| behavioral |
| Psychoses | MS-DRG | 885 | 7 | $52,302 | $52,302 | $12,252 | $13,731 | 1.1× | $28,343 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 21 | $201 | $180.9 | $78.39 | $180.9 | 1.0× | $192.96 |
| Psychiatric eval with medical services | CPT | 90792 | 21 | $201 | $180.9 | $78.39 | $180.9 | 1.0× | $192.96 |
| Psychotherapy 30 minutes | CPT | 90832 | 21 | $201 | $180.9 | $78.39 | $180.9 | 1.2× | $192.96 |
| Psychotherapy 45 minutes | CPT | 90834 | 21 | $201 | $180.9 | $78.39 | $180.9 | 1.1× | $192.96 |
| Psychotherapy 60 minutes | CPT | 90837 | 21 | $201 | $180.9 | $78.39 | $180.9 | 0.95× | $192.96 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 21 | $201 | $180.9 | $78.39 | $180.9 | 1.1× | $192.96 |
| emergency |
| ED visit level 1 | CPT | 99281 | 29 | $339 | $305.1 | $7.31 | $113.21 | 0.81× | $325.44 |
| ED visit level 2 | CPT | 99282 | 29 | $609 | $548.1 | $27.3 | $206.15 | 0.87× | $584.64 |
| ED visit level 3 | CPT | 99283 | 29 | $1,065 | $958.5 | $46 | $236.16 | 0.58× | $1,022.4 |
| ED visit level 4 | CPT | 99284 | 29 | $1,639 | $1,475.1 | $78.45 | $402.24 | 0.60× | $1,573.44 |
| ED visit level 5 | CPT | 99285 | 29 | $2,359 | $2,123.1 | $113.49 | $582.72 | 0.56× | $2,264.64 |
| Critical care, first hour | CPT | 99291 | 29 | $3,240 | $2,916 | $139.51 | $668.7 | 0.62× | $3,110.4 |
| imaging |
| CT head without contrast | CPT | 70450 | 29 | $1,169 | $1,052.1 | $22.35 | $173.4 | 0.84× | $1,169 |
| CT head with contrast | CPT | 70460 | 27 | $1,561 | $1,404.9 | $226.85 | $1,404.9 | 6.0× | $1,561 |
| CT head with and without contrast | CPT | 70470 | 27 | $1,561 | $1,404.9 | $226.85 | $1,404.9 | 5.3× | $1,561 |
| CT neck with contrast | CPT | 70491 | 27 | $1,561 | $1,404.9 | $226.85 | $1,404.9 | 5.1× | $1,561 |
| MRI brain without contrast | CPT | 70551 | 27 | $2,412 | $2,170.8 | $308.59 | $2,170.8 | 5.4× | $2,412 |
| MRI brain with contrast | CPT | 70552 | 27 | $2,940 | $2,646 | $451.21 | $2,646 | 5.5× | $2,940 |
| MRI brain with and without contrast | CPT | 70553 | 27 | $2,940 | $2,646 | $451.21 | $2,646 | 4.5× | $2,940 |
| Chest X-ray single view | CPT | 71045 | 27 | $426 | $383.4 | $112.55 | $383.4 | 4.1× | $408.96 |
| Chest X-ray 2 views | CPT | 71046 | 27 | $426 | $383.4 | $112.55 | $383.4 | 3.9× | $408.96 |
| Chest X-ray 3 views | CPT | 71047 | 27 | $432 | $388.8 | $112.55 | $351.39 | 3.7× | $414.72 |
| CT chest without contrast | CPT | 71250 | 27 | $1,169 | $1,052.1 | $135.21 | $1,052.1 | 4.9× | $1,169 |
| CT chest with contrast | CPT | 71260 | 27 | $1,561 | $1,404.9 | $226.85 | $1,404.9 | 5.0× | $1,561 |
| CT chest with and without contrast | CPT | 71270 | 27 | $1,561 | $1,404.9 | $226.85 | $1,404.9 | 4.8× | $1,561 |
| MRI chest without contrast | CPT | 71550 | 27 | $2,412 | $2,170.8 | $308.59 | $2,170.8 | 5.0× | $2,412 |
| MRI chest with contrast | CPT | 71551 | 27 | $1,749 | $1,574.1 | $682.11 | $1,574.1 | 1.9× | $4,227 |
| MRI chest with and without contrast | CPT | 71552 | 27 | $2,940 | $2,646 | $451.21 | $2,646 | 4.4× | $2,940 |
| Lumbosacral spine X-ray | CPT | 72100 | 27 | $516 | $464.4 | $62.79 | $154.56 | 1.5× | $495.36 |
| CT cervical spine without contrast | CPT | 72125 | 27 | $1,169 | $1,052.1 | $135.21 | $1,052.1 | 5.2× | $1,169 |
| CT thoracic spine without contrast | CPT | 72128 | 27 | $1,169 | $1,052.1 | $135.21 | $1,052.1 | 5.3× | $1,169 |
| CT lumbar spine without contrast | CPT | 72131 | 27 | $1,169 | $1,052.1 | $135.21 | $1,052.1 | 5.2× | $1,169 |
| MRI cervical spine without contrast | CPT | 72141 | 27 | $2,412 | $2,170.8 | $308.59 | $2,170.8 | 5.5× | $2,412 |
| MRI thoracic spine without contrast | CPT | 72146 | 27 | $2,412 | $2,170.8 | $308.59 | $2,170.8 | 5.8× | $2,412 |
| MRI lumbar spine without contrast | CPT | 72148 | 27 | $2,412 | $2,170.8 | $308.59 | $2,170.8 | 5.8× | $2,412 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 27 | $2,344 | $2,109.6 | $451.21 | $2,109.6 | 4.6× | $3,968 |
| MRI cervical spine with and without contrast | CPT | 72156 | 27 | $2,940 | $2,646 | $451.21 | $2,646 | 4.9× | $2,940 |
| MRI lumbar spine with contrast | CPT | 72158 | 27 | $2,940 | $2,646 | $451.21 | $2,646 | 4.8× | $2,940 |
| CT pelvis without contrast | CPT | 72192 | 27 | $1,169 | $1,052.1 | $135.21 | $1,052.1 | 5.3× | $1,169 |
| CT pelvis with contrast | CPT | 72193 | 27 | $1,561 | $1,404.9 | $226.85 | $1,404.9 | 5.0× | $1,561 |
| Shoulder X-ray | CPT | 73030 | 27 | $426 | $383.4 | $112.55 | $383.4 | 4.1× | $408.96 |
| Humerus X-ray | CPT | 73060 | 27 | $426 | $383.4 | $39.78 | $116.84 | 1.3× | $408.96 |
| Hand X-ray 3 views | CPT | 73130 | 27 | $426 | $383.4 | $39.78 | $116.84 | 1.3× | $408.96 |
| MRI upper extremity joint without contrast | CPT | 73221 | 27 | $2,412 | $2,170.8 | $308.59 | $2,170.8 | 5.2× | $2,412 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 27 | $2,940 | $2,646 | $451.21 | $2,646 | 4.3× | $2,940 |
| Knee X-ray 1-2 views | CPT | 73560 | 27 | $426 | $383.4 | $39.78 | $116.84 | 1.3× | $408.96 |
| Ankle X-ray 3 views | CPT | 73610 | 27 | $426 | $383.4 | $39.78 | $116.84 | 1.3× | $408.96 |
| MRI lower extremity joint without contrast | CPT | 73721 | 27 | $2,412 | $2,170.8 | $308.59 | $2,170.8 | 4.6× | $2,412 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 27 | $2,940 | $2,646 | $451.21 | $2,646 | 4.2× | $2,940 |
| CT abdomen without contrast | CPT | 74150 | 27 | $1,169 | $1,052.1 | $135.21 | $1,052.1 | 5.6× | $1,169 |
| CT abdomen with contrast | CPT | 74160 | 27 | $1,561 | $1,404.9 | $226.85 | $1,404.9 | 4.9× | $1,561 |
| CT abdomen with and without contrast | CPT | 74170 | 27 | $1,561 | $1,404.9 | $226.85 | $1,404.9 | 4.2× | $1,561 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 27 | $2,653 | $2,387.7 | $308.59 | $2,387.7 | 6.6× | $2,653 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 29 | $3,234 | $2,910.6 | $56.96 | $552.98 | 1.0× | $3,234 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 27 | $3,234 | $2,910.6 | $451.21 | $2,910.6 | 5.1× | $3,234 |
| MRI abdomen without contrast | CPT | 74181 | 27 | $2,412 | $2,170.8 | $308.59 | $2,170.8 | 5.6× | $2,412 |
| MRI abdomen with and without contrast | CPT | 74183 | 27 | $2,940 | $2,646 | $451.21 | $2,646 | 4.7× | $2,940 |
| Abdominal ultrasound complete | CPT | 76700 | 29 | $585 | $526.5 | $25.15 | $165.6 | 1.1× | $561.6 |
| Abdominal ultrasound limited | CPT | 76705 | 29 | $585 | $526.5 | $15.55 | $149.95 | 1.0× | $585 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 29 | $585 | $526.5 | $23 | $180.88 | 1.3× | $561.6 |
| Obstetric ultrasound first trimester | CPT | 76801 | 29 | $585 | $526.5 | $30.96 | $153 | 1.1× | $561.6 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 29 | $585 | $526.5 | $33.74 | $153.9 | 1.0× | $561.6 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 27 | $378 | $340.2 | $132.6 | $320.35 | 1.4× | $661.26 |
| Transvaginal ultrasound | CPT | 76830 | 27 | $585 | $526.5 | $51.87 | $150.67 | 1.0× | $577 |
| Pelvic ultrasound complete | CPT | 76856 | 27 | $585 | $526.5 | $71.76 | $176.64 | 1.2× | $577 |
| Scrotal ultrasound | CPT | 76870 | 27 | $585 | $526.5 | $135.21 | $526.5 | 4.0× | $561.6 |
| Diagnostic mammography unilateral | CPT | 77065 | 27 | $362 | $325.8 | $99.45 | $238.35 | 1.6× | $347.52 |
| Diagnostic mammography bilateral | CPT | 77066 | 27 | $442 | $397.8 | $171.37 | $397.8 | 2.1× | $424.32 |
| Screening mammography bilateral | CPT | 77067 | 27 | $364 | $327.6 | $138.04 | $327.6 | 2.1× | $349.44 |
| EKG tracing only | CPT | 93005 | 27 | $216 | $194.4 | $28.86 | $79.2 | 0.67× | $207.36 |
| Transthoracic echocardiogram complete | CPT | 93306 | 27 | $1,992 | $1,792.8 | $265.98 | $959.08 | 1.6× | $1,912.32 |
| Transthoracic echocardiogram | CPT | 93307 | 27 | $333 | $299.7 | $129.87 | $299.7 | 1.2× | $661.26 |
| Stress echocardiogram | CPT | 93350 | 27 | $653 | $587.7 | $254.67 | $587.7 | 1.2× | $1,514.34 |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 7 | $57,040 | $57,040 | $13,707 | $15,291 | 0.99× | $31,564 |
| COPD w MCC | MS-DRG | 190 | 7 | $23,777 | $23,777 | $9,716.2 | $11,012 | 0.98× | $22,730 |
| COPD w CC | MS-DRG | 191 | 7 | $39,874 | $39,874 | $7,394.36 | $8,521.99 | 0.97× | $17,591 |
| COPD w/o CC/MCC | MS-DRG | 192 | 7 | $17,429 | $17,429 | $5,631.31 | $6,631.49 | 0.95× | $13,689 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 7 | $35,752 | $35,752 | $7,068.95 | $8,173.05 | 0.96× | $16,871 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 7 | $17,007 | $17,007 | $5,512.89 | $6,504.52 | 0.97× | $13,427 |
| AMI discharged alive w MCC | MS-DRG | 280 | 7 | $48,334 | $48,334 | $14,070 | $15,681 | 1.0× | $32,368 |
| AMI discharged alive w CC | MS-DRG | 281 | 7 | $41,153 | $41,153 | $8,061.89 | $9,237.77 | 0.96× | $19,069 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 7 | $26,803 | $26,803 | $6,342.67 | $7,394.29 | 0.95× | $15,263 |
| Heart failure & shock w MCC | MS-DRG | 291 | 7 | $44,433 | $44,433 | $11,261 | $12,668 | 0.99× | $26,149 |
| Heart failure & shock w CC | MS-DRG | 292 | 7 | $27,398 | $27,398 | $7,447 | $8,578.43 | 0.96× | $17,708 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 7 | $18,663 | $18,663 | $4,964.66 | $5,916.66 | 0.95× | $12,213 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 7 | $38,408 | $38,408 | $10,561 | $11,917 | 0.99× | $24,600 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 7 | $21,388 | $21,388 | $6,453.2 | $7,512.79 | 0.97× | $15,508 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 7 | $20,952 | $20,952 | $4,965.54 | $5,917.61 | 0.95× | $12,215 |
| GI hemorrhage w CC | MS-DRG | 378 | 7 | $26,746 | $26,746 | $8,602.21 | $9,817.14 | 0.98× | $20,265 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 7 | $17,535 | $17,535 | $5,529.55 | $6,522.39 | 0.95× | $13,464 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 7 | $26,770 | $26,770 | $6,838.25 | $7,925.68 | 0.99× | $16,360 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 7 | $50,766 | $50,766 | $13,751 | $15,338 | 1.0× | $31,661 |
| Kidney/UTI w MCC | MS-DRG | 689 | 7 | $38,988 | $38,988 | $10,178 | $11,506 | 0.99× | $23,752 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 7 | $33,171 | $33,171 | $7,100.53 | $8,206.92 | 0.99× | $16,941 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 7 | $51,102 | $51,102 | $17,039 | $18,863 | 1.0× | $38,938 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 7 | $36,678 | $36,678 | $8,975.87 | $10,218 | 0.99× | $21,092 |
| Initial hospital care, low complexity | CPT | 99221 | 29 | $288 | $259.2 | $40.05 | $93 | 1.0× | $276.48 |
| Initial hospital care, moderate complexity | CPT | 99222 | 29 | $455 | $409.5 | $54.12 | $132.35 | 0.78× | $436.8 |
| Initial hospital care, high complexity | CPT | 99223 | 29 | $607 | $546.3 | $79.97 | $190.52 | 0.85× | $582.72 |
| Hospital discharge, <30 min | CPT | 99238 | 29 | $285 | $256.5 | $31.59 | $82.41 | 0.96× | $273.6 |
| Hospital discharge, >30 min | CPT | 99239 | 29 | $403 | $362.7 | $42.44 | $117.46 | 0.97× | $386.88 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 27 | $40 | $36 | $8.88 | $28.59 | 0.88× | $38.4 |
| General health panel | CPT | 80050 | 21 | $105 | $94.5 | $40.95 | $94.5 | 0.88× | $100.8 |
| Electrolyte panel | CPT | 80051 | 27 | $33 | $29.7 | $7.36 | $23.69 | 1.00× | $31.68 |
| Comprehensive metabolic panel | CPT | 80053 | 27 | $50 | $45 | $11.09 | $35.69 | 0.80× | $48 |
| Lipid panel | CPT | 80061 | 27 | $64 | $57.6 | $14.06 | $45.26 | 1.2× | $61.44 |
| Renal function panel | CPT | 80069 | 27 | $41 | $36.9 | $9.11 | $29.34 | 1.1× | $39.36 |
| Hepatic function panel | CPT | 80076 | 27 | $39 | $35.1 | $8.58 | $27.61 | 1.0× | $37.44 |
| Urinalysis non-automated | CPT | 81002 | 27 | $23 | $20.7 | $1.56 | $4.91 | 0.71× | $22.08 |
| Urinalysis automated | CPT | 81003 | 27 | $14 | $12.6 | $2.36 | $7.61 | 0.55× | $13.44 |
| Glucose quantitative | CPT | 82947 | 27 | $19 | $17.1 | $4.13 | $13.28 | 0.75× | $18.24 |
| Hemoglobin A1c | CPT | 83036 | 27 | $46 | $41.4 | $10.2 | $32.82 | 1.2× | $44.16 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 27 | $80 | $72 | $17.64 | $56.78 | 1.2× | $76.8 |
| Complete blood count with automated differential | CPT | 85025 | 27 | $47 | $42.3 | $8.16 | $26.26 | 0.99× | $45.12 |
| Complete blood count without differential | CPT | 85027 | 27 | $47 | $42.3 | $6.79 | $21.87 | 1.0× | $45.12 |
| Urine culture bacterial | CPT | 87086 | 27 | $38 | $34.2 | $8.47 | $27.28 | 1.2× | $36.48 |
| Urine culture identification | CPT | 87088 | 27 | $50 | $45 | $8.49 | $27.34 | 1.2× | $48 |
| Tissue exam by pathologist level IV | CPT | 88305 | 27 | $163 | $146.7 | $56.78 | $144.42 | 1.4× | $156.48 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 27 | $402 | $361.8 | $97.89 | $271.43 | 1.4× | $560.3 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 27 | $51.21 | $46.09 | $19.97 | $46.09 | 0.53× | $93.02 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 27 | $76.66 | $68.99 | $29.9 | $68.99 | 0.56× | $161.03 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 27 | $131.12 | $118.01 | $51.14 | $118.01 | 0.68× | $263.88 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 27 | $171.3 | $154.17 | $66.81 | $154.17 | 0.70× | $361.42 |
| Office visit, established patient, 5 min | CPT | 99211 | 27 | $197 | $177.3 | $12.4 | $162.88 | 2.5× | $204.99 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 29 | $203 | $182.7 | $17.93 | $133.2 | 1.7× | $204.99 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 29 | $326 | $293.4 | $23.91 | $160.19 | 1.4× | $312.96 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 29 | $459 | $413.1 | $38.34 | $203.4 | 1.3× | $440.64 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 29 | $643 | $578.7 | $43.99 | $285.82 | 1.5× | $617.28 |
| surgery |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 7 | $132,125 | $132,125 | $40,318 | $43,826 | 1.0× | $90,466 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 7 | $101,330 | $101,330 | $21,027 | $23,140 | 1.00× | $47,766 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 7 | $65,675 | $65,675 | $14,762 | $16,422 | 1.00× | $33,898 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 7 | $69,705 | $69,705 | $14,838 | $16,504 | 1.0× | $34,067 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 7 | $52,983 | $52,983 | $11,980 | $13,439 | 0.99× | $27,742 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 7 | $87,980 | $87,980 | $29,885 | $32,639 | 1.0× | $67,373 |
| Major joint replacement w MCC | MS-DRG | 469 | 7 | $109,046 | $109,046 | $26,606 | $29,122 | 0.98× | $60,114 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 7 | $75,886 | $75,886 | $16,919 | $18,735 | 0.99× | $38,674 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 7 | $89,252 | $89,252 | $25,545 | $27,985 | 1.00× | $57,767 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 7 | $84,895 | $84,895 | $18,372 | $20,293 | 1.00× | $41,889 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 7 | $67,765 | $67,765 | $14,306 | $15,934 | 1.00× | $32,890 |
| OR procedure for obesity w CC | MS-DRG | 620 | 7 | $57,002 | $57,002 | $14,037 | $15,645 | 0.97× | $32,294 |
| Intravitreal injection | CPT | 67028 | 27 | $1,254 | $1,128.6 | $161.46 | $665.1 | 1.9× | $1,203.84 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 7 | $40,248 | $40,248 | $10,883 | $12,263 | 1.00× | $25,313 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 7 | $92,420 | $92,420 | $17,974 | $19,866 | 1.0× | $41,008 |
| PCI single major coronary artery | CPT | 92920 | 27 | $14,345 | $12,911 | $5,594.55 | $12,911 | 2.3× | $15,774 |
| PCI with drug-eluting stent | CPT | 92928 | 27 | $25,569 | $23,012 | $9,971.91 | $23,012 | 2.3× | $31,994 |
| PCI bypass graft | CPT | 92937 | 27 | $20,924 | $18,832 | $8,160.36 | $18,832 | 1.7× | $31,994 |
| Left heart catheterization | CPT | 93452 | 27 | $5,590 | $5,031 | $2,180.1 | $5,031 | 1.6× | $8,984.72 |
| Coronary angiography with cath | CPT | 93455 | 27 | $10,020 | $9,018 | $3,907.8 | $9,018 | 2.9× | $9,619.2 |
| Coronary angiography with bypass cath | CPT | 93458 | 27 | $10,020 | $9,018 | $3,907.8 | $9,018 | 2.9× | $9,619.2 |