| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $366 | $109.8 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $551 | $165.3 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $809 | $242.7 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,274 | $382.2 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,849 | $554.7 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $2,554 | $766.2 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,247 | $374.1 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,685 | $505.5 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $3,078 | $923.4 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $950 | $285 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,478 | $743.4 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $2,421 | $726.3 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $3,530 | $1,059 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $346 | $103.8 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $314 | $94.2 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $252 | $75.6 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $894 | $268.2 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,078 | $923.4 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $3,156 | $946.8 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $2,859 | $857.7 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $3,156 | $946.8 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $325 | $97.5 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,893 | $567.9 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,893 | $567.9 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,893 | $567.9 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,478 | $743.4 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,478 | $743.4 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,478 | $743.4 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $2,421 | $726.3 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $3,576 | $1,072.8 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $3,530 | $1,059 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $944 | $283.2 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,070 | $321 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $376 | $112.8 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $332 | $99.6 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $291 | $87.3 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $3,576 | $1,072.8 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $3,994 | $1,198.2 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $297 | $89.1 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $325 | $97.5 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,576 | $1,072.8 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $3,994 | $1,198.2 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,679 | $503.7 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,972 | $591.6 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,565 | $769.5 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,615 | $784.5 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $3,426 | $1,027.8 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $3,989 | $1,196.7 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,367 | $1,010.1 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $2,937 | $881.1 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $388 | $116.4 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $650 | $195 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $388 | $116.4 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $431 | $129.3 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $457 | $137.1 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $388 | $116.4 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $388 | $116.4 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $383 | $114.9 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $393 | $117.9 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $586 | $175.8 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $478 | $143.4 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $225 | $67.5 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $3,046 | $913.8 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $2,912 | $873.6 | — | — | — |
| 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 | — | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $338 | $101.4 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $139 | $41.7 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $396 | $118.8 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $91 | $27.3 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $86 | $25.8 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $71 | $21.3 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $34 | $10.2 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $44 | $13.2 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $99 | $29.7 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $175 | $52.5 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $85 | $25.5 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $76 | $22.8 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $94 | $28.2 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $450 | $135 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $775 | $232.5 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $10,296 | $3,088.8 | — | — | — |
| 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 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| 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 | $23,014 | $6,904.2 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $37,851 | $11,355 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $37,605 | $11,282 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $14,959 | $4,487.7 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $14,959 | $4,487.7 | — | — | — |
