| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $128 | $108.8 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $247 | $209.95 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $480 | $408 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $828 | $703.8 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,256 | $1,067.6 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $1,885 | $1,602.25 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $545.02 | $463.27 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $657.24 | $558.65 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $791.08 | $672.42 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $677.73 | $576.07 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $1,196.02 | $1,016.62 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $2,531.39 | $2,151.68 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $148 | $125.8 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $160 | $136 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $175 | $148.75 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $684.31 | $581.66 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $785.68 | $667.83 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $1,152 | $979.2 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,201.48 | $1,021.26 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $1,695 | $1,440.75 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $205.25 | $174.46 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $683.12 | $580.65 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $683.38 | $580.87 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $683.5 | $580.98 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $1,212.23 | $1,030.4 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $1,310.32 | $1,113.77 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $1,294.07 | $1,099.96 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $2,546.04 | $2,164.13 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $2,519.79 | $2,141.82 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $704 | $598.4 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $988 | $839.8 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $279 | $237.15 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $297 | $252.45 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $330 | $280.5 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $1,686 | $1,433.1 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $1,832 | $1,557.2 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $222 | $188.7 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $270 | $229.5 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,125 | $956.25 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $2,140 | $1,819 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $683 | $580.55 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $950 | $807.5 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $1,025 | $871.25 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $600 | $510 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $950 | $807.5 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $1,300 | $1,105 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,213 | $1,031.05 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $1,428 | $1,213.8 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $276.32 | $234.87 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $205.25 | $174.46 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $364 | $309.4 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $391 | $332.35 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $388 | $329.8 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $396 | $336.6 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $468 | $397.8 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $426 | $362.1 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $380 | $323 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $400 | $340 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $350 | $297.5 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $42 | $35.7 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $205 | $174.25 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $18 | $15.3 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $1,553 | $1,320.05 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,313 | $1,116.05 | — | — | — |
| 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 | — | — | — | — | — |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $157 | $133.45 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $212 | $180.2 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $311 | $264.35 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $115 | $97.75 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $164 | $139.4 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $114 | $96.9 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $95 | $80.75 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $50 | $42.5 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $45 | $38.25 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $147 | $124.95 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $101 | $85.85 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $18 | $15.3 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $21 | $17.85 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $31 | $26.35 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $45 | $38.25 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $67.27 | $57.18 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $45 | $38.25 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $35 | $29.75 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $58 | $49.3 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $277 | $235.45 | — | — | — |
| maternity |
| Vaginal delivery only | CPT | 59409 | 0 | $1,372 | $1,166.2 | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $1,764 | $1,499.4 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $166 | $141.1 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $205 | $174.25 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $305 | $259.25 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $390 | $331.5 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $104.56 | $88.88 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $110.48 | $93.91 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $155 | $131.75 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $220 | $187 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $305 | $259.25 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $483 | $410.55 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $613 | $521.05 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $298 | $253.3 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $464 | $394.4 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $547 | $464.95 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $703 | $597.55 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $734 | $623.9 | — | — | — |
| 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 | — | — | — | — | — |
| Open appendectomy | CPT | 44950 | 0 | $1,027 | $872.95 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $963 | $818.55 | — | — | — |
| 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 | $1,114 | $946.9 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $1,150 | $977.5 | — | — | — |
| 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 | — | — | — | — | — |
| Open umbilical hernia repair | CPT | 49560 | 0 | $1,180 | $1,003 | — | — | — |
| Umbilical hernia repair age 5+ | CPT | 49585 | 0 | $716 | $608.6 | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $1,037 | $881.45 | — | — | — |
| Lap incisional hernia repair | CPT | 49652 | 0 | $1,190 | $1,011.5 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $1,615 | $1,372.75 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $1,343 | $1,141.55 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $1,409 | $1,197.65 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $1,566 | $1,331.1 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $1,088 | $924.8 | — | — | — |
| 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 | $18,504 | $15,728 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $37,011 | $31,459 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $37,011 | $31,459 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $10,645 | $9,048.25 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $10,645 | $9,048.25 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $10,645 | $9,048.25 | — | — | — |
