| behavioral |
| Psychoses | MS-DRG | 885 | 26 | $43,009 | $25,806 | $48.5 | $75 | $2,861 |
| emergency |
| ED visit level 1 | CPT | 99281 | 34 | $789 | $473.4 | $82.99 | $513.64 | $1,860 |
| ED visit level 2 | CPT | 99282 | 22 | $1,030 | $618 | $506.76 | $670.53 | $1,860 |
| ED visit level 3 | CPT | 99283 | 34 | $1,951 | $1,170.6 | $268.67 | $1,270.1 | $1,860 |
| ED visit level 4 | CPT | 99284 | 22 | $3,751 | $2,250.6 | $1,845.49 | $2,284.36 | $3,188.35 |
| ED visit level 5 | CPT | 99285 | 34 | $4,958 | $2,974.8 | $586.12 | $3,227.66 | $4,214.3 |
| Critical care, first hour | CPT | 99291 | 34 | $6,849 | $4,109.4 | $812.98 | $4,451.85 | $5,821.65 |
| imaging |
| CT head without contrast | CPT | 70450 | 34 | $1,232 | $739.2 | $102.89 | $878.42 | $1,700 |
| CT head with contrast | CPT | 70460 | 34 | $1,444 | $866.4 | $172.63 | $1,070.73 | $1,700 |
| CT head with and without contrast | CPT | 70470 | 34 | $1,606 | $963.6 | $172.63 | $1,190.85 | $1,700 |
| CT neck with contrast | CPT | 70491 | 34 | $1,362 | $817.2 | $172.63 | $1,009.93 | $1,700 |
| MRI brain without contrast | CPT | 70551 | 34 | $5,642 | $3,385.2 | $234.83 | $3,971.97 | $4,795.7 |
| MRI brain with contrast | CPT | 70552 | 34 | $7,089 | $4,253.4 | $343.36 | $5,054.46 | $6,025.65 |
| MRI brain with and without contrast | CPT | 70553 | 34 | $7,752 | $4,651.2 | $343.36 | $5,457.41 | $6,589.2 |
| Chest X-ray single view | CPT | 71045 | 34 | $415 | $249 | $85.65 | $295.9 | $352.75 |
| Chest X-ray 2 views | CPT | 71046 | 34 | $568 | $340.8 | $85.65 | $401.29 | $482.8 |
| Chest X-ray 3 views | CPT | 71047 | 34 | $600 | $360 | $85.65 | $423.9 | $510 |
| CT chest without contrast | CPT | 71250 | 34 | $1,361 | $816.6 | $102.89 | $970.39 | $1,700 |
| CT chest with contrast | CPT | 71260 | 34 | $1,528 | $916.8 | $172.63 | $1,089.46 | $1,700 |
| CT chest with and without contrast | CPT | 71270 | 34 | $1,765 | $1,059 | $172.63 | $1,284.93 | $1,700 |
| MRI chest without contrast | CPT | 71550 | 34 | $6,218 | $3,730.8 | $234.83 | $4,377.47 | $5,285.3 |
| MRI chest with and without contrast | CPT | 71552 | 34 | $6,931 | $4,158.6 | $343.36 | $4,879.43 | $5,891.35 |
| Lumbosacral spine X-ray | CPT | 72100 | 34 | $711 | $426.6 | $102.89 | $516.54 | $604.35 |
| CT cervical spine without contrast | CPT | 72125 | 34 | $1,155 | $693 | $102.89 | $856.44 | $1,700 |
| CT thoracic spine without contrast | CPT | 72128 | 34 | $1,527 | $916.2 | $102.89 | $1,132.27 | $1,700 |
| CT lumbar spine without contrast | CPT | 72131 | 34 | $2,148 | $1,288.8 | $102.89 | $1,592.74 | $1,825.8 |
| MRI cervical spine without contrast | CPT | 72141 | 34 | $5,906 | $3,543.6 | $234.83 | $4,157.83 | $5,020.1 |
| MRI thoracic spine without contrast | CPT | 72146 | 34 | $5,742 | $3,445.2 | $234.83 | $4,042.37 | $4,880.7 |
| MRI lumbar spine without contrast | CPT | 72148 | 34 | $5,794 | $3,476.4 | $234.83 | $4,078.98 | $4,924.9 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 34 | $6,084 | $3,650.4 | $343.36 | $4,164.5 | $5,171.4 |
| MRI cervical spine with and without contrast | CPT | 72156 | 34 | $7,799 | $4,679.4 | $343.36 | $5,490.5 | $6,629.15 |
| MRI lumbar spine with contrast | CPT | 72158 | 34 | $7,818 | $4,690.8 | $343.36 | $5,503.87 | $6,645.3 |
| CT pelvis without contrast | CPT | 72192 | 34 | $1,161 | $696.6 | $102.89 | $827.79 | $1,700 |
| CT pelvis with contrast | CPT | 72193 | 34 | $1,273 | $763.8 | $172.63 | $943.93 | $1,700 |
| Shoulder X-ray | CPT | 73030 | 31 | $721 | $432.6 | $349.69 | $535.7 | $612.85 |
| Humerus X-ray | CPT | 73060 | 34 | $198 | $118.8 | $85.65 | $141.17 | $168.3 |
| Hand X-ray 3 views | CPT | 73130 | 31 | $872 | $523.2 | $422.92 | $647.9 | $741.2 |
| MRI upper extremity joint without contrast | CPT | 73221 | 31 | $6,188 | $3,712.8 | $3,001.18 | $4,597.68 | $5,259.8 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 31 | $6,822 | $4,093.2 | $3,308.67 | $5,068.75 | $5,798.7 |
| Knee X-ray 1-2 views | CPT | 73560 | 31 | $1,162 | $697.2 | $281.79 | $493.85 | $987.7 |
| Ankle X-ray 3 views | CPT | 73610 | 31 | $612 | $367.2 | $296.82 | $454.72 | $520.2 |
| MRI lower extremity joint without contrast | CPT | 73721 | 31 | $5,545 | $3,327 | $2,689.33 | $4,119.94 | $4,713.25 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 31 | $7,671 | $4,602.6 | $3,550 | $5,699.55 | $6,520.35 |
| CT abdomen without contrast | CPT | 74150 | 34 | $1,179 | $707.4 | $102.89 | $840.63 | $1,700 |
| CT abdomen with contrast | CPT | 74160 | 34 | $2,696 | $1,617.6 | $172.63 | $1,958.65 | $2,291.6 |
| CT abdomen with and without contrast | CPT | 74170 | 34 | $3,048 | $1,828.8 | $172.63 | $2,173.22 | $2,590.8 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 34 | $2,367 | $1,420.2 | $234.83 | $1,725.79 | $2,011.95 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 34 | $2,800 | $1,680 | $343.36 | $2,034.2 | $2,380 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 34 | $3,706 | $2,223.6 | $343.36 | $2,692.41 | $3,150.1 |
| MRI abdomen without contrast | CPT | 74181 | 34 | $3,612 | $2,167.2 | $234.83 | $2,575.36 | $3,550 |
| MRI abdomen with and without contrast | CPT | 74183 | 34 | $8,686 | $5,211.6 | $343.36 | $6,310.38 | $7,383.1 |
| Abdominal ultrasound complete | CPT | 76700 | 34 | $1,807 | $1,084.2 | $102.89 | $1,312.79 | $1,535.95 |
| Abdominal ultrasound limited | CPT | 76705 | 34 | $475 | $285 | $102.89 | $345.09 | $403.75 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 34 | $1,983 | $1,189.8 | $102.89 | $1,440.65 | $1,685.55 |
| Transvaginal ultrasound | CPT | 76830 | 34 | $530 | $318 | $102.89 | $377.89 | $450.5 |
| Pelvic ultrasound complete | CPT | 76856 | 34 | $515 | $309 | $102.89 | $367.2 | $437.75 |
| Scrotal ultrasound | CPT | 76870 | 34 | $768 | $460.8 | $102.89 | $557.95 | $652.8 |
| EKG tracing only | CPT | 93005 | 34 | $378 | $226.8 | $58.06 | $264.6 | $321.3 |
| Transthoracic echocardiogram complete | CPT | 93306 | 34 | $3,590 | $2,154 | $537.78 | $2,608.14 | $3,051.5 |
| Transthoracic echocardiogram | CPT | 93307 | 34 | $922 | $553.2 | $234.83 | $651.4 | $783.7 |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 31 | $144,675 | $86,805 | $48.5 | $75.5 | $69,737 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 30 | $58,145 | $34,887 | $48.5 | $75.5 | $69,737 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 30 | $20,497 | $12,298 | $48.5 | $75.5 | $69,737 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 31 | $69,348 | $41,609 | $48.5 | $77.75 | $21,996 |
| COPD w MCC | MS-DRG | 190 | 31 | $295,447 | $177,268 | $48.5 | $74.15 | $10,481 |
| COPD w CC | MS-DRG | 191 | 27 | $46,568 | $27,941 | $48.5 | $75.25 | $10,114 |
| COPD w/o CC/MCC | MS-DRG | 192 | 27 | $53,024 | $31,814 | $48.5 | $75.25 | $10,114 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 27 | $20,902 | $12,541 | $48.5 | $75.25 | $10,114 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 27 | $13,189 | $7,913.28 | $48.5 | $75.25 | $10,114 |
| Heart failure & shock w MCC | MS-DRG | 291 | 30 | $60,247 | $36,148 | $48.5 | $75.5 | $26,047 |
| Heart failure & shock w CC | MS-DRG | 292 | 30 | $67,123 | $40,274 | $48.5 | $75.5 | $33,663 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 31 | $25,603 | $15,362 | $48.5 | $77.75 | $37,896 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 31 | $34,547 | $20,728 | $48.5 | $77.75 | $45,886 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 31 | $15,200 | $9,120.18 | $48.5 | $77.75 | $45,886 |
| GI hemorrhage w CC | MS-DRG | 378 | 27 | $29,613 | $17,768 | $48.5 | $75.25 | $10,114 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 27 | $17,784 | $10,670 | $48.5 | $75.25 | $10,114 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 27 | $21,871 | $13,122 | $48.5 | $75.25 | $10,114 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 27 | $24,137 | $14,482 | $48.5 | $75.25 | $10,114 |
| Kidney/UTI w MCC | MS-DRG | 689 | 27 | $52,607 | $31,564 | $48.5 | $75.25 | $10,114 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 27 | $20,833 | $12,500 | $48.5 | $75.25 | $10,114 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 27 | $70,335 | $42,201 | $48.5 | $75.25 | $10,114 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 27 | $26,271 | $15,763 | $48.5 | $75.25 | $10,114 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 34 | $111 | $66.6 | $8.46 | $78.42 | $94.35 |
| General health panel | CPT | 80050 | 31 | $315 | $189 | $57.33 | $234.05 | $267.75 |
| Electrolyte panel | CPT | 80051 | 34 | $76 | $45.6 | $7.01 | $49.86 | $64.6 |
| Comprehensive metabolic panel | CPT | 80053 | 34 | $350 | $210 | $10.56 | $254.28 | $297.5 |
| Lipid panel | CPT | 80061 | 34 | $308 | $184.8 | $13.39 | $223.76 | $261.8 |
| Renal function panel | CPT | 80069 | 34 | $78 | $46.8 | $8.68 | $56.67 | $66.3 |
| Hepatic function panel | CPT | 80076 | 34 | $364 | $218.4 | $8.17 | $264.45 | $309.4 |
| Urinalysis non-automated | CPT | 81002 | 34 | $18 | $10.8 | $3.48 | $12.72 | $15.3 |
| Urinalysis automated | CPT | 81003 | 34 | $21 | $12.6 | $2.25 | $14.97 | $17.85 |
| Glucose quantitative | CPT | 82947 | 34 | $28 | $16.8 | $3.93 | $20.34 | $23.8 |
| Hemoglobin A1c | CPT | 83036 | 34 | $161 | $96.6 | $9.71 | $112.7 | $136.85 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 34 | $278 | $166.8 | $16.8 | $201.97 | $236.3 |
| Complete blood count with automated differential | CPT | 85025 | 34 | $43 | $25.8 | $7.77 | $30 | $36.55 |
| Complete blood count without differential | CPT | 85027 | 34 | $32 | $19.2 | $6.47 | $23.25 | $27.2 |
| Urine culture bacterial | CPT | 87086 | 34 | $74 | $44.4 | $8.07 | $53.28 | $62.9 |
| Tissue exam by pathologist level IV | CPT | 88305 | 34 | $546 | $327.6 | $51.29 | $396.67 | $464.1 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 34 | $60,239 | $36,143 | $48.5 | $892.66 | $58,344 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 34 | $20,745 | $12,447 | $48.5 | $892.66 | $6,278 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 34 | $11,540 | $6,923.77 | $48.5 | $79 | $6,278 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 34 | $12,219 | $7,331.37 | $48.5 | $85 | $6,278 |
| Colonoscopy diagnostic | CPT | 45378 | 34 | $14,459 | $8,675.69 | $48.5 | $79 | $6,278 |
| Colonoscopy with biopsy | CPT | 45380 | 34 | $20,310 | $12,186 | $48.5 | $471.1 | $6,278 |
| Colonoscopy with polyp removal | CPT | 45385 | 34 | $18,130 | $10,878 | $48.5 | $85 | $6,278 |
| surgery |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 31 | $196,536 | $117,922 | $48.5 | $75 | $10,075 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 27 | $69,481 | $41,689 | $48.5 | $75.25 | $10,114 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 27 | $58,696 | $35,218 | $48.5 | $75.25 | $10,114 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 27 | $42,718 | $25,631 | $48.5 | $75.25 | $10,114 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 27 | $46,872 | $28,123 | $48.5 | $75.25 | $10,114 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 30 | $73,976 | $44,385 | $48.5 | $75.5 | $58,953 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 30 | $72,578 | $43,547 | $48.5 | $75.5 | $58,953 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 30 | $50,114 | $30,069 | $48.5 | $75.5 | $58,953 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 27 | $27,267 | $16,360 | $48.5 | $75.25 | $10,114 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 28 | $167,146 | $100,287 | $48.5 | $75 | $10,114 |
| PCI single major coronary artery | CPT | 92920 | 14 | $12,444 | $7,466.4 | $6,122.45 | $7,217.52 | $9,955.2 |
| PCI with drug-eluting stent | CPT | 92928 | 34 | $75,179 | $45,107 | $48.5 | $85 | $58,344 |
| Left heart catheterization | CPT | 93452 | 14 | $9,877 | $5,926.2 | $4,859.48 | $5,728.66 | $7,901.6 |
| Coronary angiography with bypass cath | CPT | 93458 | 34 | $36,035 | $21,621 | $48.5 | $5,601.67 | $58,344 |