| behavioral |
| Psychoses | MS-DRG | 885 | 19 | — | — | $1,458 | $11,541 | 0.90× | $32,139 |
| imaging |
| Knee X-ray 1-2 views | CPT | 73560 | 14 | — | — | $34.41 | $87.25 | 0.94× | $365.53 |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 19 | — | — | $2,778 | $17,481 | 0.87× | $45,354 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 19 | — | — | $2,778 | $9,091.7 | 0.85× | $23,185 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 19 | — | — | $2,778 | $6,269.48 | 0.82× | $15,693 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 19 | — | — | $2,778 | $14,296 | 0.93× | $36,856 |
| COPD w MCC | MS-DRG | 190 | 19 | — | — | $2,778 | $9,868.94 | 0.88× | $25,604 |
| COPD w CC | MS-DRG | 191 | 19 | — | — | $2,778 | $7,594.31 | 0.86× | $19,587 |
| COPD w/o CC/MCC | MS-DRG | 192 | 19 | — | — | $2,778 | $5,969.09 | 0.85× | $14,756 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 19 | — | — | $2,778 | $7,354.58 | 0.87× | $18,696 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 19 | — | — | $2,778 | $5,790.04 | 0.87× | $14,198 |
| AMI discharged alive w MCC | MS-DRG | 280 | 20 | — | — | $11,974 | $15,268 | 0.97× | $37,424 |
| AMI discharged alive w CC | MS-DRG | 281 | 20 | — | — | $6,885.67 | $8,991.65 | 0.93× | $26,466 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 20 | — | — | $5,416.36 | $7,201.7 | 0.92× | $19,849 |
| Heart failure & shock w MCC | MS-DRG | 291 | 19 | — | — | $2,778 | $11,484 | 0.90× | $29,749 |
| Heart failure & shock w CC | MS-DRG | 292 | 19 | — | — | $2,778 | $7,661.39 | 0.86× | $19,635 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 19 | — | — | $2,778 | $5,249.23 | 0.84× | $12,510 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 19 | — | — | $2,778 | $10,754 | 0.89× | $27,495 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 19 | — | — | $2,778 | $6,661.34 | 0.86× | $16,856 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 19 | — | — | $2,778 | $5,328.16 | 0.86× | $12,757 |
| GI hemorrhage w CC | MS-DRG | 378 | 19 | — | — | $2,778 | $8,800.09 | 0.88× | $22,479 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 19 | — | — | $2,778 | $5,892.36 | 0.86× | $14,517 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 19 | — | — | $2,778 | $7,027.19 | 0.87× | $17,791 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 19 | — | — | $2,778 | $13,563 | 0.89× | $34,768 |
| Kidney/UTI w MCC | MS-DRG | 689 | 19 | — | — | $2,778 | $10,505 | 0.90× | $26,683 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 19 | — | — | $2,778 | $7,217.72 | 0.87× | $18,299 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 19 | — | — | $2,778 | $17,243 | 0.92× | $44,736 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 19 | — | — | $2,778 | $9,212.46 | 0.89× | $23,507 |
| lab |
| Tissue exam by pathologist level IV | CPT | 88305 | 14 | — | — | $47.08 | $52.04 | 0.51× | $360.14 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 17 | — | — | $334.95 | $953.37 | 1.0× | $4,042 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 17 | — | — | $334.95 | $953.37 | 0.99× | $5,016 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 16 | — | — | $130.67 | $877.65 | 1.0× | $4,042 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 16 | — | — | $328.5 | $931.31 | 1.0× | $4,042 |
| Colonoscopy diagnostic | CPT | 45378 | 17 | — | — | $328.5 | $961.24 | 1.1× | $5,016 |
| Colonoscopy with biopsy | CPT | 45380 | 17 | — | — | $429.26 | $1,241.11 | 1.0× | $5,016 |
| Colonoscopy with polyp removal | CPT | 45385 | 17 | — | — | $429.26 | $1,241.11 | 1.0× | $5,016 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 16 | — | — | $1,783.12 | $17,299 | 4.2× | $35,280 |
| Total hip replacement | CPT | 27130 | 16 | — | — | $6,546 | $13,240 | 3.1× | $29,633 |
| Total knee replacement | CPT | 27447 | 16 | — | — | $6,546 | $13,240 | 3.2× | $29,633 |
| Knee revision arthroplasty single component | CPT | 27486 | 4 | — | — | $1,724.02 | $6,546 | 3.9× | $16,721 |
| Knee revision arthroplasty all components | CPT | 27487 | 4 | — | — | $2,157.35 | $6,546 | 3.3× | $16,721 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 4 | — | — | $1,704 | $5,668 | 17.3× | $11,704 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 17 | — | — | $2,398.52 | $7,058.7 | 2.1× | $15,605 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 17 | — | — | $1,088.27 | $3,404.28 | 1.7× | $13,821 |
| ACL reconstruction | CPT | 29888 | 17 | — | — | $3,300.05 | $6,869.86 | 2.1× | $14,895 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 19 | — | — | $6,182 | $39,768 | 0.92× | $104,695 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 19 | — | — | $6,182 | $20,772 | 0.89× | $53,892 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 19 | — | — | $6,182 | $14,572 | 0.89× | $37,643 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 19 | — | — | $6,182 | $14,622 | 0.89× | $37,812 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 19 | — | — | $6,182 | $11,747 | 0.87× | $30,041 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 19 | — | — | $6,182 | $30,371 | 0.94× | $80,473 |
| Laparoscopic appendectomy | CPT | 44970 | 16 | — | — | $5,013.07 | $6,151.73 | 3.9× | $12,036 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 6 | — | — | $35,308 | $65,965 | 1.3× | $96,148 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 6 | — | — | $32,720 | $36,812 | 1.1× | $53,029 |
| Major joint replacement w MCC | MS-DRG | 469 | 20 | — | — | $22,734 | $29,909 | 1.0× | $74,526 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 20 | — | — | $13,588 | $17,558 | 0.93× | $42,989 |
| Laparoscopic cholecystectomy | CPT | 47562 | 16 | — | — | $1,888.85 | $5,886.12 | 3.3× | $15,605 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 16 | — | — | $1,888.85 | $5,886.12 | 3.1× | $15,605 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 20 | — | — | $9,144 | $25,576 | 0.91× | $67,055 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 20 | — | — | $9,144 | $18,100 | 0.89× | $47,308 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 20 | — | — | $9,144 | $13,998 | 0.88× | $36,170 |
| Lap inguinal hernia repair | CPT | 49650 | 17 | — | — | $1,888.85 | $6,068.46 | 5.4× | $13,821 |
| Total abdominal hysterectomy | CPT | 58150 | 4 | — | — | $1,237.51 | $5,162 | 5.3× | $16,163 |
| Vaginal hysterectomy | CPT | 58260 | 16 | — | — | $1,526.99 | $5,101.21 | 2.8× | $15,605 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 17 | — | — | $1,888.85 | $6,068.46 | 4.1× | $16,721 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 16 | — | — | $3,110.01 | $9,884.78 | 4.4× | $20,949 |
| Lap salpingo-oophorectomy | CPT | 58661 | 17 | — | — | $1,888.85 | $6,068.46 | 3.0× | $15,605 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 20 | — | — | $6,182 | $24,074 | 0.89× | $62,164 |
| OR procedure for obesity w CC | MS-DRG | 620 | 20 | — | — | $6,182 | $14,633 | 0.90× | $36,412 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 20 | — | — | $6,182 | $13,599 | 0.90× | $33,329 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 19 | — | — | $6,182 | $10,534 | 0.86× | $27,330 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 19 | — | — | $6,182 | $16,997 | 0.89× | $44,551 |