| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $683 | $478.1 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $1,228 | $859.6 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $2,398 | $1,678.6 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $3,490 | $2,443 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $4,165 | $2,915.5 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $6,400 | $4,480 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,115 | $1,480.5 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,664 | $1,864.8 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,831 | $1,981.7 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,492 | $1,744.4 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $1,000 | $700 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $525 | $367.5 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $553 | $387.1 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $2,291 | $1,603.7 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,621 | $1,834.7 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $3,543 | $2,480.1 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $519 | $363.3 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,663 | $1,864.1 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,341 | $1,638.7 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,405 | $1,683.5 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,096 | $1,467.2 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,709 | $1,896.3 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $515 | $360.5 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $389 | $272.3 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $436 | $305.2 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $515 | $360.5 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $418 | $292.6 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $2,350 | $1,645 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,662 | $1,863.4 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $3,165 | $2,215.5 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $3,035 | $2,124.5 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $4,194 | $2,935.8 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $4,354 | $3,047.8 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,075 | $752.5 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $858 | $600.6 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $939 | $657.3 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $651 | $455.7 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $893 | $625.1 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $985 | $689.5 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $724 | $506.8 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $641 | $448.7 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $628 | $439.6 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $405 | $283.5 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $593 | $415.1 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $411 | $287.7 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $1,059 | $741.3 | — | — | — |
| 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 | — | — | — | — | — |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $1,026 | $718.2 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $254 | $177.8 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $137 | $95.9 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $150 | $105 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $153 | $107.1 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $120 | $84 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $179 | $125.3 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $27 | $18.9 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $94 | $65.8 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $113 | $79.1 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $170 | $119 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $275 | $192.5 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $310 | $217 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $161 | $112.7 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $512 | $358.4 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $177 | $123.9 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $717 | $501.9 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $378 | $264.6 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $501 | $350.7 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $341 | $238.7 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $382 | $267.4 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $271 | $189.7 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $377 | $263.9 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $450 | $315 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $517 | $361.9 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $531 | $371.7 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $1,111 | $777.7 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $1,111 | $777.7 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $1,081 | $756.7 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $1,398 | $978.6 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $1,398 | $978.6 | — | — | — |
| surgery |
| 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 | — | — | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | — | — | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 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 | — | — | — | — | — |
| 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 | — | — | — | — | — |
