| behavioral |
| Psychoses | MS-DRG | 885 | 6 | — | — | $8,163.29 | $8,592.94 | $10,977 |
| emergency |
| ED visit level 1 | CPT | 99281 | 10 | $478 | $167.3 | $2.27 | $36 | $430.2 |
| ED visit level 2 | CPT | 99282 | 10 | $696 | $243.6 | $45.11 | $280.86 | $626.4 |
| ED visit level 3 | CPT | 99283 | 10 | $1,615 | $565.25 | $17.18 | $208 | $1,485 |
| ED visit level 4 | CPT | 99284 | 9 | $2,833 | $991.55 | $310.35 | $1,708.31 | $3,276 |
| ED visit level 5 | CPT | 99285 | 9 | $3,449 | $1,207.15 | $445.48 | $2,326.36 | $4,368 |
| Critical care, first hour | CPT | 99291 | 9 | $4,680 | $1,638 | $591 | $2,960 | $4,368 |
| imaging |
| CT head without contrast | CPT | 70450 | 10 | $3,735 | $1,307.25 | $92.98 | $491.31 | $3,361.5 |
| CT head with contrast | CPT | 70460 | 10 | $4,333 | $1,516.55 | $152.34 | $825.2 | $3,899.7 |
| CT head with and without contrast | CPT | 70470 | 10 | $5,110 | $1,788.5 | $152.34 | $889.72 | $4,599 |
| CT neck with contrast | CPT | 70491 | 10 | $4,580 | $1,603 | $152.34 | $889.72 | $4,122 |
| MRI brain without contrast | CPT | 70551 | 10 | $6,236 | $2,182.6 | $196.35 | $473.92 | $5,612.4 |
| MRI brain with contrast | CPT | 70552 | 10 | $7,027 | $2,459.45 | $252.74 | $543.16 | $6,324.3 |
| MRI brain with and without contrast | CPT | 70553 | 10 | $8,381.42 | $2,933.5 | $314.09 | $1,507.46 | $7,543.28 |
| Chest X-ray single view | CPT | 71045 | 10 | $612 | $214.2 | $20.71 | $222.16 | $550.8 |
| Chest X-ray 2 views | CPT | 71046 | 10 | $759 | $265.65 | $28.74 | $254.64 | $683.1 |
| Chest X-ray 3 views | CPT | 71047 | 10 | $760 | $266 | $36.75 | $244.85 | $684 |
| CT chest without contrast | CPT | 71250 | 10 | $3,403 | $1,191.05 | $92.98 | $577.62 | $3,062.7 |
| CT chest with contrast | CPT | 71260 | 10 | $4,528.44 | $1,584.96 | $152.34 | $515.59 | $4,075.6 |
| CT chest with and without contrast | CPT | 71270 | 10 | $5,572 | $1,950.2 | $152.34 | $515.59 | $5,014.8 |
| MRI chest without contrast | CPT | 71550 | 10 | $4,918 | $1,721.3 | $196.35 | $1,122.08 | $4,426.2 |
| MRI chest with contrast | CPT | 71551 | 10 | $5,312 | $1,859.2 | $432.7 | $1,094.13 | $4,780.8 |
| MRI chest with and without contrast | CPT | 71552 | 10 | $7,482.24 | $2,618.79 | $314.09 | $1,507.46 | $6,734.02 |
| Lumbosacral spine X-ray | CPT | 72100 | 10 | $1,004 | $351.4 | $33.08 | $325.07 | $903.6 |
| CT cervical spine without contrast | CPT | 72125 | 10 | $4,074 | $1,425.9 | $92.98 | $580.2 | $3,666.6 |
| CT thoracic spine without contrast | CPT | 72128 | 10 | $4,074 | $1,425.9 | $92.98 | $579.56 | $3,666.6 |
| CT lumbar spine without contrast | CPT | 72131 | 10 | $4,074 | $1,425.9 | $92.98 | $233.5 | $3,666.6 |
| MRI cervical spine without contrast | CPT | 72141 | 10 | $5,496 | $1,923.6 | $196.35 | $473.92 | $4,946.4 |
| MRI thoracic spine without contrast | CPT | 72146 | 10 | $5,496 | $1,923.6 | $196.35 | $473.92 | $4,946.4 |
| MRI lumbar spine without contrast | CPT | 72148 | 10 | $5,496 | $1,923.6 | $196.35 | $473.92 | $4,946.4 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 10 | $4,728 | $1,654.8 | $305.06 | $931 | $4,255.2 |
| MRI cervical spine with and without contrast | CPT | 72156 | 10 | $8,551 | $2,992.85 | $314.09 | $931 | $7,695.9 |
| MRI lumbar spine with contrast | CPT | 72158 | 10 | $7,828 | $2,739.8 | $314.09 | $931 | $7,045.2 |
| CT pelvis without contrast | CPT | 72192 | 10 | $4,000 | $1,400 | $92.98 | $233.5 | $3,600 |
| CT pelvis with contrast | CPT | 72193 | 10 | $4,331 | $1,515.85 | $152.34 | $515.59 | $3,897.9 |
| Shoulder X-ray | CPT | 73030 | 10 | $848 | $296.8 | $27.74 | $176.42 | $763.2 |
| Humerus X-ray | CPT | 73060 | 10 | $818 | $286.3 | $27.4 | $96.84 | $736.2 |
| Hand X-ray 3 views | CPT | 73130 | 10 | $794 | $277.9 | $30.08 | $102.64 | $714.6 |
| MRI upper extremity joint without contrast | CPT | 73221 | 10 | $5,506 | $1,927.1 | $196.35 | $1,122.08 | $4,955.4 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 10 | $7,953 | $2,783.55 | $314.09 | $1,507.46 | $7,157.7 |
| Knee X-ray 1-2 views | CPT | 73560 | 10 | $704 | $246.4 | $29.4 | $176.42 | $633.6 |
| Ankle X-ray 3 views | CPT | 73610 | 10 | $869 | $304.15 | $29.74 | $103.28 | $782.1 |
| MRI lower extremity joint without contrast | CPT | 73721 | 10 | $5,739 | $2,008.65 | $196.35 | $1,122.08 | $5,165.1 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 10 | $7,949 | $2,782.15 | $314.09 | $931 | $7,154.1 |
| CT abdomen without contrast | CPT | 74150 | 10 | $3,568 | $1,248.8 | $92.98 | $233.5 | $3,211.2 |
| CT abdomen with contrast | CPT | 74160 | 10 | $5,013 | $1,754.55 | $152.34 | $515.59 | $4,511.7 |
| CT abdomen with and without contrast | CPT | 74170 | 10 | $5,875 | $2,056.25 | $152.34 | $515.59 | $5,287.5 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 10 | $6,938 | $2,428.3 | $189.79 | $2,725.56 | $6,244.2 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 10 | $7,204 | $2,521.4 | $252.74 | $543.16 | $6,483.6 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 10 | $8,393 | $2,937.55 | $252.74 | $889.72 | $7,553.7 |
| MRI abdomen without contrast | CPT | 74181 | 10 | $6,073 | $2,125.55 | $196.35 | $473.92 | $5,465.7 |
| MRI abdomen with and without contrast | CPT | 74183 | 10 | $7,304 | $2,556.4 | $314.09 | $931 | $6,573.6 |
| Abdominal ultrasound complete | CPT | 76700 | 10 | $1,797 | $628.95 | $92.98 | $243.8 | $1,617.3 |
| Abdominal ultrasound limited | CPT | 76705 | 10 | $1,541 | $539.35 | $87.21 | $243.8 | $1,386.9 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 10 | $1,816 | $635.6 | $92.98 | $243.8 | $1,634.4 |
| Obstetric ultrasound first trimester | CPT | 76801 | 10 | $1,379.16 | $482.71 | $92.98 | $160.54 | $1,241.25 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 10 | $1,247.4 | $436.59 | $92.98 | $200.29 | $1,122.66 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 10 | $1,984 | $694.4 | $114.46 | $380.19 | $1,785.6 |
| Transvaginal ultrasound | CPT | 76830 | 10 | $1,429 | $500.15 | $92.98 | $346.7 | $1,286.1 |
| Pelvic ultrasound complete | CPT | 76856 | 10 | $1,586 | $555.1 | $92.98 | $243.8 | $1,427.4 |
| Scrotal ultrasound | CPT | 76870 | 10 | $1,567 | $548.45 | $64.49 | $243.8 | $1,410.3 |
| Diagnostic mammography unilateral | CPT | 77065 | 9 | $532 | $186.2 | $82.82 | $258.72 | $478.8 |
| Diagnostic mammography bilateral | CPT | 77066 | 9 | $658 | $230.3 | $105.92 | $350.06 | $592.2 |
| Screening mammography bilateral | CPT | 77067 | 9 | $458 | $160.3 | $87.57 | $259.1 | $412.2 |
| EKG tracing only | CPT | 93005 | 9 | $693 | $242.55 | $47.49 | $324.97 | $623.7 |
| Transthoracic echocardiogram complete | CPT | 93306 | 9 | $4,833 | $1,691.55 | $274.29 | $2,265.7 | $4,349.7 |
| Transthoracic echocardiogram | CPT | 93307 | 10 | $1,795 | $628.25 | $132.65 | $206.68 | $1,615.5 |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 6 | — | — | $11,408 | $12,008 | $16,373 |
| COPD w MCC | MS-DRG | 190 | 6 | — | — | $7,559.41 | $7,957.27 | $9,972.36 |
| COPD w CC | MS-DRG | 191 | 6 | — | — | $6,005.08 | $6,605.08 | $7,835.75 |
| COPD w/o CC/MCC | MS-DRG | 192 | 6 | — | — | $4,725.32 | $5,548.26 | $6,165.85 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 6 | — | — | $5,868.4 | $6,492.21 | $7,657.4 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 6 | — | — | $4,522 | $5,380.36 | $5,900.55 |
| AMI discharged alive w MCC | MS-DRG | 280 | 6 | — | — | $10,239 | $10,778 | $14,429 |
| AMI discharged alive w CC | MS-DRG | 281 | 6 | — | — | $6,338.28 | $6,880.23 | $8,270.52 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 6 | — | — | $4,933.4 | $5,720.09 | $6,437.36 |
| Heart failure & shock w MCC | MS-DRG | 291 | 6 | — | — | $8,717.03 | $9,175.82 | $11,898 |
| Heart failure & shock w CC | MS-DRG | 292 | 6 | — | — | $6,086.68 | $6,672.46 | $7,942.22 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 6 | — | — | $4,437.68 | $5,310.73 | $5,790.52 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 6 | — | — | $7,961.64 | $8,380.67 | $10,641 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 6 | — | — | $5,095.92 | $5,854.3 | $6,649.43 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 6 | — | — | $3,797.12 | $4,781.75 | $4,954.68 |
| GI hemorrhage w CC | MS-DRG | 378 | 6 | — | — | $6,753.76 | $7,223.34 | $8,812.66 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 6 | — | — | $4,332.28 | $5,223.69 | $5,652.99 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 6 | — | — | $5,197.92 | $5,938.53 | $6,782.52 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 6 | — | — | $9,099.52 | $9,578.44 | $12,534 |
| Kidney/UTI w MCC | MS-DRG | 689 | 6 | — | — | $7,492.19 | $7,886.52 | $9,860.56 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 6 | — | — | $5,386.96 | $6,094.64 | $7,029.19 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 6 | — | — | $11,530 | $12,137 | $16,577 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 6 | — | — | $6,946.88 | $7,382.81 | $9,064.66 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 10 | $542 | $189.7 | $7.11 | $23.1 | $487.8 |
| Electrolyte panel | CPT | 80051 | 10 | $525 | $183.75 | $5.89 | $21.09 | $472.5 |
| Comprehensive metabolic panel | CPT | 80053 | 10 | $886 | $310.1 | $5.34 | $21 | $797.4 |
| Lipid panel | CPT | 80061 | 10 | $482 | $168.7 | $7.57 | $19.4 | $433.8 |
| Renal function panel | CPT | 80069 | 10 | $542 | $189.7 | $7.29 | $24.07 | $487.8 |
| Hepatic function panel | CPT | 80076 | 10 | $512 | $179.2 | $6.86 | $31.5 | $460.8 |
| Urinalysis automated | CPT | 81003 | 10 | $96 | $33.6 | $1.89 | $11.59 | $86.4 |
| Glucose quantitative | CPT | 82947 | 10 | $163 | $57.05 | $3.3 | $11.48 | $146.7 |
| Hemoglobin A1c | CPT | 83036 | 10 | $297 | $103.95 | $5.34 | $14.84 | $267.3 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 10 | $376 | $131.6 | $5.34 | $16.87 | $338.4 |
| Complete blood count with automated differential | CPT | 85025 | 10 | $332 | $116.2 | $6.53 | $23 | $298.8 |
| Complete blood count without differential | CPT | 85027 | 10 | $261 | $91.35 | $5.43 | $12.5 | $234.9 |
| Urine culture bacterial | CPT | 87086 | 10 | $351 | $122.85 | $6.78 | $39.24 | $315.9 |
| Tissue exam by pathologist level IV | CPT | 88305 | 10 | $777 | $271.95 | $42.46 | $108.85 | $699.3 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 10 | $628 | $219.8 | $13.62 | $152.97 | $565.2 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 1 | — | — | $1,354.78 | $3,010.63 | $3,440.72 |
| Vaginal delivery only | CPT | 59409 | 6 | — | — | $1,431.85 | $2,355.96 | $3,636.43 |
| Vaginal delivery with postpartum | CPT | 59410 | 1 | — | — | $676.94 | $1,504.31 | $1,719.22 |
| Routine obstetric care with C-section | CPT | 59510 | 1 | — | — | $1,502.65 | $3,339.23 | $3,816.26 |
| C-section delivery only | CPT | 59514 | 2 | — | — | $596.67 | $1,363.82 | $2,826 |
| C-section with postpartum | CPT | 59515 | 1 | — | — | $822.32 | $1,827.38 | $2,088.43 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 7 | $410 | $143.5 | $47 | $203.7 | $369 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 7 | $477 | $166.95 | $56.07 | $200.26 | $429.3 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 7 | $631 | $220.85 | $47 | $391.89 | $567.9 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 7 | $1,646 | $576.1 | $47 | $552.28 | $1,481.4 |
| Office visit, established patient, 5 min | CPT | 99211 | 7 | $265 | $92.75 | $18.47 | $158.51 | $238.5 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 7 | $355 | $124.25 | $47 | $211.8 | $319.5 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 7 | $437 | $152.95 | $36.49 | $183.35 | $393.3 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 7 | $514 | $179.9 | $47 | $306.9 | $462.6 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 7 | $1,563 | $547.05 | $47 | $479.88 | $1,406.7 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 10 | $3,238.4 | $1,133.44 | $263.85 | $851.06 | $2,914.56 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 7 | — | — | $263.85 | $727.12 | $2,007 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 7 | — | — | $87.32 | $366.02 | $1,392 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 7 | — | — | $263.85 | $712.79 | $1,392 |
| Colonoscopy diagnostic | CPT | 45378 | 7 | — | — | $263.85 | $712.79 | $2,007 |
| Colonoscopy with biopsy | CPT | 45380 | 7 | — | — | $353.3 | $931.31 | $2,007 |
| Colonoscopy with polyp removal | CPT | 45385 | 7 | — | — | $353.3 | $931.31 | $2,007 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 6 | — | — | $949.84 | $8,006.06 | $11,060 |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 6 | — | — | $18,238 | $19,198 | $27,734 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 6 | — | — | $12,170 | $12,811 | $17,641 |
| Hip hemiarthroplasty | CPT | 27125 | 6 | — | — | $739.57 | $7,117.06 | $11,060 |
| Total hip replacement | CPT | 27130 | 6 | — | — | $885.4 | $8,006.06 | $11,060 |
| Total knee replacement | CPT | 27447 | 6 | — | — | $2,826 | $11,060 | $16,197 |
| Knee revision arthroplasty single component | CPT | 27486 | 6 | — | — | $917.96 | $8,006.06 | $11,060 |
| Knee revision arthroplasty all components | CPT | 27487 | 6 | — | — | $1,148.13 | $8,006.06 | $11,060 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 2 | — | — | $196 | $1,244.5 | $2,293 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 7 | — | — | $1,028.6 | $5,486.02 | $8,970.27 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 7 | — | — | $848.61 | $2,542.04 | $4,232.37 |
| ACL reconstruction | CPT | 29888 | 7 | — | — | $1,028.6 | $5,486.02 | $8,970.27 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 6 | — | — | $27,438 | $28,883 | $43,037 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 6 | — | — | $15,108 | $15,904 | $22,529 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 6 | — | — | $10,687 | $11,249 | $15,174 |
| CABG single arterial graft | CPT | 33533 | 3 | — | — | $975 | $2,716.2 | $3,104.22 |
| CABG 2 arterial grafts | CPT | 33534 | 3 | — | — | $975 | $2,965.12 | $3,652.03 |
| CABG 3 arterial grafts | CPT | 33535 | 3 | — | — | $975 | $3,142.29 | $4,068.91 |
| CABG 4+ arterial grafts | CPT | 33536 | 3 | — | — | $975 | $3,270.42 | $4,370.38 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 6 | — | — | $10,569 | $11,125 | $14,979 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 6 | — | — | $8,579.92 | $9,031.5 | $11,670 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 6 | — | — | $20,310 | $21,379 | $31,181 |
| Open appendectomy | CPT | 44950 | 6 | — | — | $1,747 | $2,859.08 | $4,657.86 |
| Laparoscopic appendectomy | CPT | 44970 | 6 | — | — | $2,826 | $4,544.88 | $7,181.89 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 6 | — | — | $37,476 | $39,448 | $59,731 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 6 | — | — | $22,543 | $23,730 | $34,895 |
| Major joint replacement w MCC | MS-DRG | 469 | 6 | — | — | $18,018 | $18,966 | $27,368 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 6 | — | — | $11,699 | $12,315 | $16,858 |
| Laparoscopic cholecystectomy | CPT | 47562 | 7 | — | — | $1,028.6 | $4,544.88 | $7,181.89 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 7 | — | — | $1,028.6 | $4,544.88 | $7,181.89 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 6 | — | — | $17,698 | $18,630 | $26,836 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 6 | — | — | $12,743 | $13,413 | $18,593 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 6 | — | — | $10,349 | $10,894 | $14,612 |
| Open umbilical hernia repair | CPT | 49560 | 7 | — | — | $848.61 | $2,842.54 | $4,657.86 |
| Umbilical hernia repair age 5+ | CPT | 49585 | 7 | — | — | $848.61 | $2,842.54 | $4,657.86 |
| Lap inguinal hernia repair | CPT | 49650 | 7 | — | — | $1,028.6 | $4,431.26 | $7,181.89 |
| Lap incisional hernia repair | CPT | 49652 | 7 | — | — | $1,028.6 | $4,544.88 | $7,181.89 |
| Total abdominal hysterectomy | CPT | 58150 | 3 | — | — | $654.56 | $1,579.25 | $2,826 |
| Vaginal hysterectomy | CPT | 58260 | 7 | — | — | $1,028.6 | $3,960.3 | $7,043 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 7 | — | — | $1,028.6 | $4,544.88 | $7,181.89 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 7 | — | — | $1,028.6 | $7,800.15 | $12,153 |
| Lap salpingo-oophorectomy | CPT | 58661 | 7 | — | — | $1,028.6 | $4,431.26 | $7,181.89 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 6 | — | — | $17,894 | $18,835 | $27,161 |
| OR procedure for obesity w CC | MS-DRG | 620 | 6 | — | — | $10,959 | $11,535 | $15,626 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 6 | — | — | $10,080 | $10,611 | $14,165 |
| Complex cataract surgery | CPT | 66982 | 7 | — | — | $732.33 | $1,867.34 | $6,798 |
| Cataract surgery with lens implant | CPT | 66984 | 7 | — | — | $732.33 | $1,867.34 | $6,798 |
| Intravitreal injection | CPT | 67028 | 7 | — | — | $30.62 | $267.14 | $1,392 |
| Vitrectomy mechanical | CPT | 67042 | 7 | — | — | $1,028.6 | $3,518.6 | $7,043 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 6 | — | — | $7,604.22 | $8,004.44 | $10,047 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 6 | — | — | $11,134 | $11,720 | $15,918 |
| PCI single major coronary artery | CPT | 92920 | 9 | $18,211 | $6,373.85 | $3,727 | $9,688.26 | $17,899 |
| PCI with drug-eluting stent | CPT | 92928 | 9 | $23,378 | $8,182.3 | $3,727 | $12,437 | $36,997 |
| PCI bypass graft | CPT | 92937 | 9 | $22,005 | $7,701.75 | $3,727 | $11,707 | $36,997 |
| Left heart catheterization | CPT | 93452 | 9 | $40,417 | $14,146 | $2,473.49 | $8,412.66 | $36,375 |
| Coronary angiography with cath | CPT | 93455 | 9 | $31,246 | $10,936 | $2,473.49 | $8,412.66 | $28,121 |
| Coronary angiography with bypass cath | CPT | 93458 | 9 | $51,699 | $18,095 | $2,473.49 | $8,412.66 | $46,529 |