| behavioral |
| Psychoses | MS-DRG | 885 | 19 | — | — | $2,778 | $14,878 | 1.2× | $26,286 |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 19 | — | — | $2,778 | $21,871 | 1.1× | $37,095 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 19 | — | — | $2,778 | $11,275 | 1.1× | $18,963 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 19 | — | — | $2,778 | $7,953.87 | 1.0× | $13,666 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 19 | — | — | $2,778 | $17,773 | 1.2× | $30,144 |
| COPD w MCC | MS-DRG | 190 | 19 | — | — | $2,778 | $12,224 | 1.1× | $20,942 |
| COPD w CC | MS-DRG | 191 | 19 | — | — | $2,778 | $9,460.33 | 1.1× | $16,218 |
| COPD w/o CC/MCC | MS-DRG | 192 | 19 | — | — | $2,778 | $7,596.6 | 1.1× | $13,053 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 19 | — | — | $2,778 | $9,120.66 | 1.1× | $15,634 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 19 | — | — | $2,778 | $7,383.61 | 1.1× | $12,687 |
| AMI discharged alive w MCC | MS-DRG | 280 | 20 | — | — | $9,027.7 | $17,937 | 1.1× | $30,609 |
| AMI discharged alive w CC | MS-DRG | 281 | 20 | — | — | $5,069.9 | $10,353 | 1.1× | $26,466 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 20 | — | — | $3,988.05 | $8,304 | 1.1× | $19,849 |
| Heart failure & shock w MCC | MS-DRG | 291 | 19 | — | — | $2,778 | $14,242 | 1.1× | $24,332 |
| Heart failure & shock w CC | MS-DRG | 292 | 19 | — | — | $2,778 | $9,501.15 | 1.1× | $16,249 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 19 | — | — | $2,778 | $6,740.3 | 1.1× | $11,581 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 19 | — | — | $2,778 | $13,336 | 1.1× | $22,488 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 19 | — | — | $2,778 | $8,416.49 | 1.1× | $14,428 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 19 | — | — | $2,778 | $6,834.2 | 1.1× | $11,743 |
| GI hemorrhage w CC | MS-DRG | 378 | 19 | — | — | $2,778 | $10,913 | 1.1× | $18,385 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 19 | — | — | $2,778 | $7,505.31 | 1.1× | $12,896 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 19 | — | — | $2,778 | $8,753.66 | 1.1× | $15,041 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 19 | — | — | $2,778 | $16,939 | 1.1× | $28,436 |
| Kidney/UTI w MCC | MS-DRG | 689 | 19 | — | — | $2,778 | $13,028 | 1.1× | $21,824 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 19 | — | — | $2,778 | $8,968.04 | 1.1× | $15,374 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 19 | — | — | $2,778 | $21,573 | 1.2× | $36,589 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 19 | — | — | $2,778 | $11,425 | 1.1× | $19,226 |
| lab |
| Tissue exam by pathologist level IV | CPT | 88305 | 13 | — | — | $47.75 | $61.37 | 0.60× | $292.86 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 13 | — | — | $15.78 | $194.05 | 1.0× | $2,866 |
| Routine obstetric care with C-section | CPT | 59510 | 2 | — | — | $3,573.64 | $3,597.78 | 1.4× | $7,006 |
| office |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 2 | — | — | $97.17 | $227.23 | 1.5× | $276.83 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 16 | — | — | $334.95 | $1,163.16 | 1.3× | $4,419 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 16 | — | — | $334.95 | $1,163.16 | 1.2× | $4,958 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 15 | — | — | $130.67 | $890.04 | 1.1× | $4,419 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 15 | — | — | $328.5 | $1,130.54 | 1.3× | $4,419 |
| Colonoscopy diagnostic | CPT | 45378 | 16 | — | — | $328.5 | $1,130.54 | 1.3× | $4,958 |
| Colonoscopy with biopsy | CPT | 45380 | 16 | — | — | $429.26 | $1,486.25 | 1.2× | $4,958 |
| Colonoscopy with polyp removal | CPT | 45385 | 16 | — | — | $429.26 | $1,486.25 | 1.2× | $4,958 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 15 | — | — | $2,236.46 | $17,284 | 4.2× | $28,519 |
| Hip hemiarthroplasty | CPT | 27125 | 5 | — | — | $1,744.68 | $5,388 | 4.3× | $13,933 |
| Total hip replacement | CPT | 27130 | 15 | — | — | $5,388 | $14,887 | 3.4× | $21,421 |
| Total knee replacement | CPT | 27447 | 15 | — | — | $5,388 | $14,887 | 3.6× | $21,421 |
| Knee revision arthroplasty single component | CPT | 27486 | 5 | — | — | $2,162.32 | $5,388 | 3.2× | $17,086 |
| Knee revision arthroplasty all components | CPT | 27487 | 5 | — | — | $2,705.82 | $5,388 | 2.7× | $17,086 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 5 | — | — | $2,579 | $4,856.5 | 14.9× | $11,621 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 16 | — | — | $2,398.52 | $8,240.86 | 2.5× | $12,483 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 16 | — | — | $1,088.27 | $4,051.43 | 2.0× | $11,621 |
| ACL reconstruction | CPT | 29888 | 16 | — | — | $3,300.05 | $8,240.86 | 2.5× | $11,621 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 19 | — | — | $6,182 | $47,983 | 1.1× | $85,630 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 19 | — | — | $6,182 | $25,795 | 1.1× | $44,078 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 19 | — | — | $6,182 | $18,153 | 1.1× | $30,788 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 19 | — | — | $6,182 | $18,134 | 1.1× | $30,926 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 19 | — | — | $6,182 | $14,567 | 1.1× | $24,571 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 19 | — | — | $6,182 | $35,506 | 1.1× | $65,818 |
| Open appendectomy | CPT | 44950 | 15 | — | — | $4,601.82 | $7,016.81 | 6.2× | $14,887 |
| Laparoscopic appendectomy | CPT | 44970 | 15 | — | — | $5,083.89 | $6,716.08 | 4.3× | $14,887 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 6 | — | — | $35,308 | $73,572 | 1.5× | $91,851 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 6 | — | — | $35,308 | $40,577 | 1.2× | $50,658 |
| Major joint replacement w MCC | MS-DRG | 469 | 20 | — | — | $17,978 | $36,025 | 1.2× | $61,515 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 20 | — | — | $10,370 | $21,696 | 1.1× | $36,028 |
| Laparoscopic cholecystectomy | CPT | 47562 | 15 | — | — | $1,888.85 | $7,153.89 | 4.0× | $14,887 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 15 | — | — | $1,888.85 | $7,153.89 | 3.8× | $14,887 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 20 | — | — | $9,144 | $31,081 | 1.1× | $54,844 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 20 | — | — | $9,144 | $22,389 | 1.1× | $38,693 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 20 | — | — | $8,725.2 | $17,372 | 1.1× | $29,583 |
| Lap inguinal hernia repair | CPT | 49650 | 16 | — | — | $1,888.85 | $6,716.08 | 6.0× | $11,526 |
| Total abdominal hysterectomy | CPT | 58150 | 5 | — | — | $1,552.14 | $5,388 | 5.5× | $15,605 |
| Vaginal hysterectomy | CPT | 58260 | 15 | — | — | $1,526.99 | $5,759.5 | 3.2× | $14,887 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 16 | — | — | $1,888.85 | $7,153.89 | 4.8× | $13,933 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 15 | — | — | $3,110.01 | $10,430 | 4.7× | $15,753 |
| Lap salpingo-oophorectomy | CPT | 58661 | 16 | — | — | $1,888.85 | $6,716.08 | 3.3× | $12,483 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 20 | — | — | $6,182 | $28,714 | 1.1× | $50,844 |
| OR procedure for obesity w CC | MS-DRG | 620 | 20 | — | — | $6,182 | $17,995 | 1.1× | $29,781 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 20 | — | — | $6,182 | $16,788 | 1.1× | $28,880 |
| Complex cataract surgery | CPT | 66982 | 16 | — | — | $849.94 | $2,992.35 | 1.3× | $12,483 |
| Cataract surgery with lens implant | CPT | 66984 | 16 | — | — | $849.94 | $2,992.35 | 1.4× | $12,483 |
| Intravitreal injection | CPT | 67028 | 15 | — | — | $48.45 | $329.81 | 0.96× | $3,500 |
| Vitrectomy mechanical | CPT | 67042 | 15 | — | — | $1,533.49 | $5,637.54 | 2.2× | $14,887 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 19 | — | — | $6,182 | $12,890 | 1.0× | $22,353 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 19 | — | — | $6,182 | $20,881 | 1.1× | $36,438 |
| PCI with drug-eluting stent | CPT | 92928 | 15 | — | — | $6,379 | $12,672 | 1.3× | $23,216 |