 | $90 | $15,837 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 14 | — | $3,614.35 | $36.9 | $6,748.84 | $19,766 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 14 | — | $3,614.35 | $36.9 | $3,058.44 | $15,611 |
| ACL reconstruction | CPT | 29888 | 14 | — | $3,614.35 | $36.9 | $6,748.84 | $19,766 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 14 | — | $51,030 | $36.9 | $34,778 | $152,259 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 14 | — | $33,991 | $36.9 | $18,138 | $79,407 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 14 | — | $27,492 | $36.9 | $12,733 | $55,746 |
| CABG single arterial graft | CPT | 33533 | 15 | — | — | $18.8 | $50 | $11,100 |
| CABG 2 arterial grafts | CPT | 33534 | 15 | — | — | $18.8 | $50 | $11,100 |
| CABG 3 arterial grafts | CPT | 33535 | 15 | — | — | $18.8 | $50 | $11,100 |
| CABG 4+ arterial grafts | CPT | 33536 | 15 | — | — | $18.8 | $50 | $11,100 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 14 | — | $26,602 | $36.9 | $12,799 | $56,034 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 14 | — | $23,276 | $36.9 | $10,334 | $45,242 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 14 | — | $47,204 | $36.9 | $25,779 | $112,860 |
| Open appendectomy | CPT | 44950 | 14 | — | $4,562.7 | $36.9 | $6,021.16 | $15,611 |
| Laparoscopic appendectomy | CPT | 44970 | 14 | — | $9,859.82 | $36.9 | $5,650.93 | $19,766 |
| Major joint replacement w MCC | MS-DRG | 469 | 14 | — | $42,510 | $36.9 | $22,950 | $100,475 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 14 | — | $28,085 | $36.9 | $14,594 | $63,895 |
| Laparoscopic cholecystectomy | CPT | 47562 | 14 | — | $6,899.93 | $36.9 | $5,650.93 | $21,424 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 14 | — | $9,859.82 | $36.9 | $5,650.93 | $21,424 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 14 | — | $43,943 | $36.9 | $22,035 | $96,470 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 14 | — | $32,978 | $36.9 | $15,847 | $69,380 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 14 | — | $23,747 | $36.9 | $12,340 | $54,027 |
| Lap inguinal hernia repair | CPT | 49650 | 14 | — | $6,805.46 | $36.9 | $5,650.93 | $19,766 |
| Total abdominal hysterectomy | CPT | 58150 | 15 | — | — | $18.8 | $50 | $15,611 |
| Vaginal hysterectomy | CPT | 58260 | 14 | — | $7,171.38 | $36.9 | $4,675.94 | $15,611 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 14 | — | $14,883 | $36.9 | $5,650.93 | $20,250 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 14 | — | $9,859.82 | $36.9 | $9,886.57 | $19,766 |
| Lap salpingo-oophorectomy | CPT | 58661 | 14 | — | $9,859.82 | $36.9 | $5,650.93 | $19,766 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 14 | — | $38,816 | $36.9 | $21,847 | $95,645 |
| OR procedure for obesity w CC | MS-DRG | 620 | 14 | — | $25,719 | $36.9 | $12,108 | $53,010 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 14 | — | $23,389 | $36.9 | $11,413 | $49,966 |
| Complex cataract surgery | CPT | 66982 | 14 | — | $2,145.3 | $36.9 | $2,200.12 | $12,598 |
| Cataract surgery with lens implant | CPT | 66984 | 14 | — | $2,145.3 | $36.9 | $2,200.12 | $12,598 |
| Intravitreal injection | CPT | 67028 | 14 | — | $671.28 | $36.9 | $309.31 | $2,843 |
| Vitrectomy mechanical | CPT | 67042 | 14 | — | $3,614.35 | $36.9 | $3,844.4 | $24,352 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 14 | — | $16,953 | $36.9 | $9,295.74 | $41,098 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 14 | — | $19,885 | $36.9 | $15,353 | $67,876 |
| PCI single major coronary artery | CPT | 92920 | 14 | — | $10,293 | $36.9 | $5,320.07 | $39,758 |
| PCI with drug-eluting stent | CPT | 92928 | 14 | — | $18,167 | $36.9 | $10,791 | $39,758 |
| PCI bypass graft | CPT | 92937 | 14 | — | $18,167 | $36.9 | $10,791 | $39,758 |
| Left heart catheterization | CPT | 93452 | 14 | — | $8,357.75 | $36.9 | $3,060.48 | $27,498 |
| Coronary angiography with cath | CPT | 93455 | 14 | — | $8,357.75 | $36.9 | $3,060.48 | $27,498 |
| Coronary angiography with bypass cath | CPT | 93458 | 14 | — | $8,357.75 | $36.9 | $3,060.48 | $27,498 |