| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $912 | $218.88 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $1,511 | $362.64 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $2,694 | $646.56 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $4,878 | $1,170.72 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $4,289 | $1,029.36 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $8,398 | $2,015.52 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $12,075 | $2,898 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $18,761 | $4,502.64 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $20,506 | $4,921.44 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $16,447 | $3,947.28 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $9,931 | $2,383.44 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $11,580 | $2,779.2 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $15,185 | $3,644.4 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $1,760 | $422.4 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $1,760 | $422.4 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $237 | $56.88 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $11,364 | $2,727.36 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $16,447 | $3,947.28 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $19,300 | $4,632 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $9,595 | $2,302.8 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $8,041 | $1,929.84 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $13,855 | $3,325.2 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $1,771 | $425.04 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $12,787 | $3,068.88 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $10,655 | $2,557.2 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $12,787 | $3,068.88 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $10,825 | $2,598 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $9,059 | $2,174.16 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $10,825 | $2,598 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $12,513 | $3,003.12 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $16,552 | $3,972.48 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $16,552 | $3,972.48 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $10,655 | $2,557.2 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $15,419 | $3,700.56 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $2,329 | $558.96 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $2,796 | $671.04 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $2,797 | $671.28 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $9,021 | $2,165.04 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $13,793 | $3,310.32 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $3,110 | $746.4 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $2,797 | $671.28 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $9,043 | $2,170.32 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $13,824 | $3,317.76 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $12,075 | $2,898 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $17,475 | $4,194 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $20,506 | $4,921.44 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $24,147 | $5,795.28 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $34,941 | $8,385.84 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $41,000 | $9,840 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $9,191 | $2,205.84 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $14,052 | $3,372.48 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $3,261 | $782.64 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $3,261 | $782.64 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $2,983 | $715.92 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $2,391 | $573.84 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $3,419 | $820.56 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $2,972 | $713.28 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $4,326 | $1,038.24 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $2,972 | $713.28 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $1,182 | $283.68 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,450 | $348 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $1,405 | $337.2 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $1,008 | $241.92 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $6,105 | $1,465.2 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $3,912 | $938.88 | — | — | — |
| 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 | $215 | $51.6 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $61 | $14.64 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $202 | $48.48 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $167 | $40.08 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $100 | $24 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $94 | $22.56 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $29 | $6.96 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $29 | $6.96 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $61 | $14.64 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $122 | $29.28 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $247 | $59.28 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $167 | $40.08 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $167 | $40.08 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $355 | $85.2 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $98 | $23.52 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $766 | $183.84 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $2,608 | $625.92 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $33,966 | $5,094.96 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $40,754 | $6,113.08 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $27,205 | $4,080.81 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $44,067 | $6,610.04 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $26,501 | $3,975.08 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $38,327 | $5,749.03 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $41,314 | $6,197.06 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $318,006 | $47,701 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $235,113 | $35,267 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $242,553 | $36,383 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $191,643 | $28,746 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $429,580 | $64,437 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $187,337 | $28,101 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $204,269 | $30,640 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $120,483 | $18,072 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $239,452 | $35,918 | — | — | — |
| 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 | — | — | — | — | — |
| Open appendectomy | CPT | 44950 | 0 | $183,611 | $27,542 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $175,775 | $26,366 | — | — | — |
| 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 | $141,652 | $21,248 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $132,443 | $19,867 | — | — | — |
| 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 | $142,684 | $21,403 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $161,815 | $24,272 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $173,325 | $25,999 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $185,099 | $27,765 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $180,878 | $27,132 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $129,255 | $19,388 | — | — | — |
| 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 | $116,983 | $17,547 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $242,251 | $36,338 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $57,071 | $13,697 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $39,311 | $9,434.64 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $98,671 | $14,801 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $86,783 | $13,017 | — | — | — |
