| 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 | $628 | $345.4 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $778 | $427.9 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $793 | $436.15 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $576 | $316.8 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $1,273 | $700.15 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,968 | $1,082.4 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,757 | $1,516.35 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $3,563 | $1,959.65 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $7,500 | $4,125 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,532 | $1,392.6 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,985 | $1,641.75 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $4,566 | $2,511.3 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $3,491 | $1,920.05 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $4,071 | $2,239.05 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $4,801 | $2,640.55 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $6,228 | $3,425.4 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $530 | $291.5 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $737 | $405.35 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $3,314 | $1,822.7 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $4,153 | $2,284.15 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $4,776 | $2,626.8 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $4,418 | $2,429.9 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $1,008 | $554.4 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $3,476 | $1,911.8 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,827 | $1,554.85 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,999 | $1,649.45 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $4,418 | $2,429.9 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $4,077 | $2,242.35 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $4,351 | $2,393.05 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $4,801 | $2,640.55 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $7,217 | $3,969.35 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $7,217 | $3,969.35 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,700 | $1,485 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $4,216 | $2,318.8 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $595 | $327.25 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $531 | $292.05 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $604 | $332.2 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $4,071 | $2,239.05 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $6,287 | $3,457.85 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $570 | $313.5 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $648 | $356.4 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,460 | $1,903 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $6,287 | $3,457.85 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $2,952 | $1,623.6 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $3,891 | $2,140.05 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $4,647 | $2,555.85 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $5,232 | $2,877.6 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $7,679 | $4,223.45 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $8,993 | $4,946.15 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $4,418 | $2,429.9 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $6,287 | $3,457.85 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $2,025 | $1,113.75 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,408 | $774.4 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $2,025 | $1,113.75 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,571 | $864.05 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,571 | $864.05 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,629 | $895.95 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $855 | $470.25 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,566 | $861.3 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,762 | $969.1 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $522 | $287.1 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $713 | $392.15 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $428 | $235.4 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $69 | $37.95 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $514 | $282.7 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $32 | $17.6 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $4,952 | $2,723.6 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $405 | $222.75 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $2,860 | $1,573 | — | — | — |
| 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 | $243 | $133.65 | — | — | — |
| General health panel | CPT | 80050 | 0 | $388 | $213.4 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $262 | $144.1 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $318 | $174.9 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $312 | $171.6 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $300 | $165 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $392 | $215.6 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $14 | $7.7 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $77 | $42.35 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $41 | $22.55 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $171 | $94.05 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $311 | $171.05 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $207 | $113.85 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $137 | $75.35 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $41 | $22.55 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $238 | $130.9 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $342 | $188.1 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $1,470 | $808.5 | — | — | — |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | $5,294 | $2,911.7 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $12,559 | $6,279.5 | — | — | — |
| 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 | $130 | $71.5 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $189 | $103.95 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $288 | $158.4 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $358 | $196.9 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $50 | $27.5 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $76 | $41.8 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $128 | $70.4 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $188 | $103.4 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $251 | $138.05 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $16,758 | $8,379.05 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $17,934 | $8,966.93 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $14,036 | $7,018.23 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $14,730 | $7,364.95 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $13,759 | $6,879.64 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $16,944 | $8,471.96 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $17,896 | $8,947.94 | — | — | — |
| 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 | $66,181 | $33,090 | — | — | — |
| 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 | $52,682 | $26,341 | — | — | — |
| 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 | $2,417 | $1,329.35 | — | — | — |
| 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 | $48,266 | $24,133 | — | — | — |
| 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 | $1,275.45 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $1,854 | $1,019.7 | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $255 | $140.25 | — | — | — |
| 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 | — | — | — |
