| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $365 | $91.25 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $969 | $242.25 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,521 | $380.25 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,492 | $623 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $2,971 | $742.75 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $3,694 | $923.5 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,659 | $664.75 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $4,373 | $1,093.25 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $5,313 | $1,328.25 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $4,369 | $1,092.25 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $4,706 | $1,176.5 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $6,801 | $1,700.25 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $7,981 | $1,995.25 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $408 | $102 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $493 | $123.25 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $574 | $143.5 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $2,487 | $621.75 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,405 | $851.25 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $4,175 | $1,043.75 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,715 | $928.75 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $4,044 | $1,011 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $7,980 | $1,995 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $747 | $186.75 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,631 | $657.75 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,642 | $660.5 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,665 | $666.25 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $4,735 | $1,183.75 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $4,301 | $1,075.25 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $4,871 | $1,217.75 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $6,392 | $1,598 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $7,291 | $1,822.75 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $8,220 | $2,055 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,828 | $707 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $3,518 | $879.5 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $513 | $128.25 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $427 | $106.75 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $591 | $147.75 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $4,730 | $1,182.5 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $6,153 | $1,538.25 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $336 | $84 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $576 | $144 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $4,754 | $1,188.5 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $6,958 | $1,739.5 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $2,576 | $644 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $3,844 | $961 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $4,523 | $1,130.75 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $4,362 | $1,090.5 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $5,684 | $1,421 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $6,415 | $1,603.75 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $4,193 | $1,048.25 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $7,731 | $1,932.75 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,580 | $395 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,362 | $340.5 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,857 | $464.25 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,027 | $256.75 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,196 | $299 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,868 | $467 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,069 | $267.25 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,305 | $326.25 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,351 | $337.75 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $610 | $152.5 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $755 | $188.75 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $693 | $173.25 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $484 | $121 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $4,055 | $1,013.75 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,240 | $310 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $1,210 | $302.5 | — | — | — |
| 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 | — | — | — | — | — |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $312 | $78 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $420 | $105 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $621 | $155.25 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $223 | $55.75 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $327 | $81.75 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $226 | $56.5 | — | — | — |
| General health panel | CPT | 80050 | 0 | $373 | $93.25 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $67 | $16.75 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $449 | $112.25 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $336 | $84 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $218 | $54.5 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $244 | $61 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $39 | $9.75 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $66 | $16.5 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $71 | $17.75 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $235 | $58.75 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $350 | $87.5 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $141 | $35.25 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $113 | $28.25 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $113 | $28.25 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $100 | $25 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $697 | $174.25 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $1,595 | $398.75 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $2,671 | $667.75 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $316 | $79 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $359 | $89.75 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $498 | $124.5 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $603 | $150.75 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $292 | $73 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $216 | $54 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $270 | $67.5 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $333 | $83.25 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $422 | $105.5 | — | — | — |
| preventive |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $2,430 | $607.5 | — | — | — |
| surgery |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 0 | — | — | — | — | — |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 0 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $640 | $160 | — | — | — |
| 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 | $20,526 | $5,131.5 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $29,846 | $7,461.5 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $27,132 | $6,783 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $12,665 | $3,166.25 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $15,583 | $3,895.75 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $24,386 | $6,096.5 | — | — | — |
