| behavioral |
| Psychoses | MS-DRG | 885 | 0 | $41,534 | $29,073 | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $871 | $334.6 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $983 | $334.6 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $381 | $204.4 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $509 | $273.7 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $752 | $273.7 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $716 | $334.6 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $286 | $200.2 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $813 | $569.1 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,045 | $731.5 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,027 | $1,418.9 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $3,290 | $2,303 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $2,699 | $1,889.3 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $3,259 | $2,281.3 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $3,491 | $2,443.7 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $3,615 | $2,530.5 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $3,894 | $2,725.8 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $5,657 | $3,959.9 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $4,474 | $3,131.8 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $7,760 | $5,432 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $296 | $207.2 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $347 | $242.9 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $405 | $283.5 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $3,884 | $2,718.8 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $4,416 | $3,091.2 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $3,597 | $2,517.9 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $4,830 | $3,381 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $4,476 | $3,133.2 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $7,762 | $5,433.4 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $705 | $493.5 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,870 | $2,009 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,791 | $1,953.7 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $4,171 | $2,919.7 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $5,718 | $4,002.6 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $5,375 | $3,762.5 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $5,718 | $4,002.6 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $4,418 | $3,092.6 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $7,752 | $5,426.4 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $7,796 | $5,457.2 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,596 | $1,817.2 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $4,135 | $2,894.5 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $609 | $426.3 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $622 | $435.4 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $580 | $406 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $5,636 | $3,945.2 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $5,948 | $4,163.6 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $570 | $399 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $580 | $406 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $5,656 | $3,959.2 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $6,148 | $4,303.6 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $3,453 | $2,417.1 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $4,129 | $2,890.3 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $5,127 | $3,588.9 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $6,866 | $4,806.2 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $8,413 | $5,889.1 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $9,752 | $6,826.4 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $5,703 | $3,992.1 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $7,762 | $5,433.4 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,619 | $1,133.3 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,229 | $860.3 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,138 | $796.6 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $696 | $231.7 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,268 | $887.6 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,003 | $557.2 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $939 | $657.3 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,313 | $919.1 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,366 | $956.2 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $923 | $646.1 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,184 | $828.8 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $874 | $611.8 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $86 | $25.8 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $433 | $303.1 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $47 | $14.1 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $1,484 | $1,038.8 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $824 | $247.2 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $1,393 | $975.1 | — | — | — |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 0 | $146,294 | $102,406 | — | — | — |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 0 | $81,273 | $56,891 | — | — | — |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 0 | $50,055 | $35,038 | — | — | — |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | $61,478 | $43,035 | — | — | — |
| COPD w MCC | MS-DRG | 190 | 0 | $41,286 | $28,900 | — | — | — |
| COPD w CC | MS-DRG | 191 | 0 | $39,100 | $27,370 | — | — | — |
| COPD w/o CC/MCC | MS-DRG | 192 | 0 | $29,609 | $20,726 | — | — | — |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 0 | $36,117 | $25,282 | — | — | — |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 0 | $22,948 | $16,063 | — | — | — |
| AMI discharged alive w MCC | MS-DRG | 280 | 0 | $71,710 | $50,197 | — | — | — |
| AMI discharged alive w CC | MS-DRG | 281 | 0 | $41,157 | $28,810 | — | — | — |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 0 | $31,932 | $22,352 | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | $41,380 | $28,966 | — | — | — |
| Heart failure & shock w CC | MS-DRG | 292 | 0 | $33,886 | $23,720 | — | — | — |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 0 | $33,898 | $23,729 | — | — | — |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 0 | $44,521 | $31,165 | — | — | — |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 0 | $31,364 | $21,955 | — | — | — |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 0 | $34,081 | $23,857 | — | — | — |
| GI hemorrhage w CC | MS-DRG | 378 | 0 | $56,656 | $39,659 | — | — | — |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 0 | $40,843 | $28,590 | — | — | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 0 | $37,516 | $26,261 | — | — | — |
| Fractures of femur w/o MCC | MS-DRG | 533 | 0 | $63,533 | $44,473 | — | — | — |
| Kidney/UTI w MCC | MS-DRG | 689 | 0 | $55,139 | $38,597 | — | — | — |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 0 | $34,576 | $24,203 | — | — | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 0 | $87,750 | $61,425 | — | — | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 0 | $43,697 | $30,588 | — | — | — |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $584 | $175.2 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $777 | $233.1 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $1,138 | $341.4 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $410 | $123 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $602 | $180.6 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $237 | $165.9 | — | — | — |
| General health panel | CPT | 80050 | 0 | $637 | $445.9 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $167 | $116.9 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $526 | $368.2 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $416 | $291.2 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $397 | $277.9 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $269 | $188.3 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $65 | $45.5 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $117 | $81.9 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $106 | $74.2 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $169 | $118.3 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $433 | $303.1 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $277 | $193.9 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $198 | $138.6 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $213 | $149.1 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $171 | $119.7 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $813 | $569.1 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $809 | $566.3 | — | — | — |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | $14,901 | $4,470.3 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $7,532 | $5,272.4 | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $6,670 | $2,001 | — | — | — |
| Routine obstetric care with C-section | CPT | 59510 | 0 | $16,591 | $4,977.3 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $5,789 | $1,736.7 | — | — | — |
| C-section with postpartum | CPT | 59515 | 0 | $8,289 | $2,486.7 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $287 | $189 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $485 | $249.2 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $788 | $322 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $1,069 | $344.4 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $218 | $152.6 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $265 | $185.5 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $387 | $243.6 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $571 | $310.8 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $841 | $327.6 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $3,800 | $2,660 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $3,665 | $2,565.5 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $1,673 | $1,171.1 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $1,892 | $1,324.4 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $6,420 | $4,494 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $6,990 | $4,893 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $5,024 | $3,516.8 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $8,836 | $2,650.8 | — | — | — |
| Hip hemiarthroplasty | CPT | 27125 | 0 | $6,910 | $2,073 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $7,868 | $2,360.4 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $7,855 | $2,356.5 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $8,590 | $2,577 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $10,735 | $3,220.5 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $1,069 | $320.7 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $6,511 | $1,953.3 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $3,298 | $989.4 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $5,949 | $1,784.7 | — | — | — |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 0 | $181,338 | $126,937 | — | — | — |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 0 | $113,165 | $79,216 | — | — | — |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 0 | $80,883 | $56,618 | — | — | — |
| CABG single arterial graft | CPT | 33533 | 0 | $11,641 | $3,492.3 | — | — | — |
| CABG 2 arterial grafts | CPT | 33534 | 0 | $13,665 | $4,099.5 | — | — | — |
| CABG 3 arterial grafts | CPT | 33535 | 0 | $15,236 | $4,570.8 | — | — | — |
| CABG 4+ arterial grafts | CPT | 33536 | 0 | $16,391 | $4,917.3 | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 0 | $77,945 | $54,562 | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 0 | $61,191 | $42,834 | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 0 | $149,042 | $104,329 | — | — | — |
| Open appendectomy | CPT | 44950 | 0 | $4,027 | $1,208.1 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $3,761 | $1,128.3 | — | — | — |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 0 | $216,488 | $151,542 | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | $154,251 | $107,976 | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | $95,608 | $66,926 | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $4,134 | $1,240.2 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $4,497 | $1,349.1 | — | — | — |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 0 | $154,960 | $108,472 | — | — | — |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 0 | $104,355 | $73,049 | — | — | — |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 0 | $81,815 | $57,270 | — | — | — |
| Open umbilical hernia repair | CPT | 49560 | 0 | $4,610 | $1,383 | — | — | — |
| Umbilical hernia repair age 5+ | CPT | 49585 | 0 | $2,783 | $834.9 | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $2,688 | $806.4 | — | — | — |
| Lap incisional hernia repair | CPT | 49652 | 0 | $4,660 | $1,398 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $6,120 | $1,836 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $5,077 | $1,523.1 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $5,343 | $1,602.9 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $5,945 | $1,783.5 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $3,955 | $1,186.5 | — | — | — |
| OR procedure for obesity w MCC | MS-DRG | 619 | 0 | $51,966 | $36,376 | — | — | — |
| OR procedure for obesity w CC | MS-DRG | 620 | 0 | $59,147 | $41,403 | — | — | — |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 0 | $51,496 | $36,047 | — | — | — |
| Complex cataract surgery | CPT | 66982 | 0 | $5,516 | $1,654.8 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $4,027 | $1,208.1 | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $2,417 | $743.4 | — | — | — |
| Vitrectomy mechanical | CPT | 67042 | 0 | $12,087 | $3,626.1 | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | $52,584 | $36,809 | — | — | — |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 0 | $137,851 | $96,496 | — | — | — |
| PCI single major coronary artery | CPT | 92920 | 0 | $14,241 | $9,968.7 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $21,631 | $15,142 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $21,631 | $15,142 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $11,816 | $8,271.2 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $12,714 | $8,899.8 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $16,649 | $11,654 | — | — | — |
