| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $615 | $412.05 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $525 | $351.75 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $376 | $251.92 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $376 | $251.92 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $250 | $167.5 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $275 | $184.25 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $550 | $368.5 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $850 | $569.5 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,200 | $804 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,500 | $1,005 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $1,648 | $1,104.16 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,390 | $931.3 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,860 | $1,246.2 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,280 | $1,527.6 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,941 | $1,300.47 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,363 | $1,583.21 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $2,718 | $1,821.06 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $3,264 | $2,186.88 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $250 | $167.5 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $250 | $167.5 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $394 | $263.98 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,142 | $765.14 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,212 | $1,482.04 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,427 | $1,626.09 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $2,697 | $1,806.99 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $262 | $175.54 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,430 | $958.1 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,430 | $958.1 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,430 | $958.1 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,029 | $1,359.43 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,212 | $1,482.04 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,101 | $1,407.67 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $2,417 | $1,619.39 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $2,798 | $1,874.66 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $2,901 | $1,943.67 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,142 | $765.14 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,941 | $1,300.47 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $525 | $351.75 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $240 | $160.8 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $479 | $320.93 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $1,723 | $1,154.41 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $4,760 | $3,189.2 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $384 | $257.28 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $524 | $351.08 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,606 | $1,076.02 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $4,768 | $3,194.56 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,142 | $765.14 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,860 | $1,246.2 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,218 | $1,486.06 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $1,540 | $1,031.8 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $2,355 | $1,577.85 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $2,657 | $1,780.19 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,497 | $1,672.99 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $3,446 | $2,308.82 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $631 | $422.77 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $524 | $351.08 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $524 | $351.08 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $524 | $351.08 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $524 | $351.08 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $480 | $321.6 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $444 | $297.48 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $560 | $375.2 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $444 | $297.48 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $346 | $231.82 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $384 | $257.28 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $355 | $237.85 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $250 | $167.5 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $30 | $20.1 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $1,449 | $970.83 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $108 | $72.36 | — | — | — |
| inpatient |
| COPD w MCC | MS-DRG | 190 | 0 | $36,709 | $24,595 | — | — | — |
| 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 | $26,984 | $18,079 | — | — | — |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 0 | $26,984 | $18,079 | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | $19,343 | $12,960 | — | — | — |
| Heart failure & shock w CC | MS-DRG | 292 | 0 | $16,094 | $10,783 | — | — | — |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 0 | $59,522 | $39,880 | — | — | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 0 | $52,629 | $35,261 | — | — | — |
| Kidney/UTI w MCC | MS-DRG | 689 | 0 | $16,259 | $10,894 | — | — | — |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 0 | $32,438 | $21,734 | — | — | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 0 | $21,414 | $14,348 | — | — | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 0 | $16,821 | $11,270 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $185 | $123.95 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $275 | $184.25 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $46 | $30.82 | — | — | — |
| General health panel | CPT | 80050 | 0 | $106 | $71.02 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $87 | $58.29 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $33 | $22.11 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $84 | $56.28 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $268 | $179.56 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $44 | $29.48 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $46 | $30.82 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $46 | $30.82 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $95 | $63.65 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $109.15 | $73.13 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $63 | $42.21 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $68 | $45.56 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $95 | $63.65 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $53 | $35.51 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $27.5 | $18.43 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $207 | $138.69 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $451.36 | $302.41 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $2,080 | $1,393.6 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $259 | $173.53 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $276 | $184.92 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $414 | $277.38 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $484.53 | $324.64 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $310.82 | $208.25 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $201 | $134.67 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $256 | $171.52 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $445.82 | $298.7 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $431 | $288.77 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $2,189.1 | $1,466.7 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $2,278.5 | $1,526.6 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $1,117.34 | $748.62 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $1,511 | $1,012.37 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $1,864.5 | $1,249.22 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $1,938.2 | $1,298.59 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $2,614.3 | $1,751.58 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | — | — | — | — | — |
| Hip hemiarthroplasty | CPT | 27125 | 0 | — | — | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | — | — | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | — | — | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | — | — | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | — | — | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | — | — | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | — | — | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | — | — | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | — | — | — | — | — |
| CABG single arterial graft | CPT | 33533 | 0 | — | — | — | — | — |
| CABG 2 arterial grafts | CPT | 33534 | 0 | — | — | — | — | — |
| CABG 3 arterial grafts | CPT | 33535 | 0 | — | — | — | — | — |
| CABG 4+ arterial grafts | CPT | 33536 | 0 | — | — | — | — | — |
| Open appendectomy | CPT | 44950 | 0 | — | — | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | — | — | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $2,635 | $1,765.45 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | — | — | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | — | — | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $2,917 | $1,954.39 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | — | — | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | — | — | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | — | — | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | — | — | — | — | — |
| Complex cataract surgery | CPT | 66982 | 0 | — | — | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | — | — | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $1,100 | $737 | — | — | — |
| Vitrectomy mechanical | CPT | 67042 | 0 | — | — | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | — | — | — | — | — |
| PCI single major coronary artery | CPT | 92920 | 0 | — | — | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | — | — | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | — | — | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | — | — | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | — | — | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | — | — | — | — | — |
