| behavioral |
| Psychoses | MS-DRG | 885 | 0 | $56,412 | $22,565 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $500 | $262.87 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $867 | $362.07 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,500 | $673.62 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,811.31 | $1,124.52 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $4,031.39 | $1,612.56 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $6,800.1 | $2,720.04 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $5,831.84 | $2,332.74 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $6,621.14 | $2,648.46 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $8,005.72 | $3,202.29 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $4,729.16 | $1,891.66 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $8,884.58 | $3,553.83 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $5,748.94 | $2,299.58 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $11,216 | $4,486.4 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $1,104.37 | $441.75 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $1,195.54 | $478.22 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $1,195.54 | $478.22 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $4,671.11 | $1,868.44 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $5,291.29 | $2,116.52 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $6,714 | $2,685.6 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $5,336.05 | $2,134.42 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $5,513.48 | $2,205.39 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $6,286.2 | $2,514.48 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $1,237.02 | $494.81 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $4,802.11 | $1,920.84 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $4,921.51 | $1,968.6 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $4,853.52 | $1,941.41 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $10,806 | $4,322.56 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $9,342.24 | $3,736.9 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $9,954.11 | $3,981.64 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $12,300 | $4,920.18 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $9,798.23 | $3,919.29 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $11,309 | $4,523.54 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $3,701.07 | $1,480.43 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $4,846.88 | $1,938.75 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $951.8 | $380.72 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $736.23 | $294.49 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $1,033.05 | $413.22 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $8,546.31 | $3,418.52 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $9,957.42 | $3,982.97 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $946.83 | $378.73 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $1,230.39 | $492.16 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $9,755.13 | $3,902.05 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $8,761.86 | $3,504.74 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $4,445.61 | $1,778.24 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $5,531.71 | $2,212.68 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $6,888.11 | $2,755.24 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $8,140.04 | $3,256.02 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $10,370 | $4,148.12 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $13,433 | $5,373.19 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $6,717.32 | $2,686.93 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $7,795.14 | $3,118.06 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $3,124.02 | $1,249.61 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $2,533.71 | $1,013.48 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,346.46 | $538.58 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,930.14 | $772.06 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,484.09 | $593.64 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,356.41 | $542.56 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $2,046.21 | $818.48 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $2,638.18 | $1,055.27 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $2,709.49 | $1,083.8 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $902.05 | $360.82 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,344.8 | $537.92 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $1,079.48 | $431.79 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $666.33 | $266.53 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $9,685.48 | $3,874.19 | — | — | — |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | $40,701 | $16,280 | — | — | — |
| COPD w MCC | MS-DRG | 190 | 0 | $40,553 | $16,221 | — | — | — |
| COPD w CC | MS-DRG | 191 | 0 | $70,529 | $28,212 | — | — | — |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 0 | $36,214 | $14,485 | — | — | — |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 0 | $18,774 | $7,509.51 | — | — | — |
| AMI discharged alive w MCC | MS-DRG | 280 | 0 | $42,257 | $16,903 | — | — | — |
| AMI discharged alive w CC | MS-DRG | 281 | 0 | $26,858 | $10,743 | — | — | — |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 0 | $32,164 | $12,866 | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | $34,643 | $13,857 | — | — | — |
| Heart failure & shock w CC | MS-DRG | 292 | 0 | $21,278 | $8,511.33 | — | — | — |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 0 | $60,411 | $24,164 | — | — | — |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 0 | $28,437 | $11,375 | — | — | — |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 0 | $22,015 | $8,805.92 | — | — | — |
| GI hemorrhage w CC | MS-DRG | 378 | 0 | $47,839 | $19,135 | — | — | — |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 0 | $22,500 | $9,000.08 | — | — | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 0 | $27,129 | $10,852 | — | — | — |
| Kidney/UTI w MCC | MS-DRG | 689 | 0 | $147,246 | $58,898 | — | — | — |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 0 | $27,367 | $10,947 | — | — | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 0 | $40,336 | $16,134 | — | — | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 0 | $30,723 | $12,289 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $619.17 | $247.67 | — | — | — |
| General health panel | CPT | 80050 | 0 | $1,744.91 | $697.96 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $632.85 | $253.14 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $756.06 | $302.42 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $921.89 | $368.76 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $568.96 | $227.58 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $632.85 | $253.14 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $330.11 | $132.04 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $380.34 | $152.14 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $520.29 | $208.12 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $737.83 | $295.13 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $590.25 | $236.1 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $305.77 | $122.31 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $465.51 | $186.2 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $127.68 | $51.07 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $895.41 | $358.16 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $424.44 | $169.78 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $558.31 | $223.32 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $739.34 | $295.74 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $1,011.65 | $404.66 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $419.87 | $167.95 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $424.44 | $169.78 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $424.44 | $169.78 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $558.31 | $223.32 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $739.34 | $295.74 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $8,329.53 | $3,331.81 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $8,405.08 | $3,362.03 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $8,811.06 | $3,524.42 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $8,491.54 | $3,396.62 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $8,269.82 | $3,307.93 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $8,491.54 | $3,396.62 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $8,491.54 | $3,396.62 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $30,572 | $12,229 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $39,478 | $15,791 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $60,364 | $24,146 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $13,270 | $5,307.91 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $18,366 | $7,346.3 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $33,253 | $13,301 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $63,398 | $25,359 | — | — | — |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 0 | $143,756 | $57,502 | — | — | — |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 0 | $77,656 | $31,062 | — | — | — |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 0 | $101,126 | $40,451 | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 0 | $69,912 | $27,965 | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 0 | $74,778 | $29,911 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $30,908 | $12,363 | — | — | — |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 0 | $237,972 | $95,189 | — | — | — |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 0 | $138,669 | $55,467 | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | $64,336 | $25,734 | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $29,046 | $11,618 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $12,846 | $5,138.55 | — | — | — |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 0 | $77,000 | $30,800 | — | — | — |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 0 | $58,730 | $23,492 | — | — | — |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 0 | $64,521 | $25,808 | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $20,647 | $8,258.66 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $15,580 | $6,232.16 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $16,149 | $6,459.42 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $14,039 | $5,615.66 | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | $35,850 | $14,340 | — | — | — |