| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 12 | $657 | $427 | $131 | $205.5 | 1.2× | $20,688 |
| Psychiatric eval with medical services | CPT | 90792 | 12 | $657 | $427 | $131 | $205.5 | 1.2× | $20,688 |
| Psychotherapy 30 minutes | CPT | 90832 | 12 | $620 | $403 | $124 | $198 | 1.3× | $20,688 |
| Psychotherapy 45 minutes | CPT | 90834 | 12 | $620 | $403 | $124 | $198 | 1.2× | $20,688 |
| Psychotherapy 60 minutes | CPT | 90837 | 12 | $620 | $403 | $124 | $198 | 1.0× | $20,688 |
| emergency |
| ED visit level 1 | CPT | 99281 | 12 | $980 | $637 | $69 | $196 | 1.4× | $11,519 |
| ED visit level 2 | CPT | 99282 | 12 | $1,127 | $733 | $125 | $312 | 1.3× | $21,221 |
| ED visit level 3 | CPT | 99283 | 12 | $1,984 | $1,290 | $259 | $595.5 | 1.5× | $37,022 |
| ED visit level 4 | CPT | 99284 | 12 | $3,337 | $2,169 | $402 | $1,001 | 1.5× | $57,470 |
| ED visit level 5 | CPT | 99285 | 12 | $4,925 | $3,201 | $583 | $1,477.5 | 1.4× | $83,343 |
| Critical care, first hour | CPT | 99291 | 12 | $3,668 | $2,384 | $734 | $1,144.5 | 1.1× | $115,141 |
| imaging |
| CT head without contrast | CPT | 70450 | 12 | $1,330 | $865 | $100 | $399 | 1.9× | $14,266 |
| CT head with contrast | CPT | 70460 | 12 | $2,408 | $1,565 | $167 | $722.5 | 3.1× | $23,840 |
| CT head with and without contrast | CPT | 70470 | 12 | $2,696 | $1,752 | $167 | $808.5 | 3.0× | $23,840 |
| CT neck with contrast | CPT | 70491 | 12 | $2,408 | $1,565 | $167 | $722.5 | 2.6× | $23,840 |
| MRI brain without contrast | CPT | 70551 | 12 | $1,162 | $755 | $223 | $348.5 | 0.86× | $31,794 |
| MRI brain with contrast | CPT | 70552 | 12 | $1,264 | $822 | $253 | $431 | 0.90× | $49,900 |
| MRI brain with and without contrast | CPT | 70553 | 12 | $2,282 | $1,483 | $349 | $684.5 | 1.2× | $49,900 |
| Chest X-ray single view | CPT | 71045 | 12 | $311 | $202 | $62 | $104 | 1.1× | $11,791 |
| Chest X-ray 2 views | CPT | 71046 | 12 | $311 | $202 | $62 | $104 | 1.1× | $11,791 |
| Chest X-ray 3 views | CPT | 71047 | 12 | $311 | $202 | $62 | $104 | 1.1× | $11,791 |
| CT chest without contrast | CPT | 71250 | 12 | $1,330 | $865 | $100 | $399 | 1.9× | $14,266 |
| CT chest with contrast | CPT | 71260 | 12 | $2,408 | $1,565 | $167 | $722.5 | 2.6× | $23,840 |
| CT chest with and without contrast | CPT | 71270 | 12 | $2,696 | $1,752 | $167 | $808.5 | 2.8× | $23,840 |
| MRI chest without contrast | CPT | 71550 | 12 | $1,162 | $755 | $223 | $348.5 | 0.81× | $31,794 |
| MRI chest with contrast | CPT | 71551 | 12 | $3,402 | $2,211 | $680 | $1,051.5 | 1.3× | $103,892 |
| MRI chest with and without contrast | CPT | 71552 | 12 | $2,282 | $1,483 | $349 | $684.5 | 1.1× | $49,900 |
| Lumbosacral spine X-ray | CPT | 72100 | 12 | $572 | $372 | $100 | $171.5 | 1.7× | $14,266 |
| CT cervical spine without contrast | CPT | 72125 | 12 | $1,330 | $865 | $100 | $399 | 2.0× | $14,266 |
| CT thoracic spine without contrast | CPT | 72128 | 12 | $1,330 | $865 | $100 | $399 | 2.0× | $14,266 |
| CT lumbar spine without contrast | CPT | 72131 | 12 | $1,330 | $865 | $100 | $399 | 2.0× | $14,266 |
| MRI cervical spine without contrast | CPT | 72141 | 12 | $1,162 | $755 | $223 | $348.5 | 0.88× | $31,794 |
| MRI thoracic spine without contrast | CPT | 72146 | 12 | $1,162 | $755 | $223 | $348.5 | 0.93× | $31,794 |
| MRI lumbar spine without contrast | CPT | 72148 | 12 | $1,162 | $755 | $223 | $348.5 | 0.93× | $31,794 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 12 | $2,282 | $1,483 | $349 | $684.5 | 1.5× | $49,900 |
| MRI cervical spine with and without contrast | CPT | 72156 | 12 | $2,282 | $1,483 | $349 | $684.5 | 1.3× | $49,900 |
| MRI lumbar spine with contrast | CPT | 72158 | 12 | $2,282 | $1,483 | $349 | $684.5 | 1.3× | $49,900 |
| CT pelvis without contrast | CPT | 72192 | 12 | $1,330 | $865 | $100 | $399 | 2.0× | $14,266 |
| CT pelvis with contrast | CPT | 72193 | 12 | $2,408 | $1,565 | $167 | $722.5 | 2.6× | $23,840 |
| Shoulder X-ray | CPT | 73030 | 12 | $950 | $618 | $62 | $190 | 2.0× | $11,791 |
| Humerus X-ray | CPT | 73060 | 12 | $311 | $202 | $62 | $104 | 1.2× | $11,791 |
| Hand X-ray 3 views | CPT | 73130 | 12 | $572 | $372 | $62 | $156 | 1.7× | $11,791 |
| MRI upper extremity joint without contrast | CPT | 73221 | 12 | $1,162 | $755 | $223 | $348.5 | 0.84× | $31,794 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 12 | $2,282 | $1,483 | $349 | $684.5 | 1.1× | $49,900 |
| Knee X-ray 1-2 views | CPT | 73560 | 12 | $311 | $202 | $62 | $104 | 1.1× | $11,791 |
| Ankle X-ray 3 views | CPT | 73610 | 12 | $311 | $202 | $62 | $104 | 1.1× | $11,791 |
| MRI lower extremity joint without contrast | CPT | 73721 | 12 | $2,863 | $1,861 | $223 | $581 | 1.2× | $31,794 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 12 | $2,282 | $1,483 | $349 | $684.5 | 1.1× | $49,900 |
| CT abdomen without contrast | CPT | 74150 | 12 | $1,330 | $865 | $100 | $399 | 2.1× | $14,266 |
| CT abdomen with contrast | CPT | 74160 | 12 | $2,408 | $1,565 | $167 | $722.5 | 2.5× | $23,840 |
| CT abdomen with and without contrast | CPT | 74170 | 12 | $2,696 | $1,752 | $167 | $808.5 | 2.4× | $23,840 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 12 | $2,368 | $1,539 | $223 | $710.5 | 2.0× | $31,794 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 12 | $3,754 | $2,440 | $349 | $1,126.5 | 2.1× | $49,900 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 12 | $3,754 | $2,440 | $349 | $1,126.5 | 2.0× | $49,900 |
| MRI abdomen without contrast | CPT | 74181 | 12 | $1,162 | $755 | $223 | $348.5 | 0.89× | $31,794 |
| MRI abdomen with and without contrast | CPT | 74183 | 12 | $2,282 | $1,483 | $349 | $684.5 | 1.2× | $49,900 |
| Abdominal ultrasound complete | CPT | 76700 | 12 | $572 | $372 | $100 | $171.5 | 1.1× | $14,266 |
| Abdominal ultrasound limited | CPT | 76705 | 12 | $572 | $372 | $100 | $171.5 | 1.2× | $14,266 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 12 | $572 | $372 | $100 | $171.5 | 1.2× | $14,266 |
| Obstetric ultrasound first trimester | CPT | 76801 | 12 | $572 | $372 | $100 | $171.5 | 1.2× | $14,266 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 12 | $572 | $372 | $100 | $171.5 | 1.1× | $14,266 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 12 | $572 | $372 | $114 | $228 | 0.97× | $31,794 |
| Transvaginal ultrasound | CPT | 76830 | 12 | $572 | $372 | $100 | $171.5 | 1.2× | $14,266 |
| Pelvic ultrasound complete | CPT | 76856 | 12 | $572 | $372 | $100 | $171.5 | 1.2× | $14,266 |
| Scrotal ultrasound | CPT | 76870 | 12 | $572 | $372 | $100 | $171.5 | 1.3× | $14,266 |
| EKG tracing only | CPT | 93005 | 12 | $553 | $359 | $56 | $140 | 1.2× | $7,936 |
| EKG interpretation only | CPT | 93010 | 5 | $160 | $104 | $10 | $55 | 3.0× | $208 |
| Transthoracic echocardiogram complete | CPT | 93306 | 12 | $2,433 | $1,581 | $487 | $742 | 1.2× | $71,582 |
| Transthoracic echocardiogram | CPT | 93307 | 12 | $2,433 | $1,581 | $223 | $730 | 3.0× | $31,794 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 5 | $81 | $53 | $1 | $11.5 | 0.35× | $105 |
| Electrolyte panel | CPT | 80051 | 5 | $67 | $44 | $13 | $34 | 1.4× | $87 |
| Comprehensive metabolic panel | CPT | 80053 | 5 | $144 | $94 | $1 | $46 | 1.0× | $187 |
| Lipid panel | CPT | 80061 | 5 | $129 | $84 | $26 | $65 | 1.7× | $168 |
| Renal function panel | CPT | 80069 | 5 | $84 | $55 | $1 | $12 | 0.44× | $109 |
| Hepatic function panel | CPT | 80076 | 5 | $79 | $51 | $16 | $40 | 1.5× | $103 |
| Urinalysis non-automated | CPT | 81002 | 5 | $25 | $16 | $5 | $13 | 1.9× | $33 |
| Urinalysis automated | CPT | 81003 | 12 | $108 | $70 | $2 | $14 | 1.0× | $315 |
| Glucose quantitative | CPT | 82947 | 5 | $38 | $25 | $1 | $6.5 | 0.37× | $49 |
| Hemoglobin A1c | CPT | 83036 | 12 | $93 | $60 | $10 | $30 | 1.1× | $1,359 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 5 | $162 | $105 | $19 | $69 | 1.5× | $211 |
| Complete blood count with automated differential | CPT | 85025 | 5 | $106 | $69 | $2 | $34 | 1.3× | $138 |
| Complete blood count without differential | CPT | 85027 | 5 | $62 | $40 | $12 | $31 | 1.4× | $81 |
| Urine culture identification | CPT | 87088 | 5 | $78 | $51 | $16 | $39 | 1.8× | $101 |
| Tissue exam by pathologist level IV | CPT | 88305 | 5 | $224 | $146 | $45 | $112 | 1.1× | $291 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 5 | $1,470 | $956 | $218 | $685.5 | 7.9× | $1,911 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 5 | $1,663 | $1,081 | $218 | $728.5 | 6.0× | $2,162 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 5 | $1,800 | $1,170 | $167 | $709 | 4.1× | $2,340 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 5 | $1,937 | $1,259 | $218 | $823.5 | 3.7× | $2,518 |
| Office visit, established patient, 5 min | CPT | 99211 | 5 | $1,090 | $709 | $22 | $180.5 | 2.8× | $1,417 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 5 | $1,090 | $709 | $45 | $256.5 | 3.2× | $1,417 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 5 | $1,270 | $826 | $254 | $635 | 5.5× | $1,651 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 5 | $1,451 | $943 | $218 | $681 | 4.5× | $1,886 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 5 | $1,300 | $845 | $218 | $617.5 | 3.3× | $1,690 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 12 | $25,061 | $16,290 | $743 | $2,416 | 2.6× | $117,621 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 12 | $20,620 | $13,403 | $743 | $2,416 | 2.5× | $117,621 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 12 | $3,550 | $2,308 | $710 | $1,133.5 | 1.3× | $118,591 |
| Colonoscopy diagnostic | CPT | 45378 | 12 | $18,490 | $12,019 | $710 | $2,308 | 2.6× | $118,591 |
| Colonoscopy with biopsy | CPT | 45380 | 12 | $19,050 | $12,383 | $936 | $3,681.5 | 3.0× | $153,120 |
| Colonoscopy with polyp removal | CPT | 45385 | 12 | $19,641 | $12,767 | $936 | $3,043 | 2.5× | $153,120 |
| surgery |
| Total knee replacement | CPT | 27447 | 11 | $50,615 | $32,900 | $10,123 | $12,198 | 2.9× | $65,800 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 5 | $65,237 | $42,404 | $13,047 | $32,619 | 99.8× | $84,808 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 12 | $30,440 | $19,786 | $2,645 | $6,613 | 3.2× | $419,995 |
| ACL reconstruction | CPT | 29888 | 11 | $28,032 | $18,221 | $5,606 | $6,631 | 2.0× | $36,442 |
| Laparoscopic appendectomy | CPT | 44970 | 11 | $31,006 | $20,154 | $5,241 | $6,201 | 4.0× | $40,308 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 8 | $273,586 | $177,831 | $8,922 | $191,510 | 5.7× | $465,096 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 8 | $141,035 | $91,673 | $8,922 | $98,725 | 5.2× | $239,760 |
| Laparoscopic cholecystectomy | CPT | 47562 | 11 | $67,326 | $43,762 | $4,489 | $12,403 | 7.0× | $87,524 |
| Open umbilical hernia repair | CPT | 49560 | 5 | $14,556 | $9,461 | $2,911 | $7,278 | 3.8× | $18,923 |
| Umbilical hernia repair age 5+ | CPT | 49585 | 5 | $14,556 | $9,461 | $2,911 | $7,278 | 5.5× | $18,923 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 11 | $37,977 | $24,685 | $7,595 | $9,540 | 4.3× | $49,370 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 8 | $67,437 | $43,834 | $8,922 | $47,206 | 3.8× | $114,643 |