| behavioral |
| Psychotherapy 30 minutes | CPT | 90832 | 17 | $190 | $48 | $76 | $152 | 1.0× | $175 |
| Psychotherapy 45 minutes | CPT | 90834 | 17 | $250 | $63 | $100 | $152 | 0.95× | $230 |
| Psychotherapy 60 minutes | CPT | 90837 | 17 | $345 | $86 | $138 | $160 | 0.84× | $317 |
| emergency |
| ED visit level 1 | CPT | 99281 | 17 | $263 | $66 | $70 | $89 | 0.64× | $242 |
| ED visit level 2 | CPT | 99282 | 17 | $541 | $135 | $128 | $164 | 0.69× | $498 |
| ED visit level 3 | CPT | 99283 | 17 | $811 | $203 | $84 | $272 | 0.67× | $746 |
| ED visit level 4 | CPT | 99284 | 17 | $1,073 | $268 | $117 | $422 | 0.63× | $987 |
| ED visit level 5 | CPT | 99285 | 17 | $1,329 | $332 | $200 | $612 | 0.59× | $1,223 |
| Critical care, first hour | CPT | 99291 | 17 | $3,150 | $788 | $667 | $888 | 0.83× | $2,898 |
| imaging |
| CT head without contrast | CPT | 70450 | 17 | $2,002 | $501 | $105 | $110 | 0.53× | $1,842 |
| CT head with contrast | CPT | 70460 | 17 | $2,252 | $563 | $175 | $184 | 0.79× | $2,072 |
| CT head with and without contrast | CPT | 70470 | 17 | $2,502 | $626 | $175 | $184 | 0.69× | $2,302 |
| CT neck with contrast | CPT | 70491 | 17 | $2,252 | $563 | $175 | $184 | 0.67× | $2,072 |
| MRI brain without contrast | CPT | 70551 | 17 | $2,550 | $638 | $233 | $245 | 0.61× | $2,346 |
| MRI brain with contrast | CPT | 70552 | 17 | $2,800 | $700 | $366 | $385 | 0.81× | $2,576 |
| MRI brain with and without contrast | CPT | 70553 | 17 | $4,311 | $1,078 | $366 | $385 | 0.65× | $3,966 |
| Chest X-ray single view | CPT | 71045 | 17 | $324 | $81 | $80 | $109 | 1.2× | $298 |
| Chest X-ray 2 views | CPT | 71046 | 17 | $324 | $81 | $39 | $87 | 0.88× | $298 |
| Chest X-ray 3 views | CPT | 71047 | 17 | $300 | $75 | $80 | $91 | 0.95× | $276 |
| CT chest without contrast | CPT | 71250 | 17 | $2,006 | $502 | $105 | $110 | 0.51× | $1,846 |
| CT chest with contrast | CPT | 71260 | 17 | $2,271 | $568 | $175 | $184 | 0.65× | $2,089 |
| CT chest with and without contrast | CPT | 71270 | 17 | $2,502 | $626 | $175 | $184 | 0.63× | $2,302 |
| MRI chest without contrast | CPT | 71550 | 17 | $2,550 | $638 | $233 | $245 | 0.57× | $2,346 |
| MRI chest with contrast | CPT | 71551 | 17 | $2,800 | $700 | $681 | $801 | 0.98× | $2,576 |
| MRI chest with and without contrast | CPT | 71552 | 17 | $3,050 | $763 | $366 | $385 | 0.64× | $2,806 |
| Lumbosacral spine X-ray | CPT | 72100 | 17 | $425 | $106 | $47 | $105 | 1.0× | $391 |
| CT cervical spine without contrast | CPT | 72125 | 17 | $2,351 | $588 | $105 | $110 | 0.55× | $2,163 |
| CT thoracic spine without contrast | CPT | 72128 | 17 | $2,002 | $501 | $105 | $110 | 0.55× | $1,842 |
| CT lumbar spine without contrast | CPT | 72131 | 17 | $2,002 | $501 | $105 | $110 | 0.54× | $1,842 |
| MRI cervical spine without contrast | CPT | 72141 | 17 | $2,665 | $666 | $233 | $245 | 0.62× | $2,452 |
| MRI thoracic spine without contrast | CPT | 72146 | 17 | $2,665 | $666 | $233 | $245 | 0.66× | $2,452 |
| MRI lumbar spine without contrast | CPT | 72148 | 17 | $2,665 | $666 | $233 | $245 | 0.65× | $2,452 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 17 | $2,800 | $700 | $366 | $385 | 0.85× | $2,576 |
| MRI cervical spine with and without contrast | CPT | 72156 | 17 | $4,311 | $1,078 | $366 | $385 | 0.71× | $3,966 |
| MRI lumbar spine with contrast | CPT | 72158 | 17 | $4,311 | $1,078 | $366 | $385 | 0.70× | $3,966 |
| CT pelvis without contrast | CPT | 72192 | 17 | $2,002 | $501 | $105 | $110 | 0.55× | $1,842 |
| CT pelvis with contrast | CPT | 72193 | 17 | $2,252 | $563 | $175 | $184 | 0.65× | $2,072 |
| Shoulder X-ray | CPT | 73030 | 17 | $291 | $73 | $40 | $87 | 0.94× | $268 |
| Humerus X-ray | CPT | 73060 | 17 | $220 | $55 | $29 | $87 | 0.97× | $202 |
| Hand X-ray 3 views | CPT | 73130 | 17 | $296 | $74 | $58 | $101 | 1.1× | $272 |
| MRI upper extremity joint without contrast | CPT | 73221 | 17 | $2,567 | $642 | $233 | $245 | 0.59× | $2,362 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 17 | $4,133 | $1,033 | $366 | $385 | 0.63× | $3,802 |
| Knee X-ray 1-2 views | CPT | 73560 | 17 | $235 | $59 | $40 | $90 | 0.97× | $216 |
| Ankle X-ray 3 views | CPT | 73610 | 17 | $296 | $74 | $36 | $87 | 0.94× | $272 |
| MRI lower extremity joint without contrast | CPT | 73721 | 17 | $2,583 | $646 | $233 | $245 | 0.52× | $2,376 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 17 | $3,050 | $763 | $366 | $385 | 0.61× | $2,806 |
| CT abdomen without contrast | CPT | 74150 | 17 | $2,119 | $530 | $105 | $110 | 0.58× | $1,949 |
| CT abdomen with contrast | CPT | 74160 | 17 | $2,444 | $611 | $175 | $184 | 0.64× | $2,248 |
| CT abdomen with and without contrast | CPT | 74170 | 17 | $2,669 | $667 | $175 | $184 | 0.55× | $2,455 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 17 | $2,275 | $569 | $233 | $245 | 0.67× | $2,093 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 17 | $2,525 | $631 | $366 | $385 | 0.70× | $2,323 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 17 | $2,775 | $694 | $366 | $385 | 0.67× | $2,553 |
| MRI abdomen without contrast | CPT | 74181 | 17 | $2,550 | $638 | $233 | $245 | 0.63× | $2,346 |
| MRI abdomen with and without contrast | CPT | 74183 | 17 | $4,311 | $1,078 | $366 | $385 | 0.68× | $3,966 |
| Abdominal ultrasound complete | CPT | 76700 | 17 | $950 | $238 | $105 | $110 | 0.74× | $874 |
| Abdominal ultrasound limited | CPT | 76705 | 17 | $848 | $212 | $105 | $110 | 0.75× | $780 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 17 | $651 | $163 | $105 | $110 | 0.77× | $599 |
| Obstetric ultrasound first trimester | CPT | 76801 | 17 | $456 | $114 | $74 | $147 | 1.0× | $420 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 17 | $686 | $172 | $92 | $169 | 1.1× | $631 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 17 | $456 | $114 | $85 | $233 | 0.99× | $420 |
| Transvaginal ultrasound | CPT | 76830 | 17 | $747 | $187 | $88 | $110 | 0.74× | $687 |
| Pelvic ultrasound complete | CPT | 76856 | 17 | $747 | $187 | $105 | $110 | 0.77× | $687 |
| Scrotal ultrasound | CPT | 76870 | 17 | $731 | $183 | $105 | $110 | 0.84× | $673 |
| Diagnostic mammography unilateral | CPT | 77065 | 9 | $372 | $93 | $94 | $223 | 1.5× | $342 |
| Diagnostic mammography bilateral | CPT | 77066 | 9 | $454 | $114 | $120 | $272 | 1.4× | $418 |
| Screening mammography bilateral | CPT | 77067 | 9 | $385 | $96 | $99 | $204.5 | 1.3× | $354 |
| EKG complete | CPT | 93000 | 9 | $40 | $10 | $16 | $24 | 0.98× | $37 |
| EKG tracing only | CPT | 93005 | 17 | $310 | $78 | $55 | $61 | 0.52× | $285 |
| EKG interpretation only | CPT | 93010 | 9 | $24 | $6 | $9 | $14 | 0.77× | $22 |
| Transthoracic echocardiogram complete | CPT | 93306 | 17 | $1,926 | $482 | $136 | $552 | 0.92× | $1,772 |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 9 | $250 | $63 | $100 | $150 | 1.6× | $230 |
| Initial hospital care, moderate complexity | CPT | 99222 | 9 | $339 | $85 | $136 | $203 | 1.2× | $312 |
| Initial hospital care, high complexity | CPT | 99223 | 9 | $500 | $125 | $200 | $300 | 1.3× | $460 |
| Hospital discharge, <30 min | CPT | 99238 | 9 | $236 | $59 | $74 | $142 | 1.7× | $217 |
| Hospital discharge, >30 min | CPT | 99239 | 9 | $263 | $66 | $105 | $158 | 1.3× | $242 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 9 | $67 | $17 | $8 | $40 | 1.2× | $62 |
| Electrolyte panel | CPT | 80051 | 9 | $56 | $14 | $7 | $34 | 1.4× | $52 |
| Comprehensive metabolic panel | CPT | 80053 | 9 | $84 | $21 | $11 | $50 | 1.1× | $77 |
| Lipid panel | CPT | 80061 | 9 | $107 | $27 | $13 | $54 | 1.4× | $98 |
| Hepatic function panel | CPT | 80076 | 9 | $65 | $16 | $8 | $39 | 1.5× | $60 |
| Urinalysis automated | CPT | 81003 | 9 | $20 | $5 | $2 | $12 | 0.86× | $18 |
| Glucose quantitative | CPT | 82947 | 9 | $42 | $11 | $4 | $22 | 1.3× | $39 |
| Hemoglobin A1c | CPT | 83036 | 9 | $77 | $19 | $10 | $22 | 0.82× | $71 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 9 | $275 | $69 | $17 | $121 | 2.6× | $253 |
| Complete blood count with automated differential | CPT | 85025 | 9 | $62 | $16 | $8 | $29 | 1.1× | $57 |
| Complete blood count without differential | CPT | 85027 | 9 | $134 | $34 | $6 | $47 | 2.2× | $123 |
| Urine culture bacterial | CPT | 87086 | 9 | $64 | $16 | $8 | $38 | 1.6× | $59 |
| Tissue exam by pathologist level IV | CPT | 88305 | 9 | $220 | $55 | $88 | $132 | 1.3× | $202 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 17 | $664 | $166 | $19 | $209 | 1.1× | $611 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 9 | $11,339 | $2,835 | $2,178 | $5,670 | 2.5× | $10,432 |
| Vaginal delivery only | CPT | 59409 | 17 | $5,434 | $1,359 | $805 | $2,979 | 1.3× | $4,999 |
| Vaginal delivery with postpartum | CPT | 59410 | 9 | $2,565 | $641 | $1,026 | $1,539 | 1.4× | $2,360 |
| Routine obstetric care with C-section | CPT | 59510 | 9 | $14,359 | $3,590 | $2,415 | $6,889 | 2.8× | $13,210 |
| C-section delivery only | CPT | 59514 | 9 | $2,266 | $567 | $145 | $620 | 0.65× | $2,085 |
| C-section with postpartum | CPT | 59515 | 9 | $3,118 | $780 | $1,247 | $1,871 | 1.5× | $2,869 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 9 | $186 | $47 | $52 | $112 | 1.3× | $171 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 9 | $264 | $66 | $77 | $158 | 1.3× | $243 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 9 | $403 | $101 | $131 | $242 | 1.4× | $371 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 9 | $507 | $127 | $171 | $304 | 1.4× | $466 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 9 | $110 | $28 | $26 | $66 | 0.82× | $101 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 9 | $182 | $46 | $52 | $109 | 0.95× | $167 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 9 | $357 | $89 | $80 | $214 | 1.4× | $328 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 9 | $373 | $93 | $113 | $224 | 1.2× | $343 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 17 | $7,004 | $1,751 | $160 | $864 | 0.94× | $6,444 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 17 | $7,325 | $1,831 | $320 | $864 | 0.90× | $6,739 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 17 | $168 | $42 | $67 | $871 | 1.0× | $958 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 17 | $815 | $204 | $326 | $871 | 0.98× | $958 |
| Colonoscopy diagnostic | CPT | 45378 | 17 | $6,723 | $1,681 | $231 | $871 | 0.99× | $6,185 |
| Colonoscopy with biopsy | CPT | 45380 | 17 | $6,922 | $1,731 | $278 | $1,124 | 0.93× | $6,368 |
| Colonoscopy with polyp removal | CPT | 45385 | 17 | $7,513 | $1,878 | $263 | $1,124 | 0.93× | $6,912 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 17 | $4,125 | $1,031 | $1,650 | $17,756 | 4.3× | $19,532 |
| Hip hemiarthroplasty | CPT | 27125 | 9 | $3,013 | $753 | $1,205 | $1,868 | 1.5× | $11,593 |
| Total hip replacement | CPT | 27130 | 17 | $3,620 | $905 | $1,448 | $12,540 | 2.9× | $13,794 |
| Total knee replacement | CPT | 27447 | 17 | $3,620 | $905 | $1,448 | $12,540 | 3.0× | $13,794 |
| Knee revision arthroplasty single component | CPT | 27486 | 9 | $3,435 | $859 | $1,374 | $2,130 | 1.3× | $14,368 |
| Knee revision arthroplasty all components | CPT | 27487 | 9 | $5,100 | $1,275 | $2,040 | $3,162 | 1.6× | $17,979 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 9 | $30,794 | $7,699 | $189 | $6,376.5 | 19.5× | $28,330 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 17 | $2,593 | $648 | $1,037 | $6,816 | 2.1× | $7,498 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 17 | $10,942 | $2,736 | $519 | $3,084 | 1.5× | $10,067 |
| ACL reconstruction | CPT | 29888 | 17 | $2,628 | $657 | $1,051 | $6,816 | 2.0× | $7,498 |
| Laparoscopic appendectomy | CPT | 44970 | 17 | $1,525 | $381 | $610 | $5,498 | 3.5× | $6,047 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 16 | $66,432 | $16,608 | $6,672 | $7,172 | 0.38× | $59,789 |
| Laparoscopic cholecystectomy | CPT | 47562 | 17 | $14,411 | $3,603 | $668 | $5,498 | 3.1× | $13,258 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 17 | $1,893 | $473 | $757 | $5,498 | 2.9× | $6,047 |
| Open umbilical hernia repair | CPT | 49560 | 9 | $1,774 | $444 | $710 | $1,100 | 0.58× | $3,109 |
| Umbilical hernia repair age 5+ | CPT | 49585 | 9 | $1,072 | $268 | $429 | $665 | 0.51× | $3,109 |
| Lap inguinal hernia repair | CPT | 49650 | 17 | $1,580 | $395 | $421 | $1,382.5 | 1.2× | $6,047 |
| Total abdominal hysterectomy | CPT | 58150 | 9 | $2,477 | $619 | $991 | $1,486 | 1.5× | $2,279 |
| Vaginal hysterectomy | CPT | 58260 | 17 | $2,533 | $633 | $1,013 | $4,739 | 2.6× | $5,213 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 17 | $2,428 | $607 | $971 | $9,808 | 4.4× | $10,789 |
| Lap salpingo-oophorectomy | CPT | 58661 | 17 | $2,300 | $575 | $635 | $2,012.5 | 0.99× | $6,047 |
| Cataract surgery with lens implant | CPT | 66984 | 17 | $7,552 | $1,888 | $2,022 | $2,331 | 1.1× | $6,948 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 16 | $27,184 | $6,796 | $6,672 | $7,172 | 0.58× | $24,466 |