| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $647 | $452.9 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $675 | $472.5 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $326 | $228.2 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $446 | $312.2 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $564 | $394.8 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $668 | $467.6 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $269 | $188.3 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $347 | $242.9 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $595 | $416.5 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $880 | $616 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $998 | $698.6 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $1,970 | $1,379 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,453 | $1,017.1 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,401 | $980.7 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,010 | $1,407 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,796 | $1,257.2 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,380 | $1,666 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $1,969 | $1,378.3 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $3,184 | $2,228.8 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $246 | $172.2 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $399 | $279.3 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $430 | $301 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,607 | $1,124.9 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,742 | $1,219.4 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,165 | $1,515.5 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,723 | $2,606.1 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $3,723 | $2,606.1 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $4,433 | $3,103.1 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $499 | $349.3 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,765 | $1,235.5 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,629 | $1,140.3 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,681 | $1,176.7 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,691 | $1,883.7 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,682 | $1,877.4 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,648 | $1,853.6 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $3,172 | $2,220.4 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $3,241 | $2,268.7 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $3,494 | $2,445.8 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,449 | $1,014.3 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,715 | $1,200.5 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $610 | $427 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $610 | $427 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $622 | $435.4 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $2,502 | $1,751.4 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $4,433 | $3,103.1 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $622 | $435.4 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $615 | $430.5 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $2,735 | $1,914.5 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $3,204 | $2,242.8 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,607 | $1,124.9 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,740 | $1,218 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,296 | $1,607.2 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,874 | $2,011.8 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $4,348 | $3,043.6 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $3,893 | $2,725.1 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,318 | $1,622.6 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $3,042 | $2,129.4 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $943 | $660.1 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $542 | $379.4 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $870 | $609 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $914 | $639.8 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $904 | $632.8 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $914 | $639.8 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $538 | $376.6 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $963 | $674.1 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $953 | $667.1 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $351 | $245.7 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $443 | $310.1 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $370 | $259 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $120 | $84 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $223 | $156.1 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $81 | $56.7 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,233 | $1,563.1 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $887 | $620.9 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $1,165 | $815.5 | — | — | — |
| 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 | $303 | $212.1 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $473 | $331.1 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $649 | $454.3 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $205 | $143.5 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $308 | $215.6 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $70 | $49 | — | — | — |
| General health panel | CPT | 80050 | 0 | $277 | $193.9 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $35 | $24.5 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $94 | $65.8 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $80 | $56 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $43 | $30.1 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $41 | $28.7 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $54 | $37.8 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $20 | $14 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $21 | $14.7 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $55 | $38.5 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $96 | $67.2 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $57.5 | $40.25 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $50 | $35 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $51 | $35.7 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $322 | $225.4 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $289 | $202.3 | — | — | — |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | $3,065 | $2,145.5 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $1,696 | $1,187.2 | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $1,988 | $1,391.6 | — | — | — |
| Routine obstetric care with C-section | CPT | 59510 | 0 | $3,980 | $2,786 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $2,457 | $1,719.9 | — | — | — |
| C-section with postpartum | CPT | 59515 | 0 | $2,910 | $2,037 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $382 | $267.4 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $503 | $352.1 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $626 | $438.2 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $759 | $531.3 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $187 | $130.9 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $221 | $154.7 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $340 | $238 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $455 | $318.5 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $580 | $406 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $597 | $417.9 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $670 | $469 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $255 | $178.5 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $306 | $214.2 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $876 | $613.2 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $969 | $678.3 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $1,122 | $785.4 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $10,383 | $7,268.1 | — | — | — |
| Hip hemiarthroplasty | CPT | 27125 | 0 | $18,301 | $12,811 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $25,755 | $18,029 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $10,548 | $7,383.6 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $9,623 | $6,736.1 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $12,646 | $8,852.2 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $6,947 | $4,862.9 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $8,289 | $5,802.3 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $6,157 | $4,309.9 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $10,657 | $7,459.9 | — | — | — |
| 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 | — | — | — | — | — |
| CABG 2 arterial grafts | CPT | 33534 | 0 | — | — | — | — | — |
| CABG 3 arterial grafts | CPT | 33535 | 0 | — | — | — | — | — |
| CABG 4+ arterial grafts | CPT | 33536 | 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 | $1,989 | $1,392.3 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $1,938 | $1,356.6 | — | — | — |
| 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 | $2,678 | $1,874.6 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $2,550 | $1,785 | — | — | — |
| 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 | — | — | — | — | — |
| Umbilical hernia repair age 5+ | CPT | 49585 | 0 | — | — | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $1,836 | $1,285.2 | — | — | — |
| Lap incisional hernia repair | CPT | 49652 | 0 | — | — | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $3,442 | $2,409.4 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $2,983 | $2,088.1 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $3,045 | $2,131.5 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $3,211 | $2,247.7 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $3,325 | $2,327.5 | — | — | — |
| 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 | $71 | $49.7 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $71 | $49.7 | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | — | — | — | — | — |
| Vitrectomy mechanical | CPT | 67042 | 0 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | — | — | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | — | — | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | — | — | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | — | — | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | — | — | — | — | — |
