| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $477 | $228.96 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $371.1 | $178.13 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $245.1 | $117.65 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $368.7 | $176.98 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $556.5 | $267.12 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $556.5 | $267.12 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $190.1 | $91.25 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $360.2 | $172.9 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $690.9 | $331.63 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,284.8 | $616.7 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,902.6 | $913.25 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $3,215.6 | $1,543.49 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $899.6 | $431.81 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,349.5 | $647.76 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $1,799.4 | $863.71 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $899.6 | $431.81 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $1,142.4 | $548.35 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $1,498.5 | $719.28 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $1,900 | $912 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $432.9 | $207.79 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $432.9 | $207.79 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $288.4 | $138.43 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $899.6 | $431.81 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $899.6 | $431.81 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $1,349.5 | $647.76 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,710.4 | $820.99 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $2,090.2 | $1,003.3 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $2,470.4 | $1,185.79 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $432.9 | $207.79 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $899.6 | $431.81 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $899.6 | $431.81 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $899.6 | $431.81 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $1,140.2 | $547.3 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $1,140.2 | $547.3 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $1,140.2 | $547.3 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $1,520.3 | $729.74 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $1,900 | $912 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $1,900 | $912 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,349.5 | $647.76 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,349.5 | $647.76 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $432.9 | $207.79 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $432.9 | $207.79 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $288.4 | $138.43 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $1,900 | $912 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $2,660.4 | $1,276.99 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $432.9 | $207.79 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $432.9 | $207.79 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,710.4 | $820.99 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $2,660.4 | $1,276.99 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $899.6 | $431.81 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,349.5 | $647.76 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $1,799.4 | $863.71 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $1,349.5 | $647.76 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $1,799.4 | $863.71 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $2,249.1 | $1,079.57 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,280.2 | $1,094.5 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $2,850.4 | $1,368.19 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $948.5 | $455.28 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $790.5 | $379.44 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $790.5 | $379.44 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $793.4 | $380.83 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,027.4 | $493.15 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,586.8 | $761.66 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,027.4 | $493.15 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $790.5 | $379.44 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,230.6 | $590.69 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $971.5 | $466.32 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,079.3 | $518.06 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $863.5 | $414.48 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $258.4 | $124.03 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $1,729.6 | $830.21 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,164 | $558.72 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $3,687.7 | $1,770.1 | — | — | — |
| 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 | $254.3 | $122.06 | — | — | — |
| General health panel | CPT | 80050 | 0 | $140.2 | $67.3 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $115.2 | $55.3 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $463.2 | $222.34 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $53.6 | $25.73 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $295.2 | $141.7 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $243.7 | $116.98 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $88.5 | $42.48 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $184.4 | $88.51 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $65 | $31.2 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $92.6 | $44.45 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $97.9 | $46.99 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $306.1 | $146.93 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $73.8 | $35.42 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $49.2 | $23.62 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $1,047.7 | $502.9 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $953.8 | $457.82 | — | — | — |
| office |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $249.9 | $119.95 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $289.2 | $138.82 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $358.2 | $171.94 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $427.6 | $205.25 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $485.4 | $232.99 | — | — | — |
| 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 | $20,454 | $9,818.02 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $48,193 | $23,133 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $48,166 | $23,120 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $7,615.4 | $3,655.39 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $9,519.3 | $4,569.26 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $12,375 | $5,940 | — | — | — |
