| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $408 | $204 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $411 | $205.5 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $365 | $182.5 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $436 | $218 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $768 | $384 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,244 | $622 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $3,465 | $1,732.5 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $2,563 | $1,281.5 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $620 | $310 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $749 | $374.5 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $915 | $457.5 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $645 | $322.5 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $1,276 | $638 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $1,530 | $765 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $2,264 | $1,132 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $328 | $164 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $328 | $164 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $306 | $153 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,051 | $525.5 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,258 | $629 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $1,570 | $785 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,276 | $638 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $1,619 | $809.5 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $1,813 | $906.5 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $325 | $162.5 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $673 | $336.5 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,051 | $525.5 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,051 | $525.5 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $1,276 | $638 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $1,415 | $707.5 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $1,415 | $707.5 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $1,530 | $765 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $2,258 | $1,129 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $2,264 | $1,132 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,613 | $806.5 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,216 | $608 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $176 | $88 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $314 | $157 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $176 | $88 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $2,489 | $1,244.5 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $2,535 | $1,267.5 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $314 | $157 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $314 | $157 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,268 | $634 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $2,535 | $1,267.5 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,008 | $504 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,216 | $608 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $1,506 | $753 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $1,751 | $875.5 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $2,028 | $1,014 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $2,442 | $1,221 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,276 | $638 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $1,276 | $638 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $559 | $279.5 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $998 | $499 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $559 | $279.5 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $559 | $279.5 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $559 | $279.5 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $559 | $279.5 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $559 | $279.5 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $559 | $279.5 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $517 | $258.5 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $659 | $329.5 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $545 | $272.5 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $528 | $264 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $128 | $64 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,911 | $1,455.5 | — | — | — |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 0 | — | — | — | — | — |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 0 | — | — | — | — | — |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 0 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $374 | $187 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $78 | $39 | — | — | — |
| General health panel | CPT | 80050 | 0 | $510 | $255 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $65 | $32.5 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $98 | $49 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $125 | $62.5 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $80 | $40 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $76 | $38 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $43 | $21.5 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $26 | $13 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $44 | $22 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $148 | $74 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $324 | $162 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $104 | $52 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $58 | $29 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $148 | $74 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $66 | $33 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $1,809 | $904.5 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $671 | $335.5 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $3,526 | $1,763 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $436 | $218 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $683 | $341.5 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $837 | $418.5 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $930 | $465 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $374 | $187 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $376 | $188 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $575 | $287.5 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $434 | $217 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $405 | $202.5 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $2,096 | $1,048 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $2,453 | $1,226.5 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $627 | $313.5 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $585 | $292.5 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $2,468 | $1,234 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $2,549.44 | $1,274.72 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $2,751 | $1,375.5 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $17,549 | $8,774.5 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $45,089 | $22,545 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $15,254 | $7,627 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $4,319.66 | $2,159.83 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $12,555 | $6,277.26 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $6,243.5 | $3,121.75 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $21,734 | $10,867 | — | — | — |
| 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 | $7,662 | $3,831 | — | — | — |
| 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 | $6,556 | $3,278 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $22,672 | $11,336 | — | — | — |
| 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 | $23,849 | $11,925 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $7,685 | $3,842.5 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $4,031.33 | $2,015.67 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $13,350 | $6,675 | — | — | — |
| 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 | $3,870 | $1,935 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $4,107 | $2,053.5 | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $989 | $494.5 | — | — | — |
| 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 | $8,774 | $4,387 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $13,782 | $6,891 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $14,221 | $7,110.5 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $6,472 | $3,236 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $8,808 | $4,404 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $8,812 | $4,406 | — | — | — |
