| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $243 | $145.8 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $272 | $163.2 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $115 | $69 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $152 | $91.2 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $225 | $135 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $384 | $230.4 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $774 | $464.4 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,363 | $817.8 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,568 | $1,540.8 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $50,899 | $30,539 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $5,699 | $3,419.4 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,291 | $774.6 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,376 | $825.6 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $1,572 | $943.2 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,523 | $913.8 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $1,193 | $715.8 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $1,192 | $715.2 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $1,192 | $715.2 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $295 | $177 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $295 | $177 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $295 | $177 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,115 | $669 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,769 | $1,061.4 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $1,916 | $1,149.6 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,193 | $715.8 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $1,192 | $715.2 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $1,192 | $715.2 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $295 | $177 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,761 | $1,056.6 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,526 | $915.6 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,291 | $774.6 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $1,193 | $715.8 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $1,193 | $715.8 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $1,193 | $715.8 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $1,192 | $715.2 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $1,192 | $715.2 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $1,192 | $715.2 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,350 | $810 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,720 | $1,032 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $374 | $224.4 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $249 | $149.4 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $443 | $265.8 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $1,193 | $715.8 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $1,192 | $715.2 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $374 | $224.4 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $443 | $265.8 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,193 | $715.8 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $1,192 | $715.2 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,350 | $810 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,621 | $972.6 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $1,720 | $1,032 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,295 | $1,377 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $2,484 | $1,490.4 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $3,351 | $2,010.6 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,193 | $715.8 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $1,192 | $715.2 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,192 | $715.2 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,057 | $634.2 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $886 | $531.6 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $939 | $563.4 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $998 | $598.8 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,188 | $712.8 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $986 | $591.6 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $999 | $599.4 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $886 | $531.6 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $447 | $268.2 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $573 | $343.8 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $473 | $283.8 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $24 | $14.4 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $319 | $191.4 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $11 | $6.6 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,724 | $1,634.4 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,134 | $680.4 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $1,907 | $1,144.2 | — | — | — |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 0 | $32,748 | $19,649 | — | — | — |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | $32,976 | $19,786 | — | — | — |
| COPD w MCC | MS-DRG | 190 | 0 | $25,921 | $15,552 | — | — | — |
| COPD w CC | MS-DRG | 191 | 0 | $15,455 | $9,273 | — | — | — |
| COPD w/o CC/MCC | MS-DRG | 192 | 0 | $44,250 | $26,550 | — | — | — |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 0 | $33,439 | $20,063 | — | — | — |
| AMI discharged alive w MCC | MS-DRG | 280 | 0 | $46,683 | $28,010 | — | — | — |
| AMI discharged alive w CC | MS-DRG | 281 | 0 | $34,775 | $20,865 | — | — | — |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 0 | $45,923 | $27,554 | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | $28,267 | $16,960 | — | — | — |
| Heart failure & shock w CC | MS-DRG | 292 | 0 | $15,397 | $9,238.2 | — | — | — |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 0 | $31,176 | $18,706 | — | — | — |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 0 | $36,568 | $21,941 | — | — | — |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 0 | $10,954 | $6,572.64 | — | — | — |
| GI hemorrhage w CC | MS-DRG | 378 | 0 | $22,343 | $13,406 | — | — | — |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 0 | $22,976 | $13,785 | — | — | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 0 | $17,169 | $10,301 | — | — | — |
| Kidney/UTI w MCC | MS-DRG | 689 | 0 | $26,470 | $15,882 | — | — | — |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 0 | $24,699 | $14,819 | — | — | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 0 | $44,408 | $26,645 | — | — | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 0 | $29,112 | $17,467 | — | — | — |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $114 | $68.4 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $179 | $107.4 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $239 | $143.4 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $111 | $66.6 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $158 | $94.8 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $16 | $9.6 | — | — | — |
| General health panel | CPT | 80050 | 0 | $67 | $40.2 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $13 | $7.8 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $20 | $12 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $25 | $15 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $16 | $9.6 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $15 | $9 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $4 | $2.4 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $4 | $2.4 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $7 | $4.2 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $18 | $10.8 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $31 | $18.6 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $14 | $8.4 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $12 | $7.2 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $15 | $9 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $15 | $9 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $112 | $67.2 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $8,621 | $5,172.6 | — | — | — |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | $8,143.67 | $4,886.2 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $8,143.07 | $4,885.84 | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $8,143.07 | $4,885.84 | — | — | — |
| Routine obstetric care with C-section | CPT | 59510 | 0 | $64,048 | $38,429 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $64,048 | $38,429 | — | — | — |
| C-section with postpartum | CPT | 59515 | 0 | $64,048 | $38,429 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $102 | $61.2 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $157 | $94.2 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $236 | $141.6 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $311 | $186.6 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $80 | $48 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $129 | $77.4 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $182 | $109.2 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $256 | $153.6 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $29,801 | $17,881 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $32,718 | $19,631 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $7,775.5 | $4,665.3 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $32,660 | $19,596 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $6,648.38 | $3,989.03 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $19,377 | $11,626 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $30,870 | $18,522 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $129,752 | $77,851 | — | — | — |
| Hip hemiarthroplasty | CPT | 27125 | 0 | $90,137 | $54,082 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $144,289 | $86,574 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $118,691 | $71,214 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $1,894 | $1,136.4 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $117,838 | $70,703 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $68,411 | $41,047 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $70,345 | $42,207 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $58,298 | $34,979 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $113,658 | $68,195 | — | — | — |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 0 | $260,746 | $156,448 | — | — | — |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 0 | $184,799 | $110,880 | — | — | — |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 0 | $135,763 | $81,458 | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 0 | $123,075 | $73,845 | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 0 | $80,084 | $48,051 | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 0 | $28,507 | $17,104 | — | — | — |
| Open appendectomy | CPT | 44950 | 0 | $88,530 | $53,118 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $100,987 | $60,592 | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | $60,630 | $36,378 | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | $127,698 | $76,619 | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $87,376 | $52,426 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $111,179 | $66,707 | — | — | — |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 0 | $93,365 | $56,019 | — | — | — |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 0 | $77,118 | $46,271 | — | — | — |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 0 | $64,548 | $38,729 | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $77,864 | $46,719 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $1,377 | $826.2 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $1,134 | $680.4 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $1,214 | $728.4 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $92,569 | $55,541 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $104,661 | $62,796 | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | $92,184 | $55,310 | — | — | — |
| PCI single major coronary artery | CPT | 92920 | 0 | $34,261 | $20,557 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $35,397 | $21,238 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $35,397 | $21,238 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $1,146 | $687.6 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $10,946 | $6,567.3 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $29,505 | $17,703 | — | — | — |
