| behavioral |
| Psychoses | MS-DRG | 885 | 16 | — | — | $1,337 | $28,291 | 2.2× | $34,191 |
| emergency |
| ED visit level 1 | CPT | 99281 | 18 | $965 | $482.5 | $75 | $338.4 | 2.4× | $14,850 |
| ED visit level 2 | CPT | 99282 | 18 | $1,100 | $550 | $346 | $659.94 | 2.8× | $26,706 |
| ED visit level 3 | CPT | 99283 | 18 | $1,880 | $940 | $732 | $1,054 | 2.6× | $46,696 |
| ED visit level 4 | CPT | 99284 | 18 | $2,040 | $1,020 | $810 | $1,734 | 2.6× | $71,812 |
| ED visit level 5 | CPT | 99285 | 18 | $3,430 | $1,715 | $876 | $2,528 | 2.4× | $103,397 |
| Critical care, first hour | CPT | 99291 | 7 | $4,170 | $2,085 | $1,985 | $3,336 | 3.1× | $142,103 |
| imaging |
| CT head without contrast | CPT | 70450 | 18 | $2,940 | $1,470 | $475 | $1,071 | 5.2× | $17,934 |
| CT head with contrast | CPT | 70460 | 18 | $3,140 | $1,570 | $475 | $1,071 | 4.6× | $30,022 |
| CT head with and without contrast | CPT | 70470 | 18 | $4,610 | $2,305 | $475 | $1,071 | 4.0× | $30,022 |
| CT neck with contrast | CPT | 70491 | 18 | $3,140 | $1,570 | $475 | $1,071 | 3.9× | $30,022 |
| MRI brain without contrast | CPT | 70551 | 18 | $4,220 | $2,110 | $650 | $1,436 | 3.6× | $40,765 |
| MRI brain with contrast | CPT | 70552 | 18 | $4,420 | $2,210 | $650 | $1,436 | 3.0× | $60,229 |
| MRI brain with and without contrast | CPT | 70553 | 18 | $6,530 | $3,265 | $650 | $1,436 | 2.4× | $60,229 |
| Chest X-ray single view | CPT | 71045 | 18 | $400 | $200 | $200 | $320 | 3.4× | $14,849 |
| Chest X-ray 2 views | CPT | 71046 | 18 | $480 | $240 | $200 | $337.5 | 3.4× | $14,849 |
| Chest X-ray 3 views | CPT | 71047 | 18 | $590 | $295 | $200 | $346.5 | 3.6× | $14,849 |
| CT chest without contrast | CPT | 71250 | 18 | $2,940 | $1,470 | $475 | $1,071 | 5.0× | $17,934 |
| CT chest with contrast | CPT | 71260 | 18 | $3,140 | $1,570 | $475 | $1,071 | 3.8× | $30,022 |
| CT chest with and without contrast | CPT | 71270 | 18 | $4,610 | $2,305 | $475 | $1,071 | 3.7× | $30,022 |
| MRI chest without contrast | CPT | 71550 | 18 | $4,220 | $2,110 | $650 | $1,436 | 3.3× | $40,765 |
| MRI chest with and without contrast | CPT | 71552 | 18 | $6,530 | $3,265 | $650 | $1,436 | 2.4× | $60,229 |
| Lumbosacral spine X-ray | CPT | 72100 | 18 | $580 | $290 | $200 | $343.5 | 3.3× | $17,934 |
| CT cervical spine without contrast | CPT | 72125 | 18 | $2,940 | $1,470 | $475 | $1,071 | 5.3× | $17,934 |
| CT thoracic spine without contrast | CPT | 72128 | 18 | $2,940 | $1,470 | $475 | $1,071 | 5.4× | $17,934 |
| CT lumbar spine without contrast | CPT | 72131 | 18 | $2,940 | $1,470 | $475 | $1,071 | 5.3× | $17,934 |
| MRI cervical spine without contrast | CPT | 72141 | 18 | $4,220 | $2,110 | $650 | $1,436 | 3.6× | $40,765 |
| MRI thoracic spine without contrast | CPT | 72146 | 18 | $4,220 | $2,110 | $650 | $1,436 | 3.9× | $40,765 |
| MRI lumbar spine without contrast | CPT | 72148 | 18 | $4,220 | $2,110 | $650 | $1,436 | 3.8× | $40,765 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 18 | $4,420 | $2,210 | $650 | $1,436 | 3.2× | $60,229 |
| MRI cervical spine with and without contrast | CPT | 72156 | 18 | $6,530 | $3,265 | $650 | $1,436 | 2.7× | $60,229 |
| MRI lumbar spine with contrast | CPT | 72158 | 18 | $6,530 | $3,265 | $650 | $1,436 | 2.6× | $60,229 |
| CT pelvis without contrast | CPT | 72192 | 18 | $2,940 | $1,470 | $475 | $1,071 | 5.4× | $17,934 |
| CT pelvis with contrast | CPT | 72193 | 18 | $3,140 | $1,570 | $475 | $1,071 | 3.8× | $30,022 |
| Shoulder X-ray | CPT | 73030 | 18 | $1,240 | $620 | $200 | $462.5 | 5.0× | $14,849 |
| Humerus X-ray | CPT | 73060 | 18 | $1,180 | $590 | $200 | $442.5 | 4.9× | $14,849 |
| Hand X-ray 3 views | CPT | 73130 | 18 | $1,300 | $650 | $200 | $473.75 | 5.1× | $14,849 |
| MRI upper extremity joint without contrast | CPT | 73221 | 18 | $4,220 | $2,110 | $650 | $1,436 | 3.5× | $40,765 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 18 | $6,530 | $3,265 | $650 | $1,436 | 2.3× | $60,229 |
| Knee X-ray 1-2 views | CPT | 73560 | 18 | $870 | $435 | $200 | $358.16 | 3.8× | $14,849 |
| Ankle X-ray 3 views | CPT | 73610 | 18 | $1,260 | $630 | $200 | $466.25 | 5.1× | $14,849 |
| MRI lower extremity joint without contrast | CPT | 73721 | 18 | $8,440 | $4,220 | $650 | $2,857.5 | 6.1× | $40,765 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 18 | $6,530 | $3,265 | $650 | $1,436 | 2.3× | $60,229 |
| CT abdomen without contrast | CPT | 74150 | 18 | $2,940 | $1,470 | $475 | $1,071 | 5.7× | $17,934 |
| CT abdomen with contrast | CPT | 74160 | 18 | $3,140 | $1,570 | $475 | $1,071 | 3.7× | $30,022 |
| CT abdomen with and without contrast | CPT | 74170 | 18 | $4,610 | $2,305 | $475 | $1,071 | 3.2× | $30,022 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 18 | $5,880 | $2,940 | $475 | $1,071 | 2.9× | $40,765 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 18 | $6,280 | $3,140 | $475 | $1,071 | 2.0× | $60,229 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 18 | $9,220 | $4,610 | $475 | $1,071 | 1.9× | $60,229 |
| MRI abdomen without contrast | CPT | 74181 | 18 | $4,220 | $2,110 | $650 | $1,436 | 3.7× | $40,765 |
| MRI abdomen with and without contrast | CPT | 74183 | 18 | $6,530 | $3,265 | $650 | $1,436 | 2.5× | $60,229 |
| Abdominal ultrasound complete | CPT | 76700 | 18 | $1,770 | $885 | $300 | $553.5 | 3.7× | $17,934 |
| Abdominal ultrasound limited | CPT | 76705 | 18 | $1,350 | $675 | $300 | $553.5 | 3.8× | $17,934 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 18 | $1,370 | $685 | $300 | $553.5 | 3.9× | $17,934 |
| Obstetric ultrasound first trimester | CPT | 76801 | 18 | $1,070 | $535 | $300 | $553.5 | 3.9× | $17,934 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 18 | $1,320 | $660 | $300 | $553.5 | 3.6× | $17,934 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 18 | $1,070 | $535 | $300 | $553.5 | 2.3× | $40,765 |
| Transvaginal ultrasound | CPT | 76830 | 18 | $915 | $457.5 | $300 | $537.5 | 3.6× | $17,934 |
| Pelvic ultrasound complete | CPT | 76856 | 18 | $1,700 | $850 | $300 | $553.5 | 3.9× | $17,934 |
| Scrotal ultrasound | CPT | 76870 | 18 | $1,190 | $595 | $300 | $553.5 | 4.2× | $17,934 |
| Diagnostic mammography unilateral | CPT | 77065 | 18 | $825 | $412.5 | $200 | $340 | 2.3× | $701.25 |
| Diagnostic mammography bilateral | CPT | 77066 | 18 | $950 | $475 | $200 | $360 | 1.9× | $807.5 |
| Screening mammography bilateral | CPT | 77067 | 18 | $445 | $222.5 | $200 | $305 | 1.9× | $378.25 |
| EKG tracing only | CPT | 93005 | 18 | $280 | $140 | $140 | $229.14 | 1.9× | $10,017 |
| Transthoracic echocardiogram complete | CPT | 93306 | 18 | $5,960 | $2,980 | $2,069 | $3,805.75 | 6.4× | $92,469 |
| Transthoracic echocardiogram | CPT | 93307 | 18 | $4,120 | $2,060 | $2,010 | $2,678 | 10.8× | $40,765 |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 15 | — | — | $32,710 | $40,012 | 2.0× | $48,250 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 15 | — | — | $16,722 | $20,454 | 1.9× | $24,666 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 15 | — | — | $11,318 | $13,845 | 1.8× | $16,695 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 15 | — | — | $26,582 | $32,515 | 2.1× | $39,210 |
| COPD w MCC | MS-DRG | 190 | 15 | — | — | $18,467 | $22,589 | 2.0× | $27,239 |
| COPD w CC | MS-DRG | 191 | 15 | — | — | $14,127 | $17,280 | 2.0× | $20,838 |
| COPD w/o CC/MCC | MS-DRG | 192 | 15 | — | — | $10,643 | $13,018 | 1.9× | $15,698 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 15 | — | — | $13,484 | $16,494 | 1.9× | $19,890 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 15 | — | — | $10,240 | $12,525 | 1.9× | $15,104 |
| AMI discharged alive w MCC | MS-DRG | 280 | 15 | — | — | $26,991 | $33,016 | 2.1× | $39,814 |
| AMI discharged alive w CC | MS-DRG | 281 | 15 | — | — | $15,158 | $18,542 | 1.9× | $22,359 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 15 | — | — | $11,924 | $14,585 | 1.9× | $17,588 |
| Heart failure & shock w MCC | MS-DRG | 291 | 15 | — | — | $21,456 | $26,245 | 2.1× | $31,649 |
| Heart failure & shock w CC | MS-DRG | 292 | 15 | — | — | $14,162 | $17,323 | 1.9× | $20,889 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 15 | — | — | $9,022.82 | $11,037 | 1.8× | $13,309 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 15 | — | — | $19,830 | $24,256 | 2.0× | $29,250 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 15 | — | — | $12,157 | $14,871 | 1.9× | $17,932 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 15 | — | — | $9,200.42 | $11,254 | 1.8× | $13,571 |
| GI hemorrhage w CC | MS-DRG | 378 | 15 | — | — | $16,212 | $19,831 | 2.0× | $23,914 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 15 | — | — | $10,470 | $12,807 | 1.9× | $15,444 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 15 | — | — | $12,831 | $15,695 | 2.0× | $18,927 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 15 | — | — | $25,075 | $30,673 | 2.0× | $36,988 |
| Kidney/UTI w MCC | MS-DRG | 689 | 15 | — | — | $19,244 | $23,540 | 2.0× | $28,387 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 15 | — | — | $13,198 | $16,144 | 1.9× | $19,468 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 15 | — | — | $32,265 | $39,467 | 2.1× | $47,593 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 15 | — | — | $16,954 | $20,738 | 2.0× | $25,008 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 18 | $235 | $117.5 | $6.77 | $24.84 | 0.77× | $199.75 |
| General health panel | CPT | 80050 | 18 | $560 | $280 | $37.82 | $336 | 3.1× | $476 |
| Electrolyte panel | CPT | 80051 | 18 | $115 | $57.5 | $5.61 | $51 | 2.1× | $97.75 |
| Comprehensive metabolic panel | CPT | 80053 | 18 | $315 | $157.5 | $8.45 | $31.17 | 0.70× | $267.75 |
| Lipid panel | CPT | 80061 | 18 | $250 | $125 | $10.71 | $111 | 2.9× | $212.5 |
| Renal function panel | CPT | 80069 | 18 | $285 | $142.5 | $6.94 | $25.8 | 0.95× | $242.25 |
| Hepatic function panel | CPT | 80076 | 18 | $280 | $140 | $6.54 | $24.12 | 0.91× | $238 |
| Urinalysis non-automated | CPT | 81002 | 18 | $30 | $15 | $2.78 | $10.5 | 1.5× | $25.5 |
| Urinalysis automated | CPT | 81003 | 18 | $50 | $25 | $1.8 | $24 | 1.7× | $42.5 |
| Glucose quantitative | CPT | 82947 | 18 | $55 | $27.5 | $3.14 | $27 | 1.5× | $46.75 |
| Hemoglobin A1c | CPT | 83036 | 18 | $165 | $82.5 | $7.77 | $34.08 | 1.3× | $140.25 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 18 | $210 | $105 | $13.44 | $49.58 | 1.0× | $178.5 |
| Complete blood count with automated differential | CPT | 85025 | 18 | $140 | $70 | $6.22 | $22.95 | 0.87× | $119 |
| Complete blood count without differential | CPT | 85027 | 18 | $100 | $50 | $5.18 | $19.11 | 0.88× | $85 |
| Urine culture bacterial | CPT | 87086 | 18 | $160 | $80 | $6.46 | $23.88 | 1.0× | $136 |
| Urine culture identification | CPT | 87088 | 18 | $160 | $80 | $6.47 | $93 | 4.2× | $136 |
| Tissue exam by pathologist level IV | CPT | 88305 | 18 | $615 | $307.5 | $57.17 | $375.15 | 3.7× | $9,010.77 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 18 | $550 | $275 | $132.5 | $330 | 1.8× | $33,927 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 13 | — | — | $5,692 | $10,865 | 4.7× | $14,482 |
| Vaginal delivery only | CPT | 59409 | 18 | $1,890 | $945 | $1,134 | $5,889 | 2.7× | $8,773 |
| Vaginal delivery with postpartum | CPT | 59410 | 13 | — | — | $1,894 | $10,379 | 9.8× | $14,038 |
| Routine obstetric care with C-section | CPT | 59510 | 13 | — | — | $5,692 | $17,638 | 7.0× | $20,860 |
| C-section delivery only | CPT | 59514 | 13 | — | — | $5,692 | $20,121 | 21.0× | $25,737 |
| C-section with postpartum | CPT | 59515 | 13 | — | — | $5,692 | $17,638 | 13.9× | $20,860 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 18 | $265 | $132.5 | $65 | $93 | 1.1× | $225.25 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 18 | $390 | $195 | $65 | $93 | 0.76× | $331.5 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 18 | $505 | $252.5 | $65 | $93 | 0.53× | $429.25 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 18 | $525 | $262.5 | $65 | $93 | 0.42× | $446.25 |
| Office visit, established patient, 5 min | CPT | 99211 | 18 | $200 | $100 | $60 | $84.6 | 1.3× | $170 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 18 | $300 | $150 | $65 | $93 | 1.2× | $255 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 18 | $390 | $195 | $65 | $93 | 0.81× | $331.5 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 18 | $505 | $252.5 | $65 | $93 | 0.61× | $429.25 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 18 | $525 | $262.5 | $65 | $93 | 0.49× | $446.25 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 15 | — | — | $1,894 | $2,955 | 3.2× | $4,387 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 15 | — | — | $1,979 | $2,976 | 3.1× | $6,800 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 15 | — | — | $1,183 | $2,115 | 2.5× | $3,500 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 15 | — | — | $1,183 | $2,115 | 2.4× | $3,500 |
| Colonoscopy diagnostic | CPT | 45378 | 15 | — | — | $1,979 | $2,976 | 3.4× | $6,800 |
| Colonoscopy with biopsy | CPT | 45380 | 15 | — | — | $1,979 | $2,976 | 2.5× | $6,800 |
| Colonoscopy with polyp removal | CPT | 45385 | 15 | — | — | $1,979 | $2,976 | 2.5× | $6,800 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 14 | — | — | $8,466 | $19,631 | 4.7× | $25,737 |
| Hip hemiarthroplasty | CPT | 27125 | 13 | — | — | $9,580 | $18,523 | 14.8× | $25,737 |
| Total hip replacement | CPT | 27130 | 14 | — | — | $9,580 | $19,631 | 4.5× | $25,737 |
| Total knee replacement | CPT | 27447 | 14 | — | — | $9,580 | $19,631 | 4.7× | $25,737 |
| Knee revision arthroplasty single component | CPT | 27486 | 13 | — | — | $9,580 | $19,631 | 11.7× | $25,737 |
| Knee revision arthroplasty all components | CPT | 27487 | 13 | — | — | $9,580 | $19,631 | 9.8× | $25,737 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 15 | — | — | $1,291 | $1,950 | 6.0× | $14,586 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 15 | — | — | $8,466 | $13,851 | 4.2× | $17,350 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 15 | — | — | $7,978 | $9,953 | 4.9× | $15,250 |
| ACL reconstruction | CPT | 29888 | 15 | — | — | $6,461 | $13,752 | 4.1× | $16,378 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 15 | — | — | $75,509 | $92,364 | 2.1× | $111,381 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 15 | — | — | $38,869 | $47,545 | 2.0× | $57,334 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 15 | — | — | $27,149 | $33,209 | 2.0× | $40,047 |
| CABG single arterial graft | CPT | 33533 | 14 | — | — | $14,482 | $19,352 | 10.3× | $25,737 |
| CABG 2 arterial grafts | CPT | 33534 | 14 | — | — | $14,482 | $19,352 | 9.0× | $25,737 |
| CABG 3 arterial grafts | CPT | 33535 | 14 | — | — | $14,482 | $19,352 | 8.5× | $25,737 |
| CABG 4+ arterial grafts | CPT | 33536 | 14 | — | — | $14,482 | $19,352 | 7.9× | $25,737 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 15 | — | — | $27,271 | $33,358 | 2.0× | $40,226 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 15 | — | — | $21,667 | $26,503 | 2.0× | $31,960 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 15 | — | — | $58,039 | $70,994 | 2.2× | $85,612 |
| Open appendectomy | CPT | 44950 | 14 | — | — | $7,978 | $9,917.5 | 8.7× | $12,444 |
| Laparoscopic appendectomy | CPT | 44970 | 15 | — | — | $6,461 | $13,851 | 8.9× | $16,378 |
| Major joint replacement w MCC | MS-DRG | 469 | 15 | — | — | $44,951 | $58,562 | 2.0× | $79,286 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 15 | — | — | $25,929 | $33,781 | 1.8× | $45,735 |
| Laparoscopic cholecystectomy | CPT | 47562 | 15 | — | — | $8,466 | $13,851 | 7.8× | $23,500 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 15 | — | — | $8,466 | $13,851 | 7.4× | $23,500 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 15 | — | — | $48,362 | $59,157 | 2.1× | $71,337 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 15 | — | — | $34,120 | $41,736 | 2.1× | $50,329 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 15 | — | — | $26,087 | $31,910 | 2.0× | $38,480 |
| Lap inguinal hernia repair | CPT | 49650 | 15 | — | — | $8,243 | $13,851 | 12.3× | $16,378 |
| Total abdominal hysterectomy | CPT | 58150 | 14 | — | — | $9,882 | $17,346 | 17.8× | $25,737 |
| Vaginal hysterectomy | CPT | 58260 | 15 | — | — | $8,456 | $11,750 | 6.5× | $23,500 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 15 | — | — | $9,580 | $13,851 | 9.4× | $23,500 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 15 | — | — | $11,037 | $13,851 | 6.2× | $17,350 |
| Lap salpingo-oophorectomy | CPT | 58661 | 15 | — | — | $8,466 | $13,851 | 6.8× | $17,350 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 15 | — | — | $44,835 | $50,333 | 1.9× | $66,134 |
| OR procedure for obesity w CC | MS-DRG | 620 | 15 | — | — | $26,261 | $29,481 | 1.8× | $38,737 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 15 | — | — | $24,038 | $26,986 | 1.8× | $35,457 |
| Complex cataract surgery | CPT | 66982 | 15 | — | — | $2,789 | $3,350 | 1.5× | $20,000 |
| Cataract surgery with lens implant | CPT | 66984 | 15 | — | — | $2,789 | $3,350 | 1.5× | $20,000 |
| Intravitreal injection | CPT | 67028 | 15 | — | — | $1,183 | $1,789 | 5.2× | $3,500 |
| Vitrectomy mechanical | CPT | 67042 | 15 | — | — | $8,466 | $11,716 | 4.6× | $23,500 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 15 | — | — | $19,711 | $24,111 | 2.0× | $29,076 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 15 | — | — | $32,132 | $39,304 | 2.1× | $47,396 |
| PCI single major coronary artery | CPT | 92920 | 14 | — | — | $11,037 | $13,802 | 2.4× | $16,378 |
| PCI with drug-eluting stent | CPT | 92928 | 14 | — | — | $11,302 | $15,454 | 1.5× | $20,860 |
| PCI bypass graft | CPT | 92937 | 14 | — | — | $11,302 | $15,454 | 1.4× | $20,860 |
| Left heart catheterization | CPT | 93452 | 14 | — | — | $7,978 | $10,357 | 3.3× | $12,855 |
| Coronary angiography with cath | CPT | 93455 | 14 | — | — | $7,978 | $10,357 | 3.3× | $12,855 |
| Coronary angiography with bypass cath | CPT | 93458 | 14 | — | — | $7,978 | $10,357 | 3.3× | $12,855 |