| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $618 | $309 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $1,238 | $619 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,854 | $927 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $4,011 | $2,005.5 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $13,958 | $6,979 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $12,835 | $6,417.5 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $4,154 | $2,077 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $5,240 | $2,620 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $6,207 | $3,103.5 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $4,717 | $2,358.5 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $5,135 | $2,567.5 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $6,641 | $3,320.5 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $7,996 | $3,998 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $849 | $424.5 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $988 | $494 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $2,885 | $1,442.5 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $4,514 | $2,257 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $5,985 | $2,992.5 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $4,459 | $2,229.5 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $4,089 | $2,044.5 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $1,035 | $517.5 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $4,325 | $2,162.5 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $4,074 | $2,037 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $3,845 | $1,922.5 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $6,212 | $3,106 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $5,835 | $2,917.5 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $6,699 | $3,349.5 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $5,273 | $2,636.5 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $8,946 | $4,473 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $8,810 | $4,405 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $3,908 | $1,954 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $5,087 | $2,543.5 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $1,570 | $785 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $784 | $392 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $1,358 | $679 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $6,440 | $3,220 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $6,916 | $3,458 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $369 | $184.5 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $1,094 | $547 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $6,313 | $3,156.5 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $6,916 | $3,458 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $3,805 | $1,902.5 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $4,565 | $2,282.5 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $6,324 | $3,162 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $3,940 | $1,970 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $5,183 | $2,591.5 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $6,376 | $3,188 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $5,540 | $2,770 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $6,702 | $3,351 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,609 | $804.5 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,057 | $528.5 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,322 | $661 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $981 | $490.5 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,936 | $968 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,038 | $519 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,055 | $527.5 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,700 | $850 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $249 | $124.5 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $310 | $155 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $270 | $135 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $863 | $431.5 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $11,773 | $5,886.5 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $6,532 | $3,266 | — | — | — |
| 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 | $287 | $143.5 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $209 | $104.5 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $347 | $173.5 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $340 | $170 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $270 | $135 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $197 | $98.5 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $60 | $30 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $146 | $73 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $72 | $36 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $277 | $138.5 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $295 | $147.5 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $338 | $169 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $269 | $134.5 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $298 | $149 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $66 | $33 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $388 | $194 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $3,626 | $1,813 | — | — | — |
| office |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $395 | $197.5 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $60 | $30 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $4,289 | $1,286.7 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $11,868 | $3,560.33 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $13,912 | $4,173.59 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $10,867 | $3,259.98 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $11,174 | $3,352.21 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $9,711.9 | $2,913.57 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $13,086 | $3,925.7 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $14,146 | $4,243.77 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $384,172 | $115,252 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $144,580 | $43,374 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $134,847 | $40,454 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $73,131 | $21,939 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $138,674 | $41,602 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $93,469 | $28,041 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $104,310 | $31,293 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $47,547 | $14,264 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $122,873 | $36,862 | — | — | — |
| 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 | $63,453 | $19,036 | — | — | — |
| 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 | $55,010 | $16,503 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $72,399 | $21,720 | — | — | — |
| 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 | $55,028 | $16,508 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $85,862 | $25,759 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $69,740 | $20,922 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $64,285 | $19,286 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $42,880 | $12,864 | — | — | — |
| 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 | $218,464 | $65,539 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $77,554 | $38,777 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $77,554 | $38,777 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $143,482 | $43,044 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $88,979 | $44,490 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $129,842 | $38,953 | — | — | — |