| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $446 | $214.08 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $507 | $243.36 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $197 | $94.56 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $261 | $125.28 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $384 | $184.32 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $368 | $176.64 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $378 | $181.44 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $1,066 | $511.68 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,823 | $875.04 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $3,079 | $1,477.92 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $4,463 | $2,142.24 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $5,435 | $2,608.8 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,619 | $1,257.12 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $3,764 | $1,806.72 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $4,520 | $2,169.6 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $4,746 | $2,278.08 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,422 | $1,162.56 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $3,570 | $1,713.6 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $4,053 | $1,945.44 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $543 | $260.64 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $487 | $233.76 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $612 | $293.76 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $3,261 | $1,565.28 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $4,432 | $2,127.36 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $5,464 | $2,622.72 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $6,652 | $3,192.96 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $7,228 | $3,469.44 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $9,048 | $4,343.04 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $612 | $293.76 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $3,957 | $1,899.36 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $3,957 | $1,899.36 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $3,926 | $1,884.48 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,988 | $1,434.24 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,988 | $1,434.24 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $3,003 | $1,441.44 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $4,614 | $2,214.72 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $5,259 | $2,524.32 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $5,236 | $2,513.28 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $3,248 | $1,559.04 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $6,975 | $3,348 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $807 | $387.36 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $766 | $367.68 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $898 | $431.04 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $3,968 | $1,904.64 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $8,263 | $3,966.24 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $828 | $397.44 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $891 | $427.68 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,968 | $1,904.64 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $8,226 | $3,948.48 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $3,210 | $1,540.8 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $6,937 | $3,329.76 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $7,844 | $3,765.12 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $4,029 | $1,933.92 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $8,725 | $4,188 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $9,845 | $4,725.6 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,151 | $1,512.48 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $5,827 | $2,796.96 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,709 | $820.32 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,298 | $623.04 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,601 | $768.48 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,536 | $737.28 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,918 | $920.64 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,860 | $892.8 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,889 | $906.72 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,586 | $761.28 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $988 | $474.24 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $57 | $27.36 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $726 | $348.48 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $24 | $11.52 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $4,516 | $2,167.68 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $133 | $63.84 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $2,162 | $1,037.76 | — | — | — |
| 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 | $241 | $115.68 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $329 | $157.92 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $483 | $231.84 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $179 | $85.92 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $259 | $124.32 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $99 | $47.52 | — | — | — |
| General health panel | CPT | 80050 | 0 | $308 | $147.84 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $82 | $39.36 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $124 | $59.52 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $157 | $75.36 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $102 | $48.96 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $96 | $46.08 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $9 | $4.32 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $27 | $12.96 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $46 | $22.08 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $121 | $58.08 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $254 | $121.92 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $91 | $43.68 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $76 | $36.48 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $97 | $46.56 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $318 | $152.64 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $238 | $114.24 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $13,145 | $6,309.6 | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $3,143 | $1,508.64 | — | — | — |
| Routine obstetric care with C-section | CPT | 59510 | 0 | $7,855 | $3,770.4 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $10,716 | $5,143.68 | — | — | — |
| C-section with postpartum | CPT | 59515 | 0 | $3,871 | $1,858.08 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $169 | $81.12 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $240 | $115.2 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $366 | $175.68 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $750 | $360 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $50 | $24 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $156 | $74.88 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $291 | $139.68 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $429 | $205.92 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $635 | $304.8 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $1,430 | $686.4 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $2,979 | $1,429.92 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $380 | $182.4 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $590 | $283.2 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $817 | $392.16 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $965 | $463.2 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $1,091 | $523.68 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $4,290 | $2,059.2 | — | — | — |
| Hip hemiarthroplasty | CPT | 27125 | 0 | $3,360 | $1,612.8 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $3,810 | $1,828.8 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $3,929 | $1,885.92 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $4,164 | $1,998.72 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $5,194 | $2,493.12 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $1,674 | $803.52 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $3,177 | $1,524.96 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $1,616 | $775.68 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $2,902 | $1,392.96 | — | — | — |
| 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 | $5,484 | $2,632.32 | — | — | — |
| 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 | $1,914 | $918.72 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $1,796 | $862.08 | — | — | — |
| 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 | $1,969 | $945.12 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $2,143 | $1,028.64 | — | — | — |
| 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 | — | — | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $1,937 | $929.76 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $3,006 | $1,442.88 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | — | — | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | — | — | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | — | — | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $2,907 | $1,395.36 | — | — | — |
| 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 | $3,554 | $1,705.92 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $1,694 | $813.12 | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $552 | $264.96 | — | — | — |
| Vitrectomy mechanical | CPT | 67042 | 0 | $3,394 | $1,629.12 | — | — | — |
| 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 | $1,546 | $742.08 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $1,721 | $826.08 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $1,719 | $825.12 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $2,097 | $1,006.56 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $839 | $402.72 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $887 | $425.76 | — | — | — |
