| behavioral |
| Psychoses | MS-DRG | 885 | 19 | — | — | $2,778 | $12,871 | 1.0× | $26,286 |
| imaging |
| Hand X-ray 3 views | CPT | 73130 | 14 | — | — | $37.09 | $95.51 | 1.0× | $306.47 |
| Knee X-ray 1-2 views | CPT | 73560 | 14 | — | — | $34.41 | $95.51 | 1.0× | $306.47 |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 19 | — | — | $2,778 | $19,198 | 0.95× | $37,095 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 19 | — | — | $2,778 | $9,814.43 | 0.92× | $18,963 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 19 | — | — | $2,778 | $6,643.01 | 0.87× | $12,835 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 19 | — | — | $2,778 | $15,601 | 1.0× | $30,144 |
| COPD w MCC | MS-DRG | 190 | 19 | — | — | $2,778 | $10,838 | 0.97× | $20,942 |
| COPD w CC | MS-DRG | 191 | 19 | — | — | $2,778 | $8,291.47 | 0.94× | $16,021 |
| COPD w/o CC/MCC | MS-DRG | 192 | 19 | — | — | $2,778 | $6,246.33 | 0.89× | $12,069 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 19 | — | — | $2,778 | $7,914.12 | 0.93× | $15,291 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 19 | — | — | $2,778 | $6,009.9 | 0.90× | $11,612 |
| AMI discharged alive w MCC | MS-DRG | 280 | 20 | — | — | $9,027.7 | $15,921 | 1.0× | $30,609 |
| AMI discharged alive w CC | MS-DRG | 281 | 20 | — | — | $5,069.9 | $8,940.96 | 0.92× | $26,466 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 20 | — | — | $3,988.05 | $7,033.06 | 0.90× | $19,849 |
| Heart failure & shock w MCC | MS-DRG | 291 | 19 | — | — | $2,778 | $12,593 | 0.99× | $24,332 |
| Heart failure & shock w CC | MS-DRG | 292 | 19 | — | — | $2,778 | $8,311.75 | 0.93× | $16,060 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 19 | — | — | $2,778 | $5,295.69 | 0.85× | $10,232 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 19 | — | — | $2,778 | $11,639 | 0.96× | $22,488 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 19 | — | — | $2,778 | $7,135.24 | 0.92× | $13,786 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 19 | — | — | $2,778 | $5,399.92 | 0.87× | $10,434 |
| GI hemorrhage w CC | MS-DRG | 378 | 19 | — | — | $2,778 | $9,515.25 | 0.95× | $18,385 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 19 | — | — | $2,778 | $6,144.99 | 0.90× | $11,873 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 19 | — | — | $2,778 | $6,366.74 | 0.79× | $14,551 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 19 | — | — | $2,778 | $14,717 | 0.97× | $28,436 |
| Kidney/UTI w MCC | MS-DRG | 689 | 19 | — | — | $2,778 | $11,295 | 0.97× | $21,824 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 19 | — | — | $2,778 | $7,746.16 | 0.93× | $14,967 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 19 | — | — | $2,778 | $18,937 | 1.0× | $36,589 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 19 | — | — | $2,778 | $9,950.51 | 0.96× | $19,226 |
| lab |
| Tissue exam by pathologist level IV | CPT | 88305 | 14 | — | — | $46.05 | $58.16 | 0.57× | $292.86 |
| office |
| Office visit, established patient, 5 min | CPT | 99211 | 1 | — | — | $26.61 | $26.75 | 0.42× | $32.42 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 17 | — | — | $334.95 | $1,090.38 | 1.2× | $4,419 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 17 | — | — | $334.95 | $1,090.38 | 1.1× | $4,958 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 16 | — | — | $130.67 | $858.4 | 1.0× | $4,419 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 16 | — | — | $328.5 | $1,025.99 | 1.1× | $4,419 |
| Colonoscopy diagnostic | CPT | 45378 | 17 | — | — | $328.5 | $1,078.27 | 1.2× | $4,958 |
| Colonoscopy with biopsy | CPT | 45380 | 17 | — | — | $429.26 | $1,405.49 | 1.2× | $4,958 |
| Colonoscopy with polyp removal | CPT | 45385 | 17 | — | — | $429.26 | $1,405.49 | 1.2× | $4,958 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 16 | — | — | $2,236.46 | $16,878 | 4.1× | $27,505 |
| Total hip replacement | CPT | 27130 | 16 | — | — | $5,388 | $14,030 | 3.2× | $21,421 |
| Total knee replacement | CPT | 27447 | 16 | — | — | $5,388 | $14,030 | 3.4× | $21,421 |
| Knee revision arthroplasty single component | CPT | 27486 | 5 | — | — | $2,162.32 | $2,629.85 | 1.6× | $17,086 |
| Knee revision arthroplasty all components | CPT | 27487 | 5 | — | — | $2,705.82 | $3,290.87 | 1.6× | $17,086 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 5 | — | — | $2,866 | $5,460 | 16.7× | $11,621 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 17 | — | — | $2,398.52 | $7,813.39 | 2.4× | $12,483 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 17 | — | — | $1,088.27 | $3,842.51 | 1.9× | $11,621 |
| ACL reconstruction | CPT | 29888 | 17 | — | — | $3,300.05 | $7,519.03 | 2.2× | $11,621 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 19 | — | — | $6,182 | $44,318 | 1.0× | $85,630 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 19 | — | — | $6,182 | $22,813 | 0.98× | $44,078 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 19 | — | — | $6,182 | $15,934 | 0.97× | $30,788 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 19 | — | — | $6,182 | $16,006 | 0.97× | $30,926 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 19 | — | — | $6,182 | $12,717 | 0.94× | $24,571 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 19 | — | — | $6,182 | $33,234 | 1.0× | $65,818 |
| Laparoscopic appendectomy | CPT | 44970 | 16 | — | — | $4,903.08 | $6,301.76 | 4.0× | $14,887 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 5 | — | — | $35,308 | $73,572 | 1.5× | $91,851 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 5 | — | — | $35,308 | $40,577 | 1.2× | $50,658 |
| Major joint replacement w MCC | MS-DRG | 469 | 20 | — | — | $17,978 | $31,870 | 1.1× | $61,515 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 20 | — | — | $10,370 | $18,384 | 0.97× | $36,028 |
| Laparoscopic cholecystectomy | CPT | 47562 | 16 | — | — | $1,888.85 | $6,477.23 | 3.7× | $14,887 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 16 | — | — | $1,888.85 | $6,477.23 | 3.4× | $14,887 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 20 | — | — | $9,144 | $27,936 | 1.00× | $54,844 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 20 | — | — | $9,144 | $19,709 | 0.97× | $38,693 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 20 | — | — | $8,725.2 | $15,069 | 0.94× | $29,583 |
| Lap inguinal hernia repair | CPT | 49650 | 17 | — | — | $1,888.85 | $6,301.76 | 5.6× | $11,526 |
| Total abdominal hysterectomy | CPT | 58150 | 5 | — | — | $1,552.14 | $1,887.73 | 1.9× | $15,605 |
| Vaginal hysterectomy | CPT | 58260 | 16 | — | — | $1,526.99 | $5,583.58 | 3.1× | $14,887 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 16 | — | — | $3,110.01 | $10,589 | 4.8× | $15,605 |
| Lap salpingo-oophorectomy | CPT | 58661 | 17 | — | — | $1,888.85 | $6,443.69 | 3.2× | $12,483 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 20 | — | — | $6,182 | $26,314 | 0.97× | $50,844 |
| OR procedure for obesity w CC | MS-DRG | 620 | 20 | — | — | $6,182 | $15,413 | 0.95× | $29,781 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 20 | — | — | $6,182 | $14,108 | 0.93× | $28,880 |
| Complex cataract surgery | CPT | 66982 | 17 | — | — | $849.94 | $2,804.18 | 1.3× | $12,483 |
| Cataract surgery with lens implant | CPT | 66984 | 17 | — | — | $849.94 | $2,804.18 | 1.3× | $12,483 |
| Vitrectomy mechanical | CPT | 67042 | 16 | — | — | $1,533.49 | $4,564.21 | 1.8× | $14,887 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 19 | — | — | $6,182 | $11,569 | 0.94× | $22,353 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 19 | — | — | $6,182 | $18,859 | 0.99× | $36,438 |