| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $382.46 | $363.34 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $311.99 | $296.39 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $158.4 | $150.48 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $202.76 | $192.62 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $296.41 | $281.59 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $220.05 | $209.05 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $333.08 | $316.43 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $746.58 | $709.25 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,737.16 | $1,650.3 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $2,687 | $2,552.65 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $3,849.21 | $3,656.75 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,595.04 | $1,515.29 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,123.56 | $2,017.38 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,391.44 | $2,271.87 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,748.39 | $2,610.97 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $3,562.11 | $3,384 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $4,452.55 | $4,229.92 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $4,864.98 | $4,621.73 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $323.87 | $307.68 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $323.87 | $307.68 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $323.87 | $307.68 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,642.09 | $1,559.99 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,378.68 | $2,259.75 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,854.19 | $2,711.48 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,562.11 | $3,384 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $4,864.98 | $4,621.73 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $564.12 | $535.91 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,083.47 | $1,979.3 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,082.81 | $1,978.67 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,082.81 | $1,978.67 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $4,452.55 | $4,229.92 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,562.11 | $3,384 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $3,562.11 | $3,384 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $4,452.55 | $4,229.92 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $4,864.98 | $4,621.73 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $4,864.98 | $4,621.73 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,612.29 | $1,531.68 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,466.89 | $2,343.55 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $959.2 | $911.24 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $501.36 | $476.29 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $405.2 | $384.94 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $3,562.11 | $3,384 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $4,864.98 | $4,621.73 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $405.2 | $384.94 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $405.2 | $384.94 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,562.11 | $3,384 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $4,864.98 | $4,621.73 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,971.31 | $1,872.74 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,378.68 | $2,259.75 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,776.38 | $2,637.56 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $3,530.5 | $3,353.98 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $5,432.53 | $5,160.9 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $5,300.07 | $5,035.07 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,562.41 | $3,384.29 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $4,864.98 | $4,621.73 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $870.37 | $826.85 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $932.62 | $885.99 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,021.51 | $970.43 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,137.99 | $1,081.09 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,100.21 | $1,045.2 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $768.8 | $730.36 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $987.42 | $938.05 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $703.47 | $668.3 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $562.99 | $534.84 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $629.11 | $597.65 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $382.91 | $363.76 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $102 | $96.9 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $222.47 | $211.35 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,600 | $2,470 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $1,830.16 | $1,738.65 | — | — | — |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 0 | — | — | — | — | — |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 0 | — | — | — | — | — |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 0 | — | — | — | — | — |
| 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 | $269.74 | $256.25 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $368.22 | $349.81 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $81.66 | $77.58 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $69.48 | $66.01 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $102 | $96.9 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $122.01 | $115.91 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $81.67 | $77.59 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $100.71 | $95.67 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $24.76 | $23.52 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $46.21 | $43.9 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $35.71 | $33.92 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $91.53 | $86.95 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $153.04 | $145.39 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $74.93 | $71.18 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $85.65 | $81.37 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $73.67 | $69.99 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $474.14 | $450.43 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $51 | $48.45 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $4,491.32 | $4,266.75 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $318.46 | $302.54 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $549.02 | $521.57 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $763.03 | $724.88 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $1,188.98 | $1,129.53 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $229.74 | $218.25 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $296.81 | $281.97 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $418.71 | $397.77 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $669.95 | $636.45 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $822.59 | $781.46 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $2,655.78 | $2,522.99 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $2,655.78 | $2,522.99 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $2,673.58 | $2,539.9 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $2,673.58 | $2,539.9 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $2,673.58 | $2,539.9 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $3,483.86 | $3,309.67 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $3,483.86 | $3,309.67 | — | — | — |
| 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 | — | — | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $9,310.13 | $8,844.62 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $12,603 | $11,973 | — | — | — |
