| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $823 | $296.28 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $1,231 | $443.16 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $2,345 | $844.2 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $3,694 | $1,329.84 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $5,635 | $2,028.6 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $7,344 | $2,643.84 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $4,154 | $1,495.44 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $6,421 | $2,311.56 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $6,742 | $2,427.12 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $5,704 | $2,053.44 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $5,696 | $2,050.56 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $6,581 | $2,369.16 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $8,935 | $3,216.6 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $566 | $203.76 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $1,043 | $375.48 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $1,347 | $484.92 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $4,534 | $1,632.24 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $6,270 | $2,257.2 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $8,044 | $2,895.84 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $7,228 | $2,602.08 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $10,081 | $3,629.16 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $1,003 | $361.08 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $4,534 | $1,632.24 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $4,534 | $1,632.24 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $4,534 | $1,632.24 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $5,666 | $2,039.76 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $5,668 | $2,040.48 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $5,913 | $2,128.68 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $6,765 | $2,435.4 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $9,779 | $3,520.44 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $9,368 | $3,372.48 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $4,534 | $1,632.24 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $5,947 | $2,140.92 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $815 | $293.4 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $568 | $204.48 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $815 | $293.4 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $5,156 | $1,856.16 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $8,511 | $3,063.96 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $568 | $204.48 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $1,629 | $586.44 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $4,643 | $1,671.48 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $9,388 | $3,379.68 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $4,534 | $1,632.24 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $6,270 | $2,257.2 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $8,044 | $2,895.84 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $9,065 | $3,263.4 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $12,221 | $4,399.56 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $17,508 | $6,302.88 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $6,025 | $2,169 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $8,873 | $3,194.28 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $2,541 | $914.76 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,710 | $615.6 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $2,541 | $914.76 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $2,563 | $922.68 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $2,563 | $922.68 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $3,048 | $1,097.28 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,507 | $542.52 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $2,361 | $849.96 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,125 | $405 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $667 | $240.12 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $978 | $352.08 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $962 | $346.32 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $342 | $123.12 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $22,815 | $6,160.15 | — | — | — |
| 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 | $408 | $146.88 | — | — | — |
| General health panel | CPT | 80050 | 0 | $1,502 | $540.72 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $398 | $143.28 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $617 | $222.12 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $679 | $244.44 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $578 | $208.08 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $522 | $187.92 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $58 | $20.88 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $72 | $25.92 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $116 | $41.76 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $347 | $124.92 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $412 | $148.32 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $350 | $126 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $316 | $113.76 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $78 | $28.08 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $774 | $278.64 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $898 | $323.28 | — | — | — |
| office |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $954.95 | $343.78 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $13,290 | $3,588.27 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $15,204 | $4,104.96 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $11,238 | $3,034.32 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $13,875 | $3,746.26 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $11,678 | $3,153.15 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $14,398 | $3,887.5 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $15,254 | $4,118.6 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $222,894 | $60,181 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $137,084 | $37,013 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $157,170 | $42,436 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $167,465 | $45,216 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $99,063 | $26,747 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $136,398 | $36,827 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $72,918 | $19,688 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $173,463 | $46,835 | — | — | — |
| 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 | $45,186 | $12,200 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $95,378 | $25,752 | — | — | — |
| 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 | $101,671 | $27,451 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $82,848 | $22,369 | — | — | — |
| 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 | $91,784 | $24,782 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $98,009 | $26,462 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $65,198 | $17,603 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $105,670 | $28,531 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $98,005 | $26,461 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $56,589 | $15,279 | — | — | — |
| 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 | $26,145 | $7,059.03 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $17,888 | $4,829.88 | — | — | — |
| Vitrectomy mechanical | CPT | 67042 | 0 | $46,760 | $12,625 | — | — | — |
| 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 | $29,112 | $10,480 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $54,136 | $19,489 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $56,730 | $20,423 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $31,842 | $11,463 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $30,351 | $10,926 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $36,437 | $13,117 | — | — | — |
