| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $1,177 | $659.12 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $3,890 | $2,178.4 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $791 | $442.96 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $1,040 | $582.4 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $720 | $403.2 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $1,060 | $593.6 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $843 | $472.08 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $1,558 | $872.48 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $2,896 | $1,621.76 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $4,844 | $2,712.64 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $7,536 | $4,220.16 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $10,553 | $5,909.68 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $4,790 | $2,682.4 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $5,260 | $2,945.6 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $6,340 | $3,550.4 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $5,830 | $3,264.8 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $6,480 | $3,628.8 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $9,030 | $5,056.8 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $9,820 | $5,499.2 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $850 | $476 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $900 | $504 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $1,040 | $582.4 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $5,080 | $2,844.8 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $6,720 | $3,763.2 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $7,820 | $4,379.2 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $8,920 | $4,995.2 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $10,400 | $5,824 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $14,530 | $8,136.8 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $990 | $554.4 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $5,770 | $3,231.2 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $5,770 | $3,231.2 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $5,770 | $3,231.2 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $6,670 | $3,735.2 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $6,510 | $3,645.6 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $5,860 | $3,281.6 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $8,920 | $4,995.2 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $10,590 | $5,930.4 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $11,040 | $6,182.4 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $6,410 | $3,589.6 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $8,500 | $4,760 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $1,170 | $655.2 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $1,080 | $604.8 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $1,010 | $565.6 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $5,900 | $3,304 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $13,540 | $7,582.4 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $720 | $403.2 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $1,080 | $604.8 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $6,140 | $3,438.4 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $11,070 | $6,199.2 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $3,940 | $2,206.4 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $4,500 | $2,520 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $5,060 | $2,833.6 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $7,770 | $4,351.2 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $8,490 | $4,754.4 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $11,790 | $6,602.4 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $6,160 | $3,449.6 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $10,660 | $5,969.6 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,770 | $991.2 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,480 | $828.8 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,610 | $901.6 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $2,320 | $1,299.2 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,690 | $946.4 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,610 | $901.6 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,280 | $716.8 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,680 | $940.8 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,590 | $890.4 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $670 | $375.2 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $900 | $504 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $670 | $375.2 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $160 | $89.6 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $680 | $380.8 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $94 | $52.64 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $6,830 | $3,824.8 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $2,300 | $1,288 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $7,400 | $4,144 | — | — | — |
| 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 | $345 | $193.2 | — | — | — |
| General health panel | CPT | 80050 | 0 | $496 | $277.76 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $128 | $71.68 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $456 | $255.36 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $279 | $156.24 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $254 | $142.24 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $239 | $133.84 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $65 | $36.4 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $100 | $56 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $67 | $37.52 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $142 | $79.52 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $277 | $155.12 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $220 | $123.2 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $160 | $89.6 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $282 | $157.92 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $173 | $96.88 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $410 | $229.6 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $890 | $498.4 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $17,860 | $10,002 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $3,010 | $1,685.6 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $6,620 | $3,707.2 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $5,990 | $3,354.4 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $4,020 | $2,251.2 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $5,410 | $3,029.6 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $6,570 | $3,679.2 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $6,340 | $3,550.4 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $6,190 | $3,466.4 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $20,250 | $11,340 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $16,360 | $9,161.6 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $46,000 | $25,760 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $9,360 | $5,241.6 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $11,250 | $6,300 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $13,080 | $7,324.8 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $32,500 | $18,200 | — | — | — |
| 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 | $19,440 | $10,886 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $40,500 | $22,680 | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | — | — | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $34,320 | $19,219 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $28,240 | $15,814 | — | — | — |
| 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 | $46,550 | $26,068 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $26,700 | $14,952 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $25,260 | $14,146 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $33,860 | $18,962 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $49,380 | $27,653 | — | — | — |
| 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 | — | — | — | — | — |
| Complex cataract surgery | CPT | 66982 | 0 | $19,180 | $10,741 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $15,400 | $8,624 | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $1,800 | $1,008 | — | — | — |
| Vitrectomy mechanical | CPT | 67042 | 0 | $27,990 | $15,674 | — | — | — |
| 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 | $20,860 | $11,682 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $24,550 | $13,748 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $47,010 | $26,326 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $27,880 | $15,613 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $29,990 | $16,794 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $34,800 | $19,488 | — | — | — |
