| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $556.37 | $306 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $920.29 | $506.16 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $2,020.2 | $1,111.11 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,587.08 | $1,422.89 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $4,063.74 | $2,235.06 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $11,771 | $6,474.22 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $5,727.02 | $3,149.86 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $7,651.58 | $4,208.37 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $9,537.65 | $5,245.71 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $6,381.37 | $3,509.75 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $6,933.08 | $3,813.19 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $9,387.19 | $5,162.95 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $10,685 | $5,876.96 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $632.19 | $347.7 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $948.28 | $521.55 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $705.03 | $387.77 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $7,651.58 | $4,208.37 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $8,742.17 | $4,808.19 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $10,557 | $5,806.4 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $6,541.17 | $3,597.64 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $8,095.98 | $4,452.79 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $1,558.31 | $857.07 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $7,651.58 | $4,208.37 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $7,651.58 | $4,208.37 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $7,651.58 | $4,208.37 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $6,933.08 | $3,813.19 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $6,933.08 | $3,813.19 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $6,933.08 | $3,813.19 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $9,387.19 | $5,162.95 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $10,685 | $5,876.96 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $10,685 | $5,876.96 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $7,141.87 | $3,928.03 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $8,161.3 | $4,488.72 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $3,435.05 | $1,889.28 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $2,110.02 | $1,160.51 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $2,073.86 | $1,140.62 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $6,933.08 | $3,813.19 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $10,685 | $5,876.96 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $2,199.83 | $1,209.91 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $2,855.35 | $1,570.44 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $6,933.08 | $3,813.19 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $10,685 | $5,876.96 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $7,141.87 | $3,928.03 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $8,161.3 | $4,488.72 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $10,047 | $5,526.05 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $7,141.87 | $3,928.03 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $8,161.3 | $4,488.72 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $10,047 | $5,526.05 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $6,933.08 | $3,813.19 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $10,685 | $5,876.96 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $4,231.7 | $2,327.44 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $2,639.56 | $1,451.76 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $3,646.17 | $2,005.39 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $2,903.17 | $1,596.74 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $2,567.25 | $1,411.99 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $3,340.57 | $1,837.31 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $3,340.57 | $1,837.31 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $2,934.66 | $1,614.06 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $1,103.41 | $606.88 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,323.86 | $728.12 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $1,136.07 | $624.84 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $282.27 | $155.25 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $3,074.63 | $1,691.05 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $2,351.46 | $1,293.3 | — | — | — |
| 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 | $419.9 | $230.95 | — | — | — |
| General health panel | CPT | 80050 | 0 | $989.11 | $544.01 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $349.92 | $192.46 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $524.88 | $288.68 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $687.01 | $377.86 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $443.23 | $243.78 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $466.56 | $256.61 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $157.46 | $86.6 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $234.45 | $128.95 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $317.26 | $174.49 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $899.29 | $494.61 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $289.27 | $159.1 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $349.92 | $192.46 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $498.05 | $273.93 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $226.28 | $124.45 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $1,711.11 | $941.11 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $20,164 | $4,839.35 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $24,064 | $5,775.37 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $15,524 | $3,725.68 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $19,920 | $4,780.86 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $29,750 | $7,140.08 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $27,232 | $6,535.69 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $195,172 | $46,841 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $139,898 | $33,575 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $90,924 | $21,822 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $93,869 | $22,529 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $52,183 | $12,524 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $112,319 | $26,957 | — | — | — |
| 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 | — | — | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $67,746 | $16,259 | — | — | — |
| 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 | — | — | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $69,010 | $16,562 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $70,748 | $16,980 | — | — | — |
| 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 | — | — | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $80,892 | $19,414 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $62,560 | $15,014 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $83,335 | $20,000 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $58,281 | $13,988 | — | — | — |
| 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 | — | — | — | — | — |
| Complex cataract surgery | CPT | 66982 | 0 | $18,249 | $4,379.65 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $15,565 | $3,735.49 | — | — | — |
| 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 | $27,168 | $14,942 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $41,260 | $22,693 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $34,002 | $18,701 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $22,847 | $12,566 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $16,533 | $9,092.9 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $30,003 | $16,502 | — | — | — |
