| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $331 | $119.16 | — | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $395 | $142.2 | — | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $165 | $59.4 | — | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $219 | $78.84 | — | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $401 | $144.36 | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $880 | $316.8 | — | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $1,187 | $427.32 | — | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,822 | $655.92 | — | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,913 | $1,048.68 | — | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $20,321 | $7,315.56 | — | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $7,020 | $2,527.2 | — | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,776 | $999.36 | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $3,462 | $1,246.32 | — | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $4,156 | $1,496.16 | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $4,062 | $1,462.32 | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,807 | $1,010.52 | — | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $2,807 | $1,010.52 | — | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $3,319 | $1,194.84 | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $578 | $208.08 | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $898 | $323.28 | — | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $1,093 | $393.48 | — | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $4,498 | $1,619.28 | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,292 | $1,185.12 | — | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $4,678 | $1,684.08 | — | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $2,807 | $1,010.52 | — | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $2,807 | $1,010.52 | — | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $4,366 | $1,571.76 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $1,343 | $483.48 | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $4,509 | $1,623.24 | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $3,932 | $1,415.52 | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $4,728 | $1,702.08 | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $4,366 | $1,571.76 | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,015 | $1,085.4 | — | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,807 | $1,010.52 | — | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $2,807 | $1,010.52 | — | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $4,159 | $1,497.24 | — | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $5,861 | $2,109.96 | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $3,451 | $1,242.36 | — | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $4,248 | $1,529.28 | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $1,008 | $362.88 | — | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $693 | $249.48 | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $723 | $260.28 | — | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $4,539 | $1,634.04 | — | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $4,539 | $1,634.04 | — | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $723 | $260.28 | — | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $693 | $249.48 | — | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,765 | $1,355.4 | — | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $5,973 | $2,150.28 | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $4,156 | $1,496.16 | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $4,847 | $1,744.92 | — | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $5,541 | $1,994.76 | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $7,619 | $2,742.84 | — | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $9,095 | $3,274.2 | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $10,377 | $3,735.72 | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,983 | $1,073.88 | — | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $4,149 | $1,493.64 | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $3,036 | $1,092.96 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $2,228 | $802.08 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,608 | $578.88 | — | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $2,142 | $771.12 | — | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $2,269 | $816.84 | — | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $2,183 | $785.88 | — | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,277 | $459.72 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,903 | $685.08 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,880 | $676.8 | — | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $500 | $180 | — | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $651 | $234.36 | — | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $647 | $232.92 | — | — | — | — |
| EKG complete | CPT | 93000 | 0 | $74 | $26.64 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $559 | $201.24 | — | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $32 | $11.52 | — | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $10,200 | $3,060.04 | — | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $3,426 | $1,233.36 | — | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $4,826 | $1,737.36 | — | — | — | — |
| 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 | $229 | $82.44 | — | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $310 | $111.6 | — | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $414 | $149.04 | — | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $148 | $53.28 | — | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $217 | $78.12 | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $186 | $66.96 | — | — | — | — |
| General health panel | CPT | 80050 | 0 | $594 | $213.84 | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $108 | $38.88 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $489 | $176.04 | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $216 | $77.76 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $447 | $160.92 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $266 | $95.76 | — | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $240 | $86.4 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $86 | $30.96 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $74 | $26.64 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $163 | $58.68 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $262 | $94.32 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $108 | $38.88 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $108 | $38.88 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $263 | $94.68 | — | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $49 | $17.64 | — | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $850 | $306 | — | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $6,451.71 | $1,935.51 | — | — | — | — |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | $5,294 | $1,905.84 | — | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $2,075 | $747 | — | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $2,647 | $952.92 | — | — | — | — |
| Routine obstetric care with C-section | CPT | 59510 | 0 | $5,843 | $2,103.48 | — | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $2,505 | $901.8 | — | — | — | — |
| C-section with postpartum | CPT | 59515 | 0 | $3,198 | $1,151.28 | — | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $143 | $51.48 | — | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $206 | $74.16 | — | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $315 | $113.4 | — | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $396 | $142.56 | — | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $71 | $25.56 | — | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $83 | $29.88 | — | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $139 | $50.04 | — | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $206 | $74.16 | — | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $278 | $100.08 | — | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $9,741.93 | $2,922.58 | — | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $11,380 | $3,414.02 | — | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $6,923.28 | $2,076.98 | — | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $10,471 | $3,141.37 | — | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $7,257.89 | $2,177.37 | — | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $11,273 | $3,382.02 | — | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $10,735 | $3,220.61 | — | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $5,494 | $1,977.84 | — | — | — | — |
| Hip hemiarthroplasty | CPT | 27125 | 0 | $4,259 | $1,533.24 | — | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $5,417 | $1,950.12 | — | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $4,878 | $1,756.08 | — | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $5,293 | $1,905.48 | — | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $658 | $236.88 | — | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $4,044 | $1,455.84 | — | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $2,052 | $738.72 | — | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $2,505 | $901.8 | — | — | — | — |
| 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 | — | — | — | — | — | — |
| CABG single arterial graft | CPT | 33533 | 0 | $7,049 | $2,537.64 | — | — | — | — |
| CABG 2 arterial grafts | CPT | 33534 | 0 | $8,334 | $3,000.24 | — | — | — | — |
| CABG 3 arterial grafts | CPT | 33535 | 0 | $9,286 | $3,342.96 | — | — | — | — |
| CABG 4+ arterial grafts | CPT | 33536 | 0 | $9,940 | $3,578.4 | — | — | — | — |
| 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 | $65,900 | $19,770 | — | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $72,739 | $21,822 | — | — | — | — |
| 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 | $65,205 | $19,562 | — | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $64,432 | $19,330 | — | — | — | — |
| 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 | — | — | — | — | — | — |
| Open umbilical hernia repair | CPT | 49560 | 0 | $4,252.5 | $1,530.9 | — | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $72,098 | $21,629 | — | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $111,692 | $33,508 | — | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $3,158 | $1,136.88 | — | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $3,370 | $1,213.2 | — | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $83,974 | $25,192 | — | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $81,558 | $24,467 | — | — | — | — |
| 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 | $26,830 | $8,048.99 | — | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $27,899 | $8,369.63 | — | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $33,270 | $9,981.08 | — | — | — | — |
| Vitrectomy mechanical | CPT | 67042 | 0 | $39,059 | $11,718 | — | — | — | — |
| 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 | $18,084 | $6,510.24 | — | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $33,790 | $12,164 | — | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $35,563 | $12,803 | — | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $27,428 | $9,874.08 | — | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $27,362 | $9,850.32 | — | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $34,290 | $12,344 | — | — | — | — |