| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $1,152 | $115.2 | — | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $1,152 | $115.2 | — | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $390 | $39 | — | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $489 | $48.9 | — | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $576 | $57.6 | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $3,283 | $328.3 | — | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $3,305 | $330.5 | — | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $3,312 | $331.2 | — | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $3,931 | $393.1 | — | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $4,035 | $403.5 | — | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $4,035 | $403.5 | — | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $3,810 | $381 | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $5,060 | $506 | — | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $6,890 | $689 | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $5,936 | $593.6 | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $9,437 | $943.7 | — | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $10,761 | $1,076.1 | — | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $12,368 | $1,236.8 | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $988 | $98.8 | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $1,576 | $157.6 | — | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $956 | $95.6 | — | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $5,510 | $551 | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $6,117 | $611.7 | — | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $7,697 | $769.7 | — | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $11,559 | $1,155.9 | — | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $13,530 | $1,353 | — | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $14,527 | $1,452.7 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $1,826 | $182.6 | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $5,512 | $551.2 | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $4,422 | $442.2 | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $5,864 | $586.4 | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $8,766 | $876.6 | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $8,895 | $889.5 | — | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $8,601 | $860.1 | — | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $10,235 | $1,023.5 | — | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $11,949 | $1,194.9 | — | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $11,893 | $1,189.3 | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,673 | $267.3 | — | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $6,609 | $660.9 | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $1,341 | $134.1 | — | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $1,434 | $143.4 | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $1,257 | $125.7 | — | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $7,747 | $774.7 | — | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $9,650 | $965 | — | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $1,460 | $146 | — | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $1,402 | $140.2 | — | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $10,110 | $1,011 | — | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $12,527 | $1,252.7 | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $5,041 | $504.1 | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $5,689 | $568.9 | — | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $7,102 | $710.2 | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $7,899 | $789.9 | — | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $8,366 | $836.6 | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $9,325 | $932.5 | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $9,002 | $900.2 | — | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $12,368 | $1,236.8 | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $4,606 | $460.6 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,636 | $163.6 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $4,606 | $460.6 | — | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,173 | $117.3 | — | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $3,555 | $355.5 | — | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $3,933 | $393.3 | — | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $2,547 | $254.7 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $2,806 | $280.6 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $2,694 | $269.4 | — | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $1,428 | $142.8 | — | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $2,141 | $214.1 | — | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $1,687 | $168.7 | — | — | — | — |
| EKG complete | CPT | 93000 | 0 | $65 | $6.5 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $698 | $69.8 | — | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $5,455 | $545.5 | — | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,948 | $194.8 | — | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $5,066 | $506.6 | — | — | — | — |
| 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 | $197 | $19.7 | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $149 | $14.9 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $294 | $29.4 | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $313 | $31.3 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $456 | $45.6 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $241 | $24.1 | — | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $39 | $3.9 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $114 | $11.4 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $142 | $14.2 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $253 | $25.3 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $369 | $36.9 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $228 | $22.8 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $186 | $18.6 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $286 | $28.6 | — | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $206 | $20.6 | — | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $1,402 | $140.2 | — | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $2,062 | $206.2 | — | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $566 | $56.6 | — | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $859 | $85.9 | — | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $1,152 | $115.2 | — | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $1,444 | $144.4 | — | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $566 | $56.6 | — | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $566 | $56.6 | — | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $566 | $56.6 | — | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $859 | $85.9 | — | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $1,152 | $115.2 | — | — | — | — |
| 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 | — | — | — | — | — | — |
| 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 | $21,437 | $2,143.7 | — | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $30,369 | $3,036.9 | — | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $30,369 | $3,036.9 | — | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $14,447 | $1,444.7 | — | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $14,447 | $1,444.7 | — | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $16,944 | $1,694.4 | — | — | — | — |