| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $2,163.11 | $389.36 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $3,401.64 | $612.3 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $6,720.11 | $1,209.62 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $10,036 | $1,806.52 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $14,308 | $2,575.35 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $18,315 | $3,296.71 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $12,684 | $2,283.04 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $18,400 | $3,311.97 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $20,539 | $3,696.95 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $18,167 | $3,270.01 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $21,594 | $3,886.97 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $22,964 | $4,133.5 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $24,457 | $4,402.21 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $1,863.3 | $335.39 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $3,161.47 | $569.06 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $2,725.1 | $490.52 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $10,042 | $1,807.51 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $12,881 | $2,318.51 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $13,773 | $2,479.14 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $19,164 | $3,449.43 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $11,934 | $2,148.13 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $20,304 | $3,654.71 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $2,913.45 | $524.42 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $14,843 | $2,671.7 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $12,713 | $2,288.27 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $18,492 | $3,328.5 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $22,911 | $4,124.03 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $17,821 | $3,207.85 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $21,539 | $3,877.08 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $23,385 | $4,209.22 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $25,822 | $4,647.89 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $23,910 | $4,303.74 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $16,497 | $2,969.52 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $17,409 | $3,133.68 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $6,262.53 | $1,127.26 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $6,262.53 | $1,127.26 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $5,525.54 | $994.6 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $22,994 | $4,139.01 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $25,964 | $4,673.46 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $4,958.05 | $892.45 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $5,178.61 | $932.15 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $22,994 | $4,139.01 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $25,964 | $4,673.6 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $15,120 | $2,721.57 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $16,690 | $3,004.27 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $21,127 | $3,802.91 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $33,677 | $6,061.8 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $36,282 | $6,530.7 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $41,467 | $7,463.98 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $10,858 | $1,954.43 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $14,113 | $2,540.31 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $4,232.85 | $761.91 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $5,435.27 | $978.35 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $3,074.36 | $553.38 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,684.35 | $303.18 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,590.17 | $286.23 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,700.82 | $306.15 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $3,238.39 | $582.91 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $4,265.81 | $767.85 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $3,543.72 | $637.87 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $1,615.26 | $290.75 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $2,027.33 | $364.92 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $1,610.23 | $289.84 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $3,137.93 | $564.83 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $13,630 | $2,453.43 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $6,899.84 | $1,241.97 | — | — | — |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | — | — | — | — | — |
| COPD w MCC | MS-DRG | 190 | 0 | — | — | — | — | — |
| COPD w CC | MS-DRG | 191 | 0 | — | — | — | — | — |
| COPD w/o CC/MCC | MS-DRG | 192 | 0 | — | — | — | — | — |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 0 | — | — | — | — | — |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 0 | — | — | — | — | — |
| AMI discharged alive w MCC | MS-DRG | 280 | 0 | — | — | — | — | — |
| AMI discharged alive w CC | MS-DRG | 281 | 0 | — | — | — | — | — |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 0 | — | — | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | — | — | — | — | — |
| Heart failure & shock w CC | MS-DRG | 292 | 0 | — | — | — | — | — |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 0 | — | — | — | — | — |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 0 | — | — | — | — | — |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 0 | — | — | — | — | — |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 0 | — | — | — | — | — |
| GI hemorrhage w CC | MS-DRG | 378 | 0 | — | — | — | — | — |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 0 | — | — | — | — | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 0 | — | — | — | — | — |
| Fractures of femur w/o MCC | MS-DRG | 533 | 0 | — | — | — | — | — |
| Kidney/UTI w MCC | MS-DRG | 689 | 0 | — | — | — | — | — |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 0 | — | — | — | — | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 0 | — | — | — | — | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 0 | — | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $1,932.37 | $347.83 | — | — | — |
| General health panel | CPT | 80050 | 0 | $611.43 | $110.06 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $1,524.24 | $274.36 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $3,031.98 | $545.76 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $1,047.01 | $188.46 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $2,475.5 | $445.59 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $1,437.9 | $258.82 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $824.9 | $148.48 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $999.15 | $179.85 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $503.9 | $90.7 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $1,152.99 | $207.54 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $434.03 | $78.13 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $364.97 | $65.69 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $2,274.57 | $409.42 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $1,136.11 | $204.5 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $4,005.21 | $720.94 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $1,013.35 | $182.4 | — | — | — |
| office |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $29,500 | $3,540.05 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $28,169 | $3,380.31 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $46,665 | $5,599.82 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $27,662 | $3,319.38 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $35,755 | $4,290.57 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $29,012 | $3,481.49 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $46,453 | $5,574.41 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $46,522 | $5,582.64 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $225,366 | $27,044 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $216,097 | $25,932 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $187,202 | $22,464 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $205,952 | $24,714 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $246,156 | $29,539 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $124,459 | $14,935 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $133,911 | $16,069 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $94,295 | $11,315 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $155,479 | $18,657 | — | — | — |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 0 | — | — | — | — | — |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 0 | — | — | — | — | — |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 0 | — | — | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $124,681 | $14,962 | — | — | — |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 0 | — | — | — | — | — |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 0 | — | — | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | — | — | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $104,124 | $12,495 | — | — | — |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 0 | — | — | — | — | — |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 0 | — | — | — | — | — |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 0 | — | — | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $121,680 | $14,602 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $201,715 | $24,206 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $133,817 | $16,058 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $147,711 | $17,725 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $180,147 | $21,618 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $101,373 | $12,165 | — | — | — |
| OR procedure for obesity w MCC | MS-DRG | 619 | 0 | — | — | — | — | — |
| OR procedure for obesity w CC | MS-DRG | 620 | 0 | — | — | — | — | — |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 0 | — | — | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | — | — | — | — | — |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 0 | — | — | — | — | — |
| PCI single major coronary artery | CPT | 92920 | 0 | $99,999 | $18,000 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $99,999 | $18,000 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $99,999 | $18,000 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $24,332 | $4,379.75 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $30,116 | $5,420.82 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $50,103 | $9,018.6 | — | — | — |
