| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $331 | $148.95 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $370 | $166.5 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $165 | $74.25 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $219 | $98.55 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $329 | $148.05 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $728 | $327.6 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $1,043 | $469.35 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,831 | $823.95 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,948 | $1,326.6 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $4,841 | $2,178.45 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $2,148 | $966.6 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,908 | $1,308.6 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,861 | $1,287.45 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $3,916 | $1,762.2 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $4,773 | $2,147.85 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $3,598 | $1,619.1 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $4,184 | $1,882.8 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $5,305 | $2,387.25 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $488 | $219.6 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $877 | $394.65 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $1,040 | $468 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $2,887 | $1,299.15 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,476 | $1,564.2 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $4,051 | $1,822.95 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,780 | $1,701 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $3,876 | $1,744.2 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $5,849 | $2,632.05 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $1,378 | $620.1 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $5,199 | $2,339.55 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $3,838 | $1,727.1 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $5,812 | $2,615.4 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,896 | $1,753.2 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,443 | $1,549.35 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,807 | $1,263.15 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $4,184 | $1,882.8 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $5,849 | $2,632.05 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $5,849 | $2,632.05 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $3,130 | $1,408.5 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $3,649 | $1,642.05 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $781 | $351.45 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $678 | $305.1 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $654 | $294.3 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $3,598 | $1,619.1 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $4,498 | $2,024.1 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $923 | $415.35 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $677 | $304.65 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,598 | $1,619.1 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $4,498 | $2,024.1 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $3,130 | $1,408.5 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $3,649 | $1,642.05 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $4,173 | $1,877.85 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $4,258 | $1,916.1 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $7,686 | $3,458.7 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $8,063 | $3,628.35 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,581 | $1,611.45 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $5,849 | $2,632.05 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $2,400 | $1,080 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $2,601 | $1,170.45 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $2,264 | $1,018.8 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,535 | $690.75 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $2,259 | $1,016.55 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $2,181 | $981.45 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,521 | $684.45 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $2,268 | $1,020.6 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,799 | $809.55 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $604 | $271.8 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $837 | $376.65 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $885 | $398.25 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $69 | $31.05 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $596 | $268.2 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $32 | $14.4 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $4,908 | $2,208.6 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $3,425 | $1,541.25 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $4,336 | $1,951.2 | — | — | — |
| 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 | $103.05 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $310 | $139.5 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $414 | $186.3 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $148 | $66.6 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $217 | $97.65 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $347 | $156.15 | — | — | — |
| General health panel | CPT | 80050 | 0 | $629 | $283.05 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $295 | $132.75 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $476 | $214.2 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $444 | $199.8 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $549 | $247.05 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $301 | $135.45 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $239 | $107.55 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $90 | $40.5 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $181 | $81.45 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $175 | $78.75 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $231 | $103.95 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $143 | $64.35 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $96 | $43.2 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $248 | $111.6 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $58 | $26.1 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $484 | $217.8 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $5,272.3 | $1,423.52 | — | — | — |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | $5,294 | $2,382.3 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $15,534 | $4,194.14 | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $2,647 | $1,191.15 | — | — | — |
| Routine obstetric care with C-section | CPT | 59510 | 0 | $5,843 | $2,629.35 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $2,505 | $1,127.25 | — | — | — |
| C-section with postpartum | CPT | 59515 | 0 | $3,198 | $1,439.1 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $118 | $53.1 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $159 | $71.55 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $268 | $120.6 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $345 | $155.25 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $50 | $22.5 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $75 | $33.75 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $105 | $47.25 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $162 | $72.9 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $229 | $103.05 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $9,923.75 | $2,679.41 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $11,181 | $3,018.93 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $22,368 | $6,039.48 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $18,637 | $5,032.03 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $8,126.73 | $2,194.22 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $11,486 | $3,101.26 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $11,148 | $3,010.03 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $190,042 | $51,311 | — | — | — |
| Hip hemiarthroplasty | CPT | 27125 | 0 | $4,259 | $1,916.55 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $143,880 | $38,847 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $137,552 | $37,139 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $125,119 | $33,782 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $261,031 | $70,478 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $68,550 | $18,508 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $95,839 | $25,877 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $51,297 | $13,850 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $108,478 | $29,289 | — | — | — |
| 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 | $3,172.05 | — | — | — |
| CABG 2 arterial grafts | CPT | 33534 | 0 | $8,334 | $3,750.3 | — | — | — |
| CABG 3 arterial grafts | CPT | 33535 | 0 | $9,286 | $4,178.7 | — | — | — |
| CABG 4+ arterial grafts | CPT | 33536 | 0 | $9,940 | $4,473 | — | — | — |
| 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 | $1,027.8 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $78,606 | $21,224 | — | — | — |
| 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 | $48,846 | $13,188 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $61,978 | $16,734 | — | — | — |
| 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 | $1,913.63 | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $55,422 | $14,964 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $3,812 | $1,715.4 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $84,121 | $22,713 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $79,028 | $21,338 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $88,035 | $23,770 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $62,969 | $17,002 | — | — | — |
| 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 | $2,319 | $1,043.55 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $25,787 | $6,962.45 | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $255 | $114.75 | — | — | — |
| 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 | $24,396 | $10,978 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $35,199 | $15,840 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $33,524 | $15,086 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $13,105 | $5,897.25 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $14,310 | $6,439.5 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $14,310 | $6,439.5 | — | — | — |
