| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $331 | $89.37 | — | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $370 | $99.9 | — | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $165 | $44.55 | — | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $219 | $59.13 | — | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $329 | $88.83 | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $95 | $25.65 | — | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $175 | $47.25 | — | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $261 | $70.47 | — | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $288 | $77.76 | — | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $428 | $115.56 | — | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $512 | $138.24 | — | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $3,288 | $887.76 | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,514 | $408.78 | — | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $4,651 | $1,255.77 | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $4,550 | $1,228.5 | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $3,462 | $934.74 | — | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $3,053 | $824.31 | — | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $5,413 | $1,461.51 | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $586 | $158.22 | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $906 | $244.62 | — | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $3,652 | $986.04 | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,681 | $993.87 | — | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $5,231 | $1,412.37 | — | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,457 | $933.39 | — | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $3,053 | $824.31 | — | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $4,748 | $1,281.96 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $1,352 | $365.04 | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $5,043 | $1,361.61 | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $4,228 | $1,141.56 | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $5,288 | $1,427.76 | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,462 | $934.74 | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,462 | $934.74 | — | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $3,463 | $935.01 | — | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $3,053 | $824.31 | — | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $5,422 | $1,463.94 | — | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $5,422 | $1,463.94 | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $3,872 | $1,045.44 | — | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $4,750 | $1,282.5 | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $1,015 | $274.05 | — | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $721 | $194.67 | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $842 | $227.34 | — | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $3,462 | $934.74 | — | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $3,654 | $986.58 | — | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $719 | $194.13 | — | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $763 | $206.01 | — | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,462 | $934.74 | — | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $5,413 | $1,461.51 | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $4,651 | $1,255.77 | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,514 | $408.78 | — | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $6,197 | $1,673.19 | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $8,946 | $2,415.42 | — | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $10,680 | $2,883.6 | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $9,095 | $2,455.65 | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,053 | $824.31 | — | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $3,053 | $824.31 | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $2,910 | $785.7 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $2,074 | $559.98 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,538 | $415.26 | — | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $2,054 | $554.58 | — | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $2,176 | $587.52 | — | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $2,116 | $571.32 | — | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,217 | $328.59 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,827 | $493.29 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,805 | $487.35 | — | — | — | — |
| EKG complete | CPT | 93000 | 0 | $69 | $18.63 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $576 | $155.52 | — | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $32 | $8.64 | — | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $5,804 | $1,567.08 | — | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $3,386 | $914.22 | — | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $4,770 | $1,287.9 | — | — | — | — |
| 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 | $61.83 | — | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $310 | $83.7 | — | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $414 | $111.78 | — | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $148 | $39.96 | — | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $217 | $58.59 | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $243 | $65.61 | — | — | — | — |
| General health panel | CPT | 80050 | 0 | $629 | $169.83 | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $133 | $35.91 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $701 | $189.27 | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $290 | $78.3 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $442 | $119.34 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $350 | $94.5 | — | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $226 | $61.02 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $116 | $31.32 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $74 | $19.98 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $208 | $56.16 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $340 | $91.8 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $146 | $39.42 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $141 | $38.07 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $358 | $96.66 | — | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $58 | $15.66 | — | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $808 | $218.16 | — | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $670 | $180.9 | — | — | — | — |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | $5,294 | $1,429.38 | — | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $2,075 | $560.25 | — | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $2,647 | $714.69 | — | — | — | — |
| Routine obstetric care with C-section | CPT | 59510 | 0 | $5,843 | $1,577.61 | — | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $2,505 | $676.35 | — | — | — | — |
| C-section with postpartum | CPT | 59515 | 0 | $3,198 | $863.46 | — | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $118 | $31.86 | — | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $159 | $42.93 | — | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $268 | $72.36 | — | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $345 | $93.15 | — | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $50 | $13.5 | — | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $75 | $20.25 | — | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $105 | $28.35 | — | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $162 | $43.74 | — | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $229 | $61.83 | — | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $556 | $150.12 | — | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $657 | $177.39 | — | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $245 | $66.15 | — | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $292 | $78.84 | — | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $1,232 | $332.64 | — | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $1,354 | $365.58 | — | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $1,174 | $316.98 | — | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $185,180 | $49,999 | — | — | — | — |
| Hip hemiarthroplasty | CPT | 27125 | 0 | $4,259 | $1,149.93 | — | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $164,521 | $44,421 | — | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $146,916 | $39,667 | — | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $5,293 | $1,429.11 | — | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $212,741 | $57,440 | — | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $68,691 | $18,547 | — | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $71,063 | $19,187 | — | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $39,722 | $10,725 | — | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $93,350 | $25,204 | — | — | — | — |
| 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 | $1,903.23 | — | — | — | — |
| CABG 2 arterial grafts | CPT | 33534 | 0 | $8,334 | $2,250.18 | — | — | — | — |
| CABG 3 arterial grafts | CPT | 33535 | 0 | $9,286 | $2,507.22 | — | — | — | — |
| CABG 4+ arterial grafts | CPT | 33536 | 0 | $9,940 | $2,683.8 | — | — | — | — |
| 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 | $616.68 | — | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $2,254 | $608.58 | — | — | — | — |
| 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 | $2,465 | $665.55 | — | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $2,676 | $722.52 | — | — | — | — |
| 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 | $1,148.18 | — | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $2,417 | $652.59 | — | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $3,812 | $1,029.24 | — | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $3,158 | $852.66 | — | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $3,370 | $909.9 | — | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $3,745 | $1,011.15 | — | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $5,520 | $1,490.4 | — | — | — | — |
| 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 | $626.13 | — | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $1,854 | $500.58 | — | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $255 | $68.85 | — | — | — | — |
| 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 | $416.88 | — | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $1,544 | $416.88 | — | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $1,543 | $416.61 | — | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $2,199 | $593.73 | — | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $2,590 | $699.3 | — | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $2,667 | $720.09 | — | — | — | — |