| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $392.4 | $392.4 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $173.31 | $173.31 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $304.11 | $304.11 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $886.17 | $886.17 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $1,519.46 | $1,519.46 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $2,808.93 | $2,808.93 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $5,545.92 | $5,545.92 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $7,149.31 | $7,149.31 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $5,634.21 | $5,634.21 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $9,882.99 | $9,882.99 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $9,374 | $9,374 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $11,691 | $11,691 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $9,277.18 | $9,277.18 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $8,466.03 | $8,466.03 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $6,706.77 | $6,706.77 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $15,259 | $15,259 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $1,396.29 | $1,396.29 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $2,705.38 | $2,705.38 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $3,841.16 | $3,841.16 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $6,306.61 | $6,306.61 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $9,061.58 | $9,061.58 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $7,768.43 | $7,768.43 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $7,283.38 | $7,283.38 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $6,168.31 | $6,168.31 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $2,156.02 | $2,156.02 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $8,908.59 | $8,908.59 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $7,432.08 | $7,432.08 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $8,125.3 | $8,125.3 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $11,613 | $11,613 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $8,977.24 | $8,977.24 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $11,129 | $11,129 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $9,624.7 | $9,624.7 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $15,257 | $15,257 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $12,969 | $12,969 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $7,633.43 | $7,633.43 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $8,811.3 | $8,811.3 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $3,314.15 | $3,314.15 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $2,164.74 | $2,164.74 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $2,898.86 | $2,898.86 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $16,644 | $16,644 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $18,279 | $18,279 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $1,698.77 | $1,698.77 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $3,050.91 | $3,050.91 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $13,250 | $13,250 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $21,994 | $21,994 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $6,851.03 | $6,851.03 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $8,534.33 | $8,534.33 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $11,462 | $11,462 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $16,192 | $16,192 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $19,424 | $19,424 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $18,223 | $18,223 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $9,924.45 | $9,924.45 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $13,206 | $13,206 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $6,605.4 | $6,605.4 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $3,093.42 | $3,093.42 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $13,152 | $13,152 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,461.69 | $1,461.69 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $2,170.19 | $2,170.19 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,982.71 | $1,982.71 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $2,806.75 | $2,806.75 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $3,937.08 | $3,937.08 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $3,001.86 | $3,001.86 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $1,654.62 | $1,654.62 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,919.49 | $1,919.49 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $975.55 | $975.55 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $1,385.39 | $1,385.39 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $7,091.54 | $7,091.54 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $5,948.13 | $5,948.13 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $2,401.27 | $2,401.27 | — | — | — |
| 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 | — | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $1,218.62 | $1,218.62 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $319.37 | $319.37 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $2,419.8 | $2,419.8 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $969.01 | $969.01 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $635.47 | $635.47 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $850.2 | $850.2 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $305.2 | $305.2 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $910.15 | $910.15 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $238.71 | $238.71 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $674.71 | $674.71 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $1,396.29 | $1,396.29 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $612.58 | $612.58 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $784.8 | $784.8 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $350.98 | $350.98 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $514.48 | $514.48 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $1,673.15 | $1,673.15 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $645.28 | $645.28 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $4,035.18 | $4,035.18 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $1,296.01 | $1,296.01 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $1,361.41 | $1,361.41 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $1,735.28 | $1,735.28 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $1,914.04 | $1,914.04 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $796.79 | $796.79 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $892.71 | $892.71 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $1,342.88 | $1,342.88 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $1,490.03 | $1,490.03 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $1,678.6 | $1,678.6 | — | — | — |
| surgery |
| 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 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| 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 | $51,859 | $51,859 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $46,010 | $46,010 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $58,786 | $58,786 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $34,496 | $34,496 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $39,978 | $39,978 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $49,470 | $49,470 | — | — | — |
