| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $331 | $182.05 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $370 | $203.5 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $165 | $90.75 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $219 | $120.45 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $329 | $180.95 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $456 | $250.8 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $987 | $542.85 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,682 | $925.1 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,696 | $1,482.8 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $3,775 | $2,076.25 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $5,732 | $3,152.6 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,879 | $1,583.45 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $5,667 | $3,116.85 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $6,460 | $3,553 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $4,435 | $2,439.25 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $3,836 | $2,109.8 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $6,458 | $3,551.9 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $2,884 | $1,586.2 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $696 | $382.8 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $1,052 | $578.6 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $3,373 | $1,855.15 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,381 | $1,859.55 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $6,069 | $3,337.95 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $4,512 | $2,481.6 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $8,362 | $4,599.1 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $1,282 | $705.1 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $5,838 | $3,210.9 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $5,671 | $3,119.05 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $6,290 | $3,459.5 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $4,488 | $2,468.4 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $1,504 | $827.2 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,767 | $1,521.85 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $8,611 | $4,736.05 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $8,905 | $4,897.75 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $8,898 | $4,893.9 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $3,557 | $1,956.35 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $5,724 | $3,148.2 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $1,102 | $606.1 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $1,063 | $584.65 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $1,084 | $596.2 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $5,338 | $2,935.9 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $7,453 | $4,099.15 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $916 | $503.8 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $1,123 | $617.65 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $5,642 | $3,103.1 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $7,378 | $4,057.9 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $4,982 | $2,740.1 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $5,138 | $2,825.9 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $5,693 | $3,131.15 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $7,829 | $4,305.95 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $9,347 | $5,140.85 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $11,011 | $6,056.05 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,884 | $1,586.2 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $5,388 | $2,963.4 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $3,815 | $2,098.25 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $3,049 | $1,676.95 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $2,843 | $1,563.65 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,626 | $894.3 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $2,393 | $1,316.15 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $2,314 | $1,272.7 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $2,652 | $1,458.6 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $2,404 | $1,322.2 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,626 | $894.3 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $806 | $443.3 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,025 | $563.75 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $838 | $460.9 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $74 | $40.7 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $583 | $320.65 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $32 | $17.6 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $6,866 | $3,776.3 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $405 | $222.75 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $186 | $102.3 | — | — | — |
| 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 | $229 | $125.95 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $310 | $170.5 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $414 | $227.7 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $148 | $81.4 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $217 | $119.35 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $206 | $113.3 | — | — | — |
| General health panel | CPT | 80050 | 0 | $1,278 | $702.9 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $492 | $270.6 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $543 | $298.65 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $240 | $132 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $531 | $292.05 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $435 | $239.25 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $257 | $141.35 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $110 | $60.5 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $37 | $20.35 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $329 | $180.95 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $465 | $255.75 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $120 | $66 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $250 | $137.5 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $288 | $158.4 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $59 | $32.45 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $907 | $498.85 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $791 | $435.05 | — | — | — |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | $5,294 | $2,911.7 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $2,075 | $1,141.25 | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $2,647 | $1,455.85 | — | — | — |
| Routine obstetric care with C-section | CPT | 59510 | 0 | $5,843 | $3,213.65 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $2,505 | $1,377.75 | — | — | — |
| C-section with postpartum | CPT | 59515 | 0 | $3,198 | $1,758.9 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $143 | $78.65 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $206 | $113.3 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $315 | $173.25 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $396 | $217.8 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $50 | $27.5 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $83 | $45.65 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $265 | $145.75 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $217 | $119.35 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $292 | $160.6 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $8,213.2 | $1,971.17 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $16,199 | $3,887.84 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $6,178.87 | $1,482.93 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $5,014.03 | $1,203.37 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $8,437.37 | $2,024.97 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $16,199 | $3,887.82 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $19,762 | $4,742.95 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $5,494 | $3,021.7 | — | — | — |
| Hip hemiarthroplasty | CPT | 27125 | 0 | $4,259 | $2,342.45 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $5,417 | $2,979.35 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $4,878 | $2,682.9 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $5,293 | $2,911.15 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $658 | $361.9 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $4,044 | $2,224.2 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $2,052 | $1,128.6 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $3,725 | $2,048.75 | — | — | — |
| 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 | $3,876.95 | — | — | — |
| CABG 2 arterial grafts | CPT | 33534 | 0 | $8,334 | $4,583.7 | — | — | — |
| CABG 3 arterial grafts | CPT | 33535 | 0 | $9,286 | $5,107.3 | — | — | — |
| CABG 4+ arterial grafts | CPT | 33536 | 0 | $9,940 | $5,467 | — | — | — |
| 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 | $2,284 | $1,256.2 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $67,052 | $16,092 | — | — | — |
| 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 | $46,704 | $11,209 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $2,676 | $1,471.8 | — | — | — |
| 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 | $2,338.88 | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $61,543 | $14,770 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $3,812 | $2,096.6 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $3,158 | $1,736.9 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $3,370 | $1,853.5 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $3,745 | $2,059.75 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $5,520 | $3,036 | — | — | — |
| 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 | $28,458 | $6,829.86 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $24,741 | $5,937.84 | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $475 | $261.25 | — | — | — |
| 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 | $1,544 | $849.2 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $1,544 | $849.2 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $1,543 | $848.65 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $2,199 | $1,209.45 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $2,590 | $1,424.5 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $2,667 | $1,466.85 | — | — | — |
