| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 9 | $349 | $174.5 | $54.98 | $166.59 | $296.65 |
| Psychotherapy 30 minutes | CPT | 90832 | 9 | $291 | $145.5 | $45.85 | $166.59 | $247.35 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 9 | $291 | $145.5 | $40.58 | $166.59 | $247.35 |
| emergency |
| ED visit level 1 | CPT | 99281 | 9 | $200.1 | $100.05 | $55.94 | $84.85 | $170.09 |
| ED visit level 2 | CPT | 99282 | 9 | $300.15 | $150.08 | $120.06 | $158.73 | $255.13 |
| ED visit level 3 | CPT | 99283 | 9 | $400.2 | $200.1 | $160.08 | $262.82 | $340.17 |
| ED visit level 4 | CPT | 99284 | 9 | $767.05 | $383.53 | $306.82 | $496.67 | $660.09 |
| ED visit level 5 | CPT | 99285 | 9 | $1,067.2 | $533.6 | $171.38 | $596.64 | $907.12 |
| Critical care, first hour | CPT | 99291 | 9 | $1,867.6 | $933.8 | $260.41 | $810.65 | $1,587.46 |
| imaging |
| CT head without contrast | CPT | 70450 | 9 | $1,386 | $693 | $98.12 | $585.38 | $1,178.1 |
| CT head with contrast | CPT | 70460 | 9 | $1,512 | $756 | $164.62 | $638.6 | $1,285.2 |
| CT head with and without contrast | CPT | 70470 | 9 | $2,394 | $1,197 | $164.62 | $1,011.11 | $2,034.9 |
| CT neck with contrast | CPT | 70491 | 9 | $2,016 | $1,008 | $164.62 | $851.46 | $1,713.6 |
| MRI brain without contrast | CPT | 70551 | 9 | $1,984 | $992 | $223.94 | $837.94 | $1,686.4 |
| MRI brain with contrast | CPT | 70552 | 9 | $2,362 | $1,181 | $327.43 | $997.59 | $2,007.7 |
| MRI brain with and without contrast | CPT | 70553 | 9 | $2,488 | $1,244 | $327.43 | $1,050.81 | $2,114.8 |
| Chest X-ray single view | CPT | 71045 | 9 | $110.25 | $55.13 | $15.37 | $78 | $93.71 |
| Chest X-ray 2 views | CPT | 71046 | 9 | $82.9 | $41.45 | $11.56 | $58.65 | $82.9 |
| CT chest without contrast | CPT | 71250 | 9 | $1,732.5 | $866.25 | $98.12 | $1,021.35 | $1,472.63 |
| CT chest with contrast | CPT | 71260 | 9 | $2,010 | $1,005 | $164.62 | $848.93 | $1,708.5 |
| CT chest with and without contrast | CPT | 71270 | 9 | $2,160 | $1,080 | $164.62 | $912.28 | $1,836 |
| MRI chest without contrast | CPT | 71550 | 9 | $1,719.9 | $859.95 | $223.94 | $726.4 | $1,461.92 |
| MRI chest with and without contrast | CPT | 71552 | 9 | $2,381.4 | $1,190.7 | $327.43 | $1,005.79 | $2,024.19 |
| Lumbosacral spine X-ray | CPT | 72100 | 9 | $463.05 | $231.53 | $64.57 | $195.57 | $393.59 |
| CT cervical spine without contrast | CPT | 72125 | 9 | $1,764 | $882 | $98.12 | $745.03 | $1,499.4 |
| CT thoracic spine without contrast | CPT | 72128 | 9 | $1,764 | $882 | $98.12 | $745.03 | $1,499.4 |
| CT lumbar spine without contrast | CPT | 72131 | 9 | $1,890 | $945 | $98.12 | $798.24 | $1,606.5 |
| MRI cervical spine without contrast | CPT | 72141 | 9 | $1,638 | $819 | $223.94 | $691.81 | $1,392.3 |
| MRI thoracic spine without contrast | CPT | 72146 | 9 | $1,984.5 | $992.25 | $223.94 | $838.16 | $1,686.83 |
| MRI lumbar spine without contrast | CPT | 72148 | 9 | $1,984.5 | $992.25 | $223.94 | $838.16 | $1,686.83 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 9 | $2,381.4 | $1,190.7 | $327.43 | $1,005.79 | $2,024.19 |
| MRI cervical spine with and without contrast | CPT | 72156 | 9 | $2,142 | $1,071 | $327.43 | $904.68 | $1,820.7 |
| MRI lumbar spine with contrast | CPT | 72158 | 9 | $2,778.3 | $1,389.15 | $327.43 | $1,173.42 | $2,361.56 |
| CT pelvis without contrast | CPT | 72192 | 9 | $1,890 | $945 | $98.12 | $798.24 | $1,606.5 |
| CT pelvis with contrast | CPT | 72193 | 9 | $2,268 | $1,134 | $164.62 | $957.89 | $1,927.8 |
| Shoulder X-ray | CPT | 73030 | 9 | $363.3 | $181.65 | $50.65 | $153.44 | $308.81 |
| Humerus X-ray | CPT | 73060 | 9 | $298.2 | $149.1 | $41.58 | $125.95 | $253.47 |
| Hand X-ray 3 views | CPT | 73130 | 9 | $330.75 | $165.38 | $46.11 | $139.69 | $281.14 |
| MRI upper extremity joint without contrast | CPT | 73221 | 9 | $1,984.5 | $992.25 | $223.94 | $838.16 | $1,686.83 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 9 | $2,205 | $1,102.5 | $307.45 | $931.28 | $1,874.25 |
| Knee X-ray 1-2 views | CPT | 73560 | 9 | $204.75 | $102.38 | $28.55 | $87.18 | $174.04 |
| Ankle X-ray 3 views | CPT | 73610 | 9 | $330.75 | $165.38 | $46.11 | $139.69 | $281.14 |
| MRI lower extremity joint without contrast | CPT | 73721 | 9 | $1,984.5 | $992.25 | $223.94 | $838.16 | $1,686.83 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 9 | $2,381.4 | $1,190.7 | $327.43 | $1,005.79 | $2,024.19 |
| CT abdomen without contrast | CPT | 74150 | 9 | $1,732.5 | $866.25 | $98.12 | $731.72 | $1,472.63 |
| CT abdomen with contrast | CPT | 74160 | 9 | $2,488.5 | $1,244.25 | $164.62 | $1,051.02 | $2,115.23 |
| CT abdomen with and without contrast | CPT | 74170 | 9 | $2,646 | $1,323 | $164.62 | $1,117.54 | $2,249.1 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 9 | $1,890 | $945 | $223.94 | $798.24 | $1,606.5 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 9 | $2,370 | $1,185 | $327.43 | $1,000.97 | $2,014.5 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 9 | $2,646 | $1,323 | $327.43 | $1,117.54 | $2,249.1 |
| MRI abdomen without contrast | CPT | 74181 | 9 | $1,984.5 | $992.25 | $223.94 | $838.16 | $1,686.83 |
| MRI abdomen with and without contrast | CPT | 74183 | 9 | $2,249.1 | $1,124.55 | $327.43 | $949.91 | $1,911.74 |
| Abdominal ultrasound complete | CPT | 76700 | 9 | $959.7 | $479.85 | $98.12 | $405.33 | $815.75 |
| Abdominal ultrasound limited | CPT | 76705 | 9 | $695.1 | $347.55 | $96.92 | $293.58 | $590.84 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 9 | $793.8 | $396.9 | $98.12 | $335.26 | $674.73 |
| Obstetric ultrasound first trimester | CPT | 76801 | 9 | $595.35 | $297.68 | $79.06 | $350.97 | $506.05 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 9 | $598 | $299 | $83.39 | $252.57 | $508.3 |
| Transvaginal ultrasound | CPT | 76830 | 9 | $598 | $299 | $83.39 | $252.57 | $508.3 |
| Pelvic ultrasound complete | CPT | 76856 | 9 | $926.1 | $463.05 | $98.12 | $391.14 | $787.19 |
| Scrotal ultrasound | CPT | 76870 | 9 | $695.1 | $347.55 | $96.92 | $293.58 | $590.84 |
| Diagnostic mammography unilateral | CPT | 77065 | 9 | $218.4 | $109.2 | $30.46 | $92.24 | $185.64 |
| Diagnostic mammography bilateral | CPT | 77066 | 9 | $231 | $115.5 | $32.21 | $101.77 | $196.35 |
| Screening mammography bilateral | CPT | 77067 | 9 | $212.1 | $106.05 | $29.57 | $89.58 | $180.29 |
| EKG tracing only | CPT | 93005 | 9 | $264.5 | $132.25 | $36.88 | $111.71 | $224.83 |
| Transthoracic echocardiogram complete | CPT | 93306 | 9 | $1,500 | $750 | $209.15 | $633.53 | $1,275 |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 0 | — | — | — | — | — |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 0 | — | — | — | — | — |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 0 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| 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 | 9 | $82 | $41 | $4.35 | $23.71 | $69.7 |
| General health panel | CPT | 80050 | 5 | $302 | $151 | $16.5 | $212.54 | $256.7 |
| Electrolyte panel | CPT | 80051 | 9 | $68 | $34 | $3.59 | $19.89 | $57.8 |
| Comprehensive metabolic panel | CPT | 80053 | 9 | $130 | $65 | $5.42 | $33.71 | $110.5 |
| Lipid panel | CPT | 80061 | 9 | $68 | $34 | $6.89 | $25.83 | $57.8 |
| Renal function panel | CPT | 80069 | 9 | $82 | $41 | $4.46 | $23.71 | $69.7 |
| Hepatic function panel | CPT | 80076 | 9 | $97 | $48.5 | $4.2 | $26.71 | $82.45 |
| Urinalysis automated | CPT | 81003 | 9 | $39.1 | $19.55 | $1.15 | $9.87 | $33.24 |
| Glucose quantitative | CPT | 82947 | 9 | $45 | $22.5 | $2.02 | $12.58 | $38.25 |
| Hemoglobin A1c | CPT | 83036 | 9 | $82 | $41 | $4.99 | $25.25 | $69.7 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 9 | $85 | $42.5 | $8.63 | $31.87 | $72.25 |
| Complete blood count with automated differential | CPT | 85025 | 9 | $72.45 | $36.23 | $4 | $21.58 | $61.58 |
| Complete blood count without differential | CPT | 85027 | 9 | $72.45 | $36.23 | $3.33 | $20.4 | $61.58 |
| Urine culture bacterial | CPT | 87086 | 9 | $83 | $41.5 | $4.14 | $23.96 | $70.55 |
| Urine culture identification | CPT | 87088 | 9 | $38 | $19 | $4.15 | $14.98 | $32.3 |
| Tissue exam by pathologist level IV | CPT | 88305 | 9 | $163.3 | $81.65 | $25.47 | $76.71 | $138.81 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 9 | $247 | $123.5 | $34.44 | $174.75 | $209.95 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 8 | $250 | $125 | $20.49 | $102.9 | $212.5 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 8 | $375 | $187.5 | $35.44 | $158.35 | $318.75 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 8 | $500 | $250 | $53.12 | $257.56 | $425 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 8 | $625 | $312.5 | $69.02 | $334.62 | $531.25 |
| Office visit, established patient, 5 min | CPT | 99211 | 8 | $100 | $50 | $3.76 | $19.1 | $85 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 8 | $200 | $100 | $11.66 | $53.69 | $170 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 8 | $300 | $150 | $23.63 | $106.13 | $255 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 8 | $400 | $200 | $36.24 | $161.87 | $340 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 8 | $925 | $462.5 | $45.32 | $229.94 | $786.25 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | — | — | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | — | — | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | — | — | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | — | — | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | — | — | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | — | — | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | — | — | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | — | — | — | — | — |
| Hip hemiarthroplasty | CPT | 27125 | 0 | — | — | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | — | — | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | — | — | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | — | — | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | — | — | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | — | — | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | — | — | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | — | — | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | — | — | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | — | — | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | — | — | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | — | — | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | — | — | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | — | — | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | — | — | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | — | — | — | — | — |