| behavioral |
| Psychoses | MS-DRG | 885 | 0 | $68,247 | $47,773 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $67 | $46.9 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $128 | $89.6 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $210 | $147 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $353 | $247.1 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $514 | $359.8 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $624 | $436.8 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $3,851 | $2,695.7 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $4,036 | $2,825.2 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $4,582 | $3,207.4 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $3,918 | $2,742.6 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $4,132 | $2,892.4 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $4,822 | $3,375.4 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $5,233 | $3,663.1 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $396 | $277.2 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $431 | $301.7 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $359 | $251.3 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $4,704 | $3,292.8 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $5,441 | $3,808.7 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $6,218 | $4,352.6 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $682 | $477.4 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $4,704 | $3,292.8 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $4,480 | $3,136 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $4,704 | $3,292.8 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $4,132 | $2,892.4 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $4,132 | $2,892.4 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $4,132 | $2,892.4 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $2,235 | $1,564.5 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $4,983 | $3,488.1 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $4,983 | $3,488.1 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $4,480 | $3,136 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $5,441 | $3,808.7 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $503 | $352.1 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $503 | $352.1 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $383 | $268.1 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $4,132 | $2,892.4 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $8,791 | $6,153.7 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $258 | $180.6 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $435 | $304.5 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $4,132 | $2,892.4 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $8,372 | $5,860.4 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $4,704 | $3,292.8 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $5,181 | $3,626.7 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $4,128 | $2,889.6 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $6,719 | $4,703.3 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $7,770 | $5,439 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $5,895 | $4,126.5 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $4,132 | $2,892.4 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $5,233 | $3,663.1 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,624 | $1,136.8 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $809 | $566.3 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $433 | $303.1 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $438 | $306.6 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $433 | $303.1 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,800 | $1,260 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,428 | $999.6 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,800 | $1,260 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,809 | $1,266.3 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $469 | $328.3 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $469 | $328.3 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $469 | $328.3 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $81 | $56.7 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $1,357 | $949.9 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $1,880 | $1,316 | — | — | — |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | $39,336 | $27,535 | — | — | — |
| COPD w MCC | MS-DRG | 190 | 0 | $36,200 | $25,340 | — | — | — |
| COPD w CC | MS-DRG | 191 | 0 | $25,257 | $17,680 | — | — | — |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 0 | $37,713 | $26,399 | — | — | — |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 0 | $9,511.35 | $6,657.94 | — | — | — |
| AMI discharged alive w MCC | MS-DRG | 280 | 0 | $84,971 | $59,480 | — | — | — |
| AMI discharged alive w CC | MS-DRG | 281 | 0 | $41,463 | $29,024 | — | — | — |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 0 | $15,705 | $10,994 | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | $26,781 | $18,747 | — | — | — |
| Heart failure & shock w CC | MS-DRG | 292 | 0 | $65,055 | $45,538 | — | — | — |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 0 | $26,323 | $18,426 | — | — | — |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 0 | $1,575 | $1,102.5 | — | — | — |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 0 | $26,796 | $18,758 | — | — | — |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 0 | $10,845 | $7,591.34 | — | — | — |
| GI hemorrhage w CC | MS-DRG | 378 | 0 | $20,946 | $14,662 | — | — | — |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 0 | $28,036 | $19,625 | — | — | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 0 | $28,629 | $20,041 | — | — | — |
| Fractures of femur w/o MCC | MS-DRG | 533 | 0 | $104,907 | $73,435 | — | — | — |
| Kidney/UTI w MCC | MS-DRG | 689 | 0 | $28,559 | $19,991 | — | — | — |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 0 | $25,363 | $17,754 | — | — | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 0 | $38,512 | $26,958 | — | — | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 0 | $29,925 | $20,948 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $193 | $135.1 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $101 | $70.7 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $315 | $220.5 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $233 | $163.1 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $198 | $138.6 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $186 | $130.2 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $45 | $31.5 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $42 | $29.4 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $135 | $94.5 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $213 | $149.1 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $81 | $56.7 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $45 | $31.5 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $199 | $139.3 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $71 | $49.7 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $583 | $408.1 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $687 | $480.9 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $5,040 | $3,528 | — | — | — |
| office |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $252 | $176.4 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $318 | $222.6 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $308 | $215.6 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $308 | $215.6 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $184 | $128.8 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $229 | $160.3 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $262 | $183.4 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $1,724 | $1,206.8 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $1,968 | $1,377.6 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $1,557 | $1,089.9 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $2,050 | $1,435 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $2,320 | $1,624 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $2,050 | $1,435 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $1,864 | $1,304.8 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $59,828 | $41,880 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $31,690 | $22,183 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $27,718 | $19,403 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $32,100 | $22,470 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $6,120 | $4,284 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $9,697.54 | $6,788.28 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $11,244 | $7,870.76 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $14,569 | $10,198 | — | — | — |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 0 | $82,375 | $57,663 | — | — | — |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 0 | $45,165 | $31,615 | — | — | — |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 0 | $33,809 | $23,666 | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 0 | $78,748 | $55,124 | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 0 | $42,634 | $29,844 | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 0 | $53,968 | $37,777 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $18,674 | $13,072 | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | $101,468 | $71,028 | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $18,680 | $13,076 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $18,899 | $13,229 | — | — | — |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 0 | $52,126 | $36,488 | — | — | — |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 0 | $58,080 | $40,656 | — | — | — |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 0 | $50,783 | $35,548 | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $20,916 | $14,641 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $12,160 | $8,512 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $20,294 | $14,206 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $29,192 | $20,434 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $14,932 | $10,452 | — | — | — |
| Complex cataract surgery | CPT | 66982 | 0 | $10,817 | $7,572.16 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $10,353 | $7,246.86 | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | $27,879 | $19,516 | — | — | — |
| PCI single major coronary artery | CPT | 92920 | 0 | $14,700 | $10,290 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $29,220 | $20,454 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $29,220 | $20,454 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $24,979 | $17,485 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $24,979 | $17,485 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $24,979 | $17,485 | — | — | — |
