| behavioral |
| Psychoses | MS-DRG | 885 | 0 | $10,886 | $8,164.73 | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $200 | $150 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $305.29 | $228.97 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $343.63 | $257.72 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $538.75 | $404.06 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $812 | $609 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,216.5 | $912.38 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $1,948.8 | $1,461.6 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $837 | $627.75 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,241.23 | $930.92 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $939 | $704.25 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,216.75 | $912.56 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,269.93 | $1,702.45 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $2,269.93 | $1,702.45 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $199.52 | $149.64 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $199.52 | $149.64 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $199.52 | $149.64 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,216.75 | $912.56 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,216.75 | $912.56 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $1,216.75 | $912.56 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $297.6 | $223.2 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,125.15 | $843.86 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,125.15 | $843.86 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,125.15 | $843.86 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $1,646.84 | $1,235.13 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $1,646.84 | $1,235.13 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $1,646.84 | $1,235.13 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $1,583.5 | $1,187.63 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $1,646.84 | $1,235.13 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,402.57 | $1,051.93 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,651.13 | $1,238.35 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $199.52 | $149.64 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $199.52 | $149.64 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $199.52 | $149.64 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $1,848 | $1,386 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $1,776.93 | $1,332.7 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $199.52 | $149.64 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $279.17 | $209.38 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,848 | $1,386 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $1,848 | $1,386 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,402.57 | $1,051.93 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,717.17 | $1,287.88 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $1,982 | $1,486.5 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,180 | $1,635 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $2,180 | $1,635 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $2,966 | $2,224.5 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,344.8 | $1,758.6 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $3,705.81 | $2,779.36 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $816.06 | $612.05 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $518.61 | $388.96 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $816.06 | $612.05 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $713.02 | $534.77 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $713.02 | $534.77 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $536.6 | $402.45 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $657.4 | $493.05 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $482 | $361.5 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $313.71 | $235.28 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $386.8 | $290.1 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $313.71 | $235.28 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $275.88 | $206.91 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $60.96 | $45.72 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,431.65 | $1,823.74 | — | — | — |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | $26,250 | $19,687 | — | — | — |
| COPD w MCC | MS-DRG | 190 | 0 | $17,286 | $12,964 | — | — | — |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 0 | $17,297 | $12,972 | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | $19,394 | $14,546 | — | — | — |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 0 | $22,972 | $17,229 | — | — | — |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 0 | $16,657 | $12,493 | — | — | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 0 | $14,655 | $10,992 | — | — | — |
| Kidney/UTI w MCC | MS-DRG | 689 | 0 | $23,800 | $17,850 | — | — | — |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 0 | $18,494 | $13,870 | — | — | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 0 | $26,699 | $20,024 | — | — | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 0 | $22,615 | $16,961 | — | — | — |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $283.67 | $212.75 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $307.79 | $230.84 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $454.58 | $340.94 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $194.17 | $145.63 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $235.1 | $176.33 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $110.7 | $83.03 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $108.15 | $81.11 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $140.4 | $105.3 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $118.55 | $88.91 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $116.79 | $87.59 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $107.12 | $80.34 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $53.11 | $39.83 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $83.41 | $62.56 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $97.41 | $73.06 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $148.82 | $111.62 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $106.31 | $79.73 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $65.25 | $48.94 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $75.66 | $56.75 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $160.99 | $120.74 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $631.6 | $473.7 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $225.8 | $169.35 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $225.8 | $169.35 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $272.59 | $204.44 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $329.83 | $247.37 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $416.32 | $312.24 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $225.8 | $169.35 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $225.8 | $169.35 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $225.8 | $169.35 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $249.86 | $187.4 | — | — | — |
| surgery |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 0 | $69,390 | $52,042 | — | — | — |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 0 | $36,350 | $27,262 | — | — | — |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 0 | $31,071 | $23,304 | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | $43,300 | $32,475 | — | — | — |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 0 | $54,371 | $40,778 | — | — | — |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 0 | $44,303 | $33,227 | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | $22,740 | $17,055 | — | — | — |
