| behavioral |
| Psychoses | MS-DRG | 885 | 0 | $28,003 | $7,000.65 | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $297 | $135.5 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $305 | $152.5 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $297 | $74.25 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $297 | $84.5 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $297 | $125 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $297 | $120.5 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $138 | $34.5 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $181 | $45.25 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $423 | $105.75 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $859 | $214.75 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,004 | $251 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $1,282 | $320.5 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,310 | $327.5 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,422 | $355.5 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $1,527 | $381.75 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,422 | $355.5 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,424 | $606 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $2,598 | $649.5 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $3,638 | $909.5 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $214 | $53.5 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $261 | $65.25 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $256 | $64 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,310 | $327.5 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,422 | $355.5 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $1,527 | $381.75 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $979 | $244.75 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $3,638 | $909.5 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $261 | $65.25 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,310 | $327.5 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $514 | $131.5 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,310 | $327.5 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,424 | $606 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,764 | $691 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,424 | $606 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $2,598 | $649.5 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $3,638 | $909.5 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $3,638 | $909.5 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,310 | $327.5 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,422 | $355.5 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $258 | $64.5 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $213 | $53.25 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $245 | $61.25 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $2,424 | $606 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $3,638 | $909.5 | — | — | — |
| Hip X-ray 2 views | CPT | 73510 | 0 | $69 | $34.5 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $213 | $53.25 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $246 | $61.5 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $2,424 | $606 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $3,430 | $857.5 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,310 | $327.5 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,422 | $355.5 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $1,527 | $381.75 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,621 | $655.25 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $2,672 | $668 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $3,056 | $764 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,424 | $606 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $3,638 | $909.5 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $438 | $115 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $437 | $109.25 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $451 | $112.75 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $521 | $130.25 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $601 | $150.25 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $583 | $177 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $513 | $128.25 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $537 | $134.25 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $513 | $128.25 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $76 | $38 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $316 | $158 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $399 | $99.75 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $23 | $11.5 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $129 | $32.25 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $13 | $6.5 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $1,348 | $337 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $596 | $149 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $364 | $182 | — | — | — |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | $20,132 | $5,033.01 | — | — | — |
| COPD w MCC | MS-DRG | 190 | 0 | $18,563 | $4,640.67 | — | — | — |
| COPD w CC | MS-DRG | 191 | 0 | $14,569 | $3,642.2 | — | — | — |
| COPD w/o CC/MCC | MS-DRG | 192 | 0 | $12,659 | $3,164.76 | — | — | — |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 0 | $15,339 | $3,834.86 | — | — | — |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 0 | $14,338 | $3,584.58 | — | — | — |
| AMI discharged alive w MCC | MS-DRG | 280 | 0 | $11,658 | $2,914.57 | — | — | — |
| AMI discharged alive w CC | MS-DRG | 281 | 0 | $33,526 | $8,381.49 | — | — | — |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 0 | $29,439 | $7,359.64 | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | $13,073 | $3,268.29 | — | — | — |
| Heart failure & shock w CC | MS-DRG | 292 | 0 | $17,322 | $4,330.42 | — | — | — |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 0 | $7,029.15 | $1,757.29 | — | — | — |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 0 | $12,218 | $3,054.41 | — | — | — |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 0 | $7,469.37 | $1,867.34 | — | — | — |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 0 | $7,183.22 | $1,795.81 | — | — | — |
| GI hemorrhage w CC | MS-DRG | 378 | 0 | $39,542 | $9,885.58 | — | — | — |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 0 | $24,416 | $6,103.98 | — | — | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 0 | $11,066 | $2,766.39 | — | — | — |
| Fractures of femur w/o MCC | MS-DRG | 533 | 0 | $18,995 | $4,748.71 | — | — | — |
| Kidney/UTI w MCC | MS-DRG | 689 | 0 | $17,745 | $4,436.35 | — | — | — |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 0 | $14,267 | $3,566.81 | — | — | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 0 | $18,443 | $4,610.8 | — | — | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 0 | $14,559 | $3,639.87 | — | — | — |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $119 | $59.5 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $188 | $94 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $251 | $125.5 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $161 | $80.5 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $228 | $114 | — | — | — |
| lab |
| Electrolyte panel | CPT | 80051 | 0 | $36.45 | $9.11 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $13 | $3.25 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $69.63 | $17.41 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $42.48 | $10.62 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $16 | $4 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $11.7 | $2.93 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $20.44 | $5.11 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $18 | $9 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $33.64 | $8.41 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $131 | $65.5 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $159 | $49.5 | — | — | — |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | $4,381 | $2,190.5 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $5,832 | $1,458 | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $2,475 | $1,237.5 | — | — | — |
| Routine obstetric care with C-section | CPT | 59510 | 0 | $4,381 | $2,190.5 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $2,133 | $1,066.5 | — | — | — |
| C-section with postpartum | CPT | 59515 | 0 | $2,475 | $1,237.5 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $302 | $75.5 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $346 | $94 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $398 | $143.5 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $459 | $181.5 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $56 | $20 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $154 | $43.5 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $206 | $68.5 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $283 | $99.5 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $359 | $135 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $569 | $284.5 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $735 | $367.5 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $292 | $146 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $560 | $280 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $1,763 | $440.75 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $853 | $426.5 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $896 | $448 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $2,912 | $1,456 | — | — | — |
| Hip hemiarthroplasty | CPT | 27125 | 0 | $2,291 | $1,145.5 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $2,847 | $1,423.5 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $2,844 | $1,422 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $2,836 | $1,418 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $3,876 | $1,938 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $270 | $135 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $2,162 | $1,081 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $1,217 | $608.5 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $2,165 | $1,082.5 | — | — | — |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 0 | $91,602 | $22,901 | — | — | — |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 0 | $60,956 | $15,239 | — | — | — |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 0 | $47,012 | $11,753 | — | — | — |
| CABG single arterial graft | CPT | 33533 | 0 | $3,682 | $1,841 | — | — | — |
| CABG 2 arterial grafts | CPT | 33534 | 0 | $4,325 | $2,162.5 | — | — | — |
| CABG 3 arterial grafts | CPT | 33535 | 0 | $4,805 | $2,402.5 | — | — | — |
| CABG 4+ arterial grafts | CPT | 33536 | 0 | $5,176 | $2,588 | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 0 | $51,016 | $12,754 | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 0 | $44,400 | $11,100 | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 0 | $73,321 | $18,330 | — | — | — |
| Open appendectomy | CPT | 44950 | 0 | $1,293 | $646.5 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $1,218 | $609 | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | $93,821 | $23,455 | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | $58,582 | $14,646 | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $10,752 | $2,688 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $1,452 | $726 | — | — | — |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 0 | $77,825 | $19,456 | — | — | — |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 0 | $64,838 | $16,210 | — | — | — |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 0 | $35,368 | $8,841.88 | — | — | — |
| Open umbilical hernia repair | CPT | 49560 | 0 | $1,420 | $710 | — | — | — |
| Umbilical hernia repair age 5+ | CPT | 49585 | 0 | $862 | $431 | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $880 | $440 | — | — | — |
| Lap incisional hernia repair | CPT | 49652 | 0 | $1,433 | $716.5 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $2,044 | $1,022 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $1,682 | $841 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $1,771 | $885.5 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $1,969 | $984.5 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $1,308 | $654 | — | — | — |
| OR procedure for obesity w MCC | MS-DRG | 619 | 0 | $30,254 | $7,563.51 | — | — | — |
| OR procedure for obesity w CC | MS-DRG | 620 | 0 | $38,927 | $9,731.76 | — | — | — |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 0 | $36,219 | $9,054.83 | — | — | — |
| Complex cataract surgery | CPT | 66982 | 0 | $1,471 | $735.5 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $1,074 | $537 | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $224 | $112 | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | $40,081 | $10,020 | — | — | — |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 0 | $38,590 | $9,647.5 | — | — | — |
| PCI single major coronary artery | CPT | 92920 | 0 | $1,031 | $515.5 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $1,146 | $573 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $1,145 | $572.5 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $1,708 | $854 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $1,921 | $960.5 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $1,982 | $991 | — | — | — |
